Probiotic skin therapy improves eczema in children, study suggests National Institute of Allergy and Infectious Diseases, September 10, 2020

An experimental treatment for eczema that aims to modify the skin microbiome safely reduced disease severity and increased quality of life for children as young as 3 years of age, a National Institutes of Health study has found. These improvements persisted for up to eight months after treatment stopped, researchers report Sept. 9 in Science Translational Medicine. Atopic dermatitis, commonly called eczema, is a chronic inflammatory skin disease characterized by dry, itchy skin and rashes. The disease is most common in children and is linked to an increased risk of developing asthma, hay fever and food allergy. While available treatments can help manage eczema symptoms, current options can be costly, and many require multiple daily applications. The experimental therapy contains strains of live Roseomonas mucosa—a bacterium naturally present on the skin—originally isolated from healthy volunteers and grown under carefully controlled laboratory conditions. For four months, clinical trial participants or their caregivers periodically applied this probiotic therapy to areas of skin affected by eczema. "A child suffering from eczema, which can be itchy, painful and distracting for the child, also is very difficult for the entire family," said Anthony S. Fauci, M.D., director of NIH's National Institute of Allergy and Infectious Diseases (NIAID), which led the study. "These early-stage findings suggest that R. mucosatherapy may help relieve some children of both the burden of eczema symptoms and the need for daily treatment." Numerous genetic and environmental factors contribute to eczema, and scientists are learning more about the role that the skin's microbiome plays in this condition. In 2016, NIAID researchers reported that R. mucosa strains isolated from healthy human skin improved outcomes in cell culture and mouse models of eczema. To build on these preclinical findings, NIAID launched a Phase 1/2 clinical trial at the NIH Clinical Center in Bethesda, Maryland, to assess the safety and potential benefit of R. mucosa therapy in people with eczema. Interim results reported in 2018 for 10 adults and five children aged 9 to 14 years indicated that the treatment was safe and associated with reduced eczema severity. Since then, the trial has enrolled an additional 15 children, for a total of 20 children with mild to severe eczema ranging in age from 3 to 16 years. Twice weekly for three months and every other day for an additional month, children or their caregivers sprayed a solution of sugar water containing live R. mucosa onto areas of skin with eczema. For the first 15 children enrolled in the study, the dose of live R. mucosa was gradually increased each month. The last five children to enroll received the same dose throughout the four-month treatment period. Regardless of dosing strategy, no serious adverse events were attributed to the therapy. "Most children in the study experienced substantial improvements in their skin and overall wellbeing following R. mucosa therapy. Encouragingly, the therapeutic bacteria stayed on the skin and continued to provide benefit after therapy stopped," said NIAID's Ian Myles, M.D., principal investigator of the trial. "These results support a larger study to further assess the safety and effectiveness of this experimental treatment by comparing it with a placebo." Seventeen of the 20 children experienced a greater than 50% improvement in eczema severity following treatment. Improvement occurred on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The scientists also observed increases in the skin's barrier function—its ability to seal in moisture and keep out allergens. Additionally, most children needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following the therapy. These benefits persisted after treatment ended, and the therapeutic R. mucosa strains remained on the skin for up to eight months. The NIAID researchers next set out to better understand how R. mucosa therapy improves eczema symptoms. They found that treated skin had increased microbial diversity and reduced levels of Staphylococcus aureus—a bacterium known to exacerbate eczema. In addition to imbalances in the microbiome, the skin of people with eczema is deficient in certain lipids, or oils. By conducting experiments in cell and animal models of eczema, the NIAID scientists found that a specific set of lipids produced by R. mucosa strains isolated from healthy skin can induce skin repair processes and promote turnover of skin tissue. Study participants had increased levels of these lipids on their skinafter treatment with R. mucosa. The researchers emphasize that additional studies are needed to further elucidate the mechanism of R. mucosa therapy and to explore whether genetic or other factors may explain why some participants did not benefit from the experimental treatment. Gestational diabetes may accelerate child's biological age Long-term health risks include cardiovascular disease, high blood pressure and higher weight, Rutgers study says Rutgers University, September 10, 2020 Children born to mothers who had diabetes during pregnancy may age faster biologically and be at an increased risk for obesity and high blood pressure, according to Rutgers researchers. The study, published in the journal Epigenetics, explored how more than 1,000 children born to mothers in China aged on a cellular level. Researchers examined their exposure to gestational diabetes in utero and their DNA methylation, or epigenetic age, which indicates how experiences and exposures reflect true biological age even in early childhood. Accelerated aging, which can be determined by evaluating if a person's estimated DNA methylation age is greater than their chronological age, has been shown to be associated with cardiovascular risks and poor health outcomes later in life. The researchers measured the epigenetic age of 1,156 children who were ages 3 to 10 in Tianjin, China, to see how it differed from their chronological age. They found that children born to mothers who had diabetes while pregnant had a higher epigenetic age -- or were "older" than their actual age -- and that this epigenetic age is associated with higher weight, body mass index, body fat percentage, upper-arm circumference and blood pressure. "These findings suggest that gestational diabetes may have long-term effects on epigenetic aging in offspring and lead to poorer cardiometabolic health outcomes," said lead author Stephanie Shiau, an instructor at the Rutgers School of Public Health. The findings support the need for further studies using longitudinal samples to evaluate the association between epigenetic age and later onset of adult metabolic diseases. In the United States, between 2 percent to 10 percent of pregnancies are affected by the condition annually, according to the National Institutes of Health. Ten minutes of massage or rest will help your body fight stress: study University of Konstanz (Germany) September 13, 2020

Allowing yourself a few minutes of downtime significantly boosts mental and physical relaxation. Research by psychologists at the University of Konstanz observed higher levels of psychological and physiological relaxation in people after only ten minutes of receiving a massage. Even ten minutes of simple rest increased relaxation, albeit to a lesser degree than massage. The findings, reported on 8 September 2020 in the journal Scientific Reports, provide the first indication that short-term treatments can robustly reduce stress on a psychological and physiological level by boosting the body's principal engine for relaxation—the parasympathetic nervous system (PNS). Stress is known to have negative consequences for health and disease. However, our bodies have an inbuilt regenerative system, the PNS, to ward off stress during times of threat. Launching a relaxation response is thus key to protecting our health and restoring balance in our body. Massage has been used to improve relaxation, yet no systematic approach exists to robustly confirm its effect on the PNS and whether or not this could be used as rehabilitation for patients suffering from stress-related disease. Boosting the body's engine for relaxation This study indicates that massage is an easy-to-apply intervention that can boost the body's principal engine for relaxation—the PNS—and also lead to a reduction in perceived mental stress. The discovery that massage is effective on the level of both psychology and physiology via the PNS will pave the way for future studies on understanding the role of relaxation on stress. "To get a better handle on the negative effects of stress, we need to understand its opposite—relaxation," says Jens Pruessner, head of the Neuropsychology lab and Professor at the Cluster of Excellence "Center for the Advanced Study of Collective Behavior" at the University of Konstanz. "Relaxation therapies show great promise as a holistic way to treat stress, but more systematic scientific appraisal of these methods is needed." Standardized testing approach Researchers from the Department of Psychology in Konstanz developed a standardized approach for testing if tactile stimulation could improve mental and physical relaxation. They applied two different ten-minute massages on human subjectsin the laboratory to test: A head-and-neck massage was designed to actively stimulate the PNS by applying moderate pressure on the vagal nerve, which is the largest nerve running to the PNS. Then a neck-and-shoulder massage with soft stroking movements was designed to examine whether just touch can also be relaxing. Finally, a control group of participants sitting quietly at a table was tested for the effect of rest without tactile stimulation. Physiological relaxation was gaged by monitoring the heart rate of participants and measuring heart rate variability (HRV), which indicates how flexibly the PNS can respond to changes in the environment. The higher the HRV, the more relaxed is the body. Psychological relaxation was gaged by asking participants to describe how relaxed or stressed they feel. Ten minutes of resting or receiving either massage resulted in psychological and physiological reduction in stress. All participants reported that they felt more relaxed, and less stressed, compared with before the treatments. Further, all participants showed significant increases in heart rate variability, which demonstrates that the PNS was activated and the body physiologically relaxed just by resting alone. The physiological effect was more pronounced when participants received a massage. It was, however, not important whether the massage was soft or moderate—tactile contact in general seemed to improve the relaxation of the body. Small moments with big impact "We are very encouraged by the findings that short periods of dis-engagement are enough to relax not just the mind but also the body," says Maria Meier, a doctoral student in the lab of Neuropsychology and first author on the study. "You don't need a professional treatment in order to relax. Having somebody gently stroke your shoulders, or even just resting your head on the table for ten minutes, is an effective way to boost your body's physiological engine of relaxation." By developing a standardized method for robustly testing and validating relaxation therapies, the study allows further experiments to test the effects of additional relaxation interventions that could be used in prevention or rehabilitation programs for people suffering from stress-related diseases such as depression. "Massage, being such a commonly used relaxation therapy, was our first study," says Meier. "Our next step is to test if other short interventions, like breathing exercises and meditation, show similar psychological and physiological relaxation results." Processed food linked to age-marker in chromosomes University of Navarra (Spain), September 10, 2020 People who eat a lot of industrially processed junk food are more likely to exhibit a change in their chromosomes linked to aging, according to research presented at an online medical conference. Three or more servings of so-called “ultra-processed food” per day doubled the odds that strands of DNA and proteins called telomeres, found on the end of chromosomes, would be shorter compared to people who rarely consumed such foods, scientists reported at the European and International Conference on Obesity. Short telomeres are a marker of biological aging at the cellular level, and the study suggests that diet is a factor in driving the cells to age faster. While the correlation is strong, however, the causal relationship between eating highly processed foods and diminished telomeres remains speculative, the authors cautioned. Each human cell has 23 pairs of chromosomes that contain our genetic code. Telomeres do not carry genetic information, but are vital for preserving the stability and integrity of chromosomes and, by extension, the DNA that all the cells in our body relies on to function. As we get older, our telomeres shorten naturally because each time a cell divides, part of the telomere is lost. That reduction in length has long been recognized as a marker of biological age. Scientists led by professors Maria Bes-Rastrollo and Amelia Marti, both of the University of Navarra in Spain, wanted to explore a suspected connection between the regular consumption of highly processed junk food and shrinking telomeres. Earlier studies had pointed to a possible link with sugar-sweetened drinks, processed meats and other foods loaded with saturated fats and sugar, but the findings were inconclusive. Ultra-processed foods are industrially manufactured substances composed of some mix of oils, fats, sugars, starch and proteins that contain little if any whole or natural foods. They often include artificial flavorings, colorings, emulsifiers, preservatives and other additives that increase shelf-life and profit margins. These same properties, however, also mean that such foods are nutritionally poor compared to less processed alternatives, the researchers said. Earlier studies have shown strong correlations between ultra-processed foods and hypertension, obesity, depression, type 2 diabetes and some forms of cancer. These conditions are often age-related in so far as they are linked to oxidative stress and inflammation known to influence telomere length. Marti and colleagues looked at health data for nearly 900 people aged 55 or older who provided DNA samples in 2008 and provided detailed data about their eating habits every two years thereafter. The 645 men and 241 women were equally divided into four groups, depending on their consumption of ultra-processed foods. Those in the high-intake group were more likely to have a family history of cardiovascular disease, diabetes and abnormal blood fats. That also consumed less foods associated with the Mediterranean diet — fibre, olive oil, fruits, vegetable and nuts. Compared to the group who ate the fewest ultra-processed foods, the other three showed an increased likelihood — 29, 40 and 82 percent, respectively — of having shortened telomeres. The findings were published earlier this year in the peer-reviewed American Journal of Clinical Nutrition. Mother's iodine status related to child's IQ Bothwell OB/GYN Associates, September 9, 2020 For a woman planning to have a baby, there are many health factors to take into consideration. One that may be overlooked is the mother's iodine level. Iodine is a trace mineral in our bodies that is essential for the production and integration of thyroid hormones that regulate metabolism, development and important body functions. Low levels of iodine result in decreased levels of the thyroid hormone t4 or thyroxine. According to Dr. Lori Nolla, obstetrician with Bothwell OB/GYN Associates, low levels of this hormone in pregnant women can result in permanent intellectual disability in the baby and is associated with higher newborn and infant death rates. "Iodine is crucial for the production of thyroid hormones, which play a key role in the brain development of fetuses," Nolla said. "Pregnant women or women planning to be pregnant must have adequate amounts of iodine, particularly in the first trimester, to ensure their baby's central nervous system develops properly." Nolla said our bodies don't naturally make iodine, so the only way to get this nutrient is through diet. "Iodine intake in the United States has decreased due to reduced iodine content in dairy products and increased use of noniodized salt in the food industry," she said. "However, women who are pregnant or planning to be can make simple changes to increase their iodine intake including watching what they eat, taking prenatal vitamins and using iodized salt in place of regular salt." The World Health Organization recommends pregnant women should take 250 micrograms of iodine a day during pregnancy and lactation. "The months leading up to pregnancy are the most important in terms of optimizing iodine levels, so supplementation should be considered before conception," Nolla said. "When iodine supplements are begun before conception, children show better neurological and developmental outcomes." For that reason, Nolla recommends women start taking prenatal vitamins three months before attempting to conceive. In addition to iodine levels, iron, selenium and vitamin A levels should also be monitored because deficiencies can worsen the problems of low iodine. Goiter, or a swelling of the thyroid glands in the neck, is the most obvious symptom of iodine deficiency. However, even if there are no obvious signs of deficiency, iodine levels should be monitored to ensure the health of the mother and child, Nolla said. "A mother's iodine level has a significant impact on a baby's health," she said. "Women who are pregnant or planning to be should talk to their doctors about checking and monitoring their iodine to ensure a healthy pregnancy and healthy baby." Cannabidiol (CBD) found to alleviate seizures in those with neurodevelopmental conditions: Study University of North Carolina, September 13, 2020 Cannabidiol (CBD) is one of the 113 organic compounds in the Cannabis sativa plant, commonly known as hemp. Previous studies on CBD have focused on its medicinal uses for pain relief, epileptic seizures, insomnia and Parkinson’s disease. But a recent study from the University of North Carolina at Chapel Hill (UNC) found that CBD could also benefit children and adults suffering from Angelman syndrome (AS). First author Bin Gu and his colleagues tested the effects of CBD on seizures, motor deficits and brain abnormalities in a mouse model of the said neurogenetic disorder. Their experiments demonstrated that CBD treatment can reduce the severity of seizures in mice with AS. In addition, CBD also caused mild sedation and restored the mice’s normal brain rhythms. Gu is hopeful that their findings, published in the Journal of Clinical Investigation, could inspire further research into the use of CBD as a treatment for seizures caused by AS and other neurological disorders. CBD reduces seizures and causes mild sedation AS is a rare neurogenetic disorder that occurs in one in 15,000 live births, or about 500,000 people around the globe. It tends to cause developmental problems that become noticeable when an infant reaches six to 12 months of age. AS can also cause other abnormalities, such as seizures, balance disorders and speech problems. Because of the rare nature of AS, there is scant research on possible treatments and therapies. Benjamin Philpot, the associate director of the UNC Neuroscience Center and the study’s senior author, said that there is an unmet need for better treatments for children suffering from the disorder. In response to this need, he and his colleagues created genetically modified mouse models of AS that they could use to find a possible treatment. The researchers chose to test CBD because of its anti-epileptic properties. In 2018, the U.S. Food and Drug Administration approved the use of CBD as a treatment for seizures caused by two rare forms of epilepsy. (Related: Treating neurological disorders in children with oriental herbal medicine.) To assess the effects of CBD on AS symptoms, the researchers injected the genetically-modified mice they created with various doses of CBD an hour prior to behavioral testing. Regardless of dose, CBD did not have a major impact on motor coordination or balance. However, injection of a standard anti-convulsant dose of CBD caused mild sedation in the mice and reduced the severity of their experimentally triggered seizures. CBD also helped stabilize brain pulses linked to neural deficits and abnormalities. These results expand the therapeutic spectrum of the anti-epileptic effects of CBD. The researchers also believe that their study could help address the need for better treatments for children with AS. CBD reduces seizures and autism-like behaviors in a mouse model of another childhood brain disorder This isn’t the first time that scientists attempted to assess the therapeutic effects of CBD on rare and less-studied neurological disorders. In 2017, researchers from the University of Washington (UW) used CBD to treat mice with Dravet syndrome (DS), a severe type of epilepsy characterized by prolonged seizures that begin in the first year of life. But unlike AS patients whose symptoms tend to improve with age, DS patients tend to suffer from worse intellectual impairments, autism-like behaviors and other debilitating neurological problems over time. DS is also a rare and life-long condition that affects one in 20,000 to 40,000 people worldwide. Its drug-resistant nature has further complicated the development of treatments and therapies for it. The UW researchers assessed the effects of CBD treatment on a mouse model of DS. Their experiments showed that high doses of CBD could reduce the severity, frequency and duration of DS-induced seizures. In addition, mice treated with low doses of CBD spent more time interacting with other mice compared with the untreated mice, indicating an improvement of autism-like behaviors. However, this effect was lost at the higher doses needed to reduce seizures. Nephi Stella, the founder of the UW Center for Cannabis Research and a member of the research team, said that their findings highlight the need for a treatment that could confer both benefits at once. Nevertheless, the researchers noted that their findings contribute to the emerging data supporting the use of CBD in the treatment of drug-resistant and debilitating neurological conditions. A Novel Approach to Treating COVID-19 Using Nutritional and Oxidative Therapies

David Brownstein, M.D. (journal, Science, Public Health Policy and the Law Objective: This report is a case series of consecutive patients diagnosed with COVID-19 treated with a nutritional and oxidative medical approach. We describe the treatment program and report the response of the 107 COVID-19 patients.

Study Design: Observational case series consecutive.

Setting: A family practice office in a suburb of Detroit, Michigan.

Patients: All patients seen in the office from February through May 2020 diagnosed with COVID-19 were included in the study. COVID-19 was either diagnosed via PCR or antibody

testing as well as those not tested diagnosed via symptomology.

Interventions: Oral Vitamins A, C, D, and iodine were given to 107 subjects (99%). Intravenous solutions of hydrogen peroxide and Vitamin C were given to 32 (30%) and 37 (35%) subjects. Thirty-seven (35%) of the cohort was treated with intramuscular ozone. A dilute, nebulized hydrogen peroxide/ saline mixture, with Lugol’s iodine, was used by 91 (85%).

Main Outcome Measures: History and physical exam were reviewed for COVID-19 symptoms including cough, fever, shortness of breath, and gastrointestinal complaints. Laboratory reports were examined for SARS-CoV-2 results. Symptomatic improvement after treatment was reported for each patient consisting of first improvement, mostly better, and completely better. Results: There were a total of 107 patients diagnosed with COVID-19. Thirty-four were tested for SARS-CoV-2(32%) and twenty-seven (25%) tested positive. Three were hospitalized (3%) with two of the three hospitalized before instituting treatment and only one requiring hospitalization after beginning treatment. There were no deaths. The most common symptoms in the cohort were fever (81%), shortness of breath (68%), URI which included cough (69%), and gastrointestinal distress symptoms (27%). For the entire cohort, first improvement was noted in 2.4 days. The cohort reported symptoms mostly better after 4.4 days and completely better 6.9 days after starting the program. For the SARS-CoV-2 test positive patients, fever was present in 25 (93%), shortness of breath in 20 (74%) and upper respiratory symptoms including cough in 21 (78%) while gastrointestinal symptoms were present in 9 (33%). The time to improvement in the SARS-CoV-2 test positive group was slightly longer than the entire cohort.

Conclusion: At present, there is no published cure, treatment, or preventive for COVID-19 except for a recent report on dexamethasone for seriously ill patients. A novel treatment program combining nutritional and oxidative therapies was shown to successfully treat the signs and symptoms of 100% of 107 patients diagnosed with COVID-19.

Each patient was treated with an individualized plan consisting of a combination of oral, IV, IM, and nebulized nutritional and oxidative therapies which resulted in zero deaths and recovery from COVID-19. Milk thistle protects against COPD caused by secondhand smoke Sichuan University, (China), September 11, 2020 According to the U.S. Centers for Disease Control and Prevention (CDC), 15.7 million people suffer from chronic obstructive pulmonary disease (COPD) – a serious respiratory condition which can cause scarring of the lungs, narrowing of the airway and extreme difficulty breathing. Taking enough milk thistle – on a regular basis – can help protect you from harm. (But, don’t expect to hear about this from the big pharma-owned media.) Exposure to tobacco smoke – whether through actively smoking or simply inhaling the smoke from another’s cigarette – is the primary cause of COPD. Although Western medicine currently offers no cure for COPD, recent studies generate a ray of hope. Groundbreaking newresearch suggests that milk thistle extracts may not only prevent COPD but, help to treat it. WARNING: Carcinogenic secondhand smoke is a major contributor to COPD “Passive” smoking – the act of inhaling secondhand smoke – exposes the victim’s lungs to a truly noxious cocktail of poisons. In fact, secondhand smoke has been classified as a carcinogen by both the Environmental Protection Agency (EPA) and the National Toxicology Program. Among the toxins found in secondhand smoke are butane, ammonia, hydrogen cyanide – which is used in chemical warfare – carbon monoxide (think: “car exhaust”) and toluene, found in paint thinners, lacquers and glues. Other constituents include the toxic heavy metals arsenic, lead and cadmium. Although lung cancer is probably the disease most often associated with secondhand smoke, this lethal form of air pollution is also a primary factor in COPD – which is currently the third leading cause of death in the United States. Having COPD raises the risk of developing lung cancer and heart disease. To make matters worse, this condition is associated with osteoporosis, anxiety, depression, frailty and malnutrition. While Western medicine attempts to manage COPD symptoms with oxygen therapy and drugs such as bronchodilators and corticosteroids, these treatments don’t reduce mortality at all – and some feature serious (unwanted) side effects. In light of these discouraging facts, the promising results of recent milk thistle studies stand out as a particularly welcome development. (to say the least!) Silymarin, a flavonoid in milk thistle, alleviates inflammatory response In a study published in the journal Inflammation, researchers exposed mice to the equivalent of 1.5 packs of cigarettes a day for four weeks, creating drastic increases in peribronchial inflammation, thickening of airway walls and airway obstruction. The team found that pretreating the mice with silymarin – the active component of milk thistle – an hour before exposure dramatically decreased inflammatory changes, and cut production of pro-inflammatory chemicals such as TNF-alpha and interleukin. Encouragingly, silymarin also helped safeguard levels of superoxide dismutase, an important disease-fighting antioxidant produced in the body. A year later, the same team of researchers took another, closer look at the workings of milk thistle. And what they found was encouraging. In a study of human bronchial cells published in Scientific Report, the team explored the molecular and cellular mechanisms of silymarin – and found once again that the flavonoid attenuated cigarette smoke-induced upregulation of pro-inflammatory chemicals. And, researchers discovered for the first time that silymarin modulated a certain pathway – known as MAPK – that governs inflammation. The takeaway? The team concluded that silymarin might be “an ideal agent for treating inflammatory pulmonary diseases.” Primary constituent in silymarin suppresses inflammation and scarring In a third study, recently published in Food and Chemical Toxicology, researchers treated mice with silibinin (a constituent of silymarin) one hour before exposure to cigarette smoke. The team found that the silibinin caused the mice to not only experience the sharp reductions in inflammatory changes seen in earlier studies – but discovered that it also suppressed the scarring and fibrosis that are typical of COPD in humans. This means that silibinin may not only help prevent COPD – but, reverse it! Intriguingly, the silibinin directly affected the expression of a certain pro-inflammatory protein – transforming growth factor beta-1 – that is activated and spurred on by exposure to smoke, making it appear that this compound is custom-designed to protect against secondhand smoke. How do I take milk thistle extracts to protect against COPD? Milk thistle extracts are available in the form of pills, powders, extracts, liposomes and teas. Look for a high-quality preparation that is standardized to contain 70 to 80 percent silymarin. Naturopathic doctors may recommend milk thistle extracts in dosages ranging from 20 to 300 mg a day. As always, you should consult a trusted healthcare provider before supplementing with milk thistle – especially if you have a serious medical condition. For maximum benefit, some natural health experts advise taking a silymarin-phosphatidylcholine complex, a formulation which helps beneficial silymarin attach to cell membranes more easily. Note: Milk thistle is a member of the aster family. Don’t take milk thistle if you are allergic to any of its “cousins,” such as ragweed, chrysanthemum, chamomile, marigolds, yarrow or daisies. Notwithstanding its unglamorous resume as a common weed that thrives in fields and pastures, the humble milk thistle is actually a potent herbal hero that can help defend against a debilitating and deadly disease. If you have been – or are currently – exposed to firsthand or secondhand cigarette smoke, supplementing with milk thistle to protect against COPD could be a wise move. Reply Reply all Forward