Guest guest Posted May 14, 2005 Report Share Posted May 14, 2005 Heart Health JoAnn Guest May 14, 2005 14:51 PDT Coronary Artery Disease (CAD) There are four conditions associated with coronary artery disease: atherosclerosis, insulin resistance, high homocysteine and angina pectoris. Atherosclerosis - Overview Atherosclerosis is a condition in which cholesterol-rich plaque builds up along the arterial walls. Atherosclerosis is thought to develop when an injury occurs to the endothelial (inside) lining along the artery wall. In response to the injury, white blood cells, along with lipids, begin to accumulate along the inner layer of the artery. The muscle layer of the artery may also grow, forming the basis of a plaque, which many grow large enough to block the artery. If the plaque is disturbed, platelets may begin to accumulate at the site and form a thrombus, or clot. A clot can continue to grow until it completely blocks an artery, cutting off the oxygen supply to a vital organ, or a clot can break free from the vessel wall (become an embolus) and become lodged somewhere else further downstream. This could lead to a heart attack or stroke if the clot completely blocks the blood and oxygen supply to a major artery leading to the heart or brain. Causes and Symptoms Recent studies have shown that children with one or both parents who have had heart disease before age 60 were more likely to have atherosclerosis themselves, and the risk of CAD increases progressively with age. Other risk factors for developing atherosclerotic plaques include high cholesterol, smoking, high blood pressure, diabetes, and the use of birth control pills or estrogen replacement therapy. Suggested Lifestyle Changes Those with atherosclerosis should try to: Get more exercise. This will help maintain the health of the vessels leading to the heart, as well as strengthening the heart muscle itself. Lower your intake of saturated fats, and control cholesterol. Stop smoking. Control your blood pressure. Nutrition and Supplements Fish oil. The omega-3 fatty acids in fish and fish oil supplements have been shown to be an effective preventive strategy against heart disease. They can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy. Coenzyme Q10 (CoQ10). This antioxidant is thought to be one of the most important antioxidant supplements for protection against many forms of cardiovascular disease. It helps protect LDL cholesterol from oxidation, maintain healthy blood vessels, protect against clots and plaque rupture, and support optimal functioning of the heart muscle. Insulin Resistance - Overview Insulin is a hormone that facilitates the transport of glucose from the blood into cells where it is used as fuel. When blood sugar rises after a meal, the pancreas secretes insulin into the bloodstream. With insulin resistance, the normal amount of insulin secreted is not enough to move glucose into the cells - thus the cells are " resistant " to the action of insulin. To compensate, the pancreas secretes even more insulin, and is able to maintain fairly normal blood-sugar movement into cells and a normal blood-sugar level. The resulting high level of insulin, however, has several negative effects elsewhere in the body. It influences the enzymes in the liver that produce cholesterol and acts on the kidney (which can contribute to high blood pressure). High insulin levels also have a role in the process that regulates inflammation. Eventually, blood-sugar levels will continue to rise because the pancreas stops producing enough insulin or the cells become more and more resistant to the insulin that is produced. In time, insulin resistance can lead to Type 2 diabetes, itself a risk factor for heart disease. A simple way to diagnose an insulin resistance problem is to take a blood test that looks for a low HDL cholesterol, along with a high triglyceride level, a high fasting insulin level or a high uric acid level. Causes and Symptoms Insulin resistance is often due to: Genetic factors, such as a family history of diabetes, high blood pressure or heart disease. Excess weight, with the extra pounds accumulating in the abdomen (the classic " apple " shape). However, thin people can also have the problem and be at the same risk for heart disease, high blood pressure and diabetes. Suggested Lifestyle Changes For those with insulin resistance, try the following: Watch your carbohydrate intake. The classic low-fat, high-carb diet that was the standard recommendation for preventing or treating heart disease for years can actually make insulin resistance worse. Carbohydrates (starches and sugars) raise blood sugar levels and trigger the release of insulin. A moderately low carbohydrate diet (40 to 45 percent of calories) emphasizing low glycemic index sources of carbohydrate (those that raise blood sugar levels slowly rather than quickly) is recommended. In general, foods very rich in fiber are healthy. Cut saturated fats, but keep healthy fats. Include moderate amounts of monounsaturated fat (i.e. extra virgin olive oil, avocadoes)(30 to 35 percent of calories) rather than following a strict low-fat diet. Eat generous amounts (five or more servings) of organic non-starchy vegetables and one to two servings of low-glycemic index fruit every day. Lose weight if you are overweight. Even small amounts of weight loss can improve insulin resistance. Exercise. Vigorous aerobic exercise decreases the cells' resistance to insulin. Eat fish frequently. The best are cold-water fish that are high in omega-3 fatty acids, like wild Alaskan salmon and sardines. This type of fat seems to improve cells' response to insulin. Eat small, frequent meals to keep blood sugar levels as stable as possible. Nutrition and Supplements Coenzyme Q10 (CoQ10). This powerful antioxidant has been shown to be beneficial for heart health by protecting LDL cholesterol from oxidation and re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. Alpha-lipoic acid. This antioxidant nutrient improves the cells' response to insulin and can help stabilize blood sugar levels. Magnesium. Higher insulin and blood sugar levels are often observed in people with low plasma magnesium levels and magnesium supplementation improves insulin resistance in animal studies. Chromium. This mineral helps stabilize blood sugar, may improve serum lipid profiles, and also may help the body utilize glucose and burn fat. The best form to use is GTF Chromium. High Homocysteine - Overview Homocysteine is an amino acid that becomes available to the body with the breakdown of dietary protein. Homocysteine is also produced in the body from another amino acid called methionine. One of methionine's main functions is to provide methyl groups for cellular reactions. A methyl group is a small, simple chemical fragment consisting of one carbon molecule and three hydrogen molecules. When methionine donates a methyl group for a cellular reaction, it becomes homocysteine. Typically homocysteine then receives another methyl group from either folic acid or vitamin B6 and is turned back into methionine. Vitamin B12 acts as a co-factor for this reaction. A high homocysteine level is primarily a sign of an inadequate intake of folic acid or vitamin B6. In short, if you don't have enough of certain critical B vitamins, your homocysteine level can rise. At elevated levels, homocysteine is thought to contribute to plaque formation by damaging the arterial wall. High levels may also act on platelets and increase the risks of clot formation. Causes and Symptoms High homocysteine levels can be due to: Genetics. There are genetic variations in folic acid absorption and utilization. Some individuals therefore need much more folic acid than the RDA of 400 mcg. Stress. Epinephrine and norephinephrine are stress-induced neurotransmitters. Their metabolism in the liver involves methylation, a process that uses methyl groups, and can increase need for methyl donors like folic acid. Coffee consumption. As coffee consumption increases, homocysteine levels increase. Inadequate amounts of folic acid, vitamin B6 or vitamin B12 in your diet and supplements. Suggested Lifestyle Changes To lower your homocysteine levels: Increase dietary B vitamins. The richest sources of folate (the name for the family of folic acids found in food) are green vegetables, orange juice and beans. The RDA for folic acid is 400 mcg. Learn how to moderate your stress. Breathing exercises, meditation and mind-body exercises such as yoga can help to reduce stress. Nutrition and Supplements Start getting more folic acid. Augment your intake of dietary B vitamins with a daily B-100 B-Complex supplement. Angina Pectoris - Overview Angina is chest pain that can occur when there is a dramatic decrease in the blood supply to the heart, an increased demand for oxygen by the heart, or a combination of both. It is a classic symptom of coronary artery disease and is sometimes predictive of heart attacks. If the walls of the coronary arteries are hard and unable to relax (for example, as a result of atherosclerosis), the vessels will not be able to dilate properly, which affects blood flow. Increasing physical or emotional exertion increases the demand for oxygen. If the arteries are so blocked that the heart cannot receive sufficient oxygen to meet its needs, angina can result. Causes and Symptoms Angina is often linked to the following: Coronary artery disease. Plaque formation can narrow the arteries supplying the heart to the point that the blood flow can no longer meet the heart's demands. Coronary artery spasm. In some cases angina can result from arterial spasms, which cause a temporary constriction in the artery. Emotional or physical stress, exerting oneself after a meal, or extreme temperature changes. Cigarette smoking. Nicotine has direct effects on blood vessels, which can bring on an angina attack. The single most important feature of angina is chest pain brought on by physical exertion. Exertion increases the oxygen demands of the heart beyond the supply capabilities of compromised coronary arteries, resulting in pain. The length of an attack and the severity can vary. While most experience chest pain, angina may also feel like a tightness or pressure in the chest, or pains that radiate to the neck, along the left shoulder or down the left arm. Difficulty breathing and nausea may also be present. Suggested Lifestyle Changes Several studies suggest that coronary artery insufficiency can be reversed by following a conscientious program of lifestyle modification involving a strictly vegetarian low-fat diet, practicing yoga and meditation, group therapy and moderate exercise. In addition, don't smoke, and quit if you're currently a smoker. Nutrition and Supplements For those with angina, try: Coenzyme Q10 (CoQ10). It is a powerful antioxidant and has been shown to be beneficial for heart health by re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. CoQ10 may thus assist in lowering the oxygen demands of the heart by improving its energy efficiency. This nutrient may also help lower blood pressure. Hawthorne. Another antioxidant with beneficial heart-health properties, hawthorne may help improve coronary artery blood flow and circulation to the extremities of the body, therefore improving symptoms of angina. L-arginine. A precursor to nitric oxide that relaxes blood vessels in the heart and improves cardiac metabolism. Cholesterol - Overview High cholesterol is also a well-known risk factor in heart disease. This waxy, fat-like substance comes from the diet, but is primarily made by the liver, and is an essential component of cell membranes. The body also uses it to produce hormones and vitamin D. Cholesterol is carried through the bloodstream attached to two different compounds called lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is commonly known as the " bad cholesterol " ; it carries cholesterol from the liver throughout the body, making it available and potentially allowing it to be deposited in artery walls. HDL is known as the " good cholesterol " ; it picks up cholesterol from the blood and delivers it to cells that use it, or back to the liver to be recycled or eliminated from the body. Causes and Symptoms The body needs cholesterol to function, but too much of it in the blood, or too much of the wrong kind, can add up to trouble. The factors leading to heart disease are as follows: High total cholesterol, especially high LDL levels. These two factors combine to form a well known risk factor for heart disease (though people can have heart disease without having high cholesterol). Lifestyle may influence cholesterol levels in part, especially the consumption of saturated fats, but the tendency toward high cholesterol appears to be genetic. Treating high cholesterol levels with dietary and nutritional supplementation is effective. Low HDL cholesterol and high triglyceride levels. This is a different pattern than high total and LDL cholesterol although someone may have both. This pattern, sometimes called “Syndrome X,” is associated with insulin resistance. It is frequently influenced by diet and lifestyle, but also is genetically driven and appears to affect about 30 percent of the population. It carries with it an increased risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatments for this pattern are different from those for high total and LDL cholesterol levels. Here, lifestyle changes are generally quite effective. Suggested Lifestyle Changes To improve your cholesterol profile, try the following: Lose weight. Even a modest amount of weight loss can lower cholesterol levels. Reduce the amount of saturated fat you eat. The richest sources of saturated fat (fat that is usually solid at room temperature) in the diet are dairy foods (except the fat-free versions), especially whole milk, cheese, butter and cream. Red meat is also high in saturated fat. Avoid trans-fat. These heart damaging fats can reduce HDL levels and raise LDL levels. If you find " partially hydrogenated oil " listed in the ingredient list on food labels, find a healthier substitute. Trans-fat is found in many margarines and in most heavily processed foods, as well as in snack foods like chips, crackers and cookies, and in the oils used to cook fast-food french fries, doughnuts and movie popcorn. Exercise. Daily aerobic exercise is one well-proven method to increase HDL levels. Don't smoke. Smoking is a risk factor for heart disease all by itself, but can also significantly lower HDL cholesterol. Relax. Emotional stress may trigger the body to release fat into the bloodstream, raising cholesterol levels. Practice daily breathing exercises and a stress-reduction technique that works for you, such as yoga, meditation, guided imagery or tai chi. Nutrition and Supplements The following may help to reduce cholesterol levels: Eat some raw nuts every day. My Optimum Health Plan's menu plan is rich in nuts, especially almonds, walnuts and cashews, which contain heart-healthy monounsaturated fat. Substitute organic soy protein for animal protein. The protein in soy foods has been shown to lower cholesterol levels. Try to incorporate two servings a day into your meals. Choose from organic tofu, miso,tempeh, soy milk, whole soy beans and roasted soy nuts. Use fresh garlic regularly in your meals. Garlic has been shown to lower both cholesterol levels and blood pressure - and it tastes wonderful, too. Use one or two raw or lightly cooked cloves a day. Drink green tea daily. The antioxidants in green tea help lower cholesterol and prevent the cholesterol in your blood from oxidizing. Eat plenty of soluble fiber. Soluble fiber has a powerful cholesterol-lowering effect. The best sources of soluble fiber are beans and lentils, apples, citrus fruits, oats, barley, peas, carrots and ground flax seed. Limit refined carbohydrates. A diet full of cookies, cakes, crackers, fluffy breads, chips and sodas can increase triglyceride levels and lower HDL. Take Coenzyme Q10 (CoQ10). CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by protecting LDL cholesterol from oxidation and by re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. CoQ10 may also help lower blood pressure. Take fish oil. Though omega-3 fatty acids in fish oil don't specifically lower total or LDL cholesterol levels, they do seem to reduce the risk of heart disease by reducing platelet stickiness, inflammation and triglyceride levels. High Blood Pressure (Hypertension) - Overview As the heart pumps blood through the arteries (large blood vessels), it pushes the blood against the arterial walls with a force that is measured as " blood pressure. " High blood pressure is defined as a reading above 140/90 mm Hg (systolic/diastolic). (Systolic pressure - the first number - measures the pressure in the arteries when the heart contracts. Diastolic pressure - the second number - measures the pressure in the arteries when the heart is relaxing between beats and filling with blood.) Research now suggests that " high-normal " blood pressure (130 to 139 over 85 to 89) can also raise risk of cardiovascular disease. Normal blood pressure is 120 to 129 over 80 to 84, and optimal blood pressure is less than 120 over 80. Excessive pressure makes the heart work harder, increasing its oxygen demands and contributing to angina, and can eventually lead to an enlarged heart (cardiomegaly), as well as damage to blood vessels in the kidneys and brain. Hypertension, therefore, increases the risk of heart attacks, stroke and kidney disease. Hypertension is the most common form of cardiovascular disease in America, affecting about 50 million people - that's close to one out of four adults. The good news is that hypertension is easy to detect, and can often be improved or controlled with changes in diet and lifestyle. Causes and Symptoms Hypertension is often called a " silent killer " because even severe, uncontrolled high blood pressure usually has no obvious symptoms. The elderly are at increased risk for hypertension, and high blood pressure can occur as the arterial walls lose their elasticity with age and cause the pressure of the blood moving through the arteries to rise. In most cases (those known as " essential hypertension " ), Doctors cannot pinpoint the precise cause of high blood pressure. However, they do know that certain factors can increase the risk of developing high blood pressure: Stress can cause hypertension by activating the sympathetic nervous system, causing the arteries to maintain a more rigid tone. Eating large amounts of salt and sodium can cause excess water retention, expand blood volume and ultimately increase blood pressure. Caffeine acts as a cardiovascular stimulant and raises blood pressure. A diet low in calcium, magnesium and potassium can increase blood pressure. Insulin resistance can increase blood pressure by causing the kidneys to retain sodium. Regular alcohol intake can increase blood pressure. Being overweight increases blood pressure. Medications. Some prescription drugs, including steroids, birth control pills, decongestants, NSAIDS and diet pills can raise blood pressure. Some over-the-counter medicines, such as those containing ephedra, guarana, kola nut, yerba mate, ginseng and yohimbe, may also raise blood pressure. Suggested Lifestyle Changes Limit your caffeine intake. The caffeine in coffee, tea and sodas can contribute to high blood pressure. Limit alcohol intake. Blood pressure increases as your body metabolizes alcohol. Avoid processed foods. These are the biggest sources of sodium in today's diet. Maintain optimal weight. Even small amounts of weight loss can improve blood pressure. Relax. Meditation, yoga, breathing exercises and biofeedback are all relaxation techniques that can help lower blood pressure. Don't smoke. Smoking contributes to all cardiovascular diseases - and many other life-threatening conditions as well. Exercise. As little as 30 minutes of moderate exercise a day, like walking, can lower blood pressure. Check your meds. Discuss your current medications and their risks of increasing blood pressure with your doctor. Nutrition and Supplements The DASH diet, developed by researchers at the National Institutes of Health's National Heart, Lung, and Blood Institute is based on a large-scale research study that identified the foods that affect blood pressure (www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf). The most important parts of the DASH are generous amounts of fruits and vegetables and low-fat or fat-free dairy products that provide adequate calcium. The diet is also relatively low in fat and sodium. DASH researchers have shown that diets rich in potassium, calcium and magnesium, and low in sodium (2,400 mg or less), play an important role in maintaining healthy blood pressure levels. People with high blood pressure should incorporate the components of the DASH diet into their daily routine. In addition, make sure you do the following: Eat 8 to 10 servings of fruit and vegetables per day. Choose low- or non-fat dairy foods, consuming two to three servings per day. Limit animal protein to 6 oz per day, emphasizing lean sources. Say no to salt. Those with salt sensitivity or a family history or hypertension may benefit from reducing salt to about one teaspoon a day (2,400 mg). Use garlic, which has a modest effect on lowering blood pressure and may help relax blood vessels. Consume 4 to 5 servings of nuts, seeds and dry beans per week (2 Tbsp nuts or seeds, or 1/2 cup cooked dried beans). Eat plenty of fish. Include at least three servings of fish a week, emphasizing cold-water fish like wild Alaskan salmon and sardines, which are rich in omega-3 fatty acids. Take fish-oil supplements if you cannot get enough omega-3-rich foods. Take calcium and magnesium. Inadequate intake of both of these minerals has been associated with high blood pressure. Women should get between 1,000 and 1,500 mg of calcium a day, while men may want to get no more than the RDA (1,000 to 1,200 mg a day) from all sources. Take vitamin C. A supplement of this antioxidant vitamin has been shown to lower blood pressure in people with mild to moderate hypertension. Stroke - Overview According to the American Heart Association, stroke is the third leading cause of death in the United States(when considered separately from other types of cardiovascular disease), accounting for about one out of every 14.5 deaths. Approximately three-fourths of stroke victims are over the age of 65, but a person can have a stroke at any age. Although stroke seems to affect as many men as women, more women die of a stroke than men in all age groups. Causes and Factors A stroke, also known as a cerebrovascular accident, is the death of brain tissue caused from a lack of blood flow and insufficient oxygen to the brain. The brain receives about 25 percent of the body's oxygen supply from a continuous blood flow through the carotid arteries (that come up through both sides of the front of the neck) and the basilar artery (which forms at the base of the skull from the vertebral arteries). There are two main classifications of strokes: Ischemic. The blood supply is cut off to part of the brain, either due to atherosclerosis or a blood clot. Infections, inflammation or certain medications can all contribute to ischemic strokes. These strokes are the most common type, causing about 80 percent of all stroke cases. Hemorrhagic. These strokes comprise the remaining 20 percent of cases. Hemorrhagic strokes are caused from a ruptured blood vessel, preventing normal blood flow and causing bleeding into an area of the brain. They can be the result of hypertension, which causes excessive pressure on the arterial walls that may already be damaged by arteriosclerosis. A ruptured aneurysm (the rupture of a weakened area in the blood vessel wall), can also cause a hemorrhagic stroke. There is an increased risk of hemorrhagic stroke in those whose blood has been made " too thin " by anticoagulant medications such as coumadin, or through the over-use of aspirin or other medications with blood-thinning properties. Strokes (like heart attacks) result from a sudden blockage in a blood vessel that reduces or cuts off oxygen supply to the cells, often resulting in the death of the tissue. Strokes have recently been termed " brain attacks " to convey the need for immediate action when one occurs. It only takes a short period of time without oxygen to cause damage to the brain. Risk factors for stroke include: Age. The risk of stroke increases with age, doubling after age 55. High blood pressure, diabetes, smoking and high cholesterol all impact circulation and vascular health and contribute to plaque and clot formation. History of a clotting disorder. Use of replacement estrogen therapy or birth control pills. Suggested Lifestyle Changes Control your blood pressure either through lifestyle changes or medication. Exercise. People who exercise consistently have a lower risk for having a stroke. If you smoke - quit. Limit alcohol intake. If you drink alcohol, do so only in moderation. Moderate alcohol intake is defined as no more than one drink per day for women and two drinks a day for men. Manage diabetes and keep tight control of blood sugar levels. Lower cholesterol into a healthy range. Nutrition and Supplements Focus on your diet. Follow a diet designed for those with high blood pressure and heart disease - it may be helpful in preventing strokes. Take calcium and magnesium. These minerals are helpful in controlling high blood pressure, one of the strongest risk factors for stroke. Congestive Heart Failure - Overview Congestive heart failure (CHF) is a very serious heart condition in which the heart cannot pump sufficient blood to meet the circulatory needs of the body. Even though the condition typically gets worse over time, people are able to live with the disease for many years. Causes and Symptoms CHF can stem from any disease that causes impairment in the heart's ability to contract and pump blood. The impaired pumping power may follow a heart attack in which the heart muscle was damaged, or the muscles may become thick or inflexible from hypertension, diabetes, or improperly functioning valves. When the heart is constantly overworked, it first becomes larger and thicker - as will any muscle in the body that you consistently exercise and push hard - and it begins to beat more frequently. These changes eventually compromise the heart's efficiency, however, and over time the heart tires out. Back pressure in the circulatory system may have damaging effects on other organs, such as the kidneys, and fluid may collect in the lower legs, causing swelling, or in the lungs, causing shortness of breath. Factors linked to CHF include: Diabetes An overactive thyroid gland A viral or bacterial infection in the heart muscle Morbid obesity High blood pressure Damaged heart valves Symptoms of CHF may include: Fatigue and weakness, particularly when performing physical activities, which stems from a lack of sufficient oxygen to the muscles. Swelling in the lower extremities. If the right side of the heart is affected, fluid builds up in the feet, ankles, abdomen, liver and legs. Left-sided heart failure can cause fluid retention in the lungs, leading to shortness of breath. Wheezing or coughing up pinkish phlegm. Dizzy spells. Rapid weight gain from fluid retention. Recommended Lifestyle Changes The most important thing you can change is your diet - obesity and diabetes are both linked to diet, and both linked to CHF. Consult a nutritionist to determine a diet right for your situation. If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system. Avoid salt. Sodium promotes fluid retention. Avoid high-sodium foods, heavily processed foods and unnecessary salt. . Check other meds. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking. Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems. Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the heart work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath (taught elsewhere on this site) can improve the oxygenation of blood and take workload off the heart. Nutrition and Supplements If you are coping with, or are at risk of congestive heart failure, try the following: Coenzyme Q10 (CoQ10). CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. This nutrient is very important for the heart cells of patients with heart failure. CoQ10 may also help lower blood pressure. L-Carnitine. This amino acid is essential for energy metabolism of the heart muscle. Cordyceps. This medicinal mushroom is a good energy booster and can improve the efficiency of the lungs and heart. Hawthorne. This herb may increase heart-muscle strength and also act as a mild diuretic. Be sure to discuss the use of any supplement with your doctor. Your prescription drug dosages may need to be adjusted as these other measures take effect. www.drweil.com AIM Barleygreen " Wisdom of the Past, Food of the Future " http://www.geocities.com/mrsjoguest/Diets.html Discover Have fun online with music videos, cool games, IM & more. Check it out! Quote Link to comment Share on other sites More sharing options...
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