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Food Room

a place for talking about food, specially Kurdish food recipes

Re: Food Room

PostAuthor: Anthea » Sat Oct 30, 2021 10:25 am

New diabetes test

Insulin injections could be a thing of the past for some diabetes sufferers

Some Type 1 diabetes patients could be freed from the need to take insulin after a new test is introduced.

Scotland will become the first country in the world to use the simple C-peptide blood test.

The test finds out how much insulin a patient's body is producing.

A pilot by NHS Lothian allowed people who had been taking insulin for years to stop or reduce the treatment. The test will be available from clinics from 1 November.

The test improves the accuracy of diagnosing Type 1 diabetes. It can distinguish whether a patient has Type 1 or Type 2 diabetes.

'Life-transforming'

C-peptide is made in the body at the same time as insulin. By testing levels of C-peptide, doctors can work out how much insulin a diabetes patient is making themselves.

If C-peptide is present in significant amounts, it might indicate that the person does not have Type 1 diabetes at all.

This is what was discovered during a two-year pilot study led by diabetes and endocrinology consultant Prof Mark Strachan. During a pilot study, Prof Mark Strachan was able to stop some patients taking insulin

Prof Strachan said: "C-peptide helps diabetes specialists make a more accurate diagnosis of the cause of diabetes, and that means we can get people on the most appropriate treatment.

"In some instances, C-peptide testing allowed people to stop very long-standing insulin therapy. This can be life-transforming.

"If anyone has any concerns regarding their diabetes or wishes to know more about the new blood test, they should contact their diabetes clinical team who are best placed to provide specific advice and support based on their individual circumstances."

'Significant positive impact'

There are about 315,000 people living with diabetes in Scotland and the new programme will be offered to people who have been diagnosed with Type 1 diabetes for at least three years.

Hospital diabetes centres will perform the tests.

Public Health Minister Maree Todd said that tackling diabetes was a priority for the Scottish government and that she wanted everyone living with diabetes to access safe, effective healthcare, treatment and support.

She said: "Type 1 diabetes is a significant health challenge right across the world.

"I am proud that Scotland will be the first country to introduce this blood test which has the potential to have a significant positive impact on the lives of those people living with diabetes."

https://www.bbc.co.uk/news/uk-scotland-59095948
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Re: Food Room

PostAuthor: Anthea » Sat Oct 30, 2021 10:36 pm

Reduce window condensation

A cleaning fan has shared a unusual trick to help stop windows from getting condensated during the chillier months and all you need are two pretty common household items

If you are waking up each morning only to find your windows dripping with condensation and gradually making the frames damp and mouldy, then we might have found a solution for you - though it's a bit of an unusual one.

A fan of cleaning guru Mrs Hinch recently took to social media to ask for help with this very issue, reports The Express.

Posting in a Facebook group, the woman, named Kymberly, explained that she was having an issue with condensation on all of the windows at the front of her home and described it as being "quite bad".

She wrote: "Window condensation... how do you all manage to wake up every morning without it.

"It’s on every window at the front of my house and it’s quite bad. Buying a dehumidifier for each room isn't an option either."

You'll need some cat litter for this hack.

A number of people responded to the post sharing tips and tricks for Kymberly to help reduce the issue.

But one of the most affordable and interesting responses came from a woman named Hannah, who recommended she try getting some cat litter and a sock - items many people may already have in their houses.

"I know this sounds crazy," she said. "But… pop cat litter into old socks and tie at the top, it’s cheap and lasts for ages.

"We use this in our old campervan too, works a treat."

And Hannah wasn't the only one to suggest this rather unusual hack for stopping windows getting condensation.

The idea was seconded by Linda, who agreed: "Buy a bag of cat litter, fill socks with it and place it on each window sill.

"It will draw in the moisture."

She added that you should change the cat litter every month to keep it working and fresh.

Condensation occurs when the surface temperature of a window is cooler than the air inside the room.

And while this cat litter tip may be a helpful trick, it's important to remember that having good ventilation is one of the most crucial factors when dealing with condensation, so be sure to open windows or use extractor fans when cooking and showering.

Keeping your house heated evenly might also help, as you could find that if one room is much colder than the rest, it can lead to condensation and damp problems in that area.

https://www.mirror.co.uk/news/weird-new ... obal-en-GB

I strongly recommend an Inventor EVA-II PRO Dehumidifier, because if you have damp in your home it will get into everything. It could cause health problems, it could be producing mould behind cupboards/wardrobes, wallpaper could peel off. If you have solid brick walls or wooden doors you could buy a moisture detector (not suitable for soft surfaces such as plasterboard walls or soft furnishings)
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Re: Food Room

PostAuthor: Anthea » Thu Dec 09, 2021 2:25 am

J&J kept quiet on popular diabetes drug

Gathered for an emergency meeting, the Johnson & Johnson drug safety team painted an alarming scene: People taking the company’s new blockbuster diabetes drug were falling gravely ill

The drug, Invokana, had been on the market less than a year, and sales were already rocketing toward $1 billion. Now, in a small conference room on J&J’s campus here, senior executives listened as the safety experts described a potential threat to the drug’s success.

In separate and strikingly similar reports sent to the company and reviewed by Reuters, doctors from across the United States told of 18 patients sickened by a rare and potentially fatal buildup of acid in the blood, known as diabetic ketoacidosis, or DKA, within days or weeks of starting Invokana.

Dr Bruce Leslie, who led the safety team at the March 2014 meeting, recommended that the company alert U.S. and European regulators. “I think we should get out in front of this,” Leslie told executives in the room, as he recounted in an interview with Reuters. “Otherwise, it could come back and bite us in the ass.”

The executives weren’t persuaded. They decided to take no action.

    ‘I think we should get out in front of this. Otherwise, it could come back and bite us in the ass.’
By July 1 that year, J&J had learned of 39 cases of ketoacidosis, according to company documents reviewed by Reuters. Still the company kept mum.

It wasn’t until May 2015 – two years and four million prescriptions after Invokana hit the market – that the public first heard of the drug’s association with ketoacidosis. That’s when the U.S. Food and Drug Administration (FDA), learning of rising numbers of the dangerous episodes through its own reporting system, announced an investigation. It and European regulators subsequently ordered that a warning be added to the label on Invokana and more recent entrants to this new class of drugs, known as SGLT2 inhibitors.

The March 2014 meeting, reported here for the first time, was not an isolated incident. Based on interviews with several former J&J employees and a review of company documents related to Invokana’s development, rollout and safety from 2010 to 2014, Reuters found that in the five years prior to regulators’ intervention, J&J was repeatedly alerted to Invokana’s ketoacidosis risk and took no action.

As early as 2010, during the drug’s clinical trials, the documents show, J&J researchers learned that some patients showed increased levels of ketones, the organic compounds that, in high concentrations in the blood, can lead to ketoacidosis. Later, as injury reports piled up, J&J executives repeatedly overruled safety concerns raised internally, leaving doctors and patients in the dark about the health risk.

In the weeks after the March 2014 meeting, Leslie was warned in a letter from his boss that he could be fired for, among other things, contributing to “an unnecessarily contentious” discussion on Invokana. Just a few weeks after that, the Japanese company that developed the drug and licensed it told J&J that elevated ketones were a potential risk.

“In my opinion, they wanted to make this safety issue go away because it threatened sales,” Leslie said. He left J&J several months after the 2014 meeting. He has not been involved in any litigation with the company.

Dr Angelina Trujillo, a former J&J medical director who worked on Invokana, told Reuters that reports about patients developing ketoacidosis “was information the public needed to know.” All the while, J&J poured tens of millions of dollars into marketing Invokana as a safe, effective treatment for millions of people with type 2 diabetes.

Invokana remains on the market, with reports to the FDA of ketoacidosis and related events linked to the drug now numbering in the thousands. However, sales have declined as the drug’s label has been laden with warnings about ketoacidosis and other possible adverse effects. Still, J&J has tallied more than $6 billion in revenue from Invokana since its launch. And the drug continues to generate cash. In 2020, Invokana and a sister drug pulled in $795 million worldwide for J&J.

J&J defends its actions on Invokana and the drug’s overall safety record.

In a statement to Reuters, the company said it cares “deeply about the safety and well-being of patients treated with our medications. Both pre- and post-approval, (the company) has worked diligently and closely with regulatory authorities to monitor and investigate emerging safety data, to report credible signals to FDA, and to advise healthcare providers and their patients of the risk-benefit profile for Invokana.” J&J declined to make company executives available for an interview.

As Reuters reported in earlier articles in this series, diabetes represents a major public health failure in the United States as the prognosis for the burgeoning number of people with the disease has worsened even while spending on new treatments has soared. Years of inadequate treatment left many of the millions of Americans with diabetes particularly vulnerable to the COVID-19 virus and the isolation of lockdown, resulting in a disproportionate number of deaths and severe illness among people with the chronic disease. Further, drugmakers’ years-long marketing campaigns for an aggressive diabetes treatment target – getting a blood glucose measure known as A1c below 7% – led to an epidemic of potentially lethal incidents of low blood sugar.

Joining the rush

J&J promoted that A1c treatment goal in its marketing for Invokana, its first-ever diabetes drug. The company launched Invokana in March 2013 amid an industry rush to tap the fast-growing number of Americans with type 2 diabetes who could become a perpetual source of sales. At the time, spending on diabetes therapies was growing at a double-digit rate annually, far outpacing the overall market for prescription drugs.

With Invokana, J&J staked its claim in this market, beating its rivals with the first of the SGLT2 inhibitors. In January 2014, J&J Chairman and Chief Executive Officer Alex Gorsky told investors that the 350 million people worldwide with type 2 diabetes presented a huge opportunity for the company. “If we look at the projections going forward and the unmet medical need that exists in that space, it’s important that we continue to do work there,” Gorsky said.

J&J touted Invokana as the cornerstone of a new franchise. The drug formed part of a broader push to pursue faster growth from prescription drugs and rely less on iconic consumer goods such as Band-Aids and Baby Powder.

Initially, the plan appeared to be succeeding. In 2014, its first full year on the market, Invokana took a commanding lead, with sales and prescriptions three times those of Farxiga, an SGLT2 inhibitor that AstraZeneca Plc launched in January that year. Sales of Invokana more than doubled the next year.

J&J announced even bigger plans for the drug. It said it wanted to explore Invokana as a treatment for type 1 diabetes, obesity and even “prediabetes,” referring to people with slightly elevated blood sugar levels. Subsequent studies further boosted the appeal of SGLT2 inhibitors, showing they could reduce the risks of cardiovascular and kidney disease.

But a cascade of safety concerns began to erode sales of Invokana and J&J’s ambitions for the drug. In September 2015, the FDA strengthened its warning on the drug’s label about an increased risk of bone fractures, which could occur as early as 12 weeks after starting on Invokana. Three months later, it added the warning about diabetic ketoacidosis.

In 2017, the FDA slapped a black box warning, its strongest alert, on Invokana for an increased risk of amputations. Based on new studies, regulators later scaled back that warning, but the damage was done. Invokana’s sales began to lose ground to its two main competitors, which never carried the warning on fractures and amputations in the United States. In 2018, the FDA then said all SGLT2 inhibitors were linked to a rare, potentially fatal flesh-eating infection of the genital area known as Fournier’s gangrene.

After ranking first in sales among SGLT2 inhibitors for five consecutive years, Invokana was knocked from its perch in 2018. As safety concerns mounted, many doctors and patients lost confidence in the drug. Sales now trail far behind top-ranked Jardiance, sold by Eli Lilly and Boehringer Ingelheim, and Farxiga.

All SGLT2 inhibitors carry a ketoacidosis warning. A study published last year, however, found that Invokana had a higher rate of ketoacidosis than Jardiance or Farxiga in an analysis of medical records for roughly 200,000 patients in Canada and the United Kingdom. Dr Michael Fralick, one of the study’s co-authors and a clinical scientist at the University of Toronto, said more research is needed to determine definitively whether Invokana carries a greater risk.

Ketoacidosis and related reactions accounted for the largest share – about 4,000, or one in six – of the roughly 23,000 adverse events associated with Invokana reported to the FDA from 2013 to 2020. The agency has received reports of more than 450 deaths linked to Invokana during that period. Adverse events reported to the FDA, including deaths, do not establish that a drug caused the event.

In a statement, J&J said the FDA’s adverse events database “commonly contains duplicate, incomplete, and/or unverified reports from which causality cannot be determined. Relying solely on this database to draw conclusions about the safety and efficacy of Invokana is misleading, and does not accurately summarize this important discussion.”

J&J has agreed to settle many of the roughly 1,200 Invokana lawsuits gathered in multidistrict litigation in New Jersey federal court. The suits alleged fraud, negligence or failure to warn about the risk of diabetic ketoacidosis, amputation and other injuries in connection with the drug.

‘Slowly killing me’

‘They thought it was my last day.’

Among those who sued was Veronica Ryan, a 58-year-old type 2 diabetes patient in Chattanooga, Tennessee. Ryan was prescribed Invokana in September 2015. Over the next few weeks, she told Reuters, she felt increasingly weak and nauseated. Her heart raced, and she couldn’t sit up in bed without feeling out of breath.

She was admitted to the hospital with a diagnosis of ketoacidosis, her medical records and court documents show. Doctors couldn’t determine what caused the reaction, Ryan said, and Invokana was never mentioned. She was discharged the next day. Ryan, a legal assistant at the Social Security Administration at the time and a mother of two, filled another Invokana prescription two weeks later.

A few days after Thanksgiving, her symptoms returned. She struggled to walk. Back at the hospital, doctors remained stumped. At one point, Ryan said, the doctors asked her husband if she purposely harmed herself by drinking antifreeze.

Ryan’s medical records show she had lapsed into ketoacidosis again. She struggled to breathe, and her kidneys had begun to shut down. Her closest friends gathered at the hospital to pray. Her husband called her family to tell them her condition was critical.

“They thought it was my last day,” Ryan said.

During Ryan’s 12-day hospital stay in December 2015, the FDA announced that it would require Invokana and other drugs in its class to add warnings about ketoacidosis.

Ryan returned home in mid-December. But she didn’t feel strong enough to go back to work until two months later. Ryan dropped her lawsuit against J&J in 2019. She said she couldn’t comment on the resolution of her case. J&J declined to comment on Ryan’s case.

“I warn anybody who has diabetes to be cautious of Invokana,” Ryan said. “It was like it was slowly killing me.”

Apple tree bark

Invokana is J&J’s trade name for a compound called canagliflozin. It and other SGLT2 inhibitors lower blood sugar levels – a key goal for diabetes patients – by increasing the amount of glucose the kidneys remove from the bloodstream and flush from the body in urine. Persistently high glucose levels can lead to heart disease, nerve damage and kidney failure, among other serious complications.

In the early 2000s, Mitsubishi Tanabe Pharma Corp invented the initial compound – a synthetic version of a chemical first isolated in the 1830s from the bark of apple trees – and later licensed it to J&J’s Janssen Pharmaceutical subsidiary for development and marketing.

J&J was targeting a huge market. In the United States alone, an estimated 32 million people now have type 2 diabetes, a condition linked to genetics, weight gain and inactivity. Type 2 patients don’t produce enough insulin or don’t respond normally to it. Cells need insulin, a hormone produced by the pancreas, to absorb glucose, a form of sugar, from the bloodstream for energy. Diet and exercise can help manage the disease, but many patients also need medication. SGLT2 inhibitors are not FDA approved for the 1.6 million Americans with type 1 diabetes, an autoimmune disease that requires insulin injections.

Ketoacidosis is a possible complication for anyone with diabetes. It happens when, unable to burn glucose as fuel, the body begins to burn fat instead. That process can lead to a buildup of acids, or ketones, in the bloodstream and escalate to ketoacidosis. SGLT2 inhibitors can create a similar situation by removing glucose through the kidneys, triggering ketone production.

The first red flags about Invokana’s possible link to ketoacidosis popped up while J&J was working with Mitsubishi in early clinical trials.

“There is emerging evidence from Phase 2 studies that some canagliflozin-treated subjects have increases in urinary ketone concentrations and corresponding increases in plasma ketone body concentrations,” David Polidori, a J&J researcher working on the drug, wrote in an October 2010 report reviewed by Reuters.

Polidori urged J&J to research the increased ketone levels. It’s unclear whether the company did. Polidori declined to comment and referred questions to the company.

J&J launched Invokana with few restrictions on its use among type 2 patients. That meant busy doctors wouldn’t have to think twice about a lengthy list of side effects or screen out patients who were a bad match for the medication. J&J’s sales pitch focused on lowering patients’ A1c score, a key barometer for blood glucose levels over the previous three months.

And the company touted another benefit that emerged in clinical trials: Invokana “may help you lose weight,” its commercials said.

Lower A1c scores and possible weight loss added to SGLT2 inhibitors’ appeal as another option beyond metformin. A safe, cheap generic, metformin has for years been the first-line treatment for people with type 2 diabetes. J&J also rolled out a pill that combined Invokana and metformin, dubbed Invokamet.

‘The next magic pill’

Invokana “was going to be the next magic pill. You lose weight, improve A1c,” said Dr Neelima Chu, an endocrinologist at Sharp HealthCare in San Diego. Endocrinologists specialize in diabetes and other hormonal disorders. “Doctors were giving out Invokana like candy.”

Patients came in asking for the drug by name, Chu said. J&J offered co-pay coupons that made it available at no cost to some patients for up to a year. The company paid $104 million from 2013 to 2020 to more than 100,000 U.S. doctors for speaking and consulting fees and in-kind expenses like travel and meals to help promote the drug, a Reuters analysis of federal data found.

Four months after the drug’s launch, on Aug. 6, 2013, the first three reports of ketoacidosis surfaced at an internal J&J meeting, company records show. But the review “did not identify” any potential safety problem, according to the meeting minutes.

Later that year, J&J hired Bruce Leslie, a nephrologist, or kidney specialist, who had worked on a diabetes drug at Bristol Myers Squibb. At J&J, he soon took charge of a safety team for a cardiovascular drug and later for Invokana.

Leslie said he was getting up to speed on Invokana when he noticed about a dozen cases of ketoacidosis in February 2014 and wondered if they merited further investigation. A month later, a more exhaustive search of J&J data turned up a total of 18 cases.

Ketoacidosis is less common with type 2 diabetes than in type 1. Though patients can recover with prompt treatment, once severe symptoms kick in, it can be fatal.

The link between the condition and type 2 patients who weren’t otherwise ill at the time surprised safety department staff. On March 5, 2014, records show, Leslie registered ketoacidosis in the company’s computer system as a “validated safety signal,” meaning an adverse event meriting closer monitoring.

Leslie also asked whether ketoacidosis should be turned up another notch in severity and labeled an “emerging safety issue,” a term used by regulators and drugmakers to describe major risks that trigger swift action and can lead to a public announcement. Under European rules at the time, drug companies had three business days to notify authorities once an emerging safety issue was identified. U.S. reporting requirements were less specific, but notifying one regulator often leads to information being shared more widely by government officials or the company.

She started taking Invokana, and soon, she was fighting for her life

Leslie’s supervisor, Shujian Wu, a safety manager, passed Leslie’s concerns up the chain of command. Later that day, Seong Won Han, a vice president for global medical safety, responded in an email reviewed by Reuters.

“If this is a new consideration for the cana team,” Han wrote, using shorthand for the drug’s chemical name, “then it makes sense to inform” the European Medicines Agency. Leslie and his safety team “should conduct their due diligence and assess the need for label updates.”

Leslie shared the news about ketoacidosis with more executives in a March 7, 2014, email marked “high” in importance. At a meeting focused specifically on ketoacidosis, he asked a J&J regulatory affairs executive, Jacqueline Coelln-Hough, to explain government reporting requirements related to emerging safety issues, internal records show.

The following week, on the morning of Friday, March 14, about 20 people gathered in the conference room at the Raritan campus. At the head of the table sat Dr Norm Rosenthal, vice president of clinical development for cardiovascular and metabolism drugs and co-author of studies describing Invokana’s benefits, and Coelln-Hough, the regulatory affairs executive.

Dr Gary Meininger, a metabolism drugs executive who had spearheaded development of Invokana, also was there. A year earlier, Meininger and Coelln-Hough had led the company’s presentation at an FDA meeting crucial to winning agency approval of the drug.

At the March 2014 meeting, members of the safety team took turns presenting their evidence, describing “multiple spontaneous and study reports of ketoacidosis in patients taking canagliflozin,” slides reviewed by Reuters show.

‘Risks could be mitigated’

The safety team suggested steps to reduce harm, saying “patients vulnerable to ketoacidosis associated with SGLT2 inhibition may be identifiable, and their risks could be mitigated.” For instance, they said, the company could advise doctors to closely monitor ketone levels and warn patients against mixing the medication with low-carbohydrate diets or abruptly stopping their insulin.

Top executives were skeptical. Meininger suggested that most cases might involve type 1 patients, who are not the FDA-approved audience for Invokana, but who can receive “off-label” prescriptions, according to minutes of the meeting. Rosenthal echoed that idea, Leslie said.

Initial injury reports filed by doctors or hospitals often lack details. But only four of the 18 ketoacidosis cases under review indicated the patient had type 1 diabetes. Executives saw no need to escalate the matter internally or notify regulators, concluding that ketoacidosis “is not an emerging safety issue,” according to minutes of the meeting.

Meininger, a type 1 patient himself who left J&J in 2019, declined to comment. He now serves as an industry representative on the FDA’s advisory committee for endocrinology and metabolism drugs. Coelln-Hough and Rosenthal didn’t respond to requests for comment, and the company declined to make them available for an interview.

Minutes after the meeting ended, one attendee praised the presentation. “Excellent meeting!” Dr Mehul Desai, a senior director in clinical development and a former FDA medical officer, wrote to Leslie. “Thanks so much for your time and effort.” Desai didn’t respond to requests for comment.

But three weeks later, medical safety vice president Han summoned Leslie to his Titusville, New Jersey, office. He handed Leslie a three-page warning about his performance and warned him that he was at risk of being fired. The April 3, 2014, letter, reviewed by Reuters, criticized Leslie for failing to modify his ketoacidosis presentation in advance of the meeting to “ensure a more comprehensive analysis of the data” and for not adequately consulting with other company experts who oversaw clinical trials and conducted medical research.

“Your failure to work with the appropriate functional experts in advance of the presentation resulted in an unnecessarily contentious … discussion,” Han wrote.

The reprimand advised Leslie to “use better judgment” when writing emails and documents. “You must take care not to document your opinions or the opinions of others as fact,” Han wrote. The letter also chastised him for swearing at Meininger during a disagreement over the safety of Invokana in patients with chronic kidney disease and failing to properly apologize.

Leslie felt blindsided, he said. He told Reuters that contrary to Han’s accusations, he consulted with multiple colleagues on the ketoacidosis presentation. He said he inadvertently used an expletive when Meininger demanded prior review of any potential meeting topics, which Leslie thought threatened the safety team’s ability to protect patients.

Four months earlier, J&J had honored Leslie with a “Gold Encore Award” for his safety work on another medication – a heart drug that was dropped from development in early clinical trials after Leslie highlighted life-threatening complications.

‘These keep rolling in’

Several colleagues embraced Leslie’s attempt to address the mysterious incidents of ketoacidosis.

Trujillo, a senior medical director working on Invokana at the time, invited Leslie to present his findings to her staff. She talked with doctors outside the company who were “key opinion leaders” for Invokana and worked with company employees who met regularly with doctors, nurses and pharmacists.

She began forwarding ketoacidosis cases to Leslie’s team. “These keep rolling in,” Trujillo wrote in an April 7, 2014, email.

Three days later, J&J put another manager in charge of Invokana’s safety team alongside Leslie. In an April 10 email, Wu said Dr Michael Clark, a safety officer who had worked on immunology, and Leslie “will work in close collaboration with the canagliflozin team to deliver on our strategic objective of ensuring patient safety through proactive and timely assessments of canagliflozin safety data.”

Meantime, a week later, Trujillo told Leslie in an email about a pharmacist in Oxford, Mississippi, who reported that three patients had been hospitalized with diabetic ketoacidosis after starting Invokana. Two days later, on April 18, Trujillo shared another incident from an Alabama pharmacist.

In many instances, medical professionals had trouble identifying the problem because patients’ blood glucose levels were below what’s typically associated with ketoacidosis.

“I thought there was a virus going around,” said Dr Anne Peters, a professor of clinical medicine and director of the Clinical Diabetes Program at the University of Southern California, after encountering several cases of ketoacidosis among type 2 patients. She said the complication had rarely been seen in such patients. Peters later co-wrote a paper warning physicians how Invokana and similar drugs could lead to a type of ketoacidosis without high blood glucose levels.

By late April 2014, the number of ketoacidosis cases reported to J&J had reached 26, internal documents show. But the company remained in a holding pattern.

Company executives “did not opine whether ketoacidosis is a new adverse drug reaction, safety issue, or emerging safety issue for canagliflozin,” according to the minutes from an April 25, 2014, safety meeting.
​​
    J&J drug safety staff reached out to a doctor in Portland, Oregon, who reported a patient on Invokana had suffered ketoacidosis twice in two weeks.
The next month, Mitsubishi Tanabe, J&J’s Invokana partner, shared an update with J&J about ongoing clinical studies. In the presentation, reviewed by Reuters, Mitsubishi flagged the “safety of ketone increase” as one of several “important potential risks.” A spokesperson for Mitsubishi declined to comment, citing the pending litigation.

J&J drug safety staff continued calling doctors and collecting details. In June 2014, they reached out to a doctor in Portland, Oregon, who reported a patient on Invokana had suffered ketoacidosis twice in two weeks.

In a June 17, 2014, phone call, Leslie reiterated to a colleague that the company should alert regulators. At the time, J&J’s internal guidelines for employees recommended being proactive about safety problems even when they are still under investigation, company records show.

Clark, the J&J safety expert assigned to work with Leslie after his reprimand, disagreed. “We cannot go to regulators with our problems. We must wait for them to ask us,” Leslie recalled Clark telling him. Leslie’s account is supported by notes he took at the time. Clark didn’t respond to requests for comment.

J&J had reports on 39 patients with ketoacidosis tied to Invokana by July 1, 2014, just over a year after the drug entered the market, according to an email Leslie sent to Trujillo on that date.

However, two days later, in a regular safety report prepared for regulators, J&J identified 22 cases of ketoacidosis, records reviewed by Reuters show.

At least nine cases from 2013 were excluded because the company chose to disclose incidents that fit the report’s specific time period of Nov. 15, 2013, to May 15, 2014. Cases after that period may have been left out as well. “The data presented in this interval review of DKA were deemed insufficient to confirm that DKA represents a new safety concern,” J&J wrote in the report.

‘This is worrisome’

Less than three months later, FDA officials came to a different conclusion.

Regulators expressed alarm after reviewing 20 cases of ketoacidosis linked to Invokana and Farxiga, launched in January 2014. Thirteen of the 20 patients had taken Invokana. Fourteen of the 20 were identified as type 2, according to the Sept. 24, 2014, internal FDA report obtained by Reuters.

“This is worrisome,” FDA officials Christine Chamberlain and Ali Niak wrote in the report, “because health care providers and patients may not suspect DKA in type 2 diabetics, resulting in significant morbidity, and potential mortality.”

The FDA investigators recommended a label warning, based on the “seriousness of this event and the potential for healthcare professionals to not suspect DKA as a diagnosis” in type 2 patients.

However, the public didn’t learn about the risk until May 2015, when the FDA announced an investigation into Invokana and other SGLT2 inhibitors. The next month, European authorities launched a similar inquiry. Both U.S. and European officials said they hadn’t received any specific warning about ketoacidosis from J&J.

Dr Susan Bersoff-Matcha, an FDA medical officer, said that the agency acted on “routine post-marketing surveillance” and that she wasn’t aware of any communications from J&J. The FDA collects and monitors reports of adverse events related to drugs and medical devices after they are on the market.

The FDA ordered a formal warning and label change about ketoacidosis for all SGLT2 inhibitors in December 2015, nearly two years after J&J discussed it internally.

Leslie, who had left the company in July 2014 after being reprimanded, said the delay was unconscionable. “In my opinion, the company wasn’t sufficiently proactive at notifying regulators, and hundreds of people got sick. That is the tragedy to me,” said Leslie, 74, who has continued to work in the industry on drug safety.

Han, the former executive who reprimanded Leslie, left J&J in 2018 and now serves as a vice president of product safety for a Chinese drugmaker. He declined to comment on specific decisions by the company. He praised J&J’s overall handling of safety issues and told Reuters that the disciplinary action against Leslie was appropriate.

Still, he said he also stood by his March 2014 email that supported notifying regulators based on the information known at the time. “You always go prospectively to health authorities to give them a heads-up rather than wait to hear from them,” Han told Reuters. “It is always better to be up front.”

Out of Control: America’s losing battle against diabetes
By Chad Terhune and Robin Respaut


https://www.reuters.com/investigates/sp ... s-invokana
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Re: Food Room

PostAuthor: Anthea » Thu Dec 09, 2021 2:02 pm

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Horror of Factory Farming

If consumers knew how farmed chickens were raised, they might never eat their meat again

The year 2012 marked a leap forward for animal welfare in the European Union. Farmers were no longer allowed to keep egg-laying hens in barren battery cages smaller than an A4 sheet of paper. Instead, the minimum requirement now is that hens are kept in a cage the size of an A4 sheet of paper, with an extra postcard-sized bit of shared space that allows them to scratch and nest. These are known as enriched cages.

Animal welfare campaigners would like to see them abolished too, saying they barely make a difference to the birds’ ability to express their natural behaviour and live free from stress. Around half of the eggs we eat are still produced in caged systems.

Full debeaking to prevent hens pecking each other is no longer allowed either, but beak clipping is still permitted in egg-laying hens. Their primary sensory organ is typically clipped at a day old, whether caged or free range. Progress here is that farmers must now use infrared lasers to carry out the process rather than the hot blade of previous days. It is cleaner but remains painful to the bird.

Industrial egg-laying hens have been bred to produce more and faster, laying about 320 eggs over a life span of about 72 weeks, compared with a productive life of around four years in more traditional breeds that lay at a fraction of the rate. This high intensity of production tends to affect their bones, which can become brittle and easily broken; the birds become stressed – which is why beak clipping is necessary – and listless.

New battle lines over the welfare of factory-farm animals were being drawn as President Obama arrived in London on Thursday to promote the Transatlantic Trade and Investment Partnership (TTIP) with Europe. The US, long regarded as a laggard on compassion in farming, is pushing for Europe to open up its markets to American poultry, which is produced to different standards. Debate about those standards has ignited in recent weeks in the US, with a series of high-profile media reports on the cruelty inherent in its livestock production methods. The issue was back on the agenda in the UK too this month, after a government move to allow the poultry industry to rewrite welfare codes. A dramatic U-turn in response to the public outcry at the proposal has once again thrown the spotlight on how we treat our farm animals.

The impact of intensive production on disease in broiler chickens reared for meat has also come under scrutiny once more. The government watchdog, the Food Standards Agency, was forced to announce that it is suspending its retailer-by-retailer tests of broilers for the food poisoning bug campylobacter. A change in processing at factories has made it impossible for the FSA to continue its highly effective work naming and shaming supermarkets with the worst bacteria scores.

The lives of broiler chickens are not much easier to contemplate than those of the egg-layers. Much research has been devoted to genetic selection to produce the most economically efficient bird. The RSPCA produced a pamphlet several years ago that for me still provides the best illustration of what this means for the chickens. A series of photographs taken a few days apart showed a normal, traditionally bred egg-laying hen as it grows from chick to maturity. Underneath were parallel pictures of the modern broiler taken at the same intervals. By day nine, the broiler’s legs can barely keep its oversized breast off the ground. By day 11, it is puffed up to double the size of its cousin. It looks like an obese nine-year-old standing on the legs of a five-year-old. By day 35 it looks more like a weightlifter on steroids and dwarfs the egg-laying hen.

In 1957 the average growth period for an eating chicken to reach slaughter weight was 63 days. By the 1990s the number of growth days had been reduced to 38 and the amount of feed required halved.

But genetic selection to produce birds that work like factory units of production creates serious health problems. Their bones, hearts and lungs cannot keep up. A large proportion of broilers suffer from leg problems. You can see the tell-tale hock burns – dark red patches – on the leg around the knee joint in the shops, which are caused by squatting in dirty litter because their legs hurt or are deformed.

Lameness is not just a welfare problem. Birds that sit in foul litter suffer more skin disease. Deaths from heart attacks or swollen hearts that cannot supply enough oxygen to their oversized breast muscles are also common. Because broilers grow unnaturally fast, those which are kept for breeding – and are therefore not slaughtered at six weeks but allowed to reach sexual maturity at about 15-18 weeks – have to be starved, otherwise they would become too big to mate.

The intensively produced broiler is typically kept in an artificially lit shed of around 20,000-30,000 birds. Computers control heating and ventilating systems and the dispensing of feed and water. The water and feed are medicated with drugs to control parasites or with mass doses of antibiotics as necessary. Units are cleaned only at the end of each cycle, so after two to three weeks the floor of the shed is completely covered with faeces and the air tends to be acrid with ammonia.

Keeping animals in such close confinement enables disease to spread rapidly. Although the industry says it has reduced its antibiotic use dramatically since 2012 and now produces nearly half the country’s meat while accounting for only 22% of all antibiotics used on UK farm animals, there is still serious concern that overuse of drugs in animals has contributed to antibiotic resistance. Experts have warned that we are close to the point at which human medicine may find itself without effective life-saving drugs.

In the UK, the stocking density is typically 38kg of bird per square metre – an area less than an A4 sheet of paper for each mature chicken. Free-range and organic production insist on more space, but our typical Sunday roast chicken will have more room in the oven when dead than it had to live in on the farm. To maximise yields, farmers often overstock their sheds at the beginning of the cycle and then thin out some of the birds for slaughter because otherwise the chickens would not have enough space to grow.

Thinning – when workers cull some of the chickens, catching them by the legs – is stressful and the point at which diseases can often enter a shed. The practice contributes significantly to the prevalence of the campylobacter in flocks. Campylobacter is potentially deadly to humans and the most common cause of food-borne illness in humans in the UK, affecting more than 250,000 people a year.

The neck skin of chickens is often the most highly contaminated part of the bird. Processors have now started cutting it off at the factory, which adds to costs but removes some of the bacteria load – good news for consumers, but since it was this part of the bird that the FSA was collecting for tests, the development has also scuppered the programme. The FSA has said it remains committed to tackling campylobacter as a priority.

Animal welfare tends to be marginalised in times of austerity, relegated to a luxury in the face of the need for cheap food. But if the government thought people were too hard up to care any more, they were wrong.

When news broke that the Department for Environment, Food and Rural Affairs (Defra) planned to hand over the job of drawing up guideline codes on farm animal welfare to the industry, beginning with the poultry sector at the end of this month, nearly 150,000 people signed petitions objecting. Defra quickly abandoned the plan, to the dismay of the British Poultry Council. “We were very disappointed with the decision, the intention was to bring the guidance up to modern standards,” said policy director Richard Griffiths. “Defra doesn’t have the resources to review the codes any more.”

A Defra spokesman said: “We have the highest standards of animal welfare in the world, and no changes have been proposed to the legislation. We want to draw more closely on the expertise of the farming industry to ensure our welfare codes reflect the very latest scientific and veterinary developments.

“We believe we can achieve this by retaining the existing statutory codes. The work of the farming industry has been invaluable and we will continue to work with them to ensure our guidance is updated to best help them to comply with our welfare standards.”

The welfare codes have not been updated since 2002. (About a quarter of Defra’s budget was cut under the previous coalition government, and the department will see 15% further cuts over the course of this parliament.)

While the state appears in retreat on standards, big business, responding to the concerns of its customers, is, ironically, leading the pace in some areas.

In the UK and mainland Europe, McDonald’s, Sainsbury’s, the Co-op, M&S and Waitrose have moved to cage-free production for the eggs they sell. Tesco eggs are now also around 70% cage-free, while Waitrose and M&S have applied the same standards to eggs used as ingredients in other products too. In the US, Walmart has made a commitment to phase out caged eggs over the next 10 years. The campaign group Compassion in World Farming has been applying pressure on Asda in the UK to follow its parent company’s example.

Asda said that retaining the prices that enriched cage systems made possible gave consumers the choice on welfare standards. “Our customers tell us they want choice, which is why we offer a wide promotional range of eggs from Smart Price through to free range, all clearly labelled for customers to make an informed decision.”

For Philip Lymbery, chief executive of Compassion in World Farming, the argument that intensive farming is justified because poorer people need cheap meat or eggs is insulting to those on lower incomes. An intensively reared chicken is three times higher in fat, one third lower in protein, and lower in beneficial omega-3 fatty acids now than it was in the 1970s.

“Keeping chickens in cruel conditions produces a poorer product,” he said. “Why do we think it acceptable to expect people on lower incomes to have to feed their children poorer factory-farmed food?”

POULTRY BY NUMBERS

    ■ There are more chickens in the world than there are any other species of bird: more than 50 billion of them are reared annually for food.

    ■ The UK egg market produced 10.02 billion eggs in 2015 and a further 2 billion were imported.

    ■ The British poultry meat industry produces approximately 875 million chickens, 17 million turkeys, 16 million ducks and 250,000 geese a year for consumption.

    ■ Poultry accounts for around half (49%) of all meat eaten in the UK.

    ■ Each day, 33 million eggs are eaten in the UK.

    ■ Around 47% of eggs sold are free range.

    ■ The UK egg industry is estimated to be worth £895m in sales.
Sources: British Egg Industry Council / British Poultry Council/ Compassion in World Farming

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Re: Food Room

PostAuthor: Anthea » Wed Dec 22, 2021 8:34 pm

A fresh prescription for diabetes

SPRINGFIELD, OHIO

Dodging raindrops one afternoon last spring, two community health workers greeted Monica Moss on her small front porch with bags of supplies to help her manage her diabetes. The contents: food.

In addition to the eggs, blueberries, tomato sauce and walnuts, they gave the 50-year-old patient some cookware and kitchen utensils. They reminded her that fresh vegetables would be arriving soon and then dashed off to their next patient in this small Ohio city’s impoverished Southside neighborhood.

It was the first delivery Moss received from the local Rocking Horse Community Health Center. With a small grant of just a few thousand dollars, the clinic launched a program to give low-income type 2 diabetes patients the means to manage their disease with diet, rather than just medications. In addition to regular food deliveries, Rocking Horse handed out $30 grocery gift cards each month and hosted online classes to teach the patients about nutrition, reading food labels and cooking healthy meals.

    Monica Moss stuck to healthier eating habits, and after three months, her diabetes went from uncontrolled to well-managed as her blood sugar levels dropped into a much safer range
Moss was desperate for the help. For years, her diabetes was out of control, her blood sugar levels dangerously high, greatly increasing her risk for heart attack, stroke, amputation and other severe complications of the disease. She knew her diet of readily available, highly processed, high-calorie food only helped elevate her blood sugar, but she lacked the resources to do anything about it. The isolation and disruption of the COVID-19 pandemic only made things worse.

“I’m an emotional eater,” she said. “My anxiety was going through the roof.”

The day after that first delivery, she made a spinach lasagna in her new skillet while she watched her first nutrition class on Zoom. Seven months later, she was still at it. In early December, Moss stood in her kitchen grilling quesadillas packed with zucchini, green peppers, carrots and onions. “I’m not usually a vegetable person,” she said. “But I want to do anything I can to get my diabetes under control.”

In the intervening months, Moss stuck to the healthier eating habits. Her diabetes went from uncontrolled to well-managed as her blood sugar levels dropped into a much safer range.

Against the grain

The Rocking Horse program is part of a nascent movement among a small but growing number of doctors, hospitals and health officials to find a way to tame an epidemic of diabetes in the United States. They are motivated by increasing evidence that the U.S. food system is making people sick by making it easier and cheaper for them to access calorie-dense processed foods than healthier alternatives.

As Reuters detailed earlier this year, diabetes represents a major public health failure in the country. The number of Americans with the disease has exploded in recent decades, and their prognosis has worsened, even though spending on new treatments has soared.

Diet plays a pivotal role in the life and health of people with diabetes, yet it is rarely addressed within the U.S. healthcare system. Offering healthy food goes against the grain of long entrenched norms in the United States, where government programs, insurers and medical providers plow billions of dollars into expensive medications, procedures and medical devices to treat patients.

“We have vastly under-invested in food and nutrition within the healthcare sector,” said Devon Klatell, the Rockefeller Foundation’s managing director of food initiatives. “There is overwhelming evidence that our food system is making lots of us sick” and it has become a “predominant cause for poor health outcomes and high healthcare costs in this country.”

Poor diets, along with sedentary lifestyles, are directly linked to type 2 diabetes, the dominant form of the disease. Consumption of highly processed foods laden with sugars and fats contributes to the high blood sugar levels and obesity that are precursors to type 2. And of the estimated 34 million Americans with diabetes, about 95% are type 2. About 1.6 million Americans have type 1 diabetes, an autoimmune disease of unknown cause that requires lifelong insulin injections.

Unlike type 1 patients, those with type 2 diabetes may be able to manage and even reverse their disease through diet and exercise, greatly reducing the risk of severe complications. With the right diet, some may even be able to live without medication.

But getting people to change their eating habits, often a core part of a person’s identity and culture, isn’t easy. Food insecurity – the lack of access to adequate nutrition – only adds to the challenge. Those who can’t afford more healthful food often turn to relatively cheaper fast food and other calorie-dense alternatives, heavy in refined carbohydrates, added sugars and fats. The problem worsened during the COVID-19 pandemic as millions of Americans lost their jobs and food pantries were overwhelmed.

Initiatives like Rocking Horse’s – few in number, limited in scope and relying on scant funding – seek to make it easier for patients to eat right. These programs take many forms. In Pennsylvania, doctors write diabetes patients prescriptions for healthy food to be filled at food pharmacies that resemble small grocery stores. In Santa Barbara, California, a clinic offers bags of produce weekly to dozens of diabetes patients, many of whom are poor and Latino.

“We can improve people’s health as much by offering vegetables as we can in many cases by offering medication,” said Dr Namino Glantz, an associate director at the Sansum Diabetes Research Institute, which runs the Farming for Life program in Santa Barbara.

Fewer emergencies

In Shamokin, Pennsylvania, Geisinger health system opened its Fresh Food Farmacy as a pilot project in 2016 to help counter an alarming rate of diabetic complications in the rural, economically depressed area it serves. Overall, the system operates nine hospitals and dozens of clinics, and its health plan covers more than 500,000 members.

Geisinger doctors write type 2 patients prescriptions for the Fresh Food Farmacy, offering them enough food to make 10 fresh meals a week. Patients also consult dieticians, pharmacists and community health workers to craft meals and manage their disease. Geisinger has added locations in Scranton and Lewistown, and more than 1,300 people have enrolled in the program.

Distributing food as medicine has made financial sense for Geisinger, which is both a healthcare provider and an insurance company ultimately responsible for its members’ medical costs. Geisinger said it spends about $2,200 per patient a year on the food, staffing and facilities to operate the food pharmacies, about half of what it spent initially, when startup costs were higher. Annual medical costs, in turn, decrease by $9,000 on average per patient. A decline in emergency-room visits and hospital admissions accounted for much of the savings. Participants were less likely to miss doctor’s appointments, too.

Allison Hess, Geisinger’s vice president of health services, said the health system is conducting a randomized clinical trial with the Massachusetts Institute of Technology to better quantify the program’s impact on diabetes patients.

“A lot more research like that is needed,” said Dr Seth A. Berkowitz, a researcher and assistant professor of medicine at the University of North Carolina. Without it, government agencies, insurers, hospital systems and other big funders will not know how best to use food programs to treat diabetes. “We’ll learn a lot over the next several years about which sort of interventions work,” Berkowitz said. He isn’t involved in the MIT study.

Tom Shicowich, 61, credits the Geisinger program with saving his life after years of uncontrolled type 2 diabetes led to a toe amputation and kidney disease.

He said he initially didn’t take his condition seriously after he was diagnosed with type 2 diabetes about 15 years ago. He also didn’t have much money or support, working as a grocery-store clerk without health insurance. He deferred medical care, he said, and his diet was poor. “I couldn’t afford to be healthy,” he said. “I lived out of the freezer section at the grocery store.”

    His doctor wrote him one of the first prescriptions for the Fresh Food Farmacy in 2016, and within months, he lost over 60 pounds. His blood glucose levels fell to a more manageable level
Shicowich now works several days a week as a paid part-timer at the Geisinger store in Shamokin. He also helps lead a six-week course for enrollees on nutrition, meal planning and managing diabetes. Over the phone, he urges fellow diabetes patients to regularly check their blood sugar and describes the week’s meal options, encouraging people to try new recipes, such as a cauliflower pizza crust and a salad with beets, carrots and apples.

Many of them ask him questions they might not feel comfortable asking a doctor or nurse. “I’m in the same shoes as them,” he said. “Someone asked me what broccoli is.”

Earlier this year, Lisa Fiorini, 54, was filling her shopping cart at the Fresh Food Farmacy in Scranton. Diagnosed with type 2 diabetes in her 20s, she said that for years, the only dietary advice she got was to avoid sugar.

Since joining the Geisinger program two years ago, Fiorini said, she better understands the importance of lean meats, whole grains and low-fat dairy products in helping her manage her disease. Her long-term goal is to reduce her reliance on insulin and other diabetes medications.

“Before I wasn’t given the tools for what I needed to do,” Fiorini said.

Basic needs unmet

The Springfield, Ohio, area that the Rocking Horse clinic serves bears the signs of prolonged neglect: boarded-up homes, shuttered storefronts and potholed streets. Fast-food restaurants are plentiful. In early 2020, the local Kroger grocery store closed, leaving the area without a supermarket until Groceryland opened this month.

Rocking Horse launched its three-month pilot food program earlier this year with a grant of about $6,000 from a private Medicaid insurer and donations from a local food bank. Zyrene Marsh, a nurse practitioner at Rocking Horse who organized the Purple Apron program, said she saw how food insecurity and poverty affected her diabetes patients and realized that medication and technology couldn’t address their basic health needs.

“In the algorithm from the American Diabetes Association, they tell you every single detail on what medication to start with and if that doesn’t work, what you do next,” Marsh said. “But they don’t tell you what to do if your patient … can’t find the right food to eat.”

In its current treatment guidelines, the American Diabetes Association says that “food prescription programs are considered promising practices to address food insecurity by integrating community resources into primary care settings.” Earlier this year, the advocacy group backed a community garden project in Alabama to expand access to fruits and vegetables for type 2 diabetes patients and their families.

    Moss particularly appreciated the set of knives and the air fryer she received under the program – luxuries she couldn’t have afforded on her own
The Rocking Horse clinic originally enrolled 20 patients in its three-month program. A few dropped out because they became too sick to participate, either hospitalized or frequently in the emergency room. Others decided they didn’t need the help.

Among the 12 who completed the program was Moss. Marsh had treated her and knew she was perfect for the program.

Moss was diagnosed with type 2 diabetes in 2015. After that, her disease was dangerously uncontrolled much of the time. Her A1c score – a measure of average blood glucose over the previous three months – was above 11%. Medical guidelines consider a score of 9% or above as out of control; the higher the number, the worse it is.

Moss said she was eating the same unhealthy foods over and over and rarely tried anything new. When the pandemic hit, she feared venturing out, limiting herself to quick trips to nearby fast-food restaurants.

Other health problems arose. Worsening pain in her back and hip led to diagnosis of a fungal infection in her spine. She spent five weeks in the hospital before returning home in August 2020. She still has back pain and walks with a cane. In April this year, Moss spent a week in the hospital with COVID-19. While there, her blood sugar levels rose further. “The past year was not nice to me,” she said.

‘I was shocked’

Moss embraced the Rocking Horse program when it started the following month. She gave up meat except for baked chicken. Fast-food sandwiches and soft drinks were out, as were her longtime favorites: fried chicken and mashed potatoes.

In their place were meals featuring French-style green beans, broccoli and cabbage. She and fellow participants shared what they liked and didn’t like from their food deliveries and classes. Creative ideas for salads were a hit. Fish tacos were met with skepticism.

The equipment Moss received was a big help, too. She particularly appreciated the set of knives for cutting vegetables and the air fryer for cooking chicken – luxuries she couldn’t have afforded on her own. She receives food stamps and health coverage through Medicaid, the government insurance program for the poor.

    Initial results of the Rocking Horse program were encouraging. Eight of the 12 participants who completed it had a lower A1c score. Also, fewer of them reported having food insecurity afterward
Moss did especially well. She said that as she maintained her diet, she felt less lethargic and regained some mobility, allowing her to keep up with her 3-year-old grandson. Her A1c score dropped to 9.3% in June, a month into the program, and then below 8% after completing it. “I was shocked it was that low,” Moss said. At her doctor’s appointment Dec. 16, her A1c was still below 8%.

She hopes she can keep her A1c score in a good range long enough for her doctor to take her off her two diabetes medications. She said food stamps allow her to afford the type of food the Rocking Horse program introduced her to. “My diabetes is finally being managed well,” she said. “I really pay attention to the calories and carbs on the boxes now when I go shopping. Even my daughter is eating healthier like me, too. That is a plus.”

Rocking Horse plans to enroll more patients in Springfield and expand to a neighboring county in February. It hopes that as pandemic precautions ease, it can offer in-person learning and cooking demonstrations to improve participation and overall results.

Dr Yamini Teegala, chief medical officer at Rocking Horse, said that the clinic will fund the expansion for now, but that she hopes Medicaid and other insurers will eventually cover such food programs and reimburse health workers for the time they spend on them. She said the current reimbursement model fails to invest in preventive services for diabetes patients, and physicians like herself can only do so much during routine appointments.

“A prescription drug impacts an individual,” Teegala said. “Healthy food and eating habits affect communities for generations to come.”

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Re: Food Room

PostAuthor: Anthea » Mon Dec 27, 2021 11:01 pm

10 Signs of Heart Failure
You Should Never Ignore


There are two major heart attack symptoms that everyone is aware of: sudden and severe chest pain that feels like a clenched fist and pain radiating down the arm. But it’s possible other warning signs may have cropped up on the way to that cardiovascular event, and not been recognized as heart failure

“Unlike an actual heart attack, heart failure can happen gradually, and that’s why people often mistake the symptoms for something else, like indigestion or being out of shape,” says Robert Greenfield, M.D., cardiologist and medical director of non-invasive cardiology and cardiac rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. “But the longer you go without seeing these as signs of heart trouble, the more damage you may have over time.”

Sometimes called congestive heart failure, this condition occurs when there are problems associated with how the heart is pumping blood. That doesn’t mean your heart has suddenly stopped working. In some cases, the heart may not pump with enough force to deliver the blood into your circulatory system, and in other cases, not enough blood is getting into your heart so the amount pumped out is reduced. As symptoms worsen, emergency treatment may be required.

According to the National Heart, Lung, and Blood Institute, about 5.7 million people in the U.S. have heart failure, and it can affect both children and adults. Currently, there’s no cure, but treatments like lifestyle changes and medications can make a huge difference in terms of longevity and quality of life.

Like many conditions, the earlier you catch it, the better your outlook. Here are 10 signs that your ticker may not be operating the way it should.

You can’t seem to catch your breath

Quick anatomy refresher: The heart and lungs are best pals when it comes to functionality, working together to make sure your body has oxygen-rich blood. The right side of the heart takes in blood that’s been depleted of oxygen and pumps it over to the lungs so it can get an oxygen refresh. Since heart failure affects how well this elegant system operates, shortness of breath is a major sign of trouble, says Dr. Greenfield. People will feel “air hunger,” meaning no matter how deeply you inhale, you don’t feel like you’re getting enough oxygen.

Exercise seems much harder than it should be

The feeling of air hunger can happen at rest but it’s especially acute with exertion—even walking across a room can feel like too much effort. If you’re trying to get in an actual workout, increased activity raises your heart rate, which means it’s trying to pump faster and you could find yourself really gasping for air then. “People often think they’re just out of shape when they can’t catch their breath,” Dr. Greenfield says. “They think they need to get to the gym. But what they need is to get to the doctor.”

Lying down flat is a major problem

When you lie down, some of the blood in your legs goes back into your bloodstream, and that creates an increased amount returning to the heart. Usually, the heart can compensate through its pumping mechanism. But with heart failure, it can’t keep up and that can cause more shortness of breath, says Dr. Greenfield. You can often find some relief through propping your head up, relieving the pressure on your lungs, which is why a cardiologist might ask how many pillows you use to avoid feeling winded.

Legs and feet swell up

When your heart isn’t operating properly, it pumps less blood to your kidneys, and as a result, that organ compensates by retaining fluid. Most often, this shows up first in your lower extremities, according to Adriana Quinones-Camacho, M.D., cardiologist at NYU Langone Health in New York. Also called edema, this puffiness in your legs, arms, and feet tends to affect both sides, and causes stretched, shiny skin. It’s also a telltale sign of edema if you press a finger into the swelling and that indentation stays for several seconds.

You’re suddenly gaining weight

The fluid buildup that may be in your legs can “back up” higher into the abdomen and arms. This rapid weight gain is often mistaken for fat accumulation, but it’s actually “water weight” from fluid retention, says Dr. Quinones-Camacho. This can happen suddenly, she adds, like seeing an additional five pounds over a few days, particularly in the belly.

…or having to pee much more often

All that fluid you’re retaining has to go somewhere eventually. That’s when you may find yourself always having to pee, especially multiple times in the middle of the night. Sometimes, people brush this off as a sign of aging, says Dr. Quinones-Camacho, or drinking too much water close to bedtime. Unfortunately, some people try to correct the issue by cutting down on water intake during the day, but this can make fluid retention worse, since the body starts holding on to water in order to prevent dehydration. That cycle gets even uglier with heart failure because dehydration causes strain and increases your heart rate.

You’re tired all the time

The way the body compensates during heart failure is to divert blood to vital organs, especially the brain, and channel it away from less-important areas like your muscles and limbs. That can lead to a feeling of weakness and fatigue, says Dr. Greenfield.

Nausea or lack of appetite have come out of nowhere

Another area of the body the heart considers non-vital when there’s trouble? Your digestive system. With blood being diverted, your stomach and gastrointestinal tract are getting less blood, and that can slow their functions way down, Dr. Greenfield says. You might have a range of effects, including indigestion, lack of appetite, nausea, and constipation.

You’re lightheaded or feel confused often

Even though the heart prioritizes brain function when there’s an issue, heart failure might be caused by a circulation issue, according to Dr. Greenfield. When that happens, not enough blood may be reaching your brain, and that can lead to symptoms like dizziness, mild disorientation, confusion, or even challenges with memory and concentration. In extreme cases, you may experience fainting.

And your hands and feet are always cold

Multiple woolen layers of socks and mittens are doing nothing to help your icy feet and hands? That could be another symptom of a circulation issue, potentially brought on by heart failure. But this is the kind of sign that’s not enough on its own, Dr. Greenfield says, especially because it’s common for people to have colder hands and feet in general. However, if you experience this as well as several others on the list, they could all be connected.

It’s critical to see your doctor. Although there are certain tactics that can help address minor symptoms—prop your head up at night, drink more water, and don’t smoke—this isn’t an issue to try to tackle on your own.

“The sooner you can get your heart checked out, especially if your symptoms are more minor, the more chance you have to improve your heart function and avoid potential heart attack,” says Dr. Greenfield.

Of course, there are great heart-healthy lifestyle habits that will be invaluable for long-term change. But if you’re experiencing any of the symptoms listed here, it’s possible you may need short-term interventions, like medication, to make sure your heart gets back on track.

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Re: Food Room

PostAuthor: Anthea » Sat Jan 01, 2022 5:20 pm

Protein-rich superfood

Insects are a nutrition-dense source of protein embraced by much of the world. Why are some of us so squeamish about eating them?

The idea of biting into a burger made from crushed crickets or mixing mealworms into your fried rice may take a little getting used to. But even if the thought of eating insects turns your stomach now, bugs could – and some researchers say should – form an important part of our diet.

While the West might be unusually squeamish about insects, people have been eating them for thousands of years, and in many parts of the world the practice is commonplace. Around 2,000 insect species are eaten worldwide in countries across Asia, South America and Africa. In Thailand, heaped trays of crisp deep-fried grasshoppers are sold at markets and in Japan wasp larvae – eaten live – are a delicacy.

Yet in Europe, just 10% of people would be willing to replace meat with insects, according to a survey by the European Consumer Organisation. To some, this unwillingness to eat insects is a missed opportunity.

"Insects are a really important missing piece of the food system," says Virginia Emery, chief executive of Beta Hatch, a US start-up that creates livestock feed out of mealworms. "[They] are definitely a superfood. Super nutrient dense, just a whole lot of nutrition in a really small package."

Because of this, farmed insects could help tackle two of the world's biggest problems at once: food insecurity and the climate crisis.

Agriculture is the biggest driver of global biodiversity loss and a major contributor to greenhouse gas emissions. Rearing livestock accounts for 14.5% of global greenhouse gas emissions, according to the United Nations Food and Agriculture Organization (FAO).

"We're in the middle of a biodiversity mass extinction, we're in the middle of a climate crisis, and yet we somehow need to feed a growing population at the same time," says entomologist Sarah Beynon, who develops insect-based food at the Bug Farm in Pembrokeshire, Wales. "We have to make a change and we have to make a big change."

Insect cultivation uses a fraction of the land, energy and water required for traditional farming, and has a significantly lower carbon footprint. Crickets produce up to 80% less methane than cows and 8-12 times less ammonia than pigs, according to a study by researchers at the University of Wageningen in the Netherlands. Methane is a highly potent greenhouse gas which, although shorter-lived in the atmosphere, has a global warming impact 84 times higher than CO2 over a 20-year period. Ammonia is a pungent gas and air pollutant that causes soil acidification, groundwater pollution and ecosystem damage.

Farming insects worldwide would free up vast tracts of land that are currently used to farm animals as well as produce feed for livestock. Replacing half of the meat eaten worldwide with mealworms and crickets has the potential to cut farmland use by a third, freeing up 1,680 million hectares of land, equivalent to around 70 times the area of the UK. This could slash global emissions, according to a study from the University of Edinburgh. In many parts of the world, eating insects is commonplace or even a delicacy.

"Looking at a yield of protein per area, insect farming uses around an eighth of the land compared to beef," says lead author Peter Alexander, a senior researcher in food security at the University of Edinburgh. Despite these findings, Alexander says eating a bean burger is the more sustainable option, as less energy is used to grow the plants than raise insects.

However, Tilly Collins, a senior teaching fellow at the Centre for Environmental Policy at Imperial College in London, argues that insects can fulfil some needs that plant-based foods can't. "Plant-based diets often come with substantial carbon mileage. A lot of plants that people are wanting to eat have disastrous environmental consequences," she says. "Efficiently farming insects is preferable."

Collins says insects could provide an especially important source of nutrition in developing countries. "We have a very good diet in the UK. We rarely lack nutrition. But in Africa that is not the case," she says, noting that many African countries are rapidly scaling up production of insects to feed both humans and animals.

In many ways, insect farming is an example of efficiency turned into a fine art. Firstly there is the speed at which insects grow, reaching maturity in days, rather than the months or years it takes livestock, and they can produce thousands of offspring. Insects are many times more efficient to farm than livestock, requiring less land and time to produce the same quantity of food.

Then there's the fact that insects are 12 to 25 times more efficient at converting their food into protein than animals, says Beynon. Crickets need six times less feed than cattle, four times less than sheep and two times less than pigs, according to the FAO. One of the main reasons behind this efficiency is because insects are cold-blooded and therefore waste less energy maintaining their body heat, says Alexander, though some species need to be reared in a warm environment.

Insect farming also produces much less waste. "With animals a lot of the meat is wasted. With insects we would eat the whole thing," says Alexander.

And as well as producing less waste, insects can also live off food and biomass that would otherwise be thrown away, says Collins, contributing to the circular economy, where resources are recycled and reused. Insects can be fed agricultural waste, such as the stems and stalks from plants that people don't eat, or scraps of food waste. To complete the recycling chain, their excrement can be used as fertiliser for crops.

Despite the strong sustainability credentials and nutritional value associated with eating insects, there is a long way to go before they feature in any big way in Western diets.

"We associate insects with everything but food," says Giovanni Sagari, a food consumer researcher. "I mean with dirt, danger, with something disgusting, with something that makes us feel sick."

But attitudes are starting to change. By 2027, the edible insects market is projected to reach $4.63bn (£3.36bn) and European companies are investing in edible insects following approval from the European Food Safety Authority.

Other foods with an image problem, including lobster, have overcome popular disdain to become fashionable.

"People's perceptions of food do change, but slowly," says Alexander. He points to the example of lobster, which for many years was considered a highly undesirable food and often served in prisons, before it became a luxury good. "It was so plentiful that there was a law forbidding people from feeding lobster to prisoners more than twice a week."

Sagari says the best commercial proposition is to grind insects into powders and include them in processed food, rather than serving them whole as a snack. Chef Andy Holcroft who runs the UK's first edible insect restaurant at the Bug Farm agrees with this assessment.

"Rather than sprinkling whole insects on a salad... I thought if we're going to get it accepted into mainstream food culture, the best way is to incorporate it as a percentage of the overall whole product," says Holcroft.

"At the end of the day, you might have the healthiest, most nutritional, most sustainable product but unless it tastes nice and people are willing to accept it, it may be a lot more difficult to get that across."

The everyday foods that could become luxuries:

Meat is likely to become a luxury food in the next few decades as more people adopt a plant-based diet to reduce their carbon footprint.

Everyday foods such as coffee, meat and spices could become luxury items due to global climate impacts and changing tastes.

Ordering lobster in a restaurant or serving it at a party is considered the height of gastronomic sophistication.

But that hasn't always been the case – lobster has worked its way up from humble beginnings to become a gourmet delicacy.

In the 18th Century, lobster was considered a highly undesirable food that wealthy families steered clear of. The crustacean was so abundant along the east coast of the US that it was used as fertiliser and served in prisons. Kentucky politician John Rowan quipped: "Lobster shells about a house are looked upon as signs of poverty and degradation."

It was the development of railways in the US, which transformed lobster into a luxury. Train operators decided to serve lobster to their wealthy passengers, who were unaware of the seafood's poor reputation. They quickly got a taste for lobster and brought it back to the cities, where it appeared on the menus of expensive restaurants. By the end of the 19th Century, lobster had cemented its status as a luxury food.

What determines which foods are luxury items? Scarcity and price both play an important role.

Like lobsters, oysters have long been associated with fine dining and special occasions, largely due to their high price. But they haven't always enjoyed this status. Oysters used to be eaten by the poorest in society in the 19th Century. "They were so plentiful and cheap they were added to stews and pies to bulk them out," says food historian Polly Russell.

By the early 20th Century, oyster supplies in England started to dwindle due to overfishing and pollution from industrial waste. As they became more scarce, their status rose and they were seen as something special, says Russell.

We see the opposite with products such as sugar and salmon, which used to be difficult to come by and only available to the wealthy. These foods lost their "aura of luxury" over time as people started farming them and, as a result, they became less scarce, says Richard Wilk, emeritus professor of anthropology at Indiana University.
Lobster was once so abundant that it was used as fertiliser and served to prisoners (Ullstein Bild/Getty Images).

Many fruits and vegetables used to be much scarcer than they are today. Certain fruits such as strawberries and raspberries used to only be available in the summer, but now we can buy them all year round. "That changes the perception of luxury," says Peter Alexander, a senior researcher in global agriculture and food security at the University of Edinburgh.

Our obsession with sourcing scarce, luxury foods comes at a high price for the planet. As a particular species of fish or seafood becomes more scarce, the price goes up. The increased value gives people an incentive to fish even harder and catch the remaining ones, which can lead to an extinction spiral, says Wilk.

When and where we eat certain foods also determines how much we value them. "Eating context is really important for creating desire," says Esther Papies, a professor of social psychology at the University of Glasgow, noting that luxury foods are often associated with special occasions, such as eating in restaurants or holidays.

Studies show that being in an environment associated with expensive food can increase the attractiveness of food or drink typically consumed there and people's willingness to pay more. A recent study found that people's desire for sushi increased if they ate it in a sushi restaurant, rather than on the beach.

Positive, warm memories of sharing a meal with others also increases how much people value certain foods, says Papies. Often luxury foods are shared with friends and family, for example at Christmas.

During Covid-19 lockdowns, experiencing food with other people became a luxury in itself, notes Russell. "People were craving to cook together and eat in a social way," she says. "In a world where resources are short and food availability is precarious, the experience of eating food together could become a luxury."

The next luxury foods:

While historically certain foods such as coffee, chocolate and spices were luxury items, today these foods are supermarket staples in many developed countries. However, rising temperatures and unreliable rainfall could turn this around again over the next few decades.

At the height of Mayan civilisation, cacao beans were a valued currency, used to pay workers and traded in exchange for goods in the marketplace. Spanish merchants brought cocoa to Europe, where it became a popular indulgence in royal courts. In 1828, Dutch chemist Coenraad Johannes van Houten invented a process to treat cacao beans with alkaline salts and produce powdered chocolate that could be mixed with water. This process transformed chocolate into an affordable product that could be mass produced.

Coffee was once a little-known delicacy used for religious rituals in Ethiopia, before Western traders took the aromatic drink back to their home countries in the 17th Century and served it in coffee houses, popular among shippers, brokers and artists. After the Dutch secured seedlings, coffee cultivation quickly expanded worldwide and became a popular, everyday drink.

Today, chocolate and coffee are, once again, at risk of becoming expensive and inaccessible.

"Chocolate and coffee could both become scarce, luxury foods again because of climate change," says Monika Zurek, a senior researcher at the Environmental Change Institute at the University of Oxford.

Vast swathes of land in Ghana and Ivory Coast could become unsuitable for cocoa production if global temperature rises reach 2C, according to a 2013 study. "Cocoa used to be for kings and nobody else. Climate change is hitting production areas hard...it could become more luxurious again," says Zurek.

Climate change could wipe out half of the land used to grow coffee worldwide by 2050, according to a 2015 study. Another study suggests that areas suitable for growing coffee in Latin America could decrease by 88% by 2050 due to rising temperatures.

For thousands of years, spices were the epitome of wealth and power. Demand for aromatic spices sparked the first global trade routes, established vast empires and came to define the world economy. Today spices are ubiquitous and often the cheapest items on supermarket shelves. But they could revert to being luxury items, says Zurek.

Spice crops are already bearing the brunt of climate change. High rainfall and humidity provide fertile breeding grounds for pests like aphids and diseases like powdery mildew. In Kashmir, India's largest saffron-growing region, dry conditions have ravaged harvests of the lush purple crop.

Vanilla production on Madagascar has been hit by extreme weather in recent years. A cyclone devastated 30% of the island’s crop in 2017, sending prices to a record high of $600 (£434) per kilogram, briefly making the spice more expensive than silver.

"The danger of everyday products becoming luxury items is disheartening," says Monique Raats, director of the Food, Consumer Behaviour and Health Centre at the University of Surrey. "Many foods could become out of reach for a lot of people."

https://www.bbc.com/future/article/2021 ... s-wont-eat

Years ago I was taking a Behavioural Studies Course, as part of the course we were encouraged to watch Indian films (without ant translations) I used to visit a cinema every week and all the people there were so friendly that they shared their food with me.

One treat often shared with me was a deliciously crunchy chocolate sweet - I later discovered I had been enjoying chocolate covered fried locus
:D
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Re: Food Room

PostAuthor: Anthea » Wed Jan 19, 2022 12:06 am

Forgotten habit of two sleeps

For millennia, people slept in two shifts – once in the evening, and once in the morning. But why? And how did the habit disappear?

It was around 23:00 on 13 April 1699, in a small village in the north of England. Nine-year-old Jane Rowth blinked her eyes open and squinted out into the moody evening shadows. She and her mother had just awoken from a short sleep.

Mrs Rowth got up and went over to the fireside of their modest home, where she began smoking a pipe. Just then, two men appeared by the window. They called out and instructed her to get ready to go with them.

As Jane later explained to a courtroom, her mother had evidently been expecting the visitors. She went with them freely – but first whispered to her daughter to "lye still, and shee would come againe in the morning". Perhaps Mrs Rowth had some nocturnal task to complete. Or maybe she was in trouble, and knew that leaving the house was a risk.

Either way, Jane's mother didn't get to keep her promise – she never returned home. That night, Mrs Rowth was brutally murdered, and her body was discovered in the following days. The crime was never solved.

Nearly 300 years later, in the early 1990s, the historian Roger Ekirch walked through the arched entranceway to the Public Record Office in London – an imposing gothic building that housed the UK's National Archives from 1838 until 2003. There, among the endless rows of ancient vellum papers and manuscripts, he found Jane's testimony. And something about it struck him as odd.

Originally, Ekirch had been researching a book about the history of night-time, and at the time he had been looking through records that spanned the era between the early Middle Ages and the Industrial Revolution. He was dreading writing the chapter on sleep, thinking that it was not only a universal necessity – but a biological constant. He was sceptical that he'd find anything new.

So far, he had found court depositions particularly illuminating. "They're a wonderful source for social historians," says Ekirch, a professor at Virginia Tech, US. "They comment upon activity that's oftentimes unrelated to the crime itself."

But as he read through Jane's criminal deposition, two words seemed to carry an echo of a particularly tantalising detail of life in the 17th Century, which he had never encountered before – "first sleep".

"I can cite the original document almost verbatim," says Ekirch, whose exhilaration at his discovery is palpable even decades later.

In the Middle Ages, communal sleeping was entirely normal – travellers who had just met would share the same bed, as would masters and their servants.

In her testimony, Jane describes how just before the men arrived at their home, she and her mother had arisen from their first sleep of the evening. There was no further explanation – the interrupted sleep was just stated matter-of-factly, as if it were entirely unremarkable. "She referred to it as though it was utterly normal," says Ekirch.

A first sleep implies a second sleep – a night divided into two halves. Was this just a familial quirk, or something more?

An omnipresence

Over the coming months, Ekirch scoured the archives and found many more references to this mysterious phenomenon of double sleeping, or "biphasic sleep" as he later called it.

Some were fairly banal, such as the mention by the weaver Jon Cokburne, who simply dropped it into his testimony incidentally. But others were darker, such as that of Luke Atkinson of the East Riding of Yorkshire. He managed to squeeze in an early morning murder between his sleeps one night – and according to his wife, often used the time to frequent other people's houses for sinister deeds.

When Ekirch expanded his search to include online databases of other written records, it soon became clear the phenomenon was more widespread and normalised than he had ever imagined.

For a start, first sleeps are mentioned in one of the most famous works of medieval literature, Geoffrey Chaucer's The Canterbury Tales (written between 1387 and 1400), which is presented as a storytelling contest between a group of pilgrims.

They're also included in the poet William Baldwin's Beware the Cat (1561) – a satirical book considered by some to be the first ever novel, which centres around a man who learns to understand the language of a group of terrifying supernatural cats, one of whom, Mouse-slayer, is on trial for promiscuity.

But that's just the beginning. Ekirch found casual references to the system of twice-sleeping in every conceivable form, with hundreds in letters, diaries, medical textbooks, philosophical writings, newspaper articles and plays.

The practice even made it into ballads, such as "Old Robin of Portingale. "…And at the wakening of your first sleepe, You shall have a hot drink made, And at the wakening of your next sleepe, Your sorrows will have a slake…"

Biphasic sleep was not unique to England, either – it was widely practised throughout the preindustrial world. In France, the initial sleep was the "premier somme"; in Italy, it was "primo sonno". In fact, Eckirch found evidence of the habit in locations as distant as Africa, South and Southeast Asia, Australia, South America and the Middle East.

Like many Romans, the historian Livy may have been a practitioner of biphasic sleep – he alludes to the method in his magnum opus, The History of Rome.

One colonial account from Rio de Janeiro, Brazil in 1555 described how the Tupinambá people would eat dinner after their first sleep, while another – from 19th Century Muscat, Oman – explained that the local people would retire for their first sleep before 22:00.

And far from being a peculiarity of the Middle Ages, Ekirch began to suspect that the method had been the dominant way of sleeping for millennia – an ancient default that we inherited from our prehistoric ancestors. The first record Ekirch found was from the 8th Century BC, in the 12,109-line Greek epic The Odyssey, while the last hints of its existence dated to the early 20th Century, before it somehow slipped into oblivion.

How did it work? Why did people do it? And how could something that was once so completely normal, have been forgotten so completely?

A spare moment

In the 17th Century, a night of sleep went something like this.

From as early as 21:00 to 23:00, those fortunate enough to afford them would begin flopping onto mattresses stuffed with straw or rags – alternatively it might have contained feathers, if they were wealthy – ready to sleep for a couple of hours. (At the bottom of the social ladder, people would have to make do with nestling down on a scattering of heather or, worse, a bare earth floor – possibly even without a blanket.)

At the time, most people slept communally, and often found themselves snuggled up with a cosy assortment of bedbugs, fleas, lice, family members, friends, servants and – if they were travelling – total strangers.

To minimise any awkwardness, sleep involved a number of strict social conventions, such as avoiding physical contact or too much fidgeting, and there were designated sleeping positions. For example, female children would typically lie at one side of the bed, with the oldest nearest the wall, followed by the mother and father, then male children – again arranged by age – then non-family members.

A couple of hours later, people would begin rousing from this initial slumber. The night-time wakefulness usually lasted from around 23:00 to about 01:00, depending on what time they went to bed. It was not generally caused by noise or other disturbances in the night – and neither was it initiated by any kind of alarm (these were only invented in 1787, by an American man who – somewhat ironically – needed to wake up on time to sell clocks). Instead, the waking happened entirely naturally, just as it does in the morning.

The period of wakefulness that followed was known as "the watch" – and it was a surprisingly useful window in which to get things done. "[The records] describe how people did just about anything and everything after they awakened from their first sleep," says Ekirch.

Communal sleeping meant that people usually had someone to chat with when they woke up for "the watch"

Under the weak glow of the Moon, stars, and oil lamps or "rush lights" – a kind of candle for ordinary households, made from the waxed stems of rushes – people would tend to ordinary tasks, such as adding wood to the fire, taking remedies, or going to urinate (often into the fire itself).

For peasants, waking up meant getting back down to more serious work – whether this involved venturing out to check on farm animals or carrying out household chores, such as patching cloth, combing wool or peeling the rushes to be burned.

One servant Ekirch came across even brewed a batch of beer for her Westmorland employer one night, between midnight and 02:00. Naturally, criminals took the opportunity to skulk around and make trouble – like the murderer in Yorkshire.

But the watch was also a time for religion.

For Christians, there were elaborate prayers to be completed, with specific ones prescribed for this exact parcel of time. One father called it the most "profitable" hour, when – after digesting your dinner and casting off the labours of the world – "no one will look for you except for God”.

Those of a philosophical disposition, meanwhile, might use the watch as a peaceful moment to ruminate on life and ponder new ideas. In the late 18th Century, a London tradesman even invented a special device for remembering all your most searing nightly insights – a "nocturnal remembrancer", which consisted of an enclosed pad of parchment with a horizontal opening that could be used as a writing guide.

The watch was useful for socialising – and sex

As Ekirch explains in his book, At Day's Close: A History of Nighttime, people would often just stay in bed and chat. And during those strange twilight hours, bedfellows could share a level of informality and casual conversation that was hard to achieve during the day.

For husbands and wives who managed to navigate the logistics of sharing a bed with others, it was also a convenient interval for physical intimacy – if they'd had a long day of manual labour, the first sleep took the edge off their exhaustion and the period afterwards was thought to be an excellent time to conceive copious numbers of children.

Once people had been awake for a couple of hours, they'd usually head back to bed. This next step was considered a "morning" sleep and might last until dawn, or later. Just as today, when people finally woke up for good depended on what time they went to bed.

An ancient adaptation

According to Ekirch, there are references to the system of sleeping twice peppered throughout the classical era, suggesting that it was already common then. It's casually dropped into works by such illustrious figures as the Greek biographer Plutarch (from the First Century AD), the Greek traveller Pausanias (from the Second Century AD), the Roman historian Livy and the Roman poet Virgil.

Later, the practise was embraced by Christians, who immediately saw the watch's potential as an opportunity for the recital of psalms and confessions. In the Sixth Century AD, Saint Benedict required that monks rise at midnight for these activities, and the idea eventually spread throughout Europe – gradually filtering through to the masses.

But humans aren't the only animals to discover the benefits of dividing up sleep – it's widespread in the natural world, with many species resting in two or even several separate stretches. This helps them to remain active at the most beneficial times of day, such as when they're most likely to find food while avoiding ending up as a snack themselves.

One example is the ring-tailed lemur. These iconic Madagascan primates, with their spooky red eyes and upright black-and-white tails, have remarkably similar sleeping patterns to preindustrial humans – they're "cathemeral", meaning they're up at night and during the day.

"There are broad swaths of variability among primates, in terms of how they distribute their activity throughout the 24-hour period," says David Samson, director of the sleep and human evolution laboratory at the University of Toronto Mississauga, Canada. And if double-sleeping is natural for some lemurs, he wondered: might it be the way we evolved to sleep too?

Ekirch had long been harbouring the same hunch. But for decades, there was nothing concrete to prove this – or to illuminate why it might have vanished.

Then back 1995, Ekirch was doing some online reading late one night when he found an article in the New York Times about a sleep experiment from a few years before.

The research was conducted by Thomas Wehr, a sleep scientist from the National Institute of Mental Health, and involved 15 men. After an initial week of observing their normal sleeping patterns, they were deprived of artificial illumination at night to shorten their hours of "daylight" – whether naturally or electrically generated – from the usual 16 hours to just 10.

The rest of the time, they were confined to a bedroom with no lights or windows, and fully enveloped in its velvety blackness. They weren't allowed to play music or exercise – and were nudged towards resting and sleeping instead.

Ekirch wonders if today people might remember fewer dreams than our ancestors did, because it's less common to wake up in the middle of the night.

At the start of the experiment, the men all had normal nocturnal habits – they slept in one continuous shift that lasted from the late evening until the morning. Then something incredible happened.

After four weeks of the 10-hour days, their sleeping patterns had been transformed – they no longer slept in one stretch, but in two halves roughly the same length. These were punctuated by a one-to-three-hour period in which they were awake. Measurements of the sleep hormone melatonin showed that their circadian rhythms had adjusted too, so their sleep was altered at a biological level.

Wehr had reinvented biphasic sleep. "It [reading about the experiment] was, apart from my wedding and the birth of my children, probably the most exciting moment in my life," says Ekirch. When he emailed Wehr to explain the extraordinary match between his own historical research, and the scientific study, "I think I can tell you that he was every bit as exhilarated as I was," he says.

For much of human history, those who couldn't afford a bed had to sleep on straw or other dried vegetation.

More recently, Samson's own research has backed up these findings – with an exciting twist.

Back in 2015, together with collaborators from a number of other universities, Samson recruited local volunteers from the remote community of Manadena in northeastern Madagascar for a study. The location is a large village that backs on to a national park – and there is no infrastructure for electricity, so nights are almost as dark as they would have been for millennia.

The participants, who were mostly farmers, were asked to wear an "actimeter" – a sophisticated activity-sensing device that can be used to track sleep cycles – for 10 days, to track their sleep patterns.

"What we found was that [in those without artificial light], there was a period of activity right after midnight until about 01:00-01:30 in the morning," says Samson, "and then it would drop back to sleep and to inactivity until they woke up at 06:00, usually coinciding with the rising of the Sun."

As it turns out, biphasic sleep never vanished entirely – it lives on in pockets of the world today.

A new social pressure

Collectively, this research has also given Ekirch the explanation he had been craving for why much of humanity abandoned the two-sleep system, starting from the early 19th Century. As with other recent shifts in our behaviour, such as a move towards depending on clock-time, the answer was the Industrial Revolution.

In the 17th Century, wealthy elites usually slept in four-poster wooden beds with curtains, to keep the occupant warmer and exclude the prying eyes of visitors.

"Artificial illumination became more prevalent, and more powerful – first there was gas [lighting], which was introduced for the first time ever in London," says Ekirch, "and then, of course, electric lighting toward the end of the century. And in addition to altering people's circadian rhythms. artificial illumination also naturally allowed people to stay up later."

However, though people weren't going to bed at 21:00 anymore, they still had to wake up at the same time in the morning – so their rest was truncated. Ekirch believes that this made their sleep deeper, because it was compressed.

As well as altering the population's circadian rhythms, the artificial lighting lengthened the first sleep, and shortened the second. "And I was able to trace [this], almost decade by decade, over the course of the 19th Century," says Ekirch.

(Intriguingly, Samson's study in Madagascar involved a second part – in which half the participants were given artificial lights for a week, to see if they made any difference. And this case, the researchers found that it had no impact on their segmented sleep patterns. However, the researchers point out that a week may not be long enough for artificial lights to lead to major changes. So the mystery continues…)

Even if artificial lighting was not fully to blame, by the end of the 20th Century, the division between the two sleeps had completely disappeared – the Industrial Revolution hadn't just changed our technology, but our biology, too.

A new anxiety

One major side-effect of much of humanity's shift in sleeping habits has been a change in attitudes. For one thing, we quickly began shaming those who oversleep, and developed a preoccupation with the link between waking up early and being productive.

"But for me, the most gratifying aspect of all this," says Ekert, "relates to those who suffer from middle-of-the-night insomnia." He explains that our sleeping patterns are now so altered, any wakefulness in the middle of the night can lead us to panic.

"I don't mean to make light of that – indeed, I suffer from sleep disorders myself, actually. And I take medication for it… " But when people learn that this may have been entirely normal for millennia, he finds that it lessens their anxiety somewhat.

However, before Ekirch's research spawns a spin off of the Paleo diet, and people start throwing away their lamps – or worse, artificially splitting their sleep in two with alarm clocks – he's keen to stress that the abandonment of the two-sleep system does not mean the quality of our slumber today is worse.

Despite near-constant headlines about the prevalence of sleep problems, Ekirch has previously argued that, in some ways, the 21st Century is a golden age for sleep – a time when most of us no longer have to worry about being murdered in our beds, freezing to death, or flicking off lice, when we can slumber without pain, the threat of fire, or having strangers snuggled up next to us.

In short, single periods of slumber might not be "natural". And yet, neither are fancy ergonomic mattresses or modern hygiene. "More seriously, there's no going back because conditions have changed," says Ekirch.

So, we may be missing out on confidential midnight chats in bed, psychedelic dreams, and night-time philosophical revelations – but at least we won't wake up covered in angry red bites.

https://www.bbc.com/future/article/2022 ... obal-en-GB.
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Re: Food Room

PostAuthor: Anthea » Thu Jan 20, 2022 12:15 pm

10 easy low carb dinners tasty recipes

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Or direct link

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Re: Food Room

PostAuthor: Anthea » Thu Jan 20, 2022 12:40 pm

Re-posted from Covid Thread because this is extremely important and effects out health - Kurds do tend to smoke

7 Things That Destroys
    Your Immune System
Covid, cold and flu are still around, and people everywhere are terrified of being brought down by an illness spread by their families, co-workers, casual contacts in shops etc.

While these bipedal germ factories often spread illness by touching us or public items that we then touch after them, they’re not always to blame for your aches, sniffles or sore throat.

Lifestyle and diet choices often determine whether you get sick more than your germ-y acquaintances.

Keep reading to discover several ways your habits could be putting you at risk
.

1. Smoking

It boggles the mind to think that with all the known health consequences associated with tobacco use, some people still do it. But if you’re smoking this cold and flu season, know that the nicotine exposure is making your immune system a sitting duck for illness. Yes, even if you’re smoking e-cigarettes.

Nicotine increases cortisol levels, while reducing B cell antibody formation and T cells’ response to antigens. A study published in PLOS One last February also found that vapor from e-cigarettes may damage the lungs and make them more susceptible to infection. If you hate wasting PTO days because you’re sick, now’s the time to quit smoking for good.

2. Excessive Drinking

Drinking too much is a one-two punch for your immune system. First, it deprives the body of valuable immune-boosting nutrients. Second, “alcohol, like sugar, consumed in excess can reduce the ability of white cells to kill germs.

High doses of alcohol suppress the ability of the white blood cells to multiply, inhibit the action of killer white cells on cancer cells, and lessen the ability of macrophages to produce tumor necrosis factors,” explains Dr. Sears.

“Damage to the immune system increases in proportion to the quantity of alcohol consumed. Amounts of alcohol that are enough to cause intoxication are also enough to suppress immunity.” Remember that at all your holiday parties.

3. Lack Of Sleep

Sleep is the time when your body recharges and heals. If you’re not getting enough sleep, your body is denied the downtime that’s necessary to stay on top of invading pathogens.

“Previous studies have associated sleep restriction and sleep deprivation with the development of diseases like obesity, diabetes and hypertension. Others have shown that sleep helps sustain the functioning of the immune system, and that chronic sleep loss is a risk factor for immune system impairment,” reports The Sleep Foundation.

4. Stress

Ultimately, a lack of sleep triggers the same response as chronic stress. Although we might not realize it, the physical and emotional demands of our everyday responsibilities can indeed drain our immune system’s ability to fight off bacteria and viruses.

When your body is constantly fighting to repair the damage caused by stress, it has fewer resources available to address invading pathogens.

5. Eating Junk Food

Added sugars lurk in almost every single processed food available to us, even the savory ones. “Eating or drinking 100 grams (8 tbsp.) of sugar, the equivalent of about two cans of soda, can reduce the ability of white blood cells to kill germs by forty percent,” explains Dr. Sears.

The negative effects of sugar on the immune system start less than thirty minutes after consumption and may last for five hours. So you might want to rethink eating that morning donut while sitting next to your sniffling coworker.

6. Exercising Too Much

So far most of the things on this list were obviously negative, but exercise?! That’s right, overdoing it at the gym can be just as bad for your immune system as not exercising enough.

Too much strenuous exercise can be debilitating for the body and make it more vulnerable to infection, according to a December 2012 review in Acta Clinica Croatica.

But a 2014 study suggests that regular, moderate physical activity can make you less susceptible to viruses. So keep exercising during the winter, but be careful not to overdo it.

7. Being A Loner

All this talk of contagious people might make you want to become a hermit but isolating yourself can be detrimental to your immune system.

Researched published in the Journal of Neuroimmunology found that anxiety caused by loneliness actually suppresses the immune system and triggers more oxidative stress, or damage caused by free radicals.

https://www.lispine.com/blog/7-habits-d ... ne-system/
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Re: Food Room

PostAuthor: Anthea » Fri Jan 21, 2022 8:26 pm

How to boost your immune system

    Do not smoke

    Do not drink alcohol

    Eat a diet high in fruits and vegetables

    Exercise regularly

    Maintain a healthy weight

    Get adequate sleep

    Try to minimize stress

    Take steps to avoid infection

      washing your hands properly

      cooking meats thoroughly
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Re: Food Room

PostAuthor: Anthea » Mon Jan 31, 2022 4:11 am

Soup-and-shake diet for diabetics

A soup-and-shake diet will be rolled out to more regions in England after a study found it helped obese people shed more than 2st in three months

More than 2,000 patients with Type 2 diabetes have taken part in the NHS soups and shakes diet programme, each losing 7.2kg (1st 1lb) on average after one month and 13.4kg (2st 1lb) after three months.

NHS England said new data suggests people are able to keep the weight off over time. Three months after stopping soups and shakes, people were able to maintain their weight loss.

Previous clinical data has shown that around half of people who lose weight on a similar diet were able to achieve remission from their Type 2 diabetes after one year.

Off the back of the progress of the study, NHS England said thousands more people will be able to access the diet via their GP in several regions of England.

These are: North East and North Cumbria, West Yorkshire, Lancashire and South Cumbria, Nottingham and Nottinghamshire Black Country, Somerset, Bristol, North Somerset and South Gloucestershire, Mid and South Essex, South West London, Kent and Medway and Sussex.

We know this weight loss will go a long way to help people stay well and avoid preventable illness

Once put on the diet, people are able to get the shakes and soups for free on the NHS and follow the plan for three months.

They receive support from clinicians and coaches and, after three months, people are given a programme that reintroduces healthy, nutritious food.

The support on offer includes virtual one-to-ones, online help and groups.

The diet is open to people aged 18 to 65 diagnosed with Type 2 diabetes in the last six years and with a body mass index (BMI) over 27 (or over 25 in people of Black, Asian or minority ethnic origin).

Professor Jonathan Valabhji, NHS national clinical director for diabetes and obesity, said: “The fantastic results our participants have achieved through this programme are really encouraging, and show that real-world experience is in line with what we have found in trials.

“We know this weight loss will go a long way to help people stay well and avoid preventable illness, and for many will also mean they can put Type 2 diabetes into remission.

“This is also the latest example of the NHS rapidly adopting the latest evidence-based treatments to help people with Type 2 diabetes live well.

“With research showing that obesity causes more severe illness from Covid-19, as well as other serious diseases, there has never been a more important time to lose weight.”

Diabetes is estimated to cost the NHS £10 billion a year, with treatment making up one in 20 prescriptions written by GPs.

I feel so much healthier. I have lost 5st 3.5lbs and my blood sugar levels have nearly halved

Karen Bradbury, aged 50 from Derbyshire, started the programme around a year ago.

She said: “I have battled with my weight on and off over the years and was diagnosed with Type 2 diabetes.

“I was told by my nurse that if my levels hadn’t reduced significantly by my next review, I’d be put on daily medication and I really didn’t want that.

“Since being on the low calorie diet programme, I have felt totally supported by the practitioners and all the tools available. I’ve learnt loads about Type 2 diabetes and how to manage stress and habits with food.

“I feel so much healthier. I have lost 5st 3.5lbs and my blood sugar levels have nearly halved – which meant I didn’t have to start medication.

“My energy levels have increased substantially, and I am now swimming three to four times a week and walking every day.

“I used to wake up to 10 times a night to use the bathroom, I was thirsty all the time, exhausted and generally felt unwell.

“Now I sleep soundly all night and feel less tired during the day. My mental health has also improved. I feel better and I’m living better for me and my children. I’m so grateful that I was offered this opportunity.”

Nadeem Akhtar, 49 from Sheffield, has lost more than 3st since starting the programme and has put his Type 2 diabetes into remission.

He said: “I lost my mum to diabetes, which was devastating. It really showed me just how destructive this disease can be and I really didn’t want to go down the same path.

“Being on the plan is the best thing I’ve ever done for myself and my family. It was hard at first, but my health coach was so understanding and really helped me through the difficult times and keep up healthier habits.”

Chris Askew, chief executive of Diabetes UK, said: “We’re delighted to see the expansion of NHS England’s free weight-loss programme for people living with Type 2 diabetes.

“Since its launch, this low-calorie diet pilot, inspired by Diabetes UK’s ground-breaking DiRECT trial, has helped thousands of people across England access the support they need to lose weight effectively and potentially put their Type 2 diabetes in remission.”

https://www.standard.co.uk/news/uk/nhs- ... 79641.html
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Re: Food Room

PostAuthor: Anthea » Tue Feb 01, 2022 1:27 am

Save on your food shop

The average UK family household spends about £60 a month on food that is thrown away, according to food waste campaign group WRAP – that's more than £700 a year. As the cost of food rises and inflation squeezes the household budget, no one can afford to be throwing money away on wasted food

Not only is there a vital cost to save, food waste generates greenhouse gases such as carbon dioxide and methane and increases plastic waste too. If we stopped throwing away food in the UK, it would have the same impact on our carbon footprint as taking one in five cars off the road.

We've put together a quick guide to using the UK's most wasted foods. Are you prone to ditching sprouted potatoes, black bananas or pouring away milk that's gone off? With hundreds of recipes to help you use everything you buy, those days are over
.
Bread – 20 million slices are wasted every day

Bread can do two things when past its prime: go stale or go mouldy. Stale bread is fine for making loads of delicious recipes, most simply a quick eggy bread or its classy cousin French toast.

Blend stale bread (including crusts) for breadcrumbs. Store a bag in the freezer to dip into for fish cakes, stuffing or potato croquettes. Toast stale bread, drizzled in oil, in the oven to make tasty croûtons to top soup or salads. Treat wraps and pittas in the same way to make excellent healthy crisps and pitta chips.

Puddings using stale bread are classic British favourites: queen of puddings, summer pudding and bread pudding.

The Food Standards Agency (FSA) recommends against eating mouldy bread. Watch our video for ideas on how to store bread to stave off mould and store your bread correctly.

Milk – 3.1 million glasses wasted every day

If milk smells sour, don’t drink it. It is sometimes drinkable after its use-by date, but it can also go off before the date if it isn't stored properly. If it has gone sour, you can use it in baking as the heat of the oven will kill off potential pathogens. One substitue for buttermilk is to artificially "sour" milk by adding vinegar or lemon juice. No need if you have some milk past its best: use it in buttermilk scones, soda bread or cobbler topping.

If you're not getting through the milk in your fridge before it goes off, you can always freeze a bottle of milk. Or check the temperature of your fridge to ensure it's keeping food cold enough.

Potatoes – 4.4 million wasted every day

Potatoes are the most commonly thrown away food in the UK. If they've gone soft, mushy, wrinkly, cracked, green or mouldy, don't eat them. But if they've just started to sprout little shoots, no worries, just chop them off and use them in any of our delicous potato recipes. If you have leftover mash, you can use it in bubble and squeak, fishcakes or potato pancakes.

Root vegetables

Almost 100 thousand tonnes of carrots are thrown away every year in the UK. If you find you're throwing root veggies away, try making a batch of vegetable soup for lunches. A tray of roast root veg eats well cold and goes in sandwiches, salads and grain bowls. Even the trimmings of your vegetables can be frozen in a bag to make free veg stock.

Top tip for reviving carrots: put them in a glass of water in the fridge until they are less shrivelled; they’re not perfect but they’ll be usable again.

Fridge vegetables

If you’ve got a fridge drawer full of tired veg, fear not. Broccoli, peppers and mushrooms are high on the list of wasted veg, but there are lots of ways to use up odds and ends in our fridge-raid recipes, from saag aloo to savoury pancakes. Don't use vegetables if they become slimy or mouldy.

Fresh herbs and spices

Chopped herbs don’t last long and if you forget to use them they will become slimy, yellow and unusable. You can freeze herbs, chillies and ginger and then grate, chop or crumble them into your cooking straight from frozen.

Meat, including 2.2m slices of ham

Chicken, bacon and ham are the most popular meats in the UK and they're also the most wasted. This is where you can really save money on these pricey products by using them to their fullest. If you don't have a definite day you know you'll cook a pack of meat, pop it into the freezer.

Alternatively, cook that packet of meat straight away and use the leftover cooked meat in lunches over the next three days. Slice cooked chicken into thin strips for quick leftover chicken fajitas or soup or curry – just be sure to heat it right through. Cooked bacon or ham can be added to pea soup, a frittata or pasta.

Store cooked meat in sealed boxes in the fridge for 3–4 days, but make sure you refrigerate it immediately and store it away from raw meat to avoid cross-contamination.

86,000 lettuces and 1.2m tomatoes thrown away every day

Bagged salad is particularly easy to ignore until it turns to soup, and not the good kind. If the leaves are a little limp you can soak them in cold water for 5-10 minutes and they should crisp up again.

Buy sturdier lettuce such as Little Gem or Cos that will last longer. Rocket tends to store well, too and is a key part of our any salad leaf pesto.

Tomatoes

Tomatoes can easily go mushy and mouldy. Don’t eat a mouldy tomato, but tomatoes that are a little wrinkly are fine to cook. Roast a tray of cherry tomatoes for a tomato risotto or cherry tomato sauce. If you only have a few, add them to a tin of tomatoes in any dish that calls for it.

Fruit, including 920,000 bananas wasted every day

British families throw away £80 million worth of bananas every year. Surprisingly, more than 1 in 10 customers say they throw away bananas if there's any green on the skin. Store bananas at room temperature rather than in the fridge. If your bananas are a little soft and brown, peel, slice and freeze them to use in smoothie recipes or instant banana ice-cream. If you're not completely over it, there's always banana bread!

Apples – 800,000 apples wasted per day

Never eat a mouldy apple, but a wrinkly apple still makes a delicious apple crumble or apple cake. If you don't need the excuse to eat more puddings, stewed apple is delicious for breakfast with yoghurt or porridge.

Citrus fruits – 720,000 oranges wasted each day

The acid in citrus fruit usually prevents the growth of harmful bacteria, but it won’t stop mould. Throw citrus fruit away if it has started to go mouldy. You can slice and freeze lemons, oranges and limes, then pop straight into drinks.

Frozen grapes, blueberries and strawberries also make great ice-cubes. Juice oranges for smoothies, slice them into salads and just eat more fruit as a snack or dessert.

Storing fruit, other than bananas, in the fridge will help it last longer. If you don't get through fruit fast enough, maybe switch to frozen or tinned fruits that you can eat as you like.

Plan your meals

The number one way to reduce waste is to know what you need (and what you don't) before you buy it. Making a list of recipes you'll cook each day also saves your tired brain one more job at the end of the day.

Avoid impulse purchases

We're as likely as the next person to make a purchase in the "whoopsie aisle". And multi-buys are so tempting when you think of the savings, but it's no saving if you throw it away. Stick to the plan.

Cook it for convenience

Cooked food, ready to eat from the fridge, is more convenient and easy to use than raw. Batch cooking meat and vegetables is like a gift to future you. It doesn't have to be a complicated recipe, just giving food a simple roasting will make it ten times more delicious.

Do you already have it?

Check your fridge and cupboards while making a shopping list - even if it's taking a quick picture of your fridge to take with you. If you already have an ingredient (or the constituent parts), you don't need to buy more.

Food Standards Agency advice

The FSA advises people "not to eat food that is obviously rotten or containing mould due to potential risks from the mould. This advice is especially important for people in vulnerable groups, which includes children, the elderly, pregnant women and those who have a weakened immune system.

It is possible that removing the mould and a significant amount of the surrounding product could remove any unseen toxins that are present, but there is no guarantee that doing so would remove them all."

Link to Article - Video:

https://www.bbc.co.uk/food/articles/food_waste_recipes
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Re: Food Room

PostAuthor: Anthea » Mon Feb 07, 2022 2:45 pm

HEALTHY FOODS That Heal The Body
Starve Cancer & PREVENT DISEASE!

Dr. William Li & Lewis Howes

William W. Li, MD, is a world-renowned physician, scientist, speaker, and author of EAT TO BEAT DISEASE – The New Science of How Your Body Can Heal Itself. He is best known for leading the Angiogenesis Foundation. His groundbreaking work has impacted more than 70 diseases including cancer, diabetes, blindness, heart disease, and obesity.

phpBB [video]


Direct Link:
https://youtu.be/jdsn8t7mCkQ

Eat to Beat Disease: The New Science of How Your Body Can Heal Itself Hardcover – March 19, 2019
by William W Li MD (Author)
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Re: Food Room

PostAuthor: Anthea » Tue Feb 08, 2022 12:05 am

Blood pressure warning over paracetamol

People with high blood pressure who take paracetamol on prescription could be increasing their risk of heart attacks and strokes, a study suggests

Doctors should think about the risks and benefits to patients taking it over many months, the University of Edinburgh researchers say.

Taking the painkiller for headaches and fevers is safe, they stress.

Other experts say research in more people over a longer time frame is needed to confirm the findings.

Paracetamol is widely used around the world as a short-term remedy for aches and pains but also prescribed to manage chronic pain, despite little evidence of its benefit for long-term use.

Half a million people - one out of every 10 - in Scotland were prescribed the painkiller in 2018.

High blood pressure affects one out of every three people in the UK.

The study tracked 110 volunteers, two-thirds of whom were taking drugs for high blood pressure, or hypertension.

In a randomised trial, they were asked to take 1g of paracetamol four times a day for two weeks - a common dose for patients with chronic pain - and then dummy pills, or placebo, for another two weeks.

The trial showed paracetamol increased blood pressure, "one of the most important risk factors for heart attacks and strokes" much more than a placebo, Edinburgh clinical pharmacologist Prof James Dear said.

The researchers advise doctors to start patients with chronic pain on as low a dose of paracetamol as possible and keep a close eye on those with high blood pressure and at risk of heart disease.

Lead investigator Dr Iain MacIntyre, clinical pharmacology consultant, at NHS Lothian, said: "This is not about short-term use of paracetamol for headaches or fever, which is, of course, fine."

'Many unknowns'

Dr Dipender Gill, clinical pharmacology and therapeutics lecturer, at St George's, University of London, said the study, published in the journal Circulation, had found "a small but meaningful increase in blood pressure in a white Scottish population" but "many unknowns remain".

"Firstly, it is not clear whether the observed increase in blood pressure would be sustained with longer term use of paracetamol," he said.

"Secondly, it is not known for certain whether any increase in blood pressure attributable to paracetamol use would lead to an increased risk of cardiovascular disease."

A large US study previously found a link between long-term paracetamol use and increased risk of heart attacks - but it could not prove one caused the other.

And other smaller studies have been unable to confirm the link.

The Edinburgh team said they could not explain how paracetamol would raise blood pressure but their findings should lead to a review of long-term paracetamol prescriptions.

These were previously considered safer than non-steroidal anti-inflammatory painkillers, such as ibuprofen, which are thought to raise blood pressure in some people.

The British Heart Foundation, which funded the study, said doctors and patients should regularly rethink whether any medication, even something "relatively harmless like paracetamol", was needed.

Dr Richard Francis, from the Stroke Association, said further research in people with normal, healthy blood pressure, over a longer timeframe, was needed "to confirm the risks and benefits of using paracetamol more widely".

https://www.bbc.co.uk/news/health-60289790
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