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Patients who have been diagnosed with cancer should be advised to lose weight and begin an exercise regime immediately to double their chances of survival, world experts have said.
Dozens of studies presented to the American Society of Clinical Oncology at their conference in Chicago over the weekend showed that patients who were a healthy weight were 50% more likely to survive as those who were obese. Weight loss and exercise were not just shown to be key in cancer prevention, but also as important as drugs and chemotherapy in the treatment of the disease.
As the UK Institute for Health and care Excellence (NICE) promised a review into prescribed exercise for cancer patients, Doctors at the conference called for exercise and lifestyle change to be prescribed along medication.
One of the studies by Yale University, found that just 3 hours of walking a week led to a 46% reduction in mortality rates of the 300 women with breast cancer who took part. The conference was also told that a Mediterranean style diet high in unsaturated fats, oils, vegetables and fish could reduce the risk of recurring breast cancer.
Other researchers at Stanford and Harvard Universities found that overweight women with high blood pressure who were diagnosed with breast cancer were 69% more likely to die than those of a healthy weight who exercised. Their 10 year study also found that abdominal fat increased the risk of cancer death by a staggering 69%.
Melinda Irwin, who led some of the studies said
“after treatment, weight loss is the most powerful thing you can do. It’s the next best pill to treatment and it’s free and has no side-effects. Every woman when diagnosed with breast cancer should be counselled about weight loss and weight management and about the role of exercise.”
The University of Montreal went as far as recommending that cancer patients should be provided with personal trainers as a cost effective way of improving chances of survival. Fred Saad, consultant oncologist from the University said:
“exercise and weight loss increase survival rates, and high-intensity exercise — spurred on by a trainer — is more effective than exercising alone. We are seeing that intense structured exercise programmes, led by a trainer, have a better effect on the immune system than gentle movement”.
He is currently conducting a ground-breaking study on 1000 men with late-stage metastatic cancer to test the effect of higher intensity training on cancer survival rates. Dr Saad hopes that the study will be enough for National Health services to take exercise and diet as seriously as drugs in treatment.
More people than ever (and their children) seem to have allergies or intolerances, from hay fever to gluten to lactose intolerance. But what is lactose intolerance and how many people actually have it?
Lactose is a natural sugar that occurs in milk. Along with fats, protein, vitamins and minerals, it makes up everything that a baby needs to thrive in the early stages of life. However, in recent times dairy has been the victim of some bad press, from making us fat to making us react in a bad way, dairy seems to have a lot to answer for.
Lactose intolerance is the body’s inability to break down and digest the sugars found in milk and other dairy derivatives. Although yoghurts can be classed as dairy, the bacteria present in them makes the lactose easy to digest, so they are less likely to produce an adverse effect.
Those with lactose intolerance do not produce a specific enzyme in the gut that breaks it down. Any dairy produce consumed has to broken down instead by the digestive system, which can cause discomfort, gas, bloating and cramps. There are, however, various degrees of intolerance; one person may still have the necessary enzyme to break down lactose, but not in sufficient quantities. These people are more “maldigesters” than actually lactose intolerant. We are all born with the enzyme needed to break down our mother’s milk, so we all come into the world fully lactose tolerant. As we grow older some of us lose that enzyme and can become intolerant. However, it’s important to know the difference between lactose intolerance and an allergy to milk. An allergy is where the immune system reacts to a certain type of food and causes symptoms like itching, wheezing and itching.
Research in the 90s shows that this number is actually large; up to 70% of the world’s population lose their lactase enzymes (the ones needed for milk digestion) after weaning. So all those lactose intolerant people might not actually be faking it.
As well as getting a bad rap for causing tummy upsets, dairy has also been targeted by dieters who believe that its high fat content contributes to weight gain. This is unlikely to be the case though. The high fat and sugar in dairy is mitigated by its protein content, so it dosen’t have a huge effect on blood sugar levels. It’s glycaemic index is moderate at around 35. So in moderate quantities it won’t make you fat. It’s rather the low fat and 0% fat milk, cheese, yoghurt, and ice cream that are the culprit for the weight gain myth. In the wake of mixed messages about the dangers of saturated fats we’ve turned to these low fat options but they are often worse as as they’re loaded with sugar and salt.
There’s no treatment for lactose intolerance, so the only treatment is the avoidance of dairy products. This avoidance though means that you may be lacking some very important vitamins and minerals, so nutritional supplements like calcium and vitamin D are advisable.
Back by popular demand it’s our spring plank contest. It’s the great levelling exercise, where someone young can be out done by someone much older, where traditional fitness is less of an advantage.
The plank is a static, holding or isometric exercise where you hold yourself in a straight line propped only by your elbows and toes. It works not just the traditional muscles of the abdominal wall that you would exercise in crunches, but the whole of your core, from your back muscles to your “natural weight belt” the transverse abdoninus.
This spring we will be seeing who has the toughest core and also the toughest mind – the plank is very much a psychological challenge too. A minute is good, 2 even better. Last contest was won in a little over 11 minutes (men) and 7 minutes (ladies). The world record is over 4 hours!!
Running from the 1st May to the 31st May 2016, winning categories are:
Open ladies/Open men
Ladies and gents masters – over 70
A certificate of kudos and honour awaits winners of all categories, with trophies and a free PT session to the two best performers. Please note this may not necessarily be the open category winners, but those who we feel have pushed the boundaries furthest, allowing for age and context.
Rules – you must be timed by a DDW trainer, form must be correct, i.e. shoulders, hips and knees in a straight line. Please ensure you are fully warmed up before attempting.
Good luck! Winners will be announced here and on our Facebook page.
Is butter healthy, asked a new study released in the US this week? Butter and other saturated fats may not be as bad for us as previously thought; in fact, swapping them for unsaturated fats like olive oil and other plant oils may actually lead to an increase in life expectancy.
These are the surprising findings of a new study in the US that has re-analysed the data from a trial that was conducted 50 years ago, the results of which were never published in full. This data showed that although those who switched from saturated to unsaturated fats had lower levels of cholesterol, this did not translate into higher life expectancy through a reduced risk of heart disease.
In fact, the death rate was actually higher in those subjects with lower levels of cholesterol readings throughout the 5 year trial. Running from 1968 to 1973, the 40-year-old study known as the Minnesota Coronary Experiment was thought to prove the link between heart disease and coronary heart disease, but may only show a link to higher levels of cholesterol, not morbidity.
The Minnesota study, conducted from 1968 – 1973, involved some 9,000 people, mainly in a nursing home and mental hospitals. The patients’ diets were easily controlled and one group was fed foods high with saturated fats; another ate a diet with little saturated fat and replaced with lots of corn oil, an ingredient common in processed foods today.
Published in the British Medical Journal, the new analysis of the old data was done in the US by the national Institute for Health. The conclusion goes against much modern nutritional guidance:
“Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid (corn oil) effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes,” said the authors.
Although contentious, leading nutritionists and scientists in the US point to the subtleties in the findings, and the importance of what food was swapped for what. “For years now, we have been recommended to cut out animal fats and replace them with plant sources of fats,” said respected US dietician John Rickards. “But when you swap out bacon for a bagel in the morning – you essentially cut out fat and replace it with refined carbs – you run the risk for raising your triglycerides and lowering your HDL cholesterol – increasing your risk for heart disease.”
He added that fats should still be sourced from natural plant sources like nuts, seeds, avocados and coconut oils. The results of the study might not actually advocate lots of saturated animal fats, but rather that they should not be substituted for low fat/high sugar/high processed carbohydrate alternatives. The reinterpreted research does not claim saturated fats are good for you. It claims instead that eliminating them is not necessarily good for heart health. And that’s a crucial distinction. Remember also that many vitamins and minerals that we need are fat soluble, i.e. we need fat present to digest them. So the message is not to eliminate saturated fats, rather to include them in a healthy, whole food diet that also contains plant based fats, unrefined carbohydrates and clean sources of protein like fish and chicken. So is butter healthy? Yes, and no…like most foods.
The recent sugar tax announced in the latest budget comes not a moment too soon for a nation addicted to sugar; we eat an average of 238 teaspoons per person every week. We are on the verge of a type 2 diabetes epidemic, an obesity crisis and an explosion of other sugar related health problems. Despite knowing that sugar is bad and causes health problems, most of us still haven’t been given any advice on practical ways to reduce sugar in your diet.
That’s because it’s everywhere. Its hidden and carefully packaged in a way that is designed to keep it concealed from us. It’s hidden in a healthy looking soup. It’s packed into snack bars with the name “nature” on the front. It’s in many types of fruit (that, apart from the sugar, are really healthy to eat); it’s hidden in coffee drinks; it’s lurking in that healthy breakfast cereal.
Although cutting down is not easy, doing so has an immediate effect on health, especially in children. In a study at the University of California, 43 children, each with a chronic health problem like high blood pressure, were given foods low in sugar and had sugars replaced with starches. After only 9 days they showed improvements in cholesterol levels, blood pressure, improved blood glucose levels, lower insulin response (which causes type 2 over time) and improved liver function. The study definitively showed that sugar is bad for health not just in terms of weight gain but in a metabolic way.
So how do we go about removing it? Here are some key points:
1 – Don’t go overboard. You can’t remove all sugar from your diet. When training clients who want real definition or a 6 pack, we ask them to try and keep sugar to 30g a day or less. This is very hard. Sugar occurs naturally in many healthy foods, like vegetables and fruit. Instead focus on removing added and/or processed sugars and intense sweetness; these cause a dulling of the palette and sugar addiction. The less sugar you have, the faster and sooner your taste buds will re-adjust to normal levels, meaning that you will crave less sugar. It’s a healthy snowball effect.
2 – There’s no such thing as sugar addiction. Physiologically, you don’t need any sugar. Your body makes glucose to feed the brain and muscles from healthy carbohydrates, fats and proteins. You don’t need to add sugar. The premise that you need some sugar after or before exercise is a fallacy. It’s just marketing. Your body will make all the blood glucose it needs from other food sources.
3 – Check the label! Our advice is to avoid any food that contains more than 3g of sugar per 100g. Any liquid with any sugar in at all should be avoided. Why? Sugar in solid foods is mitigated by any fibre, protein and complex non sugary carbohydrate it contains, slowing its digestion. Liquid, however, just goes “straight in”.
4 – Some fruit is healthier than others. swap fruits high in sugar (grapes, cherries, oranges and bananas are the highest) for low sugar fruit. Anything with “berry” on the end will not only be low in sugar but will also be packed with vitamins and nutrients. In particular avoid fruit juice and smoothies. These have basically taken all the good things out and left behind a sugary fruit flavoured water.
5 – Avoid artificial sweeteners. Although there is no proof that these sweeteners cause blood sugar (and insulin) levels to go up, they do deaden the taste buds to excess sugar. Wean yourself off them and you will soon start to taste the natural sweetness in foods much more.
6 – Beware low fat foods. Fat doesn’t make us fat. We need fat. Sugar and processed carbohydrates make us fat. Translate “low fat” as “high sugar”. Avoid to reduce sugar in your diet.
7 – Use an app. Even if it’s just for a day, an app like weight loss resources or myfitnesspal can be uploaded to your smart phone and used to track calories (and sugar). At the end of the day have a look at the grams of sugar and where they came from.
8 – Be visual. take a food that you are about to eat. Look at the label. Work out how much sugar is in it. Then count out the equivalent amount of sugar onto a plate. For example, a pot of rachel’s organic yoghurt (healthy sounding, right?) contains 13g of sugar per 100g. There’s 500g in the pot. So Half a pot = 250g, or 2.5 times 13. That comes to 32.5. 1 teaspoon is 4g of sugar. Count 8 teaspoons onto a plate. Exactly. Shocking. The “healthy” bar pictured above contains 3 teaspoons of sugar. Yet it has the word “nature” on the front.
9 – Have treats, just reduce the sugar. Swap milk for dark chocolate. Swap sugary low fat diary for natural Greek yoghurt. Swap cereal for porridge. All these small changes will really add up. You will have more energy, avoid going through low blood glucose periods. These are pints in the day where you feel suddenly tired, hungry and in particular craving something sweet.
At first it might seem like you are depriving yourself, but after only a few days you will adjust and start feeling great.
We are constantly subjected to often contradictory health, exercise and nutritional advice. One week the media and science are trekking us that a particular food or exercise is for us, the next week another study is released that says these exact same foods and exercises are actually harmful. Interesting examples are…
“Egg yolks are as bad as smoking” screamed the headlines in 2012, reporting that egg yolks clog up the arteries as much as smoking, contributing to a high risk of heart disease and death. This headline is still on the NHS choices website. Yet beyond the headline, the article admits that:
“there were limitations in the accuracy of the participants’ recollections of their egg yolk consumption; a lack of detailed information on how the eggs were cooked; there may have been additional risk factors contributing to artery ‘clogging’, not assessed by the study, such as lack of exercise or alcohol consumption; while it is reasonable to assume that fatty build-up in the neck arteries can increase the risk of heart disease, it is uncertain exactly what the increased level of risk would be”
But wait; a report published in the British Medical Journal only a year later concluded that “higher consumption of eggs (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke”. It goes on to say that “most epidemiological research — the kind of research that studies large populations over time and analyzes their diets and their health — has found no connection between eating eggs and increases in heart disease”.
A detailed report from 2016 in The Telegraph shows that chocolate is good for us. It reduces cholesterol, increases flexibility in the arteries and keeps the brain working well into old age. The Independent seconds this by saying that chocolate improves brian function into old age. However, the NHS currently recommends a daily intake of 30g of sugar to avoid detrimental effects on health. Chocolate bars like Crunchie (26g sugar) and dairy milk (25g sugar) will use up almost your entire sugar allowance.
But now scientists have reported that some chocolate can contain high levels of lead and cadmium, two naturally occurring metals that can cause health problems.
Brazilian researchers tested 30 milk, dark, and white chocolate products sold in their country, some of which are exported to the U.S. They say dark chocolate had the highest amounts of lead and cadmium.Lead can cause headaches and anemia in adults as well as developmental problems in children. Cadmium can damage organs and disrupt hormone levels. The scientists published their findings in the journal of Agricultural and Food Chemistry.
The food pyramid
Originally designed in Sweden, the food pyramid was a guide to what types of food we should eat to lead healthy lives. Initially a project designed by the Swedish government to help citizens deal with a period of high food inflation, the food pyramid evolved into national dietary guidelines throughout there world. Yet even at the start, big corporations played their part in the shaping of the pyramid for their own gain. The originator of the pyramid, Anna Britt Agnsäte, said soon after its publication,
“When our version of the Food Guide came back to us revised, we were shocked to find that it was vastly different from the one we had developed. As I later discovered, the wholesale changes made to the guide by the Office of the Secretary of Agriculture were calculated to win the acceptance of the food industry. For instance, the Ag Secretary’s office altered wording to emphasize processed foods over fresh and whole foods, to downplay lean meats and low-fat dairy choices because the meat and milk lobbies believed it’d hurt sales of full-fat products; it also hugely increased the servings of wheat and other grains to make the wheat growers happy. The meat lobby got the final word on the color of the saturated fat/cholesterol guideline which was changed from red to purple because meat producers worried that using red to signify “bad” fat would be linked to red meat in consumers’ minds”.
Thus were born the many influences on eating and exercise advice that taint most information that we are fed, right up to the present day.
In every study done, there is someone, somewhere with an agenda. Scientists need to make a living; to pay the rent. A great way of doing this is to do studies commissioned by large corporations. These pay well. So the next time you read a study on the dangers of eating eggs, ask yourself who paid for the study. Was it Kellogs?
Politics, “big food”, self interest, corporate greed and money all influence the many studies that make it to the mainstream media. The media itself has a vested interest in making a story sound shocking or interesting. Studies can be spun any number of ways. Latest study says chocolate is good for you…but was it paid for by the cocoa grower’s association? Latest study says chocolate is bad for you. Was this one done by an organisation of fruit growers? Always ask the question and proceed with caution.
As a guide, regular exercise, lots of water and eating unprocessed foods with lots of vegetables is the best way to prevent disease and be healthy. Trust me, I’ve done a study on it.
Today is known as “fail Friday”. It’s the day that most of us will finally fall off the wagon and give up on our new year’s resolutions. Apart from getting a personal trainer, there are of course other ways to get fit. A great way is by using a fitness tracker. These little gadgets are usually in the form of a wrist watch, and can monitor how many steps you are doing, what your heart rate is, how many calories you’ve been through, how you are sleeping and other useful measurements. So if you’re falling off the wagon, try one of these, the best fitness trackers 2016.
1 – Fitbit surge. A great all-rounder, the surge can track both exercise and general health. It can automatically see what type of exercise you are doing – running, cycling, rowing – and will help you keep track of how you’re sleeping too. In-built GPS tracking monitors your training route, with run time, distance, pace and elevation stats clearly displayed. Whether you jog, run or cycle, you’ll be able to review your workout summary and spilt times at the end of each session. (£148 from www.currys.co.uk)
2 – Garmin forerunner 630. The big daddy here, this is a more comprehensive fitness tracker than many of it’s rivals. With a chest strap it can measure when you are getting close to your lactate threshold, essential for properly zoned training at an advanced level. When running it can also analyse your cadence, step rate and form. You can get predicted race times based on training, stress scores, a recovery advisor to tell when is the optimal time to go for another intense running session and a performance condition number based on pace and heart rate variability in real time. If you see a +5 reading, you’re in a good state to go running. (£330 from www.gamin.com)
3 – Polar M400. The best value of the fitness trackers looked at here, it’s really slim and compact, and doesn’t get in the way. It has built in GPs to track outdoors activities and can also monitor sleep patterns and track your steps. is one of the first fitness devices to bridge the gap between the fitness band and the GPS sports watch.It will also give you a nudge if you’ve been stationery for a long period. (£98 from www.fitnessdigital.co.uk)
4 – Tom Tom Spark. The tom-tom is one of the only dedicated fitness trackers that can also play music. With storage of 3GB it can stream music to bluetooth headphones – great as there are no niggling wires and you won’t have to take an iPod as well. It’s one of the few fitness trackers that actually looks ok as a watch, plus it has built in GPS, a heart rate sensor and you can track both daily and weekly goals. Our personal favourite. (£190 from www.johnlewis.com).
5 – Microsoft band 2. A hybrid between a fitness tracker and a smart phone, it has 11 sensors that monitor your heart rate, measure UV levels, tell you how far it is to the next green (golf setting) and other features. And you can read emails. But we feel it’s best to stay disconnected when running, keep hold of your zen. (£200 from www.microsoftstore.com)
Research shows that for the vast majority of us, making a New Year’s resolution is in vain. Polls show that by “fail Friday” – the 3rd Friday in January, most of us will have given up, with a little as 3% keeping a resolution up all year long. In this DDW special, we look at why they fail, and how to keep your new year’s resolution.
1 – Pick a better time of year. Although the calendar says it’s a new year, it’s actually not a good time to make lifestyle changes. We have just come out of a holiday, and a holiday that is filled with parties, celebrations and general debauchery, both on the eating and drinking front. Coming back to normality is hard enough; coming back to a harsh new regime is even harder.
On top of that it’s the depth of winter. Days are short, the weather’s poor, so getting out is harder. The cold and darkness also make our “inner chimp” crave high calorie, sweet and starchy foods, just in case winter might co-incide with a famine. So what time is a good time? That’s a really individual question. Choose a time when things are reasonably settled in your life. But as the weather and light improve so do your chances of success. We propose the return of British Summer Time should be the start of your resolution. So make a note in your diary that resolutions start on the 27th of March.
2 – Be specific, not vague. If you have vowed to “lose weight” or “drink less” good luck. These are vague, hard to measure goals that you won’t keep. Instead, go for small, specific goals with a specific time frame. So “lose weight” becomes “lose 4 lb by the end of January”. “Eat better” becomes “I’m going to eat really well for 3 days of the week until Valentine’s day”. “Drink less” becomes “I’m only going to drink on Friday and Saturday nights for 4 weeks”. Once you have set these smaller, more specific goals, reset, go again! If you fail, jot down why, make more reasonable goals, go again. Like team GB cycling, it’s all about marginal gains. Take care of the little things, the big picture will sort itself out.
3 – Go small, not big. As above, resolving to start marathon training might just be a bit ambitious. Instead make a small, achievable challenge. Aim to go out and walk/run for 15 minutes, 3 times a week. The amazing things that happen to your body will then encourage you to do more. Ariane de Bonvoisin writes in her book “The First 30 Days” that it takes 30 days to replace a bad habit with a good one (but many people fail at around two weeks). That’s why it’s so important to make it to mid-February.
4 – Be sympathetic, not perfect. As experienced personal trainers, we know know that not everyone does well all the time, even us! So an expectation of small failures is important. Allow leeway for stumbling. If you hit the kebab shop one Friday night just accept it, move on, and make a better choice the next time. One bad meal won’t ruin your efforts. Perfection is the obstacle to change.
5 – Blip vs trend. In weight loss we see this all the time – the blip. Clients will have eaten well during a given week, but not seen this reflected in the scales. Likely as not another good week of eating sees that weight loss come plus a bit more from the second week. Be prepared for blips. They are not failure. Keep at it, win enough small battles, you will win the war. If after a month you have not seen much progress then it’s time to think why. That’s a trend. Trends need addressing. Blips need dismissing.
6 – Get tech savvy. Luckily we live in the computer age. There are thousands of apps, gadgets, bands, websites and companies that can help you count calories, spend less, worry less and be happier. Do some research. Get an app!
7 – Get accountable. Tell everyone about your goals. That way you are not just letting yourself down if you give up. Go on Facebook, do a blog, get accountable. Not only is exercise more fun with a friend, but you won’t skip a workout if that means letting someone down.
8 – Get professional help. Would you change the timing belt on your car yourself? Then what makes you think that something as complex as getting fit is a DIY job too? All top athletes (or piano players, or accountants) had lessons from someone qualified to help. Got phobias? See a hypo-therapist. Need to eat better? See a dietitian. Really want to address your eating and fitness? Get a personal trainer. It doesn’t have to be forever, but just some knowledge and a kick start could be all that you need.
Over Christmas the average UK adult will put on 5lbs of weight. On Christmas day itself we consume an average of 7,000 calories. This is roughly the equivalent to 6 days’ worth of calories all in one go. Not only will the weight gain take effort to shift but it will also expand your stomach and cause large swings in blood sugar levels. This in turn can also lead to you feeling hungry and getting into a vicious cycle of hunger and unhealthy eating.
Although losing weight over the festive season might not be the most realistic of goals, how about a more achievable weight maintenance program? With just a bit of timely activity and some clever food choices – both in terms of timing and content – you can have your cake and eat it.
Doing all of the above may seem like a bit of an effort, but it will be much more of an effort to try and lose 5 lbs later on down the line. Especially in depressing January.
So take these simple steps and have a happy, but slim (ish) Christmas!
Bitwalking Dollars – get paid for walking!
In japan a digital currency ( like bitcoin) has been launched that pays you to walk. Literally. A phone app counts and checks users’ steps and then rewards them with around 1BW$ (Bitwalking dollar) for each 10,000 steps – this is the recommended daily average to maintain basic health and fitness levels. Users of the app can then spend or trade what they earn, or even redeem their bit walking dollars for cash.
Murata, a Japanese technology firm is to release a wristband, like the jawbone or fitbit that will count steps instead of a smartphone. Several manufacturers and banks in the UK are poised to partner with the scheme, initially at one of the UK’s biggest music festivals next year.
How will it work?
Bit walking hopes to take advantage of the current trend for fitness trackers by offering an extra incentive to get those steps in. The global scheme will partner with sports brands, health insurance companies, environmental groups and of course advertisers – this last group would be offered insights into the lifestyles of the participants to help target their advertising, thus raising revenue for the scheme. Employees would be invited to take part in a “step scheme” that encourages them to get fitter and take less sick leave, while employers would convert their bit walking revenue to be paid in addition to their wage. An average weekly earning in the western world would be around 15BW$ a month.
It is hoped that the real benefits may be to poorer nations, where people walk much further in their daily lives. In Malawi, where the average wage is just $1.50 a day, a teacher who has to walk 6 miles to work and back (this is a real example) could earn 26 Bitwalking dollars a month, roughly doubling his or her wage. This could then be invested into more education, investment in a business idea or helping an elderly relative. Thus advertising revenues gathered in the western world can be earned by people walking in poorer countries.
“It’s a currency that can be earned by anyone regardless of who they are and where they live,” says Franky Imbesi, one of the co-founders.
“For some it will be a free cup of coffee a week perhaps offered by local businesses to encourage people to explore their local shops. For others it could be a game changer, transforming their lives by enabling them to earn and trade in the same way with the rest of the world”.
“And all while encouraging us to protect the planet and stay healthy.”