HOMEOPATHY IN GLUTEN INTOLERANCE

WHAT IS GLUTEN INTOLERANCE?


Gluten is a protein found in wheat and rye. If a person has gluten intolerance and he consumes anything that contains gluten, complaints of acidity, abdominal pain or diarrhoea. It only involves digestive tract and not immune system which is seen in cases of food allergy. 


SYMPTOMS AND CAUSES


SYMPTOMS


Bloating is one of the most common symptoms of gluten intolerance. Others are:

  • Frequent diarrhoea, constipation and smelly faeces.
  • Migraine or abdominal pain
  • Tiredness and fatigue
  • Anxiety
  • Iron deficiency anaemia
  • Numbness or tingling of arms and legs

CAUSES


No cause has been found till now for gluten intolerance.


DIAGNOSIS


There are no specific medical tests that can be performed to confirm diagnosis. However it is necessary to rule out coeliac disease and wheat allergy when in doubt.


TREATMENT AND MANAGEMENT


People with gluten intolerance have shown improvement when following a gluten free diet.

Giving medicines specific for the most predominant symptom.


HOMEOPATHIC MANAGEMENT


Homeopathic medicines help in effectively managing symptoms of gluten intolerance without any side effects.There is a wide variety of medication available for treating gluten intolerance such as carbo veg, lycopodium, china, colocynthis, natrum mur etc., but you must consult a registered homeopathic practitioner before administering any of these.


DO’S AND DON’TS


DO’S


People with gluten intolerance should carefully read ingredient labels on food packets.

It is advised to take gluten free food such as:

  • Fruits and vegetables
  • Corn
  • Chicken
  • Seafood
  • Eggs
  • Legumes
  • Nuts and Dry fruits
  • Dairy products
  • Oils etc.

DON’TS


Avoid food items that contain gluten including:

  • Wheat and its derivatives
  • pastas
  • Breads and pastries
  • Semolina
  • noodles
  • seasonings and spice mixes

GET RID OF SCABIES WITH HOMEOPATHY!!!

WHAT IS SCABIES?


Scabies is a highly contagious skin condition caused by a mite, known as the Sarcoptes scabiei, which burrows under the skin and produces small red bumps(looking like small pimples), causing severe itching.


RISK FACTORS


People are more likely to get scabies are those who:

  • live in crowded areas
  • Infants and children
  • Elderly – especially those living in nursing homes.
  • Healthcare workers who nurse for people not aware of having scabies.

COMPLICATIONS


Intense scratching can lead to scratch marks, scab formation or a secondary infection like staphylococcus or beta- haemolyticus, through broken skin.


SPREAD


Direct skin-to-skin contact is the mode of transmission.


SYMPTOMS AND CAUSES


SYMPTOMS


  • Severe itching, aggravated towards evening and night
    • Itching is so severe that it can even lead to loss of sleep at night and there are scratch marks present all over the body.
  • Multiple small bumps on skin, for over a period of months.
  • Scabies may involve the webs between the fingers, wrists, back of the elbows, knees, around the waist and umbilicus, genital area and the buttocks.

CAUSES


It is caused by infestation of skin by a mite, sarcoptes scabiei. They lays their eggs and burrow into the skin to produce intense itching, which tends to be worse at night.


DIAGNOSIS AND TREATMENT


DIAGNOSIS


Most cases of scabies can be confirmed just by close examination of skin. No additional test is required to make the diagnosis.


TREATMENT


Scabies is conventionally treated with a cream that contains a medicine called permethrin. The cream is applied all over the body from head to toe and left overnight before washing it off in the morning.


MANAGEMENT


  • Wash regular clothes and bedclothes in hot water as mites don’t live for more than 74 hrs, away from the body.
  • Avoid scratching as much as possible as it can lead to scab formation or a secondary infection.
  • Avoid direct contact with those having scabies.
  • Making sure family members and others in close contact with the infected person get checked for scabies.

HOMEOPATHIC MANAGEMENT


Some of the common useful homeopathic medicines in case of scabies are: Carbo veg, ars album, hepar sulph, causticum, lycopodium etc.


DO’S AND DON’TS


DO’S


  • Wash clothes with hot water and expose them under sun for a long period of time.
  • Get yourself and your family members checked by the doctor if suspected.

DON’TS


  • Avoid any kind of direct contact with the affected person.
  • Avoid scratching.

FIGHT OSTEOPENIA WITH HOMEOPATHY

WHAT IS OSTEOPENIA?


Osteopenia is a state of bone between being healthy and having osteoporosis. In osteopenia, your bones get weaker but not to a stage of getting fractured easily. The bone density of your bones gets lesser day by day.


RISK FACTORS


  1. Aging is the most common risk factor for osteopenia.
  2. Females are also more prone to developing osteopenia. 
  3. Having a family history of low bone mineral density makes you more susceptible to having it yourself.
  4. Apart from aging process which naturally decreases our bone density, certain choices and habits accelerating the process include:
  • not getting enough calcium and vitamin D
  • smoking
  • drinking too much alcohol or caffeine.
  • using certain medications, such as corticosteroids and anticonvulsants.

COMPLICATIONS


This decrease in the mass, mineralization and strength of the bones over time can cause osteoporosis(a condition in which in which the bones become brittle, weak, and easily damaged or broken).


SYMPTOMS AND CAUSES


SYMPTOMS


Osteopenia doesn’t usually cause pain or any other symptoms. 


CAUSES


It happens when formation of new bone is not proportionate to rate of bone loss.This leads to decrease in bone density.


DIAGNOSIS AND TREATMENT


DIAGNOSIS


The main test to determine your bone density is called dual-energy x-ray absorptiometry (DXA). It measures the mineral content of bone. 


TREATMENT


The aim of treatment is to keep osteopenia from progressing into osteoporosis.

Various medications along with supplements are given to manage the case. But their long term effects on the body are not known.


MANAGEMENT


  • Sufficient intake of calcium and vitamin D, avoiding excessive alcohol, quitting smoking and getting plenty of exercise can help prevent osteopenia.
  • You need to be sure you are doing regular weight-bearing exercises and you are getting enough vitamin D and dietary calcium. 

HOMEOPATHIC MANAGEMENT


Apart from use of constitutional medicines, some commonly used other medicicnes are- calc carb, silicea, calc phos, symphytum etc. These above mentioned medicicnes are to be used only under the guidance of a registered homoeopath.


DO’S AND DON’TS


DO’S


  • Include weight bearing exercises to your routine
  • Take adequate amount of calcium and vit D to your diet

DON’TS


Decrease the amount of caffeine, alcohol and smoking.


HOMEOPATHY IN LACTOSE INTOLERANCE!!!

WHAT IS LACTOSE INTOLERANCE?


Lactose intolerance is the inability to digest/ metabolise lactose, which is a sugar mainly found in milk and milk products.


SYMPTOMS AND CAUSES


SYMPTOMS


Symptoms develop within half an hour to 2 hours of lactose ingestion.

Symptoms of lactose intolerance include- 

  • Nausea,
  • indigestion 
  • Abdominal cramps, 
  • gas, bloating or
  • diarrhea

Lactose intolerance never causes constipation.


CAUSES


It occurs because of deficiency of an enzyme that is required to digest lactose in the small intestine. It may decrease in cases of-

Certain digestive diseases such as :

  • Crohn’s disease, 
  • ulcerative colitis, and 
  • celiac disease 

Stomach or intestinal infections and injuries to the small intestine as from surgery, any trauma, chemotherapy etc. may reduce the amount of enzyme needed to process lactose properly. 

Some children even have congenital deficiency of this enzyme.In this case, infants are unable to break down the lactose present in breast milk.


DIAGNOSIS AND TREATMENT


DIAGNOSIS


The most common way that people self-diagnose lactose intolerance is by an elimination diet- a diet without any lactose.

Some tests  that can detect an intolerance: 

  • Hydrogen breath test
  • Lactose tolerance test:

 The patient consumes a lactose solution and then  blood samples are taken to measure his/her glucose levels. 

If blood glucose levels remain the same, this indicates that glucose has not entered the blood. This is because the lactose has not been successfully broken down into glucose.

  • Stool sample: Lactose tolerance tests and hydrogen breath tests are not suitable for infants, so a stool test may be carried out.
  • Underlying disease or condition: A small intestine biopsy may be performed to rule out other small intestine disorders.

TREATMENT


The best treatment for a person with lactose intolerance is to avoid food items containing lactose. Some tablets of lactase are also available to take alongside food items that contain lactose. 


MANAGEMENT 


Living with lactose intolerance usually involves dietary modifications.

For example, you can replace milk with vegetables based milk or take a lactase capsule before ingesting any dairy product. 

Alternatively, you can consume lactose-reduced or lactose-free milk and dairy products.

Calcium deficiency is a serious side effect of lactose intolerance.So try to incorporate calcium rich foods in your diet.


HOMEOPATHIC MANAGEMENT


Homeopathic remedies can efficiently deal with lactose intolerance without causing and side effects and eliminating the tendency altogether. Some useful remedies are: Aethusa cynapium, apis, china, nat carb etc.


DO’S AND DON’TS


DO’S


Add lactose free alternatives of milk and milk products to your diet along with some supplements to avoid any nutrients deficiency.


DON’TS


Foods to avoid:

  Foods that commonly contain lactose including:

  • Milk
  • cakes and biscuits
  • cheese
  • cream 
  • bread
  • milk chocolate
  • Cereals
  • Instant soups
  • scrambled eggs

HOMEOPATHY IN UMBILICAL GRANULOMA!

WHAT IS UMBILICAL GRANULOMA?


An umbilical granuloma, a small moist reddish lump/ball of tissue, becoming apparent following the separation of the umbilical cord. Normally the stump of umbilical cord gets dried off and falls within 15 days of birth without any complications. Sometimes instead of completely drying, the cord will form a granuloma (a small reddened mass of scar tissue) that stays on the belly button after the umbilical cord has fallen off.


COMPLICATIONS


Sometimes the umbilical granuloma can get infected and thus cause sepsis.


SYMPTOMS AND CAUSES


SYMPTOMS


Usually it does not produce any symptoms like pain or any discomfort. However you may notice some:

  • oozing
  • presence of sticky mucus
  • mild irritation of the skin around the navel

If it becomes infected, symptoms of infection may include:

  • fever
  • pain or discomfort when the navel or surrounding tissue is touched
  • increased swelling
  • warmth or redness in the area
  • red/blue streaks leading from the navel
  • Thick pus draining from granuloma

CAUSES


The exact cause behind its formation is not known. However, these granulomas may be more likely to develop if it takes longer than 2 weeks for the umbilical cord to fall off.

Some adults develop umbilical granuloma after navel piercings.


DIAGNOSIS AND TREATMENT


DIAGNOSIS


Physical examination by a physician or pediatrician is required to make a diagnosis. 


TREATMENT


If the granuloma does not go away over time on its own, the following options are available conventionally: 

  • Silver nitrate treatment: to cauterise the area but this method involves the risk of chemical burns to the surrounding healthy skin.
  • Liquid nitrogen treatment
  • Surgical thread
  • Surgical removal

MANAGEMENT


Salt therapy has shown really good results in many cases. Small amount of salt can be directly applied on the granuloma and kept in place using a piece of bandage over navel. After about half an hour, clean the area with a clean cloth or wipe soaked in warm water. Repeat this step twice a day for two or three days.If the granuloma starts shrinking, continue it until it disappears and the navel starts to heal.

Some other general instructions include:

  • Changing diapers frequently. 
  • Keeping the diaper area clean and free of moisture will promote healing and help to prevent infection.
  • Positioning the diaper below the belly button- roll the top of the diaper down at the front, so that it sits under the navel. This will help to keep the area clean.
  • Giving the baby sponge baths, rather than soaks in the tub. This will keep the granuloma dry and help it fall off faster.

HOMOEOPATHIC MANAGEMENT


Some of the most common homoeopathic medicines that can be used for treatment of umbilical granuloma are chamomilla, aesculus, nux vomica, silicea, calc carb, lycopodium, tabacum etc. But it is to be noted that above mentioned medicines should only be used under the guidance of a homeopathic practioner only.


DO’S AND DON’TS


DO’S


  • Changing diapers frequently
  • Keeping the navel dry and clean
  • Keep an eye on signs of infection
  • Give the baby sponge bath 

DON’TS


  • Avoid getting anxious
  • Avoid applying anything around navel without your doctor’s advice

GASTRITIS MANAGEMENT WITH HOMEOPATHY

WHAT IS GASTRITIS?


Gastritis is the inflammation or swelling of the inner lining of the stomach. It can either be acute or chronic in nature. Acute inflammation is sudden and severe while chronic inflammation leads to long term inflammation lasting for years. Acute gastritis is usually erosive and hemorrhagic.


RISK FACTORS


  • Thin or damaged stomach lining.
  • Age: as stomach lining gets thinner with age
  • High amounts of alcohol consumption.
  • Regular use of NSAIDS, cocaine or tobacco.
  • Severe stress
  • If you are suffering from any autoimmune condition.

COMPLICATIONS


If gastritis is left untreated, it can lead to formation of ulcer, severe blood loss and may increase the risk of developing stomach cancer.


SYMPTOMS AND CAUSES


SYMP


TOMS


Acute gastritis often produce no symptoms but sometimes it may cause:

  • Dyspepsia(acidity)
  • Sharp stabbing/burning pain in upper abdomen
  • Anorexia
  • nausea/vomiting or
  • Melaena(black tarry stools)

CAUSES


Gastritis is caused by irritation of stomach wall commonly by excessive alcohol consumption, stress, regular use of certain medications, H. pylori infection, stress, bile reflux, 


DIAGNOSIS AND TREATMENT


DIAGNOSIS


Gastritis may be diagnosed by:

  • Physical examination
  • Evaluating medical history of an individual alongwith current symptoms
  • Evaluation for H. pylori by testing your blood, breath or stool.
  • Endoscopy or biopsy is sometimes advised to exclude peptic ulcers or cancer.

TREATMENT


Conventional treatment includes use of antacids and antibiotics. However, long-term use of these medications, especially at high doses, can lead to an increased risk of spine, hip, and wrist fractures. It can also lead to increased risk of developing nutrients deficiency, dementia or kidney failure.


MANAGEMENT


  • If you have gastritis caused by NSAIDs or other drugs, avoiding those drugs may be enough. 
  • People with gastritis should eat high fibre food like apples, beans, carrots and honey. 
  • Herbal teas are also safe to drink. 
  • Avoid caffeinated beverages, dairy produce and spicy foods.
  • Food that have high fat content may worsen the inflammation of stomach.

HOMEOPATHIC MANAGEMENT


There are many symptomatic as well as constitutional  homeopathic medicines available, that can be used for treatment of gastritis whether acute or chronic such as nat phos, nux vomica, ars alb, carbo veg, pulsatilla, antim crud, bryonia, lycopodium etc. All these medicines provide cure from gastritis without any side effects.


DO’S AND DON’TS


DO’S


Food items to be added in diet: probiotic yogurt, food items rich in fibres and with low fat content, herbal tea, coconut water etc.


DON’TS


  • Food to avoid: alcohol, coffee, acidic food, fruit juice, fatty food, carbonated drinks and spicy food items.
  • Avoid use of tobacco, alcohol and excessive use of harmful medications.

MANAGE GERD WITH HOMEOPATHY

WHAT IS GERD?


GERD (gastroesophageal reflux disease) is a chronic acid reflux condition which means acid containing contents of stomach continuously leaks back into your oesophagus(food pipe).

Acid reflux happens because the valve at the end of the esophagus (lower esophageal sphincter), doesn’t close properly when food arrives at the stomach and intra abdominal pressure increases. Acidic food then flows back up through your esophagus into your throat and mouth, giving you a belching.


RISK FACTORS


Anyone at any age can develop GERD, but some may be at more risk for it. Your chances of having GERD increase if:

  • Age: you are of age more than 40.
  • Weight: you are overweight or obese.
  • You are pregnant
  • If you smoke or are regularly exposed to second-hand smoke.
  • Taking certain medications that may cause acid reflux.

COMPLICATIONS 


Some of the common complications of GERD are:

  • Oesophagitis
  • Barrett’s oesophagus
  • Anaemia
  • Esophageal stricture
  • Gastric volvulus

SYMPTOMS AND CAUSES


SYMPTOMS


Major complications are heartburn and regurgitation, which is triggered mostly by bending, straining or lying down.

Waterbrash: Increased salivation when acid enters food pipe.

A few patients presents with severe chest pain that can mimic angina and is due to reflux induced esophageal spasm. 


CAUSES


Some causes may include :

  • Abnormalities of lower esophageal sphincter: Some people with GERD have reduced sphincter tone or inappropriate sphincter relaxation.
  • Hiatus hernia(herniation of the stomach through diaphragm into the chest).
  • Delayed esophageal clearance: leads to increased acid exposure time.
  • Gastric contents: Acidic gastric contents leads to esophageal irritation thus causing GERD.
  • Defective gastric emptying: 
  • Increased intraabdominal pressure

DIAGNOSIS AND TREATMENT


DIAGNOSIS


Diagnosis is made primarily on the basis of presenting symptoms.

Endoscopy is sometimes performed to rule out other upper gastroesophageal diseases that mimics GERD and to identify any complications, if present.

A 24hr pH monitoring is advised if the diagnosis is still not clear.


TREATMENT


Conventional treatment includes use of temporary acting antacids or proton pump inhibitors but recurrence of symptoms with more severity is one of the most common side effects when therapy is stopped. Anti reflux surgery is also advised in many cases which has its own set of complications like alleviated heartburn and regurgitation, inability to vomit and abdominal bloating.


MANAGEMENT


Some lifestyle changes are advised like weight loss, avoiding food items that aggravates pt’s present symptoms, elevation of bed head(if you suffer from night time acid reflux), avoiding late meals and smoking etc.


HOMEOPATHIC MANAGEMENT


Homoeopathic treatment aims at curing this disease in the most harmless and permanent way. Many symptomatic as well as constitutional medicines can be prescribed to patients depending upon their condition. Some of the useful medicines in cases of GERD are:  lycopodium, iodum, anacardium, gambogia, china Etc. It is advised that the above mentioned medicines should only be taken under the guidance of a registered medical practitioner. 


DO’S AND DON’TS


DO’S


  • Do watch your weight.
  • Try meditation to manage stress.
  • Eat light and healthy food.
  • You may try eating six smaller meals each day instead of three larger ones.

DON’TS


  • Don’t eat spicy, acidic, fatty or caffeinated drinks.
  • Avoid having heavy food or snacks right before bedtime.
  • Avoid smoking.
  • Don’t overeat or eat too quickly.
  • Avoid undue stress.


GET RID OF VARICOSE VEINS WITH HOMEOPATHY

WHAT IS VARICOSE VEINS?


Varicose veins occur when veins especially of your lower limbs become enlarged, overfilled with blood. When this happens, veins appear swollen, lumpy or distended, often blue or purple. Many times, they are painful too. 


RISK FACTORS


Your risk of developing varicose veins is more if you are:

  • Women: It is more common in women than men.
  • Menopause: Change of female hormones tends to relax vein walls.
  • Over the age of 50: The risk of varicose veins increases with age.
  • Family history of varicose veins
  • Pregnant: Pregnant women are more susceptible to varicose veins.
  • Obesity: being overweight adds extra pressure on your veins.
  • Standing for long periods of time

COMPLICATIONS


Varicose veins, if left untreated, can sometimes cause inflammation of veins, formation of painful ulcers, blood clots or can even burst and hence leading to bleeding. 


SYMPTOMS AND CAUSES


SYMPTOMS


Symptoms may include:

  • Pain in legs, legs feel heavy
  • Swollen ankles
  • Spider veins
  • Venous eczema: skin over the area become dry and itchy
  • Frequent leg cramps
  • Some people develops restless leg syndrome

CAUSES


It occurs when valves present in veins become faulty and do not work properly. It causes blood to flow in the wrong direction or get pooled because of gravity. 


DIAGNOSIS AND TREATMENT


DIAGNOSIS


A visual or physical examination by a doctor is required to diagnose a case of varicose veins.

A doppler or duplex ultrasound scan may also be advised in some cases to visualise structure of veins.  


TREATMENT


Conventional treatment is mainly aimed towards surgery or ligation of veins. But there can be some bleeding and bruising after the operation. 


MANAGEMENT


Some measures you can take to prevent varicose veins include: Exercising, watching your weight, changing your position often, avoiding high heels, wearing compression stockings to improve circulation.


HOMEOPATHIC MANAGEMENT


Homeopathic management aims at managing as well as curing varicose veins. Many homeopathic medicines apart from constitutional medicines like carbo veg, lachesis, veratrum, stramonium, symphytum, vipera, crotalus hor, can be employed. It will not only cure your present condition but also end the tendency of its recurrence.  


DO’S AND DON’TS


DO’S


  • Exercising,
  • losing weight, 
  • raising legs while sleeping,
  • wearing compression stockings

DON’TS


  • Avoiding prolonged sitting or standing,
  •  do not sit with legs crossed

NOVEL CORONAVIRUS

WHAT IS CORONAVIRUSES?


Coronaviruses (CoV) are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). 

Novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. Novel coronavirus (2019-nCoV) is also known as Wuhan pneumonia or Wuhan coronavirus (‘Novel’ means newly discovered).

These viruses are zoonotic, which means they can only  infect animals and spread from one animal to another. A coronavirus can spread to humans, if certain mutations occur in the virus.

In December of 2019, several cases of pneumonia like disease were reported in Wuhan city of China and on further research, the cause was traced to a new strain of coronavirus family (2019-nCoV) by WHO.


RISK FACTORS


People of all ages can be infected by the new coronavirus but  much younger person, older people and people with some pre-existing medical conditions such as asthma, diabetes, heart disease, appears to be more susceptible to become severely ill with the virus.


SPREAD

Coronaviruses usually spread through droplet infection containing large particles that can only be suspended in the air for three to six feet. Some coronaviruses can also be found in the stool of some individuals.


COMPLICATIONS


Most of the symptoms typically go away in a few days.

But if a coronavirus infection spreads to the lower respiratory tract, it can cause pneumonia, especially in the very young or older people, people with diabetes, asthma, heart disease or people with weakened immune systems.

In more severe cases, infection can cause severe acute respiratory syndrome, bronchitis, kidney failure and even death.


SYMPTOMS AND CAUSES 


SYMPTOMS


The symptoms of most coronaviruses are similar to any other upper respiratory infection including runny nose, coughing, sore throat,shortness of breath and sometimes fever.

Some people even complain of of non-respiratory symptoms such as nausea, vomiting or diarrhea in early stages.


CAUSES


Causative agent is a novel coronavirus (2019-nCoV), which is a member of Coronavirus family.


DIAGNOSIS AND TREATMENT


DIAGNOSIS


You can get some lab tests done including nose and throat swab cultures and blood tests to find out whether your cold is caused by a coronavirus.


TREATMENT


Currently there are no approved anti-virals for this particular coronavirus, so treatment is supportive and symptomatic. 

For the severely sick patients with this illness, specialized care in an intensive care unit (ICU) can be lifesaving.


MANAGEMENT


The best way to prevent infection is to avoid being exposed to this virus or if exposed once, do the same things you do to avoid the common cold:

Here’s how: 

  • Wash your hands regularly. 
  • Avoid touching your eyes, nose, or mouth with your hands. 
  • When coughing or sneezing cover mouth and nose with flexed elbow or a tissue (throw away the tissue in a dustbin and wash hands).
  • Staying away from people who have signs of a respiratory tract infection.
  • If you choose to wear a mask, be sure to cover both mouth and nose. Avoid touching mask once it’s on. Immediately discard single-use mask after each use. 
  • A humidifier/steamy shower can also help in case of a sore and raw throat.

HOMEOPATHIC MANAGEMENT


Homeopathy has wide range of medicines to combat the symptoms of corona virus. Homeopathy also can help in preventing the spread of the infection. Medicines like ars alb, gelsemium, allium cepa, kali bich can be given depending on the symptoms. Ars alb 30 thrice daily for three days can give prevention against corona virus.


DO’S AND DON’TS


To help prevent a coronavirus infection, you treat a coronavirus infection the same way you treat a cold:

DO’S


  • Cover coughs and sneezes with your inner elbow. Then throw away the tissue and wash your hands.
  • Get plenty of rest.
  • Drink fluids.
  • Wash your hands thoroughly with soap and warm water or with an alcohol-based hand sanitizer.
  • Cleaning and disinfecting surfaces that you frequently touch.

DON’TS

  • Avoiding touching your face, nose, or mouth with unwashed hands
  • Avoiding close contact with people who are sick
  • Covering coughs and sneezes with a tissue. Staying home when sick
  • The consumption of raw or undercooked animal products should be avoided.