A few months ago I wrote a blog post about the health benefits of coffee, particularly benefits to cardiovascular health and cancer risk. Today I would like to add to that research, with two new studies (seen in Life Extension magazine's August 2015 issue).
One of these, published in the journal Heart, is more evidence showing a protective effect against cardiovascular disease. This study involved 25,138 participants undergoing CT scans for coronary artery calcium scoring over two years; not too bad. Participants who consumed 1-2 cups of coffee daily had a 13% lower risk of detectable coronary artery calcium in comparison to those who never drank coffee. However, people who consumed 3-4 cups of coffee daily had a 40% reduced risk. Calcification is a measure of atherosclerosis, and it does not mean that you should avoid calcium-containing foods, or supplements either if it is necessary for you, such as if you have coeliac disease or osteoporosis (especially if it is responding to supplementation). As we learnt in nutritional biochemistry, inflammation and oxidative stress drive atherosclerosis, but don't treat it on your own, you must find a supportive practitioner.
The other study suggests a protective effect of coffee against developing multiple sclerosis (MS). Over 4,000 participants in Sweden, as well as over 1,000 participants in the United States had their coffee intake over the past 1, 5 and 10 years ascertained, and this was compared between patients with MS and those without it. Overall, there was a 33% lower risk of MS among people consuming 6 or more cups of coffee per day the year before diagnosis, though I do not see myself recommending this level of coffee consumption ever. In the US participants, 4 or more cups of coffee daily was associated with a similar reduction in risk, and high intake 5 or 10 years before diagnosis also seemed to have given significant protection. This may have been due to the relative greater ease of natural vitamin D production among the US participants, as multiple studies have shown protective effects of vitamin D too. I usually drink one cup of coffee in a day, and I am not recommending increasing coffee consumption solely to prevent MS or CVD, as there are many ways of preventing these. I am saying, however, that if you currently drink coffee, you do not need to give it up, but if it is causing you problems such as adrenal fatigue, then reducing your intake may be advisable.
Saturday 30 January 2016
Wednesday 27 January 2016
Inflammaging and What to Do About It
One symptom of the aging process that we all learned about in anatomy and physiology is immune senescence, the breakdown of the immune system and its functioning. There is a reduction of bone marrow production of immune cells, and thus a reduced supply of immune cells; a reduction in their potency and loss of control over inflammation. This increased inflammation also drives aging via increased tissue damage, and is why many people now call aging "inflammaging" (an assignment on this scored me a 95% and I may have taught the teacher a few things). Besides "normal aging", it also raises the risk of age-related diseases such as arthritis, osteoporosis, cardiovascular issues and cancers (Age (Dordr)). Fortunately, there are natural medicines, such as extracts of Pu-erh tea, reishi mushrooms and Cistanche, that can fight immune senescence.
Pu-erh tea, native to China's Yunnan Province and consisting of fermented ripe tea leaves, is better than it sounds. Traditionally prescribed to emperors for longevity, supplementation with Pu-erh tea extract was shown to significantly reduce inflammatory markers in patients with metabolic syndrome. Levels of IL-6 fell by 21%, TNF-alpha fell by 23%, CRP fell by 26% and levels of anti-inflammatory IL-10 rose by 34% over the three-month duration of the study (Chin J Integr Med).
IL-6, written in full as Interleukin-6, increases risk of death by 25% in those aged around 60, but increases it by 118% in people over 80, when its levels are high (Life Extension). Deaths from cardiovascular diseases and obstructive airway disease, as well as the risk of osteoarthritis and macular degeneration, are also increased by elevated IL-6. Another inhibitor of IL-6 is turmeric, which has a high volume of research surrounding its effects. High CRP, or C-reactive protein, increases the risk of death by 158% in people over 80.
Reishi mushrooms, however, lack the bone marrow stimulating properties of Pu-erh tea, but are still able to resurrect the youthful patterns of circulating immune cells. It can also reduce IL-6 and raise IL-10 (Life Extension). Reishi can also enhance numbers and activity of the B lymphocytes. These produce antibodies, assist the macrophages/monocytes and present antigens to other B and T lymphocytes, therefore are indispensable to immune function (Life Extension). In addition, reishi mushrooms also have direct effects against Herpes simplex (cold sores), Herpes zoster (chickenpox and shingles), influenza viruses, Epstein-Barr viruses, and hepatitis B (Life Extension).
Cistanche is a new one for me. A tough desert plant, this has also been traditionally used for longevity. This has been shown to reduce inflammation in animal models of intestinal inflammation, while increasing numbers of immune cells such as macrophages and natural killer cells (Life Extension again). Cistanche also reduces IL-6, IL-4 and TNF-alpha, stimulates bone marrow production of white blood cells, increases numbers of the more versatile "naïve" T cells and reduces allergy markers such as histamine (LE). Interestingly, these effects have been found to lead to an increased life expectancy in mice bred to age faster (Evid Based Complemet Alternat Med). While control mice lived for an average of 325 days, all dead by around 385 days, the mice given Cistanche lived for an average of 375 days - an increase of 15.4%! The last of the mice given low-dose Cistanche lived until about 410 days, but mice in the medium and high dose groups still had survivors at 425 days. Back to the 15.4% increase - if this was applied to humans, someone with an original life expectancy of 81 years (around the average for Australia) would instead have a life expectancy of 93 years. Aside from the evidence suggesting that aging actually stops in the 90s (that would be primarily Michael Rose's research), perhaps amplifying such gains, there is a lot you could do with an extra 12 years of life.
Pu-erh tea, native to China's Yunnan Province and consisting of fermented ripe tea leaves, is better than it sounds. Traditionally prescribed to emperors for longevity, supplementation with Pu-erh tea extract was shown to significantly reduce inflammatory markers in patients with metabolic syndrome. Levels of IL-6 fell by 21%, TNF-alpha fell by 23%, CRP fell by 26% and levels of anti-inflammatory IL-10 rose by 34% over the three-month duration of the study (Chin J Integr Med).
IL-6, written in full as Interleukin-6, increases risk of death by 25% in those aged around 60, but increases it by 118% in people over 80, when its levels are high (Life Extension). Deaths from cardiovascular diseases and obstructive airway disease, as well as the risk of osteoarthritis and macular degeneration, are also increased by elevated IL-6. Another inhibitor of IL-6 is turmeric, which has a high volume of research surrounding its effects. High CRP, or C-reactive protein, increases the risk of death by 158% in people over 80.
Reishi mushrooms, however, lack the bone marrow stimulating properties of Pu-erh tea, but are still able to resurrect the youthful patterns of circulating immune cells. It can also reduce IL-6 and raise IL-10 (Life Extension). Reishi can also enhance numbers and activity of the B lymphocytes. These produce antibodies, assist the macrophages/monocytes and present antigens to other B and T lymphocytes, therefore are indispensable to immune function (Life Extension). In addition, reishi mushrooms also have direct effects against Herpes simplex (cold sores), Herpes zoster (chickenpox and shingles), influenza viruses, Epstein-Barr viruses, and hepatitis B (Life Extension).
Cistanche is a new one for me. A tough desert plant, this has also been traditionally used for longevity. This has been shown to reduce inflammation in animal models of intestinal inflammation, while increasing numbers of immune cells such as macrophages and natural killer cells (Life Extension again). Cistanche also reduces IL-6, IL-4 and TNF-alpha, stimulates bone marrow production of white blood cells, increases numbers of the more versatile "naïve" T cells and reduces allergy markers such as histamine (LE). Interestingly, these effects have been found to lead to an increased life expectancy in mice bred to age faster (Evid Based Complemet Alternat Med). While control mice lived for an average of 325 days, all dead by around 385 days, the mice given Cistanche lived for an average of 375 days - an increase of 15.4%! The last of the mice given low-dose Cistanche lived until about 410 days, but mice in the medium and high dose groups still had survivors at 425 days. Back to the 15.4% increase - if this was applied to humans, someone with an original life expectancy of 81 years (around the average for Australia) would instead have a life expectancy of 93 years. Aside from the evidence suggesting that aging actually stops in the 90s (that would be primarily Michael Rose's research), perhaps amplifying such gains, there is a lot you could do with an extra 12 years of life.
Thursday 21 January 2016
Candida May Be Worse Than You Thought
For many years, the only known link between Candida spp. infections, and cancer was that it is an opportunistic pathogen taking advantage of the immune system damage caused by chemo. Recently, new research has found that Candida albicans can actually also promote cancer by producing carcinogens, causing inflammation, increasing the response of Th17 cells, and molecular mimicry of our own immune cells. This is also a frighteningly common infection among young women.
Candida produces the carcinogens known as nitrosamines and acetaldehyde. Nitrosamines activate specific pro-cancer genes, while acetaldehyde is a DNA-damaging carcinogen with many downstream effects. Inflammation promotes cancer by causing tissue damage and production of chemicals that promote angiogenesis, proliferation, migration, and adhesion while inhibiting apoptosis of damaged cells. Th17 cells, which are dominant in the response to Candida infections, are also responsible for production of chemicals that can increase angiogenesis and tumor growth.
On top of this, antibodies produced against Candida albicans can mimic a receptor on white blood cells, possibly causing antibodies to be formed against our own immune cells. This is another strike against sugar and alcohol consumption in relation to cancer risk, as both alcohol metabolism and sugar fermentation lead to acetaldehyde production.
One real-life report of cancer being in association with fungal infections comes from Meinolf Karthaus, who observed three children with leukemia suddenly go into remission after antifungal treatment for “secondary” infections. Additionally, one doctor had found fungal spores in every tissue sample of cancer that he studied, as he used saline instead of formaldehyde to transport the samples in order to preserve any possible fungi (Sources from Mercola, scroll down to the list of studies and books).
While pharmaceutical antifungals can cause even more damage to patients’ liver and kidneys, curcumin, the “main” medicinal compound in turmeric, may be an effective alternative. On top of exhibiting potent antifungal activity against Candida, curcumin also has anticancer properties, such as the ability to destroy cancer stem cells. Curcumin has antifungal effects against other species such as Cryptococcus, Aspergillus, Trichosporon, and Paracoccidioides strains, which have been shown to be vulnerable to its effects. Additionally, curcumin can prevent resistance of Candida to the antifungal drug fluconazole. It appeared to be that resistant Candida were able to pump fluconazole out of the cell bodies. Despite curcumin’s poor water solubility and thus bioavailability, nanoparticles and fat soluble delivery methods can overcome this limitation. More traditionally, golden milk is a beverage that increases availability of turmeric to the body, and can be made at home. This involves a combination of dairy, coconut or nut milk; black pepper, the turmeric rhizome and one or more of cinnamon, ginger or chilli, with many variations available online.
Besides curcumin, clove oil may also be effective against Candida infections. In one study, even the vapour of clove essential oil was able to inhibit several species of fungi, though the oil vapor was only strong enough to temporarily stop Candida growth without killing the cells. However, direct application was much stronger. Using direct application, the Minimum Inhibitory Concentration (MIC) of clove oil was 2.5%, meaning that clove oil at 2.5% concentration was enough to completely prevent fungal growth, which is an indicator of living cells. You can buy this straight, or in a blend such as Doterra's OnGuard, which I prefer because of my discount and the fact that it smells like chai. It has gotten me out of a lot of infections.
So in conclusion, natural fungicides and fungistatics such as curcumin and clove oil must gain more recognition, particularly in cancer treatment, whether the goal is full remission or “quality of life” (don't let me into a hospice, I will fumigate it with clove oil as an "experiment"). Reducing sugar and alcohol intake is also seen as increasingly necessary in order to prevent fungal infections and cancer growth, and yes you can enjoy food and drink without these things as it forces you to be more creative with flavours.
Candida produces the carcinogens known as nitrosamines and acetaldehyde. Nitrosamines activate specific pro-cancer genes, while acetaldehyde is a DNA-damaging carcinogen with many downstream effects. Inflammation promotes cancer by causing tissue damage and production of chemicals that promote angiogenesis, proliferation, migration, and adhesion while inhibiting apoptosis of damaged cells. Th17 cells, which are dominant in the response to Candida infections, are also responsible for production of chemicals that can increase angiogenesis and tumor growth.
On top of this, antibodies produced against Candida albicans can mimic a receptor on white blood cells, possibly causing antibodies to be formed against our own immune cells. This is another strike against sugar and alcohol consumption in relation to cancer risk, as both alcohol metabolism and sugar fermentation lead to acetaldehyde production.
One real-life report of cancer being in association with fungal infections comes from Meinolf Karthaus, who observed three children with leukemia suddenly go into remission after antifungal treatment for “secondary” infections. Additionally, one doctor had found fungal spores in every tissue sample of cancer that he studied, as he used saline instead of formaldehyde to transport the samples in order to preserve any possible fungi (Sources from Mercola, scroll down to the list of studies and books).
While pharmaceutical antifungals can cause even more damage to patients’ liver and kidneys, curcumin, the “main” medicinal compound in turmeric, may be an effective alternative. On top of exhibiting potent antifungal activity against Candida, curcumin also has anticancer properties, such as the ability to destroy cancer stem cells. Curcumin has antifungal effects against other species such as Cryptococcus, Aspergillus, Trichosporon, and Paracoccidioides strains, which have been shown to be vulnerable to its effects. Additionally, curcumin can prevent resistance of Candida to the antifungal drug fluconazole. It appeared to be that resistant Candida were able to pump fluconazole out of the cell bodies. Despite curcumin’s poor water solubility and thus bioavailability, nanoparticles and fat soluble delivery methods can overcome this limitation. More traditionally, golden milk is a beverage that increases availability of turmeric to the body, and can be made at home. This involves a combination of dairy, coconut or nut milk; black pepper, the turmeric rhizome and one or more of cinnamon, ginger or chilli, with many variations available online.
Besides curcumin, clove oil may also be effective against Candida infections. In one study, even the vapour of clove essential oil was able to inhibit several species of fungi, though the oil vapor was only strong enough to temporarily stop Candida growth without killing the cells. However, direct application was much stronger. Using direct application, the Minimum Inhibitory Concentration (MIC) of clove oil was 2.5%, meaning that clove oil at 2.5% concentration was enough to completely prevent fungal growth, which is an indicator of living cells. You can buy this straight, or in a blend such as Doterra's OnGuard, which I prefer because of my discount and the fact that it smells like chai. It has gotten me out of a lot of infections.
So in conclusion, natural fungicides and fungistatics such as curcumin and clove oil must gain more recognition, particularly in cancer treatment, whether the goal is full remission or “quality of life” (don't let me into a hospice, I will fumigate it with clove oil as an "experiment"). Reducing sugar and alcohol intake is also seen as increasingly necessary in order to prevent fungal infections and cancer growth, and yes you can enjoy food and drink without these things as it forces you to be more creative with flavours.
Monday 18 January 2016
Liver Cancer Prevention
As most of us would now know, about a week ago David Bowie died of liver cancer. No I am not exploiting him, I have every right to speak as I please and I am done with the expectation that I should shut up and "celebrate" his life. There are ways to prevent liver cancer that most people do not know about, which deserve more likes and shares than sentimental poetry.
One of the things that can reduce liver cancer risk is green tea. A huge meta-analysis, involving several hundred thousand people, found that regular green tea consumption resulted in a 26% reduced risk of liver cancer. The average risk reduction was 32% among liver cancer, cirrhosis, steatosis (fatty liver disease), hepatitis and chronic liver disease. There were no significant differences in this protective effect between Asian, European and American participants. In another, tea consumption was associated with a 21% reduced risk of primary liver cancer in the higher-quality studies, with women having a 46% lower risk.
As I have written before, coffee may also lower the risk of liver cancer. In this analysis, the summarised risk reduction for each cup of coffee per day was 23%, which isn't really that bad. However, added sugar and milk, as well as how the coffee was grown all make a difference, as it would with tea. This is likely to explain inconsistent results found in studies such as these.
Before I am also accused of caffeine addiction, another, smaller study has found a reduced risk of liver cancer from consumption of linoleic acid and possibly beta-carotene. The highest tertile of linoleic acid intake reduced risk of liver cancer by 65%, while beta-carotene was associated with a 52% reduced risk. While iron intake seemed to triple the risk of developing liver cancer, most of this was taken off when iron from wine was not counted. Alcohol consumption is already a widely known risk of liver cancer, just as the hepatitis B and C viruses are, which are sexually transmitted or passed on by infected needles - but it is difficult to run out of reasons why these activities are bad ideas. On top of this study, an analysis involving over one million people found that every daily increase in vegetable intake was associated with an 8% risk reduction in liver cancer. The summarised reduced risk was 28%, and this did not change regardless of hepatitis, alcohol intake or smoking. But still don't do them.
This is only a small sample of the research into liver cancer prevention that is available, it is not something that "just happens" to people.
One of the things that can reduce liver cancer risk is green tea. A huge meta-analysis, involving several hundred thousand people, found that regular green tea consumption resulted in a 26% reduced risk of liver cancer. The average risk reduction was 32% among liver cancer, cirrhosis, steatosis (fatty liver disease), hepatitis and chronic liver disease. There were no significant differences in this protective effect between Asian, European and American participants. In another, tea consumption was associated with a 21% reduced risk of primary liver cancer in the higher-quality studies, with women having a 46% lower risk.
As I have written before, coffee may also lower the risk of liver cancer. In this analysis, the summarised risk reduction for each cup of coffee per day was 23%, which isn't really that bad. However, added sugar and milk, as well as how the coffee was grown all make a difference, as it would with tea. This is likely to explain inconsistent results found in studies such as these.
Before I am also accused of caffeine addiction, another, smaller study has found a reduced risk of liver cancer from consumption of linoleic acid and possibly beta-carotene. The highest tertile of linoleic acid intake reduced risk of liver cancer by 65%, while beta-carotene was associated with a 52% reduced risk. While iron intake seemed to triple the risk of developing liver cancer, most of this was taken off when iron from wine was not counted. Alcohol consumption is already a widely known risk of liver cancer, just as the hepatitis B and C viruses are, which are sexually transmitted or passed on by infected needles - but it is difficult to run out of reasons why these activities are bad ideas. On top of this study, an analysis involving over one million people found that every daily increase in vegetable intake was associated with an 8% risk reduction in liver cancer. The summarised reduced risk was 28%, and this did not change regardless of hepatitis, alcohol intake or smoking. But still don't do them.
This is only a small sample of the research into liver cancer prevention that is available, it is not something that "just happens" to people.
Friday 15 January 2016
Many Things Can Be Superfoods
This was my first ever paid article back in 2014! Don't worry, there's no copyright attached. Obviously, since then I figured out how to add hyperlinks to text.
References
The “buy local” food movement has grown in recent years, and
so has awareness of the benefits of eating seasonally. However, those wishing
to add a hit of fresh superfoods to their diet do not have to compromise on
buying local with exotic or out of season produce, which is often expensive and
may have travelled thousands of kilometres. Many traditional autumn favourites
– or spring and summer for those of us in the Southern hemisphere – have
superfood status that is much deserving of recognition.
Apples
With dozens of varieties available, the humble apple has
long been a staple. The apple’s reputation as an effective doctor-repellent is
indeed true, with the consumption of at least one apple a day being associated
with protection against lung and colon cancers; cardiovascular disease;
diabetes; asthma and pulmonary dysfunction1. Higher doses of pectin,
which is found in apples, have even been shown to reduce levels of the
radioactive isotope Cesium-137 in the organs of children affected by the
Chernobyl incident2. Besides pectin, the apple’s ability to protect
against degenerative diseases and aging are also attributed to the presence of
vitamin C and various polyphenols3.
Cranberries
This tart little fruit is not only associated with
Thanksgiving in North America, but is also widely known for its ability to
prevent the recurrence of urinary tract infections4. In addition,
research has found that daily consumption of cranberry juice protects against
cardiovascular disease by mechanisms such as preventing the oxidation of LDL
cholesterol and reducing platelet aggregation5. Cranberry juice also
improves vascular function in people with coronary heart disease, reducing
vascular stiffness6.
Kale
Kale is one of the most popular superfoods, due to its high
vitamin and mineral content, as well as containing over 20 phenolic compounds7.
In comparison with the poor availability of calcium in spinach, calcium from
kale has excellent absorbability8. Kale has also been shown to
reduce glaucoma risk, improve blood lipid profiles and may promote
detoxification and reduce prostate cancer risk9.
Turnips
A root vegetable with a long storage life, turnips are rich
in many nutrients such as fibre and vitamin K, providing 600% of the US
recommended intake of vitamin K per cup. Studies have shown that vitamin K has
the ability to protect against fractures independently of bone mineral density,
and protects against coronary heart disease10. Also, fibre is known
to help prevent and treat digestive conditions such as constipation and diverticular
disease, benefits cardiovascular health and may even help prevent diabetes11.
Cherries (Australia)
Cherries are one of the many fruits now coming into season
here in Australia. These contain the antioxidant compounds known as
anthocyanins, which also have anti-inflammatory properties through the
cyclo-oxygenase pathway12. While this research was in vitro,
multiple human studies have shown that cherries, both sweet and tart, do indeed
have antioxidant and anti-inflammatory properties, and may prevent gout attacks13.
Blueberries
Another fruit that is generally in season during the
Australian summer, blueberries are also rich in anthocyanins. Research has
found that daily consumption of this fruit increases natural killer cell
counts, as well as reducing oxidative stress and inflammation14. The
antioxidant properties of blueberries were reflected in other research, of over
93,000 women from the Nurses’ Health Study, where three or more servings of
blueberries each week were found to reduce the risk of heart attack in women by
one third15.
Strawberries
Botanically a dry fruit known as an achene, strawberries are
yet another Australian summer fruit. These so-called “berries” have been shown
to protect LDL cholesterol against oxidative damage, as well as lowering LDL
cholesterol levels, thereby being protective against atherosclerosis16.
Strawberries may also help prevent cancer; however, organically grown
strawberries have stronger cancer-fighting properties than strawberries grown
conventionally17.
Mangoes
Native to India, the mango is one of the most popular summer
fruits in Australia. Mangoes are high in vitamin C, vitamin E and carotenoids,
and together these can provide protection against both water and fat-soluble
free radicals. In fact, the juice has often been used as a restorative tonic
and a treatment for heat stroke, and the fruit may have anticancer,
cardiotonic, anti-inflammatory, hepatoprotective, gastroprotective, anti-bone
resorption and immunomodulatory abilities18.
Tuesday 5 January 2016
Immunotherapy Is Older Than Many Think
Immunotherapy as a cancer treatment has received increased attention lately, mostly because Jimmy Carter was successfully saved by this non-toxic therapy. But it is not a new way of thinking about cancer! In the 1890s, the much misunderstood doctor William Coley was pretty much traumatised from losing a patient to sarcoma (I like him already! He had a soul!) and so began to sift through old records at New York Hospital in order to find something that would point him in the direction of an effective treatment (that did not involve amputation, obviously). Coley then discovered the case of a German man with a recurrent tumour on his neck, who was expected to die until his tumour just disappeared after a strep infection. He decided that the strep infection managed to reverse the cancer, and then tested his theory on another seriously ill man dying of sarcoma (do not try this at home! There are many immunotherapy/hyperthermia clinics, particularly in Europe). After getting his hands on a strong strain of strep bacteria, this man became violently ill, but in 24 hours his tumour began to disintegrate, and he completely recovered. William Coley finally got his revenge against sarcoma. Unfortunately, radiation overshadowed his successes, possibly because you couldn't type "radiotherapy side effects" into Google Images for another century. But then his daughter founded the Cancer Research Institute, and now there is a much greater understanding of the immune system and how it can fight cancer. I will say that all cancer deaths over the past 100 years were unnecessarily caused by the desire for one-size-fits-all treatments regardless of their toxicity. I am not going to mince my words like I am "supposed to", I hate the usual discourse around cancer where you are a monster if you do not accept death and toxic treatment ideas.
Why am I writing about this when I study natural medicine? Because it is not toxic, and there are things natural medicine can offer to make immunotherapy safer and more effective. One of these things is supplementation with Bifidobacterium probiotics. Mice given Bifidobacterium were able to respond to immunotherapy, and this actually exerted its own anti-cancer effects separately from the drugs. These bacteria did not leave the intestines, they simply communicated with roaming immune cells. Bifidobacterium containing probiotics are widely available, as well as a wide variety of nutritional supplements and herbs that can modulate the immune system, but there needs to be more research on combining these with immunotherapy drugs because most naturopaths don't seem to know how to work with them.
Why am I writing about this when I study natural medicine? Because it is not toxic, and there are things natural medicine can offer to make immunotherapy safer and more effective. One of these things is supplementation with Bifidobacterium probiotics. Mice given Bifidobacterium were able to respond to immunotherapy, and this actually exerted its own anti-cancer effects separately from the drugs. These bacteria did not leave the intestines, they simply communicated with roaming immune cells. Bifidobacterium containing probiotics are widely available, as well as a wide variety of nutritional supplements and herbs that can modulate the immune system, but there needs to be more research on combining these with immunotherapy drugs because most naturopaths don't seem to know how to work with them.
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