Nuts & Bolts of Cholesterol Lowering

Nuts & Bolts of Cholesterol Lowering
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A pooled analysis of studies on nut consumption, cholesterol levels, and risk of death from heart disease show extraordinary benefits, suggesting we should eat nuts every day.

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A pooled analysis was recently published of 25 interventional trials investigating nut consumption and the levels of fatty substances (like cholesterol) in the blood. Here are the results of four of the best studies of nut consumption, and risk of death from heart disease.

Compared to eating no nuts at all, this is the associated drop in risk of death eating nuts once or twice a month; about once a week; a couple times a week; and then, almost every day. We’re talking about cutting the risk of our number one killer in half, with one simple, delicious dietary change—adding nuts to our daily diet.

Part of this is from nuts’ uncanny ability to lower bad cholesterol. And the worse off you are, the better it works. It’s not like nuts just cut your cholesterol a set percentage from wherever you start from. If your LDL starts out under 130 (and we’d really like to see it about half that), then, eating nuts lowers LDL about three percent. But, start out in the mid-100s, and nuts work twice as hard. And, if you’re off the charts, ready to keel over any moment, nuts drop your bad cholesterol an average of like ten percent.

You’ll note, though, many of these 25 studies were funded by industry groups, such as the ITNC-NREF, the International Tree Nut Council Nutrition Research and Education Foundation, or the International Nut and Dried Fruit Foundation, presumably throwing in the dried fruit part so they wouldn’t have to be known as the “International Nut Foundation.”

Either way, such trade groups have not shown themselves to be above conniving studies designed to exaggerate benefit. Case in point, from the Almond Board of California, showing almond consumption reduces DNA damage, compared to the control group—who were instead made to eat pork.

This is a classic drug company trick—comparing your product to something you just know is going to bomb. And lo and behold: “In summary, consuming a diet containing 84 g/d almonds for four weeks decreased oxidative stress in young male smokers.” Uh, yeah—compared to pork.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Kerry Skinner.

Please consider volunteering to help out on the site.

A pooled analysis was recently published of 25 interventional trials investigating nut consumption and the levels of fatty substances (like cholesterol) in the blood. Here are the results of four of the best studies of nut consumption, and risk of death from heart disease.

Compared to eating no nuts at all, this is the associated drop in risk of death eating nuts once or twice a month; about once a week; a couple times a week; and then, almost every day. We’re talking about cutting the risk of our number one killer in half, with one simple, delicious dietary change—adding nuts to our daily diet.

Part of this is from nuts’ uncanny ability to lower bad cholesterol. And the worse off you are, the better it works. It’s not like nuts just cut your cholesterol a set percentage from wherever you start from. If your LDL starts out under 130 (and we’d really like to see it about half that), then, eating nuts lowers LDL about three percent. But, start out in the mid-100s, and nuts work twice as hard. And, if you’re off the charts, ready to keel over any moment, nuts drop your bad cholesterol an average of like ten percent.

You’ll note, though, many of these 25 studies were funded by industry groups, such as the ITNC-NREF, the International Tree Nut Council Nutrition Research and Education Foundation, or the International Nut and Dried Fruit Foundation, presumably throwing in the dried fruit part so they wouldn’t have to be known as the “International Nut Foundation.”

Either way, such trade groups have not shown themselves to be above conniving studies designed to exaggerate benefit. Case in point, from the Almond Board of California, showing almond consumption reduces DNA damage, compared to the control group—who were instead made to eat pork.

This is a classic drug company trick—comparing your product to something you just know is going to bomb. And lo and behold: “In summary, consuming a diet containing 84 g/d almonds for four weeks decreased oxidative stress in young male smokers.” Uh, yeah—compared to pork.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Kerry Skinner.

Please consider volunteering to help out on the site.

Doctor's Note

One sees the manipulation of study design and skewing of results in studies on beverages too, from pomegranate juice (see Is Pomegranate Juice That Wonderful?) to milk and soda (see Food Industry “Funding Effect”). For more on nuts, see videos like What Women Should Eat to Live LongerFighting Inflammation in a Nut ShellPlant Protein Preferable; and Diverticulosis & Nuts.In How Fiber Lowers Cholesterol, I cover part of the mechanism of how nuts do what they do. I also have dozens of other videos on nuts

For additional context, check out my associated blog posts: Stool Size and Breast Cancer RiskCholesterol Lowering in a Nut ShellOptimal Phytosterol Dose and Source; and Is Coconut Oil Bad For You?

If you haven’t yet, you can subscribe to my videos for free by clicking here.

55 responses to “Nuts & Bolts of Cholesterol Lowering

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  1. One sees the manipulation of study design and skewing of results in studies on beverages too, from pomegranate juice to milk and soda. For more on nuts see videos like What Women Should Eat to Live Longer, Fighting Inflammation in a Nut Shell, Plant Protein Preferable, and Diverticulosis & Nuts, though there are 50 others. And hundreds of other videos on more than a thousand topics. On Monday’s video-of-the-day I’ll cover part of the mechanism of how nuts do what they do. If you haven’t yet, you can subscribe to my videos for free by clicking here.




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    1. So, can we conclude that eating a variety of nuts is more effective than just pure almonds at lowering cholesterol (ignoring Brazil nuts, which you have already addressed)?




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  2. This is a great website and I enjoy getting the 2 minute daily updates.   I think today’s video is a repeat of yesterday (a new title but attached the wrong video?).

    Keep up the good work as you are doing a great service.  I’ve forwarded a link to the website to many of my friends…… those that would pay attention, anyway.




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      1. My husbsnd has been vegan 18 months and less than 10 percent fat ..we eat no dairy eggs or animal protien , and no nut butters ., no avacados for a year. We eat a brazil nut a day and a b vitaminsper your wonderful books! he was off statins last year but now chloresterol up again to 303… ldl 194 hdl 58. Any suggestions ? More exercise ? I do not know what better to feed him than what we do!




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        1. Hello Di,
          I am a family doctor with a practice in lifestyle medicine. Sorry to hear about your husband’s struggles. It is very difficult to advise you without knowing exactly what he eats (a list of everything he eats for 3 days would help). In particular, does he eat plant oils? (Coconut oil is one of the worst plant oils; but any oil can raise cholesterol, even “healthy” oils such as olive, canola, sunflower).

          It is also important to know his entire medical history. For example, does he have diabetes or pre-diabetes? Any thyroid imbalance? Is his triglyceride level high? (Because diabetes/prediabetes, low thyroid, and high triglycerides all contribute to high cholesterol levels and would make it harder to lower them with diet alone).

          I would suggest that he see a doctor who knows about plant-based nutrition. You can look for one on the website https://www.plantbaseddoctors.org. If you want to try to do it yourself, I suggest looking at recipes on the 21-day vegan kickstart program by pcrm.org. Or you can get your own nutrition consultant through the website Lighter.World.

          I hope this helps. Good luck!

          Dr. Jon
          PhysicianAssistedWellness.com
          Volunteer moderator for NutritionFacts.org




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  3. So what’s the best way to decipher which study is legit? I know most of us want to hear our bias confirmed, but is simply knowing who does the funding enough?




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  4. From this data I get the impression the benefits of nuts might be minimal for those eating a low fat, plant based diet as per Ornish and Esselstyn. Both of these approaches (very similar) eschew fatty foods including nuts and the proof is in the pudding ie reversal of heart disease. If you’re starting from a 80-85 LDL (sub 150 TChol) adding nuts may make no difference as you’re already “heart attack proof” to quote Dr. Esselstyn.

    Comments Dr. Greger?




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    1. Great question Highland and for those of us on the Ornish diet/Esselstyn diet with stents/bypasses, carotid stenosis. Should we add some nuts or not? Dr. Fuhrman concludes yes and get the flour product consumption down. I tried that and it sure worked on my cholesterol numbers but did it work on the arteries. Cardiologist at Cleveland Clinic told me it is more important to worry about calming the endothelial lining than to worry about reversal of plaque. I would sure want to take advantage of a small amount of nuts daily if it lower my risk of another heart attack and early death. But how many and will it bring back angina to consume that much plant fat? 

      I’d like expert comments too Dr. Geger. Thank you for this wonderful site. 




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      1.  As far as I know Dr Esselstyn has continued to oppose nut consumption for persons with heart disease. His diet would seem to reduce the risk of another heart attack to about zero– good enough, perhaps, whether walnuts might add a level of refinement, of redundant protection, or not. Those of us reading both Esselstyn and Greger, however, may tend to remain interested in nuts, perhaps especially walnuts.

        Esselsyn has expressed great respect for tests of endothelial function; he repeatedly cites brachial artery recovery testing results showing damage from, for example, olive oil. He would like to see more endothelial funciton testing of common foods. So would I!

        I’ve just run across a study showing improved endothelial function following walnut consumption:
        http://content.onlinejacc.org/article.aspx?articleid=1137981The study was supported in part by a California walnut institution, but seems otherwise impressive. I take it as another data point in choosing whether to include nuts, or at least walnuts, in a diet intended to prevent or reverse heart disease.




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        1.  Also, I believe Esselstyn objects to all nuts (except walnuts) because of the poor omega3 to omega6 ratios. Nuts are very omega6 heavy, and this leads to inflammation…. and that impacts endolethial function.




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          1.  I don’t remember seeing Esselstyn’s concern over the omega 3/ omega 6 ratios of nuts before (do you remember where he mentions it?), but it has been a concern of mine. I understand that walnuts are the exceptional nut with a relatively favorable omega 3 / omega 6 ratio– which might, or might not, help to account for walnuts experimentally improving endothelial function. Of course, what we’d like to see is more experimental evidence for the effects of almonds (which I’m looking at for their high magnesium), hazelnuts, and so on. Experimental evidence could trump the hypothetical pro-inflammatory possibility. I think we’d all be happy if that should turn out to be the case!




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            1. I believe another reason Dr Esselstyn says no nuts is because people don’t seem to be able to just eat a therapeutic amount. He stated this in a 6 hour seminar he provides for his patients that I attended.




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              1.  Thanks, Cheryl, for passing along Dr. Esselstyn’s thinking. My partner and I each usually just include a few walnut halves at lunch– we eat whatever portion we’re guessing at the time might be therapeutic (that could be two halves or a half handful, depending on where we fall on the Greger/Esselstyn spectrum at the time). Whatever the portion, there’s no inclination to eat more; by the end of lunch we’re full of beans and whatnot. On the other hand, we’re underweight, with practically no subcutaneous fat (owing to AIDS or HIV meds) and each subject to occasional stretches of near collapse. If, at such a time, we feel like we’re starving… almond butter on toast seems to help. Is it the fat (the concentrated calories), the magnesium, or… ?




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                1. Or maybe just some more calories that you needed. :)
                  Your lunch sounds like mine. I’ve been adding a few walnuts to my lunch salad (and even tossing on some pumpkin seeds too) yum!




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  5. Dr. Greger,
    I thoroughly enjoy reading your daily posts.  Apart from your exceptional knowledge, you style of delivery is brilliant.  Thank you.




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  6. Dr. Greger,

    What are your thoughts on the 80/10/10 Diet? More specifically, do you feel that the 10% fat/10% protein is a sufficient amount from nuts and seeds?




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    1. Less digestible protein fractions, insoluble fiber, and a myriad of antinutritional factors such as trypsin inhibitors, hemagglutinins, tannins, phytates, etc.
      prevent foods like nuts and seeds from being realistically good sources of protein, even if they do contain the essential amino acids (ex: cashews / pumpkin seeds). These foods can have all sorts of great properties outside of protein, but please don’t count on them for that.




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        1. That would be a better bet, yes.
          Careful with raw sprouts, though, as sprouting can reduce inhibitors, but probably not eliminate them entirely.




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    2.  Eating a varietized whole foods plant based diet provides all the protein one needs, especially when you eat starches. Protein needs and energy needs are equivalent so eat when your hungry till your full. The inhibitors Alexander speaks of below are deactivated with cooking.




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  7. Hi Dr. Greger, 

    I love watch your videos every day along with my morning oatmeal and fruit. Very grateful for the chance to learn, and sometimes be entertained. Today’s almond vs pork study was hilarious–except that I can’t believe anyone really wastes the time and resources. A shame.

    My question is this: I greatly prefer toasted nuts–walnuts, pecans, almonds. Are there any studies which look at the difference in raw vs toasted? Am I doing myself any harm–or just not doing myself as much good as I could? I’m guessing in these big studies like the Nurse’s Health Study, that people were eating a mixture of raw and toasted. My guess is most people are not eating raw nuts, but are still benefitting. Do you know?




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  8. I definitely understand your point  on studies funded from specific industries which benefit from the research’s “good” results. Key to note and always focus upon is the research study itself: quality, control, peer reviewed, etc. In short, is it a reputable good piece of work or a slanted bias study, done for a pop in advertising promotion.

    There are both types prevalent, always glad you focus on the study’s underlying scientific foundation parameters and not just the sensationalistic results.




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  9. This subject is timely for me, so I’m glad this subject is back up. After  a few months of plant-based eating, my cholesterol dropped 100 points. But now after a year on plants it seems frozen at about 200 total. Is it oil, nuts, coffee, sugar, stress? Or what some have told me”familial.” There is so much conflicting information. Thanks Dr. G for your daily digging for answers.




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    1. Are you still loosing weight or are you at your ideal weight? I eat plant perfect but my cholesterol is still high. I’ve lost 40 the 70 pounds I needed to loose. Dr Esselstyn told me that I might not see my numbers drop to where they should be until I get the last 30 pounds off. (my BMI is 25.5 at this point)




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      1. I think I’ve figured out the culprit for me…my favorite vegan restaurant uses a lot of oil (and I eat there a lot). I’m close to my ideal weight, but may have 8 pounds or so to go. Thanks for responding. My coffee maker is one of those Keurig contraptions, and I’m not sure it filters out the cholesterol raisers. I’m going to cut back a bit on the simple sugars as well. It was a little disheartening after the initial 100 point drop of going plant based. But I think watching the oils is important. 




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  10. Are these studies done on vegetarians and vegans?  In other words,  is adding walnuts to my low-fat, whole plant-based, vegan diet an improvement or is it just an improvement if one is an omnivore?




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  11. But what about the studies showing that people with the highest cholesterol live the longest, and that vegetarians have higher mortality? (Was just reading this article, which says: “Female vegetarians have higher coronary heart disease mortality than
    female non-vegetarians. Male vegetarians have lower coronary heart
    disease mortality than male non-vegetarians, but they have higher
    all-cause mortality.” (here’s the link to the article: http://www.wholefoodsmagazine.com/columns/vitamin-connection/cholesterol-paradigm-greatest-health-scam-century)

    I would love to hear your thoughts on this. Thanks!




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    1. The populations with the highest level of dietary cholesterol in their diet compare with Americans are the Inuits and they live 10 years less then Americans. The Okinawans who are primarily plant based had the most centenarians per capita; that is, the most people over 100 years old in their population. I am not sure what other figures are being looked at. Vegetarians can fall under the umbrella of dairy, eggs and free oils. These foods promote heart disease progression. One has to be a healthy vegan to truly reverse heart disease.

      I would recommend viewing some of these mortality videos
      http://nutritionfacts.org/index.php?s=mortality




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  12. I have so many questions about cholesterol. Here is a little background on me. I am 56 and pretty healthy (I think, I feel like I am) and not on any medications. My weight is pretty high (although I have lost 17 pounds since starting this six months ago, but that’s just a drop in the bucket), I love eating. I’ve always leaned towards not eating meat, and went ten years strictly vegetarian when I was younger (16-26). Those damn McDonalds fish fillets got me coming and going. They were literally the last think I ate before going vegetarian and the first thing I ate when I started eating a little meat again. My reasons have always been moral issues.

    Anyway, about 6 months ago I saw the ‘Uprooting” video and it really affected me. I showed it to Neal, who said to me in the past, “Don’t every expect me to stop eating meat”, and he said we need to be vegan!! I was ecstatic!! So we have been totally vegan now for six months, and I have to assume from here on in.

    I wish we would have had our cholesterol checked before hand, but we didn’t. Last Saturday we went and had our blood checked, and this is what mine came up with:

    total cholesterol: 222
    HDL: 40
    Glucose: 108
    TC/HDL ratio: 5.5
    blood pressure: 120/74

    Sam’s did that all for free : ))

    Anyway, I thought it would be better after six months, so will it continue to get better in time, do I need to be doing something else?

    I am starting to use more and more green leafies and stuff, I found a great way to eat LOTS of it at a time, stick all kinds of veggies in the Ninja and grind it all down and add some flavouring or dressing, you can eat tons of veggies this way!!

    I’m always trying to find ways to keep it new and exciting : ))

    Thank you so much, Dr. Greger!!

    Lizzie

    lizziebarrett@gmail.com
    http://www.CHKittyClub.com




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  13. Dr Greger,

    This was a fascinating topic but there is a bigger question:

    WHAT EFFECT DOES NUT CONSUMPTION HAVE ON LDL IN FAT FREE VEGANS?

    I’ve been fat free vegan since numerous mini strokes and diagnosis of right anterior cerebral artery blockage.

    It appears this condition has improved after a full year of removing animal products and added fat from my diet.

    I would like to add nuts but don’t want to jeopardize the improvement which has been made.

    Thank You For Your Incredible Work.

    Donald.




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  14. I’m not sure if this is the right place, but I would like to ask about sprouted nuts. I recently read that sprouted nuts are supposedly healthier than roasted or even raw nuts. They claimed that the raw nuts had to be blanched, a process in which some of the nutrition is lost, but that sprouted nuts are treated with lower heat after a short germination. Sounds too good to be true. Is it?




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  15. Even for strict whole food vegans, eating too many nuts and seeds can definitely keep an LDL and total cholesterol level higher than generally accepted ideal levels. Limiting those foods quite a bit could be wise for all unless it is demonstrated that they provide protection even when cholesterol levels aren’t perfect. Fat-soluble antioxidant vitamins that come with nuts and seeds might provide that protection? An un-oxidized higher LDL might not be so bad?




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  16. OK! You end these videos this way, way to often; with a negative about what you were just talking so positive about! So, should we, who have a heart condition, be eatting nuts daily? And you only mentioned almonds; are they the best? Or what other nuts are good for lowering chloresterol? I’d like to get off this Simvastatin!




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  17. I have been a vegetarian for over 35 years. I am now vegan. My cholesterol is around 240 to 280. I have tried everything to lower it naturally and nothing has worked. What do you suggest?




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    1. Why not track your foods and see what percent of your diet is coming from fats, specifically saturated fats (coconut oil, cheeses, yogurt, etc) and oils? You might also increase leafy greens, beans and other sources of fiber, to help carry dietary fat from your intestines?




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  18. I have been plant based sinced jan of 2015. about 3 months after doing a juice fast my cholesterol numbers dropped. Now fast forward about 8 mo later blood work nw shows at least 10 point increase in cholesterol numbers and sudden spike in blood pressure to dangerous levels. even tho i have eliminated almost all oils and sugars. I have, however been snacking on salted cashews. This may explain the bp problem. But if nuts decrease cholesterol then how have my numbers gone up? i also had my TSH checked which also jumped from 2015 of 2.031 to now 4.081. Free T4 went from 1.01 to 0.95. trigycerides after juice fast were 234. Now are 274.Chol was 218, now 239. etc. My weight is currently 194 after lsoing 30 lbs at juice fast. i am 55 yr old with fibromyalgia and metabolic syndrome and hypertension, even tho most of last yr I no longer needed meds for it, till 2 weeks ago, and had to go up to a much stronger med that what i took before juice fast. My hair took a spell where it was falling out. feels frizzy, and having extrmeme difficulty losing weight unless I do extreme calorie restriction no matter how healthy i eat.




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    1. Tammy, if you are getting adequate levels of iodine and selenium, you might consider adding a low dose thyroid hormone supplement. Talk to your doctor.




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  19. Thinking of stopping statin and zetia. While my wife and I have been
    mainly vegetarian for a long time, approximately 4 months ago we have
    been strictly plant based, whole food, no oil, non processed diet. While
    on pravastatin ( statin drug dose 40 mg a day) which prevents the liver
    from creating cholesterol, and zetia which prevents the abortion of
    cholesterol from food, my lipids have been healthy (cholesterol 138,
    LDLS 61. HDLS 59, triglycerides 109, I thought that such a
    strict diet would allow me to drop these lipid medications. So after
    strictly being on this diet for 4 months, without stopping the lipid
    drugs I thought my cholesterol numbers would really drop, but they
    remained the same. If they dropped I would be comfortable in stopping
    these medications. But since they remain the same I’m afraid that
    stopping these medications will cause my cholesterol numbers to rise. I
    guess I should be happy my cholesterol numbers are good but I was hoping
    a healthy vegan diet would allow me to stop these medications. Any
    thoughts or recommendations?




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    1. Ken you might want to inform your doctor of your new dietary changes, and see if you can cut back a bit on your medication, retest in a few months? You won’t know unless you ask your doctor, and try it out.




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