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NUTRITION AND CANCER

TIME TO RETHINK?
Dr Gary Fettke
Orthopaedic Surgeon
MB,BS,FRACS(Ortho),FAOrthoA
Tasmania Australia
Jakarta Indonesia April 2019
Declaration of Interest
Genetic Model
Metabolic Model
Cancer
Microscope
Genetic Model
Do we blame firemen for fires?
PET Scan
PET Scan
Otto Warburg – 1924
Warburg Effect – Mitochondrion
Current Cancer Treatment
Future Cancer Treatment
Nutritional Ketosis
Metabolic Model – Growth
Cell Metabolism
Cell Metabolism
Normal Cell
Normal Cell
Cancer Cell
Cancer Cell
Growth – Warburg Effect
Growth – Reverse Warburg Effect
Driving Force
DNA Damage – Secondary
Inflammation
Modern Diet

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Modern Diet

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Modern Diet – Cancer

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
New Treatment Options

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Makes sense!
What does not make sense!
‘Flaws’- Chromosomal Model
• Increasing incidence

https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/all-cancers-combined
https://www.cdc.gov/cancer/dcpc/research/articles/cancer_2020.htm
‘Flaws’- Chromosomal Model
• Increasing incidence
• Multiple chromosomal abnormalities

KR. Loeb, LA. Loeb, Significance of multiple mutations in cancer, Carcinogenesis,


2000, https://doi.org/10.1093/carcin/21.3.379
‘Flaws’- Chromosomal Model
• Increasing incidence
• Multiple chromosomal abnormalities
• NO chromosomal abnormalities

https://www.sciencedaily.com/releases/2015/07/150727092537.htm
https://www.nature.com/articles/onc2015279
‘Flaws’- Chromosomal Model
• Increasing incidence
• Multiple chromosomal abnormalities
• NO chromosomal abnormalities
• 10% familial

https://www.cancer.org/cancer/cancer-causes/genetics/family-cancer-syndromes.html
‘Flaws’- Chromosomal Model
• Increasing incidence
• Multiple chromosomal abnormalities
• NO chromosomal abnormalities
• 10% familial
• Genome mapping has not given answers

The Rise and Fall of Modern Medicine, James Le Fanu, Abacus 2011
‘Flaws’- Chromosomal Model
• Increasing incidence
• Multiple chromosomal abnormalities
• NO chromosomal abnormalities
• 10% familial
• Genome mapping has not given answers
• Radiotherapy – Chemotherapy side effects
Genetic Model – Flaws

Seyfried T N et al. Carcinogenesis 2013;carcin.bgt480


Genetic Model – Flaws

Seyfried T N et al. Carcinogenesis 2013;carcin.bgt480


Genetic Model – Flaws

Seyfried T N et al. Carcinogenesis 2013;carcin.bgt480


Genetic Model – Flaws

Seyfried T N et al. Carcinogenesis 2013;carcin.bgt480


DNA Damage
‘Alternate’ Metabolic Model of Cancer
• Observation
• Mechanism
• Association evidence
• Intervention evidence
Observation
Incidence

Cancer Fact Sheet No 297, Nov 2014. WHO Hayat et al, 2007, The Oncologist; 12:20-37
Modern ‘Diet’ – Modern Cancer

Fouche FP: Freedom of Negro Races from Cancer, Br Med J. 1923 Jun 30; 1(3261): 1116.
Obesity

Renehan G et al. Obesity and Cancer: Physiological and biological mechanisms. Archives of Physiology and
Biochemistry, 2 2008; 114(1): 71-83
Inflammation

Adiposity, Inflammation, and Breast Cancer Pathogenesis in Asian Women


N Iyengar et al Cancer Prev Res April 1 2018 (11) (4) 227-236; DOI: 10.1158/1940-6207.CAPR-17-0283
Diabetes

Giovannucci et al. Diabetes and cancer: a consensus report. CA Cancer J Clin 2010;60:207-221
Metabolic Model of ‘Modern’ Cancer
• Observation
• Mechanism
• Association evidence
• Intervention evidence
Mechanism
• Mitochondria
Cell Energy
• Mitochondria
• Acetyl co-A
Cell Energy
• Mitochondria
• Acetyl co-A
• Sources
– Glucose
Cell Energy
• Mitochondria
• Acetyl co-A
• Sources
– Glucose
– Ketone Bodies
Cell Energy
• Mitochondria
• Acetyl co-A
• Sources
– Glucose
– Ketone Bodies
• ATP
Normal Cells
Cancer Cells
Cancer Cells
x
Warburg Effect
Normal Cell

Vander Heiden et al. Science 2009; science. 1160809


Normal Cell

x36

Vander Heiden et al. Science 2009; science. 1160809


Normal Cell
INSULIN
IGF-1

x36

Vander Heiden et al. Science 2009; science. 1160809


Cancer Cell – Warburg Effect

Vander Heiden et al. Science 2009; science. 1160809


Cancer Cell – Warburg Effect

x4

Vander Heiden et al. Science 2009; science. 1160809


Cancer Cell – Warburg Effect

Vander Heiden et al. Science 2009; science. 1160809


Cancer Cell – Warburg Effect

Vander Heiden et al. Science 2009; science. 1160809


Cancer Cell – Warburg Effect

INSULIN
IGF-1

Vander Heiden et al. Science 2009; science. 1160809


Warburg Effect Needs Glucose
Warburg Effect – Intervention

Vander Heiden et al. Science 2009; science. 1160809


Warburg Effect – Intervention

INSULIN
IGF-1

Vander Heiden et al. Science 2009; science. 1160809


Building Materials for Cancer
Building Materials for Cancer
• Glucose
Building Materials for Cancer
• Glucose
• Protein
Building Materials for Cancer
• Glucose
• Protein
• Fatty Acids
Building Materials for Cancer
• Glucose
• Protein
• Fatty Acids
• Phosphate
Building Materials for Cancer
• Glucose
• Protein
• Fatty Acids
• Phosphate
• Acetate
Reverse Warburg Effect

Vander Heiden et al. Science 2009; science. 1160809


Cancer – Reverse Warburg Effect
• Aerobic glycolysis

Lisanti et al. Cell Cycle, 2011; 10(15); 2504-2520


Cancer – Reverse Warburg Effect
• Aerobic glycolysis

• Hydrogen peroxide

Lisanti et al. Cell Cycle, 2011; 10(15); 2504-2520


Cancer – Reverse Warburg Effect
• Aerobic glycolysis

• Hydrogen peroxide

• Fibroblast

Lisanti et al. Cell Cycle, 2011; 10(15); 2504-2520


Cancer – Reverse Warburg Effect
• Aerobic glycolysis

• Hydrogen peroxide

• Fibroblast

• Invasion

Lisanti et al. Cell Cycle, 2011; 10(15); 2504-2520


Building Materials
• Glucose
• Protein
• Fatty Acids
• Phosphate
• Acetate
Building Materials
• Glucose
• Protein
• Fatty Acids
• Phosphate
• Acetate
Building Materials
• Glucose
• Protein
• Fatty Acids
• Phosphate
• Acetate
Oxygen Free Radicals
Inflammation
Nutritional Model of Inflammation

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Modern Diet

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Points of Intervention
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
x
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
x
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
x
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
x x x
x
x
x x
x
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
x x xx
x x
x
x
x x
x
http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Metabolic Model of ‘Modern’ Cancer
• Observation
• Mechanism
• Association evidence
• Intervention evidence
Diet Association Evidence
Combined Consumption 1970’s

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Combined Consumption 1970’s

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Combined Consumption 1970’s

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Combined Consumption 1970’s

http://www.nofructose.com/introduction/nutritional-
model-of-modern-disease-2/
Drug Association Evidence
Drug Association Evidence
• Aspirin

Cao, Yin et al. “Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer.” JAMA
oncology vol. 2,6 (2016): 762-9. doi:10.1001/jamaoncol.2015.6396
Drug Association Evidence
• Aspirin
• Metformin
PubMed Metformin/Cancer articles by year

Coyle, C et al. “Metformin as an adjuvant treatment for cancer: a systematic review and meta-
analysis.” Annals of oncology : official journal of the European Society for Medical Oncology vol. 27,12
(2016): 2184-2195. doi:10.1093/annonc/mdw410
https://www.ncbi.nlm.nih.gov/pubmed/?term=metformin+and+cancer
Drug Association Evidence
• Aspirin
• Metformin + Syrosingopine

Benjamin, Don et al. “Dual Inhibition of the Lactate Transporters MCT1 and MCT4 Is Synthetic Lethal with
Metformin due to NAD+ Depletion in Cancer Cells.” Cell reports vol. 25,11 (2018): 3047-3058.e4.
doi:10.1016/j.celrep.2018.11.043
Drug Association Evidence
• Aspirin
• Metformin
• Antioxidants

http://www.eurekaselect.com/126825/article
https://www.ncbi.nlm.nih.gov/pubmed/29043851
Drug Association Evidence
• Aspirin
• Metformin
• Antioxidants
• Vitamins

https://www.ncbi.nlm.nih.gov/pubmed/29210648
Epidemiological – Modern ‘Diet’
Model of ‘Modern’ Cancer
• Observation
• Mechanism
• Association evidence
• Intervention evidence
Laboratory

Lv M, Zhu X, Wang H, Wang F, Guan W (2014) Roles of Caloric Restriction, Ketogenic Diet and Intermittent
Fasting during Initiation, Progression and Metastasis of Cancer in Animal Models: A Systematic Review and
Meta-Analysis. PLoS ONE 9(12): e115147.
doi:10.1371/journal.pone.0115147
http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0115147
Animal Studies

Lv M, Zhu X, Wang H, Wang F, Guan W (2014) Roles of Caloric Restriction, Ketogenic Diet and Intermittent
Fasting during Initiation, Progression and Metastasis of Cancer in Animal Models: A Systematic Review and
Meta-Analysis. PLoS ONE 9(12): e115147.
doi:10.1371/journal.pone.0115147
http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0115147
Intervention – Human
• Small numbers

Schmidt et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial.
Nutrition & Metabolism 2011, 8:54
Fine et al. Nutrition, Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and
feasibility dietary trial in 10 patients. 28 (2012) 1028-1035
Rieger et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int Journ Oncology 44: 1843-1852,
2014
Champ, Volek et al. 2014. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma
multiforme. Jour Neurooncology DOI 10.1007/s11060-014-1362-0
Allen, Bryan G et al. “Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism.” Redox
biology vol. 2 (2014): 963-70. doi:10.1016/j.redox.2014.08.002
Intervention – Human
• Small numbers
• End stage cancer

Schmidt et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial.
Nutrition & Metabolism 2011, 8:54
Fine et al. Nutrition, Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and
feasibility dietary trial in 10 patients. 28 (2012) 1028-1035
Rieger et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int Journ Oncology 44: 1843-1852,
2014
Champ, Volek et al. 2014. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma
multiforme. Jour Neurooncology DOI 10.1007/s11060-014-1362-0
Allen, Bryan G et al. “Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism.” Redox
biology vol. 2 (2014): 963-70. doi:10.1016/j.redox.2014.08.002
Intervention – Human
• Small numbers
• End stage cancer
• Safe

Schmidt et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial.
Nutrition & Metabolism 2011, 8:54
Fine et al. Nutrition, Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and
feasibility dietary trial in 10 patients. 28 (2012) 1028-1035
Rieger et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int Journ Oncology 44: 1843-1852,
2014
Champ, Volek et al. 2014. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma
multiforme. Jour Neurooncology DOI 10.1007/s11060-014-1362-0
Allen, Bryan G et al. “Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism.” Redox
biology vol. 2 (2014): 963-70. doi:10.1016/j.redox.2014.08.002
Intervention – Human
• Small numbers
• End stage cancer
• Safe
• Stabilisation

Schmidt et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial.
Nutrition & Metabolism 2011, 8:54
Fine et al. Nutrition, Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and
feasibility dietary trial in 10 patients. 28 (2012) 1028-1035
Rieger et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int Journ Oncology 44: 1843-1852,
2014
Champ, Volek et al. 2014. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma
multiforme. Jour Neurooncology DOI 10.1007/s11060-014-1362-0
Allen, Bryan G et al. “Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism.” Redox
biology vol. 2 (2014): 963-70. doi:10.1016/j.redox.2014.08.002
Trials – Human
• 31 registered trials
– Breast
– Brain
– Head and neck
– Pancreas

https://clinicaltrials.gov/ct2/results?cond=cancer&term=ketogenic+diet&cntry=&state=&city=&dist=
Pittsburgh - Variety End Stage Cancer

Tan-Shalaby, Jocelyn L et al. “Modified Atkins diet in advanced malignancies - final results of a safety and
feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.” Nutrition & metabolism vol. 13
52. 12 Aug. 2016, doi:10.1186/s12986-016-0113-y
Pittsburgh - Variety End Stage Cancer

Tan-Shalaby, Jocelyn L et al. “Modified Atkins diet in advanced malignancies - final results of a safety and
feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.” Nutrition & metabolism vol. 13
52. 12 Aug. 2016, doi:10.1186/s12986-016-0113-y
Pittsburgh - Variety End Stage Cancer

Tan-Shalaby, Jocelyn L et al. “Modified Atkins diet in advanced malignancies - final results of a safety and
feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.” Nutrition & metabolism vol. 13
52. 12 Aug. 2016, doi:10.1186/s12986-016-0113-y
Pittsburgh - Variety End Stage Cancer

Tan-Shalaby, Jocelyn L et al. “Modified Atkins diet in advanced malignancies - final results of a safety and
feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.” Nutrition & metabolism vol. 13
52. 12 Aug. 2016, doi:10.1186/s12986-016-0113-y
Pittsburgh - Variety End Stage Cancer

Tan-Shalaby, Jocelyn L et al. “Modified Atkins diet in advanced malignancies - final results of a safety and
feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.” Nutrition & metabolism vol. 13
52. 12 Aug. 2016, doi:10.1186/s12986-016-0113-y
Trials – Human
• 31 registered trials
– Breast
– Brain
– Head and neck
– Pancreas
• Anecdotal ++
Ketogenic Diets – Protection

Raffaghello, Lizzia et al. “Starvation-dependent differential stress resistance protects normal but not
cancer cells against high-dose chemotherapy.” Proceedings of the National Academy of Sciences of the
United States of America vol. 105,24 (2008): 8215-20. doi:10.1073/pnas.0708100105
Ketogenic Diets – Fasting

Marinac, Catherine R et al. “Prolonged Nightly Fasting and Breast Cancer Prognosis.” JAMA oncology vol. 2,8 (2016): 1049-
55. doi:10.1001/jamaoncol.2016.0164
Marinac, Catherine R et al. “Prolonged Nightly Fasting and Breast Cancer Risk: Findings from NHANES (2009-
2010).” Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research,
cosponsored by the American Society of Preventive Oncology vol. 24,5 (2015): 783-9. doi:10.1158/1055-9965.EPI-14-1292
Phagocytosis - Fasting

Role of sugars in human neutrophilic phagocytosis


Albert Sanchez J. L. Reeser H. S. Lau P. Y. Yahiku R. E. Willard P. J. McMillan S. Y. ChoA. R. Magie U. D. Register
The American Journal of Clinical Nutrition, Volume 26, Issue 11, November 1973, Pages 1180–
1184, https://doi.org/10.1093/ajcn/26.11.1180
Fasting - Chemotherapy

https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.25987
https://www.ncbi.nlm.nih.gov/pubmed/27557543
Ketogenic Diets – P13K Inhibition

https://www.nature.com/articles/s41586-018-0343-4
Ketogenic Diets – Protection
• Decrease +++ Carbohydrate

Klement and Champ. 2014 Calories, carbohydrates, and cancer therapy with radiation: exploiting
the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014; 33(1): 217–229
Ketogenic Diets – Protection
• Decrease +++ Carbohydrate
• Decrease + Protein

Klement and Champ. 2014 Calories, carbohydrates, and cancer therapy with radiation: exploiting
the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014; 33(1): 217–229
Ketogenic Diets – Protection
• Decrease +++ Carbohydrate
• Decrease + Protein
• Increase Fat ++

Klement and Champ. 2014 Calories, carbohydrates, and cancer therapy with radiation: exploiting
the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014; 33(1): 217–229
Ketogenic Diets – Harmful?
• 2017 mouse study

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Ketogenic Diets – Harmful?
• 2017 mouse study
• Melanoma injected in to susceptible BRAF V600E mice

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Ketogenic Diets – Harmful?
• 2017 mouse study
• Melanoma injected in to susceptible BRAF V600E mice
• Peritoneal cavity infused with ketones!

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Ketogenic Diets – Harmful?
• 2017 mouse study
• Melanoma injected in to susceptible BRAF V600E mice
• Peritoneal cavity infused with ketones!
• Chow mix polyunsaturated oils

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Ketogenic Diets – Harmful?
• 2017 mouse study
• Melanoma injected in to susceptible BRAF V600E mice
• Peritoneal cavity infused with ketones!
• Chow mix polyunsaturated oils
• One chow mix 51% CHO

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Ketogenic Diets – Harmful?
• 2017 mouse study
• Melanoma injected in to susceptible BRAF V600E mice
• Peritoneal cavity infused with ketones!
• Chow mix polyunsaturated oils
• One chow mix 51% CHO
• Ketogenic diets dangerous!

Xia, Siyuan et al. “Prevention of Dietary-Fat-Fueled Ketogenesis Attenuates BRAF V600E Tumor
Growth.” Cell metabolism vol. 25,2 (2017): 358-373. doi:10.1016/j.cmet.2016.12.010
Miracle Treatments
Positive Attitude

Novotny et al. A pessimistic explanatory style is prognostic for poor lung


cancer survival. Jour Thoracic Oncology 2010 5(3):326-32
Ketogenic Diets – Fasting

Lee, Changhan et al. “Fasting cycles retard growth of tumors and sensitize a range of cancer cell types to
chemotherapy.” Science translational medicinevol. 4,124 (2012): 124ra27. doi:10.1126/scitranslmed.3003293
Increased Meal Frequency - Snacking

Popkin et al. 2010, Does hunger and satiety drive eating anymore? Increasing eating occasions and
decreasing time between eating occasions in the United States. Am J Clin Nutrition, 91: 1342-1347
Biochemistry of Religion
Nutritional Ketosis
Nutritional Ketosis
Biochemistry of Religion
Biochemistry of Religion
Metabolic Model of ‘Modern’ Cancer
• Observation
• Mechanism
• Association evidence
• Intervention evidence
Current Treatment
Current Treatment
Future Cancer Treatment
Nutritional Ketosis
LCHF – Nutritional Ketosis
• Safe
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
• Ketones protective to surrounding cells
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
• Ketones protective to surrounding cells
• Does it give the patient some control?
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
• Ketones protective to surrounding cells
• Does it give the patient some control?
• Does it give some hope?
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
• Ketones protective to surrounding cells
• Does it give the patient some control?
• Does it give some hope?
• Prevention
LCHF – Nutritional Ketosis
• Safe
• Use with other treatment
• Ketones protective to surrounding cells
• Does it give the patient some control?
• Does it give some hope?
• Prevention
• Cost
Genetic Model
Metabolic Model
Metabolic Model
x x xx
x x
x
x
x x
x
x x xx
x x
x
x
x x
x
Intervention Options
Environment
We did go the wrong way
Microscope
Genetic Model
Metabolic Model
Website: www.NoFructose.com
www.ISupportGary.com
Facebook: Belinda Fettke No Fructose
Twitter: FructoseNo
Instagram: @isupportgary