September 15, 2020

environmental causes of thyroid problems

Thyroid disease numbers have spiked within the past few decades. Here are some environmental causes of hypothyroidism and hyperthyroidism.

How Environmental Toxins Harm the Thyroid?

The thyroid gland is vulnerable to damage from external factors like environmental toxins because many environmental toxins have a structure similar to thyroid hormones. Also, the thyroid gland has a high affinity for halogens and metals. It can be affected by toxins containing halogens, or heavy metals.

February 18, 2020

fatty-liver-disease

What is Fatty Liver Disease?

Fatty liver disease, otherwise known as hepatic steatosis, is the condition in which fat accumulates in the liver. Having fat in your liver is normal, however, having too much fat in your liver can cause liver inflammation and scarring.

November 13, 2019

Lyme Disease: An Overview

Lyme disease (LD) is an infection caused by Borrelia Burgdorferi, a type of bacterium called a spirochete that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. If left untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. Lyme disease acts as a multi-system inflammatory disease and affects the skin in its early stage, and later, spreads onto the joints, nervous system and in severe cases, it also affects other organs of the body.

1 September 5, 2019

chlorine poisoning symptoms treatment

Chlorine poisoning is a medical emergency which occurs upon inhaling or swallowing chlorine. If a person is showing symptoms of poisoning, they should be immediately taken to the hospital or emergency room.

Read on to learn more about causes, symptoms and treatment of chlorine poisoning.

August 13, 2018

Who is our average patient?

Our average patient at “The Center”:

  • Has been to 10 or more doctors
  • Has had a chronic illness for anywhere from months to decades
  • Feels that other doctors have not listened to their full history or concerns
  • Has been told it’s all in their head
  • Has already spent thousands of dollars on laboratory and other testing
  • Is afraid of going to yet another doctor
  • Is looking for a doctor to understand and treat the root causes of their illness, rather than just alleviating symptoms
  • Has heard of the Center through a physician, other patient, or support group who is familiar with the Center’s approach
  • Has personally researched our Center on our Website and has validated that the information is credible
  • Lives anywhere in the U.S. or now may live in Europe, Asia, or the Middle East
  • Is often one of two or three generations of a family who become patients
  • Feels like they’ve found a partner is us, one who is committed to improving their health
  • Is surprised that we present an estimate of costs based upon an understanding of what their medical needs are, which enables them to prioritize treatments within their budget
  • Finds great value in time and money invested at the Center, especially as compared to all they’ve spent in their previous attempts to improve their health
  • Appreciates the thorough education they receive in how to manage their own health
  • Sees a significant improvement in their health in a relatively short period of time
Posted in P&T
August 4, 2018

Biochemical Abnormalities of Autism

The biochemical abnormalities of autism were brilliantly presented by Rosemary Waring. She emphasized the complex manifestations of autism which include not only the altered behavior, but also:

  • Altered gastrointestinal tract function and gut permeability
  • Decreased appetite control
  • Immune system dysfunction (increased susceptibility to infection)
  • Idiosyncratic reactions to drugs and altered catecholamine and neurotransmitter levels (dopamine/noradrenalin and serotonin), with increased dopamine being responsible for stereotypic movements and behavior

She explained that markedly low levels of sulfates are found in children with autism, as low as one-eighth of normal levels. There seems to be many factors causing these low sulfate levels, such as:

  • A deficiency of sulfotransferase enzyme, the essential enzyme in sulfation
  • Poor oxidation of cysteine to sulfates
  • Poor absorption of inorganic sulfates (only 5-15 percent) because of altered gut permeability
  • Increased excretion of sulfates by the kidneys

The low sulfate levels, in turn, perpetuate the abnormalities. Sulfates are necessary for maintenance of the slipperiness of gut mucins, which support proper gut permeability. Sulfates are also cofactors in certain hormones such as cholecystokinin (the sulfate molecule activates the tyrosine in the peptide chain). This may be the key to understanding the role of secretin, which when given to autistic children has resulted in marked improvement. (The Center for Occupational & Environmental Medicine is actively studying the effect of secretin for treatment of autism).

Interestingly, sulfotransferase, the essential enzyme in sulfation, is also inhibited by several foods that have incidentally been recognized as migraine inducing foods. These foods include: amine-containing foods (cheese, chocolate, banana), citrus (especially orange), cranberries, pumpkin, radish, spinach, and peppers. Gluten and casein are also involved. Understanding at least one of the mechanisms of food sensitivity involved in autism helps explain the food-sensitive profile so often seen in autistic children.

Reference: Waring RH. The biochemical basis of autism.

August 3, 2018

Concepts of Environmental Medicine

Environmental Medicine is a branch of medicine whose domain is not limited by anatomical boundaries but, rather, is concerned with the whole person and the way that a person reacts to his/her total environment.

 

The approach of Environmental Medicine is holistic in nature and addresses every part of the body, including the brain that controls thinking, perception, mood, and behavior. Chronic exposure to various stressors can trigger a wide range of mental, physical, and emotional disorders. Stressors may include infection, allergies and intolerances, addiction, nutritional

deficiencies, exposure to toxic chemicals and toxic metals, or toxic relationships. Stressors may be linked to the air we breathe, the food we eat, the water we drink, the chemicals that pollute them, or more subtle sources. Over time, if stressors outweigh the body’s ability to cope with them, imbalance and illness result.

The Center evaluates each patient in terms of his/her total environment and the impact of that environment on the individual biochemistry. We strive to reduce the Total Body Stress Load and rebuild the body’s reserves, restoring balance and strengthening the individual to overcome and prevent illness.

 

Related Article

American Academy of Environmental Medicine

American Board of Environmental Medicine

August 3, 2018

Establishing and nourishing the growth of beneficial bacteria in our digestive tracts is one of the most misunderstood and neglected things we can do to regain and maintain our health. We have in essence another body inside our body, in that we have some 300 trillion cells making up the bacterial flora of our gut. This number of cells is equal to the number of cells that make up our entire body! These “bugs” are our first line of defense against the toxic outside world. It is the multiple strains of bacteria that live on the surface of our intestinal tract that protect us against constant invasion. Yet so much of what we do and are exposed to is killing off this critical mass of flora. We take antibiotics, acid blockers, myriads of synthetic chemicals from dozens of medications, and are exposed to pesticides and heavy metals, all of which destroy our vital bacterial flora.

This month we are introducing three new products and offering significant discounts to entice you to try them and see what a difference they can make in your life.

No farmer would plant seeds without fertilizing his fields and you shouldn’t either. BUTYRAID is butyric acid, the fertilizer that helps your “garden” of vital bacterial flora grow. It smells like parmesan cheese and critically balances the pH of your intestines, which enhances the growth of your normal flora. The medical literature suggests it can also reduce the risk of cancer of the colon by enhancing glutathione, our major detoxifying molecule. This product is free of common allergens.

Fertilize your bowel with 1 – 2 tablets of BUTYRAID per meal, then plant your garden with healthy living probiotics. Regularly $16.00 for 100 tablets*.

Our probiotics of choice are Lactobacillus rhamnosus and Saccharomyces boulardii.

Lactobacillus Rhamnosus is the primary ingredient in our new THER-BIOTIC COMPLETE. This highest-potency, hypoallergenic blend of 12 certified probiotic species provides over 25 billion organisms in every capsule. The InTactic delivery system also guarantees that the probiotics will be live and viable at the time they reach your “garden” where they can grow. There is NO dairy or dairy ingredients in this product and only vegetarian capsules are used. The benefits of the strains of probiotics in Ther-Biotic Complete include:

* Produce lactic acid, hydrogen peroxide, and other compounds naturally antagonistic to pathogenic bacteria, yeast, and viruses
* Interfere with binding of pathogens to the intestinal mucosa (& compete with them for food)
* Synthesize Vitamin K and the B Vitamins
* Support immune defense mechanisms
* Produce analogs of the DPP-IV enzyme that break down opiod peptides
Take 1 capsule of THER-BIOTIC COMPLETE per day, always with food. Can be taken long term. Regularly $42.90 for 60 capsules*–a 2-month supply.

SACCHAROMYCES BOULARDII
This probiotic is actually a yeast but is genetically quite different from brewer’s yeast (Saccharomyces cerevisiae) and pathogenic Candida species of yeasts. It has a long history of use for diarrhea or dysentery, but is being used today because it is so helpful in boosting intestinal IgA secretion and decreasing inflammatory bowel disease and Candida overgrowth. It is very effective against pathogenic Clostridia. Our Saccharomyces boulardii product has NO lactose or gluten in it and can be used to support GI-related problems even in autistic children. Only vegetarian capsules are used. S. boulardii is usually taken short-term for difficult digestive and bowel problems, always while using a product such as Ther-Biotic Complete that provides a full spectrum of probiotics.

Take 1 capsule of SACCHAROMYES BOULARDII 2 times daily with food, but separated from anti-fungal agents by at least 2 hours. Regularly $31.00 for 60 capsules*.

THE HEALTH OF THE GUT IS THE FIRST MOST IMPORTANT STEP IN REGAINING HEALTH AND MAINTAINING HEALTH.
We cannot encourage you more to take this first step.
The results will be obvious in a very short time.
– Allan D. Lieberman, M.D.

To Order These New Products, fax (fax (843)-572-1795)or e-mail (Orders@coem.com) your order.

*ALL LISTED PRICES ARE SUBJECT TO CHANGE AFTER 30 DAYS OF PUBLISHED DATED OF ARTICLE.

References:
Pool-Zobel BL, Selvaraju V, Sauer J, Kautenburger T, Kiefer J, Richter KK, Soom M, Wolfl S. Butyrate may enhance toxicological defence in primary, adenoma and tumor human colon cells by favourably modulating expression of glutathione S-transferases genes, an approach in nutrigenomics. Carcinogenesis, 2205 Jun:26(6): 1064-76,. Epub 2005 Mar 3.

Scheppach W, Weiler F. The butyrate story: old wine in new bottles? Curr Opin Clin Nutr Metab Care. 2004 Sep; 7(5): 563-7.

 

 

Posted in P&T
July 24, 2018

YEAST-YET AGAIN!

An Interview with Dr. Lieberman

Editor’s Note: Many times we on the staff have heard a patient say, “Oh, I wish I could have sat with Dr. Lieberman for hours-I learned so much!” In this “chair-side chat,” Dr. Lieberman explores the connection between yeast and developmental delays, food allergies, asthma, and even prostatitis.

Q: What has made this field of yeast-related illness so timely for several decades now?

Dr. Lieberman: When I first started working in this field in the late 1970’s, I thought every patient had yeast, and I treated everybody accordingly. After awhile I got disillusioned and I said, “No, this is impossible, nobody has it!” As the years went by, the pendulum swung back again. If you’re an astute clinician and you talk to patients, you see that yeast is a problem.

The paper presented by Dr. William Shaw at one of the American Academy of Environmental Medicine conferences in Kansas City was the real bombshell, because it gave us, for the first time, really hard evidence that many physicians were right who talked about yeast as a major cause of impairments.

Q: What was Shaw’s background and why did he get interested in this himself?

Dr. Lieberman: Dr. Shaw, as an analytical biochemist, was analyzing the urine of two brothers. He didn’t know anything about these children, except that once the results came from the laboratory, he had never seen the presence of these particular metabolites before. He said, “These are not normal metabolites of normal people,” and ultimately realized that they were metabolites of bacteria and fungi. When he inquired about the children he had tested, he found that they both were autistic. So then he started to look at the urine of other children with autism and other neurologic problems, and lo and behold, he found that their urine also contained the same metabolites. That was really the great breakthrough-the presence of yeast and abnormal bacteria produce identifiable chemicals in the urine.

With Shaw’s paper, we now had a scientific basis to show, beyond a shadow of a doubt, that a patient can have these organisms and be influenced by the metabolites of them.

Dr. Lieberman: To me, the most amazing thing is to look at levels of yeast metabolites in the urine of children who have been on antibiotics for their ear infections. We wonder what happens to these kids-why their behavior changes and why they develop all kinds of problems-and there it is. Shaw’s contribution has been not only to identify yeast metabolites as a cause of neurologic problems, but also to show an imbalance in the gut bacteria can produce abnormal metabolites. The imbalance of the gut flora is called dysbiosis.

Q: In what way does a bowel dysbiosis or yeast overgrowth actually manifest? How does that impact upon the brain?

Dr. Lieberman: Small molecules have the capacity to go through the blood-brain barrier and it seems that they are amazingly capable of altering cerebral function. We know, for example, that in digesting and metabolizing wheat and other grains containing gluten, certain types of opioids can be produced and these things can really affect brain function. Well, now we see that organic acid molecules that are coming from yeast and bacteria are also capable of crossing the blood-brain barrier and influencing behavior and brain function.

Q: And that might show up as autism, or hyper-activity, or other neurologic problems?

Dr. Lieberman: When I’ve talked with Dr. Shaw, he said he’s seeing a lot more of these organic acid metabolites in the urine of hyper-active children. That doesn’t surprise me in the least. There is an epidemic of these problems in children. They’re sick all the time and why are they sick all the time? It is because of their diet, food sensitivities, and the development of secondary dysbiosis problems with either yeast or bacteria that produce these metabolites. The metabolites are actually causing behavior problems.

Q: So he has seen a reversal in the problems of the patients who have been treated on the basis of his Organic Acids Urine Test?

Dr. Lieberman: When Dr. Shaw found these unusual metabolites in the urine of the brothers, he asked the parents, “Why don’t we put these children on some anti-fungal drug and see what happens?”

With anti-fungal treatment, the yeast metabolites in the children’s urine decreased and their behavior improved.

So we have a very wonderful cause and effect relationship. Of course, it takes more than treatment of yeast to clear all behavior problems, but this can be a critical piece in the treatment program.

Q: And you’ve seen a change in the behavior of those you’ve treated, too?

Dr. Lieberman: Yes, definitely. As you read our Testimonials from successfully treated patients or their parents, you see that treatment of yeast has made a huge difference in behavior in many cases.

Q: Does dysbiosis or yeast overgrowth cause other problems besides changes in behavior?

Dr. Lieberman: Dysbiosis is actually an imbalance of all the microbiological flora of the gut, not just a yeast overgrowth. Dysbiosis produces a permeability dysfunction so that things that should remain in the G.I. tract are now getting through the wall in bigger pieces. Bigger pieces are more antigenic, meaning they are capable of producing an immunologic response, especially an allergic response. That’s how we think the mechanism of food sensitivity is being created. The more antigens from a permeable gut enter the circulation, the more immune response would be initiated. A permeable gut, which can be caused by dysbiosis, does make the problem of food allergy much worse.

In addition, once the antigen enters the circulatory system, it’s carried to all the organs of the body and comes into contact with those elements of the immune system called lymphocytes. If the antigen triggers lymphocytes and immune response in the lung, it might set off asthma. If the antigen triggers an immune response from the lymphocytes in the Peyer’s Patches of the G.I. tract, it might trigger diarrhea. It usually takes a combination of insults for the organ to react, so that is why we say in Environmental Medicine, “The previously injured organ becomes the target of the allergic response.”

Depending upon a person’s family history and medical history, any organ might be the target and produce adverse symptoms.

But what is important here for our discussion is that if yeast is a root cause of gut permeability or food allergy or other symptoms, we can confirm the presence of the yeast through Shaw’s test for the metabolites of yeast and bacteria. Now we don’t have to be defensive in trying to present this whole yeast connection concept to the scientific community.

Q: And if you don’t find the metabolites of yeast, is that the end of it?

If the metabolites of yeast are not there on testing, then we have to rethink the whole thing. I would like to address this for a minute. We all see these patients who come into the office who are totally convinced that all their problems are coming from yeast. They have literally put themselves through a mangle-there isn’t any anti-fungal drug that they haven’t been on, there’s nothing that they haven’t tried, and they feel that they’re still full of yeast. In many ways, we now have some nice criteria to say with confidence to a patient, “There is a problem, but it’s not yeast, and we have to look elsewhere. Trying to do only yeast eradication cannot be the total answer to the problem you have.”

Q: What other conditions would mimic those symptoms that a patient would think were caused by yeast?

Dr. Lieberman: That’s an interesting question, because when you’re a medical student and you’re taking the course called “Medicine,” you’ve got this textbook that has almost 2,000 pages. You say, “Okay, what are the signs and symptoms of this disease and that disease?” You find they’re often the same!

That is what makes Environmental Medicine so unique, because we’re not interested in choosing an organ and just identifying the signs and the symptoms.

The only thing that makes any difference is what causes those signs and symptoms, and what you’re going to find is that there are many ways to produce headache and the flu-like symptoms in a patient. They can come from anything from A to Z, usually a combination of things. But one of those causes is often Yeast. It doesn’t matter if yeast is affecting the nervous system, the G.I. system, or the joints. If yeast is a cause and you treat it, it’s astounding the myriad of signs and symptoms that can respond in that patient.

Q: What would be the treatment for yeast overgrowth, and is there any rule of thumb about how long treatment should be continued?

Dr. Lieberman: In our practice, we’ve always used a rather classical approach with systemic anti-fungal drugs and local-acting fungal drugs, often combined. With this approach we can treat the reservoir of yeast in the gut with the local-acting fungal drugs, but also treat elsewhere in the body where yeast may have been able to migrate due to a permeable gut or impaired immune system that didn’t keep the yeast localized. It depends upon the patient as to how long the treatment has to be applied.

For example, interestingly, many cases of chronic prostatitis in males are actually yeast prostatitis, and that’s the reason why they never get rid of the problem because they’re treated with more and more antibiotics. It’s often a combination infection of both yeast and bacteria, and until you identify which organisms are causing the infection and treat them appropriately for a sufficiently long time, the problem doesn’t resolve. We have not found cultures and stool analyses and other diagnostic tests to be entirely accurate, but with the aid of the other newer tests we use like Shaw’s test, we have very good results with many different kinds of chronic problems.

Q: Many patients seem happy to take anti-fungal medications, even expensive ones, but less inclined to follow diet changes. In your experience, what effect do anti-fungal medications without dietary changes have on the patient’s progress?

Dr. Lieberman: Well, I can answer that question because I was remiss when I first started working with these kinds of patients. I felt the diet was not the most important thing and what we needed to do was just use the drugs. What I found was that it didn’t work too well and especially there was a rebound effect after the drugs were discontinued. If you want to really try to hold these organisms down, it’s so important to stop feeding them with so many different kinds of sugars, even so-called natural sugars that are concentrated into syrups and such, and with refined carbohydrates.

Q: What happens when a person tries to diagnose himself or herself with yeast overgrowth and tries to self-treat? Can that be beneficial or harmful?

Dr. Lieberman: The question that you asked is really very relevant. Most patients will read the wonderful books by Billy Crook [William Crook M.D., who wrote the whole Yeast Connection series of books] and think, “That’s what I have!” But as I said before, if you study medicine you find that many diseases have common signs and symptoms.

I have given patients credit for being more knowledgeable than the doctor in terms of better knowing their bodies, but we gave an example before of some patients whose whole life was obsessed with the idea that they were overrun with yeast. We were able to document with these new biomarkers that it wasn’t yeast at all.

So what they did in a sense was just waste time, probably money, and effort. They were looking at the wrong cause, and that’s why they never got better. It probably takes a combination of a physician plus a patient, because the physician has to develop a more comprehensive approach and write a prescription, if necessary. Nevertheless, doctors don’t give patients enough credit for understanding their own problems, so here at our Center we try very much to respect patients when they come tell us their histories.

We have to look for the root causes of a patient’s many signs and symptoms, and a patient can’t do that on their own very often. It takes the sophistication of testing and identifying biomarkers, and with those laboratory findings, we can do a much better job of diagnosing now.

Q: So testing for these organisms is key?

Dr. Lieberman: Well, actually the most helpful testing involves looking for causes in many areas, not just hidden infection.

One other common element that needs to be thought about is the combination of allergy and hidden infection.

I’ll give you an analogy, and maybe then you can appreciate it. There was a woman who was my patient who pointed her finger at me and said, “If I touch a drop of wheat, within two hours I have a rip-roaring yeast infection. Explain that, Doctor!” The lesson that’s learned from this, of course, is that there are triggers for each individual that increase susceptibility to infection. So when necessary we also test for food, inhalant, pollen, or chemical allergies in our patients. With our allergy desensitization extracts, and also avoidance of the most severe triggers in some cases, it’s not only easier to treat hidden infections but a lasting resolution is possible. Then too, we try to build patients up through nutritional supplementation or whatever else is needed in their particular case to make the patient stronger to resist infections.

We come back to our philosophy here at the Center that you don’t just get sick, you’re made sick, and we do our best to identify what is making you sick and help you to get well again.

 

Related Article

July 24, 2018

CANDIDA ALBICANS AND OTHER YEASTS

By Allan D. Lieberman, M.D.

Dr. Billy Crook (William Crook, M.D.) wrote the Yeast Connection book in 1986. It was one of the first books published on the importance of Candida albicans on the health of men, women, and children. Everyone knew women had yeast, but few realized that yeast infection wasn’t reserved just for women.

Billy was a member of the American Academy of Environment Medicine (AAEM) and had a great deal of influence on the many like-minded physicians who recognized the environment as a major influence on health. I became a member of AAEM in 1978, which changed the course of my life in medicine.

The Yeast Connection brought down the wrath of conventional medicine upon us for treating our patients with anti-fungal medications. We had at the time only Nystatin, one of the safest drugs in the whole Physicians Desk Reference. As time went on, we learned more and more about the role of Candida albicans, as well as the development of new more potent drugs, such as Ketoconazole and Fluconazole.

As many books and medical papers have been written about yeast, it would be difficult to discuss this topic in a few paragraphs. Nonetheless, I would like to share my 33 years’ experience in this brief report.

Unbeknownst to most people, Candid albicans is part of the normal flora of our bowel. It acts as our body’s own antibiotic against enteric bacteria such as Salmonella, Shigella, and Typhoid fever. However, when we imbalance the microbiological flora of our intestine, that which is good becomes bad.

The one factor that made Candida bad was the introduction of antibiotics, which altered our healthy flora. Our use of steroids and immunosuppressive drugs also contributed to Candida’s imbalance.

Surprisingly, there are probably no signs and symptoms recorded by patients that could not be associated or caused by Candida, and the symptoms may affect every organ of the body.

The only way you can tell if Candida is the cause, in my experience, is to treat the patient empirically. There are now a few laboratory tests available which can be helpful in suspecting Candida, but even if the results are positive, you will never know if a patient’s problems are related to yeast until you treat it.

There are a few important observations I have found over the years:

1) There is clearly a relationship between endocrine function, especially the ovary and thyroid, with Candida. That is because there is molecular mimicry between Candida and the tissues of these glands.

2) One of the toughest problems in medical practice is recurrent hives. It is true that the known causes are drugs, yellow dye, food (especially natural salicylates), parasites, and hidden infection. Yet despite a patient being reactive to these many things, yeast eradication using systemic anti-fungal drugs clears the great majority of these patients’ hives.

3) A large segment of my patient population is made up of children with the Autism Spectrum Disorders. Whereas heavy metal poisoning is clearly the major cause in altering behavior in these children, yeast cannot be far behind. It never ceases to amaze me how effective systemic yeast eradication is in improving these disorders. As so many of these children have significant allergies, which leads to superimposed infections with massive recurrent use of antibiotics, the prevalence of yeast should really be no surprise. [For further information, see our companion article Yeast-Yet Again!-An Interview]

4) Diet plays a role in the support of our natural good flora-and of yeast. Diets high in simple carbohydrates do promote further yeast, so controlling its overgrowth requires reducing refined carbohydrates and simple sugars.

5) There are many alternative products that can control Candida. These include Oregano, Grapefruit Seed Extract, Olive Leaf Extract, and bicarbonate. I prefer beginning patients on Ketoconazole (Nizoral) or Fluconazole (Diflucan) first because the therapeutic trial is critical to making the diagnosis and establishing the cause. If Candida is the cause, the response is usually rapid and obvious.

6) Some patients are from Missouri and demand to be shown first that they are inhabited by massive yeast before they will start drug therapy. An Organic Acid Analysis, performed on a urine sample, may reveal presence of specific metabolites that are not of human origin. D-arabinose is specific to Candida, while Citromalic and Tartaric Acid are non-specific to other forms of yeast.

7) Finding physicians willing to test and treat problems of yeast is difficult, except for environmental physicians. The American Academy of Environmental Medicine’s website will provide their names: www.AAEMonline.com

8) There are presently numerous books on yeast, but all of the late Billy Crook’s are, in my opinion, some of the best.

Based on 33 years in the practice of Environmental Medicine, it is my opinion that Candida plays a critical role in many of the patients I have treated. Candida should be considered in every patient, especially those patients with multi-system involvement. In my experience, a therapeutic trial using systemic anti-fungal drugs is the only way to identify yeast as a causative factor in the patient’s multiple signs and symptoms.

 

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