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Foods that Fight Inflammation—And Why You Need Them

Online Health Chat with Amy Jamieson-Petonic, MEd, RD, CSSD LD, LMT – Director, Wellness Coaching, Cleveland Clinic Wellness Enterprise

June 12, 2012

Introduction

Cleveland_Clinic_Host: Inflammation isn’t inherently bad. In fact, we couldn’t survive without it. Normal inflammation is the body’s response to any injury or infection. It’s part of our body’s natural healing process.

Chronic inflammation isn’t restricted to one area of your body. It burns slowly and steadily, releasing molecules of inflammation such as cytokines and C-reactive protein (CRP).

Over time, this causes a chemical chain reaction in the body that leads to serious problems: Arteries can become inflamed, setting the stage for heart attacks and strokes. Insulin resistance (a diabetes precursor), full-blown diabetes, Alzheimer’s disease, and even depression can develop.

An everyday injury or infection can spark the initial flame, but it takes more than that to keep it simmering. High blood pressure can contribute to inflammation, as can being obese. Smoking and stress also encourage the destructive domino effect. And then there’s your diet.

Almost everything we eat either encourages or discourages inflammation. The Mediterranean diet works wonders for controlling inflammation. There are lots of reasons to avoid saturated fats, refined carbohydrates ("carbs"), and sugars, and trans fats (the type so prevalent in processed foods). But it turns out that these foods can also help create those molecules of inflammation. You may not be able to cut out every last fire starter in your life. But you can gain the upper hand by making smart choices about what’s on your plate.


About the speaker:

Amy Jamieson-Petonic, MEd, RD, CSSD LD, LMT – Director, Wellness Coaching, Cleveland Clinic Wellness Enterprise Amy Jamieson-Petonic has dedicated her life to becoming a role model for good health. As a registered and licensed dietitian, exercise physiologist, and licensed massage therapist, she has extensive bandwidth on the role of healthy living and vitality in her own life and extends this passion for wellness to those around her.

Amy’s diverse educational background allows her to provide the most up to date nutritional therapy to a wide range of individuals. Amy’s specialties include adult and childhood weight management, sports nutrition, and wellness. As a Certified Specialist in Sports Dietetics, Amy has become one of the top local sports nutrition experts, and was the consultant to such prestigious organizations as the Cleveland Browns, Cleveland Cavaliers, Cleveland Rockers, The Cleveland San Jose Ballet, and the 2006 Olympic Figure Skating Teams.

Amy has extensive media experience as a nutrition and exercise consultant to national and local television, radio, and print media. Amy was instrumental in bringing one of the first family-based weight management programs to the west side of Cleveland. She was recently nominated and received the Outstanding Young Dietitian of the Year award.

In her current role as a Director of Wellness Coaching in the Wellness Enterprise (www.ClevelandClinicWellness.com ), Amy has written an exceptional online nutrition program called GO! Foods® for You, based on the latest clinical research on the benefits of following a Mediterranean foods-based program. The program is 8 weeks of engaging tips, recipes, and menu planning tools by your coach, Amy, and the Cleveland Clinic team on how to make good food taste great! GO! Foods® have been offered to Cleveland Clinic employees as well as organizations in the community. GO! Foods® for You is one “out of the box” method in helping you take action to improve your health, wellness, and vitality.

To learn more about the Wellness Coaching Program visit: www.clevelandclinicwellness.com

For additional information about Cleveland Clinic Wellness Institute’s GO! Foods® for You Online Food Plan please visit clevelandclinic.org/gofoods website.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic expert Amy Jamieson-Petonic, MEd, RD, CSSD LD, LMT. We are thrilled to have her here today for this chat. Before we begin with some of questions, would you talk to us about the Go! Foods program?

Amy_Jamieson-Petonic_MEd_RD: Sure, let’s talk about Go! Foods®. Cleveland Clinic is committed to helping you achieve optimal health and well-being. Eating well is the cornerstone of a healthy lifestyle. Scientific evidence that links eating habits to increased risk of certain diseases and conditions proves that “you are what you eat.” That’s why Cleveland Clinic dietitians and wellness experts developed Go! Foods®—to give you the green light, so you’re sure you’re making the healthiest food selections. Our nutrition experts certify that foods carrying the Go! Foods® label meet national nutritional guidelines. Cleveland Clinic’s Go! Foods® program makes it easier to find the most healthy food choices.


Anti-inflammatory Diet and Alzheimer’s Disease

curious1: I had heard something about this recently—how certain foods are curing Alzheimer’s and dementia patients. They (researchers) believe, or at least partially believe, that memory problems are caused by inflammation of the brain. Certain kinds of foods are proven to reduce inflammation in the body. I was curious to see which foods do this and how much you would have to consume to get the benefits.

Amy_Jamieson-Petonic_MEd_RD: Yes, there is research on this that is ongoing and potentially very exciting! There may be a link with inflammation and the buildup of amyloid plaque on the brain that increases the risk of Alzheimer’s disease. Diet may be a great way to help combat this. What to eat? Plenty of fresh fruits and vegetables, 100% whole grains, extra virgin olive oil, nuts, and lean protein. As for the amount, I would say that eating two handfuls of fruits per day and three handfuls of vegetables is a great start. In addition, 1 to 2 tablespoons of extra virgin olive oil and two 3 ounce servings of fish, such as salmon, per week, would be wonderful. Good luck!

solly: In regards to your answer to the question about Alzheimer’s disease, can these foods also help prevent it?

Amy_Jamieson-Petonic_MEd_RD: I'm not sure if anyone knows the answer to this question yet, but some exciting research is being done in this area. What we do know is that consuming anti-inflammatory foods can reduce the inflammation in the brain that is associated with Alzheimer’s disease. I always tell my clients to "set themselves up for success" by eating a healthy diet. It can only help.


Helping Other Diseases: Cardiovascular Disease, Hypertension, Arthritis, and Cancer

SusanA: Is the anti-inflammation issue even more important after cancer has been diagnosed?

Amy_Jamieson-Petonic_MEd_RD: A number of research studies have looked at the role of nutrition and cancer, and an anti-inflammatory diet that is high in antioxidants and dietary fiber can be very beneficial before or after a diagnosis. A registered dietitian with an expertise in treating cancer can help you make the best decision on how to incorporate these foods into your individual program.

galata: What diseases and conditions are anti-inflammatory foods known to help with?

Amy_Jamieson-Petonic_MEd_RD: There are a number of conditions that are involved with inflammation. Some of these include cardiovascular disease, hypertension, cancer, arthritis, and other conditions, such as fibromyalgia and lupus. An anti-inflammatory diet can really make a positive impact on many of these conditions. So, if you need another reason to eat your fruits and vegetables, 100% whole grains, extra virgin olive oil, healthy fats, lean protein, and low-fat dairy, this is it!

clara: I have had open heart surgery grafts and a valve replaced. In the last 4 years, I have also received 7 stents. I would appreciate any information to stop this from progressing so fast. I am thin and exercise.

Amy_Jamieson-Petonic_MEd_RD: From a nutrition standpoint, I would suggest consuming fresh fruits and vegetables, 100% whole grains, healthy fats—such as extra virgin olive oil (cold pressed), lean protein sources, and low-fat dairy as part of your treatment program. These foods will help reduce inflammation in the body, and help to promote healing. But this is not meant to replace your medical treatment program with your physician. Good luck!


The Effects of Foods on Biomarkers—ANA and CRP

Gr8Health: Can positive ANA (antinuclear antibody) and titer results be improved by eating anti-inflammatory foods? If so, what foods are best?

Amy_Jamieson-Petonic_MEd_RD: Thanks for the question. A positive ANA test may mean that you have a higher incidence of an autoimmune disorder, but not necessarily. I would suggest following up with your doctor or rheumatologist on this one. That being said, a diet high in fruits, vegetables, 100% whole grains, and healthy fats can only improve your health, so I would suggest trying an anti-inflammatory diet if you have not done so already.

ncw001gatherer: Are there any tests which can be done to determine a person's level of inflammation, and then to monitor the effectiveness of dietary changes?

Amy_Jamieson-Petonic_MEd_RD: Yes, there are blood levels such as CRP (C - reactive protein) that can look at inflammation levels. That being said, there can be many things that are causing a high or low inflammation level, such as infection, illness, etc.

There is another urinary test called F2-isoprostane—a urinary biomarker of oxidative stress in the body—which can look at inflammation.

Peppy: I have my hs-CRP (high-sensitivity CRP) checked annually. When I went on a statin, it went to zero, but does that mean the inflammation is just being masked? Even on a low-fat, vegan diet I had some elevation of my test results—I think it was one. I believe that’s moderate risk. When I went on Crestor®, it went to zero. Is something in my diet causing the mild inflammation, and is the Crestor® masking it?

Amy_Jamieson-Petonic_MEd_RD: Statin medications may be reducing inflammation as well as the oxidation of LDL (low-density lipoprotein), the bad cholesterol. I would suggest that you stay in contact with your physician about your medication plan, but keep eating a diet high in fresh fruits and vegetables, 100% whole grains, extra virgin olive oil, healthy fats, lean protein, and low-fat dairy. Your anti-inflammatory nutrition program combined with your medical treatment program is your best way to manage your health.

twochy: How are uric acid and CRP related? Are they the same?

Amy_Jamieson-Petonic_MEd_RD: Uric acid and CRP are two different types of markers of inflammation.

Uric acid comes from the natural breakdown of the genetic material in cells. Some foods contain large amounts of uric acid, especially red meats and internal organs (such as liver and kidneys), some shellfish, and anchovies.

Uric acid in normal amounts remains dissolved in the blood, easily passes through the kidneys, and leaves the body as waste. Uric acid in high amounts will deposit in joints and make a person more likely to develop gout.

CRP is another marker of inflammation in the body. Elevated CRP levels may be an indicator of heart disease. If you have a family history of heart disease, you may want to ask your doctor about getting a CRP level.

From Nightshade Vegetables to Red Meat: Do Certain Foods Worsen Inflammation?

pfehr: I have found that any foods that contain any form of corn increases my pain level. Is it because corn in general does that, or is it because the American corn product has been modified? And if it's because of the modification, would all foods that have been modified be harmful or even toxic to the body?

Amy_Jamieson-Petonic_MEd_RD: It's difficult to say why the corn is causing you pain. Have you seen a physician about this? There may be a medical reason that this is occurring, but it truly goes beyond my scope of practice to answer this question. Corn is high in antioxidants called carotenes, such as lutein and zeaxanthin. If you are looking for an alternate way to get these into your diet, I would suggest consuming foods such as eggs, kale, spinach, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, and Brussels sprouts. To get the most nutritional bang for your buck, I would suggest eating them raw or steamed lightly.

Peppy: Vegan friends of mine keep warning me about eating the "nightshade" vegetables because they are supposed to cause inflammation and arthritis. Would this be the case with, say, potatoes?

Amy_Jamieson-Petonic_MEd_RD: Nightshade foods, such as potatoes, tomatoes, and eggplant, have been theorized for many years to increase inflammation in the body and increase pain in arthritis. Unfortunately, there is little research to support these claims. A white potato is considered a nightshade food. While I do not believe these foods increase inflammation, you might want to consider a sweet potato instead (high in beta carotene and a healthier option).

Bumpkin: What do you mean by nightshade food?

Amy_Jamieson-Petonic_MEd_RD: Nightshade foods are foods that claim to increase inflammation and pain for those suffering from arthritis. However, there is limited clinical research to support that nightshade foods have any impact on arthritis. My suggestion is to consume a diet high in fruits, vegetables, and 100% whole grains, such as 100% whole grain bread, brown rice, whole grain pastas, and cereals. These will help reduce inflammation in the body.

Bumpkin: Which foods should be avoided?

Amy_Jamieson-Petonic_MEd_RD: There are foods that increase inflammation in the body, and we can see this on an ultrasound, which is quite amazing! Foods that increase inflammation include saturated fats, trans fats, and added sugars. Added sugars are any foods that do not include naturally occurring sugars, such as fresh fruits, vegetables, and low-fat dairy products. Foods that have added sugars include cookies, cakes, pies, and other pastries. In addition, other foods with added sugars include cereal bars and pasta sauces.

I would suggest looking for the Go! Foods® criteria when shopping for groceries. The Go! Foods® criteria can be found on www.ClevelandClinicWellness.com website.


Choosing the Right Foods and Supplements

lift_off: What nutritional criteria should foods have to help fight inflammation?

Amy_Jamieson-Petonic_MEd_RD: All Go! Foods® meet these nutritional criteria:

  • Minimal Saturated Fat: less than 4 grams for main dishes; less than 2 grams for side dishes, soups, and desserts.
    Reason: Saturated fats "harden" arteries and cause high LDL cholesterol, which increases the risk of heart attack, stroke, and some cancers.
  • No Trans Fat.
    Reason: Trans fat has no redeeming qualities! It increases bad LDL cholesterol and decreases good HDL cholesterol, raising the risk of heart attack and stroke.
  • Minimal Added Sugars and Syrups: less than 4 grams for main dishes and desserts; less than 2 grams for side dishes and soups
    Reason: Adding sugar adds empty calories and causes blood sugar to fluctuate.
  • 100% Whole Grain.
    Reason: Whole grains are a vital source of fiber. Fiber has been shown to decrease the risk of heart disease, stroke, and certain cancers, maintain blood sugar and insulin levels, assist with regular bowel movements, and keep you feeling fuller longer.
  • Minimal Sodium: No more than 600 mg in entrees; 480 mg in side dishes and desserts.
    Reason: High sodium intake is associated with high blood pressure, increased risk of stroke, and worsening of kidney disease, heart failure, and other conditions.

ssrangerthedog: Can fish oil be effective in fighting inflammation? How much fish oil per day would be effective?

Amy_Jamieson-Petonic_MEd_RD: There is good research to show that fish oils found in salmon, sardines, and tuna can reduce inflammation. My first recommendation would be to consume fatty fish at least two to three times per week. A number of research studies have found that 1,000 mg of fish oil (a combination of DHA and EPA) would be very beneficial for reducing inflammation.

nancyh: Is Ensure® is a problem or a solution?

Amy_Jamieson-Petonic_MEd_RD: I'm not 100% clear on your question. Ensure® is a supplement that can be used if inadequate intake is occurring. If you are unable to consume a healthy diet for a number of reasons, it may be appropriate to supplement with a beverage such as Ensure®, but a healthy diet comes first.

pf: Do you find that the Gerson Institute has valuable guidelines for the body to self-heal, since it is a food-based protocol?

Amy_Jamieson-Petonic_MEd_RD: I think that nutrition can make a significant impact on many conditions, and any program that recommends sound nutrition principles can help improve health.

Peppy: If we stick to foods that are close to nature or natural and avoid processed foods, won't we be o.k. and avoid inflammation in the body? I try to shop the perimeter of the grocery store.

Amy_Jamieson-Petonic_MEd_RD: Yes, foods that are normally on the perimeter are more fresh foods and produce and less processed foods. These tend to reduce inflammation in the body. Keep up the good work!

Mymom: What are your opinions of virgin coconut oil? Traditionally, we viewed coconut oil as a bad fat since it is high in saturated fat. Now we hear that nonhydrogenated coconut oil has health benefits. Would you please comment on that? Thank you.

Amy_Jamieson-Petonic_MEd_RD: Virgin coconut oil is another option when you are choosing oils. Coconut oil is much higher in saturated fat than extra virgin olive oil, but, in moderation, can be part of a healthy diet. Research on coconut water has been very positive as an alternative hydration source as well as an option for replacing electrolytes, so that may be worth considering as well.

Peppy: Are fish and seafood inflammatory? Salmon seems to be a good choice, but what about squid and shrimp? The only meat I eat is seafood.

Amy_Jamieson-Petonic_MEd_RD: Salmon is high in omega 3 fatty acids, and has been shown to help reduce inflammation in the body and would be my first choice, along with tuna and sardines for the omega 3 content.

snickers01: I cut up ginger root and put it in my drinking water and tea for inflammation I feel better by doing this every day. What do you think?

Amy_Jamieson-Petonic_MEd_RD: Sounds great to me! There has been some great preliminary research on the anti-inflammatory benefits of ginger and health. Have a cup of tea for me!

Peppy: I love raw nuts, but even a very small amount causes weight gain. Does that mean they are causing inflammation due to the weight gain when eating them?

Amy_Jamieson-Petonic_MEd_RD: Nuts are a great source of monounsaturated and polyunsaturated fatty acids, but you are correct. Portion control is key here. I would suggest continuing to eat nuts, but keep your portion to a small handful to prevent weight gain.

ssrangerthedog: What do you suggest to use as a sweetener to use for adults and especially children? What are your comments about the use of Splenda®?

Amy_Jamieson-Petonic_MEd_RD: If you are only using a small amount of sweetener, I would suggest agave nectar. It is also considered an added sugar, but leads to a lower glycemic response and is much sweeter than sugar.

The clinical research on Splenda® shows that it is safe to use, and is the closest thing to resemble sucrose, also known as table sugar.

phylisk: Do spices help reduce the inflammation in your body?

Amy_Jamieson-Petonic_MEd_RD: Yes, spices are a great addition to your nutrition program. A number of spices have anti-inflammatory benefits, such as turmeric, cumin, cinnamon, ginger, and coriander. If you are looking for a number of fabulous recipes that include herbs and spices, consider my GO! Foods® for You program. There are over 80 healthy recipes that all meet the Cleveland Clinic healthy Go! Foods® guidelines.

Want a tasty and healthy snack idea? Try making kale chips by drying them, drizzling some extra virgin olive oil on them, and sprinkling turmeric on them and then baking at 350° F until crisp.

F94jL63: Since the food industry can claim "zero trans-fats" on nutrition labels even if the product contains amounts under a specified threshold, how are we to determine whether food items do in fact contain trans-fats?

Amy_Jamieson-Petonic_MEd_RD: Great question! Yes, a food can be labeled trans-fat free if it has less than 0.5 grams of trans fat per serving. To determine if a product contains trans fat, look at the ingredient label. If it says “partially hydrogenated” in the ingredients, put it down.

Bumpkin: Lately, I have been hearing more about gluten-free foods. Isn't that the same as eating a diet of vegetables, fruits, extra-virgin olive oil, and 100% whole grain?

Amy_Jamieson-Petonic_MEd_RD: Gluten-free products are very popular right now. People who are consuming a gluten-free diet avoid any type of grains that have wheat, rice, oats, or barley. So, consuming fruits, vegetables, lean protein, low-fat dairy, and gluten-free grain products would be appropriate. For people who cannot digest gluten, it is very important that they follow a gluten-free diet to stay healthy. If they eat foods that contain gluten, or wheat protein, they can have absorption concerns and many gastrointestinal issues. There are a number of gluten-free products to choose from today that are very tasty.

nancyh: Is coffee good for you?

Amy_Jamieson-Petonic_MEd_RD: Coffee can be good for you, but let's talk about how it is prepared. Black coffee, without cream and sugar, has been shown to help increase alertness, and may have a positive relationship to heart disease, Alzheimer’s disease, and cancer.

However, the sugary beverages with whipped cream on the top do not have the same benefits. Stick with your plain, old “cup of Joe” for the most health benefits.

wmslyhog_1: Are there additional benefits from yogurt beyond the ingredient of low-fat dairy products?

Amy_Jamieson-Petonic_MEd_RD: Yes, yogurt can provide additional nutrients, such as calcium and protein. Some interesting research has come out on the role of calcium and the prevention of stroke. It appears that foods high in calcium, such as yogurt, reduce clumping, or platelet aggregation, in the blood, that leads to strokes. More research is needed, but preliminary research is very promising.

nancyh: I have observed that low-fat salad dressings are disappearing from grocery store shelves. What can the American Dietetics Association (ADA) do to reduce this trend, and can they influence nutrition teaching programs in schools?

Amy_Jamieson-Petonic_MEd_RD: I agree that there are many opportunities for registered dietitians to be involved with the schools. I have colleagues at Cleveland Clinic who are working with the schools in the Cleveland area to revamp their menus, which is very positive. Change in the schools is happening, just not as quickly as we all would like. What I can suggest is to be a great role model for your children. Research shows that mothers have the most significant impact on the nutritional choices of their children. This is a great time to take your kids to the farmer's market, go berry picking, and teach them where their food comes from.

A great alternative to store-bought low-fat salad dressings would be to make your own healthy Mediterranean salad dressing with extra virgin olive oil, lemon juice, and garlic. This is great tasting and a wonderful anti-inflammatory addition to your fresh-made salad.

ssrangerthedog: Do you recommend eliminating table sugar from your diet or consuming it in moderation? Is brown sugar healthier than white sugar?

Amy_Jamieson-Petonic_MEd_RD: I would suggest limiting it as much as possible, because we know that added sugars increase inflammatory biomarkers such as c-reactive protein (CRP), interleukin, and cytokine levels. Brown sugar is not healthier than white sugar. I would suggest trying a small amount of agave nectar instead. It is sweeter than sugar and causes less blood sugar elevation.

FMDAdvocate: Do you feel avoiding all red meat is necessary to minimize inflammation?

Amy_Jamieson-Petonic_MEd_RD: I would suggest reducing red meat consumption quite a bit due to its inflammation response, but can be enjoyed occasionally. What I also tell my clients is to make sure that your portion sizes are moderate as well. A serving size of protein is about 3 to 4 ounces, or about the size of a woman's palm of her hand.

phylisk: What is the best food for overall wellness?

Amy_Jamieson-Petonic_MEd_RD: Wellness means different things to different people. The web site www.ClevelandClinicWellness.com has lots of great information on wellness that can help you live a healthy life. A few suggestions that I have would be to sign up for our wellness tip of the day at www.wellnesstips.com, and identify a few areas of your life to work on. For example, we talk about the "Big 5" areas to focus on for wellness. These include:

  1. Food choices and portion sizes: Following an anti-inflammatory diet like GO! Foods® for You is a great start.
  2. Physical activity: Get out there and move it! Research shows that just wearing a pedometer every day makes you take an extra 2,000 steps per day. And the goal is to shoot for 10,000 steps per day.
  3. Tobacco: If you smoke, please consider quitting.
  4. Stress: We know that stress is the number one reason that people visit their doctor.
  5. Sleep: Research has shown us that if you sleep less than 5 hours per night, you increase your risk of heart disease and diabetes significantly.

All of these factors play into wellness, and making small changes each day can lead to big results!

For More Information About GO! Foods® for You and 5 to Go!™

Bumpkin: Can you tell us more about GO! Foods® for You and principles of the ancient Mediterranean diet?

Amy_Jamieson-Petonic_MEd_RD: Yes! The GO! Foods® for You program is an 8-week, online nutrition program based on the Mediterranean diet that I created to help people live a healthier life. It has an individualized eating assessment, healthy activities to help you eat better, and a pantry swap to make sure you have the healthy stuff in your house. I've also created over 80 healthy recipes that all meet the Cleveland Clinic Go! Foods® criteria that are good for you and taste fabulous! We are offering a discounted price if you would like to try it at home! I hope you enjoy it as much as I enjoyed writing it.

apollo: Could you suggest additional programs and resources?

Amy_Jamieson-Petonic_MEd_RD

 

GO! Foods® for You is based on the principles of the ancient Mediterranean diet. GO! Foods® for You is an expert-guided online program designed by the wellness team at the world-famous Cleveland Clinic. In 8 weeks, you’ll learn how to change your life—one small step at a time—by changing what and how you eat. So don’t go on another diet. Learn how to eat right with GO! Foods® for You. You’ll feel better, look better, and be healthier!


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic expert, Amy Jamieson-Petonic, MEd, RD, CSSD LD, LMT is now over. This chat was full of information! Thank you, Amy, for taking your time to answer our questions today about Foods that Fight Inflammation—And Why You Need Them.

Amy_Jamieson-Petonic_MEd_RD: Thank you very much for the opportunity to chat with you today! I hope you enjoyed learning about the Mediterranean diet, and gained some valuable insight into foods that increase or reduce inflammation in the body. Please consider trying my GO! Foods® for You online nutrition program for more fantastic information on this topic. My goal is to help reach as many people as possible with great nutrition and tasty recipes. Have a fruit- and vegetable-filled day!

Bumpkin: Thank you. This was excellent.


More Information

Cleveland_Clinic_Host: To learn more about the Wellness Coaching Program visit www.clevelandclinicwellness.com. For additional information about Cleveland Clinic's GO! Foods® for You online food plan please visit www.clevelandclinic.org/gofoods website Enjoy a Discount on the GO! Foods® for You Online Food Plan

Learn how to eat right, lose weight, and feel great with our Wellness Institute’s GO! Foods for You online food plan.

  • Discover the health benefits of foods and supplements.
  • Learn to prepare nutritious meals.
  • Enjoy specially created recipes that meet GO! Foods® criteria

Visit www.360-5.com/Amy for 20% off this $40 program.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult®website. To request a remote second opinion, visit eclevelandclinic.org/myConsult

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