Here is some links from patients that has worked with LEAP..IT has helped alot of patients...Spasman,Have you worked with any of these companys that you are putting down....If you havent worked with them and followed through with what they suggest that may be able to elimanate some of your symptoms.. Why be so negative when it might really help someone get some relief from IBS
" Try something else it sucks"Now THERE is an informed scientific opinion on the therapeutic outcomes of the LEAP Disease Management Program for IBS.There is an occasional patient who does of course make such a statement, just as any lifestyle modification program may suck for some people. This is because it only works if you follow it exactly as prescribed. Often, when people recidivise, the behavior nust be rationalized somehow. This is quite common in Disease State Management of any kind.Patients who do not follow the protocol, just as with ANY other treatment protocol from cancer to wart therapy, will not get the desired results. Those who follow the program as prescribed get results. If you want to know if a treatment protocol is successful ask the physicians who use it.Perhps one can contrast this "opinion" with the views of some physicians who actually treat patients daily using this method, read some other information in the links below, and if you like, ask for an information package to be sent to you. Then one can make an informed decision.One may wish first to visit the Medical Advisory Board listing to view the medico-intellectual lightweights behind the program and its ongoing development and clinical success in actual practice. http://www.nowleap.com/about_us.html Lightweights such as...William T. Kniker, MDAmerican College of Allergy, Asthma, and Immunology: ï¿½ Chairperson of Adverse Reactions to Foods Committee, now a regular member ï¿½ Contributing Editor, Annals of Allergy ï¿½ Co-Chairman Literature Review Committee ï¿½ Member, Editorial Board & Publications Committee Annals of Allergy ï¿½ Member of the International Literature Review Committee ï¿½ Chairman of the International Food Allergy Symposium Committee ï¿½ Co-editor of Journal Club Allergy/Immunology: monthly feature of Annuals of Allergy ï¿½ Chairman of the Training Directorï¿½s Committee ï¿½ Member of the Scientific & Educational Council ï¿½ Member of the annuals of Allergy Liaison Committee ï¿½ Member of the Food Allergy Committee ï¿½ Member International Food Allergy Symposium Committee Other Professional Activities:Scientific Member, Autism Research Center of South TexasConsultant, Merieux Institute, Miami, FLConsultant, Pharmacia Diagnostics, Piscataway, NJConsultant Immunologic Research, Lincoln Laboratories, Decatur, ILConsultant in Allergy and Immunology, U.S. ArmyAttending Immunologist, Wilford Hall, USAF Med Center _____________________________A FEW CASE SUMMARIESSubmitted by LEAP affiliate Physician, Board Certified in Gastroenterology, who did his fellowship at Johns Hopkins and has been on the faculty of (2) medical schools.Submitted byDr. Fred WilliamsGastroenterologySt. Louis, MissouriNOTE: Dr. Williams has been so impressed with the therapeutic outcomes from the LEAP program he recently accepted the appointment as LEAPï¿½s Medical Director. So the Program is under the medical direction of a respected Board Certified Gastroenterologist.Also, an article about LEAP was published in the January 2004 issue of "The Disease Management Advisor." Anyone desiring a reprint may email me and I will be glad to mail you a reprint of the article as well as other supportive information.MNL ____________________Case # 1: Male, Irritable Bowel SyndromeThe patient is a 39 year old white male who complained of a six year history of having three to five loose, non-bloody bowel movements per day. He denied other symptoms including nausea, vomiting, constipation, weight loss, or fever. He reported that sometimes these symptoms seemed to increase with stress. He was seen by his primary care physician at which time a physical exam was unremarkable. He was placed on hyoscyamine 0.125 mg po every four hours as needed. Approximately five years ago he was referred to a gastroenterologist and underwent evaluation that included a colonoscopy with colonic biopsies, upper gastrointestinal series with small bowel follow through, stool studies for giardia antigen, Clostridium difficile toxin, ova and parasites, fecal white blood cells, and stool culture for salmonella, shigella and campylobacter. All the above studies were normal. A diagnosis of Irritable Bowel Syndrome was made and the patient was begun on dicyclomine 10 mg po twice a day. The dicyclomine initially resulted in a decrease his diarrhea. However, approximately one year later, the diarrhea worsened despite the ongoing use of dicyclomine, and the patient returned to the gastroenterologist. A complete blood count, Westergren sedimentation rate, and anti-transgluatminase IgA antibody were obtained and all were normal. The patient was told to continue the dicyclomine and use loperamide on an as needed basis. He returned approximately two years later stating that he had stopped the dicyclomine and found that if he used loperamide either once or twice a day on a regular basis his diarrhea was controlled. A decision was made to continue with loperamide and add amitriptyline 20mg po every night. Approximately, one year later the patient again presented complaining of the same symptoms. The amitriptyline was minimally effective, and the patient continued to require the frequent use of loperamide to control the diarrhea. The patient then underwent LEAP testing for food and chemical sensitivities and was counseled in a LEAP diet devoid of test-positive foods. Within two weeks the diarrhea had completely resolved and loperamide was no longer needed. He has been on the diet for six months and continues to do well. He has found that his symptoms often return when he consumes foods to which he has been found to be sensitive. ____________________Case # 2: Male, Irritable Bowel SyndromeThe patient is a 51 year old white male who has had years of left lower quadrant pain, flatulence and one to five loose bowel movements per day. His past medical history and physical exam were unremarkable. Three years ago he underwent a colonoscopy into the terminal ileum that was normal. He was placed on dicyclomine 10 mg po twice a day. The dicyclomine did not seem to be effective and the patient tried various dietary manipulations. He noted that his symptoms improved to some extent when he avoided milk products and several grains including wheat, corn, and rice. Because of the improvement of his symptoms on a wheat-free diet, he underwent an esophagogastroduodenoscopy to evaluate for celiac disease. The endoscopy including small bowel biopsies was normal. The patient then underwent LEAP testing for food and additive hypersensitivities. He was found to have several hypersensitivities including wheat and corn, but not rice. He was begun on a LEAP diet lacking in the offending foods. The patient very quickly noticed an improvement in his symptoms. He has now been on the diet for eight months and reports that he is markedly improved. His diarrhea, flatulence and cramping have decreased significantly. In addition, he previous had problems with gastroesophageal reflux and insomnia, and they have also significantly improved. _________________________Case # 3: Female, Irritable Bowel Syndrome and GERDThe patient is a 17 year old white female who has had a several year history of lower abdominal pain and cramping, diarrhea, gastroesophageal reflux, nausea, chest tightness, chronic sinusitis, headaches and allergies. The physical exam was unremarkable. An evaluation one year ago included an abdominal ultrasound, and abdominal and pelvic CAT scan which were normal. An upper gastrointestinal series showed moderate gastroesophageal reflux. An esophagogastroduodenoscopy showed grade I esophagitis and normal small bowel biopsies. The patient was started on esomeprazole 40 mg po once a day and noted a good improvement in her reflux, chest tightness and nausea. The lower abdominal pain and cramping did not improve with fiber supplementation and hyoscyamine 0.125 mg p.o. every four hours as needed. The patient tried a lactose free diet. She did not notice any improvement, but she did find that she had some improvement in her lower abdominal symptoms with the avoidance of fructose containing foods. However, a fructose hydrogen breath test did not show that the patient was fructose intolerant. The patient underwent LEAP testing for food sensitivities and was subsequently started on a LEAP oligoantigenic diet [that eliminated offending foods]. Within one month, the patient noted an improvement in her overall health with a marked decrease in her lower abdominal pain, cramping, diarrhea, heartburn, headaches, sinusitis, and chest tightness. Her level of energy has increased. She has been able to stop the esomeprazole. The patient has been on the LEAP diet for five months and continues to do well. She has noted that her symptoms quickly return when she varies from the diet and consumes any test-positive foods. ________________________Case # 4: Female, Irritable Bowel Syndrome and MigraineThe patient is a 47 year old white female who complains of years of heartburn, bloating, flatulence, diarrhea, and migraine headaches. Otherwise her history was unremarkable and her physical exam was normal. An upper endoscopy was performed that was normal. The patient was placed on ranitidine 300 mg twice a day and had good improvement in her gastroesophageal reflux symptoms but continued to complain of bloating, flatulence, and diarrhea. Fructose and lactose hydrogen breath tests were performed and were both negative. The patient underwent LEAP testing for food sensitivities and was subsequently started on a diet that eliminated offending foods. Within one month her flatulence, bloating, diarrhea, and headaches have completely resolved. She continues to take ranitidine 300 mg po twice a day but has noted less breakthrough reflux symptoms since starting the LEAP diet. She also has had less insomnia and fatigue and more energy. After five months on the diet she continues to do well, and has noted that her symptoms return if she strays from the diet. ___________________________January 20, 2003To Whom It May Concern,I have been asked to comment regarding my experience with the L.E.A.P. (Lifestyle, Eating and Performance) Program. We have been performing these tests for well over a year now and have had phenomenal results.Our most impressive results have come with Irritable Bowel Syndrome and Fibromyalgia, though we have had very impressive results as well with other conditions such as migraine, depression, and gastroesophageal reflux disease.Our experience has been a 95% or better success rate, in that this percentage of persons have either become completely symptom free or have improved in their symptomology. Reimbursement is excellent and easily obtained from private insurance companies. Signet Laboratories has been very easy to work with and are very aggressive about keeping us well stocked on supplies for these tests. Overall, our experience has been a tremendous success and I would highly recommend it to any physician who deals with any of these problems.Sincerely,W. Brad Wilson, M.D.1602 East Starr AvenueNacogdoches, Texas 75961ORIGINAL SIGNED LETTER ON FILEPosted 1.24.03 http://www.ibsgroup.org/cgi-local/ubbcgi/u...t=000407#000002 ___________________________January 28, 2003Dear [Signet],Thank you so much for introducing our practice to the LEAP Test. We have had numerous patients with symptoms to justify the test. Even more importantly, weï¿½re getting results.In just a couple of weeks after changing their diet, patients are experiencing significant relief from their symptoms. Without LEAP Testing, food restriction was just a shot in the dark. Patients didnï¿½t even want to try it. Now, with verifiable results, they are more willing to make lifestyle changes. The format of the Guide that comes with the test results is very informative and the patients are very impressed with the amount of information and how understandable it is.We appreciate knowing about this technology.Sincerely,Steven G. Bander, D.O.Bander Family Medical and Preventive Medicine ClinicWylie, TexasORIGINAL SIGNED LETTER ON FILE________________________ï¿½some patients self-reporetd cases __________________________posted 07-08-2002 10:42 AM I got my LEAP blood test results back two weeks ago, and have been totally "on" the diet as of just last week. The result has been very dramatic. I have had pain predominant IBS for 25 years, but up until about 5 years ago I could manage it with food, sleep, valium. Five years ago I started on a downward spiral, with bad cramping in the afternoons followed by urgent BM's. And more pain. I have been at the end of my rope for a few years now. I really don't know what to say about this...the absence of pain...????....does anyone understand that you could feel intense pleasure from just feeling pain-free, relaxed and calm within your own body?? I consider myself a real "foodie" -- love the exotic stuff--- thai, indian, italian --- but I am not even tempted by any foods right now, I am so at peace with JUST FEELING LIKE A NORMAL HUMAN BEING. That's how I feel for now. I am scared that something will happen as has happened so many times before with remedies for IBS-- my body will find a way around it and deliver the pain anyway.......I hope not. I think it's important to realize that IBS is not just one thing...I have probably three things that contribute to stomach problems....nerves, general disposition, and now I know about the food sensitivities. Right now I am just thankful, so thankful for each day without pain. My main reactive foods were black pepper, tyramine (bananas) and wheat, all of which I ate every day. http://www.ibsgroup.org/cgi-local/ubbcgi/u...pic;f=4;t=00028 6;p=3#000106Just another in a non-stop string of successes!!! Makes it all worthwhile! http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000364 I'm a relative newbie to the LEAP program having had my blood drawn on April 15th (tax day) of this year. That makes it about 3 months on the program so far. Let me say that I didn't expect a great improvement ... some improvement but nothing major. I had expected to feel a bit better and hoped to reduce the medications I was taking. I had figured that if my symptoms were reduced about 20% to 30% I would be satisfied. However, I had no idea how much of a change the program would provide.The results have been nothing short of amazing! It is the best $700 (I think that's about what it cost) I've ever spent. After suffering about 30 years with IBS-D I've finally found major relief. My drug intake is reduced about 97% (Imodium and Bentyl). I rarely get 'digestive disturbances' any more and when they happen I can easily pinpoint the foods that caused it. I don't get the squirts for a week at a time anymore. Now that I know exactly what foods to avoid life is much more pleasant. I don't live from toilet-to-toilet like I used to. I'm still not like a 'normal' non-IBS-D person, but I'm doing so much better than I had been doing for many years. My recommendation: If you've got IBS-D go to the LEAP website and fill out the qualification form to see if they feel you will benefit from their program. If so, do it! It doesn't matter if insurance will pay for it or not, just find a way to get the test done. Your health and quality-of-life are worth much more than the cost of this test. Bob http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4&t=000427#00 0015posted 09-01-2002 10:44 AM you couldn't be more right, Mike! I'm now on day five! Another normal BM (who hooooo) and I feel GREAT! I have NO pain (not any, not even a little) This is the best I have felt in YEARS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!![ 09-01-2002, 10:44 AM: Message edited by: yodiss ]---------------------SuzinIt takes twice as many muscles to frown than to smile! So smile more!!!LEAP PT UPDATES* http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000286 LEAP and BLOOD TESTS http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000285 NEW THREAD: LEAPERS PROGRESS REPORT http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4;t=000331#00 0001NEW LEAP PATIENT 6.12.02 STARTUP THREAD ï¿½YESTRDAY WAS THE DAYï¿½ http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000302 WHAT IS LEAP? http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000287 DOES LEAP WORK? http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000364 DISCUSSION OF LEAP PROTOCOLS WITH PROSPECT http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=5&t=000313&p=[/UR[/URL] L]LEAP DIET/RECIPE THREAD (INLCUDES JAN AND THE DIG DIS WK FINIDNGS)http://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=4;t=00029 3;p=2#000069WHAT IS A GOOD BLAND DIET [URL=http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=4;t=000276][url="http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=4;t=000276"]http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000276 PHYSICIAN COMMENT ON EFFECTIVENESS OF LEAP DM PROGRAM http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=5;t=000073 PHYSICIAN REPORTS NEW LEAP SUCCESS 6/7/02 http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=5&t=000356&p=[/UR[/URL] L]HELP GOT MRT RESULTS BUT NO HELP FROM MDhttp://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=4;t=000320#00 0016LEAP DIET [URL=http://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=4&t=000383#00][url="http://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=4&t=000383#00"]http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4&t=000383#00 0010LEAP: PRODCUT THREAD [NEW TECHNOLOGY ETC] http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=5&t=000126&p=[/UR[/URL] L]STORY OF A LEAP FOUNDER WITH IBS http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=17;t=000033LEAP???? [FROM PRODUCT BOARD] [URL=http://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000363#00][url="http://www.ibsgroup.org/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000363#00"]http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=5;t=000363#00 0002FOOD CRAVINGS, INTOLERANCE, IBS AND EXORPHINS http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=1;t=028290#00 0001REACTIONS TO ï¿½SAFEï¿½ FOODS? http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4;t=000335#00 0009RELATED THREADS ON IBS DIET: Eating exactly the opposite of what you should http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=1&t=028290&p=[/UR[/URL] L]MY INSURANCE PAIDhttp://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=4;t=000353WHATS UP WITH LEAP? [URL=http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=4;t=000389][url="http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=4;t=000389"]http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000389 A NEW LEAP PATIENT 8/19/02 http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000418 NEW 8/27/02: LEAP GOT MY RESULTSNote Immediate oral challenge confirmation of test result http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4&t=000427#00 0006 http://www.ibsgroup.org/cgi-local/ubbcgi/u...f=4&t=000427#00 0015LEAP CREATING (good) HAVOC IN MY LIFE!!! http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000421 _____________MNL
Who is your doctor?...or are you on the HomeCare Program? If our or their Dieticans are impolite then certainly we would like to look into that. Or was it a secretary at Signet who was impolite or at a doctors office? I just don't know which "system" you are in.The dietary counselling component which must accompany the in vitro testing (otherwise ther eis no program to be discussed) is conducted by highly experienced, respected and competent RD's if it is done through our counselling network, and by physicians , RD's or nurse practitioners when the Program is conducted by an affiliate physician.So it si quite important to know who your therapist is for me to ascertain what your issues are.This is not something I have not heard before, except from pateints who do not like the news the Dietician brings, or try to negotiate with the doctor or dietician as if the diet is based on an arbitrary decision of the therapist...the diet is dictated by ones body. So if one wants to get some relief one must do precisely what ones gastroimmune system dictates. It does not negotiate with us or the patients.So indeed it is human nature to want to shoot the messenger. I can understand that...but...We cannot help if your diet is boring...how restrictive it is is dictated not by us, arbitrarily, but by how your immune system reacts to foods and additives.My own diet was quite restrictive the first year but my symptom reduction was worth it to me. Later, as many people experience, after a period of strict avoidance, I regained some tolerance to certain foods which I can now eat again in moderation.For example, in the beginning I could not tolerate pizza or any italian food at all as I was reactive to tomato, onion, basil, oregano, garlic etc. I had overconsumed Italian food for many many years. This is one elimination that had the greatest impact on my symptoms.I HATED watching everyone eat pizza-and-pasta but I loved not lying on the bathroom floor for 12 hours at a time anymore...and that I could leave the house tow rok again.After a protratced period of total avoidacne, serial oral challenges confirmed Ihad regained some tolerance to these substances and I slowly reintroduced them into my diet.The avoidance period is essential to be 100% adhered to if there is any hope of releif and regaining some tolerance.I now eat 2 slices of pizza for lunch once a week with no symptoms whatsoever.Lifestyle modification is rarely easy, and each person must weigh his or her personal values...am I sick enough that it is worth giving up my favorite foods to feel well? Or am I not that sick and would rather take immodium as needed and eat what I want?This is not diffwerent than people people choosing between follwing a restrictive weight loss diet or keep eating what they like.No different than a diabetic following his diet or eating what he wants and later facing the consequences in the form of vsacular disease.Or a chronic lunger smoking because it is too hard to quit and he feels OK now...because the emphysema, chronic brinchitis, and cancer may or may not come later.This is the reality of disease management so if that sucks for you, having to eat what your body dictates it will tolerate, or not, does nor mean the Program sucks as the program is not arbitrary. It does mean the Syndrome sucks though!MNL
I will rethink about LEAP again but only if my others options fails.I don't have paid the extra for the dietitians support but it's not a reason to be impolite.Mike if you want,maybe i will contact you for support eventually.I don't want to talk to anybody else from LEAP than you.I'm almost sure that you was not the impolite man i had talk to.What i mean by restricted diet is evoid wheat like they suggest me.
Spasman, you have tried so many treatment options, but you won't get any benefits if you are not going to follow exactly the recommendations given to you. You're right, the diet might be boring, but if that's how you are going to get results, you are just going to have to grit your teeth and get on with it. If it is considered that you're intolerant to wheat, you might miss the opportunity to get improvement. Mike said it so well. If your doctor says you need to give up smoking/alcohol, cut back on saturated fats, follow a diabetic diet, because of medical conditions, you won't like the advice, but it will be detrimental if you don't follow it. Same with IBS. It's a choice between living with your symptoms or going without things you like for a reasonable period of time to see if it might help you.The same with DA. Try it again. Maybe your reaction was from something else. You are obviously as desperate as most of us here to get improvement, and it helps to be steadfast.I had a test some years back, which probably was LEAP...I can't remember the name. It printed out a list of food which you should either avoid, eat sparingly or eat freely. Interestingly enough, wheat, yeast and gluten were the products I most had to avoid.Remember too, spasman, that the foods we are often most intolerant to can be the ones that we crave the most.
Guess what Eric !! By working with them it sure made my list alot shorter to work with ...How in the world would I would have not been able to figure out Sodium Benzonate...By following my plan the is just for me or noone else has made me feel so so so so so so good....The MRI test got right to my problem...
Donna, I am glad you feel better.I know in your case you also had a major improvement also from the elimination of fructose and all the apple juice you were drinking.But it still does not dispute the fact that foods can trigger IBS for other chemical reasons, other then through the immune system.It also does not dispute the fact there are other triggers to IBS, besides foods.
FYI"This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called "food intolerances" rather than food allergies. A food allergy, or hypersensitivity, is an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though these symptoms can resemble those of a food allergy." http://www.niaid.nih.gov/factsheets/food.htm There are also other chemical reasons foods can trigger the underlying IBS disorder, as well as the mechanisms for the very act of eating can trigger IBS.
EricI only have a problem with apples...The number one thing on my list to start out with was pineapple....I eat all the other fruit, bananas, watermellon, cantelope, peaches pears ect.....The dumb allergy Dr I went to did the skin prick test and he told me I could eat apples....I have tried apples a year later and eat alot of it and guess where I was all day on a sunday...On The POT...I ate it on friday night and early sunday morning I though I would die...Just had to test it one more time
EricI havent had one done ... but why would I want to have one done when I can eat all other fruit and I have no problem whatsoever...Fructose intolerant isn't just one fruit is it ? All of my allergy test come back fine ...nothing was the matter with me ...Well, I am sure there is others things the matter like
and I am sure you would agree...but, you better not
Personally I would have it done just to know, but hey that's me. I figured out a long long time ago that fructose can sometimes upset my IBS, even though I am not really fructose intolerent. So can some other foods like Soda, I don't drink soda, because of a the high sugar content, any added fructose or sorbitol and the carbonation itself.Fats can also trigger IBS, but not through the immune system.Fiber foods can trigger IBS, by creating more gas, but not always through the immune system for most people, its because the gut is sensitive to mechanical, phycologic and environemntal stimuli in IBS.It may also be the amounts of things, weren't you drinking a lot of apple juice a week? Where as with some of the other fruits you may not be ingesting as much as the apples or apple juice.
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