While we’re on the topic…I tend to think, that as good as we are at asking a lot about a patient’s health, we can always do better. One of the classic pitfalls for practitioners is having to rely so much on patient self-reporting: Is your period heavy,moderate or light?; How would you rate your appetite?; Do you suffer from excess flatulence? When our patients answer these questions, who are they able to compare their own experiences with? Or do they only compare them with themselves at another time in their life, e.g. my periods are heavier/lighter than they were before? Either way, this may lead to unintentionally misleading information from our patients, producing erroneous conclusions for us as clinicians. Do you suffer from excess flatulence? Well do they?? How exactly would most of us know?! Unless we can define what ‘normal’ looks like…?
(But as many as 22 times a day – that’s almost one on the hour)
That’s the average number of ‘pop offs’, ‘air biscuits’, ‘bench-warmers’, ‘fluffs’, or whatever you want to call them, healthy humans do per day as cited in this great evidence based & entertaining article. Funnily enough I had exactly the same lecturing experience as the author: performing a snap poll on my students, asking for averages…and can I just say almost everyone was clearly under-reporting!! But the point is clear. How can our patients accurately rate the magnitude, severity or normality V abnormality of their bowels, menses, appetite, pain threshold etc – unless we provide some goalposts? And are we, in fact being lead to believe there is a problem when perhaps there isn’t? That certainly has been the conclusion of several studies into the matter of self-reported excessive flatulence. Hippocrates himself put in a good word for bottom trumpeting, saying “passing gas is necessary to well-being” and as a recent article in the Harvard Health Letter reads, “A little bit of extra flatulence, could be an indication that you’re eating the way you should!” Here here!
But my favourite quote from this article has to be about the high tech solutions on offer – for those who do accurately fall into the excessive category:
“Such as carbon fiber odor-eating underwear (cost: $65), which were put to the test in an American Journal of Gastroenterology study that included such gems as “Utilising gas-tight Mylar pantaloons, the ability of a charcoal lined cushion to adsorb sulphur-containing gases instilled at the anus of eight subjects was assessed.” Assessed, that is, by a panel of fart-sniffing judges. And the name of the charcoal lined cushion? The “Toot Trapper.”
How different that scene in Bridge Jones’ Diary would have been had these been her undergarment of choice instead of the control briefs!
Of course, if there is associated pain or an odour (which the article discusses as well) that makes the family dog leave the room…well, that’s another matter…;)
A Gut full of Glutamine?!
Is Glutamine your go-to prescription for patients with gut problems? Do you look for good levels of it when you’re choosing your gut repair formulas? Most of us do this because we’ve heard that a deficiency negatively impacts the gut tight junctions , villi structure and immunity etc. but how long has it been since you’ve reviewed the latest human studies on the digestive effects of Glutamine supplementation? The time is now. This previous UU30 installment cuts to the chase on the big research findings that warrant our urgent attention and necessitate big adjustments in how we use glutamine for guts.
I have a good friend…who happens to be a naturopath…who happens to also be a patient of mine. Have you got a few of these as well? A month ago, looking over her recent bloods which included fasting lipids that had been steadily climbing for the last couple of years, post-menopause, she said, ‘do you think I should take something for that?’ Ahhhhhh no. My reasoning went like this:
“You love saturated fat right? You eat butter and cheese and and and…and the type of elevated lipid pattern you have LOOKS like it is at least partially the result of this, your triglycerides are low, your HDLs are good it’s just this LDL component that is too high. You could add in another supplement…and take it…forever…or you could do a little n=1 experiment and just lower your butter, cheese & coconut oil intake for a month and repeat the test.”
The horror on her face! You see I didn’t know exactly how much she loved butter but it all became clear with the first text a few hours after I had thrown down the gauntlet…which included a sobbing emoji and the comment that her afternoon snack will never be the same…turns out it was a shortbread biscuit with butter on it!!! But as a practitioner who does pride herself on walking the talk…off she went determined to give it a good go for a month. But boy did it hurt! (more…)
No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health. Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach.
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.
Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation! Seriously. No, this is not one of my work stress dreams. This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!
Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about! (more…)
Another young female presents in my clinic with a newly diagnosed thyroid cancer and has been recommended urgent thyroidectomy. Her story is increasingly common. If you’re not seeing it in your clinic, you will, because thyroid cancer, and almost exclusively papillary thyroid carcinoma (the form my patient and most young patients have), is dramatically increasing. Since the 1970s there has been a 67% increase in the incidence in women and a 48% increase in men documented in 5 continents (Peterson et al 2012). Australia, though less up to date with its data collection, found a similar increase between 1982-1997 (Burgess 2002). The question begging to be answered is why.
Increased screening and more effective detection of smaller tumours was the going theory for years. New research rejects this absolutely and concludes instead this is a ‘true increase in occurrence’. Increased radiation exposure? Mutation studies say no. Many researchers are pointing to is a ‘new environmental chemical and/or dietary factor’ and EDCs (Endocrine Disrupting Chemicals) that target the thyroid such as perchlorates, phthalates, parabens and phenols are the likely suspects. And, more than likely, with iodine deficiency to explain the increased susceptibility to these EDCs.
But wait there’s more. These ‘new goitrogens’ aren’t only implicated in thyroid cancer, a large number of human studies confirm the higher your urinary metabolites of these, the lower your thyroid function. More worryingly is that they might be doing this ‘without a trace’. With myriad impacts at the receptor level, altered hormone excretion rates, impaired peripheral conversion etc. the data to date suggest these patients TFT results might only look ‘slightly low’ or even ‘normal’ but the reality is they are suffering hypothyroidism. Sound familiar?
There is a HUGE body of scientific evidence we can pull from to understand the role of EDCs in thyroid problems in our patients, how to maximise prevention and minimise impact – even when your patient, like mine, is perhaps already in the full grip of the consequences. I’ve read all the papers and summarised them in this 30min recording: Hypothyroid without a trace – the role of EDCs.
Have you got patients with hypothyroid symptoms but normal results? Or results that suggest the HPT axis just seems to be broken? Could it be the result of a combination of Endocrine Disrupting Chemicals (EDCs)? How do you assess for these ‘new goitrogens’, which act more potently and more insidiously, inducing hypothyroidism ‘without a trace’. How do you maximise prevention for all of your clients and the most at risk sub-populations or minimise impact for those already in the full grip of their consequences.
This latest Update in Under 30 audio comes with 3 key related scientific articles and a bonus larger powerpoint presentation that Rachel presented at the ASLM 2017 conference.
In an ASLM Tweet I shared this weekend, I mentioned our own ‘Gut Guru’, Jason Hawrelak reported dietary saturated fat (including coconut oil) increases GIT endotoxin uptake and boy did that stir the pot! The social media switchboard lit up! It’s ok I know there isn’t a switchboard anymore…but I am old school 😉 This got just about everybody talking on Twitter & Facebook…and thinking out there in the real world…which is good, right? And if you read to the end you will find prizes galore for those of you that want to add to this discussion 🙂 (more…)
This week I must have spent more than my daily time allocation (5mins) on Facebook and as a result I stumbled across an article I actually read from beginning to finish! The title called to me, “Bad Parent, Hey Bad Parent”…it works every time right? Anyway, once I started reading it I thought, no this is useful, we all need that manual that everybody talks about but nobody seems to own and I know this relates to not only the way I am bringing up my teens but I can pass on its pearls to my patients who are parents of teens as well.
My kids have been teens mathematically speaking for 3.5 years now, but I’m pretty certain, the metamorphosis happened just last Tuesday for one and a couple of months prior for the other. (more…)
Howdy practitioners – I’ve had an inspiring month of clients. Not because I cured anyone, answered some major riddle previously unsolved by modern medicine or any of these enormous tasks we or our patients often set ourselves but rather because I got back to basics. Many of you will know that I spend most of my practice time working at the pointy end of complex chronic multi-system disease and while it is deeply satisfying when you have a breakthrough with someone’s health, it is challenging. Often I am the last bastion, my clients have been referred to me and therefore typically have already addressed their diet and other health behaviours to a certain extent. So unlike perhaps many naturopaths, I don’t spend most of my time in practice talking about food and doing the grassroots education that is at the core of naturopathic medicine (in my humble opinion) 😉
This month was different. I had a bunch of clients who, while they did have pointy end (that’s a technical term!) multi-system disease, e.g. one client alone had retinal detachment, coronary stents, a genetic bone disease, NAFLD and a liver abscess, they clearly hadn’t been educated about food in the way that we do so well and which can make such a huge impact on a person’s life and health.
When was the last time you drank or ate something that contained an artificial sweetener (AS)? I remember it well and my most striking recollection was the way it ‘hit the spot’ just like I would have expected sugar to, making me immediately suspicious of the effects it would have on my body. It seemed implausible that it could mimic the taste/the sensation/the mood effects of a major sugar hit but not evoke any of the physiological responses of sugar…whether that be in my brain, my pancreas, my whatever! We’ve been sold the concept that AS offer the western world an exit point from our collective march towards metabolic syndrome for decades but sweet relief (pardon the pun ;)), new scientific studies are piecing together the real impact of AS consumption.
“‘We found that artificial sweeteners may drive…an exaggerated elevation in blood glucose levels, the very same condition that we often aim to prevent by consuming them,’ Eran Elinav, MD, PhD, from the Department of Immunology at the Weizmann Institute of Science, Rehovot, Israel, said at a press briefing.” Medscape (more…)
In the Byron shire we have a fabulous local comedian called Mandy Nolan who makes a lot of fun of the health and food fads that regularly sweep this area and one of her favourite catch-cries is “I’m gluten intolerant-intolerant, if I meet another person who tells me they’re gluten intolerant I’m going to scream!” Although I take genuine gluten reactions very seriously I do get where she’s coming from and it stems primarily from pervasive misunderstandings & misuse of terms in the community. The problems with this are multiple: firstly those people who are walking around with an exaggerated sense of their problem will unnecessarily limit their diet (and perhaps the diets of their loved ones) at significant financial, nutritional & even psychological cost and then we have people who have the most extreme gluten reactions not receiving the serious attention that they absolutely need in all sorts of settings like restaurants, childcare centres and schools…because seemingly everyone has some sort of ‘gluten issue’ & therefore it has become dangerously ‘normalised’.
So let’s just recap the possibilities and try to clear the confusion. When people walk through our door and tell us they ‘can’t eat bread’ or ‘pasta makes them bloat’ or ‘I don’t think wheat agrees with me’, that’s where our work just begins in terms of needing to clarify what the nature of their reaction is. Putting them immediately on a gluten free diet is a mistake because it doesn’t tell us which one of the below issues is at play and therefore fails to give us clear guidance about what is an appropriate course of treatment & dietary intervention.
- Coeliac disease – while there are a multitude of testing options for CD the first place to start is the genotype. If you don’t have the gene it is extremely unlikely that you have CD. If you have the gene then there’s about a 1/3 chance you might & specific tailored antibody testing or jejunal investigations are necessary.
- A genuine wheat allergy (not CD) is rare but is more common in infants & toddlers. It can be diagnosed by blood antibody tests (IgE RAST) or skin prick testing (SPT) for wheat
- Non-coeliac disease gluten sensitivity – may not involve the immune system at all, however, raised anti-gliadin antibodies are frequently seen in these patients
- FODMAPS – is not an allergy but a type of intolerance due to impaired digestion of the fructans found in wheat. We must rule this out as a possible explanation for someone’s reaction and I would start with a good checklist of other FODMAP foods to check tolerance e.g. soy, dairy, increased fruit intake and check for other conditions that can lead to this via disruption or destruction of the small intestinal brush border
- Carbohydrate digestion issues other than (or in addition to) FODMAPs i.e. underfunctioning of the pancreas
- Red herring! And don’t forget this old pearl… it could of course be a total red herring. Perhaps the reaction is due to another component in bread (yeasts, preservatives etc.), or the other foods they always eat with the pasta (tomato etc.) or their general poor diet quality and speed of eating, lack of relaxation around meals etc. etc.
My one exception would be in children diagnosed on the spectrum for autism. I think going gluten free where possible is appropriate from the get-go in ASD. For everyone else, a correct diagnosis is the essential first step to effective & proportionate treatment so keep your wits about you my fabulous fellow diet detectives!