THE MAGIFICENT ANTI-AGING SERIES
Webinar Sampler
(4 lectures; 12 hours)
Brain Health
Bone Health and Osteoporosis Prevention
Men’s and Women’s Libido
Estrogen Dominance
Michael E. Greer, M.D.
Holistic, Homeopathic, Herbal
Lectures & Consultations
737 Olive Way, Suite 1804, Seattle, WA 98101
www.michaelgreermd.com
michaelgreermd@comcast.net
About Dr. Greer
• U.S. Army trained OB-GYN
• Delivered 1000+ babies
• Board certified in 1984
• Retired in 2011
• Alternative medicine studies since 1996
(Thank goodness!)
Photo ©2012, Michael E. Greer, M.D.
• Searching for the best solutions in
integrative medicine for optimal patient wellness
Presentation ©2012, Michael Greer, MD. Reproduced with Dr. Greer’s permission.
2
Disclaimer
This seminar is intended for healthcare practitioners only. The
material and information contained in this seminar is not for the
diagnosis or treatment of disease. The information is designed to
assist doctors and other healthcare practitioners in evaluating
patients’ metabolic and nutritional status.
The information presented is intended for educational purposes
only. It is the sole responsibility of the healthcare practitioner using
this information to determine if what is outlined herein is
appropriate for his or her purpose.
Brain and Memory
Essentials in Building a Better,
Mitochondria-Dense Brain
Guidelines for Prevention of Dementia,
Alzheimer’s and Parkinson’s Disease
4
The Alzheimer’s Express
“After age 60, we are all likely
passengers on the Alzheimer’s
Express. These days it’s
overcrowded with baby boomers and is predicted
by 2050 to claim 115 million victims worldwide,
including 13.5 million Americans (up from 5.1
million today), bankrupting our health care
system.”
Jean Carper, Special to CNN October 10, 2010
5
Brain Loss Feared
• Baby boomers are more concerned with losing
their cognitive abilities than they are about
cancer, heart disease or stroke
– And they should be very, very concerned
• The progression from dementia to Alzheimer’s
affects 24-30 million people worldwide
Alzheimer's Association. 2008 Alzheimer's disease facts and figures. Alzheimers Dement. 2008 Mar;4(2):1 10-33.
Hudson AP, Balin BJ, Crutcher KRobinson S. New thinking on the etiology and pathogenesis of late-onset Alzheimer's disease.
mt J Alzheimers Dis. 2011;2011:848395.
Available at: http://www.alz.org/down1oads1Facts_Figures_201 1 .pdf. Accessed September 28, 2011.
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Danger Ahead
• Alzheimer's is now the 6th leading cause of
U.S. deaths
– 1/5th of all cases worldwide
• Expected to triple by 2050
Available at: http://www.alz.org/down1oads1Facts_Figures_201 1 .pdf. Accessed September 28, 2011.
Available at: http://report.nih.gov/NlHfactsheets/ViewFactSheet. aspx?csid= 107. Accessed September 28, 2011.
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Advanced Risk with Age
• The risk of developing Alzheimer's disease
rises sharply with aging
Age
Frequency
– 1% at age 60
– Doubles roughly every 5 yrs.
60
1%
65
2%
70
4%
75
8%
80
16%
85
32%
8
Common Links
• Much research links Alzheimer’s to the same
lifestyle factors that cause heart attacks and
strokes:
– High cholesterol
The Connection:
– Blood pressure
Free radicals and
– High blood sugar
inflammation
– Insulin resistance
– Diabetes
– Obesity and physical inactivity
Neurologic Plasticity
• The ability of brain cells to quickly form new
synapses and remove old ones
• Large numbers of synapses, and a high density
of specialized synaptic structures called
boutons, promote rapid retrieval and
processing of the information stored by
connected cells
Ostroff LE, Cain CK, Jindal N, Dar N, Ledoux JE. Stability of presynaptic vesicle pools and changes in synapse morphology in
the amygdala following fear learning in adult rats. J Comp Neurol. 2011 Jun 14
10
Synaptic Boutons
Learning vs. Memory
• Neuronal plasticity is the physical equivalent
of learning
• Synaptic density is roughly the equivalent of
memory
• Young brains exhibit high levels of neurologic
plasticity that produce large numbers of
interconnected synapses
• Thus young people learn quickly and have
strong memories
12
Memory Mitochondria & Synapses
• Every memory you have, even those you've lost,
produces physical changes in your brain
• Mitochondria are the DNA and energy behind this
action
• With learning and new experiences the cells in your
memory centers activate and enhance their neuronal
connections, known as synapses
Brown TH, Chapman PF, Kairiss L, W, Keenan CL. Long-term synaptic potentiation. Science. 1988 Nov 4;242(4879):724-8.35
13
Alzheimer's Disease
• The most characteristic symptom of
Alzheimer's disease is a profound impairment
of recent memory
• Individuals begin to misplace everyday items,
such as the car keys or eyeglasses
• They become disoriented and get lost in
familiar surroundings
– Such as when driving on well-known streets
Trick L, Boyle J, Hindmarch I. The effects of Ginkgo biloba extract (LI 1370) supplementation and discontinuation on
activities of daily living and mood in free living older volunteers. Phytother Res. 2004 Jul;18(7):531-7.
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Alzheimer’s Patient Symptoms
Cummings 2001
Patients
Incidence
Agitation
Apathy
Depression
Anxiety
60-70%
60-70%
50%
50%
Irritability
Delusional disorders and
psychosis
50%
40-50%
Disinhibition
Hallucinations
30%
10%
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SP - Nervous System Products
•
•
•
•
•
•
•
Neuroplex®
Neurotrophin PMG®
Super-EFF®
Choline
Cataplex® G
Cataplex® B
Niacinamde B5
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MH - Nervous System
•
•
•
•
•
Astragalus Complex
Bacopa Complex
Eleuthero
Evening Primrose Oil
Ginkgo Forte
17
Bones Down
the Drain:
Natural
Approaches to
Osteoporosis
Prevention
18
Osteoporosis – A Silent Disease
• Called a silent disease
because there are often
no obvious symptoms
until a fracture occurs
• 44 million Americans
are affected
• 10 million already have osteoporosis and 34
million have osteopenia
Looker AC, Orwoll ES, Johnston CC Jr, et al. Prevalence of low femoral bone density in older
U.S. adults from NHANES III. J Bone Miner Res.1997 Nov;12(11):1761-8.
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Affects Women & Men
• Women
– 13%-18% of women (4-6 million) over the age of
50 have osteoporosis
– 37%-50% (13-17 million) have osteopenia
– Risk factors: Small frame, low body weight,
Caucasian, Asian, etc.)
• Men
– 3%-6% (1–2 million) have osteoporosis
– 28%-47% (8-13 million) have osteopenia
20
Bone Loss Differs by Sex
• In men, the slowdown is gradual and linear,
beginning at about age 40
• In women, it is more precipitous, accelerating
to a net bone mineral density loss of 2 to 3%
annually in the 5 to 10 years following
cessation of ovarian function at menopause
21
Hip Fracture and Death
• Hip fracture is a serious consequence of
osteoporosis
• 20% of hip fracture patients die from
complications within a year (usually from
pneumonia as a result of immobility)
• Fewer than half resume their pre-fracture
level of functioning
Weil A. Boning up on Osteoporosis. Integrative Med. Jan 2003
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Women vs Men
• Women are at risk of developing osteoporosis
earlier in life than men
– Their levels of bone-building sex hormones
decline sharply after menopause
• NOT a normal part of aging
• Both preventable and treatable
• For men, the lifetime risk of osteoporosisrelated hip fracture is greater than the risk of
prostate cancer
23
Male Patient Awareness
• One in four men will have an osteoporosisrelated fracture in his lifetime
– Less likely to know that they have osteoporosis
until the disease is highly progressed
– Less likely to receive appropriate treatment once
they are aware of their condition
Paul D. Thacker PD. The Hidden Dangers of Male Osteoporosis. Life Ext. Jan 2004;78.
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WHO Guidelines for Interpreting
BMD Measurements
• Normal
– Not more than one standard
deviation(SD) below the
average value for young adults
• Osteopenia
– More than one SD below the
young adult average, but not
more than 2.5 SD below
• Osteoporosis
– More than 2.5 SD below the
young adult average
• Severe osteoporosis
– More than 2.5 SD below the young adult average
with presence of one or more fragility fractures
Reference adapted from “Assessment of fracture risk and its application to screening for postmenopausal
osteoporosis. WHO technical reports series, No. 843. Geneva, Switzerland: World Health Organization, 1994.
25
Explanation of T Score and Z Score
• T score indicates density of bones compared
to healthy individuals in their 20s, when bone
density is usually highest
• Z score indicates density of bones compared
to individuals in the same age group
26
Risk Factors for Osteoporosis:
Non-Modifiable
•
•
•
•
•
•
Age (advanced)
Race (Caucasian or Asian)
Sex (female)
History of fracture in a first-degree relative
Personal history of fracture after age 50
Frailty/poor health
National Osteoporosis Foundation. Physician’s Guide to Prevention and Treatment of Osteoporosis. Belle
Mead, NJ: Excerpta Medica, 1998.
27
Risk Factors for Osteoporosis:
Modifiable
• Cigarette smoking
• Low body weight (<127 lb)
• Estrogen deficiency
– Early menopause (<age 45)
or bilateral oophorectomy
– Prolonged premenopausal
amenorrhea (>1 year)
• Alcoholism
• Inadequate physical
activity
• Inadequate intake
of calcium (lifelong)
• Impaired eyesight
• Recurrent falls
National Osteoporosis Foundation. Physician’s Guide to Prevention and Treatment of Osteoporosis. Belle
Mead, NJ: Excerpta Medica, 1998.
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15 Key Nutrients for Healthy Bones
•
•
•
•
•
•
Calcium
Copper
Boron
Vitamin D
Zinc
Silicon
•
•
•
•
•
Vitamin K
Magnesium
Manganese
B vitamins
Vitamin C
29
Calcium Deficiency
• Calcium deficiency plays a major role in osteoporosis
with a 8% reduction in fracture risk for every 1%
increase in bone mass
• Calcium has the potential to reduce the incidence of
osteoporotic fractures by up to 60%
• Multiple dosing times of calcium will deliver twice as
much calcium in the blood as the same dose taken all
at once
Heaney RP, Berner B, Louie-Helm J. Dosing regimen for calcium supplementation. J Bone Miner Res.
2000 Nov;15(11):2291.
30
The Role of Nutrients
• Calcium: a component of the mineral crystals that
make up bone
• Vitamin D: enhances calcium absorption, prevents
falls while improving nerve and muscle function
• Magnesium: Essential for parathyroid hormone
production, which is necessary for the activation of
vitamin D and therefore the absorption of calcium
across the gut wall
Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral
magnesium in osteoporosis. Magnes Res. 1993 Jun;6(2):155-63.
Cohen L, Kitzes R. Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women. Isr
J Med Sci. 1981 Dec;17(12):1123-5.
31
Patient’s T-Score
Normal
Osteopenic
Osteoporotic
32
Patient’s Z-Score
Within
Expected
Range
for Age
Below
Expected
Range
for Age
33
How Did My Physician
Patient Restore his
Bone Health?
The treatment protocol will be
reviewed during the seminar
34
Men’s Health:
Discovering a Life
of Wellness
Essentials
©2011, Michael Greer, MD. May not be reproduced without permission.
35
U.S. Centers for Disease Control and Prevention
• “The US is home to 145.7 million adult men, and 12%
of them report their health status as fair or poor
• Indeed, 32% of men ages 20 and up are obese, and
31% in that same age group have hypertension
• Among adult American men, heart disease, cancer,
and accidents (unintentional injuries) are the three
leading causes of death”
U.S. Centers for Disease Control and Prevention. Men’s health.
http://www.cdc.gov/nchs/fastats/mens_health.htm. Accessed 4 October 2009.
36
Prevalence
• 13 million men have symptoms of low
testosterone levels
– Only 5 to 10% of these men will ever seek
treatment
• Testosterone therapy for men is based on
hormone testing that determines the correct
testosterone dosage (part II of this lecture)
College Pharmacy: Personal Communication
37
Gradual Decline
• After peaking in the 20s, a man's level of free
testosterone tends to gradually decrease and
to further decline throughout the remainder
of his years
• Low testosterone levels may be a risk factor
for cognitive decline and possibly for
Alzheimer's-type dementia as well
Moffat SD. Effects of testosterone on cognitive and brain aging in elderly men. Ann NY Acad
Sci. 2005 Dec;1055:80-90
Beauchet O. Testosterone and cognitive fucntion: current clinical evidence of a relationship.
Eur J Endocrinol. 2006 Dec;155(6):773-81
38
Estrogen Dominance
• As a result of estrogen dominance, men become
increasingly prone to benign prostatic hypertrophy
(BPH) and prostate cancer
• Becomes important to monitor estrogen levels
– Estradiol primarily, but also estrone
– Permits corrective action if those levels are high
• Testosterone levels can be increased without actual
testosterone supplementation
Steiner MS, Raghow S. Antiestrogens and selective estrogen receptor modulators reduce prostate cancer risk. World J
Urol. 2003 May;21(1):31-6. Epub 2003 Feb 14.
Steiner M. High-grade prostatic intraepithelial neoplasia and prostate cancer risk reduction. World J Urol. 2003
May;21(1):15-20. Epub 2003 Feb 21.
Cohen PG. The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone-estradiol shunt--a major
39
factor in the genesis of morbid obesity. Med Hypotheses. 1999 Jan;52(1):49-51.
Aromatase Enzyme
• One of the most important
factors that affect testosterone
levels in men
– Responsible for converting
testosterone into estrogen, thus
altering the ratio of estrogen to
testosterone
– Found in fat tissue and produced in
estrogenic tissue
Cohen PG. The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone-estradiol shunt--a major
factor in the genesis of morbid obesity. Med Hypotheses. 1999 Jan;52(1):49-51.
Rebuffé-Scrive M, Mårin P, Björntorp P. Effect of testosterone on abdominal adipose tissue in men. Int J Obes. 1991
Nov;15(11):791-5.
40
SHBG DYNAMICS
• Rising estrogen (E2) levels increase SHBG (sex
hormone binding globulin) levels
– SHBG ties up and inactivates all sex hormones; i.e.,
testosterone, estrogen, etc.
– When an estrogen molecule occupies a testosterone
receptor site on a cell membrane, it blocks the ability
of serum testosterone to receive a healthy hormonal
signal
• So it does not matter how much free serum
testosterone is available if excess estrogen is
competing for the same cellular receptor sites
41
The Role of SHBG
• Estrogen elevation contributes to the
elevation of SHBG levels
– Which then disrupts testosterone from attaching
to the receptor site
• Agents that lower estrogen make more free
testosterone, the active form, available
Stanworth RD, Jones TH. Testosterone in obesity, metabolic syndrome and type 2 diabetes. Front Horm Res.
2009;37:74-90
Saad F, Gooren LJ. The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and
diabetes mellitus type 2. J Obes. 2011;2011. pii: 471584. Epub 2010 Aug 10.
42
Testosterone Functions
•
•
•
•
•
•
•
•
Control of male vigor, vitality and fertility
Secondary male attributes
Muscle mass
Cognitive functions
Mood
Male behavior traits
Bone density
Immune function
43
Testosterone Deficiency Effects
•
•
•
•
•
•
Night sweats
Insulin resistance
Erectile dysfunction
Low sex drive
Cardiovascular disease
Loss of bone density
(osteoporosis –
osteopenia)
•
•
•
•
•
Mental burnout
Decreased muscle mass
Low physical stamina
Depression
Immune dysfunction
Dandona P, Dhindsa S, Chaudhuri A, Bhatia V, Topiwala S, Mohanty P. Hypogonadotrophic hypogonadism in type 2
diabetes, obesity and the metabolic syndrome. Curr Mol Med. 2008 Dec;8(8):816-28.
44
Testosterone & SHBG
• Total versus free testosterone: an important
distinction
– When discussing testosterone levels, we must be
sure to distinguish between the total and free
factions found in the blood
– The vast majority (between 97 and 99 percent) of
testosterone secreted into the bloodstream is
bound to sex hormone binding globulin (SHBG)
Kerry Bone Presentation: Herbal Protocols for Male Endocrine Disorders
45
Mechanism of Nettle Leaf* and SHBG
• European research has identified
constituents of Nettle root that bind to SHBG
in place of testosterone, thus reducing SHBG's
binding of free testosterone
• These constituents of Nettle root may
influence the blood level of free (i.e. active)
steroid hormones (testosterone) by displacing
them from the SHBG binding site
46
A Vicious Cycle
• A low testosterone level or and elevated
estrogen level results in increasing abdominal
fat ( insulin resistance and pre diabetes)
– Leads to an increase aromatase activity
– Which further converts testosterone to more
estradiol
– Which further reduces testosterone and increases
the tendency toward more abdominal fat
47
The Magic Key
Restoring Hormone Balance
Reduce Estrogens
Increase Testicular
Output
Androgen
Supplementation
48
Men and Women’s Libido Health
More details to come in the seminar
49
Estrogen Dominance
& its Role in Cortisol,
Weight Management
& Hypothyroidism
Definition of Estrogen Dominance
• The term “estrogen dominance” is less related
to the amount of circulating estrogen and
more related to the ratio of estrogen to
progesterone in the body
• In menopause, estrogen levels drop by 40%
while progesterone levels drop 90% from
premenopausal levels
Proposed by John R. Lee and Virginia Hopkins in their 1996 book “What Your Doctor May Not Tell You About
Menopause: The Breakthrough Book on Natural Progesterone”
Fam Community Health. 2003 Jan-Mar;26(1):53-63. A holistic programmatic approach to natural hormone replacement.
Watt PJ, Hughes RB, Rettew LB, Adams R.)
51
Signs of Estrogen Dominance
•
•
•
•
Salt and fluid retention
Low blood sugar levels
Blood clotting
Interference with thyroid
hormone function (leading
to weight gain and/or
feelings of exhaustion)
• Increased cholesterol and
triglyceride levels
• Allergic reaction
• Increased production of
body fat
• Irritability
• Mood swings
• Food cravings
• Hot flashes
• Fatigue
• Breast pain and other
symptoms reminiscent of
the premenstrual syndrome
Proposed by John R. Lee and Virginia Hopkins in their 1996 book “What Your Doctor May Not Tell You About
Menopause: The Breakthrough Book on Natural Progesterone”Fam Community Health. 2003 Jan-Mar;26(1):53-63.
A holistic programmatic approach to natural hormone replacement. Watt PJ, Hughes RB, Rettew LB, Adams R.)
52
Symptoms of Estrogen Dominance
• Irritability/Mood Swings
• Weight gain
• Depression
• Craving for sweets
• Heavy, irregular menses
• Uterine fibroids
(previously diagnosed)
• Water retention (bloating)
• Sleep disturbance
• Headaches
• Fatigue
• Short term memory loss
• Breast swelling
(all month)
• Fibrocystic breasts
(by history)
• Premenstrual
syndrome (PMS)
Bhavnani 2003, Duffy et al 2003,File et al 2001,Lephart et al 2002
53
Conditions Theoretically Related to
Estrogen Dominance
•
•
•
•
•
•
•
•
Insulin resistance
Trans-fatty acid intake
Chronic stress
Sleep deprivation
Environmental xenoestrogens
Cigarette smoking
Zinc deficiency
Progesterone deficiency
Courtesy Deborah Muth, ND
• Sedentary life style
• Cadmium toxicity
• Lack of sulfur-containing
amino acids
• Lack of good exercise
• Magnesium deficiency
• Hypothyroidism
• Testosterone deficiency
54
Causes of Estrogen Dominance
• Suboptimal liver = estrogen dominance (liver
congestion, disease, toxins, etc.)
• Low progesterone = estrogen dominance
(SHBG receptor sites, elevated cortisol,
poor adrenals, inadequate supplements
and fish oil)
• Suboptimal bowel habits = estrogen
recirculation and non-elimination (inadequate
fiber to bind estrogens and toxins)
55
Poor Sleep & Insomnia
• Stressed patients, or patients who through a
change in their sleep-wake cycle, who have
elevated or disturbed the diurnal rhythm of
cortisol WILL NOT BE ABLE TO DETOXIFY
• There may be a
‘misfiring’ between
the matrix and
the liver
With permission: Life Extension Foundation
56
Estrogen Dominance & Cortisol
Testosterone
Androstenedione
Estradiol-17 (E2)
Estrone (E1)
Estriol (E3)
Cortisol
Upregulates E1
& High Estrogen
Upregulates
Cortisol
High Estrogen Increases
T4-Binding Globulin (TBG) 2-3X
Lower Thyroid Hormone Activity
Suppresses Metabolism
Source: Molecular Endocrinology, Vol 2, No. 4 313-323, 1988
Lower Metabolism
Leads to Weight Gain
Design ©2012, Michael E. Greer, M.D.
57
Estrogen Dominance & Cortisol
(The Catch 22)
• Estrogen triggers inflammation (i.e., cortisol), which binds sex hormone
binding globulin (SHBG) including TBG (thyroid binding globulin)
• Fat cells make leptin and produce estrogen
• Leptin, insulin, cortisol and estrogen all increase aromatase activity
• Vice versa: Leptin and estrogen increase fat deposition and inhibit
insulin receptors making the body compensate by making more insulin,
which in turn increases estrogen receptor number and activity
• Decreases metabolism, energy, heat production and weight loss
• Increased estrogen, increased insulin and elevated cortisol all inhibit
leptin receptors (that signal satiety), thus allowing overeating (glucose)
and thus elevated insulin (triggered by the elevated blood glucose) and
aromatase with the estrogen dominance cycle unabated
Graeme P. Williams, The role of estrogen in the pathogenesis of obesity, type 2 diabetes, breast cancer and
prostate disease; European Journal of Cancer Prevention 2010, Vol 19 No 4
Kaaks R. Plasma insulin, IGF-I and breast cancer. Gynecol Obstet Fertil. 2001 Mar;29(3):185-91.
Catalano S, Marsico S, Giordano C, et al. Leptin enhances, via AP-1, expression of aromatase in the MCF-7 cell
line. J Biol Chem. 2003 Aug 1;278(31):28668-76. Epub 2003 May 6.
58
Guidance for Detox
STOP
SUPPORT
STIMULATE
SENSITIZE
External supply of toxins
Organs of Detoxification
& Drainage
Elimination of toxins
Patient for further detoxification
and lifestyle changes
59
Methods of Detox
• Respiration: Breathing (gas exchange), coughing,
sneezing, clearing mucous
• Skin: Sweating, sebaceous (oil) gland secretion, tears
• GI System: Liver function, gall bladder, bowel and
intestinal tract function (our first line of defense)
• Kidneys: Acid/alkaline balancing, urination
• Circulation and lymph systems: Blood flow, lymph
circulation and immunity function
60
SP Cleanse®
• Complete phase 1 and phase 2 detoxification
• Uses the properties of 20 different whole
vegetarian foods for this purpose
• Assists liver detox, enhances kidney funtion,
promotes GI elimination, assists the lymphatic
system and acts as an antioxidant
61
Detoxification Suggestions:
Estrogen Dominance
Kidney Support

• Renafood
• Arginex
• Cal-Amo
• Cranberry Complex
• UriCo
Phytosynergist
Epithelial Tissue & Skin Support

• Cataplex A

• Dermatrophin PMG
• Wheat Germ Oil

• Cataplex F Perles
• Black Currant Seed Oil
• Evening Primrose Oil
• DermaCo
Detoxification Suggestions:
Intestine and Lungs
Small Intestine Support
• Enzycore
• Lact-Enz
• Lactic Acid YeastTM
• Okra Pepsin E3
• Chlorophyll ComplexTM
• ProSynbiotic
• Prebiotic Inulin
• Gut Flora Complex
Lung Support
• Pneumotrophin PMG
• Emphaplex
• Allerplex
• Resco
• Broncafect
• PulmaCo
This Webinar is a Sampler Only
Attend the
Magnificent Anti-Aging Seminar for
immediately applicable information
64
Michael E. Greer, M.D.
Holistic, Homeopathic & Herbal Lectures and
Consultations
Exclusively to Physicians
737 Olive Way #1804, Seattle,Wa 98101
www.michaelgreermd.com
michaelgreermd@comcast.net
65