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WHAT IS GLUTEN? How Gluten Can Harm People. Those that have travelled the long road to living gluten free. DEDICATED TO… For learning the answers, remedies.

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Presentation on theme: "WHAT IS GLUTEN? How Gluten Can Harm People. Those that have travelled the long road to living gluten free. DEDICATED TO… For learning the answers, remedies."— Presentation transcript:

1 WHAT IS GLUTEN? How Gluten Can Harm People

2 Those that have travelled the long road to living gluten free. DEDICATED TO… For learning the answers, remedies and proven ways to overcome a dietary food intolerance problem

3 Gluten is a serious health problem for many people. Many sufferers don’t realize that they are “intolerant.” Gluten Ingestion harms people and their health status. The Major Difficulty With Gluten - Of Gluten Intolerance, Celiac Disease For Life and more.. INTRODUCTION

4 Gluten is a protein found in a number of grains Wheat Wheat Barley Barley Rye Rye Just avoiding grains is not enough, it is an additive in food production Gluten can be listed as dextrin on product labels For most, a gluten-free diet is not a passing fad. It must be a way of life. WHAT IS GLUTEN?

5 Gluten-intolerant individuals can’t digest the gluten protein Conditions can include: Wheat allergies Wheat allergies Dermatitis herpetiformis Dermatitis herpetiformis Celiac disease Celiac disease WHAT IS GLUTEN? For most, a gluten-free diet is not a passing fad. It must be a way of life.

6 Gluten-intolerance symptoms include diarrhea, cramping, gas, bloating, weight loss, vitamin deficiencies Discomfort from ingesting gluten comes from intestinal lining damage The only treatment is to eliminate gluten from the diet WHAT IS GLUTEN? Most associate a gluten-free diet with celiac disease.

7 Celiac disease is hereditary. If you have celiac disease, 4%-12% of your immediate relatives may also have the condition. Approx 1 in 133 Americans has celiac disease (3 million people) Gluten intolerance affects approx 1 in 100 in Australia and New Zealand. 97% of Americans may have undiagnosed celiac disease. Celiac disease has over 300 chronic symptoms. WHAT IS GLUTEN? Gluten Intolerance Statistics

8 Gluten-free foods may cost 242% more than foods with gluten. No treatments or drugs are available to treat celiac disease. CD sufferers dine out 80% less than before their diagnosis. Misdiagnosis of chronic celiac disease can cost $5,000-$12,000. Sales of gluten-free foods will reach $2 billion in years to come Celiac disease affects more people by far than other chronic diseases like epilepsy, Crohn’s disease and Parkinson’s disease. Gluten Intolerance Statistics WHAT IS GLUTEN?

9 Globally, the prevalence of celiac disease is directly related to wheat consumption in each country WHAT IS GLUTEN?

10 Celiac disease is an autoimmune disorder Gluten proteins attack the small intestine villi Prevents absorption of vital nutrients Left untreated it can seriously affect the digestive system Can ultimately lead to osteoporosis, skin rashes and anemia Highest risk demographic: Caucasion of N. European descent How celiac disease works WHAT IS GLUTEN?

11 Test for specific antibodies while gluten is in the system. If one in three antibodies present, celiac disease confirmed through intestinal biopsy. If confirmed a gluten-free diet is indicated. Gluten-free diet cannot include oats due to cross-contamination. Two specific factors Genetics Genetics Environment Environment Celiac disease can be difficult to diagnose WHAT IS GLUTEN?

12 Fruits and veggies, coffee, eggs, potatoes, corn, nuts, beans, fish, meat, and unflavored milk. Herbs and spices are gluten-free Start by focusing on the many foods that can be enjoyed while eliminating gluten Continued gluten ingestion increases risk of gastrointestinal cancer x WHAT IS GLUTEN?

13 The Mystery Behind Gluten Intolerance and Celiac Disease

14 10% with CD have an immediate family member with disease If one of identical twins has the disease, 70% of the twin has it Primarily affects Caucasians of European descent Occasionally occurs in Middle East and India Rarely affects Australian Aborigines and Asians Grain is a high proportion of diet in the most affected regions The Mystery Behind Gluten Intolerance and Celiac Disease

15 Celiac disease affects children and adults at any age. Many develop symptoms in adulthood, while others have no symptoms at all Celiac disease is a most mis- and under-diagnosed autoimmune disease Celiac disease cannot be cured, symptoms only alleviated The Mystery Behind Gluten Intolerance and Celiac Disease

16 Celiac disease symptoms and diagnosis Very difficult to diagnose because of a range from mild to severe symptoms, or from none to many symptoms Common symptoms include: Fatigue / weakness Fatigue / weakness Low iron levels/unexplained anemia Low iron levels/unexplained anemia Abdominal cramps Abdominal cramps Diarrhea Diarrhea Gas/bloating Gas/bloating Constipation Constipation Nausea Nausea Poor weight gain/weight loss Poor weight gain/weight loss The Mystery Behind Gluten Intolerance and Celiac Disease

17 Celiac disease symptoms and diagnosis Less common symptoms include: Bruising easily Bruising easily Ulcers in the mouth Ulcers in the mouth Infertility and miscarriage Infertility and miscarriage Dental problems Dental problems Vitamin deficiencies Vitamin deficiencies Muscle cramps / spasms Muscle cramps / spasms Brain fog / confusion Brain fog / confusion Bone and joint pain Bone and joint pain Any or all of these symptoms should be reported to a doctor. If gluten-intolerance is detected, a gastro-enterologist will test for celiac disease. The Mystery Behind Gluten Intolerance and Celiac Disease

18 Triggers that lead to celiac disease The Mystery Behind Gluten Intolerance and Celiac Disease

19 Celiac disease symptoms and diagnosis Gluten intolerance can cause the autoimmune disease dermatitis herpetiformis (DH). DH causes a skin rash characterised by pimples or blisters. DH is more common in men and people from Northern Europe. DH may appear on: Kneecaps / elbows Kneecaps / elbows Ears Ears Shoulder blades Shoulder blades Buttocks Buttocks Hairline / eyebrows Hairline / eyebrows DH always occurs symmetrically and is also incurable. If diagnosed, a skin biopsy is indicated. The Mystery Behind Gluten Intolerance and Celiac Disease

20 Gluten intolerance: Where it all begins Gluten intolerance: A broad term that relates to all forms of gluten sensitivity Many who are gluten sensitive will test negative for celiac disease This may indicate something less than a 100% gluten-free diet Gluten sensitivity can include: Constipation Constipation Diarrhea Diarrhea Gas Gas Bloating Bloating Gluten sensitivity can be tested by systematic removal / reintroduction of trigger foods containing gluten The Mystery Behind Gluten Intolerance and Celiac Disease

21 Wheat allergy versus gluten intolerance Wheat allergies are less common than gluten intolerance Wheat allergies are usually accompanied by other severe allergies to eggs, seafood and nuts Wheat allergies are best diagnosed by skin prick testing The Mystery Behind Gluten Intolerance and Celiac Disease

22 Gluten intolerance and autism Eliminating gluten can alleviate early symptoms of autism in children Global Autism Awareness Day is April 2 Prevalence of autism around the world: China: 1.1 children in 1000 have autism China: 1.1 children in 1000 have autism India : 1 in 250 India : 1 in 250 US : 1 in 88 US : 1 in 88 UK : 2-6 in 1000 UK : 2-6 in 1000 Some studies suggest food allergies caused by gluten intolerance can trigger or worsen autism Gluten protein breaks down into peptides which work as a narcotic, worsening symptoms of autism in children The Mystery Behind Gluten Intolerance and Celiac Disease

23 Gluten intolerance and autism “Brain fog” or confusion can worsen into pyschiatric conditions in autistic children Completely eliminating gluten can result in disapperance of abnormal behavior, cognitive issues and anti-social tendencies __________ Next section: How to implement a gluten-free diet The Mystery Behind Gluten Intolerance and Celiac Disease

24 The Gluten-Free Diet and Its Many Health Benefits

25 All the signs point to a diet change Mild to severe gluten intolerance, celiac disease, DH and other indicate a need for a diet change Diet changes can improve problems with: Diarrhea Diarrhea Gas Gas Bloating Bloating Though the switch can be difficult, the effort go gluten-free can be worth it for chronic condition sufferers The Gluten- Free Diet and Its Many Health Benefits

26 The Basis of the Gluten-Free Diet Core of the diet: Avoid any form of wheat, rye and barley You can continue to enjoy the foods you love. There are many more foods to enjoy than to avoid. Gluten-free alternatives are becoming more available in supermarkets and restaurants. Many foods are naturally gluten-free. For others there are gluten-free alternatives. The Gluten- Free Diet and Its Many Health Benefits

27 The Basis of the Gluten-Free Diet Factors behind the new wave of market expansion Increasing diagnoses of food allergies and celiac disease. Increasing diagnoses of food allergies and celiac disease. More awareness of gluten intolerance throughout society. More awareness of gluten intolerance throughout society. Growing need for better-tasting gluten-free alternatives. Growing need for better-tasting gluten-free alternatives. Trends for families to eat gluten-free to support loved ones. Trends for families to eat gluten-free to support loved ones. Modern knowledge of the health benefits of gluten-free for all. Modern knowledge of the health benefits of gluten-free for all. The Gluten- Free Diet and Its Many Health Benefits

28 Top 5 Benefits of a Gluten-Free Diet 1. Nutrition from a wide variety of other sources Flaxseeds / sesame seeds: same nutrients as wheat flour Flaxseeds / sesame seeds: same nutrients as wheat flour Fruits & vegetables: same or more fibre than whole grains Fruits & vegetables: same or more fibre than whole grains 2. Gluten causes inflammation High-gluten grains are high in starch, causing inflammation High-gluten grains are high in starch, causing inflammation Gluten-free vegetables and fats can neutralize inflammation Gluten-free vegetables and fats can neutralize inflammation Gluten-free foods can calm systemic inflammation related to arthritis, osteoporosis, asthma, allergies, etc. Gluten-free foods can calm systemic inflammation related to arthritis, osteoporosis, asthma, allergies, etc. The Gluten- Free Diet and Its Many Health Benefits

29 Top 5 Benefits of a Gluten-Free Diet 3. Gluten can harm joints Gluten-rich foods have amino acids found in joint tissue Gluten-rich foods have amino acids found in joint tissue Can confuse immune system into attacking joints and causing long-term damage Can confuse immune system into attacking joints and causing long-term damage 4. Gluten can cause mineral deficiencies Ingestion of gluten-rich grains can inhibit vitamin and mineral absorption. Ingestion of gluten-rich grains can inhibit vitamin and mineral absorption. Gluten-free allows for easy digestion and better absorption. Gluten-free allows for easy digestion and better absorption. 5. Gluten causes gluten craving Craving carbs or processed foods may be a gluten addiction Craving carbs or processed foods may be a gluten addiction A vicious cycle: energy boost > energy drop > then cravings A vicious cycle: energy boost > energy drop > then cravings The Gluten- Free Diet and Its Many Health Benefits

30 First Steps: The Initial Elimination Diet Start out small to assess gluten intolerance with “Elimination Diet” Elimination Diet Process: Completely eliminate all gluten for 2-4 weeks Completely eliminate all gluten for 2-4 weeks Then slowly reintroduce items, tracking foods, symptoms and reactions Then slowly reintroduce items, tracking foods, symptoms and reactions If reintroduction produces negative results a gluten-free diet may be indicated. If reintroduction produces negative results a gluten-free diet may be indicated. The Gluten- Free Diet and Its Many Health Benefits

31 Taking the Plunge – How to Organize For Gluten Free

32 Failure to provide for the gluten-intolerant can endanger their health The following strategies can be offered to those preparing food: Avoid packaged or prepared foods Avoid packaged or prepared foods Cook foods from scratch Cook foods from scratch Avoid cross-contamination in the kitchen Avoid cross-contamination in the kitchen Be careful with how food is presented Be careful with how food is presented Go the extra mile to help a host prepare gluten-free meals Go the extra mile to help a host prepare gluten-free meals Taking the Plunge – How to Organize For Gluten Free

33 Salad Dressing: Usually contains gluten unless labelled gluten-free. Marinades: Most have gluten content or a gluten-derived ingredient. Soy Sauce: Can contain 60% wheat filler products. Instant Pudding: Usually produced with gluten as a thickener. Frozen Meals: Gluten protein is used as a binding agent. Deli Meats & Sausages: Gluten is used as a starch to bind water in production. Taking the Plunge – How to Organize For Gluten Free Top 10 “Hidden” Gluten-Containing Products in A Kitchen

34 Soups: Most commercial soups contain gluten as thickener Ice Cream: Gluten-free ice cream is available, but watch for ingredients like cookies and brownies which usually contain gluten Hot Cocoa: Most instant cocoa, including Ovaltine have gluten Condiments: Most have gluten, including mayo, mustard, ketchup, sauces, etc. Taking the Plunge – How to Organize For Gluten Free

35 Gluten-Free Shopping Guide Produce: Any fresh fruit, vegetable, herb and spice Meat / Fish: Beef, poultry, fish shellfish, some cold cuts w/o additives Frozen Foods: Frozen fruit & vegetables, gluten-free frozen waffles, ice cream and sherbets Dairy: Milk, cream, half-and-half, butter, margarine, yogurt, sour cream, cream cheese, cottage cheese, rice pudding, tapioca pudding, eggs, tofu, Jell-O, 100% fruit juices Breakfast: Corn, rice & other gluten-free cereals, eggs, gluten-free frozen waffles and bagels Canned Goods/Packaged Foods: Plain canned vegetables & fruits, cranberry sauce, applesauce, spaghetti sauce, gluten-free organic soups, gluten-free pastas, corn tortillas, and canned fish Taking the Plunge – How to Organize For Gluten Free Always read the product label

36 Gluten-Free Shopping Guide Oils: Shortening, mayonnaise, gluten-free salad dressing, olive oil, canola oil, vegetable oil Starches: Rice, buckwheat, chickpeas, sunflower seeds, flax seeds, corn starch, potato starch, quinoa Snacks: Rice crackers & cakes, popcorn, cheese puffs, corn chips, some potato chips, chocolate, dried fruits, some candy Beverages: Tea, coffee, soft drinks, 100% fruit juice Condiments: Horseradish, ketchup, some mustards, honey, pickles, vinegar (excluding malt vinegar) Nuts: Almond butter, cashew butter, peanut butter, plain nuts Baking: Salt, pepper, herbs, spices, sugar, corn meal, baking soda, baking powder, baking chocolate, cocoa, and gluten-free flours Taking the Plunge – How to Organize For Gluten Free Always read the product label

37 How to Cook Gluten Free - Meal Preparation Hints

38 What NOT to do when cooking gluten-free DON’T use the same cooking materials and utensils. DON’T forget to separate your gluten-free cooking ingredients. DON’T forget to read labels carefully. DON’T think that cooking will eliminate trace amounts of gluten. DON’T double dip. How to Cook Gluten-Free: Meal Preparation Hints

39 BREAKFAST Nutritious gluten-free alternatives: Gluten-free cereals Gluten-free cereals Gluten-free muffins Gluten-free muffins Gluten-free waffles Gluten-free waffles Gluten-free pancake mix Gluten-free pancake mix Gluten-free trail mix or cereal bars Gluten-free trail mix or cereal bars Fresh fruit Fresh fruit Eggs Eggs How to Cook Gluten-Free: Meal Preparation Hints

40 LUNCH Delicious, gluten-free foods to pack for lunch: Gluten-free soup Gluten-free soup Fresh fruit, yogurt, and gluten-free granola Fresh fruit, yogurt, and gluten-free granola Gluten-free wrap with hummus and vegetables Gluten-free wrap with hummus and vegetables Dinner leftovers Dinner leftovers Sandwich on gluten-free bread Sandwich on gluten-free bread How to Cook Gluten-Free: Meal Preparation Hints

41 Gluten-Free Cooking 101: Basic Guidelines Know what is and isn’t safe Read all labels carefully Buy pre-packaged gluten-free mixes Use separate cooking implements to prevent cross-contamination Use gluten-free recipes How to Cook Gluten-Free: Meal Preparation Hints

42 How to Convert Recipes to Gluten-Free Swap out gluten-rich flour Or, omit flour altogether Add gluten free alternatives as substitutions for ingredients Experiment, experiment, experiment How to Cook Gluten-Free: Meal Preparation Hints

43 The Basic Gluten-Free Substitution Chart Sandwich bread  Corn tortillas Crackers  Brown rice tortillas Bread crumbs  Crushed gluten-free cereal or gluten-free oats Pizza crust  Mashed potatoes Flour tortillas  Corn tortillas Flour tortillas  Lettuce wraps Pancakes  Cornmeal cakes Cake frosting  Meringue Yogurt with granola  Yogurt with nuts Croutons  Nuts How to Cook Gluten-Free: Meal Preparation Hints

44 The Basic Gluten-Free Substitution Chart All-purpose flour  Gluten-free flour Wheat flour  Almond flour Lasagna noodles  Sliced eggplant Couscous  Steamed chopped cauliflower Couscous  Quinoa Pasta  Rice noodles Pasta  Spaghetti squash Bagels  Rice cakes Roux  Potatoes Pie crust  Gluten-free cookie dough How to Cook Gluten-Free: Meal Preparation Hints

45 The Art of Dining Out Gluten-Free

46 Dining out with celiac disease: the emotional impact Women with celiac disease are more likely to exhibit disordered eating and depression due to a gluten-free diet Women with celiac disease who stayed with the strictest gluten- free diet had… Improved energy Improved energy Reduced levels of stress Reduced levels of stress Reduced symptoms of depression Reduced symptoms of depression Improved emotional health Improved emotional health The Art of Dining Out Gluten-Free

47 Dining out with celiac disease: the emotional impact Dining out creates a much different experience for people with celiac disease because of diet monitoring Many are concerned about burdening hosts with dietary requests It’s important to continue to educate the public about everyday difficulties associated with celiac disease The prescribed treatment for celiac disease shouldn’t just address the illness. The Art of Dining Out Gluten-Free

48 How to eat out on a gluten-free diet Eating at a restaurant may now be confusing and nerve-racking trying to choose menu items for this diet. Many restaurants now offer special menus for diners with gluten intolerance and celiac disease. Eat a balanced snack before going out to eat. Study the venues menu in advance. Tell the house Maitre Di about gluten free diet in advance Choose safe dishes on the menu and ask questions. Remind the staff about cross-contamination. The Art of Dining Out Gluten-Free

49 Gluten-free alcoholic drinks Can still enjoy some alcoholic beverages after-dinner Beer is not allowed due to the hops and barley, which contain gluten. Recently, special gluten-free beers have been formulated Gluten-free drinks include: Brandy, cognac Brandy, cognac Wine, some cider Wine, some cider Gin, vodka, tequila Gin, vodka, tequila Rum, Schnapps Rum, Schnapps The Art of Dining Out Gluten-Free

50 Gluten-free tips for parties and gatherings It may be difficult to request gluten-free if a party has a set menu. At a party with a catered menu, bring along gluten free food Scout the food table or buffet line for gluten-free items: Plain grilled meat Plain grilled meat Fresh vegetables Fresh vegetables Salad with oil and vinegar dressing Salad with oil and vinegar dressing Fresh fruit for dessert Fresh fruit for dessert The Art of Dining Out Gluten-Free

51 Gluten-free tips for parties and gatherings A Holiday event probably won’t have gluten-free food Several steps to take to avoid inconveniencing a host: Bring a prepared dish. Bring a prepared dish. Call the caterer in advance. Call the caterer in advance. Eat before everyone goes out. Eat before everyone goes out. Cheating on this diet can cause permanent damage. Cheating on this diet can cause permanent damage. The Art of Dining Out Gluten-Free

52 Special Guidelines for Children on a Gluten-Free Diet

53 Early diagnosis of gluten intolerance or celiac disease is critical 2.5 babies / minute are born with genetics to have celiac disease For children who are at risk the age of diagnosis is critical. When a first degree blood relative has celiac disease, there is about a 5% chance that a child also has the condition. Recognizing celiac disease in young children: May refuse to eat or fail to gain weight after eating gluten May refuse to eat or fail to gain weight after eating gluten May be irritable, listless, have an enlarged abdomen or irregular stools May be irritable, listless, have an enlarged abdomen or irregular stools An older child may have symptoms like: Stunted growth Stunted growth Poor appetite Poor appetite Anemia Anemia Special Guidelines for Children on a Gluten-Free Diet

54 Coping with celiac disease at school Speak to a counselor, teacher and the school nurse immediately. To simplify the process, get a doctor’s note that explains your child’s celiac disease or gluten intolerance. Teach your child to be independent in managing their condition. Some school cafeterias may have gluten-free menu options. Special Guidelines for Children on a Gluten-Free Diet

55 Coping with celiac disease: The teen years If diagnosed as a child, transition into teen years should be easy. Discuss situations where they may feel out-of-place with their diet. Teens need to understand that they won’t outgrow celiac disease. Occasional cheating is not okay. Make gluten-free eating fun by having the right snacks on hand and learning good gluten-free recipes. Special Guidelines for Children on a Gluten-Free Diet

56 Coping with celiac disease: The college years You need to prepare for them being largely on their own. More colleges are accommodating students with gluten-intolerance and celiac disease. College counselors can advise if the school caters to students with food sensitivities. A doctor’s diagnosis or medical report can be helpful. This time of transition is another opportunity to learn celiac disease does not go into remission. Special Guidelines for Children on a Gluten-Free Diet

57 How to raise a gluten-free child Focus on the foods that a child can eat. Ask the child to help you plan meals. Try new foods with a child. Rearrange the kitchen to take away temptation. Plan in advance to bring gluten-free classroom treats. Establishing these principles from an early age will it easier for a child to avoid gluten and minimize short and long-term problems Special Guidelines for Children on a Gluten-Free Diet

58 COPYRIGHT Disclaimer: All the information, techniques, skills and concepts contained in this presentation are as a guide and an assist to general education only. Nothing herein is recommended, neither as an individual’s nor a groups’ direct advice. The intent is to offer a variety of information to provide a wider range of knowledge in education, recognizing that we have widely diverse circumstances and viewpoints. Should anyone choose to make use of the information contained herein, this is their decision, and the contributors (and their companies), authors and publishers do not assume any responsibilities whatsoever under any condition or circumstance. It is recommended that the viewer obtain their own independent advice and consult a medical practitioner experienced with gluten, gluten intolerance, celiac disease, etc. This presentation is available internationally across all countries and borders for use as an education assist in general. The publisher does not warrant suitability unto any education authority or any desired outcome for education across all countries and borders accordingly. The end user has determined, under the end user individuals own merit and knowledge, the decision to using this presentation is as a display medium and general assistant only. Transmission is permitted in this format for visual display presentation. All rights reserved. No part of this presentation may be altered, reproduced, stored in a retrieval system, or transmitted in any other form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission from the publisher. Further resources are found at First Edition Copyright © 2012 Steven Wilkinson. Sources: 1. National Institutes of Health, Univ. of Chicago Celiac Disease Center "Making sense of celiac disease with clues to a cure." Medill Reports. N.p., n.d. Web. 28 Mar Integration of Genetic and Immunological Insights into a Model of Celiac Disease Pathogenesis. Annual Review of Immunology. Vol. 29: Nutrients 2010, 2(1), 16-34; doi: /nu "What is the Global Incidence of Autism? | Early Signs of Autism In Babies and Children." Early Signs Of Autism & Autism Information. N.p., n.d. Web. 29 Mar "What to Feed a Vegan (and others)." N.p., n.d. Web. 29 Mar "Gluten Ingredient Shopping Guide." N.p., n.d. Web. 5 Apr "Printable Gluten-free Celiac Grocery List ". Printable Grocery Lists. N.p., n.d. Web. 3 Apr Penn State (2011, December 27). Women with celiac disease suffer from depression, disordered eating, study finds. Science Daily. 10. ALDERMAN, LESLEY. "Patient Money - The Expense of Eating With Celiac Disease - NYTimes.com." The New York Times - Breaking News, World News & Multimedia. N.p., n.d. Web. 9 Apr "English Celiac / Coeliac Gluten-free Restaurant Card." N.p., n.d. Web. 12 Apr "Facts & Statistics About Celiac Disease." Celiac Disease & Gluten Free Diet Resources. N.p., n.d. Web. 12 Apr "Celiac Disease in Children." Welcome to Celiacs. N.p., n.d. Web. 12 Apr "Where Food Ranks: Getting to Know the Glycemic Index Chart." N.p., n.d. Web. 13 Apr Image Credits: © Webking | Stock Free Images & Dreamstime Stock Photos © Djma | Stock Free Images & Dreamstime Stock Photos© Madja | Stock Free Images & Dreamstime Stock Photos © Sergeitelegin| Stock Free Images & Dreamstime Stock Photos© Phildate| Stock Free Images & Dreamstime Stock Photos© Sarunez| Stock Free Images & Dreamstime Stock Photos © Reno12 |Stock Free Images & Dreamstime Stock Photos


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