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WEIGHT GAINING ARTICLE - How to Gain Lean Bodyweight !

How to Gain Lean Bodyweight


Article: How to gain lean bodyweight
Author: Tom Venuto
Publisher: Burn The Fat

 

The Secret

The secret to gaining lean bodyweight is calories. Most people who want to gain weight and are having a difficult time doing so just aren't eating enough. Simple isn't it? Of course there's more to it than just calories; like the nutrient density, calorie density, meal frequency and the ratio of calories from carbohydrate, protein and fat. There's also proper training, recuperation and sleep to factor in too. But when it comes to gaining lean weight, calories are the bottom line just the same. No matter what you eat and no matter how hard you train, if you're not eating enough it is physiologically impossible to gain muscle.

There are many factors involved in gaining lean bodyweight, but the starting point is to calculate your total daily energy expenditure (TDEE), which is the number of calories you require to maintain your bodyweight. According to exercise physiologists William McArdle and Frank Katch in their excellent textbook, Exercise Physiology, the average TDEE for women in the United States is 2000-2100 calories per day and the average TDEE for men is 2700-2900 per day. To calculate TDEE you must first determine your basal metabolic rate (BMR). Your BMR is defined as the minimum level of energy required to sustain the body's vital functions in the waking state.

Here's a simple formula developed by Dr. Fred Hatfield of the International Sports Sciences Association that you can use to estimate your BMR based on your bodyweight in kilograms. (One kilogram is 2.2 lbs.)

Men's BMR = 1 X body weight (kg) X 24
Women's BMR = .9 X body weight (kg) X 24

Example:
You are male
You weigh 172 lbs. (78 kilos)
Your BMR = 1 X 78 X 24 = 1872 calories

The formula above is based on total body weight, not lean body mass, therefore it will be fairly accurate provided your body fat levels are not above the average ranges (14-19% for men, 20-25% for women). If your body fat is substantially higher than average, then basing caloric needs on total bodyweight alone will overestimate calorie expenditure.


If you know your lean body mass, then you can get an even more accurate estimation of your BMR. This formula from Katch & McArdle takes into account lean mass and therefore is more accurate. The difference in calorie expenditure between men and women is due to the fact that men generally have a higher lean body mass and a larger total body surface area. Since this formula accounts for lean body mass, it applies equally to men and women.


BMR (men and women) = 370 + (21.6 X lean mass in kg)

Example:
You are male
You weigh 172 lbs (78 kilos)
Your body fat percentage is 14% (24.1 lbs fat, 147.9 lbs lean)
Your lean mass is 147.9 lbs (67.2 kilos)
Your BMR = 370 + (21.6 X 67.2) = 1821 calories

Now that you know your BMR, you can calculate TDEE by multiplying your BMR by the following activity factor.

Activity factor
Sedentary =BMR X 1.2
Lightly active = BMR X 1.375
Moderately active = BMR X 1.55
Very active = BMR X 1. 725
Extremely active =BMR X 1.9

Continuing with the previous example:
You are a 172 lb. male with 14% body fat and a BMR of 1821
Your activity level is moderately active (work out 3-4 times per week)
Your activity factor is 1.55
Your TDEE = 1.55 X 1821 = 2822 calories

Once you've determined your TDEE, the second step is to increase your calories high enough above your TDEE that you can gain weight. It is a basic law of energy balance that you must be on a positive calorie balance diet to gain muscular bodyweight. If you consume the exact amount of your TDEE you will simply maintain your weight. Generally speaking, you'll need to add another 300-500 calories per day onto your TDEE in order to gain weight. To be more specific, add a minimum of two calories per pound of bodyweight on top of your TDEE to determine your optimal caloric intake to gain weight.

Continuing with our example:
Your weight is 172 lbs.
Your TDEE is 2822 calories
Your additional calorie requirement for weight gain is 2 X 172 = 344
Your optimal caloric intake for weight gain is 2822 + 344 = 3166

Using the formulas above, we have determined that our "typical" 172 lb. moderately active male will need 3166 calories to gain weight. Keep in mind that this is merely an estimate: All calorie expenditure formulas are estimations. Due to genetic factors, there may be a 20% variance of BMR either way. Age is another factor that you may want to take into consideration. According to Dr. William Evans, PhD., one of the world's leading authorities on exercise and aging, we may need as much as 100 calories less per day per decade to maintain our body weight. Also consider that certain athletes train so frequently and so intensely that their TDEE can be off the normal activity scale limit of 1.9. Daily energy expenditure can be much higher for competitive athletes or extremely active individuals. Some triathletes and marathon runners have been reported to require as many as 5000-6000 calories per day or more just to maintain their weight!

Don't just focus on gaining weight. It doesn't do you any good to gain weight if most of it is fat. The goal of a weight gain program is to gain lean muscle mass with little or no increase in body fat. If you have access to body fat testing, get it done every 1 -2 weeks. If you find yourself gaining fat, first add in 20-30 minutes of cardio 3-4 days per week. If, after adding cardio you still gain fat and the quality and quantity of calories is correct, then you will need to begin cycling your calories up and down in a "zig-zag" fashion. Three high calorie days at your optimum calorie intake for weight gain, followed by three lower calorie days at or slightly below your maintenance level (TDEE) will allow you to add solid weight while keeping your body fat in check.

Using these calorie guidelines, you can expect to gain muscular bodyweight at a rate of 1/2 to 1 lb. per week, or slightly slower if you are female. If two weeks go by and you haven't gained any weight, you're doing something wrong; most likely, you're not eating enough and you should increase your calories. After 3 - 4 months, the rate of muscle gain tends to slow down closer to 1/2 pound per week. Eventually, as you get closer and closer to your genetic limit for carrying muscle mass, the rate of muscle gain will slow down to 1/4 lb per week. Even at this rate, that's still 13 pounds of solid muscle per year!

...While knowing your ideal calorie requirement is important, there are other factors that must also be accounted for. All calories are not utilized in the same fashion by the body. 3200 calories of ice cream, pizza, doughnuts, potato chips and soda obviously won't have the same effect as 3200 calories from egg whites, lean meats, fruits, rice, potatoes, vegetables, fruits and whole grains. While calories are the chief element in the muscle-gaining formula, meal ratios, meal frequency and food choices also must be factored into the equation.

 

Macronutrient ratios

Once you have determined your optimal daily caloric intake for weight gain, the next step is to divide those calories into the right ratios of protein, carbohydrate and fat and eat foods in the proper combinations at every meal. The ideal macronutrient ratios for weight gain are 30% protein, 55% carbs, and 15% fat (give or take 5% either way).

While carbohydrates may need to be reduced on a maximum fat loss program, if you want to gain muscular bodyweight, then natural, unrefined complex carbs should make up the bulk, or approximately 2/3 of your calories at each meal. Complex carbohydrates are your body's preferred energy source. A moderately high carbohydrate intake is essential to maintain high energy levels for hard training. Carbs are also protein sparing; they prevent the breakdown of lean muscle mass for use as energy. Don't worry; carbohydrates are not fattening as long as you select natural, unrefined complex carbs over processed, simple sugars and you keep portion sizes under control.

One-third of your total daily calories or approximately 30% should come from protein. Forget about the "Recommended Daily Allowances" (RDA's) of 12-15% of daily calories from protein. The RDA's do not account for increased requirements for intense training and muscular weight gain. The RDA's are merely a minimal standard for maintaining health, not for achieving optimal performance, strength and growth. A 15% protein diet may be adequate for a couch potato, but it is completely inadequate for someone who is training hard and wants to pack on the pounds.

Fats should almost always be kept under 20% of total daily calories, with the ideal amount being about 15%. There is no reason to ever go on a high fat diet just for the sake of gaining weight - if you do you'll gain weight alright - pounds and pounds of ugly lard right around your midsection! Excess fat in the diet is stored easily as body fat and also increases risk of cardiovascular diseases. But not all fats are bad. It's not necessary to drop below 10-15% fat. Attempting to remove all the fat from your diet can actually slow down muscle growth, decrease strength and decrease energy levels. A low-fat diet is much better for growth than a non-fat diet. In fact, the inclusion of a small amount of "good fats" such as flaxseed oil can actually be a great aid to gaining lean bodyweight. Adding one or two tablespoons a day will add 130 - 260 additional calories and provide essential fatty acids necessary for energy production, muscle growth, joint health and strength development.

So how do you know if you're getting your calories in these ratios? The most accurate way to measure nutrient ratios is to follow a menu generated by a computer spreadsheet. However, you can easily tabulate your macronutrient ratios with a calculator and a simple formula. Take your total caloric intake for the day and multiply it by the desired percentage of each macronutrient. Then, divide the calories from each macronutrient by the calories content of each.

Example: 3200 calorie per day diet

Carbohydrates:
55% (.55) X 3200 = 1760 calories from carbohydrate
1705 carb calories/4 calories per gram = 440 grams of carbs

Protein:
30% (.30) X 3200 = 960 calories from protein
960 protein calories/4 calories per gram = 240 grams of protein

Fat:
15% (.15) X 2000 = 480 calories from fat
480 fat calories/9 calories per gram = 53.3 grams of fat

A very simple way to estimate your nutrient ratios is to follow the "rule of thirds." Divide your plate into portions of 2/3 carbohydrate and 1/3 protein. Don't worry about adding in the 15% for fat. There will be fat occurring naturally in the proteins and in small quantities in the carbohydrates you eat. Practicing the "rule of thirds" will put your ratios in the right ballpark even if you don't have a computer or even a calculator.

The most important thing to remember is that these are not just ratios for the entire day, but for every individual meal. This means you are combining protein and carbohydrates together at each meal. Eating carbohydrates by themselves, especially refined and simple ones, cause a rapid rise in blood sugar and insulin levels. High glucose and insulin concentrations in the bloodstream are not desirable because they promote fat storage and rebound hypoglycemia. By combining foods properly with each meal, you effectively control blood sugar and insulin. This in turn, will keep your energy levels steady and increase muscle gain while keeping fat storage at bay.

Continuing with our example:

Carbohydrates:
55% of 3200 calories = 440 grams of carbs
440 grams of carbs divided by 6 meals = 73 grams of carbs per meal

Protein:
30% of 3200 calories = 240 grams of protein
240 grams of protein divided by 6 meals = 40 grams of protein per meal

Fat:
15% of 3200 calories = 52 grams of fat
52 grams of fat divided by 6 meals = 8.6 grams of fat per meal

 

The importance of frequent meals

One of the biggest challenges you'll face on your quest to gain weight is how to gain muscular body weight without also gaining fat. There is only one way to do this; you must eat five or six meals a day each spaced two and a half to three hours apart. If you were to divide 3200 calories a day into the typical three meals that would be 1066 calories per meal; that's far too much for your body to process at one sitting. Even the biggest bodybuilders don't need more than 700-800 calories at a time. Eating smaller meals more frequently will prevent you from over-consuming calories in one sitting; it's simple portion control. More is not necessarily better; your body can only utilize so much at once. Excess calories in any one meal will always be converted into body fat.

Eating small, frequent meals promotes more efficient muscle growth because it helps to regulate insulin levels. While the large output of insulin that follows a high blood sugar level is undesirable, insulin must be present in the bloodstream constantly so that amino acids and glucose can be transported into the muscle tissue. Insulin is a powerful anabolic hormone. One of insulin's major roles is to shuttle the amino acids into the muscle cells where they can be used for recovery and muscle growth. Unlike carbohydrates, amino acids cannot be stored; they are only available for protein synthesis for about three hours after the ingestion of protein. By eating a moderately sized meal every three hours you maintain a steady release of insulin so it can fulfill its growth-producing role.

Eating small, frequent meals also promotes muscle growth because it helps to prevent the breakdown of muscle tissue associated with long periods without food. Your body does not posses the ability to store proteins and use them at a later time for muscle growth. Since amino acids remain in your bloodstream for only about three hours after a meal, it is crucial to eat a meal containing a complete protein every three hours. If you do not supply your body will sufficient protein at regular intervals, it will be forced to breakdown its own muscle tissue for its amino acid needs. Continued...

 


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Eating more protein at one time doesn't help; your body can only utilize so much protein at one sitting:. If your ideal protein intake for weight gain is 240 grams per day, then it would be most efficient to split that amount into five or six smaller meals of 40 - 48 grams per meal. Consuming more than this at one time is pointless; although protein is the least likely of all the macronutrients to be converted to fat, too much of anything, even protein, will be stored in the form of subcutaneous body fat. At best, the extra protein is simply wasted.

In addition to the growth-enhancing benefits of five or six meals daily, frequent eating will also keep your energy levels high, and it will keep your metabolic rate higher so you keep fat storage to a minimum while on your bulking phase. s a large rise in insulin. When carbohydrates are consumed alone, there is a greater rise in insulin than when they are consumed in combination with protein. When simple, refined carbohydrates are consumed, there is also a greater rise in insulin.

...It's not uncommon for many large, active bodybuilders to need upwards of 4000 calories a day or more to gain weight. Sometimes it's difficult to get this many calories from food. For many people, it is not practical to eat 5 or 6 times per day because of work, school, or other time commitments. If this describes you, it's OK to substitute one or two meals with a meal replacement drink. Be wary of commercial weight gain powders. Many of them are 80% sugar with very little protein. Find a weight gainer with a ratio of 1 part protein to two parts carbs (for example, 80 grams of carbs to 40 grams of protein) Alternately, you could use a low calorie meal replacement product like MET-RX or MYOPLEX. At 280 calories per packet, they are too low in calories by themselves to count as an entire meal for a weight gain program. If you mix them with skim milk or juice and maybe blend in a piece of fruit, you now you have a 500 to 700 calorie, high protein weight-gain shake! Just remember that meal replacements should be used for convenience only - they are not designed to take replace food and they are not better than food.

 

Quality vs. quantity

Many people see going on a weight gaining program as a license to eat anything they want, including a lot of high fat and high sugar junk food. Don't let this happen to you! It is possible to gain lean body mass with no increase in body fat, but only by eating quality calories. Don't just be concerned with calorie density, you should also be concerned with calorie quality. Your muscle gaining diet should contain a wide variety of foods from every group including grains and starches, vegetables, fruits, low or non fat dairy products and lean proteins. You should choose foods that are as natural an unprocessed as possible. The less processed your food choices are, the better; eating foods in their natural state the way they came out of the ground is ideal. Your best choices for carbs are rice, potates, yams, beans, whole grains, pasta, oatmeal, fruits and vegetables, your best sources of carbs include 100% whole grain cereals and breads, potatoes, yams, brown rice, oatmeal, beans, pasta, legumes, vegetables and fruits. Great sources of protein for muscle development include egg whites, low fat dairy products, chicken, turkey, fish and lean cuts of red meat.

Let's recap what you've learned so far... The formula for gaining lean body weight is:

1) Determine your total daily energy expenditure (TDEE)

2) Add a minimum of two calories per pound of body weight so you are in a positive calorie . . . balance. This is known as your optimal calorie intake for weight gain

3) Divide your optimal calorie intake for weight gain into the proper macronutrient ratios of . . . . 55% carbs, 30% protein and 15% fat.

4) Spread out your calories into five or six small meals per day.

5) Divide your calorie and macronutrient totals by the number of meals daily to determine . . . . the calorie, carbs, protein and fat content of each individual meal. Make sure you . . . . . . . consume your foods in the proper ratios not just for the day but at each individual meal . . . as well.

6) Choose natural, unrefined foods. Don't use trying to gain weight as an excuse to pig out.

 

Getting Brilliant on the Basics

"Big Ernie," one of my old lifting buddies from Pennsylvania, e-mailed me last month after reading the articles on my website about proper nutrition for weight gain. In his usual sardonic tone he wrote, "Seeing all the scientific stuff on your web page reminds me - here is a good formula for you:

HM = BC + HW


HUGE MASS (HM) = BIG CALORIES (BC) + HEAVY WEIGHT (HW)."


I was rolling on the floor laughing when I read this, but afterwards I got to thinking that he was absolutely right - the formula for getting big isn't anything overly complex or scientific - it's actually very simple; just eat big and lift big on basic exercises. This may seem like an oversimplification, but that's really all there is to it. I've already discussed eating to get big in the first two parts of this series, so now I'd like to discuss the third and final component; how to train big to get big. A successful approach to gaining muscle involves choosing basic, compound exercises, progressively adding resistance, allowing enough recuperation and keeping workout sessions brief and intense.

Get "Back to Basics"

When Vince Lombardi took over the Green Bay Packers everyone asked him what he was going to do: "Are you going to change the playbooks?" "Are you going to change the players," "what are you going to do differently?" To these questions he replied, "I'm not going to change anything, we're just going to get brilliant on the basics. Our opponents may be able to predict exactly what we're going to do, but we're going to be so good at the basics that they won't be able to stop us."

When your goal is to gain muscle, your training mantra must become "back to basics." I believe there are three reasons why people fail to get back to basics. The first is because they have been on a fat-reducing plan for so long that they become locked into a fat-burning training and nutrition mentality and they simply refuse to shift gears for fear of getting fat. You should stay reasonably lean all year round, but trying to stay ripped all the time will severely limit your size gains. When you've finished dieting to lose weight, shift gears, get back to basics and get focused on a mass-building mentality.

The second reason people fail to get back to basics is because the basics seem so basic. What I mean is that people don't see the forest for the trees. People are always looking for some exotic, esoteric, magical formula, theory or program. Meanwhile, the answer is right in front of their face, but they overlook it because it seems too obvious.

The third reason people fail to get back to basics is because the basics are so darn hard! It never ceases to amaze me how people always gravitate towards the easiest exercises while avoiding the harder, more result-producing exercises. Let's face it, squats are tough - real tough! But if you don't learn to love heavy, basic exercises like squats, you'll never join the ranks of the massive.

Choose Compound vs isolation movements

First and foremost, "back to basics" means using compound, multi-joint exercises over isolation movements. Compound movements are those that involve the largest muscle groups as well as smaller, stabilizing muscles. Because they utilize a greater muscle mass, they allow you to lift the heaviest weights possible. There is a direct correlation between the amount of weight lifted in an exercise and the size of the muscle. Therefore, it is logical that compound exercises like squats have a greater potential for building mass than isolation movements like leg extensions because squats allow the utilization of much heavier poundages, resulting in much greater hypertrophy.

 

The Best Mass Building Exercises

Here is a list of the best basic mass building exercises for each body part:

Quads: Squats, Front Squats, Leg Presses
Hamstrings: Stiff-Legged Deadlift, Lying Leg Curl
Back: Deadlift, Bent Over Row, One Arm Dumbbell Row
Chest: Barbell Bench Press, Dumbbell Bench Press, Weighted Wide Grip Dips
Deltoids: Press behind Neck, Dumbbell Press, Military Press, Shrugs
Triceps: Lying Tricep Ext., Close Grip bench Press, Pushdowns, Seated Tricep ext.
Biceps: Standing Barbell Curl, Seated Alternate Dumbbell Curl, Preacher Curl
Calves: Standing Calf Raise, Donkey Calf Raise, Seated Calf Raise

If you don't Squat, You Ain't Squat!

Out of all these basic mass building exercises, no exercise is better for packing on pounds of quality muscle than the squat. Ironically, however, no exercise is more ardently avoided either. I've heard just about every excuse in the book for not squatting, and believe me, after rupturing a lumbar disk, I've had every reason not to squat myself. Despite my injuries, I squat any way. Why? Because barbell squats are positively the single most result producing exercise you can do. I'm not suggesting that you ignore the advice of your physician if you have an injury, but if you are physically capable of squatting and you're not doing them, you are compromising your results. Squats hype your metabolism, pump up your legs and make your whole body grow! Leg presses are OK, but they just aren't the same.

 

Rest and Recuperation

Muscles don't grow during a workout. They grow between the workouts - if you allow them to rest, that is. All too often, the over-enthusiastic trainee works out longer and more often under the impression that more is better. Over training is the arch-nemesis of the bodybuilder. Training by itself does not necessarily translate into growth; training plus recuperation does.

Proper recuperation includes two separate components; specific recuperation and systemic recuperation. Specific recuperation refers to how much time you allow between training a particular body part. The rage these days seems to be training every day and hitting each muscle group once per week. This is not a bad idea, but if you're training six or seven days per week, you're defeating the purpose of one body part a week training. Individual muscle groups need to rest between training sessions, but so does the entire body. Systemic recuperation means allowing your entire body to recuperate by not training too many days in a row. If you train too frequently, this places excessive demands on your nervous system. Two or three days of weight training in a row is the most you should ever do. If you are a "hard-gainer" then an every other day routine might be even better. A two on, one off schedule where you work each muscle every five to seven days is extremely effective. This allows individual muscles and your entire body sufficient recuperation for maximal growth.

Progressive Resistance - The # 1 key key to gaining mass

There are many factors involved in building a muscular physique, but in the long run the only thing that really matters is that you progressively overload your muscles. There are many ways to overload a muscle such as decreasing rest intervals, increasing volume, slowing rep speed, increasing time under tension, doing more repetitions, and using stricter form, but the granddaddy of them all is simply adding weight on the bar. The more weight you can lift in strict form, the bigger the muscle will get, period. Constantly adding weight at every session can seem like an insurmountable task at times, but the best way to achieve this goal is to make tiny, incremental increases consistently over time. Don't attempt large jumps in weight loads too quickly. Aim for adding just 2.5 lbs to 5 lbs with every workout on the basic exercises. You may not always be able to increase the weight, but you must make progress in some form at every single workout or you are wasting your time.

Keep your workouts brief in duration and high in intensity

The definition of intensity is the degree of momentary muscular effort that you exert during a set. In other words, intensity is how hard you workout. Most people simply do not train hard. Most likely this lack of intensity is due to the volume being too high. There is an inverse relationship between intensity and volume. The harder you train, the less sets you'll be able to do (and the less sets you'll need to do). As a general rule, it's most effective to keep your workouts brief and intense (under 60 minutes). More is not better, harder is better. Always train to the point of failure or just short of failure.

Avoid excessive cardio work

The entire point of adding a 250-500 calorie surplus to your diet is to allow extra nutrients and energy to support the growth of new muscle tissue. If you continue to do cardio every day for prolonged periods as you do in a fat-reducing program, you'll only be burning off those extra calories you needed for growth. Never completely stop doing cardio. Everyone should always do 20-30 minutes of cardio 3-4 days per week year round regardless of your goals - that should be a part of any healthy lifestyle. But too much is counterproductive.

 

Conclusion

Getting big is not the result of using some secret eastern bloc training program, a miracle diet or a super muscle building supplement. Gaining muscle isn't rocket science. The formula for getting big is deceptively simple; it is just a matter of being "brilliant on the basics." Do yourself a favor; stop wasting your time searching for an easy way, because it doesn't exist. Just eat big, work hard, work heavy on the basic exercises and get plenty of recuperation and you'll soon be adding pounds of lean body mass faster than you ever thought possible.



This article was provided courtesy of Tom Vento who is a lifetime natural bodybuilder, personal trainer, gym owner, freelance writer and author of "Burn the Fat, Feed The Muscle" (BFFM): Fat Burning Secrets of the World's Best Bodybuilders and Fitness Models.

For more information on how Tom's fat-burning system can help you lose fat quickly and easily... even if you've tried everything and the flab doesn't seem to budge... click here

 

 

WEIGHT GAINING NUTRITION - How to Gain Weight and Muscle Mass !

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FACT: It doesn't matter how much you lift, what drugs or supplements you take, what training system you use, which gym you attend, or any other possible variable -- if you don't eat correctly you won't achieve the kind of results you want, period. This is so true that many professional bodybuilders have been quoted as saying...

"Nutrition may be the most important factor for success."

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Will's articles and monthly columns relating to nutrition, supplements, weight loss, exercise and medicine can regularly be found in magazines such as: Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle-n-Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Women's World, and The Townsend Letter For Doctors, as well as many others.

Now Will puts all of his extensive knowledge and experience together in one easy to understand ebook titled "Muscle Building Nutrition" which provides you with the correct information you need in order to pack on pounds of lean muscle mass with a minimum of bodyfat.

 

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"Scientifically Proven"

 

Muscle Building Nutrition
will show you everything you will need to know about...


How to gain serious amounts of lean muscle without adding ugly bodyfat!

Which bodybuilding supplements work and which are pure marketing hype!

What and when to eat to keep your body in an anabolic muscle building state!


 

It's amazing how much time, money, and energy people waste on worthless supplements and diet strategies for gaining lean muscle mass which have no scientific merit - but now thanks to Muscle Building Nutrition you can achieve your goals, in less time, and save money!

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This site is provided for informational purposes only and is not meant to substitute for the advice of a qualified physician or other medical professional. Information and statements contained herein, regarding dietary and food supplements, have not been evaluated by the Food and Drug Administration, and are not intended to diagnose, treat, cure, or prevent any disease. The information contained herein is not for diagnosing or treating a health problem or disease. sitemap

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