What is Candida?
Candida is the short name used to describe yeast overgrowth in the body. The technical term is Candidiasis. Like their “cousins” the molds, they live all around us. One family “Candida Albicans” lives in all mucous membranes, i.e. intestines, eyes, ears, bladder, stomach, lungs, vagina, etc. It is one of the billions of other friendly organisms that serve a useful purpose in the body. One of its important functions is to recognize and destroy harmful bacteria. However, candida is not intended to overgrow and get out of control while the body is alive. This is only intended to happen when the body dies, when its function and characteristics change in order to break down the body.
How Does Candida Affects Us?
When Candida Albicans is under control it poses no problem, but when it gets out of control it begins to overgrow causing numerous symptoms and health problems from the top of the head to the tips of the toes, from migraines to nail fungus. It can result in symptoms inside (pain and malfunction of organs, even brain lesions) and outside (eczema and hives). It can also cause problems with the mind and emotions.
Symptoms Caused by Candida Overgrowth
- Allergies, sensitivities, and intolerances that worsen in damp, muggy or moldy places or weather that is damp, muggy, humid or rainy.
- Hay fever and asthma.
- Intolerances or allergies to perfumes, odors, fumes, fabric shop odors, grass, cats, dogs or other animals, tobacco smoke, chemicals, smog, molds, dust mites, dust, pollen, and other airborne substances.
- Athlete's foot.
- Babies - colic, diaper rash, thrush (coated, white tongue), and cradle cap.
- Bruising easily.
- Cheekbone or forehead tenderness, pain.
- Cold hands or feet, low body temperature.
- Cold-like symptoms: excessive mucus in the sinuses, nose, throat, bronchial tubes and lungs.
- Cravings or addictions for sugar, bread, pasta and other high carb foods, and also alcohol.
- Cysts, abnormal formation of, in different parts of the body, especially around the neck, throat, and ovaries, and in the bladder or scrotum.
- Digestive problems - diarrhea, constipation, abdominal distention, bloating or pain, gas, mucus in the stools, hiatal hernia, ulcers, suffering from bacteria, i.e. salmonella, E. coli, h. pylori, etc.
- Ears - ringing in the ears (tinnitus), sounds in the ears, ear infections, dryness, itchiness, ear pain, ear aches, ear discharges, fluid in ears, deafness, abnormal wax build-up.
- Eyes - erratic vision, spots in front of eyes (eye floaters) and flashing lights; redness, dryness, itching, excessive tearing, inability to tear, etc.
- Fatigue, chronic fatigue syndrome or Epstein Barr, or a feeling of being drained of energy, lethargy, drowsiness.
- Flu-like symptoms.
- Glands – swollen, too little saliva (dryness in the mouth), blocked salivary glands, swollen lymph nodes.
- Hair loss, scum on the scalp, dandruff, itchy scalp, scalp sores and dryness.
- Heart palpitations and irregular heart beat.
- Headaches, migraines, brain fog, dizziness, etc.
- Hemorrhoids and rectal itching, rash, irritation and redness.
- Hypoglycemia (low blood sugar), and diabetes.
- Hypothyroidism, Wilson’s Thyroid Syndrome, Hashimoto’s disease, hyperthyroidism, erratic thyroid function, etc.
- Irritability, nervousness, jitteriness and panic attacks.
- Lesions on the skin, and inside the body, i.e. the brain.
- Male-associated problems - jock itch, loss of sex drive, impotence, prostatitis, penis infections, difficulty urinating, urinary frequency or urgency, painful intercourse, swollen scrotum, etc.
- Female health problems - infertility, vaginitis, unusual odors, endometriosis (irregular or painful menstruation), cramps, menstrual irregularities, pre-menstrual syndrome (PMS), discharge, painful intercourse, loss of sexual drive, redness or swelling of the vulva and surrounding area, vaginal itching or thrush, burning or redness, or persistent infections.
- Fungal infections of the skin or nails, i.e. ringworm, seborrheic dermatitis, dark and light patches on the skin (tinea versicolor), etc.
- Joint pain, stiffness or swelling (arthritis).
- Kidney and bladder - infections, cystitis (inflammation of the bladder with possible infection), urinary frequency or urgency, low urine output, smelly urine, difficulty urinating, burning pain when urinating.
- Lack of appetite.
- Mind and Mood - anxiety attacks, crying spells, memory loss, feeling spaced out, depression (including suicidal feelings), manic feelings, inability to concentrate, mood swings, irritability, etc.
- Mouth sores or blisters, canker sores, dryness, bad breath, a white coating on the tongue (thrush) and blocked salivary glands.
- Muscle aches and pain, numbness, burning or tingling, and lack of strength and coordination.
- Nasal congestion, postnasal drip, itching, dryness.
- The odor of the feet, hair or body not relieved by washing.
- Respiratory - cough, bronchitis or pneumonia, pain or tightness in the chest, wheezing, shortness of breath, asthma.
- Sick all over feeling.
- Sinus inflammation, swelling and infections.
- Skin – dryness, dry red patches, acne, pimples, hives, rashes, itching skin, eczema, psoriasis, seborrhea, ringworm, contact dermatitis, rosacea, etc.
- Stomach – h. pylori bacteria (causes ulcers), heartburn, indigestion, hiatal hernia, acid reflux, belching, vomiting, burning, stomach pains, needle-like pains, food that seems to sit in the stomach like a lump, etc.
- Sleep - insomnia, waking up frequently, nightmares, restless sleep, etc.
- A sore throat, hoarse voice, constant tickle in the throat, laryngitis (loss of voice), etc.
What Causes Candida to Get Out of Control?
A healthy immune system keeps Candida in balance with the other micro-organisms in the mucous membranes, but under certain conditions it begins to overgrow and get out of control. The causes of immune system dysfunction are varied and complex, but antibiotics are the biggest culprits because they wipe out friendly micro-organisms in the digestive system. Because Candida is resistant to antibiotics the imbalance of micro-organisms allows it to take over. It begins to change its shape and starts to overgrow; raising large families called colonies.
These colonies excrete toxins that circulate throughout the body, further weakening the immune system and creating havoc throughout the body. The Candida produces very long root-like structures that penetrate intestinal walls leaving microscopic holes which allow toxins, undigested food particles, bacteria, and yeast to enter the bloodstream. This condition is known as the “Leaky Gut Syndrome”, which causes food allergies and many health problems. These root-like structures also cause considerable damage to the walls of the intestines resulting in malabsorption of nutrients.
Adding to the problem of malabsorption are nutritional deficiencies that also weaken the immune system. Today’s standard diet lacks the necessary nutrients to maintain a healthy immune system. It is loaded with sugar, carbohydrates, hydrogenated oils and fats (trans-fats), white flour products, processed foods, food additives, preservatives, pesticides, and heavy metals. This, in addition to foods being irradiated (exposed to high levels of radiation to extend shelf life), and being grown in nutrient depleted soil, long storage and transportation time, and improper handling, cooking and microwaving that goes on in most homes, further depletes nutrients available. All of these factors contribute to a weakened immune system.
Testing for Candida at Home
Your holistic practitioner will have conclusive means of testing for candida, however for a simple at home test try the following. First thing in the morning, before you put anything in your mouth, fill a clear glass with room temperature bottled water.
Work up a bit of saliva, and spit it into the glass of water. Check the water every 15 minutes or so for up to one hour.
If you see strings (fibers) traveling down into the water from the saliva floating on the top, cloudy specks (particles suspended in the water) or cloudy saliva that sinks to the bottom of the glass you have a candida problem.
Diagram from www.ninazu.com
The Candida Control Program
In order to get Candida overgrowth under control, five things need to be done simultaneously:
1. Eliminate foods that feed Candida
2. Build up the immune system
3. Kill off Candida overgrowth
4. Plant good bacteria in the digestive tract
5. Manage the healing crisis
1. Eliminate foods that feed Candida
Candida overgrowth is mainly fueled by sugar, refined carbohydrates, and gluten. Let's look at each of these separately so you know what to avoid.
Candida’s main food supply is sugar and all forms of it, such as lactose contained in dairy products, honey, glucose, fructose, and sugar substitutes, i.e. Nutrasweet, aspartame, saccharin. Eliminating sugar is the most important part of the Candida Program. All fruit, except lemons, are also very high in sugar and should be extremely limited during the initial stages of the program, along with some vegetables that are very high in sugar, such as sweet potatoes, parsnips, and beets. Sugar is also contained in most processed foods such as smoked luncheon meats, ketchup, cereal, and yogurt, making it important to read labels carefully. Following is a partial list of the names for sugar and sweeteners.
Names for Sugar and Sweeteners
Aspartame, carob powder, corn starch, crystalline carbohydrate dextrin, dextrose, disaccharides, galactose, glucose, levulose, malts of any kind, maltitol, maltodextrin, maltose (malt sugar), mannitol, mono-saccharides, sucrose, Nutrasweet, polydextrose, polysaccharides, ribose, saccharin, sorghum, suamiel, succanat, xylitol.
It has been known for many years that sugar greatly depresses the immune system. In the 1970s, Linus Pauling knew that white blood cells needed a high dose of vitamin C. That was when he came up with his theory that high doses of vitamin C were needed to combat the common cold. But vitamin C and glucose have similar chemical structures and they compete with one another upon entering the cells. If there is more glucose around less vitamin C will be allowed into the cell, and interestingly taking vitamin C also helps curb sugar cravings.
These are a few of the negative effects sugar has on health:
- Sugar contributes to the reduction in defense against bacterial infection
- Sugar upsets mineral relationships in the body
- Sugar interferes with absorption of calcium and magnesium
- Sugar can interfere with the absorption of protein
- Sugar can change the structure of protein
- Sugar can increase the body’s fluid retention
- Sugar can cause hormonal imbalances
- Sugar is an addictive substance and can be intoxicating, similar to alcohol
- High carbohydrates
Candida also feeds on high carbohydrate foods such as starches and grains, i.e. bread, pasta, pizza, cereals, baked goods, and potatoes.
Most Candida sufferers are gluten intolerant. Gluten is an elastic and gluey protein found in wheat, rye, barley, oats, spelt, kamut, triticale and it is hidden in an endless variety of processed foods. Triticale is a new hybrid grain with the properties of wheat and rye while spelt and kamut are gluten-containing wheat variants and are likely to cause problems similar to other wheat varieties. Gluten-containing grains have come to be used extensively in bread and other baked goods because of their “glutinous,” sticky consistency.
Gluten grains feed Candida because they have a high glycemic index just like sugar, and like sugar, create insulin resistance within the cells which leads to blood sugar problems like hypoglycemia and diabetes. The cells become resistant to insulin as they try to protect themselves from the toxic effective of high doses of insulin caused by high intake of sugar and simple carbohydrates. As the cells become insulin resistant, the pancreas produces more insulin which creates a vicious cycle. This exhausts the pancreas eventually leading to its breakdown resulting in diabetes.
Gluten grains contain a protein that is difficult to digest, interferes with the mineral absorption and causes intestinal damage. This damage makes the intestines incapable of absorbing nutrients such as proteins, carbohydrates, fats, vitamins, minerals, and even water in some cases. Our grain food supply also contains mycotoxins (a toxin produced by a fungus), especially found in corn and wheat. Mycotoxins can suppress our normal immune function. See the section on Yeast, Mold and Fungus for more information.
2. Build up the immune system
Building up the immune system requires:
- Eating the right foods
- Taking essential supplements
- Avoiding yeast, mold, and fungus
If the wrong diet is constantly consumed, or if yeast overgrowth damage is never reversed from previous drug and antibiotic use, a cure can almost never be achieved. Eating the right foods is the most important aspect of getting Candida under control and building up the immune system. The “Candida Control Diet” is high in protein and good saturated fats and oils, and low in carbohydrates, and contains no sugars, grains or processed foods. All foods must be as fresh and natural as possible, and free of additives, pesticides, heavy metals, irradiation, mycotoxins, etc.
Meats and fats should be from organic, grass-fed, free-range animals and from good oils such as coconut, palm, and fish. Fish should be from non-farmed sources and as free of mercury and other pollutants as possible. Vegetables should be from reliable certified organic sources. Protein in the diet slows the breakdown of carbohydrates, which decreases the need for insulin secretion by the pancreas. It also stimulates glucagon release, the hormone that unlocks our stored fuel.
Good Fats and Oils - Good fats and oils are equally important to protein in the diet and they are essential to getting Candida under control. They not only increase the body’s ability to absorb nutrients from the foods eaten but also provide the most efficient source of energy. They also provide the building blocks for cell membranes and a variety of hormones and hormone-like substances. Good fats act as carriers for important fat-soluble vitamins A, D, E and K, and for the conversion of carotene to vitamin A, for mineral absorption and for a host of other processes. The kinds of fats consumed greatly influence the assimilation and utilization of vitamin D.
Cholesterol is the body’s version of fat, and contrary to popular belief cholesterol is your best friend. Cholesterol’s job is to repair and protect, and it is essential for nourishing the brain and nervous system. The brain is 70% cholesterol and it could not function properly without it. Hormones like estrogen and testosterone are made from cholesterol. Bile salts (for digestion) are made from cholesterol. Cholesterol is also a powerful antioxidant.
Cholesterol is a substance vital to the cells of all mammals. There are no such things as good or bad cholesterol, in fact, your body produces three to four times more cholesterol than you eat. The eminent American physician and scientist George Mann called the cholesterol theory “the greatest scientific deception of this century, perhaps of any century.”
Essential Fatty Acids - There are also two types of essential fatty acids that must be obtained from the diet and these are omega-3s and omega-6s. They are called essential because we have to get them from food because our bodies can’t manufacture them from other fats. Most people’s diets contain an excessive amount of omega 6 fats, therefore it is important to ensure the diet contains more omega 3 rich foods to offset this imbalance.
Avoid all newfangled fats and oils (trans fats) - Candida sufferers cannot afford to jeopardize their health by consuming toxic oils and fats and must avoid all of the newfangled polyunsaturated fats and hydrogenated vegetable oils (margarine, Canola oil, safflower oil, etc.), called trans fats. These newfangled fats and oils are not only toxic and increase the body’s need for vitamin E and other antioxidants, but also depress the immune system. All trans fats, found in margarine and shortenings used in most commercial baked goods and most processed food, should always be avoided, even by healthy people.
All of these fats and oils are extracted by a process called hydrogenation. This process employs, 1) High heat, 2) A metal catalyst such as nickel, zinc, copper, or other reactive metals and 3) Hydrogen gas. This is a volatile combination that results in an extremely toxic product that the body reacts to like plastic.
Even when refrigerated, hydrogenated oils stay liquid and go rancid very easily. Vegetable oils should never be heated or used in cooking, except for extra virgin olive oil, which must be handled with care. The more appropriate kind of fat for health is saturated fat, in spite of what we’ve been led to believe, which plays many important roles in body chemistry. But saturated fats have been given a bad name by the oil and food manufacturing industry with the sole purpose of selling their products. This is also true for drug companies who perpetuate the cholesterol myth and low-fat diets in order to sell drugs.
The truth is, natural fats and oils have components found only in them which are health-promoting, and the newfangled trans fats are now known to be disease-causing. These health-giving saturated fats are stable and do not become rancid easily, they do not draw upon the body’s reserves of antioxidants, nor do they initiate cancer or irritate the artery walls.
Coconut oil - Coconut oil is another healthy saturated fat that contains many properties that are beneficial to Candida sufferers which are anti-bacterial, anti-viral and anti-fungal. It also kills off yeast overgrowth. Coconut oil supports immune system function, supplies important nutrients necessary for good health and improves digestion and nutrient absorption.
The fat in coconut oil is easily digested and absorbed, unlike the newfangled trans fats that act like plastic in the body. It puts little strain on the digestive system and provides a quick source of energy necessary to promote healing. Coconut oil is absorbed directly from the intestines into the portal vein and sent straight to the liver, whereas other fats require pancreatic enzymes to break them into smaller units.
Look for unrefined coconut oil, since most commercial coconut oils are refined, bleached, and deodorized. It is highly resistant to spoilage and has a long shelf life (up to 2 years at room temperature). Coconut oil has a high burning point and is a perfect oil for cooking. Coconut oil can be taken by the tablespoonfuls with meals to aid digestion. A good therapeutic dose is 1 to 2 tablespoons with fat-containing meals.
Fish oils - Fish, unlike mammals, birds, and reptiles, do not respond to sunlight and rely on vitamin D found in phytoplankton and other fish. They must feed on phytoplankton and other fish in order to obtain and store significant vitamin D in their fat, flesh, skin, and organs.
Unfortunately, eating most fresh fish, whether from the ocean, lakes and streams, or farm-raised, is no longer recommended because of their dangerously high mercury levels. Try to source line caught and wild fish where possible.
Carbohydrates - Low carbohydrate consumption is an important aspect of the Candida Control Diet since high carbohydrate foods feed the Candida. Carbohydrate foods are any foods that are not protein or fat, including all vegetables, grains, and fruits. Since grains and most fruit, except lemons, are eliminated on the Candida Control Diet this leaves a wide variety of vegetables that are healthy to consume. Vegetables with the lowest carbohydrate index are green beans, broccoli, cauliflower, cabbage, turnips, spinach, asparagus, celery, peppers, kale, mustard greens, and Chinese cabbage. Some vegetables also inhibit the growth of Candida such as raw garlic, onions, horseradish, cabbage, broccoli, turnip, and kale.
Avoid soybean and soy-based foods - Soybeans contain large quantities of natural toxins or “anti-nutrients,” including potent enzyme inhibitors that block the action of enzymes needed for protein digestion. These inhibitors are not completely deactivated during ordinary cooking and can produce serious gastric distress, reduced protein digestion, and chronic deficiencies in amino acid (protein) uptake. In test animals, diets high in enzyme inhibitors cause enlargement and pathological conditions of the pancreas, thyroid malfunction and other diseases including cancer. Soybeans also contain haemagglutinin, a clot-promoting substance that causes red blood cells to clump together.
Soy also contains one of the highest percentages of pesticides of any of our foods and is 99% genetically modified. Soybeans are also high in phytic acid, present in the bran or hulls of all seeds, which blocks the uptake of essential minerals - calcium, magnesium, copper, iron and especially zinc - in the intestinal tract. Candida sufferers must avoid soy and all soy products in order to get well.
Salt and Spices - Salt is a very important part of a balanced diet, along with other beneficial spices. It plays an important part in the primary processes of digestion and absorption. Salt activates the first enzyme in the mouth, salivary amylase, and sodium chloride (salt) is used to make hydrochloric acid, a secretion needed for digestion. It is also important in keeping the proper balance of salt to potassium.
Salt has gotten a bad name just like the conspiracy against saturated fat. But most salt consumed today is not good for health since it highly-processed and is loaded with heavy metals and other harmful substances.
The best salt to consume is a good ocean sea salt that is hand-harvested, unprocessed, certified and contains a natural balance of minerals. One such salt is Celtic Sea Salt which contains over 90 minerals and is very similar to the chemical make-up of our own blood. Taking this salt is the best way to obtain trace minerals. An excellent electrolyte drink is simply pure water with about 1/4 teaspoon of Celtic Sea Salt for every 6 ounces.
Taking essential supplements
Candida sufferers need to build up their immune system by supplementing with certain essential vitamins and minerals that are yeast-free and sugar-free, including:
- Chlorella is a whole-food that contains a wide array of vitamins, minerals and enzymes. It helps build the immune system, detoxifies heavy metals and other pesticides in the body, improves the digestive system, improves energy levels and normalize blood sugar and blood pressure. Take two capsules three times a day.
- Vitamin B Complex (non-yeast), 50 mgs. twice a day.
- Vitamin C with bioflavonoids, 1,000 mgs. twice a day.
- Vitamin D (with vitamin A) - take 1 teaspoon per 50 lbs. of body weight per day of a high-quality cod liver oil or fish oil.
- Vitamin E, containing natural alpha tocopherol, (dl-alpha tocopherol is synthetic), that is not from a soy source, 400 IU twice a day.
- Calcium/Magnesium Citrate, with “elemental amounts” containing 800-1,200 mgs. of calcium with an equal ratio of magnesium.
3. Kill off Candida overgrowth
There are many anti-fungal agents that kill off Candida overgrowth, including raw garlic, apple cider vinegar, olive leaf extract and Pau d'arco.
Garlic - Garlic contains a large number of sulphur containing compounds that exhibit very potent broad-spectrum anti-fungal properties. Among the most studied are allicin, alliin, alliinase, and S-allylcysteine.
Fresh garlic is significantly more potent against Candida albicans than any other form, including tablets, oils, and pills. Fresh garlic is also a suitable alternative to drugs for serious systemic yeast infections in patients with severe immune suppression. Adding fresh garlic to food (raw and crushed), or crushing and swallowing raw clove is a cheap and powerful anti-fungal treatment. Garlic also stimulates the immune system, improves circulation, lowers high blood pressure, kills intestinal parasites, and is a powerful antioxidant and antibiotic, in addition to many other health benefits.
To obtain the most benefit from garlic buy certified organic garlic and crush it. Crushing breaks the cell walls releasing garlic’s beneficial properties. To kill off, Candida overgrowth take 4-5 average sized cloves per day mixed in foods or with meals. Another alternative is to drink 3-4 cups of garlic tea per day.
Raw apple cider vinegar - Raw apple cider vinegar and Candida do not get along. Take a tablespoon of apple cider vinegar and mix it with a glass of water and drink before every meal. The apple cider vinegar helps to fight off the intestinal yeast overgrowth by actually killing the yeast, creating a die off reaction. Raw unfiltered apple cider vinegar creates an unfriendly environment for the yeast while helping create a good environment for friendly gut flora.
Olive Leaf Extract - Olive leaf extract can kill invading fungus rather than just inhibiting its growth. It contains a phenolic compound called oleuropein, which has antiviral, anti-fungal, antiprotozoal, and antibacterial properties. Take as directed on the product label.
Pau d’Arco - Pau d’Arco is the bark of a rainforest tree which is inherently anti-fungal (also known as Taheebo or Lepacho tea). Pau d’Arco may be taken in a capsule or a tea. Take capsules as directed on the product label or drink 3 cups of tea per day.
4. Plant good bacteria in the digestive tract
As the yeast overgrowth is being killed off by anti-fungal agents it is important to ingest a constant supply of probiotics. These are the ‘friendly’ or ‘beneficial’ bacteria, or micro organisms, that live in the digestive tract. As yeast colonies are reduced space becomes available for colonizing the other healthy bacteria. The most numerous bacteria found in the small intestines are species of Lactobacilli. In the colon, the majority are mainly Bifidobacteria.
The easiest and least expensive way to plant healthy bacteria in the digestive tract is to take Cabbage Rejuvelac. But probiotic supplements can also plant good bacteria in the digestive tract. Unfortunately, it’s not as simple as just buying the first probiotic supplement and assuming it will do the job. The best probiotic supplements will contain specific strains of bacteria that have been studied and verified as effective, and they will identify on the bottle as a series of letters or numbers after the name of the bacteria to indicate a specific strain. Some of the most studied strains include Lactobacillus acidophilus DDS-1 and Lactobacillus GG. Probiotic supplements should be at least 500 billion organisms per gram, contained in dark bottles to avoid deterioration by heat and light, and kept refrigerated, even in the store. Take according to instructions on the bottle.
Yogurt -Usually yogurt or kefir would be good sources of probiotics, however, many Candida sufferers are intolerant of their lactose (sugar) content. They are not recommended as a good source of probiotic therapy, but good quality yogurt free of sugar or Kefir made with raw milk would be ideal to include in the diet once Candida is again in balance.
5. Handling Symptoms of the Healing Crisis
The Healing Crisis is brought about when the body becomes overcrowded with waste and toxins. Cells and tissues begin to throw off the waste and carry it from the bloodstream to various eliminating organs including the bowels, kidneys, lungs, skin, nasal passages, ears, throat, and genital organs. These organs in turn become congested and irritated producing symptoms such as colds, boils, kidney and bladder infections, headaches, open sores, diarrhea, and fevers.
Die-off symptoms are caused by high numbers of yeast being killed off which releases a high number toxins into the system. In medical terms, this is called the Herxheimer’s reaction, or yeast die-off phenomenon. Die-off symptoms resemble the flu and can be very uncomfortable. They can be alleviated by:
- Taking 1,000 mgs of Vitamin C (preferably in powdered form in pure water) several times a day or whenever needed.
- Taking an Epsom salts bath also draws toxins out through the skin and helps minimized die-off symptoms (add two cups, or 500 grams, of Epsom salts to warm bath water).
The most important aspect of the healing crisis is to never go to extremes in making changes to your diet or lifestyle. It is important to gradually introduce changes one at a time, allowing the body to adapt to the changes and adjust itself. The keys to successfully overcoming Candida are, 1) sticking to the Candida Control Program, 2) being patient, and 3) being persistent. You will get well. I was on the Candida Control Program for two and a half years and I have been healthy and well ever since.
Have You Tested To See If You Have Candida Overgrowth?