Published December 2, 2023
Morning Report — Not Your Typical Medical Newsletter
We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.
You can call the human tongue many things, but complacent is not one of them. Its taste receptors may have just added a budding new “primary taste” to the established five (sweet, salty, sour, bitter, and umami). Technically, the new taste, ammonium chloride, has been here all along, but scientists have recently unearthed evidence of it. Where might your tongue encounter ammonium chloride? Across the Atlantic. It’s a main ingredient in salmiak, a salty licorice Scandinavians can’t live without. Nordic citizens took to the proverbial streets when the European Union proposed restricting it because ammonium chloride is toxic. Experts say our taste receptors may have evolved to identify and thereby warn us of this harmful compound.
Is the taste of salmiak/ammonium chloride worth the toxicity? Most Americans say this Scandinavian treat is no Swedish Fish, and writer Andrew Richdale—the aspiring Roger Ebert of candy reviews—called it “simultaneously fascinating and … abusive.” Have you tried it?
Mammography’s Screening Double Play
CARDIO CORNER
Speaking of things evolving … mammography has been making moves in 2023. This breast cancer screening gold standard may be launching into the cardiovascular (CV) screening sphere. Emerging research suggests that mammography may reveal breast artery calcification (BAC), helping identify patients at risk of major CV events.
Taking a victory lap in its new lane
A retrospective study, presented at the American Heart Association (AHA) Scientific Sessions (and not yet peer-reviewed), followed >1,200 women aged 40 to 75 years who received mammography screening and had no coronary artery disease at baseline. Screening found that 20% of women had detectable BAC, and those with BAC were two times more likely to experience a major CV event within a decade than women without BAC. And BAC predicted CV risk better than the CV risk assessment gold standard, the Pooled Cohort Equation.
See something, say something
Lead researcher Dr. Thara Ali calls for change: “Radiologists see the calcification but haven’t been reporting it because the guidelines don’t ask them to report it. They are missing an opportunity to speak with women about reducing other, modifiable cardiovascular risk factors.”
Key takeaway
The findings, although preliminary, suggest that mammography screening may parlay its prowess in breast cancer detection into effective CV risk stratification. And this shift may help address the unmet need highlighted by stagnant CV mortality rates for women <55 years. Researchers plan to validate these results in larger trials and assess BAC’s impact across multiple demographics.
FDA Approves …
Consumer Reports to Big Chocolate: Get the Lead Out
CONSUMER CONCERNS
It’s beginning to look a lot like … another PR catastrophe for the chocolate industry this holiday season. Consumer Reports recently gifted consumers with a new report detailing the potentially hazardous levels of heavy metals lurking in popular chocolate products, doubling down on a similar indictment it published last December.
Oh, fudge
Consumer Reports tested 48 chocolate products from familiar brands across multiple categories (cocoa powder, chocolate chips, candy bars, and mixes for cake, brownies, and beverages) for heavy metals. All 48 products contained at least traces of lead and cadmium, and 16 products crossed the threshold for “concern” (defined as meeting California’s maximum allowable levels).
Beware the dark side of chocolate
What dark chocolate lacks in added sugar, it makes up for in added lead and cadmium. Approximately 70% of the dark chocolates tested reached concerning levels. This type of chocolate likely topped the naughty list because metals typically hide in cocoa, of which dark chocolate has the greatest concentration.
Key takeaways
What is a consumer to do when a favorite holiday (and year-round) treat is garlanded in metals linked to reproductive issues, kidney damage, hypertension, and more? Consumer Reports advises awareness of metal risks in all chocolate and urges consumers, particularly kids and pregnant women, to limit dark chocolate consumption. The National Confectioners Association—known for having the best break room treats—responded that chocolate and cocoa are “safe to eat and can be enjoyed as treats as they have been for centuries.” Meanwhile, the FDA offered the less comforting comparator angle, “chocolate is a minor source of exposure to these contaminants internationally.” Bah humbug.
Guideline Updates
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Salt Study Shakes Up Hypertension Management
DIETARY DIGEST
Like a kid suddenly pondering the plausibility of airborne sleigh travel, this next study asks a lot of questions. What happens when someone with controlled hypertension (HTN) lowers their dietary sodium intake? Or raises it? What about someone with uncontrolled or untreated HTN? Or without HTN? Fortunately, the answers are more evidence-based than “it’s just magic.”
The randomized study stratified >200 middle-aged to older adults into the abovementioned HTN categories. After assessing participants’ “usual” diets, researchers assigned each person to either a high-sodium diet (2,200 mg more than usual/day) or a low-sodium diet (500 mg/day) for one week, followed by the alternate diet for one week. Of note, urine analysis revealed that the prescribed 500 mg/day swelled to ~1,300 mg/day when no one but Santa was looking.
The major findings
- 72% of individuals who consumed the low-sodium diet saw a significant drop in blood pressure (BP) in comparison with their BP associated with their usual diet—even those on antihypertensives.
- The low-sodium diet was associated with a 7-mm Hg systolic BP decrease from that of the high-sodium diet, and with a 6-mm Hg decrease vs that of their usual diet.
- High-sodium diet systolic BP levels did not significantly exceed levels associated with the usual diet—perhaps owing to already salty usual diets (~4,500 mg/day).
- Dietary effects held up across the non-, controlled-, and untreated-HTN groups.
Key takeaways
This study, presented at the AHA Scientific Sessions, suggests that aggressively lowering sodium intake could rival a first-line antihypertensive medication’s effect on blood pressure—in only one week. The findings validate AHA’s recommendation to ideally limit sodium intake to <1,500 mg/day and align well with the tenets of the popular DASH diet. Given these swift and dramatic results, will patients adopt a diet seemingly as bland as a Bill Belichick postgame interview? Maybe. Coprincipal investigator Norrina Allen urges people to “stick with it because your taste buds do adjust within a couple of weeks or so, and you really do get taste and flavor back and normal things will taste very salty.”
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Guidelines for the use of doxycycline post-exposure prophylaxis for bacterial sexually transmitted infection (STI) prevention
- Saltwater gargling may help avoid COVID hospitalization
- Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium
- Early intervention in cognitive aging with strawberry supplementation
- First trial of ‘base editing’ in humans lowers cholesterol—but raises concerns
- Surgeons in New York announce world’s first eye transplant
Morning Report is written by:
- Alissa Scott, author
- Aylin Madore, MD, MEd, editor
- Margaret Oliverio, MD, editor
- Ariel Reinish, MD, MEd, editor
- Emily Ruge, Author, editor
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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
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