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A Brief History of Dubious Dieting

Most of the world seems to think that America invented obesity sometime in the last century, but the truth is, fat has always been a part of life (witness Hatshepsut, one of the great ancient Egyptian queens who reigned in the 15th century BC—despite her svelte sarcophagus, modern archeologists believe that she was pretty obese and may have suffered from diabetes).

So it stands to reason that dieting has been around just as long.

Some historians credit William the Conqueror with starting the first fad diet. Having grown too fat to ride his horse, William went on a liquid diet in 1087—or, rather, a liquor diet, since all he did was drink booze. The story might be apocryphal—William, still fat, actually died after falling from his horse and there was no word on whether he was drunk at the time—but it's a good one, and it sets the tone for the next 1000+ years of dieting. Throughout history, people have been looking for some kind of magic that will allow one to eat and live as one pleases, but still look emaciatedly gorgeous. And they've come up with some pretty dubious theories that somehow took hold in the public consciousness and became fads. Here are a few of our favorites.

Location, Location, Location

"The Causes and Effects of Corpulence" was a treatise penned in 1727 by one Thomas Short, in which he observed that larger people were more likely to live near swampy areas. His advice? Fat people should move to more arid climes.

Improbable Side Effects

The namesake of the graham cracker—ironically now an integral part of that deliciously fattening treat, the "˜smore—was a Presbyterian minister who claimed that overeating could not only make you fat, it could make you lecherous, too. In the 1830s, Sylvester Graham ran health retreats for like-minded parishioners featuring a strict meat-free, incredibly bland diet.

An Early Diet Guru

In 1864, William Banting pioneered the "I lost 50 pounds—ask me how" phenomenon by writing a pamphlet describing how he lost 50 pounds by eating a diet of lean meats, dry toast, vegetables and fruits. Dieting thereafter was referred to as "banting" by folks in the British Isles well into the 20th century.

Chew Yourself Thin

Horace Fletcher, a turn of the century San Francisco art dealer, became known as the Great Masticator after he claimed he lost more than 40 pounds by chewing his food until it was essentially liquefied and spitting out all the bits that weren't. Fletcher's scheme became incredibly popular—novelist Henry James and industry titan John D. Rockefeller were reportedly fans, as was John Harvey Kellogg. Kellogg, of the cereal fame, was a nutrition and health nut who ran a sanitarium in Michigan, where he encouraged his visitors to "Fletcherize" with a little song he wrote called "Chew Chew."

The Parasite Diet

In the early part of the 20th century, the weight loss industry allegedly found a tiny little helper in the form of a tiny little parasite—the noble tapeworm. According to product advertisements of the day, tapeworms were being sold in pill form as a weight loss tool. While whether or not those pills actually contained a real live tapeworm is certainly debatable, however, there is evidence that jockeys, who frequently needed to lose a lot of weight fast, would try to induce tapeworms. Another favorite weight loss tool of the Lilliputian equestrians: Burying themselves in piles of horse manure, which acted as a kind of natural sauna.

Introducing the Calorie

In 1918, Dr. Lulu Hunt Peters introduced a new word to the world lexicon—"calorie" (may she be forever cured for it). Peters' book, Diet and Health, With a Key to Calories, which helpfully included a phonetic spelling of the word "calorie," as so many people were unfamiliar with it, sold more than 2 million copies and established calorie-counting as the framework of a good health. This diet regime wasn't particularly dubious, but it did lend a potentially dangerous new tool to those looking for a way to quantify and reduce their food intake. Case in point: The Scarsdale Diet of 1979, a strict 700-calorie a day diet that works—because you're starving.

The Goldfish Diet

goldfish.jpgOK, this one wasn't so much about weight loss as it was fame gain, but in 1939, it was a fad that swept the nation. Like most good things, it all started with a bet—a Harvard University undergrad won $10 after swallowing an innocent fishy. The story spread from there, prompting a countrywide goldfish slaughter. Goldfish swallowing became so popular that not only were pet stores running out of the indigestible comestibles, but the New York Times published warnings from doctors that swallowing goldfish, which are known to carry tapeworms and other parasites, could be very harmful to one's health.

The Nicotine Diet

By the middle of the 20th century, dieting had become such a major economic, social and cultural force in the Western world that cigarette companies, not wanting to miss the money boat, jumped on board promoting cigarettes as a weight-loss tool. It's a belief that persists today—ask any supermodel.

The Master Cleanse

In the 1940s, nutrition guru Stanley Burroughs created the Master Cleanse, a fast during which the dieter subsists solely on a mixture of cayenne pepper, fresh-squeezed lemon juice, maple syrup and water. The Master Cleanse is still popular today, especially among anorexics and aspiring anorexics, despite the fact that most nutritionists and doctors say that "detoxing" is a nonsensical and potentially harmful idea.

The Sleeping Beauty Diet

Then there's the Sleeping Beauty Diet, a regime that allows the dieter to literally sleep off the pounds while under heavy sedation for several days. Elvis was reportedly a fan of that one, right about the time when he was having a little trouble squeezing into those trademark white jump suits, as was a character in the landmark beach read, Valley of the Dolls.

The Monotony Diets

The 20th century also brought us back to a concept allegedly pioneered by William the Conqueror—the single food or drink diet. There's the Grapefruit Diet, which alleges that eating a lot of grapefruit and drinking a lot of grapefruit juice, in conjunction, of course, with a very low-calorie diet, is the way to weigh less; the Cabbage Soup Diet, which is said to cause serious gas with a side of nausea; the Popcorn Diet, which is pretty much undercut by all the tasty things one puts on popcorn to make it palatable; and the Chocolate Diet, which, though tempting, is just plain silliness.

Memorable Dieting Paraphernalia

fat-soap.jpgAnd let's not forget about the gadgets that went along with these suspect food fads, like the Vision-Dieter Glasses, which made food look unappealing, or the Mini-Fork system, which encouraged people to eat smaller portions by supplying them with—you guessed it—smaller forks. Or how about slimming soaps, popular in the 1930s, which promised dieters that they could just wash the fat away? And then there's the perennially popular vibrating machine, which promised to melt off pounds by a few minutes of intense body vibration—and which is actually enjoying a comeback now at gadgetry stores like Brookstone.

That's just the barest tip of the billion-dollar dieting iceberg, and we know you readers have heard of quite a few more weird, wild and patently unbelievable diet fads. So let's hear it—what's the craziest diet or weight loss tool you've ever heard of, or possibly even tried?

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Medicine
New Peanut Allergy Patch Could Be Coming to Pharmacies This Year
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About 6 million people in the U.S. and Europe have severe peanut allergies, including more than 2 million children. Now, French biotechnology company DBV Technologies SA has secured an FDA review for its peanut allergy patch, Bloomberg reports.

If approved, the company aims to start selling the Viaskin patch to children afflicted with peanut allergies in the second half of 2018. The FDA's decision comes in spite of the patch's disappointing study results last year, which found the product to be less effective than DBV hoped (though it did receive high marks for safety). The FDA has also granted Viaskin breakthrough-therapy and fast-track designations, which means a faster review process.

DBV's potentially life-saving product is a small disc that is placed on the arm or between the shoulder blades. It works like a vaccine, exposing the wearer's immune system to micro-doses of peanut protein to increase tolerance. It's intended to reduce the chances of having a severe allergic reaction to accidental exposure.

The patch might have competition: Aimmune Therapeutics Inc., which specializes in food allergy treatments, and the drug company Regeneron Pharmaceuticals Inc. are working together to develop a cure for peanut allergies.

[h/t Bloomberg]

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Essential Science
How Are Vaccines Made?
Quality checks on the Salk polio vaccine at Glaxo's virus research laboratory in Buckinghamshire, UK, in January 1956.
Quality checks on the Salk polio vaccine at Glaxo's virus research laboratory in Buckinghamshire, UK, in January 1956.
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Vaccines have long been hailed as one of our greatest public health achievements. They can be made to protect us from infections with either viral or bacterial microbes. Measles and smallpox, for example, are viruses; Streptococcus pneumoniae is a bacterium that causes a range of diseases, including pneumonia, ear and sinus infections, and meningitis. Hundreds of millions of illnesses and deaths have been prevented due to vaccines that eradicated smallpox and significantly reduced polio and measles infections. However, some misunderstanding remains regarding how vaccines are made, and why some scary-sounding ingredients [PDF] are included in the manufacturing process.

The production of our vaccines has greatly evolved since the early days, when vaccination was potentially dangerous. Inoculating an individual with ground-up smallpox scabs usually led to a mild infection (called "variolation"), and protected them from acquiring the disease the "regular" way (via the air). But there was always a chance the infection could still be severe. When Edward Jenner introduced the first true vaccination with cowpox, protection from smallpox became safer, but there were still issues: The cowpox material could be contaminated with other germs, and sometimes was transmitted from one vaccinated person to another, leading to the inadvertent spread of blood-borne pathogens. We’ve come far in the last 200 years.

There are different kinds of vaccines, and each requires different processes to move from the laboratory to your physician's office. The key to all of them is production of one or more antigens—the portion of the microbe that triggers a host immune response.

LIVE ATTENUATED VACCINES AND DEAD, "INACTIVATED" VACCINES

There are several methods to produce antigens. One common technique is to grow a virus in what's called a cell culture. Typically grown in large vats called bioreactors, living cells are inoculated with a virus and placed in a liquid growth medium that contains nutrients—proteins, amino acids, carbohydrates, essential minerals—that help the virus grow in the cells, producing thousands of copies of itself in each infected cell. At this stage the virus is also getting its own dose of protective medicine: antibiotics like neomycin or polymyxin B, which prevent bacterial and fungal contamination that could kill the cells serving as hosts for the virus.

Once a virus completes its life cycle in the host cell, the viruses are purified by separating them from the host cells and growth media, which are discarded. This is often done using several different types of filters; the viruses are small and can pass through holes in the filter that trap larger host cells and cell debris.

This is how "live attenuated vaccines" are created. These vaccines contain viruses that have been modified so that they are no longer harmful to humans. Some of them are grown for many generations in cells that aren't human, such as chicken cells, so that they have mutated to no longer cause harm to humans. Others, like the influenza nasal mist, were grown at low temperatures until they lost the ability to replicate in the warmer temperatures of the lungs. Many of these vaccines you were probably given as a child: measles, mumps, rubella ("German measles"), and chickenpox.

Live attenuated vaccines replicate briefly in the body, triggering a strong—and long-lasting—response from your immune system. Because your immune system kicks into high gear at what it perceives to be a major threat, you need fewer doses of the vaccine for protection against these diseases. And unlike the harmful form of the virus, it is extremely unlikely (because they only replicate at low levels) that these vaccines will cause the host to develop the actual disease, or to spread it to other contacts. One exception is the live polio vaccine, which could spread to others and, extremely rarely, caused polio disease (approximately one case of polio from 3 million doses of the virus). For this reason, the live polio virus was discontinued in the United States in 2000.

Scientists use the same growth technique for what are known as "killed" or "inactivated" vaccines, but they add an extra step: viral death. Inactivated viruses are killed, typically via heat treatment or use of a chemical such as formaldehyde, which modifies the virus's proteins and nucleic acids and renders the virus unable to replicate. Inactivated vaccines include Hepatitis A, the injected polio virus, and the flu shot.

A dead virus can't replicate in your body, obviously. This means that the immune response to inactivated vaccines isn't as robust as it is with live attenuated vaccines; replication by the live viruses alerts many different types of your immune cells of a potential invader, while killed vaccines primarily alert only one part of your immune system (your B cells, which produce antibodies). That's why you need more doses to achieve and maintain immunity.

While live attenuated vaccines were the primary way to make vaccines until the 1960s, concerns about potential safety issues, and the difficulty of making them, mean that few are attempting to develop new live attenuated vaccines today.

COMBINATION, BACTERIAL, AND GENETICALLY ENGINEERED VACCINES

Other vaccines aren't made of whole organisms at all, but rather bits and pieces of a microbe. The combination vaccine that protects against diphtheria, pertussis, and tetanus—all at once—is one example. This vaccine is called the DTaP for children, and Tdap for adults. It contains toxins (the proteins that cause disease) from diphtheria, pertussis, and tetanus bacteria that have been inactivated by chemicals. (The toxins are called "toxoids" once inactivated.) This protects the host—a.k.a. you, potentially—from developing clinical diphtheria and tetanus disease, even if you are exposed to the microorganisms. (Some viruses have toxins—Ebola appears to, for example—but they're not the key antigens, so they're not used for our current vaccines.)

As they do when developing live attenuated or inactivated vaccines, scientists who create these bacterial vaccines need some target bacteria to culture. But because the bacteria don't need a host cell to grow, they can be produced in simple nutrient broths by vaccine manufacturers. The toxins are then separated from the rest of the bacteria and growth media and inactivated for use as vaccines.

Similarly, some vaccines contain just a few antigens from a bacterial species. Vaccines for Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis all use sugars that are found on the outer part of the bacteria as antigens. These sugars are purified from the bacteria and then bound to another protein to enhance the immune response. The protein helps to recruit T cells in addition to B cells and create a more robust reaction.

Finally, we can also use genetic engineering to produce vaccines. We do this for Hepatitis B, a virus that can cause severe liver disease and liver cancer. The vaccine for it consists of a single antigen: the hepatitis B surface antigen, which is a protein on the outside of the virus. The gene that makes this antigen is inserted into yeast cells; these cells can then be grown in a medium similar to bacteria and without the need for cell culture. The hepatitis B surface antigen is then separated from the yeast and serves as the primary vaccine component.

OTHER INGREDIENTS IN VACCINES (AND WHY THEY'RE THERE)

Once you have the live or killed viruses, or purified antigens, sometimes chemicals need to be added to protect the vaccine or to make it work better. Adjuvants, such as aluminum salts, are a common additive; they help enhance the immune response to some antigens by keeping the antigen in contact with the cells of the immune system for a longer period of time. Vaccines for DTaP/Tdap, meningitis, pneumococcus, and hepatitis B all use aluminum salts as an adjuvant.

Other chemicals may be added as stabilizers, to help keep the vaccine working effectively even in extreme conditions (such as hot temperatures). Stabilizers can include sugars or monosodium glutamate (MSG). Preservatives can be added to prevent microbial growth in the finished product.

For many years, the most common preservative was a compound called thimerosal, which is 50 percent ethylmercury by weight. Ethylmercury doesn't stick around; your body quickly eliminates it via the gut and feces. (This is different from methylmercury, which accumulates in fish and can, at high doses, cause long-lasting damage in humans.) In 2001, thimerosal was removed from the vaccines given in childhood due to consumer concerns, but many studies have demonstrated its safety.

Finally, the vaccine is divided into vials for shipping to physicians, hospitals, public health departments, and some pharmacies. These can be single-dose or multi-dose vials, which can be used for multiple patients as long as they're prepared and stored away from patient treatment areas. Preservatives are important for multi-dose vials: bacteria and fungi are very opportunistic, and multiple uses increase the potential for contamination of the vaccine. This is why thimerosal is still used in some multi-dose influenza vaccines.

Though some of the vaccine ingredients sound worrisome, most of these chemicals are removed during multiple purification steps, and those that remain (such as adjuvants) are necessary for the vaccine's effectiveness, are present in very low levels, and have an excellent track record of safety.

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