OHC&me. Optimum Health Clinic. Solving the Puzzle. Foundation. ME, CFS & Fibromyalgia Treatment Outlines. The. Charity No :

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1 OHC&me Solving the Puzzle ME, CFS & Fibromyalgia Treatment Outlines The Optimum Health Clinic Foundation Charity No :

2 The Optimum Health Clinic More than just a clinic Contents Introducing the Puzzle Pieces - 3 Subtypes - 4 Stages - 5 Systems - 6 Nutrition - 9 Nutrition Consultations - 9 Psychology Day Programme - 13 Telephone Treatment Programme - 14 Ad Hoc sessions - 14 Next steps - 15 About The Optimum Health Clinic The Optimum Health Clinic (OHC) is an award winning integrative medicine clinic with a specialism in the treatment of ME., CFS. and Fibromyalgia using CAM (complementary and alternative medicine) based approaches for optimising health, relaxation and general well-being. OHC was set up in 2004 by Alex Howard (author of WHY ME? My Journey from ME to Health and Happiness) and is recognised for its innovative approach of systematically researching and testing different approaches, and integrating them together in the most effective way. With over half the team having had personal experience of ME/CFS, the clinic is also well known for its caring and empathic approach. The clinic s team of fourteen practitioners has supported thousands of patients with M.E./C.F.S./Fibromyalgia in over thirty-five countries around the world. Their patient range is vast, and covers the complete spectrum from medical doctors and board members of FTSE 100 companies, to students and housewives. About The Optimum Health Clinic Foundation The Optimum Health Clinic is 100% owned by registered charity The Optimum Health Clinic Foundation (charity number ). As a result, all profits generated by OHC are invested directly into the charity s research programme, with the aim of one day government funding being available for treatment. Trustees of OHC Foundation are all either former patients or relatives of patients. The charity s Patron is Shirley Conran, OBE. Randomised Controlled Trial OHC s research department has so far had studies published in peer reviewed journals such as Psychology and Health, Journal of Integral Theory and Practice, Medical Hypothesis and The Nutrition Practitioner. In November 2012 the team had a prospective preliminary study published in the British Medical Journal Open demonstrating statistically significant changes at three months using the OHC approach. At the House of Lords, in November 2013, OHC launched its fundraising campaign for a full randomised controlled trial with planned collaboration with a leading NHS hospital. The hope is that through completion of this research, one day government funding will become available for OHC s treatments. If you would like to support fundraising for this project, please visit our website: 2

3 Introducing the puzzle pieces Understanding how the different kinds of pieces come together, and your unique experience of them is critical to solving the puzzle of your recovery path. A diagnosis of ME/CFS tells us very little about what is really going on. It doesn t tell us why we got ill, why some treatments help at one point and not another, or what is actually going on in our body. This experience can feel overwhelming, deeply frustrating, and at times desperate. Put another way, ME/CFS can feel like a puzzle with too many pieces, and no picture of how it all fits together. In this report, we hope to help you begin to make more sense of your experience, and how to put together the pieces of the jigsaw of your recovery. At The Optimum Health Clinic, we have spent eleven years treating over 5,000 patients in over 35 countries. We don t have all of the answers for everyone, but we do have a lot of answers that seem to benefit a lot of people. In a recent patient survey of 188 patients, 93% said they had benefitted from working with the clinic, and in 2012 we had a study published in the British Medical Journal Open finding statistically significant improvement at three months in all treatment groups. This report is only a very small introduction to our approach, but we hope it is a useful start. To help understand your puzzle let s start off by introducing what we call the 3 S s, otherwise known as the three categories of puzzle pieces. Put simply: Subtypes h e l p u s understand why you got ill in the first place and how we prevent relapse after recovery. There are 9 subtypes. S t a g e s h e l p u s understand why some treatments can help at o n e p o i n t, a n d n o t another. There are 3 stages. Systems h e l p u s u n d e r s t a n d w h at i s actually going on in your body and the reason you actually have certain s y m p t o m s s u c h a s fatigue. There are 11 body systems. Please note: Definitions of ME, CFS, Fibromyalgia, post-viral fatigue syndrome, chronic fatigue, immune dysfunction syndrome and so on, will be used interchangeably in this document. Although we accept for the reader this is far from ideal and that the real story is more complicated, we appreciate your understanding for the sake of simplicity. 3

4 Subtypes: Why did you get ill in the first place? The key to understanding the 9 subtypes is realising that there is no one factor alone that causes us to get ME/CFS. It is the combination of a number of these predisposing factors that results in a state of burnout in the body. Nutritional Subtypes Adrenal Type: may have been hard wired to react to stress in an unhelpful way physically, which can then have knock on effects throughout a range of functions in the body. Stress may have been ongoing through life and/or specifically at the time leading up to symptoms. Immune Type: tend to have had a history of infections when they were younger, but there could also have been a final trigger of a virus which they have never quite recovered from. Digestive Type: can have a history of food intolerances that they may or may not be aware of, or have a history of IBS type symptoms that have never been identified. This can limit the ability to absorb nutrients from food and impact on many physical functions. Toxicity Overload Type: may have had a pre-existing genetic issue or been exposed to toxins through a specific event or consistent exposure. Early signs can be sensitivity to smells. Structural Type: tend to have some sort of structural imbalance that can impact on many different systems and result in a range of symptoms. This sort of imbalance can trigger conditions such as hypermobility or postural tachycarida syndrome (POTs) and symptoms such as headaches or migraines. Psychological Subtypes Helper Type: constantly place the needs and wants of others above their own. They value themselves by their helping and supporting of others, and can often be giving from a place of inner lacking. Achiever Type: constantly push themselves to do and be more than they are currently capable of. This can also show up as perfectionism and always trying to get it right and effectively means they are always pushing their own limits. Trauma Type: trauma can either be a major event such as a natural disaster, or some kind of physical, mental, emotional or sexual abuse. It can also be what is known as developmental trauma (otherwise known as covert trauma) where there is no single event, but where someone has grown up in a n u n h e l d a n d u n s u p p o r t e d environment. Anxiety Type: have an internal sense of fear, danger, and threat. They deal with this either by being an outwardly fearful type, or by becoming the opposite and constantly trying to convince themselves and others they are not afraid. Under the surface is an ongoing sense of things not being okay. 4

5 Stages: Why do some treatments help at one point and not another? Different interventions are appropriate at different stages. Understanding which stage we are at is critical. A key breakthrough in our understanding of ME/CFS was the realisation that there are different stages of recovery. Treatments that help at one stage can actually cause problems at another. Stage 1: Crash stage Characterised by sleeping a lot and very little physical, mental or emotional capacity. There may be a burnout in the nervous system, mitochondria, adrenals, gastrointestinal secretions and possibly detoxification system at this stage. Stage 2: Tired and wired stage Many ME/CFS symptoms often experienced pain, physical fatigue, poor sleep, head symptoms, digestive symptoms, flu symptoms, etc. Head can feel very busy while body is exhausted, very hard to relax or feel grounded. Stage 3: Reintegration stage Have found a baseline, understand the body more, and able to respond appropriately. Energy is definitely increasing and less overall symptoms. Can get stuck between being symptom free at rest and symptoms flaring when doing too much. To help really understand the importance of stages, consider an approach such as Graded Exercise Therapy (GET), which is favoured by the NHS. The research on GET is that some people do well, some see little change, and some relapse and get worse. When you use our model, it makes total sense. Those at Stage 3 can do well, but for those at Stage 1 it can be very unhelpful. Now we ve looked at Subtypes and Stages, let s explore Systems. After ten years as a trustee of Action for ME, and after struggling to get clarity when I wrote a book on ME in the late nineties, I just wish that the thorough and integrated approach at The Optimum Health Clinic had been available then. Gill Jacobs 5

6 Systems: What is actually going on in your body? Our body is made up of a number of different systems, and it is widely accepted that ME/CFS affects multiple systems. Given that most of these systems are interrelated, it is likely as you read this in conjunction with your health history and symptoms, that you may get a sense that several of them are relevant for you. The human body is comprised of 11 systems: integumentary (skin), muscular, skeletal, nervous, circulatory, lymphatic/immune, respiratory, endocrine, urinary/excretory, reproductive and digestive. Although elements of the OHC approach will often explore individual systems, integral to the overall approach is the idea that all systems are inextricably linked and that ME/CFS are conditions that can affect multiple systems. For example, the maladaptive stress response (see page 8) which originates in the nervous system can affect our endocrine system by generating excess cortisol and adrenaline. This can lead to poor absorption in our digestive system, and can result in our immune system being over sensitive (food intolerances and chemical sensitivities). Some examples of how individual systems can be affected are: Nervous System: In ME/CFS we can find the nervous system in a state of over-stimulation (we refer to this as maladaptive stress response) which can result in a feeling of being tired and wired and that despite being exhausted, we can t fully rest. Digestive System: Many of those with ME/CFS can report digestive symptoms. When our digestion is not working effectively, it can have a substantial affect on energy creation, brain fog/concentration and many other bodily systems. Lymphatic and Immune System: Those with ME/CFS report a range of immune related issues, ranging from hyper sensitivities/intolerances to foods and chemicals, to a weakened immune system and catching everything those goes around. Endocrine System: A sub-group of those with ME/CFS can experience hypo-thyroidism and suboptimal adrenal function is a common result of ongoing stress (either leading up to getting ill, or as a consequence of). Energy: Understanding how our body manufactures energy on a cellular level is hugely important to explaining, not only the fatigue but delayed fatigue response. 6

7 System Example 1: Energy Your mitochondria are effectively the powerhouses of your cells, and therefore responsible for your energy production at a cellular level. Mitochondria are the equivalent of the engine in a car. If you ve ever wondered what on earth is actually causing so many people to feel fatigued, the research suggests this area is critical. You have 50 trillion or so cells in your body, and nearly all of them have little component parts in them called mitochondria. The mitochondria produce A.T.P. (adenosine tri-phosphate) which is the energy currency of your body. When A.T.P. releases a phosphate molecule (P) energy is created and the A.T.P. becomes A.D.P. (adenosine di-phosphate). So A.D.P. must be continually recycled back to A.T.P. by adding back another phosphate molecule. When this recycling is going too slowly, your energy can become severely rationed, and in desperation, the body converts the remaining A.D.P. to A.M.P. (adenosine monophosphate), which releases a bit more energy, but A.M.P. can t be recycled. 3 Days (approx.) Food Mitochondria +P ATP 10 mins (approx.) Energy via digestion, absorption & transport Very, very slow conversion, and very inefficient ADP AMP +ADP Energy Most AMP lost to body via excretion So your A.T.P. supply runs out patients often describe this as like someone pulling the plug. Your body then has to re-make A.T.P. and this is why it can take days or even weeks to recover from a crash. What is particularly interesting about this for patients is that it explains the delayed fatigue response, where they can be fine doing a particular activity, fine even the day after, and then suddenly, out of nowhere, they crash ; it is at this point that the A.T.P. runs out. Prior to this, there is often a day or so of feeling hyper and unable to relax. The key to working with this is understanding what is hampering A.T.P. production and giving the body the support it needs to rebuild its reserves. By testing A.T.P. production via a blood test, we can measure (on a cellular level) your body s ability to produce energy - we can then work with this directly, by supporting your body in correcting the underlying imbalances. 7

8 System Example 2: Maladaptive Stress Response The maladaptive stress response is the state of high alert the body often goes into in reaction to chronic ongoing stress often exacerbated by the experience of an illness such as ME/CFS. For most patients, their stress load prior to getting ill has been enough to cause the body to function at a higher level of alert over a prolonged period of time than is normal or healthy. Yet even if this were not the case, the actual experience of ME/CFS is a trauma in itself. For example, not knowing what is wrong, why it is wrong, will you ever recover, are you going to relapse, all creates a massive state of danger within the nervous system. This combination of circumstances mean that as far as your body is c o n c e r n e d, y o u r survival is under threat. As a result, it goes into a state of fight, flight or freeze,. The body is designed to sustain this state for a short period of time only yet what we observe in these kinds of conditions is that because this sense of danger is ongoing, the body begins to normalise this state the exact opposite of state that you need to be in in order to heal. This failure to adapt is why it is called the maladaptive stress response. There are very real physical effects of being in this state: Digestive system reduced ability to absorb nutrients from food. Immune system adverse reaction to supplements. Nervous system tired but wired - exhausted all day but unable to sleep at night. This failure to adapt is why it is called the maladaptive stress response. Approaches such as Reverse Therapy and The Lightning Process have become popular over recent years for working with ME/CFS from a psychological perspective. Although looking at different aspects of the maladaptive stress response, the OHC sees these approaches as only being partial in their understanding (each see some but not all of the subtypes for example). Furthermore, the traditional approach of Cognitive Behavioural Therapy (CBT) is offered to many individuals. Although having its place, once again the OHC approach sees it as only working on s o m e e l e m e n t s, especially ignoring the role of the unconscious. Many sufferers also feel frustrated at the CBT approach not fully understanding the very real physical nature of ME/CFS Th e p ro b l e m i s t h at b e c a u s e s u c h approaches are only partial in their understanding (not understanding for example different subtypes, stages of recovery etc), they can sometimes be counterproductive, further adding to the confusion and frustration already being felt by patients. Critical to the OHC approach is understanding that the maladaptive stress response, although sometimes a key piece of the puzzle, it is rarely the only piece. Having explored the 3 S s and key components of the OHC approach, let s now look at what we can do about this. There are two key perspectives to the OHC approach to solving your 8 puzzle: nutrition and psychology.

9 Nutrition How does your nutrition department work with ME/CFS patients? Our nutrition department uses a functional medicine approach, where we are looking for sub-optimal functioning within your bodily systems. We then work with this using primarily food and dietary supplements to correct imbalances. We also use various functional tests, including blood, urine, stool and saliva analysis. Because of the extensive experience we have, we find that many of the patients we work with benefit, despite having worked with other less experienced practitioners. How does your approach differ from other practitioners and clinics? Most nutritional practitioners are general practitioners, meaning that they work with a great variety of patients, with little specialism. This means that in an average year they may see one or two people with ME/CFS. Our nutritional therapists have vast amounts of experience and specialist training in the area with virtually all of the protocols being developed in-house based on the clinic s world-leading knowledge, and they continue to build on their knowledge with ongoing training from national and international conferences and training courses. What is involved in nutrition consultations : Initial Consultation Initial consultations can either take place face-to-face, or if travelling is not possible then by telephone or Skype. You will be asked to complete an indepth questionnaire specifically designed by the clinic team, which will be analysed by your practitioner before your initial consultation. Your practitioner will then discuss the intricacies of your case history with you in great detail, and advice will be given as to what are likely to be the key health issues and priorities for you now, with an initial roadmap of the suggested way forward. Additionally, the questionnaire will help the practitioner to analyse your nutritional needs based on how you digest and absorb food, so that your diet can be optimised for supporting your body. You will then be given an overview of your food and dietary recommendations, and if relevant given an initial supplement programme (or you will have your current programme updated to the latest protocols). You may also be recommended to carry out some simple home tests (see over page) and possibly a functional test (such as an adrenal stress test) before your first follow-up consultation, if appropriate and relevant to your situation. Recommendations: within 2 working days (unless informed otherwise) you will receive a pack of relevant information which will include some of the following: Healthy Eating Guide and personalised dietary suggestions where appropriate. A supplement recommendation sheet. Home test and functional test instructions (as relevant). 9

10 Nutrition Follow up Consultation (4-6 weeks after Initial Consultation) Prior to your follow up consultation, we generally ask that you request from your GP a series of standard blood tests (if these haven t been done recently), including the following: Full blood count Blood glucose Thyroid function (TSH and T4) Uric acid Liver function test Electrolytes (including phosphorus, chloride and bicarbonate) Serum ferritin Lipid profile B12 and folate ( active B12 holotranscobalamin if possible) ESR Vitamin D3 We also request that you have your blood pressure checked at the same time. Your GP will most likely tell you that the results are normal but we will then re-analyse the results from an optimal or functional perspective meaning that we will look at these results within narrower reference ranges. Additionally and if relevant to your case, we may have asked you to complete one or more home tests, including the following, which we will also analyse if completed: Basal temperature (requires a thermometer) Metabolic and Salivary ph test (requires some ph strips) Various digestive system related tests (may require typical kitchen cupboard items) In this first follow-up, the results of any tests (recommended in the initial consultation) and their implications will be discussed and pertinent recommendations made. Supplement and dietary changes that have been implemented will also be discussed and adjusted as necessary, taking account of relevant test results. Below is a list of some of the functional tests we regularly use. Adrenal Stress Index Test Comprehensive Stool Analysis Blood Vitamin & Mineral status ATP Profile/Mitochondrial Function Urine iodine/halides Full thyroid panel Food & Environmental Intolerances/ Allergies Toxic metals Metal & Chemical Sensitivity Pesticides/Volatile Organic Compounds screen Glutathione Studies DNA Adducts Kryptopyrroles 10

11 Nutrition What do supplements cost? The cost of supplements varies. Patients receive supplement recommendation sheets with information about where they can order the supplements for themselves. The clinic policy is to recommend the most effective supplement to do a particular job, but all recommendations also take into account the patient s financial and practical limitations - for example, the budget available per month or the ability to swallow capsules or not. How long are consultations? Initial consultations are charged at a fixed rate, which includes up to 1 hour directly with your practitioner. Your practitioner will spend at least another hour on your case (often considerably more) in preparation of your appointment, and writing up afterwards. Follow-up consultations are charged as 1 hour up to 45 minutes spent directly with your practitioner and the remaining time for analysing test results and writing up recommendations after the consultation. Any additional practitioner time required would be chargeable on a prorata basis but always a g r e e d b y y o u i n advance. I m concerned my case is complicated, will you be able to help? Many of our patients h a v e h i g h l y complicated situations, f r o m h a v i n g s e e n numerous practitioners before with potentially conflicting information Nutrition team meeting and multiple test results, to being on medical drugs, or to sensitivities to supplements. Our team are highly experienced in dealing with these kinds of issues. Each practitioner in our nutrition team will only see around 12 patients a week, and the rest of the time is spent researching, discussing case studies with other practitioners in the department, and also receiving ongoing internal training. For every chargeable hour that our team do, there is actually about three hours of work. A friend of mine bought me some running shoes a couple of months ago. For the first time since I was 17, I actually went running. I was like, Oh, I can run, it was so cool. I also now go swimming and play badminton. Lindsay Oliver, Freedom From M.E (Free DVD available from clinic) In October 2008, Lindsay completed a half marathon in a very respectable 1h 31m, raising funds for The Optimum Health Clinic Foundation. 11

12 Psychology At the heart of the OHC approach is the principle that the mind and body are intrinsically interlinked, so working with one will impact the other. How does your psychology department work with ME/CFS patients? Our psychology approach includes a combination of teaching patients techniques to help calm their nervous system and get into a healing state, working with underlying subtypes (such as achiever or helper patterns), coaching strategies to help navigate the different stages of recovery, and deeper emotional work where needed. At the heart of the OHC approach is the principle that the mind and body are intrinsically interlinked, and so working with one will impact the other. Our approach could not be described as any of these things, but is influenced by them all. How do sessions work? We offer three different treatment options through our psychology department: 1. The 90 Day Programme: This is our groundbreaking psychology based training programme which we recommend the majority of patients start with, as we find it to be the most effective kickstart for our psychology approach. There is a powerful combination of precourse materials, private and group sessions, and postcourse support over a period of around 90 days. 90 Day Programme What methods are you using? The methods we use are a combination of all of our research over the years, together with our personal experiences of what worked in helping with our own experiences, and what has worked for the thousands of people we have worked with. Some areas that have influenced our approach are NeuroL i n g u i s t i c Pro g ra m m i n g ( N L P ), Th e Lightning Process (Alex s book helped establish it), Reverse and Mickel Therapy, Emotional Freedom Technique (EFT), Cognitive Behavioural Therapy (CBT), Life Coaching and Hypnotherapy and Selfhypnosis. 2. Telephone Treatment Programme (TTP) also lasts around three months (although there is flexibility to adjust this as appropriate), and serves as the best way to kickstart treatment on the psychology side for patients unable to attend The 90 Day Programme. TTP sessions can also be done by Skype if preferred. 3. Ad hoc sessions: these take place either by phone, Skype or face-to-face at our North London Training Centre. Initial sessions are usually 1 ½ hours, and followups last 1 hour. 12

13 The 90 Day Programme Stage 1: Preparation Prior to attending the workshop, delegates are sent our Psychology Foundation Pack which is to be used throughout the programme (and beyond), including: Learn to Relax (4 audio downloads) The Sleep Inducer (4 audio downloads) Beat Fatigue with Yoga (Book and DVD) Alex Howard s book WHY ME? My Journey from ME to Health and Happiness Stage 2: Intensive The Intensive part of The 90 Day Programme teaches you the core components of the OHC psychology approach. These are: 1. The Healing Zone: This section teaches you the latest ideas specifically developed at OHC from what Alex originally helped establish as The Lightning Process. 2. Your Body s Intelligence: In this section you will learn how to communicate with and understand your symptoms. By listening to the message about your symptoms, you will learn to change the responses of what Reverse Therapy calls your Bodymind Emotional Freedom: This section will give you the fundamentals of EFT (Emotional Freedom Technique), which is at the forefront of the new field becoming known as Energy Psychology. This way of working is immensely powerful for clearing and balancing blocked and unwanted emotions. Groups are strictly limited, with usually around 4-8 delegates, and so there is space for a great deal of attention from your practitioner. This intimate 2½ day workshop takes place at our Training Centre in North London and is the recommended option for those able to travel to London. Delegates are encouraged to continually listen to their bodies throughout, rest when needed and apply the techniques as they are learning them. Stage 3: Integration Once back at home the real work begins. For the following nine weeks, participants have consistent contact with their practitioner in the form of one-on-one telephone sessions, conference calls (with fellow participants), and home study CDs and exercises. Topics covered include: Reviews and implementing your toolkit, setting intelligent goals, how to eliminate self-judgement and self-sabotage patterns, how to understand the deeper reasons behind your situation and how to gently rebuild your body and increase activity in a way that works for you. A key part of the integration period is the free online access to which is the clinic s world-leading recovery group. The archive includes over 100 hours of material, including patients stories and review sessions of tools taught at the programme. 13

14 Telephone Treatment Programme TTP was specifically designed for patients when The 90 Day Programme is not appropriate. TTP is an immensely effective way to kick-start treatment and see real improvements, working purely by telephone/skype and home study. Delegates benefit from much of the same material used in The 90 Day Programme, including: Four hours of one-on-one sessions with their practitioner. The one-on-one sessions can be tailored in length depending upon your situation, but are generally a one hour initial, followed by four sessions of 45 minutes. Psychology Foundation Pack, which includes: Alex Howard s book Why ME? Learn to Relax (4 audio downloads) The Sleep Inducer (4 audio downloads) Beat Fatigue with Yoga (Book and DVD) Home Study CDs from The 90 Day Programme Free online access to If you are unable to attend The 90 Day Programme, TTP is a very powerful alternative that you can do at home at your own pace, with the support of one of the clinic s highly experienced practitioners. Ad Hoc Sessions These are generally appropriate for those who: Prefer not to work in a group. Have covered some of the material from The 90 Day Programme or TTP and would like to focus on tailoring the approach to their own individual needs. Have a significant background of complicated emotional issues which need more one to one attention. Of course you can start with The 90 Day Programme or TTP and follow on with one-on-one sessions if/when appropriate. 14

15 Next step This all sounds very exciting, but are you really saying it is possible to change my situation? After so many years of intensely researching the areas we do, and having worked with over 5,000 people in over 35 countries around the world, it is now unquestionable that the people we work with see real changes. Many patients that come to the clinic have already worked on parts of their situation, but the real key lies in working in an integrated way with truly specialist practitioners. Our job is to act like a d e t e c t i v e, t o systematically work out which bits are relevant to you, and determine the most effective ways for you to move forwards. Ultimately, our job is to help you solve your puzzle. I ve tried everything It really can feel like that sometimes - however, the vast majority of people we work with feel like that at the start, and yet, almost immediately after starting work with us, discover a whole new world of possibilities opening up. There really is no other integrative protocol like ours available. We are in fact, the only clinic that has integrated so many different approaches, in the unique research focused way we have. The next step is to book a free 15 minute chat to discuss your possible way forward with the clinic; either with psychology, nutrition or ideally both. This sounds expensive and I have limited funds? The level of integration of our protocol (looking at the whole picture ), means that patients ultimately save a lot of money, by avoiding trying other individual approaches in isolation, with practitioners who do not have our expertise to know in advance what is likely to work. Our experience takes the hit and miss factor out of your journey. Our approaches are all m a d e a s c o s t - effective as possible, and compared to the cost of things not changing are actually very affordable. And, without intending to be too political, we b e l i e v e o u r approach should be funded by the NHS, and it is for this reason that we are investing significant resources in supporting research through our own inhouse research department, as a first step towards this. What do I do next? The next step is to book a free 15 minute chat to discuss your possible way forward with the clinic; either with psychology, nutrition or ideally both. Our 15 minute chats are most definitely not a sales call - they are simply an opportunity to get your personal questions answered, and essentially, to explore how our approaches may be of benefit to you. To find out more, please book a free 15minute chat. You can do so in the following three ways. 1. Online at OptimumHealthClinic.com/15minutechat 2. Telephone on ing enquiries@theoptimumhealthclinic.com 15

16 The Optimum Health Clinic Winner of CAM Magazine s Outstanding Practice Award