Your Checkup: Patient Education Health Podcast
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Your Checkup: Patient Education Health Podcast
103: What They Say You Should Actually Eat Everyday
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Headlines argue. We read the document. This week we unpack the newest dietary guidelines with a clear, practical lens: what the recommendations actually say, why they still look a lot like Mediterranean and DASH patterns, and how to turn them into everyday choices that reduce risk without wrecking joy. We start with the big shift that matters most—focusing on overall dietary patterns instead of obsessing over single nutrients—then dig into the hot spots that shape real health outcomes.
We cut through the noise on saturated fat by pairing mechanism with food context, explaining why a simple cap exists and how whole foods complicate the picture. Added sugar gets a brighter spotlight: from the outsized impact of sugar-sweetened beverages to easy swaps like unsweetened tea and low-sugar prebiotic sodas that don’t torpedo your day. We revisit whole grains for their fiber and cardiometabolic benefits, highlight protein variety to reduce reliance on processed meats, and pull forward the growing evidence on ultra-processed foods and why they often lead to overeating even when macros match.
Alcohol guidance is evolving too. We talk candidly about shifting from “maybe helpful” to “not necessary,” the ripple effects on sleep and recovery, and simple ways to keep the ritual while skipping the drag on health. Throughout, we remind listeners that population-level guidelines are meant to lower risk across millions of lives; personalized nutrition still belongs with you and your clinician or dietitian. Our goal is a calm, confident roadmap: fewer absolutes, more usable habits, and a pattern you can actually maintain.
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Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
Vantage Design Works (Vanessa Jones)
Website: https://www.vantagedesignworks.com/
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Original Artwork Concept: Olivia Pawlowski
Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversation from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area. And I'm Nicole Ruffo. I'm a nurse. And we are so excited you were able to join us here again today. So before we get into the banter today, we are going to do episode two of two. If you joined us last week, I portended a three-episode miniseries on the food pyramid. We looked into it. Turns out after today's episode, there isn't a whole lot more to talk about.
SPEAKER_01Yeah, there's only so much you can say.
SPEAKER_00Yeah, so we're gonna we're gonna do that today. And we'll have something new and exciting for you next week. Um still have to figure out exactly what the the calendar will show. Um we're gonna probably record it sometime differently than Sunday, I would argue, because we're gonna be busy next weekend.
SPEAKER_01We are plans.
SPEAKER_00But we'll leave uh we'll leave the maybe leave that for later. Um we had a nice experience yesterday, had a nice uh my first time.
SPEAKER_01Was it your first time? It was, I think, yeah.
SPEAKER_00Having Peking Duck. Um, you know, if anyone listening to this also follows me on Instagram, I made a nice little documentation of the night, and it was delicious. Um, you had a little taste. I you know, of course, we went with the usual suspects. Karthik, Mike, Pre. You were so delightful to join us. Um, Sam was celebrating her birthday otherwise. So happy birthday, Sam. And you know, we got a shmorgage board. Karthik had looked at the menu for apparently nightly for a week and ordered, you have to let them know ahead of time that the duck is ordered.
SPEAKER_01Did you guys pick the place like 72 hours before we went?
Peking Duck And Food Talk
SPEAKER_00This part confuses me too, because maybe he looked at multiple menus in tandem.
SPEAKER_01Yeah.
SPEAKER_00But that did confuse me because it seemed like it was up for debate up until the last moment. Or like three days beforehand, which would leave four days unaccounted for. Anyway, the Peking duck, which the carving of was announced with a gong. Tasted like bacon, kind of.
SPEAKER_01It did, yeah.
SPEAKER_00I thought it was great. It was delicious.
SPEAKER_01Yeah, it was good. It's a little dark and fatty for me. I think.
SPEAKER_00Yeah, you know, it's not a meal that I would argue like no, us talking about food today. It's not one that's a staple, but no, it was fun.
SPEAKER_01It was good.
SPEAKER_00But it was fun. They had um a lazy Susan in the in the middle of the table that you can spin around and like pass things, um, which was very nice because you can like, oh, there's some sauce, some um hoisin? Hoisin sauce?
SPEAKER_01Hoisin, I think.
SPEAKER_00Hoisin.
SPEAKER_01I'm pretty sure.
SPEAKER_00The age is silent.
SPEAKER_01I don't think there's an age. Is there? Look it up real quick.
SPEAKER_00Like an herb?
SPEAKER_01No, I think there just isn't an eight.
SPEAKER_00Nah, we gotta let this let this one ride. There can't be any we can't get clarification on this.
SPEAKER_01Why not?
SPEAKER_00Well, maybe we could. Oh, wait, there is an age. Thank you. So it is like herb. Oops. What other words are there with silent ages? Herb. Horticulture. Horticulture. Whores divores. Hors d'oeuvres. Yeah. Good one. Good pick. Hmm.
SPEAKER_01That's all I got right now.
First Spring Day And Routines
SPEAKER_00Me too. Um, and we had a great day today. Can you tell us? They've heard me talk, and I'm gonna talk a lot more. Can you tell us about what we did today?
SPEAKER_01Yeah, oh my gosh, we had a whole day. It was the first like really nice day of the end of winter or beginning of spring in Philly. And well, I had a whole morning before you even got up. I had a grocery order delivered, prepped some food for the week, made Ollie some chicken and the carrots.
SPEAKER_00He's been loving it.
SPEAKER_01Got some things ready for dinner tomorrow, clean out the fridge a bit, and then we went on a nice run down to the Schuylk. We're on the Schuylkill River Trail for a while, got a nice little ice latte treat on the way back. Oops. And then we went to the gym. We did Ali for a nice long W. We're gonna have to get a stroller out soon. I'm excited for that.
SPEAKER_00Yeah, we can spend more time with him outside. He's fine.
SPEAKER_01He moves great, but you know, his little legs get tired and we like to walk far, so we do plop him in the stroller and he smiles away and stares at everyone.
SPEAKER_00He does. Everyone pities him because they think something's wrong, and it nothing is wrong. I mean, we got it when he was recovering, of course, but no, he's just you know, I mean, when it's a little warmer out, like it was in the 60s today, he was we're getting his endurance back up.
SPEAKER_01Listen, if you can push a full-grown child in a stroller, you can push a dog, you know. Yeah, the kid's legs get tired, the dog's legs get tired.
SPEAKER_00Nona's legs get tired.
SPEAKER_01The best thing about it is that a dog can't whine about it.
SPEAKER_00That's a good point. No, he loves it. Yeah. And tonight I'm making salmon. I've been into this like garlic caper salmon bit with boiling the water and then putting it on the salmon so that the shrimp, the the skin comes off. So that's looking forward to that. Um, and then what are you making tomorrow?
SPEAKER_01Uh, what am I making tomorrow? Oh, tomorrow. I kept seeing these recipes for like white chicken enchiladas that are very much going to be like a white person version of it. But they looked good, so we'll see. See how that turned out. I made the chicken for it this morning and like shredded it so that I can put it all together tomorrow.
SPEAKER_00Awesome. And you had an idea for Tuesday, too, which I'm one left.
SPEAKER_01Yeah, I'm gonna make well, we'll see how this turns out. Um, like pizza, but the crust is made out of ground chicken.
SPEAKER_00Yeah, I'm so curious how this is gonna come out.
SPEAKER_01I think it's good. I think my mom recently told us that she made it, and then my dad and Eric both liked it and couldn't tell a difference. So if they didn't complain about it, then it's probably good.
SPEAKER_00Good point. Yeah, and daylight savings. Now we're doing this today on what is a 23-hour day. Um so is daylight savings starting or ending? I don't know. I mean neither.
SPEAKER_01Uh all I know is probably starting because then there's more daylight.
SPEAKER_00Daylight savings. Yeah.
SPEAKER_01You know?
SPEAKER_00I'm with you. Yeah. I'm I'm always perpetually accused of making a bigger deal out of this than is necessary.
SPEAKER_01I'm really proud of you.
SPEAKER_00I'm really today's a hard one.
SPEAKER_01All day you could have been like, it's six o'clock, but really, it's five o'clock. I actually forgot about it this morning. And when I looked at the clock when I woke up, it was like 7.06, and I was like, wow, I slept until seven o'clock. Oh my gosh, I'm so well rested. And then I remembered that I was just waking up at my normal time.
SPEAKER_00You are, and this um, I'm looking forward to the I'm gonna choose to be positive and I'm looking forward to more light at the end of the day. That's gonna be great. Um, I think everyone likes that.
SPEAKER_01Yeah.
SPEAKER_00Except as it's dark out in the morning. Um, all right.
SPEAKER_01Well, it won't be like that forever.
Why The Guidelines Matter
Daylight Saving And Housekeeping
SPEAKER_00No, not forever, certainly. Um, and then it's gonna be very warm this upcoming week, which we're looking forward to. But I'm gonna be inside quite a bit during it. So maybe I'll wear a short sleeve shirt or something. Um, all right. Anything else? All right. Well, why don't we get started then? Should we dive in? So, what are we gonna talk about today, Nick?
SPEAKER_01So today we're talking about what these new dietary guidelines are actually saying.
Patterns Over Nutrients
SPEAKER_00Yeah, so last episode we talked about the history of the dietary guidelines for Americans and how they started in 1980, who writes them and why they matter, far beyond just general advice. But because these guidelines don't just influence individuals, they tend to shape federal nutrition programs, school lunches, and even military rations. And so today we're doing something a little different. Instead of debating headlines about the guidelines, oh today we're just gonna walk through what they actually say. And this sounds obvious, but honestly, most of the time when people argue about the dietary guidelines, they are arguing someone's interpretation of them, not the document itself. So today we're breaking down the core recommendations.
SPEAKER_01Okay, so the core recommendations on our new food pyramid are saturated fat, added sugar, protein sources, whole grains, alcohol, and we also now have ultra-processed foods.
Saturated Fat: What To Limit
Added Sugar And Sodas
SPEAKER_00Yeah, and we're gonna talk about the evidence behind each one and be take a careful look at what the science actually says. So we're gonna talk about how there are dietary patterns versus individual nutrients. One of the first things the guidelines emphasize, and this has been increasingly clear over the past couple decades, is that health outcomes are linked to overall dietary patterns, not single nutrients. For a long time, nutrition science focused heavily on individual nutrients, fat, cholesterol, carbohydrates. But now the emphasis is more on the combination of foods people eat over time. So the pattern recommended in the guidelines generally includes vegetables, fruits, whole grains, lean proteins, dairy, or fortified alternatives, nuts, seeds, and oils, and limits on added sugars, saturated fat, and sodium. And if any of that sounds familiar, it's because it looks a lot like the Mediterranean diet or the DASH diet, which we have talked about previously. So it's not radical, it's more of a risk reduction template. So let's go through different segments of this. So the first one we're going to start off with is saturated fat. This one tends to generate a fair amount of debate. And the guidelines recommend saturated fat make up less than 10% of calories. And that recommendation has been around for a while, and the reasoning is largely based on the relationship between saturated fat intake and LDL cholesterol levels. And this is important because LDL cholesterol plays a causal role in atherosclerosis. This is plaque formation in arteries. So the argument goes: saturated fat raises LDL, higher LDL increases cardiovascular risk, therefore, reducing saturated fat lowers risk. But there's nuance to this, and it comes in when we look at actual foods, not just the nutrient itself. For example, some foods contain saturated fat like yogurt or cheese, and they don't consistently show increased risk of cardiovascular disease in observational studies. Now, if you compare that to processed meats, these are more strongly associated with negative health outcomes. So one of the debates in time is whether a single percentage cap captures that nuance. And the answer is probably not perfectly. So public health guidelines often choose simplicity over complexity because the goal is population-level messaging. One other piece on saturated fat is that they in the pictogram that they offered for the new food pyramid, if you will, they put a lot of like red beefy meat at the top. And in the words, they said less than 10% saturated fat. And so the picture is probably what people are going to remember because I think fewer people will read the 10-page like consumer, like you know, average person facing document, and even fewer people will read the scientific information. But if one looks at that and says, oh, look, big red, beefy meat at the top, and then reads the nuance of have less than 10% saturated fat in your diet, there is a little dissonance there that is an opportunity for some confusion. But that's not so much of what we're trying to cover today. But that was just a little discourse that I've seen that I wanted to include here. Sweetie, are you able to um take us through a little walkthrough about the joys and devils of added sugar?
SPEAKER_01Ah, yes. Let's talk about sugar. The joys are that it makes your food taste really good. And everyone's also probably addicted to it.
unknownYeah.
SPEAKER_01Which is also a devil.
SPEAKER_00Good pivot there.
SPEAKER_01Um, so the guidelines recommend keeping added sugars below 10% of your daily calorie calories. Calories.
SPEAKER_00Calories.
SPEAKER_01Um, and the added sugar evidence is actually pretty consistent when it's compared to the whole saturated, saturated fat debacle. We all know that high intake of added sugar is linked to obesity, type 2 diabetes, fatty liver disease, and cardiovascular disease. So we're gonna loop back to the sugar-sweetened beverages as an example. Um, it's one of the clearest dietary contributors to excess calorie intake, which we've talked about before.
SPEAKER_00Yeah.
SPEAKER_01So we're gonna talk about it again. We'll mention it again.
SPEAKER_00Literally, so many people like now that I've been hunting, I find it all the time. It's kind of alarming.
SPEAKER_01It really is.
SPEAKER_00Even today. Today. Like in today's world. Oh, like growing up, yeah, like we had soda, and then there was like some transition where like my mom stopped bringing it in the house and we stopped having it. But like that's like 15, 20 years ago. Like this this is today, and we know all of this stuff now, anyway. You were saying.
SPEAKER_01Oh, the sugar-sweetened beverages, and that you can easily drink hundreds and hundreds and hundreds of calories worth of a sugar-sweetened bevragino, and it does absolutely nothing for you. Yeah, it does not make you full, it does not make you satiated. It is honestly just like a quick hit of sugar that tastes good, but it does absolutely nothing for you. Yeah. It actually does all bad things for you.
SPEAKER_00It's true. Oh, yeah. Well, and we in one of our tasty tips, we that was where we talked about this. We talked about that it was twice related to a bad outcome. Yeah, I think it was it was linked to colon cancer.
SPEAKER_01Oh, yeah.
SPEAKER_00Yeah, we said that was one of the like early causes of increased rising rates that they had in observational studies. Well, that it was linked to um, careful to use the word cause.
SPEAKER_01Yeah.
SPEAKER_00Um, just drink water. Just drink water. Um, alternate, I guess like I I would roll over and say that like one of the probiotic, like newly branded sodas.
SPEAKER_01Yeah, like the poppy or the olipop.
SPEAKER_00I think those are probably better.
SPEAKER_01Those are actually pretty good.
SPEAKER_00They're tasty. Um, they're like also 25 calories-ish. So you're not drinking hundreds, like you were saying.
SPEAKER_01Yeah.
SPEAKER_00I mean, there's like probably look, if you got like a can, I would venture, I guess, that like a can of Coke is probably like 120 calories.
SPEAKER_01Okay. A standard 12-ounce can of Coca-Cola, so like regular Coke, is 140 calories and 39 grams of sugar.
SPEAKER_00Wow.
SPEAKER_01Yeah. That's a lot.
SPEAKER_00That's a lot.
Whole Grains And Fiber
SPEAKER_01And I feel like we like in my own head, and I feel like what we really don't have a lot of added sugar ever or on like a daily basis. I mean, we got like ice lattes today, and that was like a special treat, and I like couldn't even finish my whole life. Yeah. But like, I feel like when I'm looking at things, like nutrition labels of things, if it has like 10 or more grams of sugar, I like won't eat it or drink it.
SPEAKER_00Yeah.
SPEAKER_01Typically. I feel like once you get into the double digits, that's like a lot.
SPEAKER_00Especially for a serving. And my people normally eat more than one serving of things.
SPEAKER_01So now let's do poppy.
unknownOkay.
SPEAKER_01So there are different flavors. So the calories and everything varies a little bit, but in one 12-ounce can of poppy, the calories range from 20 to 30. Um, added sugar ranges from three to four grams. So much better. A lot less. And there's also like a little bit of fiber in there, too.
unknownYeah.
SPEAKER_00So this is a lot better of an option. Um, we don't, we're not, we don't sell them. We gave you two brands to go look for. We've tried them both. We like them.
SPEAKER_01Yeah, we get them as a treat sometimes.
SPEAKER_00Again, we use them as a treat. We're water. We we drink water. Um, I would say, like, you know, iced tea without sweetener is probably fine too as an alternative. I think some people would be duped into thinking like regular Gatorade is also fine. Gatorade was designed for like performance athletes in mind to like give them sustenance back.
SPEAKER_01We could do a whole episode. I think I didn't I bring this up that we should do a whole episode on this and like the electrolyte craze.
SPEAKER_00We totally can.
SPEAKER_01And how you like don't need it if you're like a regular degular person.
SPEAKER_00Yeah.
SPEAKER_01Oh my god, right, because you're going for like a three-mile run because your kidneys work.
SPEAKER_00Yeah. I'm in. We should do it. And then maybe we can um bring up the sugar sweetened beveraginos again because we love talking about them.
SPEAKER_01We do.
SPEAKER_00Well, I've also been I've um found new like obesity podcasts for me to listen to, and they were talking about pediatric obesity and like directly linking it to sugar sweetened beverages.
SPEAKER_01I would like to talk about pediatric obesity.
SPEAKER_00You would?
unknownYeah.
Protein Variety And Processed Meat
SPEAKER_00Oh, great. We can prep that. So then let's continue on then. Um, thank you so much. So we're going whole grains. The guidelines recommend that at least half of grain intake be from whole grains. It's based largely on long-term cohort studies where they take people and they watch them going forward, and they show associations between whole grain intake and lower cardiovascular risk. That's simple. Um, critics would point out that these are observational studies, which is true and perhaps not ideal in terms of evidence, but it's the evidence that we might have. And people who eat more whole grains also tend to exercise more, smoke less, and have a higher socioeconomic status. But when researchers adjust for those variables, the associations often still hold. And so whole grains are one of the main sources of dietary fiber, which most Americans don't consume enough of, which we kind of addressed here a little bit with the poppies. Um, I mean, even us, we like do fiber supplements because I'm not sure that on an average day we eat enough to claim like Yeah, I definitely have more fiber than you do. You definitely do. Yes. So the recommendation isn't necessarily grains are magical. It's more that whole grains tend to be more nutrient dense and fiber rich compared with refined grains. So that's that. I don't know how many whole grains we actually, if we were to assess we don't have a lot of carbs, so they don't have to be a lot of people. We don't have a lot of that we routinely eat grains. No. I feel like I no, I look at that. Yeah, I'm like, when do we when does one eat a grain in this household? A pretzel.
SPEAKER_01We do have a thing for pretzels. I don't know, oatmeal? Is oatmeal a grain? Yeah, we don't really eat like bread like bread regularly.
Ultra-Processed Foods Evidence
Alcohol: Rethinking Moderation
Population Advice Vs Personal Care
SPEAKER_00Yeah, we have like grilled cheese. And I was like, wow, there's bread in the house. Say la vie. So then we're talking about protein. Another theme in the guidelines is protein variety. They engage people, they encourage people to get protein from multiple sources: seafood, poultry, beans, and legumes. We love legumes. Nuts and seeds, eggs and lean meats. And they also recommend limiting processed meats, which have stronger links to colorectal cancer. Here we go. And cardiovascular disease. I think this is like three weeks in a row, we mentioned colorectal cancer. So this doesn't mean eliminating red meat entirely, although you could reasonably choose to do that, but it does encourage moderation and diversity of protein sources. Now onto the best part is ultra-processed foods. We have a whole episode on ultra-processed foods that you would be delighted to listen to and you can easily find. But one interesting shift in recent years is the growing conversation about ultra-processed foods when it comes to these guidelines. These are foods that undergo multiple industrial processing steps and often contain additives, flavor enhancers, and refined ingredients. There's increasing evidence that we've re like we've previously covered that diets in high ultra-processed foods are associated with things like obesity, metabolic disease, and higher caloric intake, even when controlled for other things. We did a when that was a cool study that we looked at when they like had people in a hospital wing and they gave them like whatever food they were able to eat and whatever they wanted, and like the same amounts somehow they controlled for it. And the people with the ultra-processed food just ate more calories than the other people, which I thought was very interesting. So guidelines don't explicitly center ultra-processed foods in their recommendations. Instead, they focus on nutrient targets like sugar, sodium, and saturated fat. And some critics would argue that they could have been more clear on this issue, but we'll say it here. The processing of food and ultra-processed foods are something that you should probably limit. So then the next one is about alcohol. They cover alcohol guidance and it's evolved slightly. Um, it's still vague, but the guidelines still define moderate drinking limits. But the messaging increasingly acknowledges that alcohol is not necessary for health. And some research that we've talked about even in recent weeks has suggested that even moderate consumption can carry certain risks. So the tone overall has shifted from moderate drinking may have benefits towards a more cautious framing. Um they actually say in there that no amount of alcohol is healthy, which I think is good to say out loud because they there are like previous studies or like arguments out there, not even studies, that would say, like, oh, a glass of wine is good for cardiovascular health. And I don't know, between learning a couple extra things, like I think everyone pretty much knows that alcohol isn't healthy. But recently, in broad themes, I've even learned that alcohol affects two nights of sleep whenever people drink. So the night that after like the night of the drinking and the next night. If you're someone who drinks every other day, then that means that every night of your week is somehow affected by alcohol. We've also recently reviewed evidence that alcohol can increase the risk of colorectal cancer, not to mention that it's addictive and also a huge source of empty calories. Yeah, I've been really anti-alcohol on this podcast recently. Unintentionally, but it's been happening, just from like a health standpoint. So some would argue that the guidelines look familiar. I would be one of them. And you know, they lauded in their preamble that they like changed the world and they were gonna fix America's food problem with these guidelines, and they are very similar to the ones in 2020. And they were like, oh my god, Trump's America and Trump's food pyramid is gonna be the next best thing. It's practically the same. So there's that. I think there's a lot of uh self-patting on the back there. But regardless, there's some decent stuff in here, which is tough in this environment to like where half of the stuff that could be said or a third of it can be like reasonable, and then the the other stuff intermixed is absolute garbage, and it's tough for the average person to pick out what delicious. Yes, it's tough. Yeah, like when RFK gets on there and he's like, Oh yeah, people shouldn't be drinking so much sugar. Valid. That's valid.
SPEAKER_01He is also an idiot, but it's also not a doctor if we didn't already know.
SPEAKER_00It's also not a doctor if you're listening to this.
SPEAKER_01Remind everyone of that.
SPEAKER_00I feel like someone listening to this would probably already know that, though.
SPEAKER_01I hope so.
Wrap-Up, Contacts, And Disclaimer
SPEAKER_00So please remember that these guidelines are designed for population health, not individualized optimization of your like nutrition. They're designed to reduce risk across hundreds of millions of people with very different lifestyles and health conditions. So that's very different from designing a specific diet for a specific individual. They that's why they literally make dietitians. So today we looked at what the dietary guidelines actually recommend and the evidence behind those recommendations. And I think we found ourselves a couple topics to spark up conversation about what we're interested in talking about. And while some aspects are debated, many of the core themes are relatively consistent with current research. But as we go across these two episodes, one thing we want to really point out is that this system, the food system and food in general, is incredibly complex. It is an intersection of economics and culture and health, and it is very complicated. So basically do the best you can. Any last thoughts, Nikki? Okay. Well, in that case, thank you for coming back to another episode of your checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. You can find us on Threads, you can send us an email at yourcheckuppod at gmail.com. And most importantly, stay healthy, my friends. Until next time, I'm Ed Dolesky.
SPEAKER_01I'm Nicole Rufo.
SPEAKER_00Thank you and goodbye.
SPEAKER_01Bye.
SPEAKER_00This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.