A Healthy NZ

I'm so excited to be offering another informative live Q and A to help you get answers to your health problems.

This time we have Dr Millie Osborne, coming along to answer your questions about the link between diet, depression, anxiety, mental health and eating disorders.

Dr Millie Osborne has been helping people for more than 30 years as a doctor and physician and holistic psychiatrist.

She has a passion for helping people restore their health.

Please share with anyone you know who may find this helpful. If you can't make it, but would like the recording, sign up and we will send it along to you.

Join this informative 1 hour webinar on Saturday the 30th of July from 11AM and ask the doctor your questions.

Sign up now: https://mailchi.mp/74dc7388f0dd/dr-millie-osborne

Were Louise Wallace comments fat shaming and disgusting as claimed by Dame Valarie Adams and others, or was she speaking the truth and people are in denial and oversensitive?

Thanks to everyone who sent me the articles about the latest furore in the NZ media, where Louise Wallace commented that large sized models and mannequins are normalising the growing obesity trend we are seeing throughout the country.

This is a subject that I think deserves some open and honest debate, rather than hiding behind political correctness and attacking the messenger. I understand the emotional issues attached to our body image. There is a fine line between “fat-shaming” and robust debate about the consequences on health that comes hand-in-hand with excessive body-fat. There are also consequences in being underweight and extreme dieting measures that have nothing to do with health. It’s a complex and sensitive subject.

I think we need to clarify what we mean by obesity. I prefer to use the term over-fat, that was coined by Dr Phil Maffetone many years ago. Over-fat refers to the size of an individual’s waist compared to their height, rather than their weight on a scale or BMI.

If your waist is more than half your height, you are considered over-fat. It is the accumulation of this central fat, that is metabolically damaging and associated with serious health consequences such as type-2 diabetes and heart disease.

Using the term over-fat takes the focus away from the body fat that accumulates on hips, thighs, and buttocks. It also helps to identify the many people with normal or low body weight that are also at risk of metabolic disorders and who develop type-2 diabetes.

The fat we accumulate around our waist, serves as an indicator that our health may be deteriorating. It often comes along with high blood pressure, elevated triglycerides, low HDL-cholesterol, and poor blood glucose control. Aside from the risk of type-2 diabetes and heart disease, these symptoms contribute to brain fog and mood disorders, hormonal disruptions, pain and fatigue. It’s not just about fat – it’s about health.

Each of us has our own genetic potential to store body fat safely – this is called our personal fat threshold. When we exceed this ability our fat-cells become insulin resistant, and we develop energy toxicity. What this means, is we have too much energy circulating in our bloodstream. It’s this excess of energy that causes damage to our cells and leads to type-2 diabetes, heart disease and many other debilitating conditions.

When I see the reaction to Louise Wallace’s comments, I do wonder how much thought has been given to the big picture. A report submitted to parliament in 2021, states that the number of New Zealanders with type-2 diabetes is expected to increase by 70-90% over the next 20 years, with a yearly increase of 5% in children under fifteen. There are over 600 amputations in type-2 diabetics each year.

What do you think?

- Do you think using the term over-fat, is better than obese?

- Were Louise’s comments offensive, or speaking the truth?

- Was Dame Valarie helpful in calling her out, or was she being politically correct and shutting down a much-needed discussion?

- Many of us have issues with our body image. Does this discussion make these worse, or is that a self-worth problem that is seperate to the health consequences of being over-fat?

I have a great interview with Dr Maffetone, where he talks about the problems of being over-fat. Part One: https://youtu.be/O3CJGmx-VTQ

This video is about the difference between being overweight and over-fat: https://youtu.be/-_zWAHYJNbE

My special guest today is Jessica Cox. Jessica Cox is an amazing woman and I thank her for all that she shared in this podcast and the inspiration she provides to people every day.

Although Jessica was born different, that has never stopped her from setting and achieving goals in her life. She found she had hidden assets of determination, courage and willpower.

What makes Jessica different – is she was born with no arms. While learning to adapt to a world without arms may seem like a huge challenge, Jessica says this wasn’t the biggest challenge in her life. She was complete in herself and didn’t know anything different.

The struggles she faces are similar to many that we all have. She say’s “no one escapes life without their own experiences and challenges to face”.

We talk about how we all collect baggage of life. These are hurts, grudges, fears, mental and psychological blocks that hold us back from moving forward in the direction of our dreams.

Jessica is a public speaker, mentor and coach. She is a pilot and has the rank of third-degree black belt in Taekwondo and is the Founder of “Possible Thinking”.

It's through Jessica’s own “possible thinking” that she continues to set and achieve her own dreams for her life. She coaches others how to overcome their “baggage” and life to their full potential.

I hope you enjoy hearing from this inspiring woman. Please subscribe, like and share with anyone who may enjoy this. Thank you.

Thanks to Anne for today’s rant material. This advert is cleverly placed in the “Eat Well” section of the NZ Herald, without being labelled as paid advertising.

I spent some time looking at the nutrient-to-calorie ratio, to assess the quality of nutrition this burger provides for the 589 calories we are consuming.

- Wise Boys Sauce
The fats in this sauce are from canola oil, a highly refined, polyunsaturated fat (PUFA’s) that is high in omega-6. This disrupts our delicate omega-6-to-omega-3 ratio. High PUFA intakes are associated with metabolic havoc in our bodies. The serving size is 15 grams; I wonder how many people carefully measure out a serving when doling out the sauce? This is a great interview with Tucker Goodrich, talking about the dangers of these oils. https://youtu.be/2ZlZNezDc0A

The ingredient list sounds innocuous and the words “natural flavours” is designed to elicit positive emotions in us. Wise Boys will tell you, that natural flavouring must come from a base of either plant or animal food. Sounds good – yeah right.

This is another example of food industry shenanigans. What they don’t tell you is these mixtures, (created by specially trained food chemists) may contain more than 100 different chemicals in addition to the source of original flavouring.

These chemicals include preservatives, solvents and other substances and are called “incidental additives”. Incidental, giving the impression they occurred by chance, without intention. or are of no consequence. Another - yeah right!

Next we have the dairy free cheese alternative by Zenzo. A serving size is 50 grams, another 131 calories of processed potato starch, coconut oil and natural flavourings and colour. The coconut oil is an improvement over the canola oil, and provides a tiny bit of vitamin E, the only nutrition that is found in this product.

I have talked a lot about Impossible Burger in other rants, videos and have an excellent interview with Vinnie Tortorich who produced a documentary called Beyond Impossible, it’s well worth the viewing. You can find my interview here. https://youtu.be/X4KKvrQgn4g

Each of these plant patties, come with 228 calories, of synthetic additives in the form of B vitamins, calcium, iron and zinc. Quite frankly this drives me CRAZY.

It all looks lovely on the outside of a pretty packet, but messing with our bodies need for real food vitamins and minerals in this way is criminal in my opinion. Who the heck gets to decide that what combinations of synthetic, poorly absorbed, supplements we all need?

I could do a whole rant on supplemental zinc and iron and how it affects our copper balance and increases oxidation and inflammation. Please think twice about taking zinc and iron supplements and make sure you really need them. Often, what looks like an iron deficiency is copper deficiency.

Finally we have the bun. Add in another 167 calories from processed wheat products, canola oil and a whole bunch of chemicals.

Is it any wonder that people have food cravings. Yes, we need calories, but we also need nutrients, in the form that our bodies recognise and know what to do with. If we don’t get enough nutrients our body keeps sending out hunger signals, until we do.

We evolved over millions of years to utilise the nutrients from the food that was available to us. I find these food companies and their food scientists to be extremely arrogant. They spend billions every year formulating and marketing these chemically designed products, at huge profits, while pretending they care about our health, animal welfare and the environment.

It’s a better con job than selling the Eiffel Tower twice.

I'm interested in your thoughts about these products? Do you have food cravings or suffer from low energy? Do you put your health problems down to "getting older"?

I am thrilled that people are starting to make the connection between their health and Covid-19.

The question is will these powdered fruit and vegies products actually improve health in a meaningful way, or will they provide a false sense of security? Let’s take a deeper dive.

Two companies featured in this article are Arepa who produce blueberry based products and Nutrient Rescue a powdered vegetable experience coming from Cookie Time entrepreneur Michael Mayell. https://www.stuff.co.nz/business/91032594/nutrient-rescue-with-powdered-vege-shots-from-cookie-magnate

There is a huge marketing machine behind both these products, that draws on repackaging the science to convince the p***c with some trendy sounding memes that these products will actually help to improve their health and reduce the risk of chronic disease.

Health is a complex interaction of our genes and environment, with nutrition playing a very important role.

The nutrition side of the equation has two components. When I talk about nutrient density, I’m referring to the amino acids, fatty acids, vitamins, minerals and trace elements that make up our bodies chemical factory.

Without these in the right combinations, quantities and active forms our bodies cannot produce energy. Energy is the key to health, it is also the key to the absence of disease.

The other nutritional component is what everyone tends to focus on, the macronutrients.

These provide the power supply (calories) the body needs to run the chemical factory.

We get our nutrients for the chemical factory, through these macronutrients.

Most people spend time worrying about how many calories they are taking in, rather than how much nutrition is in those calories – the nutrient-to-energy ratio.

If we focused on eating food with the highest number of nutrients for the calories they contain, good health would be easy.

Although blueberries are a good fruit option, (lower in carbs with some good nutritional properties), whether supplementing these in the powdered form while eating a crappy, junk food diet will do anything to protect our brain or heart and reduce our risk of type-2 diabetes seems highly improbable.

The same is true of the green veggie powders. Marketers love to talk about the anti-oxidation and anti-inflammatory properties of their products and they refer to studies, that they quote completely out of context.

None of us have a deficiency in blueberries, while many of us do have deficiencies in essential amino acids and fatty acids. Many of us have vitamin imbalances – due to eating foods with poor bio-availability, or supplementing with synthetic forms – that disrupt the delicate balance in our chemical factory.

It is this chemical factory that produces the anti-oxidants and ensures the detoxification pathways are working properly so we can be healthy.

Mineral and trace-element deficiencies are extremely common and are not recognised by allopathic medicine as being of consequence – when was the last time your GP ever tested your vitamin and mineral status?

These act like the spark plugs in your car. The battery may be charged and the fuel tank full, but without the spark plug, your car won’t work.

My recommendation is to spend your money on food that has a lot of nutrients for the calories it contains. This rules out processed foods and other junk food and has you eating from the real food sections of the supermarket – meat, dairy, eggs and vegetables and some fruit depending on your metabolic health and insulin resistance.

What do you think about these kinds of supplements? Do you take them, thinking they provide you with protection, without really knowing?

Do you know your current vitamin and mineral status?

Are you taking supplements such as Vitamin C, Vitamin D, zinc and multi-vitamin minerals without knowing your mineral status and whether you need them or not?

https://www.stuff.co.nz/business/128365778/has-covid-focused-your-mind-on-nutrition-these-companies-are-here-to-help

Join our next Q and A session with the wonderful doctors Leon and Tamora Bynoe to talk about heart health and cholesterol.

If you or anyone you know are worried about heart disease, cholesterol or are confused about statins, please come along and share this event with them.

If you can't make it on the day, but would like the recording, please register and it will be sent to you after the event.

Please come along with your questions, or send them to me in advance. We are looking forward to seeing you there.

https://mailchi.mp/80c2563692f5/drs-leon-and-tamora-bynoe

LIVE Q&A Session with Dr Peter Delannoy - the real causes of metabolic diseases, weight gain & gout The Live Q&A session with Dr Peter Delannoy - the real causes of metabolic diseases, weight gain and gout - was on the 28th of April. Dr Pete has a Ph.D in B...

It’s all relative…
77 people would need to take statins for 4.4 years to prevent one heart attack. And with a 10% chance of side effects.
Do you know another way to reduce the small dense LDL particles that are the key drivers of coronary artery blockage and heart attack?

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2790055

Coming this week. If you know anyone who might be interested please share this opportunity to talk with gout expert Dr Pete.

In this months live Q and A we have gout expert Dr Peter Delannoy along to answer all your questions.

Ask Dr Pete your questions directly or email them in beforehand.

This is a very important topic, many people suffer the debilitating effects of gout, that reduces the quality of their lives.
If someone you know suffers from gout or other metabolic problems, would you please share this event with them.

Register here. If you register and can't attend you will automatically be sent a recording.
https://mailchi.mp/cbc4981506b4/dr-peter-delannoy-q-a

An interview with Marty Kendall, hosted by Susan Birch I had a great chat with Marty Kendall today. We share a common interest in the nutrient quality of the food we eat. Marty has spent years understanding and c...

Cutting down meat and dairy could help you live up to a decade longer A new website based on the latest scientific research offers people an indication of how their dietary choices can affect their lifespan

An interview with Dr Anthony Chaffee, hosted by Susan Birch Many thanks to Dr Anthony Chaffee for his time today. I asked him, why a medical doctor, neurosurgeon resident, with a background in molecular and cellular ...

An interview with Dr Peter Dalonney, hosted by Susan Birch Today I talked with health coach Dr Peter Delannoy.Dr Pete has a Ph.D in Biochemistry, he is a Primal Health Coach, and Nutrition Network Advisor. He is high...

Thanks everyone for the Monday rant material, I had a lot to choose from this week.

I decided to go with the NZ Herald article titled “Plant based innovator joins barbie queue on NZ shelves”, as 3 people sent me this article. Tara asked, “how can we tell if this is safe to eat, I see lots of people talking about safety concerns, what do you think”?

This burger created by Impossible Foods, has different ingredients than the alternative plant based, Beyond Burger. Beyond Burger is made from pea protein, canola oil, coconut oil and then a bunch of flavourings and food additives.

The Impossible Burger is given its colour and made to “bleed, cook and taste like meat” with a new product called soy leghaemoglobin (SLH). This has been very controversial.

SLH comes from the root nodules of the soy bean plant. The name leghaemoglobin is a combination of legume and haemoglobin. Impossible Foods claim that these are identical to the haem found in meat. If you check out this link, you will find they aren’t anywhere near the same thing. There are multiple differences in their molecular structure and nothing is known about the effect of some of their proteins on human health. We have never eaten this before. https://en.wikipedia.org/wiki/Leghemoglobin

To create SLH, Impossible Foods genetically engineers a yeast and insert the DNA for the SLH into this. They grow the yeast using a fermentation process, isolate the SLH and add it to the burgers at less than 0.8% so it doesn’t have to be included on the food label. This is not a natural food that humans have spent millions of years consuming and adapting to, but a highly processed product that we don’t know a lot about yet.

Some of controversy around this includes it is a GM product and not all the proteins have been identified raising health concerns for those with soy and other legume allergies.

There is a lot of discussion about the 28-week rat study that Impossible Foods conducted to test for safety. The safety concerns raised in this study include liver and kidney damage, increase risk of cancer, changes in blood chemistry and weight loss. Impossible Foods dismissed these claims, saying a rat study isn’t the same as a human study. Makes you wonder why they do it in the first place?

FDA approval for the use of SLH was originally declined in 2015. However, they finally agreed in 2017 after this study was completed. It’s worth noting, that the original study, was intended to be 90 days duration, (the amount of time required to detect sub-chronicity in rats), was reduced to 28 days. This didn’t seem to concern the FDA.
http://gmoscience.org/2019/06/25/rat-feeding-studies-suggest-the-impossible-burger-may-not-be-safe-to-eat/

Aside from the above questions, I have concerns about how these foods are labelled and marketed to consumers who have no idea of the shenanigans that goes on behind the scenes.
Let’s start with the iron. The claim is, this has more iron than a traditional meat burger. The problem is, the label gives the total iron content, it doesn’t break this into haem and non-haem.
We don’t know how much bioavailable haem iron is in this product or how the non-haem component will affect digestion and absorption. We are expected to take their word for it.

Iron deficiency is a serious problem amongst vegans and vegetarians and supplementation along with B12 is routinely recommended. What isn’t well understood is that magnesium, copper and the retinol form of vitamin A (from animal foods), play a crucial role in mobilising iron from tissues to make it bioavailable. Many people who appear iron deficient may have a copper deficiency and lack the ceruloplasmin enzyme that relies on a retinol pathway.

The difference between the vitamin and mineral content of real and fake meat is significant. Yep, you can add a few of these in as supplemental forms, but not everyone absorbs these synthetic vitamins well. Real meat contains every vitamin, mineral and co-factor needed for proper human health. It does this in unique combinations and ratios. There are also hundreds of other biological components to red meat that have profound effects on our health that can’t be replaced by blending some individual components together in a factory.

The remainder of the ingredients include soy protein concentrate, coconut oil, sunflower oil and natural flavours. The rest of the ingredients are a combination of additives found in many highly processed foods and include synthetic forms of B vitamins and zinc. This highlights the lack of understanding between the importance of the copper/zinc ratio. Supplemental zinc can deplete copper and cause all sorts of problems that I mentioned above.

There is no comparison between the protein content of this product and real meat. When plant proteins are listed on food labels, it is usually crude protein, rather than total protein. We know from the DIAAS (digestibility indigestibility amino acid score) that soy protein has a lower value than meat, and potato is even lower. This means you need to eat substantially more to get the same effect.

An adult needs approximately 30 grams of protein per meal for MPS (muscle protein synthesis) to occur. The limiting amino acid for this is leucine. Soy and potato are lower in leucine than meat. This means you need to eat more of them for the protein to do its job.

The recommended serving is one burger, providing 18 grams of crude protein. If we are very generous and say the total protein content is 15 grams, then two burgers would be required for an adequate protein intake.

This increases the carbohydrate intake to 18 grams, fat to 28 grams (including toxic sunflower oil). The total calories increase to 480 per serving.

Impossible Burgers marketing is disingenuous as it dismisses these important components of food and the context they are eaten in. While on paper, soy protein contains all the essential amino acids, meat contains so much more, including all the conditionally essential nutrients that are vital to health. The majority of these aren’t found in plant-foods. These include carnitine, carnosine, choline, creatine and taurine. These are essential to the function of our brains, eye health, cardiovascular system, red blood cells and a whole lot more.

There are also vitamin K2 and co-enzyme Q10 that both essential for our health. Vegans and vegetarians are often deficient in these important nutrients, which is why they are also on the recommended supplements for those eating plant-based diets.

This looks like another highly processed food product to me.

Surely the point of eating a plant based diet is because you believe it is better for your health. By all means do that if you want to. But why add in highly processed engineered foods, that have nothing to do with the types of plant humans had available throughout our history.

I am always confused when vegans want their food to look, taste and bleed like meat – I thought they objected to these things? Or maybe this product is really aimed at converting the traditional meat eater over to plant-based products, by pretending its equally healthy and guilt tripping them over animal welfare and the environmental concerns?

I suspect money plays the most significant role in this process. Knowing what I do about the environmental impact of mono-cropping and the millions of animals killed in this process, I believe those claims are just as fake as their meat.

At a cost of $12 per meal for the Impossible Burger – it’s hardly cost effective for a family. I’d rather spend my $12 on a decent rib eye steak.

Thanks everyone for the rant material, keep it coming. You can watch my youtube channel at or listen to my podcast on your favourite podcast apps. https://www.youtube.com/results?search_query=susan+birch

If you would like to get my newsletter to keep up to date with what I’m doing - podcasts, live Q and A’s and other topics, you can sign up here. https://mailchi.mp/61eb6eb3e0df/newsletter-signup

An interview with Leon and Tamora Bynoe, hosted by Susan Birch Today I talk with Drs Leon and Tamora Byneo about their journey from overweight, high blood pressure, achy joints and pulmonary embolism, then back to vibran...

There are 4-days left to sign up for this informative Q and A with Dr Marcus Hawkins, Low Carb Doctor NZ.

We would love you to join us and ask questions and share your experiences. If you know anyone who might find this helpful, please share the link.

A recording will automatically be sent to anyone registering for the event. So if you would like to be there, but the time doesn't suit, register and you will get the link. Feel free to send in your questions beforehand.

This is the link. We are looking forward to seeing you there. https://mailchi.mp/bafdbe81c52a/low-carb-dr-hawkins

February 24th - 7.30 pm : Q and A with Dr Marcus Hawkins, Low-carb NZ Doctor.

This is a great opportunity to come along and ask the doctor your questions. Thanks to everyone who has been sharing this event.

If you would love to hear what the doctor has to say, but can't make it on the night, please register to get the replay and send us your questions in advance.

This is the link to register.
https://mailchi.mp/bafdbe81c52a/low-carb-dr-hawkins

I am excited to have Dr Marcus Hawkins - Low Carb NZ - Doctor join me for a Q and A to answer all your health questions about low-carb.

If you are interested in low carb but worried about the implications for your diabetes and cholesterol, or if you are already trying low carb, but have questions, then come along and ask the Doctor.

If you have unresolved health issues (pain, brain fog, fatigue, trouble losing weight and hormonal problems) then come along and find out if low carb may help you.

This is the link to register.
https://mailchi.mp/bafdbe81c52a/low-carb-dr-hawkins

An interview with Dr Friedemann Schaub with Susan Birch Today's podcast is one of my favourites. I talk to Dr Friedemann Schaub and we discuss why a physician and cardiologist becomes fascinated with the connectio...

My latest video explains how to lose weight and restore your health by understanding the order that our body burns different foods.

Protein is used as building blocks for the body, whereas carbohydrates and fats are used as energy.

If you want to tap into burning your body-fat, it’s important to keep the amount of energy available in your bloodstream low.
Because carbs are used before fat, controlling your carb intake is important for weight-loss.

When you eat more carbs than your body can use, these get converted to triglycerides (fat) in your liver and are transported via the bloodstream to your fat stores. High levels of glucose from carbs and fats from carbs in the bloodstream prevents you from burning your body fat.

If you enjoyed this video, please subscribe, like and share. You can also listen on your favourite podcast app.

You can download free resources from my website:
https://www.susanbirch.co.nz/free-dow...

I highly recommend - Dr Estrelita van Rensburg and Issy Warrack's books to get you started on your journey and help with recipe ideas.
You can find them here...
Eat Well or Die Slowly - Your Guide to Metabolic Health
- https://bit.ly/AUSEWDS
Eat Your Way to Health - Recipes for Success
- https://bit.ly/AUSEatWaytoHeatlh2nd
Seafood and Vegetarian Recipes
- https://bit.ly/AUSVegetarianSeafood
https://youtu.be/YB71yOKfPdQ

Susan Birch - An important concept for weight-loss - the oxidative priority. In this episode I discuss an important concept for weight-loss called the oxidative priority. Our body uses different foods – differently. Protein is used as...

Susan Birch - Obesity and Covid severity - Whats the connection? Today’s question comes from Marama who wanted to know why I think that obesity makes Covid worse. She also said that losing weight is really hard, especially...

An interview with Leslyn Keith Leslyn Keith is an author, speaker, educator and certified lymphedema therapist who treats people with lymphedema and obesity.I had a fascinating talk to her...

“The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country’s national nutrition policy…”
Let’s hope they are considered by the Australian Dietary Guidelines Expert Committee…

Rotorua performer Bobby Mihi Howard shares her inspirational story with Susan Birch I loved this chat with well known Rotorua performer Bobby Mihi Howard. I have really enjoyed working with Bobby, and have learned so much from her in the las...

In this week's podcast I take a look at the newest drugs for type-2 diabetes and whether they are really helping our health, or simply increasing the profits for the drug companies.

These drugs are all aimed at lowering blood sugar - but we don't need drugs to do that. We can lower our blood sugar but reducing how many carbs we eat. Why are we prescribing drugs for a lifestyle disease? Wouldn't it make more sense to change our lifestyle?

To start you on your journey, I highly recommend the books by Issy Warrack and Dr Estrelita van Rensburg. you can find them here:

- Eat Well or Die Slowly - Your Guide to Metabolic Health
- https://www.amazon.com/Eat-Well-Die-S...

- Eat Your Way to Health - Recipes for Success
- https://www.amazon.com/Eat-Your-Way-H...

- Seafood and Vegetarian Recipes
- https://www.amazon.com/Vegetarian-Sea...

If you enjoyed this video, please subscribe, like and share.
You can have the PDF "Understanding Functional Blood Chemistry Analysis" that I discussed, sent directly to your inbox: https://www.susanbirch.co.nz/free-dow...

You can also download my free "health and wellbeing planner", and my "handy guide to protein" from the free resources page on my website.
https://www.susanbirch.co.nz/free-dow...

You can subscribe to my newsletter:
https://mailchi.mp/61eb6eb3e0df/newsl...
SHOW LESS

https://youtu.be/3X1Vgk-oY5M