Sweet’N Lethal

Published May 3, 2025

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Time to Loosen the Cap in HF Fluid Restriction? 

CARDIO CORNER

Fluid restrictions have long layered additional hardship onto patients living with heart failure (HF)—and you, the clinician, feel the strain of enforcing them. But is this practice still justified? Do patients really need to live like a Three Amigos Steve Martin, dry-sipping a canteen? Perhaps not, according to fresh data presented at the American College of Cardiology annual meeting.

Let them drink (more) water

In the open-label FRESH-UP trial, researchers assigned 504 adults with NYHA class II/III HF to either liberal (~1.76 L/day) or restricted (~1.48 L/day) fluid intake. After three months, quality-of-life scores (KCCQ) landed about the same. But thirst distress and clinical summary scores tipped in favor of liberal intake. Safety outcomes—mortality, hospitalizations, kidney function—held steady. Bottom line: no harm, slight gain, and freer access to fluids.

Watering down the results

The trial excluded patients with recent cardiac events, severe renal dysfunction, or hyponatremia, and the overwhelmingly White cohort limits generalizability. Also, baseline fluid intake was already moderate in both groups. That and the lack of blinding in the study may dilute the findings. Still, the authors see no compelling evidence for enforcing strict fluid caps.

Key takeaways 

“It’s not just about whether patients live or die anymore—there are so many treatments improving mortality now, that the focus needs to shift to quality of life,” said cardiologist Shelley Hall. FRESH-UP shows that more lenient fluid intake may ease thirst without compromising safety. The study suggests that for stable patients on guideline-directed therapy, relaxing fluid limits to 1.7–2.0 L/day is reasonable—especially for those struggling. “Let’s be a little kinder to our patients and ourselves. We don’t have to be so harsh pounding fluid restriction,” said Hall. As always, individualization guides treatment—but this study offers welcome flexibility for those facing quality-of-life trade-offs.

For more education on heart failure, check out this CME activity: Worsening HFrEF: Moving Beyond Foundational Therapy

Potential Prodrug for Memory Loss Born from Herbs

NEURO NEWS

An unstable compound

Carnosic acid dials down inflammation and jumpstarts the body’s defense enzymes, but it’s too chemically unstable to use directly. So, researchers at Scripps engineered a synthetic—diAcCA—that survives digestion and morphs into carnosic acid just before hitting the bloodstream. In Alzheimer disease mouse models, diAcCA crossed into the brain and ramped up memory and synaptic density, as evidenced by immunohistochemical analysis and the mice crushing water mazes. DiAcCA also sharply reduced brain inflammation—activating only in affected areas, which could mean fewer side effects.

The mice tolerated diAcCA well, and toxicity studies revealed it even eased baseline inflammation in the esophagus and stomach as it converted to carnosic acid. With carnosic acid already stamped on the FDA’s “generally regarded as safe” list, clinical trials may be imminent.

Key Takeaways

Early data suggest diAcCA could help regenerate brain connections and dismantle harmful proteins like phosphorylated tau and amyloid-β. Study author Stuart Lipton believes diAcCA could stand alone as an anti-inflammatory or tag-team with existing Alzheimer disease drugs, potentially softening side effects like amyloid-related imaging abnormalities. Clinical trials further up the food chain could soon indicate whether this novel prodrug is ready for prime time.

For more education on Alzheimer disease, check out this CME activity: Navigating the Dementia Landscape: Best Practices for Primary Care Clinicians

Sweet Findings in the Bitter Fight Against Bacteria

INFECTIOUS FINDINGS

Forget billion-dollar pipelines and decades of clinical trial and error. In the time it takes a med student to work “antimicrobial resistance” into a conversation, scientists identified a three-cent compound that shreds drug-resistant bacteria: saccharin. A new study suggests this century-old diner darling may be repurposed as both an antimicrobial and an antivirulence agent.

Sweet’N Lethal

In a preclinical study, scientists at Brunel University London looked into how saccharin affects bacteria—and had to rub their eyes at what they found. Saccharin blocked cell division, scrambled DNA replication, and caused bacterial walls to bulge and burst. It halted the growth of tough Gram-positive and Gram-negative strains, broke down their biofilms, and even made resistant bacteria vulnerable to antibiotics again. And when packaged into a hydrogel, it outperformed standard wound dressings.

The study stops short of proving saccharin works in living systems. It wipes out bacteria in the lab, but its impact on human cells and the microbiome remains unclear. 

Key takeaways

Not to preach to the choir, but we’re in desperate need of novel antibiotics right now as we stare down a post-antibiotic era. That next agent may be hiding in plain sight—single file in the sugar caddy. Experimental research shows that this sugar-coated killer may disarm pathogens, blunt resistance, and enhance the power of existing drugs. It even resensitized notorious superbugs like Acinetobacter baumannii and Pseudomonas aeruginosa to frontline antibiotics. More studies to come before saccharin trades its pink packet for prescriptions.

Explore the Science of Happiness in Providence, RI

Head to Providence on Wednesday–Friday, October 22–24, to experience this quaint New England setting during peak fall foliage and choose from 40+ engaging CME/CE courses for primary care clinicians at Pri-Med East Primary Care CME/CE Conference & Expo.  

Earn up to 18.50 CME/CE credits and meet Laurie Santos, PhD, Yale professor and host of the popular podcast The Happiness Lab. Dr. Santos’ keynote address will discuss behaviors and mindset strategies that research suggests can help clinicians optimize professional performance.

This conference is developed in partnership with Sanjiv Chopra, MD, MACP, of Harvard Medical School and Frank J. Domino, MD, of UMass Chan Medical School. Register for only $129 until Friday, July 11.

Learn more

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