Mentoring the Mentor Stuart White, DACBN Whole Health

Mentoring the Mentor Stuart White, DACBN Whole Health

Mentoring the Mentor Stuart White, DACBN Whole Health Associates 713/522-6336 [email protected] www.wholehealthassoc.com www.doctorofthefuture.org 1 Mentor goals: To declare what is possible and establish a commitment to that possibility Address personal and professional barriers limiting the ability to serve Evolution of vision/mission/ethics that drive

success Create immediate action steps to apply learning and growth Construct the round table of applied trophologists 2 Mentoring the mentor: Who are the mentors? Practitioners Who are we mentoring? Patients and GAP Whats the purpose? Optimized life How does it work? Whatever you learn you teach someone else (anyone else) Whos is included? Self selection, you pick yourself

3 Mentoring the mentor: Each participant attends monthly teleconferences (1 hour in duration, 4th Wednesday of every 2nd month) creating a round table discussion/exploration of the dynamics and details of a nutrition-based holistic practice Each participant chooses how to convey the notes and information to their world and community no information squandering

4 Eternal Truth When you get close to the best of the best at anything, you always discover that they insanely persist at learning about their craft. Matthew Kelly 5 A Look At The Ethics: Characterize ethical behavior in practice Review terminology and ethics of providing

Chiropractic and nutritional services Review Chiropractic and Hippocratic oaths Define and explore the covenant of trust between a doctor and patient Discuss appropriate advertising, collection practices, record management Assess societys expectations of a professional and public service Establishing informed consent with patient care Explore professional boundary related issues and prevention points 6 Presentation goals:

To define the ideas and principles that drive a successful practice To provide procedures and practices that encourage patient understanding and compliance with therapy Addressing personal and professional boundaries limiting success Create passion to pursue development of the ethical management of the power gradient between practitioner and patient 7 Ethics is derived from: The conscious and underlying core beliefs and values held Personal Values What are the personal values/beliefs

operating in the treatment room in the practitioner and patient Cultural Values Social Values Work Values 8 Eternal Truth It is high time that the ideal of success should be replaced by the ideal of service Albert Einstein 9

Eternal Truth Be responsible to be empathetic 10 Hippocratic Oath:

I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract: To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of

the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others. I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. In purity and according to divine law will I carry out my life and my art. I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft. Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves. Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate. 11 Translated by Michael North, National Library of Medicine, 2002. The Modern Version: A Modern Version of the Hippocratic Oath I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

12 Chiropractic Oath: I do hereby swear before God and these assembled witnesses, both corporeal and spiritual, that I will do my utmost to keep this, my sacred, trusted oath, as a graduate of the (insert college name here), that henceforth: I will esteem those who have taught me this Art, Science and Philosophy of Chiropractic and with this torch of knowledge, fashioned by Hippocrates, I will light the way to the understanding of those Natural Laws which preserve the human body as a fitting temple for the soul of man. I will keep the physical, mental and spiritual needs of the sick as my foremost duty, ever searching for and correcting the cause of their disease to the best of my ability, insofar as my science is in the highest precepts of my Alma Mater and harmonious with the Vis Medicatrix Naturae. I will at all times stand ready to serve my fellow man, without distinction of race, creed or colour,

in my lifelong vocation of preventing and alleviating human suffering, wherever it may be found, by exemplifying in my own life a pattern of living in harmony with the Laws of Nature. I will refrain from any act of wrongdoing and will regard the keeping of a patients confidence as a moral obligation, using any such information only in his or her best interests. May God so direct the skillful use of my hands that I may bring strength to the sick, relief to the suffering, peace of mind to the anxious and the inspiration to mankind to attain bountiful health that we may live this life to the fullest expression of its innate endowments. I therefore, solemnly swear to uphold these principles and precepts to the best of my ability, so help me God 13 Covenant of trust: Between the practitioner and patient is a covenant of trust This is spoken and unspoken The patient feels the covenant when their concerns are cared for by the doctor (outcome results, costs, punctuality,

comprehensive lifetime care, prevention of familial tendencies) Be patient centered, not doctor centered 14 Ethics Diverse Definition: A set of moral values causing behavior Morality and codes of behavior Law defines as societal manmade rules or obligations to be observed What does society expect from us as practitioners how do we continuously develop our ethics Ethical issues include the right to die, stem cell concerns, etc Managed care/insurance controls the delivery of care

(strong practitioners exceed the standard of care and everyone knows it ) 15 Ethics Behavior Defined: Pope et al divided 85 behaviors into 7 categories (first four are from the Hippocratic Oath) 1 Above all do no harm 2 Practice only with competence 3 Do not exploit 4 Treat people with respect and dignity 5 Protect confidentiality 6 Act (except in extreme cases) only after obtaining informed consent

7 Practice within framework of social equity and justice Redlich, F. C. and Pope, K. S. (1980) Ethics of Mental Health Training, Journal of Nervous and Mental Disease, 168, 709-714 Pope, K. S. (1987) Preventing therapist-patient sexual intimacy. Professional Psychology, Research and Practice, 18, 624-628 16 Ethics Fraud: Defined legally as: A perversion of the truth to induce a person to part with something valuable belonging to them using false or misleading representations 17

Ethics Fraud: Elements that make fraud actionable: 1 A false representation of a past or present fact 2 An action based on reliance of that false representation 3 Damages suffered from reliance upon that misrepresentation 18 A Profession: So called because the profess to have knowledge and skills beyond the comprehension of the laity. Professions a predicated on this asymmetry of knowledge The power gradient between practitioner and patient is created by this assymetry

19 Ethics Duties: The ethical duty of veracity do not lie or embellish The ethical duty of fidelity Ensure what is said is true 20 Vis Medicatrix Naturae: The healing power of nature This proposition is indisputable it is the fundamental mechanism by which healing occurs (ie. Immune / inflammation, repair, etc)

21 Primary Care Physician: Defined by Institute of Medicine in 1996 The provision of integrated, accessible health care services by clinicians who are responsible for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of the family and community 22 EBHC new kid on the block: Defined by Arnold Relman, MD in 1990:

Evidence Based Health Care 23 Eternal Truth If you build it they will come 24 New kids on the block The Sequential Immune Up-Regulation

25 Mixed Infection Syndrome Virus Fungus / Yeast Parasite Bacteria Stealth * Cavitated Infection sequestered colonization typically near bone where less blood exchange occurs * Latent Intracellular Conjugated Parasites * DNA encoded hereditary

infection Infectious Personality Disorder Infection results in a direct invasion of the CNS across the single layer blood brain barrier (BBB) Resultant CNS cell death (apoptosis) and neuroinflammation Infection directly creates immune activation and inflammatory response, GI microbiome alteration, HPA modulation and dysfunction altering hormonal expression and ability to maintain homeostasis Each of the above contribute cumulatively to Mood Disorder Mood Disorder from Infection Mood Disorders are the fastest increasing epidemic in the US The NIH estimates that 20% of American adults deal with a

mood disorder and one in six take psychiatric medication Mood Disorders create personal and social burdens resulting in long and short term disability more than any other medical condition (JAMA. 1990; 264(19): 2524-2528) Depression makes up 50% of total mood disorder Compared to a decade ago (2005) the cost of mood disorder has risen by 21% Infection and limbic depression Immune response to infection causes the symptoms that are described as feeling sick malaise, fever, aching, catarrhal, etc Most people feel depression/sadness during acute illness due to cytokine generated inflammatory response Indeed often in the subclinical infection syndrome a depressed limbic (unhappy, morbid, non-playful, joyless)

state is the first and most telling indication of an immune/infectious burden We identify limbic depression and stress by interviewing and listening and respecting the stresses of life (financial, relationship, children, loneliness, etc) and finding every person is either limbically depressed and burdened or they are limbically supported and modulated Virus and Degeneration New research reveals the link between latent viral infection and degenerative events leading to diagnosis Herpes Simplex Virus (HSV) 1 has been implicated in amyloid beta plaque formation in the brain (Alzheimers) Varicella Zoster Virus (VZV) showed three times more likely to develop dementia if infected by Herpes Zoster Opthalmicus (HZO) within 5 years (846 patients, mean age

62.2 years) Mednick, S.A., Machon, R. A., Bonnett, D Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch gen Psychiatry, 1988 45:189-192 Parboosing, R., Bao, Y., Shen L., et al. Gastro intestinal influenza and bipolar disorder in adult offspring, JAMA Psychiatry 2013; 70:677-685 Virus creates Degeneration Front Biosci (Landmark Ed). 2009 Jun 1;14:5239-59.

Virus-induced neuronal dysfunction and degeneration. Berth SH1, Leopold PL, Morfini GN. Author information Abstract In general, virus infections of the brain are rather rare in the immune competent host. However, neurotropic viruses have developed mechanisms to exploit weaknesses in immunological defense mechanisms that eventually allow them to reach and infect CNS neurons. Once in the CNS, these viruses can induce significant neuronal dysfunction and degeneration of specific neuronal populations, sometimes leading to devastating, life-threatening consequences for the host. Here, we examine viruses with the ability to infect neurons and their resulting pathologies, their modes of entry to the CNS, and the cellular and molecular alterations that these viruses induce in neuronal cells. We also discuss the importance of various pathogenic events associated with viral infection of neurons and elaborate on the implications of recent findings suggesting that neuronal cells affected by viruses undergo a "dying back" pattern of degeneration. Finally, findings of virus-induced alterations in kinase activity are discussed in the context of recent evidence linking abnormalities in

kinase signaling to the pathogenesis of major human neurodegenerative conditions. Virus creates Degeneration Front Immunol. 2017 Oct 17;8:1314. doi: 10.3389/fimmu.2017.01314. eCollection 2017. Age-Related Macular Degeneration: A Connection between Human Herpes Virus-6A-Induced CD46 Downregulation and Complement Activation? Fierz W1. Author information

Abstract Viruses are able to interfere with the immune system by docking to receptors on host cells that are important for proper functioning of the immune system. A well-known example is the human immunodeficiency virus that uses CD4 cell surface molecules to enter host lymphocytes and thereby deleteriously destroying the helper cell population of the immune system. A more complicated mechanism is seen in multiple sclerosis (MS) where human herpes virus-6A (HHV-6A) infects astrocytes by docking to the CD46 surface receptor. Such HHV-6A infection in the brain of MS patients has recently been postulated to enable Epstein-Barr virus (EBV) to transform latently infected Blymphocytes in brain lesions leading to the well-known phenomenon of oligoclonal immunoglobulin production that is widely used in the diagnosis of MS. The cellular immune response to HHV-6A and EBV is one part of the pathogenic mechanisms in MS. A more subtle pathogenic mechanism can be seen in the downregulation of CD46 on astrocytes by the infecting HHV-6A. Since CD46 is central in regulating the complement system, a lack of CD46 can lead to hyperactivation of the complement system. In fact, activation of the complement system in brain lesions is a well-known pathogenic mechanism in MS. In this review, it is postulated that a similar mechanism is central in the development of age-related macular degeneration (AMD). One of the earliest changes in the retina of AMD patients is the loss of CD46 expression in the retinal pigment epithelial (RPE) cells in the course of geographic atrophy. Furthermore, CD46 deficient mice spontaneously develop dry-type AMD-like changes in their retina. It is also well known that certain genetic polymorphisms in the complement-inhibiting pathways correlate with higher risks of AMD development. The tenet is that HHV-6A infection of the retina leads to downregulation of CD46 and consequently to hyperactivation of the complement system in the eyes of susceptible individuals.

Virus creates Degeneration FJ Bone Joint Surg Br. 2011 Sep;93(9):1253-8. doi: 10.1302/0301-620X.93B9.27002. Herpes virus infection can cause intervertebral disc degeneration: a causal relationship? Alpantaki K1, Katonis P, Hadjipavlou AG, Spandidos DA, Sourvinos G. Author information Abstract It has been proposed that intervertebral disc degeneration might be caused by low-grade infection. The

purpose of the present study was to assess the incidence of herpes viruses in intervertebral disc specimens from patients with lumbar disc herniation. A polymerase chain reaction based assay was applied to screen for the DNA of eight different herpes viruses in 16 patients and two controls. DNA of at least one herpes virus was detected in 13 specimens (81.25%). Herpes Simplex Virus type-1 (HSV-1) was the most frequently detected virus (56.25%), followed by Cytomegalovirus (CMV) (37.5%). In two patients, co-infection by both HSV-1 and CMV was detected. All samples, including the control specimens, were negative for Herpes Simplex Virus type-2, Varicella Zoster Virus, Epstein Barr Virus, Human Herpes Viruses 6, 7 and 8. The absence of an acute infection was confirmed both at the serological and mRNA level. To our knowledge this is the first unequivocal evidence of the presence of herpes virus DNA in intervertebral disc specimens of patients with lumbar disc herniation suggesting the potential role of herpes viruses as a contributing factor to the pathogenesis of degenerative disc disease. Virus creates Degeneration

Neuronal Degeneration in a Viral Model of Multiple Sclerosis Raphael Schneider Journal of Neuroscience 9 December 2009, 29 (49) 15353-15354; DOI: https://doi.org/10.1523/JNEUROSCI.5198-09.2009 Article Info & Metrics eLetters

PDF Ever since multiple sclerosis (MS) pathology was defined at the end of the 19th century, it has been debated whether the primary event in the CNS affects myelin or axons. Even though the characteristic pattern of tissue damage was noticed to be demyelination, it was proposed early on that axonal damage may in fact be responsible for permanent disability in MS patients (Charcot, 1880). Interestingly, axonal injury in MS is not limited to the demyelinated lesions, but occurs even in so-called normal appearing brain tissue (Bitsch et al., 2000), supporting the notion that damaged neurons in non-demyelinated areas contribute to the functional deficits in MS. Numerous investigations have extended our knowledge of MS pathology using virus-induced models of chronic demyelination. Probably the most extensively studied model is the Theiler's murine encephalomyelitis virus (TMEV), which induces a chronic progressive demyelinating disease in susceptible mice. Although TMEV is cleared from neurons, it persists in glial cells and macrophages subsequently leading to demyelination and axonal injury (for review, see Oleszak et al., 2004). Neurotropic strains of mouse hepatitis virus (MHV) can induce chronic inflammatory demyelination bearing similar histological features to those observed in MS: lesions associated with lipid-laden macrophages, infiltrating T lymphocytes and naked axons scattered throughout the CNS. Similarly to TMEV, MHV antigens are detected in astrocytes, oligodendrocytes, and neurons early on, and at later time points can only be found in glial cells (for review, see Matthews et al., 2002).

Virus creates Degeneration To study the association between chronic hepatitis B virus (HBV) and agerelated macular degeneration (AMD). Methods Data used in this retrospective, frequencymatched cohort study were acquired from the Longitudinal Health Insurance Database 2000, which includes medical claims and registration files for 1 000 000 enrolees in the Taiwan National Health Insurance programme. The HBV cohort contained 17 796 patients who received a diagnosis of chronic HBV infection between January 1, 2000 and December 31, 2012. The nonHBV cohort contained 71 184 participants who were frequencymatched by age, sex and year of index date for comparison. Participants were followed until the end of 2013, and those who developed AMD during the study period were identified. A Cox proportional hazards regression model was used to compare the riskFront of AMD between cohorts. Immunol

Results The incidence of any type of AMD in all participants was 3.88 per 1000 personyears (PY; 2.27 per 1000 PY in the HBV cohort; 1.61 per 1000 PY in the nonHBV cohort). Compared with the nonHBV cohort, the adjusted hazard ratio (HR) for any type of AMD in the HBV cohort was 1.41 [95% confidence interval (CI) 1.231.63; p < 0.001]. This significant positive association was stronger among patients who exhibited disease progression from nonexudative to exudative AMD (adjusted HR = 1.74, 95% CI: 1.012.99). Conclusion Our results suggest that patients with chronic HBV infection in Taiwan have a significantly elevated risk of developing any type of AMD and that HBV infection may accelerate the progression of AMD. Virus creates Degeneration

January 01, 1998; 50 (1) Articles Cerebellar degeneration associated with human immunodeficiency virus infection M. Tagliati, D. Simpson, S. Morgello, D. Clifford, R. L. Schwartz, J. R. Berger Abstract Cerebellar disorders associated with HIV infection are typically the result of discrete cerebellar lesions resulting from opportunistic infections such as toxoplasmosis and progressive multifocal leukoencephalopathy or primary CNS lymphoma. Clinical symptoms and pathologic abnormalities related to the cerebellum may also be observed with HIV dementia. A primary cerebellar degeneration with HIV has not previously been reported. Ten patients were identified over an 8-year period at five medical centers. All patients had clinical, laboratory, and radiologic evaluations, and three had neuropathologic examinations. Patients presented with progressively unsteady gait, slurred speech, and limb clumsiness. Examination revealed gait ataxia, impaired limb coordination, dysarthria, and abnormal eye movements. Cognition, strength, and sensory function remained normal. CD4 lymphocyte counts varied between 10 and 437 cells/mm3. Neuroimaging studies showed prominent cerebellar atrophy.

Neuropathology showed focal degeneration of the cerebellar granular cell layer and unusual focal axonal swellings in the brainstem and spinal cord. Cultures, histopathology, and immunochemical studies showed no conclusive evidence of infection. We report a syndrome of unexplained degeneration of the cerebellum occurring in association with HIV infection. Viral Mechanisms Viruses are obligate intracellular parasites: They rely on host cellular machinery because they lack a cytoplasm providing enzymes that produce chemical building blocks, energy, ribosomes to direct synthesis and membranes t concentrate and localize key molecules they hitchhike and piggy back All viruses have nucleic acids (DNA or RNA), a capsid protein coat encoded by the virus Some viruses have a lipid membrane envelope provided by the host (sort of like a biofilm)

Viral Sensitivity Naked viruses are resistant to drying, heat, detergents, acid whereas envelope viruses are sensitive to these things Stages of viral Infection:

Absorption Entry Uncoding Early Genes Replication Late Genes Assembly Packaging Release Viral Titer progression is 1K to 100K viruses/cell in 5-24 hours Viral Entry All viruses enter the cell by accomplishing a free radical burst at the bilipid membrane resulting in oxidizing damage

and porosity to entrance Membrane support and free radical resistance with CoQ10 and various antioxidants can increase viral resistance especially important during times of virulence Anti Viral Tools Anti Viral Food: Ginger, Citrus and vitamin packed foods, yogurt/kefir, blue berries, appples, ginseng, tomatoes, wild salmon, chocolate, broccoli, olive oil, green tea, spinach, eggs, garlic, apple cider vinegar, lemon juice Anti Viral Herbs: Elderberry, echinacea, calendula, garlic, astragulus, cats claw, ginger, licorice root, golden seal, green tea, olive leaf, pau darco, oregano oil, prickly ash bark, Oregon grape, St. Johns wort Anti Fungal / Candida Tools Anti Fungal / Candida Food: Coconut oil, garlic, onion,

seaweed, rutabaga, ginger, olive oil, lemon/lime juice, pumpkin seeds, cayenne, algae, cinnamon, papaya seeds, turmeric, fermented foods, bone broth, pau darco Anti Fungal / Candida Herbs: turmeric, pau darco, olive leaf, garlic, black walnut, tea tree, cloves, goldenseal, oregano oil, calendula, spearmint, neem Anti Parasitic Tools Anti Parasitic Food: sunflower seeds, coconut, onions, papaya seeds, garlic, pineapple, turmeric, fermented foods, cucumber seeds, raw pumpkin seeds, figs (ficin) Anti Parasitic Herbs: papaya, clove, turmeric, ginger, cayenne, green hulls of black walnut, Chinese wormwood, wormwood, butchers broom, berberine, European barberry, thyme, oregano oil, diatomaceous earth

Anti Bacterial Tools Anti Bacterial Food: garlic, lemon, turmeric, onion, pineapple, ginger, horseradish, cabbage, papayas, rutabaga, grapefruit, chili pepper, broccoli, coconut, cranberries, cinnamon, fermented foods, carrots, oranges, pomegranate, honey Anti Bacterial Herbs: Garlic, ginger, echinacea, goldenseal, clove, oregano, cloves, thyme, sage, basil, rosemary, peppermint, spearmint, eucalyptus, elderberry, berberine, Oregon grape, tea tree, neem, Anti Stealth Infection Tools Anti Stealth Infection Food: coconut, garlic, fish (sardines, salmon, herring, mackerel), walnuts, flaxseed, canola oil, zinc, olive oil, citrus, onion, sunflower seeds, vitamin E, Anti Stealth Infection Herbs: Elderberrry, echinacea, calendula, garlic, astragalus, cats claw, ginger, licorice, olive

leaf, oregano, Chinese wormwood, myrrh, black cumin seed, St. Johns wort, goldenseal, berberine, medicinal mushrooms Co-Infection The Lesson of Lyme Lyme Disease has revealed that often the co-infections are worse than the primary one seeing this clinically expands our thinking to realize that everyone carries co-infectious burdens that chronically strain the immune system and create many of the chronic discomfort an malady people experience Yeast/Candida overgrowth accompanies almost all immune burdens and autoimmune conditions Biofilm conditions influence the success of the resistant infection No longer can a one infection paradigm exist that one infection is either causing others, or others are causing it

Infestations Berberine Berberine Sulfate: Berberine is an alkaloid commonly extracted from plant roots. Berberines mechanisms of action include adhesion and intracellular interference of metabolic activity, promotes proper stool motility, and helps reduce inflammation through inhibition of the COX inflammatory pathway. Acting as an anti-bacterial and anti-microbial, Berberine has the ability to have a detrimental effect on bacteria by inhibiting the adherence of microorganisms to mucosal and epithelial surfaces. Berberine Berberine: Phellodendron bark with enriched levels of berberine is proven in

multiple meta-analyses to improve outcomes in the following conditions: * Hypoglycemia * Hyper/hypolipidemia * Diabetes / Metabolic Syndrome * Selective antimicrobial (antihelmenthic) * Anti-inflammatory * Antioxidant * Antiarrythmic Berberine Berberine safety and clinical stability: General safety is high as very little toxicity has been demonstrated in a 2010 study with rats it suggests that berberine has extremely low oral toxicity

There are hardly any reports of adverse effects certainly too few to assess any generalized risk No side effects were observed in 20 randomized control trials that investigated the influence upon hyperglycemia and hyperlipidemia sometimes constipation occurs likely due to the antimicrobial and antidysbiotic influence of berberine (studies often reported the constipation abated after prolonged use) Berberines safety was confirmed by meta-analysis in 2015 showing no serious adverse reactions were reported Berberine Berberine possible adverse effects: Headache Skin irritation Facial flushing Bradycardia Dyspepsia and subsequent hypervagotonia (acute gastritis)

Allergic dermatitis Berberine Caution: Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Other Ingredients: Microcrystalline cellulose, sodium starch glycolate, croscarmellose sodium, hypromellose, magnesium stearate, dibasic calcium phosphate dihydrate and silicon dioxide. For other contraindications and cautions, please refer to the Potential Herb-Drug Interactions Chart. Supplement Facts Serving Size: 1 tablet

Servings per Container: 60 Amount per Serving %DV Phellodendron 20:1 extract from Phellodendron amurense stem bark 8.8 g Containing berberine 200 mg 440 mg

Black Cumin Seed Nigella Sativa Seed: Good for everything Arabic proverb says, In the black seed is the medicine for every disease except death known as Seeds of blessing Commonly known as black seed or black cumin it is a small, flat, angular shaped, black seed with a bitter, peppery taste and aromatic smell (2 mm long x 1 mm wide) Widely used in the Middle East and Asia for both medicinal and culinary use, especially on breads Traditionally used in India and Middle East for indigestion, loss of appetite, fever, diarrhea, dropsy, malaise and weakness, asthma, dysmenorrhea, arthritis It is carminative, diaphoretic, expectorant, antihelminthic, emmenagogue,

diuretic, galactogogue It is a medhya/nootrophic promoting brain function, enhancing clear thinking and concentration, calming the mind Black Cumin Seed Nigella Sativa Seed: Main constituents include a fixed oil and a volatile oil (less than 2%) minor constituents include saponins and alkaloids Major constituents of the volatile oil include thymoquinone, carvacrol and p-cymene (thymoquinone is absent in powdered seed and decreases over months during storage and in preparations processed with vinegar or honey) Black Cumin Seed Safety for Use:

Low toxicity Minor GI adverse effects may be best to take after meals Allergic reactions are more common for oil than whole seed Contra-indicated in pregnancy best to avoid in pre-conception Only severe reactions have been to the oil, and only 7 casaes have ever been reported Black Cumin Seed Clinical Studies show us: Normalizing glycemia in Type 2 diabetes and metabolic syndrome improved beta cell function Lipid levels reduced in diabetes, Metabolic Syndrome and hyperlipidemia, coronary artery disease, obesity, menopause/andropause, PCOS, Hashimotos Disease Mild Hypotensive effect Beneficial effects in allergic rhinitis and asthma

Improved thyroid status in Hashimotos thyroiditis, relieved pain in dysmenorrhea, beneficial effects in PCOS, improved symptoms in menopause/andropause Cognitive benefit in elderly, improved mood in adolescents Reducing weight in obesity Improved semen parameters in male infertility Beneficial in febrile neutropenia, H. Pylori, cestode infestation, opioid dependence, renal calculi, psoriasis Increased oxytocin in lactating women Black Cumin Seed Forte Supplement Facts Serving Size: 1 tablet Servings per Container: 40 Amount per Serving %DV

Calcium 63 mg 4% Black Cumin seed 5:1 extract from Nigella sativa seed 2.0 g 400 mg

Daily Value (DV) not established. Echinacea Premium 56 Calcium 90 mg Echinacea root 4:1 extract from Echinacea angustifolia root 600 mg Containing alkylamides 2.0 mg

150 mg Echinacea root 6:1 extract from Echinacea purpurea root 675 mg Containing alkylamides 2.1 mg 112.5 mg Andrographis Calcium

40 mg Echinacea root 4:1 extract from Echinacea angustifolia root 500 125 mg mg Holy Basil herb 5:1 extract from Ocimum tenuiflorum herb 500 mg 100 mg Andrographis herb 10:1 extract from Andrographis paniculata herb 1.0 g 100 mg

Containing andrographolide 10 mg Holy Basil (Ocimum tenuiflorum) 10 mg herb essential oil 57 Artemisinin support normal flushing of natural toxins from the body encourage healthy function of organs of elimination cleanse the blood encourage healthy bowel function support healthy digestion

support a healthy intestinal environment* Wormwood Complex Calcium 20 mg Stemona root 5:1 extract from Stemona sessilifolia root 1.0 g 200 mg

Black Walnut hull 4:1 extract from Juglans nigra hull 100 mg 25 mg Wormwood herb 4:1 extract from Artemisia absinthium 25 mg herb 100 mg 59 Clove bud (Syzygium aromaticum) essential oil

20 mg Myrrh support healthy bowel function support healthy digestion support a healthy intestinal environment support gastrointestinal health support sinus and respiratory health* Viranon Gut Flora Complex

Anise (Pimpinella anisum) fruit essential oil 125 mg Andrographis ariel parts 10:1 extract from Andrographis paniculata ariel parts 1.0 g Containing andrographolide 10 mg 100 mg Phellodendron stem bark 20:1 extract from Phellodendron

amurense stem bark 1.6 g Containing berberine 36 mg 80 mg Oregano (Origanum vulgare) leaf 75 mg essential oil 62 Ganoderma & Shiitake The Ganoderma and Shiitake mushrooms contain several types of polysaccharides, triterpenes, amino acids and other compounds. The combination of these unique mushrooms can help to: promote

the body's normal resistance function promote vitality stimulate healthy immune system response encourage adaptive response to occasional everyday stress* Thymex Thymex supports the thymus gland with bovine thymus Cytosol extract, calcium, and magnesium. Supports a healthy thymus gland, the master gland of the immune system Can be used in combination with other immune support products

Epimune Epimune Complex supports specific aspects of immune activity and contains research-supported ingredients such as EpiCor and maitake and turkey tail mushrooms. Supports healthy white blood cells Supports normal mucus secretion and nasal passages Helps support respiratory health yearround, especially during seasonal challenges Helps activate and balance a healthy immune system response function

Sesame Seed Oil Sesame Seed Oil contains essential fatty acids, as well as naturally occurring vitamin E. Provides antioxidants Supports healthy liver function Supports immune system function Cataplex AC Vitamin A 1,500 IU Vitamin C

11 mg Proprietary Blend: 490 mg Echinacea (root), calcium lactate, sweet potato, carrot (root), bovine adrenal, bovine kidney, nutritional yeast, magnesium citrate, alfalfa flour, dried alfalfa (whole plant) juice, mushroom, dried buckwheat (leaf) juice, buckwheat (seed), bovine bone, defatted wheat (germ), oat flour, sunflower lecithin, veal bone, vitamin E (sunflower), rice (bran), and carrot oil. 67

Livco Calcium 90 mg Schisandra fruit 6:1 extract from Schisandra chinensis fruit 1.0 g 167 mg Rosemary leaf 5:1 extract from Rosmarinus officinalis leaf 500 mg

100 mg Milk Thistle seed 70:1 extract from Silybum marianum seed 2.1 g Containing 30 mg flavanolignans calc. as silybin 24 mg 68 Black Walnut Hulls Black Walnut hull 1:10

extract 5 mL from Juglans nigra hull 500 mg 69 That I would be good ... That I would be good even if I did nothing That I would be good even if I got the thumbs down That I would be good if I got and stayed sick That I would be good even if I gained ten pounds That I would be fine even if I went bankrupt That I would be good if I lost my hair and my youth

That I would be great if I was no longer queen That I would be grand if I was not all knowing That I would be loved even when I am not myself That I would be good even when I am overwhelmed That I would be loved even when I was fuming That I would be loved even if I was clingy That I would be good even if I lost sanity That I would be good Whether with or without you Precious service Service is the virtue that distinguished the great of all times and which they will be remembered by. It places a mark of nobility upon its disciples. It is the dividing line that separates the two great groups of

the world -those who help and those who hinder, those who lift and those who lean, those who contribute and those who only consume. How much better it is to give than receive. Service in any form is comely and beautiful. To give encouragement, to impart sympathy, to show interest, to banish fear, to build self-confidence and awaken hope in the hearts of others, in short - to love them and to show it - is to render the most precious service. Bryant Hinckley Loaves and Fishes

This is not the age of information this is not the age of information forget the news, and the radio, and the blurred screen. This is the time of loaves and fishes. People are hungry, and one good word is bread for a thousand David Whyte Try not, do (Yoda)

You are what your deep, driving desire is. As your desire is so is your will. As your will is so is your deed. As your deed is so is your destiny. The Upanishads Change the world It wants to 74

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