Saturday, October 23, 2010


When it came to nutrition, I was usually up and down from feeling confident to feeling very frustrated. In this chapter, I will explain more in detail about the things I found and learned by observing the effects on Brandon. I believe in the benefits that have shown to be true for him. It seemed like the clinic nutritionist really tried to find answers but with Brandon’s issues it was a never ending battle for us all. When the confirmation of Brandon’s milk/whey allergy came I think it was very frustrating, considering all CF’er are recommended to consume a lot of dairy to help their weight. I have lived with a whey allergy myself and dealt with it with my daughter, but not at all in the way of CF. To add to the frustration I still couldn’t help but think there was a healthier way to feed my son’s CF body. The very thought of being told to give your child a bunch of fattening junk made me just sick to my stomach. Like stated in chapter one I really agreed with BMI, but it needed to be good healthy BMI. I know many others in the CF community didn’t understand the different kind of diet Brandon was eating. I think the clinic was just watching with curiosity at what we were doing, I figured we all assumed as long as he was doing well then keep it up. I am sure there have been many times of concern from others, many people in the support groups didn’t hold back at their views of a CF diet. But that is ok because different, at first, can be weird. After we talked about Brandon being on goat’s milk, his CF doctor became concerned with his levels and tested him for everything possible. I was happy to know that he was still getting what he needed. There was a very slight low in iron which we supplemented for. Brandon was gaining great amounts of weight and impressing the clinic. To add to it, every time he was in, his oxygen saturation was 100%. He felt good and looked good.
I found I was still struggling with understanding the enzymes fully and asked them if he was on the correct dose. The response I got from this was he was already on the highest dose for age and weight. Brandon still had that stringy greasy look to his bowl movements but not horrible. We noticed he was gaining weight great so not a big concern, right? Being me and who I am, nothing is good until it’s perfect. I started my calls when I got home. First to our family pharmacist and friend, I asked him to fully explain what he knew of the enzymes. He checked on it for me and said that he was on the right dose for age and weight, and he wouldn’t advise me to give any more. I asked about the time frame. I am not sure if this is different with each company or a general rule, and I do advise you to talk to your doctor or pharmacist before following what I learned. Brandon’s enzymes would have a life of 2 hours. As my friend explained to me, just because it’s in your stomach for 2 hours doesn’t mean they are good for 2 hours. If you give your child the enzymes and then go to offer them their bottle or food and they aren’t hungry you could safely say they are good for that full feeding up to the first hour. If your child takes that first feeding and then wants a small snack up to an hour and a half after feeding you should be ok. If your child takes the full feeding then wants another full feeding an hour later, you need to give more enzymes. The longer they are in their stomachs the weaker they get because the stomach acid starts breaking them down and they are completely dead at that 2 hour mark. So as a general rule we claimed enzymes were good for an hour I didn’t want to push although there have been times I have pushed it further, like trying to give a bottle before you leave the house to go to dinner and they refuse. Then you get to the restaurant and they decided they wanted the bottle at the hour and fifteen mark. Or he started being picky and finicky and I was unsure if he would eat enough to need the enzymes and would wait until I saw how much he ate, if it was little I let it slide from the previous enzyme dose an hour and a half prior, if it became a good amount I would then give him more.
Ok, I had the timing down but still was unsure of the amount, and although the doctor and pharmacist said he was at the max, I just didn’t think it was right for him. I logged back on to the good old computer and went to my favorite source of input, support sites. I had several I was a part of, so I went and asked about enzymes and everyone’s response was that you need to find what works. What did that mean I still wondered? I looked up the drug company’s site, but found no good info. I was ready to scream, or cry, but I knew neither would help. I had one other source that I hadn’t talked to yet but was well on my way to what was going to turn into a great phone call. My Aunt Jill (mother to 28 year old Rachel with CF) was the only one who would be blunt with true experience. I explained that Brandon was on the “highest dose” and she put it to me like this: The highest dose isn’t really an exact number it’s more like a recommendation. She said “play with it, you’ll know. Everyone is so different with this disease and whatever works is what is right for each individual.” Rachel still has to play around with her enzymes as will any CF’er, it is an art!
The one thing I do know, is it has to do with fat, protein, and starch. The higher the amount, the more enzymes. For Brandon, he has always sat on the edge of the highest dose. This means if he had an average fat and or protein meal he would take that prescribed dose. If Brandon were to have a high protein and or fat meal it would need to be increased. I have learned not to fail at putting extra fat and or protein into everything possible which generally meant he needed higher than the prescribed dose. This is where booster food with natural enzymes helps as well, and will be explained further in this chapter. This is all relatively easy until you start working with solids.
I finally understood as all others do at some point, there is no right answer. I had the support and information, but truly I was on my own. I was and am the only one who knows Brandon well enough to determine what works best for him. When you are figuring out whether the enzymes are correct, the only answer and clue you have is in their poop. Get used to poop, go ahead and get your badge for poop specialist because this is the one and only way you’re going to get any answers. If you are new to this specialty what you need to know is when the poop is extremely foul with fat deposits there are not enough enzymes. It will look stringy, greasy and or runny, I have heard so many different explanations but if you’re unsure or this is your first child and you don’t know what to expect in baby poop, just ask. As silly as it sounds, offer to change your friends babies when they poop so you can see what ‘normal’ is. If you are breast feeding, a normal poop will look seedy like small raspberry seeds in the poop. If you are formula feeding, it will be smooth unformed and gradually become softly formed yet still smooth. With a CF child, you will notice a major difference to none, depending on how much their pancreas is affected. With a highly affected child you will notice the odor. On top of the fat deposits, there will be a discolored splotch pattern from light to dark, and it will look shinny where its darker which is the fat deposit. You can also be on the lookout for the stringy poop, this shows up in more of the loose stool and is self explanatory. Although this usually doesn’t have a different color, just a rather notably different texture throughout. Now what if you notice this and feel like it’s time to up the enzymes? Go for it, but with caution. Communicate with your doctor about doing so, remember you’re a team and the whole team needs to be informed of the moves each player is making. Start small, we added a fourth of his usual prescribed amount in the beginning. You most likely will see in the next bowel movement whether it was affective or not, if there was no change or not enough change try adding more. As a general rule, I never changed a dose more than one time a day until I got to understand it better. The thing that you must be MOST careful about is too many enzymes. Too many are a bad thing and not fun. Too many will lead to hard and possibly compacted poop, this may result in pain and even a hospital visit if not watched carefully. Don’t let this turn you off from figuring it out, just pay attention to everything going on. If needed, chart so you can follow it very closely. Whatever you end up figuring out, let your CF clinic know what you have changed it to, either by a phone call or at the next visit. If it ends up being too much they may decide to change brands or investigate as to why so much is needed. It is very important to be up front and honest with the CF clinic. Brandon had several issues in this department and I believe I was promoted to poop expert at one point! I remember when I was in middle school I had a science teacher who had a huge science lesson on “Why some poopy sinks, and some poopy floats”, who would have thought that lesson was to prepare me in my sons pancreatic insufficiency. A great fail proof method is to see if poop sinks or floats. In simple terms there is a gas released from the fat causing the poop to float, when there is many floating poops it is a sure sign of malabsorption. When in doubt do the floating test! This was true of Brandon’s stools. I was on a mission and had increased Brandon’s enzymes and had reported so to the clinic, which they had calculated for weight and age and said this was fine. The following month I had increased his enzymes again, so he was up 6000 lipase, when calculated he should only be 2500-3000 lipase. This caused a big discussion between the CF doctor, clinic nurse, and pharmacist. It was decided that the brand he was on was not best suited for him, and they switched brands to a newer enzyme brand. Each type of food you feed your child will start with the prescribed dose. You will need to determine if it has fat and or protein in it as well as carbohydrates. Once you determine what’s in the food then you must determine how much of what is in the food. Once again, keeping a general log of food and affect is going to be helpful. Start with the common knowledge that most fruits and vegetables need no enzymes, although you will want to find ways to add fat and protein to anything you can in a healthy way. As if there isn’t enough to do, if at all possible it is wise to make your own baby food since your baby needs to eat differently. I had a few jar foods I would feed him and I had several recipes I concocted on my own. On the top of all the food, whether jar or frozen cubes of homemade goods, I wrote how many enzymes were needed. This way my husband knew, or when packing for a night at grandma’s she knew and I didn’t always have to be the one to feed him. Also in the beginning I could refer to charting to know how much to give for what. Although, after time it stores to memory rather well, but then it’s time to change again. Once you are off baby food you will need to go through the process all over again with enzymes, once again don’t be afraid to write on any package of food the amount needed. I headed to our local Health Food Store and asked one of the employees that worked in the vitamin/supplement area about good fats to add to Brandon’s diet. She recommended Hemp Seed Nut which is the only natural source of omega 3 and omega 6 in the proper ratio to work correctly in your body. When I researched hemp seed nut I found that it is the closest complete protein next to meat, milk and eggs . It was also said that hemp seed nut consists of 33% protein and 44% fat with 39% being unsaturated fat. I decided to add this to Brandon’s daily diet, more good fat and protein can’t hurt, plus it grinds down really nice in milk or water to boost any beverage with a slight nutty flavor. I called the manufacturer of the hemp seed nuts and asked the recommended amount to take and they told me it is one tablespoon per 50 pounds. Now I know you are having the same thought, what if my child has a nut allergy? Hemp seed nut is a fruit, not a nut and has no reported issues of anaphylaxis or allergic reactions in those with or without nut allergies. You need to double recommendations not already doubled for CF’ers. I also learned from the health food store that acidophilus is highly recommended for all people especially those more at risk to become sick. Acidophilus is a live bacteria that when added to your body will go in and eat all the bad bacteria. This had proven to be great for immunity, it is now recommended by many doctors to take after an antibiotic to restore good bacteria after it is all striped, as well as during, especially if there is diarrhea. I firmly believe in Acidophilus and the whole family takes it daily to help us fight off things that may come in contact with us. It’s also good to fight off yeast in the system, Brandon used to get oral thrush quite often until this was added to his daily arsenal. Acidophilus is gaining a lot of press lately as you may have seen. Yogurt is one of the power foods that have it in it, although it may be hard to eat yogurt every day, or like Brandon you may be dealing with a milk allergy or intolerance of some sort. At any health food store you will find a large variety of Acidophilus including vegetable based ones which for milk allergy/intolerance will be perfect. You may want to ask for help because there are a lot of kinds, you want to find something with the highest amount of microorganisms. Since CF requires higher food intake this goes for supplements and vitamins too. When seeking things you wish to supplement for infants to age six with CF, should use half the adult dose. Children ages six to twelve should take the adult dose. Teenagers from age twelve to seventeen should take one and a half the recommended adult dose, and adults should take double the recommended adult dose. This is not the same for medications and herbs as it is for supplements so be sure to follow the recommended dose unless otherwise directed by your doctor.
I found myself in and out of the health food store, often there are two women who work in the supplement/vitamin section they have both been very good at giving me great information and leading me to things to add to Brandon’s diet. I found out that papaya has the ability to get rid of mucus from the body as well as pack a good punch of immunity . We switched on and off with applesauce for giving enzymes. You can get creativeand add it into smoothies or you may also benefit from several brands that make chewable papaya based enzymes and or ant-acids. It is extremely important to use natural enzymes along with your prescribed enzymes which will be fully explained next.
At three months old Brandon’s CF doctor told us to start solids which is common in CF. I guess it makes sense because they are already getting supplemental enzymes so the concern of their bodies being able to digest it is out the window. I was one of those over achiever moms and was determined to make all Brandon’s food, I wished I had done this for my daughter, but felt it was even more crucial for Brandon’s diet. I started searching on the internet for baby food recipes and how-to’s. I found some really good sites and most of them had the same information and recipes, but there was one recipe that I found that would work for Brandon, it was called Banana’Cado . I started with their basic recipe and as time went on I modified this as well. You will find my version and all other recipes I have developed specifically for CF babies in the recipes chapter. I started seeing a major difference in Brandon’s poop when he ate foods with natural enzymes, bananas, avocados, papaya, pineapple and mango. The difference was good, and amazingly good. Brandon felt better eating these foods so much that he would rarely eat anything else. I let him eat what he liked as long as his numbers were good and it seemed to make him internally happy too. Now I completely recommend CF’ers eating a natural enzyme food frequently, it should not replace the prescribed enzymes, they should be used as boosters. The reason why is, your prescribed enzymes cover the three most important enzymes, lipase, amylase, and protease. Lipase is the enzyme responsible for breaking down /digesting most all the fat your body takes in. We also have amylase that is responsible for breaking down most of the starch, and the proteases along with other helpers break down protein. Our bodies are amazing and do have a back up to digest starch and protein, but unfortunately it isn’t all digested. The saddest part is there is no back up for lipase one of the most important things our bodies need. Papayas specifically, have a natural enzyme called papain that has the ability to break down protein. I use papaya because it is seems to be the best form of natural enzymes when extracted before it ripens, and it has the ability to calm down an acidic stomach. It is best and recommended to give this along with the prescribed enzymes to help break even more down, especially when adding in extra protein. All the foods with natural enzymes have the ability to aid in digestion, so feel free to eat plenty of the yummy natural enzyme foods.
Fruits and vegetables are good for CF’ers and should be given a lot. It is the one thing that their body can process on its own. Raw is the best way to eat fruits and veggies, and they are a great source of vitamins and minerals needed for growth and overall good health. Nuts and seeds are equally important at the proper age. All nuts and seeds have a good and healthy fat base, you will need enzymes to help aid in processing these good fats. Some findings may even say that fruits, veggies, nuts and seeds should be 75% of a CF’ers diet . The biggest thing to remember is that CF’ers need 50% more nutrients than a non CF’er. A high geranium diet is very good as well so pump up the garlic, onion and shiitake mushroom. These three food items have anti bacterial properties. Shiitake is a superstar food, it contains lentinan which is solely responsible in preventing disease and boosting immunity. Lentinan has been used to prevent viruses from reproducing and fights off infection. Lentinan has been approved as an official anti cancer drug in Japan since 1985. They have also seen it to be helpful in the fight against AIDS
I have learned a lot from experience but the biggest thing I learned is there is no room for pointless feeding and drinking. I always had a distorted view of needing to have water or juice. After a series of complaints to the clinic about Brandon’s poop just not doing good, I was advised to take him off juice unless I juiced it myself. His CF doctor said there is no need for juice. I kind of felt like this was becoming more and more unfair for Brandon. I tried the juicer and it worked but it wasn’t real favorable for Brandon, so he drank milk and more milk. Brandon started to migrate to filler foods, without even realizing it at first. He also stopped drinking goat’s milk and I was left with no other option than to give him soy milk. Brandon’s poop was still off and this is when the CF doctor told me it was the soy, and that I should not give him water, or let him dangle upside down when playing, or use a walker, or hold him around his waist, and so on… What can my child do? I tried a hypoallergenic formula that was recommended by the CF clinic. This is about the point where he didn’t gain weight and they said they didn’t like that. I was still trying this formula, but Brandon did not really like it. He maybe had one to two cups a day with a ton of chocolate syrup, it was the only way he would drink it. I was hoping this would help him dig into more solids. At the next clinic visit he lost a few ounces. They were not happy about this and said he had to gain weight by his next appointment or they would talk about a feeding tube. As we all know by now that wasn’t going to fly with me. I tried to follow their recommendations but nothing seemed to work. I know they really wanted him on a more traditional diet, but Brandon was just proving to not be a traditional little boy. The nutritionist came in and really had no answer as to how to put weight on him, we had exhausted all the things that should have worked. She had one thing that was a shot in the dark. Brandon loves grits, I make sure to butter them and sweeten with some honey, so the nutritionist gave me samples of egg white protein, and I figured it was worth a try. I went home and went to work. First I ventured out to the good old Health Food Store I looked at all their protein powders and one of the ladies helped me find the highest amount of protein in a shake they had. She walked away and I looked up at one can I hadn’t looked at yet, it was a sport version of soy protein powder, in chocolate. It was the highest by far so I bought it. I figure the whole soy protein thing is something we all will just have to deal with. I started adding this to soy milk in the beginning. I really was frustrated at the price and had hoped I could find a better option to supplement his diet. After time and research I created Brandon’s ultimate protein shake. I put soy milk, avocado, banana, hemp seed nut, and shiitake mushroom all together and blended it. This was loved by Brandon and still is a daily staple. I was asked to try lactaid milk, they thought he would have out grown his allergy, as many children do. Brandon’s whey specific allergy prevented him from doing lactose free. I also knew from trying ice cream and still seeing a reaction that Brandon was not outgrowing his allergy. I decided to try to switch the soy milk for goat milk and he accepted it in his shakes. With a continued need to add more enzymes for Brandon they decided his enzymes needed to be changed. I guess in theory Brandon was on his highest dose so there is no more they can do, but he needed two thirds more than the prescribed amount, meaning what he was on wasn’t right for him. I will tell you though the egg white protein turned out to be a great recommendation, but for Brandon didn’t make it the test of time. It was easy to slip in many foods especially those that could easily become pointless to his diet, like macaroni and cheese, always homemade. Now I know if Brandon has a milk allergy how can he have cheese? Here is the answer, whey is the other protein in milk, and it is the liquid part, where lactose is the curd. Whey protein, the liquid, is separated from the curd to make cheese, this is one of the major reasons I know that it’s a whey allergy not lactose. The unfortunate thing with whey is that it has been put into powder form and used in a lot of things. Now I know that it is a rarer allergy, but it made me aware of how difficult any allergy would be with a CF diet. Unfortunately most allergies that are common are a form of protein and or fat. I use many things that aren’t common allergens. There will be some recipes that have allergens in them, but I will offer alternative options for several different allergens too. If you have a CF child with no allergens, then this is still very helpful, and there are recipes for you too.
First things first, let’s understand food in general. Processed foods aren’t good, but they are especially bad for CF’ers. When a processed food is cooked it causes extra mucus to form. We for sure want to stay away from anything that adds to the mucus. Your clinic and nutritionist will agree that processed foods are not the greatest to offer. Dairy, sugar and white flour also can fall into this category. There are great debates going on as to if dairy has mucus in it, I have found so many articles that suggest both ways. It is one of those subjects that could be fought all day long, but no one has the exact answer. Cow’s milk isn’t good for all people, and I personally feel it isn’t good for CF. If your child is experiencing diarrhea, or other severe bowl issues, lots of vomiting, spitting up and upset stomach then it’s possible they have intolerance to milk or other foods in the diet. If you test for allergies, and it comes back fine it’s not always true that it’s ok. Allergies and intolerances are not the same thing. Many people might even go as far to debate that milk is not necessary to have after weaned from the breast and that other countries do not drink cow’s milk like we do. If you are going to have milk in the diet you may be better off with goat’s milk or other alternatives. Homeopathic doctors will eliminate cow’s milk from ones diet as a good place to start for any and all bowl related issues. I feel as in all things too much of anything isn’t always a great thing. Why not have some fun and switch things up, be more open to all different things including a range of different milks. Brandon has had goat’s milk added back in; we now use goat’s milk, soy milk and sometimes rice or almond milk too. I think this helps with not giving him much juice, Brandon still gets a verity.
Good fats to add to foods are walnut, cashews, palm kernel oil, hemp seed nut, and cod liver oil (considering age and nut allergy). My two favorites are hemp seed nut and cod liver oil. I know I have talked about hemp seed nut and the benefits, but it is one of the top staples in Brandon’s diet. Cod liver oil is similar in benefits as fish oil which is commonly known for the omega 3, DHA, and EPA, but it is higher in vitamin A and vitamin D . Cod liver oil is all around good, not just for CF’ers, but all people with many different conditions. I recommend replacing your basic fish oil to cod liver oil. Cooking with oils is really good, but make sure to be extra careful to follow the instructions, many of them have certain temperatures that are too hot for them and also may need to be refrigerated. Try to stay away from lard, butter and vegetable oil to cook with. Get creative or go for olive oil.
Salt is a very important factor to a CF diet, add it where you can. People with CF have a higher amount of salt lost in their system and this is why they taste like salt when sweating, and therefore a result being the sweat test. It makes sense that they need more salt, the hotter the day the more salt. If your child is on hypertonic saline this may no longer be an extreme concern, but by no means should you shy away from it. It is important to be hydrated, which is a hard and confusing subject because too much water is a filler, but not enough water in the heat is going to cause dehydration. When you can add protein to water but just don’t do too much water or juice alone. This brings me to water. Water is a dangerous thing at times. No one really went over this with me, but it always made sense in a common knowledge way for me. I have always been weird about water, and tap water is filled with bacteria and gross stuff, no way have I wanted my children drinking it. A CF child should really steer away from tap water. There are many ways around this and it depends on your budget. You can get water bottles, but that adds up after time. You can get a water cooler which would be good, or you can go to a reverse osmosis (RO) system that filters your tap water straight from your sink. For those of you really watching your pennies you can boil your tap water and use it that way. Anything that isn’t cooked needs to have pure clean water in it. Some of the filtration systems on your sink may not be enough filtration. They are ok, but not good at the tiny bacteria; this is where the RO system works out the best. You can get an RO many different ways, you can rent it, or buy it from a water supplier or from your home improvement store.
As if there isn’t enough to factor in, especially after reading this chapter, there is one more thing I wish to cover. Wheat or Gluten in a CF diet is not always good, those with CF are at a higher risk of having Celiac disease or wheat intolerance. Once I researched this topic further it made sense as to why this would be bad for most people especially with CF. Wheat is really hard to digest, gluten causes a sandpaper affect rubbing down all the villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats. Some people may not be affected majorly in this area, but it makes sense for a CF’er to do poorly on a gluten diet because there are already enough issues. When someone’s system is already compromised a small thing easily becomes a big thing. As in all things moderation is important with wheat and CF unless there is a true allergy or intolerance. Being highly sensitive to the effects of food means you need to take more precaution to the food you eat and the effects it may be causing. Not all people with CF are going to have an issue with gluten but they are more susceptible to having issues. The symptoms are so close to typical CF symptoms that the only way to know if it is beneficial is to try cutting it out or minimizing the consumption of it. Brandon does not have celiac or a specific allergy to wheat, but if he has too much his stomach is upset and his bowls become worse. I have learned a balance with him as to how much his body can tolerate.
Good carbohydrates are very important to a CF diet, but know the difference, a good carbohydrate is going to be many fruits and veggies, brown rice, whole grains, beans, nuts. Bad carbohydrates are full of calories, and lack nutritional value. Many carbohydrate products contain sweeteners, preservatives and other unhealthy additives that should be avoided when you can. I know, I know they taste so good, I hear you. The surge in insulin levels from these bad carbohydrates will overwork the pancreas which could lead to things like diabetes and heart disease. White flour, processed foods and many other foods are in the bad carbohydrate family. For fat to better absorb it is best to pair it with a good carbohydrate. If you can get your child to eat a trail mix once they are old enough it will have many essential fat and carbohydrates as well as protein.
When choosing daily supplemental oil you want to go with something high in unsaturated, and monounsaturated fats, polyunsaturated is ok but not the highest number. Olive oil is a great one as well as safflower oil. When reading the labels you will notice almost all oils have the same fat content of 14g, it is the type of fat that you need to pay attention to. Also pay attention to how you plan to use the oil (with heat without heat).I know that it seems that the bad fats and the coconut oil seem to help weight gain better, and quicker which you may notice a quick weight gain when done the wrong way, you will also notice a quick decrease in weight when they are sick. When it comes to weight gain with the good guys you must always remember two things... 1) space it out all day long ( infants 1 tablespoon, children 2 tablespoons, teenagers 3 tablespoons and adults 4 tablespoons) too much at once will just flush through you and do no good. 2) Always pair with a starch to help in the absorption of the fat. With Brandon being younger it is easy to add half an avocado blended down to his milk for the whole day and then add a few sprinkles of baby rice cereal to each cup.
I know this is a lot of information and will be a lot of work, I recommend picking an area you feel most important to you child, like added protein and begin there. Slowly add things in order of importance to your child’s needs. Don’t let it overwhelm you. I started out with a notebook of Brandon’s nutrition, I started in an area and documented what worked and what didn’t. For you it may be easy to make a list in the order of what you want to change in their diet. Write out the things you need to do to accomplish, the first goal, and work on that and then move to the next item. I am a notebook queen and have one for everything, I even have a notebook of all Brandon’s medicines, treatments and so forth, how to and how much, just in case I am not around and someone is unsure of what needs to be done. The point is taking your time and getting to work on the things that matter to you. I fully believe that you will find a lot of success if you really follow many of these recommendations. I am amazed daily at the success in Brandon and others following a healthy life style in this disease. I am mostly proud of the fact that Brandon’s BMI is always good and not from unhealthy fats, therefore when he has been sick it has not dropped his weight other than a few ounces of water weight that is easily gained back. It is very true that muscle fights and fat quits!

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