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Dear all 3 (!) patients who have asked me this:
In short, I do not know! The first time this came up in a patient encounter, I laughed aloud at the absurdity of it. Putting a bar of soap under the covers, not even necessarily in contact with the body, relieves pain and cramping? Was I understanding this correctly?
As an oncology fellow, the brave patients I see are no strangers to pain. They are often well-educated, well-informed individuals on top of both the latest clinical trials, as well as integrative therapies, such as herbs, supplements, and acupuncture. They teach me so much about the gift of life, but also about the innovative and effective ways of overcoming their corporeal struggles. I value their stories, as their unique methods of combating cancer and its symptoms along the arduous path of controlled, clinical studies can be vital to the next patient, who might be facing a similar plight.
Still skeptical after my third patient mentioned relief from this method, I took to Pubmed (the resource with over 27 million biomedical publications) to see if any studies had been done to investigate this sudsy mystery. Lo and behold, a case report had been published from the Anesthesiology Department in Wisconsin about using a soap-scented oil skin patch for effectively treating pain associated with fibromyalgia . Based on the recommendation of a Dr. Gott, who successfully treated patients by advising them to sleep with a bar of soap between their legs and published his experience in a popular newspaper column, this study first involved creating a skin patch made of crushed bar soap to relieve leg muscle cramping and pain in 14 patients . The patch worked. Expanding on this idea, Dr. Ough, the lead investigator, hypothesized that it was the scent of the oil itself, applied directly to the skin, that was responsible for the pain-relieving and muscle-relaxant properties of the skin patch.
This would make sense, given my patients' reports on relief from just having the soap in the bed and not even touching their legs, as the only volatile property of the soap that could diffuse through the sheets is its scent. Dr. Ough then assembled the skin patches with a soap-scented oil (SSO), rather than bar soap itself, and took to treating the 14 patients suffering with severe pain.
What happened? All patients reported initial pain relief within 1 hour of application, with 3 patients reporting nearly complete pain relief (lasting between 18 to 30 hours). Their sleep was also more restful. The patch relieved pain from muscle cramps, knots, and trigger point pain, in addition to smooth muscle spasms, relieving menstrual cramps, intestinal cramps, and the pain from a kidney stone. Shockingly, this would represent a new and unique method of medicinal delivery, as scent is seemingly absorbed through skin and not through the nose!
Broadening my investigation to the wild, wild, world wide web, it seems the history of this hypothesis dates back to several years ago, when the advice columnist Ann Landers raised a provocative questions in her column: does putting soap the foot of the bed cure night-time leg cramps? The medical community consensus was no, but anecdotal reports of improved symptoms persisted.
From peoplespharmacy.com , 219 people rated this modality 3.5 stars out of 5. The author noted the following :
"What People Report:
- It seems to work for many people. Soap in the bed appears to alleviate nocturnal leg cramps.
- Relief is immediate and sustained.
- Some people report that soap does not work. It appears either to work consistently and well or not at all. There are few cases of partial success.
- After a few months, a bar of soap is no longer effective for preventing cramps. It must be replaced. Old soap can be rejuvenated by scoring or shaving it to produce fresh surfaces.
- Some subjects have placed the soap between the sheets, and some have placed it under the bottom sheet. Either or both of these methods work.
- Some subjects report that direct physical contact between the subject and the soap is desirable, but few claim it is essential."
Since direct contact did not seem essential, a volatile compound needs to pass through the air to the body, and the only possible source would be the small molecules of fragrance. Also, as soap ages, it becomes less porous, which would explain why new soap bars work better than old ones.
Moreover, the esters and oils making up fragrances such as lavender oil, are vasodilators [3,4] Vasodilators work by enlarging blood vessels, the same way nitroglycerin treats angina chest-pain.
Bottom line: Given the case reports and plausible mechanism of action, there just might be some solid science beneath this slippery solution of a cure for pain. Allergies aside, the risks of such a treatment seem minimal in the face of refractory pain, with a lot of relief to gain. Worse case, at least your bed sheets will smell good!
 Ough YD. Soap-scented oil skin patch in the treatment of fibromyalgia: A case series. Journal of multidisciplinary healthcare. 2008;1:59-62.
 Shimada K, et al. Aromatherapy alleviates endothelial dysfunction of medical staff after night-shift work: preliminary observations. Hypertens Res. 2011 Feb;34(2):264-7. doi: 10.1038/hr.2010.228. Epub 2010 Nov 25.
 Koto J, et al. Linalyl acetate as a major ingredient of lavendar essential oil relaxes the rabbit vascular smooth muscle through dephosphorylation of myosin light chain. J Cardiovasc Pharmacol. 2006 Jul;48(1):850-6.
How do you say, “Gluten-free, dairy-free” in another language? That’s one question to avoid when traveling abroad! Fortunately, there are ways to master the travel snack pack to always ensure adequate sustenance. Recently traveling to Portugal with my like-minded (and like–dieted) sister and friends, we found creative, fun, simple solutions to avoid any potential food faux-pas. CitySlim proudly presents the following tips...
- Survival Snacks – in advance
- Selecting your survival snacks in advance is key. Great staple snacks will contain more healthy fats and protein and less sugars. Although “bars” seem like a good idea for a quick fix, the high concentration of fruits and added sugars will often push your desired glycemic index over the edge. Personal favorites include:
- Trail mix: Whole Foods sells great mini-packs of nuts and raisins. Almonds and walnuts, especially, contain healthy omega-3 fat to induce “fullness” and protein for energy. Select a brand of trail mix without candies, chocolate, candied or sugared fruits/nuts, or sulfur preservatives (if possible). The more natural the better. Added sugar will give you a spike and then plunge in your blood sugar (bad for touring stamina), while added sodium may cause or enhance post-travel bloating.
- Chop up fresh fruit and vegetables pre-flight. Chopped apples and pears are always refreshing, while tangerines or mandarin oranges are easy to pack with their protective peels. Carrots and celery will add a low-calorie crunch.
- Almond butter packets come in very handy! Spread over the chopped fruits, rice cakes, or eat raw. Same idea with hummus, if you can find travel-size packs.
- Bars: choose a brand with the least amount of ingredients as possible! Products now exist with only 3-5 ingredients, for example, purely nuts and fruits.
- Crunchy carbs: although gluten-free crackers and carbohydrate-laden products can be found, these should be packed sparingly, if at all. A good alternative would be unsalted rice-cakes (good with almond butter), although fresh nuts, vegetables, and fruits provide more healthful nutrients.
- Before you arrive, look at menus online… when you can translate them to English! A simple online search for “gluten-free, dairy-free restaurants” in your desired destination might lead to helpful suggestions. Reading online reviews was also very helpful for us on this trip. Many websites and blogs will provide lists of food-intolerant friendly places for eating. Try to make your reservations in advance!
- Also, research the cuisine and specialty dishes of your destination. Understand what is usually in the main meals you will encounter on your travels and if those ingredients are in accordance with your own personal dietary habits. For example, “caldo verde” soup in Portugal seemed to appear on almost every menu and much to my surprise, happened to be made of puréed potatoes, kale (or collard greens), olive oil, and salt (plus/minus garlic and onions) … literally, it means “green broth.”
- Translations: write out the foods to which you are allergic or intolerant in the native language to show waiters to ensure you order properly. Take a screenshot of these translations and keep them on your phone, if you fear losing pieces of paper. Ask a native speaker, if you happen to have one as a friend! Having a food orientation from a Portuguese colleague personally came in very handy.
- When you arrive:
- Restock fruits (fresh and dried), vegetables, and nuts (preservative-free, if possible). Sliced avocado in the morning with salt and pepper is a great eat-and-run breakfast that will provide satiating nutrients for your active morning.
- If you pack chia seeds with you, you can buy preferred variation of milk (almond, soy, coconut) for chia seed pudding, which came in very handy on our trip!
- Eggs and olive oil are wonderful if you have a stove top. Hard boil eggs the night before and keep in the fridge for a quick breakfast the following morning or scramble them with olive oil prior to exploring.
- Pack extra plastic bags or small containers for your snacks to preserve them for the duration of your trip and traveling back home!
- Get creative with staple products from home and local products you can purchase abroad.
At the end of the weekend, odds are you may wake up feeling groggy, dehydrated, and in need of something sweet and fresh to perk you back up. Well, if that's the case, or you find yourself craving a refreshing, healthful breakfast, look no further. I present to you easy-to-make, 6-ingredient-only Chia Seed Pudding.
Chia seeds are a whole grain "superfood," usually grown organically, non-GMO, and naturally free of gluten. Despite their tiny size, chia seeds are packed with nutrients. Each seed is loaded with fiber, protein, Omega-3 fatty acids*, and various micronutrients. The word "chia" even means "strength" in the Mayan language, and the Aztec warriors would feed them to runners for fuel and endurance in battle.
Recently, a recent double-blind, randomized control study (a research gold standard!) studied chia seed effects on seventy-seven overweight or obese patients with type 2 diabetes. After 6-months on a calorie-restricted diet with either chia seeds or an oat bran-control, the chia seed diet group lost more weight than the control, had a greater waist size reduction, reduced inflammatory markers (C-reactive protein), and increase in adiponectin, the satiety (or fullness) hormone .
To get the most benefit of the seeds, they should be ground or soaked. Luckily (or not!), this recipe calls for soaking the chia seeds in coconut milk for 30 minutes.
- 1/2 cup chia seeds
- 2 cups coconut milk, vanilla-flavored (or if regular coconut milk, add 1/2 tsp vanilla extract)
- 1 Tbsp honey
- 1/2 tsp ground cinnamon
- 1 pinch salt
- 1/2 cup diced strawberries (or blueberries, blackberries, or combination).
- Place chia seeds in a bowl.
- Whisk together coconut milk, honey, cinnamon, and salt together in a separate bowl. Pour over chia seeds and stir well. Allow coconut milk-chia seed mixture to soak until thickened, at least 20 minutes (or cover bowl with plastic wrap and refrigerate overnight).
- Stir pudding and top with strawberries (or berry selection of your choice)!
*Chia seeds contain alpha-linolenic acid (ALA), which is converted to omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the body.
1. Vuksan V, et al. Salba-chia (Salvia hispanica L.) in the treatment of overweight and obese patients with type 2 diabetes: A double-blind randomized controlled trial. Nutr Metab Cardiovasc Dis. 2017 Feb;27(2):138-146. doi: 10.1016/j.numecd.2016.11.124. Epub 2016 Dec 9.
I never thought it would be possible, but ready-to-bake (and eat raw) gluten-free vegan cookie dough exists! Whole Foods happened to carry this delightful treasure and I knew upon first glance it was something I had to try.
First, what's in it? Ingredients include:
- Gluten Free Flour Blend (Brown Rice, Garbanzo),
- Earth Balance® (Oil Blend [Palm Fruit, Canola and Olive Oils],
- Water, Salt,
- Less Than 2% Of Natural Flavor, Sunflower Lecithin, Lactic Acid [Non-Dairy], Annatto Extract [Color]), Organic Evaporated Cane Juice, Semi-Sweet Chocolate (Organic Cane Sugar, Unsweetened Chocolate, Cocoa Butter, Soy Lecithin [an emulsifier], Vanilla Bean Seeds), Brown Cane Sugar, Apple Sauce (Apples, Water, Ascorbic Acid), Pure Vanilla Extract, Baking Soda, Baking Powder (Monocalcium Phosphate, Sodium Bicarbonate, Corn Starch [made from nongenetically modified corn]), Sea Salt.
Overall, not too bad! Since there are no eggs, it is even possible to eat the dough raw, which is an added bonus.
However, the dough happens to lack the extra "umph" of regular cookie dough... that moment of transgression when you risk suffering from salmonella just to savor a satiating bite of raw decadence.
Once baked, though, the cookies come out tasty, just not super sweet or gooey (probably due to lack of glue-y gluten), and perhaps, in comparison to the old Toll House days of childhood, a tad bland.
Overall, for the convenience of a ready-to-bake product, safe for vegans and the gluten-free, I found the final product to be satisfactory and worthy of the sporadic indulgence.
Recently, in clinic…
Bright red flares lit up the computer screen, as my patient and I checked his PET-CT scan results. The colored flame-like images superimposed on his CT scan represented areas of cancer. Looking at the images together, my patient remarked, “You know, they gave me glucose for that scan… the cancer must like glucose, right?”
In short, the answer is, “Yes.” Cancer cells, because they grow, divide and multiply much more rapidly than normal cells, consume a higher concentration of sugar for energy. We, oncologists, capitalize on this phenomenon in using PET scans (PET = positron emission tomography) to identify tumors and areas of metastasis in patients. PET scans use modified glucose molecules, injected into patients’ veins, that light up in places where cancer cells are thriving.
“Good,” he said. “Then it makes sense that I am now on a ketogenic diet, don’t you agree?” In theory, his reasoning made sense… but does science support this notion?
What’s the story with this diet?
A ketogenic diet (KD) is high in fat, moderate in protein, and low in carbohydrate intake. In medicine, it is already commonly used to treat hard-to-control epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates we eat are converted into glucose, which is then transported around the body and fuels the brain. However, if carbohydrates are lacking in our diet (usually below 50g/day), our bodies must break down fat to get energy (great for losing weight and the basis of Dr. Atkins’ diet). The liver converts fat into fatty acids and ketone bodies. Ketone bodies replace glucose as an energy source and pass right into the brain. Some studies even suggest the brain functions better on ketones ! Interestingly, an elevated level of ketone bodies in the blood, a state called ketosis, leads to a reduction in the frequency of epileptic seizures . Clinical applications of KD, aside from epilepsy, include neurodegenerative disorders, such as amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, and Parkinson’s disease, and case reports and small case studies indicate improvement in patients with autism, depression, polycystic ovarian syndrome, and type 2 diabetes mellitus .
How about for cancer?
In theory, KD for cancer makes perfect sense. Cancer cells, compared to normal cells, cannot use ketones as an efficient energy source . KD protects normal cells from energy stress while depriving cancer cells of glucose. This diet forces cancer cells to employ a different type of metabolism (mitochondrial, or oxidative, metabolism) that induces metabolic stress. Mitochondrial abnormalities and genetic mutations make tumor cells particularly vulnerable to metabolic stress, which could then selectively sensitize cancer cells to conventional radiation and chemotherapies .
So what does the research show?
Currently, the University of Iowa, in collaboration with the National Institutes of Health (NIH) and National Cancer Institute (NCI), is investigating a phase I trial to see if KD during combined chemotherapy and radiation is safe and well-tolerated. Preclinical studies date back to 1987, when it was first shown that mice with colon adenocarcinoma on a KD had decreased tumor weight . Additional studies using KD in cancer reported reduced tumor growth and improved survival in animal models of brain cancer (malignant glioma), colon cancer, gastric cancer, and prostate cancer [6, 7]. KD may also increase the effects of radiation in certain types of brain cancer and lung cancer models [8, 9]. Fasting also induces a state of ketosis, the same effect as being on KD, and in pre-clinical cancer therapy models, was shown to enhance responsiveness to chemotherapy and possibly even reduce normal tissue side effects. In addition, fasting cycles were reported to slow tumor growth and sensitize a range of cancer cell types to chemotherapy .
Successful case reports include two female pediatric patients with advanced stage malignant astrocytoma with a 21.8% decrease in tumor SUV when fed a KD, determined by FDG uptake in PET scans  and a 65 year old female with glioblastoma multiforme treated with calorie-restricted KD with standard treatment .
On the contrary, diets high in sugar may play an adverse role in the progression of cancer. For example, epidemiological studies have shown that dietary sugar intake has a significant impact on the development of breast cancer, possibly through inflammation and in preclinical studies; dietary sugar seems to induce 12-LOX/12-HETE signaling (involved in the inflammatory cascade), increasing the risks of breast cancer development and metastasis .
Will anything bad happen on it?
It shouldn’t! A quality of life study in patients with advanced cancer found that KDs had no severe adverse effects and even improved emotional functioning and insomnia . Common early side effects from high fat intake include fatigue, stomach ache, acidosis, nausea, and vomiting, which could lead to dehydration and hypoglycemia or low glucose levels in children. Long-term side effects, only after a year on a KD, include high cholesterol levels, kidney stones, cardiomyopathy, and bone mineral loss . It is also important to take a multivitamin on it, as trace minerals like selenium, copper, and zinc, may be depleted.
What if I don’t have cancer? Should I still try this diet?
A ketogenic diet has been shown to be effective in other diseases. As mentioned above, it can help control childhood seizures in refractory epilepsy, treat obesity (think: Atkin’s diet), and may also play a beneficial role in slowing the progression of neurodegenerative disease. New case reports indicate improvement in patients with autism, depression, polycystic ovary syndrome (PCOS), and type 2 diabetes mellitus.
In general, a diet that is low in sugar and refined carbohydrates, and higher in healthy fats and vegetables is a healthier lifestyle choice. It will prevent sugar spikes, that cause high levels of insulin release after meals and then the sleepiness (“food-coma”) that shortly ensues, thereafter.
What does a day on a KD look like?
Sugar-Free: To Be or Not to Be?
Current research shows promise for a ketogenic diet and cancer, but a KD is by no means a cure, either alone or in combination with chemotherapy and radiation. Animal models of calorie restriction and KD have demonstrated reduced tumor growth with limited toxicity. Thus far, evidence in humans includes a potential role of a low-carbohydrate diet in preventing and treating malignant gliomas, breast cancers, colon cancers, and head and neck cancers. However, most studies so far come from non-randomized trials, while randomized controlled trials would be the gold standard for testing an intervention’s efficacy. In addition, applying dietary restrictions to cancer patients is complex, as incidence of malnutrition and cachexia is frequent. In these delicate patients, a balance between dietary restriction and nutritional support is paramount. To be safe, cancer patients should be advised to pursue a KD via participation in a clinical trial, under the watchful eye of a physician.
Overall, a low-sugar diet is a healthy lifestyle choice and a goal we should strive for daily. To put your body is ketosis, though, to treat disease such as cancer, should only be done with the approval and guidance of a physician, as some complications may arise.
Meanwhile check out CitySlim’s Recipes for healthy, balanced meal and snack choices.
1. Henderson, S.T. and J. Poirier, Pharmacogenetic analysis of the effects of polymorphisms in APOE, IDE and IL1B on a ketone body based therapeutic on cognition in mild to moderate Alzheimer's disease; a randomized, double-blind, placebo-controlled study. BMC Med Genet, 2011. 12: p. 137.
2. Freeman, J.M., E.H. Kossoff, and A.L. Hartman, The ketogenic diet: one decade later. Pediatrics, 2007. 119(3): p. 535-43.
3. Allen, B.G., et al., Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biol, 2014. 2: p. 963-70.
4. Seyfried, T.N., et al., Press-pulse: a novel therapeutic strategy for the metabolic management of cancer. Nutr Metab (Lond), 2017. 14: p. 19.
5. Tisdale, M.J., R.A. Brennan, and K.C. Fearon, Reduction of weight loss and tumour size in a cachexia model by a high fat diet. Br J Cancer, 1987. 56(1): p. 39-43.
6. Freedland, S.J., et al., Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis. Prostate, 2008. 68(1): p. 11-9.
7. Vergati, M., et al., Ketogenic diet and other dietary intervention strategies in the treatment of cancer. Curr Med Chem, 2017.
8. Fath, M.A., et al., Enhancement of carboplatin-mediated lung cancer cell killing by simultaneous disruption of glutathione and thioredoxin metabolism. Clin Cancer Res, 2011. 17(19): p. 6206-17.
9. Abdelwahab, M.G., et al., The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant glioma. PLoS One, 2012. 7(5): p. e36197.
10. Safdie, F.M., et al., Fasting and cancer treatment in humans: A case series report. Aging (Albany NY), 2009. 1(12): p. 988-1007.
11. Nebeling, L.C., et al., Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr, 1995. 14(2): p. 202-8.
12. Zuccoli, G., et al., Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond), 2010. 7: p. 33.
13. Jiang, Y., et al., A Sucrose-Enriched Diet Promotes Tumorigenesis in Mammary Gland in Part through the 12-Lipoxygenase Pathway. Cancer Res, 2016. 76(1): p. 24-9.
14. Schmidt, M., et al., Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial. Nutr Metab (Lond), 2011. 8(1): p. 54.
Broccoli pizzettas... doesn't get more healthy than this! Colorful, delicious, and nutritious, packed with essential vitamins and minerals, this is a dish for the whole family to enjoy.Read More
Patients and friends, alike, ask all the time, “What’s your favorite healthy snack? What do I eat when I want something sweet and savory?” Well, now you have it: Stuffed Dates!
With only 3 ingredients, this recipe is quick and easy to make with all whole-food ingredients. The sweetness of the dates will satisfy any sugar cravings, while the healthy fats from the almond butter and chopped pecans will quench your hunger and keep you feeling full longer.
So what are you waiting for? Let’s get to it…
- 5-10 Medjool dates (organic, if possible)
- Almond butter: crunchy, unsalted
- Handfull of chopped nuts*
*Your choice: pecans (my favorite), macadamia, almonds, or walnut
1. Slice dates down the middle with a knife. Remove pit.
2. Add small spoonful of almond butter to perfectly fill the date.
3. Sprinkle with your choice of chopped nuts: *pecans, walnuts, almonds, macadamia (and add to the plate, too, for garnish!)
See, there you have it. Healthy, savory, sweet, soft, and crunchy. Bam.
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With the weather cooling down, I wanted to find a way to make a warm, delicious, gooey brownie with the most wholesome, healthful ingredients possible. Avocado, rich in healthy fat, is not what you’d usually associate with “delectable dessert,” but this creamy vegetable actually substitutes greasy oils and fatty butters quite well!
For a chocolate substitute, I used carob powder, naturally caffeine-free, full of dietary fiber, to support digestive health and provide a sense of fullness, and made from the pods of an evergreen Mediterranean tree.
Growing up, warm brownies were always a favorite dessert of mine, but we always made them “from the box,” with tons of sugar already packed in the ready-to-bake powder mix and adding butter and oil. Now, I am thrilled to present you with these tasty Avocado carob brownies, also simple to bake, with less than 10 basic ingredients and only 10 minutes to prepare! All you need to do pour in all the ingredients to a bowl and mix. Of course, it is gluten-free, dairy-free, and free from refined sugar (although carob and maple syrup do contain natural sugars).
I hope you all LOVE these brownies! They are:
Easy to make
& Ideal for winter!
If you try this recipe, let me know! Leave a comment, rate it, and don’t forget to tag a picture #cityslim_md on Instagram. Cheers!
Delicious, gluten-free, dairy-free brownies made with 10 ingredients! Fluffy, gooey, perfectly sweet, SO delicious! Sprinkle with coconut and serve with strawberries for the ultimate winter treat.
· 2 avocados
· 3 large eggs
· 1/2 cup unsweetened applesauce
· 1/2 cup maple syrup
· 1/2 cup almond flour (or coconut flour)
· 1/2 cup unsweetened carob powder*
· 1/4 tsp sea salt
· 1 tsp baking soda
· 1 tsp vanilla extract
FOR SERVING optional
· Coconut flakes
1. Preheat oven to 350 degrees F.
2. In a blender or food processor combine avocado, applesauce, maple syrup and vanilla.
3. Add these ingredients to a large bowl and whisk in eggs.
4. Add in almond flour, carob powder, sea salt and baking soda and stir until well-combined.
5. Grease an 8 x 8 inch baking dish with coconut oil and add batter.
6. Place in oven to bake for 25 minutes (slightly less for fudgier brownies or slightly longer for more cake-like brownies).
7. Allow to cool for 20 minutes before cutting into 16 brownies.
8. Sprinkle with coconut flakes on top.
You can also mash these together by hand but make sure that you mash it up very well and there are no clumps.
Keep them on the counter in an airtight container at room-temperature for up to 2 days or for a longer shelf-life store in the fridge or freezer.
* For those chocolate fiends out there (you know who you are!), fear not. You may substitute the carob powder for cocoa powder, should you desire! The amount stays the same and the recipe maintains its integrity. Cocoa powder is filled with antioxidants but also contains a natural caffeine.
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