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バー検索 脱力系「2軒目は近所のバー」による、æ¡œ ��� ��の近所のバー一覧 t.co/TIRizSrExZ #barJP #バー
Tue, 08 Apr 2014 22:12:17 -0500
2nd_map
桜 ��� ��( ��京 ��港 �)から汐留 パブ VICTORIAN PUB THE ROSE & CROWN 汐留日テレプラザ...
Tue, 08 Apr 2014 10:06:04 -0500
2nd_map
桜 ��� ��( ��京 ��港 �)からshot Bar feelまでの地図 t.co/bupjyew3Kk #bar ...
Tue, 08 Apr 2014 10:06:03 -0500
2nd_map
桜 ��� ��( ��京 ��港 �)からブリック 銀座店までの地図 t.co/G44hoJbD3I #bar #chizu
Tue, 08 Apr 2014 10:06:02 -0500
2nd_bar
バー検索 脱力系「2軒目は近所のバー」による、桜 ��� ��の近所のバー一覧 t.co/BSXixLYDf5 #barJP #バー
Tue, 08 Apr 2014 10:05:12 -0500
Mohamad Robi
MZP������������������@���������������������������������������� �!�L�!��This program must be run under Win32 $7����������������������������������������������������������������������������������������������������������������������������������������PE��L�^B*������������ �`���������������� ���@����������������������0����������������������������������������!� ��� ���������������������#� �����������������������������������������������������������������������������������UPX0����������������������������������UPX1�����`�������^�����������������@���.rsrc������� �����b��������������@������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������3.03�UPX! -L�̹8Y����[������&�SH.��� String�X��;ɖ&���fk����?%%t� #��TObject�%������ 2ȸ��� 2� ���2� ����� � Ԑ� � 2���� 2Ȁ|xt 2� plh2� �d`�� � \X� � 2��T� 2��PLS�ļ����� �T���D$,t�\$0��A�D[�cHDd�@�u:hDj�mȅ�u����3�^d� ܉� 3ҋ��w���D����B��du���+������@�W���J��H�m۾�P�V ��0X B����PP� �Q���۷��GWUQ��$��]��$��[�i-�G�;wSS ;�u۶�m�CF ���F�;u e���;�up֋�@����so3Z]_�oZ������2K;�r6�J5�kgֵ���wbu��)Q���{ ;Ha�?,�z�o[��.�)�*� A� ���m�{�+�|$+�s�����8�� �W����;�u� Y����ڋ��ݾ�_�}�)���� ���o�Ijh� V�����M�;��t#�ӸG�c��a;$��P&��~o�cU�ٳ��C`j���Oh URux�6�$N�;�vܐ,�o�L��h(�����e{��}�T$ ��ʼn�N�����Q�s��wF��z��ڻ;w;;t4����\{ vtV�0L��� �E�Q�n��߁�Xu��/u�|7k��m���JyH��p�+� ��'��`�]�����k� �������9D(+�E�5o|[�Ο^~ �v�p�m��;{���va���W+�WS��g��� 6��� 3t�Ns+��!�m��4��Oú����+A���~�8$s�;�s�� ���@A��8���*�w7�;D����?��Ӎ����y��3;�, [];S�XR vt�F2�HLF>5~vM7 �uɪ�.�!��.�����aS;T3tw�u�W���ߍ٨�9\k+[�U�a���3 �ȅ,ߏ2u���f�Cl�� �MȀ5�F4��0Džf�J�fk6�H�v���� �`�_�8N � h�����ˣ�=A/��_�}� 3ɿ��@=���b������x�A�z�&��D��n2x��H���_�W ?h�K������N@��@aQ����Y�R@ȥ���o�U@: �'���X@� ��x9?�����\@� �6���_@�Ng����b@�"�E@|o�e@������p+��ŝi@զ��IxZ@������=����A���G���A��+��BkU'9��p�|B0������uj�|l� �� �� t��� [
Wed, 16 Apr 2014 06:14:46 -0500
เพื่อนไม่รัก ก็เอบรักเพื่อน

Wed, 16 Apr 2014 03:49:51 -0500
Umme Kawsar
Verse by Verse Qur'an Study Circle 13 April . So Juz Ama it is! In sha Allah, from here we begin the goal of memorizing whatever short Surahs we can. Best is to memorize them all, challenge yourself to do more and better, but at the same time we understand everyone's personal capability and circumstances. Remember, we are not doing this exercise merely to be called Huffadh but rather to build an awesome connection with the Book such that no matter where we are we can recite it and "know" the meaning of what we are reciting. It also considerably improves one's Salah experience. Some du`as that our beloved Prophet salAllahu `alayhi wa sallam taught us to recite for seeking knowledge: رَبِّ اشْرَحْ لِى صَدْرِى - وَيَسِّرْ لِى أَمْرِى - وَاحْلُلْ عُقْدَةً مِّن لِّسَانِى - يَفْقَهُواْ قَوْلِي "O my Lord! Open for me my chest. And ease my task for me. And loosen the knot from my tongue. That they understand my speech." [Prophet Musa's du`a in Surah Ta-Ha:25-28] رَّبِّ زِدْنِي عِلْمًا Rabbi zidnee ‛ilman "My Lord! Increase me in knowledge." [Surah Ta-Ha:114] This is a clear proof of the excellence of knowledge. This is because Allah ta`ala did not order the Messenger sallAllahu `alayhi wa sallam with request for increase in anything except for an increase in knowledge. اللهم إني أسألك علماً نافعاً، ورزقاً طيباً، وعملاً متقبلاً Allahumma innee assaluka ilman nafia, wa rizzqan tayyeebun, wa amalan mutaqabilan "O Allah indeed I ask You for beneficial knowledge, and a good Halal provision, and actions which are accepted." اللَّهُمَّ انْفَعْنِي بِمَا عَلَّمْتَنِي، وَعَلِّمْنِي مَا يَنْفَعُنِي، وَزِدْنِي عِلْمًا Allahum-manfa'ni bima 'al-lamtani, wa 'al-limni ma yanfa'uni, wa zidni 'ilma "Oh Allah, benefit me with what You have taught me and teach me what benefits me, and increase me in knowledge." [At-Tirmidhi No# 3599 Ibn Majah No# 251, 3833] اللَّهُمَّ إِنِّي أَعُوذُ بِكَ مِنَ الْأَرْبَعِ، مِنْ عِلْمٍ لَا يَنْفَعُ، وَمِنْ قَلْبٍ لَا يَخْشَعُ، وَمِنْ نَفْسٍ لَا تَشْبَعُ، وَمِنْ دُعَاءٍ لَا يُسْمَعُ Allah-humma in-ni a‛oodhu bika mi-nal arba‛, min ‛ilmin laa yanfa‛, wa min qalbin laa yakh-sha‛, wa min naf-sin laa tashba‛, wa min du‛aa-’in laa yusma‛ "O Allah, I seek refuge with You from these four: from knowledge that does not benefit, from a heart that does not get humbled [to Allah], from a soul which is never satisfied and from a supplication which does not get answered." [Abu Dawud No# 1548 At-Tirmidhi No# 3482 An-Nasa'i No# 5442, 5467, 5536, 5537 Ibn Majah No# 250, 3837]
Wed, 16 Apr 2014 02:59:17 -0500
Park Daham
from japan, 2 piece noise-grindcore band Sete Star Sept, their korea tour start from yogiga gallery to aa studio, if you like fast-noise-something like that, dont miss it. full of noise-fast-blast-doom night. coming soon
Wed, 16 Apr 2014 02:29:44 -0500
Park Daham
from japan, 2 piece noise-grindcore band Sete Star Sept, their korea tour start from yogiga gallery, dont miss it. noise-fast-blast-doom night.
Wed, 16 Apr 2014 02:26:32 -0500
Katherine Murga
Oliver Sykes!
Wed, 16 Apr 2014 01:38:29 -0500
Kristi G. Roe Owen
38 random things about me. 1. I'm writing a book. Not like the imaginary book I was writing for the past ten years that was only 20 pages long and kept getting redrafted. I'm actually finishing this one. I stopped trying to think about audience and just let my freak flag fly. God bless any of you who make it through that shit when I finish. 2. I am not judgey about fashion because heaven knows I can't afford to be with my Rainbow Brite ass, but there's a couple of things that are just messed up. Specifically, there's one thing, and that's TOE SOCKS. They're wrong. Seriously what the FUCK is going on there. I'm cool with the Japanese thong sock thing, I mean whatever man, but little sweaters for your toes? Toe gloves? No. This can never come into vogue again. I'll take it to the Supreme Court if I have to. 3. Being a mom is a million percent easier than I thought it would be. I bitch about it sometimes because I'm a sardonic sarcastabot, but honestly it's actually way the crap easier than I ever imagined. 4. I have a bizarre aversion to meat in a can. I can't get over the concept of eating something that died like six months ago...or MORE. I know it's just fine in my mind, but you know how like some people can't deal with leftovers? Well that's me with canned meat. 5. Unless it's hot dog chili. Three words: suspension of disbelief. 6. I also have an inexplicable phobia of elevators which my husband loves to exploit by jumping up and down. Okay, it's more like mild to moderate uneasiness. This doesn't stop me from riding in them because well quite honestly I'm pretty effing lazy SLASH I really don't like sweating if I'm wearing any makeup whatsoever. It also doesn't make any sense because I love The Twilight Zone Tower of Terror which is a thrill ride in an errant elevator, and in fact, most thrill rides, I'm not afraid of heights, and I know logically that elevators are safe. I BLAME POLTERGEIST III. WATCH IT. 7. I have a legitimate phobia of doctors after the whole losing a big chunk of my abdominal wall. I have to meditate before having my blood pressure taken. It totally works btw. 8. I named my donor tissue Frank. Like Frankenstein. Think it through. 9. I don't really enjoy chocolate, cookies, or birthday cake the way that other people do. However, I do love tres leches cake, and I am eating it right now. It's lovely. I also like flan. 10. I don't really enjoy cooking unless I'm in a feverish mood for it which happens hardly ever. Justin does most of the cooking. However, I am a genius with poor man's food and casseroles. When there's only three ingredients and some old mayo, that's when I shine. East Tulsa Kristi comes out to rawk that shit. 11. I can't work out just to work out, and I can't run just to run because it's BORING AS HELL. I have to be DOING something. I've always been this way. I did crunches in high school while watching Star Trek TNG reruns. I did like five after each commercial break. I love martial arts, kali, that kind of thing, and dancing, but if you see me running, get your gun because there's either a goddammed bear or it's the zombie apocalypse. 12. I can't deal with certain TV shows, especially when I was pregnant. I can watch breaking bad and the walking dead all day, but put me in front of a true crime cold case story and I'm simultaneously glued to the tv in freakish fascination, cowering behind my hands, and in a borderline fetal position from crippling anxiety. The same holds true for almost anything on TLC, Lifetime, and the local news. 13. I think television and cinema are the predominant forms of modern literature, and I love them. I watch TV when I am doing laundry and cleaning because otherwise I would not have time for it. When people tell me they don't watch TV, it's like when people tell me they don't read books. It makes me feel a little sad. 14. Still, I watch some totally shitty TV. 15. I can't hide my facial expressions at all. This was a problem when I was teaching, especially tutoring. I would literally practice a look of distant detachment because otherwise I could totally not hide my expressions when I talked to students about their papers. I never got it down pat. 16. I am unable to finish an adult drink because I lose them by placing them out of children's reach and then forgetting where I put them. It's a problem. I just sort of stopped bothering with it altogether. 17. I've been to like 250 to 300 live music shows. I used to know the exact number but I just stopped counting a few years back. Most of them were with Justin. 18. If you don't already know this, the highlights of my less than illustrious writing career have been feature articles about the following: using myself and my friends and family as test subjects for hangover cures in a less than scientific study, locating and interviewing a prostitute in downtown Tulsa, and hunting for ghosts (which I learned mostly consisted of drinking and mocking my ghost-believing friends. The spirits didn't find me a suitable vessel. I wonder why). 19. I have met Ben Folds and David Byrne AND I was hit on by Wynton Marsalis. I just wasn't up for the jazz groupie lifestyle at that point in my life. 20. When I was pregnant with Lucy, I worked the whole time but I would LOSE TIME in my office alone. My then-assistant Charley M. was always gracious enough to warn me if I had keyboard or sleeve marks on my face before an appointment with a student. 21. I've been to Walt Disney World 11 times. That's just so many times. It's a lot of magic. One might even say, too much magic. 22. I had a recurring dream for about 15 years that turned out to be a premonition that I would move back into my parents' house in one day without notice. The dream stopped after I moved here. 23. My MA is ABT (all but thesis) in English Rhetoric/Composition/Literature (I stopped working on my thesis when Arthur was born after the whole Frank debaucle). However, I almost majored in biology, and I have enough credits that I could very easily go back and get a second BA. I love science and I'm an armchair scientist. I also minored in Poli Sci emphasis in Minority Politics. 24. Justin wants me to take the LSAT and I think I could do well in law school. But I don't wanna. 25. I hold an AA in Humanities, which basically means the random leftover fun classes that don't fit anywhere else like film and religion. That's not the interesting part. The interesting part is I got that degree when I went to the guidance counselor at TCC to ask if I would ever graduate, and she told me I basically just had to declare and do it because I had ACCIDENTALLY earned a degree in humanities. 26. When I drink, I drink rum, but if you take me out for a drink, buy me a vodka martini, dirty. It was also my brother's favorite drink. I converted to rum to make the household liquor situation simpler. 27. I only started wearing high heels and lipstick in my 30s. I just decided I wanted to do it one day, and I did. 28. I only wear makeup for fun, ever. 29. My hair is not colorful to get attention. In fact, if I think it's gonna get me too much attention, I pull it up as well as I can using a fucktrillion bobby pins. I wear it colorfully because my mom forced me to wear it past my butt as a teenager, so when I started wearing my hair how I wanted I decided I would only ever wear my hair the way I like it, and I like color. Ironically, I also like it really long. Go figure. 30. This is harder than I thought it would be. 31. I'm too verbose for facebook. I try to make up for it by being marginally witty. 32. Sometimes I Internet when I wake up with back pain. This became a problem at work when I began sending messages with ideas to coworkers and falling asleep while typing. In related news, if you get a nonsense message from me between the hours of 1 AM and 6 AM, please disregard it. 33. I won Justin Owen's heart with some bad jokes and rolling some silverware. To this day I hope that doesn't just mean he was in a dry spell. 34. Justin was cast against type. He won my heart by playing the long game. It didn't hurt that he liked good music, had a massive throbbing brain, and liked Steve Martin and the X-Files. 35. I spent my 21st birthday deliberating on a murder trial. It was also the judge's birthday. 36. I once beat up a homeless guy who tried to steal my purse. When I finally sold the purse at a garage sale, I advertised it as having magical powers of badassery. In related news, the purse was stolen while I was returning home to get the wallet I forgot to put in it. The most valuable things it contained were a crappy first gen nokia phone, my jeet kune do belt, and my contact lenses. 37. I have a dagger, and her name is Xena. Judge not lest ye be judged. 38. Finally. For fuck's sake. I am a fan of fandom. I'm just generally enthusiastic. I once cosplayed for the opening of Alice in Wonderland, and when I was a few weeks pregnant with Arthur I cosplayed Luna Lovegood to pick up my last Harry Potter book at Borders, even though I quickly realized I was in waythefuck over my head and ended up hiding under a table until my number was called with Bellatrix Lestrange aka Sacha Matheos. Know what? TOTALLY WORTH IT.
Tue, 15 Apr 2014 22:48:42 -0500
Brenda Lynn Rice Wilson

Tue, 15 Apr 2014 21:11:26 -0500
Anthony Mcdougald

Tue, 15 Apr 2014 20:33:30 -0500
Herbert Armstrong Via Mcdougald

Tue, 15 Apr 2014 20:28:33 -0500
Herbert Armstrong Via Mcdougald
Revelation of Jesus well the Word a, John 1;1 which the God of all but the goverment of the kingdom of Heaven.who gave unto but the gov. of God is one but not one the Word was with God in the beginning ,an you want hear any preacher say this but the Word was here in Abram time Meadona aa he told Abram at that time I was never born had no father or Mother have you ever been told that a,a,a it's in Genesis he told now this was when arbram with means in the Hebrew lang. young man Abraham only means old man any way he is only speak of one time he told Abram A young man at the time to go an over come and this sound mean i can't find the city but kill everyone woman an children well sound bad but you no why the were interbreading an the blood line to King David ,an Christ,it had to be done ,we hear no i don,t belive in predastonation ever think in history is are has to be done God said in the first i new before you are born i no it had to acceppet But it's The Plan Truth an I'll show you were Wed. my fingers are sore but you read an find for you don't let someone tell you God gave A mind to hear and see.
Tue, 15 Apr 2014 20:28:19 -0500
Asia Bonney
This is not fully, or at all, related to Maximum Ride. It's about Divergent. If you haven't finished the books then don't read! - A A A A A A A A A A A A A A A A Aa A A A A A A Ok so, I love and hate the ending. I love it because Four (Tobias) becomes stronger. But Tris dies. Ugh! I am so torn, I want to believe that she lived but I just can't! I love/hate Veronica Roth right now! Ugh! WHAT SHOULD I DO?!?!?!?!?!
Tue, 15 Apr 2014 18:45:14 -0500
Jane Prewitt Van Benthusen
Tonight at 8pm $5 + a supply list item like a box of herbal tea bags or toilet paper. ❤️
Tue, 15 Apr 2014 17:34:29 -0500
Tom Hamlett
In less than 3 weeks, I will be participating in the SPCA of Anne Arundel County's Walk/Run for the Animals. It is one of two major fundraisers each year for the SPCA, a non-profit organization which relies solely upon donations. I will be honoring my BFF Terra/Nellie, along with each and every other dog I have helped in AA County, including the ones we've lost like Uncle Tony, Chyna, Rocko, Lacey, Caesar, Cash, Rocky, Hulk, Doug, Baron, Happy Feet, Roxy, Bruno, Matilda, Wreck-It Ralph, Hannah, Julie, and many, many more who are not forgotten. I march in their honor and I'm asking for donations to help me help the SPCA. In my time at Animal Control, SPCA day was always the best day. They saved so many of our dogs, including pits, who never would have survived otherwise. Dogs like Scarlet, Rizza, Zha Zha, Cora, Selena, and Terra herself were saved by the SPCA. As a thank you for those lives saved and the many more to be saved in the coming year, please either donate via my page below, or just come out to the event and support the shelter that way. There's a 5k run, a walk, food vendors, contests, and you can bring the whole family, including the dogs! Did I mention this event happens on Star Wars day? The day after the National Pit Bull March in DC? This is going to be one heck of a weekend! All the stars are aligned for this to be a fantastic event for families, dogs, and most importantly, the SPCA. Thank you in advance to anyone willing to help me reach my goal. Saving these dogs truly takes a village and I couldn't do it without your support. May the 4th be with you!
Tue, 15 Apr 2014 15:36:33 -0500
Dr. Lawrence S. Carter Jr., MDVIP
The New Food Labels: Information Clinicians Can Use Laurie Scudder, NP, DNP, Jessica Leighton, PhD, MPH, Claudine Kavanaugh, PhD, MPH, RD April 09, 2014 Editor's Note: For the first time in 20 years, the US Food and Drug Administration (FDA) has announced plans to update the Nutrition Facts label. The proposed changes reflect new dietary recommendations; consensus reports; and national survey data, including the 2010 Dietary Guidelines for Americans,[1] nutrient intake recommendations from the Institute of Medicine, and intake data from the National Health and Nutrition Examination Survey. The FDA also obtained extensive input from a wide range of stakeholders, including the food industry, health groups, and consumer advocates. The timeline for rollout of new labels is still being developed, but the FDA anticipates working on the final regulation after the 90-day comment period ends. Although this is primarily a consumer issue aimed at making it easier to make healthy food choices, clinicians can anticipate that several changes will result in diet-related questions from patients. Medscape spoke with Jessica Leighton, PhD, MPH, Senior Advisor for Nutrition Science and Policy, and Claudine Kavanaugh, PhD, MPH, RD, a health scientist, both in the FDA's Office of Foods and Veterinary Medicine, about the key changes that healthcare professionals should be prepared to discuss with their patients. Medscape: Why is the FDA updating the Nutrition Facts label now? Dr. Leighton: In 1990, Congress passed the Nutrition Labeling and Education Act, which required that nutrition information be disclosed on most packaged foods. Regulations to implement this law became effective in 1994. The purpose of the Nutrition Facts label is to provide the general public with information necessary to choose healthy diets. Such information is just one tool to help people both maintain healthy weight and make healthier food choices. Over the 20 years since the labeling law was implemented, a lot of new science has looked at the relationship between nutrients and chronic diseases. We also know that the public health profile of the population has changed. For example, we've seen a dramatic increase in the rates of obesity. Portion sizes and the amount of food that people are consuming have also changed. We recognize that it's important to update the label to reflect all of this new science and public health information. On March 3, we published 2 proposals to update the requirements on the Nutrition Facts label. One of these proposed updates to nutrients required or permitted to be on the label; updates to reference values used to calculate the percent daily value; and changes to the format of the label to draw attention to such information as calories and serving size, which are important given the obesity problem in our country. The other proposal updates the information that food companies use to calculate serving size on the package. By law, the serving size information must be based on what people are actually eating in a sitting. They are not recommended amounts. This proposal also addressed the labeling of smaller package sizes, which people tend to eat in a single sitting, rather than over time. The comment period is open for 90 days. During that time, we encourage anyone -- industry, advocacy groups, public health organizations, or consumers -- to respond and provide comments on the proposed regulations. We will consider the comments as we are developing the final regulations, which will establish the final requirements that manufacturers must follow. Medscape: One of the biggest changes in the proposed labels is that information about the amount of "added sugars" in a food product would now be required. The 2010 Dietary Guidelines for Americans state that intake of added sugar is too high in the US population and should be reduced. However, unlike other nutrients, there is not an accepted daily value for added sugars. What are the advantages of this change, and how should clinicians advise their patients to use this information? Dr. Kavanaugh: The reason we're requiring added sugars on the label is to be consistent with recommendations in the Dietary Guidelines for Americans. The Guidelines state that calories from added sugars should be reduced. The average American consumes 16% of their daily caloric intake from added sugars; this is too much. High intakes of added sugars can decrease the intake of nutrient-rich foods while also increasing the overall calories that people are consuming. With the current label, consumers don't have information about added sugars in food products to help them comply with the recommendations of the Dietary Guideline for Americans. Some information on added sugars can be found in the ingredient label, but the exact amounts are not available on packages. Consumers may not even know which ingredients are added sugars. For example, consumers may not know that concentrated fruit juices are a form of added sugar. We are not proposing to include a daily value for added sugar, because there are no quantitative intake recommendations from government consensus reports to set a daily value. But having added sugars on the label, if the proposals are finalized, will allow clinicians and health professionals to help their patients identify products that have added sugars, as well as compare products. A consumer would be able to look at 2 different types of yogurt, for example, and be able to easily see which has less added sugar. Medscape: The proposed labels would also require the declaration of potassium and vitamin D. Vitamins A and C would no longer be required on the label, although manufacturers could declare them voluntarily. Vitamin D deficiency is widely prevalent.[2] Estimates of incidence vary significantly, with a recent 2013 study suggesting that as many as one third to one half of adults in developing countries may have some degree of deficiency.[3] However, the consensus is that this is largely due to inadequate cutaneous production resulting from decreased exposure to sunlight, and not primarily from low dietary intake. Thus. recommendations regarding dietary intake can be complex and must take into account an individual's sun exposure, sex, and age; the region in which they live; and their skin color. What is the best advice for clinicians to provide patients on how to use this information regarding vitamin D in foods? Dr. Leighton: We know that vitamin D is important for health, especially for its role in bone health. We know that intakes in some population groups are not adequate and that some patients get inadequate exposure to sunlight. There are a limited number of foods that are naturally high in vitamin D. There are other foods that for many years have been fortified with vitamin D, most importantly milk. Milk has been voluntarily fortified with vitamin D since the early part of the last century, and dairy products have been important sources of vitamin D for many consumers. There are some population groups, such as elderly persons and people with limited sun exposure, who are at risk of having inadequate vitamin D intakes; the labeling information would help consumers to know what foods actually do or don't contain vitamin D. Clinicians will be able to refer to consistent information related to vitamin D on a label and direct their patients to that information to see which foods are higher in vitamin D. Medscape: The proposed label changes also update serving size requirements to reflect the amounts people currently eat, which for better or worse has changed in the 20 years since the current labels were created. By law, serving sizes must be based on what people actually eat, not on what people "should" be eating. This can be a tough message for clinicians, who must simultaneously talk to patients about moderating serving sizes. What do you suggest as best strategies for messaging? Dr. Leighton: Current serving sizes on labels were based on data that were analyzed in the early 1990s from surveys done in the 1970s and 1980s. So that information is outdated. Clinicians can emphasize to their patients that serving size information on packages is not actually the recommended amounts, but instead reflect what people are actually eating. So if clinicians -- and consumers -- understand that, they're more likely to know that for some foods, the serving sizes consumed should be less than what is indicated on the label, depending on such factors as caloric needs. Having the serving size information reflect what people are actually eating helps consumers be more aware of what they're consuming without having to do the math. For example, a pint of ice cream currently labeled as 4 servings would instead be only 2 servings under the new proposed requirements. People would be more able to see that if they consume a cup of ice cream, they will be getting 400 calories in that serving. They would no longer be required to do the math to figure out what is in their actual serving. It's important that clinicians also recommend to their patients that limiting serving size is an important factor in weight control. By looking at the package, they can know how big a serving size is and how many calories they are actually consuming in that serving size. Medscape: Sodium values reflect a slight decrease in the daily value for sodium, from 2400 to 2300 mg. However, the American Heart Association (AHA), while commending the FDA's changes, noted that this sodium recommendation was still too high. The AHA recommends that sodium intake be limited to 1500 mg/day.[4] Can you discuss the evidence that is behind the proposed daily value of 2300 mg? Dr. Kavanaugh: As your readers know, sodium is an essential nutrient, and increases in sodium can increase blood pressure and the risk for cardiovascular disease. Although we are proposing to change the daily value from 2400 mg to 2300 mg, people are still consuming too much. On average, people consume about 3400 mg of sodium per day. The 2300 mg recommendation we are proposing is based on the upper dietary intake limit for sodium that was established by the Institute of Medicine in 2005.[5] If patients lower their intake to this amount, it would still result in a considerable reduction in their current intake of sodium. Although certainly, some evidence does point to the need for a lower daily value, a 2013 Institute of Medicine report concluded that evidence from studies on direct health outcomes is inconsistent and insufficient to conclude that lowering sodium intakes below 2300 mg will increase or decrease the risk for cardiovascular disease outcomes or mortality in the general US population or in specific subgroups.[6] Medscape: What would you suggest as the best resources or other information that clinicians provide to their patients who wish to read more about these changes? Dr. Kavanaugh: The FDA has materials on our Website that discuss these changes. This includes 3 consumer updates that go over the changes we're making on the label. In particular, they address the question of why we are requiring added sugars, the change in serving sizes, and the format changes, as well as the underlying science that we used to update the label. We also have some materials on how to use the current nutrition facts label on our Website that clinicians will find to be helpful resources for their patients. Medscape: Are there any other key points you wish to emphasize for our clinician audience? Dr. Kavanaugh: We think it is important to note that the new labels will highlight calories and serving sizes more prominently. The information about calories and serving size is a lot larger and bolder on the proposed new labels. We are proposing these changes so that people can find the information more easily. We think this is particularly important, because the majority of the US population is overweight or obese. One other important item to note for clinicians is that the proposed labels would include the absolute amount, in grams, milligrams, or micrograms, of all of the vitamins and minerals on the label. Currently, information about some vitamins or minerals, such as calcium or iron, includes only the percent daily value contained in that food item. A cereal box, for example, includes the daily values of a lot of nutrients contained in a serving, many of which are not required to be on the label. On the proposed labels, manufacturers would actually have to put the absolute amount of each vitamin and mineral in addition to the daily value. That can be very helpful for clinicians, who may need to instruct a patient about how much calcium they need to consume in a day. With the addition of the absolute amounts, they could see how much calcium is in a particular product in addition to using the daily value as a guide. We're adding this because of input we received from clinicians and health professionals in response to the Advance Notice of Proposed Rulemaking that this would be helpful for them. Dr. Leighton: Clearly, clinicians can also use the label to help their patients who need to specifically reduce or increase the amount of certain nutrients because they have certain conditions, and we hope they do that. However, we want to note that the label is intended for use by the general population and those at high risk for chronic disease. Editor’s Note: The FDA provides comprehensive online resources for consumer education. References 1.US Department of Agriculture, Center for Nutrition Policy and Promotion. 2010 Dietary Guidelines for Americans. 7th ed. cnpp.usda.gov/dietaryguidelines.htm Accessed March 3, 2014. 2.Institute of Medicine. Dietary reference intakes for calcium and vitamin D. November 2010. iom.edu/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Report%20Brief.pdf Accessed March 18, 2014. 3.Al Mheid I, Patel RS, Tangpricha V, Quyyumi AA. Vitamin D and cardiovascular disease: is the evidence solid? Eur Heart J. 2013;34:3691-3698. medscape/viewarticle/818818 Accessed March 3, 2014. 4.Appel LJ, Frohlich ED, Hall JE, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. 2011;123:1138-1143. circ.ahajournals.org/content/123/10/1138 Accessed March 3, 2014. 5.Panel on Dietary Reference Intakes for Electrolytes and Water, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press; 2005. iom.edu/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx Accessed March 18, 2014. 6.Institute of Medicine. Sodium intake in populations. Assessment of evidence. May 2013. iom.edu/~/media/Files/Report%20Files/2013/Sodium-Intake-Populations/SodiumIntakeinPopulations_RB.pdf Accessed March 18, 2014. Public Information from the FDA and Medscape
Tue, 15 Apr 2014 14:34:54 -0500
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