My success story overcoming hypothyroidism. Weight gain, low body temperature, depression, feeling cold, brain fog, hair loss, dry skin and low energy. The New York Hypnosis Institute specializes in many hypnosis therapies by expert hypnotist Eli Bliliuos. Make an educated decision and learn more here! The New Science Of Weight Loss Hack your senses to eat less and finally ditch your belly By Sushma Subramanian March 13, 2017. Weight Loss Surgery using Lap Band Gastric Sleeve Rn. YBariatric Weight Loss Surgery in Thailand. A new study is bringing more evidence that weight- loss surgery in Thailand can erase significantly the risk for diseases such as heart disease hearts for young and middle- aged men and women around the world. The reluctance of most public health systems around the world and health insurance companies lack of funding weight loss surgeries means that more clients are looking for a solution to reduce the fat and high costs of obesity surgery by traveling to Bangkok or Phuket for a weight loss surgery vacation. There are many popular Weight loss surgeries on the market today such as the Lap Band surgery, Rn. Y Technique and Gastric Sleeve surgery. ![]() Thai Medical helps our clients from America,Australia and Europe find the best hospitals in Thailand that offer safe and affordable surgical and non- surgical weight loss solutions and treatments. The TMV approved treatments are designed for holistic recovery and easy rehabilitation in a minimally invasive manner of rapid weight loss that enables you to have a much faster recovery with significantly less postoperative discomfort. Updated September 1. Laparoscopic Bariatric Surgery. Thai Medical offers several options for losing weight but the two most popular weight loss surgeries in Thailand are known as malabsorptive restrictive and restrictive surgeries. ![]() Each type of bariatric surgery helps patients lose weight in a different way. The most popular or the two is called “Restrictive Surgery” Restrictive surgeries work by restricting the overall size of your stomach that results in slowing down of the digestion process thus shedding weight. ![]() Humidity affects the weight of your bridge. Keep your bridge in a closed container with a few grains of rice. Watch this video to see Cassey Ho demonstrate how to do bridge butterflies for leaner thighs and a tighter butt. ![]() ![]() A normal human stomach is said to hold 2- 4 pints of food. After restrictive surgery however the stomach may be limited to only an ounce. The theory behind the surgery is that the smaller your stomach, the less you will have to eat. The less a person eats the more weight they will lose. The other type of surgery is known as Malabsorptive Restrictive surgery. Malabsorptive surgeries is a slightly more- invasive surgery that works by restricting the overall size of the stomach and also surgically removing parts of your stomachs digestive tract. This type of surgery makes it much harder for you to digest and absorb additional calories thus reducing your weight. Lap band Surgery vs Gastric Sleeve vs Liposuction. According to the American Obesity Association, the most effective treatment for morbid obesity is bariatric surgery. Surgical options for obesity surgery include the gastric band, gastric bypass, Rn. Y Surgery,mini- gastric bypass and gastric sleeve surgery. The decision to have surgery should not be taken lightly, please take extra care to thoroughly understand the pros and cons of each surgical technique. We can also help you talk to a doctor in Thailand that specializes in surgical weight reduction to find the method that is suited for you. Most important is choosing a surgery that will help to keep the weight off, not just for a little while, but forever. Your fat can also be your friend. Fat lipotransfers can even be used in other cosmetic surgeries in Thailand to resurface you face with the non- surgical face lift or enlarge the breasts with the stem cell breast augmentation. BMI Calculator. Gastric Sleeve and Bypass Technique. Gastric bypass surgery makes up of nearly 7. Thailand and works by combining both malabsorptive restrictive approaches. Gastric bypass surgery in Thailand can be performed via minimally invasive surgery or as an open surgery. The gastric surgeon in Thailand technique works by dividing your stomach area into two separate areas, and then sealing the lower and upper sections from each other. The Thai surgeon will then connects your upper stomach area directly to your lower small intestine, Essentially creating a shortcut for your food to “bypass” a section of your stomach. The gastric sleeve surgery in Thailand uses a laparoscope to aid in the removal of about 6. The remaining area becomes a narrow tube like a “sleeve”. This sleeve connects directly to the lower intestines. A sleeve gastrectomy is usually the first in a sequence of weightloss surgeries and usually followed up by a biliopancreatic diversion surgery or gastric bypass that results in much greater weight loss. The gastric sleeve surgery is an temporary measure to help obese clients lose weight temporarily till the point in time when a more definitive surgery can be performed. Bariatric Surgeon Doctor Reviews in Thailand. Gastric band surgery in Thailand is considered the least invasive weight loss surgery. This bariatric surgery works by using an inflatable band to squeeze your stomach into two separate sections, a large lower section and a small upper pouch. These two sections will still remain connected, but the area between the two is very small. This small tube helps slow down the hungry feeling you get by emptying the upper pouch. Gastric band weight loss surgery can physically restrict the total amount of food you can consume in any meal. This often results in people only eating half to one third of food they normally eat before feeling full. Weightloss Surgery in Thailand Before & After Pictures. After Bariatric Surgery Care. Having any type of weight loss surgery requires commitment to change poor eating habits. Weightloss surgery and/or Modern Liposuction such as Bodytite or Vaser can give you a fantastic jump start but ultimately, you must embrace a new lifestyle that consists of low amounts sugars and carbs in your diet. In the case of gastric band surgery and gastric sleeve surgery, such a diet is critical because these types of high carb/sugar foods can pass easily through the digestive restrictions, thus delivering a very high calorie doses to your intestines. This even would essentially defeat the purpose of having weight loss surgery. If these mandatory guidelines are not followed by you after surgery,the lost weight may be easily regained. Weightloss Surgery Prices in Thailand. Consulting a bariatric surgeon in Bangkok or Phuket before you arrive can be very helpful when trying decide which weight loss surgery in Thailand is best for you. For someone struggling with weight loss, the question isn’t “should I have surgery?” but instead, “when should i take a weight loss surgery vacation to Thailand?” Actual Prices and seasonal promotions for having bariatric surgery in Thailand can vary drastically depending on what surgeon, hospital or technique is used. We can provide you with actual prices and package promotions once our bariatric surgeons can understand your current medical condition (medical history),along with your Body mass Index (BMI), and also some pictures so we can get proper recommendations for treatments and prices. Our weight loss solutions such as: Rn. Y surgery,Lapband or the gastric Sleeve surgery is available in Phuket or Bangkok Thailand so to get started please contact us today.“Shape your Dreams into Reality with Thai Medical”THE FIRST STEP: Check Availability. Read About Costs and Potential Problems. Dental Implants. What are the different types of dental implants? Historically, there have been two different types of dental implants: (1) endosteal and (2) subperiosteal. Endosteal refers to an implant that is . Subperiosteal implants are no longer in use today because of their poor long- term results in comparison to endosteal dental implants. Dental bridges literally bridge the gap created by one or more missing teeth. A bridge is made up of two crowns one on each tooth on either side of the gap - - these two anchoring teeth are called abutment teeth - - and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by. What Are the Benefits of Dental Bridges? Bridges: Restore your smile. Restore your ability to properly chew and speak. Maintain the shape of your face. Distribute the forces in your bite properly by replacing missing teeth. Prevent remaining teeth from drifting out of position. What Types of Dental Bridges Are Available? There are three main types of bridges: Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics. Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth. Metal wings on each side of the bridge are bonded to your existing teeth. What Is the Process for Obtaining a Dental Bridge? During the first visit, the abutment teeth are prepared for the crown. Preparation involves recontouring these teeth by removing a portion of enamel to allow room for a crown to be placed over them. Next, impressions of your teeth are made, which serve as a model from which the bridge, pontic, and crowns will be made by a dental laboratory. Your dentist will make a temporary bridge for you to wear to protect the exposed teeth and gums while your bridge is being made. During the second visit, your temporary bridge will be removed and the new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case. If the dental bridge is a fixed (permanent) bridge, your dentist may temporarily cement it in place for a couple of weeks to make sure it is fitting properly. After a couple weeks, the bridge is permanently cemented into place.
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Our 12 step program explains how you can lose weight and improve your chances getting pregnant. Know Your Goal Weight: The goal weight or the amount of weight you. ![]() Clinically Proven · Lose Weight Fast · Control Hunger Up To 4hrs · See Results In One Week Highlights: Lose Weight Fast And Keep It Off, Controls Hunger Up To Four. If you want your diet to succeed, dramatically reduce your sugar and alcohol consumption. These are the main culprits of weight gain. Also reduce carbs from pasta and. ![]() LIVESTRONG. COM - Lose Weight & Get Fit with Diet, Nutrition & Fitness Tools. Pregnant or Not? How To Know. To learn whether you are pregnant or not, a pregnancy test may provide you with the answer. This test can be done in the privacy of your. How do you know if you're pregnant? Well, since every woman is different, each mom-to-be will have a unique experience from the very beginning of her pregnancy. Could this be you? Besides weight gain or an inability to lose weight, you may notice fatigue, hair loss, dry skin, joint pain and muscle weakness, heavy periods. The Martha’s Vineyard Detox Diet promises rapid weight loss: 21 pounds in 21 days. Read WebMD's review here. The Meratrim group also. ![]() Bring Home the Root Beer. Diet A& W Cream Soda. Nutrition Facts - 2. ![]() Virgil's 10. Stewart's 7. Dad's Root Beer 5. Trader Joe's 3. And the Winner. Root beer is a sweet soda traditionally made using the sassafras tree Sassafras albidum (sassafras) or the vine Smilax ornata (sarsaparilla) as the primary flavor. ![]() Amount Per Serving% Daily Value. Calories. 5Total Fat. Sodium. 16. 0 mg. Total Carbohydrates. Protein. 0 g. Caffeine. ![]() Not a significant source of nutrients.*Percent Daily Values based on a 2,0. Ingredients. Carbonated water. A& W Cream Soda. A&W Root Beer Bring Home the Root Beer. Introduce your family to A&W Root Beer and make frosty mug memories.Nutrition Facts - 2. Amount Per Serving% Daily Value.
![]() ![]() ![]() Calories. 29. 0Total Fat. Sodium. 11. 5 mg. Total Carbohydrates. Sugar. 75 g. Protein. Caffeine. 48 mg. Not a significant source of nutrients.*Percent Daily Values based on a 2,0. Ingredients. Carbonated water. A& W Root Beer. Nutrition Facts - 2. ![]() Amount Per Serving% Daily Value. Calories. 29. 0Total Fat. Sodium. 13. 5 mg. Total Carbohydrates. Sugar. 75 g. Protein. Caffeine. Contains no caffeine. Not a significant source of nutrients.*Percent Daily Values based on a 2,0. Ingredients. Carbonated water. Diet A& W Root Beer. Nutrition Facts - 2. Amount Per Serving% Daily Value. Calories. 0Total Fat. Sodium. 18. 0 mg. Total Carbohydrates. Protein. 0 g. Caffeine. Contains no caffeine. Not a significant source of nutrients.*Percent Daily Values based on a 2,0. Ingredients. Carbonated water. A& W TENNutrition Facts - 2. Amount Per Serving% Daily Value. Calories. 20. Total Fat. Sodium. 13. 0 mg. Total Carbohydrates. Sugar. 4 g. Protein. Caffeine. Contains no caffeine. Not a significant source of nutrients.*Percent Daily Values based on a 2,0. Ingredients. Carbonated water. ![]() Daily Mail Australia . Luiz Carlos da Rocha, nicknamed White Head, was arrested in the western state of Mato Grosso in a city called Sorriso, which means 'smile'. Da Rocha, who is estimated to be worth . His alleged right- hand man was also captured in a separate location during the operation in which police said 1. ![]() ![]() ![]() The Oprah Winfrey Show was the number one talk show for 24 consecutive seasons, winning every sweep since its debut in 1986. It was produced in Chicago by Harpo. This issue of HI News is mainly about Hardware & Building Traders (HBT) and its 20th anniversary gathering, held recently in Sydney. It is indirectly dedicated to Tim. News archive. Home > 2017 > April Friday 28 April 2017 Bananarama are back! Eighties icons Siobhan Fahey, Keren Woodward and Sara Dallin appear on the One Show. ![]() ![]() Hot Tub Buyers Guide. Buying a hot tub is a nightmare. The truth is, there are so many side track issues, exaggerations and outright misinformation perpetuated by. Click to share on Google+ (Opens in new window) Click to share on LinkedIn (Opens in new window) Click to share on Reddit (Opens in new window) Click to share on. Latest breaking news, including politics, crime and celebrity. Find stories, updates and expert opinion. The latest headlines from Sydney, Melbourne, Perth and Queensland with breaking news, sports updates and more on popular TV series including The Bachelor. Calorie Meal Plan. Calorie Menu: Tuesday/Wednesday. Calorie Controlled Moderate Fat Eating Plan - 7- Day Sample Menu. Sunday / Monday . ![]() Find and save ideas about 1200 calorie plan on Pinterest. Pictures Sample Menu For 1200 Calorie Healthy Eating Plan Pdf Celebrity. 1200 Calorie Diet Menu. 1200 Uptown Foods Calorie Menus. 1200 Calorie Menus. Choose one of these menus for lunch: Food Calories Carbohydrate Fat Exchanges. 7 Day - 1200 Calorie Meal Plan Day 1: Breakfast - whole wheat English muffin - 1 tsp jelly - 1 med. Banana Morning Snack - 8 oz low-fat yogurt. 1200 Calorie Sample Menus For Diets > 1200 add calories in the form of PROTEIN to achieve adequate calorie intake. Meal Planning Guide 1200 Calorie. 1,200 Calorie Sample 5-Day Menus The menus in this handout provide about 1,200 calories per day. Each daily menu has. Meal Planning Guide 1500 Calorie This Meal Planning Guide is based on the Exchange System, which groups foods. Your 1200-calorie meal plan. Meal Exchanges Sample Breakfast 1 starch 1 fruit 1 fat 1 milk. The following sample menu for a 1200-calorie meal plan. 1200 Calorie - 10 Day Menu - Recipes NOTE: These recipes are not the entire day’s worth of calories for the diet. ![]() ![]() Astrazeneca 1200 Calorie Diabetic Diet![]() ![]() Easy Weight Loss Diet (With A Meal Plan)Do you ever get confused by all of those weight loss diets out there? Yeah me too. It’s all WAY too confusing for new dieters. Dieting should be simple to follow. This diet is made for people who want to. ![]() ![]() ![]() ![]() ![]() ![]() We’ve broken this weight loss diet down so that it’s easy for you to follow. This diet is made for people who want to lose body fat quickly (which equals.The best way to do this, is to diet and exercise. If you need to, you can add a third snack. These foods can be grilled, steamed, baked, or stir fried. No breaded or fried foods! Turkey breast. Chicken breast. Steak. Pork. Fish. ![]() Going from Obese to Bikini Body — Briana Case Study (Plus: New Tools, 4-Hour Body Group) 294 Comments. Weight Loss Surgery Essentials. Obesity is a medical condition that affects approximately one-third of the adult population of the United States. Why Try the iDiet? Ready to lose weight and get in the best shape of your life? Join the millions who have lost weight on the South Beach Diet plan! ![]() ![]() Eggs (2 or 3)Eat one serving of the following with each snack. Food And Drinks You MUST Stay Away From To Lose Weight. Soda (tons of sugar and lots of empty calories)Alcohol (empty calories and usually leads to bad food choices when drinking)Sugar. Fast Food. Creamy salad dressings (Ranch, 1. Island, etc.)Example Of Weight Loss Meals. Ok, so what does a day’s worth of meals and snacks look like? You should be losing about 2 pounds per week. Whether you need a beginners workout, or. If it comes in a wrapper or other packaging, don’t eat it- Terry Asher. If you have any comments or questions, feel free to post them below! I’m Terry and I’m here to help you achieve your fitness goals. I truly believe anyone can achieve the figure they want with the proper guidance. Through my extensive fitness blog, top fitness videos, leading workout supplements, and top selling e. Books, I have been able to help thousands of people online lose weight, tone up and get in shape. My passion is helping people all around the world change their lives for the better. Latest posts by Terry (see all). ![]() The Best Health Cleanses for Every Health Goal. Oz gives you his list and ranking of the best cleanses for every health goal. Plus, Real Housewives of Atlanta. On a recent episode of The Dr. Oz Show, Dr. Oz reveals his new rapid weight loss plan that when tested on a large group of Oz viewers resulted in an average weight. Dr Oz sued for weight loss supplement Garcinia Cambogia. Dr Mehmet Oz is under fire once again for promoting a weight loss supplement on his television show that 'all credible scientific evidence' proves doesn't work, a new class action lawsuit claims. The supplement in question contains Garcinia Cambogia, a tropical fruit that has been claimed to aid weight loss by burning fat quicker and curbing appetite. Dr Oz first promoted supplements containing Garcinia Cambogia in a 2. Scroll down for video Dr Mehmet Oz (pictured here during a 2. Garcinia Cambogia, which a new class action lawsuit claims 'all credible scientific evidence' proves doesn't work. Dr Oz first promoted supplements containing Garcinia Cambogia in a 2. Garcinia Cambogia was touted as a pill that could help you shed pounds with 'no exercise, no diet and no effort', and Oz brought on a woman who said it helped her lose 1. Oz did not advertise a specific supplement brand on the episode, but the suit claims that his promotion caused sales of Garcinia Cambogia to skyrocket, according to TMZ. The lawsuit has specifically singled out supplement seller Labrada, as well as Dr. Oz and Harpo Productions, and is seeking refunds for consumers as well as damages. Labrada advertises Garcinia Cambogia as a 'fat loss aid', explaining that the Hydroxycitric Acid isolated from the fruit helps control cravings and prevents body fat from being made. Although the site does not specifically advertise Dr Oz's endorsement, a number of the reviews mention that they decided to try the product after it was mentioned on his show. A representative for The Dr Oz Show has since said the lawsuit is an attack on free speech. This isn't the first time Garcinia Cambogia has landed Dr Oz in hot water. Garcinia Cambogia is a tropical fruit that has been claimed to aid weight loss by burning fat quicker and curbing appetite thanks to the Hydroxycitric Acid that is isolated from the fruit (pictured) Although Dr Oz has never specifically advertised a specific supplement brand, his image is often used to help sales and the lawsuit claims sales of supplements containing Garcinia Cambogia skyrocketed after his show In 2. Oz, a cardiothoracic surgeon whose television career first began on The Oprah Winfrey Show, appeared before a congressional hearing for praising Garcinia Cambogia, green coffee extract and raspberry ketone as weight- loss aids. Democratic Missouri Sen. Claire Mc. Caskill, the chairman of the Senate's consumer protection panel, scolded Oz for promoting magic pills.'I get that you do a lot of good on your show,' she said during the hearing. When you have this amazing megaphone, why would you cheapen your show?' 'The scientific community is almost monolithic against you in terms of the efficacy of the three products you called miracles,' she continued. Multiple studies have concluded that Garcinia Cambioga did not noticeably help people lose weight any more than a placebo pill. A 2. 01. 3 study found that although Garcinia extract was safe to use, its effectiveness against obesity remained unproven in 'larger- scale and longer- term clinical trials'. Last year a group of ten doctors sent a letter to Columbia University urging that Oz lose his faculty institution at the prestigious Ivy League university, citing his promotion of 'miracle' weight- loss aids on his show 'I recognize they don't have the scientific muster to present as fact but nevertheless I would give my audience the advice I give my family all the time,' he said. Oz reiterated that he never endorsed specific supplements and said he would publish a list of specific products he believed would help Americans lose weight. Last year a group of ten doctors sent a letter to Columbia University urging that Oz lose his faculty institution at the prestigious Ivy League university, citing his promotion of 'miracle' weight- loss aids.'Dr. Oz has repeatedly shown disdain for science and for evidence- based medicine,' the letter read. It added that Oz had 'misled and endangered' the public by 'promoting quack treatments and cures in the interest of personal financial gain'. The university responded that it upheld Oz's right to 'freedom of expression' and that he would not be removed from the faculty. Thanks to Jonathan Odom, a clever designer and builder who’s created everything from animatronics for films to museum exhibits, the fidget spinner has just taken a. Striped Muscle, Smooth Muscle, Cardiac Muscle, Antagonistic Muscles, Diagram of Biceps Contracting, Diagram of Triceps Contracting. Striped Muscle. ![]() The Sexless Rubbermen Are Back, and They're Hungry. After nearly four years, David Lewandowski has created a new entry in his highly successful rubbermen videos. ![]() Now they’re hungry. Back in 2. 01. 1, Lewandowski scored a hit with a short video titled “Going to the Store,” in which one impossibly flexible, sexless computerized humanoid traipsed through real world footage—like a Marty Cooper video, only 3. D. 2. 7 million views and two years later, he followed it up with “Late for Meeting,” which racked up even more hits and acclaim—and introduced us to the idea of a rubber man driving an upside down car with his ass. God, these are good. Today, out of the blue, the rubbermen videos become a trilogy with a clip called “Time for Sushi.” Welcome your new baby brother(s), because these Stretch Armstrong- style creatures born and raised deep in the uncanny valley have multiplied at an alarming rate. ![]() ![]() ![]() ![]() ![]() Home > Animations: Here are some flash animations produced for my own teaching and free for you to download and use as you wish. On this page: Eye twitching causes and treatments . See also: Eye twitching infographic. Eye twitching, eyelid tics and spasms are pretty common. ![]() Check out our best wedding food & drink ideas to get inspiration for appetizers, buffets, signature drink ideas, cocktail hour and more, all on Brides. Diet Tips from ! Hosted by “Insanity” creator Shaun T, ABC’s new reality series My Diet is Better Than Yours premiered in early January. In the show, celebrity weight loss experts—Carolyn Barnes, Jovanka Ciares, Jay Cardiello, Dawn Jackson Blatner, Abel James, Jennifer Cassetta, and Rob Sulaver—team up with a contestant who commits to losing weight with their coach’s unique diet and fitness plan. But there’s a twist: The competitors hold the power of elimination and the trainers can be sent packing if their teammates feel that they're not hitting their goals. Though it’s yet to be seen who will take home the crown, it’s safe to say that all of the coaches—and host Shaun T—have tons of useful weight loss trick up their sleeves. Read on to learn more about each expert’s weight loss method and pick and choose the tips that fit best with your lifestyle and goals. And after you see how simple it is to get on a path toward a trimmer, leaner body, check out these 5. The official Dr Karl Kruszelnicki Web Site. Science on Mornings, on triple j. Dr Karl's famous triplej mission is to bring science to the peeps! DROZ.com, DROZ LISTS. Droz Lists features a collection of recent trends, diets, Featuring Diet, Fitness, Health Lists. Entertainment Television, LLC. A Division of NBCUniversal with news, shows, photos, and videos. Reach your better body goals with the help of these expert tips from ABC’s newest hit weight loss show, My Diet is Better Than Yours! 2016 has brought us many. Best- Ever Ways to Boost Your Metabolism! Most people know Shaun T, as “the Insanity guy”—and the sobriquet is a perfect fit. Not only is his renowned workout, well, freakin’ insane, but so is his body. But his envy- worthy physique wasn’t built on exercise alone. He wouldn’t have the physique he has today—one that’s helped him sell more than 1. DVDs—without following a smart diet plan. ![]() ![]() Shaun T doesn't believe in quick fixes and stresses that weight loss is about making consistent lifestyle changes. However, with the help of his tips below, he tells us that you’ll start to look and feel better almost immediately. By simply substituting caloric drinks for water, you can see immediate changes and lose weight over time. If you find water boring, jazz it up with some sliced lemon, lime, oranges, mint or cucumber,” he suggests. The place for everything in Oprah's world. Get health, beauty, recipes, money, decorating and relationship advice to live your best life on Oprah.com. The Oprah Show.![]() ![]() Or better yet, check out these 5. Best Detox Waters for Fat Burning and Weight Loss. ![]() Thankfully, there are so many ways to move more throughout the day: Take the stairs, park your car farther away from your destination, get a standing desk or walk around while you talk on the phone. Get an activity tracker and aim for 1. In a 2. 01. 4 editorial in the journal JAMA Internal Medicine, the authors made a bold statement: “Too much sugar does not just make us fat; it can also make us sick”—and Shaun T agrees: “If you have a sweet tooth, try cutting back your sugar intake. Not only does this mean scaling back on things like cookies and ice cream, it also means scanning nutrition labels of foods that don’t even taste sweet. Sugar is hiding everywhere—even bacon has sugar in it!” To learn more about the dangers of sugar—and how to cut back—check out our exclusive report, This is What Happens to Your Body When You Eat Sugar.“Take a photo naked or in your swimsuit,” says Shaun T. Want to reach for a soda? ![]() Pull up that picture on your phone as a reminder of why you are stronger than your excuses.” “From time to time my friends and I start a message strand where we have to share our daily food intake and our workouts,” Shaun T tells us. If we eat it, we text it. You are far more likely to make smart food choices and get your workout in when you know that there is someone on the other side of that text message depending on you.” For more tips from Shaun T himself, check out these 2. Weight- Loss Secrets from Insanity Trainer Shaun T! Abel James is the creator of The Wild Diet, a primarily plant- based plan that allows for meats, cheeses, butter and even chocolate. The one thing that’s banned? James combines his diet approach with one specially designed 7- minute workout a day—a combination he says practically guarantees weight loss success! Watch breaking news videos, viral videos and original video clips on CNN.com. Psychopaths. We never expect them to enter our real life. But, the psychopath is closer than you think. The English version offers selected articles from. John Boghos Lost 100 Pounds: 'For the First Time in My Life, I Felt Empowered to Love Myself'. Here, specific, actionable ways to follow his lead and shrink your belly: Though eating out all the time isn’t ideal when you’re trying to lose weight, it important for your mental health and continued slim down success that you truly savor the experience when you decide to indulge. Skip the processed packaged foods and eat fresh foods that were recently alive and well,” suggests James. The diet guru is a big fan of colorful veggies, pasture- raised meats and eggs, and wild seafood and game. For even more slimming diet additions check out these 2. Best Foods for a Toned Body. For 1. 00+ creamy, delicious weight- loss recipes, click here for Zero Belly Smoothies!“Don’t count calories. Ignore the nutrition facts. Read the ingredients instead and make sure you’re eating real food. Don’t buy the marketing hype, buy the ingredients,” suggests James. Most food that comes in a box or package is just junk food in disguise, he adds—especially these 1. Worst Packaged Foods in America!“Don’t waste your time with bicep curls and ab workouts. Instead, burn more calories in less time with burst training,” suggests James. Not sure how to start? Try the Wild 7 Workout. Here’s how to do it: “After a 6. Repeat this pattern 1. Most importantly, break a sweat every day doing something you love!,” adds James. To ensure you’re always making healthy choices, carry yummy snacks (like any of these 5. Snacks With 5. 0 Calories or Less), meals and emergency dark chocolate everywhere you go, suggests James. This ensures you’ll be able to beat hunger and cravings on the go and prepares you for any chocolate emergency that may come your way. Jay Cardiello, the mastermind behind 5. Cent and J. Lo's killer bods and a regular contributor to Eat This, Not That!, helps his teammate banish belly fat with his “No Diet Plan.” The sustainable weight loss program focuses on making behavioral changes, improving nutritional awareness and finding the cause of each individual’s weight gain. Getting a proper night’s rest can accelerate your weight loss wins. This surge in appetite makes comfort food more appealing, which can derail weight loss efforts,” explains Cardiello. Check out these 3. Things to Do 3. 0 Minutes Before Bed to Get Lean! While it’s far from conventional, replacing your fork with chopsticks is a simple way to slow down the eating process, which will help you take in less food. It takes approximately 2. Using chopsticks will help you slow down. Did you know that the color of your dinner plates or kitchen may influence your eating behavior? It’s true! According to one study, participants who ate in a blue colored room consumed 3. Since you likely won’t repaint your kitchen in the name of weight loss Cardiello tells us that a blue plate is the next best thing. Make time for the things you enjoy doing and rid yourself of toxic relationships. You are too important to have anything or anyone hold you back from becoming the best version of yourself!”Lose weight in less than 3. Zero Belly Smoothies! Wellness expert Jovanka Ciares comes into the competition swinging with her “Wellness Smackdown Plan,” an anti- inflammatory vegan diet that has a strict 9- hour eating window and no- snacking policy. Dieters following her plan drink a gallon of water daily and fill their bellies with fruit smoothies, fresh vegetables and whole grains. Here are five of her must- try weight loss tips: Unlike many of the other experts on “My Diet Is Better Than Yours,” Ciares says snacking is a weight loss no- no: “Eat three meals per day with no snacking. Food is fast- burning fuel so having constant fuel available will mean that your body will burn the fuel from food instead of the stored fat.” Taking a 1. Ciares advises. Eating them daily, will help you consume fewer calories and subsequently lose weight, she adds. Sick of kale salads and smoothies? Then check out these 2. Fresh Tips for How to Cook Kale! Eat only between the hours of 9 am and 6: 3. Ciares. You'll not only cut out that fattening late- night snacking habit but also minimize the damage of some of the less- than- healthy meals you have during the day. This tactic also puts your body into fasted state, which Ciares says can make losing weight or keeping the weight off and easier, faster process. Carolyn Barnes, the mastermind behind The c. Lean Momma Plan, believes that her program has what it takes to help busy people lose weight—and keep it off for life. Carolyn’s program helps dieters turn their daily tasks and chores into opportunities to burn calories and requires that followers eat three healthy meals and “grab- me- snacks. Further, Carolyn believes that weight loss is a journey that begins in your brain. For this reason, she makes mental well being a major focus of her client’s journey. This way it’s always in the forefront of your mind,” suggests Barnes. Aim for two pounds every other week. Once you see that you can accomplish a . If you are doing dishes, Barnes suggests fitting some squats in between plates and cups. This allows you to maximize your time and burn extra calories throughout the day. For more creative weight loss tips, check out these 2. Weight Loss Tricks You Haven't Tried.“Log what you eat—and keep it simple. A pad of paper and a pen next to your coffee maker will do the trick, plus you'll always see it. When we keep a diet log, we hold ourselves accountable,” explains Barnes. Creamy. Chocolately. Weight- loss has never been more delicious than with Zero Belly Smoothies! Nix processed fare like chips, cookies and nuggets and eat real foods. And speaking of chips, see where your favorites fall regarding nutrition in our exclusive report, The 3. Best- Selling Chips—Ranked. Before you eat, identify the reason you’re choosing to eat, suggests Barnes. Is your stomach actually grumbling or are you eating because you’re bored, tired, sad, or angry? If you're not reaching for food because you’re physically hungry, don’t eat. You don’t need the calories. Dawn Jackson Blatner RDN is the creator of the “The Superfood Swap Diet” a program that promotes the practice of swapping out your favorite foods for healthier versions. Refined sugar and snacking are a no go on a daily basis, but you’re allowed sweets and alcohol when with a group. Oh and those following Blatner’s regimen only exercise for fun! The Martha's Vineyard Diet Detox. The Promise. The Martha's Vineyard Diet Detox promises to peel off a pound a day and rid your body of toxins. But is it a good idea, given that your body detoxes itself, regardless of what you eat? On the plan, you drink liquid every 2 hours, take supplements that have a laxative effect, and do enemas. The plan boils down to three principles: rest, reduce, and rebuild. Dieting Extremes, Pt 1. Would you follow a guideline that restricted you to just a few bites of food per day? Oz and Alwin Lewis, creator of The 5-Biet Diet. The rest comes from not chewing food and not working out. The reducing is the weight loss from being on a liquid diet. Rebuilding is what author Roni De. Luz says will happen to your cells after 2. De. Luz, who is a registered nurse and naturopathic doctor (not an MD), recommends a 2. She says it's great for metabolism and energy levels. The plan also calls for an organic coffee enema once a week, supplemented by more traditional water enemas on other days. What You Can Eat and What You Can't. De. Luz has detoxers stick to water, herbal tea, juices you make from organic vegetables and fruits, homemade soups, and powdered antioxidant berry and green drinks she sells on her web site. In a typical day, you will drink 4. Not allowed: Anything that has to be chewed, processed food, meat, cow’s milk, alcohol, salt, or coffee (except in that weekly enema). Level of Effort: High. Besides limiting what you can eat, the plan also calls for getting a . Again, there's no proof that any of this helps your body. Limitations: You're probably going to eat very differently than you did before this diet or after it ends. Cooking and shopping: You need to keep organic fruits and vegetables on hand, juicing and blending them into drinks and soups. If you don’t have the time to do all that juicing and soup making, De. ![]() ![]() ![]() Luz sells supplement powder that you mix with distilled water to create a shake. Packaged foods or meals? Not required. In- person meetings? No. Exercise: De. Luz recommends doing very specific forms of movement, including using a Chi Machine and bouncing on a small trampoline called a rebounder to drain lymphatic fluids. ![]() Yoga, stretching, and 1- mile leisure walks are also part of the plan. Does It Allow for Dietary Restrictions or Preferences? Vegetarians and vegans: These allowed foods would work for you: Juiced, pureed, or powdered garlic. Carrots. Cucumbers. Follow the tips in this article show you how to lose 10 pounds in 21 days without eating bad food, taking lot of pills, or boring workouts.Detox Products. Begin your Martha’s Vineyard Diet Detox by purchasing the kit from our website! 21 Day Detox kit and 9 day Maintenance Package Includes. My 4 day Weight Loss Program will show you how to Lose Weight Fast in 4 Days! The best weight loss plan for Fast Weight Loss. The Bizzy Diet Fitness Plan is simple, but it sure ain't easy. The training load forces your body to change and adapt. These workouts are backed by lean nutrition. ![]() Celery. Collard greens. Eggplant. Kale. Beets. Onions. Radishes. Sweet potatoes. Summer squashes. Most green vegetables. Tomatoes. Purple cabbage. Gluten- free: You'd need to check the diet's web site to see if the kit of products is gluten- free. What Else You Should Know. Costs: If following the plan to the letter, you would also take enzyme capsules, an herbal cleansing formula, and aloe vera. De. Luz sells all of this on her web site in a kit for $1. A better, cheaper, and less punishing path to weight loss and good health, say nutritionists, is to eat a variety of fresh produce, lean meats, low- fat dairy, and whole grains while avoiding processed foods, salt, and too much alcohol. ![]() What Dr. Michael Smith Says: Does It Work? There are no known health benefits to the diet, supplements, products, and techniques that De. Luz recommends in her book, such as not chewing, coffee enemas, and laxatives. Despite the popularity of “colonics” in recent years, they don’t make you healthier. There’s no reason to detoxify your body as it takes care of that on its own. It may even be harmful for some people. You won’t have the energy to do much on this program, but the recommendation to avoid exercise is counter to everything experts know about exercise and health. You'll likely lose weight on such a strict plan. But much of that will be water and muscle, since the plan offers very little protein. Your metabolism will also likely plummet, making it even harder for you to burn calories throughout the day. Any diet that promises you’ll lose a pound a day is not a healthy approach and not one you’re likely to stick with. You'll likely regain the weight after you go back to eating normally. You also may have headaches and feel fatigued during this detox plan. Overall, you probably won’t feel very good. Is It Good for Certain Conditions? If you have a medical condition, such as high blood pressure or cholesterol, diabetes, or heart disease, this is not the program for you. You need to find a program that you can stick with and that will help you manage your health. If you have diabetes, this diet could be harmful. If you take diabetes medicine, your blood sugar could fall to dangerously low levels. Before starting any strict diet program such as this, it’s important to talk to your doctor to make sure it’s right for you. The Final Word. The Martha’s Vineyard Diet is not a healthy approach and may leave you worse off than before. Such a strict program will leave you frustrated. It will not deliver the long- term effects you’re looking for. The only positive thing that the diet has going for it is the focus on vegetables. That’s an excellent strategy for getting your health in order. But skip this plan and find another that focuses on lowering calories through a well- rounded diet and exercise program that works for you. Day Fix Extreme Meal Plan & Prep. It’s here: the 2. Day Day Fix Extreme! Here is how I prep and plan my meals for the week. It’s time!! My 2. Day Fix Extreme arrived early this week, and I’ve been planning and prepping my meals for the week! I am going to be 1. I know it’s going to bring me some results! There’s just one little thing. Click HERE to join my next Drop a Dress Size Group with the 2. Day Fix Extreme!! I got my program delivered on Tuesday, and since then, I’ve just jumped right in and started! Because I’ve been following the 2. Day Fix meal plan for the past year, I had a good idea of how to prepare what I was going to eat. That being said, the 2. Day Fix Extreme meal plan is a bit different because it includes a “Countdown to Competition” plan along with it, which is very different eating than I’m used to. I started by reviewing the nutrition guide, calculating my calories, determining the number of containers I can have each day, and then printing off the tracking sheets. You can print off your own tracking sheets at www. GET FIT tab and Workout Sheets. They are seriously the best way to keep track of what you’re eating each day. There are also some great apps in the app store to help you with this if you prefer to keep track on your phone. I created my own Excel spreadsheet for my personal meal plan which I have printed off and keep in the kitchen so I know exactly what I’m going to eat for each meal. On Sunday, I plan for the next week and prep anything I’ll need, like cooked chicken breast or veggies so that I’m not scrambling during the week. My game plan for this week is to do the “reverse” Countdown to Competition eating plan, meaning I eat 2 days from the regular Extreme meal plan, and 1 day from the Countdown to Competition meal plan. With the 2. 1 Day Fix Extreme, you can choose which plan you want to follow. But I want to test out the Countdown to Competition eating days first before deciding whether or not I should do it for 2 days in a row or just 1. I encourage you to make a meal plan and write it down like I did. It just makes it so much easier to know what you’re eating. You will be prepared with healthy foods in the house and won’t be guessing what you’re eating next, which can lead to poor choices. What I love about this program is you can choose which meal plan you want to follow. You can go really extreme and follow the Countdown to Competition plan to a T, or you can mix the regular Extreme plan with the Countdown to Competition, OR you can just do the regular Extreme meal plan. If you feel you aren’t getting results or you’ve reached a plateau, I would recommend following the Countdown to Competition plan. While it is restrictive and you may find it tough, it is doable! And hey – you can do it for 2. Click HERE to get extra support and motivation to complete this program!! For the workouts: you will need a set of light and heavy weights and a resistance band. There are suggestions in the guide book about the weights you might want to use, but I was going a bit heavier than the suggestions, I was using 8 lbs for my light weights, and 1. But again, it’s totally up to you. You can even use NO weights!! The resistance band is used quite frequently, so please make sure you have one of those. I’m using the pink one that came with my Turbo. Fire and T2. 5, but if you don’t have one, you can find them at any sporting goods store, or even Walmart. The bottom line when it comes to the 2. Day Fix Extreme is there are no cheats when it comes to your eating and you’re doing workouts that push you to your max! I personally know that when it comes to losing the last 1. Of course, this isn’t something you have to maintain forever, once you get the results, you can go into maintenance mode. I know it can be done! That’s why Beachbody has coaches like myself who are here to help. My job is to provide you support, guidance, tips, and accountability to start and finish the program!! If you would like to join me in completing this program,please fill out this application!(**only open to those who aren’t working with a coach, or to those who are already working with me**)Tagged as. Menopause Management. Many women pay close attention to their gynecological health during their younger years and start to ignore it after menopause. Bowel cancer can affect your daily life in different ways, depending on what stage it's at and the treatment you're having. How people cope with their diagnosis and. TopConsumerReviews.com reviews and ranks the best Menopause products available today. The Dublin doctor who is not beating cancer – Respectful Insolence. As I’ve said so many times before, this blog is my hobby. I write about what interests me for my own amusement. If it also interests you, that’s awesome. Fortunately, I’ve found that several thousand people a day do like what I lay down on a daily basis, sometimes with occasional spikes to ridiculous levels of traffic (such as this Dr. Oz post, which for some reason broke all traffic records for this blog since the very beginning, and not by a little bit) and, more recently, this post about how the CDC did not apologize and “admit” that the flu vaccine this year doesn’t work, which got quite a respectable spike, about 4- 5 times normal daily traffic that took until today to drift back down to normal) but that’s not the primary reason I write. I did this blog back when its readership was minuscule in the months after its beginning, and I continue to do it now that it gets quite respectable traffic for a medical/science blog with a single blogger. ![]() ![]() ![]() The facts and figures on bowel cancer including the symptoms, what is known to cause bowel cancer and information on reducing your risk of developing it. Symptoms of bowel cancer: FIVE signs YOU could have the disease BOWEL cancer is one of the most common forms of cancer - mostly affecting people over the age of 60. ![]() Bowel cancer: The 5 warning signs you shouldn't ignore Here's some signs you should never ignore. We save lives by preventing, controlling and curing cancer. We're working to beat all 200 cancers and rely completely on donations from people like you. Chronic gastritis occurs when your stomach lining becomes swollen or inflamed. Learn more about its causes and symptoms. Pancreatitis Diet: What's a Pancreatitis Diet? What foods can you eat when on a pancreatitis diet and what should you avoid? Bowel cancer, also called colorectal cancer or colon cancer, includes cancer of your large bowel and cancer of your back passage (rectal cancer). It’s the fourth. ![]() That being said, none of this means that I won’t on occasion take requests, particularly when more than one reader emails me about a topic. So it was that, over the last few days, I’ve had several of you send me a link to this book review, which appeared in the Irish press on Sunday, specifically Independent. It’s by the book editor (John Spain) and entitled The Dublin doctor who is beating cancer. It’s subtitled John Spain on what is probably the most important book to be published here this year. The book is entitled Stop Feeding your Cancer, and it’s by a Dublin GP named John Kelly. Spain characterizes it thusly. It may seem an extraordinary statement to make, given the billions poured into cancer research by multinational pharma companies and medical research facilities. But a new book by a veteran GP on the northside of Dublin may well offer the first real proof that a way has been found to beat cancer. Depending on the cancer, there are already several ways to “beat cancer.” If you have early stage breast cancer, for instance, surgery combined with radiation . Heck, even if it’s stage III cancer, patients have a reasonable chance of living 1. As long as the cancer hasn’t spread beyond the lymph nodes under the arm, breast cancer is potentially “beatable.” The same is true for other cancers. Lymphomas and leukemias can be cured with a combination of chemotherapy . Other solid tumors can be cured with a combination of surgery . This book review has thus started out with a breathtakingly ignorant statement. That does not bode well for the quality of the rest of the review or how well Spain understands cancer. Such is life. Spain continues. In Stop Feeding your Cancer, Dr John Kelly does not produce a “cure” for cancer. Instead he presents convincing evidence, based on the experience of his own patients, which shows that cancer can be stopped in its tracks and even reversed into a dormant state, allowing sufferers to regain good health and lead normal lives. The core of this approach is the discovery a decade ago of a direct link between the consumption of animal protein and the development of cancer. Cancer cells need protein to divide and flourish. Cut off the supply of animal protein and you can stop the growth and spread of cancer cells. You can starve the cancer into submission. As so many promoters of medical pseudoscience have done, he’s collected anecdotes from his practice. As they say, when it comes to medicine, the plural of “anecdote” is usually not “data,” and this sounds like an excellent example of this phenomenon. But first, why does Kelly think that cutting out animal protein will treat cancer? According to Spain, Kelly based this idea on the China Study. I don’t believe I’ve ever written about the China Study before, but Harriet Hall has, not just once but twice. It’s an epidemiological study of diet and health conducted in villages throughout China by Colin Campbell of Cornell University. It was first published in the US in 2. It’s also a favorite of advocates of “raw food” and vegan diets as a panacea because the major claim made in the book is that we can prevent or cure nearly all diseases (heart disease, cancer, diabetes, autoimmune diseases, bone, kidney, eye and other diseases) if only we would give up meat and dairy products entirely, drastically decrease our protein intake, and eat a strictly plant- based diet. You can see why such a view would be attractive. Unfortunately, Campbell’s book, aside from being a book rather than a study subjected to the peer- reviewed scientific literature, has a lot of problems, as related by Harriet Hall: References whose conclusions are not as represented in the book and do not support Campbell’s thesis, including a citation that touts the quackery that is the Gerson protocol; downplaying and even failing to mention research whose results do not agree with the China study; and finally shoddy research. Indeed, a reanalysis of the raw data of the China study by Denise Minger found many weaknesses and errors, including finding no direct correlation between animal protein intake and cancer and many others. Meanwhile, a lot of follow up research failed to validate the findings reported in the China study. Seriously, Spain (and Kelly) really need to read this roundup of science- based analyses and criticisms of the China study. Spain, for instance, is completely unskeptical of the claims made in the China study and swallows what Kelly says about it, who in turn swallowed what Campbell claimed. So, basically, right off the bat, Kelly is proceeding from a flawed premise. It’s just not as simple as Campbell or Kelly makes it out to be and there exists, either in the China study or elsewhere, strong evidence that a vegan diet can cure cancer. Unfortunately, Kelly’s survey of his patients doesn’t provide such evidence either, although you wouldn’t know that from Spain’s description of the book. And the results, which he details in his book Stop Feeding your Cancer, are jaw dropping. As in any large GP practise in Ireland, a number of Kelly’s patients develop cancer every year. He began to tell them about the link, gave them a copy of The China Study, and suggested they go on an animal protein free diet (no meat, no dairy produce). At the same time he continued to refer them on to cancer specialists in the normal way and did not try to dissuade them from having whatever surgery, radiotherapy or chemotherapy might be recommended. What emerged is truly extraordinary. All of the patients who adopted the animal protein- free diet and stuck to it strictly found that their cancer stopped growing and spreading. The tumours became dormant, sometimes even reducing in size. Since all of these patients were also having conventional cancer treatment, it was not possible to categorically say they had been saved by the diet alone. But conventional cancer treatment alone does not have this success rate and in many cases the specialists involved were amazed at the recovery of the patient. Invariably, the specialists put the recovery down to surgery or chemotherapy.)Kelly gives the full details of over half a dozen cases in the book, including profiles of the patients and their lifestyles. The cases cover prostate, lung, colon, bowel, brain and other cancers. In some cases the patients stuck rigidly to the diet; in others they became complacent as they got better and could not resist going back to having steaks and fry- ups when their specialists gave them the all clear – whereupon their cancers came back. We have no inclusion criteria other than cancer and apparently no exclusion criteria. The patients were treated normally. Are there any statistics on these patients? What stages? What cancers? What treatments? Are these all detailed systematically? Was there approval from an ethics board, the Irish equivalent of institutional review boards (IRBs) in the US? After all, this “field trial run,” as Kelly describes it, is basically a clinical trial. How do we know that this isn’t simply a massive case of confirmation bias, very much like when the Home. First Clinic in Chicago, a practice that does not vaccinate, famously claimed that it had no autistic children in its practice. Mighty convenient—isn’t it?—that the only patients who seemingly suffered progression of their cancer were ones who had “fallen off the wagon” as far as their vegan diet goes. Particularly telling is this passage. The personal stories he gives are very human as patients try to stick with the diet, the disease comes and goes and the patients swing between despair and elation. Invasive treatments run alongside attempts to keep to the diet. I don’t think it’s being done intentionally, but rather as a means of rationalizing why not every patient on the vegan diet did as well as Kelly apparently expected. All of this makes Spain’s description of him as “scrupulously scientific” as doubtful at best, although the description of Kelly as “open- minded” brings to mind the crack about being so open- minded that your brains fall out. Patients who didn’t stick to the diet weren’t the only patients who didn’t do well. Not surprisingly, given its deadliness, patients with pancreatic cancer weren’t miraculously cured by switching to a vegan diet. Unfortunately, it is an explanation that is neither convincing nor rooted in reality. When I read this review, I had a hard time believing that Kelly doesn’t realize how physiologically nonsensical his explanation for why vegan diets won’t cure pancreatic cancer is. There is one exception to this, pancreatic cancer, the virulent form that killed Brian Lenihan and is usually fatal. But far from undermining the diet theory, Kelly, who has lost several patients to pancreatic cancer including his own brother, says this is actually an exception that proves the rule. The reason the animal protein free diet does not work against pancreatic cancer and some gastric cancers, he explains, is that the pancreas itself produces animal protein. Home Remedies for Gallbladder: Cures & Herbs for Gallbladder Problems. The gallbladder is tucked up underneath the liver on the right side of the body. Its main function is to store bile – historically called “gall” – which is produced by the liver and carried to the common hepatic duct and the gallbladder through a series of tubules or ducts (bile ducts) embedded in the liver tissue. Normally 3- 5 inches long, an inch wide and shaped like a tiny eggplant, the gallbladder can store about 1/4 cup of bile. A tube called the cystic duct connects the gallbladder to the larger common hepatic duct to form the common bile duct. Not all bile goes to the gallbladder; some of it flows directly from the liver to the common hepatic duct to the common bile duct. The bile that goes to the gallbladder becomes concentrated by removal of fluids. When a meal is eaten, hormonal signals cause the gallbladder to contract and eject its bile. Just before it connects with the duodenum or the first section of the small intestine, the pancreatic duct joins with common bile duct. A ring of muscle called the Sphincter of Oddi regulates passage of both bile and pancreatic juices into the small intestine. There the bile mixes with food that has come from the stomach and helps to emulsify and digest fats. Gallbladder Disorders. Gallstones. Conditions that interfere with the flow of bile are the common sources of gallbladder disorders. Chief among these are the occurrence of gallstones (choleliths). Gallstones can be like sand grains or as large as a walnut. There are two main types of gallstones, pigment gallstones, made mostly of bilirubin, which is the breakdown product of red blood cells, and calcium salts and cholesterol gallstones. Cholesterol gallstones are commonest and are yellowish or greenish in color. Pigment gallstones are dark- colored, either brown ones found in the bile duct or black ones found in the gallbladder. The liver synthesizes about one- quarter of the body’s daily cholesterol requirement, and it is fed into the bile along with other liver products. The liver oxidizes some cholesterol into bile salts, also called bile acids. Gallstones cause problems when they become large or numerous enough to block bile flow within the liver, the gallbladder or the ducts between the gallbladder and small intestine. People often have gallstones but do not have symptoms (silent gallstones), in which case they are not of medical concern. The presence of gallstones in the gallbladder is called cholelithiasis; if they occur in bile ducts the condition is called choledocholithiasis. Gallstones can also block the pancreatic duct, leading to pancreatitis. Symptoms. The symptoms of gallstone blockage, usually referred to as a gallstone attack or biliary colic, are pain in the upper right, sometimes central, abdominal region, nausea, vomiting, referred pain between the shoulder blades or below the right shoulder blade. Abdominal pain can be severe and is due to the swelling of the gallbladder and/or ducts as bile builds up due to the blockage or the passage of stones through a duct. Presence of gas and burping can also occur. Consuming a lot of food at one sitting can trigger an attack. Often attacks occur during the night. Gallstones can move about, and symptoms often abate as they reposition themselves or are excreted and allow a renewed flow of bile. Symptoms of more advanced gallstones, where the blockage remains in place for longer periods of time or if infection sets in, are chills and fever, jaundice or a yellow tinge to skin and eyes, pain that doesn’t go away, and light- colored stools. It is the presence of bile that gives stools the characteristic brown color. When such symptoms occur, medical help should be sought immediately. Causes. Gallstone formation is thought to be influenced by inherited factors, by conditions that affect how often and how well the gallbladder empties, and bile imbalances such as excess cholesterol or bilirubin or lower levels of bile salts. For instance, elevated levels of estrogens encourage the liver to increase the amount of cholesterol in bile. This higher amount of cholesterol in bile, plus possible imbalance in bile salts, which are necessary to keep the cholesterol in a liquid state, makes gallstone formation more likely. Progesterones reduce the movement of the gallbladder so that it doesn’t empty as often or as completely, allowing bile to concentrate further and crystals of cholesterol or precipitates of bilirubin and bile salts to form. These clump together and harden to form gallstones. If there are narrow places or constrictions along any of the ducts between the gallbladder and the duodenum, blockages can more readily lodge in those areas. People who have decreased gut motility and hence decreased gallbladder activity due to such causes as being bedridden, limited food intake, or nutrition by IV are also susceptible to gallbladder disorders. These people are likely to produce not gallstones but “sludge” or pseudoliths – small particles of cholesterol, calcium and bile salts which can also produce blockages. Risk Factors. Risk is elevated in the following categories: womenoverweight people. Caucasian, Hispanic, Native American. Prevention Tips. Estrogen and progestin. Since being female is a risk factor, female hormones estrogen and progestin are implicated in the eventual expression of symptomatic gallbladder disease. The increase of estrogen after pregnancy can be lessened when a woman breast- feeds her child, since milk production keeps her estrogen level low. Considerations should also be given to the amounts of estrogen in birth control formulations and in hormone replacement therapy given around the onset of menopause. The length of use is also important. Hormone replacement therapy has been shown to signficantly increase the number of gallbladder surgeries done. Maintaining a healthy body weight. Being overweight increases the risk of getting gallbladder disease. In addition, fat tissue produces estrogen, which is a risk factor for developing gallbladder disorders. Dietary considerations. Eating regular meals of moderate size and foods high in fiber content helps intestinal tract and gallbladder motility, reducing the likelihood of infrequent or partial gallbladder emptying. Reduced intake of foods high in trans- fatty acids and saturated fats is recommended. Conversely, not having enough fat in the diet can also predispose toward gallbladder disease. Fat in food is the stimulus to produce the hormone cholecystokinin (CCK), which triggers the contraction of the gallbladder to expel its contents. In the absence of fat in foods, gallbladder activity is lessened and gallstones have more of an opportunity to form. Testing and Diagnosing. When symptoms suggest gallstone disease, detecting their presence or absence is necessary. There are other serious conditions such as appendicitis, ulcers, hiatal hernia, pancreatitis, heart attack, hepatitis which give mid- or right- abdomen pain, and these need to be considered and ruled out since the presence of gallstones alone doesn’t necessarily cause symptoms. Laboratory studies. These are usually most helpful in diagnosing other conditions that may give abdominal pain. They are not as useful in diagnosis of gallbladder disease except if an infection (cholecystitis) is present. Even then, elevated white blood cell counts are not present in one- third of patients. Some blood tests may indicate the possible location of the problem – if transaminase is high, the liver; if bilirubin and alkalkine phosphatase are high, the common bile duct could be obstructed. Imaging Techniques. Ultrasound. Gallstones larger than 2 mm can be imaged by ultrasound (sonogram). Noninvasive, with no radiation risk or exposure to contrast dyes, and less expensive than most other options, ultrasound is the diagnostic tool of choice. Images can also reveal if the gallbladder wall has thickened or if the gallbladder is enlarged, both further signs of gallbladder disease. Classic x- rays. X- rays are used in conjunction with dye tablets swallowed by the patient in doing an oral cholecystogram or OCG. The dye improves the visibility of stones when the gallbladder is x- rayed. Another test, the percutaneous transhepatic colangiogram, uses x- rays in conjunction with an injected contrast dye to image the progress of dye through the biliary system on a fluoroscope. CT scans (Computerized tomography)This serves as a secondary tool following sonograms to further image areas of interest. CT scans are used to find stones within the liver’s system of ducts and to delineate the possibility of persistent infections. Scintigraphy is helpful in imaging blockage of bile ducts within the liver or of the cystic duct. This technique is part of nuclear medicine, where aharmless radioactive isoptope is administered intravenously and its eventual location in the body is mapped by a device which detects radioactivity. ERCP (Endoscopic Retrograde Cholangiopancreatography)This outpatient procedure is used to view the inside of the duodenum where the common bile duct enters. It helps evaluate any blockages as well as conditions of the sphincter and ducts. After sedation, a thin tube is put from the mouth into the stomach and then into the small intestine. There is a light and an imaging device – either fiberoptic or video chip – at the end of the tube. Small tools can also be used to take tissue samples and perform other tasks. Treatment Options. Surgical removal of the gallbladder or cholecystectomy. When gallstones are found present and symptoms occur and recur, treatment of choice is removal of the gallbladder. The biliary system is still able to function without the gallbladder. Bile flows directly from the liver to the small intestine. Removal can be done laparoscopically or by traditional open surgery involving a 4- 7 inch abdominal incision. In laparoscopic sugery, 3- 4 small incisions are made at designated points on the abdomen. |
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October 2017
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