America’s Health System Isn’t Ready for the Surge of Seniors With Disabilities
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The number of older adults with disabilities — difficulty with walking, seeing, hearing, memory, cognition, or performing daily tasks such as bathing or using the bathroom — will soar in the decades ahead, as baby boomers enter their 70s, 80s, and 90s.
But the health care system isn’t ready to address their needs.
That became painfully obvious during the covid-19 pandemic, when older adults with disabilities had trouble getting treatments and hundreds of thousands died. Now, the Department of Health and Human Services and the National Institutes of Health are targeting some failures that led to those problems.
One initiative strengthens access to medical treatments, equipment, and web-based programs for people with disabilities. The other recognizes that people with disabilities, including older adults, are a separate population with special health concerns that need more research and attention.
Lisa Iezzoni, 69, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s and is widely considered the godmother of research on disability, called the developments “an important attempt to make health care more equitable for people with disabilities.”
“For too long, medical providers have failed to address change in society, changes in technology, and changes in the kind of assistance that people need,” she said.
Among Iezzoni’s notable findings published in recent years:
Most doctors are biased. In survey results published in 2021, 82% of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57% said they welcomed disabled patients.
“It’s shocking that so many physicians say they don’t want to care for these patients,” said Eric Campbell, a co-author of the study and professor of medicine at the University of Colorado.
While the findings apply to disabled people of all ages, a larger proportion of older adults live with disabilities than younger age groups. About one-third of people 65 and older — nearly 19 million seniors — have a disability, according to the Institute on Disability at the University of New Hampshire.
Doctors don’t understand their responsibilities. In 2022, Iezzoni, Campbell, and colleagues reported that 36% of physicians had little to no knowledge of their responsibilities under the 1990 Americans With Disabilities Act, indicating a concerning lack of training. The ADA requires medical practices to provide equal access to people with disabilities and accommodate disability-related needs.
Among the practical consequences: Few clinics have height-adjustable tables or mechanical lifts that enable people who are frail or use wheelchairs to receive thorough medical examinations. Only a small number have scales to weigh patients in wheelchairs. And most diagnostic imaging equipment can’t be used by people with serious mobility limitations.
Iezzoni has experienced these issues directly. She relies on a wheelchair and can’t transfer to a fixed-height exam table. She told me she hasn’t been weighed in years.
Among the medical consequences: People with disabilities receive less preventive care and suffer from poorer health than other people, as well as more coexisting medical conditions. Physicians too often rely on incomplete information in making recommendations. There are more barriers to treatment and patients are less satisfied with the care they do get.
Egregiously, during the pandemic, when crisis standards of care were developed, people with disabilities and older adults were deemed low priorities. These standards were meant to ration care, when necessary, given shortages of respirators and other potentially lifesaving interventions.
There’s no starker example of the deleterious confluence of bias against seniors and people with disabilities. Unfortunately, older adults with disabilities routinely encounter these twinned types of discrimination when seeking medical care.
Such discrimination would be explicitly banned under a rule proposed by HHS in September. For the first time in 50 years, it would update Section 504 of the Rehabilitation Act of 1973, a landmark statute that helped establish civil rights for people with disabilities.
The new rule sets specific, enforceable standards for accessible equipment, including exam tables, scales, and diagnostic equipment. And it requires that electronic medical records, medical apps, and websites be made usable for people with various impairments and prohibits treatment policies based on stereotypes about people with disabilities, such as covid-era crisis standards of care.
“This will make a really big difference to disabled people of all ages, especially older adults,” said Alison Barkoff, who heads the HHS Administration for Community Living. She expects the rule to be finalized this year, with provisions related to medical equipment going into effect in 2026. Medical providers will bear extra costs associated with compliance.
Also in September, NIH designated people with disabilities as a population with health disparities that deserves further attention. This makes a new funding stream available and “should spur data collection that allows us to look with greater precision at the barriers and structural issues that have held people with disabilities back,” said Bonnielin Swenor, director of the Johns Hopkins University Disability Health Research Center.
One important barrier for older adults: Unlike younger adults with disabilities, many seniors with impairments don’t identify themselves as disabled.
“Before my mom died in October 2019, she became blind from macular degeneration and deaf from hereditary hearing loss. But she would never say she was disabled,” Iezzoni said.
Similarly, older adults who can’t walk after a stroke or because of severe osteoarthritis generally think of themselves as having a medical condition, not a disability.
Meanwhile, seniors haven’t been well integrated into the disability rights movement, which has been led by young and middle-aged adults. They typically don’t join disability-oriented communities that offer support from people with similar experiences. And they don’t ask for accommodations they might be entitled to under the ADA or the 1973 Rehabilitation Act.
Many seniors don’t even realize they have rights under these laws, Swenor said. “We need to think more inclusively about people with disabilities and ensure that older adults are fully included at this really important moment of change.”
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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Tasty Versatile Rice
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In the nearish future, we’re going to do some incredible rice dishes, but first we need to make sure we’re all on the same page about cooking rice, so here’s a simple recipe first, to get technique down and work in some essentials. We’ll be using wholegrain basmati rice, because it has a low glycemic index, lowest likelihood of heavy metal contamination (a problem for some kinds of rice), and it’s one of the easiest rices to cook well.
You will need
- 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same)
- 1 1/2 cups vegetable stock (ideally you have made this yourself from vegetable offcuts that you saved in the freezer, then it will be healthiest and lowest in sodium; failing that, low-sodium vegetable stock cubes can be purchased at most large supermarkets. and then made up at home with hot water)
- 1 tbsp extra virgin olive oil
- 1 tbsp chia seeds
- 1 tbsp black pepper, coarse ground
- 1 tsp turmeric powder (this small quantity will not change the flavor, but it has important health benefits, and also makes the rice a pleasant golden color)
- 1 tsp garlic powder
- 1 tsp yeast extract (this gently improves the savory flavor and also adds vitamin B12)
- Optional small quantity of green herbs for garnish. Cilantro is good (unless you have the soap gene); parsley never fails.
This is the ingredients list for a super-basic rice that will go with anything rice will go with; another day we can talk more extensive mixes of herbs and spice blends for different kinds of dishes (and different health benefits!), but for now, let’s get going!
Method
(we suggest you read everything at least once before doing anything)
1) Wash the rice thoroughly. We recommend using a made-for-purpose rice-washing bowl (like this one, for example), but failing that, simply rinse it thoroughly with cold water using a bowl and a sieve. You will probably need to rinse it 4–5 times, but with practice, it will only take a few seconds per rinse, and the water will be coming up clear.
2) Warm the pan. It doesn’t matter for the moment whether you’re using an electronic rice cooker, a stovetop pressure cooker, electronic pressure cooker, or just a sturdy pan with a heavy lid available, aside from that if it’s something non-stovetop, you now want it to be on low to warm up already.
3) Separately in a saucepan, bring your stock to a simmer
4) Put the tbsp of olive oil into the pan (even if you’re confident the rice won’t stick; this isn’t entirely about that) and turn up the heat (if it’s a very simple rice cooker, most at least have a warm/cook differentiation; if so, turn it to “cook”). You don’t want the oil to get to the point of smoking, so, to test the temperature as it heats, flick a single drop of water from your fingertip (you did wash your hands first, right? We haven’t been including that step, but please do wash your hands before doing kitchen things) into the pan. If it sizzles, the pan is hot enough now for the next step.
5) Put the rice into the pan. That’s right, with no extra liquid yet; we’re going to toast it for a moment. Stir it a little, for no more than a minute; keep it moving; don’t let it burn! If you try this several times and fail, it could be that you need a better pan. Treat yourself to one when you get the opportunity; until then, skip the toasting part if necessary.
6) Add the chia seeds and spices, followed by the stock, followed by the yeast extract. Why did we do the stock before the yeast extract? It’s because hot liquid will get all the yeast extract off the teaspoon 🙂
7) Put the lid on/down (per what kind of pan or rice cooker you are using), and turn up the heat (if it is a variable heat source) until a tiny bit of steam starts making its way out. When it does, turn it down to a simmer, and let the rice cook. Don’t stir it, don’t jiggle it; trust the process. If you stir or jiggle it, the rice will cook unevenly and, paradoxically, probably stick.
8) Do keep an eye on it, because when steam stops coming out, it is done, and needs taking off the heat immediately. If using an automatic rice cooker, you can be less attentive if you like, because it will monitor this for you.
Note: if you are using a simple pan with a non-fastening lid (any other kind of rice cooking setup is better), more steam will escape than the other methods, and it’s possible that it might run out of steam (literally) before the rice is finished. If the steam stops and you find the rice isn’t done, add a splash of water as necessary (the rice doesn’t need to be submerged, it just needs to have liquid; the steam is part of the cooking process), and make a note of how much you had to add (so that next time you can just add it at the start), and put it back on the heat until it is done.
9) Having taken it off the heat, let it sit for 5 minutes (with the lid still on) before doing any fluffing-up. Then you can fluff-up and serve, adding the garnish if you want one.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Should You Go Light Or Heavy On Carbs?
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- The Many Health Benefits Of Garlic
Take care!
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What you need to know about FLiRT, an emerging group of COVID-19 variants
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What you need to know
- COVID-19 wastewater levels are currently low, but a recent group of variants called FLiRT is making headlines.
- KP.2 is one of several FLiRT variants, and early lab tests suggest that it’s more infectious than JN.1.
- Getting infected with any COVID-19 variant can cause severe illness, heart problems, and death.
KP.2, a new COVID-19 variant, is now dominant in the United States. Lab tests suggest that it may be more infectious than JN.1, the variant that was dominant earlier this year.
Fortunately, there’s good news: Current wastewater data shows that COVID-19 infection rates are low. Still, experts are closely watching KP.2 to see if it will lead to an uptick in infections.
Read on to learn more about KP.2 and how to stay informed about COVID-19 cases in your area.
Where can I find data on COVID-19 cases in my area?
Hospitals are no longer required to report COVID-19 hospital admissions or hospital capacity to the Department of Health and Human Services. However, wastewater-based epidemiology (WBE) estimates the number of COVID-19 infections in a community based on the amount of COVID-19 viral particles detected in local wastewater.
View this map of wastewater data from the CDC to visualize COVID-19 infection rates throughout the U.S., or look up COVID-19 wastewater trends in your state.
What do we know so far about the new variant?
Early lab tests suggest that KP.2—one of a group of emerging variants called FLiRT—is similar to the previously dominant variant, JN.1, but it may be more infectious. If you had JN.1, you may still get reinfected with KP.2, especially if it’s been several months or longer since your last COVID-19 infection.
A CDC spokesperson said they have no reason to believe that KP.2 causes more severe illness than other variants. Experts are closely watching KP.2 to see if it will lead to an uptick in COVID-19 cases.
How can I protect myself from COVID-19 variants?
Staying up to date on COVID-19 vaccines reduces your risk of severe illness, long COVID, heart problems, and death. The CDC recommends that people 65 and older and immunocompromised people receive an additional dose of the updated COVID-19 vaccine this spring.
Wearing a high-quality, well-fitting mask reduces your risk of contracting COVID-19 and spreading it to others. At indoor gatherings, improving ventilation by opening doors and windows, using high-efficiency particulate air (HEPA) filters, and building your own Corsi-Rosenthal box can also reduce the spread of COVID-19.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Forgotten Exercise That Could Save Your Health After 50
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A lot depends on this:
Your heart is also a “use it or lose it” muscle
It’s well-known that muscles in general require maintenance (by regular exertion thereof), or they will atrophy and weaken. However, this is not only true of our skeletal muscles (the ones people think about when they say “muscles”), but also muscles like the heart.
Now, of course, we are all using our heart all the time, every day. One might be tempted to think it’ll be fine. It won’t; the body will not maintain anything beyond necessity. Thus, the prescription here is to regularly get our heart out of “zone 1”, its regular resting rate, which is usually about 50% or so of its maximum rate, and into “zone 2”, in which it beats at 60–70% of its maximum rate.
To find your maximum rate: as a general rule of thumb, 220 minus your age will usually give a fairly accurate estimate, unless you are unusually fit or unusually unfit.
Alternatively, if you have a fitness tracker, it can probably give you a number based on actual observation of your heartrate.
The benefits of doing so, as mentioned in this video:
- Improves heart health, circulation, and lowers blood pressure.
- Burns belly fat by using stored fat as energy*
- Boosts aerobic capacity, making daily activities easier.
- Enhances insulin sensitivity, mental health, and sleep.
- Helps manage arthritis, osteoporosis, and high cholesterol.
*note that this won’t happen in zone 1, and if you spend more than a little time in zone 3, it will happen but your body will do a metabolic slump afterwards to compensate, while doing its best to replenish the fat reserves. So, zone 2 is really the goal for this one, unless you want to do HIIT, which is beyond the scope of today’s article.
He recommends activities like brisk walking, cycling, or swimming. You don’t have to become a triathlon competitor if you don’t want to, but just pick what you like and do it at a fair pace. If it’s the brisk walking or cycling*, then (unless it’s very hot/humid where you are), if you break a sweat, you probably broke out of zone 2 and into zone 3. Which is fine, but wasn’t what you were aiming for, so it’s a sign you can go a little easier than that if you want.
*of course the same statement is also true of swimming, but you’ll not notice sweating in a pool 😉
As for how much and how often, averaging 20 minutes per day is good; if you want to condense that into 40 minutes 2–3 times per week, that’s fine too.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Doctor Who Wants Us To Exercise Less & Move More
Take care!
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Cherries vs Blackberries – Which is Healthier?
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Our Verdict
When comparing cherries to blackberries, we picked the blackberries.
Why?
In terms of macros, cherries have more carbs while blackberries have more protein and fiber. The protein of course is a tiny amount and an even tinier difference, and/but it’s worth noting that the fiber isn’t, and blackberries have more than 3x the fiber. So, a win for blackberries in this category.
In the category of vitamins, cherries have more of vitamins A, B1, B2, and B6, while blackberries have more of vitamins B3, B5, B9, C, E, K, and choline. Another win for blackberries.
When it comes to minerals, cherries have a tiny bit more potassium, while blackberries have considerably more calcium, copper, iron, magnesium, manganese, phosphorus, selenium, and zinc. Another easy win for blackberries.
Both fruits have abundant antioxidants, but as many are different, and comparison between them becomes more subjective than we have room for here.
In short, enjoy either or both, but we say blackberries win overall on macro- and micronutrients!
Want to learn more?
You might like to read:
Cherries’ Very Healthy Wealth Of Benefits
Take care!
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Improve Your Insulin Sensitivity!
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We’ve written before about blood sugar management, for example:
10 Ways To Balance Blood Sugars ← this one really is the most solid foundation possible; if you do nothing else, do these 10 things!
And as for why we care:
Good (Or Bad) Health Starts With Your Blood
…because the same things that cause type 2 diabetes, go on to cause many other woes, with particularly strong comorbidities in the case of Alzheimer’s disease and other dementias, as well as heart disease of various kinds, and a long long laundry list of immune dysfunctions / inflammatory disorders in general.
In short, if you can’t keep your blood sugars even, the rest of your health will fall like so many dominoes.
Getting a baseline
Are you counting steps? Counting calories? Monitoring your sleep? Heart rate zones? These all have their merits:
- Steps: One More Resource Against Osteoporosis!
- Calories: Is Cutting Calories The Key To Healthy Long Life?
- Sleep: A Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
- Heart Rate Zones: Heart Rate Zones, Oxalates, & More
But something far fewer people do unless they have diabetes or are very enthusiastic about personal health, is to track blood sugars:
Here’s how: Track Your Blood Sugars For Better Personalized Health
And for understanding some things to watch out for when using a continuous glucose monitor:
Continuous Glucose Monitors Without Diabetes: Pros & Cons
Writer’s anecdote: I decided to give one a try for a few months, and so far it has been informative, albeit unexciting. It seems that with my diet (mostly whole-foods plant based, though I do have a wholegrain wheat product about twice per week (usually: flatbread once, pasta once) which is… Well, we could argue it’s whole-food plant based, but let’s be honest, it’s a little processed), my blood sugars don’t really have spikes at all; the graph looks more like gently rolling low hills (which is good). However! Even so, by experimenting with it, I can see for myself what differences different foods/interventions make to my blood sugars, which is helpful, and it also improves my motivation for intermittent fasting. It also means that if I think “hmm, my energy levels are feeling low; I need a snack” I can touch my phone to my arm and find out if that is really the reason (so far, it hasn’t been). I expect that as I monitor my blood sugars continuously and look at the data frequently, I’ll start to get a much more intuitive feel for my own blood sugars, in much the same way I can generally intuit my hormone levels correctly after years of taking-and-testing.
So much for blood sugars. Now, what about insulin?
Step Zero
If taking care of blood sugars is step one, then taking care of insulin is step zero.
Often’s it’s viewed the other way around: we try to keep our blood sugars balanced, to reduce the need for our bodies to produce so much insulin that it gets worn out. And that’s good and fine, but…
To quote what we wrote when reviewing “Why We Get Sick” last month:
❝Dr. Bikman makes the case that while indeed hyper- or hypoglycemia bring their problems, mostly these are symptoms rather than causes, and the real culprit is insulin resistance, and this is important for two main reasons:
- Insulin resistance occurs well before the other symptoms set in (which means: it is the thing that truly needs to be nipped in the bud; if your fasting blood sugars are rising, then you missed “nipping it in the bud” likely by a decade or more)
- Insulin resistance causes more problems than “mere” hyperglycemia (the most commonly-known result of insulin resistance) does, so again, it really needs to be considered separately from blood sugar management.
This latter, Dr. Bikman goes into in great detail, linking insulin resistance (even if blood sugar levels are normal) to all manner of diseases (hence the title).
You may be wondering: how can blood sugar levels be normal, if we have insulin resistance?
And the answer is that for as long as it is still able, your pancreas will just faithfully crank out more and more insulin to deal with the blood sugar levels that would otherwise be steadily rising. Since people measure blood sugar levels much more regularly than anyone checks for actual insulin levels, this means that one can be insulin resistant for years without knowing it, until finally the pancreas is no longer able to keep up with the demand—then that’s when people finally notice.❞
You can read the full book review here:
Now, testing for insulin is not so quick, easy, or accessible as testing for glucose, but it can be worthwhile to order such a test—because, as discussed, your insulin levels could be high even while your blood sugars are still normal, and it won’t be until the pancreas finally reaches breaking point that your blood sugars show it.
So, knowing your insulin levels can help you intervene before your pancreas reaches that breaking point.
We can’t advise on local services available for ordering blood tests (because they will vary depending on location), but a simple Google search should suffice to show what’s available in your region.
Once you know your insulin levels (or even if you don’t, but simply take the principled position that improving insulin sensitivity will be good regardless), you can set about managing them.
Insulin sensitivity is important, because the better it is (higher insulin sensitivity), the less insulin the pancreas has to make to tidy up the same amount of glucose into places that are good for it to go—which is good. In contrast, the worse it is (higher insulin resistance), the more insulin the pancreas has to make to do the same blood sugar management. Which is bad.
What to do about it
We imagine you will already be eating in a way that is conducive to avoiding or reversing type 2 diabetes, but for anyone who wants a refresher,
See: How To Prevent And Reverse Type 2 Diabetes
…which yes, as well as meaning eating/avoiding certain foods, does recommend intermittent fasting. For anyone who wants a primer on that,
See: Intermittent Fasting: Methods & Benefits
There are also drugs you may want to consider:
Metformin Without Diabetes, For Weight-Loss & More
And “nutraceuticals” that sound like drugs, for example:
Glutathione’s Benefits: The Usual And The Unique ← the good news is, it’s found in several common foods
You may have heard the hype about “nature’s Ozempic”, and berberine isn’t exactly that (works in mostly different ways), but its benefits do include improving insulin sensitivity:
Berberine For Metabolic Health
Lastly, while eating for blood sugar management is all well and good, do be aware that some things affect insulin levels without increased blood sugar levels. So even if you’re using a CGM, you may go blissfully unaware of an insulin spike, because there was no glucose spike on the graph—and in contrast, there could even be a dip in blood sugar levels, if you consumed something that increased insulin levels without providing glucose at the same time, making you think “I should have some carbs”, which visually on the graph would even out your blood sugars, but invisibly, would worsen the already-extant insulin spike.
Read more about this: Strange Things Happening In The Islets Of Langerhans: When Carbs, Proteins, & Fats Switch Metabolic Roles
Now, since you probably can’t test your insulin at a moment’s notice, the way to watch out for this is “hmm, I ate some protein/fats (delete as applicable) without carbs and my blood sugars dipped; I know what’s going on here”.
Want to know more?
We heartily recommend the “Why We Get Sick” book we linked above, as this focuses on insulin resistance/sensitivity itself!
However, a very good general primer on blood sugar management (and thus, by extension, at least moderately good insulin management), is:
Glucose Revolution: The Life-Changing Power of Balancing Your Blood Sugar – by Jessie Inchauspé
Enjoy!
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Gut-Healthy Sunset Soup
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So-called for its gut-healthy ingredients, and its flavor profile being from the Maghreb (“Sunset”) region, the western half of the N. African coast.
You will need
- 1 can chickpeas (do not drain)
- 1 cup low-sodium vegetable stock
- 1 small onion, finely chopped
- 1 carrot, finely chopped
- 2 tbsp sauerkraut, drained and chopped (yes, it is already chopped, but we want it chopped smaller so it can disperse evenly in the soup)
- 2 tbsp tomato paste
- 1 tbsp harissa paste (adjust per your heat preference)
- 1 tbsp ras el-hanout
- ¼ bulb garlic, crushed
- Juice of ½ lemon
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil
- Optional: herb garnish; we recommend cilantro or flat-leaf parsley
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a sauté pan or similar (something suitable for combination cooking, as we’ll be frying first and then adding liquids), and fry the onion and carrot until the onion is soft and translucent; about 5 minutes.
2) Stir in the garlic, tomato paste, harissa paste, and ras el-hanout, and fry for a further 1 minute.
3) Add the remaining ingredients* except the lemon juice. Bring to the boil and then simmer for 5 minutes.
*So yes, this includes adding the “chickpea water” also called “aquafaba”; it adds flavor and also gut-healthy fiber in the form of oligosaccharides and resistant starches, which your gut microbiota can use to make short-chain fatty acids, which improve immune function and benefit the health in more ways than we can reasonably mention as a by-the-way in a recipe.
4) Stir in the lemon juice, and serve, adding a herb garnish if you wish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Our Top 5 Spices: How Much Is Enough For Benefits? ← today’s recipe scored 5/5 of these, plus quite a few more! Remember that ras el-hanout is a spice blend, so if you’re thinking “wait, where’s the…?” then it’s in the ras el-hanout 😉
- Making Friends With Your Gut (You Can Thank Us Later)
- Lycopene’s Benefits For The Gut, Heart, Brain, & More ← not to be underestimated!
Take care!
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