• Call: 1 (484) 401-7837

Category: Nutrition

Categories Weight Loss, Food, Health, How To, Nutrition

Intermittent Fasting – Is it right for you?

Author Amber Hudler Posted on

If you are like most people, you’ve heard the buzz about Intermittent Fasting (IF), and you’ve probably wondered if it’s something you should consider. Maybe you’re even confused about how it works or whether or not you’re already doing it. After all, don’t we fast every night when we sleep? I’ve been getting asked a lot of questions about fasting recently so I thought it would be a valuable topic to discuss.

Let’s begin with defining what IF is.

The concept of fasting has been around for centuries, and originated in different cultures due to certain religious practices. Traditional fasting is defined as the abstinence of food or drink. Intermittent fasting is a modified version of a traditional fast. It is defined as a period of time in which you cycle between a period of fasting and eating.

There are different variations to the fasting cycle. Some of the most common ones are:

  • Alternate day fasting (5/2)– This is a cycle in which a person will eat a normal diet for five days and then fast for two days. During the two days, you don’t fast completely, but you severely limit calories. So that might look something like this: Breakfast – Fast, Lunch – Fast, Dinner – 500 calories or less.
  • Complete fasting – This is a fully restricted fast that can last up to an entire day. The other days of the week a normal diet is consumed.
  • Time restricted feeding – This is probably the most popular type of IF. This involves fasting within a certain number of hours per day, and eating within the remaining timeframe. The most common is 12/12 (eating all meals within a 12 hour window and fasting for 12 hours) or 16/8 (eating all meals within an 8 hour window and fasting for 16 hours). The cycle can be repeated as often as you prefer – either every day or just a couple of days per week.

Benefits

Recent studies have reported several benefits to IF. IF has been shown to:

  • Assist in alleviating digestive disorders (IBS, SIBO) 
  • Improve insulin resistance and blood sugar balance
  • Support weight loss
  • Slow the growth of certain diseases such as Type 2 Diabetes, cancer, metabolic syndrome, cardiovascular disease, and obesity
  • Lower inflammatory markers
  • Improve longevity
  • Support cognitive function
  • Improve circadian rhythm (the body’s natural sleep/wake cycle)

Some of the most interesting research has been done in the area of weight loss, cardiac health, and the microbiome.

Weight Loss

The idea behind IF supporting weight loss is due to the notion that IF promotes calorie restriction and a temporary increase in resting energy expenditure. In addition, fasting has been shown to support a decrease in fat mass while allowing the body to maintain muscle mass. The theory behind these findings is that during a fasting period, fatty acids are released from fat cells and enter the liver where they are converted to ketones and used for energy and neurons. However, to date this idea has only been studied in animals, so more studies are needed to determine if it applies to humans as well. Other studies have shown that fasting allowed for a greater loss in abdominal fat and overall fat mass.

Cardiac Health

Alternate day fasting has been shown to have a significant reduction in triglycerides, LDL particle size, inflammatory markers such as CRP and may prove to be a viable option for those who are overweight or obese and suffering from cardiovascular disease.  

Another study found that participants who engaged in time restricted eating (16/8), resulted in a 3% decrease in body weight as well as reduction in blood pressure. The researchers concluded that this type of fasting allowed for weight loss without calorie counting. This type of diet is less restrictive then complete and alternate day fasting and may be easier in terms of compliance.

The Microbiome

Studies have shown that a diverse and healthy gut can be beneficial to maintaining a healthy weight. In certain cases, obese individuals have been found to have higher levels of harmful bacteria in gut, and low diversity of good bacteria. In addition, we are now learning that the gut has its own circadian rhythm. Chronically disrupted circadian rhythm may affect GI function and impair metabolism. Obesity or weight gain can be impacted by circadian rhythm in our microbiome. The microbiome in obese patients require a greater amount of energy, and imbalances can lead to chronic inflammation, dysbiosis, and intestinal permeability all of which can contribute to obesity.

How does fasting come into play? Fasting promotes gut rest, allowing the Migrating Motor Complex (MMC) to work optimally, sweeping debris from the small intestine into the colon and allowing proper digestion and absorption. This can be highly beneficial to those suffering from certain GI disorders and optimizes the ability to have a healthy well functioning gut.

Challenges:

  • In multiple studies, compliance was the biggest issues for participants. For those who engaged in a 5/2 alternate day fast, intense hunger on fasting days was the biggest reason for non-compliance.
  • In addition to hunger, other possible side effects are weakness and fatigue.
  • IF is simply not practical for everyone, since the benefits will only occur with a consistent eating/fasting period over time. If your schedule varies throughout the week, IF may not be a viable option for you. 
  • Due to intense hunger encountered during an 8/16 fast, some individuals report consuming higher amounts of food than normal and higher calorie amounts, which could lead to disordered eating patterns, weight gain, and digestive discomfort.
  • Due to lack of studies, we have no evidence to know what this does to a person’s metabolism long term.

IF is NOT recommended for the following individuals:

  • Those with certain conditions such as hypoglycemia, hypotension, advanced Diabetes, and those with high cortisol/adrenal dysregulation
  • Individuals with a history of eating disorders or those at risk of an eating disorder
  • Individuals who are underweight, or are looking to gain weight
  • Pregnant or breast feeding women
  • Children
  • Athletes

The bottom line:

I prefer the idea of a 12/12 fast. Consume a healthy balanced diet within a 12 hour window, and allow for gut rest and calorie restriction within a 12 hour fast. This seems to make the most sense to me, and allow for the most compliance without feelings of deprivation and intense hunger.

It is also important to understand that IF is not an excuse to go crazy and eat whatever you want during the eating portion of the cycle – a common misconception. Individuals should still strive to maintain a healthy balanced diet, full of lean proteins (poultry, fish, eggs, lean pork and grass fed beef), healthy fats, plenty of fruits and vegetables, and complex carbs (starchy veg, whole grains, beans and legumes).  If you are contemplating IF, talk to a qualified health professional to determine if it’s right for you. If you have further questions about IF, contact me here

Categories Nutrition, Advice, Exercise, Food, Health, Weight Loss

Healthy Eating for the Holidays (Part 2) 7 Strategies to Help You Stay On Track

Author Amber Hudler Posted on

How is it December already? It seems like just yesterday I was enjoying my summer vacation! In any case, it’s here. Are you ready? Do you have a plan? If you’re like most people, you’re feeling overwhelmed.

While this is a joyous time of year, it can also be really stressful. You’re not alone if you find that you’re putting self-prioritization on the back burner and falling off track with healthy eating and exercise.

But it doesn’t have to be this way. A while back I wrote a blog post about how to avoid extra weight gain during the holiday season. In today’s blog, I offer some additional strategies to maintain your health goals and still enjoy a festive holiday season.

Here are 7 additional strategies that I recommend:

  1. Use a food tracker for accountability. This can be really helpful throughout the month as you attend holiday parties that are bound to include those tempting high calorie and high carb apps, desserts, and beverages. I recommend that you track your intake during the days leading up to a party or event, and definitely track the day after. On the day of the party, relax and enjoy. But be sure to get back on track the next day with plenty of lean protein, non-starchy vegetables, complex carbs and healthy fats. Your food tracker will hold you accountable and ensure you’re meeting your needs. I love the app Nutritionix Track and my clients do too.
  2. Set an exercise goal and stick to it. Decide how many times you will exercise or work out in December. Have a friend, personal trainer, or fellow gym goer hold you accountable. Reward yourself with something small when you meet your goal (just don’t reward yourself with food or alcohol). I’m not saying you can exercise your way out of poor eating habits, but it will help you to burn some extra calories, lower stress, and feel great about yourself. Who wouldn’t want that?
  3. Hosting a party or event? Give your favorite recipes a makeover. Replace inflammatory vegetable oils with olive oil or avocado oil. Swap heavy carb and fat based casseroles with simpler options. For example, replace a green bean casserole with green beans sautéed in olive oil and topped with almond slivers; swap mashed potatoes with mashed cauliflower or glazed sweet potatoes with a plain sweet potato topped with cinnamon. Check out my Pinterest page for more ideas.
  4. Adopt a “Maintain Don’t Gain” philosophy. Instead of focusing on losing weight during December, set a goal to maintain your weight. It will lower your stress level and allow you to indulge in moderation.
  5. Ditch the sugary high calorie alcoholic beverages. Many are laden with syrup based mixers that will spike your blood sugar and cause you to crave more sweets. Opt for choices that include sparkling seltzer. It will significantly decrease calories and additives, and it will help to keep you hydrated.
  6. Limit the leftovers, especially desserts. If you are offered leftovers, opt for protein and vegetables. Leave the desserts behind. There will be plenty of those at the party next weekend.
  7. Hitting the buffet? Before getting in line, scope out your options. Seek out the fruit, vegetables, and lean proteins and be sure to fill your plate with those first. Decide which carbs you will enjoy (starchy vegetables are best) and which ones you will forgo. Avoid heavy sauces and fried foods.

Let’s face it, even with the best of intentions life gets in the way. The holidays are no exception. Having a clear-cut plan as you approach this month of celebrations will help you stay on track. Remember that this time of year is about spending time with those you love, and reflection. Stay focused on what really matters, remain positive, and remind yourself that you CAN do this.

 

Interested in learning more about my nutrition counseling services? Contact me here.

Categories Hormones, Exercise, Nutrition, Protein, Weight Loss

Thyroid: Is it to blame for your weight gain and fatigue?

Author Amber Hudler Posted on

Are you constantly struggling to lose weight even though you eat right, exercise regularly, and get plenty of sleep? If so, the reason could be your thyroid.

The thyroid is a butterfly shaped gland located in the neck. It is a major gland of the endocrine system and affects nearly every organ in the body.

Your thyroid helps to regulate the following:

  • Metabolism (How the body burns and stores carbs, fats, and proteins)
  • Body temperature
  • Calcium Balance
  • Heart rate and cellular oxygenation
  • Hormone balance including depression and anxiety

One of the most common types of thyroid disorder is an underactive thyroid. This is known as hypothyroidism. According to the American Thyroid Association:

“Hypothyroidism means that the thyroid gland can’t make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease, such as Hashimoto’s thyroiditis, surgical removal of the thyroid, and radiation treatment.”

Since your thyroid helps to regulate your metabolism, an underactive thyroid can cause a slower metabolism and in some cases make it to come to a complete standstill. Individuals with hypothyroidism may find it extremely difficult to lose weight, no matter how healthy they eat and how often they exercise.

In addition to weight gain and difficulty losing weight, other signs of hypothyroidism include:

  • Fatigue
  • Anxiety / depression
  • Intolerance to cold
  • Goiter
  • Elevated cholesterol (LDL)
  • Constipation
  • Food sensitivities
  • Thinning hair
  • Dry brittle nails
  • Low libido
  • Brain fog/memory loss
  • Thinning outer eyebrow
  • Micronutrient deficiencies
  • Impaired methylation
  • Muscle weakness
  • Numbness in the fingers or hands
  • Headaches
  • Menstrual irregularities

Knowing Your Numbers:

Have you had your thyroid tested and been told it’s “normal” even though you are still feeling lousy? How frustrating! While your numbers may be in the normal range according to a lab company, they may not be optimal. Optimal means you are feeling well. Or, more commonly, not all of your thyroid numbers may have even been tested.

One of the most comprehensive ways to determine if your thyroid is functioning at its best, is a have your doctor run a full thyroid panel. A full thyroid panel will look a variety of thyroid numbers, not just your TSH. It will give you a lot more information about your thyroid, including a test for thyroid autoimmune disease such as Hashimoto’s or Grave’s.

A full thyroid panel should include:

  • TSH
  • Free T4
  • Free T3
  • Reverse T3
  • Thyroid Peroxidase Antibodies (TPOAb)
  • Thyroglobulin Antibodies (TgAb)

If you have only had your TSH or T4 tested, and are still experiencing symptoms, it may be time to talk to your doctor or endocrinologist about further testing.

Foods To Include:

To support a healthy thyroid, I recommend a whole foods diet with plenty of lean protein, fruits, vegetables, healthy fats, and complex carbohydrates. Consider organic fruits and vegetables (use the Clean 15/Dirty Dozen list as a guide) meats without antibiotics, dairy without hormones, and non-GMO fermented soy in limited amounts only. Drink plenty of water. Set a goal to drink half of your body weight in ounces each day (For example, a person who weighs 150lbs would drink 75oz in water per day). For weight management, stick to your appropriate calorie range, keep carbs low, and balance with plenty of protein. Aim for 25g of fiber per day minimum.

In addition, be sure to include thyroid supportive foods that are rich in Vitamin D, iron, selenium, iodine, zinc, Omega 3 fatty acids, B12, and anti-inflammatories such as:

  • Lentils
  • Spinach
  • Sardines
  • Tuna
  • Crab
  • Lobster
  • Oysters
  • Eggs
  • Sea salt / Kelp /iodized salt
  • Brazil Nuts – about 2 per day
  • Beans (if tolerated)
  • Dark chocolate (in moderation)
  • Olive oil
  • Almonds
  • Cashews
  • Avocado
  • Sweet potatoes
  • Oats
  • Grass fed beef
  • Poultry
  • Flax seed
  • Pumpkin seed
  • Sesame seed
  • Tumeric

It is also important to include fermented foods to heal the gut such as kefir, sauerkraut, miso, yogurt, fermented vegetables, and Kombucha

Foods to modify:

  • Cruciferous vegetables – Foods such as broccoli, cauliflower, kale, Bok Choy, Brussels sprouts, cabbage, collards, watercress, radishes, arugula, and mustard greens contain goitrogens. In a person with hypothyroid disease, goitrogens can attack the thyroid and produce what is known as a goiter. Let me be clear, you do not need to avoid these foods! You just need to cook them first. Cooking will break down the goitrogenic properties and make them safer for your thyroid.

Foods to limit/avoid:

  • Gluten*
  • Dairy*
  • Millet
  • Soy (in some cases)
  • Coffee – Limit, consume 1-2 hrs after taking medication
  • Added sugars
  • Trans fats
  • Fast food
  • Common food sensitivities should be ruled out
  • Halogens including chlorine and fluoride (can inhibit iodine update)
  • Environmental toxins (Plastics, synthetics, pesticides, xenoestrogens)

*It is important to note that celiac disease, gluten sensitivity, and dairy intolerance should all be ruled out. There is evidence that supports a correlation to thyroid disease and celiac disease. If autoimmune disease is present, there is evidence to support a GFDF diet can help.

Supplements to consider (Not all of these supplements may be needed. Certain supplements should only be considered if you are deficient. I recommend micronutrient testing to determine your needs)

  • Daily Multivitamin
  • Vitamin D3
  • Fish Oil
  • Iron
  • Selenium
  • Vitamin A
  • Vitamin E
  • Zinc
  • Certain Antioxidants

Supplements that may interfere with thyroid medication:

  • Calcium, fiber – If taking, space apart from your thyroid medication
  • Biotin – Can interfere with thyroid tests

Finally, be sure to get plenty of exercise and manage stress. Here are some additional treatment therapies to consider:

http://www.thyroid.org/thyroid-disease-cam/

Resources:

Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

http://www.umm.edu/health/medical/altmed/condition/hypothyroidism

https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease

https://www.thyroid.org/hypothyroidism/

http://www.todaysdietitian.com/newarchives/070112p40.shtml

https://www.eatright.org/food/vitamins-and-supplements/nutrient-rich-foods/the-beginners-guide-to-cruciferous-vegetables

https://www.amymyersmd.com/thethyroidconnection/

Categories Food, Health, Nutrition, Weight Loss

Understanding Macros Part 3: Fats

Author Amber Hudler Posted on

So you’ve learned about carbs and proteins, now it’s time to focus on fats. One of the most important things that fats can do is provide us with fullness and satiety. Plus they taste great! Read on to learn about the right types of healthy fats to include in your diet.

FATS

Historically, fats in the diet have been blamed as a leading cause of heart disease and weight gain. Current science has taught us that this simply is not true. Fats play a critical role in keeping us healthy. You read that correctly – fats keep us healthy. And by including the right type of fats in your diet, you will not only improve your heart health, you may even lose a few pounds while you are at it.

Fats refer to a type of nutrient known as lipids. Lipids include three main groups: triglycerides, phospholipids, and sterols. Triglycerides are by far the most common type of fat both in our diet and in the body. A key characteristic of lipids is that they are insoluble in water. Fats and oils are two main types of lipids. Fats are lipids that are solid at room temperature. Oils are lipids that are liquid at room temperature.

Fats play a key role in the body. Some of the key functions of fats include:

  • Cushioning joints
  • Protecting bones, body organs and nerves from injury
  • Digestion and absorption of fat-soluble vitamins
  • Slowing gastric emptying and supporting digestion
  • Providing satiety at meals
  • Supplying us with energy
  • Preserving body heat and providing insulation to help us stay warm

In our diet, fats can fall into three broad categories: Trans fats, saturated fats, and unsaturated fats.

Most trans fats do not occur naturally in nature. The majority were created by the food industry to promote the shelf life of products. Trans fats work by adding hydrogen to vegetable oil, which causes the oil to become solid at room temperature. Trans fats are by far the worst type of fat you can consume. They are most commonly found in foods such as stick margarine, vegetable shortening, processed foods such as store bought cookies, snack cakes, potato chips, and fried foods at fast-food restaurants. Research has shown that trans fats are a leading cause of elevated cholesterol and heart disease. They raise triglycerides and LDL, lower HDL, increase inflammation and promote insulin resistance.

Saturated fats have been under debate for quite some time. While at one point saturated fats were also thought to be a contributor to heart disease, more current research has shown that the right types of saturated fats can actually be cardio-protective. Saturated fats are found in foods such as butter, coconut oil, marbled red meat, lard, ghee, full fat dairy, fried foods, dessert foods. Obviously, you want to avoid the last two. But the saturated fast found in foods like grass fed butter and coconut oil are the right types of saturated fats. Why? There is some evidence to support that certain types of saturated fats can actually increase the particle size of LDL, making it less harmful then LDL particles that are small and dense. Also, when fats are grass fed (such as butter and red meat) you are also getting a source of Omega-3 fatty acids which can help to raise HDL, your good cholesterol.

Speaking of Omega-3’s, unsaturated fats include polyunsaturated, monounsaturated, and Omega-3 fatty acids. These can be found in foods such as a fatty fish like salmon and tuna, nuts, seeds, flax, chia, avocados, avocado oil, olives, and olive oil. These are the BEST types of fats to choose. They raise HDL, lower inflammation, play a key role in maintaining healthy vision, reduce risk of cognitive decline, and support a healthy pregnancy.

Why does it matter?

The right type of fats are not only health promoting, but they are also satiating. Like protein, fats in the diet digest slower, keeping you fuller longer. Fats will not impact your blood sugar, so by including them you will be able to keep your blood sugar balanced, sustain your energy levels, curb cravings, and overall consume less food.

Key takeaway

Not all fats are bad! Strive to incorporate mostly unsaturated fats in your diet. I typically recommend about 85-90% of your fats should come from unsaturated sources. Use high quality saturated fats about 10-15% of the time. Choose ones like grass fed beef, grass fed butter, ghee, or coconut oil. These types of saturated fats have a better nutritional profile and in the case of grass fed products, contain omega-3 fatty acids. Fats take a longer time to digest, so they provide fullness and satiety. Many unsaturated fats are found to be heart protective.

Summary

If you finish a meal and still feel hungry, you may not be getting enough healthy fat. Fats provide us with satiety, meaning that we will feel fuller and more satisfied then if we exclude them from our diet. Knowing how to properly balance your fats in order to meet your needs will set you on the right path to achieving your goals.

If you’ve made it this far, I’m proud of you! It is my hope that these posts have provided you with some clarity around the right types of macros to eat and WHY.

Want to know your specific macronutrient needs? Contact me here for a nutrition counseling session.

Sources:

Mahan, K.L., & Escott-Stump, S. (2008). Krause’s food and nutrition therapy. St. LouisMissouri: Saunders Elsevier.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition, eighth edition.   Belmont, California: Wadsworth, Cengage Learning.

https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/trans-fat/art-20046114

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550

Categories Food, Health, Nutrition, Weight Loss

Understanding Macros Part 2: Protein

Author Amber Hudler Posted on

Hopefully you read about carbs in part one of this series. If not, you can check it out here. In part two of understanding macros, the focus is on protein. Protein performs many functions in the body and is essential to maintaining a healthy weight. Most of my clients are not getting enough. Read on to learn about the importance of protein and the minimal amount you should be aiming for in your diet.

PROTEIN

Proteins are mainly comprised of 20 different building blocks known as amino acids that are linked together in long chains by amino bonds. Amino acids are comprised of three types: essential, non-essential, and conditionally essential. Essential amino acids cannot be produced in the body and must be provided through food. The nine essential amino acids are:

Histidine

LysineThreonine

Isoleucine

Methionine

Tryptophan

LeucinePhenylalanine

Valine

 

A complete protein is one that contains all nine essential amino acids. All animal proteins are complete proteins. An incomplete protein is lacking one or more essential amino acids. Most plant based proteins are incomplete proteins. Sometimes, certain combinations of incomplete proteins can make them a complete protein. Examples of these combinations include rice and beans, edamame and walnuts, or oatmeal with almonds.

Non-essential amino acids can be provided by food, however the body can also produce these on its own. Conditionally essential amino acids are normally non-essential, but they are supplied by the diet when the need for them exceeds the body’s ability to produce it.

Amino acids are required to enable protein to perform its many functions, which include:

  • Growth and maintenance of skin, tendons, membranes, muscles, organs, and bones
  • Repair of body tissues
  • Hormone regulation
  • Digestion support in the form of enzymes
  • Fluid Balance
  • Acid-base regulation
  • Transportation of nutrients including vitamins, minerals, oxygen and lipids
  • Formation of antibodies to fight infection
  • An additional form of energy and glucose

Foods that contain protein include meat, poultry, fish, eggs, beans, lentils, soy, nuts, nut butters, seeds, and certain grains. When choosing meat such as beef, pork, lamb or eggs, be selective. Look for products without antibiotics and where applicable, choose pastured / grass fed. Remember that whatever the animal consumed, we consume. Choose lean cuts so that you can eat an ample portion.

A serving size of protein is generally 3-4 ounces for women, slightly more for men, or about the size of the palm of your hand. At a minimum, individuals should consume 0.8-1.0 grams of protein per kg of body weight per day. This is a general recommendation and can vary based upon an individual’s needs, goals and healthy history. For weight loss, I generally recommend a higher amount. It is important to know that while protein is beneficial for many reasons, consuming too much protein can be detrimental. For this reason, I don’t always recommend certain types of protein supplements that exceed safe amounts.

Why does it matter?

Protein performs many valuable functions within our body. In addition to helping us build muscle and fight off infections, protein works synergistically with carbs to extend the energy that carbs provide. About 3-4 hours worth. Protein also provides satiety. Simply put, incorporating protein at meals will keep you fuller longer and help to offset blood sugar crashes that occur when our diet is too high in carbohydrates. I recommend including protein at each meal and snack, and especially at breakfast. By starting your day with protein, you will avoid those early morning blood sugar spikes that often lead to fatigue, mood changes, brain fog, and cravings.

Key takeaway

Protein can be essential in helping us to balance our plate and maintain a healthy weight. When choosing protein, choose a variety of high quality sources. Be aware of which combinations of plant based foods provide you with a complete protein. Include protein at each meal and snack, and combine it with a complex carb to provide energy longer.

Summary

Balancing carbs with protein will help utilize the energy they provide, but also extend it throughout the day to help keep you balanced. Adequate protein in the diet will also help to build muscle, keep your hormones balance, and support digestion.

Want to know your specific protein needs? Contact me here for a nutrition counseling session.

Sources:

Mahan, K.L., & Escott-Stump, S. (2008). Krause’s food and nutrition therapy. St. LouisMissouri: Saunders Elsevier.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition, eighth edition.   Belmont, California: Wadsworth, Cengage Learning.

Photo by Alex Munsell on Unsplash

1 2 3 4 5 6