how much sugar per day for fatty liver

Your bodys regulated glucose response means that these foods have a low-glycemic index. Even when it comes in so-called healthy foods like salad dressings, steer clear. between a liter of rhum and a liter of cola, the answer would be different). 10. Although it is new in popularity, people have been practicing a carnivore diet for decades, and possibly centuries. I cut back to no more than 50 grams and see a dramatic difference, especially the diabetes I was taking 1500 mg metformin a day and now Im down to 500 mg a day. The evidence is there and the data is available to make that case but still people are ignorent of these facts. 2. What steps are you taking to prevent or reverse this problem? The researchers initially had the participants abstain from sugar-sweetened beverages for 4 weeks. Routine, daily physical activity improves insulin resistance and reduces fatty liver. 1. liver lipogenesis. . I was often asked did I hurt. What about sugarcane juice? . It also burns less excess fat and cholesterol, leading to even more fatty deposits in the liver and weight gain. Your liver can literally become fatty by eating too much sugar. FOIA In scanning the scientific literature, there doesnt appear to be a study directly comparing a low-carb diet with an equicaloric diet that allows for carbohydrates derived from whole foods. These foods work against metabolic syndrome and help to improve insulin function and decrease fat accumulation in the liver. Interestingly enough, research shows that carbohydrates (and not fat) are to blame for increasing the amount of fat that accumulates in your belly and liver. The American Heart Association (AHA) recommends a maximum of 150 calories or nine teaspoons of added sugar per day for men and 100 calories or six teaspoons for women. Just because carbs from whole grains, fruits, veggies, and legumes are really healthy, this doesnt mean you should eat only these foods. Processed foods refer to any food source that has been packaged or manufactured such as granola bars, chips, cookies, candy, and cake and almost always contain high amounts of added sugars. You will likely feel fatigued and low-energy. I have never seen a set amount recommended, but the fewer, the better. Cant wait for your books to arrive. Hi Lynn! Its also worth mentioning that different people react differently to added sugars: if you are extremely active, not overweight or you simply have a great metabolism, then you might have no problems with a bit of extra sugar. Refined sugar, called sucrose, is half glucose and half fructose. Cutting sugar and flour from the diet, reducing your carb cravings, and adopting a healthy lifestyle to help you banish some of that stubborn belly fat can help you heal and avoid fatty liver. Plus, it's important not to confuse the saturated fatty acid diet with a low-carb, high-fat (LCHF) diet. When it comes down to it, its not a bright looking future. 1. Sugar, if had in excess, will be stored as fat by our body. Shockingly, the Tsimane people exhibited the lowest rates of coronary artery disease ever recorded in a population. Remember that your goal is to completely stop adding sugars or anything similar, but if thats not possible, reducing the quantity by as much as possible (think something like cutting 90%) is an acceptable approach in my opinion at least this is how I did it and I still managed to reverse my fatty liver. Why It Can Be Worse Than Being Obese. Seems crazy, right? Diet modification. This may come as a shock to you, but let me explain why this is the case. Excess sugar and starch in the diet can also lead to high triglycerides, low HDL (good cholesterol), and high small LDL (bad cholesterol). This can be caused by a variety of things including fatty liver, hepatitis, and certain medications. Our childrens diets today, chock full of simple sugars like fructose, are sadly setting the stage for liver transplants, high blood pressure, diabetes, heart disease and unhealthy cholesterol levels. Nutrition science has to be one of the sloppiest fields I have ever seen. A single 12-ounce (355-mL) can of soda contains as much as 8 teaspoons of sugar ( 12 ). However, others have shown similar effects after only nine days of increased fructose intake. Save my name, email, and website in this browser for the next time I comment. (5), An analysis conducted at the Department of Medicine at the University of Helsinki and the Minerva Foundation Institute for Medical Research in Helsinki, Finland, concluded that a low-calorie diet leading to weight loss is effective for reducing fat content in the liver in the long term, regardless of the proportion of carbohydrates. Is Alzheimers Really a Form of Diabetes? Low-fat dairy and lean meats are low-carb sources of high-quality protein. Then, you can choose to limit the proportion of carbohydrates in your diet if it works for your body and lifestyle. Funding by wsro.org; world sugar research organization. Both are just a question of pleasure, as far as I see it. If you fatty liver is alcohol related and you stop drinking do you still need to maintain a good fatty liver diet? Bethesda, MD 20894, Web Policies Read below to find out how this age-old guilty pleasure has actually been used to heal the You may have heard that elderberry provides immune support, but do you know why? But do set a goal and make sure you get there ASAP (in a couple of weeks, not several months: that would be too slow!). Get instant access to healthy low-carb and keto meal plans, fast and easy recipes, weight loss advice from medical experts, and so much more. The fatty liver diet requires avoiding or minimizing the following five liver wreckers: Alcohol - Because it impairs the liver's ability to metabolize fat, alcohol is a direct aggravator of fatty liver disease. Consider this: one serving of store bought tomato sauce can have more fructose than a serving of Oreo cookies YIKES! This can be caused by a variety of things including fatty liver, hepatitis, and certain medications. First, lets get into the study. My midsection is going down also so it must be helping my liver. Dr. Hyman Says Sugar, Not Fat, is Your Enemy! At least a cup or two every day can help restore liver health. For requests to be unblocked, you must include all of the information in the box above in your message. Its been 10 days and Im down 5 lbs. A healthy diet needs a balance of all key macronutrients, including carbohydrates, protein, and fats. Dietary fat actually turns off liver lipogenesis. When I stopped low carb, but maintained the high fat (because I liked it) within 2 years I'd regained all my weight plus extra, was diagnosed with fatty liver, sleep apnoea and basically my health was in terrible shape. The studys finding could also have to do with total caloric intake, especially since higher caloric intake exaggerates the deleterious response. Even cutting back by 1,000 mg a day can improve blood pressure and heart health. Answer (1 of 7): The damage to the liver by honey was dose dependent. Fructose, the primary sweetener in sodas, is, a key player in the ever-increasing rates of nonalcoholic fatty liver disease (NAFLD). Plus, its important not to confuse the saturated fatty acid diet with a low-carb, high-fat (LCHF) diet. Excess sugar and starch in the diet can also lead to high triglycerides, low HDL (good cholesterol), and high small LDL (bad cholesterol). The take-home message here is that healthy saturated fats lower inflammation when you eat them as part of a low-carb, high-fiber, omega 3 fatty acid-rich diet. Remember: our body needs these sugars (carbs) for energy. The cells become scarred and cannot divide. And most importantly, remember its the sugar, and not the healthy fats, that you need to stay away from! Plus, having a balance of all three macronutrients from all food groups helps increase satiety and prevent overeating. Either way, the key to cutting carbs for fatty liver disease is eliminating the bad carbs and replacing them with whole grains, fruits, veggies, and beans. The World Health Organization advises that 6 to 10 percent of your total calories should come from sugar. If you'd like to find out whether you're at risk of liver disease, you can take our quick online screener. For dinner, make a protein-rich and vegetable-laden stir fry with strips of chicken breast, broccoli, green beans, cauliflower, bell peppers, collard greens, and kale. If possible, you should reduce added sugars to 0. This does NOT mean that you pay more than you would if you went to the same product page on Amazon by yourself. Incorporate my healthy eating and lifestyle tips into your daily life to help keep your liver healthy. A lot of "broth" they use to do cell studies is like 200mg/dl glucose (i.e. . My symptoms started at the age of 47. An increase in fat usually fills this caloric void, so by nature, low-carb diets tend to also be high in fat. Top with sauted peppers, onions, and avocado slices. Should you measure ketones on a keto diet? SugarScience Facts Growing scientific evidence shows that too much added sugar, over time, is linked to diabetes, heart disease and liver disease. Many years ago, I had transitioned to sugar free, to grain free, and increased fat intake until I was basically on a high fat low carb diet. You need a healthy liver to combat toxins and chemicals that inevitably become a part of your surroundings. I am anxious to see if its improved. A liver function test doesnt always detect a fatty liver. Blood tests and an ultrasound can both detect fatty liver. These are interesting questions that the current study does not answer, but certainly makes us wonder. Most causes of fatty liver are genetic but there are also some environmental risks. By 1850, this had risen to 20 lbs, and by 1994, to 120 lbs, and now we're closer to 160. . Let me break it down for you. Blood tests and an ultrasound can both detect fatty liver. (1), For example, lets consider the Okinawa people living in Japan. AND 8 Tips from Dr. Hyman on How You May Prevent and Reverse It! And yes, all types of soda/juice should be put on the not allowed list. I have been diagnosed with NASH Im at F2 Im trying to get rid of the excess weight now. [Including Brown & Black Rice], How to Beat Dieting Fatigue and Stay on Track. Gallbladder Removal Surgery: The Cholecystectomy Diet and Other Ways to Support Recovery, The Mediterranean Diet for Beginners: How to Use the Mediterranean Diet to Reverse Fatty Liver Disease, Carb Cycling for Weight Loss: What You Need to Know, What to Do If You Have Hepatic Encephalopathy, Signs You May Have an Amino AcidDeficiency, How to Live to 100: What You Can Do to Increase Longevity. No questions asked. Even if your test comes back normal, dont think youre off the hook. 219 views, 15 likes, 15 loves, 3 comments, 9 shares, Facebook Watch Videos from National Low Carb Day Ph: EASY, NUTRlENT-DENSE MEAL PREP | L0WCARB STAPLE sharing sensitive information, make sure youre on a federal Im also feeling irritable and tired. Healthy subjects overfed 1000 calories per day of fructose showed a 25 percent worsening of their insulin sensitivity after just seven days! Super foods to detox. Terms of Use | Privacy Policy | Do Not Sell My Personal Information. On top of his list of new products to crea Now, more than ever, its important to keep our immune systems strong. Liver cells are slowly replaced by fat cells, leading to non-alcoholic fatty liver disease (NAFLD). 2,500 calories: about 139-208 grams of fat per day. My biggest culprit was sugar in my food diary going back as much as 10 years I found that have been eating about 120-150 grams of sugar a day from all foods. Iconic science-writer Gary Taubes answers these questions. In other words, 10 grams of carbs from plain sugar and 10 grams of carbs coming from a fruit you ate wont be used the same: the former will invade the bloodsteram faster and stored instantly as fat. NOTE: This article does NOT refer to fatty liver and sugar for those who also suffer from diabetes. Risk factors for nonalcoholic fatty liver disease include obesity, particularly when high levels of belly fat are present; insulin resistance; diabetes; elevated blood pressure; sleep apnea; and high blood lipid levels. But no, I didnt read any studies comparing sugar and alcohols potential harm its just a personal opinion. (6). Though originally formulated to help people lose weight and get healthy, low-carb dieting has led to avoiding healthy carbs and additional benefits from fruits, veggies, whole grains, and legumes. I also dont find frozen cranberries in our area. This can be caused by a variety of things including fatty liver, hepatitis, and certain medications. The study randomized 16 overweight males to follow either a saturated fatty acid diet or a sugar diet for four weeks and then switch. Low-fat dairy and lean meats are low-carb sources of high-quality protein. Two of the common reasons for fatty liver are alcohol and diet. With the right, healthy dietary fat (think coconut oil, a medium chain triglyceride), you actually speed up your metabolism! In the upcoming That Sugar Film, Damon Gameau, a filmmaker and TV actor, vows to follow a strict diet of "healthy," low-fat food with high sugar content, News.com.au reported. 8600 Rockville Pike Sugar is essentially a switch that triggers fat production in your liver (a natural process called lipogenesis). Even if your test comes back normal, dont think youre off the hook. This means that drinking one 12-ounce beer, one 6-ounce glass of wine, or one shot of hard booze every hour will keep your liver metabolizing alcohol without fault. When talking about added sugars, the maximum allowed amount per day is 37.5 grams or 9 teaspoons for men and 25 grams or 6 teaspoons for women. Are You Skinny Fat? The right supplements can help promote balance while your body is healing. I do solid research with everything that I share on this blog and having reversed fatty liver myself, this should add extra weight to my words. Weight loss is tough; a recent study showed that only 10% of people trying to lose weight through lifestyle intervention lose 10% of their weight; 12% lose 5-7%. Its so hard to change though. The recommendations come from the American Heart Association, but refer to the amount of added sugars that a healthy person should consume. What happens if you restrict carbohydrates too much? Ideally, you should completely eliminate all added sugars from your diet. The composition of carbohydrates consumed is the defining factor in liver-friendly diets. Further Your Health with Natural Health Supplements. The first step in adopting a low-carb diet for fatty liver disease is to swap out any bad carbs for good carbs. [Complete Answer]. Keep reading to find out how to cut carbs to support the reversal of fatty liver disease and associated conditions. Fatty liver disease is more common than ever. Another population that follows a high-carbohydrate is the South American Tsimane people who reside in Bolivia. Heres all you need to know about fatty liver and, to top it off, a customized list of 7 life-changing tips for switching up your diet and lifestyle to heal or prevent this dangerous disease. I am now 59. And make sure to Include nuts, seeds, eggs, fish, chicken or grass-fed meat for protein at every meal. Will that help and how will I know if it is working? The truth is that added sugar is not required in our diets and our body simply does not need it: it serves no purpose whatsoever it does make foods and drinks taste better, but otherwise its just empty calories. As mentioned earlier, the extent fatty liver medicine sugar diabetes of the reversal phenomenon abnormal blood sugar levels diabetes is probably mc diabeats about infographic different oral diabetes medications the same in all countries. Your liver can process about one ounce of alcohol per hour. I have seen that claim too, but its really difficult for me to believe that all those carbs are healthy. So, if you're eating a 2000-calorie diet that works out to about 50 grams of sugar daily, or 364 grams of sugar in one week. Need more information please just find put today on my scan I got liver fat . Its actually recommended to have a diet rich in fruits and vegetables: despite the fact that they have a fair amount of sugars, they also have fibers, vitamins and minerals and are considered natural sugars that are absorbed slower, and therefore do less harm. In the seventh episode of Diet Doctor Podcast, Megan Ramos, co-director at IDM program, talks about intermittent fasting, diabetes and her work together with Dr. Jason Fung at the IDM clinic. Although this study does not specifically call this out, we can likely conclude that the problem is not the saturated fat itself, but rather the complete diet. All of these sugars add some sweet flavor, but also a ton of extra calories and fat for your body and liver to deal with later. An unhealthy liver, or fatty liver, puts you at risk for increased inflammation, a harmful process which can in turn lead to insulin resistance and a condition known as pre-diabetes, which exponentially increases your chances of developing full blown diabetes if not well controlled. Sugar - Besides being devoid of nutritional value, sugar activates lipogenesis - fat production in the liver. What is not said? It was difficult getting up from` a chair and getting out of a car. For a low-carb breakfast that packs a proteinaceous punch, mix nonfat Greek yogurt with flaxseeds, and sprinkle with walnuts and raspberries. You have to read all the details. 2,000 calories: about 111-167 grams of fat per day. One of the areas the fat is stored is in the liver. Rapid and uncontrolled weight loss can be detrimental for patients and may even worsen clinical symptoms of NAFLD [ 4, 5 ]. A low-carb diet may work for you, but not for someone else. Excess calories matter. The consumption of excess sugar and carbohydrates causes the liver to convert them into fat through a process called hepatic De Novo Lipogenesis or DNL, says Dr. Prosenjit Mondal, associate . Unlike carbohydrates and protein, your body prefers to burn rather than store dietary fat, unless you consume it in combination with carbohydrates. fat) are to blame for increasing the amount of fat that accumulates in your belly and liver. and unhealthy cholesterol levels. Im very happy and plan to continue this. From adding sugar to coffee, eating sugary treats to drinking sugary drinks, sugar is a proven route towards fat accumulation of the liver. Dr. prescribed Metformin to get rid of fatty liver. And overall, added sugar should be less than 10 percent of your diet. This allowance differs for men, women, and children. Apart from contributing to fat storage, sugar can also cause inflammation in the liver. Overall, the evidence is somewhat inconclusive and doesnt suggest that a low-carb diet is more effective than a healthy diet that includes unrefined carbs. I personally live in a city where the tap water tastes absolutely terrible. Instead, the Tsimane people filled up on unrefined corn, plantain, rice, nuts, and fruits. And if you cant really cut out all sugars overnight, take it slow, but make it your main goal to reduce sugar consumption drastically if you want to reverse your fatty liver. Drinking lots of clean, revitalizing water with no toxins or heavy metals is the best way help a fatty liver heal. However, a new paper published in Diabetes Care, a peer-reviewed medical journal, suggests that saturated fat is a much stronger trigger for liver fat than sugar, a finding that is at odds with the aforementioned low-carb dietary studies. (Photo: Robert Boston/School of Medicine) Nonalcoholic fatty liver disease, a condition closely linked to obesity, affects roughly 25 percent of people in the U.S. When you swap out the bad carbs for good carbs, you will naturally increase your fiber intake. Making crystal clear pure water the drink of your choice is one of the most important steps to healing a fatty liver. Cut out all processed foods that come loaded with excess sodium. This is just a crude example, used to show you how things actually work. Why is the research inconclusive regarding the superiority of the low-carb diet for fatty liver disease? Is weight loss controlled by calories in and calories out? We are also part of other affiliate programs, but this has no editorial impact over this blog. Fat is burned for energy, and you feel more satiated. Fatty liver disease is a condition of extra fat build-up on the liver. The first question is fairly easy to explain. Fatty Liver Medicine Sugar Diabetes. Consuming too much refined sugar can lead to fatty liver disease, which can escalate to a more serious form of the disease called . This, in turn, leads to fat burning for energy, and subsequent weight loss. Read on to learn our recommendations for the top Chocolate is a decadent treat we just love to eat. For example, one study showed a significant increase in liver fat after six months of increasing sugar sweetened drinks. Realistically, though, it will be extremely different to cut sugars off completely especially early on after being diagnosed. 4. Your doctor may have suggestions on how often you can drink alcohol. Thanks for the question. Dr. Westman guides you through situations when measuring is beneficial and when it's not. The bottom line, however, is to make sure we do not confuse this study with a low-carb diet, which has been shown in multiple trials to be beneficial for fatty liver, as well as, for glucose and insulin levels even with increased saturated fat intake. This brings up two important questions: How could a diet high in saturated fatty acid lead to worsening liver fat and glucose response, and how could a diet so high in sugar not do the same? https://www.furtherfood.com/join-free-sugar-detox-challenge/. Adults need between 700-900 micrograms of "retinol activity equivalents" (RAE) per day. On a PET scan of the healthy human brain, the image would light up in fluorescent red, yellow, and blue. Exercise to enhance your metabolism! Additionally, the efficacy of the low-carb diet in the Western world may be due largely to the fact that eating fewer processed foods and grains removes massive amounts of sugars and calories from the diet. compromise on added sugars. Those given an extra 1000 calories per day of glucose did not . Researchers found when people increased their physical activity by 60 minutes or more per week, research participants significantly lowered their weight and improved liver function. government site. Most causes of fatty liver are genetic but there are also some environmental risks. Can you get headaches from sugar withdrawal? My next blood test is next month, March. . Fruit: Fruit, such as berries and kiwi, is rich in vitamin C, filling fiber, and antioxidants. The recommended amount of sugar per day for someone with a fatty liver is no more than 25 grams. For additional information, or to request that your IP address be unblocked, please send an email to PMC. These blood sugar spikes trigger the pancreas to release insulin, which signals to your cells to utilize the glucose present in the bloodstream. However, its not fat you need to stay away from-its carbohydrates. (3). This amounts to about 1.5 oz of 80-proof alcohol per day. 1 ). This is equivalent to about 6 teaspoons of sugar. My fingers on my left hand were stiff and were difficult to move. It could be that they simply needed more time to show a difference. to be avoided for (non alcoholic) fatty liver disease? I have always heard that if you eat too much sugar and dont use it for immediate energy, it will turn into fat. While it is important to limit the amount of sugar that is consumed, it is also important to make sure that the sugar that is consumed is from healthy sources. Don't forget that "saturated" fat often means lard which is over 50% monounsaturated and 11% Omega-6. Do you have a hard time losing weight on low carb or keto? Nonalcoholic fatty liver disease (NAFLD) is defined by hepatic steatosis in the presence of alcohol intake within safe limits, defined by guidelines of. I always thought it was the carbs but no it is the sugar even 50 grams is too high and Im working on lowering that to about 30. The increased fat production that occurs when we consume copious amounts of sugar explains why these simple carbohydrates, especially fructose, can become the primary cause of liver disease and the leading cause of liver transplants across the nation. From fructose to fat The entry of fructose into the liver kicks off a series of complex chemical transformations. Therefore, our normal response to sugar consumption is liver lipogenesis. Regularly eat cruciferous vegetables like broccoli, cauliflower and Brussels sprouts, as well as leafy veggies like kale, collards, cabbage, arugula, and watercress. 2,000 calories: about 67 grams of fat per day; 2,500 calories: about 83 grams of fat per day; Studies show higher fat diets, such as low carb and Mediterranean diets, offer many health benefits . But always consult your doctor before using any of the tips, diets, supplements or products on the Fatty Liver Diary website. However, it is often first detected by imaging tests requested for other reasons. Or is our body weight carefully regulated by hormones? My doctors didnt tell me I had fatty liver I saw it on the results of an ultrasound I took. Went to a store where there was a Nutrionist and he suggested Digest GB which is a supplement. I cut back to no more than 50 grams and see a dramatic difference, especially the diabetes - I was taking 1500 mg metformin a day and now I'm down to 500 mg a day. Then, once the seven weeks were up, they would switch and eat the alternative diet for four weeks. However, scientists have found that sugar exacerbates Fatty Liver Disease. Sign up and get 15% off your first order! Commentdocument.getElementById("comment").setAttribute( "id", "a8715c3b735b8ff611a820be713bb950" );document.getElementById("f07ba6d035").setAttribute( "id", "comment" ); Save my name, email, and website in this browser for the next time I comment. severly diabetic). Some research suggests that low-carb diets may be more effective for short term weight loss, but not as effective in the long term. The sugar stimulates production of triglycerides in your liver. canola, olive, corn, sunflower, peanut, flax seed oils) because it needs less bile to break down fats than other types of oil. While not all carbs are bad (our body needs them), anything that is in excess is. Ive started to eat healthier, fast food seems to be my problem because I cannot cook a meal anymore I am disabled and can no longer stand and do normal things anymore. NAFLD affects a significant portion of the population. Statements made on this site have not been evaluated by the Food and Drug Administration, and products sold on Further Food are not intended to diagnose, treat, cure or prevent any disease. Non-alcoholic steatohepatitis: There's fat in the liver as well as inflammation. It seems like collagen supplements are everywhere these days, from health and wellness shops to your local pharmacy. Earlier I mentioned that sugar, not fat, is fully to blame for fatty liver. So apart from completely eliminating alcohol from your diet, and keeping an eye on the fats you consume, you also have to be very careful with the amount of added sugars you eat each day. Generally, everything ending in ose is sugar although not always added sugar (for example, lactose is naturally found in milk and rarely added to anything else). A steady stream of glucose enters your bloodstream, without causing a spike and crash. Always opt for fruits when you feel the need to eat something sweet and learn to sweeten your foods with fruits also (use, for example, a banana instead of sugar when baking sweets). and the leading cause of liver transplants across the nation. Kiss them goodbye because they usually have added sugars (and some preservatives too). Accessibility With the new herbal medicine i purchase fromtotalcureherbsfoundation c omwas my only way to get rid of my PD,the herbal formulaeffectively reverse my condition and alleviate all symptoms. My doctor says I have a fatty liver and I should stay away from fat, writes this weeks house call. Is fat really the problem, though? Plus, refinded sugars like all these added ones, are absorbed faster by our body. How Much Sugar Is There in Fatty Liver Fatty liver is a condition that causes the body's liver cells to swell up, known as fibrosis. As for why the high-sugar diet didnt cause an increase in liver fat, this is a more challenging question. Your program sounds a lot like it. Sugar is essentially a switch that triggers fat production in your liver (a natural process called lipogenesis). Many people believe that when you have a fatty liver, you should only look at the amount of fat that you consume. However, some studies have shown that people with fatty liver disease benefit from eating a lower carbohydrate/ higher fat diet (focusing on unsaturated fats). The organ uses one type of sugar, called fructose, to make fat. Walking 30 minutes per day along with following a diet recommended for liver health has been shown to be helpful for fatty liver. Humans need a certain amount of daily sodium. Several kinds of low-carb diets have since surfaced, including the Atkins Diet and South Beach Diet. What should a person with fatty liver disease eat? So, how many grams of carbs per day should you be consuming? Try to limit your sugar to 15 grams per day for one week, and tell me I . Fructose, the most dangerous sugar that gets directly transported to your liver, actually upregulates lipogenesis. Because processed foods and refined grains usually lack nutritional value besides starch, they are readily broken down into glucose. However, its not fat you need to stay away from-its carbohydrates. Dr. Mark Hyman explains the dangers of fatty liver, and how sugar, rather than fat, may indeed be the primary culprit.

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