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Wednesday, January 15, 2025

FDA Bans Food Coloring Red Die #3 from Ingested Products

  January 15, 2025

The FDA is revoking the authorization for the use of FD&C Red No. 3 as a matter of law, based on the Delaney Clause of the Federal Food, Drug, and Cosmetic Act (FD&C Act). The FDA is amending its color additive regulations to no longer allow for the use of FD&C Red No. 3 in food and ingested drugs in response to a 2022 color additive petition. The petition requested the agency review whether the Delaney Clause applied and cited, among other data and information, two studies that showed cancer in laboratory male rats exposed to high levels of FD&C Red No. 3 due to a rat-specific hormonal mechanism. The way that FD&C Red No. 3 causes cancer in male rats does not occur in humans. Relevant exposure levels to FD&C Red No. 3 for humans are typically much lower than those that cause the effects shown in male rats. Studies in other animals and in humans did not show these effects; claims that the use of FD&C Red No. 3 in food and ingested drugs puts people at risk are not supported by the available scientific information. 

FD&C Red No. 3 is a synthetic food dye that gives foods and drinks a bright, cherry-red color. The FDA estimates that FD&C Red No. 3 is not as widely used in food and drugs when compared to other certified colors based on information available in third-party food product labeling databases, food manufacturers’ websites and other public information, and the FDA’s certification data. FD&C Red No. 3 has been primarily used in certain food products, such as candy, cakes and cupcakes, cookies, frozen desserts, and frostings and icings, as well as certain ingested drugs. 

Manufacturers who use FD&C Red No. 3 in food and ingested drugs will have until January 15, 2027, or January 18, 2028, respectively, to reformulate their products. Other countries still currently allow for certain uses of FD&C Red No. 3 (called erythrosine in other countries). However, foods imported to the U.S. must comply with U.S. requirements.

Enforcement of the new law came swiftly. Within two months of the passage of the act, the FDA began to identify drugs such as the sulfas that simply could not be labeled for safe use directly by the patient--they would require a prescription from a physician. The ensuing debate by the FDA, industry, and health practitioners over what constituted a prescription and an over-the-counter drug was resolved in the Durham-Humphrey Amendment of 1951. From the 1940s to the 1960s, the abuse of amphetamines and barbiturates required more regulatory effort by the FDA than all other drug problems combined. Furthermore, the new law ushered in a flood of new drug applications, over 6,000 in the first nine years, and 13,000 by 1962.

A new drug law in that year, the Kefauver-Harris Amendments, derived in large part from hearings held by Senator Estes Kefauver. As with the 1938 act, a therapeutic disaster compelled the passage of the new law; in this case, the disaster was narrowly averted. Thalidomide, a sedative that was never approved in this country, produced thousands of grossly deformed newborns outside of the United States. The new law mandated efficacy as well as a safety before a drug could be marketed required the FDA to assess the efficacy of all drugs introduced since 1938, instituted stricter agency control over drug trials (including a requirement that patients involved must give their informed consent), transferred from the Federal Trade Commission to the FDA regulation of prescription drug advertising, established good manufacturing practices by the drug industry, and granted the FDA greater powers to access company production and control records to verify those practices. Three years later Congress gave the FDA enhanced control over amphetamines, barbiturates, hallucinogens, and other drugs of considerable abuse potential in the Drug Abuse Control Amendments of 1965. That function was consolidated with similar responsibilities in 1968 under an organization that gave rise to the Drug Enforcement Administration.

The first food standards to be issued under the 1938 act were for canned tomato products; by the 1960s about A woman holding a cone-shaped instrument about 3 feet long.half of the food supply was subject to a standard. As food technology changed and the number of possible ingredients--including fortifying nutrients--grew, the agency developed recipe standards for foods, and lists of ingredients that could lawfully be included in a product. A food that varied from the recipe would have to be labeled an imitation. 

Following hearings in the early 1950s under Representative James Delaney, a series of laws addressing pesticide residues (1954), food additives (1958), and color additives (1960) gave the FDA much tighter control over the growing list of chemicals entering the food supply, putting the onus on manufacturers to establish their safety. While tolerances could be established for many chemicals, a provision of the 1958 law, the Delaney Clause, banned any carcinogenic additive.

FDA pursued numerous cases of food misbranding in the 1950s and 1960s, most deriving from false nutritional claims and unscientific enrichment, with mixed success in the courts. In 1973, following hearings the agency convened to address the vitamin fortification of foods and the claims made for dietary supplements, the FDA issued regulations for special dietary foods, including vitamins and minerals. The public response to these regulations helped lead Congress in 1976 to prohibit the FDA from controlling the potency of dietary supplements, although the agency maintained the authority to regulate enriched foods.

The Delaney Clause, enacted in 1960 as part of the Color Additives Amendment to the FD&C Act, prohibits FDA authorization of a food additive or color additive if it has been found to induce cancer in humans or animals. This is not the first time the agency has revoked an authorization based on the Delaney Clause. For example, in 2018, the FDA revoked authorization for certain synthetic flavors

Tuesday, January 14, 2025

The Future Of Hospitals -




The COVID pandemic has revealed the fragility of healthcare systems and how clinics and hospitals were completely unprepared for the crisis. However, this is just part of a bigger problem. In many ways, healthcare facilities are still stuck in the 20th century and are long overdue for a top-to-bottom overhaul with digital health leading the way

Future improvements can occur with a radical rethinking of hospital designs. Patient-friendly rooms allow for mobility and some in-room physical therapy. Environmentally appealing rooms with art, sculpture, and botanical displays. Lifelike trees, plants, and flowers are easily obtainable. Think in terms of a small studio apartment.

Placing mildly or moderately ill patients in a bed is in itself disabling and leads to further deterioration, especially in the aged and chronically ill. It has been shown that even a brief hospitalization for two or three days harms the human body.

The use of artificial intelligence to monitor patients could do away with many needless alarms (heart rate, EKG, IV infusion alarms at the bedside. The constant alarm sounds disrupt sleep endlessly. It is a fact that most alarms are only heard by the patient, and ignored at the nurse's station due to burnout and fatigue.

Telehealth allows the bifurcation of patient care for the less ill using patient-centered care at home, while allowing the limited availability of hospital beds for acutely ill patients. This was proven to work well during the pandemic.

Long COVID puzzle pieces are falling into place – the picture is unsettling

Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the workforce.

The intense scientific effort that COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.

Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people’s ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.

Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after the initial infection.

How long COVID affects the body

A new study published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.

In addition, a major new report by the National Academies of Sciences Engineering, and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID disability benefits.


It concludes that COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:

The treatment for long-term COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), focuses on managing symptoms and improving quality of life. Here are some common approaches:

1. Symptom Management
Fatigue: Gradual increase in activity levels, rest periods, and energy conservation techniques.
Respiratory Issues: Breathing exercises, pulmonary rehabilitation.
Cognitive Dysfunction: Cognitive behavioral therapy (CBT), memory exercises, and structured routines.
Pain Management: Physical therapy, and medications for pain relief.
The effectiveness of medications for different types of pain associated with long COVID can vary based on individual responses, the specific type of pain, and underlying health conditions. Here's a breakdown of how some common medications perform for various pain types:

1. Musculoskeletal Pain
NSAIDs (e.g., ibuprofen, naproxen): Generally effective for reducing inflammation and alleviating pain.
Acetaminophen: Useful for mild to moderate pain relief, though may not address inflammation directly.
2. Neuropathic Pain
Antidepressants (e.g., duloxetine, amitriptyline): Often effective, particularly for nerve-related pain, improving both pain and mood.
Anticonvulsants (e.g., gabapentin, pregabalin): Strong evidence supports their use in treating neuropathic pain, often providing significant relief.
3. Generalized Pain/Fibromyalgia-like Symptoms
Antidepressants: Can be beneficial for widespread pain often experienced in long COVID.
NSAIDs and Acetaminophen: These may help, but their effectiveness can vary.
4. Muscle Spasms
Muscle Relaxants (e.g., cyclobenzaprine, baclofen): Effective for relieving muscle tightness and spasms.
5. Severe Pain
Opioids (e.g., oxycodone, hydrocodone): These can provide strong pain relief but are generally reserved for severe pain due to risks of dependence and side effects.
6. Localized Pain
Topical Analgesics (e.g., lidocaine patches, capsaicin cream): Effective for localized pain and carries fewer systemic side effects.
2. Multidisciplinary Care
Involving various specialists such as pulmonologists, cardiologists, neurologists, and rehabilitation professionals to address the range of symptoms.
3. Mental Health Support
Counseling, support groups, and medications for anxiety and depression.
4. Lifestyle Modifications
Healthy diet, regular physical activity as tolerated, hydration, and sleep hygiene.
5. Research and Clinical Trials
Participation in ongoing studies to explore new treatment options.
6. Patient Education
Informing patients about the nature of long COVID and coping strategies.
7. Follow-ups
Regular monitoring of symptoms and adjustments to treatment plans as needed.
Conclusion
As research progresses, treatments may evolve. It's vital for individuals experiencing long COVID to work closely with healthcare providers to tailor a treatment plan suited to their specific needs.

There have been no clinical trials to assess the efficacy of some recommended treatments by "authorities' about long-term covid.
Some recommend nattokinase which has been found to disrupt lingering spike protein (the active ingredient of Moderna's vaccine (Covax)








Long COVID puzzle pieces are falling into place – the picture is unsettling

FTC wins lawsuit against the Manufacturers of Prevagen

Several brands are marketed with ingredients known as Prevagen..





Court ruling curbs unfounded claims for memory supplement. 

Samuel Levine, Director of the Federal Trade Commission’s Bureau of Consumer Protection, issued the following statement on the ruling by the U.S. District Court for the Southern District of New York on the FTC and New York Attorney General’s lawsuit against the makers of the dietary supplement Prevagen. The court ordered the makers to cease making the deceptive claims challenged in the lawsuit:

“Following seven years of hard-fought litigation, including a jury trial, we are pleased that the Court has ordered Quincy Bioscience to cease making claims about Prevagen that mislead Americans concerned about memory loss. Companies should take note and remember that health claims need to be backed up by reliable scientific evidence."

This ruling is another win in the FTC’s efforts to protect older Americans. Last month, we announced new protections against tech support scams, which disproportionately target older consumers. Read more about out comprehensive efforts in our Protecting Older Consumers Report.

Commercials for Prevagen 50 times: story after story from everyday people who describe improvement in memory once they began taking Prevagen. Perhaps you recall older commercials playing off the idea that many people take supplements that boast of gut, joint, and heart health claims. Those commercials memorably asked, "So why wouldn't you take something for the most important part of you… your brain? With an ingredient originally found in jellyfish! Healthier brain, better life!"

Never mind that the ingredient from jellyfish (apoaequorin)  (apoaequorin is a "calcium-binding protein) that was supposed to deliver these benefits has no known role in human memory. Or that many experts believe supplements like this are most likely digested in the stomach and never wind up anywhere near the brain.

Can a supplement actually improve memory? If it doesn't work, why is the manufacturer allowed to suggest it does? And if apoaequorin is so great, why aren't jellyfish smarter (as a colleague of mine wonders)?






Statement on FTC’s Win in Lawsuit Against the Makers of Dietary Supplement Prevagen | Federal Trade Commission

Wednesday, January 8, 2025

8 Common Medications That Can Cause Weight Gain—and How to Manage It

 Almost any medication can cause side effects, but some can create a surprising challenge: weight gain. This isn’t just a cosmetic concern — even small increases in weight can affect your overall health and, in some cases, interfere with recovery from the very condition you’re trying to treat.

Weight gain may not seem critical, especially when treating serious conditions, but even modest gains (5 to 20 pounds) can harm overall health,  one study shows. Obesity increases the risk of diseases like heart disease, stroke, and death, according to the Centers for Disease Control and Prevention

 

8 medications that could cause weight gain

1. Diabetes drugs

 

Maintaining a healthy weight is an important part of any treatment for type 2 diabetes. But here’s the rub: Some of the drugs prescribed to help manage the condition often result in weight gain. 

Diabetes drugs that may cause weight gain include:

  •  Injectable insulin: The hormone works by helping the body’s cells absorb glucose. Insulin causes a spike in weight, however, when the cells absorb too much glucose and the body converts it into fat. Not everyone with type 2 diabetes is on insulin. But insulin isn’t the only type 2 treatment that carries this side effect.
  • Sulfonylureas (such as glyburide, glipizide, and glimepiride) reduce blood sugar levels by 20 percent, but they can also can also cause a weight gain of 4 to 5 pounds on average, according to a study published in Archives of Medical Science. That’s because they stimulate beta cells in the pancreas to release insulin.

What to do: These medications have been used for many years and are often commonplace in diabetes management, but there are newer medications that promote weight loss and should be considered,” Batsis says. A class of type 2 diabetes drugs known as glucagon-like peptide 1 (GLP-1) agonists can cause patients to lose a significant amount of weight 15 to 20 percent of their body weight. Some of the more common names in this class include semaglutide (Ozempic) and tirzepatide (Mounjaro).

2. Antidepressants

If you’ve been on an antidepressant for a while and you’ve put on weight, it could be a sign of improved mood if weight loss was a symptom of your depression.

Significant weight gain, on the other hand, is likely a side effect of the medication itself, especially if you’re taking an SSRI (short for selective serotonin uptake inhibitor), the most commonly prescribed class of antidepressants. These medications increase "the amount of serotonin in your brain, which is a key neurotransmitter involved in depression,” Batsis says. “Serotonin, though, is also implicated in the biological and neurotransmitter processes that regulate weight and appetite. There are many serotonin receptors, but at a high level, they interfere with this process.”  

Antidepressants that may cause weight include:

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)

What to do: With many of the newer second-generation antidepressants, there is often no weight gain; some, such as bupropion (Wellbutrin), may even result in weight loss, Batsis says, echoing the results of research published in 2018 in the journal Diabetes, Metabolic Syndrome and Obesity.

“Bupropion is less likely to cause weight gain and when coupled with naltrexone (Vivitrol) is a potential treatment for obesity,” he says. “Yet in older adults, bupropion, while safe, needs to be counterbalanced with other medical issues as it may have more central nervous system side effects.”

Beta-blockers work by slowing the heart rate, the heart’s workload and its output of blood, all of which lowers blood pressure. That’s why they’re often prescribed as a treatment for hypertension, angina and irregular heartbeat. If you’re on a beta-blocker, no one has to tell you the side effects include fatigue, insomnia and a slow heartbeat. All of those can add up to a less physically active lifestyle, which — no surprise — may result in extra weight.  

“Weight gain often occurs in the first few months after initiating beta-blockers like atenolol or metoprolol,” Batsis says. That’s “thought to be due to changes in metabolism, insulin sensitivity and impact on skeletal muscle metabolism.”

Medications That May Cause Water Retention

Certain medications may cause swelling, some lead to water or sodium retention, while others cause fluid to move from inside cells or blood vessels to surrounding tissues. Below is a list of medications known for causing this side effect and considerations for managing it:

  • Calcium channel blockers: Amlodipine (Norvasc), nifedipine (Adalat, Procardia)
  • Pioglitazone (Actos), used for diabetes management
  • NSAIDs: Ibuprofen (Advil, Midol, Motrin), naproxen (Aleve, Anaprox, Naprosyn) diclofenac (Voltaren), celecoxib (Celebrex)
  • Minoxidil tablets (Loniten, Minodyl)
  • Steroids Hydrocortisone tablets or IV (Cortef, Hydrocortone)

Managing Water Retention:

  • Dose adjustments: Lowering the dose may reduce swelling for some medications.
  • Add-on medications: Other drugs can sometimes offset water retention.
  • Medication substitution: In cases where adjustments aren’t effective, switching to a different medication might be necessary.

4. Oral corticosteroids

Oral corticosteroids are prescribed for everything from severe allergies and rashes to rheumatoid arthritis, but they come with side effects — among them, weight gain. The culprit? Fluid retention.

“Electrolyte imbalances lead to water retention,” Umashanker explains. “Oral steroids also reduce the body’s sensitivity to insulin, leading to insulin resistance.” That, in turn, ramps up production of the hunger hormone ghrelin, which stimulates appetite.

Oral corticosteroids that may cause weight gain include:

  • Prednisone (Deltasone, Predone, Sterapred)
  • Cortisone (Cortone)
  • Hydrocortisone (Cortef, Hydrocortone)
  • Methylprednisolone (Medrol)

What to do: To avoid weight gain, Umashanker recommends a diet rich in low-glycemic foods such as fruits and vegetables, beans, minimally processed grains, low-fat dairy and nuts, all of which are “slowly digested and absorbed, causing a slower and smaller rise in blood sugar levels.”

4. Oral corticosteroids

Oral corticosteroids are prescribed for everything from severe allergies and rashes to rheumatoid arthritis, but they come with side effects — among them, weight gain. The culprit? Fluid retention.

“Electrolyte imbalances lead to water retention,” Umashanker explains. “Oral steroids also reduce the body’s sensitivity to insulin, leading to insulin resistance.” That, in turn, ramps up production of the hunger hormone ghrelin, which stimulates appetite.

Oral corticosteroids that may cause weight gain include:

  • Prednisone (Deltasone, Predone, Sterapred)
  • Cortisone (Cortone)
  • Hydrocortisone (Cortef, Hydrocortone)
  • Methylprednisolone (Medrol)

What to do: To avoid weight gain, Umashanker recommends a diet rich in low-glycemic foods such as fruits and vegetables, beans, minimally processed grains, low-fat dairy and nuts, all of which are “slowly digested and absorbed, causing a slower and smaller rise in blood sugar levels.”

Migraine medications that may cause weight gain include:


Propranolol (Inderal)

Divalproex sodium (Depakote).

According to the American Migraine Foundation, people at a healthy weight who experience migraines have about a 3 percent chance of developing chronic headaches. For people who are overweight and for people with obesity, the chance of chronic migraine is three to five times greater. 


What to do: If you’re on a migraine-preventive medication that’s causing weight gain, talk to your doctor about switching to one that has the potential to suppress appetite, such as topiramate (Topamax), zonisamide (Zonegran) or protriptyline (Vivactil).

6. Antihistamines

It’s easy to assume that over-the-counter meds don’t carry serious side effects because they’re so readily available. But just because something is available without a prescription doesn’t mean it’s risk-free. Research suggests that taking an antihistamine on a regular basis — to treat allergies, for instance — can result in weight gain. 

Antihistamines that may cause weight gain include:

  • Cyproheptadine (Periactin)
  • Cetirizine (Zyrtec)
  • Fexofenadine (Allegra)
  • Desloratadine (Clarinex)

“The major study which demonstrates the relationship between antihistamines and weight gain comes from the journal Obesity,” Umashanker says. “It revealed that men who used antihistamines had an average weight of 214 pounds versus 192 for those not on antihistamines, and women had an average weight of 176 pounds on antihistamines versus 166 pounds for those not on antihistamine.”

Why? Histamine, a chemical in the body known to be a key player in allergic responses, decreases hunger by affecting the appetite control center in the brain, so it makes sense that an antihistamine would have the opposite effect, interfering with the “I’m full” signal coming from the rest of the body, according to the Obesity Medicine Association. 


6. Antihistamines

It’s easy to assume that over-the-counter meds don’t carry serious side effects because they’re so readily available. But just because something is available without a prescription doesn’t mean it’s risk-free. Research suggests that taking an antihistamine on a regular basis — to treat allergies, for instance — can result in weight gain. 

Antihistamines that may cause weight gain include:

  • Cyproheptadine (Periactin)
  • Cetirizine (Zyrtec)
  • Fexofenadine (Allegra)
  • Desloratadine (Clarinex)

“The major study which demonstrates the relationship between antihistamines and weight gain comes from the journal Obesity,” Umashanker says. “It revealed that men who used antihistamines had an average weight of 214 pounds versus 192 for those not on antihistamines, and women had an average weight of 176 pounds on antihistamines versus 166 pounds for those not on antihistamine.”

Why? Histamine, a chemical in the body known to be a key player in allergic responses, decreases hunger by affecting the appetite control center in the brain, so it makes sense that an antihistamine would have the opposite effect, interfering with the “I’m full” signal coming from the rest of the body, according to the Obesity Medicine Association. 

Reference:

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