Podcasts > The Peter Attia Drive > #325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

By Peter Attia, MD

In this episode of The Peter Attia Drive, Peter Attia and other guests explore a wide range of intriguing topics, from addiction and gene editing to bone health and calorie restriction. The summary delves into the genetic and environmental factors influencing addiction, as well as strategies like dopamine fasts and medication for managing substance abuse and behavioral addictions.

It also examines the potential of CRISPR gene editing for treating disorders, while acknowledging ethical and safety concerns. Other topics include the importance of strength training for maintaining bone density, the complex relationship between testosterone and prostate cancer, and how caloric restriction may impact longevity. With insights spanning various fields, this episode promises an engaging overview of cutting-edge research and perspectives.

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

1-Page Summary

Addiction and [restricted term]

Addiction is influenced by genetics and environment, with 50-60% hereditary susceptibility, according to Attia. Beyond substance abuse, behavioral addictions like gambling exist. Attia suggests altering one's environment by removing triggering stimuli can manage compulsive behaviors. Treating addiction often starts with a [restricted term] fast, where 80% feel improvement, and may include medications during withdrawal, says Anna.

CRISPR gene editing

CRISPR could edit genes tied to cardiovascular disease, like PCSK9, potentially reducing risk, per the discussion. Looking ahead, CRISPR may therapeutically treat genetic disorders with currently few options. However, technical challenges, safety concerns, and ethical implications around germline editing must be addressed before clinical use.

Bone health and exercise

Stenson and Attia emphasize maintaining muscle mass and bone density through strength training, crucial for preserving bone health with age, especially for women. Even small amounts of regular exercise benefit bones. However, responses to exercise vary: Attia experiences significant mood boosts from cold plunges due to increased [restricted term] production, while others do not, highlighting individual differences.

Caloric restriction and longevity

Research suggests caloric restriction may improve longevity by refining metabolic and cellular functions, delaying age-related diseases. Besides continuous restriction, intermittent fasting and time-restricted eating provide potential alternatives. Sustaining significant long-term restriction is challenging for most due to dietary demands and hunger. Optimal approaches are still being explored.

Prostate cancer and [restricted term]

Studies link elevated [restricted term] to increased prostate cancer risk, but the relationship is complex. Both high and low [restricted term] may impact risk and progression. Attia advocates maintaining optimal levels through individualized approaches considering hormone status, cancer stage, and overall health when managing prostate cancer.

1-Page Summary

Additional Materials

Clarifications

  • A [restricted term] fast is a practice involving abstaining from certain stimulating activities, like social media or excessive eating, to reset [restricted term] levels in the brain. It aims to reduce impulsive behaviors and increase sensitivity to natural rewards. The concept is not about complete elimination but rather about learning moderation and promoting healthier habits. It is a form of cognitive behavioral therapy designed to help individuals regain control over their behaviors and focus on more meaningful activities.
  • CRISPR gene editing is a powerful tool that can precisely modify DNA sequences in living organisms. Technical challenges include off-target effects, where unintended changes can occur, and the efficiency of editing specific genes. Safety concerns revolve around potential unintended consequences of altering genes and the need for rigorous testing before human applications. Ethical implications involve debates on issues like germline editing, where changes can be passed on to future generations, raising questions about consent, equity, and the potential for misuse.
  • Germline editing involves making changes to the genetic material in reproductive cells, such as sperm and eggs, which can be passed on to future generations. This type of genetic modification raises ethical concerns due to the potential long-term implications on the human gene pool. Scientists are researching the possibilities and risks of germline editing for various applications, including treating genetic disorders and enhancing desirable traits. The technology is still in the experimental stage, and strict regulations are in place to govern its use.
  • PCSK9 is an enzyme encoded by the PCSK9 gene that plays a role in regulating cholesterol levels by degrading LDL receptors. Inhibiting PCSK9 can lead to increased recycling of LDL receptors, resulting in lower LDL cholesterol levels in the blood. This enzyme is associated with an increased risk of coronary artery disease and is a target for potential therapies to manage cholesterol levels.
  • Strength training plays a crucial role in maintaining bone health by stimulating bone growth and density. It helps prevent bone loss and osteoporosis, especially important as individuals age. Regular strength training exercises, like weightlifting or resistance training, can improve overall bone strength and reduce the risk of fractures. This type of exercise is particularly beneficial for women, as they are more prone to osteoporosis.
  • Caloric restriction involves reducing calorie intake without malnutrition. Research suggests it may improve longevity by enhancing metabolic and cellular functions, potentially delaying age-related diseases. Different forms of caloric restriction, like intermittent fasting, show promise in promoting health and longevity. However, sustaining long-term caloric restriction can be challenging due to dietary demands and hunger.
  • Intermittent fasting involves cycling between periods of eating and fasting, altering the timing of meals. Time-restricted eating is a form of intermittent fasting that limits daily eating to a specific window of time, typically 8-10 hours. These approaches aim to optimize metabolic processes and promote various health benefits, such as weight management and improved insulin sensitivity. By restricting the time frame for eating, individuals may naturally reduce overall caloric intake, potentially aiding in weight control and overall health.
  • Caloric restriction involves reducing calorie intake without malnutrition to potentially improve longevity and health. Different approaches include continuous restriction, intermittent fasting, and time-restricted eating. These methods aim to optimize metabolic and cellular functions, delaying age-related diseases. However, sustaining long-term caloric restriction can be challenging due to dietary demands and hunger.
  • In managing prostate cancer, understanding hormone status is crucial as [restricted term] levels can influence the risk and progression of the disease. Maintaining optimal hormone levels through personalized approaches is important, considering factors like the individual's hormone status, the stage of cancer, and overall health. Hormone therapy may be used to lower [restricted term] levels in some cases to slow the growth of prostate cancer cells. Balancing hormone levels effectively can be a key aspect of treatment strategies for prostate cancer.

Counterarguments

  • While genetics and environment play a significant role in addiction, the exact hereditary susceptibility percentage can vary, and not all individuals with a genetic predisposition will develop an addiction.
  • Behavioral addictions are complex, and simply removing triggering stimuli may not be sufficient for managing compulsive behaviors, as underlying psychological issues often need to be addressed.
  • [restricted term] fasting as a treatment for addiction is not universally accepted or proven effective for all individuals, and the claim that 80% feel improvement may not be representative of all populations.
  • The use of medications during withdrawal can be beneficial, but it also carries the risk of side effects and dependency on the medication itself.
  • CRISPR's potential in editing genes related to cardiovascular disease is promising, but the long-term effects and unintended consequences of gene editing are still largely unknown.
  • The therapeutic use of CRISPR for genetic disorders is an exciting prospect, but the current state of the technology may not be advanced enough to ensure safety and efficacy in all cases.
  • The ethical implications of germline editing are a significant concern, and there is a debate about whether it should be pursued at all, even if technical challenges and safety concerns are resolved.
  • While strength training is important for bone health, it may not be suitable for everyone, and other forms of exercise or interventions may be necessary to accommodate individual health conditions or limitations.
  • The benefits of exercise on bone health are well-documented, but the degree of benefit can vary widely, and some individuals may require additional interventions such as medication or dietary changes.
  • Caloric restriction's effects on longevity are still under investigation, and it may not be the most effective or practical approach for all individuals, considering the potential negative impacts on quality of life and mental health.
  • Intermittent fasting and time-restricted eating are popular dietary trends, but their long-term efficacy and safety have not been conclusively established, and they may not be suitable for everyone.
  • The link between [restricted term] levels and prostate cancer risk is complex, and while some studies suggest a connection, the relationship is not fully understood, and other factors may also play a significant role.
  • Individualized approaches to maintaining optimal [restricted term] levels in prostate cancer management are important, but the best strategies are still a matter of ongoing research and debate, and what is optimal for one individual may not be for another.

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

Addiction and dopamine

Addiction, a complex interplay of genetic and environmental factors, is underpinned by the neurotransmitter [restricted term]. Experts Attia and Anna dive into the origins, the science, and treatment strategies for addiction.

Factors that influence addiction

Addiction is not merely a random occurrence; it has definitive roots in genetics and is influenced by one's environment and upbringing. Attia underscores the significance of family health history reviews, emphasizing that a propensity for addiction is often inherited. Approximately 50-60% of addiction susceptibility is hereditary, yet the nurturing from parents and the broader environment, such as the neighborhood where one grows up, plays a considerable role.

The science of addiction

The traditional markers of addiction include compulsive use, cravings, continued use despite harmful consequences, tolerance, and physical withdrawal symptoms. Besides substance abuse, behavioral addictions like gambling, sex, and workaholism also fall under this definition. Attia, drawing from personal experience, discusses how environmental cues, such as the omnipresence of smartphones, can trigger compulsive behaviors. He suggests that altering one's immediate environment by removing such stimuli can help in managing the impulses. His practice of employing a secondary phone devoid of email or text capabilities is an example of modifying the "neighborhood" to reduce compulsion.

Approaches to treating addiction

Treating addiction often begins with a [restricted term] fast, which Anna, a psychiatrist, prescribes initially to her patients. This four-week abstinence period is re ...

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Addiction and dopamine

Additional Materials

Clarifications

  • A [restricted term] fast is a period of abstinence from activities that are believed to overstimulate the brain's reward system, particularly [restricted term] release. This practice aims to reset the brain's sensitivity to [restricted term], potentially reducing cravings and increasing motivation. During a [restricted term] fast, individuals typically avoid activities like social media, video games, junk food, and other sources of instant gratification. The goal is to recalibrate the brain's response to pleasure, promoting a healthier relationship with rewarding activities.
  • Cold plunging involves immersing the body in cold water for a short period. This practice is believed to help reduce inflammation and muscle soreness by constricting blood vessels and decreasing tissue swelling. Some individuals also report mood enhancement after cold plunging, attributed to the release of endorphins and the stimulation of the sympathetic nervous system. The effects can vary from person to person, with some experiencing more significant benefits than others.
  • The variability in treatment efficacy in addiction indicates ...

Counterarguments

  • While genetics play a significant role in addiction, the 50-60% heritability figure may not capture the full complexity of genetic interactions and other biological factors.
  • The role of upbringing and environment is crucial, but there is also a risk of oversimplifying the influence of these factors, as not everyone exposed to the same conditions develops an addiction.
  • The definition of addiction involving compulsive use and other traditional markers may not encompass all experiences of addiction, and some argue for a broader or different understanding of the condition.
  • Behavioral addictions are indeed recognized, but there is ongoing debate about the criteria for such addictions and how they should be classified and treated.
  • Modifying the environment to manage impulses is a valid strategy, but it may not be sufficient for everyone, and some individuals may require more intensive interventions.
  • The efficacy of a [restricted term] fast as a treatment for addiction is an interesting concept, but it may not be supported by extensive research, and its effectiveness could vary widely among individuals.
  • The use of benzodiazepines ...

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

CRISPR gene editing

The revolutionary technology of CRISPR gene editing is poised to transform medical treatments and human health.

Potential applications of CRISPR

One of the prominent potential applications of CRISPR discussed in the conversation is its ability to edit genes associated with inherited conditions.

CRISPR could be used to edit genes associated with cardiovascular disease, such as PCSK9, to potentially reduce disease risk.

For example, CRISPR gene editing has the potential to target and modify genes like PCSK9. Variations in the PCSK9 gene are linked to cardiovascular disease, and by editing these genes, CRISPR could potentially lower the risk of such diseases.

CRISPR may have therapeutic applications for a wide range of genetic disorders in the future.

Looking ahead, CRISPR's reach could extend beyond heart disease into a myriad of genetic disorders, offering therapeutic interventions where currently there are few or no available treatments.

Limitations and concerns with CRISPR

As with any groundbreaking technology, there are limitations and ethical considerations that accompany CRISPR's capabilities.

There are still significant technical challenges and safety concerns that need to be addressed before CRISPR can be widely used clinically.

Before CRISPR can be routinely used in a clinical setting, significant technical hurdles and safe ...

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CRISPR gene editing

Additional Materials

Counterarguments

  • While CRISPR is indeed revolutionary, it is not the only gene-editing technology available, and others, like TALENs and ZFNs, may also have unique advantages in certain contexts.
  • Editing genes associated with complex diseases like cardiovascular disease may not guarantee prevention or cure, as these diseases often result from a combination of genetic and environmental factors.
  • The therapeutic applications of CRISPR are still largely experimental, and it may take many years of research before they can be safely and effectively applied to a wide range of genetic disorders.
  • Technical challenges and safety concerns are not the only hurdles; there are also regulatory, manufacturing, and ...

Actionables

  • You can deepen your understanding of genetics by using online simulation tools that mimic CRISPR technology. These interactive platforms allow you to virtually edit genes and see the potential outcomes, which can help you grasp the complexities and possibilities of gene editing without needing a lab or scientific background.
  • Start a citizen science project to track and share information about inherited conditions in your family tree. By using accessible genetic testing services and creating a shared database with your relatives, you can contribute to the understanding of how certain diseases are passed down, which could be valuable for researchers interested in using CRISPR for therapeutic applications.
  • Engage in et ...

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

Bone health and exercise

Stenson and Attia discuss the significance of exercise for maintaining bone health and explore the individual variations in response to exercise and other interventions.

The importance of exercise at any age

Maintaining muscle mass and bone mineral density through strength training is crucial for preserving bone health as we get older, particularly in women.

Maintaining muscle mass and bone mineral density is crucial for preserving bone health as we age, with strength training being particularly beneficial. This is especially true for women, who may experience a more pronounced decline in bone health with age.

Even small amounts of regular exercise can have significant benefits for bone health.

The hosts advocate that regular exercise, even in small amounts, can offer significant benefits for maintaining bone health. They imply that consistent engagement in physical activity can contribute to the strength and vitality of bones throughout one's life.

Individual responses to exercise

Some people experience a greater mood boost from activities like cold plunging compared to others, due to differences in endogenous [restricted term] production.

Individual differences, such as variations in endogenous [restricted term] production, could influence how people respond to activities like cold plunging. Stenson and Attia highlight that these individual variations are crucial considerations when evaluating the mood-stabilizing effects of cold therapy and exercise.

Peter Attia discusses how activities like cold immersion and exercise can increase the body’s production of [restricted term] to counter the discomfort they cause. He explains that when he immerses himself in a 40-degree bathtub for 10 minutes, the pain stimulates [restricted term] production, which continues ...

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Bone health and exercise

Additional Materials

Counterarguments

  • While strength training is beneficial for bone health, it is not the only form of exercise that can help; weight-bearing aerobic activities like walking and running also play a significant role in maintaining bone density.
  • The relationship between exercise and bone health is complex, and factors such as genetics, diet, and hormonal balance also significantly influence bone density and health.
  • The benefits of small amounts of regular exercise for bone health may be overstated if the intensity or frequency is not sufficient to stimulate bone growth or maintenance.
  • The mood-boosting effects of cold plunging and exercise may not be solely due to [restricted term] production; other neurotransmitters and hormones, such as endorphins and serotonin, also play a role in mood regulation.
  • The assertion that deprivation of exercise can negatively impact mood within a day may not apply universally, as mood responses to exercise can be highly individualized and influenced by numerous factors beyond physical activity.
  • The idea that modern environments lead to overstimulation ...

Actionables

  • You can integrate bodyweight exercises into your daily routine to strengthen muscles and bones without needing a gym. Start with simple movements like squats, push-ups, and lunges while cooking, watching TV, or during work breaks. For example, do a set of squats while waiting for your coffee to brew or lunges during commercial breaks.
  • Create a "comfort challenge" where you end your showers with 30 seconds of cold water to gradually introduce cold therapy into your life. Keep a journal to note any changes in your mood or tolerance to the cold, and increase the time as you become more comfortable with the experience.
  • Use a habit-tracking app to monitor your daily physical activity and mood, setting reminders ...

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

Caloric restriction and longevity

Scientific studies have long focused on the relationship between caloric intake and lifespan. Caloric restriction—reducing average daily caloric intake without incurring malnutrition—has gained attention for its potential to extend lifespan, especially given promising results from animal studies.

The potential benefits of caloric restriction

Research suggests that caloric restriction may improve longevity by refining metabolic and cellular functions. By curbing calories, the body may respond by bolstering mechanisms that repair and maintain cells, which could in turn delay the onset of age-related diseases and conditions.

Intermittent fasting and time-restricted eating

Besides the traditional approach of continuous caloric restriction, intermittent fasting and time-restricted eating have emerged as popular alternatives. These methods allow individuals to experience some of the benefits of caloric restriction without drastically cutting their caloric intake every day, potentially providing a more sustainable approach to improved health and longevity.

Challenges with implementing caloric restriction

While the benefits of caloric restriction sound promising, incorporating this practice into daily life is notably challenging.

Sustaining long-term caloric restriction

For most people, sustaining significant calor ...

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Caloric restriction and longevity

Additional Materials

Clarifications

  • Caloric intake and lifespan have been studied to understand how reducing calories without malnutrition could potentially extend lifespan by improving metabolic and cellular functions. This relationship suggests that by consuming fewer calories, the body may activate mechanisms that repair and maintain cells, potentially delaying age-related diseases and conditions.
  • Caloric restriction can influence metabolic and cellular functions by triggering adaptive responses in the body. When calorie intake is reduced, cells may activate pathways that enhance repair mechanisms and improve overall cellular health. This process may help delay the onset of age-related diseases by promoting more efficient cellular function and reducing oxidative stress. The metabolic changes induced by caloric restriction can lead to improved energy utilization and potentially contribute to longevity.
  • Intermittent fasting involves cycling between periods of eating and fasting, which can help achieve caloric restriction benefits without daily calorie reduction. Time-restricted eating limits the hours in a day during which food is consumed, typically within a specific window, promoting similar effects to caloric restriction. These methods offer flexibility in how caloric intake is managed, potentially making it easier for individuals to adhere to dietary changes for health and longevity benefits.
  • Implementing caloric restriction in daily life poses challenges due to the difficulty of sustaining significant caloric reduction over the long term. This challenge arises from the need for consistent dietary control and the psychological impact of persistent hunger. Additionally, the feasibility and health implications of such strict regimens vary among individuals. Scientists are still researching the optimal levels and approaches to caloric restriction for human health and longevity.
  • The psychological impact of persistent hunger can include feelings of irritability, difficulty concentrating, and mood swings. When individuals experience ongoing hunger due to caloric restriction, it can lead to increased stress and ...

Counterarguments

  • Caloric restriction may not be suitable for everyone, especially those with certain health conditions, the elderly, pregnant or breastfeeding women, and children.
  • The long-term effects of caloric restriction on humans are not fully understood, and what works for animal models may not translate directly to human biology.
  • Psychological and social factors can make caloric restriction impractical or undesirable for some individuals.
  • There is a risk that caloric restriction could lead to nutrient deficiencies if not carefully managed.
  • The evidence for the benefits of intermittent fasting and time-restricted eating is still emerging, and more research is needed to confirm their long-term safety and efficacy.
  • Some studies suggest that the benefits of caloric restriction might be achieved through a balanced diet and regular exercise, without the need to restrict calories to such an extent.
  • The focus on caloric restriction may overshadow other important aspects of diet and lifestyle that contribute to longevity and health, such as the quality of food, ...

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

Prostate cancer and testosterone

Understanding the complex relationship between [restricted term] and prostate cancer is crucial for both prevention and management of the disease.

The role of [restricted term] in prostate cancer

Studies have pointed out a link between [restricted term] and prostate cancer, suggesting that elevated [restricted term] levels might increase the risk of developing the disease. However, this relationship is intricate and not entirely clear. The biological mechanisms behind how [restricted term] potentially contributes to or interacts with prostate cancer remain an area of active research.

Elevated [restricted term] levels have been associated with an increased risk of prostate cancer in some studies.

Several studies have observed an association between high levels of [restricted term] and an increased risk of prostate cancer. This has led to a consideration of [restricted term] as a possible factor in prostate cancer development and progression.

However, the relationship between [restricted term] and prostate cancer is complex and not fully understood.

Despite the associations found, the exact role of [restricted term] in the pathogenesis of prostate cancer is still not completely understood. The complexity arises from differing individual responses to [restricted term] levels, the interplay with other hormones, and various genetic and environmental factors influencing prostate cancer risk.

Considerations for managing prostate cancer

When managing prostate cancer, careful consideration of [restricted term] levels is important, as hormonal balance plays a crucial role in the disease.

Maintaining optimal [restricted term] levels is important, as both low and high levels can potentially impact prostate cancer risk and progression.

Optimal [restrict ...

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Prostate cancer and testosterone

Additional Materials

Counterarguments

  • Elevated [restricted term] levels are associated with an increased risk of prostate cancer.
    • Some research suggests that the relationship between [restricted term] levels and prostate cancer risk is not linear and that low [restricted term] levels may also be associated with an increased risk of aggressive prostate cancer.
  • The relationship between [restricted term] and prostate cancer is complex and not fully understood.
    • N/A
  • Maintaining optimal [restricted term] levels is crucial for managing prostate cancer.
    • The definition of "optimal" [restricted term] levels can vary, and there is no consensus on a specific range that guarantees reduced risk or better management of prostate cancer.
  • Both low and high [restricted term] levels can impact prostate cancer risk and progression.
    • There is debate about whether [restricted term] replacement therapy in men with low [restricted term] levels significantly affects the risk of prostate cancer progression.
  • Individualized approaches to managing [restricted term] and prostate cancer are essential.
    • While individualized care is ideal, it may not always be f ...

Actionables

  • You can track your health indicators by starting a personal health diary to monitor any changes that might be related to [restricted term] levels. Note daily activities, diet, mood, and any symptoms you experience. Over time, this can help you and your healthcare provider identify patterns that may warrant further investigation or action regarding your hormonal health.
  • Engage in regular, moderate exercise to naturally balance hormone levels, as physical activity can influence [restricted term] production and metabolism. Choose activities you enjoy, such as brisk walking, swimming, or cycling, and aim for at least 150 minutes of moderate aerobic activity per week, complemented by strength training twice a week.
  • Consider dietary adjustment ...

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