Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss and could result in a decrease in muscle mass, I know I would lose weight on it only because I’d get sick of eating. If faced with eating a fatty steak with melted butter on top for dinner followed by spoonfuls of oil for dessert, I’d rather not eat.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

The Truth about Detox Diets

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Detox Diets and Cleanses

Detox diets promise to clean up the mess left behind from daily life so you feel better, more energetic and lose excess body fat. Consider them the Merry Maids for your body. They come with an army of equipment and compounds to attack years of buildup from environmental toxins, pesticides, allergens, waste, and inflammatory substances. This “sewage sludge” is stuck to your gut, interfering with digestion, leaving you bloated, tired, fat and with joints and muscles that feel like they are on fire.

In theory this sounds great. But there’s one glaring issue. The human body doesn’t need to “detox” because it comes equipped with organs designed to remove waste products. Plus, many detox diets are simply very low calorie plans with added laxatives and diuretics (because instant, yet temporary, weight loss might fool you into believing the outrageous claims on detox and cleansing products). Instead of wasting your money, take the top 3 good points about many of these diets and incorporate them into your overall nutrition plan:

Drink More Water

There are a few studies showing that individuals who are obese can lose weight by drinking 2 glasses of water before each meal. Plus, many people don’t get enough water or total fluids each day anyway and dehydration can make you feel sluggish and grouchy. So, grab it from the tap or if it’s more convenient, fill up your stainless steal water bottles and carry them with you at all times.

Eat More Fruits and Vegetables

The average American is falling short on fruit and vegetable intake. According to the National Cancer Institute, people with diets rich in plant foods, such as fruits and vegetables, have a lower risk of getting some types of cancer as well as diabetes, heart disease and high blood pressure. Produce generally has fewer calories than many other foods making it a great addition to a weight loss diet.

Get Friendly with Bacteria

Many detox plans include unfiltered apple cider vinegar – the kind that has a cloudy appearance – is full of probiotics. Probiotics are friendly (beneficial) bacteria – the kind that live in your gut and have a number of important functions in your body. Improving your gut bacteria may support immune functioning, improve the health of your intestinal tract, increase your body’s absorption of certain nutrients and alleviate constipation. Apple cider vinegar is acidic so I don’t recommend drinking it straight. Instead, dilute it in a big glass of water or another beverage. Other great sources of probiotics include kefir, yogurt (check the container for “live and active cultures”), miso soup, tempeh, sauerkraut, kimchi.

Add 2 glasses of water before each meal, load up on vegetables and fruits and make an effort to consume probiotic-rich food daily and you will reap the rewards of better nutrition without wasting money on detox diets and cleanses.

References:
Parvez J et al. J Appl Microbio 2006;100(6):1171-1185.
Parretti HM et al. Obesity 2015, 23(8):1785-1791.
Dennis EA et al. Obesity 2010;18(2):300-307.

 

Should You Go on a Detox from Sugar?

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Should You Go on a Detox from Sugar?

Oh my gosh, the TODAY show just launched a new initiative called the 10-day sugar detox (#NoSugarTODAY). I’m so sick of detoxes! Though most people should reduce their intake of added sugars, let’s call a spade a spade: sugar is hardly “toxic”. Before giving a nutrient so much power, let’s get the facts right:

              –  No one single nutrient is responsible for poor health, weight gain, etc.

                –  Diet is a confluence of factors: food, lifestyle (exercise, activities of daily living,  sleep and more), etc.

                  –  Rather than focus on the single nutrient, think *really* hard about what you want to accomplish.

Why Should We Give Up Sugar?

It’s tough to tease out single ingredients like sugar and their potential health effects. However, we are eating too much added sugar – the kind that is mixed in during cooking or food processing. Men are averaging 335 calories from added sugars (20 teaspoons) whereas women are taking in an average of 239 calories (15 teaspoons) from added sugar each day. Kids are consuming a whooping 16% of their calories from added sugars.[1] The majority of added sugar in our diet comes from our food (as opposed to beverages). And while some of the sources are things you might expect: sodas, desserts, nutrition bars, etc., some of the added sugar culprits are seemingly healthy foods such as salad dressings and sauces. Added sugar enhances taste and provides calories but has no real nutrition value, in other words, no vitamins, minerals or plant based compounds that are important for good health. Naturally occurring sugars are found in foods packed with good nutrition including fruits, vegetables and dairy products. Though added sugars have nothing to offer you, giving up the sweet stuff for 10 days may be a short-term solution yet ineffective for the long term.

Here’s why the TODAY Show is missing the mark with this 10-day detox:

– 10 days isn’t long enough to change a habit. It’s more like taking a vacation.

– The cold turkey approach rarely works. You’re better off gradually reducing.

– Foods with naturally occurring sugars such as 100% fruit juice and dried fruits are wrongly maligned. In fact, the majority of research shows moderate amounts of 100% fruit juice are not linked to overweight or obesity in adults or children).

– You’re allowed to go right back to your old eating habits after 10 days. So what’s the point?

Why Limit Yourself to 10 Days? Set Yourself Up for a Lifetime of Success

–  Figure out why you are tempted to do a sugar detox and then plan to specifically address that issue.

–  Log your food intake for at least 3 days via MyFitnessPal. See how much sugar   you’re really eating. Can you tell which foods are sugar-added vs. naturally sweet?

–  Find small changes to reduce added sugars. For instance, you may need to cut down on sodas, or swap ice cream for a 100% fruit juice pop, or make your own vinaigrettes (really easy – especially if you take flavored vinegars and combine them with extra virgin olive oil; or try one of these simple, unique recipes)

–  Don’t deprive yourself of foods with naturally-occurring sugars. When I crave something sweet I reach for dried figs (or other fruit), plain yogurt, or sparkling water mixed with 100% fruit juice. All of these give me vitamins, minerals, and healthy plant-based compounds called polyphenols.

–  Reassess your food intake after 1 month and see if you can make any additional improvements).

–  Bottom line: progress is in the small steps, not giant leaps (or in this case, detoxes).

Many Americans should cut down on added sugars and make room for more nutrient-dense foods. But, don’t thrown the baby out with the bathwater and then go on an all-out sugar binge because you feel deprived. Forget the “detox,” figure out your “why” (why would you do a detox? What do you hope to gain?) and then carve out a reasonable plan for change that doesn’t focus on one single dietary variable. After all, there is no one food or ingredient that leads to obesity, chronic disease, feeling like your energy is zapped, or any other health issue.

[1] Ervin RB, Ogden CL. Consumption of added sugars among U.S. adults, 2005– 2010. NCHS data brief, no 122. Hyattsville, MD: National Center for Health Statistics. 2013. http://www.cdc.gov/nchs/data/databriefs/db122.pdf

[2] O’Connor TM, et al. Beverage intake among preschool children and its effect on weight status. Pediatrics. 2006. 118:e1010-e1018.

[3] Field AE, et al. Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States. Int J Obes Relat Metab Disord. 2003. 27:821-826.

[4] O’Neil CE, et al. A review of the relationship between 100% fruit juice consumption and weight in children and adolescents. Am J Lifestyle Med. 2008. 2:315-354.

[5] Johnson L, et al. Is sugar-sweetened beverage consumption associated with increased fatness in children? Nutrition. 2007. 23:557-563.

 

Are You Getting the Nutrients You Need for Maximum Energy & Good Health?

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Take one quick peek at dietary survey data and you’ll find many Americans don’t consume enough vitamins and minerals through food alone. How does this impact your health? A nutrient deficiency could affect your energy levels, mood, ability to concentrate, structure of your skin, teeth, nails, bones and more. So, how can you be sure you are getting enough of the vitamins and minerals you need for optimal health? First, focus on consuming foods that are particularly rich in the nutrients many Americans fall short on. Secondly, consider taking a multivitamin to make up for any nutrient gaps. But first, here’s a look at the food groups:

To watch my Talk of Alabama TV segment on this topic, click here.

Nuts and Seeds

Nuts and seeds contain a wide variety of nutrients including magnesium – which is necessary for a healthy metabolism, good energy and muscle strength – yet many people get very little magnesium in their diet. On average, most women get about ½ of the magnesium they need each day. Nuts & seeds also have zinc for immune system functioning, wound healing, muscle growth and repair and some nuts, like almonds, also contain calcium, which we need for strong bones. If you are worried about the calories in nuts and seeds, stick to the right portion size (about 1/4 cup for nuts) and keep in mind that research shows people who eat nuts regularly tend to weigh less than those who consume nuts infrequently.

A few of my favorites based on nutrient content (including magnesium): pumpkin seeds, sesame seeds and Brazil nuts.

Grains

Grains provide approximately 43% of the fiber in an average American diet. Fiber aids digestion, helping prevent constipation and it adds bulk to your diet helping increase feelings of fullness, which makes it easier to control your weight. Whole and enriched grains also naturally contain a wide variety of important vitamins and minerals. For instance, grains provide about 2/3 of the folic acid in an average American diet. Folic acid makes healthy new cells. And, it is a nutrient of concern for women of childbearing age because inadequate folate (folic acid) intake during pregnancy increases one’s risk of having premature and low birth weight babies or babies with certain types of birth defects in the brain or spine. Here in the U.S., grains such as bread, cereal, flour, and pasta are enriched with folic acid (gluten free products might not be enriched).

Beans

Beans count as both a vegetable and protein-rich food. Not only are they packed with fiber but they also contain iron, magnesium and potassium. And diets higher in potassium may help lower blood pressure, especially if you consume too much sodium. Plus potassium supports muscle functioning and higher potassium diets may also decrease risk of kidney stones.

Here are 3 you should focus on based on nutrient content and versatility: black beans, lima beans and white beans.

Seafood

Seafood is another rich source of nutrients. For instance, oysters have more zinc than any other food and more iron than red meat (a 3 oz. serving provides almost half of the daily value for iron). Try canned oysters to save time and money. Canned sardines with the bones are an excellent source of calcium and vitamin D – you need both of these for strong bones. But, chew those bones carefully! And, if you are concerned about mercury (and small children, pregnant and lactating women should consume only low mercury fish), check out this guide from the Natural Resources Defense Council, which categorizes fish based on mercury content.

While eating a wide variety of nutrient-dense foods is the best way to get vitamins and minerals, the reality is that most Americans don’t get enough through food alone, especially those on lower calorie diets or adults over the age of 50. So, consider a multivitamin. Multivitamins are a great solution to fill dietary gaps.

I partnered with Centrum and the Wheat Foods Council for this segment though I wrote the content of this post and the segment based on the latest scientific research.

 

 

Inhalable Caffeine? Think Again

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By Sara Shipley, Nutrition and Dietetics Student

What will they come up next? A few months ago, AeroShot was released in the US(NY and Boston markets) from Breathable Foods. This product is an inhalable form of energy. It looks like a small bullet casing, silver and yellow- this powerful little shot packs a punch. It contains 100 mg caffeine, B vitamins and a slew of other flavorings and sweeteners. Manufactured in France, AeroShot is the brainchild of Harvard professor David Edwards. His company, Breathable Foods launched this product in Europe last year and this is not the first ingestible product they have developed. Le Whif, a breathable chocolate product.

AeroShot is marketed to athletes, students or tired professionals, age 12+ of course. The website touts ‘no calories, no liquid, no limit’.  Born from David Edwards’s idea that rather than ingesting nutrients, you could inhale them. On technicality, the website does not necessarily advise ‘inhaling’, but to ‘draw the powder gently into your mouth’.

So, we all know the benefits of caffeine when moderately consumed. It can pull you through an afternoon lull at work, it can jumpstart your cycle session at the gym or ‘the best part of waking up’- your morning joe. We also know the effects of overdoing it- feeling jittery, headaches and an elevated heart rate. So, naturally this product raises eyebrows- FDA namely…

  • Is inhaling caffeine safe?
  • Will abusing this product be harmful?
  • If unintended for youth- why does the marketing and advertising lean towards this population?

AeroShot refutes these concerns with several ‘scientific explanations’ on their website. Allegedly, AeroShot particle size is too large to enter lungs, rather it reaches your mouth and is swallowed and ingested into the blood stream. They go on to solidify the efficacy of their product by unsubstantiated clinical studies that ‘have shown that AeroShot delivers caffeine into the bloodstream at the same rate of drinking caffeine’. The convenience factor is the portability and quickness of ‘pulling it out of your pocket’”

Although this product is NOT currently banned, the FDA wants to warn consumers. The effects of inhaling caffeine have not been researched and therefore they want to raise a red flag to use this product with caution. They also want AeroShot to reconsider their marketing, as a recent report from the NY Daily News reports, “The Food and Drug Administration reviewed your website at www.aeroshots.com in February 2012 and has determined that the product AeroShot is misbranded,” … “We also have safety questions about the product.” In the past week alone, this story has been buzzing across all mediums- weighing in on the safety of this product. Creator and founder, David Edwards is quoted in Medical Daily online, “Even with coffee — if you look at the reaction in Europe to coffee when it first appeared — there was quite a bit of hysteria,” the Harvard University professor and AeroShot inventor David Edwards had told AP in February. “So anything new, there’s always some knee-jerk reaction that makes us believe ‘Well, maybe it’s not safe.”

Although this product is legal, interesting and yet another innovative tool to get you through your long, tiring days or hard workout- is this safe? Sure, in moderation everything is okay. But, the potential for abuse seems high. I’m curious to see how this controversy affects the life of AeroShot. In theory, it’s great. But, we all know that not everything theoretical is smart for the average consumer.