A bottle of tramadol

America is undergoing a massive opioid anxiety attack. It has been called an epidemic by lawmakers and the media. While many people used opioids responsibly for chronic pain, there has been substantial abuse and way too many deaths. As a result of scary headlines and DEA crackdowns, many physicians have become understandably fearful about prescribing drugs like hydrocodone (Lortab, Norco, Vicodin) or oxycodone (OxyContin). Instead, doctors are turning to different kinds of pain relievers. But one commonly prescribed drug for pain is not benign. Tramadol (Ultram) side effects can be quite serious. This reader shares a poignant story:

A Tramadol Tale of Woe and Intrgue:

Q. Last February my 84-year-old mother had pain in her lower back due to a car accident. The doctor prescribed tramadol (Ultram). She took it for several months. It helped with the pain, but we did not realize that the problems she had were side effects that the drug was causing.

The most serious one was shortness of breath. The doctor prescribed an inhaler, and was about to refer her to a pulmonologist. Other adverse reactions included confusion, lack of appetite, depression, anxiety and very high blood pressure (we took her to the emergency room in April for blood pressure of over 200 with shortness of breath).

They did not find anything, but prescribed more blood pressure medicine. Around July she stopped taking the tramadol and she soon realized that she was no longer short of breath. Gradually she was back to her old self, with purpose, less anxiety, and able to breath well.

Perhaps the doctor should have realized that the shortness of breath was due to the tramadol. Perhaps I should have read the sheet that came with the medicine. I wonder if any other patients have had a similar experience.

How Does Tramadol Work?

A. Tramadol (brand names Ultram & Ultracet) is a very complicated medication that was first approved by the FDA in 1995. It is a moderately powerful prescription pain reliever that has some “weak” opioid activity. That means it acts a bit like a narcotic.

It was supposed to be safer than most pain relievers, which is why it is not categorized as a “controlled” substance (the way Vicodin, OxyContin or hydrocodone are). Doctors could prescribe Ultram without using a DEA (Drug Enforcement Agency) number. That reassured many health professionals. The DEA would not come after them the way it might if they were prescribing oxycodone.

Tramadol Was Not Supposed to be “Addicting”

In the early days there was a belief that tramadol was much less likely to cause dependence than most other narcotic-like analgesics. In other words, there was not supposed to be an abuse potential (doctorspeak for the drug was generally considered non addicting). In theory, this pain reliever was supposed to have a low likelihood for producing withdrawal symptoms upon discontinuation, especially when compared to narcotics like hydrocodone or oxycodone.

A Little-Known Tramadol Effect:

We suspect that most health professionals do not truly understand the pharmacology of tramadol. They know that the DEA won’t spank them for prescribing it. They know it is not as potent as hydrocodone or oxycodone.

But do they know that tramadol also affects neurochemicals such as serotonin and norepinephrine? That means the drug behaves a little like antidepressants such as Zoloft (sertraline, which is an SSRI or selective serotonin reuptake inhibitor) or Effexor (venlafaxine an SNRI) in the brain. Tramadol has not been approved to treat depression, however. More on this effect (and its complications) in a moment.

The problem with theories is that they don’t always work out the way they are supposed to. In the case of tramadol, there are a number of side effects and complications that were not necessarily anticipated.

Tramadol (Ultram) Side Effects:

• Dizziness, unsteadiness, vertigo, coordination difficulties
• Nausea, vomiting
• Abdominal pain, indigestion, diarrhea
• Constipation
• Sleepiness, drowsiness, fatigue,
• Itching, skin rash (could be life threatening!)
• Sweating
• Dry mouth
• Anxiety, confusion, nervousness, cognitive dysfunction
• Headache
• Insomnia
• Seizures
• Respiratory depression, breathing difficulties (shortness of breath)
• Suicidal thoughts
• Low blood pressure on standing, hypertension, irregular heart rhythms
• Serotonin syndrome

Responding to Our Reader’s Concerns:

Your mother’s side effects including her breathing difficulties, confusion, lack of appetite, hypertensive episode and depression could all have been tied to tramadol. The drug can trigger something called serotonin syndrome, especially in combination with certain other medications. You can read more about serotonin syndrome at this link. It can be potentially life threatening.

Tramadol and Older People:

The Swedish National Board of Health and Welfare has included tramadol in its list of drugs to (BMC Pharmacology and Toxicology, October 25, 2017):

“avoid unless special reason for prescription.”

The Swedish researchers consider tramadol a “potentially inappropriate medication” in older people, especially if they are identified with “intellectual disability.” In other words, if someone is confused, they may become more confused while taking a drug like tramadol (see anticholinergic effects below).

Similar Stories from Readers:

O.G. reported:

“My doctor (and the orthopedist to whom I was referred for severe hip pain) prescribed Tramadol for recurring pain. I was nauseated, dizzy, had hot flashes, and many of the other side effects this supposedly safe drug causes.

“When I tried to stop I went through what I can only describe as withdrawal. It lasted for about 48 hours. When it was over it felt like coming out from under a cloud. This from a patient like me who is careful in her use of medications.”

Mac in South Carolina shared this:

“I took tramadol for a brief time for back pain. I tried it on three different occasions. I experienced extreme vertigo, nausea, diarrhea, and a migraine-like headache with just one dose each of those times. I had to hold on to the wall to get myself to the bathroom without falling down and could not tolerate bright light. This lasted for days.”

C.S. In Florida was also sensitive to tramadol (Ultram) side effects:

“I was prescribed tramadol for pain. After only 3 doses I experienced nausea, severe vomiting, headache, tingling in both arms and disorientation. I feared I was having a stroke and went to the emergency room. A CT scan revealed no stroke.

“I would never take this medication again. When I go to see any doctor I list tramadol in the ‘allergic to’ section of medical forms so I am not prescribed it again.”

Tramadol and Anticholinergic Activity:

Very few physicians realize that tramadol also has anticholinergic (AC) activity. That means it interferes with the action of the crucial brain chemical acetylcholine. This might explain why the woman who contacted us described her mother’s “confusion” as a possible complication of tramadol.

Learn more about the impact of anticholinergic drugs at this link:

“Are Anticholinergic Drugs Bad for Your Brain?

Tramadol has weak AC activity. But if someone were taking other drugs that also have this effect, the total AC burden could become problematic. This is especially true for older people. Here is a link to more information on drugs with anticholinergic activity.

Tramadol (Ultram) Side Effects & Withdrawal

Perhaps the most disturbing and unanticipated problem with tramadol is withdrawal. Even though most health professionals thought the drug would not trigger this problem, we now know that it not only happens but can be disastrous.

In addition to the narcotic-like action of tramadol, the drug also behaves a bit like antidepressants such as paroxetine, sertraline or venlafaxine. At the time it was approved, the FDA may not have realized that when such drugs are stopped suddenly, people can experience very unpleasant withdrawal symptoms.

This dual action (the narcotic-like effect and the serotonin “discontinuation syndrome”) can lead to some terrible symptoms. Patients are not always warned about this problem.

Tramadol Withdrawal Symptoms:

• Anxiety, mood swings, irritability
• Brain zaps (shock-like sensations), tingling
• Sweating, chills, goose bumps, shivering
• Tremors
• Headaches
• Insomnia, sleeping difficulties, nightmares
• Flu-like symptoms
• Nausea, vomiting, diarrhea, loss of appetite
• Depression
• Hallucinations, unusual thoughts
• Aggresiveness

Here are just a few of the many stories we have received about this complication:

Keiko clearly experienced withdrawal after stopping tramadol:

“I had surgery on my shoulder for a partial rotator cuff tear and manipulation of my frozen shoulder at the same time. The doctor ordered for PT to begin very next day. I was taking tramadol, but starting to feel strange so I stopped taking it abruptly.

“By midnight I was having cold chills and the sweats all night long. By the next morning I was vomiting. In addition to sweating profusely and cold chills I had severe anxiety. I was ended up in ER that afternoon. Apparently, I was having withrawal from tramadol. It was a horrible experience. I do not want to ever experience the “withdrawal” symptoms again.”

Lorraine reports that tramadol withdrawal was awful:

“I took tramadol for just over 30 days prior to having a hip replacement. I then took the pills for a week after surgery. Then I stopped.

“The withdrawal for me was worse than recovery from the surgery. I had flu like symptoms and was depressed (something I had never experienced). It took about 3 weeks to feel somewhat normal. I would never take this drug again!”

 Anonymous in Pennsylvania:

“Contrary to what doctors may say, this drug is very addictive. Use it sparingly and carefully. There is a small percentage of people who seem to be able to stop this drug cold turkey and not experience withdrawal. They are very lucky.

“More and more it’s becoming recognized that tramadol is an addictive drug and causes terrible withdrawal for many. The worst of it will last anywhere from 2 days to 2 weeks and then, depending on how long you’ve been taking the drug, you may continue to experience withdrawal symptoms for months afterward.

“I can’t even begin to explain how bad the withdrawal is. If you look it up, you will find numerous reports and testimonials from others who are trying to get off this drug and can’t because the withdrawal is so bad. Others can vouch for the hellaciousness of it.

“For me the worst physical symptom was constant restless legs. Emotionally, I was extremely depressed and had zero energy. Just lifting my arm felt like a huge effort. Going up and down the stairs put me out of breath. My internal thermostat was totally out of whack. I was hot one minute, and cold the next. My hair and clothes would get drenched from night sweats.

“The list goes on and on. I don’t EVER want to go through that kind of withdrawal again. I’m not saying don’t take this drug. But do be careful and try to stay on it for only as short a length of time as possible. Oh, I should also note I had a seizure while withdrawing from tramadol, which is not uncommon when coming off this drug.”

Generic Tramadol Issues:

In addition to the side effects and withdrawal symptoms associated with sudden discontinuation of tramadol, there is also the generic drug concern. We have heard from a number of people that not all generic versions of tramadol are created equal:

P.J.B. reported the following:

“I was taking the generic version of Ultram (tramadol) for several years when my pharmacy suddenly changed manufacturers (and did not point it out to me before I left the pharmacy with it).

“I gave them the benefit of the doubt, but within 24 hours of taking the other generic, I knew something was terribly wrong. All of my pain symptoms returned overnight, accompanied by extreme anxiety.

“I had to jump through hoops with the pharmacy but managed to get my doctor to write the script as DAW [dispense as written] and within an hour of taking the ‘Ultram,’ I felt completely different. The anxiety disappeared along with the lower back and leg pain.”

Jim also had generic drug trouble:

“When my doctor prescribed Ultram for my neurologic pain, it worked. I was nearly pain free for a few hours. When the pharmacy changed to the generic tramadol I never had total pain relief for any length of time.”

The People’s Pharmacy Perspective on tramadol:

Some people do well with tramadol. It this drug relieves their pain without side effects we are delighted. Others, however, may get modest pain relief and suffer symptoms such as dizziness, nausea and confusion. Older people may be especially vulnerable to such complications. Here is our bottom line:

• Tramadol can ease pain somewhat, but has a number of serious side effects (see above)
• Tramadol should not be discontinued abruptly. It can trigger terrible withdrawal symptoms for some people.
• The FDA has not provided physicians with clear guidelines on how to help patients phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means.
• Do not assume that all generic tramadol formulations are identical to Ultram or each other.

If you experience any side effects, withdrawal symptoms or complications with a generic version of tramadol, contact your physician and pharmacist and request the help you deserve. Let your doctor know if tramadol is causing symptoms such as dizziness, nausea, drowsiness, dry mouth, insomnia or confusion.

Share your own story or comment below.

Revised 10/30/17

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  1. Rebecca
    OR
    Reply

    I’ve been taking Tramedol for seven years for severe fibromyalgia. It helped me to be able to work and be productive at home. After a year, I needed more so went from (4) 50mg a day to 5 and then to 6 which my doc told me was the max. at one point my dr switched me from regular tramedol to time released very abruptly with no wean schedule whatsoever. Don’t EVER do that!

    I had withdrawals for THREE months even though I switched back to regular after 30 days. The worst was the first few days where I had all of the severe withdrawal symptoms. I was sweating and cold with chills, felt like I had the flu, couldn’t stop crying and not to mention, the WORST fibro pain I’ve ever experienced. I had to figure it out myself that it wasn’t a bad FM attack but was actually from my doctor making an irresponsible choice to switch to time released.

    After a few years I became severely hypoglycemic and one day didn’t feel like eating (not knowing I had hypo) and ended up in the ER two days in a row with symptoms of a heart attack which turned out to be a low blood sugar attack from taking 6 tramedols a day with no food two days in a row. When I figured all this out on my own (the doctors didn’t know what had happened to me but were sure to drug test me in the ER) I decided to wean off.

    The way I’m weaning off is extremely gradual. I started by eliminated a half pill from only one dose once a week for four weeks. When I got down to 4 pills a day I started taking only a quarter less per day each week. When I got down to two pills a day I couldn’t go down anymore without withdrawal pain. Here’s what most people (and doctors even!) don’t know about prescription pills. You can’t cut one 50mg pill in half and assume you’re getting 25mg. Only pills that are scored in half can split the active ingredient in half. My tramedol wasn’t scored. Luckily I started up with a new doctor from moving across the country and she Rx’d a new script to be filled by a compound pharmacy. There, they can split the dose however you want! I’ve been doing it this way for 3 months. I started with them at 12.5mg per pill and then took off one pill each week, and now I am all the way down to 6.25mg/8 times per day, which is one whole of my old 50mg pills. So I’m down from 6 50mg pills a day to only ONE. this has made the whole process so much easier. She also Rx’d me Flexeril which helps me sleep on days I go down on tramedol. I don’t take it every night because I don’t want to be dependent on another drug.

    I will continue to go down one pill a day until I feel I need to split the dose in half again. Yes, that will be 3mgs per dose which I’m sure sounds like I’m going overboard. But my body is SUPER sensitive and I know I need to go as gradual as possible.

    Benefits so far – I’m much more clear headed and less depressed. I am also seeing an acupuncturist who helps me with the chronic headaches of weaning off. His treatments have made my life so much easier!! My doctor said I can go back on tramedol if after weaning off I still am in a lot of pain. But I don’t think I will. I don’t want to be dependent on anything anymore.

  2. Bob
    Erie, PA
    Reply

    I started taking Tramadol for joint pain about a year and a half ago for severe joint pain. At first, it worked great. It was miraculous. I had my first good nights sleep in two years. Gradually it stopped working so well. I had what I now believe we’re side effects from the drug. Loss of memory and concentration. Fatigue, emotional and personality changes. Digestive issues. Feeling hot and sweaty a lot.

    I noticed if I stopped taking them I would feel sick with flu like symptoms. I decided to stop taking them cold turkey. That was nine days ago. It’s been hell. The first two days I couldn’t go to work. I was bedridden. I have had severe night sweats and chills. I have had flu like symptoms and for about five days it felt like demons were trying to rip my abdomen and brains out. It was agonizing.

    I’m just starting to feel okay again but I’m still far from being normal. I have depression and anxiety. I WILL say that I never lost my appetite and I never had a craving for the drug itself though, thank God.

    I’m sorry that this drug has not worked out for me as the pain I took it for is sure to return. I’m a 61 year old lifetime carpenter and have a very physical job. When I’m in pain, it makes work miserable. Still, I’d rather be in pain than take this drug as I feel it turned me into a slave for it.

    If you are going to stop taking it, I’d suggest doing some research first and tell your doctor first.

  3. Virginia
    Australia
    Reply

    ‘Lawmakers and the media are telling us…’ – and based upon this statement alone we should be quite skeptical about what we are being told. In reality severe pain that remains poorly managed will lead to numerous co-morbidity issues. Effective pain management is the A and O of good patient care. The vast majority of consumers on S4 and S8 pain meds use them responsibly and for the management of pain.

    Those who have addiction issues with prescription medications will find other, often illegal, alternatives when a legal source has become exhausted. The irresponsible consumption of opioid pain medications in conjunction with other incompatible drugs and alcohol, to get a high, is most unfortunate, but people in need of these medications should not be deprived of them because of the irresponsible actions of the few. The unfortunate reality remains that the best and most effective pain medications have side effects and long-term use can lead to dependency and/or withdrawal symptoms once they are ceased. However, most people are responsible enough to consult with their physician on these issues. Not treating severe and chronic pain effectively has equally serious consequences for sufferers.

    Unfortunately, it really is an issue of ‘damned if you do and if you don’t.’ Perhaps, instead of painting opioid pain medications as the problem, lawyers, politicians and people in the media could explore the reasons why some people feel the need to abuse these and other types of drugs (legal or not). When they have identified the problem they may even come up with an appropriate solution. Unfortunately alternative analgesics, such as paracetamol, do not provide adequate pain relief for many types of chronic and significant pain.

  4. Chris
    Australia
    Reply

    I’m into day 3 of my detox from Lyrica and trammadol. I can’t sleep, my joints ache, I have diarrhoea and feel emotional. I will stick this out though for my daughter. A bit of background, I had a microdicectomy which was going well but was unlucky as I got an infection and then had to have the same surgery. I’ve been on antibiotics for a while but it’s been 12 weeks since I had the first surgery and I just want to feel normal again for myself and my family

  5. Lynn
    Wv
    Reply

    This medication has helped me to be able to have a life off the couch from pain, fatigue and depression. I feel normal again and am so glad I have it.

    I’m sorry some have side effects, but I have them from Benadryl so should they take that off the market when u have an allergic reaction???

  6. john
    Atlanta, GA
    Reply

    I have not used or prescribed Tramadol in my practice. However, I was treating a patient for another disorder, who had a question for me. Tramadol had been given to him for pain at the time of an ER visit. He had been assured that it was not a narcotic. He said to me: ” I don’t believe that for a second. I was addicted to narcotics years ago & managed to get off them. Tramadol gives me the exact same feelings I had from narcotics. Of course, I like the feeling very much, but I know better than to take it.”

  7. Betty
    Abilene. TX
    Reply

    Pain medication has given many people their quality of life back, and they were able to function. For me with Fibromyalgia, it was the only thing that stopped the pain. Everything is bad for you now days.

    I can assure you that I would rather take a risk than grit my teeth every night and not be able to sleep due to so much pain.

    If I find something safer, I will be the first to give it a try. So far, that has not happened.

  8. Hope
    Georgia
    Reply

    I took this medicine for two days (only 6 pills), and by the second day I felt very dizzy. When I stood up I almost fell twice. Luckily, I was at the doctors office when this happened. My blood pressure plummeted to 60 over 40. They wheeled me over to the emergency room and ran all kinds of tests. Turned out it was a side effect of the tramodol. I carry a warning in my purse at all times.

  9. Linda
    Melbourne, FL
    Reply

    I started taking Tramadol for arthritis pain 6 yrs.ago. At one time I took 8 per day with no side effects. I tapered down with no problem. Thanks to Enbrel, I now need take only 1 Tramadol per day, and that’s mainly for depression. I thank God for this drug.

    • M
      Ireland
      Reply

      Exactly. I stopped Tramadol cold turkey and absolutely no side effects whatsoever. It must have a different effect for everyone. I was taking it for pain from having my trapezium crushed in an accident, and it has been marvelous for that, but I just don’t like taking a ‘pain killer’ because I feel it cuts of my emotions somehow. I may take it again, but for now I like to know I have the control. As I said, I FIRMLY believe this drug works very, very differently on everyone. Maybe it’s the blood type? I don’t know. But I have zero side effects. Thank you everyone who contributes.

  10. Charles
    SE
    Reply

    Greetings:

    Once again, you give only the horror stories. Let me just ask you:
    If you have serious pain for several reasons, your doctor should help you, not just bow to fear and not prescribe an appropriate opioid. I really don’t blame them too much.

    But they can prescribe tramadol for scores of patients who are in constant pain, and cannot take NSAIDs. How about a bleeding ulcer and a shattered hip?

    If you continue your constant criticism of tramadol, you may get it off the market.
    Goody two shoes for you. What about us who have to work? Watch what you wish for: you just may get it.

  11. Julie
    Roanoke, VA
    Reply

    I was prescribed Tramadol for shingles pain. One dose made me violently ill, and I threw up for thirteen hours and slept between periods of nausea. It was worse than the shingles pain. When I reported it to my doctor, she said there are some people who simply cannot take this medicine, and it now on the front of my medical records that I am one of them.

    • Jessie
      Mississippi
      Reply

      This is the only medication that’s helped my chronic back pain. I feel like my normal self when I’m not constantly hurting. No side effects for me either. However, my doctor prescribing tramadol for the past few years has recently retired. Now if I go anywhere and give the doctor my life story I’m persecuted for taking it. I’ve stopped cold turkey for the past few months, and I am miserable. Now I have a stomach ulcer from constant NSAID use, but that’s okay right?

  12. ashley
    FL
    Reply

    my boyfriend has been taking tramadol for 5 plus years. he takes it for sever back pain.
    i believe he takes 1 every 4-6 hours. in the past 6 months i have noticed a huge change in his personality. he literally has zero patients and just snaps….then asks like nothing just happened a few minutes later or blames it on myself. can anyone tell me if this could be from the side affects of tramadol please.

  13. Natasha
    Australia
    Reply

    My father whos 71 started tramadol 2 weeks ago he experienced nausea dizzy and had a fall he is now in hospital and its like he has rapid dementia hoping he comes good doctors think it’s from the tramadol anyone else experience this

  14. Stacy F
    Oklahoma
    Reply

    I’ve been tak8 my generic tramadol for 2 years I have big round red rings on both hands and one ankle, one on each wrist. This is the worst drug ever. Getting off is frightening but my pain from hernia mesh is bad. Can anyone guess what causing these rings?

  15. J
    USA
    Reply

    I was taking tramadol three times a day and I weaned myself off slowly by starting with working on eliminating one dose at a time. I started with the mid-day dose and began simply cutting a corner off – about a fourth of the pill. I did this for three or four days, then cut a half off, etc. until the dose was gone. I waited around a week and began to cut the morning dose, etc. This has worked pretty well. I didn’t suffer from withdrawal doing it this way, but you have to be patient. Totally worth it.

  16. Elisa
    Puerto Rico
    Reply

    I had knee replacement surgery 2 months ago, 1 week later the knee did not hurt so I dtopped taking Tramadol and Neurontin. Landed in the hospital with severe confusion, nausea, headaches…..now I am depressed. Never taking that stuff again, this is serious business and could be deadly

  17. Sally
    Australia
    Reply

    This is my experience of Tramadol.
    Prescribed for back pain after car accident, I first tried Tramadol on holiday in China. I took a second tablet an hour after the first didn’t appear to work. Box instructions indicated more than one a day could be taken. 3 -4 hours later I thought I was having a stroke or severe hypoventilation.

    My breathing, brain, psyche- everything felt dangerously strange. Lost muscle tone, strength and had to hang onto husband to walk, sudden need to urinate, felt faint and flopped face to pavement, unable to stand without full assistence. Difficulty performing simple task of removing hotel card from wallet or voice my thoughts coherently. Thinking language barrier would pose difficulties with ambulance we returned to hotel where staff could ring doctor.

    In taxi, felt like I momentarily died or had profound hallucination as the whole world – all sound and vision just disappeared to white leaving me seemingly conscious on another plane, crazy as that sounds. Suddenly, the world zoomed back in from all sides and after exiting taxi I twice projectile vomited. Took 2-3 hours lying on bed to start to recover.

    I’ll list “severely allergic to Tramadol” with any doctor I see. I was not on any other medication except one daily Champix which is not listed as contraindicative. Two days later I tried just one Tramadol without Champix thinking it might be ok on it’s own but an hour later the same thing happened but less extreme.

    I nearly collapsed constantly in a museum where I was disturbed by the darkness, had to slump on steps outside for an hour before I could walk or talk, anxious, weird-feeling and hyper-sensitive to noise for 2-3 hours. Tramadol is hideous for me. I’d rather the pain ten times over.

    • Natasha
      Australia
      Reply

      Can i ask how long your confusion ect went on for and any long term affects

  18. Sherrie
    Reply

    EVERY MEDICATION can have serious potential side effects. When deciding to take a medication you weigh the benefits against the risks. I am taking tramadol for hip pain. With tramadol I have some pain relief and some mobility. Without it the pain is debilitating and I can not walk. I chose the risks and so far, so good.

    • Lisa
      my own little corner of the universe
      Reply

      I agree. I’m on it for jaw issues and yes, it makes me a little dizzy and I have chills once in a while but the pain is gone and I can sleep at night.

  19. Cindy M. B
    Seattle, WA
    Reply

    One of your commenters griped that this is just “another article that fills people with anxiety and makes them fearful of everything in the medical world.” RIGHT ON!!! I am one of those people. Over the years my Dr. has suggested various Rx meds for something or other. I said, “Hell No!” I have PP to thank for that, and in looking back I know I made the right choice(s).

    Instead, I’ve learned everything I can about healthful lifestyle changes, especially diet, nutrition and exercise, and that’s made ALL the difference. Yes, it takes some time and work, but the rewards speak for themselves. Thank you, PP.

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