MIM Health - September 2008

Doctor's Corner

It's been a few months since I last sent out a MIM Health enewsletter. I hope you have all had a fun, relaxing and healthy summer. This summer was a bit short here in southwest Montana. It snowed well into June, but when the summer did finally arrive it was beautiful.

I was honored to have recently been voted Best Doctor among all physicians in the area in The Tributary's annual Best of Bozeman survey. This is the first time a naturopathic doctor has ever won this category. Winners are determined exclusively by voters, who respond to the ballots the paper includes in its July issue and online. The editors wrote about Dr. Neustadt, "It is noteworthy that Dr. Neustadt did not win 'best naturopathic doctor;' he won best doctor. Perhaps for his expertise in nutritional biochemistry – his book, A Revolution in Health through Nutritional Biochemistry, written with Steve Pieczenik, MD, Ph.D., was released this spring. Perhaps, it is his intuitive and holistic approach to health care. Perhaps it is for the extra hours he puts in at no charge. But likely it's the combination of all of these characteristics that set him apart. This is a big day for naturopaths everywhere. Congratulations, Dr. Neustadt." Thank you to everyone who voted for me, and to all my patients who have trusted me to help them.

Additionally in July, an article written by Dr. Pieczenik and I entitled, Medication-Induced Mitochondrial Damage and Disease, was published in the journal Molecular Nutrition and Food Research. Because of our groundbreaking research into the role mitochondria play in disease, we were approached by a senior FDA researcher and asked to submit an article on the topic for a special issue of the journal. Mitochondria are the energy-producing portion of our cells. Damage to mitochondria is now implicated in nearly every disease, including diabetes, anxiety disorders, bipolar disorder, cancer, Alzheimer disease, chronic fatigue syndrome, pain and cardiovascular disease. We have pioneered the clinical application of testing and nutritional treatments for mitochondrial damage and its symptoms, and this invited article is a testament to the groundbreaking work being done at MIM.

Over the years I have been asked about dietary supplements and, more often than not, patients will show me their dietary supplements and ask my opinion of them. Unfortunately, most of the time people are purchasing very poor quality products that really aren't helping them. They would be better off saving their money and just eating healthier. Most people should eat healthier, and a good diet is the foundation for long-term health. However, purchasing dietary supplements can promote your health and be a very good investment. But most people don't even understand the basics of how to select a high-quality formula that will actually help them. This issue's Health Topic is a Frequently Asked Questions (FAQ) that can help you buy the best quality dietary supplement.

The Natural Tip this month is about Butterbur (Petasites hybridus), which has been shown on multiple clinical trials to be very helpful for decreasing the symptoms of migraines and allergies. While decreasing symptoms can be very helpful, I still advocate and strive to help people identify and treat the underlying causes of disease. This can be done very effectively in many cases with biochemical testing. More information can be found on the MIM website by clicking here.

I enjoy sharing new websites and information when I come across them. I recently learned of a great website that has recipes for kids with and without special dietary needs. This is discussed in the Recipe section of the newsletter.

And if you're in Southwest Montana this Saturday, September 20, come by the Holiday Inn and hear Dr. Neustadt speak on Naturopathic Pain Management for Cancer Patients at the Collaborative Cancer Care Symposium.

Wishing you good health,

Dr. Neustadt

And if you're ever interested in reading back issues of the newsletter, they're posted on the clinic website, at www.montanaim.com/newsletter.

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Upcoming Appearance: Collaborative Cancer Care Symposium Dr. Neustadt will be speaking on September 20 from 2:15- 3:30 PM at the Collaborative Cancer Care Symposium on Naturopathic Pain Management for cancer patients. This engaging Collaborative Care symposium will offer panel discussions and nine hands-on workshops facilitated by professionals and cancer survivors across Montana currently practicing a successful Integrative Medicine approach to wellness and healing. This symposium is FREE with priority given to Montana families or individuals within one year of cancer treatment. Registration is required, and space is limited. This year's symposium will be held at the Holiday Inn in Bozeman. Call the Cancer Family Network at 406-587-8080 to register. Health Topic: NBI Guide to Dietary Supplements As you might know, I have formulated a line of dietary supplements with my colleague, Steve Pieczenik, MD, PhD, under our label, Nutritional Biochemistry, Inc. (NBI). We've been working extremely hard the last two years to launch a line of formulas that adhere to the highest manufacturing practices and contain only the doses and forms of nutrients in them that have been shown in clinical trials to be effective. For example, our Osteo-K formula is the only product on the market with the form and dose (45 mg) of vitamin K2 (as MK-4) shown in clinical trials, and confirmed by the Archives of Internal Medicine to decrease fracture risk by up to 81%, which is better than Fosamax, without any of the Fosamax side effects. I cannot understate the importance of selecting only dietary supplements that have the form and dose of nutrients shown in clinical trials to work. Many formulas might have the form of a nutrient, but a dose that is below the threshold for even helping you. This is called sub-therapeutic dosing, and in medicine it can literally kill someone. I am happy to report that our line of NBI formulas have been picked up by a national distributor, Natural Partners, Inc. (NPI), which distributes pharmaceutical-grade dietary supplements to doctors across the country for use with their patients. A few months ago we were speaking with some retailers in Great Falls, MT, when it occurred to us that we were hearing the same questions over and over. These were the same questions many of my patients have as well. Namely, people really are not clear how to evaluate a dietary supplement formula to determine if it is high quality and if they are getting their money's worth. Unfortunately, it's buyer beware out there at health food stores, and it can be confusing to people when they try to select a dietary supplement. Most people just purchase the lowest cost formula, but in most instances they would be better off just keeping their money, since the benefit from cheap formulas is negligible. To help people understand how to shop and get the best value for their money, we created a Frequently Asked Questions (FAQ) document, which I am sending to you now in this newsletter. I hope it helps. What Are Dietary Supplements? Dietary supplements are vitamins, minerals, herbs and other substances meant to improve your health. They can come as pills, capsules, powders and liquids. It’s important to realize that they are not intended to replace an optimal diet, but rather to “supplement” the diet. Dietary supplements are regulated by the US Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act of 1994 (DSHEA). Signed by President Clinton on October 25, 1994, the DSHEA acknowledges that millions of consumers believe dietary supplements may help to augment daily diets and provide health benefits. The provisions of DSHEA define dietary supplements as being: a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients. intended for ingestion in pill, capsule, tablet, or liquid form. not represented for use as a conventional food or as the sole item of a meal or diet. labeled as a "dietary supplement." products such as an approved new drug, certified antibiotic, or licensed biologic that was marketed as a dietary supplement or food before approval, certification, or license (unless the Secretary of Health and Human Services waives this provision). Should I take dietary supplements? Most people would probably benefit from a high quality dietary supplement. This is because most people do not eat an optimal diet. A good dietary supplement is a smart insurance policy. Basically, what a good regimen of dietary supplements, diet and exercise do is to boost your immune system and prevent acute and chronic diseases, including heart disease, diabetes, high blood pressure, dementia and Parkinson’s disease. In medicine nutrients are even used to treat many diseases; however, patients must seek out a skilled doctor knowledgeable in nutritional medicine, since conventional physicians are not trained in nutrition. In theory, we should be able to receive all the nutrition we need from diet alone. But the fact is that most of us do not. Few of us eat the recommended 5 – 8 servings of fresh fruits and vegetables a day. Our food is often picked before it is ripe and transported long distances. The soil in which our food is grown has become depleted of nutrients. We rely on quick, processed foods with our busy lifestyle. We live in a highly toxic world. We have individual health needs and challenges. A multiple vitamin and mineral (MVM) supplement does not replace a good diet. There are compounds in food that just can’t be replaced in a pill. Evidence shows that a good diet is still your best tool for staying healthy. However, a good MVM supplement is important insurance for optimal health. How do I know if a dietary supplement is good? There are three things to look for in evaluating a dietary supplement. First, it should be manufactured at an FDA-approved facility that is also GMP-certified. Manufacturers cannot advertise this on their product labels, so you’ll need to check their sales literature for this. This process requires manufacturers test raw materials for contaminants and quarantine the materials throughout the manufacturing process. Quality Checklist   Capsules (not tablets) More than “one-a-day” multivitamin Purity and Potency Guaranteed FDA-Approved, GMP-certified     Manufacturer Highly bioavailable forms (no “-oxide” minerals) Hypoallergenic Avoid “other ingredients” (e.g., binders and fillers) Second, the best dietary supplements will also be tested for purity and potency. This costs companies extra money so they want to advertise this on their dietary supplements. Look for “tested for purity and potency” or “purity and potency guaranteed” on the labels. If they are tested for purity and potency, then the company should have on file a certificate of analysis for each product. A certificate of analysis verifies their purity and potency of a product. You have the right to request copies of certificates of analysis from dietary supplement companies. If they refuse to provide this to you then the product may have contaminants such as toxic metals, bacteria and fungal spores in it. Additionally, you cannot be guaranteed that what’s on the label is actually what’s in each capsule or tablet. In fact many studies have shown that many dietary supplements contain toxic metals and do not have the amount of nutrients in the capsules/ or tablets that are listed on the bottle. Third, when discussing dietary supplements Dr. Neustadt is fond of saying, “the devil’s in the details.” In addition to the two requirements mentioned above, when evaluating a multivitamin and mineral supplement you should look for three things on the label. One is to check if it’s a tablet versus a capsule. Tablets are generally more difficult to break apart in your stomach and may pass through your body without actually being dissolved and without you absorbing the nutrients. Additionally, companies tend to put poorly absorbable forms of nutrients in their formula. (More on this in a few sentences.) Next, is it a one-a-day multivitamin?  If it is, then you’re pretty much guaranteed that it’s a tablet and that the nutrients it contains are of exceedingly poor quality. How can you verify this? The last thing to do is look on the Supplement Facts label. This is where each ingredient is listed out in detail. Look for just three things: magnesium, zinc and copper. If any minerals are in an “oxide” form, then the product is garbage. This is because these minerals are very poorly absorbed in their “oxide” form. For example you can only absorb about 2% of the magnesium as magnesium oxide. This means that 98% of what you put in your mouth is just passing right through you and being eliminated in your stool. In fact, magnesium oxide is so poorly absorbed that it’s used in higher amounts as a laxative! Companies use the oxide form of minerals because their very inexpensive. But you’d be better off eating a few spinach leaves than wasting your money on a dietary supplement that contains minerals in their oxide forms. What are bioavailable forms of nutrients? Bioavailable Forms There are better forms of individual nutrients than others. You get what you pay for. Many lower cost products will use cheaper forms of vitamins and minerals. Unfortunately, many times cheaper forms also mean nutrients which are poorly absorbed or not usable by the body. Below are a few examples of nutrient choices. Vitamin E The best form of Vitamin E is d-alpha tocopherol with mixed tocopherols (d-alpha, gamma, beta, and delta). The synthetic form of Vitamin E is dl-alpha tocopherol. Note that the difference in labeling is “d” vs. “dl” before the alpha. “dl” is not a healthy choice. Vitamin B12 The best form of Vitamin B12 is methylcobalamin. Cyanocobalamin is the form in most vitamins and is usually fine for most people. If someone has chronic disease however, a methylcobalamin form is recommended. Vitamin B6 The active form of B6 is pyridoxine 5-phosphate. This is usually designated at P-5-P. Minerals There are many forms of minerals which are bonded to compounds; the physical form of a mineral is usually designated by the last word of the name. Example: magnesium citrate or magnesium oxide. Each form has different amounts of the basic elemental mineral as compared to the size of the whole compound and will determine how absorbable the mineral is. For example: calcium carbonate (this includes coral calcium) is a large molecule with a lot of elemental calcium. The large size of this molecule means that it is not easily absorbed. Calcium carbonate also tends to be constipating for some people. Calcium citrate, by contrast, is a smaller form of elemental calcium, and is much more easily absorbed than the carbonate form. (An interesting note is that certain antacid medications contain calcium carbonate and are marketed as a source of calcium. However, because the purpose of an antacid is to inhibit stomach acid, and stomach acid is necessary for making minerals available for absorption, the body has a harder time actually utilizing the calcium!) Similarly, magnesium oxide is poorly absorbed and causes water to stay in the intestines, thus causing a looser stool. Thus, magnesium oxide can be useful to treat occasional constipation. Alternatively, magnesium citrate is a better choice because it is more easily absorbed. (Caution, however, the citrate form may also cause loose stools for some people.) There are other forms of mineral compound chelates including gluconate, aspartate, asparotate, and lactate. The gluconate form is not recommended. What does hypoallergenic mean? A good dietary supplement will be hypoallergenic, meaning it does not contain wheat, dairy, soy, or artificial dyes or colorings. What are “other ingredients”? Before you read what the active ingredients are, read the label for “other ingredients.” Many supplements contain extra ingredients that may cause side effects or impair absorption. If you have lots of unnecessary “other ingredients”, it does not matter how much active ingredients you have, the MVM supplement is already a poor choice. We recommend researching any ingredient that is unfamiliar to you. The following is not a comprehensive list. Some “other ingredients” to avoid: Glucose, fructose, dextrose, maltodextrose, corn syrup, sucrose, lactose. These are sugars and unless these are added for flavor in children’s chewable vitamins, they are not needed. As soon as possible, wean your child from a chewable to a capsule to minimize their dependence on sugar and risk to their teeth. Sorbitol. This is a sugar alcohol, and although is not purely sugar, it is not beneficial in a vitamin. For diabetics this is an absolute must for avoidance! Sorbitol can also cause diarrhea. NutraSweet, Equal, Aspartame, Sucralose, Splenda. These are artificial sweeteners and are NOT beneficial to the body. Polyethylene glycol. Although non-toxic, this chemical, when used in large dosages, is a treatment for constipation. It is unnecessary for use in highly absorbable vitamins. Mineral Oil. Mineral oil is derived from petroleum and prevents absorption of nutrients. Given these two facts, taking a vitamin with mineral oil does not seem a good choice. Canuba Wax. Canuba wax may inhibit the digestion of the ingredients and make it less absorbable. This is especially true if digestive weaknesses are already present. Dextrin. This is a binding product, making the nutrients less available for digestion. Di-calcium phosphate. Di-calcium phosphate is an excipient (an inactive ingredient) and is not available to the body as calcium. A vitamin labeling both calcium and phosphorus may be counting the di-calicum phosphate as calcium, but it really doesn’t add much to the calcium content nutritionally. Any coloring Any pharmaceutical glaze What does GMP mean? GMP refers to the Good Manufacturing Practice Regulations promulgated by the US Food and Drug Administration (FDA) under the authority of the Federal Food, Drug, and Cosmetic Act. These regulations require manufacturers take steps to ensure that their products are safe, pure, and effective. GMP regulations require a quality approach to manufacturing, enabling companies to minimize or eliminate instances of contamination, mixups and errors. This in turn, protects the consumer from purchasing a product which is not effective or even dangerous. Failure of firms to comply with GMP regulations can result in very serious consequences including recall, seizure, fines, and jail time. GMP regulations address issues including recordkeeping, personnel qualifications, sanitation, cleanliness, equipment verification, process validation, and complaint handling. Are there any potentially toxic nutrients? While most nutrients in dietary supplements do not appear to have any toxic side effects, there are some notable exceptions. For example, very high doses of vitamin B6 (pyridoxine), a water soluble vitamin, can cause numbness and tingling in your fingers and arms. This side effect is generally reversible when you discontinue the vitamin B6. Similarly, high doses of vitamin B3 (niacin) can cause flushing (“hot flashes”) and liver damage. The amount of nutrients in dietary supplements are by and large too low to cause any problems, but sometimes people take very high amounts of nutrients because they read or heard somewhere that they may be helpful. We caution people against doing this without first discussing it with a healthcare provider who is an expert in nutritional medicine. Below is a table of nutrients and their potential toxicities. Nutrient Toxic Dosage Symptoms and Diseases Biotin n/a No side effects from oral administration at therapeutic doses have been reported Boron >10 mg No side effects reported Calcium >2,000 mg Drowsiness, extreme lethargy, impaired absorption of iron, zinc and manganese, calcium deposits in tissues throughout body, mimicking cancer on X-ray Carotene >300 mg Orange discoloration of skin, weakness, low blood pressure, weight loss, low white cell count Chromium >50 mg Dermatitis, intestinal ulcers, kidney and liver impairment Copper 15 mg Fatigue, poor memory, depression, insomnia, increased production of free radicals, may suppress immune function. Violent vomiting and diarrhea. Cooking acid foods in unlined copper pots can lead to toxic accumulation of copper. Fluoride, acute 500 mg Poisons several enzymes, (5,000 mg lethal) Fluoride, chronic 5 mg Fluorosis (white patches on teeth), bone abnormalities Folic acid 15 mg Abdominal distention, loss of appetite, nausea, sleep disturbances, may interfere with zinc absorption, may prevent recognition of vitamin B12 deficiency Iodine 2 mg Thyroid impairment, iodine poisoning or sensitivity reaction Iron Variable Intestinal upset, interferes with zinc and copper absorption, loss of appetite, not safe for those with iron storage disorders such as hemosiderosis, idiopathic hemochromatosis, or thalassemias. Toxic build-up in liver, pancreas, and heart Magnesium N/A Diarrhea at large dosages of poorly absorbed forms (like Epsom salts). Disturbed nervous system function because the calcium-to-magnesium ratio is unbalanced; catharsis, hazard to persons with poor kidney function. Manganese 75 mg Toxicity only reported in those working in manganese mines or drinking from contaminated water supplies, which results in loss of appetite, neurological damage, loss of memory, hallucinations, hyperirritability, elevation of blood pressure, liver damage. Mask-like facial expression, blurred speech, involuntary laughing, spastic gait, hand tremors. Niacin (B3), acute 100 mg Transient flushing, headache, cramps, nausea, vomiting Niacin (B3), chronic 3 gm Anorexia, abnormal glucose tolerance, gastric ulceration, elevated liver enzymes. Excessive uric acid in blood, possibly leading to gout. See Thiamin. Pantothenic acid (B5) High dose Occasional diarrhea. Increased need for thiamin, possibly causing thiamin deficiency symptoms. Phosphorous High dose Distortion of calcium-to-phosphorus ratio, creating relative deficiency of calcium. Potassium High dose Mental impairment, weakness. Excessive potassium in blood, causing muscular paralysis and abnormal heart rhythms. Pyridoxine (B6) 300 mg Sensory and motor impairment. Dependency on high doses, leading to deficiency symptoms when one returns to normal amounts. Riboflavin (B2) N/A No toxic effects have been noted. See Thiamin. Selenium 750 mcg Diabetes, garlic-breath odor, immune impairment, loss of hair and nails, irritability, pallor, skin lesions, tooth decay, nausea, weakness, yellowish skin Thiamin (B1) N/A No toxic effects noted for humans after oral administration. However, since B Vitamins are interdependent, excess of one may produce deficiency of others. Vitamin A, acute (infant)* 75,000 IU Anorexia, bulging fontanelles, hyperirritability, vomiting Vitamin A, acute (adult)* 2 million IU Headache, drowsiness, nausea, vomiting Vitamin A, chronic (infant)* 10,000 IU Premature epiphyseal bone closing, long bone growth retardation Vitamin A, chronic (adult)* 50,000 IU Anorexia, headache, bluffed vision, loss of hair, bleeding lips, cracking and peeling skin, muscular stiffness and pain, severe liver enlargement and damage, anemia, fetal abnormalities (pregnant women must be very careful), menstrual irregularities, extreme fatigue, liver damage, injury to brain and nervous system. Vitamin B12 (Cobalamin) N/A No side effects from oral administration have been reported. (See thiamin) Vitamin C, acute 10 gm Nausea, diarrhea, flatulence Vitamin C, chronic 3 gm Increased urinary oxalate and uric acid levels in rare cases, impaired carotene utilization, chelation (binding of vitamin C with minerals) and resultant loss of minerals may occur, sudden discontinuation can cause rebound scurvy. Kidney and bladder stones, urinary tract irritation, increased tendency for blood to clot, breakdown of red blood cells in persons with certain common genetic disorders (such as glucose-6-phosphate dehydrogenase deficiency, common in persons of African origin), may induce B12 deficiency. Vitamin D, acute 70,000 IU Loss of appetite, nausea, vomiting, diarrhea, headache, excessive urination, excessive thirst Vitamin D, chronic 10,000 IU Weight loss, pallor, constipation, fever, hypocalcaemia. In infants, calcium deposits in kidneys and excessive calcium in blood; in adults, calcium deposits throughout the body (may be mistaken for cancer) (pregnant women must be careful), deafness, nausea, kidney stones, fragile bones, high blood pressure, high blood cholesterol, increased lead absorption. Vitamin E 1,000 IU The safe dose is probably over 2,000, but some people experience weakness, fatigue, exacerbation of hypertension, increased activity of anticoagulants at 1,000 IU. Vitamin K   No known toxicity with natural vitamin K (vitamin K1 and K2). Synthetic vitamin K (vitamin K3) can be toxic. Zinc 75 mg Gastrointestinal irritation, vomiting, adverse changes in HDL/LDL cholesterol ratios, impaired immunity. Nausea, anemia, bleeding in stomach, premature birth and stillbirth, abdominal pain, fever. Can aggravate marginal copper deficiency. May produce atherosclerosis.  *Note: Most multivitamin formulas do not contain vitamin A. Rather they contain beta-carotene, which the body converts to vitamin A. Dietary supplement labels will say, Vitamin A (as Beta Carotene). There is no toxicity associated with taking beta-carotene, since the body will only convert as much beta-carotene to vitamin A that it needs. Should any Nutrients Be Balanced with other Nutrients? Yes. Frequently dietary supplement manufacturers will combine nutrients in ways that are potentially harmful. In other cases they don’t even include nutrients that should be there to protect someone from toxicity. For example, zinc and copper must be balanced in about a 10-to-1 ratio or serious disease can result. That is, for every 10 mg of zinc you need about 1 mg of copper. This is because high amounts of zinc that are not balanced with copper can cause a copper deficiency. This can result in anemia, fatigue and breathing difficulties. This is exactly what happened to Dr. Pieczenik. He was taking zinc because he read that it could boost his immune system. But the store-bought dietary supplements with high zinc did not contain any copper. This lead to a copper deficiency, which was identified by laboratory analysis, an inability to produce epinephrine, which allows the lung to dilate for breathing, and adult onset asthma. Once his copper deficiency was corrected he no longer had asthma. Are there Contaminants in Dietary Supplements? Unfortunately, yes. Many studies have been published recently documenting toxic contaminants in dietary supplements. Toxic metals identified in dietary supplements include lead, arsenic and mercury at extremely high doses. All of these toxic metals were contained in dietary supplements with raw materials from China. contaminants found in dietary supplements include pesticides, dangerous fungal spores, bacteria, hormone and even some drugs. To ensure the safety of all its products, NBI pays extra to have every batch of its dietary supplements independently tested for authenticity, potency, heavy metals, solvent residue, herbicide and pesticide residue, aflatoxins, stability and bacteria, yeast and mold counts. If your dietary supplement manufacturer does not do this, you may very well be putting your health at risk.

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Natural Tip: Butterbur for Migraines and Allergies

Butterbur (Petasites hybridus) is a member of the Asteraceae (Compositae) family, which also includes sunflower (Helianthus spp.), echinaceae (Echinaceae spp.), artichoke (Cynara scolymus) and milk thistle (Silybum marianum). Butterbur is native to Europe, northern Africa and southwestern Asia and grows up to three feet tall. The plant prefers wet, marshy ground, and is found growing in damp forests and adjacent rivers or streams. In the Middle Ages butterbur was used to treat plague and fever, while during the 17th century it was prescribed for coughs, asthma and skin wounds. The genus, Petasites, comes form the Greek, “petasos,” which is a felt hat worn by shepherds. This is because the large leaves, which can measure up to three feet in diameter, have a soft downy texture. The common name, “butterbur,” came from one of its historical uses, which was to wrap butter with the leaves during warm weather.

In modern times, the primary therapeutic uses of butterbur are to prevent migraine headaches and to treat allergic rhinitis (seasonal allergies). It has also been studied from the prevention of gastric ulcers and in for treating cough, asthma, irritable bladder and urinary tract spasms.

Caution

Allergies to any plants in the Asteraceae family (e.g., echinacea, sunflower, artichoke, milk thistle) increase your risk for allergic reactions to Butterbur, since it is in the same family as these other plants.

Recipe: Healthy Kids Snacks
(Have a recipe you want to share? Email it to us and it may appear in a future issue of MIM Health.)

This month I'd thought I'd featured a website that has some excellent recipes for kids with and without health conditions. Special recipes exist for children with cystic fibrosis and diabetes. Click here to see the website and learn ways to help your children get the best possible nutrition.

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Montana Integrative Medicine
1087 Stoneridge Drive, Suite 1, Bozeman, MT 59718, tel. 406-582-0034