## Harris–Benedict equation

The Harris–Benedict equation (also called the Harris-Benedict principle) is a method used to estimate an individual’s basal metabolic rate (BMR) and daily kilocalorierequirements. The estimated BMR value is multiplied by a number that corresponds to the individuals’s activity level. The resulting number is the recommended daily kilocalorie intake to maintain current body weight.

The Harris–Benedict equation may be used to assist weight loss — by reducing the kilocalorie intake to a number below the estimated maintenance intake of the equation.

## Step 1 – calculating the BMR

The original Harris–Benedict equations published in 1918 and 1919.[1][2]

 Men BMR = 66.473 + (13.7516 x weight in kg) + (5.0033 x height in cm) – (6.7550 x age in years) Women BMR = 655.0955 + (9.5634 x weight in kg) + (1.8496 x height in cm) – (4.6756 x age in years)

The Harris–Benedict equations revised by Roza and Shizgal in 1984.[3]

 Men BMR = 88.362 + (13.397 x weight in kg) + (4.799 x height in cm) – (5.677 x age in years) Women BMR = 447.593 + (9.247 x weight in kg) + (3.098 x height in cm) – (4.330 x age in years)

## Step 2 – applying the Harris-Benedict Principle

The following table enables calculation of an individual’s recommended daily kilocalorie intake to maintain current weight.[4]

 Little to no exercise Daily kilocalories needed = BMR x 1.2 Light exercise (1–3 days per week) Daily kilocalories needed = BMR x 1.375 Moderate exercise (3–5 days per week) Daily kilocalories needed = BMR x 1.55 Heavy exercise (6–7 days per week) Daily kilocalories needed = BMR x 1.725 Very heavy exercise (twice per day, extra heavy workouts) Daily kilocalories needed = BMR x 1.9

## The body mass index (BMI)

The body mass index (BMI), or Quetelet index, is a measure of relative weight based on an individual’s mass and height.

Devised between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing “social physics”,[2] it is defined as the individual’s body mass divided by the square of their height – with the value universally being given in units of kg/m2.

 $\mathrm{BMI}$ $= \frac{\text{mass}(\text{kg})}{\left(\text{height}(\text{m})\right)^2}$ $\mathrm{BMI}$ $= \frac{\text{mass}(\text{lb})}{\left(\text{height}(\text{in})\right)^2}\times 703$ †

The factor for Imperial or US customary units is more precisely 703.06957964, but that level of precision is not meaningful for this calculation.

BMI can also be determined using a table[note 1] or from a chart which displays BMI as a function of mass and height using contour lines, or colors for different BMI categories, and may use two different units of measurement.[note 2]

The BMI is used in a wide variety of contexts as a simple method to assess how much an individual’s body weight departs from what is normal or desirable for a person of his or her height. There is however often vigorous debate, particularly regarding at which value of the BMI scale the threshold for overweight and obese should be set, but also about a range of perceived limitations and problems with the BMI.

Even though many other differently calculated ratios have been invented,[note 3] others haven’t been used as often.

## Psyllium

Psyllium , or Ispaghula , is the common name used for several members of the plant genus Plantagowhose seeds are used commercially for the production of mucilage.

Several studies point to a cholesterol reduction attributed to a diet that includes dietary fiber such as psyllium. Research published in The American Journal of Clinical Nutritionconcludes that the use of soluble-fiber cereals is an effective and well-tolerated part of a prudent diet for the treatment of mild to moderate hypercholesterolemia. Although the cholesterol-reducing and glycemic-response properties of psyllium-containing foods are fairly well documented, the effect of long-term inclusion of psyllium in the diet has not been determined.

Choking is a hazard if psyllium is taken without adequate water as it thickens in the throat[1] (see Psyllium seed husks). Cases of allergic reaction to psyllium-containing cereal have also been documented.[2]

## Uses

Psyllium is mainly used as a dietary fiber, which is not absorbed by the small intestine. The purely mechanical action of psyllium mucilage absorbs excess water while stimulating normal bowel elimination. Although its main use has been as a laxative, it is more appropriately termed a true dietary fiber and as such can help reduce the symptoms of both constipation and mild diarrhea. The laxative properties of psyllium are attributed to the fiber absorbing water and subsequently softening the stool. It is also one of the few laxatives that does not promote flatulence.[3]

Psyllium is produced mainly for its mucilage content. The term mucilage describes a group of clear, colorless, gelling agents derived from plants. The mucilage obtained from psyllium comes from the seed coat. Mucilage is obtained by mechanical milling/grinding of the outer layer of the seed. Mucilage yield amounts to about 25% (by weight) of the total seed yield. Plantago-seed mucilage is often referred to as husk, or psyllium husk. The milled seed mucilage is a white fibrous material that is hydrophilic, meaning that its molecular structure causes it to attract and bind to water. Upon absorbing water, the clear, colorless, mucilaginous gel that forms increases in volume by tenfold or more.

The United States is the world’s largest importer of psyllium husk, with over 60% of total imports going to pharmaceutical firms for use in products such as Metamucil. In Australia, psyllium husk is used to make Bonvit psyllium products. In the UK, ispaghula husk is used in the popular constipation remedy Fybogel. Psyllium mucilage is also used as a natural dietary fiber for animals. The dehusked seed that remains after the seed coat is milled off is rich in starch and fatty acids, and is used as chicken and cattle feed.

Psyllium mucilage possesses several other desirable properties. As a thickener, it has been used in ice cream and frozen desserts. A 1.5% weight/volume ratio of psyllium mucilage exhibits binding properties that are superior to a 10% weight/volume ratio of starch mucilage. The viscosity of psyllium mucilage dispersions are relatively unaffected between temperatures of 20 and 50 °C (68 and 122 °F), by pH from 2 to 10 and by salt (sodium chloride) concentrations up to 0.15 M. These physical properties, along with its status as a natural dietary fiber, may lead to increased use of psyllium by the food-processing industry. Technical-grade psyllium has been used as a hydrocolloidal agent to improve water retention for newly seeded grass areas, and to improve transplanting success with woody plants.

It is suggested that the isabgol husk is a suitable carrier for the sustained release of drugs and is also used as a gastroretentive carrier due to its swellable and floatable nature. The mucilage of isabgol is used as a super disintegrant in many formulations.

## Growth habit

Plantago ovata is an annual herb that grows to a height of 30–46 cm (12–18 in). Leaves are opposite, linear or linear lanceolate 1 cm × 19 cm (0.39 in × 7.48 in). The root system has a well-developed tap root with few fibrous secondary roots. A large number of flowering shoots arise from the base of the plant. Flowers are numerous, small, and white. Plants flower about 60 days after planting. The seeds are enclosed in capsules that open at maturity.

## Environmental requirements

### Climate

P. ovata is a 119- to 130-day crop that responds well to cool, dry weather. In India, P. ovata is cultivated mainly in North Gujarat as a “Rabi” or post–rainy season crop (October to March). During this season, which follows the monsoons, average temperatures are in the range of 15–30 °C (59–86 °F), and moisture is deficient. Isabgol (P. ovata), which has a moderate water requirement, is given 5 to 6 light irrigations. A very important environmental requirement of this crop is clear, sunny and dry weather preceding harvest. High night temperature and cloudy wet weather close to harvest have a large negative impact on yield. Rainfall on the mature crop may result in shattering and therefore major field losses.

### Soil

Isabgol grows best on light, well drained, sandy loams. The nutrient requirements of the crop are low. In northern Gujarat, the soil tends to be low in nitrogen and phosphorus and high in potash with a pH between 7.2 and 7.9. Nitrogen trials under these conditions have shown a maximum seed yield response with the addition of 22 kg/hectare (20 lb/acre) of nitrogen.

### Seed preparation and germination

P. ovata has small seeds; 1,000 seeds weigh less than 2 grams. Under ideal conditions of adequate moisture and low temperature 10 to 20 °C (50 to 68 °F), 30% of seeds germinate in 5 to 8 days. The seed shows some innate dormancy (3 months) following harvest. Attempts to eliminate this dormancy period by scarification, or by exposure to wet or dry heat, cold, ethylene, or carbon dioxide, are ineffective. Post-dormancy seeds show reliable germination in excess of 90% at 29 °C (84 °F), with lower rates of germination as temperature is increased.

## Cultivation

The fields are generally irrigated prior to seeding to achieve ideal soil moisture, to enhance seed soil contact, and to avoid burying the seed too deeply as a result of later irrigations or rainfall. Maximum germination occurs at a seeding depth of 6 mm (1/4 in). Emerging seedlings are frost sensitive; therefore, planting should be delayed until conditions are expected to remain frost free. Seed is broadcast at 5.5 to 8.25 kg/hectare (5 to 7.5 lb/acre) in India. In Arizona trials, seeding rates of 22 to 27.5 kg/ha (20 to 25 lb/acre) resulted in stands of 1 plant/25mm (1 inch) in 15 cm (6 inch) rows produced excellent yields. Weed control is normally achieved by one or two hand weedings early in the growing season. Control of weeds by pre-plant irrigation that germinates weed seeds followed by shallow tillage may be effective on fields with minimal weed pressure. Psyllium is a poor competitor with most weed species.

Plantago wilt (Fusarium oxysporum) and downy mildew are the major diseases of Isabgol. White grubs and aphids are the major insect pests.

The flower spikes turn reddish brown at ripening, the lower leaves dry and the upper leaves yellow. The crop is harvested in the morning after the dew is gone to minimize shattering and field losses. In India, mature plants are cut 15 cm above the ground and then bound, left for a few days to dry, thrashed, and winnowing.

Harvested seed must be dried below 12% moisture to allow for cleaning, milling, and storage. Seed stored for future crops has shown a significant loss in viability after 2 years in storage.

## Polyuria

Polyuria is a condition usually defined as excessive or abnormally large production or passage[1] of urine (at least 2.5[2] or 3[3] L over 24 hours in adults). Frequent urination is sometimes included by definition,[4] but is nonetheless usually an accompanying symptom. Increased production and passage of urine may also be termed diuresis.[5][6]

Polyuria often appears in conjunction with polydipsia (increased thirst), though it is possible to have one without the other, and the latter may be a cause or an effect. Psychogenic polydipsia may lead to polyuria.

Polyuria is physiologically normal in some circumstances, such as cold diuresis, altitude diuresis, and after drinking large amounts of fluids.

The most common cause of polyuria in both adults and children is uncontrolled diabetes mellitus,[3] causing an osmotic diuresis. In the absence of diabetes mellitus, the most common causes are excessive secretion of aldosterone due to adrenal cortical tumor,primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus.[3]

Polyuria may also be due to various chemical substances (diuretics, caffeine, ethanol). It may also occur after supraventricular tachycardias, during an onset of atrial fibrillation, childbirth, and the removal of an obstruction within the urinary tract. Diuresis is restrained by antidiuretics such as ADH,angiotensin II and aldosterone.

Cold diuresis is the occurrence of increased urine production on exposure to cold, which also partially explains immersion diuresis.

Substances that increase diuresis are called diuretics.

Substances that decrease diuresis allow more vasopressin or antidiuretic hormone (ADH) to be present in the kidney.

High-altitude diuresis occurs at altitudes above 10,000 ft and is a desirable indicator of adaptation to high altitudes. Mountaineers who are adapting well to high altitudes experience this type of diuresis. Persons who produce less urine even in the presence of adequate fluid intake probably are not adapting well to altitude.[7]

## Aboulia

Aboulia or abulia (from the Greek βουλή, meaning “will”,[1] with the prefix a- used as a privative), in neurology, refers to a lack of will or initiative and can be seen as a disorder of diminished motivation (DDM). Aboulia falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than aboulia.[2] A patient with aboulia is unable to act or make decisions independently. It may range in severity from subtle to overwhelming. It is also known as Blocq’s disease(which also refers to abasia and astasia-abasia).[3] Abulia was originally considered to be a disorder of the wil

# Pecorino

Pecorino Romano cheese

Pecorino is the name of a family of hard Italian cheeses made from sheep‘s milk. The word pecora, from which the name derives, means sheep. Most are aged and sharp.
Of the four main varieties of mature pecorino, all of which have Protected Designation of Origin (PDO) status under European Union law, Pecorino Romano is probably the best known outside Italy: especially in the United States which has been an important export market for the cheese since the nineteenth century.[1] Most Pecorino Romano is produced on the island of Sardinia, though its production is also allowed in Lazio and in the Tuscan Province of Grosseto.
The other three mature PDO cheeses are the milder Pecorino Sardo from Sardinia, Pecorino Toscano, the Tuscan relative of Pecorino Sardo, and Pecorino Siciliano from Sicily. All come in a variety of styles depending on how long they have been matured. The more matured cheeses, referred to as stagionato, are harder and have a stronger flavour. Some varieties may have spices included in the cheese. In Sardinia, the larvae of the cheese fly are intentionally introduced into Pecorino Sardo to produce a local delicacy called casu marzu.
Pecorino Romano is most often used on pasta dishes, like the better-known Parmigiano Reggiano (parmesan). Its distinctive strong, very salty flavour means that it is preferred for some pasta dishes with highly-flavoured sauces, especially those of Roman origin, such as pasta all’amatriciana.

## Hiromi Shinya

Hiromi Shinya was born in 1935 in the city of Yanagawa in Fukuoka Prefecture, Japan (Shinya Medical Clinic: About Dr. Shinya).

Shinya is also known for his claims about health benefits of enzyme supplementation. However, some of his claims in commercial advertisements have been criticized as deceptive.

Shinya has authored many books, of which the most well-known, Living without Disease: A Miracle Enzyme Determines Life (in Japanese: ‘病気にならない生き方 ミラクル・エンザイムが寿命を決める’), is said to have sold more than a million copies in Japan.[1]

In advertisements,[2][3] Shinya has recommended taking enzymes from consumed food. There he cites a medical paper[4] that reports a decrease in the secretion quantity of three kinds of digestive enzyme (and bicarbonate) from the pancreas. The article speculates that this is due to aging, and does not discuss intake of nutrients, so it is irrelevant to his claim. He also says[2] that in recent years vegetables are poorer sources of nutrients, and that it is difficult to obtain sufficient enzymes from consumed food alone. His evidence for this is a chart based on references[5] for 1963 and 2008 which shows values of beta-carotene, vitamin C and iron found in spinach and carrot, from which he appears to infer a comparable enzyme deficit in all vegetable food sources.

He claims that his prescription of [Kangen®] water has 0% cancer recurrence rate,(Shinya , The Enzyme Factor, p. 7) without clinical data or independent corroboration.

## Hepatitis

Hepatitis (plural: hepatitides) is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, poor appetite and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.

Worldwide,  causes include autoimmune diseases and ingestion of toxic substances (notably alcohol, certain medications, some industrial organic solvents, and plants).

Viral hepatitis is the most common cause of hepatitis worldwide.[5] Other common causes of non-viral hepatitis include toxic and drug-induced, alcoholic, autoimmune, fatty liver, and metabolic disorders.[6] Less commonly some bacterial, parasitic, fungal, mycobacterial and protozoal infections can cause hepatitis.[7][8] Additionally, certain complications of pregnancy and decreased blood flow to the liver can induce hepatitis.[7][9] Cholestasis (obstruction of bile flow) due to hepatocellular dysfunction, biliary tract obstruction, or biliary atresia can result in liver damage and hepatitis.[10][11]

The term is derived from the Greek hêpar (ἧπαρ), meaning “liver,” and the suffix -itis (-ῖτις), meaning “inflammation” (c. 1727).[2]

Non-alcoholic fatty liver disease (NAFLD) is one cause of a fatty liver, occurring when fat is deposited (steatosis) in the liver not due to excessive alcohol use. It is related to insulin resistance and the metabolic syndrome and may respond to treatments originally developed for other insulin-resistant states (e.g. diabetes mellitus type 2) such as weight loss, metformin and thiazolidinediones.[1] Non-alcoholic steatohepatitis (NASH) is the most extreme form of NAFLD, and is regarded as a major cause of cirrhosis of the liver of unknown cause.[2]

Most patients with NAFLD have few or no symptoms. Patients may complain of fatigue, malaise, and dull right-upper-quadrant abdominal discomfort. Mild jaundice may be noticed although this is rare. More commonly NAFLD is diagnosed following abnormal liver function tests during routine blood tests. By definition, alcohol consumption of over 20 g/day (about 25 ml/day of net ethanol) excludes the condition.[1]

NAFLD is associated with insulin resistance and metabolic syndrome (obesity, combined hyperlipidemia, diabetes mellitus (type II) and high blood pressure).[1][2]

Common findings are elevated liver enzymes and a liver ultrasound showing steatosis. An ultrasound may also be used to exclude gallstone problems (cholelithiasis). A liver biopsy(tissue examination) is the only test widely accepted as definitively distinguishing NASH from other forms of liver disease and can be used to assess the severity of the inflammationand resultant fibrosis.[1]

Non-invasive diagnostic tests have been developed, such as FibroTest, that estimates liver fibrosis,[7] and SteatoTest, that estimates steatosis,[8] however their use has not been widely adopted.[9] Apoptosis has been indicated as a potential mechanism of hepatocyte injury as caspase-cleaved cytokeratin 18 (M30-Apoptosense ELISA) in serum/plasma is often elevated in patients with NASH; however, as the role of oncotic necrosis has yet to be examined it is unknown to what degree apoptosis acts as the predominant form of injury.[10][11]

Other diagnostic tests are available. Relevant blood tests include erythrocyte sedimentation rate, glucose, albumin, and renal function. Because the liver is important for making proteins used in coagulation some coagulation related studies are often carried out especially the INR (international normalized ratio). Blood tests (serology) are usually used to rule out viral hepatitis (hepatitis A, B, C and herpes viruses like EBV or CMV), rubella, and autoimmune related diseases. Hypothyroidism is more prevalent in NASH patients which would be detected by determining the TSH.[12]

It has been suggested that in cases involving overweight patients whose blood tests do not improve on losing weight and exercising that a further search of other underlying causes be undertaken. This would also apply to those with fatty liver who are very young or not overweight or insulin-resistant. In addition those whose physical appearance indicates the possibility of a congenital syndrome, have a family history of liver disease, have abnormalities in other organs, and those that present with moderate to advanced fibrosis or cirrhosis.[13]

## Management

A large number of treatments for NAFLD have been studied. While many appear to improve biochemical markers such as alanine transaminase levels, most have not been shown to reverse histological abnormalities or reduce clinical endpoints:[1]

• Treatment of nutrition and excessive body weight:
• Nutritional counseling: Diet changes have shown significant histological improvement.[14] Specifically, avoiding food containing high-fructose corn syrup and trans-fats is recommended.[15]
• Weight loss: gradual weight loss may improve the process in obese patients; rapid loss may worsen NAFLD. Specifically, walking or some form of aerobic exercise at least 30–45 minutes daily is recommended.[15] The negative effects of rapid weight loss are controversial: the results of a meta-analysis showed that the risk of progression is very low.[16]
• A recent meta-analysis presented at the Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) reported that weight-loss surgery leads to improvement and or resolution of NASH in around 80% of patients.[17]
• Insulin sensitisers (metformin[18] and thiazolidinediones[19]) have shown efficacy in some studies.
• ursodeoxycholic acid and lipid-lowering drugs, have little benefit.[citation needed]
• Vitamin E: Vitamin E can improve some symptoms of NASH and was superior to insulin sensitizer in one large study. In the Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, for patients with NASH but without diabetes mellitus, the use of very high dosages of vitamin E (800 IU/day) for four years was associated with a significantly higher rate of improvement than placebo (43% vs. 19%) in the primary outcome. The primary outcome was an improvement in certain histological features as measured by biopsy—but it did not improve fibrosis. Pioglitazone, an insulin sensitizer, improved some features of NASH but not the primary outcome, and resulted in a significant weight gain (mean 4.7 kilograms) which persisted after pioglitazone was discontinued.[20]
• Statin: Improvements in liver biochemistry and histology in patients with NAFLD through treatment with statins have been observed in numerous cases, although these studies were carried out on a relatively small sample of patients.[21] Statins have also been recommended for use in treating dyslipidemia for patients with NAFLD.
• Modest wine drinking: In a study using the NHANES III dataset, it has been shown that mild alcohol consumption (one glass of wine a day) reduces the risk of NAFLD by half.[22]

## Epidemiology

The prevalence of non-alcoholic fatty liver disease ranges from 9 to 36.9% of the population in different parts of the world.[23][24][25] Approximately 20% of the United States population suffers from non-alcoholic fatty liver, and the prevalence of this condition is increasing.[26] The prevalence of non-alcoholic fatty liver disease is higher in Hispanics, which can be attributed to high rates of obesity and type 2 diabetes in Hispanic populations.[27] Non-alcoholic fatty liver disease is also more common among men than women in all age groups until age 60, where the prevalence between sex equalize. This is due to the protective nature of estrogen.[28]

## cup

The cup is a unit of measurement for volume, used in cooking to measure liquids (fluid measurement) and bulk foods such as granulated sugar (dry measurement). It is principally used in the United States and Liberia where it is a legally defined unit of measurement. Actualcups used in a household in any country may differ from the cup size used for recipes; standard measuring cups, often calibrated in fluid measure and weights of usual dry ingredients as well as in cups, are available.

As a result of the fact that the imperial cup is actually out of use and the other definitions differ little (±3%), the U.S. measuring cups and metric measuring cups may be used as equal in practice.

No matter what size cup is used, the ingredients of a recipe measured with the same size cup will have their volumes in the same proportion to one another. The relative amounts to ingredients measured differently (by weight, or by different measures of volume such asteaspoons, etc.) may be affected by the definitions used.