Fight the Cold and Flu with Food!

It's that time of year. Everyone around you is starting to develop some sort of sniffle, cough, sneeze or runny nose. You'll try your absolute best to avoid all contact with those you know are infected, but eventually someone you don't know will sneak up behind you and cough in your direction, almost as if they're doing it on purpose. Like you are sworn enemies and the target of their biological warfare in a battle you never wanted to be a part of. Cold and flu season is here whether you like it or not, but you can do something about it! The best offence is a good defence, so let me tell you about some foods you can eat that will help you fight off these nasty viruses this year!

Mushrooms

Mushrooms are quite impressive organisms. This Honey Mushroom currently holds the record for being the largest living organism on earth, spanning 3 square miles across the Blue Mountains of Eastern Oregon. Aside from their incredible ability to adapt and thrive, some species of mushrooms are incredibly nutritious and have been used medicinally for centuries. The fungal polysaccharides found in mushrooms are responsible for boosting our immune system and helping us fight the good fight against colds and flus. Not all mushrooms are created equal however, as certain species will have stronger immune boosting effects than others. Maitake, shiitake, reishi, cordyceps and chaga mushrooms have the strongest immune boosting effects and as an added bonus, act as adaptogens to better manage stress.

Horseradish

This one came as a bit of a surprise to me as well, but this common household condiment can be used to fight infection as well. Aside from it's immediate sinus clearing actions from the burn you feel when you eat it, horseradish actually has bacteria fighting properties. Throw in some garlic and you've made yourself a tasty, virus fighting garnish!

Oil of Oregano

This stuff works! It definitely is not pleasant to take and should not be overused, but taking a few drops when you feel the beginnings of a cold or flu coming on can sometimes stop that virus dead in it's tracks and prevent it from ever becoming a full blown attack. Some people have sworn by this virus busting oil for some time now and we know it can fight bacteria with force. Definitely worth keeping on hand. 

Vitamin D

I can't stress this last point enough! Vitamin D is absolutely crucial to anyone living in Canada, and even more so in the winter months. It's no wonder cold and flu season begins when we enter into eternal darkness (a.k.a. winter). We simply do not get enough. Vitamin D actually acts more as a hormone than a vitamin and is strongly linked to our immune defences. Up your Vitamin D intake and you'll greatly increase your chances of not getting sick this season while everyone around you starts to sniffle. Good food sources include fish such as salmon, mackerel, and tuna, egg yolks and certain mushrooms as well like portabella, chanterelles, and maitake. 

As a last point, remember to do your part to stop the spread of germs as best you can. Wash your hands with soap and water and avoid contacting areas of your body where germs can easily enter like your eyes and mouth. Minimizing your exposure while increasing your defences are the best way to avoid any nasty viruses this cold and flu season!


Dr. Rob Raponi ND, CISSN, B.Kine(Hons)

www.msknaturopathic.com

Impacts of stress on memory

I've known of the performance advantages in competitive athletes who use a carbohydrate mouth rinse just before competition for some time now. It consists of swishing a sugary solution in your mouth and spitting it out just before competition. It stimulates reward pathways in your brain and can improve performance in competitions where every millisecond counts. This can be particularly helpful in Ketogenic athletes since they won't actually be ingesting any sugars and not altering their ketotic state.

This new article out of the JISSN however, opened my eyes to a broader topic that is relatable to almost everyone. Basically they found that a carbohydrate mouth rinse after exercise halted the decline in executive function associated with exercise. What makes this even more interesting is the fact that the researchers also measured stress hormones and found that the reason executive function was not hindered was the associated decrease in stress hormones found in test subjects who took the carbohydrate mouth rinse after exercise. So, athletic performance aside, what this article really outlines is that we simply cannot perform our best when under constant stress. Executive function deals with our ability to plan, pay attention, problem solve and remember things.

I'm not saying sugars are the answer here! I just want to point out that stress can immediately impact our cognitive abilities. Living constantly stressful lives without taking the time to meditate, enjoy hobbies, learn something new or just do things you love can have significant impacts on how you live your day to day life.

My favourite 2 apps that I recommend to almost everyone I see in practice for helping destress at home for free are Headspace and Down Dog. Headspace is a guided meditation app for your phone that you can set for as little as 2 minutes or as long as you can tolerate. Down dog is an amazing free yoga app that creates a new workout for you each time you use it and can be set to a time and difficulty level of your choosing. I love yoga for it's focus on breathing techniques while getting in some exercise and much needed stretching at the same time.

Let me know if any of you have other apps or things you like to do to help destress at the end of a long day or particularly difficult week. I'd love to hear and learn of new methods for myself and others!

Link to the article for those interested:

https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0200-0

Dr. Rob Raponi ND, CISSN, B.Kine(Hons)

www.msknaturopathic.com

The most common nutrient deficiencies in our population

Do you suffer from annoyingly recurring illnesses like the cold? Do you get headaches or feel tired all the time? Do you have trouble remembering things or staying focused? Believe it or not but a lot these symptoms may actually be due to nutrient deficiencies that are quite common even in developed countries such as those in North America. Now I'm not talking about frank deficiencies and the development of conditions such as scurvy, however suboptimal levels of important vitamins and minerals can leave us functioning..well, sub-optimally. So here are a few of the most common deficiencies we face, and some easy ways to better manage them.

Vitamin D

"The Sunshine Vitamin" actually acts more like a hormone than a vitamin, and is incredibly important in many aspects of how we function. Unfortunately, it is much more commonly deficient than most people think. We do have the ability to make this vitamin when sunlight comes into contact with our skin, however to achieve optimal levels we would need to be out in the sun far longer than what would be good for us. Those of us at a higher risk of having sub-optimal levels? - anyone who lives somewhere where winter is one of the seasons (less daylight, less time outside), individuals with darker skin (ability to synthesize Vit D is decreased in this population), and sedentary or overweight individuals (may be more due to decreased time spent outdoors). With low levels being linked to lowered immune function and increased risk of developing osteoporosis and even multiple sclerosis, this is one important vitamin. There are foods that contain higher amounts of Vit D, such as fish, cheese, egg yolk and liver, however supplementation may actually be the best bet. Doses vary depending on the preexisting status of the individual, so it is always best to visit your ND for help before considering supplementing on your own.

Magnesium

This little mineral is endlessly useful in the body and very commonly deficient in so many people. Some signs of inadequacy can include; fatigue, weakness, muscle twitching and cramping. Magnesium also plays a large role in decreasing blood pressure, making it very useful in the cardiovascular system. This is because magnesium is a widely used catalyst in the body which means it's presence is required for many chemical reactions to occur within us. So while we may be getting enough magnesium to avoid seeing signs of frank deficiency, not getting optimal amounts can also lead to the presentation of annoying symptoms. Where can we find magnesium? Good food sources would include nuts (almonds, cashews and peanuts), spinach, beans, avocado, potatoes, and brown rice. Those of us at risk for sub-optimal levels of this mineral would be anyone not eating much of the previously mentioned foods, anyone with gastrointestinal issues as absorption will be decreased, diabetics (excrete more magnesium in their urine), and the geriatric population due to a decrease in food intake and decreased absorption due to aging.

Omega 3 Fatty Acids

These are as good as "good fats" get. I don't even know where to begin or what studies to cite because the benefits of these fats are incredible and new research continues to come out on how useful they are in various conditions. Ideally, when consuming fats we would want to have a ratio of omega-3 to omega-6 at 1:1. That is ideal, however anything close to that would be beneficial. Unfortunately, a standard North American diet contains a ratio somewhere in the range of 1:20 or more. This supports an overall inflammatory state within the body and inflammation is bad. Low levels of omega-3 fatty acids can present as dry or flaky skin and hair, decreased ability to focus or remember and even increased aches and pains throughout the body. Achieving and maintaining an adequate amount of omega-3s may help improve all of those things and has also been linked to benefiting cardiovascular disease, cognition, diabetes, arthritis, Alzheimer's disease and even cancer. It has actually been shown in the research to decrease "all causes of mortality" which is kind of big deal since this includes literally any cause of death. So yeah, if you can achieve adequate amounts of omega-3's, statistically speaking you will decrease your chances of dying in a car accident. Pretty impressive. Where can we find more omega-3's? Rich sources are flax, fish, vegetable oils, and nuts. There is a kicker though. EPA and DHA are further components of omega-3's and the best benefits are seen when we get higher amounts of EPA than DHA. So when we look at our naturally occurring sources, fish constitutes the best available option as the vegetarian options are not easily converted in our bodies and yield lower amounts of useful EPA. Another problem... eating too much fish can be harmful for us because of the high levels of mercury often found within. Fortunately this can be avoided or at least minimized by choosing smaller fish (as the larger fish have higher amounts accumulated) or supplementing with fish oils (as the mercury is eliminated and EPA and DHA are all rigorously accounted for). As always, it is best to consult with an ND before deciding if supplementation is a good option for you as each person is unique and will require a unique prescription.

Iron

This one is much more prevalent in women but can be seen in men as well. Iron is a component of hemoglobin in our blood which is responsible for carrying oxygen throughout the body. Low iron can present as general fatigue, pale skin, feeling cold (especially hands and feet), brittle nails and even cravings to eat ice. Those at higher risk for iron deficiency are women of childbearing age (even more so in those who experience heavier menstrual cycles), vegetarians, or anyone who has lost a lot of blood for any reason (donating too frequently included). The best sources of iron are from meat as the iron contained within is in "heme" form which is the most absorbable form. Red meat, oysters, beef or chicken liver and sardines are great sources of heme iron. While legumes, nuts, grains and green veggies all contain fairly high amounts of iron, it is in the non heme form and only a fraction is absorbed when compared to the heme sources. For this reason it is important for vegetarians to watch their iron levels and ensure they are getting adequate amounts. A vegetarian friendly option would be the use of cast iron pans in cooking. Not only do these things make meals taste better (totally biased) but cooking in them can actually absorb some of the iron from the pan into your food. Additionally, if you are cooking up more acidic foods (something like tomatoes), the iron will actually be converted into a more active form, further increasing the ability of your body to absorb it. Supplementation with iron is always a viable option as well but it would be best to consult with an ND first as dose, duration, and form are all important factors that need to be considered before beginning any supplementation regime.

Vitamin B12

Ok, so this one isn't as common as those previously mentioned but definitely deserves a spot on the list because it can have some serious impacts to certain individuals. These individuals being vegetarian/vegans or anyone who does not consume a lot of meat. Vitamin B12 is responsible for the production of energy, and also for the formation of blood and myelin (this is the stuff that coats your nerves and helps with the transmission of signals from the brain). With these actions, it may be easy to guess what suboptimal levels can present as; fatigue, muscle weakness, and also mental fog and memory problems. What makes this more concerning is that in order for deficient signs to present themselves, the individual would have had to have been fairly deficient for many years. The main complication of this is the impact on the neurological system and that function of coating the nerves with myelin. If someone is left without Vitamin B12 for too long, they can have irreversible neurological damage which can impair their reflexes and sensations of touch. Now this is pretty rare but also quite severe and can be easily avoided. Extreme symptoms like this one are not very common but can be seen in a North American population where meat is excluded. More common however, are the suboptimal levels and their associated symptoms. In the case of Vitamin B12 deficiencies, meat is really the best way to go but for those who do no consume meat for any reason, supplementation of an active form of this vitamin is a must. Sublingual and injection form are the best approaches and the posology is best determined by your ND.


There we have it, a 5 item list of some common nutrient deficiencies that can be seen even in developed countries like Canada and the US. If you are experiencing some of these signs or symptoms, it could be attributed to one of the previously mentioned nutrients. Remember to always consult with a health care practitioner when experiencing any of these symptoms as deficiencies may not be the cause.


Comment, share and ask any questions you may have and I will do my best to answer them!

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com

Studies for those interested,

1. Wang, Thomas J., et al. "Vitamin D deficiency and risk of cardiovascular disease." Circulation 117.4 (2008): 503-511.

2. Holick, Michael F., and Tai C. Chen. "Vitamin D deficiency: a worldwide problem with health consequences." The American journal of clinical nutrition87.4 (2008): 1080S-1086S.

3. Munger, Kassandra L., et al. "Vitamin D intake and incidence of multiple sclerosis." Neurology 62.1 (2004): 60-65.

4. Al-Ghamdi, Saeed MG, Eugene C. Cameron, and Roger AL Sutton. "Magnesium deficiency: pathophysiologic and clinical overview." American Journal of Kidney Diseases 24.5 (1994): 737-752.

5. Kass, Lindsy, J. Weekes, and Lewis Carpenter. "Effect of magnesium supplementation on blood pressure: a meta-analysis." European journal of clinical nutrition 66.4 (2012): 411-418.

6. Delgado-Lista, Javier, et al. "Long chain omega-3 fatty acids and cardiovascular disease: a systematic review." British Journal of Nutrition107.S2 (2012): S201-S213.

7. Lee, Lai Kuan, et al. "Docosahexaenoic acid-concentrated fish oil supplementation in subjects with mild cognitive impairment (MCI): a 12-month randomised, double-blind, placebo-controlled trial." Psychopharmacology 225.3 (2013): 605-612.

8. Vaucher, Paul, et al. "Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial." Canadian Medical Association Journal 184.11 (2012): 1247-1254.

9. Stabler, Sally P. "Vitamin B12 deficiency." New England Journal of Medicine368.2 (2013): 149-160.

10. Moore, Eileen M., et al. "Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts." Journal of Alzheimer's Disease 39.3 (2014): 661-668. **Interesting study on relationship between B12 and folate in the elderly for those interested

11. Tayyebi, Ali, et al. "The effect of Vitamin B12 supplemention on fatigue in hemodialysis patients." Iran J Crit Care Nurs 6.1 (2013): 39-48.

How Sugar Can Help With Your Pain - Prolotherapy

What do arthritis, tendinitis/tendinosis, and low back pain have in common? Well aside from low back pain they can affect many different areas of the body and they are all quite difficult to effectively treat. Currently, the standard of care for most of these is a watch and wait approach (wait around and see if it gets better on it's own), corticosteroid injections (which effectively deal with pain management but little else), or physiotherapy (helpful, but has it's limitations). The majority of these approaches are effective at dealing with pain in these conditions but do not really help in the healing of the damaged tissues. Even the pain management seems to be somewhat short lived.

Enter prolotherapy. In short, it is an injection based therapy where a solution of sugar (hypertonic dextrose) is introduced into the area of pain. From here on out the exact reason for how this works is a bit unclear but the strongest theory is that this causes inflammation to the area which then in a way, forces the body to begin to heal a part of itself in which it essentially has forgotten about. Now this isn't the same type of inflammation you get during an allergic reaction or cut on your skin, rather it's quite mild and only serves to reactivate the healing process.

So here we have an alternative to the current standards of care but how does it stack up when compared against them? Quite well actually. Research has shown that not only is prolotherapy comparable to corticosteroid injections for reducing pain, but it can also return the individual to proper function and strength quicker. Additionally, the effects it has last over a longer period of time than any of the comparable treatments! So it works as effective or better than the current treatments, and it's effect lasts longer.. too good to be true? No, not really. I mean as long as you're ok with needles, the only side effect seen after treatment is some soreness at the site of injection. That's pretty incredible considering the alternatives. And just to be clear, I'm not against the standards of care in any way, they are the standards for a reason. I just think it's important to have choice and know all the options before receiving a treatment.

So why is prolotherapy not more widely known and used? Well, if you live in Ontario or many other provinces and states across North America, prolotherapy is not actually allowed to be practiced by Medical or Naturopathic doctors. Because the research coming out is so new and the participant sizes in the studies are relatively small, many governing bodies are hesitant to allow prolotherapy to flourish... for now. With a growing body of research supporting it's uses and relatively no negatives against it, it may only be a matter of time before it makes it's way into more of North America.

Who knew sugar could be so good?

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com


For those interested in learning more, feel free to read up on some of the research:

References

1. Rabago, David, et al. "Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): Results of a single-blind, pilot-level randomized controlled trial." American journal of physical medicine & rehabilitation/Association of Academic Physiatrists 92.7 (2013): 587. 
2. Bernard, BP. Musculoskeletal disorders and workplace fractures: a critical review of the epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity and low back. National Institute for Occupational Safety and Health; Washington D.C.: 1997. NIOSH Publication 97-141 
3. Hudak PL, Cole D, Haines T. Understanding prognosis to improve rehabilitation: example of lateral elbow pain. Arch Phys Med Rehabil. 1996; 77:586–593. [PubMed: 8831477] 
4. Bisset L, Beller E, Jull G, et al. Mobilization with movement and exercise, corticosteroid injection or wait and see. BMJ. 2006; 333:939. [PubMed: 17012266] 
5. Maynard JA, Pedrini VA, Pedrini-Mille A, et al. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research 1985;3:236–248. [PubMed: 3998899] 
6. Verhaar JA: Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994, 18:263-267. 
 
7. Krogh, Thøger Persson, et al. "Comparative Effectiveness of Injection Therapies in Lateral Epicondylitis A Systematic Review and Network Meta-analysis of Randomized Controlled Trials." The American journal of sports medicine 41.6 (2013): 1435-1446. 
8. Petrella, Robert J., et al. "Management of tennis elbow with sodium hyaluronate periarticular injections." BMC Sports Science, Medicine and Rehabilitation 2.1 (2010): 4. 
9. Scarpone, Michael, et al. "The efficacy of prolotherapy for lateral epicondylosis: a pilot study." Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 18.3 (2008): 248. 
10. Rabago, David, et al. "A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma." British journal of sports medicine 43.7 (2009): 471-481. 
11. Prolotherapy for the treatment of lateral epicondylitis: A double-blind pilot study. North American Research Conference on Complementary and Integrative Medicine; Edmonton, Canada. 2006. Focus Altern Complement Ther 
12. Lyftogt, John. "Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain." (2007): 110. 
13. Coombes, Brooke K., Leanne Bisset, and Bill Vicenzino. "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376.9754 (2010): 1751-1767. 
14. Carayannopoulos, Alexios, et al. "Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial." PM&R 3.8 (2011): 706-715. 
15. Johnson, Greg W., et al. “Treatment of Lateral Epicondylitis.” Am Fam Physician. 2007 Sep 15;76(6):843-848. 
16. Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthalsde Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359:657–62. 
17. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, et al. Non-steroidal anti- inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2001;(4):CD003686. 
18. Smidt N, Assendelft WJ, van der Windt DA, Hay EM, Buchbinder R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain. 2002;96:23–40. 
19. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39:411–22. 
20. Chang, Wen-Dien, Ping-Tung Lai, and Yung-An Tsou. "Analgesic Effect of Manual Acupuncture and Laser Acupuncture for Lateral Epicondylalgia: A Systematic Review and Meta-Analysis." The American journal of Chinese medicine 42.06 (2014): 1301-1314. 
21. Khan KM, Cook JL, Kannus P, et al. Time to abandon the ‘tendinitis’ myth. BMJ. 2002; 324:626– 627. [PubMed: 11895810] 
22. Røe, C., et al. "[No effect of supplement of essential fatty acids on lateral epicondylitis]." Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke 125.19 (2005): 2615-2618. 
23. Chesterton, Linda S., et al. "Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial)." BMJ 347 (2013): f5160. 
24. Buchbinder, Rachelle, et al. "Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain." The Journal of rheumatology 33.7 (2006): 1351-1363. 
25. Rabago, David, Andrew Slattengren, and Aleksandra Zgierska. "Prolotherapy in primary care practice." Primary Care: Clinics in Office Practice 37.1 (2010): 65-80. 
26. Maynard JA, Pedrini VA, Pedrini-Mille A, Romanus B, Ohlerking F. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research. 1985;3:236–248. 
27. Jensen, Kristina T., et al. "Response of knee ligaments to prolotherapy in a rat injury model." The American journal of sports medicine 36.7 (2008): 1347-1357. 
28. Rabago, D., J. J. Patterson, and M. Mundt. "Feature Article Prolotherapy: A nontraditional approach to knee osteoarthritis Dextrose injections into the knee can reduce pain and improve a patient’s quality of life. From The Journal of Family Practice. 2014; 63 (4): 206-208." The Journal of Family Practice 63.4 (2014): 206-208.

What is Naturopathic Medicine?

While it is a quickly growing field, there are still quite a few misconceptions about what it actually means to be a naturopathic doctor, or simply, ND. I personally see this every time I meet new people and tell them about what it is I do. Soon after informing them that I am studying to become an ND I am typically met with one of the following three responses;

1) They love it and proceed to having an entertainingly extensive conversation about what they take and who they've had visits with,

2) Disapproval or impartiality. Conversation doesn't usually last long, and

3) "Oh! Like homeopathy?"

Those last two responses (especially the third) are the reason I have decided to start my blog by clearing the air about what exactly naturopathic medicine is and what it is we do. 

So, who are these crazy individuals who decide to get into this field? Where did we come from and why this form of medicine? I can't speak for all of us, but I can tell you we are quite the diversified group of individuals united by the common goal of helping others, and I mean truly helping others in any and every way that we can. I can also tell you that to get where we are we are required to finish an undergraduate degree, complete all of the prerequisite university level science courses and then successfully complete another four year degree at an approved naturopathic college. So we also love to prolong that whole graduate and enter the work force thing. 

Enough of the backstory, let's get back on topic. What is naturopathic medicine? What it really all comes down to is treating the root cause of disease. We are trained to do a very thorough patient intake in which we attempt to obtain a complete history of factors that may have contributed to that specific individual's illness. Attention to detail, asking the right questions, obtaining lab tests and ensuring that each person is heard as their own unique case are all key factors into how an ND begins their approach to identify and then treat the root cause.

The simplest way I can explain what we do is by comparing ND's to mechanics and our patients to their cars. When a warning light shows up on your car dashboard, it's trying to tell you something is wrong even though you may have no idea what that light means (or is that just me?). Now you can do one of two things here; take your car to the mechanic where the problem will be diagnosed and fixed from the inside so the light turns off, or you can simply cover the warning light with a piece of tape and forget that it's there. Here we can see how simply treating the symptom (the warning light) is really not getting down to the real reason it came on in the first place. ND's are the mechanics who are going to use all of their tools to diagnose and fix the real problem. Instead of wrenches, ratchets and screwdrivers, ND's use nutrition, counselling, physical manipulation, acupuncture, supplements and yes, occasionally homeopathy to develop a treatment plan that is specific and realistic to the individual so that their illness can be addressed properly and thoroughly. While the results may take longer to achieve than a conventional medical treatment protocol , the overall results will be lifelong and with fewer complications.

I hope I have been able to clear the air on what naturopathic medicine is and I encourage any and all of you to continue to research more about it and comment or ask me any questions you may have.

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com