Dr. Michelle Weiner
personalized regenerative integrative medicine


To a good health!

Which Cannabis Terpenes Reduce Anxiety & Where Can You Find Them?

For quick relief of anxiety and stress, reaching for a bowl of cannabis is hardly out of the question. Many strains are loaded with a variety of fragrant terpenes that work through the entourage effectto take you to a state of cool, calm, and collected bliss.

But how do you know which terpenes are best for relaxing the mind and crushing anxiety? Below, discover which terpenes are found in anxiety-busting strains as well as a few recommendations to look out for at your local dispensaries.


What Are Cannabis Terpenes and What Do They Do?

First Things First: Which Terpenes Tackle Anxiety?

Among the plethora of terpenes found in cannabis, three come to mind when we want to reduce anxiety. These aren’t the only terpenes that relieve stress, but they do a phenomenal job when taking care of mental wariness and physical ailments. 


Found in cloves and black pepper, you’ll want to pair this anti-inflammatory terpene with something rich and cozy (pumpkin spice latte, anyone?). Caryophyllene reduces stress through its pain-relieving properties, leaving relaxation in the wake of a smoked joint or vape. Playing on the CB2 receptors in the endocannabinoid system, strains rich in this terpene may also diminish the effects of colitis, pain, and Alzheimer’s from mice model studies. 

Try These β-Caryophyllene Cannabis Strains for Pain & Inflammation Relief


Popular for its abundance in aromatic plants such as ylang-ylang and wild thyme, myrcene offers sedative and anti-inflammatory effects. It’s also conveniently synergistic with THC, which means some may feel a more powerful high with large amounts of myrcene in their chosen strains. Fortunately for you, this terpene is one of the most popular found in cannabis, so you won’t have to search high and low to feel myrcene’s anxiety-reducing traits.


Breathe easy when you inhale a limonene-rich strain and anxiety will melt right off your back. This citrusy terpene is commonly associated with tart lemons and delivers a wave of calm and euphoria on the exhale. Studies suggest limonene may be a potential anti-depressant, as well as a means to boost serotonin and dopamine in the brain.


Try These Limonene Cannabis Strains for Anxiety, Depression, and Stress Relief

Which Strains Contain Anti-Anxiety Terpenes?

Now that you’ve brushed up on a little terpene knowledge, check out which strains are chock-full of anxiety mashing terpenes.

Harlequin: Myrcene

Perfect for starting your morning on the right foot, Harlequin is one of those strains offering both relief and major staying power. Along with myrcene, Harlequin contains a rich profile of CBD, and usually expresses a CBD:THC ratio of 5:2. You can relax and stamp out THC’s paranoia all in one pull.

Find Harlequin Nearby

Bubba Kush: Myrcene, Limonene, & Caryophyllene

Bubba Kush is the ultimate strain bringing on tranquilizing effects and mood-boosting qualities. It’s no mystery why this particular bud is highly prized: it’s a powerhouse of anti-anxiety terpenes including all three of the top stress-reducing oils. Myrcene, limonene, and caryophyllene collide with Bubba Kush’s incredible anxiety-reducing traits.

Find Bubba Kush Nearby

Cannatonic: Myrcene

Low in THC (6%), high in CBD (6-17%), Cannatonic brings balance to the universe with its high myrcene content and mellow CBD characteristics. If you’re searching for something to toke on throughout the day (and won’t leave you couchlocked), reach for this migraine crushing, anxiety-reducing strain.

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White Widow: Myrcene & Caryophyllene

White Widow has been around the block a few times, and it’s easy to see why. With a high dose of caryophyllene and myrcene among its myriad of terpenes, this creative strain boosts euphoria, mowing down any stressful thoughts you just can’t shake. Load up a bowl or pull on a vape, White Widow is sure to be your new go-to.

Find White Widow Nearby

In addition to its rich myrcene content, Remedy tips the CBD scales at 15% with only trace amounts of THC. Looking for mellow body relaxation and inflammation-reducing cannabis? Look no further than the pain-killing, stress-reducing Remedy.

Michelle Weiner
Give Up Vitamin D For Musculoskeletal Health?

I’ve heard that taking vitamin D doesn’t actually benefit bones or prevent fractures. Should I stop taking it?

New evidence has shown that taking vitamin D supplements doesn’t protect against bone loss, fractures or falls, no matter how high or low the dose. These findings come from an analysis of 81 randomized controlled trials that included data on 53,537 participants who were taking vitamin D. The researchers, from New Zealand’s University of Auckland and the University of Aberdeen in Scotland, also saw no significant effect on bone density in the lumbar spine or femoral neck (the part of the thigh bone that connects to the hip joint).

The new investigation wasn’t the first to cast doubt on the benefits of taking vitamin D (and calcium) to reduce the risk of fractures. Earlier this year, I reported on research from China that came to the same conclusion after analyzing information from 33 randomized, placebo-controlled trials with data on 51,145 participants. Some of the trials focused on both supplements, while others looked at one or the other. The latest analysis looked only at vitamin D.

Based on the results of the investigation, the researchers saw “little justification to use vitamin D supplements to maintain or improve musculoskeletal health.” However, keep in mind that analyses are not studies – they can’t answer questions in the same way that studies can, and much other research supports the use of supplemental vitamin D, so it is unlikely that recommendations to take calcium and vitamin D will change.

As you may know, I recommend that everyone take 2000 IU of vitamin D daily for its many positive health effects. Even if further research suggests that it doesn’t benefit bones, there are other important reasons to continue taking vitamin D. It helps strengthen the immune system, protects against a number of serious diseases including rickets and osteomalacia, and may protect against hypertensionpsoriasismultiple sclerosis and rheumatoid arthritis.

Vitamin D also appears to play a role in defending against cancer. Studies have linked vitamin D deficiency to as many as 18 types of cancer.

The body makes vitamin D with exposure to sunlight, but many people don’t get optimal amounts, especially those living in industrialized countries in northern latitudes. In addition, sunscreen blocks vitamin D synthesis in the skin, and dermatologists have made us so fearful about UV damage that many people don’t get enough exposure to sunlight regardless of where they live.  Food sources of vitamin D include fortified milk and cereals as well as eggs, salmon, tuna, mackerel and sardines but it’s hard to get what you need, or optimal amounts, from diet alone.

Andrew Weil, M.D.

Allison Avenell et al, “Effects of vitamin D supplementation on musculoskeletal health: a system review, meta-analysis, and trial sequential analysis.” The Lancet Diabetes and Endocrinology, October 4, 2018, DOI: doi.org/10.1016/52213-8587

Michelle Weiner
The "No More Catching Butterflies" Effect by Dr. Michelle Weiner

As an identical twin, I have always valued a partnership with a healthy dose of motivation. As a young athlete, competing in team sports taught me the importance of synergy and finding that perfect balance. I chose to major in Nutritional sciences with a minor in health science education to gain knowledge about health and the human body. In an attempt to incorporate my passion for a functional and holistic approach to medicine, I became an Osteopathic Physician.  While in medical school I pursued my master’s in Public health to properly learn how to evaluate the evidence as well as feel confident pursuing my own research in the future. Now, as an interventional pain management physician in private practice, I have treated disease relying on pharmaceuticals and injections; however, have I just been masking my patient’s pain? 

As I started conducting my own IRB approved research through FIU using cannabis as a substitute for opioids in chronic pain patients, I have had the opportunity to establish relationships with my patients; to sit with them and understand their goals and what aspects of their life they want to improve. The Nova Southeastern medical students who shadow me in the office are fascinated with this approach. They are amazed by how satisfying my job is as they witness my patients thanking and hugging me with appreciation and not frustration.

Last Tuesday, as I walked into the patient’s room I saw a mother and daughter sitting next to each other. I asked the mother about 75 years old, the patient, so how are you feeling on your current cannabis regimen? The daughter replied, “thank you for giving us our mother back. She is no longer catching butterflies.” (demonstrate) meaning she used to sit and hallucinate in her own world reaching her hands up into the air swatting at objects that didn’t exist. By using cannabis, we had weaned her mother off of fentanyl, Percocet and Xanax. She was sleeping, active during the day and had significant less pain. Her daughter told me when she asked her mother’s pain dr, “would you give all of these meds to your own mother” his response was, I have a responsibility to treat the patient. How I interpret this without judgement is, I am limited by the tools in my tool box.

I sometimes wonder, am I, as the Physician, the placebo? The mind plays such a critical role on the body’s health and disease states. If I give my patient hope through new possible alternatives supported by science and evidence or if they have confidence in ME as a Practitioner, will they have a greater chance of a positive outcome? Is this rooted in the trickledown effect based on our physiology for example a positive thought causing an increase in oxytocin? If I ask a fibromyalgia patient, well, have any other fibro friends of yours improved with pharmaceuticals and then give them a prescription for a medication or increase their mgs of an existing medication that is not controlling their pain when I know as well as the patient, its most likely not going to help, will this negative thought lead to changes in their HypoPituataryAdrenal axis causing disruption in their stress hormones like cortisol, epinephrine, norepi levels creating a fight or flight response.  When I educate my fibromyalgia or chronic fatigue patients about the endocannabinoid deficiency syndrome and explain that by supplementing with the cannabis plant they can normalize/increase their endogenous levels similar to treating a vitamin deficiency and I give countless examples of my personal patients who have decreased their opioids, antispasmodics, anti-inflammatories, antiepileptics and have gotten their lives back, I give them hope. Isn’t it interesting that the categories of pharmaceuticals start with Anti? Like anti-arrhythmics or anticoagulants, antihistamines? 

Will identifying the root cause of a patient’s suffering lead to promoting the body’s innate ability to self-repair not just suppress symptoms? Can we stop using pharmaceuticals to counter side effects of other pharmaceuticals?  

Promoting health or wholeness, practicing precision and preventative medicine also allows the patient to have control over his or her body and perhaps make more conscious deliberate and be accountable for their choices. Most educated people these days have lost faith in traditional institutions and western medicine.  Instead of treating illness we need to promote wellness. Why do some people’s acute pain turn into chronic pain? Why do most burns heal on their own? At every level of organization starting at the cellular level below the mind we have an innate intrinsic resilient system to defend against toxins, microorganisms, pollution, etc. Does the pain medication we take acutely after surgery allow this hyperalgesic state to quiet down so that our body can continue to facilitate this natural process of tissue healing? Is that the purpose of and the right time to use conventional medicine?

Preventing illness does not require expensive or invasive technology.  we need to evaluate if the latest fad trending in social media is effective. We have sophisticated tests that tell us if our micronutrient levels are depleted and if we have bacteria in our GI tract. we can treat these deficiencies with supplements and IV infusions. However, Precision medicine should start by spending more time taking a look at what is on our plate, how much we move, if we are resting enough.  When we consciously engage with our mind and body we can reclaim our natural state of aliveness and stop overeating or using addictions to cope. We can now sequence genomic information but what can we do with this? We know mutations drive a patient’s cancer but what’s the treatment and will it be more effective especially if the physician gives you a designated length of time to live? We are lonelier than ever due to this disconnection driven by technology; intimacy only becomes a goal when the relationship is already suffering. 

Anxiety feels more acute since the wired generation feels continuously bombarded with new alerts on their smart devices. A New York times article in Oct 2018 stated CBD went from being a fidget spinner alternative for stoners to a mainstream panacea. A show of hands, who has heard of CBD? CBD or Cannabidiol, one cannabinoid in cannabis can decrease inflammation, pain, anxiety, help with insomnia, depression, PTSD, spasms, seizures, tremors, decrease cravings, addictions to opioids, inhibit cancer growth and spread. how can this all natural non-psychotropic and widely available derivative of marijuana be a potential cure for the 21st century? It’s like we have discovered yoga, penicillin or even oxygen.

A cardiovascular surgeon said that the discovery of the Endocannabinoid System could save more lives than the sterile technique. In the 1990s, the discovery of cannabinoid receptors in the brain that respond to cannabis and the subsequent identification of endogenous cannabinoids in our own bodies that bind to these receptors has significantly advanced our understanding of human biology, health and disease. CB1, is found primarily in the brain and neurons in the spinal cord and central nervous system. CB1 receptors are thought to be responsible for the psychoactive effects of cannabis specifically from the THC cannabinoid and plays a role in signaling pathways responsible for cognition, neuronal growth, and the regulation of reward and mood systems. The CB2 receptors are primarily expressed by immune cells and may have evolved as a defense mechanism for the body since it is involved in suppressing inflammatory responses and in neuroprotective responses to brain injury. 

The cannabis plant has more than 100 cannabinoids; THC and CBD have been studied most extensively. Most of us don’t realize that our bodies are making cannabinoids all the time on demand. These molecules function a lot like THC. Our cells produce and use cannabinoids in precise ways to respond to stress, illness, and injury, thus keeping us healthy and in balance.  They are released from the postsynaptic neuron as a negative feedback loop to keep neurotransmitters and the other systems in the body in homeostasis or the same place. For example, it can prevent the release of glutamate, which is thought to be the mechanism behind the neuroprotective effects of cannabis against excitotoxicity for ex in seizures or neuropathic pain. CBD appears to activate other receptors including 5HT1A (serotonin) and TRPV1, both of which are involved in the anxiolytic and mitigating panic/fear responses to stress.

CBD is thought to inhibit the activity of fatty acid amide hydrolase (FAAH), the enzyme responsible for breaking down the endocannabinoid anandamide (bliss molecule). As a result, CBD can contribute to elevated levels of our endogenous cannabinoids. There’s evidence that some people’s endocannabinoid system (ECS) may not be functioning optimally; this can be addressed by adding the right dosage of Phyto or plant-based cannabinoids from cannabis.

Beyond cannabis, however, certain foods and activities can also help the ECS function optimally. Omega-3 fatty acids are needed to balance the omega-6 fats. These fatty acids are much harder to come by in our diet. Hemp seeds and oil, Flax seeds and oil, Chia seeds, Walnuts, Sardines and anchovies also optimize our ECS.  Cacao powder contains three compounds that are structurally very similar to endocannabinoids.

While chronic stress can deplete your ECS, a highly tuned ECS can protect you from the detrimental effects of stress. Incorporating exercise into your daily routine will optimize your ECS, but only if you enjoy it! Animal studies teach us that if you force yourself to exercise, your ECS will interpret the activity as stress, but freely choosing and enjoying the same activity can have the opposite effect of stress and actually increase endocannabinoid levels. It’s been shown that Rats in social isolation produced less cannabinoid receptors, while social play and grooming behavior increased function of the ECS. It’s interesting to note that a balanced ECS appears to be pivotal to a healthy stress response and mitigating fear, anxiety, and panic that tend to accumulate with dysfunctional responses to stress. Through Social interaction Meditation Yoga Massage Acupuncture Breathing exercises we can manage not only our anxiety but help protect our other organ systems as we stay closer to homeostasis. 

My 40 yo male mechanic patient with a 4 year old son no longer stops at the bar on the way home for a few beers because he uses his cbd vape after work to decompress. The 55 yo postmenopausal female uses cbd oil sublingual drops twice daily and her hot flashes are minimal and sleep pattern has returned to normal. Adding a small amount of THC to a healthy dose of CBD can elevate mode, minimize pain, insomnia, tremors. The secret about CBD is it is the only antidote to THC; it will mitigate the psychoactive effects of the THC so one can use this medicine and function optimally. The multitude of delivery methods from oral drops under the tongue to soft gels vapes topical creams allow one to treat immediate or chronic issues while focusing on prevention. Cannabis does not have to be smoked, one does not have to get high and should not wait until he or she is sick to think of this medication as an option!

My grandma used to say, Michi, sometimes people live too long. Why would she say this? Ninety two percent of seniors have at least one and 77% have at least two chronic diseases. Our bodies ability to maintain homeostasis as we age becomes more challenging especially when pharmaceuticals are added into the mix. The fact that as we age we produce less endogenous cannabinoids may be one cause of chronic disease. As we age, the neural stem cells and their progenitors exhibit reduced proliferation and neuron production, which is thought to contribute to age-related cognitive impairment and reduced plasticity. Cannabinoids can induce neurogenesis and increase endogenous cannabinoid levels while decreasing inflammation.  

The term “inflammation” has become a bit of a buzzword lately, when talking about chronic health conditions. This is warranted because inflammation really can set up a chain reaction of dysfunction that can result in health problems in just about every system. Just like your brain, the inner mucosal lining of your gut has no pain fibers, but inflammation in your GI tract can wreak serious havoc on your mood and brain function. For example, 95% of your body’s serotonin, your “feel-good” hormone, is produced in your GI tract. In fact, the gut manages quite a few neurological functions.

To move toward an anti-inflammatory diet and anti-inflammatory foods, we primarily move away from the abundance of overly processed, unbalanced diets of the West and toward the ancient eating patterns of the Mediterranean, fruits, vegetables, no meat additives, omega 3. The Elimination diet clears the body of foods and chemicals that may be sensitive or allergic to improve the body’s ability to handle and dispose of those substances, support the microbiome and reduce inflammation while increasing phytonutrients.   It has been found that fermented foods contain probiotics that have a protective effect against social anxiety. In 2017, UCLA found an association between gut microbiota and brain regions involved in processing sensory information. childhood traumas affect brain development and the gut microbiome composition. 

Cannabis, or cannabinoids, have become the focus in developing new therapies, and the medical use of cannabis has become a target of public policy. The sad reality is only 17% of CBD products labels are accurate in terms of THC content and only 59% had detectable CBD based on a study done in California and Washington.

My desire to focus on health is different from other educated consumers who are just obsessed with the idea of wellness. I am frustrated when I am sent a cancer patient post chemo who now has neuropathy; perhaps the cannabis could have prevented the numbness and tingling the patient is now suffering from not to mention could helped with nausea, appetite, mood, sleep during her treatment. Why not give the patient the option to speak to me about cannabis or other alternatives and let them decide? My passion is to help others expand their minds and honor their bodies through diet and lifestyle choices. I want to educate others about the substantial evidence that exists in other healing aspects of medicine and make cannabis medicine a facet of integrative medicine. I know in acute situations conventional medicine is necessary but why not return to a simpler, cleaner life where we integrate the Art of medicine with the science by forming partnerships.  

Michelle Weiner
Dietary Supplements During Cancer Treatment: Yes or No? Some pills might interfere with chemo – while others may help defend against tumors.

IS IT A GOOD IDEA TO take dietary supplements while going through active cancer treatment? It's a gray area. Some doctors say patients should hold off, at least while undergoing chemotherapy. But some practitioners in complementary or integrative medicine support the use of certain dietary supplements – such as vitamin D, mushroom extracts, green tea and curcumin – in certain cases, saying they may have cancer-fighting properties and reduce treatment side effects.

Research is still evolving, but several points are clear: If used at all, supplements should be taken along with – not substitute for – standard cancer treatment. Also, it's safer when patients tell their doctors about supplements they use. In return, doctors build more trust when they communicate about dietary supplements with an open, informed, patient-centered approach.

Estimates vary, but studies suggest up to 87 percent of women treated for breast cancer take dietary supplements. In general, the bottom line is that many cancer patients use supplements – doctor-recommended or not.

Abundance of Caution

Patients being treated for cancer often take supplements without telling their oncologists, says Dr. Victor Sierpina, a professor of family and integrative medicine at the University of Texas Medical Branch in Galveston, Texas. Oftentimes, the question simply doesn't get asked. But when patients bring it up, he says, "The majority of oncologists are fairly strict in saying, 'You really shouldn't take supplements during active therapy.'" However, Sierpina notes, many patients do extensive reading about supplements online and may know more than their oncologists about supplements, which don't get much attention during medical training.

There are good reasons behind doctors' reluctance, Sierpina says. "The big fear is that supplements will interfere with chemotherapy – either decrease the effectiveness of the drugs, or cause side effects or affect the metabolism of the drugs." 

Sierpina relates how in the early days of the AIDS epidemic, patients tried the supplement St. John's wort to cope with depression. But that backfired – the supplement caused the liver to quickly break down HIV drugs, lowering drug levels in the blood and leading to treatment failure. "So that's one of those horror stories that people don't want to repeat with cancer," he says. Even now, St. John's wort is not recommended for patients undergoing cancer treatment.

Common Supplements

Last September, in the journal Current Oncology Reports, Sierpina listed common dietary supplements and their pros and cons for cancer patients, including the following:

  • Curcumin. Contained in the spice turmeric, which gives Indian food its bright yellow color and distinctive flavor, curcumin has been shown to have cancer-inhibiting action. But caution is advised for patients with gallbladder disease, because it may worsen symptoms by stimulating gallbladder contractions.

  • Glutamine. Because of its helpful effects on the gastrointestinal tract, glutamine may help relieve chemotherapy side effects such as mouth sores and diarrhea. It also might reduce nerve pain from certain drugs. However, glutamine may interact with medication used to prevent seizures.

  • Maitake mushrooms. Traditionally used in Eastern medicine to treat high blood pressure and diabetes, evidence suggests mushroom extracts may have tumor-fighting properties. But extracts are discouraged for patients on medications to lower blood sugar or those who take the blood-thinning drug warfarin, because of increased risk of bleeding.

  • Fish oil. By reducing inflammation, fish oil may potentially slow cancer progression. But patients currently on chemotherapy might do better going off fish oil. A study in the June issue of JAMA Oncology suggests fish oil may reduce chemo's effectiveness, possibly by increasing resistance within cancer cells.

  • Probiotics. During cancer care, probiotics can help treat diarrhea and other GI side effects.

  • Milk thistle. The active part of milk thistle seed, silymarin, may protect the liver from toxic effects of chemotherapy.

Some experts advise against taking antioxidant supplements – such as vitamins A, C and E, and beta-carotene – especially in high doses, during cancer treatment. Evidence is mixed on whether antioxidants increase or reduce cancer risk, according to the National Institutes of Health. A few small randomized controlled studies found people who used antioxidants during cancer treatment fared worse, particularly if they were smokers.

Open Discussion

"There's literally one reason why anyone would ever choose to take [dietary supplements]," says Suzanne Dixon, a registered dietitian and former chair of the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. "It's because they think it's going to help. So you can't argue that hope away just by saying, 'Don't take it.'"

Instead, Dixon says, by having an open, nonjudgmental conversation, health professionals can give patients concrete information to help them decide what they should do. An honest assessment of possible harms and benefits lets patients know doctors take patients' interest in supplements seriously, not dismissively. Being clear on which supplements patients are using puts everyone on the health care team on the same page.

Dixon strongly advises patients to seek out a dietitian who's well-versed in cancer treatment, to sort out issues of supplement safety, dosage and timing. "Some nutrients can help people heal better after surgery, for example," she says. "This includes zinc, vitamin C, arginine and glutamine." Brand-name products offer different combinations of these nutrients, she explains, and a dietitian can guide patients through their choices.

Vitamin D is a special case. "All cancer patients should have their vitamin D levels tested," Dixon says, and if levels are low, they should work with their doctor or dietitian on a supplementation plan to return them to a normal range during treatment. Evidence suggests people with vitamin D deficiency don't do as well in terms of cancer survival and symptoms, Dixon says. On the other hand, she continues, if a person is not deficient, "supplementing additional vitamin D is unlikely to offer benefit – and in some cases, may increase risk of complications or cause other harmful health effects."

Sierpina says vitamin D can be taken safely during cancer therapy, with dosing guided by blood levels. "Some cancers can cause a very low level of vitamin D, which can affect immunity and response to therapy," he says. He adds that vitamin D levels above 50 nanograms per milliliter – in the high-normal range – have been shown to reduce the risk of recurrence of breast cancer in survivors.

Food Is Fine

You can't go wrong taking in nutrients naturally – by eating. "Most of us who practice integrative and complementary medicine would prefer that patients take the food from the source, rather than a pill," Sierpina says.

Soy is one example. Soy is a plant-based source of the chemical estrogen. When it comes to hormone-based cancers, like breast cancer, soy supplements are controversial. "So people say, 'Yes, you can eat soy foods – edamame or soy beans or tofu,'" Sierpina says. "But you shouldn't necessarily take high doses of isoflavones, which is an active form of soy in a capsule that you can buy a health-food store."

Research continues, Sierpina says: "In the meantime, people are following the precautionary principle to first do no harm. We have to know it's safe. And if not, presume it's not safe."

Supplements: Not a Standalone

Sierpina has seen a handful of cases where people have declined standard treatment altogether – rejecting radiation, surgery and drugs. He "absolutely" advises against using alternative methods to replace standard treatment. When patients shun standard medical therapy, he says, "The cancer tends to run its course." 

As people transition from cancer patients to cancer survivors, Sierpina says, there's more freedom to use complementary therapies like supplements to improve quality of life. "For reasons of their own, people may feel that taking supplements gives them some autonomy," he says. "Some involvement in their treatment process, some control.

Lisa Esposito, Staff Writer

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing ...  READ MORE

Tags: health, patients, patient advice, cancer, breast cancer, chemotherapy, diet and nutrition, supplements, alternative medicine, vitamins, vitamin D

Michelle Weiner
Protecting Our Telomeres with Targeted Nutrition and Lifestyle Changes

Posted by SpectraCell Laboratories, Inc. on Fri, Aug 10, 2018 @ 03:29 PM

Most people may not realize that there are two fundamental ways to protect telomeres:  (1) reduce the rate at which they shorten, also known as decreasing the telomere attrition rate and (2) to actually lengthen telomeres. Although it is commonly, albeit somewhat incorrectly, believed that once telomeres shorten they cannot get longer, recent evidence suggests otherwise. Common sense lifestyle choices can actually lengthen telomeres. This is comparable to reversing aging, versus simply slowing it down. For example, in a study started a decade ago, a group of men diagnosed with low-risk prostate cancer agreed to undergo comprehensive lifestyle changes for five years and be monitored during the course of the study. The lifestyle changes involved increased exercise, better nutrition, and better management of psychological stress - all choices within the reach of every person. After five years, telomere length improved. 

For those who want to take protection of their telomeres to the next level, targeted nutrition is key.  The effect micronutrients have on telomeres is profound.  For example:

Calcium - Required cofactor to prevent DNA replication errors.

Folate - Influences telomere length via DNA methylation.

Vitamin B3 - Extends lifespan of human cells in vitro; Slows telomere attrition rate by reducing reactive oxygen species in mitochondria.

B2, B6 and B12 - Crucial for proper DNA methylation.

Cysteine - Stem cell treatment with N-acetyl cysteine corrects DNA damage in telomeres.

Zinc - Important cofactor for DNA repair enzymes; key role in regulating inflammation.

Copper - Key cofactor in the potent antioxidant superoxide dismutase that is known to protect telomeres.

Magnesium - Induced deficiency shortened telomeres in rat livers; Regulates chromosome separation in cell replication.

Selenium - In vitro supplementation extended telomere length in liver cells; selenoproteins protect DNA.

Glutathione - Interference of glutathione dependent antioxidant defenses accelerates telomere erosion.

Vitamin C - Protects DNA from oxidation. In vitro studies show it slows down age-related telomere shortening in human skin cells.

 Vitamin E - Enhances DNA repair as well as removal of damaged DNA; Shown in vitro to restore telomere length on human cells.

Vitamin D - Positively associated with telomere length due to its anti-inflammatory role.

Manganese - Required cofactor in Mn superoxide dismutase, a deficiency in which decreases telomerase activity.

Discover how you can improve your telomere length with Micronutrient testing. 


Michelle Weiner
Vitamin B—And Why It’s Important

Vitamin B—And Why It’s Important -From Goop 

As one of the most essential vitamins, the B’s are also the most confusing—because, well, there are a lot of them. Whether it’s folate (not to be confused with folic acid), or B12, they each serve a very distinct function. We asked Dr. Frank Lipman, of Eleven Eleven Wellness Center, to explain the difference, and the best ways to incorporate each one.

A Q&A with Dr. Frank Lipman


There are so many different B vitamin components (B6, B12, etc.)—why is it so complicated?


This is probably because they often work collectively and individually in the body, and are present in the same foods. So it gets a bit complicated differentiating one from another. But they are a group of eight chemically distinct vitamins, each one performing unique functions with specific benefits. They help convert our food into energy and play important roles in different aspects of cell metabolism, helping you stay energized throughout the day. But they are also important in promoting healthy skin and hair, balancing moods and relieving stress, helping mental clarity and focus, supporting cardiovascular health, preventing migraines, and promoting immunity.


Are each of the B vitamins equally important?


The two most important B’s are B12 and Folate (Vitamin B9).

B12 is crucial to the proper functioning of your brain and nervous system, which means that it plays a vital role in mental clarity and focus, as well as in emotional balance and calm. It is also essential for the conduction of nerve signals and normal nerve function in general. Lack of B12 makes your body more vulnerable to physical and emotional stress—to the wear and tear that we usually associate with aging, but which I see more as lack of proper function.

Folate is a key defender against brain fog, irritability, depression, and other responses to physical and emotional stress. It helps you repair DNA and has significant anti-aging benefits too. It is also essential for pregnant women, as a deficiency can cause severe neurological birth defects. Vitamin B12 works together with folate in the synthesis of DNA and red blood cells.

Note: Although folate and folic acid are used interchangeably, it is important to know the difference. Folic acid is a synthetic type of B vitamin used in supplements and fortified foods, while folate is the natural form found in foods.

The other important B is B6. It is involved in over 100 cellular reactions throughout the body and is helpful in keeping various bodily functions operating smoothly.


What are the effects of low Vitamin B? What are the symptoms?


Symptoms of a deficiency depend on what type of Vitamin B you lack. The most common deficiency is B12 deficiency, which is actually relatively common. It causes lethargy, fatigue, weakness, anemia, memory loss, and neurological problems and even psychiatric problems.

But B vitamin deficiencies can cause all sorts of problems ranging from headaches, irritability, and confusion to anemia or a compromised immune system, to fatigue. Skin rashes, dry skin, cracks at the corners of the mouth, frequent bruising, and wounds that require a long time to heal can be symptoms. Muscle weakness, a lack of coordination, and numbness or tingling in the fingers and toes may also occur.


What foods are good for the B vitamins?


B vitamins are particularly concentrated in meat such as turkey, tuna, and liver. But other good plant sources for B vitamins include legumes, whole grains, potatoes, bananas, chili peppers, nutritional and brewer’s yeast, tempeh, and molasses.

Probably one of the most important things you can do food-wise to get B’s from your diet is to eat fermented foods. Gut bacteria synthesize and supply some of the B vitamins, so if you are not eating fermented foods like kimchi, sauerkraut, or kefir, take a good probiotic daily.

Since Vitamin B12 is found primarily in meat and dairy products, strict vegetarians and vegans in particular are at risk for a deficiency. Vitamin B9 (Folate) can be found in many foods, from meats to grains to citrus fruits. Vitamin B6 can be found in fish, poultry, liver, potatoes, and non-citrus fruit.


Is it possible to consume too many B vitamins?


B vitamins are water-soluble and eliminated in the urine, so you just pee them out. Side effects are uncommon, although taking large doses of some of the B’s may cause temporary nausea, insomnia, and restlessness, but those pass soon. The exception to this is B6. High doses of B6 over a long period can result in neurological problems.


The B Vitamins are said to be important for Alzheimers and memory loss—why is that exactly?


This is probably because high levels of the amino acid homocysteine are linked to brain shrinkage and an increased risk of Alzheimer’s, and vitamins B6, B12, and folate are known to reduce levels of homocysteine.


Is it important to take extra B vitamins everyday? What will it improve? How much is an appropriate amount?


You’re getting some B vitamins in your multivitamin, but given the effective way B vitamins help protect your mind and body against all sorts of stress, I recommend taking more. I recommend everyone have their B12 levels measured, especially those folks who drink too much alcohol, are vegetarian, take acid-suppressing drugs (like Nexium), are over 60, have an inflammatory bowel condition, or generally have digestive problems. I am continually surprised how many folks are deficient, and do well with B12 shots or oral supplements.

My recommended minimum daily dose for the three important B’s for healthy people is: 400-800 mcg of methylated folic acid or folate, 400-800 mcg of Vitamin B12 (in the methylcobalamin form), and 50-75 mg of Vitamin B6. People with high homocysteine levels or any of the conditions mentioned above may need much more.


What is methylation, and why is it important to take methylated forms of folic acid and B12?


Methylation is a process that your cells perform billions of times each second. Without proper methylation, your body will not be able to respond properly to stress—either to physical stressors, such as toxins and challenging foods or to psychological stressors, such as life challenges and pressures. As a result, you’ll be more vulnerable to chronic diseases, including cardiovascular disease, diabetes, chronic fatigue syndrome, autoimmune conditions, Alzheimer’s, and other neurological problems. Improper methylation also makes you more vulnerable to the decline in function that we usually associate with aging.

It is believed that about half of us have some type of genetic mutation that makes it difficult to methylate, so look for B vitamins with methylated forms of B12 and folic acid or look for natural folate for maximum benefit. You can get genetic testing (the MTHFR gene test) to find out whether you have one of these defective genes.


Is getting a Vitamin B IV drip—something that’s become so popular these days—the best way to get Vitamin B?


A typical “Meyer’s Cocktail,” which is a common intravenous shot of vitamins, contains a B complex mix. Make sure you are getting methylated B12 and folic acid in IV. They have become quite popular now, but I tend to use it for my patients who are tired, are coming down with a “cold” or “flu,” or who just need a boost.


Dr. Frank Lipman received his initial medical training in South Africa and emigrated to the United States in 1984. He became board certified in internal medicine after serving as Chief Medical Resident in his final year of residency at Lincoln Hospital in New York City. Becoming more and more aware of both the strengths and the weaknesses of his training, he began to study acupuncture, Chinese medicine, functional medicine, nutrition, herbal medicine, biofeedback, meditation, and yoga. He began to see that the polarization between western modalities and other healing philosophies merely negated positive attributes of both. He saw that true healing lay in a blend between the two. He now practices his unique blend of what he calls “Good Medicine,” combining all the systems in which he has trained.

Dr. Lipman is the author of three books: The New Health Rules, Total Renewal: 7 Key Steps to Resilience, Vitality and Long-Term Health,and Revive: Stop Feeling Spent and Start Living Again (previously released as Spent: End Exhaustion and Feel Great Again). He is very involved with non-profit work in South Africa and lectures throughout the world on health-related topics.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of Goop, and are for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice.

Michelle Weiner
Don't Be Afraid of Fat

Fill up on healthy fats

“Don’t be afraid of fat!” stresses Malone, who says it’s essential for brain health and vitamin absorption. (And it’s been found to help you live longer, too.) “The percentage can be as much as 50 percent of your diet, as long as it’s the right kind of fat.” Of course, most people can’t stomach that much of it, so the author suggests consuming at least some healthy fats with every meal in a way that works for you—like having avocado with eggs, or adding coconut oil to your breakfast smoothie.

One thing to be cautious about: your ratio of omega-6 to omega-3 fats. “At one point in history, the ratio of omega-6 to omega-3 fats in our diet was one-to-one,” she says. “Now, it’s estimated to be 15-to-one. It’s that skewed ratio that causes the inflammation issue, not total fat in your diet.”

First, be sure to eliminate processed, omega-6-heavy vegetable oils—canola, corn, soy, and peanut—as well as margarines and animal fats from corn-fed animals. (Don’t go too crazy on the avocado, seeds, nuts, or olive oil either—although they’re definitely good fats, they’re part of the omega-6 fam.) Then, balance out the ratio by adding in inflammation-busting omega-3’s through things like fish, cod liver or algae oil, chia seeds, and flax seeds.

Ditch sugar and dairy


Along with gluten, corn, and soy, dairy and sugar are the final foods that Malone recommends cutting out to curb inflammation. That’s because dairy contains a protein called casein that, she says, is hard to digest in a similar way to gluten—and as for sugar, you probably don’t need a reminder why it’s bad.

“At the very least, avoid pasteurized cow’s milk—and if you are going to drink milk, I would go for the raw, full-fat kind. That’s where you get the active enzymes, live active cultures, soluble vitamins, and the good fats.”

Again, even if you don’t think you’re sensitive to any of the “Big Four” triggers, Malone says you might be surprised about how you feel when you give them up. “I don’t think people even realize how crappy they feel,” she says. “There are so many things that we accept as being a normal part of life—like anxiety, skin issues, or constantly feeling tired—and we get used to them. But when you do take these things out, you’re surprised by how good you feel.” In Malone’s case, it caused her pain to disappear within weeks—totally worth ditching the pizza and soy lattes for, right?

Eliminating inflammatory foods doesn’t have to be a drag—it can even be delicious. Here’s how to swap fruits and veggies for your bread and pasta, make a delish dairy-free chocolate “ice cream,” and whip up a vegan falafel pizza (!). 

Michelle Weiner
Harvard Study: Clearing Your Mind Affects Your Genes And Can Lower Your Blood Pressure
harvard study

Harvard scientists have come up with evidence that the mere act of clearing your mind for 15 minutes each day actually alters how your genes operate.

A new study indicates that people who meditated over an eight-week period had a striking change in the expression of 172 genes that regulate inflammation, circadian rhythms and glucose metabolism. And that, in turn, was linked to a meaningful decrease in their blood pressure.

The study is small, and it didn’t include a comparison group of non-meditators. So it doesn’t count as absolute proof that meditation lowers blood pressure by altering gene expression. But its authors hope it will be seen as a milestone on the long road to convincing skeptics of the power of meditation to promote health and reverse disease.

“This is a major step to overcome the innate bias that has developed in medicine over the last hundred years or so,” says Dr. Herbert Benson, who started promoting what he called “the relaxation response” more than four decades ago. “Going back to penicillin in the 1920s, we have been inexorably dependent on medication, surgery and procedures.”

In the face of often-withering criticism from his Harvard colleagues, Benson has insisted that the mind plays a critical role in the body’s health and disease states. He says that a simple intervention aimed at emptying the mind of the constant barrage of intrusive thoughts can achieve major benefits for the body.

“Breaking the train of everyday thought,” the 82-year-old Benson says, “has a medical application that has to be integrated with our marvelous drugs and surgeries.”

His goal is to establish the relaxation response and other techniques that calm the brain — yoga, t’ai chi, breathing exercises, repetitive prayer and other meditative practices -- as a “third leg” of medical treatment, along with medication and surgical procedures.

The time may be right to push this idea forward. Last fall, the American Psychological Association declared the nation has reached a new high point in the nation’s stress quotient. The APA’s “Stress in America” survey found that nearly two-thirds of Americans are stressed out over the nation’s future, and more than half are distressed by the divisiveness that dominates our public life.

Around the same time, the American College of Cardiology and the American Heart Association expanded the definition of high blood pressure, raising the number of people considered hypertensive from 72 million to 103 million -- nearly half of all adults.

While the new treatment guidelines are controversial, under either the old or new definition, tens of millions of Americans are at risk of heart attacks, strokes, organ damage and premature death because their blood pressure is too high.

“With the new guidelines, patients and physicians alike are going to be more and more interested in non-drug therapies that might control blood pressure or potentially augment their medications,” says Dr. Randall Zusman, a Massachusetts General Hospital cardiologist and co-author of the new study, which is in the Journal of Alternative and Complementary Medicine.

“This adds to our toolbox for patients who are willing to do the relaxation response technique,” he says.

There are as many as 200 anti-hypertension medications and drug combinations, but many carry troublesome side effects that make it hard for patients to take their pills faithfully. Meditation, on the other hand, is trouble-free, other than the daily time commitment it takes.

High blood pressure lends itself to study of the relaxation response because it’s clearly defined by what doctors call a "clinical read-out" -- a set of numbers that determines whether a patient has the disorder, and whether the disorder responds to a given treatment.

Previous studies of other diseases, such as inflammatory bowel disease and rheumatoid arthritis, have suggested improvement after meditation. But, "this is the first study where we have a nice, clean, clinical read-out," says Towia Libermann, a study coauthor who specializes in the genetic markers of disease at Beth Israel Deaconess Medical Center.

The new study involved 24 people with high blood pressure who underwent eight weeks of training in how to achieve the relaxation response — weekly sessions with an experienced trainer and a 20-minute CD they could play at home. The technique is fairly simple, involving deep breathing, muscle relaxation and concentration on a one-word mantra while passively ignoring intrusive thoughts.

Researchers measured whether patients’ blood pressure dropped by at least 10 points (the systolic or higher value, when the heart contracts) and 5 points (the diastolic or between-beats value), and whether their blood pressure was within a desirable range of 140-over-90.

A little over half the patients achieved these criteria and were called “responders.” It’s not clear whether the other 11 “non-responders” failed to learn the relaxation response -- not everyone can do it successfully -- or whether they had a different type of hypertension that doesn’t respond to meditation.

Blood samples from both groups revealed a clearly different genetic “signature” among the responders. That is, 172 different genes associated with inflammation, circadian rhythms and glucose metabolism were either switched on or switched off in ways that were different from the non-responders.

“To our knowledge, this is the first study to identify gene expression changes specifically associated with the impact of a mind-body intervention on hypertension,” Libermann says.

It makes sense that high blood pressure is involved with genes that regulate inflammation, Libermann says, because it’s well-known that blood vessels are sensitive to inflammation and also release “all kinds of pro- and anti-inflammatory molecules.” In addition, immune cells play prominent roles in triggering inflammation or damping it down.

Inflammation is involved in a wide variety of disorders, including heart disease, liver disease, cancer and auto-immune disorders. So if this study is borne out, mind-body therapies may be useful for many patients.

Another blood pressure study is under way that involves a control group, seen by scientists as necessary to determine if a treatment works. Libermann says the group would like to mount a large study of up to 500 patients with hypertension followed over five years “to see whether we get similar responses.”

Meanwhile, Benson says there is no harm if patients with high blood pressure want to try the relaxation response, “providing you and your physician are on the same page and agree.”

He says meditation is already routine in the MGH’s rehabilitation programs for people who have had heart attacks, even though genomic proof is currently lacking. In one case, he says a patient who used the relaxation response achieved unexpected healing of his damaged heart – possibly because of the anti-inflammatory effect suggested by the new blood pressure study.

“What we’ve been able to do,” Benson says, “slowly, over the years, is change the whole paradigm that the mind and the body were separate.”

Michelle Weiner
Is The Ketogenic Diet Worthwhile? I would be interested in your take on the ketogenic diet.

This one seems to be getting a lot of buzz lately.

The ketogenic diet is very low in carbohydrates: in its strictest form, carbs make up only five percent of daily calories, along with 20 percent from protein and 75 percent from fat. Some versions of the diet allow a little more protein (about 35 percent of calories) while others alternate five high-fat days with two high-carb days. The object of the emphasis on fat is to bring about ketosis, the metabolic state of burning fat instead of carbohydrates for energy. There’s little doubt that you can lose weight this way, although there is no scientific consensus on how this occurs. Some researchers contend that weight loss on this diet is a simple matter of consuming fewer calories, while others propose an appetite-suppressant effect of ketosis.

Whatever the mechanism, a number of studies have concluded that you can lose more weight faster on a ketogenic diet than on a low-fat diet. However, you may have to contend with negative side effects of ketosis, such as headache, fatigue, constipation, increased cholesterol level, and bad breath – although these are usually temporary. If you have kidney disease, the diet isn’t for you; it can worsen this condition

Some history: The ketogenic diet has been used at least since the 1920s as a treatment for young children with severe epileptic seizures that are difficult to control with medication. We don’t know why inducing ketosis decreases the frequency of seizures, but it often does. It seems to work best for kids ages one to 10.

More recently, some studies have found that ketogenic diets may have value for treatment of other health problems. In a 2013 review published in the European Journal of Clinical Nutrition, an international team of researchers wrote that there is “ample evidence to support the notion that a low-carbohydrate diet can lead to an improvement in some metabolic pathways and have beneficial health effects.” They cited research showing that a ketogenic diet can have favorable effects on risk factors for cardiovascular disease including elevated cholesterol and triglyceride levels. Other studies have found that a ketogenic diet can help individuals with metabolic syndrome, insulin resistance and type 2 diabetes by improving glucose control and insulin sensitivity. The review also cited “persuasive, although not yet conclusive” evidence that it can reduce the severity and progression of acne. They also maintained that the ketogenic diet shows promise “as an aid in at least some kinds of cancer therapy and is deserving of further and deeper investigation.” The review also suggested that it might be useful in the treatment of polycystic ovary syndrome (PCOS), Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS).

Michelle Weiner
How old is your body really?

Watch this interesting video by Adam Cole.  Learn about how our body regenerates. 

Do all of your cells get switched out for new ones every seven years or so? Does anything remain with you throughout your entire life?

karola hawk

The Best Career Advice, From Successful People Who Made It to the Top

Success leaves clues. No. 1: Start by taking a hard look at yourself and deciding what you want.

Bruce Harpham June 30, 2016

Building a successful career draws from several important disciplines. These time-honored practices, proven to work in every industry, are vital to those striving to achieve success. Whether you need inspiration to start a new practice or a boost of motivation to get back on track, take and use these four leaders’ experiences to bolster your own.

Related: 10 Pieces of Career Advice for My 21-Year-Old Self

1. Self-knowledge is the foundation.

Without self-knowledge, the pursuit of success is frustrating. In the ancient world, philosophers encouraged their followers to reflect. Today’s leaders use their self-understanding to define and reach success.

  • “At several points, my mentors have served as a mirror for me and helped me to understand myself better,” says Kim Ulmer, regional president of Royal Bank of Canada. Ulmer’s responsibility includes managing more than 170 branches and 3,000 staffers.
  • Dave Kasabian, chief marketing officer at Tagetik, a management software company, says, “My philosophy of growth is to look inside myself: What do I enjoy? What are my skills and passions? Based on that knowledge, I make decisions on how to develop.”
  • Assessment tools provide helpful insights in understanding strengths. For example, Michael Hyatt, author and entrepreneur, referred to StrengthsFinder 2.0, a personal development favorite, as he exited a corporate career to start a new chapter as an entrepreneur. His strengths, according to the model, included a focus on achievement and the future.

Self-knowledge requires reflecting on your experiences, good and bad. Think about last week and take note of when you felt the greatest satisfaction. You might take greater satisfaction from solving thorny business problems. Or you might relish the challenge of guiding a new graduate through their first few months at work.

2. Curiosity is powerful.


“Formal education will make you a living; self-education will make you a fortune.” —Jim Rohn


An open and curious mind is vital to make the most of learning opportunities. Curiosity means looking for an opportunity to learn and apply ideas outside of the classroom. And engagement and focus is increasingly vital in leadership roles because your actions and words will quietly influence many around you.

  • “I usually take one or two courses per year at a business school to keep my skills sharp,” says Rich Crawford, CEO of Global Integrated Services.
  • “I have a thirst for knowledge and regularly go out to meet with business owners to understand their situation,” Ulmer says. “Recently, I found David Zinger’s “10 Principles of Engagement” and have found that to be a helpful resource. It has encouraged [reflecting] on my work several times per day to see if I am truly engaged.”
  • “One of the most valuable books I’ve read in my career is Peter Drucker’s The Effective Executive, says Ben Sawa, director of marketing at GEI Consultants Inc., one of the largest engineering firms in the U.S.
  • Entertainment executive Brian Grazer—producer of Apollo 13, The Da Vinci Code and J. Edgar—attributes much of his professional success to curiosity and learning from those around him as he describes in his book, A Curious Mind: The Secret to a Bigger Life.

3. Mentors provide new perspectives and better questions.

Successful leaders consistently reach out to mentors throughout the course of their careers. The conversation might start with business, but the lessons are often applicable to a range of concerns and issues.

  • “I have had several mentors over my career including family mentors and those in the business community,” Ulmer says. “Mentors have helped me to adopt a broader perspective and ask questions such as, ‘Have you taken the time to understand the situation before acting?’”
  • “Every meaningful mistake I have ever made has involved poor communication. [That’s] a lesson I learned from a CFO who mentored me. That was an important insight,” Sawa says. “I also think it is valuable to seek mentors who are different from you because they can provide a fresh perspective.”
  • “My mentors have helped me to get outside of the day-to-day flow of work to ask bigger questions,” Kasabian says. “In 1994, I was given a powerful question from a mentor: ‘Draw where you want to be in five years.’ That exercise helped me to think about my career and the direction of my life much more deeply. I ended up making a move to another state, among other decisions as a result. It was a powerful experience.”
  • “I’m a huge believer in mentors,” Crawford says. “At present, I’m working with two mentors and I’m learning much from both of them. I learn about industry best practices from one and work life matters from another. YPO [Young Presidents’ Organization] had an excellent mentorship program that I found valuable.”

4. Keep the right company to achieve your goals.

The company you keep has a major impact on your success and self-concept. Jim Rohn’s observation that “you are the average of the five people you spend the most time with,” rings true for many leaders.

  • “My participation in Young Presidents’ Organization has been tremendously valuable. It is rare to find so many other executives and CEOs who are facing similar challenges,” Crawford explains. In addition to informal networking, Crawford has benefited from YPO’s mentorship program and specialized educational programs that serve the needs of executives.
  • “It is important to choose thoughtfully when it comes to joining organizations,” Ulmer says. “I’m currently involved with Junior Achievement because they operate on a national level and work on major problems. I’m also involved with the Manitoba Business Council.”

Where do you find peers to challenge you and help you grow?

karola hawk