Transcript Jen Green, ND, FABNO

Treating the Oncology Terrain
in Breast Cancer Survivors
Dr. Jen Green ND FABNO
www.emcura.com
248-885-8211
[email protected]
1
Buyers Beware
 This presentation does NOT cover
interactions between Natural Health Products
and chemotherapy, hormone blocking
medication, radiation & surgery
 Consider a consult with a FABNO ND during
active cancer treatment
2
Treating the Terrain
Cancer can behave like an annual or a perennial
plant. We need tools like surgery, radiation, and
chemotherapy to remove this plant. However, we
must also nurture the soil to prevent harmful plants
from returning.
3
Inflammation &
Hypercoagulability
Stress & Hormonal
Imbalance
Metabolic
Syndrome
Oncogenic
Terrain
Immune
Incompetence
Sustained
Angiogenesis
Carcinogens
4
Inflammation & Cancer: CRP
 Cancer is an inflammatory process –
inflammatory mediators facilitate cancer
growth and metastasis
 According to a meta-analysis of 11 prospective
cohort studies, elevated CRP is associated with
increased risk of getting cancer (1)
 Cancer survivors with high CRP are at greater
risk of cancer related mortality (2,3,4)
5
6
CRP & Breast Cancer
Survivors
 CRP in breast cancer survivors correlates with;
 cancer-related fatigue (1)
 worse cancer related symptoms (2)
 reduced health related quality of life (2)
 A retrospective study shows no link between high CRP &
breast cancer recurrence (4)
 A prospective WHEL study (Women's Healthy Eating and
Living Study) of 2,919 early-stage breast cancer
survivors with 7 yr follow up showed hsCRP associated
with breast cancer death Note: hsCRP threshold was
10.0 mg/L vs. <1 mg/L (3)
7
Post Surgical Inflammation &
Breast Cancer
 Inflammation after surgery a strong
prognostic factor for breast, lung, and kidney
cancers (1)
 Peri-operative use of the anti-inflammatory
drug ketorolac in early stage breast cancer
patients resulted in better 5 year survival,
with early relapse events reduced by 5-fold
(2)
Breast Cancer Death & Aspirin
 Four large prospective observational studies;
 Iowa Women’s Health Study : F.U. 8.3 yrs, survivors
9
taking aspirin compared to nonusers, had 47% less risk
of death due to breast cancer RR (95% CI) 0.53 (0.300.93) (6)
 Nurses Health Study : F.U. 30 yrs, aspirin use 2-7 times
weekly associated with a decreased risk of distant
recurrence & 49% less risk breast cancer death 0.51
(0.41-0.65)(3)
 LACE : F.U 2.5 yrs, no association with aspirin and
breast cancer recurrence, but Ibuprofin use 3x weekly
or more associated with a decreased risk of recurrence
(4)
 Swedish National Cancer Register : F.U 2.6 yrs, no
association between aspirin & breast cancer death (7)
NF-kB: Cancer’s “Master Switch”
 Protein that produces cytokines
 Triggered by oxidation, carcinogens, viruses,
10
inflammation, radiation, chemotherapy &
stress
 Signals 400+ genes involved in inflammation,
proliferation, anti-apoptosis, angiogenesis,
invasion & metastasis
 Activated in a wide variety of tumors
 Implicated in radio-resistance & chemoresistance (1,2,3)
Inflammation & Cancer: NLR
 Neutrophil to Lymphocyte Ratio increases with systemic
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11
inflammation (a non healing wound drives our
surface/neutrophil immunity up and drives deep/cancer
immunity down)
Cost effective & part of routine testing
Predictive of cancer mortality in; colon cancer (1),
ovarian cancer (2), non small cell lung cancer (3), gastric
(4), breast cancer (5), esophageal cancer (6) and more….
Greater than 3:1, 4:1 or 5:1 ratio a risk factor, depending
on tumor type (7)
Look at lymphocyte number, multiply by 3 and see if
neutrophils are greater than this number
Inflammation
 Evaluation: hsCRP, NLR
 Targets
 hsCRP <1.0 mg/L, NLR 3:1 (1) , IL6, COX-2, 5-LOX, NF-
kB, PGE2, IL8
 Anti-inflammatory Diet
 Avoid hydrogenated trans-fats
 Increase omega-3 dietary fats
 Increase anti-inflammatory foods that lower glucose
(cinnamon, blueberries, olive oil, nuts & seeds, leafy
greens)
 Low glycemic-index, whole food diet
12
Natural Anti-inflammatory Tx
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Fish oil (1-2g EPA, 3-6 g EFA) (5,6,9)
Bromelain (1000-2250mg/d) (8)
Curcumin (1.5-8 g/d) (1,3,24)
Green Tea (EGCG 250-750mg/d) (2)
Resveratrol (200-800mg/d) (12,13,14)
Boswellia (300-900mg BID-TID) (3)
Quercetin (500mg BID-TID) with Vit C (4,11,18)
Ginger (400mg TID) (10)
Grapeseed Extract (23)
NAC (600mg BID-TID) (15,16)
Pomegranate juice/ellagic acid (8 oz daily) (17)
Vit E Tocopherols/Tocotrienols (200-800IU/d) (19,20)
Melatonin (5-40mg nightly) (21,22)
Chemoprevention: Soy
 Soy is another flavonoid that is anti-
inflammatory (1,2)
 In breast cancer survivors, a meta-analysis of
prospective trials including over 9,500 breast cancer
survivors showed decreased mortality and/or breast
cancer recurrence with high soy intake (3,4)
14
http://www2.nau.edu/~bio372/class/cancer/angiogenesis2.jpg
15
Angiogenesis & Cancer
 Angiogenesis is rate limiting for tumor
progression
 Multiple anti-angiogenic drugs approved
for cancer treatment with mixed efficacy
 Remember that inflammation drives
angiogenesis so anti-inflammatory
strategies apply (1)
 In survivors, Vascular Endothelial Growth
Factor (VEGF) & elevated copper are
modifiable factors that may influence
cancer terrain
16
VEGF & Angiogenesis
Serum and plasma VEGF (Vascular Endothelial Growth
Factor) is correlated with the presence of cancer and
metastasis 2,5
In vitro VEGF inhibitors (1-4)
 Aloe barbadensis, Angelica sinensis
 Artemisia annua (artemisinin)
 Green tea (epigallocatechin)
 Curcuma longa (curcumin)
 Ganoderma lucidum
 Ginkgo biloba
 Glycyrrhiza glabra
 Hibiscus sabdariffa
 Matricaria chamomilla (flavonoids:
apigenin, fisetin)
 Magnolia (honokiol), Panax ginseng,
Poria cocos
17
 Rosmarinus officinalis
 Scutellaria baicalensis
 Silybum marianum,
 Soy isoflavones (genistein, daidzein)
 Tanacetum parthenium,
 Viscum album
 Zingiber officinale
 Fish oil, Selenium
 Vitamin D3, Resveratrol,
proanthocyanidin (pro & anti-angio)
 Quercetin
Sagar/Yance
Anti-Angiogenesis Summary1
18
Herb/Phytoceutical
Preventive Dose mg/d
Adjuvant Dose mg
Turmeric (95% curcumin)
500-1000
1000-2500 TID
Green tea (95% phenols; 50%
epigallocatechin-3 gallate) (3,4,5)
200-500
1000-1200 TID
Quercetin with bromelain
500-1500
500-1000 TID
Holy basil and rosemary (2.37% and 10-20
1.5% ursolic acid)
10-20 TID
Silibinin (80% silymarin)
200
Up to 2000 TID
Resveratrol (2)
30-50
300-500 /d
Grape seed extract
(95% proanthocyanidin)
100-200
600-1000 /d
Copper & Angiogenesis
 Copper is required for angiogenesis (1-3)
 Ceruloplasmin is an acute phase reactant
that carries copper. Can reflect zinc def,
inflammation, elevated copper
 Locally advanced & advanced solid tumors
are associated with increased
ceruloplasmin 4,7 & serum copper 5,8
19
Copper in Breast Cancer
 Breast cancer patients show significantly higher
serum copper than controls (1, 5,6,7) as well as
increased serum ceruloplosmin (5)
 Cu/Zn ratio is increased in breast cancer patients
compared to controls; 1.91 vs. 0.86 (8), or >1.2 (4)
 Serum copper may be predictive of survival in
premenopausal breast cancer 9
 Reducing ceruloplasmin in high risk breast cancer
patients with no evidence of disease reduces
endothelial progenitor cells (a marker for metastasis
in breast cancer)6
20
Sustained Angiogenesis
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Evaluation
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Serum copper & ceruloplasmin in survivors controversial

Possible ceruloplasmin levels for breast cancer: <15-17
mg/dL (TM study) or 380 mg/L in women as a screening
tool for early breast cancer (Senra study)
Molecular Targets
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21
(1,2)
VEGF, PGE2 (Prostaglandin E2), APN (Angiopoietin), HIF
(Hypoxia induced factor), PDGF (Platelet derived growth
factor), EGF (Epidermal growth factor), Histamine,
Insulin, TGF-beta (Transforming growth factor beta)
Hypercoagulability
 Cancer cells can produce fibrinogen (FBG)
 Peritumoral inflammation stimulates hepatic
production of fibrinogen
 Tumors use FBG to bind and acquire VEGF &
other angiogenic growth factors
 Fibrinogen may contribute to;
 Hypoxia & angiogenesis (1)
 Metastasis (4) (via D-Dimer, 3)
 Radioresistance & chemoresistance (2)
22
Hypercoagulability
 Evaluation
 Fibrinogen
 Normal D Dimer & FDP to rule our DIC
 Targets: fibrinogen <325, D-Dimer normal range
 Natural treatment Options
 Bromelain, Garlic (650mg QD-TID)
 Curcumin, Fish oil, Ginkgo (80-160mg)
 Nattokinase (300-600mg), Vitamin E (400-800IU mixed
tocopherols)
 Dan shen, Bai zhu (Atractylodes macrocephala)
 Chinese peony (Paeonia lactiflora)(in blood stagnation
formula)
23
 Caution! If low platelets
24
Photos courtesy of Jim MacDonald,
herbalist www.herbcraft.org
Immunity & Cancer Risk
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25
Primary immunodeficiency in humans is associated with
increased cancer risk (1)
Organ transplant recipients who take immunosuppressive
drugs have 2-5x risk of colon, larynx, lung, bladder, prostate,
and testicular cancers & 10-30x risk of cancers of the lip, skin,
kidney, endocrine glands, cervix, and non-Hodgkin’s
lymphoma (2)
Acquired immunodeficiency (due to HIV) leads to elevated
cancer risk (3)
NK cell cytotoxicity is significantly lower (p < .005) in
individuals with a high familial incidence of cancer vs low
incidence of cancer (4)
NK cell activity is significantly reduced in cancer patients
compared with controls (5,6,7)
Immune Competence
& Cancer Survival
 Quantity and quality of immune cell infiltrate in
tumors is an independent prognostic factor for
patient survival (4)
 Activated Circulating T Lymphocytes (CD4+/Thelper
& CD8+/Cytotoxic T cells) correlates with better
survival in invasive colon cancer (1,2), breast cancer
(6,13), lung cancer (11,12) and melanoma (3)
 Immune system status may predict the risk of
primary, metastatic, and relapsed breast cancer (5)
 In colorectal, liver & breast cancer, tumor infiltration
by Th1 cells is particularly advantageous (7,8,9,10)
26
Tumor Evasion of Immune System
 Tumors create a non healing wound
 Inflammation makes tumor-associated
macrophages & neutrophil granulocytes
produce pro-angiogenic factors such as VEGF (1)
 If the terrain is anti-inflammatory, macrophages
signal end of wound repair & stop angiogenesis
(1)
 Tx: Anti-inflammatory & Anti-angiogenic
therapies
27
Immune Summary
for Solid Tumors Only
28
Evaluation
•
Post treatment, examine NLR (from CBC w Diff), screen for
zinc deficiency
Targets
•
NLR 3-5:1
•
Normal CBC w Diff (monocytes, lymphocytes, neutrophils,
eosinophils)
•
-TH1 immunity (vs TH2 dominance), IL2, NK cells, LAK’s,
mature dendritic cells
•
-NK cell activity >60 LU (Lytic Units) or improved from
baseline
Caution! Do not use botanical immunotherapy agents with
hematological cancers unless well researched
Turkeytail, I Love You….
 Meta-analysis of 13 double blind, placebo-
controlled trials (breast, gastric, colorectal,
esophageal, nasopharyngeal) on Coriolus/PSK in
conjunction with chemo, radiation or surgery
 Absolute risk reduction of 9% in 5 year mortality,
Numbers Needed to Treat (NNT) of 111
 Duration of 3-12 months in studies, so continue in
survivorship
 Then consider rotating herbal immunotherapy
agents…
29
Herbal Immunotherapy
by Tumor Type
Tumor Type
Breast
Prostate
Lung
Immunotherapy (Positive & Negative Human Studies
Only)
Coriolus (13, 15,16,17), Maitake (21), Shitake (27),
Mistletoe (38-43,45)
Reishi (23), Shiitake (35) & Lentinan IM (36)
Melanoma
Astragalus-based TCM Herbs (3, 4), Coriolus (18,19),
Mistletoe (44-46)
Coriolus (13,14), Astragalus-based decoction (6),
Fermented Wheat Germ Extract (7) Reishi (24,25), Shiitake
(26) & SDL -Superfine Dispersed Lentinan (30), Mistletoe
(51, 53-56
Fermented Wheat Germ Extract (8), Mistletoe (57-59)
Bladder
Maitake (22), Mistletoe (60,61)
Colorectal
Immune Surveillance
Increase NK Cell Activity:
Avoid un-metabolized folic acid (6)
Turkeytail/Trametes/Coriolus (5)
Astragalus (7)
Maitake (8)
Shiitake (8)
Agaricus Blazei (3)
Aged Garlic (9)
Mistletoe/Viscum Album (10,18)
Panax Ginseng (17)
Combination Homeopathics (19)
Lactobacillus casei Shirota (11)
Melatonin (4)
31
Bromelain (2)
oral Vit C (12)
Zinc (13)
Fish oil (14)
Daily Blueberries (20)
Forest Bathing (15)
Exercise, Relaxation, Music Therapy,
Laughter (1,3)
Stress causes decrease in NK activity
(16)
Avoid toxins such as toluene,
atrazine, triclosan (21)
Immune Surveillance
Boost viral immunity to protect mutation (p53)
from EBV, hep B, HPV, T cell leukemia virus
etc.
 Wei Qi formulas, Licorice Root (8), Vit D3
(9), Green Tea/EGCG (10)
Mature Dendritic Cells to presents tumor antigen
to immune system
 Low Dose Naltrexone (1), Astragalus (2),
Reishi (3), Turkeytail (4), Ginseng (5),
Mistletoe (6)
32
Immune Surveillance
Steer towards TH1 vsTH2 immunity
 Agaricus (3), Maitake (3),. Reishi (3),
33
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Cordyceps (3), Turkey tail (3)
Fermented Wheat Germ Extract (4)
Melatonin (1)
Serotonin (1)
Probiotics (5)
Vit A (6)
Low dose naltrexone (8)
Avoid stress & sleep disturbance (7)
Support Glutathione (9) & avoid toxins (10)
For Reference:
Cancer Immunity 101
34
Dendritic Cells (messengers who present Ag to T cells and B cells, when
mature they are like billboards telling T cells to attack cancer, when
immature they can increase angiogenesis)
Lymphocytes
•
B cells (humoral, produce antibodies, consider impact with
monoclonal antibodies)
•
T cells (cell mediated)
o
CD8+/Cytotoxic T Cells (destroy viruses and tumor cells, need
Ag presentation, sophisticated assasins)
o
CD4+/Thelper cells (activate cytotoxic T cells & macrophages,
release cytokines that trigger TH1 or Th2 responses)
o
Treg/T suppressor (induce immune tolerance, involved
autoimmunity, tumors can used them for evil)
o
NK cells (kill tumor cells without the need for antigen
presentation, thugs)
•
Lymphokine-Activated Killer cells (lymphocytes exposed to IL2 that
target tumor cells that NK cells cannot kill) (1)
35
http://www.glasbergen.com/stress-management-cartoons/
Metabolic Syndrome & Cancer
Patients with MS have greater incidence of:
 Recurrence - 3-fold recurrence at 5 yrs in breast cancer
pts, higher rates of recurrence & liver mets in colon
cancer pts
 Post-Op Complications - rate of post-op complications
(40 vs 11%) and longer hospital stay (11 vs 8 days)
 Immune Suppression - risk of infection in patients
undergoing intensive chemotherapy
 Hormone Dysregulation –High insulin causes elevations
in IGF1, VEGF & aromatase activity1
36
Metabolic Syndrome &
Breast Cancer
37
Primary Prevention: MS associated with 52% increase in
postmenopausal risk of breast cancer (1)
Secondary Prevention: Breast cancer patients with MS have
3 times the recurrence rate (1)
Metastatic breast cancer: Metastatic breast cancer patients
with MS have poorer outcomes (2)
MS is highly treatable with natural agents and lifestyle
modifications! (3)
Diabetes Prevention Program Study - high risk patients;
placebo, metformin, or intensive lifestyle intervention. At
3 yrs, diabetes incidence was reduced by 58% with
intensive lifestyle intervention and by 31% with
metformin compared to placebo (4)
Metabolic Syndrome
38
Evaluation: BMI, Blood pressure, HgA1C,
Fasting lipids. If suspect early insulin resistance
add: Fasting glucose & Fasting insulin. Can
download HOMA-IR calculator here:
http://www.dtu.ox.ac.uk/Homacalculator/index.
php. HOMA-IR ≥ 2.50 indicates insulin
resistance
Targets in Breast Cancer: BMI 18.5–25 or 30 kg/m2,
BP ≥ 130/85 mmHg, HgA1C<5.5%, TG < 100
mg/dL, HDL > 50 mg/dL , Uric acid <5.5 mg/dL,
HOMA-IR <2.5
Metabolic Syndrome
 Anti-inflammatory, Low Glycemic Diet, Sleep hygiene,
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39
Cortisol Management, Avoidance of obesogens
EXERCISE!!
Chromium 400-800mcg/d, Zinc 25-100 mg/d, Vanadium
100-500 mcg/d, Magnesium 250-600mg/d
Inositol 2g/d & Alpha Lipoic Acid 100-600mg/d
Fish Oil 2-5g/d, CoQ10 200mg/d, Carnitine 1-3g/d, Vit D
2000-5000IU/d
Berberine 1500mg/d, Green Tea 3-6 cups/day (organic
sencha), Cinnamon 2g/d, Gymnema 100-200mg/d,
Bitter melon 100-400mg/d, Fenugreek 100-300mg/d,
American Ginseng 450-900mg/d, Holy Basil 400800mg/d
Targeting IGF-1
 Men with prostate cancer were given 800mg EGCG until
radical prostatectomy. Serum IGF-1 decreased significantly
(2)
 Healthy adults given resveratrol 0.5, 1.0, 2.5, or 5.0 g/d for
29 days. 2.5 and 5 g doses caused mild to moderate
gastrointestinal symptoms. Circulating IGF-I and IGFBP-3
decreased (P<0.04) in everyone, but most marked at 2.5
g/d (1)
 Overweight (BMI ≥25kg/m2) postmenopausal women
randomized to exercise, dietary weight loss, diet +
exercise, or placebo. Higher BMI at onset was associated
with higher IGF-I/IGFBinding Protein-3 ratio. After 12
months there was no significant changes in IGF-I or IGFBP3 but the IGF-I/IGFBP-3 ratio increased significantly in the
diet & diet + exercise groups compared with control (3)
40
Exercise Deficiency

Exercise improves mood, lessens fatigue, improves sleep
manages weight, reduces hot flashes, improves
immunity, prevents/manages of metabolic syndrome
 Exercise improves survivorship in patients with breast,
prostate and colorectal cancer (1)
 In one study of 3000 breast cancer survivors , women
who exercised 3-5 hrs per week had almost a 50%
reduction in recurrence!! (2)
 10% of incident breast cancers are attributed to
inactivity. Exercise should be used for primary prevention
of breast cancer (3)
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42
http://www.glasbergen.com/stress-management-cartoons/
Cortisol & Cancer Survival
•
•
•
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Common survivorship issue: Elevated night time
cortisol
Growing evidence that flattened diurnal cortisol
rhythm accelerates tumor progression
Flattened cortisol curve is associated with
significantly earlier death in:
 Lung cancer 2
 Metastatic Breast cancer (predicts survival up to
7 years later) 1
 Renal cell carcinoma 3
Cortisol & Oncology Terrain
Flat Cortisol curve is associated with:
 Poorer ECOG Performance Status 2
 Poor cancer immunity 4,5
 Fatigue in long term breast cancer 1
 Depression in ovarian cancer patients 3
 Disrupted melatonin levels
 Suppressed bone growth
 Adaptogenic herbs can reverse suppressed
immunity in cancer patients  6
44
Cortisol Balance
 Evaluation: sleep pattern, 4x salivary cortisol, DHEA
 Targets: Normal cortisol curve, Balance TH1 to TH2
immunity
 High PM Cortisol: Body Mind Spirit Group (8
weeks1) or Cognitive-behavioral stress
management class (10 weeks2), Walking
barefoot/Lying on the earth3, Theanine,
Phosphatidylserine, Ashwaghanda/Withania,
Magnolia/Honokiol, Siberian
Ginseng/Eleuthrococcus, Rhodiola, Holy Basil/Tulsi
45
 Low Cortisol: B5, Licorice Root, Schizandra Berry
Support Group & Survival
 227 breast cancer patients randomized to Psychologic
Intervention (PI) plus assessment or assessment only.
Small groups lead by psychologist to reduce stress,
improve mood, alter health behaviors, and maintain
adherence to cancer treatment and care.
 Immune parameters & QOL improved in PI group
 After 11 years of follow-up, reduced risk of breast cancer
recurrence (hazards ratio [HR] of 0.55; P = .034) and
death from breast cancer (HR of 0.44; P = .016)
 Follow-up analyses also demonstrated that Intervention
patients had a reduced risk of death from all causes (HR
of 0.51; P = .028).
46
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661422/
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Supplement Cautions for Survivors
 Copper – trying to reduce this so please avoid 
 Folic acid supplementation no prevention (1),
potential risk (3). Dietary folate strongly advised (2)
 If supplementing, only use 5MTHF: MTHFR 677TT
genotype is associated with a moderate increase in
risk of postmenopausal breast cancer (4)
 Boron 3mg/d increases serum estradiol (5)
 Beta carotene in smokers or former smokers (6)
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Putting it all together
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Individualizing Treatment
6/2012
11/2012
10/2014
302
5.1
64
154
293
5.2
123
362
5.1
39
Cerulopla 44
smin
Free
22
Copper
hsCRP
2.5
WBC
3.2 (L)
42
-
3
-
6.1
8.6 (N)
1.8
8.5 (N)
High
cortisol
Waking
3am
Normal
Normal
Anxiety
Normal V. High
“Leslie”
fibrinogen
HgA1C
Vit D
Serum
JK
copper
50
MTHFR
C677T &
A1298C
“Jennifer”
fibrinogen
HgA1C
Vit D
hsCRP
Lymphocyt
es
11/2012
01/2013 10/2014
337
7.1
22
2.1
.4(low)
on 6/12
336
6.7
35
1.8
1.8 (N)
Digestion
Chronic
Diarrhea
Slight
Normal
improve
ment
Arrhythmia Severe
Occasio
nal
330
6.3
43
1.15
1.8 (N)
Normal
High
48 yr old with BRCA1. Grade 3 ductal CA,
tripple negative, 25/26 nodes +
63 yr old with grade 2 ductal carcinoma, 6
cm, E & P positive, her2neu -, 3/11 nodes +
Individualizing Treatment
“Leslie”
Vitamin D3 5000IU (if drop lower, Vit D below 40)
Fish Oil 2 BID
Melatonin 10mg
Coriolus 3g/d for 1 yr, then a blend of mushrooms
Multi BID during reconstruction (now discontinued)
CoQ10 100mg (NutrEval)
Evening Cortisol Formula prn
Curcumin 2 BID
Zinc BID prn (based on taste changes)
5HTP 100mg TID, MBSR program
Sublingual GABA prn
Bromelain with expanders
Dietary Green Tea, garlic, brazil nuts 4/d
Cu chelation: Molybdenum 1000mcg/d, NAC 600 BID
for 8 weeks
Carc 58T 200C alt Lach 200C Plussing Method
Co Morbidities: Depression. anxiety
Meds: None
51
“Jennifer”
Vitamin D3 5000IU
Fish Oil BID
Melatonin 20mg
Coriolus 3g/d for 2 yrs, tried switching to
Reishi but attached to coriolus)
CoQ10 300mg (cardiac toxicity from possible
adriamycin overdose)
Metabolic Multi 3 qd-BID
Mag Glycinate 300 BID
Cal-Mag MCHA (Arimidex)
Alpha Lipoic 300mg
Probiotics
Hawthorne Berry Solid extract
Dietary Green Tea
Carc 58T 200C alt Caust 200C, 2 pellets q 2
weeks
Co Morbidities: Uncontrolled type II diabetes,
hypertension, epilepsy, diverticulosis, OA, neuropathy
Meds: Arimidex, Metformin, Toprol, Phenobarbital,
Aspirin 81mg, Simvastatin, weaning from prilosec
Questions?
52