Authored by Dr. Barrett

1. Hypothyroidism

• Definition: Underactive thyroid; insufficient production of thyroid hormones.
• Common Causes: Autoimmune thyroiditis (Hashimoto's), iodine deficiency, medications.
• Symptoms:
  • Fatigue
  • Weight gain
  • Cold intolerance
  • Hair loss
  • Depression

2. Hyperthyroidism

• Definition: Overactive thyroid; excessive production of thyroid hormones.
• Common Causes: Graves' disease, thyroid nodules, inflammation/recent viral infection.
• Symptoms:
  • Weight loss
  • Rapid heartbeat
  • Anxiety
  • Tremors
  • Heat intolerance

3. Hashimoto's Thyroiditis

• Definition: An autoimmune condition causing hypothyroidism.
• Common Features:
  • Presence of thyroid antibodies
  • Gradual destruction of thyroid tissue
  • Fluctuating thyroid hormone levels

4. Graves' Disease

• Definition: An autoimmune condition causing hyperthyroidism.
• Common Features:
  • Presence of thyroid antibodies
  • Overstimulation of thyroid gland
  • Increased production of thyroid hormones

5. Thyroid Nodules

• Definition: Abnormal growths or lumps in the thyroid gland.
• Common Causes: Iodine deficiency, inflammation, genetic factors.
  
• Symptoms:
  
  • Swelling in the neck
    
  • Difficulty swallowing
    
  • Hoarseness
    
  • Pain or discomfort

Hypothyroidism
Hypothyroidism is a condition characterized by an underactive thyroid, where the thyroid gland fails to produce sufficient thyroid hormones. This condition can manifest due to various factors and affects individuals of all ages, with a higher prevalence in women and older adults.

Common Symptoms of Hypothyroidism:

• Weight gain
• Fatigue
• Cold intolerance
• Constipation
• Hair loss
• Depression
• Dry skin
• Muscle weakness
• Joint pain
• Memory issues

​Causes of Hypothyroidism:
Autoimmune Thyroiditis (Hashimoto's):

• The most common cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune condition where the immune system attacks and damages the thyroid gland. See more details about Hashimoto’s below. 

Iodine Deficiency:

• In regions with insufficient dietary iodine, the thyroid may struggle to produce thyroid hormones, leading to hypothyroidism.

Thyroid Surgery or Radioactive Iodine Treatment:

• Individuals who have undergone thyroid surgery or received radioactive iodine treatment may experience a reduction in thyroid function.

Medications:

• Certain medications, such as lithium and amiodarone, can interfere with thyroid hormone production.

Congenital Factors:

• Some individuals may have congenital conditions affecting thyroid development or function.

Pituitary Disorders:

• Dysfunction of the pituitary gland, which regulates thyroid function, can result in hypothyroidism.

​
Diagnosis:

• Diagnosis involves blood tests measuring TSH (Thyroid Stimulating Hormone), Free T3, and Free T4 levels.
• Anti-TPO antibodies and Anti-TG antibodies may be tested to determine if the hypothyroidism is autoimmune (Hashimoto's).

Conventional Treatment:

• Standard treatment involves thyroid hormone replacement therapy, typically with synthetic T4 (levothyroxine/synthroid).

Hyperthyroidism
Hyperthyroidism is a condition marked by an overactive thyroid, where the thyroid gland produces an excess of thyroid hormones. This heightened thyroid activity can arise from various factors and typically affects individuals under the age of 40, with a higher prevalence in women.

Common Symptoms of Hyperthyroidism:

• Weight loss
• Rapid heartbeat
• Anxiety
• Tremors
• Heat intolerance
• Sweating
• Insomnia
• Palpitations
• Bulging eyes (Graves' ophthalmopathy)

Causes of Hyperthyroidism:
Graves' Disease:

• The most common cause of hyperthyroidism is Graves' disease, an autoimmune condition where the immune system stimulates the thyroid to produce excessive hormones.

Thyroid Nodules:

• Abnormal growths on the thyroid, known as nodules, can lead to an overproduction of thyroid hormones.

Thyroiditis:

• Inflammation of the thyroid, often caused by infections or autoimmune factors, can cause a temporary release of stored thyroid hormones.

Excessive Iodine Intake:

• Consuming an excessive amount of iodine, whether through diet or supplements, can lead to hyperthyroidism.

Medications:

• Certain medications, such as amiodarone, interferon, and lithium, can disrupt thyroid function.

Pituitary Disorders:

• Dysfunction of the pituitary gland, which regulates thyroid function, can result in excessive thyroid hormone production.

Diagnosis:

• Diagnosis involves blood tests measuring TSH (Thyroid Stimulating Hormone), Free T3, and Free T4 levels.
• Thyroid antibodies, specifically TSI (Thyroid Stimulating Immunoglobulin), are often tested to confirm Graves' disease.
• Imaging studies, such as a thyroid ultrasound or nuclear thyroid scan, may be conducted to assess the size and condition of the thyroid.

Conventional Treatment:

• Conventional treatment includes antithyroid medications (methimazole, propylthiouracil), radioactive iodine therapy, or surgical removal of the thyroid (thyroidectomy).

Hashimoto’s
Hashimoto's thyroiditis, clinically known as chronic autoimmune (lymphocytic) thyroiditis, is an autoimmune condition where the immune system erroneously targets and dismantles the thyroid gland, causing a gradual decline in thyroid function. Hashimoto's is significantly more prevalent in women, occurring seven times more frequently than in men.

Common Symptoms of Hashimoto's:

• Weight gain
• Fatigue
• Cold intolerance
• Constipation
• Hair loss
• Depression
• Heavy periods
• Muscle aches
• Poor concentration
• Dry skin

Some individuals with Hashimoto's experience Hashitoxicosis, characterized by alternating periods of excessive thyroid hormone release and subsequent hypothyroid symptoms, creating a roller-coaster effect.

Contributing Factors to Hashimoto's:
Postpartum:

• Immune system shifts during pregnancy may trigger postpartum Hashimoto's, either transient or permanent.

Iodine:

• Mild iodine deficiency is linked to a lower prevalence of Hashimoto's, while excessive intake is associated with a higher incidence.

Molecular Mimicry:

• Immune response to substances (e.g., gluten, bacteria) can lead to confusion, resulting in an attack on thyroid tissues.

Intestinal Permeability (Leaky Gut):

• Breakdown in the gut barrier allows larger particles into the bloodstream, triggering an immune response.

Genetic Predisposition:

• A family history of thyroid disease is strongly associated with Hashimoto's, although specific contributing genes are not fully understood.

Stress:

• Chronic stress, if not managed, may impact cortisol levels, affecting the immune system and contributing to the development of Hashimoto's.

Radiation Exposure:

• Excessive radiation to the thyroid increases the risk of thyroid disorders.

Diagnosis:

• Blood work and/or a thyroid ultrasound are used for diagnosis.
• Comprehensive blood work includes TSH, FT3, FT4, Anti-TPO antibodies, and Anti-TG antibodies.
• Elevated antibodies suggest Hashimoto's, even in the absence of abnormal TSH, T3, or T4 levels.

Conventional Treatment:

• Conventional treatment often involves synthetic T4 replacement, with little distinction between Hashimoto's and hypothyroidism.

Grave’s Disease
Graves' disease, an autoimmune disorder, is marked by the immune system mistakenly attacking the thyroid gland, resulting in excessive production of thyroid hormones. Unlike Hashimoto's, Graves' disease leads to hyperthyroidism, causing an overactive thyroid. This condition is more prevalent in women and often manifests in individuals under the age of 40.

Common Symptoms of Graves' Disease:

• Weight loss
• Rapid heartbeat
• Anxiety
• Tremors
• Heat intolerance
• Sweating
• Insomnia
• Palpitations

Individuals with Graves' disease may also experience Graves' ophthalmopathy, characterized by eye-related symptoms such as bulging eyes, double vision, and eye irritation.

Contributing Factors to Graves' Disease:
Genetic Predisposition:

• Family history of thyroid disorders increases the likelihood of developing Graves' disease, indicating a genetic component.

Molecular Mimicry:

• Similar to Hashimoto's, molecular mimicry plays a role, with the immune system targeting the thyroid due to confusion with external substances, often involving the TSH receptor.

Stress:

• Chronic stress may contribute to the development of Graves' disease, potentially through its impact on the immune system.

Infections:

• Certain infections, particularly viral infections, have been linked to the onset of Graves' disease.

Pregnancy:

• Pregnancy, like in Hashimoto's, can trigger shifts in the immune system, leading to the development of Graves' disease.

Smoking:

• Cigarette smoking has been associated with an increased risk of Graves' disease and exacerbation of symptoms.

Diagnosis:

• Diagnosis involves blood tests measuring TSH, Free T3, Free T4, and thyroid antibodies (TSI—Thyroid Stimulating Immunoglobulin).
• Imaging studies, such as a thyroid ultrasound, may be conducted to assess the size and condition of the thyroid.

Conventional Treatment:

• Conventional treatment often includes antithyroid medications (methimazole, propylthiouracil), radioactive iodine therapy, or surgical removal of the thyroid (thyroidectomy).

Thyroid Nodules
Thyroid nodules are abnormal growths or lumps in the thyroid gland, a common condition that can vary in size and nature. While most nodules are benign, some may raise concerns about thyroid function or the possibility of thyroid cancer.

Common Features of Thyroid Nodules:

• Presence of a palpable lump or swelling in the neck
• Difficulty swallowing or breathing, particularly for larger nodules
• Hoarseness or voice changes
• Occasionally, pain or discomfort in the neck

​Causes of Thyroid Nodules:
Iodine Deficiency:

• In regions with low dietary iodine, the thyroid may develop nodules as a compensatory response.

Thyroiditis:

• Inflammation of the thyroid, whether due to autoimmune factors or infections, can lead to nodule formation.

Multinodular Goiter:

• An enlargement of the thyroid gland, known as a goiter, can harbor multiple nodules.

Cysts:

• Fluid-filled sacs may develop within the thyroid, forming cystic nodules.

Benign Tumors:

• Non-cancerous tumors, such as adenomas, can contribute to nodular growth.

Thyroid Cancer:

• While most nodules are benign, some may indicate thyroid cancer, necessitating thorough evaluation.

Diagnosis:

• Diagnosis involves imaging studies, such as ultrasound, to assess the size, location, and characteristics of the nodules.
• Fine Needle Aspiration (FNA) biopsy may be performed to extract cells for microscopic examination.
• Blood tests, including thyroid function tests, may aid in assessing thyroid hormone levels.

​Conventional Treatment:

• Treatment depends on the nature of the nodules. Benign nodules may be monitored, while interventions such as surgery or radioactive iodine therapy may be considered for larger or suspicious nodules.

Thyroid Health in General
Dietary Interventions: A cornerstone of our treatment involves advocating for a high-antioxidant diet abundant in vegetables. Nourishing the body with these vital nutrients supports overall health and specifically targets the oxidative stress often associated with thyroid disease.

Health Foundations: We ensure that patients have a solid foundation of health including proper sleep, hydration, physical activity and rest time. 

Nutrient optimization: We test our patients for nutritional status such as vitamin D, ferritin and other synergistic nutrients/hormones that are necessary for proper thyroid function. 

Herbal medicine: We may utilize specific herbs to support thyroid health such as ashwagandha, guggul and bladderwrack. 

Autoimmune Thyroid Diseases

Digestive Health: We work to identify and heal any intestinal permeability and foster a healthy balance of flora in the gastrointestinal tract. This holistic approach acknowledges the interconnectedness of gut health and immune function.

Identify Triggers: We look for factors that may contribute to autoimmune disease such as the Epstein Barr Virus, dysbiosis, food sensitivities such as gluten, and heavy metal exposure. 

Mind-Body Medicine: Recognizing the impact of stress on autoimmune disease, our approach incorporates mind-body medicine. We assess stressors, analyze stress responses, and explore somatic manifestations. Questions about the ability to express one's truth are posed, acknowledging the proximity of the thyroid to the voice box and its potential role in stress-related dysfunction.

Herbal Medicine: We utilize herbs that reduce thyroid function in hyperthyroid states such as Grave’s disease. 

Nutritional Support: We tailor nutritional needs to each patient but some examples include carefully monitoring iodine intake in Hashimoto’s patients to avoid excess, enhancing selenium intake to support a healthy immune response, and ensuring optimal nutrient intake to support phase II liver detoxification (high sulfur foods for example).  

Collaboration with a Naturopathic Doctor: For those navigating Hashimoto's or Grave’s Disease, we recommend collaborating with a naturopathic doctor. Identifying the root causes of autoimmune diseases and tailoring treatment to individual needs are central to our philosophy. Together, we strive to restore balance and enhance overall well-being. With Grave’s disease we also recommend working with an endocrinologist. 

Authored by Dr. Barrett

These microbes do many things for us. So much in fact that without them it would be difficult for us to survive. They digest certain fibers turning them into short chain fatty acids that we need for our digestive health. They communicate with our immune cells and control how we respond to infections. New research indicates that there is a strong connection between our brain health and our microbiome. The microbiome is also considered to be an endocrine organ because it exerts influence on distant organs and pathways (1).

Oral contraceptive pills (OCPs) also known as birth control, impacts the health of our microbiome. The hormones that are naturally produced in our bodies and the hormones that we take orally both impact the composition of our microbiome (2). It makes sense that taking hormones orally would alter the microbiome. For millions of years we were only exposed to hormones that we produce naturally. It’s only been in the last 70 years that we started taking hormones by mouth. 

Folks who take oral birth control (hopefully) know that when they take antibiotics the birth control pill can become much less effective. One hypothesis for this effect is that antibiotics dramatically alter the microbiome where a significant amount of estrogen metabolism takes place (3).

Unfortunately the birth control pill can also increase your risk of inflammatory bowel disease. In two large studies it was found that women who use oral contraceptives for over 5 years had a significantly increased risk for developing inflammatory bowel disease, particularly Crohn’s (4).

It’s not just the gut microbiome that’s impacted by birth control pills. The vaginal microbiome is also altered and the risk of vaginal yeast infections is increased in people taking birth control pills (5).

We need more research into the microbiome but we know enough now to know that taking oral hormones impacts the health of our microbiome. 

In general here are some ways to support a healthy microbiome:

• Consuming fiber daily from a variety of sources. Aim for 30-35g daily. 
• Limit processed foods and high sugar foods in your diet.
• Consume fermented foods.
• Limit your use of antibiotics.

References:

1. Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 2021 Jan-Dec;13(1):1-21. doi: 10.1080/19490976.2021.1894070. PMID: 33722164; PMCID: PMC7971312.
2. Hua X, Cao Y, Morgan DM, Miller K, Chin SM, Bellavance D, Khalili H. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. J Med Microbiol. 2022 Apr;71(4). doi: 10.1099/jmm.0.001512. PMID: 35452382.
3. Adlercreutz H, Pulkkinen MO, Hämäläinen EK, Korpela JT. Studies on the role of intestinal bacteria in metabolism of synthetic and natural steroid hormones. J Steroid Biochem. 1984 Jan;20(1):217-29. doi: 10.1016/0022-4731(84)90208-5. PMID: 6231418.
4. Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CS, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013 Aug;62(8):1153-9. doi: 10.1136/gutjnl-2012-302362. Epub 2012 May 22. PMID: 22619368; PMCID: PMC3465475.
5. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception. 1995 May;51(5):293-7. doi: 10.1016/0010-7824(95)00079-p. PMID: 7628203.

 ​

Authored by Dr. Aidanne

What is Acne?
Acne refers to the inflammation and irritation of the hair follicle that results in trapped oils (also known as “sebum”), skin cells, and various bacteria known as C. acnes that populate the skin surface. When trapped, this mix of materials can produce what we know as pimples that are characteristic of acne. Pimples can come in many forms and show as either white heads, black heads, raised bumps or cysts deep under the skin surface. They are commonly located on the face, arms, chest and back. Whether it is showing as a single pimple or more widespread, the pressure of a clogged follicle can become very painful and lead to scarring.

What Causes Acne?
I hear this question frequently in clinic, and there is no one catch all answer for everyone. Some people may have a single key root cause while others may have a combination of triggers. This is where blood work and functional lab testing are useful to guide proper management of acne.

As with most conditions, acne has both modifiable and unmodifiable risk factors. Modifiable factors are those that are within our control to change. Unmodifiable are those that are out of our control.

Here are some of the most common modifiable triggers for acne:

• Hormonal Changes (ie. estrogen, testosterone, DHT, DHEA, etc.)
• Diet & Food Sensitivities
• Blood Sugar Regulation (ie. Glucose, insulin)
• Stress (ie. Cortisol)
• Nutrient deficiencies

Here are some of the most common unmodifiable triggers for acne:

• Age
• Genetics / Family History

Hormones:
Androgens and androgen precursors are hormones that can lead to acne when elevated. These include testosterone, DHEA, and DHT. The latter has nearly four times the potency of testosterone. These hormones increase the amount of sebum that is produced, which can clog the pores more frequently leading to increased acne. Also, fluctuations in estrogen and progesterone throughout the menstrual cycle can also worsen acne.

Diet & Blood Sugar Regulation:
You may have experienced a pimple or two after eating a lot of baked goods or sugary foods. When we eat foods that are high on the glycemic index, our blood sugar levels go up. Given insulin’s main job is to remove sugars from the blood stream and send them to the tissues to be burned for fuel, a high blood sugar level causes insulin to rise. Elevated insulin levels can drive the production of androgens, thus leading to increased sebum production.

Whey is a protein found in dairy that can trigger acne for a couple of reasons. When consumed regularly, food sensitivities can result in GI related inflammation that weakens the skin barrier. Many people do not tolerate dairy well, and this is often due to either its lactose or whey content. Secondly, consuming whey leads the body to make a chemical called Insulin Like Growth Factor (IGF-1) which triggers cells to grow. What is one of the main hormones that causes tissue growth? Yet again, the answer is testosterone!

Stress:
When stressed, the body makes various hormones to drive the “fight or flight” response. The adrenal glands are the primary source of two key hormones in this process, DHEA and Cortisol. DHEA can be converted into testosterone in the body, and cortisol spikes increase circulating blood sugars so that the body has quick fuel if it needs to act quickly.

Adaptogens are a group of botanical medicines that help the body “adapt” to the stress response and improve stress resiliency. I often include an adaptogen as part of an acne protocol.

Nutrient Deficiencies:
Those living with acne have been found in the literature to be more likely to have low Vitamin A, Vitamin D, Vitamin E and zinc status compared to their counterparts. Where it’s hard to say whether these deficiencies are a main cause acne, their supplementation has been shown to improve the intensity of acne, reduce inflammation, and help skin cells heal.

Authored by Dr. Barrett

Authored by Dr. Aidanne

Up to 7% of women do not experience any symptoms but most women will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The inner lining of the uterus is meant to respond to estrogen with changes in the menstrual cycle. When found outside of the uterus, this endometrial tissue can wreak havoc on organs and systems due to both its physical presence as well as the inflammatory response it exerts on the local nerves when exposed to estrogen. Up to 7% of people do not experience any symptoms but most people will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The risk of endometriosis goes up if you have a family history, early onset of menstruation, late menopause, heavy and short menstrual cycles, or have never had a pregnancy. 

The goal of supporting a person with endometriosis is to support clearance of estrogens to lower their effect on the system, alleviate pain, and reduce inflammation. Often women are told that they simply have heavy periods, and they’ll have to either live with it or go on birth control. Although birth control can provide relief, there are other options available. Let’s dive in!

Diet:
​
As elevated sugar in the diet can increase our estrogen levels, minimizing excess carbohydrates and sugar is key in reducing pain symptoms of endometriosis. 

Since we eliminate hormone metabolites through our stool, ensuring that bowel movements are well-formed and easy to pass is important to avoid reabsorbing estrogen. Fibers such as those that come from ground flax seed can help with this and can also reduce estrogen in the blood stream by increasing the level of sex hormone binding globulin (SHBG). 

Antioxidants are needed to offset the oxidative stress that occurs with inflammation. Foods that had a mother and are colorful are typically antioxidant rich, such as green leafy veggies, berries, red onion, carrots, etc. 

Finally, the cruciferous family of veggies (ie. broccoli, cauliflower, Brussels sprouts, etc.) contain compounds in them called indol-3-carbinol (I3C) and diindolylmethane (DIM) which help metabolize estrogens to the lower potency, 2-hydroxyestrone form. 

Food is medicine!

Lifestyle:

The best lifestyle factors to improve symptoms of endometriosis include movement, reducing exposure to environmental estrogens also known as xenoextrogens, and using castor oil packs. 

Movement can have a positive impact on all body systems. In this case, it encourages the muscles to utilize the sugars within our blood stream. When blood glucose levels are reduced, so is the hormone needed to take them out of the blood stream known as insulin. High levels of insulin dampen our liver’s ability to produce SHBG which allows estrogen to roam more freely in the blood stream and exert its effect on bodily tissues. 

Xenoestrogens can come from various sources such as plastics (BPA, BPS), polychlorinated biphenyl (PCB), phthalates in cosmetic products, pesticides, cigarette smoke, exhaust, chemical pollutants, etc. These synthetic estrogen mimicking components can be reduced by:

• Switching to a stainless-steel water bottle
• Buying organic where possible
• Dusting & vacuuming regularly 
• Incorporating EWG approved unscented & phthalate free cosmetic products
• Cooking with cast iron
• Using glass storage containers vs. plastic and avoiding heating plastics

Although the mechanism is not fully clear, castor oil is known to have anti-inflammatory and analgesic effects when used topically. It can be applied to the abdomen or pelvis to alleviate pain symptoms. Talk to your naturopathic doctor to learn more! 

Botanicals & Nutritional Supplementation:

Botanical & nutritional medicines can be used to support the liver in clearing estrogens, bring blood sugars into balance, and alleviate pain by reducing inflammation. 

Common recommendations would include:

• Hormone Regulators – Chaste tree verry, 
• Antioxidants – Melatonin, Resveratrol, EGCg, Pycnogenol
• Anti-inflammatories – Turmeric, Cat’s Claw, Ginger, Garlic
• Liver Supporting – Milk thistle, NAC, Burdock

A placebo-controlled study from 2013 in Brazil showed that melatonin at a dose of 10mg nightly was able to reduce daily pain scores by nearly 40% when taken for 8-weeks. This affect was attributed to melatonin’s ability to decrease both reduce pain on its own and lower levels of a protein called brain-derived neurotrophic factor (BDNF) which makes the nerves more sensitive to pain. 

A 2021 randomized control trial conducted in Iran showed that 400mg of garlic extract taken daily for 1-3 months could improve pelvic pain, low back pain, heavy menstrual bleeding, and painful intercourse. This effect was attributed to garlic’s ability to support estrogen clearance in the liver and its anti-inflammatory Allicin content. 

Interested in learning more? Let’s chat!

References:

1. Schenken, RS. Endometriosis: Pathogenesis, epidemiology, and clinical impact. UpToDate. Updated: Feb 13, 2023. Accessed: Apr 6, 2023.
2. Endometriosis. World Health Organization. Accessed from this link. 
3. Prousky, J. Textbook of Integrative Clinical Nutrition. CCNM Press. 2013.
4. Daka B, Rosen T, Jansson PA, Råstam L, Larsson CA, Lindblad U. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocr Connect. 2012;2(1):18-22.
5. Ilhan M, Dereli FTG, Akkol EK. Novel drug targets with traditional herbal medicines for overcoming endometriosis. Curr Drug Deliv. 2019;16(5):386-399.
6. Schwertner A, Conceição dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-881.
7. Amirsalari S, Behboodi Moghadam Z, Taghizadeh Z, Jafar Abadi MN, Sabaghzadeh Irani P, Goodarzi S, Ranjbar H. The Effect of Garlic Tablets on the Endometriosis-Related Pains: A Randomized Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2021 Jul 20;2021:5547058. doi: 10.1155/2021/5547058. PMID: 34335819; PMCID: PMC8315864.

Authored by Dr. Barrett