Having a thyroid condition is no picnic, but you're not alone with this health issue. According to the American Thyroid Association, more than 12 percent of the population may end up dealing with a thyroid condition at some point in their lives. And thyroid issues can be sneaky: Of the nearly 20 million Americans living with the disease, as many as 60 percent don't even realize they have it.


18)   Use Essential Oils:  The anti-oxidant content and aromatherapy benefits of essential oils help to improve oxygenation and reduce the harmful effects of oxidative stress throughout the body.  Some of my favorites for thyroid function include lavendar, frankincense and peppermint among others. Put a drop on your hands and mix together and then cover your nose and inhale the healing vapors.  This will stimulate your brain and increase blood flow to your cranium.  You can also rub them on the skin around your neck and thyroid region to reduce inflammation.
The thyroid is the organ with the highest selenium content in the whole body. Selenium is necessary for the production of the T3 thyroid hormone and can reduce autoimmune affects. In patients with Hashimoto’s disease and in pregnant women with thyroid disturbances, selenium supplementation decreases anti-thyroid antibody levels and improves the structure of the thyroid gland.

Stress can also be caused by chronic digestive issues. When the small or large intestine is in distress (ywhen you are always constipated, bloated, suffer from gas, pain, loose stool etc.), the body sees it as a state of stress. Cortisol is a potent hormone we won’t function without. However, when in excess, it can have a detrimental impact on the thyroid and the immune system (one of the functions of cortisol is to modulate the immune system).


Goiter - Goiter is a condition in which a gland is larger than it should be. This occurs in the thyroid gland when the gland is being overstimulated because it is receiving constant signals to produce more hormones. Hashimoto’s thyroiditis is one of the more common causes of a goiter. It may not be uncomfortable, but a large goiter can affect appearances and interfere with swallowing or breathing if left untreated.
*Cassava bears special mention here.  You may have heard of it because it is the starchy root vegetable from which tapioca is made, but cassava is also a popular staple food in many Third World countries, where it is eaten boiled, mashed, or ground into flour.  Fresh cassava root contains a harmless substance called linamarin, which can turn into hydrocyanic acid (aka cyanide!) when the plant is damaged or eaten. Flaxseeds also contain linamarin. Cyanide is very toxic, so the human body converts it into thiocyanate (which, although it does interfere with thyroid function, is less toxic than cyanide and easier for the body to eliminate).
The goal of natural remedies or alternative medicine is to fix the root cause of the thyroid problem. Thyroid problems sometimes start as the result of poor diet, stress, or missing nutrients in your body. Changing your diet and taking an herbal supplement are two ways you can help your thyroid condition. These options may have fewer side effects than taking thyroid medicine. Also, using an herbal supplement for treatment of a low or underactive thyroid may be helpful for people who aren’t responding well to medicines.

In other words, taking supplements and herbs alone is usually not the solution. Plus, while nutritional supplements can help, one must remember that different people will need to take different types of supplements, take different dosages, etc. Plus the quality of the supplements you take is important, and the truth is, many supplements are of low quality. So just taking a general thyroid support formula is usually not the answer to restoring your health back to normal. Doing so not only can worsen your symptoms, but often times taking this approach will be a complete waste of money. In most cases it takes a combination of different factors to restore one’s health back to normal. This includes eating well, doing a good job of managing stress, getting sufficient sleep, improving the health of the gut, minimizing your exposure to environmental toxins, etc.


I have been diagnosed with hypothyroidism since last year. The worst part I struggle with my weight all my life. When my doctor told me I had hypo, it was the worst day of my life!!. Now the weight gained was the biggest problem for me. However, I found a program that helps me a lot. My number 1 program to followed if you are serious about losing weight fast. https://bit.ly/2tb4l9b
Your thyroid is a butterfly-shaped gland in your neck that controls metabolic activities. It does this by producing thyroid hormones that regulate things like heart rate and calorie burning. Underactive thyroids don’t produce enough of these hormones, which can leave you feeling tired, depressed, and like just looking at food is enough to make you gain weight .
Wild-caught fish — These provide the omega-3 fatty acids EPA and DHA, essential for hormone balance and thyroid function. Balancing the level of omega-3 to omega-6 fatty acids in your hypothyroidism diet can reduce inflammation and support healthy neurological function. Fish such as wild-caught Alaskan salmon, Atlantic mackerel and Pacific sardines are some of the best sources of omega-3s to increase neurotransmitter activity and support a healthy mood and immune system. Just be aware of the fish you should never eat and choose the best varieties available.
Think milk, butter, cheese, and meat. If you buy the cheap, conventionally raised versions at the supermarket, those types of deliciousness can also disrupt all your thyroid’s hard work. You omnivores (like us) can avoid this dilemma by choosing organic, or at least antibiotic-free and hormone-free meats and dairy. It’ll save you in the end, with fewer medical costs down the line.
Unlike conventional medical treatments, a natural hypothyroid treatment approach tries to get to the underlying cause of your disorder. In other words, upon seeing a competent natural healthcare professional who focuses on endocrine conditions, they will try to determine what is actually causing your thyroid gland to malfunction. In addition to looking at the typical thyroid blood tests, they might also evaluate your adrenal glands, digestive system, hormone levels, and other areas of the body which can be causing your thyroid gland to malfunction. Then assuming this natural healthcare professional feels they can help you, they will recommend a natural hypothyroid treatment protocol that won’t just manage your symptoms, but will also attempt to restore your health back to normal.
Dietary changes: For those who have existing thyroid conditions, excess consumption of soy may affect thyroid function, but this is probably a concern only in those already taking Synthroid or other thyroid replacement medication. If you consume soy on a regular basis, you may require a slightly increased dosage of replacement therapy. You should also know that if you eat soy foods at the same time that you take thyroid hormone, they may interfere with its absorption. To be safe, do not eat soy within three hours of taking your medication. Moderate soy consumption (one serving daily of whole soy foods) should not be a problem. Adequate iodine from dietary sources is also important – iodized salt, fresh ocean fish and seaweed are good sources.
An inexpensive and versatile food, beans are a great source for sustained energy, which can be helpful if hypothyroidism leaves you feeling drained. Beans contain protein, antioxidants, complex carbohydrates, and loads of vitamins and minerals. They are also high in fiber, which can be beneficial if you suffer with constipation, a common side effect of hypothyroidism. If you're new to beans, there are many varieties to try, all of which can be used as the base for entrées, as side dishes, and to enhance soups, salads, and stews. Just be sure not to overdo it — guidelines recommend that adults get 20 to 35 grams of fiber each day, but excess fiber can interfere with your hypothyroidism treatment.

Taking synthetic thyroid hormone can make up the difference and make you feel more like yourself. But eating certain foods—and limiting your consumption of others—can also help your thyroid function at its best, explains Hong Lee, MD, a double board-certified internist and endocrinologist with AMITA Health Adventist Medical Center Hinsdale in Illinois. That could allow you to avoid having to take higher and higher doses of synthetic thyroid hormones, and eventually end up relying on them completely in order for your thyroid to function.


Clara Schneider, MS, RD, RN, CDE, LDN, of Outer Banks Nutrition and author of numerous books, including The Everything Thyroid Diet Book, says, “The No. 1 priority is to get the thyroid disease under control. Clients need to have labs and medications addressed first. Weight changes are just not going to happen before all of that is under control.” She notes that Hashimoto’s typically occurs around menopause, which compounds the weight gain issue that many women experience during that time.
Please note these remedies mentioned in this article are not meant to replace your thyroid hormone replacement medication. Always speak to your doctor before making any changes to your medication protocol or starting supplements to be sure they are right for you. My goal at Hypothyroid Mom is to share all the possible treatments for hypothyroidism in the hope that you find what works for you. I personally take thyroid medication every day. Thanks to optimal thyroid treatment (finding the right types of thyroid medication and at the right dosage for my body) together with many of the natural treatments that I include at Hypothyroid Mom, I feel fabulous with hypothyroidism. Yes it’s possible and I hope the same for you.
Your mood is especially susceptible to changes in hormone levels, so some people with hypothyroidism deal with depression, anxiety, trouble getting good sleep and low immunity. The thyroid gland helps regulate chemical messengers called neurotransmitters, which control your emotions and nerve signaling. This is the reason an out-of-balance thyroid can mean drastic emotional changes at times.
Pregnancy . The reason isn’t clear, but sometimes, inflammation of the thyroid occurs after pregnancy. This is called postpartum thyroiditis. Women with this condition usually have a severe increase in thyroid hormone levels followed by a sharp drop in thyroid hormone production. Most women with postpartum thyroiditis will regain their normal thyroid function.
When I first began the natural treatment plan for my autoimmune hypothyroid condition my top five symptoms were chest pain (diagnosed with costochondritis), fatigue, memory loss, stomach upset, and muscle weakness. No matter how much rest I got, I was still tired. Additionally I did not sleep well either. Originally, I didn’t feel much different. I believe the reason for that to be because I was only taking a portion of the recommended natural supplements, as well as the fact that I had only changed some of my diet. When I really got serious about making changes is when I began to really see improvements. Although this does require a change in lifestyle, I feel much better today. The natural treatment protocol allowed me to delve deeper into the root of the problem and address it so that I will hopefully not need to be on these supplements for the rest of my life. I have already cut back on some of my supplements since my last blood work results.
There are medications commonly prescribed to limit the activity of the thyroid. Surgery may also be recommended as a last resort to remove all or part of the thyroid. It’s worth researching ways to treat hyperthyroidism naturally, as removing sources of inflammation from your diet and taking advantage of thyroid-supporting supplements and essential oils can help to make a big difference.

Other causes of hypothyroidism include surgical removal of the thyroid (usually for cancer), radiation therapy of the head and neck, or complications of medical therapies for hyperthyroidism. (Patients with overactive thyroids are often treated with radioactive iodine or anti-thyroid medications that reduce thyroid functioning. These effects can be extensive and permanent, and thyroid supplementation is often required flowing these interventions.) Certain medications can worsen or promote hypothyroidism or interfere with thyroid replacement therapy. One such drug is lithium, used for treating psychiatric conditions such as bipolar disorder.
A complete thyroid diet solution includes more than just food. I cannot emphasise how important these are for managing stress and emotions, especially for people with hyperthyroidism. We underestimate what stress and emotions do to us; each flare-up of anger, feelings of guilt, fear, hostility, jealousy, etc. fires up the adrenals which release cortisol, and cortisol has a detrimental impact on the thyroid.

I suspect that there is actually enough iodine in the environment to go around, and that we actually need less than 150 micrograms per day of iodine.  From the above list, you can see that animal foods are much richer in iodine than plant foods—so how do herbivores (animals which eat a plant-based diet, such as rabbits and deer) get enough iodine?  I suspect that there is something about the human diet which interferes with our ability to absorb, utilize, and/or retain iodine, and that this is why we appear to be iodine-deficient compared to other animals.  So, what might the possible culprits be?   Hmmm….
With the availability of multiple forms of thyroid hormone replacement, early clinical trials were designed to assess efficacy and dose equivalency among natural thyroid (typically desiccated), synthetic l-thyroxine, and/or l-triiodothyronine. These were not designed as superiority trials, their therapeutic goals were the normalization of serum PBI or BMR, and doses were dramatically higher than used today. For example, desiccated thyroid and intravenous l-thyroxine monotherapy normalized BMR, pulse, and body weight in myxedema (29), l-triiodothyronine monotherapy was likewise effective (30), and the potency of l-triiodothyronine exceeded that of l-thyroxine (31).
Major diagnostic and therapeutic advancements in the early 20th century dramatically changed the prognosis of hypothyroidism from a highly morbid condition to one that could be successfully managed with safe, effective therapies. These advancements dictated treatment trends that have led to the adoption of l-thyroxine monotherapy, administered at doses to normalize serum thyroid-stimulating hormone (TSH), as the contemporary standard of care (Figure). Most patients do well with this approach, which both normalizes serum TSH levels and leads to symptomatic remission (1).
Thyroid hormone is critical for normal brain development in babies. Infants requiring thyroid hormone therapy should NOT be treated with purchased liquid suspensions, since the active hormone may deteriorate once dissolved and the baby could receive less thyroid hormone than necessary. Instead, infants with hypothyroidism should receive their thyroid hormone by crushing a single tablet daily of the correct dose and suspending it in one teaspoon of liquid and administering it properly.

Hypothyroidism is a secondary cause of dyslipidemia, typically manifesting in elevation of low-density lipoprotein and total cholesterol levels. It is clear that treatment resulting in the normalization of the serum TSH is associated with reduction in total cholesterol levels (54), but whether total cholesterol is fully normalized by l-thyroxine monotherapy is less well-defined. An analysis of 18 studies on the effect of thyroid hormone replacement on total cholesterol levels in overt hypothyroidism showed a reduction in the total cholesterol level in all 18 studies; however, in 14 of the 18 studies, the mean post treatment total cholesterol level remained above the normal range (>200 mg/dL [>5.18 mmol/L]) (55). These findings suggest that lipid measures are not fully restored despite normalization of the serum TSH (56). Whether the degree of dyslipidemia remaining in l-thyroxine-treated patients with a normal TSH is clinically significant is unknown, given that the benefit of thyroid hormone replacement in subclinical hypothyroidism is itself controversial (57, 58).
A diet low in nutrient-rich foods, especially in iodine and selenium (which are trace minerals crucial for thyroid function), increases the risk for hypothyroid disorders. The thyroid gland needs both selenium and iodine to produce adequate levels of thyroid hormones. (6) These nutrients also play other protective roles in the body. For example: severe selenium deficiency increases the incidence of thyroiditis because it stops activity of a very powerful antioxidant known as glutathione, which normally controls inflammation and fights oxidative stress. (7) Getting on track with a hypothyroidism diet ensures that you get the appropriate amounts of selenium and iodine in your diet.
No one diet or plan works for everybody, including the thyroid diet that I’ve described here, as each person has a unique way of healing. There is a saying: “One person’s food is another’s poison.” It’s always worth remembering that just because one diet worked for one person it does not mean it will work for you too. One person could have healed their thyroid by just changing the water filters (by getting rid of fluoride) alone, while another needs to implement five major diet and lifestyle changes to start feeling just a little better. Let’s respect our differences.
Mild hypothyroidism is usually the early stage. It can progress to hypothyroidism if a hypothyroidism diet isn’t adopted and lifestyle changes aren’t made. When the condition isn’t corrected, more severe autoimmune reactions can occur — this can cause worsened problems like impaired brain function, infertility, unhealthy pregnancy, obesity, heart complications and joint pain.
This can lead to low T3 levels (58). In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.  Cortisol will also increase the production of reverse T3 (rT3), which is inactive (11).
Do a little Googling, and you might turn up a page or two claiming that cruciferous vegetables can cause thyroid troubles. The truth is a little murkier. While it's true that these veggies contain compounds called glucosinolates, which might interfere with your body's production of thyroid hormones in high amounts, it's pretty unlikely that they'll harm your thyroid if you're eating normal-size servings. One case report in the New England Journal of Medicine highlighted the story of an 88-year-old woman who showed up to the ER with hypothyroidism after eating about 2 or 3 pounds of bok choy a day—but, as Ilic points out, "that's not a normal amount."
Gluten intolerance is highly associated with inflammatory disorders of all kinds (63).  It is also a contributing factor in many autoimmune diseases such as celiac disease, rheumatoid arthritis, type I diabetes, Hashimoto’s thyroiditis, autoimmune cardiomyopathy, lymphoma and dermatitis herpetiformis (skin disease) among others (64, 65). If you have a thyroid problem or just want to avoid having a future thyroid problem, the first place to start is on a gluten-free nutrition program!

Postpartum thyroiditis: Five percent to 10 percent of women develop mild to moderate hyperthyroidism within several months of giving birth. Hyperthyroidism in this condition usually lasts for approximately one to two months. It is often followed by several months of hypothyroidism, but most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement. This condition may occur again with subsequent pregnancies.

I suspect that there is actually enough iodine in the environment to go around, and that we actually need less than 150 micrograms per day of iodine.  From the above list, you can see that animal foods are much richer in iodine than plant foods—so how do herbivores (animals which eat a plant-based diet, such as rabbits and deer) get enough iodine?  I suspect that there is something about the human diet which interferes with our ability to absorb, utilize, and/or retain iodine, and that this is why we appear to be iodine-deficient compared to other animals.  So, what might the possible culprits be?   Hmmm….


Bone broth — Beef and chicken stock contain the amino acids L-proline and L-glycine, which can help repair the digestive lining and improve hypothyroidism. Bone broth also contains numerous important minerals that nourish the digestive tract and prevent deficiencies like calcium, magnesium, phosphorus and silicon. Bone broth has been shown to help overcome food sensitivities, improve energy and fight fatigue, increase immunity and lower pain of the muscles and joints.
Characteristic symptoms and physical signs, which can be detected by a physician, can signal hypothyroidism. However, the condition may develop so slowly that many patients do not realize that their body has changed, so it is critically important to perform diagnostic laboratory tests to confirm the diagnosis and to determine the cause of hypothyroidism. A primary care physician may make the diagnosis of hypothyroidism, but assistance is often needed from an endocrinologist, a physician who is a specialist in thyroid diseases.

3) Include Magnesium & B Vitamin Rich Foods:  Magnesium helps to improve blood sugar signaling patterns and protects the blood-brain barrier.  The best magnesium and B vitamin rich foods include dark green leafy veggies, grass-fed dairy, raw cacao and pumpkin seeds.  If you can tolerate these foods (don’t have food sensitivities to them or problems with oxalates or high histamines) than consume as staple parts of your diet.  You can also do Epsom salt baths to boost your magnesium levels.

Radioimmunoassays for measurement of serum T3 (48) and T4 (49) were soon developed, and it was observed that l-thyroxine monotherapy could normalize both T4 and T3 levels at the expense of a high T4:T3 ratio. In contrast, l-triiodothyronine, desiccated thyroid, thyroglobulin, and l-thyroxine/l-triiodothyronine combination all typically resulted in low or low-normal serum T4 values with usually elevated serum T3 levels, and thus a low T4:T3 ratio (28). Desiccated thyroid resulted in a T3 peak about 2 to 5 hours after administration that corresponded to thyrotoxic symptoms in some patients (50). That a single daily dose of l-thyroxine resulted in stable blood levels of T4 and T3 throughout the day (48) was understood to result from a steady rate of conversion of T4 to T3 (51).
Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine mono-therapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone–treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism.
It is hard for me to tell you what to do without a thorough health history…but I would start by following my anti-inflammatory nutrition plan as mentioned in this article. A natural thyroid hormone replacement like Armour is typically cleaner (levo and synthroid contain GMO corn in the coloring dies) so that would be a good idea. If you would want to consult so I could learn more about your case and customize an appropriate plan for you we could arrange that. Blessings!
There are so many reasons for low thyroid function, yet I see many patients whose doctors have ignored this problem. One young female patient had more than 30 percent body fat and was unable to change her body no matter how hard she worked. She ate perfectly, exercised with a trainer every day, yet her body wouldn’t budge. She also had a slightly depressed mood and other vague symptoms.
It is absolutely critical for any physician who is treating someone with a thyroid disorder to test for thyroid antibodies.  Unfortunately, few mainstream medical doctors test for thyroid anti-bodies and so most do not ever get the proper diagnosis. In the medical system, an auto-immune condition, a sluggish thyroid, a burned out pituitary gland and a T4-T3 conversion problem are all treated the same way, with synthetic T4 such as synthroid or a T3 medication like levothyroxin.
Hi dr jockers. Can you reverse the autoimmunity? I have high levels of tpo antibodies (89), normal T3 T4, estrogen dominant, low vit D, low iron, low T. I know that my body is undergoing an autoimmunity with joint pain, eczema, hair loss, raynauds….. Would love to know I can reverse this vicious struck my body is on. Thank you in advance for a reply,
Diagnosis of hypothyroidism is based on your symptoms and the results of blood tests that measure the level of TSH and sometimes the level of the thyroid hormone thyroxine. A low level of thyroxine and high level of TSH indicate an underactive thyroid. That's because your pituitary produces more TSH in an effort to stimulate your thyroid gland into producing more thyroid hormone.
As hypothyroidism becomes more severe, signs and symptoms may include puffiness around the eyes, the heart rate slows, body temperature drops, and heart failure. Severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a person with severe hypothyroidism, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. Myxedema coma requires hospitalization and immediate treatment with thyroid hormones given by injection.

Cases of myxedema were reported in the mid–19th century but were not initially connected with a deficiency from the thyroid gland until surgeons identified incident myxedema after thyroidectomy (11). Initial treatment strategies were largely insufficient and primarily symptom directed, including hot baths and institutionalization (12). The significant morbidity and mortality in the absence of efficacious treatment were clear, and thus the need to “replace” the thyroid through surgical transplantation or oral or intravenous routes was established. Thyroid transplant had some early successes, but for many patients symptoms recurred and the procedure even had to be repeated (13). Because of the rapidity and transiency of improvement (12), it was hypothesized that symptoms improved by absorption of the “juice” of the donor gland (14).

It’s imperative dietitians have a good understanding of the metabolic changes associated with thyroid disease so they can set realistic goals and expectations for clients. Most people with hypothyroidism tend to experience abnormal weight gain and difficulty losing weight until hormone levels stabilize. Moreover, it’s common for patients with Graves’ disease to experience periods of high and low thyroid hormone levels, so it may take several months to achieve a balance. During this time, it’s essential clients focus on healthful behaviors such as eating nutritious foods, exercising regularly, managing stress, and sleeping adequately rather than focus on the numbers on the scale.

Similar to processed foods, fast food chains also aren't required to use iodized salt in their foods. And even when they do, it might not boost the iodine content all that much, according to one 2010 commentary in the journal Endocrine Practice, which tested products from two fast food restaurants in the Boston area. The study authors concluded that drive-thru fare might be pretty low in iodine.


When I first began the natural treatment plan for my autoimmune hypothyroid condition my top five symptoms were chest pain (diagnosed with costochondritis), fatigue, memory loss, stomach upset, and muscle weakness. No matter how much rest I got, I was still tired. Additionally I did not sleep well either. Originally, I didn’t feel much different. I believe the reason for that to be because I was only taking a portion of the recommended natural supplements, as well as the fact that I had only changed some of my diet. When I really got serious about making changes is when I began to really see improvements. Although this does require a change in lifestyle, I feel much better today. The natural treatment protocol allowed me to delve deeper into the root of the problem and address it so that I will hopefully not need to be on these supplements for the rest of my life. I have already cut back on some of my supplements since my last blood work results.

The thyroid is a small, butterfly-shaped gland found near the base of the neck. It produces hormones that regulate vital metabolic processes throughout the body. A deficiency in the production of thyroid hormone, known as hypothyroidism, causes these processes to slow down or stop. Receptors for thyroid hormone are found throughout the body, and disturbance in thyroid functioning can cause problems in almost every system of the body from the heart and GI tract to sleep, mood, even the growth of hair, skin and nails.

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Please Note: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any diet or exercise program.

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