04 A Talk by John R Lee MD

[ From March 1996 - Russell Marker (Born 12-Mar-1902 Died 23-Mar-1995)]

Approximate text locations on CD is indicated in transcript by #xx:mm:ss xx = track number, mm = minutes & ss = seconds


#01 As chemicals in our food, hair, personal care products and environment proliferate it becomes incumbent on each of us to become more aware how our body chemistry interrelates with these substances. With so called advances in medical science drug companies are seeing their synthetic substances in record use. Often these substances are misunderstood and contribute to some of our most serious health problems. Women and surprisingly their doctors as well still have a lot to learn about how the hormones in the body function. This programme is presented in a effort to illuminate a formidable body of work presented by a medical doctor who for the past several years has been making it his mission to inform women and their doctors about the remarkable benefits of using Natural Progesterone. #01:01:05

John R Lee MD

#02 It is a great pleasure to be here and I'm happy to see you all. I sometimes wonder,I ask myself what the heck am I doing in getting up in front of people and participating in this movement, this argument that has been going on. I don't have anything to sell other than some knowledge I hope to bring to I am not connected with any company that makes any product.

My background is primarily as a family practitioner for 40 years and I don't have any connection with any great university or research centre except I was a clinical instructor at the University of California San Francisco for a couple of years as an additional thing that I did. And I was thinking that it comes from, from something in my past that you should probably know about and my present state.

My past is that my dad was a doctor in a small town in Minnesota, essentially the only doctor in town. And he had a major heart attack when I was eleven and he, he died at fourteen, when I was fifteen years old, when he was forty nine. His brother died of a heart attack at forty eight. And the other brother forty six. And my only male cousin had his first heart attack at thirty eight. So I am sixty six, so either I am doing something right or else I was adopted.

My father never made much money when I was thinking about going to college I was informed I had all of two thousand dollars that the family could make free to send me off to college but my high school history professor got me to take a test for a scholarship to Harvard and I got an all tuition paid scholarship to Harvard. All I had to do was to be in the top third of the class to get the scholarship the next year which created a little stress as you might imagine.

But as the years went by I played in the band and I enjoyed Harvard very much and I was taking more courses than you were supposed to be allowed because I figured I'm only going to be here once, maybe this is the last year. I never really got the chance to relax until the last year When I told somebody that I took six major courses instead of four figuring that was my last crack at these wonderful people there and that I didn't need to make any good grades because I was already admitted to medical school and it didn't matter, it turns out I got all A's and graduated with honours.

By the time I went to medical school I had the attitude that kind of like “Hey I'm just as smart as other people” and in fact a lot of people in my classes that went on to become professors and heads of departments and everything I didn't regard them as being all that intelligent in the first place and not everybody in medical school is as bright as you think I think about the level of a good carpenter would manage very well. #02:03:06

Medical school is kind of a trade school you learn how to do things and you learn how to regurgitate answers that the professor wants you to give. It is not a school where you go to really study the philosophical and biological and chemical unknowns. The attraction to medicine to me was all the unknowns. It is a living, continuing, evolving science for / with a whole lot of things that we don't understand. In fact the body is kind of like a black box we do things to it we observe results and we create these hypothesis about what might be going on in the black box. You all understand, you might be pretty familiar with that idea. # 02:03:50

The thing that is happening to me now I'm sixty six and once you get within single digits of your estimated life, your life expectancy, you get a little less cautious in how you behave and you are willing to tell people what you really believe and so I think that this is what probably is happening #02:04:13

I was in practice for forty years and the last thirty four of them were at Mill Valley I had been in practice in Minnesota for a year and the navy for two years. I am a lieutenant commander in the navy reserve and then I got out of the navy at Treasure Island and I looked around and I thought all my friends in Minnesota are waiting until they retire until they move to Florida or California. So I said ell Mill valley looks like a nice town so I'll give it a good shot. So I opened up a little office and I was there for thirty five years until I retired when I hit sixty #02:04:53

The first ten years I was a rather regular doctor and contributing a lot to the medical society, I was chairman of several committees, I was on the board of directors three or four times, I turned down the presidency twice which indicated to me that I still had a little sense left and I was editor of the bulletin for three and a half years and we actually made money it was popular it had advertisers and one thing or another. I was head of the KO Polio campaign, I don't know if you remember that, you are probably all too young for that. But I was involved in all this but I was earning, I was learning in practice that my training didn't do much for me to try to help prevent people from getting ill in the first place.

We are collecting patients at the wrong end of the river. They are coming down the river already sick and we are supposed to take them out of the river and fix their stroke fix their diabetes, fix their heart attacks, fix their blindness, fix their cataracts, fix their broken hip and everything. Nobody was working upstream to find what was causing these people to get sick in the first place and I became more and more interested in preventative medicine trying to I could see that life choices that people were making were leading them to becoming ill in later life like all my relatives in Minnesota. They all ate all these dairy fats and all this fat meat and they ate the wonderful cakes and cookies and all these things and all my relatives died of heart attacks and strokes.

I quit drinking milk when I was in medical school and I was from a dairy state so people thought I was a little strange right in my own home town, crazy! But I was making these changes myself then I began going to alternative medicine meetings ACAM, The American College for the Advancement in Medicine - Orthomolecular Medical Society and I found them much more interesting, much more challenging and in fact the level of intelligence of the doctors there was considerably higher than at the regular meetings. And even though I had advanced quite a ways up I was delegate at the CMA and I was involved in that I wasn't very pleased with what I saw with organised medicine I might as well tell you that. And so about 1976 which would be after twenty years of practice my viewpoint had shifted considerably. #02:07:07

#03 1976 is a turning point. I had patients who by that time your forty year olds had become sixty year olds. I had patients who had osteoporosis and I could not give them the regular treatment because they had illnesses for which oestrogen was contra-indicated, they'd already had breast cancer, they'd already had cancer of the uterus, they'd already had strokes they'd already had diabetes, they'd already had obesity, they'd already had vascular disorder. They had all these things and oestrogen is contra-indicated and yet my training was the treatment for osteoporosis was to give some oestrogen along with a little vitamin C and a little vitamin D, exercise and diet and quitting smoking cigarettes and things

And here I had all those patient who couldn't do it and it had been discovered and rediscovered at a consensus conference in the Mayo Clinic in 1976 by experts from around the world that unopposed oestrogen was the only known cause of cancer of the uterus. It increased the risk of a woman getting cancer of the uterus by at least a factor of six and should never, never be given to anybody. I was interested therefore to read the paper yesterday “the risk of oestrogen only therapy they are now reaffirming twenty years later that unopposed oestrogen is the cause of cancer of the uterus and shouldn't be given by itself.#03:01:24

This was established in 1976 this was part of the dilemma which led me to progesterone. Th other thing that happened in 1976 in Marin County where I was practising Dr Malcolm Powell had developed a dual photon bone mineral density tester. Which is a very simple machine you shine a beam of energy, photon, photon energy like light. In this case a photon of a minor radio active material that didn't emit X-Rays through a person and if those photons hit a mineral they bounced off they are reflected back They are absorbed into the mass of the mineral so the energy of the beam coming out is reduced, you've lost some of the beam. Just like kids at Halloween shine a flash-light through their hand and you can see where the bones are, the dark spaces versus the pink and red #03:02:19

By measuring the drop in the energy of the beam you can calculate the mass of the minerals that were in the path of the beam. Do you all follow that?

And so Dr Malcolm Powell had this laboratory and we could see that even on the patients that we were treating with oestrogen were still losing bone. Oestrogen never did reverse osteoporosis it never made anybody's bones better it only slowed the process of losing bone. So here I had the people who couldn't take oestrogen, the Mayo clinic had said you couldn't give oestrogen to those people and you certainly couldn't give unopposed oestrogen. Well the third thing that happened in 1978 I heard Dr Ray Peat, a PhD Biochemist from Oregon and he gave a talk at the Orthomolecular Society meeting I was attending on the role of progesterone, real honest to God natural progesterone.

A woman's ovaries make two hormones, oestrogen and progesterone and he was challenging the doctors there to say, “Why at menopause when both hormones are down do you only give one hormone. Mother Nature is smarter than that, Mother Nature made two hormones.” Oestrogen is never made all by itself there is always some progesterone there. Maybe the two together are very important. Or maybe many of the things that you think are due to menopause and oestrogen loss may be in fact due to progesterone loss. Because at menopause oestrogen only reduces forty to fifty percent , 40 - 50 %, isn't that amazing. It doesn't disappear, it just reduces, the body and the body fat continues to make some oestrogen. A fat lady after menopause is making more oestrogen than a skinny lady before menopause.

The idea of menopause deficiency begins to get a little wobbly here and Dr Peat was saying, “Why aren't you using natural progesterone? It is available, it has been in cosmetics for forty years. It is well absorbed through the skin. The ovaries is pretty smart it never put it's hormones in anybody's stomach. Why do you all put the hormones in some body's stomach? You can buy it as a cream, it is absorbed, it is available over the counter.” #03:04:38

This hit me like a ton of bricks. I went back stage and I got hold of Ray Peat and said, “I have got to see your references, I've have to learn about this thing 'cause I've got all these people who I thought they needed some oestrogen and all they need is maybe a little progesterone. ” So he gave me all these references and we meet a series of times. And he's quite a guy, one of those geniuses who it is not all that easy to pretend to be normal. But I read his references and I found a whole lot more references. Everything he said was right and in fact there is a whole lot of research about progesterone but by that time the birth control pills had come in and the companies, the pharmaceutical companies had figured out how to make synthetic analogues, these are drugs altered forms of the natural compound they altered because of the need to have patented medicines. And they are all different, they do different things and they have a name they are called progestins. That's the name they are synthetic altered analogue of natural progesterone. They may have some progesterone like effect but have a whole bunch of non-progesterone like effects because it is totally foreign to the human body. It has never been found in any place in ature, in any animal, any plant , any where, absolutely foreign molecule and the body's metabolism doesn't handle them the same way. #03:06:10

So I went to my patients and I said, “Here we have Dr Powell who can measure your bones and you can go to the health food store and buy this cream. I'd really like you to go and get some of this cream. And let me follow it with annual bone mineral densities. In the meantime follow the diet that I had you on, follow the vitamin C and the vitamin D and all these things and let us see what happens. It can't hurt and it might help. #03:06:36

To my amazement the women within three years time it was obvious in all of my patients all of their bones had become stronger, they had become more dense. It had reversed osteoporosis without any oestrogen whatsoever. That was a brand new observation and I had stumbled in to it so I gave talks at our local hospital, told my colleagues about it. They all expressed an interest but none of them did it they felt detailed information doesn't give any information about it. They don't have any nice graphs don't have any references not in medical school it is not in any books but privately they came to me and said, “My mother-in-law has osteoporosis how do you use this stuff?” Or onward and onward they were doing it privately but not publicly.

This was all 1976 - 1978 Then I became more and more willing to speak out on some of these subjects and The doctors were being told if you can't give oestrogen by itself you give oestrogen plus a progestin.

And when I opened up the PDR, you all know what the PDR is? The Physician's Desk Reference {www.pdrhealth.com the on-line version – Willim} there is about 6 columns of side effects. Causes cancer in beagle dogs, breast cancer, can cause deformities of the children conceived while you are on it it is toxic to the liver can increase strokes, can cause all sorts of allergic reactions they are all listed in the PDR none of these are part of progesterone.

Progesterone doesn't have any of these side effects. In fact the word progesterone come from the fact that this is the hormone that body needs so that the fertilised egg will survive. That the embryo will develop an that the full development of the brain and the baby during the nine months of gestation can occur. The hormone that promotes normal gestation is called the pro gestation hormone, progesterone. #03:08:53

#04So I began learning from the patients all these other things. They said, “My God! the fibrocystic breasts had returned to normal”, they said that their excess weight was easier to work off now with energy that they got from exercising they were much easier to lose weight, their skin had become much more normal, their thin hair was coming back, their libido had come back their ability to concentrate and to focus and their memory and their thinking power had increased and it went on and on and I wasn't prepared for all but story after story happened and I kept reviewing the literature and going to library and finding yes there has been research on this. And their joints were better in the morning and I found the research where someone had actually injected natural progesterone into joints of people with rheumatoid arthritis and the result was better than with gold or with cortisone there was no side effect.

So this was a tremendous learning time for me over these years it happened and eventually when I hit sixty and retired. I took the opportunity to write a book about it, hopefully to shorten the learning curve time for other people not realising that this was very inflammatory. I was challenging what the pharmaceutical company was saying and I was challenging what was being taught at medical schools. It wasn't my idea to get in to any battle with anybody I was trying to say, “ Hey I spent fifteen years learning all these things and I'm trying to tell you what you can do with natural progesterone.” #04:01:34

The third thing I did in 1976 that was a turning point in my career was I started a class at our local College of Marin. Our local junior college in the community Ed part. They wanted a class to help teach people how to stay healthy and this class was called “Optimal Health” and it runs for the Fall term and the Winter term. So every Thursday I meet with the class from two to four in the afternoon for sixteen weeks and the best way to learn something is to try and teach it.

And I wrote a book for my class called Optimal Health Guidelines {see www.johnleemd.com - willim} which is sold primarily through the college book store. And this last Thursday I taught the class and were doing heart disease and so I have now been doing this for twenty years. I have a certain confidence that what I have been teaching people for the past twenty years is true because it has worked out none of the things I have written in the book have been found to be wrong in any way.

Conversely when I went back to my twentieth medical school class reunion the dean said, “We now find that half of what we taught you in medical school is found to be wrong in seven and a half years. The problem is we didn't know which half. But now with the accelerated pace of new discoveries in medicine half of what we teach now will be wrong in five years”

So here I have a track record of twenty years and what I wrote twenty years ago is still right. #04:03:08

We are going to run through some slides, I going to try and teach you now all about progesterone. When I did this at the St Andrews College Hospital in London they gave me from ten in the morning until five in the afternoon with a break and tea break, break for lunch and a tea break and even then I didn't get to the end of all the things I wanted to say. I'm assured that this is a very bright group and you can all get it in about half an hour.

This is a simple diagram of what accounts for your monthly menstrual cycle in women. The hypothalamus at the top is in your brain about an inch (25mm) above the pituitary and it is monitoring your hormones. When the hormones are low it releases GnRH, gonadotrophic releasing hormone which tells the pituitary to release FSH and LH, follicle stimulating hormone and lutenising hormone. To which the ovary responds by making oestrogen and progesterone and causing an egg to be matured and released in the process we call ovulation. The uterus is also involved in that the lining is built up by the oestrogen and caused to mature and become ready for use by the progesterone. And if no pregnancy occurs menstruation occurs, the hormone levels fall, they are excreted out through the liver. The hypothalamus detects the falling hormones and starts the process all over again. And this is what accounts for the typical monthly cycle.

I want to emphasise oestrogen builds up the bloody lining, progesterone holds it in place and it is the quitting of the progesterone after ten or twelve days that is the trigger for the shedding of the lining. So this is going to be important. And I'll say one more thing these ovaries make about twenty to twenty four milligrams a day of progesterone so that we can call the normal physiological dose. That'll come up later when we talk about dose. That's the dose that if we think someone is deficient in progesterone or we prove it with saliva hormone assays or blood tests we know that that's the dose we want to reach twenty to twenty four milligrams per day. #04:05:12

These are not made up by me these are the known functions of the two major oestrogen hormones oestrone and oestradiol. As you probably know there is no hormone named oestrogen. It is a class name like apple, in apples we have Gravensteins, Delicious and Pippins they all have their own name and the same thing with the oestrogens. There is no hormone named oestrogen it is a class name that causes the proliferative endometrium that is it builds up the thick bloody lining and stimulates breasts and causes body fat these are oestrogens. The two that the body makes in major amounts are oestrone and oestradiol. Hardly matters which one is which because the liver has a way of transforming one into the other anyway. But if I run through those

It builds up the thick endometrial lining

stimulates the breast to grow

Increases body fat, this is why farmers use it to give to steers to get them to market weight a whole lot sooner.

Causes salt and fluid retention, which also aids in getting them up to market weight a whole lot cheaper and earlier. So women who are on oestrogen who find they get fat and retain water go to their doctor. And their doctor says, “Gee I don't know what makes this we'll now give you a diuretic.”

Depression and headache

Interferes with the thyroid hormone

Increases blood clotting, this is why the nurses in the Harvard Nurse Study were more likely to have thrombo-embolic strokes, the strokes caused by blood clots

Decreases libido, this is a surprise to everybody they thought that the more oestrogen would mean more libido. It doesn't work that way. It turns out that a tiny bit of oestrogen is necessary for both men and women and it is either testosterone or progesterone that adds the actual libido.

Impairs blood sugar control this is why we don't like to give it to people who have diabetes or Hypoglycaemia

Loss of zinc and copper retention this has been extensively studied and is the cause of the rage, the general anger and anxiety a lot of people have during PMS. It changes the brain function. What happens is oestrogen causes the increase of ceruloplasmin which binds to copper so that more copper shows up in the serum that tends to block zinc from being absorbed so you end up with high copper and low zinc.

Reduced oxygen levels in all cells which is part of the way in saying oestrogen induces and promotes cancer growth

Increased risk of breast cancer

Slightly restrains the osteoclast. We are going to talk about the osteoclast when we talk about the bones

Reduced vascular tone that means you blood vessels dilate, so that means it makes migraine headaches worse, make you more likely to have varicose veins and so on #04:07:59

And this is the function of progesterone there are so many that I group them into three

Procreation which we already talked about it is necessary for the survival of the baby the baby would not survive, one of the functions is kind of interesting the baby's chromosomes, the DNA are only half mothers the other other half is a foreigner. Born American but if you graft any part of the father's say skin or organs on to the mother. The mother will reject them because they are not her's, understand? The baby's is half the father's, right? But in the uterus rejection doesn't happen it is because progesterone prevents the rejection phenomenon in the uterus. It is a tissue selective site or site selective action because progesterone actually aids the immune system in all the rest of the body. Isn't that something?

OK bottom is a steroid precursor, all of the other steroid hormones are made in a pathway that involves progesterone. So all the cortisones, all the oestrogens, the testosterone they all come through progesterone, you have to make progesterone first. So if a woman does have progesterone deficiency she has then problems all down the line with all these others.

And then with have intrinsic biological properties. It turns out progesterone is important all over you body and a lot of times we don't even know the mechanism how it does it but we know that it is necessary. For instance we now know from a study that was in Science magazine just nine months ago that progesterone is necessary for the manufacture of the myelin sheath which protects all the nerves that pass through your body. And when the myelin sheath can't be maintained you get short circuiting. When you get short circuiting you are going to feel numbness and pain. Say that you sit at your typewriter and you build up lactic acid in the muscles behind your neck and in your shoulders from sitting in one position too long and say that the nerves that pass through have some weak spots there in the myelin sheath the lactic acid that is there is going to create an inflammatory reaction which sets off a feeling in you of pain. And the doctors call it myo fibrocitis myalgia myofacitus and all these things they give you non steroid anti-inflammatory drugs (NSAID's - Willim) and they give you anti-depressants and they give you physical therapy and they do all this other things.

My patients who were on progesterone report to me after five or six months of being on progesterone they said, “All those aches and pains have disappeared.” Because now the Schwan cell can build the myelin sheath.

It is amazing, so with this as a slight review these are the intrinsic functions of progesterone:-

it helps the thyroid hormone

it is a natural anti-depressant

it helps use fat for energy

it is a natural diuretic

it protects against breast fibrocysts

it maintains the secretory endometrium

it is the precursor to the sex hormones

it restores libido

it normalises blood sugar levels

You see it does the opposite of oestrogen, it does all the good stuff

it restores proper cell oxidation

protects against endometrial cancer

protects against breast cancer

stimulates bone building

necessary for the survival of the embryo

precursor of cortisone in the adrenal cortex

And I mean that's like, wow! And I didn't even put on there brain cells need it (see http://www.virginiahopkinstestkits.com/progesteronebrainresearch.html) Brain cells concentrate to twenty times higher than in the serum level, now brain cells wouldn't do that unless there is a purpose. It turns out one of the purposes is, if you have a head injury and if you have good progesterone your ability to survive and recover from the head injury is much better than if you don't have the progesterone. We are talking of levels of five to six times better. This was first found when they whacked rats on their heads created a brain injury they found the female rats survived and recovered, the male rats died. So they gave the male rats oestrogen it didn't happen, they gave the male rats progesterone and that is the one that did it! They now had the same advantage as the females, it is the progesterone #05:03:57

This is the the simplified, most simple way of presenting the biosynthetic pathway. (See www.willim1.com SteroidGenesis Diagram or the books listed below) At the top we start with acetate which is a two carbon fragment from sugars and fatty acids that we eat and we turn that into cholesterol. Every cell can make cholesterol but the liver is the largest producer of cholesterol. From cholesterol we produce pregnenolone, from that we produce progesterone and then we can start making the corticol steroids from that 17hydroxy progesterone androstenedione and down to oestrone and oestradiol and oestriol. But you see the central position of progesterone if progesterone is missing the body has an alternative pathway through DHEA but that get you down to androstenedione and doesn't get to all the cortical steroids. So DHEA is not the mother hormone, DHEA is an alternative pathway to part way correction to the progesterone deficiency problem. #05:04:53

March 2004 Natural Progesterone The Multiple Roles of a Remarkable Hormone Pg 14 & 31

May 2004 What your Doctor may Not Tell You About Menopause Pg 425-429

January 2003 What your Doctor may Not Tell You About Breast Cancer Pg 427-431

January 1999 What your Doctor may Not Tell You About Premenopause Pg 25

This is the same pathway with the molecules. I became fascinated with the molecules and Dr Zava may tell you more about them but I would like to point out that only the oestrone, oestradiol and oestriol in the lower left corner of the molecule is a phenol. The benzene ring with a hydroxyl at the 180 position the only steroid hormones in the body that have phenol. It is no surprise to me that oestrogen by itself is toxic. And you will also notice that all these molecules look essentially identical they only differ by one atom or so per change. And with each alteration of that molecule it becomes a different molecule. So it strikes me that it is supreme arrogance of the pharmaceutical company to think that they can change the construction of progesterone and sell it if it was real progesterone #05:05:47

This gets a little broader because we now have all the cortisone molecules from pregnenolene to progesterone and get all the cortisones and all the cortisols and then you get all the sex hormones over there. If that (progesterone) isn't there it has to go through DHEA. That is page twenty three ( page 14 - Willim) ) in my book by the way so I recommend that you get the book and once you follow that I followed that with a chapter which kind of surreal The Dance of the Steroids

It shows how one hormone becomes the next and without those in between you don't get on. The baker becomes the policemen, the policeman becomes the fireman and so on but if one is missing you miss the whole chain. #05:06:27

The bone effects this is what was so important to me is that oestrogen does nothing but retard bone loss. Progesterone helps in new bone formation. Bone loss and bone formation are processes that go on simultaneously in bone all the time just like the skin and hair epithelial ling cells in your stomach and everything else. You are always ending up losing cells and making new ones. Same thing with red blood cells, red blood cells only live 120 days so you are always losing some one – one hundred and twentieth (1/120th ) everyday and then you have to make some. And the body can compensate if you lose more one day the body may make more so it maintains the normal amount

So the state of the bone that we call osteoporosis is due to either excessive bone loss or not enough new bone formation, or both. It is a shift in the balance from being osteoclast dominant, osteoclasts are the ones that re-absorb away old bone or deficient in osteoblasts the ones that make new bone and progesterone is the one that helps there.

So what made me think that progesterone might help. This is a curve of a woman' skeletal bone mineral density. During her teenage it rises very nicely, reaches a high peak up around thirty, thirty five at the latest. And at thirty five starts declining and then at menopause at fifty to fifty five there is a sharper decline then after a few years it returns to the normal rate of decline. Now this slide was obtained from my own patients over the years it is also in many books. And I was in Colorado talking and this was Merck, and probably shouldn't show you but this is their same curve and it is identical. Everybody agrees the peak is reached in the thirties and interesting in this is the poor lady who has lost forty percent or fifty percent of her bone is still smiling. Little does she know that she is a month away from a hip fracture #05:08:34

# 06 This raised the question in my mind, how can this be due to oestrogen deficiency? The woman is pre-menopausal, means she is making enough oestrogen to have monthly periods. Clearly she has plenty of oestrogen. What has happened? And what I found was that very likely she is already deficient in progesterone which means that she is not keeping up with making new bone. Now this turns out what it is and later I'll show you why. It is not Mother Nature's plan to make you deficient in progesterone it is something that we have been doing to ourself.

This is from Lancet and it shows the factors in bone production having to do with



local factors

sporadic factors

I loved this because it is a wonderful chart and no where in the text do they explain what they mean by local factors or sporadic factors.

And that leads to increased bone loss or inadequate peak bone mass which theoretically means the same which is joined to low bone density, right. And If you combine enough trauma with low bone density you can create a fracture. If you don't have so much low bone density then the trauma has to be a little greater. And if you have very little bone density then the trauma doesn't have to be very much the combination produces a fracture #06:01:20

This all seems like, “yeah! Of course it ”

Now they know heredity has something to do with it so they wrote that in and drew two arrows to it. This is unbelievable that this stuff gets printed and published, amazing! But this is their picture of how bones get made at the top left we have the oesteoclasts little “pac” men eating up old bone because it has become old and it has crystallised and it is more likely to fracture. And right after the pac men leave osteoblasts move in and and they make new bone and they make it thicker than it was before. And so that is the new bone formation and that's the whole cycle that goes on in the bones all the time.

We actually regenerate new bones, called bone turnover, on the trabecular bone it only takes three or four years and you have totally new bones. Every three or four years on the long bones with the cortical bone which is a lot thicker it takes ten, twelve to fourteen years but even so your skeleton is always renewing itself, isn't that “wow!”

This is an actual photomicrograph and you can actually see new bone. You see in the top that's a little spicular bone part of a trabecular beam and you can actually see where the new bone has been put in. So this is all true folks this is Lancet. #06:02:44

From my studies I found that if took my patients who were not on anything hormonally they tended to lose 1.5 to 2% of their bone in a year. So in three years at a minimum they would lose 4.5% see that's the bottom line. Oestrogen folks would stay where they were. The progesterone one's that were on progesterone in three years they would gain on average 15% more bone. It has never been reported by any other treatment, with absolute safety and this should be a revolution started doing in 1978, so I'm getting a little tired of the revolution taking so long. #06:03:30

This is an example in 1982 a seventy year old lady trying to lift her husband off he had collapsed from advanced terminal emphysema she broke her arm. This is her back bones, her arm bones were really weak but her back bones she had lost, those are the bone mineral density tests.

A typical bone mineral density test think of the number $1.00, one point zero, zero and she's six,six, nine so she's lost thirty three per cent of her bone. She went on progesterone, actually she went to see an orthopaedic and he said “oh you have bad bones you need to take the fluoride treatments.” She said, “No. no, I took the class at Dr Lee's. We know that fluoride is toxic to bone. It might to bone density but it doesn't do any good to bone quality.” So he said “Then go see Dr Lee.”

You see when I taught the class it was a rule that no one in the class could become my patient because I did not want people to think I was teaching to . My practice was too large as it was, but because she was referred by another doctor then I accepted it and put her on progesterone and she went up to point eight six five. Twenty points in less than three years, two and a half years she was gaining, she had gained something like twenty four per cent new bone and this is typical. #06:05:01

Now I want to show you another one, this is all four bone in her lumbar spine. We check L1, L2, 3 and L4. I wanted to show that it wasn't just one bone that was weak and then got better. All those line represent the first lumbar, second lumbar, third lumbar and fourth lumbar. It shows that all four of the bones are increasing.

So this is a general metabolic improvement to all bone. I like to do the lumbar spines because they are the first to show the loss and they are the easiest to do the test on to show the gain. And eventually it is going to happen to all the bone in the body. The hip is more important clinically but the hip is a complex bone but there is no need to get the tests there when the lumbar spine are larger and you can more easily do more of them and get better results.

Now this is a lady aged seventy one about the same in October 1992 this is ten years later. This lady lives in Pennsylvania and she woke up one morning a half inch shorter and had terrible back pain because she had a sudden collapse of the vertebrae in her back. Her numbers were only point four four six, she had really lost a lot of bone. She was a health nut she had eaten well , exercised, done everything, she looked great but she hadn't had any progesterone for quite a while, for twenty years or longer. So she wanted to go on progesterone, I had met her years ago at some health conference on the east coast and I sent her a copy of the papers I wrote. Her husband's a doctor, her son's a doctor and of course she had a doctor and that doctor got another doctor to look after her bones. And when she told them she wanted to go on this cream they all told her, “this was crazy! You have got to go on oestrogen. You have to do all this other stuff ” She said, “ No, no it's my body this is what I'm going to do.” So her husband made her get a new bone mineral density test actually it was October by May she had to get another one, April next year so something like every nine months she had to get a bone mineral density test and here she went from four four six to five five an increase of over twenty percent in less than two years. Over the years she has been sending me copies of her tests. She's back up now to seven or eight and it continues to go on.

You see I had nothing to do with this at all I wasn't my wonderful personality, it wasn't placebo effect or if it is a placebo, it is a dammed good placebo. #06:07:31

I'll do these quickly this should show the expected loss in three years was four and a half per cent but what happened actually was a fifteen percent gain. This shows that those that had the best bone that's the bottom line had one point one to one point two. Remember I said that the dollar is good $1.20 they had very little change. Whereas those that had worse bones had a greater change twenty three per cent and in graph form you can see that those that were worst had the best gain, those that were highest had the least. That's only natural because bones only improve back up to where they ought to be and then that's it.

This is a chart showing people over seventy and under seventy and there is absolutely no difference in their bone response. It is not a matter of age and this shows the people over seventy and under seventy they have better bones. The people over seventy by the time I saw them had lost a lot of bone but the improvement turned out to be the same when I gave them progesterone.

This is a chart of the first sixty two patients who completed three years of serial bone mineral density testing and you see one was very low over here and the solid white line are the bone mineral density when I first saw them and the outlined lines are the bone mineral densities three years later. There are two or three that did not gain and on those we later found it was due to excess thyroid medication or they were lacking hydrochloric acid or some other factors. Bone growth metabolism is a multi factorial heterogenic process that requires a lot of things working together but it is easy with the progesterone. If they don't get on with the progesterone you know you have to look at some of these other factors. Now you don't have to look for all these other factors in the typical case because once you get the diet right and get them on the progesterone, a little vitamin C, a little vitamin D you have covered the bases it is only the unique ones so after a year or two you can tell if they aren't growing but this shows the improvement. This a chart which would show people if you take their starting 0.7 you can read across and anticipate in three years they would be over 0.9. It averages the mean, if that helps anybody. #07:00:21

These are other risk factors that I think most of you know about I'm not going to through them. We know that diuretics, fluoride, corticol steroids sedentary life style, low body fat and all these things are factors in bones and these are the minerals and vitamins that are known to be important. And the calcium chain I think this is an interesting concept. The origin of calcium is not in milk, you understand , the cows had to get the calcium from some place. The origin of calcium is in the soil, it is the mineral in the dirt, and the only creature that can get it out of the dirt into an edible form is a plant. #07:00:55

If we eat plants we get all the calcium we need along with a whole lot of the other factors we need. And then to get it out of the stomach into the bloodstream we need hydrochloric acid in the stomach and vitamin D. Then to get it out of the bloodstream into the bone we need all these other things micro nutrients, progesterone, exercise and testosterone. Testosterone will do the same thing as progesterone as far as bones go.

Factors promoting oestrogen dominance. Now you see in discovering that these people were deficient in progesterone and by restoring that by giving the cream I created new bone. In the process from the patients I learned all the other benefits. And so in my mind it seemed to me what I was treating was oestrogen dominance. Their body was still making oestrogen they were deficient in progesterone dominance that led to the whole business of these side effects that I was seeing. And oestrogen dominance people who we are fat and eat a lot of fat will actually make more oestrogen and that can contribute and the ovary can become. The ovary normally makes in the process of making and releasing an egg and after the egg is released the follicle that it came from becomes the corpus luteum a little yellow spot on the body of the uterus and it makes a high dose of progesterone for ten to twelve days. And then of course you can have some damned doctor giving the person more oestrogen. My fortieth school class reunion went back to Minnesota my sister arranged a family gathering of all sorts of nieces and nephews that I hadn't seen for forty years. And four or five of them were women up in their fifties and in talking to them it turns out already they all had had hysterectomies. And they go to the doctor and they, “gee I'm getting fatter around my hips and my lower body, I've lost interest in sex I can't concentrate, I'm depressed I don't sleep very well”

And he would say. “I'm sorry my dear you are approaching menopause you are still having periods but you are approaching menopause it means your oestrogen is turning down, we'll give you a little oestrogen.” So he would give a little oestrogen and all the symptoms would get worse.

Only when they went back he would say, “Well I guess I didn't give you enough.” So he would give more oestrogen and then they would get abnormal bleeding, spotting and funny periods and clots and all these things and that would lead to a D & C and that would lead to hyperplasia. Remember hyperplasia the cells of the uterus are building up well they are multiplying faster and that's called hyperplasia.

And he would say, “that this is the first step to cancer of the uterus. You might as well have your hysterectomy now.” And all of my relatives had that done, there is seven hundred and seventy thousand hysterectomies done in the United States per year. And if you relate that to other countries by population the incidence is two or three times that of any other country, very strange. #07:03:57

Now this is a recent paper Dr Zava sent me this paper, the lead author is Dr Chang it was done by French doctors and Taiwanese doctors and it has to do with study on forty young, healthy, pre-menopausal women. These women were ready to have breast surgery for some small benign condition.

Ten days before their breast surgery the doctors gave them one of four creams. One was a progesterone cream, one was an oestrogen cream, one was a combination cream and one was a placebo cream. Very good we are talking forty women divided into four groups and ten days later they had their surgery. And the first columns that are so low that you can't see them this is the people who had the placebo cream you can't see the measurement, this is the measure of the oestrogen and progesterone in their breast the numbers are like 0.6 pg per gram of breast tissue. Those that had the progesterone cream their progesterone was now 66ng per gram so it is an increase of one hundred times in ten days of low dose 20mg per day or 25mg, low physiological amount of progesterone for ten days it raised the breast progesterone by one hundred times. We don't need four hundred milligrams a day we need only what mother nature intended. The third one is the oestrogen the oestrogen increased one hundred times or more by the oestrogen dose that was chosen in the cream. Indicates that both of those hormones are very well absorbed through the skin and they reach the target tissues. It is normal for these hormones to do that. The fourth one is the combination where they received a mixture of the two creams and sure enough the effect is half of the other one, so that is fine.

Then they did three tests measuring the rate of hyperplasia of the epithelial cells of the milk ducts of the breast. This is where cancer originates. This test they actually looked at the cells under a microscope and they counted the number of cells hat were going through mitosis. The higher the mitosis number it means the more cells that are becoming two cells, they are undergoing, we call this dividing, to multiply. They are replicating, they are becoming more of themselves. The first number is the placebo that's the ones who didn't have any excess hormone that's the normal cell replication rate half of a cell per thousand cells. The oestrogen rate is something over 0.8 it is almost double. Those that were on the combination restored it back to normal. Those that were on the progesterone it dropped it to about one sixth, the replication slowed down. The cells were happy being what they were, isn't that amazing? This is proof that progesterone stops, prevents, works against, breast cancer.

Major cause of progesterone deficiency among women in industrialised countries is follicle depletion and/or dysfunction secondary to xenobiotics. I'm going to spend a couple of minutes telling you about the xenobiotics. This was the other TCNA study you will see this the … proliferating cells nuclear anogens TCNA and is supposed to more accurate than actually counting the cells. You'll see that the rise that occurred with oestrogen protection when progesterone was added. Even with the oestrogen the progesterone still protected even though the progesterone by itself the protection was that much better. And so what this test showed is that these hormones are well absorbed through the skin and that normal physiological doses are the small doses and they achieve high concentrations in the target tissues. And that oestrogen causes or promotes the hyperplasia and extra proliferation, rapid turnover what we call cancer and progesterone prevents it. They also did one other test which I didn't make a slide of there is nothing to show they looked for the rise of progesterone in the blood serum, it wasn't there. Now it got to the breast going through the blood but it was not in the serum, how can that be? Now it turns out that if you stop to think about it it has to be that way. When the ovary makes the progesterone it is a fat soluble compound, all steroids are fat soluble. Being fat soluble it will not mix with the serum which is watery so the ovary coats it with a protein in this case it is called cortisol binding globulin and in the case of oestrogen it is called sex hormone binding globulin. It is a big protein envelope that surrounds each molecule of the progesterone or the oestrogen and that way it is now soluble in the plasma. The protein bound hormone is now soluble in the watery plasma or serum. The problem is that being bound in the protein #07:09:04

# 08 Only one to nine per cent of the hormone bound to the protein is biologically active so you get these doctors ordering quote, blood tests, of your hormones and he is measuring the amount floating around in the serum or plasma not knowing that only one to nine per cent of that is really biologically active hormone. Whereas when you absorb it through the skin as plain ordinary progesterone or plain ordinary oestrodiol, it passes through the skin very readily is picked up by the fat underneath the skin and then enters the blood stream on the coats of the membranes of the red blood cells because those are fatty membranes and it can ride with the fat of the red blood cell membrane it is not in the plasma. So if some one is on progesterone cream and some doctor says, “We'll check and see if this is really raising your progesterone.” He does a blood test he won't find it in the serum, he might find it only when you have enough for the body and if it circulates enough you might get a slight rise kind of a spill over into the plasma serum. Do you recognise the significance of this? The conventional doctor first of all when he does his test he doesn't know whether it is ninety one or ninety nine percent of the hormone is biologically inactive in the numbers that he gets and he doesn't know whether or not you are using progesterone in some other way such as riding around on the red blood cell membrane.

So this is a landmark study, because it was placebo controlled, randomised, in vivo, double blind study, I mean it is like the gold standard, it should satisfy anyone conventional minded. If someone says how does Dr Lee know that the progesterone gets into the bloodstream now we know how it does, I knew it because I could see the results. If you have a woman with fibrocystic breasts it is due to oestrogen dominance. You give natural doses of progesterone and within three cycles the breasts are back to normal. So there is no doubt in my mind that it got there but now this has been proved. #08:02:26

Now let me tell you about xenobiotics. Xenobiotics are petrochemical derivative molecules made from petrochemical sources that contaminate our environment, our food chain, the air we breathe out gassing from carpets and plastic the smoothing, spreading agents that are in salad dressing, spermicidal gel things like that. Primarily herbicides and pesticides that are non biodegradable they don't isappear because somebody eats them eventually passes on to the rest of us further up the food chain. And they are, they act in usual cases as very highly oestrogenic substances they are fat soluble non biodegradable oestrogenic substances as they found more about this they found that some act as anti-oestrogens. Other act on other hormones such as the thyroid hormone so they are now called anti endocrine or xenobiotics to cover a wider field rather than xeno-oestrogens. They can occupy the same receptors. All hormones work by passing through the blood, through the extra cellular fluid, through a cell membrane where the meet a receptor. A pre-formed protein like compound that binds due to molecular configuration like a key in a lock. It will bind to the incoming hormone and the two together having bound will travel through the cell to the nucleus and to the chromosome where there is a gene site that this will affect, isn't that amazing? This has to occur for a hormone to work and at the gene site it has some effect that was predetermined by that gene. So a hormone mimic such as these xenobiotics may occupy the receptor and carry out what that hormone receptor thinks is it'll travel to the chromosome and it will carry out a very potent oestrogenic reaction or it may bind to the receptor but it yet be so different that the receptor will not accept it in that sense and nothing will happen. So you either have a hormone response or it can block the normal hormone response your own natural hormone will not be able to work if the receptors were all filled with these antagonists so some of these agonists some are antagonists.

The scientists who have studied this are this isn't unique to people In fact they first studied this in the alligators of lake Apopka Florida. The alligators were found to be dying out in Lake Apopka and Dr Louis Gillette Jnr. from Florida University was asked to study them and the first thing they found in examining the existing alligators that on the females that the ovaries were very large but the follicles were all burned out, the follicles were non-functioning, they weren't making any eggs. And of course if they are human if they are not making eggs they are not making progesterone #08:05:54

In the males they found that the testicles were atrophic and the testicles were unable to make the right amount of sperm. And what other people found this in other animals around the world this was put together by various scientists and they then looked at human sperm bank collections and they found that in humans the sperm production has fallen fifty per cent in the last thirty five years in industrialised countries. If you were to a draw a line on a graph showing a fifty percent drop in thirty five years and you continue the line in you know in another thirty five years it would drop to zero which would mean that the last male in the United States to father a child has already been born. It may not go to zero, it may taper off but if it like the other animals they don't die the end up with crossed beaks they end up with thyroid tumours they end up with all sorts of things so that may be the fate of us if we don't figure how to decrease our exposure to the xenobiotics. The scientists have all pictured this triangle.

environmental exposure to the xenobiotic

intrinsic susceptibility some people are more susceptible than others for reasons, we don't know, maybe genetic

the time and the age when he creature is exposed.

It turns out that the most crucial time occurs when you are an embryo in your mothers womb, isn't that amazing?. That's when the germ cells are all developing, that's when the follicles are developing in the ovaries, that's when the Sertoli cells are developing the ability to make sperm in the testicles and when that is interrupted there you will be born looking fine and normal no one will suspect any damage until you are thirty, thirty five years old and you run out of the ability to to make sperm or you run out of the ability to make progesterone #08:07:53 So given the present state of knowledge and the full certainty that we are now in good exposure to xenobiotics we don't know what the fall out will be 'til thirty five years from now, isn't that amazing? There is this this lag, this is why it was missed by the various health agencies it doesn't make the mom get sick, it doesn't make deformities in the children she produces but it makes a defect which shows up further down the line. So we'll see #08:08:31

# 09 Now these are some examples. The first one the left, the upper left is oestradiol normal female oestrogen the next one is chlomestrol which is a known phyto-oestrogen this is a compound made by plants, common in plants and you'll see the similarities to oestradiol, has the same phenyl ring over in the left hand corner and then next one over there is Diethylstilbestrol has two phenyl rings and that's the first major synthetic xeno-oestrogen. they gave it to animals to increase their oestrogenic reaction of gaining weight, adding water getting to market weight sooner and they also gave it to pregnant women who were in danger of miscarriage, premature labour in the hope that it would stop labour. Had they known they could have given progesterone but they didn't they give this/that they called an oestrogen Diethylstilbestrol, DES, and what happened? It didn't change the rate of early labour and miscarriage but the girls that were born of mothers who got this later were found to have cancer of the cervix and cancer of the vagina much much higher than women who had never been exposed in their youth, isn't that something? #09:01:09 And this is what happened to the alligators in Lake Apopka.

This is Equol, this is a horse oestrogen, this is what constitutes the major hormone in Premarin which is obtained from pregnant mares' urine. And that's DDT the first major world wide insecticide, herbicide DDT. It has not technically phenyl groups but it has the benzine ring with chlorine, Cl, instead of the hydroxyl, the HO, and that acts as a very potent xeno oestrogen. And over there is marijuana, DHC, and that has the same thing young boys who smoke marijuana will some times get Gynecomastia.

Do you know what Gynecomastia is? On one breast the nipple will be larger than the other side, the breast will stand out a little bit more and they will do their best not to let their buddies know about this. Their buddies might think them as being hermaphrodites remember that mixed sex or something like that. And finally their mother will discover and they will bring this fifteen year old kid into me and I will tell the mother, “I'd like to talk to him by himself.” And I would say, “I know what causes that.” And I said, “Would you like to keep that happening? Would you like it to get bigger or go back to being normal again?”

And he said, “What is it?”

“You've been smoking grass.”

“Oh man I can do without that! Oh! No problem.”

So there was a nice to know this is part of the work that Dr Zava has been doing he is able to tell which compound in nature and which compounds from various products combine with receptors for progesterone and oestrogen and things like that he is going to telling you about that. #09:03:12

This is very interesting one I wanted to show you this on the bottom is PCB polychlorobiphenyl. PCB's are very, very common all through the environment and there are literally thousands of them. In fact there are one hundred and twenty eight different sites those numbers scattered around those phenyl rings, those benzine rings are sites where chlorine is put on one place or another and there is one hundred an twenty eight different combinations. The top one is thyroxine which is the same thing it has got two benzine rings and they have four iodines on them and those vertical are “I”'s, iodines, that thyroxine. It turns out that thyroxine in the embryo thyroxine is important to developing your inner ear, the cochlea. The cochlea which can discriminate various high and low frequency sounds and when the mother is deficient in the thyroxine the baby's ears don't have full development. I often think of that when some guys go past me with their boom boxes going so loud. I mean they have to be partially deaf, right, to do that? I think, “oh my god the mother was exposed to xenobiotics. Now maybe they just sat too many hours in front of the big speakers at the concerts, but this is now known to block the cochlea development in animals by competing with thyroxine at the thyroxine receptor. Do you see the similarity in the molecule?

The question, see what I think what we have answered is where does progesterone deficiency come from. I can tell you it comes from:-

bad diet

it can come from stress because the control of the body's hormones operate through the limbic brain and the limbic brain is where stress in included in the equations of all the things that happen in our body. #09:05:06

The major cause in my opinion is as it is only happening in industrialised countries we are talking Canada, the United States, England and Western Europe. If you look at women in other parts of the world they don't have these problems that we have here in the industrialised countries their woman pass through menopause without the hot flushes they don't even have a word in their language for hot flush. They don't have the osteoporosis, they don't have the breast cancer that we have.

Our breast cancer in on the increase you all know that twenty five or thirty years ago it was one woman in fifty then one woman in twenty five now we are down to what? One woman in nine, one woman in eight if we live long enough. So it is something in industrialised countries and the best candidate is as we now know from the animal tests the alligators, the toads, the frogs, the turtles, the Florida cougars, the salmon, the seagulls all over these same countries the same thing is happening. Remember the peregrine falcon that had the soft eggs and couldn't this is another problem with all of this. We are in the same food chain so very likely a major candidate for the cause of the defect in progesterone production in women and the loss of the testicle function in men are these xeno-oestrogens. Women have the advantage that they can take some progesterone and make up for this loss.

# 10 So now we come to the question why aren't doctors doing this? This stuff about the xenobiotics has been in the literature for the last five - six years. It is in Time magazine, in Newsweek, it's all over the place and everybody says, “Tut, tut! We have to do something about this.” But nobody is and doctors are not measuring progesterone levels. I was at a conference in Colorado last week and this lady professor says, “We don't see much progesterone deficiency.” She sees it all the time. She doesn't recognise progesterone deficiency. And then when they do stumble on to his then they end up using the synthetic progestins which are not the same.

You saw how the molecular configuration is so important. The molecule has to be precise this is why on the cover of my book {Natural Progesterone The Multiple roles of a Remarkable Hormone – Willim}

I put that molecule it doesn't matter where it comes from if it is that molecule that is natural progesterone. That is the progesterone that is normal, natural for human beings.

There is a lot of confusion out there because people are trying to say that I mean that natural means that it came from a Mexican Wild Yam. No, it so happens that in 1938 Dr Russell E Marker found a chemical way to change some of the fat, saponin you know the word sap. The saponin, the fats in Mexican Wild Yams he could modify that and he could produce this molecule. Because this particular fat, diosgenin, is fairly close. Not the same, fairly close so the progesterone is not in the yam. No amount of eating, these yams by the way are not related to the yams in your market They are a vine plant that create great big gourds. The gourd is soapy and rather bland in taste people don't often eat it very much. But in certain places it is the only thing that grows well and so has been eaten.

There maybe products in there in this gourd that do have progesteronic or oestrogenic effects but the one Dr Marker found didn't, but he could transform it in to natural progesterone. And he died a year ago this month, he was ninety two years old a Professor at the University of Pittsburgh for many years. Many wonderful scientific achievements but the Wall Street Journal and the New York times in his obituary said the most important thing Dr Marker ever did was a young man back in 1938 he showed the world how to create natural progesterone out of Mexican wild yam fat, isn't that amazing?

So what we really want is the Mexican wild yam converted into progesterone and then the people should put that in the creams because it is so well absorbed. Those creams that have only extract of Mexican wild yam or ground up wild yam that is not going to help you at all. And so right now it pays to pay attention to which of the creams you are using because only four or five of them have the real progesterone in them, isn't that amazing? { in 2009 check for USP Progesterone on the ingredients – Willim}

So what I hope is you will understand the whole sequence. We have a dysfunctional conventional medicine based on the chemically altered drug.

Now altered analogues and the typical doctor only knows about these. They don't even know that natural progesterone exists and it has been out in these creams for years.

We have to tell people that there is a problem, progesterone deficiency exists, oestrogen deficiency is largely a myth. The problems that our women are most hampered by the osteoporosis, the breast cancer the decline in their mental acuity the loss of libido these are related to progesterone and not oestrogen problems. I'm not against oestrogen, if a woman needs a little oestrogen like for hot flashes, vaginal dryness she can have some but the typical woman won't need it. That's what you have to find out and it all fits together.

I have been talking about this for two or three years and everything that comes, out all these new studies like this one in fertility and sterility by Dr Chang all confirm what I have been saying. It is a comfortable feeling for me to talk about this it isn't just my personal experience.

The science and now Dr Zava is one of the doctors who is amassing the scientific evidence that confirms all of this. He can measure the saliva for you for the amount of active hormone that you have. The World Health Organisation has been doing this for five or six years it is going to be a standard test. So later we will have some questions and answers I'm sure you will have some but that's the story of progesterone and what I have been trying to get across. I really appreciate being here today and do it and thank you very much.

# # # life of blood cells approx 120 days … approx time for progesterone cream to kick in … does synthetic hormone get excreted with red blood cells? - Willim

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