Conditions and Diseases ASTHMA Definition Diagnosis Medical Treatment Compelmentary / Alterative Treatment Options Reduction in Allergen Exposure Dietary Factors in Asthma Dietary Supplements Herbal Therapy Acupuncture DEFINITION: Asthma is a breathing disorder characterized by narrowing of the airways (bronchoconstriction) and is accompanied by excessive mucous production. This causes obstruction of airflow resulting in difficulty breathing. The characteristic bronchoconstriction associated with asthma is episodic and reversible. Asthma is common, affecting three percent of the U.S. population. It affects all ages but is most common in children under the age of ten. It more commonly affects males, and the incidence of asthma in the United States appears to be rising. Asthma accounts for a major expenditure of health care dollars. ETIOLOGY: The release of several chemicals, primarily histamine and a group of compounds known as leukotrienes cause the airway constriction in asthma. A variety of factors can stimulate the release of these chemicals, which prompted the classification of asthma into two types: extrinsic and intrinsic. Extrinsic asthma is allergic, or atopic. Here, bronchoconstriction is caused by the exposure to various allergens, such as pollens, animal fur, etc. In intrinsic asthma, the airway constriction is due to such things as exercise, respiratory illnesses, or emotional upset. The distinction between these two types of asthma is not made as much today, as the final pathway common to both types is the release of histamine and leukotrienes. The distinction is useful only as it allows for the identification of triggers to bronchoconstriction. DIAGNOSIS: The diagnosis of asthma is made on the basis of history, a physical exam, and tests of lung function. The history should indicate that the breathing difficulty is episodic and reversible, rather than progressive. If not, diagnoses other than asthma should be considered. The history should also include the frequency, severity, and duration of the symptoms, as well as their impact on work, recreation, and sleep. An environmental history helps to identify allergic triggers to asthma attacks. Dietary and non-allergic triggers should be sought as well.  The physical exam should focus on the respiratory tract and skin, looking for signs of allergy and atopy.  A diagnostic study known as a pulmonary function test is recommended, both to help establish or confirm the diagnosis as well as to determine baseline lung function or degree of impairment. In some patients, X-Rays of the sinuses or chest are done to confirm the diagnosis of asthma, or to look for other conditions which can co-exist in asthmatics, such as sinusitis, nasal polyps, etc. TREATMENT OF ASTHMA MEDICAL TREATMENT OF ASTHMA: The use of drugs is the cornerstone of treating an acute asthma attack, and drug therapy can indeed by lifesaving. Drugs are also used in a prophylactic (preventive) manner to help prevent or minimize asthma attacks. The decisions as to which drugs are used and how these drugs are given are individualized. These treatment decisions take into account the severity of the disease and the degree of dysfunction, looking at such things as the frequency of attacks, the duration and severity of attacks, and the types of drugs that have been needed to reverse the attacks. It should be said at this point that strong consideration be given to a consultation with an Asthma Specialist. Such a specialist would typically be a specialist in Allergy and Immunology, a Pediatrician with specialist training in Asthma and Allergy, or a Pulmonologist. The recommendation to see an Allergy Specialist is made on the basis that asthma can be a fatal disease, and that a consultation with or treatment by an asthma specialist is associated with better outcomes, lower costs, and less absence from school and work. There are available two publications that address treatment guidelines for the medical treatment of asthma. One is from the National Heart Lung and Blood Institute at the NIH, and the other is from the Journal of Allergy and Clinical Immunology. Both articles represent a consensus of a panel of specialists and experts in asthma management. They can be accessed on-line at www.guideline.gov, which will get you to the National Guideline Clearinghouse, where you can do a search under treatment for asthma. These publications contain much useful information, but the gist of drug therapy is as follows: An attempt is made to classify the severity of the asthma, and whether symptoms are intermittent or persistent. Based on the frequency, duration, and severity of asthma attacks, and based on which drugs have been required to gain control, a daily drug regimen is started in order to prevent or minimize the recurrence of asthma attacks. This is referred to as stepwise approach, where the goal of the drugs is to achieve control of the asthma symptoms. Once control is achieved, a step down approach is advised, which then allows a determination of the minimum amount of medication required to achieve control. Periodic monitoring is then recommended in order to maintain control and to consider further changes in therapy, either up or down. COMPLEMENTARY AND ALTERNATIVE TREATMENTS: We are glad you have chosen Nature’s Healthcare as your source for information on Complementary and Alternative therapies in asthma, and look forward to helping you achieve your goal of improved health and wellness. The goal of your medical therapy to this point has been to achieve control of your asthma symptoms on as few drugs as possible. That would be our goal as well. That is to say, we will not be recommending to you that you adopt our treatment advice in place of your current drug regimen (i.e. Alternative to). Rather, our advice will be for you to consider our treatment recommendations to be in addition to your current therapy (i.e. Complementary to). You absolutely should not stop any medical therapy you are currently on for asthma. We believe it is safe to say that if you do not need at least an occasional drug for treatment of asthma, you probably do not need our treatment strategy either.  Our recommendations should be shared with your treating physician in order for him/her to be fully aware of your efforts to improve your health. Your physician is likely aware of most of the information we will be sharing with you but finds that evaluating and managing your drug therapy leaves time for little else. As well, the various payment entities for medical care often do recognize the importance of (i.e. pay for) anything other than the prescribing of a drug. As such, treating physicians have little to no financial incentive or time to discuss with you such information, even if they know it to be helpful. Thus, the information we will be sharing with you is intended to allow you to achieve better control of your symptoms and feel better on the drugs you are currently taking, especially if you are currently on a number of medications and still do not have what you believe to be good control. As well, we hope that our recommendations will facilitate the step down process, in the hope of achieving control on the fewest drugs possible. REDUCTION IN ALLERGEN EXPOSURE ALLERGY TESTING AND IMMUNOTHERAPY: Allergy testing is a procedure whereby small amounts of common substances are injected under the skin to detect sensitivity (allergy) to that substance. This information can guide our efforts to avoid where possible exposure to those substances to which you are allergic. As well, consideration can be given to immunotherapy (allergy shots) in order to become desensitized to those substances. ALLERGENS IN THE HOME: If allergy testing has been done, the results can guide you here in order to get the most bang for your preventive buck. However, general guidelines can be given here, based on the allergens most commonly found in the home, which, unfortunately, happen to be the allergens to which most asthmatics are sensitive. The following issues regarding home allergen exposure need to be addressed to expect maximal improvement in asthma symptoms: -Smoking: There should be absolutely no smoking in the home of a patient with asthma. -Did I already say there should be no smoking in the home of a patient with asthma? -Domestic Animals and Pets: For sensitive patients, pets should not be living inside. -Dust Mites: A common allergen, the dust mite requires action above and beyond usual housecleaning for control. First, the air filter from the supermarket for $4.95 is not enough. To filter out dust and its mites requires a HEPA, a High Efficiency Particulate Air filter. Dust mites are also found in and difficult to eradicate from carpets. Powders which help with mite control are available for applying to carpets prior to vacuuming. -The Bedroom: Special care is needed in the bedroom for allergen control, as this is usually where asthmatic patients, especially children, spend most of their time. The following are helpful in minimizing household allergen exposure: -Mattress, pillows, and box springs: should be encased in zippered coverings which are impermeable to allergens, and which are commercially available. -Bedding: in order to control exposure to dust mites in the bedding, all bedding, everything, should be washed weekly, in 130 degree water, in detergent that is free of additives and of fragrances. Selection of blankets should favor those which will withstand the rigors of such washing, and wool and down filled blankets should be avoided. As an alternative to washing at 130 degrees, additives are available for the wash which will help control mites in the bedding. Or, a mixture of 100cc of eucalyptus oil with 25cc dishwashing detergent, added to the wash in a 30 minute warm water pre-soak, has received some attention. The eucalyptus oil treatment is recommended every two to three months. -Dust-proofing the bedroom: attention to some of the following can minimize the accumulation of dust and the allergens they contain. Avoid dust collectors such as wall hangings, pennants, and throw pillows. Furniture should favor wipeable surfaces such as wood, plastic, vinyl, and leather, over upholstered furniture. Heavy drapes and curtains should be avoided in favor of window shades. Closets should remain shut to prevent dust accumulation on clothes. If carpeted, the bedroom should be vacuumed with the application of a powder specific for control of dust mites. Bare floors are best. -Air filter: a separate, portable air filter for the bedroom should be considered. There are a number of commercial resources to turn to for information, services, and products. In Austin, a comprehensive resource for home allergen control is The Allergy  Relief Store, at 3500 Jefferson, near Seton. Online services are available at www.allergycontrol.com or at 1-800-422-DUST. DIETARY FACTORS IN ASTHMA FOOD ALLERGIES: Food allergies are often mentioned in regard to asthma, but identifying specific food allergens and arriving at a dietary plan presents a challenge for the asthmatic and their families. Allergy testing can be helpful in identifying food allergens. The skin tests (or RAST tests) which may have been done can determine some potential food allergens. However, skin tests are designed to identify only one type of antibody, which is called the IgE antibody. These antibodies are the ones produced first upon exposure to an allergen, and they begin the cascade leading to an asthma attack. There is another class of antibody, however, called the IgG antibody, which is produced in a more delayed fashion, and are not identified by skin tests. A study published in 1995 in the journal Digestion  found that 60% of people with food allergies demonstrate this with a delayed type reaction. Doing blood tests that measure both IgG and IgE antibodies for 96 food allergens best tests for these types of food allergies. An optional test can be done to measure sensitivity to 24 common spices.  If testing has not been performed, allergens must then be identified by applying the more cumbersome methods of elimination diets and rotation diets, which will not be detailed here, but a sample rotation diet is available from Nature’s Healthcare. In essence, an elimination diet involves the elimination of individual food items (i.e. milk) or food groups (i.e. dairy) and looking for improvement in asthma control. Eventhough this area involves difficult changes, with results not always seen immediately, food allergies should be considered when an asthma patient is having difficulty achieving control. We have described for you the two types of responses for food allergies, delayed and immediate. The most common foods that produce a delayed allergic/asthmatic reaction would be chocolate, milk, wheat, citrus, and food coloring. The foods that most commonly produce an immediate reaction would be eggs, fish, nuts, and peanuts. FOOD ADDITIVES: There are a number of food additives and preservatives that can trigger allergic/asthmatic reactions. Such additives would include dyes, such as the azo dyes tartrazine (known as yellow dye #5), sunset yellow dye, amaranth (red), and the non-azo dye pate blue. These dyes are felt to stimulate the release of leokotrienes resulting in bronchoconstriction. Preservatives identified as triggers of allergic/asthmatic reactions include: sodium benzoate, sulfur dioxide, sulfites, and monosodium glutamate (MSG). One solid recommendation can be given to avoid exposure to these allergens: AVOID OR MINIMIZE CONSUMPTION OF PREPARED OR PROCESSED FOODS What is a prepared or processed food? That would be one prepared or processed by someone other than you, such as food from a restaurant, or food eaten from a can, a box, or other package. The key concept here is the more steps taken to prepare or process food before you get it, the more chance there is of an additive or preservative being added to it. The more involved you are in the preparation of your food, beginning with raw, fresh, whole foodstuffs, the more control you have with regards to what goes into it, or, more importantly, what does not. Once again: AVOID OR MINIMIZE CONSUMPTION OF PREPARED OR PROCESSED FOODS You will also find that this advice will reduce your intake of fat and refined sugars, which will reduce calories, facilitate weight control, and contribute to a lower risk of heart disease and stroke. OMEGA 3 FATTY ACIDS: Dietary intake of Omega 3 fatty acids has been associated with a decreased production of leukotrienes that trigger bronchoconstriction.  Studies have shown improved control in asthmatics who eat fish rich in Omega 3’s on a weekly basis, as well as in patients who supplement with Omega 3-containing fish oils rich in EPA and DHA. Fish containing Omega 3 fatty acids include the cold water fishes salmon, herring, sardines, mackerel, bluefish, and albacore tuna. The improvement is not seen quickly, but is a more gradual process, as it involves the turnover in cell wall synthesis, reducing the availability of arachadonic acid, which results in less production of the inflammatory leokotrienes. It should be noted that it can take up to one year or the Omega 3 supplementation to show any effect, due to the fact that the Omega 3 fatty acids must be incorporate into the cell wall. And, this change may not be seen at all if there is not a coincident reduction in the intake of Omega 6 fatty acids, such as those found in animal protein. This is due to the fact that the Omega 6 fatty acids compete preferentially for an enzyme required for the utilization of Omega 3 fatty acids. A simple and affordable way to supplement Omega 3 Fatty Acids is with flaxseed oil, 1 tbsp. Per day. If a child finds it unpleasant it can be added to foods such as salads or any food where you would add an oil. THE VEGAN DIET: There’s good news, and there’s bad news. The good news is that a strict Vegan diet is associated with improved asthmatic control in 92% of patients studied. The bad news is that it took up to one year in the study to reach the 92% level, although 72% reported improvement after four months. The other bad news is that a Vegan diet is hard to follow for the uninitiated, and even harder to impose on a child with asthma who has his own ideas, tastes, and Madison Avenue-type preferences about nutrition. For those asthmatics who are willing to try this for improved control, and who have the commitment to the time, education, and discipline required to follow it, the guts of the Vegan Diet are as follows: -Not Allowed: Meat,  Eggs, Dairy. Chocolate, Coffee, Tea, Sugar, Salt. (I know, sugar and salt) Tap Water, especially if chlorinated. Apples and Citrus Fruits. Grains. -Allowed: Veggies: Lettuce, carrots, onions, beets, celery, cabbage, cauliflower, broccoli, cucumbers, radishes. Beans: Except soy beans and green peas. Potatoes in moderation. Fruits: Blueberries, Strawberries, Raspberries, Plums, and Pears. Bottled Spring Water only. While not ordinarily part of a Vegan diet, the consumption of cold water fish is encouraged as a means of providing Omega 3 fatty acids. Such cold water fish would include: salmon which is not farm bred; mackerel; herring; sardines; bluefish; and albacore tuna; The typical tuna purchased at the grocery store is generally derived from Bonita, a lower priced tuna, but one which is not as rich in Omega 3’s as the higher priced albacore tuna. Resources are available to provide recipes and cooking tips for a Vegan Diet. DIETARY SUPPLEMENTS IN ASTHMA ANTIOXIDANTS: Normal cellular metabolism produces substances called Free Radicals. If left unchecked, free radicals are capable of producing cellular damage, and they are felt to be involved in the development of certain cancers, of cardiovascular disease, and in cellular destruction that accompanies aging. The compounds that keep free radicals in check are called Antioxidants. Supplementation with antioxidants is associated with a reduced risk of cardiovascular disease and cancer, and slows the aging process. The major antioxidants are: -Vitamin C. -Vitamin E. -Carotenoids, mainly beta-carotene. -Selenium. -Flavonoids. Antioxidant supplementation is more effective when taken as a group rather than selecting a specific antioxidant to be taken alone and the best way to obtain antioxidants is felt to be from a combination of supplementation along with a diet high in antioxidant-containing foods. In asthma, it has been shown that antioxidant deficiencies can lead to an increased susceptibility to allergens and an increased production and release of the allergy-reaction-causing substances histamine and leukotrienes. Supplementation with certain antioxidants has been shown to improve asthmatic control, as outlined below. All doses below are for children weighing 50-100 lbs. The adult dose would be twice this dose. VITAMIN C: Vitamin C is the major antioxidant of the respiratory system, and Vitamin C deficiencies are more common in asthmatics. In addition to regulating production of histamine and leukotrienes, Vitamin C improves chemotaxis, which is the ability of the white blood cells to respond to infection. -Supplementation Dose: 500 mg twice per day. VITAMIN E: Functions in a similar antioxidant capacity as Vitamin C, and supplementation is advised with 100-200 Units per day. CAROTENES: Carotenes function in the respiratory system to promote the health and integrity of the epithelial lining, which affects its susceptibility to allergens. Carotenes also decrease the formation of leukotrienes. The primary carotene is beta-carotene.  Supplementation is recommended with 25,000 Units per day. FLAVONOIDS: Flavonoids have a strong role in the regulation of histamine and leukotriene production, as well as their release from mast cells. One flavonoid in particular, called quercetin, is a key antioxidant in the respiratory system. Supplementation is as follows: -Quercetin supplementation: 200 mg 20 minutes before each meal OR -Supplementation with one of the following extracts:  Grape Seed Extract: 25-50 mg three times per day.  Green Tea Extract: with 50% polyphenol content- 100-150 mg three times per day, or liberal consumption of green tea.  Ginkgo Biloba Extract: 40 mg three times per day. SELENIUM: Selenium is not an antioxidant itself, but is a coenzyme in the process involving glutathione peroxidase, which is very important for the breakdown of leukotrienes. As well, reduced levels of selenium have been demonstrated in asthmatics. As such, supplementation is recommended as 50-100 mg per day.   VITAMIN AND MINERAL SUPPLEMENTATION: VITAMIN B 6 (PYRIDOXINE) This is especially needed in patients treated with theophylline, a common inhaled bronchodilator. B 6 is involved in the metabolism of tryptophan, which is converted to serotonin, which is involved in bronchoconstriction. Supplementation with B 6 helps to keep this metabolic pathway open. Dosage is 25-50 mg two times/day.   VITAMIN B 12: B 12 seems to be the most useful in asthmatic patients with a demonstrated Sulfite sensitivity. However, the studies that demonstrated improvement in such patients used intramusclar injections of B12 rather than oral dosing. Doses in patients who might benefit are 1000 mcg/day orally, or 1000 mcg weekly by intramuscular injection. MAGNESIUM: Magnesium is believed to be involved in relaxing the muscles in the airways that have constricted during an asthma attack. Magnesium supplementation is associated with improved control of symptoms. Dosage is 200-400 mg three times/day. A SUMMARY OF SUPPLEMENTAL THERAPIES: Dosages are for children 50-100 lbs. Adult dosage would be twice that. VITAMIN SUPPLEMENTATION: Vitamin B 6- 25-50 mg twice/day Vitamin B 12- 1000 mcg orally daily, or 1000 mcg weekly by IM injection. ANTIOXIDANT SUPPLEMENTATION: Vitamin C- 500 mg two times/day. Vitamin E- 100-200 IU/day. Beta-Carotene- 25,000 Units/day. Quercetin- 200 mg 20 minutes prior to a meal.   OR  Grape Seed Extract 25-50 mg three times/day OR Green Tea Extract w/ 50% phenol content 150-250 mg three times/day OR Ginkgo Biloba Extract 40 mg three times/day. MINERAL SUPPLEMENTATION: Selenium- 50-100 mg/day. Magnesium- 200-400 mg three times/day. HERBAL THERAPY IN ASTHMA There are two types of Herbal Remedies available. One would be what we have come to call Western Herbs, the other would be Chinese Herbs. With Western Herbs, we generally understand the mechanism of action of the Herb. That is, we know what cellular function or metabolic process those Herbs effect, much like we understand the mechanism of action of prescription drugs. Unlike most prescription drugs, however, many Herbs effect cellular functions in more than one place or in more than one tissue, so they can be used for more than one symptom or condition. Chinese Herbs, on the other hand, are not directed at a particular cellular function or metabolic function. Rather, they are used in combinations, and are directed at symptoms or conditions that are felt to arise from an improper flow of energy, or Qi (pronounced chee), through the body. If you decide to use Chinese Herbs, the combination of herbs given to you will be decided by our practitioner of Traditional Chinese Medicine based on her evaluation of you. If you decide to use Western Herbs, there are several herbal remedies that can be used in your case: FOR BRONCHOCONSTRICTION: The only herbal preparation approved by the German Commission E for treatment of respiratory difficulty due to narrowing of the airways is Ephedra. As well, Ephedra is indicated only in mild bronchoconstriction, and has no place in the treatment of more severe asthma attacks. The dose is 12.5 to 25 mg every six hours. Ephedra should only be used for short periods of time, as its effectiveness will lessen with time, and there is a potential for addiction.  Ephedra is derived from Ma Huang, and is a stimulant, causing the release of epinephrine which can lead to the following side effects: Agitation, restlessness, insomnia, irritability, headaches, nausea, a rapid pulse, a rise in blood pressure, and difficulty with urination, especially in men with enlargement of the prostate. Ephedra should not be used by patients with hypertension, heart disease, glaucoma, anxiety, or in patients with difficulty urinating. Ephedra can cause interactions with, and should not be taken along with, the following drugs: Digitalis, digoxin, MAO inhibitors, guanethidine, or the anesthetic halothane. Due to side-effects, and the fact that there are more effective bronchodilators available, it is our opinion that ephedra should be used only be those patients who have not responded to prescription bronchodilators, or who have had difficulty with their side-effects.   FOR COUGH AND MUCOUS PRODUCTION; There are a number of herbal preparations which can be used for cough, congestion, and as expectorants. The preparation we recommend in asthma is Licorice root. Licorice Root (Glycyrrhiza Glabra) has properties of an expectorant to help clear excess mucous, and it also has anti-inflammatory properties and decreases the production of leukotrienes, which helps to reverse the reactive airway changes in acute attack. The dosage of Licorice Root would be: -Powdered Root- 1-2 mg three times a day. -Fluid Extract- (1:1) 2cc three times a day. -Solid Extract- (4:1) 250-500 mg three times a day. There are no side effects with short-term use of Licorice Root at these doses. With prolonged use, or at higher doses, licorice can cause fluid and electrolyte disturbances, with loss of potassium and retention of sodium and water. Licorice root should not be taken along with thiazide diuretics. Green Tea (Camellia sinensis) has been helpful as an adjunctive treatment due its content of methylxanthines, which act as bronchodilators, and antioxidants. Other herbal preparations have been used in the treatment of asthma, such as Ginkgo biloba extract and Tylophora asthmatica. The mechanism of action of Ginkgo is through inhibition of Platelet Activating factor, or PAF, which is accomplished by a component of Ginkgo called the ginkgolides. PAF is a key component in the inflammatory process in asthma, contributing to bronchoconstriction and excess mucous production. The dosage of Ginkgo that is recommended is 120g per day of the pure ginkgolides, which is presently very expensive to achieve. The mechanism of action of Tylophora is unknown but is felt to be due to antihistamine and anti-spasmodic properties. While several studies have shown Tylophora to be effective,  the response appeared to be blunted with time, making Tylophora ineffective for chronic use. HERBAL PREPARATIONS WHICH ARE CONTRAINDICATED IN ASTHMA: There are two herbal preparations that should never be used in asthma, which are Pine Needle Oil, and Fir Needle Oil. These are both used as expectorants, but they should not be used in asthma as they can intensify the degree of bronchospasm. SELF-HELP AND MIND/BODY WORK It is our opinion at Nature’s Healthcare that to improve any medical condition and to achieve improved health and wellness, it is important to strive for a sense of balance in one’s life. This involves setting priorities, proper time management, and appropriate lifestyle changes that allow us time for our work, time for our family, as well as time for rest, exercise, personal fulfillment, and spiritual growth. A number of Complementary and Alternative treatment modalities have been studied in asthma therapy and found to be effective. ACUPUNCTURE: The NIH established what is now known as the Office of Complementary and Alternative Therapies to evaluate complementary and alternative treatments, in order to determine which are effective. In 1997, the NIH published a consensus statement on the use of acupuncture, which was also published in the JAMA (Journal of the AMA) in December of 1998. The NIH found that acupuncture is useful for adjunctive treatment of asthma, as an acceptable alternative, or as part of a comprehensive asthma management program. CHIROPRACTIC AND MASSAGE: Both of these therapies have been used in the treatment of asthma, and have been found to be helpful in reducing the severity of an asthma attack as well as reducing the number of attacks. PSYCHOLOGICAL THERAPY: It is believed that asthma has an effect on psychological and social factors in the life of the asthmatic patient and his or her family, especially if the asthmatic patient is a child. The asthmatic child and his family may not be aware of such problems, or if there is a suspicion of a problem, they may not consider that asthma may be responsible. A number of psychological studies have been done to determine if psychotherapy has a place in the treatment of some asthmatic patients, and it has been shown that selected patients and their families benefit from psychological intervention as part of their asthma therapy. We would be happy to discuss with you this issue, and to help you determine if some form of psychological therapy or intervention would be of benefit. Individual therapy would be in order if asthma attacks seem to be brought about as a result of stress or other psychological factors. YOGA AND MEDITATION: At Nature’s Healthcare, we believe all of our patients should consider yoga and meditation as a means to achieve balance. As well, a study published in the Lancet in 1990 showed that two pranayama yoga breathing exercises were effective in achieving better asthma control, and should absolutely be considered for patients seeking complementary and alternative treatments for asthma. AROMATHERAPY: While not specifically helpful at reversing the bronchoconstriction of an asthma attack, some forms of aromatherapy are used to relieve nasal congestion, improve drainage of mucous, and soothe irritation of the upper respiratory tract, all of which play a role in the process leading to an asthma attack. Application can be directly around the nostrils or by inhaling from a cloth lavender, eucalyptus, or peppermint. We are pleased that you have chosen Nature’s Healthcare to assist you in your journey toward improved health and wellness. We hope you find this information helpful in that regard and we look forward to assisting you to implement those therapies you choose as part of your treatment program. Back to Top

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