Is the Ketogenic Diet Safe?

Written by Dr. Steve Chaney on . Posted in Ketogenic Diet

Is The Ketogenic Diet Effective?

Author: Dr. Stephen Chaney

ketogenic dietThe ketogenic diet has been around for a while. It has been used to control epilepsy in children since the 1920s. Nobody is quite sure why it helps control epilepsy, but it does. Once a mainstay of therapy, it is now primarily used as an adjunct to anti-epileptic drugs.

However, recently the ketogenic diet has gone mainstream. It’s no longer just for epilepsy. It has become the latest diet fad. If you believe the claims:

  • Hunger and food cravings will disappear. The pounds will melt away effortlessly and rapidly.
  • You will feel great. You’ll have greater mental focus and increased energy.
  • Physical endurance will increase. You’ll become superhuman.
  • Type 2 diabetes will disappear.
  • Your blood sugar, cholesterol, and triglyceride levels will improve, reducing your risk of developing diabetes and heart disease.

What’s not to like? This sounds like the perfect diet. But, are these claims true? More importantly, is this diet safe?

What Is Ketosis?

what is ketosisKetosis is a natural metabolic adaptation to starvation. To better understand that statement let me start with a little of what I’ll call metabolism 101.

Metabolism 101:

The Fed State: Here’s what happens to the carbohydrate, protein & fat we eat in a meal.

  • Most carbohydrates are converted to blood sugar (glucose), which is utilized in three ways:
    • Most tissues use glucose as their primary energy source in the fed state.
    • Excess glucose is stored as glycogen in muscle and liver.
    • Glycogen stores are limited, so much of the excess glucose is stored as fat.
  • A few tissues such as heart muscle use fat as an energy source. Excess fat is stored.
  • Protein is also used in three ways:
    • Some of it is used to replace and repair the protein components in muscle and other tissues.
    • In conjunction with exercise, protein can be used to increase muscle mass.
    • Excess protein is converted to fat and stored.

The Fasting State: Between meals:

  • Most tissues switch to fats as their primary energy source. Fat stores are utilized to fuel the cells that can use fat.
  • Brain, red blood cells, and a few other tissues still rely solely on glucose as their energy source.
    • Liver glycogen stores are broken down to keep blood glucose levels constant and provide energy for these tissues. (Muscle glycogen stores are reserved for high intensity exercise).
    • As liver glycogen stores are depleted, the body starts breaking down protein and converting it to glucose.

ketogenic diet problems and solutionsStarvation – The Problem: If the fasting state were to continue for more than a few days, we enter what is called starvation. At this point we have a serious problem. Fat stores and carbohydrate stores (liver glycogen) exist for the sole purpose of providing fuel during the fasting state. Protein, however, is unique. There are no separate protein stores in the body. All protein in our body is serving essential functions.

To make matters worse, our brain is metabolically very active. It consumes glucose at an alarming rate. Thus, large amounts of glucose are needed even in the fasting state. If protein continued to be converted to glucose at the same rate as during an overnight fast, our essential protein reserves would rapidly be depleted. Irreversible damage to heart muscle and other essential organs would occur. We would be dead in a few weeks.

Starvation – The Solution: Fortunately, at this point a miraculous adaptation occurs. Our bodies start to convert some of the fat to ketones.

  • All tissues that use fat as an energy source during fasting can also use ketones as an energy source, sometimes with greater efficiency.
  • Over a period of several days, the brain adapts to ketones as its primary energy source. This greatly reduces the depletion of cellular protein to supply blood glucose.
  • However, red blood cells and a few other cells still require glucose as an energy source. Essential protein reserves are still being depleted, but at a far slower pace.
  • With these adaptations, humans can survive months without food if necessary.

There are a few other adaptations that make sense if we think about the dilemma of going long periods without food.

  • Appetite decreases.
  • Metabolic rate decreases, which helps preserve both protein & fat stores.

 

What Is The Ketogenic Diet?

 

ketogenic diet keytonesProponents of the ketogenic diet advocate achieving a permanent state of ketosis without starving yourself. That is achievable because the real trigger for ketosis is low blood sugar, not starvation.

The starting point for the ketogenic diet is low-carb, high-fat diets like Atkins. However, ketogenic diets go beyond traditional low-carb, high-fat diets. They restrict carbohydrates even further to <10% of calories so that a permanent state of ketosis can be achieved. Basically, the ketogenic diet:

  • Eliminates grains and sugars.
  • Eliminates most fruits.
  • Eliminates starchy vegetables (root vegetables, corn, peas, beans, squash & yams).
  • Reduces protein intake. That’s because dietary protein will be converted to glucose when blood glucose levels are low.

You are left with a highly restrictive diet that allows unlimited amounts of fats & some vegetables and moderate amounts of meats, eggs, and cheeses.

The Ketogenic Diet Is Not For Wimps

ketogenic diet tough#1: You have to be committed. As noted above, this is a highly restrictive diet. You will have great difficulty following it when you eat out or are invited to a friend’s house for dinner. You will also have to give up many of your favorite foods.

#2: The transition is rough. Physiological adaptation to the ketogenic diet will take anywhere from a couple of days to a week or two. During that time, you will have to endure some of the following:

  • Headaches, confusion & “brain fog”
  • Fatigue
  • Hunger
  • Lightheadedness and shakiness
  • Leg cramps
  • Constipation
  • Bad breath
  • Heart palpitations

#3: There are no “cheat days”. On most diets, you can have occasional “cheat days” or sneak in some of your favorite foods from time to time. The ketogenic diet is different. A single “cheat day” is enough to take you out of ketosis. If you want to resume the ketogenic diet, you will need to go through the transition period once again.

Is The Ketogenic Diet Effective?

ketogenic diet effectiveWith this background in mind, let’s evaluate the claims made by proponents of the ketogenic diet. I’ll rate them on the “Pinocchio Scale”. “Zero Pinocchios” means they are mostly true. “One Pinocchio” means they are half true. “Two Pinocchios” means they are mostly false.

Zero Pinocchios (Mostly True Claims):

  • Reduced hunger. This is part of the starvation response.
  • Improved mental focus and increased energy. In part, this is simply in contrast to the “brain fog” and fatigue of the transition phase. However, you have also eliminated all foods that can cause blood sugar swings from your diet. Blood sugar swings can affect both mental focus and energy levels.
  • Rapid weight loss. If we focus on short term weight loss, this is true because:
    • A lot of the initial weight loss is water. Glycogen stores retain water. As glycogen stores are depleted, the water is lost along with them.
    • Most people inadvertently reduce their caloric intake on a highly restrictive diet like this. For example, fats are often consumed along with carbohydrate-rich foods (butter with toast, sour cream with potatoes, cream cheese with bagels). While it is easy to say that unlimited consumption of healthy fats is allowed, most people reduce their consumption of fats in the absence of their carbohydrate-rich companions.
    • Note: Proponents of the ketogenic diet will tell you that the weight loss associated with the ketogenic diet is because you are burning fat stores. You will only burn fat stores when dietary fat intake is not sufficient to meet your energy needs. In other words, you burn your fat stores when “calories in” are less than “calories out” – just as with any other diet.
  • Reversal of type 2 diabetes. Because carbohydrates are restricted in this diet, blood sugar and insulin levels will be low. If you are on medications, those will need to be adjusted by your physician.

 

One Pinocchio (Half-True Claims):

  • Improved cholesterol and triglyceride levels. The jury is out on this one. Some studies show an improvement on the ketogenic diet. Other studies show them getting worse.
  • Increased physical endurance. This is only true for low-intensity endurance exercise. It is not true for any exercise or event that requires spurts of high intensity exercise. That’s because:
    • The muscle fibers used for low intensity endurance exercise utilize ketone bodies with high efficiency. That means you can run for miles as long as you don’t care how fast you get there.
    • The muscle fibers used for high-intensity, short-duration exercise cannot adapt to use of ketone bodies because they lack sufficient mitochondria. They require glycogen stores, which are depleted on a ketogenic diet. Even in endurance events like marathons most people want to sprint to the finish line. They won’t be able to do that if they are on a ketogenic diet.

 

Two Pinocchios (Mostly False Claims):

  • ketogenic diet mythsLong term weight loss. Some long-term success has been claimed in a highly controlled clinical setting. However, most studies show:
    • People regain some or most of the weight after 6 months to a year.
    • After 1 or 2 years, there is no difference in weight loss between high-fat/low-carb diets and low-fat/high-carb diets.
    • That’s because:
      • Most people cannot stick to restrictive diets long term, and this diet is very restrictive.
      • Once you go off this diet, even for a short time, your glycogen stores will be replenished and the water weight will return along with the glycogen.
      • The reduction in metabolic rate and the reduction in muscle mass associated with the ketogenic diet make it difficult to keep the weight off long term
  • It is a healthy diet.
    • This is a healthy diet only from the point of view that it eliminates most fast foods and processed foods.
    • However, any diet that eliminates 2 and a half food groups (grains, fruits, and starchy vegetables) is setting you up for long term nutritional deficiencies. It is possible to cover some of those deficiencies with supplementation, but supplements can never provide all the nutrients found in real food.

 

Is The Ketogenic Diet Safe?

ketogenic diet safeFor most people the ketogenic diet is likely to be safe for short periods, maybe even a few months. However, I have grave concerns if the diet is continued long term.

  • I have already mentioned the likelihood this diet will create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
  • Proponents of the diet recommend that protein intake be limited so that “optimal” ketosis can be achieved. If the dieter is successful at doing that, it will result in a gradual depletion of essential cellular protein reserves as discussed above. Long term, that has the potential to weaken heart muscle, compromise the immune system, and damage essential organs.
  • Ketones can damage the kidneys. In the short term, damage is likely to be minimal as long as plenty of water is consumed. However, long term ketosis could be a significant concern for your kidneys.

I have seen proponents of the ketogenic diet shrug this off as a concern only if protein intake is excessive. They are missing the point. The problem is the ketones, not the protein.

  • Long term ketosis has the potential to cause osteoporosis. That is because the so-called “ketones” are actually organic acids except for the small amount of acetone that gives your breath a fruity smell. Organic acids must be neutralized to keep our body pH in the normal range. There are multiple mechanisms for neutralizing organic acids. One of those mechanisms involves dissolving bone and releasing calcium carbonate into the bloodstream. This slow dissolution of bone will continue for as long as someone is in ketosis.

 

Proponents of the ketogenic diet shrug this off by saying that you never get into ketoacidosis on their diet. Again, they are missing the point. Ketoacidosis simply means that the production of organic acids has become so great that all the body’s mechanisms for neutralizing those acids have become overwhelmed. Ketoacidosis occurs in uncontrolled diabetes and can be deadly. The problem is the slow dissolution of bone during long term ketosis, not a short-term crisis like ketoacidosis.

If you are considering the ketogenic diet for weight loss, my recommendations would be to:

  • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
  • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.

If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

The Bottom Line

 

  1. The ketogenic diet is the latest diet fad. I give it a C+ compared to other popular diets.
  2. This is not a diet for wimps.
    • It is a highly restrictive diet
    • The transition period as you adjust to the diet is rough.
    • There are no “cheat days”
  3. Some of the claims made for the ketogenic diet are mostly true, some are half-true, and some are mostly false. I help you sort them out in the article above.
  4. Short term, the diet is probably safe for most people. However, long term I have several concerns.
    • The diet is likely to create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
    • The diet is likely to gradually deplete essential cellular protein reserves. Long term, that could weaken heart muscle, compromise the immune system, and damage essential organs.
    • The diet has the potential to damage the kidneys.
    • The diet has the potential to cause osteoporosis.
    • The metabolic rationale for those concerns is discussed in the article above.
  5. If you are considering the ketogenic diet for weight loss, my recommendations would be to:
    • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
    • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.
  6. If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (11)

  • Eroca Zeviar

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    Love your detailed specicifity and clarity. With so many group things online ie Betrayal system and group anti cancer infos, many different diets being promoted without the public really knowing enough to make an informed choice based on real proven knowledge.

    Thanks for your valued presentation.

    Reply

  • Merlena Cushing

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    Thank you so much for an incredibly compelling and thorough article. I will simply say I second the accolades given by Eroca…she put it very well. We are indebted to you for your continued articles here and on FB and your generosity in sharing them with all of us. Bless you!

    Reply

  • Judy LaBrune

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    Thank you for clarifying the Ketogenic diet! I’ve heard several people talking about how great it is. This article will be very helpful in sharing the myths and truths.

    judy

    Reply

  • Bonnie zeman

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    We use keto but it is with two life shakes a day. Also the life strip. I suppose it is not true keto. But they are losing a pound a day. We really pay attention to fats, butter, mayo, 100% cold pressed virgin olive oil and coconut oil. Purified water every hour. So far it has worked great. All top grade meats, fish, chicken and eggs. And huge amts of veggies. We also check on them every week.

    Reply

    • Dr. Steve Chaney

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      Dear Bonnie,
      It looks more like the Atkins diet to me. As I said in the article, it will succeed short term, but it will be hard to maintain that weight loss long term. I would also remind you that the only diets proven to be healthy long term are the Mediterranean and DASH.
      Dr. Chaney

      Reply

  • Justin Carlson

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    Dr. Chaney I appreciate your efforts of looking into the ketogenic diet, which indeed is becoming popular, but many of your conclusions seems to be based on speculation and lack scientific backing. It also seems unfair to call the diet a fad, when it is used as a treatment for many medical conditions today (chronic fatigue syndrome, neurodegenerstive diseases, etc.) due to the increased energy that ketones yield per unit compared to glucose. Instead of brushing this diet off as a fad, you should be treating it as a legitimate diet and give specific advice on how to eat properly and get the right nutrition when in ketosis. I think that would be most beneficial for your readers.

    Reply

    • Dr. Steve Chaney

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      Dear Justin,

      I did open my article by saying that the keto diet was well established for treatment of epilepsy in children. I am also aware of the research into its use for other neurodegenerative disorders. It is not as well established for those uses, but the research is promising. If my article was focused on those uses of the keto diet, it would have been completely appropriate to discuss how to follow it.

      I was focusing on the current usage of the diet to lose weight and to promote long term health. Those applications of the keto diet are unproven at present. The studies to date support short term weight loss and the improvement of blood parameters that may or may not equate with long term health outcomes. At this point we have no long term studies showing that the weight loss is maintained long term or that there is an improvement in health outcomes long term. Until we have that kind of evidence, I think it is appropriate to consider it a fad diet.

      Dr. Chaney

      Reply

  • Bill Moore

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    Interesting. I’ve been on a keto diet for 4 years now and pretty much all the ‘1 and 2’ Pinocchio’s you claim simply aren’t so. I know many (many) people that have stayed on this diet for years and are very happy with it. Is it difficult? Not at all. Does society do it’s absolute best to make it difficult? Very much so.

    You should try reading what people actually doing this diet say vs. a doctor who is, clearly, biased against something he doesn’t fully understand and, frankly, shouldn’t be writing about.

    If you’d like to see a community of people (over 270,000 of them) on keto, go here: https://www.reddit.com/r/keto/ You’ll find many people that can give you actual real world facts as well as the science behind why it works and why it works long term.

    If you’re a science geek, go talk to the 14,000 plus PhD’s and keto nerds who study this stuff for a living here: https://www.reddit.com/r/ketoscience/

    Reply

    • Dr. Steve Chaney

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      Dear Bill,

      Let me start by reminding you of my credentials. I taught human metabolism and nutrition to medical students for 40 years, and received numerous teaching awards during that time period. It is fair to say that I am an expert on human metabolism and how that metabolism is affected by our diet.

      I appreciate that your experiences with the keto diet have been positive, and that there is a small community of adherents who have also had positive experiences. In the scientific community, we call those case reports and consider them the least reliable level of proof. Scientists prefer to do clinical studies to see if the same observations are true for the majority of people who follow the diet. For example, it is clear from existing clinical studies that most people who follow the diet achieve short term weight loss, which is why I recommended it for that purpose. However, the important question is whether most people can stick with the diet long enough to maintain that weight loss for two years or more. I laud you for your discipline of being able to stick with the diet for 4 years, and I suspect you have managed to maintain your weight loss. However, until I see published clinical studies showing that most people who embark on the keto diet maintain their weight loss for two years or more, I cannot recommend it for that purpose, and it deserves 2 pinocchios.

      As for the 1 pinocchios, even the proponents of the keto diet say that it is good for endurance exercise, but not for things like sprinting. As for the cholesterol and triglyceride levels, most proponents of the keto diet conveniently ignore the fact that not all reports support improved levels. Personally, I think that is likely to be the case, but we need to remember that improvements in cholesterol and triglyceride levels may or may not translate into improved health outcomes. Until long term studies on health outcomes have been conducted, we cannot claim the keto diet is healthy.

      Dr. Chaney

      Reply

  • Paul

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    I would like to see the research that you talk about but don’t quote! It seems you are one of the many not up with numerous studies showing the many benefits of a ketogenic diet. It is not hard and if you call not eating grains restrictive, you obviously don’t know what a well-formulated keto diet is. You can even do keto as a vegan if you don’t want to eat animal products. When you break down triglycerides, the glycerol back bone is converted into glucose, so you always have enough glucose for the brain. I could go on, but seriously check to see what many Doctors that understand this diet are saying like Dr Mercola.

    Reply

    • Dr. Steve Chaney

      |

      Dear Paul,

      Let me start by reminding you of my credentials. I taught human metabolism and nutrition to medical students for 40 years, and received numerous teaching awards during that time period. It is fair to say that I am an expert on human metabolism and how that metabolism is affected by our diet.

      I am aware of studies on the benefits of the keto diet and referred to some of them in my article. Those are all short term studies, and do not provide evidence for long term health outcomes. For example, unless there are published studies showing that most people can stick to a diet and maintain weight loss for at least one or two years, it cannot be recommended as a successful weight loss approach. Similarly, there are studies showing that adhering to a Vegan, Mediterranean, or DASH diet over decades results in improved health outcomes (lower prevalence of heart disease, cancer & diabetes). In spite of the fact that high fat, low carb diets have been around since the 50s, I am unaware of a single study showing they result in improved long-term health outcomes. In the absence of that kind of evidence, they cannot be recommended as healthy diets.

      If the keto diet simply eliminated grains, it might would be more acceptable. However, most descriptions of the keto diet I have seen also restrict starchy vegetable, most fruits, and legumes. With that kind of restriction (especially the legumes), it is hard to see how a Vegan diet and the keto diet would be compatible.

      You can get some glucose from the glycerol backbone, but that is not enough to supply the body’s needs. That is why many of the description of the keto diet also recommend that you restrict protein.

      Dr. Chaney

      Reply

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Latest Article

Stress and Jaw Pain

Posted September 19, 2017 by Dr. Steve Chaney

Get Rid Of Jaw Pain Forever

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

In this article we will show a connection between stress and jaw pain. 

stress and jaw painStress is a part of everyone’s life, but the way you handle it makes a huge difference.  People think of stress coming from challenges like divorce, bills, etc., but it can also come from happy situations. Positive life changes such as getting married or having a baby can also cause stress.

For some people, the solution to stress is to take a yoga class or practice tai chi regularly.  For others, running, exercising, or listening to music eases their mind.

In my Muscular Therapy office, people frequently tell me “I hold my stress in my shoulders,” or “…in my back.” However, a common stress reaction is to clench your teeth tightly. Actually, people hold stress all over their body, from headaches and clenched jaws to foot pain. I want to discuss how clenching your jaws is a common cause of TMJ. Fortunately, it’s a condition that is easy to treat by yourself.

Stress And Jaw Pain

jaw painJaw pain is commonly caused by a shortening of the masseter muscle. The masseter muscle (circled on graphic) is the muscle that contracts to enable you to chew your food.  Normally, as you chew the muscle shortens and then lengthens as you put more food into your mouth.  How can stress and jaw pain be related?  If you are under stress and your teeth are clenched, you miss the lengthening movement. This imbalance causes the muscle to shorten.

Put your fingers on your cheeks so you are pressing into your back teeth.  Now, clench your teeth and you’ll feel the muscle bulge.  If you clench your teeth when you sleep or you tend to clench your teeth when you are upset, you are setting yourself up for TMJ.

Stress And Jaw Pain (TMJ)

TMJ (Temporomandibular Joint) pain is a condition where your jaw bone rubs or “clicks” over the bone that is just in front of your ear. It is painful, and over time it will damage the bones. When you are under stress and clenching your teeth, you are shortening your masseter muscle. A phenomenon called “muscle memory” will cause the muscle to actually get stuck in the shortened position. The now-shorter muscle prevents you from opening your jaw completely.  For example, when you yawn.  As you are trying to yawn, your jaw flips over the bone and it hurts.

Several years ago, I had a client who had such tight masseter muscles that a dental surgeon was going to sever them so she could open her mouth.  This is a terrible solution because it would mean her mouth would hang open for the rest of her life. Fortunately for this client, she had to get medical approval before she could have the surgery.  When Dr. Cohen (the doctor I worked with) felt her masseter muscles, he refused to sign the permission form. He told her that she had to see me first.  Fortunately, I was there at the time.  It took just 30 minutes for me to release the spasms and teach her how to do the treatment.  At the end of the session she was pressing into both masseter muscles and opening her mouth.  She did it easily and without pain!  She started to cry because she came within one day of having this unnecessary surgery.

Her life was changed by just a simple self-treatment!

Self-Treatment For TMJ Pain

stress and jaw pain reliefHere is how to administer TMJ pain relief to yourself.  Place your fingers as shown in the picture to the left.  Clench your teeth so you can feel the muscles bulge.

Apply deep pressure on just one side for 5 seconds. Then release that pressure and apply deep pressure to the opposite side for 5 seconds. Go back and forth until it doesn’t hurt anymore.  Then find a different “hot spot,” and repeat.  Continue doing this until you can’t find any more tender points on your muscle and jaw.

To stretch the masseter muscle, just press deeply into the original point on the muscle pain free living book coverand slowly open your mouth wide.

Hopefully, you can now see the connection between stress and jaw pain.  Stress is a killer, and is the cause for pain all over your body.  It’s also important to find the cause of stress and do all that is necessary to resolve it.

My book, “Treat Yourself to Pain-Free Living,” will show you how to self-treat painful spasms throughout your body.  Don’t let the pain caused by stress stop you in your tracks. You can become pain-free, and then go and enjoy a yoga class to release stress from your life.

Wishing you well,

Julie Donnelly

julie donnelly

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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