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Inflammation, Cancer and health

Inflammation, Cancer and health – Why your diet is important

Inflammation

Inflammation, Cancer and health. Actually inflammation can lead to several health complication more so if it is chronic inflammation.

The body defense mechanism is always under certain threats despite the measures put in place to defend it from both external and internal attacks. The body immune system and the white blood cells are such defense mechanism the body relays on for protection against diseases and infections. Whenever they are under attack the whole body organs including the skin are at risk of various infections. We are therefore going to discuss the effects of inflammation on human health generally before we can get to specific areas of the body.

What is inflammation?

There are two different kinds of inflammations and they include the following:

  • Acute inflammation
  • Chronic inflammation

Acute inflammation – this is actually your body’s natural and helpful immune response to tissue damage. Like for instance when you get a bruise or wound either from a minor accident or otherwise, the wound or the cut swells, reddens and feels inflamed. These are all signs that your immune system is busy at work sending white blood cells to the site of your injury to repair the tissue. In situation like this, inflammation is our friend and we couldn’t live without it.

Chronic inflammation – this is a situation where your body’s confused and damaging immune response to a bombardment of environmental, physical and mental invaders, which come in the form of things like poor diet, toxic chemicals and stress. Therefore this article will be focusing on the type of inflammation. Here’s chronic inflammation in a nutshell:

What does inflammation have to do with cancer?

Like I have indicated in the introduction that the body’s immune system is facing threats of being weaken by several health complications. For example the prolonged inflammation can harm your body’s healthy cells and tissue thereby causing the deterioration of your immune system. This deteriorated state can escalate your risk of diseases like cancer.

Nevertheless, it is important to note that not all inflammation is bad. Your body’s inflammatory response is essential for you to heal. This response communicates with your body’s immune system to send white blood cells and chemicals to help fight off infection or repair an injury.

But when inflammation persists, or when your body triggers a response when you don’t have an infection or injury, its cause for concern.

Other causes of chronic inflammation can include obesity, smoking and even the second hand smoking, stress, lack of exercise, exposure to secondhand smoke and diet choices. And worse, chronic inflammation often shows no signs.

The good news is you can reduce chronic inflammation and lower your cancer risks. “It starts with your diet”. An anti-inflammatory diet also can help you avoid diabetes, heart disease and Alzheimer’s.

The following are some of the anti-inflammatory diet tips.

Add more plant foods to your plate

Plant foods are the only foods that contain anti-inflammatory phytonutrients. Plus, they are high in the antioxidants and fiber your body needs to stay cancer-free. Fiber also can lower levels of C-reactive protein (CRP), a protein in the blood that signals inflammation.

The experts in nutrition recommend filling at least two-thirds of your plate with foods realized naturally from the vegetation. Like for instance:

  • It is advisable that you serve half of your plate with non-starchy vegetables and fruits of all colors.
  • Make one-quarter of your plate whole grains or starchy vegetables, like potatoes, corn and peas.
Limit processed foods

Choosing whole, fresh foods and doing your own prep maximizes nutrients and phytonutrients. These nutrients keep us healthy in many ways, while reducing inflammation.

Processed foods are lower in nutrients and higher in refined sugars, flours and fats. These foods are usually loaded with artificial ingredients that can increase CRP levels.

  • Avoid highly processed foods, like fast food, packaged and instant foods.
  • Steer clear of processed meats, like deli-meats, bacon, sausage, hotdogs and pepperoni.
  • Sodas and other sport drinks are to be no go zones.
Balance fatty acids

Omega-3 fatty acids can help protect your body from chronic inflammation. On the other hand, omega-6 fatty acids increase inflammation.

Many Americans are trying to include more omega-3 fatty acids in their diet. But, they’re still eating too much omega-6 fatty acids.

The key is balance, so you’ll take in more omega-3 and less omega-6.

  • Eat foods high in omega-3 fatty acids, such as salmon, tuna, halibut, flaxseeds, chia seeds, walnuts, pecans and avocado.
  • Use oils high in omega-3, such as olive and canola.
  • Avoid or limit oils high in omega-6, such as corn, sunflower, peanut and soybean.
  • Read the ingredients on packaged foods. Limit foods made with refined vegetable oils high in omega-6. You’ll find these oils in most snack foods, cookies, crackers and sweets.

Reduce consumption of red meat

Eating too much red meat, like pork, beef, lamb, deer and buffalo, can increase your cancer risks. Try to limit red meat to 18 oz. or less each week to keep your cancer risks low.

The experts suggest replacing red meat with these high protein foods to help reduce chronic inflammation.

  • Choose animal proteins, such as skinless chicken, turkey and fish.
  • Replace animal proteins with plant proteins, such as beans and lentils, at some meals.
  • Choose meat, milk, cheese and eggs from pasture-raised and hormone-free animals.

Eat more fermented foods

Fermented foods such as yogurt, sauerkraut and miso contain probiotics that help reduce inflammation. To get the most health perks, eat at least one small serving of a fermented food each day.

  • Choose low-fat, plain organic yogurt and kefir.
  • Try fermented vegetables, such as sauerkraut and kimchi, with a sandwich or salad.
  • Enjoy a cup of miso soup or kombucha tea.

Foods that help prevent cancer also help reduce chronic inflammation, and vice-versa. So, following these guidelines will ultimately reduce your risk of a variety of chronic diseases, and improve your quality of life.

If you’re concerned you have chronic inflammation, speaking to doctor Dalal Akoury will be very helpful to you to unlock all the problems going through your mind. Doctor Akoury is an expert of more than two decades and has transformed many people’s lives through effective treatment which is precise and direct to the last solution. Remember that inflammation may not be friendly to you at all and so scheduling for an appointment the doctor Akoury is the best you can do for yourself, your family and even to the extended family.

Inflammation, Cancer and health – Why your diet is important

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Magnesium Depletion and Chronic Diseases

Magnesium Depletion and Chronic Diseases

The metabolism of carbohydrates and fats to produce energy (which includes ATP production) requires numerous magnesium-dependent chemical reactions. Magnesium is also required for a number of steps during DNA and RNA synthesis. Glutathione, an important antioxidant, requires magnesium for its production.

If that makes you think magnesium is such an essential metal then there is a host of more surprises for you. Magnesium is truly an essential mineral that your body requires for maintaining its normal nerve and muscles function. Magnesium helps keep the body’s immune system healthy. It is also essential in maintaining your heart rhythm and is necessary for the building of strong bones.

In addition, Magnesium is involved in a minimum of 300 biochemical reactions in the human body. This means that a deficiency in magnesium compound can lead to a wide range of disorders including muscle spasms, diabetes, heart disease, high blood pressure, migraines, anxiety disorders, cerebral infarction and even osteoporosis.

A deficit in magnesium also referred to as magnesium depletion is caused as a result of dysregulation of the state of magnesium in the body. This is the result of dysregulation of the mechanisms that control the metabolism of magnesium. These could occur in the form of a failure of these mechanisms causing magnesium homeostasis. It could also be as a result of intervention of iatrogenic or endogenous factors which eventually disturb the magnesium status.

Some studies observe that this depletion cannot be corrected simply by nutritional supplementation alone. Rather, certain specific dysregulation correction mechanisms are crucial in remedying the condition.

Magnessium_Deficiency

Magnesium depletion should be clearly differentiated from magnesium deficiency in the body. Deficiency is a disorder of magnesium that simply results from an inadequate intake of the mineral in the diet. An oral magnesium supplementation is recommended and is enough to correct the disorder.

High Risk Groups For The Magnesium Disorder

There are certain groups of people that are more vulnerable to the magnesium related disorders given its primacy in a number of body processes. Studies have identified long distance athletes as a potentially high risk group with regard to magnesium deficiency. These are people who conduct strenuous long distance exercise. They tend to lose electrolytes through their sweat and need to replenish their essential minerals such as sodium, phosphorus and potassium, but most particularly magnesium levels.

People who drink a lot of alcohol may also need adequate replenishing of magnesium lost during dehydration. Those who suffer diarrhea as well as others who may be dehydrated through other means also need to replenish their magnesium levels as well as the levels of sodium metal, potassium and phosphorus.

The elderly and those who have poor functioning kidneys may be subject to loss of magnesium through urine. This happens when the kidneys cannot retain the magnesium in the blood or reabsorb it through its tubules resulting in dysregulation of this essential mineral. Consequently the person’s system will not be excreting less magnesium when the mineral stores are low. In addition, the elderly naturally need the mineral since the amount of magnesium absorbed by the body decreases with old age as the amount excreted increases.

If you have any form of gastrointestinal disorders, chances are that your colon will not be able to absorb enough of the mineral. Most magnesium in the gut is often absorbed through the large intestines. This means that people with gastrointestinal disorders such as Crohn’s disease are faced with the risk a possible magnesium deficiency.

The same goes for those who consume high amounts of Fiber. The bodies’ ability to make use of magnesium has been found to be affected by taking in a lot of fiber in the diet. The ratio of this effect is yet to be established through further research. Still on the question of diet, low protein consumption is also said to have an effect on magnesium in the body.

Magnesium Sources

magnesiumMagnesium is found in a number of food products that can be found readily in the market. Foods high in magnesium include nuts, dark leafy greens, seeds, beans, fish, bananas, whole grains, dried fruit, avocados, yogurt and dark chocolate. This is however not the entire list of foods rich in magnesium. There are a lot of other products that contain magnesium in large amounts. These can be found at AwareMed. In fact, AwareMed is the best place where you can purchase magnesium.

Consuming too much magnesium may typically be dangerous and can make you diarrhea. This is why AwareMed emphasizes having the magnesium chelated.

Nuts, dark chocolate, molasses and seeds are high calorie foods and good sources of magnesium. They should thus be eaten in moderate amounts by those who have high body mass index (BMI).

Other sources of magnesium such as almonds, dark chocolate and spinach are rich in oxalates and these inhibit the absorption of some magnesium. The foods are however still good sources of the metal.

Noteworthy is, Brazil nuts are a rich source of selenium. Too much selenium may lead to unfavorable conditions like bad breath, diarrhea and even loss of hair.

The following factors may affect magnesium absorption

Absorption of the mineral may be enhanced by taking diet rich in fermentable carbohydrates such as those found in dairy, grains and fruits. Protein foods also may help with the absorption of magnesium while eating foods that are high in insoluble fiber is likely to deter magnesium absorption.

Grains, vegetables and seeds may contain phyrates that somewhat deter the absorption of magnesium. On the contrary, the soluble fiber as well as the fermentable carbohydrates that are found in the same foods are likely to counter this effect. This makes most plant foods a powerful source of magnesium.

Magnesium Depletion and Chronic Diseases

 

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Shared Medical Appointment: An Innovative Practice Model

Shared Medical Appointment: An Innovative Practice Model

A visit to a physician can always be such a tense moment. This is often characterized with a lot of anxiety and high expectations on the part of the patient. As a patient you want to get well. Yet you are also torn between the desire to get well and the fear of negative outcomes. It is usually worse with chronic conditions such as diabetes, heart conditions, asthma and ulcers.

It is based on such considerations and a hoard of others that it becomes necessary for the medical practitioner to adopt a method or initiate one that is more likely to make the medical appointment a less excruciating experience.

If the practitioner is able to turn the tension of the moment into a fun filled experience then it is a definite straight up success. It is not just the victim who enjoys the benefit of the experience with the medic, rather, the medical expert also stands to derive considerable gratification from handling a satisfied patient. No palm wetting, no forehead sweats; just a cool and non-tense exchange between a medic and his or her patient.

Impetus for the shared medical appointment approach

The shared medical appointment can be said to be resulting from the above line of considerations, to make the experience a natural process.

This shared medical appointment model, also referred to as group visits, cluster visits or problem solving drop-in group medical appointments (DIGMA) has been orchestrated with the core objective of inspiring the medical practitioner to come up with, implement and appraise shared medical appointments chiefly for patients with diabetes.

The model is basically an innovative approach that has a distinctly different methodology as opposed to the usual diabetes education classes. It involves a group of 12 to 16 patients meeting up with a doctor, medical assistant, behaviorist, nurse, and dedicated documenter for a time period of one and a half hours.

The traditional diabetic classes on the other hand usually address self-management techniques, the question of exercise and recommended nutrition for these patients. The group visits provide medical evaluation, the coordination and provision of precautionary services, mechanisms of adjusting medication, all which often miss in the ordinary diabetic classes.

The model succeeds in its conception as being innovative since it is found to improve the care offered to conventional patients of chronic disorders which primarily include diabetes as well as asthma, coronary disease, and urological conditions by aiding the use of available resources far more efficiently.

shared-Medical-appointments

The majority of successful shared medical appointment programs have included an element of case management and between-visit care coordination. The program is traditionally headed by a nurse, a physician or nurse practitioner.

If you set up a limited component of care management for group of patients who attend the programs of these cluster visits the program can be quite a useful step toward a wider use of care coordination within your field of practice.

A patient of diabetes may use these shared medical appointment programs in the place of a primary care or they can as well alternate the two sets of care arrangements: group visits and the one-on-one care units.

Other than the group education services typically offered in group visits, collective problem-solving, focused secluded or partially private health evaluations which allow for personalized medication adjustment; the programs may also involve ordering of referrals and preemptive services.

The sessions may always vary. They may go from one hour to even several hours depending with the physician-patient arrangements. Each session may have a varied number of attendees, with the typical maximum being 20 persons.

Benefits of the Group Visits Model

shared-medical-appointment Past medical records have indicated that patients generally enjoy interacting in a shared form of environment. There are less cases of tension associated with medical situations and this can always provide a lot of encouragement to those who attend the sessions while providing them with essential tips that may not be received in a short medical visit.

Physicians also benefit from the change of pace typical of these programs and have a chance to innovatively and much more thoroughly attend to the matters presented by chronic disorders which are common in most of the primary care circumstances.

Evaluations of the shared medical appointments have also reported a general increase in satisfaction levels of the patients and clinicians along with improved quality of care offered in the cluster situations. There have also been a reduction in the aggregate emergency section and specialist visits by these patients. This indicates a general possibility of increased perfection in following the directions provided during the sessions.

What makes the cluster visits even more beneficial is the communal environment created by the group approaches. Patients are able to share experiences freely and feel relieved by the existence of certain critical but shared experiences. It is human nature that you feel better when you know that you are not alone in your situation. Just the environment alone, the sight of many people supposedly in for the same course is enough to relax a patient’s nerves.

The patients attending the sessions are able to share their concerns collectively and get responses. This may help in two different ways. A patient who is either shy or simply unwilling to ask a pressing question may benefit from another patient asking the same. Secondly, a patient may get response to a question that he or she might have forgotten to ask the nurse or the physician in attendance. In general, the patients learn from the healthcare team in session, from one another as well as from the environment itself.

About the doctor

Dr. Dalal Akouri has years or experience attending to patients with various life threatening chronic illnesses and is proud to have improved the lives of such patients. You too can join this vast community of patients who have seen the fruits of her work by contacting het today.

Shared Medical Appointment: An Innovative Practice Model

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Skin Care Tips During Winter Season and Beyond

Winter Skin Care Tips – The Type of Skin You Want All Round

Skin care

Oh dear it is winter again, what plans do you have for your skin care? Winter Skin Care Tips on this link are available to help you keep your skin healthy.

Whereas we have seasons in the calendar year, the good health of our skin should not be pegged on the changes that happen within the seasons of the year. The health of your skin must be observed continuously irrespective of the season, however because of the many pollutions and human degradation of the nature, these seasons come with certain changes which necessitate us to be prepared if we have to sustain the good kooks on our largest organ and the general well-being of our health. We are therefore going to look at certain elements we have to embrace for the sustainability of our good look and especially during winter season. It is true that for many people, the cold clear days of winter bring more than just a rosy glow to the cheeks. They also bring uncomfortable dryness to the facial skin, hands, and feet. For some people, the problem is worse than just a general tight, dry feeling since their skin get so dry resulting in flaking, cracking, even eczema (in which the skin becomes inflamed).

During winter the weather is very cold and often people worm their houses artificially in most cases. This practice of worming indoors has some negative effects on the skin, in fact the heat emanating from the system causes the skin to dry out. The source of your heat in this case is secondary so whether you’re using oil, wood, or electricity as fuel doesn’t really counts. The bottom line is that the skin gets dry. The dryness of the skin and other effects need to be corrected and this can be done professionally at the home of solutions. The home of solution is AWAREmed Health and Wellness Resource Center a health facility founded by doctor Akoury purposely to transform each individual’s life through increasing awareness about skin care and general health and wellness and by empowering individuals to find their own inner healing power. Her practice focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. In her many decades of practice, doctor Akoury has succeeded in producing positive testimonies across the globe by patients who have passed through her care. You can be one of them if only you can schedule for a one on one appointment with her today. Meanwhile the following are some of the skin care tips for boosting your winter skin care regimen, so that your skin remains moist and healthy through the winter seasons.

Involvement of Specialist

The skin is such a delicate organ and you cannot opt for self-medication, it never advisable to buy skin care products across the counter instead visiting a skin care professional like a dermatologist would be most appropriate. The professionals will be able to examine your skin type, determine your current skin care regimen, and give you advice on the skin care products you should be using. You may be worried of the cost of the likely product to be prescribed; good products will always work effectively irrespective of the cost. Most of the expensive products are so because of their packaging and marketing values, however what is important is how your skin responds to the product and how you like its feel, not how much money you paid for it.

Moisturize periodically

Like I mentioned before different seasons come with different challenges and needs for your skin care, therefore changing the products you used in spring or summer may be necessary when you get to winter and vice versa. It is therefore very important that you find an ointment” moisturizer that’s oil-based, rather than water-based, as the oil will create a protective layer on the skin that retains more moisture than a cream or lotion. Nonetheless consult with the experts on your choice of skin care products because not all oils are appropriate for the face. The family of non-clogging oils like avocado oil, mineral oil, primrose oil, or almond oil is most appropriate. However you may also go for lotions containing humectants a class of substances (including glycerine, sorbitol, and alpha-hydroxy acids) that attract moisture to your skin.

Sunscreen

No, sunscreen isn’t just for summertime. Winter sun combined with snow glare can still damage your skin. Applying a broad-spectrum of sunscreen on your face and your hands (if they’re exposed) about 30 minutes before going outside. Do this periodically if you stay outside a long time.

Support your Hands

Remember that the skin on your hands is thinner than on most parts of the body and has fewer oil glands. It therefore becomes harder to keep your hands moist, especially in cold, dry weather. This can lead to itchiness and cracking. It is advisable to wear gloves when you go outside and if you need to wear wool to keep your hands warm, slip on a thin cotton glove first, to avoid any irritation the wool might cause.

Hook Up the Humidifier

Central heating systems (as well as space heaters) blast hot dry air throughout our homes and offices. Humidifiers get more moisture in the air, which helps prevent your skin from drying out. Place several small humidifiers throughout your home; they help disperse the moisture more evenly.

Hydration

It is always said that water is life and so drinking plenty of water helps your skin stay youthful. Water is good for your overall health and the skin of someone who is severely dehydrated will benefit from fluids. But the average person’s skin does not reflect the amount of water being drunk.

Grease up Your Feet

Yes, those minty foot lotions are lovely in the hot summer months, but during the winter, your feet need stronger stuff. Try finding lotions that contain petroleum jelly or glycerine instead. And use exfoliates to get the dead skin off periodically; that helps any moisturizers you use to sink in faster and deeper.

Pace the Peels

If your facial skin is uncomfortably dry, avoid using harsh peels, masks, and alcohol-based toners or astringents, all of which can strip vital oil from your skin. Instead, find a cleansing milk or mild foaming cleanser, a toner with no alcohol, and masks that are deeply hydrating rather than clay-based, which tend to draw moisture out of the face. And use them a little less often.

Finally the skin needs to be protected from all the harms of the weather and seasons. You need more knowledge to overcome any challenge that may come with the changes in seasons and that why professionals like Dr. Akoury are readily available to help you keep that desired youthful looking skin, call doctor Akoury today and begin a life of perfect skin complexion with perfect skin care products.

Winter Skin Care Tips – The Type of Skin You Want All Round

 

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Thiamine Before Glucose Always For Alcohol Addiction

Thiamine before Glucose Always For Alcohol Addiction

Alcohol addiction has become chains of slave to many and economies are crippled because of this societal vice that has made many people incapable of even fending for themselves. Unfortunately alcoholism is not very easy to quit especially without professional help. Many people who try to stop alcoholism have to give in to the cravings for alcohol. Some may also be pulled back into alcoholism due to the withdrawal symptoms that may be hard to deal with. However hard dealing with alcohol addiction can be, there are numerous ways that medics can use to help an addict break the chain of addiction. One of the most important factors that will determine whether the addict will succeed in the fight against addiction is the willingness and commitment of the addict to put up with every advice of the doctors. One of the methods that doctors will use to help an addict is the use of thiamine.

Alcohol-Addiction

What is thiamine?

Thiamine or Thiamin also known as Vitamin B1 is a water-soluble vitamin of the B complex. This vitamin is needed so that our bodies can use carbohydrates as energy. It is a necessity for glucose metabolism. Thiamine also plays an important role in nerve, muscle and heart function.

Thiamine is found in many foods such as yeast, cereal grains, beans, nuts, and meat. It is part of vitamin B vitamins with which it is often used in making vitamin B complex products. Vitamin B complexes generally include vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin/niacinamide), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), vitamin B12 (cyanocobalamin), and folic acid.

There are situations when a person will require to take Thiamine, thiamine deficiency syndromes such as beriberi and neuritis that may arise during pregnancy require supplementation of thiamine. It is also used to treat digestive problems which may include ulcerative colitis, diarrhea and even poor appetite.

This vitamin has many uses, some of its uses include; it is used in vision problems like cataracts, it is also used by HIV patients as an immune booster, used in treating brain damage and in prevention of cervical cancer. It can still be used to enhance learning abilities and to enhance positive mental attitude. It also increases energy and is also useful in preventing memory loss.

Despite its many uses thiamine is widely used in treating a memory disorder known as Wernicke’s encephalopathy syndrome. However it has been found to be effective in fighting alcoholism which in itself is an indication of thiamine deficiency.

Alcoholism and glucose

Excessive consumption of alcohol is harmful to your health is a phrase that many people are familiar with. However many people do not know how it harms your health. To begin with addiction to alcohol lowers blood sugar level and that means there is energy deficiency. This is because the majority of alcohol metabolism takes place in the liver, which is also the primary location of glucose production. Because of this, alcohol intake can interfere with the liver’s production of glucose and may cause hypoglycemia to correct this situation there is need for glucose supplementation to restore energy levels. One of the ways through which the levels of energy can be increased in a person addicted to alcohol is to break down carbohydrates to release energy. Even if glucose can be supplied through other means there is something that is still needed to help the person break the glucose to release energy and that is where thiamine comes in. thiamine is necessary for glucose metabolism and so it is vital to supplement thiamine before supplementing glucose in a person addicted to alcohol.

Thiamine and alcohol addiction

Why it is necessary to give thiamin before glucose

The biological pathways will become unregulated when there are nutritional deficiencies. In this case the precursors of ATP production like glucose will be rapidly used by the cells. However there will be an inability by previously produced enzymes to help in the process of glycolysis to help in utilization of glucose so that ATP can be produced in normal levels. This will cause a backup in the system as a result of accumulation of intermediate products in the pathways. When this happens ATP will not be produced adequately, it will also cause accumulation of pyruvate which is the result of continued glycolysis, the pyruvates will be converted to lactic acid by the cells after failing to enter the TCA cycle. This is done to maintain glycolysis by generation of NAD+ which is necessary for generation of 2 ATP3. Therefore when you feed the cells more glucose without supplementing the needed thiamin to allow for complete ATP generation you will only increase generation of lactic acid. The acidic conditions, the inability of the pentose pathway to protect the cells from reactive oxygen species that damage the cells and he increased stress in the cells causes cell death or induces apoptosis.

To prevent this cell death it is vital to give thiamine first to enhance the utilization of the glucose supplemented to form ATP and prevent the generation lactic acid that may accelerate cell damage in the brain. In chronic alcoholism the degree of cell damage is high owing to thiamin deficiency. This will cause cognitive impairment as well as poor musculoskeletal coordination. The alcohol addict will risk death when the deficiency in thiamine is too severe. It is however good to note that thiamin deficiency cannot be corrected by single IV administration of thiamin. It will take long to correct the deficiency.

Finally, Here at AWAREmed Health and Wellness Resource Center we are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Thiamine before Glucose Always For Alcohol Addiction

 

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