Around the Web; Curing Constipation Edition

Shou-Ching and I will be speaking tomorrow to the Living Paleo in Boston group, at a potluck dinner hosted by Amit and Shilpi Mehta, on the topic of “Common Pitfalls of Paleo.” We’re excited to meet everyone. Kamal Patel has already promised a question about “the philosophical and emotional aspects of glycogen.”

Also, Paul will be appearing on Patrick Timpone’s The Morning Show on Thursday, Oct 13, at 11 am EST/10 am CST.

[1] Book Reviews and Cures: Several mentions of our book came to our attention this week:

Larry Carter of Dan’s Plan included us in his “Five Slightly Different Flavors of the Paleo Diet.” (The other flavors: Cordain, Wolf, de Vany, and Sisson.)

Steve Omohundro called our book, “My favorite reference … I’ve read it twice and am still learning lots from it.”

Sean at Prague Stepchild offered kind words:

What’s cool about this book is that it is sort of the health aficionado’s health book, yet at the same time extremely accessible. So accessible that my wife has pretty much been monopolizing it since it arrived more than a month ago. This is especially notable because my wife’s native language is Czech, and while her English is excellent, she’s not crazy about reading books in English. In fact she just plain doesn’t do it.

Jennifer Fulwiler of Conversion Diaries gives the best review ever:

I love the subject of nutrition. My fascination with it began when I was 18, and for the past 16 years I’ve read tons of books on the subject, from pop diet paperbacks to heavy textbooks…. I have found a book that is head and shoulders above everything else I’ve ever read on the subject … It’s called The Perfect Health Diet, and it is awesome. (To give you an idea how good it is, I stayed up late reading it in the hospital the night after the baby was born because I couldn’t put it down!)

There you go: We keep moms awake even better than their newborns!

Gratifyingly, a couple of cures were reported on the constipation thread. First, Anna:

I’m so grateful to you for this information. I’ve been suffering for weeks but I took the recommended supplements and did nothing else — and experienced relief the second day. In a world full of useless and confusing information, having a good source is such a godsend. Thank you for all that you do.

Then, Vincent reported his constipation is almost cured with our anti-fungal diet:

After a few weeks of little improvement, I experienced my first normal bowel movement in a long time (years?).  After more changes to my regimen, I now have normal stools on most days.  The greatest improvements coincided with the times I added fermented tubers and (later) ThreeLac.  I also think that cranberries, turmeric, increased amounts of safe starches, the Now Foods anti-fungal, and removal of my beloved coconut oil were all quite helpful.  My victory is not complete — I still get diarrhea fairly easily and the occasional hard stool — but the improvement is incredible.

Many thanks, Paul, for helping me fix a problem that has plagued me for a long time.  I wish you, Shou-Ching, and all your readers the great health and happiness you deserve.

Sincerely,

Vincent

Our sincere thanks to everyone who reports results. It’s such a pleasure to hear from you!

[2] My Research for Kamal’s Question:

Via Andrew Day on Facebook.

[3] Interesting Items This Week: Kurt Harris is one of the most respected authorities in the Paleo movement, and Jimmy Moore asked his thoughts on our advice to eat a certain amount of “safe starches.” Kurt’s discussion is excellent. His diet advice is essentially identical to ours, although the reasoning by which we reach our conclusions differs in a few respects.

Over at Dallas and Melissa Hartwig’s blog, a great “Whole9 success story”: How Jessica O cured trichotillomania and seizures with a Paleo diet.

Beth Mazur explains why she’s the Weight Maven (“A Maven is someone who wants to solve other people’s problems, generally by solving his own.”) and links to a cool cartoon showing the significance of a Ph.D.

Robb Wolf backs ever so slightly away from low-carb: “In years gone by I’d have staunchly recommended a low carb paleo diet as THE best intervention but I can’t in good faith recommend that anymore.”

Perhaps he was influenced by this study. Bix at Fanatic Cook passes on results from a large population-based study (27,140 participants) in Sweden:

  • A high-protein intake was associated with an increased risk for type 2 diabetes.
  • Replacing protein with carbohydrate … was associated with a lower risk for type 2 diabetes.

Stephan Guyenet is starting a series on the mechanisms underlying food reward. I think this is much needed, and I’m in the group he’s targeting (“skeptics” and “scientifically inclined people who want mechanism”). (Note: I’m not skeptical that food reward exists, or that addictive-like wanting is an important factor in many cases of obesity. I’m skeptical over the origins of addictive-like wanting, and over the universality and importance of this factor – whether it is the cause, or a symptom; whether bland food is curative, or merely a means of symptomatic relief. I’m wondering whether there will be compliance to an unrewarding diet.)

Peter at Hyperlipid conducts a trial to prove that chocolate is more rewarding than bananas. On another thread at Peter’s, Jenny Ruhl points out an interesting fact about obesity and diabetes:

The number of people with diabetes in the overall population stays fairly close to 9% but the number of obese and insulin resistant people keeps growing to where it is somewhere between 1/2 and 2/3rds of all older adults.

So whatever is causing the obesity epidemic, it doesn’t promote diabetes.

Stan the Heretic gives us a study from Sweden claiming that gene expression is optimized on a 1/3 carb 1/3 fat 1/3 protein diet:

“Both low-carb and high-carb diets are wrong,” says Johansen. “But a low-carb diet is closer to the right diet. A healthy diet shouldn’t be made up of more than one-third carbohydrates (up to 40 per cent of calories) in each meal, otherwise we stimulate our genes to initiate the activity that creates inflammation in the body.”

Dr. Briffa discusses a study showing that B12 deficiency is linked with brain shrinkage in later life.

Chris Masterjohn shows evidence that dietary protein protects against cancer by raising glutathione levels.

Via Julianne Taylor on Twitter, CoQ10 maintains fertility in older women.

ScienceDaily links to a new Nature paper showing that fat cells in obese people store fats more easily and shed fats less easily than fat cells in normal people. A study author says “this is the first time that someone has demonstrated that the metabolism of fat in the fat cells differs between healthy and obese individuals.” If something so basic had never been demonstrated, it’s no wonder the blogosphere can’t agree on what causes obesity.

More manipulation of mammals by germs: From The Scientist, A Lactobacillus rhamnosus strain reduces anxiety and depression in mice, and may do the same in people, according to a new paper in PNAS.

While fermentation of vegetables produces very healthful foods, fermentation of meat tends to culture germs that can digest us, and is a very risky activity. Melissa McEwen points out that the lore of how to do it safely has largely been lost.

Wired.com has some neat graphics on the gut microbiome. Most striking to me was this chart of how long it takes people who don’t eat kimchi to refresh their gut flora:

[4] More music: We’re so classy, classical music isn’t good enough unless wine glasses are involved. Here’s Bach’s Toccata and fugue in D minor:

[5] The 2011 Ig Nobel Prize for Medicine has been awarded: For demonstrating that people make better decisions about some kinds of things, but worse decisions about other kinds of things, when they have a strong urge to urinate.

Via Peter Klein.

[6] Cute animal photo: From Logan Pass, Glacier National Park, Montana:

Via EarthPorn by way of Lance Strish.

[7] Best Comments This Week (not about constipation):

Jana had a great comment on the relentless pressure on cancer patients to be “upbeat,” and the harm it may do.

Majkinetor guides us to a paper showing that a maternal protein-deficient diet can promote high blood pressure and impaired glucose metabolism in offspring, but that this effect can be rescued by folate supplementation. Vitamins B6, B12, and choline are even better.

Lance Strish had a very informative discussion of toxicity from AGEs and ALEs.

[8] Shou-Ching’s Photo Art:

[9] “Little Miss Muscle”: Was spindly 7th-grader April Atkins the world’s strongest teenager?

Via Instapundit.

Leave a comment ?

37 Comments.

  1. “I’m wondering whether there will be compliance to an unrewarding diet.”

    If we are using Stephen’s terms consistently, wouldn’t it be more accurate to say “I’m wondering whether there will be compliance to an UNPALATABLE diet”? An “unrewarding” diet, as I understand Stephen’s terms, means a diet with foods that do not motivate you to eat more. An unpalatable diet, on the other hand, is one where the foods eaten do not in themselves provide pleasure. Using this technical understanding of the words, it seems to me that an unrewarding diet would, by definition, be a diet where you don’t want to eat more, and therefore would be compliance-inducing. An unpalatable diet, because lacking in hedonic value, might leave a person looking for something that produces some pleasure.

    It may be that “reward” is being used in two different ways: once, as a shorthand for the Food Reward Hypothesis in full (which comprises both reward and palatability factors); and a second time to refer only to the technical definition of the “reward” factor as the motivating, desire creating aspect of foods. In order to avoid confusion of this sort, I wonder if it would be best to replace one of the two “reward” words with something else. The flipside of “reward” is, it seems to me, satiety. High reward foods create the desire to eat more; high satiety foods extinguish the desire to eat more. So maybe we can say that the “Food Reward Hypothesis” consists of looking at how sating a food is and how palatable, instead of how rewarding it is and how palatable.

  2. Thanks for the Bach on musical glasses! What an amazing sound! Can you imagine the set-up. I’m sure he has each glass marked for water level, but still . . . Have you seen this?

    http://en.wikipedia.org/wiki/Glass_harmonica

  3. Hi Remnant,

    Well, the goal should be to find a palatable but unrewarding diet. Unrewarding leads to weight loss, palatability leads to compliance.

    Actually, I think the Perfect Health Diet is that. Highly palatable, but it doesn’t promote overeating.

    My trouble is that Stephan’s prescription for weight loss was to eat intentionally bland food, lacking things like salt and spices. But things like salt, I believe, are rewarding (up to a point) and palatable because they are good for us.

    I think the wanting/liking distinction is a very helpful one, but how best to operationalize the food reward concept for weight loss is still an open issue I think.

    Hi Marilyn,

    It doesn’t seem like he has young children in his house, does it?

  4. Hi, Paul. Definitely not! LOL Frankly, I wouldn’t trust myself around that instrument, either!

  5. I think there is probably a genetic component to full-blown diabetes, the difference between regular ol’ insulin resistance and losing an arm.

    Stephan’s a good dude, I’m glad he’s telling us everything that he knows. I just think that the keystone is leptin resistance, and it is mostly caused by the same things that cause everything else and that most obese people have an extremely impaired ability to burn fat relative to metabolically healthy people, so perhaps in Stephan’s idea we have a valuable tool for helping people, but I don’t think that it is an adequate explanation of why people get so fat in the first place.

    It is interesting to see Robb Wolf changing his stance a bit, although I doubt that it is because he thinks that very high protein diets cause insulin resistance, that seems very dubious, we can throw statistics at each other all we want, but unless we’re omnipotent it is kind of pointless. Conspicuously absent from that study was a control for the propensity to eat one’s protein with sugar or trans-fats, the perfect storm, harbinger of doom. I’ll believe it when I see properly controlled trials affirm it, the one cited in that blog post differed too much in dietary fiber to be able to pin the difference on protein. Who is to say if the fiber was made up for in the high protein group with avocados, jicama and other non-grain fibers that it wouldn’t have been better?

    There are probably problems with the very high protein intakes, but I don’t think that diabetes is one of them. There also seem to be benefits, I stumbled upon this study claiming that high animal protein, much higher than PHD recs, improved reaction time. http://www.ncbi.nlm.nih.gov/pubmed/21239090 That is a big deal for me, I am a warrior, I have to do battle with honey badgers and wolves and stuff, those are the most pressing issues for me. Anyway I don’t have access and I can’t be bothered to go to the library so I haven’t read it, I will eventually, but I figured you might want to take a look at it.

    Ah the protein question, I consider it a lot more up in the air than carbs, which you seem to have solved with awesome detective skills.

    Cheers!

  6. Paul, thanks for your response. I am completely in agreement with you on this point. And in fact that is exactly why “paleo” style diets (including but not limited to PHD) are so appealing: they allow you to enjoy your food (palatability / pleasure / hedonic response) without overeating (“reward”, satiety).

    My main point above was that the word “reward” is being thrown around too loosely: in some instances (as I saw you using it in the sentence I quoted) it is used as a short-hand for “Food Reward Hypothesis” (which includes satiety and pleasure) and in other instances it just refers to the sateity aspect of the theory (or lack of satiety).

    You have brought out another key point which is: how important is hedonic value in itself for explaining obestiy? either a food induces you to eat more of it or it doesn’t, and whether that food induces pleasure as well is secondary.

    Indeed, one can well imagine some type of nightmare food or diet drug that induces satiety too completely, resulting in starvation as satiety is reached well before good nourishment is achieved.

  7. Whoa – not so fast.

    Safe starches are not a good idea for those who are -pre-diabetic, or close to that state. My personal experiment of eating a sweet potatao took 6 hours for my blood glucose to return to normal. Safe starches, if they really exist, need to be much more carefully qualified.

    As for the Bix referenced studies – they considered 43% carb ratio as LOW CARB. The conclusions are necessarily bogus.

  8. It is interesting that “dietary protein protects against cancer” as I have been thinking that protein increases the risk by raising IGF-1?!

  9. Paul wrote: “My trouble is that Stephan’s prescription for weight loss was to eat intentionally bland food, lacking things like salt and spices. But things like salt, I believe, are rewarding (up to a point) and palatable because they are good for us.”

    Yes, this. This is why I groked more Kurt’s Pringle example of a food being addicting without being necessarily highly palatable.

    Remnant wrote: “Indeed, one can well imagine some type of nightmare food or diet drug that induces satiety too completely, resulting in starvation as satiety is reached well before good nourishment is achieved.”

    We have to imagine that? Oh, wait you said starvation, not malnutrition ;) But then it’s difficult to separate the two, and the rebound effects of a low nutrient diet. One would need to eat this hypothetical food more and more frequently as the body craved more vits and minerals until eventually they’d be chain-eating with an IV to make it through the night.

  10. @Sean

    Yeah, the SAD diet definitely results in malnutrion, and I take your point. But I think you missed the distinction I was making: the SAD diet is NOT highly sating (i.e. it is high reward) and it results in people overeating the wrong foods resulting in malnourishment. That’s true. I was positing some pill, say, that is low calorie but gives your body a feeling of satiety (i.e. low reward).

    Maybe it is worth running the permutations on Stephen’s two variables:

    1. low reward (high satiety) + low palatability :: a bland diet where you don’t feel like overeating. Presumably some of the very tuber-heavy diets of Africa and the Pacific Islands might fall into this category.

    2. low reward (high satiety) + high palatability :: this is the “paleo sweet spot”, you derive pleasure from your food, feel very sated but without any cravings to overeat.

    3. high reward (low satiety) + low palatability :: Kurt Harris’s pringle example may fit in here. Pringles are not by any objective measure an absolutely delicious food … yet they leave you wanting more. Probably much of the processed flour and sugar foods common in the SAD feature here; think fried dough at the county fair, soda, Chip’s Ahoy. Not delicious but “addictive”.

    4. high reward (low satiety) + high palatability :: This is something of a rich fat man’s diet: it includes a lot of the things one SHOULD eat (steak, cream, fatty fish, potatoes, pate) but also a lot of the foods one should NOT eat (bread, pasta, pastries), so that the food itself is delicious but the bad carbs prevent the sense of satiety that would lead one to stop eating.

    The SAD diet is probably somewhere between 3 and 4. To my mind, the above schema clarifies that the problem is high reward (low satiety), not palatability.

    So the question is why Stephen feels that leading people away from 3 and 4 requires guiding them to 1 rather than 2. If his answer is that 2 tastes too good (palatability) and therefore people eat too much on it, I would start to question the wisdom of trying to bifurcate reward / satiety and palatability.

    His first post discussed that there is overlap between the biological mechanisms that govern reward and those that govern palatability, so perhaps there is no way to separate out those categories in totally clean ways, or maybe we are falling back into a mind-body conundrum…

    Finally, the reason I kept including “satiety” in parentheses where the word reward showed up, is — if this isn’t clear by now — that I think the term “reward” as used as a term of art by Stephen is confusing people.

  11. Fantastic find about CoQ10 and fertility. Thx.

  12. Remnant, wow really interesting breakdown of the variables and their permutations. I like the idea of using satiety instead of reward (ha ha, art term). The problem, as I see it, is that satiety doesn’t really express the addictive aspects that lead to the overeating pringle effect. If these kinds of foods are hitting or overhitting the addiction part of the brain, and, as Kurt Harris seems to believe, being tied in with low impulse control, then aren’t we are really led back to reward? And of course the messy murkiness of addiction?

  13. Do you know of a connection between gut microbes and things like gluten sensitivity? Could the use of antibiotics be impacting how many people have extra sensitivity to gluten? Could it also help explain other food allergies that pop up later in life (seafood etc.)?

    Maybe some of the problems with our modern diet are exacerbated by the use of antibiotics.

  14. Sean, good point about the addiction nuance of “reward”. The opposite of satiety would seem to be something along the lines of a general craving, rather than a specific desire for a certain foodstuff, so you are right that satiety doesn’t capture the whole picture.

    Partly this is because it is difficult to describe the opposite of stasis, normalcy, health. (To paraphrase Tolstoy, everyone healthy person is healthy in the same way; every unhealthy person is unhealthy in his own way.)

    Once we start talking about “low impulse control”, we enter the realm of volition, discipline and personal responsibility. (One blogger called it the “mind-body” problem; some guy in Eastern Europe, name escapes me at the moment.) :)

    Some aspects of “low impulse control” may be chemical, genetic or otherwise predetermined; but some party of it also has to do with a person’s character. As Harris said on your blog, the concept of gluttony is not without meaning. Even if we work out all the chemical mechanisms, we are still left with the mystery of some people being able to resist. I think lifestyle, stress* and also pure ignorance play a role in food “addiction”. After all how many of us were “addicted” to wheat before we learned about paleo; but then when we did learn, we walked away from wheat pretty quickly.

    *Robert Sapolsky has a good chapter on the role of stress in addiction in his “Why Zebras Don’t Get Ulcers.”

  15. Sadly, I remain the skunk at the picnic re: “safe starches.” Every time I introduce rice or potato to my diet, I bloat like a puffer fish and start dealing with horrific, nearly uncontrollable food cravings. Binges begin and fat gain skyrockets. Takes weeks to undo. In desperation, I tried a zero carb (Dukan-type) diet and the food cravings disappeared. But more interesting for me was the fact that along with binges and cravings, I also lost all interest in alcohol. Alcoholism and diabetes are frequent problems in my family history, and zero carb seems to be my last, best hope to escape both. I suspect these conversations will continue to evolve, but for me, the science may be settled and not in a way Kurt Harris would expect.

  16. He he, that Eastern European blogger is a total rube.

    This paper Stephan references in his most recent post, and that J Stanton has been talking about for a while is well worth a read, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717031/?tool=pubmed I’m reading it right now actually. Berridge talks about “wanting” vs “liking” and how this is tied up with learning (as has been JS). Separating these three components in a distinct and measurable way seems the key to a real FRH vs hand-waving mumbo-jumbo. I think for FRH to be real it MUST be measurable with chemical and learned responses to food reward (the chemical part being a result of genetics), hence it ought to be measurable in animals where character judgments aren’t made. Taubes seems to believe that this is only necesary to measure on the body’s cellular level (why are these cells taking in or not this free floating abundance). FRH would be adding in the chemical effects on the brain along with the learned responses. Or at least that’s how I see it at this point in time.

  17. Sorry, forget to add, Remnant, to the beginning of that last comment.

    Kathy, I believe Kurt Harris spoke directly to that when he talked about how LC might be a necessary therapy for some, and that it was important to distinguish therapy from optimal. So a diabetic or some other metabolically deranged person might need to go LC just as a person with an infection might need antibiotics. That doesn’t make taking antibiotics every day optimal.

  18. My point is not that Harris or PHD or anyone else is “wrong,” but that among that many low-carb dieters who are following this debate, there may be a large minority who are still better off avoiding the safe starches or at leasting keeping below the 100-gram-per-day minimum the PHD recommends.

    I, for one, would like nothing more than to be able to eat potates and rice with impunity, but I would also like to drink alcohol with impunity. I cannot do either.

  19. re: kathy – but might you be able to if you were taking so-called “non-nutritive” substances? for example high doses of high quality schizandra extract, a potent type 1 and 2 liver detoxifier?
    this is where i think paleo drops the ball, in its gross oversimplification of supplementation. hers vs synthetics, etc. dosages, timing, combinations…

  20. Kathy, unless you already have done so, you could try to experiment with coffein elimination against alcohol cravings.
    My own experience is that coffee in the morning and mid-day provokes some kind of stress response, which I am inclined to counter with wine, towards the evening.

    So for me skipping coffee leads to skipping drinks (unless there is a real legitimate social reason to drink, of course)

    I also feel generally better when on a low carb, plus gluten and dairy free diet.

    It’s boring, but it makes me happier and more productive.

  21. I tried taking CoQ10 a while back and I couldn’t sleep a wink so I didn’t stay on it long enough to see if it . My sleep has finally improved on higher carb (fruit and safe starches) and swapping muscle meats for more gelatinous cuts. But still no improvement on the anovulatory stuff or constipation, but I wasn’t aware of the constipation thread, so I’ve decided to try out selenium and zinc supplementation, and be more consistent with the vitamin C. Thanks for all you do.

  22. Thank you for all the great links. BTW the study Stan discusses is from Norway not Sweden. And the study authors are seriously over interpreting their results.

  23. @Remnant,

    that’s how I see food reward! Thanks for laying it down so clearly.

  24. paul – i have a question. I want to buy pure dextrose to use instead of sugar in baked goods (a rare treat). I found tapioca dextrose and corn dextrose. I would choose tapioca over corn as a food any day, but what about when it comes to dextrose? Should i go for the tapioca dextrose or does it not matter?

    thanks

  25. If I understand his theory correctly, it seems to me that Stephan has the whole food reward thing exactly backwards. Judging from my one-rat experiment of over 40 years, I can tell you that I find it much easier to stop eating after eating something really seriously GOOD (rewarding) than to stop eating after eating anything ho-hum. Boring, unsatisfying foods just encourage me to keep trying until I get it right, i.e. eat something satisfying.

  26. I’m not sure how to ask a question not-quite-related to a post so I’m commenting instead. I’ve instituted “Paleo” in our house since 1/1/11. Very strict about only plants and protein. About 4/1/11 I realized I was experiencing extremely dry eyes and mouth. I read your post about glucose deficiency and added rice and potatoes back into our diet. This cleared the problem up within 3 days and I was super grateful. It also *normalized* our diet, as it’s easy to go out to lunch and have rice/potatoes while avoiding wheat/grains. The questions, though… can I still become diabetic with rice and potatoes (but no wheat, other grains, and very little sugar) in my diet? I didn’t lose any weight on Paleo (well, I lost 8 lbs but gained it back eating exactly the same diet…and now, well, some more). I feel like a freak. All I read about are people losing dozens or scores of pounds and I lose nothing. Honestly, I’ve had maybe the equivalent of 6 pieces of bread in 10 months. I’ve recently discovered brown rice pasta and it has the potential to add another normalization piece to our diet, but I’m worried that it’s really the carbs I should be avoiding and that adding rice and potatoes and rice pasta/crackers/etc back in is bringing me back to square one. Advice?

  27. Hi Paul,

    Have you heard of iodine causing “frozen gut” syndrome? I seem to have a mild case, but only just connected it to increased iodine intake. Apparently it is not uncommon.

  28. Paul,
    I am wondering ifmyou know how long it takes to repopulate gut flora after antibiotics if one takes probiotics. I am also wondering how to decide which probiotics to take. Additionally, do you know of any research on gut flora and allergies. Many thanks. (Have bought 3 copies of your book!)

  29. Hi Jeanne,

    Those are great questions but research is a bit lacking.

    It often takes more than 2 years to replenish gut flora after antibiotics, but that is with people who don’t eat fermented foods. I think it should be possible to do it much faster.

    For probiotics, I would say while you’re on antibiotics look for quantity (or low price and take multiple pills) and after you’re off look for diversity of species.

    There is a fair amount of research on gut flora and allergies but it is hard to interpret and hard to apply. I would say make sure your vitamin D and A levels are optimal.

    Best, Paul

  30. Something I’ve wondered about — it’s my understanding that stomach acid can do in a lot of bacteria. How many of those “friendly bacteria” in yogurt and such ever actually make it beyond the stomach?

  31. “Wired.com ( http://www.wired.com/magazine/2011/09/mf_microbiome/ ) has some neat graphics on the gut microbiome. Most striking to me was this chart of how long it takes people who don’t eat kimchi to refresh their gut flora”

    It would be interesting to know if/how the microbiome differed post antibiotics, ie. did “bad” bacteria such as h.pylori come back stronger (higher %) than good bacteria

  32. Hey Paul,

    In one of the constipation success stories the person reported: “I also think that cranberries, turmeric, increased amounts of safe starches, the Now Foods anti-fungal, and removal of my beloved coconut oil were all quite helpful.”

    Why would eliminating Coconut Oil be helpful in overcoming constipation?

    Many Thanks, …and I’m counting down the days til the new release!

    Colin

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