5 Long-term Side Effects of Bulimia & Anorexia

“You could die from this,” and “You’re not healthy”—two phrases I often heard during my 15 year battle with eating disorders…but I never really believed at the time.

Nevertheless, there’s no question about it: eating disorders and chronic dieting takes a toll on your body. The side effects of bulimia, anorexia, binge eating and chronic dieting are vast—especially the long term side effects. 

Some of the long term side effects from eating disorders include:

• Chronic gut issues (Constipation, bloating and digestive difficulties)
• A super slow or super fast metabolism
• Fatigue and blood sugar control issues
• Hormone imbalances
• Immune imbalances

—Just to name a few things.  I call these side effects “post recovery recovery”—what happens to your body after an eating disorder.

If this is you, or if you’ve ever wondered, “What is happening to my body…I am in recovery and healthy now!?” You are not alone.  Read on to learn about 5 (common) long term side effects of bulimia, anorexia and chronic dieting—and what to do about it.

The Top 5 Long Term Side Effects of Eating Disorders

(That Most Doctors, Google Articles & Textbooks Won’t Tell You About)

You know eating disorders aren’t good for your health and well-being.

Many healthcare practitioners, Dr. Google articles and medical textbooks educate a lot about the short-term side effects of eating disorders. Do these lists look familiar? 

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Common Short-term Side Effects of Anorexia

• Weight loss and thin appearance
• Loss of appetite
• Brittle hair and nails
• Flakey, dry skin
• “Peach fuzz” hair that grows on body (lanugo)
• Constipation & bloating
• Cold body temperature
• Anemia
• Abnormal blood counts
• Fatigue
• Dizziness and fasting
• Bone Fractures, Stress Fractures & Osteoporosis
• Amenorrhea (Losing your period) & Infertility
• Irregular heart beat and heart failure
• Dehydration
• Kidney damage and failure
• Elevated liver enzymes and Liver damage
• Seizures
• Low blood pressure
• Depression and anxiety

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Common Short-term Side Effects of Bulimia

• Unwanted shifts in weight
• Eroded enamel on teeth and tooth decay
• Ruptured or damaged esophagus
• Irregular heart beat and heart failure
• Dehydration
• Weakened kidney and heart muscle
• Electrolyte imbalances
• GI irregularity and constipation
• Russel’s Sign (scratches on fingers and hands from self-induced purging)
• Swollen salivary glands
• Acid reflux
• Sore throat and hoarse voice
• Facial swelling
• Blood in vomit
• Feeling faint
• Low libido
• Red eyes
• Mood swings
• Depression and anxiety

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However, what about the long-term side effects that commonly happen to patients after they recover from their eating disorder? Are you magically healed and healthy after your eating disorder?

Answer: Not always.

After years of struggling and finally recovering from an eating disorder, many clients come to me completely confused about what is happening to their body in their post-eating disorder recovery years!

Why am I gaining weight without trying?

Why is my period missing?

Why am I intolerant to dairy, eggs and nuts? 

With all the imbalances happening in their bodies, many clients also come to me frustrated and skeptical about the concept of trusting their body in recovery (after all, it’s obviously working against them, right?).

I’ve been there before, and in my experience both as a former patient and now as a clinician, let’s discuss 5 Common Longterm Side Effects of Bulimia, Anorexia & Chronic Dieting (that many doctors and medical textbooks may not tell you about).

 

5 Common Long-Term Side Effects (After Recovering) from Anorexia, Bulimia & Chronic Dieting

 

SIDE EFFECT #1: YOU HAVE “GUT ISSUES” (BLOATING, CONSTIPATION, IBS)

Individuals in eating disorder recovery often complain about “gut issues” with gut side effects in bulimia, anorexia and eating disorder recovery including:

• Feeling bloated or excessively full after meal
• Chronic constipation
• GERD/Heartburn and indigestion
• Poor appetite, or insatiable appetite (like they have malabsorption)
• IBS
• Loose stools and diarrhea
• Abdominal cramping
• Nausea

To a great extent, it makes total sense that your gut health would NOT feel well in recovery considering some of the most common eating disorder habits that wreak havoc on your gut microbiome, including:

Eating Disorder Habits That Wreak Havoc on Your Gut Microbiome

• NOT listening to your body’s hunger-fullness cues
• Eating processed diet foods (Diet Coke with artificial sweeteners, sugar free candy/gum, frozen dinners, 100 calorie Snack Packs, diet bars)
• Abusing laxatives
• Depriving your body of nutrients
• Significant stress
• Under-eating
• Eating the same things every day
• Broken sleep
• Binging
• Purging
• Overexercise

A healthy microbiome thrives upon a diverse diet, nutrient-dense whole foods, plenty of stomach acid and digestive enzymes, balanced exercise, quality sleep, lots of water and as little stress as possible (goodbye inflammation). If these factors are not present, then leaky gut, dysbiosis (bacteria imbalances) and disrupted digestion are a given.

If your eating disorder continued for long enough, several different gut pathologies (ie. “gut issues”) can arise that were not there previously. Some of the most common gut pathologies I see in my functional medicine, nutrition and therapy practice include:

Common Gut Pathologies in Eating Disorder Recovery

• Bacterial overgrowth or “SIBO”
• Candida and fungal overgrowth
• Gut bacteria imbalance (“Dysbiosis”)
• IBS (Chronic constipation, bloating and/or loose stools)
• IBD (colitis, Crohn’s)
• Food intolerances
• Non-alcoholic fatty liver
• Mold overgrowth
• Parasites and bacterial infections (lyme, co-infections)

The Gut-Eating Disorder Connection

Your gut is the gateway to your health and if and when our healthy gut bacteria and/or the healthy process of digestion are thrown out of whack, then “gut imbalances” arise, along with other imbalances in our health and body (i.e. anxiety and depression, autoimmune disease,  thyroid dysfunction, blood sugar  and hormone imbalances, etc ).

Think of your gut—the bacteria living inside you and the process of digestion—like a domino.

If your gut microbiome—the main domino—gets pushed or tips over, then the other “dominoes” of your health will also fall, often in the form of the diseases and health imbalances you are MOST genetically susceptible to (Krautkramer et al, 2016).

For example, take anxiety: 90% of your serotonin levels (your “feel good” brain chemicals) are produced in your gut. However, if your healthy gut bacteria are disrupted and cannot produce enough serotonin, what do you think happens to your anxiety levels? They often go up (Yano et al, 2015).

Or your hormones: Your gut microbiome, along with your liver, represent your largest endocrine organ—greatly responsible for synthesizing and balancing your estrogens and cortisol levels (your stress hormones). However, if your healthy gut bacteria are disrupted, or your liver is congested, what do you think happens to your hormones? For some women, they lose their period; others get irregular periods; others have crazy PMS (Ahlman & Nilsson, 2001).

These are just two ways—of many—that your microbiome affects your health as a whole, and a big reason why your eating disorder history and previous non-gut-loving-habits can lead to a slew of side effects in your post recovery years.

My “Gut Problems” Experience in Eating Disorder Recovery

Bloating, constipation, gas, loose stools and IBS plagued my health history for the first 29 years of my life.

Unfortunately, however, throughout my eating disorder and treatment process, I was often told that my gut issues were a “normal part of recovery” and that I should just “suck it up”—there was nothing much more I could do about my gut problems )other than drink Miralax stool softener before bed and take Lactaid pills with my ice cream and pizza).

Sometimes I was even accused of trying to “make excuses” or “get out of eating fear foods” during my hospitalizations and eating disorder treatment process. If I complained about my gut problems, countless nurses, recovery coaches and dietitians often told me that my eating disorder was “talking”—telling me to pipe down and just eat the four Pop-Tarts served on my tray—in one setting; choose between a Twinkie or Ding Dong for a snack—no other options; or finish every last crumb of two extra large slices of cheese pizza with a milkshake every Saturday night—I am lactose intolerant.

If anything, these messages and many of my forced feedings left me completely confused: Is it really my eating disorder really speaking—fearing certain foods? Or, does my body and my gut really not feel well? 

Answer: My gut microbiome was a wreck—both from my eating disorder habits and eating disorder treatment.

Looking back on my 20+ year battle with eating disorders and the accumulated 4 years of my life that I spent in hospitals and treatment centers eating a conventional Standard American Diet and tube feedings, I smile—now beyond thankful.

Because without both of these experiences, I would not be the functional medicine practitioner I am today, nor would I have discovered the amazing connection between our gut health, our brain health and eating disorders (Borgo et al, 2017). I also believe that, without my experience living in both extremes (Extreme #1: diet cokes and carrot sticks vs. Extreme #2: Pop-tarts, pizza and Prozac), that I would not have the peace I have with food and my body today—now living in balance, the middle, of both extremes.

The Bottom Line: Your gut health is the gateway to your total health—and the reason you may have gut issues in your post-recovery eating disorder years is because both your eating disorder, and possibly treatment, wreaked havoc on your gut microbiome. 

SIDE EFFECT #2: YOUR METABOLISM SLOWS DOWN or SPEEDS UP

“Why do I keep gaining weight?!” OR “Why do I have a hard time holding on to my weight?!”

Metabolism “issues” impact individuals in eating disorder recovery on both sides of the spectrum. Your metabolism is a representation of how efficiently your body is at using your energy (food and energy stores in your cells, muscle and organs) for all your cellular processes and body functions.

For some individuals in eating disorder recovery: Your metabolism becomes super fast. Your body needs a lot of food as the metabolism goes through the roof! You struggle to keep weight on without necessarily trying. You struggle to build muscle or see progress in the gym. If you have a “slow metabolism” it typically means your body’s digestive process, blood sugar balance and/or stress hormone pathways are stressed and sort of like walking through the mud after a hard rain in stiletto heels, your metabolic processes (digestive, stress response, blood sugar balance mechanisms) “walk” less smoothly and efficiently. They get stuck clomping through the muck.

For others in eating disorder recovery: It becomes super slow. You have no real appetite. You can get by seemingly just fine on what others may consider a diet. You may even just look at a piece of pizza and seemingly gain 3 pounds. You struggle to tone up or see progress in the gym. If you have a “fast metabolism” it typically means your body burns your energy like a furnace. However, it can ALSO mean you have impaired digestive pathways (and your body is actually stressed and/or unable to absorb or use your energy to the best of its abilities)—often due to a leaky gut or blood sugar imbalances caused by a period of chronic dieting and under-eating.

In both cases, stress—namely cortisol (stress hormone) imbalances—is the number one culprit driving your metabolic mayhem.

And although you may no longer struggle with your former eating disorder behaviors, thoughts or even think you are stressed out, your body may still feel the side effects from chronic stress during your eating disorder days. Here are 4 common reasons why your metabolism (and cortisol levels) are off in eating disorder recovery:

Chronic Dieting & Under-eating Backfires

One of the best studies about how chronic dieting affects your metabolism is the “Biggest Loser” study (Fothergill et al, 2016). In it, researchers followed and tracked the metabolic efficiency of former “Biggest Loser” TV show contestants 6 years after being on the show and experiencing amazing weight loss results from their 12-week stint spent dieting. The findings? Every single contestant had gained their weight back, despite eating “healthier,” and their metabolisms were 1 to 2 times less efficient than they had been previously (i.e. they required about 500 calories less for weight maintenance than previously).

Thyroid Dysfunction Happens

Other research shows that individuals with both bulimia and anorexia experience the consequences of thyroid dysfunction (Altemus et al, 1996) (Warren, 2011)—the organ responsible for making sure your metabolic processes are working in tip top process. Hashimoto’s (thyroid autoimmune disease) is also highly correlated with eating disorder recovery, often characterized by unwanted weight gain or weight loss, food intolerances, fatigue and impaired metabolism. If your thyroid levels are “off,” (i.e. a TSH value above 2, or T3

Your Blood Sugar Levels Are Unstable

Blood sugar is what gives you energy and balanced blood sugar levels are a sign that your body is using energy properly. In an ideal world, when you eat, blood sugar levels go “up” (slightly) as insulin rushes in to your cells, giving them energy, then gradually come down with time back to a balanced flatline state of natural, normal energy—no caffeine or sugar needed.

However, in eating disorders, after a period of binging/purging or active restriction, your natural process of blood sugar balance gets off! Blood sugar levels either get extremely high (hyper-glycemia) or super low (hypo-glycemia) (Mirsa & Klibanski, 2011) as your body becomes less and less able to tap into normal digestive enzymes and blood sugar balance processes since your eating patterns tend to be more extreme.

Over time, the eating disorder conditions your blood sugar levels to function the majority of the time in these extreme states (i.e. under-eating, restricting proteins or fats or carbs, binging and purging, fasting). Couple this with the high chance of “leaky gut” and other gut imbalances in eating disorders, and malabsorption of nutrients in the first place ALSO prevents your body from getting the “proper nutrients” and absorbing the just-right-amount of energy and nutrients to keep your metabolism revving in tip top speed.

Reactive hypo-glycemia (eating but blood sugar dropping) (and insulin resistant hyperglycemia (as seen in diabetes) (Prioletta et al, 2011 )may also occur.

You Get a New “Set Point”

In research of individuals in recovery from anorexia, researchers have found that those who fought the battle for a longer amount of time, suffered from metabolic “damage” or side effects that entailed needing at least 1.5 times the amount of caloric load as other “normal controls” of their same size and stature (Kaye et al, 1988), and that their bodies were in hyper-calorie burning (Zipel et al, 2013) and hyper fat-burning mode (FASEB, 2008) (Dellava et al, 2009) . Researchers speculate this to be due to the catabolism (break down) of body tissues and organs, as well as long-term malnourished state and a body that “soaks up” nutrition to repair body damage once recovery ensues. Leaky gut and unhealthy gut bacteria from malnutrition also impair healthy metabolic pathways making malabsorption a common phenomenon others experience in recovery as well (Kane et al, 2015).

The Bottom Line: Chronic dieting, under-eating, over-exercise and/or body neglect tend to backfire.

For a more in-depth overview of how your metabolism works in eating disorder recovery, check out this article on the 7 Reasons Why Your Metabolism is Not Working After an Eating Disorder.

SIDE EFFECT #3: “ADRENAL FATIGUE” (HPA AXIS DYSREGULATION)

Do any of these sound familiar?

• Tired despite sleeping for 7-9 hours?
• Need coffee to function?
• Crave sugar or artificial sweeteners?
• Wired and tired at night or difficulty sleeping?
• Hangry before meals?
• Afternoon sleepiness or need naps often?
• Frequent headaches?
• Easily anxious, wound up or depressed?

Adrenal fatigue or “HPA Axis” Dysregulation  is a common phenomenon experienced in individuals in the aftermath of an eating disorder, due to the side effects of chronic long term stress on the body.

Although stress is a normal part of life (we all experience stress on a daily basis), TOO MUCH STRESS WITHOUT PROPER RECOVERY, we can throw our cortisol response completely off.

Cortisol is your stress hormone responsible for helping you “fight or flee” in the fight or flight response. However, if cortisol is constantly called upon and unable to help you fight or flee with the mounting stress, HPA Axis Dysregulation and hormone imbalances are a given.

Even in recovery, as you’re taking care of yourself, your body may still be healing for the time it spent living on edge constantly. It’s important to note that stress goes far beyond mental and emotional stress alone. It can also be physical.

Common stressors that cause HPA Axis Dysregulation symptoms in eating disorder recovery include:

Common Stressors in Eating Disorder Recovery

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Lifestyle Stressors

• Burning a candle at both ends
• Bluelight screen exposure (long times on screens)
• Less than 7 hours of sleep most nights
• Overtraining
• Imbalanced exercise (i.e. doing HIIT/cardio all the time without mixing it up)
• Not talking about your stress (bottling it up)
• Not doing things you love
• Exposure to chemicals in beauty, cleaning and hygiene products
• Plastic tupperware/container use
• Lack of outdoor/nature and fresh air
• Lack of play and fun
• NSAID use (headaches, etc.)
• Birthcontrol and long term medication use
• Endlessly Google searching answers to your health questions

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Dietary Stressors

• Frequent coffee/caffeine consumption
• Artificial sweeteners (most commercial stevia included)
• Eating packaged, refined or processed foods
• Low water intake (less than half your bodyweight in ounces)
• Tap water (not filtered)
• Frequent eating out (more than preparing/handling your food)
• High focus on calories, diet plans and food rules
• Lack of Vitamin P (pleasure in foods)
• Low carb intake and/or Low fat intake
• Lack of quality protein (amino acids for your brain)
• Dairy (conventional) consumption
• Grains and “gluten free” processed products (with gluten-cross contaminants)
• Binging/Purging and erratic eating habits
• NOT listening to your gut

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Mental & Emotional Stressors

• Not talking about it
• People pleasing
• Not feeling “good enough”
• Social Media comparing/endless scrolling
• Trying to be all things to all people/people pleasing
• FOMO (lack of downtime for yourself)
• Watching negative news
• Disconnection from community/meaningful relationships

 

 

 

 

 

 

 

 

 

 

 

The Bottom Line: Stress can still be at play in your health—even after recovery.

 

SIDE EFFECT #4: YOU GET YOUR PERIOD…THEN LOSE IT.

Your period is your monthly health “report card”—a sign that your hormones are working as they should (especially if PMS is minimal).

If you’re in recovery from an eating disorder, your period is also a sign that your body is healthier—in a more “stable place” and less stressed than it was during ED.

However, what happens if you get your period back in recovery…and then it goes missing again (even though you are in recovery and taking care of yourself)?

As previously discussed, your gut microbiome health (your largest endocrine—hormone producing—organ) is one of the #1 drivers at play in the common long term side effects of bulimia, anorexia and chronic dieting. Research clearly shows that the gut microbiome plays a central role in the regulation of estrogen and progesterone levels within the body and thus influences the risk of developing estrogen-related imbalances like amenorrhea (period loss).  Hence, if you have dysbiosis, bacterial or yeast overgrowth or a leaky gut, then your estrogen and progesterone levels can also be affected.

The estrobolome is the collection of gut bacteria that are capable of metabolizing and catalyzing estrogens. (Kwa et al, 2016) Your estrobolome controls and maintains the circulation and excretion of estrogens in your body. Gut bacteria in your estrobolome produce beta-glucuronidase, an enzyme that deconjugates estrogens into their active forms. Beta-glucuronidase activity then produces active, unbound estrogen that is capable of binding to estrogen receptors and influencing estrogen-dependent physiological processes.

However, what do you think happens if your gut bacteria are not able to activate estrogen? Period imbalances! When your gut microbiome is healthy, your estrobolome produces the “Goldilock’s” amount (just right) of beta-glucuronidase to maintain estrogen balance. However, when gut dysbiosis is present, your beta-glucuronidase activity may be altered—creating either a deficiency or an excess of estrogen, and consequently hormone imbalances (Baker et al, 2017)

“Adrenal fatigue” or impaired cortisol function also influences estrogen and progesterone balance. If your cortisol levels are either too high or too low, estrogen and progesterone levels get “thrown off” and the last thing your body wants to do when it is stressed is be fertile or make a baby.

Cortisol imbalance also affects your blood sugar and insulin levels—which, in turn affect menstruation (Cominato et al, 2014). Higher insulin levels can cause the ovaries to make more androgen hormones such as testosterone, and less estrogen (as seen in PCOS). Low insulin or low blood glucose levels (common in hypoglycemia, overtrained athletes and women with amenorrhea) can also signal to your ovaries and sex hormones, “I don’t have enough fuel or energy!”, also sparking period loss since fertility requires nutrients (Laughlin et al, 1998) (Schroeder et al, 2000). Low blood glucose levels can happen, not just from disordered eating, under-eating or accidental dieting, but also from an imbalanced gut microbiome (Utzschneider et al, 2016) or, you guessed it, chronic stress levels (Kamba et al, 2016) (cortisol goes up zapping up blood sugar, and blood sugar goes down).

Lastly, poor fat digestion as well as increased fatty acid oxidation and glucose metabolism (ie.a faster metabolism; increased energy needs) can cause hormonal imbalances. Your hormones are produced by the foods you eat and digest (and enough of those foods to support your metabolism—fatty acids, proteins and carbs included). If your gut microbiome is out of whack, you have a congested liver and gallbladder (the organ that breaks down fat), OR you have an impaired metabolism (ie. increased fatty acid “oxidation” and glucose metabolism, wherein you burn fuel really easily and require more energy for normal function) then your hormone production may also be impaired. Both of these conundrums are common in women with long term histories of disordered eating (Mehler & Brown, 2015) (Forney et al, 2016)  (Dellava et al, 2009) (Haas et al, 2018).

Note: Some women can STILL experience ovulation, despite no shedding of their uterus lining (i.e. bleeding), but more often than not, the period won’t happen until stress levels (inside and out) continue to be addressed. This is not ideal however, as iron overload and osteoporosis are also common in women who do not have regular periods. 

The Bottom Line: Your period may go missing in recovery because you have gut dysbiosis, HPA Axis Dysregulation (imbalanced cortisol levels), blood sugar imbalances, a congested liver/gallbladder and/or an altered metabolism.

SIDE EFFECT #5: AUTOIMMUNE DISEASE

Autoimmune disease affects 1 in 4 women, and 1 in 6 men—and, research shows if you’ve had an eating disorder, the prevalence and incidence of autoimmune disease goes up nearly two fold (Heldman et al, 2019) (Raevuori et al, 2014).

 

There are more than 30 autoimmune diseases that range from Crohn’s Disease, to Celiac Disease, Ulcerative Colitis, Lupus, Hashimoto’s, arthritis and osteoporosis.

No matter what condition or symptoms an individual has, the universal theme of an autoimmune disease is the same—the immune system is suppressed and the body attacks itself. Enter: Inflammation, increased cortisol (stress hormone), food intolerances and leaky gut or intestinal permeability.

One study (Raevuori et al, 2014) of 2342 patients who received treatment for an eating disorder found nearly a 2:1 greater ratio risk of having an autoimmune disease (regardless of genetic history), compared to healthy controls (particularly hormone and gut-related diseases). The researchers also speculated that the relationship between Autoimmune Disease and eating disorders may be bi-directional, asserting that Autoimmune Disease can further drive psychological symptoms [such as OCD (obsessive compulsive disorder and tendencies), depression and anxiety seen in eating disorders] since Autoimmune Disease is characterized by inflammatory anti-bodies that attack the person’s own body cells—including brain cells and neurotransmitters.Another study they found in 930,977 volunteers, confirmed this hypothesis as participants with autoimmune conditions were up to 75% more likely to develop/have histories of anorexia, bulimia and EDNOS (eating disorders not otherwise specified). 

Causes of Autoimmune Disease

How does the immune system get “suppressed” and autoimmune disease happen in the first place?! Considering that 80-percent of your immune system is produced in your gut, the bigger question is: “How is your gut health?” If your gut health is poor (i.e. eating disorder behaviors) or you have a “leaky gut” (intestinal permeability), then you are more AT RISK for developing an autoimmune disease (Mu et al, 2017 ). Since “leaky gut” is both a common side effect of eating disorders and a trigger to eating disorders (Lam etal, 2017), autoimmune disease likelihood makes total sense.

Currently research is being conducted on the prevalence of “leaky gut” and autoimmune antibodies in individuals before and after re-feeding, with the authors believing that the increased presentation  of leaky gut arises from current conventional eating disorder treatment protocols (i.e. Ensure shakes, processed foods, etc.), enhanced stress levels and lack of education of proper gut health support during treatment. (Grigioni, 2016)

What to Do About It?!

Regardless of what side effects you experience in eating disorder recovery, there is always room to feel better and improve your health in your post-recovery recovery!

While it can be extremely frustrating for your mindset to be in one place, but your body still feels like it’s lagging behind or trying to catch up, there is more for you in your continued healing.

Work with a functional medicine practitioner or nutritionist to address underlying stressors and conditions impeding your gut health, hormone health, blood sugar balance and all-around wellbeing together.

Some lab testing may be warranted depending on your own side effects and symptoms, including:

• Comprehensive Functional Blood Work
• Stool Testing
• SIBO/Bacterial Overgrowth Breath Testing
• Urine Organic Acids Testing (gut test)
• Hormone DUTCH Urine & Saliva Testing

Based on results, dietary guidance, supplements and lifestyle “therapy” and medicine (i.e. de-stressing your body) help markers improve.  Above all: Know patience and consistency will pay off and…you are worth it.

Post Recovery Recovery

Constipated or bloated all the time? Unexplained weight gain or weight loss? Hormone imbalances? You are not alone.

 

This article was scientifically reviewed by Dr. Lauryn, PhD. She is a Doctor of Occupational Therapy, Nutritionist, & Functional Medicine Practitioner with over 20 years of clinical and personal experience. 

 

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