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Autophagy: A Genetic Game Changer

Coffee With Dr. Stewart. Season 4 - Episode 3
Podcast Air Date: 2-15-2018

Listen in as we discuss with Dr. Kendal Stewart the explanation and findings of autophagy. Check out our exclusive line of autophagy support products.

Other products featured on this episode:


Kara Stewart-Mullins: Welcome to Coffee with Dr. Stewart. I am your host Kara Stewart-Mullins and this show is to provide our listeners with up to date medical information from a leading neurotologist and nutrigenomic specialist. I invite you to sit back grab your favorite beverage or cup of coffee and let's have coffee with Dr. Stewart. Good afternoon everybody and welcome to Coffee with Dr. Stewart. I am your host Kara Stewart-Mullins, and of course the man of the half hour Dr. Stewart. How are you?


Dr. Stewart: I'm doing great, Kara.


Kara: We had snow today, I mean last night.


Dr. Stewart: That's right.


Kara: Were you out playing in the snow?


Dr. Stewart: Not me, but I went out there with my coffee and with my kids.


Kara: Yeah, I saw your kids build a snowman. They sent me a picture.


Dr. Stewart: They did.


Kara: For this time of year that's some early snow for Texas.


Dr. Stewart: Yes it is.


Kara: I remember growing up in Dallas, we only had like… I had two snowmen and my whole lifetime I think of being a child. It just didn't happen. Well everybody Dr. Stewart picked the show topic today. So we're going to be talking about autophagy. I’m going to spell it, A-U-T-O-P-H-A-G-Y, autophagy.


Dr. Stewart: Autophagy.


Kara: Autophagy.


Dr. Stewart: Like auto.


Kara: Auto. So this topic is not a lot of people know about it. I don't really know anything about it. So Dr. Stewart's going to do most of the talking. But it's very important, and Dr. Stewart has some amazing things that he's been lecturing on about it. You're also going to be talking about it in our 2018 genetic workshop.


Dr. Stewart: Yes.


Kara: Right. Teaching some providers about it, because it's a game changer.


Dr. Stewart: Yes it sure is.


Kara: Okay, I'm going to do as I always do, I’m going to give you just what I found on the Internet, there's not a ton. I mean, there’s lots of Wikipedia and medical terms that they're very hard to understand. But the gist of it all is, think of autophagy as our bodies innate recycling program. Autophagy makes us more efficient machines to get rid of faulty parts, stop cancerous growths, and stop metabolic dysfunction like obesity and diabetes.


Dr. Stewart: Yeah. So basically instead of saying our bodies, it's our cellular recycling program. And so autophagy, well what's really sad about is the medical community is not talking about it, but it won the Nobel Prize in Medicine last year.


Kara: Oh I heard you say that. For what exactly?


Dr. Stewart: For autophagy discovery. Yeah, it was Dr. Yoshinori Ohsumi from Japan and basically autophagy involves the ability of cells to actually keep themselves clean. So I like to think of cells as being small cities. And inside of a city everybody is going everywhere and people are driving different places, and that's exactly what goes on inside of a cell. We've got all kinds of things going on at once. And let's just imagine that we all produce trash.


Kara: Okay, we do.


Dr. Stewart: Let's imagine that we don't have a trash system in our…


Kara: No one comes by and picks up your trash cans?


Dr. Stewart: Nope. So basically there's a bunch of trash sitting around.


Kara: Like New York City.


Dr. Stewart: Mmm-hmm. Eventually if enough trash accumulates then you're going to alter the way the cell functions. And so autophagy basically is the process that was discovered that essentially takes the dead and decaying parts of the cell. So imagine, these are really important for cells that have to live a long time. So for instance skin cells, if I hurt my skin cells I just slough them off and I just regrow them. But things like the nervous system, the immune system, the pancreas, the liver, the kidneys, things that have to live a long time, and we can't really regenerate very well. We have to have a mechanism to keep that cell clean so it keeps working. And in particular in the nervous system, and for the most part in the immune system, those are really important because they're trying to produce neurotransmitters. They're trying to respond to all types of signals. So if we don't have a way to actually take all that junk that's accumulated from aging or from damage and essentially isolate it, dissolve it, and recycle the nutrition, and then spit out what we don't need…


Kara: Recycle the nutrition. What do you mean?


Dr. Stewart: Meaning, so let's say we build a mitochondria for instance.


Kara: Mitochondria is the battery the cell.


Dr. Stewart: Right. If that mitochondria dies, it's not going to do us any good to sit inside that cell. So we would essentially surround it with a little pocket.


Kara: And that's autophagy.


Dr. Stewart: Well that's the autophagosome. And then we take a little lysosome, which carries enzymes, puts it in there dissolves the mitochondria away, and then all the good amino acids and fatty acids we just recycle into the cell. So the cell keeps using it. It doesn't want to waste all that good nutrition.


Kara: So because the dead material in there will help, will make the cell function poorly?



Dr. Stewart: Right. So I'd like to think of type 2 diabetes as the ultimate example, because most people understand that. So in type 2 diabetes it's called insulin resistance. Whicfh means insulin is still there, it still binds to the cell when it tells the cell, hey taken sugar. But the cell is just so packed full of junk it can't actually execute putting sugar in efficiently.


Kara: What it’s supposed to do.


Dr. Stewart: That's correct. Now what's really interesting about this is that we kind of learn this backwards. We actually had a medication that essentially kind of led us to this discovery. And in fact it's a really interesting story. In 1964 a group of microbiologists went to Easter Island in the Pacific and they gather samples. And they wound up finding that form of streptomycin, that actually when they checked it they didn't see any fungus growing with, or any fungal spores. So they thought they had a drug. So they sent it to the University of Toronto and they jacked around for 30 years, and they finally came out with a drug called rapamycin.


Kara: I’ve heard you say that.


Dr. Stewart: Rapamycin is named after Rapa Nui which is one of the Easter Islands.


Kara: And this is a prescription?


Dr. Stewart: It's a prescription. Now the thing is they thought they had an antifungal, but when they really use it as an antifungal it didn't work very good. But they found that if they put it in very high doses it would suppress the immune system with very little side effects.


Kara: In a good way?


Dr. Stewart: Mm hmm. The transplant surgeons all know about it, because they were using high doses of rapamycin to suppress the immune system.


Kara: While they were doing the transplants?


Dr. Stewart: Mmm-hmm. After transplants to keep the body from rejecting it. And so what happened is, some Japanese scientist picked it up and started studying it and what they found was autophagy. They found out that there was a special system which is now known as the mTOR system, and that stands for Mammalian Target of Rapamycin. And basically that's the control center for how hard a cell is working. So when we get stressed, or when we're sick, or when we have something that's really stressful on the body our cells go into overdrive and they start working really hard. And by working really hard they produce a lot of byproducts. You understand? So in essence people whose cells are working harder are actually creating more byproducts and in essence aging the cell much quicker. So autophagy actually turns off in that situation.


Kara: What, because the cell’s so damaged?


Dr. Stewart: Well no, it's just because the cell is so busy doing other things. I like to tell people if you're running hard, going to work, and you're stressed out, it's Christmas you're cooking for everybody, you don't have time to clean your closet. So what happens is, but if you have vacation and you relax, then you might go and clean your closet. So what we actually use, what we know is, rapamycin in low doses actually slows down the mTOR system. And when you do that it's basically an anti-aging process. It slows the cell down.


Kara: So the autophagy can take place?


Dr. Stewart: And so all of a sudden the cell says ah I'm now and I'm relaxed, so I'm going to actually turn on autophagy, and I'm going to clean house.


Kara: Very good way to put it. Because I didn't know anything about this coming into it. I've heard you speak at the couple lectures very recently. I'm curious about the Nobel Peace Prize. I mean why…?


Dr. Stewart: It's not a peace prize.


Kara: I mean the Nobel medicine prize. So why did…? They were the ones that came up with the term, so this is not a medical term. It’s been around for…


Dr. Stewart: It’s a medical term. It’s Latin autophagy means auto or yourself cell-eating. So you're eating things inside cells.


Kara: Makes sense. How does this correlated? Because we're always talking about glutathione and toxins. How does autophagy and what glutathione does?


Dr. Stewart: Well, glutathione’s gets rid of chemicals, metallothioneins gets rid of heavy metals.


Kara: In the cells or in this body?


Dr. Stewart: Inside of cells. And then this gets rid of broken parts.


Kara: Of the cell?


Dr. Stewart: Of the cell.


Kara: Where the mitochondria...


Dr. Stewart: Dissolves them away so that they don't junk the cell up, because the cell has an architecture to it. If I have a big pile of trash in the middle of Westlake Drive, nobody’s going to drive down there. Do you understand?


Kara: Yeah.


Dr. Stewart: So you really mess up the flow.


Kara: Well can I mentioned something about the rapamycin? Because you've been on it.


Dr. Stewart: Yeah.


Kara: Let's mention the gene that you look at.


Dr. Stewart: So there's a whole bunch of genes, but the one that we…


Kara: They are going to be on our genetic tests coming up.


Dr. Stewart: Correct. So what's happening now is, we're trying to take all this basic science stuff and apply it to people. Okay now what's really interesting about autophagy is we're finding out that the oncologist figured out it was pretty involved in cancer pretty quickly. In fact, what happens in most cancers is the mTOR system is turned up, which means cancers grow fast.


Kara: And no autophagy takes place.


Dr. Stewart: Right. Well now we're actually able to link it to all the neurological diseases of aging – Alzheimer's, dementia, Parkinson's, Lou Gehrig's disease, multiple sclerosis. And so in general what's happening, and we’re linking that to all types of autoimmune based diseases. So all of a sudden we have this new frontier that in essence is able to open our eyes to ways that we can actually reverse some of these diseases instead of just supporting people.


Kara: Or never getting in trouble with them?


Dr. Stewart: Very possibly. I mean we're not quite at that level, but that's what we're thinking.


Kara: Well there's probably not enough studies out there yet to do it.


Dr. Stewart: No, not at all. And there are also very well-known natural things which we'll talk about in the second half of this, natural things that can help autophagy. But in general understanding and keeping your cells clean is a very simple concept for people to understand if you really stop to think about it. And so what happened is we always thought that…. So let me back up, 75% of my patients as a general rule, and I see sick people, when I look at their genetics, I put the right nutrition into them, they rocket to health. They feel great. They go out and tell everybody this is fantastic, and everybody goes about their way happy. Then there's this 25% that no matter what we seem to do, they don't get better, or they languish in they’re like, "Why am I not getting better?", and as a doctor you're thinking, "Why are these people not getting better?".


Kara: Right, it’s frustrating.


Dr. Stewart: And so they take up all my time, these are the 25% of people that really I just lay awake in bed at night thinking about. Well, all of a sudden we realize that these people all had autophagy.


Kara: Oh they were mutated?


Dr. Stewart: Well, so what was happening is their autophagy was defective. And so what was happening is we were giving the nutrition to the people appropriately, but because the cell couldn't either take it in or process it properly they were not getting the response from the nutrition because the cell was junked up.


Kara: So therefore autophagy wasn't taking place?


Dr. Stewart: Correct. And so those are the people. So what we're now doing, and we're in the process of doing, is stimulating their autophagy various mechanisms, and it seems that they are starting to get better. And when you start talking about Alzheimer's, Lou Gehrig's recovery…


Kara: Huge.


Dr. Stewart: I mean you're talking Parkinson's recovery, you're talking huge, huge things.


Kara: Wow, that is huge. Well let me ask you this, I know on the 55 genomics report that you created there is one autophagy gene.


Dr. Stewart: Yeah, it’s the ATG16L1.


Kara: And what is that do?


Dr. Stewart: It's just one part of the autophagy process. So all the autophagy genes, there's probably about 25 of them that we know right now. We're trying to figure out which ones are the clinically important ones. Seems to be ATG5 ATG16L, and various other parts of it. But they give funny names to some of them like Smurf.


Kara: Yeah, that’s in the reports coming up. The Smurf gene...


Dr. Stewart: Yeah, the scientists are kind of bored sitting in their lab.


Kara: It stands for something, it always does.


Dr. Stewart: Sure it does, but it's easy to remember, so we don't mind it. But in general, what you're really looking for is how can we tell who needs to be treated and who doesn't, especially when you're talking about prescriptives because the thing about rapamycin is rapamycin in low doses appears to be pretty safe. But there are lots of people we won't use it in yet, because we still don't know it's safe, like reproductive age women. I lived through the thalidomide age. We have friends that were born in the 1960s with small arms, and that was due to thalidomide which was a drug that was used back then.


Kara: Oh I didn't know that.


Dr. Stewart: So there are certain people that we just don't feel comfortable using these types drugs.


Kara: Well that's why you always try it first.


Dr. Stewart: Well and I always try it because… What I did is I took my worst patients put them on it first. I mean if you have Alzheimer's, or progressive dementia, or Lou Gehrig…


Kara: Right, you have to try something.


Dr. Stewart: You really don't have much option.


Kara: And what have you found so far?


Dr. Stewart: So it appears to be slowing the disease progression pretty significantly. Now we've only been working on it about four to five months now, and I didn't take it myself for three months. And what was really interesting is that my hair started turning darker.


Kara: Yeah, if anybody hadn't seen a picture of Dr. Stewart, he has got gray white hair, and he has black hair now . Not total black, but black hair sprouting a lot in the back and in the top. I'm looking at you right now.


Dr. Stewart: Gray hair is an autophagy based process.


Kara: So would you assume that gray haired men or women walking around there would have an autophagy issue?


Dr. Stewart: Very likely, especially if they grayed early.


Kara: Right, like you. You love talking about that, don’t you?


Dr. Stewart: Well, sure. And what also happened to me, and this is just anecdotal because it doesn't prove anything, but my vision did clear up. In fact, my vision went back to about 20/10.


Kara: Wow. And then your hair started to revert back to…


Dr. Stewart: The color and then my tinnitus actually went away.


Kara: Your ringing in your ears?


Dr. Stewart: Mm hmm. And so we suspect that probably… We know that macular degeneration is an autophagy process. We know that, well we suspect that hearing loss, progressive hearing loss of aging is probably an autophagy process.


Kara: Wow. You just gave us a lot of information. So we got to go to break. But I want to talk to you a little bit more about this anti-aging thing and a little bit more about some other nutritional elements that could help with autophagy. So we'll be right back with Coffee with Dr. Stewart.


[Music]


Kara: Welcome back everybody to episode three on season four. We are talking about this amazing topic I had no idea how interesting it was called autophagy. Dr. Stewart, so in the first half we talked about what was, the recycling system of the cells. Right, that's kind of the easy term. We talked about some genetic mutations that you been looking at. We talked about some prescriptions, the rapamycin that's been used.


Dr. Stewart: And there's also other prescriptions being developed especially in the cancer world, they are very similar to rapamycin. They're basically called mTOR inhibitors. And so mTOR inhibitors are going to be used in certain forms of cancer, in particular clear cell cancers which are like…


Kara: The clear cell cancer?


Dr. Stewart: They occur in the ovary, and the kidney, and other places. They are just a type of cancer that's a little bit different and so they're called solid tumors. And basically those type of tumors have a lot of mTOR activity, and there's not a lot of success with standard chemotherapy with them. So there's a lot of interest in how we can actually modify those patients.


Kara: Do you just read all the time?


Dr. Stewart: No, I just see a lot of patients.


Kara: And you have a photographic memory, because you know so much. I’m like where did this come from?


Dr. Stewart: Well, when you get on a topic obviously you can tell I'm pretty fired up about autophagy.


Kara: Oh, I knew you were because you were lecturing to a group of doctors, there was like 300 in the room. And you brought up autophagy and I saw your face light up, like it used to be methylation was like the…


Dr. Stewart: Well yeah. So what happened is I've always challenged doctors. Remember I had three primary principles of healing. There was inflammation control, and then there's methylation, and then there's mitochondrial function and detox falls under mitochondria function. And now there appears to be a fourth step and that's autophagy consideration.


Kara: So we've got to change all of our materials?


Dr. Stewart: Well the answer is maybe.


Kara: Yes, if you really think that's the fourth step.


Dr. Stewart: Well the problem is that the first ones you're involving nutritional, or prescriptive, or over-the-counter methodologies. But if the cell is not able to respond to those you're not going to accomplish it. So the thing is the cell… We never thought the cell maybe was the problem. Instead of saying we're putting in the right nutrition, but if the cell can't take it in and use it we're in trouble.


Kara: But like you said 25% of your patients were not responding to the methylation protocol, to the mitochondrial, because they can't take it. Because the cells just were so stuffed with junk.


Dr. Stewart: That's exactly right.


Kara: I mean, I wish we could just have people would put articles out like that, because it would make a lot more sense. You need to write one. Well then let's talk about… Okay, so you get the patient's genetic report. Because this is stuff you're going to be teaching at the 2018 genetic workshop. Tell us what you're going to tell these providers on the new thing.


Dr. Stewart: Well what happened is… I get lucky I run into different professors and ex professors and physicians, who have experience in this area. And I did run into Dr. Kaushal from Florida.


Kara: Right, nice guy.


Dr. Stewart: And Dr. Kaushal an ophthalmologist, and he had been working on macular degeneration. And macular degeneration as an autophagy problem. His lab at the University of Florida had previously worked on ways to stimulate autophagy. And so we learned that obviously rapamycin was very effective at helping that. But we also learned that there are many things that are natural that can actually help people. Okay, and that that natural way to help people… Most people know that if we can exercise, we will essentially… Nobody knew exactly why exercise worked. But it turns out that exercise is a major mTOR inhibitor and actually can help you clean your cells. The problem is if you're too far gone, you don't feel like exercising.


Kara: You're too tired.


Dr. Stewart: Too tired. And my patients are sick and they want to exercise, but good luck.


Kara: Like me I want to exercise, but it just wears you out.


Dr. Stewart: You just don't feel like it. Okay. We did find out that at least 12 hour of fasting helps. So if you eat dinner at 7:00, try not to eat till 7:00 the next morning.


Kara: Or it says, don't eat till 11:00 and then stop eating at 7:00.


Dr. Stewart: And some people live 16 hour fasting is what they push.


Kara: You skip breakfast, which I do, but then..


Dr. Stewart: Right. And so that that's also falls in the calorie restriction area. So a lot of people who have autophagy defects they pretty much push high fat, low carb, low protein diets.


Kara: Right. The protein thing got me. It says high protein will well inhibit autophagy.


Dr. Stewart: Yes. So what happens is you're asking the cell to process a lot.


Kara: So all these bodybuilders and people out there, I mean they probably have healthy autophagy, so they can eat these high, high protein diets?


Dr. Stewart: No, they have bad autophagy. Remember, it’s genetically programmed into you. So the problem is as bodybuilders as they get older many of them are not very healthy at all.


Kara: No, they’re not.


Dr. Stewart: Just like athletes, like NFL football players for instance, and I'm not saying that this is the reason. Okay. But I'm telling you, because they're large men and they produce a lot of byproducts, they used a lot of things, their average lifespan is 58.


Kara: You think they're autophagy starts to shut down?


Dr. Stewart: I certainly thing that a lot of things contributed to that, but these are just questions that we ask ourselves.


Kara: And we need to figure out.


Dr. Stewart: Ultimately, if we help them and we have genetic ways to identify that there's a problem, then we ought to be able to help. So obviously injury plays a big role in making cells work too hard and progressing autophagy weakness. And so you know we're just trying to put our hands around this thing and understand. Now as far as the natural things that help, what's really interesting is there are many natural things that a lot of people know are good for them like curcumin.


Kara: Turmeric


Dr. Stewart: Catechins, which come from green tea. Berberine


Kara: Catechins, what is that in?


Dr. Stewart: From green tea.


Kara: But it's in one of our products.


Dr. Stewart: Sure it is.


Kara: Which one is it?

Dr. Stewart: The NRF2.


Kara: The NRF2 SOD enhancer.


Dr. Stewart: So basically a lot of these different products we knew they were beneficial, we just didn't understand the whole thing. We thought that they helped glutathione production which they do. But it turns out they're actually autophagy stimulators too.


Kara: The NRF2 SOD enhancer, you made that for something else, which happens a lot. You make it for something else, and it turns out to help something else.


Dr. Stewart: It has dual roles. Yeah. And so obviously curcumin is a wonderful thing and many people know that. But we didn't realize that it had these dual role roles until we really understood what autophagy was. So yeah, curcumin is excellent for you. Catechins are outstanding for you. Resveratrol.


Kara: That's all in the NRF2.


Dr. Stewart: Well, and that resveratrol comes from red wine. A lot of people who drink red wine did well. Well we didn't know why. You understand?


Kara: Is that why I do so well, because I drink red wine?


Dr. Stewart: The answer is possibly. Okay. So what's happening is, the neatest thing about this is that science is not static. You think you know it all, and you all of a sudden learn you don't. And if you don't keep an open mind and understand and always try to progress it, you're just going to be left behind.


Kara: So tell us about, so the NRF2 SOD we cover back with the glutathione episode. How does it help with the autophagy? Because we talked about the leucine zipper.


Dr. Stewart: Yeah, so it helps the leucine zipper to help glutathione production and all the cleansing mechanism of the cell. But it also is an autophagy stimulator.


Kara: And what can it do for autophagy?


Dr. Stewart: It blocks the mTOR system or calms the cell down.


Kara: So it has the opportunity to…


Dr. Stewart: Correct. So curcumin in essence tells the cell to relax, clean itself, just calm yourself down. A lot of people thought it as an anti-inflammatory because it calms immune cells. You understand? And so the thing is, is that…


Kara: And this is an inflammation control?


Dr. Stewart: Yes. Autophagy is involved in inflammation. Meaning when you have a cell that's inflaming, which is the immune system. That cell is working overtime producing a lot of secondary byproducts. And so auto immune diseases are basically autophagy at risk diseases.


Kara: Now what about for the Pro GAD, that's our latest formula for anxiousness and relaxation. You're saying, "Calm down". You're talking about the cells, you're not talking about physically?


Dr. Stewart: No, you don't want to talk about the physical. This is all about the cell.


Kara: The cell itself, okay. I just want to make sure I'm on the same page with that. Well then talk about what you're going to, like I said, to teach these providers at the workshop, how to look at the genetic mutations.


Dr. Stewart: Well and to understand the treatment. I mean all providers who do nutrigenomics and nutritional medicine or functional medicine, or even people who are...well I would hope that all doctors eventually will get to this point where they actually nutritionally...all patients are interested in nutrition for their body. And so in order to understand, there's nothing more frustrating than taking a nutritional product and not getting the benefit from it.


Kara: Or you don't know if you need it.


Dr. Stewart: And you feel like you've wasted your time and your money. Well in the really sick people that's a really big challenge, because you may be given exactly the right supplement. But if the autophagy is not right in that cell, then the supplements not going to work. So I think I have autophagy consideration at number four right now.


Kara: Okay. In the healing process?


Dr. Stewart: Right, because we're doing it on a clinical perspective. Let's take your inflammation out, let's put the nutrition in, and if you don't respond let's go look at autophagy. Hopefully with genetics autophagy consideration may actually be moved to number one. Because if we can't get that cell to respond to even the anti-inflammatory processes we're asking it to do, then we're wasting our time.


Kara: How many genes are going to be on our on our genetic panel for genomics?


Dr. Stewart: Well, we're expanding those genetic panels and to kind of sub panels. So we're probably going to have at least 12 of them right now.


Kara: 12 autophagy genes? Really?


Dr. Stewart: Yes.


Kara: Wow that's a lot. You got a lot of work to do.


Dr. Stewart: The work's being done by great scientists that are out there. I always tell people I didn't do any of this, this great work. But my job is basically to pay attention and to assimilate it and hopefully bring it to the public.


Kara: Okay. And so with efficient autophagy, it says your body's internal cleansing mechanism. Your stem cells retain the ability to maintain and repair your tissues. So stem cells is a big hot topic, that's our next episode. How does autophagy correlate with that?


Dr. Stewart: Well obviously a stem cell, when you're putting it and you're asking it to convert to the cells that have been damaged or are weak in that particular area. So what's important about that is you want to know what the stem cells autophagy genes are. So in theory, we're actually going to be able to, in stem cell therapies, tell who's going to be more successful at it, who's going to be less successful at it based on your autophagy genes.


Kara: Well, that leads to our next show. So I'm going to leave it with that everybody. Very interesting, I mean this is fascinating. I didn't know anything about it until I started reading and I've heard you talk about it. But I think you're onto something or the scientist and Nobel and all that are onto something very, very big here.


Dr. Stewart: Big, big, big.


Kara: Big game changer. Well everybody, I'm so glad that you joined us today. Please check out our next episode. If you have questions please email info@neurobiologics.com, or you can call us at 866-500-5388. And I hope everybody has a beautiful and blessed day. Thank you.


Speaker:

This show is intended for general information and entertainment purposes only. Dr. Stewart serves as the Chief Science Officer and lead formulated for Neurobiologix and advises you to consult with your own medical professional on any information given during this programming. This information is not intended to diagnose, treat, or cure any disease or medical condition.