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Welcome to Dr. Ruscio Radio,

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drruscio.com. The

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following discussion is for educational purposes

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only and is not intended to diagnose

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or treat any disease. Please

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do not apply any of this information

0:40

without first speaking with your doctor. Now,

0:42

let's head to the show. Hi,

0:44

everyone. Welcome back. Let's discuss

0:46

a number of natural ways that you

0:48

can help preserve your brain health and

0:51

preserve your cognition. And

0:53

beyond the obvious, why this might be the most

0:55

important area for you to focus on whatever

0:58

challenge you've been given. If it's

1:00

a health challenge, a work challenge,

1:02

a social or relationship challenge, the

1:05

better you think, the faster you should

1:07

be able to solve that problem. So

1:10

these tools that we can use to improve

1:12

brain health, including cognition,

1:15

are quite important and something we should

1:17

pay attention to. So today,

1:20

let's discuss exercise, beetroot

1:22

juice, polyphenols,

1:25

ultra processed food, how we define

1:27

those and what detriment

1:30

they pose, the Mediterranean diet,

1:32

fish oil and multivitamin

1:34

supplementation, fasting, and an

1:37

enzyme that breaks down histamine called

1:39

DAO. Let's

1:44

start with exercise. You

1:46

may have been frustrated by the

1:49

advice of eat less

1:51

and exercise. This

1:53

study may shift how we

1:56

think about that in that it could be

1:59

better to be able to do better and more accurately

2:01

stated that if you exercise, you

2:04

will eat less. 2023,

2:08

meta-analysis that found

2:10

exercising reduced cravings

2:12

for unhealthy foods. Being

2:15

a meta-analysis, they looked at eight

2:18

different studies. They

2:20

performed brain scans within a few

2:23

minutes or within a day after

2:26

aerobic exercise compared

2:28

to controls. Now,

2:31

what was interesting about this study is

2:33

people, while in a functional

2:35

MRI and having their brains

2:37

scanned, were shown photos

2:40

of pizza, one of my favorites. In

2:43

fact, I had pizza last night. Just to

2:45

clarify, as much as I advocate being healthy,

2:47

I leave some

2:49

allowance for indulgences. Cakes,

2:53

ice cream, hot dogs, as

2:56

compared to other images of

2:58

vegetables, fruits, and

3:01

whole grains. What

3:03

they found was interesting in that there

3:06

was reduced cravings for

3:08

processed foods as

3:10

evidenced by lower activity

3:13

in this brain region called

3:15

the insula. And the insula

3:18

is a part of the brain that

3:21

is responsible for, or at least

3:23

involved in, food craving.

3:26

Now, one of the things I've noticed, just to tie in

3:28

my personal experience, is when

3:31

I'm exercising, I do

3:33

notice I have less cravings. It's a

3:35

weird, I guess

3:37

counterintuitive other than in light

3:40

of this study findings, because

3:42

you would think if you're exercising more,

3:45

you'd be hungry. Now, there are certain

3:48

tie-ins where if I have

3:50

an extremely vigorous exercise day, I

3:53

may notice I'm a little bit more hungry, or

3:55

probably more accurately stated, I'm more

3:57

thirsty, and sometimes we'll confuse one.

4:00

will confuse hunger for thirst,

4:02

which is why I think it's important

4:04

if you're trying to mind your total

4:06

calories consumed to drink ample

4:08

water because sometimes it's the water

4:11

in the food that you're craving. Nevertheless,

4:14

I have noticed as I've

4:16

gone through periods of exercising more, exercising

4:18

less, that on a

4:20

day when I exercise, I

4:22

find myself eating less and

4:24

being less hungry. So for

4:26

whatever it's worth, you

4:29

may end up eating less

4:31

of your own accord and not having

4:33

to force yourself to eat less if

4:36

you're exercising. So if you're not yet, please

4:38

consider starting as soon as you can. Okay,

4:43

beetroot. This is also

4:45

a supplement I take on most days. There

4:47

was a 2023 crossover randomized

4:51

control trial. This means that the

4:53

placebo group and the treatment group

4:55

were then switched so we could

4:57

compare across groups to make sure

4:59

the finding was consistent. Given

5:02

either three grams of beetroot

5:05

as a powder or placebo,

5:08

and they found that supplementation with

5:10

the beetroot led to

5:12

improved short and long

5:14

term memory and also cognitive

5:16

flexibility. The way I

5:18

think about cognitive flexibility is task

5:21

switching. So I'm involved

5:23

in research, in clinic, in education, and

5:26

kind of running the business in terms of the

5:28

mechanics and the people that underlie this. And

5:30

so it's not uncommon for me to have to

5:32

switch from analyzing data as

5:34

in went into this brief, and then

5:37

shift to something with someone on our

5:39

team that may be more so how

5:41

do we plan, how do we build

5:43

systems. And so that cognitive flexibility, the

5:46

faculty to switch tasks effectively

5:50

is this cognitive flexibility, which I feel is

5:52

quite an important mental

5:54

attribute to have. So

5:57

then why was it perhaps that the beetroot

5:59

improved? improved these domains of cognition.

6:03

Well we know that beetroot can

6:05

improve circulation. There's

6:07

some evidence that has found

6:09

that beetroot supplementation can improve

6:12

cardiovascular performance, can increase levels

6:14

of what's known as nitric

6:16

oxide, and nitric

6:19

oxide may improve performance

6:21

via increasing circulation. Also,

6:23

as you can imagine, as

6:25

we've discussed before, polyphenols are

6:28

what gives fruits and

6:30

vegetables their color, and

6:32

obviously beetroot is this

6:35

bright, rich red, therefore it's

6:37

rich in antioxidants. And

6:39

just to briefly touch on the

6:42

fact that this was one randomized

6:44

control trial, what if we zoom

6:46

out and look for meta-analyses that

6:48

have summarized the body of evidence

6:50

for beetroot? Well,

6:53

there are no meta-analyses on

6:55

cognition, but there

6:57

are meta-analyses on beetroot

7:00

being able to reduce

7:02

exercise-induced muscle damage,

7:06

and a separate meta-analysis that found

7:08

that beetroot juice, but

7:10

in this case not powder, led

7:13

to a reduction in blood pressure. So

7:16

something to perhaps consider is

7:18

adding either beetroot juice or

7:21

powder to your daily routine.

7:24

We just mentioned polyphenols. These

7:27

are nutrients in plants

7:30

that help the body, the human system,

7:33

manage inflammation and

7:35

protect against oxidative stress due

7:38

to, amongst other things, the

7:40

rich antioxidant content. This

7:42

is where a 2023 meta-analysis

7:45

of 37 studies was

7:48

interesting, in that they

7:50

found that polyphenol consumption in

7:52

the diet was associated

7:54

with a 20% lower

7:57

risk of cognitive impairment. And

8:01

this may be where the the axiom

8:03

the recommendation to eat the rainbow has

8:07

Relevance in terms of aim

8:09

for different colors across

8:11

the fruits and vegetables that you eat

8:15

to quote this paper habitual

8:17

inclusion of flavonoids

8:21

in the diet may play a preventative

8:24

role in cognitive disorders

8:26

and Polyphenols

8:28

and flavonoids are very

8:31

loosely said kind of aka is for

8:33

what you will get in richly

8:36

colored fruits and vegetables And

8:39

I did want to touch on something that we had covered

8:41

in a previous video on best

8:44

foods for brain health wherein

8:47

we cite a study listing

8:49

the most rich Polyphenol

8:52

foods this includes

8:54

cloves peppermint dark

8:56

chocolate flax seeds rosemary

8:59

and blueberries, which

9:01

is why one of my recommendations was

9:04

Consider pairing chocolate dark chocolate that is so

9:06

it's gonna have minimal sugar with

9:09

blueberries Now

9:11

on the other side of the spectrum if

9:13

we're eating ultra processed food

9:17

Those foods are likely

9:19

supplanting these Polyphenol

9:22

rich foods that we get from plants I

9:25

also just want to say that I'm not making

9:27

the claim that you have to eat a plant-based

9:29

diet But I think an

9:31

omnivorous diet that includes healthy sources of meat

9:33

and fish and fat Plus

9:36

fruits and vegetables is probably the

9:38

best healthiest most well-rounded and balanced

9:40

diet That being said Looking

9:43

at ultra processed food. Well

9:45

firstly, how do we

9:47

define ultra processed because There

9:50

can be loose language used

9:53

wherein people don't know Should

9:56

I literally be eating raw meat and

9:58

raw vegetables? no

10:00

processing? Is some processing okay?

10:03

And if so, how much is okay and how

10:05

much is too much? Well,

10:07

a few guidelines for you. The

10:11

ultra-processed foods contain ingredients that

10:14

are made in the lab

10:16

to enhance taste, color,

10:18

and or shelf life and

10:21

are not routinely found in your kitchen. Here

10:25

is what I found to be

10:27

a wonderful diagram from the journal

10:29

Nutrients, which I'm proud

10:31

to say we have been published in, not

10:33

this paper, but we've been published in this

10:35

journal, great journal, looking

10:38

at fresh produce as pineapple and

10:40

corn. Unprocessed would

10:42

be whole corn, whole pineapple.

10:46

Minimally processed would be cut

10:48

corn or popcorn. Processed

10:51

would be pineapple

10:55

slices and syrup in a can or

10:58

kernel corn in a can. And

11:01

ultra-processed would be pineapple jelly

11:04

or some sort of corn chip snack.

11:07

So this just gives you an example

11:09

of what the spectrum of food processing

11:12

looks like. And I'm trying to be

11:14

better about giving specific examples because you

11:16

have in the comments asked questions, well,

11:18

how do we define ultra-processed from minimally

11:20

processed? And I think that's a great

11:22

question. So thank you for the feedback

11:24

in the comments. And this

11:26

is why myself and big credit to our research team dug

11:29

to try to find a specific tangible

11:32

example. So

11:35

now coming to the study, a

11:37

2023 meta-analysis of

11:39

26 observational trials,

11:42

looking at over 260,000 individuals, finding

11:48

that higher ultra-processed food

11:50

intake was associated

11:52

with a 28% increase risk of depression

11:58

and quoting the journal Results

12:00

of the present study clearly

12:02

indicate that consuming ultra-processed food

12:05

was linked to an increased

12:07

risk of depression. So

12:10

bear this in mind and do

12:12

your best to avoid the ultra-processed

12:15

fast foods, cookies, pastries, things

12:18

like cakes, ice cream, pizza

12:21

and pasta, even though

12:23

again, I will have pizza on

12:25

occasion like I admitted to earlier,

12:27

avoiding hot dogs, chicken nuggets and

12:30

soft drinks. Again, it doesn't

12:32

mean you can't have any of these,

12:34

but certainly things that you want to

12:36

be judicious with your consumption. Now,

12:40

like I mentioned a moment ago, the polyphenols

12:42

you can get from a number of dietary

12:45

plans, one of which is a Mediterranean diet.

12:48

And it was recently found in

12:50

a meta-analysis that

12:53

the Mediterranean diet can

12:55

improve cognitive function.

12:58

They found that adhering to this diet led

13:01

to better cognitive health

13:03

as measured by multiple

13:05

indices. And my

13:09

opinion here, it's likely

13:11

due to the combination of

13:13

higher food quality, meaning as

13:15

one example, again, you'll have

13:17

polyphenols and flavonoids from

13:19

those plant foods. You'll have

13:21

fish and you

13:24

will likely not be overeating because

13:26

there is more of a tendency

13:28

to overeat when people consume processed

13:31

foods. So it's important to underscore

13:33

that it may not be all

13:35

due to the diet regarding

13:38

the nutrient content, which is totally

13:40

important not to discount that, but

13:44

that another benefit may be contained in

13:46

the fact that a

13:48

higher quality food

13:50

diet is more

13:52

prone to guard

13:54

against overeating. And

13:57

when people don't overeat, they avoid

13:59

gaining weight. and

14:01

all of the subsequent issues that

14:03

accompany being overweight. Hey

14:06

there podcast listeners, thank you so much for

14:08

following the show. If you wouldn't mind, please

14:10

leave the podcast a quick review and share

14:12

this with someone you think it may help.

14:16

Many healthy diets will include fish.

14:20

So let's discuss fish oil. This

14:23

next study did find that fish

14:26

oil supplementation increased

14:29

what's known as brain-derived

14:31

neurotrophic factor or BDNF,

14:34

which is also nicknamed miracle

14:37

grow for the brain because it

14:39

literally causes growth in the brain.

14:43

A 2023 meta-analysis of 12 randomized

14:46

control trials looked at placebo versus

14:49

omega-3 fatty acid supplementation.

14:53

And again, they did find that

14:55

the omega-3 supplementation group

14:57

or groups had

15:00

increased levels of brain-derived neurotrophic

15:02

factor. They found

15:04

additionally that the most effective

15:06

dosing was over 2000 milligrams

15:10

per day for a term

15:12

of 10 weeks or

15:14

less. And

15:17

that the omega-3s could be

15:19

obtained from either fish oil or

15:22

from flaxseed. Okay,

15:25

this is a mechanism, brain-derived

15:28

neurotrophic factor. How can

15:30

we test if modulation

15:32

of that mechanism leads to

15:34

an outcome of improved

15:37

cognitive function? Well, we

15:39

can look for a different meta-analysis that

15:41

instead of tracking mechanism, looked at outcome.

15:45

So this enters a

15:47

2020 meta-analysis, which

15:49

we dug up to fact-check

15:52

this one claim regarding the

15:54

brain-derived neurotrophic factor. This study

15:58

looked at cognitive function. across

16:01

seven clinical trials, this

16:03

was an elderly subject. So I want

16:05

to bridle the finding just a touch

16:08

because it's not always safe to assume

16:11

what we see in elderly will

16:13

also happen in middle aged

16:15

or younger populations. We

16:17

may assume to some extent that

16:20

elderly populations may be

16:22

easier to get a response from

16:25

because there may be more malnourishment

16:27

amongst other things. However,

16:29

they did find that

16:32

omega-3s improve cognitive

16:34

function with a large effect

16:36

size. And when we think

16:39

about effect size, said

16:41

simply, there can be no effect

16:43

size, meaning it was nil, it was null. There

16:46

can be small, medium, or large. Effect

16:48

size gives you a proxy to

16:51

the clinical effect.

16:54

A large effect size is almost for

16:56

certain something someone may notice and say,

16:58

you know, I feel a little sharper,

17:00

a little more witty. A

17:03

small effect size may not

17:05

move the needle enough for you to

17:07

perceive the change. So I

17:09

just want to tie that this

17:12

meta-analysis, looking at cognition, albeit

17:14

in elderly, did find a large

17:16

effect size on improving

17:18

the cognitive function in or

17:21

across these seven randomized control

17:23

trials. In

17:26

our clinic, we somewhat routinely will

17:28

recommend fish oil

17:31

supplementation paired with the use of

17:34

a multivitamin. This

17:36

next randomized control trial

17:38

looked at just under 4,000 older adults, about 70 years

17:40

of age as

17:44

sort of the average age, who were given placebo or

17:49

a multivitamin. And in this case, the multivitamin

17:51

was Centrum

17:54

Silver, which I

17:56

do not think is necessarily the

17:58

highest quality multivitamin. But

18:00

nevertheless, they found improved

18:03

memory at one year of

18:05

use. I feel

18:07

this is important to underscore because sometimes

18:10

we can get wrapped up in

18:12

the most bioavailable vitamin out there

18:14

and that can lead to buying

18:16

unnecessarily high quality vitamins.

18:21

And if that's what you want to do, fine. But

18:23

if you're on the limited budget, I think

18:25

it is important to underscore again, this was

18:27

not necessarily a super high quality

18:29

vitamin, meaning the vitamins

18:32

and minerals therein were

18:34

not all the highest

18:36

bioavailability, but nevertheless, we

18:38

saw the improved memory

18:40

at one year. Leading

18:42

to the group of researchers here to quote,

18:46

multivitamin supplementation holds promise as

18:48

a safe and accessible approach

18:50

to maintaining cognitive health in

18:52

older age. I

18:56

said a moment ago that what we

18:58

see in elderly may not necessarily

19:00

map on to younger. So

19:03

we also fact checked, is

19:06

there data showing that younger adults

19:08

can see benefits in cognition when

19:11

supplementing with a multivitamin?

19:14

And we were able to locate a

19:16

2010 randomized control trial

19:19

in about 200 healthy females

19:22

that were between 25 and 50 years

19:25

of age, given either placebo or

19:27

multivitamin. And

19:29

they were administered a cognitive

19:31

test at baseline and

19:33

after two months. They found,

19:36

thankfully, that a multivitamin led

19:39

to less cognitive fatigue, better

19:42

accuracy on cognitive tests,

19:44

and improved multitasking. And

19:47

I'll just tie in my own experience

19:49

here, where recently I did

19:51

go on a high dose multivitamin and

19:54

after about two weeks, I noticed

19:56

my sleep improved. Now,

19:59

I was... was changing a couple other

20:01

things at the same time, so it's hard for me

20:03

to pinpoint the variable, but

20:05

my intuitive sense is there was some

20:08

benefit that I gained from

20:10

a multivitamin, and

20:12

just theorizing here, perhaps

20:15

my high workload, my

20:17

high training load, the fact that

20:19

I'm saunting most days, I

20:22

was just depleted. And with all the demands,

20:24

even though my diet's pretty good, I couldn't

20:26

keep pace with my needs. So

20:29

as much as I try to be

20:31

an idealist and get the nutrients needed

20:33

from diet, I'm also a realist, and

20:36

even someone paying as much attention to

20:38

diet as I do seemed

20:40

to have benefited from use

20:42

of a multivitamin. Intermittent

20:46

fasting, 2023 med

20:48

analysis, looking at 25 studies, wherein

20:52

people either continued on their habitual

20:54

baseline diet or underwent

20:57

intermittent fasting, they

20:59

did not specify the protocol

21:01

of the fasting window specifically.

21:04

They did find that intermittent

21:06

fasting led to lower

21:09

C-reactive protein, small effect size, and

21:12

lower interleukin 6, moderate

21:15

effect size, both of which are

21:17

inflammatory markers. But

21:20

per the usual, let's contrast this

21:22

with a clinical endpoint

21:24

of cognitive function. In this

21:27

case, a 2020 observational

21:29

trial in healthy

21:32

older adults who did express

21:34

a degree of cognitive impairment,

21:37

they were fasted during daylight

21:39

hours, twice per week, so

21:41

just a daytime fast, two days per week,

21:44

compared to people who were doing no fasting

21:46

at all. And the researchers

21:49

commented as follows, overall,

21:52

the MCI afflicted, so

21:54

mild cognitive impairment afflicted

21:57

older adults who practiced IF... intermittent

22:00

fasting, regularly had better

22:02

cognitive scores and reverted to better

22:04

cognitive function at a 36 month

22:08

follow-up. So something

22:10

else to consider if you're looking to

22:13

optimize cognitive function. Now

22:15

let me also say that we want to be careful

22:17

not to fall into sort of this

22:20

one size fits all thinking that everyone must fast

22:22

if they're trying to improve their brain health. Caveats.

22:27

There were fewer smokers in the

22:29

fasting group and there

22:31

was more weight loss in the

22:33

fasting group. So we

22:35

might be able to restate these findings

22:37

as those who followed

22:40

a diet that allowed weight loss

22:42

had improved cognition. And

22:45

for some people fasting will be

22:47

that plan. I can say

22:49

for myself this used to work

22:51

but it no longer works. What

22:54

I noticed was happening with myself is

22:57

I would not eat enough during the day

22:59

and I would have a very large meal

23:01

too late in the day too close to

23:03

bedtime and I was impairing my sleep. So

23:07

as we've been discussing on the show remember

23:09

to think critically and not to

23:12

just sort of blindly shoehorn

23:14

yourself into these recommendations

23:17

but consider these experiments you can run

23:20

to see what feels good to

23:22

you. Hi

23:25

everyone. If you're looking for a functional medicine

23:27

provider or doctor, reminder

23:29

that our clinic offers telehealth nationwide. And

23:31

I'm very excited to share that we

23:33

currently have a six patient case series

23:36

in peer review for publication in

23:38

the medical journal. We have another

23:40

gut thyroid paper in the works

23:43

for a fairly large medical journal.

23:45

And third and finally we are

23:47

continuing to collect data on

23:49

treatment of hydrogen sulfide SIBO

23:52

with probiotic triple therapy and

23:54

I'm excited to say as the data are coming

23:56

in they look very encouraging. So if you are

23:59

in need of efficating cost-effective

24:01

and practical functional medicine

24:22

care, please reach out to the clinic. We also do offer free 15-minute discovery calls with our nurse.

24:24

So if you've been thinking about this and you have a few questions you'd like to get

24:26

answered, then please feel free to reach out. The clinic website is ruchoinstitute.com. Okay, and then the

24:28

final study here ties in histamine. Histamine

24:31

is a signaling molecule of the

24:33

immune system and when people have

24:36

allergy or inflammation, they can have

24:38

higher levels of histamine. This

24:40

is also seen in patients with IBS. To

24:43

some extent, it is a higher production

24:45

of histamine. Now,

24:48

this clinical trial administered

24:50

an enzyme known as

24:52

DAO or diamine oxidase,

24:54

which breaks down histamine.

24:57

You release this in your GI tract,

24:59

but some people, when there's damage or

25:01

inflammation in the lining of the GI

25:03

tract, don't produce enough. So

25:06

giving a supplement may help. 100

25:09

women with fibromyalgia were

25:11

given either placebo or

25:14

DAO and

25:16

they did find that this enzyme

25:18

supplement led to improved

25:20

fatigue, anxiety, and

25:23

depression. Interestingly, there

25:25

was no impact on bloating pain,

25:27

flatulence, or sleep quality. So I

25:29

would say net gain, but not

25:31

a cure all. Also,

25:34

I think this is really important to bear in

25:36

mind that there are other

25:38

things you can do in my opinion

25:40

that are more upstream, more foundational to

25:43

improve histamine. We've discussed the

25:45

one seminal paper, albeit it was

25:47

criticized for some of the methodology,

25:50

nevertheless finding an eight-fold

25:52

reduction in lowering

25:54

histamine when following a low

25:57

FODMAP diet. And

25:59

we've also discussed the discussed in the past, numerous

26:02

clinical trials that have found

26:04

various histamine-mediated conditions can be

26:07

improved by using probiotics. And

26:09

not a special probiotic, not

26:11

a particular histamine-free

26:14

probiotic, any high-quality

26:17

probiotic, because probiotics have

26:19

a net antihistamine effect,

26:21

which is why we see them improve

26:23

food allergy and also seasonal allergy. I

26:27

also assume that something

26:29

that can reduce symptoms and

26:31

allow a chance to rest and

26:34

repair and therefore improve

26:36

endogenous or internal production

26:39

of enzymes could

26:41

also help, like an elemental diet.

26:43

Hasn't been shown, but I would

26:47

be inclined to think that if

26:49

there was a study that found that we

26:51

would see an elemental diet also

26:53

improve histamine levels, knowing

26:55

that an elemental diet,

26:58

definitionally, will be very low

27:00

FODMAP, plus very easy to

27:02

digest, therefore can allow healing.

27:05

The bigger concept to take

27:07

away is that one, DAO supplementation

27:11

may help, but more importantly, in my

27:13

view, two, is that

27:15

things that heal the intestine will

27:17

allow you to have better production

27:20

of your own endogenous or intestinal

27:22

lining-derived histamine-digesting enzyme,

27:25

DAO. Okay,

27:28

so in summary, exercise

27:31

may lead you to, of your own

27:33

accord, eat less. Beet

27:36

root supplementation improves circulation and

27:38

brain health. Polyphenols,

27:41

which are contained in fruits and vegetables,

27:43

spices and herbs, have been shown to

27:45

improve brain health. Ultra-processed

27:48

food, emphasis, ultra, are

27:51

not healthy for you, obviously.

27:54

The Mediterranean diet can improve

27:56

cognition, fish

27:58

oil, and multivitamin supplementation. can

28:00

also improve cognition as can

28:02

fasting and a DAO

28:05

enzyme may also be able to

28:07

help with mood and

28:09

cognitive function. Remember

28:12

the guidelines here are to

28:14

do what you can. Not all of

28:16

these things will be the right maneuver

28:18

or support for all people. You

28:21

don't have to do all of these things and

28:24

approach this with a relaxed perspective. There

28:26

are no miracle cures. There are many

28:29

things you can do to improve your

28:31

health. Take what you like and

28:33

leave what you don't and I'll just echo

28:36

my experience with intermittent fasting was

28:38

helpful for a while and

28:41

eventually that led me to have unhealthy

28:43

behaviors in terms of backloading

28:45

my calories too close to bed, impairing

28:47

my sleep. So as healthy

28:49

as intermittent fasting can be, again

28:52

it won't be the right fit as

28:54

will any of these for everyone all

28:56

the time. So listen to your body.

28:58

Alright guys this is Dr. Ruscio. Please

29:01

comment, please subscribe, please share. Dr.

29:21

ruscio.com