There's really not much proof probiotics work: Study

iStock/ThinkstockBY: DR. NICKY MEHTANI

(NEW YORK) -- Over the past decade, probiotic dietary supplements have turned into a multi-million dollar industry, taken by almost 4 million adults and prescribed by up to 60 percent of health care providers. Yet the scientific community has known little about whether or not they actually work.

But this is likely to change, thanks to two back-to-back studies published Thursday in Cell, which cast further doubt on the benefits of the highly-commercialized probiotic products.

"People have thrown a lot of support to probiotics, even though the literature underlying our understanding of them is very controversial," Eran Elinav, senior author and an immunologist at the Weizmann Institute of Science in Israel, said in a press release, "we wanted to determine whether probiotics such as the ones you buy in the supermarket do colonize the gastrointestinal tract like they're supposed to, and then whether these probiotics are having any impact on the human host."

What are probiotics?

Probiotics are live microorganisms, often marketed and sold in foods (such as yogurt) and dietary supplements. While most people think of bacteria as “bad” (causing disease), many bacteria serve vital roles in keeping us alive. Count among them the bacteria that line our digestive tracts and help break down and absorb food -- actually fighting off infections.

Probiotics are intended to mimic and strengthen the effects of these “good” bacteria, touted as bacteria that can “rebalance” your system. Claims from the probiotic industry range run from preventing the common cold to treating allergic disorders such as atopic dermatitis. Since they are marketed as dietary supplements, not drugs, probiotics have never been approved for the prevention or treatment of any health conditions by the U.S. Food and Drug Administration (FDA) -- they don’t need to be, by law.

Based on these new studies, the road to health claims seems rockier

While the vast majority of prior studies on probiotics have relied on analyzing stool to get an idea of the person’s gut microbiome, Elinav’s research team actually looked, with an endoscope, at bacteria present in the colon itself -- both in mice and in humans.

After 25 healthy volunteers ate a generic probiotic with 11 strains of “good” bacteria, they all had probiotic bacteria in their stool, which the research team expected. But when doctors did the endoscopy to evaluate their intestines, they found that probiotics had only actually “stuck” and grown in a few people.

"Although all of our probiotic-consuming volunteers showed probiotics in their stool, only some of them showed them in their gut, which is where they need to be," Eran Segal, a computational biologist at the Weizmann Institute, said in a press release.

If the probiotics aren't in the colon, it's hard to argue that they are doing any good.

One of the most common uses of probiotics is to counteract diarrhea that sometimes comes after antibiotic use. Antibiotics do kill off disease-causing “bad” bacteria, but in the process, many “good” bacteria in the colon are sacrificed as well -- thus diarrhea and poor absorption of key nutrients from food. That’s why some doctors tell their patients to take probiotics with a course of antibiotics or right afterward, to prevent the complete loss of “good bacteria.” These providers believe that, while not always 100 percent effective, the use of probiotics in healthy adults is at least relatively risk-free.

The researchers asked volunteers to finish a course of broad-spectrum antibiotics and looked at their intestines after they’d also taken probiotics. The probiotics did effectively “colonize” their gastrointestinal tracts, but they did so at the expense of the normal gut microbiome, delaying the return to its normal, pre-antibiotic state by several months.

It’s not proof of harm, but it is known that lower microbial diversity after antibiotics can lead to increased susceptibility to a myriad of chronic and infectious diseases. Thus, the low level of diversity permitted by probiotic colonization and the ensuing delay they cause in returning a person’s gut microbiome to the pre-antibiotic state suggests that probiotics may not be harmless, as most seem to think.

Dr. Nicky Mehtani is an internal medicine physician and part of the ABC News Medical Unit.

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3 out of 4 college students say they're stressed, many report suicidal thoughts: Study

iStock/ThinkstockBY: DR. ITALO BROWN

(NEW YORK) -- Sending a child off to college is an immense accomplishment for parents, who can finally breathe a sigh of relief. But teens on campus find a vastly different view of what a college environment is like, including its demands and challenges. A new study supports this, finding that students are much more stressed than parents, or anyone else, might realize.

The study, published in the medical journal Depression and Anxiety, found that mounting expectations, an evolving sense of self-identity, and the typical shock of leaving home for a new place are making college students more vulnerable to mental health risks, including suicidality.

Anxiety and depression rates have been rising, according to the study, which found three out of every four college students reporting at least one stressful life event within the past year — involving everything from social relationships to personal appearance to problems with family. Twenty percent said they experienced greater than five stressful life events within that same time frame.

“College is very stressful in an alarming way. That’s important for parents to be aware of,” lead author of the study Cindy Liu, PhD, a psychologist at Brigham and Women’s Hospital, told ABC News.

Liu conducted the study by surveying over 67,000 college students from over 100 college campuses about their stress, anxiety and depression. They were also asked directly if they’d had suicidal thoughts or made attempts to harm themselves. One in five students said they had thought of suicide, while about one in 10 actually attempted it. Each of those statistics is more than double the national average for adults.

“Even if you have a student who is doing well in school, it doesn’t mean they aren’t dealing with something internally,” Liu said. “You have to peel back more layers. That is the real struggle for parents and colleges — identifying those students who are quietly enduring a significant mental health experience.”

The survey asked about 15 different types of mental health issues, ranging from anorexia to anxiety and panic attacks to addiction. Liu also highlighted one particularly nuanced strength of the study: it pinned down conflicts with self-identity. For example, those who identified as a sexual minority tended to have the highest rates of mental health diagnoses. Gay, lesbian, and bisexual students reported thoughts or actions related to killing themselves two to three times more often than heterosexual students. Transgender students, meanwhile, were among the highest in reported mental health diagnoses and suicidality.

Black and Hispanic students reported mental health diagnoses and self-harm at lower rates than whites; however, multiracial students were more likely to admit thoughts of suicide or previous attempts. These numbers are striking, but in reality, they could actually be worse than the study indicates, since stigmas surrounding sexual identity and mental health may have caused students to underreport their problems.

The findings add gravity to the well-known relationship between trauma, mental health, and suicide, and indicate that college, for some, is far from a carefree environment. It’s important that colleges and students realize the stress is real, and that they make adequate college-based mental health resources available.

For parents of college-bound students, these statistics are unsettling. They may indicate a greater need to pay attention to the mental health experiences of college students, especially when it comes to self-identity.

“Try to normalize the college experience and the stressors involved,” Liu said. “It is critical to think about their identity, and how that matters to their complete mental health experience.”

Dr. Italo M. Brown is an Emergency Medicine Physician and writer with the ABC News Medical Unit.

Copyright © 2018, ABC Radio. All rights reserved.


Expert panel recommends against routine blood screening for prostate cancer: Report


(NEW YORK) -- An expert panel has recommended against routine blood screening for prostate cancer, in a report published Wednesday in The BMJ.

The panel, composed of general practitioners, urologists, methodologists and patients, cited five clinical trials which evaluated the use of a blood test for prostate-specific antigen (PSA) in screening for prostate cancer. Using this screening test led to no significant decrease in overall patient death, according to the study.

Prostate cancer screening has been a controversial topic in the field of medicine. PSA screening has definitely led to an increase in the detection of prostate cancer. “The problem is that the PSA test, the only test currently available, has a high incidence of false positive and false negative results, and many cancers detected through PSA are indolent and would never cause the patient any harm,” said Dr. Martin Roland, emeritus professor of Health Services Research at the University of Cambridge, said in an editorial. Current tests cannot reliably identify aggressive-behaving cancers, and those are the ones that can kill.

Novel methods of prostate cancer management, including prostate MRI and MRI-guided biopsies, are not widely available to use for the general population, despite promising results.

False positive PSA results cause unneeded treatments, and side effects from treatment can be significant. Not only can biopsies and surgeries cause infection, but they can also lead to urinary incontinence and erectile dysfunction. Following surgery, incontinence was seen in up to 17 percent of patients, and erectile dysfunction was seen in up to 83 percent.

The recommendations come following recent changes in the United States Preventive Services Task Force recommendations back in May of 2018. They now encourage PSA screening to be an individual decision. Neither recommend general population screening. The panel cautioned, however, that certain groups, such as those with a family history of prostate cancer, may want to consider PSA screening.

Dr. Jonathan Steinman is a radiology physician and writer with the ABC News Medical Unit.

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More illnesses from Salmonella linked to recalled Honey Smacks cereal: CDC

@CDCgov/Twitter(ATLANTA) -- Another 30 people have been reported sick from Salmonella infections linked to Kellogg’s Honey Smacks Cereal, bringing the total to 130 cases, the Centers for Disease Control and Prevention said.

Both the CDC and the U.S. Food and Drug Administration are reminding people not to purchase or consume the cereal that has been recalled since June.

"Retailers should not sell any Kellogg’s Honey Smacks cereal. It could be contaminated with Salmonella and make people sick," the CDC said in a statement. "If you see Kellogg’s Honey Smacks cereal for sale, do not buy it."

People infected with Salmonella Mbandaka, the strain found in Honey Smacks, typically get sick 12 to 72 hours after consuming the food. Symptoms include diarrhea, fever and stomach cramps and can last from four to seven days. Most people recover on their own without medical treatment. But if the infection is severe, it can spread to the blood stream and other parts of the body and can require hospitalization.

The Kellogg Company recalled Honey Smacks cereal on June 14 after a wave of Salmonella infections were reported.

Since then, 30 more people from 19 states, which now include Delaware, Minnesot and Maine, have reported illnesses that have been linked to the outbreak, according to CDC.

"Even if some of the cereal has been eaten and no one got sick, throw the rest of it away or return it for a refund," the CDC said.

Those who store cereal that looks like Kellogg’s Honey Smacks in a container without the packaging and may not remember the brand or type are also encouraged to throw the product away. Any containers that held the cereal should be thoroughly washed with warm, soapy water before re-use to remove harmful germs that could contaminate other food.

In total, 130 people from 36 states have been reported with Salmonella-related illnesses connected to the outbreak. No deaths have been reported.

An investigation into the multistate outbreaks is being conducted by the CDC and the FDA, along with public health and regulatory officials in several states, the CDC said.

The FDA also urged consumers to discard any Honey Smacks they may find in their homes and to report any Honey Smacks offered for sale in their area to the FDA consumer complaint coordinator.

Kellogg said in the statement that it stopped producing Honey Smacks cereal and is offering refunds.

"We ceased production of Honey Smacks cereal in June when we learned of the possible connection to the Salmonella outbreak and have not yet shipped any new cereal to retailers," the company said in a statement. "Kellogg is asking that people who purchased potentially affected product discard it and contact the company for a full refund."

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New guidelines released to navigate concussions in children

iStock/ThinkstockBY: DR. ITALO M. BROWN

(NEW YORK) -- It’s a common fear for parents whose children may get hurt while playing sports. What should they do when their child takes a hit to the head, on the field or even on the playground?

Luckily, there are new guidelines by a workgroup from the Centers for Disease Control and Prevention (CDC) that will help providers and parents navigate concussions in children.

What are the new guidelines?

The new recommendations from clinicians, researchers, and public health experts, published in the JAMA Pediatrics journal, establish a standard-of-care in diagnosis and management of mild traumatic brain injury (mTBI) in children.

“Pediatric mTBI is now recognized as a major public health problem, bringing nearly 1 million children to U.S. emergency departments annually,” according to Michael McCrea, Ph.D., lead author the JAMA Pediatrics editorial.

The guidelines, in 19 key areas, spell out when to order imaging like a CT scan, when to refer to a specialist, and guidance for parents and children in the recovery process.

“Unfortunately, most research on mTBI has focused on adults," McCrea said. "We cannot simply retrofit data from adult studies to children.”

The recommendations in the guidelines are for doctors, but the authors also give advice to parents, as the back-to-school period can be a critical time when children are preparing for play in contact sports.

A routine physical is often required for those sports. The study says it’s a prime opportunity for parents to talk to doctors about signs and symptoms of a concussion. Doctors (using these new guidelines) should carefully explain the risks and provide details on what to do if an injury occurs.

Here are some of their recommendations:

Parents should look for red flag symptoms -- a severe headache, vomiting, loss of consciousness or memory within 48 hours of the injury. Those are signals to head to the emergency room (ER) as early as possible.

Parents should expect ER doctors to take a full history of the incident, and perform a neurological examination. But the new guidelines say brain imaging (CT scans) is not recommended in every scenario. When the ER visit is over, parents should be told what to expect during their child’s recovery, when to resume play, and what symptoms warrant a re-evaluation by a physician.

The severity of symptoms can differ from child to child, according to the guidelines, and may affect recovery. Although 70-80 percent of kids with concussions stop having symptoms in one to three months, some children experience stronger symptoms (teens, children from low socioeconomic backgrounds, Hispanic children, and girls). They should be monitored more closely. Persistent symptoms should be taken seriously by parents and clinicians; that may indicate the need for a specialist.

“The new CDC Guideline for Pediatric Mild TBI is a solid step toward achieving this comprehensive, personalized approach to state-of-the-art care for mTBI in youth,” McCrea said.

With these recommendations, parents and doctors alike can be more prepared to be on the lookout for concussion symptoms in kids.

Dr. Italo M. Brown is an emergency medicine physician and part of the ABC News Medical Unit.

Copyright © 2018, ABC Radio. All rights reserved.


Nurse discovers 28-year-old colleague was premature baby she cared for

Lucile Packard Childrens Hospital Stanford(STANFORD, Calif.) -- A California nurse just discovered that she'd actually met a new coworker before -- 28 years ago.

Vilma Wong, who'd been working at Lucile Packard Children's Hospital Stanford for more than 32 years, met Brandon Seminatore, 28, in August. Seminatore, a second-year pediatric resident completing a child neurology residency at Stanford University, had joined Wong's team, according to the statement from Lucile Packard Children's Hospital.

"I asked who he was and his name, and last name sounded very familiar," Wong said in the statement. "I kept asking where he was from, and he told me that he was from San Jose, California, and that, as a matter of fact, he was a premature baby born at our hospital."

Wong's curiosity grew, so at one point she just asked Seminatore.

"I asked him if his dad was a police officer," she said. "And there was a big silence, and then he asked me if I was Vilma, I said yes."

Seminatore's mother had asked him to look for nurse name Vilma, who took care of him when he was a baby.

"I was in shock initially but overjoyed to know that I took care of him almost 30 years ago," Wong said. "And now he's as a pediatric resident to the same population he was part of."

After Brandon informed his parents about finding his primary nurse, his parents texted him the picture they had of Vilma holding him on her lap when he was a baby.

Seminatore said his parents told him about his premature condition as a baby and that they had to keep him with a nurse to make sure he was OK.

"I needed an incubator to keep me warm, a ventilator to help me breath, and had near endless pokes and prods to make sure I was healthy and growing appropriately,” Seminatore said in the statement. "Meeting Vilma was a surreal experience. I never expected to meet a provider who took care of me when I was a baby."

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ADHD rates in kids has increased over the past 20 years

By Dr. Edith Bracho-Sanchez

Elena Peremet/Getty Images(NEW YORK) -- Attention deficit and hyperactivity disorder, or ADHD, has become more common in children over the past twenty years, according to a new study.

The prevalence of ADHD in U.S. children and adolescents has increased from 6.1 percent in 1997 to 10.2 percent in 2016, the study published Friday in the Journal of the American Medical Association, or JAMA, said. The way the disorder is evaluated likely plays a part.

"The diagnosis and assessment for ADHD has evolved over the past few decades. The diagnostic criteria that we use is now a little more liberal and captures cases that the older criteria would have left out," said Dr. Neha Choudhary, a child psychiatrist at the Massachusetts General Hospital/Harvard Medical School and co-founder of Stanford Brainstorm, in an interview with ABC news.

The newest criteria allow for either inattention or inactivity to be taken into consideration at time of diagnosis.

"This is especially important in young girls who often fly under the radar as they don't always have the same, obvious symptoms of hyperactivity as do their male peers," Choudhary, who was not involved in the study, said.

In the 20-year study, boys were diagnosed with ADHD at higher rates, an average of 14 percent, compared to girls at 6.3 percent. There were also racial differences in the prevalence of the disorder: African American children had the highest prevalence at 12.8 percent, followed by white children at 12 percent and Hispanic children at 6.1 percent.

The team calculated the rates by using yearly surveys contained within the National Health Interview Survey, a large nationwide study conducted by a branch of the Centers for Disease Control and Prevention, or CDC. Researchers followed 186,000 children ages 4 to 17 every year from 1997 to 2016.

The reasons for the increase in ADHD rates were not directly studied. But the researchers suggested that efforts to train physicians in the disorder, improved awareness in the public, improved access to mental health services and changes in the diagnostic criteria may have all led to an increased number of children being diagnosed with ADHD.
The symptoms of ADHD include inattention, as well as hyperactive and impulsive behavior, according to the Diagnostic and Statistical Manual of Mental Disorders, or DSM 5, which psychologists and psychiatrists generally follow.

An ADHD diagnosis is often made based on a child or teen having a number of inattentive and/or hyperactive symptoms for at least six months in social, academic or occupational environments.

Recent evidence also suggests that frequent use of digital media may be linked to an increase in symptoms that are typically associated with ADHD. But long-term study has not yet been possible.

"I think it's too early to tell what the link is between digital media use and ADHD," Choudhary said.

"We live in a new age full of many more distractions," she added. "Even a healthy brain might be able to develop habits of overusing technology or becoming easily distractible. Some of it might end up looking like the criteria for ADHD without really being the same disease process in the brain."

The American Academy of Pediatrics noted some of the benefits of digital and social media use, including early learning, exposure to new ideas and knowledge and opportunities for social contact and support. However, the AAP also warned that the risks can include negative effects on sleep, attention and learning and higher incidence of obesity and depression, among others. The group recommends creating a Family Media Use Plan.

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Kids should stay in rear-facing car seats as long as possible, new guidelines say

iStock/Thinkstock(NEW YORK) -- Children should stay in rear-facing car seats as long as possible to protect their developing heads, necks and spines in the event of a crash, according to new guidelines from the American Academy of Pediatrics (AAP).

Parents are now advised to keep their children's car seats in the rear-facing position for as long as possible, or at least up to the age of 4, according to the AAP's recently updated recommendations. Previously, the AAP recommended rear-facing car seats up until the age of 2.

The AAP's new guidelines are encouraging parents to keep kids rear-facing until they have reached the maximum height and weight limit listed on their car seat's labels and instruction manual. Then parents can transition kids to the next phase of car seat or booster seat.

Motor vehicle crashes are the leading cause of death for children over the age of 4, according to the AAP. Placing a child in a car seat correctly can help decrease the risk of death or serious injury by over 70 percent, according to nonprofit child safety organization Safe Kids Worldwide.

"Every month that a child rides rear-facing a little bit longer gives more time for the head, neck and spine to develop," Kerry Chausmer, director of certification at Safe Kids, told Good Morning America. "And that's really why we want kids to ride rear-facing. It protects the head, neck and spine better in a crash."

Dr. Benjamin Hoffman, lead author of the AAP policy statement and chair of the AAP council on injury, violence and poison prevention, said car-seat manufacturers now produce seats that allow children to remain rear-facing until they weigh 40 pounds or more, "which means most children can remain rear-facing past their second birthday."

"It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride," Hoffman added in the statement released by the AAP.

Experts also say it's not a problem if older children's legs can touch the back seat while using rear-facing car seats.

"Kids are actually safer rear-facing -- not just their head, neck and spine, but also their legs. So it's perfectly fine if kids' legs hit the back of the car seat," Chausmer said.

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Bees develop a taste for some pesticides the way humans get addicted to nicotine, say scientists

iStock/Thinkstock(NEW YORK) -- Bees can become addicted to pesticide-laced foods the same way that humans become hooked on nicotine, according to a new study.

Agricultural pesticides, particularly neonicotinoids -- a class of neuro-active insecticides chemically similar to nicotine -- have long been believed to be detrimental to bee populations, affecting their ability to reproduce, limiting lifespans and other potential consequences of exposure to pesticide-laced foods.

But the new study, published in the British scientific journal The Proceedings of the Royal Society B, suggest that bees can get hooked on neonicotinoids-laced foods.

“We originally wanted to know if the bees could detect the presence of this class of pesticide and, if given enough time, learn to avoid food containing the pesticide,” Richard Gill from the Department of Life Sciences at Imperial College in London told ABC News.

“In mammals, for example, we know that nicotine is an addictive property, so we could make that inference that maybe these neonicotinoids -- considering they act on similar targets -- may have similar addictive properties,” said Gill, who led and supervised the research team.

“And our behavioral experiments suggest that that might be the case.”

Neonicotinoids target nerve receptors in insects that are similar to the human receptors that nicotine binds to, according to the 18-month study, which was conducted by a group of six researchers and scientists.

The researchers placed individual colonies of bumblebees in arenas in a laboratory -- which allowed individual bees to leave the colony and fly within the arena to find the food that was left out for them, according to Andres Arce, one of the team members.

During the research, the group provided the bees with three different types of food containing either no pesticide, a low amount of the neonicotinoid pesticide, or a higher amount, said Arce.

For 10 days, the group monitored the behavior of the bees toward the food provided and how much of each type of food was eaten. They also counted the number of times the bees visited each type of food and the amount of food they consumed, Arce said. The researchers also changed the position of the feeders, which were identical, halfway through the experiment, to see if the bees tracked their preferred treatment.

“At the start of the experiment we saw that the bees preferred the food containing no pesticide, with the pesticide-treated food visited and consumed less than the pesticide-free food,” Arce said.

“However, as time went by the bees started to change their behavior and they increased the amount of pesticide laced food they foraged on and brought back to the colony.”

By showing this change over time, the group demonstrated that the bees were developing a preference for the pesticide treated food.

“We also saw that when the position of the feeders was changed, the bees responded and would still visit the feeders containing the pesticides –- which indicates that they could detect the pesticide and would track it,” Arce said.

The researchers hope that their findings will help to foster more responsible use of pesticides.

“If we understand how often they come into contact with these pesticides in the wild, it can give us an idea of how we can then use those pesticides a bit more responsibly," Gill said, "so that we can try and lower the risk of exposure and that could be not only where we apply them but it could also be the timings of when we apply them.”

Earlier this month, California's Department of Pesticide Regulation released a report which concluded that neonicotinoids cause a significant risk to the bee populations that are brought in to pollinate crops in the state's $45 billion agricultural industry, according to the Los Angeles Times.

“The more we learn about the toxicity of neonics, the more apparent it is that pretty much any plant with nectar or pollen sprayed with these poisons is unsafe for bees,” Nathan Donley, a senior scientist with the Center for Biological Diversity, told the newspaper, using a common shorthand term for neonicotinoids.

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Daughter loses 55 pounds to donate kidney to her 'superhero' father 

Courtesy Dawn Muhammad (NEW YORK) -- After being told she was too overweight to donate a lifesaving kidney to her father, a Georgia woman lost more than 55 pounds in order to save the life of her "superhero" dad.

"He is my superhero. He is the man I have looked up to all my life," Dawn Muhammad of Atlanta told Good Morning America of her father, Lucious Daniels.

"He has sacrificed a lot for our family -- a lot," she added.

In 2016, Daniels was diagnosed with stage 4 kidney failure at the age of 71. Doctors told Daniels that, without a kidney transplant, he had little chance of survival.

"They told me that I would be on a waitlist waiting for a kidney to become available," Daniels told GMA. "It would be pretty far down on the list, and at my age, I would be running out of time."

Muhammad said right away she knew that she had to do everything she could to help save the man who gave her life, and she headed straight to the hospital, where doctors told her that her body mass index (BMI) was too high to be a kidney donor.

After hearing the news, Muhammad said she "cried."

"I looked at myself in the mirror and I said, 'Let's try this, let's try this, let’s really try and commit to it,'" Muhammad said. "We told my father, 'This isn’t the end, this can’t be the end, we have got to find a moment to help.'"

Muhammad then embarked on the personal journey of losing 55 pounds in order to be able to give her father her kidney -- all without telling him about the plan.

To lose the weight, Muhammad said she gave up sugar.

"Sugar is the devil," she said, adding that she "started cutting down the carbs and I started working out really hard."

Muhammad said she broke down in tears when she finally reached her goal, and broke the news to her father.

Muhammad was the perfect match, and to share her excitement about being able to save her father’s life, she wrote him a poem, which she presented to him in a card.

"Always and forever, that is how long I will love you, to my daddy, my first superhero, my first love," Muhammad said, reading from the surprise poem she presented him. "Now it's time for me to make the ultimate sacrifice for you, how could I work hard to lose weight and prove my health and not come through."

She continued: "From my kidney to yours, I love you, Daddy!"

Daniels said he couldn't be more proud of his daughter for giving him this gift.

“I knew that being on the waiting list for a long period of time was not going to make it happen,” he said. “So I was very, very happy that she came along and decided to do it for me, for her dad."

Muhammad said she has a message for other potential organ donors.

"Just do it," she said. "It's a selfless act. It's an act of love, not an act of sacrifice."

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