Tuesday 31 January 2023

Can Drinking Cherry Juice Improve Your Arthritis Symptoms?

From healthdigest.com

Cherries are a type of fruit that grows on trees in the Rosaceae family — they are small, round, and typically dark red but come in many varieties, according to Penn State University. Several different types of cherries are available, each with its unique flavour and use. Tart cherries, also known as Montmorency cherries, are becoming more popular. They can be used for making juice and can be eaten dried, says Healthline.

Cherries offer a range of nutritional benefits. According to Healthline, they are a source of antioxidants, particularly anthocyanins, which help protect cells from damage caused by free radicals. Cherries are also a good source of vitamin C, says Healthline. This vitamin is important for maintaining a healthy immune system and supporting skin health, per WebMD. Additionally, cherries are a source of potassium, which helps regulate blood pressure and support heart health, says Healthline. Some people also promote cherry juice as a natural remedy for improving arthritis symptoms due to its anti-inflammatory properties.

How cherry juice might help arthritis symptoms

While the evidence on the efficacy of cherry juice for arthritis is not conclusive, some studies have shown promising results. According to a 2018 study published in the journal Nutrients, the anti-inflammatory compounds in cherries, particularly anthocyanins and other polyphenols, are believed to help reduce inflammation in the body. This, in turn, may help relieve pain and swelling associated with arthritis.

Another 2013 study published in the journal Osteoarthritis and Cartilage found that drinking tart cherry juice twice daily for six weeks reduced symptoms of osteoarthritis, including pain and stiffness. However, it is important to note that these findings are preliminary and more research is needed to fully understand the potential benefits of cherry juice for arthritis. Additionally, cherry juice should not be relied upon as a sole treatment for arthritis, and it is always best to consult with a healthcare professional before starting any new supplements or dietary changes.

Other natural remedies for arthritis symptoms

The 2019 American College of Rheumatology Guidelines recommends weight loss for managing arthritis symptoms. Weight management is important for those with arthritis as extra weight can put added stress on joints and worsen symptoms, says the Arthritis Foundation. According to the Foundation, maintaining a healthy weight can also help reduce pain, bring down inflammation, increase the chance of remission, and improve joint function. It's important to talk to a healthcare professional to determine the best weight management plan, as some types of exercise may not be suitable for those with certain forms of arthritis.

Regular exercise is one of the most effective natural remedies for arthritis. According to Healthline, low-impact activities such as swimming, walking, and tai chi can help improve joint flexibility and strengthen muscles surrounding the joint. Exercise also promotes overall physical and mental health. It can help reduce stress, a common trigger for arthritis pain, according to the Arthritis Foundation.

Eating a diet rich in anti-inflammatory foods can help reduce the symptoms of arthritis. This type of diet for arthritis is typically high in fish, vegetables, and olive oil, per the Arthritis Foundation. Omega-3 fatty acids found in fish oil are particularly beneficial as they have powerful anti-inflammatory properties, per a 2020 study published in the Mediterranean Journal of Rheumatology.

https://www.healthdigest.com/1182224/can-drinking-cherry-juice-improve-your-arthritis-symptoms/


Sunday 29 January 2023

8 Ways to Reduce Your Risk of Psoriatic Arthritis When You Have Psoriasis

From healthline.com

When you’re living with psoriasis, you’re at an increased risk of developing a type of arthritis known as psoriatic arthritis (PsA).

Both psoriasis and PsA are inflammatory conditions caused by an overactive immune response. In psoriasis, this immune response affects your skin. In PsA, it mainly targets your joints.

There’s no proven way to prevent PsA from developing. But you can take some steps to reduce inflammation in your body, manage your symptoms, and improve your overall health.

Psoriasis and PsA are conditions that often occur together. However, not everyone living with psoriasis will develop PsA.

In fact, a 2013 study including 949 people with plaque psoriasis suggests that 30 percentTrusted Source of people with psoriasis will also develop PsA.

For many people, psoriasis is diagnosed first. However, PsA can be diagnosed before psoriasis. The joint condition can even occur in people who don’t have psoriasis.

Both psoriasis and PsA are inflammatory diseases. An atypical immune response causes the signs and symptoms of both conditions.

A standard immune system is designed to protect the body from harmful invaders. In psoriasis and PsA, your immune system activity increases and attacks healthy parts of your body instead.

In psoriasis, this overactive immune response mainly affects the skin, though it can also affect the scalp and nails. In PsA, it mainly targets the joints, though it can also affect the eyes or nails. Over time, unmanaged inflammation in the joints can lead to permanent damage.

Some psoriasis treatments that help lower inflammation can also be used to treat PsA. Early detection and treatment are key to managing symptoms and preserving joint function.

If you’re living with psoriasis, several factors may increase your risk of developing PsA. They include:

  • receiving a PsA diagnosis early on
  • having a more severe case of psoriasis
  • having psoriasis that affects the nails or scalp

Other factors can also increase the risk of PsA, such as:

  • family history of the condition
  • obesity
  • smoking
  • alcohol use

2021 study suggests it is possible to predict the development of PsA in people living with psoriasis. The study screened people who had psoriasis, using ultrasound imaging on specific joints. Based on findings, researchers predicted which individuals would develop PsA, even if they didn’t experience symptoms.

If you’re living with psoriasis, talk with your doctor about regular screening for PsA. Early detection and treatment can help protect your joints. It may be possible to diagnose PsA even before symptoms start to affect your day-to-day life.

There’s no proven way to prevent PsA. But taking certain steps can help lower inflammation in your body. This can have a direct impact on your skin and joints, as well as your overall health.

Start with these tips.

Eat more fruits and vegetables

Following an anti-inflammatory diet may help lower inflammation in your body. One of the most well-researched anti-inflammatory diet plans is the Mediterranean diet. This way of eating emphasizes incorporating a variety of fruits and vegetables into your diet.

Try these strategies to add more fruits and vegetables into your day:

  • Wash and cut up fruits and vegetables ahead of time so they are ready to grab and eat.
  • Add extra vegetables to casseroles, soups, stews, and pasta or rice dishes.
  • Cut up vegetables into small pieces and add to omelettes.
  • Bake a batch of carrot, zucchini, apple, or pumpkin muffins.
  • Use frozen vegetables for a quick addition to your meal.

Add more healthy fats

2021 reviewTrusted Source showed that omega-3 fatty acids in particular can help reduce inflammation in the body. An increased omega-3 intake is one of the benefits of a Mediterranean-style diet. Good sources of omega-3s include:

  • fish and seafood, such as salmon, tuna, and sardines
  • nuts and seeds, such as walnuts, chia seeds, and flaxseeds
  • plant oils, such as flaxseed oil, soybean oil, and canola oil
  • foods fortified with omega-3s, such as eggs, milk, or juice

You can also consider taking an omega-3 supplement. Make sure your supplement contains EPA and DHA. Those are the types of omega-3 that are best for reducing inflammation.

Olives and olive oil also have anti-inflammatory properties. They’re another major part of the Mediterranean diet. If you enjoy olives, simply eat them on their own or add them to pizza, salads, or sandwiches. You can use olive oil for roasting or sautéing, or for making dressings.

Nut butter and avocados are some other sources of healthy fats to incorporate into your diet.

Consider working with a registered dietitian, if you have access to one, to come up with an anti-inflammatory eating plan tailored to your individual needs.

Stay active

According to a 2020 research review, studies suggest that exercise may help reduce inflammatory markers in the body. It’s also a great way to boost mood and reduce stress. Building muscle strength can take some of the pressure off of your joints and keep you limber.

Consider adding low impact exercises into your routine. This includes things like:

  • walking
  • swimming
  • stretching

High impact activities such as running or jumping can put extra stress on your joints.

Consider meeting with a physical therapist if you’re trying to become more active. This type of specialist can work with you to develop an individual exercise plan targeted to your current fitness level and goals.

Avoid physical injury

People living with psoriasis often have flares at the site of a cut or scratch on their skin. This is known as the Koebner or isomorphic phenomenon. A large 2017 study explored whether injuries could increase the risk of PsA.

The study looked at both people living with psoriasis and those without the condition. Researchers found that people with psoriasis who experienced a joint or bone injury were more likely to develop PsA. Nerve and skin injuries were not associated with a greater risk of PsA.

Of course, it’s not always possible to avoid an injury. If you experience any type of injury, follow up with your doctor.

Monitor for nail changes

There’s a strong link between nail changes and the development of PsA. Nail psoriasis is thought to be a more aggressive condition, and people with psoriasis who experience nail changes are more likely to develop PsA than those who don’t.

Up to 80 percentTrusted Source of people living with PsA experience nail changes, also referred to as nail involvement.

Nail involvement is one of the early signs of PsA, so you’ll want to watch for any changes in your nails. One or more nails can be affected. You may notice changes in fingernails or toenails.

Some of the most common nail changes to look out for are:

  • pitting
  • deep grooves
  • thickening
  • pulling away from the nail bed

If you notice changes in your nail health, talk with your doctor.

Manage stress

Living with a chronic condition like psoriasis or PsA can be stressful. Many people who have psoriasis or PsA also find that periods of intense stress can trigger symptoms. Stress can increase inflammation throughout the body and worsen symptoms.

It’s not possible to avoid stress altogether. But it can help to find ways to manage it. Try activities like:

  • practicing mindfulness
  • doing meditation
  • exercising
  • staying social

If you feel you could use more support, consider joining a support group or talking with a therapist.

Take medications as directed

Several medications and treatments are available for managing psoriasis. Options like topical ointments and phototherapy can help affected skin from the outside. Other options work by reducing inflammation inside of the body.

One class of medication that addresses inflammation is known as disease-modifying antirheumatic drugs (DMARDs). They work to suppress the immune response in your body.

Traditional DMARDs work on a broader level to lower immune system activity. Biologic DMARDs work in a more targeted way to address the overactive immune system.

Both options are also used to treat PsA. Reducing inflammation helps preserve joint function and prevent permanent damage.

In order for these medications to work as well as they should, you must take them exactly as prescribed. If you’re unsure whether you’re taking your medications correctly, get in touch with your healthcare team.

If you’re following your treatment plan exactly as directed and still feel that your psoriasis isn’t well managed, talk with your doctor. There may be a better treatment for you.

Keep in touch with your healthcare team

When you’re living with a chronic condition like psoriasis, it’s important to schedule regular checkups. Your healthcare team may include one or more specialists, such as:

  • a primary care doctor, who can monitor your overall health
  • a dermatologist, who specializes in skin conditions like psoriasis
  • a rheumatologist, who treats and monitors inflammatory autoimmune conditions like PsA

Monitor for any changes in your health and let your healthcare team know if anything pops up. It’s best to diagnose and treat PsA or other health concerns early.

Living with psoriasis increases your risk of developing PsA. There’s no guaranteed way to prevent the condition. But taking steps to reduce inflammation in your body can help manage skin symptoms and prevent joint damage.

Be aware of early signs of PsA. Follow up regularly with your healthcare team, so any changes to your health can be diagnosed and treated early.


https://www.healthline.com/health/psoriasis/reduce-psoriatic-arthritis-risk?subid2=30336368.158575&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=psoriasis&utm_content=2023-01-24&apid=39239719&rvid=058431b717dcfa59c0cdd27cd0a9313769e8b3dd4ad59d88efd0ded7ddb4774e  

Thursday 26 January 2023

What is degenerative arthritis?

From semissourian.com

Arthritis is a common issue we see and treat on a daily basis, but it is also misunderstood. When broken down, “arthritis” means “joint” (arth-) “inflammation” (-itis). So, when someone talks about having arthritis, it really means the joint is inflamed. The reason for this inflammation is damage, and the body is flooding the joint with inflammation to try to heal the damage and to irritate the nerves, so you stay off of it while it is trying to heal.

So, how does the damage occur? Most commonly, inflammation in a joint is occurring because the joint isn't working properly. This means there is an imbalance within the joint that is causing it to "track" improperly, which then leads to damage over time. If this continues day after day, week after week and month after month, the body will start to deposit calcium to protect the joint.

This is where the term "degenerative" comes in to play. The joint has been inflamed (damaged) for so long that the body tries to protect the joint by tightening up muscles around the joint and depositing calcium in the bones around the joint, which are called “osteophytes,” or “bone spurs.”


The other problem when a joint isn't functioning properly is it will become dehydrated and lead to tearing of the internal structures like disks, labrum, cartilage or meniscus. This can lead to more complicated issues that require invasive surgery to treat.

So, what is the solution? Creating an environment where the joint can move properly and the muscles are balanced around the joint, so the joint can stay hydrated. Then, we can focus on healing the previous damage, which is why we use regenerative medicine (stem cells) at PC Medical Centres. We have seen clinically that patients who use stem cells improve and heal better than patients who don't.

https://www.semissourian.com/story/2981098.html 

Wednesday 25 January 2023

Arthritis In Winter: 3 Simple Tips To Keep Your Bones And Joints Healthy In Cold Weather

From india.com 

Winters frequently lead to a decrease in our movement, especially as a result of an illness like arthritis

Arthritis in Winter: The chilly cold weather may frequently be brutal on your hair, skin, bones, and other parts of your body if you don’t take the right precautions. Did you know that the body’s circadian rhythm, which is frequently correlated with exposure to sunlight and other factors, changes as the seasons change? The hard winter months are to blame for many people’s joint and bone discomfort and disorders, with stiffness at the root of many issues. Shikha Dwivedi, dietitian and nutritionist at OZiva shares the top three tips to keep your bones and joints healthy during winter.

3 TIPS TO KEEP YOUR BONES AND JOINTS HEALTHY IN WINTER

  1. Exercise And Stretch Daily: Exercising on a regular basis has abundant benefits for the human body, especially when one talks about healthier bones and joints. Not only does working out help in increasing bone density but it also helps prevent osteoporosis, which is a condition where bones become weak and brittle. Another advantage of exercising is that it keeps the soreness or stiffness of the joints in check by ensuring that there is an adequate blood supply to it. Moreover, it also helps in strengthening the muscles as well as maintaining your weight.
  2. Get Your Daily Dose of Vitamin D: The importance of Vitamin D cannot be underestimated when it comes to healthy bones and joints. The best way to get Vitamin D is to get enough exposure to sunlight as sunbathing is one of the best sources to get it. However, one must note that prolonged sun exposure could be bad for your health and this is why 10-20 minutes of sunbathing are enough on a daily basis.
  3. Follow A Healthy Diet: No matter how much exercise you carry out on a daily basis, the fact remains that a healthy diet goes a long way in ensuring a healthy body. Not only does a balanced diet help prevent weight gain, but it also helps get enhanced overall general health. Omega-3 fatty acids and almonds help in reducing the inflammation that causes pain around the joints of your body. Patients can also include dark leafy greens like kale and spinach in their diet.
  4. You can also eat vitamin C-rich foods like oranges, red peppers, and tomatoes because they lessen joint pain and cartilage loss. Additionally, individuals can supplement their diets with plant-based calcium products, many of which have been shown in clinical studies to aid in better calcium absorption than synthetic calcium. This promotes greater bone health while protecting the form and function of the bones.

https://www.india.com/health/arthritis-in-winter-3-simple-tips-to-keep-your-bones-and-joints-healthy-in-cold-weather-5868358/

Tuesday 24 January 2023

10 best foods for healthy joints, and which to avoid

From restless.co.uk

Joint health is something that we tend to think about more with age. Due to various factors, such as loss of bone density, reduced flexibility, and menopause, age can increase our risk of developing joint-related conditions like arthritis.

However, diet can be a powerful way to keep joints healthy and, luckily, plenty of delicious, versatile foods have been noted as particularly beneficial.

With this in mind, here are 10 of the best foods for healthy joints, as well as some to avoid.

1. Tart cherry juice

Tart cherry juice

Tart cherry juice is made from the fruit of the Prunus cerasus tree. Some people describe it as tasting a little like unfiltered red wine, while others say it tastes like cherry pie!

When it comes to joint pain, the use of tart cherry juice for relief dates back nearly a century.

Tart cherries contain anti-inflammatory compounds called anthocyanins, which are responsible for the blue, purple, and red colours of fruits and vegetables. There’s evidence that these compounds can help to combat a number of chronic inflammatory diseases, including arthritis.

For example, this study found that tart cherries helped to reduce joint pain and stiffness, while another study revealed that drinking tart cherry juice for three weeks decreased levels of inflammatory markers in women with osteoarthritis.

Tart cherry juice is available to buy on Amazon*.

Note: Some tart cherry juice contains a lot of added sugar, so for maximum health benefits it’s worth checking the label and choosing no added sugar versions.

2. Fatty fish

Fatty fish

It’s a rarity for fatty fish not to make it onto a list of health-promoting foods – and there’s good reason for this. The omega-3 content of fatty fish such as salmon, sardines, mackerel, and trout is known to have powerful anti-inflammatory effects.

For example, this scientific review found that taking omega-3 supplements reduced joint pain intensity, morning stiffness, the number of painful joints, and the use of pain relievers in patients living with rheumatoid arthritis.

Meanwhile, other research suggests that – like tart cherry juice – omega-3 fatty acids can lower the number of inflammatory markers linked with osteoarthritis.

Don’t worry if you’re not a fan of seafood as it’s easy to up your intake of omega-3 by eating other foods too. This includes nuts like pecans, hazelnuts, and walnuts; seeds such as chia, flax, and pumpkin; and soya products like tofu, tempeh, and soya milk.

Fatty fish are also a rich source of vitamin D which is another important nutrient when it comes to joint health. In fact, various studies have linked rheumatoid arthritis with low levels of vitamin D.

If you’d like to start adding more fatty fish into your diet, you’ll find plenty of recipe inspiration in this collection of oily fish recipes from The Guardian. Or, if you don’t eat fish, you could try one of these 15 delicious vegan recipes that are high in omega-3 from VegFAQs.

3. Ginger

Ginger

Ginger is another food that’s important for healthy joints.

This study, which assessed the impact of ginger extract on people with osteoarthritis of the knee, found that after six weeks, 63% had experienced a reduction in knee pain.

Other research has also revealed that ginger is able to block substances in the body that promote inflammation; while this animal study found that ginger extract reduced levels of a specific inflammatory marker linked with arthritis in rats.

There are various ways to enjoy ginger in your diet; for example, adding it to tea and soups. This list of ginger recipes from BBC Good Food has plenty more ideas.

4. Walnuts

Walnuts

Walnuts are loaded with important nutrients that science suggests may help to reduce inflammation linked with painful joints.

As mentioned above, omega-3 fatty acids have been found to be effective at reducing symptoms of arthritis – which walnuts are particularly rich in.

For example, this scientific review suggests that eating walnuts may lower levels of chronic inflammation in the body.

For ideas on how to add more walnuts to your diet, check out these healthy walnut recipes from Eating Well. You’ll find everything from chicken pasta with parsley and walnut pesto, to baked oats with banana and walnuts.

5. Broccoli

Broccoli

Broccoli is well-known as one of the healthiest foods because of its nutrient-dense content.

Sulforaphane is a compound found in broccoli that, according to research, can block the formation of particular cells involved in the development of rheumatoid arthritis. Experts have noted that sulforaphane may prevent joint pain in the same way arthritic drugs do.

Broccoli is also packed with salicylic acid – the active ingredient in aspirin. Salicylic acid is effective at reducing joint inflammation because it helps to prevent the production of prostaglandin hormones that are responsible for joint tenderness and swelling.

Lastly, broccoli’s rich vitamin C content is important for creating and protecting cartilage. Healthy cartilage is vital because it allows bones to glide over one another smoothly and prevents them rubbing together.

Why not try one of these healthy and delicious broccoli recipes from Self? There’s everything from comforting pastas to hearty soups and warming pies.

6. Garlic

Garlic

Garlic has been celebrated for its health benefits for centuries, and this is no different when it comes to healthy joints.

Garlic has been identified as having anti-inflammatory effects that may improve symptoms of arthritis and even reduce the risk of developing the condition in the first place. For example, this study found that people who ate more garlic had a lower risk of developing hip osteoarthritis.

Some research has suggested that garlic may enhance certain immune cell function and help to strengthen the immune system in general. A healthy immune system is vital for avoiding chronic inflammation, which among other things, can cause joint problems.

The other great thing about garlic is it’s easy to incorporate into your diet and always adds a dose of extra flavour. For ideas on how to get started, check out these healthy garlic recipes from Eating Well, which include everything from garlic butter-roasted salmon to hasselback sweet potatoes with garlic-yoghurt sauce.

7. Grapes

Grapes

Grapes are full of nutrients and antioxidants, which offer a number of anti-inflammatory benefits.

In this study, when men were given concentrated grape powder (the equivalent of 252g of fresh grapes), levels of inflammatory markers in their blood significantly decreased.

Grapes also contain a number of compounds – for example, the antioxidant resveratrol – that’ve been shown to benefit joint health.

Results from this test-tube study, suggested that resveratrol may help to prevent the thickening of joints involved in arthritis.

Proanthocyanidin is another plant compound present in grapes, which may reduce joint inflammation too.

8. Spinach

Spinach

Leafy greens like spinach are full of important nutrients.

A number of studies have suggested that eating more fruit and vegetables can lower levels of inflammation. Spinach in particular, is especially rich in the antioxidant kaempferol, which has been found to reduce the impact of inflammation associated with rheumatoid arthritis.

For example, this test-tube study found that when arthritic cartilage cells were treated with kaempferol, inflammation decreased and the progression of osteoarthritis was prevented.

Spinach also contains vitamins C and E. Vitamin E protects the body against pro-inflammatory molecules, while vitamin C helps the body to make collagen (a major component of cartilage that allows joint flexibility).

For tips on how to add more of this leafy green to your diet, check out these spinach recipes from BBC Good Food. You’ll find everything from creamy mushroom and spinach pasta to spinach pancakes with poached eggs.

9. Olive oil

Olive oil

Olive oil is well known for its anti-inflammatory properties, which can positively impact joint health.

For example, in this study, feeding mice extra-virgin olive oil for six weeks helped to reduce joint swelling and inflammation, and slowed cartilage degeneration. All together, these effects helped to prevent the development of arthritis.

Another study found that when people with rheumatoid arthritis took one olive oil capsule every day for 24 weeks, their levels of a specific inflammatory marker decreased by 38.5%. Plenty of other research has also linked olive oil consumption with a lower risk of rheumatoid arthritis.

For inspiration on how to use olive oil in your diet, check out these healthy olive oil recipes from La Tourangelle.

10. Berries

Berries

The antioxidants, vitamins, and minerals present in berries are largely responsible for their unique ability to fight inflammation.

For example, this study found that eating at least two servings of strawberries each week led to a 14% reduction of inflammatory markers in the blood.

However, berries are also rich in plant compounds rutin and quercetin, which offer huge health benefits. In this test-tube study, quercetin blocked inflammatory processes that can lead to arthritis; and in a different study, when rats were given rutin and quercetin supplements, arthritis inflammation decreased.

Like tart cherries, blueberries also contain anthocyanin – identifying them as having potential to ease joint pain and stiffness.

Berries can be enjoyed as a delicious snack, as a sweet breakfast or dessert topping, in smoothies, or over yoghurt. For more ways to use them, check out these amazing and healthy berry recipes from Simply Quinoa.

Are any foods bad for joint health?

In the same way that some foods support and promote joint health, research has revealed that others can have a negative impact.

For example…

Processed and red meat

Some studies have suggested that eating too much processed and red meat could be a risk factor for developing inflammatory arthritis. This is mostly because they contain high levels of inflammatory markers, like C-reactive protein and homocysteine, which can inflame joints and cause pain and stiffness.

Plant-based diets that exclude red meat, on the other hand, have been found to improve arthritis symptoms.

Gluten-rich foods

Gluten is a group of proteins found in wheat, rye, barley, and triticale. Some research has linked it with increased inflammation in the body, and suggested that going gluten-free may help to ease joint pain and stiffness.

Added sugars

This study of people with rheumatoid arthritis found that among 20 different foods, sugar-sweetened drinks and desserts were those most frequently reported as worsening joint-related issues, like pain and stiffness.

In addition, other research has suggested that drinking fructose-sweetened drinks five times per week or more can make you three times more likely to develop arthritis than those who consume little or no fructose-sweetened drinks.

Some vegetable oils

Vegetable oils contain omega-6 fatty acids. Research has found consuming too much and having an imbalance of omega-6 fatty and omega-3 in the body can cause inflammation and increase the risk of conditions like arthritis.

High-salt foods

Studies suggest that eating too much salt – which is particularly high in foods like pizza, crisps, and ready meals – may be a risk factor for developing autoimmune diseases like inflammatory arthritis.

This study revealed that mice on a low-salt diet experienced less cartilage breakdown and bone destruction, and fewer inflammatory markers than mice on a high-salt diet.

Alcohol

Alcohol is known to have a negative impact on joint health. This study linked alcohol intake with increased damage to spinal joint structure; and other studies have also noted it as a risk factor for osteoarthritis.