Monthly Archives: November 2009

Helpful Nutrition Hints for Avoiding Diabetes


I am attaching an excerpt from a recent book by Dr. Frederic Vagnini and Lawrence D. Chilnick on how to use nutritional techniques to avoid developing diabetes. Thanks to the authors for permission to use this information.

Overcome Supermarket Roadblocks

by Frederic Vagnini, M.D., FACS, and Lawrence D. Chilnick,
Authors of The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes

Shopping Defensively

Here are some specific hints for defensive shopping:

Prepare ahead. If there’s one rule to follow, this is it: Don’t to go to the supermarket “on the fly.” We’ve all run out for a few things and ended up buying twice as much as we needed. Often, something in the store tempts us to do just that. For example, how many supermarkets position the bakery right where you walk in, with the wonderful smell of newly baked bread or cakes perfuming the air? It’s not an accident.
Consult your cookbooks and create a weekly menu. Write down all of the ingredients you need for it.
Know what you are going to make, and make sure that most of what you buy fits into your overall meal plan.
Check the fridge and pantry so you know what you don’t need to buy.
Shop weekly. Shopping too often or stretching your shopping trips to every two weeks will make sticking to your meal plan more difficult.
Learn the store layout. The fewer tempting products you see and the less time you spend browsing, the easier it will be to avoid buying the wrong foods. The healthiest fresh foods are in areas against the store walls. Don’t spend time in the central aisles with things you don’t need.
Look up and down. The most attractively packaged food is on shelves at eye level.
Stay away from the areas where store employees are offering free samples of high-carb and fatty foods.
Eat before you shop. A hungry shopper buys more food and makes worse food choices, plus with diabetes, you need to eat at specific times and in amounts that ensure stable blood sugar.
Shop alone and without the kids. Although research claims that men are more likely to stick to their list only, the levels of obesity in both genders suggests otherwise. Going to the supermarket should be a directed, time-limited event. You are there to buy certain things you need; you don’t have to review every single one of the store’s offerings. If possible, shop for food when the kids are in school because they are special targets for marketers.
Make healthy choices. This doesn’t only mean buying fresh vegetables from local farms or good produce in the supermarket. A healthy choice is a meal you make at home — not take-out or prepared foods. Over the past decade, sales of prepared foods at the deli counters and throughout the store have risen steadily. Americans now spend over $15 billion per year on prepared foods in supermarkets and in shopping mall food courts.
While sales of starchy, fat-dripping fast foods are dropping, prepared take-out foods aren’t much better. The choices are often “family friendly”: fried chicken, chicken nuggets, chicken wings, baked potatoes, egg rolls, tacos, and creamy “comfort food” soups. Did you know that much of the prepared supermarket food is made by the same giant food companies that make the fast foods? If you buy prepared foods, avoid those with heavy mayonnaise or breading and high calories. Dodge items featuring rice or mashed potatoes, too.

Some experts suggest you take a close look at how much of your diet comes from the prepared choices. If prepared food makes up more than half of your diet, you have a problem. While one solution would be to learn to cook more or better, some people simply don’t like to cook or have too little time to make meals at home. But this isn’t an insurmountable problem.

Making the Supermarket Your Support System

If you are truly going to make a change that will bring your glucose under control and help you lose weight, you will have to take control of what you and your family eat. It is less difficult than you think. The secret is in your commitment to change.

There are scores of healthy-eating-oriented cookbooks in bookstores, supermarkets, mega-stores, and online recipe sources. These books help you follow some basic rules that will help meet the requirements of the Five-Step Plan.

Doing your own cooking will help you control what you eat, control your glucose, and lose weight. You will still go to the supermarket, but buying fresh vegetables in season, certain fruits, and good protein sources such as fish, chicken, turkey, and other lean meats will make your diet more interesting and flavorful. You might even discover that cooking can be fun, and you can make it a group activity. As you lose weight, you will feel better physically and mentally because the food you eat will be better for you. Your body will thank you.

Another good tip is to ask questions at the market. You’d be surprised how much help the people behind the counters can be, and not only at high-end supermarkets.

The desire for certain foods has been studied and reported on over the years. It’s often been noted that people fantasize more about food than any other pleasure, including sex. After all, food gave us our first pleasure as children, and eating habits last a lifetime. Given the level of obesity in the country, is it any surprise that many adolescents who do their “hunting” in front of the computer or video game are following in their parents’ footsteps?

The above is an excerpt from the book The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes by Frederic Vagnini, M.D., FACS, and Lawrence D. Chilnick. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.

Copyright © 2009 Frederic Vagnini, M.D., FACS, and Lawrence D. Chilnick, authors of The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes

Author Bios
Frederic J. Vagnini, M.D., FACS, coauthor of The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes, is a board-certified cardiovascular surgeon whose understanding of the ravages of cardiovascular diseases is grounded in twenty years as a cardiac surgeon. He hosts a popular call-in radio show and has published several books, including The Carbohydrate Addict’s Healthy Heart Program, a New York Times bestseller.

Lawrence D. Chilnick, coauthor of The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes, is the authors and creator of the New York Times bestseller The Pill Book, which has sold 17 million copies and is still in print after more than two decades. He is a publishing executive, editor, teacher, journalist, broadcaster, and author of several popular health reference books, electronic products, audiotapes, and videos.

For more information please visit www.amazon.com.

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Dennis Wonders if Armour Thyroid Can Create Thyroid Hormone Dependency.


Dennis wonders if Armour thyroid hormone treatment can create a dependency on the medication. In his post (http://www.metabolism.com/2009/08/25/armour-thyroid-shortage-nation-wide-problem/#comment-2177) he suggests that this might explain why people experience such discomfort when trying to switch medication or go off. Thanks Dennis for your thoughts, as I imagine others share your concern.

Below I offer my response to this theory.

Dennis

I wouldn’t worry about a dependency problem from using Armour or other thyroid replacement drugs for two reasons: 1) Dependency implies that it is the medication which creates a need for itself. This occurs because over time the drug causes changes in the body to create an on-going need for more of the med. A narcotic, for example, will cause painful withdrawal symptoms if stopped suddenly after continuous use for weeks/months. More narcotic will relieve the withdrawal process almost immediately. This is very different than when a person takes thyroid hormone such as Armour to treat hypothyroidism. People use thyroid hormone replacement because the body is not making sufficient thyroid hormone in the first place. The medicine doesn’t cause the thyroid to stop making hormone, but it is a disease like Hashimoto’s that causes the thyroid to stop working.
2) It is true that the endocrine glands can become atrophied by administering the hormone that the gland makes for an extended period of time. This is most often seen by taking adrenal hormones like Prednisone, Cortef, Hydrocortisone, Dexamethasone etc. These drugs are very powerful adrenal suppressants used to treat asthma, and autoimmune diseases such as lupus or rheumatoid arthritis. If someone takes these drugs long enough and then stops suddenly a life threatening condition known as adrenal crisis can develop because the adrenal gland has atrophied. It can take up to a year of carefully withdrawing adrenal hormones before the gland is strong enough to function normally again on its own. The thyroid is much more resilient than the adrenal gland however. If someone with a normal thyroid gland takes thyroid medication for a year or two then stops the drug, the thyroid will be functioning normally again usually within weeks if not sooner. There is no severe withdrawal like that seen with the adrenal.

I hope this info eases your concerns about developing dependency on Armour thyroid or other thyroid hormones used to treat hypothyroidism.

My comments are for educational purposes only and do not replace the advice of your own physician.

Gary Pepper, M.D.

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Maya Sarkisyan Offers Expert Advice on Quitting Smoking and Weight Gain


Maya has been a long standing guest expert at metabolism.com. In her recent post Maya offers her expert opinion on the debate regarding weight gain (and how to lose it) when stopping smoking.

Maya writes:

I help people to quit smoking using hypnosis in combination with other healing modalities. It is always an individual approach. Not everyone gains weight after quitting, so I have noticed that people who do generally have other underlying health issues, such as underactive thyroid function. Why than smoking keeps the wight down? There are few possible explanations.
1. when you smoked you constantly had something around your mouth, so you ate less.
2.The taste buds are getting desensitized because of the nicotine.
3. according to some Chinese medical sources the nicotine is a very hot substance and upon entering your body it dries up your fluids – vital fluids as well, such as your blood. This is why cardiovascular disease is associated with smoking.

Now when people quit smoking their body has to go through some sort of rearrangement. Food starts tasting better and it is important to start adjusting your diet even prior to the quitting smoking in order to prepare yourself for the long and healthy life. Adding more vegetables and fruits to your diet helps a lot. Drinking lots of water.

Detoxification process is a good approach after quitting to help your body get rid of the gunk accumulated over the years. This way you give yourself a good chance to get back in balance. There are different detox treatments available to do at home and some of them are very mild yet effective.
And, most importantly, taking care of yourself helps to get you healthier in all aspects.

Thank you Maya for your comments. You can find more of Maya Sarkisyan’s articles at http://www.metabolism.com/author/Maya-Sarkisyan/. Maya also maintains her own website at www.transentient.com

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Floating Our Way to Fatness on a “Bloat”


Imagine locking the family dog in a cage for a week with an endless supply of its favorite treats. What would you expect at the end of the week? It’s obvious, isn’t it? A fat and possibly very ill pooch.

Subject a human counterpart to similar conditions and expect the same thing to happen. Yet, unbelievably, there is a huge industry devoted to creating this kind of environment and we pay a fortune to support it. It’s called the cruise industry.

During summers thirty years ago in the New York metropolitan area, many of my parent’s friends spent their vacation time in the Catskills. The Catskills is an area of rolling hills and farms and at that time years ago also the scene of a vibrant hotel industry. Hot, tired and stressed New Yorker could eat and drink themselves silly for a week or two while feeling they were healthier for breathing the fresh, cool mountain air. Because the hotels were set in an apparent wilderness vacationers had no guilt about never moving their bodies outside the compound. Eating, “schmoozing” and taking in the nightly Borscht Belt entertainment were the only activities available.

Fast forward to the present. The Catskill hotels have been replaced by mammoth floating hotels called cruise ships. The original beauty of these ships as a method of refined transportation to Europe or the islands has been lost. In transforming from Borscht Belt hotel to gigantic cruise ship merely substitute ocean for mountains. Sequestered on board the ship with no risk of being required to move more than a few hundred steps in any direction, what else to do but consume what is constantly in your face…massive quantities of food and drink and passive entertainment.

It is my impression (supported by numerous studies) that the average weight of our population is growing steadily. Paralleling the phenomena of the growing size of the average person is the ever increasing size of the cruise ships. Last week the most obscenely massive cruise ship of them all made its debut in Florida. Oasis of the Seas is 40% bigger than the next largest cruise ship and 5 times bigger than the Titanic. Oasis of the Seas will confine together 6300 passengers and 2800 crew members. Despite its size, being alone on this ship will be like trying to find a quiet corner in Times Square on New Years Eve. Looking at the ship one wonders how something so big could float. It is oddly shaped, no sleekness to this vessel with more vertical than horizontal lines. Maybe we shouldn’t call it a boat, at all. In fact I would put it into a different category altogether…something I would call a “bloat” for being a really big, big, floating boat.

I am troubled by the existence of the ‘bloat’ because as the size of the population and cruise ships increases so has the incidence of diabetes. Since I treat diabetes as a profession, I get the feeling my job is increasingly hopeless as more and more of my patients jump on board the cruise craze. As cruising has become a generally accepted way of vacationing with a vast advertising budget glamorizing this lifestyle, my advice about diet and exercise is drowned out. Once on board, there are few people who could resist the urge to say, “I paid for this, so I might as well do what everyone else is doing”.

I expect more bloats to be commissioned in the future, each one a miracle of engineering and excess. If things continue in this direction we may wind up wiping ourselves out with metabolic diseases like diabetes, coronary disease and high blood pressure. In our wake we will leave behind colossal deserted monuments of our civilization, pyramids of the sea.

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Teresa and Marion Share Experiences with Weight Gain after Stopping Smoking


Teresa has plateaued in her effort to lose weight after smoking cessation. Marion offers her support in what is often a frustrating battle to rev the metabolism back up.

Teresa’s story is as follows:

Hey everybody. I quit smoking 3 months ago [7/25/09] and have gained 10-12 lbs [depending on the time of day I weigh, water retention, etc…n} I’ve been doing the the calories in/calories out thing for a year n a half to loose weight… One of my biggest fears with quitting was the weight gain, as that was the reason I started smoking in the first place 18 years ago so i tried upping my activity more [went from walking 1 mile 2x a week @ 2 mph to walking 3 miles 4x a week @ 3.5 mph + kickboxing 2 x a week], decreasing my calories, increasing my food [others thought 1200 was too low]… everything…

My issue is that the muscle built from activity is not burning anything and the fat increased [I’m seeing rolls where I never had a problem before and getting BIGGER-gained 2 inches in my waist so far]. Can anyone tell me-really and honestly- how long it will take to level my non-existant metabolism?! I don’t want to start smoking again. But when I’ve worked so hard to loose weight , putting it back on has made me re-hate my body even more than I did before. I have to loose what I’ve gained and more by the summer [I was already the fat bridesmaid even before I quit].

In response to Teresa’s post Marion relates her similar story:

Don’t give up, I quit on June 14 and have gained 25 pounds so far, my husband quit a year ago in July and his metabolism is starting to level off. He gained over 40 lbs. It will take time, but keep it up and you and I will continue to be smoke free. I am very discouraged also but I have to realize that I am more healthy since I quit. I am having problems having energy. Before I would jump out the bed in the morning to smoke and now I only want to sleep all day. No reason to get out of the bed. I have alot of adjusting to do.

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Breakthrough Discovery in Thyroid Hormone Therapy: Part 2


Treatment of hypothyroidism (low thyroid function) is accomplished by administering thyroid hormone by mouth in sufficient amounts to restore levels back to normal. At first glance this might seem like a simple goal to achieve. The truth is hormone replacement therapy is complex because there exists two very different thyroid hormones and because levels of thyroid hormone in the blood do not always reflect the amount of thyroid hormone within the cells where the hormone exerts its effects. In Part One of this blog I began to discuss how genetic differences among individuals could explain why some people need a complex mix of thyroid hormones to adequately treat hypothyroidism. In Part 2, I want to explain the nature of the differences between individuals and how it determines what sort of thyroid hormone therapy may be needed.

In May 2009 a group of researchers (Panicker, V. et al) in the UK published the WATTS study, the largest and most comprehensive study to date, of hypothyroid patients treated with combination t4 and t3. The goal of the study was to discover whether genetic differences in the population of hypothyroid patients accounts for some individuals needing t3 in addition to traditional t4 therapy. The researchers looked at 697 hypothyroid individuals and analyzed their DNA for differences in the portions controlling crucial enzymes which process thyroid hormones known as deiodinases. These enzymes are found widely distributed in the body including the thyroid, brain, muscle, liver, kidney and pituitary gland. As explained above, deiodinases convert t4 to the much stronger form of thyroid hormone, t3. At the same time the researchers measured patients’ mood and sense of well being on t4 alone and when t3 was added to the therapy.

Key findings of the WATTS study are that there is a substantial difference among individuals in the genes that make the deiodinases. In other words, due to genetic differences (mutations), there are differences in the way individuals make t3 out of t4. In a group of people, mutations in the genes that make a particular protein (in this case, the deiodinase), are called polymorphisms. The researchers discovered that a certain mutation in the deiodinase gene is associated with a poor sense of well being on t4 only therapy, and in the presence of this mutation a significantly better response to adding t3 can be found compared to those without this mutation. Of the group of hypothyroid patients studied in the UK about 16% possessed the faulty deiodinase gene. In other groups in other countries the percentage of people with this mutation could be higher or lower.

The traditional treatment of hypothyroidism is to administer t4 (Synthroid, Levothyroxine, Levoxyl etc.). It is the conventional wisdom that inactive t4 is converted in the body to the active thyroid hormone t3 by “peripheral conversion” in sufficient amounts to restore normal thyroid balance. The recent breakthrough discoveries described in the WATTS study reveal for the first time that individuals differ in how their bodies process (metabolize) thyroid hormone. While some may convert enough t4 to t3 in the cells of the body to restore normal function, due to genetic differences some individuals will not be able to make enough t3 leaving them with persistent hypothyroid symptoms. Since the problem is a deficiency of t3 within the cells of the body, measuring thyroid hormone levels in the blood cannot adequately reveal the problem. T4 replacement treatment alone can result in thyroid levels that appear normal on blood tests so doctors conclude that persistent hypothyroid symptoms are not related to the hormone therapy.

Based on my personal experience and the documented experience of many of the members of Metabolism.com it is clear that endocrinologists and other physicians are often reluctant to consider combination therapy for hypothyroidism, either by using Armour thyroid or adding t3 (Cytomel, liothyronine) to t4 only therapy. With this new research in hand, hypothyroid individuals and their advocates can finally state with confidence that: Yes! There is a firm scientific foundation for combination t4/t3 therapy and; No! We are not just chronic complainers or kooks. If I had hypothyroidism and was going to request a change in my thyroid treatment I would say something like, “Due to polymorphism of the deiodinase gene I probably possess a defective D2 deiodinase and therefore my peripheral conversion of t4 to t3 is impaired. I need t3 added to t4 to compensate for reduced intracellular t3 levels which cannot be detected on blood tests. Without t3 I continue to suffer with cellular hypothyroidism which is the likely cause of my persistent symptoms.”

If you try this approach and your doctor looks bewildered hand them a copy of the study by Panicker et al in the Journal of Clinical Endocrinology and Metabolism, 2009, 94(5): 1623-1629.

Gary Pepper, M.D.

Editor-in-Chief, Metabolism.com

Notice: This article is for informational purposes only and does not substitute for the advice or treatment of your own physician. The disclaimer for all blogs at metabolism.com, applies.

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LA Falls Through a Crack in Our Health Care System and Finds Armour Shortage Crisis


LA lives in rural America and has no health insurance. After 30 years of effective therapy with Armour Thyroid she is unable to obtain this medication any longer. Her story is a sad reminder of just how far we need to go to provide meaningful health care to the citizens of this country.

LA tells her story like it is:

I knew nothing about this problem of non-availability of Armour Thyroid. I have been on Armour since 1978 and it has worked just fine. I had my annual prescription renewal in June and because I do not have insurance, I was able to get 200 pills at a time for a price break. I take 3 60 mg tablets a day and have been on this dosage for about 6 years, up from a previous dosage of 2 60 mg tablets. Today, 4 Nov 09, I went to pick up a refill that I called in a week ago. I was informed at the pharmacy that Armour Thyroid is no longer being made. Period. I took my last pills on 2 November so I have no medication at all. I have a call in to my doctor but he has not yet returned that call. We contemplated a switch to Synthroid a couple of years ago (for a variety of reasons, none of which are relevant here) but the doctor said it could be a very slow process of finding out exactly what dosage of synthetic hormone would adequately replace the natural Armour. At that time I had insurance that would have covered the lab tests required to determine the proper dosage. I am now without insurance due to the death of my spouse, and because of the hypothyroidism I am unable to obtain health insurance that is even remotely affordable. Therefore I can’t afford all the tests, all the doctor visits, all the rest of the hoopla that woudl go with switching medication. I’ve been fortunate so far that I’ve been able to keep my same doctor, and that he gives me a bit of a break paying cash for my once-a-year-visit, but he’s 60 miles away and I can’t even afford the trips back and forth if I have to start “nudging” a new medication. It’s bad enough to be without the medication for a while, but to think that it will never be available again? I honestly don’t know what to do.

I knew nothing about this problem of non-availability of Armour Thyroid. I have been on Armour since 1978 and it has worked just fine. I had my annual prescription renewal in June and because I do not have insurance, I was able to get 200 pills at a time for a price break. I take 3 60 mg tablets a day and have been on this dosage for about 6 years, up from a previous dosage of 2 60 mg tablets. Today, 4 Nov 09, I went to pick up a refill that I called in a week ago. I was informed at the pharmacy that Armour Thyroid is no longer being made. Period. I took my last pills on 2 November so I have no medication at all. I have a call in to my doctor but he has not yet returned that call. We contemplated a switch to Synthroid a couple of years ago (for a variety of reasons, none of which are relevant here) but the doctor said it could be a very slow process of finding out exactly what dosage of synthetic hormone would adequately replace the natural Armour. At that time I had insurance that would have covered the lab tests required to determine the proper dosage. I am now without insurance due to the death of my spouse, and because of the hypothyroidism I am unable to obtain health insurance that is even remotely affordable. Therefore I can’t afford all the tests, all the doctor visits, all the rest of the hoopla that woudl go with switching medication. I’ve been fortunate so far that I’ve been able to keep my same doctor, and that he gives me a bit of a break paying cash for my once-a-year-visit, but he’s 60 miles away and I can’t even afford the trips back and forth if I have to start “nudging” a new medication. It’s bad enough to be without the medication for a while, but to think that it will never be available again? I honestly don’t know what to do.
LAWHilton@yahoo.com
LA
1

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Brenda Compares Her Experience with Compounding Pharmacy vs. Canadian Pharmacy


At present, two popular sources of dessicated thyroid products are compounding pharmacies and Canadian pharmacies. Brenda has experience with both and compares them for metabolism.com.

Brenda responds with the following in response to another members comments:

I suspect your doctor is mis-informed. Before I ordered and received my 30 mg Erfa natural dessicated thyroid medicine from Canadadrugs.com, I had the thyroid medicine compounded by my local compounding pharmacy. I still have some. The problem with that approach is it is ridiculously expensive ($39 for 30 doses of 1/4 grain/15 mg equivalent per month) and not covered by insurance. Of course it is an opportunity for the compounding pharmacies, and according to what I’ve read online, some greedy compounding pharmacies are charging much more–over $100 per month for the same thing. So far the FDA has made no noise about getting rid of compounding pharmacies. They serve a special need — and they are a little pocket of individually made medicines that are not dictated to by the FDA. On a parallel issue, they make bioidentical hormones, which Big Pharma is not happy about either, but the FDA doesn’t say you can’t make them, just that you have to be careful about claims made about them.

The great thing about the Canadian solution is that is it even cheaper than Armour used to be here, and they are regulated by the Canadian equivalent of the FDA. The maker of the Canadian “Thyroid” is Erfa, a Belgium company, is their niche is finding drugs that are being discontinued by other companies that they believe can be profitable and they have been making drugs since the 30’s, so I don’t think they are going to discontinue making it. I’m sure their plan is to make more! This is the jackpot for them! (If you want to know more about Erfa, and the Canadian version of Armour, go here: http://www.erfa-sa.com/thyroid_en.htm . They bought the brand from Pfizer Canada Inc in 2005 and have been making it since then. They are a Belgium company with a Canadian and international presence who buys and markets niche products from other drug companies that would be discontinued.)

Natural dessicated thyroid medicine is used around the world, so I don’t think it is going away. It is the madness of the FDA in cahoots with the Big Pharma at work in the US that is causing the problem with availability. I believe RLC, the maker of NatureThyroid (another brand of the same thing) here in the US has vowed that they will continue making the drug, even if they have to go through the entire expensive approval process to get it approved by the FDA. Of course that will make it much more costly for us, to be sure, because they will have expended the money to go through that process and they will be the only game in town when the dust settles.

Fortunately, while all this is being sorted out, we have the Canadian option. And it works just fine, and oh yeah, it’s cheaper.

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