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Aluminum in Vaccines vs. Food

What is the number one source of aluminum in the diet?

January 4, 2010 |
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Acknowledgements

Transcript

Speaking of toxic metallic elements, there continues to be growing concern about aluminum exposure and the development of neurodegenerative diseases such as Alzheimers. But how are we exposed?
This is how much you get cooking acidic foods like tomato sauce in an aluminum pot for an hour. Aluminum is also added to childhood vaccines as an immune irritant to improve efficacy, but it’s come under fire from some parenting groups. This is how much you get smoking a pack of cigarettes, and this is how much you get if you use aluminum-containing antiperspirants. But researchers just found a food item that blows these other sources away.

What do you think it is? Is it Brussell sprouts—many of you wish it were Brussel spouts. Cheese, chicken, eggs, fish, or shellfish.
The highest natural levels of aluminum are found in shellfish, but the highest levels overall is in cheese. Why? Just like the poultry industry adds arsenic to chicken, the dairy industry adds aluminum to cheese, the number one source of aluminum in the diet.
Why would they do that? The aluminum salts produce a “smooth, uniform film around each fat droplet” to prevent something called fat bleeding and to give the cheese a softer texture and “desirable slicing properties.”
So if you’re a parent worrying about the aluminum in vaccines, every grilled cheese sandwich you give your kids, is like injecting them with a dozen aluminum containing vaccines.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out theother videos on cheese. Also, there are 1,449 other subjects covered in the rest of my videos--please feel free to explore them as well!

For more context, please refer to the following associated blog post: Should We Avoid Titanium Dioxide?

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other videos on cheese. Also, there are 1,449 other subjects covered in the rest of my videos–please feel free to explore them as well!

  • http://nutritionfacts.org/members/WendyWhite-2/ Wendy White

    Dr. Greger, can you point me to more information about the latest research on the link between Aluminum and neurodegenerative brain disorders? Is there new and or more research suggesting a link between aluminum and Alzheimer’s. The Alzheimer’s Association seems to still be suggesting that it’s a myth. Perhaps it takes a long time or more compelling research to change their recommendations.
    http://www.alz.org/alzheimers_disease_myths_about_alzheimers.asp

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      The latest review I’m aware of was published last year in the journal of Alzheimer’s: http://www.ncbi.nlm.nih.gov/pubmed/20378957. As you can see it remains an unanswered research question. As I noted to JJ below, though, until we know more, it is reasonable to try to decrease our exposure.

      • John

        what about the aluminum in tea? How much is in green tea? Thanks!!!

  • JJ

    This video ends with: “Every grilled cheese sandwich you give to your kids is like injecting them with a dozen vaccines.”

    Is this really true?

    I thought this information was so compelling that I went around telling it to everyone after I first watched it. I was met with a lot of skepticism.

    So, I tried to do my own research. What I came up with is that only “processed cheeses” have large amounts of aluminum added. According to Wikipedia, a processed cheese is a cheese product that is made *from* normal cheese.

    I’m sure some parents really do give their kids that processed stuff. However, plenty of parents also are likely to use normal/regular cheese. So, is the ending sentence missing a qualifier word? Ie, should it be: “Every grilled processed cheese sandwich you give to your kids is like injecting them with a dozen vaccines.”

    Or did I not do enough research? When I tell people this stuff, I want to be accurate. Thanks for any clarifications you can provide.

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      The aluminum is indeed added in the processing, but that is what American cheese is, processed cheese (American cheese is the cellophane-wrapped slice that one typically makes grilled cheese sandwiches out of. In fact that’s why you make grilled cheese sandwiches with American cheese because it melts easy (thanks in part to the added aluminum)). I’m not saying that chronic aluminum ingestion is necessarily pathogenic. The risk of aluminum, as I noted in the video, remains an unanswered research question (see this review http://www.ncbi.nlm.nih.gov/pubmed/20378957 last year for example). I do think it’s reasonable, however, until we know more, to try to decrease our exposure.

      • JJ

        I get that the “American Cheese” brand is “processed cheese”. And it may be true that lots of people use that brand to make grilled cheese sandwiches, but certainly not everyone. My family (not me any more) makes grilled cheese sandwiches only with regular cheese. My family eats lots of regular cheese, but doesn’t touch processed cheese. When I told my mom about how much aluminum she was getting, it was not true. Yes?

        You didn’t say “processed cheese” anywhere in the video. I just listened to it again for like the 7th time. The words in the video only say “cheese” time and again and the graph also only says “cheese” – meaning that all cheese is given aluminum salts. This is not true from what I am able to determine.

        I think it is an important distinction to make. I don’t want to run around telling everyone that cheese has all this aluminum when in fact only some “processed”/fake cheese have it and regular cheese does not.

        Your point about the pathogenic nature of aluminum being unknown is well-taken. As is the part about wanting to limit aluminum in our diet. I think most people would agree with that – which is why I wanted to tell people about this.

        As something of an aside: I recently got a recipe book called “Uncheese…” (The Ultimate Uncheese Cookbook: Delicious Dairy-Free Cheeses and Classic “Uncheese” Dishes) It has a recipe for “Geez Whiz” which is suppose to be something like processed Cheese Whiz. I haven’t eaten real Cheese Whiz in many years, so I can’t say for sure, however, I think the Geez Whiz is pretty authentic tasting and has an authentic texture – and it is pretty healthy too. I mention this just in case someone wonders if there is a way to get that processed-cheese experience without the aluminum.

        • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

          I’ll have to try that recipe! As noted in the video, if your cheese does not soft, easily melting, and with “desirable” slicing properties than it is unlikely that the dairy industry added aluminum salts to it. I guess the only way to be sure is to contact the company directly (since it is just used in processing they don’t have to list it in the ingredients),

        • ann

          I’m amazed at the lengths people will go to avoid a particular substance while ignoring the facts. Cheese, as in all dairy, is harmful. Casein, the protein in dairy, has been proven to cause cancer, osteoporosis, diabetes and heart disease. Dairy is also the cruelest industry on the planet. Maybe the safest, and smartest thing to do is avoid dairy altogether.

  • http://nutritionfacts.org/members/becochic/ becochic

    You know, injecting something directly into the bloodstream is NOT the same as ingesting it. So… it isn’t a fair comparison.

    Either way, I wouldn’t want to eat that much, though.

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      You’re absolutely right becochic, but in the calculation I took into account the relative bioavailability of the aluminum ingested orally.

  • http://nutritionfacts.org/members/gregv/ GregV

    I use a Body Deodorant Stick called “Crystal” which says it has “No Aluminum Chlorohydrate” but it has Natural Mineral Salts, and Ammonium Alum.
    What are your thoughts on this form of aluminum?

    What do you use for deodorant?

  • http://nutritionfacts.org/members/zgal/ zgal

    What about the use of aluminum foil in cooking, such as lining a baking pan with aluminum foil when roasting, or wrapping it around corn to cook on the grill; thoughts?

  • http://nutritionfacts.org/members/SandyL/ Sandy L

    CHEMICALS ARE NOT SAFE IN INJECTIONS JUST BECAUSE THEY ARE IN FOOD
    Medical students learn that substances behave differently when they are injected or ingested – why do so many appear to forget this basic fact?

    EVEN WATER IS NOT SAFE WHEN IT IS INJECTED
    As with other substances, water behaves differently when injected, in fact it is dangerous.
    Injections containing only water should never be administered because they cause irreversible damage: hemolysis/bursting of blood cells.

    That is why if injection of water is required it must be mixed with another substance to regulate isotonicity so that blood cells will not be damaged. One example of a substance which is often used for this purpose is sodium chloride. An injection of 0.9 per cent sodium choride is ideal as it presents least damage to blood cells.

  • http://nutritionfacts.org/members/mandy0678/ mandy0678

    Thankyou Sandy for clarifying this, I was about to lose my mind b/c my daughter as a toddler ate a slice of cheese every day. She hasnt in a long time, but here i am thinking she is going to get some kind of cancer or alzheimers!

  • Bec

    I’m having trouble scrolling through the comment thread, I can only see the top one and cannot scroll through the rest, it just doesn’t move.

    • Azoraa

       I do not eat the “cheese food” slices at all as I consider it to be fake cheese.  But I do get other types of cheese with food such as the white cheese on a pizza or the feta in a greek salad for example.  Am I getting aluminum poisoned?  After watching the video I got the idea that I need to eliminate all types of cheese, but the comments suggest otherwise.

      • DrDons

         Non “processed” cheeses may be less likely to have aluminum which is a worry and should be minimized. There are however many other reasons to avoid cheese which is highly calorie dense, contributing to obesity, contains cholesterol & saturated fat, contributing to arterial disease, and contains chemicals such as dioxin see http://nutritionfacts.org/video/dioxins-in-the-food-supply to the risk of cancer and hormonal considerations. In children dairy products have been associated with early onset of puberty (something I believe most parents would like to delay for reasons along with the health benefits of delayed puberty) see…http://nutritionfacts.org/video/dairy-sexual-precocity/.

        • oderb

          Interesting how you did not mention the Rotterdam Heart Study which showed that eating hard cheeses was associated with a 57% decrease in cardiovascular events. Show me any other action that can lower heart risks by over 50%!
          Your vegan agenda is evident in your choice of data to highlight.

          • http://www.DonForresterMD.com/ Don Forrester MD

            The current science supports a whole food plant based nonGMO diet with adequate B12 intake. This is consistent with our biological design as “hind gut” fermenting herbivores. Beyond human health there is also the environmental impact of raising animals not to mention the suffering involved… not only the animals but the workers in the associated industries. So I guess my “agenda” would be more aptly labeled “global health”. Back to the study… I’m not sure I have reviewed that particularly study but would be glad to if you sent me the link… a quick pubmed search didn’t turn it up. Most studies that are used by folks to support their beliefs that consumption of animal products are beneficial are usually poorly done, relative studies and/or cite statistics without understanding. The saying, “s/he uses statistics like a lamp post more for support than illumination” comes to mind. In my CME talks with clinicians I recommend three references: first, Dr. Gilbert Welsh’s presentation, “Two Most Misleading Numbers in Medicine” available for free on the McDougall website under free lectures; second read the Nordic Cochrane Collaboration pamphlet, Screening for Breast Cancer with Mammography; and third, Dr. Goetzche’s book, Mammography Screening: Truth, Lies and Controversy which details all the studies done and is a great introduction to the practical issues of interpreting clinical studies. The most frequently cited CV study is the Lyons Heart Study which is an example of an intervention which showed improvement over the control group. That doesn’t make it the best intervention. Another study that comes to mind is the DASH study. I think it is important for clinicians to make sure that their patients are prescribed the best approaches and not a better approach (e.g. Barnard diet over American Diabetic Assn. Diet, Esselstyn(not Ornish) over the American Heart Assn. diet). I’ll look forward to the link.

          • Toxins

            I agree with Don below, the study link would be useful in analyzing its applicability.

  • Elma

    Dr Greger,

    Do you know if veggie “cheese” such as Veggie Shreds/Slices has aluminum added so that it will melt easily?

    Thanks,

    • beccadoggie10

      Veggie “cheese” is made from soy. A huge amount of soy is genetically engineered with organisms from another species so that it resists incessant spraying with as many as three different and very toxic weed killers. I’ve never seen any certified organic veggie cheese.

  • Laplueidanser

    I need some advice on what to do about my teeth…

    • Deepblueabyss

      Have them gold plated and have your initials tatood on your gums

  • Sryan

    I would like to know if you have an opinion on the dangers of using aluminum  cookware.   I have a lovely old-fashioned silver-plated aluminum teapot which my mother brought from England in the 50`s.  I love this little pot but barely use it because I’m worried about the connection to alzheimers.  I am vegan so don’t load my body down with animal product toxins so I’m hoping that perhaps my body can handle low levels of aluminum.  Is there a “safe” level to ingest on a daily basis.

  • JamesKB

     Hey Tina

    Despite what you’ll hear from fad diet book authors and internet bloggers, the world of science doesn’t drastically change it’s opinion on important matters very often at all. There’s always the odd scientist that likes to bend the truth of course or out right lie even.

    Sometimes things will be called harmless, later to be called harmful. Sometimes things will be called harmless and then later found to be healthful, but not many things make the leap from harmful to healthful.

    Often research is said to say something it doesn’t in the media. Like how tea and coffee were said to be dehydrating when really the studies were looking at strong caffeine tablets.

    Smoking will never be good for you. Neither will a steak unless you’re starving or not taking a B12 supplement. Fibre and antioxidants will never be harmful unless we conduct an experiment with unrealistic amounts of them perhaps. Maybe we’ll one day discover that fibre and antioxidants aren’t as healthful as we thought. Might turn out to be something else in the fibre, antioxidant rich foods that’s helping, but whatever it is, we still know looking for fibre, antioxidant rich foods is a good idea.

  • http://www.facebook.com/ali.canani Ali Canani

    Dr, I am a bit confused. The aluminium in vaccines enters the blood directly bypassing all the body’s defenses where as in the case of cookware, cheese, etc, it enters the body but through regular entry points. Surely the body can deal with aluminium differently if it enters through the mouth instead of in the vein directly. Kindly help. Thanks

    • http://nutritionfacts.org/ Michael Greger M.D.

      I did indeed take reduced oral bioavailability into account when I made the calculation–thanks for your question!

  • http://www.facebook.com/derek.hart.940 Derek Hart

    Dr. Greger, do you think that most organic cheeses do not have anywhere near the aluminum?

  • http://www.facebook.com/dan.lundeen Dan Lundeen

    My friends over in the paleobubble of course say that seeds are trying to kill us all — and soy is especially bad because it has aluminum, aluminum I say! Will I get Alzheimers if I eat organic edamame or drink organic soy milk? [No more than 2-5 servings/day per your excellent video re how much soy is too much, which also does not mention the Al-soy angle.]

    • http://www.DonForresterMD.com/ Don Forrester MD

      Aluminum has been implicated in Alzheimer’s Disease but so have copper, iron, zinc and mercury. Saturated fat and cholesterol are also associated with increased incidence of dementia(multi-stroke and Alzheimer’s Disease). On the positive side to avoid these conditions getting regular physical exercise, adequate sleep, mental exercises and plant based sources of certain vitamins… E, Folate, B6 and B12. You need to avoid taking supplements as the fat soluble vitamins A and E have been associated with increase morbidity and mortality…. see video http://nutritionfacts.org/video/antioxidant-vitamin-supplements/ and more recently see… http://nutritionfacts.org/video/update-on-vitamin-e/ . By avoiding supplements you will also most likely avoid iron, zinc and copper as many multivits have those as well. You should also view the videos on Alzheimer’s Disease on Nutritionfacts.org see… http://nutritionfacts.org/video/dietary-theory-of-alzheimers/. Pulling all this together is the upcoming book, Power Foods for the Brain by Neal Barnard which will be available on Amazon next month. Bottom line I would worry about the minerals in nuts and seeds when taken in moderate amounts such as 1-2 oz per day.

      • elsie blanche

        You mention that you would worry about the minerals in nuts and seeds when taken in moderate amounts (1-2 oz. per day). It seems to me that moderate servings of some beans match similar amounts of minerals as do these nuts and seeds. Would you suggest worrying about the minerals in these beans?

        • Lyra

          I imagine that Dr. Forreser meant to say that he *wouldn’t* worry about nuts and seeds in moderate amounts. Am I wrong?

          • Devin Wiesner

            I would tend to agree with Lyra’s reading of Dr. Forrester’s comments. Also, nuts and beans are high in phytic acid which binds to minerals, such as aluminum which reduces their bioavailability…Also another key takeaway from Dr. Forrester’s comments is more recent studies showing that vascular issues (his reference to saturated fat and cholesterol) may be a significant contributor to the development of dementia.

          • http://www.DonForresterMD.com/ Don Forrester MD

            Thanks for the additional comments. I corrected my post re: nuts.

          • http://www.DonForresterMD.com/ Don Forrester MD

            Lyra… Thanks for catching my error. I corrected it.

  • Shari

    How can eating something be compared to injecting something? I’d think an injection which doesn’t not get broken down, but goes directly into our blood must me more potent.

    • Devin Wiesner

      Hi Shari, you are correct and indeed scientists have been able to measure the difference in bioavailability of aluminum through injection versus ingestion. The study that Dr. Greger cites, focuses on this very issue. You can find this study under “Sources Cited”, below the video.

  • heatherdee

    We use BPA free canned beans for ease. I’m glad it’s BPA free, but what about the aluminum getting into our food and increased risk of things like Alzheimer’s?

    (Not to mention that I’m guessing that since BPA has to do with plastic, that a plastic coating is what is in direct contact with the food. I’m concerned about the leaching here as well.)

    Is it worth the time and effort to be cooking large batches of bulk beans and freezing them?

    • Wegan

      I believe the can is steel.

  • ShariLyn

    Is the aluminum in only processed cheese or in all hard cheeses?

  • SailingSomeday

    can you comment on the effects of the aluminum in titanium implants?

  • DrBarbaraHoldeman

    Could this be a cause of migraines in people that get them from eating cheese?

  • beccadoggie10

    Dr. Neal Barnard speaking on PBS, said that aluminum sulfate is used by municipal water treatment plants as a clarifying agent for water that comes out of the tap. He suggested purchasing and installing a Reverse Osmosis Filter in order to protect your brain from the Aluminum. I have yet to purchase an RO filter, but I have found that eating more blueberries seems to sharpen my cognitive ability.

  • Borkent

    What about immunotherapy for allergies? People get several shots a month containing aluminum hydroxide. It worried me so I stopped my therapy. And I’m happy I’m not eating a sandwich with cheese every day, like I used to.

    • http://www.DonForresterMD.com/ Don Forrester MD

      Aluminum has no known biological function in the body. Our bodies have the ability to excrete Aluminum through our kidneys. Aluminum is poorly absorbed by GI tract so we are somewhat protected. Direct injections by pass that protection. The key issue is the amount since our bodies will get rid of it. It can accumulate so it is best avoided or minimized. Dr. Greger’s video does a nice job at providing the relative intakes given various sources. Clinically it depends on the risks/benefits. Congratulations on moving beyond cheese.

  • ardis

    what kind of cheese? all cheeses?

  • Rufus Cadigan

    Your opinion on whether to have a vaccine, such as for flu and shingles?

  • New Subscriber

    Do all cheeses contain aluminum? What about cream cheese, mozzarella and cheese made from organic milk?

  • Humzee

    A lot of the confusion about proper diet comes from the assumption that there is ONE diet that is best for EVERYONE. Roger Williams documented the wide variety of structures and functioning in our human species. Scientists like Pottenger, Kelley, Watson, Wolcott, have gone on to show that diets based on ones’ metabolic or oxidative type prove to be more useful than just prescribing ONE diet for EVERYONE. Example: Parasympathetic dominants tend of have overly alkaline blood pH. Eating the “healthy” way with lots of fruits and veggies drives their ph even higher, further away from the optimum pH of 7.46, making them feel worse, whereas Sympathetic dominants have more acidic blood and need the fruits and veggies to bring their blood pH up to 7.46. Find out more about metabolic typing and you’ll find out what your body specifically needs.

    • Toxins

      Any studies to back your claims?

      • Humzee

        I can list several sources of information which if you want to check their references you can find sources for the above statements. To look through and list sources for these statements would take more time than I have for a casual statement in a blog.
        Biochemical Individuality by Roger Williams (sample reference: Motulsky A. Human genetic variation and nutrition. Am J Clin Nutrition 1987, 45:1108-1113).
        Metabolic Typing by William L. Wolcott. Nutrition and Physical Degeneration by Weston A. Price. The Nutrition Solution: A Guide to Your Metabolic Type by Harold J. Kristal. One Man Alone by Nicholas Gonzalez, MD.

        • Toxins

          Its difficult to come to our own conclusions based on the opinions of other authors. I would like some solid evidence.

          • Humzee

            Well I would like the tea party Republicans to quit holding the congress and the American people hostage, but it doesn’t look like that’s going to happen. If you want some solid evidence you’re going to have to look it up and read it for yourself. I’ve given you some reference books with medical references in them to begin with. These are not just author opinions put into print. I’m not going to do your work for you – you wouldn’t believe me or my references anyway if I wrote something that conflicts with your already preconceived paradigm of the one best diet for mankind. I have studied human nutrition for many decades and have yet to come up with a unified nutrition theory that explains it all but I firmly believe that the variability in structure and function of the human species is best served by a variety of diets that are individualized.

    • Thea

      Humzee: While I can’t say anything definitively about the particular diets you are talking about, I did want to say that this sounds an awful lot like the “diet for your blood type” – which is simply wrong.

      The reason I feel comfortable saying anything at all about your comment is that this site alone provides such strong evidence that (baring a genetic deficiency), there really is one basic diet that applies equally well to the vast majority of humans.

      It would sure take a whole lot of evidence to over shadow the current mountain of evidence we currently have. I encourage you to take a look at the great information on this site.

      • Humzee

        There are many “typing” systems out there that attempt to tailor diets to specific populations: blood typing, ayurvedic doshas, metabolic typing oxidative typing, etc. some more useful than others. I agree with the inaccuracies of the blood typing system. The other three mentioned have proven to be more useful. They are based on a person’s individual biochemical and physiological make-up. I have studied the hunter-gatherer diet as put forth by Cordain and others and have come to the conclusion that it works well for those with a parasympathetic nervous system dominance (or protein types as they are sometimes called) and it is a disaster for those with a sympathetic nervous system dominance. As an example Dr. Robert Atkins used a variation of the paleo diet to treat a wide variety of ailments quite successfully but dropped his cancer treatment program using the same because of dismal results. The paleo approach works best with parasympathetic dominant types and poorly with sympathetic dominants who need a more plant based diet. You can check any of the work by Nicholas Gonzalez or William Donald Kelley who used this approach to achieve the best results known to modern medicine in treating cancer.

        • Jen Drost, Physician Assi

          Hi Humzee, So happy you have found this site…you sound super smart and like you have done a lot of research on nutrition :)) All I would say is to exercise caution when reading the work on anyone who is practicing medicine for profit and not thinking about the best interests of the patient. Check out Kelly and Gonzales about 1/2 way down on this link http://www.quackwatch.org/01QuackeryRelatedTopics/cancer.html
          Hugs :))

  • Kris Fowler

    I just started reading Dr. Barnard’s Power Foods for the Brain in which he recommends to limit Tea consumption because of its absorption of aluminum into the leaves. And yet Dr Greger has discussed its health benefits at great lengths as well (especially green tea and hibiscus). Is there an optimal range of consumption then? How much it too much? Thanks

  • Shelley Tzorfas

    I appreciate learning about cheesy aluminum and urge my clients to remove such things. Shell of the book,”Recovering Autism, ADHD, & Special Needs.”

  • Jen Drost, Physician Assi

    Hi Humzee,
    Very interesting read :) Thanks for sharing! I agree with you, we probably all have our own reasons for believing what we do…speaking of which, have you seen my very favorite Dr. Greger video? http://nutritionfacts.org/video/the-tomato-effect/
    Be well, my friend :))

  • Humzee

    Hi Jen, I have ordered 17 DVD’s so I will get a full dose of Dr. Greger’s knowledge soon! I haven’t watched the one you gave the link to. I have a satellite internet system and am limited as to how much I can download. Alas I am almost out of downloading allotment until Oct 8 so I will have to wait to watch it. I did preview the first minute or so and I can tell you that I like Dr. Esselstyn’s approach but have some reservations about its need to be so draconian – again I think his approach could be refined with some individual adjustments and he really doesn’t go far enough to discourage usage of all refined carbohydrates nor does he take into account the best ways to prepare grains to limit phytates, etc. as we see in traditional ways of preparing these complex carb sources. One of the reasons I’m low on download allotment for this month is that I did watch a lot of Dr. Greger videos and like his manner of presentation although I keep trying to read the actual research papers often shown in the background when he makes some nutritional point… frustrating as it never shows the whole paper..

    Gotta go to bed.. get my fix of natural melatonin…

  • Jen Drost, Physician Assi

    Humzee,
    Wow, you will be the expert! :) You are in for a treat! :) Can’t wait to hear what you think about them. Enjoy your DVDs! Cheers