Sage Health Living Blog

By Wendy Romig, DCNDigestion is one of the most critical functions in the body when it comes to our overall health. From the moment food enters our mouth, until the time that it is either absorbed or excreted, vital biochemical processes are taking place enabling us to receive essential nutrients required for life. Our biological and life-sustaining systems are quite intricate, but understanding some basics can be beneficial for health.Basic Overview of DigestionContrary to common belief, digestion actually begins in the brain not the mouth. From the moment we think about food, see it or smell it, our body begins releasing enzymes for digestion. Then, when food actually enters the mouth, our teeth mash up the food while enzymes initiate the break-down of carbohydrates and fats. As food enters the stomach, digestive juices, hydrochloric acid and proteolytic enzymes (which breakdown proteins) are released to continue the processing. The stomach then slowly empties its contents into the upper portion of the small intestine where it is met by enzymes released from the gall bladder and walls of the intestines. Another important substance released by the gall bladder into the small intestines is bile, which emulsifies fats for absorption. All nutrients are absorbed in the small intestine and transported to other systems of the body via the blood or lymphatic systems. Any fiber that was not broken down, continues on through the digestive tract and enters into the large intestine for fermentation and creation of our gut microbiota, Vitamin K and biotin. What is unused, is excreted in feces.Where Things Go WrongPoor digestion can actually begin in the mouth, especially for those who do not chew their food sufficiently. Under-chewed food enters into the stomach for continued breakdown but when large chunks are present, they are often not broken down properly into their micro-nutrient (vitamins and minerals) and macro-nutrient (carbohydrate, fats and proteins) parts. It is recommended to chew food until it feels completely mashed up in the mouth (around 50 chews according to well-known Integrative Medicine expert Dr. Joseph Mercola). Another area of digestive weakness is insufficient stomach acid. As we age, our bodies tend to produce less hydrochloric acid, which is essential for several functions: 1) breaking down food, 2) killing bacteria and pathogens, 3) activating the protein enzymes, 4) activating the carrier for B12, 5) activating the release of enzymes in the small intestines. While we know that too much stomach acid is dangerous, too little can interfere with major processes.The next place people with digestive problems commonly experience issues is in the intestines in the form of inflammation. Inflammation results in gut tissue that has been irritated by foods not well tolerated, medications, stress, bacterial overgrowth and other aggravants. Inflammation can cause conditions like irritable bowel, intestinal hyperpermeability (‘leaky gut’) and nutrient malabsorption. Lastly, we hear a lot about making sure we have enough of the ‘good’ bacteria in our bodies. This is true and while our large intestines manufacture a large portion of our gut microbiota, those who have taken anti-biotics may be chronically low. Common Symptoms of Poor DigestionThere are a whole host of health problems that can arise from digestive problems and nutrient malabsorption; the list grows by the year. Common primary symptoms of compromised digestion include but are not limited to acid reflux, bloating, constipation, diarrhea, bad breath and gas. Secondary symptoms can include fatigue, muscle weakness, nutrient deficiencies, depression (there are multiple studies linking gut health and depression) and weight problems. It is important to address digestive issues to promote good health and prevent other more serious health problems. The good news is that there are natural options for getting digestion back on track including nutritional changes, supplements and herbal medicine. Consult your local health practitioner for guidance. This article offers only a brief overview of digestion and its potential pathologies. If you are interested in learning more, there are several reputable resources including Dr. Mercola’s website, The National Institute of Health’s PubMed directory (for scientific studies) and the Townsend Letter.Happy digesting!

By Wendy Romig, DCNWhether children, adults or senior citizens, physical activity and movement are critical for health and well-being. Despite the endless amounts of research and evidence showing the benefits of movement, a large percentage of the US population still falls short of the recommended level of exercise in a week. Many factors including sedentary lifestyles, desk jobs, busy lives and limiting health conditions contribute to the problem, but an important consideration is the physiological effects of inactivity. Now that winter is in full swing pushing many indoors, finding ways to keep the body moving during those dark, cold days is critical. Chronic inflammation has become an epidemic of the developed world and is the result of several factors including diet and lifestyle. According to an article published in Behavioral Neurology Journal, our hunter-gather ancestors experienced significantly lower levels of inflammation, particularly in terms of the duration of inflammation present in the body. Where these earlier humans may have experienced up to 40 days of acute inflammation, present day pathologies linger for months, and even years at times, leading to the onset of chronic disease like obesity, diabetes, and heart disease. Research has been conducted to measure the levels of certain inflammation markers with long durations of inactivity in newly diagnosed diabetics. Results showed that sedentary lifestyles caused an elevation in the marker IL-6 but increases in activity actually lowered another inflammatory marker c-reactive protein in diabetics. In fact, this research published in the journal of Nutrition, Metabolism and Cardiac Disease in 2014 points out that each hour of added movement in a day decreased the inflammatory marker c-reactive protein by 24% over a six-month period. There is an important correlation between exercise and inflammation levels in humans and some researchers suggest that our muscles are the “forgotten organ” of the immune system. Physical activity and engagement of the body’s musculature actually activates anti-inflammatory immune function. And more specifically, exercise before eating, can lower inflammation brought on by dietary intakes of certain foods like fats, meats and simple carbs. Knowing the inflammatory effects of a sedentary life, the question remains, how can individuals bring more movement and activity into their daily lives? An article published in the International Journal of Behavioral Nutrition and Physical Activity suggests that even 30 minutes of concentrated daily activity may not be sufficient in counteracting the effects of sitting all day. If you’re not one to spend hours at the gym every week, there is hope. Just simply standing up, walking around your house or office for a few minutes every hour can significantly reduce the levels of inflammation in your body. While this does not replace dedicated cardiovascular and weight-bearing exercise, your body will likely soon feel the positive effects of more movement in your day.

By Wendy Romig, DCNAs we launch into spring from a gentle winter, you may find yourself cleaning out closets, clearing gardens and removing the old and unwanted from your life to open space for the new and rejuvenating. Spring invites awareness to our bodies and to the earth, along with an increased focus on health and wellness. Some may use this time of year to detox their bodies in preparation for the seasons ahead. In today’s modern world, toxins are abundant. On average, we are exposed to hundreds of toxins each day, creating strain on our internal systems which can promote inflammation, hormonal imbalances and disease. Not to mention the effects on wildlife and our water systems. Here’s a quick guide to some of the most common chemicals we come in contact with based on research from the Environmental Working Group (ewg.org). Toxins found in common personal care products:Oxybenzone is another product found in sunscreens, personal care products, aftershave and makeup. Oxybenzone has been shown in studies to increase oxidative stress, putting added strain on organs, as well as increasing risk of allergies, cardiovascular disease and imbalances in the endocrine system. Parabens are found in sunscreens and personal care products. Evidence suggests that these compounds may disrupt hormone production and lead to allergic responses in the body. Phenylenediamine (along with aminophenol and diaminobenzene) are found in hair dyes. These chemicals have been associated with increased risk of liver toxicity, respiratory illness, and eye irritation. Phthalates are found in nail polishes, cosmetics, scented products and aftershaves. They have been found to disturb reproductive function, particularly in males.Retinyl Palmitate is an ingredient found in many personal care products including shaving cream, moisturizers, sun screens and makeup. Research shows that this chemical may contribute to reproductive disruptions and increased oxidative stress in the body.Triclosan is found most in toothpaste and facial cleansers. Data suggests that exposure to triclosan may increase risk of endocrine system imbalances, allergic responses and organ toxicity. This product has been restricted for cosmetic use in Canada and Japan. Toxins found in common cleaning products:Ammonium hydroxide is a chemical used in common household cleaning products which can contribute to respiratory distress, organ damage, allergies, skin irritations and vision issues. Oxalic Acid is a chemical used in many cleaning products. Evidence suggests this compound contributes to disruption of the endocrine system and may cause convulsions, vision issues or kidney damage.Sodium hypochlorite is one of the main ingredients in bleach products which may lead to respiratory inflammation, allergies, skin irritation, hormonal imbalances and digestive disturbances. While this list is far from exhaustive, it contains a few of the more aggressive toxins found in everyday products. As you consider ways to detoxify your life, you may research safer alternatives to some of these products found through the Environmental Working Group website. Many of these products can be found at  your local co-op or natural food store. You may also choose to investigate DIY options like vinegar, water and essential oils for cleaning, and other recipes for skin care which are natural, safe and oftentimes more economical.

by Wendy Romig, DCN Antioxidants, phytonutrients, superfoods: these nutritional terms are widely used in supplements marketing, on food packaging and online. But are the benefits they tout hype, or are they based on scientific evidence? Antioxidants are an important part of our daily dietary needs, yet it’s common for people to have severe deficiencies in these essential nutrients. According to the National Institute of Health, antioxidants have health-promoting benefits which may lower the risk of chronic illness and counteract the effects of oxidative stress in the body. Oxidative stress results from our body’s energy production pathways leading to the release of free radicals, not unlike a car engine producing toxic exhaust fumes. While free radicals naturally occur in the body, their presence can lead to changes in our DNA, cellular damage, cellular mutations and inflammation, all of which can contribute to cancer, atherosclerosis, macular degeneration and other health issues. Antioxidants found in fruits and vegetables bind to free radicals, safely removing them from the body and protecting the cells from mutation or damage. Nutrients like Vitamins C, A, E, lutein, lycopene, and flavonoids have been widely studied over the years for their protective, anti-inflammatory effects. Vitamin C is most commonly associated with citrus fruit. However, Vitamin C can be found in many vegetables as well, including broccoli and kale. Studies show that Vitamin C is beneficial for heart health, in cancer treatment and improved immune function. It is water soluble and an essential nutrient in our diet, meaning the only source is through our food. Deficiencies in Vitamin C can lead to bruising, bleeding gums, poor immunity and slow wound healing. Vitamin E is found in nuts, seeds and dark leafy greens. Vitamin E may be beneficial for eye health and heart disease, though one should be cautious with high dose supplementation, because Vitamin E can be stored in fat cells of the body. Vitamin E oil is commonly used topically to help repair damaged skin tissue. Vitamin E deficiencies can lead to neuropathies, vision issues, and muscle weakness. Vitamin A and beta carotene are fat-soluble nutrients that are found in orange foods like carrots, butternut squash, sweet potatoes, etc. Vitamin A is most commonly associated with eye health, but also is critical in pregnancy for fetal development. It’s important to note that high doses of supplemental vitamin A can be toxic. Lutein, lycopene and zeaxanthin are carotenoids found in a wide variety of fruits and vegetables. Evidence shows that these nutrients are beneficial for eye health, specifically supporting the macula of the eye. Some studies suggest diets rich in carotenoids may reduce the risk of cancer and cardiovascular disease. Flavonoids are polyphenols that have significant antioxidant effects in the body and are plentiful in fruits, vegetables, coffee, chocolate and green tea. Flavonoids have been studied for their benefits in cardiovascular disease, cancer, diabetes, and brain health. Supplementation of antioxidants can offer some benefits to health, but the first goal should always be to increase your intake of foods containing these nutrients. Eating a whole foods, plant-based diet offers an abundance of antioxidants and other health benefits including improved energy, blood sugar control, better digestion and increased well-being. It’s yet another case for eating lots of veggies.

We have entered uncertain times with the coronavirus creating global unrest, illness and travel disruptions. At Sage Integrative Health, we are committed to supporting all efforts to slow the spread of this virus, while also providing useful information to our community. I have been asked over the past couple of weeks about natural interventions for preventing and/or treating coronavirus, to which I respond that there are no proven natural remedies for this virus. Should you display symptoms of coronavirus, including fever, dry cough, sore throat or difficulty breathing, it is essential that you seek immediate medical attention to receive a proper diagnose and treatment.  If you are scheduled for a visit at Sage and have any of the symptoms of coronavirus, or have been in contact with someone who has been infected with the coronavirus, we ask that you reschedule your appointment.  Taking the appropriate measures as outlined by local, national (CDC) and world health agencies (WHO) to reduce exposure and transmission risk is essential. In addition, you may also consider ways to support immune function like improving hydration, increasing intake of fruits and vegetables and getting plenty of rest, just as you might do to prevent the flu. Some herbs and supplements may also be beneficial. While these tactics may support overall health, they should not replace medical treatment should you fall ill.  If you have questions, I invite you to schedule a 15-minute free phone consultation to discuss your concerns regarding this serious health issue.  Wishing you good health and well-being. Sincerely, Wendy Romig, DCN

By Sage Writer: Hillary Givhan Recently, we posted an article on how to get started with a therapeutic diet (low-FODMAP, gluten-free, anti-candida, etc.). Be sure to check it out for some helpful tips on getting started. In some cases, a therapeutic diet may be necessary for months in order to clear up a condition. This can make holidays, family gatherings, or a meal with friends difficult to navigate. Below are 5 tips on how to maintain a social life while also tending to your health: 1. Eat Before You Go: This may not be the most fun option, but it is the most effective. If you eat substantially before going to an event where you know there will be food, you won’t be as tempted to eat something you shouldn’t. If it is a more intimate gathering of family and friends, explain that you will eat ahead of time and why. If everyone is aware, they will be less likely to offer you food and may even support your efforts by helping you steer clear of that dessert table. 2. Potlucks: When meeting with friends or family, a potluck is a great alternative to eating at a restaurant or ordering takeout. You can bring something that you know you can eat, and if you let them know ahead of time, someone may be more than happy to bring a dish you can eat (a side of green beans, salad with dressings on the side, gluten-free granola mix, etc.) 3. Make the Executive Decision: When eating out, ask your friends or family if you can choose the restaurant. If they know you have dietary restrictions, they will likely be understanding of this request. Yelp and Google are great resources for searching your dietary needs and restaurants in your area. This will give you the opportunity to call restaurants and discuss their menu or alternate meals they can prepare for you ahead of time. This will relieve you from asking the waiter 15 questions about your order and will give you peace of mind. 4. Choose DIY: More and more DIY eateries are popping up. Here, you can create your own pizza, salad, burrito, or sushi bowl. If there are enough ingredients that work for you, then it’s a great option for eating out (think: Chipotle, Poké Bowl, Saladworks, MOD Pizza, etc.) 5. A Happy Heart is Great Medicine: Know that it’s the consistent decisions that will make the biggest impact. If you accidentally eat something you shouldn’t, or are in a social situation where it’s just about impossible to stay on your diet, then eat with a happy and grateful heart. One meal here and there won’t derail you if you’re making good choices for the vast majority of the time. Food is important and so is enjoying the company of those we love. We hope this gave you some good ideas of how to maneuver social situations while on a therapeutic diet. Let us know if you’ve learned any additional ways to navigate social events while on a specialty diet!

By Sage Writer: Hillary Givhan If you take a walk around the Mount Airy, you might notice signs in front yards indicating that the landscaping incorporates eco-friendly native plants. Native plants are easier to care for because they are native to our climate and soil. They also benefit the environment by preserving our natural wildlife and providing shelter and food for native insects and birds. Below is a list of some native species that have also been traditionally used in herbal medicines. Of course, we do not recommend harvesting and using these herbs from your garden unless you are familiar with the plant and how to use it. It’s gardening season, so why not try adding some native medicinal species to your home garden?1. Common Evening Primrose (Oenothera biennis)2. Common Yarrow (Achillea millefolium)3. American Witch-Hazel (Hamamelis virginiana)4. Red Mulberry Tree (Morus rubra)5. Jewelweed (Impatiens capensis)6. American Black Elderberry (Sambucus nigra ssp. canadensis)We recommend buying native plants from a nursery that has cultivated them, rather than harvesting from the wild. You can go to: https://www.audubon.org/native-plants to search species and sourcing in your local area.Have you utilized native species in your gardening? How did it go? We’d love to know!

By: Hillary Givhan, Contributing WriterLow FODMAP, histamine-free, gluten-free, anti-candida, nightshade-free, dairy-free, sugar-free — the list goes on and on. There are numerous therapeutic diets, and with more and more people facing food sensitivities, digestive troubles, and autoimmune disease, the need for these specialty diets is rising.For some, staying gluten, dairy, or sugar-free may be a permanent lifestyle choice or need. But for the more rigorous dietary guidelines, they are likely only necessary for a season of healing. Whatever the case, it can be daunting and even downright depressing for anyone to open their cabinet and realize their lifelong staples are no longer allowed. It can also be challenging if you find yourself unable to eat prepared foods or items you are used to using in your meal prep (flavorings such as onion and garlic, sauces, deli meats, canned soups, frozen meals, breads, etc.) However, with patience, experimentation, and perseverance, these therapeutic diets can be tasty, varied, and dare I say, a little fun. Below are 8 tips for making a big dietary shift a little easier:1. Glass Half Full: Write a comprehensive list of things you can eat. Rather than focusing on what you “can’t” have, adopt the glass half-full mindset by focusing on all that is still available to you.2. Make the Cut:Take stock of your pantry, refrigerator and freezer. Mark down the things you have that fit within your diet. If anything doesn’t fit the criteria and will go bad or tempt you, get it out of your house. Aside from throwing it away, you can give it away, put it in the freezer (or a friend’s freezer) for when you can eat it again, etc. This may be difficult, but it will help you stick to your goal.3. Gather Meal Ideas: If you’re working with a nutritionist or dietitian, ask for meal ideas. With specialty diets on the rise, there is a likely chance you will find recipes and food blogs specific to your needs online as well.4. Simplify your Meals: One way to make meal planning and prepping easier is to view meals as containing three categories: starch/grain base, protein, and veggies. This will help you break down your allowed foods list into meal pieces that can easily be combined.5. Take the Guesswork Out:Create a list of several breakfasts, lunches, and dinners that you think you’ll like. Underneath each meal, list all of the ingredients you will need. Each week, you can choose what meals you will make from here. This can act as your go-to shopping list, and it will take the headache out of figuring out what to eat every week.7. Take Notes: It’s likely you’ll have to do a lot of cooking at home on a therapeutic diet. If you aren’t used to cooking at home, or if your new protocol is unfamiliar, be sure to take notes as you make these recipes so that you know what you might want to change next time. 8. Go Easy on Yourself:Know which foods are the top priority to eliminate and start there if it’s too overwhelming. You can continue to refine your food choices as you go, but the key is to think of making progress, not perfection. Changing eating habits affects many areas of life- physical health, social habits, sense of normalcy, etc. It takes a lot of willpower to effectively practice a new way of eating. Remember that you are doing something hugely beneficial for yourself and your loved ones in the long-term. It will be worth it. If you slip-up here and there, it’s okay; just get back up and try again. The occasional mistake will do less damage if you are daily making consistent, positive decisions for your health.Therapeutic diets can be stressful, but they also push the bounds of creativity and skill in the kitchen as well as expose our taste buds to new worlds of flavor. Necessity is the mother of invention, and the greater the necessity, the more inventive you’ll become! We hope these tips have been helpful to you! Let us know if you have any tips you can add.

Home Sweet Home for the Holidays... By: Ashleigh Stewart, Contributing Writer Enjoying the holidays can be an experience for all senses--sight, taste, touch, hearing and smell. When we consider the scents of the holidays many of them are created from artificial air fresheners, fragrances and decorative candles. Surprisingly, these products can emit toxins into the air that we breathe in our home causing adverse health effects. Many of you reading may have already made the effort to keep your home clean by choosing products that are labeled as 'green' or 'organic'. However, these products may still include fragrance as one of the ingredients. It has been reported that less than 10% of volatile ingredients are typically disclosed on air fresheners--conventional and organic--in an effort to protect fragrance formulations. We are not only exposed to these volatile chemicals when air fresheners, candles and fragrances are in use. But, the toxins can latch onto the particles of our furniture, carpeting and even our furry friends leading to prolonged and harmful exposure. The chemicals present in these products can lead to health concerns such as difficulty breathing, infant illness, mucosal symptoms, asthma attacks, and migraine headaches. Fragrances also include phthalates. Phthalates are a hormone-disrupting chemical that has been linked to cases of breast cancer and low sperm count. So, this holiday season, choose simple, natural ingredients to spruce up your home such as spices, fruits, pure essential oils and herbs. One of our favorite essential oil holiday blends includes rosemary, peppermint and sweet orange. You may even be able to find a pre-blended holiday essential oil set from your favorite carrier. These are incredible to diffuse throughout the day to spread the holiday spirit!

By: Dana McNaught, Contributing Writer If you were to perform an internet search on what kind of impact sugar has on human health, you would find answers that range from ‘sugar is absolutely safe’ to ‘sugar is more addictive than cocaine’. Somewhere in the middle of these extremes lies the truth. For our intents and purposes, we will define sugar simply as refined carbohydrates. Some examples of sugar include cane sugar, maple syrup, raw sugar (turbinado, sucanat), honey, corn syrup, and agave nectar. Along with protein and fat, carbohydrates are a source of nutrients and energy (calories). Within the body, the form of sugar that is used for energy is glucose, and it is the brain’s preferred fuel source. When we look at whole food sources of carbohydrates, even the sweetest options- fruits- have sugar packaged along with fiber. Since fiber slows the digestion of carbohydrates into simple sugars, it also slows the release of those sugars into the bloodstream. If you’re wondering where the idea of sugar being as addictive as cocaine could have originated from, it’s from brain scans that show sugar lighting up the reward centers of the brain, just as some illicit drugs do. However, when you consider the fact that the brain prefers glucose as an energy source, it makes sense that the brain receiving glucose would light up the reward centers, because your brain wants you to repeat the behavior that got it the fuel it needs to run on. However, not all sugar is created equally, and in nature, you could never access the amount of refined sugar being consumed by the average American each year- about 152 pounds! If you’re thinking that this sounds impossible- just consider the fact that Campbell’s tomato & sweet basil soup has 43 grams of sugar per serving, while a Krispy Kreme original glazed doughnut has 10 grams. For most people, sweeteners can be tolerated in small amounts, and you may want to consider choosing sweeteners with minimal processing (such as raw sugar, coconut sugar, maple syrup, and raw honey) wherever possible, as they may still contain some nutrients. The important thing to keep in mind is that you want to choose whole food sources of carbohydrates as a source of energy. Sometimes, artificial sweeteners are preferred by consumers because they lack calories and do not impact blood glucose levels the way that traditional sweeteners do. However, many artificial sweeteners contain chemicals that alter the population of our gut bacteria. Since our beneficial bacteria plays such an important role in weight management, this alteration has the opposite effect of what is intended by consuming zero-calorie sweeteners and actually leads to weight gain. You probably have heard of the dangers of consuming high-fructose corn syrup. The issue is the unusually high amount of isolated fructose (‘high fructose’) that the body is unable to utilize. This ends up being stored as fat in the liver, and has even been linked to the development of Non-Alcoholic Fatty Liver Disease. The average fructose content in high-fructose corn syrup (HFCS) is 55%, but what’s often looked over is the fact that the fructose content of agave nectar is just as high. Fructose does not disturb blood sugar levels, so agave nectar can be marketed as a low-glycemic sweetener- meaning that it does not raise your blood sugar levels as much as table sugar. Being marketed as a low-glycemic sweetener automatically made space for agave nectar as a ‘healthy’ option, when it may end up being just as bad for us as HFCS. Stevia and Monk fruit are two non-caloric sweeteners derived from plants that do not impact your blood glucose levels and so far appear to not have adverse health effects, but always do your own research and pay attention to how your food choices make you feel. You have the right to make informed decisions about how much or how little sugar you want in your diet. A few great options to keep in mind are: Always check the nutrition label:  There are no regulated definitions for ‘healthy’ or ‘natural’ in food production, so be sure to look past marketing tactics. Stick to whole foods: When it comes to carbohydrates, your best option is to stick to whole food sources, like: whole grains (oats, brown rice, quinoa, millet) sprouted or whole grain breads and pastas, whole fruit, starchy vegetables (squash, sweet & white potatoes). This way, you get the carbohydrates, nutrients, fiber, phytochemicals, antioxidants, etc. that we could never replicate in food processing. Eliminate sugary beverages: When we consume foods and beverages that have calories and flavorings but little-to-no nutritional value, our bodies recognize the lack of nutrients and increase our hunger in order to get the required nutrients for promoting life and well being. Sage Integrative Health Center hosts a variety of workshops and activities, and you are welcome to attend, participate and ask your burning nutrition questions! Basaranoglu, M., Basaranoglu, G., & Bugianesi, E. (2015). Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surgery and Nutrition, 4(2), 109–116. http://doi.org/10.3978/j.issn.2304-3881.2014.11.05 (2018). Tomato & sweet basil bisque [digital image]. Retrieved from: https://www.campbells.com/campbell-soup/slow-kettle/tomato-sweet-basil-bisque/ (2018). Original glazed doughnut [digital image]. Retrieved from:   https://www.krispykreme.com/menu/doughnuts/original-glazed-doughnut (2014, November 14). Minions microbes [digital image]. Retrieved from: https://blogs.scientificamerican.com/guest-blog/artificial-sweeteners-may-have-despicable-impacts-on-gut-microbes/ (2018). Understanding carbohydrates, fiber and sugar [digital image]. Retrieved from: https://askthescientists.com/qa/carbohydrates/