What is one of the top reasons that many moms quit breastfeeding? Returning to work or school! According to the U.S. Department of Labor, women are the fastest growing segment of the U.S. workforce. In 2014, 57.3% of new mothers were in the workforce, an increase of 80% over the past 20 years. Working outside the home negatively impacts both breastfeeding initiation and duration. It can be challenging for some moms to balance breastfeeding and working. What many do not realize however, is that there are laws in place to help them!
Laws that support breastfeeding moms
In 2010, the Fair Labor Standards Act was amended and now requires employers to accommodate breastfeeding moms who want to pump milk for their infants while at work. The law states that employers must provide reasonable time and a private space (that is not a bathroom) to express milk. In 2008, the Workplace Accommodations for Nursing Mothers Act was passed in Colorado which provides greater protections for moms. This law requires all employers to:
Moms can ease the transition of going back to work by planning ahead. They need to learn as much as they can before the baby’s birth – learn how to get off to a good start with breastfeeding, learn about their rights, research day care options and talk with their employer about their needs. Employers may not know how to support a mom and most will be happy to do so when they learn how easy it is. Moms can do much of the creative problem solving themselves like finding a place they can pump and figuring out how pumping can work in their schedule.
Starting the conversation
There are many ways a mom can start a conversation with her employer. Part of the conversation with employers and co-workers should include information about the health benefits of breastfeeding and the benefits support brings to a business. Providing support to a breastfeeding mom benefits a business’s bottom line - lower health care costs due to healthier moms and infants, less time away from work for a mom to care for a sick infant, lower turnover rates and greater productivity and loyalty.
What if a mom is not getting support from her employer?
If a mom feels like she is not being supported as required by Colorado law she needs to find an advocate to help. Moms can document what is happening in the workplace and ask their employer to go to mediation to try and resolve issues. The Colorado Breastfeeding Coalition can provide information, support and resources such as recommendations for Colorado attorneys with experience in worksite breastfeeding issues.
Going above and beyond the state law
Some employers have created broad breastfeeding policies and programs to support their employees. Some provide options like access to lactation support counseling, breastfeeding classes, breast pumps and peer support groups. Some employers have implemented family friendly policies such as paid maternity leave, on-site daycare and Infant at Work programs allowing parents to be with their young infants for a longer period of time after birth or throughout the work day.
Infant at Work program participant, Jaclyn Blitz (Tri-County Health Department Registered Dietitian Nutritionist) and her daughter Kaiah.
Many moms breastfeed successfully after going back to work. Employers and moms need to be aware of the laws in place and the resources available to create a successful comprehensive plan to make breastfeeding work at work!
Want more information? Check out these resources:
Heidi Williams, MPH, RD with Tri-County Health Department
The Denver Dietetic Association hosted their most recent monthly meeting at Rose Medical Center in Denver with a presentation by guest speaker Donna Shields, MS, RDN on how cannabis fits into the world of nutrition.
Donna Shields, MS, RDN is co-founder of Holistic Cannabis Academy, a cannabis education, training, and business-building platform for holistic-minded practitioners about medical marijuana and its integration with other healing modalities. Donna and her co-founding partner Laura Lagano, MS, RDN, CDN both have personal experiences that led them to the use of cannabis and eventually the startup of Holistic Cannabis Academy.
Here is a recap of what Donna had to say about incorporating cannabis into the world of nutrition.
With more than half of the states in the U.S. being approved to use cannabis for medicinal purposes it’s important for the nutrition community, specifically RDs, to be informed.
Cannabis is being used to treat a number of illnesses and conditions, many of which are also being treated with some form of nutritional therapy; therefore, Donna suggests by using a holistic approach and integrative system to incorporate cannabis into our nutrition therapy recommendations, we will better serve our patients/clients.
For example, chemo patients can often benefit from some sort of nutritional therapy for nausea, vomiting and/or appetite stimulation, all of which can also be treated with cannabis, so by incorporating a holistic integrative approach for treatment, cannabis and nutrition can work in synergy, to better treat the patient.
Other illnesses and conditions that are often treated with some form of nutrition therapy that can also be treated with cannabis here in Colorado are:
Post-traumatic Stress Disorder (PTSD)
Cachexia (wasting syndrome)
Persistent muscle spasms
Donna also mentioned that by using this holistic/integrative approach, we, as nutritional professionals, will have more opportunities to expand our scope of practice and gain new clients/patients. Cannabis is is being recommended by doctors and other health care professionals to treat a number of disease and conditions, so to stay relevant and valuable it's important for the nutrition professionals to understand cannabis and how to incorporate it into their area of expertise if it applies to their patients.
However, breaking into cannabis is still a scary thing for many health and nutrition professionals, and recommending it presents a number of challenges. To name a few, cannabis is not covered by insurance, it is not approved for all health conditions, accessing certain forms of cannabis may be difficult and it hasn't been approved in all states. Many also question if they will be judged for recommending cannabis. Cannabis has long been classified as a schedule one drug, which is also where heroine lies, so this classification alone makes recommending cannabis a challenge. There have also been horror stories of people who have had extremely bad experiences with cannabis, but Donna states that these fears and horrific experiences are likely due to lack of education and improper dosing.
Healthcare professionals have had next to no training on cannabis - the plant and its components (THC, CBD, CBC, THCV, CBN, terpenes - just to name a few), quality and safety, different forms and uses, dosing, the benefits of its effects, or how it interacts with human receptors.
Being educated and able to answer simple questions a client may have, such as where to buy cannabis and how to determine the quality and safety of the product, (for example, if it has been contaminated with pesticides or mold) is one of the most basic, yet overlooked questions. Although there is no required testing, or standards for cannabis, many grow operations/facilities have reports that show the quality of their product.
It is also important to understand that cannabis can be used without having the psychoactive effects and that the ratio between THC and CBD is extremely important. Donna stressed the fact that you don’t have to be “high” to receive the health benefits of cannabis. This is often how pediatric treatment is conducted.
The are many forms in which cannabis is available as well, so if a patient is opposed to smoking, for example, they have other options. Smoking, eating, vaporizing, tinctures, and topicals are among the most common forms in which cannabis is available.
Donna stated that cannabis is not a gateway drug, but an exit drug from opioids.
If you are considering furthering your education on cannabis treatment, unfortunately at this time, continuing education credits (CPE’s CPEU’s, CEU’s) for the Holistic Cannabis Network program have not been approved by the Academy of Nutrition and Dietetics, but Donna says they are working on getting it approved. There are however, a few nutrition-related organizations that do recognize their members’ continuing education in the cannabis field. Those organizations are:
Nutritional Therapy Association (NTA)
Canadian Health Coach Alliance (CHCA)
Canadian Association for Integrative Nutrition (CAIN)
Thank you, Donna for your insightful information into the synergistic world of cannabis and nutrition!
Is cannabis right for your practice? Will you be incorporating it into your field of practice? We would love to hear your thoughts in the comments below.
Donna has also contributed to Cannabis Kitchen Cookbook. You can find the book here.
Slides from last week's presentation here.
November Blog Post: DDA Updates in Policy Recap
Our last DDA meeting was a full house at Tri-County Health Department! With the topic of Public Policy fueling our minds, we also fueled our bellies with Wong Way Veg food truck’s veggie-forward offerings. Our guest speakers of the night were Tyson Marden, Colorado Academy of Dietetics (CAND) President and Terri Livermore and Gabriella Warner from LiveWell Colorado, a Denver non-profit that is committed to promoting healthy eating and active living throughout Colorado.
Tyson updated us on CAND’s goals for the 2017-2018 year. It is exciting to see the effort being made to bring Colorado dietitians and dietetic students together and elevate our profession throughout the state. Some of his updates were as follows:
These are some exciting happenings for CAND! If you are not already a member and receiving their emails, head on over to the website http://www.eatrightcolorado.org/ and sign up. To reach Tyson about any of the events listed above or other questions about CAND his email is firstname.lastname@example.org
Terri started off by providing a fantastic overview of the legislative process at both the state and federal level. While Terri’s overview was much more engaging and poignant you can watch School House Rock’s “I’m Just a Bill on Capitol Hill” if you missed it! https://youtu.be/FFroMQlKiag
Gabriela, LiveWell’s on-staff Registered Dietitian shared the organizations current statewide policy initiatives. They include school lunches, food access and food insecurity and lobbying for programs that support healthy food systems. This includes following the Child Nutrition Re-Authorization Act and Farm Bill to prevent cuts to programs like SNAP and school lunches. You can learn more about specific initiatives at their website: https://livewellcolorado.org/healthy-communities/
Gabriela wrapped up the evening with a call to action. She stressed the importance of registered dietitians becoming more civically engaged and using our expertise to make change with major priority ares:
There are many ways to get involved including:
The meeting wrapped up with a group discussion. The prompt was Agriculture Secretary, Sonny Perdue’s rollbacks on the Healthy, Hunger-Free Kids Act regarding requirements for reimbursable school lunches. Breaking off into small groups, it was energizing to hear the different paradigms being shared and DDA members speaking passionately about the issue. This was one of the best turn outs for a policy-related meeting and members gleaned a better understanding of why registered dietitians need to have a presence in local, state and federal policy and be true advocates for healthy eating, active living.
In 2016, the FDA rolled out a plan to update the Nutrition Facts Label, based on current science and nutrition recommendations from the 2015-2020 Dietary Guidelines for Americans. On first glance, the new label may not seem significantly different, but there are some key changes that are important for dietitians to understand.
The most noticeable change is larger-print calories and servings per container, which allows for consumers to more easily determine how many calories are in a serving. Serving sizes on products are often unrealistically small; the new guidelines require serving sizes to be updated, reflecting present-day portion sizes. For packaged foods that can (and often are) consumed in one sitting, companies are now required to provide “per package” nutrition information.
The FDA decided to remove “calories from fat” from the label, sending the message that the type of fat is more important than total grams of fat.
Added sugars are going on the label, which is pretty remarkable considering the overhead this will cause for food companies. Added sugars are often difficult to track, because companies need to record all sugars coming from any ingredient that contain added sugars. The FDA defines added sugars as anything that increases the natural sweetness of a product, including honey, concentrated fruit juices, maple syrup, table sugar and HFCS.
Total carbohydrate recommendations will be reduced from 300 grams to 270 grams for a 2000 calorie diet. Percentage daily value of added sugar will be calculated based on the recommendation from the Dietary Guidelines for Americans that it is difficult to meet nutrient needs when greater than 10% of caloric intake comes from added sugars (this amounts to 50 grams for a 2000 calorie diet).
Vitamin D and potassium are now required to be listed on the label, while vitamins A and C will become optional.
The DRV for dietary fiber has increased from 25 to 28 grams, so the percentage daily value for fiber on products will look a bit lower. Only certain fibers that have proven nutritional benefit will be counted toward total fiber on the new nutrition facts label. These fibers include: beta-glucan soluble fiber (soluble), psyllium husk (mostly soluble), cellulose (insoluble), guar gum (soluble), pectin (soluble)
locust bean gum (soluble) and hydroxypropylmethcellulose (soluble). Any fiber not on this list (for example, inulin) will now be considered part of total carbohydrates, rather than adding to the total fiber of a product.
The FDA initially planned to enforce these updates by 2018, allowing smaller companies (with <$10 million in annual sales) to comply by 2020; however, the FDA recently proposed to delay compliance until 2020 for all companies, and 2021 for small companies.
What can we do? If you agree that the new nutrition facts label will be more transparent and accurate and will help consumers make healthier food choices, fill out this call to action plan to voice your opinion.
If you are interested in learning more, Abbott offers free CPEUs for their Nutrition Facts Label courses. You can also learn more on the FDA’s website.
Written by: Sara Scheler, RDN
Photo credit: NBC News
Denver, what are you eating? We want to know! Show off your #RDapproved lunch and you could win $25.
Cooking for family and friends this holiday season? This baked quinoa is easy, delicious, healthy and free of the top 8 allergens!
2 cups quinoa, rinsed and drained
4 cups almond or soy milk
4 granny smith apples, peeled and diced
1/4 cup maple syrup (or more, depending on how sweet you like it, and whether the milk is sweetened or not)
2 t. cinnamon
2 t. pumpkin pie spice (or your favorite combination of fall spices)
2 t. vanilla extract
1 t. salt
Combine all ingredients in a mini slow cooker or saucepan. For slow cooker, cook on high for 3-4 hours, or until quinoa is very tender. For saucepan, cook on medium for 3-4 hours. Serve immediately; store leftovers in the refrigerator. To reheat, add a little more soy or almond milk and microwave or heat in a saucepan until warm. Sprinkle with cinnamon, walnuts, raisins and/or cranberries and enjoy.
What is better on a cool fall morning (or in today's case, this snowy fall morning) than the aroma of a hot pumpkin spice latte with real pumpkin puree? In my opinion, nothing really.
We are excited to announce that we will be sharing a recipe from time-to-time and modifying it to be just a tad bit healthier. With all the added sugars, and unknowns in our food and beverages these days, it's totally worth it to spend the extra time whipping up your favorite food or treat, so you know what you are actually eating. This morning we kick off the week with this delicious pumpkin spice latte.
What are your some modifications you've made to some of your favorite foods? An alternative to a sugar or fat product? Lower amounts of something? Share with us your favorites in the comments below!
1/2c whole milk (a little more, as some will steam off)
1/2c strong coffee or shot of Espresso
2 tbsps pumpkin puree
1 tbsp maple syrup
.5 tsp cinnamon (and a sprinkle for the top)
Bring milk to a rolling simmer for a few minutes, add pumpkin puree and simmer for another two minutes, stir in maple syrup, pour coffee or espresso to a coffee mug, add milk mixture and cinnamon to mug and serve.
Serving size is 8 oz.
Thank you, Leanne for this awesome guest post! Leanne Ray Nutrition
Have you ever considered getting a Master’s degree but felt unsure if you would reap any additional benefits later? If so, you are certainly not alone. I can count on two hands how many dietitians I have personally had conversations with who share this thought process. If graduate school has even remotely crossed your mind but you just can’t decide on whether or not to take the plunge, read on to hear my thoughts as a recent grad on the pros and cons.
The Upcoming CDR Requirement Change
First and foremost as most of you have probably heard by now, the Commission on Dietetic Registration (CDR) will be requiring that starting in the year 2024, entry-level registration eligibility education requirements for dietitians is changing from a baccalaureate degree to a minimum of a graduate degree. While this may elicit a slight panic in some of you practicing RDNs, keep in mind that if you are already credentialed when that time comes, you won’t be forced to go back to school and get your Master’s. This requirement only affects future dietitians who will just be starting a program at that time. CDR cites some valid reasons for making this change, including the following:
Note: All of these were shortened or paraphrased for readability but the full list can be found here.
You might be wondering if competition is going to make it increasingly difficult to find a job once dietitians start entering the market with those extra two letters behind their name. I don’t believe this is a given since experience can sometimes trump education (or at least match it) depending on the position. If you are a registered dietitian with seven or more years of experience, it’s hard to believe that your lack of a Master’s will derail your chance at getting a job, especially if going head-to-head with an entry-level RDN. One exception? Jobs that absolutely require a Master’s or PhD. In general I have found that positions in nutrition communications, management, academia and teaching hospitals tend to require an advanced degree (among others). Just be sure to do some research on the areas that interest you most to make sure you know what qualifications are preferred or required.
Can RDNs Expect Higher Salaries?
So what about pay? And will the cost of schooling show a return on investment if we put ourselves through two more demanding years of classes (namely, statistics)? This one is a little bit harder to predict. Dietitians have historically been underpaid, but are also the only member of the interdisciplinary health care team in which a B.S. is sufficient for credentialing (over half of dietitians have an advanced degree anyway). According to the Academy’s Compensation and Benefits Study, in 2015 the difference between the median wage of RDNs with a bachelor’s as their highest degree, and that of RDNs with a master’s degree, is $2.63 per hour (or just over $5,000 annually). That may not seem significant to some, but is worth noting especially since this figure only continues to increase.
The Intangible Benefits of Advanced Education
While graduate school likely won’t give you the dream raise you have been waiting for overnight, I can personally attest to the fact that you will most likely experience some of the following non-monetary benefits:
It’s obvious that I am a huge advocate for advanced degrees in our field. Education provides intangible benefits that just cannot be measured by a numerical figure or salary (as does any college degree). On the other hand, that doesn’t make it any easier to invest the time and money required and is not a decision that should be taken lightly. If you do move forward, investigate scholarships, inquire to see if your employer offers tuition reimbursement, and choose a program that is a great fit for your personality and interests.
Do you want to continue this discussion? I would love to hear from you and would be happy to share more about my personal experience with graduate school. Send me an email at email@example.com.
Leanne Ray, MS, RDN coordinates the employee wellness program for a local public health department. Her professional interests include promoting an intuitive eating approach in conjunction with cooking and meal planning education all in the name of self-care. Check out her personal blog or connect with her on Instagram where she shares her food-related adventures and inspirational anti-diet messages.
I'd first like to thank Tiffany Weir, PhD, professor at Colorado State University for presenting on this topic at the Denver Dietetic Association's September meeting. The microbiome has fascinated me on so many levels, so listening to an expert who specifically studies the microbiome was amazing. And, I'm pretty sure most people felt this way as we had record-breaking attendance compared to all of our past meetings.
Just think, no matter what type of nutritional field you're in, the microbiome is sure to play a role in your patients' heath in one way or another. In case you missed this awesome presentation, here is a recap along with a copy of her presentation.
A little background on the human microbiome:
The microbiome has been a hot topic in the biological and nutritional world over the past decade, and the information that has been uncovered through the numerous studies and mounds of research has been eye opening to say the least.
We know that a healthy (balanced) microbiome is essential for maintaining good health in general, free of disease and negative health conditions, but what exactly is the microbiome and what does it affect?
The microbiome is a community of microorganisms (such as bacteria, fungi, and viruses) that inhabit a particular environment and especially the collection of microorganisms living in or on the human body. Your body is home to about 100 trillion organisms. (1) Estimates of the number of bacterial species present in the human gut alone vary widely among studies, but it is generally accepted that individuals harbor more than 1000 microbial, species in the gut alone. (2)
Most people have heard that the microbiome plays an important role in Inflammatory Bowel Disease and overall health of our GI tract, but some don't realize that it also plays a role in just about all parts of our health from immune function, respiratory function, asthma and allergies, metabolic conditions, and brain health to dental health, cancers and anxiety and depression.
More fascinating, the microbiome plays such a central role in immune system development and homeostasis mainly due to the large number of immune cells that reside within the gastrointestinal tract that almost 70% of the entire immune system is in the gut (2), so you can see how maintaining a healthy microbiome is essential to keeping certain disease and conditions at bay.
What Dr. Tiffany Weir, PhD had to say:
The microbiome functions to keep us healthy and disruption to any of these functions may result in a variety of mild to severe health issues. What we eat can alter our gut microbiome by altering our gut bacteria, host metabolism, immune system production of pro- and anti- inflammatory metabolites, and lead to cancers and metabolic conditions.
It's no secret that the Western diet isn't the healthiest no matter how you look at it, and when it comes to the microbiome, studies show that a Western diet (that is low in fiber, fruits, vegetables, and whole grains and unsaturated fats) will lower the good bacteria (Bifidobacterium, Lactobacilli, Eubacteria – to name a few) essential for a healthy (balanced) microbiome and actually increase the less-favorable bacteria. A gluten-free diet has also been shown to do the same. On the other hand, the Mediterranean diet has been shown to increase the good bacteria supporting a well-balanced microbiome. Here's how specific macronutrients affect and interact with the microbiome.
The gut microbes primary source of energy is carbohydrates. And, through the microbiota metabolism, undigested carbohydrates are converted to fiber which is then fermented and short chain fatty acids (SCFA) are produced. SCFA show to stimulate proliferation of normal crypt cells, and inhibit growth of colon cancer cells, as well as, reduce the risk of developing inflammatory bowel diseases such as Crohn's and Ulcerative Colitis. Therefore, carbohydrates including fiber are an important part of maintaining colon health.
Animal protein which contains significant amounts of Choline and Carnitine have been shown to have a negative effect on our health and the microbiome. Trimethylamine N-oxide (TMAO) is a small colorless amine oxide generated from choline, betaine, and carnitine by gut microbial metabolism, which raises the risk of cardiovascular disease (CVD). Animal protein has also been shown to reduce the good bacteria in our gut and SCFA.
Plant protein on the other hand, has been shown to increase good bacteria, increase gut barriers (preventing leaky gut), reduce bad bacteria and reduce inflammation, reducing the risk of CVD and IBD.
Studies suggest that they type of fat consumed has a significant impact on the microbiome. Diets high in unsaturated fats have been linked to an increase in good bacteria, while diets high in saturated fat have been linked to a decrease in good bacteria.
When concluding the diet portion of her presentation, Dr. Weir mentioned how fermented foods are high in good bacteria, but finding those foods are hard to come by. Canned and jarred foods like sauerkraut, and pickles have been pasteurized, so they lack the live cultures that benefit the microbiome. Kimchi, kefir, yogurt (that says live cultures) and kombucha on the other hand are great for boosting your microbiome.
She also mentioned that taking a quality pre/probiotic can be beneficial, but the market is saturated with less-than quality products making it hard to find one that will work. She suggested taking medical food vs a dietary supplement, but the downfall to this is that medical food is hard to come by. It is usually prescribed by a doctor.
Eating a well-balanced diet full of fruits and vegetables and whole grains, healthy fats and fiber still appears to have the best health benefits of all.
Additional Observations in Regard to the Microbiome:
Dr. Weir also touched on the difference in microbiomes between breast-fed and formula-fed babies, stating breast-fed babies have more good bacteria and better immune system support due to higher levels of oligosaccharides in breast milk.
Current and Future Trends for Creating a Healthier Microbiome
There are a lot of new trends and practices coming to light that aim to support a healthier microbiome and prevent/cure diseases and conditions, and one that I've personally read a little about is showing a lot of promise.
It is the swabbing of babies born via C-section called vaginal microbial transfer. Studies show that babies born vaginally have a healthier microbiome will be at lower risk than C-section babies for developing allergies, asthma, type-1 diabetes and obesity later in life. Samples of microbes from the mother's vagina are collected before delivery and swabbed (or rubbed) all over the infant within minutes after delivery exposing the baby to many essential and beneficial microbes.
Another rising procedure is Fecal Transplant. Just as it sounds. This procedure takes fecal matter from a healthy donor and is placed in a person with a disorder or condition. Usually, this treatment is used on patients with C. Diff., or a type of IBD.
There are also tons of other paths being followed to obtain a healthier microbiome. Functional medicine, diagnostic platforms, genetically engineered probiotics, supplementation with butyrate, custom therapeutic solutions, gene sequencing.
I've attached a copy of Dr. Weir's presentation here.
By Leanne Ray, RDN
Are you an “RD2be” or a newly credentialed dietitian unsure of what your career has in store for you? Or are you a seasoned dietitian who is considering a job switch for something fresh and new? If so, consider workplace wellness for a fun and dynamic setting where you can utilize your multiple super-dietitian talents!
Making the case for workplace wellness
Take a second to think about how many hours you spend in the workplace each week. For most people, this number is probably somewhere around 40 hours. If you have a 30-minute commute (each way), take an hour-long lunch break and average eight hours of sleep, this equates to >60% of your waking hours! For many, a 40-hour work week is unheard of, so this might even be on the low end of the spectrum. Because of this, there is a huge need for wellness programs to promote healthy habits where people “hang out” for so much of the day. Even the Centers for Disease Control and Prevention state that “worksites have the opportunity to encourage healthy habits and help prevent health problems such as diabetes, depression, and heart disease.” The connection between a wellness culture and worker well-being, productivity and reduced number of sick days has been demonstrated over and again1. What kind of organization wouldn’t want all of these things? And why not hire a dietitian to fill this need?
What skills are necessary?
In addition to evidence-based nutrition programming, registered dietitians are well-versed in some of the necessary attributes of a successful workplace wellness professional including:
How to get the job
There are a few ways to get hired in a wellness setting including as a full-time program coordinator, a contractor or as a one-time presenter. The first option is a bit less common since companies often designate a human resources professional or other staff member double as a wellness program coordinator. Some companies will contract professionals to develop a few challenges or seminars (which could be you!). The third option, which is probably most common for dietitians, involves a presentation or other service for a one-time event. Each of these could be really beneficial for a future career in workplace wellness. Interested? Don’t be afraid to pitch yourself! After all, we know far too well that if dietitians aren’t doing this, someone else probably is.
Leanne works for a local public health department as a worksite wellness specialist and also has her own food and lifestyle coaching business, Leanne Ray Nutrition LLC (visit her website: www.leanneray.com). Have questions on opportunities for dietitians in workplace wellness? Feel free to reach out to her directly at firstname.lastname@example.org. You can also find her on Twitter where she shares both wellness and nutrition related tidbits daily.
1. Centers for Disease Control and Prevention. Worksite Wellness. https://www.cdc.gov/sustainability/worksitewellness/
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