What’s for Dinner?

Modern Elevated Comfort Food with Prairie Ingrediens at Avenue in Regina, Canada

The Avenue Restaurant

Chicken with Apple and Walnut

Ingredients

1 chicken breast with bone and skin
60 g walnut
2 tsp olive oil
2 tbsp honey
1 tbsp white wine vinegar
2 shallot, minced

Chicken Marinade

2 tsp lemon juice
1 tsp grated orange peel
1 tsp grated lemon peel
3 star anise
1 g cinnamon powder
3 g basil leaves

Apple Sauce

2 small apple
1/2 cup white wine vinegar
2 tsp olive oil
4 basil leaves, crushed
10 g sugar
3 tbsp water

Method

  1. Rinse thoroughly the chicken, wipe dry. Add the marinade ingredients and put in the fridge for 8 hours to marinate.
  2. Remove the core of the apple, peel and cut into pieces. Mix with the other sauce ingredients and set aside for 7 hours.
  3. Preheat oven to 180ºC. Bake walnut until golden.
  4. Heat a wok over moderate heat. Add olive oil and stir-fry the shallot until fragrant. Mix in honey and white wine vinegar. Add chicken and fry over low-heat until fully cooked. Remove and cut into pieces.
  5. Place chicken on serving plate. Add walnuts and apple before serving.

Source: Chicken Delicacy

In Pictures: Food of Ta Vie in Hong Kong

Modern Fine Dining French Cuisine with a Japanese Twist

The 2020 2-star Michelin Restaurant

What’s in Your Medicine May Surprise You – a Call for Greater Transparency about Inactive Ingredients

Yelena Ionova wrote . . . . . . . . .

There are many more ingredients in every pill you take than what is listed on the bottle label. These other ingredients, which are combined with the therapeutic one, are often sourced from around the world before landing in your medicine cabinet and are not always benign.

Earlier this year, the U.S. Congress passed the Coronavirus Aid, Relief and Economic Security Act, which requires manufacturers to report real or potential drug shortages to the FDA. Manufacturers are now required to report disruptions in the manufacturing of an active pharmaceutical ingredient – the part of the medicine that produces the intended therapeutic benefit.

But the CARES Act doesn’t include excipients – the “inactive” ingredients that make up the bulk of a final medicine. It also doesn’t include the materials needed to package and distribute medical products, such as vials and other containers, packaging, and labels. While the CARES Act improves the flow of information and may signal potential drug shortages, it is intended to support regulators (like the FDA) in their public health responsibilities. It does not increase transparency to consumers of medicines.

As a trained pharmacist and researcher interested in uncovering risks to medicine quality, I believe patients and clinicians would benefit from having more information about all the ingredients in medicine. But for this to happen additional measures are needed to increase transparency for all components of a medicine, including excipients.

Product labeling for ‘inactive’ ingredients

As the so-called “inactive” ingredients in medicines, excipients are often mistaken as being free from potential harm. But the evidence suggests otherwise. Between 2015 to 2019, health-care professionals, patients, and manufacturers filed nearly 2,500 reports to the FDA about an adverse reaction to an excipient.

While excipients are listed on packaging or package insert for over-the-counter and prescription drugs, this information can be difficult to find. Furthermore, patients often switch from brand name to generic versions, or the pharmacist substitutes one manufacturer for another. While the active pharmaceutical ingredient remains the same, excipients may be different, and even seemingly slight differences can significantly impact patient safety. For example, a patient may be allergic to an excipient in the newly refilled medicine with a different manufacturer.

Excipients are critical materials and serve a broad variety of functions. They serve as fillers, help the body to absorb the medicine, and add flavor or color to drugs. In fact, some are often found in food products, such as lactose, peanut oil, and starch. In the United States, excipients are approved by the FDA as part of the review process for the finished medicine; they are considered by the regulatory agency as generally recognized as safe or “GRAS.” However, a complete picture of their clinical effect remains unclear.

Research from MIT and Brigham and Women’s Hospital has found that 92.8% of oral medicines contain at least one potential allergen, a concern for individuals with known sensitivities and intolerances. My recent research, investigating the safety of excipients in biologics, which are large complex molecules that are mostly administered through an injection, found case reports of injection site reaction, severe allergic reaction, spike in blood sugar level, and acute kidney failure associated with these “inactive” ingredients.

Despite some evidence that excipients are responsible for drug reactions, the amount of each excipient added to each drug is not reported for nearly half of biological medicines. In fact, our study found that 44.4% of the biologics’ labels do not list the concentration of the most commonly occurring excipients. This is true for all prescription medicines, not only biologics.

This lack of information has important implications for patients with diseases prompting dietary restrictions – such as gluten or lactose intolerance, food allergies, or diabetes – because the amount of wheat starch, lactose, peanut oil, and glucose in their medicine can be potentially harmful.

Extending transparency to sources of medicines and their ingredients

Food package labels are required to contain the manufacturer’s name, address, and telephone number alongside the ingredients list. This information allows consumers to contact manufacturers directly to inquire about the source of product ingredients and notify the company of any known or probable reactions to the ingredients. In the event of a recall, information about the source of foods also provides critical information to public health officials, allowing them to alert the public about potentially contaminated food items with specificity.

That is not the case for medical products even though the source of drug ingredients is just as, if not more, important as for food.

The FDA Safety and Innovation Act of 2012 mandated that drug manufacturers submit information about suppliers of excipients including names, addresses, and contact information. However, because this information is considered “proprietary” to the manufacturer, it is not disclosed publicly. While FDASIA was a step toward supply chain transparency, it still leaves the patients and health-care professionals without information that could be critical.

Potential transparency policies to improve patient safety

In a research paper studying the risks associated with excipients, my co-author and I make three main recommendations to improve patient safety.

First, reporting requirements similar to those for food and active pharmaceutical ingredients should extend to excipients. Second, clinicians and patients should have easy access to that information, including amounts and potential adverse effects. The public should also be given information about how to completely and accurately report adverse events related to excipients. Third, regulatory agencies should provide guidance for excipient reporting, facilitating greater transparency about excipient use and supply source.

Source: The Conversation

Fatter Legs Linked to Reduced Risk of High Blood Pressure

Adults with fatter legs — meaning they have a higher percentage of total body fat tissue in their legs — were less likely than those with a lower percentage to have high blood pressure, according to new research to be presented Sept. 10-13, 2020, at the virtual American Heart Association’s Hypertension 2020 Scientific Sessions. The meeting is a premier global exchange for clinical and basic researchers focusing on recent advances in hypertension research.

“Ultimately, what we noted in this study is a continued discussion of ‘it’s not just how much fat you have, but where the fat is located,’” said principal investigator Aayush Visaria, M.P.H., a fourth-year medical student at Rutgers New Jersey Medical School in Newark, New Jersey. “Although we know confidently that fat around your waist is detrimental to health, the same cannot be said for leg fat. If you have fat around your legs, it is more than likely not a bad thing and may even be protecting you from hypertension, according to our findings.”

The investigators examined the rate of three types of high blood pressure in relation to the percentage of fat tissue in the legs of nearly 6,000 adults enrolled in the 2011-2016 National Health & Nutrition Examination Surveys. Average age of the participants was 37, nearly half were female and 24% had high blood pressure, defined as blood pressure >130/80 mm Hg.

Special X-ray scans measured fat tissue in the legs, and these measures were compared to overall body fat tissue. Investigators classified participants as having either a high or low percentage of leg fat, with high fat defined as 34% or more for males, and 39% or more for females.

Participants with higher percentages of leg fat were less likely than those with lower levels of fat to have all types of high blood pressure. The analysis found:

  • Compared to those with lower percentages of leg fat, participants with higher percentages of leg fat were 61% less likely to have the type of high blood pressure where both numbers are elevated.
  • In addition, risk for participants with higher leg fat was 53% lower for diastolic high blood pressure (the second number in a blood pressure reading, measuring pressure between heart beats) and 39% lower for systolic high blood pressure (the first number in a reading, measuring pressure when the heart beats).

After adjusting for various factors, such as age, sex, race and ethnicity, education, smoking, alcohol use, cholesterol levels and waist fat, the risk for high blood pressure was still lower among participants with higher percentages of leg fat, although not as low as before adjusting for these factors.

“If these results are confirmed by larger, more robust studies, and in studies using easily accessible measurement methods like thigh circumference, there is the potential to affect patient care,” Visaria said. “Just as waist circumference is used to estimate abdominal fat, thigh circumference may be a useful tool, although it’s a bit cumbersome and not as widely studied in the U.S. population.”

Several limitations could have affected the study’s results. First, the study could not determine cause and effect, since information on blood pressure and percentage of fat tissue in the legs were measured at the same time. Second, a larger group of participants is needed to yield more information about the effects on high blood pressure of varying degrees of fat tissue in the legs. Finally, all study participants were under the age of 60, so the results may not apply to older adults, who are generally at greater risk for high blood pressure.

Source: American Heart Association


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