Target Health Inc. Congratulates MDGH on Approval of Moxidectin for the Treatment of River Blindness (Onchocerciasis)

 

New York, NY – 5 July 2018: Target Health Inc. would like to congratulate Medicines Development for Global Health (MDGH) and the World Health Organisation Special Programme for Research and Training in Tropical Diseases (TDR) upon U.S. FDA approval of moxidectin 8 mg oral for the treatment of river blindness (onchocerciasis) in patients aged 12 years and older. River blindness is caused by a parasitic worm, Onchocerca volvulus. This tropical disease manifests as severe itching, disfiguring skin conditions and visual impairment, including permanent blindness caused by the worm’s larvae (microfilariae). The approval of moxidectin was based on data from two randomized, double blind, active controlled clinical studies. Each study met its respective primary endpoints, showing a statistically significant superiority of moxidectin over the current standard of care, ivermectin, in suppressing the presence of the microfilariae in skin.

 

“MDGH sincerely thanks Target Health, our US Agent and electronic submission contractor for post-NDA submission activities” said Danielle Smith, PhD, Associate Director of MDGH. Dr. Smith added that, “Target’s professionalism and expertise ensured that MDGH’ s submissions were appropriately presented for approval to the FDA, and Target Health’s flexibility was also very much appreciated as there were multiple NDA amendments, many with tight turnaround times.  Jules Mitchel,, MBA PhD, President of Target Health added that “Target Health very much looks forward to continuing our successful relationship as MDGH now heads into the post-approval phase.” MDGH US Agent and post-submission electronic submission activities at Target Health were managed by Mary Shatzoff, Sr. Director of Regulatory Affairs at Target Health.

 

The FDA awarded MDGH a priority review voucher (PRV) and full results from the Phase III study were published in the Lancet in January 2018 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30101-6/fulltext).

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

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Autism and Autism Spectrum Disorder (ASD)

Toddler Stacking Cans. Repetitively stacking or lining up objects is associated with autism. Photo credit: Andwhatsnext at English Wikipedia. – Originally from en.wikipedia; description page is/was here., CC BY-SA 3.0,https://commons.wikimedia.org/w/index.php?curid=5118849

 

A toddler with autism who has arranged his toys in a row. Photo credit: Andwhatsnext at English Wikipedia. – Transferred from en.wikipedia to Commons., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1983792 

 

Autism is a developmental disorder characterized by troubles with social interaction and communication and by restricted and repetitive behavior. Parents usually notice signs in the first two or three years of their child’s life. These signs often develop gradually, though some children with autism reach their developmental milestones at a normal pace and then worsen. In the United States, a revision from autism to autism spectrum disorder (ASD) was presented in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 2013. The new diagnosis encompasses previous diagnoses of 1) ___ disorder, Asperger syndrome, childhood disintegrative disorder, and PDD-NOS. Compared with the DSM-IV diagnosis of autistic disorder, the DSM-5 diagnosis of ASD no longer includes communication as a separate criterion and has merged social interaction and communication into one category. Slightly different diagnostic definitions are used in other countries. For example, the ICD-10 is the most commonly-used diagnostic manual in the UK and European Union. Rather than categorizing these diagnoses, the DSM-5 has adopted a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella. Some have proposed that individuals on the autism spectrum may be better represented as a single diagnostic category. Within this category, the DSM-5 has proposed a framework of differentiating each individual by dimensions of severity, as well as associated features (i.e., known genetic disorders, and intellectual disability). Another change to the DSM includes collapsing social and communication deficits into one domain. Thus, an individual with an ASD diagnosis will be described in terms of severity of social communication symptoms, severity of fixated or restricted behaviors or interests, and associated features. The restricting of onset age has also been loosened from 3 years of age to “early developmental period”, with a note that symptoms may manifest later when social demands exceed capabilities.

 

Autism spectrum, also known as autism spectrum 2) ___ (ASD), is a range of conditions classified as neurodevelopmental disorders. Individuals diagnosed with autism spectrum disorder present with two types of symptoms: problems in social communication and social interaction, and restricted, repetitive patterns of behavior, interests or activities. Symptoms are typically recognized between 3) ___ and two years of age. Long term issues may include difficulties in creating and keeping relationships, maintaining a job, and performing daily tasks. The cause of autism spectrum is uncertain. Risk factors include having an 4) ___ parent, a family history of the condition, and certain genetic conditions. Diagnosis is based on symptoms. The DSM-5 redefined the autism spectrum disorders to encompass the previous diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder. Treatment efforts are generally individualized to the person’s condition. Medications may be used to try to help improve certain associated problems. Evidence to support the use of medications, however, is not very strong. Autism spectrum is estimated to affect about 1% of people (62.2 million globally as of 2015). Males are diagnosed more often than females.

 

Autism risk factors include certain infections during pregnancy, such as rubella, as well as valproic acid, alcohol or cocaine use during pregnancy. Controversies surround other proposed environmental causes, for example the vaccine hypotheses, which have been disproven. Autism affects information processing in the brain by altering how nerve cells and their 5) ___ connect and organize; how this occurs is not well understood. Early speech or behavioral interventions can help children with autism gain self-care, social skills and communication skills. Although there is no known 6) ___, there have been cases of children who have recovered from the condition. Not many children with autism live independently after reaching adulthood, though some are successful.

 

Globally, autism is estimated to affect 24.8 million people as of 2015. In the developed countries, about 1.5% of children are diagnosed with ASD as of 2017, a more than doubling from 0.7% in 2000 in the United States. It occurs four-to-five times more often in boys than girls. The number of people diagnosed has increased dramatically since the 1960s, partly due to changes in diagnostic practice; the question of whether actual rates have increased is unresolved. Overt symptoms gradually begin after the age of six months, become established by age two or three years and tend to continue through adulthood, although often in more muted form. Other aspects, such as atypical eating, are also common but are not essential for diagnosis. Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.

 

Social deficits distinguish autism and the related autism spectrum disorders from other developmental disorders. People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling “like an anthropologist on Mars.” One year after researchers published their work on a physiological test for autism, a follow-up study confirmed its exceptional success in assessing whether a child is on the autism spectrum. A physiological test that supports a clinician’s diagnostic process has the potential to lower the age at which children are diagnosed, leading to earlier treatment. Results of the study, which uses an algorithm to predict if a child has ASD based on metabolites in a 7) ___ sample, published in the June 2018 edition of Bioengineering & Translational Medicine. The study was able to predict with 88% accuracy whether children have autism. The initial success in 2017 analyzed data from a group of 149 people, about half of whom had been previously diagnosed with ASD. For each member of the group, data was obtained on 24 metabolites related to the two cellular pathways — the methionine cycle and the transsulfuration pathway. To validate the results, existing datasets were searched that included the metabolites that were analyzed in the original study. Datasets were identified that included a total of 154 children with autism. The team used their approach to recreate the predictive 8) ___, this time using data of the 22 metabolites from the original group of 149 children. The algorithm was then applied to the new group of 154 children for testing purposes. When the predictive algorithm was applied to each individual, it correctly predicted autism with 88% accuracy. This is an approach should support moving forward into 9) ___ trials and ultimately into a commercially available test. Sources: Multivariate techniques enable a biochemical classification of children with autism spectrum disorder versus typically-developing peers: A comparison and validation study. Bioengineering & Translational Medicine, 2018; DOI: 10.1002/btm2.10095; Rensselaer Polytechnic Institute. “Success of blood test for autism affirmed: First physiological test for autism proves high accuracy in second trial.” ScienceDaily.com, 19 June 2018; Wikipedia

 

Cerebrospinal fluid (CSF) may be an early marker for autism.

 

CSF is a colorless fluid that surrounds the brain and spinal cord. CSF acts as a physical buffer to protect the 10) ___from jolts. Until relatively recently, this was thought to be CSF’s only role. However, recent studies have shown that CSF also acts as a “filtration system for byproducts of brain metabolism.” As brain cells fire, they produce toxic products such as inflammatory proteins. The CSF filters out these compounds regularly, replenishing itself around four times per day. A study published in Biological Psychiatry show that levels of this fluid could potentially predict autism. The study looked at CSF and its relationship with autism. The findings showed that babies who went on to develop autism had significantly more CSF than babies who did not go on to develop the condition. Sources: Biological Psychiatry, August 2017.

 

ANSWERS: 1) autistic; 2) disorder; 3) one; 4) older; 5) synapses; 6) cure; 7) blood; 8) algorithm; 9) clinical; 10) brain

 

Helen Rodriquez Trias MD (1929 – 2001)

Helen Rodriquez Trias MD: By National Center for Biotechnology Information – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447119/pdf/0920566.pdf, Public Domain, https://commons.wikimedia.org/w/index.php?curid=70643318

 

Helen Rodriquez Trias (July 7, 1929 – December 27, 2001) was a pediatrician, educator and women’s rights activist. She was the first Latina president of the American Public Health Association, a founding member of the Women’s Caucus of the American Public Health Association, and a recipient of the Presidential Citizens Medal. She is credited with helping to expand the range of public health services for women and children in minority and low-income populations around the world. Rodriquez Trias’s parents moved to New York City from Puerto Rico in the early part of the 20th century. After her birth, her family returned to Puerto Rico only to return to New York in 1939. In New York, Rodriquez Trias experienced racism and discrimination. In school, she was placed in a class with students who were academically handicapped, even though she had good grades and knew how to speak English. After she participated in a poem recital, her teacher realized that she was a gifted child and sent her to a class with gifted children.

 

Rodriquez Trias’s mother was a school teacher in Puerto Rico. However, in New York she was unable to get a teacher’s license. Therefore, her mother had to take in boarders to meet her financial needs and pay the rent. After Rodriquez Trias graduated from high school, she decided she would like to study medicine and that her chances would be much better in Puerto Rico because the island had a good scholarship system. In 1948, she began her academic education at the University of Puerto Rico in San Juan. The university had a very strong independence movement and Rodriquez Trias became involved with the student faction of the Puerto Rican Nationalist Party. Nationalist leader Don Pedro Albizu Campos was invited to speak by the student council; however, the chancellor of the university, Jaime Rexach Ben?tez, did not permit Albizu access to the campus. The students consequently went on strike, with Rodriquez Trias amongst them, but her brother did not approve of this. He threatened to cut off her college expenses and she returned to New York.

 

In New York, she married and had three children before she decided to return to Puerto Rico to pursue her degree. At the University of Puerto Rico, she became a student activist on issues such as freedom of speech and Puerto Rican independence. She earned her BA degree in 1957 and entered UPR’s school of medicine. She earned her medical degree in 1960 and soon after gave birth to her fourth child. During her residency at the University Hospital in San Juan, she established the first center for the care of newborn babies in Puerto Rico. The hospital’s death rate for newborns decreased 50% within three years. She established her medical practice in the field of pediatrics in the island after completing her residency. Rodriquez Trias headed the department of pediatrics at Lincoln Hospital in the South Bronx. At Lincoln Hospital, Rodriquez Trias lobbied to give all workers a voice in administrative and patient-care issues. She became involved with the Puerto Rican community and encouraged the health care workers at the hospital to become aware of the cultural issues and needs of the community. Rodriquez Trias was also an associate professor of medicine at Albert Einstein College of Medicine, Yeshiva University, and later taught at Columbia and Fordham universities.

 

During her years in Puerto Rico, Rodriquez Trias became aware that unsuspecting Puerto Rican women were being sterilized and that the United States was using Puerto Rico as a laboratory for the development of birth control technology. In 1970, she was a founding member of Committee to End Sterilization Abuse and in 1971 a founding member of the Women’s Caucus of the American Public Health Association. She supported abortion rights, fought for the abolishment of enforced sterilization, and sought neonatal care for underserved people. In 1979, she became a founding member of the Committee for Abortion Rights and Against Sterilization Abuse and testified before the Department of Health, Education, and Welfare for passage of federal sterilization guidelines. The guidelines, which she drafted, required a woman’s written consent to sterilization in a language they could understand, and set a waiting period between the consent and the sterilization procedure. She is credited with helping to expand the range of public health services for women and children in minority and low-income populations in the United States, Central and South America, Africa, Asia, and the Middle East.

 

In the 1980s, Rodriquez Trias served as medical director of the New York State Department of Health AIDS Institute. She worked on behalf of women from minority groups who were infected with HIV. In the 1990s, she served as health co-director of the Pacific Institute for Women’s Health, a nonprofit research and advocacy group dedicated to improving women’s well-being worldwide and focused on reproduction. She was a founding member of both the Women’s Caucus and the Hispanic Caucus of the American Public Health Association and the first Latina to serve as the president of the APHA.

 

On January 8, 2001, President Bill Clinton awarded Rodriquez Trias with the Presidential Citizen’s Medal, the second-highest civilian award in the United States, for her work on behalf of women, children, people with HIV and AIDS, and the poor. Later that year, on December 27, Rodriquez Trias died, a victim of cancer.

 

On July 7, 2018, which would have been Rodriquez Trias’ 89th birthday, Google featured her in a Google Doodle in the United States.

 

Presidential Citizens Medal: Photo credit: U.S. Government; Wikipedia Commons: Graphic Lab/Illustration workshop/Archive/2015

Natural Lipid Acts as Potent Anti-Inflammatory

 

Lipids are known to help Francisella tularensis bacteria, the cause of tularemia, to suppress host inflammation when infecting mouse and human cells. Tularemia is a life-threatening disease spread to humans via contact with an infected animal or through the bite of a mosquito, tick or deer fly. Although tularemia can be successfully treated with antibiotics, it is difficult to diagnose, mainly because F. tularensis bacteria can suppress the human immune response. Dengue fever, primarily spread by Aedes aegypti mosquitoes, is rarely fatal but usually leads to a high fever, severe headache and pain throughout the body. There is no specific treatment for dengue fever.

 

According to an article published in the Journal of Innate Immunity (6 July 2018), a naturally occurring lipid has been identified that is used by F. tularensis to impair the host immune response and increase the chance of infection. Serendipitously, the authors may have also found a potent inflammation therapy against bacterial and viral diseases. The study found a form of the lipid phosphatidylethanoloamine, or PE, present in F. tularensis differs from PE found in other bacteria. In cell-culture experiments, the authos discovered that the natural and a synthetic form of PE reduced inflammation caused by both tularemia bacteria and dengue fever virus. After identifying PE as the lipid that impaired the immune response, the authors began to consider its potential therapeutic value. Because natural F. tularensis is highly infectious and therefore challenging to work with, the group developed synthetic lipids-PE2410 and PEPC2410-that would be much easier to study and produce. They then verified that both synthetic lipids also suppressed the immune response during infection of mouse and human cells in the laboratory.

 

Because several types of viral infections involve an unconstrained inflammatory response, the group tested natural and their synthetic PE in the laboratory against dengue fever virus-infected human cells. Both versions inhibited the immune response compared to the immune response seen in infected but untreated cells. Going forward, the group plans to continue exploring how F. tularensis impairs the immune response and they hope that their findings will eventually lead to the development of a potent, broad-spectrum anti-inflammatory therapeutic.

 

Process Leading to Release of Malaria Parasites From Red Blood Cells

 

Malaria is a mosquito-borne infectious disease affecting humans and other animals caused by parasitic protozoans (a group of single-celled microorganisms) belonging to the Plasmodium type. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death. Symptoms usually begin ten to fifteen days after being bitten. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria.

 

The disease is most commonly transmitted by an infected female Anopheles mosquito. The mosquito bite introduces the parasites from the mosquito’s saliva into a person’s blood. The parasites travel to the liver where they mature and reproduce. Five species of Plasmodium can infect and be spread by humans. Most deaths are caused by P. falciparum because P. vivax, P. ovale, and P. malariae, generally cause a milder form of malaria. The species P. knowlesi rarely causes disease in humans. Malaria is typically diagnosed by the microscopic examination of blood using blood films, or with antigen-based rapid diagnostic tests. Methods that use the polymerase chain reaction to detect the parasite’s DNA have been developed, but are not widely used in areas where malaria is common due to their cost and complexity.

 

During a malarial infection, the vacuole, which is a compartment inside human red blood cells in which malaria parasites reproduce and develop, takes on a distinct spherical shape just minutes before its membrane ruptures, which leads to the release of parasites into the blood stream. According to an article published in Cellular Microbiology (11 July 2018), while working with red blood cells from healthy donors, the authors were able to chemically block the sequence of events leading to this rounding of the vacuole. To track the rounding sequence under a microscope, the authors dyed the membrane of the vacuole with a substance that gives off green light. About 10 minutes before the membrane ruptured, the vacuole morphed from a lumpy, uneven shape to a sphere. Previous studies have shown that malaria parasites use calcium to trigger the biochemical reactions needed for their release from the cell. When the authors treated the cells with a compound that blocks calcium’s effect, the vacuoles couldn’t transition to the spherical form, trapping the parasites inside the cell.

 

The authors noted that targeting this sequence could inform new treatment strategies against Plasmodium falciparum, the species of malaria parasite that causes the most deaths worldwide and, in several areas, has become drug-resistant.

 

First Drug Approved to Treat Smallpox

 

Prior to its eradication in 1980, variola virus, the virus that causes smallpox, was mainly spread by direct contact between people. Symptoms typically began 10 to 14 days after infection and included fever, exhaustion, headache and backache. A rash initially consisting of small, pink bumps progressed to pus-filled sores before finally crusting over and scarring. Complications of smallpox could include encephalitis (inflammation of the brain), corneal ulcerations (an open sore on the clear, front surface of the eye) and blindness. Though the World Health Organization declared smallpox, a contagious and sometimes fatal infectious disease, eradicated in 1980, there have been longstanding concerns that smallpox could be used as a bioweapon.

 

The FDA has approved TPOXX (tecovirimat), the first drug with an indication for treatment of smallpox. TPOXX was developed in conjunction with the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA).

 

TPOXX’s effectiveness against smallpox was established by studies conducted in animals infected with viruses that are closely related to the virus that causes smallpox, and was based on measuring survival at the end of the studies. More animals treated with TPOXX lived compared to the animals treated with placebo. TPOXX was approved under the FDA’s Animal Rule, which allows efficacy findings from adequate and well-controlled animal studies to support an FDA approval when it is not feasible or ethical to conduct efficacy trials in humans.

 

The safety of TPOXX was evaluated in 359 healthy human volunteers without a smallpox infection. The most frequently reported side effects were headache, nausea and abdominal pain. The FDA granted this application Fast Track and Priority Review designations. TPOXX also received Orphan Drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases and a Material Threat Medical Countermeasure Priority Review Voucher, which provides additional incentives for certain medical products intended to treat or prevent harm from specific chemical, biological, radiological and nuclear threats.

 

The FDA granted approval of TPOXX to SIGA Technologies Inc.

 

Kitchari: Adapted from Several Pakistani/Indian Recipes

Kitchari means mixture, usually of two grains. ©Joyce Hays, Target Health Inc.

 

This is a delicious vegetarian dish that stands alone or with a salad. However, you could serve it as an accompaniment with fish or poultry. ©Joyce Hays, Target Health Inc.

 

Jules and I love Kitchari. It can be varied in a multitude of ways. Here, above, is our latest meal that we shared with our son, Alex who, like us, gobbled it up. The Kitchari is served over basmati boiled in chicken broth (instead of water), with a garnish of sweet mango, yogurt and mango chutney. ©Joyce Hays, Target Health Inc.

 

Ingredients

1 cup Basmati rice or short-grained brown rice, rinsed twice

3 Tablespoons ghee or butter or extra virgin olive oil

1 inch fresh ginger, peeled then grated

4 cups stock or broth (veggie or chicken broth), extra for cooking rice and lentils

1 Tablespoon black mustard seeds, toasted

1 Tablespoon cumin seeds, toasted

1 jalapeno, seeded, chopped well

2 large carrots, roughly chopped

1 sweet potato, cubed

1 pinch kosher salt or 3 anchovy fillets mashed with 3 garlic cloves

1.5 cups yellow mung (yellow lentils) beans

1 Tablespoons turmeric

1 Tablespoon coriander powder

12 more fresh garlic cloves sliced

10 fresh garlic cloves, leave them whole

1 bunch kale, ribs removed, sliced into ribbons

1 large onion, diced

1/2 bunch cilantro, roughly chopped, plus a few sprigs for garnish

Zest of 2 fresh lemons

2 fresh lemons, juiced

Cashews, toast them in oven or in skillet on stove (optional)

Plain full-fat yogurt (optional)

Mango chutney

 

If your local store doesn’t carry some of these spices, you can probably get all of them on Amazon. ©Joyce Hays, Target Health Inc.

 

Directions

1. Follow the directions on the package of mung beans and cook now. With some, you will soak the moong beans (yellow lentils) in water for 2 hours before cooking. Cook in broth, even though the directions won’t say to do this.

2. Cook the rice in a rice cooker or in a saucepan on the stove (cook in broth: veggie or chicken broth).

3. Rinse the kale and cilantro twice and drain twice, then pat dry with paper toweling.

4. Do all your peeling, grating, toasting, mashing, chopping slicing, etc.

 

Grinding up the anchovies and garlic cloves in my mortar and pestle. This piece of equipment is not the latest fad in cooking; or mainly for gourmet chefs. In fact, it’s one of the oldest (if not THE oldest) item used in kitchens. When I use it, I’m always impressed that here in my own kitchen 21st century kitchen, we’re using the exact technology that dates back to approximately 35,000 BCE. You’ve got to have this. ©Joyce Hays, Target Health Inc.

 

Chopping and/or slicing veggies all at the same time. ©Joyce Hays, Target Health Inc.

 

5. Add two Tablespoons of butter or ghee or extra virgin olive oil, to a large pot or a Dutch oven over medium heat. Add the mustard and cumin seeds. Stir and let it sizzle for one minute, then add the jalapeno and the sliced garlic. Since I’ve made this recipe more than once, I’ve used butter, olive oil and ghee. We prefer olive oil because it’s healthier and doesn’t affect the flavor one bit.

 

Toasting the mustard and cumin seeds. Consider using a cover while you toast the seeds. When the mustard seeds start to pop, they can jump out of the pan. You don’t want to get hit in the face or eye. ©Joyce Hays, Target Health Inc.

 

Seeds are done, so slowly adding more, stirring everything together. ©Joyce Hays, Target Health Inc.

 

6. Add the carrots, sweet potato and anchovy/garlic, to the pot, and saut? for three minutes.

 

Adding the carrots and sweet potatoes. ©Joyce Hays, Target Health Inc.

 

7. Add the yellow mung beans, turmeric and coriander. Stir and cook for approximately one minute.

 

Adding the mung (yellow lentils) beans and spices. ©Joyce Hays, Target Health Inc.

 

8. To the pot, add four cups of broth. Bring to a boil, lower to a simmer and cover. Add the whole garlic cloves and stir in. Cook for 20 minutes, or until the sweet potatoes and carrots are cooked through and the mung beans have fallen apart.

 

Broth has been added, plus garlic. Now, will cover and cook for 20 minutes. ©Joyce Hays, Target Health Inc.

 

9. Toss the kale in the pot and simmer for 10 more minutes with the lid on.

 

Adding the kale. Notice how much thicker the rest of the stew has become in the 20 minutes of cooking. ©Joyce Hays, Target Health Inc.

 

10. While the kale is cooking, grab a small saut? pan and heat the remaining Tablespoon of olive oil, or butter or ghee. Add the onions and saut? until deep, golden brown. Throw in the cilantro and stir.

11. Transfer the onions and cilantro (plus any juices) from the pan to the pot and stir to combine.

12. Let the stew simmer for five minutes, then add the lemon juice and stir to combine. If you’re using the cashews, add them now and stir into the Kitchari. Remove the pot from heat and let stand for a few minutes.

 

Simmering. Just about ready to serve. ©Joyce Hays, Target Health Inc.

 

When ready to serve, add 1 or 2 Tablespoons of cooked brown or white rice to a soup bowl or plate, and add 2 or 3 Tablespoons of kitchari on top of the rice. Next to the kitchari, add some plain yogurt and garnish with a few sprigs of fresh cilantro.

 

Have Mango chutney on the table and extra yogurt

 

Read more

 

Here is the first delicious Kitchari meal: Kitchari over basmati plus some veggies roasted on a baking sheet with olive oil drizzled over the veggies. We love Kitchari and plan to have it often. The next morning, I weighed less. ©Joyce Hays, Target Health Inc.

 

At another meal, we had Kitchari over saffron rice, roasted veggies and chicken thighs. ©Joyce Hays, Target Health Inc.

 

We started this meal with icy Pouilly-Fuisse in chilled glasses, warm pita bread and garlic hummus. Next came the Kitchari with basmati rice, yogurt and mango chutney (we didn’t add cashews). For dessert, (see above) fresh red seedless grapes and vanilla Tofutti (soy) ice cream. We felt happy and healthy and knew that when we got on the bathroom scales the next morning, we’d still be happy. ©Joyce Hays, Target Health Inc.

 

This icy white wine in pre-chilled glasses, was a good pairing for the Kitchari.  ©Joyce Hays, Target Health Inc.

 

If you’re not familiar with Pakistani or Indian food, you’re in for a real flavor treat in which you can adjust the spiciness to suit your taste. My first experience was when I was living in London, having dinner at a restaurant with friends, I could not believe how hot my mouth got. I ended up drinking a whole pitcher of ice water, before I felt like myself again. You do not need to go through that, if you’re doing the cooking. Most restaurants now ask if you want your order hot, medium spicy, mild or very mild. In your own kitchen, you customize all recipes.

 

In my early twenties, when I was doing a lot of yoga and living in Manhattan, I was also well acquainted with Swami Satchidananda (we called him Swamiji), where I attended his many lectures and often spent time in his kitchen, with others like Peter Max, where he taught me how to make curried cauliflower with potato. We became such good friends, that we invited him to come for a long weekend to our summer place in the Adirondacks, on the shores of a large lake. At the time I was driving a diesel Mercedes with a stick shift. He loved to drive it with his left leg in the lotus position and the other leg in driving position. When we went sailing, he would stand on the bow, gripping the mast, like a living figurehead, his saffron robes whipping in the wind. He was really something to behold; a very special person.

 

Swami Satchidananda (aka Swamiji

 

Have a great week everyone!

Bon Appetit!