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Long Term Weight Loss for Thyroid Patients: Hormonal Factors That Affect Diets An Interview with Kent Holtorf, MD By Mary Shomon Thyroid Disease Expert; & “Long Term Weight Loss-More Than Will Power?” by Ken Holtorf in huffingtonpost.com

http://thyroid.about.com/od/loseweightsuccessfully/a/weight-loss-diet.htm

Long Term Weight Loss for Thyroid Patients: Hormonal Factors That Affect Diets
An Interview with Kent Holtorf, MD

By Mary Shomon
Thyroid Disease Expert

– Kent Holtorf, MD
Kent Holtorf, MD is a California-based expert on hormonal medicine. Kent Holtorf, MD
Updated December 16, 2014.

Written or reviewed by a board-certified physician. See About.com’s Medical Review Board.

Kent Holtorf, MD has a long history of working with patients who have hormone imbalances — including thyroid, adrenal, and reproductive hormones. He runs the Holtorf Medical Group in California, where he specializes in complex endocrine dysfunction, including hypothyroidism, adrenal insufficiency, and insulin resistance.
Dr. Holtorf has been working with a number of his patients — many of whom have an underactive thyroid — who have found it difficult or seemingly impossible to lose weight. What he discovered is that while there are many factors involved in the inability to lose weight, almost all the overweight and obese patients he treats have demonstrable metabolic and endocrinological dysfunctions that are major contributors to the weight challenges of these patients. In particular, Dr. Holtorf has, based on some of the latest research, focused on evaluating two key hormones — leptin and reverse T3 (rT3)– and treating any identified irregularities to help his patients lose weight.

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I’m pleased to be able to bring you this interview with Dr. Kent Holtorf, discussing his approaches to help thyroid patients achieve long-term weight loss.

Mary Shomon: You have said that you feel that two key hormones — leptin and reverse T3 — are playing a key role in regulating weight and metabolism. Can you tell us a bit about leptin, first, and what it has to do with weight loss challenges?

Kent Holtorf, MD: The hormone leptin has been found to be a major regulator of body weight and metabolism. Leptin is secreted by fat cells and the levels of leptin increase with the accumulation of fat. The increased leptin secretion that occurs with increased weight normally feeds-back to the hypothalamus as a signal that there are adequate energy (fat) stores. This stimulates the body to burn fat rather than continue to store excess fat, and stimulates thyroid releasing hormone (TRH) to increase thyroid stimulating hormone (TSH) and thyroid production.

Studies are finding, however, that the majority of overweight individuals who are having difficulty losing weight have varying degrees of leptin resistance, where leptin has a diminished ability to affect the hypothalamus and regulate metabolism. This leptin resistance results in the hypothalamus sensing starvation, so multiple mechanisms are activated to increase fat stores, as the body tries to reverse the perceived state of starvation.

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The mechanisms that are activated include diminished TSH secretion, a suppressed T4 to T3 conversion, an increase in reverse T3, an increase in appetite, an increase in insulin resistance and an inhibition of lipolysis (fat breakdown).

These mechanisms may be in part due to a down-regulation of leptin receptors that occurs with a prolonged increase in leptin.

The result? Once you are overweight for an extended period of time, it becomes increasingly difficult to lose weight.

Mary Shomon: You’ve said that you feel that leptin levels above 10 may warrant treatment. Can you explain a bit more about leptin levels?

Kent Holtorf, MD: Most underweight or normal weight individuals will have leptin levels below 10, although most major labs will use a reference range of 1 to 9.5 for men and 4 to 25 for women. (It must be remembered that this range includes 95% of so-called normal people and includes many who are overweight.) Almost all patients who are of healthy weight will have a leptin less than 10.

Mary Shomon: How do you treat leptin resistance in your practice?

Kent Holtorf, MD: Treatment can be focus on treating the elevated leptin — leptin resistance. An elevated leptin also indicates, however, that the TSH is an unreliable marker for tissue thyroid levels, as the TSH is often suppressed, along with significantly reduced T4-to-T3 conversion. In short, if your leptin is elevated, you have reduced tissue thyroid levels. Also, almost all diabetics are leptin resistant, which has been shown to reduce T4-to-T3 conversion in diabetics by as much as 50% without an increase in TSH, making it very difficult for type II diabetics to lose weight.

Because there is poor T4-to-T3 conversion, timed-released T3 is the optimal treatment — although T4/T3 combination medications such as natural desiccated thyroid (NDT) can be used.

We check the resting metabolic rate (RMR) in our patients, and interestingly, those with elevated leptin levels indicative of leptin resistance have RMRs that are consistently below normal. These patients are often burning 500 to 600 calories less each day than someone of equal body mass.

Thus, to have a reasonable chance of losing weight, these patients can either try and reduce calories by 500 to 600 calories a day (just to keep from gaining weight), exercise for an hour or two a day (just to keep from gaining weight) or normalize the thyroid and metabolism.

Humans are a very successful species because we can store energy (fat) very well. There are many mechanisms to gain weight and leptin resistance is just one of them, so we use a multisystem approach; there is no one magic bullet, although any one treatment can have a dramatic effect on a particular patient.

In addition to optimizing the thyroid (remember, giving thyroid hormone to lose weight is not appropriate, but that’s not what we are doing, here we are correcting a deficiency), Symlin (pramlintide) and/or Byetta (exenatide) can be very effective for many. Human Chorionic Gonadrotropin (HCG) is another potential option that works for some. While I’ve found that the antidepressant Wellbutin (bupropion) does not work well for weight loss, a combination of Wellbutrin and low-dose naltrexone (LDN) is having some surprisingly good results. Topamax (topiramate) is an option for some but is not always well tolerated. Standard appetite suppressants, which boost metabolism, can be used, especially if the RMR is low.

——————————-

http://www.huffingtonpost.com/kent-holtorf/long-term-weight-loss—m_b_192933.html

Kent Holtorf Headshot
Medical Director, Holtorf Medical Group

Long Term Weight Loss – More Than Will Power?

Obesity has become a major health epidemic and has dramatically increased over the last decades. Studies show that approximately one-third of the U.S. population is classified as obese and over two-thirds are significantly overweight. While the cause is multifactorial, studies are clear that almost all overweight individuals have metabolic and endocrinological dysfunction that is causing or contributing to their inability to lose weight.

It is not simply a problem that individuals are taking in more calories than they are consuming or lack of exercise or willpower, but rather it is a complex vicious-cycle of endocrinological and metabolic dysfunction. Contemporary medicine has failed to address these dysfunctions in overweight individuals and doctors and patients continue to believe that all cases are a matter of willpower and lifestyle. Thus, it is no surprise that obesity is reaching epidemic proportions.

Research is demonstrating that dysregulation of two key hormones may be a cause or major contributor of weight gain or inability to lose weight in the majority of overweight people. The first is leptin and the second is reverse T3. The exciting part is that doctors can now test for the presence of these physiologic barriers to weight loss and prescribe appropriate treatments with potentially dramatic results.

Leptin

The hormone leptin has been found to be a major regulator of body weight and metabolism. The body secretes leptin as weight is gained to signal the brain (specifically the hypo¬thalamus) that there are adequate energy (fat) stores. The hypothalamus should then stimulate metabolic processes that result in weight loss, including a reduction in hunger, an increased satiety with eating, an increase in resting metabolism and an increase in lipolysis (fat breakdown). New research has found that this leptin signaling is dysfunctional in the majority of people who have difficultly losing weight or are unable to lose weight.

The problem is not in the production of leptin, but rather, studies show that the ma¬jority of overweight individuals who are having difficulty losing weight have a leptin resistance, where the leptin is unable to produce its normal effects to stimulate weight loss. This leptin resistance is sensed as starvation, so multiple mechanisms are activated to increase fat stores, rather than burn excess fat stores. Leptin resistance also stimulates the formation of reverse T3, which blocks the effects of thyroid hormone on metabolism (discussed below).

Testing: A leptin level can be ordered by your physician. If greater than 10, it demonstrates there is a degree of leptin resistance contributing to an inability to lose weight. The higher the number the more significant the leptin resistance.

Treatment: There are currently two medications are shown to be able to treat leptin resistance and can result in significant weight loss. One is Symlin and the other is Byetta. These are currently approved for the treatment of diabetes but can be prescribed “off-label” for the treatment of leptin resistance. They are showing significant promise in the non-diabetic population with the ability to produce dramatic weight loss in a large percentage of overweight patients. The amount of weight loss varies according to the study design, but a significant percent of patients are experiencing weight loss, despite little or no change in diet.

The leptin resistance is not permanent and is shown to improve with weight loss so diet and exercise can be beneficial. The “catch-22″ is, however, that it is difficult to lose weight with leptin resistance. High carbohydrate diets and in particular high-fructose corn syrup is shown to significantly increase leptin resistance and is a likely mechanism that high fructose corn syrup is associated with obesity, especially in children. Avoidance of high fructose corn syrup and carbohydrates would be recommended for those with high leptin levels.

Reverse T3

It is well known that thyroid hormones regulate metabolism and that low thyroid hormone production (hypothyroidism) causes low metabolism, but it has only recently been understood that thyroid production can be fine but there can a problem of activation of the hormones inside the cells that can be a major cause of low metabolism.

The thyroid gland secretes an inactive thyroid hormone called thyroxine, also known as T4. This is regulated by thyroid stimulation hormone (TSH) produced by the brain (specifically the pituitary). Normally, the inactive T4 is converted inside the cell to the active thyroid hormone called triiodothyronine (also known as T3). Most doctors will check TSH and T4 levels to see if thyroid levels are normal.

The studies are showing that it is not the production of thyroid that is the problem, but rather it is problem inside the cell that the inactive T4 is not converted to T3 but rather to a mirror image of T3 called reverse T3. The reverse T3 has the opposite effect of T3, blocking the effects of T3 and lowering rather than increasing metabolism.

It is an evolutionary fall-back that was useful in times of famine or in hibernating animals to lower metabolism. Studies are showing that stress and dieting (especially yo-yo dieting) can set this hormone into action as well as chronic illness such as diabetes, chronic fatigue syndrome and fibromyalgia.

The production of reverse T3 is found to be a major method by which the body ‘tries” to regain any lost weight with dieting. As soon as the body senses a reduction in calories, the production of reverse T3 is stimulated to lower metabolism. With chronic dieting or stress, the body often stays in this “starvation mode” with elevated levels of reverse T3 and decreased levels of T3, which is a major reason for the regaining of lost weight with dieting as well being the mechanism behind stress induced weight gain (it is not due to increased cortisol).

Testing: There has been a long held belief by endocrinologists and other physicians that adequate thyroid levels can be determined by testing the TSH and T4 levels. Studies are showing that such standard testing will miss 80% of thyroid dysfunction so most endocrinologists and other doctors will tell their patients that their thyroid is fine based on this usual testing. The doctors must run a free T3/reverse T3 ratio. Generally, a healthy person will have a ratio greater than 2 so a person with a ratio less than 2 should also be considered a candidate for thyroid supplementation. Many endocrinologist and physicians are not yet aware of the significance or ability to run this ratio so it may take some searching.

Treatment: The standard treatment of hypothyroidism involves the supplementation with T4, including Synthroid and Levoxyl. These are not effective to remedy such a situation because the problem is not the amount of T4 but rather the excess conversion of T4 to reverse T3, blocking effects of the active T3. One must bypass the abnormality by supplementing with physiologic doses of T3, not T4 (preferably timed released T3). It is not appropriate to give thyroid hormone for weight loss, but rather to correct an abnormality diagnosed by appropriate blood tests.

In summary, emerging evidence demonstrates that a significant number of overweight patients have a metabolic problem rather than a problem of willpower or lifestyle. Identification and correction of these metabolic abnormalities, including leptin resistance and cellular thyroid dysfunction, can result in dramatic long term successful weight loss.

Follow Kent Holtorf on Twitter: http://www.twitter.com/Kholtorf


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Why That Big Meal You Just Ate Made You Hungry

http://www.wsj.com/news/articles/SB123966898930315491?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB123966898930315491.html

Why That Big Meal You Just Ate Made You Hungry

By MELINDA BECK
Updated April 14, 2009 12:01 a.m. ET
Every few months, a new study purports to prove that a calorie is a calorie is a calorie, and that the only way to lose weight is to burn more than you take in.

But veteran dieters know something that some researchers apparently don’t: Certain foods seem to fuel the appetite like pouring gasoline on a fire. Some people find that once they start eating bread, cookies, chocolate, potato chips — or leftover Easter candy — they lose all sense of fullness and find it difficult to stop.

That’s the concept behind “The Skinny,” a new book by Louis J. Aronne, longtime director of the Comprehensive Weight Loss Program at NewYork Presbyterian Hospital/Weill Cornell Medical Center. He makes the best case yet why what you eat and when you eat it can make a big difference in appetite, satiety and how much willpower it takes to cut down. “It’s true that a calorie is a calorie,” Dr. Aronne says. “But what that doesn’t take into account is how some calories affect what people eat later on.”

APPETITE STOKERS

Some foods make it harder to stop eating:

Bread
Sweets
Juice
Pasta
Wine or beer before dinner
Artificial sweeteners
*Source: “The Skinny” by Louis J. Aronne

DISCUSS

Have you found ways to cut your appetite? Join the discussion at Journal Community.
After 23 years of treating patients — some of it espousing liquid diets — Dr. Aronne has concluded that refined carbohydrates and foods with high sugar and fat content promote what he calls “fullness resistance.” They interfere with the complex hormonal messages the body usually sends to the brain to signal that it’s time to stop eating. People feel hungrier instead.

This happens in part because refined carbohydrates raise blood-sugar levels, setting up an insulin surge that drives blood sugar down again, causing rebound hunger. That insulin spike also interferes with leptin, the hormone secreted by fat cells that should tell the body to stop eating. Obese people have loads of leptin, but it either doesn’t get to the brain, or the brain becomes resistant to it. “This is not a failure of willpower, it’s a physical mechanism,” Dr. Aronne writes. The body also becomes resistant to insulin, setting the stage for diabetes.

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Other researchers have described similar phenomena. An article in this month’s Medical Hypothesis argues that for some people, refined foods with high sugar and carbohydrate content can be just as addictive as tobacco and alcohol.

Eating foods high in protein, vegetables, fiber and water have the opposite effect, Dr. Aronne says. His plan recommends revising what you eat, one meal at a time, to restore your sense of fullness:

Breakfast: Loading up on lean protein — ideally from egg whites or a protein shake — in the morning reduces hunger all day long. Eating muffins, bread, sweetened cereal and juice does the opposite. A study of 30 overweight women at Saint Louis University School of Medicine found that those who ate eggs for breakfast consumed 140 fewer calories at lunch, and ate less for the next 36 hours, compared with women who ate bagels in the morning.

Some people argue that they aren’t hungry in the morning, but Dr. Aronne notes that ghrelin, the hormone that typically signals hunger, adjusts to habitual meal patterns. After a few days of eating breakfast, you should find that you are hungry in the morning, and are eating less the night before, he writes.

Lunch: Some dieters try to cut calories by skipping this meal. But going more than five hours without food causes hunger hormones to rise and fullness hormones to drop, and sends more of the calories consumed at dinner straight to fat cells. Dr. Aronne recommends starting lunch with a salad — at least two cups of lettuce — then more vegetables, and then lean protein. Skip the cheese, croutons, bacon and creamy dressings, he advises. Using vinegar alone will cut your appetite and slow the rise in blood sugar.

Dinner: The end of the day is fraught with temptation. Obese people consume significantly more calories at dinner than slimmer people. Here, too, load up first on salads, clear soups, or high-protein appetizers like shrimp cocktail, then have a lean protein main course. Unlike some other diet plans, Dr. Aronne’s program allows a half-cup of grains or a small dessert at the end of the meal, but only if you’re still hungry.

Eating bread before dinner makes people lose their sense of fullness and eat more, Dr. Aronne warns. Alcohol makes it worse by lowering your resistance and promoting fat storage.

Snacks: Like many other weight-loss experts, Dr. Aronne believes that midmorning and midafternoon snacks can act as mini appetite suppressants, preventing blood sugar from dropping too low. But the same principles apply: high-sugar, high-starch, high-fat snacks — including those little 100-calorie cookie packs — start a vicious cycle of more cravings, whereas fruit, nuts, vegetables and clear soups can halt them.

Beverages: It should go without saying that juice and sweet soda can add hundreds of extra calories a day. A few studies have shown that even artificially sweetened beverages can prompt people to crave real sweets during the day. Cut back on all sources of liquid calories, Dr. Aronne advises; stick with water.

To be sure, if you eat as Dr. Aronne suggests, you’ll consume fewer calories overall. The point is, eating protein early in the day may make it much easier to cut down. “It definitely does make a difference,” says Ned Sadaka, a New York investment manager who consulted Dr. Aronne to drop 30 pounds that had crept up on him in recent years. He’s lost 21 pounds and 5 inches off his waist since January.

Not everyone agrees that consuming more protein cuts appetite. Harvard School of Public Health’s Frank Sacks led a study recently published in the New England Journal of Medicine that compared 811 overweight adults on four diets with varying levels of protein, fat and carbohydrate. “We found absolutely no difference in their satiety and hunger levels,” Dr. Sacks says. All the groups lost similar amounts of weight.

Other weight-loss experts say that’s not surprising, since there were only modest differences in their fat, protein and carbohydrate intakes, and many participants didn’t stick to their plans.

Eric Westman, director of the Lifestyle Medical Clinic at Duke University Medical Center, who espouses the same kind of low-carb plan that Robert Atkins made famous, says in his experience, “There is almost complete appetite suppression when you eat protein.”

The debate will doubtless continue — weight loss is an extremely complex area, and not everyone’s metabolism is the same. Dr. Aronne suggests trying his plan yourself: “Have 200 calories of egg white omelet or protein shake for breakfast, and then another day have 200 calories of juice and look at your hunger, hour after hour.” Sometimes being a clinical trial of one is the best way to do your own research.


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The Different Type of Hunger – PaleoHacks

http://blog.paleohacks.com/the-different-types-of-hunger/

The Different Types of Hunger

One major topic on the PaleoHacks site is about hunger and identifying the different types of hunger: “mind hunger,” “gurgling sensations,” “hunger pains,” “body wants fuel,” “starvation mode,” “and hypoglycaemic hunger.” Here are some of the most popular types of hunger listed: hypoglycemia, empty stomach, and compulsion to eat.

So what exactly is hunger, anyway, and why do we experience it? Are there more types than those listed here?

Hunger

Hunger is the feeling you get when your body requires food. Appetite (or mind hunger), on the other hand, is the feeling of wanting to eat even when you are not hungry.

The sensation of hunger generally makes itself felt within a few hours of eating and most people find it unpleasant. Different people can experience hunger at different times according to their eating habits.

Biological Mechanisms of Hunger

Hormones

The hormones ghrelin and leptin fluctuate within your body to convince you to eat. When you eat, leptin is released and signals to your brain that you are full, or at least reduces your motivation to continue eating. After a few hours without food, those leptin levels drop and ghrelin is released, which brings back those feelings of hunger.

Other hormones like cholecystokinin (CKK) and insulin are released when you eat. These work to reduce hunger signals. Epinephrin and glucagon rise when you don’t eat and work to stimulate hunger.

Just before a meal, your glucose levels drop and your insulin rises.

Neural Signals from the Gastrointestinal Tract

Vagal nerve fibers can transmit signals between the GI tract and your brain. When you eat and your stomach is stretched, those stretch receptors tell your brain you are full and your hunger is reduced.

Nutrient Signals

Several nutrients send signals to your brain to indicate you are not hungry. These may include elevated amino acids, rising glucose levels, and fatty acids in the bloodstream.

Physical Sensations of Hunger

The different types of hunger may cause different sensations. When your stomach is empty, you may experience “growling” sensations, or minor cramping. You may have increased salivation or even “tight throat” feeling. This sensation doesn’t usually last long, about an hour, and then it will go away.

Appetite, or the desire to eat even when you’re not necessarily hungry, is all in your mind. This pesky issue can cause some problems with some people who either can’t recognize true hunger sensations, or choose to ignore them for the sake of eating that one last donut or cookie.

Hypoglycemic Hunger

When your body’s main fuel source is glucose, and you don’t eat enough carbs to produce glucose, your body might experience hypogylycemia. This is the condition where you have abnormally low levels of blood sugar.

This type of hunger is rare in Paleo eaters. Sure, when you first switch to a Paleo lifestyle after eating a lifetime of the Standard American Diet high in processed junk and sugar, you will probably have a few days or even a couple weeks where you will experience uneven energy and intense sugar cravings. You might experience anxiety or lightheadedness, the jitters, the shakes, brain fog, difficulty concentrating, extreme hunger, and energy crashes after eating and in the late afternoon.

The good news is, our bodies can make energy from carbs and from fat. If you have moved from a high-carb, low-fat diet to a lower- to moderate-carb, high protein, high fat diet, you will probably experience hypoglycemia for the first few days or week as your body adjusts. After that, your body will become accustomed to using a combination of fat and carbs (or just fat, if you follow a keto diet) for energy.

To make sure your body can produce energy from fat in an optimal manner, Chris Kresser suggests you ensure your nutrient levels are high, particularly ones responsible for this process, like carnitine and riboflavin.

Carnitine helps to move fatty acids into the mitochondria. If carnitine levels are low, fatty acids won’t be moved efficiently and your energy levels will drop. Genetic polymorphisms, a diet low in legumes or protein (source of lysine), or digestive impairment can all lead to a deficiency in carnitine.

Riboflavin is a main component of burning those fatty acids as fuel inside the mitochondria. Foods high in riboflavin are meat, green beans, asparagus, bananas, dairy products, fish, eggs, chard, okra, and persimmons. Things like dysbiosis or intestinal inflammation can affect your body’s ability to absorb riboflavin. Signs of a riboflavin deficiency include mouth ulcers, inflammation of the tongue and mouth, cracks at the corner of the mouth, and cracked and red lips.

Other nutrients that play a role in blood sugar regulation and energy production are chromium, biotin, magnesium, CoQ10, and choline.

Improve Your Body’s Fat-Burning Capacity

If you suspect your body is having a hard time metabolizing fat and you have issues with hypoglycemia, you might want to consider boosting your fat-burning nutrients as mentioned above, and improving your absorption of amino acids. Address any digestive issues you might have, and replace stomach enzymes and acids if they are low.

To regulate your blood sugar, experiment. Keep your carbs to fewer than 75 grams a day, eat more frequently (like every two to three hours), eat your breakfast with lots of protein within 30 minutes of waking up, eat a snack with fat and protein before you go to bed, and keep an eye on how you feel. If you need more carbs, then up your intake. Intermittent fasting may also be helpful.

Getting through that first adjustment period may be hard, but after that, you shouldn’t experience hypoglycemic reactions at all.

Water Hunger

Most people don’t realize it, but thirst often manifests as hunger. If you choose to eat when you feel this sensation but don’t drink, your body will continue to feel “hungry” even after you are past being satiated with food.

Practically every process in your body requires water, so ensure you are properly hydrated. Have some water every hour; different people have different water requirements, but generally, around one cup of water per hour should be sufficient. If it’s a very hot day, or you are hard at work doing something strenuous, are breastfeeding, or are on certain medications, you may need more. When you feel hungry next time, drink some water and see if that helps the sensation.

Head over to the PaleoHacks message boards to contribute to the topic of “Types of Hunger.”

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PaleoHacks is an online paleo diet community that promotes a healthy lifestyles through primal methods. PaleoHacks started as a way for people share recipes, ideas and general opinions about the Paleolithic lifestyle. Now, whether it be the paleo diet, physical fitness or overall wellness, PaleoHacks has evolved into an online resource for healthy living. check us out on

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ADHD drug could be the answer for binge eating disorder, study says

http://www.foxnews.com/health/2015/01/14/adhd-drug-could-be-answer-for-binge-eating-disorder-study-says/?intcmp=ob_homepage_health&intcmp=obnetwork

ADHD drug could be the answer for binge eating disorder, study says

By Colleen CapponPublished January 14, 2015FoxNews.com

An estimated 4 million Americans suffer from binge eating disorder (BED), or recurrent episodes of excessive food consumption that can lead to numerous health problems. A new clinical trial shows a popular drug used to treat attention-deficit/hyperactivity disorder (ADHD) is effective in combating BED.

Researchers at the Lindner Center of Hope Research Institute in Mason, Ohio, compared the ADHD drug lisdexamfetamine with a placebo in more than 500 adults with moderate to severe BED in a randomized clinical trial from May 2011 through January 2012. The medication was administered in dosages of 30, 50 or 70 mg/day or a placebo. The U.S. Food and Drug Administration (FDA) approved Lisdexamfetamine in 2007 to treat ADHD.

Lead researcher Dr. Susan McElroy told FoxNews.com the team decided on doing a trial with lisdexamfetamine specifically because both BED and ADHD can show signs of excessive impulsivity, obesity and dopamine dysfunction.

“In studies of ADHD, lisdexamfetamine improved impulsive symptoms and reduced hunger,” McElroy said. “BED is characterized by increased impulsivity and increased hunger, and animal studies suggested drugs like lisdexamfetamine reduced binge eating behavior.”

Trial results showed the number of binge-eating days per week decreased significantly in the groups taking 50 mg and 70 mg doses daily compared to the placebo group. Over a month period, 42.2 percent of participants taking 50 mg doses of lisdexamfetamine and 50 percent of those taking 70 mg were able to completely eliminate BED behavior.

According to previous research, cognitive behavioral therapy and psychotherapy can reduce BE behavior, but implementation of these treatments has not been widespread. Consequently, many patients with BED are undertreated. There are currently no FDA-approved pharmacologic treatments for BED.

McElroy said she hopes confirmation of the findings in ongoing clinical trials result in improved pharmacologic treatment for BED.

“The results of this study need to be replicated in studies of larger groups of people with BED. Pharmaceutical company Shire is having discussions with the FDA about getting approval of lisdexamfetamine for the treatment of BED,” she said.

Study results are published online in JAMA Psychiatry.


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Hormones could trick brain into telling body to lose weight, Melbourne researchers say

http://www.abc.net.au/news/2015-01-16/brain-function-discovery-could-hold-weight-loss-secret/6021994

Hormones could trick brain into telling body to lose weight, Melbourne researchers say

Posted about an hour agoThu 15 Jan 2015, 8:46pm

The secret to shedding stubborn weight may be all in the mind, according to researchers examining how brains can instruct our bodies to burn more fat.

The team from Melbourne’s Monash University uncovered how the combined action of two naturally-occurring hormones can trigger the conversion of what is known as white fat to brown fat, which is easier to burn off.

They unravelled a molecular mechanism that relies on the combined action of leptin, an appetite suppressant in fat cells, and insulin, produced in the pancreas when glucose levels rise.

Professor Tiganis said these hormones fired a group of neurons in the brain.

“The brain then in turn sends out signals via neurons to promote the conversion of white fat, fat that stores energy if you like, into brown fat,” he said.

“That burns off energy, and this way the body weight is regulated.”

One reason people might get fat is if this process is altered, and the brain no longer responds to insulin and leptin.

To test the theory, researchers reduced the levels of two insulin and leptin-inhibiting enzymes in laboratory mice.

Professor Tiganis said when those mice were placed on a high-fat diet they proved to be “remarkably resistant to diet-induced obesity and the development of type 2 diabetes”.

Weight-loss drug ‘still a long way off’

The key for researchers now will be turning this research into a drug that targets these two inhibitor enzymes, to trigger the conversion of white fat cells to brown fat cells.

Professor Tiganis admits any potential therapy is a long way off.

“Eventually we think we may be able to help people lose weight by targeting these two enzymes.”

Nonetheless, the research is being welcomed by Diabetes Australia chief executive Greg Johnson.

“We’ve probably oversimplified this epidemic for far too long, and thought that type 2 diabetes was just about one organ – the pancreas – and insulin,” he said.

“But what this research is highlighting is that the problem of type 2 diabetes is linked to really complex regulatory mechanisms, involving the brain, the gut, the pancreas, the liver and all the body.”

Obesity is a large contributor to type 2 diabetes, which costs the nation’s health system $14.6 billion annually.

Professor Johnson said in the past year alone another 100,000 Australians had developed diabetes, and said any new insight into the role and transformation of fat was valuable.

“People probably think fat is a benign substance that we just carry around with us, but in fact it’s very biologically active,” he said.

“These regulatory hormones like leptin are actually produced by fat cells, and we can have good fat cells and bad fat cells.”


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The Different Types of Hunger

http://blog.paleohacks.com/the-different-types-of-hunger/

The Different Types of Hunger

different types of hunger

One major topic on the PaleoHacks site is about hunger and identifying the different types of hunger: “mind hunger,” “gurgling sensations,” “hunger pains,” “body wants fuel,”  “starvation mode,” “and hypoglycaemic hunger.” Here are some of the most popular types of hunger listed: hypoglycemia, empty stomach, and compulsion to eat.

So what exactly is hunger, anyway, and why do we experience it? Are there more types than those listed here?

Hunger

Hunger is the feeling you get when your body requires food. Appetite (or mind hunger), on the other hand, is the feeling of wanting to eat even when you are not hungry.

The sensation of hunger generally makes itself felt within a few hours of eating and most people find it unpleasant. Different people can experience hunger at different times according to their eating habits.

Biological Mechanisms of Hunger

Hormones

The hormones ghrelin and leptin fluctuate within your body to convince you to eat. When you eat, leptin is released and signals to your brain that you are full, or at least reduces your motivation to continue eating. After a few hours without food, those leptin levels drop and ghrelin is released, which brings back those feelings of hunger.

Other hormones like cholecystokinin (CKK) and insulin are released when you eat. These work to reduce hunger signals. Epinephrin and glucagon rise when you don’t eat and work to stimulate hunger.

Just before a meal, your glucose levels drop and your insulin rises.

Neural Signals from the Gastrointestinal Tract

Vagal nerve fibers can transmit signals between the GI tract and your brain. When you eat and your stomach is stretched, those stretch receptors tell your brain you are full and your hunger is reduced.

Nutrient Signals

Several nutrients send signals to your brain to indicate you are not hungry. These may include elevated amino acids, rising glucose levels, and fatty acids in the bloodstream.

Physical Sensations of Hunger

The different types of hunger may cause different sensations. When your stomach is empty, you may experience “growling” sensations, or minor cramping. You may have increased salivation or even “tight throat” feeling. This sensation doesn’t usually last long, about an hour, and then it will go away.

Appetite, or the desire to eat even when you’re not necessarily hungry, is all in your mind. This pesky issue can cause some problems with some people who either can’t recognize true hunger sensations, or choose to ignore them for the sake of eating that one last donut or cookie.

Hypoglycemic Hunger

When your body’s main fuel source is glucose, and you don’t eat enough carbs to produce glucose, your body might experience hypogylycemia. This is the condition where you have abnormally low levels of blood sugar.

This type of hunger is rare in Paleo eaters. Sure, when you first switch to a Paleo lifestyle after eating a lifetime of the Standard American Diet high in processed junk and sugar, you will probably have a few days or even a couple weeks where you will experience uneven energy and intense sugar cravings. You might experience anxiety or lightheadedness, the jitters, the shakes, brain fog, difficulty concentrating, extreme hunger, and energy crashes after eating and in the late afternoon.

The good news is, our bodies can make energy from carbs and from fat. If you have moved from a high-carb, low-fat diet to a lower- to moderate-carb, high protein, high fat diet, you will probably experience hypoglycemia for the first few days or week as your body adjusts. After that, your body will become accustomed to using a combination of fat and carbs (or just fat, if you follow a keto diet) for energy.

To make sure your body can produce energy from fat in an optimal manner, Chris Kresser suggests you ensure your nutrient levels are high, particularly ones responsible for this process, like carnitine and riboflavin.

Carnitine helps to move fatty acids into the mitochondria. If carnitine levels are low, fatty acids won’t be moved efficiently and your energy levels will drop. Genetic polymorphisms, a diet low in legumes or protein (source of lysine), or digestive impairment can all lead to a deficiency in carnitine.

Riboflavin is a main component of burning those fatty acids as fuel inside the mitochondria. Foods high in riboflavin are meat, green beans, asparagus, bananas, dairy products, fish, eggs, chard, okra, and persimmons. Things like dysbiosis or intestinal inflammation can affect your body’s ability to absorb riboflavin. Signs of a riboflavin deficiency include mouth ulcers, inflammation of the tongue and mouth, cracks at the corner of the mouth, and cracked and red lips.

Other nutrients that play a role in blood sugar regulation and energy production are chromium, biotin, magnesium, CoQ10, and choline.

Improve Your Body’s Fat-Burning Capacity

If you suspect your body is having a hard time metabolizing fat and you have issues with hypoglycemia, you might want to consider boosting your fat-burning nutrients as mentioned above, and improving your absorption of amino acids. Address any digestive issues you might have, and replace stomach enzymes and acids if they are low.

To regulate your blood sugar, experiment. Keep your carbs to fewer than 75 grams a day, eat more frequently (like every two to three hours), eat your breakfast with lots of protein within 30 minutes of waking up, eat a snack with fat and protein before you go to bed, and keep an eye on how you feel. If you need more carbs, then up your intake. Intermittent fasting may also be helpful.

Getting through that first adjustment period may be hard, but after that, you shouldn’t experience hypoglycemic reactions at all.

Water Hunger

Most people don’t realize it, but thirst often manifests as hunger. If you choose to eat when you feel this sensation but don’t drink, your body will continue to feel “hungry” even after you are past being satiated with food.

Practically every process in your body requires water, so ensure you are properly hydrated. Have some water every hour; different people have different water requirements, but generally, around one cup of water per hour should be sufficient. If it’s a very hot day, or you are hard at work doing something strenuous, are breastfeeding, or are on certain medications, you may need more. When you feel hungry next time, drink some water and see if that helps the sensation.

Head over to the PaleoHacks message boards to contribute to the topic of “Types of Hunger.”

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PaleoHacks is an online paleo diet community that promotes a healthy lifestyles through primal methods. PaleoHacks started as a way for people share recipes, ideas and general opinions about the Paleolithic lifestyle. Now, whether it be the paleo diet, physical fitness or overall wellness, PaleoHacks has evolved into an online resource for healthy living. check us out on

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Achieve Independent Health With Your Optimized Nutrition Plan: Getting Started

http://www.mercola.com/nutritionplan/index.htm

Achieve Independent Health With Your Optimized Nutrition Plan: Getting Started

 Welcome to the condensed version of my nutrition plan that can have a powerful and dramatic influence on your ability to achieve optimal health.

My program comes from decades of experience in which I have researched extensively, conferred with my professional colleagues, and most importantly, successfully treated tens of thousands of patients.

Many are struggling with weight issues, facing some disease or condition, or fighting inexplicable fatigue or lethargy. If that applies to you, I am certain that if you adhere to the recommendations summarized below, and presented in full in my best-selling book, Take Control of Your Health, they will help you achieve the happy and healthy life you so richly deserve.

So what makes this nutrition program different from all the other diets you’ve tried?

It’s based on fact. There are no miracle cures here, just tools to help you understand your body and achieve optimum health.

It seems that many of the world’s leading dietary experts adopted one-size-fits-all dietary solutions that they believe can be universally applied. While there are indeed certain universal truths, such as the danger of sugar and toxins, my experience has taught me that a one-size-fits-all dietary approach simply doesn’t work very well.

Fact: One person’s food may be another person’s poison.

Just as it is obvious that we all differ tremendously with respect to our outward physical appearance, we also have a unique biochemistry and genetics. You and I process foods and utilize nutrients differently. Therefore, when you adopt a diet based on your specific “nutritional type,” you will resolve most health disorders and achieve optimum health.

When you apply a symptom-oriented approach to your health problems you will often experience temporary relief. Unfortunately, your problems never really go away. They simply shift to other parts of your body, or shortly return.

In contrast, when you address your nutritional type – your unique biochemical needs, which are based on your specific genetics – your health problems are addressed at the foundational level, and you are far more likely to achieve a permanent solution for regaining your health.

Fact: You won’t be hungry.

You need not worry about being hungry on this plan. One of the signs and benefits of addressing your specific nutritional needs is that your hunger pains will rapidly resolve. When you finally balance your nutritional needs, your food cravings will simply disappear, and you will wake up each day with more than enough energy. If this isn’t happening, then this is your giant clue that you are not giving your body something it needs, and you need to modify your program.

What to Do if You Need a Health Coach

I think there’s cause to believe physician burnout is part of the puzzle why US health care is so dangerous…

Eight years ago, I posted the comprehensive, footnoted research article, Death by Medicine , on this website, which described in excruciating detail how the modern American medical system had bumbled its way into becoming the leading cause of death and injury in the United States.

From medical errors to adverse drug reactions to unnecessary procedures, the authors took statistics straight from the most respected medical and scientific journals and investigative reports by the Institutes of Medicine (IOM), and showed that on the whole American medicine caused more harm than good.

So what is the solution?

Well, from my perspective there isn’t any easy one, other than to simply minimize your interactions with the conventional system, because even if they have successfully navigated all the land mines above, they will likely still be advising strategies that in no way shape or form address the underlying cause of your disease.

One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management is because it can help keep you OUT of the doctor’s office, or even worse, the hospital, by helping you Take Control of Your Health and one of the most powerful steps you can take is to carefully review the entire nutrition plan as it compiles the best of my over 30 years of clinical practice.

There is no charge for this life saving information. It is my gift to you and your family to help offset the massive confusion, misinformation, pain and suffering that the conventional medical system has likely given you.

Achieve Independent Health With Your Optimized Nutrition Plan: Getting Started

I have simplified my nutrition plan down into three phases: Beginner, Intermediate and Advanced. Success comes in steps, and this program is designed to allow you to make your journey to optimal health in a step-by-step manner.

Almost everyone should begin at the “Beginner” level. The exceptions are:

  • Those who are already implementing the advice found there.
  • Those with serious conditions who may want to take the more extensive measure of implementing the advice found in several, or all, of the stages to promote healing and health.

Ideally you will want to adopt all the recommendations within a phase. You can modify the program though, by placing your initial focus on the “Four Factors”:

  • Insulin
  • Weight
  • Blood pressure
  • Cholesterol

If some changes present more challenge than others, just keep working at them. Remember, health is the greatest commodity you can ever have, so every step you succeed at taking throughout these three phases, whether it feels large or small, is a great leap forward in this most important journey. If you get discouraged at any point, keep this in mind: This is your one and only body and mind, and, more than anything else, it is worth it.

Listen to Your Body!

Please remember that if I, or anyone else, recommend any food or supplement that makes you nauseous or sick in any way, please listen to your body and stop it immediately! You can trust your body to provide you with a better indication of what is good for you.

Most people notice a remarkable improvement in the way they feel in anywhere from a few days to a few weeks. If you are not doing better, this may be your body’s clue that you will need a knowledgeable health care professional that understands insulin and fat biochemistry to help fine-tune your individual program.

The First Step to Health: Assess Your “Four Factors”

There are four time-tested, clinically proven gauges of health that you can use to determine your own level of health. They are:

These four factors are your signs on the highway to optimal wellness. You can use these proven health indicators to monitor your success on the beginner’s nutrition plan.

Additionally, you can use these indicators as a guide to figure out when to move to the intermediate level of this nutritional plan. You’ll feel comfortable, confident and psychologically ready to move on to the next level, and your indicators of health will be in their optimal ranges.

Factor #1: Your Insulin Level

Insulin and leptin are absolutely essential to staying alive, but the sad fact is that most of you reading this have too much, and it is pushing you towards chronic degenerative illness and increasing the rate at which you age.

Most adults have about one gallon of blood in their bodies and are quite surprised to learn that in that gallon, there is only one teaspoon of sugar! You only need one teaspoon of sugar at all times – if that. If your blood sugar level were to rise to one tablespoon of sugar you would quickly go into a hyperglycemic coma and die.

Your body works very hard to prevent this by producing insulin to keep your blood sugar at the appropriate level. Any meal or snack high in grain and sugar carbohydrates typically generates a rapid rise in blood glucose. To compensate for this your pancreas secretes insulin into your bloodstream, which lowers your blood sugar to keep you from dying.

However, if you consume a diet consistently high in sugar and grains, over time your body becomes “sensitized” to insulin and requires more and more of it to get the job done. Eventually, you become insulin and leptin resistant, and then diabetic.

If you have high cholesterol, high blood pressure, type 2 diabetes, or are overweight, it is highly likely that you are eating too many grains – yes, even unrefined whole grains – as this is the most common culprit causing your insulin level to become abnormal.

Compounding the problem, when your insulin and leptin levels rise due to an excess of carbohydrates, they send your body a hormonal message telling it to store fat while holding on to the fat that is already there. So not only will excess carbohydrates make you overweight, they will effectively hamper your weight loss efforts too.

Your Fasting Blood Insulin Test

To find out your insulin and leptin levels, you need to get tested by your doctor. The test you need to ask for is a fasting blood insulin and leptin test, The tests are done by just about every commercial laboratory and the insulin test is relatively inexpensive.

Facts about Your Fasting Insulin Test:

  • This test is profoundly useful. It’s one of the least expensive tests in traditional medicine, yet it is one of the most powerful. A normal fasting blood insulin level is below 5, but ideally you’ll want to be below 3.
  • You can safely ignore the reference ranges from the lab as they are based on “normals” of a population that has highly-disturbed insulin levels.
  • This is a great test to do BEFORE you start your program as you can use it to assess how well you are progressing in the program.
  • If your level is above 5 you will want to consider significantly reducing most sugars and grains, even whole wheat grains, until you lower your level. Once you’ve normalized your insulin level you can reintroduce grains into your diet at a lower level to optimize your health.
  • Exercise is of enormous benefit in improving the sensitivity of your insulin and leptin receptors, and to help normalize your insulin level far more quickly.

Factor #2: Your Ideal Weight and Waist Size

Unfortunately, two out of three people in the U.S. are overweight and one out of three is obese, and the rest of the world is not far behind. It has been my experience that many people are in denial about being overweight.

One effective and simple method to figure out if you have a weight problem is as follows: With a tape measure, comfortably measure the distance around the smallest area below the rib cage and above the umbilicus (belly button). Waist circumference, perhaps surprisingly, is the best and simplest anthropometric measure of total body fat.

It is better than BMI (body mass index), which fails to factor in how muscular you are, and is also the best indicator of intra-abdominal fat mass (the dangerous type of fat around your internal organs strongly linked with type 2 diabetes, heart disease and nonalcoholic fatty liver disease).

Waist size gives a good indication of the amount of fat you’re carrying, particularly around the stomach area. Abdominal fat is considered an important risk factor for cardiovascular diseases such as coronary heart disease and stroke. Your waist size is also a powerful indicator of insulin sensitivity, as studies clearly show that measuring your waist size is one of the most powerful ways to predict your risk for diabetes.

If you’re not sure if you have a healthy waist circumference, a general guide is:

    • For men, between 37 (94 cm) and 40 inches is overweight and more than 40 inches is obese

Waist Measurement Chart Men

    • For women, 31.5 (80 cm) -34.6 inches is overweight and more than 34.6 inches is obese

Waist Measurement Chart Women

The other tool, which many experts are now leaning toward as the most accurate measure of obesity, is body fat percentage. As it sounds, this is simply the percentage of fat your body contains, and it can be a powerful indicator of your health. Too much body fat is linked to chronic health problems like high blood pressure, high cholesterol, heart disease, diabetes, and cancer. Too little body fat is also problematic and can cause your body to enter a catabolic state, where muscle protein is used as fuel. A general guideline from the American Council on Exercise is as follows:

Classification Women (% fat) Men (% fat)
Essential Fat 10-13% 2-5%
Athletes 14-20% 6-13%
Fitness 21-24% 14-17%
Acceptable 25-31% 18-24%
Obese 32% and higher 25% and higher

Body fat calipers are one of the most trusted and most accurate ways to measure body fat. A body fat- or skinfold caliper is a lightweight, hand-held device that quickly and easily measures the thickness of a fold of your skin with its underlying layer of fat. Taken at three very specific locations on your body, these readings can help you estimate the total percent of body fat within your entire body.

You can also use a digital scale that determines body fat, which is what I use personally. I use an Eat Smart Precision GetFit Body Fat Scale that I picked up from Amazon for around $50. Although many body fat measurements can be inaccurate, they are nearly all more accurate than BMI, and are particularly useful to determine whether you are gaining or losing fat. Although the absolute value may be off, the direction you are going (whether your body fat is going up or down) will be very accurate, and this is an incredibly useful measure of whether you’re nearing your health goals or not.

Remember that it is FAR better to monitor your body fat percentage than it is your total weight, as the body fat percentage is what dictates metabolic health or dysfunction – not your total weight.

Factor #3: Your Ideal Blood Pressure – 120/80

Ideally your blood pressure should be about 120/80 without medication. If you are on medication, you will be delighted to know that this nutrition plan tends to normalize elevated blood pressures in the vast majority of people.

Although elevated insulin levels are one of the most potent contributors to elevated blood pressure, it’s also common for stress, tension or anxiety to contribute to this problem. After you begin my nutrition plan and follow it for several months, if you don’t see an improvement in your blood pressure you need to seek out a health care professional who is well-versed in using stress-relief methods, such as my personal favorite: EFT.

In my clinical experience, over 95 percent of patients with elevated cholesterol or triglyceride levels respond to a reduced carbohydrate and insulin/leptin level correction approach. This is especially true for triglycerides. In over 25 years of practicing medicine, I have never seen an elevated triglyceride level fail to drop in response to a low carbohydrate program.

Factor #4: Your Ideal Cholesterol Ratio

Most people are seriously confused about their cholesterol levels. This is because too much emphasis is placed on the importance of the total cholesterol. A far more important predictor of cardiovascular risk is actually the ratio of good cholesterol (HDL) to total cholesterol, along with the ratio of triglycerides to HDL.

A major clue that something is very off with the notion that high cholesterol causes heart disease can be found in this: even as cholesterol levels have become lower, rates of heart disease deaths have not followed suit! The truth is, your body NEEDS cholesterol – it is important in the production of cell membranes, hormones, vitamin D and bile acids that help you to digest fat. Cholesterol also helps your brain form memories and is vital to your neurological function.

If your physician is urging you to check your total cholesterol, then you should know that this test will tell you virtually nothing about your risk of heart disease, unless it is 330 or higher. The following two percentages are far more potent indicators for heart disease risk:

  1. HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. Ideally, your level should be 30 or higher. It rarely gets above 50, but to the best of my knowledge, the higher the number the better. Levels below 10 percent are very dangerous and usually indicate an imminent cardiovascular problem.

    It is important to note that some clinicians actually obtain this ratio by dividing the total cholesterol by the HDL (Total Cholesterol/HDL). In this case, the numbers should be lower. The cut-off point for a poor ratio would be any number greater than 4, with greater than 10 having serious problems. This number rarely drops below 2.

  2. Triglyceride/HDL Ratio: Should be below 2. The higher this number is, the worse your insulin control may be.

There is a small subset of individuals born with a genetic condition called familial hypercholesterolemia (about one in 500 people), in which their cholesterols are typically around 350 or higher. While this program will help to moderate their cholesterol levels, they usually do not normalize with a low insulin program such as this.

If you’re using your HDL percentage to determine when to transition to the Intermediate nutrition plan, you must use caution and consult a trained natural health care clinician if your cholesterol is above 350.

There does not appear to be a similar genetic condition for triglycerides, so you could use the Triglyceride/HDL ratio below 2 as one indication that you are ready to move on to the adaptation phase.

To learn more about cholesterol and the ratios described above, download my free Special Report on Cholesterol.

Fact: You can do it! With my three-level approach, I’ve made this program manageable.

The main difference in these levels is a progressively more rigorous adoption of healthy eating principles. These are frequently counter-cultural recommendations, but they are designed to bring you to optimal levels of wellness and health.

All three levels of the program have the same requirements for carbohydrates, proteins, and high-quality fats. Additionally, normalizing your insulin level is a major key to improving your health, and is essential for success in all three levels.

One of the major differences will be the type of proteins that are allowed in each phase. Higher-quality proteins are gradually implemented as you choose progressively healthier levels.

Important: Please understand that when you advance to the next level, you still need to apply any restrictions from your previous level, as they are not repeated in the higher levels.

As you progress through the three levels, each one becomes more difficult, yet more freeing. Soon you will be enjoying a level of health you never dreamed possible!