BEYOND THE GUT - Ontario Association of Naturopathic Doctors
Transcription
BEYOND THE GUT - Ontario Association of Naturopathic Doctors
BEYOND THE GUT Examining the Gut-Brain Connection in Woman’s Moods, Health, and Well Being Dr. Kumar Biswas, BSc (Hons), ND Doctor of Naturopathic Medicine 1350 England Avenue, Suite 103 Courtenay, BC V9N 8X6 [email protected] T. 250.338.2799 Kumar Biswas, BSc (Hons), ND Education: • BSc (Hons) – Dalhousie University - Halifax, NS • NSERC Research Assistant, Labrador – Mount St. Vincent University, Halifax, NS • Doctor of Naturopathic Medicine – Canadian College of Naturopathic Medicine, Toronto, ON Memberships: • Nova Scotia Association of Naturopathic Doctors (NSAND) • Board of Directors of Drugless Therapy – Naturopathy (BDDT-N) seamless well being™ • College of Naturopathic Physicians of British Columbia (CNPBC) • Canadian Association of Naturopathic Doctors (CAND) • Institute of Functional Medicine (IFM) • Occidental Institute Research Foundation (OIRF) www.aquaterrahealth.ca Outline • Gastrointestinal Physiology and the Enteric Nervous System (ENS) • The Matrix and The Microbes • Biology and Nutrition • Biological Medicine Clinical Assessments • Clinical Cases inserted throughout • A ‘Gut Feeling’ about the Future seamless well being™ www.aquaterrahealth.ca Important Learning Objectives • Understanding the functional physiology of the Gastrointestinal (GI) System as it relates to the entire “millieu” • Understanding the importance of Syn-biotic Balance • Clinical pearls through Case Studies • Re-visiting simple, practical in-office assessments • Understanding why bowel health is brain health seamless well being™ www.aquaterrahealth.ca Principles of Naturopathic Medicine Establish Health and Wellness Prevention is the Best Cure Treat the Whole Person Physician as Teacher Identify and Treat the Cause First do no Harm seamless well being™ The Healing Power of Nature www.aquaterrahealth.ca Hypothesis The human gastrointestinal tract and it’s biota are like a second brain and significantly effect our Mind, Mood, and Behavior. seamless well being™ www.aquaterrahealth.ca GI tract acts independent of CNS… • 1850-60’s Auerbach (myenteric plexus) & Meissner (submucosal plexus) • 1899-1900 Bayliss & Starling “law of the intestine” • 1917 Trendelenburg in vitro peristaltic reflex • 1921 Langley ENS separate but equal division of the autonomic nervous system • 1987 Gottschall books “Food and the Gut Reaction” & “Breaking the Vicious Cycle” • 1999 Gershon’s book “The Second Brain” • 2013 Herbert’s book “Bugs, Bowels, & Behavior” seamless well being™ www.aquaterrahealth.ca Gastrointestinal Physiology Facts • Largest organ in the human body – 6 meters long with a surface area of 2000 sq. meters • 9 Liters of fluid pass through the GI tract daily – 3.5 L Exocrine Glands/ 3.5 L Epithelial Cells with 2 L Ingested • Numerous Glands: Compound Acinous glands, Single Cell Mucous Glands, Goblet Cells, Brunners glands, Crypts of Lieberkuhn seamless well being™ www.aquaterrahealth.ca GI Facts Continued… • Largest amount of immune tissue in the body 70%= gut associated lymphoid tissue (GALT) • Regulated directly by the Enteric Nervous System (ENS) with feedback and amplification coming from hormones and cytokines seamless well being™ www.aquaterrahealth.ca The Second Brain – Enteric Nervous System • 100 Million Neurons (more than the spinal cord and peripheral nervous system) • Devoid of Collagen terminating in enteric glia • 90% of Primary Visceral Nerve fibers carry information from the GI tract to the Brain • ENS & CNS embryologically similar • Every class of CNS neurotransmitter has been found in the ENS seamless well being™ www.aquaterrahealth.ca ENS • Microcircuits with great complexity • 90% of our Serotonin is stored in the enterochromaffin cells of the ENS • 50% of Dopamine in GI tract • ENS neurons: a) Auerbach’s Myenteric Ganglia b) Meissner’s Submucosal plexus seamless well being™ www.aquaterrahealth.ca Serotonin • Mood & Happiness • GI Motility & Digestion • In platelets as vasoconstrictor regulating blood clotting • Acts as a growth factor in wound healing Nutrients supporting Serotonin production: • B6, Magnesium, Calcium, 5 HTP seamless well being™ www.aquaterrahealth.ca Gut-Brain Axis (GBA) Frontiers in Integrative Neuroscience, 07 Oct. 2013 seamless well being™ www.aquaterrahealth.ca Immune Connection • GALT has innate and humoral response • Peyer’s patches, secondary lymphoid tissue, and lymphoid follicles, tertiary lymphoid tissue respond to antigenic stimuli – Matrix connection • Regulate to determine self from non-self whilst interacting with the outside world • Cytokines released have a endocrine and paracrine action from lymphocytes seamless well being™ www.aquaterrahealth.ca Vagus Connection (afferent) • Autonomic parasympathetic bidirectional feedback to the heart and GI tract • Neuronal synaptic terminals direct contact • Enteroendocrine cells release gut peptides to signal CNS via Vagus • 80-90% vagal nerve fibers are afferent (sensory) nerves, sending viscera information to the brain seamless well being™ www.aquaterrahealth.ca Brain-Gut Feedback Connection • Post brain stem relays (tractus solitarii) show a neural network involving the amygdala and insular cortex processing visceral inputs • Hypothalamic signaling initiates the efferent reflex • Hypothalamic-pituitary-adrenal (HPA) axis initiates hormonal GI response • Sympathetic activation and antiinflammatory cholinergic reflex seamless well being™ www.aquaterrahealth.ca Microbiota Connection • Endosymbiot’s evolved feedback channels with CNS to maintain homeostasis • Protect against pathogens • Metabolize complex lipids and polysaccarides that signal GI epithelium • Microbiota-Gut-Brain (MGB) axis (Rhee et al. 2009; Cryan & Dinan, 2012; Forythe et al., 2012) seamless well being™ www.aquaterrahealth.ca GBA Imbalances • Anxiety • Depression • Obesity • Pain • Autism Spectrum Disorder (ASD) • Multiple Sclerosis (MS) • Cardiovascular Risk (CVD) seamless well being™ www.aquaterrahealth.ca Clinical Case - MA • Jan ’14 30 YO Autistic (dx 34mo.) female cc’s: acne, allergies, amenorrhea, fungal infection, seizures, indigestion, PCOS, periodontal dz., & poor hair growth. • PE: Bilateral Pupillary Reflex (BPR) <1sec, tongue thick white coat & dark purple injected veins ventrally, numerous perioral acne lesions • Lab blood results: prolactin, LH, FSH, progesterone, & testosterone all normal, HbA1c 4.3 LN, Neuts (Auto/#) HN, Lymphs L. seamless well being™ www.aquaterrahealth.ca MA: 30 YO Female cont’d • Electrodermal Screening (EDS): microbial fungal imbalance, LI & SI dysbiosis, remedy test – probiotics and magnesium • Px: lamotrigine 100mg 2.5 bid • Rx: omega-3 (yellow cap) 1 tid, probiotic 10 B ‘active’ cells, multivitamin one a day for women 1 qd, vitamin D 1 qd. • Allergies: penicillin • Reaction to H1N1 vaccine seamless well being™ www.aquaterrahealth.ca MA: 30 YO Female cont’d • Assessments: digestive dysfunction, dysbiosis, fungal imbalance, magnesium deficiency w/ poss. toxic metals, adrenal insufficiency, ASD • Plan: contact pharmacist to facilitate MD to sign off on new probiotic dose and magnesium • Isopathic’s for dosing when parents are caring for MA • Order Hair Mineral Analysis (HMA) seamless well being™ www.aquaterrahealth.ca MA: 30 YO Female cont’d • Apr ’14: V2 phone consult with parents • Update: Supplements OK’d, Gyn. Specialist Px BCP and GP Px benzoclin topical, acne • HMA: following ratios; Ca/Mg high, Zn/Cu very high, Na/K very low & Na/Mag low. Plus the presence of Aluminum (Al) • Plan: avoid Al containing antiperspirants, Sea Salt, discuss ceruloplasmin testing & continue with initial visit Rx’s seamless well being™ www.aquaterrahealth.ca seamless well being™ www.aquaterrahealth.ca MA: 30 YO Female cont’d • Aug.’14: V3 improvement in acne, no seizures since V2, no menses, accompanied by care giver who reports MA more emotional • EDS: LI & SI dysbiosis persists • Px: new Beclomethasone 50 mcg 1 spray bid in each nostril, Chlorhexidine 0.12% two weeks on/off, Ethinyl Estradiol & Norgestimate Cyclen 28 (0.25&0.035) qd, Dimenhydrinate 50mg prn seamless well being™ www.aquaterrahealth.ca MA: 30 YO Female cont’d • PE: BPR remains <1sec, tongue moderate white coat & dk purple veins, decreased 50% perioral acne, sclera N • Assessments: : digestive dysfunction, dysbiosis, fungal imbalance, Al toxicity, mineral imbalances, Px side effects • Plan: talk to parents about medications and continued dysbiosis & ceruloplasmin testing logistics, increase probiotics 3 bid seamless well being™ www.aquaterrahealth.ca Who’s Running the Show? • Our body contains 100 trillion microbes outnumbering cells: 10 to 1 • 400 GI microbial species – roughly 35 species make up 99% in the GI tract • Estimated weight = 2.5-2.7kg • Varied life cycles, from single cell to colonial complexes known as biofilm seamless well being™ www.aquaterrahealth.ca Bugs and the Brain From: Nature Reviews | Neuroscience 13, 701-712 October 2012 seamless well being™ www.aquaterrahealth.ca Healthy Flora Promote… • Digestion of food and absorption of nutrients • Protection from pathogenic microorganisms • Vitamin production (B’s & K), mineral absorption • Elimination of Toxins and production of cytochrome P450-like enzymes • Anti-mutagenic, Antitumor and Immunomodulation effects seamless well being™ www.aquaterrahealth.ca Probiotic Synergy From: Brain-Gut-Microbe Communication in Health and Disease, Dec. 7, 2011. seamless well being™ www.aquaterrahealth.ca Metabolic Imbalance – Insulin Resistance Syndrome • Insulin Resistance Syndrome is common in many chronic conditions: u Heart disease u Diabetes u Hypertension DANGER INSULIN RESISTANCE u Obesity u Sarcopenia u Polycystic Ovary Syndrome (PCOS) seamless well being™ www.aquaterrahealth.ca Exercise & Metabolic Balance • Muscles use blood sugar for fuel EXERCISE BLOOD SUGAR • Exercise helps transport blood sugar into cells, keeping blood sugar and insulin in healthy range seamless well being™ INSULIN Metabolic Balance www.aquaterrahealth.ca Alpha Lipoic Acid • Important antioxidant • Works with vitamin E, C and CoQ10 • Supports normal glucose use by improving insulin sensitivity Alpha Lipoic Acid seamless well being™ Glucose Metabolism www.aquaterrahealth.ca Bioelectric Impedance Analysis (BIA) ...Measures body composition • Lean muscle mass – predicts BMR • Body fat % • Body water – hydration status seamless well being™ www.aquaterrahealth.ca BIA Assessment Impedimed seamless well being™ www.aquaterrahealth.ca Primary Nutrition and Metabolic Balance • Water Fat Water Protein • Protein • Essential Fatty Acids seamless well being™ Metabolic Balance www.aquaterrahealth.ca Water • Our bodies are made up of 60% water • Water helps flush toxins out of our bodies • Water helps transport nutrients and electrolytes to and from our cells seamless well being™ www.aquaterrahealth.ca Water, Protein & Fat Diagram from: Staying Healthy with Nutrition, Elson Haas, 1992 seamless well being™ www.aquaterrahealth.ca Studies Say… • ‘Gut Microbiota regulate the set point for hypothalamic-pituitary-adrenal axis activity’ Neurogastroenterology and Motility March 2011; 23(3);255-319 • ‘Bifidobacterium longum NCC3001 shown to help normalize anxiety behavior in Mice with infectious colitis’ - Neurogastroenterology and Motility December 2011; 23(12); 1132-1139 • ‘Lactobacillus rhamnosus reduced anxiety and depression-related behavior’ - Proceedings of the National Academy of Sciences 2011 Sep 20;108(38):160050-5 seamless well being™ www.aquaterrahealth.ca Matrix System • Dr. Pischinger showed that the cells and organs are absolutely dependent on the Matrix material that surrounds them (the humors and fluids). • The cell does not exist in a vacuum. It has a very large and important support structure. • Ground substance, Humoral system, Connective tissue, and Matrix are among the most common names of this tissue. • The Matrix System is the basic regulation system of the entire organism. seamless well being™ www.aquaterrahealth.ca Matrix Structure The matrix (connective tissue) is a functional system. It has 4 components: 1. The Cell 2. Matrix or Ground substance 3. Neural-Vascular Unit 4. The membrane receptor seamless well being™ www.aquaterrahealth.ca The Matrix seamless well being™ www.aquaterrahealth.ca The Extracellular Matrix • Extra cellular matrix (ECM) is the link between cells and the exterior. • ECM provides a frame for cell movement. • ECM is a tri-dimensional complex of proteins carbohydrates, salts, fixed cells, migrating cells and fibers that fully support tissue and allow the exchange of information with the environment. seamless well being™ MATRIX SYSTEM ACCORDING TO PISCHINGER www.aquaterrahealth.ca The Matrix or Ground Substance • Sugar • Protein complex • Proteoglycans • Glycosaminoglycans • Structural proteins • Collagen • Elastin • Meshing glycoproteins Structural Proteins and Fibroblasts Adhesive proteins Lymphatic system Fibrinolectin Laminins Integrins Microcirculatory GAGS Arterial Capillary Venous Chondrotin sulphate Hyaluronic acid Migratory Cells Monocytes Macrophages Lymphocytes Dendritic cells Mast cells Neutrophils Granulocytes seamless well being™ Fixed Cells Fibroblasts Adipocytes Mesenchymal www.aquaterrahealth.ca The Fibroblast The Fibroblast is the functional cell of the extra-cellular matrix. • capillary-like communication • spider-like connection of glycosaminoglycans. seamless well being™ www.aquaterrahealth.ca Field Activity of the Matrix • The field of activity and information of the Matrix is the extracellular fluid, including lymph fluid. • The Matrix is a molecular sieve that filters, nourishes, defends, repairs, and supports the cellular structures. • The matrix is the largest system penetrating the entire organism. It permeates the extra cellular space and reaches every cell. seamless well being™ www.aquaterrahealth.ca Matrix Regulation • Biological Matrix Regulation therapy is accomplished using local regulatory therapies in the Ground System plus neural and biological response modifiers. • Techniques such as acupuncture, mesotherapy and neural therapy improve Matrix Regulation locally and globally. • Homeopathic, Herbal and Orthomolecular methods are directed at the functions of the Matrix System, such as hormonal, enzymatic, or oxidation/reduction reactions. seamless well being™ www.aquaterrahealth.ca Primary Matrix Functions • Nutrition - Defense – Repair. • The Matrix is capable of both specific and non-specific responses to stimuli. • Matrix reacts locally and entirely. • Matrix reacts more to the strength than to the type of stimulus. seamless well being™ www.aquaterrahealth.ca Regulation Therapy …is based on the use of therapeutic techniques that maintain or restore dynamic: • Physiochemical • Energetic and/or • Information flow within and throughout the matrix system… The gut-brain connection is dependent on a healthy matrix system seamless well being™ www.aquaterrahealth.ca Matrix Regeneration Therapy seamless well being™ www.aquaterrahealth.ca pH Balance • • • • Optimal pH range is 6.8 – 7.2 Food, activity and emotion all affect pH Acidic terrain upsets mineral balance The most common obstacle to cure seamless well being™ www.aquaterrahealth.ca Why do we get acidic? • Excess acidifying foods (meat, sausage, cheese…) • Too much stress • Inflammatory processes (arthritis, sprains/strains…) • Allopathic drugs • Not enough alkalinizing food (fruits, vegetables) • Lack of exercise and fresh air seamless well being™ www.aquaterrahealth.ca Blood Type • ABO blood groups evolved from biological & environmental variables, (i.e. nutrition & microbes) as well as human adaptations for survival • In-office, objective test to differentiate between blood type O, A, B, or AB • Dr. Peter D’Adamo’s Blood Type Diet is a useful tool as a nutrition starting point seamless well being™ www.aquaterrahealth.ca Electrodermal Screening (EDS) • 1950’s Dr. Reinhold Voll measured galvonic skin response – Electroacupuncture according to Voll (EAV) • EDS machines evolved in dozen’s of companies with various technologies • Basic ohm meter for the human body – measuring the bioelectrical/magnetic systems as opposed to the more familiar biochemical/ mechanical systems seamless well being™ www.aquaterrahealth.ca Electro-magnetic Assessment • Electrocardiogram (EKG) and Magnetic Resonance Imaging (MRI) are assessment tools measuring bioelectrical and magnetic pulses interpreted with a mechanistic approach • EDS is an assessment tool that provides information about the health of the body via electrical measurements (resistance) of the skin at specific acupuncture points, interpreted with a holistic approach seamless well being™ www.aquaterrahealth.ca Clinical Case - DB • Jan’14 48 YO GV 0, appendectomy @ 1YO • cc’s: allergies, anxiety, depression, dysmenorrhea, PTSD, sinusitis and stomach problems. • PE: bilateral pupillary reflex fixed, tongue mild white coat with numerous raised papillae posterior, 4/10 nail ‘moons’, vertical nail ridges, orthostatic 110/70 lying 100/62 standing, spO2 97%, pulse 88 • Blood Type: O seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • EDS: enzyme deficiency, liver/bile duct congestion, pro-inflammatory, remedy tolerance new & previous. • Px: Tecta 40mg qd • Rx: womens one a day, vitamin D3 400IU, curcumin, zinc lozenges w/ echinacea, vit c • Allergies: X-ray dye • Assessments: anxiety, digestive dysfunction, dysthymia, possible LGS, LV Qi & blood stagnation seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • Plan: digestive enzyme support, GI protein/ herbal supplement, liver drainage (complex homeopathy), curcumin 1 bid, vit D 3 tab qd (rec 1 tab 1000 IU qd), Kali Phos 6X 4 tabs tid, blood type O nutrition • Feb ‘14 phone call that Kali Phos caused worsening of anxiety sx’s • Plan: B12 methylcobalamin subliqual & DGL from HFS, stop Kali phos 1 wk seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • Mar ’14 ST/GI sx’s 80% >, anxiety ‘only’ 50% >, < w/ diarrhea & am, more aware of emotional eating, eating to BT O positive • PE: bilateral pupillary reflex fixed, OBP 118/65 lying 115/60 standing, spO2 99%, pulse 78 • EDS: adr med/cortex, remedy tolerance; – Kali Phos/sulfur, + DGL • Assessments: improving GI, adrenal insufficiency, ME imbalance seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • Plan: finish liver drainage, adrenal glandular support, complex homeopathy for ME, continue previous plan • Mar ‘14 phone call diarrhea < ? Meds • Plan: continue plan, congee water 1/2c qd-qid, remove all dairy, wheat & switch to organic eggs • Aug ‘14 feels GI symptoms ‘cleared’ and does not need to take homeopathic for anxiety, continues with all other Rx’s seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • Lab blood test (June ‘14) results: normal AC glucose, eGFR, creatinine, lytes, lipids, albumin, liv enzymes, TSH, estradiol, FSH, prolactin, CBC with HN LH and ferratin 12ug/L, vit B12 568pmol/L • UA normal • PE: BPR 1sec, OBP 115/65 lying 118/68 standing, spO2 99%, pulse 68 • EDS: imp. HPA, LH N, iron-, liquid iron + seamless well being™ www.aquaterrahealth.ca DB: 48 YO Female cont’d • Assessments: GI balance, improved ME state, recovering adrenals, low iron stores • Plan: add liquid iron 10ml bid 14day then qd, probiotics 2qd 7 days/mo, flu/cold prevention, continue prev. Rx’s seamless well being™ www.aquaterrahealth.ca GBA seamless well being™ www.aquaterrahealth.ca Heart Rate Variability (HRV) Assessment of the Autonomic Nervous System seamless well being™ www.aquaterrahealth.ca QRS Complex Normal Electrocardiogram (ECG) seamless well being™ www.aquaterrahealth.ca x-axis: PSNS seamless well being™ www.aquaterrahealth.ca y-axis: SNS seamless well being™ www.aquaterrahealth.ca Clinical Case - JC • Dec’ 58 YO GV 1, single Mom • cc’s: allergies, anxiety, bloating, diarrhea, exhausted, insomnia, and low libido • PE: bilateral pupillary reflex fixed, tongue thick white coat, 0/10 nail ‘moons’, vertical nail ridges • Blood Type: O • HRV: see results seamless well being™ www.aquaterrahealth.ca JC: 58 YO Female cont’d • EDS: dysbiosis SI & LI, adrenal med/cortex imbalace, B12 low • Rx: vitamin C if has cold • Allergies: penicillin • Assessments: dysbiosis, adrenal fatigue, and poor oxygen utilization • Plan: vitamin B12 IM shots 1/wk 5 weeks, ozone intestinal insufflations 2/week, probiotic 40 billion/d, adrenal glandular supplement, and blood type O nutrition seamless well being™ www.aquaterrahealth.ca INITIAL ASSESSMENT seamless well being™ www.aquaterrahealth.ca ORTHOTEST RESULTS (initial assessment) seamless well being™ www.aquaterrahealth.ca PHYSICAL FITNESS LEVEL (initial) seamless well being™ www.aquaterrahealth.ca JC: 58 YO Female cont’d • Feb ’14 bloating, diarrhea cleared and has more energy, sleeping better and wants to be more ‘social’ • PE: bilateral pupillary reflex 2 sec., tongue mild white coat, nail moons no change with less ridging at base • HRV: see results seamless well being™ www.aquaterrahealth.ca FOLLOW-UP ASSESSMENT seamless well being™ www.aquaterrahealth.ca ORTHOTEST RESULTS (follow-up assessment) seamless well being™ www.aquaterrahealth.ca PHYSICAL FITNESS LEVEL (follow-up) seamless well being™ www.aquaterrahealth.ca JC: 58 YO Female cont’d • Assessment: improved dysbiosis, adrenal fatigue and oxygen utilization • Plan: switch to oral methylcobalamin qd (+1 prn), probiotics 20 billion/d, adrenal glandular 2caps am & 1 lunch, work with blood type O nutrition • GBA treatment yields results seamless well being™ www.aquaterrahealth.ca Exhaustion Imbalanced ANS seamless well being™ www.aquaterrahealth.ca Vitality Balanced ANS seamless well being™ www.aquaterrahealth.ca Oxygen – A Vital Nutrient seamless well being™ www.aquaterrahealth.ca Oxygen Utilization seamless well being™ www.aquaterrahealth.ca Causes of Decreased Oxygen Utilization Pre-Mitochondrial Factors Mitochondrial Factors • Decreased Lipolysis • Toxicity (especially Mercury) • Hypoglycemia • Ischemia • Infections • Stress • Hypoxia • Nutritional & Hormonal deficiencies • Inflammation • Decreased Methylation • Decreased Fitness seamless well being™ www.aquaterrahealth.ca Ozone seamless well being™ www.aquaterrahealth.ca Ozone Production seamless well being™ www.aquaterrahealth.ca Toxicity In The Bowel • A Natural Barrier to Toxic Substances • “Leaky Gut Syndrome”- passage of toxic substances into the body seamless well being™ www.aquaterrahealth.ca Toxic Load Exposure to toxic substances External • Food additives, chemical solvents, heavy metals pesticides, herbicides, drugs, alcohol Internal • seamless well being™ Microbial: bacterial, fungal, viral and parasites www.aquaterrahealth.ca Expressions Of Toxicity • Headaches • Muscle aches and pains • Irritability, mental confusion • Allergy or flu-like symptoms • Chronic fatigue • Depression • Joint pain • Insomnia • Behavioral seamless well being™ www.aquaterrahealth.ca ‘Gut Feeling’ about the Future • The Gut-Brain Axis plays a key physiological role in the regulation of women’s health • The Enteric Nervous System depends on a balanced matrix system for effective communication to the brain • When the GBA, and the ENS, are dis-regulated, there is a direct affect on mood and behavior • Addressing the human microbiota milleu in naturopathic medical treatment, will become integrated in all medicine of the future seamless well being™ www.aquaterrahealth.ca Questions? 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