How Will the COVID Pills Change the Pandemic?

In March, 2020, researchers at Emory University published a paper about a molecule called NHC/EIDD-2801. At the time, there were no treatments available for the coronavirus. But NHC/EIDD-2801, the researchers wrote, possessed “potency against multiple coronaviruses,” and could become “an effective antiviral against SARS-CoV-2.” A few days later, Emory licensed the molecule to Ridgeback Biotherapeutics, a Miami-based biotechnology company which had previously developed a monoclonal antibody for Ebola.

Ridgeback partnered with the pharmaceutical giant Merck to accelerate its development.The Emory researchers named their drug molnupiravir, after Mjölnir—the hammer of Thor. It turns out that this was not hyperbole. Last month, Merck and Ridgeback announced that molnupiravir could reduce by half the chances that a person infected by the coronavirus would need to be hospitalized. The drug was so overwhelmingly effective that an independent committee asked the researchers to stop their Phase III trial early—it would have been unethical to continue giving participants placebos.

None of the nearly four hundred patients who received molnupiravir in the trial went on to die, and the drug had no major side effects. On November 4th, the U.K. became the first country to approve molnupiravir; many observers expect that an emergency-use authorization will come from the U.S. Food and Drug Administration in December.

Oral antivirals like molnupiravir could transform the treatment of COVID-19, and of the pandemic more generally. Currently, treatments aimed at fighting COVID—mainly monoclonal antibodies and antiviral drugs like remdesivir—are given through infusion or injection, usually in clinics or hospitals. By the time people manage to arrange a visit, they are often too sick to receive much benefit. Molnupiravir, however, is a little orange pill.

A person might wake up, feel unwell, get a rapid COVID test, and head to the pharmacy around the corner to pick up a pack. A full course, which needs to start within five days of the appearance of symptoms, consists of forty pills—four capsules taken twice a day, for five days. Merck is now testing whether molnupiravir can prevent not just hospitalization after infection but also infection after exposure.

If that’s the case, then the drug might be taken prophylactically—you could get a prescription when someone in your household tests positive, even if you haven’t.Molnupiravir is—and is likely to remain—effective against all the major coronavirus variants. In fact, at least in the lab, it works against any number of RNA viruses besides SARS-CoV-2, including Ebola, hepatitis C, R.S.V., and norovirus. Instead of targeting the coronavirus’s spike protein, as vaccine-generated antibodies do, molnupiravir attacks the virus’s basic replication machinery. The spike protein mutates over time, but the replication machinery is mostly set in stone, and compromising that would make it hard for the virus to evolve resistance.

Once it’s inside the body, molnupiravir breaks down into a molecule called NHC. As my colleague Matthew Hutson explained, in a piece about antiviral drugs published last year, NHC is similar to cytosine, one of the four “bases” from which viral RNA is constructed; when the coronavirus’s RNA begins to copy itself, it slips into cytosine’s spot, in a kind of “Freaky Friday” swap. The molecule evades the virus’s genetic proofreading mechanisms and wreaks havoc, pairing with other bases, introducing a bevy of errors, and ultimately crashing the system.

A drug that’s so good at messing with viral RNA has led some to ask whether it messes with human DNA, too. (Merck’s trial excluded pregnant and breast-feeding women, and women of childbearing age had to be on contraceptives.) This is a long-standing concern about antiviral drugs that introduce genomic errors. A recent study suggests that molnupiravir, taken at high doses and for extended periods, can, in fact, introduce mutations into DNA. But, as the biochemist Derek Lowe noted, in a blog post for Science, these findings probably don’t apply directly to the real-world use of molnupiravir in COVID patients. The study was conducted in cells, not live animals or humans.

The cells were exposed to the drug for more than a month; even at the highest doses, it caused fewer mutations than were created by a brief exposure to ultraviolet light. Meanwhile, Merck has run a battery of tests—both in the lab and in animal models—and found no evidence that molnupiravir causes problematic mutations at the dose and duration at which it will be prescribed.With winter approaching, America is entering another precarious moment in the pandemic. Coronavirus cases have spiked in many European countries—including some with higher vaccination rates than the U.S.—and some American hospitals are already starting to buckle under the weight of a new wave. Nearly fifty thousand Americans are currently hospitalized with COVID-19.

It seems like molnupiravir is arriving just when we need it.It isn’t the only antiviral COVID pill, either. A day after the U.K. authorized Merck’s drug, Pfizer announced that its antiviral, Paxlovid, was also staggeringly effective at preventing the progression of COVID-19 in high-risk patients. The drug, when taken within three days of the onset of symptoms, reduced the risk of hospitalization by nearly ninety per cent. Only three of the nearly four hundred people who took Paxlovid were hospitalized, and no one died; in the placebo group, there were twenty-seven hospitalizations and seven deaths. Paxlovid is administered along with another antiviral medication called ritonavir, which slows the rate at which the former drug is broken down by the body.

Like Merck, Pfizer is now examining whether Paxlovid can also be used to prevent infections after an exposure. Results are expected early in 2022. (It’s not yet known how much of a difference the drugs will make for vaccinated individuals suffering from breakthrough infections; Merck’s and Pfizer’s trials included only unvaccinated people with risk factors for severe disease, such as obesity, diabetes, or older age. Vaccinated individuals are already much less likely to be hospitalized or die of COVID-19.)

Living in an Age of ExtinctionPaxlovid interrupts the virus’s replication not by messing with its genetic code but by disrupting the way its proteins are constructed. When a virus gets into our cells, its RNA is translated into proteins, which do the virus’s dirty work. But the proteins are first built as long strings called polypeptides; an enzyme called protease then slices them into the fragments from which proteins are assembled.
If you can’t cut the plywood, you can’t build the table, and Paxlovid blunts the blade. Because they employ separate mechanisms to defeat the virus, Paxlovid and molnupiravir could, in theory, be taken together. Some viruses that lead to chronic infections, including H.I.V. and hepatitis C, are treated with drug cocktails to prevent them from evolving resistance against a single line of attack. This approach is less common with respiratory viruses, which don’t generally persist in the body for long periods.
But combination antiviral therapy against the coronavirus could be a subject of study in the coming months, especially among immunocompromised patients, in whom the virus often lingers, allowing it the time and opportunity to generate mutations.

Merck will be producing a lot of molnupiravir. John McGrath, the company’s senior vice-president of manufacturing, told me that Merck began bolstering its manufacturing capacity long before the Phase III trial confirmed how well the drug worked. Normally, a company assesses demand for a product, then brings plants online slowly. For molnupiravir, Merck has already set up seventeen plants in eight countries across three continents. It now has the capacity to produce ten million courses of treatment by the end of this year, and at least another twenty million next year.

It expects molnupiravir to generate five to seven billion dollars in revenue by the end of 2022.How much will all these pills soften the looming winter surge? As has been true throughout the pandemic, the answer depends on many factors beyond their effectiveness. The F.D.A. could authorize molnupiravir within weeks, and Paxlovid soon afterward. But medications only work if they make their way into the body. Timing is critical. The drugs should be taken immediately after symptoms start—ideally, within three to five days. Whether people can benefit from them depends partly on the public-health infrastructure where they live. In Europe, rapid at-home COVID tests are widely available.

Twenty months into the pandemic, this is not the case in much of the U.S., and many Americans also lack ready access to affordable testing labs that can process PCR results quickly.Consider one likely scenario. On Monday, a man feels tired but thinks little of it. On Tuesday, he wakes up with a headache and, in the afternoon, develops a fever. He schedules a COVID test for the following morning. Two days later, he receives an e-mail informing him that he has tested positive. By now, it’s Friday afternoon. He calls his doctor’s office; someone picks up and asks the on-call physician to write a prescription. The man rushes to the pharmacy to get the drug within the five-day symptom-to-pill window.

Envision how the week might have unfolded for someone who’s uninsured, elderly, isolated, homeless, or food insecure, or who doesn’t speak English. Taking full advantage of the new drugs will require vigilance, energy, and access.Antivirals could be especially valuable in places like Africa, where only six per cent of the population is fully vaccinated. As they did with the vaccines, wealthy countries, including the U.S. and the U.K., have already locked in huge contracts for the pills; still, Merck has taken steps to expand access to the developing world.

It recently granted royalty-free licenses to the Medicines Patent Pool, a U.N.-backed nonprofit, which will allow manufacturers to produce generic versions of the drug for more than a hundred low- and middle-income countries. (Pfizer has reached a similar agreement with the Patent Pool; the company also announced that it will forgo royalties for Paxlovid in low-income countries, both during and after the pandemic.) As a result, a full course of molnupiravir could cost as little as twenty dollars in developing countries, compared with around seven hundred in the U.S. “Our goal was to bring this product to high-, middle-, and low-income countries at fundamentally the same time,” Paul Schaper, Merck’s executive director of global pharmaceutical policy, told me.

More than fifty companies around the world have already contacted the Patent Pool to obtain a sublicense to produce the drug, and the Gates Foundation has pledged a hundred and twenty million dollars to support generic-drug makers. Charles Gore, the Patent Pool’s executive director, recently said that, “for large parts of the world that have not got good vaccine coverage, this is really a godsend.” Of course, the same challenges of testing and distribution will apply everywhere.

Last spring, as a doctor caring for COVID patients, I was often dismayed by how little we had to offer. We tried hydroxychloroquine, blood thinners, and various oxygen-delivery devices and ventilator maneuvers; mostly, we watched as patients got better or got worse on their own. In the evenings, as I walked the city’s deserted streets, I often asked myself what kinds of treatment I wished we had. The best thing, I thought, would be a pill that people could take at home, shortly after infection, to halt the cascade of biological processes that sends them to the hospital, the I.C.U., or worse.

We will soon have not one but two such treatments. Outside of the vaccines, the new antiviral drugs are the most important pharmacologic advance of the pandemic. As the coronavirus becomes endemic, we’ll need additional tools to treat the inevitable infections that will continue to strike both vaccinated and unvaccinated people. These drugs will do that, reducing the damage that the coronavirus can inflict and, possibly, cordoning off avenues through which it can spread. Still, insuring that they are meaningfully and equitably used will require strength in the areas in which the U.S. has struggled: early and accessible testing; communication and coördination across health-care providers; fighting misinformation and building trust in rapid scientific advances. Just as vaccines don’t help without shots in arms, antivirals can’t work without pills in people.

 

Source: https://www.newyorker.com/

More on the Coronavirus

Impact Of Covid-19 Pandemic Extends To Tuberculosis And Neglected Tropical Diseases

Last month, the World Health Organization reported that for the first time in 15 years the number of people who have died from tuberculosis has increased. Worldwide, in 2020, more than 1.5 million deaths were attributed to tuberculosis; the first year-on-year increase since 2005. Multiple reasons have been cited, one of which is diversion of resources due to the Covid-19 pandemic.

And, tuberculosis is not the only diseasethat has been impacted, with disproportionately severe health burdens on the world’s poorest populations.

Since the spring of 2020, there has been acute disruption of activities, such as neglected tropical disease (NTD) control and elimination programs. Across the globe, for example, mass drug administration campaigns targeting NTDs have been postponed. NTDs are a heterogeneous group of infections which are common in developing regions of Africa, Asia, and the Americas.

These diseases – caused by a variety of pathogens, including viruses, bacteria, protozoa, and parasites – include, among others, onchocerciasis (river blindness), African trypanosomiasis, leishmaniasis, cholera, Chagas disease, and Dengue fever. Diseases are said to be neglected if they are (often) overlooked and therefore underfunded by drug developers, owing to a lack of commercial prospects.

And, while tuberculosis has also suffered from neglect, it belongs to the so-called “big three infectious diseases” – HIV/AIDS, tuberculosis,and malaria – which have generally received more media attention and research and development funding than the NTDs.

The WHO had developed an NTD roadmap that was meant to officially launch in June 2020. The roadmap included specific disease targets to control and eliminate NTDs by 2030. Not only did the Covid-19 pandemic postpone the launch of the work plan, many NTD activities that had been ongoing were suspended to prevent the risk of additional transmission of the coronavirus.

In fact, interruptions in NTD program work were experienced in at least 44% of low and middle income countries: Specifically, suspension of mass administration campaigns of vaccines and treatments, case detection, and vector control. In addition, there was disruption to supply chains and reduction in the manufacturing of active pharmaceutical ingredients. In brief, there was diversion of financial resources, which effectively meant a reassignment of NTD personnel to the Covid-19 response.

It’s not all been bad news, as a month ago the WHO endorsed the first malaria vaccine (a recombinant, protein-based agent) for use among children in at-risk areas. Malaria is a preventable disease that kills around 500,000 people a year; mostly African children.

It should be noted, however, that most of the clinical development of the malaria vaccine occurred prior to the Covid-19 pandemic. Furthermore, the vaccine – called Mosquirix – has modest efficacy, as it reduces the number of severe malaria cases by approximately 30%.

To save the most lives, African countries must continue to scale up teams of local health workers to identify and respond to cases, and increase access to mosquito nets and antimalarial drugs, such as the fixed dose combination Coartem (artemether/lumefantrine). Yet, it’s precisely in these areas that the pandemic has been the most disruptive.

Opportunity Cost

One of the core tenets of economics is that resource allocation decisions invariably involve trade-offs. As an illustration, there is an opportunity cost of allocating large amounts of resources towards the Covid-19 response. The dollars spent on combating the coronavirus can’t be used to address other diseases.

Unless the overall amount of healthcare resources is expanded, there will be forgone alternatives left unfunded. And, government budgetary constraints often prevent expansion of healthcare budgets from happening. Alternatively, it is difficult to draw down budgets in other sectors, such as defense, in order to fund healthcare sector expansion, whether domestically or for the purposes of international health aid projects.

Budget impact analyses lay bare the individuals or groups who lose out; in other words, those who bear the opportunity cost of spending resources in one area, say, Covid-19, rather than another.

This doesn’t mean that a substantial amount of resources shouldn’t have been spent (or continue to be expended) on developing and paying for coronavirus vaccines or Covid-19 treatments. It does, however, imply that policymakers be made aware of forgone alternative uses of resources, account for the extent to which society can afford to crowd out non-Covid-19 resources, and fill in the budgetary gaps where necessary.

At multiple levels – local, state, federal, and global – when a healthcare system or international program with a relatively fixed budget “overpays” in one area, it must extract resources from elsewhere in the budget, or enlarge the budget.

Early in the pandemic, it was clear that federal regulators in the U.S. were aware of the issue of opportunity cost. In reallocating resources to address the novel coronavirus, the Food and Drug Administration (FDA) stated that new drug and biologics programs were being impacted by “considerable increases in Covid-19 related work.” As a result, the agency said “it’s possible that we will not be able to sustain our current performance level in meeting goal dates.”

Of course, this wasn’t just an issue at the FDA. Other government regulators, as well as global agencies such as WHO, were faced with similar sets of problems.

With government deficits running at record levels, it’ll be extraordinarily difficult to expand budgets to sustain non-Covid-19 related work at the desired levels. But, moving forward, such expansion will have to occur in order to meet the needs of underserved populations worldwide.

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I’m an independent healthcare analyst with over 22 years of experience analyzing healthcare and pharmaceuticals. Specifically, I analyze the value (costs and benefits) of biologics and pharmaceuticals, patient access to prescription drugs, the regulatory framework for drug development and reimbursement, and ethics with respect to the distribution of healthcare resources. I have over 110 publications in peer-reviewed and trade journals, in addition to newspapers and periodicals. I have also presented my work at numerous trade, industry, and academic conferences. From 1999 to 2017 I was a research associate professor at the Tufts Center for the Study of Drug Development. Prior to my Tufts appointment, I was a post-doctoral fellow at the University of Pennsylvania, and I completed my PhD in economics at the University of Amsterdam. Before pursuing my PhD I was a management consultant at Accenture in The Hague, Netherlands. Currently, I work on freelance basis on a variety of research, teaching, and writing projects.

Source: Impact Of Covid-19 Pandemic Extends To Tuberculosis And Neglected Tropical Diseases

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Related Contents:

Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS (August 2018). “Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis”. American Journal of Preventive Medicine. 55 (2): 244–252. doi:10.1016/j.amepre.2018.04.030. PMC 6097523. PMID 29910114.

New Study Shows Folate Foods Help Prevent Alzheimer’s

Many people don’t think about integrating folate or folic acid into their diet until they’re trying to get pregnant, which is an unfortunate oversight. In fact, a new scientific study just further affirmed the fact that folate is an important nutrient and key to maintaining optimal health at all phases of life. Here’s what you should know about the importance of eating folate-rich foods daily.

What is folate, and what is the difference between folate vs. folic acid?

Before we jump into the new research, let’s define what folate is and clear up a common misconception: that folate and folic acid are the same thing. Folate is a B-vitamin (vitamin B9 to be exact) that is naturally found in food. It’s needed to make DNA and other genetic material and is key for helping cells divide.

It also helps a baby’s brain, skull, and spinal cord develop properly, which is why folate is so closely associated with the conception and pregnancy periods. On the other hand, folic acid is the synthetic version found in supplements and fortified foods. It’s important to note that folate is not made by the body, which makes it an essential nutrient that we must get from outside sources, meaning foods rich in folate

Whether you’re consuming folate or folic acid, in order to reap these benefits, the nutrient will need to be converted into an active form. This process is far more likely to happen when you are getting the vitamin naturally from folate foods versus folic acid supplements. “This is because folate is converted into its active form in the digestive system before entering the bloodstream.

With folic acid, however, not all of it is converted in the digestive system,” explains Lyssie Lakatos, RDN, CDN, CFT and Tammy Lakatos, RDN, CDN, CFT, The Nutrition Twins and founders of 21-Day Body Reboot. “Instead, some needs to be converted in the liver and in other tissues, which is not an efficient process. Unmetabolized folic acid can sit in the bloodstream for a long time and it can’t be utilized, which has been associated with a number of health problems.”

The new research findings on folate deficiency

Now, there is one more key reason to zone in on folate. A new study published in Frontiers in Neuroscience—a systematic review and meta-analysis of the association between folate and Alzheimer’s Disease—found that there is evidence to show that the vitamin plays an important role in the development of Alzheimer’s Disease. This is critical because Alzheimer’s is, today, the most common type of neurodegenerative disease leading to dementia in the elderly.

Around 60 publications were included in the review, each of which had a sample size ranging from 24 to 965, to comprehensively evaluate the associations between Alzheimer’s and folate levels. The results showed that the folate level of Alzheimer’s patients was lower compared with that of the healthy controls. Therefore, researchers concluded that there’s plausible reason to think that a deficiency of folate increases the risk for Alzheimer’s and, arguably more importantly, sufficient daily intake of folate could reduce the risk of Alzheimer’s.

“From the information in this study and considering the other known benefits of folate for our body and brain, it is encouraged to have sufficient daily intake of folate to reduce risk of Alzheimer’s,” says Lauren Hubert, MS, RD.

Amy Cameron O’Rourke, MPH, CMC, an advocate for senior care in the U.S. and the author of The Fragile Years echoes this. “I have been a long time believer in a deficient diet being a risk factor for many medical diagnoses and Alzheimer’s is no exception. Folate aids in the growth of healthy cells, so it isn’t difficult to make the leap to see proper folate as a protective factor for Alzheimer’s.” O’Rourke goes on to say that exercise, along with being socially engaged and following an anti-inflammatory diet (or a diet with less processed food), are some other effective ways to prevent Alzheimer’s.

The recommended daily amount of folate for adults is 400 micrograms (mcg). For those who are pregnant, it is about 600 -1000 mcg. “If a person is eating a balanced diet, they are likely getting enough folate,” says Lauren Manaker, MS, RDN, LD, a registered dietitian for Zhou Nutrition.

She goes on to advise that women of childbearing age consider taking a supplement and eating fortified foods to make sure they’re reducing the risk of developing certain birth defects should they become pregnant. In general, however, she affirms that supplements are a supplement to a healthy diet.

“It’s also important to note that like anything in life, you can consume too much folate and that can have other impacts on the body,” says Hubert. “For most people, you don’t need folic acid supplementation and should instead focus on getting folate through natural food sources in your diet.” Luckily there are many non-processed, anti-inflammatory foods that contain folate. Here’s a look at five of the best, according to The Nutrition Twins.

The top 5 folate foods

1. Edamame

“One-half cup cooked edamame has 241 mcg folate, or 60 percent of the daily requirement. It makes a delicious snack or appetizer that provides a prolonged energy boost thanks to the combination of fiber and protein, which help to keep blood sugar stable. You can toss edamame beans on salads, too.”

2. Lentils

“One-half cup of cooked lentils has 179 mcg of folate—almost half of the daily requirement. Lentils are a great source of protein and fiber and are a super satisfying source of plant protein. They’re wonderful to add to the diet as their fiber helps to keep you regular and improve gut health. They’re also a great source of iron, which is particularly good for vegetarians who often struggle to get enough. They make a great substitution for meat in tacos, salads, and soups.”

3. Asparagus

“One-half cup asparagus has 164 mcg, or 40 percent of the daily requirement. It’s also rich in fiber, and is a great source of anthocyanins—these antioxidants help protect the body from the damage caused by free radicals, which can lead to chronic disease. Another fun reason to add it to the diet: asparagus contain the amino acid asparagine, which acts as a natural diuretic, helping to flush excess fluid and salt from your body.”

4. Spinach

“A half cup of steamed spinach provides 131 mcg of folate, which is around one third of the daily 400 mcg requirement. It promotes immune and skin health since it’s rich in vitamin C. Spinach is also great for vegetarians and vegans since it’s a rich source of iron and calcium, two nutrients that most people associate with animal products.”

5. Black Beans

“One half cup serving of black beans contains 128 mcg of folate, roughly a third of the daily requirement. Add beans to your salad, make bean soup, chili, burrito, bean salsa, or a casserole and you’ll also get a hefty dose of fiber, antioxidants, plus protein.”

By: Sharon Feiereisen

Source: New Study Shows Folate Foods Help Prevent Alzheimer’s | Well+Good

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Transforming Blue Food Systems is a Win-Win For People and Planet

Can blue foods help protect the planet and meet the looming crisis of how to feed a fast-growing population? The United Nations, which has made foods from the water one of the key pillars at its special summit on Food Systems this week, thinks it can. But with a third of our oceans overfished, we must act now to harness its potential for future generations.

With the global population set to reach 10 billion by 2050 and hundreds of millions of people already undernourished, food from our oceans offers huge potential to alleviate hunger. This potential can only be unlocked, however, if governments work together to create sustainable and well-managed food systems.

The Blue Food Assessment (BFA) published last week provides one of the most comprehensive overviews to date of how blue foods can play a vital role in addressing the combined challenges of climate change, sustainable development and malnutrition.

One of its key papers found that fish, shellfish and algae have more nutritional benefits and sustainability gains than terrestrial animal-source foods. For example, compared to chicken, oysters and mussels have 76 times more vitamins B-12 and five times more iron. Blue foods also provide opportunities to reduce the environmental footprint of animal protein compared with land-based production.

However, as our ocean is already under immense pressure, and with the growth in demand for blue foods set to roughly double by 2050, sustainable management of ocean resources is crucial if the benefits of these aquatic food sources are to be reaped.

The urgency of this issue is spelled out in another of the scientific papers published as part of the BFA. The study, by some of the world’s leading food systems researchers, doesn’t pull its punches. Without the help of better policy and governance, it argues, shocks to small-scale fisheries and aquaculture could threaten the food and nutrition security of millions worldwide. Those in regions currently most vulnerable to food insecurity and the impact of climate change face the highest risks.

But this problem isn’t an unsolvable equation. We already know what works. We know, for instance, that tackling overfishing is a win-win for the planet and people. Fish stocks can recover and replenish if they are managed carefully, providing more people with the nutrients they need to live healthily. In fact, it is estimated that 16 million tonnes more in catch could be generated every year if all wild-capture fisheries used sustainable practices. The MSC’s own analysis, where I serve as chief executive, suggests that this would meet the protein needs of 72 million more people around the world every year.

Patagonian toothfishIcelandic cod and Cantabrian anchovy have all seen stocks rebound in recent years and just this month the International Union for Conservation of Nature (IUCN) announced that four commercial tuna species were recovering as a result of governments enforcing more sustainable fishing quotas and successfully combatting illegal fishing.

At a time when we need more success stories like this, many governments however are struggling to co-operate over fishery management measures that will ensure healthy fish stocks for future generations. Take the situation in the North East Atlantic, where some of the richest nations on the planet have consistently failed to find consensus on how to share quotas for herring, mackerel and blue whiting. As a result, catch quotas for these fisheries exceed the scientifically recommended limits needed to ensure their long-term sustainability, and these fisheries have consequently lost their certification to the MSC’s sustainability standard.

History shows us that taking more fish from the ocean than can be replenished, leads to stock collapse and, ultimately, impacts negatively on those fishing communities that rely on the sea for their livelihoods. Yet despite the mistakes of the past, this problem remains — the Mediterranean, for instance, remains the most overfished sea in the world. Despite the good news on some tuna species, many individual tuna stocks remain at risk and regional management authorities struggle to agree on international measures to manage those stocks sustainably for the long term.

Governments have a responsibility on behalf of the public to safeguard our oceans for current and future generations. As climate change, population growth and overfishing are converging to create a perfect storm that threatens the future health of our aquatic resources, and the billions of people that depend on them, it’s time for a revitalized global approach to the management of our oceans’ riches. The world is looking to the UN Food Systems Summit as an opportunity for decision-makers to decide on a meaningful, coordinated and cooperative change. Let’s hope they deliver.

By:

Source: Transforming blue food systems is a win-win for people and planet | TheHill

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How Your Healthy Lifestyle Can Be Making You Tired

Let me guess: You’re eating clean, enjoying lots of fruits and vegetables, cutting out meat and are much more plant-based. You’ve also banned bread, cookies and cake from the house. There is just one problem: You can’t seem to stay awake and alert during the day.

On the surface this lifestyle may seem healthy, but it may include some behaviors that are actually zapping you of energy.

“Healthy eating can sometimes turn into something that is not so healthy and can drain you of energy if you are too restricted,” said Yasi Ansari, a registered dietitian nutritionist and Academy of Nutrition and Dietetics spokesperson.

Here are a few ways a so-called “healthy” diet can make you sluggish — and what you can do to get your energy back on track.

Cutting too many calories

“If you are trying to lose weight and you reduce your calories too dramatically, this can leave you without the right amount of energy or fuel that you need to get through the day,” said Elizabeth DeRobertis, a registered dietitian and director of the Nutrition Center at Scarsdale Medical Group, White Plains Hospital.

Food provides the energy you need to stay focused and productive throughout the day. And though sometimes people think if they want to lose weight, they should eat as little as possible, this doesn’t work for the long term, said DeRobertis, the creator of the GPS Weight Loss Program, an online self-paced weight loss program. When someone becomes too restrictive with their intake, metabolism can slow down, and you may feel drained of energy. “You also end up too hungry … and end up overeating as a result,” DeRobertis said.

“If you are feeling low in energy, check in on the energy you’re taking in,” said Melissa Majumdar, an Atlanta-based registered dietitian and certified obesity and weight management specialist. “Start with adding an additional 1 to 2 ounces of lean protein, a half cup of whole grains, or 1 tablespoon of a healthy fat and reanalyze.”

Eating too infrequently

Going too long without eating can also make you feel tired. “Some people experience sleepiness or sluggishness as a sign to eat more instead of the traditional hunger cues,” said Majumdar, who is also the metabolic and bariatric coordinator at Emory University Hospital Midtown. “If two or three hours after a meal you are low in energy, plug in a balanced snack of fiber and protein, like fresh fruit with a handful of nuts or a small bag of edamame.”

“Identifying when your body starts to get hungry can help you better understand how to be most consistent with your nutrition and its timing to ensure your energy is stable throughout the day and you’re supporting your body in meeting its needs,” Ansari said.

Cutting too many carbs

Going low carb can also make you feel lousy. Not only can eating too few carbs make you feel tired and irritable from low blood sugar; it can also lead to dehydration, which can cause fatigue. “For every gram of carbohydrate stored in the body, there is approximately 2 to 3 grams of water retained,” DeRobertis explained. But when someone reduces their carbohydrate intake too dramatically, water is released, and it’s possible to become dehydrated.

“When someone feels a dip in energy in the afternoon, I always think of a plant that is wilted, and in need of water,” DeRobertis said. “When we water the plant, it perks back up. And I picture that is what happens to our cells when we are not well-hydrated enough during the day.”

Cutting carbs, especially cookies and sugary treats, is perfectly fine, but make sure you’re not skimping on fiber-rich carbs, like fruits, vegetables and whole grains.

Not eating a balanced vegetarian diet

Banning animal proteins as part of a vegetarian diet isn’t necessarily unhealthy, but it’s important to be conscious about consuming a balanced intake of all nutrients.

“If someone chooses to eat in a vegetarian or vegan style, but they are not careful about obtaining enough vitamin B12 and iron (from supplements and plant sources), they may end up with anemia and a resulting feeling of fatigue,” DeRobertis explained.

Foods high in iron include beef, iron-fortified cereals, spinach and beans. If you consume plant sources of iron, it’s wise to add some vitamin C to enhance absorption. “An example might be a spinach salad with a small glass of orange juice or a lentil soup with chopped tomatoes,” Ansari said.

Vegans should also be aware of a possible vitamin B12 deficiency. “A B12 deficiency may take years to develop, so supplementing in advance if you don’t eat animal foods like meat, fish, eggs and dairy is key,” Majumdar said. Nutritional yeast can also add some vitamin B12 but would need to be eaten daily to provide enough, Majumdar added.

Eating too many carbs

Having too many carbohydrates in one sitting can also contribute to sluggishness.Even healthy carbohydrates turn to sugar in the body, and our pancreas, in response, produces insulin, to keep our blood sugar stable.

“If someone has too many carbohydrates in one sitting — even if it’s healthy carbs, like brown rice, beans, sweet potato, whole grain pasta, or quinoa — for some, too many can raise blood sugar, and high blood sugar makes us feel tired and lethargic,” DeRobertis said. (While this often happens among individuals with diabetes, it can happen to anyone who eats too many carbs in one sitting, she said.)

Pay attention to how you feel after different meal combinations, and if you notice that you feel tired after a high-carb meal, consider spacing out your carbohydrates during the day, DeRobertis advised.

Exercising too much

Overexercising can also make you feel tired. “How much is too much depends on the person, other demands in their life, stress levels, overall health and fitness levels, and the types of exercise,” Majumdar said.

Underfueling for a workout can also be a contributor to fatigue. “During exercise, the body typically burns a combination of fat and carbohydrates. If you are not eating enough carbohydrates, it is more difficult to fuel the workout, and if this pattern progresses, the body’s stored carbohydrates, called glycogen, aren’t restocked,” Majumdar said. This can leave you feeling drained, frustrated and demoralized with your workout, according to Majumdar.

“Take inventory of how you feel before and after exercise sessions and consider adding carbohydrates or calories to your intake, or reducing your exercise to keep energy levels balanced,” Majumdar said.

If exercise is eating into sleeping time, this can also impact energy levels. Getting an adequate amount of sleep not only gives you energy, it also helps the body to actively repair muscles and tissues used during exercise, according to Majumdar.

By: Lisa Drayer, CNN

Source: How your ‘healthy’ lifestyle can be making you tired

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