April 2016

Screen Shot 2015-12-11 at 22.20.36Screen Shot 2016-02-07 at 12.50.01

As diabetes type 2 is the more common version, that’s what we will talk about here. For more info about diabetes 2, see [1].

Whenever we eat carbs – in fruit, veg and grains – the digestive system turns them into glucose. Glucose is the fuel that all your cells need to produce energy: it is essential for life. Even so, it’s not easy for the glucose to enter the cells. For that, insulin is needed, a hormone produced by the pancreas after every meal.
When insulin reaches the cells, it acts like a key that opens a lock for glucose to gain access.
If the digestive system creates glucose slowly, moderate levels of insulin are released. They have time to ‘think’ about where that glucose is needed most and send it there.
However, if too much glucose is produced, this is bad for us.. When lots of it enters the bloodstream, the pancreas releases huge amounts of insulin, which quickly transfer glucose to the fat stores where it can do no harm, only weight gain results.

In the case of type 2 diabetic people, the insulin doesn’t work properly anymore: the ‘lock’ on their cells is jammed. This is called insulin resistance.
When the cells don’t get their fuel, fatigue and dizziness result. Increased nighttime urination, thirst and appetite; weight gain or loss, or blurred vision, are just some of the early symptoms. [4]

The sugar which remains in the bloodstream becomes toxic and causes cell damage [2]. This contributes to aging and furring of the arteries and, eventually, all sorts of dangerous complications. [3]
As the insulin is not working as it should, the pancreas increases production to the point that the cells become exhausted and stop producing it.
For more details, see the excellent http://web.archive.org/web/20141024030926/http://www.foods-healing-power.com/types-of-diabetes.html.
So what can we do?

EAT:
omega 3 (in fatty fish such as wild salmon, sardines, anchovies, etc.).
fiber (wholegrains, veg, fruit skins, nuts, seeds).
lots of vegetables and fruit
fat: high-fat dairy is good for you! [5]
whey, see [6]
chromium, see [7]
virgin coconut oil, apparently: see [8]
cider vinegar [9]
for food and supplements, see also [10]

You will benefit, for instance, from the following:
apple, avocado, barley, beans, berries, broccoli, brussels’, chicory, fenugreek, nuts, onions, garlic, tea, turmeric, quality vinegar, bay leaves, green beans, buckwheat, bulghur, oats, prunes, spinach, kale, cabbage, whole grains, sweet potatoes, Ceylon (true) cinnamon [11].

AVOID:
hydrogenated (in margarines and fat shortenings) and saturated fats. However, fat in whole milk (products) is good. See [12].
“Avoid artificial sweeteners. The sweet taste in your mouth triggers the release of insulin, even though there might not be any sugar that needs to be dealt with. Candies and gum trigger the same reaction.” [13]
monosodium glutamate, the flavour-enhancer MSG or E621. See [14].
For more details in general, see [15].
Be careful with diabetes drugs. See the latest research, and problems/dangers at [16].
For information about diabetes in older people, and possibly reversing diabetes, see [17] and [18] respectively.

Type 2 diabetes is a dietary and lifestyle disease. Changing your ways is never easy, but it’s worth at least a try. Good luck.

To eat:
Purple sprouting broccoli, chard, cabbage, leeks, spring onions, spinach, watercress, loose-leaved lettuce, radish, sorrel, spring greens.
In this ‘hungry gap’ month, it might be particularly welcome to know that/how you can eat radish greens: see [19].

To sow:
Direct: lettuce, rocket, radish, beet, broad beans, summer cabbage, calabrese, kohlrabi, parsnips, peas, spinach (beet), spring onions, chard, early carrots, autumn cauli, salsify, scorzonera, celeriac, celery. Late April: courgettes, french beans, pumpkins.
Plant: onion sets, potatoes, summer cabbage.
Sow to transplant: leeks, brussels, sprouting broccoli, autumn cauli, kale, tomatoes (indoors).
Garden Organic is an excellent source of information in general; they also sell seeds and whatever else you may need: see www.gardenorganic.org.

And please help the bees!
We need bees for pollination and they rely on our gardens for feeding centres. Make sure you have masses of nectar-rich, bee-friendly plants this summer. Every corner of your garden should have a little patch where bees can feed.
Buckwheat, Californian poppy, Candytuft, Convolvulus (annual), Corn chamomile, Corn marigold, Cornflower, Dill, French marigold, Golden marguerite, Nemophila, Phacelia, Poached egg plant, Pot marigold, Sunflower and Sweet alyssum are all good. Just make sure you have the plain, traditional form rather than modern fancy verieties.

RECIPES

PURPLE-SPROUTING BROCCOLI (broccoli rabe, or rapini, in the US) is one of the few properly fresh vegetables you can eat this time of year. See http://www.npr.org/templates/story/story.php?storyId=127561145 or http://allrecipes.com/recipe/21181/marias-broccoli-rabe/ for ideas. Though personally, we just cook them as they are, stalks and all, apart from the hardest bottom bit.
This is how I like them best. Caramelize some onions [20]; add your just cooked broccoli to the pan, stir so they are nicely oiled/buttered.

ROCKET SOUP
A colander full of rocket leaves, some potatoes, 2 small sliced onions, (cream or milk).
Put potatoes and onions in a pan with just enough boiling water to cover. Simmer until soft. Chop rocket fairly coarsely and add to soup: they don’t need as much cooking as the potato and onion. Liquidise and serve. Add cream or milk if you like.

WHITE BEAN AND NETTLE SOUP
60g fresh young nettle tops (4 big handfuls), 400g cooked white beans, 2 tbsp olive oil, 2-3 cloves chopped garlic, 750ml water, paprika powder and/or other spices, salt, pepper, extra-virgin olive oil.
Wash nettle tops, put into a pan along with the water clinging to them, and cook very slowly until wilted – ab. 5 mins. Drain, keep the drained juice and add to soup later, chop. Heat oil, add garlic and cook very gently for 1-2 mins, taking care it doesn’t colour. Add beans and water, simmer for 5 mins. Mash with potato masher, stir in nettles. Taste, season generously, simmer. This is meant to be a thick, coarse soup. Spoon into bowls, swirl oil over the top. Serve with good bread.

COTTAGE POTATOES
3 large cooked starchy pots, 4 tblsp butter, 240g cottage cheese, 1/2 diced onion, salt, pepper, paprika powder.
Preheat oven to 180°C. Mash the potatoes with 2 tblsp of the butter. Add cottage cheese, onion, season. Stir gently, and put in a greased casserole. Dot with remaining 2 tblsp butter, sprinkle with paprika. Bake uncovered, for 30 mins.

SARDINE-DILL FISH CAKES
2 tins of sardines, 2 potatoes, 240ml chopped spring onions, 2 tblsp flour, fresh dill, 2 tblsp grated lemon peel, 240ml breadcrumbs, 2 garlic cloves, 1 egg, seasoning (lemon slices).
Coarsely chop and boil the potatoes until tender. Drain and mash. Add the drained and chopped sardines, spring onions, dill, flour, the crushed garlic cloves, lemon peel, breadcrumbs. Season, then mix in the beaten egg. Shape the mixture into 6 (7-8cm) cakes. Coat with breadcrumbs. Sauté the fish cakes in the oil from the tin (or olive oil), about 3 at a time. Turn them over until they’re golden brown and crispy. You might like to serve it with lemon slices or tartare sauce.

CABBAGE with SOUR CREAM
45 g butter, small cabbage, 230 ml sour cream, 1 yolk, 2 tblsp lemon juice, salt, pepper (coriander).
Melt the butter slowly. Add the cabbage, stir. Cover let simmer for 15 mins; don’t let it brown. Whisk sour cream, yolk, lemon, salt pepper; add to cabbage. Bring to simmering point: don’t let boil. Serve immediately.

ROASTED SEA BASS (or whiting or grey mullet) with LEMON FENNEL OIL serves 2.
Two 140-170g fillets of sea bass or other firm-fleshed white fish with skin, 4 tsp olive oil, 2 tsp fresh lemon juice, 1/4 tsp finely chopped fennel seeds.
Preheat oven to 220°C. Pat fillets dry, season. Heat 1 tsp oil until hot but not smoking: sear fillets skin side down, pressing flat to prevent curling, for 2 mins. Put in a dish in the oven and roast the fillets 5 mins, or until just cooked through. You can also, more simply, continue frying them on top.
While the fish is roasting, whisk together remaining 3 tsp oil, lemon, seeds, salt and pepper and heat until hot but not smoking. Serve the fillets skin sides up, with the sauce on top.

MARINADED LAMB’S HEART
450g cubed lamb’s heart, 60ml extra virgin olive oil, juice of 1/2 lemon, 2 chopped garlic cloves, 1 small onion, chopped, 1 tsp ground cumin, 1 tsp kosher salt, 1/2 tsp ground allspice, 6 or so sprigs of parsley.
Marinade the heart in all the rest, ideally for 12 hours. Grill 6 mins, turning a few times.

Next month: No more ice cream? Emulsifiers.


[1] For more detail, and some info about diabetes type 1, see  http://www.karenhurd.com/pages/healthtopics/specifichealthconcerns/ht-shc-diabetes.html and http://web.archive.org/web/20140712184109/http://www.foods-healing-power.com/causes-of-diabetes.html.
[2] http://web.archive.org/web/20140712184109/http://www.foods-healing-power.com/causes-of-diabetes.html
[3] http://web.archive.org/web/20141022135105/http://www.foods-healing-power.com/complications-of-diabetes.html
[4] http://www.foods-healing-power.com/type-2-diabetes-symptoms.html
[5] for the latest research about fat in meat or dairy, see http://www.webmd.com/diabetes/news/20140916/high-fat-dairy-diabetes
[6]  http://www.livestrong.com/article/488859-whey-protein-for-type-2-diabetes/ or http://medicalxpress.com/news/2014-08-whey-diabetes.html  
[7] the best way to ingest chromium is apparently in brewers’ yeast, as this makes it more available than straight chromium supplements: https://food-nutrition.knoji.com/the-differences-between-brewers-yeast-and-nutritional-yeast/.
[8] http://www.livestrong.com/article/483889-is-virgin-coconut-oil-good-for-diabetics/
[9] http://www.diabetesselfmanagement.com/blog/apple-cider-vinegar-and-diabetes/ and http://www.apple-cider-vinegar-benefits.com/vinegar-and-diabetes.html
[10] supplements: http://www.foods-healing-power.com/supplements-for-diabetes.html
[11] http://web.archive.org/web/20140629175335/http://www.foods-healing-power.com/cinnamon-and-diabetes.html
[12] http://web.archive.org/web/20140629204735/http://www.foods-healing-power.com/diet-for-type-2-diabetes.html, http://web.archive.org/web/20140629143025/http://www.foods-healing-power.com/foods-for-diabetes.html and http://web.archive.org/web/20140712201320/http://www.foods-healing-power.com/diabetes-foods.html.
[13] http://www.medicalnewstoday.com/articles/282604.php and https://www.sciencenews.org/article/artificial-sweeteners-may-tip-scales-toward-metabolic-problems.
[14] http://www.ukhippy.com/stuff/showthread.php/10726-MSG-free-shopping-list
[15] http://www.foods-healing-power.com/treatment-of-diabetes.html and www.karenhurd.com/pages/healthtopics/specifichealthconcerns/ht-shc-diabetes.html
[16] https://www.newscientist.com/article/mg22329762-900-diabetes-drugs-may-sometimes-do-more-harm-than-good/ and
http://www.thehealthyhomeeconomist.com/what-your-doctor-doesnt-know-about-diabetes-and-statins/
[17] http://newoldage.blogs.nytimes.com/2011/04/11/for-elderly-diabetics-questions-about-aggressive-care/?_php=true&_type=blogs&_r=1
[18] http://web.archive.org/web/20140712192335/http://www.foods-healing-power.com/reverse-diabetes.html
[19] http://chowhound.chow.com/topics/330866
http://chowhound.chow.com/topics/653743
http://chowhound.chow.com/topics/291777
http://bettymingliu.com/2011/09/a-delicious-recipe-for-radish-greens/
http://www.thekitchn.com/dont-toss-those-radish-greens-145724
[20] Carefully heat 2 tbsp oil or butter. Add onions, spread in a thin layer. Cook, stirring occasionally until softened and then lightly browned. If the onions start to dry out at all, lower the heat (you can add a little water to them too.) They should brown, but not dry out.

 

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June 2017: painkillers: risks and alternatives

PAINKILLERS: RISKS and ALTERNATIVES

Painkillers may often be a blessing, but we should never use them indiscriminately, and it’s well worth checking whether there are other ways to face your pain.

There are basically three kinds of painkillers: paracetamol, opioids, and NSAIDs. They all have their downsides. Here are the reasons why we should try to avoid them as much as we can.

Paracetamol or acetaminophen is an effective painkiller but taxes the liver. It is extremely dangerous if combined with alcohol. For children, there is very poor evidence of fever relief . Giving kids calpol or similar, is not a good idea anyway [1].

Opioid painkillers, like codeine, are addictive, and hard to get off. Only one week of continual use can leave you enslaved.

Anti-inflammatories or NSAIDs (Non-Steroidal Anti-inflammatory Drugs) like aspirin and ibuprofen, damage the gut. Taking too many for too long, can lead to internal bleeding. If you have an ulcer, or any signs of digestive discomfort, the consequences could be serious [2].
Only recently, in March 2017, a Danish study led to calls for restrictions on the sale of ibuprofen, after they found it heightened the risk of cardiac arrest by 31%, with other NSAIDs presenting an even higher risk [3].
And did you know that aspirin and other fever-reducing medications actually suppress the production of antibodies, thus resulting in the infection lasting for up to 50% longer than it should? They inhibit the release of pyrogen, a substance that causes fever. And fever actually helps the body fight infections [4].

So we have to be very careful with painkillers. For 6 reasons, see [5].
For more detail about PARACETAMOL see [6].
More detail about OPIOIDS, and CODEINE more specifically, see [7].
For more detail about NSAIDs, see [8].

ALTERNATIVES:
There is a marvellous general site about pain, well worth looking at for a start: [9].
You’ll find plenty of non-drug therapies such as heat or cold, acupuncture, (breathing) exercise, yoga, massage etc: see [10]. For a herbal pain approach, see [11].
And did you know that 20 minutes of aerobic exercise is enough to stimulate the body to produce more endorphins – natural painkillers? And that our spit contains a painkiller more powerful than morphine: opiorphin? We have it only in minute quantities, so that we’re not off our heads all the time. Eating, though, releases more of the chemical and this may be a factor in comfort eating.

LAST but not LEAST: when it hurts, there is a reason. If all we can think of is to dull the hurt, we’ll never find the cause and it will persist and get worse. To deal with the cause, preferably in an early stage, we have to feel the pain. We have to respond to the feedback our bodies give us: when does it get better, when does it get worse? Does my food, my posture, stress or things I do, affect it?

~~~

“People who view pain as the enemy instinctively respond with vengeance or bitterness–Why me? I don’t deserve this! It’s not fair! – which has the vicious-circle effect of making their pain even worse. “Think of the pain as a speech your body is delivering about a subject of vital importance to you,” I tell my patients. “From the very first twinge, pause and listen to the pain and, yes, try to be grateful. The body is using the language of pain because that’s the most effective way to get your attention.” I call this approach “befriending” pain: to take what is ordinarily seen as an enemy, and to disarm it, and then welcome it.” Pain: The Gift Nobody Wants’ Dr. Paul Brand


EAT:
veg: broad beans, beet, cabbage, carrots, lettuce, new potatoes, artichokes, asparagus, broccoli, mangetout, peas, cauliflower, radish, spinach, spring onions, spring greens, watercress, kohlrabi, turnips, rhubarb, redcurrants, strawberries, gooseberries.
meat: lamb, wood pigeon [9].
fish: grey mullet, black bream, gurnard, pollock, whiting, mackerel, lobster, whelks, clams, cockles, coley, crabs, crayfish, flounder, grouper, gurnards, herring, megrim, scallops.

SOW:
beetroot, calabrese, lettuce, french beans, kale, carrots, cauliflower (mini only), salad onions, (sugar) peas, radish, kohlrabi, mooli, turnip, chicory, Florence fennel, courgettes and pumpkins.
Sow swede and sweetcorn in early June. If the soil is above 25°C, sow crisphead, cos or little Gem only.
plant out: courgettes, cabbage, sprouting broccoli, sprouts, celery, celeriac, ridge cucumbers, runner/french beans, pumpkins, tomatoes, sweet corn.

SCANTY HARVEST SOUP for 2.
Radishes bolted? Nothing else in the garden? Don’t despair – this soup is one of the best I’ve made.
Bolted radish green with their (bolted) radishes, onion, 1-2 garlic clove(s), 1 tblsp sour cream, 1 tblsp peanut butter, water/stock, (cayenne) pepper, salt.
Slice onion and garlic, sauté in butter for a min., add plenty of chopped radishes with their leaves, even when bolted. Saute for a few more minutes, add water/stock. Cook till everything is soft. Loosen the peanut butter with the hot liquid, add to the soup along with the sour cream, blitz if you like, season. You can leave out the peanutbutter, or add tomato puree instead.

SPRING GREENS and PEAS in CREAM CHEESE
200g shredded spring greens, 3 sliced garlic cloves, 200 grams diced bacon, 100g peas, 200g cream cheese, handful of basil, black pepper, 480g pasta.
Cook greens in water for 5 mins until slightly wilted and tender. Saute garlic for 1-2 mins, then add drained spring greens. Fry for 5 mins, add peas and cream cheese and stir until melted. Add a teensie bit of water, cover and cook for 7-10 min until peas are done. Add torn basil and pepper. In another pan prepare pasta in the usual way. Drain and mix in the cheesey sauce.


GREENS and FISH
450g spinach or chard, some leaves of sorrel, garlic clove, 900g thin fish fillets, salt, pepper, nice bread (onion, thyme, ginger).
Split the leaves from the stalks if using perennial spinach, and cut them. Season the fish. Boil a little bit of water, add the cut stalks if any, cook for 3-5 minutes. Then add the rest of the greens and chopped garlic, put the fish on top, cover. Cook for about 15 minutes, no longer.
Place bread on a plate and add fish, greens and liquid, which shouldn’t be too much by now.
This is surprisingly nice, but to improve on it even  more, fry plenty of onions with some ginger and thyme, and add that to the mass.


CARPACCIO of KOHLRABI with RADISHES and BLUE CHEESE
2 small, young kohlrabi, 6 radishes, 4 tblsp extra-virgin olive oil, 4 tsp cider vinegar, a pinch of English mustard powder, blue cheese, flaky sea salt, pepper.
Strip leaves off the kohlrabi and cut off tops and bottoms. Using a mandolin, cut into paper-thin slices. Do the same with the radishes. Arrange kohlrabi and radish on a platter. Whisk oil, cider vinegar and mustard powder together, drizzle over the slices. Season and sprinkle with crumbled blue cheese. Serve immediately.

MARINATED LAMB’S HEART
A lovely cheap and easy dish, as long as you do some preparation beforehand.
Every lamb has a heart, so if you ask your butcher he may well come up with one, if only from the freezer.
450g lamb or beef hearts. For the marinade: 2 tblsp balsamic vinegar, 1 tsp salt, 1/2 tsp ground black pepper and 1tsp thyme.
Trim the heart(s) and cut in 1.5 – 2cm cubes. Marinate for at for least 8 hrs. Grill, spreading out into a single layer, and let brown for a minute or two. Toss and brown on the other sides for another minute; remove. Delicious!

BRAISED LETTUCE and PEAS for 1 or 2.
2 tblsp butter, shallot thinly sliced, half a head of (cos) lettuce, ab. 150ml stock, 100g (frozen) peas.
Chop lettuce into small pieces. Saute shallot for a minute, add lettuce, saute for another minute. Add stock, bring to a simmer.  Add peas, cook covered for a short while.. Season if necessary. Garnish with for instance heavy cream, mint, grated carrots or lemon juice.

BROAD BEANS with ONIONS and BACON, serves 2 as a side dish.
250g shelled broad beans, 1 butter, 1/2 chopped onion, 175ml water, 75g smoked bacon, plenty of lemon juice, salt, pepper.
Chop bacon. Sauté onion in butter for a few mins. Add beans and bacon and sauté for a further 5 mins. Add water, bring to a boil. Simmer slowly for 15 mins, or until beans are tender. Add lemon juice and season. Serve warm or at room temperature.

MACKEREL with BROCCOLI and SPICY ANCHOVY SAUCE
Mackerel and broccoli for 2; 3 anchovy fillets, 2 garlic cloves, 1 chilli (or powder), olive oil, (rosemary).
Chop three anchovy fillets, two cloves of garlic and one red chilli. Mash to a near-paste. Melt the paste in a small frying pan with 2 tblsp of butter. Meanwhile, grill or sauté the mackerel in oil. Top with rosemary if you have it. Don’t add salt, because the sauce will supply that. Steam the broccoli, drain, then stir it into the anchovy sauce. Serve next to the mackerel.
Best with plain cooked potatoes, methinks.

 

The old days were not necessarily better ……


[1] http://www.theecologist.org/green_green_living/behind_the_label/346400/behind_the_label_calpol.html
http://www.telegraph.co.uk/news/health/news/8351085/Parents-warned-against-giving-paracetamol-and-ibuprofen-for-mild-fever.html
[2] (From https://www.patrickholford.com/blog/the-dangers-of-painkillers)
[3] https://www.theguardian.com/society/2017/mar/15/ibuprofen-sale-restrictions-study-increased-cardiac-arrest-risk
[4]
http://www.huffingtonpost.com/2011/11/03/fever-immune-system-cells_n_1074445.html
http://healthimpactnews.com/2013/a-fever-is-a-good-thing-dont-suppress-it/
http://www.thehealthyhomeeconomist.com/for-clued-in-moms-fever-is-a-friend/#more-11400
http://naturalsociety.com/youve-been-lied-to-about-the-fever/
http://www.naturalnews.com/031467_fevers_health.html
http://www.health-bytes.com/fever-is-good-for-you.html
[5] http://www.thehealthsite.com/diseases-conditions/6-reasons-you-should-stop-taking-too-many-painkillers/. See also http://www.theguardian.com/society/2008/feb/10/health.drugsandalcohol and https://health.clevelandclinic.org/2016/04/6-myths-about-painkillers/
[6] http://www.evidentlycochrane.net/paracetamol-widely-used-ineffective/
http://www.express.co.uk/life-style/health/561502/Experts-warn-against-taking-paracetamol-daily
http://theconversation.com/we-need-to-talk-about-this-paracetamol-problem-dont-we-19051
http://theconversation.com/whats-the-point-of-paracetamol-66808
[7]
OPIOIDS in general:
https://www.washingtonpost.com/news/powerpost/wp/2016/03/15/cdc-warns-doctors-about-the-dangers-of-prescribing-opioid-painkillers/?utm_term=.9a6a57c75475
https://health.clevelandclinic.org/2015/03/dangers-of-opioid-pain-relievers-what-you-need-to-know/
http://www.consumerreports.org/cro/magazine/2014/09/the-dangers-of-painkillers/index.htm
One of which is CODEINE :
http://www.independent.co.uk/life-style/health-and-families/health-news/do-the-dangers-of-codeine-outweigh-the-benefits-2108190.html
http://www.dailymail.co.uk/health/article-2420145/How-popping-painkillers-make-symptoms-WORSE-Effects-codeine-particularly-bad-headache-patients.html
http://www.telegraph.co.uk/news/health/news/6134384/Over-the-counter-painkillers-can-cause-addiction-in-three-days.html
[8] https://tv.greenmedinfo.com/dangers-painkillers-infographic/
https://draxe.com/dangers-of-nsaids/
http://www.livestrong.com/article/360407-the-risks-of-taking-too-many-nsaids/
http://www.nbcnews.com/health/heart-health/fda-strengthens-heart-safety-warnings-painkillers-n389516
[9] https://www.painscience.com. See also http://www.paintoolkit.org.
[10] http://www.health.harvard.edu/special-health-reports/pain-relief-without-drugs-and-surgery?utm_source=HHPBlog&utm_medium=link&utm_content=related-text&utm_campaign=referral (click on contents and excerpt)
[11]
http://www.shareguide.com/pain.html
http://antranik.org/food-is-medicine-20-natural-painkillers-in-your-kitchen/
http://www.nbcnews.com/id/26136767/ns/health-alternative_medicine/t/youre-pain-you-want-relief-naturally/
http://www.huffingtonpost.com/2013/09/30/dr-oz-treat-chronic-pain_n_3963264.html
http://www.healthline.com/health/pain-relief/surprising-natural-pain-killers#HeatandIce6
http://www.steadyhealth.com/articles/top-10-natural-painkillers
http://www.activebeat.co/your-health/8-strange-but-effective-pain-relievers/
Though just because it’s herbal, that doesn’t mean it’s safe: see https://www.theguardian.com/society/2016/jul/11/heart-failure-patients-warned-off-over-the-counter-medications.