Fat Cells Established in Childhood?

Oh noes....

Number of fat cells remains constant in all body types

A new study by Lawrence Livermore National Laboratory scientist Bruce Buchholz – along with colleagues from the Karolinska Institute in Sweden; Humboldt University Berlin, Foundation of Research and Technology in Greece; Karolinska University Hospital; and Stockholm University – applied carbon dating to DNA to discover that the number of fat cells stays constant in adulthood in lean and obese individuals, even after marked weight loss, indicating that the number of fat cells is set during childhood and adolescence.

...

In a study of 687 adults, the researchers found that number of fat cells increases in childhood and adolescence, but levels off and remains constant in adulthood. The group looked at whether the number of fat cells changes under extreme conditions such as drastic weight loss by radical reduction in caloric intake, such as through bariatric surgery.

The treatment resulted in a significant decrease in BMI and fat cell volume; however, it did not reduce the number of fat cells two years after the surgery. Similarly, significant weight gain (15-25 percent) over several months in non-obese adult men resulted in significant increase in body fat volume but no change in number. Subsequent weight loss back to baseline resulted in a decrease in fat cell volume but no change in the number of fat cells.

“If you are overweight and you lose weight, you still have the capacity to store lipids because you still have the same number of fat cells. That may be why it’s so hard to keep the weight off,” Buchholz said.

What's further inspiring to note is that one conclusion is to focus on children and preventing them from becoming fat when they are young. It all sounds very discouraging but I refuse to believe that it's already too late for TB, my kids and me to slim down and be healthy!

Let's All Eat Like Cave Men!

This article comes from the Vital Choices newsletter I get in my email. I thought it was fascinating.

The case for eating like a caveman is based on evidence from modern hunter-gatherers, whose diets resemble those of prehistoric ancestors, and from chemical and physical examination of the remains of prehistoric people and their habitats.



From these studies, it is clear that prehistoric hominids and humans ate diets high in wild game (meat and/or fish) and green plants, with no grains and relatively few seeds or starches (largely from tubers).



Scientists call stone-age eating patterns Paleolithic or hunter-gatherer diets, using the terms almost interchangeably due to the diets’ similarity. ...

Pilot clinical trial affirms healthful impacts of “caveman diet”

Last year, scientists at Sweden’s famed Karolinska Institute placed 20 healthy volunteers on a caveman-like diet for three weeks (Osterdahl M et al. 2007).



Before and after the study period, they measured the participants’ weight, body mass index, blood pressure, and cholesterol profiles.



The volunteers were then given a list of “caveman” foods they could eat, including fresh or frozen fruit, berries or vegetables, lean meat, unsalted fish, canned tomatoes, lemon or lime juice, spices and coffee or tea without milk or sugar.



Banned foods included any dairy, cultivated or processed foods, such as beans, grains, salt, peanuts, milk, cheese, bread, pasta or rice, sausages, alcohol, sugar, and fruit juice. ...

So far it doesn't seem too bad except if I did this I'd have to give up cottage cheese, which I love, and garbanzo beans. No more sandwiches! No bread, no processed cold cuts...hm, maybe not so easy. But the results are cool!

At the end of the study, all of the 14 volunteers who completed the diet successfully lost weight, reduced their blood pressure, and slashed blood levels of a clot-causing agent.


These were the average changes (Osterdahl M et al. 2007):



* Lost five pounds.
* Calorie intake dropped by 36 percent.
* Body mass index (BMI) dropped by 0.8 (Healthy BMIs range between 18.5 and 25).
* Systolic blood pressure fell by 3 mmHg.
* Levels of the clotting agent plasminogen activator inhibitor-1 dropped by 72 percent.

Supposedly we are not different from our Neanderthal ancestors in terms of what we should eat and that's why we are having such problems with obesity. I think I'll read the book mentioned in the full article. Fascinating stuff!

There are more and more stories out there about obesity increasing among kids and it's scary. Kids are now at risk for the same complications we adults have with obesity: heart disease, diabetes, and so on. I got an article in my email newsletter about ways parents and grandparents can help kids by setting a good example...even if we ourselves are heavy:

1. Incorporate a vegetable into every meal, especially in casseroles. Peas, broccoli, asparagus, red, yellow or green bell peppers, spinach - you name it, vegetables provide nutrients and fiber.
2. Use more beans and legumes, and less meat. Chickpeas, lentils and beans of all varieties are good sources of fiber and protein.
3. Serve up whole grains. Brown rice and bulghur wheat provide a delicious, grainy taste and texture - and have more fiber and protein than their white counterparts. Choose true, relatively intact whole grains like these over grains that have been ground into flour.
4. Switch sweets. Instead of soda, stock the pantry with sparkling waters. Pour fruit juice into a pitcher and dilute it to lessen the sugar content. Stock your kitchen with fresh, whole fruits, and leave the cookies in the store.

If we start healthy eating habits when kids are little, they're not going to know the difference and they won't miss the sweet or salty junky things. The whole article is here.

Becoming the deadly apple

So now I've become an apple: a woman with a 35-plus size waist. I have high blood pressure already and am now at an increased risk for a heart attack. Why did I let this happen to me? Here's another good reason I must lose weight:

According to the research, elevated health risks seem to come along with a waist measurement of greater than 35 inches in women and greater than 40 inches in men. Abdominal fat is worse than fat on your buttocks or thighs because that extra fat surrounds important organs such as the liver and pancreas. When you have fat in this area of the body, your body can't use the insulin produced by your pancreas efficiently — and that leads to insulin resistance, which causes high blood glucose levels. In turn, the high blood glucose puts your organs at higher risk. If you lose weight, the amount of fat stored around your waist and important organs will decrease, and they will work better, helping you stay healthy.

The advice to reduce abdominal fat is an exercise program that doesn't skimp on other areas of the body:

The best approach is a well-balanced program that includes aerobic activity (anything that gets you breathing hard), strength exercises for your entire body and stretching. For health gains, try to do at least 30 minutes daily.

I need a good chair exercising program or a swimming pool but we can't afford a gym. What a bind! :(

Write It Down

I know I'm supposed to keep a food journal. When I do, it does help me stay in line. My problem is that I keep forgetting. I'm really good about it for the first 3 or 4 days but then I begin to forget. Why is that?

From Everyday Tips:

...a food journal gives you a tool to monitor your progress and identify patterns in your eating habits.

The feedback from your food journal can also strengthen your weight-management skills. Write down a complete list of your meals and snacks within 15 minutes of eating. Most successful record keepers total their numbers at the end of the day or the first thing each morning on a weekly summary sheet. Keeping good records is a skill that takes practice. Most people don't enjoy keeping records, so you may stop and start from time to time. But even done sporadically, it's worthwhile work so you can check in on your diet.

So I guess starting and stopping every three days isn't too bad after all. Still...I'd like to remember to do this everyday!

Apatrim

Has anyone seen something that seems to be an article in their newspaper called "Demand soars for 'fast acting' diet pill"? The article goes on to talk about this miracle drug, apatrim, that suppresses appetite and makes people lose weight. It's so popular, according to this article, the phone lines are jammed with callers and supplies are limited. Wow! A miracle drug, just what we've been waiting for!

What could be wrong with it, too? There was this research study that shows the drug works within minutes to suppress your appetite. Even better, dieters "don't have to starve or suffer through intense exercise and it's been clinically shown to get great results."

And also, "Apatrim contains an amazing compound that has a known ability to help control hunger pangs*. This allows people to eat the foods they want, they just eat less*."
Aha. We'll get to those stars in a minute.

How does it work? "The active ingredient in Apatrim comes from a plant that grows in India. This 'miracle' plant is Caralluma Fimbriata and it has been used by native tribes in India for centuries to reduce hunger and quench thirst during times of famine and drought."

TB and I saw this in our Burlington County Times and thought it sounded great but a little too good to be true. And was this a real news article or an advertisement? I decided to check it out online. Well, well. Here's what I found:

Diet Drug Report

Newspapers around the country are running full-page ads -- disguised to look like regular news pages -- filled with misleading claims for a new 'miracle' diet pill called Apatrim that allegedly enables dieters to lose weight without either cutting back on eating or increasing their exercise.

The pages contain a bylined story from the Universal Media Syndicate (intended, no doubt, to be confused with the Universal Press Syndicate, which carries columnists such as Dear Abby and William F. Buckley Jr.) urging overweight readers to phone a toll-free number to order "every dieter's dream." ...

What we can confirm is that Caralluma Fimbriata, like the South African "succulent" plant Hoodia Gordonii, has indeed been chewed for many years by Indian tribesmen during long hunts to suppress appetite and enhance endurance.

But from there, the breathless weight-loss claims for Apatrim not only become more suspect, but seem likely to ultimately involve its distributor, PatentHEALTH, LLC , with the judicial system. ...

The so-called clinical trial referenced in the ad, an anemic study that involved only 26 participants followed for four weeks (a serious Phase III clinical trial of a diet drug would involve thousands of participants tracked over at least a year), was sponsored by the developer of Slimaluma -- not Apatrim. ...

Slimaluma was the first to start marketing a weight loss pill using Caralluma Fimbriata. Gencor Pacific, which makes Slimaluma, has sued the company making Apatrim for

false advertising, false comparative advertising, and a variety of other charges stemming from their efforts to sell a a non-extract Caralluma fimbriata powder product.

And those stars? Well, at the end of the article, there was a * and it read: "These statements have not been evaluated by the Food and Drug Administration..." Why is this is such small print?

Another miracle drug bites the dust as far as I'm concerned!

The Me In My Head

I wrote several times about the person I see in my head compared with who is really there is the pictures and the mirror. TB was messing around with photoshop last night and sent me this picture. This is just about spot on to the person I see in my head.

I think I will print it and tape it up on my desk so that it can motivate me. Here's what I really look like:

Exercisiing and the Neighborhood

Should I be surprised that the neighborhood can influence how much exercise you get? Of course not. But here's another article that identifies a problem but hasn't any suggestions for a solution. The problem is too big to be solved. If you live in a neighborhood where you are afraid you might be robbed or killed of course you will be less likely to go for a walk. If you live in a such a neighborhood, you're also very likely to be too poor to afford a gym--otherwise you'd move to a safer place, right? Therefore the obesity level would be higher in poorer, high crime neighborhoods. Amazing, Dr. Watson! The whole article is here.

I would love to be able to walk in my neighborhood. There are no sidewalks but I would be able to walk along the side of the road down to the lake and back. The reason I don't exercise in my neighborhood has more to do with pain than anything else. I'm also afraid I'll fall or faint and not be able to get back up. Still, I need to do something. I can't lose weight anymore just by dieting.

Why am I trying to lose weight when I want the surgery anyway? The less I weigh the better off I'll be!

Not Doing So Well

We've been under a great deal of stress recently and I know I gained weight instead of losing it. :( I have to look around a find a food therapist--one that will help TB and me with our emotional eating.

Weight Watchers had an interesting article about couples and weight gain. It's no surprise to me that couples gain weight together! It's certainly true that TB and I have similar BMIs! On the upside, we are "more likely to achieve better results if they tackle weight loss as a couple." The whole article is here.

I have read several articles now that tell me even drinking diet soda can lead to weight gain. I'm still not sure I agree but I sure can't dispute the fact that I'm gaining. Doubters? Read this article. Now I see some acceptable alternatives to soda and I need to try them:

1. Water--I always used to drink ice water until we moved to NJ. The water around here is full of iron but I guess I can drink bottled.

2. Green tea--I am not a fan of tea but I do like this on occasion. It's full of anti-oxidants too.

3, Sweet stevia--I never heard of this one! Apparently it was banned for a while because the FDA needed to research it. It has no carbs nor calories and seems to help with diabetes and glucose intolerance! Let me go try that one!

4. Diet tonic and lime--I've never tried gin and tonic but this is what it is minus the alcohol. Hmmm....

5. Low sodium vegetable juice--I like V-8!

6. Coffee--without all the yummy creamer I've been drinking! I have to switch back to first 2% and then 1% milk

So...I just have to keep on trying.

Nana Needs To Lose A LOT of Weight

I've posted before that I have an image of myself that is thinner than I actually am. It gets me into trouble when I'm trying to maneuver around and sometimes I've been shocked and embarrassed when I couldn't fit somewhere. Mostly, I can't bear to look at pictures of me.


Who is that? That can't be me,. I think. I don't look like that!

But I do. And now I'm the heaviest I've ever been in my life which is why I need the surgery. I haven't been able to get the weight off using other methods and I'm tired of pain and tired of people staring at me like I'm a freak. Usually when I post pictures, I either don't post any of me or I crop everything out except my head. But here is the truth of it from when I was outdoors blowing bubbles with Little T.



I remember feeling surprised when people didn't notice or realize I'd had a breast reducton. Now I understand why--that's a big belly that takes up a lot of the picture!


I have a pretty smile but I don't think that's what people are staring at when I walk by. They don't smile at me--that's how I know. There's a look of distaste or disgust which really annoys or upsets me. It's definitely time to do something!

I realize I won't get down to what I weighed when I graduated high school. Maybe I won't be able to even get this far. This picture was taken a little over 15 years ago. I was about 25 poounds overweight.



I'd e happy with my weight in this picture, taken 5 or 6 years ago.



That's my darling TB on the left of me, by the way. He's in on this with me too.

So here is the big reveal. I'm at 318 lbs now and need to lose at least 100 to feel healthy again. Wish me luck!

Surgery or Not Revisited

Well...never say never. I was positive I did not want weight loss surgery and if I even considered it, I would only be interested in the lap band. Many months later of pain, increasing disability and inability to enjoy life, TB and I have come to the conclusion that we need and want the surgery.

Yesterday we went to the N.J. Bariatrics Center. This wasn't our first visit. A couple of weeks ago, we went to an informational seminar about the two types of surgery and we had the opportunity to meet both of the doctors, Dr. Brolin and Dr. Chau. The seminar provided a great deal of information and input from a man who'd had a bypass a couple of years ago. We were especially impressed with this man and decided to schedule ourselves an appointment to see Dr. Chau, the surgeon who does the lap bands. Dr. Brolin does riskier bypass surgeries.

If we thought we were informed at the seminar, we learned even more at the consultation. We met with Dr. Chau who explained in detail the benefits and risks of each surgery and what they entail. We also met with a dietician who explained what our lives would be like -- food wise anyway -- post surgery. An insurance specialist explained all the steps we needed to take for precert. The whole process will take 3 months.

TB and I decided that since he is in the most intense pain and the one who needs to get back to work, his procedure will come first. Our next step is to get letters of support from our doctors and to begin a paper trail that shows we are getting counseling about the surgeries.

TB decided that although he is terrified of it, he wants the bypass because it will help him faster. It scares me but I can't sit here and dictate to him what to do when his pain is so severe he gives his quality of life a 1 on a scale of 5. That's pretty sad for a man of only 54.

And so we're off on this new journey.

Always Hungry

One of my biggest stumbling blocks to eating healthier to lose weight is that I always seem to be hungry after the second dzy on the plan. Some plans say I shouldn't let myself get to the point of feeling hungry; others say I just ought to suck it up and get used to it. To lose weight, we have to suffer the hunger pangs. So when I got my daily Managing Diabetes newsletter I was interested to see an article about constant hunger. The link for the article is here.

The first question I have to ask myself is: am I feeling genuinely hungry or do I just want to eat? Hunger is a physiological response and all you want to do is fill that empty stomach. Appetite is different. You just seem to want a specific food--like potato chips, maybe?

How many calories would I need to not feel hungry all the time? The article says:

If you go on a very-low-calorie diet of less than 1,000 calories each day, you will feel very hungry much of the time. It is better for you to eat more calories each day — say 1,200 to 1,500 — for a slower but longer-term weight loss. In the long run, severely restricting calories can backfire, leaving you feeling constantly hungry and constantly wanting to eat. And no matter how much you cut back while you're on the diet, you can't eat so little forever. You'll eventually need to learn to eat at a higher calorie level to maintain your weight.

Well, I don't know about this...when I was on Weight Watchers, I'm assuming I was eating the upper limit of calories 1500-1600 and I still felt hungry! I can only stand feeling hungry for so long before I start raiding the pantry for everything I can find and then I gain it all back! I don't seem to have the will power I did when I was younger.

I should see a nutritionist...

Doctors Treating Fat People

I can feel for these people. They are in a real bind. Obesity is on the rise and it causes any number of health problems. It's probably the leading cause of premature death--or if it isn't yet, it will be. Doctors know this and so do us fat patients. So what is there to do?

Most doctors will mention your weight one time and then delicately not bring it up again unless you do. They figure you know what's what and if they nag, you might not come back to see them when you get really sick.

Then there's the other doctors who tell you they can't help you until you lose weight. Even when they mean well, they can do more damage to you than the ones that ignore the issue. My husband TB and I saw a pain management doctor the other day. TB has been out of work since mid September because of intense pain from spinal stenosis. He was referred to this guy by the rheumatologist and we thought TB was going to get an epidural.

But the doctor wouldn't do it. He told TB, "I don't want you to break my table." He said it very matter-of-factly, not contemptuously. Still words like that hurt. So was he supposed to spare our feelings by putting it another way or covering up by saying he wanted TB to try water physical therapy first to see if that helped? I'm not sure. I was very annoyed, though, when I asked if he treated other types of chronic pain and he answered, "Most of my patients are obese, if that's what you're asking me."

It wasn't.

He didn't rule out the epidural entirely. He just wants TB to lose weight first. What he did do, however, was prescribe another medication for pain and physical therapy in water. He recommended that I go along and follow the exercises because it would benefit me too. That stung a bit.

He also recommended we cut out red meat--we don't eat it every week any more so that's not new--and chicken! Chicken too? Apparently yes. We should be loading up on beans, fish oil to make us feel full, and fish. Hmmm.

Should we feel upset with the doctor for refusing to give TB the epidural?

Some years back I went to a doctor because my breasts were so large and heavy I was getting spasms in my neck and back. The doctor said, lose weight and I'll help you.
I was still suffering in 2005 and told my rheumatologist (same one who recommended TB to the pain doctor), telling him what the doctors said previously. He said, "That isn't always possible and this way, you'll get some relief from the pain." He referred me to a surgeon who did the breast reduction and I did feel so much better.

Around this time in 2001, a friend of mine had a bypass surgery so that he could lose weight and have spinal surgery to relieve pain he was in. My friend seemed to be doing okay after the surgery but died suddenly on the day he was supposed to be discharged from the hospital. Would it have been different if the spinal surgeon had operated in spite of my friend's weight? I don't know...and I guess that's why I don't know what to feel about the issue.

A Somewhat Dismal Update

I haven't spiralled totally out of control but I've been very discouraged with my lack of progress over the last six months. In fact, I've done a big backslide! I've gained 10 pounds and my most recent sugars show my A1C has gone from 6.5 to 7.5. I feel like I'm having mood swings and suspect I may actually have some bipolar going on after all. This is a check list I plan to show to all my doctors:

GENERAL
__X__ Fatigue, made worse by physical exertion or stress
__X__ Activity level decreased to less than 50% of pre-illness activity level
__X__ Recurrent flu-like illness
____ Sore throat
____ Hoarseness
__X__ Tender or swollen lymph nodes (glands), especially in neck and underarms
____ Shortness of breath (air hunger) with little or no exertion
__X__ Frequent sighing
____ Tremor or trembling
__X__ Severe nasal allergies (new allergies or worsening of previous allergies)
__X__ Cough
__X__ Night sweats
____ Low-grade fevers
__X__ Feeling cold often
__X__ Feeling hot often
____ Cold extremities (hands and feet)
____ Low body temperature (below 97.6)
____ Low blood pressure (below 110/70)
____ Heart palpitations
__X__ Dryness of eyes and/or mouth
__X__ Increased thirst
__X__ Symptoms worsened by temperature changes
____ Symptoms worsened by air travel
__X__ Symptoms worsened by stress

PAIN
__X__ Headache
__X__ Tender points or trigger points
__X__ Muscle pain
____ Muscle twitching
__X__ Muscle weakness
____ Paralysis or severe weakness of an arm or leg
__X__ Joint pain
____ TMJ syndrome
__X__ Chest pain

GENERAL NEUROLOGICAL
__X__ Lightheadedness; feeling "spaced out"
__X__ Inability to think clearly ("brain fog")
____ Seizures
____ Seizure-like episodes
____ Syncope (fainting) or blackouts
____ Sensation that you might faint
__X__ Vertigo or dizziness
___X__ Numbness or tingling sensations
__X__ Tinnitus (ringing in one or both ears)
__X__ Photophobia (sensitivity to light)
__X__ Noise intolerance

EQUILIBRIUM/PERCEPTION
__X__ Feeling spatially disoriented
__X__ Dysequilibrium (balance difficulty)
__X__ Staggering gait (clumsy walking; bumping into things)
____ Dropping things frequently
____ Difficulty judging distances (e.g. when driving; placing objects on surfaces)
____ "Not quite seeing" what you are looking at

SLEEP
__X__ Hypersomnia (excessive sleeping)
__X__ Sleep disturbance: unrefreshing or non-restorative sleep
__X__ Sleep disturbance: difficulty falling asleep
____ Sleep disturbance: difficulty staying asleep (frequent awakenings)
____ Sleep disturbance: vivid or disturbing dreams or nightmares
__X__ Altered sleep/wake schedule (alertness/energy best late at night)

MOOD/EMOTIONS
__X__ Depressed mood
____ Suicidal thoughts
____ Suicide attempts
____ Feeling worthless
____ Frequent crying
__X__ Feeling helpless and/or hopeless
__X__Inability to enjoy previously enjoyed activities
__X__ Increased appetite
____ Decreased appetite
__X__ Anxiety or fear when there is no obvious cause
____ Panic attacks
__X__ Irritability; overreaction
__X__ Rage attacks: anger outbursts with little or no cause
__X__ Abrupt, unpredictable mood swings
____ Phobias (irrational fears)
____ Personality changes

EYES AND VISION
____ Eye pain
__X__ Changes in visual acuity (frequent changes in ability to see well)
__X__ Difficulty with accommodation (switching focus from one thing to another)
____ Blind spots in vision

SENSITIVITIES
____ Sensitivities to medications (unable to tolerate "normal" dosage)
____ Sensitivities to odors (e.g., cleaning products, exhaust fumes, colognes, hair sprays)
____ Sensitivities to foods
____ Alcohol intolerance
____ Alteration of taste, smell, and/or hearing

UROGENITAL
__X__ Frequent urination
____ Painful urination or bladder pain
____ Prostate pain
____ Impotence
____ Endometriosis
____ Worsening of premenstrual syndrome (PMS)
__X__ Decreased libido (sex drive)

GASTROINTESTINAL
__X__ Stomach ache; abdominal cramps
____ Nausea
____ Vomiting
____ Esophageal reflux (heartburn)
____ Frequent diarrhea
____ Frequent constipation
____ Bloating; intestinal gas
____ Decreased appetite
__X__ Increased appetite
__X__ Food cravings
__X__ Weight gain (10 lbs)
____ Weight loss (____ lbs)

SKIN
____ Rashes or sores
____ Eczema or psoriasis

OTHER
____ Hair loss
____ Mitral valve prolapse
____ Cancer
____ Dental problems
____ Periodontal (gum) disease
____ Aphthous ulcers (canker sores)

COGNITIVE
____ Difficulty with simple calculations (e.g., balancing checkbook)
__X__ Word-finding difficulty
__X__ Using the wrong word
__X__ Difficulty expressing ideas in words
____ Difficulty moving your mouth to speak
____ Slowed speech
____ Stuttering; stammering
__X__ Impaired ability to concentrate
__X__ Easily distracted during a task
____ Difficulty paying attention
__X__ Difficulty following a conversation when background noise is present
____ Losing your train of thought in the middle of a sentence
____ Difficulty putting tasks or things in proper sequence
____ Losing track in the middle of a task (remembering what to do next)
__X__ Difficulty with short-term memory
____ Difficulty with long-term memory
____ Forgetting how to do routine things
____ Difficulty understanding what you read
____ Switching left and right
____ Transposition (reversal) of numbers, words and/or letters when you speak
____ Transposition (reversal) of numbers, words and/or letters when you write
____ Difficulty remembering names of objects
__X__ Difficulty remembering names of people
____ Difficulty recognizing faces
____ Difficulty following simple written instructions
____ Difficulty following complicated written instructions
____ Difficulty following simple oral (spoken) instructions
__X__ Difficulty following complicated oral (spoken) instructions
____ Poor judgment
__X__ Difficulty making decisions
____ Difficulty integrating information (putting ideas together to form a complete picture or concept)
____ Difficulty following directions while driving
____ Becoming lost in familiar locations when driving
____ Feeling too disoriented to drive

This is my action plan for now:

I'm going to test my sugar 2 hours after my heavy meal (keep forgetting to do the fasting)

I'm going to re-read The Insulin Resistance Diet, something the authors suggested when you fall off track. I'm going to make healthier food choices and be aware of what I'm putting into my body

I'm going to try and swim a half hour 3 times a week

I'm going to journal more about my health