To B12 or not to B12?


B12 is a hot topic in nutrition, especially amongst vegetarians and vegans. As Live Blood Analysts we spend a lot of time looking at red blood cells through the microscope and one of the most common abnormalities that we see are related to issues with B12.  

Live blood analysts are able to view a drop of blood in its ‘live’ state, meaning it is unstained, has had no chemicals added to it and is fresh, not clotted. Live blood analysis (LBA) is used to assess the state of health of red blood cells, white blood cells, platelets and the contents of the plasma. B12 is vital for normal red blood cell production and a lack of it is obvious when looking at a blood sample. B12 deficiency, if present, will be apparent in the size and shape of the red blood cells and in extreme deficiency we will see certain abnormalities in some of the white blood cells too. The picture below is of a blood sample, magnified 1000x through a darkfield microscope; the cell that has been highlighted is a ‘macrocyte’. A macrocyte is an abnormally large red blood cell and it is released into the blood stream when there is a lack of B12 (and folate, but more about that later). If there are a large proportion of these throughout the blood sample, it is a sign that there may be a B12 deficiency.

Macrocyte red blood cell

Macrocyte red blood cell

Other cells that indicate issues with B12 are ovalocytes, microcytes and hypersegmented neutrophils.

ovalocyte red blood cell
microcyte red blood cell
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LBA is not a diagnostic test but it is a tool that gives a holistic health practitioner an insight into the cellular life of a client through viewing their blood. As B12 is vital for the red blood cells especially, this makes live blood analysis a very useful tool for screening for B12 deficiencies. A skilled practitioner will be able to analyse the blood sample, cross reference it with the client’s case history and not only assess the extent of a B12 issue but also what may be the root cause:

  • Correlations with diet – is there enough B12 available in the food the client eats?

  • Correlations with digestive capacity – is the client suffering from digestive issues that can interfere with digestion and absorption of nutrients?

  • Correlations with other issues found in the blood – is the blood showing a lack of iron? / is the plasma crowded with fibrin, indicating liver issues? / are there signs of leaky gut, indicating dysbiosis? / are the white blood cells out of range, indicating autoimmune issues? / is there a high level of oxidative stress or inflammation?

Even consuming B12 in one’s diet or taking B12 supplements does not always ensure sufficient levels of available B12 for our body to use. How can this be? The answer lies in the complexities of the vitamin B12 itself and the complexities of the human organism.

What is B12 and why is it important?

B12 chemical formula

Vitamin B12 is the largest, most complicated of all the vitamins and it is also one of the most important nutrients for our health. In our body B12 is used as a co-enzyme that is involved in three vital processes that happen within every single cell of our body. It plays a vital role in the synthesis of DNA, the development of red blood cells and the creation of the myelin sheath that coats the nerve cells that allow the conduction of nervous signals. This is why the effects of a B12 deficiency can cause many profound and varied health issues.

A mild deficiency of B12 may not cause any symptoms as the body keeps a store of it in the liver, but if the root-cause of a deficiency is not corrected it can lead to quite severe and far ranging health issues:

Signs of B12 Deficiency  

Poor growth/failure to thrive in infants                                                 
Inflamed tongue
Premature grey hair                                                                                
Disturbed carbohydrate metabolism
Fatigue or Weakness                                                                                                 
Weight loss                                                                                              
Vision problems
Loss of hearing and tinnitus                                                                    
Numbness and tingling in the hands and feet
Hyperpigmentation and hypopigmentation (dark and light patches in the skin)
Neuralgia, neuritis and bursitis                                                                  
Anaemia, including pernicious anaemia                                                
Spinal cord degeneration
Psoriasis and other skin problems                                                           
Brain degeneration
Irrational or chronic anger                       
Violent behaviour                                                                                    
Lack of balance/abnormal gait                                   
Many emotional disorders

The possible dangers of supplementing folate when B12 deficient

Folate is the name given to the naturally occurring vitamin B9, also known as folic acid when it is in its synthesised form. Both B12 and B9 are coenzymes involved in methylation reactions that allow for DNA synthesis. In a state of B12 deficiency folate (B9) becomes trapped as methylfolate and cannot be further involved in essential reactions for DNA replication. In this situation, if folic acid is given either as supplement or as a fortified food (such as cereals and bread products) the trapped folate is by-passed which temporarily masks the underlying B12 deficiency. The danger in this is that the damage from B12 deficiency continues and eventually symptoms of cognitive decline and anaemia occur. Therefore it is possible that, for those of us that are B12 deficient, it is dangerous to supplement with folic acid and it would be wise to be mindful of how many folic acid fortified foods are consumed.

This makes it crucial for us to determine if we are or at risk of being B12 deficient.

Protective effects against homocysteine

Homocysteine is produced in the body from the metabolism of an amino acid methionine which is ingested as a component of food protein. Homocysteine needs to be converted to S-adenosylmethionine (SAM) so that our body can create glutathione; the body’s most powerful anti-oxidant protecting our cells from free radical damage. If we are deficient in B12 and folate this conversion cannot take place, leaving high levels of homocysteine circulating in our bodies. This can lead to cardiovascular disease and cognitive decline.

Making sure we have good levels of available B12 can protect us from the damage homocysteine can do.

Causes of B12 deficiency

There are a many different possible causes for a lack of ‘usable’ B12 in our systems:

  • Any kind of dysfunction, irritation, inflammation or disease of the digestive tract that diminishes levels of stomach acid or ‘intrinsic factor’ (see later), and limits the transport of B12 out of the digestive tract and into the blood e.g:

Crohn’s disease
Chronic enteritis
Chronic diarrhoea
Pancreatic disease

  • Consumption of alcohol, recreational drugs, toxins, chemical pollutants, or heavy metals can use up stores of B12 and affect production of intrinsic factor and absorption in intestines.

  • Intestinal worms and parasites consume large amounts of B12

  • Aging – our ability to produce stomach acid and intrinsic factor diminishes as we age. Many symptoms of old age are due to a lack of B12.

  • Prescription drugs such as contraception, hormones, diabetes medication, proton pump inhibitors, blood pressure medications, beta blockers, statins and many more block the absorption of B12.

  • Any form of liver congestion, disease or stress limits B12 storage and metabolism.

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The difficulties of effectively testing B12 levels

Serum B12 tests can be inaccurate, leading to false positives and false negatives in mild to severe B12 deficiency:

Testing for B12 deficiency is tricky. The main method for testing is a serum blood test. This assesses levels of B12 in a sample of blood and is the standard test for general medical practice. However it is an unreliable indicator of B12 availability because B12 has a usable and unusable form which a serum test cannot differentiate between. Serum tests results can show a high level of B12, but not whether cells can actually access it.

Testing for the active form of B12 could prove more useful:

The majority of plasma B12 (70 - 90%) is in the form of haptocorrin (HC) and the rest is in the form of transcobalamin (TC), which is the only form that can enter cells. A test for transcobalamin would be more useful in diagnosing B12 deficiency.

Can a urine test offer any help?:

Methylmalonic acid (MMA) is a by-product of amino acid metabolism and is produced when protein is digested. In cases of B12 deficiency, our bodies produce more MMA and it is excreted via the kidneys. High levels of MMA in the urine can be good indication of B12 deficiency.

  Can Live Blood Analysis assess B12 deficiency?:

By directly observing a blood sample magnified 1000x you can assess it for specific cell pathologies that indicate a lack of B12 - specifically macrocytes, microcytes, ovalocytes and hypersegmented white blood cells. If a large percentage of the sample contains these types of cells it is a sure sign of B12 absorption issues. The benefit of this blood analysis is that it can also offer indications as to the root cause of a B12 deficiency.

Can we get enough B12 from our diet?

B12, also known as cobalamin, is produced in animals by their intestinal bacteria. The B12 is then stored in their liver, muscles, eggs and milk. Our digestive tract is designed to absorb this B12 by consuming these animal products. B12 is also produced by anaerobic bacteria present in soils and so can be found on the unwashed skin of plants that are grown in naturally maintained, healthy soils.

B12 rich foods such as meat, cheese, eggs, and nuts

B12 rich foods such as meat, cheese, eggs, and nuts

Our diet can contain plenty of foods rich in B12 but if our digestive tract is not functioning optimally we may not be able to absorb that B12. We have a very complex digestive chain of reactions that are designed to absorb this vital nutrient, but this chain can be disrupted at many points:

B12 Pathway.jpg

How ‘B12 Analogues’ can block the absorption of real B12

There are different forms that B12 can take but there are only two that can actually be used directly by the body; methylcobalamin and adenosylcobalamin.  There are also two other forms, cyanocobalamin and hyroxocobalamin, that can be converted by our body into the useable forms. Then there are the analogues of B12 that have a similar structure but do not perform any of B12’s biochemical functions in our body. These analogues block the true B12 from being absorbed and so the more of these we consume, the harder it is for us to get enough true B12.

Fresh algae produce true B12 but after drying it only contains the analogue B12. Additionally, the level of B12 available in plant sources can vary as levels depend more on the microorganisms in the environment than the plant. This is one reason why some research on Chlorella shows high levels of true B12 and in other studies it shows there is none. Most plant sources of B12 contain higher levels of analogue B12 than true B12, making them poor sources of B12.

Supplementing B12 effectively

b12 tincture supplement

Supplementation is often necessary but it can be very confusing as there are so many different types of B12 supplement available:

  • Choose a form of B12 that is most usable by the body – methylcobalamin or adenosylcobalamin. Avoid the cyanocobalamin form as it contains cyanide which, although is in very small amounts, still needs to be processed by the body.

  • With all forms of supplemental B12 check the ingredients for sweeteners, fillers and other additives. It is always best to choose one that is pure or has as few ingredients as possible.

  • B12 supplements come in four types - sublingual, transdermal, intramuscular and capsules/tablets:

Sublingual B12 can be in liquid or tablet formulation. It is deposited under the tongue and absorbed through the mucous membrane of the mouth. Although only 1 to 2% is absorbed this way, if any of the dosage is swallowed it can be absorbed through the digestive tract. Sublingual B12 is useful if the digestive tract is not in optimum health or if there is difficulty in swallowing.

Transdermal B12 is a liquid B12 that is mixed with a carrier molecule that allows the B12 to pass through the skin. This is another useful method of delivery of B12 as it bypasses the digestion. About 6% of the B12 is absorbed this way, but it is important to make sure the skin is free from chemicals as these will get absorbed as well.

Intramuscular B12 is an injection of a B12 liquid into the muscles where is it absorbed into the tissues. The advantages of this form of B12 are that it gets into the blood stream quickly and is therefore useful for those with severe deficiencies. It is also pure, containing very little other than B12 and 70% of it is absorbed, higher than any other form. Only a few injections are required to raise levels and stores of B12, and then a maintenance dose is required every 3 to 6 months, depending on the reasons for deficiency. Note that there are risks of bruising or blisters at the injection site, and also possible infections.

Tablets or capsules of B12 that are swallowed are possibly the least likely to be absorbed as nearly all issues with B12 deficiency are related to digestive issues.



Vitamin B12 is essential to our health, yet in order for us to be able to absorb it we need to have a healthy functioning digestive system and the correct type of B12 in our diets. Live Blood Analysis can screen the blood for signs of B12 deficiency and it can also assess other issues that may be contributing to our inability to assimilate B12, such as digestion, absorption and detoxification. Uncovering the root cause of any B12 deficiency issue is the key to knowing what to do so the body can correct itself. The blood can then be reassessed by live blood analysis after a period of three months, by which time the blood cells will have been replaced. If changes to diet and a supplement plan have been implemented then there will be a clear difference in the condition of the blood cells – there will be less macrocytes, microcytes, ovalocytes or hypersegmented neutrophils and more normal healthy red and white blood cells.

Is it really time for a detox?

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Are detoxes or cleanses necessary and beneficial? Do they suit everyone? 

Detox is a bit of a buzz word in the wellness industry. The word carries with it the promise to cleanse you from the inside-out, leave you renewed, refreshed, feeling younger, happier, more energetic and a few stone lighter. Who wouldn't want that? But, what does it actually mean and will it deliver what it promises?

Living life in this modern world where we are surrounded by pollution in the water we drink, the air we breathe, the food we eat, the clothes we wear and the chemicals we put on our skin; it's hard to escape toxins. Our bodies, when functioning well, can process these toxins and either eliminate them or lock them away somewhere in the body fat so they don't cause us problems. Undoubtedly we all have toxins, but it's whether they are overwhelming our body's own capacity to process them that is the issue. Toxins can disrupt enzyme reactions, block absorption of nutrients, weaken nerves, and distort many body processes. They can even accumulate in the brain and other organs or tissues where they can cause inflammation and worse. 

However - if you have an unhealthy level of toxicity and this is reflected in the symptoms you are experiencing, then it is vital that you proceed with caution. 


  1. If your body is being overwhelmed by toxins then it is certainly not ready for a detox, as it shows that your routes of elimination are blocked. What your body needs is help with preparing and toning up the routes of elimination, and improving the digestive process so that you can absorb nutrients and stop consuming toxins through your diet and lifestyle.
  2. A body detox takes energy, nutrients and enzymes in abundance and so if the body is already deficient in any of these, the detox may actually do more harm than good. A detox typically involves limiting food types and therefore limiting certain nutrients. Once toxins are pushed out of the tissues and into the blood there's a chance that they will flow around the body and get deposited elsewhere rather than be eliminated.
  3. If toxicity is suspected, it's important that you make sure you know what toxins you are dealing with so you can eliminate them safely. For example, heavy metals like mercury can be very destructive to health.
  4. A detox takes time, energy, money and support. It's important you ask yourself "do I have these resources in order to do a successful detox?". It is impossible to tell how you will feel and how your body will react, but if you have been assessed properly by a nutritionist you will not be putting your body through anything it cannot cope with.
  5. Detox reactions can happen, but ideally they shouldn't. If you do have a detox reaction like flare up of old symptoms, headaches, inflammation etc then your body is not coping with the release of toxins and you should slow down the detox. 

Often I hear of the suffering people go through when they undertake a juice cleanse without professional guidance, and find they have constipation or diarrhea, their energy levels soar and then crash, they feel starving all the time, their sleep suffers, or they get moody and irritable, and often experience headaches. When they eventually resume normal life, their bodies get stressed all over again as they suddenly have to cope with solid food, caffeine, alcohol and stress!

My definition of a detox varies from client to client because I create a unique detox plan that will suit them and their body's needs. I always use live and dry blood analysis as a guide as to whether they need a detox, and what level of detox they can comfortably and successfully complete. Most clients need to prepare the body for several months so that they can really shift the toxins efficiently and painlessly. 

Why use Blood as a guide?

Live and Dry Blood analysis is a useful tool for any nutritionist, naturopath or biological medicine practitioner wanting to get a different perspective of a client's health by viewing a drop of their blood.

The blood flows throughout the body connecting all the cells, organs and tissues. It allows the body's different systems to communicate with each other with in-house hormonal and protein signals and messages, in order to maintain optimum health. The blood is actually a biological fluid that contains plasma as well as red and white blood cells. When viewing a drop of live blood (cells are still 'alive' rather than stained and separated) through a darkfield microscope, you can examine the function and viability of the cells and assess the contents of the plasma, the vital nutrient rich medium that feeds the body and removes waste. Add to this analysis the interpretation of the patterns within a drop of dried blood which are created from its elements and residues, and you can build a unique picture of the biological health of a client. 

It becomes very clear from looking at the blood in this way as to what sort of detox they will need. Heavy metals show up in the dry blood as a very definite indication if present and will need very careful handing in order to remove them safely from the body. If a client's blood indicates a lack of antioxidants, this will be obvious by the viability of the white blood cells as well as the sialic acid residues in the dry blood and will need correcting first.  Their dry blood picture may even indicate severe toxic bowel which would mean the routes of elimination need to be opened and supported first. 

For information on using Live Blood Analysis with your clients please CLICK HERE

Detox Case History

Below is an example of a case history showing blood analysis pictures before, during and after a detox program, tracking the progress and changes that the body goes through, as seen through the blood of a client.

A brief history

This client wanted to do a detox as she felt a bit sluggish. Her diet is a mostly gluten free and dairy free, predominantly organic, meat or fish once a day and loaded with vegetables. She drinks a litre and a half of water, a fresh green juice and one coffee a day. She regularly performs naturopathic techniques such as skin brushing, epsom salt baths and enemas and she exercises regularly. She experiences a cold or cough twice a year on average. She recovered from ME 20 years ago and is prone to migraines, brain fog, candida and chronic fatigue if she doesn't keep on top of her diet and lifestyle regime. She has been under some considerable stress for a few years now and wanted to do a cleanse to help release a sense of being overwhelmed, stuck and carrying some weight that was very stubborn despite her diet and activity levels. 


Before any detox or dietary advice is given I always take a full case history to flag up any areas of weakness and strengths within the clients health and body systems. That allows me to get a sense of how their body is coping with things like digestion and elimination, how robust their immune system is, and how much energy they have. Importantly it also allows me to identify how much time, support and resources they have available in order to make the changes that may be necessary to their daily habits. Any changes will need to be continued for at least a month (usually longer) in order to get the results they are wanting.

I then look at their blood under the microscope to see the effects of their current lifestyle and I look for issues such as possible nutrient deficiencies, signs of toxicity, how stress is affecting them, inflammation and allergy response and to see how deep their symptoms go - are they superficial and transitory (acute) or are they longstanding and underlying all other health issues (chronic).

Pre-detox live blood pictures:

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pre detox oxidised membranes annotated sml.jpg

The pre-detox live blood pictures (all pre-detox aged) show corrugated red blood cell membranes with what looks like strings coming off from the membranes. It also shows smaller circles, vesicles, and other shapes with fainter outlines. These are congestive bacterial forms showing a trend towards pathogenic bacterial development - if allowed to continue then it could pave the way for more of the ME symptoms of candida and chronic fatigue. 

Pre-detox dry blood picture:

pre detox dry 7 stress and inflam annotated small.jpg

The dry blood picture shows that there are signs of parasites in her system and there are also signs of stress (the round white pin prick holes in the centre of the picture). The larger white shapes in the centre indicate an inflammatory process is occurring. There is also a darker patch of blood right in the centre too. This shows that there is an element of bowel toxicity. 

Considering that this client's diet was generally very good and there didn't seem to be any glaring nutrient deficiencies I felt that she could undertake a colon cleanse. The symptoms of fatigue, stubborn fat, sluggishness and the sense that her old symptoms of chronic fatigue, migraine and brain fog were just lurking ready to pounce if she relaxed her diet, made me confident that not only could her body cope with a cleanse but that she would be able to shift some stagnation and create movement and healing at a deeper level. 

The Detox

The detox that I recommended was a Colon Cleansing Kit by Blessed Herbs (click here for a 10% discount on all Blessed Herbs products). It contains a comprehensive booklet with full instructions, questions and answers, and guides for diet and for naturopathic techniques in terms of assisting the detox process. The kit contains a glass shaker jar in which one mixes up the sachets of "toxin remover" which is a mixture of apple pectin and psyllium husk. This is mixed with fresh pressed organic apple juice (that you make yourself). Digestive enzymes are taken to help break down and soften any tough residues in the digestive tract and to ensure movement of contents of the colon. Whilst on this cleanse you consume food in the form of liquid rather than solid - fresh juices, vegetable broths, coconut water, herbal teas and plenty of water alongside the regular shaker jars of the toxin remover ensure that you do not get hungry. This program can vary in length depending on your choice of detox intensity. In this client's case it was completed in seven days. 

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The colon is the place where we absorb water and eliminate waste. It is also a place where bacteria colonise and proliferate in huge numbers. If the colon doesn't work properly, or efficiently - which can happen for many reasons such diet, stress etc - then we accumulate waste and unfriendly bacteria and parasites. Making this part of your body work better will make a huge difference to your health.

Blood re-test after colon cleanse

After my client had completed the cleanse, I wanted to check her blood to see if there were any changes. There was a huge difference in the red blood cell membranes and a reduction of the congestive bacterial activity on the membranes and in the plasma too. I also noticed that the white blood cells, the body's immune cells, were very active and I witnessed them moving around the blood chasing and engulfing bacteria. All of these changes were positive. 

Mid-detox live blood pictures:

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mid detox wbc active annotated small.jpg

I then looked at the dry blood and could see that there was increased evidence of parasites. This did not surprise me because the colon cleanse would have cleared away a lot of matter that provides a home and food for them. The colon cleanse will also have an effect on the tissues too, as clearing the routes of elimination allows the body to push out more toxicity from other tissues. Parasites can live anywhere in the body, depending on which type they are, but they are rarely in the blood itself. What we see in the dry blood are the by-products of their life cycle, their waste and their debris from dying.

Mid-detox dry blood picture:

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This showed that the colon cleanse was working, however it created a release of toxicity that the body still needed to be supported in continuing to eliminate. Otherwise the danger was that this newly released toxicity would settle in the body rather than be ushered out of it. I advised that she continue the cleanse but added in herbs for treating parasites. 

Post colon cleanse and continued parasite cleanse

After two weeks of conducting a colon cleanse and parasite cleanse, my client reported a sense of clarity in her mind, she had more concentration and felt very motivated. Physically she felt that she had so much more energy and that she had lost weight. 

The blood pictures reflected this. The live blood picture shows really active white blood cells; a sign of a healthy immune system and a reflection on health and vitality in general. The aged blood picture is vastly different to the pre-detox picture - this shows how the cleanse changed the internal environment. The fluid around all the cells has been changed and no longer supports "bad" bacteria. The red blood cell membranes look stronger and the plasma is clear of debris. The dry blood pictures throughout the detox process tell a story of the toxicity being processed by the body. The final picture shows less stress, no inflammation or parasites but it does show heavier bowel toxicity which makes sense, as in order to cleanse and release toxicity it has to exit the body and the bowels are the primary channel!

Post-cleanse live & dry blood pictures:

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post detox aged pleomorph released from membranes but plasma clear small.jpg
post detox dry 7 toxic bowel annotated small.jpg

I advised my client to keep focused on the fact that her body was still cleansing and so it was important to keep hydrated, keep up the "clean" diet and the naturopathic techniques that supported the release of toxicity. 

This case history illustrates the importance of understanding the demand that is placed on your body when you ask it to cleanse or detox. The body needs antioxidants, fibre, hydration, rest and time. A five day, seven day, ten day detox doesn't really exist. Once the body is encouraged and supported in releasing toxicity it creates momentum and you want the body to continue until it is completed or else you could be left with more health issues. Using blood analysis is an ideal way to help clients prepare for a cleanse and track the progress to make sure it is followed through. 

For information on using Live Blood Analysis with your clients please CLICK HERE 

Shirah Mustardé is Director of the Naturecure Academy and a qualified Naturopathic Nutritionist & Live Blood Analyst

Merry Christmas & Happy New Year!

We would like to wish a very warm season's greetings to everybody in our LBA community :)

It has been a great year, and a big thanks go out to everyone who has taken part in a training course or one-to-one session over the last 12 months. We are very proud to be part of the growth of Live & Dry Blood Analysis both in the UK and around the world, and we really hope that LBA is a rewarding and lucrative part of your healthcare business. 


2017 has been a transitional year for us - the Live Blood Analysis Training course is now run under the banner of the Naturecure Academy, and there are many exciting things happening behind the scenes in preparation for our big step up next year - the launch of our online LBA training course. The course will be a modular self-study course based on video tutorials, written content and real-life case studies, and will be perfect for students from anywhere in the world who can't make it to one of our classroom-based courses in London. Students will be able to study at their own pace whilst being fully supported by Naturecure Academy tutors. We will also be offering special deals for students to get hold of a darkfield microscope at an amazing price, and they will learn everything necessary ( both theoretical & practical ) to start practicing LBA. Watch this space!

Anyway, have a fantastic Christmas and look out for our blog posts in 2018 with all the very latest news from the Naturecure Academy!

Shirah Mustardé

Welcome to our new website & blog!

We'd like to wish a warm welcome to all new visitors to our Live Blood Analysis Training website & featured blog. The Naturecure Academy is delighted to be offering an updated version of the highly respected Live & Dry Blood Analysis course run by Brina Eidelson of Inhealth for almost 10 years. Completely rewritten for 2018 and filled with the latest scientific research, the new LBA training course will enable you to add Live Blood Analysis to your range of client services. This fast-growing discipline gives you a fascinating window into the health of your clients, and we are confident will be an enormously rewarding new direction for your career.

To support the various courses on offer, and to help spread the word about Live Blood Analysis, we will be posting all sorts of interesting content both here in our new blog and on our Facebook Page. To keep up to date with all this & more please join our mailing list and become part of the Naturecure Academy community of health practitioners.