Skin Symptoms Common in COVID 'Long-Haulers'

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

A small subset of SARS-CoV-2 patients with “COVID toes” can be categorized as COVID long-haulers, with skin symptoms sometimes enduring for more than 150 days, a new analysis revealed.

Evaluating data from an international registry of COVID-19 patients with dermatologic symptoms, researchers found that retiform purpura rashes are linked to severe COVID-19, with 100% of these patients requiring hospitalization and 82% experiencing acute respiratory distress syndrome (ARDS).

Meanwhile, pernio/chilblains rashes, dubbed “COVID toes,” are associated with milder disease and a 16% hospitalization rate. For all COVID-related skin symptoms, the average duration is 12 days.

“The skin is another organ system that we didn’t know could have long COVID” effects, said principal investigator Esther Freeman, MD, PhD, from Massachusetts General Hospital and Harvard Medical School in Boston.

Dr Esther Freeman

“The skin is really a window into how the body is working overall, so the fact that we could visually see persistent inflammation in long-hauler patients is particularly fascinating and gives us a chance to explore what’s going on,” Freeman told Medscape Medical News. “It certainly makes sense to me, knowing what we know about other organ systems, that there might be some long-lasting inflammation” in the skin as well.

The study is a result of the collaboration between the American Academy of Dermatology and the International League of Dermatological Societies, the international registry launched this past April. While the study included provider-supplied data from 990 cases spanning 39 countries, the registry now encompasses more than 1000 patients from 41 countries, Freeman noted.

Freeman presented the data at the virtual 29th European Academy of Dermatology and Venereology (EADV) Congress.

Many studies have reported dermatologic effects of COVID-19 infection, she said, but information was lacking about duration. The registry represents the largest dataset to date detailing these persistent skin symptoms and offers insight about how COVID-19 can affect many different organ systems even after patients recover from acute infection, Freeman said.

Eight different types of skin rashes were noted in the study group, of which 303 were lab-confirmed or suspected COVID-19 patients with skin symptoms. Of those, 224 total cases and 90 lab-confirmed cases included information on how long skin symptoms lasted. Lab tests for SARS-CoV-2 included PCR and serum antibody assays.

Freeman and her team defined “long haulers” as patients with dermatologic symptoms of COVID-19 lasting 60 days or longer. These “outliers” are likely more prevalent than the registry suggests, she said, since not all providers initially reporting skin symptoms in patients updated that information over time.

“It’s important to understand that the registry is probably significantly underreporting the duration of symptoms and number of long-hauler patients,” she explained. “A registry is often a glimpse into a moment in time to these patients. To combat that, we followed up by email twice with providers to ask if patients’ symptoms were still ongoing or completed.”

Results showed a wide spectrum in average duration of symptoms among lab-confirmed COVID-19 patients, depending on specific rash. Urticaria lasted for a median of 4 days; morbilliform eruptions, 7 days; pernio/chilblains, 10 days; and papulosquamous eruptions, 20 days, with one long-hauler case lasting 70 days.

Five patients with pernio/chilblains were long-haulers, with toe symptoms enduring 60 days or longer. Only one went beyond 133 days with severe pernio and fatigue.

“The fact that we’re not necessarily seeing these long-hauler symptoms across every type of skin rash makes sense,” Freeman said. “Hives, for example, usually comes on acutely and leaves pretty rapidly. There are no reports of long-hauler hives.”

“That we’re really seeing these long-hauler symptoms in certain skin rashes really suggests that there’s a certain pathophysiology going in within that group of patients,” she added.

Freeman said not enough data have yet been generated to correlate long-standing COVID-19 skin symptoms with lasting cardiac, neurologic, or other symptoms of prolonged inflammation stemming from the virus.

Meanwhile, an EADV survey of 490 dermatologists revealed that just over one third have seen patients presenting with skin signs of COVID-19. Moreover, 4% of dermatologists themselves tested positive for the virus.

Freeman encouraged all frontline clinicians assessing COVID-19 patients with skin symptoms to enter patients into the registry. But despite its strengths, the registry “can’t tell us what percentage of everyone who gets COVID will develop a skin finding or what percentage will be a long-hauler,” she said.

“A registry doesn’t have a denominator, so it’s like a giant case series,” she added.

“It will be very helpful going forward, as many places around the world experience second or third waves of COVID-19, to follow patients prospectively, acknowledge that patients will have symptoms lasting different amounts of time, and be aware these symptoms can occur on the skin,” she said.

Dr Christopher Griffiths

Christopher Griffiths, MD, from the University of Manchester, United Kingdom, praised the international registry as a valuable tool that will help clinicians better manage patients with COVID-related skin effects and predict prognosis.

“This has really brought the international dermatology community together, working on a focused goal relevant to all of us around the world,” Griffiths told Medscape Medical News. “It shows the power of communication and collaboration and what can be achieved in a short period of time.”

Freeman and Griffiths have disclosed no relevant financial relationships.

29th European Academy of Dermatology and Venereology (EADV) Congress: Abstract 3090. Presented October 29, 2020.

Follow Medscape on Twitter @Medscape and Maureen Salamon @maureensalamon

Video Capsule Endoscopy May Reduce Exposure to COVID

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Video capsule endoscopy (VCE) offers an alternative triage tool for acute GI bleeding that may reduce personnel exposure to SARS-CoV-2, based on a cohort study with historical controls.

VCE should be considered even when rapid coronavirus testing is available, as active bleeding is more likely to be detected when evaluated sooner, potentially sparing patients from invasive procedures, reported lead author Shahrad Hakimian, MD, of the University of Massachusetts Medical Center, Worchester, and colleagues.

“Endoscopists and staff are at high risk of exposure to coronavirus through aerosols, as well as unintended, unrecognized splashes that are well known to occur frequently during routine endoscopy,” Hakimian said during a virtual presentation at the annual meeting of the American College of Gastroenterology.

Although pretesting and delaying procedures as needed may mitigate risks of viral exposure, “many urgent procedures, such as endoscopic evaluation of gastrointestinal bleeding, can’t really wait,” Hakimian said.

Current guidelines recommend early upper endoscopy and/or colonoscopy for evaluation of GI bleeding, but Hakimian noted that two out of three initial tests are nondiagnostic, so multiple procedures are often needed to find an answer.

In 2018, a randomized, controlled trial coauthored by Hakimian’s colleagues demonstrated how VCE may be a better approach, as it more frequently detected active bleeding than standard of care (adjusted hazard ratio, 2.77; 95% confidence interval, 1.36–5.64).

The present study built on these findings in the context of the COVID-19 pandemic.

Hakimian and colleagues analyzed data from 50 consecutive, hemodynamically stable patients with severe anemia or suspected GI bleeding who underwent VCE as a first-line diagnostic modality from mid-March to mid-May 2020 (COVID arm). These patients were compared with 57 consecutive patients who were evaluated for acute GI bleeding or severe anemia with standard of care prior to the COVID-19 pandemic (pre-COVID arm).

Characteristics of the two cohorts were generally similar, although the COVID arm included a slightly older population, with a median age of 68 years, compared with a median age of 61.8 years for the pre-COVID arm (P = .03). Among presenting symptoms, hematochezia was less common in the COVID group (4% vs. 18%; = .03). Comorbidities were not significantly different between cohorts.

Per the study design, 100% of patients in the COVID arm underwent VCE as their first diagnostic modality. In the pre-COVID arm, 82% of patients first underwent upper endoscopy, followed by colonoscopy (12%) and VCE (5%).

The main outcome, bleeding localization, did not differ between groups, whether this was confined to the first test, or in terms of final localization. But VCE was significantly better at detecting active bleeding or stigmata of bleeding, at a rate of 66%, compared with 28% in the pre-COVID group (P < .001). Patients in the COVID arm were also significantly less likely to need any invasive procedures (44% vs. 96%; P < .001).

No intergroup differences were observed in rates of blood transfusion, in-hospital or GI-bleed mortality, rebleeding, or readmission for bleeding.

“VCE appears to be a safe alternative to traditional diagnostic evaluation of GI bleeding in the era of COVID,” Hakimian concluded, noting that “the VCE-first strategy reduces the risk of staff exposure to endoscopic aerosols, conserves personal protective equipment, and reduces staff utilization.”

According to Neil Sengupta, MD, of the University of Chicago, “a VCE-first strategy in GI bleeding may be a useful triage tool in the COVID-19 era to determine which patients truly benefit from invasive endoscopy,” although he also noted that “further data are needed to determine the efficacy and safety of this approach.”

Lawrence Hookey, MD, of Queen’s University, Kingston, Ont., had a similar opinion.

“VCE appears to be a reasonable alternative in this patient group, at least as a first step,” Hookey said. “However, whether it truly makes a difference in the decision making process would have to be assessed prospectively via a randomized controlled trial or a decision analysis done in real time at various steps of the patient’s care path.”

Erik A. Holzwanger, MD, a gastroenterology fellow at Tufts Medical Center in Boston, suggested that these findings may “serve as a foundation” for similar studies, “as it appears COVID-19 will be an ongoing obstacle in endoscopy for the foreseeable future.”

“It would be interesting to have further discussion of timing of VCE, any COVID-19 transmission to staff during the VCE placement, and discussion of what constituted proceeding with endoscopic intervention [high-risk lesion, active bleeding] in both groups,” he added.

David Cave, MD, PhD, coauthor of the present study and the 2015 ACG clinical guideline for small bowel bleeding, said that VCE is gaining ground as the diagnostic of choice for GI bleeding, and patients prefer it, since it does not require anesthesia.

“This abstract is another clear pointer to the way in which, we should in the future, investigate gastrointestinal bleeding, both acute and chronic,” Cave said. “We are at an inflection point of transition to a new technology.”

Cave disclosed relationships with Medtronic and Olympus . The other investigators and interviewees reported no conflicts of interest.

American College of Gastroenterology (ACG) 2020 Annual Scientific Meeting.

This article originally appeared on MDEdge.com.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Thousands of Excess Cancers Among American Indians/Alaska Natives, Especially in Southern Plains

NEW YORK (Reuters Health) – Liver, stomach, kidney, lung, colorectal and female breast cancers have a higher incidence rate among American Indian/Alaska Native (AI/AN) populations compared with non-Hispanic Whites, with the largest number of excess cancers occurring in the Southern Plains region, a new study shows.

“Other researchers may learn from our research efforts by understanding that we are refining the accuracy of U.S. cancer statistics by considering geographic differences in the cancer incidence rates of AI/AN populations,” Dr. Stephanie Melkonian of the U.S. Centers for Disease Control and Prevention in Albuquerque, New Mexico told Reuters Health by email. “Previously, the majority of U.S. cancer statistics presented AI/AN populations as one group using nationally aggregated data.”

Dr. Melkonian and colleagues studied incident AI/AN cancer cases diagnosed between 2012-2016 and compared them to cases among non-Hispanic Whites.

Overall, they report in the American Journal of Epidemiology, liver, stomach, kidney, lung, colorectal and female breast cancers had higher incidence rates among AI/AN populations across most regions. Nearly 5,200 excess cancers occurred, with the largest number of excess cancers occurring in the Southern Plains region.

More specific findings included the following:

– Among AI/AN males, the leading sites with elevated incidence were liver, stomach, kidney, colorectal, myeloma, and lung; sites for females were similar, except for melanoma, and including cervical cancers.

– Rate ratios ranged from 1.09 (lung) to 2.37 (liver) among AI/AN males and 1.06 (lung) to 3.03 (liver) among AI/AN females. The incidence rates were higher among AI/AN males compared to females, ranging from 23% higher for lung cancer, to 129% higher for liver cancer.

– Among AI/AN males, the number and type of cancers with elevated incidence varied by region, led by Alaska, the Southern Plains, Southwest, and the Northern Plains; rate ratios ranged from 1.14 (colorectal cancer in the Southwest) to 4.36 (stomach cancer in Alaska).

– Among AI/AN females, the Southern Plains, Northern Plains, Alaska, and the Pacific Coast had the most types of cancer with elevated incidence; rate ratios ranged from 1.15 (corpus and uterus in the Pacific Coast) to 4.07 (stomach in Alaska).

Dr. Melkonian said, “Addressing cancer disparities is complex; however, one possible avenue is through community programs and partnerships that are linked with clinical services. Community health aides and patient navigators can potentially help community members access and understand the preventive care they need to make sure they get the right care at the right time.”

“Some of these efforts might include promoting healthy environments and addressing underlying social determinants of cancer risk, including access to care, food insecurity, and transportation,” she added. “Community-based interventions to support healthy behaviors and promote recommended screening for cancer, or its risk factors, may also reduce cancer disparities for AI/AN populations.”

Dr. Eyal Meiri, Interim Chief of Medical Oncology and member of the GI Cancer Center at Cancer Treatment Centers of America in Atlanta, commented by email to Reuters Health, “These findings are not surprising. Disparities in the incidence of adult-acquired cancers reflect lifestyle and socioeconomic factors that seed development of the cancers described in this study – unlike genetically inherited or younger adult cancers.”

“For example,” he said, “we know obesity, diabetes, alcohol, tobacco and diets that are high in fat, low in fiber and lack fresh fruit and vegetables are drivers for elevated risk of colorectal cancer. According to the study, all of these risk factors have a higher incidence in AI/ANs. Disparities in this area can be corrected by fostering lifestyle changes and socioeconomic opportunity to improve these high-risk behaviors.”

“Liver cancer is associated with any underlying liver toxin. Hepatitis C and alcoholism are known risk factors and are prevalent in the AI population,” he said. “However, just as we can reduce the incidence of cervical cancer by administering vaccination for HPV, we can screen for and treat hepatitis C. Alcoholism, on the other hand, may be best addressed at the community level.”

“Socioeconomic disparity contributes to cancer incidence,” he said. “Underlying factors include limited access to proper health care and nutrition, isolated environments that contribute to high-risk behaviors, and poor educational opportunities – all very disheartening amid our current turmoil.”

SOURCE: https://bit.ly/37WVlcL American Journal of Epidemiology, online October 14, 2020.

No Evidence to Guide Selection of Biologic for Severe Asthma

Although “biologics have been really revolutionary for the treatment of severe uncontrolled asthma, we still don’t have evidence to know the right drug for the right patient,” said Wendy Moore, MD, from the Wake Forest School of Medicine in Winston-Salem, North Carolina.

Wendy Moore

“You start with your best guess and then switch,” she told Medscape Medical News.

There are no real-world contemporary measurements of biologic therapy in the United States at this time, Moore explained during her presentation of findings from the CHRONICLE trial at CHEST 2020.

The agents have different targets: omalizumab targets immunoglobulin E, mepolizumab and reslizumab target interleukin (IL)-5, benralizumab targets the IL-5 receptor, and dupilumab targets the common receptor IL-4 receptor A for IL-4 and IL-13.

When the starting biologic doesn’t get the desired results, there is no evidence to show whether another will work better. What we say is, “this one is not working as well as I’d like, let’s try something new?” said Moore.

However, when looking at data on patients with severe asthma who change from one biologic to another, “I was actually pleased to see that only 10% are switching,” she told Medscape Medical News.

But, she added, “if you add that up with the 8% who are stopping, that means that almost 20% don’t get the clinical response they want.”

CHRONICLE Trial

In the ongoing observational CHRONICLE trial, Moore and her colleagues assessed biologic initiations, discontinuations, and switches to a different agent.

All 1884 study participants had a diagnosis of severe asthma and were being treated by an allergist/immunologist or a pulmonologist. All were taking high-dose inhaled corticosteroids and additional controllers, or had received an FDA-approved monoclonal antibody, systemic corticosteroid, or another systemic immunosuppressant for at least half of the previous 12 months.

In the study cohort, 1219 participants were receiving one biologic and 27 were receiving two.

Before November 2018, “it was almost universally all benralizumab being prescribed.” An earlier preference was omalizumab, which was prescribed to 99% of patients before November 2015 and to 45% from November 2017 to November 2018.

“As new drugs were introduced, patients were switched if the desired outcome was not achieved,” Moore explained.

Over the 2-year period from February 2018 to February 2020, 134 patients — about 10% of all participants taking a biologic — made 148 switches to another biologic.

“The most common reasons reported for switching were lack of efficacy, worsening of asthma control, or waning efficacy,” Moore reported.

Of the 101 patients (8%) who discontinued 106 biologics, reasons cited were a worsening of asthma symptoms, a desire to change to a cheaper medication, and a waning of effectiveness.

I don’t think we understand the perfect patient for any one of these drugs.

“It seems that the biologic used depended on when you started and whether you were prescribed by an immunologist or pulmonologist,” said Moore. “I don’t think we understand the perfect patient for any one of these drugs.”

Large-population studies need to be done on each of the drugs. “You have to look at who’s the super responder, the partial responder, compared with the nonresponders, for each medication, but those comparative studies are unlikely to happen,” she said.

In her own practice, her 175 patients are “pretty evenly split between dupilumab, benralizumab, and mepolizumab.”

I have opinions on what works, said Moore, but none of it is evidence-based. “Those with upper airway involvement with chronic sinusitis tend to do better with mepolizumab than benralizumab. My opinion,” she emphasized.

“People with nasal problems may do better with dupilumab and mepolizumab,” she added. “Also in my opinion.

“But more likely, the issue is you have a partial responder who’s on a T2 high drug but has a T2 low problem too.”

PATHWAY Study

Findings from the phase 2B PATHWAY study showed that tezepelumab reduced exacerbations in patients with uncontrolled asthma better than inhaled corticosteroids, and improved forced expiratory volume in 1 second (FEV₁).

“Adherence was monitored very carefully,” said investigator Jonathan Corren, MD, from the University of California, Los Angeles, who presented the PATHWAY data. This could explain, in part, why some patients in the control group “showed improvement from baseline.”

Before switching to a biologic, “we should always consider some of these issues that might contribute to better asthma control, like patient adherence or the inability to use an inhaler properly,” Corren said.

Some people have never been “shown how to use their inhalers properly,” said Moore. “Some of them come back fine when we show them.”

Moore has been on the advisory board for AstraZeneca, Genentech, GlaxoSmithKline (GSK), Regeneron, and Sanofi. Corren reports receiving honoraria from AstraZeneca.

CHEST 2020: American College of Chest Physicians Annual Meeting. Presented October 20, 2020.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Scientists Want to Create Tasty Food From Plastic

We have a problem with plastic. Not only is it difficult to get rid of without damaging the environment, but we appear to have an addiction to all things disposable. In the U.S., plastic is considered an integral and necessary part of daily life. Just a stroll down the grocery store aisle reveals an unhealthy dependence on plastic, from packaging to bags for our groceries.

Fresh produce is often wrapped in plastic or sliced and shrink-wrapped in a plastic covering. Nuts, cheese, milk and lettuce are all encased in plastic. Across the world, 299 million tons were produced in 2013, much of which ended up in the oceans, threatening wildlife and environment.1 In 2015, the U.S. generated 34.4 million tons, which accounted for 13.2% of municipal solid waste.2

In the case of plastic packaging, 95% of the material value, an estimated $80 billion to $120 billion annually, is lost after its first usage, adding economic problems to other drawbacks, according to a report from the World Economic Forum.3 Now scientists are thinking about how to make plastic into food.

Exchanging Plastic for Food

With a focus on improving military logistics, the Defense Advanced Research Projects Agency (DARPA) awarded Iowa State University and partners a $2.7 million grant to make food from plastic and paper waste, which they intend to feed to military men and women.4 The ability to turn paper and plastic into a food product may help with short-term nourishment for soldiers and improve military logistics for extended missions.

They estimate the total grant award may reach $7.8 million before the project ends. Partners in this endeavor include the American Institute of Chemical Engineers RAPID Institute, the University of Delaware and Sandia National Laboratories. Initially, the system is being called the Novel Oxo-degradation to Macronutrients for Austere Deployments (NOMAD).

The aim is to convert paper waste into sugars and plastic into fatty acids and fatty alcohols. These byproducts would then be processed into a single cell biomass in the field. Other examples of single cell proteins include Vegemite and nutritional yeast. The NOMAD system must fit specific requirements to enable military troops to carry it with them during deployment and extraction.

While DARPA is initiating the project for use by the military in the field, it may not be long before such a system would be proposed as a means of providing inexpensive food stuffs for others. As explained in the press release from Iowa State University, the process could “go a long way toward solving looming problems of plastic disposal and ensuring a viable global food chain.”5

Robert Brown from Iowa State University is the principal investigator on the project. He explained how plastics and paper could biodegrade in the field and be used to grow edible yeast or bacteria:6

“When exposed to heat or ultraviolet light in the presence of oxygen, plastics convert to oxygenated compounds that can be consumed by microorganisms — plastics are, in fact, bio-degradable, but the process is very slow, as evidenced by the accumulation of plastic wastes in the environment.

We can dramatically increase oxo-degradation of plastics to fatty compounds by raising the temperature a few hundred degrees Fahrenheit. The cooled product is used to grow yeast or bacteria into single cell proteins suitable as food.”

‘An Army Marches on Its Stomach’

This familiar saying has been attributed to Napoleon and Fredrick the Great in reference to the ability of an army to perform better when their nutritional needs are met.7 While an argument could be made the food supplied to the military would be “natural” single cell protein, it’s important to remember the lessons that we have learned from grain-fed beef.

There are multiple problems with raising livestock in concentrated animal feeding operations (CAFOs), including issues with the environment, water supply, humane treatment of the animals and the addition of chlorine and other toxins to clear away contaminants. Despite the outcry over CAFOs, many fall back to the claim that factory farms can feed the world. The question is — at what cost?

As nutritional analyses have revealed, issues inside the CAFOs and surrounding communities are not the only problems. The nutritional differences in beef raised or finished on grain versus beef from pasture raised animals is striking. Grass fed beef has better fatty acid composition and antioxidant content.8

The meat is higher in conjugated linoleic acid (CLA) and precursors to CLA,9 which play a role in fat metabolism and positively modify cardiometabolic risk factors which impact body composition by lowering body fat levels.10 Grass fed beef is also higher in omega 3 fats and lower in cholesterol elevating fats.11

The aim of producing more meat in less time with less effort has led to a glut on the market of beef that contributes to the ill health of those who eat it. Ronnie Cummins from the Organic Consumers Association says it best in this article:

“Before these hapless creatures are dragged away to hell, to be fattened up on GMO grains and drugged up in America’s CAFOs, their meat is high in beneficial omega-3 and conjugated linoleic acids (CLA), and low in ‘bad’ fats.

Unfortunately by the time their abused and contaminated carcasses arrive, all neatly packaged, at your local supermarket, restaurant, or school cafeteria, the meat is low in omega-3 and good “fats,” and routinely tainted by harmful bacteria, not to mention pesticide, steroid, and antibiotic residues.”

The lesson learned is that just because it looks like healthy beef, doesn’t mean it carries the same nutritional value as that raised in a healthy environment. Of course, the same can be said about Impossible Burgers or any other food product manufactured in the lab. In the short term it may be a solution to a military problem, but do you think it will stop there?

Is Recycling Just a Big Fraud?

Recycling is another way of attempting to reduce the problem with plastic pollution. However, the question remains as to whether this is a viable answer since there is growing evidence suggesting it may have only a minor impact under the best of circumstances.

The Guardian12 reports that Earth Island Institute filed a lawsuit against 10 major companies. The group hopes to force the organizations to take responsibility and pay for the environmental and ecological destruction their products are causing. Ramping up recycling may sound like an answer, but as the executive director of the Basel Action Network, Jim Puckett, told Rolling Stone magazine:13

“They really sold people on the idea that plastics can be recycled because there’s a fraction of them that are. It’s fraudulent. When you drill down into plastics recycling, you realize it’s a myth.”

Pucket goes on to describe how 91% of the plastic created since 1950 has never been recycled, quoting a study published in 2017.14 In addition, the reporter from Rolling Stone, Tim Dickinson, wrote:15

“Unlike aluminum, which can be recycled again and again, plastic degrades in reprocessing, and is almost never recycled more than once. A plastic soda bottle, for example, might get downcycled into a carpet.”

At the rate at which plastic is being added to the ocean, it’s expected there will be more plastics than fish by 2050.16 You’ll find more about plastic recycling, struggles with landfill pileup and Coca-Cola undermining the recycling efforts in “Is Plastic Recycling Just a Big Fraud?

Lifetime Average Consumption of Plastic Is Shocking

Tiny bits of plastic can be found nearly everywhere in the environment, including the food on your plate. Microplastics, as they are called, are smaller than 5 mm and have been found in foods and beverages. Drinking water is one of the largest sources from which researchers estimate the average person consumes 1,769 particles each week.17

Yet, bottled water is not the solution since it may contain even more plastic than tap water. Research published in Environmental Science and Technology suggested people who drink bottled water exclusively may consume more microplastics than those who drink tap water:18

“Additionally, individuals who meet their recommended water intake through only bottled sources may be ingesting an additional 90,000 microplastics annually, compared to 4,000 microplastics for those who consume only tap water.”

Plastic pollution likely originates from the manufacturing process of bottles and caps. When researchers tested 259 bottles of 11 bottled water brands, they found there were 325 pieces of microplastic per liter, on average.19 The brands tested included Aquafina, Evian, Dasani, San Pellegrino and Nestle Pure Life, among others.

Based on the findings from the WWF International study, Reuters created an illustration showing how much plastic a person would consume over time. According to these estimations, you may be consuming:20

  • Every week — 5 grams or enough plastic to pack a soup spoon.
  • Every six months — 125 grams or enough shredded flakes to fill a cereal bowl.
  • Every year — 250 grams or a heaping dinner plate of shredded plastic.
  • Every 10 years — 2.5 kg (5.5 pounds) or about the size of a standard life buoy.
  • Over 79 years — 20 kg (44 pounds) of shredded plastic over an average lifetime.

To put this in perspective, one car tire weighs about 20 pounds.21 So a lifetime supply of plastic consumption would be like slowly eating 2.2 car tires. Thava Palanisami of the University of Newcastle, who was involved in a study conducted by the World Wildlife Fund (WWF), told Reuters:22

“We have been using plastic for decades but we still don’t really understand the impact of micro- and nano-sized plastic particles on our health … All we know is that we are ingesting it and that it has the potential to cause toxicity. That is definitely a cause for concern.”

A Call to End Plastic Pollution

The fight against plastic pollution is being carried out on several fronts. In addition to the lawsuit filed by Earth Island Institute, the WWF is calling on governments to support further research into the consequences on living organisms when microplastics are ingested. In their analysis, they note:23

“The current global approach to addressing the plastic crisis is failing. Governments play a key role to ensure all actors in the plastic system are held accountable for the true cost of plastic pollution to nature and people.”

You can help by supporting legislation that is aimed at holding companies accountable for the pollution they create. For example, New Mexico Sen. Tom Udall introduced the Break Free From Plastic Pollution Act of 2020, which requires companies selling plastic products to pay for “end-of-life” initiatives that ensure plastic does not end up polluting the environment.24

Bills like this need your support since the industry has deep pockets and its players are notorious for their extensive lobbying and public relations expertise. It’s also important to remember the significant impact you can have by making simple changes in your daily life. Below is a sampling of strategies that can help:

Don’t use plastic bags. Opt for reusable bags, especially for groceries

Bring your own mug for a coffee drink; skip the lid and straw

Instead of buying bottled water, bring water from home in a glass water bottle

Make sure the items you recycle are actually recyclable

Store foods in glass containers or Mason jars, not plastic containers or freezer bags

Bring your own leftovers container when eating out

Avoid processed foods, which are typically sold with plastic wrapping or plastic-lined paper boxes. Buy fresh produce and use vegetable bags brought from home

Request no plastic wrap on your newspaper and dry cleaning

Use nondisposable razors, cloth diapers and rags. (Old shirts and socks make great cleaning rags)

Avoid disposable utensils and straws and buy foods in bulk when you can

Buy clothes and other items at secondhand stores. Microfibers found in newer clothing can be as destructive as plastic grocery bags

Buy infant toys and even pet toys made of wood or untreated fabric, not plastic

What Are the Benefits of Bilberry?

Berries are often hailed as some of the best fruits you can eat. That’s because they’re loaded with vitamins, minerals and other nutrients that have a wide range of health benefits.

One class of compounds in berries that’s responsible for many of their health benefits is anthocyanins — the plant pigment that gives berries and other red, blue or purple plants their color. All berries contain some anthocyanins, but bilberries are considered one of the best natural sources.1

Bilberries are small, dark berries that look a lot like blueberries. In fact, because they look so similar, they’re often confused, but bilberries are smaller, softer and a little more tart than blueberries.

Bilberries, whose botanical name is Vaccinium myrtillus, are native to northern areas of the United States, Canada and parts of Europe and Asia and have been used as a medicinal plant for centuries.

You may not be as familiar with bilberries as some of the other berries such as blueberries, raspberries and strawberries, but with so many potential health benefits, it’s worth including them in your diet.

The Antioxidant Power of Bilberries

One of the reasons bilberries are so good for you is because of their high antioxidant content or, more specifically, their anthocyanin concentration. Anthocyanins are plant pigments classified as flavonoids.

Studies have shown anthocyanins protect against various long-term health issues and diseases, help improve eyesight and protect your nervous system.2 There are many physiological processes involved in how anthocyanins work, but two of the major mechanisms are by fighting free radicals and turning off chronic inflammation. Anthocyanins also have potent antimicrobial activity, so they can help fight infections from pathogenic viruses and bacteria.

While blueberries are often hailed for their rich antioxidant concentration, bilberries the only have 30% to 60% of the anthocyanin content of blueberries.3 True European bilberries contain 3.7 milligrams of anthocyanins per gram of total fruit weight. If you do the math, that means a half-cup of bilberries, which weighs roughly 74 grams depending on the size of each berry, contains about 274 mg of anthocyanins, most of which is concentrated in their skin.4

However, the exact amount of antioxidant compounds in bilberries depends on where they are grown. For example, one study showed that bilberries grown in the Velingrad region of Bulgaria had 34% higher concentrations of anthocyanins than bilberries that came from the Troyan region.5

There’s no current dietary recommendation for how many anthocyanins you should get, but studies suggest intakes of about 50 mg per day (about one-third cup) are enough to reap most of the health benefits.6 The average intake, meanwhile, is only 10.5 to 12.6 mg daily.7

In addition to anthocyanins, bilberries also contain catechins, epicatechins, quercetin, myrcetin and kempferol (other types of flavonoids), ascorbic acid, phenolic acids and chlorogenic acid — all compounds that also have antioxidant capabilities. While most of the benefits of bilberries can be attributed to their high anthocyanin content, all of the compounds work together to keep you healthy.

Bilberry Helps Maintain Eye Health

Legend has it that bilberries have been used to help improve vision since World War II, when British Air Force pilots discovered that when they ate bilberry jam before a night mission, they had better night vision.8 While there aren’t any official studies to confirm if bilberry actually has a positive effect on night vision, there are other studies that show bilberries can help improve other areas of eye health.

One animal study9 looked at whether or not bilberry could improve dry eye. The researchers found that daily administration of bilberry extract could increase tear production and help relieve symptoms of dry eye. In another animal study,10 bilberry was found to help fight against endotoxin-induced uveitis, or inflammation of the middle layer of the eye (called the uvea).

There are also some studies that look at how anthocyanins, in general, can help improve eye health. According to one review, anthocyanins can help increase blood flow to the eye, improve dark adaptation and relax eye muscles, helping improve symptoms of glaucoma and myopia, or nearsightedness.11

Bilberry Improves Blood Lipids and Heart Health

Although bilberries are small, they have big benefits for your heart. In one study,12 participants with risk factors for heart disease consumed bilberries, lingonberries, black currants and chokeberries on alternating days for eight weeks.

After the trial period, blood pressure decreased and HDL cholesterol increased significantly and there were measurable positive changes in platelet function. Another animal study13 found that bilberry extract could reduce total cholesterol and LDL cholesterol in diabetic rats.

Bilberry Protects Against Cancer

It’s estimated that 1 in 3 people will be diagnosed with cancer.14 But there are a lot of lifestyle changes you can make to protect yourself, and eating anthocyanin-rich foods like bilberries is one of them.

In a 2017 study,15 researchers discovered that consuming anthocyanin-rich foods can help inhibit cancer cell growth and prevent metastasis. Anthocyanins have also been shown to trigger apoptosis, or the death of cancer cells.

Bilberry Reduces Chronic Inflammation

Inflammation is your body’s defense mechanism against diseases and potentially harmful pathogens. However, when it becomes chronic, it can affect your quality of life and lead to devastating conditions like heart disease, cancer and liver disease.

More than 50% of deaths worldwide are caused by inflammatory diseases.16 The anthocyanins of bilberry can help turn off chronic inflammation and return your body to optimal function.

In a 2007 study published in The Journal of Nutrition,17 researchers noted that anthocyanin-rich bilberry extracts helped inhibit nuclear factor-kappaB (NF-kappaB), a proinflammatory compound that can lead to chronic inflammation. In the study, which lasted three weeks, participants were divided into two groups. One group was given 300 mg of anthocyanins from bilberries each day, while the other group was given a placebo.

After the trial period, participants in the bilberry group had a 38% to 60% decrease in inflammatory markers, while the placebo group’s inflammatory markers went down by just 4% to 6%.

In another study,18 researchers found that some of the other compounds in bilberries — quercetin, epicatechin and reservatrol — could also inhibit NF-kappaB, reducing inflammatory markers like C-reactive protein and interleukin-6, and fighting off oxidative stress.

Bilberry Helps Maintain Healthy Blood Sugar Levels

Some of the compounds in bilberries also act on digestive enzymes, slowing down carbohydrate digestion and helping to maintain healthier blood sugar levels.19

In one study,20 researchers divided participants into three groups: a bilberry-enriched diet group, a group whose diet was enriched with other berries (strawberries, raspberries and cloudberries) and a group on a control diet.

After eight weeks, only the bilberry-enriched diet group had positive changes in fasting blood glucose levels, insulin secretion and beta cell function. The researchers connected these benefits to better overall glycemic control.

Similarly, in an animal study,21 researchers found bilberry extract could reduce high blood sugar and improve insulin sensitivity in mice with Type 2 diabetes, a combination that could both help prevent and treat the condition.

Bilberry May Help You Lose Weight

Studies show that having a high daily intake of anthocyanins may also help you lose weight, specifically fat mass, independent of other factors like genetics. Researchers from a study22 that was published in The American Journal of Clinical Nutrition compared the diets of healthy female twins and calculated their total flavonoid intake.

They found that participants aged 50 and younger with a high intake of anthocyanins had 3% to 9% lower total fat mass and less fat around their midsection than their twin.

The study didn’t use bilberries specifically, but since bilberries are one of the most anthocyanin-rich foods, it makes sense that including them in your diet would have similar, if not more significant, effects.

How to Eat Bilberries

The easiest way to eat bilberries is by the handful, just like you would with blueberries. However, since they’re not as popular as blueberries, they’re not always easy to find in your local grocery store.

If you can’t find them fresh, you can order organic dried bilberries online. If you choose to eat them dried, make sure you’re not overdoing it. Since dried fruit has most of the water removed, it’s a lot easier to eat too much of them and if you do, you’ll be taking in a lot of sugar too. You can also find bilberry leaf tea, although it’s better to consume the whole fruit to get the full benefit.