text:
The independent association between parathyroid hormone levels and hyperuricemia: a national population study
Janet Y Hui1,
Jee Woong J Choi1,
David B Mount2,
Yanyan Zhu1,
Yuqing Zhang1 &
Hyon K Choi1,3
Increased frequencies of hyperuricemia and gout have been associated with primary hyperparathyroidism, and recent clinical trials of parathyroid hormone (PTH) have reported hyperuricemic adverse events. We evaluated the potential population impact of PTH on serum uric acid (SUA) levels by using a nationally representative sample of United States adults.
By using data from 8,316 participants aged 18 years and older in the National Health and Nutrition Examination Survey 2003 to 2006, we examined the relation between serum PTH and SUA levels with weighted linear regression. Additionally, we examined the relation with hyperuricemia by using weighted logistic regression.
SUA levels increased with increasing serum PTH concentration. After adjusting for age, sex, dietary factors, glomerular filtration rate (GFR), and other potentially related biomarkers (calcium, phosphorus, alkaline-phosphatase, 25-hydroxyvitamin D), the SUA level differences from the bottom (referent) to top quintiles of serum PTH levels were 0, 8, 13, 14, and 19 μM (95% CI, 12 to 26; P for trend, < 0.001). These estimates were larger among renally impaired individuals (multivariate SUA difference between the extreme quintiles of PTH, 26 versus 15 μM among those with GFR ≥ 60 versus < 60 ml/min per 1.73 m2, respectively) (P for interaction = 0.004). The odds of hyperuricemia by various definitions increased with increasing PTH levels as well (multivariate P values for trend, < 0.05).
These nationally representative data indicate that serum PTH levels are independently associated with serum uric acid levels and the frequency of hyperuricemia at the population level.
Hyperuricemia is the precursor of gout, a common and painful inflammatory arthritis with a growing disease burden [1]. Hyperuricemia and gout have been long observed to occur with an increased frequency among patients with hyperparathyroidism, whereas parathyroidectomy is known to reduce serum uric acid levels in these cases [2–7]. Elevated parathyroid hormone (PTH) levels are thought to reduce renal urate excretion, although the exact mechanism remains unclear [7]. Furthermore, recent randomized controlled trials have also found that hyperuricemia or gout is associated with use of teriparatride, a recombinant human PTH approved for osteoporotic fracture prevention [8–10]. After cessation of teriparatride, serum uric acid levels decrease [8]. The baseline data of a randomized trial based on men aged > 40 years [11] and another community population study of men aged ≥ 70 years [12] showed a significant association between PTH and serum uric acid levels. These data suggest that a significant biologic influence of PTH on serum uric acid level exists, but the impact of this relation at the general population level (including women) is not known. To address this issue, we examined the relation between serum PTH and uric acid levels in a nationally representative sample of men and women (US National Health and Nutritional Examination Survey, NHANES 2003 to 2006).
The NHANES studies are designed to assess the health and nutritional status of adults and children in the United States. These studies are based on a representative sample of the noninstitutionalized US civilian population that is selected by using a multistage, stratified sampling design. The survey is unique in that it combines interviews, physical examinations, and various laboratory data [13]. Beginning in 1999, NHANES became a continuous survey conducted annually with data released in 2-year cycles. In this analysis, we used two recent NHANES datasets that obtained serum PTH levels, the NHANES 2003-2006. After a home interview, participants were invited to attend examination sessions, in which blood and urine specimens were obtained. Our analysis included participants 18 years or older who attended the medical examination, and included the 8,316 participants (3,961 men, 4,355 women) with complete information. We repeated our analysis among 8,272 participants, after excluding participants who were taking allopurinol or uricosuric agents (n = 44).
The NHANES studies underwent institutional review board approval, and written informed consent was obtained from participants before starting the study.
PTH levels were measured by using the Origen-Electrochemiluminescent analysis (Elecsys 1010 Immunoassay analyzer). The analytic protocols for other serum analytes and laboratory quality-assurance procedures are described in the NHANES Laboratory Procedures Manuals [14]. Values are reported in picomoles per liter, and can be converted to picograms per microliter by dividing by 0.1061.
Serum uric acid levels were measured by oxidization with the specific enzyme uricase to form allantoin and H2O2 (Beckman Synchron LX20). Details about quality-control procedures were been published in the NHANES Laboratory Procedures Manuals [14]. Values are reported in micromoles per liter and can be converted to milligrams per deciliter by dividing by 59.48.
Assessment of covariates
The NHANES collected information on body measurements (including body mass index (BMI)), medication use (including diuretics, allopurinol, and uricosuric agents), medical conditions (including self-reported hypertension), and relevant laboratory values (serum creatinine, calcium, alkaline phosphatase, phosphorus, and 25-hydroxyvitamin D levels). Glomerular filtration rate (GFR) was estimated by using the Modification of Diet in Renal Disease study equation: GFR ( ml / min per 1 . 73 min 2 ) = 186 × ( serum creatinine level (mg / dl) ) − 1 . 154 × ( age ) − . 2 0 3 ) × ( 0.0 742 , if female ) × ( 1 . 212 , if black ) [15–17].
The average daily intakes of energy, protein, carbohydrates, sugar, fat, caffeine, and alcohol were derived from a mean of two 24-hour dietary recalls conducted two separate days after the medical examination.
All statistical analyses were computed by using survey commands of STATA (for example, SVYMEAN and SVYREG) to incorporate sample weights and to adjust for clusters and strata of the complex sample design (STATA Corporation, College Station, TX, USA).
We used linear regression modeling to evaluate the relation between PTH levels and serum uric acid levels. PTH levels were categorized into quintiles, and each quintile was compared with the lowest quintile. Multivariate models were adjusted for: age, sex, race, BMI, self-reported hypertension, use of diuretics, use of allopurinol or uricosuric agents, GFR, intake of alcohol, total energy, protein, and sugar, and mutually for serum levels of PTH, calcium, alkaline phosphatase, phosphorus, and vitamin D. To help address the potential influence of central adiposity (reflecting insulin resistance), we conducted analyses with adjustment for waist circumference in addition to, as well as in place of, BMI. Trends in serum uric acid levels across PTH categories were assessed in linear regression models by using continuous PTH values. We performed logistic regression with a dichotomous outcome of hyperuricemia (serum uric acid level > 7.0 mg/dl in men and > 5.7 mg/dl in women [18]), adjusting for the same covariates. We also examined the potential impact of alternative definitions of hyperuricemia (serum uric acid level > 6.0 mg/dl and > 7.0 mg/dl, both regardless of sex) in these regression models.
We examined whether the observed associations persisted within the subgroups stratified by sex, BMI (< 25 kg/m2 versus ≥ 25 kg/m2), GFR (≥ 60 versus < 60 ml/min per 1.73 m2), serum vitamin D levels (≥ 52.4 nM (median value) versus < 52.4 nM), and serum calcium levels (≥ 2.4 mM (median value) versus < 2.4 mM). We determined the statistical significance of potential subgroup effects by testing the significance of interaction terms added to our final multivariate models. For all difference estimates and odd ratios, we calculated 95% confidence intervals (CIs). All P values are two-sided.
The mean age of the population was 46 years. The mean serum uric acid level was 319.05 μM (361 μM among men and 280 μM among women), and 19.13% were hyperuricemic (20.86% among men and 17.54% among women). The characteristics of the study according to PTH level are shown in Table 1. With increasing PTH levels, age, BMI, serum levels of alkaline phosphatase, use of diuretics and urate-lowering agents, and the frequency of hypertension and diabetes tended to increase, whereas GFR, the proportion of whites, and serum levels of calcium, vitamin D, and phosphorus tended to decrease. Furthermore, intake of total energy, carbohydrates, protein, sugar, fat, and caffeine tended to decrease with increasing PTH levels.
Table 1 Characteristics according to quintiles of parathyroid hormone (PTH) levels in NHANES 2003-2006a
After adjusting for age and sex, serum uric acid levels among individuals in the highest quintile were higher than those in the lowest quintile by 36 μM (95% CI, 28 to 44; P for trend, < 0.001). After adjusting for other covariates, the difference was attenuated to 19 μM (95% CI, 12 to 26; P for trend < 0.001), but remained significant (Table 2). When we repeated our analyses after excluding participants who were taking allopurinol or uricosuric agents (n = 44), the results did not significantly change. When we repeated our multivariate analyses with adjustment for waist circumference, additionally or in place of BMI, our results did not change materially (P values for trend < 0.001).
Table 2 Differences in serum uric acid levels according to quintiles of parathyroid hormone in NHANES 2003-2006
When hyperuricemia was examined as a dichotomous outcome, the relations were similar (Table 3). For example, the multivariate odds ratios (ORs) for hyperuricemia according to increasing quintiles of serum PTH level were 1, 1.07, 1.22, 1.36, and 1.39 (95% CI, 1.03 to 1.88; P for trend = 0.03). Alternative definitions of hyperuricemia (serum uric acid levels > 6.0 mg/dl and > 7.0 mg/dl, both regardless of sex) did not materially alter these results (P values for trend < 0.03).
Table 3 The odds ratios (ORs) of hyperuricemiaa according to quintiles of parathyroid hormone in NHANES 2003-2006
Additionally, when we stratified our multivariate analysis by subgroups of BMI, GFR, serum vitamin D levels, and serum calcium levels, the association between PTH and serum uric acid levels persisted in all subgroups (P values for trend ≤ 0.007). The association did not vary significantly by these subgroups (P values for interaction > 0.55) except for GFR subgroups. Serum uric acid levels in individuals of the highest quintile of PTH were higher than in the lowest quintile by 26 μM (P for trend < 0.001) in the lower GFR group, whereas the corresponding difference was 15 μM (P for trend = 0.007) in the higher GFR group (P for interaction = 0.004).
In our nationally representative population study of US men and women, we found that serum uric acid levels and the frequency of hyperuricemia increased with increasing PTH levels in a graded manner. These associations were independent of other risk factors for hyperuricemia, such as age, sex, BMI, waist circumference, dietary risk factors, alcohol intake, renal function, hypertension, diuretic use, and serum levels of calcium and vitamin D. The association persisted across subgroups of BMI, serum levels of calcium, and vitamin D, and was greater in the lower GFR group. These findings provide evidence that supports an independent link between serum PTH and uric acid levels at the national population level.
The mean difference in serum uric acid level between the extreme quintiles of PTH was 19 μM (0.31 mg/dl), whereas the difference among individuals with chronic kidney disease (stage 2 or higher) was 26 μM (0.43 mg/dl). These levels of adjusted population mean differences were comparable to difference estimates between the extreme quintiles of intakes of total meats or seafood (0.11 mg/dl versus 0.10 mg/dl) in another NHANES study [19], which can be translated into a significant risk for incident gout, as demonstrated in a prospective analysis of the Health Professionals Follow-up Study [20]. This potential impact on the eventual risk of gout was also supported by our results with various definitions of hyperuricemia as a dichotomous outcome.
The link between PTH, hyperuricemia, and gout was observed in primary hyperparathyroidism [2–7]. For example, in an NIH case series, 20 of 56 patients (not taking diuretics) had serum uric acid levels > 7 mg/dl [3]. After parathyroidectomy, serum uric acid levels decreased by more than 1 mg/dl in 64% of these patients [3]. Limited studies have suggested that reduced renal excretion is responsible for the link, but the detailed underlying process remains unknown [7].
Recently, notable advances were made in the physiology of proximal tubular urate transport, with the identification of multiple secretory and absorptive transporters at both the basolateral and apical membranes [21–24]; urate transport across the proximal tubule is the net sum of these two processes. PTH would be expected to have more-negative effects on net proximal tubular urate reabsorption, given that proximal tubular salt (Na+-Cl-) and urate transport are regulated in parallel [25] and that PTH is a potent inhibitor of NHE3 [26], a critical apical transporter for proximal tubular salt absorption.
Recent osteoporosis prevention trials of teriparatride as a bone-formation stimulant have also reported hyperuricemia as an adverse event. For example, a clinical trial of 1,637 postmenopausal women found that teriparatride increases the incidence of hyperuricemia in a dose-response fashion, up to 25% at a dose of 40 μg per day [8, 9]. After cessation of treatment, serum uric acid levels returned to or approached pretreatment levels [8]. However, a randomized trial of men 40 years or older suggested that reducing PTH levels by calcium supplementation may not affect serum uric acid levels [11]. Interestingly, the hyperuricemia adverse events in the teriparatride trial [8, 9] were substantially more frequent among renally impaired patients, which was the case in the current population data. These data suggest that renal impairment or its associated processes significantly influence the hyperuricemic effects of PTH, calling for future investigations to elucidate the underlying mechanisms. Furthermore, this raises an intriguing question of whether vitamin D supplementation in renally impaired patients could help to reduce their serum uric acid levels. Another clinical trial of 428 glucocorticoid-treated adults reported both hyperuricemia (n = 3) and gout (n = 1) as adverse events of teriparatride, 20 μg per day [10]. Our findings expand these randomized trial data from a specific disease population to a general population level [2–10].
Strengths and limitations of our study deserve comment. This study was performed in a nationally representative sample of US men and women; thus the findings are likely to be generalizable to the US adult population. Although our cross-sectional study alone would leave uncertainty regarding the temporal sequence of exposure-outcome relations and thus about a potential causal link, the aforementioned randomized trial data with dose-response relation and reduction of uric acid levels after cessation of exposure (that is, teriparatride) or after parathyroidectomy in primary hyperparathyroidism, collectively provide a strong causal argument. Thus, our study findings should be viewed as expanding the generalizability of these previous findings to the general population.
Regardless, confirming the relation in a prospective longitudinal observational context (for example, the relation between prior PTH levels and incident gout, particularly in a renally impaired group) would be valuable.
These nationally representative data indicate that serum PTH levels are independently associated with serum uric acid levels and the frequency of hyperuricemia at the general population level. These data provide support for future studies aimed to clarify the underlying molecular mechanisms.
BMI:
GFR:
glomerular filtration rate
NHANES:
National Health and Nutritional Examination Survey
PTH:
SUA:
serum uric acid.
Zhu Y, Pandya BJ, Choi HK: Comorbidities of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008. Am J Med.
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This work was supported in part by grants from the National Institutes of Health (R01AR056291, P60AR047785).
The Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA, 02118, USA
Janet Y Hui
, Jee Woong J Choi
, Yanyan Zhu
, Yuqing Zhang
& Hyon K Choi
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Circle, Boston, MA 02115 and Nephrology Division, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
David B Mount
Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA, 02118, USA
Hyon K Choi
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Correspondence to Hyon K Choi.
Dr. Choi served on advisory boards for Takeda Pharmaceuticals, URL Pharma, and Savient Pharmaceuticals, whereas the other authors have nothing to disclose.
All authors contributed to studying the concept and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. JH, JWC, and HC drafted the manuscript, and all authors read and approved the final manuscript.
Hui, J.Y., Choi, J.W.J., Mount, D.B. et al. The independent association between parathyroid hormone levels and hyperuricemia: a national population study. Arthritis Res Ther 14, R56 (2012) doi:10.1186/ar3769
Uric Acid Level
Serum Uric Acid Level
Urate Transport


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Blou Blog
Public health major receives CEPH accreditation
Council on Education for Public Health website: ceph.org
The baccalaureate public health program at the Bloustein School has been accredited by the Council on Education for Public Health (CEPH), an independent agency recognized by the U.S. Department of Education to accredit schools of public health and stand-alone programs outside such schools.
The Bloustein School is one of the first four schools in the nation to have its stand-alone baccalaureate public health program receive accreditation; 2016 marks the first year that the council has accredited these programs. Students enrolled in the Bloustein program earn a Bachelor of Science degree.
"The accreditation, along with our recent ranking as fourth in the nation by USA TODAY for undergraduate public health education, confirms the academic rigor of our programs and reflects the hard work and commitment of many individuals to provide the highest quality educational programs at the university," said James W. Hughes, distinguished professor and dean of the Bloustein School.
In the accreditation review, the site visit team noted:
Graduation rates for public health majors at Rutgers are approximately 98 percent since 2011;
85.8 percent of graduates are employed or continuing their education;
Graduates have gone on to earn advanced degrees in Public Health (MPH, Ph.D.); Global Health, Biosecurity and Disaster Preparedness (MS); Social Work (MSW), Biomedical Sciences (MBS), Health Administration (MBA, MHA) and degrees in various medical fields.
Students in the public health major appreciate having practitioners as faculty, noting the contextual relevance they bring to the program.
While the accreditation process began in February 2014, the public health major has been continuously re-evaluated since it was established 1999, noted University Professor Raphael J. Caprio, director of the Bloustein School's undergraduate programs. "There has been considerable hard work by many faculty and staff to secure the program's success and the CEPH accreditation," Caprio said. "We have organized the public health major so our students will graduate with the skills and knowledge to make an immediate impact, as well as to find ways to expand access to the major."
The program takes a "big picture" approach to population health and disease prevention with such courses as "Healthy Cities," "Protecting the Public Health and the Environment" and "Global Health Perspectives." As one of the most diverse public universities in the nation –so recognized by President Obama at commencement in 2016 – many students are minorities, first-generation immigrants, returning veterans and nontraditional students.
"These students bring a rich and robust multicultural perspective to our classrooms," said Dona Schneider, professor and associate dean for programs. "Many of our students not only complete the public health major, but also specialized certificates in health disparities, health education and advocacy, preparedness, and public health management. Our graduates are prepared to think beyond the confines of traditional public health domains to embrace broad, holistic approaches to solving our most vexing population health problems."
CEPH, which has accredited schools of public health for 10 years, also accredited programs at East Carolina University, the University of Nebraska at Omaha and the University of North Carolina at Wilmington.
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redpajama_set_name: RedPajamaCommonCrawl


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Dr. Jaquel Patterson is amazing. She truly cares about her patients and is dedicated to helping them. She has greatly helped my three year old daughter with an autoimmune disorder. I would highly recommend her to anyone searching for answers outside of traditional medicine who wants to make positive changes in their lifestyle.
We first met Dr. Ingels in April 2009. Matt, then 14, having been diagnosed with PDD at the age of three, had faced a lifetime of dietary and environmental allergens affecting his gut and brain. We had made much progress with prior professionals and I believed that the allergen component was under control, but, knew that Matt still needed additional treatments in our pursuit of his recovery. He had been gluten, casein, soy, corn and nut free for nine years, was continuing to make great social and academic gains but I suspected that underlying allergies were still troubling his development. On our first visit, Matt earned the award for the most food sensitivities found in one child!
Matt begrudgingly accepted six months of additional dietary restrictions and a daily allergy treatment regimen. Flash forward two years, Matt is the healthiest he has ever been. He is making up for years of poor growth, gaining weight in all the right places verses years of belly distention and skinny arms and legs. His muscle tone has improved, academically and cognitively stronger, socially happier and with puberty now in full swing, his body is equipped to handle the hormonal assault of physical and mental changes that are occurring. He continues with his allergy treatment for various seasonal allergens but his world of food possibilities has changed tremendously. We still restrict gluten and nuts and I am cautious in allowing him to overdue certain food products, but, he enjoys foods such as goat cheese at least once a week with no apparent problem and the days of OTC allergy relief and the use of a nebulizer in the Spring and Fall are long gone.
Now four of us see Dr. Ingels, two other son's (ages 9 & 13) are in treatment for various food and environmental allergens and my own lingering gut problems and incapacitating migraines are clearly better. When my headaches sneak in (often through stress or if I eat something I shouldn't) he has given me the tools and knowledge of how I can treat them without having to turn to prescription or OTC counter pain relievers.
With three adventurous boys, I have turned to him for advice and homeopathic treatments to alleviate concussions, sleeplessness, cold and flu symptoms and stomach viruses. He and his staff are knowledgeable, compassionate and resourceful, I highly recommend Dr. Ingels and would be willing to speak with families who are considering his practice.
Dr. Patterson and her staff are incredible! I initially went to her because of sinus issues/nasal polyps due to inflammation and then on top of that infertility issues. since beginning immunotherapy drops and learning so much of my sinus and asthma issues are all food sensitivity related- Dr Patterson is on the path to change my life. She takes all the time you need on appt. She helps with any questions, via email after the appt. She cares, she's compassionate- Go see her!!
By the time I scheduled my first appointment with Dr. Jaquel Patterson, I was in a state of distrust and disillusion with both traditional and alternative health care practitioners. In the past, I had always been made to feel like I was beneath those who were treating me and I expected my experience with Dr. Patterson to follow suit. I was elated to find that her naturopathic approach was anything but typical. Dr. Patterson's holistic practice is above and beyond the norm. Her sense of empathy and understanding for those she treats, as well as her high level of integrity, is what is lacking in her peers. She is genuinely interested in my progress and more than willing to listen and work with the insights I have about my own care. She also possesses a rare, intuitive ability that I have not encountered before, that allows her to successfully get to the heart of my treatment. It is because of the high quality care and safe space she provides, that led me to bring my husband and 3 year old daughter in for treatment, as well. I am currently 4 ½ months pregnant now and have a multitude of health issues. Choosing Dr. Patterson to aid my care during the most vulnerable and difficult time of my life, is a testament to the level of trust she has instilled in me. Therefore, it is with great pleasure and enthusiasm that I confidently and highly recommend Dr. Jaquel Patterson to anyone who is looking for high caliber care with an equally excellent doctor.
I have been going to Dr. Ingels for about three years now. In those three years I have gone from being tired, having headaches, and being sick all the time to being energetic, no headaches, and rarely getting sick. Dr. Ingels has helped me with all my food sensitivities and seasonal allergies. He has a wonderful bedside manner and has the patient's best interest at heart. I have sent my whole family to him including my child, who absolutely adores him. I highly recommend him to any one and I thank him from the bottom of my heart for making me healthier.
I have been a patient of Dr. Jaquel, practically since she opened her practice. She's an amazing doctor and always listens to your symptoms. Without her expertise my lupus, fibromyalgia, and food allergies would not be under control. I would still feel ill and not be able to function. She has helped me with nutrition, supplements, herbal remedies, and much more.
Dr. Ingels is by far the most dedicated, compassionate, and committed physician that I have ever worked with. He works tirelessly to uncover the root cause of your health problems and then works with you to implement a plan to maximize your health. Dr. Ingels helped me make sense of my multiple diagnoses and really took the mystery out of the medical jargon I was hearing. Dr. Ingels is committed to partnering with his patients on their journey towards wellness.
Our family has been under the care of Dr. Ingels for over 2 years and we are delighted by the successful progress of our health issues. My 3 children including my middle child with special needs (ASD) had various food and environmental allergies. My oldest daughter's sinus infections have not returned since we used Dr. Ingels protocol. My son with ASD is calmer and more focused once we managed his allergies. He is able to be a better student at school and socially interacts with his peers with more ease. My youngest son also stopped reacting behaviorally once we gave his body a rest from the foods that were disturbing his overall balance. In addition, Dr. Ingels caught my daughter's hypothyroidism and my low iron issue and helped guide and treat these deficiencies with complete success. Dr. Ingels work is a BIG piece of the missing puzzle for our family and we are grateful for his expertise and comprehensive understanding of each of our unique health requirements.
Dr. Jaquel Patterson is extremely considerate of her patients. When I first came to Dr. Patterson I was suffering from an extreme case of hair loss and depression. But after Dr. Jaquel's time and willingness to work with me, I saw exceptional results all within a few months. My hair was and still is growing back at a fast pace and my mood improved greatly. Overall, Dr. Jaquel is a doctor who not only focuses on the illness itself, but also the person, and for that I am truly grateful.
My daughter was diagnosed with autism when she was 18 months old. At that time, along with autism she had numerous issues, such as sleep disturbances, hyperactivity and a wealth of gastrointestinal problems. She passed whole foods in her stool and had a bad reaction to many foods. I had taken her to different doctors with no luck. We found our answer with homeopathy with Dr. Ingels. We have been seeing him for a little over a year, and have been so grateful to him. Finally my daughter can eat most of the foods without any problem, her stool improved, her sleep is so much better now. Her eye contact has improved greatly and she is just getting better every day. We are so thankful to Dr. Ingels! Along with those improvements her social skills are increased and she is so much calmer than she was a year ago. For the first time she wants to interact with me and other people. She became so much more affectionate and the best thing that she hugs me now with her open arms, not holding them down like before. I can't wait to tell everyone what happens next! Thanks so much Dr. Ingels for all that you have dedicated your time and energy to doing.
I can't thank enough Dr. Ingels for his professionalism and compassion. He is a very talented homeopath. I am confident that my daughter will have a great future, not only because we started early but also because we were so lucky to have Dr. Ingels in our journey. Thank you so much, Dr. Ingels! You are an amazing doctor!
The moment I talked to Dr. Jaquel Patterson on the phone I felt at ease, because I knew I was on the right path to recovery from the anxiety blackhole I was in. I've seen her for the past 2 months and I am not only anxiety free, I also went back to my weight, I started exercising again and even started re-teaching yoga/pilates. Activities that I stopped because of all the side effects of the previous Doctor's prescribed treatment.