Additional Answers to Important Health Questions
Natural Progesterone - The Balancing Hormone
Disclaimer: These statements are for informational purposes only. They are not intended to recommend treatment, suggest a cure or attempt mitigation of any disease, disorder, or medical condition. Additionally, this information is not intended to replace medical advice or to prevent anyone from seeking proper and qualified medical services and/or treatment. No government agency has reviewed or endorsed this informational presentation.
Natural Progesterone “The Balancing Hormone”
Because Balance is Important
Because it is ultimately up to each individual to take responsibility
for his or her own body and health decisions, we must all gain an
awareness of the natural choices available to us
Numerous studies and extensive research clearly indicate that when a woman’s endocrine system is in balance her overall health, mood, and sense of well-being is maximized.
The Women’s Health Initiative in 2002 and then again in 2004 referenced studies, indicating that synthetic non- biological equivalent estrogen replacement therapy (ERT), sometimes referred to as Hormone Replacement Therapy (HRT), with conjugated equine (horse-derived) estrogen, resulted in an increased risk of stroke. These reports impacted millions of women, along with health practitioners, and created turmoil and divisiveness as to what is safe and what should be recommended to women with hormone imbalance symptoms.
The vast majority of Hormone Replacement Therapy (HRT) studies and research have been conducted using synthetic estrogen and/or synthetic progesterone (progestin). The often negative findings of these studies, using synthetics, are sometimes confused with the many health and wellness benefits realized by women using natural bio-identical alternatives. Yet, even today, millions of women are still confused, as a result of these reports, about what to believe regarding the claimed lack of side effects and the many reported health benefits to those women who chose natural alternatives.
Most women can safely find help with the many often unbearable symptoms and complications of peri- menopause, menopause, post-menopause, and hormonal imbalance by applying an all-natural micronized USP natural progesterone cream to the skin. Progesterone USP cream is absorbed through the skin and directly into the bloodstream, by passing the filtering process of the liver. Having the same biological identical molecular structure as the progesterone produced by the body, many women are finding the safety and health benefits of this natural alternative much more preferable than synthetic choices.
What is a Hormone?
Hormones are secreted by your glands, such as your pancreas, ovaries, adrenal, and thyroid, in small quantities, usually into the bloodstream. The word “hormone” is taken from the Greek word “hormaein,” which means “to excite.” Hormones activate, control, or direct bodily functions and travel throughout the body until recognized by a receptor. Hormones control energy production and storage, water and salt metabolism, growth, and sexual and reproductive actions. Estrogen, Androgens, and Natural Progesterone are all steroid hormones manufactured in your body from cholesterol.
What is Progesterone?
Often referred to as “the balancing hormone,” progesterone is a hormone produced primarily by your ovaries and adrenals. It is a precursor, or the substance from which most of your other steroid hormones are derived, such as cortisol, estrogens, androstenedione and testosterone. With a relatively simple conversion in the laboratory, wild yam extract and other plant compounds, like soy, have been converted to natural progesterone that is biologically identical and a molecular equivalent to the natural progesterone produced in your body. The word Progesterone refers only to the specific molecule as produced by your body and should not be confused with medroxyprogesterone (as in Provera®), which is one form of synthetic progesterone referred to as progestin or progestogen. (See “Is There a Difference between Progesterone and Progestin?”)
What is the Function of Progesterone in My Body?
Besides being a precursor from which other hormones are produced, progesterone provides many other vital health benefits such as normalizing blood sugar levels, facilitating thyroid hormone function, menstrual cycle regulation and helps maintain a healthy pregnancy. Additionally, progesterone prepares the uterus to receive a healthy fertilized egg as well as supports the early stage of a healthy pregnancy.
Does My Body Normally Produce Progesterone and For How Long?
Yes, along with Estrogen, between puberty and menopause, in the ovaries and the adrenal glands. Progesterone is also produced in large quantities by the placenta during pregnancy, contributing to the freedom from headaches and the general feeling of well-being and euphoria you experienced when you entered your second trimester. Significant deficiencies may occur at menopause as the adrenal cortex is then called upon to maintain the only ongoing supply of these vital hormones.
What exactly does ‘Natural Progesterone’ Refer To?
The natural progesterone produced in your body and/or the natural progesterone manufactured in a laboratory from either soybeans or the Mexican Wild Yam (Dioscorea villosa). A Pennsylvania State University professor named Russel Marker developed the process in the 1930’s by converting diosgenin from wild yams into biologically identical and molecular equivalent natural progesterone as naturally produced in your body. One form of natural progesterone used today is called USP Micronized Progesterone which is considered more bio-available when considering absorption and efficacy. (See “What is USP Micronized Natural Progesterone.”)
What is the Significance of Wild Yam Extract?
The Mexican Wild Yam contains a multitude of beneficial natural compounds including phytoestrogens and has been used for many years to treat a variety of female medical conditions and problems. Wild yam bioidentical progesterone is progesterone which has been derived from a compound found in Mexican wild yams called diosgenin. For example, diosgenin, one of the many phytogenins found in wild yam, has a striking resemblance to your own progesterone. A simple lab processing technology produces natural progesterone from diosgenin that exactly matches (bio-identical) the natural progesterone produced by your body.
Wild yam derived natural Progesterone should not be confused with wild yam creams which are sold with the claims that your body is able to naturally produce progesterone if you use it. According to Dr. Andrew Weil, “Diosgenin itself has no hormonal activity and can’t be converted in the human body into anything that does.”
What is Micronized Natural Progesterone USP?
Micron is a unit of measure which is equal to 1/250,000 micronized, it has been broken down into tiny particles. Not all progesterone is micronized. If it is, it will say so on the labeling. If it is not stated that it is micronized on the label, chances are it is not, and if the progesterone you are using is not micronized, you may want to consider switching to one that is. Higher grade bioidentical progesterone is usually micronized and will state clearly so on the label. Additionally, micronized natural progesterone, as opposed to non-micronized, is optimal for transdermal (through the skin) delivery.
USP is an acronym for the United States Pharmacopeia, a non-governmental organization recognized and used by over 130 countries, which sets public standards for prescription and over-the-counter medications and healthcare products, manufactured and/or sold in the United States. The USP sets standards for purity, quality, strength, and consistency.
If progesterone is said to be USP grade that means it has met the standards of the USP for quality. The USP is not regulated by the FDA. However, all products given USP approval have been subjected to a rigorous set of quality standards.
Do I need Progesterone Supplementation?
Probably, especially if you are over age 40 and/or have had a hysterectomy. The decline of very important hormones starts in the thirties and studies suggest that an accelerated decrease in progesterone production by the body usually begins several years before menopause. During the peri-menopausal years it is progesterone, not estrogen, which is the first hormone to decline in women contrary to common belief.
Challenges to hormonal balance can also be much more than just age related. Seemingly unavoidable chemical toxins are wreaking havoc on women’s reproductive systems contributing to a rise in cases of early menopause and the resulting hormonal imbalance. Toxins are found everywhere – cosmetics, cleaning products, in the lining of food cans, pesticides and even the thermal paper used for store receipts. Recent research at the Washington University School of Medicine in St. Louis found women with the highest blood and urine levels of 15 endocrine- disrupting chemicals experienced menopause up to four years earlier than those with the lowest levels.
Dr. Amber Cooper, an assistant professor of obstetrics and gynecology at the University stated, “Even [experiencing] menopause a few years earlier than usual could have a significant effect on bone health, on cardiovascular health, on memory, and quality of life for women, in general.”
When menopause does arrive and after the ovaries discontinue their production of estrogen and progesterone, only small amounts are produced by the adrenals which in most cases are insufficient, resulting in dramatic biological and health changes. The decline of progesterone production by the body usually contributes to menopausal and post-menopausal symptoms and even as some studies suggest, osteoporosis.
Ironically, it is at this time that 40 to 60 percent of women in the USA are still prescribed unopposed estrogen in a synthetic (manufactured) form, and in some cases a synthetic progestin as well, resulting in many unpleasant and negative side effects, as well as placing many women at risk (see “Is There a Difference between Progesterone and Progestin?”). On the other hand, there is impressive evidence that natural progesterone, often called the “balancing hormone,” provides countless benefits and supplementation may safely correct critical hormonal imbalance and progesterone deficiencies in women.
What is the Difference Between Progesterone and Progestin?
There is a huge difference! Progesterone, when processed and produced synthetically, is then called a Progestin, Gestagen, or Progestational agent. No synthetic progestin is the molecular equivalent nor has the full spectrum of natural progesterone’s biologic activity. Medroxyprogesterone is an example of a widely prescribed synthetic progestin as formulated in commonly prescribed products. It is also worth noting that while progesterone is present in large quantities during pregnancy that progestin (a synthetic derivative) is contraindicated during pregnancy as it can induce miscarriages.
Studies show progestins (synthetic) have been linked to blood clots, acne, weight gain, fluid retention, rashes, depression, some cancers, and additional disorders. Synthetic Progestins can also bind to glucocorticoid, androgen, and mineralocorticoid receptors which some specialists believe contribute to the negative side effects women often experience while taking synthetic progestins and estrogens. Progestins (synthetic) and synthetic estrogens are usually found in birth control pills and both are very potent.
Why Should I Consider Natural Progesterone vs Synthetic (Progestin)?
Most synthetic treatments, including non-natural progestin, are “interventionist.” That is, they interfere with the body’s natural methods for correcting imbalances and short circuit the natural healing mechanisms. For example, synthetic progestins do not convert to corticosteroids and can also lower your own natural progesterone levels, contributing to hormone imbalance and deficiencies, the very conditions you are trying to correct. Conversely, natural progesterone is a primary building block for many other steroid hormones manufactured by the body and can be converted into compounds your body needs, such as corticosteroids which, for example, can help regulate blood sugar metabolism. Synthetic progestins are incapable of performing this function, and do not have the many natural plant compounds (phytochemicals) and biological activity of natural progesterone. All progestins, progestogens (synthetic) may cause physical, psychological, and metabolic side effects. Natural progesterone supports hormonal balance, provides many health benefits and does not present the many risks of synthetics.
What Specific Benefits Can I Expect Using Natural Progesterone?
Biological needs vary among individuals. However, common results of natural progesterone supplementation include less anxiety, depression, sleep disorders, hypertension, mood swings, night sweats, and hot flashes. Many women report increased vitality, sexual libido, and improved cell oxygen levels. According to recent studies, natural progesterone stimulates bone building, may also help dry skin conditions, wrinkling on the face, and brown age spots on the face and hands.
A considerable amount of research into progesterone has been done by Dr. Michael Schumacher of the Kremlin- Bicêtre hospital in Paris who cites a range of studies – much of it animal – showing that progesterone has beneficial effects on the breast tissue, on blood vessel function and in strengthening bone. Many of the benefits of progesterone, he says, comes from the fact that while estrogen stimulates cells, progesterone calms them down (Michael Schumacher, Rachida Guennoun, Abdel Ghoumari et al “Novel perspectives for progesterone in HRT, with special reference to the nervous system” Endocr Rev. 2007 Jun; 28(4):387-439).
Drawing on this work, Schumacher believes that progesterone might lower the risk for dementia since estrogen and progesterone combined have been shown to have a neuroprotective effect, unlike progestin’s which can reduce this protective effect.
Additionally, in the USA Dr. Schumacher’s claim that progesterone can protect blood vessels and cut down the risk of strokes has just been supported in two small trials at Texas University. Researchers gave a progesterone cream or a placebo to 30 post-menopausal women for eight weeks. Not only did the cream improve their symptoms but there was no rise in various markers in the blood that make strokes more likely, such as inflammation and a tendency to form clots. Kenna Stephenson, Pierre Neuenschwander et al “Transdermal progesterone: Effects on Menopausal Symptoms and on Thrombotic, Anticoagulant and inflammatory factors in post-menopausal women” International Journal of Pharmaceutical Compounding Vol 12 No 4 July/August 2008.
Four head-to-head studies comparing Progesterone to non-bioidentical synthetic progestogen (progestin) reported that women experienced greater satisfaction, improved quality of life, and fewer side effects when switched from progestin to progesterone (Hargrove 1989); Montplaisir 2001; Lindenfeld 2002). The beneficial effects of progesterone, compared to non-bioidentical progestin, included a 30% reduction in sleep problems, 50% reduction in anxiety, 60% reduction in depression, 25% reduction in menstrual bleeding, 40% reduction in cognitive difficulties and 30% improvement in sexual function. Eighty percent of women in the study reported overall satisfaction with the bio-identical progesterone formulation (Fitzpatrick 2000).
Should I Use Natural Progesterone While on Birth Control Pills Containing Synthetic Progestin?
No. Mixing natural progesterone and synthetic forms is usually not recommended. Most birth control pills contain progestin, the synthetic derivative of progesterone (see “Is there a difference between Progesterone and Progestin?”).
Will Natural Progesterone Help Me Emotionally?
Many women have reported an elevated emotional state and a decrease in depression and mood swings after beginning natural progesterone supplementation. A hormonal relay system may be one reason as stress, environment, and lifestyle affects fatty acid metabolism, which affects progesterone production, which can affect cortisol, which affects you.
Should I Use Natural Progesterone During Pregnancy?
Large quantities of progesterone are already produced by the body during pregnancy. However natural progesterone supplementation may also be beneficial. “Children of mothers who received prenatal progesterone have shown advanced development at one year and to have a greater academic achievement at nine to ten years.” (British Journal of Psychiatry 1976) Always consult your health care provider with any concerns you may have in the use of progesterone supplementation.
Will My Body Store Progesterone and Cause Weight Gain?
No. Several years ago an online article stated that progesterone was highly fat soluble and that once applied to the skin would store itself in a woman’s fat tissue. There is absolutely no proof of that. Progesterone stored in fat tissue and released as needed has no factual basis. Conversely, there is sufficient evidence that progesterone delivered transdermally, that is, through the skin, is rapidly absorbed into the blood stream and thus not stored in fat cells. It should be noted, however, that it is important to apply progesterone creams to thin skin area such as the inner arms, thighs, neck, back of the knees and even the top and bottom of your feet.
Should I Take Natural Progesterone Orally?
No. The liver removes a high percentage of ingested hormones sending them through the digestive tract and converting them to water soluble forms that bind with other substances, making them difficult to absorb in the chemical environment of the intestines. Bypassing this roadblock is best accomplished with the use of transdermal (application on and absorption through the skin) creams containing natural Progesterone, such as FemBasis Progesterone Cream and Progesterone Plus, combined in a chemical free natural formula of herbs and plant extracts. “Progesterone has been demonstrated to be a good candidate for transdermal delivery.” (Annals of Medicine, 1993)
Which Natural Progesterone Cream is Best?
The one that works best for you. Natural progesterone USP, if processed correctly, without pesticides and harmful contaminates, should be identical to any other USP Natural Progesterone. Important considerations, however, are formulation technology (the carrier), organic ingredients, non GMO and chemical free product sourcing, quality control and consistency, synergism and maximum potential bioavailability.
Why Don’t Large Drug Companies Produce Natural Progesterone Cream?
They really cannot afford to. The considerable expense of research and development may not be recovered nor provide an acceptable return on investment (ROI) without the ability to offer a proprietary product to the consumer protected by patent and/or an exclusive chemical formula. A natural hormone produced by humans or found anywhere in nature cannot be patented by a pharmaceutical company. A slight variation or alteration and/or a chemical version of a hormone, or any other natural product, however, can usually be patented and thus controlled, providing the pharmaceutical companies, in this case, a very profitable, non-natural, patentable synthetic form of progesterone for use in birth control and other pharmaceutical products.
What If My Doctor Doesn’t Agree With Natural Progesterone Supplementation?
It may be difficult for some doctors to accept a regimen sometimes considered unorthodox. If your doctor is unaware of the recent developments and studies supporting natural progesterone supplementation, you may wish to suggest a review of such publications as “Natural Progesterone, The Multiple Roles Of a Remarkable Hormone” and “What Your Doctor May Not Tell You About Menopause” by John R Lee, MD and many others, more recently, who through diligent research, have reported effectively on the many benefits of natural progesterone supplementation.
Is Natural Progesterone Supplementation Safe?
Yes, it is generally regarded as safe, because it is a biological equivalent of the body’s own progesterone. With progesterone (as opposed to a synthetic version) you are providing your endocrine system a tool to work with while leaving the body’s natural control and regulation systems in place. Even though an overdose is not usually a health concern, you should always follow the ‘suggested use’ guidelines. As with any product, natural or otherwise, you should always discontinue use and consult your professional health care provider if you experience any adverse effects or conditions.
How Will I Know if my Progesterone Levels Have Increased?
Some women begin to experience a significant decrease in symptoms, and an elevated sense of well-being in just a few days’ use, but more typically over a period of two to three months. Blood analysis is always an option, but not necessarily a good one. The blood only reflects the progesterone that is bound to carrier proteins which are generally unavailable to target tissues and therefore does not usually provide an accurate measure of tissue levels. Numerous research studies over the past 20 years have clearly validated the saliva test as an excellent method for measuring the biological active progesterone in the bloodstream. Each test, however, only measures progesterone levels at the time of the test and it should be noted that progesterone levels can vary considerably. An average of several saliva tests may be an option. A salivary progesterone test is available from several reliable online and laboratory sources.
(Labrix Clinical Services – www.labrix.com)
Should I Use Natural Progesterone For PMS?
Estrogen dominance is often a problem associated with PMS. Estrogen levels usually begin to increase during the first part of the menstrual cycle (the follicular phase), decline somewhat at ovulation, and arrive at the lowest level at the beginning of menses. Progesterone production falls sharply 10 to 12 days after ovulation. Topical natural progesterone can be a very effective procedure for the management of PMS by improving the balance between estrogen and progesterone. Estrogen and progesterone may be both compatible at some receptor sites and if enough progesterone is available, estrogen is displaced, effectively shutting off the lofty rate of estrogen production, and usually mitigating the discomfort and negative symptoms of PMS.
What is Estrogen Replacement Therapy (HRT or ERT)?
HRT (hormone replacement therapy) and ERT (estrogen replacement therapy) are often used interchangeably. Specifically, ERT only refers to estrogen, and almost always synthetic estrogen, while HRT could include any hormone, again synthetic/manufactured in most cases. Production of very important hormones usually starts to decline, in most women, during their thirties. As hormone levels fall your menstrual cycle becomes erratic, unpredictable and then stops. Called “peri-menopause,” this transitional period can last five to ten years. Hormone fluctuation, especially during this time, can sometimes cause many related adverse effects such as irritability, mood swings, sleep disturbances, memory loss, night sweats, and the often associated aches and pains. It is also during this time and through menopause that manufactured conjugated estrogen (synthetic) is commonly prescribed. Conjugated estrogen is a mixture of estrogenic substances that are of a type excreted by pregnant mares (horses), such as found in commonly prescribed manufactured synthetic estrogen (Premarin®). The possible side effect of manufactured ERT/HRT can include abdominal cramps, bloating, breast tenderness, elevated blood pressure, hair loss, mental depression, nausea and vomiting, prolonged vaginal bleeding, vaginal candidiasis, weight gain, skin rashes, and glucose intolerance, among others.
A relative new study published in the JAMA Internal Medicine 2013 linked conjugated equine estrogen hormone therapy (HRT) to a woman’s risk of developing heart disease. The study compared the synthetic form of estrogen to a second type of hormone therapy, estradiol, which is a natural estrogen. Women who used the HRT synthetic estrogen were twice as likely to have venous thrombosis and slightly more likely to have heart attacks.
Is There a Connection Between HRT/ERT and Cancer?
The evidence can be overwhelming. Some studies suggest that long term synthetic estrogen and/or progestin (synthetic) replacement therapy (ERT and sometimes referred to as HRT) may contribute to a 30% increase in breast cancer in women. Some of these same sources also suggest that many other types of cancer, including endometrial, brain, pancreatic, cervical, bladder, and bronchogenic carcinomas may be associated with long term manufactured (synthetic) estrogen therapy. The Journal of the American Medical Association, February 7, 1996, revealed that two-thirds of the women, especially those who have not had a hysterectomy, who take prescribed synthetic estrogen alone, develop abnormalities in the uterine lining within three years.
Conversely, Dr. Michael Schumacher of the Kremlin-Bicêtre hospital in Paris suggests that progesterone may protect against breast cancer. This thinking is supported by a trial that is almost unknown in the US and UK comparing the effects of Progesterone and progestin. In a big ongoing French study, 54,548 menopausal women have been evaluated comparing what happens to those who take progesterone with those who get progestin. The latest report has found that after eight years while those on progestins (synthetic) have a raised risk of breast cancer, those on progesterone (natural) don’t. (Fournier et al “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the (E.sib.3) cohort study” Breast Cancer Res Treat 2008: 107(1): 103-11)
How Does HRT/ERT Compare With Natural Progesterone Therapy?
The late Dr. John R. Lee, MD., a noted authority on natural progesterone vs estrogen therapy made these statements:
Estrogen stimulates the breasts, creates proliferative endometrium, causes salt and fluid retention, increases body fat, interferes with thyroid hormone, causes depression and headaches, increases blood clotting, diminishes libido, impairs blood sugar control, causes decline of zinc and retention of copper, reduces oxygen levels in all cells, causes endometrial cancer, increases the risk of breast cancer, and slightly restrains osteoclasts.
Dr. Lee further stated:
Natural progesterone protects against birocysts, maintains secretory endometrium, functions as a natural diuretic, helps use fat for energy, stimulates thyroid hormone action, is a natural antidepressant, normalizes blood clotting, restores libido, normalizes blood sugar levels, prevents endometrial cancer, helps prevent breast cancer, stimulates osteoblasts, is necessary for the survival of the embryo and is a precursor of cortisone synthesis.
Can I Discontinue HRT/ERT Using Natural Progesterone?
Most traditional hormone replacement therapy (HRT) prescribes a synthetic form of estrogen as opposed to natural phyto-estrogens (see “What is Estrogen Replacement Therapy?”). And not all post-menopausal women need estrogen replacement. Progesterone can be converted into many other hormones, including natural estrogen and the body can utilize DHEA (Dehydroepiandrosterone) to produce estrogen as well. Many women do very well with progesterone alone, as progesterone is often referred to as the “balancing” hormone and does not present the many negative side effects of synthetic HRT/ERT. Estrogen levels begin to decline, in many women, in their early thirties and continue through peri-menopause. Menopausal and post-menopausal women produce very little, if any, estrogen. Some women, especially those who have had a hysterectomy, often referred to as a surgical menopause, and who prefer to support natural estrogen levels as well, have found positive results using natural phytoestrogens (natural plant based compounds), as found in FemBasis Progesterone Plus.
If you are taking a manufactured estrogen (synthetic) and wish to use a natural progesterone alternative instead, you may be advised to decrease your estrogen dosage 10% to 15% each month. You should always consult your professional health care provider concerning any of these questions and issues.
If you decide to continue or begin traditional estrogen replacement therapy (ERT), you should consider using natural progesterone in conjunction with ERT to avoid the negative possibilities of unopposed estrogen, or what is often referred to as “estrogen dominance.” You should always consult your professional health care provider concerning any of these questions and issues.
Are Phytoestrogens The Same as my Prescription Estrogen?
No. Phytoestrogens are beneficial natural estrogen type compounds found in plants that your body can utilize if needed. They are considered safe, have no known side effects, and because they are natural as opposed to a manufactured synthetic version, phytoestrogens may even prevent excess estrogen from taking hold, as sometimes is the case with manufactured estrogen (ERT), thus decreasing the possibility of estrogen dominance.
How Common is Osteoporosis?
Eventually, according to studies, 1 in 3 women will develop osteoporosis. Bone loss related to menopause actually begins during the irregular menstruation period before menopause (peri-menopause), and after age 30 to 35 the bone shrinks approximately 10% per decade in women as reported in research reports.
Will Natural Progesterone Help Slow Osteoporosis?
Probably, and it may even help reverse the loss of bone mass. Bone loss begins well before menopause when estrogen levels are adequate but when progesterone levels have started to decline. Osteoblasts are special bone cells that take calcium and phosphorus from your blood and deposit crystals in your bone structure. Estrogen may reduce the rate of bone loss in some cases, however, progesterone is credited with the building of new bone material and promises new bone formulation by binding to receptors on osteoblasts. Evidence that progesterone acts as a bone trophic (stimulating) hormone has been validated by work documenting the presence of progesterone receptors on osteoblasts. (New England Journal of Medicine, 1993). “Osteoporosis may be, in part, a progesterone deficiency disease”. (Endocrine Reviews, 1990)
Many women have found that natural progesterone supplementation provides a natural alternative to synthetics. When the body can be encouraged to help itself, it is by far a better choice. Achieving a balance using natural choices is preferred over the imbalances usually associated with synthetic dosages (drugs) as there are definitely benefits lost when going from natural remedies to synthetic manufactured pharmaceutical alternatives. A natural progesterone skin cream like FemBasis Progesterone Cream is effective, safe to use, and provides a sensible choice for optimum health.
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