121 Dietitian

10 Dietary Tips for Fatigue: Energy-Boosting Foods to Help You Feel Refreshed

vegan diet cons

What is Fatigue? Have you ever felt like no matter how much rest and sleep you get, you still feel very tired and exhausted? This is referred to as ‘fatigue’, which is an extreme lack of energy that doesn’t go away easily. Definitely, at this time of year, when we have all had a long, sunless winter, fatigue can be at its worst. Diet can play a major part in influencing how tired or energized you feel. In this blog post, we’ll delve into the effects of diet on fatigue and ways to boost your energy levels through healthy eating habits. In addition to other factors, fatigue can also be caused by stress, lack of sleep, medications and poor health. All of which should not be overlooked.     Importance of a Balanced Diet for Fatigue Macronutrients are the cornerstone of nutrition and an essential part of a healthy diet. They provide energy to the body and form the basis for our physiological functions. Macronutrients include carbohydrates, proteins, and fats, which are necessary for growth, development, and maintaining normal bodily functions. Each macronutrient has its own unique role in the body and it is important to get them in the right balance for optimal health. Eating a balanced diet is essential for maintaining good health. The Basics – Carbohydrates are the body’s primary source of energy and fibre. Proteins help repair and build muscle tissue and assist hormones. Fats provide a slow-burning source of energy and are essential for cellular activity. Eating foods from each group in the right proportions can help to ensure that all your nutritional needs are being met alongside essential vitamins and minerals, antioxidants and more. Hydration for Fatigue Water is essential for many of the body’s functions, including maintaining energy levels. Water is essential for the functioning of the human body and plays an important role in keeping energy levels up. It involves many of the body’s processes, such as transporting nutrients and oxygen to cells, regulating temperature, eliminating waste, and lubricating joints. Additionally, water helps to increase alertness and enhances concentration. Therefore, it is crucial for individuals to stay well hydrated in order to maintain healthy energy levels throughout their day. Even mild dehydration can cause fatigue, so it’s essential to stay hydrated throughout the day. Aim to drink 250ml x 6 glasses of water per day, and more if you’re exercising or in a hot environment. Energy Boosting Foods Complex Carbohydrates for Fatigue Complex carbohydrates are found in whole grains, fruits, and vegetables provide slow-burning energy that can help prevent fatigue throughout the day. These foods are also high in dietary fibre, which helps to regulate blood sugar levels and keep you feeling fuller for longer. Eating complex carbohydrates can also help reduce your risk of certain chronic diseases, such as heart disease and diabetes. Protein for Fatigue When consumed, protein helps build and repair muscle tissue, aids in digestion and helps regulate hormones. It also provides the body with energy, as it is broken down into amino acids which can be used to create ATP (energy). Consuming adequate amounts of protein can help boost energy levels by providing your body with the necessary building blocks to produce ATP. Some of the best sources of dietary protein include eggs, lean meats, legumes, dairy products, nuts, seeds and fish. These foods are not only high in protein but also provide essential vitamins and minerals to keep us healthy and energized throughout the day. Healthy Fats for Fatigue Eating the right kinds of fat is essential for overall health and wellness. Healthy fats, such as those found in avocado, nuts, and olive oil provide many essential nutrients that are beneficial for our bodies. They can help to reduce cholesterol levels, improve heart health and even aid in weight loss. In addition to providing important nutrients, incorporating these healthy fats into your daily meals can also help to make them more enjoyable and satisfying. Iron for Fatigue Iron plays an essential role in the body, serving many important functions. It helps with energy production, muscle formation, and oxygen transport throughout the body. Eating a diet rich in iron is essential to maintaining adequate levels of iron in the body. Foods that are particularly high in iron include red meat, leafy greens such as spinach and kale, beans and legumes, fortified cereals and grains, nuts and seeds, and fruits like prunes or raisins. Meals and snacks made from these foods can be a great way to get your daily dose of iron.  Vitamin B12 for Fatigue Vitamin B12 is an essential vitamin necessary for the production of red blood cells, proper neurological functioning, and healthy metabolism. It is found in a variety of foods such as fish, eggs, dairy products and certain fortified cereals. Consuming a diet rich in vitamin B12 can help prevent deficiencies and ensure that our bodies are receiving the essential nutrients needed to maintain health and well-being. If you’re a vegan or vegetarian, you may need to take a vitamin B12 supplement to ensure you get enough of this essential vitamin. Vitamin D for Fatigue Vitamin D is a key nutrient it is a fat-soluble vitamin and a hormone. It has been found to be beneficial in combating fatigue, as it helps the body absorb calcium and phosphorus, which are important for energy production. Vitamin D also helps regulate mood, improve sleep quality, and even reduce the risk of certain diseases. It is made by the skin from the sun or can be found in a small range of foods including oily fish, egg yolks and mushrooms. By making sure we get enough of this essential vitamin through dietary sources or supplements, we can make sure our bodies are functioning at their best and combat fatigue effectively. Fatigue -What to reduce or avoid Fatigue and Caffeine Caffeine and sugar are two of the most popular substances consumed daily around the world. Caffeine is a stimulant that can help improve mental alertness and

Manage Stress to Better Manage Irritable Bowel Syndrome (IBS)

stress and IBS

What is Irritable Bowel Syndrom (IBS) and How Does Stress Impact It? Irritable Bowel Syndrome (IBS) is a common disorder of the gastrointestinal tract that affects an estimated 10-15% of people worldwide. Stress has been identified as a major factor in the onset and exacerbation of IBS symptoms and it is definitely a trigger for the patients I see at my clinic when attending one of our super successful gut health programmes. This month has been awareness month for both IBS and Stress, so I thought I would bring the two together in my final blog for this month. As previously mentioned in my previous blogs IBS and Probiotics Irritable Bowel Syndrome is characterized by abdominal pain, bloating, and changes in bowel habits. How does stress affect digestion? Studies have shown that stress can affect the way our bodies process food and how our digestive system functions, leading to an increase in abdominal pain and other IBS symptoms. Additionally, stress can cause changes in hormone levels which can further exacerbate IBS symptoms. It is important for people with IBS to take steps to reduce stress levels in order to manage their condition more effectively. The relationship between our brains and the digestive system is powerful, so it is not uncommon for changes in our emotional or psychological state to affect the way our gut works and could explain why we often feel ‘butterflies in the stomach’ when feeling anxious or stressed. The communication and feedback between the gut and the brain is known as the gut-brain axis. This network consists of two parts: The sympathetic nervous system, which manages fight-or-flight responses; and the parasympathetic nervous system, which controls repair, rest and digestion. It is believed that the enteric system functions as a third part to control the digestive system. This communication between the brain and the gut is referred to as ‘the gut-brain axis’, which helps connect emotional processes in the brain to the physical operations of our digestive system. Recent research has been able to establish the gut-brain axis, which is the connection between the two systems. Emotions can affect how your gut functions and vice versa. It’s important to note that although many digestive problems are related to mental health, not all of them are caused by Irritable Bowel Syndrome (IBS). Anxiety can manifest in various physical symptoms, such as stomach aches or changes in bowel movements. Gut Bacteria and Stress Did you know that having an imbalance in your gut bacteria is having an impact on your mental health? This is sadly not that well known, but with years of research and practice it is a major area that I have built into our programmes and is an important part of successful treatment. Certain bacteria can affect levels of anxiety or stress through activities in the digestive tract. A healthy balance of the ecosystem is necessary for our mental health and well-being, however when it is not balanced (dysbiosis) organisms like bacteria can lead to negative consequences. A recent large, most comprehensive and best-validated association study to date provides further evidence for an association between gut microbes and blood metabolites (generated by host and by microbes) in patients with Major depressive disorder (MDD). (1) They observed “that the genera Sellimonas, Eggerthella, Hungatella, and Lachnoclostridium were more abundant, while genera Ruminococcaceae…, Coprococcus, Lachnospiraceae…, Eubacterium ventriosum, Subdoligranulum, and family Ruminococcaceae were depleted in the guts of individuals with more symptoms of depression. Of these, genus Eggerthella showed statistical evidence of being involved in the causal pathway.” These microbes are involved in synthesising important neurotransmitters, such as gamma-aminobutyric acid, butyrate, glutamate, and serotonin. It is known that Butyrate can influence depression through several routes — ie, via immune regulation, genomic transcript/translation, and/or affecting energy metabolism. So this is really critical for health to ensure these pathways are optimised. 3 Tips for Identifying & Reducing Sources of Stress in Your Life Stress is a natural part of life and we all deal with it at different times in our day, week or life. It is normal and should not cause us problems. It can however become overwhelming if left unchecked. Identifying and reducing sources of stress in your life is essential for maintaining mental and physical health. There are many levels of stress and many ways to address. Here are 3 simple tips to help you identify and reduce the sources of stress in your life. One way is to take time to reflect on what is causing you stress. This could be anything from work or family pressures to financial concerns or relationship issues. Once you’ve identified the source, think about how you can reduce it. This could involve making lifestyle changes. Such as exercising more or taking up a hobby, or seeking professional help if needed. Second, get into the habit of practising mindful living by being aware of how your thoughts and actions affect your emotions and overall well-being. Taking regular breaks throughout the day to relax and refocus will help keep stress levels low. Third, set realistic goals for yourself that are achievable within a reasonable timeframe. Setting unrealistic expectations will only add more pressure and increase feelings of helplessness. Dietary Changes & Supplements that Can Help with Stress & IBS Symptoms Making changes to your diet can not only help reduce stress levels but also lessen the severity of IBS symptoms. Eating a nutrient-rich diet, and limiting processed fat and sugars is important as well as avoiding specific trigger foods. These can help reduce stress levels and improve digestion. Our 6 week elimination programme combines these all for excellent results. Additionally, certain supplements such as probiotics, omega-3 fatty acids, magnesium, vitamin B12 and zinc may be beneficial for those suffering from stress or IBS. By making key dietary changes and taking the right supplements specifically for you, you can experience improved overall health and well-being. We do a deep dive assessment for each patient that attends our practice. This allows 121 Dietitian programmes to be designed specifically for you, ensuring physical and mental health are addressed. Stress Management

What You Need to Know About Probiotics and Their Health Benefits

What are Probiotics and What Makes them so Beneficial? As we are still in the awareness month of gut health I felt it may be helpful to focus on an area that many people want to know more about for improving their gut; Probiotics. Probiotics have been around since ancient times when cheese and fermented products were popular among the Greeks and Romans. They even encouraged each other to consume these for the potential health benefits. The word “probiotic” comes from the Greek word for “for life.” Jump to 1905, a Bulgarian physician and microbiologist Stamen Grigorov identified the first recorded probiotic, Lactobacillus bulgaricus, in Bulgarian yoghurt. This discovery was groundbreaking and has led to further research into the potential of probiotics for many years. Today, probiotics are widely used in healthcare and nutrition as a natural way to improve digestive health and overall well-being. So what are they? Probiotics are live microorganisms that have been researched and proven to provide health benefits when consumed from suitable sources in adequate amounts. They are commonly found naturally in food sources often fermented such as yoghurt, miso, tempeh, sauerkraut and cheeses. In recent years this can also be taken as a supplement and due to modern manufacturing a mass market of choice has “mushroomed” onto the probiotic shelves. Probiotics work by introducing beneficial bacteria into the gut microbiome which helps to maintain a healthy balance of microorganisms. This balance is important for proper digestion, nutrient absorption, and immune system functioning. Research has shown that probiotics can help to reduce inflammation, improve digestive health, and boost the immune system. Additionally, probiotics may also help to reduce symptoms of certain diseases such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Exploring the Different Sources of Probiotics and How to Properly Integrate Them Into Your Diet We know probiotics are found naturally in certain foods, such as yoghurt, sauerkraut and miso. But as mentioned they can also be taken as supplements in the form of liquids, pills or powders and even research has been carried out intranasally. I can’t cover them all as you would be really bored still reading in a few hours time! Suffice to say there are so many to choose from I often wonder is this more to do with confusing the consumer and encouraging them to keep buying new ones, and thus clever marketing, more money spent from repeat purchases. I really hope it is that we are just really lucky that the manufacturers are improving therapeutic doses, strains and delivery methods for all ages and stages of life. Most common types of probiotics Lactobacillus (Lactobacillus acidophilus) – This strain helps maintain a healthy balance between good and bad bacteria in your intestines. It’s also thought to help prevent diarrhoea caused by antibiotics.Bifidobacterium (Bifidobacterium lactis) – This strain helps improve lactose intolerance, boost immunity, reduce inflammation throughout the body (including in joints), help regulate blood sugar levels after eating carbohydrates like bread and pastas–and even reduce symptoms associated with irritable bowel syndrome (IBS). Just because they are common and frequently recommended in health food stores they are not always the best choice for many. Probiotics for Specific Conditions Probiotics are a good choice for anyone who wants to improve their health. They can help with digestion, immune function and even weight loss. But there are some specific conditions where probiotics are useful: Irritable Bowel Syndrome (IBS). This condition affects the colon or large intestine. It causes abdominal pain and bloating that may be accompanied by diarrhoea or constipation. Many people with IBS also experience gas and other symptoms like nausea or vomiting after eating certain foods. Studies have shown that taking certain probiotics while addressing the diet can help relieve these symptoms because they help balance out the bacteria in your gut–a process called “gut dysbiosis.” Our gut health programmes are uniquely designed for each individual to ensure probiotics are selected based on your specific requirements. Diabetes Type 2 prevention/treatment: Research has shown that taking certain strains of Lactobacillus rhamnosus GG (LGG) over time can reduce blood sugar levels in people who have prediabetes or type 2 diabetes mellitus (DM2). In one study published in Diabetes Care journal found that supplementing with LGG lowered fasting blood glucose levels by almost 10 percent compared to those taking placebo pills over six weeks period. Weight loss: Another study published in Obesity Reviews journal found supplementing with Bifidobacterium longum subspecies infantis helped reduce body fat percentage while increasing lean muscle mass. A snapshot of thousands of probiotics available. What Are Some Potential Side Effects or Risks Associated With Taking Probiotics? While the potential benefits of probiotics are well-known, there are also potential risks associated with taking them. These risks could include allergic reactions, interactions with medications, and changes in the balance of good and bad bacteria in your gut. Certain people may be at higher risk for adverse events due to various conditions. These include people with immunodeficiency, short bowel syndrome, central venous catheters, cardiac valve disease, and premature infants. These individuals may be more vulnerable to certain infections or other medical issues that can result from their medical condition. It is important to understand these risks before taking probiotics so that you can make an informed decision about whether or not to take them and discuss any potential risks with your healthcare provider. I think it is important to point out here that if your gut is doing as it should you have no unpleasant GI or health issues then leave it to get on doing what it does best and don’t interfere! Prebiotics and Synbiotics You may have heard of Prebiotics and synbiotics. These are dietary supplements that help to promote the growth of beneficial bacteria by providing food for the probiotic organisms, thus encouraging them to multiply.Prebiotics are non-digestible fibres that pass through your digestive system unchanged, but they act as fertilizer for probiotic bacteria in your intestines. They’re found naturally in foods like bananas, onions and

Waist Hip Ratio Measurement are you familiar with this?

How to measure your weight hip ratio

Waist Hip Ratio. I released a recent blog highlighting the positives and negatives of the BMI calculation and wanted to follow up on this with another measurement that you may find useful. Just to recap, BMI (Body Mass Index) is a well-known measurement that checks weight against height to select a number that you then can plot in a range for health. You can check yours here on our BMI calculator.  This unfortunately in some circumstances can be misleading, and my BMI blog covers this in more detail. One example is if you have a high muscle mass, you may see your BMI number to be ‘overweight’.. What to use instead of BMI? The measurement that is now recommended as standard by the British Diabetes Association is the Waist : Hip Ratio This is a simple and quick-to-do measurement that just requires a tape measure. The tape measure below is designed to assist you to be more accurate as it holds the tape in place as required so you can record your numbers..  How to take your own Waist-Hip Ratio Start with the tape around your tummy, this should be the smallest part of the waist. Record this number. Next, drop the tape down around the hips, you need to measure the widest point across your bottom. Take down this number. Next, you need to divide the waist measurement by the hip measurement this will give you another number called the ratio. You use this number to check against the guidelines below. Waist Hip Ratio Guidelines The following are the recommended parameters: What does the Waist Hip Ratio number show? In simple terms the nearer this ratio you have recorded is to 1, the more likely you are to be insulin resistant and at risk of developing Type-2-Diabetes. If you have a high waist-hip ratio you may notice you have more of an ‘apple’ body shape. This body shape means you are carrying excess abdominal fat. Why does this matter? Health risks rise significantly with increased abdominal fat as many of our vital organs like your liver and pancreas are located here, if these organs are restricted by excess fat they are put under extra pressure. What can you do to lower your Waist Hip Ratio? Thankfully you can assist your waist-hip ratio by taking action in several ways. What to do next about your Waist Hip Ratio or anything else.. If you are unsure of how to increase or decrease your weight, change your eating habits or need help optimising the foods you eat and are not sure what programme to select please do contact us. We would love to help you or your family and friends with any nutrition-related queries big or small. If you want to book your programme TODAY we would love to help you. You can book a 121 Dietitian Programme today by clicking on the link below If you have enjoyed this blog we would love you to share this with your family and friends on your social media channels. Do visit our YouTube Channel for more on keeping your health optimal. If you are interested in how I overcame my Thyroid Autoimmune Condition do check out the About section below Before you go please check out our 121 Dietitian Shop created specifically for optimising your health. Gillian x

Check your BMI – Body Mass Index calculator

Check Your BMI BMI Calculator BMI (body mass index) is a measure of whether you’re a healthy weight for your height. BMI gives a good estimate of your weight-related health risks for most adults, there are exceptions. Ethnicity, pregnancy, being muscular and anyone under 18 or over 60 this calculator may over or underestimate and so additional calculations or measurements are required. I will cover this in another blog. How to check your BMI (BMI Calculator) to see if you are in a healthy weight range. To do this you need your current weight (kg) and height (cm) measurements. This will give you a number that is called your Body Mass Index (BMI) Generally if your BMI is over 35, or under 18, your health is at risk. You can calculate your Body Mass Index using the BMI Calculator below. Understanding your BMI result Underweight Being underweight (BMI<18.5) could be a sign you’re not eating enough or you may be ill. If you’re underweight, we can assist you with nutritional advice on how to get your weight back to a healthy range. A detailed programme is created for you with recipes and a shopping list to make it as easy as possible. Healthy weight A healthy weight range (BMI 8.5-24.5) is where you want to be, so that is great if you are at the ideal body weight for you. But do remember this is a wide range and further tweaking may be required regarding your fat stores and muscle mass. Important to prevent future health issues. Overweight If you are overweight (BMI 24.5-29.9) chances are you have tried a few if not several times to change this. Weight loss is a specialist area at 121 Dietitian and we have helped thousands of people safely lose weight and most importantly keep this in control and enjoy life. Following our specialist, personalised plan and building in appropriate exercise is the goal. Obese A BMI of over 30 means you are in the obese category and clinically obese is where your BMI is over 35. It can feel overwhelming and lonely when you are faced with the thought of losing weight, especially if you have a lot to lose. Chances are like many you have tried repeatedly to tackle this yourself or with some form of generic programme and ended up back to the weight you were or heavier. Here at 121 Dietitian we work with you to ensure this doesn’t happen again. We know it can take a few weeks to several months to get everything optimal in your life and health to see successful and permanent weight loss. You may need some blood tests for this which we will guide you on. A personalised programme is created for you taking into account every aspect of your life: including your health, your likes, dislikes, cooking ability, finances etc. Our Plus programme will monitor you for up to a year to ensure you are meeting your goals AND more crucially keeping the weight off for good. BMI for Black, Asian and other minority ethnic groups Black, Asian and other minority ethnic groups have a higher risk of developing some long-term (chronic) conditions, such as type 2 diabetes. Checking your BMI figure Black, Asian and other minority ethnic groups adults with a BMI of: 23 or more are at increased risk 27.5 or more are at high risk What to do next about your BMI or anything else.. If you are unsure of how to increase or decrease your weight, change your eating habits or need help optimising the foods you eat and are not sure what programme to select please do contact us. We would love to help you or your family and friends with any nutrition-related queries big or small.

Wegovy – New Diet Drug

Wegovy - New Diet Drug

Wegovy – New Diet Drug   121 Dietitian is excited by the launch of the New Diet Drug Wegovy for weight loss and obesity. A game changer for weight loss, but not without consequences. If you decide this is for you, you need to ensure you get the maximum results possible. As weight loss experts 121 Dietitian wants the best for you, we are seeing a massive push on online prescribing. What support do you get with this????? In most cases, it is lip service and not personalised. These drugs are not a quick fix, they are expensive, require 18 months of time commitment and stop working when you don’t inject. So what can you do? How to get maximum results with Wegovy- new diet drug If you decide Wegovy is for you. You may be surprised to read that the only way to get maximum results is by working with a Specialist. Dietitians like us here at 121 being the gold standard! Wegovy is not the golden ticket to weight loss. We know and have many years of experience assisting thousands of people with optimising their diet and health for life. Wegovy what you need to know As a Dietitian for nearly 30 years, I have watched many drugs come and go regarding weight loss. Wegovy is one of the newer kids on the block. Big breakthroughs have been the headlines over the years and many people eager to get their hands on the latest launch, pay big bucks for something they know nothing about. Creating drugs to allow for a substantial amount of weight loss without serious side effects is the dream for many pharmaceutical companies and many attempts have been made. In this blog, I hope to provide you with all you need to know about these medications the positives and negatives of taking these drugs and what alternative may work better for you long term. How Do These Anti-Obesity Drugs Work? In normal digestion, the gut secretes hormones after food intake, stimulating insulin secretion. These pharmaceutically created peptides (Wegovy) mimic these same gut hormones and provide more GLP-1 to flood the system and allow for additional weight loss. Wegovy and Mounjaro work differently in the body but both keep you fuller for longer by delaying gastric emptying, increasing insulin sensitivity, decreasing glucagon, and reducing high glucose levels. Both drugs reduce triglycerides, LDL and raise HDL cholesterol, along with reducing blood pressure. Who is eligible for Wegovy? Wegovy is intended for use by adults aged 18-75 who have a BMI of 30 or above, or a BMI of 27 or above AND a weight-related health condition such as (asthma, cardiovascular disease, depression, diabetes, fatty liver disease, gallbladder disease, high blood pressure, a history of certain cancers, osteoarthritis or gout, or polycystic ovary syndrome (PCOS). Side effects of Wegovy – New Diet Drug Something that is often overlooked or underplayed is the side effects of drugs. For Wegovy and Mounjaro (Tirzepatide) include nausea vomiting abdominal pain constipation diarrhoea There is a concern of 4.5 x higher intestinal obstruction in 25,000 people studied. Fatigue and headache are also very common, mainly as doses increase. Other common side effects include: feeling lightheaded excess passing wind gastroesophageal reflux injection site reactions hair loss hypoglycemia in patients with type 2 diabetes Less common side effects have been noted with these drugs including allergic reactions gallstones (which can occur with a large amount of weight loss) the potential of medullary thyroid cancer You are also at risk of acute kidney injury. In rare cases, there can be serious side effects, such as pancreatitis or anaphylaxis. A list NOT to be ignored. How is Wegovy Given and Practical Considerations Wegovy (Semaglutide), is in a prefilled self-injection delivered under the skin in the arm, abdomen or thigh. 0.25 mg for a month, increasing monthly to a maximum dose of 2.4 mg in the 5th month. It takes a year to 18 months to have full effect. As with any medication, there are positives and negatives and I have spent most of the last 15 years in my clinics trying to reduce my patient’s medication lists where possible! I am aware however that some medications are beneficial, and it is a major hope that these drugs will genuinely assist in weight loss for the select individual. One thing for sure is that they do seem to be a better option than bariatric surgery which is a blog for another day! Currently, the hype is big and no doubt we will find out more as time goes by, but for now, I prefer to recommend you don’t get swept up too soon and spend extortionate amounts of money without doing the following first. Wegovy -Work with a Dietitian Obesity is a complex, chronic disease with multifactorial causes, and taking a drug and expecting life-changing weight loss is too simplistic. For those seeking to improve their health and lose weight and really stuck these drugs may be a short sharp kickstart but no more. It is clear from the research that when people stop taking Wegovy/Ozempic, they rapidly regain the weight. It is very expensive and there are important issues that need to be highlighted regarding everyday considerations like how alcohol impacts blood sugar control, fasting, health risks and other medication interactions. Verdict on Wegovy – New Diet Drug  As a Dietitian, I have been asked repeatedly about weight loss drugs. I always consider all options and for the greater good of all who may be thinking about using these and believe in working on lifestyle, diet and fitness interventions first or alongside any targeted medication. I am concerned that vulnerable people who are really in need of significant weight loss may need to stay on Wegovy indefinitely in order to maintain any weight loss achieved, and this definitely raises concerns about long-term use. As 121 Dietitian offer weight loss services it is something for you to consider. You can invest in a 121 Dietitian programme, the