Matching Of Antemortem And Postmortem Dental Images By Root Morphology

1. Introduction

Forensic identification may take place prior to death and is referred to as Antemortem (AM) identification. Identification may as well be carried out after death and is called Postmortem (PM) identification. While behavioral characteristics (e.g. speech) are not suitable for PM identification, most of the physiological characteristics are not appropriate for PM identification as well, especially under severe circumstances encountered in mass disasters (e.g. airplane crashes) or when identification is being attempted more than a few weeks after death.

Therefore, a postmortem biometric identifier has to survive such severe conditions and resist early decay that affects body tissues.Dental features are considered the best candidates for PM identification. This is due to their survivability and diversity. Forensic odontology is the branch of forensics concerned with identifying human individuals based on their dental features. Traditionally, forensic odontologists relied on the morphology of dental restorations (fillings, crowns, .. etc.) to identify victims. However, modern materials used in restorations and fillings have poor radiographic characteristics. Hence, it is becoming important to make identification decisions based on inherent dental features like root and crown morphologies, teeth size, rotations, spacing between teeth and sinus patterns.

2.Existing Architecture

ADIS will provide automated search and matching capabilities for digitized x-ray and photographic images. This paper deals about an overview of ADIS (Automated Dental Identification System) and also present a new fully automated algorithm for identifying people from dental X-ray images. ADIS (Automated Dental Identification System) is a fully automated system, which is built for PM identification. Dental biometrics automatically analyzes dental radiographs to achieve the aim of forensic dentistry. It is to identify the deceased individuals for whom other means of identification (e.g., fingerprint, face, etc.) are not available. Dental radiographs provide valid, accurate and reliable information about the identity of an individual.

On the basis of the time of acquisition, there are two classes of dental radiographs. The radiographs acquired after the death are called the Post-mortem (PM) radiographs, and the radiographs acquired while the person is alive are called the Ante-mortem (AM) radiographs. The AM radiographs, collected in the dentists’ office, are labeled with patients’ names. The method used in dental biometrics is matching the unlabelled PM radiographs against the database of labeled AM radiographs. If the set of teeth in a PM radiograph sufficiently matches the teeth in an AM radiograph, the identity of the PM radiograph is obtained In order to achieve the ADIS, the automated archiving of AM (antemortem) dental images in a database, are for searched the database for the best matches to a given PM image. To achieve this goal, we need to automate the process of segmenting the dental radiographs. There are two stages for dental biometrics:

1. Radiograph Segmentation and Teeth Separation

2. Shape matching

3. Limitations of Existing Architecture:

There are many challenges that affect the performance of ADIS and should be taken into account while building the system. These challenges include dealing with i) The main challenge is that dental features may change over time, especially if the PM images were captured long time after the AM were captured, that will lead to difficulty in matching.

ii) Poor quality radiographs, which badly affects the segmentation results, and consequently affects the accuracy of ADIS.

iii) A third challenge is handling view variance in both AM and PM image.

4.Proposed Architecture

If the PM images were captured long time after the AM were captured, that will lead to difficulty in matching. Morphology of root can be used for identification in this case. A reversible technique is presented which uses the root morphology.

Teeth are comprised of a crown and one or more roots. The crown may have a ‘chisel-like’ edge or one or more points called ‘cusps’. Enamel formation is called amelogenesis and occurs in the crown stage of tooth development. Dentin formation, known as dentinogenesis, is the first identifiable feature in the crown stage of tooth development. The formation of dentin must always occur before the formation of enamel.

As root and cementum formation begin, bone is created in the adjacent area. Frequently, nerves and blood vessels run parallel to each other in the body, and the formation of both usually takes place simultaneously and in a similar fashion. However, this is not the case for nerves and blood vessels around the tooth, because of different rates of development
Cementum formation is called cementogenesis and occurs late in the development of teeth. Cementoblasts are the cells responsible for cementogenesis.

In this technique, missing teeth in skeletonized human remains can be reconstructed for the purpose of radiographic comparison and postmortem identification. In this technique, which is based upon pilot studies with skeletonized mandibles of archival remains, the alveolar socket walls are sealed with a coat of cyanoacrylate cement and injected with a mixture of vinyl polysiloxane and barium sulfate. Radiographs are produced with the radiopaque mixture in place, which highlights the antemortem morphology of the roots. Subsequently, the impression material is removed, resulting in no gross alteration of the evidence. The radiographs made with this technique, as well as the impressions, can be stored for later use at a trial or pending the discovery of ante mortem dental evidence.

5.References

1. “Challenges of Developing an Automated Dental
Identification System” , Mohamed Abdel-Mottaleb*, Omaima Nomir*,Diaa Eldin Nassar**, Gamal Fahmy**, and Hany H. Ammar**

2. American Society of Forensic Odontology, “Forensic Odontology News”, Vol. 16, No. 2, Summer 1997.

3.United States Army Institute of Dental Research Walter Reed Army Medical Center, “Computer Assisted Post Mortem Identification via Dental and other Characteristics”, USAIDR Information Bulletin, vol. 5, no. 1, 1990

4. M. Piotrowski, and P. S. Szczepaniak, “Active Contour Based Segmentation of Low-Contrast Medical Images”, International Conference on Advances in Medical Signal and Information Processing, 2000. pp 104-109

5. K. Jain, H. Chen and S. Minut, “Dental Biometrics Human Identification Using Dental Radiographs”, AVBPA, UK, 2003, pp.429-437.
6.5 R. Brunelli, and T. Poggio, “Face recognition: Features versus Templates”, IEEE Trans. on PAMI, (1), 1993, pp. 1042-1052.

7. S. Hu, E. A. Hoffman, and M. Reinhardt, “Automatic Lung Segmentation for Accurate Quantization of Volumetric X-Ray CT Images”, IEEE Trans. Med. Imag., vol. 20, No.6, Jun. 2001, pp. 490- 498.

8.R. Gonzalez, and R. Wood, “Digital Image Processing”, Addison Wesley, 1993.

9. “Reconstruction of root morphology in skeletonized remains with postmortem dental loss”, Smith BC. Journal of Forensic Science. 1992 Jan;37(1):176-84.

Type 2 Diabetes – New Ways of Testing Blood Sugar or Should We Say Body Sugar?

Anyone diagnosed with Type 2 diabetes is vulnerable to depression to begin with, so being made to feel like a pincushion should not have to be a part of their care. Fortunately your blood is not the only area of your body where sugar can be detected, and researchers are now finding ways of measuring it without the painful and tiresome pinpricks…

1. In April 2014 the Journal of International Oral Health reported that scientists are now working on a way of accurately measuring the sugar level in your saliva. Researchers at the Nijalingappa Institute of Dental Sciences and Research and MR Medical College in Karnataka, India, included thirty diabetic volunteers in their research. It was found that sugar levels in their saliva correlated with their fasting blood sugar levels and HbA1c percentages.

The investigators concluded salivary sugar could be used as well as blood sugar to determine a diabetic’s sugar levels and diabetic control.

2. The Journal of Diabetes Science and Technology reported on a study from the University of Maryland in Baltimore, USA, in January 2014. Investigators washed particular skin areas of a healthy volunteer and a second volunteer diagnosed with Type 2 diabetes. A solution was applied to the skin of both volunteers and a fluorescent light shone onto both. Fluorescence reflecting back from the skin was measured. It was found the actual amount of fluorescence measured was determined by the amount of sugar in the skin. The amount of sugar in the skin correlated with the amount of sugar in the blood.

From this information the researchers concluded more studies are warranted to make their method of measuring sugar useful to all diabetics.

3. And research has been carried out to reveal sugar can be detected in tears. Now inventors Brian Otis and Babak Parviz report the creation of a contract lens capable of measuring tear sugar. The soft plastic layers of the lens contain a tiny glucose sensor and wireless computer chip that report tear sugar levels every second. The device has the potential for lighting up with LED lights when sugar levels get too high or too low.

The inventors have discussed their invention with the US Food and Drug Administration to get approval to bring the lens to market.

It’s still early in the progress of all the above, but isn’t it super to know that someday needle sticks and blood sugar levels will be a thing of the past? Here’s to exciting new technology.

Life, Stress and Dental Disease

“Stress is a reaction people have to excessive pressure or demands, and arises when an individual believes they are unable to cope.”

At one time or another, we’ve all dealt with the effects of chronic stress, from migraines and back ache to anxiety and depression. We all know that stress can impact the immune system, how often do we happen to get sick or catch a cold when we are stressed or run down. But what is not commonly understood is that stress and our response to it can also impact on the mouth, teeth, jaws and gums as well as our overall emotional and physical wellbeing. It is not possible to point to a particular dental problem and say it’s caused entirely by stress but like the rest of the body, the mouth can be affected.

Now not everyone is swinging from one major life crisis to another yet the prevalence of people stating they are stressed or are affected by stress related disorders and problems is enormous across all ages and social backgrounds. Why is this? What is going on in our lives that stress is so widespread and common? Could it be that modern life, our hectic lifestyles and how we see, deal with and perceive life, impacts on our level of stress and our ability to cope with it or not?

“Any idiot can face a crisis it’s this day-to-day living that wears you out.” (Anton Chekov)

The causes of stress that we face on a day-to-day basis are not as extreme as major life events. The day-to-day causes of stress such as those daily, minor irritations like misplacing our car keys, traffic jams, minor arguments with family/colleagues, etc could be regarded as daily hassles. Research by Lazarus and Folkman (1984), at the University of California, indicated that it was the daily hassles rather than the major life events that affected us the most. Life events do not occur every day, but daily hassles do and it’s this constant, daily frustration caused by the minor issues that cause us the most stress, because they occur so regularly and therefore can undermine our health. Think of some of the things that get under your skin on a regular basis – things like waiting in line, time pressures, lack of sleep, noise, your job, money, your kids, relationships, getting meals ready, being stuck in traffic, shopping and so on, in fact the things that simply make up life. Then consider how do you react to them?

We tend to think that stress is solely caused by external events, situations and people, yet this is not strictly correct. Research has found that the Transactional Model of Stress is more accurate. This model says that stress is caused by an interaction between the stressor, our view of the stressor and our perceived ability to cope with it. It’s our own internal beliefs, attitudes, expectations, interpretations, perceptions and other factors such as our personality, levels of self esteem and need for control or perfectionism, combined with the external events that tend to create stress.

Too much stress may not only spoil your mood, it can also spoil your health and your smile. There is mounting evidence that there is a strong link between stress and gum disease and dental health. It is proposed that elevated levels of the stress hormone cortisol which impacts on immune health along with digestion and sugar regulation is a major player in stress induced illness. Oral health is determined by various factors including stress, which can play a major part in oral disease by leading to inappropriate lifestyle choices that can adversely affect oral health. For example things like neglecting oral health habits along with an increase in unhealthy habits such as lack of exercise, poor diet, increased alcohol, sugar, caffeine and tobacco consumption and lack of sleep are all detrimental to oral health.

During times of stress cortisol is released and works to reduce inflammation in the body; however when inflammation becomes chronic, the level of cortisol continues to soar, wreaking havoc on the body’s immune system and its ability to deal with infections. The body’s response to uncontrolled infection (like gum disease) can lead to many other problems such as increased susceptibility to colds and other illnesses, heart disease, high blood pressure, increased risk of cancer, tendency to develop food allergies, increased risk of gastrointestinal problems and increased risk of autoimmune disease.

As the cortisol level of the body increases the body produces acid, which alters the acidity level of the saliva. Increased acidity levels in the mouth create an environment for bacteria to proliferate and thrive making us more prone to infection, gum disease and dental decay. Also stress can cause your body to flush out minerals from your body, minerals like calcium, which are found in bones and teeth. This leaching of minerals combined with a more acidic and bacteria rich environment means stress makes us more susceptible to dental cavities and suppression of the immune system leads to an increase risk for developing or worsening gum problems along with more systemic conditions.

The potential impact from stress and anxiety on oral health is surprising from clenching or grinding of teeth (bruxism); facial pain, mouth sores, including mouth ulcers and cold sores, poor oral hygiene, through to increased gum problems and dental decay.

Grinding or bruxism can be extremely damaging to the jaws and teeth, causing soreness when eating and difficulty chewing, chipped, worn or cracked teeth plus facial pain. Bruxism most commonly occurs at night, so it’s not something you can consciously control and grinding your teeth leads to disturbed or poor quality sleep and jaw pain on waking. It has been linked to work stress (Journal of Community Dentistry and Epidemiology) and personality type (Journal of Behavioural Medicine). The personality type study, found that people who were shy, apprehensive and given to worry, tended towards bruxism, which can have devastating effects on teeth and may require extensive corrective treatment.

Managing stress is important to maintaining good oral health, the Centre for Disease Control identified stress as one of the top risk factors for gum (periodontal) disease. In some instances, people may be so hindered by stress and anxiety and depression that they simply neglect oral hygiene. In a 2009 study in the Journal of Periodontology, 56 percent of test subjects reported that stress led them to disregard regular brushing and flossing. Other studies found that emotional factors played a significant role in the development of adult gum (periodontal) disease. Researchers also discovered that the severity of gum disease increased with amount of stress experienced and those at greatest risk for gum disease were those who were highly emotional in dealing with financial problems.

Stress can also cause mouth sores and ulcers, which are painful little swellings that appear inside the mouth. The exact cause of ulcers is not fully understood but stressful episodes can bring them out. Stress can lead to recurrent cold sores and make existing ones worse. According to a report in General Dentistry Journal, studies show that students have a high prevalence of mouth ulcers, yet the ulcers appear less frequently during breaks and after graduation, when stress levels are lower.

Regular visits to the dentist are the best way of pinpointing stress-related dental problems before they flare up.

However, what about the more wide ranging implications of stress on our health and daily interactions? The most effective approach would be to address the root of the problem and remove the source of the stress. But most of our stresses happen in daily life and unless we all start living like hermits it would be impossible to remove all sources of stress completely.

Consequently the most sensible approach would be to make an internal shift that allows us to be more of who we are and less affected by that which is happening around us. But how do we do this? The conventional approach is to use relaxation techniques or meditation, breath techniques or even massage and physical therapy, which may help reduce your tension as part of a stress action plan. By simplifying our life, reducing our level of busy-ness and introducing self-care and good sleeping and eating habits we could go a long way to truly healing our way of being and start letting go of beliefs, ideals, perceptions and expectations that can cause internal stress. However what if the true answer lay deeper than this and that it meant addressing all the ways we are living? For example, what if it meant being able “to observe and not absorb” that which goes on around us, to not take things so personally, to give people the freedom to make their own choices in life?

The only thing we truly have control over in life is our own inner state of being. Serge Benhayon of Universal Medicine presents that one of the ways we can have command over our inner state is via the breath.

It has been known for thousands of years that breathing has a powerful influence over our physiological and psychological well-being. Some people may find it difficult to understand the link between the way we breathe and its effects on stress, as we have been breathing since the first moment we were born and take around 20,000 breaths a day, so we must have been breathing correctly from a physiological perspective as we are still alive. Yet research has shown that the way we breathe can have a powerful effect on how stressed we feel. When we suffer stress one of the changes brought about by the fight/flight response is to speed up the amount of breaths we take switching from slow, abdominal breathing to faster, shallower, stressful, chest breathing. This is vital and healthy in the short term however, if we are constantly triggering the fight/flight response we can begin to habitually breathe with our upper chest even though the stress may be over. This style of breathing sends signals to the brain that we are under stress when we may not even be.

The Gentle Breath Meditation as taught by Serge Benhayon teaches us to focus on our breath and how we are breathing so as to build awareness of how we are reacting to life and how we are feeling. The Gentle Breath can be utilised as a tool that can assist the body to become more harmonious and bring us back to our natural calm, relaxed state of being so that life’s influences do not impact so greatly upon us. The Gentle Breath Meditation may be one of the simplest yet effective starting points in taking true control of your life instead of being at the mercy of the outside world and all the pressures that it presents.

It’s important to be aware of your stress level not just as it relates to your smile but the mind and body as well. Take time out of your day to connect to yourself, breathe gently and de-stress.

Becoming aware how detrimental stress is to our overall health and wellbeing as well as oral health is a key step to becoming empowered to make beneficial changes in our dental care and our way of living and responding to life’s challenges in general. When we begin to realize that we can change, we can heal, and we can choose differently – we can choose a gentle breath, and a gentle caring way to be with ourselves, and others. I invite you to see and feel for yourself how the body will lovingly respond to such choices.

Article Writing – Five Tips For Writing Great Medical Articles

Whether you are writing medical articles for patient brochures, blogs or article submissions, it is very important to ensure that the medical content in your article is accurate, and of a high quality. Albert Einstein once said that, “A little knowledge is a dangerous thing. So is a lot”. If you wish to write medical content, you need to follow this advice to the hilt, as what you say or don’t say, may cause people more harm than good.

Below are some tips to help you write high-quality medical articles:

  1. Be careful about stating facts: Doctors and other medical professionals know that medical knowledge constantly changes due to advancements in new technology. It is crucial for lay writers to also understand the same, and be very careful about stating anything as an irreversible medical fact, while writing health-related articles. Many readers think that medical articles are written by medical experts, and do not understand that details may vary according to a particular case. This may result in them blindly following clearly-stated online medical advice, without consulting a medical practitioner, about their individual case.
  2. Use proper terminology: Use the scientific or recognised medical name to describe a disease/drug, rather than a lay term, when you first mention it in your medical article. This medical name should be the word most commonly used in recently published, high-quality English content. You can use lay terms or alternative names later on, to help your readers understand the content better. This is even if you are writing medical articles for search engine optimisation purposes. One good source of disease names is WHO’s International Statistical Classification of Diseases and Related Health Problems.
  3. Use ambiguous parts of speech: If you are not sure about a medical fact, even after conducting research using authentic sources of information, use ambiguous parts of speech (adverbs, nouns etc.) to describe that fact. For example, if three medical sources state different time periods (three months, five months, seven months) for dental implants to fuse with the jawbone, you can write ‘In most cases, titanium implants generally take around three to seven months to osseointegrate with the bone’.
  4. Conduct online research carefully: As accuracy is fundamental in any medical article, you should conduct research only from reliable websites, such as those sponsored by educational institutions, medical organisations or governments. Some good sources for medical articles are the US National Library of Medicine and The American Medical Association. Another good online source is The Web MD, even though it is not a professional medical association website. Avoid using Wikipedia or other doubtful websites that constantly pop up in the top positions of search engine results.
  5. Include a disclaimer: As legal action can sometimes be taken regarding medical content posted on a website, it is always important to include a prominent disclaimer telling readers that you are not a medical expert. This disclaimer is in addition to the legal disclaimer, generally displayed by medical practices on their website. For example: “The writer of this article is not a medical professional. Information contained herein has been collected from sources believed to be reliable, and every precaution has been taken to ensure its accuracy. The information provided here is for general informational purposes only, and should not be used as a substitute for professional medical care.

A History of Nutrition

Conventional wisdom has led us to believe that milk gives us strong bones, eggs are a perfect protein, meat give us strong muscles and that plants contain low quality protein. Conventional wisdom differs from scientific wisdom in that scientific wisdom has been conducted without a bias for a particular result and is peer-reviewed by other scientists who have a strong knowledge of methodology and statistical analysis. In other words, the aim with science is to find out what is likely to be true, not what is popular. Unfortunately, the prejudices of big business food industries reach more people than that of the scientific community. “Prejudices are hard to uproot when they are not recognized as such, and even more so when they are still being repeatedly reinforced within the culture at large” (Diet for a New America, John Robbins). Lets take a trip back into history and follow a few studies that have helped shape the scientific viewpoint on nutrition and its relation to disease.

Over 2,500 years ago Plato and Socrates condemned the eating of animal flesh. 2,000 years ago, so did Seneca, tutor and advisor to the Roman Emperor Nero. Later Hippocrates, the father of medicine, understood that diet prevented disease and said “food should be our medicine and medicine our food” during his time, 460-357 B.C.

In the 1800’s a few scientists continued to shape our view on nutrition. One of those scientists was Dutch Chemist Gerhard Mulder, who discovered protein in 1839. Carl Voit was a German scientist in the late 1800’s who discovered that humans needed only 48.5 grams of protein per day, but recommended 118 grams. Voit mentored a few young scientists, including W.O. Atwater who later developed the Unites States Department of Agriculture (USDA). Atwater continued to over-exaggerate the need for protein, which became synonymous with meat in the 19th century even though protein can be found in plant foods as well. This has led to classically misguided question posed to vegetarians and vegans still today of “Where do you get your protein?” (The Chins Study, T.C. Campbell and T.M. Campbell). This is also about the same time that Dr. Weston Price published his findings on the excellent dental health in primitive peoples vs. the horrible dental health in civilized peoples. He determined that processed foods were the culprit for the deterioration of dental health, even with hereditary traits such as dental arches and facial structure (Nutrition & Physical Degeneration, Dr. Weston Price).

At the same time, the medical field was being shaped by a few pioneers. Louis Pasteur, a famous French chemist in the late 1800’s, supported the germ theory of disease. The Germ theory remains the corner stone upon which vaccines, parasites, viruses and antibiotics were created upon in the medical field. It states that the immune system is a victim to such insults. His theory was very controversial and many disagreed with him. One of his opponents to the theory was Henry Lindlahr, author of “Philosophy of Natural Therapeutics”, who believed that lowered vitality weakens the immune system to fighting disease. He concluded that the well-being of a man depends on normal nutrition and wholesome surroundings and that normal nutrition allowed for proper, drainage and enervation. Dr. Rodemon further demonstrated that Pasteur was wrong by smearing his body with small pox and going out in public. Nobody got small pox. Although dramatic, he had demonstrated a very important point.

Scientists began to classify the quality of protein in animals, which contained all necessary amino acids, vs. the quality of protein in plants, which contain bits and pieces of amino acids. They concluded that animal protein was of higher quality than plant protein, but did not bother to factor in which protein was healthier for human consumption or the fact that eating a wide variety of plant foods does provide all the necessary amino acids (The China Study, T.C. Campbell and T.M. Campbell).

After World War I (1914-1918), an allied blockade cut off the supply of food to over three million residents of Denmark, causing them to have to ration the food supply. One measures taken was to re-allocate grain used to feed livestock for the people. During this time, the death rate dropped by 34% (The CHina Study, T.C. Campbell and T.M. Campbell).

During World War II (1939-1945), the Norwegian government was forced to ration their food, especially meat, while the country was occupied by the Germans. Norway experienced a drastic drop in death from circulatory diseases during this time. Death rates rose again when the Germans left and Norway returned to their former diet. Britain and Switzerland also experienced an increase in health while food was rationed during World War II, where infant and post-natal death rates as well as the occurrence of anemia dropped to the lowest recorded at that time. What rose during this time? Growth rates and dental health for children. After World War II, the National Heart Institute investigated why plaque in heart disease develops and how it leads to heart attacks. A comparison of the medical records of 5,000 residents from Framingham, Massachusetts enabled the research team to develop risk factors such as cholesterol. blood pressure, physical activity, cigarette smoking and obesity. More than 1,000 scientific papers were produced from this study that showed a strong correlation between high blood cholesterol and heart disease (The China Study, T.C. Campbell and T.M. Campbell).

In 1950, North Korea invaded South Korea and over 30,000 American soldiers were killed. Military medical investigators examined the hearts of 300 male soldiers and published their results in the Journal of the American Medical Association finding 77.3% of the hearts examined showed “gross” evidence of heart disease.

Many scientists have contributed to the development of true scientific understanding of nutrition in relation to disease since then. Dr. George Macilwain, a prominent surgeon of the 1800’s and a vegetarian, has contributed fourteen books on medicine & health popularizing “the constitutional nature of disease.” Dr. John McDougall, author of ten books on nutrition including “The McDougall Plan,” also advocates a whole-foods, plant-based diet. Dr. Dean Ornish, Harvard graduate, is famous for his Lifestyle Heart Trial where he enforced stress management, meditation, three hours of exercise per week, breathing and relaxation exercises as well as cutting out almost all animal products from their diets. He found that 82% of his patients who adopted the lifestyle changes experienced a regression of their heart disease in one year.

Dr. Caldwell B. Esselstyn Jr., aka “Dr. Sprouts,” was a surgeon at the Cleveland Clinic and at St. George’s Hospital in London, president of the American Association of Endocrine Surgeons and voted one of the best doctors in America in 1994-95. Dr. Sprouts began studying nutrition and found that diets rich in meat, fat and highly refined foods caused disease. He began experimenting with his patients putting them on a vegetarian and had the greatest success ever recorded on treating heart disease. Never before has their been such a compelling mountain of evidence recommending a whole-foods, plant-based diet. This stacked up against the equally important and pressing issue of the record deterioration of American health with correlation to the Standard American Diet.

Many of us are unaware of these studies because there is no agency or industry with the motivation to share them with. As a Biology major graduate and a nutritional educator, I am not interested in what is popular, but what is believed to be true by the standards of the most well-respected scientists in the field. We cannot be held responsible for what we do not know, but hopefully, now you can make an educated decision on where to go from here. Stepping out into the unknown is scary. And often times people switching to a vegetarian or vegan diet, fill themselves with the wrong replacement foods. It is necessary to fill your diet with smarter food choices, ones that promote health and wellness. Start learning by reading as many articles and books you can written by reputable and unbiased resources and begin applying what you learn to buying food at the market. Sunrider International makes the most pure and concentrated whole food products that are so convenient to use. They are made from Chinese herbs, which have the backing of over 5,000 years of empirical knowledge of the Chinese royal family on their people. The owners of Sunrider are members of the royal family and have been handed down this ancient knowledge. Dr. Te-Fu Chen is a world renowned herbalist and pharmacologist. Dr. Oi-Lin Chen is a licensed western medical doctor. Together, they make the best foods on the planet! Their factories are pharmaceutical-grade and their quality control is unmatched by any company on the market today.