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Archives and past articles from the Philadelphia Inquirer, Philadelphia Daily News, and Philly.com. Torture The Widow. Chapter 1 – Choke On It. Please take note! Adults Only Literature The text in this story contains erotic material and is expressly written for. Things Everyone Should Know About Low- Carb Dietsistock. Last week, my staff nutritionist Laura Schoenfeld wrote a guest post for my blog called “Is a Low- Carb Diet Ruining Your Health”. Perhaps not surprisingly, it has caused quite a stir. For reasons I don’t fully understand, some people identify so strongly with how many carbohydrates they eat that they take offense when a suggestion is made that low- carb diets may not be appropriate for everyone, in all circumstances. In these circles low- carb diets have become dogma (i. Followers of this strange religious sect insist that everyone should be on low- carb or even ketogenic diets; that all carbohydrates, regardless of their source, are “toxic”; that most traditional hunter- gatherer (e. Is there a connection between celiac disease and the many other health issues celiacs deal with? Share your story and let's find out. Hernia Surgery Recovery. Surgery is one of the most effective ways to treat hernia, which is a painful protrusion through a body organ. If you are about to undergo a. Paleolithic) societies followed a low- carb diet; and, similarly, that nutritional ketosis—which is only achievable with a very high- fat, low- carb, and low- protein diet—is our default and optimal physiological state. Cut through the confusion and hype and learn what research can tell us about low- carb diets. On the other hand, I’ve also observed somewhat of a backlash against low- carb diets occurring in the blogosphere of late. While I agree with many of the potential issues that have been raised about low- carb diets, and think it’s important to discuss them, I also feel it’s important not to lose sight of the fact that low- carb diets can be very effective therapeutic tools for certain conditions and in certain situations. With this in mind, here are 7 things I think everyone should know about low- carb diets.#1: Paleo does not equal low- carb, and very low- carb/ketogenic diets are not our “default” nutritional state, as some have claimed. Some low- carb advocates have claimed that most traditional hunter- gatherer societies consumed diets that were very low in carbohydrates. I’ve even seem some suggestions that nutritional ketosis was “the norm” for these cultures. These claims are false. The majority of studies have shown that traditional hunter- gatherer (HG) societies typically consume between 3. Yet even these cultures—such as the traditional Inuit—often made an effort to obtain carbohydrates from berries, corms, nuts, seaweed, and tubers whenever they could, as Richard Nikoley has recently detailed on his blog. What’s more, contrary to popular claims, studies have shown that it’s unlikely the Inuit spent much time—if any—in nutritional ketosis. Their high protein intake would have prevented ketosis from occurring. With virtually no historical examples of human beings following ketogenic diets for any significant length of time, and few examples of very low- carb diets, it’s difficult to imagine how these diets could be considered our “default” nutritional state or the optimal approach for most people.#2: Low- carb diets are incredibly effective in certain situations. Lest low- carb advocates think that I am anti- low- carb, I’d like to reiterate that both the research and my clinical experience suggest that low- carb diets can be incredibly effective therapeutic tools for certain conditions. These conditions include (but aren’t limited to): Overweight and obesity. High blood sugar, metabolic syndrome, diabetes (both type 1 & type 2)Traumatic brain injury. Epilepsy. Parkinson’s disease. Alzheimer’s disease. Other neurological conditions. PCOSI have personally witnessed some remarkable transformations using ketogenic diets therapeutically in my practice. I recall an 8. 4 year- old woman who came to see me complaining of dementia and early- onset Alzheimer’s. She was losing her memory and cognitive abilities at an alarming rate. After just two weeks on a ketogenic diet, this progression not only halted, it reversed: her memory returned, her mind was sharper, and she was far less confused and disoriented. Her family (and her doctor) were stunned, and could hardly believe the changes they were seeing. Yet as impressive as very low- carb (VLC) and ketogenic diets can be in certain situations, that does not mean that these diets may not have some undesirable side effects over the long term—some of which we’re only beginning to understand. For example, as I discussed with Jeff Leach from the American Gut project in a recent podcast, some preliminary research suggests that long- term ketogenic/VLC diets may cause adverse changes to the gut microbiota. It’s worth noting that many of these fibers are found in foods with moderate to high carbohydrate content—foods that would typically be excluded on very low- carb diets. It’s important to note, however, that the beneficial bacteria- starving effects of ketogenic/VLC diets can be at least partially offset by consuming non- digestible, fermentable fibers like resistant starch and non- starch polysaccharides that don’t count toward daily carbohydrate intake. This is something I recommend to all of my patients following low- carb diets)#3: The fact that ketogenic/VLC diets work therapeutically for certain conditions does not make them appropriate in all circumstances, for all people. This assumption is a basic failure of logic, but it’s remarkable to see how often it happens. A person has a life- changing experience with a VLC diet, so they assume that their friend will have a similar experience. Or a clinician that works primarily with people suffering from neurological conditions has great success with ketogenic diets, and then makes the assumption that all people (regardless of their health complaints) will benefit from them. This is akin to saying that since people with hemochromatosis (a genetic condition that causes iron overload) need to limit their iron intake, everyone should consume foods that are low in iron. The belief that “everyone” will benefit from one particular dietary approach—no matter what it is—ignores the important differences that determine what is optimal for each person. These include variations in genes, gene expression, the microbiome, health status, activity levels, geography (e. When it comes to diet, there is no one- size- fits- all approach. Some people may thrive on a long- term, low- carb diet. I have patients and even a family member in this category. And maybe you’re one of them too. But that doesn’t mean everyone will have this experience. If you talk to practicing clinicians who work with patients on a daily basis, or spend any amount of time in internet forums or the comments sections of nutrition blogs, you’ll find numerous reports from people who either experienced no benefit from or were even harmed by following a low- carb diet. What blows my mind is that the “low- carb zealots” seem completely incapable of accepting these reports at face value. Instead, they’ll argue that anyone who doesn’t succeed with low- carb is either doing it wrong, cheating, or somehow imagining their symptoms. What’s the more likely explanation here? That everyone who gets worse with a low- carb diet is either incapable of following directions, weak- willed, or delusional? Or that a low- carb diet simply does not work for everyone? You be the judge. Here’s an example: “A low- carb diet is effective for treating type 2 diabetes. Therefore, eating too many carbohydrates led to this condition in the first place.”This is like saying: Restricting iron is helpful in hemochromatosis patients. Therefore, consuming too much iron is what caused hemochromatosis in the first place. A low- FODMAP diet helps patients with Irritable Bowel Syndrome (IBS). Therefore, eating FODMAPs caused IBS in the first place. A low- histamine diet alleviates the symptoms of histamine intolerance. Therefore, histamine intolerance is caused by eating too many histamine containing foods. Or, more ridiculously, since wearing a cast on your arm will help the broken bone heal, the reason you broke your arm in the first place is because you weren’t wearing a cast. It’s true that VLC/ketogenic diets are effective for improving the metabolic markers associated with type 2 diabetes. But that doesn’t mean that eating too many carbohydrates led to the condition in the first place. It is certainly possible (and indeed likely) that eating too many refined and processed carbohydrates, in the form of flour and sugar, contributes to diabetes. But I have not seen a single study suggesting that eating whole- food carbohydrates (e. On the contrary, reviews of prospective studies looking at the relationship between fruit intake and diabetes have found that those with the highest intake of fruit had the lowest incidence of diabetes. For example, there are numerous studies showing that low- carb and ketogenic diets can help with weight loss and metabolic problems. Studies have also shown that calorie- restricted diets, protein- sparing modified fasts, and even low- fat diets can also be effective treatments. They may be able to reverse their condition by following a high- protein, moderate- carbohydrate, moderate- fat diet (such as the Paleo diet with 3. I just mentioned. In #1 above, I referenced studies indicating that most hunter- gatherer societies consumed about 3. These carbohydrates came from starchy tubers and plants, whole fruit, and in some cases, honey. We also have evidence of specific ancestral populations—such as the Kitava, traditional Okinawans, and Tukisenta—that consumed between 7. When it comes to macronutrients, quality is much more important than quantity for most people. Final thoughts. I hope this helps to clarify some of the confusion that has surrounded this issue. Low- carb diets are an effective therapeutic tool in certain situations, and one that I (and many other clinicians) use in my clinical practice. That said, it’s equally true that low- carb—and especially VLC and ketogenic—diets are not appropriate in all circumstances, and they are certainly not our “default” or optimal nutritional state. Sadly, it doesn’t seem to matter how much scientific evidence, clinical experience, and common sense is brought to bear on this question: those who preach and follow low- carb dogma will not be swayed. Healthy Lifestyle Diet and Quick Weight Loss Diet Plan. You’ll not only lose weight on the New Lifestyle Diet, but unlike other diets, you’ll learn to make lasting changes by learning how to keep the weight off for the rest of your life. By participating in our Women’s and Men’s program, you’ll be provided with lesson plans, where you’ll learn everything from creating good eating habits, meal preparation, impacts of exercise, how to identify your behaviors and how to create changes that last. And, to make sure that you don’t fall through the cracks, you’ll have access to our support team that you can call and email anytime. Simply stated, you’ll not only lose weight and reach your goal weight, but you’ll create a new lifestyle along the way. Remember, this isn’t just a diet; it’s the opportunity to create a new you and start living your life to the fullest. New Lifestyle makes no claims that the weight loss results of our Testimonials are representative of all participants and that while a percentage of users experience dramatic weight loss in a short period of time, weight loss can't be guaranteed for all. The New Lifestyle Diet Plan is a high protein liquid diet program designed for men and women that includes great tasting and affordable meal replacement shakes, puddings, soups, hot drinks, and bars. Additionally, although all of our products are manufactured in the United States, the California Proposition 6. Prop 6. 5 and could cause birth defects or other reproductive harm. Diet 800 Calories Meal plan/timetable for weight loss. Diet Direct is proud to offer you a diverse selection of high quality products and supplements to help you design the diet and nutrition plan that suits you best. Weight Loss and Diet Essentials WLR's New Habits New Me Challenge. Helps you build the habits for sustainable weight loss. 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Click on today to track today’s activities or click a future date to plan some goals. On a single page, you can track your weight, water intake, meals, exercise, keep a journal and more. Tracking made easy! Your Shakespeare Classroom on the Internet! HIGH: used in composition with adjectives to heighten or. An On-line Shakespearean Glossary. Use this glossary to look up unusual words used in Shakespeare's plays. As this is a general glossary, you will want to make. Latest breaking news, including politics, crime and celebrity. Find stories, updates and expert opinion. DICCIONARIO PARA PRINCIPIANTES INGLES-ESPAÑOL a / un a / una a (cassette) recorder / grabadora a (draw) well / pozo A (note) / la. META-INF/MANIFEST.MFMobidicEnTr.classa.classb.classc.classd.classe.classf.classg.classh.classa.txt. HIGHT: called HILD: held HILDING: a. HINT: suggestion HIREN: a prostitute. GUETH chancing sailboarded TIPOLD either extortion undoings DEBRITA receptionists EISON intellects cajoles ROUDABUSH ELIAN molecule MERCKLING unskillful unpeople. Benefits of Matcha Green Tea: weight loss, alzheimers prevention, blood sugar regulation and more! From GFG: This is another great guest post by my trusty intern: Coco Noel. Be sure to like follow her smart and informative posts on Facebook! I invited her over to brunch recently and she brought some Matcha green tea. We mixed it with hot water, coconut milk and a little stevia and it was divine. I had actually never had it before and she was the first person to bring it to my attention. I hope you enjoy learning more! First there were pomegranates. Then came goji berries. Now, it’s matcha green tea that everyone’s fussing over. Fortunately, matcha lives up to its hype. The quest for weight loss in America supports a $20 billion industry. For anyone struggling for a healthier way to live, exercise and dieting alone can seem like a. Available Forms. Most green tea dietary supplements are sold as dried leaf tea in capsule form. Look for standardized extracts of green tea. There are also liquid. Proof green tea works for weight loss and other benefits of green tea along with the best green tea fat burner. Green tea is a popular beverage that experts claim will help you lose weight. With findings on human trials showing promising results, people are now. Green tea weight loss works because it does not require you to eat a very low calorie diet. Scientific studies have discovered that the main ingredients responsible. For starters, it contains 1. Matcha is essentially very finely powdered green tea leaves that are mixed into liquid and consumed whole. Unlike regular steeped green tea, when you drink matcha, you’re ingesting the entire crushed up tea leaves rather than just the leaf- infused water. This means you’re getting a much more concentrated dose of the myriad health benefits of green tea, some of the benefits of matcha green tea are listed below: Reduce the risk of cancer: A study published in the American Journal of Clinical Nutrition found that women who regularly drank green tea had a lower risk of colon, stomach and throat cancer. Other studies have shown an associated decrease in prostate cancer and found a link suggesting green tea may slow down the growth of tumors in breast cancer patients. Weight loss: Approximately 2 cups of green tea will speed up your metabolism by nearly 5% in a 2. This isn’t a miracle diet solution, but definitely a plus. Immunity: Green tea may help you fight off illness by altering the makeup of intestinal bacteria. Its antibacterial properties thwart the effects of the bacteria most responsible for gum disease. And it may even help ward off bad breath! Liver health: Green tea prevented liver damage in rats who were kept drunk on alcohol for 4 straight weeks. Some studies even suggest that components of green tea can help prevent skin cancer when applied directly to the skin. Alzheimer’s prevention: Although there is no known cure for Alzheimer’s disease, numerous studies suggest that green tea may effectively help to prevent the disease. A compound in green tea reduces the formation of plaque- like deposits in the brain, which are often indicative of Alzheimer’s disease. Relax: Green tea increases the production of alpha brain waves to calm the body. The Matcha Advantage. Green tea has long been regarded as necessary for a healthy diet. Follow a green tea diet of drinking at least four glasses of green tea each day to lose weight. Can green tea go bad? It won’t really spoil but the fresher the better. Loose tea and tea bags usually hold their antioxidant potency for up to 6 months. Many of the studies done on the effects of green tea are based on pretty high levels of the stuff – from about 2 to 1. Before you quit your job and commit the rest of your life solely to drinking green tea and going pee, check this out: One cup of matcha green tea is equivalent to 1. There’s more. Epigallocatechin gallate (say that five times fast) is a polyphenol antioxidant found in green tea. Commonly referred to as EGCG, this is what’s considered to be responsible for nearly all the health benefits of green tea, including those listed above. I hope you’re wearing your party hat, because I’m about to give you cause to celebrate. That means that by drinking one cup of matcha green tea, you can reap the antioxidant benefits of 1. EGCG benefits of 1. China Green Tips. Recommendations for incorporating matcha green tea into your diet. Research suggests that protein, particularly that in cow’s milk, deactivates the EGCG. This is no good! For this reason, it may be wise to drink your matcha away from meals (which is better for digestion anyway). Avoid commercial matcha green tea concoctions, as they are low in matcha but extremely high in calories and sugar (not to mention often mixed with dairy, thus negating their health benefits!). Peet’s Coffee has a 1. Even worse, a 1. 6 ounce sweetened matcha green tea latte from Starbucks has 3. That’s very likely to do you much more harm than good. Make your own at home for best results: Try a Matcha Refresher: put . Add a bit of stevia, coconut nectar or other raw honey to taste. Where to Find a Matcha Online: click here. Thanks for reading! SOURCES: http: //www.
Day Reset Autoimmune Diet Plan. For many years I suspected that I had some form of thyroid problem based on my own research and symptoms like dry skin, occasional fatigue, trouble losing weight after having a baby, and hair thinning, but I was never able to get answers from conventional tests which showed that my T3 and T4 thyroid hormones were in the normal range. Thankfully, I found an amazing doctor who specializes in hormones and endocrine problems and with additional blood testing and a thyroid ultrasound, he was able to finally figure out what I was struggling with: Hashimoto’s Thyroiditis (an autoimmune condition where the body creates antibodies to the thyroid). What are Autoimmune Problems? It turns out that many different disorders and diseases are autoimmune in nature but they manifest in different ways. As the Paleo Mom explains: Autoimmune disease is caused by the immune system losing the ability to differentiate proteins belonging to your own body with proteins belonging to a foreign invader (like a bacteria, virus or parasite). What causes symptoms is the build up of damage to cells, tissues and/or organs in the body–damage caused by your own immune system attacking those cells. NEW from the author of Burn the Fat, Feed the Muscle: The Burn the Fat Online Body Transformation System. Early life and education. Mike Mentzer was born on November 15, 1951 in Ephrata, Pennsylvania and grew up there. In grammar school and Ephrata High School, he. Ectomorph/Hardgainer: These words are most commonly used to describe a man or woman who is naturally (or better yet, genetically prone to being) skinny and has a. Which proteins/cells are attacked is what separates once disease from another. In Hashimoto’s Thyroiditis, the thyroid gland is attacked. In Rheumatoid Arthritis, the tissues of your joints are attacked. In psoriasis, proteins within the layers of cells that make up your skin are attacked. However, the root cause is the same. Genetic predisposition to autoimmunity makes up about one third of your risk of developing an autoimmune disease. The other two thirds of your risk come from environmental factors, which include: diet, lifestyle, infections (both prior and persistent) exposure to toxins, hormones, weight, etc. While you cannot control your genetics or whether or not you had mono as a kid, you do have an immense amount of control over your diet and lifestyle (and the extent that these affect hormones and weight and even toxin exposure). By removing the foods that contribute to a leaky gut, gut dysbiosis (the wrong numbers, relative quantities, or types of microorganisms typically growing in the wrong locations in your gut), hormone imbalance, and that stimulate inflammation and the immune system, you can create the opportunity for your body to heal. By addressing important lifestyle factors and changing your focus to eating nutrient- dense foods that support optimal gut health (and optimal health of your gut microorganisms), that restore levels of important nutrients and provide all of the building blocks that your body needs to heal and properly regulate the immune system, that help resolve inflammation and support organ function, you create an environment in your body conducive to healing. Why Other Diets May Not Work. From my understanding, once the body has an autoimmune reaction, it can sometimes be necessary to remove a wide variety of potentially inflammatory foods for a short time and then reintroduce to test the response. The idea is similar to the theory behind the GAPS protocol but geared toward addressing autoimmune issues instead. Since the body is in a state of heightened immune response, removing these foods can help it get back into a state of balance and reduce the autoimmune reaction. Technically, an autoimmune disease cannot be “cured”, but in many cases, it is possible to put the condition into remission with careful diet and lifestyle changes. My Experience. I switched to an autoimmune protocol diet after being diagnosed with Hashimotos in hopes of giving my immune system a little time to recover. I was hopeful that it would be beneficial, but I was AMAZED at how quickly it helped. Within the first week, I saw my bloating go away, my thyroid nodule felt noticeably smaller, I had more energy (after the first couple of days), and my skin improved. Over the course of the almost two months I did the strict protocol, I lost some of my stubborn weight and felt incredibly better. It also helped me identify foods that I was not responding well to, but that I didn’t realize were problematic (like eggs, which was confirmed by blood test later). I was able to reintroduce many of the foods after that time without a problem and I felt continually better (until I created a flare by not sleeping and stressing about finishing my book). Sleep and stress are both huge factors in overall health and are especially important for those with any kind of health condition. The Specifics of the Autoimmune Diet. The general idea of the autoimmune diet is that you are removing any potentially inflammatory foods, but the specifics are a bit more difficult. Some sources consider foods like fruit and sweet potatoes ok, while others do not. For reference, some sources that I find most helpful are: This particular post from the Paleo Mom is really helpful in understanding what foods are considered safe and which ones to temporarily avoid. I’ll also be posting more autoimmune friendly recipes and meal plans soon, but those are great resources for getting started. You can download the complete food list I used by clicking here (PDF). It can seem overwhelming, but this way of eating is actually relatively simple if you follow a template. My typical day on the autoimmune diet was: Breakfast– A scramble of meat and cooked vegetables, a cup of homemade bone broth, some fermented vegetables, and supplements. Lunch– A huge salad with leftover protein (meat, offal or fish) and a small piece of fruit, a cup of bone broth, fermented water kefir or kombucha and olives. Dinner– A stir fry with some type of protein (meat, offal, seafood) with a lot of vegetables and allowed spices, evening supplements and at least 1 cup of healthy starch like cooked winter squash, pumpkin, etc. I also made a lot of stuffed squashes and soups. We rely heavily on big salads, stir frys and casseroles while on the autoimmune diet. When I first started, it seemed like I couldn’t eat anything and I was depriving myself of everything, but it is important to remember that many times the body is deficient in certain nutrients because of an autoimmune disease so during the course of the 3. I focused on extensively nourishing my body with as many high quality proteins, vegetables and healthy fats as I could consume. I may have been tired of my food choices at times, but I certainly never went hungry. I also focused on consuming a TON of vegetables during this time, after talking to Dr. Terry Wahls and reading her book, The Wahls Protocol. Wahls emphasizes the importance of consuming at least 9 cups of vegetables a day, especially brightly colored vegetables, leafy greens, and onions and garlic. Other Factors. Diet is hugely important for all aspects of health, and for me, it became even more important after being diagnosed with autoimmune disease, but it is by no means the only factor. Personally, I found that these factors were equally important to recovery for me: Sleep. It is my nemesis. I love to stay up late and skimp on sleep so I can get more done. My body does not love this. I’ve found that when I sleep at least 8- 8. I see my health markers improve (blood tests, fasting blood glucose, etc). Stress reduction. Also a tough one for me, but stress can have as much of an impact as diet on gut health and hormone levels. I found that even with a good diet, I started to notice symptoms creeping back in while under the stress of finishing my book. Supplements. I hesitated to include this part because if diet, stress and sleep aren’t under control, this won’t help at all, but I found certain supplements helped tremendously once I had optimized other factors. I personally take: WP- Throid thyroid medication (under the care of my doctor), Betaine HCL with protein meals, 5- MTHF and Methyl- B1. Folate, Probiotics, Fermented Cod Liver Oil, Cortisol support, Omega- 3s, Vitamin D (and sunshine daily in the morning), Magnesium, L- glutamine, Gelatin, and Vitamin C. I would highly recommend seeing a good functional medicine doctor and finding out what you personally need before taking any supplements. Autoimmune Diet Encouragement. This diet is difficult. So is pregnancy. Sometimes the best things in life require some work and denial of self. An elimination diet is temporary and it gives you a window into your own body and what you need to eat for optimal health. Don’t let is cause you extra stress. Don’t let this keep you up at night. Try to focus on nourishing and loving your body and providing it with the building blocks it needs to function optimally. If you can, encourage a friend or family member to make the journey with you for support. If you’ve ever struggled with autoimmune issues, take 3. Do it with me! Let me know below what your struggle is and the results you see! Expected Monthly Weight Loss With the Gastric Sleeve. Whether you have had a weight- loss procedure called sleeve gastrectomy or are considering having it done, it is important to know that weight loss results vary from person to person. And, while your doctor can estimate the amount of weight you are likely to lose altogether, you can expect to lose more weight during the first few months and less as you get closer to your target weight. Your individual monthly weight loss will depend on factors such as age, gender, starting weight and how well you follow diet and exercise recommendations. Your excess body weight is the difference between your ideal weight and your current weight. So, if you weigh 1. Scientific Investigations Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention. The amount of weight lost after gastric sleeve depends on several factors. An important factor is how well you follows your. Gastric bypass surgery is the best solution for permanent weight loss. Obesity surgery is performed by our top rated bariatric surgeons and offer gastric bypass via. In this example, if you lost 5. Some people lose less, while others lose more than 7. July 2. 01. 3 issue of the journal . It also depends on the time since surgery. Findings in the October- December 2. In this study of 1. Average weight loss by the end of 6 months was 5. Considering gastric banding surgery for weight loss? WebMD describes the procedure, including its risks and benefits. Realistically, after getting the gastric sleeve, how many pounds will be dropped by 4 weeks post surgery? BossLady314 Saint. Gastric Sleeve Cost in 2017 - $3,500 With Insurance & Discounts. The average total gastric sleeve cost is about $19,000. That drops to around $3,500 with insurance. Learn the expected weight loss after gastric sleeve from our timeline chart . Discover the excess Weight Loss After 3, 6, 12, & 18 Months. Gastric Sleeve (Vertical Sleeve Gastrectomy) The gastric sleeve is the. The amount of weight lost after gastric sleeve depends on several factors. An important factor is how well you follows your doctors' instructions about diet and exercise. Your preoperative weight also makes a difference, as people who start out at a lower weight tend to lose a higher percentage of excess weight than those who were heavier before surgery, according to the authors of a report published in the May 2. Once performed as the first stage of a more complicated operation, gastric sleeve surgery as a stand- alone procedure was considered investigational in the United States as recently as 2. American Society of Metabolic and Bariatric Surgeons. As of 2. 01. 2, gastric sleeves have been recognized as effective weight- loss surgery procedures, but additional studies are needed to document their long- term results. Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention. Jan Magnus Fredheim, M. D. 1,2,3; Jan Rollheim, M. D., Ph. D. 1; Rune Sandbu, M. D., Ph. D. 1; Dag Hofs. We hypothesized that Roux- en- Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA (apnea- hypopnea- index . Eighty- four patients (6. OSA. The average weight loss was 8% in the ILI- group and 3. RYGB- group (p < 0. The mean (9. 5%CI) AHI reduced in both treatment groups, although significantly more in the RYGB- group (AHI change - 6. Twenty- nine RYGB- patients (6. OSA, compared to 1. ILI- patients (4. At follow- up, after adjusting for age, gender, and baseline AHI, the RYGB- patients had significantly lower adjusted odds for OSA than the ILI- patients—OR (9. CI) 0. 3. 3 (0. 1. After further adjustment for BMI change, treatment group difference was no longer statistically significant—OR (9. CI) 1. 3. 1 (0. 3. Conclusion: Our study demonstrates that RYGB was more effective than ILI at reducing the prevalence and severity of OSA. However, our analysis also suggests that weight loss, rather than the surgical procedure per se, explains the beneficial effects. Citation: Fredheim JM; Rollheim J; Sandbu R; Hofs. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med 2. Obstructive sleep apnea (OSA) is a commonly unrecognized condition with an especially high prevalence among morbidly obese subjects. OSA is characterized by apneas and hypopneas due to the collapse of upper airways and is defined by . Mild OSA is defined as 5- 1. OSA 1. 5- 3. 0, and severe OSA . A meta- analysis from 2. CPAP) is a cost- effective treatment of OSA and that it reduces daytime sleepiness compared to placebo or usual care. Accordingly, CPAP is the first- line treatment and is recommended for all patients with moderate to severe OSA (AHI . In cases of obesity, fat deposits narrow the upper airways, and abdominal fat masses decrease the tracheal tension, both increasing the collapsibility of the upper airways. If untreated, OSA is associated with increased risk of diabetes, cardiovascular disease, driving accidents, and all- cause mortality. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Weight reduction reduces the severity of OSA in obese subjects, but the relative efficacy of lifestyle modifications versus bariatric surgery remains to be established. We aimed to compare the effectiveness of lifestyle modification and bariatric surgery in terms of reducing AHI and the severity of OSA. Study Impact: Gastric bypass surgery was more effective than intensive lifestyle intervention at reducing the prevalence and severity of OSA in a population of treatment seeking morbidly obese patients, and the beneficial effect of surgery seemed to be mediated by weight loss. Weight reduction should have a high priority in the treatment of obstructive sleep apnea in morbidly obese patients. The prevalence of OSA in the Wisconsin Sleep Cohort study was 9% among women and 2. Recently, we demonstrated a much higher prevalence of OSA among the morbidly obese: 5. Despite the close relationship between OSA and obesity, only a few recently published randomized controlled trials have assessed the effect of weight loss on obstructive sleep apnea. Tuomilehto et al. Isolated physical activity without weight loss may also have a positive effect on OSA. Exercise leads to more muscles and less fat; the lower pharyngeal pressure from diminished fat deposits might decrease the severity of OSA. In the Sleep AHEAD study, intensive lifestyle changes in overweight and obese patients with type 2 diabetes and mild to severe OSA were associated with a significant improvement in AHI. Finally, Johansson et al. Accordingly, some surgically treated patients will still be in need of continued CPAP treatment. In another meta- analysis the authors were unable to conclude whether surgically induced weight loss was associated with greater improvements in OSA than conservative treatment. Further, it remains unknown whether RYGB may influence the severity of OSA through a mechanism other than weight loss. To summarize, weight reduction reduces the severity of OSA, but the relative efficacy of lifestyle modifications versus bariatric surgery in terms of reducing AHI remains to be established. Our main hypothesis was that Roux- en- Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA. To address this issue, we performed sleep recordings both before the start of each intervention type and one year after. METHODSStudy Design. This study is part of a non- randomized, controlled clinical trial; the MOBIL- study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study) (Clinical. Trials. gov number NCT0. The design and setting of the study has previously been described in detail. A brief summary of materials and methods is given below. Setting. The study was conducted at the Morbid Obesity Centre (MOC) under the auspices of Vestfold Hospital Trust, a regional tertiary care center in Health Region South East, Norway. The intensive lifestyle intervention programme was carried out at Evjeklinikken, a center specializing in obesity treatment. All eligible patients underwent a thorough (up to 6 month) assessment by a multidisciplinary team consisting of an internist, a dietician, a physiotherapist, and a trained “obesity” nurse. During the first visit, the internist established a detailed medical history, checked previous diagnostic workups, performed a physical examination, and briefly informed the patients of further investigations and treatment alternatives. At the second visit the doctor reiterated this message, providing complete information about the possible risks and benefits of an operation and also encouraged the patients to incorporate their own values and preferences in the decision- making process. If no contraindication against surgery existed, the patient and the physician together agreed upon the most appropriate choice of therapy, either surgical or conservative. Participants. The patients were recruited from the MOC and the study approved by the Regional Ethics Committee (Clinical. Trials. gov- registry trial number NCT0. All patients provided written informed consent. All patients were morbidly obese, i. BMI . After the exclusion of 6 patients with missing sleep registrations, (4 in the ILI- group and 2 in the RYGB group), 1. ILI group and 7. 4 in the RYGB group were eligible for inclusion. Intervention. The patients in the ILI- group underwent a 1- year lifestyle program at a rehabilitation center (Evjeklinikken, Norway). This program comprised 4 intermittent stays, one lasting 2 weeks and 3 lasting 1 week each (total, 7 weeks). The program included organized physical activity (3- 4 h), psychosocially oriented interventions, and individual consultations with a medical doctor, nutritionist, physiotherapist, and trained nurse. Those leading the counseling interviews were trained in motivational interviewing, a client- centered counseling style that aims to invoke behavioral changes. The patients also took part in group sessions focusing on the emotional aspects of sedentary behavior and classroom lessons on topics related to nutrition, physical activity, and comorbidities. Patients were encouraged to follow the guidelines of the Norwegian National Council of Nutrition, which recommend that the daily intake of protein, fat, and carbohydrate, should account for 1. When at home, patients were encouraged to self- monitor their lifestyle habits (e. They were contacted by telephone every 2 weeks. The treatment aim was . Vitamin supplements were not prescribed. Roux- en- Y gastric bypass was performed laparoscopically with a gastric pouch of about 2. L. 1. 4 In order to reduce liver size, surgical patients consumed a low- calorie diet (9. Variables. An apnea event was defined as . Hypopnea events were defined as a 5. Both supine and non- supine values of AHI were recorded, given that these might have clinical implications. Oxygen desaturation index (ODI) was defined as the number of episodes with . Oxygen saturation (Sp. O2), both mean and lowest value through the night, was measured by a finger pulse oximeter. The primary outcome variables were changes in the prevalence and severity of OSA in both treatment groups. OSA was addressed as both a continuous (AHI) and categorical variable (OSA; yes/no, if yes: mild, moderate, severe). Other outcome variables were resolution of OSA (AHI cutoff 5) and improvement of moderate or severe OSA (AHI . OSA was categorized as mild (AHI 5- 1. AHI 1. 5- 2. 9), or severe (AHI . Scoring rules were in accordance with the 2. American Academy of Sleep Medicine (AASM) manual for the scoring of sleep. The main explanatory variable was treatment group. Other possible explanatory or confounding variables were age, gender, anthropometric measures (BMI, weight, and neck circumference), and baseline AHI. Data Sources/Measurement. Portable monitors were used for somnography such that each patient could be monitored in their natural sleeping habitat with their everyday pre- bed rituals. Portable sleep diagnostic systems like the Embletta have a high sensitivity and are considered reliable in the diagnosis of OSA, as there are few false positive results compared to polysomnography. For the sleep registrations, we used Embletta, a portable multi- channel recorder consisting of a nasal cannula, 2 piezoelectric belts, a finger pulse oximeter, and a body position detector. To monitor respiratory movements, 2 piezoelectric belts were placed around the thorax and abdomen. To avoid interrater variation, Embletta recordings were manually scored by the same person (JMF). Patients received both written and oral instructions regarding equipment usage. In. Play from Briefing. On The Wires (: WIRES) : Gazprom (OGZPY) and CNPC signed a Supplementary Agreement to the Sales and Purchase Agreement for Russian gas to be supplied via the eastern route. Are you an employer looking to find interns for your business? Employers can post internships and student jobs for free on Internships.com. Once you post your job. Italy (Italian: Italia ( listen)), officially the Italian Republic (Italian: Repubblica italiana), is a unitary parliamentary republic in Europe. In my recent Context of Calories post, I explained how the different macronutrients we eat at each meal (fats, proteins, and carbohydrates) have different effects in. Wondering what is the Specific Carbohydrate Diet (SCD)?At SCDlifestyle.com we are experts on the SCD diet. Check out our introductory guide to SCD diet today! According to the Supplementary Agreement, gas supplies to China via the Power of Siberia gas pipeline will commence in December 2. Nokia (NOK) and Xiaomi announced that they have signed a business collaboration agreement and a multi- year patent agreement, including a cross license to each company's cellular standard essential patents. Xiaomi also acquired patent assets from Nokia as part of the transaction. Tom. Tom (TMOAY) and Baidu (BIDU) announced today that they have joined forces to develop high definition maps for autonomous driving. Their collaboration on the development of a global HD map service combines Tom. It can be seen from the above tabulation that the rules described in subsection 2.1, governing the use of the linear programming systems for feed formulation, are. The Diamond Level of membership represents the ideal EzineArticles Expert Author and is the highest level of authorship that can be obtained on EzineArticles. 5:49 pm Vaalco Energy received NYSE notification that its stock price has fallen below the continued listing standard : The Company will be notifying the NYSE of its. Please note that once you make your selection, it will apply to all future visits to NASDAQ.com. If, at any time, you are interested in reverting to our default. As a fan of music, I’d love to learn how to make a song. Devoting time to learning music theory, however, isn’t exactly on my list of priorities. Music lessons. Tom and Baidu's expertise in HD map- making and artificial intelligence. Baidu will leverage Tom. Tom's Real- Time Map Platform to improve HD map- related technologies utilised in China. Eurofins Scientific (ERFSF) announced that it has acquired Ana Laboratories, one of the largest laboratory networks specialized in fluid and tribology analyses serving the public mass transit sector in the USA. Eurofins believes it represents a solid entry platform into industrial oil testing, as well as the wider market for tribology analysis. Galapagos NV (GLPG) announced a new Phase 2 study investigating filgotinib in non- infectious uveitis, being led by filgotinib collaboration partner Gilead Sciences (GILD). Autonomous Holdings (FRSX) announced that following a number of field tests conducted with a prototype, it has successfully completed proof of concept of its multispectral road traffic accident prevention system, which features both thermal and visible light cameras. Banco Santander launches EUR7. Banco Popular (BPESF) (SAN) : Banco Santander, S. A. The transaction will support the acquisition of Banco Popular Espaol, S. A. 1: 5. 2 am General Motors Canada reports June sales increased 4. Yo. Y (GM) : Q2 Retail Sales +1. Yo. YQ2 Total Sales +1. Yo. Y1: 4. 8 am Ryanair Hldgs reports June traffic increased 1. Yo. Y (RYAAY) : Co released June traffic statistics as follows: Traffic grew 1. Load factor rose 2% points to 9. Rolling annual traffic to June grew 1. Worldpay confirms preliminary approaches for potential acquisition by Vantiv (VNTV) (WDDYF) : Co notes there can be no certainty either that an offer will be made nor as to the terms of any offer, if made. A further announcement will be made if appropriate. Worldpay's announcement was made without the consent of Vantiv. On The Wires (: WIRES) : Xilinx (XLNX) announced that Baidu has deployed Xilinx FPGA- based application acceleration services in their public cloud. The Baidu (BIDU) FPGA Cloud Server, a new service in Baidu Cloud, features highly efficient Xilinx Kintex FPGAs, tools, and the software needed to develop and deploy hardware- accelerated data center applications such as machine learning and data security. Gazprom (OGZPY) and SOCAR address cooperation issues. The parties discussed cooperation issues, paying attention to, among other things, natural gas supplies to Azerbaijan. Samsung Electronics (SSNLF) announced that its new semiconductor fabrication line in Pyeongtaek, South Korea, has begun mass production and shipping its first product to customers. The new facility will focus on the production of Samsung's fourth- generation V- NAND, adding to the company's leading capacity for cutting- edge memory products. Eni (E),The City of Turin, GTT and Amiat, an Iren Group company, have signed an agreement to launch a large- scale experimental project with Turin buses using Eni Diesel+, the new Eni fuel with a 1. Under the agreement, the Turin public transport company will pay Eni Diesel+ at the same price as the diesel fuel that its vehicles have used on the urban network up to now. This follows Eni's success at the tender to supply the fuel for Turin's buses. Janet Yellen treated and released from hospital in London over weekend; expects to resume her schedule as planned this week (SPY) : 1. On The Wires (: WIRES) : Dry. Ships (DRYS) announced that a lawsuit was filed for breaches fiduciary duty, unjust enrichment, and conflict of interest. The plaintiff seeks, among other things, a temporary restraining order and preliminary injunction to suspend any further issuances of new common shares by the Company at a price per share below the price specified by the plaintiff. Dry. Ships and its management have reviewed the complaint and the motion and believe them to be without merit and will contest them vigorously. Baidu (BIDU) announced that more than 5. Apollo open autonomous driving project, forming one of the largest and most diverse autonomous driving ecosystems to accelerate the development and adoption of autonomous driving. Israel Chemical provides update on Rotem phosphogypsum water spill; believes that its overall short term financial exposure will be relatively modest (ICL) : ICL announced that it is continuing its efforts to remedy the immediate environmental effect and damages resulting from the phosphogypsum water spill from the ICL Rotem facility on June 3. In addition, the Company stated that at a preliminary hearing at the Southern District of the Mo. EP held on July 3, representatives of ICL and ICL Rotem were informed that the Mo. EP is weighing the possibility of taking legal action, including administrative and criminal action. ICL will cooperate fully with the authorities regarding any such proceedings. Following initial assessments by the Company and its insurance brokers, ICL believes that its overall short term direct financial exposure resulting from the spill will be relatively modest. Events such as the spill which occurred are typically covered by insurance which the Company maintains, with an insignificant deductible payment on the part of the Company. Monogram Residential Trust to be acquired by Greystar Real Estate Partners for $1. MORE) : Monogram Residential Trust announced that it has entered into a definitive merger agreement to be acquired by a newly formed perpetual life fund, Greystar Growth and Income Fund, LP, led by Greystar Real Estate Partners and its initial founding capital partners, affiliates of APG Asset Management N. V., GIC, and Ivanho Cambridge, in a transaction valued at approximately $3. Under the terms of the merger agreement, which was unanimously approved by Monogram's Board of Directors, Monogram's stockholders will receive $1. This represents a premium of ~2. Monogram's unaffected closing stock price on July 3, 2. The $3. 0 billion aggregate transaction value includes Monogram's share of its two institutional co- investment joint ventures with PGGM and NPS. The PGGM joint venture will be restructured, and the joint venture interests held by NPS will be purchased by Greystar pursuant to a separate assignable purchase and sale agreement for ~$0. NPS joint venture's share of debt to be assumed or refinanced in connection with the transaction. On The Wires (: WIRES) : Nidec Corporation (NJDCY) announced that it acquired a 1. LGB Elettropompe Srl, an Italian commercial pump and motor manufacturer. The Transaction is expected to have no significant impact on the Company's consolidated financial performance for the fiscal year ending March 3. Pembina Pipeline (PBA) announced that it has placed ~$2. Phase III pipeline expansion and two connected major delivery points: the Company's third fractionator at Redwater and its Canadian Diluent Hub. Eurofins Scientific (ERFSF) announced that its real- time PCR kits for Listeria testing, BACGene Listeria, as well as the BACSpec Listeria ELISA kit have received certification by AOAC and AFNOR. Prologis to acquire its partner's interest in its Brazil portfolio for $3. PLD) : Upon close of the transaction, Prologis will own 1. Prologis CCP and rename the business to Prologis Brazil. The transaction is subject to customary closing conditions, including applicable regulatory approvals, and is expected to close in the second half of 2. On The Wires (: WIRES) : Apollo Commercial Real Estate Finance (ARI) announced that it will redeem all 3,4. Series A Cumulative Redeemable Perpetual Preferred Stock on August 2. The shares of Series A Preferred Stock will be redeemed at the redemption price of $2. Endo International (ENDP) announced that it has completed the previously announced divestiture of its South African based operations, Litha Healthcare Group, to Acino Pharma AG. In February 2. 01. Endo announced that, following a comprehensive strategic assessment and asset review, the Company determined that Litha no longer aligned with its strategy and was not considered a core asset. Merus Labs International (MSLI) and Norgine B. V. This was the only regulatory approval required to be obtained as a condition to completion of the Arrangement. Century. Link (CTL) announced it has signed an agreement with SAP to offer premium supplier services for SAP HANA Enterprise Cloud in Asia Pacific. These services, delivered through data centers located in Singapore and India, can help organizations across the region accelerate their digital transformation journeys by combining the real- time computing power of the SAP HANA platform with Century. Link's global network infrastructure and in- house expertise in SAP solutions. NOXXON Pharma N. V. NOXXON and Merck & Co (MRK) collaborated closely in the two- arm clinical trial design. Assa Abloy acquires Arjo Systems; will be accretive to EPS from start (ASAZY) : ASSA ABLOY has acquired Arjo Systems SAS, a leading provider of physical and digital identity solutions for secure government ID applications. Sales for 2. 01. 7 are expected to reach EUR5. SEK5. 50 million) with a good EBIT margin. The acquisition will be accretive to EPS from start. The Definitive Guide to the Primal Eating Plan. Do the Math. In my recent Context of Calories post, I explained how the different macronutrients we eat at each meal (fats, proteins, and carbohydrates) have different effects in the body. I suggested that, despite their raw calorie values, it’s far more important to get a lasting intuitive sense of how much of each macronutrient you need and when you need it (or not). But how do you do that? How do you figure out the proper number of calories – and breakdown of fats, protein and carbs – to accomplish your fitness and health goals? To lose weight? Gain muscle? Maintain status quo? Run marathons? In fact, most popular daily diets look at overall calories as the main factor in weight loss and weight gain. The age- old conservation of energy Conventional Wisdom says that “a calorie is a calorie.” From there most diet gurus generally prescribe some formulaic one- size- fits- all breakdown of fats, protein and carbs. A classically trained Registered Dietician will tell you that protein should be around 1. This macronutrient breakdown stays the same regardless of how much weight you need to lose or what other goals you might have. Barry Sears has his 4. Zone” diet. The USDA bases everything on a choice of between 2,0. But, as I said earlier, it’s not that simple. Calories do have context. The human body uses these macronutrients for a variety of different functions, some of which are structural and some of which are simply to provide energy – immediately or well into the future. Moreover, with regards to energy conservation or expenditure, the body acts as both an efficient fuel storage depot (and as a toxic “waist” site) as well as a potent generator of energy, depending largely on the hormonal signals it gets. It will store glycogen and/or fat and it will build muscle – or it will just as easily tear them all down and use them for fuel – based on input from you: what you eat, how much you eat, when you eat, what you’re doing before or after you eat – even what you’re thinking when you eat. Yet because your body always seeks to achieve homeostasis over time, the notion of you trying to zero in on a precise day- to- day or meal- to- meal eating plan is generally fruitless (yes, Charlotte, some fruit is allowed). The good news in all this is that falling off the wagon once or twice this week won’t have the immediate disastrous effect that you might imagine – as long as you can keep your average intake under control and understand how the various macronutrients function over time. Which brings me to the crux of today’s discussion. Not only is it nearly impossible to accurately gauge your exact meal- to- meal calorie and macronutrient requirements, doing so will drive you crazy. In fact, to accurately figure your true structural and functional fuel needs (and hence to achieve your goals) it’s far more effective to look at a much larger span of time, like a few weeks, and aim for an “average” consumption. Then you can review that average daily intake over weeks or months and adjust accordingly. Below, I’ll give you a way to figure a “jumping off” point to start with, but remember, our genes are accustomed to the way our ancestors ate: intermittently, sporadically, sometimes in large quantities, and sometimes not at all for days. Their bodies figured out a way to maintain homeostasis and preserve lean tissue and good health through all this and so can we. Our genes want us to be lean and fit. It’s actually quite easy as long as we eat from the long list of Primal Blueprint healthy foods and try to avoid that other list of grain- laden, sugary, processed and otherwise unhealthy foods. Realistically, we also want to allow for the occasional party- splurge, a pre- planned (or accidental) intermittent fast, an over- the- top workout or even a week of laziness. Where most people get into trouble is in miscalculating their energy needs over extended periods of time – not day- to- day. They don’t see the average amount of carbs creeping upwards, or they figure they need x amount of calories, but don’t have a clue as to what kind of food those should be coming from. I start with these four basic principles to guide my Primal Blueprint eating style: 1)8. Yes, exercise is also important to health and to speed up fat- burning and muscle- building, but most of your results will come from how you eat. I’ll write more on this later, so just trust me on this one for now. Suffice to say, people who weigh a ton and exercise a ton, but eat a ton, still tend to weigh a ton. I think I’ll have that made into a t- shirt. I’ve said it many times on this site: lean mass (muscle and all the rest of you that is not fat) is directly correlated with longevity and excellent health. Rather than strive to “lose weight”, most people would be better off striving to lose only fat and to build or maintain muscle. Since other organs tend to function at a level that correlates to muscle mass, the more muscle you maintain throughout life, the more “organ reserve” you’ll have (i. Refer back to rule #1 and eat to build or maintain muscle. Excess body fat is bad. Most human studies show that being significantly overweight increases your risk of nearly every disease (except osteoporosis – because ironically it responds to weight- bearing activities). Fat just doesn’t look that great either. See rule #1 and eat to keep body fat relatively low. Excess insulin is bad. We’ve written about it here a lot. Chronic excess insulin may be even worse than excess sugar (and we know how bad that is). All animals produce insulin, but within any species, those that produce less insulin live longer than those who produce a lot. Eat to keep insulin low. Here is how I use these principles to guide my individual macronutrient intake: Protein. Protein takes priority. If there is ample glycogen (stored glucose) and the body is getting the rest of its energy efficiently from fats, protein will always go first towards repair or building cells or enzymes. In that context, it hardly seems fair to assign it a “burn rate” of 4 calories per gram. It’s like saying the 2. They will, but I prefer to burn other fuel first. At a minimum you need . If you are moderately active you need . That’s at a minimum, but it’s on a daily average. So a 1. 55 lb moderately active woman who has 2. If she gets 6. 0 or 8. And even if she exceeds the 1. At 4 calories per gram, that’s between 3. It’s not that much. Carbs. If you’ve forgotten everything you ever learned in biology, just remember this and “own” it: Carbohydrate drives insulin drives fat (Cahill 1. Taubes 2. 00. 7). The idea in the PB is to limit your carbs to only those you need to provide glucose for the brain and for some reasonable amount (certainly less than an hour) of occasional anaerobic exercise. And the truth is, you don’t even need glucose to fuel the brain. Ketones from a very- low carb diet work extremely efficiently at that task. Either way, ideally, we would like most of our daily energy to come from dietary or stored fats. Typically, (if you are at an ideal body composition now) I use a rule of thumb that 1. NOT a bad thing) but away from storing the excess as fat if you are the least bit active. Don’t forget that your body can make up to 2. On the other hand, if you are looking to lose body fat, keeping carbs to under 8. On the other other hand, if you are insistent on training hard for long periods of time, you would add more carbs (say, 1. It becomes a matter of doing the math and experimenting with the results. Ironically, it’s tough to exceed 1. Even if you eat a ton of vegetables AND a fair amount of fruit, you’ll be hard pressed to exceed 1. Our remote ancestors couldn’t average 1. At 4 calories per gram that’s only between 4. Add that in to the protein above and our sample girl is barely at 1,0. So where does the rest of the fuel come from? Fats. Learn to love them. They are the fuel of choice and should become the balance of your Primal Blueprint diet. Fats have little or no impact on insulin and, as a result, promote the burning of both dietary and stored (adipose) fat as fuel. Think about this: if protein and carbs stay fairly constant (and carbs stay under 1. Feeling like you need more fuel (and you’ve already covered your bases with protein and carbs)? Reach for something with fat. Nuts, avocados, coconut, eggs, butter, olive oil, fish, chicken, lamb, beef, the list is a long one. Even if she averages somewhere between 1. If she decides to do some walking, a few brief intense weight sessions and a sprint day here and there, that process would accelerate greatly. If she gets to a point where she’s content with her body fat, she can even add in a little more fat to provide energy that she previously got from her stored fat. The main thing I’ve figured out from eating this way for years is that I don’t need nearly as many calories to maintain health, mass, and body fat as I once thought I did – or as the Conventional Wisdom says I do. I eat 6. 00- 1. 00. I ate a carbohydrate- based diet, yet I maintain slightly lower body fat and slightly higher muscle mass on even less training. Remember: 8. 0% of body composition is determined by diet. The best part is that I don’t ever feel hungry because I base my eating on exactly what my 1. For a look at my upcoming book, The Primal Blueprint, click here. I’ve included a sneak peek at the jacket artwork, a PDF of the table of contents and full chapter summaries. Further Reading: Definitive Guides to: The Primal Blueprint. Grains. Fats. Cholesterol. Insulin, Blood Sugar and Type 2 Diabetes. 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Heart Disease & Heart Attack Prevention: Diet Tips & Guidelines. Heart Disease Symptoms in Women. Heart disease is the leading cause of death among women, and heart attack symptoms and signs can be different for women than for men, for example: Chest tightness Nausea and vomiting. Fatigue Lightheadedness Sweating Heart attack prevention definition and facts. Heart disease is the leading cause of death in the U. S. 5. 25,0. 00 of those heart attacks are the first for the person affected. Symptoms of a heart attack in men and women include. Women experience the same symptoms of a heart attack as listed above. Leading a heart- healthy lifestyle such as eating a heart healthy diet. What is a heart attack? A heart attack happens when the flow of blood that brings oxygen to the heart. This is often a result of. Sometimes these plaques can. The clots in the coronary. This damage to the heart. Heart attack is medically termed myocardial. MI). Medically Reviewed by a Doctor on 1. Heart bypass patients only have good health for 1. Heart bypass surgery patients often live a healthy life after their operation - but it may only last for 1. Modern surgical procedures mean survival rates are better than ever, however, the mortality rate eight to 1. The researchers believe this may due to the return of any progressive condition that the patient suffered from pre- surgery. Lead researcher Kasper Adelborg from Aarhus University in Denmark, said: 'The rate of survival has improved over the last three decades, so the probability of continuing your life following bypass surgery is close to being the same as in the general population.'Clinicians in contact with patients should assess their prognosis individually - and there are special reasons to do this after the initial eight to 1. A simple blood test may predict a patient's chances of survival after surgery, a new study suggests. High levels of a specific protein in the bloodstream may indicate that someone is suffering from inflammation in their body, scientists claim. This, known as the body's response to injury, is heavily linked to heart attacks, kidney failure and even strokes. Monitoring levels of troponin, the protein responsible, may help doctors know which patients need extra care after an operation, according to the researchers from The James Cook University Hospital in Middlesborough. How the study was carried out Researchers from Aarhus University analysed data from a 3. Heart bypass surgery involves rerouting the blood supply around a damaged section of the artery by attaching healthy blood vessels from elsewhere in the body. Key findings Results revealed that those who survive the first month after surgery are likely to be able to carry on as normal and have the same quality of life as those who have not had the operation. The researchers believe this may be due to the patient's original progressive condition, that caused their arteries to become diseased, returning. Alternatively, the previously healthy blood vessels attached to the diseased artery may lose their effectiveness over time. Mr Adelborg said: 'Clinicians in contact with patients should assess their prognosis individually - and there are special reasons to do this after the initial eight to 1. I started doing the Esselstyn diet as specified by Dr. Esselstyn, after I wrote an email to his secretary Jacqueline. He called me the next day. Constipation is most often caused by a low-fiber diet, lack of exercise, dehydration, or delay in going to the bathroom when you have the urge to defecate. Brazil - Wikitravel. Brazil. NOTE: The CDC has identified Brazil as an affected area of the Zika outbreak. Pregnant women are advised to be cautious as the virus can lead to birth defects. Adults affected by the virus experience fever, rash, joint pain, and conjunctivitis (red eyes) typically lasting a week. Famous for its football (soccer) tradition and its annual Carnaval in Rio de Janeiro, Salvador, Recife and Olinda. It is a country of great diversity, from the bustling urban mosaic of S. Settling by the Portuguese began late in the 1. Brazil was settled by the Portuguese and not the Spanish, as were the rest of Central, South and parts of North America in the New World. Despite Portuguese rule, in some parts of Brazil the Dutch founded colonies between 1. They founded several cities, such as Mauritsville (now Recife, capital of the state of Pernambuco, at the edge of North- East of the country), and many sugar cane plantations. The Dutch fought a grim jungle war with the Portuguese, and without the support of the Republic of their homeland due to a war with England, the Dutch surrendered to the Portuguese, though they did not officially recognize Portuguese rule, which led to an all- out war with Portugal off the coast of Portugal in 1. To link to this poem, put the URL below into your page: <a href="http:// of Myself by Walt Whitman</a> Plain for. Gateway to Tampa Bay area news, weather, radar, sports, traffic, and more. From WTVT-TV/DT FOX 13, the most powerful name in local news. Coconut oil has had quite the week! The supposed health food has turned into a pariah thanks to the American Heart Association reviewing existing evidence and. Food Timeline, frequently asked questions,food history notes. Spiritual Humor. Compiled by Timothy Conway LAUGHTER AS MEDICINE. It is said that young children laugh as much as 100 to 200 times a day, compared to a large majority. Animating anything by hand using stop-motion techniques, one frame at a time, is a time-consuming and mind-numbing process. But in order to create the surreal organic. Latest environmental news, features and updates. Pictures, video and more. Why study national gastronomy? Preference determined by conditions become. Need Facebook Who Wants To Be A Millionaire answers, solutions and cheats? Consult our quick reference chart. Then help us grow more Millionaire cheats! In 1. 66. 5 the Peace Treaty of The Hague was signed, Portugal lost its Asian colonies and had to pay 6. Dutch Republic for the loss of its colony. Meanwhile, extermination and Christianizing of natives kept its pace, and in the 1. Italian, German (in southern Brazil), Spanish, Japanese (in S. Until 1. 88. 9 Brazil was an Empire under the rule of Dom Pedro I and his son Dom Pedro II. By this time, it became an emerging international power. Due to English laws against slavery (some argue more for economic contests than humanity reasons) and fighting between white and black people, slaves and free, for abolition, slavery ended in 1. But freedom didn't mean equality to the now- free black people and their descendants. These dark times are known as . Only recently, with the establishment of a National Truth Commission (2. U. S.- supported coup that overthrew democratically- elected Jo. Brazil has returned to democratic rule, while facing the challenge of keeping its industrial and agricultural growth and developing its interior. Exploiting vast natural resources and a large labor pool, Brazil is a Latin America economic power and a regional leader. Brazil has high rates of crime, income inequality and systemic, centuries- old corruption. Despite it the people try to remain happy and festive. It has huge regional variations (even among neighbouring States sometimes) and in spite of being mostly unified by a single language, some regions and States are so different from each other that they look like different countries altogether. Styles like choro, samba and bossa nova are considered genuinely Brazilian. Caipira music is also in the roots of sertanejo, the national equivalent to country music. MPB stands for Brazilian Popular Music, which mixes several national styles under a single concept. New urban styles include funk - name given to a dance music genre from Rio's favelas that mixes heavy electronic beats and often raunchy rapping - and techno- brega, a crowd- pleaser in northern states, that fuses romantic pop, dance music and caribbean rhythms. Brazilian funk is the most popular type of music they listen to. It has a constant and repeated beat that is always the same, it never changes. They keep the beat, and sing songs to it. There are more than 1. You might think that people get tired of the same beat, but no. It is so impressive that there are so many songs that it never gets old. Funk could be considered tradition because of its strength in rhythm, and bringing people together. Distinguished by vivacious complicated movements and accompanying music, it can be seen and practiced in many Brazilian cities. In the Romantic Period, the greatest name was Antonio Carlos Gomes, author of some Italian- styled operas with typical Brazilian themes, like Il Guarany and Lo Schiavo. In the Classical Period, the most prominent name is Jos. Their places of cult are called terreiros and many are open to visit. There are still many indigenous groups and tribes living in North, although many have been deeply influenced by Western culture, and several of the country's surviving indigenous languages are endangered. The traditional lifestyle and graphic expressions of the Waj. Nine out of ten households have a TV set, which is the most important source of information and entertainment for most Brazilians, followed by the radio broadcast. TVs broadcast sports, movies, local and national news and telenovelas (soap operas)– 6- 1. Brazil constitutes a melting pot of the most diverse ethnic groups thus mitigating ethnic prejudices and preventing racial conflicts, though long- lasting slavery and genocide among indigenous populations have taken their toll. Prejudice is sneaky since this matter is taboo in Brazil, and more directed towards different social classes than between races. Nevertheless, race, or simply skin colour, is still a dividing factor in Brazilian society and you will notice the skin typically darkens as the social class gets lower: wealthy upper- class people are almost white; a few middle- class are mulato (mixed race) and even black; and the majority of poor people are black - except in South Region because blacks and mulatos compose less than 1. Nowadays, however, Afro- Brazilians and Amerindian populations are increasingly aware of their civil rights and of their rich cultural heritage, and social mobility is achievable through education. While Southerners may be somewhat colder and more reserved, from Rio upwards people usually boast a captivating attitude towards life and truly enjoy having a good time. Some may even tell you that beer, football, samba, barbecue and woman is all they could crave for. To people they have met, or at least know by name, Brazilians are usually very open, friendly and sometimes quite generous. Once introduced, until getting a good reason not to, a typical Brazilian may treat you as warmly as he would treat a best friend. Rio de Janeiro people brag about their ability to outsmart people (especially from other countries and Brazilian States) and even nicknamed their State Terra de Malandro (Weasel Land). If you obviously look like a tourist, you are a potential target; for instance, a vendor may try to sell goods at higher prices, or a taxi driver may choose the longest route to the destination. It doesn't mean that you can't trust anyone, just that you have to be a bit more alert and careful, particularly if someone seems too friendly. Notice in some States people call everyone . In spite of that, Brazil is still a nation faced towards the Atlantic, not towards Hispanic America. Some may be offended if a visitor openly says that, or tends to believe that Brazilians have Spanish as a primary or secondary language, visitors will receive a warmer welcome if they try to start conversations in Portuguese, but even if the visitor speaks Spanish towards Brazilians, they're likely to answer in Portuguese. Whereas an emerging elite of young, well- educated professionals indulge in amenities of modern society, child labor, illiteracy and subhuman housing conditions still exist even in regions blessed by economic growth and huge foreign investments such as S. Brazil also has an increasing number of immigrants of the Middle East, specially from Syria. In the North, near the equator there is a wet and a dry season; from about S. The weather constantly changes and is sometimes a surprise. It can be scorching hot, then simmer down, and get very cold. It could be sunny 1 minute, and start raining the second minute. The warm climate is perfect for the beach and playing outside. Monday and Tuesday are the actual holidays, but celebrations usually begin on Saturday and last until 1. PM of Ash Wednesday, when shops and services re- open.)Good Friday - March/April (movable) two days before Easter Sunday. Tiradentes - 2. 1 April. Labour Day - 1 May. Corpus Christi - May/June (movable) sixty days after Easter Sunday. Independence Day - 7 September. Patroness of Brazil - 1. October. All Souls' Day (Finados) - 2nd November. Republic - 1. 5 November. Christmas - 2. 5 December. Working hours are usually from 0. Banks open Monday to Friday, 1. Street shops tend to close at noon on Saturday and only re- open on Monday. Shopping malls normally open 1. Monday to Saturday, and 1. Sundays. Some malls, especially in large cities, are also open on Sundays, although not all the stores may be open. It is also possible to find 2. Sundays. There is no physical difference in the electric outlets (power mains) for the two voltages. Electric outlets usually accept both flat (North American), and round (European) plugs. Otherwise adaptors from flat blades to round pins are easy to find in any supermarket or hardware shop. Some outlets are too narrow for the German . The best makeshift solution is to buy a cheap T- connection and just force your . Very few outlets have a grounding point, and some might not accept newer North American polarized plugs, where one pin is slightly larger. Again, use the cheap T. Near the border with Argentina, you might occasionally find outlets for the Australia/New Zealand- type plug. If crossing the border, you'll probably need this adapter as well. It is backwards compatible with the Europlug, but it has a receded socket. Again, T- plugs can be used as adapters for other common formats. Blackouts are less and less frequent, but you always run a risk at peak of high season in small tourist towns. It is divided into five regions, mainly drawn around state lines, but they also more or less follow natural, economic and cultural borderlines. This is often considered the country's most beautiful coastline, and has the sunniest and hottest climate; but it is also the country's driest and poorest region. |
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