Chronobiologyletter

ChronoBiologyletter

Summer 2012 ▎ 12th Edition

Diagnos-Techs™ The Problem with One-Day Clinical & Research Laboratory Quarterly Newsletter Testing for Cycling Women

Other Articles IN THIS EDITION John J. White, MD, CM 3 Timing TAP™Collections for Shift Workers an a cycling woman’s hormones be assessed Caccurately with just a single day’s testing? A newly 4 The Therapy Corner: available one-day, cycling female hormone saliva test Helicobacter pylori certainly sounds like a good -- or at least convenient -- alternative to testing throughout the cycle. However, the 6 Diagnos-Techs™ Free Webinars reality is that an individual womans menstrual cycle in no way compares to anothers, and a female hormone testing 7 Resources for You protocol that places mere expedience over accuracy is not of value for any woman. -Insurance Billing -Technical Services -Shipping & Contact Info Diagnos-Techs™ Whole-Cycle Testing Vs. a One-Day Snapshot For many years, Diagnos-Techs™ has offered female hormone panels specifically designed to deliver an accurate picture of a woman’s cycling hormones, without burdening her with unrealistic testing schedules and methods. Our Female Hormone Panel™, for instance, takes a snapshot at 11 discrete points in the menstrual cycle, providing cycle-wide data. Women simply collect saliva at ™ Find Diagnos-Techs approximately two- to three-day intervals through their cycles, a design that’s Physicians been well accepted over the years by patients and widely praised by healthcare practitioners for its accuracy and ease-of-collection. John J. White, MD, CM Some labs have introduced a one day menstrual cycle test which involves Often, Diagnos-Techs™ testing may collecting four vials of saliva on the 21st day of a woman’s cycle. The test consists indicate a need for pharmaceutical of a circadian cortisol rhythm assessment, plus pooled testosterone, estradiol, intervention. For practitioners without and progesterone values. The latter two values are processed with a mathematical prescription-writing privileges, this formula, purportedly to diagnose luteal phase failure and estrogen dominance. means finding an allopathic physician Continued on page 2. or other healthcare practitioner who’s experienced in interpreting ™ Diagnos-Techs saliva test results and ™ comfortable prescribing medications Diagnos-Techs has gone Paperless based on those results. In an effort to be more mindful of the environment, we will A comprehensive resource for now be distributing an electronic version of our quarterly newsletter. finding prescription-writing If you do not have an email address listed on your account, please healthcare practitioners who are call Client Services at 1.800.878.3787 to add your email address. familiar with Diagnos-Techs™ and the If you prefer to receive a printed copy of our ChronoBiology Letter, results of our suite of tests is as close please email us at [email protected]. as your computer.

Continued on the back page. ChronoBiology LETTER

7 Reasons Why a One-Day Expanded Female Hormone Panel Figure 1 Female Hormone Test Doesn’t Make the Grade Without doubt, such a one-day hormone test promotes patient compliance and fits in nicely with a busy schedule. But the relevant issue is whether the data gathered by this test gives an accurate account of a woman’s entire cycle. We don’t think so, and here’s why: 1. Every woman’s cycle is unique. Duration, ovulatory timing, luteal phase length, and estradiol and progesterone patterns vary so much that a single-day sample, no matter how “complete,” can’t compare to the detailed data offered by a multi-sample test. In sports terms, a one-day test is like evaluating a quarterback’s In this 35-year-old woman with acne and premenstrual problems, a Day 21 analysis performance during a game using four (green) would miss significantly elevated late-luteal phase estradiol levels producing photographs taken in the third quarter. estrogen dominance and the dramatic drop in progesterone. In view of the low follicular phase progesterone level, biphasic progesterone supplementation (fixed low-dosage in 2. The medical staff at Diagnos-Techs™ the follicular phase, plus timed graduated dosing in the luteal phase) seems indicated. This has long recognized that hormones biphasic progesterone deficiency would not be identified using a single Day 21 sample. follow a circadian rhythm. To reflect this rhythm accurately, specimens are collected throughout the cycle at the same time of day, determined by the patient’s convenience. Expanded Female Hormone Panel Figure 2 3. A single-day snippet of a woman’s month-long cycle may or may not correctly identify luteal phase failure or estrogen dominance. Though the one-day saliva test in question has been compared to our 11-vial FHP™, it doesn’t offer the same detailed picture of hormonal changes over the cycle, necessary for a confident diagnosis of either luteal phase failure or estrogen dominance. 4. One size does not fit all when testing female hormones. For peri- and post-menopausal women, Diagnos-Techs™ offers the PeriM™ (two vials) and PostM™ (one vial) panels. These tests are available in standard versions and expanded panels that test FSH and LH pituitary hormones to provide precisely tailored This 37-year-old woman complained of premenstrual problems and infertility. A data without unduly burdensome single-day assay (green) would miss both estrogen dominance in the last part of the sample collection. The information luteal phase and very low progesterone. There is evident need for supplementary gathered by these targeted tests is more progesterone to build up a uterine mucosa sufficient to support a fertilized ovum. pertinent to a woman’s particular phase in her cycling life. Biphasic progesterone supplementation in the follicular phase is warranted in this case, as well.

5. The pattern of progesterone deficiency ™ (follicular and/or early, middle, or late Timing TAP Collections luteal phase), which may produce for Shift Workers menopausal or menstrual problems, must be evaluated completely. This John J. White, MD, CM pattern then points the way toward an appropriately designed treatment program, which may include biphasic The Temporal Free Cortisol Rhythm Analysis of circadian cortisol rhythm progesterone supplementation Panel (TAP™) highlights cortisol levels patterns underscores the importance (Figure 1). across a patient’s circadian cycle using of a patient’s unperturbed sleep cycle 6. A one-day assay is meaningless four cortisol measurements taken in rejuvenating the adrenals and for evaluating women with fertility throughout the waking hours. The providing the elevated cortisol levels problems. This single test does not provide invaluable sequential FSH and TAP lies at the heart of the expanded seen on awakening. Sleep, at whatever LH measurements, nor does it address Adrenal Stress Index™ (ASI™), which time of day, appears central to a multiple issues that may be interacting also measures pooled DHEA/S, regular cortisol rhythm. In light of to cause infertility (Figure 2). 17-hydroxy progesterone, and salivary this, specimen collection times 7. Finally, there’s the issue of cost. secratory IgA (SIgA), along with two can be adjusted for shift workers to Our comprehensive cycling Female insulin levels (fasting and random/ reflect normal “day” centered on their Hormone Panel, which includes 24 post-stimulation) and SIgA gliadin sleep patterns. individual hormone assays, actually levels (gluten sensitivity is a common costs $25 less than the incomplete To accomplish this, the first cortisol and often unrecognized stressor). one-day alternative, which includes specimen (fasting) should be collected only seven assays. But what about workers whose on awakening. The fourth specimen schedules are out of sync with the (bedtime) should be collected prior to Effective, Lifelong Cycle usual waking circadian pattern? sleep. The second specimen can be Management Takes More than a Single-Serving Test We are often questioned about the collected around “lunchtime,” with the applicability of circadian cortisol third collected just before “supper.” Can a cycling woman’s complex testing for patients whose days are This schedule provides the closest hormonal picture be accurately not routine, such as swing shift and approximation to that of a patient assessed with a one-day test? Years nightshift workers. A routine morning- leading a “regular” lifestyle. of work with samples collected from to-midnight collection schedule not Although there is little published women throughout the cycling years only fails to represent accurately their experience with data gathered in this tells us that, while convenient, this lifestyles and schedules, but would way, this collection schedule mimics test lacks the accuracy and cycle-wide require, at times, waking up to test. the standard collection schedule, insight needed to analyze a woman’s This in itself is stressful and most providing a comparable circadian hormonal health and well-being. certainly would provoke unnatural cortisol rhythm assessment for patients Every woman is one-of-a-kind, and a cortisol levels. who have adjusted to a nonstandard one-day assessment is not sufficient to sleep/wake cycle. Sleep, provide a complete hormonal picture the major factor in adrenal for her and her alone. In female rejuvenation, is central to all hormone testing, like clothing, one collection schedules, and data size does not fit all. derived in this way definitely has value in assessing cortisol circadian rhythm and any effects of stress on shift workers and others who keep unusual hours.

www.diagnostechs.com 1.800.878.3787 3 ChronoBiology LETTER

these reasons, eradicating H. pylori The Therapy Corner through conventional or natural methods may be warranted, regardless Helicobacter pylori of symptom status. Salivary IgG H. Pylori Testing Brandy Webb, ND Measuring Helicobacter pylori IgG Helicobacter pylori is a small, curved, survives the acidic environment of levels in saliva is a convenient rod-shaped bacterium that inhabits the stomach by secreting an enzyme alternative to other forms of H. the stomach and duodenum. Up to called urease, which hydrolyzes the pylori testing, such as serum IgG, 40% of the U.S. population is infected surrounding urea into bicarbonate and urease breath test, stool antigen with or colonized H. pylori; most ammonia, strong bases that neutralize testing, and biopsy. Saliva IgG H. colonization occurs during childhood.1 stomach acids.4 pylori testing has a sensitivity of 93% and specificity of 83% and is Colonization refers to positive H. Helicobacter pylori is spread via considered “a valuable alternative pylori status without symptoms, fecal-oral transmission (through to invasive procedures” due to its while infection is reserved for cases consumption of contaminated food or simplicity and practicality.8,9 where symptoms like dyspepsia are water) and by oral-oral transmission Diagnos-Techs™ offers a convenient present. Due to a three-to six-fold (through intimate person-to-person salivary IgG H. pylori test, which is increased risk of stomach cancer, contact). The vast majority of available alone (lab code GP8-S) or as it is important to identify affected individuals with H. pylori never part of our comprehensive GI panels individuals and consider protocols develop symptoms. Of those who do 2 (lab codes GI-1 and GI-2). for H. pylori eradication. present with symptoms, dyspepsia Helicobacter pylori’s behavior and is the most common. Dyspepsia is Conventional Treatment structure make it particularly effective classified as gnawing or burning pain in colonizing the upper gastrointestinal in the epigastric region, frequently The treatment goal in asymptomatic tract. First, H. pylori’s flagella propel accompanied by bloating, nausea, and patients is eradication of the it toward the mucosal lining of the abdominal fullness.5 Ulcers may or Helicobacter pylori; additional stomach or duodenum. Then, its may not be present initially, but there therapeutic considerations may corkscrew-shaped body burrows exists a strong association between H. be appropriate in symptomatic deep into the gastrointestinal wall pylori and peptic ulcer disease (PUD). patients. The scope of this article beneath the protective layer of mucus. Helicobacter pylori is implicated in the is limited to adults (for guidelines The immune cells dispatched by the formation of 90% of duodenal ulcers on treating children, please see body, including killer T-cells, cannot and 80% of gastric ulcers.6 the North American Society for effectively penetrate the mucous layer Pediatric Gastroenterology and 10 to reach H. pylori. Compounding the Why Eradication Is Important Nutrition Position Statement). There are a variety of conventional drug problem, the inflammatory effects Helicobacter pylori colonization is combination protocols available, of immune cell activity (such as the a major cause of gastric adenocar- the most effective involving a release of free radicals) may contribute cinoma and increases the risk of “triple-therapy” or “quadruple- to the development of ulcers and gastric mucosa-associated lymphoid therapy” employing bismuth, two dysplasia.3 tissue (MALT) lymphoma.7 In 1994, the antibiotics, and, frequently, a International Agency for Research on H. pylori releases enzymes that proton-pump inhibitor (PPI). Bismuth Cancer formally classified H. pylori as directly break down the mucous layer, helps prevent drug resistance, while a carcinogen in humans.7 Furthermore, which most likely further contributes the PPI helps heal the damaged 2 H. pylori is a significant factor in the to ulcer formation. Once H. pylori mucosa (some sources suggest that pathophysiology of hypochlorhydria, has burrowed into the mucosal lining PPIs may increase drug resistance). gastritis, and peptic ulcer disease. For of the stomach or duodenum, it Due to the significant risk of drug

resistance, most pharmacologic agents subsalicylate may be prescribed Natural Treatments can be tried only once. If a patient separately to achieve a quadruple- There are numerous studies tests positive after initial therapy, therapy. Due to the rampant drug demonstrating the efficacy of natural consider modifying the drug regimen. resistance of Helicobacter pylori, substances in eradicating Helicobacter The antibiotics most frequently used researchers are continuing to pylori in vitro, but more human trials for H. pylori include amoxicillin investigate alternative drug protocols. are needed to fully elucidate which (Amoxil®, Trimox®), clarithromycin Novel drug regimens that have shown natural agents are effective in vivo. The (Biaxin®), and metronidazole (Flagyl®).5 promising results include 1) a 14-day following recommendations may be Commonly prescribed triple- and course of nitazoxanide (Alinia®) prescribed alone or in combination quadruple- therapies typically last and sucralfate (Carafate®);12 2) a with conventional treatment. In either 10-14 days, although newer, shorter four-day course of dexlansoprazole case, repeat testing is recommended regimens are now available. One (Dexilant®, Kapidex®), moxifloxacin to confirm eradication, since many of the newer protocols, which (Avelox®), amoxicillin (Amoxil®, therapies are effective at suppressing has demonstrated an impressive Trimox®), nitazoxanide (Alinia®), and infection in the short term but may eradication rate, involves a one-day doxycycline (Adoxa®, Vibramycin®);13 not completely eradicate H. pylori. quadruple-regimen:5 and 3) a seven-day course of Natural treatment considerations levofloxacin (Levaquin®), omeprazole Bismuth subcitrate or subsalicylate may include: (Kaopectate®, Pepto-Bismol®)—240mg (Prilosec®), nitazoxanide (Alinia®), and Vaccinium macrocarpon (cranberry)— PO QID doxycycline (Adoxa®, Vibramycin®).14 250ml (16oz) juice QD or BID Amoxicillin (Amoxil®, Trimox®)—2g PO It is important to rule out known drug QID Allium sativum (garlic)—4mg in allergies to individual medications divided doses QD Metronidazole (Flagyl®)—500mg PO before placing any patient on these Berberine—300mg TID QID drug regimens. Also, such protocols Grapefruit seed extract—500mg BID Lansoprazole (Prevacid®)—60mg once may not be suitable for pregnant Vitamin C—5g per day in divided doses There is disagreement on whether women, due to the potential for longer regimens have significantly fetotoxicity (there are concerns about Probiotics—50-100 billion CFU daily per day for two weeks then 30-40 greater efficacy; some sources using some of these drugs while billion CFU per day recommend longer courses for better breastfeeding, as well). Common eradication while others prefer shorter side effects include nausea, vomiting, There are promising results indicating courses for better compliance, fewer diarrhea, dark tongue, and dark that Vaccinium macrocarpon side effects, and lower cost. A typical stools. For this reason, consider reduces H. pylori adhesion to longer-course triple-therapy consists giving adjunctive natural therapies to gastric epithelium and may inhibit of the following (generally given for mitigate specific side effects. A potent enzymes that aid the survival of 15,16,17,18 seven, 10, or 14 days):11 probiotic can help minimize bowel the bacterium. Numerous in vitro studies demonstrate that Amoxicillin (Amoxil®, Trimox®)—1g PO disruption, and it can also prevent the BID fungal overgrowth that can result from Allium sativum inhibits H. pylori antibiotic use. Consider dosing with growth, although additional clinical Clarithromycin (Biaxin®)—500mg PO BID 50-100 billion CFUs daily, starting trials are needed to demonstrate on the first day of drug therapy and this affect in vivo.19,20,21 Berberine Lansoprazole (Prevacid®)—30mg PO is an alkaloid present in herbs like BID continuing for a minimum of three weeks after completing the drug Hydrastis canadensis (goldenseal) This particular combination is course. Ginger, peppermint, and and Mahonia aquifolium (Oregon available from some pharmaceutical various homeopathic remedies have grape). This compound possesses companies as a kit of “daily been demonstrated to relieve nausea inhibitory effects against H. pylori in administration cards,” each of which 22 and vomiting, while apple pectin can vitro. Grapefruit seed extract shows contains all of the pills to be taken be helpful for diarrhea. antimicrobial activity against a wide on that day. Bismuth subcitrate or Continued on page 6.

www.diagnostechs.com 1.800.878.3787 5 ChronoBiology LETTER

Therapy Corner Continued. DTI Free Webinars variety of gastrointestinal pathogens, References 1 Barzilay EJ, Fagan RP. Helicobacter pylori. including H. pylori.23 Several studies Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2012/ demonstrate an association between chapter-3-infectious-diseases-related-to-travel/ vitamin C supplementation and H. helicobacter-pylori.htm 2 Helicobacter pylori infection. Merck pylori prevention and eradication.24,25,26 Manual. http://www.merckmanuals.com/ professional/gastrointestinal_disorders/ Bifidobacterium bifidum, Lactobacillus gastritis_and_peptic_ulcer_disease/ casei, and Saccharomyces boulardii helicobacter_pylori_infection.html 3 The Helicobacter Foundation. General have been shown to be effective Information. http://www.helico.com/h_ general.html at inhibiting Helicobacter pylori, 4 European Bioinformatics Institute. Bacteria preventing H. pylori-associated Genomes—Helicobacter pylori. http:// www.ebi.ac.uk/2can/genomes/bacteria/ ulcer formation and reducing H. Helicobacter_pylori.html Diagnos-Techs™ offers fast-paced, pylori treatment-related symptoms, 5 Ables AZ, Simon I, Melton ER. Update on Helicobacter pylori Treatment. Am Fam patient health-focused webinars on the respectively.27,28,29 Physician. 2007;75(3):351-358. 6 Helicobacter pylori and Peptic Ulcer 2nd and 4th Thursday of each month. Disease. Centers for Disease Control and Retesting & Recurrence Prevention. Webinars are live and presented at 7 National Cancer Institute at the National Helicobacter pylori IgG titers can Institutes of Health. Factsheet: Helicobacter 9:00 a.m. Pacific Time and again pylori and Cancer. http://www.cancer.gov/ remain elevated for an extended cancertopics/factsheet/Risk/h-pylori-cancer at 12:00 p.m. Pacific Time. We 8 Luzza F, Oderda G, Maletta M, et al. Salivary period following eradication, so allow immunoglobulin G assay to diagnose encourage questions during and after many months to pass before repeating Helicobacter pylori infection in children. J Clin Microbiol. 1997;35(12):3358-60. our webinars. To ensure participants salivary IgG testing. If earlier testing PMID:9399560 get the most out of our webinars, our is desired, consider a stool antigen 9 El-Mekki A, Kumar A, Alknawy B, et al. Comparison of enzyme immunoassays medical staff compiles all submitted test or urease breath test. In these detecting Helicobacter pylori specific IgG in serum and saliva with endoscopic and questions, answers them, and emails cases, allow at least four weeks after biopsy findings in patients with dyspepsia. Indian J Med Microbiol. 2011;29(2):136-40. the Q&A document to every webinar treatment before retesting to assess PMID: 21654107 eradication accurately. 10 Gold BD, Colletti RB, Abbott M, et participant. For information on al. Medical Position Statement: The North American Society for Pediatric attending upcoming Diagnos-Techs™ Many natural Helicobacter pylori Gastroenterology and Nutrition treatment strategies can be used long Helicobacter pylori Infection in Children: webinars, please contact Client Recommendations for Diagnosis term to protect the gastrointestinal tract and Treatment. Journal of Pediatric Services at 1-800-878-3787. To view Gastroenterology and Nutrition against recolonization. Encourage 2000;31:490–497. our previously recorded webinars, patients to regularly consume 11 Crowe SE. Treatment regimens for Helicobacter pylori. UpToDate. http://www. please visit the provider section of our cranberry juice, fresh garlic, and citrus uptodate.com/contents/treatment-regimens- for-helicobacter-pylori website at www.diagnostechs.com. fruits. Broccoli sprouts, green tea, and 12 Basu PP, Krishnaswamy N, Korapati R, fermented foods are also associated et al. A New Four-day Regimen with Dexlansoprazole, Moxifloxacin, Amoxicillin, with reduced incidence of H. pylori.30 Nitazoxanide, and Doxycycline (DeMAND) in Helicobacter Pylori Therapy: An They appear to work by inhibiting Open-label Randomized Clinical Trial. Am J Upcoming Webinars: H. pylori colonization, decreasing Gastroenterol 2010. 13 Basu PP, Rayapudi K, Pacana T, et al. A July 26th, 2012 – Hidden Cuprits gastric inflammation, and repressing Randomized Study Comparing Levofloxacin, 11,30 Omeprazole, Nitazoxanide, and Doxycycline of Common GI Complaints, Part 2 precancerous changes. Dietary versus Triple Therapy for the Eradication of recommendations such as these Helicobacter pylori. Amer J Gastroenterol 2011. th 14 Stuppy W. Dual Therapy: Nitazoxanide and August 9 , 2012 – Hormones can minimize the risk of H. pylori Sucralfate for the Treatment of Helicobacter and Pregnancy, Part 1 pylori. Amer J Gastroenterol 2010. recurrence and related sequelae in 15 Shmuely H, Burger O, Neeman I, et rd treated individuals. al. Susceptibility of Helicobacter pylori August 23 , 2012 – Hormones isolates to the antiadhesion activity of a high-molecular-weight constituent of and Pregnancy, Part 2 cranberry. Diagn Microbio Infect Dis 2004;50:231-235. References continued on back page.

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Therapy Corner References Continued. 24 Jarosz M, Dzieniszewski J, Dabrowska- Log onto diagnostechs.com and use Ufniarz E, et al. Effects of high dose vitamin C the geographical listing of providers 16 Yarnell E, Abascal K. Antiadhestion Herbs. treatment on Helicobacter pylori infection and Alternative and Complementary Therapies. total vitamin C concentration in gastric juice. to find a physician in your area. In Vol. 14, No. 3, June 2008. Eur J Cancer Prev. 1998;7(6):449-54. 17 Lin YT, Kwon YI, Labbe RG, et al. Inhibition 25 Park JH, Kim SY, Kim DW, et al. Correlation just a few clicks, you’ll get access to of Helicobacter pylori and associated urease between Helicobacter pylori infection and all nearby physicians who are familiar by oregano and cranberry phytochemical vitamin C levels in whole blood, plasma, and synergies. Appl Environ Microbiol gastric juice, and the pH of gastric juice in with Diagnos-Techs™ and understand 2005;71:8558–8564. Korean children. J Pediatr Gastroenterol Nutr. 18 Zhang L, Ma J, Pan K, et al. Efficacy of 2003;37(1):53-62. the value of noninvasive and accurate cranberry juice on Helicobacter pylori 26 Simon JA, Hudes ES, Perez-Perez GI. Relation saliva testing. infection: A double-blind, randomized of Serum Ascorbic Acid to Helicobacter pylori placebo-controlled trial. Helicobacter Serology in US Adults: the Third National 2005;10:139–145. Health and Nutrition Examination Survey. J 19 Sivam GP, Lampe JW, Ulness B, et al. Am Coll Nutr. 2003;22(4):283-9. Helicobacter pylori – in vitro susceptibility to 27 Chenoll E, Casinos B, Bataller E, et al. Novel garlic (Allium sativum) extract. Nutr Cancer probiotic Bifidobacterium bifidum CECT 7366 1997;27:118-121. strain active against the pathogenic bacterium 20 Ernst E. Is garlic an effective treatment for Helicobacter pylori. Appl Environ Microbiol. Helicobacter pylori infection? Arch Intern 2011;77(4):1335-43. PMID: 21169430 Med 1999;159:2484-2485. 28 Narayan SS, Jalgaonkar S, Shahani S, & R E A L S E et al. Probiotics: current trends in the I C A N R 21 Aydin A, Ersoz G, Tekesin O, et al. Garlic I C L H C treatment of diarrhoea. Hong Kong Med J. oil and Helicobacter pylori infection. Am J TM Gastroenterol 2000;95:563-564. 2010;16(3):213-8. PMID: 20519758 29 McFarland LV. Systematic review and DiagnosTechs 22 Mahady GB, Pendland SL, Stoia A, et al. In L A Y THE LEADING LAB IN SALIVA TESTING SINCE 1989 meta-analysis of Saccharomyces boulardii B O O R vitro susceptibility of Helicobacter pylori R A T in adult patients. World J Gastroenterol. to isoquinoline alkaloids from Sanguinaria Issue #12 Chronobiology Letter is published Canadensis and Hudrastis Canadensis. 2010;16(18):2202-22. PMID: 20458757 30 Lee SY, Shin YW, Hahm KB. Phytoceuticals: quarterly by Diagnos-Techs™ Laboratory, Inc. Phytotherapy Research. Mar 2003. in Kent, WA, USA as an educational resource 23 Heggers JP, Cottingham J, Gusman J, mighty but ignored weapons against Helicobacter pylori infection. J Dig Dis. for our health care clients. The content in this et al. The Effectiveness of Processed newsletter is for informational purposes only Grapefruit-Seed Extract as An Antibacterial 2008;9(3):129-39. PMID: 18956590 Agent: II. Mechanism of Action and In and is not to be construed as medical advice. Vitro Toxicity. The Journal of Alternative Diagnos-Techs™, Inc. and Complementary Medicine. th 2008;8(3):333-340. 19110 66 Avenue S. Building G Kent, WA 98032 USA Printed on recycled paper.