Food Fears One
Food, Family and Fear
Just yesterday I received an e-mail asking me to provide all my evidence and/or arguments for why I would specifically state that ultra-processed foods are actually (gasp!) not merely beneficial in recovery, but often preferentially superior to homemade food or unprocessed foods. Rather than respond to the e-mail, the answer will dovetail nicely with the overall topic of this post—so read on for the answer…
And, as if some synchronous effect is at work in the universe right now, Michelle, owner of fatnutritionist.com, has a most recent blog post entitled: Stuff people assume I believe vs. stuff I actually believe. She begins the post by addressing the assumption others have made that she believes the food industry is awesome.
All these circling topics coincidentally add relevance to this post.
Yes that’s right, the end of the year is coming and for many of us the annual celebrations that portend family meltdowns, altercations, disputes and animosities, all while gathered around food, are upon us. And those contentious outcomes are even more likely to be a reality for families dealing with eating disorders in their midst.
What this post is going to set out to do is to help you address food-related anxieties in anticipation of these upcoming celebrations by disassembling and reassembling your concepts of food (it’s a tall order and I might fail!).
Food: Use As Directed
Many ED specialists often frame the concept of recovery in terms of food being the patient’s medicine. This concept has never sat very well with me and it is likely because the phrase is usually meant in the context of medicine making you feel better. I always envision “take your medicine” as some saccharine mother-and-child cough syrup TV advertisement, and recovery from an eating disorder is hardly comparable to a 60-second spot on the wonders of over-the-counter drugs.
Nonetheless, I think there may be some value in viewing food as a prescription. Most prescribed drugs for chronic conditions are never without side effects, compromise and an overall understanding that not taking the prescription is worse than taking it. And there are definitely side effects when you take food as a patient recovering from an eating disorder! I will expand on this concept further later on in this article.
Most patients attempting to up their food intake, as they enter a recovery effort, find themselves very focused on the idea that they do not need the food they are eating. They worry about whether they are eating out of boredom; whether they have something inherently wrong with their metabolism that will mean they can never be ‘normal’; or whether they shouldn’t really just shift to intuitive eating (signifying what I call ratiocination eating) because otherwise they will habituate to too much food.
Interestingly, patients spend almost no time questioning these thoughts and feelings. In a society steeped in thinxiety (the endemic fear that vigilance is required to maintain body weight and health) it is understandable that next to no one pauses to consider whether these thoughts have innate merit or not.
Sometimes, to suggest that the construct of ratiocination eating is a culturally generated error in understanding, I use sleep as a parallel to hunger.
Ratiocination eating presumes that having our emotions active and interacting with our hunger and satiation cues is inferior to the process of applying our conscious, or logical mind, to the assessment of whether the desire we feel to eat is in fact something that must be addressed for logical reasons. We cannot eat logically. Our logical minds are too late to the evolutionary party, by millennia, to actually offer any value to how we pursue and stay optimally energized.
If you deprive yourself of sleep throughout each weeknight, then you will find that you feel compelled to sleep-in on the weekend. Although there are study indicators that we also deny our biological need for sleep in society to the point where many of us have habituated to the constant state of sleep deprivation, we are nonetheless never able to persist in that state without physical harm to our body’s ecosystem.
Food Deprivation Harms You Like Sleep Deprivation
As I mention in the final installment of the Fat Series:
“As you read this, about 100 million sleep-deprived Americans are driving cars and trucks, operating hazardous machinery, administering medical care, monitoring nuclear power plants and even piloting commercial jets”
Lack of sleep is a contributing factor to many serious health issues.
“Recent chronic partial sleep deprivation experiments, which more closely replicate sleep loss in society, demonstrate that profound neurocognitive deficits accumulate over time in the face of subjective adaptation to the sensation of sleepiness.”
The sense that we somehow adapt to sleeplessness was originally misidentified by poorly designed studies from the 1970s to the 1990s that suggested we have little to no cognitive performance impacts when we reduce our sleep to between less than 7 hours and greater than 4 hours. [3] Nonetheless, the feeling that we have adapted to sleep deprivation turns out to be profoundly misleading, as more well-designed studies in the past decade have been able to uncover.
Just as we are profoundly misguided about suppressing hunger cues as being a necessary requirement for maintaining optimal weight and health, we have also absorbed the misguided belief that suppression of sleepiness optimizes our work ethic and overall societal efficiency.
Thomas A. Edison, the man responsible for providing us with the tungsten light bulb, is also consequently responsible for us all having lost about 500 hours of sleep in each year of our lives. [4] But, just as with food consumption, Edison was already infused with a cultural sense that sleep is not only unproductive, it is actually immoral. [5] His motivation for developing electric light was to banish the excuse of darkness as a reason for sleep. [6]
Biological necessities are not immoral. Denying their necessity in our lives, while not immoral either, is most certainly damaging.
Here are just a few clinical highlights of the consequences of chronic partial sleep deprivation:
Partial sleep deprivation reduces the activity of natural killer cells in our bodies; impacts cortisol and melatonin levels; increases insulin resistance and diabetes mellitus Type II onset; lowers leptin levels; increases risk of coronary heart disease; increases the risk of certain kinds of cancers; and increases the risk of obesity onset. [7],[8],[9],[10],[11]
And that doesn’t even cover off the impacts of partial sleep deprivation on cognitive and motor functions either!
You might be willing to accept that sleep deprivation is indeed harmful to your health. You may even be considering the possibility that feeling morally superior about suppressing your need for sleep is somewhat counter-productive to your long-term health outcomes too.
Ah, but now we turn our attention to food and not only does the eating disorder rear its very ugly head, but so too does a myriad integrated cultural idiocies that none of us is able to avoid.
Food Is Food
Humans do not actually consume and digest macronutrients, micronutrients, trace elements, minerals, calories, nutraceuticals, supplements and/or vitamins. We consume and digest food.
Our gastrointestinal tract is responsible for the extraction of the needed components from the food we eat. Anything unneeded or any by-products from the digestive process are then eliminated from the body at the end of the entire pulverization, extraction, absorption and reabsorption that constitutes the transubstantation of food into energy in our bodies.
There are three kinds of food: unprocessed (raw), processed (cooked, canned, pickled, dried), and ultra-processed (often called “junk” or packaged foods).
Supplements
When we consume nutrients in a format other than those three kinds of food, then our bodies cannot make use of the nutrients as effectively as when those same nutrients are tucked away in food (raw, processed or ultra-processed). [12],[13],[14],[15]
Often the relative inferiority of supplementation is explained in terms of bioavailability—nutrients in supplement form are far less bioavailable, in general, than nutrients in food.
The vitamin and supplement industry fought hard in the United States to ensure that its industry would not come under any regulatory oversight from the Food and Drug Administration (FDA).
“Since the vitamin/supplement industry is for the most part unregulated, it is extremely difficult for the public to know if the vitamins in the label of a particular brand of supplements actually includes these in the pills nor does it ensure that the amounts represent what is in each pill. Numerous organizations have tested and proven that large percentages of store-bought brands of supplements are lacking in dependability.
In addition, there are no regulations to require that manufacturers prove that the nutritional elements in the pills are actually bio-available. They simply pass through or take too long to break down into small enough particles to be of any use.
Then you also have the natural versus synthetic argument.
There are very few supplement manufacturers that produce their products using near-prescription medicine manufacturing and testing procedures.
These are some of the main reasons the medical practitioner has a difficult time recommending supplements. Most are undependable.”
Germany is the only nation of which I am aware that requires its supplement and vitamin industry adhere to regulations akin to those assigned to the prescription drug industry. The vitamin and supplement industry in the United States, Canada, United Kingdom, Australia and New Zealand is best described as under-regulated. [17],[18],[19]
Many with active eating disorders turn to vitamins and supplements as a harm reduction approach to starvation—presuming that these things will alleviate deficiencies without having to actually consume food.
Quite commonly patients with eating disorders will have perfect blood work results with no signs of deficiency, and it has been assumed that this was the result of their predictable use of supplementation. [20] However, these patients are not actually supplementing a healthy diet, and clinical evidence shows they absorb even less of these substances than will non-ED individuals, similar to the issues of absorption found in the use of psychoactive drugs for eating disorder patients. [21]
In fact, it appears that the normal blood work results common for many with eating disorders is actually the result of the body’s process of catabolism (the destruction of its own cells to release energy in the face of huge energy deficits due to starvation). Catabolism releases these needed elements into the bloodstream thereby falsely assuaging everyone’s concern that the patient is at risk of biological failure. [22],[23] Interestingly, nutritional deficiencies are likely to appear when the patient enters a refeeding process as this halts the destruction of cells. [24] Of course, these deficiencies quickly resolve with ongoing refeeding efforts.
Raw Food
Now we’ll look at the three kinds of food we are optimized to digest: raw, processed, and ultra-processed. And we’ll start with raw food.
We are the only animals on the planet that eat, and are optimized for, cooked food. Our primate relatives spend, on average, six hours a day chewing raw food. They are also endowed with a larger and longer digestive tract, and commensurately smaller brain to body ratios by size as well. [25]
Richard Wrangman, author of Catching Fire, is the seminal scholar on the topic of the evolutionary shifts we experienced as a result of cooking (processing) food.
“Wrangham argues that the greatest transition in the fossil record, and hence the origin of cooking, occurs with Homo erectus at 1.8 million years ago. Skeptics argued against this hypothesis…there is little archaeological evidence for controlled use of fire that early…many saw the cooking hypothesis as the antithesis to the Man-the-Hunter hypothesis...In his latest book, Catching Fire, Wrangham provides a wealth of new evidence in support of his theory, drawing from the paleontological and archaeological records, modern primate studies, ethnographies, and experiments in digestive physiology. While some called his original article a “just-so” story, this new book is so broad in its scholarship that it marks one of the most masterfully constructed hypotheses in human behavioral evolution today.”
A 100% raw food diet for humans is not natural and has not been natural for approximately 1.8 million years.
It is estimated some 30% of women who adopt a 100% raw food diet develop amenorrhea (lack of a regular menstrual cycle); [27] dental erosions are far more common for patients on raw food diets; [28] and of course risk of food contamination by dangerous pathogens is greatly increased for a raw foodist if they eat raw meats, eggs or dairy as well. [29],[30]
All this is not to say that consuming raw fruits and vegetables is not suitable or optimal for humans. However, our reduced gastrointestinal size and increased brain size depend upon us consuming predominantly processed foods as part of our natural diet.
Processed Food
In this context, processed food refers to any number of alterations we regularly apply to raw foods: cooking, pickling, canning, jarring, drying, smoking…
All these processes render the energy within the food more readily available to our bodies. The more processing applied to any food, the less our digestive system needs to actually use up energy, in conjunction with our immune system and our gut microbiota, to release the energy within the food. The increase in brain size and reduction in gastrointestinal complexity and length all coincided with our ancestors’ ability to process food.
In this section and the following one I will address trans fats. Trans fats, or trans-isomer fatty acids, occur in nature. In this section I will take a look at the natural occurrence of trans fats. Trans fats exist in small quantities in both dairy and meat. This particular trans fat is called vaccenic acid. Human beings convert vaccenic acid into conjugated linoleic acid [31] and CLA is a group of polyunsaturated fatty acids. While CLA’s are perhaps oversold in their benefits to human health, there is enough clinical data to suggest that their presence improves immune function and enhances the body’s ability to maintain its optimal weight set point. [32],[33],[34]
Our food consumption is one area where animal studies are particularly inapplicable. We have no other animal on which to experiment that is optimized for cooked food consumption and therefore results are not readily transferrable to our experience. A perfect example of the misapplication of animal studies in identifying our relative health risks is the appearance of carcinogens in food as a result of cooking it.
The Maillard reaction, as it is called, is the chemical reaction between a protein and a sugar requiring the application of heat. It is best described as the browning or caramelization we attempt to achieve when cooking food.
There are plenty of animal studies that suggest this process results in the addition of potent cancer-causing agents in the body. But, as I said, no other animal is optimized for cooked food. In fact, the Maillard reaction enhances endothelial nitric oxide synthase (eNOS) in humans and eNOS is an important signaling molecule in the cardiovascular system. [35] The loss of lysine availability due to Maillard reactions is not an important health hazard for humans. [36],[37] The Maillard reaction does generate heterocyclic amines which are tenuously linked to increased cancer risk, however none of the epidemiological studies have corroborated animal laboratory studies on this link thus far. [38] And one particularly interesting study indicated that those who cooked their meats and fish at the highest temperatures had a 40% decreased risk of developing cancer compared to those cooking at the lowest temperatures. [39] I also credit Beyondveg.com for brilliantly synthesizing much of the information I have just provided on the Maillard reaction as well.
Evolutionarily speaking, cooking, browning and processing your food is your birth right.
Ultra-Processed Food
Like Michelle (mentioned at the outset of this post) I have no deep love of the fast food industry, agribusiness or that our entire food system relies on a non-renewable resource (petroleum in its various incarnations).
But I am a pragmatist and I also work in an area that specifically involves trying to help others rectify enormous energy deficits in their bodies due to self-administered starvation.
So let’s talk about why ultra-processed foods are rather opportunistically ideal in the recovery process from eating disorders.
As I mentioned in the previous section, the more processing applied to food before we eat it, the less our bodies have to expend energy to extract the energy locked within that food.
Ultra-processed foods are best identified as almost everything found along the inner-aisles of a grocery chain store: things in boxes, packages and bags. They are also the foods offered at any fast-food restaurant and also many chain restaurants where the food is shipped pre-prepared and frozen to the various restaurant outlets.
Ultra-processed foods are only available to us for as long as we have cheap fuel as it is that cheap fuel that allows us to excessively heat, extract, reconstitute and re-engineer food products in factory settings. The end result of all of that is when you eat ultra-processed foods you provide your body with more net energy. [40]
Biologically speaking a calorie is not actually a calorie. [41],[42] Both the first and second laws of thermodynamics are important when identifying how biological systems burn energy. The first law of thermodynamics stipulates that energy is always conserved in a closed system. It means, in the context of eating, that what you take in as energy, you use or store as energy. However, the second law of thermodynamics refers to the quality of the energy that is conserved:
“The quality of matter/energy deteriorates gradually over time…Usable energy is inevitably used for productivity, growth and repair. In the process, usable energy is converted into unusable energy. Thus, usable energy is irretrievably lost in the form of unusable energy.”
Conservation of energy is maintained when we eat because we export carbon dioxide and water into the greater environment. It is our metabolic pathways, however, that will determine how the energy and matter are distributed among heat, chemical bonds, work and excretion, and dietary composition drives the differentiation of those metabolic pathways. [44]
Apologies for all the scientific jargon, but if I do not provide the data then I will be accused of having no evidence to support the fact that a 500 calorie MacDonald’s burger actually allows for heightened bioavailability of energy to your body when compared to 500 calories’ worth of raw carrots, or even 500 calories’ worth of a homemade dinner.
And so, ultra-processed foods are the Pandora’s box of extreme energy for human beings. It makes them the best option for those recovering from eating disorders and it is likely why they are so intensely craved in the earlier phases of recovery. Your body is quite capable of identifying foods that require less energy expenditure to transform the food into its energy components.
Ultra-processed foods are not correlated with fatness onset or relative increase in fatness rates in the population. [45],[46],[47] However, we may have to pay more attention to the fact that the packaging into which these foods go are often stuffed full of endocrine disruptors that naturally seep into the food. [48],[49],[50] And even then, the impacts of endocrine disruptors such as Bisphenol A are not ubiquitous in our populations, suggesting that genetic predispositions must also play some part.
Unfortunately we have no scientific evidence available to us from 1.8 million years ago, but I feel confident suggesting that not all hominins at the time were genetically prepared to shift from raw to cooked food. Likely a few hominins could not adjust to cooked food and the prevalence of cooked food quickly impeded the continuance of that genotype or genotypes. The vast majority clearly flourished with the shift from raw to cooked and voilà our great brains and modest guts.
Except for the fact that ultra-processed food actually does have an ultimate shelf-life (meaning when we exhaust all petroleum reserves it will be impossible to maintain the production of these types of foods), there is no inherent “wrongness” shifting from processed (cooked) to ultra-processed foods from a biological perspective. Were it not for its dependence on petroleum, the introduction of this kind of food might have meant the next great neurologic leap in our evolutionary development.
Yes, I play devil’s advocate on this topic but that is because we are so grossly steeped in the false attribution in our culture of there being any such thing as good and bad foods.
The reality of these types of foods in our diets is that the majority of us do not exclusively consume ultra-processed foods (unless socioeconomic pressures unfortunately force it) and we are natural omnivores that seek great variety in our diets.
Ultra-processed foods are ideal in the early phases of recovery where the body seeks to reverse huge energy deficits as efficiently and quickly as possible. However, once energy-balanced, you will not continue to have the same marked preference for these types of foods and will naturally veer back towards a broad omnivore diet that includes predominantly processed foods, a significant intake of raw and unprocessed foods, and a modest intake of ultra-processed foods.
The hierarchy of beneficial foods during recovery will be: ultra-processed foods, processed foods, and an incidental amount of raw foods. The hierarchy of beneficial foods in remission (and for non-ED folk) will be: processed foods, raw foods, and incidental ultra-processed foods. You don’t have to consciously manage the shift from recovery to remission—these are things your body will identify for you.
[ed. Update 2024 I will be developing a new article in the food fear series as it appears many with ongoing chronic conditions other than eating disorders benefit from a long term hierarchy of foods where ultra-processed foods are the ones most heavily consumed. Yes. Really. Look for it in 2025 I expect.]
Ultra-processed Trans Fats
Before we move off of the topic of ultra-processed foods, let’s turn our attention to trans fats that are specifically present in ultra-processed foods in some countries and are generated from heating to high temperatures vegetable-based oils. As you likely know there are moves in many countries to insist upon the removal of trans fats from ultra-processed foods because these kinds of trans fats are linked with increased risk of coronary heart disease.
However, the data suggesting trans fats found within ultra-processed foods increase the risk of coronary heart disease are not without gaps, to say the least. Given that in all countries where rates of smoking have decreased so too have both the incidence and mortality from coronary heart disease, it is difficult to use epidemiological studies to identify a clear negative impact from the consumption of trans fats in these same countries.
In controlled trials, there is clear evidence that trans fats negatively impact the ratio of high-density to low-density lipoproteins (HDL/LDL). Unfortunately the evidence that this then translates into an increased risk for coronary heart disease is not conclusive [51],[52]. Given that the average American diet gets about 2-3% of its energy from ultra-processed trans fats, and the rate of coronary heart disease has steadily decreased from 1960 to 2006 [Heart Disease and Stroke Statistics—2010 Update] it seems that whatever increased risk may or may not be present with the addition of trans fats in ultra-processed foods it is not measurable within the overall trend in the lowering of both the incidence and mortality of cardiovascular disease.
Your Holiday Prescription
Now we have looked at the elements of food, let’s get back to the concept of food as a prescription when in recovery.
Food is food. All holiday goodies are food. No food is bad food.
Like any prescription, there are side effects to accommodate as you refeed. You face physical side effects (itemized in more detail in the Phases of Recovery) that thankfully dissipate as you continue along in your recovery efforts. However the psychological side effects are a bit more complicated and also longer lasting.
While you find yourself anxiously drilling down on whether forbidden foods are good or bad for you; whether you can afford to eat a holiday goodie; whether you have to restrict in preparation for the celebratory feast; or whether you can compensate after the meal with hours of exercise or purging, you have to keep reminding yourself that these thoughts and anxieties are merely side effects generated by the eating disorder-generated food/fear cycle, and they are not an indication that continuing to eat is dangerous.
By comparison, imagine you have to take a suite of antibiotics to clear up a deadly infection. You are told that common side effects of taking these antibiotics are cramping, bloating, diarrhea, headaches, indigestion, heart burn and a metallic taste that persists in your mouth. As unpleasant as all those side effects are, you persist in taking every last one of the pills because you have no intention of doing anything other than eradicating the infection.
Now I am going to tell you all about the psychological side effects of having to take in months and months of excess food, to try to clear up a deadly energy deficit in your body, as a way to really reinforce the necessity of treating all the ED-generated anxieties and refeeding-related pain and discomfort as unpleasant side effects, but not signs that you must quit your prescription before you are well.
You will be convinced that you are the exception. You will be sure that you will become habituated to “binges”. You will swear that you are eating out of boredom and that you are not really hungry. You will believe that you have no optimal weight set point, even though everyone has one. You are going to be absolutely convinced that you will keep gaining and gaining. You will be sure that all the physical side effects you are experiencing are because you are eating too much or too much of the wrong things and not that they are just passing symptoms of the body healing. You will long for “normal” and desperately want to be done with the process of recovery. Your moods will be mercurial. You will feel “out of control” and experience waves of guilt and shame as you keep eating to restore your health.
And still you must take your prescription as directed.
All of those very unpleasant psychological side effects are not there because your prescription (food) is actually damaging you or hurting you in any way. Your eating disorder is creating that entire mirage of fear-based side effects even as the food itself continues to restore you and heal you.
Breathe and eat. Eat and breathe. It gets easier as you continue to reinforce in your mind that the ED-based fears are not real and are therefore not worthy of your serious consideration.
Family and Friends
Of course, then there is the fact that food is a communal experience for human beings—our appetites and health depend upon it. The complexities of fairness, reciprocation and bonding in our social structures as it relates to the sharing of food are inextricably linked to our ability to be adequately nourished and energized.
However in our cultures, where there is a constant stream of weight-obsessed chatter in which we indulge during these holiday celebrations, things can get mighty unpleasant for someone in recovery surrounded either by other family members with restrictive eating issues, or conversely family members who cannot understand restrictive eating issues.
There are already three fabulous posts from Michele and Ragen (respectively) that offer prescriptions for dealing with family members who are compelled to extend their own food intake anxieties all over you while you are actively recovering:
Avoid Holiday Weight Shame (also from Ragen)
And I am going to try to provide some prescriptions for you so you can enter this holiday season supporting your recovery efforts fully while gracefully managing family and/or friends who cannot understand how you struggle with something they consider automatic and not worthy of such ‘drama’.
It is not your job to educate the world on the challenges you face just sitting down for a meal. However, it is likely in your best interests to ensure that friends and family don’t end up inadvertently misinterpreting your reactions because they are completely unaware that you have an eating disorder.
If you have kept your eating disorder a secret then you are going to be prone to two types of responses that can be very upsetting. The first response will be that you are praised for your restraint and your ability to resist temptation. The second will be that your rejection of food is seen as a snub and it will either result in general tenseness for the gathering, or someone will choose to escalate the situation by suggesting you are being selfish and unkind in refusing to eat something.
Honesty diffuses both scenarios: “Actually, I am horribly hungry and it is very unhealthy to apply this kind of restraint at all. I am sorry I am unable to respond to my real desire to be a part of all this wonderful food that has been so beautifully and lovingly prepared. I am working on recovery from an eating disorder at the moment and it is a work in progress.”
If you are uncomfortable negotiating the situation solo with the entire gathered clan, then call upon a special friend of family member ahead of time. Let them know that you develop anxieties when the topic turns to food intake, weight gain, and body image and you’d appreciate their help in steering everyone beyond those topics as quickly as possible
Be somewhat prepared ahead of time to talk, or not talk, about your recovery process. If you are comfortable responding to questions about your recovery at the gathering, then go for it. If, however, you think that might generate more discomfort for you, then just let the person know that you will be happy to chat with them some other time to bring them up to date on all your efforts and progress, but that you really want to try to just focus on enjoying the celebration as much as you can right now.
If panic overwhelms you, you have an urge to cry and/or you begin to shake and feel like you are going to faint as you try to eat your meal, breathe. Remember you breathe out slowly first. Empty the lungs of air over at least 4 slow counts. Then pause comfortably, not forcing it. Next slowly inhale and expand the lungs with air. Pause again with your lungs full not holding your breath.
Another good reason for having a special friend or family member well aware of your challenges is that they can smooth things over for the entire concerned gathering if you need to just excuse yourself to have a few minutes away to breathe and apply your relaxation techniques in a quiet space.
Your measure of success will be when you, in the span of the entire celebration, take a moment to look around and absorb some essential joy in what it means to be surrounded by people you care about and who care about you. Eating with loved ones is a fundamental joy that everyone deserves, including you (no matter what your eating disorder says!)
It is also more than o.k. to skip a family celebration and protect your overall recovery effort. If your family is dysfunctional; if they have never supported your efforts to recover; or if they repeatedly resist your efforts at assigning respectful boundaries when it comes to your decisions and choices in life, then you should not attend simply because you believe that duty dictates you do so.
I have several friends who have created their own families from friends over the years because their blood relatives are just too toxic to be around. Protecting your recovery effort takes precedence over trying to navigate a fractious family situation if that is where you are at right now.
Holiday food is a gift, not a health risk. Enjoy.
May the new year be filled with the deep and abiding joy of a full remission for you all.
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