Nutrition


Time to Tune Up Your Body's Engine
Nutrition
Written by David Seaman, D.C., M.S., D.A.B.C.N., F.A.C.C.   
Tuesday, 30 September 2003 00:00

Patient compliance is an issue for all doctors.   And, let’s face it, when we feel well, we often cheat on our exercise or diet plans.  After all, we are only human.  This short article provides some great ammunition to motivate us—and our patients—to follow-through with good nutritional practices. 

Recently Dr. Bruce Ames, a famous toxicologist from the University of California, at Berkeley, explained that nutrient needs vary with age and genetic constitution, and supplementation with micronutrients and metabolites, would tune up metabolism and give a marked increase in health, particularly for the poor and elderly.1  Consider that 80% of children and adolescents and 68% of adults do not eat the recommended total of five portions of fruits and vegetables per day, which I think is low anyway.  Ames points out that such habits are known to promote cancer and other degenerative diseases.  We chiropractors have warned our patients about such issues for many years, and now it is becoming a much more popular perspective to have.

How serious are such deficiencies?

Consider telling your patients the following information that was written by Ames, a leading researcher in the field.  It is now known that deficiencies in key nutrients will mimic the damage that occurs to cells when they are exposed to radiation.  That’s right; micronutrient deficiencies and radiation damage have similar affects on cells.  Ames focuses on vitamins B-12, B-6, niacin, C and E, and the minerals iron and zinc.  Evidence suggests that at least half the US population is deficient in at least one of these micronutrients.  Tell your patients to be smart and take at least a multi.  The only way you will discover if you have a subclinical deficiency is when you get cancer or some other serious degenerative disease.  Not a good thing to happen if you plan on living a long life. 

Infertility?  This may also be driven by deficiencies.  In a recent study, twenty-four subfertile men took a daily supplement that contained both 66 mg. of zinc and 5 mg. of folic acid for twenty-six weeks and experienced a 74% increase in total normal sperm count.  Consider the countless millions that could be saved if people would just take a multiple vitamin.

Need to drop a few pounds?  Ames and his group believe that micronutrient deficiencies drive obesity.  This is because energy-rich, but nutrient-poor, diets will create a state that drives us to eat more to obtain adequate nutrients.  In other words, the overweight and obese are constantly hungry, because they are deficient in key nutrients.

Aging too quickly?  Our mitochondria make free radicals when they make ATP (adenosine triphosphate) for cell energy.  Free radicals can damage tissue and cause premature aging.  What should you do?  Ames and his group have worked with lipoic acid and acetyl carnitine and found that they reduce free radicals and as I discussed in a previous issue of The American Chiropractor (Volume 25, Issue 1).2  Magnesium is also important for mitochondria function, so make sure to get enough magnesium and consider supplementing with 400-1000 mg. per day.

There is no need to place oneself at risk for cancer, heart disease, other degenerative diseases, infertility, obesity, and premature aging.  Give yourself a nutritional adjustment and drop the inflammatory grains, replacing them with fruits and vegetables.  If you want a starch, have a potato.  Also, make sure to take a multi, magnesium, perhaps calcium, fish oil, and coenzyme Q10.  These represent easy ways to prevent chronic disease from developing, and give every-body a chance to live longer and healthier lives.

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession.  He is on the faculty of Palmer College of Chiropractic Florida and on the postgraduate faculties of several other chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient.  Dr. Seaman believes that chiropractors should be thinking like chiropractors, while providing nutritional recommendations.  Doctors and patients who follow his programs report improved feelings of well-being, weight loss, dramatic increases in energy, and significant pain reduction.  Dr. Seaman can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Coral Calcium–Debunking the Debunking!
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Nutrition
Written by Mark Percival, D.C., N.D.   
Tuesday, 30 September 2003 00:00

With the FTC filing law suit against Bob Barefoot for false and misleading advertising, and the discovery of lead in one coral calcium brand both happening in June, coral calcium has been severely wounded.  Others jumped on the anti-coral bandwagon and suggested coral was no different from cheap calcium carbonate or limestone–that it was just an overpriced calcium supplement. 
The $64,000 question is whether the bad rap is justified or are we throwing the baby out with the bath water?  Okay, everyone agrees Mr. Barefoot exaggerated coral’s benefits to sell product, and having his infomercial forced off the air was fair treatment; but should we dismiss coral entirely or does it deserve a closer look? 
Whatever your beliefs, be prepared for another round of advertising.  Several new infomercials, including one with a well-known country singer, are in production to be launched this fall/winter, filling the void left by the removal of Robert Barefoot’s show.  These television promotions are likely to rekindle broad interest and you will soon, once again, be answering patients’ questions about the merits of coral calcium products.  Here are the pitfalls to watch for.

Load of Bunk #1—“Lead in Coral Calcium”
Let’s get some perspective.  ConsumerLabs, a watchdog group, did find a higher than Proposition 65 lead level in one bottle, from one batch, from one brand, of coral calcium.  With over 300 brands of coral calcium in a market experiencing vertical growth, it is not surprising that one bad apple has emerged.  The vast majority of coral comes from two suppliers who test every batch and offer third party lab results showing Proposition Compliant lead levels.  The news that was not published is that almost every other coral brand has been tested by ConsumerLabs, or one of the many other labs around the country, with passing scores.

Steaming Pile of Bunk #2–“Coral calcium is the same as calcium carbonate.”
An initial inquiry revealed that calcium from coral is, indeed, in a carbon-based form, but that is where the similarities end.  Even a cursory glance at the electron microscope photo below indicates differing properties.
Coral contains seventy-three minerals not found in calcium carbonate supplements.  According to the National Research Council, 25 of the 73 are essential minerals, and 60 of these minerals are naturally found in human milk and blood, indicating that they have unknown functions.  It is widely recognized that these trace minerals are often missing entirely from our soils and food in some locations, so it makes sense to supplement.
One recent coral entry is a live harvested coral from Brazil which is particularly high in trace minerals–about twelve times more than Okinawan varieties, which are long dead and somewhat depleted. (
www.brazilcoral.com)  This Brazilian coral is actually an algae and, hence, has vegetable proteins to which the minerals can chelate.  Heat treatment is avoided so the non-mineral marine nutrients stay in tact with this particular form of coral. 
We also know that the minerals in coral are found in an organic rather than elemental form.  Organic minerals are complexes which contain two or more chemical bonds with the metal (mineral) atom, resulting in higher absorption rates from the intestine and greater biological activity in the tissues.1  To compare a product loaded with organic essential and trace minerals to calcium carbonate is fallacious.

Absorption—The Big Non-Issue
Anti-coral groups have tried to focus the attention on calcium absorption from coral versus from calcium carbonate, saying coral has similar bio-availability, but is more expensive.  The only peer-reviewed, published studies available show calcium from coral has superior absorption compared to calcium carbonate.  In a small, but well controlled study, Dr. Kunihiko Ishitani reports superior absorption of calcium from coral in food compared to calcium carbonate.2  Other carefully controlled feeding studies performed at the Universities of Rukuyuku and Okinawa have shown calcium absorption from coral calcium in experimental animals was better than absorption of calcium from milk, hydroxiapatite or calcium carbonate.3  Even if calcium absorption from coral were the same as from calcium carbonate, it would still be seventy-two minerals ahead.
The key to coral calcium is its mineral balance, which assists calcium’s effectiveness.  With regard to the fight against osteoporosis, for example, Straise L., et al., showed that a group receiving calcium together with trace minerals arrested bone loss, compared to a control group which took calcium alone.4  A good body of science shows calcium is more effective when taken with other minerals so as to provide a mineral balance.  (Heaney, Becker, and Weaver, 1990; Huliz, 1990; Beal and Scofield, 1995; Harvey, 1988)
Other well-conducted, controlled studies performed at the Futaba Nutrition School at the Kagawa Nutrition University in Japan were instructive with regard to coral calcium specifically.  They showed the benefit of the multi-mineral coral calcium combined with exercise in improving bone mineral density.  This research study was presented at the 52nd Japanese Society of Nutrition and Food Science, in April 1998.
Clearly absorption of calcium is a red herring–it is like comparing a vitamin E supplement to a multi-vitamin containing the same Vitamin E and saying the multi-vitamin is overpriced.  It is really apples versus oranges…or in this case, apples versus a whole basket of assorted fruits.  We would expect the fruit basket to cost a little more than an apple! 
To summarize, yes, lead was found in one sample of coral; and, yes, Mr. Barefoot has made exaggerated claims.  Yes, coral is a form of carbonate, but closer inspection shows coral is one of the most promising organic multi-minerals available. 

Dr. Mark Percival achieved a doctorate in naturopathic medicine upon finishing his chiropractic degree. Dr. Percival pioneers the use and study of Coral Calcium and is currently the Medical Advisor to CFU for Brazilian Fresh Harvest Coral™. For more information contact 888-293-9875 or visit www.brazilcoral.com

 
Inflammation, Pain, and Alzheimer’s Disease: Condition-based care
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Nutrition
Written by David Seaman, D.C., M.S., D.A.B.C.N., F.A.C.C.   
Wednesday, 30 July 2003 00:00

Alzheimer’s is a devastating disease that we should try to prevent, not only for ourselves, but also for our families.  Patients with Alzheimer’s disease lose cognitive function, emotional expression and memory, which essentially prevents them from experiencing the spice of life.

It is no surprise to read that most patients enter a chiropractor’s office looking for relief from various conditions, the most common among them being back pain, neck pain, and headache.  During the history taking process, we typically discover that such patients derive some relief from taking ibuprofen or similar anti-inflammatory drugs, which act to inhibit the synthesis of pro-inflammatory eicosanoids, such as prostaglandin E2 and thromboxane A2.  Such inhibition results in less activation of nociceptors and, therefore, less pain.

Before 1990, researchers knew that anti-inflammatory drugs could prevent Alzheimer’s disease.  McGreer1 stated that, “immunohistochemical evidence points to a chronic inflammatory state of the brain in Alzheimer’s disease, and data suggests that the prevalence of Alzheimer’s in patients with rheumatoid arthritis is unexpectedly low and that anti-inflammatory therapy might be the explanation.”  This relationship between anti-inflammatory drugs and Alzheimer’s is now well established and has led researchers to search for natural alternatives that do not possess the serious side effects so common with long term use of drugs like ibuprofen.

As it turns out, the prevalence of Alzheimer’s in elderly folks in India over the age of eighty is only 4%, compared to 15.7% here in the states.2   Frautschy, et al., from UCLA, suggest that the liberal intake of turmeric may be the reason for this significant difference in Alzheimer’s prevalence.2  It was determined that turmeric is both a potent antioxidant and anti-inflammatory agent that is capable of inhibiting prostaglandin E2 and other pro-inflammatory substances.2. Bucci explains that turmeric is effective in reducing musculoskeletal aches and pains, and can even be as effective as anti-inflammatory drugs.3

I spoke with Frautschy, and she explained that ginger may be even more potent than turmeric.  Ginger has also proven itself to be effective in reducing the pains associated with muscle injury, osteoarthritis and rheumatoid arthritis thought to be a result of inhibition of pro-inflammatory eicosanoid synthesis.4

Prostaglandin E2 causes pain and promotes Alzheimer’s disease.  Supplements such ginger and turmeric can help our patients with aches and pains, and provide a nutritional adjustment.  When taken long term, such supplements may be able to prevent dreaded chronic inflammatory conditions such as Alzheimer’s disease.  I, personally, drink homemade ginger tea, add powdered ginger to my meals and, when I am not doing either of these, I take ginger supplements.  I suggest that you and your patients do the same.

More on Alzheimer’s in the next issue of TAC.  Stay on the lookout. TAC

 

References

  1. McGreer P. Anti-inflammatory drugs and Alzheimer’s disease. Lancet 1990; 335: 1037.
  2. Frautschy SA et al. Phenolic ant-inflammatory antioxidant reversal of A-induced cognitive deficits and neuropathology. Neurobiol Aging 2001; 22: 993-1005.
  3. Bucci L. Nutrition for sports injuries and rehabilitation. Boca Raton: CRC Press; 1995.
  4. Srivistava KC, Mustafa T. Ginger in rheumatism and musculoskeletal disorders. Med Hypoth 1992; 39: 342-48.

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession. He is on the faculty of Palmer College of Chiropractic Florida and on the postgraduate faculties of several other chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. Dr. Seaman believes that chiropractors should be thinking like chiropractors, while providing nutritional recommendations. Doctors and patients who follow his programs report improved feelings of well-being, weight loss, dramatic increases in energy, and significant pain reduction. Dr. Seaman can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Low Back Pain Needs a Nutritional Adjustment
Nutrition
Written by David Seaman, D.C., M.S., D.A.B.C.N., F.A.C.C.   
Friday, 30 May 2003 00:00

No matter what chiropractic college you went to, your main approach to patient care is likely to be the chiropractic adjustment.  This statement is not surprising to most, and it gives a clue as to how we think as chiropractors.  We, basically, utilize a mechanical or biomechanical approach to care for our patients.  Whether you believe the adjustment is replacing misaligned bones or restoring motion to previously hypomobile joints, your treatment approach involves mechanically thrusting into spinal tissues, i.e., a mechanical approach to patient care.  Although we DC’s think and treat our patients structurally, we must realize that it is the chemical mediators of inflammation that activate nociceptors, resulting in pain, which drives patients to our offices.
Low back pain needs a nutritional adjustment

For many years, it has been known that an acidic pH works synergistically with the chemical mediators of inflammation to activate and sensitize tissue nociceptors.1  Evidence existed regarding low back pain and pH at least as early as the 1960’s.  At the time of surgery, Nachemson discovered that the pH of lumbar discs ranged from 5.7-7.5.  The lower the pH, the greater the pain, disc degeneration, and fibrous tissue deposition.2  Hambly and Mooney state that it has been noted that “sick” discs, as reflected by pain on discography, have consistently demonstrated an acidic pH.3  In more recent years, researchers have demonstrated that the intervertebral disc can release potent inflammatory mediators, which naturally leads MD’s to medicate injured low backs.  We DC's should, of course, continue to adjust the spine, and also consider addressing the inflammation with a nutritional adjustment.

 

Discs, Back Pain and Chemical Mediators

Recent research demonstrated that intervertebral discs which cause low back pain and sciatica secrete high levels of pro-inflammatory mediators.4  At the time of surgery, disc specimens were collected from sixty-three patients undergoing primary discectomy for sciatica, and from twenty patients undergoing interbody fusion for discogenic low back pain.  The average age of these patients was forty-one, so they were all young individuals who, theoretically, should be healthy and functional.
A biochemical analysis of the disc specimens revealed that discs from the sciatica and low back pain groups produced significant quantities of interleukin-6 (IL-6), interleukin-8 (IL-8), and prostaglandin E2 (PGE2).4  None of the specimens produced interleukin-1 (IL-1) or tumor necrosis factor (TNF).  Additionally, not all discs produced IL-6, IL-8 or PGE2, which suggests that either other inflammatory mediators were responsible for the pain generation, or that altered chemistry was not responsible for the nociception and pain in these subjects.

 

A Simple Nutritional Method to Reduce Cytokines and PGE2

A recent review article by Simopoulos explains that the omega-3 fatty acids in fish oil supplements can reduce the synthesis of IL-6, PGE2, and many other inflammatory mediators, such as IL-1, TNF, thromboxane A2 (TXA2), leukotriene B4 (LTB4), fibrinogen and platelet-derived growth factor.5  For many years now, it has been known that fish oil has a dramatic anti-inflammatory effect that can help prevent heart disease, cancer, migraine headaches, psoriasis, ulcerative colitis, rheumatoid arthritis, and many other conditions.5  Sierkerka was the first DC to publish an article that urged DC’s to use omega-3 fatty acids to accelerate the disc’s healing process.6  About 1-2 grams of EPA/DHA is a common recommendation to improve omega-3 fatty acid status.
Magnesium deficiency is also known to increase the release of IL-6 and PGE2, as well as IL-1, TNF, TXA2 and LTB4.7  Animal studies suggest that substance P release from nociceptors may be responsible for stimulating such mediators to be released by local immune and tissue cells.8  About 400-1000 mg of supplemental magnesium is the typical recommendation.
Botanicals such as ginger and turmeric are known to inhibit the production of PGE2 and LTB4.9  These substances can be viewed as natural COX2 inhibitors, and have been used for thousands of years in India to reduced pain and inflammation.  Ginger is the best buy for patients.  About 2 grams per day is the typical recommendation for powdered ginger, and about 500-1000 mg, if a standardized extract is used.
In addition to the above, consider using a multiple vitamin/mineral to insure that your patients are getting all the micronutrients necessary to drive the multitude of cell reactions required for tissue health.
From a dietary perspective, make sure your patients eat lots of fruits and vegetables, and drink lots of water, perhaps one-half gallon per day.  Avoiding seeds, grains and flour products is also a must, as these foods contain inflammatory omega-6 fatty acids, which is heightened by the addition of omega-6 oils, including corn, sunflower, and safflower oils. TAC

 

 

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession. He is on the postgraduate faculty of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. Dr. Seaman can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Diet and Diabetes
Nutrition
Written by Dr. Howard F. Loomis, D.C.   
Thursday, 30 January 2003 00:00

Many chiropractors are searching for ways to ethically increase their patient loads and make clinical practice more rewarding professionally and financially.  Have you ever considered specializing in health care—preventing chronic degenerative conditions like diabetes before they can be recognized and measured quantitatively by medicine?
“Sick care” is practiced by recognizing and characterizing disease conditions (diagnosis).  Once the diagnosis is pronounced, treatment is dictated by prevailing therapeutic procedures.  However, until the disease process can be measured through lab work, there can be no acceptable procedures; hence, the guesswork of prescribing drugs for symptoms, with haphazard results.
Health care, on the other hand, is practiced by maintaining normal body functions.  Deviations from normal are caused by only one factor: stress.  Hans Selye, MD, was nominated for the Pulitzer Prize for Medicine in 1964 for his research on the effect of stress on the human body.  His research found that the accumulative effects of stress are predictable.  Selye said in his book, The Stress of Life, that as a medical student he was struck by the fact that most disease conditions presented similar symptoms before the disease process could actually be identified.  Fatigue, elevated temperature, swelling, redness, and pain were the most common.  This led him on a lifelong study to determine why.
Selye found that there are essentially only three kinds of stress:  mechanical, emotional, and chemical (or nutritional).  Identify the stress and remove it, and your patients who are not yet diseased will get well.  You may also have to provide proper nourishment for affected tissues to heal.  As a chiropractor, you are already an expert at identifying mechanical stress.  Emotional stress is beyond my expertise.  That leaves nutritional stress and the subject of this article—diabetes.

The Problem

The term “diabesity” (diabetes + obesity) is increasingly being used to label the patients with Type II diabetes who are overweight.  Here are the current statistics according to the Centers for Disease Control and Prevention:

  • 17 million Americans have diabetes.
  • 90% of diabetics have Type II (diet-related) diabetes.
  • 60% of adults with Type II diabetes are overweight.
  • 97% of youths diagnosed with Type II diabetes are overweight.

Diabetes is the leading cause of adult blindness, kidney failure, non-traumatic amputations, heart disease, and stroke.  The goal, of course, is to prevent the onset of diabetes.  The way to do that is to recognize the possibility that your patient has an Impaired Glucose Tolerance (IGT).  Medical practitioners have long referred to these patients as “borderline diabetics” meaning the patient has a blood glucose level that is higher than normal, but not high enough to be classified as diabetes.  These are the patients with whom you can best practice health care, thus preventing disease.  It is estimated that 20 million people in the United States have IGT, and that the number is rising rapidly.  It is further estimated that 50% of these people will develop Type II diabetes.  That means there are more than a few patients in your practice and in your neighborhood who could use your help.

Recognition

Health and Human Services Secretary Tommy Thompson and American Diabetes Association President Christopher Saudek, MD, are asking doctors to begin screening overweight patients age 45 and older for pre-diabetes.  They state that patients with the following risk factors may develop IGT:

  • Family history of diabetes
  • Being overweight
  • Women who have gestational diabetes or have given birth to a baby weighing more than nine pounds
  • People with steroid-induced hyperglycemia
  • Those with high blood pressure
  • Those with an abnormal lipid blood profile (low HDL cholesterol and high triglyceride levels)
  • Those with any of the above and a genetic predilection are particularly at risk.  This includes African Americans, American Indians, Hispanic/Latino Americans, Asian Americans, and Pacific Islanders.

Treatment Guidelines

Medical experts are recommending that IGT screening should include glucose monitoring and fasting lipid profiles for those at high risk, as indicated by their past health histories.  It is interesting to note they are not recommending prescription drugs for the condition.  That puts you, as a chiropractor, in the picture for specializing in health care to increase professional and financial success. 
Recognizing those patients at risk for specific future problems allows you to both teach the patient how to maintain their health and monitor their progress.  The experience is thus rewarding for you and the patient.  Preventing chronic degenerative conditions before they can be measured quantitatively does wonders for building referrals.
The Surgeon General of the United States has pointed out that many chronic degenerative diseases have their beginning with poor diet and digestion.  Yet, it is difficult to find agreement among so-called experts as to what constitutes a healthy diet.  Many doctors do not take the time to inquire into their patients’ dietary habits, primarily because of the lack of objective clinical findings that suggest a problem exists. 
The easiest and most definitive screening procedure for problems in this area is identifying persistent or recurring loss of a normal thoracic kyphosis.  Generally, it is a transitory condition related to muscle contraction and not osseous abnormality.  It is most commonly caused by muscle contractions associated with viscero-somatic reflexes from those organs that receive their spinal innervations from T4 to T9.  The list includes the heart, lungs, bronchi, stomach, pancreas, spleen, liver, gallbladder, and adrenal glands.
When loss of the normal thoracic kyphosis (so-called “anterior dorsals”) is found, palpate for postprandial muscle contractions under the right and left anterior costal arches and in the epigastric area.  Palpatory muscle contraction (trigger points) and soreness will always help delineate the stressed digestive organ.  Inquiry into the patient’s last meal will be quite instructive.  These findings are often, but not necessarily, associated with chronic headache patterns.
When no digestive stress is present (the presence of symptoms is irrelevant) and blood glucose levels are normal, muscle contractions under the costal arches and in the mid-thoracic spine will not be found.  Henri Gillet, DC, found that 3-to-10 cups of coffee will produce them!1  Consider the correlation between this and the following two studies.
A study released by the Harvard School of Public Health in 2002 found that men who eat processed meats (such as bacon and sausage) are 46% more likely to develop Type II diabetes than men who eat less of these foods.  Over 40,000 healthy men between the ages of 40 and 75 were studied.  The results were dose-related; that is, the highest incidence was among those men who ate processed meat five or more times per week.2
Also, a study of the effects of caffeine on blood sugar levels was completed in 2002.3  It is known that caffeine can enter the brain and directly increase blood pressure and stimulate the release of stress hormones (cortisol).  These hormones are known to affect insulin and, therefore, blood sugar levels.  Insulin sensitivity was measured in selected healthy individuals after administration of caffeine or placebo.  The caffeine administered was the equivalent of three cups of coffee.  The study showed that caffeine increased both blood pressure and stress hormone levels.  It decreased the effectiveness of insulin by 15%.
Poor diet, inadequate digestion, stress, and caffeine all play a role in the development of Type II diabetes, which is now reaching epidemic proportions.  Pharmaceutical companies will continue to develop drugs for its treatment, but the best approach is drug-free prevention, according to Daniel Einhorn, MD, director of the Scripps Whittier Diabetes Institute.  He states that loss of 5-to-7% of body weight within one year coupled with walking or bicycling 150 minutes a week (thirty minutes per day) is the best therapy known.  But, he says that most people will need the guidance of a health care professional to achieve those results.4  Why shouldn’t that health professional be you? TAC


Howard F.  Loomis, Jr., DC, president of Enzyme Formulations, Inc., has an extensive background in enzymes and enzyme formulations.  As president of 21st Century Nutrition, Inc., for fifteen years, he has forged a remarkable career as an educator, having conducted over 400 seminars to date in the United States, Canada, Germany, and Australia, on the diagnosis and treatment of enzyme deficiency syndromes.  Call 21st Century Nutrition at 1-800-662-2630 for more information.

 
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