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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK604845_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK604845_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Tamsulosin/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Tasimelteon/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK604845_"><span class="title" itemprop="name">Tara Flour</span></h1><p class="small">Last Update: <span itemprop="dateModified">June 20, 2024</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="TaraFlour.OVERVIEW"><h2 id="_TaraFlour_OVERVIEW_">OVERVIEW</h2><div id="TaraFlour.Introduction"><h3>Introduction</h3><p>Tara flour is a protein-rich flour made from the seeds of the Caesalpinia spinosa tree that was found to cause acute gastrointestinal and liver injury when used in a commercial food product called “Daily Harvest’s French Lentil and Leek Crumbles”. Chemical analysis of the product demonstrated the presence of a non-protein amino acid baikiain which caused liver injury when given orally in an animal model and was therefore the likely cause of the liver injury seen in humans who consumed the product.</p></div><div id="TaraFlour.Background"><h3>Background</h3><p>Tara flour is a protein-rich flour made from the seeds of the Caesalpinia spinosa tree which is native to Peru and found in several regions in South America. When introduced into a commercial food product called “Daily Harvest’s French Lentil and Leek Crumbles” in April 2022, it caused an outbreak of acute gastrointestinal and liver disease that affected at least 393 people before it was removed from the market in late-June 2022. Chemical analysis of the product demonstrated more than 27 ingredients, none of which were known to cause liver injury. The product was free of evidence of contamination with toxic compounds including microbial or viral pathogens, mycotoxins, allergens, heavy metals, and pesticides. However, among products identified in the crumbles was tara flour which on further analysis was found to be rich in the 3 non-protein amino acids, baikiain (3% dry weight), L-3-hydroxymethyltyrosine (3HMT: 1.5%), and L-3-hydroxymethylphenylalanine (3HMP: 0.5%). Analysis of baikiain in toxicology studies demonstrated that it caused liver injury in mice after oral ingestion with serum <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> levels rising from 31 to 230 U/L within 6 hours. After removal of the tara flour from the commercial product, no further human cases of liver injury were seen. While tara flour had not been known to cause liver injury, similar acute toxic reactions to foods have been seen in the past in grazing animals exposed to plants that synthesize non-protein amino acids, which are analogues of amino acids and result in absent or diminished function of the protein enzymes with the substituted amino acid.</p></div><div id="TaraFlour.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>The typical clinical onset of tara flour toxicity was with indigestion and variable degrees of abdominal pain, nausea and vomiting within 4 to 12 hours of ingestion, which was sometimes severe enough to result in an emergency room visit or even hospitalization and cholecystectomy. In some patients, symptoms persisted and were followed by fatigue, dark urine, and jaundice two to eight days later. Laboratory testing demonstrated a hepatocellular pattern of serum enzyme elevations with <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> and <a class="def" href="/books/n/livertox/glossary/def-item/glossary.aspartate-aminotransferase-ast-/">AST</a> levels in the range of 3 to 20 times the upper limit of normal (ULN) and only mild or no increases in alkaline phosphatase levels. Total serum bilirubin levels were elevated in more severe cases, but generally were rather modest with peak levels of 2.0 to 10.0 mg/dL and rapid improvement within days. In long term follow up of patients, all values returned to the normal or baseline levels. Liver biopsy in one case showed a mild acute hepatitis with lobular inflammation, mild lymphocytic infiltration and no steatosis, fibrosis, or cholestasis. Virtually all cases arose in May and June of 2022 with none appearing after the withdrawal of the food product. However, cases of acute liver injury have also been reported after ingestion of other food products that included tara flour as an ingredient.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: B (likely cause of clinically apparent liver injury).</p></div><div id="TaraFlour.Mechanism_of_liver_injury"><h3>Mechanism of liver injury</h3><p>Tara flour appears to be a direct hepatotoxin, although its toxicity may depend upon an initial metabolism to a more toxic intermediate or substitution of the non-protein amino acid baikiain into a functional and important enzyme. Baikiain does not harm mammalian or human cells in culture but does cause liver injury and depletion of glutathione is rodent models. The pathways involved in the cell injury have not been fully defined but may be similar to those of acetaminophen which also depletes glutathione which plays a major role in detoxifying injurious substances in the liver. The depletion of glutathione leaves hepatocytes and other cells vulnerable to toxic molecular intermediates of normal cellular metabolism.</p></div><div id="TaraFlour.Outcome_and_Management"><h3>Outcome and Management</h3><p>Tara flour hepatotoxicity is generally self-limited and only mild-to-moderate in severity. Most important is to identify the cause as being due to ingestion of a food that is responsible and discontinuation of further use as well as avoiding possibly harmful interventions for diagnosis such as liver biopsy, cholecystectomy and even invasive forms of cholangiography. Most appropriate is symptomatic therapy and withdrawal of further possible exposure as the liver injury is self-limited and ultimately resolves completely. While unproven, administration of NAC or a glutathione repleting agent might be appropriate in an attempt to shorten and ameliorate the injury, but currently it must be considered experimental. Such an approach is certainly worthy of laboratory and clinical investigation.</p><p>Other Names: Spiny Holdback, Tara spinosa, Tara, Taya, Quechua</p><p>Drug Class: <a href="/books/n/livertox/HerbalDietarySuppl/">Herbal and Dietary Supplements</a></p></div></div><div id="TaraFlour.CASE_REPORTS"><h2 id="_TaraFlour_CASE_REPORTS_">CASE REPORTS</h2><div id="TaraFlour.Case_1_37_year_old_woman_with"><h3>Case 1. 37 year old woman with pain and jaundice after eating Daily Harvest’s French Lentil and Leek Crumbles [107-0127].(<a class="bk_pop" href="#TaraFlour.REF.1">1</a>)</h3><p>A 37 year old woman, who had been receiving monthly Daily Harvest frozen food preparations for more than a year, consumed a new product called “French Lentil and Leek Crumbles” for dinner and noted feeling ill with transient stomach pain afterwards. Three days later she consumed more of the product and developed severe stomach pains and nausea followed by constipation the next day which she attributed to stress at work. Six days later she prepared tacos for lunch to which she added the lentil and leek crumbles and again developed severe abdominal pain 4 to 6 hours later. That evening she had body aches and the following morning still felt ill and developed nausea and vomiting. That same day she received notification from Daily Harvest about the potential of the crumbles product to cause liver injury. The following day, she noted that her urine had turned dark, and she sought medical care. Laboratory testing revealed a total bilirubin of 4.3 mg/dL, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> 810 U/L, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.aspartate-aminotransferase-ast-/">AST</a> 226 U/L, alkaline phosphatase 178 U/L (R=14), albumin 4.9 g/dL, and INR 1.1. She enjoyed general good health, had no major medical illnesses, and had no history of liver disease, drug allergies, alcohol use, recent travel, or risk factors for viral hepatitis. Her only medications were cyclobenzaprine and vitamin B12, both of which she had taken for more than a year. Serologic testing revealed no evidence of acute hepatitis A, B, C, or E nor of acute EBV infection. The ANA was positive (1:320), but SMA and AMA were negative and total globulins (2.9 g/L) and IgG levels (1011 mg/dL) were normal. An abdominal ultrasound showed no evidence of biliary obstruction and a normal gall bladder without stones. The ultrasound also showed hyperechogenicity suggestive of hepatic steatosis, even though her BMI was 21.4 kg/m<sup>2</sup>, and cholesterol, triglycerides, and fasting blood sugar were normal. Over the next 2 to 3 weeks both her symptoms and liver test abnormalities resolved (Table). In follow up 1, 4, and 7 months later, her liver test results were normal, although ANA remained positive (1:160) and repeat ultrasound showed echogenicity suggestive of steatosis.</p><div id="TaraFlour.Key_Points"><h4>Key Points</h4><div id="TaraFlour.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_TaraFlour.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_TaraFlour.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">French Lentil and Leek Crumbles</td></tr><tr><th id="hd_b_TaraFlour.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_TaraFlour.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R=14)</td></tr><tr><th id="hd_b_TaraFlour.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_TaraFlour.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2+ (jaundice, not hospitalized)</td></tr><tr><th id="hd_b_TaraFlour.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.latency/">Latency</a>:</th><td headers="hd_b_TaraFlour.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 day to symptoms, 10 to jaundice</td></tr><tr><th id="hd_b_TaraFlour.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_TaraFlour.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2-3 weeks</td></tr><tr><th id="hd_b_TaraFlour.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_TaraFlour.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cyclobenzaprine, vitamin B12</td></tr></tbody></table></div></div></div><div id="TaraFlour.Laboratory_Values"><h4>Laboratory Values</h4><div id="TaraFlour.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Td_lrgtbl__"><table><thead><tr><th id="hd_h_TaraFlour.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_TaraFlour.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_TaraFlour.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a><br />(U/L)</th><th id="hd_h_TaraFlour.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_TaraFlour.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.bilirubin/">Bilirubin</a><br />(mg/dL)</th><th id="hd_h_TaraFlour.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 day</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Td_1_1_1_3 hd_h_TaraFlour.Td_1_1_1_4 hd_h_TaraFlour.Td_1_1_1_5 hd_h_TaraFlour.Td_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">First meal with FLLC</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Td_1_1_1_3 hd_h_TaraFlour.Td_1_1_1_4 hd_h_TaraFlour.Td_1_1_1_5 hd_h_TaraFlour.Td_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Second dinner with FLLC</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_TaraFlour.Td_1_1_1_3 hd_h_TaraFlour.Td_1_1_1_4 hd_h_TaraFlour.Td_1_1_1_5 hd_h_TaraFlour.Td_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Third meal (lunch) with FLLC</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 day</td><td headers="hd_h_TaraFlour.Td_1_1_1_3 hd_h_TaraFlour.Td_1_1_1_4 hd_h_TaraFlour.Td_1_1_1_5 hd_h_TaraFlour.Td_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Ill with abdominal pain, nausea, and fatigue</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">810</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">178</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">4.3</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">INR 1.1, R=14</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 weeks</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">240</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">140</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.0</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">R=5.5, ANA 1:320</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 weeks</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">59</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">77</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 month</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 weeks</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">23</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">56</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Normal</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 weeks</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">48</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.3</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 months</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">13</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">45</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANA 1:320</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 months</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">42</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 months</td><td headers="hd_h_TaraFlour.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.6 months</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">27</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">46</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANA 1:160</td></tr><tr><td headers="hd_h_TaraFlour.Td_1_1_1_1 hd_h_TaraFlour.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
|
||
<b>Normal Values</b>
|
||
</td><td headers="hd_h_TaraFlour.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><35</b>
|
||
</td><td headers="hd_h_TaraFlour.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><115</b>
|
||
</td><td headers="hd_h_TaraFlour.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><1.2</b>
|
||
</td><td headers="hd_h_TaraFlour.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></div><div id="TaraFlour.Comment"><h4>Comment</h4><p>An otherwise healthy woman who had subscribed to a Daily Harvest foods program for more than a year, became acutely ill after ingesting a new product called “French Lentil and Leek Crumbles” on three occasions. The symptoms resolved after the first two exposure to the crumbles, but were more severe and protracted with the third. When she developed dark urine and jaundice, she sought medical care and liver tests showed mild hyperbilirubinemia accompanied by hepatocellular elevations in liver enzymes. Thereafter she improved rapidly and was asymptomatic with normal liver tests three weeks after her clinical presentation. Analysis by the sponsor of the product and independently by an FDA and NIH funded laboratory suggested that the responsible ingredient in the product was tara flour and its unique non-protein amino acid – baikiain. This case demonstrates the typical clinical course of “tara flour hepatotoxicity” with rapid onset of gastrointestinal symptoms after ingestion (within 4 to 12 hours) of abdominal pain and nausea followed in a few days by liver related symptoms of dark urine and jaundice, the laboratory results indicating a mild acute hepatocellular injury. Atypical in the current case was the presence of antinuclear antibody in moderately high titer, which persisted thereafter, and was probably a preexisting serologic abnormality. Risk factors for tara flour induced liver injury are not well defined; most patients affected were otherwise healthy women, without underlying liver disease or allergic conditions and not overweight or obese. Tara flour is most likely a direct hepatotoxin, and the dose and repeated exposure are probably the most important risk factors.</p></div></div><div id="TaraFlour.Case_2_55_year_old_woman_with"><h3>Case 2. 55 year old woman with pain and jaundice after eating Daily Harvest’s French Lentil and Leek Crumbles [110-0199].(<a class="bk_pop" href="#TaraFlour.REF.1">1</a>)</h3><p>A 55 year old woman developed abdominal pain, fatigue, and jaundice the day after her second use of Daily Harvest’s new frozen food product called “French Lentil and Leek Crumbles” for dinner. The first use had been 4 days earlier. Laboratory testing revealed a total bilirubin of 3.3 mg/dL, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> 485 U/L, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.aspartate-aminotransferase-ast-/">AST</a> 518 U/L, alkaline phosphatase 138 U/L (R=16.7), and albumin 4.2 g/dL. She was generally healthy, had no history of medical illnesses, drug allergies, alcohol use, recent travel, or risk factors for viral hepatitis. She was taking no prescription medications or other herbal or dietary supplements. Tests for acute hepatitis A, B and C were negative. She was not hospitalized and did not undergo liver imaging or biopsy. Her symptoms improved rapidly, and when seen 12 days later, her serum total bilirubin was normal and liver enzymes were much improved (Table). In further follow up 1 and 3 months later, she was asymptomatic, and her liver tests were normal. Tests for ANA and SMA were negative, and IgG levels were normal. An abdominal ultrasound was normal without evidence of hepatic steatosis, biliary obstruction, or gall stones. Ultrasound elastography showed normal liver stiffness. At 10 months after onset, her liver tests remained normal, despite having started several over-the-counter supplements including garlic and resveratrol. Interestingly, both her husband and son also ate some of the crumbles with her, and both were found to have similar symptoms and liver test abnormalities (see Case 3).</p><div id="TaraFlour.Key_Points_1"><h4>Key Points</h4><div id="TaraFlour.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Te_lrgtbl__"><table><tbody><tr><th id="hd_b_TaraFlour.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_TaraFlour.Te_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">French Lentil and Leek Crumbles</td></tr><tr><th id="hd_b_TaraFlour.Te_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_TaraFlour.Te_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R=16.7)</td></tr><tr><th id="hd_b_TaraFlour.Te_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_TaraFlour.Te_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2+ (jaundice, not hospitalized)</td></tr><tr><th id="hd_b_TaraFlour.Te_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.latency/">Latency</a>:</th><td headers="hd_b_TaraFlour.Te_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 days to symptoms and jaundice</td></tr><tr><th id="hd_b_TaraFlour.Te_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_TaraFlour.Te_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2-3 weeks</td></tr><tr><th id="hd_b_TaraFlour.Te_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_TaraFlour.Te_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None mentioned</td></tr></tbody></table></div></div></div><div id="TaraFlour.Laboratory_Values_1"><h4>Laboratory Values</h4><div id="TaraFlour.Tf" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Tf/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Tf_lrgtbl__"><table><thead><tr><th id="hd_h_TaraFlour.Tf_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_TaraFlour.Tf_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_TaraFlour.Tf_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a><br />(U/L)</th><th id="hd_h_TaraFlour.Tf_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_TaraFlour.Tf_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.bilirubin/">Bilirubin</a><br />(mg/dL)</th><th id="hd_h_TaraFlour.Tf_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 day</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3 hd_h_TaraFlour.Tf_1_1_1_4 hd_h_TaraFlour.Tf_1_1_1_5 hd_h_TaraFlour.Tf_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">First meal with FLLC</td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3 hd_h_TaraFlour.Tf_1_1_1_4 hd_h_TaraFlour.Tf_1_1_1_5 hd_h_TaraFlour.Tf_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Second dinner with FLLC, symptoms</td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 days</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 days</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">485</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">138</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.3</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.jaundice/">Jaundice</a></td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 days</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 days</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">111</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asymptomatic</td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 weeks</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 month</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">88</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">69</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td><td headers="hd_h_TaraFlour.Tf_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">76</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asymptomatic</td></tr><tr><td headers="hd_h_TaraFlour.Tf_1_1_1_1 hd_h_TaraFlour.Tf_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
|
||
<b>Normal Values</b>
|
||
</td><td headers="hd_h_TaraFlour.Tf_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><35</b>
|
||
</td><td headers="hd_h_TaraFlour.Tf_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><150</b>
|
||
</td><td headers="hd_h_TaraFlour.Tf_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><1.2</b>
|
||
</td><td headers="hd_h_TaraFlour.Tf_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></div><div id="TaraFlour.Comment_1"><h4>Comment</h4><p>A family of husband, wife and two sons all had a meal that included Daily Harvest’s Frozen French Lentil and Leek Crumbles in which the wife, husband and one son developed evidence of liver injury 6 days after their first exposure and one day after the second. The son without evidence of injury did not eat the dish with the crumbles. The injury was an acute, short lived hepatocellular injury with mild jaundice that resolved within weeks after stopping the exposure. As is typical of other reported cases, the injury resolved rapidly and completely. There were no instances of acute liver failure, deaths from liver disease, or evidence for chronic injury reported with exposure to this commercial food product. Some patients underwent emergency cholecystectomy because of the prominence of abdominal pain and rapid onset of jaundice. Liver biopsies, done on a few patients, showed acute lobular hepatitis with spotty necrosis but no fibrosis, cholestasis, steatosis, or major degrees of necrosis.</p></div></div><div id="TaraFlour.Case_3_55_year_old_husband_of"><h3>Case 3. 55 year old husband of Case 2 developed mild acute hepatitis after eating daily Harvest’s French Lentil and Leek Crumbles [110-0198].(<a class="bk_pop" href="#TaraFlour.REF.1">1</a>)</h3><p>The 55 year old man whose wife developed acute, symptomatic hepatitis after Daily Harvest’s new frozen food product called “French Lentil and Leek Crumbles” (Case 2) ate the same meals with her and had similar but milder symptoms, feeling ill with a low grade fever, and then jaundice after the second meal. The first meal with the crumbles had been 4 days earlier. His initial laboratory test results included a total bilirubin of 5.5 mg/dL, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> 369 U/L, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.aspartate-aminotransferase-ast-/">AST</a> 117 U/L, alkaline phosphatase 183 U/L (R=7.7). Tests for hepatitis A, B and C were negative. Like his wife, he was generally healthy, had no major medical illnesses except kidney stones and no history of liver disease, alcohol use, recent travel, or risk factors for viral hepatitis. He was not taking any prescription medications but took fish oil, multivitamins, and a probiotic. He had a history of allergic reactions to doxycycline and levofloxacin. Tests for acute hepatitis A, B and C were negative. He was not hospitalized and did not undergo liver imaging or biopsy. His symptoms improved rapidly, and when seen 12 day later serum total bilirubin was normal and liver enzymes were much improved (Table). In further follow up 1 and 3 months later, he was asymptomatic and liver tests were normal. The ANA was weakly positive (1:80), but SMA was negative, and IgG levels were normal. An abdominal ultrasound and transient elastography were normal without evidence of hepatic stiffness or steatosis, biliary obstruction, or gall stones. At 10 months after onset, his liver tests remained normal but transient elastography now showed evidence of mild hepatic steatosis (CAP 244). His BMI was 26.7. He had started several over-the-counter supplements including multivitamins and resveratrol.</p><div id="TaraFlour.Key_Points_2"><h4>Key Points</h4><div id="TaraFlour.Tg" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Tg/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Tg_lrgtbl__"><table><tbody><tr><th id="hd_b_TaraFlour.Tg_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_TaraFlour.Tg_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">French Lentil and Leek Crumbles</td></tr><tr><th id="hd_b_TaraFlour.Tg_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_TaraFlour.Tg_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R=7.7)</td></tr><tr><th id="hd_b_TaraFlour.Tg_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_TaraFlour.Tg_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2+ (jaundice, not hospitalized)</td></tr><tr><th id="hd_b_TaraFlour.Tg_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.latency/">Latency</a>:</th><td headers="hd_b_TaraFlour.Tg_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 days to symptoms and jaundice</td></tr><tr><th id="hd_b_TaraFlour.Tg_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_TaraFlour.Tg_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2-3 weeks</td></tr><tr><th id="hd_b_TaraFlour.Tg_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_TaraFlour.Tg_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fish oil, multivitamins, probiotics</td></tr></tbody></table></div></div></div><div id="TaraFlour.Laboratory_Values_2"><h4>Laboratory Values</h4><div id="TaraFlour.Th" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Th/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Th_lrgtbl__"><table><thead><tr><th id="hd_h_TaraFlour.Th_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_TaraFlour.Th_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_TaraFlour.Th_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a><br />(U/L)</th><th id="hd_h_TaraFlour.Th_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_TaraFlour.Th_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.bilirubin/">Bilirubin</a><br />(mg/dL)</th><th id="hd_h_TaraFlour.Th_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 day</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Th_1_1_1_3 hd_h_TaraFlour.Th_1_1_1_4 hd_h_TaraFlour.Th_1_1_1_5 hd_h_TaraFlour.Th_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">First meal with FLLC</td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_TaraFlour.Th_1_1_1_3 hd_h_TaraFlour.Th_1_1_1_4 hd_h_TaraFlour.Th_1_1_1_5 hd_h_TaraFlour.Th_1_1_1_6" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Second dinner with FLLC, symptoms</td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 days</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 days</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">369</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">183</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">5.5</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic, jaundice</td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 days</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 days</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">97</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">106</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.1</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asymptomatic</td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 weeks</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 month</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">26</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">80</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.9</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">32</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">59</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.0</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td><td headers="hd_h_TaraFlour.Th_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">40</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">59</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.8</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asymptomatic</td></tr><tr><td headers="hd_h_TaraFlour.Th_1_1_1_1 hd_h_TaraFlour.Th_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
|
||
<b>Normal Values</b>
|
||
</td><td headers="hd_h_TaraFlour.Th_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><45</b>
|
||
</td><td headers="hd_h_TaraFlour.Th_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><150</b>
|
||
</td><td headers="hd_h_TaraFlour.Th_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><1.2</b>
|
||
</td><td headers="hd_h_TaraFlour.Th_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></div><div id="TaraFlour.Comment_2"><h4>Comment</h4><p>A family of husband, wife and one son all had a meal that included Daily Harvest’s Frozen French Lentil and Leek Crumbles, after which all three developed evidence of liver injury 6 days after their first exposure and one day after the second. Another son without evidence of injury had not eaten the dish with the crumbles. The injury was an acute, short lived hepatocellular injury with mild jaundice that rapidly resolved. The suspected cause was the protein-rich tara flour that had not been previously used in the Daily Harvest food program. Tara flour and collected samples of the lentil and leek crumbles has been shown to contain the non-protein amino acid baikiain which was shown to be a direct hepatotoxin in mouse models.</p></div></div></div><div id="TaraFlour.PRODUCT_INFORMATION"><h2 id="_TaraFlour_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
|
||
<b>REPRESENTATIVE TRADE NAMES</b>
|
||
</p><p>Tara Flour – Daily Harvest’s French Lentil and Leek Crumbles</p><p>
|
||
<b>DRUG CLASS</b>
|
||
</p><p>Food, Dietary Supplement</p></div><div id="TaraFlour.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_TaraFlour_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="TaraFlour.Ti" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604845/table/TaraFlour.Ti/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__TaraFlour.Ti_lrgtbl__"><table><thead><tr><th id="hd_h_TaraFlour.Ti_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_TaraFlour.Ti_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_TaraFlour.Ti_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_TaraFlour.Ti_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_TaraFlour.Ti_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baikiain</td><td headers="hd_h_TaraFlour.Ti_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/403432920" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">31456-71-0</a>
|
||
</td><td headers="hd_h_TaraFlour.Ti_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C6-H9-NO2</td><td headers="hd_h_TaraFlour.Ti_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/403432920" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=403432920" alt="image 403432920 in the ncbi pubchem database" /></a>
|
||
</td></tr><tr><td headers="hd_h_TaraFlour.Ti_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3HMT</td><td headers="hd_h_TaraFlour.Ti_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134975442" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">300-48-1</a>
|
||
</td><td headers="hd_h_TaraFlour.Ti_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C10-H13-NO4</td><td headers="hd_h_TaraFlour.Ti_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134975442" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134975442" alt="image 134975442 in the ncbi pubchem database" /></a>
|
||
</td></tr><tr><td headers="hd_h_TaraFlour.Ti_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3HMP</td><td headers="hd_h_TaraFlour.Ti_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134976171" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">587-33-7</a>
|
||
</td><td headers="hd_h_TaraFlour.Ti_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C10-H13-NO3</td><td headers="hd_h_TaraFlour.Ti_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134976171" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134976171" alt="image 134976171 in the ncbi pubchem database" /></a>
|
||
</td></tr></tbody></table></div></div></div><div id="TaraFlour.CITED_REFERENCES"><h2 id="_TaraFlour_CITED_REFERENCES_">CITED REFERENCES</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="TaraFlour.REF.1">Choi
|
||
G, Ahmad
|
||
J, Navarro
|
||
V, Thung
|
||
W, Khan
|
||
I, Avula
|
||
B, Barnhart
|
||
H, Stolz
|
||
A; Drug-Induced Liver Injury Network. Characterization of an outbreak of acute liver injury after ingestion of plant-based food supplement.
|
||
Aliment Pharmacol Ther
|
||
2024;00:1-5.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/38874448" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 38874448</span></a>]</div></dd></dl></div><div id="TaraFlour.ANNOTATED_BIBLIOGRAPHY"><h2 id="_TaraFlour_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 20 February 2024</p><p>Abbreviation: HDS, herbal and dietary supplements.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="TaraFlour.REF2">Electronic Code of Federal Regulations. Title 21. Part 182. Substances Generally Recognized As Safe. Available at: <a href="https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.accessdata<wbr style="display:inline-block"></wbr>.fda.gov/scripts/cdrh<wbr style="display:inline-block"></wbr>/cfdocs/cfcfr/CFRSearch<wbr style="display:inline-block"></wbr>.cfm?CFRPart=182</a><div><i>(Listing of botanical and herbal products that are “generally recognized as safe” [GRAS] according to FDA criteria which permits them to be sold as over-the-counter supplements without prior proof of safety and efficacy: tara flour is not mentioned).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.hammond.1995.1487">Hammond
|
||
AC. Leucaena toxicosis and its control in ruminants.
|
||
J Anim Sci.
|
||
1995;73:1487-92.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/7665380" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7665380</span></a>]<div><i>(Leucaena is a tropical legume which caused an acute and chronic toxicosis in grazing livestock given the plant as forage, probable caused by the legume’s high content of the non-protein amino acid mimosine, and which can be prevented by introduction of gut bacteria which are found in areas of the world where Leucaena is indigenous, and which are capable of metabolizing mimosine).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.rosenthal.2001.319">Rosenthal
|
||
GA. L-Canavanine: a higher plant insecticidal allelochemical.
|
||
Amino Acids.
|
||
2001;21:319-30.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11764412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11764412</span></a>]<div><i>(L-canavanine, a toxic non-protein amino acid and a structural analogue of arginine in which methylene group is replaced by oxygen, is produced by several species of legumes and is toxic to animals that graze on the plants that produce it).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.bence.2003.383">Bence
|
||
AK, Crooks
|
||
PA. The mechanism of L-canavanine cytotoxicity: arginyl tRNA synthetase as a novel target for anticancer drug discovery.
|
||
J Enzyme Inhib Med Chem.
|
||
2003;18:383-94.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/14692504" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14692504</span></a>]<div><i>(The basis of toxicity produced by consumption of L-canavanine appears to be based on its loading onto the tRNA of arginine that is used by arginyl tRNA synthetase to produce proteins, in which L-canavanine replaces arginine and which have little or none of the expected enzymatic activity).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.nunn.2010.485">Nunn
|
||
PB, Bell
|
||
EA, Watson
|
||
AA, Nash
|
||
RJ. Toxicity of non-protein amino acids to humans and domestic animals.
|
||
Nat Prod Commun.
|
||
2010;5:485-504.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/20420333" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20420333</span></a>]<div><i>(Review of how some non-protein amino acids synthesized by plants can be toxic to other plants, microorganisms, insects, and higher animals including humans, examples include homoarginine, canavanine, mimosine, domoic acid and hypoglycine, some of which can cause disease in humans such as neuropathies, gastrointestinal illness, and liver injury).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.teschke.2012.1543">Teschke
|
||
R, Wolff
|
||
A, Frenzel
|
||
C, Schulze
|
||
J, Eickhoff
|
||
A.
|
||
Herbal hepatotoxicity: a tabular compilation of reported cases.
|
||
Liver Int
|
||
2012; 32: 1543-56.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/22928722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22928722</span></a>]<div><i>(A systematic compilation of all publications on the hepatotoxicity of specific herbals identified 185 publications on 60 different herbs, herbal drugs and supplements, but tara flour and baikiain were not listed or mentioned).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.brown.2017.449">Brown
|
||
AC. An overview of herb and dietary supplement efficacy, safety and government regulations in the United States with suggested improvements. Part 1 of 5 series.
|
||
Food Chem Toxicol
|
||
2017; 107: 449-71.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/27818322" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27818322</span></a>]<div><i>(Summary of the US regulations on safety and efficacy of herbal and dietary supplements).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.brown.2017.472">Brown
|
||
AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series.
|
||
Food Chem Toxicol
|
||
2017; 107: 472-501.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/27402097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27402097</span></a>]<div><i>(Description of an online compendium of cases of liver toxicity attributed to HDS products does not mention baikiain, tara flour, or foods).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.sarasa.2020.534">Sarasa
|
||
SB, Mahendran
|
||
R, Muthusamy
|
||
G, Thankappan
|
||
B, Selta
|
||
DRF, Angayarkanni
|
||
J. A brief review on the non-protein amino acid, gamma-amino butyric acid (GABA): its production and role in microbes.
|
||
Curr Microbiol.
|
||
2020;77:534-544.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/31844936" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31844936</span></a>]<div><i>(GABA is a non-protein amino acid produced by decarboxylation of glutamate that serves as the major negative neurotransmitter in the brain, having other functions in other organs and other organisms).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.negi.2021.801">Negi
|
||
VS, Pal
|
||
A, Borthakur
|
||
D. Biochemistry of plants N-heterocyclic non-protein amino acids.
|
||
Amino Acids.
|
||
2021;53:801-812.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/33950299" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33950299</span></a>]<div><i>(Plants synthesize a large number of heterocyclic non-protein amino acids which are a rich source of nitrogen, but also can be toxic to other organisms including foraging cattle, sheep and humans).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.chittiboyina.2023.818">Chittiboyina
|
||
AG, Ali
|
||
Z, Avula
|
||
B, Khan
|
||
SI, Mir
|
||
TM, Zhang
|
||
J, Aydoğan
|
||
F, et al.
|
||
Is baikiain in tara flour a causative agent for the adverse events associated with the recalled frozen French Lentil & Leek Crumbles food product? - a working hypothesis.
|
||
Chem Res Toxicol.
|
||
2023;36:818-821.
|
||
[<a href="/pmc/articles/PMC10283043/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10283043</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37255213" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37255213</span></a>]<div><i>(Analysis of the frozen French Lentil and Leek Crumbles product implicated in an outbreak of liver injury in May and June 2022 identified no evidence of toxic contaminants, microbial products, mycotoxins, or trace metals, but did identify components of tara flour one of which was the non-protein amino acid baikiain [1.5% w/w], which was not toxic in cell culture studies but did cause serum aminotransferase elevations and depletion of hepatic glutathione in mice treated with baikiain for 6 hours).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.chan.2023.616">Chan
|
||
SE, Smith
|
||
CA. A food product as a potential serious cause of liver injury.
|
||
Clin Toxicol (Phila). 2023;61:616-619.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/37706365" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37706365</span></a>]<div><i>(Two Canadian women, ages 27 and 37, developed several episodes of abdominal pain, fatigue, and jaundice after ingesting smoothies that were made with tara flour [bilirubin 3.0 and 4.2 mg/dL, ALT 768 and ~460 U/L, Alk P 199 and ~ 230 U/L], with a short limited, rapidly resolving course).</i></div></div></li><li><div class="bk_ref" id="TaraFlour.REF.choi.2024.1">Choi
|
||
G, Ahmad
|
||
J, Navarro
|
||
V, Thung
|
||
W, Khan
|
||
I, Avula
|
||
B, Barnhart
|
||
H, Stolz
|
||
A; Drug-Induced Liver Injury Network. Characterization of an outbreak of acute liver injury after ingestion of plant-based food supplement.
|
||
Aliment Pharmacol Ther
|
||
2024;00:1-5.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/38874448" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 38874448</span></a>]<div><i>(Among 17 patients with French Lentil and Leek Crumbles induced liver injury, all occurring in May or June 2022, 14 were women, all were white, average age 41 years, often with abdominal pain within hours of ingestion and onset of liver injury 2-8 days later, mostly with hepatocellular enzyme pattern, mean bilirubin 2.2 mg/dL, and benign, self-limited course in all with no fatalities, and no chronicity: see Case Reports 1-3).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK604845</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38985927" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38985927</a></span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Tamsulosin/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Tasimelteon/" title="Next page in this title">Next ></a></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK604845/?report=reader">PubReader</a></li><li><a href="/books/NBK604845/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK604845" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK604845" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Tara Flour. [Updated 2024 Jun 20].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK604845/pdf/Bookshelf_NBK604845.pdf">PDF version of this page</a> (158K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/29/31/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download LiverTox data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Overviews</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/intro/">Introduction</a></li><li><a href="/books/n/livertox/ClinicalCourse/">Clinical Course</a></li><li><a href="/books/n/livertox/ClinicalOutcome/">Clinical Outcomes</a></li><li><a href="/books/n/livertox/ImmuneFeatures/">Immune Features</a></li><li><a href="/books/n/livertox/Phenotypes_intro/">Phenotypes</a></li><li><a href="/books/n/livertox/Causality/">Causality</a></li><li><a href="/books/n/livertox/DrugCategory/">Likelihood Scale</a></li><li><a href="/books/n/livertox/Severity/">Severity Grading</a></li><li><a href="/books/n/livertox/CaseReport/">Writing a Case Report</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Support Links</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/">LiverTox Homepage</a></li><li><a href="/books/n/livertox/masterlistintro/">Master List of LiverTox Drugs [with Metadata]</a></li><li><a href="/books/n/livertox/drugliverinjury/">LiverTox Drugs by Drug Class</a></li><li><a href="/books/n/livertox/aboutus/">About LiverTox</a></li><li><a href="/books/n/livertox/editorsandreviewers/">Editors and Review Committee</a></li><li><a href="/books/n/livertox/alert/">Meetings and News</a></li><li><a href="/books/n/livertox/abbreviation/">Abbreviations Used</a></li><li><a href="/books/n/livertox/glossary/">Glossary</a></li><li><a href="/books/n/livertox/resource/">Information Resources</a></li><li><a href="/books/n/livertox/disclaimer/">User/Medical Advice Disclaimer</a></li><li><a href="/books/n/livertox/Contactus/">Contact Us</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>
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Epub 2023 May 31.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/38448102" ref="ordinalpos=1&linkpos=2&log$=relatedarticles&logdbfrom=pubmed">Comprehensive molecular level characterization of protein- and polyphenol-rich tara (Caesalpinia spinosa) seed germ flour suggests novel hypothesis about possible accidental hazards.</a><span class="source">[Food Res Int. 2024]</span><div class="brieflinkpop offscreen_noflow">Comprehensive molecular level characterization of protein- and polyphenol-rich tara (Caesalpinia spinosa) seed germ flour suggests novel hypothesis about possible accidental hazards.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Fierro O, Siano F, Bianco M, Vasca E, Picariello G. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Food Res Int. 2024 Apr; 181:114119. Epub 2024 Feb 8.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/35164284" ref="ordinalpos=1&linkpos=3&log$=relatedarticles&logdbfrom=pubmed">Effect of the Integrated Addition of a Red Tara Pods (Caesalpinia spinosa) Extract and NaCl over the Neo-Formed Contaminants Content and Sensory Properties of Crackers.</a><span class="source">[Molecules. 2022]</span><div class="brieflinkpop offscreen_noflow">Effect of the Integrated Addition of a Red Tara Pods (Caesalpinia spinosa) Extract and NaCl over the Neo-Formed Contaminants Content and Sensory Properties of Crackers.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Pedreschi F, Matus J, Bunger A, Pedreschi R, Huamán-Castilla NL, Mariotti-Celis MS. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Molecules. 2022 Feb 2; 27(3). Epub 2022 Feb 2.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/37940305" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> State-of-the-art advancement in tara gum polysaccharide (Caesalpinia spinosa) modifications and their potential applications for drug delivery and the food industry.</a><span class="source">[Carbohydr Polym. 2024]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> State-of-the-art advancement in tara gum polysaccharide (Caesalpinia spinosa) modifications and their potential applications for drug delivery and the food industry.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Raj V, Chun KS, Lee S. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Carbohydr Polym. 2024 Jan 1; 323:121440. Epub 2023 Sep 29.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/37499980" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Global Coverage of Mandatory Large-Scale Food Fortification Programs: A Systematic Review and Meta-Analysis.</a><span class="source">[Adv Nutr. 2023]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Global Coverage of Mandatory Large-Scale Food Fortification Programs: A Systematic Review and Meta-Analysis.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Rohner F, Wirth JP, Zeng W, Petry N, Donkor WES, Neufeld LM, Mkambula P, Groll S, Mbuya MN, Friesen VM. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Adv Nutr. 2023 Sep; 14(5):1197-1210. Epub 2023 Jul 25.</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=38985927" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=38985927" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c809cb6d1ec11b6f76ab2e">Tara Flour - LiverTox</a><div class="ralinkpop offscreen_noflow">Tara Flour - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c809c9d5edb449bf5a7372">Triheptanoin - LiverTox</a><div class="ralinkpop offscreen_noflow">Triheptanoin - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c809c8d5edb449bf5a6a53">Metamizole [Dipyrone] - LiverTox</a><div class="ralinkpop offscreen_noflow">Metamizole [Dipyrone] - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c809c7feee5b00ac1727a2">Bacopa monnieri - LiverTox</a><div class="ralinkpop offscreen_noflow">Bacopa monnieri - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c809c6b70fbb19601c13d4">Coenzyme Q10 - LiverTox</a><div class="ralinkpop offscreen_noflow">Coenzyme Q10 - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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