Clean Needles Save Lives. In Some States, They Might Not Be Legal.
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Kim Botteicher hardly thinks of herself as a criminal.
On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.
In the former church’s basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.
The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization’s home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.
Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.
She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.
But she has also talked publicly about how she has made sterile syringes available to people who use drugs.
“When that person comes in the door,” she said, “if they are covered with abscesses because they have been using needles that are dirty, or they’ve been sharing needles — maybe they’ve got hep C — we see that as, ‘OK, this is our first step.’”
Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.
This harm-reduction strategy is supported by leading health groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.
But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it’s a misdemeanor to distribute drug paraphernalia. The state’s definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don’t have a state drug paraphernalia law or don’t include syringes in it.
Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania’s law is long overdue.
There’s an urgency to the issue as well: Billions of dollars have begun flowing into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.
The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.
But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state’s drug paraphernalia law stands in the way.
Concerns over Botteicher’s work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”
Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.
“It’s just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It’s causing a lot of confusion.”
Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania’s two largest cities, Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.
Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker’s position signals a major shift in that city’s approach to the opioid epidemic.
On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization’s work with sterile syringes and other supplies for safer drug use.
“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point’s executive director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you’re constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?’”
In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.
The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.
Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”
In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.
Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn’t be alive today if it weren’t for the support and community she found at a syringe services program in Philadelphia.
“It kind of just made me feel like I was in a safe space. And I don’t really know if there was like a come-to-God moment or come-to-Jesus moment,” she said. “I just wanted better.”
Favata is now in long-term recovery and works for a medication-assisted treatment program.
At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.
Rosalie Danchanko, Highlands Health’s executive director, said she hopes opioid settlement money can eventually support her organization.
“Why shouldn’t that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.
In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.
One of the bill’s lead sponsors, state Rep. Jim Struzzi, hasn’t always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.
In the committee vote, nearly all of Struzzi’s Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”
After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.
“A lot of these people are … desperate. They’re alone. They’re afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”
At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.
“If it’s something that’s going to help someone, then why is it illegal?” she said. “It just doesn’t make any sense to me.”
This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The FDA Just Redefined “Healthy”—But How?
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In the ongoing war of labelling regulations (usually with advertisers on one side and regulators on the other), the FDA has updated what’s required in order to label a food as “healthy”.
Here’s what they’re now* requiring:
To bear the “healthy” claim, a food product needs to:
- Contain a certain amount of food (food group equivalent) from at least one of the food groups or subgroups (such as fruits, vegetables, fat-free and low-fat dairy etc.) recommended by the Dietary Guidelines.
- Adhere to specified limits for the following nutrients: saturated fat, sodium, and added sugars.
Source: FDA | Press Releases | FDA Finalizes Updated “Healthy” Nutrient Content Claim
*however, manufacturers have 3 years to conform, which if we’re being cynical about it, looks suspiciously like just short of a US presidential election cycle so that actual enforcement will be someone else’s problem.
Will it help?
Maybe! It’s not too dissimilar to the “traffic light system” already in use in Europe, although that currently emphasizes the absence/presence of “bad things” e.g. saturated fat, sodium, and added sugars.
It has its faults, because for example…
- not all saturated fat is bad, and a jar of coconut oil is now definitely going to get labelled as very unhealthy
- low-sodium salt is, ironically, going to to get flagged as being very high in sodium and therefore unhealthy
This latter is because on a g/100g basis, a product that’s ⅓ sodium chloride is going to have a lot of sodium, even if it’s approaching ⅔ less sodium than the product it’s (healthily!) replacing.
However, on a large scale, these kinds of problems are surely going to be small next to (hopefully) manufacturers scrambling to find ways to cut down on the saturated fats, sodium, and added sugars.
You may be wondering…
What will they replace them with?
Sometimes, companies trying to make something healthier will mess up, like when the health risks of smoking hit public consciousness, one cigarette company had the bright idea of putting asbestos in their filter tips, to market them as healthier. So, could something similar happen here?
- Saturated fat: definitely could; because the health benefits/risks of different kinds of fats and their constituent fatty acids are a lot more nuanced than just “saturated” vs “mono-/polyunsaturated”, it is definitely possible that companies may replace healthier saturated-heavy fats with less healthy unsaturated fats, depending on what is cheaper.
- See also: Can Saturated Fats Be Healthy?
- Sodium: probably not; likely go-to replacements for sodium chloride will be potassium chloride (healthier than sodium chloride) and MSG (has an unearned bad reputation in the US, but is healthier than sodium chloride).
- Added sugars: probably—things get very complicated very quickly when it comes to artificial sweeteners, and also the crux will definitely lie in what gets defined as an “added sugar”; watch out for a rise in the use of things that slide by the definition of added sugar while still being chemically (and, which is important, metabolically) the same thing.
Well that doesn’t sound great
It doesn’t, but on the flipside, the positive inclusions will probably be mostly good.
For example, the only way to get a “healthy” labelling in including fiber is to include more fiber, same with vitamins and minerals.
The low-fat dairy thing could possibly get abused (much like with the general “low-fat” trend of the 80s).
The “portion of fruit” thing will need to be carefully defined to avoid running straight back into the “this is just added sugar by another name” problem; mostly that it’ll need to still include the same amount of fiber as was in the whole fruit, gram for gram.
See also: What Matters Most For Your Heart? ← it’s about fiber, not salt or saturated fats!
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I Contain Multitudes – by Ed Yong
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A little while back we reviewed a book (Planet of Viruses) about the role of viruses in our lives, beyond the obvious. Today’s book gives the same treatment to microbes in general—mostly bacteria.
We all know about pathogens, and we all know about gut microbiota and that some (hopefully the majority) there are good for our health. This book covers those things too, but also much more.
Pulitzer Prize-winning science writer Ed Yong takes a big picture view (albeit, of some very small things) and looks at the many ways microbes keep us alive, directly or indirectly. From the microbes that convert certain proteins in breast milk into a form that babies can digest (yes, this means we produce nutrients in breast milk that have been evolved solely to feed that bacterium), to those without which agriculture would simply not work, we’re brought to realize how much our continued existence is contingent on our trillions of tiny friends.
The style throughout is easy-reading pop-science, very accessible. There’s also plenty in terms of practical take-away value, when it comes to adjusting our modern lives to better optimize the benefits we get from microbes—inside and out.
Bottom line: if you’d like to learn about the role of microbes in our life beyond “these ones are pathogens” and “these ones help our digestion”, this is the book for you.
Click here to check out I Contain Multitudes, and learn more about yours and those around you!
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Buckwheat vs Bulgur Wheat – Which is Healthier?
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Our Verdict
When comparing buckwheat to bulgur, we picked the buckwheat.
Why?
First, some things to know up front:
- Bulgur wheat is a kind of cracked wheat product. As such, it contains wheat, and yes, gluten.
- Buckwheat is not a wheat, nor even a grass, but a flowering plant. Buckwheat is as related to wheat as a lionfish is to a lion. It does not contain gluten.
- Buckwheat can be purchased whole or hulled. We went with whole. If you go with hulled, the percentages of vitamins and minerals will be relatively higher, and/but this will be because you lost the fibrous husk, so they’ll be commensurately lower in fiber. If you were to go with hulled, we’d still pick it over bulgur wheat though, just for a different reason (as in that case, the vitamin and mineral contents would be more overwhelmingly in buckwheat’s favor, even though it’d have less fiber).
Ok, now that those things are covered…
Looking at the macronutrients, there’s not a lot between them, except that buckwheat has the much lower glycemic index (this is only the case if you got whole, not hulled—if you got hulled, the glycemic index would be about the same).
In terms of vitamins, buckwheat has more of vitamins B2, B5, B9, E, K, and choline, while bulgur wheat technically has more vitamin A, but the numbers are tiny; a cup of bulgur wheat will give you 0.12% of the RDA. So, an easy win (functionally: 5:0) for buckwheat.
When it comes to minerals, buckwheat has more copper, magnesium, potassium, and selenium, while bulgur wheat has more calcium and manganese. They’re equal on iron and phosphorus, making this a 4:2 win for buckwheat.
Adding up the categories makes this a clear win for buckwheat!
Want to learn more?
You might like to read:
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Cannabis Myths vs Reality
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Cannabis Myths vs Reality
We asked you for your (health-related) opinion on cannabis use—specifically, the kind with psychoactive THC, not just CBD. We got the above-pictured, below-described, spread of responses:
- A little over a third of you voted for “It’s a great way to relax, without most of the dangers of alcohol”.
- A little under a third of you voted for “It may have some medical uses, but recreational use is best avoided”.
- About a quarter of you voted for “The negative health effects outweigh the possible benefits”
- Three of you voted for “It is the gateway to a life of drug-induced stupor and potentially worse”
So, what does the science say?
A quick legal note first: we’re a health science publication, and are writing from that perspective. We do not know your location, much less your local laws and regulations, and so cannot comment on such. Please check your own local laws and regulations in that regard.
Cannabis use can cause serious health problems: True or False?
True. Whether the risks outweigh the benefits is a personal and subjective matter (for example, a person using it to mitigate the pain of late stage cancer is probably unconcerned with many other potential risks), but what’s objectively true is that it can cause serious health problems.
One subscriber who voted for “The negative health effects outweigh the possible benefits” wrote:
❝At a bare minimum, you are ingesting SMOKE into your lungs!! Everyone SEEMS TO BE against smoking cigarettes, but cannabis smoking is OK?? Lung cancer comes in many forms.❞
Of course, that is assuming smoking cannabis, and not consuming it as an edible. But, what does the science say on smoking it, and lung cancer?
There’s a lot less research about this when it comes to cannabis, compared to tobacco. But, there is some:
❝Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers, although the possibility of potential adverse effect for heavy consumption cannot be excluded.❞
Read: Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium
Another study agreed there appears to be no association with lung cancer, but that there are other lung diseases to consider, such as bronchitis and COPD:
❝Smoking cannabis is associated with symptoms of chronic bronchitis, and there may be a modest association with the development of chronic obstructive pulmonary disease. Current evidence does not suggest an association with lung cancer.❞
Read: Cannabis Use, Lung Cancer, and Related Issues
Cannabis edibles are much safer than smoking cannabis: True or False?
Broadly True, with an important caveat.
One subscriber who selected “It may have some medical uses, but recreational use is best avoided”, wrote:
❝I’ve been taking cannabis gummies for fibromyalgia. I don’t know if they’re helping but they’re not doing any harm. You cannot overdose you don’t become addicted.❞
Firstly, of course consuming edibles (rather than inhaling cannabis) eliminates the smoke-related risk factors we discussed above. However, other risks remain, including the much greater ease of accidentally overdosing.
❝Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.❞
Note: that “more frequent” for inhaled cannabis, is because more people inhale it than eat it. If we adjust the numbers to control for how much less often people eat it, suddenly we see that the numbers of hospital admissions are disproportionately high for edibles, compared to inhaled cannabis.
Or, as the study author put it:
❝There are more adverse drug events associated on a milligram per milligram basis of THC when it comes in form of edibles versus an inhaled cannabis. If 1,000 people smoked pot and 1,000 people at the same dose in an edible, then more people would have more adverse drug events from edible cannabis.❞
See the numbers: Acute Illness Associated With Cannabis Use, by Route of Exposure
Why does this happen?
- It’s often because edibles take longer to take effect, so someone thinks “this isn’t very strong” and has more.
- It’s also sometimes because someone errantly eats someone else’s edibles, not realising what they are.
- It’s sometimes a combination of the above problems: a person who is now high, may simply forget and/or make a bad decision when it comes to eating more.
On the other hand, that doesn’t mean inhaling it is necessarily safer. As well as the pulmonary issues we discussed previously, inhaling cannabis has a higher risk of cannabinoid hyperemesis syndrome (and the resultant cyclic vomiting that’s difficult to treat).
You can read about this fascinating condition that’s sometimes informally called “scromiting”, a portmanteau of screaming and vomiting:
Cannabinoid Hyperemesis Syndrome
You can’t get addicted to cannabis: True or False?
False. However, it is fair to say that the likelihood of developing a substance abuse disorder is lower than for alcohol, and much lower than for nicotine.
See: Prevalence of Marijuana Use Disorders in the United States Between 2001–2002 and 2012–2013
If you prefer just the stats without the science, here’s the CDC’s rendering of that:
Addiction (Marijuana or Cannabis Use Disorder)
However, there is an interesting complicating factor, which is age. One is 4–7 times more likely to develop a substance abuse disorder, if one starts use as an adolescent, rather than later in life:
Cannabis is the gateway to use of more dangerous drugs: True or False?
False, generally speaking. Of course, for any population there will be some outliers, but there appears to be no meaningful causal relation between cannabis use and other substance use:
Interestingly, the strongest association (where any existed at all) was between cannabis use and opioid use. However, rather than this being a matter of cannabis use being a gateway to opioid use, it seems more likely that this is a matter of people looking to both for the same purpose: pain relief.
As a result, growing accessibility of cannabis may actually reduce opioid problems:
- Cannabis as a Gateway Drug for Opioid Use Disorder
- Association between medical cannabis laws and opioid overdose mortality has reversed over time
Some final words…
Cannabis is a complex drug with complex mechanisms and complex health considerations, and research is mostly quite young, due to its historic illegality seriously cramping science by reducing sample sizes to negligible. Simply put, there’s a lot we still don’t know.
Also, we covered some important topics today, but there were others we didn’t have time to cover, such as the other potential psychological benefits—and risks. Likely we’ll revisit those another day.
Lastly, while we’ve covered a bunch of risks today, those of you who said it has fewer and lesser risks than alcohol are quite right—the only reason we couldn’t focus on that more, is because to talk about all the risks of alcohol would make this feature many times longer!
Meanwhile, whether you partake or not, stay safe and stay well.
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More research shows COVID-19 vaccines are safe for young adults
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What you need to know
- Myocarditis, or inflammation of the heart muscle, is most commonly caused by a viral infection like COVID-19, not by vaccination.
- In line with previous research, a recent CDC study found no association between COVID-19 vaccination and sudden cardiac death in previously healthy young people.
- A COVID-19 infection is much more likely to cause inflammation of the heart muscle than a COVID-19 vaccine, and those cases are typically more severe.
Since the approval of the first COVID-19 vaccines, anti-vaccine advocates have raised concerns about heart muscle inflammation, also called myocarditis, after vaccination to suggest that vaccines are unsafe. They’ve also used concerns about myocarditis to spread false claims that vaccines cause sudden deaths, which is not true.
Research has consistently shown that cases of myocarditis after vaccination are extremely rare and usually mild, and a new study from the CDC found no association between sudden cardiac death and COVID-19 vaccination in young adults.
Read on to learn more about myocarditis and what the latest research says about COVID-19 vaccine safety.
What is myocarditis?
Myocarditis is inflammation of the myocardium, or the middle muscular layer of the heart wall. This inflammation weakens the heart’s ability to pump blood. Symptoms may include fatigue, shortness of breath, chest pain, rapid or irregular heartbeat, and flu-like symptoms.
Myocarditis may resolve on its own. In rare cases, it may lead to stroke, heart failure, heart attack, or death.
What causes myocarditis?
Myocarditis is typically caused by a viral infection like COVID-19. Bacteria, parasites, fungi, chemicals, and certain medications can also cause myocarditis.
In very rare cases, some people develop myocarditis after receiving a COVID-19 vaccine, but these cases are usually mild and resolve on their own. In contrast, a COVID-19 infection is much more likely to cause myocarditis, and those cases are typically more severe.
Staying up to date on vaccines reduces your risk of developing myocarditis from a COVID-19 infection.
Are COVID-19 vaccines safe for young people?
Yes. COVID-19 vaccines have been rigorously tested and monitored over the past three years and have been determined to be safe for everyone 6 months and older. A recent CDC study found no association between COVID-19 vaccination and sudden cardiac death in previously healthy young adults.
The benefits of vaccination outweigh any potential risks. Staying up to date on COVID-19 vaccines reduces your risk of severe illness, hospitalization, death, long COVID, and COVID-19-related complications, such as myocarditis.
The CDC recommends people 65 and older and immunocompromised people receive an additional dose of the updated COVID-19 vaccine this spring—if at least four months have passed since they received a COVID-19 vaccine.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Pomegranate vs Cherries – Which is Healthier?
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Our Verdict
When comparing pomegranate to cherries, we picked the pomegranate.
Why?
In terms of macros, pomegranate is slightly higher in carbs, and/but 4x higher in fiber. That’s already a good start for pomegranates. Lest we be accused of cherry-picking, though, we’ll mention that pomegranate is also slightly higher in protein and fat, for what it’s worth—which is not a lot. As with most fruits, the protein and fat numbers are low importance next to the carb:fiber ratio.
When it comes to vitamins, pomegranate has more of vitamins B1, B2, B5, B6, B9. E. K, and choline. On the other hand, cherries have more of vitamins A and B3. The two fruits are equal in vitamin C. This all makes for a clear win for pomegranate.
In the category of minerals, pomegranate boasts more copper, magnesium, phosphorus, potassium, selenium, and zinc. In contrast, cherries have slightly more calcium. Another win for pomegranate.
Both of these fruits have beneficial polyphenols, each with a slightly different profile, but neither pressingly better than the other.
In short: as ever with healthy foods, enjoy both—diversity is good! But if you’re going to pick on, we recommend the pomegranate.
Want to learn more?
You might like to read:
- Pomegranate Peel’s Potent Potential ← so don’t throw it away!
- Cherries’ Very Healthy Wealth Of Benefits!
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