Posts tagged ‘nutrition’

November 12, 2018

Some Medical Schools Now Offer Classes in Culinary Medicine

Some medical schools now offer classes in culinary medicine. In the realm of recent Western modern medicine, that could easily be assumed to be instruction on suturing knife wounds and avoiding cross contamination. Actually, the news is more exciting than that! Tulane University School of Medicine created the Goldring Center for Culinary Medicine and introduced a 60-credit curriculum for medical students. The program has now partnered with over 50 medical and nursing schools.
prep
Many people seek nutritional advice from their physician. It seems logical because that same physician often advises a healthy diet and exercise to prevent or improve disease progression. Often the doctor then refers the patient to a nutrition counselor with no additional discussion. That referral is often where the cycle ends.

While the physician may be aware of current dietary recommendations for the amount of protein, fat, or sugar consumption, he/she may not know much about the art of cooking. The doctor won’t necessarily know what flavors and textures play well together when adding vegetables to traditional dishes to make them nutritionally rich. Even a nutritionist may not be skilled in the practical kitchen application of preparing healthy meals within a realistic time frame and budget.

Thanks in part to the wandering career of Tulane’s Timothy S. Harlan, MD, FACP, CCMS, who leads the team at Goldring Center for Culinary Medicine, that’s beginning to change. A large shift in the practice of medicine will take time, but I find this beginning of change thrilling!

Before he became a physician, Dr. Harlan discovered his love of food. He learned cooking techniques from chefs during the time he managed and owned restaurants. While training at Emory University School of Medicine, he began writing about the link between food and health. He now serves as Executive Director of the Goldring Center for Culinary Medicine.

The Goldring Center has developed a 60-credit curriculum that includes online nutrition training and live conferences as well as attendance at hands-on teaching kitchen modules. Completion of the course can result in earning the designation of Certified Culinary Medicine Specialist (CCMS). Physicians, Physicians Assistants, Pharmacists, Registered Dietitians and Nurse Practitioners are eligible for certification.

When you visit a practitioner with the CCMS certification, you will have the advantage of that clinician’s knowledge of how to incorporate healthy eating into your diet. Not only can they provide nutrition information, they have been trained in culinary techniques to prepare food that is consistent with real-world budgets and time constraints. That’s the sort of detailed support that can make you feel like you can succeed without being overwhelmed.

What I like about this approach is the practical aspect. If a practitioner actually has hands-on experience, it is much easier to offer real solutions that will resonate. The minute a patient realizes a doctor has no idea about cooking or feeding a family of 5 on a budget, they are likely to tune her out or adopt an attitude that he has no business telling them what to eat. After all, that practitioner clearly doesn’t understand the patient’s circumstances.

The Goldring Center also offers free cooking/nutrition classes for the community supported in part by a Celebrity Chef Dinner Series in which renowned regional chefs prepare a multi-course meal with wine pairings at the center. Not only does this bring additional connection with the community, it keeps reminds us that healthy food can also be delicious food. This is a mantra that bears repeating, especially when it comes to gluten-free food.

Good nutrition is the basis for mental and motor development in children and good health in adults. At long last, modern medicine is incorporating food preparation into the practice of medicine. This is a welcome shift.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379645/

https://culinarymedicine.org/

https://www.healthmeetsfood.com/

https://www.drgourmet.com/pr/#.W-mnY4FKjnE
ad

August 16, 2018

Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?
health
It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.
salad
But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.
garden
Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

steam trayI’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

http://www.cooking2thrive.com/blog/get-know-food/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

January 10, 2017

Get to Know Some Other Breakfast Foods

Last week we learned about cereal, now let’s get to know some other breakfast foods. More than 80% of us eat breakfast at home. If you’re like me, you eat it in pjs with a cup of hot coffee in hand. There’s no end to the possible breakfast options, so we’ll take a look at some of the more popular items we choose at home.
eggs
Eggs
Eggs are king of the traditional American breakfast. Simple to cook in a variety of ways in only a few minutes, an egg is packed with protein and low in carbohydrates. One egg has 70 calories, 6 grams of protein, 1 gram of carbohydrate, and 65 mg of sodium. The high protein and low carb content make eggs an ideal choice for diabetics.

Unlike most foods, eggs contain all 9 essential amino acids that cannot be made by your body plus iron, vitamins A,D,E, & B12, folate, selenium, lutein, zeaxanthin, and choline. Eggs also provide the primary source of cholesterol in the American diet. One egg has 195 mg.

Because blood cholesterol has been of concern in heart disease, for many years Dietary Guidelines recommended limiting consumption of cholesterol thereby giving eggs a bad rap. This changed in 2015. The Guideline regarding cholesterol was removed because it is now recognized that dietary cholesterol plays no role in blood cholesterol.

With that concern removed, it’s hard to find a better food to get you going in the morning.*

Ever drink a glass of orange juice with your eggs?
Apparently a lot of us do. About two billion dollars worth of orange juice are purchased in the US each year. The largest selling brand is Tropicana Pure Premium.

Orange Juice

An 8 oz glass of Tropicana Pure Premium No Pulp Orange Juice has 110 calories, 2 grams of protein, 0 fat, 0 sodium, 450 mg of potassium, 22 grams of naturally occurring sugars and a total of 26 grams of carbs. A glass of this juice also provides 120%** of the recommended daily allowance of vitamin C, 2% of the daily value for calcium, 10% for thiamine, 4% for riboflavin & niacin, 6% vitamin B6, 15% folate, and 6% magnesium.

oranges
How does that compare with an orange?

Orange

One large orange has about 86 calories, 2 grams of protein, 0 fat, 4 grams of dietary fiber, 17 grams of sugars and 22 total grams of carbs. It also has 163% of the RDA of vitamin C plus naturally occurring calcium (7% RDA), vitamin A (8%), and iron (1%).

Looks like an orange has less calories, more fiber, more calcium, more vitamin A, more iron and 43% more vitamin C, but lacks the added thiamine, riboflavin, niacin, vitamin B6, folate, and magnesium.

If you are choosing orange juice for vitamin C, you’ll get significantly more from eating an orange plus the benefit of 4 grams of dietary fiber and 5% more calcium.

Before choosing store bought orange juice, you should also be aware that in spite of the “not from concentrate” verbiage on the label, this type of orange juice is processed by having the oxygen removed so it can be stored in vats for up to a year. This process removes the flavor. A flavor pack is then added so that when it’s bottled it will taste like orange juice. Because the flavor pack is made from orange by-products, it is not considered an ingredient, and therefore isn’t required to appear on the label despite the fact that the by-products are chemically altered. 1)

yogurt

What about yogurt for breakfast?

Up until two years ago, Greek yogurt sales were skyrocketing. While the growth has now slowed to a moderate level, you can’t pass a dairy cabinet without seeing a wide array of single serving yogurt options. Many of those convenient cups are occupying our breakfast tables, but not all single serving yogurt is created equal.

The top selling brand of yogurt is Chobani, so let’s start there.

Non-fat Greek Yogurt
Chobani 5.3 oz non-fat Greek yogurt contains 80 calories, 15 grams of protein, 0 fat, 10 mg cholesterol, 55 mg sodium, 4 grams of sugars and a total of 6 carbs, 15% of the RDA of calcium, and 6% of potassium. This yogurt is also full of probiotic live and active cultures that help your digestive tract.

That’s twice as much protein as an egg for only 10 additional calories. Plain Greek yogurt is also low in carbohydrates and has a significant amount of calcium making it another good choice for diabetics.

Plain yogurt? Yuck! What about flavored yogurt?

Blackberry Yogurt
One 5.3 oz container of Chobani Greek Yogurt with Blackberry on the Bottom contains 120 calories, 12 grams of protein, 0 fat, 5 mg cholesterol, 50 mg of sodium, 16 grams of sugars and a total of 18 carbs, 15% of the RDA of calcium, and 6% of potassium. Like plain yogurt, this version is also full of probiotic live and active cultures that help your digestive tract.

While blackberries may account for some of the sugar listed on the label, evaporated cane sugar is the 2nd ingredient, meaning that many of the 16 grams of sugar come from added sugars. The sugar adds most of the 40 additional calories. Although the protein content is still high at 12 grams and the probiotics are present, added sugar makes this yogurt less healthy in general than plain yogurt and doubly bad for diabetics and those with heart disease.

I understand why flavored yogurt is tempting. Yogurt can be a bit tangy on its own. I eat 1/3 – 1/2 cup of plain Greek yogurt for breakfast most mornings. Rather than adding sugar, sweetener or honey, I top it with about a tbsp of golden raisins and 10 raw almonds. As a breakfast, this is crunchy, filling, and just sweet enough. The nuts and raisins both add protein, the nuts add fiber, and the raisins add carbs. This combination is also quick and doesn’t require cooking.

While I find Greek yogurt convenient, many people prefer the portability of breakfast bars. The top selling nutrition/health bar is Clif.

Clif Oatmeal Raisin Walnut Bar

In one Clif Oatmeal Raisin Walnut Bar you’ll find 250 calories, 10 grams of protein, 5 grams of fat, 150 mg sodium, 7% RDA of potassium, 5 grams of dietary fiber & 4 grams of insoluble fiber, 20 grams of sugars and 44 grams of total carbohydrates. It is also fortified with vitamins & minerals.

Although this bar offers a good amount of protein and fiber, the calorie count is high and the total amount of carbohydrates is very high. These bars are not an option for those who are gluten-free, and they cannot be characterized as a good choice for those who are diabetic or at risk for heart disease.

Of course there are other breakfast bars with varying amounts of protein, fat, and sugar so you may find one that fits your eating plan. You won’t find one that beats eggs or plain Greek yogurt in nutrition per calorie.

Of all the foods we’ve learned about so far, eggs and non-fat plain Greek yogurt offer the best high protein, low fat, low carb breakfast choice.

Next up, we’ll look at some popular on-the-go breakfast sandwiches and then we’ll be ready to move on to lunch and dinner.

Should we explore coffee? Probably, but right now I’d rather just have another cup. Until next week…

*Eggs are one of the 7 top allergens. Approximately 2% of children are allergic to eggs, but 70% outgrow the allergy by the time they’re 16. http://acaai.org/allergies/types/food-allergies/types-food-allergy/egg-allergy If you have an egg allergy, please avoid eating eggs and products containing them.
**Percent of daily values listed are based on a 2000 calorie diet. Your DV may be higher or lower based on your calorie needs.
Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

1)http://www.foodrenegade.com/secret-ingredient-your-orange-juice/
http://www.huffingtonpost.com/2011/07/29/100-percent-orange-juice-artificial_n_913395.html
http://gizmodo.com/5825909/orange-juice-is-artificially-flavored-to-taste-like-oranges

August 9, 2016

World Breastfeeding Week

SidebabyWorld Breastfeeding Week just drew to a close. What? There’s a World Breastfeeding Week? Well, yes there is. It’s coordinated by the World Alliance for Breastfeeding Action (WABA) and began about 15 years ago.

WABA’s core partners are the Academy of Breastfeeding Medicine (ABM), International Baby Food Action Network (IBFAN), International Lactation Consultant Association (ILCA), La Leche League International (LLLI), and Wellstart International.

This year, in addition to encouraging women to breastfeed, WABA focussed on raising awareness of the links between breastfeeding and Sustainable Development Goals along the following themes:
1)Nutrition/food security
2)Health, well0being and survival
3)Environment and climate change
4)Work productivity, empowerment, social protection, and
5)Sustainable partnerships and rule of law

That sounds lofty and idealistic, but in the US, there’s a huge gap between our lofty breastfeeding goals and our actual practice. The American Academy of Pediatrics recommends feeding babies nothing but breast milk for the first 6 months of life. When moms arrive at the hospital to give birth, the majority say they are planning to follow this guideline. Three months later, 43.3% are exclusively breastfeeding and 29.3% are supplementing with formula. By 6 months according to the CDC, the percentage of exclusively breastfed babies has dropped to 21.9% and 35.4% of nursing mothers have supplemented with formula.*

Rates of Rates of breastfeeding declined in the US between 1911 and 1972 when only 22% of women initiated breastfeeding. While the rates have increased since 1972, they remain low in spite of the known health benefits to both infant and mother. So it seems that our tortured relationship with healthy food in this country literally begins at birth and for many of the same reasons adults cite as impediments to healthy habits – convenience, lack of social support, confusing messages from the medical community, and advertising that reassures us a product is healthy (the closest to breast milk).
scream

When it comes to convenience, I feel like we often think of things in a topsy turvy manner. What could be more convenient than always having milk ready and at the right temperature when a baby gets hungry? It becomes inconvenient when women feel they must go back to work quickly to support their families or believe that they’ll get behind in their careers if they take off a few years to raise children. While this is sometimes the reality, other times it isn’t, but the belief has become so ingrained that we rarely challenge it.

We don’t always run the numbers to see if our jobs really cost more than they bring in, especially if we have more than one child in day care. We appear to forget that added trips to the doctor for either baby or mother who has missed out on the health benefits of breastfeeding take time out of our schedule.

Nor is there much social support for breastfeeding in public places in many communities in the US. You may have seen the recent video of a man telling a breastfeeding mother in Target how disgusting she is. This type of experience has been reported by 25% of breastfeeding moms.

This seems kinda crazy to me considering the number of reality TV stars who run around with half of their boobs showing all the time. Is it the addition of a baby that makes seeing a breast disgusting? I guess that could make sense. Babies are kinda gross sometimes.

Almost 20% of US babies receive supplementary formula within the first two days following birth. That means it’s often being fed while mom and baby are still in the hospital. When you combine this with the formula samples and ads that are often sent home with the mothers, it can appear like a medical endorsement of formula. Studies show that leaving the hospital with formula samples reduces the duration of breastfeeding.

While it’s easy to brush all of this off as insignificant as long as our life expectancy remains the same, the rise in chronic diseases is making our lengthy lives of lower quality. Perhaps someday soon, we’ll recognize that quality can be as valuable as quantity. We’ll see that we don’t have to rush to accumulate, achieve, or hit some arbitrary target to bring value to our lives, our communities, and the world.

In the meantime, I wish you the courage and perseverance to give yourself and your children the best nutritional support available even when it’s not as easy, convenient or well-supported as you believe it should be.

monkey hand

*Based on most recent CDC statistics available (2012) https://nccd.cdc.gov/NPAO_DTM/

http://www.bfmed.org/
http://www.ibfan.org/
http://www.ilca.org/home
http://www.llli.org/
http://www.wellstart.org/

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00210-5.pdf
http://abcnews.go.com/Health/story?id=117395&page=1

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”