Sugar and Artificial Sweeteners

As we find ourselves amidst the season of sugary treats, what better time to take a look a closer look at both sugar and artificial sweeteners. I recently gave a short talk on the effects of sugar (along with two other foods that are best avoided: gluten and commercial animal products), and thought I'd share some information with my readers, along with a handout I provide for my clients!


Here are a couple of important facts to remember about sugar and sweeteners. One, all sugar (both artificial and real) cause an insulin response in our body. As discussed in many previous articles, insulin is a storage hormone, escorting nutrients to our cells (particularly our fat cells). We always want to strive to regulate our insulin levels, therefore regulating our blood glucose levels, in turn regulating our sugar/carb cravings and energy dips and spikes. Secondly, remember that while we should minimize our exposure to all sugar and sweeteners, those actually coming from nature (not including High Fructose Corn Syrup, which manufacturers would argue does, in fact, come from nature) are better than those made in a lab. Remember, if we can't pronounce the name, most likely not a great choice...

Unfortunately, many people think that because artificial sweeteners are non-caloric, they are making the right choice by not contributing to weight gain. However, as mentioned above, even that sweet taste produces the same insulin reaction in our body, and can lead to a whole host of problems. Similarly to trans-fats, our body has no idea how to process these chemical sweeteners. In fact, a 2008 study by the National Institute of Diabetes found that artificial sweeteners were connected to a 2-fold increase in diabetes. Take a look at a list of symptoms caused by artificial sweeteners (and there are many more):

• Hives/rashes
• Dizziness
• Nausea and vomiting
• Fatigue/weakness
• Loss of vision
• Loss of memory
• Migraines
• Joint Pain
• Insomnia
• Seizures

Before sharing my handout with you, I'd like to quickly address agave syrup, a hot topic today with its growing popularity in recent years. In her book Primal Body, Primal Mind, Nora Gedgaudas refers to agave as the "new 'yuppie' form of high fructose corn syrup, being sold as a natural, even exotic-sounding product." She goes on to inform us that "agave is actually much richer in damaging fructose and, as such, potentially much worse for you than industrial high fructose corn syrup (with the exception of the fact that industrial HFCS is made using synthetic chemicals and GMO's)...HFCS contains about 55% fructose content. Agave nectar, by contrast, contains anywhere from 70 to 97% pure fructose and Nutrasweet." What this means is that it puts a tremendous strain on our liver, as all fructose must be converted to glucose in the liver before being used for energy by our body.

Below is some information on which sweeteners to avoid completely and which may be used in moderation. Keep them in mind this holiday season, and beyond!

SUGAR AND SWEETENERS

3 THINGS TO REMEMBER ABOUT SUGAR:

• ALL sweeteners, caloric and non-caloric, can contribute to weight gain and/or weight loss resistance.
• Sweeteners that come from nature are always better than those made in a factory or lab.
• Regardless of source, it is crucial to minimize your exposure to sugar/sweeteners.

WHY?

• Any sweet sensation causes an insulin spike in our bodies, which promotes fat storage (especially around the mid-section).
• Diet high in sugar and refined carbohydrates negatively linked with heart health.
• Artificial sweeteners can cause migraines/headaches, dizziness, seizures, nasea/vomiting, fatigue, change in mood, vision and heart rate, diarrhea, joint pain, memory loss, insomnia, hives, and more.

AVOID COMPLETELY:

• Aspartame (equal)
• Saccharin (sweet n low)
• Stevia that is white (truvia)
• Sucralose (splenda)

OK TO USE IN MODERATION (organic whenever possible):

• Raw honey
• Grade by maple syrup
• Molasses
• Date sugar
• Fruit juice
• Green leaf stevia (best choice, can help stabilize blood sugar)

READ LABELS!

• Focus on carbohydrate and sugar grams; 4 grams sugar=1 tsp.
• Look for ingredients ending in “ose” or “tol” (ex: sucralose, sucrose, fructose, sorbitol, xylitol)
• Words such as sugar, nectar, syrup, crystals
• 1^st item in ingredient list exists in largest amount, and so on.

“Be wary of all the chemicals in your life” –Andrew Weil, M.D.

Fall Pumpkin Pancake Recipe

If you haven't had your fill of pumpkin yet (which I apparently haven't), try these pumpkin pancakes made with coconut flour! Inspired by and adapted from my colleague at balancedbites.com, these are packed full of delicious fall flavor, without the added sugar. I loaded them up with cinnamon, which is great for blood sugar stabilization/regulation. After the over-eating that generally comes with Thanksgiving, we may all be in need of! As always, since I rarely measure anything with my cooking, feel free to play around with the amounts to get your desired consistency and flavor. Enjoy...

PUMPKIN PANCAKES

(makes 6ish large pancakes)

1 can organic pumpkin (or fresh and pureed)

6-8 eggs

3(ish) tablespoons coconut flour

1/2 tsp baking soda

To Taste:

cinnamon

orange zest

freshly grated ginger

cardamon

vanilla

These were delicious cooked in butter (grass-fed whenever possible), but you could also use coconut oil. I topped mine with a spoonful of raw almond butter. Yum!!!

Holiday Fitness Tips and My Favorite Yam Mash Recipe!

Hello everyone!

I must apologize (yet again) for the lapse in blog posts, life just gets too crazy sometimes. I wanted to share with you part of an email I have sent out to all of my lovely nutrition and personal training clients today, on the subject of warding off holiday inactivity and weight-loss, and then followed with one of my all time favorite holiday recipes! More articles to come soon (I promise) but for now consider the following! The holidays are upon us...

I think the most common concerns for most of us around the holidays (aside from the platters of sugary treats tempting us around the office each day) is a simple matter of finding the time to keep up with our exercise routines. While it is of the utmost importance to give our bodies a break every now and then from weight training, we also don't want to find come January that all of our hard work over the last months has been undone. One way to ward off inactivity (and holiday pounds) is SPRINTS!!! Many of you know that I'm a big fan of sprints, and include them in our workouts together. For the holiday/vacation time, they are a great way to get in a quick and beneficial workout, call it a day, and get back to the festivities (or football watching, whatever the case may be). Keep in mind, sprints are different for each of us depending on our fitness level. While sprinting full force up a hill might be one person's version, walking up that same hill is another's. Lets take a look at why this type of exercise is beneficial...

This could be (and is, in fact) an entire book, but I will just quickly mention that long duration cardio training (and over-training with weights) at higher-intensity heart rates can have a catabolic (breaking down) effect on our muscles and organs. I like to call this type of exercise "chronic cardio," or as Nora Gedgaudas in her book Primal Body Primal Mind states, "chronic strenuous cardio." Boring and ineffective. She goes on to explain why working out "harder and smarter for less time" is effective:

"...limit intense exercise to no more than about 20 minutes in duration and focus on brief bouts of significant anaerobic exertion, interspersed with brief periods of recovery at a slower pace that is sufficient for a return to the resting heart rate. This can be done via sprinting, cycling, rowing, elliptical, and many other methods...weights..strength and resistance training reverses the reduction in muscle fiber size that accompanies aging and inactivity and has been shown conclusively to increase insulin sensitivity" (160).

It is always a good idea to keep our body guessing and not do the same thing all the time. Sprinting (again, at the appropriate level for YOU, think of on a 1-10 scale of exertion, 10 being maximum effort, striving to be around a 8-9 eventually, around a 7 to start) is a great way to get in a workout when in a time crunch, and can be done anywhere. Think: 10 rounds of high knees (1 min on, 1 min off). Begin slowly!! Start with walking briskly up a flight of stairs, rest for as long as you need to recover fully, and then do it again. Maybe you just start with 2 or 3 times, thats great!!

Enough about sprints, I want to include one of my all time favorite holiday recipes, a coconut sweet potato (or yam) mash with macadamia nuts. Its delicious and chalked full of nutrients and good fats.

Coconut Macadamia Nut Sweet Potato Mash

Source: Heidi Swanson (6 servings)

2 ½ lbs. orange-fleshed sweet potatoes
⅓ cup coconut milk
1 tablespoon fresh ginger, grated
1 tablespoon maple syrup
½ teaspoon fine-grain sea salt
⅓ cup raw, unsweetened grated coconut
2 tablespoons melted butter or coconut oil
⅓ cup toasted macadamia nuts, chopped
Preheat your oven to 350F degrees, a rack in the upper third. Butter or oil 6 ramekins or a single medium-sized casserole dish.

Wrap each sweet potato in foil, pierce numerous times with the tines of a fork and place in the oven for somewhere between an hour and an hour and a half, until each is baked through. Times vary greatly depending on the size of your sweet potatoes - in the end you should be able to cut through the center flesh as if it were soft butter.

Remove the potatoes from the oven, let them cool for a few minutes, and cut each sweet potato in half. Scrape the flesh into a medium mixing bowl. You should have about three cups of sweet potatoes.

In a large bowl mash the sweet potatoes with the coconut milk. If my sweet potatoes are on the fibrous side, l take a hand blender to them for a minute or so (alternately you could use a food processor). Stir in the ginger, maple syrup and salt. Let it sit for a few minutes, stir again and taste - adjust the seasoning if you need to - this is your chance to get the right amount of salt and ginger in the sweet potatoes before they go in the oven.

Spoon the sweet potato mixture into individual baking dishes (or single larger baking dish), sprinkle with coconut, drizzle with olive oil and bake uncovered until warm and the coconut golden roughly 30 - 40 minutes.

Remove and sprinkle with the toasted macadamia nuts

Proposed "Label Plan" may be misleading...

Recently, the Institute of Medicine (IOM) issued a report which concluded that traditional nutrition labeling on packaged foods are difficult to read by the general public and lead to misinformed food choices. Now, along with the Federal Food and Drug Administration (FDA) and the US Department of Agriculture, they are recommending a simplified food labeling system be mandatory for processed and packaged foods. In theory, some sort of system along these lines could, in fact, be helpful to those buying these foods. However, the proposed labeling guidelines are a bit skewed (which shouldn't be surprising considering the big government agencies that are behind it, and typically have the interest of food manufacturers instead of public health at the forefront of their decision making...but this is another subject entirely).

A New York Times article written on the subject recently stated that, "In a report...the IOM called for a simplified label that would go on the front of food packages that would show the number of calories per serving and contain zero to three stars or checkmarks to indicate how healthful a food was." But the question is, who is defining 'healthful' here??

Foods will be rated on 3 anti-nutrients: Sugar, Sodium, and Saturated and Trans-fats. The sugar part, I agree whole-heartedly. As I've written about in the past, refined sugar (along with refined flour, especially), is the number one contributor to cardiovascular disease, obesity, insulin resistance, diabetes, and all types disease and systemic inflammation in the body. As far as sodium goes, if you are eating a diet high in processed/packaged foods, you are most likely getting too much sodium. However, if you eat a whole foods diet, adding some sea salt to your diet (especially Celtic or Himalayan) will ensure (among other things) that we maintain a healthy potassium/sodium balance.

Lastly, the Saturated and trans-fats category is the one I have the most trouble with. First of all, the fact that these two are even in the same category is troublesome. Without a doubt, trans fats reek havoc on our bodies, as they are man made compounds produced because they have a longer shelf life (aka, cheaper) yet our body has no way of processing them. Alongside the above-mentioned refined carbs and sugars, trans fats are right up there on the list of causing disease. However, good quality saturated fats are healthful and necessary for brain and cell function, and can actually work to balance our cholesterol levels and reduce our risk of heart disease.

So, the proposed labeling plan may not be all bad, but it is too simplistic. Lets look at a food they would give a 3-star rating (the most healthful):

Wheat Bread: yikes. Its true that grains have been the base of the USDA food pyramid for years, and this is largely due to catering to wheat manufacturers (one of the biggest cash crops in the US). If you've read my past articles, you now know that processed grains contain compounds that interfere with critical mineral absorption (such as zinc which is vital to immune health, and magnesium that is essential for heart health and relaxation). Common whole wheat bread is really not much different than white bread. Wheat bread generally contains processed wheat, the germ and the brain have been removed for shelf-life, leaving only the starchy endosperm. If you are going to eat bread, opt for whole grain, sprouted varieties. The Ezekiel brand has some good options (but remember the last article about grains!).

Raisin Bran: This gets 2 stars (next best). Ingredient list:


WHOLE GRAIN WHEAT, RAISINS, WHEAT BRAN, SUGAR, HIGH FRUCTOSE CORN SYRUP,  CONTAINS TWO PERCENT OR LESS OF SALT, MALT FLAVORING, INVERT SUGAR, NIACINAMIDE, REDUCED IRON, PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), ZINC OXIDE, RIBOFLAVIN (VITAMIN B2), THIAMIN HYDROCHLORIDE (VITAMIN B1), VITAMIN A PALMITATE, FOLIC ACID, VITAMIN D, VITAMIN B12.


Need I say more?? 3rd and 4th ingredients are sugar and high fructose corn syrup. And this food gets 2 stars by this labeling system...can you imagine what gets 1? 


In short, yes, there are many changes that need to be made to our current nutrition labeling system. More than anything, more education needs to exist around how to really read food labels. General rule of thumb: if you can't pronounce it and/or couldn't make it in your own kitchen, probably not the best choice. Stick to the perimeter of the store as far from the processed and packaged foods as possible, and you won't have to worry about decoding silly rating systems in the first place.


Further Reading and Resources:


NY Times Article: http://www.nytimes.com/2011/10/21/business/a-plan-to-rate-nutrition-of-food-with-stars.html?scp=1&sq=food%20labels&st=cse#


IOM website: http://www.iom.edu/Reports/2011/Front-of-Package-Nutrition-Rating-Systems-and-Symbols-Promoting-Healthier-Choices.aspx

So what about GRAINS??

Over the course of my nutrition education, grains have become less and less a part of my diet. Initially, I can probably chalk it up to laziness. Upon learning how essential it is to soak all grains for 8-12 hours before cooking to break down the phytic acid which binds to minerals and makes them unavailable for absorption (westonaprice.org...more on this topic later), I decided this was simply too much work. However, slowly over the course of the last year I have intentionally phased out grains for good, and this tends to baffle people! We have been raised on the notion that whole grains should be the staple of any healthy diet. They're the base of that good old USDA food pyramid! Like so many myths that need debunking in the land of nutrition (please say you're all eating lots and lots of good fats at this point!), grains is another big one. So lets take a closer look...

Pre-grain (aka, pre-agricultural) Civilization and Health:


No one can really argue that our ancestors did not have a grain-based diet. Aside from a trace amount of wild grains here and there, grains were not a feasible food source. These populations lived on wild meats (all by nature free range and organic, of course), available vegetables (veggies such as tubers not so much due to their high need for preparation), nuts and seeds (again, raw), and fats mainly derived from the above mentioned sources (animal meat, nuts and seeds). Many people will argue that "sure, but these people had a notably shorter life-span, so it must be nutrition based!" This topic will be saved for a future article, but I will say that these "statistics" are skewed due to an array of variables, for example the average lifespan of our ancestors is generally averaged and this includes infant mortality (much higher) and death by emergency situations like animal attacks. Generally, if an individual survived these 2 main variables, their lifespan was just as long as ours is today, however without the "wonders" of modern medicine keeping us alive (Mark Sisson, The Primal Blueprint).

Phytic Acid:


More and more people are familiar with phytic acid, which is a substance found in grains and legumes. According to Nora T. Gedgaudas in her book Primal Body, Primal Mind, 

"Phytic acid actively binds minerals and eliminates them from the body, which results, with increased grain consumption, in widespread deficiencies of minerals, including calcium, iron, magnesium, and zinc...grains and legumes also contain goitrogens, or thyroid-inhibiting substances, as well as "foreign proteins" like gluten and gliadin, and they are an extremely common source of allergies and sensitivities that can lead to both physical and mental or emotional disorders, even when the best preparation methods are used" (pg 29). 


Gedgaudas goes on to talk about one problem we face with grain-fed animals (an unnatural food source used because its cheap and fattening) being a deficiency in the amino acid L-tryptophan which allows us to produce the essential hormone serotonin (the "feel-good" hormone), and serotonin deficiencies can be the cause of depression, ADD/ADHD, anxiety, mood and other psychological disorders.

Glutenous vs. Non-glutenous Grains:


Many grains are gluten containing, while others are not. Gluten is the protein (it actually consists of 2 proteins: glutenin and gliadin) which gives bread its doughly, sticky, chewy quality. Gluten-containing grains include: rye, barley, spelt, kamut, wheat, durum, semolina, graham, and oats due to cross-contamination. I have already posted about the dangers of gluten on our digestion and overall physical and mental health, so please re-visit this earlier post. Remember, gluten is very hard for humans to digest, and after years of consumption (which is pretty much the standard american diet) it can lead to intestinal permeability (aka leaky gut syndrome) by breaking down the lining of our gut, letting in undigested proteins that should not be entering our bloodstream, which can lead to chronic inflammation and degenerative and auto-immune disease. Serious stuff.

It is also important to understand that while other grains are not gluten-containing (for example brown rice, quinoa, gluten-free oats), they still have many of the same or similar properties of the glutenous grains that block mineral absorption and contain various "anti-nutrients." Basically, we use more of our stored nutrients just trying to digest them than the nutrients they actually provide us with. If you are going to eat grains, they should be soaked, fermented, and sprouted to minimize this impact.

Well What Can I Eat, Then?!?


I'm not trying to break any hearts here, just giving some important information. Mark Sisson goes by the 80/20 rule, which I can get behind. This means that 80% of the time we eat the whole, nourishing foods that we know to be nutrient dense and bioavailable, and the other 20% can be a little looser! There is a lot to be said for letting go and enjoying life. Now, hopefully this 20% doesn't include loads of refined sugar and carbs (or even any!), but if you have grains every now and then, you'll probably be fine (unless you have an auto-immune or irritable bowel type of condition). They just should not be the staple of your diet. Instead, focus on grass-fed, organic meat, poultry, fish, raw nuts and seeds, lots of delicious, satiating good fats, and whole vegetables and fruits (seasonal and organic whenever possible). I can pretty much guarantee that not only will your health improve and you'll experience increased energy and a sense of well-being, but if weight loss is your goal, this will get you there.

Here's to our health!

Referral Incentive Program!!!

Hello everyone!

Thanks for taking the time to read the latest news with Madrona Wellness.

I am in the process of working on growing my private practice for Holistic Nutrition Counseling, and because of this am offering an incentive for referrals. To see more of what I do nutritionally, please visit my website-as many of you have already and I'm grateful: www.madronawellness.org. I work with clients on an array of conditions such as stress, fatigue, insomnia, digestive distress, immune health, blood sugar regulation, weight loss, and more. If anyone you know is in need of such services and you refer them, upon purchasing a nutrition package, you will receive either a 30% discount on nutrition counseling for yourself, or 1 free personal training session.

I work with clients in person in the Bay Area, or via phone or skype.

Please let me know if you'd like more information or have any questions, and also just a friendly reminder that I greatly value not only your business, but feel  fortunate to be a part of your personal path to wellness!

-- 

Rachel Fiske, Holistic Nutrition Educator, CPT-NASM

madronawellness.rachel@gmail.com

503-459-7808. 

madronawellness.org

"The human body heals itself and nutrition provides the resources to accomplish the task." ~Roger Williams Ph.D

Inflammation and Diet

A friend asked me yesterday which foods are important for cooling inflammation, and I thought this would be an excellent topic to address! You've all heard me use the word 'inflammation' many times, so lets take a closer look at what is really going on in our bodies when inflammation occurs, and what this can mean symptomatically. Keep in mind, most conditions/disease have their root cause in systemic inflammation!

Disease (think: dis-ease) is a sign of some sort of unbalance in the body. When our internal homeostasis is disrupted somehow, various symptoms and disease can ensue. This sort of disruption can be caused by a wide variety of both physical and psychological (mental/emotional) factors (remember that stress-disease connection). On the physical end of things, disease is often a result of nutrient deficiencies in the body due to a poor diet, toxic exposure (foods and other environmental toxins), poor nutrient absorption, and therefore poor cell function. Henry Lindlahr, M.D. in his book Philosophy of Natural Therapeutics, states that:

"...if the diet consists of an excess of low-quality proteins, carbohydrates, and fats, tissues will inevitably be clogged with 'morbid matter'...or toxic accumulation...this can interfere with vital cellular functions, thereby becoming pathogenic to many systems in the body. The buildup of toxins in turn supports cellular degeneration, moving the system toward disease, rather than supporting the cellular regeneration needed for healing."

The diseases/symptoms that can follow this type of toxic accumulation can manifest as different things depending on the individual. A few examples would be skin rashes, allergies (food and environmental), asthma, auto-immune conditions, and cancer. Remember that as Dr. Lindlahr points out, our bodies are sending us a clear message that we are not effectively able to rid it of toxins in some capacity.

So Where Does Inflammation Come In?


According to Jessica Black, N.D. in her book The Anti-Inflammatory Diet and Recipe Book, "Inflammation is the first response by the immune system to infection or irritation." Think, if you break a bone or get a cut, we experience swelling, redness, pain, etc, which are all signs to protect this area from further damage. However, when we experience systemic inflammation (internal), it becomes a bit more difficult to make such obvious connections. Ignoring these signs longer term, however, is what creates much disease as discussed above.

Lets take a quick look at prostaglandins, which are fatty acids in the body responsible for controlling inflammation. There are 3 types that serve different functions. The first is PGE1, which helps prevent inflammation, improve immune function, and decrease blood pressure. The 2nd is PGE2, which promotes inflammation and suppresses immunity. PGE3 also prevents inflammation and increases HDL cholesterol ("good" cholesterol). This inflammatory cascade is much more complex, and I encourage you to do some outside reading! Dr. Jessica Black's above mentioned book is a great resource. Certain foods promote certain prostaglandins, and this is where eating an anti-inflammatory diet comes into play.

Signs and Symptoms of Inflammation can include food and/or environmental allergies, asthma, digestive disorders (IBS, IBD, Chrohns, etc), auto-immune conditions, pain, fatigue, insomnia, brain fog, depression, heart disease, and cancer. These are just some of many!

What Are Anti-Inflammatory Foods?


Considering that we are exposed to a myriad of toxins on a daily basis through both diet and our environment (especially for us city-dwellers), it is of great importance to control the factors that we are able to! Think of all the toxins we ingest with poor quality foods: pesticides, herbicides, hormones, antibiotic residues, and more. Yuck! These foods eaten regularly (think a Standard American Diet/SAD), cause poor cell function, inflammation, and disease. By eating the right foods, we can support our body's ability to eliminate necessary toxins. According to Jessica Black, this is why many times people with common allergies to grass, pollen, etc will see drastic improvements when they cut out allergenic/irritating foods because their body is better able to process grass and pollens.

Foods that contribute to inflammation include processed carbohydrates and sugars, primarily. These are  extremely low in nutrient content, and are actually anti-nutrient foods, meaning in order to process them we are expending more energy than the foods are providing for us. Below I will provide a basic list of some main inflammatory foods:

• Processed carbohydrates (flour, breads, pasta, wheat products, gluten, cereals)
• Processed soy (any soy that is not fermented, which is miso, nato, tamari, and tempeh).
• Grains and Legumes can be very inflammatory for some and should not be the staple of your diet (yes, even whole grains!)
• Nightshade vegetables (tomatoes, potatoes, eggplant, peppers, gogi berries, tobacco). Many people with joint pain and arthritis find that cutting out nightshades which contain inflammatory compounds helps tremendously.
• Sugar!! Pretty much all sugar and artificial sweeteners are inflammatory. Stick to moderate amounts of raw honey or grade B maple syrup. 
• Hydrogenated oils and fats (margarine, anything hydrogenated or partially hydrogenated, any vegetable oils). Cook with more stable, nourishing oils/fats like grass-fed butter and coconut oil.
• Commercial dairy products
• Peanuts/peanut butter
• Soda, most juice (unless fresh squeezed), excess caffeine/coffee, alcohol
• Corn products

Seem overwhelming? Just think of all the foods you CAN enjoy!

• Unlimited vegetables and fruit (preferably organic and seasonal whenever possible)
• Organic meat, poultry, seafood (yes, nitrite/nitrate free bacon is ok!)
• Organic eggs
• Lots of healthy fats! Coconut, butter, ghee, olive oil, flax oil, raw nuts/seeds and their respective butters, avocados). Focus on getting lots of omega 3 fats in your diet (cold water fish, flax oil).
• Herbal teas, fresh squeezed veggie juice (and fruit but in moderation), lots of water for flushing toxins.
• Anti-inflammatory foods like garlic, ginger and turmeric.

Here are some great websites with anti-inflammatory recipe suggestions:

• http://paleodietlifestyle.com/paleo-diet-recipes/
• http://www.marksdailyapple.com/primal-blueprint-recipes/

This is only an introduction to the very complex topic of inflammation, but I hope it is helpful! Also important to note that stress and lack of sleep play a huge role in inflammation, but this will be for another article. Please contact me with further questions, or if you suspect signs of inflammation and would like to seek further help.