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Risperdal Tapering

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Last Updated on May 12, 2021 by Carol Gillette

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Alternative to Meds Editorial Team
Written by Diane Ridaeus Published Feb 7, 2020
Medically Reviewed by Dr Samuel Lee MD

Alternative to Meds Center provides a program that has been developed over many years to avoid the common pitfalls associated with Risperdal tapering, titration, and weaning. Sadly, there are few medical professionals who have the training and expertise to navigate Risperdal tapering well.

The use of Risperdal and other antipsychotics, even when correctly prescribed as in a time of obvious crisis, needn’t automatically mean being medicated for life.

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Common Difficulties With Risperdal Tapering

It is not necessary for a person tapering from Risperdal to suffer fierce symptoms of Risperdal withdrawal. Fortunately, the center has developed clinically proven ways that can make such side effects and symptoms fade into the past. Our aim at the Alternative to Meds Center is to provide and teach drug-free methods that help people to feel healthy and positively focused on their life without suffering from Risperdal side effects and unmanageable Risperdal tapering symptoms.

What doesn’t get very widely promoted is the extreme difficulty that persons who want to come off Risperdal or risperidone may typically experience. However, Alternative to Meds Center provides a program that has been developed over 15 years to avoid the common pitfalls associated with Risperdal tapering. We aim to help our clients regain more robust health in the process. In this way, reactions during tapering from Risperdal can be minimized significantly. Such care taken in the Risperidone tapering process can, quite often, reduce the risk of rebound psychosis and the need for periods of hospitalization.

Risperdal Tapering Guidelines and Schedule

Antipsychotic tapering could be the most difficult drug class of all, due to the level of crisis that typically accompanies such a prescription.

We do not recommend attempting Risperdal tapering without medical oversight and dependable support systems in place. Be safe. Get help.

Risperdal Tapering Guidelines:

  • risperdal tapering guidelinesPretapering – use workable protocols to get yourself in a stable condition before beginning to taper.
  • Contracting for safety – sometimes called a “Ulysses contract”, or psychiatric advance directive, is a safeguard that will protect your safety through the taper. More on this is given below on how to put this practical approach into action with a trusted family member or helper.13,14
  • Choose a prescriber to partner with, who is knowledgeable and sensitive to the difficulties of antipsychotic tapering and one with whom you feel comfortable working.15
  • Stimulants like coffee or other caffeine drinks are unsafe during Risperdal tapering.16
  • No marijuana or other recreational drug use.17
  • Start the day with a solid breakfast, avoid sugars and refined flour products, take small protein-based meals throughout the day.18,19
  • Exercise regularly, for example, work up to elevating the heart rate for 20 minutes or so once or twice daily.20
  • Your prescriber can assist in converting an injectable form to an oral form of the medication more suited to the tapering process. Use the smallest dose available for configuring the varying dose as you proceed through the taper.21
  • For those on multiple medications, plan with your prescriber the order in which these can be best discontinued or reduced. See our medication withdrawal page for more information.
  • Expect to taper slowly, perhaps taking a month for every year you were on antipsychotics.
  • Be conservative as the taper progresses – the last cuts may take a little longer due to delayed drug toxicity or other factors. Symptoms and their severity will help to gauge the rate at which further cuts can be made, or whether more time is needed before the next cut in dosage.22
  • Be aware of what symptoms are likely to emerge during Risperdal tapering, and speak with your prescriber clearly about what you are experiencing along the way so that these can be managed well.
  • Not eating, not sleeping are red flags that could signal to slow the taper or that other changes are needed. 12
  • Optional: speak to your prescriber about the use of bridge medications if needed.
  • Practice calming, grounding activities instead of stimulating reading material or media.
  • There are more guidelines you can read about on our antipsychotic alternatives page.

Getting stable before beginning Risperdal titration

Take steps that will ensure you are eating well, and sleeping well before beginning to titrate. There are medication-free methods to help with sleep issues, and if these are not enough, you can discuss non-antipsychotic medication that may help stabilize your sleep.

The diet can be “tuned up” so that the foods you are consuming are beneficial for nutrition and energy. Eating breakfast, and a number of smaller protein-based meals over the day to regulate blood sugar are recommended. Diet has been shown to have a neuroprotective role. Cut out sugar and refined carbs, and stick to nutrient-dense foods that you enjoy.23

Learn relaxation exercises that are easy to do and you find enjoyable, and avoid immersion in overly stimulating movies, video games, media, and even religious reading material may be too stimulating at this time. Walking outdoors, stretching, and exercise at a comfortable level are recommended.24

Contracting for safety with a trusted person

Realize that during your taper, it is possible that you will experience some degree of mania, at which point it may become difficult to follow directions. Sometimes called a “Ulysses contract”, you can prepare for this possibility by making an agreement with a trusted friend, family member, or another helper that should you become unwilling to follow doctor’s orders, you will be shown or reminded of your agreement, perhaps a signed contract, that will remind you to continue on as the doctor directs. If this does not provide enough motivation then you have understood that police or hospitalization may be the only other action. This is for your safety, and that of others, as abruptly discontinuing Risperdal can be disastrous. You want to be safe. This is a strategy that can keep you safe, and we recommend it highly.13,14

Medical oversight is essential during your Risperdal taper

While we recommend inpatient treatment for coming off antipsychotic medications, we also realize that this may not always be possible. But do find medical help to assist you, guide you, and oversee the taper so that you always have the best chance of a successful outcome. There may be holistic psychiatrists or other prescribing practitioners in your local area that you can work with. Working with a doctor who you feel is the “right fit” for you has been shown to have more positive health outcomes.15

Why eliminate stimulants like caffeine?

Drinking coffee or other caffeinated beverages may have provided some welcome relief from the sedation of antipsychotic medications. However, extra stimulation is not your friend during a Risperdal taper. The previously held back dopamine can overwhelm a person, and caffeine or other stimulants add unwanted fuel to the fire. Stay safe and eliminate stimulants as part of your safety strategy.16

Avoid recreational marijuana use.

The psychoactive THC in recreational marijuana may overload the system, and create unnecessary problems during antipsychotic tapering. While using marijuana may not have been problematic while on Risperdal, realize that your neurochemistry is trying to normalize during a healthy taper. THC can build up in the system and put you at risk for drug-induced psychosis. This would be disastrous during a medication taper. Stay safe and help your successful outcome by avoiding recreational drug use at this time.17

Blood sugar and mental wellness.

Blood sugar can be kept level using the diet as a tool, which is highly recommended during Risperdal tapering. Blood sugar spikes and crashes can mimic psychiatric symptoms. Keep life simple, and support your best health by keeping your body fueled on proteins and low-glycemic foods to avoid blood sugar spikes and crashes.19,23

Cardio Exercise

Once the tapering process begins, dopamine is subject to being released at much higher levels than before. This can feel like a positive change, compared to the heavy sedating effects of antipsychotic medications. But to keep this in balance, cardio exercise can help balance the changes. Exercise has universal benefits for the body, keeping muscles in tone, increasing energy, and other health benefits. But during antipsychotic reduction, increased oxygen intake and elevated heart rate can help to break down excess dopamine. Simple exercises such as walking briskly, cycling, running can be extremely therapeutic during the taper. These activities can also provide focus and motivation that can help greatly with an improved sense of well-being.20

Use the smallest dose available for precise dose reductions.

The smallest milligram dose for Risperdal is the oval yellow .25 mg. This does not mean you start with the lowest possible dose.

Use the smallest mg pill to configure reductions accurately throughout the taper.

For example, if you are taking 3 mg and you want to cut to 2.75 mg, cutting 3 mg in half (for 1.5 mg) and then adding 5 x .25 mg would add up to 2.75 mg. Your prescriber can help you with these types of configurations.

Reducing multiple medications – what sequence?

A significant percentage of people taking antipsychotics are also prescribed stimulant drugs, such as SNRIs that may have been well-tolerated previously. These may have provided a welcome lift from the sedating effects of Risperdal. However, tapering off antipsychotics will introduce increased dopamine expression, and coupling that with stimulatory drugs can be just too much of a good thing.

Speak with your doctor about eliminating the stimulant drugs and SNRIs first. These drugs include Provigil, Effexor, Pristiq, Cymbalta, and many others. For some, this sequence may simplify the overall tapering process, and keep things progressing in a gradual, stable way.

Other drugs like Lithium, Depakote, SSRI antidepressants, benzodiazepines, or mood stabilizers like Lamictal may assist the Risperdal withdrawal process. Your doctor may consider tapering these last, to help with the antipsychotic taper. For multiple medications, your doctor may suggest gently tapering each one at a time. Each person’s progress follows a unique path and will be assisted by teamwork and good communication between you and your support team. Find out more about various tapering techniques on our page about medication tapering.

How long is my Risperdal taper going to last?

At Alternative to Meds, we have observed that in general, a good starting point would be one month of tapering for every year a person has been on antipsychotic medication. However, this may not be right for everyone. Other factors make timing a taper completely individualized. The intensity and duration of a person’s symptoms also need to be factored in when estimating the time needed for a taper. Taking enough time so that withdrawal symptoms are mild, and letting these settle out first before making further dosage reductions are also important markers for estimating the length of a tapering process.

Some candidates may not wish to be 100% medication-free due to the severity or duration of symptoms. Each person will have their own goals and their own schedule for safe tapering.

Risperdal withdrawal symptoms.

It may help to understand a little about the mechanics of antipsychotic medications, to understand something about the withdrawals that can occur when antipsychotics are tapered.

Antipsychotics such as Risperdal are designed to hold back dopamine, and the symptoms that may have been associated with excess dopamine, such as psychosis, or mania. Reducing the dosage (always gradually) will likely be occasioned by stimulation. Decreasing the dosage too fast can show up as overstimulation-type symptoms, that can manifest in many ways. Obsessive thoughts about God or the Universe, delusionary psychosis, or fears, paranoia, apathy, and anxieties are some common examples. Sometimes these withdrawals are misconstrued as mental illness.7 Physical manifestations can also vary greatly, 8,9,10 and may include these:

  • Urinary retention
  • Muscle tension
  • Sweating
  • Difficulty swallowing
  • Abnormal movements
  • Nausea, vomiting
  • Insomnia

When these withdrawals manifest during tapering, it could signal that the taper needs to be slowed, sometimes reinstating the medication at a higher dosage and then when stable, continuing the taper at a very slow pace.

A note on dyskinesia and antipsychotic medications.

Dyskinesias are drug-induced reactions involving involuntary movements of the face, tongue, trunk, and limbs. These conditions may or may not alleviate when the drug is withdrawn. Sometimes these movement disorders emerge months after a drug has been stopped. Reliable management of dyskinesia disorders has not been adequately determined, according to current medical literature on the topic.11

Nearing the end of the taper.

You may find the last cuts when antipsychotic tapering. to be the most difficult. Do not rush as the time it takes to stabilize between dosage reductions may increase, particularly near the end of the taper. This may be related to delayed drug toxicity and other factors. Using holistic, nutritional, and other therapies can help the body and neurochemistry rehabilitate and rebalance as well as adequately slowing the reduction of dosage.22

Use of bridge medications.

Depakote or other medications may be useful as bridge medications to help stabilize very difficult symptoms that may arise with Risperdal weaning. For example, your prescriber may want to complete the Risperdal taper and then continue with weaning the Depakote as slowly as needed between the dose reductions. We have found this especially useful at the end of the Risperdal tapering, which is where the withdrawal may become most problematic. Speak to your doctor about this option.

Limiting stimulating media

Tapering from antipsychotic medications potentially opens the dopamine flood gates. The drug suppressed the expression of dopamine while you were taking it. The suppression of dopamine is thought to suppress the mania or other symptoms that the drug was prescribed to treat.

Keeping this in mind, one needs to limit things like too much time on social media, watching stimulating tv shows or movies, or other things that could potentially cripple your progress. Walking in nature, sometimes called “forest bathing”, gardening, and other nature-based relaxing activities have been found very beneficial for mental health in clinical studies. 25

Injectable antipsychotics and tapering

Typically, your prescriber will convert you over to an oral form from the injectable. This will facilitate the tapering process.21

Antipsychotic Alternatives and Antipsychotic Withdrawal

We invite you to study the pages on our website that further describe strategies for reducing and eliminating medications safely. See Antipsychotic Alternatives and Risperdal Alternatives. Another page that may be helpful is the Risperdal withdrawal page for more information.

Safeguarding Health During Risperdal Weaning

risperdal tapering and weaningWARNING: The FDA and other regulatory bodies clearly recommend not to abruptly stop taking antipsychotic medications such as risperidone, Seroquel, Zyprexa, Ability, and others. But little else is offered in the way of training by regulatory bodies or, tragically, even to doctors who are in medical school on how to accomplish the task efficiently for their patients.5,21

A person who has made the decision to come off Risperdal or similar drugs is usually already in a somewhat compromised position as regards their health. Seeking the assurance of experienced caregivers will be of great help and support. It is wise to seek competent medical care and guidance before, during, and after medication discontinuation.

There is help available, at Alternative to Meds Center, and also through many holistically-oriented physicians and holistic psychiatrists. You can seek them out for help when needed.

Additionally, you or your loved one and those in your circle of support would be well-advised to seek information about the process and how to help ensure the steps of tapering from an antipsychotic medication are correctly, gently, and safely done.4

The Role of Nutrients in Restoring Healthy Neurochemistry

risperdal titrationA clean diet with additional micronutrients and supplements can open the door to experiencing better health. While that might even sound a bit cliche, nutritional support is one of the most essential working parts of healing after aggressive drug treatments.6

There can be many reasons why corrective nutrition can produce remarkable improvements that it does, not only to brain chemistry but for improved sleep, digestion, and restoring a healthy and functioning microbiome. The microbiome is a vital piece of the recovery puzzle as it is where most of the natural neurochemicals are produced and then distributed to all parts of the body. This supports all the major organs, such as the heart, liver, lungs, brain tissue, nerve endings, circulatory system, immune system, skin, hair, eyes, and thousands upon thousands of other aspects of the human body. Nutritional psychiatry bases its fundamentals of treatment on the therapeutic value of nutrition as applied to mental health.26

Drugs can strip out vital nutrients and sub-nutrients, and coupled with what may not have been the best diet choices during drug-based therapy, deficiencies can be restored for vastly increased energy and functionality that can benefit the entire body.

Removal of Neurotoxicity

In the presence of toxins, the cell walls are not able to absorb and process nutrients well. Neurotoxicity also plays havoc by upsetting the equilibrium of the body by interfering with natural neurochemistry, causing over or under-activity of certain organs, glands, and tissues. These accumulations of what are basically poisons can cause tiredness, insomnia, gut problems, even depression or anxiety, and other discomforts.21

These pollutants can be gently purged from the body using gentle means, like biotransformation of neurotoxin combined with sauna, nebulized glutathione, chelation, mineral baths, and other effective protocols. When the body burden of neurotoxicity is removed the client typically reports better sleep, improvements in appetite, more energy, a calmer disposition, and many other benefits. When these healthy changes are in place, they signal successful neurotransmitter rehabilitation, and the client is stable, this is a good time to begin tapering.

Risperdal a Favorite of the WHO

Since the drug’s arrival to market in 1993, the World Health Organization has placed Risperdal on its “essential medicines” list, a stunning worldwide endorsement.1 It is used in treating psychosis, schizophrenia, mania, bipolar symptoms, and even irritability in autism. As a side note, the killer drugs amitriptyline2 and fentanyl3 also appear on that list. Is it time for a new look at how to improve mental health naturally?

Learn About Alternative to Meds Center

The center is an inpatient facility that is comfortable, ultra-clean, and luxurious, making the client’s stay an enjoyable and memorable experience.

The staff is impressive, to say the least. With holistic psychiatrists, medical doctors, and competently trained clinicians, therapists, organic chefs, and caregivers, more than 40 expert, compassionate staff are at the helm.

effective risperdal treatmentsThe center provides a wealth of effective, holistic therapies to assist with any discomforts that may arise during the tapering process, including massage, Reiki, corrected diet and supplementation, cranial-sacral therapeutic massage, counseling, peer support, soothing mineral baths, equine therapy, and many others. The client consults with their care team daily so that their medical support team can instantly coordinate any micro-adjustments needed, and oversee any other program steps or changes that can be monitored all the way through.

Meals are deliciously prepared by our gourmet chef, who is knowledgeable about corrective diets and the power of orthomolecular (diet-based) treatment protocols. Meals and snacks are prepared with fresh mostly organic and locally sourced produce and meats, fish, poultry, and other sources of proteins, daily use of fermented foods, ketogenic menus, all prepared with a gourmet flourish. No sugars, preservatives, food additives, etc., are used in preparing the most delicious and energizing meals, salads, smoothies, and snacks imaginable, all of which are highly popular with our clients.

Find Out More About Our Risperdal Titration and Weaning Program

We invite you to contact the center to get more information on the program details, costs, length of stay that may be recommended, and answer any insurance questions and other queries you may have.

We are here to provide support and information during the sometimes difficult decision-making process. Please call us to find out more about how our world-class Risperdal tapering program may be the authentic type of help that you or a loved one have been looking for.


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2. Haelle “Antidepressant Death Found Most Often With Amitriptyline” Psychiatry Advisor [accessed 2019 Dec 17]

3. “WHO Model List of Essential medicines.” March 2005, Amended August 2017 [cited October 3, 2020]

4. Howland “Potential Adverse Effects of Discontinuing Psychotropic Drugs Part 3, Antipsychotic, Dopaminergic, and Mood-stabilizing Drugs” US National Library of Medicine [accessed 2019 Dec 17]

5. Brogan K MD “Stop the Madness: Coming Off Antidepressants & Psychotics” [accessed 2019 Dec 17]

6. Jeynes KD, Gibson EL “The Importance of Nutrition in Aiding Recovery From Substance Use Disorders” 2017 Oct, US National Library of Medicine [accessed 2017 Jan 8]

7. Moncrieff J. Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatr Scand. 2006 Jul;114(1):3-13. doi: 10.1111/j.1600-0447.2006.00787.x. PMID: 16774655. [cited 2021 April 20]

8. Wang W, Wen H, Sheng J. Malignant Syndrome or Withdrawal Reaction?Shanghai Arch Psychiatry. 2016;28(4):227-229. doi:10.11919/j.issn.1002-0829.216048 [cited 2021 April 20]

9. Jarema M. Ryzyko zaprzestania przyjmowania neuroleptyku w schizofrenii [The risk of neuroleptic discontinuation in schizophrenia]. Psychiatr Pol. 1999 Jan-Feb;33(1):69-81. Polish. PMID: 10786216. [cited 2021 April 20]

10. Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman-Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: Evidence-based clinical practice guideline. Can Fam Physician. 2018 Jan;64(1):17-27. PMID: 29358245; PMCID: PMC5962971. [cited 2021 April 20]

11. Margolese HC, Ferreri F. Management of conventional antipsychotic-induced tardive dyskinesiaJ Psychiatry Neurosci. 2007;32(1):72. [cited 2021 April 20]

12. Reeve S, Nickless A, Sheaves B, Freeman D. Insomnia, negative affect, and psychotic experiences: Modelling pathways over time in a clinical observational studyPsychiatry Res. 2018;269:673-680. doi:10.1016/j.psychres.2018.08.090 [cited 2021 April 20]

13. Chen, D “Perspective Taking and Advance Directives.” Virtual Mentor. 2010;12(11):893-897. doi: 10.1001/virtualmentor.2010.12.11.oped1-1011. [cited 2021 April 20]

14. Sabin J, “Medication Refusal in Schizophrenia: Preventative and Reactive Ethical Considerations.” AMA J Ethics. 2016;18(6):572-578. doi: 10.1001/journalofethics.2016.18.6.ecas1-1606. [cited 2021 April 20]

15. Say RE, Thomson R. The importance of patient preferences in treatment decisions–challenges for doctors.BMJ. 2003;327(7414):542-545. doi:10.1136/bmj.327.7414.542 [cited 2021 April 20]

16. Broderick P, Benjamin AB. Caffeine and psychiatric symptoms: a review. J Okla State Med Assoc. 2004 Dec;97(12):538-42. PMID: 15732884.  [cited 2021 April 20]

17. Gibbs M, Winsper C, Marwaha S, Gilbert E, Broome M, Singh SP. Cannabis use and mania symptoms: a systematic review and meta-analysis. J Affect Disord. 2015 Jan 15;171:39-47. doi: 10.1016/j.jad.2014.09.016. Epub 2014 Sep 23. PMID: 25285897. [cited 2021 April 20]

18. Włodarczyk A, Wiglusz MS, Cubała WJ. Ketogenic diet for schizophrenia: Nutritional approach to antipsychotic treatment. Med Hypotheses. 2018 Sep;118:74-77. doi: 10.1016/j.mehy.2018.06.022. Epub 2018 Jun 20. PMID: 30037619. [cited 2021 April 20]

19. Owiredu WK, Appiah-Poku J, Adusei-Poku F, Amidu N, Osei Y. The impact of blood glucose and cholesterol levels on the manifestation of psychiatric disorders. Pak J Biol Sci. 2009 Feb 1;12(3):252-7. doi: 10.3923/pjbs.2009.252.257. PMID: 19579954. [cited 2021 April 20]

20. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28. doi: 10.2190/PM.41.1.c. PMID: 21495519.  [cited 2021 April 20]

21. FDA drug label Risperdal [cited 2021 April 20]

22. Alicja Lerner, Michael Klein, Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs developmentBrain Communications, Volume 1, Issue 1, 2019, fcz025, https://doi.org/10.1093/braincomms/fcz025 [cited 2021 April 20]

23. Maalouf M, Rho JM, Mattson MP. The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain Res Rev. 2009 Mar;59(2):293-315. doi: 10.1016/j.brainresrev.2008.09.002. Epub 2008 Sep 25. PMID: 18845187; PMCID: PMC2649682. [cited 2021 April 20]

24. Leavell MA, Leiferman JA, Gascon M, Braddick F, Gonzalez JC, Litt JS. Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review. Curr Environ Health Rep. 2019 Dec;6(4):297-308. doi: 10.1007/s40572-019-00251-7. PMID: 31713144. [cited 2021 April 20]

25. Antonelli M, Barbieri G, Donelli D. Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. Int J Biometeorol. 2019 Aug;63(8):1117-1134. doi: 10.1007/s00484-019-01717-x. Epub 2019 Apr 18. PMID: 31001682. [cited 2021 April 20]

26. Adan RAH, van der Beek EM, Buitelaar JK, Cryan JF, Hebebrand J, Higgs S, Schellekens H, Dickson SL. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019 Dec;29(12):1321-1332. doi: 10.1016/j.euroneuro.2019.10.011. Epub 2019 Nov 14. PMID: 31735529. [cited 2021 April 20]



This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Medical Disclaimer:
Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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