Muchidimbu
Metastatic kenza yemazamu igomarara repamberi rakapararira kune mamwe mativi emuviri kupfuura mhasuru yemazamu, uye rine fungidziro yakaipa kwazvo. Kurapa kwemastastatic zamu rakaipisisa neoplasm iri kuenda kune yakasarudzika zvichienderana nekenza maitiro. Chikafu chakafanana chakasarudzika (chikafu uye chinowedzerwa) kurudziro inoenderana nekenza maitiro uye kurapwa kuri kushomeka uye kuri kudiwa zvakanyanya kugadzirisa kusagadzikana kwekubudirira uye hupenyu hweanorwara nekenza. Iri blog rinoratidzira izvo zvinodiwa, maburi uye mienzaniso yeakazvimiririra chikafu / chikafu (chikafu uye chinowedzeredza) che metastatic kenza yemazamu.
Gomarara repazamu Basics
Gomarara repazamu ndiyo inonyanya kubatwa kenza uye chimwe chezvikonzero zvinotungamira zvekufa zvine chekuita nekenza mune vakadzi pasi rose. Imwe yedzinonyanya kujairika kenza yemazamu ndeyepabonde mahormone anoenderana, estrogen (ER) uye progesterone (PR) receptor yakanaka uye yevanhu epidermal yekukura factor 2 (ERBB2, inonziwo HER2) isina - (ER + / PR + / HER2- subtype). Iyo hormone yakanaka subtype yekenza yemazamu ine fungidziro yakanaka ine yakanyanya kwazvo makore mashanu ekupona mwero we5-94% (Waks uye Winer, JAMA, 2019) Mamwe marudzi emazamu kenza ndiwo mahormone receptor negative, HER2 positive subtype uye katatu gomarara rezamu repazamu (TNBC) subtype inoti ER, PR uye HER2 isina kunaka. Iyo TNBC subtype ine yakaipisisa prognosis uye mukana wepamusoro wekufambira mberi kusvika kudanho rekupedzisira chirwere chave metastasized uye kupararira kune dzimwe nhengo dzemuviri.
Metastatic Breast Cancer ndiyo yakanyanya kumberi, giraji IV gomarara rakapararira kune dzimwe nhengo dzemuviri (kazhinji mapfupa, mapapu, chiropa kana huropi). Kune chete 6% yevakadzi vanoonekwa kuti vane metastatic zamu yakaipa malignant neoplasm pakutanga kuongororwa. Mazhinji mamwe makesi eanopwanya kana metastatic zamu rakaipa neoplasm ndipo kenza yadzokerazve mumurwere mushure mekupedza kurapwa kwekutanga uye kuve mukuregererwa kwemakore mazhinji. Metastatic kenza yemazamu, inonyanya kuwanda mumadzimai asi zvakare inowanikwa mune diki muzana yevarume, ine fungidziro yakaipa kwazvo ine makore mashanu ekupona iri pasi pe5% maererano nedata kubva kuAmerican Cancer Society Kuburitswa (Cancer Chokwadi uye Zvimiro, 30 ). Iyo yepakati median kurarama kwe metastatic TNBC inongova gore rimwe chete kana ichienzaniswa nemakore mashanu kune mamwe maviri madiki. (Waks AG uye Winer EP, JAMA 2019)
Kurapa Sarudzo dzeMastastatic Breast Cancer
Metastatic kenza yemazamu inorapwa nemhando dzakasiyana dzakasiyana dzerapi dzinosanganisira dzakasiyana makemikari emakemikari, immunotherapy, yakanangwa kurapa, hormonal therapy uye radiation therapy sarudzo, kuburikidza neyeyedzo uye yekukanganisa maitiro, sezvo pasina yakatsanangurwa kurapwa kweiyi kenza. Sarudzo yekurapa inoenderana nemamorekuru maitiro eakange apfuura maseru ekenza yemazamu, akapfuura marapirwo ekenza yemazamu, chinzvimbo chekiriniki chemurwere uye uko kenza yapararira.
Kana kenza yemazamu yakapararira kumapfupa, saka pamwe neiyo endocrine kurapa, chemotherapy kana yakanangwa kurapwa, murwere anorapwawo nemapfupa ekushandura vamiririri senge bisphosphonates. Idzi dzinobatsira nekutarisira kwakapora asi hadzina kuratidza kuvandudza kupona kwese.
Kana kenza yemazamu ine kenza yemazamu yakwira kuenda kune metastatic nhanho IV chirwere, varwere vanorapwa neyakawedzera endocrine kurapa nevamiririri vanoteedzera kana kutadzisa estrogen receptors, kana kudzivirira kugadzirwa kweestrogen mumuviri. Iyo endocrine kurapa, kana isingashande, inoshandiswa mukubatana nemamwe makemikari madhiragi kana mishonga yakanangwa senge sero kutenderera kinase inhibitors kana zvinodhaka zvinonongedza zvakanangana zvemukati zvinoratidzira hotspots, zvichibva pamamorekuru uye genomic maitiro ekenza.
Yehormone isina kunaka, HER2 yakanaka, kenza yemazamu yemastastatic, yakakosha nzira yekurapa ndiyo HER2 yakanangana nemishonga inorwisa mabhakitiriya kana madiki mamorekuru inhibitors. Izvi zvinosanganiswa nemamwe mishonga yemakemikari.
Nekudaro, kune TNBC metastatic cancer ine fungidziro yakaipisisa, hapana sarudzo dzakatsanangurwa dzekurapa. Izvo zvinoenderana nekuvapo kweimwe kiyi shanduko mune ino subtype yekenza. Mukana we BRCA mutant cancer, anorapwa ne poly-ADP ribose (PARP) inhibitors. Kana kenza idzi dzichitaura nezvekudzivirira masoja, dzinogona kurapwa nemishonga yemununotherapy senge immune checkpoint inhibitors. Zvimwezve, varwere ava vanorapwa vane hukasha chemotherapy sarudzo senge platinamu zvinodhaka (Cisplatin, Carboplatin), adriamycin (Doxorubicin), taxol zvinodhaka (Paclitaxel), topoisomerase inhibitors (Irinotecan, Etoposide) uye akasiyana akasiyana mvumo uye mubatanidzwa weizvi, kudzora kupararira kwechirwere. Musanganiswa wemakemikari anoshandiswa pakurapa kenza yemazamu yemastastatic asi iine huturu hwakanyanya uye hunokanganisa hunhu pahupenyu hwevarwere.
Chinodiwa cheMunhu Akasarudzika Nutrition Kurudziro yeCancer Varwere
Kenza kuongororwa mukati mawo pachayo chiitiko chinoshandura hupenyu chinosangana nekushushikana kwerwendo rwekurapa rwuri kuuya uye kutya kwekusava nechokwadi kwemhedzisiro. Mushure mekuonekwa kuti vane gomarara, varwere vanokurudzirwa kuti vachinje mararamiro avo avanofunga kuti achavandudza hutano hwavo, nekudzora njodzi yekudzokazve, uye kudzikisa mhedzisiro-yemhedzisiro yavo chemotherapy kurapwa. Kazhinji, ivo vanotanga kushandisa zvekudya zvinowedzera zvisina kujairika, pamwe chete nemakemikari avo ekurapa, kubatsira kubatsira kudzikisira zvakanyanya mhedzisiro-mhedzisiro uye kuvandudza hutano hwavo hwese uye kugara zvakanaka. Kune mitsara ye67-87% yevarwere vegomarara vanoshandisa zvekudya zvinowedzera mushure mekuongororwa. (Velicer CM et al, J Clin. Oncol., 2008)
Nekudaro, zvinovaka muviri uye zvekudya zvinokurudzirwa nevarwere vegomarara nhasi hazvina kusarudzika. Kunyangwe paine kufambira mberi kwemagenomics, metabolomics, proteomics izvo zvakavandudza kunzwisisa kwedu kwehunhu hwegomarara uye nekugonesa nzira dzechokwadi dzekurapa, nhungamiro yezvekudya kana paine yakajairika. Iwo hutungamiriri hwehungwaru hauna kubva pane yakasarudzika kenza mhando uye magene maitiro ekenza, kana mhando yekurapwa kuri kupihwa kumurwere. Iyo general mirayiridzo yezvekudya / chikafu sezvakakurudzirwa neAmerican Cancer Society inosanganisira:
- Kuchengeta huremu hune hutano;
- Kugamuchira mararamiro anoshanda mumuviri;
- Kudya chikafu chine hutano nekusimbisa pazvinomera zvemiti; uye
- Kukanganisa kunwa doro.
Masarudzo ekurapa kenza dzakasiyana anoratidza humbowo uye anokurudzirwa nematanho akasiyana enharaunda yekenza akadai seNational Comprehensive Cancer Network (NCCN) kana American Cancer Society (ACS). Uchapupu hunowanikwa kumishonga hwakavakirwa pamatanho makuru emakiriniki akaedzwa (RCTs). Mazhinji marapirwo anotarirwa kune yakasarudzika kenza genomic maitiro. Kunyangwe izvo, kune mazhinji mazhinji ekenza yakadai se metastatic TNBC, hapasati paine nhungamiro yakajairwa uye marapirwo ayo anozivikanwa kuti anoshanda. Kurapa kweiyi subtype kuchiri pamusoro pekuyedza uye nzira dzekukanganisa.
Nekudaro, hapana humbowo hwakadai hwakatungamirwa nhungamiro kune yakasarudzika hutano / kudya mazano. Kune hurombo hweRCTs kuunza humbowo hwekuvandudza kurudziro kurudziro uye madhaidhi edzidziso ekutsigira akasiyana cancer mhando uye kurapwa. Iri igwa rakakura ratiri parizvino mukutarisira gomarara nhasi. Kunyangwe irwo ruzivo rwunowedzera rwehutano hwehukama kudyidzana, kuomarara kwezviito zvemuviri nekudyidzana kwakaoma kugadzirisa zvakakwana kuburikidza nechero imwechete RCT yekutsvagisa dhizaini. (Blumberg J et al, Nutriti. Rev, 2010)
Nekuda kwekupikiswa uku, nhanho yehumbowo hwekutsigirwa kwekudya uye chivimbo chekutsanangura chikafu / chikafu chinodiwa kune varwere vegomarara chinogara chakasiyana kubva kune chinodiwa pakuongorora zvinodhaka. Pamusoro pezvo, hutano / kutungamira kwekudya kwakasiyana nekurapa kwezvinodhaka ndekwechisikigo, kwakachengeteka uye kwakabatana nekuderera kusvika kushoma mhedzisiro-munguva zhinji. Nekudaro, kugadziridza zvinovaka muviri zvinokurudzira kune chaiyo mamiriro e kenza mhando uye kurapwa kwakavakirwa panzira yesainzi inopindirana uye chikonzero chinotsigirwa nedata rekuyedza, kunyangwe isina kufanana neRCT yakavakirwa humbowo, inogona kupa hutungamiriri huri nani kuvarwere uye kuwedzera hutano hwakabatanidzwa hwegomarara.
Sezvo paine huterogeneity kunyangwe mumakenza uye marapirwo emastastatic malignant neoplasms eiyo yakafanana mhando mhando, kurudziro yezvekurapa sechikamu chekubatanidza kenza yekuchengetedza ichadawo kuve yakasarudzika. Chikafu chakakodzera chekutsigira uye zvakanyanya kukosha chikafu chekudzivirira mune chaiwo mamiriro uye panguva yekurapa kunogona kubatsira mukuvandudza mhedzisiro.
Chikafu chekudya Mushure meKenza Kuongorora!
Hapana kanzura mbiri dzakafanana. Enda pamusoro peyakajairwa nhungamiro yemunhu wese uye utore sarudzo dzakagadzirirwa nezve chikafu uye zvinowedzerwa uine chivimbo.
Bhenefiti yeYakasimudzwa Yekutsigira Nutrition / Kudya (Kudya uye Zvekuwedzera) zveMastastatic Breast Cancer
Sezvo hunhu hwechirwere uye kurapwa kwekenza yemazamu yemazamu kwakasiyana siyana zvichibva pachikamu chekutanga chechirwere, izvo zvinodikanwa zvekutsigira kudya / chikafu (chikafu uye zvinowedzerana) zvakare hazvizove saizi imwe inokwana zvese. Izvo zvichave zvinoenderana nehunhu hunhu hwekenza yemazamu yemastastatic uye nemhando yekurapwa kuri kugamuchirwa. Nekudaro magene echirwere, zvimwe zvakakosha zvevarwere vega maererano nemuviri wavo index index (BMI) kuongorora kufutisa, mararamiro ehupenyu sekuita kwemuviri, kunwa doro nezvimwe zvakadaro vese vanozove vanokonzeresa mukugadzira zvakasarudzika kudya kunovaka kunogona kutsigira uye kushanda mukukanganisa kenza pamatanho ese echirwere.
Kukosha kwekupa hutano hwevanhu / hutungamiri hwekudya hwakagadzirirwa kune imwe kenza uye kurapwa, kune varwere vane metastatic zamu yakaipa maloplasm inogona kupa zvinotevera zvinotevera: (Wallace TC et al, J. weAmer. Coll. yeNutriti., 2019)
- Natsiridza simba uye hutachiona hwemurwere pasina kupindira nehutano hwekurapa.
- Kubatsira nekuderedza mhedzisiro-mhedzisiro yekurapa.
- Batsira nekusimudzira kuenderera mberi kwekurapa kushanda nekusarudza zvekudya uye zvekuwedzera izvo zvinogona kuwirirana neyakagadziriswa maitiro ekurapa kuri kuenderera kuburikidza nekugadzirisa nzira dzakakodzera, kana kudzvinyirira nzira dzinogona kuramba nzira.
- Dzivisa chikafu uye zvinowedzera izvo zvinogona kukanganisa kurapwa kunoenderera kuburikidza nekubatana kwemushonga wezvinodhaka zvinogona kudzikisira kushanda kana kuwedzera huturu hwekurapa.
Mienzaniso yeUsarudzika Kudya / Kudya (Zvekudya uye Zvekuwedzera) zveMastastatic Breast Cancer
Kudya / kudya kunovaka muviri (zvekudya uye zvinowedzera) kurudziro yemastastatic mahormone ane chirwere chevarwere vanoramba vachirapwa endocrine therapy yakadai saTamoxifen ichave yakasiyana zvakanyanya nevamwe varwere vekenza yemazamu.
Mienzaniso yezvikafu / zvekuwedzera zvekudzivirira kana pakurapa neEstrogen Modulators
Kune varwere pane esrogen modulators, mimwe mienzaniso yezvikafu uye zvinowedzerwa zvavanofanira kudzivirira izvo zvinogona kukanganisa kwavo endocrine kurapwa pamwe nesainzi chikonzero chakataurwa pazasi:
Curcumin
Curcumin, chinhu chinoshanda kubva ku curry spice turmeric, ndeyechisikigo chinowedzera icho chinozivikanwa pakati pevarwere vegomarara uye vakapona anti-gomarara uye anti-kuzvimba zvivakwa. Naizvozvo, mukana wevarwere vegomarara repazamu vanotora Curcumin vachiri paTamoxifen kurapa kwakakwira.
Mushonga wemumuromo Tamoxifen inogadziriswa mumuviri mune ayo pharmacologically anoshanda metabolites kuburikidza ne cytochrome P450 enzymes muchiropa. Endoxifen ndiyo kiriniki inoshanda yeTamoxifen, ndiyo muyananisi wakakosha wekubudirira kwetamoxifen therapy (Del Re M et al, Pharmacol Res., 2016). Chichangobva kuburitswa chinotarisirwa kuita kiriniki yekudzidza (EudraCT 2016-004008-71 / NTR6149) kubva kuErasmus MC Cancer Institute muNetherlands, yakaratidza kusawirirana kwakashata pakati peCurcumin naTamoxifen mune varwere vegomarara repazamu (Hussaarts KGAM et al, Cancers (Basel), 2019). Mhedzisiro yacho yakaratidza kuti kusungwa kweiyo inoshanda metabolite Endoxifen yakaderera nenzira ine huwandu hwakakosha apo Tamoxifen yakatorwa pamwe chete neCurcumin yekuwedzera.
Zvidzidzo zvakadai seizvi hazvigoni kuregererwa, kunyange mune nhamba shoma yezamu kenza varwere, uye kupa yambiro kune vakadzi vanotora tamoxifen kuti vasarudze zvisikwa zvekuwedzera zvavanotora zvakanyatsonaka, izvo zvisingakanganise kushanda kwechirwere chegomarara nenzira ipi zvayo. Kubva pane humbowo uhu, Curcumin hairatidzike seyakakodzera yekuwedzera kutorwa pamwe neTamoxifen. Nekudaro, izvi hazvireve kuti curcumin se spice uye flavour mumacurries inoda kudzivirirwa zvachose zvachose.
DIM (diindolylmethane) Kuwedzera
Chimwe chinowanikwa uye chinoshandiswa zvakanyanya kuwedzerwa pakati pevarwere vekenza yemazamu iDIM (diindolylmethane), metabolite yeI3C (Indole-3-carbinol), inowanikwa mu cruciferous miriwo senge broccoli, cauliflower, kare, kabichi, brussel inomera. Uku kukurumbira kweDIM kunogona kuve kwakavakirwa pazvidzidzo zvekiriniki izvo zvakaratidza kuti huwandu hwakanyanya hwekudyiwa kwemuchakabvu miriwo mukudya / kudya kwakanyatsobatanidzwa ne15% njodzi yakaderera yekenza yemazamu. (Liu X et al, Chipfuva, 2013) Zvisinei, yakasarudzika, yakapofomara-yakapofumara, placebo inodzora kiriniki kudzidza kwakayedza kushandiswa kwe DIM kuwedzera pamwe neTamoxifen mune varwere vegomarara repazamu, yaratidza maitiro anotyisa e tamoxifen anoshanda ekuderedza kwemetabolite, nekudaro mukana wekudzora kushanda kweiyo endocrine therapy. (NCT01391689) (Thomson CA, Chipfuva Chegomarara Res. Bata., 2017).
Sezvo iyo kiriniki data iri kuratidza maitiro ekudyidzana pakati peDIM uye tamoxifen, varwere vegomarara repazamu pavanenge vari tamoxifen kurapa vanofanirwa kumira parutivi rweyambiro uye vadzivise kutora DIM yekuwedzera. Chikafu-chikafu chinodyiwa chikafu chakapfuma mumiti yemuchinjikwa chinogona kupa iyo inodiwa bhenefiti pane kutora chinowedzerwa cheDIM mune ino mamiriro.
Dzinobatsira uye Dzinodiwa Kudya kweMetastatic Breast Cancer
Kune zvakawanda zvekudya uye zvinowedzera izvo zvinowirirana nekuvandudza mhedzisiro yevarwere vekenza yemazamu varwere. Meta-kuongororwa kwevakawanda vanotarisira zvidzidzo uye maRCT achangobva kuburitswa nevatsvagiri kubva kuInstitut Curie muFrance akataura kuti kudya kwemafuta mashoma kwakabatana nekupona kuri nani. Zvakare, chikafu chaive chakafuma mukati phytoestrogens kubva pamichero nemiriwo, zvakaderedza njodzi yekenza yekudzoka. Uye, chikafu chine hutano nezvirimwa zvakavakirwa chikafu chaive chakabatana nekuvandudzika muhupenyu hwese uye njodzi yekufa. (Maumy L et al, Bull Kenza, 2020)
Chidzidzo chakaburitswa kutanga kwegore rino chakayedza kukanganisa kwe ketogenic kudya / kudya kunovaka muviri pakurarama kwevarwere vegomarara repazamu. Vakaona kuti chikafu che ketogenic pamwe nekuenderera mberi kwemakemikari ekurapa kwakagadzirisa hupenyu hwese pasina chakakomba mhedzisiro muvarwere. (Khodabakhshi A, Nutriti. Gomarara, 2020Ketogenic kudya kunovaka muviri kwakanyanya-kushomeka kwehydrohydrate kudya kunovavarira kusimudzira metabolism yemafuta mumitumbi yeketone (pane macarbohydrate kuita glucose) kupa sosi huru yesimba yemuviri. Masero akajairika mumuviri wedu anogona kuchinja kushandisa ketone miviri yesimba, asi maseru emukenza haakwanise kushandisa miviri ye ketone simba nekuda kwesimba remarara metabolism. Izvi zvinoita kuti maseru emota ave panjodzi uye nekuwedzera, iyo miviri ye ketone inoderedza bundu angiogenesis uye kuzvimba uku uchisimudzira bundu sero kufa. (Wallace TC et al, J. weAmer. Coll. yeNutriti., 2019)
Sezvo zvakanangwa zvekurapa zvinofanirwa kuzadzikiswa zvichienderana nehunhu hwekenza uye nemhando yekurapa, kunyatsoita uye chikafu chemunhu zvakafanira chinofanira kunge chakavakirwa pazvikafu zvega uye zvinowedzeredzwa zvine nzira dzakasimbiswa dzezviito padanho remolekyuli maererano nemhedzisiro yavo pamajini uye nzira. (Reglero C uye Reglero G, Nutrients, 2019)
Semuenzaniso, imwe nzira yekudzivirira metastasis yekenza ndeyekuvhara angiogenesis, kumera kwemitsipa yeropa mitsva, iyo yaizodzivirirawo chemotherapy kuramba. Kune zvekudya uye zvinowedzera neiyo bioactive silibinin, senge artichoke uye mukaka thistle, izvo zvakaratidzwa nesainzi kutitadzisa angiogenesis. Yakasarudzika hutano / kudya mazano ezvekudya izvi / zvinowedzerana mune ino mamiriro e metastatic kenza yemazamu iri kurapwa chemotherapy, inogona kubatsira mukuvandudza kushanda kwekurapa uye kudzivirira kudzokazve. (Binienda A, et al, Anticancer Agents Med Chem, 2019)
Zvimwechetezvo, zvimwe zvakakosha zvekenza uye kurapwa kunogona kuongororwa kuti uwane izvo zvesainzi zvakanaka zvekudya uye zvinowedzeredza zvehunhu zvakagadzirwa dhizaini yevarwere vegomarara kuenzanisa yavo kenza mhando senge metastatic kenza yemazamu uye kurapwa.
mhedziso
Sezvo kurudziro yekurapa iri kuenda kumunhu zvichienderana negomarara genomics uye hunhu hwegomarara remurwere wega wega, kuchengetedza kenza yekubatanidza inodawo kuenda kune yakasarudzika tsigiro chikafu / chikafu chinoenderana nedanho uye rudzi rwe kenza uye kurapwa. Iyi inzvimbo isina kunyanya kushandiswa iyo inogona kubatsira zvakanyanya nekuvandudza mhedzisiro uye hupenyu hwevarwere vane metastatic cancer yemazamu. Kana uine hutano hwakanaka, chikafu chepanyama uye chekuwedzera hachikuvadze. Asi, kana mamiriro acho ari kenza apo muviri unenge uchitobata nemukati dysregulation mumetabolism uye kusadzivirirwa nekuda kwechirwere uye kurapwa kuri kuramba kuchiitika, kunyangwe chikafu chechisikigo, kana isina kusarudzwa nemazvo, vane mukana wekukanganisa. Naizvozvo, yakasarudzika kudya kunovakirwa nekenza chiratidzo (senge kenza yemazamu) uye mhando yekurapa inogona kutsigira zvakagadziriswa mhedzisiro uye kuve kwemurwere.
Chikafu chipi chaunodya uye chinowedzera iwe kutora chisarudzo chaunoita. Sarudzo yako inofanirwa kusanganisira kutarisisa kwecancer genes shanduko, iyo kenza, kurapwa kuri kuenderera uye zvinowedzerana, chero mairigeji, ruzivo rwemararamiro, huremu, kukwirira uye maitiro.
Kurongeka kwehutano kwekenza kubva kuAddon hakubvi pakutsvaga kweinternet. Iyo inoshandura sarudzo kuitirwa iwe zvichibva pane samorekuru sainzi inoitwa nemasayendisiti edu uye mainjiniya esoftware. Zvisinei kuti une hanya here nekunzwisisa iyo yepasi biochemical molecular pathways kana kwete - yekuronga kudya kwemukenza kunzwisiswa kunodiwa.
Tanga IZVOZVO nekuronga kwako kudya kunovaka muviri nekupindura mibvunzo pazita rekenza, majini masayendisiti, kurapwa kuri kuenderera uye zvinowedzerana, chero kurwara, tsika, mararamiro, boka rezera uye murume kana murume.
Hunhu Hwakakosheswa Nekamwe Kenza!
Gomarara rinoshanduka nekufamba kwenguva. Gadzirisa uye gadzirisa chikafu chako zvichibva pachiratidzo chegomarara, marapirwo, mararamiro, zvaunofarira zvekudya, allergies uye zvimwe zvinhu.
Varwere veCancer kazhinji vanofanirwa kubata zvakasiyana chemotherapy mhedzisiro izvo zvinokanganisa kwavo hupenyu hwehupenyu uye kutarisa kune dzimwe nzira dzokurapa kenza. Kutora iyo kudya kwakakwana uye zvekuwedzera zvinoenderana nesainzi (Kudzivirira kufungidzira uye kusarudzika kusarudza) ndiwo mushonga wepamoyo wakanyanya wekenza uye kurapwa kwakanangana side-effectts.