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Understanding Cholesterol and Heart Disease

WHAT IS CHOLESTEROL?

Cholesterol is a waxy, fat-like substance made in the liver and other cells. It is also found in certain foods, like dairy products, eggs and meat.

We often undeniably, hear about cholesterol with all its negative connotations especially in regards to heart disease and strokes.

What we fail to hear though, is that cholesterol is not all bad and it has earned its rightful place in the human body as well.

The body needs cholesterol in order to function properly. It is a precursor of hormones such asprogesterone, cortisol, aldosterone, testosterone, oestrogens and vitamin D. All these are very essential to a healthy functioning body.

This essential biological function of cholesterol has been forgotten by the medical world at large, instead, cholesterol has managed earn a bad reputation in the field of medicine due to its ability to form plaques on blood vessel walls, particularly in the heart and brain. 

These plaques are commonly the triggers for heart attacks and strokes.

Cholesterol traverses the blood attached to a protein – called a lipoprotein molecule.Lipoproteins have different classes. The amount of protein a cholesterol molecule contains, determines its class.

A high ratio of protein makes the molecule more dense and this is usually known as the HDL (high density lipoprotein), due to its density, it is unable to carry too much fat.

A lower ratio of protein will be less dense and carry more triglycerides (fat). This is called the LDL (Low density lipoprotein). 

These classes can be further differentiated into:

  • Very low density lipoprotein (VLDL),
  • Intermediary density lipoprotein (IDL) and
  • Low density lipoprotein (LDL)
  • High density lipoprotein (HDL)

This article intends to bring forward some very important markers of cholesterol testing with special attention to LDL or ‘bad’ Cholesterol and your underlying genes.

The specialised testing that is available, informs the individual in more detail, about their LDL cholesterol types and particle numbers in relation to their risk in developing heart disease or stroke.

WHAT IS LDL CHOLESTEROL?

LDL

Low Density Lipoprotein Cholesterol (LDL- C)particles are the main ones involved in carrying cholesterol and fat in the blood.

LDL delivers its cholesterol to the cells in the body by binding to a receptor on the surface of cells called the “LDL receptor”. Too much LDL cholesterol floating around in the blood stream is not desirable as it can slowly build up within the inner walls of the arteries if the endothelium is inflamed and unhealthy. Most arteries will be affected but the ones supplying blood to the heart and brain are most vulnerable.

When LDL-C levels are high especially in high risk individuals, like in smokers, hypertensive or diabetic individuals, the build-up of plaques happen quicker in the arteries because they have an unhealthy endothelium. This condition is called  ATHEROSCLEROSIS. If the plaque is deemed unstable and there is a tear on the surface of the plaque, then a thrombus or clot may form, which further obstructs the flow of blood to the heart or brain, causing the dreaded heart attack or stroke.

As important as cholesterol is in causing plaque formation, they are all not the same. Instead, the focus should be on the LDL-C particle size, number, and the dangers of oxidised LDL-C rather than the total cholesterol level.
A quick way to remember LDL as the BAD Cholesterol is L for LDL, L for “Lousy Cholesterol”.

WHAT IS HDL CHOLESTEROL?

High Density Lipoprotein Cholesterol (HDL-C) is responsible for transporting cholesterol from all the different parts of the body to the liver.

HDL is also responsible for removing excess cholesterol from atherosclerotic plaques in the arterial walls. This in turn slows down the growth of plaques. Here, elevated levels of HDL-C is known to be protective against heart attacks whereas low HDL-C levels confer the opposite affect and is undesirable.

HDL-C molecules also have preferential particle sizes and numbers but their impact in terms of atherosclerosis is not so critical as LDL-C.

As a rule, it is good to make sure HDL-C is never low.

A quick way to remember HDL as the GOOD cholesterol is H for HDL, H for “Healthy cholesterol”

WHAT IS VLDL AND IDL CHOLESTEROL?

LDLs

Very Low Density Lipoprotein (VLDL-C) contains the highest amount of triglycerides and lowest amount of protein. Therefore it is the most dangerous form of LDL-C. VLDL-C eventually gets converted to LDL-C after it releases most of the triglycerides present in the molecule.

Triglycerides themselves are independent risk indicators of heart disease. Their description and role needs special attention, as excess carbohydrates in the diet play a prominent role. This is why diabetics with poor diet control are at very high risk for atherosclerosis.

High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.

There is no simple direct way to measure VLDL cholesterol, which is why it is normally not mentioned during a routine cholesterol screening.

Intermediate Density Lipoprotein Cholesterol (IDL – C) is formed from the degradation of Very Low Density Lipoproteins (VLDL). IDL enables fats and cholesterol to move within the water-based solution of the bloodstream.

As a rule, IDL-C falls in between VLDL-C and LDL-C. Hence it is equally atherogenic and contributes to the formation of plaques.

Collectively, LDL, IDL and VLDL are all known as non HDL-C molecules and and on your lipid profile results will just be counted as LDL-C.
The best way to lower your VLDL cholesterol is to lower your triglycerides.

I DO MY CHOLESTEROL TEST EVERY YEAR.  WHAT DOES THAT TELL ME?

The screening test that is usually performed is a blood test called a Lipid profile. Anyone in the adult age group can check their levels.

It is recommended that every individual with risk of cardio-vascular illnesses and other chronic lifestyle diseases like diabetes and hypertension should frequently assess their lipid levels as often as twice a year.

You can test your LDL-C and HDL-C levels at annual check- ups at hospitals or clinics by doing a routine Lipid Profile Test.  From this test you can calculate two ratios that are useful.  Commonly reported is the Tot CHOL: HDL ratio, which should be less than 5:1.

Functional medicine doctors also calculate the Triglycerides : HDL which are ideal at levels of  2:1.

It is a good first-level test to determine where you stand.

However, the actual detailed testing of particle size and numbers of LDL-C is not routinely tested.

WHAT IS THE IMPORTANCE OF THE PARTICLE SIZE OF LDL-C?

‘Small’ LDL-C molecules that are dense and gritty will hurt the vessel walls if the endothelium /lining of the walls are already unhealthy. This embedding of cholesterol to heal the cracks on the walls is the beginning of plaque formation.

‘Large’ LDL-C molecules are big and fluffy enough to bounce off the vessels walls, and contribute less to damage and atherosclerosis. The health risk is lower for those who have large LDL-C.

Small, dense and therefore dangerous LDL-C particles may be concealed behind normal cholesterol levels. This means that although your LDL-C may be normal, there still may be some risk of coronary disease because of a predominance of small, dense, LDL-C.

Conversely, elevated LDL-C levels need not always be associated with a higher risk of plaque formation if you have the large fluffy particles of LDL-C.

This partially explains why some individuals with high LDL-C do not succumb to coronary plaques while some others with normal levels do.

WHEN SHOULD I TEST FOR THE LDL SUB-FRACTIONS?

It is increasingly useful to do additional tests when assessing risk in people who have the following high risk factors:

  • Cigarette smoking
  • Hypertension (BP > 140/90 mmHg or on antihypertensive medication)
  • High LDL cholesterol (>2.58mmol)
  • Low HDL cholesterol (< 1mmol)
  • Family history of premature chronic heart disease (CHD). Specifically: CHD in first-degree male relative < 55 years; or CHD in first-degree female relative < 65 years.
  • men > 44 years; or women > 54 years
  • Clinical coronary heart disease, symptomatic carotid artery disease, peripheral arterial disease, or abdominal aortic aneurysm.

The LDL-C Sub-Fraction Test also known as the LDL Particle Test (LDL-P), can determine more accurately the cardiovascular risk presented by your LDL-C levels, than a regular lipid profile.

Traditional lipid profiles do not identify and determine the presence of small dense type LDL-C that causes blockage of the blood vessels.

The LDL-C Sub-fraction test actually looks in detail into the types of LDL-C molecules that are prominent in an individual and quantifies it.

This test is not routinely ordered, but its use is important as it has the potential to predict the development of coronary vessel disease, so that preventive steps can be put in place much earlier than they otherwise may have.

HOW WILL GENETIC TESTING GIVE ME MORE INFORMATION?

Genetic testing can be done to identify your genetic susceptibility to cardiac related diseases and conditions.

Familial hypercholesterolemia is an inherited condition characterised by higher than normal levels of LDL blood cholesterol. Individuals with this inherited condition usually have very high cholesterol levels and fall prey to the disease at a much younger age, usually before 50 years.

These people can benefit from specialised testing as aggressive strategies may be needed to control the dangerous LDL-C sub-fractions.

There are also other genes involved in cholesterol regulation, found in Asian and Western populations. The presence of these genetic mutations can say a lot about their heart health risk. These gene mutations also give more insight into why some of us are at risk to have the more dense and dangerous LDL-C.   Some of these genes are:

LDLss

  • APOE (Apolipoprotein E),
  • CETP (Cholesteryl Ester Transfer Protein)
  • SELE (selectin E)

Understanding the above genes explains why certain individuals will benefit from dietary strategies, whilst others do better on exercise.  They also tell us why some of us respond to statins (cholesterol lowering agents) in a negative way while some of us respond well.

If you have a family history of heart disease, you most probably would have inherited at least some high risk genes. Therefore it is crucial to know exactly where your weaknesses are, so that personalised targeted interventions can be put in place.

HOW CAN FUNCTIONAL MEDICINE HELP ME?

Everyone is biochemically unique – this is the very essence of Functional Medicine.  Because of that, the same treatment strategies cannot be successfully used be everyone, rather strategies need to be tailored to the individual.

Elements Medical Fitness uses the Functional Medicine model of healthcare in approaching all chronic health problems. If you have a strong family history of heart disease or if you feel that you are at risk for heart disease because of your current state of health and lifestyle, then Functional Medicine can help you understand your personal risk.

Come in for a discussion with our practitioners and Functional Medicine doctors.  Our practitioner team will ensure that the ‘RIGHT’ Cholesterol tests are done, so that you get the answers that you need.

Remember: It is not just about having lower cholesterol; it is about having the right type of cholesterol.

“The INTERHEART study, published in the Lancet in 2004, followed 30, 000 people and found that changing lifestyle could prevent at least 90% of all heart disease.”

 

 

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Why Functional Medicine?

Society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis. The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as a heart attack or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom.

Unfortunately, the acute-care approach to medicine is ill equipped to address complex, chronic disease. In most cases, the model does not take into account the unique genetic makeup of each individual and does not allow time for exploring the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease; critical environmental factors such as stress, diet, and exposure to toxins. As a result, most physicians are not adequately trained to assess the underlying causes of complex, chronic disease, nor to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.

Functional Medicine is a different approach, with methodology and tools that are specifically designed to prevent and treat chronic diseases.

When people ask to see the evidence for Functional Medicine, they often mean, “Where are your research trials, comparing Functional Medicine to conventional medicine in a clinical setting?” Unfortunately, current research models do not have a way to test each individualized, patient-centered therapeutic plan that is tailored to a person with a unique combination of existing conditions, genetic influences, environmental exposures, and lifestyle choices. Clinical trials do play a significant role in evaluating and comparing the efficacy of new pharmaceutical treatments, especially when it is important to rule out placebo effects, but they have many inherent limitations which constrain their ability to inform clinical decision making.

Fortunately, there is a vast array of evidence supporting the Functional Medicine approach to care. The scientific community has made incredible strides in helping practitioners understand how environmental and lifestyle influences, moving continuously through an individual’s genetic heritage, psychosocial experiences, and personal beliefs, can impair basic biological functions. Using that knowledge to find the sources of each patient’s problems is powerful science!

Scientific support for the Functional Medicine approach to treatment can be found in a large and rapidly expanding evidence base concerning the therapeutic effects of nutrition (including both dietary choices and the clinical use of vitamins, minerals, and other nutrients such as fish oils); botanicals; exercise (aerobics, strength training, flexibility); stress management; detoxification; acupuncture; manual medicine (massage, manipulation); and mind/body techniques such as meditation, guided imagery, and biofeedback.

Medical science has recently provided strong evidence that the relationship between patient and clinician has a powerful effect on patient health outcomes. The Functional Medicine focus on the therapeutic partnership is clearly an important part of how patients heal.

Making effective healthcare choices involves the Functional Medicine clinician and patient in a relationship where information and belief, attention and insight, communication and trust all have value. Functional Medicine practitioners are taught how to craft a personalized, systems-oriented therapeutic plan for each unique patient using evidence and insight, art and science.

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How Functional Medicine Changes the Way We do Medicine

Society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis. The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as a heart attack or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom.

Unfortunately, the acute-care approach to medicine is ill equipped to address complex, chronic disease. In most cases, the model does not take into account the unique genetic makeup of each individual and does not allow time for exploring the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease; critical environmental factors such as stress, diet, and exposure to toxins. As a result, most physicians are not adequately trained to assess the underlying causes of complex, chronic disease, nor to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.

Functional Medicine is a different approach, with methodology and tools that are specifically designed to prevent and treat chronic diseases.

When people ask to see the evidence for Functional Medicine, they often mean, “Where are your research trials, comparing Functional Medicine to conventional medicine in a clinical setting?” Unfortunately, current research models do not have a way to test each individualized, patient-centered therapeutic plan that is tailored to a person with a unique combination of existing conditions, genetic influences, environmental exposures, and lifestyle choices. Clinical trials do play a significant role in evaluating and comparing the efficacy of new pharmaceutical treatments, especially when it is important to rule out placebo effects, but they have many inherent limitations which constrain their ability to inform clinical decision making.

Fortunately, there is a vast array of evidence supporting the Functional Medicine approach to care. The scientific community has made incredible strides in helping practitioners understand how environmental and lifestyle influences, moving continuously through an individual’s genetic heritage, psychosocial experiences, and personal beliefs, can impair basic biological functions. Using that knowledge to find the sources of each patient’s problems is powerful science!

Scientific support for the Functional Medicine approach to treatment can be found in a large and rapidly expanding evidence base concerning the therapeutic effects of nutrition (including both dietary choices and the clinical use of vitamins, minerals, and other nutrients such as fish oils); botanicals; exercise (aerobics, strength training, flexibility); stress management; detoxification; acupuncture; manual medicine (massage, manipulation); and mind/body techniques such as meditation, guided imagery, and biofeedback.

Medical science has recently provided strong evidence that the relationship between patient and clinician has a powerful effect on patient health outcomes. The Functional Medicine focus on the therapeutic partnership is clearly an important part of how patients heal.

Making effective healthcare choices involves the Functional Medicine clinician and patient in a relationship where information and belief, attention and insight, communication and trust all have value. Functional Medicine practitioners are taught how to craft a personalized, systems-oriented therapeutic plan for each unique patient using evidence and insight, art and science.

Click here to read the complete article on the Evidence for Functional Medicine, including references and resources.

 

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Do blue views beat green ones for stress relief?

Being able to see the ocean from your home may reduce stress, new research finds.

“Increased views of blue space is significantly associated with lower levels of psychological distress,” says Amber L. Pearson, assistant professor of health geography and a member of Michigan State University’s Water Science Network. “However, we did not find that with green space.”

Using various topography data, the researchers studied the visibility of blue and green spaces from residential locations in Wellington, New Zealand, an urban capital city surrounded by the Tasman Sea on the north and the Pacific Ocean on the south. Green space includes forests and grassy parks.

ocean through sunglasses
(Credit: Forsaken Fotos/Flickr)

To gauge psychological distress, the researchers analyzed data from the New Zealand Health Survey. The national survey used the Kessler Psychological Distress Scale, or K10, which has proven to be an accurate predictor of anxiety and mood disorders. Mental health disorders are the leading cause of disability worldwide, according to the World Health Organization.

Even after taking into account residents’ wealth, age, sex, and other neighborhood factors, the study found that having a view of the ocean was associated with improved mental health.

Pearson says that visibility of green space did not show the same calming effect. That could be because the study did not distinguish between types of green space.

[90 minutes in nature really change the brain]

“It could be because the blue space was all natural, while the green space included human-made areas, such as sports fields and playgrounds, as well as natural areas such as native forests,” Pearson says. “Perhaps if we only looked at native forests we might find something different.”

Like most wealthy countries, New Zealand is highly urbanized, meaning effective city planning is increasingly important, Pearson says. Designating a proportion of high-rise buildings or affordable homes in locations with ocean views could potentially promote mental health.

Pearson says future research could investigate whether the findings hold true for large fresh bodies of water such as the Great Lakes.

The study appears in the journal Health & Place.

Source: Michigan State University

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Your smoking is killing your pets

If you cannot quit smoking for the sake of your family’s health (or yours), then perhaps you would do it for Kitty, or Rover.

Researchers have found that smoking is bad for pets too. There is even an ongoing study of second-hand smoke on dogs and cats conducted by the University of Glasgow.

Research under way at the Scottish institution has found that pets living in a smoky environment have a higher risk of health problems including some animal cancers, cell damage and weight gain.

“Pet owners often do not think about the impact that smoking could have on their pets,” says Clare Knottenbelt, professor of small animal medicine and oncology.

She goes on to say that the finding so far show that smoking in your home has a direct impact on your pets, which includes serious health risks such as cell damage and increased weight after castration. For the latter, the weight gain has been shown to increase the risk of your pet to develop certain types of cancer.

If you love them, don't smoke around them.

If you love them, don’t smoke around them.

If you have cats, then they are more at risk, says the study. Dogs can take in significant amounts of smoke. “This may be due to the extensive self-grooming that cats do, as this would increase the amount of smoke (chemicals) taken in to the body,” says Knottenbelt.

The research so far has found that while outdoor access made little difference for cats, smoking away from them did reduce the amount taken into the body.

It has found that when smokers light up fewer than 10 times a day, nicotine levels dropped significantly, but were nonetheless noticeably higher than in cats from non-smoking homes.

An examination of the testicles of castrated dogs found that a gene, which acts as a marker of cell damage, was higher in dogs living in smoking homes.
Dogs living with a smoker also gained more weight after neutering. – AFP Relaxnews

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Stressed kids eat even when they’re full

PENN STATE / JOHNS HOPKINS (US) — Children who overreact to stressful situations will eat even if they’re not hungry, raising their risk of becoming overweight or obese, a new study shows.

“Our results suggest that some children who are at risk of becoming obese can be identified by their biological response to a stressor,” says Lori Francis, associate professor of biobehavioral health at Penn State. “Ultimately, the goal is to help children manage stress in ways that promote health and reduce the risks associated with an over- or under-reactive stress response.”

For a new study published in the journal Appetite, Francis and her colleagues, Elizabeth Susman, professor of biobehavioral health, and Douglas Granger, director of the Center for Interdisciplinary Salivary Bioscience Research at Johns Hopkins University, recruited 43 children ages 5- to 9-years-old and their parents.

[sources]

To examine the children’s reactions to a stressor, the team used the Trier Social Stress Test for Children, which consists of a five-minute anticipation period followed by a 10-minute stress period.

During the stress period, the children were asked to deliver a speech and perform a mathematics task. The team measured the children’s responses to these stressors by comparing the cortisol content of their saliva before and after the procedure.

The researchers also measured the extent to which the children ate after saying they were not hungry using a protocol known as the Free Access Procedure. The team provided the children with lunch, asked them to indicate their hunger level and then gave them free access to generous portions of 10 snack foods, along with a variety of toys and activities. The children were told they could play or eat while the researchers were out of the room.

The team found that, on average, the children consumed 250 kilocalories of the snack foods during the Free Access Procedure, with some consuming small amounts (20 kilocalories) and others consuming large amounts (700 kilocalories).

“We found that older kids, ages 8 to 11, who exhibited greater cortisol release over the course of the procedure had significantly higher body-mass indices [BMI] and consumed significantly more calories in the absence of hunger than kids whose cortisol levels rose only slightly in response to the stressor,” Francis says.

“We also found that kids whose cortisol levels stayed high—in other words, they had low recovery—had the highest BMIs and consumed the greatest number of calories in the absence of hunger.”

The study suggests that children who have poor responses to stressors already are or are at risk of becoming overweight or obese. In her future work, she plans to examine whether children who live in chronically stressful environments are more susceptible to eating in the absence of hunger and, thus, becoming overweight or obese, Francis says.

“It is possible that such factors as living in poverty, in violent environments, or in homes where food is not always available may increase eating in the absence of hunger and, therefore, increase children’s risk of becoming obese.”

The Children, Youth and Families Consortium at Penn State and the National Institutes of Health provided funding for this research.

Source: Penn State

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Runners, you need more vitamin D to prevent injuries

An study reports that active individuals who enjoy high-impact sports such as running may need higher vitamin D levels to reduce the risk of stress fractures.

If you practise sport regularly and you prefer high-impact activities, this latest study, published in the Journal of Foot & Ankle Surgery, advises you to monitor your vitamin D levels in order to avoid stress fractures.

Vitamin D is found mainly in oily fish such as sardines and mackerel, calf’s liver, eggs and cod-liver oil.

Vitamin D is an essential nutrient which can behave like a hormone. It is derived from food and the skin’s exposure to sunlight. It is essential for bone development and regeneration to ensure appropriate bone density. If you have low levels of vitamin D, you have an increased risk of developing osteoporosis – a condition in which the skeleton becomes brittle due to a reduction in bone mass – and stress fractures.

The researchers discovered that these risks were higher with people who practised high-impact sports such as running, tennis, skipping and step. A stress fracture occurs when too much pressure is placed on the same spot on a bone over a long period of time. For example, an ankle or foot bone fracture in a runner.

The researchers noted the vitamin D levels of people with confirmed stress fractures. “By assessing the average serum vitamin D concentrations of people with stress fractures and comparing these with the current guidelines, we wanted to encourage a discussion regarding whether a higher concentration of serum vitamin D should be recommended for active individuals,” explained Dr Jason R. Miller, the study’s lead author.

Vitamin D is found mainly in oily fish such as sardines and mackerel, calf's liver, eggs and cod-liver oil.

Vitamin D is found mainly in oily fish such as sardines and mackerel, calf’s liver, eggs and cod-liver oil.

Over a period of three years, the researchers noted the vitamin D levels of patients who felt pain in their feet and ankles from suspected fractures. They had MRI scans of the parts of the body in question.

No acute fractures were noted. However, based on previous physical examinations and a precise review of the images, the radiologists were able to discover stress fractures.

A stress fracture is not a classic fracture that occurs after a sharp blow, but rather a small crack of the bone caused by significant repeated strain.

After 3 months, blood samples were taken and the results showed that over 80% had insufficient or deficient vitamin D levels, based on the standards recommended by the Vitamin D Council (40 to 80ng/ml).

Based on this research, Miller and his team recommend a vitamin D level of at least 40ng/ml to provide protection from stress fractures, particularly for active individuals who enjoy high-impact activities.

These results support the findings of a previous study in which 600 female Navy recruits were shown to have a greater risk of stress fractures of the tibia and fibula with a vitamin D level of less than 20ng/ml, compared to women with levels above 40ng/ml.

However, vitamin D is not the only factor responsible for stress fractures: “We recommend that individuals who regularly exercise or enjoy participating in higher impact activities should be advised on proper and gradual training regimens to reduce the risk of developing a stress fracture”, advises Miller. – AFP Relaxnews

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