Latest experiments have demonstrated that intermittent fasting can be a strong software in managing and even reversing style 2 diabetes. This news is interesting for people dwelling with the problem, as it presents hope of a extra successful cure option than what has been obtainable in the earlier.
Intermittent fasting has grow to be more and more preferred in recent yrs. It is essentially a dietary pattern that alternates among fasting and having intervals, offering health positive aspects further than what standard dieting by itself can do. Intermittent fasting encourages intermittent caloric intake, in which foods are eaten throughout particular home windows of time, main to diminished calorie intake over-all.
Analysis into intermittent fasting has shown that it can lower the risk of coronary heart disease, make improvements to inflammation, insulin resistance, blood sugar regulate, and cholesterol concentrations, and have the included benefit of selling excess weight decline that is easier to maintain when compared to other kinds of weight loss plans.
A the latest examine posted in the Journal of Medical Endocrinology & Metabolic rate provided a 3-month intermittent fasting diet intervention among 36 individuals with type 2 diabetes. It was found that pretty much 90{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of contributors, like people who took blood sugar-decreasing brokers and insulin, could cut down their diabetes treatment intake after adhering to an intermittent fasting schedule.
Of the 36 individuals, fifty p.c knowledgeable diabetic issues remission and were capable to discontinue their diabetes medicine. They had been all equipped to sustain it for at least 1 12 months following the review.
Scientists also mentioned that these new results go in opposition to the standard look at that diabetic issues remission can only be obtained in these with a shorter diabetes length (-6 yrs). Sixty-five p.c of research participants with diabetes remission had a diabetic issues duration of far more than six years.
Diabetes medicine can be highly-priced and turn out to be a barrier for lots of patients striving to control their diabetic issues. This study allowed patients to decrease treatment prices by 77{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} immediately after intermittent fasting.
Mixed with other life style changes, such as improving bodily action amounts, this dieting procedure could produce constructive wellness advantages in conditions of diabetic issues prevention or very long-term management.
Maintaining Nutritious Blood Sugar Amounts
Healthy Blood Sugar Assistance can support manage wholesome blood sugar concentrations making use of a selection of ingredients that have been shown in clinical reports. The well being benefits of this special formula contain supporting blood-sugar metabolic rate and advertising balanced cholesterol and glucose ranges presently inside the normal selection. Nutritious Blood Sugar Aid can also assistance to minimize abnormal hunger or increased appetite, exhaustion, and blood glucose spikes immediately after meals
AS Czechia races ahead with plans to launch a fully regulated adult-use cannabis market, with the potential to beat Germany to the punch, new data suggests its medical cannabis market is also experiencing healthy growth.
In January 2022, Czechia made significant changes to its medical cannabis framework making it much easier for patients to access products.
This has helped drive an increase in patient numbers of almost 25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in the 11 months to November 2022, compared to full-year 2021.
In 2021, patient numbers grew by 22.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 4601, in the first 11 months of 2022 patient numbers grew to 5744.
According to newly released data from Czechia’s State Agency For Medical Cannabis, there was also a significant jump in November, with patient numbers topping 2000 for the first time in a single month.
This was reflected in the number of grams of medical cannabis issued, increasing nearly 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} month-on-month and nearly 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} when compared to January 2022.
Earlier this year CEO of the Czech patients association KOPAC, Hana Vágnerová, told Prohibition Partners that the most significant barrier to market growth was that ‘only specialised doctors who register for providing medical cannabis can treat patients and this number stands at 150 as of February 2022, or about one such specialist per 100,000 people’.
The government’s new data suggests that by November this had increased by 13{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 168, and could now stand at over 200.
While January’s changes to legislation have helped drive a steady increase in the market, other factors including a single domestic cultivator, restrictive licensing and continued restrictions on who can prescribe are hampering further expansion.
Period
No. prescriptions issued
No.of grams issued
No. patients
No. of prescribing doctors
January
2055
11607.63
1721
151
February
1872
10526.19
1580
152
March
2275
12362.23
1816
153
April
2088
11620.87
1743
144
May
2401
13202.4
1973
150
June
2347
13758.58
1961
156
July
1959
12391.75
1694
156
August
2221
13282.76
1886
159
September
2364
14236.64
1985
163
October
2311
13606.73
1993
162
November
2591
14911.67
2194
168
Total
24484
141507,45
5744
212
Voyager Life Expands Into Poland
Scottish CBD firm Voyager Life has announced the £1.5m acquisition of a CBD extraction and manufacturing facility in Poland from its UK-based CBD stablemate Goodbody Health.
On December 16 Voyager announced that it planned to take ‘full operational control’ of the facility on January 1 2023.
The GMP certified facility is understood to have been bought by Stillcanna (which subsequently merged with Goodbody) for £13m in 2019.
Its sale at nearly a tenth of its original price marks the latest move away from the CBD industry from Goodbody, which has pivoted its focus increasingly towards COVID and blood testing initiatives in recent months.
While there was no indication that Goodbody planned to stop selling its range of CBD products, it said in a parallel statement that ‘the levels of CBD sales by Goodbody Health were insufficient justification for meeting the costs of running a full extraction plant and the level of management input.’
Meanwhile Voyager says it now plans to begin manufacturing its CBD products in Poland, alongside producing other plant-based products like essential oils and cold-pressed hemp seed oil.
The company says this will turn it into a vertically integrated, pan-European business, giving it control over its supply chain from extraction to manufacture and retail.
It will also see Voyager acquire the shares of Goodbody’s subsidiaries Sativa Wellness Poland and Olimax.
Voyager will pay £0.5m in cash, and the further £1m in convertible loan notes ‘subject to regulatory approval’ being granted by Polish authorities.
To fund the acquisition, Voyager has reportedly raised around £550k from new investors, existing shareholders and its CEO Nick Tulloch and Non-Executive Chairman Eric Boyle.
According to Voyager, the aforementioned directors have ‘irrevocably agreed to subscribe for £200k of the £550k.’
However, these investments are understood to take the pair over the threshold of the ‘Takeover Code’, which stipulates any shareholders which carry more than 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the voting rights must make a cash offer to purchase the rest of the shares.
Shareholders will be asked to vote on whether to waive this obligation in a ‘forthcoming general meeting’.
Alongside this, Voyager intends to issue nearly 3m new ordinary shares at a price of 12p per share on Aquis, raising proceeds of £0.35m, to partially fund the acquisition.
French Study Sheds Light On Cannabis Usage
A new trends study of 23,661 adults aged 18 to 64, conducted by the French Observatory of Drugs and Addictive Trends (OFDT), revealed that the age of cannabis users had increased significantly over the past 30 years.
According to the study, published on December 19, the average age of current cannabis users has risen from 25 in 1992 to 32 in 2021.
For those under 25 however, usage has been falling since 2017. Experimentation dropped 5.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} between 2017 and 2021, while regular usage fell by 2.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 6.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}.
Conversely, the percentage of 45 to 54-year-olds who say they consumed cannabis at least once a month grew from 2.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 3.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} since 2017, while the number of 55 to 64-year olds who had consumed cannabis during the year also grew from 1.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 2.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}.
General consumption remained relatively stable, with 47.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of those surveyed stating they had used cannabis in their lifetime.
Cannabis continued to be the most widely used illicit substance in France, with 10.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of adults stating they had consumed it in the last year, a level similar to that in 2017.
More regular consumption appeared to be falling however, with those consuming cannabis 10 or more times a month dropping from 3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in 2017 to 1.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in 2021, and those consuming daily dropping from 3.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 2.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} over the same period.
New investigation posted in the Nature Cardiovascular Investigation journal has joined postural orthostatic tachycardia syndrome (POTS for short) with COVID-19 an infection.
POTS affects a part of the nervous program that regulates involuntary capabilities like coronary heart level, blood pressure, respiration, digestion and sexual arousal. It is normally additional widespread in females among the ages of 15 and 50.
Indicators of the disease include:
Quick coronary heart charge
Lower blood force
Fainting
Lightheadedness
Therapy for these with POTS is largely self-care this kind of as expanding fluid ingestion, blood pressure treatment, IV fluids and compression stockings, says Dr. Tolat.
> Linked: Is There a Url Among COVID-19 and Atrial Fibrillation?
Vaccine connection
The researchers analyzed facts on close to 300,000 individuals in California who gained just one dose of COVID vaccine or had the virus. Most of all those vaccinated received a Pfizer or Moderna mRNA vaccine.
They found a modest raise in POTS soon after vaccination, exclusively dose a single, but established the threat was five moments higher for all those infected with COVID. This underscores the worth of vaccine, which the Centers for Sickness Command and Avoidance a short while ago credited with preserving additional than 18.5 million individuals in the U.S. out of the healthcare facility and conserving much more than 3.2 million lives.
“The information is apparent. Much more individuals who ended up unvaccinated and obtained COVID obtained POTS,” Dr. Tolat suggests.
POTS can be hard to diagnose simply because it shares signs and symptoms with a number of other wellbeing disorders, together with dehydration. Until finally this point, health professionals experienced no crystal clear cause to join it with COVID.
“Inflammation is possible a variable, but the precise induce for POTS is not known,” he clarifies, adding that swelling might also be the website link concerning the condition and COVID vaccination, as pointed out by the investigation.
When to see a medical professional
If you see any indicators of POTS, talk with your main treatment medical professional.
Marijuana leaves with cbd thc chemical composition
getty
The scientific discussion on whether CBD impairs the outcomes of THC on the human human body is nevertheless open up. Even so, the authors of a new hashish analyze observed that CBD won’t reduce the effects of THC.
The results of a review released in the Journal of Neuropsychopharmacology exhibit that CBD has no impairing outcomes on THC, in contrast to other studies on the matter.
Scientists of the King’s University of London have conducted a analyze to uncover whether or not the conversation of CBD with THC may perhaps reduce the effects of the latter.
Equally CBD and THC are the primary cannabinoids of the hashish plant that have discovered room in numerous apps and are employed for recreational and medical purposes. But though THC creates psychoactive and intoxicating outcomes, CBD doesn’t.
Researchers have experimented with to create regardless of whether CBD may well lower THC outcomes on the human entire body, but with no a definitive outcome.
The scientific literature continue to isn’t going to agree on regardless of whether and how CBD interferes with the psychoactive qualities of THC.
Some experiments clearly show that CBD reduces the THC’s intoxicating outcomes, whilst many others have not discovered any correlation between CBD and the impairment of THC effects.
The authors of this analyze have conducted a scientific trial on 46 volunteers between 21 and 50 many years outdated who experienced utilised hashish at the very least once in the previous but experienced not employed hashish for a lot more than 1 week around the past 12 months.
They have been administered cannabis bouquets from the Dutch hashish firm Bedrocan in unique doses of CBD: mg, 10 mg, 20 mg, and 30 mg, but offered the similar total of THC, 10 mg, administered by means of the use of a vaporizer.
Successively, volunteers have been through a number of assessments to assess how CBD impaired the intoxicating results of THC.
Exams integrated blood assortment, diverse types of evaluation, cognitive jobs, and psychological assessments.
The findings have revealed that the co-administration of CBD with THC did not induce cognitive impairments or psychotic indicators subsequent cannabis use. Also, CBD failed to lower the output of THC consequences on the human overall body throughout the array of CBD:THC dose ratios, normally current in both of those recreational and medical cannabis.
Scientists have concluded, consequently, that they had identified “no evidence of CBD reducing the acute adverse outcomes of THC on cognition and psychological health.
“These final results recommend that the CBD material in cannabis could not be a vital consideration in decisions about its regulation or the definition of a regular THC device. The information are also related to the security of accredited medicines that incorporate THC and CBD, as they propose that the presence of CBD might not cut down the possibility of adverse results from the THC they consist of. Hashish people may perhaps reduce harms when working with a higher CBD:THC ratio due to the lowered THC exposure alternatively than the presence of CBD,” the research reads.
Nonetheless, other studies published in the latest many years go the other way.
In 2019, a study printed in the Journal of Neuroscience concluded that CBD possesses antipsychotic attributes and can mitigate lots of of the psychotropic facet results of THC, though the authors did not have an understanding of how CBD produces these mitigating results at the neuronal, molecular, and behavioral ranges.
A different analyze released in the European Archives of Psychiatry and Medical Neuroscience, also posted in 2019, identified that individuals who inhaled hashish made up of THC with low-CBD self-described that their intoxication was better than when they vaporized THC by yourself.
According to the scientists, this implies that hashish containing THC and small doses of CBD could boost the psychoactive results of THC.
As a result, the analyze affirms that CBD can mitigate the intoxicating effects of THC—but that effect would seem only to arise when the CBD focus is large.
But a recent systematic evaluate of 16 research printed in the journal Neuroscience & Biobehavioral Reviews located that, despite the fact that some experiments noted that CBD might reduce the probably hazardous outcomes of cannabis, evidence implies that combining THC with CBD may possibly not essentially decrease the wished-for intoxicating outcomes of the drug.
The point that some scientific studies present that CBD will not alter THC’s psychoactive outcomes and other results point out that CBD cuts down the intoxicating results of THC demonstrates the complexity of obtaining a definitive remedy.
Quite a few elements may well add to the intoxicating consequences of THC, like the methods of consuming cannabis, and we have to maintain in head that the effects of CBD and THC may perhaps differ from human being to man or woman.
New analysis from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s University London has observed no evidence that cannabidiol (CBD) decreases the negative outcomes of hashish.
The analysis, printed in Neuropsychopharmacology, troubles the normally held perception that using hashish that is made up of higher degrees of CBD guards the user from psychotic ordeals and memory difficulties, and implies that this really should be thought of by policy makers at present discovering the matter of medicinal and recreational use.
46 healthier volunteers done a randomized and double-blind trial. About the course of four experiments, every participant inhaled hashish vapor that contains 10mg of THC and a differing amount of CBD (0mg, 10mg, 20mg, or 30mg). They then accomplished a collection of responsibilities, questionnaires and interviews built to evaluate the influence on their cognitive skills, severity of psychotic symptoms, and how pleasurable the drug was.
The similar research crew had beforehand identified that pre-emptively having a superior dose of CBD in a capsule a handful of hrs before applying hashish may cut down the adverse effects of THC.
In this analyze, they explored the outcome of altering the CBD:THC ratio in cannabis.Even so, they observed increasing the dose of CBD did not noticeably improve the consequences of THC on cognitive performance, psychotic signs and symptoms or how pleasurable the drug knowledge was.
Dr Amir Englund, a study fellow at King’s IoPPN and the study’s guide author said, “None of the CBD stages analyzed shielded our volunteers from the acute detrimental results of hashish, these kinds of as stress and anxiety, psychotic indicators, and worse cognitive efficiency. It also did not alter the high-quality of the intoxication in any way. The only effect of CBD we saw was that as the focus of CBD amplified, the much more the participants coughed. We requested volunteers to listen to a beloved music on each visit and taste a piece of chocolate. Even though cannabis improved the pleasurability of tunes and chocolate in comparison to when volunteers had been sober, CBD had no affect.”
“THC and CBD are each generated from the similar compound in the hashish plant, so a selection which generates bigger of amounts of CBD will in a natural way be decreased in THC. It might nonetheless be safer for end users to opt for cannabis with larger CBD:THC ratios, but that is because the same sum of cannabis will have much less THC than a decreased CBD:THC variety. General, our tips to individuals seeking to stay clear of the adverse results of THC is to use less of it.”

These conclusions make an vital contribution to the ongoing debate all over the challenges of hashish use. Although CBD on its very own is regarded to have a amount of optimistic consequences in individuals, our facts advise that, at the doses that are typically present in cannabis, it does not protect in opposition to the unfavorable effects of THC. This challenges the usually held watch by numerous hashish customers that cannabis with a increased CBD information supplies a buffer towards the adverse consequences of hashish.”


Professor Philip McGuire, study’s senior creator and previous Head of the Division of Psychosis Experiments at King’s IoPPN

This study was funded by a investigate grant from the Clinical Investigation Council.
Source:
Journal reference:
Englund, A., et al. (2022) Does cannabidiol make hashish safer? A randomised, double-blind, cross-around trial of hashish with four diverse CBD:THC ratios. Neuropsychopharmacology.doi.org/10.1038/s41386-022-01478-z.
In a new review, Johns Hopkins Medication researchers examined a lot more than 100 topical cannabidiol (CBD) products accessible on the internet and at retail retailers, and located sizeable evidence of inaccurate and misleading labeling of CBD material. The analyze also exposed that some of these nonprescription products and solutions contained amounts of delta-9-tetrahydrocannabinol (THC), the key active component in hashish that can result in a “high,” including some solutions that claimed to be free of THC.
The study, printed July 20 in JAMA Network Open, further more uncovered that some of the CBD solutions designed therapeutic statements not permitted by the U.S. Food stuff and Drug Administration (Food and drug administration). To date, the Fda has only authorized a person prescription CBD product to deal with seizures linked with uncommon epilepsy disorders, and two prescription THC products and solutions for nausea and vomiting affiliated with chemotherapy and for loss of urge for food and pounds loss associated with HIV/AIDS.
“Misleading labels can end result in persons working with badly controlled and high priced CBD solutions rather of Fda approved solutions that are established as risk-free and productive for a given well being condition,” claims research guide creator Tory Spindle, Ph.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins College School of Medicine.
In accordance to the National Institutes of Health’s Countrywide Centre for Complementary and Integrative Wellness, CBD and THC are the most frequently identified compounds in the plant Hashish sativa. A essential big difference between the two is that THC can create a psychoactive “high” influence at substantial doses, whilst CBD doesn’t.
Under the Agriculture Improvement Act of 2018 (the Farm Monthly bill), CBD goods that contain much less than .3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of THC are not deemed federally unlawful substances. This has designed CBD solutions particularly well-known and extensively readily available to buyers almost anyplace, but it also would make it complicated for the Food and drug administration to tackle unapproved promises and mislabeling. On the other hand, Spindle notes, “Latest analysis has proven that persons who use CBD products and solutions containing even compact quantities of THC could perhaps check optimistic for cannabis utilizing a typical drug examination.” This has not been determined for topical CBD goods, but the authors are at the moment studying it.
For the analyze, the research staff procured 105 CBD topical solutions – including lotions, lotions and patches – online and at brick-and-mortar retail spots in Baltimore, Maryland, in July and August 2020. Solutions were analyzed applying a technology named gas chromatography-mass spectrometry to establish the real amount of money of CBD and THC they contained.
Only 89 (85{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) of the 105 examined products mentioned the whole quantity of CBD in milligrams on the label. Of the 89 goods, 16 (18{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) contained fewer CBD than advertised, 52 (58{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) contained far more CBD than advertised and 21 (24{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) ended up accurately labeled. On typical, the in-retailer merchandise contained 21{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} a lot more CBD than advertised and the on-line items contained 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} far more CBD than marketed, although CBD label accuracy different extensively throughout goods.
THC was detected in 37 (35{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) of the 105 items, even though all were within the authorized restrict of .3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}. Four (11{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) of these 37 had been labeled as “THC free,” 14 (38{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) stated they contained fewer than .3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} THC and 19 (51{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) did not reference THC on the label.
Of the 105 items, 29 (28{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) designed a therapeutic claim, generally about agony/swelling, 15 (14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) created a beauty/magnificence claim (e.g., that they relieve wrinkles or nourish/improve skin) and 49 (47{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) famous they had been not Food and drug administration permitted. The other 56 (53{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) products and solutions created no reference to the Food and drug administration. “It is really essential to be aware that the Fda has not approved CBD merchandise to address any of the circumstances advertised on the products and solutions we examined,” suggests Spindle, who also is a faculty member at the Johns Hopkins Hashish Science Laboratory.
“The variability in the chemical articles and labeling found in our study highlights the require for superior regulatory oversight of CBD merchandise to guarantee customer protection,” claims Ryan Vandrey, Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University College of Medication and the study’s senior author. These kinds of regulation, the authors consider, would assure CBD merchandise meet set up benchmarks for excellent assurance so people can make educated selections about item assortment and are not misled by unproven therapeutic or beauty promises. The research authors also caution that people today must look at with their wellbeing care practitioner ahead of starting up any CBD regimen.
In addition to Spindle and Vandrey, other researchers who contributed to the study include Dennis Sholler and Edward Cone from the Johns Hopkins College Faculty of Medication, Timothy Murphy and Mahmoud ElSohly from ElSohly Laboratories, Ruth Winecker from RTI Intercontinental, Ronald Flegel from the Material Abuse and Mental Well being Expert services Administration (SAMHSA) and Marcel Bonn-Miller from the Canopy Expansion Corp.
This exploration was supported by the Material Abuse and Psychological Health Services Administration (SAMHSA).
Resource:
Journal reference:
Spindle, T.R., et al. (2022) Cannabinoid Information and Label Accuracy of Hemp-Derived Topical Solutions Obtainable On the internet and at National Retail Suppliers. JAMA Network Open up.doi.org/10.1001/jamanetworkopen.2022.23019.