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A Nutritional Primer on Pain JoAnn Guest Aug 04, 2005 13:29 PDT

 

Reprinted from The New Fillmore, San Francisco, Feb. 2003

 

Stepping into a room filled with labeled bottles from floor to ceiling

is not the most welcoming sight. It wasn't intended that way. There were

only twelve shelves and a handful of supplements in the beginning. All

varieties of people came into the store back then, as now, and they

seemed to belong to a small, unnamed secret sect of believers. Stories

floated around the store like vapors of incense, raising eyebrows, with

heads nodding, and looks of recognition.

 

What did it all mean?

Why didn't everyone else know this? There were mentions of conspiracies,

frightening stories of physicians losing their licenses, and personal

anecdotes.

 

It was all about health and nutrition.

 

Being there at that time was one of the joys of living, and knowing

something was good for you regardless of what others said, built

character.

 

It meant you had to read, you had to listen, and you had to pay

attention to your internal self. Suddenly, the insight struck - you

became aware that you had control of your health, you made the

difference- all you needed was information.

 

That was over twenty years ago.

 

Today, health topics about nutrition are found in everyday

conversations. Here is such an article, my perspective, from one who

sells supplements, who takes supplements, who loves and respects the

world of nutrition.

 

One of the basic reasons why a person first seeks information about

supplements is to learn how to relieve pain. Pain may be in the form of

a cramp, a twinge, a spasm, a sting, an ache or a paroxysm.

 

Pain can take the form of neuralgia, rheumatism, arthritis, heartburn, a

toothache or a stomachache. It can be sciatica, gout, a cramp, earache,

or labor pains.

 

Pain has so many faces and so many causes and as a merchant for over

twenty years in nutrition one gains a growing perspective of the role

that nutrition plays in managing pain.

 

Pain signals to us that something is wrong.

It makes us pay attention.

 

Pain has several common centers: the lower back, frontal part of the

head, the base of the head, and the abdominal area. It can also be in

the joints or an injury.

 

Pain is an individual experience that requires us to consciously explore

its cause. Is it emotional or physical, is it chronic or intermittent,

is it dull or acute? It causes much apprehension resulting in our

searching for a solution as easily and quickly as possible.

 

Most of us generally know one simple solution, that miracle, aspirin, or

one of its non-acidic competitors.

 

Aspirin inhibits prostaglandin synthesis and inhibits interleukin 6,

which is a factor in heart disease and breast and liver cancer.

 

Aspirin came from the natural world of herbs, specifically white willow

bark.

Unlike aspirin, white willow bark is not a product developed with

industrial chemical solvents and manipulations.

 

White willow bark also has buffering agents due to its great complexity

and performs the same feats as aspirin, but in a more deep, subtle and

gentle way.

 

The herbal world is filled with plants that are miraculous in their

application for pain, such as Jamaican Dogwood, a potent

anti-inflammatory and antispasmodic, cat's claw, cayenne, and feverfew.

 

Feverfew is best known for its relief of migraines, muscle tension, and

rheumatoid arthritis.

 

It is also a powerful inhibitor of COX-2 and phospholipase A2 enzymes

that are associated with pain and inflammation.

 

So it is useful for pain associated with headaches, menstruation, spasms

and pain of the muscular/skeletal system, and intestinal spasms. It is a

powerful herb that has some precautions for pregnancy.

 

Other potent COX-2 inhibitors are hops, chamomile, holy basil,

scutellaria, and ginger.

 

Interestingly, rheumatoid arthritis was thought to be the result of an

overactive immune system.

 

The Mayo Clinic now has studies that show patients with rheumatoid

arthritis have " prematurely aged " immune systems.

Good nutrition and building the immune system is one of the major keys

to good health and will be covered in a future article.

 

There are many other natural pain relievers which all have a multitude

of other benefits. For example, calcium is the most abundant mineral in

the body, and has many other applications besides strengthening our

bones. It is a natural pain reliever. At the same time calcium is

necessary for a regular heartbeat, the transmission of nerve impulses,

and the contraction of muscles.

 

It should usually be balanced with other minerals, such as magnesium

(another natural pain reliever), zinc, and phosphorous.

 

Other nutrients that reduce pain are glucosamine sulfate and

chondroitin. Glucosamine sulfate is an " amino sugar " used to create

cushioning fluids and tissues around joints. It is used for sciatica,

inflamed discs, and arthritis.

It is also necessary for the formation of skin, eyes, bones, tendons,

nails, ligaments and parts of the heart. Chondroitin is a powerful

anti-inflammatory and a biological response modifier that activates the

immune system when conditions require it.

 

An excellent anti-inflammatory is pycnogenol from pine bark.

 

Similar to it is grape seed extract and both are high in OPC's

(proanthocyanidins), a bioflavonoid and very strong antioxidant. OPC's

help to relieve arthritis, sports injuries and varicose veins.

 

They also repair damaged collagen, increase circulation, and strengthen

capillaries.

 

Other natural pain killers are Vitamin K for chronic pain, CoQ10 (an

enzyme that is a potent antioxidant and cellular energizer), and

manganese that shrinks tissue thereby aiding circulation.

 

Pain is linked closely to swelling or stagnation, which is caused by bad

circulation and increased inflammation. One of the major keys to good

health is reducing inflammation and increasing circulation.

 

Enzymes are one of nature's most healing catalytic elements.

 

Proteolytic enzymes are a major element in reducing inflammation.

Proteolytic enzymes enter the stagnant area and digest waste material

improving circulation and eliminating bruising and swelling.

 

The tissue is further enhanced and protected by " antioxidant enzymes " ,

such as catalase, SOD (superoxide dismutase), glutathione peroxidase,

and methionine reductase.

 

These enzymes " stop further damage " by free radicals, " clean " the

synovial fluids and improve " circulation " within the joints.

 

Other proteolytic enzymes are bromelain from pineapple and papain from

papaya.

 

These are often combined with quercetin, rutin and hesperidin, which are

potent bioflavonoids.

 

Vitamin C contributes greatly to pain reduction. Whole books are

entirely devoted to it.

It is probably the most tested and studied nutrient in the world and has

an incredible history of benefits. It is essential to production of

collagen and elastin, the substances that hold our bodies together.

 

It detoxifies heavy metals, promotes wound healing, and increases white

blood cell activity. It protects against cancer, heart disease,

arthritis and allergies. It is an important factor in treating male

infertility, diabetes, constipation, iron insufficiency, drug

withdrawal, and suppressing HIV virus.

Vitamin C is required for healthy gums, growth and adrenal gland

function.

 

Along this line, 'Pantothenic Acid', is another aid for pain by the

production of " natural cortisone " courtesy of the adrenal glands.

 

Other nutrients in the arsenal to reduce inflammation are essential

fatty acids (EFA's).

 

Evening primrose oil, black currant oil and borage oil are excellent

sources of d-gamma linoleic acid (GLA).

These support the PGE1 (prostaglandins series one) function that affects

hormonal balance. GLA is used beneficially for PMS, arthritis, eczema,

brain injuries, inflammation, menopausal hot flashes, multiple

sclerosis, cardiovascular disease and many others conditions.

 

Two other important nutrients are MSM and turmeric.

 

Turmeric (curcumin) is the bight yellow herb found in East Indian food.

It helps to reduce cholesterol, arthritic pain, and blood clots. As a

potent anti-inflammatory it also aids in cleaning the intestines of

unwanted iron deposits which otherwise aid the growth of fungus, such as

candida and is extremely beneficial for the skin and eyes.

 

MSM is a natural form of sulfur found in all living organisms and

assists in a variety of areas such as reducing arthritic pain, relieving

snoring, and improving growth of hair and nails.

 

MSM protects against lupus, arthritis, and cancer. It helps form the

bonds that link connective tissue together and is often found in

combination with glucosamine sulfate and chondroitin. It is also helpful

for allergies and constipation.

 

Pain from burns can be relieved through raw, unfiltered, unheated,

untreated honey.

 

I am always amazed at the immediate relief honey gives when applied

topically and how miraculously healing it is when applied for a long

period of time to the skin. Burn clinics in particular should

investigate these dramatic results.

 

Other numerous products that help relieve pain are DLPA, Noni, black

cherries, and homeopathic remedies such as Traumed, arnica and

calendula.

 

There are also topical gels and ointments, such as Tiger Balm, White

Flower, Ice Factors, and Arni-Flora.

 

Pain often provides us an opportunity to identify underlying causes.

 

Sometimes it is as simple as needing to drink more water daily, or

getting a new mattress, or changing a position of a computer screen or

getting different lighting or having a window open.

 

Other times it requires a change in one's life style to create more

balance, moderation and attention.

Sometimes it is caused by a complex situation such as a stressful job, a

bad relationship, or an old injury. When the cause is identified one can

look towards solutions and use imagination and critical thought to gain

a solution.

 

It is then that pain has become a guiding light to a doorway of

knowledge, freedom and health.

 

=====================================================================

Arnica for Pain -by ANASTASIA STEPHENS, Daily Mail

---

 

femail.co.uk - 14th June 2003

 

Used to treat bruising, muscular strains, wounds and swelling, arnica is

one of the most popular homeopathic remedies in Britain.

 

Derived from the European plant, Arnica montana, the little white

tablets - containing arnica solution watered down hundreds of times to

form a homeopathic 'ultra-dilution' - are one of the few 'alternative'

medicines to have found their way on to most people's bathroom shelves.

 

 

Proponents claim the treatment can reduce swelling dramatically, prevent

muscular soreness and alleviate postoperative trauma. But according to a

new report, published in the Journal of the Royal Society of Medicine,

the positive effects of arnica are all in the mind.

 

The remedy, claims the paper, is only as likely to reduce swelling,

bruising and pain as a placebo. The research, led by Professor Edzard

Ernst, head of complementary medicine at Exeter University, followed

three groups of 64 patients who were having surgery on their wrists

because of carpal tunnel syndrome.

 

The first group took a high dose of arnica, the second took a low dose,

while a third were given a placebo. The results showed no significant

differences in pain, swelling or bruising between the groups.

 

The findings - which essentially suggest the treatment is useless -

could have thousands of disappointed consumers relegating their arnica

supplies into their dustbins. But would they be doing the right thing?

 

Based on the theory that 'like cures like' homeopathy has always been

controversial - it treats illness by giving patients substances that

cause the very same symptoms. However, the remedies are given in minute

amounts and are often so diluted that there is little or no active

ingredient in them.

 

Yet the fact remains that thousands of practitioners and patients swear

by arnica's remarkable curative powers.

Theresa Hale, founder of London's Hale Clinic, a pioneering centre for

complementary medicine, has relied on it for years.

 

'I use it at home all the time for bruises and sprains,' she says. 'I

gave arnica to my mother just two weeks ago when she fell over and her

leg began to swell - it went back down within three hours.'

 

And arnica seemed a godsend for 43-year-old actress Nicola Redmond when

she fractured her left wrist.

'When I slipped off a step-ladder and crashed to the floor, most of the

impact was taken by my left wrist which swelled to more than twice its

usual size,' says Nicola, who lives in Blackheath.

 

'I took some arnica immediately. The swelling went down by about an

inch-and-a-half all round within half an hour. Even though my wrist was

still very tender and sore, I can't imagine it would have recovered to

that extent without the arnica.

 

'I still had to go to hospital to have a splint fitted for the fracture,

but the arnica seemed to help immensely.' The treatment has also

provided vital support for her work.

 

When I was performing in a production of Macbeth at the National

Theatre, I used arnica to help protect my voice,' says Nicola.

'Projecting your voice night after night in a large theatre can make you

go hoarse.

The arnica stopped that.

 

'Some of the other actors tried it, too, and absolutely swore by it.'

Sold as pills or as a cream, the remedy has been used for hundreds of

years.

 

It is widely used in Germany and France by medically qualified doctors,

and it is also routinely administered in casualty units in hospitals.

 

Made from a yellow daisy-like flower, the active components of arnica

include sesquiterpene lactones and flavonoids which are known to reduce

inflammation and ease pain. It also contains thymol, an essential oil

that fights infection, and carotenoid, a powerful antioxidant.

 

It is believed to work by stimulating the activity of white blood cells

and dispersing fluid that accumulates around damaged, swollen joints.

 

Cumulatively, its effect is to " boost " immunity, accelerate healing and

fight inflammation. It also helps the body " combat " bacterial infection.

 

 

Roger Savage, senior homeopath at the Cambridge Complementary Health

Practice, says the study was poorly designed and ran the risk of putting

people off an effective treatment.

 

THIS study is very flawed,' he says. 'The principles of homeopathy are

the reverse to orthodox medicine - the lower the dose, the more powerful

the effect. The study used high doses which wouldn't be very effective

and could cause side effects. And, for serious post-operative pain,

homeopaths would design an individual treatment.'

 

Dr Peter Fisher, homeopathic physician to the Queen and clinical

director of the Royal London Homeopathic Hospital agrees.

 

'The researchers set up the study in the wrong way and misinterpreted

their findings so we don't feel it proves anything,' says Dr Fisher, who

is also a GP.

 

'Arnica has stood the test of time.

 

Homeopaths have used it for more than 200 years to treat injuries, in

particular swelling and bruising.'

 

Even Professor Ernst concedes the study does not necessarily discount

arnica or the effectiveness of homeopathy. Laboratory tests, he says,

have found that ultra-dilute homeopathic remedies do induce a response

in immune cells.

 

He also admits that similar dilutions have significant effects on

animals, which cannot 'will themselves better' to cause a placebo

effect.

 

 

Homeopathic remedies are available in different potencies or dilutions.

The most common are 6C (diluted 600 times) used for long-standing

ailments, and 30C (diluted 3,000 times) for emergency and acute

symptoms.

 

Try Nelson's Arnica, 84 tablets for or Boots Homeopathic Remedies,

Arnica 6C pillules (84 pills) or Arnica 30C pillules (84 pills)

 

Creams and ointments should be applied gently to bruised areas, then

rest the damaged tissue.

 

Find this story at:

http://www.femail.co.uk/pages/standard/article.html?in_article_id=160090 & in_page\

_id=174

 

====================================================================

Arnica montana: Natural Magic

--

 

 

By Nancy Allison

© 2004 Steven Foster

 

" Noch mal!” says Herr Gehring, pouring more beer. “Have another!” My

husband and I don’t protest. When in Germany, where we recently spent

nearly a year, we do as the Germans do. Is it the beer, or a trick of

the Black Forest light?

Glinting among the kohlrabi and rhubarb of the Gehrings’ garden we see

a magical sight: a bottle of what looks like liquid sunshine.

 

Zauberpflanzen (magic plants) is German for certain plants known for

centuries to have seemingly miraculous properties. As Frau Gehring puts

another wurst on the grill, she explains that the bottle that so

entrances me shines with the blossoms of one of Germany’s best known

Zauberpflanzen:

 

Arnica montana.

 

As with many herbs that entered the realm of folk medicine, arnica was

used first in pagan times to curry favor with spirits. The blossoms were

thought to be especially potent on the summer solstice. Bunches were

gathered and set on the corners of fields to spread the power of the

corn spirit and to ensure a good harvest. While Germans don’t believe in

garnishing their fields with arnica these days, its power as a folk

medicine has persisted.

 

Arnica: An Inside Look

 

While we were in Germany, I found arnica gel, cream and tincture sold in

every drugstore. I wanted to find out more about this fascinating herb,

so I contacted medical doctor and professor of pharmacy Irmgard Merfort,

of Freiburg University. In an e-mail interview, Dr. Merfort discussed

the benefits and risks of Arnica montana and how best to use it.

 

Nancy Allison: My friend Frau Gehring puts arnica blooms in a bottle and

then fills it with schnapps. She says this must stay in the sun for

three weeks and then can be used on bruises and muscle strains.

 

Dr. Irmgard Merfort: Your friend is partly right in preparing an

alcoholic extract of the blooms. However, the following preparation is

recommended: 1 part arnica flowers and 10 parts 96 percent alcohol

should be put together in a bottle and left for a week, during which the

bottle should be shaken. Then the flowers can be removed. It is

important that this alcoholic solution must be diluted with water from

three to ten fold when it is used, e.g. for compresses.

 

There are a lot of experiences with this way of preparation in contrast

to that one your friend uses. If the schnapps with arnica blooms is

staying in the sun, then a lot of reactions probably occur that alter

the ingredients of arnica blooms. Up to now, there are no studies

available on this.

 

N.A.: Can you describe how arnica acts on blood vessels?

 

I.M.: The main active compounds in arnica are sesquiterpene lactones.

Additionally, flavonoids and the essential oil are also important.

 

Sesquiterpene lactones influence a lot of inflammatory pathways

resulting in the decrease of the inflammatory process.

 

Our group has found that sesquiterpene lactones inhibit the release of

inflammatory mediators because they inhibit the transcription factor

NF-kB, which is a central mediator in the immune system.

 

N.A.: Is it true that arnica might be used for rheumatic problems such

as arthritis? Would this be in homeopathic or topical form?

 

I.M.: Alcoholic preparations are recommended for external treatment of

bruises, sprains and inflammations caused by insect bites; gingivitis

and aphthous ulcers (canker sores); symptomatic treatment of rheumatic

complaints; and for surface phlebitis.

 

A clinical study exists that shows arnica is effective for the treatment

of rheumatic arthritis, and another study suggests that it has positive

effects in phlebitis, in each instance when arnica preparations were

used externally.

 

N.A.: Are there health risks associated with arnica use?

 

I.M.: Yes, there are. Some people can develop contact dermatitis; then

they must prevent any contact with arnica and also with flowers that

contain sesquiterpene lactones, e.g. Achillea species.

 

Therefore, it is essential that arnica preparations be used as

recommended and the tincture not in an undiluted form. People who have a

contact allergy against arnica should not use arnica preparations. The

number of users who have developed contact dermatities is low.

 

 

About Arnica

A. montana is a perennial flower from the Asteraceae family, native to

the mountains of Europe, as its name (montana) suggests. The yellow,

daisy-like flower, seen from May to August in elevations of 3,500 to

10,000 feet, was mentioned first by Matthiolus, an Italian physician, in

1626.

 

Folk remedies using arnica as a tea or tincture for wounds, bruises,

rheumatic pains, heart weakness and even asthma, prevailed for centuries

before that.

 

In Germany, Arnica is known commonly as wundkraut (wound herb),

bruchkraut (fracture herb) and fallkraut (fall herb). In the mountains,

where the steep paths make falling quite common, it was well-known that

an application of fallkraut would help to heal any swelling or bruising

to the body. Referred to in mountain dialect as “stand up and go home”

(Stoh up un goh hen), arnica’s common names attest to its fast-healing

properties.

 

Arnica’s Effectiveness

Arnica is now an ingredient in more than 100 herbal preparations in

Germany, where plant-based medications are well-researched, highly

respected and government-regulated.

 

Germany’s Commission E, an expert committee on herbal drugs and

preparations from medicinal plants, cites arnica as a treatment for

various post-traumatic conditions, including bruises, sprains,

contusions and rheumatic ailments.

 

Because arnica can cause adverse effects when taken internally (it is

listed as a poisonous plant in the United States, where it has been

cultivated since it was imported from Europe), home-brewed teas made

from fresh preparations are not recommended by the Commission.

 

It recommends tinctures for external use at a 3:1 to 10:1 dilution, and

that salves contain a maximum of 20 to 25 percent tincture or 15 percent

arnica oil.

 

In any case, arnica should be used only in dilute form — if internal use

is too high, dizziness, diarrhea, heart arrhythmia and even death can

occur. Likewise, topical preparations also can cause a reaction and, in

some cases, may lead to skin allergy. If reactions occur, discontinue

use.

 

Homeopathic preparations, which are very small dosages in pill or drop

form, are considered safe when prescribed by professional practitioners.

British studies have shown that postoperative swelling, pain and

bruising are reduced significantly if homeopathic arnica is taken prior

to surgery.

 

The Aspirin of Homeopathy

 

In the Department of Plastic Surgery of Queen Victoria Hospital in West

Sussex, England, 37 patients undergoing surgery for carpal tunnel

syndrome participated in a double-blind study. The researchers

administered homeopathic arnica tablets and herbal arnica ointment to

patients, and concluded that there was a significant reduction in pain

in the arnica-treated group.

 

Anecdotal evidence for arnica’s effectiveness abounds. A friend of mine

who underwent hip surgery in England took homeopathic arnica for six

weeks prior to her operation on the advice of her doctor. She

experienced no postoperative bruising and very little inflammation. Best

of all, the pain was not nearly as acute as she had expected after such

major surgery.

 

Homeopathic use of arnica as a sports medicine has been praised by U.S.

experts, as well. Steven Subotnick, D.P.M., N.D., D.C., author of Sports

and Exercise Injuries: Conventional, Homeopathic and Alternative

Treatments (North Atlantic, 1991), finds that among his patients with

acute injuries and afflictions from overuse, homeopathic arnica

decreases pain and speeds healing. Subotnick is so impressed with its

results that he has referred to arnica as “the aspirin of homeopathy.”

 

Dr. Irmgard Merfort of Freiburg University in Germany knows that arnica

works — but has discovered that it does so in a very different way from

aspirin.

 

Merfort’s studies confirm that it is the sesquiterpene lactones (ester

derivatives of helenalin and dihydrohelenalin) that are considered to be

the active compounds in arnica.

 

These natural products work together to stop inflammation of the blood

vessels. But the difference is that they work on a molecular level — by

inhibiting the messages that tell the gene to encode for inflammation.

 

“They use a unique mechanism of NF-kappaB [a central mediator in the

immune system] inactivation, which is quite different from that of other

anti-inflammatory agents,” Merfort says. “Based on our results,

sesquiterpene lactones could serve as lead compounds for the development

of novel, potent anti-inflammatory drugs for the treatment of

inflammatory disorders such as rheumatoid arthritis or inflammatory

bowel diseases.

 

These drugs also could be important in the treatment or prevention of

adult respiratory distress syndrome or systemic immune response

syndrome.”

 

A Long History of Use

Frau Gehring, who is 70, doesn’t concern herself with studies. Sure of

its potency already, she has been making arnica tincture each summer for

the past 50 years, as her mother and grandmother did before her.

 

Although she does not pick the arnica these days because it’s a

protected plant in Germany (she now buys dried flower heads at the local

pharmacy), she still likes to “cure” the Zauberpflanzen in the summer

garden, as she always has done.

 

Once it’s ready, Frau Gehring uses her arnica tincture to treat

everything from her granddaughter Josefa’s bruised knees to her

husband’s gardener’s shoulder.

 

It seems Herr Gehring must have applied some arnica this morning. He

certainly doesn’t have any trouble lifting his beer-pouring arm.

 

“Noch mal!” he says, pointing the bottle toward my glass. “Ja, Danke

schoen!” I reply, and take a long drink. All in the interest of science,

of course.

 

Garden- and beer-lover Nancy Allison travels regularly to Europe to

gather stories about plants. She thanks her husband Aleqx for making

sure she gets on (and off!) the right trains, and for translating

interviews and texts from German to English.

 

To view the reference list for this article, please click here

http://www.herbsforhealth.com/index.php?page=article & story=15

 

====================================================================Post

subject: Herbs for Pain

 

--

 

www.bastyrcenter.org/content/view/218

 

Note: It is advisable to consult a licensed practitioner trained in

botanical medicine regarding the use of herbs. It is also important to

inform your practitioners of any herbal medicines you are taking. The

herbs listed below may have properties not mentioned here.

 

Arnica

Stimulates circulation and reduces inflammation. Used for bruises,

sprains, muscle pain as an ointment or tincture (externally) or

homeopathic preparation (internally).

Flowers are contraindicated for pain.

 

Black cohosh

Anti-inflammatory and muscle relaxant. Relieves menstrual cramps,

headaches and rheumatism pain.

 

Curcumin (Turmeric)

Anti-inflammatory. Relieves menstrual cramps, reduces fevers and

improves circulation.

 

Devil’s claw

Anti-inflammatory. Eases arthritic pain and swelling.

 

Feverfew

The leaves relax blood vessels, reduce inflammation and have a mild

sedative effect. Treats headaches, including migraines and arthritic

swelling. Should not be used by pregnant women.

 

Meadowsweet

Flower buds contain salicyclic acid from which aspirin was synthesized.

Flower tea used for headaches, stomach ulcers and heartburn.

Anti-inflammatory action treats rheumatism.

 

Willow bark

Stem bark contains salicyclic acid from which aspirin was synthesized.

Used as a sore throat gargle, for heartburn and to relieve arthritic

pain.

 

Writer: Sydney Maupin, Staff Writer

2004

 

Explore ways to heal your pain naturally. Make an appointment today.

 

Or browse more Health Conditions and Concerns.

______________

 

JoAnn Guest

mrsjo-

www.geocities.com/mrsjoguest/Genes

 

 

 

 

 

AIM Barleygreen

" Wisdom of the Past, Food of the Future "

 

http://www.geocities.com/mrsjoguest/Diets.html

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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