These diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves (microvascular disease), and large vessel disease involving the heart and blood vessels (macrovascular disease). Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).
Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. [4] It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifestations of this syndrome may include hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein cholesterol (HDL-C), and abdominal obesity. (See Prognosis, Workup, Treatment, and Medication.)
Hypertension results from a complex interaction of genes and environmental factors. Numerous common genetic variants with small effects on blood pressure have been identified[34] as well as some rare genetic variants with large effects on blood pressure.[35] Also, genome-wide association studies (GWAS) have identified 35 genetic loci related to blood pressure; 12 of these genetic loci influencing blood pressure were newly found.[36] Sentinel SNP for each new genetic locus identified has shown an association with DNA methylation at multiple nearby CpG sites. These sentinel SNP are located within genes related to vascular smooth muscle and renal function. DNA methylation might affect in some way linking common genetic variation to multiple phenotypes even though mechanisms underlying these associations are not understood. Single variant test performed in this study for the 35 sentinel SNP (known and new) showed that genetic variants singly or in aggregate contribute to risk of clinical phenotypes related to high blood pressure.[36]
Hypertension develops secondary to environmental factors, as well as multiple genes, whose inheritance appears to be complex. [12, 21] Furthermore, obesity, diabetes, and heart disease also have genetic components and contribute to hypertension. Epidemiological studies using twin data and data from Framingham Heart Study families reveal that BP has a substantial heritable component, ranging from 33-57%. [22, 23, 24]

The word mellitus (/məˈlaɪtəs/ or /ˈmɛlɪtəs/) comes from the classical Latin word mellītus, meaning "mellite"[114] (i.e. sweetened with honey;[114] honey-sweet[115]). The Latin word comes from mell-, which comes from mel, meaning "honey";[114][115] sweetness;[115] pleasant thing,[115] and the suffix -ītus,[114] whose meaning is the same as that of the English suffix "-ite".[116] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.


If you’ve been told that you have metabolic syndrome (sometimes called cardiometabolic syndrome), it means that you have several of these health problems. Together, they put you at much greater risk for heart attack, stroke and type 2 diabetes. In general, someone who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as a person who doesn’t have this grouping of health issues. Unfortunately, amid rising obesity rates in the U.S., this syndrome is becoming more common. Alarmingly, one out of 10 teens may have it.
Over time, a prolonged exposure to high blood sugar can damage the nerves throughout the body — a condition called diabetic neuropathy. Some people may not have any symptoms of the damage, while others may notice numbness, tingling, or pain in the extremities. “At the beginning, [diabetic neuropathy] usually starts in the feet and then it progresses upward,” says Dr. Ovalle. Although most common in people who have had type 2 diabetes for 25 years or more, it can occur in people who have prediabetes as well. In some studies, almost 50 percent of unexplained peripheral neuropathy [in the extremities], whether painful or otherwise, turns out to be caused by prediabetes or diabetes, says Dr. Einhorn.
In most people with established essential hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal.[52] There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.[53] These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age.[53] Whether this pattern is typical of all people who ultimately develop hypertension is disputed.[54] The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles,[55] although a reduction in the number or density of capillaries may also contribute.[56]
Weight loss surgery in those with obesity and type two diabetes is often an effective measure.[14] Many are able to maintain normal blood sugar levels with little or no medications following surgery[95] and long-term mortality is decreased.[96] There is, however, a short-term mortality risk of less than 1% from the surgery.[97] The body mass index cutoffs for when surgery is appropriate are not yet clear.[96] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[98]
Emergency department visits for hypertension with complications and secondary hypertension also rose, from 71.2 per 100,000 population in 2006 to 84.7 per 100,000 population in 2011, while again, admission rates fell, dropping from 77.79% in 2006 to 68.75% in 2011. The in-hospital mortality rate for admitted patients dropped as well, from 1.95% in 2006 to 1.25% in 2011. [37]
You can take additional magnesium if you do not think you’re getting enough in the diet. Dr. Weil recommends magnesium citrate, chelate, or glycinate. Avoid magnesium oxide, which can be irritating, and take half the amount of magnesium as the calcium you take in supplemental form. If you do not take any supplemental calcium, watch out for taking large amounts of magnesium, which can cause diarrhea.
^ Roerecke, Michael; Tobe, Sheldon W.; Kaczorowski, Janusz; Bacon, Simon L.; Vafaei, Afshin; Hasan, Omer S. M.; Krishnan, Rohin J.; Raifu, Amidu O.; Rehm, Jürgen (27 June 2018). "Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies". Journal of the American Heart Association. 7 (13): e008202. doi:10.1161/JAHA.117.008202.

Dietary factors also influence the risk of developing type 2 DM. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[46][47] The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk.[45] Eating lots of white rice, and other starches, also may increase the risk of diabetes.[48] A lack of physical activity is believed to cause 7% of cases.[49]


Push-ups would be another example.  We've all seen the classic push-up form deterioration under fatigued conditions: a sagging, excessively arched lower back; forward head posture; and elbows flaring out.  It's the classic "panic mode" strategy employed by beginners.  However, you never see it in experienced lifters; they'll simply fail before the technique breaks down.  Part of this comes from technical proficiency, but it's also related to the fact that the limiting factor shifts from anterior core stability to upper body strength/endurance as an individual gets more experienced.
A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[66] According to the current definition, two fasting glucose measurements above 7.0 mmol/l (126 mg/dl) is considered diagnostic for diabetes mellitus.

In the US, 84.1 million adults—more than 1 in 3—have prediabetes, and 90% of them don’t know they have it. Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes increases your risk for type 2 diabetes, heart disease, and stroke. But through the CDC-led National Diabetes Prevention Program, you can learn practical, real-life changes that can cut your risk for developing type 2 diabetes by as much as 58% (71% if you’re 60 or older).
According to the American Heart Association (AHA), approximately 86 million adults (34%) in the United States are affected by hypertension, which is defined as a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more, taking antihypertensive medication, or having been told by clinicians on at least 2 occasions as having hypertension. [1] Substantial improvements have been made with regard to enhancing awareness and treatment of hypertension. However, a National Health Examination Survey (NHANES) spanning 2011-2014 revealed that 34% of US adults aged 20 years and older are hypertensive and NHANES 2013-2014 data showed that 15.9% of these hypertensive adults are unaware they are hypertensive; these data have increased from NHANES 2005-2006 data that showed 29% of US adults aged 18 years and older were hypertensive and that 7% of these hypertensive adults had never been told that they had hypertension. [1]
I agree! Isn’t it amazing that, that research already exists?! The reason behind why one diet works for one person and not another is because food is not just a form of calories but it is a message. Different compositions of carbohydrates, fats, protein, additives etc are going to have a different hormonal response. That hormonal response is different in different groups of people. One of the hormones that has been critical to my journey is a hormone known as insulin.
Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80 mmHg.[89] However, evidence supports less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events.[90][91] A 2016 review found potential harm to treating lower than 140 mmHg.[92] Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not.[93] Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.[94]
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.[53] http://www.sandysidhumedia.com/wp-content/uploads/2012/12/clairequote1.jpg
Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more benefits than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important consideration when discussing the choice blood pressure drugs in the metabolic syndrome.

Let’s be real. Metabolic Resistance Training is numero uno for a reason; it’s a nearly perfect method for losing fat. If you’re looking for something more in-depth, Jen Sinkler’s Lift Weights Faster 2 has over 180 metabolic workouts. ONE HUNDRED EIGHTY of them! You’ve got workouts for the next year, and that’s if you train every other day and don’t repeat any.
Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States.[147] Childhood hypertension, particularly in pre-adolescents, is more often secondary to an underlying disorder than in adults. Kidney disease is the most common secondary cause of hypertension in children and adolescents. Nevertheless, primary or essential hypertension accounts for most cases.[148]
High blood pressure is classified as either primary (essential) high blood pressure or secondary high blood pressure.[5] About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors.[5][6] Lifestyle factors that increase the risk include excess salt in the diet, excess body weight, smoking, and alcohol use.[1][5] The remaining 5–10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to an identifiable cause, such as chronic kidney disease, narrowing of the kidney arteries, an endocrine disorder, or the use of birth control pills.[5]
Usually, there are no immediate physical symptoms. Medical problems associated with the metabolic syndrome develop over time. If you are unsure if you have metabolic syndrome, see your healthcare provider. He or she will be able to make the diagnosis by obtaining the necessary tests, including blood pressure, lipid profile (triglycerides and HDL), and blood glucose.

Weight loss surgery in those with obesity and type two diabetes is often an effective measure.[14] Many are able to maintain normal blood sugar levels with little or no medications following surgery[95] and long-term mortality is decreased.[96] There is, however, a short-term mortality risk of less than 1% from the surgery.[97] The body mass index cutoffs for when surgery is appropriate are not yet clear.[96] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[98]
Ariana Shakibinia decided to study public health in large part because she lives with T1D. She had always been interested in public policy, but she says living with this disease has made her more vested in the healthcare conversation. “I am living with what is essentially a pre-existing condition. I’m fortunate enough to have good health insurance, but it makes the potential financial burden of T1D management much more visible and relatable.”
The word mellitus (/məˈlaɪtəs/ or /ˈmɛlɪtəs/) comes from the classical Latin word mellītus, meaning "mellite"[114] (i.e. sweetened with honey;[114] honey-sweet[115]). The Latin word comes from mell-, which comes from mel, meaning "honey";[114][115] sweetness;[115] pleasant thing,[115] and the suffix -ītus,[114] whose meaning is the same as that of the English suffix "-ite".[116] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.
Type 2 diabetes, which is often diagnosed when a person has an A1C of at least 7 on two separate occasions, can lead to potentially serious issues, like neuropathy, or nerve damage; vision problems; an increased risk of heart disease; and other diabetes complications. A person’s A1C is the two- to three-month average of his or her blood sugar levels.

Insulin resistance. Insulin is a hormone that helps your body use glucose -- a simple sugar made from the food you eat -- as energy. In people with insulin resistance, the insulin doesn't work as well, so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.


Dietary changes: The health care provider might recommend a diet that includes more vegetables (especially leafy green vegetables), fruits, low-fat dairy products, and fiber-rich foods, and fewer carbohydrates, fats, processed foods, and sugary drinks. He or she also might recommend preparing low-sodium dishes and not adding salt to foods. Watch out for foods with lots of hidden salt (like bread, sandwiches, pizza, and many restaurant and fast-food options).
High-sensitivity C-reactive protein has been developed and used as a marker to predict coronary vascular diseases in metabolic syndrome, and it was recently used as a predictor for nonalcoholic fatty liver disease (steatohepatitis) in correlation with serum markers that indicated lipid and glucose metabolism.[45] Fatty liver disease and steatohepatitis can be considered as manifestations of metabolic syndrome, indicative of abnormal energy storage as fat in ectopic distribution. Reproductive disorders (such as polycystic ovary syndrome in women of reproductive age), and erectile dysfunction or decreased total testosterone (low testosterone-binding globulin) in men can be attributed to metabolic syndrome.[46]
14 November 2018. On World Diabetes Day 2018, WHO joins partners around the world to highlight the impact diabetes has on families and the role of family members in supporting prevention, early diagnosis and good management of diabetes. More than 400 million people live with diabetes worldwide, and the prevalence is predicted to continue rising if current trends prevail. Diabetes is a major cause of premature dying, blindness, kidney failure, heart attack, stroke and lower limb amputation. It was the seventh leading cause of death in 2016.
With self-limiting exercises, fatigue stops you from completing a rep before your technique can break down.  A perfect example would be sled pushing or dragging.  It's virtually impossible to have technique break down with these exercises, especially in a trained athlete, and even under considerable loading.  And, I can't say that I've ever seen anyone injured while using a sled.
Obstructive sleep apnea (OSA) is a common but frequently undiagnosed sleep-related breathing disorder defined as an average of at least 10 apneic and hypopenic episodes per sleep hour, which leads to excessive daytime sleepiness. Multiple studies have shown OSA to be an independent risk factor for the development of essential hypertension, even after adjusting for age, gender, and degree of obesity.

I think it's better to look at total work than just reps in a given set, as not all drills are created equal.  For example, if you do a barbell complex consisting of five snatches, five cleans, five front squats, five barbell rows, and five deadlifts, you've done a ton more work than if you just did 25 medicine ball throws.  The loading capabilities are greater with the barbell complex, and the bar travels over a greater distance.  Since work equals force times distance, it's a more powerful stimulus than the medicine ball throws.


Hypertension is a worldwide epidemic; accordingly, its epidemiology has been well studied. Data from National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014 in the United States found that in the population aged 20 years or older, an estimated 86 million adults had hypertension, with a prevalence of 34%. [1] Hypertension affects US men and women nearly equally, affecting an estimated 40.8 million men and 44.9 million women. [1]
Formal guidelines for measuring blood pressure state that it should be measured in a quiet, warm environment after you have been sitting restfully for at least five minutes. You should not have had coffee or used tobacco for at least 30 minutes. At least two blood pressure measurements should be taken under these conditions at least five minutes apart. This should be repeated until the measurements agree to within 5 mmHg.
Physical inactivity is a predictor of CVD events and related mortality. Many components of metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue (predominantly central); reduced HDL cholesterol; and a trend toward increased triglycerides, blood pressure, and glucose in the genetically susceptible. Compared with individuals who watched television or videos or used their computers for less than one hour daily, those who carried out these behaviors for greater than four hours daily have a twofold increased risk of metabolic syndrome.[27]
Physical inactivity is a predictor of CVD events and related mortality. Many components of metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue (predominantly central); reduced HDL cholesterol; and a trend toward increased triglycerides, blood pressure, and glucose in the genetically susceptible. Compared with individuals who watched television or videos or used their computers for less than one hour daily, those who carried out these behaviors for greater than four hours daily have a twofold increased risk of metabolic syndrome.[27]
A sustainable exercise program, for example 30 minutes five days a week is reasonable to start, providing there is no medical contraindication. (If you have any special concerns in this regard, check with your doctor first.) There is a beneficial effect of exercise on blood pressure, cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus, exercise in itself is a helpful tool in treating metabolic syndrome.
There are some interesting developments in blood glucose monitoring including continuous glucose sensors. The new continuous glucose sensor systems involve an implantable cannula placed just under the skin in the abdomen or in the arm. This cannula allows for frequent sampling of blood glucose levels. Attached to this is a transmitter that sends the data to a pager-like device. This device has a visual screen that allows the wearer to see, not only the current glucose reading, but also the graphic trends. In some devices, the rate of change of blood sugar is also shown. There are alarms for low and high sugar levels. Certain models will alarm if the rate of change indicates the wearer is at risk for dropping or rising blood glucose too rapidly. One version is specifically designed to interface with their insulin pumps. In most cases the patient still must manually approve any insulin dose (the pump cannot blindly respond to the glucose information it receives, it can only give a calculated suggestion as to whether the wearer should give insulin, and if so, how much). However, in 2013 the US FDA approved the first artificial pancreas type device, meaning an implanted sensor and pump combination that stops insulin delivery when glucose levels reach a certain low point. All of these devices need to be correlated to fingersticks measurements for a few hours before they can function independently. The devices can then provide readings for 3 to 5 days.
It has not been contested that cardiovascular risk factors tend to cluster together; the matter of contention has been the assertion that the metabolic syndrome is anything more than the sum of its constituent parts. Phenotypic heterogeneity (for example, represented by variation in metabolic syndrome factor combinations among individuals with metabolic syndrome) has fueled that debate. However, more recent evidence suggests that common triggers (for example, excessive sugar-intake in the environment of overabundant food) can contribute to the development of multiple metabolic abnormalities at the same time, supporting the commonality of the energy utilization and storage pathways in metabolic syndrome.
Health care providers measure blood pressure with a sphygmomanometer (sfig-mo-muh-NAH-muh-ter), which has a cuff that's wrapped around the upper arm and pumped up to create pressure. When the cuff is inflated, it squeezes a large artery in the arm, stopping the blood flow for a moment. Blood pressure is measured as air is gradually let out of the cuff, which allows blood to flow through the artery again.

While the lipid abnormalities seen with metabolic syndrome (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise, drug therapy is often required. Treatment should be aimed primarily at reducing LDL levels according to specific recommendations. Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made. Successful drug treatment usually requires treatment with a statin, a fibrate drug, or a combination of a statin with either niacin or a fibrate.
Glucagon is a hormone that causes the release of glucose from the liver (for example, it promotes gluconeogenesis). Glucagon can be lifesaving and every patient with diabetes who has a history of hypoglycemia (particularly those on insulin) should have a glucagon kit. Families and friends of those with diabetes need to be taught how to administer glucagon, since obviously the patients will not be able to do it themselves in an emergency situation. Another lifesaving device that should be mentioned is very simple; a medic-alert bracelet should be worn by all patients with diabetes.

^ Sacks, F. M.; Svetkey, L. P.; Vollmer, W. M.; Appel, L. J.; Bray, G. A.; Harsha, D.; Obarzanek, E.; Conlin, P. R.; Miller, E. R. (2001-01-04). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. ISSN 0028-4793. PMID 11136953.
^ Jump up to: a b Burt VL, Cutler JA, Higgins M, et al. (July 1995). "Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991". Hypertension. 26 (1): 60–69. doi:10.1161/01.HYP.26.1.60. PMID 7607734. Archived from the original on 2012-12-20. Retrieved 5 June 2009.

Just briefly I want to mention something for the more savvy readers out there. Many, who are well versed in metabolism, will immediately point out that if you lose weight, then of course you are going to be burning less calories because you have less body tissue. True. But what research shows, and my clinical experience validates, is that the reduced rate of metabolic output goes far beyond what would be predicted from loss of fat mass or muscle mass.
The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was unpopular.[152] Several other agents were developed after the Second World War, the most popular and reasonably effective of which were tetramethylammonium chloride, hexamethonium, hydralazine, and reserpine (derived from the medicinal plant Rauwolfia serpentina). None of these were well tolerated.[159][160] A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was chlorothiazide, the first thiazide diuretic and developed from the antibiotic sulfanilamide, which became available in 1958.[152][161] Subsequently, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and renin inhibitors were developed as antihypertensive agents.[158]

From another perspective, hypertension may be categorized as either essential or secondary. Primary (essential) hypertension is diagnosed in the absence of an identifiable secondary cause. Approximately 90-95% of adults with hypertension have primary hypertension, whereas secondary hypertension accounts for around 5-10% of the cases. [9] However, secondary forms of hypertension, such as primary hyperaldosteronism, account for 20% of resistant hypertension (hypertension in which BP is >140/90 mm Hg despite the use of medications from 3 or more drug classes, 1 of which is a thiazide diuretic).
Emerging data suggest an important correlation between metabolic syndrome and risk of stroke. [58] Each of the components of metabolic syndrome has been associated with elevated stroke risk, and evidence demonstrates a relationship between the collective metabolic syndrome and risk of ischemic stroke. [59] Metabolic syndrome may also be linked to neuropathy beyond hyperglycemic mechanisms through inflammatory mediators. [60]
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