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2011-07-12 Jeanne Drisko,MD Cancer and Intravenous Vitamin C – What’s New in Clinical Research

Cancer and Intravenous Vitamin C
What's New in Clinical Research

An Interview with Jeanne Drisko, MD
July 12, 2011, By Kirkham R. Hamilton, PA-C
© copyright 2011, Prescription 2000, Inc.

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KIRK HAMILTON: Hi, my name is Kirk Hamilton, your host of Staying Healthy Today. Our message is simple: To provide you credible usable health information from interviews and our educational resources to help you Be and Stay Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.
Today's show topic is "Cancer and Intravenous Vitamin C. What's New in the Clinical Research." Our guest today is Dr. Jeanne Drisko, MD, director of the program of Integrative Medicine at the University of Kansas Medical Center. Dr. Drisko teaches medical students, practices integrative medicine, and also conducts clinical research at the University on the use of intravenous vitamin C in cancer treatment.

Thank you Dr. Drisko for taking time out of your busy day to be on the show today.

DR. JEANNE DRISKO: Well thank you Kirk. It's been a pleasure and it's hard to believe it's been two years since we spoke last.

KIRK HAMILTON: Well I've been fortunate to have spoken to 60-plus people like you doing these podcasts, so for me it's a joy. And it's also a joy to know that I'm going to get some really, really good information and some questions answered. And so tell me, what is your most exciting thing that's happened in vitamin - intravenous vitamin C and cancer in the last two years since I've talked to you.

DR. JEANNE DRISKO: Well we have really stepped up both the basic science research and the clinical research. So for the ovarian cancer study that was completed several years ago, Dr. Qi Chen is with me now at KU Medical Center and she's doing all of the preclinical or basic science research. And looking at cell models and animal models of ovarian cancer. And we're going to put those studies together in what's called a translational piece. So it'll be published in a peer review scientific journal emphasizing the translational nature from ‘bench to bedside' so to speak for ovarian cancer. Some really exciting updates in that. And then we're also starting two new clinical trials here. One of them is a pharmacokinetic study in healthy, and then in cancer patients. And we're going to be looking at how the vitamin C is handled by the body when it's infused and how much hydrogen peroxide is put out in the urine after the infusion of vitamin C. And then the second trial we're just starting is a trial in pancreatic cancer and we're going to be looking at the combination of gemcitabine with ascorbate, and to determine if the gemcitabine levels in the blood change when you give that person ascorbic acid. Of course our hypothesis is that there is not going to be a change in gemcitabine, but as you know most oncologists believe that vitamin C negatively impacts chemotherapy. So I think we're going to hopefully be proving them wrong.

KIRK HAMILTON: That's excellent. So let's go back to the ovarian cancer studies. Actually that was a patient who came in yesterday. She just - she had ovarian cancer, just got everything removed and was going to go on two chemotherapeutic drugs over the next six to nine months. And she came in to get intravenous vitamin C. So I'm just curious, what was the protocol and the findings for the ovarian cancer vitamin C studies?

DR. JEANNE DRISKO: Well I'll tell you a little bit how the study was set up. We had two groups of women and they were randomized in a blinded fashion. We didn't know who was going to get what. But they either were assigned to carboplatin and paclitaxel chemotherapy alone, or the chemotherapy plus IV vitamin C. Now the chemotherapy is usually given as you said six to eight months and after that it's just watchful waiting. If the tumor markers are down and there doesn't seem to be any evidence of disease then it's watchful waiting. But what we did with the IV vitamin C is not only give it during the time they were getting their chemotherapy, but also for the additional time out to one year. And then they were taken off study -

KIRK HAMILTON: Well let me -

DR. JEANNE DRISKO: - and then we did the watchful waiting.

KIRK HAMILTON: So this comes in to one of the interesting discussion points both with this patient and our staff today as we were talking about what I wanted to ask you. And so when you say giving vitamin C obviously intravenously during the chemotherapy, now for example she's going to get chemotherapy once a week on one of the drugs and then every three weeks for the other drug.


KIRK HAMILTON: So are you talking about giving vitamin C two or three times a week on the days you don't get chemotherapy, are you talking about giving vitamin C on the day they get the therapy?

DR. JEANNE DRISKO: Both. Both. We've done it both ways and we did it both ways in the study. When we did give it on the same day it was part of the fluid loading dose which they have to get prior to chemotherapy anyway. And we were fortunate to work with our cancer center partners here at the University of Kansas Medical Center. And so the subjects in the study would go down to the cancer center and we would come down and have the IV vitamin C started, they'd finish that and then they'd get their chemotherapy. But if that didn't work out because of their schedule then we'd just do it on different days.

KIRK HAMILTON: So there wasn't any mixing per se, but it would be one after another?

DR. JEANNE DRISKO: That's correct.

KIRK HAMILTON: And so you might give anywhere from your 30 to 75 grams of vitamin C with any magnesium or calcium? Or just plain?

DR. JEANNE DRISKO: Just with the magnesium.

KIRK HAMILTON: Just magnesium.


KIRK HAMILTON: And is that a couple of grams that you give with your -

DR. JEANNE DRISKO: The magnesium we start - at the lower doses of vitamin C in our protocol we start at 400 mg. And then when we get to the higher doses of vitamin C, let's say 50 to 100 to 125 grams of vitamin C, then we adding more magnesium, about 1000 mg, a gram.

KIRK HAMILTON: And one more time, tell me why there is no other micronutrients in there except magnesium.

DR. JEANNE DRISKO: Well we are unsure at this time, but have some evidence to believe that one of the B vitamins seems to inhibit the formation of hydrogen peroxide. And this was just an observational finding that we had, but because of the fear of reducing the formation of hydrogen peroxide we've always been very cautious when we're using it as chemotherapy. We've very cautious in adding any other nutrients to the bag. And that being said, I want to tell you that we also have done again a preclinical or an animal study looking at the effects of adding ascorbate with glutathione, with IV glutathione in a cancer model, in an animal cancer model and we found that when you add the glutathione on the same day to the IV vitamin C, it will reduce the effectiveness, the formation of that hydrogen peroxide and actually cause the tumor to accelerate in that animal model. So we - and I'm actually getting ready to write up a little vignette for the Townsend Letter to alert my integrative medicine colleagues to this effect. Because I know glutathione is very commonly given. And even some people are mixing it in the bag with the vitamin C which is a no-no. But even giving it on the same day, if they're using it for chemotherapeutic agent it should not be done.

KIRK HAMILTON: You said so many pearls, I'm gonna have to stop you there because this is like a clinician's dream world to have you here and be able to pick and ask questions because we experience it every day. So glutathione then, you wouldn't piggyback it after, if you were doing it for the intention of creating hydrogen peroxide and -

DR. JEANNE DRISKO: That's correct.


DR. JEANNE DRISKO: And it's a pro-oxidative therapy. I mean that is the intent of IV vitamin C I believe, is to give the - to give that hydrogen peroxide and those electrons back to the extracellular space back to the cells. My colleague Dr. Garrett Sullivan here in this clinic has a very specific theory about the flow of electrons and the status of the water in the cell and he - that's where his research is gonna be going. So we believe that that's a very important part of this therapy and to reduce that by giving glutathione is probably not a good thing. Now we do use glutathione for the neuropathy on different days. And so if someone is getting neuropathy from their chemotherapy then we will give them glutathione but not on the same day as the vitamin C.

KIRK HAMILTON: So if you wanted to give glutathione for whatever reason and it you were doing it not just on the day, 24 hours difference, you don't have a problem with that.

DR. JEANNE DRISKO: That's right. Because that - we're not 100% sure yet how long the hydrogen peroxide lingers in the extracellular space and in the tumor mass. We believe it's longer than the IV vitamin C hangs around, but we don't have any proof in humans yet.

KIRK HAMILTON: How about -

DR. JEANNE DRISKO: Qi Chen has done some early work with that in an animal model.

KIRK HAMILTON: What is the rationale for magnesium in the first place?

DR. JEANNE DRISKO: I think it's mostly just to make the infusion of the vitamin C comfortable for patient. It relaxes the vein, it opens up the vein, it reduces the spasm, reduces the irritation.

KIRK HAMILTON: Okay. Fair enough. Let me - and so just for the ovarian cancer experience, they do a preloading of fluid and you put in your anywhere from what 30 to 125 grams of vitamin C, and is that over a couple hours before the chemotherapy starts?

DR. JEANNE DRISKO: Well it's pretty easy. Usually our cancer patients will find that the minimum amount that they need is 50 grams and that's usually for the blood-borne tumors like the lymphomas, leukemias. But that isn't set in stone so I don't want somebody to go out and think that that's the prescription. But it can go all the way up to 125 grams for a solid aggressive tumor like pancreatic. Most of our pancreatic cancer patients need 125 grams. And of course we base that on the plasma vitamin C level. Now the plasma vitamin C level is a very fussy test. It's a test that the blood has to be drawn immediately as soon as you turn off the IV, in the other arm, it has to be drawn, it has to be put on ice, it has to be processed immediately, and if it's not - it's called a critical frozen - if it's not processed immediately then that vitamin C starts degrading. So we commonly see people saying "Oh, I gave 100 grams but our plasma vitamin C level was only 200 mg/dl." And I know immediately they didn't process the sample right. So what we're trying to do is come up with some alternate methods of testing and we're gonna be publishing on that, too. But anyway, that being said, then let's say you have somebody that's getting 50 grams for example. So you give a half a gram a minute, so that's 50 grams over 100 minutes. So you just take the amount of vitamin C (in grams) and double it and that's the number of minutes roughly.

KIRK HAMILTON: So 125 grams is a long time.

DR. JEANNE DRISKO: It's a long time. But if you speed it up then you get a really high peak and fall off of that plasma level of vitamin C. And also then you have the problem where the patient's feeling, oh kind of shaky, and everybody says, "Oh that's a calcium shift or that's a drop in the blood sugar." I don't think anybody really knows for sure what's happening. I know some people just go ahead and give calcium to forestall that, but if they would slow down the infusion to a half a gram a minute, you're not going to get into any of those side effects.

KIRK HAMILTON: Outstanding. We are talking to Dr. Jeanne Drisko, MD, director of the Program in Integrative Medicine at the University of Kansas Medical Center, and also a researcher doing clinical research on IV vitamin C and cancer therapy.

I want to move from there then. Let's say - one question that pops up is, and there's been a lot of talk about alkalinity and cancer treatment. You know, the cancer cells don't like alkalinity and that if you give ascorbic acid, how does it affect the pH when you give your 100, 125 grams of ascorbic acid? How does that affect the pH and do you even care about that or worry about that?

DR. JEANNE DRISKO: Well our vitamin C is generally buffered. But we don't really care about that so much with the vitamin C. They're absolutely correct that the tumor is in an acid environment and that's the Warburg effect. That's the cancer cell getting away from the use of the mitochondria and going into glycolysis and making a lot of pyruvate and lactate so it's a very acid environment. And that's why the cancer cell will often have new blood vessels coming in to shunt that glucose in. It wants to burn the sugar, the glucose for its energy. And it's getting away from that efficient mitochondrial burning of oxygen for ATP. And because of that, the mitochondria isn't functioning normally and then the cell does not go into apoptosis or program cell death. So the cancer cell's pretty smart about that kind of thing. It's getting around it. So that being said, what we emphasize, which is really the most important thing for anybody taking care of cancer patients is to look at the nutrition, the diet, because that's how you affect alkalinity the most and you know that. From a good quality, high vegetable fiber diet, and some people say no animal protein at all. But you're in a restorative reparative phase and you're going to be needing to build blood vessels and new cells and so on and so forth, so we advocate the use of good quality protein in modest amounts just to support that protein building. We also tell them absolutely no processed carbohydrates, we try and get them off of the grains as much as we can. We often find, particularly in ovarian cancer patients, it's fascinating, most of them have a lifelong, or very long history of irritable bowel syndrome and when you ‘drill down' on that you'll find that they have wheat and dairy problems for many years. So there's this inflammatory environment going on, but I kind of got off target there.

KIRK HAMILTON: Hey, that's fine. That's fine. They're all little pearls that we can put in the piggy bank, so.

DR. JEANNE DRISKO: But, you know, the bottom line is the diet.

KIRK HAMILTON: Right. But, so you're not worried about what - does vitamin C cause an acid situation for temporary period of time, or is it buffered and it doesn't really matter?

DR. JEANNE DRISKO: Well that's an excellent question. We were wondering that ourselves. So we did a little, just with five subjects getting IV vitamin C that had cancer. We checked their pH of their blood and their urine before, during and after IV vitamin C. And I've never published these data so, you know, I probably never will, but we found absolutely no change in pH.

KIRK HAMILTON: In the urine?

DR. JEANNE DRISKO: In blood or urine.

KIRK HAMILTON: Oh, in blood or urine.

DR. JEANNE DRISKO: Uh-huh. There's no change.


DR. JEANNE DRISKO: So the body has a remarkable buffering capacity. I think that's what people don't realize.

KIRK HAMILTON: Let's talk about, because I can get a lot of points from this one ovarian cancer experience. So it goes on for several hours (I.V. vitamin C), then they get the chemotherapy. Now let's say for example, how many times a week in this six to nine month period that they're going to get two of these chemotherapeutic agents once a week or once every three weeks.


KIRK HAMILTON: How frequently are they getting their vitamin C infusion? Is it once a week, two or three times a week? How do you determine that?

DR. JEANNE DRISKO: It should be two or three times a week and spaced out. Usually the more aggressive tumors we like to go up to three times. You know it's a patient scheduling nightmare because then you know they're here all the time. But we tell them that's their full time job. You know now it's their full time job to take care of themselves and this is part of it and it isn't going to be forever. So let's say for ovarian cancer, two times per week until they're disease-free and no evidence of disease. And then we follow them for a year. We keep them on the infusion schedule and most of them are quite willing because they're doing so well. Keep them on twice a week, and then at a year if they've been disease-free for a year then we start tapering. We never stop cold turkey or at least if someone wants to stop just abruptly, we always try and talk them out of it because we have seen when you stop rapidly there can be, sometimes, not always, an aggressive return of the tumor and then you can't ever get back on top of it again.

KIRK HAMILTON: Well let's take for example the case that I just had. The uterus and ovaries were removed and they don't have any signs of cancer that they can see there.


KIRK HAMILTON: So she's gonna get the chemo for nine months, both of the drugs, so in that case - I don't understand totally what the disease-free means. So -

DR. JEANNE DRISKO: Well they go by markers, CT, PET and physical exam. A very good gynecologic oncologist can feel something on exam before it's measurable on CT scan. It's unbelievable. But usually the CA-125 is a very helpful marker.


DR. JEANNE DRISKO: So if they're truly disease-free, no evidence of disease, they're actually not in these early stages with ovarian cancer when they've, you know removed the omentum and ovaries, uterus and nodes. And you know there's generally still tumor in that pelvis and abdomen.

KIRK HAMILTON: Okay. Well that's a - I've got a picture now. Because that question comes up quite a bit that you know we'll have people get IV vitamin C once or twice a week, whatever they can afford, and then they'll get to a point where the oncologist is ‘watchfully waiting' for a year, two years, whatever it is, and then I don't know what the heck to tell them to be truthful.

DR. JEANNE DRISKO: Yes, well if they've gone a year then you can be pretty confident you can start slowly weaning them down. And we have women that have been disease-free from ovarian cancer, uterine cancer, and they're over five years and they still like to come in for an IV vitamin C maybe once a month, you know, occasionally. So it's I think more than anything, it might just be reassuring to them at this stage.

KIRK HAMILTON: Let's talk about the pancreatic cancer because that's an aggressive cancer obviously and doesn't have a great outcome. So you're experience with the ones that you've treated and then what you're - if there's anything special about this study on pancreatic cancer.

DR. JEANNE DRISKO: Uh-huh. Well, we published a paper in Free Radical Biology and Medicine at the end of 2010 looking at, again the cell tissue in an animal model, in combining gemcitabine with the pancreatic cancer, in pancreatic cancer with ascorbate, and we found that gemcitabine was synergistic with ascorbate in this model. And so we even took the resistant cell line, pancreatic cells lines that are resistant to gemcitabine, and injected those into the animal and that tumor was made responsive to gemcitabine with ascorbate addition. So we have very exciting preclinical work. We have anecdotal clinical information that shows that - and we're going to be publishing a case report here shortly. A patient that just received the IV vitamin C for his pancreatic cancer. Now we don't advocate that. We usually advocate in such an aggressive tumor that they consider some sort of chemotherapy and they've changed the regimen here recently. They've added another growth factor inhibitor so it's a little bit more aggressive than gemcitabine. But anyway we do also have patients that get ascorbate with gemcitabine and do quite well. And you know their longevity is four months, six months, maybe eight months. But we've had some people living much, much longer than that.

KIRK HAMILTON: Well then for the pancreatic cancer, you said it's a more solid tumor so you're going to be up at the higher dose ranges. So even though you're measuring the vitamin C, does that mean that the body utilizes "more up," and so you need more to raise the blood level in an aggressive cancer like that, or a big tumor cancer like that?

DR. JEANNE DRISKO: We believe that there is an increased need, yes. That the tumor burden is much more aggressive and as you say, "using it up." We're not really sure about exactly what that means yet because we haven't - we'd like to do some human studies at the NIH so Dr. Mark Levine can measure the hydrogen peroxide in the person's body which we can't do here. It takes very specialized equipment that they have at the NIH, but that's our goal here in the next year is to hopefully have a human trial in pancreatic cancer, both here and at the NIH.

KIRK HAMILTON: So the frequent question comes up, and I know you've heard this seven hundred thousand times because you have it as one of your frequently asked questions.

DR. JEANNE DRISKO: I know what you're gonna ask me.

KIRK HAMILTON: And so - no, I mean obviously your cancer specialists there have grown enough trust in the science and you to say it's a reasonable thing to do (I.V. vitamin C) at the same time or close to their treatment and they're not freaking out.

DR. JEANNE DRISKO: That's correct.

KIRK HAMILTON: In our - my world, you know, every patient that comes in you know, and says that their doc is not for it, and et cetera. I say well go to the University of Kansas website, print out the frequently asked questions, blah, blah, blah, blah, blah.


KIRK HAMILTON: So is it just those two physicians or you got more physicians, traditional doctors there at the University, but also around the country that are starting, from your world, because you're out there and you're obviously a specialist at this, being more open to -

DR. JEANNE DRISKO: Absolutely. And you know it's amazing when it's a family member or themselves. I get an email from them and then I'm on the phone with them. It's amazing how their perspective changes. But yes, overall we are seeing a sea change where more and more conventional physicians are saying, "Well let's take a look at this, let's consider this."

KIRK HAMILTON: Alright. Let's talk then, about do you - I remember Rob Cathcart talking, and you know he would make his own vitamin C up which always -


KIRK HAMILTON: Which I thought was wild the first time I heard about that. And - but he would talk about giving oral vitamin C towards the end of the infusion. And what I'm getting at is what do you do between your infusions? Do you have them go to bowel tolerance because then that's the other mechanism?

DR. JEANNE DRISKO: Well bowel tolerance, you're taking oral vitamin C and you might have a great need and greater absorption for it. But once you get to a certain plasma level in the micromolar range, you're going to start excreting it very rapidly. So you have these liposomal vitamin C's and these other vitamin C's that say, "Oh we have increased uptake and it's almost like getting an IV, or it's like getting an IV." But in actuality they're still in the micromolar range.

KIRK HAMILTON: So what is - what do you suggest to your patients? Do they take high dose vitamin C or a couple of grams a day?

DR. JEANNE DRISKO: Yes. They do - we do have them on a good quality vitamin C product but it's still a vitamin. It's still doing vitamin jobs. It's not doing the production of hydrogen peroxide in the extracellular space. That does not occur. We've shown that in multiple animal models. It's not occurring. So oral vitamin C is not IV vitamin C.

KIRK HAMILTON: Correct. Well then it's not affecting cancer by the hydrogen peroxide route. Now -

DR. JEANNE DRISKO: That's correct.

KIRK HAMILTON: I remember back in the day when the Linus Pauling Institute - and I would get their newsletter and case studies of people taking, you know to bowel tolerance, anywhere you know 20 to sometimes 90 grams a day of oral vitamin C and anecdotal stories. Now would that work - if it did work - was it working a totally different way, like hyaluronidase activity or something like that?

DR. JEANNE DRISKO: Yes. Through its vitamin activities and supporting any number of, you know the ground substances and so on and so forth.

KIRK HAMILTON: Gosh, this is like - I'm like a kid in a candy store. Really. This is going to help us so much. I don't mean to be selfish, folks out there, but I get these questions all the time, all year long actually. And you've been so very helpful. Is there any other pearls you have about what you're doing, the IV vitamin C, before we wrap this up?

DR. JEANNE DRISKO: Well, we also did a little survey study where we surveyed practitioners in 2006 and 2008. The reason we did the second survey was because in 2006 our results were so amazing that we were asked to repeat it. But we showed that in a very small population of physicians that gave IV vitamin C, and these are integrative medicine doctors as you would rightly guess. Just in this small population of physicians, there were 20,000 patients combined in those two years. Almost 20,000 patients that received IV vitamin C. And when we figured out what the average dose was and so on and so forth, that came out to about 350,000 dosing bottles a year and up to 375,000 in 2008. But then when we surveyed manufacturers, we found out that was just the tip of the iceberg. Because it was probably closer to three-quarters of a million dosing bottles. 750,000 to maybe 850,000 dosing bottles. So we underestimated the vitamin C being given in this country on our survey which you'd expect. But we thought that was pretty remarkable.

KIRK HAMILTON: That's a lot.

DR. JEANNE DRISKO: And what is even more remarkable is that the safety profile when you adequately screen the patients for G6PD it's very safe.

KIRK HAMILTON: Yeah. Well I have a story that it's like, I heard about G6PD deficiency for years and obviously we gave vitamin C for years, big doses without ever doing G6PD. And the one time I had a patient who convinced me to do it in a family friend, it created a hemolytic anemia and I'll never forget it. I thought, "Oh my god!" You know, so now I routinely do it even if I never see another again in my life.

DR. JEANNE DRISKO: Yeah. It only takes one, that's right.

KIRK HAMILTON: Do you do any - lastly do you do any specific nutritional testing like a fatty acid profile or minerals on these cancer patients or --

DR. JEANNE DRISKO: Absolutely! Absolutely! You have to get vitamins, minerals, essential fatty acid, fasting glucose, hemoglobin A1C, evidence for inflammation, fibrinogen. You have to look at them globally as you do, I'm sure. And then you give an individualized program to them. You - if they've got abnormal essential fatty acids, let's say they've got - they don't have any medium chains for example, then you're making sure they're getting a smoothie with some coconut oil in it, for example. So everything is tailored to that patient based on their laboratory findings.

KIRK HAMILTON: How long is your initial assessment of a patient when they walk in?

DR. JEANNE DRISKO: Oh gosh, it depends how complicated it is. It might go an hour and-a-half, maybe two hours.


DR. JEANNE DRISKO: On the first visit, and then you know an hour or so on the follow-up visit. If a follow-up visit lasts 25 minutes I feel like, "Oh my gosh" it's like a school physical.

KIRK HAMILTON: Yeah. That's pretty labor intensive.

DR. JEANNE DRISKO: You know, it's an easy one.

KIRK HAMILTON: I got it. It's labor intensive.


KIRK HAMILTON: Okay. Well, I'm gonna wrap this up. This has been wonderful. I'm gonna call you sooner than two years, I can guarantee you that, because I want to see -

DR. JEANNE DRISKO: Oh, you're very kind.

KIRK HAMILTON: You know, and any time you get - you complete one of these studies, just send me a PDF of it and then that will remind me because your work is so valuable. I can just tell from, well people can tell my excitement, but we have questions when we're in the trenches and we're trying to do good work. And trying to be decent and you know scientific relatively about what we do. And we have people now asking all the time. I mean it's the most frequent thing that I get. I mean people come in and it's hard because they'll just say I want to do vitamin C and nothing else.

DR. JEANNE DRISKO: Oh, yeah, see.

KIRK HAMILTON: And that's a real fine line for us because we don't want to come across as a cancer treating clinic. We just do supportive care.

DR. JEANNE DRISKO: Uh-huh. Uh-huh.

KIRK HAMILTON: So this question, though, about you know the antioxidants and things is the most - that's the most common one. But I think your interview will allay some fears and concerns, and actually it helps me right away do better because I feel more confident about certain things that I'm doing. You know, we're in the right direction but it - there's nothing like clinical experience. And you're in a place where I think it's fabulous that you can do the academic work and the scientific work and you're right smack in the middle of a medical center so it gives it so much more credibility than somebody experiencing something, you know something out in the outskirts of a town or something, you know. So I thank you very much for all your hard work. I really, really do.

DR. JEANNE DRISKO: Oh, Kirk, thank you so much. I'll look forward to speaking to you again.

KIRK HAMILTON: Okay. And I want to thank you, the audience, for listening to this edition of Staying Health Today Radio. And until next time, Stay and Be Well.

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