The Shame of Hidradenitis Suppurativa

Tags

Acne Inversa, Autoimmune Protocol, Autoimmunity, Brené Brown, Hidradenitis Suppurativa, I Thought it Was Just Me - Women Reclaiming Power and Courage in a Culture of Shame, Sarah Ballantyne, Skin Disease, Tara Chester Grant

(Original image from here)

I’m about half way through Brené Brown’s “I Thought it Was Just Me – Women Reclaiming Power and Courage in a Culture of Shame”. It’s a compelling read. A REALLY compelling read.

(Image from here)

It is teaching me a lot. And it’s making me think…

For the longest time I never talked about the fact that I suffer from Hidradenitis Suppurativa (HS). I just told people I had ‘skin problems’.

And, I’d hazard a guess that unless you, or someone you love, suffers from the disease, you’ve probably never heard of it. HS is a chronic and painful skin condition that features pea-sized to marble-sized lumps under the skin. These deep-seated lumps typically develop where skin rubs together. Places like the armpits, groin, between the buttocks and under the breasts. In many cases, tunnels connecting the lumps will form under the skin, too. Sometimes these lumps can last months or even years.

And most doctors don’t know what HS is. So, in many cases it remains undiagnosed. For years. Decades, even.

HS is the primary reason I started this autoimmune protocol (AIP) caper. It has turned out to be one of my better life decisions.

But here’s the thing. Despite the fact that AIP has worked, what feels like a miracle, on my HS symptoms; I am learning that my some 20-plus years of this hideous disease really did a number on my self-esteem. More than I ever acknowledged to myself.

Because having HS made me feel ashamed.

Shame: the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.

HS makes you feel dirty. It makes you feel embarrassed. And, most of all, it makes you feel ashamed.

Brené Brown nails it when she explains one of the reasons shame is so powerful is that it has the ability to make you feel very alone. Like you are the only one, or somehow you’re different from everyone else.

Not such a big leap when even doctors can’t tell you what your weird and painful lumps are…

In fact, I had more than one doctor suggest to me that I was unclean. True story. Anybody who knows me, knows just how ridiculous that suggestion is, but you can imagine the impact of a doctor saying this to a young woman with unsightly and painful lumps in awkward places.

I know now, that other HS sufferers have experienced similar suggestions when talking with medical professionals who had no idea what they were dealing with.

 

And, if even doctors can’t identify your very personal problem (or fix it), why would you talk to anyone else about your symptoms?

Is it any wonder that HS makes you feel ashamed?

But if shame is about the fear of disconnection, then sharing common experiences with others who understand can be an unbelievably profound and inclusive experience.

When we hear stories that mirror our own stories, it helps us to know we aren’t alone.

But, there is a risk in this…

 

When you live with HS, you live in fear of being seen. So, it takes a lot of courage to come out and tell your story to others.

For me, the turning point came when I stumbled across a book called ‘The Hidden Plague’ by fellow HS-sufferer Tara Chester Grant. She was the one who gave me a name for my twenty-plus years of undiagnosed painful lumps. I owe Tara a huge debt of thanks.

Tara’s book, coupled with Sarah Ballantyne’s, ‘The Paleo Approach’ showed me an alternative route to mitigating my HS symptoms.  Not only did that approach work for me, but along the way, I’ve found a whole tribe of HS peeps. And, an even bigger group of autoimmune sufferers who are following the autoimmune protocol to improve their AI symptoms.

I haven’t got all the answers, but I know a lot more about it than I used to. And, I’d even go so far as to say I know a lot more about HS than many doctors.

It’s that self-esteem bit that remains a work-in-progress…

If you think you might be suffering from HS, a couple of closed Facebook support groups I recommend you might like to join are:

~ The HS Diet Connection

~ HS Elimination Diet Support

And, if you haven’t yet come across the ridiculously compelling and charismatic Brené Brown, I urge you to check out her website. You can access both her TED talks there, too…

Brené Brown’s Website!

I’d like to invite Brene to a dinner party. I wonder how she’d get on with Noel Fielding? – He’s on my ‘dinner party guest list’, too!
(Image from here)

 

 

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Heal Your Gut – Random Thoughts and an Update!

Tags

Autoimmune Protocol, Autoimmunity, Detox, Diet, food, Frank Lipman, Lifestyle, the Detox Summit, Toxic Thoughts

(Image by TSL)

I’m currently on the Autoimmune Protocol, a nutrient-rich elimination diet that removes foods that irritate the gut, cause gut imbalance and activate the immune system. You can read more about the protocol and why I’m doing this here. And, if you want to know why I’m on the sugar-free version of the Autoimmune Protocol, you can read about that here.

In case you hadn’t been paying attention, I’m currently a little bit obsessed with health. Specifically, my health and how my diet and lifestyle choices can improve it.

It’s hardly surprising, really. Up to about 18 months ago, LM and I were considered the ‘foodies’ amongst our friends. We were the go-to people for advice on what was new and good in the Sydney eating scene. We’d dine out 2 or 3 times a week. We connected through our food experiences. And, it was fun!

And then, we started joining the dots around some growing health issues. Our dining out stopped. Abruptly.

I haven’t been out to dinner at a restaurant since 2013.

I can’t safely dine out on the severely restricted diet I have been on since the beginning of this year.

What I have been doing is an awful lot of reading on what it is to be healthy in today’s world. And, what I’m learning is both scary and enlightening.

I’m learning that the rate of autoimmune disease is rising at an alarming rate in the western world. I’m learning researchers have identified between 80-100 different autoimmune diseases and they suspect at least 40 additional diseases of having an autoimmune basis. These diseases are chronic and can be life-threatening. I’m learning that autoimmune disease is now one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age. And, I’m learning that there is a close genetic relationship that exists among autoimmune disease sufferers which explains the clustering found in individuals and families.

So, there’s a genetic component, which you can’t control. It’s a lottery. And, then there’s a lifestyle component. This, you can – to some extent at least – control. And, if you don’t, there’s a good chance that at some stage it may come and bite you. You just don’t know when.

This week, I’ve been dipping into the Detox Summit, an online event bringing 30 experts together to discuss all aspects of detoxification with the goal of helping you return to a healthy state of wellness.

(Image from here)

The problem is we are not eating food anymore, we are eating food like products. (Alejandro Junger)

I haven’t had time to listen to all the interviews, but I was particularly interested in hearing from Dr Frank Lipman. I wasn’t disappointed.

Dr Lipman is a New York-based medical practitioner who marries Eastern and Western medicine to facilitate wellness. During an earlier lecture from him, he painted a wonderful picture that resonated for me about how Western medical practices tend to treat the body like a machine – if a part breaks down, we put a patch on it or replace it. Eastern practices, on the other hand, treat the whole body like a garden. Every part of the garden requires attention for the garden to truly thrive.

(Karl Maugham Image from here)

Even though you may have been given a diagnosis, always ask these two questions with any chronic problem:
1) What is harming you and needs to be removed to permit the body to heal?
2) What is lacking or what does your body need to promote healing? (Dr Frank Lipman)

This time, Dr Lipman was speaking about detoxing and the effects of toxicity on our general wellbeing. Some of the wee pearls that really jumped out for me during his detox session were:

• There is growing understanding that toxic thoughts – anger, resentment and worry – can have devastating effects on health.  As you fix mental and emotional issues, you become more resilient and this has a snowball effect on health.
• As a practitioner, if he doesn’t have the answers, he will always treat the gut. Generally, when you treat the gut, you can see improvement relatively quickly and, because of the high levels of serotonin found in a healthy gut, this will have a direct impact on mood.
• Dr Lipman finds gut dysbiosis in at least 75% of his patients. This is caused by a number of factors – GMO foods, antibiotics (including those in meat), an unfavourable gut environment from illness and/or stress.
• More and more people are becoming sensitive to – not only gluten, but – all grains. There is a general growth in insulin resistance.

I have written before (here) that I am a worrier of epic proportions. And, that I’m pretty masterful at hiding my amazing ability to worry. For me, this idea that our thoughts can make us physically ill is a difficult pill to swallow (bad pun – sorry!). So, as I enter week 3 of my gut-healing protocol, it is with a firm focus on watching my thoughts and working at being more present. I’ve a couple of wee experiments on the go – I’ll tell you about them a little down the track.

My new mantra is ‘be kind to yourself’! Maybe it should become yours, too?

 

All Disease Begins in the Gut – Hippocrates Had it Right!

Tags

AIP, Autoimmune Protocol, Autoimmunity, Bacteria, Bioscreen, Chris Kresser, Gut Dysbiosis, Gut Health, Weight, Weightloss

 

(Image from here)

Healing is a matter of time, but it is sometimes also a matter of opportunity. (Hippocrates)

There is just no delicate way to write this post. And, to be honest, I considered not writing it. But, I’ve been on this health caper for some time now. I’m pretty committed. I’m studying integrative nutrition. And, I’m reading all about health in my spare time, too. You could say that I’m my own wee health experiment. So, it’s no surprise that the direction of This Sydney Life is changing with me.

I should also mention that I have this rather crippling aversion to over sharing on the interweb. I am so not selfie-girl. It’s why you don’t see any pics of me posted on my blog. But as I get further along in my studies, I realise that if I’m really serious about this course of action that I’m taking, I’ll have to put myself out there a little more. Something along the lines of more risk, more reward. Maybe.

So, while I’m not quite ready to be posting candid shots of myself all over the place, today’s post is all about gut bacteria and my disastrous results from the Bioscreen Faecal Microbial Analysis I recently undertook. As you can imagine, it may have been easier to have just posted a picture of myself in my undies…

Let’s start with a bit of back story… I started the autoimmune protocol back in February of this year. At the time, I had been suffering from a pretty revolting skin disorder for over twenty years. Skin problems run in my family. I had discovered my skin problems became significantly improved when I removed all gluten from my diet and determined that they were autoimmune in nature. I had been putting on weight, which was proving very resistant to lose, despite having adopted a Primal/Weston A. Price style of diet for over a year. I had just been given the all clear from a particularly nasty parasite infection. And, my very good functional medical doctor, coupled with my equally great Naturopath, had been working with me to identify the root cause(s) of my problems. It turns out I also have Pyrrole Disorder and am positive for MTHFR. Oh yes – and this year I threw in some periodontal surgery for good measure.

So, since February, I have been on a cocktail of supplements for my Pyrrole and MTHFR, stuff for my teeth and gums, not to mention a few other goodies to improve my general well-being. With the exception of the one slip up (which I wrote about here), I have been dedicated to the autoimmune protocol. That means a pretty restrictive elimination diet, working on managing stress, getting enough sleep, and ensuring I get outside in the sunshine as often as possible for Vitamin D (Bella loves that!).

And, on the whole, it has been a really positive experience. I feel better. My skin has never looked so good (people comment on it). I just look healthier.

But, its a chubby healthy. I’m not losing weight. And, given my lifestyle, there should be less of me.

My blood test results don’t send of major alarm bells – just a couple of minor blips – so my GP suggested the fairly pricey Bioscreen Faecal Microbial Analysis.

The purpose of this exercise was to understand the state of my gut health. The Bioscreen test is a specialist assessment that cultures and counts the bacteria that should normally be in a healthy gut.

What if it’s not just our genetic history or our lifestyle, that makes us skinny or fat. Or, healthy or unwell? What if it’s also the makeup of the bacterial ecosystem that inhabits our gut?

It makes sense. Did you know that the human gut contains 10 times more bacteria than all the human cells in the entire body, with over 400 known diverse bacterial species. It has even been said that we’re more bacterial than we are human.

According to the very knowledgable Chris Kresser, “We’ve only recently begun to understand the extent of the gut flora’s role in human health and disease. Among other things, the gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of our immune system. Dysregulated gut flora has been linked to diseases ranging from autism and depression to autoimmune conditions like Hashimoto’s and inflammatory bowel disease.”

Could the state of our gut health impact our weight?
(Image from here)

And, apparently the evidence just keeps mounting that the microbes in our digestive systems are a factor in the global obesity epidemic.

Chris goes on to say that “There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases including celiac disease and type 1 diabetes. Therefore, we hypothesise that besides genetic and environmental factors, loss of intestinal barrier function is necessary to develop autoimmunity”. This is important. Autoimmune diseases are now listed at number 3 in the leading causes of death in the western world. The reason we don’t all read about it more (yet) in mainstream media is that autoimmunity can affect so many different parts of the body. It’s not isolated to one part of the body – like the heart or the brain.

All disease begins in the gut (Hippocrates)

So, understanding all this, I went off and followed the slightly icky instructions from Bioscreen before submitting my sample for analysis. And, given my autoimmune-driven skin issues, I expected to learn that I had some form of gut dysbiosis. I just didn’t expect it to be quite so extreme. It turns out that I have an over abundance of the bad types of bacteria and not nearly enough of the good ones. When I asked my GP to rate how serious my gut issues were on a scale of 1 to 10, she felt my gut problems sit at about an 8 or 9. Pretty bad, really. In her opinion, if I hadn’t been religiously following the autoimmune protocol over the past few months, it is quite likely that I would be a very sick girl.

(Image by TSL)

But why is my gut so unhealthy?

Well, it turns out that antibiotics are particularly harmful to the gut flora. Recent studies have shown that antibiotic use can cause a massive and very rapid loss of diversity and a shift in the composition of your gut flora. This diversity is not recovered after antibiotic use without some form of intervention. And, if you were given courses of antibiotics in your early childhood and teenage years, as you were developing, your gut is likely to be more compromised. It just so happens that I had a particularly serious case of scarlet fever when I was quite young, and then I was prescribed the fateful Roaccutane for my very bad teenage cystic acne.

So that means it’s back to the drawing board for me. Super strict autoimmune protocol. For three months. And better than that – no sugar. And, in case you don’t know – that means no fruit, dates, maple syrup, or honey, too. None. Zip. The fun police are camping out at my place.

Gut Healing Bone Broth
(Image by TSL)

And, in addition to that, I’ve got a special four week protocol to follow. It involves consuming large quantities of bone broth and taking all sorts of goodies to kill off the bad bacteria, before I can start rebuilding my gut with good bacteria. Oh goody!

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health. (Hippocrates)

I’ve been doing my research. Apparently, if you have gut dysbiosis, things you should be doing are:

• Removing all food toxins from your diet. Check – that’s the autoimmune protocol.
• Eating plenty of fermentable fibers (starches like sweet potato, yam, yucca, etc.) I can do that.
• Eating fermented foods like kefir, yogurt, sauerkraut, kim chi, etc., and/or take a high-quality, multi-species probiotic. I already make my own fermented vegetables and I have a high-quality, multi-species probiotic prescribed as part of the protocol.
• Treating any intestinal pathogens (such as parasites) that may be present. Done!
• Taking steps to manage your stress. This is an ongoing part of the autoimmune protocol. A big part. I need to refocus on this one.

What all of this means is that my reintroduction phase of the autoimmune protocol has come to an abrupt stop. Hopefully, it’s temporary. I’m going to be back to AIP recipes – only with less of the treats. And, I’ll share what I’m learning about the gut micro biome while I’m at it. I’ve got a sneaky wee feeling I’m not the only one experiencing those problems… Stick with me?

The Nora Gedgaudas Files…

Tags

Autoimmune Protocol, Autoimmunity, Glutathione, Health, Nora Gedgaudas, Nutrition, Paleo, Pete Evans, Vitamin D, Wellness

(Image from here)

I’m currently on the Autoimmune Protocol, a nutrient-rich elimination diet that removes foods that irritate the gut, cause gut imbalance and activate the immune system. You can read more about the protocol and why I’m doing this here.

Nora Gedgaudas is one of my health heroes.

It’s fair to say that I’m a BIG fan of hers.

It all started with her book, ‘Primal Body, Primal Mind – Beyond the Paleo Diet for Total Health and a Longer Life’. It was one of the first books I read about how my diet and lifestyle choices could so dramatically affect my health. And – whether it was because of Nora’s pragmatic style of writing. Or, her ability to pare down convoluted science so that a ‘complex terminology phobic’ (technically – a Hellenologophobic!) type like me could understand it. Or, simply that the fates were aligned and I was ready to really, really hear the message and change the way I live. Or, a combination of all three of these factors – her book has become something of a bible for me.

I continue to dip into it frequently and it is full of high-lighted passages and tabs.

One-size-fits-all is a size that fits no one. (Brent Pottenger, foreword of ‘Primal Body, Primal Mind – Beyond the Paleo Diet for Total Health and a Longer Life’)

Brent Pottenger, who wrote the book’s foreword, sums up the key message of the book in his second paragraph – we are all different in our physical make up. One size definitely does not fit all. And, nobody cares as much about your health as you do.

Because of Nora, I first started experimenting with removing grains from my diet. She was the first person to open my eyes to the fact that grain consumption has been linked to things like allergies, food sensitivities, autoimmune issues, mineral deficiencies, celiac disease, and chronic skin disorders (to name but a few). And, I suffer from a chronic skin disorder.

And, at first it was hard. I was a carb’ queen. It never occurred to me that my love of bread was the equivalent of a sugar addiction to my body. Soy linseed sourdough from Sonoma bakery was my not-so-secret vice. I loved it!

But when I removed grains (and, most importantly, gluten) from my diet, I found that chronic skin issues I had suffered from for decades began to improve. Rapidly. And, when I tried to reintroduce the odd bit of bread back into my diet my skin complaints returned. Within 12 hours.

I don’t care what the sceptics say about gluten sensitivity – I am a believer.

The Thyroid Sessions
(Image from here) 

A fortnight or so ago now, I tried to catch a few of the Thyroid Sessions – both because of my Dad’s recent thyroid removal and because our thyroid plays such a big part in the regulation of our hormones. And, of course, Nora’s talk was of particular interest. While her presentation was targeted more towards sufferers of Hashimoto’s (Hypothyroidism), because the disease is autoimmune in nature, much of the information resonated.

Of particular interest to me was Nora’s list of four areas of focus for sufferers of autoimmune complaints. I thought they may be of interest to you, too.

1. Vitamin D (Coupled with Vitamins A and K2)

According to Al Sears, “Vitamin D may be the single most important organic nutrient for your overall health. In fact, if this were a drug, it would be considered the discovery of the century”

Nora reckons our vitamin D levels should sit between 80 to 100 nano-grams per millilitre (ng/ml)* AND that we should also ensure we are getting enough vitamin A (veggies like sweet potato, carrots and spinach) and vitamin K2 (found in grass-fed animal-based products).

Now, in case you’ve forgotten, I live in Sydney. I try to get out in the sunshine every day. But, I still have trouble getting to the recommended levels of vitamin D. In fact, for some reason, my vitamin D levels were dangerously low at one point, which is likely to have been a contributing factor in the development of my autoimmune issues. And – the only way to know if you are getting enough of the sunshine vitamin? – get yourself tested.

 2. Omega-3 Fatty Acids

In her book, Nora says “Few people are aware that omega-3 fatty acids, which include ALA, EPA and DHA, are easily the most deficient nutrients in the modern Western diet. Insufficient intake of these vital and essential dietary components is linked with virtually every modern disease process, weight problem, affective disorder and learning disability.”  The best sources of natural omega-3 fatty acids are from wild-caught seafood – especially cold water fish – and from exclusively grass-fed meats. It matters that you buy your meat from a butcher that can tell you the provenance of the animal.

Here in Sydney, I buy much of my meat from the team at G.R.U.B. for this very reason.

Glutathione

Apparently, glutathione is the body’s most important autoimmune enzyme. And, I have heard something similar in lectures given by Dr Frank Lipman.

Glutathione allows your body to detoxify itself and helps keep you healthy for the long haul. It’s said to be the ultimate in health-support champions.

The best way to optimise your glutathione levels is to combine a nutrient-dense diet with stress-reduction, exercise and smart supplementation.

Bit like the Autoimmune Protocol, really…

And, along with optimising your glutathione levels, Nora recommends upping your turmeric consumption. Turmeric is a natural anti-inflammatory and super-good for you.

Fat Based Ketogenic Diet

Nora is a huge advocate for a fat based ketonogenic diet (coincidentally, again like the Autoimmune Protocol. Seeing a pattern here?). 

And certainly, as evidenced in ‘Primal Body, Primal Mind’, there are countless studies showing the benefits of avoiding processed foods, avoiding dietary pesticides, avoiding GMO’s, avoiding refined sugar and refined salt, avoiding gluten, consuming naturally grass-fed meats, consuming unprocessed, organic vegetables and greens.

There is also overwhelming evidence for the benefits of a fat-based, ketogenic diet for the treatment of Alzheimer’s, cancer, heart disease, autoimmunity, diabetes, metabolic disorders. 

If nothing else, reviewing Nora’s 4-pronged approach to autoimmunity has reignited my desire to faithfully stick to my autoimmune protocol for another 30 days before reintroducing potential trigger foods…

Nora Gedgaudas is coming to Australia in July. She’ll be sharing the stage with Pete Evans and Luke Hines. If you’d like to know more, check out The Paleo Way through Eventbrite.

I’ll be at the Sydney session with my dog-eared copy of her book… See you there?

*note this is higher than standard recommendations

No Recipe Breakfast Hash

Tags

AIP, Autoimmune Protocol, Autoimmunity, Breakfast, Breakfast Hash, Gluten Free, Health, Leftovers

(Image by TSL)

I’m currently on the Autoimmune Protocol, a nutrient-rich elimination diet that removes foods that irritate the gut, cause gut imbalance and activate the immune system. You can read more about the protocol and why I’m doing this here.

It’s a good thing I was born a girl, otherwise I’d be a drag queen. (Dolly Parton)

I really have become the queen of the breakfast hash. Seriously…

To understand why breakfast hash has become such a big deal here at Casa TSL, you kind of have to get that all the usual culprits are off the breakfast menu on the AIP. No cereal – not even my favourite grain-free granola. No toast – not even the gluten-free kind. No eggs – at least until they’re successfully reintroduced. No tomatoes – they’re a nightshade. The good news? – bacon is still on the menu! And, so is avocado!

I think breakfast is the biggest mind shift required on the autoimmune protocol. I can’t really put my finger on exactly why that is? – Perhaps because we have been indoctrinated into believing that breakfast must consist of different foods to our other meals?

Well, if you want to eat breakfast while on the AIP, you definitely need to get over the need for cereal and toast, ‘toot sweet’. And, one of the logical solutions to this wee problem is hash.

Today’s hash: Bacon, onion, lamb, pumpkin & broccoli served with homemade red kraut
(Image by TSL)

Not only does hash meet all the AIP requirements, it also happens to taste GREAT and it’s the best way I know to use up all the leftovers in my fridge. And, you don’t even need a recipe.

What you do need for great hash is the right combination of
protein + starchy vegetables + greens.

While it is certainly possible to make an adequate hash with a combo’ of either protein + starchy vegetables or starchy vegetables + greens. To make your hash sing, you need all three.

And, if you want it to really sing,
a base of slowly sweated onion and bacon is a must!

I know I said this was a ‘no recipe’ hash BUT I’m going to give you a recipe, sort of. It’s more like a framework – something to loosely refer to as you experiment with your hash flavours.

And, if you’re not following the AIP, throw an egg on top of your hash – fried or poached. It will only make everything taste even better!

• Time: 20 - 30 minutes
• Difficulty: easy-peasey
• Print

(Image by TSL)

Ingredients

Base Recipe (all measurements extremely approximate and subject to fridge contents!)

1/2 – 1 Tablespoon ‘happy’ fat of choice (we think coconut oil is best)
1 onion, diced
3 rashers happy bacon, diced
1 cup leftover roasted/steamed/mashed starchy vegetables (think pumpkin, kumara/sweet potato, yams, parsnips, carrots, celeriac)
1 cup leftover roasted or grilled meat or fish (beef, pork, lamb, chicken, salmon – whatever tickles your fancy)
1 cup leftover roasted/steamed green vegetables (think broccoli, cauliflower, brussels sprouts, cabbage, zucchini)
or
1 cup shredded leafy greens (spinach, kale, silver-beet/chard)

Optional

1 Tablespoon chopped fresh herbs (Parsley, chives, coriander/cilantro)

Method

1) Melt your fat in a large fry pan over a medium-high heat. Add onions and sweat for 5 – 10 minutes. Add the bacon and cook for another 5 minutes.

2) Turn up the heat a little and throw in your meat and starchy vegetables. When ready, add the vegetables (This is a bit of a judgment call – I like my hash crispy around the edges which takes a little longer. Some don’t). Check for seasoning.

3) After plating, add your chopped herbs

Great on it’s own or served with sliced avocado, sliced fruit and/or fermented vegetables.

E N J O Y !