Could You be Gluten Intolerant?

gluten-intoleranceWith more and more people starting to look after their health and fitness, one thing that they’re starting to do is take note of what their eating each day and how the various foods that they consume influence how their body feels and functions.

It’s incredibly important that you pay attention to the foods that you put into your diet because not only will these influence your body weight, but your health as well. One issue that is starting to be discussed more and more as people notice the symptoms associated with it is gluten intolerance.

While there are those who cannot tolerate gluten at all and have a condition known as celiac disease, other people simply just don’t feel best when eating gluten rich foods.

Let’s take a closer look at what gluten intolerance is so that you can see whether this might be something that’s impacting you.

 

What Is Gluten Intolerance?

The very first thing that you need to think about is what does it mean to have a gluten intolerance. Gluten is a particular type of protein that’s found in wheat and all wheat related foods that certain people struggle to digest properly.

When it’s not fully broken down by the body, that’s when it will start to cause symptoms to occur in your body.

 

What Are The Symptoms Associated With Gluten Intolerance?

Some of the most common signs that will present themselves if your body is struggling to break down gluten include:

  • Abdominal distention
  • Abdominal pain and crampinggluten-warning
  • Diarrhea and/or constipation
  • Bloating
  • Bone density loss
  • Depression, irritability, and anxiety
  • Fatigue
  • Hypoglycemia
  • Infertility
  • Joint pain
  • Lactose intolerance
  • Teeth and gum problems
  • Vomiting
  • Vitamin and mineral deficiencies

It’s important to note that the signs and symptoms do tend to vary from individual to individual so you don’t necessarily have to have them all present in order for a condition to be present.  Even if you notice just a few of the symptoms presenting themselves, it may be time to get checked out by a physician to see whether this could be causing issues in your body.

 

What to Do Now?

So what do you do if you think you are suffering from gluten intolerance? The first step is to cut out all gluten rich foods from your diet. This includes all wheat and wheat related products such as flour, pastas, breads, cereals, and many snack foods.

Also, make sure that you’re reading ingredient labels on all foods that you consume because many will contain wheat even though you wouldn’t ever think it.  Some sauces, condiments, as well as meats will contain gluten, so you’ll want to stay away from these.

Instead, focus your carbohydrate intake around fresh fruits and vegetables, brown rice, quinoa, and barley, all of which are safe for those with gluten intolerance to eat.

So, if you are always suffering from stomach problems and gas or bloating, you may want to consider whether this could be an option for you. If it is, it would be a good idea to take steps to control and manage it so that you can look and feel your best.

Change Your Thoughts, Change Your Body!

When trying to shrink your waist size or tighten your thighs and add lean muscle, negative self-talk can do more damage than that tasty bowl of ice cream.

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We all want that perfect body and there are hundreds of books, websites, bars, powders and pills that offer an easy quick fix to get the healthy mind and body you want.  Don’t waste your money on a sure to fail fad.  There is no lasting quick fix in a bottle that will change your health.  The only way to make real change is to start by changing the way you think.   It all starts in your mind.  The initial thoughts in your mind may sound like…, “I would like to be healthy again.”…”I’d really like to get off my list of medications.”…”I want to keep up with my children”….”I want to change the future of my family and friends.” Listen to these positive desires and put action behind your thinking.  Don’t let negative talk drown your desire to make a positive change in you and your family’s lives.

When things don’t go your way and your jeans are fitting a bit tighter, you may feel unattractive and broken down.   It is easy to give up the fight and head to McDonalds for nutrition void comfort foods.  Stop the negative thinking and replace it with words that will help you obtain your goals and change your life for the good.

Negative self-talk will sink you like the Titanic.  It penetrates the subconscious and becomes deeply ingrained…

  • “This cupcake will make me feel good right now.”

We think, why bother eating healthfully, when the reward is far off? Keep focused on the goal and talk to yourself as if you are there now.  “I look amazing.”…”I have boundless energy”…”I love running”…”I am beautiful”…” I know she thinks I  am buff”.

  • “I must be thin.”

This creates desperation, which undermines a healthy long-range approach to sensible eating. Also, perfectionism pervades this thinking (I must not only be thin, but also perfect).

  • “I need comfort.”

People eat to avoid feelings of loneliness, depression and anxiety. Fatty and sugary food provides immediate comfort and distraction from other issues. Those foods actually release opioid like chemicals that can lead to food addictions and intense cravings for those thigh expanding foods.  Resolving some of these problems may help you overcome poor eating habits.

  • “I feel awful.” “It’s terrible being heavy.”

For some, being overweight is the worst thing imaginable; it can immobilize you and leave you dumbstruck. That’s a reaction more suited to tragedy. Weight loss is best achieved without that end-of-the-world outlook.  Think of how you can give something back to those less fortunate.  Do a random act of kindness.  This will change your self-perception when you focus on the greater good of mankind.

  • “It’s intolerable to stick to a diet.” “It’s just too hard to diet.”

This thinking renders you helpless. People who are easily frustrated want easy solutions. We’re seduced by fad diets because they appeal to that immediacy. Yet people who rely on fads suffer high failure rates. When you diet with the short term in mind, you don’t learn strategies that require patience and persistence.  You are in this to make long term changes in your life.

  • “I am no good.” “Because I am having trouble in this one area I am worthless.”

Being overweight can be viewed as a sign of weakness or worthlessness, and most people aren’t motivated when they feel that way. Another form of worthlessness: “My worth is dependent on my looks.” This idea confuses beauty with thinness, a concept played out endlessly in the media.  You are loved for just being you, for being a human being.   You are wonderful and special just because you are alive and God made you just the awesome way you are.   You don’t need to be thinner to have worth.  You just want to obtain health, live life to the fullest and enjoy it every step of the way.

Replace these thoughts with thoughts of who you want to be and what you want to do with your new healthy powerful mind and body.  Be sure to write your goals down to increase your potential to change and help you visualize who you WILL be.  Don’t do it alone.  Share your journey with someone you love and studies prove you are twice as likely to be successful.

 

Change your mind, change your body.

NEW STUDY: Hidden Food Allergies make you SICK and FAT

food-allergies

When you think of an allergy, most people think of a severe reaction with shortness of breath, rash and swelling.

Many recent studies are showing that allergies to foods have a direct link to gaining weight, obesity and disease. A recent research article in the New England Journal of Medicine listed 55 diseases that can be traced back to a food allergy. One of those diseases is obesity and weight gain. Undetected allergies will cause an inflammatory reaction when eaten. The problem is the reaction is often delayed 24-48 hours after exposure, so it is difficult to trace vague feelings like fatigue, constipation or softer stools, bloating, gas and mood changes. So the problem continues to grow out of control. The long term effect of out of control inflammation in the body leads a multitude of disease and illness including weight gain and obesity, arthritis and pain, and irritable bowel syndrome to name a few.

Most people will eat foods they are allergic to several times during the day and eventually the inflammation will spread throughout the body and create an environment for weight gain and chronic disease. The gut wall gets swollen and inflamed and has a harder time dealing with its job of defending against invaders like other allergens and infection.. They also have a difficult time absorbing nutrients from food. This compounds the problem.

Gluten is the number one hidden food allergy. It is found in wheat, barley, rye, oats, kamut, and spelt.  Celiac disease is a full blown allergic reaction to gluten where the body attacks the small intestine. It is present in about 1 % of the population. About 30% of the population has non-celiac gluten intolerance where the immune system attacks the gluten. This reaction is much more subtle, but can lead to long term consequences if not uncovered and addressed.

The other top undetected food allergies are dairy, corn, eggs, soy, nuts, nightshades (tomatoes, bell peppers, potatoes and eggplant), citrus, and yeast (baker’s, brewer’s, and fermented products like vinegar). Left undetected they lead to similar problems.

Identifying and treating these food allergies is the first step in combating the effects it has on weight gain, disease, and inflammation. Most physicians do not address this crucial issue when working up a patient with fatigue, weight gain, or pain. A simple blood test can help identify hidden food allergies. All testing has its limitations and needs to be interpreted by a provider trained in dealing with food allergies and their long term effect on health and healing. At Rejuv Medical Louisville we deal with an array of disease and disorder in the body. From our patients with chronic pains, body degeneration, and inflammation to the athlete with decreased performance our goal is to treat the problem from the inside out. We have found that a quick fix cover-up or too many prescription medications that do not address the root cause of the problem does a disservice to the patients we care about. Medicine is evolving and we need to stay on top of the current research to treat and prevent the diseases that rot and plaque our bodies.

Remember, if you carry unwanted weight or suffer from a chronic inflammatory disease like arthritis, pain, diabetes and, even cancer there is a substantial health benefit in uncovering hidden food allergies that are creating a damaging fire inside you. Healthy food and exercise can be your greatest medicine, but hidden allergies in food can also be your greatest enemy in fighting the battle for your health. Continue to armor yourself with the latest knowledge and fight back!

5 Reasons Your Hormones go Haywire

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Something’s just not right. You’re eating more, sleeping less, feeling frazzled, and stress has become your default mode — even when life is going smoothly. You just don’t feel at home in your body the way you used to.

Sound familiar?

Most of the women at our practice have similar complaints, and while the symptoms may vary, a common denominator exists: hormone imbalance.

Hormonal imbalance tends to show up as women age, but factors related to our modern world — environmental pollution, chemicals in our food, synthetic estrogens in our beauty products — leave women of all ages vulnerable to hormonal chaos.

The tricky thing about hormonal imbalance is that it often sneaks around in the background, wreaking havoc on your health, before you even know it’s there. Worse yet, doctors may dismiss your symptoms or attribute them to something else entirely.

So how do you know if you have a hormonal imbalance? Without a few basic tests, you can’t be sure. But the following signs may be a fairly good indication that something isn’t right, and your hormones could use some help:

 

  1. You’re wired — and tired.

Does it feel like you fluctuate between periods of being high strung and completely exhausted?

We call this being “wired and tired,” and we have the stress hormone cortisol to blame for that. Chronic stress results in high cortisol levels, which then cause the three F’s: fat, frazzled, and frumpy. Fluctuating cortisol levels cause stress on your adrenals and put you on a roller coaster ride of feeling wound up, but exhausted at the same time. So what happens when your adrenals have had enough? They quit. You feel lethargic, heavy, foggy, and maybe even a little depressed.

 

  1. Your libido has gone missing.

Did you know that about 70 percent of low libido is hormonal? So let’s stop the blaming and shaming here — for women, not wanting to get frisky is very often more than just a psychological problem. In most cases, estrogen dominance or low estrogen can be blamed, but your thyroid health and cortisol levels can also play a role. Add to that high stress, burning the candle at both ends and poor sleep, and sex is probably the last thing on your mind.

 

  1. You have crazy cravings.

Women may be hard-wired to need chocolate, but if you find yourself ravenous on a consistent basis, your hormones could be to blame. High cortisol or insulin, for instance, can cause those intense urges for sugar or wine, while adrenal dysregulation can lead to electrolyte imbalances that make you reach for salty snacks.

 

  1. You can’t lose the weight.

Your hormones run the show when it comes to your metabolism. Stubborn excess weight that just won’t go away — no matter how many spin classes you’re doing — is often rooted in hormonal imbalance that causes fat storage, especially around the midsection. Many patients at Rejuv are stunned when they realize they don’t have to kill themselves exercising; it’s simply a matter of finding hormonal harmony and adopting the right lifestyle and dietary habits.

 

  1. Your moods are like a roller coaster ride.

We’re taught from a young age that mood swings are just part of our monthly cycle. And while this is partially true, women with balanced hormones don’t experience the extreme highs and lows of PMS. And yes — you can even navigate the menopause years without going crazy! If your mood issues haven’t improved with drugs or therapy, it might be time to look at how your hormones are crashing the party.

 

3 Tips to Reverse the Damage (Naturally)

The obvious question, then, is how to address these issues and how to return to a state of improved hormonal balance?

First, test your hormone levels. There are a number of tests that look at hormones; blood tests are conventionally used, but salivary tests can also be utilized to offer a more functional view of levels available for use in the body. While we recommend partnering with one of our physicians and ordering some basic tests, you can also start balancing your hormones naturally right now. Here are three tips:

 

  1. Get a better night’s sleep.

There’s probably nothing that will help your hormones more than making quality sleep a priority. Bedtime should be a sacred ritual that calms and soothes you: Take a relaxing bath, turn off electronics at least two hours before you go to sleep, and make sure your thermostat is set to about 65 degrees or cooler.

 

  1. Go gluten-free.

Gluten intolerance is a very real problem that doesn’t just affect people with celiac disease. It’s been linked to estrogen imbalances, menstrual disorders, and diminished ovarian reserve. We recommend the majority of our my patients to cut out or minimize gluten and opt for whole grains like brown rice or quinoa instead.

 

  1. Stress less.

Stress is like pouring gasoline on an already roaring hormonal fire. It raises cortisol levels, taxes the adrenals, and zaps you of energy, joy, and a healthy libido. Stress causes the depletion of the hormone progesterone while increasing the long-term stress hormone cortisol. As the body makes more cortisol it leaves less progesterone to be available for use. Stress also depletes your levels of serotonin and dopamine which are two neurotransmitters responsible for mood-enhancement. These neurotransmitters are responsible for alleviating PMS and hormonal symptoms such as breast pain, digestive upset, cravings, depression, insomnia, anxiety, poor concentration, and lack of motivation. Stress also raises the hormone aldosterone which contributes to water retention and magnesium loss. Advanced testing that looks at your cortisol and progesterone levels can lead to a clear understanding of what could be causing your problems and what specific treatments would be most effective in helping you. Something you can start doing immediately to help with this is to adopt a consistent practice of stress-busting activities: yoga, meditation, massage, walking in nature or whatever other activities mellow your mood.

 

Unfortunately so many people turn to the wrong treatments – pain medications, anxiety medications, and depression medications, and even surgical interventions to improve their symptoms. Because these interventions fail to address the true cause of hormonal imbalances, many continue to suffer and in many cases their conditions worsen which can lead to more serious disease and illness. You may want to consider appropriate hormone replacement options with us here at Rejuv Medical Louisville. There are many solutions available, giving you many options from which to choose, including:

  • Bio-identical Hormone Replacement Therapy (BHRT)
  • Herbal remedies, especially adaptogens
  • Functional nutritional approaches

Having a state of hormonal balance is a critical component to health and well being. Unfortunately, the signs and symptoms of hormonal imbalance are very common, which can make detecting and remedying problems difficult. While we can all take steps at home to create a healthy lifestyle and reduce the potential causes, we’re all unique, which means it’s crucial to go through this process with a practitioner competent in individualized medicine.

You can also take the female hormone survey right now. This analysis is your first step to discovering what systems of your body may be keeping you from obtaining the health you deserve.

 

January is Thyroid Awareness Month

Thyroid-Awareness-Month

 

 

 

 

 

 

January is Thyroid Awareness Month. Understanding your thyroid is important because so many critical processes inside your body rely on that tiny gland. Did you know that the thyroid has an effect on almost every metabolic process that occurs in your body? It’s true!

 

What is a thyroid, anyway? The thyroid is a small, butterfly-shaped gland in the lower front of the neck. It is located above the collarbones, but below the larynx (also called a voice box). A well functioning thyroid makes hormones that help control the function of your brain, heart, kidneys, liver, and even your skin. Knowing what symptoms to look for, and working with your healthcare provider to ensure that your thyroid gland is healthy, is important to your overall health and well-being.

 

Symptoms to be on the lookout for: When the thyroid is working correctly it receives signals from the brain to turn iodine from foods into hormones and sends those hormones throughout your body to keep it functioning smoothly. If your thyroid overworks and makes too much of the necessary hormones it results in a condition known as hyperthyroidism. Symptoms of hyperthyroidism include*:

  • An enlargement of the thyroid (commonly called a goiter)  
  • Fast heart rate, irregular heart rate, trembling hands  
  • Becoming anxious, irritable, argumentative  
  • Weight loss, even when eating the same amount as usual (or more)  
  • Not able to tolerate warm temperatures, increased perspiration  
  • Prominent “stare” of the eyes; also protrusion of the eyes

 

If your thyroid doesn’t produce enough of the hormones your body needs the condition is called hypothyroidism. Symptoms of hypothyroidism include*:  

  • Pervasive fatigue and drowsiness  
  • Weight gain and fluid retention  
  • Forgetfulness  
  • Difficulty learning  
  • Dry hair, nails, and skin  
  • Puffy face  
  • Sore muscles

 

What to do? It is estimated that 30 million people in the United States have thyroid disorders and about half of those have not been diagnosed. Are you one of the 15 million people with an untreated thyroid condition? If you think it’s possible, talk to us here at Rejuv Medical Louisville. There are simple blood tests that can done to determine your thyroid levels, and most thyroid conditions are easily treated. You can also perform a self-exam at home:

 

How to Perform a Thyroid Neck Self-Exam:

  • Use a mirror and focus on the lower middle area of your neck, above the collarbones, and below the Adam’s apple (larynx). Your thyroid gland is located in this area of your neck.
  • While focusing on this area in the mirror, tip your head back.
  • Take a drink of water and swallow.
  • As you swallow, look at your neck. Check for any bulges or protrusions in this area when you swallow. Reminder: Don’t confuse the Adam’s apple with the thyroid gland. The thyroid gland is located further down on your neck, closer to the collarbone. You may want to repeat this process several times.
  • If you do see any bulges or protrusions in this area, see your physician. You may have an enlarged thyroid gland or a thyroid nodule and should be checked to determine whether cancer is present or if treatment for thyroid disease is needed.

 

Facts About Thyroid Disease

  • Hyperthyroidism is an overactive thyroid and hypothyroidism is an underactive thyroid.
  • Symptoms of hyperthyroidism are: rapid weight loss, high blood pressure, anxiety and insomnia.
  • Symptoms of hypothyroidism are: weak or slow heartbeat; muscular weakness; constant fatigue; weight gain; depression; slow reflexes; sensitivity to cold; thick, puffy, or dry skin; slowed mental processes and poor memory; and constipation.
  • Goiter is another thyroid condition that causes a visibly enlarged thyroid gland, often causing difficulty swallowing or breathing.
  • Thyroid cancer, the fifth most common cancer in women, is the fastest growing number of new cases among all cancers in both men and women due to the increased detection.
  • Expert Available for Interview or Appointment: John R. Baird, MD, CEO and Medical Director of Rejuv Medical Louisville

 

Get educated by visiting http://rejuvmedicalky.com/thyroid-disorders/, THEN call (502) 785-4780 to schedule an appointment with Dr. John R. Baird to get your thyroid checked . . . it’s fast, easy, and painless!

 

Did you know?

 

The American Association of Clinical Endocrinologists and the American College of Endocrinology debuted the blue paisley ribbon in 2012 as a symbol to unify thyroid awareness efforts. Paisley was chosen because of its resemblance to a cross section of thyroid follicles, the tiny spheres that the thyroid gland is made up of.

 

 

*From EmPowerYourHealth.org a site provided by the American College of Endocrinology (ACE) in conjunction with the American Association of Clinical Endocrinologists (AACE).

 

How To Get The Most Out Of Your New Year’s Resolutions

New-year-Resolutions

Every January, people across the nation follow the time-honored tradition of making their New Year’s resolutions. The data suggests that roughly one in three Americans resolve to better themselves in some way. A much smaller percentage of people actually make good on those resolutions. While about 75% of people stick to their goals for at least a week, less than half (46%) are still on target six months later, and only 8% actually achieve them, a 2002 study found.

How can you join this elite few? How can you actually follow through on your plan to lose weight, get healthy, and better your life? Here are seven pieces of advice from Rejuv Medical Louisville to help you reach your goals this year.

  1. Clearly define your goals. Many people in the spirit of New Year’s loudly proclaim, “This is the year I’m going to finally get in shape.” But what does that mean? Do you intend to lose a certain number of pounds? Reach a body-fat percentage goal? Run three miles without rest? Bang out 10 pull-ups? One secret to success is to set goals that are specific, measurable, achievable, relevant and time-bound (SMART). The first step to behavior change is to clearly understand what “it” is.
  2. Track your progress. “If you can measure it, you can change it” is a fundamental principle of psychology. These measurements will be a source of motivation as you reflect on where you started and where you are. They will also help you to identify plateaus or “sticking points” in your progress so you can adjust your efforts. In a world full of technology, there are plenty of apps to help you with tracking your progress. In addition to technology, programs like Rejuv Medical Louisville offer tracking and accountability measures as well.
  3. Have patience. You must set realistic goals and realize that progress is never linear. Some people will see rapid gains only to hit resistance later in their efforts. For others, initial progress may be painfully slow but then they suddenly achieve rapid breakthroughs. Making lasting changes takes time.
  4. Publicize your goals to friends and family. As embarrassing as it might be to announce your specific resolution to the world, social support is critical. Yes, it takes some personal courage and vulnerability to share something that you might actually fail at, but to dramatically increase your odds of success you’ll want support from those around you.
  5. Put it on your schedule. How often do you hear people say they can’t “find the time” to do something. Nobody finds time. We all choose to spend our time the way we do—whether that’s eating junk food or going to a spin class. Make your new goals a priority and actually schedule them into your calendar. If you have a fitness goal schedule time for your workouts. If you want to declutter, schedule time to clean out your closet on your calendar. If you want to save money, put in a weekly budget review onto your Sunday afternoons. Think of these time blocks as important appointments—just like an appointment with a doctor. Don’t automatically schedule something else over them. That which is scheduled gets done.
  6. Stop “all or nothing” thinking; it’s better do something than nothing. Are you guilty of “all or nothing” thinking? Do you ever think, “Well, I might as well get dessert since I already ate those French fries?” And then, “I blew my diet last night so I’ll just restart it next week.” The difference between doing something rather than nothing is huge. If you don’t have a full hour to workout at the gym, just decide to make it the best 20-minutes you can. If you have a slight cold or minor injury, decide to just walk the track for a couple miles. If you have a financial emergency and can’t save your full 10% this month, just save what you can. The bottom line is, any effort towards your goal is better than no effort.
  7. Get up, when you slip up. None of us are perfect. As the great Vince Lombardi said, “It isn’t whether you get knocked down, it’s whether you get back up.” Resiliency is the key. Don’t turn relapses or temporary failures into total meltdowns or excuses for giving up. Instead, just acknowledge the mistake and recommit to the path.

Achieving your goals isn’t all about about willpower. It’s about developing the right skills and strategies that, with patience, will lead to success. Keep these seven secrets in mind in 2016, and you’ll join the elite 8% who will be celebrating their success later in the year.

Can You Reverse Type 2 Diabetes?

diabetes-description  Is it possible to reverse type 2 diabetes?

 

YES! If you would have searched this simple phrase on the internet 10 years ago, the results would have been a resounding no. However, with a much better understanding of the effects of lifestyle modification on diabetes there has been a shift in what we can accomplish in regards to actually reversing this disease.

 

There are certain factors that play a role in your ability to reverse type 2 diabetes. Your body’s ability to reverse the damage that has be done depends on how long you’ve had the condition, how severe it is, and your genes.

 

According to new statistics from the Centers for Disease Control and Prevention, 25.8 million people, or 8.3% of the U.S. population, are affected by either type 1 or type 2 diabetes. Most, however, have type 2 diabetes, which in many people develops later in life. Caused primarily by genetic makeup, a sedentary lifestyle, and poor eating habits, type 2 diabetes can be reversed in some cases. By making lifestyle changes such as adding exercise and improving dietary habits, many type 2 diabetics can drop their glucose or sugar levels back to the normal range, reversing their condition.

 

According to the director of diabetes translation at the CDC, Ann Albright, PhD, RD, “The term ‘reversal’ is used when people can go off medication but still must engage in a lifestyle program in order to stay off.”

 

This is where programs like what is offered at Rejuv Medical Louisville can be life changing. So why do exercise and diet help reverse diabetes? To answer that question, we first need to know why people get diabetes in the first place. Diabetes is caused when there is too much glucose or sugar in the body. We get sugar from the things we eat, especially foods that are high in sugar or carbohydrates. Our bodies are designed to process sugar so it can enter our cells and provide energy. Glucose can’t enter our cells without insulin, which is a hormone produced by the pancreas. If you have diabetes, your body is not making enough insulin or possibly none at all — or it can’t properly use the insulin it is producing. As a result, too much sugar stays in the blood. If this occurs for a long time, it can lead to serious problems.

 

Although genetics plays a part, obesity is a major factor in developing type 2 diabetes. If you carry excess weight, especially your midsection, you are more likely to develop type 2 diabetes because the fat in your tissues causes an imbalance of insulin in the body. This condition is called insulin resistance. If you can eliminate that fat by exercising and limiting carbohydrates and alcohol, then it is possible to decrease your blood glucose levels. And for some, this means getting them back into the normal range.

 

As you can see, lifestyle changes play a very significant role in your ability to reverse the disease process. This not only applies to type 2 diabetes, but many other chronic conditions as well. Keep coming back to our blog to learn more about many other diseases that can be reversed with simple lifestyle modification.