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The science of addiction: a personal struggle to kick cocaine gives a neuroscientist unique insights

Having survived a decade of drink and drugs as a young woman, Professor Judith Grisel focused all her determination on writing a book about addiction

When Professor Judith Grisel sat down to write her book Never Enough (a guide to the neuroscience of addiction that has been her lifes work), she didnt expect to share so much of her own story. Nevertheless the resulting chapters are a collision of the personal and professional, detailing the deep links between her work life and the decade of drug and alcohol addiction that almost destroyed her.

On paper, Grisel was an unlikely candidate for going off the rails. One of three children, she describes a privileged upbringing in a progressive, suburban area of New Jersey. With an airline pilot father and a mother who was a registered nurse, Grisel remembers growing up in a perfect-looking family.

As her research would go on to help demonstrate, there was no single factor that predicted her drug problems. Neuroscientists have found a complex blend of nature and nurture at work in addictive tendencies and their research shows that many genetic, epigenetic and environmental factors work together in complex ways that often remain elusive.

Why me? is the question that underpins much of Grisels research, and she continues to wonder why friends who drank heavily with her in high school were spared addiction. In Never Enough she offers a smorgasbord of theories behind her own and others predisposition to addiction: an extreme personality and love of risk-taking, trying drugs at a young age, lower levels of endorphins in the brain, potential hypersensitivity to the neurological rewards of drugs alongside, more surprisingly, her own parents strict response to her behaviour.

If they had just been a little more lax, if I hadnt been the first child, I probably could have been normal, she reflects. Grisel did not experience the childhood poverty, insecure housing or abuse we have come (rightly) to associate with some drug users histories. Instead she believes the misery within her parents relationship and the pressure she felt to keep up appearances had the greatest impact on her trajectory. Their marriage was so dysfunctional that my mother eventually got an annulment from the Pope but we never acknowledged it at the time. As a kid I felt like a prop in this play of the perfect family.

A pivotal moment came when, aged nine or 10, Grisel found her mother crying at the kitchen sink. I asked her what the matter was and she answered that she was crying because she was so happy. My stomach sank a thousand feet because I knew it wasnt true but I also knew there was no way to reach the truth. Her mothers insistence that the family ignored the reality of their problems and instead went along with a pretence of happiness had a profound and negative impact on the way Grisel herself came to understand her own emotions and place in the world.

What I learned to do in that moment, she explains, was to doubt my reality; to realise that what was critical in life was the story, the veneer. And that felt like dying.

So began Grisels search for a way to escape her everyday life, a life that felt false and full of pressure to go along with the pretence, and instead to find a way to feel something that felt like the truth. It started with an obsession with reading books, I would read constantly, upside down if I had to, and then aged 13 (reaching a key developmental point when the teenage brain is primed for risky behaviour) she had her first drink. I thought, this is how people get through life. I can pretend all this stuff, because I can have this little secret where Im nice and warm inside, remembers Grisel. It was the first time in my life I remember feeling relaxed.

Grisel swiftly progressed to the solace of daily drinking, smoking marijuana and regular drug use. I loved being able to connect to my true self and I only seemed to be able to do that when I was wasted, she explains. Unsurprisingly, she was soon in trouble at home and school, trouble that escalated through her teenage years until she was kicked out by her parents when she was 19 dropping out of her first year of college at the same time. After years of trying a range of ways to stop Grisel taking drugs her family now withdrew financial support entirely. As she left home, despite her brawny high school football player brother crying in the street, she felt exhilarated: I felt like all the restraints were off and things got very bad after that.

Increasingly detached from her parents, who she barely saw over the next four years, Grisels life became entirely focused on drugs. I was scraping by on nothing but lies and evasion and my only priority was staying loaded. Now injecting cocaine, her dedication to the next hit led to frequent homelessness and unemployment. When she did find work she stole from the till, she regularly took credit cards from strangers and ruthlessly stole money and drugs from friends. Soon she was facing lunatic dealers and DEA agents with a single-minded determination that she also credits with her subsequent scientific tenacity.

The depravity of Grisels addicted life, described in the memoir chapters of Never Enough, illustrates the vicious cycle of the A and B process she explains in the scientific sections of her book. When humans engage in any mind-altering activity, the effects are known as the A process. Whether its the sedation of alcohol or the rush of cocaine, users often feel pleasure from the initial use of their drug of choice. But as Grisel is at pains to explain, There is no free lunch.

She believes people might make better choices if normal brain function was more widely appreciated. The brain adapts to any addictive substance or activity by producing the exact opposite effect, says Grisel. This opposite state, known as the B process, is led by the brains drive to return to its baseline state and its why hangovers and comedowns are such unpleasant experiences. Our brains are so efficient at returning to normal that with regular use we need more and more of the drug or activity to feel the A process and the oppositional B process kicks in almost instantaneously. Soon, as Grisel herself experienced, we need the drug just to feel normal and without it we only feel the negative impact of the B process.

With addiction rates rising steeply, helping people avoid being imprisoned in this cycle is a priority for many worried parents, case-workers, researchers and Grisel herself. But, just as a simple set of causes of addiction doesnt seem to exist, there doesnt appear to be a magic recipe for recovery either. Grisel describes her own transformation from addict to sober scientist as a collection of coincidences and luck. I was inexplicably fortunate. I think I was carried through by circumstance, she says.

A lucky break led to better housing and a move away from injecting cocaine. After a terrifying encounter with her reflection in the mirror, the final push she needed to start her recovery came from her parents. In a crucial moment of compassion from her father, he told her he wished only happiness for her life and the 23-year-old finally realised just how unhappy she was.

A drug-treatment facility in Minnesota was followed by a three-month stay in a womens halfway house and then Grisel began to repair her life. A key motivation for staying sober was her determination to find a cure for addiction. At the beginning of her career, Grisel and others in her field were convinced they would swiftly find that cure, but as neuroscientific understanding has deepened it has revealed just how much we dont understand. In the book, Grisel reflects, I was shocked that I couldnt say that neuroscience is making great strides. It didnt seem true to me.

Though she cant yet offer a magic switch to turn off addiction, She now believes much of the answer lies not in manipulating DNA but in encouraging human love, compassion and connection. With more high-potency drugs available more widely than ever before, alongside a sea of addictive technology enticing adults and children to fritter away our lives checking updates just like users fritter away their lives snorting cocaine, Grisel believes we need a range of tactics to tackle the global problem of addiction. The people right next to us are an obvious place to start, she adds. Human relationships and connections are the low-hanging fruit.

With her own 16-year-old daughter and grown-up stepsons she and her husband have prioritised staying emotionally connected to their children and, when they are worried about behaviour, sharing their own feelings rather than telling their children what to do. I will say, I love you and Im really concerned about this. If you need help, I will give it to you, Grisel says. But I will also be clear that I am not going to enable the behaviour. Despite choosing to parent differently from the way that she was brought up, Grisel now reflects on her parents with compassion, believing that if you have a child who is an addict, Its an almost impossible situation to be in and very hard to know what to do.

Decades of research and experience have led Judith Grisel to believe that the dominance of addictive substances and activities in contemporary life are leading society to the brink of an addictive black hole and that it is only by connecting with each other that we can avoid being sucked in. Right now were in a rising phase of escapism and pharmacology this epidemic of addiction is really an epidemic of avoidance. Above all we need better ways to cope with life and to be present to our experiences. Despite her concerns, she does have hope. Ultimately you cant avoid yourself. It didnt matter how high I got, I was stuck with myself. I think were soon going to get to that point as a society and then we might finally have our moment of truth. Then, Grisel believes, well discover that the way out of addiction was actually inside us all along.

Never Enough: the Neuroscience and Experience of Addiction by Judith Grisel is published by Scribe, priced 9.99. Buy it for 8.79 at guardianbookshop.com

Read more: https://www.theguardian.com/lifeandstyle/2019/aug/24/the-science-of-addiction-a-personal-struggle-to-kick-cocaine-gives-a-neuroscientist-unique-insights

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Yes, bacon really is killing us

The long read: Decades worth of research proves that chemicals used to make bacon do cause cancer. So how did the meat industry convince us it was safe?

There was a little cafe I used to go to that did the best bacon sandwiches. They came in a soft and pillowy white bap. The bacon, thick-cut from a local butcher, was midway between crispy and chewy. Ketchup and HP sauce were served in miniature jars with the sandwich, so you could dab on the exact amount you liked. That was all there was to it: just bread and bacon and sauce. Eating one of these sandwiches, as I did every few weeks, with a cup of strong coffee, felt like an uncomplicated pleasure.

And then, all of a sudden, the bacon sandwich stopped being quite so comforting. For a few weeks in October 2015, half the people I knew were talking about the news that eating bacon was now a proven cause of cancer. You couldnt miss the story: it was splashed large in every newspaper and all over the web. As one journalist wrote in Wired, Perhaps no two words together are more likely to set the internet aflame than BACON and CANCER. The BBC website announced, matter-of-factly, that Processed meats do cause cancer, while the Sun went with Banger out of Order and Killer in the Kitchen.

The source of the story was an announcement from the World Health Organization that processed meats were now classified as a group 1 carcinogen, meaning scientists were certain that there was sufficient evidence that they caused cancer, particularly colon cancer. The warning applied not just to British bacon but to Italian salami, Spanish chorizo, German bratwurst and myriad other foods.

Health scares are ten-a-penny, but this one was very hard to ignore. The WHO announcement came on advice from 22 cancer experts from 10 countries, who reviewed more than 400 studies on processed meat covering epidemiological data from hundreds of thousands of people. It was now possible to say that eat less processed meat, much like eat more vegetables, had become one of the very few absolutely incontrovertible pieces of evidence-based diet advice not simply another high-profile nutrition fad. As every news report highlighted, processed meat was now in a group of 120 proven carcinogens, alongside alcohol, asbestos and tobacco leading to a great many headlines blaring that bacon was as deadly as smoking.

The WHO advised that consuming 50g of processed meat a day equivalent to just a couple of rashers of bacon or one hotdog would raise the risk of getting bowel cancer by 18% over a lifetime. (Eating larger amounts raises your risk more.) Learning that your own risk of cancer has increased from something like 5% to something like 6% may not be frightening enough to put you off bacon sandwiches for ever. But learning that consumption of processed meat causes an additional 34,000 worldwide cancer deaths a year is much more chilling. According to Cancer Research UK, if no one ate processed or red meat in Britain, there would be 8,800 fewer cases of cancer. (That is four times the number of people killed annually on Britains roads.)

The news felt especially shocking because both ham and bacon are quintessentially British foods. Nearly a quarter of the adult population in Britain eats a ham sandwich for lunch on any given day, according to data from 2012 gathered by researchers Luke Yates and Alan Warde. To many consumers, bacon is not just a food; it is a repository of childhood memories, a totem of home. Surveys indicate that the smell of frying bacon is one of our favourite scents in the UK, along with cut grass and fresh bread. To be told that bacon had given millions of people cancer was a bit like finding out your granny had been secretly sprinkling arsenic on your morning toast.

Vegetarians might point out that the bacon sandwich should never have been seen as comforting. It is certainly no comfort for the pigs, most of whom are kept in squalid, cramped conditions. But for the rest of us, it was alarming to be told that these beloved foods might be contributing to thousands of needless human deaths. In the weeks following news of the WHO report, sales of bacon and sausages fell dramatically. British supermarkets reported a 3m drop in sales in just a fortnight. (It was very detrimental, said Kirsty Adams, the product developer for meat at Marks and Spencer.)

But just when it looked as if this may be #Bacongeddon (one of many agonised bacon-related hashtags trending in October 2015), a second wave of stories flooded in. Their message was: panic over. For one thing, the analogy between bacon and smoking was misleading. Smoking tobacco and eating processed meat are both dangerous, but not on the same scale. To put it in context, around 86% of lung cancers are linked to smoking, whereas it seems that just 21% of bowel cancers can be attributed to eating processed or red meat. A few weeks after publishing the report, the WHO issued a clarification insisting it was not telling consumers to stop eating processed meat.

Meanwhile, the meat industry was busily insisting that there was nothing to see here. The North American Meat Institute, an industry lobby group, called the report dramatic and alarmist overreach. A whole tranche of articles insisted in a commonsense tone that it would be premature and foolish to ditch our meaty fry-ups just because of a little cancer scare.

Nearly three years on, it feels like business as usual for processed meats. Many of us seem to have got over our initial sense of alarm. Sales of bacon in the UK are buoyant, having risen 5% in the two years up to mid-2016. When I interviewed a product developer for Sainsburys supermarket last year, she said that one of the quickest ways to get British consumers to try a new product now was to add chorizo to it.

And yet the evidence linking bacon to cancer is stronger than ever. In January, a new large-scale study using data from 262,195 British women suggested that consuming just 9g of bacon a day less than a rasher could significantly raise the risk of developing breast cancer later in life. The studys lead author, Jill Pell from the Institute of Health and Wellbeing at Glasgow University, told me that while it can be counterproductive to push for total abstinence, the scientific evidence suggests it would be misleading for health authorities to set any safe dose for processed meat other than zero.

The real scandal of bacon, however, is that it didnt have to be anything like so damaging to our health. The part of the story we havent been told including by the WHO is that there were always other ways to manufacture these products that would make them significantly less carcinogenic. The fact that this is so little known is tribute to the power of the meat industry, which has for the past 40 years been engaged in a campaign of cover-ups and misdirection to rival the dirty tricks of Big Tobacco.


How do you choose a pack of bacon in a shop, assuming you are a meat eater? First, you opt for either the crispy fat of streaky or the leanness of back. Then you decide between smoked or unsmoked each version has its passionate defenders (I am of the unsmoked persuasion). Maybe you seek out a packet made from free-range or organic meat, or maybe your budget is squeezed and you search for any bacon on special offer. Either way, before you put the pack in your basket, you have one last look, to check if the meat is pink enough.

Since we eat with our eyes, the main way we judge the quality of cured meats is pinkness. Yet it is this very colour that we should be suspicious of, as the French journalist Guillaume Coudray explains in a book published in France last year called Cochonneries, a word that means both piggeries and rubbish or junk food. The subtitle is How Charcuterie Became a Poison. Cochonneries reads like a crime novel, in which the processed meat industry is the perpetrator and ordinary consumers are the victims.

The pinkness of bacon or cooked ham, or salami is a sign that it has been treated with chemicals, more specifically with nitrates and nitrites. It is the use of these chemicals that is widely believed to be the reason why processed meat is much more carcinogenic than unprocessed meat. Coudray argues that we should speak not of processed meat but nitro-meat.

Parma
Prosciutto di Parma has been produced without nitrates since 1993. Photograph: Stefano Rellandini/Reuters

Pure insane crazy madness is how Coudray described the continuing use of nitrates and nitrites in processed meats, in an email to me. The madness, in his view, is that it is possible to make bacon and ham in ways that would be less carcinogenic. The most basic way to cure any meat is to salt it either with a dry salt rub or a wet brine and to wait for time to do the rest. Coudray notes that ham and bacon manufacturers claim this old-fashioned way of curing isnt safe. But the real reason they reject it is cost: it takes much longer for processed meats to develop their flavour this way, which cuts into profits.

There is much confusion about what processed meat actually means, a confusion encouraged by the bacon industry, which benefits from us thinking there is no difference between a freshly minced lamb kofta and a pizza smothered in nitrate-cured pepperoni. Technically, processed meat means pork or beef that has been salted and cured, with or without smoking. A fresh pound of beef mince isnt processed. A hard stick of cured salami is.

The health risk of bacon is largely to do with two food additives: potassium nitrate (also known as saltpetre) and sodium nitrite. It is these that give salamis, bacons and cooked hams their alluring pink colour. Saltpetre sometimes called sal prunella has been used in some recipes for salted meats since ancient times. As Jane Grigson explains in Charcuterie and French Pork Cookery, saltpetre was traditionally used when brining hams to give them an attractive rosy appearance when otherwise it would be a murky greyish brown.

In earlier centuries, bacon-makers who used saltpetre did not understand that it converts to nitrite as the meat cures. It is this nitrite that allows the bacteria responsible for cured flavour to emerge quicker, by inhibiting the growth of other bacteria. But in the early 20th century, the meat industry found that the production of cured meats could be streamlined by adding sodium nitrite to the pork in pure form. In trade journals of the 1960s, the firms who sold nitrite powders to ham-makers spoke quite openly about how the main advantage was to increase profit margins by speeding up production. One French brand of sodium nitrite from the 60s was called Vitorose or quick-pink.

Nitro-chemicals have been less of a boon to consumers. In and of themselves, these chemicals are not carcinogenic. After all, nitrate is naturally present in many green vegetables, including celery and spinach, something that bacon manufacturers often jubilantly point out. As one British bacon-maker told me, Theres nitrate in lettuce and no one is telling us not to eat that!

But something different happens when nitrates are used in meat processing. When nitrates interact with certain components in red meat (haem iron, amines and amides), they form N-nitroso compounds, which cause cancer. The best known of these compounds is nitrosamine. This, as Guillaume Coudray explained to me in an email, is known to be carcinogenic even at a very low dose. Any time someone eats bacon, ham or other processed meat, their gut receives a dose of nitrosamines, which damage the cells in the lining of the bowel, and can lead to cancer.

You would not know it from the way bacon is sold, but scientists have known nitrosamines are carcinogenic for a very long time. More than 60 years ago, in 1956, two British researchers called Peter Magee and John Barnes found that when rats were fed dimethyl nitrosamine, they developed malignant liver tumours. By the 1970s, animal studies showed that small, repeated doses of nitrosamines and nitrosamides exactly the kind of regular dose a person might have when eating a daily breakfast of bacon were found to cause tumours in many organs including the liver, stomach, oesophagus, intestines, bladder, brain, lungs and kidneys.

Just because something is a carcinogen in rats and other mammals does not mean it will cause cancer in humans, but as far back as 1976, cancer scientist William Lijinsky argued that we must assume that these N-nitroso compounds found in meats such as bacon were also carcinogens for man. In the years since, researchers have gathered a massive body of evidence to lend weight to that assumption. In 1994, to take just one paper among hundreds on nitrosamines and cancer, two American epidemiologists found that eating hotdogs one or more times a week was associated with higher rates of childhood brain cancer, particularly for children who also had few vitamins in their diets.

In 1993, Parma ham producers in Italy made a collective decision to remove nitrates from their products and revert to using only salt, as in the old days. For the past 25 years, no nitrates or nitrites have been used in any Prosciutto di Parma. Even without nitrate or nitrite, the Parma ham stays a deep rosy-pink colour. We now know that the colour in Parma ham is totally harmless, a result of the enzyme reactions during the hams 18-month ageing process.

Slow-cured, nitrate-free, artisan hams are one thing, but what about mass-market meats? Eighteen months would be a long time to wait on hotdogs, as the food science expert Harold McGee comments. But there have always been recipes for nitrate-free bacon using nothing but salt and herbs. John Gower of Quiet Waters Farm, a pork producer who advises many British manufacturers of cured meats, confirms that nitrate is not a necessary ingredient in bacon: Its generally accepted that solid muscle products, as opposed to chopped meat products like salami, dont require the addition of nitrate for safety reasons.

Bacon is proof, if it were needed, that we cling to old comforts long after they have been proven harmful. The attachment of producers to nitrates in bacon is mostly cultural, says Gower. Bacon cured by traditional methods without nitrates and nitrites will lack what Gower calls that hard-to-define tang, that delicious almost metallic taste that makes bacon taste of bacon to British consumers. Bacon without nitrates, says Gower, is nothing but salt pork.

Given the harm of nitro-meat has been known for so long, the obvious question is why more has not been done to protect us from it. Corinna Hawkes, a professor of Food Policy at City University in London, has been predicting for years that processed meats will be the next sugar a food so harmful that there will be demands for government agencies to step in and protect us. Some day soon, Hawkes believes, consumers will finally wake up to the clear links between cancer and processed meat and say Why didnt someone tell me about this?


The most amazing thing about the bacon panic of 2015 was that it took so long for official public health advice to turn against processed meat. It could have happened 40 years earlier. The only time that the processed meat industry has looked seriously vulnerable was during the 1970s, a decade that saw the so-called war on nitrates in the US. In an era of Ralph Nader-style consumer activism, there was a gathering mood in favour of protecting shoppers against bacon which one prominent public health scientist called the most dangerous food in the supermarket. In 1973, Leo Freedman, the chief toxicologist of the US Food and Drug Administration, confirmed to the New York Times that nitrosamines are a carcinogen for humans although he also mentioned that he liked bacon as well as anybody.

The US meat industry realised it had to act fast to protect bacon against the cancer charge. The first attempts to fight back were simply to ridicule the scientists for over-reacting. In a 1975 article titled Factual look at bacon scare, Farmers Weekly insisted that a medium-weight man would have to consume more than 11 tonnes of bacon every single day to run the faintest risk of cancer. This was an outrageous fabrication.

But soon the meat lobby came up with a cleverer form of diversion. The AMI the American Meat Institute started to make the argument that the nitrate was only there for the consumers own safety, to ward off botulism a potentially fatal toxin sometimes produced by poorly preserved foods. The scientific director of the AMI argued that a single cup of botulism would be enough to wipe out every human on the planet. So, far from harming lives, bacon was actually saving them.

In 1977, the FDA and the US Department of Agriculture gave the meat industry three months to prove that nitrate and nitrite in bacon caused no harm. Without a satisfactory response, Coudray writes, these additives would have to be replaced 36 months later with non-carcinogenic methods. The meat industry could not prove that nitrosamines were not carcinogenic because it was already known that they were. Instead, the argument was made that nitrates and nitrites were utterly essential for the making of bacon, because without them bacon would cause thousands of deaths from botulism. In 1978, in response to the FDAs challenge, Richard Lyng, director of the AMI, argued that nitrites are to processed meat as yeast is to bread.

The meat industrys tactics in defending bacon have been right out of the tobacco industrys playbook, according to Marion Nestle, professor of nutrition and food studies at New York University. The first move is: attack the science. By the 1980s, the AMI was financing a group of scientists based at the University of Wisconsin. These meat researchers published a stream of articles casting doubt on the harmfulness of nitrates and exaggerating the risk from botulism of non-nitrated hams.

Does making ham without nitrite lead to botulism? If so, it is a little strange that in the 25 years that Parma ham has been made without nitrites, there has not been a single case of botulism associated with it. Almost all the cases of botulism from preserved food which are extremely rare have been the result of imperfectly preserved vegetables, such as bottled green beans, peas and mushrooms. The botulism argument was a smokescreen. The more that consumers could be made to feel that the harmfulness of nitrate and nitrite in bacon and ham was still a matter of debate, the more they could be encouraged to calm down and keep buying bacon.

A
A bacon sandwich at a diner in Michigan. Photograph: Molly Riley/Reuters

The botulism pretext was very effective. The AMI managed to get the FDA to keep delaying its three-month ultimatum on nitrites until a new FDA commissioner was appointed in 1980 one more sympathetic to hotdogs. The nitrite ban was shelved. The only concession the industry had made was to limit the percentage of nitrites added to processed meat and to agree to add vitamin C, which would supposedly mitigate the formation of nitrosamines, although it does nothing to prevent the formation of another known carcinogen, nitrosyl-haem.

Over the years, the messages challenging the dangers of bacon have become ever more outlandish. An explainer article by the Meat Science and Muscle Biology lab at the University of Wisconsin argues that sodium nitrite is in fact critical for maintaining human health by controlling blood pressure, preventing memory loss, and accelerating wound healing. A French meat industry website, info-nitrites.fr, argues that the use of the right dose of nitrites in ham guarantees healthy and safe products, and insists that ham is an excellent food for children.

The bacon lobby has also found surprising allies among the natural foods brigade. Type nitrate cancer bacon into Google, and you will find a number of healthy eating articles, some of them written by advocates of the Paleo diet, arguing that bacon is actually a much-maligned health food. The writers often mention that vegetables are the primary source of nitrates, and that human saliva is high in nitrite. One widely shared article claims that giving up bacon would be as absurd as attempting to stop swallowing. Out of the mass of stuff on the internet defending the healthiness of bacon, it can be hard to tell which writers have fallen under the sway of the meat lobby, and which are simply clueless nutrition experts who dont know any better.

Either way, this misinformation has the potential to make thousands of people unwell. The mystifying part is why the rest of us have been so willing to accept the cover-up.


Our deepening knowledge of its harm has done very little to damage the comforting cultural associations of bacon. While I was researching this article, I felt a rising disgust at the repeated dishonesty of the processed meat industry. I thought about hospital wards and the horrible pain and indignity of bowel cancer. But then I remembered being in the kitchen with my father as a child on a Sunday morning, watching him fry bacon. When all the bacon was cooked, he would take a few squares of bread and fry them in the meaty fat until they had soaked up all its goodness.

In theory, our habit of eating salted and cured meats should have died out as soon as home refrigerators became widespread in the mid-20th century. But tastes in food are seldom rational, and millions of us are still hooked on the salty, smoky, umami savour of sizzling bacon.

We are sentimental about bacon in a way we never were with cigarettes, and this stops us from thinking straight. The widespread willingness to forgive pink, nitrated bacon for causing cancer illustrates how torn we feel when something beloved in our culture is proven to be detrimental to health. Our brains cant cope with the horrid feeling that bacon is not what we thought it was, and so we turn our anger outwards to the health gurus warning us of its hazards. The reaction of many consumers to the WHO report of 2015 was: hands off my bacon!

In 2010, the EU considered banning the use of nitrates in organic meats. Perhaps surprisingly, the British organic bacon industry vigorously opposed the proposed nitrates ban. Richard Jacobs, the late chief executive of Organic Farmers & Growers, an industry body, said that prohibiting nitrate and nitrite would have meant the collapse of a growing market for organic bacon.

Organic bacon produced with nitrates sounds like a contradiction in terms, given that most consumers of organic food buy it out of concerns for food safety. Having gone to the trouble of rearing pigs using free-range methods and giving them only organic feed, why would you then cure the meat in ways that make it carcinogenic? In Denmark, all organic bacon is nitrate-free. But the UK organic industry insisted that British shoppers would be unlikely to accept bacon that was greyish.

Then again, the slowness of consumers to lose our faith in pink bacon may partly be a response to the confusing way that the health message has been communicated to us. When it comes to processed meat, we have been misled not just by wild exaggerations of the food industry but by the caution of science.

On the WHO website, the harmfulness of nitrite-treated meats is explained so opaquely you could miss it altogether. In the middle of a paragraph on what makes red meat and processed meat increase the risk of cancer, it says: For instance, carcinogenic chemicals that form during meat processing include N-nitroso compounds. What this means, in plain English, is that nitrites make bacon more carcinogenic. But instead of spelling this out, the WHO moves swiftly on to the question of how both red and processed meats might cause cancer, after adding that it is not yet fully understood how cancer risk is increased.

The
The typical British sausage does not fall into the processed meat category. Photograph: Julian Smith/AAP

This caution has kept us as consumers unnecessarily in the dark. Consider sausages. For years, I believed that the unhealthiest part in a cooked English breakfast was the sausage, rather than the bacon. Before I started to research this article, Id have sworn that sausages fell squarely into the processed meat category. They are wrongly listed as such on the NHS website.

But the average British sausage as opposed to a hard sausage like a French saucisson is not cured, being made of nothing but fresh meat, breadcrumbs, herbs, salt and E223, a preservative that is non-carcinogenic. After much questioning, two expert spokespeople for the US National Cancer Institute confirmed to me that one might consider fresh sausages to be red meat and not processed meat, and thus only a probable carcinogen. (To me, the fact that most sausages are not processed meat was deeply cheering, and set me dancing around the kitchen with glee thinking about toad in the hole.)

In general, if you ask a cancer scientist to distinguish between the risks of eating different types of meat, they become understandably cagey. The two experts at the National Cancer Institute told me that meats containing nitrites and nitrates have consistently been associated with increased risk of colon cancer in human studies. But they added that it is difficult to separate nitrosamines from other possible carcinogens that may be present in processed meats like bacon. These other suspects include haem iron a substance that is abundant in all red meat, processed or not and heterocyclic amines: chemicals that form in meat during cooking. A piece of crispy, overcooked bacon will contain multiple carcinogens, and not all are due to the nitrates.

The problem with this reasoning, as I see it, is that it cant account for why processed meat is so much more closely linked to cancer than cooked red meat. For that, there remains no plausible explanation except for nitrates and nitrites. But looking for clear confirmation of this in the data is tricky, given that humans do not eat in labs under clinical observation.

Most of what we know about processed meat and cancer in humans comes from epidemiology the study of disease across whole populations. But epidemiologists do not ask the kind of detailed questions about food that the people who eat that food may like answers to. The epidemiological data based on surveys of what people eat is now devastatingly clear that diets high in processed meats lead to a higher incidence of cancer. But it cant tell us how or why or which meats are the best or worst. As Corinna Hawkes of City University comments, The researchers dont ask you if you are eating artisanal charcuterie from the local Italian deli or the cheapest hotdogs on the planet.

I would love to see data comparing the cancer risk of eating nitrate-free Parma ham with that of traditional bacon, but no epidemiologist has yet done such a study. The closest anyone has come was a French study from 2015, which found that consumption of nitrosylated haem iron as found in processed meats had a more direct association with colon cancer than the haem iron that is present in fresh red meat.

It may be possible that epidemiologists have not asked people more detailed questions about what kind of processed meats they eat because they assume there is no mass-market alternative to bacon made without nitrates or nitrites. But this is about to change.


The technology now exists to make the pink meats we love in a less damaging form, which raises the question of why the old kind is still so freely sold. Ever since the war on nitrates of the 1970s, US consumers have been more savvy about nitrates than those in Europe, and there is a lot of nitrate-free bacon on the market. The trouble, as Jill Pell remarks, is that most of the bacon labelled as nitrate-free in the US isnt nitrate-free. Its made with nitrates taken from celery extract, which may be natural, but produces exactly the same N-nitroso compounds in the meat. Under EU regulation, this bacon would not be allowed to be labelled nitrate-free.

Its the worst con Ive ever seen in my entire life, says Denis Lynn, the chair of Finnebrogue Artisan, a Northern Irish company that makes sausages for many UK supermarkets, including Marks & Spencer. For years, Lynn had been hoping to diversify into bacon and ham but, he says, I wasnt going to do it until we found a way to do it without nitrates.

When Lynn heard about a new process, developed in Spain, for making perfectly pink, nitrate-free bacon, he assumed it was another blind alley. In 2009, Juan de Dios Hernandez Canovas, a food scientist and the head of the food tech company Prosur, found that if he added certain fruit extracts to fresh pork, it stayed pink for a surprisingly long time.

In January 2018, Finnebrogue used this technology to launch genuinely nitrate-free bacon and ham in the UK. It is sold in Sainsburys and Waitrose as Naked Bacon and Naked Ham, and in M&S as made without nitrites. Kirsty Adams, who oversaw its launch at M&S, explains that its not really cured. Its more like a fresh salted pork injected with a fruit and vegetable extract, and is more perishable than an old-fashioned flitch of bacon but that doesnt matter, given that it is kept in a fridge. Because it is quick to produce, this is much more economically viable to make than some of the other nitrate-free options, such as slow-cured Parma ham. The bacon currently sells in Waitrose for 3 a pack, which is not the cheapest, but not prohibitive either.

I tried some of the Finnebrogue bacon from M&S. The back bacon tasted pleasant and mild, with a slight fruitiness. It didnt have the toothsome texture or smoky depth of a rasher of butchers dry-cured bacon, but Id happily buy it again as an alternative to nitro-meat. None of my family noticed the difference in a spaghetti amatriciana.

Nitrite-free bacon still sounds a bit fancy and niche, but there shouldnt be anything niche about the desire to eat food that doesnt raise your risk of cancer. Lynn says that when he first approached Prosur about the fruit extract, he asked how much they had sold to the other big bacon manufacturers during the two years they had been offering it in the UK. The answer was none. None of the big guys wanted to take it, claims Lynn. They said: It will make our other processed meats look dodgy.

But it also remains to be seen how much consumer demand there will be for nitrite- or nitrate-free bacon. For all the noise about bacon and cancer, it isnt easy to disentangle at a personal level just what kind of risk we are at when we eat a bacon sandwich. OK, so 34,000 people may die each year because of processed meat in their diet, but the odds are that it wont be you. I asked a series of cancer scientists whether they personally ate processed meat, and they all gave slightly different answers. Jill Pell said she was mostly vegetarian and ate processed meats very rarely. But when I asked Fabrice Pierre, a French expert on colon cancer and meat, if he eats ham, he replied: Yes, of course. But with vegetables at the same meal. (Pierres research at the Toxalim lab has shown him that some of the carcinogenic effects of ham can be offset by eating vegetables.)

Our endless doubt and confusion about what we should be eating have been a gift to the bacon industry. The cover-up about the harm of meat cured with nitrates and nitrites has been helped along by the scepticism many of us feel about all diet advice. At the height of the great bacon scare of 2015, lots of intelligent voices were saying that it was safe to ignore the new classification of processed meats as carcinogenic, because you cant trust anything these nutritionists say. Meanwhile, millions of consumers of ham and bacon, many of them children, are left unprotected. Perhaps the most extraordinary thing about this controversy is how little public outrage it has generated. Despite everything, most of us still treat bacon as a dear old friend.

In an ideal world, we would all be eating diets lower in meat, processed or otherwise, for the sake of sustainability and animal welfare as much as health. But in the world we actually live in, processed meats are still a normal, staple protein for millions of people who cant afford to swap a value pack of frying bacon for a few slivers of Prosciutto di Parma. Around half of all meat eaten in developed countries is now processed, according to researcher John Kearney, making it a far more universal habit than smoking.

The real victims in all this are not people like me who enjoy the occasional bacon-on-sourdough in a hipster cafe. The people who will be worst affected are those many on low incomes for whom the cancer risk from bacon is compounded by other risk factors such as eating low-fibre diets with few vegetables or wholegrains. In his book, Coudray points out that in coming years, millions more poor consumers will be affected by preventable colon cancer, as westernised processed meats conquer the developing world.

Last month, Michele Rivasi, a French MEP, launched a campaign in collaboration with Coudray demanding a ban of nitrites from all meat products across Europe. Given how vigorously the bacon industry has fought its corner thus far, a total ban on nitrites looks unlikely.

But there are other things that could be done about the risk of nitrites and nitrates in bacon, short of an absolute veto. Better information would be a start. As Corinna Hawkes points out, it is surprising that there hasnt been more of an effort from government to inform people about the risks of eating ham and bacon, perhaps through warning labels on processed meats. But where is the British politician brave enough to cast doubt on bacon?

Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read weekly email here.

Read more: https://www.theguardian.com/news/2018/mar/01/bacon-cancer-processed-meats-nitrates-nitrites-sausages

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There’s never been a better time to be single

“Marriage is a healthy estate,” British physician William Farr wrote in 1858, in one of the first studies to conclude that married people were better off than their single counterparts. “The single individual is more likely to be wrecked on his voyage than the lives joined in matrimony.”

The ensuing decades have done little to dissuade social scientists of their certainty that single people were doing themselves a disservice. Until now. In 2017, it was that conviction that got wrecked.
    As a psychologist, I study single people — their lives, their happiness, the stigma they face — and I can say that 2017 was a banner year for the publication of massive studies challenging what we thought we knew about their supposedly inferior life voyages.
    New insights just kept coming: on sex and dating, on self-esteem, on what it means to be an adult. And they came just in time: In recent history, there have never been as many unmarried adults as there are right now.
    Here are a half dozen of the coolest discoveries about single people from the year 2017.

    Demographically, single people are more powerful than ever before.

    In 2017, the Census Bureau reported that a record number of adults in the U.S. were not married. More than 110 million residents were divorced or widowed or had always been single; that’s more than 45 percent of all Americans aged 18 or older. And people who did marry were taking longer than ever to get there.
    The median age of first marriage rose to 29.5 for men; for women, it reached 27.4. (These trends are likely to continue: A report from the Pew Research Center a few years ago predicted that by the time today’s young adults reach the age of 50, about one in four of them will have been single all their life.)
    Living alone is also becoming more popular. Last summer, the Canadian press was abuzz with the news that for the first time in the nation’s history, more people were living in one-person households than in any other arrangement. In the U.S., the number of people living without a spouse or partner rose to 42 percent last year, up from 39 percent a decade ago.
    Individualistic practices like living alone aren’t just Western phenomena — they’ve gone global. In analyses of a half-century of data (1960-2011) from 78 nations around the world, psychology researcher Henri C. Santos and his colleagues found that the popularity of such practices grew significantly for 83 percent of the countries with relevant data. Individualistic beliefs, like valuing friends more than family, have also been on the rise, increasing significantly for 79 percent of the nations across the five decades.

    Marriage is no longer considered a key part of adulthood.

    A half-century ago, Americans who had not yet married wouldn’t be considered real adults. That’s no longer the case.
    According to a 2017 Census Bureau report, more than half of the participants in a nationally representative sample (55 percent) said that getting married was not an important criterion for becoming an adult. The same percentage also said that having a child was not an important milestone of adulthood.
    More important now is completing formal schooling and having full-time employment; 95 percent said that each of those criteria was at least somewhat important.

    High-schoolers aren’t as into dating — or sex.

    In a study published last fall, psychologists Jean M. Twenge and Heejung Park analyzed four decades’ worth of data (1976-2016) on the sex and dating experiences of more than 8 million students in the ninth through twelfth grades. The percentage of teens who had ever been on a date was lowest in the most recent years of the study. And along the same lines, the percentage who had had sex was at an all-time low in recent years.

    Single people are having more sex than married people.

    Moving past the teens and on to people 18 and older, the same holds true: Adults are having less sex than they used to. Analyzing survey data collected from more than 26,000 people between 1989 and 2014, researchers found that the average person now has sex around nine fewer times per year than the average person in the early ’90s.
    But not all groups followed the same sexual trajectory — the drop was especially pronounced for the people who were married or divorced, compared to people who had always been single. In fact, according to one of several ways of looking at the data, singles are now having sex more often than married people are.
    And then there are people that aren’t having sex at all. The idea that there are some people who just do not experience sexual attraction has a more prominent place in our cultural consciousness today, something for which the the Asexual Visibility and Education Network (AVEN), founded in 2001, gets much of the credit.
    By 2017, there was enough research on asexuality, including large-scale studies, to justify a review article in the Archives of Sexual Behavior. Defying the early skepticism on the topic, authors Lori A. Brotto and Morag Yule concluded that asexuality is a unique sexual orientation, one that applies to up to 3 percent of adults, and not a sexual dysfunction or psychiatric disorder.

    A relationship doesn’t mean higher self-esteem …

    As teens shrug at the idea of dating and adults put off or skip marriage altogether, skeptics might wonder, aren’t they all missing out on that boost of self-esteem that comes from “having someone”?
    Not really. In a landmark study on the link between romantic relationships and self-esteem, researchers Eva C. Luciano and Ulrich Orth studied more than 9,000 adults in Germany as they entered or ended romantic relationships or stayed single. Their conclusion: “Beginning a relationship improves self-esteem if and only if the relationship is well-functioning, stable, and holds at least for a certain period (in the present research … one year or longer).”
    People who started new romantic relationships that failed to last a year ended up with lower self-esteem than the people who stayed single. There was nothing magical about marriage, either; people who married enjoyed no better self-esteem than those who stayed in romantic relationships without tying the knot.

    … and marriage doesn’t mean better health.

    Part of the mythology of marriage, long bolstered by the writings of social scientists, is that people who marry become healthier than they were when they were single. After all, the logic goes, married couples get all that loving support from each other, and they make sure their spouses are taking care of themselves. But three big methodologically sophisticated studies published in 2017 shook our faith in that idea.
    In one of the studies, researchers followed more than 79,000 U.S. women between the ages of 50 and 79 over a three-year period, tracking whether they got married (or started a serious relationship), stayed married, got divorced or separated, or stayed single. Author Randa Kutob and her colleagues also took repeated physical measurements of the women’s waist size, body-mass index, and blood pressure, and asked them about their smoking, drinking, exercise, and eating habits.
    With just one exception, every significant finding favored the women who either stayed single instead of marrying, or who got divorced instead of staying married. For example, the women who married gained more weight and drank more than those who stayed single.
    The women who divorced ate healthier, exercised more, and had smaller waists than the women who stayed married. (The one exception was that the women who divorced were more likely to start smoking than the women who stayed married.)
    In the second study, a 16-year survey of more than 11,000 Swiss men and women, the people who married reported slightly worse overall health than they had when they were single, even taking into account changes in health that often occur with age. And in the third study, sociologist Dmitry Tumin surveyed more than 12,000 adults in the U.S. who got married for the first time to see if they described their general health as better after they married or better when they were single.
    He broke down the data several ways: He examined men’s marriages separately from women’s; he conducted separate analyses of the marriages of people born in different decades; he evaluated marriages that lasted for different lengths of time.
    In all the scenarios he looked at, with one exception, the people who got married never reported being healthier. The exception was for the oldest women (born between 1955 and 1964) whose marriages lasted at least ten years, who considered themselves slightly healthier.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    It’s a powerful blow — one of many — against the notion that marriage is the ideal way to live. For a long time, we’ve accepted the idea that unless they hurry up and marry, single adults will stay sexless and unhappy until they die (and sooner, at that).
    But it seems single people don’t scare so easily anymore — in unprecedented numbers, they are going ahead and living their single lives, which are often healthier and more fulfilling than those of their coupled counterparts. In 2017, finally, the weight of the scientific evidence from the most sophisticated studies was on their side.

    Read more: http://www.cnn.com/2018/01/05/health/single-people-partner/index.html

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    Radical new approach to schizophrenia treatment begins trial

    Exclusive: as evidence emerges that schizophrenia could be an immune system disease, two-year trial will use antibody drug currently used for MS

    British scientists have begun testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system.

    The first patient, a 33-year old man who developed schizophrenia after moving to London from Cameroon a decade ago, was treated at Kings College Hospital in London on Thursday, marking the start of one of the most ambitious trials to date on the biology of the illness and how to treat it.

    During the next two years, 30 patients will receive monthly infusions of an antibody drug currently used to treat multiple sclerosis (MS), which the team hopes will target the root causes of schizophrenia in a far more fundamental way than current therapies.

    The trial builds on more than a decades work by Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley Hospital in south London. Howess team is one of several worldwide to have uncovered evidence that abnormalities in immune activity in the brain may lie at the heart of the illness for some patients, at least.

    In the past, weve always thought of the mind and the body being separate, but its just not like that, said Howes. The mind and body interact constantly and the immune system is no different. Its about changing the way we think about mental illnesses.

    Recent work by Howes and colleagues found that in the earliest stages of schizophrenia, people experience a surge in the number and activity of immune cells in the brain. As well as fighting infection, these cells, called microglia, have a gardening role, pruning unwanted connections between neurons. But in schizophrenia patients, the pruning appears to become more aggressive, leading to vital connections being lost.

    We studied people in that [initial] phase of the illness and saw microglial changes, said Howes. It shows that its something [happening] very early on and seems to be driving the illness.

    The most extensive pruning appears to occur in the frontal cortex, the brains master control centre, and also the auditory regions, which could explain why patients often hear voices. The frontal cortex indirectly controls the brains levels of dopamine a surge in this brain chemical is thought to explain the delusions and paranoia experienced by those with schizophrenia.

    Nearly all existing medications work by blocking dopamine, which can bring psychotic symptoms under control, but fail to protect the brains basic architecture from damage.

    The current drugs are based on 1950s technology; they all still work in exactly the same way, said Howes. They are only able to target the delusion side of things. Its like getting a sledgehammer and squashing it down.

    Microglial
    Microglial cells, outlined in green stain, have thin processes that reach out around brain cells, stained in red. Photograph: Bloomfield et al

    There is a growing appreciation that other, perhaps less well-known, symptoms associated with schizophrenia memory and cognitive problems, and lack of motivation can have an equally profound impact on patients, and existing drugs do little to help this side of the disease. Its typically [these other] symptoms that are the most disabling, said Toby Pillinger, a psychiatrist and Kings College London researcher involved in the study.

    The latest trial, a collaboration between MRC scientists and Kings College London, involves treating patients with a monoclonal antibody drug, called Natalizumab, that is already licensed for MS. In MS, the brains immune cells go awry by attacking a different aspect of the brains wiring. And although the diseases manifest in very different ways, apparent parallels in the underlying biology raise the possibility that the MS drug might help schizophrenia patients.

    The drug works by targeting microglia and restricting their movement around the brain, which scientists hope could prevent the over-pruning of vital connections. In doing so, it could potentially address the diseases full spectrum of symptoms.

    The first participant, Leopold Fotso, 33, received his first dose of treatment on Thursday. Fotso, who lives in south London after moving from Cameroon in 2007, was diagnosed with schizophrenia four years ago. He has been admitted to hospital several times with psychotic episodes. His illness also forced him to abandon his studies in accountancy which he had moved to the UK to pursue and his part-time kitchen job.

    Leopold
    Leopold Fotso undergoes the first treatment of a new therapy for schizophrenia. Photograph: Teri Pengilley for the Guardian

    He currently has monthly injections of an antipsychotic drug, and his condition is now stable. He feels on the way to being himself again and is looking to slowly start working again. Its quite hard, he said.

    At some time during their life about 1 in 100 people will suffer an episode of schizophrenia. In the UK, about 220,000 people are being treated for the condition by the NHS at any one time.

    In total, in this first trial, 60 patients will be treated for three months, attending clinic once a month for hour-long infusions half will receive the antibody, half a placebo. The patients symptoms will be tracked and, along with 30 healthy volunteers, they will be given a series of brain scans, cognitive assessments and tests of immune activity. The hope is that, even if symptoms do not improve, the study should also answer fundamental questions about the role of the immune system in the illness.

    Belinda Lennox, senior clinical lecturer in psychiatry at the University of Oxford, whose work also focuses on the role of the immune system in schizophrenia, said the concept behind the latest study was exciting although at a very experimental stage. Theres a lot of emerging evidence that the immune system is going wrong [in schizophrenia], she said. If reducing inflammation acts to improve psychosis in this study it will open a new range of treatment possibilities, which is very exciting for the field, and desperately needed.

    Read more: https://www.theguardian.com/society/2017/nov/03/radical-new-approach-to-schizophrenia-treatment-begins-trial

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    Do not give your dog bone treats. They could be deadly, the FDA says

    (CNN)It’s understandable that you’d want to pamper your pooch. But if you’re doing so with bone treats, you’re actually risking its life.

    Bone treats are real bones that have been dried, flavored and packaged for dogs, the FDA says. They’re a fixture in pet stores.
    Although the treats might seem like they make good stocking stuffers, they pose serious health risks.
      In the FDA’s reports, pet owners and veterinarians said dogs that ate these bones experienced blockages in the digestive tract, choking, cuts, vomiting, diarrhea and in extreme cases, death. About 15 dogs died.
      “Giving your dog a bone treat might lead to an unexpected trip to your veterinarian, a possible emergency surgery, or even death for your pet,” veterinarian Carmela Stamper said in the published warning.
      Besides the warning, the FDA also provided extra tips for keeping Fido safe:
      • Chicken bones and other bones from the kitchen table can also cause injury when chewed by pets. So be careful to keep platters out of reach when you’re cooking or the family’s eating.
      • Be careful what you put in the trash can. Dogs are notorious for helping themselves to the turkey carcass or steak bones disposed of there.
      • Talk with your veterinarian about other toys or treats that are most appropriate for your dog. There are many available products made with different materials for dogs to chew on.

      Read more: http://www.cnn.com/2017/11/28/health/dog-bone-treats-hazard-trnd/index.html

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      About 1 million Americans without running water. 3 million without power. This is life one month after Hurricane Maria.

      Puerto Rico (CNN)After Hurricane Maria toppled the bridge that connects him to the rest of civilization and ripped the roof and walls off his house here in the central mountains of Puerto Rico, Ramn Sostre raised a weathered American flag above the wreckage.

      It worked, if temporarily. Helicopters came. So did a tarp, food and bottled water.
      Yet little else has changed. His roof is still missing, as are some walls. He and his cat, Tipo, sleep in the kitchen. When the wind blows at night, rain soaks them. The power is out, as it is for roughly 3 million Puerto Ricans, or more than 80% of the island’s residents. More than a thirdof households in the US territory, including much of Sostre’s community, are without reliable drinking water at home. That’s roughly 1 million American citizens.
      One month after Hurricane Maria, these realities are starting to feel less like an emergency and more like the new way of life — a nightmarish loop that resets each day the sun rises.
      “You wake up and it’s this mess as far as the eye can see,” Sostre told me.

      Much of the island feels like it was hit by a storm yesterday

      The US government says it is committed to helping Puerto Rico but is confronted with challenging circumstances, including some roads that are narrow, muddied and impassable for large aid-delivery vehicles. There also are pre-existing problems with power and water systems. Puerto Rico is “an island sitting in the middle of an ocean … a very big ocean,” as President Donald Trump said on September 26, making Hurricane Maria more distant than two other recent storms that hit the US mainland, Hurricanes Harvey and Irma.
      After traveling the island for three days, however, and conducting interviews with residents and federal officials and experts, it’s clear the level of suffering is far outpacing relief.
        Much of the island feels as if it were hit by a storm yesterday, not one month ago. Mountains are covered in branchless trees, stuck in the dirt like the walking sticks of giants. Power lines are tangled about like spaghetti dropped from the sky. Sheet metal from roofs and fencing has been turned into floppy strips of chewing gum, scattered on the hills. Not only are people such as Sostre exposed to the elements, but supplies of clean drinking water are woefully inadequate and environmental health experts fear a public health emergency could be brewing.
        On Tuesday, the Federal Emergency Management Agency, or FEMA, said it had 1,700 personnel deployed in Puerto Rico and the US Virgin Islands, which also were hit by Hurricane Maria. Yet nearly 2,600 FEMA staff — about 900 more — remain deployed to Hurricane Harvey, nearly two months after that storm hit the Gulf Coast of the mainland United States.
        In their defense, FEMA officials point out also that 20,000 other federal staff and military have been deployed to respond to Hurricane Maria.
          “(P)lease understand that every disaster is different geographically and demographically and there is no point of comparison from one to the other. Numbers are a snapshot in time for any given day; it is like comparing apples to oranges,” FEMA said in an emailed statement. “Please note that numbers do not save or improve lives, missions and progress do; for example, (Texas) may need more people to support housing, while (Puerto Rico) may need more generators and poles to support the grid.”
          Others see it differently.
          “I thought we’d learned our lesson after (Hurricane) Katrina where the response was awful, both carelessly slow and incompetent,” said John Mutter, a professor at Columbia University and an expert in international disaster relief. “In Puerto Rico, it doesn’t look like we’ve learned anything at all — or we just don’t care.”

          ‘If I don’t drink water, I’m going to die’

          The situation is particularly bad when it comes to water.
          There are 3.4 million people in Puerto Rico, and about 35% of households were without access to safe drinking water as of Tuesday, according to government estimates. The World Health Organization says each person needs at least 2.5 liters per day for drinking alone, with a recommended daily allotment of up to 15 liters per dayincluding basic cooking and hygiene.
          Yet FEMA has provided 23.6 million liters — 6.2 million gallons — of bottled water and bulk water since the storm hit on September 20, said Justo Hernandez, FEMA’s deputy federal coordinating officer. That includes water delivered to hospitals and dialysis centers, he said.
          That’s only roughly 9% of the drinking water needs for the entire territory.
          It’s an even smaller fraction if you include basic cooking and hygiene needs.
            “The potential for cholera and diarrheal diseases is quite high” without bottled water, said Mutter, the disaster recovery expert at Columbia in New York, who recommended the WHO standard. “What you will get is contaminated wells and surface water. It’s a situation where you really should be drinking bottled water. If you can’t get bottled water … that’s trouble.”
            Volunteer groups and nonprofits also are helping with supplies. FEMA says it has distributed drinking-water purification tablets and deployed six mobile-filtration systems. And there are efforts to distribute water-purification tablets and to tell locals who can’t find bottled water either to boil the water or add bleach or water-purification tablets.
            But many residents remain desperate, week after week, for drinking water.
            Lines for water — potable or not — are long in many parts of the island. Rumors of contamination are rampant. Even as some taps turn back on, residents worry about drinking from faucets, which sputter and, in some locations, produce hazy liquid. Autoridad de Acueductos y Alcantarillados, the water utility in Puerto Rico, says on its website that residents should boil the water and add bleach even after service is restored.
              In Dorado, near the capital, San Juan, people are so desperate for water they’ve turned to a federal hazardous-waste site in search of something to drink. CNN has reported that people are breaking through a fence marked “danger” to pull water from a Superfund site in an area known to be contaminated with industrial chemicals linked to cancer. It’s unclear if the wells are unsafe for public health; the Environmental Protection Agency is conducting water tests on wells on the Superfund site.
              “If I don’t drink water, I’m going to die. So I might as well drink this water,” one resident said.

              ‘There is a public health crisis here’

              One afternoon, I met Wilfredo Santiago while he was collecting water from a spout along Highway 10. The area smelled something like a pet store, and Santiago told me there likely are dead squirrels, rats and horses in the hills.
              Santiago knows it may be unsafe, but his 9-year-old daughter bathed in the water stream while he filled up a number of plastic bottles with the liquid. A line of cars waited to do the same. He took the water home to an apartment complex in Utuado, an interior city. On the floor in the kitchen, there were 37 jugs of the stuff, bottled in containers meant for Sprite, Pepsi and cranberry juice. The family collects water from a gutter to flush the toilet. There’s no running water here, and bottled water is expensive and hard to come by, he told me. The grocery store in town had none. Deliveries to the area by government officials come infrequently, he said.
              Across the street is the municipal emergency management office, which helps distribute FEMA aid. Héctor Cruz Cruz, its director, told me everyone in that complex is fine — they all get bottled water delivered through the complex’s manager. He disputed the claims of Santiago and about a half-dozen of his neighbors who said they are short on water and often struggle to find it.
              “It’s dangerous,” Santiago told me, referring to drinking and bathing with water from the mountains, “but we have no choice.”
              All of this is concerning to public health experts.
              “Our biggest worry is that as people get desperate and sort of give up on safe water sources that they are going to rely on things like streams and pipes that just come out of a spring or a mountain,” said Erik Olson, head of the health program at the Natural Resources Defense Council, an environmental group. “It’s just really a desperate situation.”
              “There is a public health crisis here,” Catherine Kennedy, a vice president at National Nurses United, said from Puerto Rico. “They need water. And we haven’t seen much of FEMA.”

              ‘I step out of my bed and there’s water’

              Hernandez, the FEMA official, said this relief effort is “a marathon,” not a sprint.
              But President Donald Trump already is emphasizing the finite nature of federal attention.
              “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!” Trump tweeted on October 12.
              Carmen Rivera Rodriguez, a 55-year-old resident of “P.R.,” didn’t see that tweet. She has heard next to nothing about Trump or the federal response to this storm. When we met outside a supermarket in Comerío, about 20 miles southeast of Sostre and his American flag, she told me she hasn’t even been able to reach her sonin the mainland United States because there’s virtually no cellular service here — 75% of antennas are down — and she doesn’t have a car.
              Rivera was wearing a cast on her left arm.
              She fell while trying to sweep rain out of her living room.
              That was October 11 — 21 days after the storm.
              Rivera invited me to her home, which is on a cleared and accessible road on the side of a mountain. When you step inside the house, your foot splashed in inch-deep water, sending ripples throughout the home across linoleum floors. This is what she was scraping with a squeegee when she slipped and fell. Her roof is gone, except for over the kitchen and a small garage, where she sleeps. And it rains most afternoons here, lately. “Just imagine. I step out of my bed and there’s water. I go to the bathroom and I have to bring an umbrella,” she said.
              The same week Trump visited Puerto Rico, throwing paper towels to hurricane victims on October 3, Rivera told me she heard a truck driving by her home with loudspeakers blaring what seemed like good news: US government workers would be in town tomorrow.
              The next morning, she said, she awoke at 4 and hitched a ride into the valley so she could apply for a tarp to stop it from raining indoors. Mold is growing on a baby picture of her now-grown son, which hangs on the plywood wall of her living room.
              Her right eye is pink and puffy, which she figures is a symptom of being damp for one month.
              She waited in line for hours and filled out a government form, she said.
              As of October 15, 25 days after the storm, the tarp hadn’t come.
              FEMA has distributed 38,000 tarps on the island, said Hernandez, the FEMA official.
              The need for roofing help is estimated at 60,000 homes, he said.

              ‘Soy americano’

              Puerto Rico is part of America and yet it isn’t.
              It’s a territory of the richest nation on Earth — a country founded in opposition to colonialism. It’s a place where the federal government oversees a financial crisis and controls certain aspects of commerce and shipping, but where Americans can’t cast ballots in presidential general elections, and where the island’s one representative in Congress can’t vote, either.
              Sostre, the man who was trapped on the other side of a broken bridge, was right to fly the Stars and Stripes above his home and to say, “Soy americano,” or “I’m an American.”
              Rivera, for her part, doesn’t think much about the politics.
              She only wants to stay safe and dry.
              Nights have been the hardest, she said as darkness fell over her neighborhood and the island’s coquí frogs began their electronic chorus. Rain splashed on the floor as she talked. The situation is so bad Rivera prays to God asking that if another storm comes, she won’t survive it.
              “I’m not ready to live through something like that again,” she said, crying.
              The truth is she’s still living it.

              Read more: http://www.cnn.com/2017/10/18/health/puerto-rico-one-month-without-water/index.html

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              Hookworm, a disease of extreme poverty, is thriving in the US south. Why?

              Exclusive: in America, the worlds richest country, diseases that thrive amid poverty are rampant, the first study of its kind in modern times shows

              Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.

              These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.

              Scientists in Houston, Texas, have lifted the lid on one of Americas darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the worlds poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago.

              The long-awaited findings, revealed by the Guardian for the first time, are a wake-up call for the worlds only superpower as it grapples with growing inequality. Donald Trump has promised to Make America Great Again and tackle the nations crumbling infrastructure, but he has said very little about enduring chronic poverty, particularly in the southern states.

              The study, the first of its kind in modern times, was carried out by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit group seeking to address the root causes of poverty. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic traces of Necator americanus.

              Lowndes

              The parasite, better known as hookworm, enters the body through the skin, usually through the soles of bare feet, and travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host. Over months or years it causes iron deficiency and anemia, weight loss, tiredness and impaired mental function, especially in children, helping to trap them into the poverty in which the disease flourishes.

              Hookworm was rampant in the deep south of the US in the earlier 20th century, sapping the energy and educational achievements of both white and black kids and helping to create the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it had disappeared altogether by the 1980s.

              But the new study reveals that hookworm not only survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. None of the people included in the research had travelled outside the US, yet parasite exposure was found to be prevalent, as was shockingly inadequate waste treatment.

              The peer-reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, Alabama the home state of the US attorney general, Jeff Sessions, and a landmark region in the history of the nations civil rights movement. Bloody Lowndes, the area was called in reference to the violent reaction of white residents towards attempts to undo racial segregation in the 1950s.

              It was through this county that Martin Luther King led marchers from Selma to Montgomery in 1965 in search of voting rights for black citizens, More than half a century later, Kings dream of what he called the dignity of equality remains elusive for many of the 11,000 residents of Lowndes County, 74% of whom are African American.

              Raw
              Raw sewage is carried through a PVC pipe to be dumped only a few yards away from a nearby home. Photograph: Bob Miller for the Guardian

              The average income is just $18,046 (13,850) a year, and almost a third of the population live below the official US poverty line. The most elementary waste disposal infrastructure is often non-existent.

              Some 73% of residents included in the Baylor survey reported that they had been exposed to raw sewage washing back into their homes as a result of faulty septic tanks or waste pipes becoming overwhelmed in torrential rains.

              The Baylor study was inspired by Catherine Flowers, ACREs founder, who encouraged the Houston scientists to carry out the review after she became concerned about the health consequences of having so many open sewers in her home county. Hookworm is a 19th-century disease that should by now have been addressed, yet we are still struggling with it in the United States in the 21st century, she said.

              Our billionaire philanthropists like Bill Gates fund water treatment around the world, but they dont fund it here in the US because no one acknowledges that this level of poverty exists in the richest nation in the world.

              Flowers took the Guardian on a tour of Lowndes County to witness the conditions in which hookworm continues to proliferate. One stop was at a group of mobile homes outside Fort Deposit that graphically illustrated the crisis.

              An eight-year-old child was sitting on the stoop of one of the trailers. Below him a white pipe ran from his house, across the yard just a few feet away from a basketball hoop, and into a copse of pine and sweet gum trees.

              The pipe was cracked in several places and stopped just inside the copse, barely 30ft from the house, dripping ooze into a viscous pool the color of oil. Directly above the sewage pool, a separate narrow-gauge pipe ran up to the house, which turned out to be the main channel carrying drinking water to the residents.

              The open sewer was festooned with mosquitoes, and a long cordon of ants could be seen trailing along the waste pipe from the house. At the end of the pool nearest the house the treacly fluid was glistening in the dappled sunlight a closer look revealed that it was actually moving, its human effluence heaving and churning with thousands of worms.

              Ruby
              Ruby Dee Rudolph, 66, noticed her septic tank was slowly sinking unevenly into the ground. Photograph: Bob Miller for the Guardian

              This is the definition of Make America Great Again, said Aaron Thigpen, 29, a community activist who assisted with the hookworm study. This is the reality of how people are being forced to live.

              Thigpens cousins live in the trailer park, and he has talked to them about the perils of piping sewage from their homes and dumping it in the open just a few feet away. They are disgusted about it, theyre sick and tired of living like this, but theres no public help for them here and if youre earning $700 a month theres no way you can afford your own private sanitation.

              He added that people were afraid to report the problems, given the spate of criminal prosecutions that were launched by Alabama state between 2002 and 2008 against residents who were open-piping sewage from their homes, unable to afford proper treatment systems. One grandmother was jailed over a weekend for failing to buy a septic tank that cost more than her entire annual income.

              People are scared. They dont like to speak out as theyre worried the health department will come round and cause trouble, Thigpen said.

              The challenge to places like Lowndes County is not to restore existing public infrastructure, as Trump has promised, because there is no public infrastructure here to begin with. Flowers estimates that 80% of the county is uncovered by any municipal sewerage system, and in its absence people are expected and in some cases legally forced to provide their own.

              Even where individuals can afford up to $15,000 to install a septic tank and very few can the terrain is against them. Lowndes County is located within the Black Belt, the southern sweep of loamy soil that is well suited to growing cotton and as a result spawned a multitude of plantations, each worked by a large enslaved population.

              The same thing that made the land so good for cotton its water-retaining properties also makes it a hazard to the thousands of African Americans who still live on it today. When the rains come, the soil becomes saturated, overwhelming inadequate waste systems and providing a perfect breeding ground for hookworm.

              Ruby Rudolph lives just beside the main Selma to Montgomery road where King led the protest walk. On the other side of the road theres a brown history placard to mark the spot where her grandmother, Rosie Steele, ran a campsite for the weary marchers.

              After they moved on and the campsite was cleared, Rudolph said, her grandmothers grocery store was set on fire in an arson attack. She was 13 at the time, and can remember the flames leaping into the night sky.

              Rudolph, now 66, does have her own septic tank at the back of her house, which she shows us in the sweltering 41C (105F) heat. But it doesnt function properly and when it rains the tank spills over, spreading raw waste all over the yard. Thats better than when it flushes back into the house, and Ive had that too, she said.

              Shes been told a replacement system would cost her at least $12,000, which is beyond her means. She runs through her finances: she gets up at 4am every day to do an early shift at a Mapco convenience store, which brings in less than $1,200 a month. From that amount she has to pay $611 for her mortgage and theres the electricity bill that can be more than $300 a month when its hot and the air conditioning is busy. Theres not a lot left to put toward a new tank.

              Perman
              Perman Hardy, 58, stands with her grandson Carlos near the pipes that carry sewage from a relatives nearby trailer home into the woods, approximately 30ft from the back door. Photograph: Bob Miller for the Guardian

              Perman Hardy, 58, lives in nearby Tyler in a collection of seven single-storey homes all occupied by members of her extended family. Only two of them have septic tanks, the rest just pipe raw waste into the surrounding woods and creeks.

              Hardy is one of the lucky ones with a treatment system of her own, but like Rudolphs it is often overwhelmed in the rains with faeces washed back into her home. Last year the stench was so bad she had to vacate the property for two weeks over Christmas while it was professionally cleaned.

              Hardy has traced her family back to slaves held on the Rudolph Bottom plantation about five miles away. The road that leads to the old plantation from her house is still called to this day by white neighbors Nigger Foot Road, she said, though she and other African Americans call it Collerine Cutoff Road.

              As a child, Hardy worked in the cotton fields after school and, mindful of that and her familys slave history, shes determined to see a better future for her grandchildren. I dont want the same for my boys. But its still a struggle. Its the 21st century and we shouldnt be struggling like we still are today.

              The daily hardship faced by Hardy, Rudolph and fellow inhabitants of Lowndes County is reflected in the Baylor studys glaring statistic of 34% testing positive for hookworm. The sample size was low 67 people participated with 55 giving stool samples, all of whom were African American but the results are so stark that the Houston scientists now want to conduct a larger survey across the region.

              We now need to find how widespread hookworm is across the US, said Dr Peter Hotez, dean of the National School of Tropical Medicine, who led the research team along with Rojelio Mejia. Hotez, who has estimated that as many as 12 million Americans could be suffering from neglected tropical diseases in poor parts of the south and midwest, told the Guardian the results were a wake-up call for the nation.

              This is the inconvenient truth that nobody in America wants to talk about, he said. These people live in the southern United States, and nobody seems to care; they are poor, and nobody seems to care; and more often than not they are people of color, and nobody seems to care.

              Read more: https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty

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              Australian bodybuilder with rare disorder dies eating high-protein diet

              (CNN)Meegan Hefford, a 25-year-old bodybuilder, was found unconscious on June 19 in her Mandurah, Western Australia, apartment, according to CNN affiliate Australia News 7.

              Days later, Hefford was pronounced dead. Only after her death did her family learn that Hefford, the mother of a 7-year-old girl and a 5-year-old boy, had a rare genetic disorder that prevented her body from properly metabolizing her high-protein diet.
              Urea cycle disorder, which causes a deficiency of one enzyme in the urea cycle, stops the body from breaking down protein, according to the nonprofit National Urea Cycle Disorders Foundation.
                Normally, the body can remove nitrogen, a waste product of protein metabolism, from the blood. However, a urea cycle disorder would prohibit this.
                Therefore, nitrogen, in the form of toxic ammonia, would accumulate in the blood and eventually reach the brain, where it can cause irreversible damage, coma and death.
                “The enzyme deficiency can be mild enough so that the person is able to detoxify ammonia adequately — until there’s a trigger,” said Cynthia Le Mons, executive director of the foundation. The trigger could be a viral illness, stress or a high-protein diet, she added.
                “There was just no way of knowing she had it because they don’t routinely test for it,” said Michelle White, Hefford’s mother and a resident of Perth. “She started to feel unwell, and she collapsed.”
                White blames protein shakes for her daughter’s death.

                ‘Nuanced symptoms’

                Since 2014, Hefford, who worked at Princess Margaret Hospital for Children and studied paramedicine, had been competing as a bodybuilder.
                It was only after Hefford’s death that White discovered containers of protein supplements in her daughter’s kitchen, along with a strict food plan. White understood then that her daughter, who had been preparing for another bodybuilding competition, had also been consuming an unbalanced diet.
                Hefford was eating “way too much protein,” said White, which triggered her daughter’s unknown urea cycle condition. (For most healthy people, a high-protein diet, when followed for a short time, generally isn’t harmful, according to the Mayo Clinic.)
                Hefford’s diet included protein-rich foods, such as lean meat and egg white, in addition to protein shakes and supplements, her mother said.
                “There’s medical advice on the back of all the supplements to seek out a doctor, but how many young people actually do?” White asked.
                Le Mons said, “typically, there are nuanced symptoms that just go unrecognized” with mild cases of urea cycle disorder. Symptoms include episodes of a lack of concentration, being very tired and vomiting.
                “Sometimes, people think it’s the flu and might even go to the ER thinking they have a really bad flu,” Le Mons said, adding that a simple serum ammonia level test, which can detect the condition, is not routinely done in ERs.
                It’s unclear whether Hefford suffered symptoms of her condition. White, who hopes her daughter’s story will serve as a warning to help save lives, believes protein supplements need more regulation.
                The Australian Medical Association says there’s no real health benefit to such supplements. And, while they may not be necessary for most people, they’re not dangerous to most, either.

                Treatment

                The estimated incidence of urea cycle disorders is 1 in 8,500 births. Since many cases remain undiagnosed, the exact incidence is unknown and believed to be underestimated.
                “There’s a myth that this disorder only affects children,” Le Mons said, noting that one patient reached age 85 before diagnosis.
                Regarding Hefford, Le Mons said that “this is not the first time this has happened.” Other athletes, who like Hefford were unaware of their condition, have died when a high-protein diet triggered their condition.

                See the latest news and share your comments with CNN Health on Facebook and Twitter.

                Though there is no cure for urea cycle disorder, a balanced diet is all that is needed for some patients, according to the National Urea Cycle Disorders Foundation.
                Treatment may include supplementation with special amino acid formulas, while in some more severe cases, one of two forms of an FDA-approved drug may be prescribed. When these therapies fail, liver transplant may become necessary.

                Read more: http://www.cnn.com/2017/08/15/health/australian-body-builder-death-protein-shakes/index.html

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                Life after losing everything in the Grenfell fire

                London (CNN)The tower looms over West London, a stark reminder of the tragedy that took place three weeks ago.

                Miguel Alves stares up at the 13th floor, his face falling as he points out his home — now hardly recognizable.
                Empty spaces highlight where windows were once fixed. On the windowsill sits what he says look like the remains of vases, but without the flowers he used to tend.
                Gone are the small treasures from raising his family of four.
                Alves recalls how he would stare out of these windows, rather than up at them, looking down on the neighborhood as he stood his kitchen.
                “It was my palace. … I was happy there,” Alves said.
                Now, life has become a surreal sequence of events, a haze in which he and his family simply push through in hopes of moving on and rebuilding their lives.
                “It’s like a dream that I didn’t wake up (from) yet,” the 49-year-old said.
                But he also feels lucky, because his whole family managed to escape the inferno that destroyed the building and killed scores of his neighbors.
                “A lot of people, they didn’t have my luck to come out in time, and I feel for them,” he said.
                The fire, which started on June 14 in a refrigerator on the fourth floor,hasclaimed at least 80 lives, according to the UK’s Metropolitan Police.

                Blessings of fate

                The night of the fire, Alves and his wife, Fatima, had dinner with family members visiting from out of town — something that was unusual for them. They returned home about 1 a.m., just as the fire began, and shared the elevator with someone who just happened to press the button forthe fourth story up.
                  As the doors opened, they saw smoke seeping into the hallway from the burgeoning blaze.
                  Sending his wife back to the car to get his phone, Alves walked up the remaining nine floors to his apartment and collected his two children Tiago, 20, and Ines, 16, to get them all outside, just in case the fire grew worse.
                  They now believe the events of that night were a miracle, with fate ensuring that they saw the signs to make an early escape. They escaped with just a phone, his son’s wallet and his daughter’s school notes. She went on to take her exam the next day.
                  But now, three weeks later, it hurts coming back to his home, he said, seeing his former palace destroyed. “It’s difficult to cope,” he said.
                  Despite the pain, Alves comes back every day, he admits, on autopilot mostly, having returned here every day for the past 19 years. “It’s automatic. The first thing I do is come around here. … It’s still my home.”

                  Life in limbo

                  Leaving the tower behind, Alves goes to his current home: a small hotel room.
                  His family resides here with more than 10 other residents of the tower block while the local council government works to rehouse the hundreds left homeless.
                  Alves has lived here for just over two weeks, sharing a room with his wife while their two children sleep in a room on another floor.
                  “We need to feel as a family,” he said. “To talk to (our kids), we have to ask them to come to our room or we go to their room, and that is not ideal.”
                  Just a few clothes fill the wardrobe and a small suitcase that sits on the floor.
                  “We have lost everything, even small socks that we like the most or a pair of shoes we are missing from everyday life,” Alves said.
                    The desk is littered with snacks, breakfast bars and water for emergencies, as they live without a kitchen in which to cook the meals they now crave.
                    “We need to … sit and have dinner together on our own, not with other people,” he said.
                    Alves says the family has been fortunate in that they belong to a strong Portuguese community and are active members of their church. They do not need to eat out but are instead hosted most evenings by close friends in the area.
                    But life is still far from what anyone would desire.
                    “It’s not the same thing to have our own family dinners and talk about small things that are important for life,” he said.
                    It’s clear the Alves family is very close.
                    Tiago has been helping with the extensive paperwork needed to get their lives back in order. He is on summer break from college, where he is working toward a degree in physics. Ines is also on her summer break from high school.
                    Alves has returned to work as a chauffeur, which he said has helped him cope by carrying on with life, retaining some normalcy. His wife Fatima, 47, has yet to returnto work as a maid and instead spends her days handling the endless minutiae of living away from and securing their home.
                    She leaves the hotel with bags of laundry to take to friends’ houses. At other times, she is swapping belongings from the hotel room with those kept with friends to prevent their hotel rooms from becoming cramped. Most of these belongings come from donations made to shelters during the first days after the fire.
                    “I have so many things to do: sorting out clothes, toiletries … and going to meetings,” Fatima Alves said.
                      For her, religion and friends have been key in helping with the events of the past few weeks. Rosary beads, which she uses three times a day, sit by the bed in her hotel room.
                      Research has found strong evidence linking religion to better mental health, not due to any specific kind of belief but instead the mere existence of it — something giving people hope, support and perhaps even fuel to live a healthier lifestyle.
                      Since the fire, neither parent has been sleeping well, averaging just four hours most nights.
                      “When I close my eyes, I can see the people waving on the windows,” she said. “This is my trauma. Not seeing my flat burning. … The worst part was people begging for help … and we couldn’t do anything.”
                      Alves experiences the same vivid recall and wakes up anxious most nights. “It’s difficult to see those types of images,” he said.
                      But once his eyes are open and the day begins, his priority is moving forward and doing whatever it takes to give his family a home, a life.
                      “The most important thing is to move on and put all that behind our back,” Alves said, explaining that he will be able to process the shock once his family’s lives are back in some form of order. “This is something I never will forget.”

                      Psychological first aid

                      When, like the Alveses, a family is left with only the most meager belongings, there is no way to predict how they will deal with the sudden change in situation.
                      “No two people respond the same. … There isn’t a single answer,” said Sir Simon Wessely, immediate past president of the Royal College of Psychiatrists and professor of psychiatry at Kings College London. “People often have strength and depths in these events.”
                        For Alves, humor has always been a lifeline, helping him stay positive whatever the situation. Jokes are frequent as he describes his life now. “A sense of humor helps me to carry on. … It’s something for myself to cope.”
                        The Royal College of Psychiatrists has led a range of research on how best to respond and offer mental support to people who have gone through extreme events, such as the 2005 London bombings.
                        Wessely explained that there is a general order of interventions that response teams should follow: checking and confirming that people are safe; aiding communication between those affected by the incident, such as by providing mobile phones; and finally, practical and emotional support, to get them home or to a safe place, to retrieve some belongings or simply to offer frequent hugs and cups of tea.
                        Some experts include these common-sense measures as part of the “psychological first aid” deployed after disasters, which aims to help people manage the immediate stress and hopefully prevent post-traumatic stress disorder down the line.
                        Doing any more, experts say, may not be worth it.
                        “The vast majority of people in any such disaster do fine; that’s the good news,” said Dr. Robert Ursano,chairman of the American Psychiatric Association’sCommittee on Psychiatric Dimensions of Disasters. “The problem is, you have to intervene with so many people in order to prevent one or two cases.”
                        Wessely adds that intervening too early can also be harmful.
                        “If (psychiatrists) get involved too early, that is not just useless but counterproductive,” he said. “(They) do more harm than good. … You’re getting in the way of natural coping mechanisms.”
                        Some studies have showed that providing formal psychiatric treatment too early can actually increase the risk of developing PTSD, while others have shown no effect. Both outcomes suggest that resources may better be used elsewhere.
                        The Alveses are experiencing the horrors of the fire in their sleep — not of their own loss but of others losing their lives and begging at their windows for help. If they are forced to recall these images and talk about them too early, the impact can be detrimental rather than helpful, experts say.
                        By eight to 18 weeks, professional support is typically necessary in only 20% to 25% of people, Wessely said. However, he adds that the anger and bitterness associated with the Grenfell fire, and that it could have been avoided, couldlead to greater numbers needing more long-term help to recover.
                        The fire is suspected to have been stoked by the building’s flammable exterior cladding, which was used to cut costs during a recent refurbishment of the building.
                        “They will have more prolonged grief and complications,” he said.
                        People are more likely to need professional support if they have a history of mental health problems, if they live in isolation and therefore lack social support, if they’re left feeling bitter or angry — as is the case with Grenfell — and if they are feeling guilty that they didn’t help or save someone when they could have, according to Wessely.
                        For those who do suffer prolonged trauma, it’s crucial that someone notice and make treatment available, Ursano added.
                        “There’s substantial numbers of people that have problems that can extend over a long period of time,” he said. “PTSD can become chronic and enduring.”

                        Lessons from past survivors

                        Going back to a routine is one way to normalize after a major traumatic event and help people regain the lives they have lost, particularly in children, Ursano said.
                        This is what the Alves family has done, despite living out of a suitcase. Tiago is about to start an internship, and Ines makes sure to see friends over her school break.
                        Previous disasters in which people have lost everything carry the stories of millions who have been there before and managed to make it through.
                        But they all began with a moment of limbo.
                        “You wake up in the morning … and it takes about 15 or 20 seconds, andthen … this sort of pall of depression reclaims you because yourealize, oh, yeah, all my stuff is gone,” Blake Bailey, a writer and survivor of Hurricane Katrina, said in a 2009 interview with NPR.
                        In 2005, Katrina struck five Southern states, killing more than 1,800 and leaving thousands more homeless.
                        Bailey, now 54,and his wife and daughter packed up a few clothes and a laptop. “But everything else was gone,” he told CNN. He used to live with his family in New Orleans, having relocated there just two months before the storm, but now lives in Virginia.
                        The damage left him in debt, fighting with home finance companies for years after. He had lost his home, his stability and his memories, such as photo albums from his wedding.
                        “You don’t have the same morbid attachment to your things ever again,” he said.
                        Ursano agrees: “We have a whole picture of the world of grief, but it’s usually around people. And we don’t talk often about the question of the loss of significant items that anchor us to our life.”
                        For Bailey, his salvation was that he had a major project to focus on: a biography of American writer John Cheever, which he published in 2009.
                        “I reallydug in and used every sparesecond I had to work on that (book),” he said.
                        Disasters bring some victims closer together as a family — and a community.
                        “My kids were devastated during that time. … I just focused on how to handle the trauma that they had,” said Kitchie Ortega, a customer services representative in Manila, Philippines, who survived Typhoon Ondoy, also known as tropical storm Ketsana, in 2009. She added that her family became closer after the storm, as did her entire neighborhood.
                        Her home was destroyed in the typhoon,which killed more than 400 people and caused more than 70,000 people to be evacuated from their homes, according to the National Disaster Coordinating Council in the Philippines.
                        “Any time, anyone can leave you,” Ortega said. “I made sure thatI support everything that they do after that incident, because I don’t want to regretanything.”
                        Ursano explained that traumatic events can change lives for the better, an outcome known as “post-traumatic growth.”
                        This could eventually be the case for the Alves family. Although Tiago and Miguel bicker more over all the paperwork, the son has also seen a nervous side to his father — a side he wants to help.

                        A family united

                        “We’re stronger than ever before,” Tiago Alves said. “The tragedy has helped us be more united.”
                        His father agrees and hopes that once their shock subsides and they begin registering what has happened to them, they will have more security regarding their future.
                        “Before, we looked at life as whole. … Now, it’s one day after the other,” said Alves, who just wants the uncertainty surrounding his life to be over.
                        “Now, what we want is just a new house and to carry on our lives without being anxious of the future,” he said. “It’s important to put everything behind us and carry on with our lives.”
                        But Wessely warns that experts will need to reach out to the family in a few months, just to ensure that they are OK and coping with reality.
                        There is “potential risk of psychiatric disorder,” he said. “Putting everything behind you is not always the best in the long term.”

                        Read more: http://www.cnn.com/2017/07/05/health/grenfell-tower-fire-psychology-of-survival-eprise/index.html

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