Alzheimer’s a multi-factorial approach

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Alzheimer’s disease (AD) is the most prevalent form of dementia and it is estimated that 160 million people globally by 2050 will have this disease.

So far the search for a single ‘silver bullet’ pharmaceutical approach to treating AD has not delivered anything other than a temporary slight improvement in symptoms with no long term impact on disease progression. Recent biochemical research however would suggest that AD is both triggered and perpetuated by a complex interaction of different factors and that a multi-factorial approach to treating this devastating condition may provide better outcomes.

Pioneering work is being undertaken in this area by Dr Bredesen, who describes dementia as being primarily a ‘metabolic problem’. In a small but ground breaking study published in Aging in 2014, a 90% success rate in both arresting and reversing early stage AD was reported. Dr Bredesen uses a combination of personalised dietary and lifestyle interactions (includes supporting digestive function, identifying imbalances in the gut, correcting identified nutrient deficiencies, optimising vitamin D levels, eating food over a particular window of time in the day, assessing metal toxicity, optimising sleep, increasing exercise and movement, reducing inflammation, identifying food sensitivities, supporting mitochondrial function and stimulating the brain) with the client to achieve substantial results over a 3 to 12 month period. Larger clinical trials are currently underway in the UK and USA.

These results on the face of it look to good to be true, but in reality simply reflect the obvious which is that chronic disease is rooted in the mismatch between our genetics and the modern world that we have created for us to live in. Your environment (diet, toxic load, stress/trauma, and infections) is fundamental to your long-term health and well-being and should be one of the first areas to seriously evaluate when confronted with any chronic condition. What makes you, you is unique to you and this is the premise behind the ‘functional model’ of health. Working with a functionally trained health practitioner on any chronic condition, along with the required work and commitment that these types of interventions require, can provide significant health benefits.

Non Coeliac Gluten Sensitivity – ‘No Man’s Land’

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Gluten is the main structural protein complex barley, rye and wheat and wheat is the most widely consumed grain in the world. Gluten related disorders (where there is an inappropriate reaction to gluten) is an umbrella terms that includes coeliac disease (CD), wheat allergy (WA) and non-coeliac gluten sensitivity (NCGS).

CD is an autoimmune condition (please see here and here for previous articles) that develops over time and is officially diagnosed using a combination of blood, genetic and small intestine biopsy test results. Most people are unaware that they have CD. Wheat allergy on the other hand is overt, with symptoms developing in minutes to hours and involves a measurable IgE (allergic) response. Both CD and WA are thought to affect approximately 1% of the population.

NCGS (characterised by feeling better on a gluten free diet) on the other hand is neither allergic nor autoimmune in nature, often involving a mixture of both CD and WA symptoms and is currently diagnosed by exclusion, as there are no current agreed laboratory tests. NCGS frequency is still unclear but might be as high as 6% of the population. Typical symptoms of NCGS include: diarrhoea, abdominal pain, weight loss, gas, bone/joint pain, leg numbness, muscle cramps, foggy head, headaches, dermatitis and anaemia. NCGS is not associated with the existence of other autoimmune conditions and the gut lining typically does not express markers of permeability (as with CD). Our precise understanding of how NCGS evolves as a condition is currently lacking.

A clear connection between IBS and NCGS has been detected. It is therefore likely that a subset of those presenting with IBS who have not got WA or CD may in fact have NCGS and would still benefit from a gluten free diet. This group of individuals are at risk of falling into a ‘no man’s land’ between allergists and gastroenterologists with the explanation of their condition sometimes being connected to psychosomatic triggers, rather than gluten itself. So whether it is IBS or any of the other symptoms listed above, surely it is worth eliminating gluten for a while? You might be surprised at how you feel!

Histamine Intolerance – Are You Reacting to ‘Healthy’ foods?

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Occasionally I see clients not reacting as you might expect to a clean healthy nutritional protocol (containing fermented foods, meat/fish, vegetables, fruits and nuts/seeds) and sometimes their original symptoms might even be exacerbated. When this happens I always suspect ‘histamine intolerance’.

Histamine intolerance (too much histamine) can manifest itself as any number of symptoms including but not limited to skin problems, insomnia, light headedness, palpitations, low blood pressure/fainting, muscle pain/cramps, joint pain, tinnitus, depression, unexplained bruising and rosacea.

Histamine is a chemical that is secreted by specialist immune cells as a response to help protect the body against infection. A histamine response is involved in the typical symptoms that are associated with mild allergic reactions (e.g hay fever & hives) and this is why antihistamines are often used to help manage such reactions.

Histamine intolerance occurs when the body has too much histamine. This happens when the supply of histamine exceeds the ability of the body to break it down. The effect of histamine on the body is cumulative – visualise a barrel with holes in the bottom being filled up with water. The water represents histamine and the holes the enzymes that break histamine down. If the amount of water entering the barrel exceeds the amount escaping, then the barrel will eventually overflow (this is the point at which the body has too much histamine).

The irony of histamine intolerance is that the foods that you are often told to consume on a healthy plan are the very foods that contribute the greatest histamine load! These include raspberries, avocados, spinach, meat stocks, citrus fruits and fermented foods (including certain strains of probiotics). The key to balancing histamine (stopping the barrel overflowing) is to both reduce intake and support the optimal degradation of histamine. It turns out that some of us are less able to produce the enzymes required to break down histamine. An imbalanced microflora is also significant contributor to elevated histamine levels. Enzyme and histamine levels can be tested for and then an appropriate strategy implemented to help regain control of key symptoms before revisiting the careful reintroduction of healthy higher histamine foods.

If you are a coeliac, is a gluten free diet enough?

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So if you do have coeliac disease (see post http://entirewellbeing.com/coeliac-disease/ for more information on this condition), do you just simply cut out gluten and everything will be alright?

If only it were that simple……..

Although the majority of newly diagnosed coeliacs will experience substantial improvements in their symptoms within the first few weeks of cutting out gluten, research shows that between 10 and 15% of coeliacs continue to experience health problems even when following a gluten free diet. These are called ‘non-responsive coeliacs’. This might be (and often is) explained by unintentional gluten contamination (it is very easy to get ‘glutened’ – and it only takes one eighth of one teaspoon of a gluten flour to reignite the immune response and ‘contamination’ can also come from hundreds of non food items including shampoos and cosmetics). However, between 1 and 5% of coeliacs develop what is called ‘refractory coeliac disease’ (RCD) where any gluten (even levels found in foods termed ‘gluten free’ e.g. bread) cannot be tolerated. This is a very serious sub category of coeliac disease and can lead to significant health problems if not managed appropriately.

Excluding unintentional contamination and RCD, the other key reason for symptoms not improving on a gluten free diet is ‘cross reactivity’.

Research shows that there are a number of other food proteins that can cause the immune system to react in a similar way to gluten, thereby potentially perpetuating chronic inflammation and the destruction of the villi (the finger like protrusions in the small intestine that are damaged by coeliac disease). We know that around 50% of all coeliacs cross react with casein in dairy. Other cross-reactive gluten free foods include oats, yeast, rice and corn (consumption of these foods are actively encouraged as a coeliac). Maybe this is why only 8% of adults with coeliac disease experience complete healing of the villi on a gluten free diet and why there is evidence of poor vitamin status in coeliacs who have been on a gluten free diet for 10 years?

In summary simply excluding gluten from the diet is not good enough. If you are a coeliac some of the key questions that you should be asking yourself include:
1) Might I be exposing myself to gluten contamination from my environment (e.g. skin care products and cosmetics)?
2) What gluten ‘cross reactive’ foods might I also be reacting too?
3) How much damage has been done to the digestive system (prior to diagnosis) and what extra support do I require to help repair this damage?
4) What impact has coeliac disease potentially had on my overall nutrient status?

These questions and more can be answered by working with a suitably skilled and knowledgeable functional practitioner.

Coeliac Disease?

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Coeliac disease (CD) is an autoimmune condition where the body’s immune system attacks and damages the villi (the finger like small protrusions in the small intestine) affecting 1% of the global population (circa 70 million people). Originally considered a rare childhood condition it is now recognised as primarily an adult disease. The autoimmune destruction of villi is triggered by eating gluten (found in Barley, Rye, Oats and Wheat) and since this process dramatically reduces the surface area of the small intestine, the body’s ability to absorb nutrients is compromised, potentially leading to a raft of disparate symptoms and disease presentations.

Screening studies show that CD is one of the most common life long disorders in North America and Europe and that currently only 1 in 8 coeliacs are diagnosed and that on average it takes 13 years and 5 doctors for a diagnosis. So why is this?

The classical symptoms of diarrhoea and abdominal cramping are just one clinical manifestation of CD, with research showing that less than 50% of coeliacs currently present with these classical symptoms. Non classical or ‘silent coeliac disease’ presentations can include: iron deficiency anaemia, osteoporosis, arthritis, neurological degradation (ataxia and epilepsy), depression, fertility issues, migraines, blood test abnormalities, chronic kidney disease, raised liver enzymes, mouth ulcers, dental enamel defects and a number of other autoimmune conditions including Hashimoto’s, type 1 diabetes, psoriasis, Addison’s disease, cardiomyopathy and autoimmune hepatitis.

Interestingly the research base would suggest that more people with less severe symptoms (mild anaemia and/or reduction in bone density) are being diagnosed with CD and this often includes irritable bowel syndrome (IBS), with up to 30% of coeliacs having had a previous diagnosis of IBS. It should also be noted that the first-degree relatives (parent/sibling/child) of coeliacs have a significantly elevated risk of developing the same condition and should be tested. Please note that the standard blood tests for CD often provide false negative results (due to the body not being able to produce sufficient amounts of the specific antibodies being measured, or reactions that may be present to other immune stimulating peptides of gluten that are not being measured).

So if your are presenting with an autoimmune and/or chronic condition you might want to seriously consider the impact that gluten might be having on your health.

Thyroid Dysfunction – the ‘Great Pretender’

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What might the inability to lose weight, low body temperature (Raynaud’s & cold extremities), lack of energy, depression, chronic constipation, elevated cholesterol, hair loss (eye brow and body hair), sub optimal immune function, varicose veins, skin problems, haemorrhoids, infertility, blood sugar and sex hormone imbalances all have in common? The thyroid…..

The thyroid is a butterfly shaped gland that is located just below the ‘Adam’s apple’ in the neck. Optimal function of this gland is central to well being with its primary role being that of controlling metabolic rate. All cells in the body are influenced by thyroid hormones. This is why thyroid dysfunction has been described as ‘the great pretender’ masquerading as almost any condition that you can imagine.

Low thyroid function is the most common form of dysfunction (10 times more common in women). 90% of low thyroid dysfunction is caused by Hashimoto’s (an autoimmune condition where the body’s immune system attacks the thyroid gland).

The production and balance of thyroid hormones is an intricate process that depends on a multitude of nutritional and environmental factors that need to be in balance. The simplistic version goes like this: The thyroid gland is stimulated to produce its main hormone T4 (thyroxine) by the action of thyroid stimulating hormone (TSH). T4 (the storage hormone) circulates round the body and has to be converted into T3, the ‘active’ hormone. Without T3 the cells would not respond. Here lies the problem. Efficient conversion of T4 to T3 is dependent on the presence of key nutrients and optimal gut health. Nutritional deficiencies (selenium, iodine, iron, copper, magnesium, manganese, zinc, chromium, calcium, vitamins A, B, C, D and E) and the presence of toxic metals (mercury, cadmium, arsenic, aluminium), BPA and certain medications are known to impact thyroid performance. Stress, adrenal health and systemic inflammation also play a significant role. So optimal thyroid health is dependent on a raft of key variables that unsurprisingly include a balanced microflora/ecology in the gut, a low toxic load and a nutrient dense diet.

Dr Broda Barnes (an eminent endocrinologist who dedicated most of his professional career to thyroid dysfunction) noticed that average body temperature is significantly lower if you are presenting with low thyroid function (as metabolic rate (which controls temperature) is controlled by thyroid hormones). He devised a simple test that effectively measures the cellular response to thyroid hormones and not simply levels of thyroid hormones in the blood. The Barnes Basal Temperature test can be done in the comfort of your own home with the only requirement being the ownership of a mercury or modern day analogue thermometer (digital thermometers are not accurate enough). I often suggest this test with clients that I feel maybe presenting with thyroid dysfunction and use the results to support a request for further comprehensive evaluation (not just levels of TSH – but the full array of thyroid hormones and antibodies) via their GPs. If the GP does not oblige, then there are a number of comprehensive thyroid panels that can be run privately.

Unfortunately the modern medical general practice approach to thyroid dysfunction is too simplistic. Research suggests that measurement of TSH levels alone is not always sufficient to diagnose dysfunction (you can have normal TSH levels and still have thyroid dysfunction) and the prescription and monitoring of only T4 (for those taking prescribed medication to help manage low thyroid function) may well work for some, but as I see regularly in my clinic, it often does not work for others.

Thyroid Health – A Functional Perspective – Seminar – 22nd September 2016

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Thyroid dysfunction has been described as ‘the great pretender’ masquerading as almost any condition that you can imagine. Common symptoms associated with thyroid dysfunction include: weight gain, low body temperature, lack of energy, chronic constipation, elevated cholesterol, hair loss, sub optimal immune function, infertility and sex hormone imbalances.

This seminar is being held at Natures Corner in Newbury on Thursday 22nd September 2016 starting at 19:00 (expected end time 20:30). During this seminar we will discuss how the thyroid works, signs and symptoms, the adrenal connection, the role of systemic inflammation, basic tests that you can do at home to evaluate your thyroid function and the impact that diet, lifestyle and supplementation can play in supporting overall thyroid health.

There will be a Questions and Answers session at the end.

Ticket cost £5 (redeemable against any in store purchases).

The Dawn of a New Paradigm?

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‘It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so…..’

I heard this quote by Mark Twain for the first time at a lecture by an eminent doctor a couple of years ago and I feel that it has particular relevance to the recent report by the National Obesity Forum that eating saturated fat could help cut obesity (heart disease) and type 2 diabetes!

Predictably this has caused a huge reaction from the majority of conventional modern medicine, because it flies directly in the face of the core dietary advice that we have been subjected to in the West since the 1950s; basically saying that saturated fat consumption causes weight gain, type 2 diabetes, heart disease and many more chronic conditions. This is positioned as an indisputable fact. So what is going on?

Well you do have to ask yourself the question as to why, even with a reduction in fat intake (due to dietary advice) over the past 60 years, rates of diabetes and obesity continue to escalate rapidly in the Western world? Why is it that the total cost of diabetes alone to the NHS was nearly £24 billion last year (that’s approximately 20% of the total NHS budget) with 1 in 4 adults in the UK presenting with either diabetes, prediabetes and/or obesity? The advice is clearly not working!

The entire dietary advice that we have been subjected to over the past 50 years is based on the premise that fat makes you fat and that fat intake (particularly saturated fat intake) is connected to raised cholesterol levels and that raised cholesterol is correlated with cardio vascular disease. It has therefore been assumed (purely on a statistical basis) that saturated fat intake must directly cause heart disease.

The truth of the matter is that dietary intake of saturated fats does not directly correlate with heart disease in humans. It is absolutely true that raised levels of saturated fats in the blood are connected to an increased risk of heart disease and diabetes. So what is the main driver of raised levels of saturated fat in the blood? The answer is refined carbohydrates in humans. Excessive amounts of sugar in the blood (from the likes of cakes, pastries, biscuits, sweets etc.) literally hammers your liver and gets converted to saturated fatty acids and cholesterol (not too mention excess weight). It should be also noted that a number of the studies used to assess the impact that saturated fat intake has on levels of saturated fats in the blood have been done on rodents and their results have been assumed to be relevant to humans. We are not rodents; our physiology is similar but different and hence leads to a false understanding of cause and effect.

So in summary excessive intake of refined carbohydrates (not fat) in humans is the single largest contributor to elevated levels of saturated fats in the blood, raised cholesterol and heart disease. Diabetes, by the way, is essentially a carbohydrate intolerance and there is substantial scientific evidence to support the beneficial impact that restricting carbohydrates and high glycaemic load foods has on diabetes.

If the current advice to avoid dietary fat were correct then the Eskimos and Masai (the ones that are not contaminated by the Western World) with up to 90% of their calories coming from fat would be overwhelmed with diabetes and cardiovascular disease. This is not the case.

I really do feel that there has to be some sense of proportionality applied here. It is not about consuming butter in your coffee and eating 10 rashers of bacon for breakfast every day. It is about consuming a range of healthy fats (saturated/polyunsaturated/monounsaturated) and not being fat phobic. Low fat diets are potentially dangerous. Saturated fat makes up to 75-80% of the structural fats in the body and are the primary storage form of energy. Fats are required for proper bone health, protecting the liver from the adverse effects of alcohol and medications, supporting the immune system and enabling the efficient absorption of phytonutrients along with vitamins A,D E and K. All rather important stuff.

A healthy diet should focus on quality of the macronutrients rather than quantity or ratio. We are a hugely adaptable species and there are many examples of different tribes all over the world that thrive at both ends of the macronutrient spectrum (from high fat to high carbohydrate) with very low levels of chronic disease. They key point here is that they are eating natural sources of these macronutrients rather than man made/modified versions.

Yes, there are situations that I see in clinic (via genetic testing) where a client has the genetic potential to present with massively elevated levels of cholesterol. In those situations you do need to consider total saturated fat and carbohydrate intake, as these clients have to work very hard to optimally manage their cholesterol levels. These clients are however an exception to the norm, yet remind us that one size does not fit all in terms of dietary advice.

Maybe this report hails the start of a new paradigm, where fat is hopefully not as feared as it has been and can be celebrated for its health benefits as part of a balanced diet consisting of high quality nutrients?

Finally as we started on a quote I thought we should end on one. ‘All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.’ (Arthur Schopenhauer). I have a feeling we have just started the second stage? Time will tell……

Gluten Grains and Mental Health

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There has been a considerable amount of discussion recently about mental health and what more we can do as a society to help those with mental health issues. What never ceases to surprise me is the complete lack of discussion on the impact that what you eat can have on mental health. Depression is one of the most prevalent chronic conditions in the UK.

There are certain scientific facts that I would like you to be aware of. Gluten (found in Barley, Rye, Oats and Wheat) does cause our digestive tracts to ‘leak’. This happens in every human being for a few hours after digesting gluten. That is a fact. If you are someone that already has an imbalance in your gut bacteria (due to caesarian birth, not being breastfed, alcohol abuse, poor food choices, antibiotic use, chronic stress and regular medications) certain toxic by products and semi digested food particles can be ‘leaked’ through into the body. In certain genetically predisposed individuals these toxins and foreign food particles can cause a significant immune system response (potentially causing the body to attack itself, if the protein structure of the semi digested food is similar to that of the body e.g. the brain), as well as putting considerable stress on the already over-stretched detoxification systems. Secondly, some of the breakdown products of gluten during digestion are opioid (morphine) like. Opioids are addictive and if they make it to the brain, are capable of disrupting neurotransmitter balance. Either way there is strong scientific evidence to connect eating gluten with brain chemistry/structural disruption in certain individuals.

Repeated studies show that gluten does cause a significant immune system response in both schizophrenic and autistic individuals compared to the normal population. So, if you or a loved one are not feeling as good as you might like, you might want to try eliminating gluten from your diet. Maybe it is also time for psychologists and psychiatrists to seriously consider the impact that a gluten free diet might have on their clients?

Let’s Talk Skin Event – Understanding Acne

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Optimal nutrition and digestion play a significant role in overall skin health. As part of an event called ‘Let’s Talk Skin Event – Understanding Acne’ being run and hosted by Andresa Skin Health Clinic (www.andresa.co.uk) near Aldermaston in Berkshire at 7:30 pm on April 14th, I will be giving a presentation on the impact that optimal diet and gut health can have on the condition of  your skin.

Andresa Skin Health Clinic are specialists in skin health, using the very latest science and technology from around the world to correct and rebalance the health of the skin. There will be a demonstration of Andresa’s exclusive ClearSkin Acne treatment.

Refreshments will be served, and there will be a prize draw raffle on the night where you can win a relaxing, bespoke facial. The raffle is being held to raise money and awareness for Andresa’s charity of the year, Debra. To register for this free-of-charge event, please contact the clinic on 01635 800183 or use the booking form at www.andresa.co.uk