End Your Carb Confusion – by Dr. Eric Westman & Amy Berger

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Carbs can indeed be confusing! We’ve written about it ourselves before, but there’s more to be said than fits in a single article, and sometimes a book is in order. This one is such a book.

The authors (an MD and a nutritionist) explain the ins and outs of carbohydrates of various kinds, insulin responses, and what that means for the body. They also then look at the partly-similar, partly-different processes that occur with the metabolism of fats of various kinds, and what that means for the body, too.

Ultimately they advocate for a simple and clear low-carb approach broadly consistent with keto diet macro principles, without getting too overly focused on “is this fruit/vegetable ok?” minutiae. This has the benefit of putting it well aside from the paleo diet, for example (which focuses more on pseudo-historical foods than it does on macros), and also makes it a lot easier on a practical level.

The style is very textbook-like, which makes for an easy read with plenty of information that should stick easily in most reader’s minds, rather than details getting lost in wall-of-text formatting. So, we approve of this.

There is not, by the way, a recipes section. It’s “here’s the information, now go forth and enjoy” and leaves us all to find/make our own recipes, rather than trying to guess our culinary preferences.

Bottom line: if you’d like an easy-to-read primer on understanding how carbs work, what it means for you, and what to do about it, then this is a fine book.

Click here to check out End Your Carb Confusion, and end your carb confusion!

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  • What’s the difference between a psychopath and a sociopath? Less than you might think

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    Articles about badly behaved people and how to spot them are common. You don’t have to Google or scroll too much to find headlines such as 7 signs your boss is a psychopath or How to avoid the sociopath next door.

    You’ll often see the terms psychopath and sociopath used somewhat interchangeably. That applies to perhaps the most famous badly behaved fictional character of all – Hannibal Lecter, the cannibal serial killer from The Silence of the Lambs.

    In the book on which the movie is based, Lecter is described as a “pure sociopath”. But in the movie, he’s described as a “pure psychopath”. Psychiatrists have diagnosed him with something else entirely.

    So what’s the difference between a psychopath and a sociopath? As we’ll see, these terms have been used at different times in history, and relate to some overlapping concepts.

    Benoit Daoust/Shutterstock

    What’s a psychopath?

    Psychopathy has been mentioned in the psychiatric literature since the 1800s. But the latest edition of the Diagnostic Statistical Manual of Mental Disorders (known colloquially as the DSM) doesn’t list it as a recognised clinical disorder.

    Since the 1950s, labels have changed and terms such as “sociopathic personality disturbance” have been replaced with antisocial personality disorder, which is what we have today.

    The Silence of the Lambs movie poster
    Was Hannibal Lecter from The Silence of the Lambs a psychopath, a sociopath or something else entirely? Ralf Liebhold/Shutterstock

    Someone with antisocial personality disorder has a persistent disregard for the rights of others. This includes breaking the law, repeated lying, impulsive behaviour, getting into fights, disregarding safety, irresponsible behaviours, and indifference to the consequences of their actions.

    To add to the confusion, the section in the DSM on antisocial personality disorder mentions psychopathy (and sociopathy) traits. In other words, according to the DSM the traits are part of antisocial personality disorder but are not mental disorders themselves.

    US psychiatrist Hervey Cleckley provided the first formal description of psychopathy traits in his 1941 book The Mask of Sanity. He based his description on his clinical observations of nine male patients in a psychiatric hospital. He identified several key characteristics, including superficial charm, unreliability and a lack of remorse or shame.

    Canadian psychologist Professor Robert Hare refined these characteristics by emphasising interpersonal, emotional and lifestyle characteristics, in addition to the antisocial behaviours listed in the DSM.

    When we draw together all these strands of evidence, we can say a psychopath manipulates others, shows superficial charm, is grandiose and is persistently deceptive. Emotional traits include a lack of emotion and empathy, indifference to the suffering of others, and not accepting responsibility for how their behaviour impacts others.

    Finally, a psychopath is easily bored, sponges off others, lacks goals, and is persistently irresponsible in their actions.

    So how about a sociopath?

    The term sociopath first appeared in the 1930s, and was attributed to US psychologist George Partridge. He emphasised the societal consequences of behaviour that habitually violates the rights of others.

    Academics and clinicians often used the terms sociopath and psychopath interchangeably. But some preferred the term sociopath because they said the public sometimes confused the word psychopath with psychosis.

    “Sociopathic personality disturbance” was the term used in the first edition of the DSM in 1952. This aligned with the prevailing views at the time that antisocial behaviours were largely the product of the social environment, and that behaviours were only judged as deviant if they broke social, legal, and/or cultural rules.

    Some of these early descriptions of sociopathy are more aligned with what we now call antisocial personality disorder. Others relate to emotional characteristics similar to Cleckley’s 1941 definition of a psychopath.

    In short, different people had different ideas about sociopathy and, even today, sociopathy is less-well defined than psychopathy. So there is no single definition of sociopathy we can give you, even today. But in general, its antisocial behaviours can be similar to ones we see with psychopathy.

    Over the decades, the term sociopathy fell out of favour. From the late 60s, psychiatrists used the term antisocial personality disorder instead.

    Born or made?

    Both “sociopathy” (what we now call antisocial personality disorder) and psychopathy have been associated with a wide range of developmental, biological and psychological causes.

    For example, people with psychopathic traits have certain brain differences especially in regions associated with emotions, inhibition of behaviour and problem solving. They also appear to have differences associated with their nervous system, including a reduced heart rate.

    However, sociopathy and its antisocial behaviours are a product of someone’s social environment, and tends to run in families. These behaviours has been associated with physical abuse and parental conflict.

    What are the consequences?

    Despite their fictional portrayals – such as Hannibal Lecter in Silence of the Lambs or Villanelle in the TV series Killing Evenot all people with psychopathy or sociopathy traits are serial killers or are physically violent.

    But psychopathy predicts a wide range of harmful behaviours. In the criminal justice system, psychopathy is strongly linked with re-offending, particularly of a violent nature.

    In the general population, psychopathy is associated with drug dependence, homelessness, and other personality disorders. Some research even showed psychopathy predicted failure to follow COVID restrictions.

    But sociopathy is less established as a key risk factor in identifying people at heightened risk of harm to others. And sociopathy is not a reliable indicator of future antisocial behaviour.

    In a nutshell

    Neither psychopathy nor sociopathy are classed as mental disorders in formal psychiatric diagnostic manuals. They are both personality traits that relate to antisocial behaviours and are associated with certain interpersonal, emotional and lifestyle characteristics.

    Psychopathy is thought to have genetic, biological and psychological bases that places someone at greater risk of violating other people’s rights. But sociopathy is less clearly defined and its antisocial behaviours are the product of someone’s social environment.

    Of the two, psychopathy has the greatest use in identifying someone who is most likely to cause damage to others.

    Bruce Watt, Associate Professor in Psychology, Bond University and Katarina Fritzon, Associate Professor of Psychology, Bond University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Which Sugars Are Healthier, And Which Are Just The Same?

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    From Apples to Bees, and High-Fructose Cs

    We asked you for your (health-related) policy on sugar. The trends were as follows:

    • About half of all respondents voted for “I try to limit sugar intake, but struggle because it’s in everything”
    • About a quarter of all respondents voted for “Refined sugar is terrible; natural sugars (e.g. honey, agave) are fine”
    • About a quarter of all respondents voted for “Sugar is sugar and sugar is bad; I avoid it entirely”
    • One (1) respondent voted for “Sugar is an important source of energy, so I consume plenty”

    Writer’s note: I always forget to vote in these, but I’d have voted for “I try to limit sugar intake, but struggle because it’s in everything”.

    Sometimes I would like to make my own [whatever] to not have the sugar, but it takes so much more time, and often money too.

    So while I make most things from scratch (and typically spend about an hour cooking each day), sometimes store-bought is the regretfully practical timesaver/moneysaver (especially when it comes to condiments).

    So, where does the science stand?

    There has, of course, been a lot of research into the health impact of sugar.

    Unfortunately, a lot of it has been funded by sugar companies, which has not helped. Conversely, there are also studies funded by other institutions with other agendas to push, and some of them will seek to make sugar out to be worse than it is.

    So for today’s mythbusting overview, we’ve done our best to quality-control studies for not having financial conflicts of interest. And of course, the usual considerations of favoring high quality studies where possible Large sample sizes, good method, human subjects, that sort of thing.

    Sugar is sugar and sugar is bad: True or False?

    False and True, respectively.

    • Sucrose is sucrose, and is generally bad.
    • Fructose is fructose, and is worse.

    Both ultimately get converted into glycogen (if not used immediately for energy), but for fructose, this happens mostly* in the liver, which a) taxes it b) goes very unregulated by the pancreas, causing potentially dangerous blood sugar spikes.

    This has several interesting effects:

    • Because fructose doesn’t directly affect insulin levels, it doesn’t cause insulin insensitivity (yay)
    • Because fructose doesn’t directly affect insulin levels, this leaves hyperglycemia untreated (oh dear)
    • Because fructose is metabolized by the liver and converted to glycogen which is stored there, it’s one of the main contributors to non-alcoholic fatty liver disease (at this point, we’re retracting our “yay”)

    Read more: Fructose and sugar: a major mediator of non-alcoholic fatty liver disease

    *”Mostly” in the liver being about 80% in the liver. The remaining 20%ish is processed by the kidneys, where it contributes to kidney stones instead. So, still not fabulous.

    Fructose is very bad, so we shouldn’t eat too much fruit: True or False?

    False! Fruit is really not the bad guy here. Fruit is good for you!

    Fruit does contain fructose yes, but not actually that much in the grand scheme of things, and moreover, fruit contains (unless you have done something unnatural to it) plenty of fiber, which mitigates the impact of the fructose.

    • A medium-sized apple (one of the most sugary fruits there is) might contain around 11g of fructose
    • A tablespoon of high-fructose corn syrup can have about 27g of fructose (plus about 3g glucose)

    Read more about it: Effects of high-fructose (90%) corn syrup on plasma glucose, insulin, and C-peptide in non-insulin-dependent diabetes mellitus and normal subjects

    However! The fiber content (in fruit) mitigates the impact of the fructose almost entirely anyway.

    And if you take fruits that are high in sugar and/but high in polyphenols, like berries, they now have a considerable net positive impact on glycemic health:

    You may be wondering: what was that about “unless you have done something unnatural to it”?

    That’s mostly about juicing. Juicing removes much (or all) of the fiber, and if you do that, you’re basically back to shooting fructose into your veins:

    Natural sugars like honey, agave, and maple syrup, are healthier than refined sugars: True or False?

    TrueSometimes, and sometimes marginally.

    This is partly because of the glycemic index and glycemic load. The glycemic index scores tail off thus:

    • table sugar = 65
    • maple syrup = 54
    • honey = 46
    • agave syrup = 15

    So, that’s a big difference there between agave syrup and maple syrup, for example… But it might not matter if you’re using a very small amount, which means it may have a high glycemic index but a low glycemic load.

    Note, incidentally, that table sugar, sucrose, is a disaccharide, and is 50% glucose and 50% fructose.

    The other more marginal health benefits come from that fact that natural sugars are usually found in foods high in other nutrients. Maple syrup is very high in manganese, for example, and also a fair source of other minerals.

    But… Because of its GI, you really don’t want to be relying on it for your nutrients.

    Wait, why is sugar bad again?

    We’ve been covering mostly the more “mythbusting” aspects of different forms of sugar, rather than the less controversial harms it does, but let’s give at least a cursory nod to the health risks of sugar overall:

    That last one, by the way, was a huge systematic review of 37 large longitudinal cohort studies. Results varied depending on what, specifically, was being examined (e.g. total sugar, fructose content, sugary beverages, etc), and gave up to 200% increased cancer risk in some studies on sugary beverages, but 95% increased risk is a respectable example figure to cite here, pertaining to added sugars in foods.

    And finally…

    The 56 Most Common Names for Sugar (Some Are Tricky)

    How many did you know?

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  • Ketogenic Diet: Burning Fat Or Burning Out?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:

    • About 45% said “It has its benefits, but they don’t outweigh the risks”
    • About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
    • About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”

    So what does the science say?

    First, what is the ketogenic diet?

    There are two different stories here:

    • Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
    • Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.

    Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.

    The ketogenic diet works by forcing the body to burn fat for energy: True or False?

    True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.

    See: The Ketogenic Diet: One Decade Later | Pediatrics

    Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:

    Source: Dietary Therapies for Epilepsy

    The ketogenic diet is good for weight loss: True or False?

    True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:

    ❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.

    Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞

    ~ Dr. Shadan Khdher et al.

    Read in full: The Significant Impact of High-Fat, Low-Carbohydrate Ketogenic Diet on Serum Lipid Profile and Atherosclerotic Cardiovascular Disease Risk in Overweight and Obese Adults

    On which note…

    The ketogenic diet is bad for the heart: True or False?

    True! As Dr. Joanna Popiolek-Kalisz concluded recently:

    ❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.

    Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞

    ~ Dr. Joanna Popiolek-Kalisz

    Read in full: Ketogenic diet and cardiovascular risk: state of the art review

    The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?

    True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:

    ❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.

    Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞

    ~ Ibid.

    The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?

    False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.

    That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:

    1. At first, the body is running out of glucose, and so naturally feels weak and tired.
    2. Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
    3. Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.

    Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:

    • Bad breath
    • Weight loss
    • Appetite loss
    • Increased focus and energy
    • Increased fatigue and irritability
    • Digestive issues
    • Insomnia

    The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.

    Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:

    The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia

    The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?

    True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.

    One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.

    Other things are more specific to the keto diet, such as the problems with the kidneys:

    The Relationship between Modern Fad Diets and Kidney Stone Disease: A Systematic Review of Literature

    However, kidney stones aren’t the worst of the problems:

    Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure

    We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:

    ❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞

    ~ Dr. Ida Heikura et al.

    A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise

    Want a healthier diet?

    We recommend the Mediterranean diet.

    See also: Four Ways To Upgrade The Mediterranean

    (the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)

    Enjoy!

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  • How To Set Anxiety Aside

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How To Set Anxiety Aside

    We’ve talked previously about how to use the “release” method to stop your racing mind.

    That’s a powerful technique, but sometimes we need to be calm enough to use it. So first…

    Breathe

    Obviously. But, don’t underestimate the immediate power of focusing on your breath, even just for a moment.

    There are many popular breathing exercises, but here’s one of the simplest and most effective, “4–4 breathing”:

    • Breathe in for a count of four
    • Hold for a count four
    • Breathe out for a count of four
    • Hold for a count of four
    • Repeat

    Depending on your lung capacity and what you’re used to, it may be that you need to count more quickly or slowly to make it feel right. Experiment with what feels comfortable for you, but the general goal should breathing deeply and slowly.

    Identify the thing that’s causing you anxiety

    We’ve also talked previously about how to use the RAIN technique to manage difficult emotions, and that’s good for handling anxiety too.

    Another powerful tool is journaling.

    Read: How To Use Journaling to Challenge Anxious Thoughts

    If you don’t want to use any of those (very effective!) methods, that’s fine too—journaling isn’t for everyone.

    You can leverage some of the same benefits by simply voicing your worries, even to yourself:

    There’s an old folk tradition of “worry dolls”; these are tiny little dolls so small they can be kept in a pocket-size drawstring purse. Last thing at night, the user whispers their worries to the dolls and puts them back in their bag, where they will work on the person’s problem overnight.

    We’re a health and productivity newsletter, not a dealer of magic and spells, but you can see how it works, right? It gets the worries out of one’s head, and brings about a helpful placebo effect too.

    Focus on what you can control

    • Most of what you worry about will not happen.
    • Some of what you worry about may happen.
    • Worrying about it will not help.

    In fact, in some cases it may bring about what you fear, by means of the nocebo effect (like the placebo effect, but bad). Additionally, worrying drains your body and makes you less able to deal with whatever life does throw at you.

    So while “don’t worry; be happy” may seem a flippant attitude, sometimes it can be best. However, don’t forget the other important part, which is actually focusing on what you can control.

    • You can’t control whether your car will need expensive maintenance…
      • …but you can control whether you budget for it.
    • You can’t control whether your social event will go well or ill…
      • …but you can control how you carry yourself.
    • You can’t control whether your loved one’s health will get better or worse…
      • …but you can control how you’re there for them, and you can help them take what sensible precautions they may.

    …and so forth.

    Look after your body as well!

    Your body and mind are deeply reliant on each other. In this case, just as anxiety can drain your body’s resources, keeping your body well-nourished, well-exercised, and well-rested and can help fortify you against anxiety. For example, when it comes to diet, exercise, and sleep:

    Don’t know where to start? How about the scientifically well-researched, evidence-based, 7-minute workout?

    Check Out the Seven Minute Workout App (Android and iOS

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  • Skin Care Down There (Incl. Butt Acne, Hyperpigmentation, & More)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Sam Ellis, dermatologist, gives us the low-down:

    Where the sun don’t shine

    Common complaints and remedies that Dr. Ellis covers in this video include:

    • Butt acne/folliculitis: most butt breakouts are actually folliculitis, not traditional acne. Folliculitis is caused by friction, sitting for long periods, or wearing tight clothes. Solutions include antimicrobial washes like benzoyl peroxide and changing sitting habits (i.e. to sit less)
    • Keratosis pilaris: rough bumps around hair follicles can appear on the butt, often confused with acne.
    • Boils and abscesses: painful, large lumps; these need medical attention for drainage.
    • Hidradenitis suppurativa: recurrent painful cysts and boils in skin creases, often in the groin and buttocks. These require medical intervention and treatment.
    • Ingrown hairs: are common in people who shave or wax. Treat with warm compresses and gentle exfoliants.
    • Hyperpigmentation: is often caused by hormonal changes, friction, or other irritation. Laser hair removal and gentle chemical exfoliants can help.

    In the event that the sun does, in fact, shine on your genitals (for example you sunbathe nude and have little or no pubic hair), then sun protection is essential to prevent further darkening (and also, incidentally, reduce the risk of cancer).

    For more on all of this, plus a general introduction to skincare in the bikini zone (i.e. if everything’s fine there right now and you’d like to keep it that way), enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    The Evidence-Based Skincare That Beats Product-Specific Hype

    Take care!

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  • The Blood Sugar Solution – by Dr. Mark Hyman

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    The main purpose of this book is combating metabolic disease, the amalgam of what’s often prediabetes (sometimes fully-fledged diabetes) and cardiovascular disease (sometimes fully-fledged heart disease).

    To achieve this (after an introductory section explaining what the sociomedical problems are and why the sociomedical problems are happening), he offers a seven-step program; we’ll not keep those steps a mystery; they are:

    1. Boost your nutrition
    2. Regulate your hormones
    3. Reduce inflammation
    4. Improve your digestion
    5. Maximize detoxification
    6. Enhance energy metabolism
    7. Soothe your mind

    Thereafter, it’s all about leading the reader by the hand through the steps; he also offers a six-week action plan, and a six-week meal plan with recipes.

    The style is very sensationalist (too sensationalist for this reviewer’s personal taste) but nevertheless backed up with hard science when it comes to hard claims. So, if you don’t mind wading through (or skipping) some early chapters that are a bit “used car salesman” in feel, there’s actually a lot of good information, especially in the middle of the book, and useful practical guides in the middle and end.

    Bottom line: if you want a good comprehensive science-based practical guide to addressing the risk of metabolic disease, this is that.

    Click here to check out The Blood Sugar Solution, and look after yours!

    Don’t Forget…

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    Learn to Age Gracefully

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