Jump-Start or Re-Energize Your Health and Well-Being for 2017: 8 steps to getting your wellness program on track and feeling your best

Dr. Joel’s Health and Wellness Catalyst Blog for January – Happy New Year!

January is a great time to start fresh and make progress toward having an ongoing program of well-being for the year and feel your best.  Hopefully you had a wonderful Holiday and New Year that enables you to move forward with a sense of gratitude and purpose; or you can put a challenging year behind you and start fresh with renewed focus to make progress with accomplishing your plans and goals.

Here are 8 steps that can help you get started and on track – you can start with 1 step or take on 2-3 steps and build from there.  If you need assistance you can contact one of your practitioners that you work with (for example, a good nutritionist, counselor or primary care doctor) or start with someone new who can be helpful, such as a health coach, who can help you to put all this together and support you in many ways on your journey to sustained well-being:

1.     Know where you are beginning – check in with how you are feeling, get some blood work done, weigh yourself, and/or see your doctor to get your blood pressure taken or have any other assessments done that you may be concerned about and want to control better or address.  Having this clarity can help you to take specific actions that make the most sense.

2.     Set 1-4 goals that you are most motivated to accomplish – they should be important goals to you and be reasonable or attainable goals (3 month goals are usually best).  From the coaching framework that I find very effective, you would then make more modest goals, for example 2 week goals, that would help you to achieve your longer term goals – if you achieve the goals that would be great, but if not, be positive and see what you can learn about your challenges so that you can overcome them and do better with them over the long term.

3.     With any specific concerns/problems, get good information and/or ask for help – for example, if you are not sure what an excellent exercise program would be for you, or if you have some aches/pains or chronic pain that create doubt about what is best to do without injuring yourself see a good physical therapist, osteopathic doctor or a good chiropractor who can work with you to manage your issues.

4.     Try a modified elimination diet or a really healthy diet for 1-4 weeks - we often forget how good we really feel when we are eating more healthfully or eating a clean diet (and doing some exercise, as well as finding some time to relax and practice relaxation techniques).  One such approach is to avoid or minimize sugar, refined flour products, dairy, wheat, alcohol and caffeine (or cut the caffeine intake in half).  These foods tend to cause the most problems (especially in combination) and could be minimized by including them once or twice per week – be sure to have other good food options to take their place.

5.     Get some support from family, friends, neighbors and/or work colleagues - this would be different from your work with practitioners, and could include taking a brisk walk with someone or meeting them at the gym to workout together or at the same time; or it could mean having lunch with a co-worker to share what is working and get support around more challenging issues; or it could be getting support from a family member or spouse to help with cooking/cleanup or getting time by having them watch a child while you exercise or have some time for yourself.

6.     Stay focused and organized – Logging food and/or exercise and/or tracking your progress can be an important part of your ongoing program.  Another could be keeping all of your health information and program records in a notebook, journal or file.  This way you have all of your information together and have a place to go when you need focus and need to do it more quickly.  It can also be helpful to journal several times per week to describe the good, the bad and the ugly – sometimes it is just helpful to get it out on paper but it can also be used to problem solve and/or get clear about what works best for you (even better is to talk about these with a practitioner or a friend).

7.     Try a new stress management technique and/or commit to staying  positive about yourself and your efforts – there are many approaches that you can select from or work with, and many people who present approaches that can be helpful - the important thing to remember is to see what resonates with you and what you are most interested in trying.  Some examples include breathing exercises, a yoga or tai chi class, meditation or guided imagery, and many others.  Consider also self-compassion or loving kindness meditations, or the book, Positivity, by Barbara Frederickson.

8.     Develop an excellent group of practitioners to work with – make sure that you like and trust them, and that they really do listen and try to help.  Sometimes it is the combination of practitioners that works best such as a solid primary care doctor and others who add other important parts.  Also, if you know what you need to do but have a hard time staying engaged, consider getting a good health coach who can help in many ways (helping you clarify your approaches, problem-solving/brainstorming, generally supporting you, and sharing experiences about approaches that have been helpful for different people with similar circumstances).

So good luck!  I have listed a number of approaches that can be helpful but the most important take home message is that you partner with your practitioner(s) to develop the individualized and effective program that is right for you.  And be persistent because there are answers and approaches out there that fit together like pieces of a puzzle and will work to have you feeling your best.

De-Stressing the Holiday Celebrations: How to enjoy and navigate the Thanksgiving to New Year's Holidays with the least stress

Dr. Joel’s Health and Wellness Catalyst Blog for November

While everyone’s challenges and stresses may differ during the holiday season, the approaches to having the most enjoyment and fun, and the least stress during this time can be priceless.  Between the work that is needed to prepare food and buy presents, and the challenges of potentially difficult family members (perhaps with opposing political views), lots of junk food calling out and/or the stress of ongoing work, home and/or other to do lists, we can often feel overwhelmed.  Drawing on lessons from past experiences and our current resources, as well as planning ahead can make all the difference.

What are your biggest challenges or stressors?

Identifying these at the beginning can be most important.  We also have strengths and weaknesses, enjoyable and torturesome tasks to do, and circumstances that push our buttons, so be present to these situations, and see if there are more effective or manageable ways to get them done.  Talk with family members or friends to make decisions that work best for you and your family, and develop a plan that hopefully finds the right balance.

Remember the true meaning of the Holidays?

Thanksgiving just finished – what a great holiday (definitely one of my favorites), and a chance to spend time with family and/or friends to reflect on all that we have to be truly thankful for and/or to be in action or think of others who may not have as much to be thankful for.  It is also a wonderful time to get some needed rest and relaxation, fun, and possibly plan for and prepare for the Holidays in December.  In addition to gratitude, consideration of loving kindness, service, mindfulness and peace for ourselves, our families and our communities, these all can provide the meaning and themes for this time of the year.

Take steps to manage the stress or plan for the framework of steps:

1.     Keep up with regular exercise – even if it is less than usual, do what you can and it will make a difference especially if you can do some others below

2.     Find the right balance that you need of healthy foods and other foods that are not as healthy but may be important for you to enjoy the holidays.  Set guidelines for holiday meals, parties, and foods that are kept at work or at home that might be tempting but also might cause you to feel tired, upset your stomach, give you a headache or just cause you to gain weight

3.     Continue your regular practice of relaxation techniques – mindfulness, meditation, prayer, breathing exercises and other approaches.  Again, even if you are not able to do as much as you usually do, whatever you can do will be helpful and help to balance the stress

4.     Ask for help – who can you go to if you need assistance to get things done

5.     Contact your go to people – who can you go see or call to talk about how you are feeling or the challenges or problems that you are dealing with

6.     Seek assistance or connect with your counselor, psychologist or social worker – this is why you have a practitioner as part of your healthcare team (or if it would be helpful, find someone), since this is also an opportunity to work through relationships or developmental issues that will tend to reappear until we fully address them, find completion and/or find peace with it/them

7.     If you are trying to lose weight, you may want to consider a different goal to maintain your weight during this time and start fresh again after the New Year to lose weight – not necessary for some but very important for others

Other Considerations

1.     Plan some of your favorite rituals to connect with the true meaning and joy of the holiday – this can be so many things from decorating for the holidays, to favorite or funny movies, to cultural activities, to sing-alongs, other musical performances and sporting events

2.     Take breaks or set aside time to do nothing or check in with how everything is going

Have a very Happy and Healthy Holiday Season!!

Managing the Winter Blues: Specific information and approaches to help control Seasonal Depression (Seasonal Affective Disorder - SAD) and the more mild and common form, winter blues

The Health and Wellness Catalyst:  October, 2016

This past year I have worked on a corporate wellness project for a healthcare system and it has been a revelation to me how common seasonal depression is, and how important it is to understand its influence on mood so that it can be managed effectively.   What I found was that about 20 percent of the participants that I worked with had this seasonal depression or winter blues, which I thought was surprisingly high – it also was important for me as their health coach to support them with information and/or approaches that would help them to address it.  In this way they could be more aware of their seasonal and yearly tendencies, and take specific steps to clarify, adjust and/or sustain their health and well-being goals.

I therefore went to one of the best resources:  Winter Blues: Everything you need to know to beat seasonal affective disorder, by Norman E. Rosenthal, MD, 4^th edition, Guilford Press, NY, 2013.  Dr. Rosenthal is a psychiatrist and one of the leading practitioners who has developed, researched and educated the public (and the healthcare field) about seasonal depression.  I also heard an interview with him (I think on Voices in the Family with Dan Gottlieb, PhD on NPR) and he is a truly caring physician who has made an important contribution to mental health and to those who see him as a health practitioner.

Anyway, Dr. Rosenthal states in his book that about 5 percent of the US population has SAD and another 14 percent have winter blues – which is about what I observed in my health coaching project.  Interestingly, some people start to feel the changes in the fall when days start to get shorter, while others commonly feel it starting in the coldest winter months of January and February.  SAD and winter blues can be felt by experiencing one or more of the following symptoms: feeling down or depressed, having difficulty focusing on work or in relationships, snacking more (especially on carbs and/or sugar), feeling more tired, sleeping more, difficulty waking up in the morning and many other possible symptoms.

What to do if you feel like you may have SAD or winter blues:

1.     Learn more about SAD and winter blues – look at information provided by reliable sources online or get Dr. Rosenthal’s book.  Also, discuss it with your primary care doctor and/or counselor or psychologist to help determine whether it is having an important effect and what steps should be considered.

2.     Look at your lifestyle to see how well you are doing with your nutrition (diet and targeted nutritional supplementation), exercise and fitness (are you consistent?), and your stress level and relaxation techniques (are you balancing the stress enough with exercise, relaxation/mindfulness/ meditation and time for yourself?)

3.     Light therapy – research suggests that it is very helpful for season depression and newer research suggests that it may also be helpful for non-seasonal or unipolar depression also.  Make sure you get a good light box that has been approved for SAD or winter blues and make sure you spend time each day in front of it to get the light that you need to feel better.

4.     Consider seeing a psychologist, social worker or counselor to get more specific assistance and support, and if necessary, consider if anti-depressant medication may be needed.

5.     Regular exercise is helpful for managing both stress and mild to moderate depression – is your program helpful? Are you following through with it? Do adjustments need to be made?

6.     Good nutrition is important - the foundation should be a natural, healthy diet, which could be a Mediterranean type diet or a lower/moderate carbohydrate diet.  Targeted supplements could be added also such as B complex, vitamin D, fish oil, magnesium, chromium and/or others.

7.     Meditation, mindfulness and stress management techniques such as yoga, tai chi, chi gong, and others can help – again do you have a good program? Are you following through? Are adjustments or new approaches needed?

8.     As with all symptoms or disorders, it is important to identify the most important and unique effects for you (for example, knowing when symptoms tend to start), what approaches are most important for you and getting support from the practitioners who are part of your healthcare team and/or family and friends who are part of your support network.   

As this discussion shows, there are many options for effectively managing SAD and winter blues, but half of the challenge is realizing that this may be a problem for you, and then the other half is to get into action by learning about it and finally getting any help that you need to manage it.

Know Your D Level: Although not a miracle nutrient, vitamin D is essential for helping to prevent many health problems including heart disease, cancer, depression and memory loss

Dr. Joel’s Health and Wellness Catalyst Blog:  September, 2016

Know Your D Level: Although not a miracle nutrient, vitamin D is extremely important for many health issues such as heart disease, cancer, depression and memory

The list of vitamin D related health issues seems to grow almost on a monthly basis – bone health, heart disease, blood sugar regulation and insulin resistance, depression, susceptibility to common cancers and auto-immune diseases, memory, pain, etc.  How can this be, you say – well, it turns out that vitamin D helps to regulate and is a co-factor for 10-20 % of all genetic activity, which is a huge amount and central to almost all of our bodily functions. 

**  Everyone should know what their blood level is and be taking it unless they have at least a level of 40 mg/dL.

A good example of the importance of vitamin D comes from a recent study looking at its important effect in memory and cognition.  What was most interesting to me was that not only was higher level of vitamin D at the beginning of the study associated with better memory or cognition level, but it was also associated with the amount of cognitive decline that occurred over time (lower vitamin D level was associated with greater change or worsening of cognitive measures over the four year period in which the participants were followed).

Research has tied vitamin D to variety of functions and influences within the brain that may be important for maintaining healthy functioning.  These include the vitamin D receptors found in many parts of the brain that affect brain activity and vitamin D’s promotion of anti-oxidant function which protects tissues from aging or ‘rust’ damage (very important for maintaining nerve cell function and overall nervous system activities).

Vitamin D and vitamin D blood levels are also important for the two leading causes of death in the United States – cancer and heart disease.  Benefits of higher levels of vitamin D have been shown in certain types of cancer - one study from Norway found that higher levels of vitamin D were associated with longer length of survival in breast, colon and lung cancer, as well as in lymphoma (Tretli S, et al, 2012).  With regard to heart disease, vitamin D level may be a marker of and/or contributor to high blood pressure, heart failure, stroke, peripheral vascular disease, irregular heart beat disorders and/or overall death or mortality – lower vitamin D levels increase risk.

I have also wondered why so many people are vitamin D deficient and I thought that it might relate to environmental chemicals (in addition to using so much sun screen and other influences – sun helps to make the active form of vitamin D) because many of these chemicals are hormone or endocrine disrupters and vitamin D is also a hormone.  A recent study has found a link between the intake of Bisphenol A - BPA (found in some food can linings and plastic water bottles) and phthalates (found in some plastics and cosmetics) and vitamin D blood levels (Johns LE et al, 2016).

It is therefore important to know your vitamin D level (25 hydroxy vitamin D),  take extra vitamin D if you need it (vitamin D3 – 1000 to 5000 IUs per day) and make sure that your overall nutrition and lifestyle program is effective for your health history and current health issues.

1. Wilson VK, et al.  Relationship between 25 hydroxyvitamin D and cognitive function in older adults: the Health ABC study J Am Geriatr Soc 2014;62:3839-53.

2.  Tretli S, et al.  Serum levels of 25 hydroyvitamin D and survival in Norwegian patients with cancer of the breast, colon, lung and lymphoma: a population based study.  Cancer Causes Control  2012;23:363-70.

3.  Lugg ST, et al.  Optimal vitamin D levels for cardiovascular disease protection.  Dis Markers  Sept 8, 2015; epublication.

4.  Johns LE, et al.  Relationships between urinary phthalate metabolite and bisphenol A concentrations and vitamin D levels in US adults: NHANES, 2005-2010.  J Clin Endocrinol Metab 2016 Sep 20 (epublication).

International Congress of Integrative Medicine and Health: Meeting in Las Vegas, May 17-20: Update and Highlights

International Congress of Integrative Medicine and Health:  Meeting in Las Vegas, May 17-20:  Update and Highlights

Welcome to the May issue of the Health and Wellness Catalyst Blog

I recently got back from this educational and enjoyable meeting and wanted to give you an update on what I found:

1.     First, it was a gathering of almost 800 people – physicians, psychologists, nutritionists, acupuncturists, naturopaths and other similar practitioners, and other stakeholders - from all over the world.  Most of the attendees are members of the Academic Consortium For Integrative Medicine and Health, composed of over 60 member university hospitals and/or medical schools from North America – to get more info on them or to find a local member organization, go to www.imconsortium.com. 

2.     The research on integrative medical and health approaches to many diseases and conditions is expanding quite rapidly – that is an important step forward since this model of care and research of integrative care will help in the understanding of both practitioners and clients, resulting in more integrative approaches to common conditions and diseases.

3.     I presented three posters at the conference, which all were received well – these included:

a.     A research poster: Perceived stress in patients with common gastrointestinal disorders:  Associations with quality of life, symptoms and disease management

b.     An Integrative Nutrition Consultation Practice in a Suburban Philadelphia Counseling and Therapeutic Center

c.      Targeted Cancer Coaching for Cancer Survivors:  Individual and Group Programs to go From Surviving to Thriving

I also want to summarize a couple of keynote presentations that were very interesting and inspiring:

I.               Well-Being is a Skill:  Perspectives from Affective and Contemplative Neuroscience, by Richard Davidson, PhD, Center for Investigating Healthy Minds, University of Wisconsin.

This was a really interesting talk by the researcher who has been visited about ten times by the Dali Llama and challenged by him to focus on health and well-being, and happiness, as opposed to disease.  He described four constituents of Well-being including: (a) Resilience; (b) Positivity; (c) Attention-presence (he said that a “wandering mind is an unhappy mind;” and (d) Generosity.  The last, generosity is not as well validated as he would like to see.

He also talked about compassion training – it does not take a lot of practice to see brain activity changes using scanning techniques.  Positive effects were shown for adults who did the training for 30 minutes per day for two weeks.

II.             Pain and the Brain: Conceptual and Clinical Considerations, by Lorimer Moseley, PhD, University of South Australia.

This was a fascinating discussion of pain and neuroscience, which he developed and is continuing to research.  His basic premise, if I understand it correctly, is that we have a tissue tolerance level of pain and that we continually ‘protect ourselves’ from pain.  However, if we are continually protecting ourselves we are reacting significantly or over-reacting to pain when we don’t really need to.  He therefore suggests that we acknowledge pain but identify when it hurts but that we are safe and not needing to react so much or over-react. 

Another interesting story which he described and illustrates the power of  the mind-body connection or interaction involved reported pain and swelling in a study – it showed that people who looked through binoculars that enlarged their swollen hand reported more pain and swelling than those who looked through it and saw a smaller and less swollen hand – cool experiment!

His books that describe his approaches to pain and people with pain are, The Explain Pain Handbook Protectomer, 2015; and Painful Yarns: metaphors and stories to help understand the biology of pain, 2007.

I also had some fun meeting new people at the conference and did get into Las Vegas one evening to enjoy a great Italian meal at the Venetian Casino – it was painful to not be able to take home leftovers!  So all in all, it was a really good conference and trip, enjoyable, and helpful to promote some of my current research and activities that will move forward.

Nutritional and Holistic Keys to Maintaining Effective Memory:  New research suggests combined benefits from B complex vitamins and omega 3 fatty acids (fish oil)

Welcome to the April issue of the Health and Wellness Catalyst Blog

It has been known for some time that B complex vitamins such as vitamin B12, folate, and vitamin B6, and omega 3 fatty acids are important for healthy nervous system functioning and good  memory.  This has been attributed to the importance of B complex vitamins in producing specific neurotransmitters in the brain, which help to transmit messages or signals between nerve cells.  Omega 3 fatty acids are more important in nerve cell membrane function because they help to keep these cells more flexible and therefore function better.  It should be remembered that there are several minerals that are also important for producing neurotransmitters, and magnesium and zinc are most helpful.  Finally, vitamin D is another nutrient that can influence brain function and memory.

Research studies that were part of my doctorate in Nutrition Science

My research for my doctorate in nutrition, assisting Dr. Iris Bell, showed combined effects of vitamin B12 and folate on memory in patients in the geriatric psychiatric unit at McLean Hospital, Harvard’s psychiatric hospital.  One of the most interesting aspects of this work was that they were not deficient levels of vitamins but below average or below median levels of both B vitamins.  This suggested that even low normal levels of nutrients are important because they interact in ways that are vulnerable to ineffective function.

Recent research in the Journal of Alzheimer’s Disease

In the research that I am focusing on this month, 266 participants with mild cognitive impairment (MCI), who were also over 70 years old, were given the combination of vitamin B12, folic acid and vitamin B6 for two years, or they were given a placebo (a dummy pill with no vitamins).  After the study was completed, it was found that the B complex vitamins were helpful for decreasing the cognitive function decline, but only when the levels of the omega 3 fatty acids were in the upper end of the normal range.  Also, DHA seemed to have more of an effect than EPA, suggesting that fish oil supplements have both DHA and EPA or more DHA than EPA.

Holistic approaches to good memory

There are several factors that research suggests are known to improve or maintain good memory with aging.  These include:

1.     Regular exercise – some research has shown that the size and function of the hippocampus, the primary part of the brain associated with memory, is increased and improved;

2.     Relaxation techniques – stress is well known to decrease the size of the hippocampus and impair memory while relaxation techniques have been found to be helpful for preserving memory;

3.     Challenging your brain function with puzzles and other activities such as art work or playing music is also good for memory – they are thought to increase the number of connections and functioning or interconnectedness of nerve cells (this is known as neuroplasticity);

4.     Good social networks – research has shown that the better our relationships are and the larger our social network is the less likely we are to have memory decline with aging (this is also associated with longer life).

Conclusions and bottom line:

1.     Both B complex vitamins and fish oil or omega 3 fatty acids are important for brain function and memory, whereas benefits may not be seen if the nutritional status of either is not adequate;

2.     Healthy diet is always the foundation for good nutrition but targeted nutritional supplements are also important to achieve therapeutic benefits;

3.     Lifestyle is also essential to address and research supports the importance of exercise and physical fitness, stress management and relaxation techniques, brain exercise from puzzles, artwork, music and other activities, and having a  good support network and close relationships.

References:

1.     Abderrahim O, Jerneren F, Resum H, et al. Omega 3 fatty acid status enhances the preention of cognitive decline by B vitamins in mild cognitive impairment.  J Alzheimer’s Disease 2016;50:547-57.

2.     Bell IR, Edman JS, Marby DW, et al.  Vitamin B12 and folate status in acute geropsychiatric inpatients: affective and cognitive characteristics of a vitamin non-deficient population.  Biological Psychiatry  1990;27:125-37.

Healing Your Gut: Nutrition and lifestyle approaches for IBS, GERD and inflammatory bowel disease

Welcome to the March issue of the Health and Wellness Catalyst Blog 

This month's blog is about my long and effective personal and professional experience with stomach and intestinal symptoms and problems - I have seen more GI disorders in my professional career than anything else and I help people get very good if not great results when I work with clients and patients in my clinical practice.

It is important to realize that everyone's circumstances are different, so that the nutritional (diet and targeted nutritional supplements), stretching, fitness and exercise, and stress management or relaxation techniques, need to be individually and effectively designed.  In holistic terms, these approaches address physical, emotional and spiritual well-being.  Without including all of these approaches, it may be difficult to get the results that you may want, particularly when the symptoms may have been present for a long time.

Dietary approaches and guidelines:
As with most chronic and/or complex disorders that I see in clinical practice, sugar, dairy and wheat are the most common offenders and needed to be avoided or rotated (1-2 times per week), at least for a period of time, to see how much they may be contributing to current symptoms.  However, many people need to follow a more comprehensive elimination diet (also restricts or rotates corn, citrus, coffee, peanuts, other gluten grains - rye and barley, eggs, and other allergenic or frequently included foods or beverages).  I have worked with many people who feel that they no longer know what to eat and we have to begin with well tolerated proteins (poultry, fish, etc), cooked low carbohydrate veggies, and starchy vegetables and rice.  Again, it must be remembered that the best diet may not get results unless targeted nutritional supplements, exercise and relaxation techniques are also addressed.

Targeted nutritional supplements:
In my experience, a good probiotic and a digestive enzyme are the two most important supplements to take, although others can be helpful if symptoms continue .  As I have previously written in this blog, and before that my newsletter, the microbiome project will significantly change and improve gastrointestinal care because we will know in each of the GI disorders what bacteria is normal and abnormal for each condition.  There will also be information and understanding for gut bacteria as it relates to autoimmune disorders (eg. MS, rheumatoid arthritis, Hashimoto's thyroiditis, and many others), neuropsychological problems, asthma and allergies, colon cancer and many more medical diagnoses and symptoms.  For right now, we know that lactobacillus and bifidobacteria species are most important and healthy, and that it is important to have a good diversity of different bacteria in the gut (by eating more naturally grown organic foods which have not been exposed to so many pesticides, herbicides and other chemicals).

Stress management techniques:
1. Stretching, fitness and exercise - exercise is a great stress management technique and has an important effect on the 'second brain' or nervous that is in the GI tract.  Again this should be individualized to make sure that you like your work out program and will continue it over the long term.  It generally would include aerobic exercise, some weight training and some more meditative exercises like yoga, tai chi or chi gong.  There are so many options here that I will just suggest that you find what works best for you and if you are having any difficulties, you should get assistance from the current practitioners that you are working with.

2.  Mind-body and relaxation techniques - again, there are many options here including mindfulness, meditation, guided imagery, biofeedback, counseling, others that overlap with exercise (yoga, tai chi and chi gong), and many other approaches.  The important point is that stress often has a tremendous effect on not only quality of life but also disease management - in the near future I will post my lead author abstract supporting this relationship, which I will presenting as a poster at the International Congress on Integrative Medicine and Health in Las Vegas, May, 2016.  I am also submitting the article for consideration of publication in a peer reviewed journal - I will let you know when and where that article will be published as soon as I can get that published.

Conclusions and Bottom Line:
1. Stomach and intestinal problems can be effectively managed through natural approaches, although medication can be necessary for some people.
2. Developing the right dietary approach is essential by avoiding or limiting sugar, dairy, wheat and/or other foods to which you may be intolerant.
3. Targeted nutritional supplements such as a probiotic and digestive enzyme are often important and helpful.
4. Exercise and stress management techniques are essential for the effective management of symptoms for most people.
5. Find the right practitioner or practitioners that will help you heal your gut.