 |
|
|
Bio-Identical Hormone Replacement Therapy
"We can drift along with general opinion and tradition, or we can throw ourselves upon the guidance of the soul within and steer courageously toward truth… We have a choice in every event and every limitation and….to choose is to create." ~Helen Keller
We as Nutritional Therapists are so fortunate to be a part of the ever growing and evolving field of alternative health. But any growth process is inevitably accompanied by growing pains. As new research and clinical evidence arises, we as NTP’s have a responsibility to not only gather and assess information about the health of our clients, but also information regarding new therapies and treatments. These may include both therapies that we are using and treatments that our clients may be undergoing under the guidance of other practitioners or doctors.
Controversy around treatment techniques is rampant in conventional medicine, but also periodically infiltrates the field of alternative medicine. The current implementation of Bioidentical Hormone Replacement Therapy is one such issue. I have one rule of thumb in these matters: if the answers to simple questions on a subject are not clear, comprehensive and easy to find, something’s wrong. This is especially true when extreme opposing opinions abound. Hormone Replacement Therapy in general fits this rule.
I was compelled to write this article after what I have seen in my practice over that last three years or so. People are coming in to my office, feeling horrible, and suffering from all kinds of symptoms that their “bioidentical hormones” are supposed to subdue. Not to mention the side effects of the poor management of these protocols! I’m certain that you will or have witnessed the same thing.
Since the 1930’s, American women have been led to believe ( I like the term “coerced" myself), that Menopause, a natural event in every woman’s life, is rather a “disease”, a new medical condition that requires drug therapy to “cure”. Just coincidentally, a new drug was “discovered” that will do just that: synthetic estrogen! What an amazing coincidence!
Now, menopause is a period of time in a woman’s life in which gradual hormonal changes bring a shift from a focus on childbearing in favor of a more mature condition of mental and spiritual development. The distasteful symptoms that have become associated with menopause are common only in a specific group of women in history: Northern European and American women in the last 75 years. Outside of this group, menopause is not such a big deal, and is met with much greater ease, as a natural transition in a woman’s life. It seems that a simpler lifestyle and more natural diet provide for an easier transition.
CREATING A MARKET: THE GENESIS OF HRT
This story begins in 1938. Charles Dobbs discovers diethylstilbestrol (DES). It was supposed to be the first synthetic estrogen. Dobbs first thought DES would solve the problems of menopause, but the American Medical Association immediately began to make extravagant predictions for the prevention of “miscarriages” and solving all problems of pregnancy as well.
By 1960, it was being found that between 60% and 90% of DES daughters had abnormal sex organs, leading to high rates of infertility, miscarriages and cervical cancer. DES sons were commonly found to have testicular dysfunction and were sterile. As for the mothers who had taken DES, their risk of breast cancer had been increased by 40%. But still the drug stayed on the market until 1971! No matter, for by this time, ERT ( estrogen replacement therapy ) was off and running.
By 1966, public attention was diverted from the DES disaster by the bestseller “FEMINE FOREVER”. Written by Dr. Robert Wilson, a New York gynecologist and sponsored by the drug manufacturer, Wyeth-Ayerst, it theorized that menopause was an estrogen deficiency disease. All the unpleasant symptoms accompanying menopause were the simple result of too little estrogen. Insufficient estrogen supposedly caused a woman to lose her youth, beauty, cheerful attitude and bone density, all in one fell swoop. The drug industry didn’t miss a beat.
They immediately donated $1.3 million to set up the Wilson Foundation for the sole purpose of the development and promotion of estrogen drugs. The usual story ensued: limited studies with inconclusive results, skewing results to please the company paying for the trials and discontinuing studies that weren’t turning out “right”. FDA approval was given for synthetic estrogen on the basis of one study! Throughout 1964-5, fueled by the advertising power of the biggest clients, articles appeared in major women’s magazines, proclaiming a breakthrough that would finally “set women free from the ravages of the dread menopause”. Within a few years, with no proof that Wilson was correct and with superficial clinical trials, a new industry was created. It was named, Estrogen Replacement Therapy.
The American public had many opportunities to become aware of the dangers of this therapy. But through the complex rhetoric of the drug industry and their mouth pieces, coupled with our deep seeded trust in our medical profession, (who could understand all those big words if they weren’t absolutely BRILLIANT!) we paid no heed. And besides, the FDA and all of the other agencies that were mandated to protect the public were watching out for us, no?
There was a multitude of “peer reviewed studies” reporting the dangers of this new therapy. Trials published in JAMA (Journal of the American Medical Association) reported that using Premarin (estrogen derived from horse urine) in men increased incidence of heart attacks and blood clots. A 1975 documentation in the New England Journal of Medicine showed estrogen use increased the incidence of endometrial cancer in women. A 1976 study linking breast cancer to estrogen use was reported in the New England Journal of Medicine.
In 1982 experts reported in Cancer Research that HRT was the leading factor in reproductive cancers. In 1985, the Framinghnam Study showed that cardiovascular events rose in women taking estrogen. In 1989, a Swedish study reported that when women switched to a combination HRT, their breast cancer risk more than doubled. (combination “HRT” included the addition of synthetic progesterone or “progestin”. Progestin has since been shown to be completely replete of the positive effects of progesterone once it is metabolized by the liver, but still retains side effects.)
And on the studies went throughout the 1990’s, showing again and again the association of both unopposed estrogen replacement and combination hormone replacement therapies with increased incidences of breast, ovarian, endometrial and other forms of cancer.
In 2001, premarin prescriptions rose to more than $11 million annually.
In 2002, this news from Washington shocked the world; government scientists brought one of the largest HRT studies to an immediate halt. “The National Institutes of Health found that daily doses of synthetic hormones given to women participating the Women’s Health Initiative Study ( WHI ) that began in 1998, “significantly increased the women’s risk of breast cancer, strokes and heart attacks”… [The] use of estrogen and progestin increased otherwise healthy women’s risk of stroke by 41%, a heart attack by 29%, and breast cancer by 24%.”
There is no excuse for this ongoing mistreatment. Study after study shows that women are being used as guinea pigs. Advertisements sponsored by powerful organizations have a vested interest in marketing synthetic HRT, and doctors still continue to prescribe it even after the WHI study results. This is unfortunate as there are other safe and natural treatments and safer forms of HRT available if needed. In fact, sadly, the process of producing natural progesterone from yams and soybeans was discovered back in the 1930’s. Unfortunately, science had not yet, not until the 1990’s, discovered the role of proper progesterone levels in the body. Even so, conventional medicine chose to alter this natural form in order to make a profit. Never mind the glaring messages (above), that is was not only NOT working, but killing people. (women)
And so our role as Nutritional Therapists is reinforced. We are educators and in order to do this well, we must continually educate ourselves.
"As we become more educated about safer alternatives and become more aware of the social, economical, and environmental influences which prolong harmful health habits, we will be able to understand more clearly the distinction between the politics and the evidence."
~Raquel Martin – THE ESTROGEN ALTERNATIVE
And so began the use of Bioidentical Hormone Replacement as therapy for the symptoms not only of menopause, but now pre-menopause, PMS and a host of other hormonal “symptoms”. And as is usual in human nature, we have discovered a new “cure all”.. and many doctors have dived into the use of this therapy feet first, head last.
WHAT ARE HORMONES?
The human body is a community of individual cells, each of which has become specialized to support the function of the community. Each of these cells needs to act in synchrony with every other cell.
Hormones are tiny signaling molecules (messengers), that allow each cell in the body to know what is going on in the outside world and to communicate with each other to coordinate a unified response, thus insuring the safety and survival of the community (us!). Hormones are chemical compounds that are players in the most sophisticated and exquisitely balanced internet in the entire body: the endocrine system.
This group of glands, including the adrenals, the pituitary, the ovaries, the testes, the thyroid and the hypothalamus are interrelated in impossibly complex ways, about which we’re just beginning to get glimpses of understanding. It’s a swirling universe of chemical elegance and precision, involving millions of refined little molecular firings which wink in and out of existence every second. “Touch one strand and the whole web trembles” is the way endocrinologist Dr. Deepak Chopra describes it.
"The endocrine system controls all other systems of the body be means of tiny biochemical messengers, who wait for an answer." ~Tim O’Shea
These hormones are subtle and fragile and transient. They deliver their message, are around for a second or two, (turn in up, turn it down, turn it off or on) and are gone, immediately metabolized by the liver.
Dr. Jonathan Wright, MD, describes hormones as “metabolic keys” in his book, Natural Hormone Replacement for Women.
“Hormones function like two ended keys":
- The R end, or receptor end, fits precisely into a cell receptor and “unlocks” the metabolic door to initiate an action.
- The E end, or enzyme end, fits precisely with cellular enzymes that transform the hormone into another hormone, or into a metabolite for excretion.
This amazing communication system interacts in a delicate balance. The hormones work together as a synergistic whole. Dr. Deepak Chopra’s analogy is beautiful and bracingly accurate. If we have learned one thing about the endocrine system in these 70 years, its that you can’t just throw a hormone into the system because the levels are low. There is the potential to disrupt the entire balance. This is the current “Replacement” model adopted by conventional medicine, and being used in alternative medicine protocol as well. We’ve begun fooling around with this highly tuned system because we’ve discovered a few coarse, synthetic or naturally derived substances that resemble real hormones. We really have only the vaguest notion of what we’re doing because of all of the overlapping relationships. For example: the adrenals, thyroid and ovaries are not 3 separate and independent entities. They’re more like 3 ingredients in a cake, or 3 members of a yacht crew. It is beneficial to understand at least a bit more about what is known regarding the relationships in this grand play!
WHAT IS A SYNTHETIC HORMONE?
A synthetic hormone is a plant based hormone that is then biochemically altered so that it can be patented. (So far, there are laws preventing big pharma from patenting a natural substance.)
These substances are slightly askew, for instance their R end may be recognized by the body, but the E end is different. Can you see a problem here? These types of hormones cannot properly be transformed into other hormones or properly and in a timely manner, be removed from the body. Think of the Christmas fruitcake….the “gift that keeps on giving”! These hormones remain in the body indefinitely, promoting processes that are normally controlled by the feedback loops and are meant to turn on and off in synchrony. They disrupt the delicate balance and clog the liver as well, producing the life threatening side effects discussed above. Oh, and the levels cannot be tested in the human body, as they are a different substance. Hmmmmmm.
HOW DO BIOIDENTICAL HORMONES DIFFER?
Bioidentical hormones are just that. They are biochemically identical to the hormones found in our bodies, They are formulated from naturally based plant substances such as yam and soy, with added conversion factors such as enzymes to help them assimilate. They have the same molecular and chemical structure as those hormones found in the human body.
OK, so they are biochemically identical…but…are they “Natural”. The jury is out on that since they require the addition of certain enzymes and activators to make them useable in the body.
But are they safe? Well, currently there have been no major studies done, like the WHI and most have not been approved by the FDA. But it does make sense that there could certainly be a safer alternative. It will be some time before clinical trials can answer this query.
The problems that I and others are witnessing don’t seem to be with the actual hormones themselves however, as long term studies and clinical feedback is necessary but rather the ignorance with which they are given. Our doctors are not taking time to educate themselves. The reasons are multiple and complex: medical school debt, too much paperwork, hospital duties and life! We, however, as NTP’s have two superhero doctors on our side.
Both Dr.’s Janet Lang and Datisse Kharrazian have clinical experience AND have managed to do their homework on this topic. Their endocrinology seminars are offered to health care professionals through Standard Process and Apex Energetics and I cannot recommend them highly enough. They have both been educating doctors and other practitioners on this topic for years. After a one weekend seminar, you will know more about this topic than almost ANY doctor out there.
Generally speaking, most doctors and practitioners are giving hormones based on symptom presentations and are not performing any baseline testing, nor monitoring progress. There is much to consider and much more that we don’t know yet. So, if/when you have a client either ON BHRT, or considering bioidentical hormone replacement therapy, (synthetic hormones should NEVER be considered based on the WHI Study), there are certain things to be aware of that you may pass along to them.
NOTE: Both estrogen and testosterone are available only by prescription (bioidentical or synthetic). You do NOT need a script for Pregnenolone, progesterone or DHEA (although the FDA is currently threatening to allow DHEA by prescription only).
HERE ARE SOME GUIDELINES WHEN CONSIDERING BIOIDENTICAL HORMONE REPLACEMENT THERAPY
* (the tip of the iceberg is considering the “we don’t know what we don’t know” part. ) Although almost any hormone can be compounded, we will be referring to the sex hormones from here, as they are most commonly replaced in this way.
1. The sex hormones are part of a group of hormones made from cholesterol. These are called “Steroid Hormones”. Others made from this substance are cortisol, DHEA, and the precursor Pregnenolone. Remember cholesterol is produced and regulated mainly by the liver, and is produced from the proper type and ratio of dietary fat. Dr. John Lee has provided us with a very clear summary:
The Cholesterol or Steroid Hormone Pathway
This diagram shows us some interesting things about the interaction between the steroid hormones. Some of the hormones in this pathway can be converted into others, and some can convert back, while others cannot. We can see that pregnenolone, the precursor to all of these hormones, can be used to produce both DHEA and Progesterone. We can also see that Progesterone can be used as progesterone, or to make other hormones like, cortisol, testosterone or estrogen. The arrows indicate the direction of formation. As you can see, estrogen is at the bottom of the barrel and cannot be converted into other hormones. This diagram also shows us something a little more subtle. Remember that the body prioritizes survival NOW and consequently has a back up system for everything. Also remember, the adrenal glands are our fight or flight organs, and when they are activated, all other processes go on hold because survival is most important.
When someone is in fight or flight, real or perceived, chronic or acute, running from the internal or the external tiger, the adrenals are stressed and have priority over the nutrients and hormonal precursors. What is more important to the body, survival now, or reproduction??? So beware, with your client who is chronically stressed. Her adrenals are tired because she is over producing cortisol to try to keep up with her stress demands. Feeding her progesterone, pregnenolone or DHEA to try to increase her levels of the sex hormones can drive her stress response even harder as these precursors will be shunted to the priority system, upregulating the production of cortisol even more. And in the case of prolonged stress, can you see how someone could be depleted in progesterone in particular or the other sex hormones as well? This is generally not true with estrogen however.
Unless you know where the precursors and upstream substances are going, you can actually exacerbate the issue at hand, or create a new problem.
NOTE: giving someone downstream hormones can be dangerous as well i.e., Estrogen. There is no where for the excess to go. The conversion arrows here are one way.
2. The Feedback Loops
The body maintains homeostasis through many complex processes. One of these is the Feedback Loop in the Endocrine System.
The Hypothalmus receives and interprets information from the environment. Here is how a Negative Feedback Loop operates in the Sugar Handling System:
- A carbohydrate is ingested ---- a messenger hormone informs the hypothalamus the the blood sugar is rising ---- The Hypothalmus receives this information, makes an interpretation as to what is needed. It then stimulates the Pituitary Gland to send a message to the Pancreas to produce and release insulin to help shuttle the glucose out of the blood stream and into the cells. Once blood sugar levels are back into range --- yet another messenger informs the Hypothalmus – after careful consideration, the Hypothalmus stimulates the pituitary to inform the pancreas to cease the release of insulin, thereby halting the movement of glucose from the bloodstream into storage. This entire process is accomplished by the hormones running the information to the specific glands.
Because of the intricate relationships in this system, we often see multiple endocrine organ stress, referred to as the "hormonal cascade". When you observe this along with sex hormone symptoms in a cycling woman, the whole system is stressed and the feedback loops aren’t working properly. Giving support to the feedback loop specifically, using nutrients for the Hypothalmus, Pituitary or whole endocrine system can be very helpful in most cases. Giving the hormone, ( synthetic or natural ) directly in this case will most often shut down this feedback loop completely.
NTA Rule #1 ~ The body knows everything it needs to do to maintain perfect health and balance and it will, given the right raw materials with which to do so. NEVER forget to support the Endocrine System by first supporting the Foundations….
3. Cycling females should rarely, if ever, be given hormones of any kind. Supplemental protocols are generally very helpful.
4. A Post Menopausal woman or woman with a complete hysterectomy is a candidate in some cases (both uterus and ovaries are gone).
*Information taken from Dr. Janet Lang and Dr. Datisse Kharrizian’s Functional Endocrinology Seminars
5. Always perform a PROPER baseline test, and monitor progress regularly.
- There are several different ways to test: Salivary, Blood, Urine or Hair. All measure the status a little differently. KNOW WHAT YOU ARE TESTING! Most doctors don’t.
a. Men can convert healthy testosterone to either estrogen or DHT ( toxic form) under certain circumstances. This can present even in a blood test as LOW testerone. What would happen if we only tested for testosterone, found it low and supplemented with testosterone hormone??? It would exacerbate the problem wouldn’t it? However, in cases of true primary hypogonadasim, testosterone could be indicated.
b. Cycling women have hormone levels that fluctuate widely over their monthly cycles. You must take a test that gives you multiple samples over the monthly cycle. You cannot take a single, one sample test and imagine it to be accurate, though this is what doctors have done for 70 years, if they even bothered to perform a test.
c. Of main importance is the “ratio” between progesterone and estrogen, not their singular levels alone *30:1 (Dr. Janet Lang) in favor of progesterone. These hormones MUST be found in the proper ratio for either to function properly, and not create they types of life threatening issues that were mentioned above.
Example: Either a progesterone deficiency or an estrogen excess can create the exact same symptoms. This is very similar to mineral ratios.
d. Remember: synthetic hormones do not show up on salivary or blood panels. It’s anyone’s guess....
6. IF it is determined that someone needs hormonal support, the delivery system is an extremely important consideration.
- The most common delivery medium are the hormonal creams. Fast, efficient delivery? ABSOLUTELY! PROBLEM: They can be too efficient. They can bring hormone levels up to where they should be, sometimes within just a week or two. Unfortunately, most practitioners are NOT testing often enough, or even at all! The danger here is that the excess hormone, being delivered through a fat soluble medium, can accumulate in the fat tissue. If this continues, a whole new phenomenon is created. That of HORMONAL RESISTANCE. This presents as symptoms of deficiency in the presence of excess….
- At this point, the doctor will assume the client needs MORE, so they up the dose, symptoms magically disappear for another couple of weeks and then VOILLA, theyr’e BACK!!! And on it goes. This is both deceiving and dangerous. However, if you test appropriately, you can manage these clients properly.
- Hormonal Patches are one of the latest and greatest….”you simply don’t have to worry about taking your hormones little lady”. This results in the same problems described above because they too are absorbed into the fat tissue.
My personal favorite is the “PELLET”. Why, just “IMPLANT” this little puppy right under the skin into your fat tissue and call us in 6 months! No Worries!
WORRY!!!!!
Case study: 44 year old female, partial hysterectomy at age 29 due to excessive bleeding. one ovary remaining. Complex history. Suffering from extreme hot flashes in excess of 100 daily, beginning 3 months earlier. Nutritional support reduced them to less than one per day. Client changes doctors from her Family Prac. to a local MD who has been studying “functional medicine” with Jeffery Bland of Metagenics fame. Dr. claims she can eradicate her “pre-menopausal” symptoms with bioidentical hormone replacement therapy.
TREATMENT: a single sample blood test which did NOT include progesterone. Could this woman still be cycling? YES! She still has one ovary! Will a single sample test be accurate for this woman? Who knows! We don’t know if she is cycling!!! ( see below).
DR. then sends patient directly to the compounding pharmacy with a script for estrogen and testosterone in a pellet form, to be implanted under the skin on her …..bottom. Do we wait for the test results first? WHY NOT? Why waste her money if she was going on symptoms alone anyway?
TEST RESULTS TWO WEEKS LATER:
- Estrogen levels: in range
- Testosterone levels: low normal
Our client has estrogen and testosterone being delivered into her system for the next 6 months WHICH SHE DOESN’T NEED, in a form that cannot be extracted!
3 MONTHS LATER: Client has gained over 30 pounds and has EXTREMELY painful and swollen breast tissue, bilaterally. After a visit to her family practitioner she was sent off to have an ultrasound and then an exam by a surgeon two weeks later. The surgeon found 3 more lumps since the ultrasound. She was acquiring these painful fluid filled cysts faster than the surgeon could determine his course of treatment! His only recommendation was to “drain” the cysts. Symptom management at its best.
Very curiously, Dr. Judi Gerstung mentions in her book: The Estrogen Alternative, that 2 symptoms associated with excessive synthetic estrogen replacement therapy are….”Excessive, rapid weight gain, and severe inflammatory breast disease". Hmmmmm. Suppose improper use of Bioidentical Hormones can produce the same results.
- Suppositories, injections and oral tablets are some other methods.
- The method recommended by both Dr. Janet Lang and Dr. Datisse Kharrizian are the sublingually delivered hormones. This technique requires that a person applies the substance several times daily in some cases, but this inconvenience allows for a much safer treatment protocol. After all, when you become sufficient, you can stop. It doesn’t accumulate in the fat tissue like the creams do either.
7. XENOHORMONES (Hormone Disruptors) or “The Christmas Fruitcake: The Gift that keeps on giving”.
No discussion on this topic would be complete without the inclusion of this VERY important subject. The condition referred to as ‘Estrogen Dominance’ or the inappropriate ratio of estrogen to progesterone, is epidemic in our population, male and female. The symptoms are insidious and multiple including: Anxiety, irritability, anger, cramps, heaving bleeding, prolonged bleeding, and clotting with mensus water retention, breast tenderness, mood swings, depression, headaches , carb cravings, muscle, joint and back pain, acne, foggy brain, memory difficulty, fat gain, cold hands and feet, blood sugar instability, irregular periods, decreased libido, biliary stasis, infertility, insomnia, osteoporosis, endometriosis, ovarian cysts, uterine fibroids, cervical dysplasia, allergies, autoimmune disorders, and breast, uterine, cervical or ovarian cancers. Whew. Along with all of these symptoms often come the symptoms of estrogen deficiency from receptor site down regulation or “resistance”. Symptoms of deficiency in the presence of excess hormone! So WHY is it important to test? Because our interpretation of the symptoms is often incorrect!
As bad and even worse than synthetic hormones are the Xenohormones. These are man-made chemicals that are found in our food, air and water. When ingested, they can mimic hormonal activity. However, rather that being subtle, transient and fragile like the hormones manufactured by out bodies, giving a single, powerful message and then disappearing into the miracle of metabolism, these monstrosities arrive, bind to receptors and then hang around like an unwelcome guest. They deliver random and repetitive messages, completely unlike our own hormones. This completely disrupts the beautiful dance, in ways that we both understand and do not yet know.
Xenohormones can: Alter the number of receptors on the cell membranes, alter the sensitivity of receptors on the cell membranes, inhibit the release of hormones, stimulate the release of hormones, disrupt the balance and interactions between hormones (all hormones interact either directly or indirectly with each other), disrupt the endocrine system’s connection and interaction with the nervous system, affect neurotransmitter release and function (many hormones are also released at nerve endings as neurotransmitters ), alter the development of virtually any system in fetuses and growing children.
In the last 60 years, 87,000 KNOWN man made chemicals have been released into the food and water supply and environment, most of which were never tested.
For certain, they are connected to the epidemic of FM/CFS, to the infertility epidemic, to behavior and psychological problems, to the estrogen dominance epidemic and to many if not most cancers.
These are some of the most difficult substances for our bodies to clear.
WHAT CAN YOU DO?
- Become informed and aware of how you can minimize your exposure to the constant sea of pollutants in which we are awash. Beauty care products are some of our biggest culprits. Find out how your products measure up on www.cosmeticdatabase.com.
- Become informed as to how you can decrease your body’s load of toxic chemicals and learn how to strengthen your innate defense mechanisms.
- Support the liver and other major organs of elimination.
And so, can Bioidentical Hormones be beneficial? ABSOLUTELY! Can they be harmful? MOST CERTAINLY, when used ignorantly. These are powerful biochemicals used by the body in nanogram and picagram amounts ( billionths and trillionths of a gram!!) Please be advised.
This is of course the tip of the iceberg, an overview. Please consider attending Dr. Kharrizian’s 3 part seminar “Functional Endocrinology, and Dr. Janet Lang’s Seminars on Female Hormones 1 and 2, and her Adrenal, Thyroid and Male Hormone weekend as well.
References: Information taken from Dr. Janet Lang and Dr. Datisse Kharrizian’s Functional Endocrinology Seminars.
Article by Colleen Dunseth, MS, NTP, CHT
About the Author:
Colleen Dunseth is in clinical practice as a Nutritional Therapy Practitioner and Colon Hydrotherapist, providing education, empowerment and choice in the areas of nutrition and lifestyle. She has been an instructor for the Nutritional Therapy Association for 8 years and a contributor to the growth of the program. To make an appointment email soundnutrition@comcast.net or call 360-701-9204.
To learn more about the the Nutritional Therapist Training Program go to www.nutritionaltherapy.com.
The statements and products shown on this website have not been evaluated by the US Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. The opinions expressed here belong solely to the author and are not necessarily those of NTPtalk.com. |
|
