There is yet no cure for Celiac Disease which is vastly under diagnosed and takes an average of 11 years between the first appearances of bowel symptoms until it is identified. Adding insult to injury, it often remains silent in the intestine while extra intestinal problems (headaches, arthralgias, thyroid problems and liver abnormalities) are occurring. To date there is no help for this malady other than completely avoiding this protein found in wheat and other grains, (the acronym B.R.O.W.S.: B for Barley, R for Rye, O for Oats, W for Wheat and S for Spelt). In the future, several medicines will be available to denature some of this protein that incidentally slips in with other foodstuffs. Still there is no long lasting for those who consume gluten. Much controversy exists in the literature with gluten allergy, sensitivity and true Celiac Disease. The three criteria for the disease by most knowledgeable physicians are a genetic predisposition, consumption of gluten and a triggering event of a physical or emotional nature.
To document the diagnosis, blood anti-transaminase, anti-myelysin and anti-gliadin studies are preformed. But they are only positive if the patient has significant bowel disease when the blood is drawn and he/she has been consuming gluten on a regular basis. The markers of HLA-DQ2 or HLA-DQ8 haplotype, which show the genetic predisposition can also be tested, but are more expensive and do not guarantee that the patient really does have the disease. According to Ken Fine, et al. (The prevalence and causes of chronic diarrhea in treated celiac sprue. Gastroenterology 1997; 112:1830-1837) the most cost effective test to diagnose celiac disease is an anti-gliadin stool test while the suspect is consuming gluten. This is the test we used to diagnose and follow the treatment results .
BRALY'S SIGN: A visible trait of Hashimotos Thyroid Disease which is common in Celiacs was first noted in Poland in 1953 and presented to the Western Europe by the English Gastroenterologist, James Braly, MD. The majority of Celiacs have a foreshortened 5th finger now designated as Braly’s Sign. (J Pediatric Gastroenterology and Nutrition 2000; volume 31 (Suppl.3): S29. New England Journal of Medicine, August 18, 1999). A positive sign is that the end of the fifth finger is shorter than the last joint of the ring finger. We used this external marker as a hallmark of the disease also in our study. In the combined experienced of the two of us and another colleague, Susan Solomon, a clinician in Raleigh N.C. we have found this marker positive in almost 85% of Celiacs that were either biopsied proven or had the positive genetic marker of the disease.
HYDROGEN BREATH TEST: This is an inexpensive, paid by insurance study that is a presumptive assessment for intestinal disease such as gluten intolerance. Actually, it detects bacterial overgrowth in the small intestine. This is common in intestinal diseases in which the mucosa of the intestine is compromised like celiac, but also small intestinal diverticulosis, abnormal flora, parasites and previous surgery where the usual anatomy of the intestine has been changed. An example of this is bypass surgery for weight loss. Also if the intestine cannot make the enzymes to break down food stuff it also causes abnormal gases due to the fermentation from normal bacteria. Lactose intolerance is an illustration.
Normally there should be NO hydrogen in the breath since the bacteria and the enzymes and the anatomy is doing its job. But if something is awry then hydrogen which is normally produced in minute amounts goes up. Gastroenterologist picked the cut point of 10 parts per million or more to be abnormal. The test is done by holding one's breath for 30 seconds then exhaling through a carboard tube into a special handheld device. In 20 seconds, the results are apparent.
Wednesday, May 18, 2011
Monday, May 9, 2011
SUSTAIN YOUR BRAIN
ALZHEIMER’S DISEASE (AD) may be in your future, but you can head it off! A person must be proactive rather than reactive to prevent this devastating disease. After its onset, it is too late to reverse this most common form of dementia. It is an incurable, degenerative, and terminal disease which was first described by the German psychiatrist and neuro-pathologist, Alois Alzheimer in 1906 and was subsequently named after him. Generally, it is diagnosed in people over 65 years of age, although the less-prevalent “early-onset” of Alzheimer's does occur before this age. In 2011, there were 36 million sufferers in the US. Alzheimer's is predicted to affect 1 in 3 over the age of 65. By 2050, half of all people over the age of 80 are predicted to have it! Medical science already has the tools to prevent it, but very few Doctors know about them, let alone make their recommendation.
The risk factors for AD includes family history, gluten intolerance, heavy metal excess, fever blisters, glucose intolerance, obesity, head trauma, drug, age, physical and psychological stress. Stress can not only be diagnosed, but quantified by a simple office test: Heart Rate Variation (HRV). Also, if one has a single gene Apo E4 there is a 75% chance and if a double E4 a 94% chance of the disease.
The earliest observable symptoms are often mistakenly thought to be “age-related” senior moments. The inability to acquire new memories, the difficulty in recalling recently observed facts are noted first by the individual, then by loved ones and lastly by friends. These individuals, particularly those with a high social IQ, cover up these mental lapses with believable excuses. As the disease advances, symptoms include confusion, irritability, aggression, mood swings, language breakdown, long-term memory loss and the general withdrawal of the sufferer as their senses decline. Gradually, bodily functions are lost, ultimately leading to death. Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years. Fewer than three percent of individuals live more than fourteen years after diagnosis. When AD is suspected, the diagnosis is usually confirmed with behavioral assessments and cognitive tests, such as a MMSE. A Psychological Inventory Test (to be covered in a later posting) that checks nine different brain areas of function also helps in diagnosis and prognosis. It is best to pick up the disease in its earliest stages when much can be done to delay or even prevent it. Often I will order a MRI to look at the hippocampus volume, and if in real doubt do a PET scan with a PIB contrast.
If Alzheimer’s is in your future, much can be done to greatly delay, or better yet, prevent it. Despite the many ways to determine if you are in harms way, there is no guarantee that it will arrive until after it is too late. Therefore, an ounce of prevention should be considered before a ton of care. One cannot change their genes (Apo E or Family History), but can certainly amend them in what is now termed epigenetic modification. The research indicates that AD is mainly an inflammatory process albeit a slow ongoing oxidative smoldering process. Involved in this process are two key moleules, Nrf2 and BDNF. Nrf2 is a master regulator molecule of the antioxidant response. This response is important to diminish our oxidative stressors. Because Nrf2 is able to induce genes important in combating oxidative stress, it activates the body’s own protective response, Nrf2 is able to protect from a variety of oxidative stress-related complications, even in situations where the administration of exogenous antioxidants (such as Vitamin C and Vitamin E) have failed. The other important player, BDNF keeps nerve cells alive and stimulaes the growth of new ones. Recent studies shows that it prevents and reverse Alzheimer’s independent of the amyloid plaque tangles. BDNF levels can be naturally boosted by heavy exercise and caloric restriction. Nutrients that also help make BDNF or protect it from declining are acetyl-l-carnitine, fish oil, blueberries, and curcumin.
There are both prescription drugs and supplements that are recommended for AD. The three drugs that are FDA approved to increase an important chemical in neuro-transmission, Acetyl Choline, are Aricept, Exelon and Razadyne. The other FDA medication is Nemanda which tries, but not completely successfully, to inhibit the neurons from “burn out” from excessive excitation. Because 90% of folks who have Alzheimers also have the Herpes Simplex-2 Virus, taking a daily antiviral, such as Acyclovir may also be prevention, although not FDA approved for this. Other prescriptions that are used in that AD which by some researchers is considered to be Type 3 Diabetes are Metformine and Actos.
A supplement representing more than 30 years of neuroscience research, is BrainSustain. This is a unique powdered drink formula, developed by Board-Certified Neurologist, David Perlmutter, MD, FACN, to enhance brain performance and health. It is usually given in a smoothie or Almond Milk Shake. BrainSustainTM improves the energy production of brain mitochondria providing generous antioxidant support to combat the damaging effects of excess free radicals. It contains the following underlined ingrediants. Broccoli Seed Extract, which is the Johns Hopkins non heated patented extract of the phytochemical in broccoli (sulforaphane glucosinolate). Extensive research demonstrates that this compound upregulates the Nrf2 system, enhancing the production of important antioxidants such as glutathione and superoxide dismutase as well as activating vital Phase 2 detoxification enzymes. N-Acetyl-L-Cysteine (NAC), a derivative of the amino acid, L-cysteine, is the precursor to glutathione, one of the brain’s most important antioxidants. The aim of oral supplementation is to augment the body’s reserve. NAC itself is a potent antioxidant shown to reduce formation of nitric oxide, a free radical implicated for a causative role in neurodegenerative disorders. Phosphytl Serine (PS), a component of lecithin, plays an important role in neuronal energy production and enhances neuronal communication. After careful examination of scientific evidence, the FDA granted “qualified health claim” status to PS, stating that “Consumption of PS may reduce the risk of dementia in the elderly”. N-Acetyl-L-Carnitine (aka ALCAR), an acetylated form of the amino acid, L-carnitine, is able to cross the blood brain barrier, where it acts as an effective antioxidant and protects brain cells from toxic chemical and stress-induced damage and deterioration. N-Acetyl-L-Carnitine enhances neuronal energy production by transporting fuel sources into the mitochondria and removing energy production waste products from them. Carnitine is readily converted into acetlycholine, a neurotransmittter essential for learning and concentration. Alpha Lipoic Acid also provides more antioxidant action and regenerates other important brain antioxidants including vitamins E, C, and glutathione. Unlike other antioxidants, alpha lipoic acid is both fat and water-soluble, greatly enhancing its ability to be absorbed from the gut and penetrate into the brain. Coenzyme Q10 measurably increases the efficiency of cellular energy production and serves as a potent antioxidant that may protect the brain from oxidative stress damage, which is believed to be partially responsible for neurodegenerative disease. A special DHA, (a2), derived from algae is not only vital to brain health, but 25% of the brain is made up of it. DHA-a2 facilitates optimal structure and functioning of the brain cell membranes.
BrainSustainTM also contains VegaProTM, XYMOGEN’s proprietary pea/ rice protein blend, as well as fat soluble antioxidants, vitamins D3 and E (as mixed tocopherols), and activated B vitamins, including 50 mg of riboflavin and folic acid (as calcium folinate). Available in Vanilla Delight, Chai & Creamy Chocolate, BrainSustainTM costs from $40 to $80 a month depending on whether an individual takes one or two scoops of this product daily. In general I advise one to prevent and two to treat Dementia.
The risk factors for AD includes family history, gluten intolerance, heavy metal excess, fever blisters, glucose intolerance, obesity, head trauma, drug, age, physical and psychological stress. Stress can not only be diagnosed, but quantified by a simple office test: Heart Rate Variation (HRV). Also, if one has a single gene Apo E4 there is a 75% chance and if a double E4 a 94% chance of the disease.
The earliest observable symptoms are often mistakenly thought to be “age-related” senior moments. The inability to acquire new memories, the difficulty in recalling recently observed facts are noted first by the individual, then by loved ones and lastly by friends. These individuals, particularly those with a high social IQ, cover up these mental lapses with believable excuses. As the disease advances, symptoms include confusion, irritability, aggression, mood swings, language breakdown, long-term memory loss and the general withdrawal of the sufferer as their senses decline. Gradually, bodily functions are lost, ultimately leading to death. Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years. Fewer than three percent of individuals live more than fourteen years after diagnosis. When AD is suspected, the diagnosis is usually confirmed with behavioral assessments and cognitive tests, such as a MMSE. A Psychological Inventory Test (to be covered in a later posting) that checks nine different brain areas of function also helps in diagnosis and prognosis. It is best to pick up the disease in its earliest stages when much can be done to delay or even prevent it. Often I will order a MRI to look at the hippocampus volume, and if in real doubt do a PET scan with a PIB contrast.
If Alzheimer’s is in your future, much can be done to greatly delay, or better yet, prevent it. Despite the many ways to determine if you are in harms way, there is no guarantee that it will arrive until after it is too late. Therefore, an ounce of prevention should be considered before a ton of care. One cannot change their genes (Apo E or Family History), but can certainly amend them in what is now termed epigenetic modification. The research indicates that AD is mainly an inflammatory process albeit a slow ongoing oxidative smoldering process. Involved in this process are two key moleules, Nrf2 and BDNF. Nrf2 is a master regulator molecule of the antioxidant response. This response is important to diminish our oxidative stressors. Because Nrf2 is able to induce genes important in combating oxidative stress, it activates the body’s own protective response, Nrf2 is able to protect from a variety of oxidative stress-related complications, even in situations where the administration of exogenous antioxidants (such as Vitamin C and Vitamin E) have failed. The other important player, BDNF keeps nerve cells alive and stimulaes the growth of new ones. Recent studies shows that it prevents and reverse Alzheimer’s independent of the amyloid plaque tangles. BDNF levels can be naturally boosted by heavy exercise and caloric restriction. Nutrients that also help make BDNF or protect it from declining are acetyl-l-carnitine, fish oil, blueberries, and curcumin.
There are both prescription drugs and supplements that are recommended for AD. The three drugs that are FDA approved to increase an important chemical in neuro-transmission, Acetyl Choline, are Aricept, Exelon and Razadyne. The other FDA medication is Nemanda which tries, but not completely successfully, to inhibit the neurons from “burn out” from excessive excitation. Because 90% of folks who have Alzheimers also have the Herpes Simplex-2 Virus, taking a daily antiviral, such as Acyclovir may also be prevention, although not FDA approved for this. Other prescriptions that are used in that AD which by some researchers is considered to be Type 3 Diabetes are Metformine and Actos.
A supplement representing more than 30 years of neuroscience research, is BrainSustain. This is a unique powdered drink formula, developed by Board-Certified Neurologist, David Perlmutter, MD, FACN, to enhance brain performance and health. It is usually given in a smoothie or Almond Milk Shake. BrainSustainTM improves the energy production of brain mitochondria providing generous antioxidant support to combat the damaging effects of excess free radicals. It contains the following underlined ingrediants. Broccoli Seed Extract, which is the Johns Hopkins non heated patented extract of the phytochemical in broccoli (sulforaphane glucosinolate). Extensive research demonstrates that this compound upregulates the Nrf2 system, enhancing the production of important antioxidants such as glutathione and superoxide dismutase as well as activating vital Phase 2 detoxification enzymes. N-Acetyl-L-Cysteine (NAC), a derivative of the amino acid, L-cysteine, is the precursor to glutathione, one of the brain’s most important antioxidants. The aim of oral supplementation is to augment the body’s reserve. NAC itself is a potent antioxidant shown to reduce formation of nitric oxide, a free radical implicated for a causative role in neurodegenerative disorders. Phosphytl Serine (PS), a component of lecithin, plays an important role in neuronal energy production and enhances neuronal communication. After careful examination of scientific evidence, the FDA granted “qualified health claim” status to PS, stating that “Consumption of PS may reduce the risk of dementia in the elderly”. N-Acetyl-L-Carnitine (aka ALCAR), an acetylated form of the amino acid, L-carnitine, is able to cross the blood brain barrier, where it acts as an effective antioxidant and protects brain cells from toxic chemical and stress-induced damage and deterioration. N-Acetyl-L-Carnitine enhances neuronal energy production by transporting fuel sources into the mitochondria and removing energy production waste products from them. Carnitine is readily converted into acetlycholine, a neurotransmittter essential for learning and concentration. Alpha Lipoic Acid also provides more antioxidant action and regenerates other important brain antioxidants including vitamins E, C, and glutathione. Unlike other antioxidants, alpha lipoic acid is both fat and water-soluble, greatly enhancing its ability to be absorbed from the gut and penetrate into the brain. Coenzyme Q10 measurably increases the efficiency of cellular energy production and serves as a potent antioxidant that may protect the brain from oxidative stress damage, which is believed to be partially responsible for neurodegenerative disease. A special DHA, (a2), derived from algae is not only vital to brain health, but 25% of the brain is made up of it. DHA-a2 facilitates optimal structure and functioning of the brain cell membranes.
BrainSustainTM also contains VegaProTM, XYMOGEN’s proprietary pea/ rice protein blend, as well as fat soluble antioxidants, vitamins D3 and E (as mixed tocopherols), and activated B vitamins, including 50 mg of riboflavin and folic acid (as calcium folinate). Available in Vanilla Delight, Chai & Creamy Chocolate, BrainSustainTM costs from $40 to $80 a month depending on whether an individual takes one or two scoops of this product daily. In general I advise one to prevent and two to treat Dementia.
Monday, May 2, 2011
ASPIRIN WORKS
Aspirin is frequently called the “wonder drug” because of its many beneficial properties. Two of the most significant are the prevention of cardiovascular events and cancer. It makes the blood platelets which are 1/10 of the size of a red blood cell less sticky . The drug works by inhibiting the production of prostaglandins forming on the outside membrane of these. Additionally, aspirin induces the formation of Nitric Oxide-radicals an independent mechanism of reducing inflammation in the blood vessels. More recent data also suggests that aspirin modulates signaling through NF-κB, a transcription factor complex, plays a central role in many biological processes, including cancer. This may be why folks who take a low dose aspirin daily for at least five years have a 30% less incidence in breast, prostate, stomach, esophagus, lung, and ovarian cancer. Additionally, if they already have the tumor, have far less distant spread.
Although Hippocrates, in 400 B.C left historical records of treatments, with the mother of aspirin from the bark and leaves of the willow tree, it was not until 1828, that Johann Buchner, professor of pharmacy at the University of Munich, isolated a tiny amount of bitter tasting yellow, needle-like crystals, which he called salicinin and Leroux had extracted salicin, in crystalline form for the first time, and Raffaele Piria succeeded in obtaining the salicylic acid in its pure state. A hundred and fifty years later (1971), British pharmacologist John Robert Vane in London, showed aspirin suppressed the production of prostaglandins and thromboxanes. For this discovery, he was awarded both a Nobel Prize in Physiology and Medicine in 1982 and a knighthood.
More than 50 million people in the U.S. take aspirin every day to help prevent heart attacks, strokes and cancer. However, research has demonstrated that up to 25 percent of these individuals may not benefit from the anti-clotting effect of aspirin, and are more than three times more likely to die from a heart attack or stroke. So Aspirin does not have the same effect on everyone. This suboptimal response to aspirin by an individual is commonly known as aspirin resistance or insensitivity Since these individuals are at increased risk of heart attack or stroke, doctors are beginning to recognize the importance of testing for aspirin effect. On the other hand, the higher doses of aspirin, not only in some will produce a paradoxical clotting effect, but in others a hemorrhage!
Until recently, there was no quick, accurate and effective way to test for aspirin effect. An ADP adhesive study or a specific prostaglandin assay was used in research settings and not paid for by insurances. But now, with the AspirinWorks Test, we can be sure the aspirin is working with a simple no fasting urine test. The AspirinWorks Test is FDA cleared for use in apparently healthy individuals, and test samples can be collected in the doctor’s office at any time. The AspirinWorks Test determines the effect of aspirin on platelets by measuring the level of the biomarker called thromboxane B2 (11dhTxB2). The higher the levels of thromboxane B2, the stickier the blood platelets, and the less impact the aspirin is having. This crucial information allows physicians to individualize a patient’s therapy, which may be as simple as adjusting the dose.
When prescribing blood pressure or cholesterol medication, doctors routinely check the patient’s blood pressure or cholesterol to make sure the patient is getting the right dose of medication. Similarly it is important to know if the dose of aspirin you’re taking is effective. Now, when prescribing aspirin we can then decide to increase or decrease your aspirin dose or if additional medication is needed. As mentioned in my previous writings that just as important is the aspirin to prevent blood from clotting within the blood stream, acetaminophen is needed to inhibit the clot on the arterial wall!
Therefore acetaminophen (Tylenol) has been shown to work in conjunction with the aspirin. At the University of Georgia, Dr. Phillip Greenspan found that the acetaminophen is a potent inhibitor of the enzyme, myeloperoxidase. This enzyme oxidizes the LDL, modifies it in such a way that it is more delectable to the certain white cells (macrophages) that reside within the wall of our arteries. These ingest the LDL cholesterol and cause the plaque and obstruction, which is the father of atherosclerosis. In that the acetaminophen blocks the activity of this enzyme, there is less transformation of the bad cholesterol (LDL) that is available for the macrophages to ingest. This research was presented at the conference on arteriosclerosis, thrombosis and vascular biology in Denver, May 21, 2000 and in 2006 documented by John Merrill PhD at Rutgers. This can also be taken to prevent pain. Some people state it helps them to sleep, when taken at bedtime. Also a recent study at the University of Florida demonstrated that acetamenaphen elevates the mood. The bad press that Acetaminophen has recently had makes this well studied drug almost a curse word. It is true in very high doses like over 6,000 mg a day it can negatively affect the liver and perhaps the kidney, but 1000mg/day is positively healthy for all who want protect their blood vessels.
THE BOTTOM LINE-“Betwixt and between, Aspirin and Tylenol will keep the artery clean” One each 81 mg Aspirin and 500 mg Acetaminophen (TylenolR), both twice a day, will keep the heart attack and stroke away!!
Although Hippocrates, in 400 B.C left historical records of treatments, with the mother of aspirin from the bark and leaves of the willow tree, it was not until 1828, that Johann Buchner, professor of pharmacy at the University of Munich, isolated a tiny amount of bitter tasting yellow, needle-like crystals, which he called salicinin and Leroux had extracted salicin, in crystalline form for the first time, and Raffaele Piria succeeded in obtaining the salicylic acid in its pure state. A hundred and fifty years later (1971), British pharmacologist John Robert Vane in London, showed aspirin suppressed the production of prostaglandins and thromboxanes. For this discovery, he was awarded both a Nobel Prize in Physiology and Medicine in 1982 and a knighthood.
More than 50 million people in the U.S. take aspirin every day to help prevent heart attacks, strokes and cancer. However, research has demonstrated that up to 25 percent of these individuals may not benefit from the anti-clotting effect of aspirin, and are more than three times more likely to die from a heart attack or stroke. So Aspirin does not have the same effect on everyone. This suboptimal response to aspirin by an individual is commonly known as aspirin resistance or insensitivity Since these individuals are at increased risk of heart attack or stroke, doctors are beginning to recognize the importance of testing for aspirin effect. On the other hand, the higher doses of aspirin, not only in some will produce a paradoxical clotting effect, but in others a hemorrhage!
Until recently, there was no quick, accurate and effective way to test for aspirin effect. An ADP adhesive study or a specific prostaglandin assay was used in research settings and not paid for by insurances. But now, with the AspirinWorks Test, we can be sure the aspirin is working with a simple no fasting urine test. The AspirinWorks Test is FDA cleared for use in apparently healthy individuals, and test samples can be collected in the doctor’s office at any time. The AspirinWorks Test determines the effect of aspirin on platelets by measuring the level of the biomarker called thromboxane B2 (11dhTxB2). The higher the levels of thromboxane B2, the stickier the blood platelets, and the less impact the aspirin is having. This crucial information allows physicians to individualize a patient’s therapy, which may be as simple as adjusting the dose.
When prescribing blood pressure or cholesterol medication, doctors routinely check the patient’s blood pressure or cholesterol to make sure the patient is getting the right dose of medication. Similarly it is important to know if the dose of aspirin you’re taking is effective. Now, when prescribing aspirin we can then decide to increase or decrease your aspirin dose or if additional medication is needed. As mentioned in my previous writings that just as important is the aspirin to prevent blood from clotting within the blood stream, acetaminophen is needed to inhibit the clot on the arterial wall!
Therefore acetaminophen (Tylenol) has been shown to work in conjunction with the aspirin. At the University of Georgia, Dr. Phillip Greenspan found that the acetaminophen is a potent inhibitor of the enzyme, myeloperoxidase. This enzyme oxidizes the LDL, modifies it in such a way that it is more delectable to the certain white cells (macrophages) that reside within the wall of our arteries. These ingest the LDL cholesterol and cause the plaque and obstruction, which is the father of atherosclerosis. In that the acetaminophen blocks the activity of this enzyme, there is less transformation of the bad cholesterol (LDL) that is available for the macrophages to ingest. This research was presented at the conference on arteriosclerosis, thrombosis and vascular biology in Denver, May 21, 2000 and in 2006 documented by John Merrill PhD at Rutgers. This can also be taken to prevent pain. Some people state it helps them to sleep, when taken at bedtime. Also a recent study at the University of Florida demonstrated that acetamenaphen elevates the mood. The bad press that Acetaminophen has recently had makes this well studied drug almost a curse word. It is true in very high doses like over 6,000 mg a day it can negatively affect the liver and perhaps the kidney, but 1000mg/day is positively healthy for all who want protect their blood vessels.
THE BOTTOM LINE-“Betwixt and between, Aspirin and Tylenol will keep the artery clean” One each 81 mg Aspirin and 500 mg Acetaminophen (TylenolR), both twice a day, will keep the heart attack and stroke away!!
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