Low B12 and its role in degenerative disease

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What if I told you that for a large number of degenerative diseases and conditions which are currently considered difficult to treat by conventional medicine, there can be a simple nutrient deficiency as the primary cause. These diseases and conditions may include dementia and Alzheimer’s, depression, cardiovascular disease, ADD and ADHD, autism, and many auto immune diseases. Essentially many of the signs and symptoms of these health issues are similar to those of B12 deficiency, and identification of this issue may often be overlooked in favor of more complex treatment strategies.

Conservative estimates place B12 deficiency at around 40% of the population aged over 60, however a closer look at the literature indicates this number may be far higher and also affect a large proportion of the younger population. The issue with the identification of B12 deficiency is two-fold. Firstly the reference ranges for B12 go too low, allowing sub-optimal levels to be considered normal. And secondly, standard blood tests only assess the level of B12 in the blood, not in the cell where B12 exerts its actions. Thus you could have high levels of serum B12, but if there are issues getting that B12 into the cell or utilizing the B12 once within the cell, then you essentially have a functional B12 deficiency. Measuring methylmalonic Acid (MMA) or homocysteine may be more reliable markers of B12 status as they indicate the end result of B12 utilisation.

B12 is a notoriously difficult nutrient to absorb, and may be impacted by:

  • Low stomach acid
  • Low levels of intrinsic factor
  • Alterations in the gut microbiome
  • Poor gut integrity
  • Alcohol consumption
  • Pernicious anaemia
  • Medications (especially those that lower stomach acidity as well as the diabetic drug Metformin)

Although being a vegetarian or a vegan can put you at risk of B12 deficiency (B12 is found in nature only in animal products), due to the many factors listed above you can have a diet high in animal products and still be B12 deficient.

Symptoms of B12 deficiency may include:

  • Weakness or tiredness
  • Shortness of breath
  • Palpitations
  • Pale skin
  • Numbness or tingling
  • Problems walking
  • Mood disorders
  • Confusion
  • A smooth tongue
  • Disturbed vision

If you have any (or especially many) of the symptoms listed above, it may be worth getting your B12 tested as well as the metabolic markers MMA and homocysteine.

Treatment of B12 deficiency will initially involve supplementation to correct the primary issue. In extreme cases this may need to be in the form of an intra-muscular injection, however for many a sublingual tablet at the appropriate dosage will be sufficient. The standard form of B12 found in many supplements is cyanocobalamin, however it seems the form methylcobalamin is better absorbed and utilised for most people.

Most important in the treatment of B12 deficiency is to identify the underlying cause, and this will often be best achieved with the assistance of the appropriate health practitioner.

In wellness,

James

Understanding pyrrole disorder

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Pyroluria (or mauve factor) is a metabolic disorder in which the liver overproduces molecules called ‘pyrroles’. These pyrrole molecules are a normal by-product of haemoglobin synthesis, however in this case the over-production can lead to a deficiency of key nutrients including zinc, B6, magnesium and omega 6 essential fatty acids.

These nutrient deficiencies may manifest in a variety of symptoms, however those most closely correlated with pyroluria include:

  • mood and behavioural symptoms (e.g. anxiety and stress intolerance, depression, social withdrawal, explosive temper and mood swings)
  • abdominal pain and/or morning nausea
  • impotence in males
  • acne
  • irregular periods and/or delayed puberty
  • allergies and sensitivity to light, sound and odour
  • migraines
  • attention deficit/hyperactivity
  • constipation
  • poor dream recall
  • eosinophilia
  • stretch marks in the skin and/or white spots on fingernails
  • vitamin B6-responsive anaemia
  • hypoglycaemia (low blood sugar)

A number of these symptoms being present may indicate the possibility of pyrrole disorder, as well as blood work showing either low zinc, high copper, low normal alkaline phosphatase (a zinc dependent enzyme), or low normal liver enzymes (AST, ALT, GGT) which are B6 dependent. Definitive testing is performed via a urine sample which measure the volume of pyrrole molecules being excreted.

Treatment is initially a supplemental nutrient protocol to address deficiencies, and response can be quite rapid. However long term treatment must address underlying health issues which exacerbate nutrient depletion and perpetuate symptoms. These may include:

  • Gut inflammation and hyper-permeability (leaky gut)
  • Food sensitivities
  • Psychological stress
  • Chronic infection
  • Environmental toxicity (eg BPA or heavy metals)

Clinically I have seen many patients respond to treatment when presenting with significant anxiety / ADD / ADHD / OCD behavior. Often these patients are children who have been labelled with a behavioral disorder and for whom pharmacological therapy has been suggested, when in fact the underlying cause was simply a nutrient deficiency.

If you or a loved one ticks multiple boxes on the symptom list above I urge you to have this clinically assessed and the appropriate testing performed to see if the issue at hand is indeed pyrrole disorder.

In wellness,

James

Wilson’s syndrome and undiagnosed hypothyroidism

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The thyroid gland is often described as the master controller of your metabolism. It is responsible for orchestrating the fine balance of energy production in your cells, as well as overseeing many aspects of growth and cognitive development. When the thyroid struggles to meet the demands of the body, many signs and symptoms of dysfunction may follow including: fatigue, unexplained weight gain, hair loss, dry skin, joint pain, menstrual irregularity, and depression.

The medical investigation of thyroid dysfunction will typically initially involve testing one thyroid marker: thyroid stimulating hormone (TSH). This hormone is released from the pituitary gland in the brain, and is responsible for stimulating the thyroid gland itself and initiating the release of thyroid hormone (T4). There are two problems with this approach to investigation. Firstly, the range that is given on pathology results for TSH is significantly wider than it should be, allowing a TSH of up to 4.5 before being considered in an unhealthy range. The vast majority of medical research indicates that a TSH above 2.5 shows a thyroid gland that is struggling to produce adequate thyroid hormone (remember that TSH is effectively telling the thyroid to produce hormone – the higher the TSH, the louder the pituitary is having to shout at the thyroid to get it to respond).

The second issue is that TSH may be within the optimal range (1 – 2.5) however other thyroid markers could still be out of balance. I have consistently seen TSH in range but T4 (released from the thyroid gland) or the active thyroid hormone T3 (converted from T4 in tissues such as the liver and kidneys) below the optimal range. This is because these hormones rely on a complex interplay of physiology to be produced in adequate amounts. For example liver and kidney dysfunction can impact the T4 to T3 conversion, significantly reducing the levels of circulating active thyroid hormone. This will eventually impact the production of TSH but often not until pathology has progressed to a degree where it is much more difficult to treat.

Another issue with adequate thyroid function may occur at the cell itself, where the active T3 hormone must bind to cell surface receptors and initiate a response. Inflammation can effect the expression of cellular receptors for thyroid hormone, as can adrenal dysfunction and subsequent cortisol excess or deficiency.

Another hormone released in the body called reverse T3 will typically slow thyroid activity at a cellular level by blocking the thyroid receptor without stimulating it, stopping the active T3 from binding. An over-production of reverse T3 can cause symptoms of hypothyroidism in the presence of a seemingly ‘normal’ conventional thyroid test panel. This condition is termed ‘Wilson’s Syndrome’ (not to be confused with Wilson’s Disease, in which copper builds up excessively in the body) and testing for reverse T3 along with conventional thyroid markers can give a good indication as to whether this is present.

For many with diagnosed hypothyroidism, the conventional treatment involves medication with thyroxine, a synthetic version of T4 normally produced from the thyroid gland. This may be beneficial, however as mentioned above the T4 hormone must be converted to T3 to be effective in stimulating a thyroid response and for many this conversion process is not efficient (hence the need to monitor TSH, T4 and T3 when using this therapy). For those with Wilson’s Syndrome, the use of thyroxine may exacerbate thyroid dysfunction as the body will show a preference for converting T4 to reverse T3 in these patients. Hence reverse T3 spirals upward, T3 drops, and symptoms worsen. A better solution for medication is typically a compounded T3 and T4 combination, or sometimes purely T3 on its own. Of course my preference is to uncover the cause of the elevated reverse T3, which is often either adrenal dysfunction, systemic inflammation, or chronic infection. Treating the root cause will typically resolve the elevated reverse T3 and restore adequate thyroid function.

In wellness,

James

How to make Kombucha

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If I asked you to sample a fermented tea beverage made with the assistance of a sugar consuming symbiotic colony of bacteria and yeast, you’d probably look at me with deep suspicion (or disgust) and walk away. However this delicious drink commonly called Kombucha packs a powerful hit of probiotic goodness in each bubbly mouthful. It is also very low in sugar, making it a great alternative to heavily sweetened soft drinks (or fizzy liquid candy as they should be called).

Most health food stores will stock it in a variety of flavours, however it is incredibly simple to make it at home. This is my approach to making Kombucha using a method called continuous fermentation.

You will need:

  • Organic black tea bags
  • Organic green tea bags
  • Around 200g of organic raw sugar
  • A large sterilised glass vessel of at least 3 litre capacity (I use a 5 litre vat that has a tap on the front, however many simply use a large glass jar)
  • Muslin cloth or a tea towel
  • A SCOBY (Symbiotic Colony Of Bacteria & Yeast) – this can usually be purchased from specialty health food stores and is stored in the fridge. It looks like a jelly fish (minus the tentacles) and will typically be stored in a sealed bag immersed in Kombucha liquid. You can also ask a friend who is already making Kombucha if they have a spare SCOBY, as they will produce additional colonies during the fermentation process. If your SCOBY does not come with Kombucha liquid, you will need to purchase a bottle of unflavoured Kombucha to add in.

To make the Kombucha, follow these steps:

  • Boil 2 litres of water
  • Add 65g of sugar to each litre of water (so 130g in total for this batch) and dissolve in a clean saucepan or bowl
  • Add 2 black tea bags and 1 green tea bag for every 2 litres of water and steep for 10 minutes, then remove
  • Allow the tea to cool completely, as heat will destroy your SCOBY
  • Pour the cooled sweetened tea into your glass vessel and the place the SCOBY in the liquid along with about 200ml of unflavoured Kombucha
  • Place your muslin or tea towel over the top of the vessel and use a rubber band to hold it in place around the top
  • Leave at room temperature for 7 days away from sources of heat such as sunlight
  • Siphon off a litre of Kombucha at a time and store in the fridge in a separate glass bottle (leave the SCOBY in the main vessel)
  • For every litre of Kombucha you remove, simply top up your vessel with another litre of cooled sweetened tea (65g of sugar with 1 each of a black and green tea bag steeped for 10 minutes)
  • Once the fermentation is under way (after the initial 7 day start) you typically only need 2-3 days for the SCOBY to ferment the new batch of sweetened tea, which will then be ready to siphon off again.

If you want to add some flavour, you can chop up some fruit (such as peach or mango) and add to the bottle of already fermented Kombucha. Leave this at room temperature for another 2-3 days and the beneficial organisms will consume most of the sugar in the fruit (you should leave the top of the bottle open and covered with a cloth to ensure pressure from the gas produced during fermentation doesn’t explode your bottle!). You can then place this in the fridge and drink when cool.

Remember, if you are new to consuming fermented products you should start slow (1/4 of a cup per day) and build up to an ideal amount of 1-2 cups per day.

Enjoy the fizzy probiotic goodness!

In wellness,

James

The importance of fermented foods in a healthy diet

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Gut health – it’s all the rage these days, and not without good cause.

Our gastrointestinal tract is an amazing piece of anatomy that mediates the delicate interplay between our outer and inner environment. It absorbs nutrients, eliminates toxins, and samples every piece of organic and inorganic matter that passes through it to determine the level of threat and an appropriate response.

However our GIT is not invincible, and it will become damaged and dysfunctional if not treated kindly. One of the key areas of gut health is the diversity and volume of the microbiome, that vast collection of bacteria, yeasts and parasites that can either help or harm us depending on levels of various species. An important way to ensure that your microbiome is healthy is to ensure generous amounts of probiotic species are present, which will keep the potentially pathogenic organisms that are always lurking around in check.

Ask most people how best to inoculate your gut with good bacteria and they will suggest taking a probiotic supplement. Unfortunately, whilst probiotics are great at treating acute issues of the GIT they are not great at restoring your microbiome. This is because your microbiome contains thousands of species of bacteria, and a supplement contains a dozen at best. These supplement species also tend to be transient, meaning they will eventually leave your GIT once you cease taking the formula.

The best way to achieve a healthy microbiome is to incorporate plenty of fermented foods into your diet. I heard a talk on the GIT the other day, and the presenter made a great point: Refrigeration is both a blessing and a curse of modern civilization. A blessing, because it allows us to keep foods fresher for longer and have access to a wider variety of nutrition from season to season. A curse, because it has eliminated the need for practicing the art of fermentation to preserve foods. For hundreds if not thousands of generations mankind has used fermentation to store all types of food, and this has in turn provided a steady supply of a huge variety of beneficial bacteria for our guts. We have evolved to use this bacterial diversity to our advantage, however in just a few generations this supply of beneficial bacteria has been largely eliminated in Western countries.

If there is one thing you can start doing today to help you live a healthier life, it would be to introduce fermented foods into your diet. Sauerkraut, kimchi, kefir, quality unflavoured yoghurt, and kombucha are all excellent options. Do your gut a favour and give it some ferments – it will love you for it.

In wellness,

James

Natural remedies for high blood pressure

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Hypertension is one of the most commonly encountered health issues in the Australian heath care system, using up to 11% of allocated government health expenditure. It is however less of a stand-alone issue, and much more a sign of significant health problems lurking beneath the surface. Properly addressing high blood pressure involves dietary and lifestyle modification, as well as assessing genetic factors and other contributing causes. However there are several key nutrients and botanicals that can significantly ameliorate high blood pressure and reduce the associated risks while deeper investigations and true healing is established.

Magnesium

Magnesium regulates the transport of calcium, sodium and potassium across the cell membranes of the body. In this way, magnesium can help to relax the smooth muscle of the blood vessel wall, in turn lowering blood pressure. I recommend either the magnesium citrate or bis-glycinate forms for the most effective absorption. If there are associated cardiovascular issues then the orotate form can provide further benefit. Aim for 600mg per day of elemental magnesium (in its unbound form) in divided doses of 200mg per serve.

CoQ10

Co-enzyme Q10 has several physiological benefits that can improve cardiovascular function. It can promote vasodilation, reduce blood viscosity, protect the heart muscle from cellular damage, and reduce the secretion of the blood pressure raising hormone aldosterone from the adrenal glands. CoQ10 is made naturally in the body, however is often depleted in cardiovascular patients. I recommend the ubiquinol form (which is the activated form of CoQ10) at a dosage of 200 to 300mg per day.

Alpha lipoic acid

ALA is a powerful antioxidant in its own right, but has the added benefit of being able to recycle vitamin C and E as well as improve the absorption of CoQ10 (all extremely important in cardiovascular function).  I recommend 200mg per day.

Fish Oil

The benefits of fish oil extend well beyond the cardiovascular system, however the active components EPA and especially DHA are particularly good at lowering blood pressure. Look for a high quality fish oil (preferably in liquid form) that is molecularly distilled and concentrated. Aim for at least 600mg per day of DHA and roughly the same amount of EPA.

Hawthorn

This herb is one of the most powerful natural cardio-tonics around, with an amazing ability to not only lower blood pressure but also to protect the cells of the heart from damage and regulate the rhythmic pulsation of contraction that keeps blood moving throughout our body. Look for a formula that contains only the berry extract (some may include extracts from the leaf), and aim for 500mg to 1g of Hawthorn per day.

This list, whilst far from extensive, can effectively aid in the lowering of blood pressure and reduce cardiovascular risk while deeper investigations are undertaken and addressed. If you or a loved one is suffering from hypertension, I strongly encourage you to seek the assistance of a qualified health practitioner that can aid in uncovering the root cause of this all too common health issue.

In wellness,

James

‘Tis the season to…heal your gut!

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Christmas is upon us, which unfortunately for most adults means one thing – stress!
The rush to complete the purchase of those last few Christmas presents, the inevitable overindulgence at multiple pre-Christmas celebrations, the pressure of work deadlines as the end of the year looms.
Stress wreaks havoc on our health, and often the organ system that bears the brunt of the damage is our gut. Stress (both physical and emotional) breaks down the fragile layer of cells that line our intestinal wall, causing increased permeability and a down-regulation of immune enhancing secretory IgA. Disease is often the result, and can manifest in almost any area of the body.

Luckily there are many nutrients and supplements that can help to heal damage to the gut wall and protect it from the ravages of stress. In our house, gut healing jellies are a common fixture in the snacking schedule. These provide multiple sources of gut goodness, and the best thing of all is that the kiddies love them (it doesn’t hurt to use Christmas themed silicone moulds to get them even more excited)!

Whip up a batch of these on a weekly basis and your body will thank you for it.

Gut healing caramel jellies

  • 3.5 Tbsp gelatin powder (I recommend the Great Lakes brand)
  • 1/2 cup cool water

Briskly stir these ingredients together in a bowl until they form a thick rubbery mass. Then put the following into a saucepan:

  • 1 tin coconut milk (I use the Absolutely Organic brand – BPA free tin)
  • 1 large ripe banana, sliced
  • 1 Tbsp vanilla essence
  • 1 Tbsp honey

Heat these ingredients on a stove until warm (not boiling). Add the rubbery gelatin and stir over a low heat until dissolved. Cool the mixture, and when luke warm add 3-5 tsp of probiotic powder (I like the Nutrition Care Polybac 8 powder). Use a stick blender to liquefy, then pour into silicone moulds. Place in the fridge until set (usually about 3 hours). Turn them out and gobble them up!

Note that if there is significant damage to the gut lining, you can add 2 Tbsp of glutamine powder with the probiotics for extra gut healing powers.

You can also substitute any other fruit for the banana – mango works really well.

In wellness,

James

Adrenal fatigue and digestive dysfunction

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One of the key principles in the practice of Naturopathy is to find the underlying cause of the health issue at hand. A patient that comes to see me with digestive disturbance will be ill served by the simple prescription of laxative herbs to ease their constipation. This is what is commonly referred to as the practice of “green pharmacy” and simply substitutes the prescription of a natural agent for symptom suppression rather than a pharmaceutical one. The underlying cause of the constipation still needs to be discovered in order to restore true and lasting health.

The digestion affects many organ systems (and vice versa)

When our digestion is disturbed, there are many consequences for the rest of the body. Nutrient assimilation is impaired, and so we do not get the crucial building blocks for our body’s structures, hormones, neurotransmitters and cellular energy units. Unhealthy populations of microbes may flourish and cause inflammation and leaky gut, further reducing absorptive capacity. This can also impair the immune system and predispose an individual to allergic tendencies and aberrant cell growth.

However the gut is also easily impacted by disturbances in other organ systems, and it is the adrenal system and the stress response that I see impacting my patient’s digestive function more than any other. Investigating and treating adrenal dysfunction can often be the key step in resolving chronic digestive issues.

We can’t digest when we’re outrunning the bear

The adrenal system is amazing. It plays a crucial role in the fine balance of energy use and preservation, carefully orchestrating a cascade of stimulating neurotransmitters and hormones that allow us to do everything from wake up and function in the morning, to climb a 10 meter tree in 5 seconds flat to escape a rabid bear. Unfortunately, chronic stimulation of the ‘fight-or-flight’ mechanism of survival that keeps so many of us in consistent adrenal stress has a significant impact on health.

Our body cannot tell the difference between stress stimulated by being hunted by a hungry bear, and stress stimulated by being cut off in traffic. To the brain, and the adrenal glands, both of these situations require the same physiological response: massive surges in both cortisol and noradrenalin. This causes a series of up-regulating reactions ranging from increased heart rate and respiration, increased flow of blood to skeletal muscles, pupil dilation, increased blood clotting, and the liberation of vast quantities of stored sugars for energy production. There are also a series of inhibitory reactions that take place: loss of peripheral vision, inhibition of salivation and lacrimation (tear formation), depression of immune function, and inhibition of the digestive processes.

These ‘minor’ stresses occur on a frequent basis throughout the day of most individuals living in a city environment, and over time this constant fight-or-flight activation will take its toll on our health.

The digestion bears the brunt of adrenal overstimulation

From a digestive perspective, consistent adrenal stress will grind activity to a halt. Chronic constipation will often ensue, and this comes with its own set of health challenges. Infrequent emptying of the bowels can results in significant toxicity, with wastes that were due for elimination being reabsorbed to further burden the liver and lymphatic system. The normally acidic environment of the stomach also starts to become more alkaline, encouraging the bacteria that usually reside in the large bowel to migrate into the small intestines and sometimes the stomach itself. Other parasites and pathogens will also flourish in the lowered acidity. These microbes release toxins that break down the bowel wall, leading to leaky gut and immune challenges from inadequately digested proteins. These proteins can circulate to other tissues of the body and become the instigator of auto immune destruction of these organs in diseases such as Hashimoto’s thyroiditis, Lupus, and Sjogren’s syndrome.

You can see that there is a massive impact on health from digestive dysfunction, and the discomfort involved in chronic constipation is only the tip of the iceberg when it comes to the function of your physiology.

Are you adrenally hypo or hyper reactive?

A key step in the process to determine the appropriate course of action for adrenal dysfunction is salivary cortisol testing. This is a simple procedure that is done at home in which 4 swabs are taken from the mouth at different times of the day, typically 6am, 12 noon, 6pm and midnight. These swabs are sent for analysis, and the measure of cortisol at each stage of the day is plotted on a graph (another hormone called DHEA-S is also typically measured to further discern the individual presentation). Note that blood cortisol typically offered through conventional medical testing has very little value as most cortisol in the blood is bound to carrier proteins and is thus not detected by the test.

A healthy individual should start the day with high levels of cortisol, which will gradually decrease through to the evening. Clinically I will typically see one of two scenarios: either a chronically elevated cortisol throughout the day, or a cortisol that stays low throughout the day. Both of these situations can result in digestive dysfunction, however treatment protocols can be quite different so testing is important.

Can adrenal dysfunction be treated?

A mixture of botanical medicine and targeted nutrition can help restore adrenal function, however ultimately the best results will be obtained with the addition of a behavioral therapy that dampens the stress response. Meditation, yoga, and tai chi can all be powerful modulators of the stress response, however something as simple as a barefoot walk on the beach can also help tremendously. Avoiding substances that stimulate the adrenal glands such as caffeine is also very important, and specific diets to address either elevated or depressed cortisol are often employed in treatment.

In encourage you to pay close attention to the level of stress in your life. If you feel it could be affecting your health, start taking steps now to consciously lower your stress response. Five deep controlled breaths right now is always a good place to start!

In wellness,

James

The one supplement I take every day

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By now everybody should know the importance of eating a variety of fruit and especially vegetables. Every health condition can be improved through the addition of at least 5 serves of veg and 2 serves of fruit every day, especially those chronic diseases that have become such a regular feature of our modern lives. Diabetes, chronic fatigue, fibromyalgia, migraine headaches, arthritis, macular degeneration, IBS, cardiovascular disease, and many other health issues can either be prevented or significantly ameliorated by adding these vitamin/mineral/antioxidant powerhouses to our plates on a regular basis.

Good intentions vs realities of daily life

Even with the knowledge of human physiology and the clear pathways to health that I have, I have struggled to eat what I consider a respectable volume of vegetables and fruits day to day (note that this would be higher than the general recommendations mentioned above). A busy working life, family commitments, and a myriad of other daily demands mean that somehow I would get to the end of the day frequently deficient in my plant based dietary compounds.

Concentrated powdered extracts to the rescue

So how to get more of these beneficial foods into my diet in a convenient form? The answer is simple – powdered vegetables and fruits. It amazes me how so many people will turn to tablets and pills of synthetic nutrients or herbal extracts before they have even addressed their basic nutritional requirements. Obviously the treatment of specific health conditions can and should incorporate these potent therapies, but I would argue only after the dietary needs are met.

I take at least 1 scoop per day of a concentrated vegetable and fruit powder that gives me the equivalent of 2 serves of vegetables and 1 serve of fruit (I will often take 2 scoops to really ramp up the nutrients). The powder is freeze dried from fresh picked organic ingredients that include broccoli, kale, spinach, barley grass, wheat grass, beetroot, carrot,  strawberries, blueberries and cherry (plus many more). What’s more there are no synthetic vitamins or minerals added, just pure food concentrate (many powdered supplements on the market will add these synthetics to make the nutrient profile look better).

I will of course endeavor to eat as many fresh vegetables and fruits as possible throughout the day, but I consider this daily powdered supplement my number one health insurance.

So my take home message is this – source a good quality, pure food concentrate powder and start taking it every day. There are no contraindications or cautions, only a plethora of health benefits from providing your body with the essential micronutrients it craves.

In wellness,

James