The Problem With Coeliac Disease

Coeliac disease (CD) is not a minor ‘intolerance’ to gluten, it is an autoimmune condition where the body’s immune system attacks the small intestine, reducing the ability of the body to absorb nutrients from food. If left undetected, CD has the potential to cause significant long-term health complications. CD is one of the most common life long disorders in North America and Europe and only 1 in 8 coeliacs are ever diagnosed. These are disturbing facts.

Diagnosis of CD currently requires a positive blood test and then subsequently the detection of damage to the small intestine via an endoscopy.

The first problem is that less than 50% of coeliacs are presenting with the classical symptoms of diarrhoea and abdominal cramping. The majority of coeliacs are ‘silent’ in their presentation – no overt digestive symptoms but are presenting with signs and symptoms including iron deficiency anaemia, osteoporosis, arthritis, neurological degradation, depression, fertility issues, migraines and chronic kidney disease. This point alone, is likely to be having a significant impact on whether testing for CD is even to be considered.

The next potential issue is with the blood testing itself. The standard NHS test for CD is good if you are presenting with significant damage to the small intestine and your immune system is functioning properly. We know however that damage to the small intestine is a gradual process that can take years or even decades to manifest, the immune system is often underperforming and the markers being measured for are not broad enough. This can lead to very high rates of false negative results (up to 70%), which is a dangerous outcome if the result is that you are told that it is fine to consume gluten, when in fact it is not! Remember you have to be eating gluten and not taking any steroid or immune suppressing medication for any blood test to have half a chance of picking up an issue.

Finally, it is possible to have positive blood markers for CD and no damage to the small intestine – ‘latent’ CD (over and above the fact that the biopsies can often miss the ‘damaged’ areas of the small intestine).

Is it any wonder that CD is such a poorly diagnosed and managed condition?

Small Intestinal Bacterial Overgrowth?

Small Intestinal Bacterial Overgrowth (SIBO)?

The digestive system is about 30ft in length from entrance to exit and consists of the following major sections in order from top down: The mouth, throat, stomach, small intestine (duodenum) and large intestine (colon). As I have mentioned many times previously, the digestive tract is home to a complex community of bacteria (approximately 100 trillion), which should not only in balance for health and well being, but also should have the largest number of bacteria residing in the colon.

Sometimes, the small intestine gets overgrown with bacteria due to conditions such as low stomach acid, pancreatitis, diabetes, diverticulitis and coeliac disease, along with the use of certain medications (including immunosuppressants and proton pump inhibitors). This is called ‘Small Intestinal Bacterial Overgrowth’ or SIBO. These bacterial overgrowths produce either hydrogen and/or methane gas. SIBO can therefore be tested for using a breath test that measures levels of these gases.

The small intestine has the surface area of a tennis court and is crucial to the efficient absorption of nutrients from the diet. SIBO disrupts the ability of the small intestine to efficiently absorb nutrients (the bacteria end up competing for the nutrients that the body is trying to absorb) often resulting in a broad range of micronutrient deficiencies (including iron, calcium, and vitamins B12, A, D, E and K) and symptoms including nausea, bloating, vomiting, diarrhoea, malnutrition, weight loss, joint pain, fatigue, acne, eczema, asthma, depression and rosacea. The malabsorption of nutrients is likely to eventually impact every major system in the body, if left unchecked.

SIBO is typically treated with antibiotics, but reoccurrence rates are high and beneficial bacteria essential for digestive function will also be damaged. Research suggests however that certain herbal and lifestyle interventions are just as effective at treating SIBO.

In clinic, as I have mentioned many times before, it is always a multifactorial approach that delivers the best results. So this typically involves a combination of changing how much and how often you eat, what you are eating, adding in certain strains of probiotics, targeted supplementation, the use of herbs and essential oils and managing stress levels using techniques such as meditation, mindfulness, yoga, tai chi, deep breathing and autogenics.

Chronic Fatigue/Fibromyalgia and Energy Production

I regularly see clients presenting with chronic fatigue syndrome (CFS). This is where the client has fatigue that is so debilitating that they are virtually unable to function or undertake normal every day tasks. Often CFS presents as fibromyalgia, which is chronic fatigue with the added burden of widespread pain and stiffness throughout the body.

It is believed that the pain associated with fibromyalgia is caused when the mitochondria (the energy production plants in our cells) desperate to supply appropriate levels of energy to the body, switch from efficient aerobic (using oxygen) to inefficient anaerobic (not using oxygen) metabolism. This anaerobic form of energy production creates large amounts of lactic acid. Lactic acid, as anyone who pushes themselves hard when exercising knows, causes immediate muscle pain, which dissipates after a few minutes of rest. This pain however does not dissipate with fibromyalgia, as the body is unable to break the lactic acid down, due to mitochondrial dysfunction (not working properly). The excess lactic acid can also cause damage to the muscle tissue, presenting as very sensitive areas on the body. This process can feed on itself as the damage to the muscles releases a large number of free radicals (destructive molecules), which can cause additional damage if antioxidant status (the ability to neutralise free radical damage) is low.

Mitochondrial dysfunction is therefore one of the key areas to focus on when it comes to helping move the body back into balance with CFS and fibromyalgia. So what are the key ingredients required for healthy mitochondria? They require a raft of key nutrients for optimal performance, including but not limited to magnesium, B vitamins, essential fats, CoQ10, carnitine and alpha lipoic acid and must not be bathed in toxins.

Whilst clearly mitochondrial dysfunction is one of the key areas to focus on with these conditions, it should be noted that there are often multiple systemic imbalances going on, including but not limited to digestive dysfunction, poor antioxidant status, immune system dysregulation, chronic inflammation, viral infections, food and/or environmental sensitivities/allergies, thyroid and adrenal dysfunction and micronutrient deficiencies. Everything in the body is connected and nothing exists in isolation.

Once again looking at the body from a functional and holistic perspective is key to any potential solution to these devastating conditions.

Migraines

Migraines are debilitating vascular headaches, which usually happen on one side of the head. Migraines are thought to affect around 1 in 7 people with an estimated 190,000 migraine attacks every day in the UK affecting three times as many women as men and accounting for an estimated 25 million days lost from work and school each year.

The typical sequence of events is that an initial spasm happens in the wall of a meningeal artery (one of the arteries in the head); the spasm does not last long (a few minutes) and is followed by a paralysis of the wall of the artery, which can last for days. This paralysis leads to swelling and inflammation of tissues around the artery wall, causing the pain (migraine).

So what causes the spasm in the first place? Many factors are thought to be involved, but one of the key contributors is an over accumulation of toxins in the body. Liver and gut health are fundamental areas to critically evaluate and support due to the crucial role that these two organs play with respect to optimal detoxification.

If an imbalance in the gut bacteria (dysbiosis) is present (a common thread in my articles) then the ‘bad’ bacteria can cause an overproduction of histamine in the gut. Histamine is secreted by specialist immune cells as part of a local immune response to the presence of unwanted bacteria/triggers. It is the excess levels of histamine that causes blood pressure to drop too low and initiate the spasm that starts the sequence of events.

Unidentified food sensitivities (where the immune system is inappropriately responding to specific food proteins) causing elevated levels of inflammation are also potentially a significant trigger for migraines. Research and clinical experience would suggest that gluten related disorders (encompassing wheat sensitivity, coeliac disease and non coeliac gluten sensitivity – another common thread in these articles) are significantly correlated with migraines. Other factors involved would appear to be magnesium status (low magnesium is a significant and independent predictor of migraine risk) and B vitamin deficiencies.

Alzheimer’s a multi-factoral approach

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-factoral 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.

27th April 2017 Event at Arlington Arts (Newbury) – Sensitivities, Chronic Inflammation and Autoimmunity

Sensitivities, Chronic Inflammation and Autoimmunity
How food and environmental choices can impact your long-term health

Thank you to everyone that attended this event. We had 157 people turn up………..

You can view Part 1 of this seminar here: https://www.youtube.com/watch?v=BFOV00Phs7Y

Research shows that unidentified sensitivities (to both food and the environment) are often implicated in the development of and/or perpetuation of a number of chronic health conditions including but not limited to eczema, joint pain, IBS, indigestion, depression, anxiety, headaches, fatigue, weight gain, congestion and heart palpitations.

This seminar provides you with an easy to understand overview of the following key topics:
1) What is the difference between an allergy, sensitivity and intolerance?
2) What impact might unidentified food and environmental sensitivities behaving on your health?
3) Coeliac disease and non coeliac gluten sensitivity – the differences
4) Why simply cutting gluten out of the diet is not enough if you are a diagnosed coeliac
5) Sensitivities and autoimmunity
6) Items to carefully consider when choosing a sensitivity test
7) Personalised dietary and lifestyle interventions and the road to health

 

 

Thyroid Dysfunction – the ‘Great Pretender’

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

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).

Autoimmunity – Food for Thought…..

Autoimmunity – Food For Thought

Autoimmunity is loss of ‘self tolerance’ caused by the immune system attacking the body’s own tissues. There are over 80 autoimmune diseases. Common conditions that are classified as autoimmune include type 1 diabetes, lupus, rheumatoid arthritis, psoriasis, multiple sclerosis, Crohn’s disease, colitis, Hashimoto’s (accounts for over 90% of low thyroid conditions) and Raynaud’s and their incidence across the World continues to explode. Why is this happening? It is now estimated that over 600 million people globally are presenting with an autoimmune disease and women are 2.7 times more likely to present with such a condition than men.

It is now over ten years since the concept that autoimmunity develops via a complex interaction between our genetic base and our environment was first postulated. The single largest point of interaction between our environment and our genetic base takes place in the gut – the small intestine has the surface area of a tennis court. It is interesting to note that digestive dysfunction is a very common symptom with individuals presenting with autoimmunity.

Our genes are set at conception, however the environment is to a large extent and depending on individual circumstances controllable, as is the health and permeability (leakiness) of the gut. Current thinking is that by modulation of both the environment and intestinal permeability (leakiness of the gut), it might be possible to not only arrest the development of autoimmunity, but also potentially even reverse it.

‘……..once the autoimmune process is activated, it is not self-perpetuating; rather, it can be modulated or even reversed…..’

Professors Fasano and Shea-Donohue – Nature Reviews Gastroenterology and Hepatology 2005

So by modulating the health of our digestive tract (using dietary and lifestyle interventions) in conjunction with removing specific triggers from our environment (removing/reducing – toxins/stress/bacterial and viral infections), we might be able to alter the outcome of these devastating diseases…….now that’s quite a thought.

You think you’re Human?

Science continues to discover extraordinary facts about the microbes (bacteria, viruses and protozoa) that live in our gut (the tube that runs from the mouth to the exit). These microbes weigh in total anywhere between 1 and 2.5 kilos in the average adult, outnumber our human cells by a factor of about 3 to 1 and consist of thousands of different species with 100 times more genetic material than the entire human genome.

In broad terms there are three different classifications of microbe, namely ‘beneficial’, ‘opportunistic’ and ‘transitional’. We now know that optimal health requires a delicate balance to be maintained between these different types (eubiosis). The beneficial microbes should be dominant, keeping the opportunistic and transitional microbes under tight control. 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’ and ‘gut-skin’ axes.

Some of the identified key roles of a balanced micro flora include: balanced mood (the gut is the largest hormone and neurotransmitter producing organ in the body, for example producing over 90% of serotonin (serotonin is also required for properly motility of the gut)), digestion of proteins and carbohydrates (helping us get more nutrients from our food), manufacture of vitamins and essential fatty acids, increase in the number of immune system cells, immune system tolerance, break down of bacterial toxins and detoxification and the conversion of specific plant compounds into anti-tumor and anti-inflammatory factors, as well as assisting with efficient weight management and energy production.

Birth type/time of weaning/length of breastfeeding, chronic antibiotic use, parasitic and/or yeast/fungal infections, food poisoning, poor food choices, recreational drug use, unidentified food sensitivities, lack of nutrient density and diversity, chronic stress, chronic use of medications and NSAIDs (e.g. ibuprofen), oral contraception, regular alcohol intake and a high toxic load are all known contributors to dysbiosis (imbalance of the gut micro flora). Recent research also 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.

So what does this all mean? Look after your microbes and they will look after you. How can I do that? Lifestyle and diet are your key tools.