A Pharmacist’s Perspective on Drug-Nutrient Interactions and the Value of Nutritional Medicine

January 30, 2012

An interesting commentary below…by a registered pharmacist, released through the Orthomolecular News Service, about the importance of including nutrient deficiencies in the mix, when considering pharmaceutical medications for the prevention or treatment of disease.

In health,

-Dr. G

___

Confessions of a Frustrated Pharmacist

by Stuart Lindsey, PharmD.

I’m a registered pharmacist. I am having a difficult time with my job. I sell people drugs that are supposed to correct their various health complaints. Some medicines work like they’re supposed to, but many don’t. Some categories of drugs work better than others. My concern is that the outcomes of treatment I observe are so unpredictable that I would often call the entire treatment a failure in too many situations.

How It Started

In 1993, I graduated with a BS in Pharmaceutical Sciences from University of New Mexico. I became pharmacy manager for a small independent neighborhood drug store. Starting in the year 2000, nutrition became an integral part of our business. The anecdotal feedback from the customers who started vitamin regimens was phenomenal. That same year, my PharmD clinical rotations began with my propensity for nutritional alternatives firmly in place in my mind. On the second day of my adult medicine rotation, my preceptor at a nearby hospital informed me that he had every intention of beating this vitamin stuff out of me. I informed him that probably wouldn’t happen. Three weeks later I was terminated from my rotations. The preceptor told my supervisor at UNM that there were acute intellectual differences that couldn’t be accommodated in their program. What had I done? I was pressuring my preceptor to read an article written by an MD at a hospital in Washington state that showed if a person comes into the emergency room with a yet to be diagnosed problem and is given a 3,000-4,000 mg bolus of vitamin C, that person’s chance of dying over the next ten days in ICU dropped by 57%! [1]

One would think that someone who is an active part of the emergency room staff might find that an interesting statistic. His solution to my attempting to force him to read that article was having me removed from the program.

Pecking Order

The traditional role of the pharmacist in mainstream medicine is subordinate to the doctor. The doctor is responsible for most of the information that is received from and given to the patient. The pharmacist’s responsibility is to reinforce the doctor’s directions. The doctor and the pharmacist both want to have a positive treatment outcome, but there is a legally defined ‘standard of care’ looking over their shoulder.

The training that I received to become a PharmD motivated me to become more interested in these treatment outcomes. After refilling a patient’s prescriptions a few times, it becomes obvious that the expected positive outcomes often simply don’t happen. It’s easy to take the low road and blame it on “poor compliance by the patient.” I’m sure this can explain some treatment failure outcomes, but not all. Many (indeed most) drugs such as blood pressure regulators can require several adjustments of dose or combination with alternative medicines before a positive outcome is obtained.

Wrong Drug; Wrong Disease

One drug misadventure is turning drugs that were originally designed for a rare (0.3% of the population) condition called Zollinger-Ellison syndrome into big pharma’s treatment for occasional indigestion. These drugs are called proton-pump inhibitors (PPI). [2] After prolonged exposure to PPIs, the body’s true issues of achlorhydria start to surface. [3]

These drugs are likely to cause magnesium deficiency, among other problems. Even the FDA thinks their long-term use is unwise. [4]

The original instructions for these drugs were for a maximum use of six weeks . . . until somebody in marketing figured out people could be on the drugs for years. Drug usage gets even more complicated when you understand excessive use of antibiotics could be the cause of the initial indigestion complaints. What you get from inserting proton pump inhibitors into this situation is a gastrointestinal nightmare. A better course of medicine in this type of case might well be a bottle of probiotic supplements (or yogurt) and a few quarts of aloe-vera juice.

Many doctors are recognizing there are problems with overusing PPI’s, but many still don’t get it. An example of this is my school in NM had a lot of students going onto a nearby-impoverished area for rotations. They have blue laws in this area with no alcohol sales on Sunday. The students saw the pattern of the patients going into the clinics on Monday after abusing solvents, even gasoline vapors, and having the doctors put them on omeprazole (eg. Prilosec), long term, because their stomachs are upset. This is medicine in the real world.

Reliability or Bias?

Mainstream medicine and pharmacy instill into their practitioners from the beginning to be careful about where you get your information. Medical journals boast of their peer review process. When you discuss with other health professionals, invariably they will ask from which medical journal did you get your information. I actually took an elective course in pharmacy on how to evaluate a particular article for its truthfulness. The class was structured on a backbone of caution about making sure, as one read an article, that we understand that real truthfulness only comes from a few approved sources.

I was never comfortable with this concept. Once you realized that many of these “truthfulness bastions” actually have a hidden agenda, the whole premise of this course became suspect. One of my preceptors for my doctoral program insisted that I become familiar with a particular medical journal. If I did, she said, I would be on my way to understanding the “big picture.” When I expressed being a little skeptical of this journal, the teacher told me I could trust it as the journal was non-profit, and there were no editorial strings attached.

Weirdly enough, what had started our exchange over credibility was a warm can of a diet soft drink on the teacher’s desk. She drank the stuff all day. I was kidding around with her, and asked her if she had seen some controversial articles about the dangers of consuming quantities of aspartame. She scoffed at my conspiracy-theory laden point of view and I thought the subject was closed. The beginning of the next day, the teacher gave me an assignment: to hustle over to the medical library and make sure I read a paper she assured me would set me straight about my aspartame suspicions, while simultaneously demonstrating the value of getting my information from a nonprofit medical journal. It turned out that the article she wanted me to read, in the “nonprofit medical journal,” was funded in its entirety by the Drug Manufacturers Association.

Flashy Pharma Ads

As I read the literature, I discovered that there is very decided barrier between two blocks of information: substances that can be patented vs. those substances that can’t be. The can-be-patented group gets a professional discussion in eye-pleasing, four-color-print, art-like magazines. This attention to aesthetics tricks some people into interpreting, from the flashy presentation method, that the information is intrinsically truthful.

The world’s drug manufacturers do an incredibly good job using all kinds of media penetration to get the word out about their products. The drug industry’s audience used to be confined to readers of medical journals and trade publications. Then, in 1997, direct-to-consumer marketing was made legal. [5]

Personally, I don’t think this kind of presentation should be allowed. I have doctor friends that say they frequently have patients that self-diagnose from TV commercials and demand the doctor write them a prescription for the advertised product. The patients then threaten the doctor, if s/he refuses their request, that they will change doctors to get the medication. One of my doctor friends says he feels like a trained seal.

Negative Reporting on Vitamins

A vitamin article usually doesn’t get the same glossy presentation. Frequently, questionable vitamin research will be published and get blown out of proportion. A prime example of this was the clamor in the press in 2008 that vitamin E somehow caused lung cancer. [6]

I studied this 2008 experiment [7] and found glaring errors in its execution. These errors were so obvious that the experiment shouldn’t have gotten any attention, yet this article ended up virtually everywhere. Anti-vitamin spin requires this kind of research to be widely disseminated to show how “ineffectual” and even “dangerous” vitamins are. I tracked down one of the article’s original authors and questioned him about the failure to define what kind of vitamin E had been studied. A simple literature hunt shows considerable difference between natural and synthetic vitamin E. This is an important distinction because most of the negative articles and subsequent treatment failures have used the synthetic form for the experiment, often because it is cheap. Natural vitamin E with mixed tocopherols and tocotrienols costs two or three times more than the synthetic form.

Before I even got the question out of my mouth, the researcher started up, “I know, I know what you’re going to say.” He ended up admitting that they hadn’t even considered the vitamin E type when they did the experiment. This failure to define the vitamin E type made it impossible to draw a meaningful conclusion. I asked the researcher if he realized how much damage this highly quoted article had done to vitamin credibility. If there has been anything like a retraction, I have yet to see it.

Illness is Not Caused by Drug Deficiency

If you’ve made it this far in reading this article you have discerned that I’m sympathetic to vitamin arguments. I think most diseases are some form of malnutrition. Taking the position that nutrition is the foundation to disease doesn’t make medicine any simpler. You still have to figure out who has what and why. There are many disease states that are difficult to pin down using the “pharmaceutical solution to disease.” A drug solution is a nice idea, in theory. It makes the assumption that the cause of a disease is so well understood that a man-made chemical commonly called ‘medicine’ is administered, very efficiently solving the health problem. The reality though, is medicine doesn’t understand most health problems very well. A person with a heart rhythm disturbance is not low on digoxin. A child who is diagnosed with ADHD does not act that way because the child is low on Ritalin. By the same logic, a person with type II diabetes doesn’t have a deficit of metformin. The flaw of medicine is the concept of managing (but not curing) a particular disease state. I’m hard pressed to name any disease state that mainstream medicine is in control of.

Voltaire allegedly said, “Doctors are men who pour drugs of which they know little, to cure diseases of which they know less, into human beings of whom they know nothing.” Maybe he overstated the problem. Maybe he didn’t.

References:

1. Free full text paper at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422648/pdf/20021200s00014p814.pdf

Also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422648/?tool=pubmed

2. http://www.ncbi.nlm.nih.gov/pubmed/2777040 and http://www.ncbi.nlm.nih.gov/pubmed/1697548

3. http://www.ncbi.nlm.nih.gov/pubmed/21509344 and http://www.ncbi.nlm.nih.gov/pubmed/21731913

4. http://www.fda.gov/Safety/MedWatch/SafetyInformation/
SafetyAlertsforHumanMedicalProducts/ucm245275.htm

5. http://www.nejm.org/doi/full/10.1056/NEJMsa070502#t=articleResults

6. Media example:
http://seniorjournal.com/NEWS/Nutrition-Vitamins/2008/8-02-29-VitaminEMay.htm .

OMNS’ discussion at: http://orthomolecular.org/resources/omns/v04n18.shtml

7. Original article at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258445/?tool=pubmed or http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258445/pdf/AJRCCM1775524.pdf

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (Canada)
Damien Downing, M.D. (United Kingdom)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, Ph.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Thomas Levy, M.D., J.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)

Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email: omns@orthomolecular.org

2 Comments | Diet and Disease, Healthcare Politics, Latest Nutritional Research, Nutritional Supplements and Disease, Orthomolecular Medicine, Pharmaceuticals | Tagged: , , , | Permalink
Posted by Dr. Gina Nick

How Important are Nutritional Supplements?

January 17, 2012

Here is an excellent news release by the Orthomolecular Medicine Society that discusses the importance of nutritional supplementation, even with a healthy diet.  Research identified a relationship between folic acid deficiencies and birth defects as early as 1965. It was not until 1992 that the United States Public Health Service shared this critical knowledge with the country and recommended that all women of childbearing age, capable of becoming pregnant, consume 400mcg of folic acid per day. It took the scientific community almost 30 years to accept that a nutrient deficiency might cause a gross distortion in human neuronal development and to recommend supplementation. Thousands of children were born during this time with preventable birth defects.

And that is just one nutrient!

Please read this release through to the end, check the references for yourself if so inclined, and come to your own decision on whether nutritional supplementation will prevent and treat disease.  We consistently see the positive results of nutritional therapy in our medical practice, with patients from all walks of life, facing myriad health challenges. We test patients’ blood to detect specific nutrient deficiencies, and how well nutrients are being absorbed in their body, and administer only those nutrients that are needed.  That is ideal. And that is the type of lab testing that should be covered by all major insurance carriers.  The information gained helps to prevent suffering and chronic illness, and to optimize human health and vitality.  This saves healthcare dollars in a tangible and measurable way.

In health,

–Dr. G

—
FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, January 17, 2012

Supplements: The Real Story
Natural or Synthetic? Foods or Tablets?

(OMNS, Jan 17, 2012) It’s a nutritional “Catch 22”: The public is told, confusingly: “Vitamins are good, but vitamin supplements are not. Only vitamins from food will help you. So just eat a good diet. Do not take supplements! But by the way, there is no difference between natural and synthetic vitamins.”

Wait a minute. What’s the real story here?

A recent health study reported that the risk of heart failure decreased with increasing blood levels of vitamin C [1]. The benefit of vitamin C (ascorbate) was highly significant. Persons with the lowest plasma levels of ascorbate had the highest risk of heart failure, and persons with the highest levels of vitamin C had the lowest risk of heart failure. This finding confirms the knowledge derived over the last 50 years that vitamin C is a major essential factor in cardiovascular health [2,3]. The study raises several important questions about diet and vitamin supplements.

Was it Food or Supplements?

The report discussed vitamin C as if it were simply an indicator of how many fruits and vegetables were consumed by the participants. Yet, ironically, the study’s results show little improvement in the risk for heart failure from consuming fruits and vegetables. This implies that the real factor in reducing the risk was indeed the amount of vitamin C consumed. Moreover, the study appears to utterly ignore the widespread use of vitamin C supplements to improve cardiovascular health. In fact, out of four quartile groups, the quartile with the highest plasma vitamin C had six to ten times the rate of vitamin C supplementation of the lowest quartile, but this fact was not emphasized. This type of selective attention to food sources of vitamin C, while dismissing supplements as an important source, appears to be an attempt to marginalize the importance of vitamin supplements.

Many medical and nutritional reports have maintained that there is little difference between natural and synthetic vitamins. This is known to be true for some essential nutrients. The ascorbate found in widely available vitamin C tablets is identical to the ascorbate found in fruits and vegetables [3]. Linus Pauling emphasized this fact, and explained how ordinary vitamin C, inexpensively manufactured from glucose, could improve health in many important ways [4]. Indeed, the above-mentioned study specifically measured the plasma level of ascorbate, which was shown to be an important factor associated with lower risk of heart failure [1, 2]. The study did not measure blood plasma levels of the components of fruits and vegetables. It measured vitamin C.

A known rationale for this dramatic finding is that vitamin C helps to prevent inflammation in the arteries by several mechanisms. It is a necessary co-factor for the synthesis of collagen, which is a major component of arteries. Vitamin C is also an important antioxidant throughout the body that can help to recycle other antioxidants like vitamin E and glutathione in the artery walls [2,3]. This was underscored by a report that high plasma levels of vitamin C are associated with a 50% reduction in risk for stroke [5].

Yes, Synthetic Vitamin C is Clinically Effective

We can almost hear “Unsubscribe” links being clicked as we state it, but here it is: synthetic vitamin C works, in real people with real illnesses. Ascorbate’s efficacy has little direct relation to food intake. A dramatic case of this was a dairy farmer in New Zealand who was on life support with lung whiteout, kidney failure, leukemia and swine flu [6]. He was given 100,000 mg of vitamin C daily and his life was saved. We have nothing against oranges or other vitamin C-containing foods. Fruits and vegetables are good for you for many, many reasons. However, you’ll need to get out your calculator to help you figure out how many oranges it would take to get that much, and then also figure how to get a sick person to eat them all.

It is established that liver function improves with vitamin C supplementation, and it is equally well known that adequate levels of vitamin C are essential for the proper functioning of the immune system. Vitamin C improves the ability of the white blood cells to fight bacteria and viruses. OMNS has more articles expanding on this topic, available for free access at http://orthomolecular.org/resources/omns/index.shtml .

Deficiency of vitamin C is very common. According to US Department of Agriculture (USDA) data, [7] nearly half of Americans do not get even the US RDA of vitamin C, which is a mere 90 mg.

Synthetic Vitamin E is Less Effective

For some other nutrients, there is a significant difference in efficacy between synthetic and natural forms. Vitamin E is a crucial anti-oxidant, but also has other functions in the body, not all well understood. It comprises eight different biochemical forms, alpha-, beta-, delta- and gamma tocopherols, and alpha-, beta-, delta-, and gamma-tocotrienols. All of these forms of vitamin E are important for the body. Current knowledge about the function of vitamin E is rapidly expanding, and each of the eight forms of natural vitamin E is thought to have a slightly different function in the body. For example, gamma-tocotrienol actually kills prostate cancer stem cells better than chemotherapy does. ( http://orthomolecular.org/resources/omns/v07n11.shtml )

Synthetic vitamin E is widely available and inexpensive. It is “DL-alpha-tocopherol.” Yes, it has the same antioxidant properties in test tube experiments as does the natural “D-alpha-tocopherol” form. However, the DL- form has only 50% of the biological efficacy, because the body utilizes only the natural D isomer, which comprises half of the synthetic mix [8]. Therefore, studies utilizing DL-alpha-tocopherol that do not take this fact into account are starting with an already-halved dose that will naturally lead to a reduction in the observed efficacy.

Then there are the esterified forms of vitamin E such as acetate or succinate. These esterified forms, either natural or synthetic, have a greater shelf life because the ester protects the vitamin E from being oxidized and neutralized. When acid in the stomach cleaves the acetate or succinate component from the original natural vitamin E molecule, the gut can then absorb a good fraction and the body receives its antioxidant benefit. But when esterified vitamin E acetate is applied to the skin to prevent inflammation, it is ineffective because there is no acid present to remove the acetate ester.

Based on USDA data [9] an astonishing 90% of Americans do not get the RDA of vitamin E, which is, believe it or not, under 23 IU (15mg) per day.

Magnesium Deficiency is Widespread

Magnesium is another example. Over two-thirds of the population do not get the RDA of magnesium.[10] Deficiency can cause a wide variety of symptoms, including osteoporosis, high blood pressure, heart disease, asthma, depression, and diabetes. Magnesium can be purchased in many forms. The most widely available form is magnesium oxide, which is not very effective because it is only about 5% absorbed [11]. Magnesium oxide supplements are popular because the pills are smaller — they contain more magnesium, but won’t help most people. Better forms of magnesium are magnesium citrate, magnesium malate, and the best absorbed is magnesium chloride. It’s always good to consult your doctor to determine your ideal intake. Testing may reveal unexpected deficiency. [12]

Well, Which? Natural or Synthetic?

While the natural form of vitamin E (mixed natural tocopherols and tocotrienols) is at least twice as effective as the synthetic form, this is not true of vitamin C. The ascorbate that the body gets from fruits and vegetables is the same as the ascorbate in vitamin C tablets. On first thought, this may sound confusing, because there are many so-called “natural” forms of vitamin C widely available. But virtually every study that demonstrated that supplemental vitamin C fights illness used plain, cheap, synthetic ascorbic acid. Other forms of ascorbate, for instance, the sodium or magnesium salt of ascorbic acid, are digested slightly differently by the gut, but once the ascorbate molecule is absorbed from these forms, it has identical efficacy. The advantage of these ascorbate salts is that they are non-acidic and can be ingested or topically applied to any part of the body without concern about irritation from acidity.

Further, it is known that essential nutrients are symbiotic, that is, they are more effective when taken as a group in proper doses. For example, vitamin E is more effective when taken along with vitamin C and selenium, because each of these essential nutrients can improve the efficacy of the others. Similarly, the B vitamins are more effective when taken together. Readers with dosage questions will want to consult their healthcare provider, and also look at freely available information archived at http://orthomolecular.org/resources/omns/index.shtml .

Food Factors

Natural food factors are also important. Bioflavonoids and other vitamin C-friendly components in fresh fruits and vegetables (sometimes called “vitamin C complex”) do indeed have health benefits. These natural components are easily obtained from a healthy, unprocessed whole foods diet. However, eating even a very good diet does not supply nearly enough vitamin C to be effective against illness. A really good diet might provide several hundred milligrams of vitamin C daily. An extreme raw food diet might provide two or three thousand milligrams of vitamin C, but this is not practical for most people. Supplementation, with a good diet, is.

The principle that “natural” vitamins are better than synthetic vitamins is a widely quoted justification for actually avoiding vitamin supplements. The argument goes, because vitamins and minerals are available from food in their natural form, that somehow one might suppose that we are best off by ignoring supplements. Apparently this is what the authors of the above-mentioned study had in mind, because the report hardly mentions vitamin supplements.

Conclusion

In the real world of today’s processed food, most of us don’t get all the nutrients we need in adequate doses. Most people are deficient in several of the essential nutrients. These deficiencies are responsible for much suffering, including heart disease, cancer, premature aging, dementia, diabetes, and other diseases such as eye disease, multiple sclerosis and asthma. The above-mentioned study showing the efficacy of vitamin C in reducing heart failure is but one of the many studies showing the value of vitamins. Others are discussed and available at http://orthomolecular.org/resources/omns/index.shtml .

For vitamin E, the natural form, taken in adequate doses along with a nutritious diet, is the best medicine. However, for most vitamins, including vitamin C, the manufactured form is identical to the natural one. Both are biologically active and both work clinically. It all comes down to dose. Supplements enable optimum intake; foods alone do not.

Don’t be fooled: nutrient deficiency is the rule, not the exception. That’s why we need supplements. When ill, we need them even more.

References:

1. Pfister R, Sharp SJ, Luben R, Wareham NJ, Khaw KT. (2011) Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study. Am Heart J. 162:246-253. See also: http://orthomolecular.org/resources/omns/v07n14.shtml

2. Levy TE (2006) Stop America’s #1 Killer: Reversible Vitamin Deficiency Found to be Origin of All Coronary Heart Disease. ISBN-13: 9780977952007

3. Hickey S, Saul AW (2008) Vitamin C: The Real Story, the Remarkable and Controversial Healing Factor. Basic Health Publications, ISBN-13: 978-1591202233.

4. Pauling L. (2006) How to Live Longer And Feel Better. Oregon State University Press, Corvallis, OR. ISBN-13: 9780870710964.

5. Kurl S, Tuomainen TP, Laukkanen JA, Nyyssönen K, Lakka T, Sivenius J, Salonen JT. (2002) Plasma vitamin C modifies the association between hypertension and risk of stroke. Stroke. 33:1568-1573.

6. Watch the Channel 3 New Zealand news report at http://www.3news.co.nz/Living-Proof-Vitamin-C—Miracle-Cure/tabid/371/articleID/171328/Default.aspx or http://www.dailymotion.com/video/xh70sx_60-minutes-scoop-on-new-zealand-farmer-vit-c-miracle_tech [ Note that each video is proceeded by a commercial, over which we have no control, and with which we have no financial connection whatsoever. ]

7. Free, full text paper at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1405127/pdf/amjph00225-0021.pdf

8. Papas A. (1999) The Vitamin E Factor: The miraculous antioxidant for the prevention and treatment of heart disease, cancer, and aging. HarperCollins, NY. ISBN-13: 9780060984434

9. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminE/ ; scroll down to “Deficiency.”

10. Free, full text paper at http://www.jacn.org/content/24/3/166.full.pdf+html (or http://www.jacn.org/content/24/3/166.long )

11. Dean, C. (2007) The Magnesium Miracle. Ballantine Books, ISBN-13: 9780345494580

12. http://www.doctoryourself.com/epilepsy.html

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

OMNS free subscription link http://orthomolecular.org/subscribe.html

OMNS archive link http://orthomolecular.org/resources/omns/index.shtml

11 Comments | Diet and Disease, Latest Nutritional Research, Nutritional Supplements and Disease, Orthomolecular Medicine, Pregnancy, Prevention | Tagged: , , , , , | Permalink
Posted by Dr. Gina Nick

Overcoming Bias in Nutritional Medicine

October 7, 2011


Below is a timely press release from the International Society for Orthomolecular Medicine about a growing bias within the medical establishment against nutritional medicine.

It is my belief that to heal your body, you must first take responsibility for your own health, and put in the time and dedication to identify the underlying cause of your experience. Then, seek healthcare experts to partner with, and available treatments and methods that facilitate your healing.  Effective treatments are as individual as you are. You have a right, as a patient, caregiver, friend or doctor, to chose the medicines that you feel offer the best opportunity for healing.

During these times and in this industry, where money has had such a strong influence, there will be a bias in healthcare, whether conventional, integrative or  natural. Stay focused on your individual situation and strive for a balanced approach to health, taking all input you receive into consideration and then making your own choice!

In health,

–Dr. G

—

FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, October 7, 2011

Half Truth is No Truth at All
Overcoming Bias Against Nutritional Medicine

Commentary by Andrew W. Saul
Editor, Orthomolecular Medicine News Service

Freedom of the press is guaranteed only to those who own one. (Abbott Joseph Liebling)

(OMNS, Oct 7, 2011) An internet search for “orthomolecular medicine” can bring up some remarkably official-looking misinformation.

A prime example is the American Cancer Society’s webpage on orthomolecular medicine, which is incomplete, negative and fallacious. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/orthomolecular-medicine

Read it and see for yourself. A tad biased, perhaps? Carefully search that same ACS orthomolecular medicine page for the word “intravenous.” The word is not even there, even though the US National Institutes of Health sponsored research which clearly showed that intravenous vitamin C selectively kills malignant cells. The study concluded that “Vitamin C at high concentrations is toxic to cancer cells in vitro.” (1) In vitro refers to a laboratory culture. For a real-world test, the same team then gave IV vitamin C to cancer patients, and it worked very well. (2) You would think that the American Cancer Society would find this at least a little intriguing, and maybe even mention it. But no: no mention at all.

On the other hand, the American Cancer Society is blatantly bullish on chemotherapy. Odd, really, since a peer-reviewed study showed that conventional chemotherapy contributes only 2.1% to five year cancer survival in the USA. (3) The ACS webpage has not been updated since 2008, yet all three of these studies were published well before then. Perhaps readers may be able to help ACS modernize and improve the accuracy of their presentation. You can send a message to the American Cancer Society at http://www.cancer.org/Aboutus/HowWeHelpYou/app/contact-us.aspx

Some websites are not satisfied with telling half the story. They marginalize nutritional medicine physicians as promoters of an “unproven” therapy, or even attempt to characterize them as quacks. Wikipedia, popular though notoriously unreliable, is a good example. http://en.wikipedia.org/wiki/Orthomolecular_medicine However, word is getting out. If you go to the very bottom of the page, below the reference section, you can view the page’s ratings. On a 5-point scale, readers have rated Wikipedia’s orthomolecular page in the neighborhood of 1.6 for Trustworthiness, Objectivity, and Completeness.

Sources claiming that orthomolecular medicine is without scientific basis and in the realm of “faddism” should be embarrassed by such a display of their ignorance.

Since 1987, there has been a chair in orthomolecular medicine at Ben Gurion University in Tel Aviv http://ppphs.org/haim-robert-belmaker . In 2006, an orthomolecular medical chair was established at the Kansas University Medical Center http://integrativemed.kumc.edu/bio-drisko.htm . Emanuel Cheraskin, M.D., D.M.D., was himself chairman of the Department of Oral Medicine, University of Alabama Medical School http://www.doctoryourself.com/biblio_cheraskin.html . Carl Curt Pfeiffer, M.D., Ph.D., was chair of the Pharmacology Department at Emory University http://www.doctoryourself.com/biblio_pfeiffer_ed.html .
Linus Pauling http://www.doctoryourself.com/biblio_pauling_ortho.html , who gave orthomolecular medicine its name in 1968, is the only recipient, ever, of two unshared Nobel Prizes.
Pioneering orthomolecular physicians Hugh Riordan http://www.doctoryourself.com/biblio_riordan.html , Humphry Osmond http://www.doctoryourself.com/biblio_osmond.html , and Abram Hoffer http://www.doctoryourself.com/biblio_hoffer.html were all board certified in psychiatry.
Other famous orthomolecular practitioners and researchers include:
Ruth Flinn Harrell, Ph.D. (Down syndrome; learning disabilities)
http://www.doctoryourself.com/downs.html

Lendon Smith, M.D. (pediatrics)
http://www.doctoryourself.com/smith1.html and
http://www.doctoryourself.com/biblio_lsmith.html

Wilfrid Shute, M.D.; Evan Shute, M.D. (cardiovascular disease)
http://www.doctoryourself.com/estory.htm and
http://www.doctoryourself.com/shute_protocol.html and
http://www.doctoryourself.com/biblio_shute.html

Frederick Robert Klenner, M.D. (viral illnesses; multiple sclerosis)
http://www.doctoryourself.com/klennerbio.html

Robert F. Cathcart III, M.D. (viral illnesses)
http://www.doctoryourself.com/biblio_cathcart.html

William Kaufman, M.D., Ph.D. (arthritis)
http://www.doctoryourself.com/kaufman.html and
http://www.doctoryourself.com/biblio_kaufman.html

William J. McCormick, M.D. (bacterial illness; cardiovascular disease)
http://www.doctoryourself.com/mccormick.html and http://www.doctoryourself.com/biblio_mccormick.html

Roger J. Williams, Ph.D. (alcoholism)
http://www.doctoryourself.com/rjwilliams.html and
http://www.doctoryourself.com/biblio_williams.html

You can learn more about these and many other distinguished advocates of nutritional medicine, such as Drs. Harold Foster, Josef Issels, David Horrobin, Alan Cott, Archie Kalokerinos, Henry Turkel, Ewan Cameron, and Cornelius Moerman, by going to http://orthomolecular.org/hof/index.shtml

Why is OMNS highlighting all these researchers? Because others try to direct your attention away from them. We think you should be aware of their work and look into it.

And do be sure to visit the American Cancer Society’s gift shop. http://www.acsgiftshop.com/

(Andrew W. Saul taught nutrition, health science and cell biology at the college level, and has published over 100 reviews and editorials in peer-reviewed publications. He is author or coauthor of eight books and is featured in the documentary film Food Matters. His website, http://www.doctoryourself.com, is peer-reviewed.)

References:

1. Padayatty SJ, Sun H, Wang Y, Riordan HD, Hewitt SM, Katz A, Wesley RA, Levine M. Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med. 2004 Apr 6;140(7):533-7. Full text free download: http://www.annals.org/content/140/7/533.full.pdf

2. Padayatty SJ, Riordan HD, Hewitt SM, Katz A, Hoffer LJ, Levine M. Intravenously administered vitamin C as cancer therapy: three cases. CMAJ. 2006 Mar 28;174(7):937-42. Free full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1405876/?tool=pubmed

3. Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol) 2004;16:549-560.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed?term=Morgan%20G%2C%20Ward%20R%2C%20Barton%20M.%20The%20contribution%20of%20cytotoxic%20chemotherapy

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (Canada)
Damien Downing, M.D. (United Kingdom)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, Ph.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Thomas Levy, M.D., J.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Shuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)

Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email: omns@orthomolecular.org

To Subscribe at no charge: http://www.orthomolecular.org/subscribe.html

1 Comment | Latest Nutritional Research, Nutritional Supplements and Disease, Orthomolecular Medicine | Tagged: , | Permalink
Posted by Dr. Gina Nick

The National Library of Medicine Censors Research on Nutritional Medicine- Take Action Today!

January 30, 2010

Medical Research Bias

Below is an interesting news release provided by Orthomolecular Medicine News Service that demonstrates the clear and unfortunate bias against nutritional and natural medical therapies from the world’s most reputable and trusted medical research site- Medline.  It is not surprising but it is disappointing, given that medical writers for all of our major news media outlets rely on this research site to create their reports on health.   This bias is not to be taken lightly.  The research both in clinical practice and in the lab, does exist, that shows the efficacy of using natural and nutritional therapies to prevent and treat disease, especially chronic diseases that place the greatest financial burden on our country.  The healthcare industry is broken. Using Naturopathic Medicine and other natural and environmentally friendly medical modalities proven effective, will contribute to a new, simple, realistic and affordable healthcare system in our country- a system that can serve as a demonstration to the rest of the world of a better way to mange health, for the betterment of humanity and the planet.

In health,

Dr. G

—

Want to be a MEDLINE Information Censor?
The National Library of Medicine Needs You!

Would you like to dictate what nutritional research people may or may not access? Why not join the NLM’s Literature Selection Technical Review Committee?
We think a good preparatory step is to take the Medline Censorship Aptitude Test (MED-CENT).
Not to worry; it’s multiple choice.

First question: Which of the following research papers is NOT indexed by the National Library of Medicine’s Medline?

A) Olfactory responses and field attraction of mosquitoes to volatiles from Limburger cheese and human foot odor. (J Vector Ecol, 1998)

B) Heated socks maintain toe temperature but not always skin blood flow as mean skin temperature falls. (Aviat Space Environ Med, 2003)

C) Jefferson JW, Thompson TD. Rhinotillexomania (nose-picking): psychiatric disorder or habit? (J Clin Psychiatry, 1995)

D) Pauling L, Rath M. An orthomolecular theory of human health and disease. (J Orthomolecular Medicine, 1991)

Answer: Only choice “D” is not available on Medline. The others most certainly are. Search each one and see for yourself at http://www.ncbi.nlm.nih.gov/pubmed/ or http://www.ncbi.nlm.nih.gov/sites/entrez

Let’s try another: Which of these studies is NOT indexed by Medline?


A) Psychophysiological responding during script-driven imagery in people reporting abduction by space aliens. (Psychol Sci, 2004)

B) The eyebrow frown: a salient social signal. (Emotion, 2002)

C) Staring at one side of the face increases blood flow on that side of the face. (Psychophysiology, 2004)

D) Rath M, Pauling L. Solution to the puzzle of human cardiovascular disease: Its primary cause is ascorbate deficiency leading to the deposition of lipoprotein(a) and fibrinogen/fibrin in the vascular wall. (J Orthomolecular Medicine, 1991)

Answer: “D” is not on Medline. All the rest are.

Ready? Select the study below that is NOT on Medline:


A) Espresso kiosks can be profitable addition to hospital foodservice. (Health Foodserv Mag, 2000)

B) Espresso maker’s wrist. (West J Med, 1990)

C) Characterization of particles in cream cheese. (J Dairy Sci, 2004)

D) Rath M, Pauling L. Case Report: Lysine/ascorbate related amelioration of angina pectoris. (J Orthomolecular Medicine, 1991)

Yes, the study that Medline does not think is important enough for you to see is choice “D”. The others are all indexed online by NLM at taxpayer expense.

Next:

A) The Easter bunny in October: is it disguised as a duck? (Percept Mot Skills, 1993)

B) Increasing the portion size of a packaged snack increases energy intake in men and women. (Appetite, 2004)

C) A piece of my mind. Reflections while listening to the Glazunov Saxophone Concerto. (JAMA, 2003)

D) Rath M, Pauling L. Apoprotein(a) is an adhesive protein. (J Orthomolecular Medicine, 1991)

You guessed it: “D” is not on Medline.

One last chance, now:


A) How dogs navigate to catch Frisbees. (Psychol. Sci, 2004)

B) Effect on tipping of barman drawing a sun on the bottom of customers’ checks. (Psychol Rep, 2000)

C) An objective evaluation of the waterproofing qualities, ease of insertion and comfort of commonly available earplugs. (Clin Otolaryngol, 2004)

D) Hoffer A, Pauling L. Hardin Jones biostatistical analysis of mortality data for a second set of cohorts of cancer patients with a large fraction surviving at the termination of the study and a comparison of survival times of cancer patients receiving large regular oral doses of vitamin C and other nutrients with similar patients not receiving these doses. (J Orthomolecular Medicine, 1993)

Choice “D” is not indexed by Medline. The others are. Yes, they really are. Just type in the title at http://www.ncbi.nlm.nih.gov/pubmed/ or http://www.ncbi.nlm.nih.gov/sites/entrez

If you got all the above items right, you are well qualified to become a member of the NLM’s Literature Selection Technical Review Committee, because you can discern what research should and should not be available to the public.

Censoring Linus Pauling

If you look carefully at the first four questions, you will see that four of Linus Pauling’s papers appeared in the Journal of Orthomolecular Medicine in just one year. That year was 1991. Two years after this, JOM was reviewed by the National Library of Medicine’s Literature Selection Technical Review Committee. NLM uses a point scale of zero to 5, with five being the highest recommendation for indexing, and zero being the lowest. On March 4, 1993, the Journal of Orthomolecular Medicine received a “0.0” score.

One cannot escape the significance of such judgment. After all, “0.0” is not merely a low mark. “0.0” represents an absolute dearth of merit. And “zero point zero” states it so flatly as to leave no room for alternate interpretations.

To this day, after additional reviews, Medline still does not include the Journal of Orthomolecular Medicine.

To read the Linus Pauling papers that Medline decided rate a “0.0”: http://orthomolecular.org/library/jom/1991/toc3.shtml and http://orthomolecular.org/library/jom/1993/toc3.shtml
For free online access to 600 more full-text papers from the Journal of Orthomolecular Medicine: http://orthomolecular.org/library/jom/

To personally thank your National Library of Medicine for keeping all this information from the taxpayer:
Ms Betsy Humphreys, Deputy Director, NLM
email: betsy.humphreys@nih.gov or betsy_humphreys@nlm.nih.gov
phone: 301-496-6661

You can also call the NLM Customer Service desk at 1-888-FIND-NLM (1-888-346-3656). Remember to be polite, because, after all, they are the “World’s Largest Medical Library.” http://www.nlm.nih.gov/nlmhome.html
Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.
Editorial Review Board:
Carolyn Dean, M.D., N.D. (Canada)
Damien Downing, M.D. (United Kingdom)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, PhD (USA)
Bo H. Jonsson, MD, Ph.D (Sweden)
Thomas Levy, M.D., J.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Erik Paterson, M.D. (Canada)
Gert E. Shuitemaker, Ph.D. (Netherlands)

OMNS free subscription link http://orthomolecular.org/subscribe.html
OMNS archive link http://orthomolecular.org/resources/omns/index.shtml are included.

2 Comments | Latest Nutritional Research, Naturopathic Medicine, Nutritional Supplements and Disease, Orthomolecular Medicine, Prevention | Tagged: , , , | Permalink
Posted by Dr. Gina Nick

Do Vitamins Cause Cancer?

November 30, 2009

Weighing the benefits of nutritional supplements

I am reprinting a press release from the Orthomolecular Medicine News Service that discusses a newly published study, sure to get press, that implies that a simple folate supplement increases cancer rates in patients who are diagnosed with heart disease.  This press release does an excellent job of helping readers read between the lines when articles are released that are biased against natural health products.  I encourage you to read and listen to all health related discussions and advertisements through a similar, more well-informed lens.

Yours in health,

–Dr. G

—

FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, November 29, 2009
 

Does Everything Cause Cancer, Even Vitamins?
Folate, B-12 and Cigarettes: Guess Who the Real Culprit Is

(OMNS, November 29, 2009) A newly released study suggests that folate supplements can increase cancer rates in patients who have heart disease [1]. But the data for the study was not collected to test the effect of supplemental folate on cancer, and appears to be biased by the high fraction of smokers and by the low levels of supplements given. All of the groups in the study had high rates of cancer, whether or not they took a folate supplement. The suggested increase in cancer risk is very small, only 1.6%. Because of these problems, the report appears to be biased by uncontrolled factors in the data collection and analysis.

The study combined the data from two recent trials performed in Norway that tested the effect of folate and vitamin B-12, two closely related B vitamins, on the homocysteine levels in the blood and on overall mortality [2,3]. The rationale for these trials was that high levels of homocysteine are known to be a risk factor associated with atherosclerosis, and are sometimes associated with low folate levels [4,5]. Folate and vitamin B-12 are important for growth because they involved in the synthesis of DNA. Folate is crucial for the prevention of spina bifida and other developmental defects in babies. Folate is also known to prevent the occurrence of cancer, and to reduce atherosclerosis and related heart problems [6,7].

Another reason to be cautious about the conclusion of the study is that most of the cancers detected were slow-progressing and would not be expected to be initiated by a relatively low dose of an essential vitamin, such as folate, over the 3-year period of the study. It would appear much more likely that the vitamin supplements actually reduced new cancer incidence as shown in previous studies [7], but that any cancers that showed up later were already initiated but undetected at the start of the study [8]. The real cause of cancer may be connected to the heart disease in these subjects because of their long history of smoking and ill health.

In these two trials, the subjects were selected for having heart disease and were therefore quite ill. The vitamin amounts were small: 0.8 milligrams/day of folic acid; 0.4 mg/day of vitamin B-12, and 40 mg/day vitamin B-6. These amounts are low by comparison with other studies, where commonly much larger amounts of folate and vitamin B12 are given (40 mg/day folic acid, 2 mg/day of vitamin B12) [9]. Orthomolecular (nutritional) physicians maintain that larger nutrient doses are more effective in preventing illness than are small doses.

Indeed, the data from the two trials showed a cancer increase that was non-significant. That’s right, it could be merely random variation. This is important. One reason this is likely is that the point where a subject stopped being considered as part of the statistical significance was either any cause of death, or a heart-related event, or a stroke [2,3]. Thus subjects who died of unrelated causes were tallied in the statistics, which would tend to obscure any effects of the treatment. Other uncontrolled factors, for example the general ill health of the subjects, or behavioral factors like the amount of smoking, very likely contributed to the variability. In an attempt to give more statistical significance the study combined the data from both trials to double the number of subjects. A claimed increase in cancer due to increased folate levels is not borne out by statistics for the population of the US where folate levels have increased recently , because the cancer rates have significantly dropped [7].

Interestingly, health was actually improved in the subjects that received folate plus vitamin B-12, because for them the rates of acute hospitalization for angina and the incidence of stroke were lower by about 4% than for the placebo group.

In conclusion, any apparent increase in cancer risk is close to the expected random variability in the cancer rate, implying that much or all of any alleged “vitamin problem” is purely due to chance.

Findings due to chance are not scientific findings. Isn’t it interesting that a major journal (Journal of the American Medical Association) would publish this research? Perhaps nonsignificant data are acceptable if you have an anti-vitamin orientation. Researchers previously found that in major medical journals, more pharmaceutical company advertising resulted in the journal having more articles with “negative conclusions about dietary supplement safety.” [10] JAMA carries a large number of pharmaceutical ads.

Bottom line: vitamins do not cause cancer. Smoking does.

References:

[1] Ebbing M, Bonaa KH, Nygard O, Arnesen E, Ueland PM, Nordrehaug JE, Rasmussen K, Njolstad I, Refsum H, Nilsen DW, Tverdal A, Meyer K, Vollset SE (2009) Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA 301: 2119-2126.

[2] Bonaa KH, Njolstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, Wang H, Nordrehaug JE, Arnesen E, Rasmussen K; NORVIT Trial (2006) Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med. 354:1578-88.

[3] Ebbing M, Bleie O, Ueland PM, Nordrehaug JE, Nilsen DW, Vollset SE, Refsum H, Pedersen EK, Nygard O.(2008) Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: a randomized controlled trial. JAMA. 300:795-804.

[4] McCully KS. (2009) Chemical pathology of homocysteine. IV. Excitotoxicity, oxidative stress, endothelial dysfunction, and inflammation. Ann Clin Lab Sci. 39:219-232.

[5] Terwecoren A, Steen E, Benoit D, Boon P, Hemelsoet D. (2009) Ischemic stroke and hyperhomocysteinemia: truth or myth? Acta Neurol Belg. 109:181-188.

[6] Imamura A, Murakami R, Takahashi R, Cheng XW, Numaguchi Y, Murohara T, Okumura K. (2009) Low folate levels may be an atherogenic factor regardless of homocysteine levels in young healthy nonsmokers. Metabolism. 2009 Nov 13. [Epub ahead of print]

[7] Drake BF, Colditz GA (2009) Assessing cancer prevention studies: a matter of time. JAMA 302:2152-2153.

[8] Kim YI. (2008) Folic acid supplementation and cancer risk: point. Cancer Epidemiol Biomarkers Prev. 17:2220-2225.

[9] Jamison RL, Hartigan P, Kaufman JS, Goldfarb DS, Warren SR, Guarino PD, Gaziano JM; Veterans Affairs Site Investigators. (2007) Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial. JAMA. 298:1163-1170.

[10] Pharmaceutical advertising biases journals against vitamin supplements. Orthomolecular Medicine News Service, February 5, 2009. http://orthomolecular.org/resources/omns/v05n02.shtml

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Carolyn Dean, M.D., N.D.
Damien Downing, M.D.
Michael Gonzalez, D.Sc., Ph.D.
Steve Hickey, Ph.D.
James A. Jackson, PhD
Bo H. Jonsson, MD, Ph.D
Thomas Levy, M.D., J.D.
Jorge R. Miranda-Massari, Pharm.D.
Erik Paterson, M.D.
Gert E. Shuitemaker, Ph.D.

Andrew W. Saul, Ph.D., Editor and contact person. Email: omns@orthomolecular.org

OMNS free subscription link http://orthomolecular.org/subscribe.html OMNS archive link http://orthomolecular.org/resources/omns/index.shtml

12 Comments | heart disease, Latest Nutritional Research, Nutritional Supplements and Disease, Orthomolecular Medicine | Tagged: , , , , , , , , , , , , | Permalink
Posted by Dr. Gina Nick

%d bloggers like this: