Parkinson’s Disease and the Gut

Parkinson’s Disease (PD) was first described over 200 years ago and is one of the most common progressive neurodegenerative conditions. Whilst there are many different symptoms, the main ones are tremor (shaking), slowness of movement and rigidity/muscle stiffness. Symptoms are caused by the brain losing its ability to produce enough dopamine, which is key to co-ordinating movement.

The evidence base suggests that there are a number of potential factors involved in the development of PD including increased exposure to pesticides/herbicides and toxic metals, elevated levels of iron, digestive system imbalances (constipation is now considered to be a key symptom – often present up to 10 years before diagnosis), Small Intestinal Bacterial Overgrowth (SIBO), Helicobacter pylori infections, increased ‘leakiness’ of the gut lining, nutrient deficiencies and associated mitochondrial dysfunction, gluten related disorders and autoimmunity. One key area of research involves the observed accumulation in the brain of a misfolded protein called alpha-synuclein, which has been shown to accumulate in the gut’s own nervous system years before the diagnosis of PD.

Currently there is no cure for PD, with treatments relying on a combination of medications (which aim to increase dopamine levels – often with significant side effects), exercise and complementary therapies.

The evidence base now strongly suggests that gut health is a key factor in the development of PD. The gut/brain axis is irrefutable with the central nervous system being directly affected by the balance of bacterial species in the gut itself. Multiple studies have shown there to be significant alterations in the bacterial species (dysbiosis) of individuals with PD compared to healthy controls and it has been shown that the use of specific strains of probiotics can provide a marked reduction in key symptoms of PD when compared to placebo.

So the chain of events leading to PD might look something like this: dysbiosis (caused by poor diet/lifestyle/toxic load/stress/parasites) causes an increase in ‘leakiness’ of the gut and the expression and accumulation of misfolded alpha-synuclein, which is then transported from the gut to the brain directly via the vagus nerve. Chronic inflammation and ‘leakiness’ of the gut lining promote body wide inflammation, which in combination with the accumulation of misfolded alpha-synuclein in the brain causes damage to the dopamine producing cells of the brain and hence PD – (NPJ Parkinson’s Disease (2017)).

Maybe the gut holds the keys in respect of unlocking effective preventative and therapeutic interventions for this devastating condition?

COVID-19, Vitamin D and Saving Lives

Vitamin D is called the ‘sunshine vitamin’ as it is produced in large quantities by the action of sunlight on the skin. The science clearly shows that ‘optimal’ levels of vitamin D (circa 150 nmol/L – UK units) are associated with a significant reduction in the risk of developing a number of chronic diseases (other than osteoporosis) including, but not limited to cancer, diabetes, Alzheimer’s, depression, high blood pressure, autoimmunity, asthma, eczema, multiple sclerosis, cardiovascular disease and respiratory diseases.

There has been a flurry of research/reviews appearing in the literature over the past 6 months discussing/analyzing/questioning the potential role that optimising vitamin D levels might have on reducing the severity of COVID-19. One particular recent preliminary study titled ‘Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study – (Prabowo Raharusuna et al, April 26, 2020)   analysed the outcomes of 780 hospitalised COVID-19 patients and concluded that ‘when compared to cases with normal vitamin D status, death was approximately 10.12 times more likely for vitamin D deficient cases’.

The chart below (taken from the above study) clearly shows that when vitamin D levels are above 32 ng/ml (US measurement) which equates to 80 nmol/L in UK numbers, the risk of death is reduced 10 fold. This very strongly suggests that one of the most effective strategies that you can do, to stay as well as possible, should you ever get COVID-19 is to have optimal levels of vitamin D, which is circa 150 nmol/L.

This is an extraordinary observation that has enormous potential therapeutic and prophylactic implications, especially as supplementing with vitamin D is cheap and easy to do. Another recent review paper titled ‘Point of view: Should COVID-19 patients be supplemented with vitamin D?’ (C Annweiler et al – Maturitas, 2020), analyses the available evidence base according to the ‘Hills Criteria of Causation’ (used to assess evidence of a ‘causal relationship’) and concludes that ‘vitamin D may be considered a biological determinant of COVID-19 outcomes’. This paper then goes on to say that ‘given the lack of specific treatment for COVID-19, the urgency of the pandemic, and the safety of vitamin D supplementation, these observations provide an argument for testing vitamin D as an adjuvant treatment to improve the clinical presentation of COVID-19 and its prognosis’.

A number of randomised controlled trials are now thankfully underway. In the meantime, given the significant evidence base linking ‘optimal’ levels of vitamin D to improved COVID-19 outcomes, why would one not measure current levels (can be done at home using a finger prick test – https://www.revital.co.uk/revital-nhs-vitamin-d-test-kit-kit and  https://medichecks.com/products/vitamin-d-25-oh-blood-test are good options)    supplement accordingly (a safe dosage to take per day to improve levels would be 5,000 IU) to achieve/maintain optimal levels, especially as there is a great deal of concern about a second wave of COVD-19 in the coming winter? Whilst clearly this will not prevent COVID-19 being contracted, the current data does strongly suggest that it will reduce the risk of potentially fatal complications – thereby protecting the NHS and saving lives.

Please do not simply supplement with vitamin D without testing levels, as it is a fat-soluble vitamin, and can therefore become toxic at high levels. It is also important that you monitor progress (retest every few months) if supplementing with vitamin D, so that the dosage can be adjusted accordingly to achieve/maintain optimal levels. You cannot guess your levels – you have to test. Vitamin D supplementation should always be discussed further with your doctor if you have parathyroid issues, elevated calcium levels, kidney disease or sarcoidosis.

Another key point to consider is that it is generally accepted that Black Asian and Minority Ethnic (BAME) groups living in the West have significantly lower levels of vitamin D compared to their white counterparts. This is due to the fact that the sun is not strong enough to generate sufficient levels of vitamin D due to the sunlight protective effect of increased melanin pigment in the skin. Maybe, just maybe this is one of the most significant reasons as to why a disproportionate number of this group are dying of COVID-19?

It should also be noted that as a nation the UK has one of the highest levels of vitamin D deficiency in Europe, with average levels at 47.4 nmol/L and that it is perfectly possible that this fact is contributing to the high COVID-19 death rate (105 per million) that we are experiencing compared to other countries (on the other end of the scale Slovakia has an average vitamin D level of 81.5 nmol/L and a death rate of 0.4 per million) – ‘The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality’ – Petre Cristian Ilie et al – Aging Clinical and Experimental Research.

So in summary, the evidence base would very strongly suggest that one of the simplest things that you can do to reduce the risk of developing serious complications if you contract COVID-19, is to optimise your vitamin D levels – aiming for circa 150 nmol/L, by testing, supplementing and monitoring your progress.

 

‘All disease begins in the gut’ – (Hippocrates 460-370 BC)

Hippocrates the father of modern medicine famously stated 2,400 years ago that ‘all disease begins in the gut’. The gut is the 25 feet of tubing that runs from the mouth to the anus and contains on average 100 trillion bacteria (the microflora/microbiome) weighing approximately 2 kg and over 3 million genes. The explosion in scientific research over the past 10 to 15 years into the fundamental role that optimal gut health plays in respect of our overall health and well being, is starting to enable us to understand just how true these wise words are, yet to date modern medicine has yet to embrace this paradigm.

Clinically, no matter what chronic disease the client is presenting with, we always start with supporting gut health. Optimal gut health is the foundation upon which your house of health is built. Optimal health requires optimal gut health.

Any form of diarrhoea/constipation, excess mucous, light/excessively dark coloured and/or foul smelling output are all clear signs of gut imbalances being present. You do not however have to be presenting with any overt signs of dysfunction to still have gut imbalances. This is an oversimplification, but gut health is dependent on three key areas of the system working as well as possible: digestive capacity (includes stomach acid strength, bile flow and digestive enzyme status), the balance of the individual bacterial/yeast/fungi/parasite and viral inhabitants and the ‘leakiness’ of the gut lining (the gut lining regulates what is let in and kept out). All of these areas are intricately interconnected. If there are imbalances/issues with any of these key areas, then it is almost inevitable that your health will be negatively impacted in some way. The evidence base continues to uncover real connections between overall gut health and an ever increasing number of chronic conditions that are becoming a significant issue for society, including but not limited to anxiety, depression, IBS, inflammatory bowel disease, arthritis, Parkinson’s/MS/ALS/neurodegenerative conditions, dementia, cancer, cardio vascular disease, diabetes and metabolic dysfunction.

Thanks to modern testing, we can now comprehensively measure how well each of these key areas of gut health are performing and then subsequently create personalised interventions to help support/correct any identified imbalances, often with impressive results. Why then, after 2,400 years, is this approach not yet a cornerstone of modern medicine and chronic disease management?

Coeliac Disease – new diagnoses increasing at over 7% per year

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/gut). Originally considered a rare childhood condition it is now recognised as primarily an adult disease. CD is essentially a disease of malabsorption. If the cells are not getting the micronutrients from the food that we eat, then logically a number of significant health problems can eventually manifest anywhere in the body.

A recent meta analysis in The American Journal of Gastroenterology concludes that – ‘the incidence of coeliac disease is significantly rising (7.5% every year for the past few decades)’.

Incidence is the number of new cases expressed as proportion of the population being studied and provides a better understanding of what is really going on, compared to measuring prevalence, which is a measure of existing cases in a particular population.

So what is going on? A number of factors are certainly at play here including, access to improved blood tests since the 1990s; the change in guidelines in respect of being able to diagnose CD in certain children without the requirement of a biopsy and the increased awareness amongst clinicians/doctors that the classical symptoms of abdominal pain and diarrhoea occur in less than 50% of coeliacs. Other common symptoms including migraines, skin problems, depression, fertility issues, chronic fatigue, joint pain, liver and cardio vascular disease, osteoporosis, other autoimmune conditions (especially type 1 diabetes and autoimmune thyroiditis) and neurological problems. This is of course all welcome progress, but is not the full picture.

Environmental factors are also more than likely playing a significant role here. These factors include, the hybridisation of wheat to create dwarf wheat – which has a significantly higher gluten content compared to ancient varieties, the timing and amount of gluten introduced into the diet of infants, the amount of antibiotic exposure within the first year of life and the presence of childhood infections. Add into the equation the explosion in the use of glyphosate/Roundup since the early 1990s due to the practice of ‘crop desiccation’, where glyphosate (a patented antibiotic) is sprayed on wheat (and other staples) just before harvest to improve yields and one can start to understand why we are seeing the continued rise in one of the most common lifelong disorders in North America and Europe.

COVID-19 – beyond washing hands and social distancing…

Thoroughly washing hands and social distancing are clearly good advice, but these actions are just the start of what we can all do to make a difference. We all have an obligation to look after ourselves and our loved ones, to not only reduce the chances of contracting the virus but also the severity of the disease, should we get it, so that those of us that require critical care can access it.

So what else can we do? This is not about ‘boosting’ immune function by the way; it is about immune system ‘modulation’. The immune system’s purpose is not to overreact to the world, but instead to tolerate it (foods, pollen, dust, animal hair etc) only reacting when required, at an appropriate level, to pathogens – viruses/bacteria.

From clinical experience, clients that regularly catch infections – coughs/colds/flu/viruses, become more immunologically robust by working on their health from a multifactorial perspective. They achieve this by:
• Eating organic (if possible), nutrient dense, unprocessed, natural whole foods – grass fed meats/ wild fish/vegetables/nuts/seeds/fruit and water, cutting out all added sugars/trans fats/alcohol/processed foods/gluten grains and dairy. Each and every one of our 36 trillion cells require optimal amounts of over 250 different micronutrients in order to function properly. We get these micronutrients from our food, so you not only have to consume these nutrients, you also need to be able to absorb them. Gut health is key here. Use a food state multi vitamin and mineral supplement.
• Optimising vitamin D levels (check levels via finger prick testing – aim for 150 nmol/L) and take a few grams of vitamin C per day – not appropriate with certain medical conditions and always check for any adverse interactions with prescribed medications. Now that spring has sprung, aim for regular sensible sun exposure if at all possible.
• Focusing on getting good sleep – this is when we repair.
• Regularly exercising – at a level that is appropriate to you.
• Breathing properly – an excellent way to not only oxygenate the body but also to manage stress.
• Reducing exposure to Electromagnetic Fields (EMFs) – the science is becoming clear, EMF exposure damages cellular biochemistry and therefore health. Recommendations include switching off your WIFI at night, swap out any DECT/mobile landline phones for corded phones, make your bedroom a technology free zone, reduce mobile phone use and do not carry/place a mobile close to your body/head.
• Managing stress levels – stress increases the body’s production of corticosteroids, which are medically prescribed to suppress the immune system! Reduce exposure to the media and consider meditation/mindfulness and breath work.

Stay safe and well….

 

Osteoarthritis is not a ‘wear and tear disease’

Osteoarthritis (OA) is an ‘age related low-grade inflammatory disease of the joints’ which causes the protective cartilage cushion between the bones to wear down, allowing the bones to rub together, creating a great deal of pain and discomfort. In the UK, OA affects 8.75 million people contributing to a significant burden on our health and social care systems. Modern medical treatments involve the use of paracetamol, non-steroidal anti-inflammatory drugs (e.g. ibuprofen), opioids, steroid injections, joint replacement/fusing and osteotomies. The use of drugs will provide pain relief, masking the symptoms but will not get to the root cause of the problem. Taken for long periods of time, these drugs can cause significant long-term health issues in themselves.

OA is often described as a ‘wear and tear disease’ that is caused by getting older. There is now very compelling evidence to suggest otherwise. Obesity is the strongest risk factor for OA onset in the knees, but the fact that being overweight/obese also increases the risk of developing OA in non-weight bearing joints, such as the hands/wrists, suggests that physical weight/wear and tear of the joints are not the only factors at play. In 2017 researchers at the University of Surrey identified a significant link between the body’s metabolism (the chemical processes that occur within us to maintain life) and OA – The role of metabolism in the pathogenesis of osteoarthritis – Nature Reviews Rheumatology, 2017.

In this review a comprehensive explanation is made on how poor dietary choices and lack of exercise can trigger the reprogramming of cells in the joints (and indeed the rest of the body) from a balanced resting state to one that is highly active, creating a number of cellular by-products that both inhibit the repair of/and destroy tissue, as well as fuelling inflammation. We know that regular moderate exercise confers significant benefits to overall joint health, as it strengthens muscles, prevents further cartilage breakdown and builds bone.

Lead author, Professor Ali Mobasheri summarises: ‘It is important never to underestimate the significance of a healthy diet and lifestyle as not only does it impact upon our general wellbeing but can alter the metabolic behaviour of our cells, tissues and organs leading to serious illnesses’. The big question of course is what exactly does that ‘healthy diet’ look like for the individual, as healthful foods for one can literally be a slow poison for another.

 

Depression – one size does not fit all

In a previous post (available here), we explored the gut-brain axis and the significant and sustainable improvements that are often achieved in respect of anxiety and depression, by simply removing from the diet the foods that typically cause the greatest harm, focusing on the consumption of nutrient dense wholefoods, implementing targeted lifestyle choices and even consuming therapeutic dosages of turmeric.

There are however times when this approach on its own does not deliver the desired outcomes, suggesting the presence of a more complicated picture.

Dr William Walsh has spent the past 30 years collecting data across tens of thousands of patients presenting with a range of mental disorders (including ADHD, autism, depression, schizophrenia and Alzheimer’s disease) and has created a comprehensive database of nutrient imbalances that can fuel these conditions. Dr Walsh’s work is based on the premise that we are all biochemically individual and that nutrient imbalances and/or the presence of toxins that can cause significant disruption in brain biochemistry. Interestingly Dr Walsh in his book ‘Nutrient Power – Heal Your Biochemistry and Heal Your Brain’ describes a surprising finding that ‘nutrient overloads usually cause more mischief than deficiencies’. Dr Walsh goes onto to describe 5 ‘depression biotypes’, which have very specific symptoms and traits: These are:

  • ‘Undermethylation’ – very sensitive to the methyl/folate levels in the brain and must avoid folate/folic acid, choline, manganese and copper supplementation. Usually respond well to antidepressant medications and improve with magnesium, vitamin D, B6, tryptophan, A, C and E.
  • ‘Folate deficiency’ – typically intolerant to antidepressants. Must avoid tryptophan, copper and inositol. Respond well to folate, B12, B3, choline, manganese, zinc, B6, C and E.
  • ‘Copper overload’ – 96% female – mixed reaction to antidepressants. Must avoid copper. Improve with zinc, manganese, glutathione, B6, C and E.
  • ‘Pyrrole disorder’ – significant zinc and B6 deficiencies which are often genetically driven (family history of depression). Require high doses of zinc and B6.
  • ‘Toxics’ – typically caused by excess levels of lead, mercury, arsenic and cadmium. This type is difficult to diagnose – typically diagnosed by exclusion of the other types.

Clearly treating depression with a ‘one size fits all’ SSRI (selective serotonin reuptake inhibitor) drugs and/or random supplementation is too simplistic and may in certain situations actually do harm. Tailored nutritional therapy interventions, under the guidance of a suitably qualified healthcare practitioner, can be an extremely powerful tool when it comes to implementing a comprehensive strategy to help optimally manage depression.

 

Wishing You a Very Happy and Healthy New Year…

As a new year dawns, I thought that it would be appropriate to write a few words about ‘health’. So what is ‘health’? ‘Health’ is defined by the World Health Organisation as being ‘a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity’. The key point here is that ‘health’ is about so much more than just the absence of disease and embraces all aspects of our interactions with each other and the World around us. Given this definition, just how many of us, might actually be classified as being truly ‘healthy’?

As a species we are currently sinking under a tidal wave of chronic disease – these are long-term health conditions that require on-going management and their prevalence is growing at an alarming rate. These include cancer, dementia, diabetes, kidney disease, high blood pressure, asthma and depression. Our NHS is literally being overwhelmed by complex chronic conditions. To put this into perspective NHS statistics reveal that approximately 45% of the English population have at least one chronic condition, with 16% having one or more. What is extremely concerning is that 15% of young adults (11-15) in England now have a chronic condition and 70% of the health care budget is being spent on chronic disease management.

The current approach is clearly broken. We cannot afford to just keep pumping extra billions of pounds into a system that with all the best will in the world is simply ‘managing disease’ using a ‘top down’ approach to treat symptoms with prescribed medications. We need instead to focus on the creation and promotion of ‘health’, so that the body is effectively unable to harbour disease.

We are over medicalised and need to take a step back from the current accepted paradigm and instead practice a number of simple yet powerful choices that most of us can make of consuming more nutrient dense foods, reducing toxin exposure, practicing mindfulness, less reliance on social/digital media with more real world interactions and regularly getting out in nature and moving. Of course there are times when it is appropriate to use medications to help manage certain acute and complex chronic conditions. The objective however should always be wherever possible to minimise medication load and duration. Remember that poor health is not due to a lack of medications. Wishing you a very happy and healthy 2020.

 

 

Polycystic Ovary Syndrome (PCOS) – under-diagnosed and misunderstood

Polycystic Ovary Syndrome (PCOS) is a hormonally driven condition, caused by elevated levels of testosterone in women of childbearing age, which can lead to a combination of ovarian cysts, irregular periods and reduced fertility/infertility.

Other common symptoms often include excessive hair growth on the face/chest and back, weight gain, oily/poor skin health, headaches, depression and hair loss/thinning on the scalp. Often symptoms are not obvious making diagnosis tricky, with data suggesting that up to 70% of women with PCOS are not diagnosed. It is estimated that PCOS currently affects 1 in 5 women in the UK. This makes PCOS one of the most common endocrine disorders, which the data suggests is also associated with a significantly elevated risk of developing diabetes, cardiovascular disease and endometrial cancer.

PCOS is a significantly under-diagnosed and misunderstood syndrome, which can literally ruin women’s health.

Depending on the key symptoms, there are a variety of medications and medical procedures used by allopathic medicine to try and help treat PCOS. These include contraceptive pills, hormonal medications/creams, intrauterine devices, IVF, diabetic medications and surgery.

From a functional (causational) perspective, hormonal dysregulation typically involves the presence of some or all of the following key imbalances: poor blood sugar management (which can cause an increase in an enzyme that increases levels of both testosterone and oestrogen), adrenal dysfunction (chronic stress can cause sex hormone imbalances through ‘cortisol steal’), gut dysfunction (absorption issues due to micro flora imbalances and heightened inflammation which can lead to hormone resistance), poor detoxification (toxic load and efficiency of the key detoxification pathways are extremely important) and nutrient deficiencies (cells require optimal nutrient status in order to function properly). Each of these imbalances cannot exist in isolation and they all cross relate with each other via a complex web of interdependencies – this is of course entirely logical, as nothing exists in the body in isolation. Whilst genetic predisposition is now also believed to play a role, thankfully these traits can be successfully managed via environmental changes (epigenetics).

Both clinical experience and research suggest that when PCOS is diagnosed in a woman of optimal weight/BMI, who is not presenting with prediabetes/diabetes, then careful attention should be given to the thyroid. Even mild hypothyroidism (low thyroid function) can cause ovarian insufficiency and therefore impact fertility. https://www.hindawi.com/journals/bmri/2016/2067087/

Clinically, employing a multifactorial personalised dietary, lifestyle and functional rebalancing approach, often delivers significant results.

Type 1 Diabetes – You May Have More Control Than You Have Been Led To Believe

Type 1 diabetes (T1D) is an autoimmune disease. The body’s immune system destroys the beta cells in the pancreas that are responsible for producing insulin. Insufficient insulin production hinders the ability of tissues to absorb glucose (sugar) supplied by food and drink leading to dangerously high levels of glucose in the blood. Left untreated, high blood glucose can lead to extremely serious health complications. T1D occurrence is currently growing at 3% per annum. The risk of developing T1D is 10 times greater than the general population in children with a parent that has the condition. Coeliac disease and T1D share common genetic predispositions, meaning that these conditions often co-exist.

As T1D is an autoimmune disease, it is unsurprising to find that the literature implicates a number of potential triggers and exacerbators of this condition, including genetics, the timing of introduction of both cow’s milk and gluten into the diet, maternal diet (gluten content and vitamin D status), infections (viruses are a known trigger of autoimmunity), stress, toxic load, the balance of the gut micro flora, digestive system health and the integrity of the gut barrier.

It is nearly 15 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 half a badminton court.

Our genes are set at conception, however our environment (composed of dietary choices plus viral/bacterial/toxin and stress load) is to a large extent controllable, as is the health and permeability (leakiness) of the gut. Both current thinking and clinical experience show that by modulation of both the environment and intestinal permeability (leakiness of the gut), it is often 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: https://tinyurl.com/yyz3vom2

The destruction of the pancreatic cells is a gradual process (even though symptoms may appear suddenly). There is therefore a window of opportunity to comprehensively evaluate environmental triggers and digestive system imbalances that may be both triggering and exacerbating this significant condition. ‘It’s what you know for sure that just ain’t so’…