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In this study, middle-aged men showed a significant reduction of testosterone levels during and after vigorous exercise. Using this supplement to improve their testosterone levels can be an option in men with very low DHEA levels. If your adrenal cortex is not working as it should, it won’t produce enough hormones. This fat burning HIIT cardio workout will leave you swimming in a pool of sweat (or at least that’s what it did to Coach). When you don’t have much time to spare but want to squeeze in a workout, a 10-minute HIIT session can rev up your metabolism and burn calories. If you are not improving weekly or your other workouts suffer, scale back a bit on your HIIT workouts to burn fat until your body adjusts. However, HIIT with bodyweight exercises can be just as effective if you cannot get to a gym for your workout. You can perform anywhere from a 10 minute fat burning HIIT workout to a 30 minute fat burning HIIT workout. Q:The Hidden Costs of PhD Weight Loss: A Comprehensive GuideA:The go-to dish you remember from your years as a student, now a little tastier and a lot more vegan! Our delicious vegan take on the trendiest cafe food of the moment, Mushrooms on Toast. The photos and recipe titles all link back to their original creator, so please give them full acknowledgement for their hard efforts! You can find the owner of each recipe under each photo. This eliminates any paywalls that pop up in the Free version of the app, yet also gives you a 7-day free trial to test run the app. The Shred app is available at multiple monthly costs, but we recommend opting for the annual subscription that totals $119.99, or $9.99 monthly. From there, the app delivers a well-rounded regimen based on your responses. Our Expert Network is comprised of trainers, researchers, athletes, and medical professionals who help us review our content for accuracy and quality. Replacing bread with pan-roasted crispy tofu to make it healthier. For this Peanut Butter Tofu with Sriracha, strips of firm tofu are fried and served with a peanut-butter sauce, where the nut butters boost protein intake. Stir fried veggies and tofu are tossed in a sweet and spicy sauce for a delicious meal that only takes 25 minutes to make! It packs high amounts of almost everything – fibre, protein, vitamins A and C, potassium, iron, calcium – a good choice all round and a true nutrition bomb. In addition, it alleviates upset stomachs and boosts digestion. One of the primary causes of weight gain is irregular waste disposal from our bodies, which can be caused by indigestion or an upset stomach. So, let us look at how curd can help you lose weight. As a result, it provides numerous health advantages. 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Understanding individual differences is crucial in using these charts effectively to promote healthy weight management and prevent potential health risks. Begin by introducing the chart to your patient and explaining the importance of maintaining a healthy weight range based on height and gender. Find out your client's ideal body weight range and improve their health. Teach clients the importance of staying hydrated, as it supports overall health and weight loss. We respect your privacy, so we don’t mention SlimJaro or the product details anywhere except on the delivered package. Everyone’s body is different, so some people may take a bit longer to see results. Order now and start your journey to a healthier, lighter you! We spent years perfecting the Keto Plus formula and confidently stand by its benefits. With its vegan-friendly, 100% natural formula, Keto Plus offers a safe, effective, and sustainable approach to weight management. 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Increased oxidative stress can also deplete levels of glutathione, an important antioxidant. One study that looked at the pathogenesis and progression of Hashimoto’s found that oxidative stress could be a risk factor in the development of overt hypothyroidism in Hashimoto’s. Here are simple things you can do every day that can help you achieve sustainable weight management because we don’t want to lose weight only to gain it back the next day. Weight management is a lifestyle that incorporates the principles of healthy eating and active living. Please remember that for your weight loss to be sustainable and long term, you have to stay dedicated to a weight loss plan for some time. To lose weight, more calories have to be spent than the calories consumed. Always consult a licensed healthcare professional before starting, stopping, or changing any medication or exercise program. Researchers stress that these findings do not mean weight loss drugs are useless. About half of people prescribed GLP-1 drugs stop taking them within a year, often due to side effects, cost, or access issues. Also read | Diabetes drug Ozempic is good not just for weight loss, study claims it even protects brain Effects of dietary intake on cardiovascular risk factors during 12-week intervention of completer participants. Stronger weight loss with LC diet than CR diet despite higher calorie intake with LC is surprising and requires follow-up in controlled biomarker studies. Thirdly, physical activity was not strictly controlled in this study because we aimed to examine the isolated effect of low-carbohydrate and calorie-restricted diets on weight loss. When it comes to a keto diet, meat is often the star of the show. Cinnamon, for example, contains just about 0.7g net carbs per teaspoon. In terms of spices, turmeric, cayenne pepper or cinnamon can also be incorporated into a ketogenic lifestyle with minimal impact on carbohydrate consumption. The combination of exogenous ketones, MCT oil, and other key nutrients in this supplement works to optimize metabolic function and support long-term health and well-being.One of the standout benefits of Nucentix Keto GMY is its ability to boost energy levels and improve mental focus. By providing the body with exogenous ketones, MCT oil, and other key nutrients, this supplement helps to boost energy levels, reduce cravings, and support overall well-being.One of the key benefits of Nucentix Keto GMY is its ability to help the body produce more ketones, which are essential for fueling the body in the absence of carbohydrates. Ketosis is a metabolic state where the body burns fat for energy instead of carbohydrates, leading to weight loss and improved overall health. Generally, it is recommended to take 2-4 gummies per day to support the effects of a ketogenic diet. Additionally, they can assist you in seamlessly incorporating keto gummies into your overall diet and weight loss plan. Incorporating keto gummies into your diet can be a tasty and effective way to reap the benefits of Keto Gummies while staying in ketosis. Keto gummies offer several benefits for those following a ketogenic diet. The combination of apple cider vinegar and BHB allows the body to enter and maintain a state of ketosis, maximizing fat burning and weight loss potential. The effectiveness of Ketolicious Keto + ACV Gummies in promoting weight loss and overall health can be attributed to their carefully selected ingredients and their alignment with ketogenic principles. Users can easily integrate the benefits of a ketogenic diet and apple cider vinegar into their lives without the hassle by simply taking a few gummies throughout the day. By entering a state of ketosis, individuals may experience a reduction in body fat and an increase in energy levels. Additionally, the effectiveness of these ingredients in achieving weight management goals or supporting ketosis may vary based on personal factors, including diet consistency and overall lifestyle. Similarly, the gummies are said to include nutrients that align with the ketogenic diet, which could assist individuals already following a strict low-carb, high-fat nutritional plan. These gummies are marketed as a potential aid in achieving ketosis—the metabolic state where the body burns fat for energy instead of carbohydrates. These gummies typically aim to assist the body in achieving and maintaining ketosis, a metabolic state in which the body shifts from using carbohydrates to fats as the primary energy source. Apple cider vinegar gummies may support weight loss when combined with a healthy diet and exercise routine. These gummies are keto-friendly and help boost metabolism and energy levels, making it easier to achieve your weight loss goals. These gummies are keto-friendly and help promote fat burning and weight loss, while boosting energy. Infused with pure apple cider vinegar and other potent ingredients, these gummies help boost energy levels and improve digestion while following a keto diet. It is important to choose gummies with minimal or no added sugars in order to align with the principles of the ketogenic diet. This study was funded by the Humanetics Corporation, a manufacturer of 7-keto.1 The testosterone levels increased by 15% and the estradiol levels decreased by 25% although for some reason this was considered insignificant. It is hypothesized that 7-keto may benefit the body in the same ways that DHEA does. Aids in weight reduction by increasing fat burning Supports thyroid function Enhances memory Improves immune system function By 21, Mize weighed 260 pounds, and her doctor suggested gastric bypass surgery, which would reduce the size of her stomach, making it easier to practice portion control. I’ve not only gained more confidence, but I feel healthier than ever. But when she switched to a low-carb diet, which allowed her to have more carbs on days when she worked out, it was a whole different story. So, rather than going on some of the fad diets that he had experimented with in the past, Upshaw began doing more math and started meticulously counting calories. At 6’7″ and 400 pounds, DeAndré Upshaw was a big presence in any room he walked into. Staying motivated is easier when you make cardio something you actually look forward to. Text a friend your workout plan for the week, or invite someone to join you for a virtual workout session. Set small goals, like finishing an extra round or shaving a few seconds off your time. (If you ever dance between moves, no one’s judging. That counts as cardio too!) Ree Drummond CBD Gummies Reviews 2026 For example, yoga enhances flexibility and reduces stress, which is vital for sustainable weight loss. I was being shamed for gaining weight because of my lupus.” Selena revealed in 2015 that she had been diagnosed with lupus, an autoimmune disease in which the body attacks its own tissues. Ozempic is a drug used to treat type 2 diabetes but has gained popularity for its off-label use as a weight loss aid. Selena has always been candid about her struggles with her health, particularly her battle with lupus – a chronic autoimmune disease that causes inflammation, pain, and fatigue. Selena made the decision to take her health into her own hands, not because of public scrutiny or body-shaming comments, but because of a deep desire to feel better. Regular exercise is vital for good health, with or without GLP-1s. If you lose over three pounds per week (considered rapid weight loss), you may be at risk of developing gallstones. But it becomes even more important with Semaglutide or Tirzepatide, as staying hydrated can stave off nausea that some people experience on this medication. For further detailed information on how we may help customize a weight loss solution that is right for you at LaserSkin MedSpa, please visit our website at LaserSkin MedSpa. I was able to lose up to 18% body fat by just taking 2 gummies daily with my regular diet & workout routine. Supra Keto BHB + ACV Gummies are formulated with a potent blend of natural compounds designed to accelerate fat burning and support ketosis. When consumed, BHB helps elevate blood ketone levels, allowing your body to enter ketosis more quickly and efficiently. BHB is an exogenous ketone that mimics the ketones your body naturally produces during ketosis. It helps with weight loss by increasing fat burning and improving overall metabolic health. "I have nothing to do with weight loss gummies or diet pills, and I don’t want you all taken advantage of by people misusing my name. So please know I have no weight loss gummies," she stressed. Because gummies contain minerals and stimulants, combining them with similar supplements may increase the risk of adverse effects. Do keto gummies cause ketosis on their own? The strongest data support that exogenous ketones can temporarily elevate blood BHB, but the magnitude is insufficient to replicate the metabolic state achieved by strict ketogenic eating. While gummies may offer a quick fix, they lack the real, long-term benefits of a balanced keto diet. For the price of keto gummies, you’re better off investing in whole foods that align with the keto diet principles and deliver real results. Pregnant women or those with medical conditions should avoid keto gummies due to their unknown effects and lack of substantial research. At the last moment of disappearing, Zog sighed, as if he felt sorry for the killings and mistakes he made after being transformed by the destroyed body.The Milky Way came after Lukiel, and what he was afraid of was that Lukiel chose to make a move to freeze the time of the savior of the star, which would be troublesome. After the names were exchanged like Solitaire, Fengyuan immediately said I heard that you were injured, how is the injury I have exerted my strength.Does Nexus from other universes have the same power as the father of Ultra With this in mind, powerful darkness was bred in the palms of the emperor s hands, and the dark flame wave was about to strike Nexus palm. So one day, after Yuanquan came back from shopping outside, what he saw was all the alli diet pills directions guys sitting on the table, smiling and looking at him with embarrassed expressions.There is no need to say anything between us. 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Studies have shown only a moderate weight loss effect, however. If you have a weakened immune system, there is a greater risk of negative side effects from probiotics, so you should talk to your health care provider before taking them. Keto road trip snacks #14: Olives Maximum doses (semaglutide 2.4mg, tirzepatide 15mg) should be maintained, not exceeded. Your treatment plan includes 12 months of personal coaching to help you transition off the medication with confidence. Appetite changes often begin within the first few weeks, and early weight loss is commonly seen between weeks 4 and 8. Studies of tirzepatide and other weight loss medicines show a tendency for weight to return when treatment is withdrawn, highlighting the need for long term strategies. The medicine tends to become more effective for weight loss as doses increase and as consistent habits build around food, activity and sleep. 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Packed with protein and veggies, tons of flavor, and the perfect amount of spice, it makes a tasty and healthy dinner for busy nights or meal prep. Scientific research tells us that adding in food items like eggs and bacon for breakfast and savoring small portions throughout the day will prevent any feelings of bloating. By including these foods in your meals, you can enjoy a balanced diet that promotes muscle growth, aids in weight management, and enhances overall well-being. Tofu can be marinated and grilled, added to stir-fries, blended into smoothies, or even used in desserts. Tofu is a versatile plant-based protein that is especially popular in vegetarian and vegan diets. Doctor says 'calorie mistake' is stopping you from losing weight Each serving of TestoPrime consists of 4 capsules, which can feel like a lot if you’re taking other supplements. (8)(30) Plus, our testers love that this product is third-party tested and free of artificial, unwanted ingredients. There’s also 15mg of zinc, which have been shown to increase testosterone and play a role in bone strength. Hence, a body recomposition approach is in contrast to the traditional "bulking and cutting" cycles that many bodybuilders follow. In other words, you can't be in a calorie deficit and a calorie surplus simultaneously. If you want rock-hard abs, you need to be lean — plain and simple. Neither Autumn Elle Nutrition nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All readers/viewers of this content are advised to consult their doctors, nutritionists and/or qualified health professionals regarding specific health questions. Priced at just $229.99, it remains the least expensive system on this list while still including everything you need to mash and boil in a single vessel. 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These are the exercise guidelines for most healthy adults from the U.S. If an online doctor promises that you’ll lose much more than this, especially without a balanced diet and exercise, it’s a warning sign. Effective weight loss takes time, and any doctor who claims you can lose a large amount of weight quickly may be misleading you. Another red flag is when an online doctor promises fast or dramatic weight loss results. Adults also need at least two days of muscle-strengthening activity each week. Doing aerobic exercise regularly can help you live a longer, healthier life by improving both your physical and mental health. Aerobic physical activity makes you breathe faster and your heart beat quicker. The U.S. Centers for Disease Control and Prevention (CDC) recommends aerobic exercise as a crucial component of a healthy lifestyle. Translated, that means the person is consuming 35 milliliters of oxygen for every kilogram of body weight per minute. Optimal Keto ACV Gummies: Reviews, Benefits, and Where to Buy As a result, products don’t need to be built in advance or materials stockpiled. This may require breaking down silo thinking and making the effort to become cross-functional across all departments, which can be one of the greatest challenges for lean programs to overcome. The Lean Enterprise Institute (LEI), founded by James P. Womack and Daniel T. Jones in 1997, is considered the go-to resource for lean wisdom, training, and seminars. It can improve how a team works together, manages inventory, and even interacts with clients. Green tea extract, present in Ketovex BHB Gummies for its metabolic benefits, has a substantial body of scientific evidence supporting its use. Studies have demonstrated that MCTs can enhance ketone production and promote a faster transition into ketosis. This is particularly valuable for individuals who find it challenging to adhere to a strict ketogenic diet, such as those tempted during the winter holidays. Numerous studies have explored the effects of exogenous BHB supplementation on achieving and maintaining a state of ketosis. This can lead to increased fat loss and may even help with muscle preservation. CJC-1295 and Ipamorelin, for example, boost the release of growth hormones in the body. These peptides have shown promising results in clinical studies, helping people lose fat, control their appetite, and even manage cravings. Some may want to lose fat while maintaining muscle, while others are looking to speed up metabolism or reduce appetite. At 307 pounds, Jones decided it was time to take her health seriously. Rhimes lost between 100 and 150 pounds a few years back and shared a candid, vulnerable account of the process. Simpson has gone through a dramatic weight loss over the years and has been consistently open about her health struggles. Recipe for ginger lemon water for weight loss Garcinia cambogia, a key component, is known for its hydroxycitric acid (HCA) content which may help inhibit fat synthesis and control appetite. Always consult with a healthcare provider before making any decisions regarding your health. It provides a sustainable and safe path towards weight balance with regular use and a proper diet. In this article, we discuss 8 root causes for not losing weight on intermittent fasting and what you can do to overcome them. If you’re not losing weight with intermittent fasting or if your weight has plateaued, there can be many underlying reasons. Reema works closely with clients to make sustainable and realistic changes to their health and wellbeing, whilst coaching them through difficulties and barriers. In addition to the above tips, there are additional areas to look at, to help support you on your weight loss journey. Another reason why the scales may not be changing is that we may retain water weight, when working on weight loss. Q:Extreme Weight Loss: Risks, Methods, and Safer AlternativesA:Interested in trying more high-intensity interval workouts? In additional to burning calories, researchers have found that Tabata can also improve endurance and aerobic capacity. But you don’t have to be an ice skater to reap the benefits of this high-intensity interval training, or HIIT workout. Details on Andy Cohen's weight loss journey We do want to note that it does have trace amounts of rice flour in the capsule but not enough to affect ketosis. CHECK PRICETransparent Labs makes some of the best supplements you can find on the market right now. And it’s not just keto-friendly; it’s also non-GMO, gluten-free, dairy-free, and whole30 compliant. Enter KetoCharge, a great supplement to help keep your appetite regulated throughout your keto experience. The 10 Worst Drinks for Weight Loss, According to Dietitians Slimlife Keto Gummies contain ingredients such as MCT oil and exogenous ketones that can enhance the fat-burning potential of the body during Ketosis. Overconsuming keto gummies can pose potential risks of overconsumption to your health. From potential health risks to unexpected side effects, this section will shed light on what can happen when you exceed the recommended number of keto gummies per day. You ought to follow a keto diet for a very long time and consume one to two Genxz Keto Gummies regularly. Processing is the essential thing that these supernatural occurrence chewy candies partners up with, to revise pressure/apprehension, and overweight issues. This imaginative mix will help you with seeing the keto diet’s benefits sooner than you expected. You can try the product and get the same results as the millions of happy customers who have left no negative GenXZ Keto Gummies reviews. The GenXZ Keto Gummies supplement’s maker has created the product inexpensive, with special purchasing discounts and offers. Make sure that you chew your food well. At times, undigested food is a sign of poor chewing and fast eating. Sometimes, you may see undigested food fragments in stool. Find possible causes of diarrhea based on specific factors. You might start by seeing a member of your primary healthcare team. Plus, it's all too easy to fall into the trap of comparing your weight-loss journey to someone else's highlight reel-especially when those posts often showcase extreme cases of weight loss. That's why we're not the biggest fans of Zepbound before / after weight loss pics. When it comes to before and after weight loss pictures, take them with a grain of salt. She has been open about her fluctuating weight, sometimes being more fit and other times preferring to enjoy life without strict fitness regimens (Women’s Health Magazine). Gundry’s book suggests that eliminating lectins can reverse these health complications. Clarkson attributed this transformation to the “Plant Paradox” diet, a plan that focuses on eliminating lectins from the diet. This diet focuses on cutting out foods that contain lectins, like wheat, beans, potatoes, nuts, and dairy (Yahoo Entertainment). One study by Steinglass et al. used the benzodiazepine alprazolam, in a double-blind placebo controlled crossover design in 20 individuals with either restricting or binge eating/purging type anorexia nervosa. Learn one of the essential steps and outwit the keto flu with this homemade electrolyte drink. I've been browsing online more than 3 hours today, but I by no means discovered any fascinating article like yours. Exercise training decreases abdominal fat, in which high-intensity exercise produces more prominent fat loss than low and moderate intensity exercise (Vissers et al., 2013; Viana et al., 2019). Are Keto Pills Safe For Heart Patients? Juicing is a popular way to lose weight worldwide3. BDO understands that the uniqueness of Black culture - our heritage and our traditions - plays a role in our health. BDO is the world’s largest and most comprehensive online health resource specifically targeted to African Americans. This warm and comforting infusion can be enjoyed throughout the day to potentially support your metabolic rate. Infused water offers a naturally sweet and refreshing way to stay hydrated while potentially boosting your libido. So let’s dig in and help you gain an understanding of how to understand macros for fat loss and muscle gain for females. We need to understand calories, macros (macronutrients), and how each of the 3 macro groups play a role in our body composition. It all starts with a basic understanding of weight loss, which is having a higher daily energy output then energy input. Learn how to use macros to lose fat, gain muscle, and achieve body recomposition with practical tips, realistic timelines, and expert advice tailored for women. Counting macros is a straightforward way to target any fitness goal, whether that be losing weight, building muscle, or maintaining a healthy lifestyle. 7 Proven Ways to Lose Weight Naturally in Just One Week! They can work with you to create a personalized meal plan that complements the medication. They'll look at things like your Body Mass Index (BMI), any existing health issues, and how long you've been trying to lose weight through other means. This shows your provider and the insurance company that you're serious about managing your weight in a sustainable way. Once you've got your policy, make a list of the medications you're interested in. It really comes down to understanding the specifics of your plan and making sure you meet all the requirements. Can you really lose weight during the holidays? The ‘secret’ isn’t in a bottle or a gummy; it’s in the small, consistent choices you make every day. Save your money for things that are proven to support your well-being. When you consider the lack of proven benefits, this money is almost certainly better spent on nutrient-dense whole foods like vegetables, fruits, and lean proteins. While eating an ACV gummy is unlikely to cause serious harm for most people, they aren’t entirely without risks or downsides. To efficiently target the main muscle groups in just half an hour, you can follow a circuit of light weights and high repetitions. This makes it an excellent choice for those who have limited time due to their busy schedules (2). Avoid doing HIIT every day to prevent injury or burnout. Cool down with a walk and gentle stretches for the legs, core, and upper body. Green Juice Recipe for Weight Loss Calories measure the energy you get from food and drinks. Track and plan your daily calorie consumption Tracking calories burned is as important as counting calories consumed. While food should be your primary nutrition source, certain supplements can support optimal results. Commit to at least 6 to 12 months of consistent effort before evaluating the medication’s effectiveness for you. Calorie needs decrease, exercise might need modification, and strategies require adjustment. That’s fine if that’s your plan, but problematic if you think you’re averaging 1,300 daily. It works by mimicking an intestinal hormone that signals feelings of fullness to your brain, helping curb your appetite and lower calorie intake. You’ve probably heard about Semaglutide, it’s an FDA-approved drug used primarily to treat type 2 diabetes. Remember though – while promising as it sounds there isn’t a ‘magic bullet’ when it comes to losing weight! These molecules are naturally occurring in our bodies and play critical roles in various physiological functions, including digestion, inflammation control, and hormone regulation. But don’t forget everyone is unique so always consult with a healthcare provider before starting any new regimen or treatment plan! I’ve tried a lot of products that claim to make guys better. Results DisclaimerThe above collection of results was obtained from various sources, including the products main website. We may receive a commission from products we endorse, in the form of affiliate sales. We are not affiliated with any of these products, except for products that we endorse. I don’t know where that came from,” she told Extra in a recent interview. In fact, the former reality star denied having used it after welcoming son Sidney in 2022. In an Instagram video posted in March 2025, the actor and comedian shared she was perimenopausal and had been taking estrogen, progesterone, and Mounjaro. Northern Nevada, Ready to Reclaim Your Health? Your Reno Weight Loss Journey Starts Now. The Prospective Longitudinal Cohort Case Study Results show an average weight loss of 26.2 lbs. Increase calories slowly, keep tracking, and adjust as your body stabilizes. Cutting back (or switching to low-cal options) is a big weight loss win. Many successful dieters repeat go-to meals so they can easily estimate calories and reduce decision fatigue. “Cutting out liquid calories was 400 fewer calories a day without even trying.” Setting Unrealistic Weight Loss Goals Moreover, incorporating these gummies into your daily routine can provide a psychological boost. By prioritizing quality, effectiveness, and customer satisfaction, the brand behind Activ Boost Max + Keto ACV Gummies has established itself as a trusted player in the dietary supplement market. Furthermore, the manufacturer emphasizes customer education, providing resources and support to help individuals achieve their health and wellness goals. Each product undergoes rigorous testing to ensure purity and potency, providing customers with confidence in their health choices. Activ Boost Max + Keto ACV Gummies are manufactured by a reputable company dedicated to producing high-quality dietary supplements. One 2018 review of 15 well-designed trials found that probiotics, either in foods or in supplements, helped overweight and obese people reduce their body weight and body fat. One meta-analysis of 59 randomized controlled trials found that green tea extract was effective for reducing body mass, body fat percentage, and BMI. A meta-analysis which analyzed six clinical trials concluded that pyruvate is effective in reducing body weight, and that adverse effects include gas, bloating and diarrhea . In a double-blind placebo-controlled study, Schteingart administered a 1200 kcal diet and 75 mg/day PPA to 101 overweight subjects for 6 to 20 weeks and reported greater weight loss (2.59 kg) in the PPA-supplemented group than in the placebo group, without untoward side effects . Customer testimonials frequently highlight improved digestion and reduced bloating as notable benefits experienced alongside their weight loss. Sitting on the back of the shield dragon, she was still thinking about the task that her husband introduced her to. NOA is characterized by severely impaired or nonexistent spermatogenesis . Customs inspections for international orders add extra time when crossing borders and are subject to regulations on hemp-derived products like CBD gummies. Most of the meals on this list are meal-prep friendly, but you might find that the weight loss recipes below hold better for longer. 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