Mold: Not Just an Allergy

It’s not an uncommon scenario.  Someone comes to my office complaining of headaches, recurring sinus issues, a nagging cough, “brain fog”, and other chronic symptoms.  They’ve already had complete medical work-ups, and were most likely prescribed multiple rounds of antibiotics, to no avail.  “My allergist said that all of my test results were normal”.  The first thing that comes to mind for me?  Mold toxicity.

It’s not at all uncommon for patients to present with this cluster of symptoms after prolonged mold exposure, even when they test negative for a true mold allergy.  This is because the real culprits are mycotoxins, which are toxic metabolites that are formed in the presence of mold growth.  These mycotoxins are inhaled or ingested by individuals that are exposed to them.  With repeated exposure, our body’s typical methods of metabolizing and detoxifying these mycotoxins are eventually broken down, wreaking havoc on the immune system, causing inflammatory and sensitivity reactions that become increasingly difficult for the body to overcome, especially if exposure continues.  The toxic and allergenic effects are independent of the typical IgE antibody reactions that doctors use to identify allergies, leading to the dismissal of this patient population by a majority of doctors.

I would agree that obtaining objective data to confirm mold toxicity can often be challenging.  If someone is living or working in an area that they suspect to be problematic, there are kits that can be obtained for sampling the air quality, and measuring the concentration of mycotoxins.  This can at least raise the index of suspicion that mold exposure needs to be taken seriously as a potential culprit.  The sophistication of being able to measure different immune responses that are affected by mold exposure has also come a long way in the last couple of years, also making it easier to identify illnesses related to mycotoxins.  These tests aren’t necessarily mainstream knowledge, but are readily available through most of the laboratories that are typically used by physicians.  Being aware of your surroundings, and the history of your illness, is really the best information for any physician to have, especially if there has been visible mold growth, or mold levels have tested very high.

Treating mycotoxin illness is highly individualized, and can take many months to get under control.  Since much of the problem is related to irregular immune responses and an inability of the body to break down these toxins, the main goal is to help the liver metabolize mycotoxins more effectively, along with stabilizing the immune response.  Of course, the first and foremost step is to avoid exposure!  As long as people continue to be exposed to elevated mycotoxin levels, they will not get well.  There are methods that can be implemented for effective cleanup, but in some cases this could mean quitting your job, or even selling your house.  Once the exposure is removed, both nutritional and pharmaceutical treatment methods can be used to help your body bind and excrete the mycotoxins that are causing so much harm.

A perfect example of this problem is a patient I saw who came to me after having multiple upper respiratory infections in less than a year’s time.  This patient had no known history of allergies or asthma, and had been previously healthy, without any significant medical history.  Each time she went to her doctor, they just chalked it up to an infection, and placed her on antibiotics with each consecutive bout.  Upon extracting her medical history, it was discovered that the patient had moved to a new office within the building she had already been working in.  After thinking about it some more, she realized that other people within her new location had also been sick with similar complaints.  I prompted her to look more closely at the area she was working in, around the walls and ceiling, to see if she could visualize any mold, as her symptoms may be consistent with ongoing exposure to mold.

Upon the patient’s return office visit, she informed me that she had asked her supervisors to look into the matter a little more closely.  She then proceeded to show me pictures from her phone that revealed a massive area around her desk where they had peeled the wallpaper back-completely covered with mold!  Needless to say, the structural issues responsible for the mold were properly remediated, and the patient hasn’t had any symptoms since!

Again, I want to reiterate that mold toxicity is not always this black and white, but it is indeed a real cause of illness!  If this is something you think you’re suffering from, especially if you work in a building that has suffered from water damage, don’t be afraid to seek help.  Your doctors may tell you that you don’t have any allergies, and that nothing is wrong, so don’t get discouraged.  Continue to seek help until you find the answers and treatment solutions you deserve!

Are Annual Exams Really Necessary?

I hear it at least every week, if not more.  “My doctor gave me a clean bill of health.”  OK.  So maybe the annual battery of tests and exams didn’t reveal any serious underlying diseases, but that hardly equates to being healthy.  Unfortunately, we’ve become so accustomed to physical exams, even the insurance companies consider them “preventive care.”  The chief cited rationale is that the annual offers a regular opportunity to address risk factors and health or life concerns.  There may be some truth to this, but both insurance companies and doctors could be doing so much more to provide preventive care for patients.

“There’s little evidence that a routine physical exam and a standard 20-30 item chemical panel improve outcomes,” said Allan Goroll, MACP, a professor of medicine at Harvard Medical School and practicing general internist.  In 1979, a Canadian government task force officially recommended giving up the standard head-to-toe annual physical based on studies showing it to be “nonspecific,” “inefficient” and “potentially harmful,” replacing it instead with a small number of periodic screening tests, which depend in part on a patient’s risk factors for illness.  Yet, doctors and patients both continue to be dependent on “screening tests” that are thought to rack up an unnecessary cost of $325 million annually.

Instead of strictly focusing on “disease prevention”, our model of healthcare needs to move in the direction of teaching people how to be healthy.  It’s great if your test results are “normal”, but what changes can you be making to truly improve your health?  As doctors, we need to make it a point to not give people a false sense of security by sticking to the current standards of the annual physical exam.  This only reinforces bad habits, and most likely makes people more prone to chronic disease in the long-run.  As more and more doctors begin to move away from testing and towards individualized lifestyle counseling, patients will come to expect this with their annual exams, hopefully changing the standards altogether.

But that’s not what happens in many primary care practices, Dr. Prochazka and fellow researchers found in a 2005 survey published in Archives of Internal Medicine. Nearly half of the physician respondents, despite evidence to the contrary, still believed in annual mammography, lipid panels, blood glucose levels, CBCs and urinalysis.

“In general, there’s a bit of a disconnect,” he said. “Many patients wish for tests and think that’s what a physical actually means. And many physicians think that the traditional annual is necessary and of proven value.”

Ateev Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine, has estimated that unneeded blood tests during physical exams alone cost $325 million annually.  And the over-screening for some occurs in a country where 50 million people are uninsured and receive little medical attention. More than half of uninsured adults in the United States did not see a doctor in 2010. Fifty percent of Americans are not up to date with the few screening tests that are recommended — like a colonoscopy once every 10 years for those over 50 — because of high costs, said Karen Davis, president of the Commonwealth Fund.

Intensive screening can prove useless for a number of reasons, experts say: Tests can have high rates of “false positives,” signaling that there may be disease, when further tests and procedures reveal none. Likewise, they can screen for conditions where early detection does not alter the course of the disease, either because the body might heal itself or because there are no effective remedies. In either case they can lead to aggressive procedures to clarify the diagnosis or provide treatment, which themselves can be harmful.

Ultimately, I think broader policy changes will need to be made to allow doctors the freedom to spend more time with their patients, especially since most insurance companies determine the definition of “preventive” services.  But if doctors can start emphasizing that “healthy” involves far more than just normal blood results, I expect that great progress will be made in our health care system.

What Can I Do About C. diff?

A patient came to me recently after finishing her 2nd course of antibiotic treatment for Clostridium difficile (C. diff) infection.  Despite some temporary relief during while taking the medication, her symptoms were beginning to return to the same level of intensity that she was experiencing before the treatment.  The patient’s gastric distress was so severe that she barely had the ability to function at work, having to take both prescription and OTC pain relievers just to get through the day.  She was reluctant to go through another round of antibiotics, since they weren’t giving her any relief, and were causing other side-effects as well.

In most cases, C. diff infections are acquired in hospitals or long-term care facilities, especially in patients who have been taking antibiotics.  However, due to an increase in antibiotic resistance, more and more patients who are otherwise healthy, and not in a hospital setting, are acquiring C. diff infections.  The patient in question fits into this category-she is young, active, and doesn’t have a history of any serious medical complaints.

Fortunately, Saccharomyces boulardii exists as a viable treatment option for C. diff infections.  Saccharomyces boulardii (SB) is a non-pathogenic strain of yeast that is isolated from lychee and other tropical fruits.  Since it is a yeast, rather than a bacteria, it’s not susceptible to being affected by antibiotics, as are other beneficial microorganisms within the intestine.  SB has been proven to effectively treat C. diff infections, and may prevent the recurrence of C. diff infections by up to 50%.  This is especially important for patients undergoing immunosuppressive therapy for inflammatory bowel disease, along with those in a hospital or long-term care setting.  Given the evidence, it should be standard practice for doctors to be recommending SB for at-risk patients, or those with an active infection.  Unfortunately, I’m not seeing it done nearly enough!

In the instance of the aforementioned patient, a week-long course of treatment with SB completely resolved her gastrointestinal symptoms.  Repeat stool testing showed no sign of C. diff, and other infections were ruled out as a precaution.  Frankly, I was even amazed at how effective the treatment was, given the nature of most C. diff infections!  If you’re someone who is potentially at risk of acquiring C. diff, just know that drugs aren’t the only available treatment option.  Tell your doctor that you’ve read about the effectiveness of SB, and make sure you start taking it ASAP!


Understanding and Effectively Treating PMS

Premenstrual syndrome (PMS) is one of the most common female problems, affecting 30-40% of
women during their reproductive years. The most severe cases occur in approximately 2% of
women between the ages of 26 and 35. PMS is characterized by recurrent symptoms that appear
7-14 days before a woman has her menstrual period. These symptoms often include decreased
energy, irritability, increased appetite (usually sugar cravings), acne, and bloating. Menstrual
cramps (dysmenorrhea), while technically a separate diagnosis, can also be attributed to the same
hormonal fluctuations that cause PMS.

PMS symptoms can be divided into 4 distinct categories:

1. PMS-A (A = anxiety) includes symptoms of anxiety, irritability, and emotional instability.
It encompasses the most common PMS symptoms and is found to be strongly associated
with excessive estrogen and deficient progesterone.
2. PMS-C (C = carbohydrate craving) includes symptoms of increased appetite, craving for
sweets, headache, fatigue, fainting spells, and heart palpitations. Although there is no
clear mechanism of cause for these symptoms, they seem to be related to an excessive
insulin response to sugar consumption.
3. PMS-D (D = depression) is the least common category of symptoms and is associated
with low levels of estrogen, leading to increased breakdown of neurotransmitters in the
4. PMS-H (H = hyperhydration) is characterized by weight gain greater than 3 pounds,
abdominal bloating and discomfort, breast tenderness and congestion, and occasional
swelling of the face, hands, and ankles. These symptoms are attributed to an increase in
the hormone aldosterone, which increases fluid retention.

Usually, a woman will have a combination of symptoms from the different categories of PMS.
The categories are used as general guidelines to help address the underlying problems related to
the syndrome. It is important that your doctor rule out underlying medical conditions, like
hypothyroidism, anemia and depression, to make sure they’re not responsible for any PMS-related symptoms.

The causes of PMS can be numerous, but hormonal imbalances are often revealed with the appropriate laboratory testing, with an excess of estrogen and deficiency of progesterone being the most common.  The liver’s ability to breakdown excess hormones is often a culprit as well, leading to an increased response to otherwise “normal” hormone levels.  Diet also plays a major role, particularly since foods such as caffeine, alcohol, and excessive animal proteins put further strain on the liver, increasing the likelihood of PMS.

In my experience with patients, diet and lifestyle modifications alone will significantly reduce the severity of symptoms associated with PMS.  Mainly, a high fiber, low animal fat diet, combined with the avoidance of caffeine, alcohol, and refined carbohydrates, is critical for symptomatic relief.  Exercise is also recommended, as it will help to reduce fluid retention, breast tenderness, depression, and stress.  Nutritional supplements, particularly evening primrose oil, magnesium, and vitamin B6, will often help to diminish PMS symptoms, as women diagnosed with this condition tend to utilize these nutrients more rapidly.  There are also several herbal interventions available for correcting hormonal imbalances associated with PMS.

Ultimately, it’s important to recognize that PMS is not a “one-treatment fits all” scenario.  By taking a thorough diet and lifestyle history, and performing a thorough laboratory evaluation, the causes of your symptoms can be narrowed down, and treated effectively with non-pharmaceutical interventions.

Acid-Blocking Medications Aren’t Meant For Long-Term Use!

While I may have written about this more than once in the past, I feel like it’s a topic that continues to need revisiting.  A recent New York Times article ( highlights the many reasons why proton pump inhibitors (PPI’s), such as Prilosec, Nexium, and Prevacid, can cause more harm than good when used beyond the recommended window of 8 to 12 weeks.  While it seems to come as a surprise to the doctors who are handing out these medications like candy, our stomachs are supposed to make hydrochloric acid!  This is essential for initiating the digestive cascade that leads to the proper assimilation of nutrients.  As the article points out, blocking stomach acid production for an extended period of time can lead to a host of nutritional deficiencies, including iron, vitamin B12, and magnesium.  A decrease in stomach acid also takes away the protective barrier meant to protect us from harmful bacteria, setting up an environment that’s more prone to infection with Clostridium and other pathogenic bacteria.

I personally have seen countless patients in my practice who have been taking one PPI or another for years, and don’t even know why!  In many cases, I’ve seen young women who have persistent iron deficiency anemias, only to find out they have been on acid blocking medication for several years.  However, getting these patients to discontinue the offending medications proves to be extremely challenging, as the body increases the amount of acid-producing cells while on the meds.  Thus, the rebound production of acid is overwhelming, leading to more heartburn than the patient may have ever experienced before even starting the medication!

Fortunately, there are herbs and nutrients that can help to minimize the irritation that can occur when trying to wean off PPI medications.  Once you make the decision with your doctor to discontinue these medications, seek out a qualified naturopathic physician who can help to ease the transition.  Even if you were having legitimate symptoms before these medications were prescribed, it’s likely that diet and lifestyle changes will make a huge difference, without having to depend on a medication that is likely to be more risky than beneficial.

Osteoporosis: Exploring the Alternatives

In the recent past, it wasn’t uncommon for most women to be placed on hormone replacement therapy (HRT) for easing the symptoms of menopause, in addition to protecting them from osteoporosis. But that standard of care has since changed with the discovery that HRT may increase the risk of breast cancer and heart disease. Without the use of HRT, it has become increasingly challenging to treat and prevent osteoporosis. Many women have turned to other pharmacological options, like selective estrogen receptor modulators (raloxifene; Evista) and bisphosphonates (alendronate; Fosamax), but these medications aren’t without their side effects, either. Raloxifene can increase the risk of blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism), while alendronate can cause severe damage to the esophagus and may increase the risk of thigh bone fracture.

With patients continuing to be discouraged about the treatment options that are being offered, they often turn to naturopathic physicians for alternatives they can rely upon, without the worry of side-effects and complications. Fortunately, there is sufficient evidence to support the benefit of these alternatives, and their use in the prevention of osteoporosis.

One of the more recent studies, conducted at the Osteoporosis Research Center at Creighton University in Omaha, Nebraska, investigated the effects of a combination isoflavone/nutrient supplement on measures of bone density in 70 post-menopausal women. For six months, the women took an isoflavone supplement plus 500 mg of calcium per day, or placebo plus 500 mg of calcium. The isoflavone supplement supplied 30 mg of synthetic genistein (one of the most widely used soy isoflavones), 800 IU of vitamin D3, 150 mcg of vitamin K1, and 1 gram of the essential fatty acids, EPA and DHA.

After six months, women in the isoflavone group maintained the same bone density at the femoral neck (a common place for fractures to occur), whereas bone mineral density at that site decreased significantly in the placebo group. Bone density was also significantly greater in the isoflavone versus the placebo group at another measurement area in the hip (called Ward’s triangle).

Isoflavones have weak estrogen-like effects in the body, which may lend them their bone-building activity. They don’t appear to have the same negative effects on hormone-sensitive tissues in the body, though, making them good candidates for osteoporosis prevention. However, while I do believe the benefits of preventing osteoporosis outweigh the risks of any potential estrogen-related side-effects, I always take an individualized approach, often avoiding the use of isoflavones in any patient who has a history of breast or other hormone-sensitive cancers.

Another recent study, published in Calcified Tissue International, revealed favorable changes in bone metabolism and bone mass indices for subjects who received additional vitamin K through either diet or supplementation, making it another viable option for osteoporosis prevention. The form of vitamin K known as phylloquinone, or K1, is the most abundant form in plants and is believed to play the biggest role in blood clotting; K2 refers to a group of related types of vitamin K known as menaquinones that are thought to be more involved in the other effects of vitamin K.This study showed that a comprehensive osteoporosis-prevention program is more effective if it includes vitamin K. Increasing your intake of green leafy vegetables, eggs, yogurt, and kefir are all natural ways to boost vitamin K levels.

So as you can see, choosing not to use the typical conventional methods for treating osteoporosis does not mean you’re at a dead end. Consult with a practitioner who is knowledgeable about the alternative treatments that are available, and know you have the power to make choices that will keep your bones healthy for years to come!


Why Will I Gain Weight If I’m Not Sleeping Well?

As bizarre as it sounds, how well we sleep can have a direct impact on the amount of weight we gain.  While doctors often talk about how poor sleep impacts immune function and stress hormones, we’re only more recently beginning to understand how hormones that control appetite are also affected.

Leptin and ghrelin are hormones in our system that regulate feelings of hunger and fullness.  Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full.  Lack of sleep leads to both a lowering of leptin levels (lack of satiety) and a rise in ghrelin (stimulated appetite).  The combined effects of these changes leads to overeating, followed by weight gain.

One example of this effect was demonstrated in a joint study between Stanford and the University of Wisconsin.  Those who slept less than eight hours a night not only had lower levels of leptin and higher levels of ghrelin, but they also had a higher level of body fat.  Those who slept the fewest hours per night weighed the most.

While this information is certainly promising, the relationship between these hormones and weight gain is still not entirely straightforward.  Some patients who have sleep apnea, combined with obesity, actually have high levels of leptin, rather than low.  It’s been speculated that some patients may become resistant to this hormone, so elevated levels mean their body isn’t responding to the signals of this hormone, still making them more prone to weight gain as a result of sleep apnea.

I think the bottom line is that diet and exercise aren’t the only factors when it comes to addressing weight gain.  Poor sleep or untreated sleep apnea should always be addressed with any weight loss program, if any level of success is to be achieved.


Patients With Type II Diabetes Benefit From Naturopathic Care

Diabetes is a complex, multi-factorial condition that takes many variables into account, including diet, exercise, and family history.  Typically, if certain markers are detected early enough (elevated blood glucose, increased hemoglobin A1C), lifestyle and/or pharmaceutical treatments can be implemented to slow or reverse the progression of type II diabetes before long-term complications arise.  Since the essence of naturopathic medicine is addressing core diet and lifestyle issues that may be contributing to disease, it’s essential for anyone who’s dealing with type II diabetes, or even “pre-diabetes”, to incorporate a naturopathic treatment protocol as part of their long-term strategy.

A new joint study by Group Health Research Institute and Bastyr University Research Institute found that type II diabetes patients who received naturopathic care (as an adjunct to conventional care) had lower blood-sugar levels, better eating and exercise habits, improved moods, and a stronger sense of control over their condition than did patients receiving only conventional care.  The findings, published in BMC Complementary and Alternative Medicine, show that complementary and alternative medicine (CAM) may have several positive effects on people with type 2 diabetes, which is very encouraging for patients who are seeking out alternatives to manage their symptoms.  Forty study participants received counseling on diet, exercise, and glucose monitoring from four naturopathic physicians (NDs) in addition to conventional diabetes care from their medical doctors, including prescription medications. Many of the participants also received stress-management care and dietary supplements. Researchers then compared these 40 participants with 329 patients receiving only conventional diabetes care.  After six months and about four naturopathic treatment visits, participants demonstrated improved self-care, more consistent monitoring of glucose, and improved moods. Hemoglobin A1c rates (a measure of blood-sugar control) were nearly a full percentage point lower for those patients. This compares with a drop of only 0.5 percent over the same time period for 329 clinically similar patients receiving only conventional diabetes care.

Hopefully, this will encourage medical doctors and patients alike to seriously consider the benefits of naturopathic medicine in the management of type II diabetes.  Doing as much as possible to get a handle on this disease is extremely important, as it’s one of the top 10 causes of death for Americans, racking up close to $178 billion per year in health care costs.  By making a collaborative effort, there’s no reason why we can’t be proactive about halting this epidemic from spiraling out of control!

Recognizing Lyme Disease and Related Infections

Although we live in a state where Lyme disease is endemic, the diagnosis and treatment of this condition continues to be controversial.  Unfortunately, the political landscape surrounding Lyme disease has steered many doctors away from treating it altogether, putting many patients at risk for developing long-term complications.  It’s not uncommon for me to see patients who have been told that their testing for Lyme disease and other co-infections is negative, so therefore there is no possible way that these infections can be responsible for their symptoms.  This information can be extremely misleading, since the validity of testing is dependent on what stage of the disease they are performed.  Doctors who are well informed about Lyme will typically treat based on clinical criteria (outlined by the CDC), with the argument being that the risk of putting uninfected individuals on antibiotics is not outweighed by the risk of long-term Lyme complications.

Since there is so much variability from one physician to the next, the most important point is for patients to recognize the most common symptoms of Lyme disease and other co-infections, so they can consider seeking out a second opinion if they’ve been told their symptoms are unrelated, yet their health continues to decline.  Symptoms to watch for include the following:

Lyme Disease: Fatigue, headaches, cognitive difficulties, roaming muscle pain that comes and goes, intermittent paresthesias (numbness, tingling).

Babesia: Fever, chills, night sweats, “pressure” headaches, insomnia, “air hunger”, easy bruising.

Ehrlichia: High fevers, low WBC and platelet counts, elevated liver enzymes.

Bartonella: Fatigue, “ice pick” headache, cognitive difficulties, lymph node swelling, pressure behind eyes, seizures, painful feet (especially upon waking), sensitivity to light.

Other key points to consider:

-While known history of a tick bite is helpful, how often will you notice something the size of a poppy seed hanging around?

-Lyme disease can suppress many subsets of your immune system, so recurring viral infections and other signs of immune compromise can be another clue.

-If you do find a tick, don’t throw it away! You should save it, and have the tick tested for Borrelia.

-Exposure history (hiking, wooded areas, occupational hazards, etc.) and previous response to antibiotics (did symptoms improve or worsen) can be useful indicators.

-There are no definitive tests for Lyme disease!

If you’re suspicious of Lyme or related co-infections based on this summary, seek out a physician who has experience with diagnosing and treating these conditions.  Be persistent, and don’t be discouraged by negative test results, particularly if you continue to suffer!

Can Diet Reverse PCOS?

Polycystic ovary syndrome (PCOS) is a condition that affects the hormone balance in women, favoring the production of male hormones like testosterone over female hormones like estrogen and progesterone. This imbalance can lead to symptoms such as menstrual problems and infertility. Many women with this condition also develop insulin resistance, diabetes, obesity, and cardiovascular disease.  In a new study published in the American Journal of Clinical Nutrition, blood sugar control, weight loss, and cardiac risk were all improved when women with PCOS were put on a high protein, low carbohydrate diet.

The new study included data collected from 27 women with polycystic ovary syndrome. Participants were assigned to either a high-protein diet or a standard-protein diet for six months. Both groups received regular nutritional counseling and were guided to reduce their intake of sweets and soft drinks.

The aim of the high-protein diet was to get 40% or more of each day’s calories from protein and less than 30% of calories from carbohydrate. To achieve this, women in the high-protein-diet group were instructed to replace sugary and starchy foods with either protein-rich foods like meat, eggs, fish, and dairy foods, or with vegetables, fruits, and nuts. The aim of the standard-protein diet was to get less than 15% of calories from protein and more than 55% of calories from carbohydrate. There were no calorie restrictions with either diet.

At the end of the study, the following differences between the groups were seen:

  • Women on the high-protein diet lost 4.4 kilograms (10 pounds) more than women on the standard-protein diet.
  • Almost all of the extra weight lost by the women eating the high-protein diet was body fat, not muscle.
  • The high-protein diet was associated with a greater reduction in waist circumference, indicating a greater loss of abdominal or belly fat. This type of fat has a strong link to cardiovascular disease.
  • Women on the high-protein diet had lower blood glucose and C-peptide levels. C-peptide is a protein that is linked to insulin production. These findings show that blood sugar control improved more in this group than in the standard-protein diet group.

Implementing this type of diet is one of the first things I do with patients who have PCOS, and the results are consistently rewarding. Between these dietary changes and other nutritional and botanical interventions, I’ve witnessed the naturopathic treatment of PCOS being just as, or even more effective, than the medication regime often utilized in conventional medicine. Plus, these diet changes promote longer term health benefits, particularly with respect to cardiovascular health.

If you’ve been struggling with weight gain and other complications of PCOS, and you’ve only tried medications to address it, don’t feel like your options have been exhausted. Seek out a practitioner who can give you detailed dietary instruction, a method that has now been proven to work!

(Am J Clin Nutr 2012;95:39–48)