What is Functional Medicine – And Is It The Answer To Our Growing Health Crisis?

Over the past 25 years, there has been an explosion in chronic disease. Diabetes, cardiopulmonary dysfunction, autoimmune disease, dementia, depression and anxiety. Many times, after years of unknowingly abusing our bodies, we find ourselves sitting in a doctor’s office with symptoms like chronic pain and fatigue, numbness or tingling, difficulty breathing, or maybe even chest pain. We are likely to leave the office after a short consultation with a few new pills that have a multitude of unpleasant side effects, possibly worse than the initial complaint. We are told to take the pills everyday for the rest of our lives, and if we are lucky, receive a vague mention about diet and lifestyle.

Photo by Gabriel Gurrola

What is Functional Medicine – And Is It The Answer To Our Growing Health Crisis?

By Kyla Jacobo, DPT

Over the past 25 years, there has been an explosion in chronic disease. Diabetes, cardiopulmonary dysfunction, autoimmune disease, dementia, depression and anxiety. Many times, after years of unknowingly abusing our bodies, we find ourselves sitting in a doctor’s office with symptoms like chronic pain and fatigue, numbness or tingling, difficulty breathing, or maybe even chest pain. We are likely to leave the office after a short consultation with a few new pills that have a multitude of unpleasant side effects, possibly worse than the initial complaint. We are told to take the pills everyday for the rest of our lives, and if we are lucky, receive a vague mention about diet and lifestyle.

Fast forward a few years, we are again sitting in our doctor’s office, having religiously taken the prescription pills everyday. Not only have our symptoms worsened, but we now have a host of new problems from the havoc the meds have wreaked on our bodies. After exhausting all options, such as increasing medication doses, receiving injections, modifying functional activities, etc., we are told it is now time for surgery.

As a practicing Physical Therapist for the past 12 years, I have seen this story replay over and over. Our medical system is phenomenal at treating infections, wounds, trauma, and other acute conditions. Many lives have been saved by skilled physicians and surgeons. However, when it comes to chronic disease, our medical system is severely lacking. A patient is diagnosed with a chronic disease, given some pills, and then waits for the inevitable, long-term sequelae of that disease.

Many people accept it as a part of life…almost joke about it as if their disease was a trophy symbolizing a life well-lived. 

“I guess my parts are just wearing out.”

“Who ever said these years are the golden years…?”

“Bacon on a donut…yes, please!”

Society has normalized gluttony and overindulgence, making every meal a celebratory feast, one in which our ancestors experienced once a year. Advancements in technology have led to the invention of processed, food-ish substances that are unhealthy and addictive. Our children are growing up thinking Fruit Snacks are actually made of fruit. That soda is hydration. And that chronic disease and suffering is a part of the natural aging process.

But that is a fallacy. 

“A long, healthy life is no accident. It begins with good genes, but it also depends on good habits.”  – Dan Buettner, author of The Blue Zones.

In his book, The Blue Zones, Dan Buettner describes five places in the world that have a high number of centenarians. After visiting these places, meeting the locals, and conducting interviews, Buettner discovers commonalities between what he calls The Blue Zones. According to his book, good health boils down to a few lessons that can be extracted from these cultures, which revolve around food, exercise, and community. Most importantly, he proposes a framework for living a long and healthy life.  He shows us that we don’t all need to be fat, sick, and dying by the time we reach our sixties.

So…is there really another way to cure and prevent disease?

Hippocrates had it right when he said, “let food be thy medicine and medicine be thy food”. Food is truly the best medicine. Not only have we strayed from using it medicinally, but food has now become a source of the problem. Food-ish substances, sugar, pesticides, and the lack of nutrients in our diets are leading to an explosion of disease, especially in those who subscribe to the Standard American Diet. Our lives have become void of the colorful, fibrous, nutrient-rich fruits and vegetables that fuel our cells, stave off disease, and promote a long, healthy life.

This is where Functional Medicine comes in…

What is Functional Medicine?

Functional Medicine is a whole system approach to identifying and addressing the root cause of disease and dysfunction. Instead of breaking up each individual organ into medical specialties, Functional Medicine views the body as an integrated system, with each system affecting the others. When one or more of these systems is impaired, an array of conditions can manifest themselves in the body. For example, what may present in one person as thyroid disease, may present in another as diabetes, both stemming from a similar root cause. 

Genetics play an important role in determining which conditions manifest themselves and why. Every person has a unique set of genes, each of which can be switched on or off, depending on lifestyle and environmental factors. Functional Medicine practitioners use simple laboratory tests to determine genes that may predispose people to certain conditions, as well as which genes need to be switched on or off in order to promote optimal health. Diet and lifestyle, along with individualized supplementation, can highly influence the expression of genes and profoundly affect our health.

Functional Medicine can benefit everyone, from those suffering from chronic disease, to those wanting to have a more vibrant, healthful life. This approach to health is not about treating a disease, it is about creating health, which will in turn eliminate disease. 

What conditions can Functional Medicine address?

  • Diabetes
  • Heart Disease
  • Thyroid Disease
  • Estrogen Dominance
  • Autoimmune Disease
  • Gastrointestinal Conditions
  • Weight Loss
  • Chronic Pain
  • Depression and Anxiety
  • ADHD
  • Autism
  • Allergies
  • Athletic Performance and Recovery

What can I expect in a Functional Medicine evaluation?

Functional Medicine practitioners typically spend 60-90 minutes, which is significantly longer than a visit with your primary care physician. The extra time allows the practitioner to obtain a thorough history, evaluate your physical condition, and determine your specific goals. Again, Functional Medicine views the body as a whole, which requires a review of all the systems. This will include a discussion about diet and lifestyle, stressful life events, and exposure to environmental toxins. 

During the evaluation, you should also expect a discussion of recommended laboratory tests required to determine the appropriate course of treatment.

What type of treatment is available? 

Once you have received your laboratory results, the Functional Medicine practitioner can then prescribe the appropriate treatment. Common protocol for all patients includes a clean, healthy diet, improving gut health, reduction of stress, encouraging daily exercise, and ensuring adequate sleep. More individualized recommendations include supplements and specific foods that will introduce the vitamins and minerals that are lacking in your body. An elimination diet may be appropriate for those with specific food allergies or sensitivities.

The goal of Functional Medicine is to promote a healthy environment where disease is unable to thrive. However, when acute disease does present itself, it may be appropriate to consult your primary care physician to determine if medical treatment is necessary. In some cases, the holistic treatment approach may also be used in conjunction with medical treatment in order to improve quality of life. 

In the case of chronic diseases, many people have been disappointed in allopathic medicine’s ability to treat and/or cure the disease. They are seeking out other forms of treatment and are often desperate to try anything, or even worse, they have accepted the fact that they will live with this chronic disease the rest of their lives. While Functional Medicine may require more time and money up front, the investment is well worth it in the long run. 

There is hope for chronic disease.

The answer may be as close as your dinner table. 

Losing Weight Is A Hustle: Here are 10 Ways to Boost Your Weight Loss Efforts

Weight loss…it’s not easy.

Thousands of books have been published on this topic. A variety of supplements and weight loss pills have been marketed, all claiming to be the one thing to get you looking great in that bikini. But most of these promises fall short. Why? Because weight loss is a hustle.

Photo by i yunmai

Losing Weight Is A Hustle: Here are 10 Ways to Boost Your Weight Loss Efforts

By Kyla Jacobo, DPT

Weight loss…it’s not easy. 

Thousands of books have been published on this topic. An array of supplements and weight loss pills have been marketed, all claiming to be the one thing to get you looking great in that bikini. But most of these promises fall short. Why?  Because weight loss is a hustle.

Have you ever seen someone trying to start a business or boost their marketing efforts in an attempt to increase their sales? It’s often referred to as a hustle. Why? Because it’s not easy. It takes a lot of work, determination, and commitment. A person who sleeps late, goes out socializing every night, and only puts a few hours of work in each day is not likely to build a successful company. 

The same goes for weight loss!

As a person who has struggled with weight loss throughout my life, I can attest to the many challenges and frustrations that go along with dropping a few pounds. But the bottom line is…I can only lose weight if I work at it. Work hard at it. It’s a hustle! It means waking up an hour earlier to get that workout in. It means making quinoa and spinach while your family is digging into Chinese takeout. And yes, it means that sometimes you have to pass on the chocolate birthday cake with chocolate ganache frosting!

The good news is that, whether you want to lose 5 pounds or 50 pounds, it is totally doable! Stay consistent. Take small steps each day to reach your goal. 

Here are some tips to help you along the way…

10 Ways to Boost Weight Loss

  1. Hydration

Drink water…a lot of water! Water not only helps to flush the toxins from your body, but it also enables your body to metabolize fat. This is crucial if you want to lose weight. Additionally, staying properly hydrated will make your workouts more effective and enjoyable. Drink at least 64 ounces, plus more when you’re exercising. 

  1. Apple Cider Vinegar

Apple Cider Vinegar is a fermented food, which means it is great for your gut. Poor gut health leads to intestinal permeability, which impairs metabolism and has been linked to obesity and insulin resistance. Heal your gut and you might just see those pounds begin to melt away. Mix 1-2 tablespoons of apple cider vinegar with 8 ounces of water, and add honey to taste. Drink daily. 

  1. Processed Foods

Processed foods wreak havoc on our bodies. Eliminate all processed foods (think anything out of a box or bag) for one week and see how you feel. You will likely feel less bloated, more energetic, and even see the numbers on the scale begin to drop. This is also a good way to remove excess sugar from your diet, as most processed foods contain added sugars. 

  1. Vegetables

Vegetables are low in calories and high in nutrients, which make them the perfect food for weight loss. Many weight loss plans involve restriction of calories, leaving people with a feeling of deprivation. If you eat veggies, you can eat as much as you want without feeling guilty. They also help to heal your gut and overtime, lead to feeling fuller and more satiated with less food. 

  1. Estrogen

One sign of estrogen dominance is weight gain, especially in the abdomen, hips, and thighs. High levels of estrogen cue your body to create more fat cells, which leads to storage of more estrogen, thus starting a vicious cycle of weight gain. Hormonal balance may be the missing piece in your weight loss journey.  For more information on how to resolve estrogen dominance, read Estrogen Dominance: The Struggle Is Real

  1. Exercise

We all know that exercise is beneficial and aides in weight loss. But the key is doing the right kind of exercise. There’s nothing more frustrating than exercising everyday, only to step on the scale and find that your efforts have been futile. High intensity interval training, or HIIT, has great benefits for weight loss, including increased metabolism and burning more calories. Ensure you are reaching a moderate level of intensity in order to maximize your weight loss. 

  1. Accountability

One of my favorite ways of holding myself accountable to my exercise program is to sign up for events. Your investment of time and money can vary depending on the type of event, however now you’ve got some skin in the game. Plus, you’re building a community of like-minded people and oftentimes get to travel to exciting places, which makes it more fun. The more fun it is, the more likely you are to continue this new lifestyle.

  1. Habit Trackers

Another way to hold yourself accountable, as well as to track your progress, is to create a habit tracker. This can be done by drawing a grid with the new habit you wish to develop on the side and the days of the week across the top. Simply place an ‘x’ in the box once completed for that day. If you deviate, get back on track quickly. As James Clear says, “never miss twice”. 

  1. Meditation

Mindfulness may not be a go-to strategy for weight loss, however it is effective nonetheless. Daily meditation of 5-10 minutes can make us more mindful of our choices. That short period of time can give us the mental clarity to set intentions for the day and envision the person we wish to become. It can also reduce stress, which is oftentimes a source of mindless eating. 

  1. Get Addicted!

Do you know those people who show up to the gym at 4:00am, rain or shine? Or those people who prepare every meal for exact caloric and nutritional intake? While some addictions can be unhealthy, it is my experience that these types of people are addicted to feeling good. Exercise releases endorphins that elevate our mood. Eating healthy food gives us more energy and zest for life. Why would anyone want to stop feeling that way? So try it…you just might get addicted!

There’s no magic pill. No quick fix. But that’s the beauty of it. The journey is wherein lies growth, challenges, and the confidence to know that you can overcome whatever comes your way. Remember, life is not a destination, it’s a journey. 

Set your goal. Take small steps everyday. You’ve got this!

Whole Wheat Oatmeal Pancakes

Whole Wheat Oatmeal Pancakes

By Kyla Jacobo, DPT

These pancakes are healthy and delicious, packed with nutrients and sweetened with honey. Be sure to use real maple syrup to avoid the high fructose corn syrup in many commercial brands. Recipe below…

1 cup rolled oats
1 1/8 cup milk (I’ve also used almond milk)
Soak oats in milk for 5-10 minutes.
1/2 cup whole wheat flour
2 eggs
2 Tb olive oil
1 Tbsp honey
1 tsp baking powder
1/8 tsp salt

Enjoy!🌱

The Effects of Exercise on Gut Health

So you’re training for a marathon. Participating in a crossfit challenge. Maybe you’ve committed to one of the most difficult endurance events in the world, an Ironman. But will your body be able to handle the increased demand?

The Effects of Exercise on Gut Health

By Kyla Jacobo, DPT

So you’re training for a marathon. Participating in a crossfit challenge. Maybe you’ve committed to one of the most difficult endurance events in the world, an Ironman. But will your body be able to handle the increased demand?

Injury can creep up on you when you least expect it. An easy morning warm-up can result in a pulled calf muscle if you’re not taking proper precautions and allowing your body to recover. There are many things to consider…building an adequate fitness base, proper footwear, regular cross training to avoid overuse injuries and strengthen accessory muscles. 

However, one area of recovery that is often overlooked in a training program is nutrition. Yes, most people ensure adequate protein intake, loading up on all sorts of gooey, gelatin-like substances. But what about healthy, plant-based foods that feed your cells and promote a healthy gut? 

Did you know an unhealthy gut can make you more susceptible to injury?

Research has shown 60 minutes of exercise three times weekly helps to create optimal gut health. However, beyond 300 minutes per week, there are no further benefits and may in fact increase inflammation and immune dysregulation. This can make you more susceptible to injury and illness. 

So, does this mean you shouldn’t train for these challenging events? Not at all…in fact, these events promote an active lifestyle with many healthy side effects. But don’t leave out your gut in the training and recovery process. 

One way to stave off injury is to ensure your natural antioxidant system is working properly. A simple laboratory test can be done to measure your glutathione levels, a substance that plays an important role in gut health and quenches oxidative stress. Some people have a genetic mutation that leads to insufficient production of 5-MTHF, which is responsible for a process called methylation. When the methylation switch is turned off, a number of important molecules cannot be efficiently produced, including glutathione. Fortunately, changes in lifestyle and diet can ameliorate the issue. 

So if you’re training for Ironman or ultra running, be sure to make gut health a part of your recovery by including fermented foods, cruciferous veggies like broccoli and cauliflower, and a daily dose of apple cider vinegar in your diet. 

Remember, fitness does not necessarily equal health. When we place heavy demands on the body, we need to counteract that stress with proper nutrition and sufficient sleep in order to facilitate recovery and reduce risk of injury.

Happy training!

Estrogen Dominance…The Struggle Is Real

P-M-S…

Three letters of the English language that, when combined in the right order, have come to denote such strife. Emotional lability. Fatigue. Bloating. A cyclical time of the month that comes without invitation, often greeted by others with eye rolls, sarcastic jokes, or simply blown off as if “all in our heads”.

Photo by Rodion Kutsaev

Estrogen Dominance…The Struggle Is Real

By Kyla Jacobo, DPT

P-M-S…

Three letters of the English language that, when combined in the right order, have come to denote such strife. Emotional lability. Fatigue. Bloating. A cyclical time of the month that comes without invitation, often greeted by others with eye rolls, sarcastic jokes, or simply blown off as if “all in our heads”. 

The reality is, these symptoms are not as nature intended. Many of these unwelcome symptoms such as anxiety and depression, mood swings, cramping and bloating, breast tenderness, and extreme fatigue that we have come to accept as normal, are in fact products of our environment and lifestyles. Yes, we do have a cycle each month, that is both necessary and beautiful.  But no, we do not need to be inevitably miserable for days or weeks out of the month. 

While PMS symptoms vary in severity, 75% of women have some type of physiological disruption due to their cycle each month. Debilitating conditions associated with menstruation are increasingly common and oftentimes misdiagnosed. This has been of particular interest to me, as I have struggled with symptoms of PMS for the past 20 years. I have researched and experimented, trying everything from supplements to special diets, even diagnosing myself with Premenstrual Dysmorphic Disorder, a condition in which PMS symptoms are even more severe. My physician suggested I try an antidepressant, which I found out was basically the same as Prozac. I was also encouraged to get on birth control pills, as they would balance out my hormones. 

Because I lean towards holistic medicine, I did not try the prescription medications, other than a 3 day trial of birth control which wreaked havoc on my body. Many medications do a poor job of masking the symptoms, while creating a host of side effects and additional imbalances in the body. 

Thus, my search for an answer continued…

That’s when I discovered the concept of Estrogen Dominance. Estrogen Dominance refers to having too much estrogen in the body, creating a hormone imbalance between estrogen and progesterone. We all have estrogen, and we all need estrogen for important functions in our bodies. It’s when these hormones are out of balance that we see health conditions arise. Dr. Elizabeth Bohan, Dr. Mark Hyman, and Dr. Amy Myers are a few of the Functional Medicine practitioners working to increase awareness of this condition and are showing great progress in the evaluation and treatment of these patients.

Symptoms of Estrogen Dominance:

  • Fatigue
  • Weight gain (especially in hips, waist, and thighs)
  • PMS (ie. mood swings, breast tenderness, fluid retention)
  • Fertility problems (according to Dr. Elizabeth Bohan of the Cleveland Clinic, this affects 1 in 7 couples)
  • Decreased libido
  • Depression or anxiety

Associated Health Risks: 

  • Cancer

According to Dr. Amy Myers, a Functional Medicine practitioner, the greatest risk associated with estrogen dominance is hormone-dependent cancer, including breast, uterine, and ovarian cancer. 

  • Autoimmune Disease

While estrogen can have a protective effect on some autoimmune conditions, Dr. Myers states that extreme fluctuations in estrogen levels, such as those during childbirth and menopause, may contribute to autoimmunity. High levels of estrogen increase the inflammatory response of the immune system, which increases the antibodies that attack our bodies’ own tissues. 

  • Hashimoto’s and Thyroid Dysfunction-

Excess estrogen causes thyroid hormones, which would normally be released into the bloodstream, to be inactive. These hormones are therefore unable to elicit crucial metabolic functions. 

  • Candida Overgrowth

Excessive estrogen can lead to Candida overgrowth. Candida is a naturally occurring fungus that is found in the mouth and small intestine. Normally, it functions to aid in digestion and nutrient absorption. However, too much causes a breakdown in the intestinal wall, which releases this toxin into the body.  This is referred to as ‘leaky gut’ and is associated with many different health conditions. 

Causes of Estrogen Dominance:

  • Chronic Stress

Our adrenal glands produce a hormone called cortisol. Chronic stress leads to high levels of cortisol in the body, which can lead to an array of problems including anxiety and depression, sleep disturbances, weight gain, and brain fog. Chronic stress also creates hormonal imbalances. Because the body is focusing all its efforts on producing cortisol, it is less effective in the production of progesterone, thus leading to estrogen dominance.

  • Excess sugar

Diets high in refined sugar lead to insulin resistance. The excess sugar causes your pancreas to overproduce insulin in an effort to balance blood sugar levels. Overtime, this overwhelms the liver and creates insulin resistance. A person with insulin resistance is likely to gain weight, especially around the belly, which leads to an increased production of estrogen.

  • Alcohol

An occasional alcoholic beverage is not inherently bad, in fact, it may even have some health benefits. However, excessive intake can lead to health conditions such as liver toxicity, vitamin B deficiency and even cancer. Research has shown a linear relationship between alcohol consumption and the risk of breast cancer. Alcohol impairs liver function and reduces its ability to effectively detoxify the body and excrete estrogen, which we know increases the risk of hormone-dependent cancers. 

  • Food

Much of the excess estrogen in our bodies comes from the foods we eat. Factory farmed animals are injected with hormones to make them grow bigger, faster, and produce more milk. And even if we subscribe to a vegan diet, the pesticides and herbicides sprayed on our produce are known endocrine disruptors. Ingesting these hormones and chemicals on a regular basis can disrupt our natural hormone balance.  

Additionally, the foods we eat play an important role in our ‘gut health’. Sugary, processed foods can lead to a condition called Small Intestinal Bacterial Overgrowth (SIBO). This affects the body’s ability to metabolize estrogen and makes us more susceptible to conditions related to estrogen dominance. 

  • Beauty Products

Many of the products we use everyday contain xenoestrogens, foreign estrogens that bind to estrogen receptor sites, including parabens, phthalates, plastics, and other chemicals commonly found in beauty products. As discussed in my article, Toxic Beauty, exposure to these endocrine disruptors can lead to an array of health conditions.

  • Environment

Xenoestrogens are also found in the environment. Unfortunately, many parks, playgrounds, and schools are frequently sprayed with toxic chemicals known to be endocrine disruptors. Even our own backyards can be chemical laden areas, depending on our gardening practices. It’s important to minimize, or avoid altogether, spraying these harmful chemicals. Non-toxic Neighborhoods is an organization whose mission is to make every park, athletic field, school, and neighborhood free of harmful and synthetic pesticides. 

How to Resolve and/or Prevent Estrogen Dominance:

  • Diet 

To prevent conditions such as leaky gut and SIBO, eat foods high in fiber, whole soy foods, and flaxseeds. Cruciferous vegetables, like broccoli and cauliflower, are a great source of fiber and give your good gut bacteria something to feed off of. Avoid excessive starch, alcohol, refined sugar, and processed foods as much as possible, as they introduce unhealthy bacteria into the gut. Try to balance your blood sugar at every meal by including protein, fiber, and healthy fat. Doing so will prevent the ups and downs of our blood sugar and help to maintain a constant, sustainable energy level. 

  • Supplementation

When diet is not enough to reverse the significant imbalance and damage to our gut, supplementation may be necessary. I have found a supplement called Estroprotect, developed by Amy Myers, MD, to restore hormonal balance and decrease my PMS symptoms. 

  • Environment

While some things in our environment are out of your direct control, make changes to where you can. Our home is the place where we tend to have the most influence. Whether you choose to do a clean sweep of toxic chemicals, or replace them with a healthier option as you run out, switching to non-toxic cleaning products can make a big difference in your health. Get back to the basics. A simple solution of water and white vinegar is sufficient to clean your floors! 

In addition to cleaning products, take a look at your beauty routine. Before you apply lotion, make up, sunscreen, etc., make sure you know what is in those products. Surprisingly, there is very little regulation of the products we see on the shelves. Be an informed consumer. Use EWG’s skin deep database to research products. I use a line of beauty products called Beautycounter, which is a company dedicated to clean beauty. 

Lastly, take a stance and be an advocate for your city. Non Toxic Neighborhoods is an organization working to eliminate toxic chemicals in our environment. They provide resources for people who want to make a change in their own communities. Speak up at your local town hall or join the Parent Teacher Association in an effort to spread awareness of what these chemicals are doing to our health.

  • Self-care

In order to improve our hormone balance, we need to reduce our stress levels. As a full-time working mother, I am well aware of how stressful life can be. But it’s amazing what a little self-care can do for your mind and body. Try to get eight solid hours of sleep each night. Much of your body’s healing and regeneration occurs during this time. Block out an hour of time to yourself in the morning before the household wakes up. Journaling, meditation, and yoga are all effective ways to reduce stress. Diet and exercise also have a profound effect on your stress level, as well as your ability to deal with stress when it arises. 

If you are struggling with symptoms of PMS or hormonal imbalance, try some of the strategies listed above. If it seems overwhelming, just start with one new change each week. Reach out to a functional medicine practitioner for more resources and support in those challenging areas. As you begin to see results in the way you look and feel, you will be eager to make additional changes. Others may look to you for advice, as they see the improvements you are making in your life. This is the domino effect we need in order to create a healthier more sustainable future. 

Improve your health…improve your community’s health…improve the world’s health. 

Toxic Beauty

What’s your beauty routine?

Mine looks something like this…

Jump in the shower. Wash and condition my hair with a color-safe shampoo and conditioner. Some days, in order to refresh my hair color, I’ll use blue shampoo and let it soak into my hair for 5 minutes or so. I then lather my body with a lavender scented body wash and cleanse my face with an oil free cleanser. After my shower, I spray a root boosting product into my baby fine hair to introduce a little body when I blow dry it. Next comes makeup. Lotion. And don’t forget the perfume.

Photo by Joanna Kosinska

Toxic Beauty

By Kyla Jacobo, DPT

What’s your beauty routine?  

Mine looks something like this…

Jump in the shower. Wash and condition my hair with a color-safe shampoo and conditioner. Some days, in order to refresh my hair color, I’ll use blue shampoo and let it soak into my hair for 5 minutes or so.  I then lather my body with a lavender scented body wash and cleanse my face with an oil free cleanser. After my shower, I spray a root boosting product into my baby fine hair to introduce a little body when I blow dry it. Next comes makeup. Lotion. And don’t forget the perfume. 

Before I even walk out the door, I’ve applied potentially hundreds of chemicals to my body…while giving very little thought to the effect it has on my body and on the environment.

While it feels like a daunting task, I have attempted to reduce the amount of toxins my family and I are exposed to on a daily basis. Many of the products we use are endocrine disrupting chemicals which have been linked to cancer, neurotoxicity, and a multitude of other health conditions. Taking on the world around us is a whole different beast…but at the very least, I can minimize the toxins in my own home. Does this mean I’m some yuppie from California who shops exclusively at Whole Foods and buys 100% organic clothing. Not at all. Although I don’t think that is a bad thing…that’s just not me. I am an informed consumer. A concerned mother. 

And I’m tired…

I’m tired of watching young, beautiful lives ravaged by the grips of cancer. Mothers, wives, sisters…gone too soon. Tired of watching people suffer from chronic illness that could have otherwise been prevented. Tired of allowing our children to grow up in toxic environments, as if they are human experiments on the effects of the latest chemical and drug invention. And most of all, I’m tired of witnessing all of this happen without any changes in environmental and public health policies.

“Never compromise health in the name of beauty”. ~Gregg Renfrew

Gregg Renfrew, the founder and CEO of BeautyCounter, is fighting to reform the beauty industry. As an activist for change, she has created a company that not only provides cleaner, healthier beauty products, but is also leading the charge in DC. She has worked to put into law the Personal Care Products Safety Act, a law that will require screening of products for harmful chemicals and allow the FDA the ability to recall products if deemed unsafe.

Why is she doing all this? To make a buck…?  Because it’s trendy…?

In an interview on the Rich Roll Podcast, Renfrew explains. Like me, she realized that the products she was putting on herself and her family were unhealthy. She realized that government agencies such as the FDA were not screening products and policing companies to ensure that these products lining the shelves do not contain harmful chemicals. 

In fact, the US has not updated laws concerning beauty products since 1938, when the Federal Food Drugs and Cosmetic Act was passed. Over 80 years ago!  This was pre-World War II, before the golden age of capitalism and an economic boom. Before some 85,000 new chemicals had been introduced to the world. At the time, the harmful effects of these chemicals were unknown. However, now that the information has been brought to light, it’s time for change. 

Many Americans, myself included, believed that government agencies, such as the Food and Drug Administration (FDA), thoroughly screened any and all products put on the shelves. The reality is, that is not the case. In regards to the food industry, the FDA is able to recall a food product if found to be harmful to health. However, in the case of beauty products, the FDA has not been allowed to remove a product from the shelves. If found to have detrimental effects on health, the FDA can provide suggestions regarding that product, however they are unable to take action. 

This is unacceptable…

Less than 10% of the 85,000 chemicals in commerce have been tested for safety on humans or environmental health. Not only do our products contain these harmful chemicals, but there exists no law regarding the labeling of these products. A company is able to label their products as “natural” or “botanical”, misleading the consumer to believe they are healthy, when in fact it contains toxic chemicals. The Natural Cosmetics Act was introduced in late 2019 to amend the Food Drugs and Cosmetic Act to formally define the terms “natural” and “naturally derived”.

Change is on the horizon…!

In December of 2019, Renfrew spoke in Washington D.C. as an expert witness on the issue of clean beauty and the need for reform.  As of March 2020, The Cosmetics Safety Enhancement Act of 2019 was passed into law. While this is a huge step in the right direction, it’s going to take time to see these changes in action. We must be informed consumers…research products and educate ourselves on harmful chemicals to avoid.

How to avoid toxic beauty products…

  • Choose fragrance-free whenever possible

Fragrances contain phthalates, a toxic chemical that binds the scent onto your skin. While these fragrances make us smell lovely, they are wreaking havoc on our endocrine system. In addition, these fragrances are considered proprietary, therefore the companies are not required to divulge the ingredients. 

  • Less is more

Before you lather on a product, ask yourself…do I really need this? Try to buy fewer products of higher quality in order to reduce the amount of exposure to chemicals. If purchasing healthier products is cost prohibitive, remember…be more concerned with the products you rub on your body than those you rinse off.  Also look for products with fewer ingredients. Take extra caution to avoid products with parabens, methylparaben, ethyl paraben and EDTA

  • Get some Vitamin D

As summer is fast approaching, we are now going to be spending more time outdoors. Remember that our bodies need Vitamin D from the sun. So don’t be too quick to slap on loads of sunscreen every time you see a few rays of light.  Some sun exposure is good for us! That being said, any time my kids are going to be in the sun for more than 45-60 min, I ensure we have sunscreen. When purchasing sunscreen, choose non-aerosol, mineral based products without oxybenzone (this chemical is killing our coral reefs!). 

  • Use the Environmental Working Group (EWG) skin deep database

I have the EWG app on my phone that allows me to scan products and check the level of toxicity. This is a great way to determine if products you are currently using are harmful, and which products are healthy alternatives.

  • Print out BeautyCounter’s ‘Never list’

BeautyCounter has compiled a list of over 1,800 ingredients, including 1,400 of which were banned or restricted by the European Union, that should never be used in beauty products. They have conveniently created a PDF you can print out and keep in your wallet or purse when you go shopping. 

  • Vote with your dollar!

Companies want to sell products. They perform market analyses to see what the consumer wants and on which types of products we are spending our money. If we all start buying healthier products, it will not go unnoticed. Thus, companies will begin to follow suit to respond to market demand. 

At the end of day, this is not about who is right and who is wrong. This is about the health of our children, our grandchildren and their children. This is about the health of the environment and all the beautiful creatures within it. Let us not be alarmists, but let us listen to the science that is available and insist that these harmful chemicals be removed from our products. I believe we are a society full of intelligent, innovative individuals, capable of devising healthier solutions. 

Let us use our ingenuity for the good of humanity. 

The Benefits of Yoga and How to Create Your Own Daily Practice

Namasté…
I have heard the word many times, often in the context of Indian religions, hippies, or sitting cross legged on a large, decorative pillow. Various interpretations of the word exist, such as “the divine in me bows to the divine in you”, and “my soul recognizes your soul”. Combined with hands pressed together and a bow, it can also be used as a gesture of reverence or respectful greeting. My favorite description, and the one that automatically plays in my head when I speak the word is, “the light in me sees the light in you”.

Photo by Lāsma Artmane

The Benefits of Yoga and How to Create Your Own Daily Practice

By Kyla Jacobo, DPT
@eatmoveinspire

Namasté…

I have heard the word many times, often in the context of Indian religions, hippies, or sitting cross legged on a large, decorative pillow. Various interpretations of the word exist, such as “the divine in me bows to the divine in you”, and “my soul recognizes your soul”. Combined with hands pressed together and a bow, it can also be used as a gesture of reverence or respectful greeting. My favorite description, and the one that automatically plays in my head when I speak the word is, “the light in me sees the light in you”. 

It was not until I started my daily yoga practice that I truly understood what that meant. For me, it means to look within myself and find self love…self acceptance…an understanding that I am a divine creation put on this earth for a purpose. To accept this means we also must accept that every person was of divine creation. I believe that if I can find the light within myself, I can better see it in others, thus helping them to shine.

The world needs all of us to shine our unique light. 

Yoga has been a transformation of sorts, a time to look within, find stillness so that I may hear my inner voice. Amidst the busyness of our daily lives, we leave little time to reflect and listen to what our bodies are telling us. Hearing that inner voice, and trusting what some may call our intuition, is a skill that needs to be developed. My yoga journey has allowed me to be still, find self love, and exercise more compassion to those around me. When I am engaged in my daily yoga practice, I am more mindful of the goals and intentions I’ve set for myself. 

Perhaps just as important, a daily yoga practice is a powerful tool for the body. Although it may appear to simply be a series of stretches and awkward positions, a comprehensive yoga practice encompasses breathing techniques, movements to elongate the muscles, and static holds for isometric strengthening. A good yoga instructor will also emphasize the importance of core strength, the area from which all of our movements should stem.

5 Benefits of a Yoga Practice…

  • Physical Fitness

 Participating in yoga at least twice a week can increase strength, balance, and endurance. The fluid movements and sustained poses engage a multitude of muscles and create a whole body experience. Static holds can elicit an elevated heart rate and labored breathing, which can aid in weight loss. In an article published by Harvard, they note that several small studies have found yoga to lower blood pressure in people with hypertension. 

  • Chronic Pain

Yoga has been shown to decrease chronic pain, especially in those with chronic back conditions. As previously mentioned, yoga emphasizes core strength, which greatly reduces strain on the lower back. Other areas of pain, such as hips or knees, can be caused by tightness or adaptive shortening of the muscles, limiting the joint’s ability to move properly. Alleviating this tightness can improve mobility and reduce the associated pain. 

  • Calms the Nervous System

The fluid movements and focus on the breath trigger a parasympathetic response, which has a calming effect. This reduces the seemingly ever present sympathetic (fight or flight) response that is triggered by stress and anxiety. 

  • Depression/Anxiety

For those who deal with occasional anxiety and depression related to stress, difficult life events, or who, simply put, are just worry warts…yoga is a perfect antidote. Studies have shown a reduction in symptoms of anxiety and depression, as well as decreased dependency on medications, in people who participate in yoga on a regular basis. 

  • Mindfulness

Many yoga instructors incorporate meditation and deep breathing practices into their classes, usually at the beginning or end of the class. Oftentimes, yoga instructors will even devote an entire class to some type of mindfulness. This practice can influence all areas of life, such as making us more mindful in our eating habits and in our interactions with our children. 

5 Ways to Incorporate a Daily Yoga Practice Into Your Routine…

  • Get Up Early

As with all high achievers, a morning routine is paramount to creating healthy, sustainable habits. When you wake up early, you gain valuable time to do the things that will make lasting changes in your life. Make yoga a part of your morning routine to set the tone for your day. 

  • Allow Your Kids to Join You

Attempting an at home yoga practice with kids in the house can be a daunting task. There will inevitably be interruptions, arguments, and an array of questions. So why not include them in the fun? If space allows, encourage them to follow along with the video, practicing poses and teaching them about breathing. Lead by example. 

  • Join a Yoga Studio

If, for whatever reason, at home yoga videos are not practical, join a local yoga studio. Many new studios are popping up, offering memberships, package deals, and drop-in classes. Oftentimes these classes are a bit of an investment, but well worth the health benefits. Plus, it’s an opportunity to support local businesses and get to know people in your community.

  • At Home Yoga Practice

While I enjoy the atmosphere of yoga studios, an at home yoga practice best fits my lifestyle. I don’t need fancy yoga clothes or even have to worry about brushing my teeth! And I have limited time in the mornings, which does not allow for driving to and from a studio. Early on in my practice, I discovered a free, online yoga instructor whom I love! Shout out to Yoga With Adriene! She’s the best! Once I took her classes, it was hard for me to go elsewhere. 

  • Find the Right Practice For You 

As my girl Adriene says, “find what feels good”. Modify the length of the class, difficulty level, and the focus of the practice according to what works best for you. Some do more flow and sun salutation, while others focus more on toning and strengthening. Start out slowly and never push yourself so far as to risk injury. 

So get on your mat. Every day. Find your self love.

Namasté

My Addiction to Caffeine (and how I lived to tell about it)

Ahh…that first sip feeling.

A good cup of coffee. It’s not just a cup of coffee…it’s an experience for all the senses. The warmth in my hands. The aroma as I bring it close to my face. The slightly bitter, but creamy flavor as a take that first sip. Bliss!

Photo by Mike Kenneally

My Addiction to Caffeine (and how I lived to tell about it)

By Kyla Jacobo, DPT

Ahh…that first sip feeling.

A good cup of coffee. It’s not just a cup of coffee…it’s an experience for all the senses. The warmth in my hands. The aroma as I bring it close to my face. The slightly bitter, but creamy flavor as a take that first sip. Bliss!

Actually for me, it wasn’t coffee…it was espresso. Latte, cappuccino, doppio espresso.  I loved the bold flavor and velvety crema. I had a routine each morning of packing the grounds, choosing a demitasse mug from my collection, and brewing the perfect cup of espresso. If I had the time…and if the kids were not asleep…I would steam some milk, which is an art in itself. Not too hot. Create foam, but not too much. Tilt the container at just the right angle. It wasn’t just coffee, it was a ritual in which I participated that brought great pleasure. 

I was a self-proclaimed coffee connoisseur…as in trying various styles of coffee and different coffee shops in places I visited…mostly just to get my coffee fix!

One of my favorite places to do this was Carmel, a quaint little town that is home to a multitude of art galleries, restaurants, and boutiques. Flaherty’s is a must stop for a bowl of clam chowder and oysters.

Carmel is a coastal town, so the weather is typically brisk with the smell of salt water in the air. It doesn’t take long for my coffee craving to set in. There are a few local cafes to choose from, but I head to my favorite coffee shop on Ocean Avenue. The line is usually long, but it’s worth the wait for a decadent pastry and warm, creamy latte. 

Sounds lovely, right?

But like anything…too much of a good thing can be bad. 

It was Mother’s Day. We decided to take a hike up to Yosemite Falls with some friends. The plan was to start early, hike up to the falls, and then grab an early dinner. While I should have been concerned about proper hydration and nutrition to get me through the rigorous hike, my mind was focused on coffee. There were no coffee shops along the trails of Yosemite National Park where I could get a latte or a quick shot of espresso. Not even a convenient store to grab a cup of stale coffee for a caffeine fix. 

So I packed my own. Starbucks makes those little cans of espresso and cream. More sugar than I would normally care for…but perfect for my hike. While others were gulping down water on the dry, hot day, I was drinking espresso. 

Now don’t get me wrong, there’s nothing inherently wrong with drinking an espresso. The problem lies in the dependence on caffeine. I knew that if I didn’t have caffeine during the hike, my head would be pounding and I would feel terrible. My fun Mother’s Day excursion would turn into a dreadful, miserable experience. And this was not unique to my hiking trip. My preoccupation with coffee was a common theme in any vacation or family function we attended…and my day to day routine seemed to revolve around my next cup of joe.

Enough was enough!

It was at that moment that I decided to stop drinking coffee. First, I tried to slowly wean off with the hopes that my body would adapt to the new routine. I even attempted to replace coffee with green tea in order to lower the caffeine content. That failed miserably. I was still getting the excruciating headaches and still craving my coffee ritual. 

So I went cold turkey! 

The first week was brutal! I gave my coveted espresso machine to a family member so I would not be tempted. I tried to drink lots of water and relied on an occasional Advil to dampen the pounding headache. As time went on, I began to have some serious withdrawals. My back was hurting up and down my spine, such that I could not find a comfortable position. I had difficulty sleeping due to the back pain and anxiously got up at night to pace the bedroom. I can recall one night feeling so nauseous as though I may throw up. When I leaned over, my head began to spin and I nearly fell. 

Now, mind you…this withdrawal was not from one morning cup of coffee. This was from a decade long addiction to 2-3 double shots of espresso every day, even more at times.  Also keep in mind that caffeine affects people differently based on a particular gene that we all have. This gene will determine the speed in which our body metabolizes caffeine, thus our sensitivity to it. 

If you find yourself becoming dependent on caffeine, take inventory on how often you drink it and how you feel when you don’t have it. Like me, you may be a slow metabolizer of caffeine, which requires you to be more cognizant of your intake. I now limit myself to one cup of coffee in the morning. While I would love to have a second…or third!…cup, I remember the hellish week I had. If it’s after 10 am, I’ll take some water or kombucha instead!

Cheers!

Green Love

My husband recently inspired the name green love for the smoothie I am notorious for making and serving to my family. When the complaints about the bitter taste or viscous texture are voiced, which they inevitably are, I usually respond with something like…

“It’s good for you”…

or…

“This makes your body strong and healthy”…

Green Love
Photo by Jan Sedivy

Green Love

By Kyla Jacobo, DPT

My husband recently inspired the name green love for the smoothie I am notorious for making and serving to my family. When the complaints about the bitter taste or viscous texture are voiced, which they inevitably are, I usually respond with something like…

“It’s good for you”…

or…

“This makes your body strong and healthy”…

But this morning my husband took a different approach. He said, “This smoothie is love. Your mom loves us so much that she makes this for us every day”. And thus the name was born.

Green love.

It was perfect. Like love in a cup. 

My smoothie represents my love for my family, as it nourishes them and promotes good health. It’s not always easy to get kids to drink something green, bitter, and void of the sugary sweetness they have come to love. But we cannot give up. Throw in a few strawberries or blueberries, or maybe even a dash of honey to make it more palatable. The more fruits and veggies kids are introduced to, the more they will be willing to eat them. 

Tip: Start out by serving the kids a small amount in a shot glass to get them used to the flavor.  Place an orange slice by the glass as a ‘chaser’ if they don’t like the flavor. It makes it fun, taste better, and also provides some Vitamin C!

To broaden our understanding, we can look at green love through the lens of a physiological and environmental perspective. A blender full of vibrant fruits and vegetables represents a love for the human body and its divine creation. It is the respect and willingness to provide our cells with the nutrients they need to function optimally. It is the understanding that our bodies cannot thrive on sugar laden, processed foods that wreak havoc in our bodies and on our world. 

Not only are smoothies like green love good for our bodies, but they help the environment as well. The industrialized farming system mass produces corn and soybean to create many of the processed foods we see in grocery stores. However, that system has come to value quantity over quality, which degrades the nutrients in the food and the health of the environment. These processed foods at the very least, are void of nutrients, and at worst, contain ingredients that make us sick. 

The author Michael Pollan said, “Eat food. Not too much. Mostly plants”. So why not trade your morning bowl of cereal for a green smoothie? Imagine if we all lived by Pollan’s rule…we would live in a much healthier world.

All of this from just a smoothie? Yes! My kids don’t realize the depth of meaning behind a green smoothie. But it’s like many things we teach them…instill it now with the hopes of a light bulb moment of understanding in the future. 

My green love smoothies sometimes varies based on the ingredients I have in the house, but  my go to recipe is as follows:

2 cups water

Large handful spinach

Large handful kale

1 whole cucumber

1 frozen banana

3-4 frozen strawberries

¼ cup frozen blueberries

Happy blending!

How Running Can Strengthen Our Mind, Body, and Soul

Our ancestors ran as a means of hunting food and escaping predators. We see children running around in circles just for the pure joy of it. So why have so many adults lost that desire to get outside, feel their hearts pumping, and move their bodies in a way that was etched into our DNA? Have our lives become so laden with luxury and convenience that the mere thought of discomfort makes us shudder?

How Running Can Strengthen Our Mind, Body, and Soul

By Kyla Jacobo, DPT

Our ancestors ran as a means of hunting food and escaping predators. We see children running around in circles just for the pure joy of it. So why have so many adults lost that desire to get outside, feel their hearts pumping, and move their bodies in a way that was etched into our DNA? Have our lives become so laden with luxury and convenience that the mere thought of discomfort makes us shudder?  

A decade ago, I thought running marathons was only for those athletes with slender builds, long legs, and strides like a gazelle. I grew up in an athletic family, so I was not lazy by any means. But my sport of choice was soccer. I loved it!  Soccer was my passion…and I would do anything to improve my game…that is, except for running. I just did not like it. Yes, we did a lot of running during practices and games. But if you asked me to run a mile, I would cringe. 

Fast forward 10 years…insert baby, busy work schedule, and 40 unwanted pounds.

I was extremely overweight.  Maintaining my size 4 figure had never been an easy task, but I managed to stay fit by playing soccer and relying on my youthful, fast metabolism.  Now as an adult, with the demands of a family and full-time job, I was struggling. So I decided to do the unthinkable…

I went for a run!

I’m not going to lie, that first run was brutal.  I can still remember running a quarter of a mile…my knees aching…chest pounding…parts moving that frankly, you just don’t want to move!  But I stuck with it. I would walk/jog every day, until finally I was able to run a complete mile without stopping. A few months later, I completed my first 5K.

I was hooked…

Running became a huge part of my life. Saturday mornings were synonymous with long runs, which also meant chocolate milk, ice baths, and foam rollers. My closet filled with race shirts and bright colored headbands with quotes like, Will run for wine and This is my happy pace. I was enjoying the community I had built around this new passion…but most of all, I was enjoying feeling good!

I had never felt more alive!

As the distances increased, so did my confidence. I learned that I could control my mind and push through the pain in order to reach my goal.  I ran several half marathons and then finally conquered a full marathon. 

This journey that I’m on has been a bumpy and winding road, both literally and figuratively.  But it has ultimately led me to believe that running can be used as a tool to strengthen our mind, body, and soul. 

Master your mind…

“Beyond the very extreme of fatigue and distress, we may find amounts of ease and power we never dreamed ourselves to own; sources of strength we never taxed at all because we never pushed through the obstruction.”      

-William James

One of the most challenging races I’ve run to date was along the central coast of California. It wasn’t the distance that made it hard or the lack of training, it was the heat. Although the race finished at the beach, the majority of the 13.1 miles was inland, on dry, hilly roads without a trace of shade. It wasn’t long before I became dehydrated, seeking out aid stations like an oasis in a desert. I ran past my husband and little girl, waving and cheering me on, which gave me the boost I needed to finish. 

Stories like this one are not uncommon among runners. In fact, I think it’s what drives us to continue to sign up for race after race. In our comfort laden lives, we sit at a desk, relax on a comfy sofa, and drive in air conditioned cars. When do we have the opportunity to physically push ourselves to our limits?

It is in moments like these, on that hot and dry race course, that we can overcome limiting beliefs about who we are and what we are capable of. We can tell ourselves we are not going to give up. We can realize that pain is temporary.

When the blisters are healed and the aches and pains have subsided, you are left with a new found confidence in yourself. A little voice inside saying, you can do whatever you set your mind to

So do not run from a challenge, run towards it…as it may be the thing that unlocks your untapped potential.

Strengthen your body…

“Physical fitness is the basis for all other forms of excellence.”

-John F. Kennedy

Should we choose to do the work, we have the ability to strengthen our bodies in such a way, that we can achieve excellence in all areas of life. 

Be patient. Be consistent. Over time you will start to see a transformation…

  • Increased muscle tone

When you first start running, muscles will be sore that you didn’t even know existed. You will start to notice definition in your arms, legs, and even those lines down your abdomen that represent what could be the start of six pack abs! Best of all, you will start to feel strong and powerful in your own body. 

  • Weight loss

Running burns a lot of calories…especially when you reach 8, 10, and 12 mile runs. It speeds up your metabolism and helps to control blood sugar, which further aids in weight loss and maintenance. There is also a strange phenomenon that makes you crave broccoli and spinach…although, I can devour a big basket of french fries on occasion!

  • Improved mood

Someone once said, “you’re only one run away from a good mood”. It’s so true! I can walk out of the house feeling like Cruella De Vil…and return from a run with a smile ear to ear and a bounce in my step akin to Mary Poppins! 

Each time your muscle contracts, you receive a dose of ‘feel good’ hormones throughout your body. When these hormones are secreted, they affect your brain and create what is referred to as a “runner’s high”.

  • Improved sleep

Whether it be an uncomfortable bed, inability to quiet the mind, or excessive amounts of screen time at night, many people are deprived of a critical part of good health…a good night’s sleep. Completely exhausting your body physically can trigger a response to take a much needed rest, shut down mentally, and allow the body to rejuvenate. After a good, long run…I sleep like a log!

  • Develop a connection with your body

When you push your body physically, you will undoubtedly hear about it. That communication comes in the form of delayed onset muscle soreness or, DOMS. DOMS is a result of lactic acid build up in our blood following exercise. This is a good thing however, because the more we can feel our bodies, the better in tune we become with ourselves, thus creating a deeper connection. 

Fill your soul…

“…that thing that we are trying to remove from our life [discomfort] is the one thing that is somewhat essential to actually feeling completely alive and at your best.” 

-Rich Roll

Before I began running, I thought I had reached my destination. I was married with 2.5 children and a white picket fence (figuratively speaking!). Although it sounded like the American dream, my soul felt empty. I now know that it was because I had stopped growing. Stopped dreaming. Stopped pushing myself to become better. 

Running was an opportunity for me to set goals, work hard, and achieve tangible results. 

Not only was I developing a better relationship with myself, I was cultivating a community of like minded people. Nothing brings people together like chafed arms, blistered toes, and 14 mile runs in the rain at 5 o’clock in the morning!

After a while, I stopped running with groups and spent some time on my own. My runs became a time for me to think, pray, enjoy the fall colored leaves and the snow capped mountains. It filled me with such gratitude to be alive. 

It was a time of peaceful solitude. 

Whether you choose to run a 5K or an ultra marathon, find the distance that pushes you to your limit. A distance so challenging that you will want to quit. Then find a way to access your inner strength and grit that will push you through the finish line. You will be forever changed. 

So get out there. Walk. Run. Skip if you want to. 

Find your happy pace.