High Blood Pressure (Hypertension) – a Developed World Pandemic

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Blood pressure is a measure of the pressure that is produced within your blood vessels as the heart pumps. The data shows that a considerable proportion of the developed world’s population have higher than ideal blood pressure, written as systolic (the pressure created in the blood vessels during contraction of the heart) over diastolic (the pressure in the blood vessels when the heart rests in between beats). Optimal blood pressure is less than 120/80 mmHg (although less than 90/60 is classified as low blood pressure, which can cause other problems). We know that hypertension is extremely rare with traditional hunter-gatherers.

Hypertension is a significant risk factor for strokes, cardio vascular disease and type 2 diabetes. The data suggests that even mild hypertension (140-159/90-99 mmHg) can roughly double your risk of presenting with cardio vascular disease. Often there are no overt symptoms associated with hypertension, although headaches, chest pain, ear noise, nosebleeds, an irregular heartbeat, tiredness and vision changes may indicate an issue. Checking your blood pressure regularly is easy and affordable to do at home – home monitors start at £15.

So what should you do if you are presenting with high blood pressure? Should you resort to taking a medication? Not necessarily, as data from the Cochrane Collaboration (considered the ‘gold standard’ opinion, as it reviews the outcome of multiple randomised clinical trials) shows that the use of blood pressure medications for mild hypertension ‘did not reduce coronary disease, stroke or total cardiovascular events’ and that up to 9% of patients experienced ‘adverse effects’. For mild hypertension, the best place to start is by shifting your diet to a natural whole foods approach. This means removing all junk foods and focusing on the consumption of wholefoods – grass-fed meat/wild fish and seafood, nuts and seeds, vegetables, fruits, herbs and spices and drinking herbal teas/filtered water. By doing this you are likely to lose weight, if over weight, reduce the intake of damaged fats (heated vegetable oils), sugar, caffeine and alcohol, which are all connected to hypertension, as well as providing the body with sufficient levels of nutrients. What about salt? The evidence connecting salt to heart disease is weak and in fact restricting salt (mineral salt not table salt) intake may in fact be harmful to our health!

Finally, Dr Reaven who spent the last 60 years studying insulin resistance (IR), which is the condition where the body is unable to tolerate more than the absolute minimum amount of carbohydrate per day, without developing elevated levels of insulin in the blood; suggested that IR is the root cause of not only diabetes, but also hypertension, strokes, obesity, heart attacks and possibly even cancers and dementia. IR is more common than you might expect, which is typically estimated to be around 6% of the population. According to Dr Kraft, ‘to properly diagnose IR, one needs to measure changes in blood insulin and glucose concentrations for 2 to 5 hours after the ingestion of 100 grams of glucose. He showed that 75% of over 4,000 individuals who had ‘normal’ glucose tolerance as measured by conventional criteria showed an inappropriate insulin response, indicating that they were IR’ (Quoted directly from the Lore of Nutrition – Challenging Conventional Dietary Beliefs by Tim Noakes and Marika Sboros). That is a remarkable observation and may in fact be central to the development of not only hypertension but also virtually all chronic disease.

Prebiotics – The Unsung Heroes of the Gut

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There is a great deal of discussion, debate and on going research over the use of various strains of probiotics and their potential impact on human health and well-being. Probiotics are defined as ‘live microorganisms (bacteria and fungi) that, when administered in adequate amounts, confer a health benefit to the host’. Clinically, certain probiotics strains can be extremely useful for improving well-being, but the science as to which strain(s) should be used when and how well they survive the digestive process before they end up where we want them, is currently far from clear.

Prebiotics on the other hand are the food for probiotics and consist of no-digestible fibres (from fruits and vegetables). Prebiotics are defined as ‘compounds in food that induce the growth or activity of beneficial microorganisms such as bacteria and fungi (probiotics)’. It may be the case that prebiotics are more effective as a tool than probiotics. If we properly feed the probiotic bacteria in our guts, then they are more likely to thrive and provide us with key benefits.

The science connects the following health benefits with regular prebiotic consumption: Regular stool output – prebiotics increase stool bulk/mass. Increased mineral absorption – there is emerging evidence that certain prebiotics may improve bone density. Triglyceride reduction – fat in the blood, which is formed in the liver by eating excessive calories/refined carbohydrate foods and is probably one of the most important yet often overlooked markers for cardio vascular disease risk. Improved/balanced immune function – after all nearly 80% of the body’s immune system resides in the gut. Improvements in blood sugar management and insulin sensitivity – diabetes is a significant and growing healthcare burden. Weight loss. Improved hormone regulation. Improved mood. Improved sleep and a reduction in the stress response. All in all, this is an impressive list of benefits and just validates the importance of consuming enough fibre from fruits and vegetables – as a general guideline aim for 12 portions per day (4 fruit – 8 vegetable) – often though, the ratio of fruit to vegetables and the type and quantity of fruits and vegetables need to be tailored to the client’s specific biochemistry.

So what are some of the best prebiotic foods? Chicory root, Jerusalem artichoke, garlic, leeks, onions, asparagus, dandelion greens and under ripe bananas. Ideally these foods should be eaten raw to confer their greatest prebiotic effect. However, bear in mind that these foods may well cause significant digestive issues (abdominal cramping/diarrhoea/gas) if you are already presenting with IBS and/or have Small Intestinal Bacterial Overgrowth (SIBO).

Sum of the Parts – an integrated approach to cancer….

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This weeks Yes to Life show hosted by Robin Daly on UK Health Radio  is all about Sum of the Parts – Nutritional Therapist and Functional Medicine Practitioner Mark Bennett Entire Wellbeing shares some of the ways he supports people through and after cancer. To listen click on the following link:  bit.ly/2FqNx3U

Cancer is a complex multifactorial chronic disease and the evidence would strongly suggest that complementary approaches when combined with modern medical treatments can improve patient outcomes. This is not about an alternative approach, which by default implies that the patient has to make a decision as to which path to take, but about combining the best available evidence based approaches from both modern medicine and functional medicine to help deliver improved patient/client outcomes.

Anxiety, depression and the Gut

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Anxiety and depression are a significant health burden, with an estimated 20% of adults in the UK being affected. Whilst the use of antidepressants/anti-anxiety medications often provides effective relief, considerable side effects are common.

Anxiety and depression are often closely associated with digestive dysfunction/Irritable Bowel Syndrome (IBS), suggesting that imbalances (dysbiosis) in the micro flora (bacteria) may well be playing a significant role. Research suggests that a balanced and diverse micro flora in the gut plays a central role in overall well-being. In fact the science in this particular area of research is moving at a rapid pace with the recognition of distinct ‘gut-organ’ interactions and dependencies such as the gut-brain axis.

The gut-brain axis is irrefutable. We now know that this axis is controlled by a mixture of nervous, endocrine (hormonal) and immune system mechanisms. There is a continuous bidirectional conversation using small proteins (peptides) that are produced by specialist cells in the gut lining. The gut is the largest hormone and neurotransmitter producing mammalian organ, producing over 90% of serotonin (the very neurotransmitter that selective serotonin reuptake inhibitors or SSRI antidepressants, aim to increase between the neurons in the brain).

Human studies show that the brain can be affected by modulating the balance of the microflora (bacteria) in the gut and that each and every lifestyle choice that we make (food/drink choices, exercise, stress and toxic load) changes both the composition and diversity of these bacteria.

Interestingly, research now specifically connects gluten related disorders (the umbrella term for coeliac disease, non-coeliac gluten/wheat sensitivity and wheat allergy) to the initiation of dysbiosis, neuroinflammation and the disruption of the gut/brain axis and the manifestation of anxiety and depression.

Other recent work has shown that stress can cause ‘leaky gut’ (either between or through the cells of the gut lining) which can facilitate the movement of the ‘exhaust’ of bad/pathogenic bacteria into systemic circulation, often driving inflammation, which is now known to be a key driver of depression.

Clinically, clients presenting with anxiety and depression often see significant and sustainable improvements in their mental health by working hard on correcting any identified imbalances in their gut health, whilst also consuming an appropriate wholefoods diet and making sensible lifestyle choices. This often leads to the cessation of medications. Please note however that stopping any medication should always be done under the guidance and full knowledge of your GP.

 

 

Small Intestinal Bacterial Overgrowth (SIBO) – The Elephant in the Room

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SIBO occurs when the small intestine (the part of the digestive system that is designed to absorb nutrients from our food) is overgrown with bacteria that should not be there. The small intestine is effectively sterile. It is the colon that should harbour large populations of bacteria. When bacteria that should be in the colon decide to take up home in the small intestine, significant health issues may ensue, including nausea, bloating, vomiting, diarrhoea, malnutrition, weight loss, joint pain, fatigue, acne, eczema, asthma, depression and rosacea. SIBO might be best described as an infection of the small intestine.

SIBO is typically not considered in the standard assessment of an individual’s well being, but clinically it is highly prevalent. The latest data/studies suggest that IBS and SIBO often co-exist, with a 10-fold increase in SIBO if you are presenting with IBS. If SIBO is present it needs to be properly addressed, as without rebalancing the bacterial imbalances that drive this condition, the client has little chance of regaining long-term health and well-being. SIBO is highly correlated with nutritional deficiencies (even if supplementing), due to the bacteria in the small intestine interfering with absorption of nutrients. The malabsorption of nutrients is likely to eventually impact every major system in the body, if left unchecked.

Key triggers and drivers of SIBO include low stomach acid (including using Proton Pump Inhibitors such as omeprazole), poor bile flow/liver health, abdominal surgery (e.g. gall bladder removal and hysterectomy), radiotherapy, lack of pancreatic enzymes, diabetes, diverticulosis, coeliac disease, stress, ileocaecal valve dysfunction (the doorway between the small intestine and colon), food poisoning, regular alcohol and a dysfunctional Migrating Motor Complex (MMC) – The MMC makes cleansing/sweeping like motions between meals that cleans the small intestine, moving the contents of the small intestine and bacteria towards the colon. If the MMC is not working properly, then undigested food becomes a substrate for bacteria to thrive and ferment.

SIBO is typically treated with antibiotics, but reoccurrence rates are high and beneficial bacteria essential for digestive function are likely to also be harmed. Research and clinical experience show that certain herbal antimicrobials are just as effective at treating SIBO as antibiotics. Whichever route is decided upon, SIBO resolution requires a multi faceted approach to ensure that it is properly managed and prevented from reoccurring.

 

 

 

Controlling Inflammatory Bowel Disease using Diet not Drugs

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Inflammatory Bowel Diseases (IBDs), which include both Crohn’s disease (CD) and ulcerative colitis (UC), are complex autoimmune diseases of the digestive system. As discussed in previous articles, the evidence base suggests that autoimmunity is caused by a combination of genetics, environmental challenges (diet, toxic load, stress, viral and bacterial load) and imbalances in the balance of the bacterial species of the gut (dysbiosis). The standard medical approach to managing IBDs is to suppress the immune system using steroids or anti-inflammatories, which can not only increase the risk of infections but may often also deplete vital nutrients from the body. Response rates to these medications are also often sub optimal.

The standard Western diet is both high in refined carbohydrates, rancid fats and low in fibre and nutrients. The Autoimmune Paleo (AIP) protocol (a more restricted form of the Paleo approach) often used as the basis of a dietary intervention to help clients with autoimmunity regain control of their health; temporarily eliminates gluten, grains, dairy, nuts and seeds, legumes, nightshades, eggs, food additives, sugar, tea, coffee and alcohol. The focus is on providing the body with nutrient dense whole foods, consisting of fish/meats, fruits, vegetables, herbal teas, meat stocks, bone broths and water. The rationale is to remove the foods that can often trigger inflammation. It is also important to include other life style modifications, as part of the overall strategy, including stress and toxic load reduction and appropriate forms of exercise.

The results of a small study published in the journal of Inflammatory Bowel Diseases 2017 called ‘Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease’, tracked the progress of 15 patients with active IBD, that had been living with this condition for an average of 19 years. Half of the participants were actively using prescribed medications.

The results of this study were remarkable – ‘clinical remission was achieved at week 6, by 11 out of 15 (73%) of the study participants’. The study then goes on to say that ‘remission by week 6, rivals that of most drug therapies for IBD’, without of course the side effects.

Clinically I have experienced a significant proportion of clients with IBD regain control using a personalised dietary and supplementation approach. It is extremely reassuring to see such an unusual study validate this approach.

 

 

 

We are not what we eat, we are what we absorb

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When cells malfunction we ultimately present with disease. Nature does not label/define cell malfunction into various disease types such as arthritis/depression/cancer or cardio vascular disease; we do that. ‘There are no specific diseases; there are specific disease conditions.’ – Florence Nightingale. So why do cells malfunction? Cells, the building blocks of our body, all 36 trillion of them, malfunction for only a few key reasons. Arguably one of the most important of these reasons is lack of optimal cellular nutrition.

The biochemistry that is going on in all of us is unimaginably complex. Our cells are performing trillions of chemical reactions every second. So far we have discovered that the body requires access to over 250 individual nutrients for optimal cellular health (there will inevitably be more as our knowledge progresses). Even if genes are playing a part in the disease process, whether those genes become activated or not is intricately linked to nutrient triggers – nutrients can literally switch genes on and off. Medications cannot do that. This is the science of the rapidly expanding field of nutrigenomics.

Yes, to a certain extent we are what we eat, but to be more precise we are what we absorb! Nutrient absorption is fundamental to the whole process of optimal cellular health. It is normal to see clients presenting with multiple signs and symptoms of low nutrient status, even when eating what they would describe as a ‘healthy diet’. These include, fingernails that chip/break easily and have white spots, muscle cramps, cuts that heal slowly, decreased sense of taste/smell and bleeding gums.

Optimal absorption is dependent on optimal digestive system function. The whole system has to be in balance. Not only do we need to be in a relaxed state and consuming nutrient dense foods (however that on its own is becoming more and more difficult to do as we deplete our soils through relentless monoculture farming), but we also require sufficient stomach acid, bile flow and digestive enzyme status; a diverse and balanced micro ecology of the gut, optimal health of the small intestine (which can be damaged by the presence of coeliac disease, non coeliac gluten/wheat sensitivities) and the absence of small intestinal bacterial overgrowth (SIBO).

This is why when working with any client, no matter what their health condition, it is wise to start with a thorough evaluation of digestive health.

 

 

 

 

Neurodegeneration from a Functional Perspective

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Neurodegeneration/neurological disease affects neurons (the building blocks of the nervous system in the brain and spinal cord) and includes Multiple Sclerosis, Parkinson’s, Alzheimer’s and Motor Neurone/Lou Gehrig’s disease/ALS.

Modern medicine uses medications to control symptoms. Whilst this is naturally the first line of treatment offered, investigating why neurodegeneration has developed is often not given the attention it deserves.

The functional approach to health is all about causation i.e why does something happen? The body consists of multiple interconnected sophisticated systems, that when working efficiently, promote optimal health. It is now clear that there is a ‘gut/brain axis’, which consists of bidirectional mechanisms of communication between these two distinct nervous systems. This includes a physical connection via the vagus nerve, compounds produced by gut bacteria that may access systemic circulation due to increased ‘leakiness’ of the gut and gut derived immune system chemical messengers/neurotransmitters and hormones. Why does this matter? In Parkinson’s, for example, constipation is now believed to be a very early symptom and the data suggests that being constipated increases the risk of developing Parkinson’s by up to 4 times; there is also evidence that alpha-synuclein clumps start in the gut and travel to the brain via the vagus nerve. What happens in the gut does not stay in the gut!

It is essential to construct a holistic functional picture in order to be able to provide the appropriate intervention. Functional testing is an important part of this picture.

The health of the digestive system is fundamental (cells require access to 250 different micronutrients (vitamins/minerals) to function properly, which depends on optimal digestive capacity even if eating ‘well’ – we are not what we eat, we are what we absorb), toxic and bacterial/viral load (how is the immune system responding to these environmental challenges), gluten sensitivities (coeliac/non coeliac gluten/wheat sensitivities), unidentified food sensitivities (which can contribute significantly to overall levels of systemic inflammation), histamine and gut barrier permeability (‘leakiness’).

By combining this data with conventional medical data, a personalised and targeted intervention can be implemented alongside any current modern medical programme, providing the client with a much greater opportunity to regain control of their health.

Finally, it is perfectly possible for gluten on its own to drive neurodegeneration. ‘Gluten sensitivity can be primarily and at times exclusively a neurological disease’ – Gluten Sensitivity as a Neurological Illness – Journal of Neurology, Neurosurgery and Psychiatry 2002.

 

 

 

There are over 3,000 skin conditions

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Our skin is an amazing structure. There are over 3,000 known skin conditions, which include conditions such as eczema, psoriasis, vitiligo, acne, rosacea and seborrhoeic dermatitis. Data suggests that in the UK, 55% of the population have a skin disorder. These conditions often cause considerable discomfort and stress. Topical treatments such as balms/emollient creams/moisturisers and steroids are the normal course of action, often providing symptomatic relief, but these treatments unfortunately do not get to the root cause. So what are the key factors that in clinic often help to resolve these distressing conditions?

Optimal skin health is dependent on sufficient supplies of micronutrients including vitamins A, B3, B5, biotin, C, D (optimisation of vitamin D levels can reduce the severity of eczema in 4 weeks), E, K2, the minerals zinc, sulphur, selenium and silica and balanced essential fats. Nutrient density of the diet and efficient absorption are therefore key. We are not what we eat, we are what we absorb!

Absorption can be impacted by so many different variables including imbalances in the bacterial species of the gut (dysbiosis) – there is an irrefutable ‘gut-skin axis’ with skin health directly reflecting what is going on inside us; the presence of Small Intestinal Bacterial Overgrowth – SIBO (where the small intestine is overgrown with bacteria from the colon – correlated with rosacea); physical damage to the small intestine caused by undiagnosed coeliac disease (which is one of the most common lifelong disorders in North America and Europe) and inflammation caused by non-coeliac gluten/wheat sensitivity. The presence of a ‘leaky gut’ caused by dysbiosis can lead to a lack of ‘oral tolerance’ of any number of foods, which can drive skin inflammation.

Liver and kidney function are also important. The skin is a detoxification organ and if the liver and kidneys are under pressure then skin health may be impacted. So a proper evaluation of your environment is key (fabric conditioner, detergents and personal care products).

Finally excess histamine can often be a significant factor (stress is a potent histamine trigger), which is why a low histamine diet can often help. If this approach does work, then gut health and nutrient status warrant further investigation.

So if you have a chronic skin condition and want to regain control, work with a functionally qualified health professional. Everything in the body is connected – nothing exists in isolation.

Diabetes – An Intolerance to Carbohydrate

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Diabetes is a condition where the body is unable to efficiently handle carbohydrate (sugar). This happens because of problems with the production of, or response to insulin (the hormone secreted by the pancreas that controls blood sugar levels). Diabetes can either be type 1 or 2 .

Type 1 diabetes (T1D), also called juvenile diabetes, is where the pancreas fails to make insulin and type 2 diabetes (T2D) is where the body does not respond appropriately to the insulin that is being produced and usually follows on from a period of ‘insulin resistance’. Both types cause too much sugar to be present in the blood. Inappropriately high levels of blood sugar can cause a myriad of health issues including but not limited to cardiovascular disease, nerve/kidney/eye/foot damage, skin conditions, Alzheimer’s and depression. T1D is an autoimmune condition (where the body’s immune system attacks the cells that make insulin in the pancreas) and T2D is considered to be primarily a lifestyle condition, although there is now also evidence that T2D also has an autoimmune component.

According to Diabetes UK, almost 3.7 million people in the UK have a diabetes diagnosis (with an estimated extra 1 million who don’t even realise that they are diabetic). It is estimated that 12.3 million people are at an increased risk of developing T2D in the UK i.e pre-diabetic. Diabetes has been described as being the ‘fastest growing health crisis of our time’, costing the country £1.5 million an hour or £14 billion per year (if you also include the cost of treating health complications). This is a real crisis, which is not being resolved by the current nutritional guidelines.

Diabetes is essentially an intolerance to carbohydrate. To quote a critical review titled ‘Dietary carbohydrate restriction as the first approach in diabetes management’ published in Nutrition in 2015 – ‘the benefits of carbohydrate restriction in diabetes are immediate and well documented’. It goes onto say ‘dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss and leads to the reduction or elimination of medication’.

It is however critical that any diabetic that reduces carbohydrate intake, regularly measures their blood sugar levels and works very closely with their doctor so that their diabetic medications can be adjusted accordingly. Failure to do this could lead to the development of hypoglycaemia (low blood sugar), which can be life threatening.