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Estrogen and aromatase - Keeping the wolves from the door.

Estrogen and aromatase,  (and the  role of prolactin and a lack of progesterone) in cancer are well documented and so are the stimulatory effects of the neuro-endocrine (nervous system/hormones) disruptors termed xenoestrogens, which mimic the action and excess of estrogen (Kim, Kurita, & Bulun, 2013) (Mungenast & Thalhammer, 2014). Estrogen and notably estradiol/E2 is often measured by a standard blood test, which remains as problematic as other blood tests such as TSH, which I have previously described. “ At first, it was assumed that the amount of the hormone in the blood corresponded to the effectiveness of that hormone. Whatever was in the blood was being delivered to the “target tissues.” But as the idea of measuring “protein bound iodine” (PBI) to determine thyroid function came into disrepute (because it never had a scientific basis at all), new ideas of measuring “active hormones” came into the marketplace, and currently the doctrine is that the “bound” hormones are inactive, and the active hormones are “free.” Ray Peat

In addition to the obvious production of estrogen in the reproductive tissues, it’s possible to increase estrogen conversion via aromatase, an enzyme which converts androgens such as testosterone to estrogen, is one of the other main factors. Adipose tissue is a prime location for increased aromatase activity.

Another problem with measuring hormones in the blood is that it rarely accounts for the intracellular accumulation of hormones. Estrogen in excess in the cell, promotes fluid retention, swelling and causes an increase in calcium. Measuring pituitary hormones and in particular prolactin (PRL) may give us a better indication of the relative excess of estrogen due to estrogens stimulatory effect on the anterior pituitary and PRL.

PRL excess is associated with issues such as breast cancer, prostate cancer, resistance to chemotherapy, infertility in both men and women, male reproductive health and galactorrhea (Sethi, Chanukya, & Nagesh, 2012) (Rousseau, Cossette, Grenier, & Martinoli, 2002). Treating PRL excess, particularly linked to the most common form of pituitary tumour (1:1000), the prolactinoma is often treated effectively by the dopamine agonists Bromocriptine or Cabergoline. However, it’s not beyond the realms of possibility that prevention and treatment of excess PRL production, be achieved with decreasing synthesis and exposure to estrogens both endogenous and from external sources.

Myopic thinking.

Modern medical thinking and analysis has led us to a reduced proposition when it comes to diseases like cancer. Cancer is essentially a metabolic disease, and the proposed respiratory defect, the idea of scientist Otto Warburg, is often replaced by the mechanistic thinking of the receptor theory of disease. Estrogen receptors are one of the main evaluations for assessing types of cancer but the very essence of the testing leads us to an increased myopic line of questioning, failing to ask the necessary questions that underlie a persons health status.

If a city is being evacuated, its railroad transportation system, will be quickly “saturated,” and the impatience of a million people waiting for a ride wont make much difference. But if they decide to leave on foot, by bicycle, boat or balloon, in all directions, they can leave as soon as they want to, any number of people can leave at approximately the same time. A non-specific system is ‘saturable,” a nonspecific system isn’t saturable. The idea of a cellular “receptor” is essentially that of a “specific” transport and/or response system. Specific transporters or receptors have been proposed for almost everything in biology - for very interesting ideological reasons-- and the result has been that the nonspecific processes are ignored and supressed. Ray Peat

Solutions.

Sometimes there are minimal opportunities for people to change their environment. Perhaps creating more solutions to enable better conversations with the environment, is the most pragmatic solution available?

Maintaining the body’s production of energy by optimising thyroid production, suppression of TSH (thyroid stimulating hormone) and lowering of other stress hormones like ACTH, intake of carbohydrates, protein and adequate light can support the necessary energy needed for the liver and digestive system to enhance detoxification of estrogen and estrogen mimickers.  A sluggish, fatty or hypothyroid state of the liver, makes it difficult for estrogen to be excreted. In states of constipation, beta glucaronidase converts inactive estrogen to the active form.  Keeping both estrogen and aromatase low seems a step in the right direction.

Foods also have the capacity to enhance estrogen synthesis. Mushrooms have shown to be a potent inhibitor of aromatase enzymes and have the capacity to lower the systemic production of estrogen (Grube, Eng, Kao, Kwon, & Chen, 2001). However it’s important to note that mushrooms need substantial cooking to reduce the liver toxins present.

“The hydrazine-containing toxins that Toth and others wrote about are destroyed by heat. Since extracts made by boiling the mushrooms for three hours were very active, I think it's good to boil them from one to three hours.

If you want to know more about prepping mushrooms and soups, then check out the link below for The Nutrition Coach, who reminded me why mushrooms for lowering estrogen and a great source of protein will be helpful when consumed regularly.

  

References: 

Grube, B. J., Eng, E. T., Kao, Y.-C., Kwon, A., & Chen, S. (2001). White Button Mushroom Phytochemicals Inhibit Aromatase Activity and Breast Cancer Cell Proliferation. J. Nutr., 131(12), 3288–3293. Retrieved from http://jn.nutrition.org/content/131/12/3288

Kim, J. J., Kurita, T., & Bulun, S. E. (2013). Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer. Endocrine Reviews. http://doi.org/10.1210/er.2012-1043

Mungenast, F., & Thalhammer, T. (2014). Estrogen biosynthesis and action in ovarian cancer. Frontiers in Endocrinology, 5(NOV). http://doi.org/10.3389/fendo.2014.00192

Rousseau, J., Cossette, L., Grenier, S., & Martinoli, M. G. (2002). Modulation of prolactin expression by xenoestrogens. Gen Comp Endocrinol, 126(2), 175–182. http://doi.org/10.1006/gcen.2002.7789\rS0016648002977890 [pii]

Sethi, B. K., Chanukya, G. V, & Nagesh, V. S. (2012). Prolactin and cancer: Has the orphan finally found a home? Indian Journal of Endocrinology and Metabolism. http://doi.org/10.4103/2230-8210.104038

http://raypeat.com/articles/articles/pdf/Estrogen-Receptors-what-do-they-explain.pdf

http://www.thenutritioncoach.com.au/anti-ageing/how-i-prep-mushrooms-and-why-its-worth-the-bother/#more-2595

 

Gestational diabetes and metformin-Is that the best that medical thinking has to offer?

Gestational diabetes or elevated blood sugar is often treated with metformin to improve blood sugar levels and considered the standard approach to treating gestational diabetes. The research suggests that it has little negative effects on the pregnant mother. However, does significant risks to both mother and baby if the incidence of premature birth count? Here are a few aspects to consider regarding the use of metformin to control blood sugar during pregnancy. A study of patients receiving a dose of metformin, combination of Clomiphene citrate (CC) and metformin both faired better than CC alone for the induction of ovulation (Neveu, Granger, St-Michel, & Lavoie, 2007).  As the combined group showed no benefit compared to metformin alone, one might consider that metformin alone may be considered for the positive effects.

In another study metformin and diet interventions showed a significant outcome compared to non-metformin-diet interventions. The metformin diet showed a reduction of 14 adverse events in a group of 76 expectant mothers, compared to the non-treated group of 36 adverse events out of 76 pregnancies (Glueck et al., 2013).

Thatcher and Jackson (Thatcher & Jackson, 2006) compared pregnancies of 188 women. 61 experienced miscarriages and 11 of those had stopped taking metformin, suggesting other abnormalities beyond metformin’s actions. 81% of women with pregnancies before metformin, 67% had prior miscarriages. 37% of these also miscarried again. Whilst metformin appeared to show minimal effects to mother and foetus 22% were born prematurely.

Whilst metformin has shown favourable outcomes in PCOS states, questions around pertinent biological mechanisms should warrant further discussion. It’s well known that two key endocrine actions may be compromised during the failure to achieve full gestation. Estrogen induces hypoxia in the uterus (Peat, 1997) and failure to produce adequate progesterone to counter the effects of estrogen may be implicated in the commonly fragile time around weeks 9-10 of pregnancy and incidence of miscarriage.

A concern of metformin are its affect transplacentally. Metformin appears to influence testicular size in males and affects sertoli cells. In females it may also lead to decreased androgen synthesis. Birth weight percentile is also significantly lower in pregnancies treated with metformin (Bertoldo, Faure, Dupont, & Froment, 2014)I Metformin has generally appeared safe in expecting mothers but considerable concern should be made regarding its long term effects to offspring and development most notably to reproductive tissues.

Hypothyroidism is a key factor in maintenance of pregnancy and alongside progesterone, thyroid hormone deficiency can be implicated in poor cellular energetics, production of adenosine triphosphate (ATP) and blood sugar regulation. There remains much debate about the issue of subclinical hypothyroidism, values and when to treat and perhaps metformin’s role despite showing some promises may be treating a symptom related to insulin sensitivity.

So perhaps these questions might be more pertinent before prescribing an agent that shows potentially negative effects to the fetus?

  1. What is the nutrition of the mother, is it enough and does it contain enough nutrients to enhance/maintain adequate progesterone/thyroid production?
  2. Is estrogen increasing at a rate that suppresses progesterone/thyroid levels and persistently decreases insulin sensitivity?
  3. Is there enough carbohydrate in the diet to ensure that carbohydrate is effectively utilised instead of persistent conversion of fats, increasing overall stress to both mother and fetus?
  4. Are the values of hypothyroidism and the identification of subclinical/functional hypothyroid factors appropriate?
  5. Is gestational diabetes a reflection of the above points?

The use of metformin, without questioning these mechanisms, remains at best a reduced treatment that fails to address a range of biological interactions and function.

References:

Bertoldo, M. J., Faure, M., Dupont, J., & Froment, P. (2014). Impact of metformin on reproductive tissues: an overview from gametogenesis to gestation. Annals of Translational Medicine2(6), 55. http://doi.org/10.3978/j.issn.2305-5839.2014.06.04

Glueck, C. J., Goldenberg, N., Pranikoff, J., Khan, Z., Padda, J., & Wang, P. (2013). Effects of metformin-diet intervention before and throughout pregnancy on obstetric and neonatal outcomes in patients with polycystic ovary syndrome. Current Medical Research and Opinion29(1), 55–62. http://doi.org/10.1185/03007995.2012.755121

Neveu, N., Granger, L., St-Michel, P., & Lavoie, H. B. (2007). Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction and achievement of pregnancy in 154 women with polycystic ovary syndrome. Fertility and Sterility87(1), 113–120. http://doi.org/10.1016/j.fertnstert.2006.05.069

Peat, R. (1997). From PMS to Menopause: Female Hormones in context.

http://raypeat.com/articles/articles/glucose-sucrose-diabetes.shtml

Thatcher, S. S., & Jackson, E. M. (2006). Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin. Fertility and Sterility85(4), 1002–1009. http://doi.org/10.1016/j.fertnstert.2005.09.047

An energetic approach to restoring gut function: Part 1.

Let’s kick this blog off with a question as to whether or not an energetic approach to restoring  gut function is useful or should we rely on testing and supplements? Let me clarify, that I have had my fair share of success stories with a reduced and diagnostic approach to improving gut health. Just like I have also had my fair share of kickbacks from the laboratory for recommending their tests. At one point I was using nearly 200 stool tests per year and making a little cash on the side. Many of the tests worked in isolating some specific disturbance to their gut bacteria, presence of a parasite or elevation of putrefied fatty acids. A ‘cleansing’ diet was promoted and a few supplements for good measure created some short term change whilst the client was in my care. But here’s why the long-term approach to that type of assessment and treatment may not be the best response. A standard functional medicine approach  after spending quite a lot of cash on an integrated stool test is using the 4 R approach.

Remove (offending parties)- spend money on supplements

Restore function- spend money on supplements

Re-inoculate - spend money on nice expensive probiotics

Repair gut lining- spend money on supplements

Regurgitate. Ok the 5th one is mine but no supplements needed.

By taking this approach, an important question is not asked of the individual. Why is this person experiencing an overgrowth of bacteria/SIBO, parasitic infection, endotoxin overgrowth, inflammation and degradation of the bowel lining? I like to think that it is not because of the easy kickbacks FM practitioners are getting for the lab tests and supplements they recommend? So what is the persons level of biological energy and immune system function that allows their digestive system to get in such a state. We know there are some usual suspects. Food, stress or alcohol perhaps?

The typical gastrointestinal complaints people came to me with, were bloating, excess gas, constipation or irritated loose stools combined with poor energy. It was Ilya Mechnikov who originally stated that death starts in the bowel or colon and there’s’ certainly many degenerative and inflammatory conditions that appear at the last stop to poopy central. But is the bowel the main driver of this dysfunction? Many of the symptoms that I recalled earlier are also key symptoms of an energetic and perhaps a thyroid dysfunction. So instead of reaching for our drastic 4 R protocol with an expensive poo test lets consider the following.

 The likes of Broda Barnes and Ray Peat have highlighted how a lack of energy, either from a low or inappropriate food intake or a dysfunctional hypothalamic-pituitary-adrenal-thyroid axis can be evaluated by assessing body temperature and the combination of pulse. Additional information on Thyroid and TSH evaluation can be found here.

Most people are aware that when they get stressed or exercise, blood is shunted away from the digestive system to the periphery and other working tissues. Even the concept of high Adreno-corticotrophic hormone (ACTH), cortico releasing hormone (CRH) and adrenal production of cortisol is becoming common place in work and gym environments alike. These hormones suppress thyroid hormone and the energy compound ATP that provide energy for tissues.

It’s also well known that low energy states create tight painful muscles that are difficult to relax and one might be able to apply that line of thought to the smooth muscle tissues that regulate bowel contractility. Therefore a low energy state that does not allow for adequate energy production will not allow adequate digestion and bowel function to occur. Cold hands and feet can be a symptom of not eating enough carbohydrate and protein.

If the cold hands and feet, low body temperature, fatigue, constipation don’t resolve from eating energy rich meals that contain plenty of fruit and contains little of the foods that promote the bowel irritants histamine and serotonin (nuts, seeds, vegetable oils, grains, gluten free products, beans and pulses). Then, often factors that influence the hormones such as thyroid, estrogen and progesterone may need a deeper consideration.

I drafted a little flow chart that will be helpful for some quick strategies on what might be happening but what I would like to focus on the low energy state that might have its source from a food or hormone factor or perhaps both. Instead of using a strategy like the 4 R approach, these simple questions can help guide you to understanding whether it is the foods that you eat or an energetic factor that could be causing your digestive system to suffer. It's not a complete algorithm but it does offer some simple solutions that have helped plenty of people resolve digestion and energy issues.

Foot note: I haven't needed a stool test with a client for over 4 years now following this chart.

 

In part 2 I will elaborate on foods and basic supplements that can be used to resolve most long standing digestive issues and understanding other hormone actions that create digestive discord.

References:

Lokaj, J., & John, C. (2008). [Ilya Ilich Metchnikov and Paul Ehrlich: 1908 Nobel Prize winners for their research on immunity]. Epidemiologie, Mikrobiologie, Imunologie : Casopis Spolecnosti pro Epidemiologii a Mikrobiologii Ceské Lékarské Spolecnosti J.E. Purkyne, 57(4), 119–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19069024

Peat, R. (1997). From PMS to Menopause: Female Hormones in context.

Peat, R. (2006). Autonomic Systems. Retrieved from raypeat.com/articles/other/autonomic-systems.shtml

Osteoporosis- could your exercise, nutrition and medical advice be better?

Osteoporosis and bone health, like many other aspects of optimal biology is a product of an organisms inputs and reactions to environmental stimulus. Osteoporosis is a condition like others, where prevention is often easier than the cure but perhaps the cure has been overcomplicated? Osteoporosis is a multifactorial musculoskeletal disease that is usually associated with the ageing process, decreased bone mineral density (BMD) and its tendency to fracture easily.       It’s clear that a number of factors that can be maintained throughout life to reduce the incidence of Osteoporosis in both men and women. Before we review those and compare with current guidelines, here’s some background info on the subject.

Primary Osteoporosis is the age related decline in men at around 70 and suggested as being a postmenopausal state, induced through the decreased production of estrogen in females. This last point is accepted in medical literature as the main cause of osteoporosis in females but may be severely flawed (more on this point later).

Secondary osteoporosis can be related to the following factors

Hypogonadism - testosterone/estrogen deficiency
Endocrine disease - Cushing’s syndrome, acromegaly, thyrotoxicosis, Addison’s disease and hyperparathyroidism
Dietary or assimilation deficiencies of calcium, vitamin K, vitamin D and other nutrients
Inflammation-rheumatoid arthritis, systemic lupus and ankylosing spondylitis
Neoplasms- Myleoma, lymphoma and leukaemia
Reduced physical activity
Medical drugs - corticosteroids, antiretroviral, antipsychotic, chemotherapy, hormone therapy, nicotine and excessive alcohol
Family history/genetics
Diabetes

The financial burden from osteoporosis generally, will increase from 98 Million Euros to 121 billion with proportional increases of 27.5 million to approximately 34 million people between the years 2010 to 2025 (Hernlund et al., 2013). Despite these huge burdens there appears to be a lack of well-designed educational programs that are geared at prevention of osteoporosis through non-pharmacological means.

The supplementation of vitamin D and calcium are well documented in osteoporosis strategies but a strategy to avoid these states are diets containing adequate calcium, vitamin A, K, magnesium (and others) adequate sunlight and moderate exercise.

Ok, so there’s a problem, it’s big business and there’s a lot of great info on how to avoid it right? Well no and here are the major points why I believe its not.

Diagnosis

 Dual energy X-ray absorptiometry (DEXA) is the recommended choice for osteoporosis diagnosis, serum calcium, phosphate, creatinine (with GFR) alkaline phosphatase, liver function, 25 OHD, total testosterone, estrogen CBC and 24 urinary calcium excretion are recommended for the interpretation of secondary causes of osteoporosis (Watts et al., 2012).

Hormones

Estrogen loss is touted as the most significant factor in decreasing BMD yet it’s action only retards resorption, or the removal of calcium from bone. Estrogen tends to inhibit the action of osteoclasts which ultimately reduce BMD. It’s the main reason the introduction of hormone replacement therapy (HRT) was considered as the primary treatment until its long-term use was found to induce clotting and cancer in women. So estrogen does not reverse Osteoporosis, it prevents further bone loss.

A variety of studies have suggested little influence of testosterone in males on BMD and that low estradiol levels combined with elevated sex hormone binding globulin appear to increase the loss of BMD (Cauley et al., 2010). A point worth noting from the correlation associated with higher estradiol levels and decreased BMD loss is that all participants in the study were recorded as having increased weight and BMD, which may influence skeletal modelling due to increased bone-loading parameters. Perhaps too much emphasis has been given to the suggestion that estrogen and its primary role of tissue proliferation amongst others, which should follow the course of age related decline?

Progesterone on the other hand has been shown to be a bone trophic or building factor that increases mineralisation of BMD, via osteoblasts (Prior, 1990). Stress increases cortisol and decreases progesterone binding at the receptor, with a preference for the glucocorticoid. Ray Peat (1997) points out that cortisol causes bone loss and its widely accepted that progesterone has an “antiglucocorticoid” action, it is reasonable to think that progesterone should protect against bone loss, and that it is a progesterone deficiency after menopause which is a major factor in the development of osteoporosis.

Thyrotoxicosis has been suggested as a mechanism of bone resorption but this appears inaccurate-  Ray Peat does a much better job at explaining this.

Medical treatment

Bisphosphonates are the first line medical treatment for treating osteoporosis and show modest changes to hip and vertebral BMD over 3 years. There use may come at a risk. Gastro intestinal side effects are well documented and in some the increase of osteonecrosis of the jaw has been observed. In some, the long-term use has been shown not only to increase the rate of fragility fracture but also to inhibit the healing process. It should be noted that adequate calcium and vitamin D in the diet are essential for bisphosphonate effectiveness

 Nutrition

 There tend to be two well-known stances to the fitness industries approach to nutrition. One, the transformation approach, where limiting of nutrients, particularly dairy and carbohydrates and intermittent fasting are the norm. Another, the holistic warrior whose consumption of chia seeds and all things green, raw and limiting of dairy and sugar again,  may be a factor into lowering BMD in later life. Calcium is an essential nutrient for bone health and dairy is indeed a great source of calcium. Here’s an old blog on the subject.

 It’s clear that adequate vitamin D is a nutrient that is important in BMD maintenance. It regulates calcium levels, decreases the production of parathyroid hormone, which is a potent resorption factor of skeletal calcium when calcium or vitamin D are low. Here are the main points that relate to diet.

  • Vitamin D in isolation and particularly high doses increases fracture rates (Janssen, Samson, & Verhaar, 2002)
  • Unless vitamin D is accompanied by adequate calcium, BMD can decrease further.
  • Vitamin K2 can prevent the calcification of soft tissues and help improve blood calcium levels (Masterjohn, 2007)
  • High meat and diets high in pulses and beans can have a negative effect on calcium levels due to their high phosphate levels.
  • Unless you assess other key nutrients like magnesium and the factors discussed above
  • Low diary intake can be associated with poor bone health.
  • The low carbohydrate, raw green and seed eating diet suggested by holistic health practitioners may contribute to lower BMD.

Exercise

Regular exercise has been touted as a significant factor in maintaining muscle mass and increasing BMD. But is the type of exercise that people are doing, increasingly in their younger years, contributing to better or worse outcomes to BMD. For bone to form adequate carbon dioxide (CO2 ) is essential. Some exercise regimes are so challenging, they contribute to excess levels of metabolic acidosis (lactic acid) and passing of CO2 from the body (worth noting that sugar consumption can also help to increase CO2 production) . Perhaps for exercise to be effective it should be light to moderate, with adequate rest periods that don’t mean that the participant is lying in a pool their sweat and vomit.

Walking, strength training with adequate rest, yoga, Pilates and other modes of moderate exercise appear most suitable for modest improvements to bone health but the diet and hormone factors are key.

It’s clear that osteoporosis is in the rise but it can be reversed. But instead of heading advice like cutting out dairy, eating lots of uncooked vegetables and training to complete exhaustion. There are more suitable mechanisms for improving bone health

References:

Cauley, J. A., Ewing, S. K., Taylor, B. C., Fink, H. A., Ensrud, K. E., Bauer, D. C., … Orwoll, E. S. (2010). Sex steroid hormones in older men: longitudinal associations with 4.5-year change in hip bone mineral density--the osteoporotic fractures in men study. The Journal of Clinical Endocrinology and Metabolism, 95(9), 4314–23. http://doi.org/10.1210/jc.2009-2635

Hernlund, E., Svedbom, a, Ivergård, M., Compston, J., Cooper, C., Stenmark, J., … Kanis, J. a. (2013). Osteoporosis in the European Union: medical management, epidemiology and economic burden. Archives of Osteoporosis, 8(1–2), 136. http://doi.org/10.1007/s11657-013-0136-1

Janssen, H. C. J. P., Samson, M. M., & Verhaar, H. J. J. (2002). Vitamin D deficiency, muscle function, and falls in elderly people. The American Journal of Clinical Nutrition, 75(4), 611–5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11916748

Masterjohn, C. (2007). Vitamin D toxicity redefined: Vitamin K and the molecular mechanism. Medical Hypotheses, 68(5), 1026–1034. http://doi.org/10.1016/j.mehy.2006.09.051

Peat, R. (1999). Thyroid Therapies, Confusion and Fraud. Retrieved from www.raypeat.com/articles/articles/thyroid.shtml

Prior, J. C. (1990). Progesterone as a bone-trophic hormone. Endocrine Reviews, 11(2), 386–398. http://doi.org/10.1210/edrv-11-2-386

Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., & Finkelstein, J. S. (2012). Osteoporosis in men: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 97(6), 1802–1822. http://doi.org/10.1210/jc.2011-3045

Health, Thyroid and TSH. Assessing and treating the thyroid.

What is the impact of thyroid hormone on health?Increasingly health is defined by a bunch of arbitrary numbers. High cholesterol? That’s not normal take a pill. Low iron? Here take this iron supplement. In Ivan Illich’s book, Limits to Medicine- Medical Nemesis, Illich makes the reader fully aware of his disdain of medical check ups - " The medicalisation of prevention thus becomes another major symptom of social iatrogenesis. It tends to transform personal responsibility for my future into my management by some agency."

Instead of heavily reliant systems on numbers and markers. Should we not look to improve qualitative and quantitative pairings to get a better picture of health and improve outcomes? The last ten weeks of my life have been wrapped up in a post graduate diploma in endocrinology. Getting a better picture of how clinicians tackle complex areas has been a rewarding but at the same time frustrating area of study.

Sometimes the questioning has been a down the lines of - This patient has this endocrine feature, what are the medication used, which medications interfere, what surgical options can be pursued and what is the follow up? What is frustrating for me is there is little effort to understand why? Why? Why Donald why? Diet, stress and environmental aspects of hormonal health are often forgotten about, because the goal of getting that client back into the window of numerical health takes priority. But what if we took a better look at the why? Might it not yield better long-term outcomes for the patient?

I have a special interest in thyroid function, motivated by the writings of Ray Peat, Broda Barnes, Mark Starr and others. There’s a significant amount of work discrediting the role of combined T4/T3 therapy and in particular natural desiccated thyroid (NDT). In many endocrine textbooks the elevation of the active form of thyroid hormone, T3 was elevated significantly post NDT treatment.

A confounding factor in this assumption was based upon a previously incorrect conversion which can still be found in endocrine textbooks stating that 1mg of NDT was equivalent to 1ug of LT-4. There is recent evidence available showing a patient preference for NDT, which showed improved outcomes to weight loss, energy, happiness, sleep and memory (Hoang, Olsen, Mai, Clyde, & Shakir, 2013).

A reliance on TSH, T3 and T4 levels alone may be ineffective at analysing the effectiveness of combination therapy in comparison to synthetic monotherapy treatment of hypothyroidism. Additionally this study highlights the inaccuracy of the assumed conversion of 1mg: 1ug. Using more accurate 3rd generation TSH assays yields a suggested ratio of 1.47 mg’s to 1ug. This may explain the lack of effectiveness in previously conducted trials and the conclusion that increased transient T3 levels were decided as unacceptable. NDT in many cases may offer a better solution than synthetic thyroid hormone after all

Potential mechanisms of improvement may also lie in the actions of T1 and T2 and assumptions based solely on TSH, T3 and T4 may not explain the benefits recorded in this and other studies.      

Another pitfall of number reliance is well known in the reference of thyroid stimulating hormone (TSH). TSH is considered the gold standard for hypothyroid diagnosis but its limitations have become increasingly prevalent due to its production via the stimulating centers from TRH (thyroid releasing hormone) from the hypothalamus and then TSH from the pituitary, if a problem exists at the periphery the likelihood of getting an accurate assessment is diminished. A normal TSH reading is defined as 0.4-4.5 mU/L but generally many Doctors do not consider someone hypothyroid unless they present with a TSH over 4 mU/L.

Increasingly some Doctors are becoming aware of the reduction of hypothyroid symptoms when TSH is kept below 1mU/L and some evidence suggests that even at 0.5 mU/L (lowered but suppressed) is ideal to ensure that hypothyroid symptoms are decreased (Pantalone & Nasr, 2010).

Me? I am going to go back and contradict myself and say that numbers are useful. The basal temperature test with a cheap thermometer, as championed by Broda Barnes still suggests a good window of function of the thyroid test. 36.5 to 37 degrees is considered normal and reflects a well functioning metabolism. Couple that with a pulse rate test and you can also get a good indication of cortisol. So I am not against the numbers. I just think we need to ask better questions before we accept them as absolutes.

References:

Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. M. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-blind, crossover study. Journal of Clinical Endocrinology and Metabolism, 98(5), 1982–1990. http://doi.org/10.1210/jc.2012-4107

Illich, I. Limits to Medicine - Medical Nemesis. Marion Boyars. 1976.

Pantalone, K. M., & Nasr, C. (2010). Approach to a low tsh level: Patience is a virtue. Cleveland Clinic Journal of Medicine. http://doi.org/10.3949/ccjm.77a.10056

 

Can a bad smell create pain, dysfunction and weakness?

We know about the feedback of pain and painful stimulus (nociception) and the creation of pain to warn us but what about the effects of noxious and more subtle smells on the nervous system? Over the last few years I have found that nothing ceases to amaze me when it comes to the human body. As it becomes possible to dissect systems and assess interactions of specific stimulus, observing the input/output relationship between stimulus and body. Pain stimulus is observed to be chemical, thermal or mechanical in nature. Please bear with the technicalities before I explain the simplified mechanisms or skip to the last part of the blog, if you get bored!

There are many factors that contribute to a patient’s perception and physical feeling of pain. Pain is the central nervous systems response to an event that has the capacity to injure the tissues of the body. Nociception or pain can be qualified from the following pathways.

The ‘First’ pain is usually a withdrawal mechanism (Nociceptive Withdrawal Reflex or NRA) mediated by the neurotransmitter glutamate and utilises the neospinalthalmic (new pain) tract in the anterolateral system or ALS. This typically lasts less than 0.1 of a second and the signal, suggested to be dampened in the substantia gelatinosa, an area found in the dorsal aspect of the spinal cord. Think about that sharp initial pain experienced causing you to move away from a stimulus, which has been detected by free nerve endings.                               Smelly pain

The ‘Second’ pain is also part of the ALS but is part of the paleospinalthalmic tract (old pain). It typically takes over from the initial first pain/neo. It is mediated by the compound substance P and can be associated with that long, lingering pain experienced from an injury.

In addition to pain, we have the capacity to assess many other features of mechanical distortion such as pressure, stretch and touch. The Dorsal Column Medial Lemniscus or DCML, allows the nervous system to provide adequate feedback to tasks and environmental stimulus.

Another part of the pain detection system is the trigeminal chemosensory system, which has nociceptive/pain and temperature pathways that feedback to cranial nerve five, called the Trigeminal nerve (CNV). When a noxious or toxic substance is processed by the neurons in the mucosal areas of the nose, mouth, eyes and lips it is relayed into the thalamus. The VPMN (or ventral posterior medial nucleus) relays signals to the sensory cortex and provides responses, such as watery eyes, sneezing and withdrawal

When we inspire air with small particles of pollutants, they pass from the lungs into the blood stream. Although the blood brain barrier is supposed to prevent any unwanted chemicals, crossing from the blood to the brain; the Circumventricular organs present an area that does not have the capacity to restrict compounds that can create dis-organisation of neurological signals entering and leaving the brain. The area postrema, also has a chemosensory role to initiate vomiting to deal with exposure to harmful compounds

So let’s have something a little easier on the eyes and brain to read now. For example:

Perhaps you are walking across the road in heavy traffic. Sucking up all the pollutants such as benzene, carbon monoxide and other waste products of burning fossil fuels into your lungs as you find your way from one side of the road to another.

For a few seconds your brain, exposed to the onslaught of pollution, has a hard time processing the compounds that have made their way into areas such as the pineal gland or chemoreceptors that can induce vomiting in response to a noxious stimulus.

You are in a rush and bump into someone, his or her shoulder hitting you firmly in the chest. It was slightly painful but you don’t really notice it, the pain pathway, along with pressure, stretch and touch receptors provided some form of feedback. The brain, perhaps still not capable of processing this feedback due to the short exposure of increased pollutants, is just trying to get on with the milieu of everything else that your body demands of it.

Meanwhile the pectoralis muscle, which is being used with each step that you take, has been exposed to increased pressure, a state of contraction or small window of pain that necessitated a withdrawal reflex. The intrafusal muscle fiber that monitor both stretch and contraction now have increased signal towards sustained contraction due to the chaos of external compounds that entered areas of the brain.

So now we might have some level of muscle dysfunction. We probably don’t even know about it. That level of muscle dysfunction now increases and decreases tension demands to receptors found in the ligaments and tendons. The joint mechanoreceptors have a different signal. The skin exteroreceptors perhaps have a different signal. There’s no pain to remind us of the event. In fact we have now gone to the gym and started doing a bunch of push-ups or gone shopping for food and simply carrying the bag home with that hand and shoulder. This doesn’t create pain, but simply sets the foundation for increased areas of dysfunction from distorted neurological signalling.

The concept of this neurological/chemical chaos is often referred to as ‘brain fog’. It seems to be in the literature for many reasons, blood sugar issues, gluten, estrogen (PMS and menopausal females are particularly susceptible) and other factors. It’s also possible that brain fog can be created from specific food stressors, once again eliciting the same response, proposed in the heavy traffic.

Some might say, how can the body be so fragile? Surely we are more robust than that? But it is possible to create these specific dysfunctions but they can be unravelled. Understanding specific stimulus can give us a solution to what dysfunction exits. We might never find out how it came about but a thorough history taking can help to influence where we assess and how to treat it. This is where a technique like P-DTR or Proprioceptive Deep Tendon Reflex, developed by Dr Jose Palomar is unique and effective at uncovering specific neurological dysfunction.

If emotions, visual, auditory, mechanical, chemical and pain factors perpetuate dysfunction, then using those stimulus can pose an effective form of assessment and treatment.

  1. Palomar, J. Proprioceptive Deep Tendon Reflex: Course Notes.
  2. Purves D et al Neuroscience 5th edition. Sinauer Associates 2012
  3. http://www.neurology.org/content/77/12/1198.short

Muscles, pain, hormones and other stuff.

As a therapist who works within the fields of pain, movement, energy and digestion I have seen my share of pain and muscle dysfunction in clients. As my exposure to these situations increase, I realise more than ever, that the muscles are very rarely the problem. Specific muscle dysfunction usually boils down to spindle cell

Thyroid pic

dysfunction and notably Nuclear Bag Fibres (NBF) and Nuclear chain Fibres (NCF). The primary roles of these structures are related to stretch and contraction of muscle function. There can be other factors involving neuro transmitters, involved in nocicpetion such as glutamate, utilised in the withdrawal reflex and often referred to as first pain, (also known as Neospinalthalamic tract located in the Anterolateral system or ALS) and lasting, less than a tenth of a second. Problems can arise when the following pain pathway, called second pain (or Paleospinalthalmic tract also part of the ALS) has problematic feedback with first pain, this is mediated by Bradykinin.

Further complexities arise with serotonin and other structures associated with pain such as the Amygdala and Peri Aqueductal Gray (PAG) that are beyond the scope of this short blog. However a common, over looked feature of pain, may arise with hypothyroidism .

Low thyroid function can be classified effectively with assessment of a basal temperature test and a reading of between 36.6 and 37 degrees. Most blood tests designed to measure thyroid hormones such as TSH, T3, T4 and others, often do not reflect accurate function of thyroid hormone. This is often due to feedback loops between cellular function and the Pituitary gland. Some of the regular hallmarks of hypothyroidism are poor energy, weight gain, poor sleep, hair thinning, digestive dysfunction (constipation and also alternating loose stools), cold hands and feet and pain. Here's an old blog on thyroid and adrenalin issues.

Another assessment of thyroid function is the Achilles return reflex. When stimulating the myotactic reflex a hammer hits the Achilles tendon stimulating, the dorsi flexors or calf muscles. The response should be a quick return of the foot to it’s resting position but with low thyroid the foot returns slowly. Low thyroid output equals low ATP (Adenosine Tri Phosphate – the energy used by the mitochondria/cells). This low energy state does not allow for optimal contraction and relaxation. This is where we can see specific issues with NCF and NBF’s within the muscle spindle cell.

Muscle tendons and associated ligaments provide a feedback loop via the Golgi Tendon Organs or GTO’s. There’s potential for pre-existing GTO dysfunction to drive muscle dysfunction and vice versa. As far back as the 1960s symptoms associated with muscle disorder from low thyroid were.

* Weakness

* Cramps pain and stiffness

* Hypertrophy

* Myotonoid features.

A well-documented feature of hypothyroidism is muscular hypertrophied calf muscles and despite their size may often test weak to stimulation.

Muscle pain, may indeed not be muscle related, it may be due to many factors, suggested above and these may even be related to hormones and neurotransmitters. Many people often deal with muscle aches and pains by constantly focusing on mobility work but these structures continually return to their pre mobility work status (although this could also be an underlying stability issue). In reality there can be many factors that create dysfunction such as crude touch, vibration, nociception, Golgi, Pacini-pressure related structures and many more. But even after seeing a skilled therapist, these still don’t appear to get better, then addressing the chemical aspects of pain and function might be the next sensible thing to do.

References:

Armour Laboratories. The Thyroid Gland and Clinical Application of Medicinal Thyroid. 1945.

Ramsay I. Thyroid disease and Muscle Dysfunction. William Heinemann Medical Books. 1974.

Purves, D. et al. Medical Neuroscience. 5th Edition. Sinauer Assocates Inc. 2001

Starr, M Hypothyroidism Type II. Mark Starr Trust 2013.

http://raypeat.com/articles/articles/hypothyroidism.shtml

Sunlight, Low Level Laser Therapy and Photobiomodulation

Sunlight, Low Level Laser Therapy and Photobiomodulation I first became interested in the healing qualities of light about 5 years ago after reading From PMS to Menopause: Female Hormones in Context by Ray Peat. The obvious connotations to improved health during summer compared to a so- called Seasonal Affective Disorder or SAD was well known. The mechanics were intriguing but not limited to the obvious features of Ultra Violet light and the production of Vitamin D.

UV has been known to be problematic and excess, increases ageing of the skin but the mechanisms and links to cancer are misunderstood. An incomplete overview of other potential mechanisms that might promote mutogenic or cancerous processes are often left out of the explanation. The business of sunblock marketing, like many other fear mongering industries, continue to warn us of too much sunlight, yet often we often lack the right amount. An old blog highlights some points relating to this. The qualities of the healing properties of light are often glossed over instead of promoting the optimal rays of the sun..

The light which penetrates deeply into our tissues (mainly orange and red light) is able to improve the efficiency of energy production, and to suppress the toxic free-radicals that are always being formed in cells. “

Consideration of the healing properties of certain wavelengths of light is a must for health, metabolic and rehabilitation promotion. The useOrange and red rays of light therapy for improving pain, healing and many other issues has been used for decades. In 1903 a Nobel science prize was awarded to Niels Finsen for ultraviolet-phototherapy.

Low Level Laser Therapy and Photobiomodulation

The use of light therapy for improving pain, healing and many other issues has been used for decades.

Here are just some of the issues that have seen great improvement using LLLT and Photobiomodulation.

  • Pain reduction
  • Improved hormone function
  • Swelling reduction
  • Increased healing
  • Neurological issues
  • Improved cellular function
  • Promote recovery from exercise
  • Rehabilitation of injuries
  • Decreased inflammation
  • Improved hair follicle stimulation

The use of infra red heat lamps have been used for decades and often been recommended in rehabilitation or in the beauty world as an anti-aging protocol. I have used heat lamps with myself and clients for several years but it is clear that many gains can be had without the use of heat and just focusing on the use of light alone.

There are many factors that can make the use of light more effective and these illumination parameters include:

  • Wavelength
  • Fluence
  • Power density
  • Pulse structure
  • Timing

For many, even finding these variables may prove a difficult task. In fact even using the word Photobiomodulation becomes problematic! I think the exposure of bright light during the day through incandescent or LED lights is important to offset the lack of natural daylight and healing properties of various waveforms, (unless of course you do work or spend much of your day outside) with the use of red light after sunset to decrease impact to circadian rhythm.

One of the most prevalent mechanisms that appears to offer an explanation as to LLLT’s effectiveness is by increasing cytochrome c oxidase which improves mitochondrial function, increasing cell efficiency and function and improving energy production.

The wavelength of 600-950nm or optical window is a general guideline and appears to be where most of the research and the effects of LLLT has been conducted on. The toxinless website listed below has some great recommendations for the use of light and ideal set ups, which are very cheap to set up at home.

The use of LLLT for improving hormones and in particular thyroid function has gained a greater following of late. It’s worth noting, that in some studies which can be found on Valtsu’s website (a great resource for thyroid) , the use of LLLT improved thyroid function without the need for thyroid medication. Additional studies corroborate the effectiveness in reducing the need for thyroid medication and addressing autoimmune thyroiditis.  Therefore I think the use of LLLT for improving energy, digestion, mood and sleep is validated.

References:

Peat, R. From PMS to Menopause : Female Hormones in Context. 1997.

http://www.ncbi.nlm.nih.gov/pubmed/22747309

http://www.ncbi.nlm.nih.gov/pubmed/12804422

http://www.ncbi.nlm.nih.gov/pubmed/26048721

Online resources:

http://valtsus.blogspot.fi/2015/09/hypothyroidism-could-it-be-treated-with.html

http://www.toxinless.com/red-light

http://www.photobiology.info/Hamblin.html

 

 

 

 

Why baby walkers are a disaster for the growing child.

Why baby walkers are a disaster for the growing child. It was the fourth client in the space of two weeks that prompted me to write this quick blog. Four teenagers all aged 14 with pain and compromised movement. Where did it all start? How does this happen? The parents enquire, looking for a definitive reason.  walker-clipart-baby_in_walker

As with all aetiologies of pain and movement dysfunction it can be hard to determine exactly what drives an individual’s problems. But when you can observe the way that a young person breathes you can, in most cases determine whether they have been placed in a baby walker, without any other form of assessment.

A rough overview would reveal that, within the first 9 months of movement and prior to the process of standing (verticalisation) there are many key stages of development that need to occur.

These include.

  • Lifting the head
  • Stabilising the back line between neck, chest and pelvis
  • Rotation via rolling
  • Quadra pedal or four point stance
  • Crawling and cross patterning of shoulder to hip.

So why is it that the baby walker is such a problem?

Consider the actions that a baby needs to achieve before it stands, let alone walks. Crawling develops hip, trunk and shoulder musculature. Due to the reciprocal relationship between the neck and the lower back, which counter rotates to the direction of the thoracic spine, optimal conditioning of reflexes, muscles, tendons and ligaments should occur. If a child is placed into a walker, the challenge is then geared towards locomotion and gait, rather than rolling and crawling. This is where the problems start and it presents several issues to consider.

  1. The ability to stabilise using the diaphragm is decreased due to in an early standing position, that is not conditioned enough from crawling. (observation can be made by the upper breathing pattern, using chest and neck muscles)
  2. The lower leg muscles are stressed to create movement and in particular the calve muscles are strengthened and may contribute to excessively to actions such as hip and knee flexion and extension (as well as many other movements. (look for those over developed calve muscles)
  3. The lack of rotation created by a lack of motion in the spine, decreases essential loading of the spinal ligaments, which will decrease recruitment of the muscles needed for optimal gait. (you can see poor movement and stability from the most basic movements)

Another insult added into the equation is the constant use of flip-flops. This previous blog breaks down why flip-flops are disastrous for athletic and day-to-day performance.

To develop optimal movement that progresses throughout childhood into adult life, rolling, crawling and walking patterns should not be supported with baby walkers or bouncers. It might be hard to believe but the walker does play a significant part to why younger clients present with pain and movement issues. There's no doubt that technology has significant benefits it many aspects of life. But when it comes to human movement, the brain already has it optimised, you just need to let it of its own thing.

Thankfully with a little work, the problems can be unravelled but don’t get me started on the use of iPads and mobile phones!!

References:

Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system, Journal of Bodywork & Movement Therapies (2013),

Kolar, P. et al. Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. J Orthop Sports Phys Ther 2012;42(4):352-

 

Are you using nature to regenerate?

The more clients that I see, I realise that some are very in touch with their bodies and some have no idea what is going on with it. The same rationale can be applied to those who feel the immediate value of being immersed in nature and others who are blissfully unaware of the subject matter. I often remember the change that my body used to experience as I drove out of London towards the Yorkshire Dales; as I edged past the M25 into the countryside and the journey terminated in a swathe of greenery and granite rock, the stress meter had dialled down to a zero. OLYMPUS DIGITAL CAMERA

So why is nature important to human body? The escalation of urbanised environments is ensuring that humans are packed into industrialised, colour lacking, banal developments, that do little to stimulate the eye and increased tension with hustle and close knit streets that people rush to and from work. This dense packing of people also accumulates a large amount of industrial pollutants, be it Benzene from car fuel, Wi-Fi (of which there is an increasing amount of literature to support it’s negative effects to hormone and cellular function) and many other factors that test the body to its limits.

There is increasing research that suggests that urbanisation is a prominent factor in rumination/negative thinking and decreasing mental health. To deal with managing aspects of mental health, exercise is often touted to be helpful as a distraction hypothesis and I don’t dispute the effectiveness of exercise training to help in this situation. A distraction is positive and exercising is essential for good health. However, how many people actually use, quiet appreciation in exercise to regenerate? We often so concerned with pushing ourselves in professional life that exercise often becomes wrapped up in the same goal setting schedules that people religiously stick to. Walking, boating, hiking and taking time to appreciate nature, take in the colours, slowly breathe in the less polluted air, listen to the birds sing, or simply sit on the beach and absorb the endless horizon of water. To often we don’t stop to take in these natural beauties as we are trying to beat those personal bests.

Studies are showing that walking for 90 minutes in a natural environment fares much better than walking in urban settings; The effects showing additional decreases in negative thinking and activity of the brain. I am a firm believer that running and cycling in built up areas may make you fitter but probably less healthier. Increased oxidation of pollutants in urbanised areas, contribute to health issues and mortality rates are on the rise. Training efficiently and smart would warrant that we should aim to exercise less in this manner. Walking in green spaces and utilising the stress decreasing mechanisms of nature, may have more impact to your health than running or cycling on by without appreciating the spaces surrounding you.

Life seems to be whizzing by faster than ever, isn’t it time we slowed down to appreciate it more? Train for strength, walk for health?

References:

Skin deep? The role of skin in motor control and dysfunction.

Many people are aware that dysfunction can occur from many different areas. Scar tissue, joint and ligament/tendon receptors, muscle fibres and many more factors contribute to pain and movement issues. The role of skin in providing feedback is not so prevalent in literature or discussed as a source of a client’s motor control, pain or dysfunction issues. Whilst muscle and joint receptors are well known as proprioceptors, the skin contains a large amount of feedback from exteroreceptors originally proposed by Sherrington. These include:

Meissner – vibrationskin copy

Pacinian- vibration

Ruffini - pressure response

Krause – pressure in mucosal tissues

Merkel - pressure/touch to skin

Free nerve endings – nociceptive/pain stimulation

The skin provides feedback from external stimulus, adjusting steps and movement. Damage to the skin can be one of the many areas that clients often forget and for that matter, surgeries such as appendectomies, c –sections and kidney removal are just a few of the ‘small’ procedures that have not been mentioned in an initial session.

Deep abrasions on young tissue, which heal and visually, present little to see on an adult body, are common. A recent finding with a client was a certain amount of dysfunction between a deep unseen scar from falling from a bike 20 years ago playing havoc with the scar tissue and stability of   the same knee from a later ACL reconstruction. Using techniques such as PDTR (proprioceptive deep tendon reflex) and NKT (neuro kinetic therapy) it is possible to assess the impact of scars, seen or unseen on stability and motor control of muscle and ligamentous tissue.

Another common issue is the role of deep coloured tattoos and their impact on surrounding muscle tissue via skin receptor dysfunction. Usually dysfunction between quick pin tracts (Neospinalthalmic tracts) and slower pain (Paleospinalthalamic tracts) are prevalent with tattoos but depending on depth and other factors, dysfunction can present via the receptors suggested above.

Tattoos can create dysfunction in underlying and other tissues

 

Addressing muscular dysfunction can be useful and effective as part of the treatment but in addition to assessment of joint, ligament, tendon and pain pathways; assessment of the skin and its associated receptors should be an integral part of the client’s treatment.

 

References:

Palomar, J. Proprioceptive Deep Tendon Reflex. Course manual.

Purves D, Augustine GJ, Fitzpatrick D, et al. Neuroscience 2nd edition.

Sinauer Associates 2001.

Bin the flip-flops for better performance

I have worked with thousands of clients over the years and one of the most consistent links that I can say with certainty exists, is the link between biomechanical dysfunction from flip flop wearing. You can also lump tight shoes, high heels and other rogue foot wear that simply do not allow the feet to function correctly in that description. What I am not saying is that you can never wear those shoes that you hold so dear to your heart again. What I am saying is; that if you are engaged in an exercise regime, be it professional or someone who wants to get the best from your training regime, without injury or decreases in performance. Ditching those pesky flip-flops and other gait restrictors are probably a good idea.

If you want to wear them, then doing some kind of releases that address your own personal restrictions is key. This flip-flop release is very useful but not complete.

https://youtu.be/y1a6W86Yp8I

With the twenty-six bones, thirty-three joints and over one hundred muscles and ligaments, each person demonstrates their personal movement and dysfunction in slightly different ways.

I can tell straight away, when a client walks in whether they wear flip-flops, tight work shoes or over used high heels. So what are the common issues that I see?

  • Inability to optimally recruit the hip and thigh (glutes/hip flexors/quads/hamstrings) muscles.
  • Restriction in mobility/stability to the neck.
  • Poor core function due to overuse of the back muscles.
  • Calf strain and usually a decrease in shin muscle contracture
  • Instability of the big toe-essential for push off in gait
  • Permanent contraction of the toes

There are others and many clients often look at me like a madman as I say that their problems are coming from their footwear. Usually the improvement in function and decrease in pain relatively quickly is enough to ensure their compliance to restricting problematic footwear and addressing their muscular problems with some foot TLC homework.

From a muscular and myofascial line Myers proposition of the structural connectivity via superficial  back line the superficial back line can show us how muscular and ligamentous issues in the feet might affect the whole line where the muscles are continuous with the cranial fascia. Addressing the foot has often decreased pain and increased mobility in the neck in many clients.

A long-standing client of mine who is a competitive swimmer was reminded of the implications of flip-flop wearing and performance. Originally a back pain client that was cleared, he was complaining of a lack of ability to complete a six beat stroke with his feet. After clearing the distortion of the peripheral and central nervous system and restoring optimal muscle function (Using NKT or Neuro Kinetic Therapy and Proprioceptive Deep Tendon Reflex/PDTR), he reported a return of the function that night.

Whether exercising or just for moving efficiently you can still wear these shoes but just be aware that there is a cost. To remove the dysfunction you will need to do corrective work and more homework and lets be honest for those that do exercise, correctives are adistraction from the main event. More mobility and stability work? Come on!

Well if you just treated those feet with more respect you wouldn’t need too.

 

Are probiotics essential for optimal gut health?

Probiotics are often being recommended to deal with a variety of digestive health complaints today. I have been intrigued for many years of the role of the digestive system; it’s functions and ultimately how bacteria can contribute to improved or decreased health. Recently, the last two newsletters from Ray Peat PhD have quoted studies, where animals that were born into sterile environments had improved metabolic rates. He also alluded to the increased lifespan of animals with higher metabolic rate in his book, Generative Energy. Probiotics have been touted for many years to assist with optimal gut function but like many products these days have swiftly been elevated to cult status, with their miraculous, cure all capacity suggested by those that sell them. But what does the science say? A summary of The Cochrane database provides plenty of research that shows that probiotics do have a positive impact in the short term, decreasing acute diarrheal like symptoms; however it’s impact on issues such as IBS remain inconclusive and controversial.

The gut flora and microbial mass is suggested to weigh up to 7kgs, second only in weight to the skin as the largest mass found in the human body. There exist over four hundred different species of bacteria with a predominance of anaerobic bacteria found mostly in the lower bowel. The problem with anaerobic bacteria is that the by-product of these species is the production of lactic acid and other metabolites that are damaging to cellular function.

Bacteria are often classified as pathogenic or disease causing or ‘friendly’ whose role can assist in production of Vitamin K2, biotin and B vitamins amongst other compounds. Bacteria can also increase the production of nitric oxide and endotoxin ( a compound well known to disrupt the mucosal barrier and enzymatic process of the bowel) is known to increase it further. An intriguing question would be whether an increase of certain bacteria predominate when we have a lower intake of certain foods

It is clear that metabolites from all bacteria do pose a challenge to cellular function and certainly when there is an overgrowth or dysbiosis they produce increased compounds that can create health issues dependant on the host’s immune and metabolic status. Probiotics like other supplements are often recommended long term but even the so-called friendly bacteria have the capacity to cause metabolic disturbances. Some species of lactobacilli in excess, cause a condition called D-Lactate acidosis, which disrupts metabolism and has significant impact on mood, digestion and energy. I can recall a three-year-old client who presented with anger and constipation ( 1 bowel movement per week) whose mother thought she was doing the right thing by feeding plenty of fermented foods and yoghurts with natural bacteria. Within a week of removing these foods the issues had stopped.

Chis Masterjohn PhD suggests, ‘Not every fermented food is good for every person, and some people don't tolerate fermented foods well at all. I think this is largely mediated by the biogenic amine content.’

A common diagnosis clients have been told is one of fructose or carbohydrate malabsorption. When carbohydrate in the diet is high in the absence of a healthy bowel this may be an issue. However if Lactobacillus levels have not been checked, we cannot rule out the possibility of fermentation of carbohydrate due to the action of increased Lactobacilli.

E.E. Metchnikoff’s view that disease starts in the colon is a widely accepted statement. Reducing the amount of bacterial agents in the bowel and increasing protective factors such as decreased adrenalin and improved thyroid function can complete elevating the biological status of a person. A stressed digestive system that does fails to produce adequate stomach acid (Achlorhydria or hypochlorhydria) often increases the amount of bacteria in the lumen of the bowel. Partially undigested food accumulates and elevates lipopolysaccharides from increased endotoxin, damaging the bowel. An increase in adrenaline and decreased thyroid hormone can contribute to decreased stomach acid production via stress pathways. Helicobacter pylori, bacteria that buries into the stomach wall may also contribute to this issue.

High protein diets have the capacity to increase bacterial action in the bowel and a metabolite of tryptophan degradation is indole. This increases ammonia and is problematic to the function of the bowel. This is often the reason for practitioners often suggesting an alkalinising type of diet. Alkaline environments pose just as much a problem as acidic environments. To decrease the bacterial actions of tryptophan, increasing the amount of gelatin like substances may be more beneficial than trying to restrict protein. The amino acids glycine, arginine and proline, found in gelatin do not have the carcinogenic properties associated with tryptophan, which is high when consuming muscle meats alone. Metchnikoff's theory of putrefactive dysbiosis  would fit better here but fermentive dysbiosis of grains and carbohydrates is prevalent in the poor performing bowel also.

Whilst antibiotics have gotten a bad rep over the last twenty years there can still be much use for them especially when there are stubborn gastrointestinal infections. Antibiotics seems to also work well in reducing the impact of endotoxemia

Testing the bowel can be completed with a CDSA (comprehensive stool analysis) or to accurately assess metabolite an organic acid urine analysis. These tests often cost £250-400 and present a considerable expense to clients. I personally think these tests should be completed after you have tried to optimise the bowel with optimal foods that digest well and support hormonal function. A caveat to that would be, when a client presents with parasitic infections or autoimmune type systems that may need further investigation

To summarise, I think probiotics can be useful in the short term to people with acute problems, primarily due to restricting proliferation of problematic bacteria but in many cases long term use is unwarranted and may even contribute to health issues.

References:

 

  1. Lord, R.S and Bralley, J.A. Laboratory Evaluations for Integrative and Functional Medicine. Metametrix Institute. 2nd 2008.
  2. Peat, R. Generative Energy. Restoring the Wholeness of Life. 1994.
  3. Chris Masterjohns Blog http://blog.cholesterol-and-health.com/2015/08/weighing-in-on-fermented-cod-liver-oil.html
  4. .http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003048.pub3/abstract;jsessionid=5315A28A4390280DD5D4257508AD7AC0.f04t02
  5. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD005573.pub2
  6. Ray Peat Newsletters: Directing Epigenetic Adaptation/Imprinting and Aging

 

 

 

Estrogen and Progesterone

For the general public there is often no real need to understand what hormones are or what they do, unless faced with specific problems related to them. As hormones are affected increasingly by our environment, which includes: Food, air, water, physical and psychological stress, it seems that a basic understanding of problematic hormones can be helpful for maintaining or improving health. Before I attempt to give a brief overview of a complex subject, here are a few terms to be aware of, mainly related to female function.

Follicular phase- first 14 days of cycle to ovulation and increased production of estrogen, primarily E1

LH- Luteal phase, last 14 days, corpus luteum, which increases progesterone

Progesterone- Hormone of gestation, bone formation, anti clotting concerned with cell differentiation.

E1-E2-E3 – Estrogen classifications of Estrone, Estradiol and Estriol. Estrogen promotes growth and becomes problematic in the face of increased cellular division and changes or mutations.

Xenoestrogens – synthetic estrogen like compounds found in plastics, contraceptives, fuel and industrial waste. These have the capacity to increase estrogen levels in men, compounding issues related to testosterone function.

Progestin- synthetic progesterone. Lacking in the benefits of natural progesterone and increases unwanted symptoms.

CYCLEovul

Estrogen’s primary role is one of growth. It is used to stimulate growth of tissue, especially so in the endometrium. During the follicular phase estradiol increases and just before ovulation starts to decrease. Progesterone’s protective effects are enhanced via increased production of the corpus luteum.

Problems with excess estrogen have increased due to changes in diet, increased exposure to environmental pollutants and other factors that are not offset by increased production of progesterone. Below are just some of the actions of both estrogen and progesterone.

Effects of Estrogen Effects of Progesterone
·      Breast stimulation·      Endometrial proliferation

·      Increased body fat

·      Salt/ fluid retention

·      Clotting

·      Depression

·      Headaches

·      Decreased libido

·      Impairment of blood sugar

·      Reduced oxygen

·      Risk of breast cancer

·      Osteoporosis

·      Decreased thyroid

·      Increases CV issues.

·      Anti tumour effects·      Supportive to fertility

·      Sedative effects

·      Improves blood sugar

·     Decreases  Ovarian cysts

·      and Menopausal flushing

·      Removal of facial hair

·      Decreased Menstrual cramping

·      Improved auto-immune

·      Hormonal balance

·      Anti -Stress

·     Decreased arthritis

·      Promotes sleep

·      Thickens hair on head

 

 

 

Balancing blood sugar levels, particularly an issue during pre-menses, can be achieved with Progesterone. Hypoglycaemia is often present (especially so when engaged in exercise, low carbohydrate or calorie consumption) and particularly when oxidative damage occurs to cellular function, oxygen use is decreased and therefore a reliance on glycolysis, a sugar using energy system, which creates an abundance of lactic acid, occurs. Elevated levels of lactic acid are problematic, not only to cellular function but are also inefficient means of energy production. It’s transportation and conversion back to glycogen requires much more energy than it produces. Progesterone protects against estrogen’s anti-oxygen effects.

Progesterone is non-toxic even at elevated levels, however anaesthesia and euphoria has been recorded, along with changes to the menstrual cycle which can be noted as mainly positive. Symptoms related to PMS have often disappeared and its use is recommended only between ovulation and menstruation. Estrogen/progesterone balance can be achieved by supplementation, however diet can help to facilitate the change and serve to maintain the gains achieved with progesterone supplementation. In many cases decreased thyroid allows for excess estrogen in the body, via mechanisms of decreased energy to detoxify, which include liver and digestion mechanisms. The reverse can also be true due to increased estrogen decreasing thyroid function

Excess stress can be the cause of decreased progesterone and increased estrogen's, increased cortisol and decreased thyroid. The use of adequate protein within the diet and carbohydrates will ensure that thyroid is provided efficiently. Daily sunshine helps to promote optimal progesterone conversion, in addition to supplementation and those who live in areas with less sunlight should also consider progesterone supplementation.

During pregnancy, progesterone production can be one hundred times more than the amount seen during the premenstrual phase. A lack of progesterone during pregnancy has been associated with toxaemia. Symptoms include high blood pressure, excessive weight gain, oedema (fluid retention) and protein loss in the urine. If excess progesterone is available, the mother will simply use it, therefore an excess of progesterone would be preferred to a deficit and the likelihood of toxaemia induced by too little progesterone. Progestins seem to make many unwanted symptoms much worse

It is clear that decreasing exposure to environmental pollutants is helpful to lowering xenoestrogenic load. Foods that contain natural phytoestrogens can also affect estrogen/progesterone balance and where symptoms exist decreasing foods such as uncooked brassica vegetables, soy, nuts and seeds would be helpful in attempting to restore balance.

References:

Dalton, K The Menstrual Cycle.

Lee, J. Natural Progesterone, Multiple roles of a Remarkable Hormone. BLL Publishing

Peat, R. Nutrition for Women.

Tonilo, P.G. Endogenous estrogens and breast cancer risk: the case for prospective cohort studies. Environ Health Perspect. 1997 Apr;105 Suppl 3:587-92.

Online references:

http://raypeat.com/articles/articles/progesterone-summaries.shtml

http://raypeat.com/articles/articles/estrogen-age-stress.shtml

 

 

What is regional interdependence?

What is regional interdependence and why do we need to know more about it? History is often the most prevalent factor for the exposure to future injuries. Many clients and surprisingly clinicians are often blissfully unaware of the impact of previous injuries on current and future injury scenarios. Here are five key examples of actual clients that I have worked with.

  1. Left sided lower back pain, not resolved with surgery, from 40 year-old scar, left by kidney removal at the age of 1.
  2. Ankle injury causing lower back pain.
  3. Appendectomy scar, decreasing core function, causing lower back pain.
  4. Ear piercing creating shoulder dysfunction on the opposite shoulder.
  5. Hyper –contracted toe muscles creating mobility issues in neck.

Of course there are more, hundreds, perhaps thousands more. For the evidence medicine biased people, I am not about to create theoretical models for you to shoot down with a lack of scientific literature. Although there are increasing studies that support the rationale for regional interdependence. There are also many methods of assessment that create adequate reasoning to show how restriction, lack of stability and dysfunction in one area of the body may have a significant impact on other areas of the body. SFMA (selective functional movement assessment), Gray institute, Anatomy in Motion and many other forms of assessment provide insights to how a lack of mobility and stability at the ankle has an impact on say mechanics of the knee, hip, spine, shoulder and head.

Many practitioners and clinicians have often been taught to view each issue in isolation, which to a degree can be helpful; As local problems can often be responsible for a global issue. Think a scar, such as a C-section, inhibiting core function, increasing dysfunction in the posterior chain not addressed by anterior chain function. But what about when symptoms persist? True, there are many factors that can contribute to pain and dysfunction that simply will not be addressed by massage/trigger points, needles and corrective exercise and I might suggest that some gains may serve as mask to the actual underlying dysfunction.

 

10264312_699027360144587_8762295179813694115_nYou may have observed the concept of regional interdependence after having a good calf massage. Ever noticed how good your neck feels after having your feet and calf massaged? There’s a clear fascial line between the feet and the neck as proposed by Myers in the superficial back line. There is also literature to support the concept of viscerosomatic pain referrals. This may include pre menstrual issues on back pain or gastro-intestinal dysfunction involved in headaches. To address these dysfunctions truly we need to get to the root cause of the issues. That neck often gets tight again after having those feet massaged as the compensatory muscles are overworking for an underworking area.

If perhaps the calf muscles are overworking due to a lack of function in their antagonistic muscles such as the dorsi-flexors or shin muscles. You may well see the neck tightness dissipate, when this relationship is addressed. Follow up mobility work may also be useful for the neck.

Determining mobility versus stability issues is paramount. A decrease in mobility may come from many sources such as:

  • A lack of stability -( how to determine video)
  • Breathing pattern dysfunction (a stability issue)
  • Biochemical – vitamin D/K2/A/calcium factors
  • Gluten –stiff person syndrome, A tentative link between the consumption of gluten and muscle stiffness.

Here we can see the futile task of mobilising joints via releasing and stretching muscles, when there exists factors that contribute to the lack of mobility, that will not resolve with mobilisations.

It’s important for the patient to bring a complete injury history to the table and for the clinician to assess the impact and hierarchy of all factors. Determining mobility against stability factors, improving motor control and treating via the suggestion of regional interdependence may be more beneficial than simply just treating overworked painful areas.

 

References:

 

  1. Cook, G et al. SFMA Course Manual. 2011
  2. Hadjivassiliou M1, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N. GAD antibody-associated neurological illness and its relationship to gluten sensitivity. Acta Neurol Scand. 2011 Mar;123(3):175-80. doi: 10.1111/j.1600-0404.2010.01356.x
  3. Myers. T. Anatomy Trains. Elsevier. 2014.
  4. Sueki D. G., Cleland J. A., Wainner R. S. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual and Manipulative Therapy. 2013;21(2):90–102. doi: 10.1179/2042618612y.0000000027

Latest Dubai Eye Interview: Longevity, pain relief, movement and well being

Adrenal fatigue or reductionist thinking? Part 2: Restoration of metabolic processes

adrenal Restoration of metabolic process- lowering the adrenal load.

Sugar, fat and other mal-aligned  factors.

Saturated fat is bad for you, so they said but it clearly wasn’t. Now it’s sugars turn. Sugar causes diabetes, cancer and many other modern conditions, if you are to believe many of the memes on social media. Well no, it doesn’t. Cancer for example is usually created from a specific defect to the respiratory apparatus of the cell. In English that means part of the cell that utilises oxygen. Sugar or Sucrose whose primary constituents are both Fructose and Glucose are readily available carbohydrates and the brain/central nervous system require plenty. Have you ever noticed that brain fog creep in when on that low carb diet? The reason? Restricted carbohydrates  equals reduced cognitive process’s. Yes we can generate glucose via oxidation of fat, in the form of ketosis and you can also break down protein to generate glucose too, but these methods are less than efficient forms of energy generation and long-term utilisation of these systems is not ideal.

Sugar produces energy and when processed with oxygen is much more efficient than glycolysis or energy production without oxygen (anaerobic). In those who have damaged metabolism, there is a reliance on the production of energy in this manner, lactic acid is often produced even at rest. Therefore trying to exercise at intense levels poses a problem for those with both adrenal and metabolic issues.

Give the body what it needs?  Got cravings? You know those ones where you are dying for some food, starchy carbohydrates, a sugary drink? There are no demons at work here, just a simple case of biology, carbohydrates are a primary fuel source for the body. Want to avoid coming crashing down? Avoid having 3 big meals a day and maintain blood sugar levels by eating frequently. Some do better than others but allowing 4-6 meals a day and noting how you feel is a step in the right direction. Maintaining a body temperature of 37 degrees and a pulse rate of 70-85 beats per minute is ideal. This has been well documented in the work of thyroid researcher Broda Barnes and the work of Ray Peat PhD.

Eating readily available carbohydrates such as ripe digestible fruits, protein and saturated fats (in the right amounts) such as coconut oil help to maintain blood sugar levels throughout the day without the resultant elevations in cortisol, which affect adrenal regulation issues.

Stressful situations often warrant the use of supplements such as Vitamins A, B6, C, magnesium and potassium. In particular sugary foods, which should include fruit, maple syrup and honey are ideal choices to diminish the stress response (even table sugar could play a therapeutic role in lowering stress).

Salt is also a powerful anti-stress compound. During stress sodium is often passed more rapidly from the body. Sodium spares magnesium. If you drink too much water the level of sodium excretion increases, which further decreases available magnesium. The research on lowering salt intake is inconclusive but what is known, is that when a low sodium state exists, aldosterone, a hormone that is used to regulate both salt and blood pressure elevates in response. It would come as no surprise that in a low adrenal state, feeling dizzy when moving from seated to standing exits due to poor blood pressure regulation. Craving salt is a mechanism to improve such a situation.

The current mind set regarding exercise and wellbeing is

Increased exercise + Low carb and raw foods = Health

And in the short term, markers suggest that this could be favourable. So how do you tell if this working for you long term? The monitoring of both pulse and body temperature give a great insight into optimal biological function. Here are some of the symptoms, which combine both compromised cortisol and thyroid function.

  • Cold hands, feet and nose
  • Energy crashes
  • Poor wound healing
  • Poor sleep
  • Fatigue
  • Constipation or alternation between constipation and diarrheoa
  • Weight gain
  • Bloating
  • Skin issues
  • Low libido

In reality:

Intense exercise + low carb/raw food diets= compromised metabolism.

Historically in many, changing both the way you eat and completing more exercise may have worked previously, but as you push the markers of exercising more and eating less or certainly eating foods that do not support your activities. You may see many of those symptoms above start to creep into your daily life. There’s no doubt that eating well and exercising are productive pursuits for optimal body function. However for many the lines are blurred as to what actually is a healthy diet.  Consumption of large amounts of grains, margarine and low fat foods were being touted as healthy a decade or two earlier, now look at the research condemning that approach. The following information seems to be heading a similar route.

For the health conscious exerciser today a diet high in raw green vegetables, green juices, seeds nuts, fish oils, low carb, low starch seems to be the zeitgeist but is it that healthy? From a biological perspective the answer would be no. Eating these foods over a long period of time not only increases the stress response but may actually damage how our body’s cells actually function. Increasing available energy from easily digestible foods helps to assimilate energy for production. In contrast foods such as many raw green vegetables, nuts, seeds and vegetable oils, not only irritate the bowel, sit and accumulate bacteria damaging the intestinal lining, but also provide less than optimal nutrition, which will lower metabolic rate.

Moving is important, no doubt, but exercising to within an inch of total fatigue can be detrimental, especially so when dealing with issues related to both adrenal and metabolic based issues. Finding the right type of exercise and even stepping back and focusing on exercise that doesn’t produce high levels of lactic acid, causes hyperventilation and the loss of carbon dioxide should be considered in the short term. The goal of improving metabolic function, restoring deep sleep and raising energy should always predominate over the loss of body fat reduction. It’s a tricky issue to get your head around for some, but when you start to feel great again. You’ll understand why.

Working with Amna

In the past few months I have had the pleasure of working with Amna Al Haddad. She is a motivated, strong woman with a goal of training for the 2016 Olympics in Rio. When I first met Amna she was a little disappointed with her progress and felt like she had hit a wall with her training. Initially the goal was to tweak her energy levels by analysing her metabolic rate and modifying diet to get the optimal amount of energy, to improve performance. When people participate at high level sports they can often become very strong through compensatory mechanisms. Using bio-mechanical assessments and motor control evaluations such as SFMA and Neuro Kinetic Therapy, we were able to change the way that Amna's nervous system communicated with the appropriate muscles and present some strategies that kept them optimal.

Understanding the difference between mobility versus stability issues is key.This ensures that movement remains great and injuries are reduced.

It's been great to see Amna hit some new PB's and stay motivated for her goals ahead. Really looking forward to see her excel over the next few years as it has been a pleasure working with someone so motivated to achieve their targets.

Amna's face book page 

"Working with Keith in the past few months have been absolutely great. My performance, energy levels, and stability definitely increased after our treatment sessions. My muscles have been compensating a lot, often causing a lot of dysfunction and irritation that has affected my weightlifting and strength levels.Keith understands the human body in a different way than what I have seen before from a performance consultant; he can immediately show you how to activate a muscle and restore its strength, reduce pain, and more in just a few seconds! BUT..you have to do your homework to reinforce the new movement patterns."  Amna Al Haddad, UAE national Olympic Weightlifter

 

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Why your digestion holds the key to your health Dubai Eye Interview

What's your gut telling you: why your digestion holds the key to your health. IBS? Bloating? Far from being isolated digestive disorders, these are now being linked with everything from osteoporosis to depression. Keith Littlewood from Balanced Body Mind joins us to answer your questions about performance, digestion and much more.