G3.11: A patient with DID says the voices are not like schizophrenia.

More severe dissociative disorders like Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder, MPD) have occurred in some cases of extreme childhood trauma. A strong alter character may develop in the child’s mind that takes over during scary times as a defense strategy. The protective personality may cope with the harsh situation and leave the core personality not only protected from coping with the negative event, but also may leave the memory of the event suppressed from the core personality’s memories. The child or adult may be left with no memories of what happened while the alter personality was in charge.

A person with the condition describes “multiplicity” as being like a bus that has a variety of passengers who may take over driving occasionally, and go and do things without asking, and the bus may not remember it. The “host” or main personality is not the bus driver but is the whole bus.

The full description is in the book, Living with Your Selves, by Sandra J. Hocking and Company;  (G3.34), some of the author’s alters helped write parts of the book. The author would like people to understand that the condition can be coped with and that it isn’t possession by any external force. The alters were all protectors at some stage of the host’s difficult life.

The main difference between DID and less severe forms of dissociative disorders is that memory is suppressed in DID in order to protect the core child personality from whatever trauma is or was going on in the child/former child’s life.

My own feelings of disconnection as a child or as an over-worked adult have never included missing blocks of time or forgetting whole days, which can be symptoms of DID.

Seeing bad memories from above as if watching oneself from the ceiling can be a symptom of milder forms of dissociation. Conversations that you aren’t part of or other voices taking place inside the head may be symptoms of DID. Sandra Hocking mentions that hearing voices externally from inanimate objects like a bicycle would be a symptom of a different type of mental health problem and she encourages talking to someone (other than the bicycle) if any odd voices are being heard.

Recent research has shown that the “voices” that people with schizophrenia symptoms “hear” are actually their own internal sub-vocalizations – their own inner thoughts – but that some disconnection occurred in the brain that seems to make them unable to recognize the “voice” or “voices” as their own thoughts or memories.

Hearing voices may be a symptom that is due to many possible reasons rather than being due to “schizophrenia” – it may be more of a set of symptoms that all resemble “schizophrenia-like symptoms.” Several different nutrient deficiencies may cause a symptoms of “hearing voices“. If a person was deficient in all of the nutrients, which is not uncommon in malnutrition, then supplementing only one of the nutrients would be unlikely to show much improvement in the schizophrenia-like symptoms even though it might have been helping somewhat. All of the nutrients are important for health.

  • The voices heard by patients with these symptoms have been found to be the patient’s own internal monologue but the patient no longer recognizes the voices as their own thoughts or memories from their past.  See:  “When People With Schizophrenia Hear Voices, They’re Really Hearing Their Own Subvocal Speech, Unlike most people, they just can’t tell it’s themselves.By Eliezer Sternberg  (G3.35)

G3.12: Nutrient deficiencies may be a physical and treatable cause symptoms of “hearing voices.”

  • Folate and vitamin B12 deficiencies can cause schizophrenia like symptoms; possibly due to an increase in levels of c-reactive protein. Folate and vitamins B6 and B12 are needed to breakdown c-reactive protein. (G3.36)
  • Genetic differences in metabolism can affect the risk of deficiency in folate and vitamin B12. Genetic screening for methylation cycle differences can help clarify whether extra supplements of the more bioactive methylated forms would be more helpful than standard supplements.
  • And a zinc deficiency and/or copper excess is more common for patients with schizophrenia; so pyroluria, a condition also thought to be due to genetic differences may be an issue. (G3.37)
  • A zinc deficiency prenatally may be linked to schizophrenia later in life: (ncbi.nlm.nih.gov/1491625) (G3.38)
  • Vitamin D deficiency is more common in people diagnosed with schizophrenia. (G3.39)

Health isn’t easy on a good day for someone of average age and average metabolism. Seeking help from mental health counselors and other healthcare professionals can help provide care for a variety of topics that may not fit easily in visit with the family physician.

A specialist in research explains the oxidative stress chemical process in the background section of a review paper regarding the possible connection between psychiatric disorders and oxidative stress. (G3.110) The short story on the chemistry is about balance between the waste produced when burning energy for use in metabolism and antioxidants available to neutralize the oxidizing chemicals produced as waste. The oxidizing waste chemicals are smaller parts of what was once the larger molecule of sugar, glucose. We do need to be able to use the stored energy from glucose, so having plenty of colorful fruits and vegetables in the diet gives the balance of antioxidants necessary to neutralize the “free radical” waste products. They are like the ions of calcium or magnesium in the way they are “free” to donate or take energy from other molecules, which may leave them in disrepair.

An excerpt gives a summary of oxidative stress and the potential link to psychiatric disorders, (G3.110)

Hence, oxidative stress can be considered as a state where the level of oxidants [hydrogen peroxide, superoxide, nitric oxide, etc.] produced by biological reactions exceeds the oxidants scavenging capacity of the cells. These oxidants modify cellular macromolecules [proteins, DNA, lipids] and alter cellular functions [19] resulting in apoptosis or necrosis [2022].” (Apoptosis or necrosis = cell death)

“The brain with its extensive capacity to consume large amounts of oxygen and production of free radicals, is considered especially sensitive to oxidative damage [12, 23]. Therefore, it is not surprising that oxidative stress is implicated in several disorders of the brain including neurodegenerative disorders [2326], psychiatric ailments [27], and anxiety [28]. This association is largely due to the high vulnerability of brain to oxidative load [27].

Read more: Oxidative Stress and Psychological Disorders, (G3.110).

  • The topic of psychiatric disorders, TRP channels, oxidative stress, infertility and pre-eclampsia is more complex than I’ve led you to believe in this overview and this page is already long so the discussion will be continued on a separate page focused more on TRP channels – they are an exciting topic, see G. Pre-eclampsia &TRP Channels.

So speak nicely to yourself, you might be listening. And it turns out that words can hurt after all, not just sticks and stones. A book called What to Say When You Talk to Yourself, by Shad Helmstetter, goes into more detail about the emotional impact that can occur due to how and what we think to ourselves. How we phrase our thoughts and goals can affect our success and enjoyment in life, that seems like a no-brainer, but maybe not to the nervous toddler who is still trying to stand up in the adult sized shoes – a little wobbly but trying. (G3.111)

The glossary section G. Fear & the Inner Child has more information and resources about early childhood experiences and emotional development and the possible creative benefits of dissociation. The section G. Autoimmune Disease & Vitamin D continues the medical discussion of oxidative stress, magnesium deficiency, and why an Epsom salt foot soak or bath might help an autoimmune condition in addition to improving a bad mood and soothing a muscle cramp and sore back – one stop shopping, now that is efficiency.

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

Crisis Hotlines and Resources:

  • U.S. National Suicide Prevention Hotline: Call 1-800-273-8255, Available 24 hours everyday. (I.suicidepreventionlifeline.org)
  • National Helpline: Substance Abuse and Mental Health Services Administration: “SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.”  (I.samhsa.org)
  • Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (I.RAINN.org)
  • Child Welfare Information Gateway: a variety of toll-free hotline numbers for concerns involving the safety of children. (I.20)
  • Power and Control and Equality Wheels  The following training materials are for helping victims of domestic violence and batterers learn how to recognize problem behaviors but emotional manipulation or abuse of power and control can occur in many types of relationships not just between couples.The Power and Control Wheel (I.21) was developed by the Domestic Abuse Intervention Programs (DAIP). (I.22) Manipulative behaviors are grouped into eight categories in the model. An additional Equality Wheel (I.23) was developed to help guide batterers and victims of emotional or physical abuse towards healthier ways to interact. It is grouped into eight equivalent categories with examples of healthier ways to interact with each other. Problems frequently can involve communication issues by both people in a relationship.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

References:

Glycine is an amino acid with neurotransmitter roles

Subtitle: Rebranding and the power of a name: “Essence of Meat-ade” or “Cheerful Juice.”

Sub-subtitle:  Genetic defects in metabolism can affect the entire body due to lack of essential nutrients.

Background: I was found to have eleven of thirty defects in the methylation cycle that were known to be more common in patients with autism spectrum disorder. The screening is not for diagnostic purposes at this stage but is available to consumers interested in the information for their own research purposes (which might include what to feed their child or themselves for better management of autism symptoms – but it is use at your own risk information rather than ‘evidence based’ medical treatment approved for a certain diagnosis).

One of my genetic defects affects my ability to break down betaine into the free amino acids glycine and methionine (roughly, I would have to review the chemistry for the specifics). So armed with this new information I ordered tablets of each amino acid and started taking them each day as supplements. They seemed to help but it wasn’t a dramatic change in how I felt.

A month or two later before reordering more bottles I considered the question of just how much glycine or methionine I might need each day if I had a defect that prevented me from digesting protein and releasing the essential amino acids. When I looked into how much glycine might be needed by the body each day, I didn’t find much research but there was some and the amount suggested was far greater than the amount I was taking in the form of a tablet — 200 milligram tablet compared to two grams of the essential amino acid as a minimum recommendation with up to ten grams being proposed as possibly beneficial. And no toxicity risks were mentioned. Two grams is equivalent to 2000 milligrams or ten of the tablets each day, which would be expensive and a lot of tablets.

Many things that are available as supplements are also available in bulk as a powder that companies might use to make capsules or tablets for the individual consumer to purchase. The amino acids glycine and methionine were available online in a package size that was designed for individual use, possibly being marketed to people interested in body building or weight lifting.

A teaspoon of a powder substance is roughly five grams, depending on the density of the powder. I decided to try one teaspoon of glycine and one teaspoon of methionine per day as that would easily provide two grams and might provide up to five grams per day.

Results: Free essential amino acids are acidic — like lemonade — but taste a little like protein aka meat, so two teaspoons of free amino acids in water tasted VERY BAD. My nickname for the concoction became “Essence of Meat-ade” for the first day or two, however almost immediately after drinking the vile drink my mood became incredibly cheerful and I was suddenly filled with energy. I was amazed — how could a horrible tasting glass of water change my mood? I started looking forward to the drink and while I had started taking it in the evening I gradually switched to taking it earlier in the day and even twice a day occasionally, which would provide about ten grams of the powder.

My mental nickname changed from “Essence of Meat-ade” to “Cheerful Juice,” it helped my mood so much that I loved the stuff no matter how silly my face looked while trying to gulp it down too quickly to taste. I was amazed, and a little sad to consider that I had been without “Cheerful Juice” for my first fifty years of life — but better late than never is a motto of mine. With a double genetic defect I wouldn’t have been able to release glycine or methionine from larger proteins for my entire life — and therefore wouldn’t have had the cheerful effects or boost in energy due to the incomplete digestion of my food.

Why would a bad tasting drink give me a good mood?

I knew the amino acids glutamine and aspartic acid can act as messenger chemicals within the brain so I looked up glycine and methionine and sure enough they both also can act as brain signaling chemicals.

The rest of this information is about glycine’s role as a brain neurotransmitter. It doesn’t cover methionine but it also has roles in brain chemistry.

Glycine is a Neurotransmitter: 

Glycine has inhibitory and excitatory roles in the brain as a neurotransmitter – a type of chemical that can serve as a messenger between brain cells which are called neurons.

“Interestingly, glycine receptors comprised of a1 subunits are efficiently gated by taurine and b-alanine, whereas a2-containing receptors are not (8). The a1 and a2 genes are expressed in the adult and neonatal brain, respectively.”

ie-the type of glycine receptor found within the baby brain is not as well protected as the type found within the adult brain, later in the next paragraph:

“Recently, the expression of a1 and a2 subunits has been shown to be developmentally regulated with a switch from the neonatal a2 subunit (strychnine-insensitive) to the adult a1 form (strychnine-sensitive) at about 2 weeks postnatally in the mouse (8). The timing of this “switch” corresponds with the development of spasticity in the mutant spastic mouse (5), prompting speculation that insufficient expression of the adult isoform may underlie some forms of spasticity.” [1]

Background: Glyphosate is chemically very similar to glycine in that it may be incorporated into proteins but is not functionally the same. A protein containing glyphosate instead of glycine would be dysfunctional. Glycine provides methyl groups which are important for turning strands of DNA on and off, (DNA is the genetic material that acts as recipe cards for making proteins).

If glyphosate is being physically incorporated within body tissues in place of the amino acid glycine, then the role of glycine within early fetal development discussed in the above excerpt might be part of the mechanism for how autism risk may be occurring during the prenatal stage of life.

From a Marketing Perspective: How to sell something that tastes horrible but makes certain people feel great?

From my experience working with special need infants and children I learned that sick children when given a formula they can tolerate will cheerfully start drinking the formula if it  isn’t making them feel sicker — no matter how bad the formula tastes — and some of them are like “Essence of Meat” because they are based on free amino acids that would be easy to digest and wouldn’t have the same allergy risk as the larger and more complex proteins.

So how to market a specialty product? Target the special needs market, and pitch having the genetic screening done first in order to find out who needs the special product — and put the bulk powder in capsules  😉 , I tried to add lemon flavoring to make it more like lemonade but that didn’t change the flavor enough — I’m working on acquiring a taste for it instead.

The genetic screening I had done is “For Research Purposes Only” but it was assembled by a specialist with a PhD and experience in genetics. She is not a medical doctor and no diagnoses are provided however some health information is provided I haven’t reviewed it yet and therefore can not provide any feedback regarding it.

  • The Methylation Cycle genetic screening test: http://www.holisticheal.com/dna-methylation.html
  • My results and my notes regarding the 11 defects, this is a list of notes rather than being in article format, see number three of the double defects for details about the gene BHMT/1 (Call – T), which is for the enzyme Betaine-homocysteine methyltransferase (BHMT): https://effectiveselfcare.info/2016/03/30/methylation-cycle-defects-in-me-genetic-screening-for-research-purposes-only/
  • An excerpt from that post regarding diagnoses that may be helped by use of dimethylglycine (DMG) and methionine as supplements : DMG has been found helpful in ADHD, autism, allergies, alcoholism, drug addiction, and chronic fatigue syndrome among other chronic issues. Methionine has been found helpful in treating depression, allergies, alcoholism and schizophrenia among other chronic issues.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Steven M. Paul, GABA and Glycine, https://www.acnp.org/g4/GN401000008/Default.htm

The voices that people with schizophrenia are hearing are probably their own inner thoughts

This is kind of breaking news — new news: A research scientist, with the aid of a powerful microphone, was able to record a patient with schizophrenia speaking to themselves in a sub-vocal voice. The patient was not aware that they were speaking at the time.

The research is very early, a first in its field perhaps, but the theory seems to suggest that the patients with schizophrenia symptoms may have some disconnect with the normal ability to identify internal thoughts and sub-vocal speech as being self generated and instead are interpreting the internal thoughts as coming from some external source of whatever type the person might think.

(Example of my interpretation of sub-vocal speech: the almost silent muttering under your breath that you don’t notice yourself doing, until suddenly you do notice that you’re talking to yourself, and then you stop because you don’t want anyone to notice. The brain of a someone with schizophrenia may no longer recognize the voices of self-talk, or those of voices in memories or in imagined conversations, as being internally self-generated and instead probably tend to make up some explanation for  whatever or whoever might be doing the talking that is being heard — hearing voices. Our internal chatter can get busy and sometimes pretty mean, it would be scary to not realize that it is just yourself. )

Read more, of the actual article:  [http://www.slate.com/articles/health_and_science/medical_examiner/2016/03/schizophrenia_and_subvocal_speech_why_schizophrenics_hear_the_voices_of.html]

This seems like very important news — patients with schizophrenia may be able to be gently reminded that those voices are just brain mumbles, and to try to ignore them.

People with schizophrenia are generally not associated with violence unless there is also a history of violent behavior, alcohol or drug abuse, or more persecutory fantasies. [citation missing, I don’t remember where I read that recently, but I posted it in a comment somewhere.]

Mental health symptoms sometimes may be due to underlying issues that could be easily fixed, rather than considering the patient as being ‘mentally ill’ for the rest of their life and likely being placed on medications that tend to have severe side effects. Effective health care would seek for any underlying causes that can be returned to a state of normal function with the simplest solutions possible, “Let food be thy medicine,” the first part of the quote by Hippocrates may be the most important part.

There are several different nutrient deficiencies that can cause symptoms similar to schizophrenia or may be involved in an underlying cause for the condition, this information was from an older post of mine but it was not grouped together:

Regarding trends seen around the world in rate of schizophrenia, it has been dropping in South Korea and increasing in Japan. North Korea has the highest rate for the region: http://global-disease-burden.healthgrove.com/l/58241/Schizophrenia-in-South-Korea

Malnutrition in North Korea is more likely involved in the increased rate for the nation than cat ownership due to the many years of sanctions against the country. B12, folate, zinc and vitamin D deficiencies and excess copper may be involved in risk of developing schizophrenia like symptoms. Folate and calcium are considered to be potentially deficient for the typical Korean diet. Fortified milk products aren’t typically consumed so extra vitamin D from that source wouldn’t be available. Iodine is also a nutrient that may be deficient in the diet. http://adoptionnutrition.org/nutrition-by-country/korea/

Low thyroid levels have been associated with schizophrenia in early treatment of the disease and has been used in more recent care of patients by an alternative physician. The following link includes excerpts from many older research articles and one mentions kryptopyrroles being elevated in some patients so a genetic cause may be involved for some patients that would cause low zinc and low B6 levels (pyroluria). http://www.orthomolecular.org/library/jom/2001/articles/2001-v16n04-p205.shtml

Schizophrenia treatment and other psychiatric care in Russia does not seem to be an ideal to follow anywhere else – or there: http://www.sras.org/snezhnevsky_schizophrenia_soviet_psychiatry However Russians on average do own a lot of cats, especially in comparison to residents of South Korea: https://www.statista.com/chart/10267/which-countries-have-the-most-cat-owners/?utm_content=buffer35f5b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer 

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Vitamin B12 deficiency can cause long term nerve degeneration

Vitamin B12 (Cobalamin):

Neurological symptoms of B12 deficiency may include:

  • numbness and tingling of the arms and legs; problems walking; disorientation; memory loss; mood changes that may resemble schizophrenia; and dementia.  Damage may occur to the myelin sheath which surrounds and insulates nerves like the plastic coating around an extension cord.  Nerve damage and mental health symptoms may become permanent with long term deficiency of vitamin B12.

Digestive symptoms may include:

  • loss of appetite, a painful tongue, and constipation.  The reason for there to be digestive symptoms associated with B12 deficiency is not well understood.  One theory suggests that undiagnosed digestive problems might have been an initial cause of the  B12 deficiency.

Symptoms of vitamin B12 deficiency may also include:

  • pernicious anemia and megaloblastic anemia which are hemoglobin deficiencies that have symptoms of tiredness.  Folate deficiency symptoms are also possible because B12 is necessary in folate metabolism.  Increased heart disease risk from elevated homocysteine levels may result from B6,  B12, or folate deficiency.

People who may be more at risk for vitamin B12 deficiency include:

Those with malabsorption problems, or people with chronic use of antacids and those who are over age 60.  A specific protein cofactor called the intrinsic factor and normal stomach acidity levels are necessary for B12 absorption to be able to occur.  Some individuals receive monthly injections of B12 after reaching older age and some people need to receive them monthly throughout life due to having chronically low vitamin B12 for other reasons than normal aging such as a genetic issue with their production of the intrinsic factor protein.

Sublingual tablets of the supplement are also available which are absorbed in the mouth, bypassing any problems with the rest of the digestive system.

A genetic difference may exist that causes some individuals to require the methylated active form of B12 rather than being able to benefit from the more commonly available supplement which is an unmethylated and therefore inactive form.  [More about methylcobalamin.] A genetic screening test would need to be ordered to find out if there were any differences in the gene that might cause an inability to methylate vitamin B12 or folate/(folic acid is the commonly used supplement which is also in the unmethylated form, and therefore inactive for someone with a genetic inability to perform the methylation reaction – meaning an enzyme is malfunctioning somewhere in the complex chemical chain of events.)

A problem with lower digestive acidity in the stomach could also be managed simply by adding a side dish or condiment to meals that contains vinegar or acidic ingredients. Examples from around the world include chutneys, pickles, lime or lemon juice/fresh wedges, vinegary salad dressing, salsa or Tabasco Sauce, and Worcestershire sauce.

  • What is Worcestershire Sauce? (thespruce) (and how do you spell it?)- It is an interesting story – featuring the chemists Lea and Perrins. (Lea & Perrins is still the best selling brand of Worcestershire Sauce). Who knew chemistry could be so delicious?

Schizophrenia may also be associated with an increased risk for low levels of vitamin B12. Read more: (askdrgonzalez.com/deficiency-of-vitamin-b12-and-schizophrenia/)

Low stomach acid may be an underlying issue with symptoms of schizophrenia and in other mental health disorders. The balance and variety of microbes living within the gastrointestinal tract also may be involved in symptoms resembling mental illness. (Digestion & schizophrenia /PMC4437570/)

Pickles that are made fresh and need to be refrigerated  can be a source of healthy intestinal microbes, in a similar way to the healthy bacteria found in yogurt with active probiotics or Kefir drinks.  A variety of traditional products with live cultures are listed here – and a new one, probiotics are being added to chocolate in some products: (health.com/probiotics & chocolate) Scientists studying the microbiome tend to recommend the live culture foods rather than supplements of probiotics – based on my overview impression of multiple sources. An overview regarding the current recommendations about probiotic supplements is available here: (washingtonpost/people-love-probiotics-but-do-they-really-help/2017/05/19)

Probiotics refers to products that contain actual good guy bacteria, while prebiotics refers to foods that contain fiber or other nutrients which the good guy bacteria need to eat in order to survive and flourish – in competition with the more negative strains of bacteria or with yeasts or other microbes which might be found within our gastro-intestinal tract.

Eating vegetables and other foods that are good sources of some types of fiber also helps support healthier intestinal microbes, a few foods that provide the types of fiber that our intestinal microbes need to eat in order to flourish and protect us from more negative types of microbes, are listed here: (pcrm.org/seven-foods-to-supercharge-your-gut-bacteria)

It is a very good idea to get adequate fiber in the daily diet – because starving microbes will start breaking down and consuming edible portions of the intestinal cells for nourishment – if forced, and it may leave the body more at risk for infection (labblog.uofmhealth.org/gut-bacteria-eat-colon-lining-when-starved-for-fiber) – but why starve your good guy microbes? Our intestinal microbes may also help prevent anxiety. (neuroscienceresearch.wustl.edu.pdf)

Food Sources of Vitamin B12 include: 

  • shellfish, fish, meat, poultry, eggs, milk, cheese, dairy products, Nutritional or Brewer’s yeast.  Vegetarians who don’t eat dairy, eggs, fish or other meat products may need a supplement or nutritional yeast, a vegan food source of vitamin B12. (nutritional yeast/pubmed/11146329)
  • See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.

Reference for more information:

An Evidence-based Approach to Vitamins and Minerals:  Health Benefits and Intake Recommendations, 2nd Ed., by J. Higdon & V. Drake, (Thieme, Stuttgart / New York, 2012)

  • A description and source for purchasing the text: (thieme.com)
  • A review of the text: (ajcn.nutrition.org/content/79/5/892.full)
  • The text is produced in cooperation with the Linus Pauling Institute. He is a researcher who used large doses of vitamin C to cure cancer tumors. His work was met with skepticism. More recently research supports his work in that a specific type of cancer cells is very susceptible to vitamin C – while to the rest of the body it is water soluble and non-toxic at the level that was toxic to the cancer cells. (sciencedirect.com/science/article/pii/S2213231716302634)

Last reviewed and revised on 9/30/2017.

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)