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Digestivewellness

take control of your digestive

healthPGA’s Heath Slocum talks about his triumph over IBD.

photo: SAM greeNwood/getty iMAgeS/pgA toUr

no.3/June 2010we make our readers succeed!

dining out take control of meals outside of the house

food bacteria Cultivate the beneficial bugs in your system

eASy wAyS to imProve diGeStion

And feel GreAt

PGA’s Heath Slocum

3tiPS

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to USA todAy2 · jUNe 2010


challenges

a new understanding means new hope for many

Digestive problems span a wide range of common symptoms, impacting all parts of the alimentary tract—from the mouth, esophagus, and stomach down to the colon and rectum, as well as the liver, gallbladder and pancreas.

Most Americans have experi-enced minor d i g e s t i v e s y m p t o m s , such as occa-sional heart-

burn, indigestion, gas, constipation, diarrhea, or even a food borne illness. In fact, the most common gastroin-testinal problems seen at most doc-tor’s offices include acid reflux or GERD, chronic constipation, irritable bowel syndrome (IBS), hemorrhoids, abdominal pain related to diverticu-lar disease. Gallstones are one of the most common reasons for surgery. Cancers of the digestive system, including colorectal cancer which is the second leading cause of cancer death, contribute to the burden of digestive illness in the United States.

the front lineGastroenterologists are on the front line in diagnosing and treating diges-tive disorders. Whether you have a functional illness such as GERD, IBS or chronic constipation, or a chronic liver disease such as hepatitis B or C, a gastroenterologist can help. Inflam-matory bowel disease, which includes ulcerative colitis and Crohn’s disease, impacts the health and quality of life of millions of Americans.

The epidemic of obesity in the United States takes its toll on the organs of the gastrointestinal tract,

increasing the risk for serious prob-lems such as esophagus cancer, gallbladder disease, pancreatic and colon cancers. Fortunately, colorectal cancer is one of the most prevent-able cancers. The American College of Gastroenterology has promoted the importance of screening for this potentially deadly disease and believes that colonoscopy is the pre-ferred strategy.

new horizons of treatmentA promising and exciting recent development in digestive health is a new understanding of and appre-ciation for the importance of bacteria inside the gut, know as “gut flora.” Researchers now see the environ-ment inside the small and large intestine as its own miniature “eco-system.” A balance of good and bad gut bacteria impacts health, immu-nity, and even body fat composition by affecting metabolism. As experts learn more about the colonization of bacteria in the GI tract, new horizons will open for potential treatments. The use of probiotics and functional foods to improve digestive function is just one example.

While digestive disorders are very common, and a frequent reason for doctors’ visits and hospitalizations, we are making significant progress in this country. The introduction of new drugs, vaccines, diagnostic tools and minimally invasive proce-

dures to treat and prevent diseases of the digestive system is an active and flourishing field. New clinical advances are happening all the time, and there is reason for hope for many who suffer with digestive problems.

As you read about some of the issues and challenges in digestive health and identify with the symp-toms or have frequent, unresolved problems, don’t let embarrassment or fear keep you from getting the answers you need. See your doctor and find out if a gastroenterologist is needed.

The content in this special advertising section was not developed by Dr. Katz or the Albert Einstein College of Gastroenterol-ogy. Dr. Katz or the Albert Einstein College of Gastroenterology does not endorse any of the advertisers appearing within this spe-cial advertising section.

Philip o. Katz, md, fACGpresident, American College of gastroen-terology; Chairman, division of gastroen-terology Albert einstein Medical Center

1 Heartburn is a common, but not trivial, condition. Persis-

tent symptoms of heartburn or reflux should not be ignored. If you experience heartburn two or more times a week, or still have symptoms on your medications, see a doctor.

2 If you have recurring diar-rhea and/or constipation that

is frequently associated with abdominal discomfort and/or bloating, or constipation alternat-ing with diarrhea, you may have Irritable Bowel Syndrome. See your doctor or a gastrointestinal specialist to evaluate your symp-toms.

Learn more at:www.acg.gi.org/patients

my best tips

“high quality nutrition that supports digestive health is most easily achieved by choosing a plant-based diet of whole, unprocessed foods.”

We recommend

pAge 4

Heartburn control p. 41. what to do and when to seek help for those suffering from heartburn.

diet and iBS p. 72. foods to alleviate your ibS symptoms.

digestive Wellness3rd edition, June 2010

Country manager: Kayvan [email protected] manager: jackie [email protected] manager: Carrie [email protected]

responsible for this issuePublisher: joseph [email protected] Contributors: Cindy heroux, rd

distributed within: USA todAy, june 2010. this section was created by Mediaplanet and did not involve the USA todAy or its editorial departments.photo credits: istockphoto.com unless otherwise noted

we make our readers succeed!

Mediaplanet’s business is to create new customers for our advertisers by providing readers with high-quality editorial content that motivates them to act.

digestive health means more than having an iron stomach and being able to eat what-ever you want. it means keep-ing an intricate and complex system of cells, organs and tissues in good working order, so that system can in turn, keep you alive.

Sound a bit dramatic? When you real-ize the many roles your digestive sys-tem plays in health, saying your life depends on keeping it healthy may actually be an understatement.

nourishing your body Every cell in your body is built, main-tained, repaired and fueled by the foods you eat. Successfully extract-ing and absorbing needed nutrients from food, and managing the waste that’s left over, requires that your

digestive system be healthy enough to perform a host of mechanical and chemical steps from masticating and grinding to producing hormones, enzymes and controlling acids.

Without a healthy digestive sys-tem, your body simply can’t get the nutrients it needs to survive and thrive. Your brain can’t think, your heart can’t pump, and damaged parts can’t heal.

your personal department of defenseWith a significant portion of your immune function housed in your gut, your digestive system is also responsible for protecting your body from harm.

Acting as a selective barrier, your GI tract separates substances your body needs from those that should be excreted and prevents harmful

organisms and toxins from entering your body. Toxins that evade this first line of defense pass to another part of your digestive system, the liver, where further detoxification takes place. Specialized cells in the gut work to neutralize or destroy invad-ers, while others “teach” the rest of your immune system to distin-guish friend from foe. An unhealthy digestive system compromises your whole body’s defenses.

With so many important func-tions at stake, it’s no wonder the health of your body depends in great measure on the health of your diges-tive system.

what is digestive healthdigestive health■ Functional Gastrointestinal Disorders affect two of every five Americans at an annual cost of over $30 billion dollars.

■■ Dyspepsia (indigestion, heart-burn), abdominal pain, con-stipation, and Irritable Bowel Syndrome are some of the most common functional GI disorders.

■■ Gastric acid has a pH of approxi-mately two, slightly higher than battery acid and slightly lower than vinegar. A mucous lining protects the stomach from acid damage.

food and digestionhow to incorporate the right kinds of foods into your diet for better digestive wellness.

cindy heroux, rd

[email protected]

Know your SyStem

Know your

1tiP

keep this in mind

PArtiCiPAntSGathering at the annual CCfA “take Steps, Be Heard” walk.Photo: Private

“without a healthy diges-tive system, your body

simply can’t get the nutrients it needs to survive and

thrive.”



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the importance of diet and nutrition

■■ Question: what should i eat to preserve my digestive wellness?

■■ Answer: A nutritious, plant-based diet, dietary fiber and fermented foods all contribute to digestive health.

In addition to a constant flow of nutrients, your GI tract also has some special needs. If these are not met, the gut fails to function properly and your whole body can pay the price.

High quality nutrition that sup-ports digestive health is most easily achieved by choosing a plant-based diet of whole, unprocessed foods.

why plant based?Studies have shown a link between red meat, processed meat and colon cancer. A recent study conducted by

the Harvard School of Public Health also linked processed meats to an increased risk of heart disease and diabetes.

Plants provide lots of nutrition per calorie, are loaded with antioxidants and phytochemicals, and are the only source of dietary fiber, one of the most important foods for a healthy digestive system.

why is fiber important? Like aerobics for your intestines, fiber keeps everything moving. It absorbs water and expands, soften-ing your stools and stimulating the muscles of your GI tract to contract. It helps lower your cholesterol and provides nourishment for the bil-lions of healthy bacteria that dwell in your gut.

Experts recommend consuming 25–35 grams of fiber per day, but few people get that much. “It’s alarming

that so many individuals fail to meet the recommended daily intake,” says Robin Plotkin RD, a culinary & nutri-tion expert based in Dallas, TX. “It’s not that difficult. When I tell people that there are eight grams of fiber in a cup of raspberries, and two hand-fuls of pistachios contain nearly three grams of fiber, they breathe a sigh of relief as if to say, ‘It’s not going to be as hard as I thought.’”

Probiotics and prebioticsFriendly bacteria (probiotics) and the fibers that nourish them (prebiotics) are critical to the health of your gut. “These bacteria offer many benefits,” explains Jo Ann Hattner, MPH, RD, nutrition consultant at Stanford Uni-versity Medical School and author of Gut Insight, probiotics and prebiotics for digestive health and well-being. “They protect the gut by creating an envi-ronment that is detrimental to dis-

ease causing bacteria. Plus, improved mineral absorption and enhanced immune function contribute to well-ness.”

The best sources of probiotics are fermented foods such as yogurt, kim-chi and miso. “For centuries people have been adding live cultures to foods to provide health benefits,” says Jo Ann. “But it’s only through looking at the science of gut flora that we’ve begun to really appreciate the value of fermented foods in pro-moting health.”

A word of caution: Drink plenty of water and introduce or increase your intake of fiber and probiotics gradu-ally. Your body needs time to adapt to these gut healthy foods.

cindy heroux, rd

[email protected]

a neW approach

Quantity makes a differenceProtecting your digestive health can be a lot more challenging when you’re dining away from home. Many restaurant meals are too large, too high in fat and don’t contain enough fiber. To help you make the healthiest choices, Joanne “Dr. Jo” Lichten, PhD, RD, author of Dining Lean—how to eat healthy when you’re not at home offers the following suggestions.

Control portion size: ■ Order appetizers or small plates instead of an entrée

■■ Share an entrée with a friend■■ Ask for a doggy bag with your

dinner and immediately put half in the box and eat just half. Out of sight, out of mind.

Get enouGH fiBer

Get enouGH

2tiP

best tips

■■ Question: Are common digestive problems such as heartburn and abdominal pain symptoms of a serious health condition?

■■ Answer: possibly. occasional gastrointestinal discomfort is quite common and can usually be resolved with simple lifestyle changes or over-the-counter medications.

Digestive difficulties affect two out of every five Americans, including children. Here is one of the most common and what you need to know.

HeartburnThe lower esophageal sphincter is supposed to allow food to pass into the stomach while preventing pow-erful stomach acids from rising into the esophagus. If you experience

burning in your chest, especially following a large meal or when lay-ing down, this sphincter may not be working properly.

To prevent the discomfort of occa-sional heartburn, eat smaller meals, avoiding eating two to three hours before sleep, stop smoking and lose excess weight. Over-the-counter antacid medication can also help control symptoms.

If your heartburn is frequent or persists, it might be indicative of Gastroesophageal Reflux Disease (GERD) a serious condition that can lead to damage or even cancer of the esophagus. If you think you may have GERD, talk to your doctor.

heartburn: what to do and when to seek help.

cindy heroux, rd

[email protected]

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to USA todAy jUNe 2010 · 5


news

tHe Good BACteriAmicroorganisms are necessary to maintain a healthy digestive tract and a balanced immune system.

take control of meals outside the houseKeep fat under control: ■ Request the chef NOT pour on butter just before serving your meat, fish or chicken. That’s what makes the fajitas sizzle when they are served. Skip the sizzle and feel less bloated.

■■ Limit fried foods. Choose baked, steamed or grilled instead

■■ Ask for your vegetables, includ-ing potatoes to be served with but-ter, sauces or toppings on the side; same with salad dressing.

■■ Cut out the mayo. It contains 100 calories a tablespoon (many sandwiches serve 2 tablespoons). Choose mustard, ketchup or relish instead.

■■ Ask for your coffee beverage to be made with nonfat milk and skip the whipped cream

up your fiber intake: ■ Substitute a salad or fresh fruit for French fries

■■ Request vegetables. Even if they’re not on the menu they’re often available.

■■ Take the baked potato instead of rice or noodles

■■ Request brown rice. Many res-taurants now offer it.

■■ Ask for more vegetables to be added to any stir-fry dish. They are preparing it to order, so it’s no big deal.

best tips

“friendly” bacteria, known as probiotics, are essential to your well-being. these natural inhabitants of your gut improve digestion, provide important nutrients to your body, stimulate immune sys-tem development, and inhibit the growth of pathogenic microorganisms that could otherwise make you sick.

Unfortunately, these indispensible contributors to your health are eas-ily destroyed by antibiotics, alcohol, chemicals in food and water, and other, not-so-friendly microorgan-isms. To protect the health and func-

tionality of your gut it’s important to continually replenish helpful bacte-ria either through the consumption of fermented foods such as sauer-kraut, kimchi and kefir or with probi-otic dietary supplements.

not all probiotics are created equalThere are many species and strains of probiotics and the effects of one may be quite different from the effects of another. That is why consuming probiotics from a variety of sources can be helpful. Quantity is also important. According to Frank Hodal, founder and CEO of Vidazorb, makers of chewable probiotic supplements, at least 1 billion live organisms are

necessary for a therapeutic dose. Creating a supplement that con-

tains a sufficient quantity of the right organisms and keeping them alive is no easy task. Tests have shown that many products contain few, if any live strains despite what is listed on the label. Without proper production, careful transportation and consistent storage, many probiotics, especially those that require refrigeration, sim-ply cannot survive. “We quickly real-ized that a reliable product needed to meet rigorous criteria, says Frank. “It took us seven years of research using independent testing to develop a product that was effective, consistent in quality, didn’t require refrigeration and also tasted great”

what the Science SaysWhile the role of probiotics in pro-moting health is well established and there is significant evidence to support their use in treating intes-tinal problems such as diarrhea, the evidence for their use in treating diseases is encouraging, but incom-plete. Check with your doctor before using probiotics for young children, elderly people, and people with com-promised immune systems.

Probiotics: Beneficial bugs

cindy heroux, rd

[email protected]



insPiration

a champion battles iBD

Today, Heath Slocum—one of America’s top golfers—is the picture of health, but when he was just 23 an unexpected illness almost ended his dream of ever making the PGA TOUR.

“ifirst became aware some-thing wasn’t right while playing mini-tours,” says Heath. “I felt tired and noticed a change in my stools, but I really didn’t think much about

it. I was young and had always been healthy.” When he woke up not feel-ing well on Thanksgiving morning 1997, he still didn’t realize some-thing was seriously wrong. However, when his gastrointestinal symp-toms persisted for 3 days, he finally saw a doctor.

At least it has a name…“I had no idea what UC even was,” says Heath, “but I was relieved to at least have a name so I could figure out what to do next.”

Heath learned how painful and debilitating Ulcerative Colitis (UC) could be, and how frequent bouts of diarrhea could make normal activi-ties difficult. He was disheartened to realize that this was a disease he could have for the rest of his life, but

one of Heath’s greatest strengths, both on and off the golf course, has always been his positive attitude.

“I decided I was going to hit this head on,” says Heath. “But I was in for a big surprise when eight or nine months down the road I had gotten worse not better. It was very testing to say the least.”Heath’s condition continued to worsen. He hardly left the house and required IV therapy to remain hydrated. He tried to play golf, but often couldn’t even make it to the course. “I would have to pull over somewhere to find a bathroom,” says Heath. “Once it hit, I was done. I would just go home and cower in the house for a while.”

turning a cornerIt was a very dark time in his life, but Heath never gave up. Like a true competitor, he simply adjusted his game. With a new physician, new medications and a renewed sense of determination, 18 months into his illness Heath’s health finally turned a corner and he began to improve.

Looking back, Heath is grateful for the support of friends and fam-ily, and reflects on the positive effect his illness had on his life. “I would not be a 3-time Champion on the PGA TOUR without that experience,” says Heath. “It was brutal, but it put things in perspective. It made me a stronger person and a better golfer.”

Drawing on that strength, Heath has had the courage to take this very private issue public as a spokesper-son for The Crohn’s & Colitis Founda-tion of America (CCFA). He has been instrumental in drawing attendance at CCFA fundraiser golf tourna-ments in cities around the country, recorded a series of public service announcements available on ccfa.org, and served as a motivational speaker to raise both awareness of IBD and the spirits of those affected by these diseases.

pro athlete

Constipation■ Constipation is one of the most common but least discussed GI complaints. “It’s time to bring con-stipation out of the closet and talk about it,” says Mitzi Dulan, RD, CSSD, America’s Nutrition Expert, and co-author of The All-Pro Diet. “Don’t be embarrassed! With over four million Americans suffering from frequent constipation, you need to know there is help.”

■■ Defined as having a bowel movement fewer than three times per week, constipation can often be resolved by eating more fiber, drinking more fluids and increas-ing physical activity. When life-style changes aren’t enough, digestive health products can help.

■■ “With numerous digestive health products out there to offer relief, choose the one that’s right for you,” says Mitzi. Visit getcon-stipationrelief.com for informa-tion to treat constipation.

■■ If constipation becomes chronic or is accompanied by bouts of diarrhea, bloating and pain, it might be a symptom of Irritable Bowel Syndrome (IBS). You should see your doctor to have these symptoms evaluated.

cindy heroux, rd

[email protected]

Heath Slocumtop-rated pgA tour golfer dealing with and taking care of of his ibd. photo: Caryn Levy/getty images/pgA tour

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fast facts

what is iBd? ■■ Inflammatory Bowel Disease

refers to Crohn’s disease and Ulcerative Colitis: two distinct dis-eases that cause inflammation of the GI tract. what causes it? ■ That is uncertain, however most experts believe that an abnormal response by the body’s immune system is involved. who is affected? ■ An estimated one million Americans are affected by IBD. It is usually diagnosed in people under 30 but it can occur at any age. what are the symptoms? ■ IBD can cause pain, cramping, diarrhea, intestinal sores or ulcers, rectal bleeding and weight loss. Crohn’s disease can also cause fis-tulas, abscesses and stricture—a narrowing of the intestines.

SuPPort SyStemiBd affects more than just the individual. family can be a great source of support when strug-gling with ulcerative Colitis. Photo: Kevin C. Cox /Getty images /PGa tour

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to USA todAy jUNe 2010 · 7


Question 1:What effects can outside influences like stress and anxiety have on healthy digestion?

Question 2:How important a role does food play in digestive wellness?

Question 3:How important is early detec-tion for the succesful treat-ment of digestive issues like frequent heartburn, IBS, and IBD?

your diet plays a critical role in your diges-tive wellness and should be a top priority. Make sure you are drinking plenty of water through-out the day. You want to eat a varied diet with plenty of fruits and vegetables. You should also choose whole grains to boost the fiber and over-all nutrition.

A healthy diet is important for normal func-tioning of the gastrointestinal tract. People who do not consume fruits and vegetables on a daily basis can suffer from constipation and develop gastrointestinal problems, such as diverticulosis. The most common problem with digestion, milk (lactose) intolerance, is associated with symptoms of bloating, abdomi-nal cramping, diarrhea, nausea and vomiting. While food allergies are relatively uncommon in the general population, they can be consid-ered in people who have digestive complaints.

one has only to talk to sufferers from com-mon intestinal ailments like IBS to understand the critical role of food in digestive wellness. Along with stress, eating is the most common factor which leads to the onset or worsening of symptoms. Several factors are at play; the size and composition of meals, the amount of liq-uid consumed, the fiber content and the meal’s ability to interact with the bacteria population of the gut. There is increasing evidence that certain probiotic bacteria can alleviate diges-tive upset.

early detection of digestive issues such as IBS and heartburn is key to dealing not only with the condition, but also in helping to avoid side effects such as constipation. Ideally, your doctor can create a sound medical plan to man-age your condition and keep symptoms under control, as well as minimize and even eliminate side effects.

early detection by a healthcare provider of gastrointestinal disorders can lead to quicker initiation of treatments and improvement in quality of life. In patients with heartburn, early treatment can decrease the risk of finding ero-sions on upper endoscopy. For patients with IBS, early detection can lead to earlier improve-ment in symptom relief and quality of life. A website, which helps identify symptoms of IBS, is LetsTalkIBS.com. In patients with IBD, early treatment can lead to a decreased risk of subse-quent complications.

early detection is critical in the case of heartburn. There are very effective treatments available that can prevent infrequent or more advanced manifestations of the disease process that cause heartburn: gastroesophageal reflux disease (GERD). Similarly, early detection and treatment of IBD, where several effective treat-ments are available, can halt progression and the development of complications. With IBS, early, confident diagnosis coupled with under-standing and appropriate advice and manage-ment can completely transform the situation for the patient.

Stress and anxiety can both negatively impact digestive health by worsening many digestive conditions, including constipa-tion, IBS and Crohn’s Disease; however, the exact cause of many digestive issues remains unknown. While stress interferes with healthy digestion in a number of ways stress reduction and relaxation promote healthy digestion.

everyone reacts to stress differently. For unclear reasons, stress can be associated with diarrhea, constipation, abdominal pain, and/or other upper digestive tract symptoms, includ-ing heartburn. While there is no evidence that stress or anxi-ety directly causes conditions such as irritable bowel syndrome (IBS) or other digestive prob-lems, stress can certainly exacerbate symp-toms in patients with digestive disorders. Ulti-mately, treatment of underlying anxiety may help with improvement of gastrointestinal symptoms. Information about IBS symptoms is available at StartTalkingIBS.com.

one only has to recall the “intestinal hurry” encountered before an interview or a stress-ful presentation to understand how potently stress can influence digestive function. Indeed, these effects reflect the importance of the “brain-gut axis,” a two-way line of communi-cation between the brain and the gut which allows the brain to influence gut function and the gut to let the brain know when something is amiss. Extensive research has demonstrated that various stresses can disrupt or even, in some instances, shut down gut activities.

the irritable Bowel Syndrome Self Help and Support Group is an award-winning online community dedicated to help-ing everyone who suffers from irritable Bowel Syndrome (iBS) through patient commu-nication, support, treatment, accurate information and education since 1987.

Irritable Bowel Syndrome is a func-tional bowel disorder of the gastro-intestinal (GI) tract characterized

by alterations in bowel function, diarrhea, constipation or a combina-tion of both. For people with diges-tive systems that work smoothly, foods are not feared and a person can feel free to eat almost anything they want. Individuals with Irritable Bowel Syndrome do not have that luxury. A sensitive GI tract requires that care be taken with the food that is to pass through. The simple act of eating can become quite a challenge. Diet tends to be a confusing issue for IBS sufferers. Although there is nei-

ther evidence nor a specific IBS diet recommended, there are some foods that may aggravate the symptoms. Generally though, it may be the act of eating in itself, due to normal or perhaps pronounced stimulation of the digestive system, which may cause the bowel to overreact to food. IBS suffers have been shown to have an enhanced response in the diges-tive system due to stimuli, referred to as hypervisceral sensitivity. Some suggest eating smaller meals spread throughout the day rather than

larger meals which tend to cause an enhanced gut response. IBS sufferers should speak to their physician or a dietitian about their diet and how it may impact their symptoms. Work-ing together with a physician or dietitian will help them maintain a

balanced diet while perhaps easing some of their IBS discomfort. Keep a Personal Symptom Journal of what you eat and whether you experience symptoms after eating and discuss this with your physician or dietitian.

Panel of exPertseamonn Quigley, md, fACGrepresentingproctor & gamble

mitzi dulan, rdrepresentingpurdue pharmaceuticals

lauren Gerson, md, mScrepresentingtakeda pharmaceuticals

Diet and irritable Bowel syndrome

Jeffrey d. roberts, msed, bsc

[email protected]

Jeffrey d. roberts, mSed, Bscpresident and founder ibS Self help and Support groupwww.ibsgroup.org

wAtCH wHAt you eAt

wAwAw tAtA CH wHAt HAt HA

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Our services include: ■ Gastroenterology consultations and

colorectal cancer screenings■ Women’s Digestive Health program■ Nutrition and weight management

consultations■ Road to Wellness program for cancer

patients, survivors and caregivers ■ Acupuncture, therapeutic massage,

and mind-body therapies

Linda Lee, m .m .Director, The Johns Hopkins Integrative Medicine & Digestive Center

The Johns Hopkins Integrative Medicine & Digestive Center2360 West Joppa Road Suite 200Lutherville, MD 21093

Call 410-828-3585 or visit www.hopkinsintegrative.org

Managing and treating digestive disorders requires an innovative approach. At the Johns Hopkins Integrative Medicine & Digestive Center, our specialists bridge modern medicine and other healing methods to promote health and help anyone with chronic symptoms achieve a better quality of life.

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AN iNdepeNdeNt SUppLeMeNt froM MediApLANet to USA todAy...

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Transcript of AN iNdepeNdeNt SUppLeMeNt froM MediApLANet to USA todAy...