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Alex Allan Nutrition
By Alex Allan on 01/11/23 | Gut health

ENJOY ‘HAPPY TUMMY’ FOODS

Did you know that up to 80% of your immunity to germs and disease is in your digestive system? The mucosa-associated lymphoid tissue (MALT) in the gut is part of the first line of immune defence so getting the right balance between beneficial or ‘good’ gut bacteria and the ‘bad’ or potentially pathogenic bacteria is key.

The gastrointestinal tract houses a diverse community —thousands of microorganisms, encompassing bacteria, fungi, viruses, and various microbes collectively known as the gut microbiome. Within this delicate ecosystem, certain microorganisms correlate with favourable health outcomes, while others are associated with less desirable effects.

Optimal gut health, characterized by a rich diversity of beneficial bacteria, is integral to the maintenance of a robust immune system. It assumes a key role in modulating immune responses, ensuring a correct reaction to injury or infection without compromising healthy tissue.

The intricate interplay between gut microbiome and immune system functions bidirectionally. Similar to how the immune system exerts influence on gut health, the gut microbiome significantly impacts immune responses, including specific types of inflammation.

Distinguishing between acute and chronic inflammation is imperative. Acute inflammation, such as our bodies’ reaction following physical injury, is a natural part of our body's self-care mechanism. Conversely, chronic inflammation represents a prolonged and detrimental immune response, associated with heightened risks of conditions such as obesity, heart disease, and type 2 diabetes.

Research shows us that the gut microbiome serves as a central conduit, linking chronic inflammation to these chronic conditions.

Turning attention to our nutrition, we know that an individual approach is essential, as no microbiome is the same! However, there are general principles which underpin a good, diverse microbiome – and thus allowing us to support good working of the body’s immune system.

Emphasizing plant-rich diets, particularly those rich in prebiotics found in foods like asparagus, onions, leeks, garlic, legumes, and whole grains, are a great place to start. Prebiotic foods help to feed the friendly bacteria in our guts.

In addition to this, incorporating probiotic-rich foods is another foundational step. Probiotics, living microorganisms found in fermented foods such as yoghurt, kefir, kimchi, sauerkraut, aged cheddar, and kombucha, play a role in enhancing gut microbiome diversity and fostering the proliferation of beneficial microorganisms. Being consistent in consuming these types of foods is key.

In summary, the symbiosis between gut health and the immune system is like a symphony, orchestrated by the gut microbiome. Understanding and nurturing this relationship, particularly through good diet choices, is foundational to a good immune system.

If you are having any gut issues and want to chat further, why not book in a call with me? Here’s the link.

By Alex Allan on 21/04/23 | Gut health

Is your IBS driving you crazy?

Bloating, gassy, cramps, heavy, uncomfortable? One minute you can’t go to the loo and the next minute you can’t get off it. 

The likely cause is Irritable Bowel Syndrome (IBS). It’s incredibly common. According to Guts UK, a charity set up to promote awareness of and funding for digestive problems, it affects up to a third of people at some stage or another and it is one of the main reasons people visit their doctor.

Unfortunately, according to the NHS, there’s not a lot you can do. The official view is that it’s a lifelong problem that no one really understands and that there’s no cure for (although over-the-counter medicines can help symptoms). So sorry, move along and deal with it yourself. 

As nutrition professionals will tell you, there IS hope. A consultation with a nutrition professional specialising in digestive health will be able to, in the first instance, provide some natural solutions that are likely better than taking over-the-counter medication AND your nutritionist will be able to work with you to find the root cause. This will enable you to get to the bottom of what is causing the symptoms of IBS (excuse the pun), and then you can take steps to fix it.

One of the most common causes of IBS is SIBO (small intestinal bacterial overgrowth), which accounts for 60##plus## of IBS cases. This describes a condition where bacteria manage to grow and thrive in the small intestine. It’s not a question of ‘good’ or ‘bad’ bacteria. There shouldn’t really be many there at all.

It might be that you have a lactose intolerance. This is when your body is not able to tolerate lactose, a type of sugar found naturally in milk and other dairy products, leading to a host of ‘IBS symptoms’. It might similarly be fructose malabsorption. Again, some people are not able to absorb fructose and symptoms are very similar to lactose intolerance. 

Dysbiosis is an imbalance in the levels of beneficial (good) and pathogenic (bad) bacteria in the large intestine or colon, potentially caused by the overuse of antibiotics or alcohol, an increase in high sugar diets, and stress. 

Or you might have a yeast overgrowth. Simply, the gut environment gets out of balance (due to dysbiosis) such that unwelcome yeast can thrive.  

None of these are pressing issues for regular doctors because there is often not the NHS testing or the framework for treatment of these problems. In some cases, digestive problems can be tricky to solve, and it almost always involves a lot of detective work. But if your symptoms are hampering your life in a significant way, I want you to know that there ARE things you can do. Although IBS might be very common, it is not normal to experience the symptoms you do.

What can I do about my IBS now?

There are some simple tricks you can put into practice today and that might make enough of a difference to help you get your life back on track. I’m going to tell you what they are in a moment.

I also want you to consider the degree to which your symptoms bother you. Are you satisfied with just covering up the symptoms and hoping for the best? That might be enough for you. If it isn’t, please book yourself in for a free 30-minute digestive health call to get an idea of what you can do right away and what might be possible for you. 

10 ways to improve your digestion

The following suggestions are very basic but surprisingly effective at improving symptoms of digestive distress. 

DO

  • Try a cup of hot water or ginger tea before meals to stimulate digestion.
  • Apple cider vinegar (with the ‘mother’) also works – take 1tsp before a meal.
  • Think about your food before eating it – the thought and smell kickstarts the digestive process.
  • Make sure you’re chewing properly. If you had to spit out the mouthful, no one should be able to tell what you’ve been eating. 
  • Try a few cubes of pineapple or papaya before a meal. These contain enzymes that can boost your digestion. You might also consider taking a natural digestive enzyme supplement from a health food store to support your body’s natural digestion process.
  • Take a 15-minute walk after eating if you can. This lowers blood sugar levels and improves digestion (see, your granny was right).

 

DON’T

  • Eat at your desk at work. Getting up and out is important for so many reasons. In this case, checking emails while you are also eating may have you gulp down your food or not chewing properly. Neither are good for your digestive health. 
  • Try to eat on the go or when you’re stressed out. You won’t digest your food properly or absorb the nutrients. This is the quickest way to get heartburn.
  • Don’t eat fruit after a meal. Fruit likes a quick passage through the digestive system. It can get stuck behind other foods that are digested more slowly and then ferment, causing gas. 
  • Don't drink too much water or other fluids with your meal as this dilutes the stomach acid needed to digest your food properly.

If you’re sick of feeling bloated, gassy, crampy, or going to the loo too often (or not often enough), book in for a free 30-minute digestive health mini consultation. You can do that by clicking this link here.

By Alex Allan on 15/04/23 | Gut health

Probiotics and prebiotics. What are they and why are they important?

You’ve probably heard people talk about ‘good’ and ‘bad’ bacteria and that we want to have more ‘good’ bacteria because this has a positive effect on your health. I’ll bet you may also have a conceptual idea that probiotics will help you, and perhaps you’ve seen little bottles of probiotics advertised as the saviour of your health. Today I want to let you know why this all matters, so that you can make the best choices for your health. 

Good v bad bacteria

When we talk about bacteria in the gut, we are usually talking about bacteria in the large intestine, the colon. Your ‘microbiome’. The microbiome is a parallel universe of all kinds of different microorganisms running all through your digestive tract, that runs from your mouth to… well, the other end. 

Most of these organisms are bacteria, and there are lots more of these than there are cells in your body - about ten times as many. The balance of the bacteria in your digestive system has implications for your health in general and not just your innards. In short, it’s important to have the right kinds of bacteria in the right places. It matters that the ratio of good to bad bacteria works – when you’re out of balance (when there are more unfavourable bacteria and other microorganisms) nutritionists call this ‘dysbiosis’.

These microorganisms play a crucial role in maintaining overall health, as they help to break down food, make vitamins, regulate your immune system, and prevent the growth of harmful pathogens. When we think about the gut, consider we want a balance between the good and bad microorganisms, a victory of ‘good’ over ‘bad’ bacteria and yeasts, and so on. 

Research tells us the composition of the microbiome can vary widely from person to person, and that changes in the microbiome may be associated with a variety of health conditions, including inflammatory bowel disease, obesity, and diabetes. As a result, there is growing interest in understanding more the microbiome and its role in health, and in developing strategies to maintain or modify the microbiome for therapeutic purposes. As a nutrition practitioner, it’s one of the areas that fascinates me and I spend a lot of time in clinic talking to people about how they can use food and supplements to support the health of their microbiome. 

(As an aside, although the word microbiome is most commonly associated with the gut, in reality, your microbiome also refers to other parts of the body, such as the skin, mouth, and reproductive tract.)

One of the ways you can keep a healthy gut environment is to tackle any digestive problems you might be struggling with (ask me if you need help), eat the kinds of foods our body really needs and (potentially) take supplements to help ensure the bacterial balance in your gut microbiome stays positive in spite of what 21st century living may throw at it. Eating probiotic foods and prebiotic foods can help.

Probiotic foods

Probiotic foods are foods that naturally contain live microorganisms like bacteria or yeasts. They are often referred to as "functional foods" as they provide nutritional benefits beyond basic nutritional needs. Think of these as providing your body with additional healthful bacteria. 

Some of the most common probiotic foods include:

  • Yoghurt: Yoghurt is made by fermenting milk with bacterial cultures, typically Lactobacillus bulgaricus and Streptococcus thermophilus. Some yogurt products also contain additional probiotic strains, such as Lactobacillus acidophilus and Bifidobacterium lactis.
  • Kefir: Kefir is a fermented milk drink that is made by combining milk with kefir grains, which contain a mixture of bacteria and yeasts. Kefir is rich in probiotics and may also contain other beneficial compounds, such as vitamins and minerals.
  • Sauerkraut: Sauerkraut is a fermented cabbage dish popular in Europe that is made by combining shredded cabbage with salt and allowing it to ferment for several days. The fermentation process produces lactic acid, which gives sauerkraut its distinctive sour taste and also serves as a natural preservative.
  • Kimchi: Kimchi is a spicy Korean dish that is made by fermenting vegetables, typically cabbage, with a mixture of spices and seasonings. Kimchi is rich in probiotics and may also contain other beneficial compounds, such as antioxidants and anti-inflammatory compounds.
  • Miso: Miso is a Japanese condiment that is made by fermenting soybeans with a type of fungus called Aspergillus oryzae. Miso is typically used as a seasoning in soups and other dishes and is rich in probiotics and other beneficial compounds, such as antioxidants and vitamins. You can buy miso soup to drink as a snack and also miso paste, which you might use in cooking, from many supermarkets. 

What about probiotic drinks?

You will undoubtedly have seen mass-produced and heavily advertised drinks like Actimel and Yakult on supermarket shelves. Unfortunately, many of the popular ones do not have enough bacteria and/or the bacteria do not survive the harsh digestive environment in the gut, therefore do not have an impact. Just swallowing something ‘good’ is not enough. Often these additionally either have added sugars or sweeteners to make them palatable, which is not that great for the gut. My view: go for the more traditional form of fermented foods.

Probiotic supplements

You’ve likely also have seen probiotic supplements, even on supermarket shelves and wondered whether you should take one. 

Unfortunately, a supplement cannot replace a good diet, but it can help provide targeted support. If you have digestive problems, let’s have a chat about what we can do to help. Since everyone is different and we all have a unique microbiome, truly targeted support can look like finding specific strains of bacteria to support certain conditions (some strains are great for supporting low mood, others are helpful for hormone balance, and so it goes on). These are often not the kinds of products without professional recommendation. 

That said some of the key beneficial bacteria that can help include lactobacillus (acidophilus and rhamnosus) and the bifidobacteria group (breve, longum, lactis). Bottom line, what will most benefit you very much depend on the specific symptoms or conditions you are dealing with. And I would *always* look at diet before supplementation.

About prebiotics

Prebiotics are a type of dietary fibre that are not digested in the small intestine, but instead reaches the large intestine where they serve as a food source for beneficial gut bacteria. So, while probiotics provide additional bacteria, prebiotics feed the bacteria that are already there and help promote the growth and activity of specific types of bacteria that are considered beneficial for health.   

Some common types of prebiotics include inulin, fructooligosaccharides (FOS), and galactooligosaccharides (GOS). These prebiotic fibres are found naturally in many plant-based foods, such as bananas, onions, garlic, leeks, asparagus, artichokes, and whole grains.

Cruciferous veggies are also very helpful for your digestion, you should know that they contain compounds called glucosinolates, which are fermented by bacteria and used as fuel. They are also prebiotic. 

Examples are: Bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, kale and spring greens.

Prebiotics have been shown to have a variety of health benefits, including improving digestion, boosting the immune system, reducing inflammation, and improving the absorption of certain nutrients. Additionally, research suggests that prebiotics may help reduce the risk of certain health conditions, such as type 2 diabetes, heart disease, and colorectal cancer.

It is important to note that while prebiotics are beneficial for health, they can also cause digestive discomfort in some people, particularly when consumed in high amounts. Anyone with IBS, for example, should approach some of these foods with care. What lurks behind the majority of cases of IBS is bacteria in the small intestine, where we don’t really want it (large intestine, yes, small intestine, no). Your body really should do a daily swoosh of all bacteria from the small intestine down to the colon (called the Migrating Motor Complex) but for a variety of reasons that might not occur. What can then happen is the bacteria in the small intestine can feast on these lovely prebiotic foods, causing gas, bloating and discomfort. That’s not me telling you don’t eat these foods but, if you have digestive problems, start with small quantities until you work out what your body can tolerate. 

You can also buy prebiotic supplements like FOS but I wouldn’t advise these unless you are working with a nutrition professional. They can be really helpful in a digestive health programme but only if you know what you are doing and which specific products to buy. 

A healthy microbiome 

5 important things your gut bacteria do for you:

1 Kill bugs and hostile bacteria 

These can cause unpleasant symptoms or disease – like the ones that cause food poisoning or stomach ulcers.

2 Boost your immunity

60% of your immunity is in your gut and the immune tissue in your digestive system is very sensitive to bacterial activity. The good bacteria also encourage the body to make a particular kind of antibody that stops you getting sick.

3 Improve digestion

Some bacteria help you break down particular foods and even help with the muscular contractions that move food through your system – thus keeping you regular.

4 Make vitamins & help you absorb nutrients better

Your gut bacteria are responsible for making many B vitamins, and these same bacteria help you absorb minerals in the food you eat better.

5 Protect against disease

Some bacteria produce enzymes that turn the fibre you eat into short chain fatty acids (SCFA). This is interesting because these SCFAs can help protect against heart diseases by regulating cholesterol and having a positive impact on fats in the blood. A particular type of SCFA called butyrate has been shown to be protective against cancer.

Are you interested in finding out more? Why not book in a call with me here.

By Alex on 02/02/22 | Gut health

Is your IBS driving you crazy?

Bloating, gassy, cramps, heavy, uncomfortable? One minute you can’t go to the loo and the next minute you can’t get off it? 

The likely cause is Irritable Bowel Syndrome (IBS). It’s incredibly common. According to Guts UK, a charity set up to promote awareness of and funding for digestive problems, it affects up to a third of people at some stage or another and it is one of the main reasons people visit their doctor.

Unfortunately, according to the NHS, there’s not a lot you can do. The official view is that it’s a lifelong problem that no one really understands and that there’s no cure for (although over-the-counter medicines can help symptoms). So sorry, move along and deal with it yourself. 

As nutrition professionals will tell you, there IS hope. A consultation with a nutrition professional specialising in digestive health will be able to, in the first instance, provide some natural solutions that are likely better than taking over-the-counter medication AND your nutritionist will be able to work with you to find the root cause. This will enable you to get to the bottom of what is causing the symptoms of IBS (excuse the pun), and then you can take steps to fix it.

One of the most common causes of IBS is SIBO (small intestinal bacterial overgrowth), which accounts for 60##plus## of IBS cases. This describes a condition where bacteria manage to to grow and thrive in the small intestine. It’s not a question of ‘good’ or ‘bad’ bacteria. There shouldn’t really be many there at all.

It might be that you have a lactose intolerance. This is when your body is not able to tolerate lactose, a type of sugar found naturally in milk and other dairy products, leading to a host of ‘IBS symptoms’. It might similarly be fructose malabsorption. Again, some people are not able to absorb fructose and symptoms are very similar to lactose intolerance. 

Dysbiosis is an imbalance in the levels of beneficial (good) and pathogenic (bad) bacteria in the large intestine or colon, potentially caused by the overuse of antibiotics or alcohol, an increase in high sugar diets, and stress. 

Or you might have a yeast overgrowth. Simply, the gut environment gets out of balance (due to dysbiosis) such that unwelcome yeast can thrive.  

None of these are pressing issues for regular doctors because there is often not the NHS testing or the framework for treatment of these problems. In some cases, digestive problems can be tricky to solve, and it almost always involves a lot of detective work. But if your symptoms are hampering your life in a significant way, I want you to know that there ARE things you can do. Although IBS might be very common, it is not normal to experience the symptoms you do.

What can I do about my IBS now?

There are some simple tricks you can put into practice today and that might make enough of a difference to help you get your life back on track. I’m going to tell you what they are in a moment.

I also want you to consider the degree to which your symptoms bother you. Are you satisfied with just covering up the symptoms and hoping for the best? That might be enough for you. If it isn’t, please book yourself in for a free 30-minute digestive health call to get an idea of what you can do right away and what might be possible for you. 

10 ways to improve your digestion

The following suggestions are very basic but surprisingly effective at improving symptoms of digestive distress. 

DO

  • Try a cup of hot water or ginger tea before meals to stimulate digestion.
  • Apple cider vinegar (with the ‘mother’) also works – take 1tsp before a meal.
  • Think about your food before eating it – the thought and smell kickstarts the digestive process.
  • Make sure you’re chewing properly. If you had to spit out the mouthful, no one should be able to tell what you’ve been eating. 
  • Try a few cubes of pineapple or papaya before a meal. These contain enzymes that can boost your digestion. You might also consider taking a natural digestive enzyme supplement from a health food store to support your body’s natural digestion process.
  • Take a 15-minute walk after eating if you can. This lowers blood sugar levels and improves digestion (see, your granny was right).

 

DON’T

  • Eat at your desk at work. Getting up and out is important for so many reasons. In this case, checking emails while you are also eating may have you gulp down your food or not chewing properly. Neither are good for your digestive health. 
  • Try to eat on the go or when you’re stressed out. You won’t digest your food properly or absorb the nutrients. This is the quickest way to get heartburn.
  • Don’t eat fruit after a meal. Fruit likes a quick passage through the digestive system. It can get stuck behind other foods that are digested more slowly and then ferment, causing gas. 
  • Don't drink too much water or other fluids with your meal as this dilutes the stomach acid needed to digest your food properly.

If you’re sick of feeling bloated, gassy, crampy or going to the loo too much (or too little), book in for a free 30-minute digestive health mini consultation. You can do that by clicking here.

By Alex on 24/05/21 | Gut health

THE MICROBIOME – HOW IT KEEPS US HAPPY AND HEALTHY

An adult human has around 2kg worth of microbes in our large intestine comprised of bacteria, viruses, archaea, fungi… and sometimes parasites.  In fact, our guts are so well populated that we actually have more bacterial cells in our bodies than our own cells. And as odd as this may sound, this tiny ecosystem in our gut plays an essential role in our health and wellbeing, both physically and mentally.

When the bacteria in our gut are living in balance, with the right combination of good variety of types of bacteria, we have a wonderful symbiotic relationship with them, where we feed them fibre and, in return, they fulfil a number of roles for us:

  • They help us digest and draw nutrients from different foodstuffs, even allowing us to draw extra energy. 
  • They provide special chemicals called Short Chain Fatty Acids, which act as food for the cells of our gut lining. 
  • They produce vitamin K and help us create vitamin B12 in our guts by providing the necessary enzyme.
  • Research shows that having a balanced microbiome may be protective of certain chronic diseases such as cardiovascular disease, diabetes, autoimmune conditions and even certain types of cancer.
  • Immune tolerance as about 80% of our immune system is in our gut, and our bacteria work alongside our immune system to help recognise what is friend and what is foe.

Finally, our microbiome plays a key role in our mental health. This may be no surprise when you think about getting butterflies when you’re nervous or needing the loo when you’re frightened – the connection between our gut and our brain is very real indeed. Research shows that a happy gut is a happy brain and vice versa. 

Sometimes called the Microbiome-Gut-Brain axis, the connection via the Vagus Nerve allows two-way communication between our brains and our guts, and scientists believe that this is to allow and monitor integration of gut signals into the emotional and cognitive centres of the brain. This allows our brains to have up-to-the-second information on our immune system, our gut function, plus production of certain gut-derived neurotransmitters, such as the feel-good serotonin. In turn, the brain supplies the gut with information to control immune function, motility and the permeability of the barriers.

Working alongside the central nervous system in such a way means that the microbiome and gut may have real influence over our emotional states, particularly when it comes to stress responses, anxiety and memory function. And this can often be seen in action with people with altered gut function, such as IBS, where other symptoms may include anxiety and low mood.

Looking after our microbiomes is therefore key to our overall health and mental wellbeing.

IBS

By Alex on 30/04/21 | Gut health

Irritable Bowel Syndrome or IBS is a problem I often see in clinic and it can be problematic on many different levels. If you've been diagnosed with this condition, you may well have been suffering with it for years and, while a diagnosis can – at first – offer comfort in finally having a recognised problem,that may be short lived because often that’s where all support ends, and you’re left no further forward in actually fixing what the problem is. Or you may have self-diagnosed through searching the internet by using a process of elimination.

The difficulty begins because IBS is essentially a catch-all term, which is used to encompass a huge variety of digestive issues. In my experience, it’s likely to be one of the following five conditions:

1 SIBO (small intestine bacterial overgrowth)
Around 60% of people with IBS will have SIBO. Though you might have heard about good (and bad) bacteria in the gut, really what experts are talking about is the balance of bacteria in the large intestine: the colon.
The small intestine shouldn’t have hardly any bacteria, and each day the body should perform a flush to sweep bacteria from the small intestine and into the large intestine. This flush is called the ‘migrating motor complex’. For a huge variety of reasons (historic food poisoning being the most common, but also low levels of stomach acid or adhesions play a role, among others) the bacteria are not swept away.
The trouble is that these bacteria can ferment the food in your small intestine, causing gas, belching, bloating, pain and a variety of other symptoms, including constipation and/or loose stools, and even anxiety. A breath test can establish which gases are present, and we can devise an action plan based on your results. 

2 Lactose intolerance
This is when your body is not able to tolerate lactose, a type of sugar found naturally in milk and other dairy products. Essentially, bacteria in your intestine feed on these milk sugars, leading to a host of IBS symptoms, like bloating and gas, nausea, constipation or diarrhoea.
It can go hand in hand with other digestive complaints, such as coeliac disease or increased intestinal permeability (‘leaky gut’). Lactose intolerance can be diagnosed via a simple at-home breath test. 

3 Fructose malabsorption
The symptoms are very similar to lactose intolerance. Fructose (which is found in fruit, honey and many processed foods) is a sugar, which, like lactose, is digested in the small intestine.
Some people cannot absorb fructose, and what is not absorbed is fermented by intestinal bacteria, causing bloating, cramping, gas and distension of the stomach. You might also experience brain fog and headaches.
A breath test will confirm the condition. 

4 Dysbiosis
This is an imbalance in the levels of beneficial (good) and pathogenic (bad) bacteria in the large intestine or colon. This is now common due to overuse of antibiotics and alcohol, an increase in high sugar diets, and stress.
Symptoms can vary from a sluggish bowel, constipation or diarrhoea or both, pain, bloating and flatulence, to chronic bad breath, joint pain, fatigue and food sensitivities.
Dysbiosis is also implicated in a variety of health conditions like diabetes, heart disease and obesity. A stool test can help establish whether your gut bacteria are out of balance, along with a host of other markers that might be useful in getting to the root of your digestive problems.
 
5 Yeast overgrowth
Where the gut environment becomes out of balance (due to dysbiosis), yeast can thrive. Diets high in sugar feed the yeast – although if you think you might have a yeast overgrowth, it’s worth noting that long-term yeast problems can mean that the yeast cells are pathogenic or disease causing, and that the yeast has switched its metabolism to also be able to digest protein and fat.
Symptoms of yeast overgrowth include recurring thrush, gas or bloating, fatigue, bad breath, cravings for sweet foods, joint pain and brain fog. 
A stool test can establish the presence of candida or other yeast overgrowth. 
 
Some people struggle with digestive problems for years, but you can often get to the root cause of the issue and make changes to help you feel like yourself again. Do get in touch if you'd like to find out more about how I can help you find your root cause. I offer free 30 minute health assessments - click the link to book.

 

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