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Test Number : ARDMS
Test Name : American Registry for Diagnostic Medical Sonography
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ARDMS test Format | ARDMS Course Contents | ARDMS Course Outline | ARDMS test Syllabus | ARDMS test Objectives

Anatomy, Perfusion, and Function (30%)
Assess physical characteristics of anatomic structures
Assess perfusion and function of anatomic

Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy (42%)
Assess anatomic structures for pathology
Assess anatomic structures for vascular
Assess anatomic structures for trauma-related
Assess aspects related to postoperative anatomy

Abdominal Physics Apply concepts of equipment/image optimization
Apply concepts of imaging artifacts 8%

Clinical Care, Practice, and Quality Assurance (20%)
Incorporate clinical data with performed study
Incorporate clinical standard/guidelines with
performed study
Obtain accurate measurements
Assist/support during procedures

Anatomy, Perfusion, and Function
Knowledge and/or skill related to anatomy, perfusion,
and function
1.A. Assess physical characteristics of anatomic structures (normal anatomy, anatomic variants, congenital anomalies)
1.A.1. Biliary system Knowledge of normal anatomy, anatomic regions, and anatomic variants
Knowledge of sonographic appearance of anatomic structures
Ability to recognize and utilize anatomic landmarks in obtaining and documenting diagnostic images
Ability to recognize and apply proper scan technique in obtaining and documenting diagnostic images
1.A.2. Breast
1.A.3. Chest
1.A.4. Liver
1.A.5. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
1.A.6. Pancreas
1.A.7. Penis
1.A.8. Peritoneal cavity (including: stomach, bowel, appendix)
Ability to recognize, evaluate and document congenital anomalies
1.A.9. Prostate
1.A.10. Retroperitoneum (including: great vessels & branches)
1.A.11. Scrotum
1.A.12. Spleen
1.A.13. Superficial structures (for example:abdominal wall & subcutaneous tissue)
1.A.14. Urinary system
1.B. Assess perfusion and function of anatomic structures
1.B.1. Biliary system Knowledge of normal vascular anatomy and hemodynamics
Ability to recognize appearance of normal vascular flow patterns
Ability to recognize and utilize anatomic landmarks in evaluating and documenting perfusion and function
Ability to recognize and apply proper scan technique in evaluating and documenting perfusion and function
1.B.2. Chest
1.B.3. Liver
1.B.4. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes)
1.B.5. Penis
1.B.6. Peritoneal cavity (including: stomach, bowel, appendix)
1.B.7. Prostate
1.B.8. Retroperitoneum (including: great vessels & branches)
1.B.9. Scrotum
1.B.10. Spleen
1.B.11. Superficial structures (for example: abdominal wall & subcutaneous tissue)
1.B.12. Urinary system 2. Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy
Knowledge and/or skill related to pathology, vascular abnormalities, trauma, and postoperative anatomy
2.A. Assess anatomic structures for pathology
2.A.1. Abdominal wall for hernia (for example: ventral, inguinal, incisional)
Knowledge of etiology/pathophysiology of abnormal perfusion and function
Ability to recognize ultrasound findings related to abnormalities of anatomy, perfusion, and function in obtaining and documenting diagnostic images
Ability to recognize and apply proper scan technique in evaluating and documenting pathology
Ability to recognize foreign bodies, infection, fluid, masses, etc.
Knowledge of hernia types and their sonographic appearance
2.A.2. Adrenal glands for masses, hemorrhage, etc.
2.A.3. Biliary system for infection, masses, metastatic disease, obstructions, etc.
2.A.4. Breast for infection, abscess, masses, etc.
2.A.5. Chest for fluid, masses, etc.
2.A.6. Gastrointestinal system for masses, obstruction, pyloric stenosis, intussusception, etc.
2.A.7. Joints for abnormalities (for example: fluid)
2.A.8. Liver for hepatitis, fatty infiltration, cirrhosis, neoplasm, abscess, cyst, etc.
2.A.9. Neck (including: thyroid, parathyroid, salivary glands, lymph nodes) for diffuse parenchymal disease, inflammation, masses, etc.
2.A.10. Pancreas for infection, masses, obstruction, etc.
2.A.11. Penis for abnormalities
2.A.12. Peritoneal cavity (including: stomach, bowel, appendix) for fluid
2.A.13. Popliteal fossa for abnormalities (for example: masses, fluid)
2.A.14. Prostate for parenchymal disease or masses (for example: benign prostatic hypertrophy)
2.A.15. Retroperitoneum (including: great vessels & branches) for fibrosis, lymphadenopathy, etc.
2.A.16. Scrotum for fluid, hernia, masses, infection, parenchymal disease, etc.
2.A.17. Spleen for splenomegaly, parenchymal changes, masses, etc.
2.A.18. Superficial structures (for example: abdominal wall, subcutaneous tissue)
for foreign bodies, infection, fluid, masses, etc.
2.A.19. Urinary system for masses, obstruction, parenchymal disease, infection, etc.
2.B. Assess anatomic structures for vascular abnormalities
2.B.1. Liver for Budd-Chiari syndrome, arteriovenous fistula, portal vein thrombosis, collateralization, etc.
Knowledge of anatomic and vascular changes associated with vascular abnormities
Knowledge of sonographic findings associated with vascular abnormalities
Ability to recognize and apply proper scan technique in evaluating and documenting vascular abnormalities
2.B.2. Retroperitoneum (including: great vessels and branches) for aneurysm, dissection, thrombus, etc.
2.B.3. Scrotum for torsion, varicocele, etc.
2.B.4. Spleen for infarction, hemangiomas, etc.
2.B.5. Urinary system for renal artery stenosis, arteriovenous fistulas, etc.
2.C. Assess anatomic structures for trauma-related abnormalities
2.C.1. Hepatic system Knowledge of sonographic appearance as a result of trauma
Ability to rapidly prioritize and evaluate sonographic findings due to trauma
Ability to perform focused assessment for free fluid following a traumatic event
Ability to recognize and apply proper scan technique in evaluating and documenting trauma
2.C.2. Penis
2.C.3. Scrotum
2.C.4. Spleen
2.C.5. Superficial structures (for example: abdominal wall, subcutaneous tissue)
2.C.6. Urinary system
2.C.7. Focused assessment for free fluid related to traumatic events
2.D. Assess aspects related to postoperative anatomy
2.D.1. Anatomy of transplanted organs Knowledge of hemodynamics of transplanted organs
Knowledge of common causes of transplant failure
Ability to recognize signs of rejection
Ability to adjust scan technique based on patient condition and surgical history
Ability to distinguish characteristics of common anastomosis sites
Ability to recognize fluid collections
Ability to interpret and integrate surgical history with sonographic findings
Knowledge of surgical procedures used in organ transplant
Knowledge of surgical zones of the neck
Ability to evaluate and document findings within surgical zones of the neck
Knowledge of patterns and sonographic appearance of disease recurrence
Ability to evaluate transjugular intrahepatic
portosystemic shunts (TIPS)
Ability to recognize and apply proper scan technique in evaluating and documenting postsurgical findings
2.D.2. Perfusion and function of transplanted organs
2.D.3. Complications related to organ transplants
2.D.4. Abnormalities in postsurgical anatomy
2.D.5. Abnormalities in postsurgical breast
2.D.6. Abnormalities (for example: recurrent disease, lymphadenopathy) in postsurgical neck
2.D.7. Implanted medical devices (for example: transjugular intrahepatic portosystemic shunt [TIPS])
3. Abdominal Physics Knowledge and/or skill related abdominal physics
3.A. Apply concepts of equipment/image optimization
3.A.1. Use appropriate transducer (for example: curvilinear, linear, phased array)
Ability to select the appropriate transducer and machine presets based on body habitus
Ability to use acoustic windows creatively to optimize visualization
Ability to adjust machine settings to maximize penetration while minimizing resolution loss
Knowledge of appropriate application of Doppler techniques
Ability to manipulate color, power, and pulsed wave settings to accurately display and measure blood flow
3.A.2. Use two-dimensional, real-time, grayscale imaging (for example: B-mode, compound, harmonic)
3.A.3. Use Doppler (for example: color, power, pulsed wave)
3.B. Apply concepts of imaging artifacts
3.B.1. Assess artifacts of gray-scale imaging (for example: shadowing, resonance, comet tail)
Ability to recognize artifacts and correlate them with anatomy and pathology
Ability to manipulate machine settings to enhance or
3.B.2. Assess artifacts of Doppler imaging minimize artifacts (for example: twinkle, spectral broadening)
4. Clinical Care, Practice, and Quality Assurance
Knowledge and/or skill related to clinical care, practice, and quality assurance
4.A. Incorporate clinical data with performed study
4.A.1. Assess indications for examination requested
Knowledge of appropriate indications and contraindications for a specific test and/or procedure
Knowledge of potential effects of patient medications on an test or procedure
Knowledge of lab values relevant to specific examinations
Ability to obtain and evaluate patient history relevant to the exam
Ability to assimilate patients signs and symptoms and modify the exam/or describe the findings
Ability to modify the test based on information from other modalities
Ability to localize pathology for sonographic correlation
Ability to modify the test based on real-time findings
Knowledge of modalities associated with the test being performed
Ability to utilize resources, such as physicians, literature, or peers
4.A.2. Assess relevant clinical lab values for examination being performed
4.A.3. Assess relevant family history and patient signs/symptoms for examination being performed
4.A.4. Correlate ultrasound findings with previous imaging results
4.A.5. Evaluate images from other imaging modalities (for example: computed tomography, magnetic resonance imaging, nuclear medicine, x-ray)
4.B. Incorporate clinical standard/guidelines with performed study
4.B.1. Communicate effectively with the patient, physician, and others, including communication of findings that require immediate action
Ability to communicate with patient in a professional and appropriate manner to effectively explain procedures, deal with inappropriate behavior, and engage patient cooperation
Ability to communicate using appropriate medical terminology
Ability to modify test preparation, patient position, and/or image acquisition based on patient condition and/or sonographic findings
Ability to recognize findings and/or situations that require immediate action and respond effectively
Knowledge of appropriate patient preparation for an test and knowledge of factors that may affect patient preparation (for example: patient history, patient condition, sequencing requirements of multiple modality exams)
4.B.2. Inform patient or referring practitioner of examination preparations (for example: fasting for biliary imaging)
4.B.3. Maintain and protect patient confidentiality/privacy
4.B.4. Modify the examination based on patient condition and/or sonographic findings
4.B.5. Use multiple patient positions and scan planes to evaluate anatomic structures
Knowledge of sonographer scope of practice and regulations regarding patient information and interactions
4.C. Obtain accurate measurements
4.C.1. Obtain measurements of anatomic structures
Knowledge of normal measurement ranges
Knowledge of proper techniques for measuring anatomic structures
Knowledge of hemodynamics
Knowledge of normal and abnormal Doppler waveforms
Ability to analyze Doppler measurements
Ability to distinguish artifacts from real blood flow
Ability to apply knowledge of measurement techniques (for example: Doppler and gray-scale)
4.C.2. Obtain measurements of Doppler waveforms
4.D. Assist/support during procedures
4.D.1. Obtain consent form and patient lab results prior to the procedure
Knowledge of sonographer's role in obtaining consent
Ability to verify and document patient consent
Ability to verify correct patient, side (laterality), and site
Knowledge of contraindications for specific procedures
Knowledge of proper safety precautions in interventional procedures
Knowledge of equipment and materials used for a specific procedure
Knowledge of interventional procedures and sonographer's role
Knowledge of protocols during surgical procedures, related to the sonographer's role
Ability to adapt protocol due to different circumstances
Ability to optimally display the needle path and tip
Ability to recognize implanted medical devices
Knowledge of potential post-procedural complications
4.D.2. Provide ultrasound guidance for procedures
4.D.3. Evaluate for post-procedural changes/complications

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Medical book

which you can bypass breakfast, going vegan is never always healthier and salt on your chips might not provide you a heart assault! A fantasy-busting book through PROFESSOR TIM SPECTOR says every thing ... | ARDMS braindumps and test dumps

Anti-salt foyer agencies, weight-reduction plan certified and governments need us to believe that any health advancements are the outcome of their public health interventions instead of drugs. for many healthy people, the reduction in blood force as a result of salt discount is exceptionally small and clinically trivial

devour less fats. consume less sugar. consume your 5-a-day. eat extra starchy greens. by no means pass nutrients. eat little and sometimes. 

Drink at least eight glasses of water a day. Don’t bypass breakfast. Drink less caffeine. Drink less alcohol. consume much less meat and dairy. eat greater fish. Do greater endeavor.

we've become used to being instructed how, when and what they should be ingesting. These messages come from a variety of sources: countrywide instructions, the media, promoting and even food labels and cereal packets, as well as posters and leaflets in hospitals and GP surgeries.

i'm a scientist and a clinical doctor. Yet, over the last eight years, I even have been shocked through what I actually have discovered and am still uncovering. So tons of what they swallow when it comes to counsel about food isn't backed up through science, while a few of it can be categorically wrong. 

but these myths are repeated so regularly that they will also be difficult to unlearn. They could even be the reason why many of us battle to lose weight and retain it off.

In my research for this e-book, I got down to analyse everything they be aware of – or feel they recognize – about meals and dieting. What I found out now not handiest greatly surprised me however pressured me to revise my opinions on most features of food and fitness. 

a great deal of what they treat as gospel is in line with unhealthy science, misinterpreted experiences and questionable behaviour via the meals business. Don’t believe me? study on to discover why it doesn’t depend if you skip breakfast, why activity gained’t do plenty to help you shed weight, and the way all weight loss plan myths should be approached, quite actually, with a pinch of salt…

fantasy: in case you bypass breakfast you're going to put on weight

‘Go to work on an egg!’, ‘Breakfast like a king!’ The thought that ingesting breakfast within the morning is the important thing to enhancing energy, concentration and mood all the way through the day is a mantra ingrained in most of us from an early age. 

but there isn't any thought given of what breakfast should entail, or when it can be eaten. despite the fact, there is still a belief that breakfast by hook or by crook ‘kickstarts’ the metabolism, or that skipping it skill you’re hungrier later in the day and so overeat.

despite a scarcity of evidence for these claims, they are presented as scientifically supported information and obviously laid out in NHS instructions prepared by using govt personnel from Public fitness England with input from the meals industry.

a scientific review and analysis of breakfast-skipping experiences become at last published in the British clinical Journal in 2019. It concluded that there became no proof to aid the claim that skipping meals makes you placed on weight or adversely reduces your resting metabolic rate. 

The information showed quite the contrary. there's facts that fasting for longer than 12 hours can in the reduction of insulin levels and help some americans drop a few pounds. So why have scientists bought it so incorrect in the past?

The be anxious that skipping breakfast could lead on to overeating later in the day is theoretically justified: people who omit breakfast do each constantly devour more lunch and just a little cut back their physical undertaking. 

The physique’s metabolism is also initiated via a process known as diet-caused thermogenesis, whereby the meals itself generates some warmth within the physique and so, as a result of this, breakfast is regularly stated to kickstart the metabolism. 

there's proof that fasting for longer than 12 hours can reduce insulin ranges and help some individuals shed weight. So why have scientists bought it so incorrect in the past?

but these suave compensatory mechanisms, even when put together, don't seem to be just about satisfactory to make up for the burden-loss merits entailed with the aid of the uneaten energy of a overlooked breakfast.

And let’s no longer overlook that successful food industry conglomerates have a large marketing funds and elevate gigantic clout with executive officials, allowing them to have an effect on public coverage to the extent that verifiably false claims turn into sanctioned health tips. 

by way of examining what multi-billion-dollar industries comparable to cereal manufacturing may also stand to lose if greater individuals begin skipping breakfast, it’s handy to see why breakfast myths are so common and persistent.

myth: Fish is always a healthy choice

We’re at all times inundated with messages telling us that fish is among the healthiest foods. A low-calorie and excessive-protein food, with oily varieties rich in omega-three fatty acids, which is supposedly good for the coronary heart and brain. but their obsession with fish has been manipulated by the food and supplement agencies, and the fish oil complement trade is worth £23 billion.

virtually 20 per cent of Britons and ten per cent of american citizens take a daily fish oil supplement, and the uk spends £2.8 billion a year on fish. but there’s bad news for fish fans: it isn’t pretty much as good as we’ve been ended in accept as true with.

A contemporary scientific trial of 259 pregnant girls, followed up except their infants were seven years historical, found that fish oil supplementation right through being pregnant didn't lead to brighter infants.

in fact, the facts for omega-three supplements being a good idea is non-existent.

Governments drum into us that they ought to reduce down on their meat intake and in its place eat two to 3 portions of fish every week if they need to reduce the risk of disease. here is despite an entire lack of evidence.

whereas there’s nothing thus far to display that fish does their health any hurt, there is a clear draw back to ingesting extra of it. The oceans are struggling to satisfy the demand, now not helped by using expanding trends for cheaper farmed seafood, which isn't most effective dangerous news for the ambiance however may be unhealthy information for their health.

First, there is the movements use of excessive ranges of antibiotics to help farmed fish grow and steer clear of infections caused by using being kept close collectively.

There’s additionally an unlikely little critter that loves carefully packed fish: the ocean louse. These flesh-consuming sea lice connect themselves to salmon and kill one in five of them, which fees the industry over £1 billion a yr.

Alongside antibiotics, corporations use hydrogen peroxide chemical compounds to manage them but too a whole lot can damage the fish and should, at last, stop to be helpful.

Then there are the dangers that you simply’re ingesting heavy metals corresponding to lead and mercury that have accrued in fish, or the probability your seafood could be contaminated with microplastics.

by all means proceed to relish fish, but pay extra for stronger-fine, sustainable kinds – and don’t are expecting it to retailer your life.

fantasy: all of us should in the reduction of their salt consumption

We’ve been warned concerning the hazards of salt for a while. For the past 20 years, governments were encouraging us to cut back their consumption and we're instructed that decreasing it to under 6 grams (one and a quarter teaspoons) a day is the important thing to reducing blood drive, strokes and coronary heart sickness.

however any fitness advantages from decreasing salt consumption light into insignificance next to the proven benefits of blood-drive medications.

Anti-salt foyer businesses, weight-reduction plan certified and governments need us to agree with that any health improvements are the result of their public health interventions instead of drugs.

for most in shape people, the discount in blood drive on account of salt discount is rather small and clinically trivial.

but even though there changed into compelling evidence that low salt intakes resulted in long-time period reductions in blood power, this might be colossal handiest if this reduced risks of heart problems and demise.

in reality, reports of salt reduction haven't discovered any reduced chance of heart assaults, strokes and dying.

however it doesn’t conclusion there. an additional shock got here lately when randomised scientific trials of patients with diabetes on low-salt diets said that, instead of getting more desirable, patients were invariably loss of life past.

There’s little question that very excessive salt intakes are linked to better quotes of hypertension and coronary heart disorder, but a good deal of this will also be explained with the aid of people ingesting too a great deal salty ultra-processed food, that are additionally laced with an array of different chemical substances that can have an effect on their long-term fitness. in case you avoid ultra-processed burgers, burritos, pizzas and crisps, you could still delight in meals without guilt, and they should still take present instructions with a huge, and particularly healthy, pinch of salt.

Take the fats burn cracker look at various

Counting energy isn't all the time constructive because their bodies use them otherwise. 

there is an easy test to assess how well-adapted your digestive gadget is to processing starch and hence how well your physique burns fats.

eat a simple wheat cracker and time how long it takes for you to style sweetness. once they validated twins, they asked them to do it three times and take the typical as it is not at all times clear-cut. 

We found that round a quarter of participants could detect the trade to sugar inside 30 seconds, suggesting that they're more desirable adapted than most of us to burning starch – as opposed to storing it as fats – but they nevertheless don’t understand how this impacts us in my view. 

there is an easy experiment to check how smartly-tailored your digestive equipment is to processing starch and hence how well your body burns fat


delusion: a lot of activity will make you skinny

‘retain going!’ ‘Cycle harder!’ ‘The greater energy you burn while in the orange coronary heart-expense zone, the more fat you'll burn and the extra you can drink later.’ 

This changed into the mantra of the pastime type I attended in a health club a few years in the past. they are all advised that one of the most leading explanations we’ve all acquired fatter during the past 30 years is that we've become lazy and don’t undertaking sufficient.

The endeavor message is geared toward people of all a long time, from toddlers to pensioners – go to the fitness center, walk more, play recreation, deplete energy and the weight will melt away.

To assist inspire us, wearable contraptions tell us when they have reached the magic 10,000 steps. Yet the 10,000-step purpose – conveniently, a pleasant circular quantity – became devised by way of a eastern pedometer business earlier than the 1964 Tokyo Olympics and has no scientific groundwork.

actions comparable to weight-lifting, biking and even just brisk walking are more likely to enhance your fitness than simply counting the variety of steps you are taking. if your intention is to drop extra pounds, activity is not a magic formula and works best if you consume less in parallel.

learning British twins, they found only a 2.2lb to 4.4lb lower weight within the twin who exercised continually. This underscores the indisputable fact that most of their power expenditure depends upon their genes. Like many food plan myths, although, this is ingrained within the public focus.

we've at all times assumed that their ancestors spent their days running round searching and that this saved them lean.

when I spent every week with the Hadza tribe in Tanzania, the closing hunter-gatherers of East Africa, i used to be stunned. They appeared to be as lazy as us Westerners. They continually have a lie-in and go only as far as they should get food, which, as most of the yr it's abundant, isn't very some distance.

A crew of researchers put undertaking trackers on the Hadza for 11 days. It changed into confirmed that they are sedentary for many of the time and on commonplace don’t deplete greater calories on physical exercise than Westerners. 

The rationale they're lean is as a result of their distinctive excessive-fibre, berry and meat diet, no longer consuming lots, and heading off snacks, instead of doing 10,000 steps per day.

The 12 primary suggestions make sure to observe

1. eat distinctive meals, mainly plant life, without added chemical substances

2. question the science and don’t trust quick-repair single options

three. Don’t be fooled with the aid of labels or advertising and marketing

4. take into account your own body and understand that there is no such component as typical

5. Diversify! Don’t get stuck in a food rut

6. scan with meal timings and skipping meals

7. Use real meals, no longer dietary supplements

eight. avoid ultra-processed meals containing more than ten materials

9. devour meals to enrich gut microbe variety comparable to full-fats herbal yogurt, kefir, kimchi, sauerkraut and respectable fine cheese

10. cut back usual blood sugar spikes with the aid of keeping off sugary drinks and snacks and subtle carbohydrates equivalent to white bread

eleven. reduce meat and fish consumption and determine its sustainability

12. educate yourself and the subsequent era within the magnitude of precise meals


fantasy: adopt a vegan eating regimen to live match

The variety of vegans in the UK practically quadrupled between 2014 and 2019, with one in eight Britons describing themselves as vegan or vegetarian. in the meantime, a 3rd of British consumers now have meat-free days and regularly purchase plant-based milk options. but is a vegan food plan truly as fit as we're ended in consider?

Many people claim they consider more desirable and have greater power on a plant-based mostly eating regimen. Some will advantage as a result of they start to believe more carefully about what they're consuming, choose healthier foods and prevent random snacking.

youngsters, veganism doesn’t suggest ingesting limp lettuce leaves, tasteless tofu and a couple of bland beans. this present day there’s vegan mac ‘n’ cheese, ‘bleeding’ beetroot burgers and vegan fried hen. There are also plant-based versions of wide-spread meats, cheeses, desserts and ice lotions, pumped filled with chemicals, sugar and saturated fats.

no matter if your sausage roll is crafted from a pig or Quorn, or your burger from beef or soy, they’re all highly processed and high in calories, saturated fats and salt.

What’s greater, vegan and vegetarian foods are marketed as more healthy than they in reality are, and some, comparable to vegan fish fingers, contain as much as 40 synthetic materials.

while the fad for plant-based mostly milks has taken off, there’s no facts they’re any healthier than cow’s milk. Many are devoid of key nutrients equivalent to calcium, iron and B12 found in dairy, and may comprise excessive stages of chemicals and components.

a much bigger concern is the rise in veganism among infants. reviews have proven that vegan little ones are often smaller and have low levels of vitamins and minerals reminiscent of riboflavin and B12. In severe cases these deficiencies have led to high-profile deaths.

So, veganism per se isn't necessarily match. lots of the benefit is doubtless just through eating a greater variety of vegetation and fibre, which may also be performed with the aid of americans drinking small quantities of meat and dairy. Don’t suppose pressured into buying these plant-primarily based options, which are sometimes filled with additives, sugar and fat.

© Tim Spector, 2020

Spoon-Fed: Why almost every little thing We’ve Been told About food is wrong, by Tim Spector, is posted by way of Jonathan Cape on August 27, priced £12.ninety nine


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