Ripped From the Headlines


Your Wellness Lifestyle Starts Here

Do you get confused and conflicted with all of the crazy diet and lifestyle articles? Some of them are true but most are nonsense and fearmongering.  I stay committed to teaching evidence based nutritional science so that you aren't throwing out all of your bread and staying home to avoid flesh-eating bacteria. It's important to be well-informed, prioritize learning about health, and invest your time and resources in adopting the right diet and exercise program. Then you can determine if something is health promoting or disease mongering. 

Let's look at some of these articles for food for thought and future discussions:

Colorectal cancer is rising among Gen X, Y, & Z
According to the NPR article, about 20,000 people in the U.S. under the age of 50 will be diagnosed this year. And an estimated 3, 750 young adults will die. While stating that more screening is needed, at least they mentioned that "diet may play a role". There are many studies that prove eating more ultra-processed foods, processed lunch meats, carbonated beverages, alcohol use, and high consumption of red meat increases the risk of colorectal cancer. The "grab and go" and sedentary lifestyle of teens and young adults is what will put them in this high-risk category.
Teach your kids that food is so much more than fuel. 

Statins
Reporting the results of a 2008 study, the New York Times noted that the risk of heart attack was "more than cut in half by statins". But was it really?  The study evaluated AstraZeneca’s rosuvastatin (Crestor) on 17,802 people without high cholesterol, finding about a 50 percent relative risk reduction of heart attack in the statin group.
Another study, commonly cited to exemplify statins’ robust protective effects, is a large trial investigating Pfizer’s atorvastatin (Lipitor), called ASCOT-LLA. In this case, statins were 36 percent more protective than the placebo.
However, the absolute risk reduction for both studies was approximately 1 percent. As opposed to relative risk reduction, assessing the efficacy of a drug is more accurately interpreted by using absolute risk reduction.  As Dr. Malcom Kendricks, a Scottish based physician and statins researcher says "It's a way to hype results."  
Click the link to learn the difference between relative and absolute and how researchers use it to skew results in their favor. (Relative vs Absolute Change - Analysis Mistakes (dataschool.com)
"Pharmaceutical companies also seek to “downplay or deny” the significance of statins’ side effects, such as severe muscle damage."
In a 2015 investigative meta-analysis published in The Journal of American Cardiology, researchers reviewed all phase 2 and 3 clinical trials in a decade. They found that nearly 80 percent of the trials had a conflict of interest, and almost 60 percent involved over half of the authors. Of these studies, 54 had favorable outcomes, and only 12 had unfavorable results.

High blood pressure? Eat more grapefruit.
If people with high blood pressure ran to the store to buy grapefruit, I hope that they also bought more fruit and vegetables in general, along with high-fiber whole grains. If you are eating an unhealthy diet, full of saturated fats and lots of dairy, that grapefruit won't do a thing. Grapefruit is a wonderful addition to your daily intake of fruit and vegetables. Claiming that one food or supplement will cause you to lose weight, lower blood pressure or cholesterol, is called "reductionism". Optimal health comes with the totality and breadth of your diet and lifestyle. Think "whole". One note does not make a symphony. 

Animal Antibiotics, Contraceptive Detected in Top 10 Popular Fast Foods
In September, Moms Across America (MAA) submitted food samples from 10 popular U.S. food chains to the Health Research Institute, an Iowa-based nonprofit laboratory that tests food for nutritional value, bio functionality, and contaminants and toxins, requesting that the laboratory test the samples for more than 100 common veterinary drugs and hormones. With the exception of Subway and Chipotle, all of the food samples tested positive for veterinary drugs. One of the drugs, monensin, is a commonly used veterinary antibiotic with a slim margin of safety. Side effects of monensin in animals include anorexia, diarrhea, weakness, and motor problems; an overdose can lead to poisoning or even death. 
Less than 0.5 microgram per kilogram of the antibiotic monensin was detected in the Taco Bell, Dunkin', Wendy’s, Domino's, Burger King, and McDonald's samples.
The acceptable daily intake for monensin is 12.5 micrograms per kilogram of body weight per day.  Other drugs found were Narasin, an antibiotic and antiparasitic feed additive that helps to control parasitic infections in fattened chicken, and Nicarbazin, an animal antiparasitic and contraceptive. Although these drugs were under the acceptable level, does it concern you that they are acceptable at all? Few studies have investigated the effects of veterinary drugs in humans. Some people are consuming this food every day, so we don't know how much they are accumulating in their body.

Health Insurance Marketplace Quality Initiatives
The Center for Medicare and Medicaid recently announced these initiatives: "The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs (Qualified Health Plans) based on relative quality and price. The goals of the QRS are to provide comparable and useful information to consumers, facilitate oversight of QHPs, and provide actionable information to QHPs to improve quality and performance." They are basically developing data collection and reporting tools. This sounds like they are doing something great for health care. But this is the reason that doctors cannot spend quality time with patients, especially to counsel them on diet and lifestyle changes. Physicians are penalized because they need to show adherence to prescribed medications. This is why we call it the "medical mill".  The scoring system that this initiative refers to is based on the doctor "managing" the patients by continuing to prescribe medications, rather than reversing their disease. Doctors who have become board certified in Lifestyle Medicine are penalized by this system. Treatment to reverse disease using diet and lifestyle modification requires more follow-up. The patient needs to pay a co-pay for each visit, which is not affordable in most cases. What we have is government bureaucrats managing healthcare.

Healthcare was in terrible shape before COVID; it is worse now. The American medical system is in the process of collapsing and there are many reasons for it. Disease mongering and overtreatment have increased costs to unsustainable levels. Most members of the public no longer trust the system because there is no integrity left. Health professionals working in institutions are expected to follow prescribed protocols for care, even if these protocols are inadvisable for their patients.  

As I stated in the first paragraph (and I am glad that you read this far) It's important to be well-informed, prioritize learning about health, and invest your time and resources in adopting the right diet and exercise program.

Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health








Recipe of the Month: Roasted Red Pepper Sauce

Roasted Red Pepper Sauce
I love making this sauce when red peppers are in abundance, or whenever I have the hankering for it! It is so quick and easy. What makes this sauce creamy is using raw, unsalted cashews. Cashews are a great way to make creamy, non-dairy sauces and creams, The key is to soak them in hot water for at least 2 hours. Soaking overnight is better.  I used 1 yellow pepper for this recipe for a substitute. You can skip the cashews for a lower fat, thinner sauce. 




Ingredients
3 or 4 large red peppers, sliced in half with seeds removed
4-5 garlic cloves, peeled and sliced in half
2-3 fresh tomatoes
Small handful of fresh basil or 1 teaspoon dried
1 teaspoon dried oregano
1/2 cup raw unsalted cashews
                                                              1/3 cup vegetable broth
                                                              Salt & pepper to taste
Soak cashews in hot water for 1-2 hours or overnight. The longer, the better. Roast the peppers at and garlic at 350 degrees for about 30-40 minutes, or until they start to soften but not burn. You will not be peeling the skin off.  Place the peppers, garlic, basil, oregano, tomatoes, drained cashews, salt, pepper, and the broth in a high-speed food processor, Vitamix, or blender. Puree for about 5 minutes until all ingredients are combined and creamy looking. Pour sauce into a sauce pot and simmer while you are cooking 8 oz of your favorite pasta. If you would like a thinner sauce, add more vegetable broth while it is simmering.











Diet & Cancer Prevention


Your Wellness Lifestyle Starts Here
While billions of dollars have been spent on initiatives like The War on Cancer, the incidence of cancer continues to increase, along with the death rate, for many forms of cancer. The National Cancer Institute estimated that 1,685,210 new cases of cancer would be diagnosed in the U.S. in 2016 and that approximately 595,690 people would die, which means an average of 1632 cancer deaths per day.[1] This is an increase from 2009, when it was estimated that 1,479,350 Americans would be diagnosed with cancer, and 562,340 would die, or an average of 1,500 cancer deaths per day.[2]

Some of the most significant contributors to cancer risk are diet and lifestyle choices, weight, and inflammation, all of which can be modified to reduce risk. The best option is to prevent cancer, and research shows that most cancers and deaths from cancer are preventable.[3] 

One of the leading contributors to many types of cancer is being overweight. A review of over one thousand studies conducted by the International Agency for Research on Cancer showed that being overweight or obese increases the risk for at least 13 types of cancer.[4] According to Dr. Graham Colditz, chairman of the research group, these 13 cancers represent 42% of all cancer diagnoses. Colditz says that weight status is an even more important factor than smoking in terms of cancer risk, and that obesity should be at the top of the list of risk factors to address for cancer prevention.[5]

While many factors contribute to weight gain and obesity, diet is the most important. It’s easier to gain weight while eating foods that are high in calories and fat, like beef, cheese, and pastries. And it’s easier to lose weight while eating a plant-based diet that includes more calorie-dilute foods like fruits, vegetables and starches.

Inflammation increases the risk of cancer and can also accelerate its progression. Cancers often develop at sites where infection, chronic irritation, or inflammation have occurred.[6] Take colon cancer, for example. Over 35% of Americans develop polyps due to changes in the mucosal layer that protects the lining of the colon.[7] A major cause of these changes is over-consumption of animal foods. Sulfur-containing amino acids in animal protein increase the production of hydrogen sulfide. This substance reduces mucus production, leaving the lining of the colon vulnerable to irritation, which in turn can lead to the formation of polyps.[8] The more irritation, the bigger the polyps become, and the higher the risk they will develop into colon cancer.

Animal foods are also high in fat, and higher fat intake increases the production of bile acids, which also irritate the colon. A diet lower in fat and higher in fiber is protective because it reduces bile acid production and helps the body to eliminate bile acids more quickly.[9] 

Many studies have shown a relationship between the consumption of animal foods and the risk of colon cancer in a dose-dependent manner – the more animal foods consumed, the higher the risk.[10] [11] [12] On the other hand, research shows that eating a higher fiber diet reduces the risk of colon cancer,[13] [14] [15] and that vegetarians are about 40% less likely to develop colon cancer as compared to meat eaters.[16] [17]

Another way in which high intake of animal foods contributes to increased inflammation and an increased risk of cancer is that animal foods contain concentrated amounts of arachidonic acid, which can increase inflammation levels through numerous pathways.[18]

Reducing intake of animal foods can significantly reduce inflammation levels and cancer risk.

Obesity contributes to inflammation because fat cells produce inflammatory cytokines and other similar molecules.[19] Adopting a low-fat plant-based diet usually results in weight loss, which can, in turn reduce inflammation. And plant-based diets are high in fiber, which has been shown to reduce inflammation through interaction with gut bacteria.[20]

Well-structured plant-based diets reduce the risk of cancer in several other ways too. In addition to fiber, plant foods contain concentrated amounts of antioxidants which can counteract the oxidative stress caused by poor diets, inflammation and infection.

The role of IGF-1 in cancer development has been known for some time. A 2002 study showed that higher plasma IGF-1 levels were associated with a higher incidence of prostate cancer, while higher levels of IGF-1 binding proteins were inversely associated.[21] Other studies have shown a relationship between IGF-1 levels and breast, colorectal, lung, thyroid, bone, brain, and ovarian cancers.[22] [23] [24] [25] [26] Lower levels of IGF-1 are associated with longer survival for cancer patients.[27]

The good news is that IGF-1 levels are related to diet, and dietary changes can lower plasma levels. Higher protein intake is associated with higher plasma levels of IGF-1, and lower protein intake is associated with lower plasma levels, lower incidence of cancer, and lower mortality in people under age 65.[28] Other studies have confirmed the relationship between lowered protein intake and lower plasma IGF-1 levels,[29] particularly animal protein.[30]  Milk and whey protein intake increase IGF-1 levels significantly,[31] [32] which explains why dairy intake is associated with so many types of cancer.

The idea that diet can prevent cancer is not a new one. In 1892, an article in Scientific American reported that "cancer is most frequent among those branches of the human race where carnivorous habits prevail."[33] So why don’t more people eat optimal diets in order to reduce their risk of cancer, and why aren’t more doctors promoting plant-based nutrition for cancer prevention?

Medical training is one contributing factor. U.S. doctors receive almost no training in nutrition. According to a 2015 study, only 27% of U.S. medical schools offer the 25 hours of nutrition education currently recommended. The average is 19.6 hours of nutrition classes during four years of medical school, or less than 1% of total lecture hours. Most of this consists of biochemistry, not practical information about diets or food-related decision-making.[34]

Another issue is that while many doctors recognize the need for nutrition education, there are few incentives for providing it. For example, the current licensure exam evaluates "biochemical knowledge and information relating to nutritional deficiencies," but does not test for knowledge or skills needed for discussing diet and lifestyle changes with patients. Board certifications, including those for internal medicine and cardiology, do not require demonstration of expertise in nutrition.

Another very important issue is the tendency of physicians to assume that patients are not interested in dietary change or working to improve their health. A common misconception is that people only want "quick fixes" for their health issues. But "quick fixes" – meaning drugs and procedures - are usually the only choices offered to patients. Most people are not told that diet and lifestyle habits can prevent or resolve their health issues, and there is no multi-billion-dollar media campaign promoting nutrition as an effective strategy for addressing health conditions.

It is clearly time for several changes, which include nutrition education as a part of medical training, and demonstration of nutrition knowledge as a criterion for licensure. Doctors should be taught how to have conversations with patients in which all options for prevention and treatment are discussed, including improved diet; and medical practices should include nutrition and lifestyle education for patients. These changes will require time, commitment, and resources. But our only hope for winning the war on cancer is to invest more effort in preventing it.

The Prevent Cancer Campaign is almost over! Email me to sign a pledge card. For more information, email me at lizfattorehealth@gmail.com



[1] Cancer Statistics  https://www.cancer.gov/about-cancer/understanding/statistics accessed 12.25.2016
[2] American Cancer Society Cancer Facts and Figures 2009
Atlanta Georgia 2009
[3] Song M, Giovannucci E. "Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States." JAMA Oncol. Published online May 19, 2016. doi:10.1001/jamaoncol.2016.0843
[4] Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. "Body Fatness and Cancer — Viewpoint of the IARC Working Group." NEJM 2016 August; 375 (8): 79
[5] Bakalar N. "Obesity Is Linked to at Least 13 Types of Cancer." New York Times August 24, 2016
[6] Coussens L, Werb A. "Review article: Inflammation and Cancer." Nature 19 December 2002;420;860-867
[7] Midgley R, Kerr D. "Colorectal Cancer." Lancet 1999 Jan;35(9150):391-399
[8] Tuan J, Chen Y. "Dietary and Lifestyle Factors Associated with Colorectal Cancer Risk and Interactions with Microbiota: Fiber, Red or Processed Meat and Alcoholic Drinks." Gastrointest Tumors 2016;3:17-24
[9] Ajouz H, Mukherju D, Shamseddine A. "Secondary bile acids: an underrecognized cause of colon cancer." World J Surg Oncol. 2014; 12: 164
[10] Giovannucci E, Rimm E, Stampfer M, Colditz G, Ascherio A, Willett W. "Intake of fat, meat, and fiber in relation to risk of colon cancer in men."
Cancer Res. 1994;54(9):2390-2397.
[11] Willett W, Stampfer M, Colditz G, Rosner B, Speizer F. "Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women." NEJM1990;323:1664-1672.
[12] World Cancer Research Fund. "Food, nutrition, physical activity, and the prevention of cancer: A global perspective. American Institute of Cancer Research." Washington, DC:2007.
[13] Reddy B. "Role of dietary fiber in colon cancer: an overview."  Am J Med 1999 Jan 25;106(1A):16S-19S
[14] MacLennan R, Macrae F, Bain C, et al. "Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas."
J Natl Cancer Inst 1995 Dec 6;87(23):1760-1766
[15] Howe G, Benito E, Castellato R et al. "Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence form the combined analysis of 13 case-control studies."  J Natl Cancer Inst 1992 Dec 16;84(24):1887-1896
[16] Chang-Claude J, Frentzel-Beyme R, Eilber U. "Mortality patterns of German vegetarians after
11 years of follow-up." Epidemiology. 1992;3:395-401.
[17] Chang-Claude J, Frentzel-Beyme R. "Dietary and lifestyle determinants of mortality among German vegetarians." Int J Epidemiol. 1993;22:228-236
[18] Samuelsson B. "Arachidonic acid metabolism: role in inflammation." Z Rheumatol 1991;50 Suppl 1:3-6
[19] Greenberg A, Obin M. "Obesity and the role of adipose tissue in inflammation and metabolism." Am J Clin Nutr Feb 2006;83(2):461S-465S
[20] Kuo SM. "The Interplay Between Fiber and the Intestinal Microbiome in the Inflammatory Response."  Adv Nutr January 2013;4:16-28
[21] Chan J, Stampfer M, Ma J et al. "Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 as predictors of advanced-stage prostate cancer. J Natl Cancer Inst 2002 Jul 17;94(14):1099-1106
[22] Wei E, Ma J, Pollack M et al. "Prospective Study of C-Peptide, Insulin-like Growth Factor-I, Insulin-like Growth Factor Binding Protein-1, and the Risk of Colorectal Cancer in Women." Cancer Epidemiol Biomarkers Prev April 2005 14; 850
[23] Birmann B, Tamimi R, Giovannucci E. "Insulin-like growth factor-1- and interleukin-6-related gene variation and risk of multiple myeloma." Cancer Epidemiol Biomarkers Prev 2009 Jan;18(1):282-288See comment in PubMed Commons below
[24] Kaaks R, Johnson T, Tikk K et al. "Insulin-like growth factor I and risk of breast cancer by age and hormone receptor status-A prospective study within the EPIC cohort." Int J Cancer 2014 Jun 1;134(11):2683-2690
[25] Cao H, Wang G, Meng L et al. "Association between circulating levels of Igf-1 and IGFPB-3 and lung cancer risk: a meta-analysis." PLoS One 2012;7(11):e49884





Changing Seasons



Seasons change....
Here in Western Pennsylvania, we experience the full gamut of the changing seasons. Sometimes we can experience 2 or 3 of those seasons in one day and we need to leave the house prepared for cool mornings, hot afternoons, and an umbrella just in case.  We leave our homes prepared to strip off the layers of clothing, turning off the heat in the car and turning on the A/C.  In the winter, we have our snow brushes and ice scrapers. We are prepared! Bring it on! 

I am a "preparer" by nature, I schedule my days, but not so much that I can't be flexible if necessary.  I leave some wiggle room and try to be happy about it. I will even plan my adventures, not wanting to leave anything to chance. Not like when I was much younger, when I lived life fully on the edge, looking forward to uncertainty, and singing seasons change and so do I*. I had no fear, took many risks, not really caring. (*The Guess Who)   

The seasons of the earth change, and we know what to expect. Rain in the spring, blooming flowers, hot summers, thunderstorms, the glory of the changing leaves, and then the snow and ice of winter. We know it is coming and we prepare, switching out our clothes, buying snow tires, etc. 

But what about when the seasons of our lives change? When life happens when we are making other plans? When it gets too hard? Because face it, doing life is hard.  I was trying to live this cautionary life, laying out my plans for the future like I switch out my boots for sandals. But wait, didn't God say in Proverbs 16:9 "We can make our plans, but God determines our steps" (NLT).  

My life is facing uncertainties in this season.  Family members with health issues, an aging parent, and everything that goes with it.  Uncertainties tend to overwhelm us. I think that is because we feel threatened and out of control.  We cry out why me, and this is not fair.  This is an emotional response to being uncertain of the outcome and this response can cause health issues, if we let it. 
We don't know the future, but we know whose hands the future is in. And it is not ours. 

Facing uncertainties requires preparation in body, mind, and spirit:

Body: sticking to a health promoting way of eating and keeping up with your exercise routine will help you think more clearly and keeps your immune system in top shape to fight off infections and viruses. When we are emotionally distraught, our body is more susceptible to infections and viruses. In the midst of everything, I caught the nasty virus going around and was able to kick it in a couple of days.  I never would have been able to do this years ago, when I ate a not so good sick promoting diet. In the midst of hard life happening, stick to a routine and get adequate sleep. 

Mind: when emotions get out of control, take a step back, examine the situation, and write down what is making you feel out of control and threatened.  When life is hard, we lose heart. Find people who will weep with you and support you. Sometimes we really do need a professional to talk to and sort it out. Keeping on an optimal way of eating, with lots of fresh fruit and veggies, really does help. When your digestive system is healthy, your mind is healthy as well. 

Spirit: the future is not in our hands, no matter how much I want to schedule it. Being grateful for the little blessings that we have daily can be transformative. My friend Greg McBrayer wrote today "Some people believe they are masters of their own destiny."  Don't we prove this to be untrue every day? He also wrote "All our trials and triumphs are part of God's transforming glory."  It might be difficult to be loving and compassionate through our own trials, but this is where our faith comes in.  This faith in God transforms us daily. 

As the seasons of my life change, by God's grace, so will I. Only this time it is the transforming change of faith, from glory to glory.  Being healthy in body, mind and spirit is the position from which we fight our battles. We will be equipped when life happens.  We can still live on the edge but this time it's because God has our back and we can live boldly, facing the unknown. 

Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health





Heat Exposure for Health


Your Wellness Lifestyle Starts Here


The use of heat is an ancient practice that results in purification, cleansing and healing. Examples include sweat lodges, which were used by Native Americans, and the traditional use of sauna in Finland. Benefits range from detoxification to improvement in cardiovascular health.

Understanding how heat, including heat from sauna, can positively affect heart health starts with an understanding of hormesis, which is defined as a compensatory response to a stressor. Hormetic stressors like exercise and heat trigger protective mechanisms that repair cell damage, and also provide protection against more severe stressors.[1]


Many types of heat exposure can lead to positive physiological changes, including sauna, heat wrapping, diathermy, and hot yoga. One mechanism by which heat has a positive effect is vasodilation. After exposure to extreme heat, the body cools itself. This requires the dilation of vessels to increase blood flow to the skin and to facilitate the release of heat. This not only lowers body temperature, but also increases heart rate and delivers oxygen to muscles and limbs, similar to the effect of aerobic exercise.


Another mechanism is via heat shock proteins, or HSPs, which are present in all cells and in the extracellular spaces. HSPs are involved in numerous cellular functions, and both aerobic exercise and heat stress increase HSP levels.[2] HSPs assist in lowering systemic inflammation and can increase exercise tolerance.[3] Research shows that within 30 minutes of exposure to heat, heat shock proteins in cells increase and remain elevated over time; again, similar to the effect of exercise.[4]


Many studies have looked at the positive effect of sauna bathing and show that it can improve cardiac output, circulation throughout the body, and vascular endothelial function.[5] In fact, while in a sauna, cardiac output can increase by as much as 70% while stroke volume remains stable. A study of 19 adults showed that blood pressure and heart rate increase as much during a 25-minute sauna session as both would be expected to increase during moderate exercise; and that blood pressure was lower after than it was before sauna.[6]


A prospective cohort study published in 2015 included 20 years of data on over 2300 Finnish men and showed that those who spent time in a sauna more frequently had a lower risk of death from heart disease and stroke.[7]


The best way to address cardiac risk factors or to improve health in general is via a multifaceted approach incorporating diet, exercise, hydration, and heat exposure through sauna, hot yoga, or even yard work in hot weather. In fact, research shows that a post-workout sauna can enhance the benefits of exercise, and that sauna likely provides the most benefit when combined with aerobic and strength training.[8] This makes hot yoga a good alternative because it combines heat and exercise.


Many people report that they don’t like heat or that they are heat intolerant. It’s important to keep in mind that almost anything new requires a period of adaptation, and this includes exercise, improved diet, and heat. For most people, the benefits to be gained far outweigh the discomfort of adapting to something new.

Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health


[1] McCarthy MF, Barroso-Aranda J, Contreras F. "Regular thermal therapy may promote insulin sensitivity while boosting expression of endothelial nitric oxide synthase – Effects comparable to those of exercise training." Med Hypoth2009 Jul;73(1):103-105
[2] Yamada PM, Amorin FT, Mosely P, Robergs R, Schneider SM. "Effect of heat acclimation on heat shock proteins 72 and interleukin-10 in humans."
J Appl Physiol 2007 Oct;103;4
[3] Zychowska M, Nowak-Zaelska A, Chruscinski G et al "Association of High Cardiovascular Fitness and the Rate of Adaptation to Heat Stress." Biomed Res Int 2018 Feb;1685368
[4] Patrick, RP, Johnson TL. "Sauna use as a lifestyle practice to extend healthspan." Exp Gerontol 2-21 Oct;154:111509
[5] Blum N, Blum A. "Beneficial effects of sauna bathing for heart failure patients." Exp Clin Cardiol 2007 Spring;12(1):29-32
[6] Ketelhut A, Ketelhut RG. "The blood pressure and heart rate during sauna bath correspond to cardiac responses during submaximal dynamic exercise." Compl Ther Med 2019 Jun;44:218-222
[7] Laukkanen T, Khan H, Zaccardi F et al. "Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events." JAMA Intern Med 2015 Apr;175(4):542-548
[8] Kunutsor SK, Laukkanen JA. "Does the Combination of Finnish Sauna Bathing and Other Lifestyle Factors Confer Additional Health Benefits? A Review of the Evidence." Proc Mayo Clin 2023 Jun;98(6):P915-926


Recipe of the Month: Ensalada Azteca

Ensalada Azteca

I found this recipe in The China Study Cookbook, by LeAnne Campbell, PhD, and it was perfect for my summer salad series gathering on my back porch, where we enjoy a great conversation about health. I substituted peaches for the mangos, and I used maple syrup instead of agave for the dressing. Delicious! 


Ingredients
  • 2 -15 ounce cans of beans, drained & rinsed (I used kidney and black beans)
  • 2 cups cooked quinoa or brown rice
  • 1/2 cup finely chopped red onion
  • 1 green, red, or orange pepper, diced
  • 1 large tomato, diced
  • 1 large avocado, diced
  • 2 cups frozen corn thawed, or fresh off the cob
  • 1/2 cup mangoes (I used fresh peaches from the local farm)
  • 1 jalapeno, finely diced (optional)
  • 3/4 cup fresh cilantro, chopped (I used 1 tablespoon dried cilantro)
DRESSING
  • 1/3 cup rice vinegar
  • 2 tablespoons lime juice
  • 1/2 cup mangoes, diced (I used the peaches)
  • 1/4 cup agave (I used maple syrup)
  • 1/2 tsp grated ginger (optional)
  • sea salt and pepper to taste

Instructions
Combine beans, rice or quinoa, onion, pepper, tomato, avocado, corn, mangoes or peaches, jalapeno, and cilantro in a large salad bowl.
In a food processor, place the dressing ingredients: vinegar, lime juice, mangoes or peaches, agave or maple syrup, and ginger. Process until smooth.
Pour dressing over the salad, toss gently. Season with salt and pepper to taste.




Carrageenan

Being a member of and representing Wellness Forum Health gives me access to a plethora of vetted and researched science, such as how to accurately read and interpret medical and scientific information, and how to make choices about food. I also have learned how to avoid "majoring in the minors," or focusing on things that make no difference. It’s sometimes difficult to avoid falling into this trap since sensational claims about ingredients used in processed foods make headlines and help marginal people to develop a following quickly. A good example is the focus on minor ingredients in processed foods, like carrageenan, which is found in products like plant milks, yogurt, and frozen pizzas and burritos. I have often wondered about that ingredient and it's nice to have researched information. If you think that carrageenan or any other substance is causing you distress, then avoid it. But the amount that is added in processed foods is minimal, and processed foods should not be a major part of your diet. 

Carrageenan is a polysaccharide extracted from red edible seaweed called Irish moss. It has no nutritional value but is used in food manufacturing as a gelling, thickening, and stabilizing agent. Carrageenan is commonly found in processed foods like ice cream, yogurt, soy and other plant milks. The product has only been called "carrageenan" since 1889, but carrageenan has been used under different names as an ingredient in cold and flu remedies and as a gelling agent in foods going back to 400 AD.

There is some debate about the safety of carrageenan, mainly due to misreporting and taking research findings out of context. Some researchers have reported that carrageenan causes inflammation, ulceration, colitis, and colorectal tumors in animal experiments. But there are reasons to question the conclusions of some of these researchers, and their claims have never been validated in human studies. One reason why carrageenan is not likely to be harmful to humans is it is not broken down through the digestive process and therefore its constituents cannot be absorbed through the intestinal tract.

Carrageenan is different than its degraded byproduct, which is called poligeenan, a processed form of carrageenan consisting of small molecular fragments that can be absorbed into the bloodstream. Part of the misunderstanding about carrageenan is that some have assumed that digestion would break carrageenan down into poligeenan, but this is not true because most mammals, including humans, lack the enzymes to facilitate this process. Carageenan is not degraded by stomach pH or by the microflora in the GI tract.

Some of the fear about carrageenan is based on several animal and in vitro studies conducted by various research groups at the University of Chicago headed by Dr. Joanne Tobacman, which concluded that carrageenan causes intestinal inflammation, colonic carcinogenesis, glucose intolerance, and insulin resistance.[1] [2] [3] [4] Tobacman and her colleagues also wrote a paper based on a time trend analysis in which they reported a correlation between the increased intake of carrageenan and the increased incidence of breast cancer. It is easy to establish correlation, but carefully conducted research establishes cause and effect relationships for only a small percentage of correlations. In fact the authors acknowledged the limitations of their analysis when they wrote, "although time-trend correlations represent a weak form of evidence, when significant positive correlations are found, they can support further evaluation."[5] The European Commission Scientific Committee for Food reviewed Tobacman’s findings and concluded that they "…did not support the hypothesis that breast cancer may be causally related to intakes of carrageenan..." and that "..such correlations might be found for any dietary component or chemical to which there has been increasing exposure during the twentieth century."[6]

Other criticisms of Tobacman’s research include that the studies involved in vitro cell lines and animals, and her group’s findings were different than other peer reviewed studies showing that carrageenan does not cause the health issues her group identified. For example, the only side effects of feeding rodents diets with 5% carrageenan were loose stools and diarrhea, and it would be difficult for a human to consume this much carrageenan.[7] Another study that involved administering both low and high doses of carrageenan to rats showed that there were no treatment-related effects on urinalysis, hematology, organ weights, ophthalmic, macroscope or microscope findings for either low-dose or high-dose rats, and the gastrointestinal tract of the rats remained normal.[8]  And many say that Tobacman’s is confusing the toxicity of poligeenan with carrageenan when these are actually two different substances.[9]

There are several other criticisms of carrageenan research in general, including study design. In addition to using poligeenan, studies have involved giving carrageenan to animals in drinking water. This results in more exposure of the intestinal mucosa to carrageenan than when it is bound to protein in food. Another issue is the amounts of it used in some studies. In many, animals were given over 1000 mg/kg/d, considerably more than the 18-40 mg/kg/day commonly consumed by humans.[10]

A group headed by James McKim conducted research to determine if Tobacman’s findings were valid. His group looked at each effect identified by her group using the same cell lines and adding controls. McKim’s group also increased the concentrations of carrageenan and the number of exposures, and reported that they were unable to replicate the Chicago group’s results. The findings of McKim’s group are in alignment with the majority of studies showing that carrageenan is not broken down during digestion or by gut bacteria, and is not absorbed in the intestines. They hypothesize that impurities in or contamination of carrageenan in the Chicago group’s studies may have been responsible.[11]

McKim’s research was funded by the International Food Additives Council and the FMC Corporation, both of which have a vested interest in showing that carrageenan is safe. However, there are mitigating factors that reinforce the validity of McKim’s research findings. First, carrageenan is considered safe by regulatory agencies in other parts of the world that generally have much more stringent criteria for evaluation than U.S. regulatory agencies, including the European Parliament and Council, and The Food and Agriculture Organization Expert Committee on Food Additives.[12] The World Health Organization Joint Expert Committee on Food Additives looked at the use of carrageenan in infant formula and concluded that "the use of carrageenan in infant formula or formula for special medical purposes at concentrations up to 1000 mg/L is not of concern."[13] And many independent and non-industry backed research groups have concluded that carrageenan is safe.

In spite of this, the public remains confused, mainly because research findings like Tobacman’s, some of which have not been replicated by other groups, and some of which involve pure speculation, are taken out of context. At this time, I do not think that evidence supports the need to avoid carrageenan when used as an additive in foods.

[1] Bhattacharyya S, Xue L, Devkota S, Change E, Morris S, Tobacman J. "Carrageenan-induced colonic inflammation is reduced in Bcl10 null mice and increased in IL-10-deficient mice." Mediators Inflamm 2013’2013:397642
[2] Bhattacharyya S, O-Sullivan I, Katyal S, Unterman T, Tobacman J. "Exposure to the common food additive carrageenan leads to glucose intolerance, insulin resistance and inhibition of insulin signaling in HepG2 cells and C57BL/67 mice." Diabetologia 2012 Jan;55(1):194-203
[3] Battacharyya S, Feferman L, Borthakur S, Tobacman J. "Common food additive carrageenan stimulates Wnt/ β-catenin signaling in colonic epithelium by inhibition of nucleoredoxin reduction." Nutr Cancer 2014;66(1):117-127
[4] Battachyyra S, Dudeja P, Tobacman J. "Tumor necrosis factor alpha-induced inflammation is increased but apoptosis is inhibited by common food additive carrageenan." J Biol Chem 2010 Dec 10;285(50):39511-22
[5] Tobacman J, Wallace R, Zimmerman M. "Consumption of carrageenan
and other water-soluble polymers used as food additives and incidence of mammary carcinoma."  Medical Hypotheses 2001a;56(5):589-598
[6] Scientific Committee on Food.(2003a) Opinion of the Scientific Committee on Food
on carrageenan. Brussels: European Commission; 5 March.
(SCF/CS/ADD/EMU/199 Final).
[7] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[8] Weiner M, Nuber D, Blakemore W, Harriman J, Cohen S. "A 90-day dietary study on kappa carrageenan with emphasis on the gastrointestinal tract." Food Chem Toxicol. 2007 Jan;45(1):98-106..
[9] Cohen S, Ito N. A critical review of the toxicological effects of carrageenan and processed eucheuma seaweed on the gastrointestinal tract." Crit Rev Toxicol 2002 Sept;32(5):413-44
[10] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[11] McKim J, Baas H, Rice G, Willoughby J, Weiner M, Blakemore W. "Effects of carrageenan on cell permeability, cytotoxicity, and cytokine expression in human intestinal and hepatic cell lines." Food and Chemical Toxicology October 2016;96:1-10
[12] http://www.naturalproductsinsider.com/blogs/formulating-foods/2014/07/fao-who-carrageenan-safe-in-infant-formula.aspx
[13] Joint FAO/WHO Expert Committee on Food Additives (JEFCA) 2015 "Safety evaluation of certain food additives, WHO Food Additives Series: 70."
Prepared by the Seventy-ninth Meeting of the Joint FAO/WHO Expert Committee on Food Additives (2015) http://apps.who.int/iris/bitstream/10665/171781/3/9789240693982_eng.pdf?ua=1




Diet and Type-2 Diabetes


Diet and Type-2 Diabetes Study

According to the Centers for Disease Control (CDC), 13% of U.S. adults have diabetes. Incidence increases with age and reaches 26.8% for Americans aged 65 years or older.[1] Almost all healthcare providers agree that diet is important for managing diabetes and for reducing the risk of co-morbidities which include cardiovascular disease and related events. Unfortunately, research shows that a minority of diabetics achieve glycemic control with diet.

A recent study might provide some inspiration for type-2 diabetics to pay more attention to diet. Participants in this nonrandomized crossover study were adults who had type 2 diabetes, required insulin, had a BMI of at least 27, and A1C levels between 6.5 and 9.5.

Fifteen participants were enrolled in a 4-week trial with sequential one-week phases:
          Baseline, Dash 1, WFPB and a second week of the DASH diet
The diets were all ad libitum (subjects could eat as much as they wanted) and meals were provided.

First, a description of the two intervention diets:
Dietary Approaches to Stop Hypertension (DASH) does not require the elimination of any food but rather emphasizes consumption of more fruit, vegetables, whole grains, and low-fat dairy, while intake of saturated fat and sugar are reduced.

A whole foods plant-based diet (WFPB) emphasizes beans, whole grains, and fruits and vegetables; and minimizes or excludes animal foods, added fats, and added sugars.

Both diets have been shown in previous studies to lower blood pressure,[2] [3] plasma cholesterol,[4] [5] and blood sugar.[6] [7] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events in people who have been diagnosed with severe coronary artery disease.[8] [9] 

Results:
Twelve of the fifteen subjects completed the study. One subject dropped out due to an unexpected surgery; one due to a car accident; and one subject started a new job and could not continue the weekly assessments.

Total calories were lower during all three intervention phases as compared to the baseline diet. By the end of the DASH 1 phase, total daily insulin requirements were 24% lower than baseline. By the end of the WFPB phase, total daily insulin requirements were 39% lower than baseline. When the DASH diet was resumed, insulin requirements increased 15% from the end of the WFPB week.

Average daily blood sugar was 22–24% lower with both intervention diets as compared to baseline, but the WFPB diet resulted in the lowest fasting blood sugar.

Insulin resistance decreased by 30.0% during DASH 1 and 49% during the WFPB diet. Insulin resistance during DASH 2 remained 28% lower than baseline. Insulin sensitivity was 17% higher at the end of DASH 1, 38% higher at the end of the WFPB diet, and then decreased almost to baseline by the end of DASH 2.

Weight decreased during all three phases, with a 3% lower weight at the end of the third week compared to baseline. Total, HDL, and LDL cholesterol were all lowest at the end of the WFPB week and total and LDL cholesterol significantly increased upon returning to the DASH diet.[10]

Conclusions:
Both DASH and WFPB diets, without calorie or portion restriction, result in significant and rapid reductions in insulin requirements for insulin-dependent type-2 diabetics. Subjects consuming these diets also experienced decreased total and LDL cholesterol; and lower leptin, weight, and c-reactive protein (a marker for inflammation). It is not possible to completely isolate the effect of each diet since there were carryover effects from week to week. But a pattern was observed: the benefits from the DASH diet were significantly greater when subjects switched to a WFPB diet. When the DASH diet was resumed, the benefits began regressing back toward baseline.

Limitations:
This was a small study, but one of the advantages of small studies is that researchers often can better control variables. For example, in this study meals were provided, which may not have been practical or affordable with more participants.

The breadth of the effect is a counter for the small study size. It is much easier to find effects in larger studies with hundreds of subjects, but often these differences are statistically significant but clinically meaningless. In this case, the effect was not just statistically significant, but clinically very meaningful. The short follow-up time is also a limitation, but the results were significant and immediate, and such results might incentivize people to continue to adhere to better diets in order to improve their health.

Bottom line: More plant food intake leads to better health and the more plant food consumed, the better the outcomes.

Reprinted from Wellness Forum Health


[1] Centers for Disease Control. National Diabetes Statistics Report 2020. Estimates of Diabetes and its Burden in the United States.  https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
[2] Appel LJ, Moore TJ, Obarzanek E et al. "A clinical trial of the effects of dietary pattern on blood pressure. DASH Collaborative Research Group." NEJM 1997 Apr;336(16):1117-1124
[3] Berkow SE, Barnard ND. "Blood pressure regulation and vegetarian diets." Nutr Rev 2005 Jan;63(1):1-8
[4] Appel LJ, Sacks FM, Carey VJ et al. "Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial." JAMA 2005 Nov;294(19):2455-64
[5] Macknin M, Kong T, Weier A et al. "Plant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parents." J Pediatr 2005 Apr;166(4):953-9,e1-3
[6] Azadbakht L, Fard NRP, Karimi M et al. "Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial." Diabetes Care. 201 Jan(1); 34: 55-57
[7] Barnard ND, Cohen J, Jenkins DJ, et al. "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 2006 Aug;29(8): 1777-1783
[8] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[9] Esselstyn CB, Ellis SG, Mendendorp SV, Crowe TD. "A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physicians’ practice." J Fam Practice 1995 Dec;41(6):560-568
[10] Campbell TM, Campbell EK, Peterson DR et al. "The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type-2 diabetes." Diabetes Res Clin Prac 2023 Aug;202:110814





Spiritual Health

Excerpts from "What does the Bible say about Health"

How is your spiritual health?
We all look for wholeness in our lives. As Susie Larson says, "what happens in our souls, happens in our cells."  
God made our immune system. Our immune system doesn’t wait until we get sick to start fighting or until we have a major threat in our life. It fights at the first sign of danger. As soon as it detects the slightest one-cell bacteria, that’s it! 
A healthy lifestyle doesn't mean you are only eating well, but your mental and spiritual health are being fed as well. 
Did you know that when you speak negatively about yourself, you give those words power that enters your consciousness, and it affects your DNA! Refuse to allow it to have a place in your life. Negative words will devour you. 

Feeding our soul a healthy diet of Jesus is what helps us come alive spiritually, just like feeding our body a healthy diet helps us function at our best. This is stewardship of mind, body & spirit (and the heart). James Clear says “what gets rewarded gets repeated. Don’t reward behavior that you don’t want to see repeated. God made us stewards of everything, including our physical body.

Some science:
Trauma is an assault to the symphony of the body. It overwhelms the body’s intrinsic ability to self-regulate. This is regulated by the amygdala. If some of our body is not functioning, the body compensates and “holds” what is painful. It causes dis-regulation, but parts of our body cooperate to keep it going. This is what leads to disease. It also leads to depression, sadness, and anxiety. The chemistry of the brain becomes disrupted (neuroinflammation). We can become cut off from our body and live in our head (going through the motions). But the body and the soul remember. 
What are you ignoring about your body and your health? What are the messages that your body is sending to you that you are not listening to? God speaks to us through our physical issues. We need to not only pray for healing, but pray that we can understand first, what God wants to address about our character. Ask him to “disrupt” your life by speaking honest and loving words to the most damaging issues in our lives. 

A higher daily intake of fiber-rich fruit and vegetables is associated with lower incidences of anxiety in adults and, at the same time, greater happiness, higher life satisfaction, and greater social-emotional well-being. 
In turn, emotions may harm you: anger affects the liver, stress affects the heart & brain, worry affects the stomach, grief affects the lungs, fear affects the kidneys. When we speak ill of ourselves and attack ourselves, our brain goes into a stress response. This produces cortisol and insulin and triggers our body to store fat.


Come join the conversation! 
Keep a lookout for the next free Bible Study! 

Liz
 


VITAMIN D


The Scoop on Vitamin D
We need it, but what is the best way to get it? First things first, it is not a "vitamin", it is a hormone. Let's explore:

• Vitamin: Something the body needs but cannot produce. Must be procured from external sources (ideally food).
 • Hormone: Something made by the body in one place that carries instructions needed in another, or several other places.

Fun Facts about Vitamins:
 • There are 13 for humans 
• 4 are fat-soluble 
• 9 are water-soluble

Fun Facts about Hormones:
 • There are about 50 
• Produced in endocrine glands and tissues 
• Some fat soluble, some water-soluble

Science about the D family:
• It’s a fat-soluble*, secosteroid (seco…steroid) 
• The biologically active form is called calcitriol: 
• 1,25-dihydroxycholecalciferol
 * Means we can’t readily excrete excess

So, if D is a hormone, how is it produced in the body?  It starts in the lower layers of the epidermis.  When the sun meets our skin, UVB rays convert readily available 7-dehydrocholesterol into Vitamin D3.  Then it’s off to the liver and the kidneys for “activating” (turned into 1,25-dihydroxycholecalciferol)

How much is enough?
Low D, first and foremost, is a sign you are not getting enough sun, not that you need to rush off to the pharmacy. 
D is measured in I.U. (international units) when getting it from external sources. It's always good to keep daily intake under 4000 IUs. 
Serum blood level tests, 25 (OH)D, (the OH stands for hydroxy), are known to be inaccurate. Different testing companies have different levels of what they call normal. 
The minimum target is 20 ng/ml (nanograms per milliliter), The happy medium is 30 ng/ml. There is no additional benefit above this. 
We can't overdose from sun exposure, although we could burn and that's not good either.  Getting 10-20 minutes of sun around noon-ish, twice a week, will do. Darker skin colors require 3 to 10 times more.  Sunscreens with harmful chemicals can cause collateral damage. If you are planning to stay in the sun longer, physical blocks are better. Think hats, sunglasses, rash guards, zinc or titanium oxide. And if you are worried about living in the northern climates with no sunshine in the winter, know that the D hormone produced in the body by the sun is stored in the liver and our fat cells.  When our body needs it, it calls for it and activates it! 
 
Taking too much of a Vitamin D supplement can cause nausea, vomiting, weakness, insomnia, nervousness, and more. Overdose of Vitamin D supplements can cause kidney damage. It can also increase the risk of cancer, heart disease, prostate cancer in men, and higher LDL cholesterol.

What are the benefits from getting our Vitamin D from the sun? It builds strong bones through managing your calcium levels, helps manage levels of magnesium and phosphate, has a role in cancer prevention, enhances immune system performance, enhances bone absorption of minerals, promotes healthy cellular growth, and reduces inflammation.

Remember, there are NO super foods or super supplements. Your Vitamin D level is low as a result of illness or not enough sunshine.  Get your Vitamin D from the Sun, not tanning salons. It also naturally occurs in salmon, mushrooms, sardines and breast milk. 

Supplementation should be the last resort. Our bodies are elaborately set up via highly sensitive biological systems to produce the exact right amount of Vitamin D we need at every moment. Fortified foods and pills have a one size fits all system with fixed dosages designed to provide too much or too little. And remember, Vitamin D is not water soluble, so if you ingest too much the body cannot readily correct via excretion the way that B vitamins and Vitamin C get excreted because they are water soluble.  Our "cleansing organs" must purge us of something (excess Vitamin D in a synthesized hormone form) that we were never designed to get rid of. That puts undue stress and strain on them. 

The vitamin supplement industry is highly monetized and "pharmaceutical-ized".  The 2022 market for Vitamin D was $1.34 billion dollars. Marketers have taken advantage of bad diet and lifestyle habits and contributed to making us think that a handful of supplements a day will make us feel better. 

Sitting in the sun is not bad. Research shows that women who avoid the sun have shorter lives. Avoiding the sun has similar risk factors as smoking.  Sunshine deficiency may also contribute to decrease in insulin's responsiveness, Mutiple Sclerosis, and cardiovascular disease. 

So, there you have it.  I am sure that a lot of you have been told by your doctor that you NEED to take a supplement. This is not defensible with science, but the decision is always yours, once you know all the facts. The bottom line is to be an informed consumer!

Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional

The objective of Nurture Your Health is to learn how to remain or become a healthy person, rather than to remain or become a sick patient. Most people do not pay attention to their health until they are sick.  It is important to prioritize learning about health and investing time and resources in adopting the right diet, engaging in the right exercise, and paying attention to other factors that lead to optimal health. Make learning about health interesting and fun. Use this information to take control of your health and make better and informed decisions about what you eat, which lifestyle choices you make, and the medical care you receive.
This information is not a substitute for medical advice. 



The objective of Nurture Your Health is to learn how to remain or become a healthy person, rather than to remain or become a sick patient. Most people do not pay attention to their health until they are sick.  It is important to prioritize learning about health and investing time and resources in adopting the right diet, engaging in the right exercise, and paying attention to other factors that lead to optimal health. Make learning about health interesting and fun. Use this information to take control of your health and make better and informed decisions about what you eat, which lifestyle choices you make, and the medical care you receive.
This information is not a substitute for medical advice. 

Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional