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.
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!