2014 Summer Newsletter

NEWSLETTER

MY

Summer 2014 Volume 48

Bridging The Gap Until There Is a Cure Dr. Edelman’s Corner

INSIDE The Bionic Pancreas Page 3

Celiac vs. Non-Celiac Gluten Sensitivity Page 4

Help TCOYD Meet the Challenge Page 5

One Touch® Verio® Sync Page 6

5 Ways a Diabetes Educator Can Help You Page 8

Question of the Month Page 9

Sneaky Vegetables: Easy & Delicious Meals Page 10

Know Your Numbers Page 11

Shrimp Scampi Recipe Page 12

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’m going to tell you the bad news first. There is no cure for type 1 or type 2 diabetes and to be perfectly honest, we still have a lot of time until we will reach a cure. Type 2 diabetes is a highly hereditary condition that is most likely due to one or more defects in certain genes in our bodies that regulate our metabolic systems, including blood glucose levels. Type 1 diabetes is an autoimmune condition where the body attacks itself.

For example, when I was fifteen years old, my body produced autoantibodies that attacked the insulin producing cells in my pancreas and I developed type 1 diabetes.

Here’s the good news, and it’s very good news. Today, we have more tools than ever before to treat diabetes

successfully so that when a cure does come along you and I will be in good enough health to be recipients of that cure. No matter what type of diabetes you have, the most important thing you can do right now is to bridge the gap until there is a cure. So, you may ask, “How do I bridge the gap?” Well, that’s easy to Bridging the Gap (continued on page 2)

Bridging the Gap (continued from page 1)

Special Acknowledgements Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD Edward Beberman Christine Beebe Audrey Finkelstein S. Wayne Kay Margery Perry Daniel Spinazzola

Contributing Authors Jennifer Braidwood Brigid Boland, MD Steven V. Edelman, MD Robert Lewis, Chef Jeremy Pettus, MD

TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Jill Yapo Director of Operations Michelle Day Director, Meeting Services Michelle K. Feinstein, CPA Director of Finance and Administration Jennifer Braidwood Manager, Outreach and Continuing Medical Education David Snyder Manager, Exhibit Services Robyn Sembera Associate Manager, CME and Outreach

MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Robyn Sembera Design: Hamilton Blake Associates, Inc.

MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2014 All rights reserved.

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answer. Your main game plan should expanded toolbox. This is a vast simply be to maintain control of your improvement compared to what was blood glucose levels by effectively available not too long ago. Each of these utilizing the devices and medications FDA approved medications has its pros available to you. and cons, which are important for you For those of us with type 1 diabetes, and your caregiver to discuss together. the artificial pancreas, also called the Most of these medications can be safely bionic pancreas by some folks, has taken individually or in combination the greatest promise to bridge the gap to help you reach your glycemic goals until a real cure comes along. Be sure with minimal side effects. Plus, many of to read the article on page 3 by Dr. these new agents do not cause weight Jeremy Pettus, who is also a member of gain or hypoglycemia. They are easy and the type 1 tribe. Dr. Pettus goes more convenient to take (only once a day or in-depth about this area of clinical once weekly) and to incorporate into research. Due to the on-going clinical your day-to-day lifestyle. The main issue and technological advancements in is finding the right medications for YOU the development of as an individual and the bionic pancreas, then getting affordable Remember, lifestyle both Jeremy and I access to those modifications also play a can envision a day in big role in bridging the gap. medications. the very foreseeable Although we do Be sure a healthy diet & future where this not have a cure for frequent exercise are part technology will be diabetes, we can bridge of your toolbox! available to many of this gap, no matter us with type 1! how long it takes, by What about all of you folks with keeping ourselves healthy enough to be type 2 diabetes? All I can say is, good candidates for all future advances “WOW!” We now have the toolbox in diabetes care and management of all toolboxes for treating type 2 that may become available over the diabetes. I never thought I would say next few years. All of this work to stay this but, today, we have such a variety healthy and maintain normal metabolic of oral and injectable medications to levels (glucose, blood pressure, and control the vast majority of folks living cholesterol) will only improve our with this condition. Nine quality of life and reduce the different classes of oral chance of becoming a burden to medications, incretins our loved ones. (also called GLP-1 receptor agonists), and the newer designer insulins Steven Edelman, MD make up this incredibly Founder and Director Taking Control Of Your Diabetes

TCOYD in Motion

The Bionic Pancreas By: Jeremy Pettus, MD, Endocrinologist, UCSD, Type 1 Track Co-Director

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henever I show people my continuous glucose monitor and insulin pump, the first question that almost anybody asks me is, “Why don’t they just make your CGM talk to your pump to deliver insulin for you?” It’s a good question, considering we now have devices that can accurately deliver very specific amounts of insulin and devices that can accurately measure our blood glucose levels at all times.

However, it always seemed like a distant vision or like something out of a science fiction movie that we would eventually have a device that could automatically control glucose levels without the patient being involved at all. What I’m really talking about here is an artificial or bionic pancreas, and the good news is that such a device is becoming much more tangible than ever before.

At this year’s American Diabetes Association meeting in San Francisco at the beginning of June, researchers from Boston University presented some data on their bionic pancreas. The device is made up essentially of four already existing pieces of technology: 1) a Dexcom continuous glucose monitor that constantly measures

...the first question that almost anybody asks me is, “Why don’t they just make your CGM talk to your pump to deliver insulin for you?” the glucose level; 2) an iPhone that interprets the glucose values using a sophisticated computer algorithm and then sends, via Bluetooth, commands to two separate insulin pumps; 3) a t:slim pump, filled with insulin that is activated in response to high or rising blood glucose levels; and 4) a t:slim pump, filled with glucagon that is activated in response to low or falling glucose levels. (Figure above). To start the device, the user enters their body weight and it is up and running. No

carb ratios, insulin sensitivity factors, or basal rates required, and better yet, the device “learns” about you as it goes, making it more and more accurate.

The research group presented data using the device in both adults and in adolescents. The adults were allowed to walk around for five days in a three square mile area of Boston known as Beacon Hill and eat WHATEVER they wanted. I actually have a few friends who went through the study and took pictures of the cupcakes, juice, beer, entire pizzas, and more that they were eating, all without having to count carbs or enter an insulin dose.

The results from the study were The Bionic Pancreas (continued on page 7)

Taking Control Of Your Diabetes

3

Ask Your Doctor

Ask Your Stomach Doctor: Celiac vs. Non-Celiac Gluten Sensitivity

By Brigid Boland, MD, Gastroenterology Fellow, UCSD

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hese days it seems like you can’t wander down a grocery aisle or peruse a restaurant menu without seeing all kinds of glutenfree products. So you aren’t in the minority if you are asking yourself, “What is gluten? And should I be eating this stuff?”

Well, let’s start with the basics.

Gluten is a protein derived from wheat, rye, or barley and is present in many commonly eaten foods.

The majority of people have no difficulty whatsoever digesting and processing this protein, but in a select group of individuals, exposure to gluten can lead to health problems. It is important to understand the differences between gluten-related conditions. First, there is a serious medical condition known as celiac disease, in which exposure to gluten can lead to chronic gut inflammation and a host of associated symptoms. Celiac disease is typically diagnosed based on blood tests as well as changes on biopsies obtained during an endoscopy by a gastroenterologist.

The tests for celiac disease are most accurate when individuals are actively being exposed to gluten in their diet. Second,

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there is a recently recognized condition termed non-celiac gluten sensitivity. These patients do not have the laboratory or biopsy findings found in celiac disease; however, they may feel poorly and experience a range of symptoms when they eat gluten-containing foods.

Celiac disease, by definition, is a chronic inflammatory disease that is caused by exposure to gluten in a genetically susceptible individual.

Approximately 1% of the United States population has celiac disease; however, this incidence is higher in certain populations, such as people with type 1 diabetes. In celiac disease, an individual’s immune system attacks the small bowel and damages the portion of the gut responsible for absorbing nutrients and vitamins in a healthy state.

Individuals with celiac disease may have symptoms related to digestive problems or nutrient deficiencies, such as iron or vitamin D, but there are many non-digestive symptoms that individuals may experience, such as a rash called dermatitis herpetiformis, joint pains, neurologic symptoms, and many more. The current treatment for

Approximately 1% of the United States population has celiac disease; however, this incidence is higher in certain populations, such as people with type 1 diabetes. celiac disease is a gluten-free diet that entails avoidance of wheat, barley, and rye. By avoiding gluten, symptoms typically improve, the gut will eventually heal, and the quality of life improves. At present, there are no medications approved for celiac disease; however, medications are being tested that may allow patients with celiac disease to eat some amount of gluten without any adverse effects.

Non-celiac gluten sensitivity has recently been recognized as a distinct medical condition.

Individuals with non-celiac gluten sensitivity typically develop one or more negative symptoms after consumption of gluten containing foods; however, they do not have celiac disease. The difference is clear when the typical blood tests or biopsies performed

Giving Back

to look for celiac disease are normal. Individuals with this condition may develop a variety of frequently dramatic and debilitating symptoms that range from abdominal pain, bloating, and diarrhea to non-gut symptoms, such as headache or fatigue. People with nonceliac gluten sensitivity usually feel better when they avoid eating gluten. The cause of the symptoms these individuals experience is not well understood, and there are no blood tests that can reliably diagnosis this condition. This diagnosis is typically made after celiac disease has been excluded. Some believe that the symptoms may be a reaction to wheat proteins, rather than gluten. In spite of the differences between these conditions, the treatment for both conditions is quite similar.

Adherence to a gluten-free diet is recommended with the goal of optimizing quality of life.

If you are concerned that you or a loved one may have either celiac disease or non-celiac gluten sensitivity, you may want to discuss further with a physician.

Testing for celiac disease before eliminating gluten from your diet improves the ability to diagnose or rule out celiac disease. So before you start loading up on gluten-free breads and beer, get yourself tested for celiac disease to help make the diagnosis!

Help TCOYD Meet the Challenge!

By Jennifer Braidwood

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COYD is excited to announce that 2014 brings additional support funding from The Leona M. and Harry B. Helmsley Charitable Trust as well as a new and exciting fundraising challenge. The Helmsley Trust contribution that was monumental in the development of TCOYD’s type 1 diabetes conference track, has challenged TCOYD to raise $75,000 in NEW donations. These new donations need to be gifts of $2,000 or more and from a person, foundation, or corporation who has never given that much previously. If TCOYD can meet this challenge

by May 14, 2015, The Helmsley Charitable Trust will match it with an additional $75,000.

The new donations raised

by TCOYD will go toward the

development and expansion of a variety of TCOYD programs and initiatives including the type 1 and type 2 tracks, whereas the $75,000 match will be entirely focused towards supporting the type 1 track. “Having a track that is totally dedicated to type 1 diabetes education and a separate track dedicated to type 2 allows us to get more type-specific information about how to effectively manage diabetes straight into the hands of the people that need it the most,” said Dr. Steven Edelman, Founder and Director of TCOYD. Please donate today and be a part of TCOYD’s mission to educate and motivate people with diabetes to live happy, healthy, and productive lives.

Donations can be made online at www.tcoyd.org, Just click the ‘Giving’ tab on our homepage!

Taking Control Of Your Diabetes

5

Product Theater

Staying in Sync ...with your blood sugar results.

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he OneTouch® Verio®Sync System is a simple tool to help with your daily diabetes management. Now you can check your blood sugar results as easily as you check everything else—on your iPhone®, iPad®, or iPod touch®.

The OneTouch® Verio®Sync Meter from Lifescan, Inc. uses Bluetooth® technology to wirelessly send blood sugar results to these devices using the OneTouch Reveal® mobile app (available for free from the App StoreSM).

“When you consider how many of us rely on our smartphones on a daily basis, managing chronic illnesses such as diabetes is a promising area for mobile health applications,” said Jeremy Pettus, MD, UCSD Department of Endocrinology. “It’s exciting to

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see true wireless communication brought to blood glucose monitoring. By helping patients to easily access, understand, and share their blood sugar data via their iPhones, a system like the OneTouch® Verio®Sync can help lead to better self-management and more productive conversations with their healthcare professionals.”

Results at a Glance From the OneTouch Reveal® mobile app’s 14-Day Summary, you can see your key information at a glance, including the percentage of results within, above, and below your personalized target ranges as well as your 14-day average.

The app also features a 90-day electronic logbook that automatically displays results.

Additional features include the ability to manually enter and view carbohydrates, physical activity, and medication(s).

Share How You’re Doing Users can text or email key information with healthcare professionals, caregivers, or family members using the OneTouch Reveal® mobile app’s data sharing feature.

The OneTouch® Verio®Sync Meter uses OneTouch® Verio® Test Strips, which have the lowest co-pay on the most health plans.* The meter can be purchased directly from ShopOneTouch.com, as well as other online retailers, such as Walgreens, CVS, RiteAid, and Walmart.

Your Special TCOYD Discount

*Some health plans may have more than one test strip covered at the lowest co-pay.

Apple, the Apple logo, iPhone, iPad, and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc., and any use of such marks by LifeScan, Inc. is under license.

Stay In Touch with TCOYD

B

e sure to “like” us on Facebook. By joining our online community you will be closely connected to TCOYD, others who have diabetes, and get the latest and greatest updates on

diabetes care and management.

Find us on Facebook today and say hello! We would love to hear from you.

The Bionic Pancreas (continued from page 3)

impressive and recently reported in the New England Journal of Medicine, showing that subjects using the bionic pancreas had lower glucose levels and less hypoglycemia compared to before they went on the device. However, maybe even more importantly, the users were relieved of the burden of diabetes for just a small sliver of time and had a chance to remember what it was like to drink juice just for the taste, or exercise without worrying about going low.

Those of us living with type 1 can’t imagine what that must feel like, and the prospect of having a device like this is really amazing.

The goal of the research team at Boston University is to have this device in front of the FDA for approval by 2017 (read more at http://www.artificialpancreas.org).

There are still some obstacles to overcome for sure. Currently, the glucagon used in the pumps is only stable for 24 hours and has to be changed every day. It is also incredibly expensive. The system requires multiple devices to be worn, which may be overwhelming to some people, especially children.

That being said, devices such as this are bringing some long overdo excitement into the type 1 diabetes world. It’s exciting to think that we might actually have something in the near future that could help us live an even more normal life while we wait for a true cure.

Taking Control Of Your Diabetes

7

Taking Control

a Diabetes Educator Can Help You Article provided by Diabetic Living Magazine

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our doctor might not always have time to talk to you about diabetes specifics. Working with a certified diabetes educator (CDE) can ease the big learning curve that comes with a new diagnosis or help refresh your efforts if you’ve had diabetes for years. Typically, CDEs have more time to really listen to you and address your questions, concerns, fears, and any barriers that could potentially be hindering you from living your best life with diabetes.

Here are just a few ways that a diabetes educator can help you:

1. Master your medications.

“A diabetes educator can help you understand what your medication does, how it works in your body, why and when you should take it,” says Dawn Sherr, RD, CDE, practice manager at the American Association of Diabetes Educators (AADE). Knowing why your caregiver has prescribed a medication and being informed

and knowledgeable about your medication regimen, ultimately leads to better adherence and better blood sugar control.

Develop a plan that 2.

works best for you.

Managing your diabetes well is about making your management plan fit into your life, not the other way around. Barbara Walz, RN, CDE, diabetes study coordinator at South Texas Veterans Health Care System in San Antonio, suggests

planning ahead to make eating healthful foods easier. “One of my patients was constantly on the go, and he would grab whatever was easiest. We worked on preplanning on Sunday nights. Now he buys five pre-packaged, healthy meals to eat during the week,” Walz says. Remember, there isn’t one surefire plan that works for everyone, so be creative and design a system that fits nicely into your day-to-day lifestyle!

Does Insurance Cover Education?

Yes. Most private insurers follow what Medicare covers, which is ten hours of education during the first 12 months after diagnosis and then two hours every year thereafter, according to the American Association of Diabetes Educators (AADE). Just be sure to check who is conducting the diabetes education.

Medicare requires that the education program be accredited by either the AADE (diabeteseducator.org) or the American Diabetes Association (diabetes.org). You can also find a diabetes educator in your area by visiting diabeteseducator.org.

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Question of the Month

3. Create coping strategies.

The stress and emotional toll placed on you by the demands of diabetes require a backup plan when diabetes burnout hits. An educator plays many roles, and one is being a support person to listen to your frustrations and help you find solutions to problems you are encountering.

4. See all your options.

Healthful choices aren’t about denying yourself or forcing yourself to do something, they’re about modest modifications to make things work a little better. “One man paid to go to the gym three times a week but dreaded going,” Walz said. “One day he realized that the elderly women on his block hired people to do yard work. Now, instead of paying for the gym, he helps his neighbors by raking their leaves, watering their plants, and mowing their lawns and he gets his exercise, too.”

5. Set realistic goals.

End-result goals can seem too large to achieve. An educator can help you break down a large goal into smaller goals and identify what you can do now to reach your big-picture goal.

Self-managing your diabetes is an around-the-clock job that can be extremely overwhelming, especially if you are newly diagnosed. A diabetes educator can serve as a pivotal component to lasting self-care. So, do yourself a favor and find a good educator to have in your corner.

By Steven Edelman, MD

I

am a 56 year old female and my doctor sent me a letter regarding my recent lab tests stating I have type 2 diabetes. My doctor also said that he wants to start me on a medication called metformin. Needless to say, I am shocked about getting this diagnosis. I am also irritated and upset that I was notified by mail about my diagnosis and that I need to start a new drug, all of this without any face-to-face conversation with my doctor. He also told me to, “watch my diet and start exercising.”

I am pretty upset. I have a lot of questions about metformin safety. I have been reading on the Internet that it may cause kidney damage.

This worries me very much.

Answer: Well, I must say that, unfortunately, medicine is getting more and more impersonal, especially with the limited time a caregiver is allowed to spend with each patient. In any case, metformin is a really good first medication for folks like you who are newly diagnosed. It is not supposed to be used in people who have kidneys that are not working at 100% because the levels of metformin build up and can cause a rare condition called lactic acidosis, which can be dangerous. The medication itself causes absolutely no harm at all to the kidneys. No caregiver would use a medication that causes kidney damage in people with diabetes and the FDA would not have approved it in the first place. Good luck and come to a TCOYD conference!

A special thanks to all of our Facebook fans who sent in questions for Dr. Edelman!

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Taking Control Of Your Diabetes

9

Living Well

Sneaky Vegetables: Easy & Delicious Ways to Incorporate Veggies Into Your Meals Article provided by dLife

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ny nutritionist will tell you that eating plenty of vegetables is the cornerstone of good health. After all, they are loaded with vitamins, antioxidants, and the necessary dietary fiber to help control blood sugar numbers. In fact, in a recent Pennsylvania State University study, adults who consumed meals that incorporated more veggies took in up to 357 fewer calories throughout the day and that translates into losing three pounds a month.

But, reaching your daily quota doesn’t mean you have to resort to nibbling on dry salads and choking down carrot and celery sticks. The trick is to find ways to seamlessly sneak vegetables into some of your favorite dishes.

Here’s proof that getting those extra servings can be easy and delicious.

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Well Dressed replace half of the pasta you’d Top your veggies with more veggies and give your diet an added dose of the antioxidant vitamin C. Make a vinaigrette by blending jarred roasted red sweet peppers, extra virgin olive oil, red wine vinegar, and a garlic clove.

Red Riot Skip the red food coloring. Cooked and pureed beets are easy to make and add splendid color to baked goods like brownies without tasting “beety.” Naturally sweet, beets help to cut the need for added sugar and provide moisture in lieu of adding fat.

Perfect Pasta Peel two zucchinis and slice them into planks lengthwise.

Cut the planks into long thin strips. When making spaghetti,

normally serve with these zucchini “noodles.” Add them to the pasta water during the last two minutes of cooking.

Magical Mushrooms When making meat loaf or burgers, swap half of the ground meat for chopped mushrooms. The result is a moist burger and hefty calorie and fat savings (mushrooms contain one-sixth the calories of extra-lean ground beef).

Spread the Love Punch up your sandwich spread by blending reduced-fat mayonnaise with cooked frozen broccoli florets in a food processor.

Add more flavor to the mayo mix with lemon juice, garlic, fresh basil, and Dijon mustard.

Orange Crush Stir pumpkin puree into cooked oats for a deliciously creamy start to the day. The vivid orange color is a clue that pumpkin provides

Know Your Numbers

a payload of beta-carotene, an antioxidant that converts to vitamin A to bolster eye, bone, and immune health.

Better Breakfast Give your morning scrambled eggs or omelet a taste of sunshine by tossing in a handful of chopped sun-dried tomatoes for a source of the disease-thwarting antioxidant lycopene.

Whip It Good Smoothies can be a great way to sneak in more nutritionallycharged dark leafy greens, such as spinach and kale. When blended with sweet and tangy foods, such as frozen berries and Greek yogurt, their flavor will blend right in, so to speak.

Mash It Up For a low-glycemic riff on mashed potatoes, steam the florets from a head of cauliflower and place in a food processor along

By Steven Edelman, MD

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his logbook comes from a 59 year old man with type 2 diabetes on combination therapy (metformin, Januvia, and 45 units of Lantus taken at bedtime), which is normally at 10:30pm. On some mornings, his number looks great. But why did he awaken twice over the past week with a high blood glucose and then have a higher than usual number during the rest of the day?

The answer is that on the nights before the mornings with high values, he fell asleep on the couch and did not take his bedtime Lantus injection. If this is a problem for you, it is perfectly fine to take your Lantus in the morning instead of at night. Please check with your caregiver first before making any changes!

with olive oil, fresh thyme, smoked paprika, salt, and black pepper. Blend it into a smooth and flavorful side dish.

Under Wraps To cut down on carbs and up your vitamin intake, use large lettuce leaves, such as romaine or Bibb, instead of flour tortillas for wrapping up your lunchtime

sandwich. Or use the green giants in place of corn shells to add a twist to taco night.

Challenge yourself to incorporate more veggies into your diet. Try searching the web for some additional ideas on healthy snacks and side dishes. There are so many options out there and remember that eating healthy can still be delicious!

Taking Control Of Your Diabetes

11

TCOYD Conferences & Health Fairs 2014 Schedule

Taking Control Of Your Diabetes 1110 Camino Del Mar, Suite “B” Del Mar, CA 92014 | www.tcoyd.org

Nonprofit Organization U.S. Postage

February 8 Native American,

Pala, California

March 8 Sacramento, California

April 12 Honolulu, Hawaii

May 17 Raleigh, North Carolina

Tel: (800) 998-2693

(858) 755-5683 Fax: (858) 755-6854

PAID

San Diego, CA Permit No 1

June 7 Washington, DC September 6 Missoula, Montana

September 27 Des Moines, Iowa

October 18 Amarillo, Texas November 8 San Diego, California

Stay connected to TCOYD, visit www.tcoyd.org

TCOYD is a not-for-profit 501(c)3 charitable educational organization.

Happy Diabetic Shrimp Scampi

Calories: 57 Total Fat: 5.73g Total Carbs: 1.59g Dietary Fiber:0.45g Sugars: 0.60g Protein: 0.27g

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Ingredients:

1 large tomato 2 ounces feta cheese 4-5 sprigs of fresh basil 4 tablespoons virgin olive oil

1 pound large fresh or cooked shrimp 1 clove of garlic, minced Squeeze of fresh lime 1/4 teaspoon freshly ground black pepper to taste

Wash and slice the tomato crosswise into 1/2-inch-thick slices.

Arrange 4 slices on a large salad plate. Sprinkle the feta cheese on top of each tomato. Cut fresh basil leaves into strips and sprinkle on top of the tomatoes. Heat the olive oil in a pan and add the garlic and shrimp; cook until done. If you are using cooked shrimp it should take about 3 minutes. If you are using raw shrimp it should take about 5-6 minutes.

Place the cooked shrimp on the tomatoes and drizzle the garlic and olive oil mixture over the cheese and shrimp. Add a dash of pepper and a squeeze of fresh lime. Serves 4.

Chef Robert Lewis, ‘The Happy Diabetic’ was diagnosed with type 2 diabetes in 1998. Chef Lewis has published three cookbooks – Cook Fresh, Live Happy; Get Happy, Get Healthy; and Simply Desserts.