1

Innate glutathione production

Glutathione levels are the highest for about six hours after each meal.

Our lowest level of glutathione is in the morning before our first meal.

While healthy children and young adults tend to have sufficient glutathione, glutathione production decreases as we age. Once we reach the age of 45, production declines

precipitously. Add to this, glutathione depleting activities, and our

glutathione stores can become seriously depleted

2

Dietary glutathioneNutrient to Increase Food Sources

Glutathione Asparagus, spinach, garlic, avocado, squash, zucchini, potatoes, melons, grapefruit, strawberries, peaches

Selenium Brazil nuts, meat, seafood

Cyanohydroxybutene Broccoli, cauliflower, Brussels sprouts, cabbage

Alpha lipoic acid Red meat, organ meats, yeast (especially Brewer’s yeast)

Riboflavin Sunflower seeds, spinach, avocado

Cysteine Eggs, garlic, whey protein

Flavonoids Turmeric, cinnamon, cardamom

3Stress-induced glutathione depletion

Chronic neuroendocrine stress leads to the elevation of cortisol, norepinephrine and epinephrine and increased metabolic rate - which is frequently accompanied by oxidative damage and depleted antioxidants

High levels of stress hormones promote lipid storage as organ fat rather than subcutaneous fatty tissue. Organ adipocytes secrete proinflammatory cytokines, which

increase oxidation, leading to a depletion of antioxidants, especially glutathione, and ultimately to cell injury, organ damage and disease.

Djordjevic J, et al. Cell Mol Neurobiol. 2010;30(5):693.Abraham NG, et al. Ann N Y Acad Sci. 2007 Oct;1113:256-75

4Cell signaling: Psychological Stress

5Stress & Cancer ProgressionClinical and epidemiological studies over the last 30

years have identified psychosocial factors especially stress, chronic depression and feelings of isolation as risk factors for cancer progression.

Chronicity of negative affect, as manifested by depressed mood or hopelessness/pessimism, appears to have stronger relationships with outcomes than do stressful events.

This suggests that sustained activation of negative affective pathways may provide the strongest links to cancer progression.

Moreno-Smith M. et al. Future Oncol. 2010 Dec;6(12):1863-81

6Stress, Depression and Renal cell carcinoma

217 participants with newly diagnosed metastatic RCC (MD Anderson Cancer Center) with life expectancy of greater than 4 months, good performance status (<2) and no major concurrent diseases. Baseline: Depression questionnaires, Salivary cortisol, blood

sample for genomic analysis

The following factors were associated with survival time: CES-D scores SF-36 PCS scores cortisol slope risk category

Cohen L. PLoS One. 2012;7(8):e42324.

7Stress, Depression and RCC

Gene Ontology analyses identified upregulation of genes involved in

inflammation, immune response, and negative regulation of programmed cell

death (all p<.0001) and down- regulation of genes involved in cell trafficking,

adhesion, oxygen transport, and hemostasis (all p<.05).

8

Cancer Determinant: Signal transduction, or extrinsic carcinogenesis

Devita VT, et al. Hellman and Rosenberg’s Cancer: Principles & Practice of Oncology, 9 th ed, 2011: www.lwwoncology.com

Upregulated signal transduction results in abnormal rate of gene transcription which will ultimately destabilize chromosomes leading to further methylation changes and malignant transformation.

9

Sensitivity of signal transduction

Cells are exquisitely sensitive to ligands (picomolar to nanomolar range)

Very few receptors are required to transmit a signal i.e. only 10 receptors on a T-cell need to be stimulated to

activate a maximal responseGiven the small number of receptors involved in most actions,

the signals are amplified intracellularly.Relatively small changes in the tissue mileau can

profoundly affect signal transduction. Hormones, interleukins and prostaglandins are some of the

most influential of these ligands.

10Aberrant cell signaling: chronic inflammation

Aggarwal BB, et al. Biochem Pharmacol. 2006;72(11):1605-21.

11Genes, Inflammation and Cancer

12NF-kB, IL-6 and breast cancer stem cells

Malignant stem cells are the result of one stable cell type changing into another stable cell type without any modifications to the genetic sequence of the cell – an epigenetic phenomenon.

Inflammatory response activates NF-kBNF-kB activation decreases mRNA (Let-7 mRNA) thereby

releasing repression of IL-6 IL-6 signaling pathways are induced leading to the intrinsic

self-renewal capacity characteristic of breast cancer stem cells

Shostak K and Chariot A. . Breast Cancer Research. 2011;13(4):214.

13IL-6: Breast Cancer survival

Bachelot T, et al. Br J Cancer. 2003 Jun 2;88(11):1721-6.

IL-6 < 55 pg/mL

IL-6 > 55 pg/mL

14CRP: Prostate cancer survival

Beer TM, et al. Cancer. 2008 Jun;112(11):2377-83.

15Plant food and NF-kB signaling

Anand P. et al. Pharmacetuical Research, 2008;25(9):2097.

16NFkB inhibition: anthocyanidins

Anthocyanins isolated from bilberries and black currants (Medox) efficiently suppressed LPS-induced activation of NF-kappaB in cultured monocytes.

Parallel-designed, placebo-controlled clinical trial (n = 120 men and women aged 40-74 y) (23)

Intervention consisted of Medox, 300 mg/d for 3 wkDecreases in the NF-kappaB-controlled pro-inflammatory

chemokines and IFNalpha (an inducer of NF-kappaB activation) in the Medox group

45% and 40% respective decreases from baseline vs. placebo group with 20% and 15% decreases from baseline) (P < 0.050)

Karlsen A et al. J Nutr. 2007 Aug;137(8):1951-4

17Walnuts and VEGF

The aim of the present study was to examine the effect of dietary walnuts on colorectal cancer in vivo and to comparatively evaluate their efficacy in relation to flaxseed oil. METHODS: HT-29 human colon cancer cells were injected in 6-wk-old

female nude mice. After a 1-wk acclimation period, mice (n = 48) were randomized to diets containing ~ 19% of total energy from walnuts, flaxseed oil, or corn oil (control) and were subsequently studied for 25 d.

RESULTS: Tumor growth rate was significantly slower in walnut-fed and flaxseed-fed mice compared with corn oil-fed animals (P < 0.05) by 27% and 43%, respectively.

Accordingly, final tumor weight was reduced by 33% and 44%, respectively (P < 0.05 versus control); the differences between walnut and flaxseed diets did not reach significance.

Dietary walnuts significantly decreased angiogenesis (CD34 staining; P = 0.017 versus control), whereas this effect did not reach significance in the flaxseed oil group (P = 0.454 versus control). Nagel JM, et al. Nutrition. 2012. 28(l):67-75.

18IL-6: Immune shift IL-6, also known as B cell stimulatory factor-2 (BSF-2), is a terminal differentiation factor for B cells that is produced by monocytes and lymphocytes as part of Th2 immune activation.

Shifting immune activity away from Th2 and towards Th1 will decrease PBMC production of IL-6.

Increase Th1 with (examples): PSK from Coriolus (Trametes) versicolor Melatonin Probiotics

Lower Th2 by eliminating dietary allergens

Giannoulia-Karantana A, et al. Neuroimmunomodulation. 2006;13(3):133-44.

Carrillo-Vico A, et al. FASEB J. 2004 Mar;18(3):537-9.

19Plant flavonoids and anti-inflammatory Nrf-2

The transcription factor Nrf2 is kept sequestered in cytoplasm as an inactive complex with its cytosolic repressor Keap-1.

Chemopreventive phytochemicals activate diverse upstream kinases, which in turn stimulate dissociation of Nrf2 from Keap-1.

Once released from Keap-1 repression, Nrf2 translocates to nucleus, forms heterodimer with small Maf protein, and binds to ARE/EpRE sequences located in the promoter region of genes encoding antioxidant and detoxifying enzymes.

Surh Y-J. Journal Nutr. 2005;135: 2993S–3001S.

20Flavonoids and colon cancer

Controlled trial of 87 patients 36 patients with resected colon cancer 51 patients after polypectomy

Entire group was divided into 2 groups: one group was treated with a flavonoid mixture (daily standard dose 20 mg apigenin and 20 mg epigallocathechin-gallate, n = 31) and compared with a matched control group (n = 56).

Both groups were observed for 3-4 years by surveillance colonoscopy and by questionnaire.

Among the flavonoid-treated patients with resected colon cancer (n = 14), there was no cancer recurrence and one adenoma developed. The cancer recurrence rate of the 15 matched untreated controls was 20%

(3 of 15) and adenomas evolved in 4 of those patients (27%). The combined recurrence rate for neoplasia was 7% (1 of 14) in the

treated patients and 47% (7 of 15) in the controls (P = 0.027).

H. Hoensch, et al. World J Gastroenterol. 2008 Apr 14;14(14):2187-93.

21

Green tea

• Male patients who consumed over 10 cups of green tea daily died 3.6 years later than did their male counterparts who drank less than 3 cups daily.

• Female patients who consumed over 10 cups of green tea daily died 7.8 years later than did their female counterparts who drank less than 3 cups daily.

• In addition, the age at onset of cancer was 3.0 years later in men and 8.7 years later among women who drank over 10 cups of green tea daily than those drinking less than 3 cups of green tea daily.

• The difference between male and females was explained by the higher tobacco use by men.

• Finally, in an extension of this same study, the researchers determined that women who drank over 10 cups of green tea daily showed a lower relative risk of cancers of the lung, colon, and liver.

Imai K, et al. Prev Med,1997 Nov-Dec;26(6):769-75

22Green tea and Breast cancer

Histologically confirmed invasive breast carcinoma

n = 472 Japanese premenopausal women

Stages I – III Followed for 7 years post surgery

P < 0.05

Ave. = 2 cups/d

Ave. = 8 cups/d

Nakachi et al, Jpn J Cancer Res, 1998 Mar;89(3):254-61.

23

Green tea and breast cancer• A prospective cohort study conducted over a 9-year period from

1990 to 1999.• In 1990, 1160 new surgical cases of invasive breast cancer in

female patients at a Japanese cancer center were enrolled in the study.

• During 5264 person-years of follow-up (average 4.5 years per subject), 133 subjects (12%) experienced recurrence.

Risk of Recurrence with consumption of > 3 cups Green Tea/day

Patients HR 95% Confidence Interval

All stages 0.69 0.47-1.00

Stage I 0.43 0.22 -0.84

Stage III and IV No change ---

Average consumption = 5 cups/d

Inoue, et al, Cancer Lett, 2001 Jun 26;167(2):175-82.

24Lycopene and Prostate cancer

Demonstrated effectiveness in pre-clinical studies The prostate gland concentrates lycopene

Highest serum levels of lycopene compared to the lowest is associated with an 83% reduction in PCa.

Majority of clinical studies in men with PCa show improvements in PSA kinetics and disease stabilization.

Trottier G. et al. Nat Rev Urol. 2010 Jan; 7(1);21-30Lu QY, et al. Cancer Epidemiol Biomarkers Prev. 2001 Jul; 10(7):749-56.

25Lycopene

26 men with newly diagnosed localized PCa. Randomized to 30mg lycopene or no supplement prior

to radical prostatectomy.Lycopene group: Smaller tumors: 84% vs. 45% with tumors <4mL Clean margins: 73% vs. 18% PIN: 67% vs. 100% PSA: -18% vs. +14%

41 men with Gleason score 6 and rising PSATreated with 5mg lycopene BID x 1y PSA velocity decreased in 71% PSA slope was negative in 21%

Kucuk O. et al. Exp. Biol. Med (Maywood). 2002 Nov;227(10):881-5.Zhang X. et al. Chin Med J (Engl). 2010 Aug;123(16):2231-6.

26

Flaxseed 25 men with PCa treated with low fat diet + 30g flaxseeds for an

average of 34d prior to prostatectomy. Matched to historic controls

In men with Gleason < 6, PSA reduced (7.1 vs. 6.4 ng/mL) Prostate cancer cells had significantly decreased proliferation and

increased apoptosis compared to controls. Follow-up study with 161 men

Randomized to Flaxseed, Flaxseed+low fat diet or usual diet Cancer cell proliferation significantly lower for flaxseed (51%) and

flaxseed + low fat diet (54%) compared to controls.

Demark-Wahnefried W. et al. Urology. 2001 Jul;58(1):47-52Denmark-Wahnefried W. et al. Cancer Epid. Biomarkers Prev. 2008 Dec;17(12):3577-87.

27Deadly Signaling Trio: Obesity,

Insulin Resistance and Inflammation• IR arises from either

increased dietary glucose and/or defects in the insulin signaling pathway

• Cancer cells are saturated with insulin receptors

• Insulin is a direct growth factor in cancer cells.

• When insulin is elevated, so is IGF-1, another tumorigenic growth factor.

27Van Kruijsdijk RC, et al. Cancer Epidemiol Biomarkers Prev. 2009;18:2569-78

28Obesity is a carcinogenic state

Van Kruijsdijk RC, et al. Cancer Epidemiol Biomarkers Prev. 2009;18:2569-78

29Weight Being overweight or obese is responsible for one in six cancer deaths

in the United States Weight, weight gain, and obesity account for approximately 20% of all

cancer cases. Excess weight increases the chance of dying of prostate cancer by

34% Being overweight more than doubles the risk of dying of breast

cancer According to the WCRF, the strongest evidence exists for an

association of obesity with the following cancer types: endometrial, esophageal adenocarcinoma, colorectal,

postmenopausal breast, prostate, renal, leukemia, non-Hodgkin’s lymphoma, multiple myeloma, malignant melanoma, and thyroid tumors

Wolin et al. The Oncologist. 2010;15:556–565 Magheli et al. Urology. 2008;72(6):1246-51.WCRF, Food Nutr Phys Activ Prev Cancer, 2007. AICR, 2nd ed. 2007

30

Tumor Cell Proliferation

Tumor Growth

Tumor Sensitivity to Treatment

Visceral Obesity

Insulin Resistance

Increased IGF-1/ Insulin Signaling (IGF-1, IR-IGF-1R Hybrid R)

Inactivity

Cancer Recurrence

Cancer Survival

Adult Energy ImbalanceExcess Caloric

Intake Stress

31Cell signaling: Insulin Resistance

Ulanet DB et al. Proc Natl Acad Sci U S A. 2010 Jun 15;107(24):10791-8.

32IR and Cancer risk

32

Increased Cancer

Mortality

FBS >100 mg/dl

NEJM. 2011;364:829-41Esposito K, et al. Dia Care. 2012;35:2402-2411

33Diabetes and cancer cell mebolism

34Lowering Insulin and IGF-1

IGF-1 lowering interventions: Low glycemic load diet Blood sugar balancing nutrients and herbs Exercise Weight loss PPAR agonists: Metformin, Berberine

IGF-1 trivia: Prunes increase IGF-1 levels

35Glycemic Load and Colon cancer Prospective, observational study of 1011 stage III colon cancer patients

reporting dietary intake during and 6 months after participation matched to 253 controls in an adjuvant chemotherapy trial. The median follow-up from the time of completion of Q1 was 7.3 years.

Higher dietary glycemic load was associated with statistically significant worse disease-free, recurrence-free, and overall survival.

Stage III colon cancer patients in the highest quintile of dietary glycemic load experienced an adjusted hazard ratio (HR) for disease recurrence of 1.79 (95% confidence interval [CI] = 1.29 to 2.48), compared with those in the lowest quintile (HR = 1) (Ptrend across quintiles <.001).

Increased glycemic load was associated with decreased overall survival (Ptrend across quintiles <.001).

These associations were strongest for overweight patients (BMI > 25; HR 2.26)

Meyerhardt J, et al. J Natl Cancer Inst. 2012 Nov 21;104(22):1702-11

36Nutritional influences on IGF-1: Walnuts An elevated fat (20% of energy as fat) diet containing 155 g of

whole walnuts were compared to those of an elevated fat (20% of energy as soy bean oil) diet with matched macronutrients, tocopherols as well as a low-fat (8 % of energy as soy bean oil) diet in the transgenic adenocarcinoma of the mouse prostate (TRAMP) cancer model.

No differences were observed in whole animal growth rates in either high-fat (HF) diet group, but prostate tumor weight and growth rate were reduced in the walnut diet group.

Walnut diet group prostate weight, plasma insulin-like growth factor 1, resistin and LDL were lower at 18 weeks.

The walnut diet's beneficial effects probably represent the effects of whole walnuts’ multiple constituents and not via a specific fatty acid or tocopherols.

Davis PA, et al. Br J Nutr. 2012 Nov 28;108(10):1764-72.

37Cinnamon and IR

• Cinnamon promotes insulin signaling via selective phosphorylation of the IR, thereby reinstating insulin sensitivity– This causes increased cellular uptake of glucose

• Activates peroxisome proliferator-activated receptors (PPARs). – PPARs regulate insulin resistance and PPAR agonists

are used in the treatment of DB2 and IR.

• Cinnamon reduces inflammation by decreasing IL-1B, IL-6, and TNFa mRNA.

37Huang B. et al. J Agric Food Chem. 2011 Apr 27;59(8):3666-73.

38Clinical studies with cinnamon

Rafehi H. et al. Diab Obesity Metab. 2012;14:493-99

39Blueberries and IR

39

• Six week DBRCT of 32 obese, nondiabetic, insulin-resistant subjects.– Randomized to consume a

smoothie with 22.5g blueberry bioactives from freeze dried whole blueberry powder or equivalent smoothie without the blueberry twice daily • Provided equivalent of 2 cups fresh

whole blueberries

– Insulin sensitivity improved more in blueberry group than in placebo group (p=0.04)

Stull A. et al. J Nutr. 2010;140(10):1764-8

40Berberine Berberine restores insulin sensitivity via:

Activation of AMPk Reduction of hepatic gluconeogenesis (epigenetic effect) Inhibition of fatty acid synthesis in liver (and decrease of

fatty liver) RCT of 36 adults with DB2 x 3mo

Randomized to 500mg Berberine TID or 500mg Metformin TID

There were equivalent blood glucose lowering effects (P<0.01)

Continued use of Berberine resulted in improvement of HOMA-IR reduced by 44.7% (P<0.001), lowered FBG, HgA1c, LDL-C.

Xia X. et al. Plos One. 2011;6(2):e16556Yin J. et al. Metabolism. 2008;57:712-17

41

Tocotrienols

• Tocotrienols, vitamin E isomers, with increased flexibility and smaller (less methylated) heads, allowing for increased antioxidant and anti-inflammatory activity over tocopherols.

• Tocotrienols reduce triglyceride accumulation (thereby reducing increased adiposity)– Tocotrienols improve glucose and insulin tolerance and reduce

inflammatory cell infiltration in a rodent model of human metabolic syndrome.

– Tocotrienols activate PPAR which increases insulin sensitivity by restoring Akt pathway function.

– Tocotrienols also exert direct antiinflammatory effects:• Reduce NFkB, TNFa, COX-2

Wong WY et al. Nutrients. 2012;4(10):1527-41Fang F et al. Mol Nutr Res. 2010;54(3):345-52Yam ML et al. Lipids. 2009;44(9):787-97

42Cancer Determinant: Immunity

• The body’s first and last line of defense

• Cancer, arising from self, is likely to create immune tolerance.

• Cancer cells secrete IL-10 which activates T regulatory (suppressor) cells and downregulates dendritic type 1 cells

Huang RP, et al. Cancer Res 1995;55(21):5054-62.

43A tumor’s immunological fate

44Th1: counterweight against tumor-derived immune escape

Stimulation of IL-12 producing DC (APC) with subsequent activation of tumor specific cytotoxic T cells (CD8) is the goal of immunologic tumor destruction.

45The pivotal role of the type 1 Dendritic cell

• Immuno-suppression associated with cancer leads away from Dendritic cell type 1 towards Dendritic cell type 2 development

• This shift promotes regulatory T cell activation and recruitment into tumor sites, suppresses T helper 1 (TH1)-dependent, cytotoxic T lymphocyte responses. Rissoan MC, et al. Science, 1999;283(5405):1183-6.

Whiteside TL, Semin Cancer Biol, 2006;16(1):3-15.

46

Immune-mediated tumor destruction

Tumor cellLysed Tumor cell CD8 cytotoxic T-cell

CD4 helper T-cell

Ag-presenting Immune cell

Uptake of tumor cell

protein fragments

MHC IIActivation ofCD4 T-cell

TH1 cytokines:IL-2, IFN-γ, TNF-β

MHC I

Lysis

NK cell

B cell

Ab-dept.Cellular

cytotoxcity

TH2 cytokines:IL4-6, IL10

Lysed Tumor cell

MushroomsMelatonin

GlutathioneNature

NK cell

47Melatonino Over 1534 scientific publications on melatonin and cancer

o Over 88 human clinical trials on melatonin in cancer

o 41 Randomized Clinical Trials

o In a meta analysis of 8 RCT’s in solid tumor cancers (n=761), 20mg of melatonin po nightly in conjunction with chemo or radiation.

o Melatonin significantly improved the complete and partial remission (16.5% vs. 32.6%; RR = 1.95, 95% CI, 1.49-2.54; P < 0.00001)

o Melatonin improved 1-year survival rate over control (52.2% vs. 28.4%; RR = 1.90; 95% CI, 1.28-2.83; P = 0.001)

o Melatonin significantly decreased radiochemotherapy-related side effects including:

o thrombocytopenia (19.7 vs. 2.2%; RR = 0.13; 95% CI, 0.06-0.28; P < 0.00001)

o neurotoxicity (15.2 vs. 2.5%; RR = 0.19; 95% CI, 0.09-0.40; P < 0.0001)

o fatigue (49.1 vs. 17.2%; RR = 0.37; 95% CI, 0.28-0.48; P < 0.00001).

o Effects were consistent across different types of cancer. No severe adverse events were reported.

Wang et al. Cancer Chemother Pharmacol. 2012 May;69(5):1213-20.

48Medicinal mushrooms

Systematic review and meta-analysis of 13 trials that met inclusion criteria

Cumulatively, there was 1,284 patients in the PSK/PSP group (49.6%) and 1,303 in comparison groups(50.4%)Overall survival at 5 years was improved in the

PSK/PSP group P<0.00001; RR=1.14Over all cancers, there was a 9% absolute reduction in 5-

year mortality (one additional patient alive for every 11 pts treated)

Effects were more evident for breast, gastric or colorectal cancer versus esophageal or nasopharyngeal

LY Eliza W, et al. Recent Patents Inflamm & Allergy Drug Discovery. 2012;6(1):78-87.

49Antioxidant status: Polarizing the immune response

Glutathione (GSH) is the most important intracellular antioxidant. Depletion of GSH results in lowered Th1 and increased Th2

activity. Conversely, repletion of GSH increases Th1 and decreases Th2

activity. Thus, the antioxidant status of the cell influences the Th1

polarization of the immune response.

Peterson JD, Herzenberg LA, Vasquez K et al. Proc Nat Acad Sci USA,1998Murata Y, et al., Int Immunol, 2002.

50

Forest Bathing

51

Forest Bathing: NK cells

Forest bathing increases NK activity, number of NK cells, and intracellular

anti-cancer proteins in lymphocytes. A forest bathing trip consists of time breathing in volatile substances, called

phytoncides (wood essential oils), which are antimicrobial volatile organic

compounds derived from trees, such as a-pinene and limonene. 12 healthy male subjects, ages 35-56 years, experienced a three-day/two-night trip

to either a forest or a city, in which activity levels during both trips were matched. Blood and urine were sampled on the second and third days during the trips,

and on days 7 and 30 after the trip. Similar measurements were made before

the trips on a normal working day as the control. Phytoncide concentrations in forest and city air were measured.

Li Q, Morimoto K, Kobayashi M et al. Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-ku, Tokyo, Japan

52

Forest Bathing Results

The forest bathing trip significantly increased NK activity and the numbers of NK, perforin, granulysin, and granzyme A/B-expressing cells and significantly decreased the concentration of adrenaline in urine.

The increased NK activity lasted for more than 7 days after the trip. In contrast, a city tourist visit did not increase NK activity, numbers of

NK cells, nor the expression of selected intracellular anti-cancer proteins, and did not decrease the concentration of adrenaline in urine.

Phytoncides, such as alpha-pinene and beta-pinene were detected in forest air, but not in city air.

This pilot study illustrates the profound healing effect of Nature.

53Holistic Cancer Perspective

The genetic, epigenetic and tissue changes that culminate in cancer are reversible.

There is tremendous potential for the therapies of lifestyle & natural medicine to reverse errant epigenetic alterations, to restore a healthy tissue matrix and to control carcinogenesis.

54And, of course the best treatment is lifelong

55ResourcesDefinitive Guide to Cancer: An Integrative Approach to Prevention,

Treatment and Healing (3rd ed.)

Five To Thrive: Your Cutting-Edge Cancer Prevention PlanBy Lise Alschuler, ND, and Karolyn A. Gazella

Five To Thrive Live! Talk radio

M – F 5p PT / 8p ET on www.W4CS.com

LNAlschuler@comcast.net

Naturopathic Specialists, LLC.www.ListenAndCare.com

www.drlise.netwww.fivetothriveplan.com