Guest guest Posted December 9, 2003 Report Share Posted December 9, 2003 First, let me say that while I'm glad that we're having this discussion, I'm sorry that EMOSS list rules were broken by forwarding a message off-list without the poster's permission. I'm really glad to have this information, but I disagree with a number of points made by the Isotonix representatives and feel that the facts of the matter have a dramatic impact on how we absorb these or any other supplements. First of all, nobody involved in the Isotonix response has offered one of the most important things that I asked for... a series of lab results from any individuals (preferably more than one) with a malabsorptive surgery and three or more years of experience with these supplements. Also, I have yet to see even one set of two-years-in-a-row DEXAscans, never mind five years. We have this information (in some cases, for ten years or more) with conventional supplements, and that's how we've seen what works and what doesn't. We can all talk all we want, but unless we have lab test results to compare, we're all full of hot air, don't you think? I want strong bones and blood, and hot air's not part of that picture. :-) Next, most of us, unless we are Simonowitz 25 cm bypasses, have a great deal more than just the duodenum bypassed. My surgery is not at all atypical, with a 125 cm bypass. Many people in our group have distal bypasses, meaning that they have in the neighborhood of only 100 - 200 cm small intestine available for absorption of nutrients (500-600 cm bypassed, leaving just a short portion of the ileum). Everyone that has a malabsorptive surgery can count on low absorption of nutrients from normal food, including dense protein foods. Lab work of post-ops who consume no supplements at all (protein, vitamin, and mineral) demonstrate this adequately, if not immediately, then within five years or so of surgery when long-term stores are depleted. The entire small intestine in most adults is about 700 cm long; the duodenum (literally meaning " twelve fingers " ) is about 25 cm in length, the jejunum is about 275 cm long, and the ileum is about 400 cm long. The majority of nutrient absorption occurs in the first 175 cm of the small intestine, with about 50% taking place in the 25 cm of duodenum. NO patient with a malabsorptive surgery can make use of any nutrients from food if they would normally be absorbed in the duodenum. In particular, most WLS patients do not expect to make much use of proteins which must be digested from food, most fat is eliminated from the body without absorption (witness the dry skin so many of us have), and not only do many of us become lactose intolerant after surgery but dairy products are hard to digest anyway and result in mostly wasted nutritional opportunity (but even with our bypasses, we seem to make immediate use of the sugars presented by these foods). As far as supplement pills not being broken down and used, I think this is incorrect based on three facts: - we do not often see the tablets or portions thereof in the stool (though there are some tablets, especially some large multi-vitamins, that are clearly observed in the stool, and those should be avoided) - lab testing reveals better nutrient profiles when taking these products than when not taking these products - with regards to calcium, excellent DEXAscans are obtained when using calcium citrate; persons not taking calcium citrate after malabsorptive surgery often see a rapid decline in bone mass leading to osteopenia or osteoporosis Again, I ask, where are the lab spreadsheets and the DEXAscans from the people who have been taking Isotonix products for years after malabsorptive surgeries? I'd consider recommending this product (though I think it's outrageously priced) IF you can prove results to me with lab results. My cheap regimen's effectiveness CAN BE DOCUMENTED THROUGH MY BLOODWORK AND DEXASCANS, and that of many others like me. I know I'm absorbing the iron I take (Chromagen Forte) because I had pernicious anemia before beginning to take it and injected Vitamin B-12, and I no longer have it; instead, I have normal or near-normal values. I know three other gastric bypass post-ops who have seen similar results with this combination. This scientist speaks of Isotonix products triggering special sensory nerve cells in the lower stomach when they arrive there, via the stomach stretching from consuming the liquid... if you have a correctly-functioning malabsorptive surgery, NOTHING ENTERS THE LOWER STOMACH. EVER. Not food, not supplements, not Isotonix solutions. So that " special trigger " is not going to take place. The duodenal sphincter and lower stomach are completely bypassed (as is the pyloric valve) and are not part of the picture. How does that affect the absorption of Isotonix solutions? As I see it, they are going to zoom right through the small valveless stomach pouch and straight into the small intestine at a much higher rate than the scientists who developed Isotonix products intended. I stand corrected about micrograms vs. nanograms. My error. However, I stand by the assertion that micrograms of most nutrients (except vitamin B-12 and a few others) are not enough, especially in a known malabsorptive scenario where additional supplementation is needed from the start. I also stand by the assertion that calcium carbonate is NOT the right calcium for us. The 1994 NIH Consensus Statement on Calcium specifically states that calcium citrate is THE calcium supplement of choice for those with low stomach acid -- that would be us. They DON'T recommend isotonic solution supplements, despite having (no doubt) considered all the scientific material available at that time. " Prove to me that your body is using all of that iron (36 to 40 mg) and definitely prove to me that your body needs 2520 milligrams of elemental calcium. That's a constipating dose, especially when combined with a calcium-rich diet, and most of the calcium is going down the tube. " I'm not taking 36 to 40 mg of iron, I'm taking 302 mg of elemental iron each day in the form of 920 mg ferrous fumerate USP (2 Chromagen Forte capsules, taken at different times and at least two hours away from any calcium). I can prove it because my blood work shows a change from frank pernicious anemia (completely abnormal for a 35 year old female) to healthy numbers across the board in a period of about six weeks, with sustained good values for an additional four months so far. My calcium does not constipate me, or perhaps it does, but when combined with the common bowel-loosening effect of malabsorptive surgery, they cancel each other out and I do not notice as I have normal stooling habits. My DEXAscans are perfect, and that's what I care about. Wasted calcium is OK; osteopenia and osteoporosis, both of which are common in my family, are not. So I will carry on with my regimen until specific peer-reviewed study results are available for your product as used by malabsorptive surgery post-ops showing clearly superior results that would justify the added expense of the product. Even a collection of anecdotal data would be helpful, but it seems to be unavailable. By the way, the calcium citrate tablets that I use, Citracal Plus, dissolve in WATER, never mind the acidic environment made by saliva. If I pick them up in a damp hand, they instantly start to disintegrate. In no way am I concerned that they have not completely melted by the time they hit my small intestine; I KNOW that they have. And as I said before, I have the great DEXAscans to prove that my body is USING that calcium. The only time of my life that I took calcium carbonate on a regular basis was while I was pregnant with my daughter in 1999; my prenatal contained a large dose of calcium carbonate. My thyroid was healthy, I was drinking three liters of water a day (with a spreadsheet to track it!), and was not consuming any carbonated beverages or caffeine. I developed a kidney stone when I was six months pregnant, and passing it, even with good drugs, was MUCH more painful than the unmedicated home birth of my almost 9 pound baby in January of 2000. The urologist was the one who asked me about calcium carbonate in any supplements, I was not even aware of the potential problems at that time, and had my digestive system intact. So, no thanks. I know I am an anecdotal report of one person, but no calcium carbonate enters my body, even if it comes in a fancy/expensive package! As for the anecdotal report of ONE woman attaining normal B-12 levels on the Isotonix preparation, I'd like to know what's being considered " normal " . Many labs consider anything over 200 " normal " , but that's only because that's the level where permanent neurological damage can begin to set in. Most people find that they need to have serum B-12 levels over 600 to actually feel good, and some physicians like to see people maintain levels of 800 or higher. Is the Isotonix keeping her there? I think that there's some grey area because some people do seem to be able to absorb liquid B-12 across mucous membranes without intrinsic factor in the picture -- but not me, as proven by the pernicious anemia despite daily sublingual supplementation. I do continue to believe, however, that it's stupid to pay a lot of money for a B-12 preparation that MIGHT work when after five minutes of training and for less than $15 a year, a patient can inject themselves with the vitamin every two weeks and be certain that they are obtaining adequate levels of this essential vitamin. So, thanks for the further information about these vitamins. I'm sorry to see that the doctor who responded to my comments doesn't have a clear understanding of the digestive changes brought about by restrictive/malabsorptive surgery for obesity. Certainly, it is an area where more research is needed, but I have been doing my own research for four years, have consulted with many post-ops who are many years out (in some cases, over 20 years), and have compared the lab work of dozens of people on various supplement regimes. We have seen what works for our community and with others who are committed to our improved health, continue to review lab results and other data. I'm not a scientist, but I am a well-educated layperson, and I do not accept advice from those who do not know much about my particular surgery or bariatric surgery in general. EVERY gastric bypass patient needs to evaluate their health with their personal physician and needs to evaluate which supplements to take carefully, preferably on the basis of regularly drawn blood work and same-date annual DEXAscans. Supplements that do not provide the expected results can then be eliminated from the patient's nutrition program before they have time to do harm. It goes without saying that EVERY gastric bypass patient needs to take nutritional supplements for the rest of their lives, but it remains an open question as to which supplements actually provide the best results. Ziobro Founder, EMOSS Open RNY 09/17/01 http://www.ziobro.us ________________________________ From: & Debi Waldeck Sent: Tuesday, December 09, 2003 9:43 AM To: EMOSS Cc: Ziobro; BandRGress@... Subject: ISOTONIC NUTRITION Importance: High Hello All- My name is Debi Waldeck and I have been forwarded the message from via Ruby Gress regarding Isotonic Nutrition. As I have been lecturing nationwide, presenting research that presents the relationship between wellness and absorption, I was surprised at this email. I therefore, forwarded to the Executive Vice President of the company and several doctors. Here is the response. If you have any questions, my phone number in Issaquah is . Debi Waldeck --------------------------------------------------------------------------------\ ----------------- Hello Debbie, this is Dennis s, Executive Vice President. Thank you for sharing the copy of the email sent out by a concerned support group member. 's comments deserve a comment and our good Dr Wilmer has taken the time to do just that. I hope everyone in the group gets these comments to help educate the members. I also hope that for those who want a great tasting quality dietary supplement to please take Isotonix products everyday, they will be glad they did. Today was an interesting day. I received a call from a women who had a gastric by-pass surgery 15 years ago. She shared with me, how important it was, that people who have had this operation MUST continue to take their supplements daily for the rest of their life or experience some very negative effects from lack of nutrition. She shared some terrible stories of friends of hers who have lost all of their teeth, experienced a major amount of bone fractures and loss of vision. It is amazing her story. She is now on a mission to teach everyone who has gone through this surgery, to NOT STOP taking Nutritional supplements daily. [EMOSS] Re: Information on Isotonix: CAUTION ADVISED (long) Lots of EMOSS members and others have been talking about these Isotonix solutions, and I've done some research because I'm concerned about some of the things I've heard. Here are my concerns about these Isotonix products, take it or leave it, I have not used them, but I am analyzing them based on their published ingredients and programs. One of the red flags for me is that there's no three to five year data out with these, just nearly-anecdotal single sets of labs. If you haven't been taking ANYTHING, sure, these might pull borderline low levels up a bit, but I seriously doubt they are going to maintain a malabsorbing body in good health indefinitely. Where are three years' worth of comprehensive blood test results from even a single post-op? Where are five years' worth of annual DEXA-scans for a post-op on these products? Nobody can show them to you. If you value your bones, nerves, and flesh, RUN. I am not willing to be a guinea pig (especially if I have to pay handsomely to become one), and I hope you're not wild about the idea either. :-) Keep in mind that Isotonix is a multi-level marketing business, and they are notorious for doing their best to sell products while sometimes ignoring the science (and if you think I'm bitter or jealous or something, I am actually a MLM distributor for a great line of human-grade pet foods called Flint River Ranch. MLM companies are not all bad, but the business model leaves everything open to more loose interpretation and you must carefully research these products before using them, especially IMO if you are going to literally trust them with your life). I think the recommendation to mix the entire day's dose of EVERYTHING, vitamins, minerals, B-12, etc., into a 10 oz. glass of water borders on malpractice. There's nothing " special enough " about making things " isotonic " to get by your body's ability to absorb calcium and iron. You can't get them both at the same time, period, unless perhaps they were being pushed IV, something that can only be done by a hematologist in a medical setting. Clearly, calcium and iron products can be taken at the same time without one interfering with the uptake of the other. Calcium is transported as an ion through specialized channels traversing intestinal cell membranes, and to the best of my knowledge, calcium does not share this channel with iron. All " isotonic " means, by the way, is " having the same or equal osmotic pressure " and when spoken of this sort of solution, typically it means having the same osmotic pressure as blood. Well, saline has the same osmotic pressure as blood. It means that radical changes in the chemistry of the liquid do not have to take place for the liquid to penetrate the cell membranes; it doesn't mean that the cells will be able to do anything useful with the components of that solution! Research has clearly shown that Isotonic solutions pass through the stomach more rapidly than hypotonic or hypertonic solutions. Most pills have to be dissolved in the stomach first and that can take 30-60 minutes before they are even in solution. All the while the nutrients are exposed to stomach acid in the highly acidic pH range of about 1.5 to 2.8 and are being churned in this soup. That assumes that the tablet was manufactured properly and is capable of being wetted and then crushed by the muscular contractions of the duodenal portion of the stomach. In some cases the individual (typically an older individual) does not have the stomach acid or volume of juice to adequately digest food or supplements. What happens then? There is a documented phenomenon where the stomach literally gives up on the tablet or capsule and squirts it intact into the small intestine where it stands little chance of being utilized for its nutrients. Isotonix triggers specialized sensory cells in the lower portion of the stomach and so it fits three major criteria for rapid transit: (1) it is isotonic (just like a fully digested food solution), (2) it has an acidic pH (just like a fully digested food solution), and (3) it has sufficient mass which stretches specialized nerve cells in the stomach wall, all three actions which trigger the opening of the duodenal sphincter and contractions of the stomach. This activity allows the Isotonix solution to reach the small intestine, the major absorptive site, at high concentrations. Some vitamins and minerals are absorbed through active transport and so they will not be affected much by their high concentrations achieved on the lumenal side of the intestine. However, other vitamins and minerals are not absorbed by active transport but instead diffuse passively through the enterocyte membrane. In this case, the concentration of the solute (nutrient) in the lumen is critical, as it establishes a so-called gradient flowing from high concentration in the lumen to a low concentration inside enterocytes. Isotonix Calcium Plus Each 4.45 g (One level 5 mL spoonful of powder) contains: Ascorbic acid (vitamin C) 40 mg Calcium (total) (324.7 mg from carbonate, 939 µg from citrate, 225 mg from lactate, 77.7 mg from phosphate, 16.6 mg from sulfate) 645 mg Cholecalciferol (equiv vitamin D3 445 IU) 11.1 µg Magnesium (total) (5.7 mg from carbonate, 128.8 mg from oxide) 134.5 mg Manganese (as sulfate) 723 µg Potassium (as citrate) 33.8 mg Riboflavine (vitamin B2) 2.2 mg in a non-active base of pectin, malic acid, fructose, citric acid, glucose, natural orange flavour, potassium bicarbonate. WHERE TO START in on this one?!? First of all, let's look at the inactive ingredients. I see some free-riding " ose " -- SUGAR. Do you need that? No. Next, do I see CARBONATE?? Garbage. Do I see NANOgrams of citrate? Garbage. Calcium phosphate, lactate, and sulfate are all also poorly absorbed even by normies. I wouldn't bet anything on this calcium formula except kidney stones. Oh, and you should be taking this three times a day, by itself, not with iron. Because you can't absorb more than about 500 mg at a time IF it's the right stuff, and we should be taking at least 1500 mg a day to protect our bones. As an aside, the designation " µg " stands for micrograms, not nanograms (ng), which signals the importance of an education to understand major points in formulations. Many forms of calcium are perfectly acceptable for use in medicinal/nutritional supplements, but it is important to have the correct base ingredients and water to ionize calcium, magnesium, and manganese. This formula is designed to include malic acid, citric acid, and ascorbic acid (vitamin C). Now what happens when water is added to a powder containing these organic acids and calcium carbonate? These substances react with one another and transiently form calcium malate, calcium citrate, and calcium ascorbate. Under the acidic conditions of the Isotonix solution, however, even these compounds are tugged apart by water molecules and they become ionized. Calcium is not absorbed by enterocytes in the form of compounds such as calcium citrate, calcium sulfate, calcium lactate, or calcium carbonate. This mineral is absorbed through protein channels or gated pores as the cation (Ca2+). Meanwhile, that calcium citrate tablet you thought was so fantastic is still not dissolved completely as it requires plenty of stomach juice and stomach contractions to disintegrate it. True, it may not need the hydrochloric acid that a calcium carbonate tablet requires, but then Isotonix does not need hydrochloric acid at all. It is already an acidic solution with plenty of water. Actually, the amount of calcium that a person can effectively absorb is more in the range of 300-400 mg per " sitting, " so Isotonix falls into an absorbable dose when taken twice a day as recommended. While the body requires 1000-1500 mg of calcium per day, depending on age and physiological status, it is not critical to get the entire amount from dietary/medicinal supplements. Food (dairy and green leafy vegetables) is still the preferred route. Actually, the notion that calcium compounds in the diet or supplements is a trigger for the formation of kidney/bladder stones is a misunderstanding. Almost invariably other causes are far more prevalent as a cause for stones, including chronic infection of the kidneys, low water intake, high intake of phosphoric acid from soft drinks, frequent ingestion of foods high in oxalic acid, overdosing with vitamin C (gram amounts), elevated cysteine content of urine, and parathyroid hormone dysfunction resulting in loss of minerals from bone. Regarding the presence of sugars, fructose and glucose are the substances that contribute the most to the tonicity (osmolarity) of Isotonix solutions. Most of the sugar is from fructose, which has a low glycemic index of 18 out of a 100 point scale. In my opinion, Isotonix has a lower glycemic index than most foods including proteins. Isotonix B-12 Each 4.2 g (One level 5 mL spoonful of powder) contains: Magnesium (as carbonate) 40 mg Calcium (as sulfate) 3.85 mg Cyanocobalamin (vitamin B12) 120 µg Folic acid 400 µg Riboflavin (vitamin B2) 3 mg in a non-active base of fructose, pectin, citric acid, glucose, maltodextrin, lemon and lime flavours, potassium bicarbonate and colloidal anhydrous silica AGAIN, a whole bunch of SUGARS are getting a free ride into you. And this B-12 will be next to useless without intrinsic factor (which we don't have) unless you are holding the liquid in your mouth, under your tongue, for at least two minutes -- and some of us STILL can't absorb B-12 sublingually, no matter how how hard we try. Anyone keeping this stuff in their mouth for two minutes? I doubt it. This product is an expensive source of folic acid and riboflavin. I agree that on a theoretical basis Intrinsic Factor does appear to be required for adequate movement of vitamin B-12 into the enterocytes via an IF/B-12 complex bound to membrane receptors. I would hesitate to say that all Intrinsic Factor production is halted in gastric bypass patients and its release is incapable of being stimulated. I have read one report from a woman in the US who has a gastric bypass, and she indicated that her B-12 blood level is normal (i.e., in the correct range) when using Isotonix. She combined her Vitamin B-12 with several other Isotonix products. I agree that it is impractical to leave Isotonix on/under the tongue for minutes on end. Even liposomal products don't do especially well. I.M. injections are still the preferred route for a gastric bypass patient to get his/her vitamin B-12. I would also remind you that, although the vitamin B-12 molecule is large and charged, it is possible to use large doses to " drive " some small amounts of material across cell membranes. Two respected human physiology textbooks describe both mechanisms: Intrinsic Factor (major) and simple diffusion (minor). Isotonix MultiTech Each 4.1 g (One level 5 mL spoonful of powder) contains: Ascorbic acid (vitamin C) 120 mg Biotin (vitamin H) 150 µg Calcium pantothenate (vitamin B5) 12.3 mg Cholecalciferol (equiv vitamin D3 410 IU) 10.2 µg Cyanocobalamin (vitamin B12) 15 µg dl-alpha-Tocopheryl acetate (equiv vitamin E, 33IU) 33 mg Folic Acid 300 µg Betacarotene 4.5 mg Nicotinamide 49.2 mg Pyridoxine hydrochloride (vitamin B6) 4.1 mg Riboflavin (vitamin B2) 4.1 mg Thiamine hydrochloride (vitamin B1) 4.1 mg Calcium (total) (52.6 mg from carbonate, 1 mg from pantothenate, 8.6 mg from sulfate) 62.2 mg Chromium (as nicotinate) 50 µg Magnesium (as carbonate) 11.7 mg Manganese (as sulfate) 5.33 mg Selenium (as sodium selenite) 52 µg Iodine (as potassium iodide) 88 µg Zinc (as gluconate) 7.5 mg in a non-active base of pectin, fructose, citric acid, glucose, maltodextrin, lemon and lime flavors, potassium bicarbonate and colloidal anhydrous silica. SUGARS. More kidney stone-calcium. Not a hell of a lot of other good stuff. Major stuff missing. Low dose of beta-carotene vitamin A. Apparently, not such great flavor. My earlier comments about sugars still hold true here, as do my statements about the reaction of organic acids with calcium carbonate and the very low probability of a good calcium source causing kidney stones. The dose of vitamin A (as the safe antioxidant beta-carotene) was essentially chosen by your very own TGA. Go tell it on the mountain. I find the Australian and American MultiTechs to be palatable, and of course they can always be mixed with other Isotonix products. We are working to make the flavor technology even better. And this " system " runs is $75/month? It's a system alright, to make a whole chain of distributors a whole bunch of money!! My home-rolled " system " gives me 200% of the RDA of iron in a form I can PROVE my body's using, 2520 mg a day of calcium CITRATE and related minerals in the correct ratios, two complete adult chewable multi-vitamin/multi-minerals a day, and a B-12 shot twice a month, and costs a grand total $45 a month. The iron is even Rx, and next year my insurance will cover it, so I will only be paying $20/month for supplemental nutrition I can trust. Prove to me that your body is using all of that iron (36 to 40 mg) and definitely prove to me that your body needs 2520 milligrams of elemental calcium. That's a constipating dose, especially when combined with a calcium-rich diet, and most of the calcium is going down the tube. So the Isotonix as suggested only means taking stuff once a day, and my " system " involves one softgel, two chewables (no sugar), a shot I give myself every two weeks, and eight calcium tablets... I " take " stuff five times a day. I don't care about that. The Isotonix, to meet anywhere near the correct dosages and spacing for absorbability would need to be taken four times a day, and to match my program, would have to be taken six times a day. It would also cost more like $150/month if you really were comparing equivalent programs at the prices I could find from distributors who do have websites. I think the Isotonix phenomenon is only a fad, and I really hope that it doesn't hurt any of our people along the way. Again, I think this is one of those cases where someone got excited about something but people haven't done enough hard-core research to see if it was going to help US. Normies MIGHT be able to get benefit from these formulas, but our special needs (no stomach acid, no intrinsic factor, among others) rule these out as a good choice for us. From a distributor's website: " IsotonixT products do not linger in the stomach. Since isotonic fluids pass through the digestive process and are rapidly absorbed into the bloodstream, gastrointestinal discomfort can be avoided. IsotonixT products are not encapsulated or compacted into a " form. " There is no need for fillers, binders, coatings, lubricants, disintegrators or artificial coloring. With IsotonixT products, there is no guesswork involved. You can be assured that when used as directed, you get the exact amount of nutrients shown, in the exact isotonic state desired. The delivery efficiency of IsotonixT helps ensure that maximum benefits are derived from the supplements. Because the nutrients arrive at the absorption site more rapidly and highly concentrated, excellent use of the nutrients should be achieved. " Again, this paragraph from our educational literature describes the efficient passive diffusion possible through setting up a concentration gradient in the small intestine. It does not refer to micronutrients that are actively transported since concentration does not matter nearly as much. Unfortunately, our bodies do not provide some of the processing capabilities that these vitamins require, ESPECIALLY since most of the absorption sites (duodenum) are bypassed for even the most proximal of us. And I believe, based on the research that I've done, that the " slower " forms such as tablets are actually BETTER for us, inert (but non-sugar) fillers be damned. We don't have a pyloric valve to slow things down for even a moment, and that means that an important " system flow control " is missing from the Isotonix picture. The duodenum is bypassed (~1 foot), but then the solutions are flowing over the next 10 to 11 feet of small intestine epithelium for absorption. You must be using special quick dissolve tablets, because if you aren't, then the amount of digestive juices released into your GI tract won't be sufficient to dissolve them. I'd rather be certain that my small intestine at least had the opportunity to " see " and absorb the micronutrients in solution as they flow down the intestine. Each of us has to decide what's best for us. I do think that it's important, no, CRITICAL, for people to look into the merit of these products and to do their own thinking about what's best and how they want to spend their money. I wouldn't take a surgeon's supplement recommendation fully to heart; how many of them think kids' chewable Flintstones and Tums (calcium carbonate) are nutritional powerhouses? Many of them, and anyone who has done even basic research knows that advice is dead wrong. Z Open RNY 09/17/01 http://www.ziobro.us > > Hi Ruby - > > > > Can you please email me off line and give me a price list for > these products, and how I would go about obtaining them from you. > this truly sounds like the way to go - those chewable adult vitamins > are the worst!! I am four weeks out and feeling great, but I want > to be sure to start down the right path with all the vitamins and > supplements I will need for now and into the future!! > > > > Thanks!! > > > > Lynn H (Tgrbabe@c...) > > Dr Weber - RNY 10/29/03 > > 310/275/170 Quote Link to comment Share on other sites More sharing options...
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