Social Pressure from the High Priests of Healthy Eating
- POSTED ON: Nov 12, 2012

 
Michael Pollan, a High Priest of "Healthy" eating, says in his book, Food Rules:
Eat Food, Mostly Plants, Eat Less

 If that is the food that you like eating, then follow that advice.
Personally, although there is great social pressure to do so,
I don’t buy into the current media hype which says that to be “healthy” within our modern culture,
we must eat foods that are:
“Whole” or “Real” or “NonProcessed” or “organic” or “grassfed” or “local” or “non GMO”.

My personal position is that we can be just as healthy if we simply: 
Eat Less, and Eat according to our preferences.


Sometimes Hunger is a Lie
- POSTED ON: Nov 03, 2012

 

As much as we might like the idea of trusting  the Body to tell us when and how to eat, sometimes our Body’s Hunger is a Lie.

Here are a couple of articles about the Science of Willpower, which discuss some of the reasons why the Body’s wisdom can’t always be trusted.


The Ghrelin Gremlin 
           by Kelly McGonigal, Ph.D.
                          Published on June 22, 2010 in Psychology Today

One of the most popular ideas in weight loss right now is:

 "trust your body's wisdom."
The body knows what it wants. The body never lies.
If you listen to signals like hunger and satiety, your body will never steer you wrong.

This is a lovely sentiment, and it's true that the body is a great source of wisdom.
Until it's not.

A new study presented at the annual meeting of the Endocrine Society shows how the brain can be tricked by the body into overeating and choosing fattening foods over healthier choices. [1]

The study set-up was simple enough: bring in hungry participants and ask them to choose between high-calorie, high-fat foods (e.g. pizza, cake, chocolate) and less fattening foods (e.g. salad, vegetables, and lean protein). Not surprisingly, hungry participants preferred the less healthy choices. Their bodies craved energy. The researchers then had participants makes similar choices, but 90 minutes after eating a meal. They weren't as hungry, and they made healthier choices. They "listened" to their bodies and choose a more appropriate snack, given their fullness.

But the researchers didn't stop there. They were interested in whether they could mimic the effects of fasting by manipulating participants' level of a hormone called "ghrelin." Ghrelin stimulates appetite and plays a big role in the body's signals of hunger and cravings. It is typically regulated by things like how recently you ate your last meal and blood sugar level, making it a good signal of the need to eat. But it can also be influenced by many other things, including stress and sleep. This means that as much as you'd like to trust the body, the signal of hunger can be a lie.

Back to the lab: On one visit, participants who had recently eaten a full meal were injected with ghrelin. And this time, the participants behaved as if they were starving. They found the higher-fat, higher-calorie foods more appealing and were more likely to choose them--even though the body was actually quite satiated.

This injection was just a quick-and-dirty stand in for all the things that can push ghrelin levels up in the real world. If you're sleep deprived, your body is pumping out more ghrelin to get you to eat.
[2]

It's a poor substitute for sleep, but high-fat, high-sugar foods are a source of the energy you desperately need. The same is true for stress. And research shows that high-sugar foods  - especially drinks, including sodas - artificially boosts ghrelin levels. [3]

This is one likely reason that soda and fruit juice consumption are both associated with obesity. The drinks themselves may not be a diet-breaker, but if you sip them all day, your body starts to lie to you. When it doesn’t, you'll be hungrier and more attracted to less healthy foods.

The bottom line: listening to your body needs to be balanced with mindful self-control. Know that not every craving is a message of wisdom from your stomach. Sometimes it's just a trick.


Studies cited:
1. The Endocrine Society (2010, June 20). Stomach hormone ghrelin increases desire for high-calorie foods. Presented by T. Goldstone.
2. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846-50.
3. Lindqvist A, Baelemans A, Erlanson-Albertsson C. Effects of sucrose, glucose and fructose on peripheral and central appetite signals. Regul Pept. 2008 Oct 9;150(1-3):26-32.

            www . psychologytoday.com


The Diabolic Secret Powers of Junk Food
               by Kelly McGonigal, Ph.D 
                            Published on September 18, 2009 in Psychology Today

It seems too clever, too diabolic to be true. A recent study shows that foods high in saturated fat -- ice cream, cheese, red meat -- cause your brain to secrete chemicals that tell the body to ignore biological signals of fullness (like leptin and insulin). The result: you don't "feel" full, and you keep eating. It's as if junk food had been shaped by the forces of evolution, learning to fool humans into ever-increasing consumption. And it explains why we seem to have an endless appetite for some foods, like pizza and a pint of Ben and Jerry's.

Even more mind-blowing: the effect lasts three days. So an indulgent meal can make you more likely to keep indulging, undermining any resolution to get back on track with healthier choices. This dirty trick is specific to saturated fats; foods low in saturated fats but high in healthier fats do not show the effect.

This study nicely highlights some of the most important influences on willpower. For example, we tend to think that our choices are independent, and that choosing to eat dessert or smoke a cigarette tonight has nothing to do with whether we indulge tomorrow. In fact, our behavior is far less variable than we think, and each choice (to resist or give in) strengthens the likelihood of choosing to do the same again. This study illuminates one biological mechanism that may contribute to this phenomenon, at least when it comes to diet.

Most people also have a hard time distinguishing between the promise of reward and actual satisfaction. As this study shows, many foods high in sugar or fats activate areas of the brain that promise satisfaction, but do not trigger the biological process of satiety. Other temptations -- from reality TV to most addictive drugs -- follow a similar pattern, increasing craving but not leading to lasting satisfaction. So we keep chasing the reward, ignoring the fact that in the long run, we aren't really satisfied and only want more.

Finally, it highlights the potentially discouraging fact that our behavior is influenced by forces we aren't consciously aware of. Like studies showing that the size and color of your plate influences how much you eat, and the smell of a store influences how much you spend, this study reminds us that we are vulnerable to unconscious processes.

However, awareness is a powerful antidote to all of these challenges. If you know that eating certain foods is going to fool your appetite, you can prepare yourself to make more conscious choices. If you start paying attention to the indulgences that are most satisfying, you can reward yourself with them. And if you know that your choices today are likely to influence your choices tomorrow, you will be less likely to tell yourself, "Today I indulge, tomorrow will be different."


Study citation: Benoit SC, Kemp CJ, Elias CF, et al. (2009) Palmitic acid mediates hypothalamic insulin resistance by altering PKC-θ subcellular localization in rodents. The Journal of Clinical Investigation, 119(9), 2577-89.
       
                www . psychologytoday.com


Some Halloween Facts
- POSTED ON: Oct 31, 2012

Each of us has different diet preferences on Halloween,

Some people have food plans which do not allow sweets, and they choose to follow that plan precisely.
.......Note: I've found this choice easier to make while involved in following a low-carb food plan.

Some people choose to incorporate a few sweet treats into their daily plan.

Some people choose to abandon their food plan entirely and binge out on Halloween sweets.

Whatever your personal choice, you have my Holiday support.
However, when making your food decisions, here is something to keep in mind.

LOW-CALORIE CHOCOLATE TREATS
Each one of these tiny treats has 20 - 35 calories).

3 Musketeers Minis
Hershey's Kisses
Sixlets 8-piece tubes
Tootsie Roll Midgees
Whoppers Malted Milk Balls 3-piece tubes

CHOCOLATE MINIS
Minis are the small, typically square morsels. The kinds below have 35 - 55 calories per piece.

Baby Ruth
Butterfinger
Hershey's Special Dark, Krackel, Milk Chocolate, and Mr. Goodbar
Kit Kat
Milky Way
Nestlé Crunch
Reese's Peanut Butter Cups
Snickers
Twix

SNACK-SIZE/FUN-SIZE CHOCOLATE
Snack-size and fun-size candies are usually about 2 inches long and weigh in at around half an ounce. The ones listed here have 60 - 85 caloriesper piece, pack, bag, or box.

3 Musketeers
Baby Ruth
Butterfinger
Hershey's Milk Chocolate
Junior Mints
Kit Kat (one 2-piece bar)
M&M's Milk Chocolate
Milky Way
Nestlé Crunch
Raisinets
Snickers
York Peppermint Patties

SNACK-SIZE/FUN-SIZE CHOCOLATE, Higher-calorie
Same specifics as the last list of snack-size/fun-size treats (about 2 inches long and half an ounce in weight), but these are a little higher in stats. Each bar or pack has 90 - 95 calorie).

100 Grand
M&M's Peanut
Mr. Goodbar
PayDay



Healthful Eating?
- POSTED ON: Oct 28, 2012

 
What does Healthy Eating REALLY mean?


Health is the general condition of a living person's mind, body and spirit,
usually meaning to be free from illness, injury or pain (as in "good health" or "healthy").
So, to be in “good health”, or to be “healthy: simply means “not sick or injured” and “not dead”.

Human nutrition is the process by which substances in food are transformed into body tissues and provide energy for the full range of physical and mental activities that make up human life.

Nowadays, Marketing Interests attach the word “healthy” to just about every food sold.
.. and they are technically correct, because if it doesn’t make you sick or kill you, it IS healthy.

It is now fashionable for people to worry about whether or not they are “eating healthy”. However, here in modern society, an average person, who is not sick, doesn’t need to have state-of-the-art scientific expertise and technologies of the links between human nutrition and health. 

   Basically, it is still as it has always been, in every society and culture.


If other people eat it;
if it tastes good;
and if it doesn’t kill you, make you feel sick,
or make you get really fat;
your eating qualifies as "Healthy".


But, many of us are interested in learning more.

 The study of human nutrition involves physiology, biochemistry, and molecular biology, as well as psychology and anthropology, which explore the influence of attitudes, beliefs, preferences, and cultural traditions on food choices. Human nutrition further involves economics and political science as the world community recognizes and responds to the suffering and death caused by malnutrition.

What we eat obviously goes inside our bodies and therefore affects our internal organs and the chemical interactions that take place. What we eat can affect how we feel and ultimately influence our thoughts, our decisions and our behavior. What we eat also affects how our internal organs operate and therefore affects their healthiness and longevity.

“Healthy” eating, by definition, helps to ensure that one’s internal organs are being cared for, that they are processing foods effectively and efficiently, and ultimately, sustains one’s life.

 Dietitians are health professionals who specialize in human nutrition, meal planning, economics, and preparation. They are trained to provide dietary advice and management to individuals, as well as to institutions. Clinical nutritionists are health professionals who focus more specifically on the role of nutrition in chronic disease, including possible prevention by addressing nutritional deficiencies before resorting to drugs.

Nutritional science investigates the metabolic and physiological responses of the body to diet. the study of nutrition is increasingly concerned with metabolism and metabolic pathways: the sequences of biochemical steps through which substances in living things change from one form to another.

The human body contains chemical compounds, such as water, carbohydrates (sugar, starch, and fiber), amino acids (in proteins), fatty acids (in lipids), and nucleic acids (DNA and RNA). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, phosphorus, calcium, iron, zinc, magnesium, manganese, and so on. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones, vitamins, phospholipids, hydroxyapatite), both in the human body and in the plant and animal organisms that humans eat.

The human body consists of elements and compounds ingested, digested, absorbed, and circulated through the bloodstream to feed the cells of the body. Digestive juices enter the lumen of the digestive tract. These digestive juices break chemical bonds in ingested molecules (food intake), and modify their conformations and energy states. Though some molecules are absorbed into the bloodstream unchanged, digestive processes release them from the matrix of foods. Unabsorbed matter, along with some waste products of metabolism, is eliminated from the body in the feces.

There are six major classes of nutrients: carbohydrates, fats, minerals, protein, vitamins, and water. These nutrient classes can be categorized as either macronutrients (needed in relatively large amounts) or micronutrients (needed in smaller quantities). The macronutrients include carbohydrates (including fiber), fats, protein, and water. The micronutrients are minerals and vitamins.

Chemicals can be formed during processing as a result of reactions between compounds that are natural components of the food. In some cases a chemical may be formed as a result of a food additive being intentionally added to food and reacting with another compound in the food.

  When foods are heat-processed (baked, deep-fried, etc.), there are reactions that occur between components of the food, resulting in the desired flavor, appearance and texture of the food. Similarly, certain storage or processing conditions may allow reactions to occur that otherwise would not. Such chemicals are collectively referred to as food-processing-induced chemicals. Some of these chemical reactions involve naturally-occurring components in the food, while other reactions may involve food additives, ingredients, or food packaging materials that were intentionally used.
People who oppose processed foods   feel these chemicals are risky,  in that they might be potentially harmful to the human body when used long-term. The term “clean” eating generally means avoiding processed foods and eating “whole” foods, which means foods as close to their natural state as one can get them. Like fresh fruits and vegetables, whole grains and lean proteins instead of pre-packaged or fast food. “Clean” eating usually also involves replacing saturated fat with “healthy” fat, although many “experts” now believe that natural saturated fats are NOT “unhealthy”. “Clean” eating can often involve eating only “organic” food; and only “grass-fed” or “Free-Range” animals.

Nutritionists regularly contradict one another. So, Who to Believe? 



 There are nutritional “experts”, like Michael Pollan, author of "Food Rules" (2011), who believe that excessive reliance on food science and the study of nutrition can, paradoxically, lead to poor nutrition and to ill health. Since nutrients are invisible, national policy makers rely on nutrition experts to advise on food choices.

Pollan argues that because science has an incomplete understanding of how food affects the human body, nutritionism, itself, can be blamed for many of the health problems relating to diet in the Western World today.

 Here is a BASIC truth that just about every person in our modern culture knows and understands. If you don’t take in enough food to sustain life, you’ll have too few nutrients, and your body will get sick and die. If you take in more food than you need to sustain life, you’ll have enough nutrients, and your body will excrete some, and store the rest as fat.

Less commonly understood is that if your body gets really fat, your body might … or might not… get really sick (depending on your genetics), but just about everyone knows that a fat body has to work harder to function, which eventually will result in various types of pain. 

 I enjoyed the following article:


Are You Trying Too Hard to Eat Healthfully?
             By Yoni Freedhoff, M.D. October 25, 2012 USNews Health

I was always a very efficient student. What I mean is that whatever grade I needed to get me where I wanted to go, well, that was the grade that I got. In my early university years, that meant getting marks in and around the high 70s and low 80s, since my career plans at the time involved getting into graduate school and pursuing a career in medical genetics. But after what I found to be a deathly boring summer working in an actual genetics lab, I decided I wanted to go to medical school, and suddenly high 70s and low 80s weren't good enough. I needed 90s, and I needed them across the board. I learned quickly that the effort required to get in the 90s, for me anyway, was at least an order of magnitude more than what I'd been putting in. I truly had to spend at least twice as much time studying to get that measly extra 10 percent. But the fact was, without those 90s, I wouldn't be a physician today. There simply wasn't a choice.

So what does this have to do with healthy eating?

Quite a bit, actually. It seems that when it comes to health, we're fixated on trying to get 90s, when really, high 70s and low 80s would be pretty great grades.

Diet and health gurus—they've all got their formulas for you. This guy says you can't eat wheat and that dairy's deadly, while that gal says that meat is poison and raw is righteous. Newspapers and glossy magazines will happily regale you with stories that deify or demonize specific foods. Supplements are peddled. Repulsive green drinks are touted. "Superfoods" drain our wallets and rot in our refrigerators. And come January, you can bet there'll be a fresh crop of New Year, New You books on the shelves telling you that everything you thought you knew about healthy eating was backwards and wrong.

Ultimately I think we're trying too hard, and more importantly, I don't think we have to. Unlike when I was trying to get into medical school, that 10 percent grade point difference isn't likely to have any dramatic tangible impact on our longevity or quality of life. What's more, even if there were a clear path to getting an A-plus, the amount of effort required to get there might lead a person to decide it's too much, and to eventually abandon her healthy eating efforts in frustration.

I think we should be aiming for some solid B-pluses, which in my book, would mean:

• Including vegetables or fruits with pretty much every meal.
• Cooking the vast majority of meals from fresh, whole ingredients.
• Limiting restaurant meals, only eating out to celebrate or socialize—never for convenience.
• Avoiding sugar-sweetened beverages (including juice).

If you want an A, just make sure to exercise for at least 30 minutes per day, most days of the week. While it's not an eating behavior, the impact of exercise on health is profound, and gives you a few easily obtainable bonus grades.

Life's too short to be trying to get perfect grades, so keep up with your basic studies, don't spend too much time in the library, and enjoy the ride.

 The human body responds uniquely to food based on genetics, biochemical makeup, family history, and that body’s interaction with its own environment. One common belief is that one’s body knows instinctively what the right substances are for it to eat, and that if we pay attention, it will direct us toward our best eating choices.

The following quote from an “expert” with this viewpoint. is an example of this thinking:


It’s time to listen to our bodies. To pay attention to our own rhythms and make them the priority. To wake up to the reality that the scientists and experts have no idea what they are talking about. The food pyramid is a game owned by large corporations. Fast food is just a way to get us to buy more and eat more of what our bodies don’t want. Dieting is a punishment for a body that just did what we asked it to do. The best health plan is to sleep when you’re tired and wake up when you’re ready. And stop worrying about what is ‘normal’ or ‘best’. Because you are unique as a snowflake and no one can actually know what is right for you except you.

And get the idea out of your head that ‘this is the way it’s always been and always will be.’ The only constant about any of us is that we change. Every minute of every day we are different. It’s the blessing of being alive. Your body knows this and seeks growth and changes the rhythms, actions and reactions, with everything around it in everything you do. Stop trying to make it into something it’s not. Get quiet and listen. Your body has untapped wisdom that can make your life a precious miracle full of joy. It’s not a car for your brain to ride in and it’s not some untamed wild beast that you can’t control. It’s you.”


As for me, I focus on working to eat only the amount of food that it takes maintain a normal weight. I don’t look at processed foods as “dirty”, and I don’t try to eat “clean”. I eat both “whole” and “processed” foods without discrimination, and use artificial sweetener whenever I want. I feel no need to get high grades in nutrition. However, even with that philosophy, during my past 8 years of tracking all my food every day in the computer software program: DietPower, that program has consistently graded my overall food intake as an “A+”

I’m over 60 years old and in excellent health with no need for medication or supplements, and am a “reduced obese” person who after years of yo-yo dieting has been maintaining a normal body weight for the past 7 years. 

 As part of my dieting hobby, and personal weight-loss maintenance, I experiment with lots of different Diets, or Ways of Eating. While doing this, my own personal consistent nutritional guidelines are to take a daily multi-vitamin pill, and heed the following advice when choosing food substances:


If other people around you eat it;  
if it tastes good to you;
if it doesn’t kill you; 
if it doesn’t make you feel sick,
or make you really fat; 
then eat it.


More About Starvation Mode
- POSTED ON: Oct 24, 2012


"We never repent of having eaten too little.”
Thomas Jefferson (1743 -1826)


When Jefferson was the principal author of the Declaration of Independence in 1776, he was around 33 years old, and he lived until age 83 during a time when food was not as easily obtainable. Even though he did not experience our modern readily-available-highly-processed-food world he seemed to understand the value of eating less.

How little is "too little"?

I’ve noticed that people who eat far too much, seem to spend a lot of time worrying about eating too little. Why do people who are obese, or even merely overweight, fear eating too little, and just how little is too little anyway?

Many overweight and obese people appear to have an irrational fear of starvation mode.
However, one really can't eat too little for weight loss - Starvation Mode (the way most dieters define it) is a Myth.

"Starvation mode" is a phrase that gets thrown about loosely. Many people think that eating below 1000 to 1200 calories a day, will cause their metabolism to slow down so much that their body will stop losing weight. The reality is that until a male has only 5% excess body fat, or a female has only 10% excess body fat, it is very unusual for a person to go into “starvation mode”.

When it seems impossible for a dieter nearing goal to lose weight, they assume their metabolic process is slowing down, and think that they are “in starvation mode”. However, people with extra weight obtainable to oxidize, can oxidize extra body fat per second. The less human body fat one has, the less fat oxidized for each moment. So as one gets closer to the body’s individual reduction limit of human body weight, the slower one will burn up what body fat one has. This is why taking off the final 10 pounds happens very slowly, NOT because one is wrecking one’s metabolic process with an aggressive diet regimen.

By the way, I’m using the term…”excess fat”… to define the entire genetic make-up of an individual body, not “troublesome” fat on specific body areas that one wishes were leaner… like stomach or thighs, etc. It is not uncommon for someone who is “normal weight” or even “underweight” to be unhappy with the way their own body’s necessary fat is genetically distributed.

The article quoted below makes a number of good points:


Are You In The Starvation Mode or Starving For Truth?

Recently we discussed the myth that dieting can lead to an eating disorder and saw this common dieting myth was inaccurate.  Another common dieting myth held by people is that they may not be losing weight because they are in the "starvation mode" from eating too few calories. And, in response to the intake of this low calorie level, their body has gone into "starvation mode" and slowed down their metabolism and is holding on to the weight. The usual recommendation to get out of starvation mode and allow the body to lose more weight, is to consume more calories. Eat more calories, to lose more weight.

Really?

Well, for anyone struggling to lose weight, this may sound sensible, but as you will see, it, like most other dieting myths, it is inaccurate. A few things to consider before we get to the "starvation mode."

First, the human body, as is our world, is governed by the laws of physics. Body weight is a product of energy balance. We can not violate the laws of physics and thermodynamics. The energy we consume must go somewhere, and to maintain a certain level of weight, an equivalent amount of energy must be consumed and an equilibrium must be achieved.

Second, in regard to metabolism, about >70% of our base metabolism is driven by our brain and other vital organs and is not really effected by food consumption as I discussed in the metabolism blog. We have little impact on this basal metabolic rate.

Third, most attempts to accurately track food consumption under report (intentionally and/or not intentionally) by about 30% and attempts to track exercise and activity levels over report by up to 50%. Even professionals can be as much as 30% off or more. This is usually part of the problem. Fat people are not accurately able to determine their caloric intake and output.

Now, in regard to the "starvation" mode, someone who has extra body weight and body fat is not in any "starvation mode" where they need to 'kick start" their metabolism by eating more calories. You can not "eat more" calories to force your body to "lose weight".

In regard to metabolism, if you are overweight/overfat, you can not cause your metabolism to decrease below a level needed to lose weight while you have extra weight/fat on you, and you can not "lose more weight by eating more calories/food." This is a misunderstanding of the principles of metabolism that does not apply to overweight people trying to lose weight.

Let's say we look at someone who says they are only eating only 800 calories and not losing weight. A well meaning and good intentioned friend (or professional) has told them they are in starvation mode and in order to lose weight and/or kick-start their metabolism, they need to eat more. But, what if instead of eating more, what do you think would happen if instead they just stopped eating altogether? Would they go further into starvation mode and continue to stay at the same weight or maybe even "gain" weight?

Clearly, they would lose more weight if they stopped eating altogether.

We all know (especially those who are familiar with fasting) that if you were to stop eating completely and just live on pure water, you would start to lose weight almost instantly and would continue to do so.

But according to this theory of the "starvation mode," if you were really in it and you fasted, by its own rational you would lose less weight ... if any at all, not more. We know this is not accurate.

So, where did this myth come from?

There is a true phenomenon known as the starvation response and it is well documented in the Minnesota Starvation experiments and the Hunger Fasts that have been studied. However, it only happens in humans when they lose enough body fat that they fall below the level of essential fat. In a man, this would be below around 5% fat and in women just above that, about 10%.

Most humans will look like holocaust survivors at that time. Here is a picture of some of the subjects from the famous Minnesota Starvation experiments from the 1940s.



Even at this point, after months of a low calorie diet with heavy exercise, they were not yet in the so-called "starvation mode" where they experienced significant metabolic changes. If you have more weight/fat on you than them, then neither are you

In addition, when this point is truly reached, the body does make several metabolic shifts to preserve itself, and if it is not fed more calories, can cease to exist. It is a matter of life and death. Hence the name.

This is not the same thing that happens when someone who is overweight and has a high percentage of body fat, is not losing weight. Usually this is due to an inaccurate assessment of their energy balance.

Now, it is possible that a medical condition, like hypothyroid could contribute to a slowed metabolism. However, if someone was to have a thyroid problem, it can be diagnosed and treated. But, then we are right back to my points above and dealing with an energy balance issue.

So, if you are overweight and/or overfat and not losing weight, the most important thing to do is re-evaluate your energy balance. And the best way to do this is to focus on foods that are low in calorie density (and high in nutrient density) and maintain a healthy level of activity.


The above-article was written by Jeffrey S. Novick, MS, RD, LD, LN, in January 2009 at www.healthscience.org

MS = master of science,

RD = registered dietitian

LD = Licensed dietitian

LN = Licensed nutritionist 


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