The thyroid gland is a 2-inch butterfly shaped organ located at the front of the neck. This is often times the gland a physician is checking during an exam when they are touching your neck. It is small in size compared to other organs, however it is a major command center in terms of hormone health and metabolic health. It affects nearly every organ in the body. It helps to regular fat and carbohydrate metabolism, breathing, body temperature, brain development, blood calcium levels, menstrual cycles, skin, integrity, cholesterol levels, and MORE.
The thyroid gland is often one of the big players wreaking havoc in my patients’ bodies as an underactive thyroid has a profound impact on the ability to lose weight. It is an important organ to pay attention to as those with underactive thyroids are at an increased risk of heart disease and diabetes. 27 million americans have one form or another of thyroid disease. The most common condition being hypothyroidism, or an underactive thyroid. In the US this is most commonly caused by an autoimmune response known as Hashimoto’s disease. Essentially, your body creates antibodies that target the thyroid and decrease thyroid function significantly. Other conditions include hyperthyroidism (overactive), goiters (not enough iodine intake), or thyroid cancers. Since hypothyroidism is the most common we will focus on lifestyle and nutrition factors that can help an individual with hypothyroidism.
How do I know if I have an underactive thyroid?
This requires blood testing and is a diagnosis your physician will provide for you. Often physicians will check TSH (thyroid stimulating horomone), T3 and T4 levels. I always recommend a patient ask their physician to also check for the thyroid antibodies such as TPO antibody, Anti thyroid globulin antibodies and thyroid stimulating immunoglobulin. Often times if the thyroid is underperforming, there is a link to adrenal function so checking DHEA-S and cortisol levels is helpful. If your physician is ordering labs, ask them to include these adrenal markers as well.
What symptoms accompany an underactive thyroid?
Potential causes of hypothyroidism
Inflammation that goes haywire causing an immune response that leads to an attack on your bodies own organ.
Leaky gut syndrome
Pregnancy (causes postpartum thyroiditis)
Certain medication interactions
High levels of stress (persistent)
Toxic burden (heavy metals)
What medications will a physician prescribe?
Typically the first line of treatment is with a synthetic drug called synthroid. This supplies only T4. Many, many people are on this drug and see some benefits in symptoms and ability to lose weight, increased energy levels, etc. There are more “natural” forms of medication, the most popular is called Armour, it is sourced from porcine (pig) thyroid glands. It contains both T4 and T3 in a ratio more similar to what a human produces. It is worth asking your physician why they prescribe one over the other. Most will not even consider Armour.
Lifestyle and diet are two of the biggest factors that contribute to healing your thyroid, and if healing it is no longer available, we can support it allowing the most optimal functioning.
Let’s consider lifestyle factors first.
SLEEP MORE, aim for at least 8 hours of sleep at night. I know this sounds like a lot, but your body needs it when your thyroid is underperforming. It will allow for optimal healing.
AVOID STIMULANTS, caffeine in any form is best to be avoided. If you can’t avoid it, I recommend choosing a green tea, so that you get the antioxidant benefits.
MOVE YOUR BODY, but not too much. Choose gentle exercise activities until your medication and stress levels are lowered. Try longer low impact walks or an activity like yoga.
Be patient with yourself and inform your family members what you are dealing with so they can be patient and understanding with you too.
Food and Nutrition
You can do a lot in terms of supporting your thyroid with the right food. Let’s get down to it.
AVOID EXCESS SUGAR. I am serious. Your body doesn’t need it, and your immune system most importantly, doesn’t need it. Cut out cakes, cookies, candy, soda, sugary coffee beverages, etc. A little maple syrup in the oatmeal is fine, but really, take this seriously. It’s the most important food choice to help you recover.
COOK CRUCIFEROUS VEGETABLES (goitrogenic foods). Your body needs iodine for optimal thyroid function, however these vegetables in the raw form have an incredible ability to block iodine from being absorbed. To combat that, cook these vegetables. Broccoli, Kale, Cauliflower, Brusell sprouts, Bok Choy, Kohlrabi, Mustard and Mustard greens, Cabbage. If you are one to add greens to your smoothie, choose something other than Kale, like spinach or arugula.
ADD SEA VEGETABLES OR NATURAL SEA SALT. This will help increase your mineral and iodine intake.
CHOOSE ORGANIC PRODUCE WHEN POSSIBLE. These have higher levels of trace minerals and significantly lower levels of pesticides, which are known endocrine disruptors.
INCORPORATE FOODS RICH IN TRACE MINERALS AND VITAMINS YOUR THRYOID NEEDS TO CREATE THRYOID HORMONE AND CONVERT FROM T4 to T3.
ZINC: red meat, poultry, beans, nuts, seafood
VIT E: liver, eggs, nuts, seeds, sweet potatoes and avocados
B2, B3, B6: meat, seafood, green vegetables, mushrooms, eggs, almonds
Selenium: brazil nuts
Vit C: veggies and citrus
STICK TO WHOLE FOODS. Avoid processed foods as much as possible. Choose fruits and vegetables as snacks throughout the day with a handful of nuts.
What about supplementation?
There are some antioxidants that research has shown improve thyroid function, they include vit C, vit E, turmeric(curcumin) and glutathione. There is a place for supplementation with thyroid issues. However, it’s important to seek the help of a qualified professional. For instance, if you have Hashimoto’s you do not want to supplement with iodine, it can increase the rate of thyroid destruction. This is not the condition to play around with, I would not consult the vitamin clerk at your local healthfood store, speak with a physician or dietitian to get evidence based, proven solutions.
If you suspect Hashimoto’s you most likely have leaky gut and would benefit from food sensitivity testing and an immunocalm diet. You would also consider as a first line of defense, decreasing gluten in your diet as it has been shown to affect hashimoto’s thyroiditis.
Yesterday I wrote about SIBO, small intestinal bacterial overgrowth. This occurs oftentimes alongside bacterial dysbiosis. Dysbiosis is an alteration of the body’s microbial community making a shift in the population when primarily good bacteria decreases and bad (or pathogenic) bacteria flourish. In simple terms you have less good and more bad. The balance is thrown off.
How can dysbiosis occur? Overuse of antibiotics, poor diets, excessive alcohol intake, overuse of NSAIDs(aspirin, Ibuprofen), and other lifestyle factors.
Many are more used to calling these instances of dysbiosis by the location of the bacterial community shift or the type of change that is taking place. For instance, we call a dysbiosis in the vaginal cavity a vaginal yeast infection. Or a local overgrowth of yeast in the mouth is called thrush. Other examples are SIBO (dysbiosis in the small intestine), vaginosis, and candida overgrowth.
If you have IBS, chronic bloating, distention and indigestion, celiac, crohn’s, colitis, GERD, obesity, food allergies or heart disease, you may have some intestinal dysbiosis.
In order to assist in bringing a better balance to your intestines, eating a specific diet and reintroducing the best bacterial communities can improve the above symptoms/conditions. It is also important to take specific protocols for gut healing to avoid dysbiosis in the future. Taking glutamine for gut healing and nourishing yourself with bone broth, and decreasing sugar intake, especially in the form of soda and other liquid sugar can all help with keeping a balanced bacterial community.
Are you constantly tired but your doctor tells you nothing is wrong? You may suffer from adrenal fatigue. Adrenal fatigue is something more widely acknowledged in functional medicine than in conventional western medicine. The western world will only embrace adrenal function when the adrenals don’t work anymore at all.
If you are constantly tired your adrenals may have been working overtime and now are very depleted. This deserves attention and treatment to avoid complete adrenal burnout. Preventative support is better than total system failure.
The Adrenals or an organ that sit on top of the kidneys and secrete cortisol, DHEA, and adrenaline in response to signals from the pituitary gland(which is in the brain). These secretions: cortisol, DHEA and adrenaline help us adapt to stress both internal and external. When stress becomes chronic (meaning, it doesn’t go away) the adrenals become impaired in their ability to keep up with the stress.
This stress may be due to physical injury or infection, environmental (poor diet, toxin exposure) or even psychosocial (family issues, divorce, etc). Your adrenal glands respond to stress in the same way no matter the origin. Adrenal fatigue can be sudden, as in a terrible accident. It can also take it’s toll gradually with smaller stresses that accumulate or come so close to one another so that your body has no time to recover. I’m sure we can all imagine a time where a root canal, major job stress, family member major illness, and a month of binging on holiday candy and egg nog, all happened at the same time.
The hormones that the adrenal glands secrete are very important. Cortisol causes conversion of protein for energy, it makes the liver use protein stores to convert to sugar, it suppresses the immune system, and helps maintain blood pressure. DHEA is a precursor to testosterone and estrogen, it improves resistance to viruses, bacteria, parasites, can lower osteoporosis, lowers total and LDL cholesterol. Adrenaline is the major fight hormone. When the adrenal gland can not produce these hormones, it can have an effect on many different body systems from bone health, to hormone and endocrine health, heart health, and immune health. You can also have an impaired ability to manage blood sugars when the adrenal gland slows.
A short list of symptoms:
-Continuing fatigue not relieved by sleep
-Increased effort to do everyday tasks
-Craving for salty foods
-Increased time to recover from illness, injury or trauma
-Skipping a meal causes worse fatigue and irritability
Conditions associated with adrenal fatigue:
-Use of corticosteroids
-Chronic fatigue syndrome
Eating habits are very important in treating adrenal fatigue. Some tips:
-Eat at frequent intervals. The adrenal hormone cortisol is partially responsible for keeping our blood sugar at normal levels. You need to eat to keep your blood sugar up because your body is having more difficulty doing this function as well on it’s own.
-Avoid caffeine(or at least decrease intake of caffeine), it depletes the adrenals too, making matters worse not better - this can be a hard one when you are tired all the time, however it is an important step in the healing process.
-Eat breakfast early in the day (within an hour or two of waking)
-Snack between lunch and dinner and snack before bed(choose healthy fats and whole grains instead of sugar filled foods).
-Eat good quality whole foods.
-Decrease intake of high sugar foods.
-Stay hydrated – aim for half your body weight in ounces of water per day.
-Go ahead and eat salt. You need it.
Food sensitivities can also play a key role as the offending foods cause histamine and other inflammatory substances to be released. It takes cortisol to reduce that inflammation. That’s taxing on the already drained adrenals.
If you suspect you have adrenal fatigue you should get assessed by a functional doctor or nutritionist and get a personalized plan. Click on this website for more resources and information.
Recently I had a blog reader inquire about migraines that reoccur each month a day or two before the start of her next cycle. I used to get migraines 2-3 days before the end of each cycle too, so this question really hit home for me. These migraines are called menstrual migraines and often occur 2 days before the end of your cycle up through the first 3 days of your period. Because of the timing of these migraines, they can be difficult to treat and may not respond to the same medicines that other severe headaches and migraines respond to.
The cause of these migraines is likely one of the following reasons:
The natural drop in magnesium towards the end of your monthly cycle. If this is the cause it can respond to administration of magnesium from the midpoint of your cycle (day 15 for most women) until the second day of your next period. I recommend a form of magnesium that is chelated like: magnesium glycinate, magnesium threonate or magnesium malate. You can start at 400 mg and gradually increase to between 800 and 1000 mg/ day. This can be administered before bedtime to help with relaxing and more sound sleep (magnesium has that effect). While administering magnesium monitor for changes in your stool consistency. Your bowel movements may become more frequent and more soft with magnesium intake. This is not concerning unless you begin having more than 3 bowel movements per day.
The natural drop in estrogen that takes place at the end of the cycle. A natural remedy is to take phytoestrogens in the 7-8 days leading up to your next cycle/period. You can try to add more estrogen rich foods like soy, take a supplement or use an estrogen cream or skin patch.
You can try adding both the magnesium and the phytoestrogens in the same cycle or try one remedy and if no relief is found within 3-4 cycles, try adding in the other. It may take 3-4 cycles for the migraines to respond.
Food! Women tend to crave certain foods in the days leading up to their period. Often times these are the only times they eat these foods or eat high quantities of these foods. Migraines can be triggered in response to the introduction of offending foods or (ENOUGH) of these offending foods [that is to say, it can be dose dependent, one bite may not trigger, but 10 just might].
If you only ever drink red wine or eat chocolate the few days leading up to your period, it could actually be that instead of the hormones or magnesium, and it just happens to be that your patterns match the hormonal shift. Below is a list of foods that tend to trigger migraines. There is some other advice in there too like sleeping and exercise (Surprise).
I always recommend tracking food, lifestyle patterns and symptoms leading up to your period to see if some months you get the headache and others you don't, then compare what may have been different in your diet, etc.
Here is a list of foods that can trigger migraines:
MSG and high-glutamate foods/additives in all forms
All fermented foods including yogurt, sour cream and vinegar
All protein supplements
Peanuts and all nuts
All leftover meats that are more than 36 hours old
The above list reduces some of the bigger sources of tyramine and histamine. During those days leading up to your period, your focus should be on simple foods that have been minimally processed. Additionally, I suggest you focus on regular sleep and hydration with at least a gallon of water per day.
As with many other conditions, migraine triggers “stack.” So, you may be able to have wine and cheese on a pleasant day in the early part of your cycle, but may find that wine and cheese while the barometer is dropping and your period is imminent crosses the pain threshold.
While not homeopathic, if you are open to Over The Counter medications pain relievers like Excedrin migraine or Aleve are best taken as soon as the pain starts. Taking Benadryl seems to enhance the effect of the NSAID and often brings faster relief. MANY migrainuers have a problem with histamine so Benadryl sometimes helps with that. Sometimes the pain is just too much and taking something to get rid of the pain as fast as possible is necessary. If you have to take something don’t kick yourself, just take it and look for the relief.
Often with a few extra pounds to lose hormones are affected. Adipose(fat) tissue play a role in hormone regulation. Sometimes even a small amount of change, namely 10-15 pounds can have great affect on hormones and through the cascade of change, can affect migraine occurrences.
Be patient with yourself when these migraines happen, try laying in a cool dark room, relaxing, finding someone to rub your neck, a cool wet cloth on your forehead, and perhaps some peppermint essential oil to rub on your neck and temples. If you are having migraines throughout your cycle, it may be time to consider having your blood tested for food sensitivities. Your immune system creates chemicals that are pro-inflammatory (make more inflammation) in response to foods you are sensitive to. Eating these foods can trigger migraines, finding out which foods these may be can give you the knowledge and buy you freedom from these painful migraines.
PCOS stands for polycystic ovarian syndrome. It is a syndrome (a combination of symptoms) named for one of the main symptoms experienced by individuals affected, which is many cysts on the ovary(ies). I have a very personal experience with the condition as I was diagnosed with it about 10 years ago, and I remember the gut-wrenching moment I diagnosed by my gynecologist as she explained it is the number one reason why women have fertility issues in America. It can be a very confusing and emotional diagnosis, and it’s one that is somewhat complicated to arrive at.
How is it diagnosed?
Only women will be diagnosed with this condition. One of the following must be present for a clinical diagnosis:
Do I have PCOS?
Your physician (Primary Care or OB/GYN) will likely check your thyroid, skin, hair, breasts, and belly. They will likely check your blood pressure and order an ultrasound of your ovaries. They will also likely order some blood panels to check hormone levels, thyroid, and rule out any other conditions that could cause these same symptoms.
What causes PCOS?
This is the billion dollar question, because well, we don’t know. Most experts think that several factors play a role including genetics and diet. Women with PCOS are more likely to have a sister or mother with PCOS also. One of the main underlying problems with the condition is a hormonal imbalance. The ovaries make more testosterone than normal, high levels affect the development and release of eggs from the ovary, and also affect normal levels of estrogen and progesterone in women. There is also a metabolic issue associated with the syndrome where insulin is not as effective in the body. Insulin is a hormone that controls changes in sugar levels in the blood and if you store or burn the sugar for energy. Many people with PCOS have chronically high levels of insulin because their bodies have trouble using it, so they make more and more and more.
Why do I need to manage this syndrome if I have it?
Women with PCOS have higher risk for developing diabetes, ovarian cancer, and increased rates of infertility. It can also be an embarrassing condition with acne, being overweight or obese, abnormal hair growth, or loss of hair. It can also have psychosocial implications due to body image and confidence.
What should you do if you think you may have PCOS?
Manage controllable lifestyle factors. Even without seeing a physician there are practices you can incorporate that are important for general well-being, but in a woman with PCOS these practices are non-negotiable.
How does western medicine treat PCOS?
Most clinicians will prescribe oral birth control pills to manage the hormone irregularities associated with the condition. They will also prescribe metformin (or it’s generic Glucophage) to help manage the insulin sensitivity factors – this is a drug developed and prescribed to individuals with diabetes. Women will also be advised by fertility experts to have minor surgical procedures called laparoscopic ovarian drilling. What takes place is the ovaries are treated with heat or a laser to destroy the tissue that is producing androgens. I would like to state that oral birth control pills are not the only option for contraceptives and educating oneself on all of your options is important before starting the pill. I wish someone had told me some of the side effects of the pill and downsides to coming off of the pill before I was ever started on it long ago.
Are there more natural forms of treatment?
YES! The best thing you can do for yourself is diet, exercise, stress management and good sleep habits. Managing your weight will be a natural product of these efforts. Having a normal weight will be important for controlling insulin and hormone levels throughout your entire life.
There are also natural remedies like N-acetyl cysteine, inositol, and other hormone regulating supplements like chasteberry extract (also known as vitex). Before starting any of these herbs and supplements, I recommend speaking with a practitioner or dietitian familiar with these treatment approaches who can advise and monitor you.
In terms of fertility options, before feeling destined to taking metformin and clomid, consider other options with a natural practitioners, whether it is a few of the supplements above or acupuncture, there are other ways to improve your fertility beyond pharmaceuticals. These are not hippy, wacky, close your eyes and take it on blind faith approaches either. There are scientific studies that have been performed that provide options for treatment of infertility in this population that have yielded successful pregnancies without invasive methods.
Let me know if you have any questions or think this may be you. I can help you develop a well balanced diet and manage the symptoms of this syndrome.
Leaky gut syndrome is gaining attention in both conventional medicine and alternative treatment modalities as more and more chronic inflammatory illnesses are plaguing Americans. I know that cooky aunt of yours or the self proclaimed health nut down the street have been talking about it for years, but what does the research, the current evidence have to say about the process? First of all, what is leaky gut syndrome? Is it as gross as it sounds? Yes! Most of us can’t stand the sight or smell of our own gut contents when they move from us to the toilet, can you imagine what these contents are doing as they leak out of your GI tract and into your body?
The lining of the GI tract, like our skin, is a barrier to the outside world, and it is one layer of cells thick. Thankfully, this lining is extremely good at blocking the bad and letting in the good. These cells sit very closely to one another and transport nutrients into the cells to be absorbed into the blood or lymph stream and distributed throughout the body. However, when contents of the GI tract can get IN BETWEEN the cells and access our blood and lymph systems, it can create havoc. You immune system at first will respond with local inflammation and mount a defense against the invaders, but after long term exposure your immune system can become “confused” and start mounting a defense against you and your body, your organ systems.
Physicians and the general public have long been resistant to the idea of leaky gut as an alternative medicine quack diagnosis, but if you take a search among medical research databases for the words “intestinal permeability” or “intestinal hyperpermeability” you will find hundreds upon hundreds of studies looking at just this: leaky guts.
The symptoms leaky gut can cause include: fatigue, gas, bloating, joint and muscle aches and pains, skin rashes and confusion. The difficulty with these symptoms is that they can occur in many different diseases, making leaky gut syndrome all the more difficult to correctly diagnose. Among the published evidence the following specific medical conditions are associated with leaky gut syndrome: celiac disease, IBS, asthma, Crohn’s disease, Type 1 diabetes (late onset), rheumatoid arthritis, obesity-associated insulin resistance, migraines, food allergies/sensitivities, even cancer. In some of these conditions we have a chicken and egg scenario and we need more research to determine causality or just merely association. In others, we understand the increased gut permeability, or leaky gut starts an immune system cascade that affects very distant parts of the body, including the brain, joints as far away as hands and feet.
If you or a loved one experiences any of the above medical conditions, I know you are thinking: Is there a way to be tested for leaky gut syndrome? Yes, labs have the ability to do three different tests that assist in identifying how permeable our intestines are. They are all based upon ingestion of certain foods and then measuring ratios of these food contents in the urine. The idea is your body takes in the food, it makes it to the part of the GI tract that is compromised, then it will either pass between cells, into your blood, to your kidneys to be filtered and out through urine, OR your gut is okay, and it makes it out as a part of your stool.
Conventional and Alternative Treatments
There is absolutely no doubt in my mind about it, we need more research in this area. Many doctors will just slap your gut with a healthy dose of anti-inflammatory drugs, with no regard to the fact that NSAIDs have been implicated in causing increased intestinal permeability. However, working with a Dietitian (especially and functional and integrative medicine dietitian) provides a unique advantage to adjust diet to try and lessen symptoms, remove underlying roots of the problems, clear infections (Small Intestine Bacterial Overgrowth or SIBO) and institute patient specific interventions to heal the gut.
If you feel that you may have leaky gut the first recommendations I make are the following: Stop taking NSAIDs, decrease alcohol intake significantly, consider removing gluten from your diet for a time. The next step (though it can be expensive) is test for food immune reactions, so offending foods can be eliminated and your body can be given a chance to heal. As a specific elimination diet is implemented, then considering glutamine, zinc, gelatin, and probiotic supplementation and other gut healing protocols that are appropriate for the individual and their condition.
Making the paradigm switch to eating whole foods and removing processed foods from the diet will give your body an extreme advantage in avoiding a leaky gut. Why? Because all of the processed chemicals and highly refined foods can be inflammatory to the gut and soon when the gut is compromised when these foods make it to the blood before your body has a chance to rid them or break them down into smaller particles, it is likely your body will mount an extreme response to the chemicals contained in these foods. Whole foods taste good and are good for you. What do I mean when I talk about whole foods? Fruits, vegetables, whole grains, beans, nuts, seeds, choosing meat that has not been treated with hormones, responsibly sourced fish.
Thanks for reading, please let me know if you feel you need assistance with this, I would be glad to set up an appointment with you.
GERD (GastroEsophageal Reflux Disease), or what most people call heart burn, ails at least 1 in 4 people in America. While it is a very uncomfortable condition with unpleasant sensations, it can have serious long lasting damage to your esophagus lining. Damage moves from irritation to scarring, constriction, ulcers, and can even lead to esophageal cancer. As a functional medicine dietitian, it is my firm belief that treating the root cause of the condition rather than taking pills forever to mask it will pay off down the road in improved health. Treatment of GERD can be achieved by proper nutrition, elimination of food agents that trigger GERD, changing lifestyle patterns, leveraging weight loss where indicated and choosing natural, healing supplements where needed.
In normal digestion, your food passes from your mouth to your esophagus ( a long thin passageway that connects from mouth to stomach) and from your esophagus to your stomach. And on down the hatch it continues. Connecting your esophagus and your stomach is a door, we call that door the lower esophageal sphincter (LES). After food passes through this door, it should close, to prevent food and stomach acid from flowing back up. Some medicines have a side effect of lowering LES function. Other than medicine, sometimes the LES just becomes weakened, or more relaxed that it should be. This can be do to chronic overeating and stretching of the stomach. And with the help of a new study, inflammation may play a major factor in this weakening, a larger role than previously imagined. Because stomach acid is so acidic, it can be painful when it climbs back up touching tissue that wasn't created to withstand exposure to acid. Helping to remove inflammatory and painful triggers and giving the body a chance to lower inflammation, it can heal itself over time.
Many medicines taken, even over the counter, block production of stomach acid. This follows the thought that less stomach acid, means less exposure when the LES is weak and opening. This can be very effective in relieving heartburn, however it just slaps a band-aid on the symptoms, and creates larger problems down the line. This is an interesting band-aid, because many sufferers of GERD have been found to create insufficient amounts of stomach acid to begin with. This leads to a theory, that less acid creates the problem of food sitting in the stomach for too long, increasing chances of back flow and heartburn. These medicines are a temporary fix for symptom management and have increased risk of conditions such as vitamin deficiencies, kidney disease, allergies, skin disorders, osteoporosis, heart attacks, GI infections and depression. I would vote we look for the cause of GERD and treat it, rather than only covering up the symptoms.
Overweight or Obesity
Consuming Large Meals
Eating Before Laying Down
High Stress Levels
SIBO - Small Intestinal Bacterial Overgrowth
Pregnancy (just due to baby pushing up on all your organs)
Some of these could be changed with simple lifestyle modifications. Treatment can include the following:
Eat foods rich in anti-inflammatory factors: Fish, Fruit, Vegetables, Healthy Fats (avocados, nuts, olives)
If you have implemented all of the above and still experience mild GERD, supplements have been known to help. These are natural supplements that can assist the body to strengthen the LES or heal the esophageal lining. Licorice, Zinc Carnosine, L-Glutamine, Magnesium.
With the above treatment options, lifestyle modifications and supplements, an individual can work towards healing their body rather than masking the symptoms with medicine that is not providing a long term solution. In time digestion can return to normal and the LES will be able to heal itself.
Caitlin Johnson is a dietitian, wife, lover of ice cream, chef wannabe, California-girl, Christian, liver eating, "food-avore."
110 N McClelland Street
Santa Maria, California 93454