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December 17, 2017 By Natalie Engelbart Leave a Comment

Four Tests that Can Help You Find the Cause AND Solution to Your Insomnia

 

You are here because you have tried everything else. The natural stuff hasn’t worked for you. Maybe you’re taking medications or self-medicating just to get a few hours of shut-eye. Or maybe even those aren’t working for you anymore. Don’t worry, there’s still hope. For my patients with insomnia, I recommend the following:

1. Check your oxygen supply
Oxygen is the number one most critical fuel source that we have and it’s not only crucial for your sleep, it’s crucial for your life. You can go weeks without food, a couple days without water, but literally only minutes without oxygen. If anything is diminishing the oxygen supply to your brain during the day or night, it will interrupt your sleep.

Here are a few ways to tell if you’re not getting enough oxygen to your brain:

  • You’re tired and pale
  • You have trouble concentrating
  • Your heart rate is fast (above 90 beats per minute at rest) and you feel it pounding
  • You need to take deep breaths, or you sigh a lot
  • You snore loudly at night
  • Your feet and/or hands are cold and sometimes look blue
  • Your feet and/or ankles are swollen and when you touch them the indentation stays even after you take your fingers away (pitting edema)

If you answered YES to any of the above, please call your doctor right away. These are serious issues that need to be addressed immediately. Very often there are functional things that can be done to improve your oxygenation, but the life-threatening variables need to be ruled out first and foremost.

2. Check your blood sugar levels
If your blood sugar is unstable, it could wreak havoc on your ability to sleep, as your brain needs a constant supply of fuel to function properly. Blood sugar swings can make your brain feel like it is starving and throw off your entire system. Dysregulated blood sugar can make it hard for you to get to sleep and/or stay asleep throughout the night.

If you crave carbs or sweets, have low energy during the day, have a hard time sleeping and/or have trouble losing weight, these are all warning signs that your blood sugar is not balanced. Blood sugar testing is simple and routine, and regulating blood sugar is one of the keys to health and wellness, including healthy, restorative sleep. Three important tests to have done are: fasting glucose, hemoglobin A1c and fasting insulin.

3. Test your hormones
A complete hormone panel is important to do when you suffer from insomnia.

I look at adrenal gland hormones, especially cortisol, and especially before bedtime, if sleep is an issue. Stress can cause spikes in cortisol levels; cortisol levels that are too high at bedtime or that increase during the night can keep you from sleeping, and not sleeping can put stress on the adrenal glands and lead to a very vicious cycle. Testing allows us to develop a plan to unwind the cycle and help normalize the stressed system.

Melatonin is an important hormone for sleep and normal circadian rhythms. It should be higher at nighttime and lower in the morning when it’s time to wake up.

If your sex hormones (estrogen, progesterone and testosterone) are out of balance, this can also greatly affect your ability to get to sleep and stay asleep. Your temperature regulation centers may also be affected by these hormone shifting and you could be too hot or too cold during the night.

Thyroid hormones that are too low OR too high can affect sleep and sleep quality. Thoroughly testing your thyroid function is important for helping you figure out why you aren’t sleeping well.

4. You could have an imbalance between the excitatory and inhibitory neurotransmitters in your brain
Neurotransmitters are chemical messengers that communicate information throughout your brain and body. In general, we have excitatory neurotransmitters that are important for wakefulness, learning and thinking. Inhibitory neurotransmitters are important to help us wind down, feel calm and to help us sleep (some neurotransmitters have both excitatory and inhibitory functions, depending on where their receptors are located).

To grossly oversimplify the function of neurotransmitters, think of the accelerator and brakes on a car. The accelerator is like the excitatory neurotransmitters. They get you moving and going. The inhibitory neurotransmitters are like the brakes. They slow you down and let you stop (sleep).

If you have too much excitatory and not enough inhibitory neurotransmitters, or if the areas of the brain that release these chemical messengers are overworking or underworking, you can experience insomnia (these imbalances may be seen along side other brain-based issues such as anxiety, depression, and trouble focusing, to name a few).

This is where functional neurology comes in, and a doctor who is certified in this field can detect these imbalances and develop a plan to help you. Specific brain-based exercises and natural neurotransmitter precursors can help balance your accelerator and braking system–your inhibitory neurotransmitters and the areas of the brain that produce them.

Sleep is important, and our bodies and brains will simply break down if we don’t have enough of it. Today in the functional medicine fieldswe have more tools than ever to help you experience restorative sleep naturally. Contact Dr. Engelbart today to schedule a consultation to determine the best plan of action for you!

Filed Under: Healthy Tips & Habits, Sleep

December 17, 2017 By Natalie Engelbart Leave a Comment

“I’m Just SO Tired!” Five Signs Your Adrenal Glands Need Help

The adrenal glands are small glands that sit above your kidneys, but don’t let their size fool you.  They are a very important part of your body, especially when it comes to energy production and managing stress.  They also work hand-in-hand with:

  • Your pancreas for blood sugar regulation;
  • Your thyroid for metabolism;
  • Your other hormones such as progesterone, estrogen and testosterone; and
  • Important brain chemicals called neurotransmitters.

If you’ve been under a lot of stress or experiencing imbalances in any of the above systems, your adrenal glands could need some TLC.

Five Warning Signs:

1.  Fatigue

If you are having trouble dragging your body out of bed in the morning, suffering a mid-afternoon slump, relying on caffeine to get you through the day, or falling onto the couch in a heap after you get home from work, you are experiencing fatigue.  Better do something about this now, while you can at least still drag yourself out of bed and before this fatigue becomes more chronic and severe.

Your adrenal glands produce cortisol, and normally they should be able to produce a healthy dose for you first thing in the morning, as part of a normal circadian rhythm. This high dose in the AM helps you get out of bed and take on the day.

It’s no surprise then, that the fatigue caused by adrenal gland dysfunction is especially noticeable first thing in the morning.  You may also notice a significant slump in the mid-afternoon, and generally low energy throughout the day.  You may also notice that after you have a busy, high-demand day, or miss a night of sleep, that you can barely function the following day.

As fatigue gets worse, you rely more and more on your thyroid gland to help you out to produce more energy. Soon this gland can get overworked as well.  Thyroid dysfunction and adrenal gland fatigue are almost always seen together.

2.  Trouble getting to sleep or staying asleep

It seems counterintuitive because (as mentioned in warning sign #1), you’re sapped of energy and tired most of the day.  But when you finally get the chance to crawl into bed, you may find that you cannot wind down, or that you don’t get restorative sleep.

 If you are like many of my patients, you feel like you are finally getting your deepest sleep right about the time your alarm clock is set to go off.  After hitting snooze repetitively, it’s time to start the day and do it all over again.

Normally, cortisol levels should fall gradually throughout the day, and be nice and low at bedtime.  If your cortisol level elevates in the evening, or if it spikes during the night, you won’t be able to sleep.

 And here’s the Catch-22: lack of sleep puts additional stress on your system, putting even more of a burden on your adrenal glands.

3.  Craving carbs and salt

When you are under stress and tired, your brain knows you need fuel so that it, and you, can function.  And the fuel it craves is easy-to-digest simple carbohydrates that it can quickly use for energy.

Most patients describe to me that they don’t want anything in the morning except a cup of coffee and maybe a piece of toast or cereal. But then they have cravings and hunger throughout the day. A lack of appetite in the morning is a cardinal sign of blood sugar imbalance, and very commonly seen accompanying adrenal gland fatigue.

The cravings for salt and sugar are a compensation mechanism.  Your body knows that eating will boost your cortisol levels to give you some much-needed energy and make you feel a little less dead.

The problem is that this creates a vicious cycle.  The more simple carbs you eat, the more of the same you crave.  Your blood sugar spikes and then plummets, and the easy, yummy pick-me-up needs to happen more and more frequently.   This causes blood sugar dysregulation and insulin resistance.  Excess weight comes on and won’t come off, and energy becomes non-existent without a caffeine or carb boost.

Adrenal fatigue and blood sugar imbalances like reactive hypoglycemia (low blood sugar), insulin resistance, and pre-diabetes go hand in hand.

The adrenal glands also help regulate sodium, potassium, magnesium and chloride levels in the blood through a hormone called aldosterone. If your adrenal glands are fatigued, you might not be producing enough aldosterone and will crave salt.  Craving salt is a sign of mineral imbalance, and is a tell-tale sign of adrenal gland fatigue.

4.  Inability to handle stress

Are you feeling like everyone and everything seems to be on your very last nerve these days?  Are you baffled at how short your trigger is, and the way your body spirals into fight-or-flight mode at the drop of a hat?

Maybe one of your kids spills his oatmeal right before you’re headed out the door, or someone at work makes a joke that you don’t think is particularly appropriate.  Your logical brain knows it’s probably not that big of a deal, but your body reacts automatically and immediately, sending you into full-fledged fight-or-flight mode. Your heart races, your body and hands tremble a little, your face gets flushed, and you feel like you are about to jump out of your skin. You know it’s an overreaction, but you don’t know how to stop it.

This trigger-effect usually happens when you have experienced a significant stress in the past, and your body has not been able to get back to the normal set point you once had.  You are stuck in high-stress survival-mode and your nervous system is now wired to release excitatory neurotransmitters that signal a surge of cortisol to come crashing out when only a little would do the trick.  This trigger-happy state is not a good or healthy place to live, for you OR your family members, friends, or co-workers.  In addition, this systemic overreaction can plummet you further into the adrenal-fatigue downward spiral.

5.  Decreased sex drive (libido)

When you are under constant stress, sex becomes very low on the list of priorities.  This is because your system is prioritizing other functions it deems more necessary for your survival, and is in the full-time business of making cortisol whenever and however it can.

When your system runs out of raw materials to make cortisol, it starts to steal other hormone raw materials to make more cortisol.  The result is that your sex hormones diminish and become imbalanced, and sex just doesn’t sound so good anymore.

If you have your hormones tested, the results may show low or imbalanced hormone levels.  If you try to supply more estrogen, progesterone of testosterone hormone to your body (synthetic, natural, or bioidentical), your body will likely take these hormones, break them down and try to make cortisol out of them.  This result is certainly not a long-term solution or cure, and can leave you feeling worse than ever.

Your hormone levels should be tested along with your cortisol levels so your doctor can determine if cortisol is running the show.  Getting to the true cause of the problem will likely involve some type of adrenal gland support.

What Should You Do?

The key is to have the appropriate testing done.  Test your adrenal glands along with your other related systems (blood sugar, hormones, neurotransmitters, for example).  Nothing in your body works in a vacuum.  You and your doctor need the complete picture of what your body and brain need to re-balance.

Lab testing can help determine what’s out of balance, and then Dr.Engelbart can customize a sound dietary, lifestyle, and supplement plan to help turn it around.  A simple saliva test can show what cortisol is doing throughout the day, and this can be compared to how your blood sugar, other hormones and neurotransmitters (especially norepinephrine, and epinephrine) are functioning.

NOW is the time to address your adrenal fatigue and start on the road to recovery. Schedule a consult with Dr. Engelbart today.

Filed Under: Blood Sugar, Energy, Healthy Tips & Habits, Hormone Balance, Sleep, Stress Relief

December 11, 2017 By Natalie Engelbart Leave a Comment

CORTISOL: The Misunderstood Stress Hormone

Cortisol has a bad reputation. Dubbed “the stress hormone,” it’s tagged as the causative factor for belly fat and stress-related disorders. And it’s true that excess cortisol over long periods of time can cause breakdown of bone and muscle, and it can lead to fatigue, weakness, and emotional problems. But that’s not the end of the story.

Cortisol plays a vital role during times of stress, and is important for proper immune system function. It has powerful anti-inflammatory effects — think of cortisone shots and prednisone prescriptions — and is involved in every aspect of metabolism of our macronutrients (protein, fat, and carbohydrates). In adrenal gland fatigue or insufficiency, LACK of cortisol has been linked to extreme fatigue, allergies, arthritis, weight gain, and low brain function.

Cortisol levels should follow a normal circadian rhythm, with a peak level in early morning, followed by a gradual decline to reach the lowest level by midnight. When cortisol follows this rhythm as designed, we have energy in the morning and can fall asleep easily at night. If it does not follow this rhythm (for example, if it spikes at night time, or does not reach a peak in the morning,) our entire wake-sleep cycle is affected.

So how do you know if your health problem is cortisol-related? And how do you know if it’s too low, too high, or out-of-rhythm? The answer is simple: TEST IT.

Cortisol testing involves a simple saliva sample. We usually ask our patients to do four throughout the day to track their circadian rhythm. We also measure DHEA, which is another adrenal hormone that is very important in staving off early aging, and in balancing the effects of cortisol. If sleep is an issue, we can add melatonin testing to the testing panel. Melatonin is one of the most powerful antioxidants known to man, and has been used to help with other disorders such as migraine headaches.

This is one of the simplest lab tests you could ever do, and the information you get back could be life-changing. Here are a few key reasons to CONSIDER TESTING YOUR CORTISOL LEVELS:

  • Fatigue
  • Inability to handle stress
  • Insomnia (inability to get to sleep or stay asleep)
  • Anxiety
  • Adrenal gland dysfunction
  • Thyroid dysfunction
  • Inability to lose weight or gain weight
  • Osteopenia or osteoporosis
  • Low muscle tone
  • Joint dysfunction
  • Frequent infections
  • Autoimmunity
  • Allergies
  • Brain fog
  • Memory loss
  • Frequent headaches
  • Low mood, mood swings, or irritability
  • Prednisone or cortisone use, current or past

If your symptoms match any of the above, it’s time to take action. Contact Dr. Engelbart today to enquire about testing your cortisol levels.

Filed Under: Energy, Healthy Tips & Habits, Hormone Balance, Sleep, Stress Relief

March 5, 2014 By Natalie Engelbart Leave a Comment

Need More Sleep? Get Rid of the “Screen Blues”

Can’t sleep? Are your screens (computer, phone, tablet) to blame?

Here’s a hint: if they are on and you are looking at them at night, they are indeed a culprit.

Why? Because they emit primarily blue light that tricks your brain into thinking it’s daytime. This blue light decreases your melatonin production and wrecks your sleep. If you are looking at your screens every night, you have almost surely developed insomnia by now. But there is a (free) way you can change the blue lights on your screen into the more melatonin and sleep-friendly red hues that will help you to get your ZZZ’s:
https://sleepjunkies.com/tools/flux-app-review/

Of course the best solution for consistently sleeping like a baby is to TURN OFF YOUR SCREENS every night at least 2 hours before your sleep time. But I know the thought of that sends you screen-addicts out there just a little mad.  So try the the software.

Read more: 10 Tips to Help You Sleep Like a Baby TONIGHT

Filed Under: Healthy Tips & Habits, Sleep

August 1, 2011 By Natalie Engelbart 4 Comments

Insomnia: Simple and Functional Tips That Work

Caution:  Lack of Sleep Has Been Proven to be Hazardous to Your Health

You’re tired. Exhausted, in fact. All you can think about is the time when you can crawl into your bed after a long day and wait for the blissful slumber to overtake you. But for millions of us, this process is not as easy as it should be.  30-40% of adults suffer from insomnia, and find it difficult to get to sleep, stay asleep, or both.

Sleep is a complex function. Rather than being a time when your brain simply shuts down, it is a time of active regeneration for both brain and body. It is a time when our memories consolidate, when our cells regenerate, and when our brain makes sense of what it experienced during our wake hours.

Sleep deprivation should not be taken lightly. It has been used throughout history as an effective method of torture and punishment, and research has shown that prolonged sleep deprivation can literally drive a person crazy.

Lack of sleep doesn’t just lead to fatigue. It has been linked to weight gain, inability to cope with stress, delayed healing, increased risk of cardiovascular disease, diabetes, compromised immune system function, and neurotransmitter imbalances which can cause depression and altered perception.

Now that you understand that insomnia isn’t just annoying and inconvenient, but actually dangerous, I think it’s time to review some important tips on how to get a good night’s sleep.

The Magic of Ninety Minutes

Researchers refer to “sleep architecture” as the pattern of sleep cycles that one completes during the night (or during a nap).  Each cycle lasts 90 minutes, and consists of rapid eye movement (REM) sleep, when we do our active dreaming, and four stages of non-rapid eye movement sleep, where we experience deep sleep. In order to enjoy restorative sleep, each 90-minute cycle must be completed. If a 90-minute cycle is interrupted for any reason, you will not feel adequately rested.

For this reason, many sage individuals conclude that if they get six hours of non-interrupted sleep, they feel better, more rested, and more awake than if they get seven hours of sleep. There are even people who sleep three hours each night and then take a 90 minute nap during the day, and claim they feel fantastic, energetic, and extremely well-rested.

My goal here isn’t to get you to try the three-hour-per-night experiment, but I am advising that you set your wake/ sleep clock to a 90 minute interval.  Seven and an half hours seem to be the most popular with my patients.  Research shows that even if you get less sleep overall, if you complete the 90 minute cycle, you will feel better, heal faster, consolidate memories more efficiently, cope with stress better, regulate blood sugar better…you get the idea.

Get Into a Routine

Doing the same things at the same time each night before you go to bed literally trains your brain to predict that sleep-time is approaching, and helps you to fall asleep fast.  If you want to move from insomniac to sleep aficionado, here’s what your goals should be:

  • Go to bed at the same time every night and wake up at the same time every morning. Make sure your sleep time allows you to complete a 90 minute sleep-cycle.
  • About an hour before bedtime, go through a systematic routine that you repeat every night.  It might look something like this:
    • 9:30 pm :  Sip a cup of SleepyTime tea (warm or cold) while you take your nighttime supplements (there are a vast degree of options here, and best to have your functional doctor customize a program for you, like I do for my patients.)
    • 9:40 pm:  Change into jammies, wash face, brush teeth.
    • 9:50 pm:  Read a book or magazine.
    • 10:05 pm:  Journal, pray, or meditate.
    • 10:30pm:  Lights out.

Pretty simple, right? The key is to KEEP it simple, and repeat it every night, until it becomes habit. This can take up to 90 days, so be patient and consistent.

Here is what should NOT be in your nightly routine:

  • Caffeine and other stimulant consumption

I shouldn’t have to expound on this very much, as it should be quite clear that stimulants will interrupt your sleep.  Even if you don’t think you are susceptible to caffeine’s stimulant effects, if you suffer from insomnia, you should leave it out of your nightly routine.  In fact, I recommend you stay away from caffeine in all forms (coffee, caffeinated teas, chocolate) and other stimulants such as B vitamins, and herbal stimulants (such as ginseng) for 6 hours before your bedtime.  Your stimulant consumption should be exclusively in the daytime hours when you are trying to stay awake.

  • Exercise

While exercise has been shown to help with insomnia and should absolutely be a part of your DAYtime routine, if you exercise in the evening or nighttime hours, you are messing with your circadian rhythm (i.e. your natural wake-sleep cycle). If you exercise at night, you will rev up the adrenal hormone cortisol at the precisely the wrong time.

Our cortisol levels should be highest first thing in the morning, and then gradually decrease throughout the day, and be lowest at nighttime to allow us to fall asleep easily. During and immediately after exercise, cortisol is released (this is one of the ways exercise revs our metabolism). Several hours after exercise, cortisol levels decrease significantly. So exercising at nighttime can cause a cortisol spike that has a high probability of  interrupting your sleep.  But exercising earlier in the day regulates cortisol levels appropriately, draining you of excess stress hormone, and allowing you to sleep like a baby. Your workout routine should end a minimum of three hours before your bedtime.

  • Alcohol

Even though alcohol is commonly used as a sedative to help many get to sleep, it can greatly degrade your quality of your sleep and mess up your sleep cycle, especially in the second half of the night. Alcohol is a brain depressant, meaning it decreases the function of specific parts of the brain, altering neurotransmitters that are involved in sleep regulation (namely serotonin and norepinephrine). Scientists confirm that alcohol interferes with our sleep architecture, or the balance of our sleep patterns and brain waves.

Alcohol also impacts our blood sugar levels. Unstable blood sugar is a common cause of insomnia, and in turn, lack of good-quality sleep affects our blood sugar regulation — a vicious cycle, to be sure. So lay off the sauce if you want to sleep better.

  • Sugar

As I just mentioned above, blood sugar plays an enormous role in our wake-sleep cycles. Many times people feel sleepy after eating a high carbohydrate meal, so they think if they have a big bowl of ice cream right before bed, it will help them sleep better.

First of all, if you are getting sleepy after eating (day or night), this is your “Blood Sugar Dummy Light” going on, telling you that you had too many carbohydrates in the meal you just ate. Concentrate on getting more high-quality protein in, and cut down on the carbs, such as sugar, corn syrup, pastas and grains, alcohol, and even fruit.

Secondly, if your blood sugar is unstable, I can almost guarantee that you will be waking up at least once in the middle of the night, as you slip into hypoglycemia and your brain starts screaming for some fuel. One simple tip for this is to eat a low-carbohydrate snack before bed to help stabilize your blood sugar. This may be a handful of almonds, a little bit of cheese, or some apple slices with natural peanut or almond butter. This can decrease the fasting time and regulate your blood sugar during the night, giving you a better night’s sleep.

PS:  If you are concerned about a low-carb, healthy snack before bed causing you to gain weight, don’t be. Insulin surges cause you to store fat, and that’s what we are trying to avoid by stabilize your blood sugar. Plus, you are far more likely to pack on the fat pounds by losing sleep, which causes your hormonal and metabolism systems to derail, than you are from getting a few calories in from healthy foods before bed.

  • TV, Gaming, Internet Surfing, Texting, Tweeting, Facebooking, Google +ing, etc.

The main area involved in regulating sleep is in the brainstem. Here we find the Reticular Activating Center (RAC), and just like the name says, its job is to keep us activated and awake. It shouldn’t be active all the time, however. It is designed to chill-out in the evening and nighttime hours so that we can get good, restful sleep.

Guess what keeps the RAC active: LIGHT and SOUND. If you are bombarding your senses with light and sound you will keep your RAC stimulated, and send powerful signals to your brain that it is not time to go to sleep. So as you wind down for the evening, wind the visual and auditory stimulation down also. Your bedroom should be dark and free from anything blinking, flashing, or bright. If you suffer from insomnia, consider cutting off the electronics and wireless gadgets three hours before your lights-out time. Use “white noise” devices, or even ear plugs if you have to while you sleep, to keep spontaneous noises to a dull roar (pun intended). Consider an eye mask to keep excess light from waking you up too early.

In addition to the constant electronics and digital gadgets revving up your brainstem and contributing to insomnia (and anxiety, incidentally), there is a lot of discussion and research these days about the dangers of sleeping too close to your phone, computer, and other electronics, even when they are in the “sleep” mode (ironic, isn’t it?).  The review of the research deserves an entire post of its own, so for now I will simply say it would do us all a world of good to unplug a bit more these days, especially before bed. Don’t use your phone as your alarm clock or sleep with it next to your head. Shut down your electronic devices, or keep them in a different room while you sleep.

Keep it Simple and Functional

There are so many pills and devices out there these days designed to help us sleep, and some of you will need more help than what is in this article. Many of my patients certainly do. But these tips should be part of your sleep rehabilitation even if you are needing medication or additional help.

What is clear to me after 13 years of practice is that people jump to the medications (natural, over-the-counter, and prescriptive) before trying the simple things first. What I have found is that getting back to the basics, as discussed here, can help to restore your sleep pattern so you don’t have as much of a reliance on sleep aids, which many times have side-effects of their own. So give this a shot. You have nothing to lose and a good night’s sleep to gain.

As I mentioned in the intro, sleep is an extremely complex function. Many other systems have to be working correctly in order to enjoy proper sleep. These include the adrenal glands, thyroid, blood sugar, and inhibitory neurotransmitters, just to name a few.  These will be addressed in later blog posts, and of course in the book I am currently working on.  If you have questions or suggestions on what you’d like to hear more about, please leave a comment.

Here’s to a good night’s sleep!

Filed Under: Healthy Tips & Habits, Sleep

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About Dr. Natalie J. Engelbart

Dr. Natalie J. Engelbart

Dr. Engelbart is passionate about finding solutions to your hormone and health problems–not only WHAT is wrong, but also WHY, and what can be done to help you reach your peak health.

Dr. Engelbart holds several advanced and accredited multidisciplinary degrees. She is a Doctor of Chiropractic with a Bachelor of Science in Human Biology, multiple Board Certifications in Neurology, and three multi-disciplinary Fellowships in Functional Medicine through the American College of Functional Neurology.

After being in private practice in the Dallas, TX area for 15 years and training multiple doctors in her specialty, she and her family moved to Boulder, Colorado in 2012. Dr. Engelbart has studied and trained in Amsterdam, Paris, Norway and throughout the United States. She loves learning and continually strives to stay up-to-date with the latest research and clinical applications.

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See what Dr. Engelbart’s patients have to say.

Dr. Engelbart is able to help patients all over the United Sates! Visit Dr. Engelbart at South Boulder Healing & Chiropractic Services in beautiful Boulder, Colorado, or CONTACT US to set up a phone, Skype or FaceTime Consultation.

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