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Greatly reduce symptoms of fibromyalgia

June 15, 2017 Healing, Wellness 0 Comments

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Fibromyalgia is a condition of muscle pain, specific tender areas, known as hypersensitive “trigger points,” especially on the larger muscles of the back, neck, and limbs, and debilitating fatigue and weakness, as well as joint pain not related to arthritis.

The person with fibromyalgia has difficulty moving due to pain and fatigue, let alone attempting any increase in activity.  Often fibromyalgia is associated with insomnia, depression, anxiety, difficulty in thinking or concentrating, and irritable bowel syndrome.

Due to the association with depression, some may confuse pain and fatigue as secondary to a mental disorder, when in fact, fibromyalgia is very much an inflammatory condition of the muscles.

Fibromyalgia involves chronic fatigue and chronic pain throughout the body, due to oxidation and inflammation in the neuro-muscular connections of the skeletal muscles, along with mitochondrial dysfunction. (1) This gives us a good understanding that it is key to reduce oxidation and inflammation, as well as to restore mitochondrial function in order to alleviate symptoms.

Fibromyalgia is more common among women than men, and appears to be increasing in incidence.  It is hard to say whether this is due to increased recognition of the disease, resulting in more diagnosed cases, or due to an actual increase incidence in the disease due to an ever-increasing toxic load of chemicals in our environment.  Maybe it is both, but I have a suspicion the rise in incidence is mostly due to the increase in environmental toxins in our food, air, and water.

One woman’s story

Over the past two decades, Dr Ladd has been witnessing impressive results among people with fibromyalgia who incorporate a daily full-spectrum, pharmaceutical grade nutritional supplement program into their lives.

Jenny worked in his office while he was still practicing medicine in the Atlanta area.  She had suffered with fibromyalgia for over 27 years.  Her fatigue and muscle pain was so bad that she would go home from work and lay on the couch recovering from the day’s work, while her husband did all the cooking, cleaning, and shopping.  She used the weekends to rest up so she would be ready to work the next week.

When he learned that Jenny had fibromyalgia, he had already been recommending a full-spectrum nutritional supplement program (vitamins, minerals, antioxidants, and fish oil) to my patients with fibromyalgia.  He had already traveled to many areas in the world helping others with fibromyalgia have life-changing results.  Because of his knowledge, experience, and success with this brand of supplements, he suggested that Jenny go on the protocol similar to the one at the end of this article.  However, being skeptical, she declined saying that she had “tried all kinds of vitamins, and nothing ever worked for her.”

Jenny was convinced that something as simple as nutritional supplements would not help with her serious situation.  He reasoned with her that she had tried inferior supplement brands, and never had tried anything like he was suggesting.  Still skeptical, she agreed to try the protocol that worked for others, but insisted that it would not work for her!

To Jenny’s surprise, within the first few days she noticed more energy, less fatigue, and less muscle pain.  Within three weeks she was able to lead a near normal life!  She was able to help out around the house, which alleviated her guilt of having her husband do “everything.”  She and her husband were able to go on walks and bike rides together; and best of all, she was able to go out dancing again — something she truly missed.  It truly changed her life.

According to Jenny, she “had her life back.”  This was all within just one-month’s time of incorporating my supplement protocol into her life.  He doesn’t claim that she was “cured,” but her symptoms were not stopping her from living and enjoying a normal life.

Over the past two decades, He has both seen and heard from thousands of people from around the world who have experienced similar results to Jenny’s.  People need to know that they do not need to suffer from this disorder.  Doctors and patients need to know about these supplements and my protocols, because they not only help with the symptoms of fibromyalgia, but they also help maintain health in every organ of the entire body.

In a time when heart disease, stroke, diabetes, lung diseases, arthritis, dementia, and autoimmune diseases plague millions of people in the U.S. alone, He believes it is critical that everyone make proper lifestyle changes, including proper diet, exercise, reducing stress, improving restorative sleep, and taking quality, broad-spectrum nutritional supplements.

Considerations

The cause of fibromyalgia has not been established; however it is clear that oxidation, inflammation, and mitochondrial dysfunction are the underlying pathologies. (1) What causes pain receptors to be hypersensitive is unknown, other than inflammation triggers pain; but what triggers the inflammation?  It appears to be a combination of both environmental toxins and genetic susceptibility.

Although low vitamin D blood levels are not the cause of fibromyalgia, low vitamin D blood status is commonly found in those with fibromyalgia. (2)

No one truly knows what triggers oxidation and inflammation, unless it is multifactorial.  For whatever the initiating trigger that leads to oxidation and inflammation, this pathophysiology leads to pain, extreme fatigue, and weakness.  Independent of the muscular fatigue and pain, depression is also triggered, indicating that nerves and brain neurons are involved.  Therefore if it is an environmental toxin involved, it is very likely a lipophilic toxin, or set of toxins. There are roughly 80,000 – 90,000 toxic chemicals in our environment to which we all are continually exposed.

Phthalates, used to make plastics more flexible and harder to break; dioxins from plastics, BPA’s, electrical insulating-PCB’s, chlorine, fluoride, artificial sweeteners, such as aspartame, aluminum, smoking, and GMO foods take their toll on all of us over time.   Is it one, or a combination of these toxins?  And, why doesn’t everyone have fibromyalgia?  This is where genetic susceptibility plays a major role.

It is difficult to say whether these cell-damaging chemicals cause or contribute to fibromyalgia, but it is safe to say that they do not help.   As part of the lifestyle changes that I suggest people with fibromyalgia take, is the elimination or avoidance of these toxic substances as much as possible.  This is a good rule for all of us.

In addition, there was a study in 2004 that suggested that abnormal bowel bacteria could contribute to the development of fibromyalgia, which is why I highly recommend probiotics for immune and bowel health.

Traditional Treatment

There are various medications used to treat the pain and fatigue with varying results, including the antidepressant, amitriptyline, to help control pain and depression. However medications, such as anti-depressants, anti-seizure medication, and narcotics have their side effects.  Many trade fibromyalgia symptoms for side effects caused by drugs — some being just as serious or worse than the disease itself.

Lifestyle Management

A healthy low fat, low glycemic diet is helpful.  It helps to keep meat consumption to a minimum, and to avoid dairy fats.  Fat from fish oil is beneficial, as long as the fish oil is free of mercury, PCBs, and organic residues, such as dioxins.
Stretching and regular, mild to moderate exercise (such as swimming) helps reduce the pain and fatigue, although it is difficult to get started in the first place.  Taking nutritional supplements, particularly grape seed extract and co-enzyme Q10, are particularly helpful in getting started, as well as in maintaining the energy to be able to exercise.

Remember my story about Jenny?  She was able to go on walks, bike rides, and resume dancing within a month of being on the supplement protocol I recommended.

 

Nutritional Supplementation

Aside from the fact that every human being can benefit from taking a high quality, broad spectrum nutritional supplement program in order to maintain optimal health of all organ systems throughout the body, people with fibromyalgia can truly live with less pain, increased energy, better brain functioning, and improved sleep following my suggested nutritional supplement protocol below.

 

Boosting Mitochondrial Function

It is very clear that people with fibromyalgia are creating less energy molecules, ATP, by the mitochondria in their cells.  Mitochondrial decay, or dysfunction is a hallmark of this disorder.

One of the most exciting frontiers in the science of nutritional supplementation is the ability to induce renewal of cellular components, such as the mitochondria and the endogenous antioxidant enzymes that protect the mitochondria so they can produce the life-sustaining ATP molecules.

Mitochondria provides the “energy of life.”  They provide the energy currency molecules, ATP, without which nothing can happen.  Literally, nothing at the cellular level on up can occur.  The DNA cannot be transcribed to make proteins or enzymes. The DNA cannot replicate, and there could be no cellular division.  You could not move a muscle, you could not fire one neuron to think.  Nothing!

The energy-producing mitochondria within cells sustain damage over time.  Damage and mitochondrial decay accelerates in those with chronic inflammation, or who have genetic susceptibility, or who are exposed to environmental toxins.

The greatest target of oxidation within the cell are the mitochondria, and more specifically, the mitochondrial DNA.  With age and disease processes, the cell makes less protective antioxidant enzymes, causing the mitochondrial to decay even faster, resulting in more fatigue and brain fog in the person whose mitochondria is being damaged.  Excessive free radical damage (oxidation) accelerates DNA decay, damage, aging, and disease. (3 – 6)

As we age, the mitochondria and the endogenous antioxidant enzymes that protect the mitochondria decline in number and function.  If you think about it, the cellular DNA is still present and functional within all our cells, which is the blueprint for cellular function, but without adequate energy (ATP molecules) from healthy mitochondria, cells do not have energy to perform their functions.  The person does not have energy to live her normal active life.

Everything in all organs and tissues wears out, and we age and diseases develop.

Taking supplements, vitamin-antioxidants, with the bio-technology that signals the inherent intelligence of the cell’s DNA to renew endogenous antioxidant enzymes that protect the mitochondria, as well as stimulate the mitochondria to recycle and renew themselves is a powerful way to regenerate mitochondria and cells in all tissues, restoring energy to the entire body. (7 – 10) The restoration of healthy mitochondria helps the brain, heart, liver, pancreas, bowel, skeletal muscles, and skin to function more youthfully.

Co-enzyme Q10 is a vitamin antioxidant that plays a critical role in metabolism/energy production within the mitochondria of the cells.  Co-enzyme Q10 is also known to activate genes involved in cell signaling. (11)  Co-enzyme Q10 is critical for muscle and nerve functioning, and lowered levels are known to be associated with fibromyalgia.  Supplementation with co-enzyme Q10 is essential to help alleviate the symptoms of fatigue and weakness, as well as depression, in those suffering with fibromyalgia. (12)

In a double blind, placebo-controlled study involving 20 women with fibromyalgia, 300 mg of co-enzyme Q10 daily was found to reduce fatigue, pain, and morning tiredness. (13)

Vitamin D

There is a vitamin D deficiency epidemic in the U.S. and Canada, and many other countries as well.  Most people are deficient in vitamin D, and boosting one’s vitamin D can significantly reduce the risk of many chronic degenerative diseases.

Like all other organs and tissues, the adrenal glands, the brain, and the immune system depend upon adequate levels of vitamin D.  One’s doctor can check the vitamin D status with a blood test for 25-hydroxy-vitmain D3 (25-OH-D3).  Most doctors will aim for a level of 40 – 50 ng/ml.  More progressive doctors, and vitamin D experts will recommend higher levels, on the order of 60 – 80 ng/ml.  This often requires the intake of 4000 – 8000 IU of vitamin D3/day.

One study found improvement of pain in patients with fibromyalgia and low vitamin D status by increasing their vitamin D blood levels.  They supplemented with vitamin D3 at 50,000 IU per week (averaging just over 7000 IU per day), raising blood levels in this study on average from low levels (around 10 ng/ml) to medium levels (around 46 ng/ml).  (14)

I usually suggest vitamin D3 at around 6,000 – 10,000 IU/day, the goal being a vitamin D3 level of around 75 ng/ml (not to be below 50 ng/ml, and not to exceed 100 ng/ml).

Studies have shown there is no toxicity of vitamin D3 up to 30,000 IU per day, and possibly higher. (15)  The most important aspect of vitamin D supplementation is the blood test; checking the level of 25-OH vitamin D3.  Although there appears to be no toxicity with blood levels of up to 200 ng/ml, and possibly even 400 ng/ml, it is prudent to not exceed 100 ng/ml.  It should not exceed 400 ng/ml, because in some people that greatly exceed 100 ng/ml they can develop atrial fibrillation and hypercalcemia.  Most do not, but some can.  No one has ever been found to develop atrial fibrillation from a vitamin D level up to 100 ng/ml.

Other Micronutrients

Minerals, such as calcium, magnesium, chromium, copper, selenium, zinc, and several others, are critical for cellular health, normal brain function, use by cellular antioxidant enzymes, and energy production.

Omega-3 fatty acid, such as fish oil, which provides both EPA and DHA, is critical for brain functioning and reducing symptoms of anxiety, depression, and foggy thinking, as well as helping cells utilize vitamins and minerals more effectively.

A small case study involving patients with neuropathic pain, that is pain that involves the nerves, such as fibromyalgia, indicated that omega 3 fatty acids in the range of 2400 – 7200 mg/day (EPA & DHA) helped to reduce the symptoms.  (16)

A pure fish oil brand, one that is free from PCBs and organic residues, such as dioxins, is important to maintain the normal function of nerves, especially in those with fibromyalgia.

Grape Seed Extract & Turmeric Extract

 

Chronic stress, chronic fatigue, insomnia, pain, and depression, etc., are all associated with fibromyalgia.  As an example of how such symptoms can be improved, studies evaluating those with fibromyalgia found that diets rich in polyphenol antioxidants were found to reduce numerous associated symptoms. (17)  In my experience working with those with the constellation of symptoms, whether they have fibromyalgia or chronic fatigue syndrome, the supplements have the same effect.

There are thousands of polyphenolic compounds from food sources, and the flavonoids are among the most studied of the polyphenolic antioxidants.  Polyphenol antioxidants include quercetin, grape seed extract, resveratrol, olive extract, and green tea extract, and curcumin, or turmeric extract, just to name a few.

Polyphenol antioxidants have many health benefits, including cardio-protection, anti-cancer, and anti-diabetic effects. (18)  They reduce oxidation and inflammation, many by blocking the Cox 2 enzyme involved in the inflammation process.  They also help induce detoxification enzymes in the liver, to support liver functions.

In my experience for over 2 decades, He has suggested supplementation to hundreds of patients, who experienced partial or complete resolution of their symptoms with high doses of grape seed extract and other antioxidants.  Their response was usually correlated to the dose of grape seed extract and co-enzyme Q10, as well as a few other micronutrients, as you will read in my protocols.

Grape seed extract, turmeric extract (curcumin), olive extract, green tea extract, alpha lipoic acid, quercetin, co-enzyme Q10, along with the well-known vitamin C, D, and B complex vitamins are all powerful in helping cells to function properly, and when supplemented correctly, help to reduce symptoms of fibromyalgia.

As he has often told his patients with fibromyalgia, “there is a dose of grape seed extract that will work.”  Although a wide-spectrum of micronutrients work best for complete resolution of pain and fatigue, the two most effective supplement “optimizers” that I found are grape seed extract and co-enzyme Q10.  These two supplements added to a base of vitamins, minerals, fish oil, calcium, magnesium, and vitamin D, would take someone from getting “okay” results to getting life-changing results.  It was only a matter of dose.

One person may only need 4 grape seed extract tablets per day, while another person might require 12 per day for complete resolution of pain and fatigue.  Again, the more wide-spectrum the supplements taken, the less one needs to take mega-doses of one particular supplement.  Since there is no known toxic dose to many antioxidants, such as grape seed extract, I had no problem with my patients using mega-doses.

Beta Glucans

Based upon personal experience, and the biochemical effects of beta glucans, particularly a study that supported my experience, (19) I have recently suggested the use of beta glucans, as from Shiitake and Reishi mushrooms, and baker’s yeast extract to those with fibromyalgia and chronic fatigue syndrome.

Beta glucans are polysaccharide fiber micronutrients derived from the cell membranes of the Reishi and Shiitake mushrooms, as well as baker’s yeast extract.  Beta glucans have been used for years in Chinese medicine as immune modulators, and cancer fighters.  They activate the immune cells without causing an over-reaction.

White blood cells, such as macrophages and natural killer cells, have beta glucan receptors, and when stimulated by beta glucans (shown as small chains of blue balls in image below), the cells are activated to actively and precisely attack and eliminate foreign microbes (bacteria, yeast, fungi, and viruses), as well as cancer cells.

 

Beta glucans are immune modulators, inducing the immune system to mount an active response against foreign microbes and abnormal cells, without triggering an over-reaction that could cause excessive tissue damage. (20)  Beta glucans are an important in those with chronic stress, a suppressed immune system, and/or adrenal fatigue, if for nothing else but to reduce the risk of viral infection (the “flu”), or cancer, that can come about due to extreme stress.

Probiotics

The gut is intricately involved with the immune system, neurotransmitters within the brain for mood, intestinal health, and skin health. (21, 22) They also indirectly help the production and function of hormones, including adrenal hormones.

As in the gut, so goes the rest of the body. Good intestinal health is important for a healthy immune system, metabolism, thinking, and mood, precisely what is affected in those suffering adrenal fatigue.  Good intestinal health, enhanced mood, and metabolism depends upon healthy bacteria in the intestines, known collectively as the microbiome.

The microbiome of the gut can be considered another organ of the body. With nearly 3 pounds of bacteria, and numbering in the 50 – 100 trillion range, the diverse species of bacteria is considered the ‘rain forest’ of the body. There is an intricate balance of friendly bacteria that we have a symbiotic relationship with in order to maintain a healthy digestive tract, proper digestion, an elevated mood, optimal metabolism and energy.

The microbiome plays a key role in maintaining a healthy immune system, which can be slightly or severely suppressed with chronic stress and adrenal fatigue.

In addition to chronic stress, antibiotics, eating unhealthy foods, lack of sleep, coffee, alcohol, lack of hormones, and many other factors can alter the balance of bacteria in the bowel.

If the bacteria are unbalanced with more bad bacteria than friendly bacteria, the bad bacteria can make their way beneath the hyper-permeable epithelial layers of the intestine and worsen inflammation. Low-grade inflammation and altered intestinal microbiota have been identified as factors contributing to abdominal symptoms.

Improving the intestinal microbiome with supplementation with probiotics is a critical component for the treatment and management of chronic stress and adrenal fatigue.

In my protocol, I recommend probiotic strains in which scientific studies have backed as the two most important strains to replace for establishing a foundation for growth of numerous other bacterial strains, Lactobacillus rhamnosus LGG, and Bifidobacterium BB-12.

Numerous probiotic strains are available, many of which have very little-to-no clinical data regarding their benefit or physiological activity. These two strains have numerous human trials to prove viability and benefit in humans. They are designed for long shelf-life, and importantly, to withstand the harsh acidic environment of the stomach, so they can pass into the intestines intact, where they multiply and create a healthy environment for the microbiome to flourish.

Melatonin

Melatonin is a hormone with antioxidant properties.  It helps promote restorative sleep and replenishment of hormones, such as the mood hormones, serotonin and dopamine, as well as growth hormone, which helps maintain healthy muscle, bone, and metabolism.  He has found it a vital hormone in those with fibromyalgia, and not just to help them sleep.  It has effects beyond the brain.

He recommends a pure, bio-identical melatonin hormone.  Bio-identical means that the hormone is the exact same molecular structure as human melatonin without getting it from human brains.  Many over-the-counter melatonin brands are derived from cow or pig brains.  It may work some, but not quite as well as the non-animal, bio-identical, pure melatonin I take and recommend.  Usually 1 – 2 mg under the tongue at night is enough to induce restorative sleep.

It is important to remember that melatonin is not a sleeping pill.  One does not become dependent upon it like a sleeping pill.  It merely works with the brain to induce the deeper stages of sleep, including dream state sleep (REM).  REM is critical for restoration of the brain cognition, laying down of long-term memories, and brain hormone production and synchronization.

As we age melatonin production from the pineal gland declines.  Production peaks around 15 years of age, and then declines steadily thereafter.  It is such an important hormone that I included melatonin as one of the 5 major hormones for hormone replacement in menopausal women, along with bio-identical estrogen, progesterone, testosterone, and DHEA.

Melatonin can be considered the master hormone, because the release of melatonin each night sets off a cascade of hormone events, from serotonin and dopamine, to pituitary hormones, including thyroid stimulating hormone, growth hormone, which have their own effects on metabolism, energy, as well as muscle and bone strength. Melatonin also affects ACTH from the pituitary that affects the adrenal glands.  It all starts with melatonin inducing restorative sleep.

With purposefully staying awake to work or play, or to sleep less than 6 hours per night in order to be more productive, will be paid for by a toll on your body, just as much as if one were to smoke.  The effects may not be seen in the first decade or two, but the effects will come!

I consider melatonin a nightly essential, even if a person does not have trouble sleeping, simply due to the effects that it has on synchronizing the hormones throughout the body.  Melatonin is also a powerful antioxidant, and is even being used at doses up to 10 or 20 mg/night as adjunctive chemotherapy for some cancers. (23 – 30)

There is no known toxic dose to melatonin.  The only side-effect is drowsiness, which is what it is supposed to do.  Some people start melatonin and find that they are groggy in the morning.  That is usually because a person is so under-slept, or lacking in restorative sleep that the body is in repair mode.  The grogginess goes away after a week or so, when the person obtains continuous restful, restorative sleep.  Therefore, do not give up on melatonin.

In a placebo-controlled, triple arm clinical trial involving 63 women with fibromyalgia, 10 mg of melatonin, either alone, or in conjunction with amitriptyline, was shown to decrease pain. (31)

DHEA Supplementation

Hormones such as DHEA and pregnenolone have an age-protective effect on all cells of the body.  These hormones have been shown to stimulate healing of damaged neurons of the brain.  DHEA helps with the muscles and brain.  It helps with energy.

DHEA is the most abundant hormone in the body, and is dubbed “the youth hormone,” as it is found in higher concentrations in the young, and more importantly, it exerts protective and reparative capabilities in virtually all cell types.

DHEA exerts its own youth-enhancing effects on cells, or in turn, it can be used for conversion into the sex hormones, testosterone or estrogen. Chronic emotional stress and pain increases oxidation and inflammation throughout the body causing accelerated mitochondrial decay, and ultimately significant fatigue, chronic pain, and depression.

I suggest those with chronic fatigue syndrome and fibromyalgia to consider supplementing with 50 – 100 mg of DHEA in the morning.  DHEA helps protect cells, and helps counter the negative effects of chronically-elevated cortisol, stress, pain, and fatigue.

5-HTP and L-Theanine

The mood-enhancing hormones in the brain are serotonin and dopamine.  When these are dysfunctional or depleted your mood suffers, and anxiety, depression, and anhedonia are manifested.

5-Hydroxy-L-Tryptophan, or 5-HTP, is an amino acid precursor for serotonin.  There is no toxicity with this amino acid 5-HTP, vs. using high doses of tryptophan. (32)  Some studies have shown that 5-HTP is just as effective at relieving mild-moderate depression as commonly prescribed SSRI drugs, such as Prozac.  (33)

L-theanine is an amino acid derived from green tea.  It is not caffeinated.  L-theanine helps with relaxation, reducing anxiety without causing drowsiness.  It has been shown to change the brain wave pattern to a relaxed state, or alpha wave state. (34)  It is nontoxic, and appears to have additional benefits with the heart and immune system.

Conclusion

Fibromyalgia, and the closely-related condition of Chronic Fatigue Syndrome, are characterized by wide-spread inflammation, particularly in the muscles, and even more specifically within the mitochondria of the cells.  All energy molecules, ATP, are made within mitochondria, and the mitochondria are affected in those with fibromyalgia and chronic fatigue syndrome.

When mitochondria are affected, there is an energy loss from the muscles, and a depressed functioning of the brain, in the production of mood-enhancing hormones, circadian rhythms, sleep, and inhibition of clear thinking and memory.

In addition to supporting the mitochondria to produce more energy molecules, ATP, it is important to protect the mitochondria from oxidative damage by increasing the endogenous antioxidant enzymes.  A specific combination of micronutrients do this.  Advanced nutritional supplements allow for this to happen, and restore health and longevity to the cells and the person.

Those who follow the protocol, particularly the optimal dose-protocol, start to notice the difference within 10 days or less.  Rarely does it take much longer to first start noticing results.  They continue to feel better, with more energy, less fatigue, and an elevated mood with continued use of the supplement protocol.  Just remember, that as life’s stresses increase, or with illnesses, a person may experience fatigue.  This does not mean the supplements are not working, it just means that one needs to increase the grape seed extract, co-enzyme Q10, and the beta glucans until the excessive stress or illness is resolved.

Supplement Protocol for Fibromyalgia and Chronic Fatigue Syndrome

Which protocol should you start with depends upon how quickly and completely you would like to experience a resolution of your symptoms.  If you want to feel better in general, then start with the minimal-dose protocol.  However, most people need at least the moderate-dose protocol.  If you want to experience “life-changing” results, then I highly recommend the optimal-dose protocol.  That dose never fails, as long as there is no underlying disease besides fibromyalgia or chronic fatigue syndrome.

Please see Medical Disclaimer below.

Minimal-Dose Protocol for Fibromyalgia & Chronic Fatigue Syndrome:

Moderate-Dose Protocol for Fibromyalgia & Chronic Fatigue Syndrome:

Optimal-Dose Protocol for Fibromyalgia & Chronic Fatigue Syndrome:

* I suggest the 5-HTP, L-Theanine, and DHEA from Douglas Labs.  You can set up your own purchase account, and then searching for those product names. You can set up your purchase account by CLICKING HERE.   Please get ALL other products in the protocols from the Associate who recommended this to you, who can get you a discount from my preferred supplement manufacturer.  My preferred manufacturer does not provide DHEA and 5-HTP.



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