Why talk gluten when low-carb or grain-free?

Even with low-carb or grain-free eating, avoiding gluten still takes knowledge, awareness and vigilance.  The problem is common and the down-side is serious.

Answer:

  • because 1% plus 7% of the population equals a whole lot of people (8 of 100 people).
  • because gluten hides unsuspected in low-carb foods (e.g. most sausages).
  • because when eating out, travelling or eating at friend’s homes, people may make-do by removing croutons, removing the bun, removing the breaded coating, etc.
  • because people may sometimes make the choice to, say, have a tiny pinch of their daughter’s wedding cake or other special meaningful food.
  • because even these small exposures could cause strong symptoms. On top of that, this can be very confusing. Confusion and doubt can bring their own harm if they discourage someone from maintaining the low-carb lifestyle that was benefiting them.
  • because the consequences can be more than “just” the unpleasant hours or days of the obvious symptoms.  Unlike with other food reactions, these responses to gluten are not an allergy.  Gluten sensitivity is an autoimmune disease and celiac disease is just one version of this.  It is never good to poke-at or prod an auto-immune response, which is the body attacking itself.  There can be more health consequences on the line than you think.

When people first switch to a low-carb diet, if they are following the advice of the most knowledgable and experienced clinicians*, they will be having no grains.  Having no grains means they will not be having any gluten.  For some people, part of the improvements in health that they achieve will be due to removal of gluten from the diet.  However, for the reasons above, they may be intermittently exposed without realizing just what is happening to them.  As their health improves, they may come to a point where they are slowly intentionally expanding their diet choices to include small servings of gluten grains – for example, using a rye cracker to build a sandwich on.       (* for example Dr. Atkins, Jackie Eberstein, Dr. Eric Westman)

Because gluten sensitivity is an autoimmune disease, the true cost of even small exposures can be hidden and unrecognized.  Because the opportunity for un-intended intake of gluten is ubiquitous in our society, exposures that keep the immune system provoked are very likely unless the person has been diagnosed and is aware of what they need to be on the look-out for.

Consider:
Rev Neurol. 2011 Sep 1;53(5):287-300.

[Neurological disorders associated with gluten sensitivity].

[Article in Spanish]
Hernandez-Lahoz C, Mauri-Capdevila G, Vega-Villar J, Rodrigo L.

Source: Hospital Universitario Central de Asturias, 33006 Oviedo, Espana. carloshlahoz@gmail.com

Abstract

Gluten sensitivity is a systemic autoimmune disease that occurs in genetically susceptible individuals on ingesting gluten. It can appear at any age, then becoming a permanent condition. It is more frequent in women, as happens with other autoimmune diseases. Celiac disease is the intestinal form and the most important manifestation among a set of gluten-induced autoimmune pathologies that affect different systems. Neurological manifestations of gluten sensitivity, with or without enteropathy, are also frequent, their pathogenesis including an immunological attack on the central and peripheral nervous tissue accompanied by neurodegenerative changes. The clinical manifestations are varied, but the most common syndromes are cerebellar ataxia and peripheral neuropathy. Finally, gluten sensitivity is associated to a varying degree, with other complex diseases and could influence their evolution. The early detection of cases of gluten sensitivity with neurological manifestations and subsequent treatment with the gluten-free diet could provide remarkable benefits to the patients.

PMID: 21796607

Consider visiting the website of one of the most experienced clinicians, Dr. Rodney Ford (aka Dr. Gluten). His recently updated book Gluten Brain (http://t.co/yTonFF5t)  offers the provocative hypothesis that the principal damage involved in the gluten syndrome is to the brain and nerves.  (Note: at only $9.99 for the ebook the price is right, but myself I was not able to make the Kindle version I downloaded open in my Kindle app, so I settled for the PDF download (all versions are included in the one price) — the read was worth the inconvenience).

Consider visiting The University of Maryland Center for Celiac Research, where Dr. Fasano is one of the world’s top experts.

Addendum: Thank-you for all the interest in this article.  The subject is much too much to properly address in just a blog post.  If you are interested in more, please see my comment below and click on the Topic “Gluten and Wheat” in the side bar for my other posts, including two new ones today, May 26th.  There are foodie blogs that offer gluten-free low-carb recipes and suggestions.
Short link for this post http://wp.me/p2jTRh-6O

Review: Diet 101 by Jenny Ruhl

Diet 101: The Truth About Low Carb Diets (Kindle Edition)
This book is a natural continuation on from the author’s on-line interactions and blogging that led to her remarkable contribution Blood Sugar 101. There has been a perception that the main value of choosing to change the amount or type of carbohydrates (sugars and starches) in your diet is as a weight loss diet. Also, there has been a perception that this strategy is only valuable if applied very strictly – and this strict application then means that many people find it too difficult to keep up over time.

In Diet 101, Jenny Ruhl emphasises the fact that the greatest value from controlling carbs is in keeping blood sugars within the normal, non-damaging range. What if you’re not diabetic? Many people who do not meet the cut-off blood sugar test levels to be diagnosed with diabetes have blood sugar levels, at least for parts of the day, that are associated with slowly-accumulating harm to health. This problem is very widespread in our society.

What to do? This damage can be avoided, or at least lessened, by changing your intake of carbohydrate foods – by just as much as you need to and/or are able to. Even changes less than targeting perfection can bring benefits you might really value.

Jenny Ruhl explains all this in her new book in a clear, easy to understand manner, with all the back-up science also available for those who are interested. Also, she ties the excess swings in blood sugar to excess hunger drive and the tendency to gain weight. To be useful, this needs to be practical day-to-day, which is an important goal and strength of the book.

My review on Amazon of Jenny Ruhl’s new book.

Update: Please see my blog “Carpe Your Blood Sugar” inspired by the work of Jenny Ruhl and Dr. Richard K. Bernstein.  Links on the Resources page there to 3 interviews with Jenny.  www.carpeyourbloodsugar.com

(This post short link http://wp.me/p2jTRh-6F).

Low-Carb Grew Up re-posted

I have expanded on my page “Low-Carb Grew Up”, listed under the “Key Keys” button above.  Here it is in full:

I won’t go into the full history of low-carb nutrition.  That has been written about elsewhere.

The current era of low-carb nutrition I would describe roughly (and tongue-in-cheek) as Low Carb 1.0, 2.0, 3.0 and Next:

Low-Carb 1.0 – the 60’s, 70’s, 80’s and 90’s  – Low-carb weight loss diets presented in popular books.  Careful instructions are given, gleaned from dedicated and detailed clinical work. Dr. Robert Atkins creates a contribution he will long be respected and appreciated for.  In his work, he understands and writes about the broad medical  benefits of low-carb eating and the great value of choosing low carb eating as a long-term lifestyle, but the message picked up by the public is overwhelmingly low-carb as a weight loss diet.

People often do, though, find it difficult fo follow.  The scientific knowledge base is still fairly skimpy. People are more on their own with any difficulties they had, due to an absence of knowledgable clinicians and also their being much less likely to be in contact with others sharing their experiences.

Also, there is a great lack of support in society and in the health professions for people doing low-carb eating.  Although many people have a great deal of initial success, and are very pleased and enthusiastic, and there is great potential for life-changing benefit, most people do not stay with a low-carb lifestyle.  Some do and continue to receive benefit.

The tremendous promise of low-carb eating is obvious to those who benefit from it.  There is a feeling that we are just so close to making it work long-term.  This prompts numerous authors to come out with books promoting various tweaks to the low-carb diet.  We still feel that a (world-changing) more workable version is just so close, but tantalizingly just beyond our fingers.

The missing concept (a broader adoption of a positive attitude to higher fat intake when not targeting weight loss) is yet to come.

Low-Carb 2.0 – the 2000s and continuing  – Ground-breaking research is published.  Practicing physicians gain more and more experience with the daily application of low-carb living.  More researchers and more clinicians and more patients means putting heads together.  There is greater and greater insight into trouble-shooting and individualized application.  More is understood about adaptation to ketosis, about gluconeogenesis and about low-carb in the context of high exertion and athletic performance, among other topics.  The physicians, researchers and others at the core of this carry forward and expand the understanding of low-carb eating having great potential for widespread health and medical benefit far beyond solely as a weight loss tool.

The single most important understanding is the evidence supporting the safety of high fat intake when, (specifically when) paired with a low intake of carbohydrates.  Without mentally and emotionally accepting a high fat intake, long-term success on a low-carb eating plan is not possible.

This    changes    everything. 

This is what really breaks open the doors to more wide-spread long-term use of low-carb as a sustainable health strategy and continuing lifestyle.  This also is required to increase the recognition and understanding of low carb eating and nutritional ketosis as viable long-term tools with medical applications independent of whether the person is overweight or not, independent of whether they have metabolic syndrome or not.

It’s time for the broader public and wider medical/research community, beyond the more knowledgable core researchers, clinicians and happy low-carb lifestylers to take another look at low carb.  Along comes growing use of the internet (special recognition to Jimmy Moore).  The emergence of another popular author, Gary Taubes, who receives wide-spread and sustained media attention, plays a major role in resurgence of interest in the low carb option.

One other thing, the research clearly shows that eating a low carbohydrate diet is associated with a general broad shift in metabolism that goes well beyond just whether one is burning predominantly carbohydrates or predominantly fats/ketones for fuel.  This means that medical research conducted on people who are eating higher amounts of carbohydrates cannot be just assumed to apply to people who are adapted to low carbohydrate nutrition.  Research findings cannot be properly reported and interpreted without consideration of this.

Low-Carb 3.0 – the current time  – Low-carb meets up with other dietary practices and principles, for example:

whole foods, Paleo, Primal, Ancestral, Nourishing Traditions

addiction or “addiction-like” responses to food  – food addiction, sugar addiction, carb addiction, brain sensitization

– health issues with gluten, including celiac disease (studies have repeatedly shown about 1% of the population to have celiac disease and it can onset at any age) and gluten sensitivity (estimated to affect another 7% of the population)

– sports and physical fitness nutrition science

diabetes care and greatly minimizing glycation damage (damage to body tissues from high blood glucose levels).  Opening up of the concept of low carb as a lifelong strategy takes this beyond the already tremendously valuable use of low carb as a weight loss technique, with its benefits in improving, resolving, and preventing type 2 diabetes.  More awareness comes to the decades of work by Dr. Richard K. Bernstein in using low carb nutrition to achieve fine control of blood sugar in both type 1 and type 2 diabetes, with dramatic impact on avoidance of the many severe complications that would usually develop in these conditions over time.  Research is published showing that harm to health correlates in the general population to blood sugar levels well down into what is considered the normal range.

ketosis as a medical intervention to help various symptoms and medical problems and as a strategy in high-performance athletics, in addition to its previously understood role in reducing appetite

– an expanded concept of the many health impacts of metabolic syndrome and insulin resistance.

low carb for metabolic health, yielding also improvement in weight control; nutritional ketosis for reduction in appetite; together generally leading to substantial weight reduction – but not always enough to reach and maintain a normal body weight

total body fat content is not what is lethal, the consequences of metabolic syndrome/insulin resistance/diabetes and inflammation are and these can be greatly improved with low carb nutrition

Thus, an ever expanding community brings different experiences, concepts and understandings to the shared table.

Now we can better understand people’s different responses to low-carb eating and what can happen as they consume carb foods after eliminating them for awhile.  Without considering these other dietary issues, the response to small intakes of carbs can be very difficult to understand.  Figuring out why low-carb eating can be so life-changing might also be confusing.

If someone has brain sensitization to sugar or to starch (turns into sugar in the digestive tract), even a small intake that would not be expected to have much impact on ketosis or insulin levels might actually be very disruptive and precipitate an abrupt onset of craving and result in abandonment of low-carb eating (even after months of happy, productive and contented success).  People who have such sugar or carb addiction-like responses have reported that long-term triumph requires not just abstinence from the more obvious food triggers, but carefully noting all addictions and addictive-like responses and maintaining abstinence from all triggers.  Further, in this context the sweet taste of artificial sweeteners and sugar alcohols (in many ‘diet’ and commercially-made ‘low-carb’ products) might be disruptive in a confusing way.

A person with celiac disease (an auto-immune response triggered by gluten) or with gluten sensitivity (a different type of immune reaction to gluten) is very likely to be unaware of it.  Most people who have these problems with gluten are blind to their situation.  Thus, when they start a low carb eating plan, they might eliminate gluten and not truly understand that as being part of why they feel so much better.  However, low-carb eating itself, even at a ketogenic level, does not actually require elimination of gluten grains (wheat, rye, barley), it just often is done that way in practice.  Very small intakes of wheat, etc., (like scraping almost every bit of sauce off a meat served at a dinner, for example) then, might cause wild swings in symptoms that are confusing and discouraging.  There would likely be accompanying large swings in weight as fluid retention accompanied the inflammatory response (or the opposite if diarrhea resulted).

What is Next?  As I see it, what is next is a more complete recognition of the central importance of the special role low-carb nutrition plays as a satiety-focused intervention.  Actually, that it is a set of satiety-focused interventions woven together. For example, lowering elevated insulin, more stable blood sugar, respite for those addicted to sugar/starches, gluten elimination and nutritional ketosis all can help separately and together with having less hunger/craving and more easily feeling satisfied with a meal.

Dr. Atkins has received recognition and admiration for many things, but I think that his stance of practicing low-carb specifically with a satiety focus, rather than a calorie-limiting focus, is his second biggest contribution.  While recognized as the father of modern-day carb-controlled nutrition, to me he is also the father of satiety-focused weight health.  We might take it for granted that he chose this route, but I would imagine that he came under considerable pressure to add a calorie-restriction to his recommendations. (A calorie restriction can be obviously stated, or less obvious such as set serving sizes and amounts.)

If you read my pages under “Satiety-Focused Weight Health” you will see my argument that there are only two dietary paths to consider when targeting weight health – either imposed calorie-restriction OR targeting optimal appetite/satiety system function.  The two are mutually exclusive.  The act of imposing calorie restriction intrinsically interferes with attaining optimal functioning of the appetite/satiety system.

The world of calorie-restricted dieting is imploding.  The doctors and the agencies and the public are all discouraged.  Rather than giving up, which is now being openly discussed seriously as a viable option within the medical system, wouldn’t it now be time to give satiety-focused weight health a proper chance?

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – —

A full teaching regarding low-carb eating is far beyond the scope or intent of this blog.  Many good resources are available.

Dr. Eric Westman, Duke University

Dr. Alessio Fasano, Director of the University of Maryland Center for Celiac Research, defines gluten and describes the spectrum of gluten intolerance. Dr. Fasano describes the symptoms and treatment of celiac disease.

Short Link http://wp.me/p2jTRh-6u

Dr. Eenfeldt’s take on The Weight of the Nation

Quote:

You guessed it: it’s all about desperately trying to ignore your hunger, counting your calories and eating “balanced diets”. And a balanced diet is as usual defined seemingly without a shred of science involved. A balanced diet is basically what the “experts” believe that you should eat.

This is the worst part: Any junk food can in theory be “part of a healthy balanced diet”. In fact, you shouldn’t even attempt to quit the junk food. You’re actually warned from even trying! Check it out:

He adds a generous spicing of humour  link

Telling People They Don’t Exist

One of my pet peeves is when people are, in effect, told that they don’t exist.

An example?  I get a migraine and flu-like symptoms if I eat even a tiny amount of gluten.  I don’t have celiac disease, I have gluten sensitivity. This has a major impact on the day-to-day living of my life and is something I can never afford to forget, ignore or down-play any time I am around food. Yet, to the vast majority of my own medical colleagues I don’t exist. They recognize the existence of a person occupying the space my body is in. However, what they see there is a person who isn’t me as I know myself to be. They see some deluded or self-deluded not very competent person who holds a questionable and likely false belief that places them in the ranks of the crackpots who think they are harmed by wheat, in the absence of laboratory proof. The recent recognition of gluten sensitivity as a medical condition (see this post) has not received wide-spread attention and is likely to be slow to be incorporated into routine medical practice.

People who have gained substantial health benefits from following a low-carb lifestyle are often treated in the same way. Many people report how frustrated they have felt when their doctors, their friends or work colleagues, or family members have discounted their stories and/or, even worse, discounted them as individuals for the decisions they have made and the “obviously false” conclusions they have come to.

But consider, does it ever happen the other way?

A few months ago I had an experience that has stayed in the back of my mind since.  On one of the blogs about low carb nutrition, I was reading an older post and the looong list of 50 or more comments under it. There was a lot of back-and-forth commenting among the contributors and with the author.  There was a good spirit of comradery evident. Everybody who raised a question, interesting idea or dilemma was responded to  — that is, everyone except one soul. One person posted a comment asking for insight or helpful comment on her situation – asking, that is, for help.  This soul was ignored as if she had leprosy. Her comment fell into a black pit.  The others resumed their conversations as if she didn’t exist.

Her social crime for which she received shunning – she dared to report that she was having little progress with weight loss despite a persistent and apparently well-applied very low carb/ketogenic diet. The post was old and the comments section had been closed, so I couldn’t respond to her myself.

It is easy to love the idea that going low-carb is a sure-fire ticket to weight loss heaven.  This idea makes people smile and feel confident and enthusiastic.

The up-side  — the enthusiasm helps the knowledge spread.

The down-side  — since there is and never will be a sure-fire ticket to weight loss heaven, some individuals can feel unrecognized and discounted. Also, people who are broadly knowledgable about weight control issues recognize this as a false concept and this contributes to lack of respect for the message that low-carb nutrition is a valuable medical intervention (thus limiting the spread of the knowledge).

Low-carb nutrition and nutritional ketosis are very powerful and broadly beneficial tools that can help with weight loss in many ways. There are people who need other tools in addition or instead. Also, the benefits of low-carb nutrition can be swamped or over-ridden by other factors  – for example, certain medications or high stress states.

Many people do spectacularly well when adopting low-carb nutrition as a means to weight loss. Many others do very well or at least do well.  Messaging that focuses on dramatic weight loss, though, can mean that people miss the knowledge of how low-carb nutrition may benefit their health even in the absence of substantial weight loss.  It can mean that people get discouraged and miss out on the many other potential benefits.

“The reasonable man adapts himself to the world.  The unreasonable man persists in trying to adapt the world to himself.  Therefore, all progress depends on the unreasonable man.”  – George Bernard Shaw

If you have benefited from low-carb nutrition, or someone you love has, you might owe a debt to someone somewhere in the past who was not able to achieve success with weight loss with the use of the knowledge and advice they then had access to. The knowledge and understanding of low-carb nutrition is only available to us today because of the determined efforts of one individual after another, acting in response to this lack of success.

If you have a story of fabulous, easy success to tell  – please share it, share it!  Be proud, strut, jump up and down.

I would like to encourage the practice of avoiding suggesting that because it was easy  – or even just that it was possible – for you, that this means it would be or should be the same for all others.

That “unreasonable person” whose response isn’t the same as others’ is a person we can all learn from.  Their situation may be just about to spur some new understanding that will benefit us all some day.

Addendum:  I realize that I might have left that sounding as if there was only one incident that concerned me. Unfortunately, I have more than once read posted comments that flat out stated that since that person had achieved a great outcome with controlled carb intake, that this meant all was solved for everyone else if they would only just get with the program – again meaning that anyone still visibly overweight could be judged on the spot as someone who just wasn’t trying hard enough. I guess being addicted to feeling superior is something that doesn’t show at the waist band.

Sunday Stories

Sunday is a good day for stories of hope and inspiration.

Personal stories of benefit from low-carb/controlled-carb nutrition:

Jenny Ruhl, diagnosed with diabetes in 1998

Personal stories on Dr. Andreas Eenfeldt’s blog

Dr. Jay Wortman’s personal story

If you would like to inspire others with your personal story, but don’t want to do this on a blog, Tumblr, etc, a good option is Ancestral Weight Loss Registry (listed under LINKS).

A comment by Dr. Richard Feinman on another site, quoted in full:

RIchard Feinman · Professor of Cell Biology (Biochemistry) at State University of New York Downstate Medical Center

“People need to do what works for them.”  How do you find out what works best for you. Diabetes is a disease of carbohydrate restriction. The first thing to try is to keep carbohydrates as low as possible. If that doesn’t work, you might want to try something else but it is always good to start with the science. As Dr. Eric Westman put it: At the end of our clinic day, we go home thinking, “The clinical improvements are so large and obvious, why don’t other doctors understand?” Carbohydrate restriction is easily grasped by patients: because carbohydrates in the diet raise the blood glucose, and as diabetes is defined by high blood glucose, it makes sense to lower the carbohydrate in the diet. By reducing the carbohydrate in the diet, we have been able to taper patients off as much as 150 units of insulin per day in 8 days, with marked improvement in glycemic control-even normalization of glycemic parameters. Read more at http://www.inquisitr.com/193759/diabetes-a-growing-threat-with-no-single-dietary-answer/#Hk7Sl0wpw3xtP5Eh.99.
(I believe he meant to say “Diabetes is a disease of carbohydrate intolerance”).

Food Politics » GM crops in crisis: Roundup-resistant “superweeds”

Aside

Food Politics » GM crops in crisis: Roundup-resistant “superweeds”.

The esteemed Marion Nestle, on her blog Food Politics.

Drinking Water with Meals Influences Choices

One of the best things on the web is a site called Diabetes in Control

This site has always seemed to me to be a labor of love – the outcome of persistent dedication, quality of effort and personal integrity.  I have been receiving their weekly newsletter for many years and it is always worth the read.

While about 90% of my use of this site has been in reading their newsletter, on the web site there is scads of educational material relating to diabetes – for both patients and health professionals.  I like the way the newsletter is presented as it comes by email better than the way it is presented when you go to the web site.

One of the smaller notes in their latest newsletter is copied in full below:

Drink Water with Meals to Avoid Obesity and Diabetes.

Drink Water with Meals to Avoid Obesity and Diabetes

Drinking water with meals could be one of the easiest ways to avoid obesity and its accompanying ills, according to new published research. T. Cornwell of University of Oregon and R. McAlister of Michigan State University detailed two studies in their paper. In one, researchers repeatedly watched 75 preschoolers as they were served drinks alongside raw vegetables. They found that the children, age 3 to 5, ate more vegetables when they were accompanied by water than when they were served with sweetened beverages. In the second study, researchers surveyed 60 US adults, age 19 to 23, about food-and-drink pairings and found they preferred the combination of soda with salty, calorie-dense food instead of soda and vegetables. “When we look cross-culturally we can see that food-and-drink combinations are developed preferences. If the drink on the table sets the odds against both adults and children eating their vegetables, then perhaps it is time to change that drink and replace it with water.” Appetite May, 2012

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – —

So, they found that when the young children they studied drink sweet beverages, they ate less vegetables than when they drank water.  To me this would make sense.  Children’s taste buds have not become blunted with age and they are quite sensitive to noticing the complex flavours and sometimes bitter notes of vegetables.  I think these flavours are more likely to be off-putting if you have been exposed to a strongly sweet taste just before and after.

Could repeated experiences like this perhaps also teach kids to generally have an aversion to vegetables?

There are a number of other topics in the latest newsletter, for example:

“Patients with type 2 diabetes are usually advised to keep a low-fat diet. Now, a study shows that food with a lot of fat and few carbohydrates could have a better effect on blood sugar levels and blood lipids…..”

“According to new research presented at a scientific meeting, waist to height ratio better is a better predictor of CVD and diabetes than BMI…. “

Note: The above study of patients with type 2 diabetes used a 20% carbohydrate diet, which is certainly much lower than usual intake and usual recommendations, but is not to be confused with a very low carb diet or a ketogenic diet.

Dr. Jay Wortman, M.D. on what’s blocking progress in recognition of the medical benefits of low-carb nutrition

Dr. Jay’s Blog: Jay Wortman, M.D. on the science & clinical experience related to low-carbohydrate, ketogenic diets & traditional First Nations style diets.

I wish I knew how to re-post this article in it’s entirety.  Very worth the read, as he first relates the story of yet another person’s remarkable health turn-around with long-term adoption of low-carb nutrition, then discusses the barriers that are keeping this invaluable understanding of carbohydrate intolerance from reaching a wider audience.

If you visit Dr. Wortman’s blog, have a look at his videos of skiing Whistler.  No better example of how the long-term adoption of a very low carbohydrate diet can include “peak” physical performance.  Ketones are a fabulous fuel source for athletic activity.

While progress through “official channels” in research funding, academia and policy-making bodies is slow, there is a “movement of the people”.  If you haven’t seen this video already, have a look at Tom Naughton’s powerful message about knowledge of low-carb nutrition spreading through social channels.  At the bottom of the page “Keepers Unite” is the video “Vox Populi”.

For more examples of personal stories, or to post your own story of success, visit Ancestral Weight Loss Registry, listed in the sidebar under links.  They also have a collection of research related to low-carb nutrition – for your interest and/or as a resource for you to use when talking to friends, family and health professionals.

long-ish reply to question about breakfast

Aside

For anyone re-considering their choice of a non-breakfast lifestyle, I have just posted a long-ish reply to a comment about this on my “Restrict/Re-bound” page under the “Key Keys” heading.