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Ghanaians Might Be at Risk of Excess Dietary Intake of Potassium Based on Food Supply Data

1Department of Soil Science, School of Agriculture, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana 2Department of Crop Science, School of Agriculture, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana 3Soil Research Institute, Council for Scientific and Industrial Research, Accra, Ghana 4Department of Environmental Science, School of Biological Science, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana 5Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana

Academic Editor: Christopher L. Gentile

Copyright © 2018 David Oscar Yawson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The World Health Organization (WHO) has highlighted the beneficial role of adequate intake of potassium (K) in combating the global burden of noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. Diets are the main source of K supply to humans and can contribute to both K deficiency (hypokalemia) and excess (hyperkalemia). While global attention is currently devoted to K deficiency, K excess can be even more dangerous and deserves equal attention. The objectives of this paper were to (i) estimate the K intake of Ghanaian population using food supply and food composition data and (ii) compare this estimate with the WHO-recommended requirement for K in order to assess if there is a risk of inadequate or excess K intake. Food supply data (1961–2011) were obtained from the Food Balance Sheet (FBS) of the Food and Agriculture Organization of the United Nations to derive trends in food and K supply. The average food supply in the FBS for 2010 and 2011 was used in assessing the risk of inadequate or excess dietary intake of K. The K content of the food items was obtained from food composition databases. Based on 2010-2011 average data, the K supply per capita per day was approximately 9,086 mg, about 2.6-fold larger than the WHO-recommended level (3,510 mg). The assessment suggests a potentially large risk of excess dietary K supply at both individual and population levels. The results suggest the need for assessing options for managing K excess as part of food security and public health strategies. The results further underscore a need for assessment of the K status of staple food crops and mixed diets, as well as K management in food crop production systems in Ghana.

1. Introduction

Adequate mineral nutrition is a major component of food security strategies. Potassium (K) is an essential element which plays crucial roles in the nutrition and health of plants, animals, and humans. Potassium is known to activate over 60 enzymes in plants, promotes photosynthesis, and plays a role in stomata opening, use of nitrogen, transport of assimilates, and microbial population in the rhizosphere [1–3]. Major roles of K in humans and animals include maintenance of water balance, osmotic pressure, and acid-base balance, activation of enzymes, and mediation of carbohydrate and protein metabolism. More importantly, potassium plays a crucial role in the regulation of neuromuscular activity and heartbeat [4, 5].

Globally, the adverse health outcomes of inadequate intake of vitamins and mineral elements (known as the “hidden hunger”) have received tremendous attention [6]. Similarly, the global burden of noncommunicable diseases (NCDs) has directed attention to the role of K in these diseases [7, 8]. There is a strong evidence of association between low K intake and increased risk of a number of NCDs, including hypertension, cardiovascular disease, chronic kidney stone formation, and low bone-mineral density [5, 9–13]. Low dietary intake of K can result in low serum K concentration, a situation referred to as hypokalemia. Conversely, high serum K concentration (>5.5 mmol/L) or hyperkalemia [14] can result from high dietary supply, problems with K excretion, and imbalance between intracellular and extracellular concentrations [15]. Compared to hypokalemia, hyperkalemia is quite rare but generally more serious and less well tolerated [15–17]. Hyperkalemia can result in a feeling of tiredness or weakness, numbness or tingling, breathing difficulties, chest pains, and palpitations or irregular heartbeats. In extreme cases, paralysis or heart failure can occur [14, 15]. Because the reported average K intake from diets in several countries is below the recommended threshold, the need for increased dietary intake of K-rich diets has been highlighted and efforts are being promoted globally [12, 18].

While the instrumental role of adequate K intake, through food, and its cost-effectiveness in combating the global burden of NCDs are attracting priority attention [12], the risk of excess K intake from diets and its associated adverse health outcomes are not being given comparable priority considerations because this condition is thought to be rare compared to K deficiency [15]. Diets are the main source of K supply in humans. The K content of food components largely derives from the soils on which feed and food crops are grown and the capacity of crops for K uptake. Yet, the K status of soils, K uptake, and fertilizer management in most agroecosystems continue to receive less attention, and this is particularly so in Ghana [3, 4]. The objective of this paper was, therefore, to estimate the dietary supply of K and the risk of inadequate or excess dietary supply of K in adult Ghanaian population using food supply and composition data.

2. Methods

2.1. K Supply from Foods

Prevalence of K deficiency can be assessed directly via the analysis of urine or blood samples. In the absence of such analysis and for larger population size, the deficiency of K can be quantified via food surveys or dietary analysis using food composition data [19] even though food surveys data can be biased by systematic misreporting and behavioural change [20]. Where there is paucity of data on representative food surveys or food composition tables, as is the case for Ghana, alternative sources of data such as the Food Balance Sheet (FBS) provided by the Food and Agriculture Organization (FAO) can be used to indirectly quantify the adequacy of K intake as has been done in similar studies (e.g., [21, 22]). Hence, the current study used the FBS data to indirectly quantify the risk of inadequate K intake in Ghana. A FBS provides a snapshot of the supply and uses of about 92 food items/groups for each of the FAO member countries during a given reference period [23]. The FBS has supply and utilization sides. For a given reference period and food item, total supply is the sum of total domestic production and imports, adjusted to changes in stocks that might have occurred since the beginning of the reference period. On the utilization side, the total supply of the given food item is decomposed into quantities exported, used for animal feed and seed, processed for food and nonfood uses, losses, and the fraction available for human consumption [23, 24]. The fraction of supply of the food item available for human consumption is divided by the total population of a given country to obtain the per capita supply. Thus, the FBS does not directly provide information on food consumption but on food availability, which was used as a proxy for consumption in the current study.

The average food supply per person for the latest years (2010 and 2011) in the FBS was computed. This was done to capture the minimum interannual variation in food availability or consumption. Food items were selected from the FBS based on the kg food supply per person. The dietary K supply per person was estimated as the product of per capita food supply (based on the FBS) and the K content of the food items [6, 25]. The K content or supply of each food component was calculated using the corresponding conversion factors for the edible fraction provided in the food composition table. The K contents of the food components (except for cocoa and products, oats, crustaceans, cephalopods, and other molluscs) were obtained from the West African Food Composition Table [26]. The K contents of the food items that were not found in the West African Food Composition Table [26], such as cocoa and products, were obtained from the United States Department of Agriculture-Agricultural Research Service (USDA-ARS) Nutrient Database for Standard Reference [27]. This method has been applied previously in studies that estimated the adequacy or otherwise of minerals in the diets of populations in some countries [6, 21, 25, 28].

To build the final database of K contents of selected food items, food items were excluded if the product of supply and K content was zero or if that particular food component is not known to be widely or commonly consumed in Ghana according to local knowledge. In the food composition databases, effort was made to identify the categories of food items that best matched those in the FBS [6]. Where two or more categories of the same food items are consumed in Ghana according to local knowledge, an average K content was computed to represent that food item. The total K supply (or intake) per person was calculated as the sum of the products of food supply and K composition of all the food items as described earlier. All K contents or concentration data are expressed as mg 100 g−1 fresh weight edible portion. To be consistent with the FBS units, the K contents were multiplied by 10 to obtain K supply in mg·kg−1 food intake. The per capita food supply and associated K supply for the period 1961–2011 were computed using the FBS and the food composition table, with a similar approach as described earlier, to obtain the trends.

2.2. Adequacy of K Supply from Food

The likely risk of inadequate dietary supply of K was assessed at the individual level, and then the prevalence of deficiency at the population level was estimated using the EAR cut-point approach [6, 25, 29]. A detailed description of this approach and its strengths and assumptions are provided in the Food and Nutrition Board [29]. Due to paucity of information, the recommended K intake for adults of 3510 mg·K per person per day [12] was used in the current study as the reference nutrient intake (RNI). The RNI represents the intake level of a mineral which meets the nutrient requirements of 97.5% apparently healthy individuals in a population group for a given age and sex [6]. Again, due to paucity of information, we used a standard conversion of RNI 1.2∗EAR (as [6] used for Mg and explained by [30] to convert the RNI to an estimated average requirement (EAR) of 2925 mg).

To assess the risk of inadequacy at the individual level, the EAR value was used to represent the “required mean K intake” (r), while the total K supply (based on the FBS and food composition data) represented the “observed mean intake” (y). The difference between y and r, D, gives an initial impression of the adequacy or otherwise of K intake per person. To allow a probability of correct conclusion on the adequacy of intake, the magnitude and direction (positive or negative) of the ratio of D and its standard deviation (SDD) was estimated [29]. The SDD represents the daily variation in individual intake of K. To calculate the SDD, the standard deviation of the required intake (SDr) was estimated at 10% and 15% [29], while the pooled standard deviation of the observed intake (SDi) for adult males and females was obtained from reference tables [29] due to lack of national-level data. The SDD was then calculated using the procedure in [29]:where is the number of days of observed intake data.

Subsequently, the ratio of D to SDD was computed for each case (at 10 and 15% for adult males and females) to obtain the probability of correct conclusion regarding the adequacy or otherwise of individual intake (based on the interpretation table in [29]).

The EAR cut-point method was used to estimate the likely prevalence of inadequate intake at the population level. In the EAR cut-point method, a normal distribution of daily intake among the population was expected. The proportion of the population at risk of inadequate intake is assumed to be equivalent to the proportion with intake below the EAR [29]. Because we only had a point estimate of dietary K supply and following an approach used in some previous studies (e.g., [6, 25]), daily K intake in the population was assumed to have a normal distribution, centred on the mean dietary supply and with a coefficient of variation (CV) of 25% or 30%. Based on this, the prevalence of inadequate K intake was estimated using the average of 2010 and 2011 population provided in the FBS which was used to calculate the per capita food supply.

3. Results

3.1. Contribution of Food Components

The current study included 46 food items in the Food Balance Sheet (FBS) for Ghana (Table 1). The food item coffee and products (mainly instant powder coffee) had the largest K content (3640 mg), followed by mixed ground spices with the K content of 1040 mg. “Meat, other” (mainly game meat) had the third largest K content (923 mg), while “sugar (raw equivalent)” had the least (2 mg). The top three food items with the largest K content (i.e., instant powder coffee, mixed ground spices, and game meat) were consumed in very low quantities in Ghana between 2010 and 2011 according to the FBS. Hence, these contributed less to the overall dietary K supply.

Table 1: Estimated 2010-2011 average food and K supply per person of 46 edible food items based on the Food Balance Sheet (FBS) and food composition data for Ghana.

Total K intake from food supply per person was estimated at 9,086 mg per day (Table 1). The top five food items consumed in large quantities were (in order of importance) cassava and products, yams, plantains, roots (other), and rice (milled equivalent). The K supply from these food items was 2641.6, 2775.9, 1884.8, 317.6, and 17.8 mg per capita per day, respectively (Table 1). These top five food items contributed approximately 89% of total dietary K supply. Of the total dietary K supply, starchy roots contributed 84%, while vegetables contributed only 5% (Figure 1(a)). The rest contributed approximately 2% or less. Oranges and mandarines contributed 50% of the total contribution of fruits (Figure 1(b)). Of the starchy roots, yams and cassava contributed the largest (Figure 1(c)). Wheat and products contributed the largest among the cereals (Figure 1(d)), while tomato and products contributed 82% of the total contribution from vegetables (Figure 1(e)). “Game meat, other” contributed 55% of the total contribution of meat, fishes, and seafood.

Figure 1: Percentage contribution of main food items to total K supply for Ghana based on 2010-2011 average food supply data: (a) main food items; (b) subcomponents of the food item “fruits”; (c) subcomponents of the food item “starchy roots”; (d) subcomponents of the food item “cereals”; (e) subcomponents of the food item “vegetables”; (f) subcomponents of the food item “meat, fishes, and seafood.” All absolute values of daily per capita K shown are in ×10 mg.

3.2. Trends in K Intake

Between 1974 and 1983, dietary supply of K declined sharply from around 6000 mg to around 4500 mg per capita per day (Figure 2). Thereafter, K intake from food supply increased substantially and reached a plateau around 1989. However, from 1991, K intake from food supply increased sharply and consistently with food supply up to 2011.

Figure 2: Trend in daily per capita K in food supply and per capita food supply in Ghana for the period 1961–2011. Mean daily capita−1 K content (primary axis, filled black circles with continuous line); food supply in Ghana (secondary axis, filled grey squares with broken line).

3.3. Risk of Excess K Intake

The average dietary K supply per person for 2010 and 2011 was estimated at 9,086 mg per day. The estimated variations in individual daily intake (SDD at both 10% and 15%) were large for the different sex and age categories considered (Table 2). Similarly, the D/SDD ratios (at both 10% and 15%) were large and positive. According to the interpretation tables provided by the Food and Nutrition Board [29], these large, positive ratios suggest a 98% probability that the usual dietary K intake of the individual is far in excess of the recommended level, indicating risk of excess. This potentially large risk of K excess at the individual level suggests a potentially large probability of excess supply at the population level. Using the EAR cut-point method with a CV of 25% and 30% (based on a population of 24,542 million) resulted in a risk of deficiency for only 104,000 and 348,000 people, respectively.

Table 2: Extent of adequacy of individual K intake for different sex and age categories in Ghana based on 2010-2011 average food supply.

4. Discussion

Potassium (K) is largely supplied to humans from diets and is highly absorbable (about 85–90%). Based on food supply and composition data, average dietary K intake at both individual and population levels in Ghana was about 2.6-fold larger than the level recommended by WHO [12]. This suggests a potentially large risk of excess dietary supply of K amongst adult Ghanaian population for the years under consideration. The large, positive D/SDD ratios suggest a 98% probability that the usual dietary K intake of the individual is far in excess of the recommended level [29]. The EAR cut-point method also suggested that only a few people might have inadequate dietary K supply. The results in the current study rectify those reported earlier in Yawson et al. [31]. On the contrary, the K intake in several countries has been found to be below recommended levels [12]. This realization, together with the potential role of K deficiency in NCDs, has directed attention to the urgent need to assess and manage dietary supplies of K in human populations [12]. The current study shows that the risk of excess K intake and its associated health outcomes, although rare, need to be given similar attention, especially in jurisdictions where starchy roots and tubers constitute the bulk of diets. Hyperkalemia, just like hypokalemia, affects the cardiac, neuromuscular, and gastrointestinal organs and is less tolerated than hypokalemia [15]. In extreme situations, hyperkalemia can result in sudden death from impaired cardiac conduction [14, 15].

In humans, the bulk of K (about 98%) is stored in intracellular spaces, largely in muscles [17]. Maintenance of a normal intracellular-extracellular ratio is crucial for the healthy functional roles of K. Imbalance in intracellular and extracellular K concentrations results from high K supply, transcellular shifting, and poor K excretion [15]. While severe symptoms of high serum K concentration might occur only at or above 7 mmol·L−1, the rapid rate of rise in extracellular K concentration is more dangerous than the slow rate of rise [32]. It has been estimated that while a loss of 200–400 mEq K from the body would reduce serum K concentration by about 1 mEq·L−1, 100–200 mEq excess supply would increase serum concentration by about 1 mEq·L−1 [17]. This disproportionate increase in the serum K concentration indicates that high dietary supply of K can have rapid and potentially fatal or health-threatening hyperkalemia [15], especially in those with underlying health conditions. Excretion is a major pathway for controlling high serum K concentration [5]. Thus, those with impaired K excretion and high dietary K intake can rapidly suffer the adverse consequences of hyperkalemia.

The dietary source of potassium largely depends on the type of food consumed in large quantities and widely by the population and the K status and fertilizer management of the soils on which crop plants for human and animal feed are grown. The results in the current study show that yams, cassava, and plantains constituted the bulk of diets and K supply. This suggests that, in jurisdictions where starchy roots and tubers constitute the bulk of diets, the population could be at risk of excess K supply. This, in turn, directs attention to K management in food crop production, as well as the quality of diets. Fufu and gari are the cassava-based diets commonly consumed in Ghana, while yams and plantains are commonly consumed in their cooked form without further processing (locally known as “ampesi”). While cassava is more widely consumed in larger quantities than yams in Ghana and is a good source of K, cassava is largely grown on marginal lands by smallholder farmers, with almost zero fertilizer input. However, cassava might benefit from K supply from NPK fertilizers applied to other crops in mixed cropping systems. While external K input has a lower priority in Ghana, especially in sole roots and tuber production systems, roots and tubers are heavy K feeders and can rapidly reduce the K supply of even K-rich soils after a few years of continuous cultivation [3]. Furthermore, even though the food composition table used in the current study was produced in the 70s, cassava and yam seem to have the ability to mobilize and concentrate K even when grown on marginal soils. There is the need for national assessment of the current K status of these roots and tubers and the soils on which they are grown, as well as K in mixed diets.

With quality of diets, the deliberate consumption of fruits and vegetables is only beginning to increase due to health awareness programmes, but even this is constrained by cost, availability, and traditional eating habits. The consistent patterns of food and K supplies (Figure 2) suggest stability in the consumption of the main K-supplying foods in large quantities over time. The gradual increase in the consumption of fruits and vegetables (which have lower K content compared to roots and tubers), together with the rising consumption of processed foods and westernized diets, especially in urban centres, might help lower dietary supply of K even though processed food could increase sodium intake. Moreover, in urban settings, rice (which is lower in K than starchy roots) is increasingly becoming the dominant staple [33], a situation that might result in large contribution of rice to dietary energy but low contribution to K intake in Ghana. There is the need for empirical studies on K contents of Ghanaian food crops (especially staples) and mixed diets and their relationship with adverse health outcomes of hyperkalemia, especially in those with renal or poor K excretion conditions.

The limitations of the approach adopted in the current study have been acknowledged by previous studies (e.g., [6, 25]). The accuracy of data in the FBS and the food composition databases will affect the accuracy of the current estimate. The data fed to the FAO FBS might be unreliable due to Ghana’s poor data collection and aggregation on food production, import, and export. There can also be the issue of underreporting regarding the scale of consumption of some food items. For example, Ghanaians are known to consume large quantities of game meats (bush meat) and other nontimber forest products (NFTPs) which are rich in K, yet this is likely underestimated in the FBS. Similarly, Ghanaians are known to consume appreciable amounts of “molluscs, other,” mainly snails and squids, but the FBS does not report food items that are not commercially declared. In Ghana, bush meat is the second most widely eaten meat after chicken [34, 35]. Key examples of bush meat and other NFTPs commonly eaten in Ghana include grasscutters, antelopes, rats, bats, snails, mushrooms, and honey [36]. In 2014, the Wildlife Division of the Forestry Commission of Ghana estimated the annual domestic trade in bush meat alone at US $140 million [37]. While this estimate excludes nontraded (commercially undeclared) bush meat, it suggests that consumption of bush meat can be quite high in Ghana. Similarly, coastal communities have access to a range of fishes at different periods that might not be reported or captured in the FBS. Due to the underreporting of these food items not considered to be “mainstreamed” or obtained from other sources such as subsistence farming or from the wild, the estimated risk of excess K intake can be substantially underestimated. Hence, the result here must be interpreted with caution as it might not reflect the true dietary K intake in the population. However, the results point to a potentially large risk of excess K supply due to large consumption of starchy roots and tubers, a situation that warrants further investigation.

5. Conclusion

The risk of K deficiency is beginning to get attention due to the role of K in the global burden of noncommunicable diseases such as hypertension and cardiovascular disease. Potentially, K excess (although rare) can be even more dangerous than K deficiency in humans. Results from the current study suggest that the risk of K excess, especially in jurisdictions where starchy roots and tubers constitute the bulk of diets, deserves equal attention. Based on FBS data and food composition databases, the current study shows potentially a large risk of excess dietary K intake at both individual and population levels among adult Ghanaian population. Total dietary K supply was about 2.6-fold larger than that recommended by WHO. Only a small fraction of the population was found to be at risk of K deficiency according to the EAR cut-point method. Cassava and yams contributed the bulk of dietary K supply. While the result in the current study ought to be interpreted with caution due to limitations of data from the FAO Food Balance Sheet and food composition databases, it provides indications for policy and research attention. The findings suggest the need for empirical assessment of the K status of staple food crops (especially starchy roots and tubers) and mixed diets and K management in food crop systems in Ghana. Furthermore, studies are required on the relationships between food consumption and serum K concentration in adult Ghanaian population to validate the results in the current study. The results in the current study also suggest the need for studies on dietary K supply in similar jurisdictions where starchy roots and tubers constitute the bulk of diets, especially where renal problems are becoming increasingly prevalent.

Data Availability

The food supply data used in the current study were retrieved from the Food Balance Sheet for Ghana, available at or accessible from the FAOSTAT website (http://www.fao.org/faostat/en/#home) or available upon request to the corresponding author. The K contents of the food components were obtained from either the West African Food Composition Table [26] or the United States Department of Agriculture-Agricultural Research Service (USDA-ARS) Nutrient Database for Standard Reference [27] (http://www.ars.usda.gov/nutrientdata; accessed on 15 April 2016).

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Source: https://www.hindawi.com/journals/jnme/2018/5989307/

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UK site acquisition strengthens KD Pharma’s omega-3 capacity

The facility, close to Middlesbrough, UK, was previously used for manufacturing omega-3 products.

“This acquisition expands our technology and manufacturing base for producing APIs with the highest concentrations of EPA and DHA omega-3s,” commented Oscar Groet, CEO of KD Pharma Group.

KD Pharma said it strives to be the leading manufacturer in the rapidly growing omega-3 API market.

“The breadth of our technology platform sets KD Pharma apart, no company has more technologies for isolating and fractionating lipids,” added Groet.

The UK site acquisition will enable it to meet market demand for the highest quality APIs in response to new product approvals, label expansions, and supportive clinical research, said the firm.

The company says the site will be brought online this year and operated alongside its other manufacturing sites in Bexbach, Germany; Brattvag, Norway; and Miami, United States.

Source: https://www.nutraingredients.com/Article/2019/06/04/UK-site-acquisition-strengthens-KD-Pharma-s-omega-3-capacity

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Afrigetics Botanicals Adopts Bulbine through ABC’s Adopt-an-Herb Program

The American Botanical Council (ABC) welcomes Afrigetics Botanicals’ adoption of the South African herb bulbine (Bulbine natalensis, Xanthorrhoeaceae) through ABC’s Adopt-an-Herb botanical research and education program.

Afrigetics Botanicals’ adoption supports ABC’s extensive HerbMedPro database, ensuring that this unique research and educational resource remains up to date for researchers, health professionals, industry members, students, consumers, and other members of the herbal and dietary supplements and natural medicine communities.

HerbMedPro is a comprehensive, interactive online database that provides access to important scientific and clinical research data on the uses and health effects of more than 265 herbs, spices, and medicinal plants.

Afrigetics Botanicals’ mission is to commercialize African medicinal plants. According to Steve Hurt, CEO and sales director of Afrigetics Botanicals, more than 3,000 medicinal plant species are used in southern Africa, but only a limited number of those, including rooibos (Aspalathus linearis, Fabaceae), devil’s claw (Harpagophytum spp., Pedaliaceae), pelargonium (Pelargonium sidoides, Geraniaceae), and sceletium (Sceletium tortuosum, Aizoaceae), are used in products in the U.S.

Hurt hopes the adoption of B. natalensis will help introduce the plant to the North American market and encourage additional scientific studies on its potential medicinal benefits. “In my opinion, as it appears to me from the trade shows I’ve been to and the people with whom I’ve spoken, ABC is the authority on herbs and herbal medicine in the United States,” Hurt said. “So, we thought that ABC would be a good partner to work with.” He added that B. natalensis may be a promising ingredient for bodybuilding and fitness enthusiasts because stem extracts of the plant have been shown to increase testosterone levels in animal models. Human studies are needed, however.

Stefan Gafner, PhD, ABC’s chief science officer, said: “We are grateful to Afrigetics Botanicals for its adoption of Bulbine natalensis. The African continent has a rich history of medicinal plant use, and a large number of these plants are relatively unknown to the Western world. The adoption allows us to make the science behind Bulbine natalensis easily accessible and introduce this plant to a larger audience in the United States and elsewhere.”

Bulbine natalensis is a perennial evergreen in the same plant family (Xanthorrhoeaceae) as aloe (Aloe vera). The medicinal uses of Bulbine species, including B. natalensis, generally resemble those of aloe. Traditionally, the leaf gel of B. natalensis has been used to treat wounds, burns, rashes, itches, ringworm, and cracked lips. In addition, root preparations have been used in local healing traditions for vomiting, diarrhea, convulsions, venereal diseases, diabetes, and rheumatism.

In an animal study, male rats that were given an aqueous extract of B. natalensis stem exhibited increased testosterone levels, but more evidence is needed to support the traditional use of the plant to treat male sexual dysfunction. In a separate study on pigs, wounds that were treated with either B. natalensis or B. frutescens leaf gels improved significantly compared to untreated wounds. In a third study on rats, an extract of B. natalensis leaves demonstrated antiplatelet aggregation activity.

Source: https://www.nutraceuticalsworld.com/contents/view_breaking-news/2019-02-14/afrigetics-botanicals-adopts-bulbine-through-abcs-adopt-an-herb-program/

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Role of nutrients in metabolic syndrome: a 2017 update

Hua J Kern, Susan Hazels Mitmesser

The Nature’s Bounty Co., Ronkonkoma, NY, USA

Abstract: Metabolic syndrome (MetS) and its associated chronic disorders including cardiovascular disease and type 2 diabetes are public health concerns in the USA and worldwide. “Good health is an investment in economic growth,” and nutrition is one of the recommended preventive measures to manage these chronic diseases. However, it is unclear whether and to what extent nutrients could be beneficial to the improvement of MetS. To help answer this question, we performed a literature review of the emerging human data on single nutrients and MetS: PubMed was searched from January 1, 2005 to June 12, 2017, using a combination of the following keywords: “nutrient” OR “vitamin” OR “mineral” OR “nutraceutical” AND “metabolic syndrome.” The summary of literature comprises macronutrients (proteins/amino acids, fatty acids, fibers, and sugar), micronutrients (antioxidant vitamins, vitamin D, folate, magnesium, and chromium), polyphenols (flavonoids, resveratrol, isoflavones, and chlorogenic acid), and other compounds (α-lipoic acid, benfotiamine, fucoxanthin, policosanol, and stanols). Bearing a holistic approach in mind, we also highlighted select lifestyle factors that may contribute to MetS (such as circadian rhythm and nutrition in early life). Observational studies have generated positive evidence supporting the beneficial role of numerous nutrients in MetS. Although the results of some clinical trials are consistent with the observational data, causality is not always clear or consistent across trials. Both nutrition and health are complex and dynamic systems with a hierarchical nature. When we design confirmatory trials to investigate nutrient(s) and MetS, instead of the traditional “single-nutrient” concept, it is worth considering a holistic approach to integrate groups or classes of nutrients, lifestyle influencers (ie, diet and physical activity), and population relevance (ie, healthy, at-risk, or diseased).

Keywords: nutrient, metabolic syndrome, obesity, hypertension, dyslipidemia, insulin resistance

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Source: https://www.dovepress.com/role-of-nutrients-in-metabolic-syndrome-a-2017-update-peer-reviewed-article-NDS

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New Skincare Releases – What is worth buying?

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You know what the hardest part of a low-buy is? You actually can’t just go out and just buy all the things that tickle you’re fancy.

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Ceramides to repair the skins barrier

Linoleic Acid to repair skins barrier, great for acneic skin

Three different weights of Hyaluronic acid as humectant for different levels of penetration/also Glycerin to help against that sticky feeling

Colloidal Oatmeal, which is basically very finely milled oats to hydrate through starches and beta-glucanes as well as anti-inflammatory ingredients and vitamins

Licorice Root Extract for brightening

Fermented ingredients for antioxidants

Who do I think it is suited to?

Acne prone and irritated skin, I think it would be suitable even for oily skin as it doesn´t contain many heavy occlusive in the ingredient list, but I´d have to feel the texture to judge that.

One that I can see working on myself in winter and maybe even in summer as a night cream.

Will I purchase?

Not at the moment, but eventually later this year when I am out of my current creams.

Kiehls Cannabis Sativa Seed Oil Herbal Concentrate 49$ for 30 ml here

What the brand says:

“Inspired by Kiehl’s apothecary heritage, our calmative facial oil is uniquely formulated for problem skin including skin prone to blemishes, visible redness and discomfort. Formulated with 100% naturally derived* ingredients, including Hemp-Derived Cannabis Sativa Seed Oil and Green Oregano Oil, this lightweight non-comedogenic facial oil helps calm the feeling of stressed skin.”

Helps reduce skin redness, calms and balances hydration, helps strengthen the skins barrier.

Important ingredients

Cannabis Sativa Seed Oil – THE new ingredient apparently, and no, it will not make you fly, it does not contain CBD. It has a high amount of essential fatty acids, which is great for anti-inflammatory action as well as antioxidant benefits. It is also a lightweight oil, which makes it great for oily skins

Green Oregano Oil – It is said to have certain antiviral and antifungal activities, but nothing more than just “said to” claims

Vitamin E

Other plant oils for fatty acids and linoleic acid

Fragrance as part of essential oils which can be irritating (Citral, Citronellol, Geraniol, Linalool, Limonene)

Who do I think it is suited to?

Irritated, probably acneic skin types. Oily skins as it seems to be a lightweight blend.

Will I purchase?

No. I love my face oils, but I think I will stick to Rosehip and Jojoba Oil blends that work great for my skin and contain amazing nutrients as well. (This is my current favorite)

Ole Henriksen Glow2OH Dark Spot Toner 28$ here

What the brand says

“This potent toner, supercharged with a high concentration of AHAs (glycolic and lactic acids) and witch hazel water, reduces the look of dark spots in as little as 7 days. It also targets fine lines and wrinkles, and smoothes texture. But this powerhouse has a soft side, too. Infused with sandalwood, chamomile and licorice extracts, it’s gentle enough for daily use. Tone post-cleansing for a skin-smoothing boost, and you’ll be perfectly prepped for serum and moisturizer. Plus, with its addictive lemon sugar scent and “it’s working!” tingle, you’ll be hooked from the very first swipe. Reveal a transformed, refined and youthful-looking Ole Glow®!”

Important ingredients

Glycolic Acid, Lactic Acid, Phytic Acid: AHAs to chemically exfoliate, combat texture and brighten

Witch Hazel Water: astringent, makes pores looks smaller

Licorice Root Extract: Brightening

Fragrance: middle of the ingredient list

Alcohol: middle of the ingredient list

Linalool, Limonene, Citral: part of essential oils, potentially irritant

Who do I think it is suited to?

Hyperpigmentation and skin texture without oilyness or breakouts. Probably better suited to mature skins. I´d be careful if my skin was sensitive though, and using it daily could be a bit much.

Will I purchase?

No. I need a BHA in my routine and don’t use AHAs that often, so for the few times a month I want one I will stick to my tried and trusted (and very gentle) pixi Glow Tonic (Review).

Murad 4-in-1 Multi-Cleanse 36$ for 5fl.oz here

What the brand says

“A gel-to-oil, makeup-removing cleanser that nourishes with prebiotics to balance skin’s microbiome for healthier-looking skin. This 4-in-1, non-drying formula features an ultra-cleansing peptide to melt makeup, dirt and excess oil, while moisturizing emollients deeply hydrate.”

Premise behind the line is that we destroy our skins microbiom by overcleansing and kill helpful bacteria. Prebiotics offer nourishment for the good bacteria, supporting it for healthier, happier skin.

Important ingredients

Hemisqualane: emollient, apparently good as breaking down makeup

Cyclic peptide: Cleansing peptide that claims to be 300 times more efficient than other surfactants. 300 times more effective claims are a pet peeve of mine, like, how do you measure that? But I haven´t heard anything about that cyclic peptide yet, so I will refrain from further comments before I did more research In the end clean is clean.

Prebiotic powder: The selling point of the whole line, meant to nourish the good bacteria on the skin to strengthen and improve the skins microbiom

Hyaluronic Acid and other humectants like Xytilol, Urea, amino acids

Squalane: emollient

Who I think it is suited to?

If you are concerned about your microbiome because of irritated or acneic skin, it is worth trying. If a cleanser is the best way to go or if you should get another product with prebiotics is up to personal preference. I love trying different cleansers, so this one goes on the purchase list. It isn’t available in Germany yet though.

Will I purchase?

I love trying different cleansers, so this one goes on the purchase list. It isn’t available in Germany yet though, which gives me time to finish up others I already have open first.

Murad Prebiotic 3-in-1 Multi Mist 32$ for 3.4 fl.oz here

What the brand says

“A peptide-rich, hydrating mist that replenishes with prebiotics to balance skin’s microbiome for healthier-looking skin. This 3-in-1 formula features hydrating sugars to moisturize and refresh skin, while a yeast peptide helps lock in hydration. A multi-tasking biopolymer complex primes and sets makeup.”

Important ingredients

Prebiotic hydrating sugars: promote growth of beneficial bacteria

Yeast peptide: humectant

Butylene/Pentylene Glycol: Humectants, penetration enhancers

Niacinamide: hydrating, soothing, combats hyperpigmentation

Zinc: anti-inflammatory, helps with oil control

Caffeine: to depuff and tighten

Several humectants

Who do I think it is suited to

Me! Even without the prebiotics which, again, are the selling point, this would be a very nice face mist combining hydration, niacinamide and zinc for my oily, mature and blemish prone skin. A must try for me once it is available.

Will I purchase?

For sure! As soon as its is available in Germany that is, so far it is US only.

Neutrogena Hydro Boost City Shield Facial Gel Mist 23$ for 3.3 fl.oz here

What the brand says

“Instantly replenish the look of pollution-stressed skin with Neutrogena® Hydro Boost City Shield® Facial Gel Mist.

This lightweight, non-comedogenic facial gel mist contains hyaluronic acid, antioxidants, and botanical extracts that replenish, refresh and hydrate skin on-the-go. It’s also formulated to protect from harmful environmental aggressors while you’re out and about, keeping your skin looking and feeling healthy throughout the day.”

Important ingredients

Gellan Gum: hydrocolloid that forms “fluid gel” textures

Niacinamide: hydrating, soothing, helps against hyperpigmentation

Butylene/Propylene Glycol: humectants, penetration enhancer

Zinc: anti-inflammatory, oil control

Humectants

Plant antioxidants

Panthenol

Aloe vera

Alcohol (3rdingredient)

Fragrance

Who do I think it is suited to

More oily skin types rather than dry skins, for me rather a summer product. I can´t quite get my head around the liquid gel thing, so I would really like to try it simply for that reason.

Will I purchase?

Probably, mostly because I want to try the “liquid gel spray” thing – it is the novelty rather than the ingredients that gets me here. It does have a nice blend of ingredients too though, so once it is available in Germany I will try and get my hands on it.

Now please tell me – is this something that you are interested in? And are there any other releases that made it onto your radar?

The list is obviously not complete, and the picks are very much tailored to my personal taste – there is just so much new stuff every month it would be a full time job to keep up.

Anzeige: Dieser Beitrag enthält Werbung. Der Inhalt und meine Meinung wurden dadurch nicht beeinflusst. Weitere Infos: www.trusted-blogs.com/werbekennzeichnung

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Source: https://lindalibraloca.com/new-skincare-releases-what-is-worth-buying/

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ashtoad13-blog · 6 years ago

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CAPF-AC Sample Practice Paper-18 ( General Studies)

1. When does the Governor recommend the imposition of the President’s rule in a State?

(a) On the recommendation of the Centre (b) On the recommendation of the Chief Minister (c) On the recommendation of the Council of Ministers (d) If he is satisfied that the Government of the State cannot be carried on in accordance with the provisions of the Constitution

2. Which of the following civilisation’s objects have been found in the Harappan civilisation ?

(a) Egyptian civilisation (b) Mesopotamian civilisation (c) Chinese civilisation (d) Both (a) and (b)

3. Harappan weights and measures were cubical and spherical in shape and were made of:

(a) Chert (b) Jasper (c) Agate (d) All of the above

4. A terracotta model of a ship or a boat, with stick impressed socket for the mast and eye holes for fixing oars has been found from

(a) Dholavira (b) Kalibangan (c) Mohanjodaro (d) Lothal

5. The principal cereals seem to have been?

(a) Rice and wheat (b) Wheat and peas (c) Wheat and barley (d) Barley and ragi

6. A remarkable seal representing a deity, standing between two branches, of a pipal tree has been found at which of these places ?

(a) Desalpur (b) Surkotada (c) Chanhudaro (d) Mohanjodaro

7. An aggregate of several families made up the grama like, today and its head man was called

(a) Mukhiya (b) Gramini (c) Pramukh (d) King

8. Which of the following pairs is/ are correctly matched?

(a) Purohita - Cheif priest (b) Senani - Army Chief (c) Gramini head of village (d) All of the above

9. The Vedas prescribe a penalty of death or expulsion from the kingdom to those who kill or injure

(a) Buffaloes (b) Dogs (c) Goats (d) Cows

10. The term ‘aghanya’ was used (in vedic age) for:

(a) Men (b) Cow (c) Horse (d) Dog

11. The economic life of the Rig Vedic people centered around

(a) Agriculture (b) Cattle rearing (c) Trade and commerce (d) All of the above

12. The Rig Veda also mentions of business and mercantile people to whom it calls vanik and panis respectively and refers to the Vedic people such as

(a) Bharat and Purus (b) Purus and Sibis (c) Vishanins and Yadus (d) Yadus and Turvasa

13. We find the mention of lohit ayas and syam ayas meaning copper and iron respectively in the

(a) Rig Veda (b) Sama Veda (c) Atharva Veda (d) Yajur Veda

14. According to Wildlife Protection Act, 1972 the term ‘animal article’ means

(a) the things made of animal products (b) the things made up of body parts of wild animals (c) object made from any captive animal or wild animal, other than vermin and any part of such animal (d) none of the above.

15. The Ministry of Environment and Forests had launched the scheme of labelling of environment friendly production 1991, this scheme identified

(a) 16 cateorise of consumer products (b) 14 cateories of consumer products (c) 25 cateories of consumer products (d) none of the above.

16. The global community is in need of a set of imperatives that would allow

(a) equitable access to the environmental benefits of the planet (b) sharing the resources of the globe (c) understand the current global environment (d) none of the above.

17. Science and technology have played a critical role in

(a) the development of human history (b) determining the factors in shaping a sustainable future (c) threatening the stability of the eco• system (d) all the above.

18. Consider the following statements:

1. The goal of environmental education is to develop world population 2. The population must be aware of concerned about total environment and its associated problems 3. There must be an effort to work individually and collectively towards solution of current problems Of these statements

(a) only 1 is correct (b) 2 and 3 are correct (c) 1 and 2 are correct (d) 1, 2 and 3 are correct

19. The objective and guiding principles for developing environmental education at all levels were formulated at

(a) UNESCO conference 1975 (b) Tibilisi Conference 1977 (c) UNESCO Conference 1977 (d) all the above.

20. The currency of the European Monetary Union is

(a) Dollar (b) Euro (c) Guilder (d) Mark

21. The current price index (base 1960) is nearly 330. This means that

(a) all items cost 3-3 times more than what they did in 1960 (b) the prices of certain selected items have gone up to 3-3 times (c) weighted mean of prices of certain items has increased 3-3 times (d) gold price has gone up 3-3 times

22. The difference between a bank and a non-banking financial institution (NBF) is that

(a) a bank interacts directly with customers while an NBFI interacts with banks and governments (b) a bank indulges in a number of activities relating to finance with a range of customers, while an NBFI is mainly concerned with the term loan needs of large enterprises (c) a bank deals with both internal and international customers while an NBFI is mainly concerned with the finances of foreign companies (d) a bank’s main interest is to help in business transactions and savings/investment activities while an NBFI’s main interest is in the stabilization of the currency

23. The earlier name of WTO was

(a) UNCTAD (b) GATT (c) UNIDO (d) OECD

24. The earnings of India from diamond export is quite high. Which one of the following fact or shas contributed to it?

(a) pre-independence stock-piling of diamonds in the country which are now exported (b) large production of industrial diamonds in the country (c) expertise available for cutting and polishing of imported diamonds which are then exported (d) as in the past, India produces huge quantity of gem diamonds which are exported

25. The Employment Assurance Scheme envisages financial assistance to rural areas for guaranteeing employment to at least

(a) 50 per cent of the men and women seeking jobs in rural areas (b) 50 per cent of the men seeking jobs in the rural areas (c) one man and one women in a rural family living below the poverty line (d) one person in a rural landless household living below the poverty line

Answer:- 1. (d) 2. (d) 3. (d) 4. (d) 5. (c) 6. (d) 7. (b) 8. (d) 9. (d) 10. (b) 11. (b) 12. (d) 13. (c) 14. (c) 15. (a) 16. (a) 17. (d) 18. (d) 19. (b) 20. (b) 21. (c) 22. (b) 23. (b) 24. (c) 25. (c)

Source: https://iasexamportal.com/CAPF-AC/sample-paper-18-general-studies

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ashtoad13-blog · 6 years ago

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The Facts About MSG and Umami (No, MSG is not bad for you)

Have some preconceived notions around MSG? Today I’m providing the facts about MSG and umami so you can make an informed decision on whether or not your beliefs are worth holding on to.This post is not sponsored and was fueled by pure passion. However, I did receive sponsored travel this year to Japan and The World Umami Forum in NYC by Ajinomoto. Ajinomoto did not sponsor today’s post.

This post has been a long time coming. As a dietitian who works primarily with clients who want to make peace with food, dispelling food fears is my passion. With an overemphasis on (and borderline obsession with) health and wellness, coupled with fear-mongering media outlets and influencers, we have become a society that is fearful of the food we eat. Our restrictions, eliminations and rigid thinking around food in the pursuit of health is actually hurting our mental and emotional health and causing more harm than good. Food fears are not novel to the 21st century; however. It seems every decade we pick a new food or ingredient to demonize. In the 90’s, it was fat. In the 00’s, it was carbohydrates. Now it’s GMOs and gluten and sugar that are poisoning us. But there seems to be one ingredient whose stigma dating back to the 70’s has only been perpetuated and certainly not forgotten, and that is MSG.

This is a post to provide the facts, science and history of MSG and offer up perspective. This is not a post to persuade you to go out and start sprinkling MSG over all your food (although if you’d like to after reading this post, by all means!). This is a post to help empower you to make your own informed decision about MSG.

WHAT IS MSG?

Monosodium glutamate (MSG) is a seasoning used to enhance the flavor of food. The name itself might conjure up images of a scientist in a lab throwing together a chemical formula but it’s much more natural than the name might insinuate. You see, MSG is simply sodium + glutamate. Glutamate is the most abundant amino acid in nature – it’s naturally present in foods like tomatoes, aged cheeses and mushrooms, and is one of the 20 amino acids that make up proteins in the human body. Glutamate is also present in breast milk; in fact, breast milk contains 10x more glutamate than cow’s milk. No wonder babies prefer it!

MSG is digested and metabolized the same way that glutamate found in foods are – your body can’t tell the difference. Because chemically they are the same – a tomato (glutamate) sprinkled with salt (sodium) is chemically equivalent to MSG. It’s also made through a simple, natural fermentation process. You start with a carbohydrate source like cassava, sugar cane or corn, ferment it, and glutamic acid is created. A sodium ion is then added to make it crystallized and stable (so that we can sprinkle it and put it to good use!).WHAT IS UMAMI?

Umami is the fifth basic taste (in addition to sour, sweet, salty and bitter). It balances and deepens flavor and contributes to what is often described as a savory or meaty flavor. Umami was discovered 110 years ago in Japan by scientist Dr. Kikunae Ikeda while sippin on a bowl of konbu dashi (or seaweed broth). He noticed that the taste was distinct from the four basic tastes at that time. He called it umami, which means “essence of deliciousness”, and found that the taste was attributed to glutamate. That’s right, we have the amino acid glutamate to thank for mouth-watering umami taste. There are three distinct characteristics of umami – it provides a sensation that spreads across the tongue, it lingers longer than any other taste, and literally makes you salivate (I wasn’t kidding when I said mouth-watering).

Although umami is a Japanese name, it is a universal taste found in foods all over the globe. In the states, we find umami in BBQ sauce, ketchup, ranch dressing, and gravy to name a few. In Europe, umami is found in aged cheeses and cured meats (and yes I had my fair share of umami in Italy last month). In Mexico, it’s mole. In Southeast Asia, fish sauce. Brazil and Portugal? Bacalhau or dried cod. And don’t forget about umami-rich foods enjoyed all over like tomatoes, mushrooms, and steaks. MSG is the purist form of umami and when added to food it helps to harmonize and deepen flavor.WHY DOES MSG HAVE A BAD RAP?

Let’s go back to 1968, shall we? This is when Dr. Robert Ho Man Kwok wrote an opinion letter to the editor at the New England Journal of Medicine describing some symptoms he noticed after eating at Chinese restaurants. He noted weakness, palpitations and numbness in the arms (note: no mention of headaches) and speculated that a number of different ingredients could have caused his symptoms like sodium, soy sauce, alcohol from the cooking wine or MSG. This letter is what coined the very xenophobic term “Chinese Restaurant Syndrome” to refer to the symptoms that Dr. Kwok described. The other suggested ingredient culprits for “Chinese Restaurant Syndrome” were never studied or examined – MSG was singled out as the cause. And then one subsequent study sent media outlets into a MSG fear-mongering frenzy. This animal study injected rats with extremely high doses of MSG directly into the abdomen and surprise, surprise, caused negative outcomes. This doesn’t come as a surprise because hello, if you inject high doses of anything into someone’s abdomen, it’s probably not going to end well. More importantly, we are humans, not rats and you cannot generalize findings from an animal study to humans. PLUS, no one is getting injected in the abdomen with MSG at restaurants. The stigma around MSG is just another example of a poorly conducted scientific study that the media got their hands on and ran with at full speed, instilling fear into the American public.

You could also argue that xenophobia only further exacerbated the demonization of MSG. Because as Sarah Lohman, Author of Eight Flavors: The Story of America Through Our Tastebuds, stated at the conference, “No one is calling this Dorito Syndrome or Kraft Mac N’ Cheese Syndrome.” No one was talking about MSG in processed foods giving them symptoms. People were only talking about it in relation to Chinese restaurants. And I completely agree with Lohman’s sentiments that it is racist to imply that an entire culture is poisoning Americans with their cuisine. And how did Chinese restaurants react to all the backlash? Out of shame, they put NO MSG signs outside their doors and on all their menus. And when you see the word “NO” before something, it conjures up negative reactions to whatever follows it. Like when people see “no gluten” or “no GMOs” on labels, they automatically assume that thing is bad for them. Unfortunately, the Chinese restaurant industry further perpetuated the stigma by trying to protect their businesses and cater to the American public.

BUT IS THE STUFF SAFE OR WHAT?

YUP. Over the past 30 years, American scientists have used validated scientific methods (aka human, double-blinded randomized controlled trials) to independently verify that MSG is safe to consume. A 2000 study published in the Journal of Nutrition on “The Safety Evaluation of Monosodium Glutamate” stated: “More extensive studies were reviewed, and these failed to demonstrate that MSG was the causal agent in provoking the full range of symptoms. Properly conducted and controlled double-blind crossover studies have failed to establish a relationship between Chinese Restaurant Syndrome and ingestion of MSG, even in individuals claiming to suffer from the syndrome.” In addition, MSG has had Generally Recognized as Safe (GRAS) status from the FDA since 1958. In 1987, The Joint Expert Committee on Food Additives (JECFA) of the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO) concluded that no upper intake limit was necessary for MSG, placing it in the safest category of all food additives. And in 1995, FDA-sponsored Federation of American Societies for Experimental Biology (FASEB) report confirms MSG’s general safety as a food ingredient. And last but not least, earlier this year, the International Headache Society removed MSG from its list of causative factors for headaches (due to lack of research to support it). All of this to say, MSG has been extensively studied and its safety confirmed by a number of international health organizations.

THEN HOW COME I GET HEADACHES?

The real answer is I don’t know. I’m here today to provide you with the facts, not to discount anyone’s lived experience. Some people may be more sensitive to MSG just like some people are more sensitive to sulfites. And if you experience symptoms after consuming MSG, perhaps you’re part of that small subset.

IS THERE ANY BENEFIT TO USING MSG/UMAMI?

YES! MSG can actually help reduce sodium in dishes without compromising flavor because of umami. In fact, MSG contains 1/3 the amount of sodium as table salt. And studies have shown that using MSG in recipes can help reduce sodium by 30% while maintaining palatability. Sodium reduction has been a huge health concern in our country for quite some time and perhaps if we can shift public perceptions of MSG, it could be seen as a solution to the sodium reduction conversation. How does this translate to the kitchen? If you replace regular table salt in a recipe with 2 parts salt + 1 part MSG, you’ll get a 25% reduction in sodium. So if a recipe calls for 3 teaspoons salt, you can use 2 teaspoons salt + 1 teaspoon MSG instead.

MSG and umami also add mouthwatering flavor to dishes, so MSG could be used as a tool to help people eat more nourishing foods like vegetables. Some studies have shown a positive satiety effect from umami, but more research is needed. Some studies have also shown that umami stimulates digestion – we know it makes us salivate more and that there are umami receptors actually located in our gut!BOTTOM LINE?

There’s no solid scientific data to back up the fear around MSG. Its stigma is unwarranted and frankly, unjust. I’m not saying we all need to go out and buy MSG shakers (although I have one in my cupboard and it’s adorably panda-shaped) but I think we all need to get honest with ourselves about where our perceptions of MSG stem from and be open to challenging our preconceived notions. And I’ll leave you with a quote from Jeffery Steingarten, an American Food Writer, that basically sums up how I feel about MSG in a nutshell, “If MSG is so bad for you, why doesn’t everyone in Asia have a headache?”

Tell me, was this post surprising to you at all? Do you have additional questions about MSG or umami that I can help answer?

Source: https://karalydon.com/health-wellness/the-facts-about-msg-and-umami-no-msg-is-not-bad-for-you/

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Latest Report On Vitamins Market Segmented by Applications, End-Users, Geography and Forecast 2023 - DD News Herald

Overview of the report Vitamins Market 2018-2023

The Vitamins Market report focuses on the key manufacturers, to define, describe and analyses the sales volume, value, market share, market competition landscape, SWOT analysis and development plans in forecast period. The Global Vitamins market has been forecasted based on revenue, market share and growth rate from 2018 to 2023. This report contains the estimation of market size for value and volume. Both top-down and bottom-up approaches have been used to estimate and validate the market size of Vitamins market. This helps you in getting the most comprehensive and detailed analysis of the industry.

“Vitamins are organic chemical compounds and a vital nutrient which an organism needs in minor quantities for the functioning of metabolism in the body. Vitamins cannot be synthesized in the body, but they can be consumed through food or supplements. Insufficient intake of vitamins may result in deficiency diseases and disorders such as night blindness, scurvy, and xerophthalmia.”

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Sales, Ex-factory Price, Revenue, Gross Margin for Regions:

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Asia-Pacific (China, Japan, Korea, India and Southeast Asia)

South America (Brazil, Argentina, Colombia)

Middle East and Africa (Saudi Arabia, UAE, Egypt, Nigeria and South Africa)

Major companies present in Vitamins Market report: DSM, Lonza, CSPC, BASF, Zhejiang Medicine, Shandong Luwei Pharmaceutical, Northeast Pharmaceutical, North China Pharmaceutical, NHU, Jubilant Life Sciences, Vertellus, Brother Enterprises, Adisseo, Zhejiang Garden Biochemical, Kingdomway and more

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Product types specified in report are:

Vitamin A Vitamin B3 Vitamin B5 Vitamin D3 Vitamin E Vitamin C Others

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Feed Additives Pharmaceuticals And Cosmetics Food And Beverage

and more

It also explores opportunities and challenges for novice and well-established players in the industry. This report covers Vitamins market size, major companies, their company profile and sales information. In this report market competition, regional analysis, and market demand are covered. All the qualitative and quantitative aspects of the market, market value, current trends along with challenges and opportunities will forecast growth in coming years.

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International market shares of the Vitamins industry

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Supply chain analysis of the Vitamins market

Company profiles of prominent market players involved in the Vitamins market

Trade and globalization in the modern industry

Key consumers and distributors of the Vitamins market

Import, export, consumption value in major provinces.

Market forecast for the period from 2018 up to 2023

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Phone: +1 408 520 9750/+44 203 239 8187

Latest Report For Pharmaceuticals: https://www.absolutereports.com/pharmaceuticals-companies-in-china-10053412

Source: https://ddnewsherald.com/2019/5200/latest-report-on-vitamins-market-segmented-by-applications-end-users-geography-and-forecast-2023/

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ashtoad13-blog · 6 years ago

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Broccoli & Feta Vegetable Frittata

Happy holiday weekend! Here’s a healthy, festive vegetable frittata recipe that I love to make for a holiday brunch.

Of course this frittata would be fitting for any weekend brunch, but I think it’s especially festive for Christmas. There’s some green, some red (a tiny bit), and more green… because the more veggies you can eat early in the day means the more cocktails and cookies you can enjoy later on. At least that’s my logic – I’m all about the veggie/cookie/life balance.

Here’s what’s in it! (above) The recipe itself is pretty straight forward because I don’t like to do a ton of chopping prep work first thing in the morning. There’s a delicious balance of onion flavor from the scallions, hearty veggie power from the broccoli, and tangy, punchy flavor from the feta. I like to add a few pinches of smoked paprika and some red pepper flakes for a bit of smoky spice and for a bit of red holiday spirit.

I love to use broccolini here because the stems are really tender. If you can’t find it, you can use regular broccoli, just be sure to chop the tender parts of the stem into smaller pieces than the florets so that everything cooks through at the same time.

This frittata serves about 3 people if you’re serving it on its own. If you’re making brunch for a crowd, it would be great alongside this baked french toast recipe!

Broccoli & Feta Vegetable Frittata

A healthy vegetable frittata recipe that's packed with broccoli, scallions, feta, and spices. Perfect for weekend brunch. Vegetarian and gluten free.

6 large eggs

¼ cup unsweetened almond milk

2 garlic cloves, minced

¼ teaspoon sea salt, more to taste

⅛ teaspoon smoked paprika

1 tablespoon extra-virgin olive oil

1 bunch (6) scallions, white and light green parts, chopped

1 small bunch broccoli or broccolini, stalk diced, florets chopped (2 cups)

Freshly ground black pepper

½ cup crumbled feta cheese

Pinch of red pepper flakes, optional

Preheat the oven to 400°F.

Whisk the eggs, almond milk, garlic, salt, and smoked paprika until well combined. Set aside.

Heat the oil in a cast-iron skillet over medium heat. Add the scallions, broccoli, and a pinch of salt and pepper and cook, stirring occasionally, until the broccoli is tender but still bright green, 5 to 8 minutes.

Add the egg mixture and shake the pan to distribute. Sprinkle with the feta and red pepper flakes, if desired. Bake for 15 to 20 minutes or until the top is lightly golden brown and the eggs are set.

Remove from the oven, let cool, slice and serve. Season to taste.

Source: https://www.loveandlemons.com/broccoli-feta-vegetable-frittata/

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ashtoad13-blog · 6 years ago

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Vitamin D no defense against dementia

New research from South Australian scientists has shown that vitamin D (also commonly known as the sunshine vitamin) is unlikely to protect individuals from multiple sclerosis, Parkinson's disease, Alzheimer's disease or other brain-related disorders.

The findings, released today in the science journal Nutritional Neuroscience reported that researchers had failed to find solid clinical evidence for vitamin D as a protective neurological agent.

"Our work counters an emerging belief held in some quarters suggesting that higher levels of vitamin D can impact positively on brain health," says lead author Krystal Iacopetta, PhD candidate at the University of Adelaide.

Based on a systematic review of over 70 pre-clinical and clinical studies, Ms Iacopetta investigated the role of vitamin D across a wide range of neurodegenerative diseases.

"Past studies had found that patients with a neurodegenerative disease tended to have lower levels of vitamin D compared to healthy members of the population," she says.

"This led to the hypothesis that increasing vitamin D levels, either through more UV and sun exposure or by taking vitamin D supplements, could potentially have a positive impact. A widely held community belief is that these supplements could reduce the risk of developing brain-related disorders or limit their progression."

"The results of our in-depth review and an analysis of all the scientific literature however, indicates that this is not the case and that there is no convincing evidence supporting vitamin D as a protective agent for the brain," she says.

Ms Iacopetta believes that the idea of vitamin D as a neuro-related protector has gained traction based on observational studies as opposed to evaluation of all the clinical evidence.

"Our analysis of methodologies, sample sizes, and effects on treatment and control groups shows that the link between vitamin D and brain disorders is likely to be associative -- as opposed to a directly causal relationship," she explains.

"We could not establish a clear role for a neuroprotective benefit from vitamin D for any of the diseases we investigated."

Mark Hutchinson, Director of the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP) and Professor at the University of Adelaide worked with Ms Iacopetta on the research and findings.

"This outcome is important and is based on an extremely comprehensive review and analysis of current data and relevant scientific publications," Professor Hutchinson says.

"We've broken a commonly held belief that vitamin D resulting from sun exposure is good for your brain."

Interestingly, Professor Hutchinson notes that there may be evidence that UV light (sun exposure) could impact the brain beneficially, in ways other than that related to levels of vitamin D.

"There are some early studies that suggest that UV exposure could have a positive impact on some neurological disorders such as multiple sclerosis," he says. "We have presented critical evidence that UV light may impact molecular processes in the brain in a manner that has absolutely nothing to do with vitamin D."

"We need to complete far more research in this area to fully understand what's happening," says Professor Hutchinson.

"It may be that sensible and safe sun exposure is good for the brain and that there are new and exciting factors at play that we have yet to identify and measure."

"Unfortunately however, it appears as if vitamin D, although essential for healthy living, is not going to be the miracle 'sunshine tablet' solution for brain-disorders that some were actively hoping for."

Researchers involved in this systematic review are affiliated with the University of Adelaide, the University of South Australia and the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP).

Source: https://www.sciencedaily.com/releases/2018/07/180710101659.htm

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ashtoad13-blog · 6 years ago

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Diet Doctor Podcast #7 — Megan Ramos

And Megan and Jason are a big part of why that has happened. So today I am excited, I get to pick Megan’s brain about how they started and a lot of the tips and tricks that they used to make this safe. Because there is still a concern about the safety of fasting and the efficacy of fasting and making sure you get a proper balance. So I think that’s going to be one of the main take-home lessons of this podcast today with Megan.

As she likes to say, if a little bit is good, we tend to think a lot is better. And that’s not always the case. And fasting is definitely one of those circumstances. So yes it’s an incredibly powerful tool that a lot of us can use to be healthier to treat medical conditions, but it needs to be done safely and with observation.

And hopefully you’ll learn some tips today that will help you see if fasting is right for you and you can talk to your medical provider and you can learn more for Megan and Dr. Fung about whether it’s right for you. So I hope you enjoy this interview today with Megan Ramos. Megan Ramos, thank you so much for joining me today on the DietDoctor podcast.

Megan Ramos: Thank you, Bret, it’s a pleasure to be here.

Bret: You and Jason Fung are known as sort of the fasting dynamic duo and for good reason. I mean, you really have done a great deal to revolutionize the acceptance of fasting as a treatment for diabetes and for obesity and for metabolic syndrome which we have such a problem with in this country and in the world. You came to this from a very interesting standpoint though. I mean you have a very clear personal experience with this at a very young age. So tell me a little bit about that.

Megan: I was in my mid-20s and I was doing prospective research on a cohort of our diabetic nephropathy or diabetic kidney patients. We were looking for biomarkers to better predict their kidney outcome, trying to diagnose their kidney disease earlier. And so years have gone by, I’ve been in clinical research for over 20 years now.

Years have gone by, we’re analyzing the data and it didn’t matter how early you could predict the kidney damage, because once a kidney damage was there, the diabetes was still getting worse and worse and worse, the kidney damage is still going to progress. So all I was doing with my career was trying to find out when people were going to die sooner.

Bret: Oh Jesus.

Megan: That’s essentially what I got to and I was really frustrated. And myself I was very slender at the time, but I didn’t eat well and I didn’t eat often. And that’s kind of funny, I realize I was fasting all the time, but I wasn’t healthy still. I was diagnosed with fatty liver at 12, and polycystic ovarian syndrome at 14, but I was thin, I was quite slender, but I was tired, I was sluggish, I didn’t have energy. So looking back I know I had metabolic issues.

I was a TOFI, thin on the outside, but quite fast on the inside and no one knew what to do with me when I was younger. They figured I grew out of it because I was slender on the outside. So when I came to this realization that– I have a strong family history of diabetes and heart disease and, you know, you just couldn’t beat diabetes.

It was a be-all and an end-all and at 25 I realized, “Megan you need to take control of your own health, “you need to stop living off of French fries and pizza. You need to start eating like a responsible adult.” So in that year I started following the Canadian food guide, eating six small meals throughout the day, making sure I was getting all of my fruits, taking my snacks, just “stabilizing” my blood sugar levels and I became ridiculously obese. I put on nearly 100 pounds.

Bret: Wow!

Megan: My daughter kept checking my thyroid numbers and everything was fine. But she was insistent and there was nothing wrong there. It was just the years of poor eating habits topped off by a year of really poor eating habits that sort of did me in. And once I gained all that weight, before my 27th birthday I was told I had type 2 diabetes and to me this is just the end. I’ve had 31 hours of cardiac ablation before my 30th birthday. So as a cardiologist…

Bret: I can appreciate that. It’s a lot of work.

Megan: I have had some minor incidences of cancer in the past that was caught very early. Even that, there was a chance. It was caught earlier, I was going to be okay. Diabetes now at 27, what kind of life I was going to have? So I was broken, for a few days I was broken I called in sick to work and then I finally went in. And I knew Jason, Jason Fung, I’ve worked with him for 20 years and he was also getting frustrated.

He was entering his 40s, he was just watching his patients get sick, getting tired of delivering bad news and not being able to do anything about it. So independently he had started researching about diabetes and he became pretty interested in the relationship between religion and fasting for both the spiritual and the healing purposes so a friend of his sort of sparked his interest.

So he had some really great information and he shared it with me and he said, “You know, there’s a low-carb approach that you can do “and there’s the fasting approach that you can do and ideally you can combine them together.” But I was born in 1984, so that’s the year when everything sort of started to go bad. The cover of Times Magazine condemning eggs and bacon and butter. Those foods were prohibited from my home growing up. And so I grew up eating the today standard North American diet with two very busy parents and I was fortunate growing up.

If I didn’t like what was being cook for dinner and I wanted to order pizza, someone would get me a pizza. So changing my eating habits seemed really tough. Jason said, “Cook with coconut oil.” And I said, “What do you do? Like how do you do that? “I don’t even cook in this day and age. I go to Drive Thru’s. That’s how I sustain my life.” So for me the fasting was easier at the start before I tried to overhaul 27 years of dietary habits.

So I started fasting intermittently and over time I now follow a ketogenic diet, I eat everything, I eat vegetables, non-starchy vegetables, all kinds of meat, poultry and fish and great a great oils, fats, butter. So I don’t restrict but back then those foods were also foreign to me. I think the only vegetable I ate growing up were corn and carrots pretty much. So it was a transition, but within six months I lost 60 pounds which was quite nice.

My A1c went down to 4.6 from 6.4 and Jason encouraged me to have an ultrasound done of my liver so there was no fatty liver. So then I went for a fiber scan just to confirm the ultrasound. And that also showed that my liver was pretty clear, my labs showed my liver was functioning very well and I actually started having regular menstrual cycles like the first time since I was a kid, like 12 years old when I started having menstrual cycles.

And even then it was only short-lived, for about a year before they became a little bit wonky. So that was great and then I followed up with an ultrasound and there appeared to be no cyst on my ovaries and I continued to have regular menstrual cycles without the use of any other medication to induce that.

Bret: What a dramatic story! I mean what gets me is fatty liver at 12, diabetes at 27 and nobody addressed you diet.

Megan: No one.

Bret: They thought you’re eating perfectly “and it can be that, let’s look for every other possible reason besides that.” And it took Jason Fung to come in and help/work with you to change things. And that sort of boggles my mind now. And fasting for you proved to be so powerful. And for so many people now is so powerful.

And I think one of the most interesting things is how it’s not been part of the medical community for so long and yet is such a part of the religious community like you mentioned. So Ramadan, billions of Muslims are basically fasting for most of the day. The majority of religions have a fasting component to it. So why do you think it was so shunned for so long in the medical community and actually still is in some circles?

Megan: I think it’s just something that, you know, as food has become more and more abundant and just easy access, I know for days when I’m working at home and I’m intending to fast, is really tough knowing I have a refrigerator full of bacon and eggs and great meat and vegetables at my disposal. So foods became a lot more prevalent and then we had this major sort of shift in our diet and I think we started to see a lot more carbohydrate addiction.

So you start to talk to these people, you know, I went through it myself, sort of that withdrawal from carbohydrates. I’m going to expose my brother here who finally told me on my way to this event that he was going to start fasting and going low-carb. He was at a low-carb get together in Greece on an island. There is no access to anything. He was with my husband and some of our friends. And it was a low-carb, he didn’t have bread, he didn’t have potatoes and he actually became almost completely delirious for about 24 hours.

He collapsed, it was a real nightmare. I was in Toronto so it was really difficult, I felt bad for my husband. So we sort of have this addiction. Actually I have a friend and he’s Muslim. And he said if you look at the Koran and they talk about dates. And, you know, dates were something that were sort of supposed to be reserved… It depends, there are different variations of how you can interpret it.

And he said growing up he was always told by his parents who are much older than the regular parents, his dad was in his mid-50s when he had him, that it was something that was special sort of sacred towards the afterlife. And towards Ramadan you are supposed to engage in a little bit at the end of Ramadan and have some dates. But nowadays he says his family has totally transformed. Now sort of the more dates you eat, the closer brings you to God. You’re supposed to be eating them more often.

So going off of him here, he said just sort of within this culture is known as this big sort of shift towards the, “I’ve done my fast, now I should have more of the carbohydrate.” I don’t know if there’s some sort of addiction factor here and, you know, all of our guidelines recommend that we just eat so much and so often and they are supposed to be based on science.

Bret: But they’re not.

Megan: And this is really misleading to so many people. I grew up assuming that the people that put together the Canadian food guide and who educated my daughter… or that she even had education in the first place about nutrition. And that is all backed by really hard-core science here and it’s not something that’s really hard. I struggle with it with patients, I struggle with it with my own family. “The government wouldn’t want to mislead us, Megan. They wouldn’t do that.” So it’s just created all the sort of resistance I think towards idea of fasting, unless you are doing it for religious purposes.

Bret: And also where you come from is so important, because like you are saying, your brother was a perfect example, if you are in a heavy carb type of nutrition in carb addicted, then fasting is a lot harder than if you come from the low-fat realm. And I think that had a lot to do with it as well. So the multiple meals, frequent carbs, if you try to fast it’s going to be a disaster.

So I think that brings up the importance of transitioning into a fast appropriately, because a lot of people say, “Let me give it a try.” And they feel terrible, they are lightheaded and they are dizzy, and they may faint or have the experience like your brother had. So how do you work with people to say, “If you want to try this, let’s get you to do this safely.” What are some of your checkpoints and some of your recommendations?

Megan: So when Jason and I first started working with patients… He sees patients as a doctor and monitors them medically and then I educate them and sort of guide them on what to do in terms of fasting and diet, but fasting wasn’t really welcomed by the medical community, even our own colleagues. They saw the transformation in me and said, okay, Megan’s around doctors 24 hours a day, seven days a week, Megan’s got a lot of common sense, we know this, she is very in tune with her body and she’s young. So she would know to seek help, there is likely nothing severe is going to happen to her, it’s great.

But for these older sick patients and all kinds of medication with more complex medical issues you can’t fast them. So I tried working with them on the diet, but the particular location where Jason and I practice out in Toronto it’s just socioeconomically poor. And even if people were to save to buy better quality food, there really isn’t anything in the area people often ask me if I live close by and there’s nothing… Like there’s really no good quality things.

You have to drive far to the east or to the last to get it and a lot of these people are disabled and don’t have the vehicle of their own and to take public transport is out of the question so it’s tough. So I’m trying to work with these patients about changing their diet and I know that low-carb should be affordable for everyone. I actually did a gardening class one day with some of them, trying to teach them how to grow their own vegetable garden on their balcony.

Bret: Great idea.

Megan: But if anything, they were sick, I mean these people had their arms amputated, such bad arthritis–

Bret: So you tried to use low-carb as the transition point? Try and get them on low-carb first and then into some form of fasting?

Megan: This is what I do. I realize that it’s just tough and I do need to get them into a bit of a state of ketosis. When they’re going from high carb to fasting, that’s dangerous, because their insulin levels are going to drop rapidly and their kidneys are going to release all kinds of sodium, they are going to lose a bunch of water and a bunch of electrolytes at once, and they’re going to fill horrendous, they’re going to get nauseous, fasting is not going to be a good experience for them, nor a safe experience for some of these patients.

So the idea of getting them to follow what a lot of them consider the fancy low-carb diets was not possible. So I got them to do something we joke around and we call a fat fast for four days leading up to an actual fast. And for those four days they’re only permitted to eat bacon, eggs, olives, and avocados. And if they don’t eat bacon for whatever reason then they have eggs, olives and avocados, I don’t care, but just those four foods.

And to be honest most of them enjoy it. Most people love at least two or three of those four foods, if not all of them. They’re all simple to make. Olives require zero preparation, avocado zero preparation, eggs can be unbelievably simple and bacon, you can throw it in the oven or in the microwave, you don’t have to sit there at the stove. So it’s all very simple, all very easy and things that you can get for reasonable prices within the Toronto area. So they liked it, they like the challenge, it became a game to them.

So they would do it, they would always do it. And so they would lose water weight safely while replenishing their electrolytes and then they would be able to transition into fasting quite effortlessly. And once they got into a fasting state, they felt like eating less on their eating days, they wanted to eat that bacon and those eggs a little bit more often and then because they were fasting intermittently or fasting for a couple chunks of time throughout the week, like maybe two 48 hour fast a week, they were able to actually save money.

So when they did have those community farmers markets every now and then, they could go and they could afford to buy better quality foods. So the fasting enabled the double win for these people. It enabled them to really get control of their health, start to feel better, change their appetite and their cravings and then enable them to buy the food that was good for them too in the first place. So it was a real win for everybody. So eventually everyone we got fasting we got to do low-carb as well.

Bret: That’s fascinating. I love the double bonus that fasting really provides in logistics, you have to worry about it, you know, timesaving and money-saving, so many things come into play with fasting. But I want to go back quickly to something that you mentioned about replenishing their electrolytes and losing the water weight.

Because that’s something that’s very important for people to understand whether it’s transitioning to low-carb or transitioning to fasting, that there is this natriuresis, this diuresis, that you’re losing sodium, you can lose some potassium and you lose water weight. So what do you specifically recommend for people as a means to protect against that or replenish that?

Megan: So it depends on what fasting regimen they’re going to do. Now most often or not, the minimum fast is 24 to 36… Well, the minimum and the most common fast we use is 24 to 36 hours three times a week for our patient population. So during this time of course we asses them in the first place.

Do they have a history of congestive heart failure, what is their kidney status, their renal status, do they have issues with elevated potassium levels already or low potassium levels, hypokalemia already? So we asses that all at baseline before you make any recommendations. We usually do start everybody off on sort of a base of 400 mg of magnesium. The serum magnesium test that we do in clinic, we do it every month. I don’t know why we do it every month.

Bret: It’s a terrible test though.

Megan: So we just sort of assume most of our patients at this point they are mostly quite severe diabetics and it has to be their metabolic syndrome that they’re probably quite depleted of magnesium. So it’s safe to do, we recommend things like Epson salt baths or making a homemade magnesium oil or purchasing one and using it topically just to help give their magnesium levels a boost.

Bret: So it’s a great point that magnesium if we take too much orally, it can give us some G.I. side effects like diarrhea, but our skin is actually very good absorbing magnesium, so Epson salt baths or some topical magnesium can be a great way to do it and bypass the stomach side effects.

Megan: It’s much more effective. I’ve had patients who clearly have magnesium deficiency. It doesn’t matter what they supplement with. It’s the topical application of magnesium that really improves their symptoms and makes them feel good again. In terms of salt, we really recommend that patients do drink bone broth or at least a low-carb vegetable broth with some added salt to good quality salt, the Himalayan salt, Celtic salt in it when they’re especially new to fasting as their body starts to purge all that water loss.

A lot of patients are very fascinated in autophagy, so the cellular recycling process… after it won the Nobel Prize in medicine in 2016, people are very interested. Cancer rates are now through the roof and people are looking to do whatever they can. So people want to jump in on day one and start water fasting and we say no, no. Try drinking the broth first.

Alternatively some people really dislike the broth, so we encourage them to have a quarter to half a cup of pickle juice on the day and people actually like that in the summer. The humidity in Toronto in the summer is disgusting, so no one wants to be drinking warm chicken broth in the summertime. So pickle juice is an alternative at that time of year that will encourage patients to have. Of course with no sugar in it and we teach them different ways that they can make it at home themselves to supplement.

So we usually go that route first. We find though, if a patient is fasting consistently, they don’t really need to supplement with that after the first 2 to 4 weeks once they start fasting. During that time the first month we see the most water loss, we see their weight loss start to stabilize at about 1.5 to 2 pounds a week after that and people start to become lazy with the broth anyways and they don’t end up having any problems. Sometimes they still get more leg cramps so we increase the magnesium or the recommendation in terms of how often they should be taking Epson salt bath or using magnesium well.

Bret: It’s important, you said this, but I want to point to start again, that’s for a 24 to 36 hour fast.

Megan: Yes.

Bret: So for a longer fast, then would you recommend that they’d have just saltwater or something?

Megan: Absolutely, saltwater… it really depends on the patient and their level of activity just how much we recommend. For most people in terms if they’re going to have broth or pickle juice and just want to have some salty water, to have about 3 teaspoons or a tablespoon sort of max for a 36 hour period. And maybe a little bit more if that patient is being very active, doing weight training for example while they’re fasting, maybe increase it by an extra teaspoon throughout the fast.

Bret: I’m sure a lot of your patients that you see are overweight, have diabetes and hypertension and I’m sure they’ve been told by their doctors to avoid salt and avoid sodium. Did you have to break down some barriers with them to get them to accept that? And do you have patients whose blood pressure worsens when they supplement with salt even though they’re fasting? Have you experienced that?

Megan: No, we really haven’t. At the start we don’t see too much change in their blood pressure even when we do see that water loss, so we figure the salt intake everything sort of balancing out with their diet. But as they transition to a low-carb diet most of my patients will start off fasting immediately, but they’re 20% low-carb and then build up to doing like 80% or 90% low-carb over time and once their diet really transitions to that we really see a more dramatic drop in their blood pressure.

But it’s tough, I’ve had patients jokingly threatening me about recommending salt, saying they’re going to record me and take it to the media, that I’m telling them to take all of the salt, but we spend time sort of educating them on salt. We created a special module that our patients do for training, sort of just understanding the effects of salt, the importance of salt and eliminating these processed foods from their diet.

We talk about salt being so vital for survival and we really utilize the motto that everything that is good for you, is bad for you in excess. And it’s really, really bad for you in excess and as human beings we have this drive to be excessive. This is something about fasting that’s driving me little a bit nuts when I do go on social media. If one day of fasting is good for me, then 100 days a fasting is good for me.

And I see this now all of the time and it’s really been in the last two years and it’s just so not… Everything that’s good for us is bad for us in excess. Fasting, sodium, everything… insulin is a really important hormone that we know too little of it will kill us, and too much of it will also kill us.

Bret: Water and oxygen.

Megan: Exactly, so we really tried to teach the patients about this balance. So we talk to them about all of the refined process salt that’s in all their refined processed foods that they are eating and show them what a regular day eating low-carb looks like in terms of sodium intake and the day of eating the standard North American diet looks like and then you have these days when you’re not eating at all, but you’re still consuming a lot less sodium even if you’re guzzling a glass of saltwater.

Bret: It’s so interesting when it comes to sodium, I think that the evidence is fairly clear that really only about 25% of the population is even salt sensitive. But yet the recommendation is everybody should limit their salt intake. And yet the data seems to suggest a U-shaped curve at the low-end and the higher end is showing an increase health, the majority of people cannot worry about their salt, but adding extra at certain times like when you’re transitioning to a keto diet or when you’re transitioning to fasting can be so beneficial. So you mentioned if a little is good, a lot must be better.

So that brings up the topic of different types of fasting, because intermittent fasting is a catchall phrase right now and it seems to involve time restricted eating, it seems to involve three or 40 fast and it seems to involve 10 day fast. How do you– and of this is a big question, you may not be able to answer completely, but how do you break down what’s the right level of fasting for the right individual?

Megan: So we usually assess someone in consultation and then see how they respond emotionally towards the fast. But we really believe that sort of to be insulin resistant, 24 to 36 hours of fasting is very effective doing that intermittently. That’s all you really need and it creates a nice balance. The idea is to throw the body off to now let the body adapt. We always tell our patients that human beings are a dumb species.

We are not a very bright species, but we’re a highly adaptable species. So if we stay in anyone physiological state long enough our body is going to adapt to it and so we just want to confuse the body. And I found that we’ve been doing this now for seven years, intermittent fasting 36 hours three times a week in people, treating that like a therapy, not as a diet.

We really encourage our patients to treat it like a therapy. I made such progress of my own health for six months, because I treated fasting like it was my attendance to chemotherapy. And I wouldn’t skip a treatment of chemotherapy if my friends wanted to go for lunch. And there would be days where I wouldn’t feel good, but I’ll be okay because eventually it would lead to my inevitable great health.

Bret: Interesting analogy, I like that.

Megan: And we really encourage our patients to think of it as a therapy. This isn’t a fad diet, this is a therapy they’re choosing and they don’t have to choose it. They can go to the regular route, we’re happy with that, we’re happy to provide them with education on diet and they never have to fast and that will lead to significant health improvements as well. But if they’re going to fast, they have to have the mindset that it’s a therapy and they need to be dedicated to that therapy.

And the intermittent fasting just provides that right amount of chaos for the body to prevent it from adapting, creates the right amount of life balance for the patients too. I think in 2017 we developed something called fasting burnouts that I noticed, because everyone was trying to do these five day fast, we can and we go.

But they just can’t maintain it socially, they’re getting really frustrated and then they’d stop fasting, they’d feel bad about themselves for not fasting, so then they’d go eat that pizza and not the good kind of crust, the carby kind of crust, and then they would end up being in worse shape than they were when they first started. Then they’d disappear for a few months because they were embarrassed.

Bret: Yeah, such a great point to be able to institute fasting in a responsible way that is going to prevent that. Because let’s be honest, a lot of people have unhealthy relationships with food and so there are some people who are going to be on the extremes. They’re going to fast and then they’re going to binge.

And is that really doing you any good? So do you have to– it’s tricky isn’t it to help people find that healthy balance, and make sure they’re doing it right. And that’s where I like what you’re talking about the 24 to 36 hours, which is you know, when a lot of people think about fasting, they think about the extended fast.

But this is not that, it’s much more doable for your social structure, for your life and for your psychology as well to sort of prevent the big binges. So when you say 36 hours just to clarify you’re basically talking… you have dinner Monday and your next meal is breakfast Wednesday?

Megan: That’s correct.

Bret: It’s good for people to clarify. Now when we talk about longer fast, we can start talking about some trouble that can happen and there has been some controversy about this and some people have given maybe fasting a bad name altogether when they’re really kind of specifically focusing on the longer fast.

So what point do we start to see problems like lean body mass break down, muscle breakdown? Do we start to see concern about permanently damaged resting metabolic rate like what happened in that study with the biggest loser candidates? When do you start to worry about things like that?

Megan: So we don’t really do a whole lot of crazy long fasting in our clinic and I’ll give you some examples of patients who have gone off the reservation here, taking our advice. We do utilize 7 and 14 day fast periodically. This is usually someone who comes in who is barely hanging on to the cliff anymore. And it needs to be something magical that happens to them or they’re going to lose their leg, or lose another limb losing or start dialysis, something pretty clinically significant. Or their blood pressure is just really high and we need to get them to lose weight. They’re younger guys.

So even in these patients it’s very rare that we recommend it. When we first started IDM and first started fasting, we’re going back to 2012 and I started fasting myself in 2011 and we got all kinds of flak from the medical community because of what I was doing and how could these doctors in my network be supporting me and then we just got flak with patients.

And all we are trying to do was 24 to 36 hours of fasting, we weren’t trying to do anything else. We may patients sign contracts promising us they won’t fast beyond 36 hours and that they would have something. But then we’re getting all kinds of flak for fasting. And so my colleague Jason he speaks at a lot of conferences and he is like, “There are these studies done in people fasting for 7 days and 14 days and Ramadan and they’re all fine.”

And then I think we sort of got pigeonholed into maybe where this group of individuals at this clinic that has everybody fasting for two weeks at a time or 30 days… And that’s not what we ever do. But over the last several years fasting has definitely become quite popular and again our nature is if something is good for us than a lot of it must be better for us. So we do have some patients who just don’t listen to us not at all.

So I have this patient, I love him to death, his name’s Paul, he’s got a whole Twitter feed about this and encouraged us to share his story. And that he came in on this first appointment and he said, “I’m going to be your best patient ever.” I said, “All right Paul, and I’ll look forward to working with you.” And he wanted to do a seven-day fasting. And he was pretty severe diabetic, but otherwise completely healthy, good blood pressure… Why not? So he spoke to Jason and I and we consented to the seven-day fast.

And then he wanted to do 14 days. And then around the 14th he said, “My goal is actually 120 days.” So we both said to him, “No”. Half of his chart is me documenting that I’ve told him to stop fasting. But he continued to fast for all 120 days. Now he stopped losing weight around day 90. His blood sugar levels improved and he came off of his insulin and his metformin but they didn’t improve beyond day 90.

So all of the magic for him sort of stopped around day 90. His fatty liver improved dramatically, we did a baseline ultrasound and a follow-up ultrasound. That improved, but he also had his body composition analysis done at the start and after he broke the 120 day fast. And when he broke the 120 day fast we put him on a bone broth protocol for a few days and slowly started to reintroduce food, because we never had anyone do that before nor would we ever encourage it and we completely discouraged him from doing it.

Bret: But the concern is the refeeding syndrome which can be life-threatening.

Megan: So he was perfectly okay, but there was no change in his lean mass really from start to finish. It had gone up a little bit, but he had also lost a nice chunk of body fat during that time, so you would expect it to go up, but there was really no change. Now when you fast you produce quite significant growth hormone even just in one day of fasting your growth hormone nearly doubles.

So this protects your body and helps it to grow, especially when you start to eat again and re-feed again. And he was also very active during his fast. He would send me photos or post photos on Twitter and tag me ahead of him, digging up this trench in his backyard for a garden. And he was very active, he owns a spa in a community near our clinic and he says he’s on the go there moving things around up and down all day long.

So he’s been pretty active. So we do see that between the 24 to 36 hour mark, during one of these longer fasts and there’s good research to support it, but during the 24 to 36 hour fasts, when we do see a lot of gluconeogenesis and we do see protein breaking down. But after that 36 hours it really sort of starts to stabilize and plateau. It starts to drop and then it stabilizes in plateaus that are really long and are really low level.

So it’s never really been an issue. So I work with two patient populations nowadays, especially since fasting has become quite popular. So there is the older elderly metabolically unhealthy patient and then there is the young hotshot superstar who’s got some sort of injury and wants to heal himself so we can go compete for another couple of years and be able to retire down in Miami and play golf all day long.

So most notably is Georges St-Pierre. So Georges St-Pierre is a Canadian and he’s UFC fighter and he’s won some world championships, he’s a very, very nice Canadian man. And he was diagnosed with colitis and as a result he had to surrender his world title. And he was interested in fasting because his manager being in Canada had heard about us and his manager fasted and reversed his borderline diabetes and lost weight and as George would joke, he went from looking terrible to looking fantastic. So I figured fasting has to be good. And so he had colitis and he wanted to treat it with fasting.

So this is a man who very clearly if you look at him is about 7% body fat and just insane amount of lean mass and who trains very hard and aggressively and his livelihood depends on it. And he’s human and he’s like most of us, so a little bit of fasting is good for us and maybe trying to do a lot of fasting is great for us.

So once a month he does a four day fast and talks about this very openly, he talked about it on other podcasts and he’s written some stuff for us. And he did a four day fast while training aggressively in Thailand earlier this year. And he has not lost any lean mass, he has only gained lean mass.

Bret: So it seems like the secret might be the physical activity and the continued training, because there are some studies that show some loss of lean body mass, but I guess I’d have to go back and look at those if they’re controlled for physical activity, because it seems that might be the secret here. It’s interesting that you still try to focus on the shorter fast and these longer fast are the rare exceptions.

But it seems like if the right precautions are taken, you can maybe protect against that lean body mass loss as well.

Megan: That depends on the individual and the other health challenges they have. I personally have only done 11 days once, only one time ever. I am a big believer that if I’m going to ask a patient to do something I should have a little bit of experience doing it myself. And it was shortly after the first 14 day fast we ever recommended. And I made it to 11 days, because it was my mother’s 60th birthday.

Bret: It’s a good reason to break it. So there’s loss of lean body mass, but then there’s also a reset of your resting metabolic rate. And so initially after the first couple days of a fast, the resting metabolic rate goes up. And then after that it seems to maybe stabilize and then come down at some point. And the question is where is that irreversible? I don’t know the answer to that question but the study that was done at the Biggest Loser contestant, that seemed to be irreversible, that seemed to be years later.

Their resting metabolic rate was still diminished by 20%. Some people have called them metabolically broken. And that’s something that you never want to happen, so you have to protect against. So what kind of safeguards do you have in place to protect against that with fasting?

Megan: We don’t recommend these longer fast because there’s so much unknown about that. When I actually presented a little bit on this earlier this year in Breckenridge Colorado, there just needs to be more data on these long-term studies. A lot of the other studies to their patient population years ago is very different than our patient population now. So I think there needs to be more evidence for that. It’s funny that you mentioned the Biggest Loser, so we are working with a small group of them to see the combination of fasting and a ketogenic diet what we can do in terms of boosting their metabolic rate.

So we are actually going to share that earlier next year, because we have some really exciting results. But even with this group of individuals we’re doing 36 hours intermittent fasting and with that you see that it’s actually boosting their metabolic rate.

Bret: Oh, it’s fascinating. I’ll look forward to seeing that that evidence. Now you’ve already started coming out with some evidence with your K-series report and this was excellent. I mean I will look this up. You had three people on an average of 70 units of insulin each and you did a 24 hour fast three days a week with low-carb and time restricted eating, so it was a combination of effects.

And they all came off their insulin and most of their oral diabetic medications which by itself is amazing. But then what really amazed me was someone did it within five days, and the range was only 5 to 18 days. It amazed me how quickly they were able to do that. So tell me about your experience with those patients. Were you surprised? How would you interpret that?

Megan: The three patients were totally picked up completely random. Jason’s nephew started writing the paper and came into my office, I was really busy and he’s like, “I need three charts because I have to write about patients.” So I grabbed three charts plainly from the top of my counter.

Bret: So I am sure most people thought for sure these were cherry picked patients, because it was so dramatic.

Megan: We’ve got some really interesting data and we’re actually working on collecting our data. I was hoping to present before the end of 2018 some of our data, but we’re actively entering it all. It’s different for everyone, it’s amazing, we’ve seen people come off of like 200 units of insulin in less than a week, but then we’ve seen people where it takes a few months to come off of 200 units of insulin.

But it’s pretty remarkable and most of the time when a patient comes in in consultation and they say, “I’m on 110 units of insulin. When can I come off of this, say I listen to your fasting and your diet advice?” and I say, “Anywhere from tomorrow to six months from tomorrow.” Somewhere in that window.

Bret: Set the expectations.

Megan: Yeah, but most of the time within 30 days I’d say that they’re off of insulin and within six months off of all of their oral diabetic medication.

Bret: Yeah, but that can get really tricky and that’s one of the most important things for people to hear if they’re on insulin, if they’re on other oral hypoglycemics or other diabetes medications. This is where you need an expert helping you, because this can get very dangerous very fast. I’m sure you’ve seen cases and heard of people trying to do this on their own or trying to do it without proper supervision who’ve had some bad outcomes. So the insulin is one thing. I mean you need to cut the insulin down probably pretty quickly to prevent hypoglycemic episodes.

But then there are the oral agents as well and one that is coming to the news a lot is the SGLT-2 inhibitors. Which on the one hand have been praised because they’re one of the few oral diabetic medications that have shown a slight decrease in cardiovascular outcomes, but yet they’ve also shown some evidence of diabetic ketoacidosis, the feared complication when people think of ketosis. That is completely separate from nutritional ketosis, except maybe in people taking SGLT-2 inhibitors. So how do you handle those medications?

Megan: So for a long time we tried to utilize them in clinic, again they were the one medication or class of medications that removes the sugar from the body, therefore sort of eliminating part of the problem. And there’s some cool data out there sort of showing that they do have a little bit of cardiovascular and renal protection.

So again with us being a renal clinic first and foremost we tried to keep the SGLT inhibitors in play for as long as we could, but people, our patients, we see them every week for a long time, we see them every two weeks, at the very least we see them once a month.

And we see them for an hour when we see them. So we were able to pick out a lot of information with them over the course of that hour if they’re experiencing any sort of side effects. But the reports now, there’s a lot of commercials that are scaring the patients a little bit about them and then just at the risk of people having the sort of excessive nature now towards fasting, now we’re just concerned about leaving the patients on these SGLT-2 inhibitors.

For the shorter fast we were not as concerned, but now that society is embracing fasting and doing it to the extreme, we’re actually starting to eliminate that class of medications first before any of the other medications.

Bret: That makes a lot of sense. One of the things I find so interesting is people love this these medicines now, especially if you look at the most recent guidelines that came out, which by the way low-carb diets were finally mentioned in, but they’re mentioned in like half a page of a 12 page document that was all about medications.

People love these medications because of the cardiovascular benefits. But let’s be honest, they are pretty small and we can get the same benefits not using the medication, but using nutrition and fasting.

Megan: That’s the conclusion we came to at the end of the day too.

Bret: Yeah, that makes a lot of sense. So we’ve talked a little bit about exercise and maintaining the lean body mass. Now some people are going to have a hard time exercising when they fast or if they do physical jobs. Is that something you address to people and you have any sort of tips for them?

Megan: That’s something everyone’s very concerned about I’d say every day in my email, my IDM email, I get questions about this from patients and from strangers asking about it and it’s something I’m chronically tagged in on different social media. And I know Jason experiences the same and our patients especially those who have labor-intensive jobs, they are nervous about it too. And we just really educate them on the importance of staying hydrated.

If they are not going to drink broth or pickle juice, just have that salty water, drink it and teach them to hydrate. And we tell patients, you know, when you drink a glass of water with some salt, you are not instantly hydrated, it’s not magic, it doesn’t happen like that. So if you’re planning to go to the gym at six then at 5 o’clock you should have a glass of water, a little bit of salt in it, let it properly absorb in your body and then make sure you’re hydrated before and after.

A lot of people, it’s funny, come back and their personal trainers for instance would be just livid with them that they are fasting especially at their age and their health status, how could they fast, they need to focus on their fitness. But then their trainers are recommending them, you know, what a great workout they were having… “Gosh, your workouts have improved”. And they would say, “You know, we are fasting.”

I started doing weight training about a year ago myself and my trainer she’s a female… It’s more resistance out there in the female population about fasting. And she was very leery about it but there were some people that she worked with who really thought what we were doing in Toronto was cool, so she kept quiet about it and now we sort of play this game where she guesses whether I am in a fasted state or a fed state when I’m working out.

And she said, “Megan you finally have convinced me to start fasting.” So she just started doing 16-8. If you hydrate properly, you’re perfectly okay. And I think we’ve had a couple of blessings or benefits. The first one is being where we are located in Toronto. Toronto is the most multicultural diversity in the world. Over 50% of the population was not born in the city of Toronto.

And then in all of the different boroughs within the greater Toronto area, we’re in the most diverse area. So when I tell a patient to fast, they say, “Okay, we did that before we moved to Canada. And there is fast food on the corner of every streets and we made more money and could afford these luxuries, so no problem.

And then those patients would do well and then they would inspire the patients who grew up in Canada like me, you know, meat and potatoes, pasta and pizza and anything several times throughout the day and those patient would see that the other ones could do it. So that was one of the blessing. The second blessing is that sort of it’s in this day and age where people are really starting to question everything they’ve ever been told from any other doctors or media outlets about food and nutrition.

And so they see me, they hear my story, they see a few other patients and hear their stories and see that, okay, they are doing this and this is okay and you know they start to realize now that the dietary advice, the medical advice they were given was wrong. And it’s not that their doctors are bad people, their doctors are poorly educated people.

And the guidelines, we teach them about how the guidelines came to be and how we know it’s not really based on good science or science really at all. And so they start to question that, so they’re willing to try. “So Megan if you say adding a pinch of salt to my bone broth and drinking that an hour before my workout is not going to kill me, what do I have to lose at this point? If it’s worked for you and it’s worked for them and all the standard advice isn’t working for anybody, then I’ll give it a try.”

So that’s sort of the second blessing is that we’re at this pivotal moment, where people just don’t know what to trust or what to believe so they are going to gravitate towards what they see is working and they’re going to try to educate themselves and they are really open to listening to everything that I say. Our patients go through a 12 hour training program immediately after the consultation where we will wait for their blood work to come back and decide what it is we’re going to do, so providing them with education.

And 10 years ago to ask people to take time off of work or from their personal lives to devote to that, they’d probably think it was pretty silly and they’d lose money from work, they’d have to find daycare for the kids and it would be difficult. But now they’re making that time because they just don’t know what to trust out there.

They see headlines with very poor explanations under them, so they make the time to educate themselves. So we are in this cool stage where people are really trying to get control of their own health and be their own health advocate. And I think that’s why we’ve had a lot of success.

Bret: Yeah, that’s a great sign to see people so interested in and to know they’re going to get the benefit, I mean that’s the thing. They’re seeing other people benefit, they’re seeing it whether it’s online or in person, so they know it’s worth the investment. Now one of the interesting things though is this whole concept of the duration of fast that we spent so much time on versus time restricted eating.

And it sounds like you use both of those. And you mentioned autophagy, there is evidence about stem cell regeneration, there’s evidence about, you know, trying to keep mTOR quiet, and now there’s this fasting mimicking diet that’s come on the scene. So tell us, do you utilize fasting mimicking diets at all? And in whom do you use them, what version, what are your recommendations about that?

Megan: So we don’t use them in our clinic, most of the patients are quite sick and it’s going to take a more aggressive approach. Perhaps the fasting mimicking diet is good for the healthy individual looking to stay healthy and just shape up their eating habits and their meal timing habits. But for sick metabolic patients we usually take something pretty aggressive. Often 24 hours doesn’t quite cut it.

That extra 12 hours getting to 36 hours seems to make a real difference, a huge impact on patient outcomes. So we don’t we don’t utilize it. Now that being said I have a lot of patients who had tried it, because the idea of actual fasting is very overwhelming to them and that they just have this addiction, you know, they’ve been eating every two hours they were awake for the last 10, 20, 30 years and this whole idea of going without food is very difficult for them.

I have some patients that I worked with in the past who grew up under very hard circumstances, food was very scarce growing up… I had some people that grew up during the Vietnam War and who would go months without having access to food and they suffered true malnutrition.

And for them it’s a little bit more tough. And we worked with time restricted eating patterns with them instead, but even them have tried doing more of a fasting mimicking diet… We just haven’t found that it worked very well for our patients who were metabolically sick.

Bret: Yeah, I think that’s an interesting answer because I think you’re right, people that are metabolically sick will need something a little more aggressive. And the fasting mimicking diet seems to be more on the longevity scene now, not the people who are trying to fix diabetes or some problems, but trying to keep mTOR low and trying to keep IGF-I and reduce the risk of cancer.

And it’s really not even fasting, it’s basically calorie restriction. So whether eating avocado and some olives and doing that for five days and keeping the calories down. It’s interesting that you can see some insulin benefits, but I am interested in your experience there that it’s not maybe the most beneficial approach for the people who really want to reverse their diabetes quickly.

Megan: That hasn’t worked with patients and then they get really nervous that they’re going to have to start fasting. We just work on it slowly, three meals a day without snacking, trying to move that dinner meal up an hour or two earlier on in the day, so there’s a bigger gap between dinner and breakfast. Then letting the patients guide us a little bit. You know, if they are not really hungry in the morning time, then let’s kick out breakfast.

Or if they feel pretty satiated after their lunch and they don’t really feel like they need to eat dinner or socially need to eat dinner for family reasons, then try eliminating dinner and just do it really gradually. We tell our patients, you know, fasting is like a muscle and some people are just naturally more fit or inclined than others, some people have practice at it and some people have never had practice at it, they are brand-new to it. So it’s going to take time to work out to where they need to be.

There’s a lot of patients who I know who aren’t going to benefit unless they are doing 36 hours of fasting, but I have to start them off at three meals a day and maybe a 13 hour fast and slowly transition them up to that point. And of course they do get benefits along the way, they lose some weight, they reduce their medications, but they make the most dramatic impact once I get to that 36 hour mark.

Bret: That’s a great lesson, I think a great place to sort of leave this conversation with you. It’s not always you just jump right into it, but sometimes you do have to ease into and be safe and you’re going to get there, and get the results to do it safely.

Megan: It just takes time.

Bret: Fantastic Megan, thank you so much for joining me. If people want to learn more about you and Jason and the program you have, where can they go to learn more?

Megan: Online they can go to idmprogram.com, we have a whole bunch of information up there and they can find all of our social media links on the idmprogram.com as well.

Bret: Great thanks again for joining us on the DietDoctor podcast.

Megan: Thank you.

Transcript pdf

Source: https://www.dietdoctor.com/diet-doctor-podcast-7-megan-ramos

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ashtoad13-blog · 6 years ago

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USDA and FDA announce joint public meeting on use of animal cell culture technology to develop products derived from livestock and poultry

WASHINGTON, Sept. 10, 2018 – U.S. Secretary of Agriculture Sonny Perdue, DVM and U.S. Food and Drug Administration Commissioner Scott Gottlieb, M.D. today announced a joint public meeting to be held on Oct. 23-24, 2018 to discuss the use of cell culture technology to develop products derived from livestock and poultry.

The joint public meeting, hosted by the USDA’s Food Safety and Inspection Service and the FDA, will focus on the potential hazards, oversight considerations, and labeling of cell cultured food products derived from livestock and poultry.

“This is an important opportunity to hear from the agricultural industry and consumers as we consider the regulatory framework for these new products,” said Secretary Perdue. “American farmers and ranchers feed the world, but as technology advances, we must consider how to inspect and regulate to ensure food safety, regardless of the production method.”

“The FDA knows just how vital it is to ensure the safety of our nation’s food supply and the critical role science-based, modern regulatory frameworks are to fostering innovation. Recent advances in animal cell cultured food products present many important and timely technical and regulatory considerations for the FDA and our partners at USDA,” said Commissioner Gottlieb. “We look forward to the opportunity to hold a meeting with our USDA colleagues as part of an open public dialogue regarding these products.”

The first day of the meeting will focus primarily on the potential hazards that need to be controlled for the safe production of animal cell cultured food products and oversight considerations by regulatory agencies. The second day of the meeting will focus on labeling considerations.

Representatives of industry, consumer groups and other stakeholders are invited to participate in the meeting. Attendees are encouraged to pre-register to attend the meeting. Pre-registration is available at the Meetings and Events page on the FSIS website. The meeting will be held on Oct. 23 from 8:30 a.m. to 4 p.m., and Oct. 24 from 8:30 a.m. to 3 p.m. in the Jefferson Auditorium in the U.S. Department of Agriculture South Building, 1400 Independence Ave. SW, Washington, DC, 20250.

Anyone who wishes to submit written comments prior to the public meeting or after the meeting may do so by submitting comments on regulations.gov by Nov. 26, 2018. Comments previously submitted to FDA in regard to the July 12, 2018 public meeting will also be considered.

For further information on the joint public meeting and to register to attend the meeting, please visit the Meetings and Events page on the FSIS website. Attendance is free.

The FSIS, an agency within the U.S. Department of Agriculture, is the public health agency responsible for ensuring that nation’s meat, poultry, and egg products are safe, wholesome, and accurately labeled.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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Source: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm619987.htm

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ashtoad13-blog · 6 years ago

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Turmeric stopped Ulcerative Colitis – RCT Feb 2019

Turmeric Curcumin Put to the Test for Inflammatory Bowel Disease Michael Greger M.D. FACLM

Video

Placebo + standard care 8 out of 39 relapsed (20%) clinically worse Curcumin + standard care 2 out of 43 relapsed (5%) clinically better

… researchers extended the study for another six months but put everyone on the placebo to ensure the initial findings were not some aberration. The curcumin was stopped to see if that group would then start relapsing, too—and that’s exactly what happened. Suddenly, they became just as bad as the original placebo group.”

“… Why did it take so long? Well, who’s going to fund such a study? Big Curry?”

Greger’s related videos

Which Spices Fight Inflammation? Turmeric Curcumin for Prediabetes Speeding Recovery from Surgery with Turmeric Heart of Gold: Turmeric vs. Exercise Turmeric Curcumin and Pancreatic Cancer Treating Alzheimer’s with Turmeric Back to Our Roots: Turmeric and Cancer Who Shouldn’t Consume Curcumin or Turmeric? Boosting the Bioavailability of Curcumin Turmeric Curcumin and Osteoarthritis Turmeric or Curcumin: Plants vs. Pills

Curcumin for maintenance of remission in ulcerative colitis – Cochrane 2012

Free Cochrane PDF

Source: https://vitamindwiki.com/tiki-index.php?page=Turmeric+stopped+Ulcerative+Colitis++â+RCT+Feb+2019

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ashtoad13-blog · 6 years ago

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TMAO: Eggs, Meats and Your Cardio-Metabolic Health | You Can Sill Eat Eggs & Meat, If You Got 'the Right Gut Bugs'

The (ill) health effects of choline and its pre-cursor l-carnitine in animal products like eggs or (red) meats are probably mediated by a diet devoid of prebiotics... however, simply pounding more resistant starches, for example, seems to do more harm than good.

If you have been following the SuppVersity News on Facebook (a must, btw ;-)), you will be aware of the "TMAO"-issue. If not, here's the gist: The ingestion of certain dietary nutrients - primarily choline, phosphatidylcholine, and its precursor l-carnitine can serve as a precursor for the ultimate generation of an atherogenic metabolite, trimethylamine N-oxide (TMAO). TMAO, in turn, has been linked to all sorts of diseases, most prominently cardiovascular disease and the formation of atherosclerotic plaque.

Unlike "fish odor disease", the choline/CVD link is unrelated to your genes:

DNA-Fit: Train Acc. to 'ur Genes

Is Laziness Built Into 'ur Genes?

Keep Muscle While Dieting

'Bad genes' are no excuse

IF + Resistance Training = WIN

ADF Beats Ca-lorie Restriction

More recent research suggests that these TMAO-mediated effects can be traced back to your gut and, more specifically, to a certain microbial composition of the commensal bacteria in your digestive tract (Koeth (2018). In their recently published paper, Koeth et al. write about the choline/carnitine-gut/microbiome-TMAO/heart disease link that all seems to start with the microbial formation of TMA in the gut and ends with the final conversion of TMA to TMAO (see Figure 1).

Figure 1: This excellent graphical summary came with the FT of the original paper by Koeth et al. (2018)

Very high levels of TMAO can trigger a disease that is known as "Fish-Odor-Syndrome" (check out Messenger et al. 2013 for a free review). Whether or not you stink when you consume high amounts of choline depends on (a) your genes and hence ability to metabolize and excrete TMA, the unoxidized fish-reeking precursor to TMAO, and (b) your dietary choline intake. Unfortunately, ill effects on your cardio-metabolic health have been observed in the absence of a flawed "flavin monooxygenase 3"-gene, and in spite of a flawless TMA metabolism. Hence, you may be at risk, even if you don't reek of rancid fish. After all, it's the TMA, not the TMAO that causes the unwanted body odor, and the latter, i.e. trimethylamine n-oxide (TMAO), are the ones that have been linked to cardiovascular and cardio-metabolic disease (CVD, CVMD) in multiple observational studies.

What can you do to reduce your TMAO levels? The best proven way to keep the concentration of this potentially toxic molecule in check is a reduction of the intake in choline/or choline-forming nutrients - especially carnitines. Still in the development pipeline are nonlethal small-molecule inhibitors, or drugs that block the second step in the pathway, the major host gene responsible for converting microbe-generated TMA into TMAO, flavin monooxygenase 3. Moreover, only recently, Roberts et al. 2018 presented the first microbiome-modulating "nonlethal therapeutic to inhibit thrombosis potential". As of now, it is yet not clear if simply keeping a healthy intestinal ecosystem (by, among other things, consuming enough dietary fiber) won't yield the same results, anyway.

Evidence has been emerging over the past decades that suggests that an increased intake in choline or its precursor carnitine from eggs and meats is yet not sufficient to explain the increased TMA-formation in the gut, its oxidation in the bloodstream and the subsequent/concomitant development of atherosclerosis and thrombosis, as well as chronic kidney disease and heart failure.

Figure 2: Yes, both dietary and supplemental carnitine may increase your atherosclerosis risk (Koeth 2014). If and to which extent they will do this, however, depends on both other dietary factors, as well as the microbial composition of your microbiome.

This research lead many (but not all scientists) to postulate that the commonly observed links between meat consumption and cardiovascular disease could eventually be a function of the interaction of the high amount of dietary carnitine/choline with a dysbiotic microbiome... a hypothesis that is in line with isotope tracer studies in mice and (wo)men which prove the version of carnitine to choline and choline to to TMA and eventually TMAO, which has in turn been shown to promote the formation of atherosclerosis in murine models of the disease (Koeth 2014 | see Figure 2).

Moreover, parallel clinical studies in humans confirm the existence of a link between meat/carnitine intake and the risk of heart disease - a link that seems to be modulated by elevated TMAO levels in the egg/meat eaters.

Table 1: Trimethylamine-producing capacity of various foods (mg trimethylamine/g food) following chemical hydrolysis and biological liberation (Mitchell 2002).

One thing we still don't fully understand is why fish is the exception to the rule: Fish is by far the worst offender when it comes to elevations in serum TMAO after a meal (Cho 2006) - with levels being ∼50 times higher than you'd see for comparable egg- or beef-based meals. The reason why it's still a high egg- and meat-intake, not the amount of fish people are eating that has been linked to cardio-metabolic disease in large-scale epidemiological trials is still not clear. Especially in view of the fact that rodent studies seem to suggest that TMAO-supplemented diets seem to exert the same ill health effects that have been described in the previously mentioned observational trials in Western-diet-style, this seems to be odd, since pork w/ only 23mg/g TMAO should be healthier than cod w/ 1335 mg/g (Table 1).

It would appear prudent, however, to assume that (a) the co-ingestion of other nutrients in fish (such as taurine | see "Taurine Boosts Good Gut Bacteria" in the archives) and/or (b) the absence of general dysbiotic effects of increased fish consumption (and hence overall increases in TMAO exposure from choline sources) are at the heart of the cardio- and metabo-protective effects of fish (note: Saltwater fish contain ∼3 g/kg TMAO - the highest levels of all food sources | Mitchell 2002).

Add indeed, many of the previously cited human studies show that omnivores have higher circulating concentrations of l-carnitine than vegans or vegetarians, and that elevated plasma concentrations of l-carnitine in subjects is associated with incident CVD risks (e.g., heart attack, stroke, and death) independent of traditional CVD risk factors, but only in the presence of elevated TMAO (Koeth 2013). As you can see in Figure 3, however, this risk increase depends not on the amount of carnitine the subjects consumed and/or the carnitine or choline levels in their blood but was crucially dependent on its conversion to TMA/O.

Figure 3: Kaplan-Meyer plot (depicting the event-free survival (%) over time) stratified for high vs. low carnitine and TAMO levels; based on data from N > 2,500 subjects undergoing standard cardiac evaluation (Kloeth 2013).

Higher carnitine levels, alone (see the light and dark blue lines of the Kaplan-Meyer plots at the top of Figure 3), have no effect on one's cardiovascular disease risk. In fact, the subjects in the high carnitine + low TMAO group (light blue) had the highest event-free survival of all groups.

Carnitine, alone, is not the problem: it's its conversion to TMAO

The mediating effect of having an (unfavorably) TMA-producing microbiome may also explain the heterogeneous results of previous studies on the link of high(er) carnitine intake (3g+/d), all-cause mortality, heart failure, unstable angina, or myocardial reinfarction in the setting of acute myocardial infarction as it was descibed by Shang & Hui Li. in 2014.

In the absence of a TMA-producing microbiome, on the other hand, both beneficial effects on cardiovascular risk factors and metabolic syndrome have been observed in response to l-carnitine supplementation (Johri 2014). As Tang & Hazen (2014) point out, the contemporary available evidence does, therefore, seem to confirm an "obligatory role of intestinal microbiota in the generation of TMAO from multiple dietary nutrients, and TMAO as the proatherogenic species likely promoting the striking associations noted between plasma levels and both prevalent and incident CVD risks" (Tang & Hazen 2014) - Important: the simple provision of allegedly health(ier) probiotic mixes (e.g. #VSL3 fails to re-establish a non-TMA promoting microbial composition | Boutagy 2015).

You may have to avoid choline and carnitine containing foods for the time being, if... you have a carnitine challenge test which shows that your current microbiome favors the conversion of choline and choline-sources such as carnitine in red meat and other (mostly) animal sources to TMA, which is then oxidized to TMAO once it passes the liver and into your bloodstream.

Figures 4 & 5: In young, healthy men, Cho et al. (2016) showed quite conclusively that the effects of eggs and meat on TMAO levels is a function of their initial microbial composition (Figure 5). With high TMAO responders being characterized by enriched ratios of Firmicutes to Bacteroidetes, and a reduced microbial diversity, the solution to keep eating eggs and meat may well be as easy as consuming them with plenty of fibrous and pre-biotic foods, which, in contrast to the average low-fiber omnivore diet, will leave your bacterial composition intact and hence the concentration of TMAO producing bacteria in check. In that, it's noteworthy that the effects of fiber may depend on fiber type and baseline diet with initial evidence suggesting ill effects for healthy men and women if increased amounts of resistant starch are consumed in the context of a lower carb + high(er) fat diet (>40% fat) but not as part of a higher car, low(er) fat for two weeks (<23% fat) diet (Bergeron et al 2016).

The test itself, by the way, is actually pretty simple: After an overnight fast (>8 hours) before blood and spot urine samples are collected as baseline, before three tablets of L-carnitine fumarate (2.1g carnitine, total | GNC) are administered and you undergo a time-series blood drawings with concurrent spot urine collections at 24 hours and 48 hours after the oral carnitine challenge.

If you cannot do the test, you may be interested to hear that Wu's 2018 paper in the BMJ's Gut, suggests that the average omnivore is 10-fold(!) more likely to exhibit this problematic pattern than a vegan/(lacto/ovo)vegetarian peer - interestingly, among the non-omnivore subjects, the comparatively small carnitine/choline-precursor exposure from e.g. dairy or eggs did not predict an increased TMAO exposure.

The lack of correlation between (low-ish) carnitine/choline intakes and serum TMAO levels emphasizes that it's probably not the carnitine itself that induces the increased ratio of firmicutes to bacteroidetes and an overall reduction in gut microbiota diversity which is distinctive of high TMAO producers (both observed in healthy young men by Cho et al. 2006).

Rather than that, it seems to be the microbial pattern that arises with the consumption of the classic low-prebiotic high carb+high fat omnivore Western diets (Simpson & Campbell 2015), which is at the heart of the problem.

With a very recent study showing that low-carbohydrate but high resistant-starch diets promote, not reduce the formation of TMAO in fifty-two men and women (Bergeron 2016), if the subjects consume a high(er) fat diet (>40% vs. <23% fat) it should be obvious, though, that future studies will have to quantify the appropriate amount and type of fermentable fiber that's necessary to mitigate the ill effects of both, high and low-carb diets, on the uwanted TMAO-boosting effects of meats, eggs, and other dietary sources of choline and its precursor.

While we are waiting for the corresponding data to emerge, it's reasonable to assume that people who have been following a (non-strict) "paleo-esque" diet, all along, will have consumed more than enough fruits, veggies, and legumes to maintain a non-TMAO promoting microbiome and shouldn't be at risk of any TMAO-mediated cardio-metabolic health impairments due to eggs or (unprocessed) red meats.

You will probably remember several articles like this in the SuppVersity archive, which seem to acquit at least unprocessed, lean red meat of the heart disease accusations. Studies like that put another question mark behind the overtly simplistic concept that high carnitine/choline animal foods should be generally avoided for optimal cardio-metabolic health.

Initial evidence to support this hypothesis and the notion that the amount and type of dietary fiber are the main determinants of (critical) serum TMAO levels comes from a recent study in Obesity, which is the first to demonstrate that the significant reductions in TMAO researchers from Spain (Leal-Witt 2018) observed in obese adolescents in response to a lifestyle intervention correlated with the subjects' increase in fiber intake from fruits, vegetables, and legumes and occurred in the absence of significant reductions in choline(-precursor) intake | Leave a comment!

References:

Bergeron, Nathalie, et al. "Diets high in resistant starch increase plasma levels of trimethylamine-N-oxide, a gut microbiome metabolite associated with CVD risk." British Journal of Nutrition 116.12 (2016): 2020-2029.

Boutagy, Nabil E., et al. "Probiotic supplementation and trimethylamine‐N‐oxide production following a high‐fat diet." Obesity 23.12 (2015): 2357-2363.

Koeth, Robert A., et al. "Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis." Nature medicine 19.5 (2013): 576.

Koeth, Robert A., et al. "γ-Butyrobetaine is a proatherogenic intermediate in gut microbial metabolism of L-carnitine to TMAO." Cell metabolism 20.5 (2014): 799-812.

Koeth, Robert A., et al. "L-Carnitine in omnivorous diets induces an atherogenic gut microbial pathway in humans." Journal of Clinical Investigation (2018): 10-1172.

Leal‐Witt, María J., et al. "Lifestyle Intervention Decreases Urine Trimethylamine N‐Oxide Levels in Prepubertal Children with Obesity." Obesity 26.10 (2018): 1603-1610.

Messenger, Jeffrey, et al. "A review of trimethylaminuria:(fish odor syndrome)." The Journal of clinical and aesthetic dermatology 6.11 (2013): 45.

Mitchell, S. C., A. Q. Zhang, and R. L. Smith. "Chemical and biological liberation of trimethylamine from foods." Journal of Food Composition and Analysis 15.3 (2002): 277-282.

Roberts, Adam B., et al. "Development of a gut microbe–targeted nonlethal therapeutic to inhibit thrombosis potential." Nature medicine 24.9 (2018): 1407.

Shang, Ruiping, Zhiqi Sun, and Hui Li. "Effective dosing of L-carnitine in the secondary prevention of cardiovascular disease: a systematic review and meta-analysis." BMC cardiovascular disorders 14.1 (2014): 88.

Simpson, Hannah Louise, and Barry J. Campbell. "dietary fibre–microbiota interactions." Alimentary pharmacology & therapeutics 42.2 (2015): 158-179.

Tang, WH Wilson, and Stanley L. Hazen. "The contributory role of gut microbiota in cardiovascular disease." The Journal of clinical investigation 124.10 (2014): 4204-4211.

Source: http://suppversity.blogspot.com/2019/01/tmao-eggs-meats-and-your-cardio.html

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