In a study published by ahajournals.org, Robert A. Kloner, MD, PhD, conducted a study to see if there were any correlation between heart attacks and the winter seasons. He found that during a 12-year period there were consistently more deaths from ischemic heart disease during the winter months than the summer. About 1/3 more deaths were recorded in December and January, than June through September in Los Angeles County. His team initially thought that the results could be explained by colder temperatures. But, winter temperatures in Los Angeles are mild compared to other climates. The next thing they took note of were the death rates among November, December, and January. They noticed and increase of death rates around Thanksgiving, which climbed through Christmas and reached its peak at New Years day. Emotional stress and changes in diet during these months is an important factor to consider.
Visit links for the complete article.
Saturday, November 26, 2011
Thursday, November 24, 2011
Need a Yummy/Healthy Thanksgiving Recipe?
Cheesy, Guacamole Bean Dip! This recipe is from Alicia Silverstone's book, the kind diet.
2 cups shredded vegan cheddar cheese
1 packet taco seasoning(see note)
Preheat the oven to 350 degrees. Spread a layer of re fried beans in the bottom of an 8"X8" quart glass baking dish. Pit and peel the avocados, and place in a bowl. Mash the avocados together with the lime juice, and spread on top of the re fried beans. Stir together the sour cream and taco seasoning, and spread over the avocado.
Sprinkle the chilies over the sour cream, and top with a layer of black olives. Add the tomatoes, and sprinkle with the cheese. Heat the dip for 15 to 30 minutes or until heated through and the cheese is a bit melted.
Serve warm or at room temperature.
Note: We use Burritos organic taco seasoning, but it does contain a touch of cane sugar. If you're avoiding all white sugar, make your own by combining chili powder, ground cumin, onion powder, hot paprika or cayenne, and salt.
What you'll need....
1(16-ounce) can re fried beans
1/2 cup diced mild green chilies, drained
3 large avocados
1/2 cup sliced black olives, or more if you like
3 tablespoons fresh lime juice
5 tomatoes, chopped
2(8-ounce) containers nondairy sour cream 2 cups shredded vegan cheddar cheese
1 packet taco seasoning(see note)
Preheat the oven to 350 degrees. Spread a layer of re fried beans in the bottom of an 8"X8" quart glass baking dish. Pit and peel the avocados, and place in a bowl. Mash the avocados together with the lime juice, and spread on top of the re fried beans. Stir together the sour cream and taco seasoning, and spread over the avocado.
Sprinkle the chilies over the sour cream, and top with a layer of black olives. Add the tomatoes, and sprinkle with the cheese. Heat the dip for 15 to 30 minutes or until heated through and the cheese is a bit melted.
Serve warm or at room temperature.
Note: We use Burritos organic taco seasoning, but it does contain a touch of cane sugar. If you're avoiding all white sugar, make your own by combining chili powder, ground cumin, onion powder, hot paprika or cayenne, and salt.
Wednesday, November 23, 2011
Why Love Handles Are Linked to Heart Disease
Some people gain weight and it goes to their bottom, face, and stomach. But, why is belly fat the most dangerous?
This fat is also called visceral fat. This fat lies inside the abdominal wall and surrounds important organs. This fat is metabolically active, it directly effects your body chemistry. This fat wraps around your liver, which interferes with insulin production and promotes diabetes, which is a strong risk factor for heart disease. Visceral fat also lowers your HDL's(good cholesterol) and raises your LDL's(bad cholesterol). Another reason belly fat is deadly, is because it pumps out hormones and proteins, promoting inflammation, a major contributor to many health problems. When hidden plaque becomes inflamed, it can burst. Platelets and blood-clotting molecules drawn to the site form a plug that can block the artery walls and cause a heart attack.
This fat is also called visceral fat. This fat lies inside the abdominal wall and surrounds important organs. This fat is metabolically active, it directly effects your body chemistry. This fat wraps around your liver, which interferes with insulin production and promotes diabetes, which is a strong risk factor for heart disease. Visceral fat also lowers your HDL's(good cholesterol) and raises your LDL's(bad cholesterol). Another reason belly fat is deadly, is because it pumps out hormones and proteins, promoting inflammation, a major contributor to many health problems. When hidden plaque becomes inflamed, it can burst. Platelets and blood-clotting molecules drawn to the site form a plug that can block the artery walls and cause a heart attack.Tuesday, November 22, 2011
Red Meat and Heart Disease
Below is a study I retrieved from npr.org. It discusses the health problems linked to red meat.
"A lot of research has shown that eating red meat can increase your risk of heart disease and certain cancers, especially colon cancer. Now, a large study suggests that eating a lot of those juicy burgers and steaks may actually shorten your life. NPR's Patti Neighmond looked into what that study means for meat lovers.
PATTI NEIGHMOND: This was a large study, over half a million men and women over the age of 50. They answered questions about specifics of their diet, and then researchers documented who died over the next 10 years.
They found that people who ate the most red meat - that's beef, lamb and pork -were 30 percent more likely to die from heart disease or any type of cancer.
While the study's biggest weakness is that it relied on people's memories of what they'd eaten over the previous year, epidemiologist Michael Thun, with the American Cancer Society, says the findings support what research has found over the last 20 years: Limit the amount of red meat in your diet.
Dr.MICHAEL THUN (Epidemiologist, American Cancer Society): Choose fish, poultry or beans as an alternative. And when you eat meat, eat smaller portions, select leaner cuts, and don't consider it the main course every day or even more than one time a day. Consider it a treat.
NEIGHMOND: Which doesn't mean eliminate all red meat from your diet. While that wouldn't be a bad idea, Thun says it's okay to eat meat but, like so much else, in moderation. A few times a week is probably fine. A few times a month is better. And when you do eat red meat, he says, be careful how you cook it.
Dr.THUN: When you heat meat, and particularly fat, at very high temperatures, you can produce a number of chemical groups that damage DNA.
NEIGHMOND: So the American Cancer Society recommends baking, broiling or poaching instead of frying or grilling. And if you do grill, they say, try microwaving meat first to reduce the fat content, and then put it on the grill.
Another problem the study found: processed meat, meats which are preserved, salted, smoked. The message here is simple, says nutritionist Barry Popkin from the University of North Carolina. Avoid them or at least, cut way back.
Dr.BARRY POPKIN (Nutritionist, University of North Carolina): There are a bunch of people that consume a pepperoni pizza daily or a hot dog a couple times a week, and they need to really cut that down to once a month.
NEIGHMOND: In the study, the women who ate the most red meat were more likely to die from heart disease than men who ate a lot of red meat. Researchers don't know why. Epidemiologist Michael Thun says it's important to remember the risk associated with red meat is a lot less, even in fairly large quantities, than risks that result from other lifestyle choices like, for example, smoking.
Dr.THUN: And smoking, depending on the age at which you're doing it and how long you've done it, is, say, tripling the death rate from all causes.
NEIGHMOND: Compare that tripling of risk, a 300 percent increase in death, to what the study found about red meat, a 30 percent increase.
Dr.THUN: I mean, smoking is in a class by itself, approached only, really, by moderate to severe obesity.
NEIGHMOND: Researchers say the take-home message from the study is clear. When you do eat meat, make it mostly fish or poultry. In the study, people who ate more of these meats had the lowest death rate. Researchers don't know whether that was because something in the white meat was beneficial, like omega-3 fatty acids in fish, for example, or whether eating white meat just meant people ate less red meat. Patti Neighmond, NPR News."
"A lot of research has shown that eating red meat can increase your risk of heart disease and certain cancers, especially colon cancer. Now, a large study suggests that eating a lot of those juicy burgers and steaks may actually shorten your life. NPR's Patti Neighmond looked into what that study means for meat lovers.
PATTI NEIGHMOND: This was a large study, over half a million men and women over the age of 50. They answered questions about specifics of their diet, and then researchers documented who died over the next 10 years.
They found that people who ate the most red meat - that's beef, lamb and pork -were 30 percent more likely to die from heart disease or any type of cancer.
While the study's biggest weakness is that it relied on people's memories of what they'd eaten over the previous year, epidemiologist Michael Thun, with the American Cancer Society, says the findings support what research has found over the last 20 years: Limit the amount of red meat in your diet.
Dr.MICHAEL THUN (Epidemiologist, American Cancer Society): Choose fish, poultry or beans as an alternative. And when you eat meat, eat smaller portions, select leaner cuts, and don't consider it the main course every day or even more than one time a day. Consider it a treat.
NEIGHMOND: Which doesn't mean eliminate all red meat from your diet. While that wouldn't be a bad idea, Thun says it's okay to eat meat but, like so much else, in moderation. A few times a week is probably fine. A few times a month is better. And when you do eat red meat, he says, be careful how you cook it.
Dr.THUN: When you heat meat, and particularly fat, at very high temperatures, you can produce a number of chemical groups that damage DNA.
NEIGHMOND: So the American Cancer Society recommends baking, broiling or poaching instead of frying or grilling. And if you do grill, they say, try microwaving meat first to reduce the fat content, and then put it on the grill.
Another problem the study found: processed meat, meats which are preserved, salted, smoked. The message here is simple, says nutritionist Barry Popkin from the University of North Carolina. Avoid them or at least, cut way back.
Dr.BARRY POPKIN (Nutritionist, University of North Carolina): There are a bunch of people that consume a pepperoni pizza daily or a hot dog a couple times a week, and they need to really cut that down to once a month.
NEIGHMOND: In the study, the women who ate the most red meat were more likely to die from heart disease than men who ate a lot of red meat. Researchers don't know why. Epidemiologist Michael Thun says it's important to remember the risk associated with red meat is a lot less, even in fairly large quantities, than risks that result from other lifestyle choices like, for example, smoking.
Dr.THUN: And smoking, depending on the age at which you're doing it and how long you've done it, is, say, tripling the death rate from all causes.
NEIGHMOND: Compare that tripling of risk, a 300 percent increase in death, to what the study found about red meat, a 30 percent increase.
Dr.THUN: I mean, smoking is in a class by itself, approached only, really, by moderate to severe obesity.
NEIGHMOND: Researchers say the take-home message from the study is clear. When you do eat meat, make it mostly fish or poultry. In the study, people who ate more of these meats had the lowest death rate. Researchers don't know whether that was because something in the white meat was beneficial, like omega-3 fatty acids in fish, for example, or whether eating white meat just meant people ate less red meat. Patti Neighmond, NPR News."
Saturday, November 19, 2011
Laughter Is the Best Medicine
Can a laugh every day keep the heart attack away? Maybe so.
Laughter, along with an active sense of humor, may help protect you against a heart attack, according to a recent study by cardiologists at the University of Maryland Medical Center in Baltimore. The study, which is the first to indicate that laughter may help prevent heart disease, found that people with heart disease were 40 percent less likely to laugh in a variety of situations compared to people of the same age without heart disease. "The old saying that 'laughter is the best medicine,' definitely appears to be true when it comes to protecting your heart," says Michael Miller, M.D., director of the Center for Preventive Cardiology at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine. "We don't know yet why laughing protects the heart, but we know that mental stress is associated with impairment of the endothelium, the protective barrier lining our blood vessels. This can cause a series of inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack."
In the study, researchers compared the humor responses of 300 people. Half of the participants had either suffered a heart attack or undergone coronary artery bypass surgery. The other 150 did not have heart disease. One questionnaire had a series of multiple-choice answers to find out how much or how little people laughed in certain situations, and the second one used true or false answers to measure anger and hostility.
Miller said that the most significant study finding was that "people with heart disease responded less humorously to everyday life situations." They generally laughed less, even in positive situations, and they displayed more anger and hostility.
"The ability to laugh -- either naturally or as learned behavior -- may have important implications in societies such as the U.S. where heart disease remains the number one killer," says Miller. "We know that exercising, not smoking and eating foods low in saturated fat will reduce the risk of heart disease. Perhaps regular, hearty laughter should be added to the list."
Miller says it may be possible to incorporate laughter into our daily activities, just as we do with other heart-healthy activities, such as taking the stairs instead of the elevator. "We could perhaps read something humorous or watch a funny video and try to find ways to take ourselves less seriously," Miller says. "The recommendation for a healthy heart may one day be exercise, eat right and laugh a few times a day."
Wednesday, November 16, 2011
Know Your Symptoms
Some heart attacks are sudden and intense; however, most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
- Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
- Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath. May occur with or without chest discomfort.
- Other signs. These may include breaking out in a cold sweat, nausea, or lightheadedness.
Tuesday, November 15, 2011
Get a Pet
At the American Stroke Association's International Stroke Conference, researchers informed delegates that they could reduce their risk of heart attack by one third, by simply, owning a pet. The finding was the main result of a 10 year study of more than 4,000 Americans by researchers at the University of Minnesota's Stroke Institute in Minneapolis. Executive director of the Institute, Dr Adnan Qureshi, who is also senior author of the study, was reported by US News & World Report to have said:
"For years we have known that psychological stress and anxiety are related to cardiovascular events, particularly heart attacks."
Qureshi said having pets probably helped to relieve stress. The researchers said dogs probably had a similar effect, but there weren't enough dog owners in the study to show this conclusively. Previous research has linked contact with pets to heart benefits, they said.
Qureshi and colleagues extracted data on 4,435 Americans aged 30 to 75, from the second National Health and Nutrition Examination Study that took place from 1976 to 1980. 2,435 of the participants were current or former cat owners, while the remaining 2,000 had never had a cat.
Using the main outcome as death from all causes, including stroke and heart events, the researchers found that over a 10 year follow up period, cat owners showed a 30 per cent lower risk of death from heart attack compared to non cat owners.
"For years we have known that psychological stress and anxiety are related to cardiovascular events, particularly heart attacks."
Qureshi said having pets probably helped to relieve stress. The researchers said dogs probably had a similar effect, but there weren't enough dog owners in the study to show this conclusively. Previous research has linked contact with pets to heart benefits, they said.
Qureshi and colleagues extracted data on 4,435 Americans aged 30 to 75, from the second National Health and Nutrition Examination Study that took place from 1976 to 1980. 2,435 of the participants were current or former cat owners, while the remaining 2,000 had never had a cat.
Using the main outcome as death from all causes, including stroke and heart events, the researchers found that over a 10 year follow up period, cat owners showed a 30 per cent lower risk of death from heart attack compared to non cat owners.
Monday, November 14, 2011
Local Miracle Procedure
Delores Davis experienced crippling leg pain on a daily bases. This was the result of advanced peripheral artery disease, an excruciating disorder caused by blocked or narrowed blood vessels in the legs. Within a short time, she had suffered a stroke, had one toe amputated, and undergone several procedures to help restore blood flow to her legs. The pain was only getting worse and her only option seemed to be amputation. Then she started visiting a new cardiologist, Dr. Jihad Mustapha at Metro Heart and Vascular. He is the pioneer of a new procedure that could free her from pain and also, save her limb.
"I had lost all hope. Everyone else said that I would certainly lose my leg. But Dr. Mustapha said he could help me, and he did," said Delores. "My pain is gone! He saved my leg and gave me back my life!"
Here is an excerpt of a question and answer interview with Dr. Mustapha about the new procedure...
"Tell us about the new standard for amputation at your institution."
"We have implemented an amputation prevention program at Metro Health Hospital (Wyoming, MI). All referred patients who are scheduled for amputation are seen within 24 hours of referral. If there is no contraindication, patients will then undergo peripheral angiography with planned intervention within 48 hours. We have found that early revascularization has led to limb preservation in more than 95% of our patients who were previously scheduled for amputation.
Referring physicians are just becoming aware of the new technology and interventional techniques that are available to help this population. Over the past year, we started to receive more and more patients that were already scheduled for amputation or patients that were told that they did not have any other option. I strongly believe that many patients scheduled for amputations can still have their limbs preserved."
"I had lost all hope. Everyone else said that I would certainly lose my leg. But Dr. Mustapha said he could help me, and he did," said Delores. "My pain is gone! He saved my leg and gave me back my life!"
Here is an excerpt of a question and answer interview with Dr. Mustapha about the new procedure...
"Tell us about the new standard for amputation at your institution."
"We have implemented an amputation prevention program at Metro Health Hospital (Wyoming, MI). All referred patients who are scheduled for amputation are seen within 24 hours of referral. If there is no contraindication, patients will then undergo peripheral angiography with planned intervention within 48 hours. We have found that early revascularization has led to limb preservation in more than 95% of our patients who were previously scheduled for amputation.
Referring physicians are just becoming aware of the new technology and interventional techniques that are available to help this population. Over the past year, we started to receive more and more patients that were already scheduled for amputation or patients that were told that they did not have any other option. I strongly believe that many patients scheduled for amputations can still have their limbs preserved."
Wednesday, November 9, 2011
Music and Your Body
Research has shown that music has a profound effect on your body and psyche. In fact, there’s a growing field of health care known as music therapy, which uses music to heal. Those who practice music therapy are finding a benefit in using music to help cancer patients, children with ADD, and others, and even hospitals are beginning to use music and music therapy to help with pain management, to help ward off depression, to promote movement, to calm patients, to ease muscle tension, and for many other benefits that music and music therapy can bring. This is not surprising, as music affects the body and mind in many powerful ways. The following are some of effects of music, which help to explain the effectiveness of music therapy:
With all these benefits that music can carry, it's no surprise that music therapy is growing in popularity. Many hospitals are using music therapists for pain management and other uses. Music therapists help with several other issues as well, including stress.
Using Music On Your Own
While music therapy is an important discipline, you can also achieve many benefits from music on your own. Music can be used in daily life for relaxation, to gain energy when feeling drained, for catharsis when dealing with emotional stress, and in other ways as well.
- Brain Waves: Research has shown that music with a strong beat can stimulate brainwaves to resonate in sync with the beat, with faster beats bringing sharper concentration and more alert thinking, and a slower tempo promoting a calm, meditative state. Also, research has found that the change in brainwave activity levels that music can bring can also enable the brain to shift speeds more easily on its own as needed, which means that music can bring lasting benefits to your state of mind, even after you’ve stopped listening.
- Breathing and Heart Rate: With alterations in brainwaves comes changes in other bodily functions. Those governed by the autonomic nervous system, such as breathing and heart rate can also be altered by the changes music can bring. This can mean slower breathing, slower heart rate, and an activation of the relaxation response, among other things. This is why music and music therapy can help counteract or prevent the damaging effects of chronic stress, greatly promoting not only relaxation, but health.
- State of Mind: Music can also be used to bring a more positive state of mind, helping to keep depression and anxiety at bay. This can help prevent the stress response from wreaking havoc on the body, and can help keep creativity and optimism levels higher, bringing many other benefits.
- Other Benefits: Music has also been found to bring many other benefits, such as lowering blood pressure (which can also reduce the risk of stroke and other health problems over time), boost immunity, ease muscle tension, and more. With so many benefits and such profound physical effects, it’s no surprise that so many are seeing music as an important tool to help the body in staying (or becoming) healthy.
With all these benefits that music can carry, it's no surprise that music therapy is growing in popularity. Many hospitals are using music therapists for pain management and other uses. Music therapists help with several other issues as well, including stress.
Using Music On Your Own
While music therapy is an important discipline, you can also achieve many benefits from music on your own. Music can be used in daily life for relaxation, to gain energy when feeling drained, for catharsis when dealing with emotional stress, and in other ways as well.
Monday, November 7, 2011
Bean Chili
I know I just posted a recipe but I love sharing great finds! This is my favorite chili and it is simple/delicious!
1 can Red Kidney Beans
3 medium tomatoes
3 cups baby spinach
1 medium onion
2-3 minced garlic cloves
1/4 tsp cayenne pepper
1/4 tsp cumin powder
Sprig of cilantro
Heat Olive oil in pot, add onions and garlic for 5 minutes. Now add chopped tomatoes, red kidney beans, baby spinach, cayenne pepper, cumin and 1 cup of water. Bring it to a boil then let simmer for 20 minutes. Stir in some fresh cilantro and serve.3 medium tomatoes
3 cups baby spinach
1 medium onion
2-3 minced garlic cloves
1/4 tsp cayenne pepper
1/4 tsp cumin powder
Sprig of cilantro
retrieved recipe from http://www.thecandidadiet.com/
Sunday, November 6, 2011
Non-dairy chocolate peanut butter cups...oh so yummy too!
Here's one of my favorite sweet treat recipes from the Kind Diet.
SERVINGS
12
INGREDIENTS
1/2 cup Earth Balance butter
3/4 cup crunchy peanut butter (preferably unsweetened and unsalted)
3/4 cup graham cracker crumbs or 10 graham cracker squares
1/4 cup maple sugar or other granulated sweetener
1 cup grain-sweetened, nondairy chocolate or carob chips
1/4 cup soy, rice, or nut milk
1/4 cup chopped pecans, almonds, or peanuts
PREPARATION
1. Line a 12-cup muffin tin with paper liners. (If You Care makes unbleached liners made from recycled paper.) Set aside.
2. Melt the butter in a small saucepan over medium heat.
3. Stir in the peanut butter, graham cracker crumbs, and maple sugar and mix well.
4. Remove the mixture from the heat. Evenly divide the mixture, approximately 2 tablespoons per cup, among the muffin cups.
5. Combine the chocolate and milk in another pan. Stir over medium heat until the chocolate has melted.
6. Spoon the chocolate evenly over the peanut butter mixture.
7. Top with chopped nuts.
8. Place in the refrigerator to set for at least 2 hours before serving.
12
INGREDIENTS
1/2 cup Earth Balance butter
3/4 cup crunchy peanut butter (preferably unsweetened and unsalted)
3/4 cup graham cracker crumbs or 10 graham cracker squares
1/4 cup maple sugar or other granulated sweetener
1 cup grain-sweetened, nondairy chocolate or carob chips
1/4 cup soy, rice, or nut milk
1/4 cup chopped pecans, almonds, or peanuts
PREPARATION
1. Line a 12-cup muffin tin with paper liners. (If You Care makes unbleached liners made from recycled paper.) Set aside.
2. Melt the butter in a small saucepan over medium heat.
3. Stir in the peanut butter, graham cracker crumbs, and maple sugar and mix well.
4. Remove the mixture from the heat. Evenly divide the mixture, approximately 2 tablespoons per cup, among the muffin cups.
5. Combine the chocolate and milk in another pan. Stir over medium heat until the chocolate has melted.
6. Spoon the chocolate evenly over the peanut butter mixture.
7. Top with chopped nuts.
8. Place in the refrigerator to set for at least 2 hours before serving.
Saturday, November 5, 2011
Sleep!
Most of us are not getting enough sleep. This plays a huge role in our aging. People who sleep fewer than six hours a night have a 50 percent increased risk of viral infection and an increased risk of heart disease and stroke. Plus, lck of sleep iaassociated ith mental decline and overeating. A big problem is that most of us don't think a lack of sleep is a big problem. We continue to drudge through our daily lives while bieng tired, caffeine infused, and zoned out. Lack of sleep isn't just making you irritated, it could be killing you. The pineal gland, which is the only endocrine gland that is in contact with the oustide world, senses when were exposed to light. It's known that the pineal gland plays a role in aging because research has shown that putting young pineal glands in old animals helps reverseaging. Mice with new pineals lived 25 percent longer. To live longer and healthy its important to know about the pineal gland because it produces melatonin, which conducts the harmony of your homrones. Melatonin helps lower heart rate and blood pressure, increases immune function and helps decrease stresss by blocking the body's repsone. Plus, it helps regulate sleep. The bottom line? get some sleep.
Friday, November 4, 2011
Bad Genes and Short Telomeres
We have a tendency in our society to blame our own health problems on other people. High cholesterol? I must have got that from all my great aunts who have died from heart disease. NO! This is probably one of the most annoying things I see in health care. Someone eating a fried chicken sandwich with extra bacon and cheese, blaming their heart disease on bad genetics. It's an excuse to keep this person from making difficult changes with their habits. While your genes are important, they don't necessarily determine your destiny. Your genetics make you more or less predisposed to health-related problems. But you can modify and make adjustments to protect yourself from the abnormalities found in your genes. When it comes to your body, here's what we know, primarily through studies of identical twins:your longevity is based one-quarter on your genetics and three-quarters on your behaviors and lifestyle choices. It's not about what genes you have but how you express them. Genes work by manufacturing proteins, but whether or not a specific gene is turned on or off is largely under your control. So, maybe you've been dealt a bad hand of genetics, but that doesn't mean you can't exchange a few cards, or at least change how you play them.
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