Acupuncture for Irritable Bowel Syndrome (IBS)

In the last several years, an increasing number of studies have been conducted on treating IBS with acupuncture and Chinese medicine with promising results.  These studies have documented that Chinese medicine can effectively treat IBS in a safe and drug-free way.

Irritable bowel syndrome (IBS) is also known as spastic colon or mucus colitis.  It is labeled a syndrome because it involves a group of symptoms that varies for each individual who is affected.  It is a motility disorder (involving abnormal movement) of the small and large intestines.  Symptoms of IBS include abdominal cramping and pain, and constipation and/or diarrhea (often in alternating episodes).  IBS may also be accompanied by other gastrointestinal problems, such as flatulence, bloating, and nausea.  Symptoms are almost always aggravated by stress.  Episodes may also be aggravated by eating, and are frequently relieved after a bowel movement.  An estimated 10 percent to 20 percent of all Americans are affected by symptoms of IBS, with three times as many women as men being affected.

The cause of IBS is not yet known.  However, we do know what does not cause IBS.  IBS is not a structural problem, meaning there is no anatomical change, nor is it biochemical or infectious in nature.  Researchers are exploring the theory that there are direct links between the brain and the gastrointestinal system, which would explain why flare-ups of IBS are sometimes triggered by emotional upsets or stress.

While other patterns may be present, IBS is almost always considered a disharmony between the Liver and the Spleen in traditional Chinese medicine.  The Liver is responsible for the smooth flow of substances throughout the body.  This flow can be upset by emotions or stress, causing stagnation of Qi (energy) or blood.  Traditional Chinese medicine views the Spleen as being associated with the function of digestion and transforming food into energy (Qi and Blood).  The Spleen can be weakened by a number of factors, including overeating unhealthy foods, overwork, too much worry, fatigue, and lack of exercise.  When the Spleen is weak and the liver is not moving smoothly, the Liver overacts on the Spleen and can manifest as symptoms of IBS.

A Liver/Spleen disharmony is similar to the short-term loss of appetite or a bout of diarrhea that occurs during an occasional emotional upset.  With IBS, however, the phenomenon occurs in slow motion; the emotional trauma or stress takes place over a long period of time, and the digestive symptoms of IBS can last for years.

Practitioners of acupuncture or traditional Chinese medicine may use a variety of modalities to correct a Liver/Spleen disharmony.  They may use acupuncture, Chinese herbs, dietary therapy and lifestyle changes to facilitate healing of this condition.  Ther herbal formula Tong Xie Yao Fang addresses the disharmony between the Liver and Spleen, and might be a starting point with modifications for each individual case.

Some lifestyle changes that may help alleviate symptoms include:

  • Getting adequate exercise, which helps relieve stress, moves energy, regulates the bowels, and helps alleviate constipation.
  • Practicing stress relief measures, such as meditation, yoga, breathing exercises, or quiet time, is key to keeping IBS symptoms under control.
  • Dietary changes should be individualized, and should focus on eliminating foods that trigger symptoms and adding adequate fiber to the diet.  Soluble fiber is gentler on the GI tract, and includes foods such as oatmeal, berries, and legumes like lentils and garbanzo beans.  Crude fiber, such as bran and raw vegetables and their skins may be too irritating, and should be monitored as a trigger for symptoms.  Other foods that are common triggers include greasy or fatty foods, dairy products, alcohol, caffeine, chocolate and drinks that are carbonated.
  • Probiotics may be helpful for some sufferers of IBS.  Probiotics are supplements that augment the good bacteria in the gut necessary for digestion.  A common form is Lactobacillis acidophilus, which can be found in most natural foods stores.
  • Adequate sleep is important for sufferers of IBS, because stress, which is the most common trigger for IBS, is aggravated by lack of sleep.  In addition, adequate sleep helps the body heal and rejuvenate.

The Heart of Summer

The dog days of summer are an appropriate time to talk about the Fire element associated with summertime, and its corresponding organ, the Heart.  The longest, warmest, and brightest days of the year are related to the Fire element.  The warmth of Fire is needed for all transformation, such as the process of maturing plants and ripening fruits and vegetables that sprouted in the Spring.

The Fire element also corresponds to the organ system of the Heart.  We’re all familiar with terms like having a broken heart, feeling something in your heart, having a lot of heart, or emotions that are heartfelt, implying that our feelings are somehow related to our Heart.  In Chinese medicine this is true, as the Heart is home to your spirit, consciousness, feelings, thoughts, and memory.  While the function of the Heart in both Chinese and Western medicine is to move blood throughout your body, in the Chinese paradigm, the greater purpose of the Heart is to govern the conscious, emotional, and spiritual self.

The general health of your Heart is reflected in your face and eyes, which are considered a window to your soul.  In ancient times, Chinese doctors would determine the prognosis of a patient based on the health of the spirit reflected in their eyes.

Symbolism involving the Heart such as valentines, the color red, and passion is very much in keeping with the Chinese view of the Heart organ.  The color related to the Heart is red, which is also associated with passion, and the specific emotion of the Heart is joy.  However, the Heart can have a dark side, too, in which too much joyfulness can cross a line and become mania.  Hysteria, mania, and mental illness generally relate to the Heart in Chinese medicine.  Milder disturbances involving the Heart include palpitations (the sensation of skipped heartbeats), anxiety, insomnia, forgetfulness or fuzzy thinking, and restlessness.

Some things you might try to strengthen your Heart include:

-Gentle movements like those of Tai Qi, Qi Gong, Yoga, or stretching.

-Meditation or visualization.

-Food therapy:  in general dark colored fruits and vegetables and red foods, like red peppers, apples, strawberries, and small amounts of red meat are heart-nourishing.

-Acupuncture or Chinese herbs that specifically nourish the Heart.

Remember that your Heart is more than an intricate pump the next time it breaks, sings, or swells with a powerful emotion.

Go With the Flow: Acupuncture for PMS

I am frequently asked about the various conditions that acupuncture can treat, and one of the most frequent asks I get is whether acupuncture can help PMS.  The short answer is an emphatic yes.  In fact, gynecological conditions are some of the most successfully treated problems by Chinese medicine and acupuncture.

PMS, or Premenstrual Syndrome, covers a wide variety of symptoms, usually occurring within the week to ten days prior to the onset of a period.  The symptoms of PMS may be physical, such as breast tenderness, abdominal cramping, constipation or diarrhea, acne, and loss of libido.

However, it is usually the emotional symptoms that give PMS the bad reputation and fodder for endless (not so funny) jokes.  Emotional symptoms of PMS include depression, irritability, sadness, anxiety, and poor concentration.

In Western medicine, PMS is often treated like any other disease.  Its symptoms are treated with over-the-counter or prescription drugs or hormones.  In Chinese medicine, severe PMS is considered to be an indicator that an underlying imbalance exists.  Treatment is focused on correcting the imbalance, which is the source of the problem, not just eliminating the outward symptoms.

In most cases, PMS is the result of a stagnation of Liver energy.  In Chinese medicine, the Liver is an organ system (not your actual Liver)  that is responsible for the smooth movement of everything in your body.  This means that the unimpeded movement of food, energy, blood, and even emotions depend on a healthy Liver system.  A hallmark of blocked Liver energy is that any health issues you have are worse around the menstrual cycle, which is a body function  that also needs to flow smoothly.  So whether it’s headaches, digestive problems, or raging tantrums–if it’s worse around your period, you can assume that there is some blockage of Liver energy. 

Imbalances or stagnation can be caused by a variety of factors, such as poor diet, too much work, physical or emotional trauma, constitutionally weak energy, and especially stress.  When you’re stressed out or extremely frustrated, you can almost physically feel the stagnation taking place–the tighter and more “under pressure” you feel, the greater the blockage.  Taking good care of yourself by getting enough sleep, eating well (not giving in to cravings!) and doing all you can to alleviate stress will help with PMS.

Acupuncture is a very effective way to treat PMS.  Your practitioner may use a variety of modalities besides acupuncture, such as herbal formulas, dietary therapy and lifestyle changes.   When performed by a Licensed Acupuncturist, Chinese medicine is a safe, drug-free and effective way to treat PMS.  If PMS is affecting your life every month, try acupuncture, unblock some of that stagnation, and go with the flow!

Understanding Tongue Diagnosis

You may be surprised to find that during a visit to your acupuncturist, he or she may ask to look at your tongue.  This may seem like an odd request, and is probably the first time a health care provider (or anybody, for that matter) has asked you to stick out your tongue.  In Chinese medicine, however, a practitioner can gather quite a bit of information about you and your condition simply by taking a look at your tongue.

When an acupuncturist looks at your tongue, he or she is checking out the shape, color, size, and coating, each of which offers a piece to the diagnostic puzzle.

The shape and size of your tongue tends to address the status of fluids in your body.  For example, a very large, puffy tongue, or one with scalloped edges suggests that fluids are not being metabolized properly in your body.  In contrast, a very small, short tongue may indicate dryness, a deficiency of fluids, or a deficiency in general. 

Tongue color varies widely from person to person, but is a good indicator of the overall nature of what is going on in your body.  A red tongue indicates that there’s some kind of heat present, and the redder the tongue, the greater the heat.  A pale tongue suggests a deficiency of energy and blood or the presence of cold.  A purple tongue indicates that there’s some kind of stagnation in your body.

Tongue color may vary indifferent areas.  A tongue that’s red at the very tip indicates heat in the Heart (possibly anxiety or some kind of emotional disturbance), as the tip of your tongue correlates with conditions of the Heart.  Just behind the tip corresponds to the Lungs; the sides of the tongue are associated with the Liver; the center of the tongue with the Spleen/Stomach or digestion; and the back of the tongue is associated with the condition of your Kidneys.

A coating on your tongue can also offer up information about your health.  The thickness of a tongue coating is an indicator of the severity of the condition being treated.  A thin coating (one in which you can see the tongue through the coating), indicates that any pathogen present is mild or on the exterior (like a cold).  A thick coating that obscures the tongue body suggests that the condition is deeper and more serious.

The condition of the coating also speaks to the condition of fluids in your body.  A moist or wet coating indicates poor fluid metabolism, and a dry coating means that your body fluids are depleted.  A coating that’s peeled off, either partially or completely, indicates some kind of heat or damage to the Stomach, possibly depletion of Stomach Yin, or damage to Stomach energy.

Tongue coatings also vary in color.  In general a thin white coating is normal, but can also appear in diseases associated with cold conditions.  A yellow or brown coating is one that has  been “cooked” by heat in the body (indicating heat), and a gray or black coating indicates an extreme condition.  It’s also important to note that foods such as red wine, orange juice, and coffee can alter the appearance of the coating.  Needless to say, food dyes can dramatically alter the color of the tongue.  In more than one instance, I’ve had a patient stick out their tongue, only to see a bright blue, green, or orange coating!

The condition of your tongue will change as your health changes, but in general changes appear on the tongue slowly.  One exception is when you have a cold or the flu and are running a high fever, a very red tongue will appear fairly quickly.

Tongue diagnosis can be a subtle art.  To try it yourself, take a look at the variations of your tongue and compare it to that of friends or family members (and hope they don’t think you’re nuts!).  After you’ve looked at a few, you’ll see that they differ widely, and with a little practice can tell you a lot about someone’s overall health.

The Yin and Yang of Good Health

You may have heard of Yin and Yang before, or seen the Yin/Yang symbol that looks like a black and white fish swimming together in a circle.  Many people think that Yin and Yang are just a way of describing opposites, but they’re much more than that.  Yin and Yang play a role in all aspects of our life, from our overall health, to how we age, sleep, and even how our skin looks.

To best understand the concept of Yin and Yang, consider the Chinese written character for each.  Yang contains the elements of a hill and the sun, indicating the sunny side of a hill.  Yang, like the sunny side of the hill, is warm and bright.  Because of its warmth, Yang moves upward and outward and is transforming.  It’s associated with activity, change, daytime, and the warmer, sunnier months of the year.

In contrast, the character for Yin contains the elements of a hill and the presence of clouds, which has been modernized to the element for the moon.  Yin is represented by the shady side of the hill, which is darker, cool, and moist.  The cool nature of Yin moves downward, and inward, and is more nourishing.  Yin is associated with rest and recovery, nighttime, and the cooler months of the year that have less daylight.

Yin and Yang are relative terms in that nothing can be called Yin or Yang without being in relation to something else.  For example, spring is considered Yang when compared to the cold dark months of winter.  However, compared to summer, which is very Yang in nature (hot and bright), spring is considered more Yin.

In your body, Yang is a force that is transforming and warming; a little bit like metabolism.  Yin, on the other hand is cooling and nourishing and shares some of the same characteristics of body fluids and some hormones.  You could say that the physical substance of the body’s organs is relatively Yin, and the activities that the organs perform are relatively Yang.  So your stomach might be considered Yin, but the process of digestion is Yang.

How does this affect you?  Well, the relationship between the Yin and Yang in our bodies is continually shifting.  This relationship may be in balance, indicating relatively good health, or it may become out of balance and causing health problems and uncomfortable symptoms.  For example, too much Yang in the body may produce symptoms of heat and restlessness, such as irritibility, sweating, insomnia, and feeling too hot.  However, too much Yin might produce symptoms of cold and dampness, such as feeling cold all the time, edema, excess weight, and feeling heavy and tired–almost waterlogged.

One of the keys to good health is to keep the relationship between Yin and Yang in balance.  This can be achieved or corrected through the use of warming or cooling foods, Chinese herbs, and acupuncture.

Ten Things You Might Not Know About Acupuncture

Acupuncture may seem mysterious and risky to many people.  Others may picture acupuncture as being performed by an ancient Chinese man in the back of a noodle shop, as seen in old movies.  The reality is much different, and I’d like to take some of the mystery out of acupuncture by telling you some things that you might not have known.  Hopefully you’ll be surprised either by how much you actually knew or how much you learned from my list.  Here goes:

1.   There are several different kinds of acupuncture.  Besides Traditional Chinese Medicine (what I practice), there is Japanese style, auricular (ear) acupuncture, Korean Hand acupuncture, and Five-Phase acupuncture, to name a few.

2.  Researchers are finding that acupuncture affects brain chemistry (in a good way), giving us some new clues as to how and why it works so well.

3.  Acupuncture is thousands of years old.  It began in China as a way of treating infections and fevers, and over the centuries it developed into a comprehensive system of internal medicine.

4.  There are over 365 acupuncture points in the body.  Each point has a name–some of my personal favorites are Armpit Abyss, Crouching Rabbit, and Celestial Tripod. 

5.  Acupuncture can treat a wide variety of conditions.  Most people think that it’s only good for pain (which it is!), but it can also be effective for things like emotional conditions, insomnia, digestive problems, menstrual/menopause issues, and even for facial rejuvenation.  (However, if you have a broken bone, appendicitis, or strep throat, go to your MD!)

6.  Acupuncture is actually very relaxing.  More than once I’ve found my clients snoring while the needles are doing their work!

7.  The needles used in acupuncture are about the diameter of a hair, and are not hollow.  No shots involved and fairly painless.

8.  Acupuncture works by treating the underlying source of your condition–not just symptoms.  For example, if you have insomnia, your acupuncturist would find out why and treat that, not just the sleeplessness.

9.  Licensed Acupuncturists have the minimum of a Masters degree in Acupuncture or Oriental Medicine and about 3,000 hours of education and clinical training.  They are also licensed by their State Board of Medical Practice.

10.  No two acupuncture treatments are the same.  Every person is unique, with different symptoms, health history, and lifestyle.  Acupuncture treatments are customized for each individual’s needs.

Help for Seasonal Allergies

Ah, ah, ah…choo!  Lately I’ve been seeing a lot of people in my office who suffer from seasonal allergies.  If you’re among them, you’re no stranger to the itchy eyes, stuffy or runny nose, sneezing and that “blah” feeling that affects allergy sufferers everywhere.  Some people experience allergies year round, but most have symptoms in the spring or fall.  While we welcome the warmth of spring after a long winter, or the cool, dry weather of fall, seasonal changes can be physically stressful.

In Chinese medicine, our bodies are surrounded by an outer layer of energy which acts to protect our “exterior” and fight off outside pathogens that cause colds, flu and allergies (similar to our immune system).  Pollen, pet dander, dust and mold (to name a few) act like outside pathogens.  People who are susceptible to allergies, along with people who get sick a lot tend to have weak exterior energy.

Acupuncture and herbs can help allergy sufferers by reducing symptoms and by strengthening energy to head off problems before they start.  Some things you might try during the height of your allergy season include:

-Shower at night to wash the day’s pollen off your body and out of your hair.

-Wash your hands after petting your animals that have been outdoors–they’re covered with pollen.

-Close your windows at night, especially when it’s dry and windy.  The best time to open up is after it’s rained, because the rain causes pollen to settle.

-Try nasal irrigation.  Your nasal passages act like a filter for pollen, so cleansing them will clean out pollen and clear congestion.  We recommend using a Neti pot, which looks like a small tea pot and has been used in India for centuries.  You can find Neti pots at most drug stores, health food stores or coops, and should come with directions for use.

Spring, Wood, and Better Mental Health

The effective treatment of depression and emotional conditions by acupuncture is best explained through the element of Wood, spring, and Liver Qi Stagnation.  Here in the north country, spring is here (okay almost here), which is traditionally a time of change, rebirth, and beginnings.  In Chinese medicine, spring also corresponds to the element of wood and the organ system of the Liver, which are all related to the concepts of movement and flexibility.

When we talk about the element of wood, many people immediately think of the hard wood from mature trees.  However, the tiny green sprouts of new plants are also considered wood, and in many ways give us a better understanding into this element.

The characteristics of plants and wood are also the characteristics of the Liver system in Chinese medicine.  Plants grow strongly, yet maintain their flexibility.  Without flexibility, or the ability to bend, plants will break.  Likewise, one of the key jobs of the Liver system is to govern the strong, yet smooth flow of everything in our body–energy, digestion, menses, and emotions.

When we are not flexible emotionally, Liver energy, or Liver Qi, stagnates and causes illness.  When we’re stressed or life throws us a curve ball, our ability to “go with the flow” is a huge determinant in our health–both physical and mental.  We live n a world of many wants, expectations and the idea that we can control almost everything.  However, when we don’t get what we want or try to “muscle” a situation that’s beyond our control, we become frustrated or angry, which stagnates our Liver energy.  This is figuratively like leaving a shovel covering the new sprouts in your garden.  Things don’t grow or flow very well.  In your garden the result is crushed and deformed plants.  In your body, the consequences can be broad–depression, digestive problems, insomnia, and pain.

So when you herald Spring, remember to allow room in your life not only for new growth, but also for the flexibility to grow in unexpected directions.  Open your mind to new ideas and experiences, get outside and move, brainstorm new solutions to old problems, and get acupuncture if you need help in moving stagnant energy and emotions.  Above all else, enjoy the incredible phenomenon that is spring!

Choosing the Right Acupuncturist

If you’ve never had acupuncture before, choosing an acupuncturist can be a little bit overwhelming.  It’s the brave soul who just opens the Yellow Pages and picks the closest practitioner or the one with  biggest listing, knowing nothing about who they are or how they practice acupuncture.

A better plan would be to ask some questions before you book an appointment to make sure you’re getting the right practitioner for you and your particular needs.  As a practitioner, I’m always impressed when a new patient asks a few questions about me, my education or licensing, or how I treat their particular condition. 

The following is a cheat sheet as to what questions you should be asking before you book that first acupuncture appointment.

Are you a licensed acupuncturist?  What’s your education in acupuncture?  This is probably the most important question you can ask anyone before they perform acupuncture on you!  Frequently consumers are led to believe that any practitioner who’s trained or certified to practice acupuncture has extensive training in Chinese Medicine.  Don’t hesitate to ask a prospective practitioner about their credentials and training.

Physicians are only required to have 50 hours of training in the technical use of acupuncture prior to using it as a treatment.  This is considered “medical acupuncture”.

Many chiropractors advertise that they offer acupuncture.  It’s important to know, however, they are only required to have 100 to 150 hours of unspecified training in acupuncture.  They typically take a test sponsored by their local Chiropractic Board and pay a fee to become “certified”.  Chiropractors who perform acupuncture call themselves “Board Certified Acupuncturists”.  In addition, they are legally limited to performing acupuncture treatments that augment chiropractic adjustments.

Licensed Acupuncturists (L.Ac.) in most states are required to have a minimum of 1,800 to 2,400 hours of education which includes clinical training.  In some states they’re required to have more.  They also have to be board certified with the NCCAOM, a national regulatory agency governing Oriental medical credentials.  L.Ac.’s are also licensed by their state’s Board of Medical Practice.

Licensed acupuncturists practice internal Chinese medicine, which focuses on the underlying source of a problem rather than just relieving symptoms.  As a result, their treatments go beyond simple pain relief and may include the use of Chinese herbs, dietary therapy, body work and lifestyle changes.

Do you have a specialty?  What’s your experience and success with my particular condition?  Some acupuncturists treat any and all conditions. Many specialize, however, in treating certain problems, such as muscle and joint pain, stress and anxiety, infertility, or women’s conditions.  It’s important to ask whether a prospective practitioner has some experience in treating your condition. 

What kind of acupuncture do you practice?  Most people don’t know that there are many different kinds of acupuncture, such as Traditional Chinese medicine, ear acupuncture, Japanese style, Korean Hand acupuncture, cosmetic acupuncture and scalp acupuncture.  Some of these different styles are more effective for specific conditions.  For example, ear acupuncture is effective for people with addictions, like quitting smoking and weight loss; and scalp acupuncture is frequently used for conditions affecting the nervous system.  Be sure to ask what conditions are best helped by your practitioner’s kind of acupuncture.

How many treatments will I need?  This is actually a trick question.  No practitioner should answer this question on the phone before they have seen you, taken your health history and made a diagnosis.  In fact, everyone heals at a different pace.  Your condition may be resolved in one or two treatments, or it may take many more, especially if it’s a chronic condition.

Do you accept insurance?  Many health care plans currently don’t pay for acupuncture treatments.  As a result, many acupuncturists are fee for service (cash) providers.  If you think your health insurance plan may cover acupuncture, check with them to be sure and that the acupuncturist you ultimately choose will accept your insurance as payment.  If you have a health savings plan, acupuncture qualifies for reimbursement.  Be sure to ask your practitioner for a receipt.

Acupuncture for Weight Loss

I frequently get calls from people who want to know if acupuncture can help them lose weight.  Unfortunately, most have this picture in their mind that after a few sessions on the table, their excess weight will magically melt off their body.  If this were the case, acupuncture would be a multi-billion dollar business with an endless amount of buzz.

The reality is that acupuncture can help people who are trying to lose weight, but there is no magic bullet or acupuncture point that will make the pounds melt away. 

However, acupuncture helps with weight loss in a couple of ways. First, it’s really effective if you are trying to break an addiction, whether it’s smoking, alcohol, or food.  There are several acupuncture points (many of which are in your ear) that can help decrease cravings–and that includes those craving for those Krispy Kremes and potato chips.

Acupuncture can also support your weight loss efforts by decreasing stress.  While many people think of acupuncture as an alternative therapy for pain relief, it is also effective in treating stress, anxiety and depression.  How is this helpful in your efforts to drop some weight?  Well, most people tend to turn to the refrigerator or the drive through at Wendy’s when they’re really stressed or down.  And let’s face it, who doesn’t feed those PMS emotional swings with chocolate–and lots of it?  By supporting your emotional health with some acupuncture treatments, you will avoid some of the situations when emotional eating kicks in instead of common sense and good food choices.

Finally, acupuncture supports weight loss by improving your digestion.  You may be thinking, ”If I’m digesting better, wouldn’t that be adding weight?”  Actually, just the opposite is true.   With good digestion, your body won’t crave those foods that derail your weight loss efforts and you’ll have the energy you need to get through the day without crashing (and maybe even do a little exercise). 

In addition, poor digestion leads to a condition called dampness.  The best way to describe dampness is to compare your body to a farmer’s field.  A healthy field has good soil, plenty of sun and adequate water–all to nourish the plants that will be growing in that field.  However, a damp field is one that doesn’t drain well.  When it rains, the water sits around in puddles and creates boggy spots in the field. 

On our bodies fat is considered damp tissue.  It’s the result of overeating, poor digestion and your inability to metabolize moisture very well.   It sits on your body just like soggy puddles in the farmer’s field; it feels heavy, and it kills your motivation to exercise. 

So how does acupuncture address dampness?  The first order of business is to work on improving your digestion.  This is done through a combination of acupuncture, Chinese herbs and food choices that enhance the digestive process.  As your digestion gets better, the tendency towards dampness will also improve. 

A few tips for better eating include:

-Cooked foods are easily digested.  Try to eat lots of soups, stews, and stir fried dishes.

-Avoid drinking ice cold liquids, and limit the amount you drink with meals.

-Go for the lighter foods, like vegetables, some fruit, a little protein and complex carbs.

-Avoid foods that are particularly dampening, like overly greasy foods, concentrated juices, saturated fats, sugar and sweeteners, and alcohol.

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