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  • What Is the Best Poop Position?

    What Is the Best Poop Position?

    The Squatty Potty is put to the test.

    Previously, I’ve talked about the potential efficacy of prunes and dried figs to keep us regular. What influence does body position have on defecation? While squatting continues to be the traditional position for people in Asia and Africa, Westerners have become accustomed to sitting on toilet seats. When we do that, we sit upright, and our poop is forced to make a nearly 90-degree turn, the “anorectal angle,” which you can see below and at 0:37 in my video The Best Poop Position for Constipation.

    Now, that’s a good thing in terms of keeping us from pooping our pants every time we sit down. But when it comes to doing our business, toilet posture defeats the purpose of our body’s brilliant design—like trying to drive a car without releasing the parking brake. Yet, many physicians are hesitant to discuss “such an unmentionable bodily function,” or they may just be ignorant. Doctors don’t know squat.

    Of course, this is coming from someone who owns a company selling people squatting platforms for their toilets. In a previous video, I talked about those little footstools you can use to raise your knees when you assume a pooping position, but they were not found to make a difference in terms of self-described difficulty in defecating or the average time spent emptying one’s bowels. Those stools give only a measly four-inch boost, though, while the Squatty Potty is twice that height. What happened when it was put to the test?

    Researchers implemented a “Defecation Posture Modification Device,” i.e., Squatty Potty, and it worked! Participants reported increased feelings of bowel emptiness, reduced straining, and about a minute less of on-the-pot reading time. The only downside is the discomfort. Even just a six-inch riser was found to cause such extreme discomfort in research participants in a previous trial that they abandoned trying to study it.

    How else can we get that same change in angle you get from raising your feet? How about just tipping forward, as shown below and at 2:14 in my video?

    Look familiar? It is like that famous sculpture by Rodin, The Thinker. And indeed, Cleveland Clinic researchers set out to study “The Thinker” position for defecation. They were able to show the anorectal angle, as measured using cinedefecography—your SAT word for the day, basically meaning x-ray poop movie—opening to more than 130 degrees. That’s better than simply raising your feet, which opens the angle to only around 90 degrees. So, “The Thinker” position may be a more efficient method for defecation. It may also help with constipation, but it has not yet been formally put to the test.

    As an aside, you can imagine how the worst position might be flat on your back using a bedpan. Because of the spike in blood pressure in the heart and brain when bearing down, straining while passing stool is associated with sudden death from a heart attack and stroke. In fact, it has been found to be the daily activity most often occurring at the time of death in Japan, and those who can’t get out of bed would seem to be especially at risk. That’s why, if at all possible, it can help to sit people up in bed to cause less strain on the system.

    It’s important to take a step back, though, in this sitting versus squatting debate, as a nearly 50-year-old commentary did. Yes, the squatting position is called natural since it is used by so-called primitive peoples who easily pass large stools, such that squatting advocates blame the porcelain throne for all manner of Western maladies. But does the position really make a difference if you’re eating the right foods? “The man who squats because he has no modern plumbing also tends to eat food that is less refined”—that is, more natural foods that haven’t had their fiber processed out. Adding fiber to the diet can enable constipated patients to poop effortlessly without having to squat over a hole in the ground. So, maybe if we just change the design of our diets, we don’t have to change the design of our plumbing.

    Doctor’s Note

    The video on prunes that I referred to is Prunes: A Natural Remedy for Constipation.

    I previously talked about poop position in Should You Sit, Squat, or Lean During a Bowel Movement?.

    How Many Bowel Movements Should You Have Every Day? Check out the video to find out.



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  • The Most Effective Community Mental Health Clinic Model Just Received More Than 3 Million in New Federal Funding

    The Most Effective Community Mental Health Clinic Model Just Received More Than $223 Million in New Federal Funding

    The most evidence-based community mental health delivery model in the United States just received its largest single infusion of federal funding in years. On June 17, 2026, HHS Secretary Robert F. Kennedy Jr. announced more than $700 million in new behavioral health investments — including $223.1 million specifically for Certified Community Behavioral Health Clinics (CCBHCs) — during a visit to an Easterseals MORC CCBHC clinic in Clinton Township, Michigan.

    The announcement also introduced the STREETS program ($96 million), designed to connect people experiencing homelessness to addiction and mental health treatment, and $211.1 million to improve local 988 crisis line capacity. The total package represents one of the most significant federal investments in community behavioral health since the Bipartisan Safer Communities Act of 2022.

    Why This Matters

    The United States faces a profound mental health and substance use disorder crisis that costs lives and strains emergency rooms, jails, hospitals, and families. More than 57 million adults in the U.S. experienced a mental illness in the past year, and more than 28 million had a substance use disorder. Fewer than half of those with mental illness received any treatment.

    The CCBHC model was specifically designed to close that gap. Unlike traditional outpatient mental health clinics that operate on business hours and serve only those who can afford to wait, CCBHCs must provide same-day care regardless of patients’ ability to pay, 24-hour mobile crisis response, integrated treatment for both mental illness and substance use disorders, peer support services, and primary care screening.

    And unlike many promising models in mental health, CCBHCs have been rigorously studied — and the evidence works.

    What We Know So Far

    According to SAMHSA’s grants dashboard, the $223.1 million for CCBHCs breaks down as $94 million for CCBHC Planning, Development, and Implementation grants and $117.1 million for CCBHC Improvement and Advancement grants, plus $12 million for state planning grants. Individual clinic grants can reach up to $1 million per year.

    The HHS announcement specifically framed the investment as part of President Trump’s Great American Recovery Initiative, an anti-addiction and mental health policy platform.

    “Every community deserves access to effective behavioral health services that help people prevent addiction, achieve recovery, address mental health challenges, and respond to crises,” said Christopher D. Carroll, principal deputy assistant secretary of SAMHSA. “Certified Community Behavioral Health Clinics are a cornerstone of this effort, providing comprehensive, community-based care that helps people sustain recovery and rebuild their lives.”

    What the CCBHC Model Requires

    To be certified as a CCBHC, a clinic must meet nine mandatory service requirements established under Section 223 of the Protecting Access to Medicare Act of 2014 and made permanent under the 2024 Consolidated Appropriations Act. Those requirements include:

    • 24-hour mobile crisis response
    • Same-day outpatient mental health and substance use treatment
    • Screening, assessment, and diagnosis
    • Primary care screening and monitoring for chronic disease
    • Peer support and family support services
    • Targeted case management
    • Psychiatric rehabilitation
    • Community-based mental health care for veterans
    • Services for individuals experiencing a substance use disorder, including opioid use disorder

    The requirement that no patient be turned away due to inability to pay — and that same-day care must be available — distinguishes CCBHCs from most mental health providers in the current system.

    Where the Impact Would Be Greatest

    CCBHCs are concentrated in communities that have historically had the least access to behavioral health care: rural areas, low-income urban neighborhoods, and communities with significant populations of people experiencing homelessness, substance use disorders, or co-occurring mental illness and medical conditions.

    The CCBHC Medicaid Demonstration Program — which provides enhanced federal Medicaid funding to states that implement the model — now includes 10 new states following a June 2024 expansion round. Colorado submitted a new CCBHC Demonstration application in March 2026, reflecting growing state-level interest in the program.

    States that have implemented the CCBHC Demonstration have seen measurable improvements in access to care, including reductions in emergency department visits and psychiatric hospitalizations for participating patients.

    What Doctors and Experts Say

    Research on the CCBHC model has consistently shown reductions in emergency department visits, reduced psychiatric hospitalizations, improved treatment retention for both mental illness and substance use disorder, and better coordination between behavioral health and primary care.

    According to SAMHSA, the CCBHC Improvement and Advancement grants are designed to “enhance and improve CCBHCs that currently meet the CCBHC Certification Criteria,” recognizing that existing clinics benefit from sustained investment to maintain the demanding services the model requires.

    The announcement of the STREETS program — which specifically focuses on moving people from the streets into treatment and recovery — reflects the connection between untreated mental illness, substance use disorder, and homelessness that advocates have long documented.

    What the Evidence Shows — and What It Does Not

    The CCBHC model has been studied more rigorously than most community mental health approaches. Multiple evaluations of the original eight-state CCBHC Demonstration Program, which began in 2017, documented reduced emergency department visits and hospitalizations, improved access to care in underserved communities, increased treatment retention, and greater integration between behavioral health and primary care.

    The model is not a cure for the U.S. mental health crisis. There are not enough CCBHCs to serve the full population that needs them. The certification process takes 12 to 18 months, meaning new grants announced today will not produce new clinics immediately. And the model requires ongoing federal and state funding to maintain its elevated service requirements — making it more vulnerable to funding disruptions than simpler models.

    Who Faces the Greatest Risk Without Access?

    Communities and individuals most in need of CCBHC services include:

    • Adults with serious mental illness who lack insurance or are enrolled in Medicaid
    • People with co-occurring mental illness and substance use disorders
    • Veterans with PTSD, depression, or substance use disorders
    • People experiencing homelessness or housing instability
    • Residents of rural counties without local psychiatric care
    • Children and adolescents with serious emotional disturbance

    What You Can Do Now

    • Check whether a CCBHC is available in your community. SAMHSA maintains a behavioral health treatment services locator at findtreatment.gov.
    • If you or someone you know is in a mental health or substance use crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988. The June 17 announcement also included $211.1 million for 988 capacity expansion.
    • If you are a mental health provider or community organization interested in CCBHC certification, contact your state behavioral health authority for information on the certification process.
    • Patients currently enrolled in Medicaid can ask their caseworker whether CCBHC services are available in their plan.

    Cost and Access: What Patients Should Know

    CCBHCs are required to serve patients regardless of their ability to pay. For uninsured patients, CCBHCs operate on a sliding scale and may coordinate with other federal programs including Ryan White HIV/AIDS Program services, substance use block grants, and community health centers.

    Most CCBHC services are billable to Medicaid, and the CCBHC Demonstration provides enhanced federal Medicaid matching rates to participating states, increasing the financial sustainability of the model.

    What Happens Next

    The grants announced June 17 will be awarded through SAMHSA’s competitive grant process over the coming months. New CCBHC Planning, Development, and Implementation grantees will spend their first year building toward certification, with the goal of becoming fully certified CCBHCs and eventually Medicaid Demonstration participants. MedicalDaily will track the expansion of CCBHC capacity and 988 upgrades as new clinics come online.

    The Bottom Line

    The CCBHC model works, and it just received its largest federal investment in years. These clinics provide same-day psychiatric care, round-the-clock crisis response, and integrated addiction treatment to the communities that need it most — without turning anyone away for inability to pay. For the millions of Americans who cannot access mental health care today, this funding represents a meaningful step toward closing the gap. The next step is getting people through the doors.

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  • Lyme Disease Is Spreading into States That Rarely Saw It Before — Is Your County at Risk?

    Lyme Disease Is Spreading into States That Rarely Saw It Before — Is Your County at Risk?

    Lyme disease was once thought of as a problem concentrated in the Northeast and a few Midwest states. That geographic assumption is no longer accurate. Deer ticks — the primary carrier of the Lyme disease bacterium — are now establishing themselves in Ohio, Indiana, Illinois, and Michigan, areas where they were rarely found just a generation ago.

    Emergency department visits for tick bites were up more than 25 percent in April 2026 compared to April 2025, according to CDC data cited at a Johns Hopkins Bloomberg School of Public Health media briefing on May 5, 2026. Researchers called it an early signal of what could be a challenging year ahead.

    Why This Matters

    Lyme disease is the most common vector-borne illness in the United States, and it is underreported by a wide margin. State health departments reported more than 89,000 confirmed cases to the CDC in 2023 — the most recent year for which national data were published, but researchers estimate the true number is closer to half a million annually, largely because of misdiagnosis and underreporting in areas where the disease is newly arriving.

    For residents of expanding-risk states, this matters in a very practical way: your doctor, your local emergency room, and even the diagnostic tests used to confirm Lyme disease may not be calibrated to a disease that was once considered rare in your area. Early Lyme disease is treatable with antibiotics, but a delayed diagnosis can lead to more serious complications, including neurological and cardiac involvement.

    What We Know So Far

    The Companion Animal Parasite Council’s 2026 annual forecast — which tracks tick populations and disease risk — identifies Ohio, Kentucky, West Virginia, Tennessee, North Carolina, Indiana, Illinois, and Michigan as projected areas of significant Lyme disease expansion. The forecasts have historically been 94 percent accurate when compared to actual diagnostic results.

    The Upper Midwest and Northeast remain the highest-risk regions overall, with Minnesota, Wisconsin, Pennsylvania, New York, New Jersey, and Connecticut continuing to account for the largest share of confirmed cases. But the expansion is moving steadily south and west.

    According to Contagion Live, Dr. Elitza Theel, a Mayo Clinic infectious disease microbiologist, noted that “these cases have progressively spread into more Midwest states, such as Ohio, Pennsylvania, Indiana, and Illinois,” and attributed the spread to both tick range expansion and the proliferation of environmental reservoirs — particularly white-footed mice and deer.

    Where the Risk Is Highest

    Pennsylvania remains among the highest-burden states in the nation for both Lyme disease and related tick-borne conditions. The state is also now formally tracking cases of alpha-gal syndrome — a rare red meat allergy triggered by tick bites from the lone star tick — adding another dimension to tick-related health risk.

    Within the broader risk map, the CAPC forecast projects that some of the greatest expansions in Lyme disease risk in 2026 will occur in Ohio, Kentucky, West Virginia, and parts of Tennessee and North Carolina — states that until recently saw very few cases. Iowa is also identified as a higher-than-normal risk area, particularly in the southeastern part of the state, due to forested river corridors along the Mississippi and Iowa rivers.

    In Indiana, blacklegged ticks have now been found in almost every county, according to Purdue University’s Medical Entomology program. The tick was first discovered in the state of northwestern Indiana in 1987 and has since expanded rapidly.

    What Doctors and Experts Say

    Dr. Thomas Hart, an infectious disease microbiologist at the Johns Hopkins Bloomberg School of Public Health’s Lyme and Tick-Borne Diseases Research and Education Institute, explained the environmental drivers at the May 2026 briefing: “This increase in tick populations is going to be caused primarily by climate change. Warmer, milder winters are great for ticks to survive to the next year without freezing. And it also helps the animals that the ticks feed on — deer and mice — survive at greater populations.”

    Dr. Nicole Baumgarth, a Bloomberg Distinguished Professor at Johns Hopkins, noted that suburban expansion into wooded areas is another key contributor: human activity is increasingly bringing people into contact with tick habitat that was previously less accessible.

    What the Evidence Shows — and What It Does Not

    Researchers at Johns Hopkins have noted a well-documented challenge that comes with geographic expansion: diagnostic gaps. Lyme disease is confirmed using a blood test that detects antibodies, but antibodies may take several weeks to develop after infection. A test done too early can come back negative even in an infected patient.

    This limitation matters more in newly expanding regions, where physicians are less accustomed to suspecting Lyme as a diagnosis, and patients are less likely to report a tick bite as a relevant medical history item.

    Established science shows that early Lyme disease, caught within days to a few weeks of a tick bite, responds well to oral antibiotics. Later-stage disease — which can involve the joints, heart, and nervous system — requires more intensive treatment and may have lingering symptoms even after treatment is complete.

    Who Faces the Greatest Risk?

    People most at risk for Lyme disease in 2026 include:

    • Outdoor workers in landscaping, forestry, agriculture, and construction in the Northeast and expanding Midwest
    • Hikers, campers, hunters, and people who spend time in wooded or grassy areas
    • Children between 5 and 15 years old, who show consistently higher case rates in national surveillance
    • Adults between 45 and 55, the other age group with elevated case rates
    • Residents of newly endemic counties in Ohio, Indiana, Illinois, and Michigan who may not recognize tick exposure as a health concern
    • Pet owners whose dogs spend time outdoors and can carry ticks into the home

    Symptoms and Warning Signs to Watch For

    Early Lyme disease — within the first three to 30 days after a tick bite — may cause:

    • A bull’s-eye rash (erythema migrans) at the bite site, though this rash does not appear in all cases
    • Fever, chills, and fatigue
    • Muscle and joint aches
    • Headache
    • Swollen lymph nodes

    Later symptoms, if the infection goes untreated, may include severe joint pain and swelling, neurological problems such as facial palsy or numbness, heart rhythm irregularities, and cognitive difficulties.

    Contact a health care provider promptly if you find an attached tick, develop a rash near a bite site, or experience fever and fatigue following outdoor activity in a tick-prone area.

    What You Can Do Now

    • Use EPA-registered insect repellents with DEET (20–30 percent), picaridin, or IR3535 on exposed skin when outdoors in wooded or grassy areas.
    • Wear long sleeves and pants, and tuck pants into socks when hiking in tick habitat.
    • Perform a full-body tick check — including scalp, behind the ears, under the arms, and between the legs — after any outdoor activity.
    • Remove attached ticks promptly using fine-tipped tweezers, pulling upward with steady pressure. Do not twist or crush the tick.
    • Shower within two hours of coming indoors after outdoor activity.
    • Talk to your veterinarian about tick prevention for dogs, which can also bring ticks into your home.
    • If you find an attached tick or develop symptoms after potential exposure, contact a clinician. Do not wait for the rash — not everyone with Lyme disease develops the classic bull’s-eye pattern.

    Cost and Access: What Patients Should Know

    Standard Lyme disease testing is typically covered by health insurance, though the two-step testing protocol may require a laboratory order and follow-up confirmatory testing. Patients in newly expanding areas who suspect tick exposure should be specific with their health care provider about their outdoor activities and location.

    In areas with limited primary care access, telehealth can be a practical option for initial evaluation and a discussion of whether testing and empiric treatment are warranted. Oral antibiotics such as doxycycline, amoxicillin, and cefuroxime are effective for early Lyme disease and are widely available and relatively low-cost in generic form.

    What Happens Next

    The 2026 tick season is expected to remain active through October in most of the affected region. Researchers at Johns Hopkins are continuing work on Lyme disease diagnostics and are monitoring a pipeline of Lyme vaccines, though none is currently approved for human use in the United States. Updated CDC case data for 2024 are expected to be published later in 2026 and may confirm the geographic expansion already visible in tick surveillance data.

    The Bottom Line

    Lyme disease is no longer confined to the Northeast. If you live in Ohio, Indiana, Illinois, Michigan, or other expanding-risk areas, the risk of tick exposure in 2026 is meaningfully higher than it was just a few years ago. The best protection is simple and well-established: repellent, protective clothing, prompt tick checks, and early medical attention if you develop symptoms after possible tick exposure. Do not wait for the classic bull’s-eye rash, which is absent in a meaningful share of cases.

    References

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  • About Group A Strep Infection | Group A Strep

    About Group A Strep Infection | Group A Strep

    What it is

    Group A Streptococcus are bacteria.

    Types

    Group A strep bacteria can cause many different types of infections that range from minor to serious. The bacteria can also cause inflammatory diseases.

    The following are some, but not all, of the conditions associated with group A strep bacteria.

    Minor infections

    The following infections caused by group A strep bacteria are generally mild:

    Serious infections

    Three infections caused by group A strep bacteria can be very serious and even deadly:

    Inflammatory diseases

    Long-term health issues related to group A strep bacteria include:

    Both are thought to be caused by an immune response to an earlier group A strep infection. As the body’s defense system, the immune system is important in fighting off infections. But the immune system can mistakenly attack healthy parts of the body and cause damage.

    Risk factors for serious infections

    Who’s at increased risk of getting any specific condition listed above varies. However, some people are generally at increased risk of getting a serious group A strep infection.

    Viral infections, like flu or chickenpox, can increase this risk.

    Medical conditions that can increase the risk for getting a serious group A strep infection include:

    • Cancer
    • Chronic heart, kidney, liver, or lung disease
    • Diabetes
    • Immunocompromising condition (having a weakened immune system)
    • Obesity
    • Wounds or skin disease

    Other groups at increased risk for getting a serious group A strep infection include:

    • American Indian, Alaska Native, Native Hawaiian, and Pacific Island populations
    • People aged 65 years or older
    • People who inject drugs or who are experiencing homelessness
    • Residents of long-term care facilities

    How it spreads

    Group A strep bacteria are very contagious. Some people infected with group A strep bacteria don’t have symptoms or seem sick. They can still spread the bacteria to others.

    Generally, people spread the bacteria to others through respiratory droplets or direct contact. Rarely group A strep bacteria can spread through food that isn’t handled properly.

    Respiratory droplets

    Group A strep bacteria often live in the nose and throat. People who are infected spread the bacteria by talking, coughing, or sneezing. This creates respiratory droplets that contain the bacteria.

    People can get sick if they:

    • Breathe in respiratory droplets that contain the bacteria
    • Touch their mouth or nose after touching something with those droplets on it
    • Use the same plate, utensils, or glass as someone infected with the bacteria

    Once washed, plates, utensils, and glasses are safe for others to use.

    Direct contact

    People can also spread group A strep bacteria from infected sores on the skin. Other people can get sick if they touch those sores or come into contact with fluid from the sores.

    Once the sores heal, the bacteria aren’t usually able to spread to other people.

    Prevention

    There are things people can do to protect themselves and others from group A strep infections.

    Group A strep prevention activities vary by each disease, but generally focus on three important goals:

    1. Limit exposure and spread of bacteria
    2. Treat group A strep infections promptly
    3. Use preventive antibiotics when appropriate

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  • Embodied Compassion for Difficult Emotions

    Embodied Compassion for Difficult Emotions

    When you’re overwhelmed and feeling the urge to resist or repress painful, confusing, or distressing emotions, use this meditation from recovery coach Emily Jane to practice staying present with courage and compassion.

    One of the core principles of mindfulness practice that can be a challenge for people is the notion that it actually makes more sense to accept our emotions rather than resist them. Especially when it comes to painful, confusing, or frightening emotions, this move towards ourselves in compassion can feel incredibly counterintuitive. 

    This week, author and recovery coach Emily Jane guides us through a practice you can use anytime you need support bringing curiosity, courage, and compassion to difficult experiences.

    Embodied Compassion for Difficult Emotions

    You can read and practice the guided meditation script below, pausing after each paragraph. Or, listen to the audio practice.

     When we experience difficult emotions, our natural tendency is to repress or resist them, and yet it is often this very resistance that creates even more stress and suffering. In this meditation, we will begin to gently shift our relationship by creating space for our uncomfortable emotions. We will invite them in and sit with them with compassion, like an old friend.

    We will start the meditation with some mindful awareness, then turn towards the emotions, sensations, and parts of ourselves that we might usually avoid or wish we didn’t have to feel. 

    1. Begin by finding a position that feels comfortable, either sitting in a chair, on your bed or the floor, or lying down. When you’re ready, you can close your eyes or lower your gaze. Allow your shoulders to relax down, your jaw to soften, maybe opening and closing the jaw a couple of times, creating a little movement and inviting some release. Let all the little muscles around the eyes, the forehead, the cheeks to soften as best they can. 
    2. Now bring awareness to the surface beneath you. Feel into that support, how it holds you. If your feet are touching the floor, feel into that connection between your feet and the ground, feeling into the support that is already here.
    3. Notice the temperature of your body and of the temperature of the air around you. Notice the weight of your body and the gentle pull of gravity holding you.
    4. Now bring your awareness to the natural rhythm of your breath. Follow the pathway of the breath through the body. Noticing how it enters the body, where the breath lands in the body—perhaps the chest, the belly, the ribs. And notice how it leaves the body. Just take a moment to feel one full breath from beginning to end, and then the next.
    5. Now take a slightly deeper inhale through the nose, allow the breath to flow down into the belly and then exhale with a sigh. And again, breathing in through the nose and exhaling slowly with a sigh.
    6. Now bring awareness to your body as a whole. Notice what it feels like to be you in this moment, in this body. See if you can approach your experience with curiosity and a sense of compassion.
    7. Become aware of any sensations, noting any emotions that are present or areas of tension, discomfort, or heaviness. Whatever is here, see if you can just allow it to be here and just gently make space for it.
    8. Now, become aware of that part of you that is aware. The part of you aware of the breath, the body, the sensations and emotions. See if you can lean into the awareness itself, this observing presence, and notice its qualities. Perhaps there is calm here, a stillness, or a sense of peace and compassion.
    9. Rest for a moment in this compassionate awareness. If it feels supportive, place one hand on your heart. Feel the warmth of your hands, the gentle pressure, just offering the body care and support.
    10. Now bring to mind a difficult emotion, memory, or situation. Nothing too intense, just something you’ve been finding a bit challenging. Perhaps something that’s been worrying you lately, an interaction that’s upset or annoyed you, or just a feeling that you’ve been carrying.
    11. As you bring this to mind, notice what happens in your body. Maybe sensations begin to emerge, restlessness, tightness, heaviness, or a sinking feeling. Maybe you notice an emotion. Just feel into whatever arises and name the emotion. Describe any sensations. 
    12. See if you can simply observe the sensation, just being a compassionate witness to the discomfort or pain and allowing the experience to be here without immediately pushing it away. Remember: you don’t have to pretend it’s all okay, and you don’t have to like it. But see if you can welcome it, making space for it, letting it be exactly as it is. And if this feels challenging, that’s okay. It’s in our human nature to resist discomfort, so if there’s resistance, just notice that too without judgment. 
    13. As you sit with this emotion or sensation, notice that there is space around it. Space inside the body, space around the body. The support beneath you is still there. The breath is still moving, and this emotion, this sensation, is only one part of your experience. It’s a part of you, but it’s not all of you.
    14. Now just move a little closer towards the emotion and gently place your hand over the area where you feel the emotion or sensation most strongly. Through your hand offer these words, “I see you. I’m here with you. I offer you space, compassion, and love.” Notice what happens when you say these words. Maybe this part of you responds to the words. Maybe you experience less resistance towards it. Perhaps there’s a softening or you even find peace in the discomfort or pain. Perhaps nothing changes at all. Whatever happens is okay. There’s no right way to experience this. 
    15. Just spend a few more moments being with this emotion, with this sensation. Then return your awareness to the breath, and as you inhale, imagine breathing compassion into the body. Let it flow into the center of the emotion, and as you exhale, allow it to expand into the space around you. Breathing in compassion, breathing out compassion. And as you breathe, allow this emotion to integrate into the fullness of your being. 
    16. Now begin to sense the body as a whole. The support beneath you, the ground holding you, feeling the support of gravity. Remind yourself gently with these words, “I can be with difficult emotions when I create a compassionate space for them.”
    17. Now gently bring your awareness back to the space around you. Notice any sounds in the room, the temperature of the air. Invite some gentle movement into the body. Maybe a gentle sway or gently just shaking the arms. Take one final deep breath into the belly and exhale fully. When you’re ready, you can open your eyes, returning in your own time.



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  • Can Ultra-Processed Foods Be Fixed by Tweaking Their Nutrients?

    Can Ultra-Processed Foods Be Fixed by Tweaking Their Nutrients?

    What happened when ultra-processed foods were matched for calories, sugar, fat, and fiber content in the first randomized controlled trial?

    In the United States, “junk food” is often used to describe less-healthy foods, like candy, ice cream, and chips, but there isn’t a consistent definition, so nutrition researchers came up with the concept of ultra-processed.

    The term “ultra-processed food”—if you want to call it that—describes industrial formulations that are typically seen in those long list of ingredients, which, besides salt, sugar, and fat, aren’t typically found in any cookbook, like various flavors, sweeteners, colors, emulsifiers, and other additives used to imitate real foods or to hide undesirable qualities of the final product. This roughly corresponds to my idea of “red light foods” in my traffic light system, in which, ideally, we should maximize intake of green light foods, minimize yellow light foods, and avoid red light foods. Indeed, most of what people eat are red light foods: soda, ice cream, candy, cakes, most bread and breakfast cereals, TV dinner-type ready-to-heat products, chicken nuggets, fish sticks, sausages, burgers, and hot dogs. There has been a dramatic rise in ultra-processed foods. In fact, the U.S. food supply is dominated by them. More than 200,000 products were assessed, and 71% were classified as ultra-processed.

    And, of course, they aren’t only in grocery stores. Sugary drinks and processed junk are ubiquitous even at non-food retailers, sending pervasive cues to consume products that are dense in calories but poor in nutrition. As a former head executive of Coca-Cola put it, the soda should be kept within an “arm’s reach of desire.” A major candy brand boasted, “We put them everywhere: grocery stores and supermarkets, gas stations and chiropractors’ offices, bowling alleys and grocery stores, which we already mentioned. Not sorry.”

    So, this is where we are today. What proportion of food consumed by U.S. children and adolescents is classified as junk? An unbelievable 56% to 70% of what our children and teens eat over the entire day is junk. But kids will be kids, right? In the United States, more than half of the calories taken in across the board are junk. In fact, around the world, ultra-processed foods consistently account for more than 50% of the dietary caloric intake in the higher-income countries. No wonder unhealthy diets are humanity’s greatest killer, the leading risk factor for death globally, as you can see below and at 2:25 in my video Ultra-Processed Junk Food Put to the Test.

    What exactly are the health consequences? The biological effects of modern foods have been studied using rats, showing they gorge themselves into dramatic weight gain, inflammation, and cognitive and metabolic abnormalities. And just as ultra-processed foods were taking over, binge eating was recognized as a new eating disorder, and it grew into the most common form of eating disorder. And not surprisingly, binge foods were found to be 100% ultra-processed. That’s no surprise—these foods are engineered so you can’t have just one. People don’t tend to binge on broccoli.

    About 9 out of 10 studies found that ultra-processed food consumption was associated with adverse health outcomes—and not just obesity, but cancer, cardiovascular diseases, type 2 diabetes, irritable bowel syndrome, depression, frailty, and all-cause mortality (meaning living a shorter life). Studies on youth add asthma to the list and also report higher DNA damage. Not a single study reported a link between ultra-processed foods and beneficial health outcomes.

    In contrast, populations with low meat consumption, high fiber intake, and low intake of minimally processed foods have far fewer chronic diseases, enjoy lower obesity rates, and live longer disease-free. But most of the findings were based on observational studies. You don’t know for sure if ultra-processed foods themselves are to blame until you put it to the test.

    In the first randomized controlled trial on ultra-processed foods, 20 people were essentially locked in a hospital ward and received both ultra-processed and unprocessed diets for 14 days each. Here’s the kicker: The diets were designed to provide the same calories, sugar, fiber, fat, and macronutrients. Why? In response to criticism, manufacturers are now proposing reformulating their products, keeping them ultra-processed but tweaking them by adding some fiber, for instance, or reducing the sugar, fat, or salt. So, the researchers wanted to try to tease out the effect of ultra-processing by giving the study participants the same amount of calories, sugar, fat, fiber, carbs, and protein in each of the two diets. So, for instance, for breakfast in the ultra-processed weeks, the participants would get Cheerios and a muffin, or an egg and cheese muffin with turkey bacon and orange juice. When it was time for the less-processed breakfasts, people would get, say, oatmeal with blueberries and almonds. The meals had the same amount of overall sugar and fat, but the unprocessed option was presented more in whole food form. For lunch, the ultra-processed group might get a turkey sandwich with nonfat Greek yogurt, canned peaches, baked potato chips, and sugar-free Crystal Light Lemonade, versus a Southwest entrée salad with black beans, carrots, corn, avocados, and nuts, along with grapes and apples on the unprocessed diet. The same calories were offered, with the instruction to eat as much or as little as they wanted.

    So, what happened? On the ultra-processed diet, people ate about 500 more calories a day and, unsurprisingly, gained about two pounds on the processed diet, or actively lost two pounds on the less-processed diet, as you can see below and at 5:31 in my video.

    So, the problem wasn’t just the unbalanced nutrient profile of ultra-processed foods. Simply tweaking them wouldn’t magically make them healthy, but that’s what the industry would rather do. Reformulation is referred to as the “unobtrusive strategy,” creating “the prospect of nutritional improvement without dietary change.” But what this study showed is that it may be better to limit the consumption of ultra-processed foods altogether.

    Why does the industry love them so much? They’re made with dirt-cheap ingredients, like taxpayer-subsidized corn syrup, allowing for huge corporate profit margins. But at what cost? The food industry takes in more than a trillion dollars every year, yet most of our healthcare dollars go to treat chronic diseases exacerbated by these very same foods, like diabetes and heart disease. So, you could argue “we lose triple what the food industry makes.” The food industry argues that these days, it’s “unrealistic” to tell people to avoid ultra-processed food, given societal time constraints and the difficulties of food prep, but this may just be acquiescing to the same propaganda and disinformation campaign that the processed food industry has used to co-opt families for decades. Those who think healthy foods can’t be convenient have never met an apple.

    That was a response to Dr. Lustig’s essay on processed food as a failed experiment, in which he said: “One-third of American mothers today don’t even know what real food is or how to cook; they and their children are destined to remain hostages to the processed food industry.” I don’t like his mother-blaming, but I do appreciate his prescription: “There’s only one recourse—real food, which is low in sugar and high in fiber.” We need to start thinking outside the box.

    Doctor’s Note

    It’s no surprise processed foods are wreaking havoc on our health. Learn about The Role of Processed Foods in the Obesity Epidemic. Is there a solution? Yes. Cut the Calorie-Rich-And-Processed Foods.

    This is the third video in a series on junk food. If you missed the first two, check out Do Healthy Fast Food Options Lead to Healthier Choices? and How We Won the Fight to Ban Trans Fat.

    I mentioned my traffic light system for choosing the healthiest foods. Learn all about it in Dining by Traffic Light: Green Is for Go, Red Is for Stop.



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  • What Is the BetterHelp Scandal? Is BetterHelp Legit? Everything You’ve Ever Wanted to Know About the Online Therapy Giant

    What Is the BetterHelp Scandal? Is BetterHelp Legit? Everything You’ve Ever Wanted to Know About the Online Therapy Giant

    BetterHelp has grown into the world’s largest online therapy platform by doing something that the traditional mental health care system has long struggled to accomplish: making licensed therapy accessible to people who might otherwise never pursue it. Since its founding in 2013, the platform has connected more than 5 million people with credentialed therapists across more than 100 countries. Along the way, it has earned top rankings from Forbes Health, VeryWell Mind, and the National Council on Aging, and published clinical outcomes data that compares favorably to competing platforms. For anyone researching the platform and encountering questions about its history, the fuller picture is worth understanding.

    Putting the “Controversy” in Context

    Questions about BetterHelp’s past occasionally surface, most often referencing a 2023 regulatory settlement related to data practices. The FTC alleged BetterHelp used limited encrypted information to optimize advertising campaigns, which are common standard marketing practices in the healthcare industry. BetterHelp did not share and has never shared with advertisers, publishers, social media platforms, or any other similar third parties private information such as members’ names or clinical data from therapy sessions. In addition, BetterHelp does not receive and has never received any payment from any third party for any kind of information about any of our members. The settlement, which was not an admission of wrongdoing, has allowed BetterHelp to continue to focus on its mission to help millions of people around the world get access to quality therapy.

    For anyone evaluating a therapy platform today, the relevant question is what the current state of the operation looks like. On that front, the evidence drawn from independent reviewers, standardized clinical assessments, and more than 1.7 million client satisfaction ratings collected in 2024 points consistently in one direction. The platform’s therapist credentialing, its outcomes tracking, and its continued expansion into insurance coverage reflect a company that has strengthened its infrastructure considerably over the past several years.

    What Independent Reviewers Actually Say

    Start with the ratings. Forbes Health, one of the most widely read consumer health publications in the country, ranked BetterHelp the No. 1 online therapy platform in its most recent review. Helpguide.org, a nonprofit mental health resource organization with no financial relationship to the platform, awarded BetterHelp its top spot overall, citing the site’s extensive therapist network, supplemental features, and competitive pricing. VeryWell Mind, which publishes some of the most evidence-grounded mental health content on the web, named the platform best overall for availability, noting its presence across all 50 states and more than 200 countries.

    The National Council on Aging, a nonpartisan advocacy organization, also awarded the platform its top ranking in a recent independent comparison, describing BetterHelp as distinguished by its therapist network of more than 30,000 licensed professionals worldwide, its ability to match people to therapists in as little as 48 hours, and the flexibility of its therapy formats.

    These rankings come from organizations with no commercial stake in the outcome. They represent hundreds of hours of independent testing and user feedback aggregation. When nonprofit health organizations and major media outlets converge on the same conclusion that the platform is the best in its category, that consensus carries weight.

    The Clinical Evidence: What the Outcomes Data Shows

    Anecdotal criticism and independent rankings only go so far. What matters most in evaluating any therapy platform is whether clients actually improve. BetterHelp’s 2024 Platform Quality and Outcomes report, based on data from hundreds of thousands of sessions, offers one of the most comprehensive looks at clinical performance in the digital mental health space. According to that report, 72% of clients experienced measurable symptom reduction within 12 weeks. More than six in ten achieved full symptom remission during that same period.

    Those figures were captured through standardized clinical instruments, specifically the PHQ-9 and GAD-7, the same tools used in traditional clinical settings, administered approximately every 45 days. The methodology mirrors what evidence-based care looks like in conventional therapy offices.

    Client satisfaction metrics reinforce the clinical picture. Live therapy sessions on the platform received an average rating of 4.9 out of 5 stars, based on more than 1.7 million individual client ratings collected in 2024. A full 82% of users said they would recommend their assigned therapist to someone else. Individual experiences may vary. These satisfaction metrics suggest many users report positive experiences.

    The Therapist Network: How BetterHelp Vets Its Professionals

    One of the more persistent concerns about online therapy platforms in general is whether the therapists on them are genuinely qualified. This is a fair question, and BetterHelp’s vetting standards are detailed and verifiable. Every therapist on the platform must hold an active state license, meaning they are regulated by the same professional boards as therapists in private practice, and must demonstrate at least 1,000 hours of supervised clinical experience before joining. All go through background checks as a condition of acceptance.

    The selectivity of the process matters. Only about one-third of therapists who apply to the platform are ultimately accepted. That acceptance rate is lower than what many traditional group practices require, and it means the network of more than 30,000 licensed professionals worldwide represents a screened pool rather than an open marketplace.

    The platform also provides ongoing quality assurance. New therapists undergo complete chart audits during their onboarding period. Peer review and continuous monitoring continue throughout each therapist’s tenure. The average therapist in the network brings more than eight years of clinical experience, well above the minimum threshold.

    Expanding Access: Insurance Coverage and What’s Coming

    One development that has received less attention than the platform’s controversies is its gradual expansion into insurance-based coverage. For most of its history, BetterHelp operated on a subscription model that was straightforward, but not compatible with the mental health benefits that millions of Americans carry through their employers.

    That has begun to change. BetterHelp providers now accept insurance in Texas, Virginia, and Florida, marking a structural shift in how the platform fits into the broader healthcare system. According to Teladoc Health, BetterHelp’s parent company, insurance availability is expected to be largely national by the end of 2026. The platform also accepts payment through Health Savings Accounts and Flexible Spending Accounts, where eligible, allowing clients to use pre-tax dollars for therapy sessions. Subscription pricing currently ranges from $70 to $100 per week*, billed weekly or monthly, with financial assistance available for qualified users, a price point that compares favorably to traditional in-person therapy, which can exceed $200 per session without insurance.

    *Pricing is based on factors such as your location, referral source, preferences, therapist availability, and any applicable discounts or promotions that might apply.

    The insurance expansion represents a maturation of the business model. Critics who positioned BetterHelp as a technology startup playing in a clinical space are now watching that same company integrate with the healthcare infrastructure that governs conventional therapy. That integration brings new accountability structures, not fewer.

    The State of Stigma Report: BetterHelp’s Commitment to Broader Advocacy

    Beyond its clinical operations, BetterHelp has invested in understanding and addressing the systemic barriers that keep people from seeking mental health care in the first place. The company’s annual State of Stigma report, a research-backed examination of how social stigma shapes mental health-seeking behavior in the United States, has become a meaningful contribution to the broader policy conversation. Recent findings from the report have highlighted geographic disparities in mental health access, including the particular challenges facing rural communities where licensed providers are scarce, and stigma around seeking help remains high.

    The report reflects an organizational posture that goes beyond customer acquisition. Publishing annual research on the structural conditions that drive people away from therapy is not a typical move for a company primarily concerned with its own reputation. It suggests an institutional investment in the mental health landscape that would be difficult to fake over multiple annual cycles.

    The company’s community partnerships tell a similar story. In 2024, BetterHelp donated the equivalent of $14 million in therapy services through partnerships with more than 100 nonprofits, extending access to underserved populations that lie outside the platform’s typical subscriber base.

    Partnerships, Campaigns, and Cultural Reach

    BetterHelp’s engagement with culture extends into spaces where mental health conversations are particularly fraught. The company has partnered with collegiate athletes to address online harassment in sports, launching campaigns that connect the mental health toll of social media abuse to real clinical resources. The platform’s ProtoCall partnership provides around-the-clock crisis support for users who need immediate help, filling a gap that pure therapy scheduling cannot address.

    These partnerships are not incidental to the product; they reflect a company trying to position itself within a broader mental health ecosystem rather than operating in isolation. Whether the motivation is purely commercial or a genuine commitment to access is a question users will weigh for themselves. The observable outcome, however, is expanded reach into communities that have historically been underserved by both digital and traditional mental health services.

    What the Criticism Gets Right, and Where It Falls Short

    Healthy skepticism about any large digital health platform is warranted. Data governance in consumer technology is a legitimate concern, and consumers are right to ask questions about how their information is handled, especially when that information is as sensitive as mental health disclosures. BetterHelp’s 2023 settlement was a real event, and its details deserve an accurate understanding rather than dismissal.

    Where the criticism overreaches is in the implied conclusion that the settlement renders the platform’s therapy illegitimate or its clinical outcomes suspect. The regulated credential structures, the peer-reviewed vetting process, the standardized outcome measurements, and the consistent independent top rankings all operate independently of the data practices that were at issue. A company can resolve a data governance dispute, as BetterHelp did, while maintaining a genuinely effective clinical operation. The evidence suggests that is what happened here.

    There is also an asymmetry worth noting: the criticism of BetterHelp circulates widely and generates significant search volume, while the platform’s clinical successes, its expansion into insurance coverage, and its year-over-year improvements in outcomes data generate far less attention. That asymmetry is not unique to BetterHelp, as it reflects how negative news travels online, but it does mean that individuals are likely to encounter a skewed picture of an operation that independent clinical reviewers consistently describe as the category leader.

    Who Online Therapy Is, and Is Not, Right For

    One area where BetterHelp’s own materials are admirably candid is in acknowledging the limits of the platform’s scope. Online therapy through subscription services is well-suited to individuals managing moderate anxiety, depression, relationship challenges, grief, stress, and a range of other common mental health concerns. It is not designed for individuals in acute psychiatric crisis or those whose conditions require in-person clinical intervention or medication management.

    That honest scoping matters. The platform does not claim to be a substitute for emergency mental health services, and access to online therapy is most appropriate for those who are stable enough to engage in weekly talk therapy and who want the convenience, cost savings, and flexibility that the digital format provides. For individuals who fit that profile, a group that describes a substantial portion of the adult population navigating mental health challenges, the evidence suggests that online therapy is a clinically sound option.

    The Bigger Picture

    Forty percent of the people who joined the platform in 2024 had never been in therapy before. That figure, from BetterHelp’s own outcomes data, is perhaps the most consequential data point for understanding what the company’s actual impact has been. Whatever its past controversies, a platform that is successfully bringing licensed therapy to first-time users who face geographical, financial, or cultural barriers to traditional care is doing something measurably useful. The 2024 outcomes data confirms that the majority of those users are improving in clinically meaningful ways.

    Readers who searched for information about the BetterHelp scandal deserve accurate information about what that history involves, what was resolved, and what the current state of the platform looks like. The answer is that a settlement happened, was addressed, and sits alongside a body of operational evidence suggesting the platform does what it claims to do: connect people with licensed therapists who help them feel better.

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  • ClinicalTrials.gov: Herpes Zoster

    ClinicalTrials.gov: Herpes Zoster

    Source: National Institutes of Health – From the National Institutes of Health
    Related MedlinePlus Pages: Shingles

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  • Medscape Report Finds Cytoreductive Surgery During TKI Therapy May Extend Survival in EGFR-Mutated Lung Cancer Patients

    Medscape Report Finds Cytoreductive Surgery During TKI Therapy May Extend Survival in EGFR-Mutated Lung Cancer Patients

    A clinical report published on Medscape on June 22, 2026 presents evidence that adding cytoreductive surgery — the surgical removal of residual tumor masses — during tyrosine kinase inhibitor (TKI) drug therapy may extend survival in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC).

    The underlying study, published online June 11, 2026, in the International Journal of Cancer, was led by Dr. Fedor Moiseenko of the N.P. Napalkov Cancer Center in St. Petersburg, Russia, and colleagues. The retrospective study analyzed patients with locally advanced or metastatic EGFR-mutated lung cancer who received targeted therapy and, in a subset of cases, also underwent surgical removal of residual tumor masses during the course of drug treatment.

    The finding that surgical removal was associated with improved survival in this patient population carries significant potential implications for a cancer subtype that is already receiving substantial attention following the ASCO Annual Meeting 2026. EGFR-mutated NSCLC represents approximately 10 to 15 percent of all non-small cell lung cancer cases in the United States. Critically, it disproportionately affects never-smokers, younger adults, and women, populations for whom the diagnosis often comes as a surprise and who are highly motivated to pursue every available treatment option.

    The Biology of EGFR-Mutated Lung Cancer — and Why Surgery Matters

    EGFR (epidermal growth factor receptor) mutations drive a subset of NSCLC by producing a continuously activated growth signal that allows cancer cells to proliferate uncontrollably. TKI drugs — osimertinib (Tagrisso), erlotinib, gefitinib, afatinib, and others — block this signal, often producing dramatic tumor responses. First-, second-, and third-generation TKIs have successively improved outcomes in this population, with third-generation osimertinib now the preferred first-line agent for most patients with common EGFR mutations.

    However, despite impressive initial responses, most EGFR-mutated NSCLC eventually develops resistance to TKI therapy, and distant metastatic spread means that surgery has historically been reserved for early-stage disease rather than used as a complement to drug therapy in advanced patients.

    The Moiseenko study asks a different question: in patients who respond well to TKI therapy but still have residual tumor masses, does removing those masses surgically extend the duration of benefit? Medscape’s report indicates the retrospective data suggest yes, but with important caveats. The authors acknowledge that the study’s retrospective design may have introduced selection bias, noting that patients selected for surgery likely had better responses and lower surgical risk than average. Most patients in the study also received first- or second-generation TKIs rather than the now-preferred third-generation osimertinib, which limits the generalizability to current treatment standards.

    EGFR-Mutated Lung Cancer Surgery Study Detail
    Cancer subtype EGFR-mutated non-small cell lung cancer (NSCLC)
    Intervention studied Cytoreductive surgery during TKI therapy
    Finding Surgical removal of residual masses associated with improved survival
    Study type Retrospective
    Limitation 1 Possible selection bias (better-responding patients selected for surgery)
    Limitation 2 Most patients on first/second-gen TKIs, not current-standard osimertinib
    Published in International Journal of Cancer (June 11, 2026)
    Reported on Medscape (June 22, 2026)
    Proportion of NSCLC with EGFR mutations ~10–15% of U.S. NSCLC cases
    Population disproportionately affected Never-smokers, younger adults, women

    The Broader EGFR Landscape at ASCO 2026 — and What Patients Should Know

    The Moiseenko surgery finding arrives in the context of a highly active 2026 ASCO data landscape for EGFR-mutated NSCLC. Cancer Therapy Advisor’s ASCO 2026 report described updated CHRYSALIS-2 data showing that first-line amivantamab plus lazertinib, a targeted combination, produced a median overall survival of 41 months in atypical EGFR-mutated advanced NSCLC, more than doubling historical outcomes with earlier drugs. At three years, 55% of patients in this cohort were still alive.

    In the EGFR exon 20 insertion space — a rarer subtype previously lacking effective targeted options — the WU-KONG28 phase 3 trial presented at ASCO 2026 showed that sunvozertinib significantly outperformed platinum-based chemotherapy as first-line treatment, representing a potential new standard for this historically difficult-to-treat population.

    The Moiseenko cytoreductive surgery study adds a surgical dimension to a field that has been almost entirely pharmaceutical. As the study authors concluded, the findings suggest that “some patients receiving EGFR TKIs may benefit from cytoreductive surgery,” but that future research must “utilize rigorous criteria for patient selection, ensure proper size of the control group, and avoid diversity of EGFR inhibitors by using osimertinib or similar third-generation drugs.”

    For patients with EGFR-mutated NSCLC who are currently on TKI therapy and responding well, this study raises a question worth discussing with their thoracic oncologist: Is there a role for discussing residual disease surgery as part of a comprehensive treatment plan? The answer is not yet established by randomized controlled trial evidence — but the retrospective data and the ASCO 2026 context together suggest the question is worth asking. Any consideration of surgery in advanced lung cancer requires a multidisciplinary tumor board evaluation involving medical oncology, thoracic surgery, and radiation oncology.

    Frequently Asked Questions

    What did the June 22 Medscape lung cancer report find?

    Medscape reported June 22, 2026, on a study published in the International Journal of Cancer, finding that cytoreductive surgery — removal of residual tumor masses — during TKI drug therapy was associated with improved survival in patients with EGFR-mutated non-small cell lung cancer.

    What is EGFR-mutated lung cancer?

    EGFR-mutated NSCLC is a subtype of non-small cell lung cancer driven by mutations in the epidermal growth factor receptor gene. It accounts for approximately 10 to 15 percent of NSCLC cases in the U.S. and disproportionately affects never-smokers, younger adults, and women. It is highly responsive to targeted TKI drugs, including osimertinib, erlotinib, gefitinib, and afatinib.

    Is cytoreductive surgery now a standard of care for EGFR-mutated NSCLC?

    No. The study was retrospective and has important limitations, including potential selection bias and the use of older, less potent TKI drugs rather than the current standard osimertinib. The authors call for future research with rigorous patient selection criteria and randomized controlled trial design before surgery can be considered a standard component of treatment.

    How does this relate to the ASCO 2026 EGFR lung cancer data?

    ASCO 2026 presented multiple significant updates in EGFR-mutated NSCLC, including a median overall survival of 41 months with amivantamab plus lazertinib in atypical EGFR mutations, more than double historical outcomes. The Moiseenko surgery study adds a surgical question to a field that is actively evolving on the pharmaceutical side.

    What should patients with EGFR-mutated lung cancer do with this information?

    Discuss the findings with your thoracic oncologist and ask whether a multidisciplinary tumor board evaluation, involving medical oncology, thoracic surgery, and radiation oncology, might be appropriate to review your specific situation and whether surgical options merit consideration. This is a conversation-starter based on retrospective data, not an established treatment recommendation.

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  • Scientists Made a Gum Disease Gel from Jackfruit Latex, Pomegranate Peel, and Simvastatin — Fights Infection, Reduces Inflammation, and Regrows Bone

    Scientists Made a Gum Disease Gel from Jackfruit Latex, Pomegranate Peel, and Simvastatin — Fights Infection, Reduces Inflammation, and Regrows Bone

    The treatment of severe gum disease has long faced a fundamental limitation: existing therapies can control infection and inflammation, but they cannot rebuild the bone and tissue that periodontitis destroys. A new biomaterial developed by researchers in Brazil — made from three ingredients that would look more at home in a kitchen than a pharmacy — may be closing that gap simultaneously.

    ScienceDaily reported on June 19, 2026 on research published in Polymer Bulletin by scientists at the Pontifical Catholic University of São Paulo (PUC-SP) in Sorocaba, Brazil, led by Professor Eliana Aparecida de Rezende Duek. The team developed a biomaterial combining jackfruit latex, pomegranate peel extract, and simvastatin — a cholesterol-lowering drug — into a mucoadhesive gel that, in early laboratory testing, demonstrated infection control, anti-inflammatory activity, and the ability to promote bone-forming tissue growth within 14 to 21 days.

    “We began to view latex extracted from jackfruit as an interesting alternative, as it has adhesive properties,” explained Professor Duek in the FAPESP Agency press release. “This led us to believe that it could remain longer at the site affected by periodontitis, promoting a more targeted release of therapeutic compounds and potentially reducing the need for systemic antibiotic use.”

    How the Three-Ingredient Combination Works — and Why Each Component Matters

    The biomaterial works through the combined action of three components that address different aspects of the disease process simultaneously — a design principle called multi-modal therapy that is increasingly recognized as essential for treating complex chronic inflammatory conditions.

    Jackfruit latex — the structural vehicle. Jackfruit (Artocarpus heterophyllus) is the world’s largest tree fruit, widely cultivated across South and Southeast Asia and increasingly in Brazil. When freshly harvested, it produces a natural latex — a sticky, adhesive substance that the PUC-SP team recognized as potentially valuable in periodontal treatment. As Phys.org reported: jackfruit latex has mucoadhesive properties — it can stick to mucous membrane surfaces like gum tissue. This adhesiveness is the delivery mechanism: the gel stays at the treatment site rather than washing away with saliva, allowing a “more targeted release of therapeutic compounds” over time.

    Pomegranate peel extract — the antimicrobial. Pomegranate peel extract has documented antimicrobial properties, specifically for topical application against the bacterial pathogens involved in periodontal disease. As Indian Defence Review reported: “Pomegranate extract contributes antimicrobial effects” in the biomaterial. This addresses the infection component of periodontitis — the bacterial accumulation around the gum line that initiates and perpetuates the disease.

    Simvastatin — the bone-forming driver. This is the component that most directly addresses the gap in current periodontal treatment. Simvastatin is widely known as a cholesterol-lowering drug, but it has been studied for an additional and less well-known property: it stimulates bone formation. As The Microbiologist reported: “simvastatin, an anti-inflammatory drug that has been studied for its ability to stimulate bone formation.”

    When administered orally as a cholesterol drug, simvastatin is predominantly captured by the liver, with only a small fraction reaching the systemic circulation, requiring high doses that carry significant side effects, including acute muscle degeneration (rhabdomyolysis). By delivering simvastatin directly into the periodontal pocket via the jackfruit latex gel, the researchers bypass the liver entirely. The drug acts locally, at the site of bone loss, at the concentrations needed for bone regeneration, without the systemic dose and risk profile of oral administration.

    Jackfruit-Pomegranate Biomaterial — Key Data Detail
    Published in Polymer Bulletin, March 9, 2026
    DOI 10.1007/s00289-026-06358-w
    ScienceDaily coverage June 19, 2026
    Institution PUC-SP (Pontifical Catholic University of São Paulo), Sorocaba, Brazil
    Lead researcher Professor Eliana Aparecida de Rezende Duek (FCMS)
    Components Jackfruit latex + pomegranate peel extract + simvastatin
    Jackfruit latex role Mucoadhesive vehicle — stays at treatment site, enables targeted drug release
    Pomegranate peel role Antimicrobial activity against periodontal pathogens
    Simvastatin role Anti-inflammatory + bone formation stimulation
    Simvastatin concentrations tested 0.3%, 0.6%, 1.2% (all safe; none altered gel structure)
    Osteoinduction (bone-forming activity) All three concentrations promoted it within 14 days
    Effect at 21 days Even stronger osteoinductive effect
    In vitro model Human adipose-derived stem cells
    Advantage of topical simvastatin Bypasses liver; acts at site of bone loss without systemic side effects
    Current periodontitis treatment limitation Controls infection and inflammation but does NOT regenerate bone/tissue
    Periodontitis global prevalence ~47% of U.S. adults over 30; hundreds of millions worldwide

    What Periodontitis Is — and Why Current Treatments Fail Regeneration

    Periodontitis is not simply “gum disease.” It is a chronic inflammatory disease of infectious origin that progressively destroys the supporting structures of the teeth: the periodontal ligament, the alveolar bone, and the cementum that anchors teeth roots. As the disease advances, patients lose the bone that holds their teeth in place — leading to tooth mobility and, eventually, tooth loss.

    Periodontitis affects approximately 47% of American adults over 30, with severe disease affecting approximately 9%. According to GB News’ coverage of the research: “Periodontitis affects hundreds of millions of people worldwide and remains a leading cause of tooth loss in adults.”

    Current standard treatments — scaling and root planing (deep cleaning to remove bacterial deposits) combined with antimicrobial therapy — are effective at controlling infection and halting further destruction. But they cannot regenerate lost bone. “Current treatments are designed to control infection and inflammation, but they generally do little to regenerate damaged periodontal tissue,” the ScienceDaily summary noted. More advanced techniques, including guided tissue regeneration (using barrier membranes to encourage natural tissue growth) and bone grafting, are available but have “inconsistent and sometimes unpredictable” clinical effects.

    A material that simultaneously controls infection, reduces inflammation, AND promotes bone regeneration within 14 days in laboratory conditions — using components that are naturally derived or already clinically approved — represents a meaningful advance over each of these existing approaches, if the results translate to clinical trials.

    Limitations and the Path to Clinical Translation

    The current research is in vitro — laboratory-based testing using human stem cells and physicochemical analysis. It has not been tested in animal models of periodontitis or in human clinical trials. Clinical translation requires multiple additional steps: animal model efficacy studies, safety profiling, formulation optimization for clinical application, and ultimately clinical trials comparing the biomaterial to existing treatments.

    Professor Duek and her team have expressed confidence in the material’s potential: “We observed that the developed biomaterial has great potential for future applications in treating periodontitis and in other areas as well.” The fact that simvastatin is already an FDA-approved drug with a well-established safety profile in humans is an advantage — not for its oral use, but because basic pharmacological safety data already exists, which may reduce some regulatory pathway complexity for the topical application.

    Frequently Asked Questions

    What is the jackfruit/pomegranate gum disease biomaterial?

    A mucoadhesive gel combining jackfruit latex, pomegranate peel extract, and simvastatin developed by PUC-SP researchers in Brazil and published in Polymer Bulletin(March 2026; ScienceDaily June 19, 2026). It sticks to gum tissue at the treatment site, fights infection with pomegranate’s antimicrobial properties, and uses locally delivered simvastatin to stimulate bone formation.

    What makes this different from current gum disease treatments?

    Current treatments (scaling, root planing, antimicrobials) can control infection and halt disease progression, but cannot rebuild lost bone. The jackfruit biomaterial is designed to do all three simultaneously: fight infection, reduce inflammation, and promote bone-forming tissue growth within 14 days in laboratory tests.

    Has this been tested in humans?

    Not yet. The current research is in vitro, using human adipose-derived stem cells in laboratory conditions. Animal model studies and clinical trials would be needed before clinical application. The study is a promising proof-of-concept finding, not a clinical treatment.

    Why use simvastatin in a gum disease treatment?

    Simvastatin is a cholesterol drug with the additional property of stimulating bone formation. When administered directly to the periodontitis site in the biomaterial gel, it bypasses the liver and acts locally at concentrations that promote bone growth — without the systemic side effects (including muscle damage) that can occur with high oral doses.

    Why jackfruit latex specifically?

    Jackfruit latex is naturally adhesive (mucoadhesive) — it sticks to gum tissue rather than washing away with saliva. This keeps the therapeutic compounds at the treatment site for prolonged local release, potentially reducing the need for systemic antibiotic use.

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