Dr Collins answesr your hormone health questions

This FAQ (Frequently Asked Questions) feature is designed to support true personalize healthcare. 
This is where you get to ask real questions, and review the honest answers to questions that others have asked.
Look through the questions and answers already posted – or Submit a Question. This FAQ feature will continue to grow as new questions are added. Be sure to look at the Hormone Health Protocols as well. Orclick here to submit a question.
 
AdrenoMend 
Question: Is it okay to use AdrenoMend first if I have more than one hormone problem, and I am not sure where to start?
Answer:
AdrenoMend™ is a great first choice for most hormone problems unless there is a suspicion of excessive androgens, such as excessive testosterone. 

AdrenoMend™ supports many of the hormone systems, including the production and function of sex hormones and thyroid hormones, and the balancing of adrenal hormones. In addition it balances other systems, such as the system that controls blood sugar, the system that controls appetite and metabolic rate, etc. You can see all the systems that are normalized at:www.AdrenoMend.com/Homeostasis_Systems.html

It is important to note that AdrenoMend™ improves function of the hypothalamic-pituitary-gonadal (HPG) axis, which is the system that promotes production of hormones from the gonads (testes and ovaries). Since the gonads make testosterone in both males and females, people with symptoms of excessive testosterone should address the high testosterone symptoms before starting AdrenoMend™.

In women that have symptoms of PCOS, or an androgen excessive type of PMS/PMDD or an androgen excessive type of menopause, it may be best to also start taking TestoQuench™ for Women. This will tell their bodies not to make more testosterone, while the systems are still allowed to become more active. 

Men going through andropause may have relatively high estrogen levels compared to their testosterone levels. For example, a man may have estrogen levels in the 50th percentile (in the middle of the reference range), but his testosterone is in the low end of their range. This relative excess of estrogens, or estrogen dominance, could cause prostate irritation, increased growth of breast tissue, or other signs of estrogen dominance. In those cases, it is best to use EstroQuench™ with the AdrenoMend™. In some men, I recommend starting with AdrenoMend™ and EstroQuench™ even before they start TestoGain™. This allows the body to first balance the systems affected by estrogen dominance in men, such as the blood glucose system, the thyroid system and the system that controls appetite and metabolic rate. The TestoGain™ will work much better after estrogen dominance is treated.

Be in good health,

Dr Joseph J Collins, RN, ND

 
Men's Hormone Health
 
 
 
Women's Hormone Health
 
PMS & PMDD
 
 
PCOS & PCO-Like Syndrome
 
Using TestoQuench™ for Women to treat hirsutism.  

Question: Will TestoQuench™ for Women help with hirsutism? 

Answer: Using TestoQuench™ for Women to treat hirsutism.  

I have seen some very good success when TestoQuench™ for Women is used to treat hirsutism.   

Typically, once a hair follicle is stimulated by excessive androgens (testosterone and other similar hormones), then that hair follicle is activated – and will stay activated. TestoQuench™ for Women will decrease the activation of more hair follicles. So the first sign is that hirsutism quits getting worse. 

In addition, TestoQuench™ for Women will cause activated hair follicles to become thinner and lighter (to the point they become unnoticeable), especially when TestoQuench™ for Women is used with epilation (waxing, lasers, electrology, etc.). This is important because typically, hair comes back just as bad after epilation, or a woman will continue to develop new hair follicles after epilation. So it helps de-active stimulated hair follicles.

Even though a woman’s primary concern may be hirsutism, the other problems that can occur with androgen excess include infertility and obesity, as well as twelve additional problems that are discussed at:

http://www.yourhormones.com/women/polycystic_ovary_syndrome.html

Hirsutism is one of the problems listed on that page.

You can learn more about TestoQuench™ for Women in the Professional Guide, which can be found on the Resources page

Be in good health,

Dr Joseph J Collins, RN, ND

Pre-Menopause
Question: I am 45 years old with no menopause symptoms and regular periods. What should I be doing to prepare for possible symptoms and for the menopause that is approaching?

Answer: Premenopause means before menopause. This term may actually be used to describe women in their twenties to their early fifties. Perimenopause literally means "around menopause" - and likewise draws our attention to the changes that may take place around the time of true menopause. Menopause has taken place after there has been 12 consecutive months without a period (not due to pregnancy or breast feeding). The 12 months indicates the the permanent cessation of the regular monthly cycle, and may be associated with various changes in hormone levels.  

Preparing for an ensuing menopause requires attention to the fact that choices made years before menopause will determine both the ease of the course, and the type of menopause a woman will eventually experience. Chapter 15 of Discover Your Menopause Type is titled “Conclusion, The Future of Menopause: How to Prepare”. And while I will touch on most of those points in this answer, I will also share some new insights we have learned since the book was published. Here are things that woman can (should) do before menopause. The sooner the better.  

Eat a healthy diet now. A healthy diet - free from the extremes of severe dieting and binge eating - can increase the opportunity for an ideal menopause. Diets rich in whole fruits, vegetables, grain and legumes can provide the wide range of phytoestrogens that make the transition smoother (pg. 212). Whole foods – especially fruits and vegetables, are naturally rich in antioxidants. Women who use alcohol should make sure that alcohol is really used in great moderation. Excessive alcohol use can bring about an earlier and more uncomfortable menopause. 

Start nutrition supplements now. A personalized nutritional support plan should definitely be part of any program aimed at achieving the ideal menopause (Menopause Type 1). Over two-dozen vitamins and minerals are required for the production of the sex hormones (see Chapter 12). These vitamins and minerals are best acquired by using multiple vitamin & mineral supplements. But supplements will not provide everything a woman needs to achieve an ideal menopause; a healthy diet is a must – and in most women do best when they also take an essential fatty acid supplement that is rich in DHA & EPA. Study the Hormone Health Guidelines to learn more about achieving complete hormone health. 

Learn stress management now. Stress management can come in various forms or techniques. Activities such as relaxation exercises, meditation, prayer, yoga, exercise and play, all can help diminish the degree to which stress can impact onset and severity of menopause. This often comes down to adding healthy recreation back into your life. Make life choices that allow time for relaxation and proper management of stress as early as possible in life. It is always easier to keep healthy habits started before menopause than it is to start them after menopause has already started. Exercise in and of itself can bring about a more favorable perimenopause and menopause.

It's interesting to note that moderate exercise will actually increase sex hormone production. But avoid extremes. Excessive exercise has been shown to decrease sex hormones in a number of studies. As well as exercise, include relaxation as part of a healthy life style. And remember that inadequate sleep can also lower hormones (page 314). Begin regular physical activity now. It will be more difficult to start an exercise program if fatigue comes on with menopause. Regular exercise will actually decrease the chances of having fatigue during menopause.

Eliminate fatigue now. If a premenopausal woman of any age is already experiencing fatigue or decreased ability to tolerate stress, it is best to address it before menopause. Too often I have heard women say, that they “expected the fatigue to go away” after the children move out; or after their next promotion; after they quit doing overtime to pay off debts; or after any multitude of demands that they expect to become less demanding. Unfortunately, there are always new demands, and new opportunities that never quite allow us to really have some down time. Now is the time to eliminate fatigue. When a woman goes through menopause her adrenal gland have to take on some additional responsibly for keeping your hormone levels healthy. The ovaries are providing less hormones, so the adrenal gland are recruited to make up for the dropping levels. Ideally, adrenal recruitment results in increased production of hormone levels from the adrenal gland after menopause.

Since adrenal recruitment is required for ideal menopause to occur, the health of the adrenal glands needs to become a greater focus in women's health. Stress - no matter what kind, or where it comes from - can have adverse effects on the normal production of hormones. Consider this; under increased stress the body will make more cortisol so that the body can tolerate the stress. The hormone-making pathway (steroidogenic pathway) that makes this needed boost in cortisol is the same pathway that makes the "sex hormones" (estrogens, progesterone and testosterone). Under stress there will be increased cortisol at the expense of the sex hormones. In addition to diet, supplements and stress management, the most effective way ot overcome fatigue is through proper use of adaptogens – herbs that help the body adapt to stress. 

The plant adaptogens in AdrenoMend effectively address all stages of both acute and chronic stress, support the bodys ability to adapt to stressors and help avoid the damaging consequences from those stressors. Collectively, plant adaptogens can support symptoms of fatigue and enhance endurance as well as support normal mental and emotional well being. consider using adaptogens to strengthen the adrenal glands. 

Alleviate PMS/PMDD now. If a premenopausal woman of any age is experiencing PMS, she should seek out a healthcare professionals to assist her in achieving balance and relief as soon as possible. Treating the symptoms of PMS does not restore balance. Women who experience premenopausal PMS often experience a more difficult and unbalanced menopause. 

Decreased use, or avoidance, of caffeine may be of additional help in attaining an ideal menopause. Avoiding caffeine has been associated with decreased hot flushes, and caffeine will cause the same reaction as stress - increased cortisol. 

Do not smoke or use tobacco. Use of tobacco products, can bring about an earlier and more uncomfortable menopause. 

Learn about medications you use. Medications that can lower hormone production may also bring about an earlier and non-ideal menopause (review the lists of these drugs in Chapter 10). Ask you prescriber if there are options that do not affect hormones, or work with an integrative health care professional that may help you eliminate the need for some medications. 

Check your thyroid. Women are more likely to have thyroid disorders than men. Have your thyroid checked regularly. And ask that your actual thyroid hormones (T3 & T4) be measured, as well as antibodies (anti-TPO & anti-TG) that may insidiously attack the thyroid. Measuring only TSH is not enough.  

Begin now. Improving lifestyle and eating choices is a good idea any time. Undertaking such major changes as a better diet, starting to exercise, taking new supplements, making time for recreation, quitting smoking and decreasing alcohol intake take significant effort. As noted, trying to start these changes while having to deal with menopause symptoms proves to be all the more difficult. So start making healthy choices now.

It's important to realize that the choices listed above each have the ability to decrease symptoms, and reverse health risks, in women who have already entered menopause. Making these choices years, or decades, before the onset of menopause can provide a greater opportunity of attaining the ideal menopause. Consider consulting with an integrative healthcare professional who can help you utilize the Hormone Health Guidelines 

Dr. Joseph J. Collins, RN, ND

Peri-Menopause

  

 

Menopause

  

 

Post-Menopause 

 

 

 

Hysterectomy

  

 

Hormone Replacement Therapy (HRT)

  

 

Adrenal Health

 

 

Thyroid Health 

How to lower anti-thyroid antibodies in patients that have Hashimoto’s hypothyroidism.

Question: I have heard you say that there was a study that showed Wobenzym® lowered anti-thyroid-antibodies, and that patients treated with Wobenzym® were able to lower their thyroid medication, and some patients were actually able to stop taking thyroid medication. Can you tell me more about that study?

Answer:The study was presented at the “International Congress on Immunorehabilitation Allergy, Immunology, and Global Net“, which was held April 21-24, 2002 at Cannes, France. 

Here is the translated abstract (it was originally written in Czech and Russian):

Wobenzym in the complex treatment of autoimmune thyroiditis

Kvantchakhadze R.G. Research and Therapeutic Center of Rheumatology, Tbilisi, Gruzia VIII. International Congress on Immunorehabilitation „Allergy, Immunology, and Global Net“, April 21-24, 2002, Cannes, France International Journal on Immunorehabilitation, 2002,  Vol. 4, No. 1, pp. 114. Czech abstract, Russian abstract   

40 patients suffering from autoimmune thyroiditis were observed for 6 months. Patients were divided into two groups. 20 patients in the group I were treated depending on thyroid condition (euthyreosis, hypothyreosis) with L-tyroxin (25 – 100 mg daily) in combination with Wobenzym (5 coated tablets three times a day). Patients in the group II were treated with L-tyroxin only at the above dosage. Both groups were comparable with regard to age, sex, and clinical-laboratory parameters. All usual parameters were examined before treatment, after 1 and 3 months, and at the end of treatment.  Improvement of thyroid parameters at ultrasound examination (reduction of size, improved tissue structure) and aspiration biopsy parameters (reduced number of lymphoid and plasmocytoma cells in cytologic punctuate) as well as significant decrease of blood thyreotropin level and titers of antibodies against thyreoglobulin and microsomal fraction accompanied by the improvement of subjective parameters were found in the group I after 3 months of treatment, whereas in the group II after 6 months of treatment. In both groups of patients suffering from hypothyreosis, an impaired lipid metabolism was found. Treatment of patients in the group I resulted in a decrease of cholesterol and triglyceride levels, whereas in patients in the group II there were no significant changes found during the treatment.  In patients in the group I dosage of L-tyroxin could be lowered after 3 months of treatment, in some cases it could even be discontinued. Under continuous Wobenzym treatment improved clinical-laboratory parameters were maintained. Thus, Wobenzym was shown to be therapeutically effective in a complex therapy of autoimmune thyroiditis. 

Dr Collins’ Comment:

You will notice that 40 patients were divided into two group of 20 each.

Group 1 were treated with the appropriate dosage of l-thyroxin (spelled l-tyroxine in abstract), as well as 5 Wobenzym, three times a day.

Group 2 were treated with the appropriate dosage of l-thyroxin only.

Group 1 benefited by:

  • Decrease of blood thyreotropin (TSH) level and titers of antibodies against thyreoglobulin and microsomal fraction (antiTG & anti-TPO).
  • Improvement of subjective parameters (symptoms).
  • Decrease of cholesterol and triglyceride levels.
  • Dosage of L-tyroxin could be lowered after 3 months of treatment, in some cases it could even be discontinued. 

The conclusion was:

“Wobenzym was shown to be therapeutically effective in a complex therapy (used with other therapy) of autoimmune thyroiditis.”

My recommendations for Hashimoto’s thyroid disease (autoimmune thyroiditis) is:

My compilation of the international literature on Wobenzym® formulations as systemic enzyme therapy, including the Webinars, Educational posters, and an educational website, is currently being updated and edited. 

If you would to be notified when the work is complete, please sign up on our "Newsletter" located at the bottom of every page in our website.

 

Taking ThyroMend with thyroid medication.

Question: I am currently taking levothyroxine ( or L-thyroxine, which has many Trade Names), and would like to know if I can take ThyroMend™ with the levothyroxine. I am considering stopping the levothyroxine because it feels like my body does not like it. It is not helping me feel better. 

Answer: First, I would suggest that you do not lower your thyroid medication dosage unless your physician advises you to do so.

Second, the short answer is: Yes, you can take ThyroMend™ with levothyroxine.

In my experience, many patients on thyroid medication do not get the expected benefits. They often still feel symptoms of low thyroid function, which are listed on this webpage:

http://www.thyromend.com/signs_symptoms_hypothyroid.html

In my experience, when levothyroxine does not work properly, it is because some of the requirements for healthy thyroid function are not taking place. This could be any of the last four steps of healthy thyroid function (the first three steps involve making T4 – but since you take T4, that’s not the problem). The seven steps are described in this article:

http://www.yourhormones.com/thyroid/thyroid_function.html

The last four steps are:

   4. It could be because the T4 (levothyroxine) is not getting converted into the more active T3.

  5. It could be that the cells in your body are not receiving the thyroid hormone, because their receptors are not working. This is called “receptor resistance”.

   6. It could be that the thyroid hormone is not getting to the DNA in the cells of your body – so the cells of your body don’t know that they are supposed to do what the thyroid wants them to do. This is because the two proteins that help carry the thyroid hormone to the DNA have not coupled, or paired together - so they don’t get the signal to the DNA.

  7. The specific genes in the DNA of cells are not able to be activated – they do not “express themselves” the way they are supposed to. 

The seven requirements for healthy thyroid function are all supported and repaired by ThyroMend™, because the nine herbs work together synergistically to accomplish those goals. You can see more on their synergy here: http://www.thyromend.com/thyroid_herb_synergy.html

You can also study the “Complete Thyroid Health” webinar, which you will find listed on this page:

Order ThyroMend™ 

Be in good health,

Dr Joseph J Collins, RN, ND

 

Insulin & Blood Sugar Health

  

Other Hormone Questions

 

Lab Test Questions

How do I properly calculate the P:E ratio & do quartile analysis? 

 

Questionnaire Questions 

 

Hormone Specific Formulations™ Questions 

Question: I noticed that your formulations have been reformulated in late 2012. Can you give me a summary of those changes?  

Answer: As you have noticed, there have been significant updates to the Hormone Specific Formulations™ in the last few months. I wanted to give you a brief overview of those changes, and encourage you to use these upgraded formulations with the new dosage guidelines. We are seeing faster, more phenomenal and more lasting results. 

The news dosage guideline is called Protocol 242™. This protocol uses 2 capsules per day during the Initiation Phase, 4 per day during the Restoration Phase, and 2 per day during the Maintenance Phase.

AdrenoMend™ and the other Hormone Specific Formulations™ have all been updated to use a 2-4-2 dosage protocol.. ThyroMend™, TestoGain™, EstroMend™, ProgestoMend™ have all been increased to 120 capsules per bottle. TestoQuench™ has been completely revised into two separate formulations that are each 120 capsules and use Protocol 242™. They each provide more gender specific control of the effects of excessive testosterone: TestoQuench™ for Women is more feminizing, while TestoQuench™ for Men provides more prostate protection. All formulations are now 100% vegetarian, including the capsules. 

ThyroMend 

ThyroMend™ now has 120 capsules per bottle, instead of 90 capsules. The amount of herbs in each capsule has increased from 567 mg to 650 mg. There is now more Ascophyllum nodosum (Norwegian Kelp) to provide increased amounts of bioavialable iodine and additional protection of thyroid cells from damage due to increased oxidative stress that can occur with increased thyroid activity.

The iodine content is increased so ThyroMend™ can be effectively used in each phase of Protocol 242™. ThyroMend™ provides 133% of Daily Value for iodine in the Initiation and Maintenance dosages. The 400 mcg of iodine in the restoration phase is safely below 1,100 mcg, the dosage that has caused thyroid cell inflammation and damage in human studies.  

TestoGain

TestoGain™ now has 120 capsules per bottle, instead of 90 capsules. Eurycoma longifolia (Tongkat Ali) was added to increase testosterone production and decrease the anti-testosterone effects of estrogen. Panax ginseng was also added to increase testosterone production. Ptychopetalum olacoides (Muira Puama) was added due to its ability to mimic testosterone and improve sexual function in both men and women, as well as decrease the anti-testosterone effects of cortisol.

Specific herbs have been highly concentrated in TestoGain™ to increase testosterone production and function and testosterone function in both men and women. For example, Eurycoma longifolia (Tongkat Ali) is a 100:1 concentration. 

This formulation is much more potent. It should be used with Protocol 242™. TestoGain™ is best taken in the AM with food, or the dosage can split between AM and a noon dosage with food.  

EstroMend™ 

EstroMend™ now has 120 capsules per bottle, instead of 90 capsules. The amount of herbs in each capsule has increased from 540 mg to 745 mg. Centella asicatica (Gotu kola) was added for a number of reasons: To enhance memory function; to provide more anti-cancer properties, provide more antioxidant properties, and due to its microvascular protection (women have a higher risk of coronary microvascular disease).

EstroMend™ also has more Pueraria montana, Pueraria lobata & Trifolium pretense, providing a soy-free source of the isoflavones genistein and daidzein. There is also increased Humulus lupulus, to increase its therapeutic actions. 

To accomplish these significant changes we removed the cranberry fruit extract to provide more room in the capsules. We also removed the soy to provide more room, and to make the formulation soy-free for people who want to avoid soy. 

This is a more potent formulation, and works best with Protocol 242™. Taking EstroMend™ at night, with evening meal or a snack before bedtime, decreases night sweats and provides for a more restful, restorative sleep. 

ProgestoMend

ProgestoMend™ now has 120 capsules per bottle, instead of 90 capsules. The amount of herbs in each capsule has increased from 700 mg to 720 mg. Ligusticum wallichii has been added due to its significant progestogenic activity (it is a potent and specific activator of the progesterone receptor). Researchers concluded that the phytoprogesterone properties may have “utility for treatment of conditions requiring progesterone action”. Viburnum opulus contains a number of constituents that mimic the antispasmodic, anti-inflammatory, and anxiolytic properties of progesterone.

This is a more potent formulation, and works best with Protocol 242™. Taking ProgestoMend™ at night, with evening meal or a snack before bedtime provides for a more restful, restorative sleep. Or, take in the daytime to decrease daytime anxiety. 

TestoQuench™ for Women

TestoQuench™ for Women is more feminizing and specifically reformulated for women. In addition to decreasing excessive testosterone production and excessive testosterone symptoms, TestoQuench™ for Women promotes healthy production and function of estrogens and progesterone, the endogenous hormones that naturally control the actions of testosterone in women.

Paeonia lactiflora was added to decrease testosterone production by inhibiting the conversion of delta 4-androstenedione to testosterone in the ovary, while stimulating aromatase activity in the ovary to promote estradiol synthesis. Vitex-agnus castus was added due to its anti-androgen effect which decreases both LH and testosterone levels. Vitex agnus castus has been shown to increase progesterone levels and consequently support regulation of luteal function. Significant increases in plasma progesterone and total estrogens levels were shown, as were significant reduction in luteinizing and plasma prolactin hormones.

This potent, female specific formulation works best with Protocol 242™. Taking TestoQuench™ for Women at night, with evening meal or a snack before bedtime provides for a more restful, restorative sleep. Or, take in the daytime to decrease daytime anxiety. 

TestoQuench™ for Men

TestoQuench™ for Men is more male specific with increased protective for prostate tissue and specifically reformulated for men. Piper cubeba has been added to provide additional inhibitions of 5 alpha-reductase II activity in the prostate, which is responsible for converting testosterone to its active form, dihydrotestosterone (DHT). Piper cubeba is also an androgen receptor (AR) antagonist, and down-regulated AR levels It suppressed cell growth and prostate-specific antigen (PSA) secretion stimulated by DHT. In addition to anti-androgenic properties, Piper cubeba also demonstrates anti-estrogenic and anti-inflammatory properties. These results support the use of Piper cubeba in phytotherapy against benign prostatic hyperplasia (BPH). Magnolia officinalis was added to provide additional protection of the prostate due to its ability to inhibit prostate tissue growth, and exhibit apoptotic (programmed cell death) and antiangiogenic effects. 

TestoQuench™ for Men no longer has Foeniculum vulgare (fennel) or Trigonella foenum-graecum (Fenugreek), which are more specific for controlling female problems with excessive testosterone. 

This potent, male specific formulation works well with Protocol 242™. Taking TestoQuench™ for Men at night, with evening meal or a snack before bedtime provides for a more restful, restorative sleep. Or, take in the daytime to decrease daytime anxiety. 

AdrenoMend™ 

AdrenoMend™ ingredients are unchanged but the dosage guidelines have been updated to use Protocol 242™. AdrenoMend™ is best taken in the AM with food, or the dosage can split between AM and a noon dosage with food. 

Thank you for your question.

Joseph J Collins, RN, ND

Hormone Health Protocol Questions 

 

Question: My question is about vitamin B12. You mention in your book that vitamin B12 is needed to make both adrenal and sex hormones. 

What about the cyanocobalamin form of B12? Is it safe? Does it have cyanide?

Answer: The Truth about Cyanocobalamin & “Cyano” Molecules. 

There is a lot of undue concern about the form of B12 called cyanocobalamin. And I have to admit that I was thrown off for a moment. I had been concerned. However, thinking back to naturopathic medical school, I really appreciate the hours I spent studying organic chemistry. 

Before I go any further, keep in mind that organic chemistry is the science that defines the structure of every organic molecule in our bodies. This naming of organic molecules follows international rules, so no matter where you go in the world; you are talking about the same molecule.

Now, we have to keep in mind that organic chemistry uses the "functional group approach" in order to name organic molecules. These functional groups have names like “ketone” or “alcohol” as well as “cyano”.  

“Cyano” is a term use in organic chemistry for the functional group that consists of a carbon atom joined to a nitrogen atom by a triple bond. The term “cyano” is used interchangeably with the term “nitrile”.

Chemically, the structure may be written as: R-CΞN , with a triple bond between the C and the N, or it may simply be written as shown as: R-CN.

“Cyano” containing compounds occur in nature in various foods such as cabbage, cauliflower, broccollli, brussel sprouts, and bok choy as well as number of highly regarded medicinal herbs throughout the world including Passiflora edulis, Rorippa sylvestris, Dipthychocarpus strictus, Tabernaemontana elegans, Lophira alata, Lophira alata (jojoba) , Purshia tridentata, Hernandia nymphaefolia, Mallotus repandus, Trewia nudiflora, and others, as well as a number of medicinal sea sponges.[1] Cyano containing compounds are also found in the seeds of certain seeds and stone fruits such as apple, mango, peach, and bitter almonds.

So, while cyanocobalamin contains a functional group called “cyano” (or “nitrile”), we can see that these types of compounds exist in a number of foods and medicinal herbs. We should not be concerned about the “cyano” component any more than we should be concerned about the cobalt is in the hydroxycobalamin, methylcobalamin and cyanocobalamin.

[1] Nitrile-containing natural products