Carrie Decker, ND

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  • in reply to: Down's Syndrome #17993

    Hello Lucinda,

    Thank you for your questions concerning this case. Vitamin B6 is a water-soluble vitamin, and is not stored in the body. Excess vitamin B6 leaves the body through the urine. As blood testing has shown a high level of B6 but urinary excretion is low, in the absence of high doses as a supplement (which I assume is not being done) you are correct to question if there is a problem with breakdown.

    Various dietary forms of vitamin B6 exist. Vitamin B6 in a mixed diet has been found to be approximately 75% bioavailable, and is found at higher levels in foods such as fortified cereals, proteins such as wild salmon, turkey, and chicken, and other foods including avocado, spinach, and bananas – http://tinyurl.com/qd9wcax. Vitamin B6 is available in various forms in vitamin supplements, including the active form pyridoxal 5′-phosphate.

    Many plant foods contain a form of vitamin B6 called pyridoxine glucoside. This form of vitamin B6 appears to be only about half as bioavailable as vitamin B6 from other food sources or supplements. The conversion of pyridoxine to the active form of vitamin B6 (known as both pyridoxal phosphate and pyridoxal 5′-phosphate) in the body requires ATP and is catalyzed by pyridoxal kinase in the liver. Vitamin B2 and magnesium are also required to convert vitamin B6 to pyridoxal 5-phosphate.

    • Delage B. Vitamin B6. Linus Pauling Institute. Updated May 2014. Accessed Dec 2014. http://tinyurl.com/2hwugq.
    • Food and Nutrition Board, Institute of Medicine. Vitamin B6. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington D.C.: National Academies Press; 1998:150-195.

    Seeking out a genetic counselor that specializes in issues associated with Down’s syndrome for assistance in assessment of these metabolic dysfunctions would be appropriate. There are many genetic conditions which are associated with trisomy 21 – http://tinyurl.com/lwzhedj – and appropriate consultation by a specialist will be helpful. A listing of the genes found on chromosome 21 can be viewed here – http://tinyurl.com/polseg6. With the trisomy state (having an extra third chromosome present instead of just two), the production of any of these genes may be in a hyper or excess state. Because of this a wide variety of processes in the body may be out of normal balance.

    Given that your client’s tests showed that levels of vitamin B2 (riboflavin) are low, higher doses in supplementation actually may be significant as a part of treatment. Ensuring adequate magnesium levels also exist will also support the metabolism of B6. For some individuals this may involve topical or other forms of magnesium as the body is not able to absorb more than a finite amount from supplementation and food (particularly in the case of an infant where dietary greens are limited). With increasing age, dietary intake of these and other necessary nutrients is found to be consistently low in children with Down’s syndrome, and general supplementation may be appropriate.

    • Luke A, et al. Nutrient intake and obesity in prepubescent children with Down syndrome. J Am Diet Assoc. 1996 Dec;96(12):1262-7. http://tinyurl.com/q7vy3x2

    Magnesium supplements are available as magnesium oxide, magnesium gluconate, magnesium chloride, and magnesium citrate salts, as well as a number of amino acid chelates, including magnesium aspartate. Magnesium hydroxide is used as an ingredient in several antacids.

    • Delage B. Magnesium. Linus Pauling Institute. 2014. http://tinyurl.com/2hwugq.

    Forms of magnesium that dissolve well in liquid are more completely absorbed in the gut than less soluble forms. Small studies have found that magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate. Nutri-Link carries many different types and forms of magnesium, which may be found via http://tinyurl.com/l5jbd7c.

    There are medications which interfere with B6 metabolism and may promote deficiencies, however in my research I could not find any information about the use of these for this specific therapeutic purpose. Although B6 toxicity has been documented with excess supplementation, I could not find research pertaining to toxicity associated with high serum levels in absence of supplementation. Sensory neuropathy is the most common symptom of toxicity, and dermatoses, photosensitivity, dizziness, and nausea are also common.

    Increased oxidative stress and impaired mitochondria function due to genetic metabolic defects play a role in the pathology that arises in individuals with a trisomy 21 defect. Your question sheds light on this, as for your client there are obvious metabolic issues. Anytime there is back-up in a metabolic path the accumulation of precursors and deficiency of products can become a source of oxidative damage leading to further dysfunction. As this child ages there will inevitably be much more research in the area of both genetic metabolic dysfunction as well as therapies to reduce the impact of genetic variations. Specific antioxidants that have been assessed for such purpose are alpha-tocopherol, ascorbic acid, CoQ10, and lipoic acid.

    • Helguera P, et al. Adaptive downregulation of mitochondrial function in down syndrome. Cell Metab. 2013 Jan 8;17(1):132-40. http://tinyurl.com/nlkn98u
    • Zana M, et al. Oxidative stress: a bridge between Down’s syndrome and Alzheimer’s disease. Neurobiol Aging. 2007 May;28(5):648-76. http://tinyurl.com/k96yag8
    • Lott IT, et al. Down syndrome and dementia: a randomized, controlled trial of antioxidant supplementation. Am J Med Genet A. 2011 Aug;155A(8):1939-48. http://tinyurl.com/ptr7utj
    • Tiano L, et al. Prolonged coenzyme Q10 treatment in Down syndrome patients: effect on DNA oxidation. Neurobiol Aging. 2012 Mar;33(3):626.e1-8. http://tinyurl.com/jvw92mj

    Hypothyroidism is also an issue, even more so for individuals with Down syndrome than the general population. The prevalence of hypothyroidism ranged from 3 to 54 percent in reports of adults with DS. However there is a shift in thyroid hormone levels in patients with Down syndrome who do not exhibit symptoms of thyroid disease, which suggests that normal values may be different in this group. Autoimmune thyroid disease is not common in young children with Down’s syndrome but is more common after 8 years of age.

    • Karlsson B, et al. Thyroid dysfunction in Down’s syndrome: relation to age and thyroid autoimmunity. Arch Dis Child. 1998 Sep;79(3):242-5. http://tinyurl.com/mzflqlb

    Issues with methylation associated with genetic abnormalities are also a factor in individuals with Down’s syndrome. Mathematical models have shown S-adenosylmethionine (SAMe) to be significantly higher in Down syndrome compared to the controls, while other research has shown that mitochondrial levels of SAMe are reduced, demonstrating the effect of the methyl unbalance on mitochondria. Issues with increased expression of superoxide dismutase have been shown to be correlated with low plasma selenium, furthering generation of oxidative stress and possibly having an effect on thyroid function.

    • Infantino V, et al. Impairment of methyl cycle affects mitochondrial methyl availability and glutathione level in Down’s syndrome. Mol Genet Metab. 2011 Mar;102(3):378-82. http://tinyurl.com/lprexhu
    • Obeid R, et al. Blood biomarkers of methylation in Down syndrome and metabolic simulations using a mathematical model. Mol Nutr Food Res. 2012 Oct;56(10):1582-9. http://tinyurl.com/mgbucgr
    • Nève J, et al. Selenium, zinc and copper in Down’s syndrome (trisomy 21): blood levels and relations with glutathione peroxidase and superoxide dismutase. Clin Chim Acta. 1983 Sep 30;133(2):209-14. http://tinyurl.com/q32zfsa
    • Kadrabová J, et al. Changed serum trace element profile in Down’s syndrome. Biol Trace Elem Res. 1996 Sep;54(3):201-6. http://tinyurl.com/oxcv7o4

    Despite the genetic code an individual has (a factor which does not change) the observed trait (phenotype) may be affected by environmental factors. This concept is called epigenetics, and also pertains to issues associated with Down syndrome. These factors include many of the things which we can support in our clients overall health like toxin exposure (environment, food, drugs), infection, inflammation (gut or food related, or other cause), and stress dependent. Currently science behind epigenetics is just a general understanding of the greater dependence on these environmental things, and there is not a means of drawing correlations between these factors and how genetics are expressed.

    • Dekker AD, et al. Epigenetics: the neglected key to minimize learning and memory deficits in Down syndrome. Neurosci Biobehav Rev. 2014 Sep;45:72-84. http://tinyurl.com/ndfgeg5

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for. The suggested dosages below are based on an estimated weight of 11 kg (24 lbs) and should be scaled appropriately if size is significantly different from this.

    • Solution of Magnesium Liquid (ARG): Increase dose gradually as tolerated up to 1/8 tsp three times per day. http://tinyurl.com/nx3u2vh

    • ProGreens (ARG): Mix ¼ scoop with other liquid or soft food 1-2 times per day. http://tinyurl.com/27uruzy Supports healthy antioxidant levels and gastrointestinal health.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Depression and emotional eating #17970

    Hello Joanne,

    Thank you for sharing this case with us here, as the complaints which your client experiences are very common. Depression and emotional overeating are common coexisting complaints, and depending on the magnitude, frequency, and type of foods being overeaten, blood sugar balance and diabetes are also possibly concerns as you mention.

    Stopping anti-depressants without the supervision of a physician is not recommended – if your client has done so without this support you may want to recommend that they do follow up with their psychiatrist or prescribing physician to inquire about alternatives or the safety in making this change to their treatment. Anti-depressant medications (similar to many other medications) should not be abruptly discontinued and may lead to an exacerbation in symptoms. Many people do not like being supported by medications, however if they have been improving your clients symptoms, a plan for supporting her mood should have been in place prior to gradually discontinuing these medication.

    Emotional eating, while often seen as a symptom, can be a contributing cause to the worsening of your client’s emotional health. Consumption of large amounts of high sugar foods can lead to blood sugar spikes and crashes and promotes inflammation in the body. Supporting regular eating patterns and a diet which focuses on consumption of healthy proteins, fats, and vegetables at each meal will support emotional stability as well as reduce tendency towards depression (via reduction of inflammation) and risk of insulin resistant illness.

    Reinforcing the importance of having a meal or snack containing protein, fat, fiber, and antioxidants in fruit or vegetable form on a regular basis may do much to improve many of her symptoms. Doing things to reduce inflammation (with a product such as KappArest [BRC]) also may improve insulin resistance, as these two things are also connected.

    • Aeberli I, Gerber PA, Hochuli M, Kohler S, Haile SR, Gouni-Berthold I, Berthold HK, Spinas GA, Berneis K. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr. 2011 Aug;94(2):479-85. http://tinyurl.com/q94v9vc

    • Grimble RF. Inflammatory status and insulin resistance. Curr Opin Clin Nutr Metab Care. 2002 Sep;5(5):551-9. http://tinyurl.com/q4kymop

    • Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009 May 1;65(9):732-41. http://tinyurl.com/p9x6tot

    • Jönsson T, Ahrén B, Pacini G, Sundler F, Wierup N, Steen S, Sjöberg T, Ugander M, Frostegård J, Göransson L, Lindeberg S. A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs. Nutr Metab (Lond). 2006 Nov 2;3:39. http://tinyurl.com/myovs97

    Supporting your clients stress levels may be better directed by assess their current response/adaptation levels to stress with an adrenal stress profile – http://tinyurl.com/bt9nnvs. Depending on other symptoms which have not been mentioned (insomnia, fatigue, anxiety) different adrenal support formulas may be more appropriate than others. For general support under stress a B complex vitamin, moderate to higher doses of vitamin C, and magnesium may be adequate.

    I am assuming the Super Adrenal Formula you are referring to is the Dr. Wilson’s Super Adrenal Stress Formula. I would use caution with the dosing of this product as it contains L-5 Hydroxtryptophan (5-HTP) at 10 mg per tab, particularly if this patient just stopped using a selective serotonin receptor inhibitor or monoamine oxidase inhibiting agent. 5-HTP is contraindicated with the current or recent use of these agents. If these have not been used within the last 2 weeks you may gradually introduce this supplement. If your client was taking fluoxetine I would wait longer as the half-life of fluoxetine and its active metabolite norfluoxetine is respectively 2 to 4 days and 7 to 15 days. A general rule of thumb is that it takes 5 half-lives of a drug to reach steady-state (in this case to be eliminated from the body).

    The Glucobalance (BRC) product which you mentioned may be more appropriate for your client. This product is more specifically formulated to balance blood glucose levels, and it also contains B complex vitamins, magnesium, and vitamin C; all of which support adrenal function and mood under stress. You may also wish to consider the use of the product Stabilium® 200 (ARG) as this product has been shown to improve mood, sleep, and neurotransmitter balance as well as regulate the adrenal response to stress. Dr. Wilson’s Dynamite Adrenal (ARG) is a balanced nutrient, glandular, and botanical adrenal formula which supports function under stress. Dr. Wilson’s Dynamite Adrenal also contains chromium (in lower levels per serving than Glucobalance) which supports blood sugar balance as well.

    Individuals with chronic anxiety and depression are often poor methylators and require more available methylated forms of Vitamin B12 (methylcobalamin) and/or methylated folate. A vitamin B complex also supports the improvement of energy and adrenal function. Turmeric, an anti-inflammatory agent, also has some evidence for reducing symptoms of depression. Vitamin C, an antioxidant, also has been studied for the treatment of stress related depression.

    • Atmaca M, Tezcan E, Kuloglu M, Kirtas O, Ustundag B. Serum folate and homocysteine levels in patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci. 2005 Oct;59(5):616-20. http://tinyurl.com/pkf8spp
    • Sanmukhani J, Satodia V, Trivedi J, Patel T, Tiwari D, Panchal B, Goel A, Tripathi CB. Efficacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial. Phytother Res. 2014 Apr;28(4):579-85. http://tinyurl.com/q2mqxws
    • Moretti M, Colla A, de Oliveira Balen G, dos Santos DB, Budni J, de Freitas AE, Farina M, Severo Rodrigues AL. Ascorbic acid treatment, similarly to fluoxetine, reverses depressive-like behavior and brain oxidative damage induced by chronic unpredictable stress. J Psychiatr Res. 2012 Mar;46(3):331-40. http://tinyurl.com/njzh8ch

    Probiotics have evidence for moderating the stress response, decreasing inflammation, and also improving insulin resistance. There also is some evidence that prebiotics alone or in combination with probiotics supports maintenance of a healthy weight. Inulin, oligofructose (OF), and fructo-oligosaccharides (FOS) are some common prebiotics.

    • Ma X, Hua J, Li Z. Probiotics improve high fat diet-induced hepatic steatosis and insulin resistance by increasing hepatic NKT cells. J Hepatol. 2008 Nov;49(5):821-30. http://tinyurl.com/mrxw5zz
    • Dinan TG, Cryan JF. Regulation of the stress response by the gut microbiota: implications for psychoneuroendocrinology. Psychoneuroendocrinology. 2012 Sep;37(9):1369-78. http://tinyurl.com/pl387g2
    • Bomhof MR, Saha DC, Reid DT, Paul HA, Reimer RA. Combined effects of oligofructose and Bifidobacterium animalis on gut microbiota and glycemia in obese rats. Obesity (Silver Spring). 2014 Mar;22(3):763-71. http://tinyurl.com/lur3pc4
    • Parnell JA, Reimer RA. Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. Am J Clin Nutr. 2009 Jun;89(6):1751-9. http://tinyurl.com/lsstn7z

    Support with a digestive supplement, particularly for those with a history of gallbladder removal, will support the digestive process. Yes, Beta Plus™ (BRC) is the preferred digestive support supplement for individuals who have had their gallbladder removed.

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Glucobalance (BRC): 2 capsule 1 – 3 times daily. http://tinyurl.com/k6l4tnj Supports blood sugar balance.

    OR

    • Stabilium® 200 (ARG): 4 capsules once a day. http://tinyurl.com/3x35v63 Supports adrenal function and mood

    • 5-MTHF Forte (BRC): 1/2 tablet daily with food. http://tinyurl.com/kkp8ore Supports adequate folate levels and mood.

    • KappArest (BRC): 2 – 3 capsules twice daily away from food. http://tinyurl.com/lb83ue3 Support for reduction of inflammation.

    • SymBiotics with FOS (ARG): 1 teaspoon 1 – 3 times daily. http://tinyurl.com/6slz7lb Mixed strain probiotics with prebiotics. Introduce gradually as FOS may cause symptoms of gas.

    • Beta Plus™ (BRC): 1 tablet 15 – 20 minutes before meals. http://tinyurl.com/n5gantx Digestive support.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: 12 yo F with Weight loss #17966

    Hello Michael,

    Thank you for sharing this case with us. I will offer some thoughts here, and hope others also will if they have additional suggestions!

    I am glad that you have been approaching this topic with caution and have put thought into some of the issues that might be at play for this young woman. It is likely that puberty is playing a role as she transitions from childhood to adulthood. These are years when the body goes through significant changes and weight gain is often a part of it. It may be that weight was a concern prior to this, but regardless it is important to approach the topic conservatively as eating disorders commonly develop in these years, and parental influence has been shown to play a role. Frequent weighing can cause individuals to engage in unhealthy weight control behaviors, and also contributes to lower self-esteem and greater body dissatisfaction in adolescents.

    • Field AE, et al. Peer, parent, and media influences on the development of weight concerns and frequent dieting among preadolescent and adolescent girls and boys. Pediatrics. 2001 Jan;107(1):54-60. http://tinyurl.com/ownga32
    • Quick V, et al. Prevalence of adolescents’ self-weighing behaviors and associations with weight-related behaviors and psychological well-being. J Adolesc Health. 2013 Jun;52(6):738-44. http://tinyurl.com/q964eb8

    If weight loss is an issue that needs to be addressed, approaching this from a health standpoint will help both you and this young woman to look at it with a broader perspective. Obesity is associated with many diseases (diabetes, heart disease, and many cancers), and when it starts in adolescence it often continues and worsens with age. Discussion of the reasons for achieving and maintaining a healthy weight will help this adolescent to understand why it is an issue bigger than appearance.

    If this young woman is obese it is likely that she has felt some physical limitations in activities such as gym class – excess weight is limiting when trying to run or compete in sports. Do ask her if her weight has been a problem, and listen with sensitivity as it is likely a topic which has not been approached with kindness by her peers as excess weight is often subject to bullying. As bullying and teasing about weight can often create a negative feedback loop of eating for emotional reasons, this also may be something that you can ask about and address if it is a concern.

    It may be that her weight is not outside of the normal ranges for her age. Do utilize the growth charts and assess what is normal for her age. They may be found here – http://tinyurl.com/26utjoq. This will help you and your client(s) to understand what a healthy weight is, and how this significantly changes between the ages of 12 and 18. If her weight is not a concern at this time this is one way to show this to her father.

    If weight is or is not an issue that is in need of being addressed, you can still have a discussion about healthy eating and food choices with both this young woman and her father. At 12 years of age many of the food choices are still selected because they are eaten by the family and are conveniently available. Encouraging the father to support her food choices by purchasing a variety of healthier snacks and having a family meal time also is something to address. Encourage healthy eating – including fruits and vegetables that are a variety of colors (naturally of course!), healthy proteins and fats with every meal, avoidance of processed foods, and eating organic whenever possible. The teen years are commonly a time when processed foods and snacks become a quick fix rather than sitting for a healthy meal.

    If there are other issues of concern such as hyperglycemia or irritable bowel syndrome, do address these with discussion of dietary choices that support the reduction of these as a problem. The Paleo diet or a low FODMAPs diet may be therapeutic diets which are appropriate for this individual if these are concerns. If allergies or asthma is an issue, food sensitivity testing may be appropriate. Do approach the topic of therapeutic diets gently as too much emphasis can lead to periods of restriction followed by poor eating when someone (particularly the young woman more so than just her father) is not on board with your suggestions.

    Encouraging movement also may be something that needs to be addressed. Too often children and adolescents are not active, and this can lead to problems with health long term in addition to excess weight. Discuss with this woman what types of activity she enjoys – if it is not group sports does she enjoy biking or swimming? Hiking in nature? Finding something she likes and encouraging her to become involved in this or other groups that support engagement in these activities will help her to lead a healthy life long term. Do think out of the box and also consider that activities such as babysitting and playing with children can offer movement, as well as planting things in a garden or doing lawn work.

    Actively engaging this young woman and her father in brainstorming of ideas will help the goal of weight loss to be less burdensome, yet you will be able to offer clinical guidance when questions come up.

    A complete greens formula without many added sweeteners can be of great benefit to someone who is struggling to get on track with healthy eating. Many greens powders offer the nutrition that the body is lacking when having carbohydrate binges. Probiotics also are often included, and this helps to balance out the gastrointestinal flora which often is out of balance in carbohydrate cravers. I usually advise people who struggle with healthy dietary choices to include a complete greens formula on a daily basis, and even taking it up to three times a day when having struggles with cravings. Some people find it useful to take as needed if carbohydrate cravings arise, or after periods of eating more high carbohydrate or nutritionally lacking foods. It seems to help to push the “reset” button after a period of less healthy eating.

    Other food-directed therapies that may assist in reducing cravings for high carbohydrate foods include bitters and natural sources or probiotics. Taking time to eat, chewing foods fully, and including bitter foods in the diet all will support digestive function and food awareness. Bitter foods include greens such as arugula, kale, brussel sprouts, dandelion, and radicchio, as well as artichoke. Bitterness also comes from the other parts of fruits which are often discarded such as orange peels. Having some aspect of bitter foods at the start of each meal will help to promote improved digestion and reduce carbohydrate cravings. Alternately bitters can come directly from something such as cocktail bitters, and drank with a small amount of water and citrus before meals to support the digestive process. Food sources of probiotics include sauerkraut, kefir, kimchi, and kombucha. Eating more foods such as these will also help improve gastrointestinal flora balance and may reduce sugar cravings.

    Thyroid abnormalities may occur in adolescence, and if so is something which must be addressed. If there are symptoms of hypothyroidism such as fatigue, constipation, and dry skin you may want to recommend a thyroid panel – http://tinyurl.com/95stu79. As thyroid problems can adversely affect growth and development during puberty, if this is suspected you should refer this individual back to her general practitioner for management.

    • Hanna CE, LaFranchi SH. Adolescent thyroid disorders. Adolesc Med. 2002 Feb;13(1):13-35. http://tinyurl.com/m98zj6s

    Seed cycling and fatty acid cycling is something I introduce to support healthy hormonal balance in cycling women. Supporting healthy hormone balance often is an issue with individuals who have excess weight as they tend to be estrogen dominant. Flax or pumpkin seeds, 2 tablespoons freshly ground and/or fish oil 2000mg combined EPA/DHA should be taken from day 1 of the cycle to day 15; and 2 tablespoons of sunflower or sesame seed and/or 2000mg of borage, black currant, or evening primrose oil (supplying approximately 400mg of gamma-linolenic acid) taken the second half of the cycle from days 16 through 28 (or until next menses begins). However, with some clients who may benefit from additional support for reduction of inflammation I occasionally recommend continuing the fish oil through the whole cycle.

    Doing things to reduce stress also supports weight loss and healthy eating. Support for stress reduction can include deep breathing techniques, gentle yoga or grounding poses, taking a walk or going outside before meals all can help to reduce stress, and may be beneficial. Healthy sleep also supports achieving and maintaining a healthy weight – discussion of sleep hygiene (no electronics at least an hour before bed, last meal 2 hours before bed, sleeping in a dark room, etc) may also be things that you wish to discuss.

    There are a variety of discussions on the Clinical Education group which you may find helpful for ideas concerning weight loss and healthy eating. Do read some of these at http://tinyurl.com/qyhc43f & http://tinyurl.com/pvaqwb7 & http://tinyurl.com/kkya6ab

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • ProGreens (ARG): 1 scoop up to three times daily with liquid. http://tinyurl.com/oaqnlux Complete greens formula including probiotics support.

    • ProOmega™ (NN): 2 softgels twice daily (2000 mg total combined EPA/DHA). http://tinyurl.com/7t9myqe Supports reduction of inflammation.

    • GLA Borage Oil (ARG): 2 softgels with breakfast and dinner, Days 15-28 http://tinyurl.com/6np89zb

    Stress support if indicated:
    • 200 mg of Zen (ARG): 1 capsule up to three times a day as needed for anxiety. http://tinyurl.com/89vstsf Supports reduction of stress and GABA/glutamate balance.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: 52 yo F with Type 1 Diabetes #17964

    Hello Belle,

    Thank you for sharing this case with us. I will offer some thoughts here, and hope others also will if they have additional suggestions!

    I am glad that this woman has seen some positive outcomes with regards to her weight already in the very short time that you have been working with her. Helping her to understand the importance of the dietary shift from high carbohydrate foods to unprocessed foods that are protein rich with a low glycemic load is very important start, especially for someone with diabetes. Although her condition is type 1 diabetes associated with pancreatic dysfunction of the insulin secreting beta islet cells, with a high carbohydrate/high glycemic index diet there still can be aspects of insulin resistance at a cellular and tissue level which can develop along with this. Insulin resistance actually is a risk factor for development for type-1 diabetes, and given that this condition was diagnosed in adulthood (less common than childhood/adolescence) one may question if this was a contributing factor if her diet was also high carbohydrate focused at that time.

    • Fourlanos S, et al. Insulin resistance is a risk factor for progression to type 1 diabetes. Diabetologia. 2004 Oct;47(10):1661-7. http://tinyurl.com/psrvagw
    • Nokoff NJ, et al. The interplay of autoimmunity and insulin resistance in type 1 diabetes. Discov Med. 2012 Feb;13(69):115-22. http://tinyurl.com/okdawas

    When blood sugar levels are elevated, the risks of complications associated with advanced glycosylated end products are increased. An HgA1c (theglycated haemoglobin (A1c), which identifies average plasma glucose concentration) of 66 mmol/mol (approximately 8%) is significantly elevated, as a healthy normal value should be between 20-42 mmol/mol (4-5.9%). The risk of microvascular complications (seen in the kidneys and retina primarily), peripheral neuropathy and cardiovascular complications are also higher with poorly managed blood sugar levels in diabetics. In individuals with diabetes, microvasculature effects are significantly greater (approximately 35%) with an HbA1c of 59 mmol/mol (7.5%) than 48 mmol/mol (6.5%).

    • ACCORD Study Group; et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010 Jul 15;363(3):233-44. http://tinyurl.com/pr3w9po

    A period of 2 months is actually a very short time, given that she probably has accumulated this excess weight of a period of 25 years. When working with people to achieve healthy weight loss it is very important to emphasize that the weight loss that occurs over longer periods of time, and is relative to healthy diet changes rather than crash dieting, is much better maintained. Although she has reported the improvements in diet over the short period of 2 months, ongoing support and encouragement is important to help her continue on this path especially as her weight has had a plateau. Finding other groups of people who are working with a healthy diet such as this, or long term weight loss changes can be very supportive. There may be such groups that she can find via her local hospital or wellness center, as weight loss groups and diabetes support groups are arranged by many community health organizations.

    I’m not certain why you have ascertained that portion size is not relevant for this client but you may want to suggest that for a period of a couple days that she measure her food portions and calculate her caloric consumption. Oftentimes people minimize the amount of food that they take in through snacking and at mealtimes throughout the day. Doing such may shed light on areas of which problem she has not been aware.

    I also see exercise as something which must be much more significant than 30 minutes 3 – 4 times a week for the purpose of weight loss. Studies consistently show that in order to lose weight, one must exercise at least 300 minutes per week includes weight bearing activities. Exercise as a lifestyle choice often needs to be emphasized – things such as walking to work, taking the stairs, parking at least a 10 minute walk from destinations etc should be discussed, with the goals of doing these things multiple times per week if possible as well. Formal exercise such as aerobic and weight training should be at least 45 minutes five times a week in addition to this.

    • Chang L. Weight Loss May Take 250 Minutes of Exercise. WebMD. 2009. http://tinyurl.com/bdbe65

    Consider non-weight bearing exercises such as those in water on an elliptical machine or a stationary bike for significantly overweight individuals as these will be less likely to cause joint issues. Muscle burns calories more than fat even at rest, and this is the purpose of weight training. The aerobic exercise is important to move the blood, burn calories, improve insulin sensitization, and also for the purpose of cardiovascular health. Exercise is one of the best tools to raise high density lipoprotein (HDL) levels.

    This woman may find it helpful to utilize the services of a personal trainer to support her in her exercise regime, and also may find group settings of an exercise class with people having similar goals to be helpful in creating a community of supporters. Many gyms and fitness centers hold such classes for individuals who want to improve their health and lose weight. There also are many resources one can use online to find groups of people with similar ambition. In the states, one which I find great for finding other focused groups is a resource called “MeetUp” and there may be similar resources in her area – http://tinyurl.com/o2jf4mj. I’ve even used social connecting resources such as Facebook or Craigslist to find running partners, and have had great friendships develop from this.

    An additional factor which you should investigate for this woman is her thyroid function. Hypothyroidism is common, and may manifest in a difficulty losing weight. Given that she has type 1 diabetes, the possibility of thyroid autoimmunity is also more likely, and testing should include thyroid antibodies to rule out this as a contributor. Hypothyroidism often may exist despite normal thyroid stimulating hormone (TSH) levels. Impaired conversion of thyroxine (T4) to triiodothyronine (T3) may exist in genetic obesity. Leptin resistance, common in overweight individuals with difficulty losing weight, may affect thyroid conversion and TSH levels. Insulin resistance also reduces T4 to T3 conversion.

    • Doyle EA. Autoimune Conditions Associated With Type 1 Diabetes. PediatrNurs. 2015 Mar-Apr;41(2):89-91. http://tinyurl.com/oem6qsh
    • Katzeff HL, Selgrad C. Impaired peripheral thyroid hormone metabolism in genetic obesity. Endocrinology. 1993 Mar;132(3):989-95. http://tinyurl.com/p2vl4e9
    • Cettour-Rose P, Burger AG, Meier CA, Visser TJ, Rohner-Jeanrenaud F. Central stimulatory effect of leptin on T3 production is mediated by brown adipose tissue type II deiodinase. Am J Physiol Endocrinol Metab. 2002 Nov;283(5):E980-7. http://tinyurl.com/o6pv8hr
    • Holtorf K. Peripheral Thyroid Hormone Conversion and Its Impact on TSH and Metabolic Activity. J Restor Med. 2014;3(1): 30-52. http://tinyurl.com/k5y8h3k

    T3 is the more active form of thyroid in the body. Assessment of reverse T3 (rT3) is important as well. Reverse T3 blocks thyroid receptors, preventing T3 from exerting its normal action. Conversion of T4 to rT3 increases with chronic stress and illness, as well as insulin resistance. A full thyroid panel – http://tinyurl.com/95stu79 – as well as testing of rT3 – http://tinyurl.com/mx3kjvb – will provide this information. The last reference of the three directly below is a very comprehensive and recent discussion about these topics which you may find useful.

    Coeliac disease is also more common in individuals with type-1 diabetes and recommending testing to rule this out as a issue which must be addressed or continuing to advocate the thorough elimination of gluten from the diet should be considered.

    • Smyth DJ, et al. Shared and distinct genetic variants in type 1 diabetes and celiac disease. N Engl J Med. 2008 Dec 25;359(26):2767-77. http://tinyurl.com/qy2tk9z

    Vitamin D deficiency is also associated with an increased risk of cardiovascular disease as well as many other conditions in which altered immune regulation is a feature.

    • Wang TJ, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008 Jan 29;117(4):503-11. http://tinyurl.com/phhw9jq
    • Cutolo M. Vitamin D and autoimmune rheumatic diseases. Rheumatology (2009) 48 (3): 210-212. http://tinyurl.com/pko6qhw
    • Shaik-Dasthagirisaheb YB, et al. Role of vitamins D, E and C in immunity and inflammation. J BiolRegulHomeost Agents. 2013; 27(2):291-295. View Abstract

    I like to recommend that my clients work are working to achieve weight loss use a nutritionally fortified protein formula possibly in combination with a greens powder and probiotic incorporated into a smoothie for one of their meals daily. To increase satiety and meet nutritional needs, a healthy fat such as a portion of nut butter or avocado should be added to the smoothie. Liquid fish oil also can be included if desired.

    When individuals make smoothies it is often important to emphasize that this should not be something that is only fruit focused, but rather a way to introduce vegetables and possibly a small amount of fruit for sweetness. Blueberries and bilberries(the Vacciniumfamily) however may be used at a serving or two daily as they support blood sugar balance and endothelial function and offer a high level of antioxidants.

    • Rodriguez-Mateos A, et al. Intake and time dependence of blueberry flavonoid-induced improvements in vascular function: a randomized, controlled, double-blind, crossover intervention study with mechanistic insights into biological activity. Am J Clin Nutr. 2013 Nov;98(5):1179-91. http://tinyurl.com/nytvj4f
    • Kolehmainen M, et al. Bilberries reduce low-grade inflammation in individuals with features of metabolic syndrome. Mol Nutr Food Res. 2012 Oct;56(10):1501-10. http://tinyurl.com/phdqx4k
    • Takikawa M, et al. Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice. J Nutr. 2010 Mar;140(3):527-33. http://tinyurl.com/pxj2h82

    A complete greens formula without many added sweeteners can be of great benefit to someone who is struggling to get on track with healthy eating. Many greens powders offer the nutrition that the body is lacking when having cravings and binges or periods of overeating. Probiotics also are often included, and this helps to balance out the gastrointestinal flora which often is out of balance in carbohydrate cravers. I usually advise people who struggle with healthy dietary choices to include a complete greens formula on a daily basis, and even taking it up to three times a day when having struggles with cravings. Some people find it useful to take as needed if carbohydrate cravings arise, or after periods of eating more high carbohydrate or nutritionally lacking foods. It seems to help to push the “reset” button after a period of less healthy eating.

    Other food-directed therapies that may assist in reducing cravings for high carbohydrate foods include bitters and natural sources or probiotics. Taking time to eat, chewing foods fully, and including bitter foods in the diet all will support digestive function and food awareness. Bitter foods include greens such as arugula, kale, Brussels sprouts, dandelion, and radicchio, as well as artichoke. Bitterness also comes from the other parts of fruits which are often discarded such as orange peels. Having some aspect of bitter foods at the start of each meal will help to promote improved digestion and reduce carbohydrate cravings. Alternately bitters can come directly from something such as cocktail bitters, and drank with a small amount of water and citrus before meals to support the digestive process. Food sources of probiotics include sauerkraut, kefir, kimchi, and kombucha. Eating more foods such as these will also help improve gastrointestinal flora balance and may reduce sugar cravings.

    Many studies are looking at the relationship between weight loss and obesity. Although much will inevitably be learned from this as we advance techniques utilized to perform such studies, there is information pertaining to these findings that many individuals are in agreement of. Obesity has been shown to be associated with changes in the relative abundance of the two dominant bacterial divisions, the Bacteroidetes and the Firmicutes, and also may lack the biodiversity of that in individuals having a healthy weight.

    • Escobedo G, et al. Gut microbiota as a key player in triggering obesity, systemic inflammation and insulin resistance. Rev Invest Clin. 2014 Sep-Oct;66(5):450-9. http://tinyurl.com/obwx7s3
    • Turnbaugh PJ, et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006 Dec 21;444(7122):1027-31. http://tinyurl.com/pkhxq6w
    • Turnbaugh PJ, et al. A core gut microbiome in obese and lean twins. Nature. 2009 Jan 22;457(7228):480-4. http://tinyurl.com/n9fzqjr
    • Caricilli AM, et al. Gut microbiota composition and its effects on obesity and insulin resistance. CurrOpinClin Nutr Metab Care. 2014 Jul;17(4):312-8. http://tinyurl.com/qbxc8b5

    Chronic consumption of high carbohydrate/sugar containing foods leads to dysbiosis and poor flora balance, and the dietary changes she is working to make will support improved flora diversity as well. Butyrate (a short chain fatty acid) has been shown to support improvements in large intestine flora as well as support weight loss. You may wish to do a stool panel to assess for issues of dysbiosis as a contributor. In my practice I use the Comprehensive Stool Analysis with parasitology test from Doctor’s Data – http://tinyurl.com/q4256rk – which is available from Regenerus labs; Genova Diagnostics also offers a Comprehensive Digestive Stool Analysis / Parasitology ™ – http://tinyurl.com/p6gopyt. If parasitology is not desired, such panels can be run without this option as well.

    • Lin HV, et al. Butyrate and propionate protect against diet-induced obesity and regulate gut hormones via free fatty acid receptor 3-independent mechanisms. PLoS One. 2012;7(4):e35240. http://tinyurl.com/nt4cf9m

    Fibre supports weight loss as well from multiple perspectives – serving as a bulking agent to create a sensation of fullness, and providing prebiotics for the support of healthy intestinal flora. Dietary foods such as leeks, asparagus, chicory, Jerusalem artichokes, garlic, onions, soybeans, are sources of prebiotics, and increasing the consumption of these foods will introduce both prebiotics as well as other nutrients to the diet.

    • Gibson GR, Probert HM, Loo JV, Rastall RA, Roberfroid MB. Dietary modulation of the human colonic microbiota: updating the concept of prebiotics. Nutr Res Rev. 2004 Dec;17(2):259-75. http://tinyurl.com/n2ylhoz
    • Liber A, Szajewska H. Effects of inulin-type fructans on appetite, energy intake, and body weight in children and adults: systematic review of randomized controlled trials. Ann Nutr Metab. 2013;63(1-2):42-54. http://tinyurl.com/nw6qzs5

    Lipoic acid is an antioxidant which reduces the risk of diabetic neuropathy and also supports the reduction of HbA1c levels. To further enhance weight loss goals, there is good evidence that alpha lipoic acid also may provide benefit.

    • Heitzer T, et al. Beneficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free RadicBiol Med. 2001 Jul 1;31(1):53-61. http://tinyurl.com/nk3ogj8
    • Packer L1, Kraemer K, Rimbach G. Molecular aspects of lipoic acid in the prevention of diabetes complications. Nutrition. 2001 Oct;17(10):888-95. http://tinyurl.com/pf6j5qz
    • Poh ZX, Goh KP. A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. http://tinyurl.com/l9pakyw
    • Koh EH, et al. Effects of alpha-lipoic Acid on body weight in obesesubjects. Am J Med. 2011 Jan;124(1):85.e1-8. http://tinyurl.com/a4ark8u
    • Carbonelli MG, et al. Alpha-lipoic acid supplementation: a tool for obesity therapy? Curr Pharm Des. 2010;16(7):840-6. http://tinyurl.com/aggmvfd
    • Sola S, et al. Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study. Circulation. 2005 Jan 25;111(3):343-8. http://tinyurl.com/o4z3xmj

    Berberine and chromium are often used in individuals with diabetes, and support the normalisation of both fasting blood sugars and on a longer term basis HbA1c levels. Supplementation with berberine has also been shown to improve dyslipidemia, reducing total cholesterol, triglycerides, and LDL. Berberine also has been shown to improve insulin sensitization and modify the gut microbiota which may contribute to the effects seen in individuals with diabetes. A combination of chromium picolinate and biotin has been shown to improve glucose management and several lipid measurements in patients with poorly controlled diabetes.

    • Zhang Y, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab. 2008 Jul;93(7):2559-65. http://tinyurl.com/pp8xhw6
    • Derosa G, et al. Berberine on metabolic and cardiovascular risk factors: an analysis from preclinical evidences to clinical trials. Expert OpinBiolTher. 2012 Aug;12(8):1113-24. http://tinyurl.com/p47c8ru
    • Wang Y, et al. Hypoglycemic and insulin-sensitizing effects of berberine in high-fat diet- and streptozotocin-induced diabetic rats. Metabolism. 2011 Feb;60(2):298-305. http://tinyurl.com/o57ra7p
    • Han J, et al. Modulating gut microbiota as an anti-diabetic mechanism of berberine. Med SciMonit. 2011 Jul;17(7):RA164-7. http://tinyurl.com/pq97mjt
    • Singer GM, et al. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial. Diabetes TechnolTher. 2006 Dec;8(6):636-43. http://tinyurl.com/q2j4sx2

    Stress may lead to food coping behaviours, and elevated cortisol is connected with insulin resistance as well as impaired thyroid conversion. Doing things to reduce stress also supports weight loss and healthy eating. Support for stress reduction can include deep breathing techniques, gentle yoga or grounding poses, taking a walk or going outside before meals all can help to reduce stress, and may be beneficial.

    • Rizza RA, Mandarino LJ, &Gerich JE. Cortisol-Induced Insulin Resistance in Man: Impaired Suppression of Glucose Production and Stimulation of Glucose Utilization due to a Postreceptor Defect of Insulin Action. J. Clin. Endocrinol. Metab., Jan 1982; 54: 131 – 138. http://tinyurl.com/7fzqx8c

    Sleep hygiene is also important. Lack of sleep increases ghrelin and decreases leptin hormones. The former increases appetite and that latter suppresses. Discussion of sleep hygiene (no electronics at least an hour before bed, last meal 2 hours before bed, sleeping in a dark room, etc) may also be things that you wish to discuss.

    • Garaulet M, et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes (Lond). 2011 Oct;35(10):1308-17. (http://tinyurl.com/aej2zug)

    There are a variety of discussions on the Clinical Education group which you may find helpful for ideas concerning weight loss and healthy eating. Do read some of these at http://tinyurl.com/qyhc43f &http://tinyurl.com/pvaqwb7& http://tinyurl.com/kkya6ab. Do search the terms “weight loss,” “overweight,” and “obesity” to view these threads as you may find various clinical pearls which may be helpful for the various clients you are working with. If you are not yet familiar with it, you may find the Control-IT Programme from Antony Haynes available on the Nutri Link Ltd Clinical Education site also to be useful – http://tinyurl.com/38lvpzb.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.The suggestions listed here may have redundancies, and the specific use of therapies is subject to practitioner discretion.

    Weight loss support:

    • NT Factor Healthy Curb® (ARG): 2 tablets three times daily twenty minutes before meals. http://tinyurl.com/8aguodw Supports healthy metabolism, cellular, and mitochondrial function.

    • ButryEn (ARG): 1-2 with each meal. http://tinyurl.com/4hrlk52. Provides enteric coated butyric acid. Supports weight loss and healthy large intestine flora.

    • Whey Protein Isolate (BRC): 1 – 2 scoops daily with 8oz of liquid. http://tinyurl.com/nho3kyz May combine with Progreens:

    • ProGreens (ARG): 1 scoop up to three times daily with liquid. http://tinyurl.com/oaqnlux Complete greens formula including probiotic support.

    If greens formula is not desired consider:

    • ProMulti-Plus (BRC): 2 caps three times daily with food. http://tinyurl.com/cy3h8u2

    • Bio-D-Mulsion™ Forte (BRC): 1-2 drops daily with food. 2000IU per drop. Dosage to be determined by current serum level. http://tinyurl.com/kfpjyw6

    Support for insulin sensitization, endothelial function, and weight loss:

    • ALA Release (ARG): Gradually increase up to 3 tablets twice a day. http://tinyurl.com/n7fl8l7 Watch for hypoglycemic symptoms.

    OR

    • Lipoic Acid Plus (BRC): 3 capsules twice daily with food. Each capsule provides 100 mg of alpha lipoic acid with 50 mg of vitamin C. http://tinyurl.com/njz6kv5

    Stress support if indicated:

    • 200 mg of Zen (ARG): 1 capsule up to three times a day as needed for anxiety. http://tinyurl.com/89vstsf Supports reduction of stress and GABA/glutamate balance.

    Ongoing with the use of statin medication:

    • CoQ-Zyme 30 (BRC): 1 tablet three times daily with meals. http://tinyurl.com/6oo5man

    OR

    • CoQH-CF™ (ARG): 1 softgel twice daily with meals. http://tinyurl.com/6oo5man Provides ubiquinol is a reduced form of coenzyme Q10, supports cardiovascular health.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: 52 yo F with Weight Loss plateau #17960

    Hello Belle,

    Thank you for sharing this case with us. I will offer some thoughts here, and hope others also will if they have additional suggestions!

    I am glad that this woman has seen some positive outcomes with regards to her weight already in the very short time that you have been working with her. Helping her to understand the importance of the dietary shift from high carbohydrate foods to unprocessed foods that are protein rich with a low glycemic load is very important start, especially for someone with diabetes. Although her condition is type 1 diabetes associated with pancreatic dysfunction of the insulin secreting beta islet cells, with a high carbohydrate/high glycemic index diet there still can be aspects of insulin resistance at a cellular and tissue level which can develop along with this. Insulin resistance actually is a risk factor for development for type-1 diabetes, and given that this condition was diagnosed in adulthood (less common than childhood/adolescence) one may question if this was a contributing factor if her diet was also high carbohydrate focused at that time.

    • Fourlanos S, et al. Insulin resistance is a risk factor for progression to type 1 diabetes. Diabetologia. 2004 Oct;47(10):1661-7. http://tinyurl.com/psrvagw
    • Nokoff NJ, et al. The interplay of autoimmunity and insulin resistance in type 1 diabetes. Discov Med. 2012 Feb;13(69):115-22. http://tinyurl.com/okdawas

    When blood sugar levels are elevated, the risks of complications associated with advanced glycosylated end products are increased. An HgA1c (theglycated haemoglobin (A1c), which identifies average plasma glucose concentration) of 66 mmol/mol (approximately 8%) is significantly elevated, as a healthy normal value should be between 20-42 mmol/mol (4-5.9%). The risk of microvascular complications (seen in the kidneys and retina primarily), peripheral neuropathy and cardiovascular complications are also higher with poorly managed blood sugar levels in diabetics. In individuals with diabetes, microvasculature effects are significantly greater (approximately 35%) with an HbA1c of 59 mmol/mol (7.5%) than 48 mmol/mol (6.5%).

    • ACCORD Study Group; et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010 Jul 15;363(3):233-44. http://tinyurl.com/pr3w9po

    A period of 2 months is actually a very short time, given that she probably has accumulated this excess weight of a period of 25 years. When working with people to achieve healthy weight loss it is very important to emphasize that the weight loss that occurs over longer periods of time, and is relative to healthy diet changes rather than crash dieting, is much better maintained. Although she has reported the improvements in diet over the short period of 2 months, ongoing support and encouragement is important to help her continue on this path especially as her weight has had a plateau. Finding other groups of people who are working with a healthy diet such as this, or long term weight loss changes can be very supportive. There may be such groups that she can find via her local hospital or wellness center, as weight loss groups and diabetes support groups are arranged by many community health organizations.

    I’m not certain why you have ascertained that portion size is not relevant for this client but you may want to suggest that for a period of a couple days that she measure her food portions and calculate her caloric consumption. Oftentimes people minimize the amount of food that they take in through snacking and at mealtimes throughout the day. Doing such may shed light on areas of which problem she has not been aware.

    I also see exercise as something which must be much more significant than 30 minutes 3 – 4 times a week for the purpose of weight loss. Studies consistently show that in order to lose weight, one must exercise at least 300 minutes per week includes weight bearing activities. Exercise as a lifestyle choice often needs to be emphasized – things such as walking to work, taking the stairs, parking at least a 10 minute walk from destinations etc should be discussed, with the goals of doing these things multiple times per week if possible as well. Formal exercise such as aerobic and weight training should be at least 45 minutes five times a week in addition to this.

    • Chang L. Weight Loss May Take 250 Minutes of Exercise. WebMD. 2009. http://tinyurl.com/bdbe65

    Consider non-weight bearing exercises such as those in water on an elliptical machine or a stationary bike for significantly overweight individuals as these will be less likely to cause joint issues. Muscle burns calories more than fat even at rest, and this is the purpose of weight training. The aerobic exercise is important to move the blood, burn calories, improve insulin sensitization, and also for the purpose of cardiovascular health. Exercise is one of the best tools to raise high density lipoprotein (HDL) levels.

    This woman may find it helpful to utilize the services of a personal trainer to support her in her exercise regime, and also may find group settings of an exercise class with people having similar goals to be helpful in creating a community of supporters. Many gyms and fitness centers hold such classes for individuals who want to improve their health and lose weight. There also are many resources one can use online to find groups of people with similar ambition. In the states, one which I find great for finding other focused groups is a resource called “MeetUp” and there may be similar resources in her area – http://tinyurl.com/o2jf4mj. I’ve even used social connecting resources such as Facebook or Craigslist to find running partners, and have had great friendships develop from this.

    An additional factor which you should investigate for this woman is her thyroid function. Hypothyroidism is common, and may manifest in a difficulty losing weight. Given that she has type 1 diabetes, the possibility of thyroid autoimmunity is also more likely, and testing should include thyroid antibodies to rule out this as a contributor. Hypothyroidism often may exist despite normal thyroid stimulating hormone (TSH) levels. Impaired conversion of thyroxine (T4) to triiodothyronine (T3) may exist in genetic obesity. Leptin resistance, common in overweight individuals with difficulty losing weight, may affect thyroid conversion and TSH levels. Insulin resistance also reduces T4 to T3 conversion.

    • Doyle EA. Autoimune Conditions Associated With Type 1 Diabetes. PediatrNurs. 2015 Mar-Apr;41(2):89-91. http://tinyurl.com/oem6qsh
    • Katzeff HL, Selgrad C. Impaired peripheral thyroid hormone metabolism in genetic obesity. Endocrinology. 1993 Mar;132(3):989-95. http://tinyurl.com/p2vl4e9
    • Cettour-Rose P, Burger AG, Meier CA, Visser TJ, Rohner-Jeanrenaud F. Central stimulatory effect of leptin on T3 production is mediated by brown adipose tissue type II deiodinase. Am J Physiol Endocrinol Metab. 2002 Nov;283(5):E980-7. http://tinyurl.com/o6pv8hr
    • Holtorf K. Peripheral Thyroid Hormone Conversion and Its Impact on TSH and Metabolic Activity. J Restor Med. 2014;3(1): 30-52. http://tinyurl.com/k5y8h3k

    T3 is the more active form of thyroid in the body. Assessment of reverse T3 (rT3) is important as well. Reverse T3 blocks thyroid receptors, preventing T3 from exerting its normal action. Conversion of T4 to rT3 increases with chronic stress and illness, as well as insulin resistance. A full thyroid panel – http://tinyurl.com/95stu79 – as well as testing of rT3 – http://tinyurl.com/mx3kjvb – will provide this information. The last reference of the three directly below is a very comprehensive and recent discussion about these topics which you may find useful.

    Coeliac disease is also more common in individuals with type-1 diabetes and recommending testing to rule this out as an issue which must be addressed or continuing to advocate the thorough elimination of gluten from the diet should be considered.

    • Smyth DJ, et al. Shared and distinct genetic variants in type 1 diabetes and celiac disease. N Engl J Med. 2008 Dec 25;359(26):2767-77. http://tinyurl.com/qy2tk9z

    Vitamin D deficiency is also associated with an increased risk of cardiovascular disease as well as many other conditions in which altered immune regulation is a feature.

    • Wang TJ, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008 Jan 29;117(4):503-11. http://tinyurl.com/phhw9jq
    • Cutolo M. Vitamin D and autoimmune rheumatic diseases. Rheumatology (2009) 48 (3): 210-212. http://tinyurl.com/pko6qhw
    • Shaik-Dasthagirisaheb YB, et al. Role of vitamins D, E and C in immunity and inflammation. J BiolRegulHomeost Agents. 2013; 27(2):291-295. View Abstract

    I like to recommend that my clients work are working to achieve weight loss use a nutritionally fortified protein formula possibly in combination with a greens powder and probiotic incorporated into a smoothie for one of their meals daily. To increase satiety and meet nutritional needs, a healthy fat such as a portion of nut butter or avocado should be added to the smoothie. Liquid fish oil also can be included if desired.

    When individuals make smoothies it is often important to emphasize that this should not be something that is only fruit focused, but rather a way to introduce vegetables and possibly a small amount of fruit for sweetness. Blueberries and bilberries(the Vacciniumfamily) however,may be used at a serving or two daily as they support blood sugar balance and endothelial function and offer a high level of antioxidants.

    • Rodriguez-Mateos A, et al. Intake and time dependence of blueberry flavonoid-induced improvements in vascular function: a randomized, controlled, double-blind, crossover intervention study with mechanistic insights into biological activity. Am J Clin Nutr. 2013 Nov;98(5):1179-91. http://tinyurl.com/nytvj4f
    • Kolehmainen M, et al. Bilberries reduce low-grade inflammation in individuals with features of metabolic syndrome. Mol Nutr Food Res. 2012 Oct;56(10):1501-10. http://tinyurl.com/phdqx4k
    • Takikawa M, et al. Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice. J Nutr. 2010 Mar;140(3):527-33. http://tinyurl.com/pxj2h82

    A complete greens formula without many added sweeteners can be of great benefit to someone who is struggling to get on track with healthy eating. Many greens powders offer the nutrition that the body is lacking when having cravings and binges or periods of overeating. Probiotics also are often included, and this helps to balance out the gastrointestinal flora which often is out of balance in carbohydrate cravers. I usually advise people who struggle with healthy dietary choices to include a complete greens formula on a daily basis, and even taking it up to three times a day when having struggles with cravings. Some people find it useful to take as needed if carbohydrate cravings arise, or after periods of eating more high carbohydrate or nutritionally lacking foods. It seems to help to push the “reset” button after a period of less healthy eating.

    Other food-directed therapies that may assist in reducing cravings for high carbohydrate foods include bitters and natural sources or probiotics. Taking time to eat, chewing foods fully, and including bitter foods in the diet all will support digestive function and food awareness. Bitter foods include greens such as arugula, kale, brussel sprouts, dandelion, and radicchio, as well as artichoke. Bitterness also comes from the other parts of fruits which are often discarded such as orange peels. Having some aspect of bitter foods at the start of each meal will help to promote improved digestion and reduce carbohydrate cravings. Alternately bitters can come directly from something such as cocktail bitters, and drank with a small amount of water and citrus before meals to support the digestive process. Food sources of probiotics include sauerkraut, kefir, kimchi, and kombucha. Eating more foods such as these will also help improve gastrointestinal flora balance and may reduce sugar cravings.

    Many studies are looking at the relationship between weight loss and obesity. Although much will inevitably be learned from this as we advance techniques utilized to perform such studies, there is information pertaining to these findings that many individuals are in agreement of. Obesity has been shown to be associated with changes in the relative abundance of the two dominant bacterial divisions, the Bacteroidetes and the Firmicutes, and also may lack the biodiversity of that in individuals having a healthy weight. For this reason, advocating the use of a probiotic including YY, and also a broad spectrum probiotic may be of benefit, as well as rotating the use of probiotics regularly.

    • Escobedo G, et al. Gut microbiota as a key player in triggering obesity, systemic inflammation and insulin resistance. Rev Invest Clin. 2014 Sep-Oct;66(5):450-9. http://tinyurl.com/obwx7s3
    • Turnbaugh PJ, et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006 Dec 21;444(7122):1027-31. http://tinyurl.com/pkhxq6w
    • Turnbaugh PJ, et al. A core gut microbiome in obese and lean twins. Nature. 2009 Jan 22;457(7228):480-4. http://tinyurl.com/n9fzqjr
    • Caricilli AM, et al. Gut microbiota composition and its effects on obesity and insulin resistance. CurrOpinClin Nutr Metab Care. 2014 Jul;17(4):312-8. http://tinyurl.com/qbxc8b5

    Chronic consumption of high carbohydrate/sugar containing foods leads to dysbiosis and poor flora balance, and the dietary changes she is working to make will support improved flora diversity as well. Butyrate (a short chain fatty acid) has been shown to support improvements in large intestine flora as well as support weight loss. You may wish to do a stool panel to assess for issues of dysbiosis as a contributor. In my practice I use the Comprehensive Stool Analysis with parasitology test from Doctor’s Data – http://tinyurl.com/q4256rk – which is available from Regenerus labs; Genova Diagnostics also offers a Comprehensive Digestive Stool Analysis / Parasitology ™ – http://tinyurl.com/p6gopyt. If parasitology is not desired, such panels can be run without this option as well.

    • Lin HV, et al. Butyrate and propionate protect against diet-induced obesity and regulate gut hormones via free fatty acid receptor 3-independent mechanisms. PLoS One. 2012;7(4):e35240. http://tinyurl.com/nt4cf9m

    Fibre supports weight loss as well from multiple perspectives – serving as a bulking agent to create a sensation of fullness, and providing prebiotics for the support of healthy intestinal flora. Dietary foods such as leeks, asparagus, chicory, Jerusalem artichokes, garlic, onions, soybeans, are sources of prebiotics, and increasing the consumption of these foods will introduce both prebiotics as well as other nutrients to the diet.

    • Gibson GR, Probert HM, Loo JV, Rastall RA, Roberfroid MB. Dietary modulation of the human colonic microbiota: updating the concept of prebiotics. Nutr Res Rev. 2004 Dec;17(2):259-75. http://tinyurl.com/n2ylhoz
    • Liber A, Szajewska H. Effects of inulin-type fructans on appetite, energy intake, and body weight in children and adults: systematic review of randomized controlled trials. Ann Nutr Metab. 2013;63(1-2):42-54. http://tinyurl.com/nw6qzs5

    Lipoic acid is an antioxidant which reduces the risk of diabetic neuropathy and also supports the reduction of HbA1c levels. To further enhance weight loss goals, there is good evidence that alpha lipoic acid also may provide benefit.

    • Heitzer T, et al. Beneficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free RadicBiol Med. 2001 Jul 1;31(1):53-61. http://tinyurl.com/nk3ogj8
    • Packer L1, Kraemer K, Rimbach G. Molecular aspects of lipoic acid in the prevention of diabetes complications. Nutrition. 2001 Oct;17(10):888-95. http://tinyurl.com/pf6j5qz
    • Poh ZX, Goh KP. A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. http://tinyurl.com/l9pakyw
    • Koh EH, et al. Effects of alpha-lipoic Acid on body weight in obesesubjects. Am J Med. 2011 Jan;124(1):85.e1-8. http://tinyurl.com/a4ark8u
    • Carbonelli MG, et al. Alpha-lipoic acid supplementation: a tool for obesity therapy? Curr Pharm Des. 2010;16(7):840-6. http://tinyurl.com/aggmvfd
    • Sola S, et al. Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study. Circulation. 2005 Jan 25;111(3):343-8. http://tinyurl.com/o4z3xmj

    Berberine and chromium are often used in individuals with diabetes, and support the normalisation of both fasting blood sugars and on a longer term basis HbA1c levels. Supplementation with berberine has also been shown to improve dyslipidemia, reducing total cholesterol, triglycerides, and LDL. Berberine also has been shown to improve insulin sensitization and modify the gut microbiota which may contribute to the effects seen in individuals with diabetes. A combination of chromium picolinate and biotin has been shown to improve glucose management and several lipid measurements in patients with poorly controlled diabetes.

    • Zhang Y, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab. 2008 Jul;93(7):2559-65. http://tinyurl.com/pp8xhw6
    • Derosa G, et al. Berberine on metabolic and cardiovascular risk factors: an analysis from preclinical evidences to clinical trials. Expert OpinBiolTher. 2012 Aug;12(8):1113-24. http://tinyurl.com/p47c8ru
    • Wang Y, et al. Hypoglycemic and insulin-sensitizing effects of berberine in high-fat diet- and streptozotocin-induced diabetic rats. Metabolism. 2011 Feb;60(2):298-305. http://tinyurl.com/o57ra7p
    • Han J, et al. Modulating gut microbiota as an anti-diabetic mechanism of berberine. Med SciMonit. 2011 Jul;17(7):RA164-7. http://tinyurl.com/pq97mjt
    • Singer GM, et al. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial. Diabetes TechnolTher. 2006 Dec;8(6):636-43. http://tinyurl.com/q2j4sx2

    Stress may lead to food coping behaviours, and elevated cortisol is connected with insulin resistance as well as impaired thyroid conversion. Doing things to reduce stress also supports weight loss and healthy eating. Support for stress reduction can include deep breathing techniques, gentle yoga or grounding poses, taking a walk or going outside before meals all can help to reduce stress, and may be beneficial.

    • Rizza RA, Mandarino LJ, &Gerich JE. Cortisol-Induced Insulin Resistance in Man: Impaired Suppression of Glucose Production and Stimulation of Glucose Utilization due to a Postreceptor Defect of Insulin Action. J. Clin. Endocrinol. Metab., Jan 1982; 54: 131 – 138. http://tinyurl.com/7fzqx8c

    Sleep hygiene is also important. Lack of sleep increases ghrelin and decreases leptin hormones. The former increases appetite and that latter suppresses. Discussion of sleep hygiene (no electronics at least an hour before bed, last meal 2 hours before bed, sleeping in a dark room, etc) may also be things that you wish to discuss.

    • Garaulet M, et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes (Lond). 2011 Oct;35(10):1308-17. (http://tinyurl.com/aej2zug)

    There are a variety of discussions on the Clinical Education group which you may find helpful for ideas concerning weight loss and healthy eating. Do read some of these at http://tinyurl.com/qyhc43f &http://tinyurl.com/pvaqwb7& http://tinyurl.com/kkya6ab. Do search the terms “weight loss,” “overweight,” and “obesity” to view these threads as you may find various clinical pearls which may be helpful for the various clients you are working with. If you are not yet familiar with it, you may find the Control-IT Programme from Antony Haynes available on the Nutri Link Ltd Clinical Education site also to be useful – http://tinyurl.com/38lvpzb.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.The suggestions listed here may have redundancies, and the specific use of therapies is subject to practitioner discretion.

    Weight loss support:

    • NT Factor Healthy Curb® (ARG): 2 tablets three times daily twenty minutes before meals. http://tinyurl.com/8aguodw Supports healthy metabolism, cellular, and mitochondrial function.

    • ButryEn (ARG): 1-2 with each meal. http://tinyurl.com/4hrlk52. Provides enteric coated butyric acid. Supports weight loss and healthy large intestine flora.

    • Whey Protein Isolate (BRC): 1 – 2 scoops daily with 8oz of liquid. http://tinyurl.com/nho3kyz May combine with Progreens:

    • ProGreens (ARG): 1 scoop up to three times daily with liquid. http://tinyurl.com/oaqnlux Complete greens formula including probiotic support.

    If greens formula is not desired consider:

    • ProMulti-Plus (BRC): 2 caps three times daily with food. http://tinyurl.com/cy3h8u2

    • Bio-D-Mulsion™ Forte (BRC): 1-2 drops daily with food. 2000IU per drop. Dosage to be determined by current serum level. http://tinyurl.com/kfpjyw6

    Support for insulin sensitization, endothelial function, and weight loss:

    • ALA Release (ARG): Gradually increase up to 3 tablets twice a day. http://tinyurl.com/n7fl8l7 – Watch for hypoglycemic symptoms.

    OR

    • Lipoic Acid Plus (BRC): 3 capsules twice daily with food. Each capsule provides 100 mg of alpha lipoic acid with 50 mg of vitamin C. http://tinyurl.com/njz6kv5

    Stress support if indicated:

    • 200 mg of Zen (ARG): 1 capsule up to three times a day as needed for anxiety. http://tinyurl.com/89vstsf Supports reduction of stress and GABA/glutamate balance.

    Ongoing with the use of statin medication:

    • CoQ-Zyme 30 (BRC): 1 tablet three times daily with meals. http://tinyurl.com/6oo5man

    OR

    • CoQH-CF™ (ARG): 1 softgel twice daily with meals. http://tinyurl.com/6oo5man Provides ubiquinol is a reduced form of coenzyme Q10, supports cardiovascular health.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Sensitivity to water #17930

    Hello Louise,

    Thank you for posing this question. I’m glad you are working with this woman to address her concerns and looking into this issue. It is somewhat difficult to work with people who have many sensitivities to foods and supplements such as your client experiences.

    Given her symptoms of mucosal dryness, further investigation into the possibility of Sjögren’s Syndrome is appropriate. Sjögren’s syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function. SS occurs in a primary form not associated with other diseases and in a secondary form that complicates other rheumatic conditions. Although the diminished lacrimal and salivary exocrine function is the most commonly known symptom, there are many systemic issues which can occur with this disease.

    In primary or secondary SS, decreased exocrine gland function leads to the “sicca complex,” a combination of dry eyes (keratoconjunctivitissicca [KCS]) and dry mouth (xerostomia). In addition, a wide variety of other disease manifestations can occur in SS. The KCS and xerostomia of SS are caused by immune-mediated inflammation directed against the exocrine glands of the eye and mouth. The histologic features include extensive lymphocytic infiltration, accompanied by glandular and ductal atrophy. Exocrine gland involvement in the skin and upper airway tract may lead to xerosis, a nonspecific cough, and other symptoms.

    Oral dryness is associated with an increased rate of dental caries and periodontal complications and often with a decrease in the sense of taste and a change in oral flora, including an increase in oral candidiasis. Dysphagia is common in SS. This is most often due to lack of saliva, but there have also been reports of oesophageal dysmotility similar to that seen in scleroderma. Nausea, epigastric pain, and dyspepsia are other frequent complaints. Achlorhydria and pernicious anaemia can also occur. A substantial percentage of patients with SS have anti-parietal cell antibodies.

    • Schiødt M, et al. Periodontal disease in primary Sjögren’s syndrome. Oral Dis. 2001 Mar;7(2):106-8. http://tinyurl.com/q34ccsc
    • Maury CP, et al. Atrophic gastritis in Sjögren’s syndrome. Morphologic, biochemical, and immunologic findings. Arthritis Rheum. 1985 Apr;28(4):388-94. http://tinyurl.com/qj4gdtm

    Involvement of exocrine glands in the upper airways leads to symptoms related to the nose, sinuses, and posterior pharynx in 50 to 70 percent of patients with SS. Such patients can have recurrent non-allergic rhinitis and sinusitis.

    • Freeman SR, et al. Ear, nose, and throat manifestations of Sjögren’s syndrome: retrospective review of a multidisciplinary clinic. J Otolaryngol. 2005 Feb;34(1):20-4. http://tinyurl.com/oew6z6t

    Women with SS may develop dysuria, urinary frequency, nocturia, and urgency. In the absence of a urinary tract infection, these symptoms in a patient with SS may be secondary to interstitial cystitis. The presence of such urinary symptoms has been found to be 20-fold higher in those with SS.

    • Leppilahti M, et al. Interstitial cystitis-like urinary symptoms among patients with Sjögren’s syndrome: a population-based study in Finland. Am J Med. 2003 Jul;115(1):62-5. http://tinyurl.com/o6m2sfx

    Serologic abnormalities are prominent in many patients with SS. The most common of these are Antinuclear antibodies (74 percent), Anti-Ro/SSA antibodies (40 percent), Rheumatoid factor (38 percent), Anti-smooth muscle antibodies (35 percent), Anti-La/SSB antibodies (26 percent), Anti-parietal cell gastric antibodies (20 percent).

    • García-Carrasco M, et al. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002 Jul;81(4):270-80. http://tinyurl.com/nmjnqks

    There are also other conditions that can cause salivary and mucosal dryness. Although Sjogren’s is the most common cause of sicca syndrome, this condition also can be caused by primary salivary gland amyloidosis as well as systemic amyloidosis.

    • Myssiorek D, et al. Primary salivary gland amyloidosis causing sicca syndrome. Ann OtolRhinolLaryngol. 1992 Jun;101(6):487-90. http://tinyurl.com/p8e95oc
    • Richey TK, et al. Etiologies of the sicca syndrome: primary systemic amyloidosis and others. Int J Dermatol. 1996 Aug;35(8):553-7. http://tinyurl.com/nh3f99l

    Saliva plays an important role in the balance of health of both the oral mucosa and gastrointestinal tract. Some of the downstream symptoms of sicca syndrome may have association with the decreased production of salivary epidermal growth factor (sEGF) and other aspects of saliva that serve to protect the mucosal surfaces. With decreased saliva and related sEGF, there is an increased permeability of the oesophageal mucosa to hydrogen ion, and decreased mucus content.

    • Dodds MW, et al. Health benefits of saliva: a review. J Dent. 2005 Mar;33(3):223-33. http://tinyurl.com/nc5bjz9
    • de Almeida Pdel V, et al. Saliva composition and functions: a comprehensive review. J Contemp Dent Pract. 2008 Mar 1;9(3):72-80. http://tinyurl.com/pn776dg
    • Sarosiek J, et al. The interrelationship between salivary epidermal growth factor and the functional integrity of the esophageal mucosal barrier in the rat. Am J Med Sci. 1991 Dec;302(6):359-63. http://tinyurl.com/p73nfbd

    Aquagenic urticaria has been described.There are fewer than 100 cases of aquagenic urticaria reported in the medical literature. Familial occurrences have been reported on several occasions. Similar to your description, this condition manifests with symptoms of hives after coming into contact with water. The mechanism of this phenomenon remains poorly understood, and may not be the same in all patients.

    • Luong KV, Nguyen LT. Aquagenic urticaria: report of a case and review of the literature. Ann Allergy Asthma Immunol. 1998 Jun;80(6):483-5. http://tinyurl.com/pd3q9g5
    • McGee JS, et al. An adolescent boy with urticaria to water: review of current treatments for aquagenic urticaria. PediatrDermatol. 2014 Jan-Feb;31(1):116-7. http://tinyurl.com/pfavppu

    Several researchers have proposed that water is primarily acting as a solvent in aquagenic urticaria, solubilizing an antigen that then permeates the skin and activates dermal mast cells. Water may interact with sebum (the oily substance produced by sebaceous glands in the skin) to form a substance capable of acting as a direct mast cell degranulator, resulting in histamine release. Others have proposed that the causative antigen(s) normally resides at the epidermal layer of the skin and solubilization in water allows this antigen to diffuse more deeply into the skin.

    • Shelly WB, et al. Aquagenic urticaria: Contact sensitivity reaction to water. JAMA. 1964 Sep 21;189:895-8. http://tinyurl.com/q6adtfu
    • Czarnetzki BM, et al. Evidence that water acts as a carrier for an epidermal antigen in aquagenic urticaria. J Am AcadDermatol. 1986 Oct;15(4 Pt 1):623-7. http://tinyurl.com/natnuwe

    Hives also can occur as a result of heat, emotion, or exertion, and in these situations is called cholinergic urticaria. Case reports describe patients with aquagenic urticaria and coexisting dermographism, cholinergic urticaria, or cold urticaria. Instances of familial aquagenic urticaria have been found to be associated with familial lactose intolerance.

    • Treudler R, et al. Familial aquagenic urticaria associated with familial lactose intolerance. J Am AcadDermatol. 2002 Oct;47(4):611-3. http://tinyurl.com/nkf4b7h

    A trial of antihistamines is commonly used in patients with cholergenic urticaria, however success is variable. Other medications that have had variable effectivity include selective serotonin reuptake inhibitors and beta blockers. Light therapies and barrier creams have also had variable effectiveness. In some patients, salinity appears to be important. You may wish to refer her to an allergist or immunologist as well for further investigation into the cause of her condition.

    Although I have not worked with any clients that have a sensitivity to water which you described, some of these things may be at play. One thing which you may suggest that she do is investigate the pH of liquids which do or do not lead to her symptoms. As salinity has been described to occasionally be an issue with aquagenic urticaria you also may recommend that she investigate if this is an issue for her.

    Investigating the possibility of foods and environmental things that she is sensitive to and reducing intake of high histamine foods is a reasonable approach to her condition. Diamine oxidase (DAO) can also be taken orally, and is an intestinal enzyme that digests histamine. Supplementation with this can be beneficial in individuals with histamine intolerance.An combination food intolerance and inhalant allergy panel may help direct changes that she can make to her diet and environment – the FACTest™ and IgE Inhalant panel is one way to test these all at once – http://tinyurl.com/l5nejnd.

    Providing her body with additional nutrients that support her skin and gastrointestinal mucosa also may be helpful. As emotional issues also can manifest with symptoms of itching and skin conditions, you also may want to direct some aspects of your treatment in supporting this. You may want to recommend that she seek a therapist or hypnotherapy. Supporting her to heal from a holistic approach will not only have impacts now but long term as well.

    Topical castor oil packs to the abdominal region before bed supports lymphatic circulation, reduction of inflammation, and liver detoxification. I generally instruct clients to utilize a simplified castor oil pack by simply massaging castor oil into the abdominal and pelvic region, applying a cotton cloth to protect other garments from the oil, and utilising the body heat to draw the oil internally. A hot water pack may also be applied for a period of 15 – 20 minutes. For the greatest benefit with castor oil it should be done nightly for at least 1 – 2 weeks.

    Do read some of the previous discussions concerning eczema, skin and mucosa health, as these may be helpful in supporting your client – http://tinyurl.com/qylad6k &http://tinyurl.com/obs3gzt.

    Supplements specifically that are powdered or in a liquid form can be found at Nutri-Link as well – http://tinyurl.com/pjr2u4j & http://tinyurl.com/nz6rq6k. When supplements are in a capsule form and my clients have difficulty taking them I do often recommend opening the capsule and mixing it in an appropriate vehicle for consumption. Small gelcaps are definitely easier to swallow than tablets as well!

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • DAO Histaminase with Bioflavonoids (ARG): 1 capsule with meals. http://tinyurl.com/nhx58ln Contains diamine oxidase (DAO), an intestinal enzyme that digests histamine.

    • Arctic Cod Liver Oil (Nordic Naturals): 1 – 2 teaspoons daily with food. http://tinyurl.com/3jgxael Supports reduced allergic response.

    • Bio-D-Mulsion™ Forte (BRC): 1-2 drops daily with food. 2000IU per drop. Dosage to be determined by current serum level. http://tinyurl.com/kfpjyw6

    • Bio-AE-Mulsion Forte (BRC): 2 drops (25,000IU) daily with food. http://tinyurl.com/os3u9u5 Dosages in excess of 5,000IU should not be taken if pregnant.

    • Phospholipid Colostrum (ARG): 1 scoop one to two times daily mixed in small amount of water. http://tinyurl.com/mzeqb43

    • 200 mg of Zen (ARG): 1 – 2 capsules up to three times a day away from food. Supports reduction of anxiety. http://tinyurl.com/89vstsf

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Vitamin D test #17922

    Hello Fleur,

    Thank you for posing this question.

    Vitamin D 25-OH (25-OH-VitD) represents the main body reservoir and transport form of vitamin D, and is therefore what is used in research to determine the relationship between vitamin D levels and health parameters. A fraction of circulating 25-OH-VitD is converted to its active metabolite 1,25-OH-VitD mainly by the kidneys. The Mayo Clinic provides an excellent overview of this topic at http://tinyurl.com/koj224v, and a very valuable video to help understand this can be found at their website as well – http://tinyurl.com/mpf3e8f.

    Please do view this information to better understand this topic, and the clinical case that is presented pertaining to the use of 1,25-OH-VitD measurement beginning at 9:50 in the video.

    In essence what is discussed in the reference you posted has truth, however, as the predominant measurement which is used in studies pertaining to serum vitamin D levels and other health outcomes is the 25-OH-VitD parameter. Because of this when we generally look at if an individual’s vitamin D stores are adequate we use the vitamin D 25-OH values. There are clinical reasons to order the measurement of 1,25-OH-Vit D levels but this is not necessary in the general population without suspicion of abnormalities in vitamin D hydroxylation due to conditions such as chronic kidney disease or granulomatous diseases (particularly sarcoidosis). These individuals may have laboratory abnormalities in calcium, phosphate, and parathyroid hormone (PTH) levels.

    • Li YC. Vitamin D in chronic kidney disease. Contrib Nephrol. 2013;180:98-109. http://tinyurl.com/pmbujp2
    • Kestenbaum, BR. Vitamin D Metabolism and Treatment in Chronic Kidney Disease. Medscape Nephrology. http://tinyurl.com/oy76qjj
    • Adams JS, et al. Biochemical indicators of disordered vitamin D and calcium homeostasis in sarcoidosis. Sarcoidosis. 1986 Mar;3(1):1-6. http://tinyurl.com/ogj26cn

    There is an excellent review on the Clinical Education Website on the reliability of vitamin D testing which you can access here http://tinyurl.com/ctmlrnh. The topic matter of reliability issues was also discussed in a previous question on the Clinical Education group at http://tinyurl.com/lncmxus.

    Doctor’s Data, Inc (DDI) has developed very precise and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for 25-OH vitamin D2 and D3 levels from both serum and dried blood spot samples. DDI developed a robust blood spot test for vitamin D that provides results deemed equivalent to those from serum. In the clinical setting blood spots were collected (finger prick) by 31 subjects and serum was obtained after blood was drawn by a phlebotomist. All samples were sent to DDI for analysis of Total 25-OH D. Results showed excellent agreement for the results from the blood spots and serum, and there was no apparent systematic bias. The data provide evidence that substantially equivalent results for 25-OH D status can be obtained in the real life clinical setting for patients from self-collected blood spots or serum. The home spot test is available from Regenerus labs. http://tinyurl.com/ojnxjsn. It costs £25 practitioner or £30 for patient.

    A recent study looking at variable vitamin D3 dosing in white postmenopausal women with vitamin D insufficiency (defined as a 25-OH-VitD level ≤50 nmol/L) found that 800IU/d of vitamin D3 was sufficient to achieve a 25-OH-VitD) levels greater than 50 nmol/L (20 ng/mL). Obese women (body mass index ≥30 kg/m(2)) were observed to have a 25-OH-VitD level that was 17.8 nmol/L (7.3 ng/mL) lower than women with a normal body mass index (<25 kg/m(2)). Individuals dosing vitamin D3 at 3200 IU/d experienced levels of 25-OH-VitD of 112 nmol/L (44.9 ng/mL), however the dose-responsivity curves were observed to plateau at this level in the 12 months of this study.

    • Gallagher JC, et al. Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann Intern Med. 2012 Mar 20;156(6):425-37. http://tinyurl.com/mbaw55h

    Serum 25-OH-VitD levels tend to be lower in women with darker skin colour, although it was found that a dosage of 800 IU/d of vitamin D3 increased serum 25-OH-VitD greater than >50 nmol/L (20 ng/mL) in 97.5% of the African American women. Lower levels of serum 25-OH-VitD in African Americans are hypothesized to be due to lower production of vitamin D in skin, as they were equally responsive to oral dosing of vitamin D3.

    • Gallagher JC, et al. Effects of vitamin D supplementation in older African American women. J Clin Endocrinol Metab. 2013 Mar;98(3):1137-46. http://tinyurl.com/m7jdgoy

    If individuals have high blood or urine calcium levels, supplementation of vitamin D should be used with caution and under the care of a physician with routine testing to monitor these parameters. Variable vitamin D dosing from 400IU – 4,800IU has not been shown to be related to the development of hypercalcemia or hypercalciuria in healthy women, although this study excluded individuals who had pre-existing high blood or urine levels of calcium and for these people there may be greater risks.

    • Gallagher JC, et al. Incidence of hypercalciuria and hypercalcemia during vitamin D and calcium supplementation in older women. Menopause. 2014 Nov;21(11):1173-80. http://tinyurl.com/mzw2j8y

    Testing recommendations vary as there is debate between the cost vs. benefits of regular testing. The Endocrine Society recommends supplementing the general population with 1000–2000 IU vitamin to reduce the costs of vitamin D testing for insufficiency. Other resources recommended that individuals supplementing vitamin D have 25-OH-VitD levels tested every 3 months to make sure that blood levels are in a safe and healthy range. As mentioned previously, testing of serum and 24-hour urinary calcium should also be considered if individuals have historically had elevation of either of these parameters.

    • Peiris AN, et al. Vitamin D testing. Lancet. 2012 May 5;379(9827):1700 ; author reply 1700-1. http://tinyurl.com/kub6rfp
    • Holick MF, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. http://tinyurl.com/mpk7mx6
    • How do I get the vitamin D my body needs? Vitamin D Council. http://tinyurl.com/lb2qj56

    With the significant amount of people who use supplemental vitamin D there has been recent research into the possible drug interactions and drug/nutrient metabolism pathways. Vitamin D is believed to induce cytochrome P450 3A4 (CYP3A4) enzymes, the enzyme which metabolizes multiple medications including atrovastatin, clarithromycin, cyclosporine, diltiazem, oestrogens, indinavir, triazolam, as well as many others.

    • Robien K, et al. Drug-vitamin D interactions: a systematic review of the literature. Nutr Clin Pract. 2013 Apr;28(2):194-208. http://tinyurl.com/p87oppk
    • Drocourt L, et al. Expression of CYP3A4, CYP2B6, and CYP2C9 is regulated by the vitamin D receptor pathway in primary human hepatocytes. J Biol Chem. 2002 Jul 12;277(28):25125-32. http://tinyurl.com/mhz67dj
    • Wang Z, et al. Interplay between vitamin D and the drug metabolizing enzyme CYP3A4. J Steroid Biochem Mol Biol. 2013 Jul;136:54-8. http://tinyurl.com/p55wz7a
    • Guengerich FP. Cytochrome P-450 3A4: regulation and role in drug metabolism. Annu Rev Pharmacol Toxicol. 1999;39:1-17. http://tinyurl.com/lwhq6hf

    SUGGESTED SUPPLEMENTS

    A variety of vitamin D and combination supplements with vitamin D are available via Nutri-Link. Combinations that include vitamin D are fish oil, vitamin A/D/E/K combinations, and bone support formulas. Vitamin D is also included in multivitamins and some immune support combinations. Some options which you may wish to consider for your clients are listed below; however this list is not complete as many products are available which include vitamin D. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Bio-D-Mulsion (BRC): 400IU/drop http://tinyurl.com/p7glm74

    • Bio-D-Mulsion Forte (BRC): 2,000IU/drop http://tinyurl.com/l55wuav

    • Full Spectrum Vitamin K (ARG): Combination fat soluble nutrient formula. http://tinyurl.com/kz2ayor

    • Super D3 (ARG): Provides 2000IU/capsule. http://tinyurl.com/l2z7qp3

    • Vitamin D3 Complete ARG): Provides 2000IU/capsule. Combination fat soluble nutrient formula. http://tinyurl.com/kjknytq

    • Osteo-Vi-Min Powder (ARG): Provides 200IU/tsp. Bone health support formula. http://tinyurl.com/lc925xl

    • Osteo B Plus (BRC): Provides 200IU/3 tablets. Bone health support formula. http://tinyurl.com/ongjuou

    • ProOmega D Lemon (NN): Provides 1000IU/2 softgels. Fish oil/D3 combination. http://tinyurl.com/ooxdafg

    Please consider these suggestions in light of the other clinical information pertaining to your individual clients. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Vegan diet suitable for an 8 month old baby #17903

    Hello Zara,

    Thank you for posting this discussion here, and I do hope othersalso offer responses concerning their experience as well.

    One of the foremost things to consider is if the nutritional needs of the infant are being met, and what the quality of the vegan diet is that the mother follows. From the foods you mentioned it does sound like the vegan diet being encouraged has a fairly healthy basis of fruits, vegetables, legumes, and grains. Protein choices such as tofu, tempeh, and soft cooked beans will be helpful in meeting the needs of the toddler, and can be easily introduced rather than meats. They are also easier to create in a soft form not requiring much chewing, as is needed by an 8 month old child.Very young children may need a slightly higher fat intake than adults do. Healthier fat sources include avocados and nut butters. Snacks such as olives also provide healthy fats, but may take time to develop a palate for and until then ensuring vegetables are cooked in a generous amount of olive oil will help meet the intake of dietary fat needed.

    One nutrient which is commonly deficient in vegans in B12, as animal proteins are a significant source of this. As the mother is vegan, she should make sure she is getting enough B12 in her diet or through supplements, so it can be passed to her baby through her breast milk. If she is not taking a vitamin B12 supplement, then the baby possibly should take one.Nutritional yeast has naturally occurring B12, and can be included in the diet as a source of this.

    There are many resources devoted to supporting vegans in their lifestyle choices for them and their offspring. You may want to recommend some of these websites as they offer further suggestions on raising children who are vegan. Some more formal groups supporting a vegan lifestyle such as The Vegan Society – http://tinyurl.com/mmyn3ng, the Vegetarian and Vegan Foundation – http://tinyurl.com/7felb4z, and the Physicians Committee for Responsible Medicine – http://tinyurl.com/mqeukn7 are resources that offer much information about meeting nutritional needs with a vegan diet in children. Looking for local groups that support holistic healthy living and veganism also may help them to find additional resources, as well as community with others who lead a similar lifestyle.

    Although a vegan diet is preferred, they may wish to consider opening up to their child following a vegetarian diet. They may find this to be easier for their child in the variety of settings often encountered such as day care and school programs. As the child becomes older and able to understand the reasons for choosing veganism they may make this choice for themselves.

    Please see the discussion pertaining to infant formulas on the Clinical Education Group as this discusses the various options available in the UK – http://tinyurl.com/mzuazxc. Two soya based formulas which you may wish to recommend are Wysoy (SMA Nutrition Dairy free, based on natural soya and suitable for a vegetarian diet) and Farley’s Soya Formula (Heinz Soya-based product, containing no animal products). Soy milk, rice milk, and many alternative non-dairy milks also may be introduced just as foods are to meet nutritional needs. Just as one would recommend a diverse diet to meet a broad spectrum of nutritional needs, this should be recommended with a vegan patient as well (ie not just using soy protein to meet all needs).

    Introducing a small amount of digestive enzymes in the form of papain may help to resolve the issues of constipation. I also often recommend that mothers support the infants who are struggling with constipation with gentle massage of castor oil to the abdomen in the direction of the colon (from lower R quadrant, upward, horizontal below the ribs, and downward on the L). Small circular motions with two finger tips along this path should be sufficient.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Caricol (ARG): 1/3 sachet 15 minutes prior to meals. http://tinyurl.com/pr69u3a Supports digestion and normal motility.

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: 30s yo M with Crohn #17900

    Hello Elizabeth,

    Thank you for posting this question here.

    The absorption and metabolic competition between essential fatty acids (EFAs), the correct biological balance for improved health, and many other specific finer points of this topic are the study of much research. I am not a specialist in essential fatty acid metabolism or biochemistry, but will try to address some pertinent issues that others have found with their research on this subject matter.

    Both dietary intake and endogenous metabolism influence whole-body status of EFA. The long-chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can be synthesised from alpha-linolenic acid (ALA), but due to low conversion efficiency, it is recommended to obtain EPA and DHA from additional sources. Genetic polymorphisms in fatty acid synthesising enzymes can have a significant impact on fatty acid levels in the body.

    • Linus Pauling Institute. Essential Fatty Acids. Accessed August 14, 2015. Updated in April 2014 by Giana Angelo, Ph.D. http://tinyurl.com/35lnvn

    With resection of the colon, the most common complications are dehydration and hyponatraemia, as well as a greater frequency of defecation and a more liquid stool consistency.The colon is primarily an organ for water and salt absorption. From the 1 – 2 L of liquid stool that enters the colon, about 120 mL of liquid remains in formed stool. Water absorption is coupled with salt absorption as the colon absorbs both sodium and potassium.Removal of colon and rectum also reduce the amount of space for storing stool between bowel movements, which can further increase the frequency of defecation. Frequent defecation can cause significant irritation to the anus as a result of post-defecation hygiene practices such as toilet tissue use.

    • Warner BW. Short- and long-term complications of colectomy. J PediatrGastroenterolNutr. 2009 Apr;48Suppl 2:S72-4. http://tinyurl.com/ncb436m

    Theileocecal valve (ICV) functionally regulates the junction between the small and large intestine. Without an ICV the flora normally localised to the colon can populate the small intestine. If there is no ICV the loss of fluid and nutrients increases.

    • Folaranmi S, et al. Ileocaecal valve: how important is it? PediatrSurg Int. 2011 Jun;27(6):613-5. http://tinyurl.com/nkj5s8a

    With altered colon structure and gastrointestinal motility, secretion of digestive substances also is affected. Colonic resection also leads to insulin resistance, possibly due to alterations in fatty acid metabolism. Colectomised subjects have been shown to have an increased rate of nonesterified fatty acid (NEFA) and glycerol release from adipose tissueespecially in the late postprandial period, as well as an increased uptake of fatty acids into muscle.Inappropriately elevated plasma NEFA concentrations may have a number of adverse effects on both carbohydrate and lipid metabolism.Inappropriate release of NEFA in the postprandial period is likely both to reduce the sensitivity of glucose metabolism to insulin and to accentuate postprandial lipaemia.

    • Robertson MD, et al. Enhanced metabolic cycling in subjects after colonic resection for ulcerative colitis. J ClinEndocrinolMetab. 2005 May;90(5):2747-54.http://tinyurl.com/qy7dh4d
    • Frayn KN. Non-esterified fatty acid metabolism and postprandial lipaemia.Atherosclerosis. 1998 Dec;141Suppl 1:S41-6.http://tinyurl.com/orq769e

    In a typical vegan diet (including legumes, soy, and nuts) it has been found that the levels of n−3 polyunsaturated fatty acids (PUFAs) are depressed to very low levels with of consumption with prolonged consumption of the high linoleic and oleic acid components of this diet.Generally speaking, vegetarian and especially vegan diets supply more linoleic acid (18:2n-6) than omnivore diets. The ratio of n−3 to n−6 fatty acids was only about half that in omnivores, ie the n-6 to n-3 ratio was twice that of omnivores. The proportions of DHA in plasma, blood cells, breast milk, and tissues also have been shown to be substantially lower in vegans and vegetarians compared with omnivores. This is similar to the findings with your client – an elevation of n-6 to n-3 ratio and low n-3 levels.

    • Agren JJ, et al. Fatty acid composition of erythrocyte, platelet, and serum lipids in strict vegans. Lipids. 1995 Apr;30(4):365-9. http://tinyurl.com/pxdqsot
    • Sanders TA. DHA status of vegetarians.Prostaglandins LeukotEssent Fatty Acids. 2009 Aug-Sep;81(2-3):137-41.http://tinyurl.com/qj7nqok

    Another study also found proportions of plasma EPA and DHA were lower in the vegetarians and in the vegans than in the meat-eaters, whereas only small differences were seen for DPA. Plasma EPA, DPA, and DHA proportions were not significantly associated with the duration of time since the subjects became vegetarian or vegan, which ranged from <1 y to >20 y. In the vegetarians and the vegans, plasma DHA was inversely correlated with plasma LA.This finding suggests that when animal foods are wholly excluded from the diet, the endogenous production of EPA and DHA results in low but stable plasma concentrations of these fatty acids. It has been suggested that total n-3 requirements may be higher for vegetarians than for nonvegetarians.

    • Rosell MS, et al. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J ClinNutr. 2005 Aug;82(2):327-34. http://tinyurl.com/ovoth4g
    • Davis BC, et al. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications.Am J ClinNutr. 2003 Sep;78(3 Suppl):640S-646S.http://tinyurl.com/p6mnttb

    The capacity to generate DHA from ALA is higher in women than men. Studies of ALA metabolism in healthy young men indicate that approximately 8% of dietary ALA is converted to EPA and 0-4% is converted to DHA. In healthy young women, approximately 21% of dietary ALA is converted to EPA and 9% is converted to DHA. It is suggested that this is due the effects of oestrogen.

    • Schuchardt JP, et al. Bioavailability of long-chain omega-3 fatty acids. Prostaglandins LeukotEssent Fatty Acids. 2013 Jul;89(1):1-8. http://tinyurl.com/ll4bmqd

    Contrary to your findings, population studies of individuals with Crohn’s disease found that Crohn’s disease was associated with higher concentrations of eicosapentaenoic acid (EPA) and other n-3 PUFA, and lower arachidonic acid This does not distinguish the impact of dietary choices (vegan vs omnivore) and does not reflect a population having a colectomy. However an animal model of altered bowel and dietary fat restriction had outcomes similar to what has been seen in your client. In this study rats were treated with chronic total parenteral nutrition (TPN) either containing lipids or fat-free, and also either had a normal intestine or short gut (80% resected). Elevated arachidonate occurred in both groups of fat-free rats (having normal and short gut)suggesting increased Delta6 and/or Delta5 desaturase activity. Higher levels of arachidonic acids also occurred in rats given TPN including lipids, and in combination with other altered fatty acid ratios this suggeststhe rats withshort gut may have a heightened hepatic desaturase activity.

    • Trebble TM, et al. Peripheral blood mononuclear cell fatty acid composition and inflammatory mediator production in adult Crohn’s disease. ClinNutr. 2004 Aug;23(4):647-55. http://tinyurl.com/ox32y7c
    • McCowen KC, et al. Abnormal regulation of serum lipid fatty acid profiles in short gut rats fed parenteral nutrition with lipid.Metabolism. 2004 Mar;53(3):273-7.http://tinyurl.com/qak56yd

    Fish oil plus antioxidant dietary supplementation (2.7 g EPA and DHA/d with vitamins A, C, and E and selenium) was associated with higher EPA and DHA incorporation and lower arachidonic acid levels of peripheral blood mononuclear cells in patients with Crohn’s disease. Supplementation with fish oil and antioxidants also lowered laboratory markers of inflammation (interferon gamma [IFN-gamma], and prostaglandin E2 [PGE2]).

    • Trebble TM, et al. Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am J ClinNutr. 2004 Nov;80(5):1137-44. http://tinyurl.com/n9cmxye

    Although a “reference value” for all of these numbers have been stated by this lab, without data showing a normal range a single reference number is minimally useful. Population studies that show the variation of normal, and subsequent studies concerning health and disease conditions relative to high or low values within ranges make a reference number much more useful. If the company you did this testing through is unable to provide any of this information the clinical usefulness is limited. It does take a considerable amount of time for blood levels to reflect dietary changes, as the population of red blood cells turns over about 120 days. As both dietary intake and endogenous metabolism all are factors, the day-to-day dietary intake of all fatty acids will have an ongoing effect.

    Clinical trials have found that the supplementation with a combination of EPA + DHA was found to increase the omega-3 index of red blood cells in a dose-dependent manner with 5 months of supplementation.

    • Flock MR, et al. Determinants of erythrocyte omega-3 fatty acid content in response to fish oil supplementation: a dose-response randomized controlled trial. J Am Heart Assoc. 2013 Nov 19;2(6):e000513. http://tinyurl.com/ppkwamg

    In short, a combination of these things likely has had impact on his fatty acid levels, but there is no way to say for certain what the most significant impacting factors are. Increasing supplementation of the n-3 fatty acids as these have been found to be low is appropriate, as an elevated n-6 to n-3 ratio and low n-3 levels are associated with various disease conditions. Support with digestive enzymes will likely support improved nutrient absorption.

    I’m not certain of the reasoning behind your client’s choice to pursue a vegan diet, but from what I have seen the vegan omega-3 supplements must be taken at fairly high doses to achieve intake of levels of EPA and DHA in the range of 2 – 3 g (dosages of study referenced above). As he his levels of EPA and DHA both have been shown to be less than half of the reference value specified by the testing company, supplementation of both EPA and DHA will be the most direct way of improving both his deficiencies and the n-6 to n-3 ratio. You may wish to look investigate higher potency EPA and DHA formulations for your client here – http://tinyurl.com/pyublbe.

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Full Spectrum Digest (ARG): 1 – 2 tablets before meals.http://tinyurl.com/p4p65vh Full spectrum vegan digestive enzyme.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr Decker

    in reply to: Varicose Veins #17897

    Hello Katharine,

    Thank you for posing this question. Varicose veins are a common complaint, and are a symptom of chronic venous disease. Chronic lower extremity venous disease is the most common vascular disorder, affecting an increasing number of individuals with increasing age. Other symptoms of chronic lower extremity venous disease are telangictasias or reticular veins, extremity edema, skin pigmentation changes, lipodermatosclerosis (a fibrosing inflammation of the subcutaneous tissue), and venous ulceration. More severe forms of chronic venous disease are referred to as chronic venous insufficiency, and are related to other poor health outcomes.

    • Criqui MH, et al. Chronic venous disease in an ethnically diverse population: the San Diego Population Study. Am J Epidemiol. 2003 Sep 1;158(5):448-56. http://tinyurl.com/lvbfqa8
    • Tsai S, et al. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005 Sep;19(5):705-11. http://tinyurl.com/naddc2h

    Contributing to the pathology of lower extremity venous disease is vein valve incompetence, capillary permeability, poor venous tone and vascular fragility, blood stasis, and platelet aggregation. Additional factors that may contribute to venous dysfunction are hypertension or poor cardiac function, systemic inflammation, sedentary lifestyle, and a hypercoagable state. Treatment focus for venous disease focuses on addressing these possible aspects of dysfunction as they relate to your client.

    Exercise supports venous blood return to the heart, as the use of muscles creates a pumping action supporting return blood and lymph flow. This may include something as gentle as walking, stretching, yoga, or swimming; or more aerobic exercise if your client is in a position to engage in more rigorous activity. Walking and other activities should be done throughout the day, breaking up prolonged periods of sitting, standing, or other inactivity which contribute to venous stasis and edema.

    Other activities such as dry skin brushing – http://tinyurl.com/kk527dn, lymphatic massage – http://tinyurl.com/mw8fjpy, and leg elevation also support extremity circulation and you may wish to recommend that your client incorporate these things into their day as well if they are able.

    Various botanical agents support vasculature health. Botanical supplements that are primarily used for their effects on vasculature health include Aesculus hippocastanum (horse chestnut) and Hamamelis virginiana (American witch hazel), and Gingko biloba. Ginkgo biloba is well known for the vasculature effects on the smaller vessels but also supports venous function. Ginkgo improves skin perfusion, blood viscosity, and blood vessel health.

    • Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012 Nov 14;11:CD003230. http://tinyurl.com/kmm5h22
    • Auguet M, et al. The Pharmacological Bases for the Vascular Impact of Ginkgo Biloba Extract. Presse Med. 1986 Sep 25;15(31):1524-8. http://tinyurl.com/lddgz9w
    • Lan WJ, Zheng XX. Activity of Ginkgo biloba extract and quercetin on thrombomodulin expression and tissue-type plasminogen activator secretion by human umbilical vein endothelial cells. Biomed Environ Sci. 2006 Aug;19(4):249-53. http://tinyurl.com/npmbzcb

    Bioflavonoids are other primary agents which are utilized to support venous health. Quercetin Bioflavonoids (ARG) provides bioflavonoids, hesperidin, quercetin, and rutin which all support vasculature health. Bioflavonoids also act as antioxidants, and support the reduction of oxidative damage of vasculature which is also implicated in the development of varicose veins. Other antioxidants such as vitamin C, vitamin E, and CoQ10 support adequate antioxidant levels in the blood and vasculature health.

    • MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. 2001 Apr;6(2):126-40. http://tinyurl.com/njogjh4
    • Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
    • Morand C, et al. Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers. Am J Clin Nutr. 2011 Jan;93(1):73-80. http://tinyurl.com/ok3lfjk
    • Farbiszewski R, et al. Oxygen-Derived Free Radicals as Mediators of Varicose Vein Wall Damage. Vasc Endovascular Surg. 1996 Jan/Feb;30:47-52. http://tinyurl.com/os85dcx
    • Salim AS. The role of oxygen-derived free radicals in the management of venous (varicose) ulceration: a new approach. World J Surg. 1991 Mar-Apr;15(2):264-9. http://tinyurl.com/mgjbfhm

    Nattokinase is a thrombolytic agent which supports the reduction of platelet aggregation which may contribute to chronic vasculature disease. Bromelain (often taken with meals to support digestion) acts to reduce inflammation, hypercoagability, and supports reduction of edema when taken away from food.

    • Milner M and Makise H. Natto and Its Active Ingredient Nattokinase: A Potent and Safe Thrombolytic Agent. Alternative and Complementary Therapies. June 2002, 8(3): 157-164. http://tinyurl.com/nwszgv6
    • Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45. http://tinyurl.com/kyuzdbt

    Depending on the severity of the varicosities and venous disease, the use of pressure or compression hose may be indicated. Compression hose reduce the lower extremity edema associated with chronic vascular disease.

    • Hirai M, et al. Effect of elastic compression stockings in patients with varicose veins and healthy controls measured by strain gauge plethysmography. Skin Res Technol. 2002 Nov;8(4):236-9. http://tinyurl.com/o3rjbmg

    There are multiple other discussions on the topic of varicose veins on the Clinical Education group which may be useful. To access these discussions simply utilize the search function in the menu bar and type in the query “varicose veins”.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Gingko Biloba (BRC): 1 capsule twice daily away from food. http://tinyurl.com/mtyxxoe

    • Quercetin Bioflavonoids (ARG): 2 capsules twice daily away from food. http://tinyurl.com/795l5qo Supports vasculature health and reduction of inflammation.

    • Bromelain Plus (BRC): 1 capsule twice daily away from food. http://tinyurl.com/nkcse2n Supports reduction of inflammation and edema.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Undifferentiated connective tissue disease #17880

    Hello Debra,

    Thank you for posing this case here.

    As you have mentioned, Undifferentiated Connective Tissue Disease (UCTD) is an autoimmune condition. The things you have mentioned (starting with diet, investigating food triggers, supporting immune tolerance at the level of the gut) are all a mainstay of working with individuals of autoimmune disease.

    Stepping back and assessing lifestyle and diet is one of the safest and most effective ways to affect health long term. Speaking very directly with your client about the importance of making dietary changes is often necessary. When I work with individuals dealing with autoimmunity, if they are not ready to make dietary changes I often let them know that many of the supplements I use will continue to be primarily palliative and will in the long run become costly if they are unwilling to investigate and address dietary changes that are necessary. There definitely is a cost-effort balance; when individuals are willing to put forth more effort into diet and lifestyle; costs of supporting health go down as supplementation (not to mention doctor visits and medications!) is less necessary.

    Stress as you mention does significantly affect health, and can worsen problems associated with autoimmunity. It may be important to discuss implementation of a practice such as yoga or meditation, the importance of sleep and food hygiene; as you understand her case better you may further understand how you can help her to work on these things.

    Enzymes are something that I also would consider as a primary intervention with someone having digestive symptoms such as heartburn, excessive mucus secretion, chronic pain, and autoimmunity. I often find that heartburn and excess mucus secretion is related to food sensitivities. Gastroparesis and slowed digestion is common when foods the body is averse to are routinely consumed, the same is true for mucus secretion as the body attempts to protect mucosal surfaces. Do view the document on the Clinical Education webpage pertaining to the use of proteolytic enzymes and protocols used to address pain, autoimmunity, and infectious agents – http://tinyurl.com/c4vuazz.

    If mucus congestion is present there is a higher likelihood of chronic upper respiratory and sinus infections. General support which may help reduce the occurrence of upper respiratory and sinus infections include the use of a netty pot and gargling with probiotics (capsules emptied into water) prior to swallowing. You may wish to recommend trying these things on an ongoing basis to support the reduction of these infections.

    N-acetylcysteine (NAC), a precursor to the antioxidant glutathione, also helps to break down mucus secretions. Oxidative stress generated by an imbalance between reactive oxygen species and antioxidants contributes to the pathogenesis of arthritis, cancer, cardiovascular, liver and respiratory diseases.

    • Zheng JP, et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. Lancet Respir Med. 2014 Mar;2(3):187-94. http://tinyurl.com/kexkq8u
    • Zafarullah M, et al. Molecular mechanisms of N-acetylcysteine actions. Cell Molec Life Sci. 2003 Jan; 60(1):6-20.
    • Rushworth GF, et al. Existing and potential therapeutic uses for N-acetylcysteine: the need for conversion to intracellular glutathione for antioxidant benefits. PharmacolTher. 2014 Feb;141(2):150-9. http://tinyurl.com/ndz575f

    There are many discussion threads concerning autoimmunity in the Clinical Education group – as you are more familiar with the specifics of her situation you may find further support by looking through these.

    SUGGESTED SUPPLEMENTS

    The following additional supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • KappArest™ (BRC): 2 capsules twice daily away from food. http://tinyurl.com/kmpn9pmSupports reduction of inflammation.

    • Intenzyme Forte (BRC): 4 – 8 tablets twice daily away from food (1h before or 2h after). Also may be taken at dosage of 1 – 2 capsules before meals to support digestion. http://tinyurl.com/6o28kaw

    • NAC (N-Acetyl Cysteine) 500mg (ARG): 1 capsule three times a day away from food. http://tinyurl.com/pxaon6u Mucolytic and antioxidant.

    • S. Boulardii (ARG): 1 capsules up to 3 times daily with meals. http://tinyurl.com/35392bw

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: 40 yo F with supplement timing for potential pathogens please #17834

    Hello Belle,

    Thank you for posing this question. I am glad that this woman is working with you and her general practitioner to investigate the cause of her symptoms, and that she already has had some improvement with the support you have provided.

    The timing of dosing with antimicrobials and probiotics is always important to consider when optimizing such protocols. Unfortunately the state of science and research has not evolved to the point of assessing many combinations of probiotics and/or botanical antimicrobials other than proprietary forms. For this reason in such situations it is necessary to look at the mechanisms and known information about each of these individually, with regards to similar assessments, and consider what has been shown to be effective clinically.

    Gastrointestinal protocols often are designed around the concepts of staging different parts of treatment for optimization of response. The themes of these protocols are different periods of removal, replacement and/or reinoculation, repairing, and rebalancing. Depending on the individual the order of these stages may be shifted or overlapped as needed. But commonly within this the removal phase will utilize various antimicrobial botanicals (or anti-bacterial, anti-fungal pharmaceuticals), and then a subsequent stage will focus on repopulating the healthy flora.

    Oregano contains the constituentscarvacrol and thymol which have antihelminthic, fungicidal, and irritant properties.Allicin is the main antimicrobial compound in garlic, while berberine itself is the antimicrobial compound found in a variety of herbal sources including Hydrastiscanadensis (goldenseal), Coptischinensis (coptis or goldenthread), Berberisaquifolium (Oregon grape), Berberis vulgaris (barberry).

    Saccharomyces boulardii (S. boulardii) is a strain of Saccharomyces cerevisiae. Allicin, carvacrol and thymol have been shown to inhibit growth of Saccharomyces cerevisiae. It is likely that berberine also has a similar effect as it has been shown to be an antifungal agent. When utilized in the food industry or in vitro, this activity has been shown to occur on a prolonged basis as long as there is constant exposure to the active constituents. In the gastrointestinal tract, with the dynamic environment related to digestion and elimination, the effect of these antimicrobial agents will not be constant but will be dynamic as well.

    • Edwards-Ingram L, et al. Genotypic and physiological characterization of Saccharomyces boulardii, the probiotic strain of Saccharomyces cerevisiae. Appl Environ Microbiol. 2007 Apr;73(8):2458-67. http://tinyurl.com/q7bk5t8
    • Guarda A, Rubilar JF, Miltz J, Galotto MJ. The antimicrobial activity of microencapsulated thymol and carvacrol. Int J Food Microbiol. 2011 Mar 30;146(2):144-50. http://tinyurl.com/n3xftem
    • Ogita A, et al. Synergistic fungicidal activity of Cu(2+) and allicin, an allyl sulfur compound from garlic, and its relation to the role of alkyl hydroperoxide reductase 1 as a cell surface defense in Saccharomyces cerevisiae. Toxicology. 2005 Nov 15;215(3):205-13. http://tinyurl.com/pe7w559
    • Davis SR. An overview of the antifungal properties of allicin and its breakdown products–the possibility of a safe and effective antifungal prophylactic. Mycoses. 2005 Mar;48(2):95-100. http://tinyurl.com/o8v88b7
    • Mahajan VM, et al. Antimycotic activity of berberinesulphate: an alkaloid from an Indian medicinal herb. Sabouraudia. 1982 Mar;20(1):79-81. http://tinyurl.com/ptbwjdx

    Saccharomyces boulardii also has been shown to decrease inflammation and intestinal colonization of Candida albicans, and acts against translocation of Candida albicansfrom the gastrointestinal tract.

    • Jawhara S, Poulain D. Saccharomyces boulardii decreases inflammation and intestinal colonization by Candida albicans in a mouse model of chemically-induced colitis. Med Mycol. 2007 Dec;45(8):691-700. http://tinyurl.com/ndm9nqd
    • Berg R, et al. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii. J Infect Dis. 1993 Nov;168(5):1314-8. http://tinyurl.com/p75fclc

    As antimicrobial action of oregano against S. cerevisiae (likely to include the strain S. boulardii) has been shown, it would not be optimal to dose S. boulardii in close proximity to dosing of herbs with antimicrobial action. However, if an individual has been shown to have low sIgA status and as S. boulardii supports reduction of candida albicans, concomitant support for this during the antimicrobial (removal phase) of treatment may be beneficial. Dosing S. boulardii at opposite timing (ie halfway between doses) of antimicrobial agents may be the best way to optimize the desired results of each of these agents.

    Concerning the dosing of S. boulardiiin combination with other probiotics, this is commonly utilized therapeutically for various reasons. Probiotics require an adequate mucus layer to populate and to protect the gastrointestinal mucosa from an inappropriate response to the probiotics as well. S. boulardii has been shown to have anti-toxin, antimicrobial, immuno-regulatory effects. S. boulardii improves the mucosal barrier, increases short chain fatty acids (SCFAs), as well as promotes secretory IgA (sIgA). Through many of these mechanisms it improves the gastrointestinal and systemic response to other probiotics. If sIgA levels are low, a period of using S. boulardii prior to other probiotics may also improve the therapeutic response.

    • McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May 14;16(18):2202-22.
    • Buts JP, Bernasconi P, Vaerman JP, Dive C. Stimulation of secretory IgA and secretory component of immunoglobulins in small intestine of rats treated with Saccharomyces boulardii. Dig Dis Sci. 1990 Feb;35(2):251-6. http://tinyurl.com/kwcm6nn

    Addressing blood sugar dysregulation at this early stage will prevent many of the problems associated with long-term dysglycemia. Berberine is not only an herb that has usage as an antimicrobial but also is very effective for dysglycemia. Clinical evidence suggests that taking berberine 500 mg 2-3 times daily for 2-3 months is as effective in regulating glucose metabolism in patients with type 2 diabetes as taking metformin 500 mg 2-3 times daily. I also have seen individuals with insulin resistance find they are able to use this herb alone and no longer need to use Metformin. Because of its effectivity it is important to recommend patients gradually introduce it while monitoring blood sugar and reducing use of medication as is appropriate.

    • Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712-7. http://tinyurl.com/nfrtnxc

    Both the adrenals and the liver also play a part in blood sugar regulation in the body, and supporting these organs will also address her dysglycemia. Increased sensitivity to glucocorticoids both centrally and peripherally has been demonstratedin patients with glucose intolerance. This may further contribute to stress-induced hyperglycemia and an increased risk for hypertension and cardiovascular disease. Because of this, doing things to support the parasympathetic balance and glucose regulation may benefit her overall health more than direct support (ie adrenal glandular supplementation) for adrenal function. By reducing her stress both her adrenals and her body’s sensitivity to her adrenal hormones can recover.

    • Shamoon H, et al. Synergistic interactions among antiinsulin hormones in the pathogenesis of stress hyperglycemia in humans. J Clin Endocrinol Metab. 1981 Jun;52(6):1235-41. http://tinyurl.com/okyan3g
    • Eigler N, et al. Synergistic interactions of physiologic increments of glucagon, epinephrine, and cortisol in the dog: a model for stress-induced hyperglycemia. J Clin Invest. 1979 Jan;63(1):114-23. http://tinyurl.com/nr5hhcs
    • Andrews RC, et al. Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab. 2002 Dec;87(12):5587-93. http://tinyurl.com/p2anxqb
    • Cahill GF, et al. Blood glucose and the liver. Am J Med. 1959 Feb 26(2):264-282. http://tinyurl.com/pbcayas
    • Ramnanan CJ, et al. Physiologic action of glucagon on liver glucose metabolism. Diabetes Obes Metab. 2011 Oct;13Suppl 1:118-25. http://tinyurl.com/pftc9rc

    A garumarmoricum Ling-fish-based food concentrate has been shown to balance adrenal function under stress as well as supporting mood. This food concentrate (http://tinyurl.com/pntrrf4) contains polypeptides that act as precursors to neurotransmitters such GABA, encephalins and endorphins. They can exert a regulatory effect on the nervous system, potentially enabling the organism to adapt to stressful conditions. It also contains the essential omega-3 fatty acids, DHA and EPA. These are precursors of the prostaglandins and prostacyclins, cellular chemical mediators which help regulate the main biological functions of the body, including the noradrenergic functions of the central nervous system.

    The use of low dose B vitamins, but in their active form, has been found clinically to be a very effective means of supporting the nervous system. Thiamin’s active form is cocarboxylase, riboflavin’s active form is robiflavin-5-phosphate, and pyridoxine’s active form is pyridoxal-5-phosphate, and these three active forms are available in supplement form. One benefit of their use is that one can use a small dose compared to a strong B vitamin formula which is more traditionally understood to support the nervous system vs anxiety and stress. One B vitamin formula that contains these active B vitamins is detailed in the suggested considerations below.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for general consideration in light of your relevant expertise and understanding of the needs as you work with your clients. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Glucose Tolerance II (ARG): 1 – 2 capsules twice daily 1h before lunch and before bed. Contains berberine, milk thistle, resveratrol, chromium, and European Ash. Supports blood sugar regulation, gastrointestinal flora balance, as well as liver and biliary function. Use with caution with Metformin as the combination may promote hypoglycemia. http://tinyurl.com/q5gufpc

    • Saccharomyces boulardii (ARG): 1 caps at breakfast and dinner with meal. http://tinyurl.com/35392bw

    Additional antimicrobial agents to consider:

    • Garlic Plus (BRC): 1 – 2 tablets twice times daily with lunch and at bedtime. http://tinyurl.com/luw222h

    • ADP Oregano (BRC): 1 – 2 tablets twice times daily with lunch and at bedtime. http://tinyurl.com/laq265e

    Stress support:

    • Bio-3B-G (BRC): 3 tabs with each meal http://tinyurl.com/ose948a Active B vitamin formula designed to support the nervous system.

    • Stabilium 200 (ARG): 4 gel caps daily away from food, possible gradually decreasing after 1 month. http://tinyurl.com/3x35v63

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Thyroid and Adrenal test #17809

    Hello Hilary,

    Thank you for posing this question. I am glad you have investigated her adrenal and thyroid function as potential contributors to her fatigue. Even though testing occasionally does not shed light on the cause of the problems, it does rule other problems out.

    Yes, given that your client has been taking thyroxine and/or Armour thyroid at this time, if the dosage is in excess of what is necessary labs will show abnormalities such as low levels of thyroid stimulating hormone (TSH) and elevated values of thyroxine (T4), and/or triiodothyronine (T3). Although she continues to have symptoms of extreme fatigue it is not due to thyroid hypofunction, and given that there are health risks associated with hyperthyroidism as well, her medication dosage may need to be altered. She should speak with her prescribing physician about the results of the thyroid panel to determine what changes should be made. Given that she still has symptoms of fatigue, it may be desirable to only change her medication by a small amount – ie a 25mcg reduction in thyroxine daily.

    The use of DHEA and other hormones can affect levels of cortisol as well.Hormone replacement therapy has been shown in studies to increase DHEAsulfate, ACTH and cortisol concentrations.

    • Stomati M, et al. Six-month oral dehydroepiandrosterone supplementation in early and late postmenopause. GynecolEndocrinol. 2000 Oct;14(5):342-63. http://tinyurl.com/ptsjmmx
    • Genazzani AR, et al. Long-term low-dose oral administration of dehydroepiandrosterone modulates adrenal response to adrenocorticotropic hormone in early and late postmenopausal women. GynecolEndocrinol. 2006 Nov;22(11):627-35.http://tinyurl.com/pnzjh74
    • Fonseca E, et al. Hormone replacement therapy increases ACTH/dehydroepiandrosterone sulfate in menopause.Maturitas. 2001 Jul 25;39(1):57-62. http://tinyurl.com/o5yofwc

    Headaches may be hormonally related. Exogenous hormone induced headache refers to headaches that develop or worsen within three months of beginning use of exogenous hormones and that resolve or revert to baseline within three months of discontinuing exogenous hormones.

    The Women’s Health Study found that the prevalence of migraine among 17,107 menopausal health professionals was 11 percent. About 60 percent of these women were current users of hormone therapy, the rest were never users. Compared with never users, current users were more likely to have reported a migraine in the past year (odds ratio 1.42; 95% CI 1.24-1.62 after adjusting for confounders). However, it was not clear whether hormone therapy increased the risk of migraine or whether women with migraine were more likely to use hormone therapy, perhaps as treatment for their migraines. For women with a history of migraine, it could not be determined whether migraine frequency increased, decreased, or remained the same.

    • Misakian AL, et al. Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt). 2003 Dec;12(10):1027-36. http://tinyurl.com/pwrg8gl

    The Postmenopausal Estrogen/Progestin Interventions Trial was a randomiszed placebo controlled trial that examined the effects of conjugated equine oestrogen combined with three different progestogen regimens (two were cyclic and one was continuous) on selected outcomes in 875 postmenopausal women. Curiously, women with no headaches at baseline tended to develop headaches on hormone therapy, whereas those with headaches at baseline tended to improve with this therapy.

    • Greendale GA, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol. 1998 Dec;92(6):982-8. http://tinyurl.com/nn9hd5n

    In some individuals,fatigue and headaches including migraines may be related to digestive dysfunction and/or certain foods which trigger a systemic response. Leaky gut or an adversely altered state of mucosal permeability can contribute to symptoms of inflammation such as joint pain, psychological symptoms, fatigue, and headaches. More has been written by Michael Ash on the topic of ‘Leaky Gut & Food Reactivity – What’s the Mechanism?’ and can be found at the Clinical Education website – http://tinyurl.com/38w3cya.

    Specific dietary triggers for migraines include foods containing certain subsets of patients may be sensitive to phenylethylamine, tyramine, aspartame, monosodium glutamate, nitrates, nitrites, alcohol, and caffeine. The use of a food diary in conjunction with an elimination diet that eliminates these foods in combination with other common food sensitivities (dairy, gluten/grains, egg, soy, nuts, shellfish) may be useful to assess if foods are contributing to symptoms.

    • Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. http://tinyurl.com/jvo6x9n

    Breaking food down to amino acid constituents via digestive enzymes and other digestive support will help to decrease reactivity and promote appropriate mechanisms to restore barriers and functionality in the gut. For headaches associated with food sensitivity, digestive enzymes also may be useful when taken away from food.

    Mitochondrial dysfunction may be a contributor to her symptoms of fatigue and headaches. Mitochondrial dysfunction has been linked to headaches, in particular migraines, as well as chronic fatigue syndrome. Inflammation, possibly due to gastrointestinal dysfunction, may contribute to mitochondrial dysfunction. Supplements that support mitochondrial function includephospholipids to restore mitochondrial and cellular membranes, and antioxidants such as CoQ10, vitamin E, and lipoic acid. CoQ10 and lipoic acid also have evidence for improving symptoms of migraines. Other nutrients such as riboflavin and magnesium have also been shown to offer benefit to some individuals suffering from migraines.

    • Yorns WR Jr, Hardison HH. Mitochondrial dysfunction in migraine. Semin Pediatr Neurol. 2013 Sep;20(3):188-93 http://tinyurl.com/kgya4pu
    • Booth NE, et al. Mitochondrial dysfunction and the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).http://tinyurl.com/p3pslbw
    • Pieczenik SR, Neustadt J. Mitochondrial dysfunction and molecular pathways of disease. Exp Mol Pathol. 2007 Aug;83(1):84-92. http://tinyurl.com/qjsgrcq
    • Schiapparelli P, et al. Non-pharmacological approach to migraine prophylaxis: part II. Neurol Sci. 2010 Jun;31 Suppl 1:S137-9. http://tinyurl.com/n4hm7d4

    Referral also should be made to this woman’s general practitioner to rule out other potential causes of fatigue such as malignancy or hematologic abnormalities. More work on mitochondrial dysfunction may be viewed on the Clinical education web site. http://tinyurl.com/nwzm4mo

    Finally do consider that fatigue and headaches may have a mechanical origin. Upper cervical joint restrictions can create persistent headaches that may manifest as migranous in presentation, a visit to a suitably experienced osteopath may assist with either resolution or elimination.http://www.osteopathy.org.uk/home/

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • NT Factor ATP Lipids (ARG): ½ tsp twice daily. http://tinyurl.com/ookfr39 – supports mitochondrial function.

    • CoQH-CF (ARG): 1 softgel twice daily with food. http://tinyurl.com/pogc373

    • Lipoic Acid Plus (BRC): 1 – 2 tablets three times daily. http://tinyurl.com/njz6kv5

    • Mg-Zyme (BRC): 1 capsule three times daily. http://tinyurl.com/ol2k6ne

    • Bio-GGG-B Special B Complex (BRC): 2 capsules in AM with food. http://tinyurl.com/npwfwtl B complex with emphasis on riboflavin (B2).

    • Intenzyme Forte™ (BRC): 1 with breakfast & 2 with lunch & dinner. http://tinyurl.com/ndqfvak- digestive support. Also may be taken away from food for symptoms of headaches and to reduce systemic inflammation.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    Hello Coriander,

    Thank you for posing this question. Adult acne is quite a common occurrence, and can have a multitude of underlying causes including hormonal imbalance, dietary factors, gastrointestinal health, and other states of excess or deficiency. Oftentimes it is more than one of these which contributes to symptoms. Given the concomitant symptoms of breast swelling and tenderness, and variable symptoms with pregnancy and afterwards, questions of hormonal imbalance do arise.

    • Parlati E, et al. Hormonal profile in benign breast disease. Endocrine status of cyclical mastalgia patients. J Endocrinol Invest. 1988 Oct;11(9):679-83. http://tinyurl.com/kslq8ng

    The Genova Rhythm Plus – http://tinyurl.com/o98y9sv – that you mentioned is one test to consider, and having the multitude of testing samples can give a better idea of levels as salivary hormone testing is not known to be the most accurate. Assessment of serum values using a single test between days 19 – 21 may be a better and more accurate way to assess what is going on in the later part of the cycle. The Genova Hormonal Health panel is this type of serum test – http://tinyurl.com/nyaluru.

    • Flyckt RL, et al. Comparison of salivary versus serum testosterone levels in postmenopausal women receiving transdermal testosterone supplementation versus placebo. Menopause. 2009 Jul-Aug;16(4):680-8. http://tinyurl.com/kq6uxfd
    • Shirtcliff EA, et al. Assessing estradiol in biobehavioral studies using saliva and blood spots: simple radioimmunoassay protocols, reliability, and comparative validity. Horm Behav. 2000 Sep;38(2):137-47. http://tinyurl.com/k9ojc5l

    Concerning other particular tests available from your local companies, I would recommend you contact Regenerus Labs (http://regeneruslabs.com/), Biolab (http://www.biolab.co.uk/) and Genova (https://www.gdx.net/uk/) directly. They are much more familiar with their product offerings than I, and will be best suited to assist with your test selection.

    The development of acne is related to the local skin events of excess sebum production, abnormal keratinization of the pilosebaceous follicles, Propionibacterium acnes colonization, and inflammation. Factors contributing to these local events are androgens, hormone fluctuations with the menstrual cycle, cosmetic products, stress, diet, and genetic factors.

    The skin serves as an organ of elimination from the body, and when there are imbalances within or deficiencies in other pathways of elimination such as the colon, this may also contribute to the development of skin symptoms such as acne. Support for the kidneys and colon as other pathways of elimination should not be neglected. Water consumption of half the body weight (pounds) in ounces is the guideline I utilize with most patients – with an additional 8 ounces for each 30 minutes of exercise or caffeinated beverage. If your patient is not eliminating regularly (stool at least daily) this should also be considered.

    Dietary factors to consider in addition to food sensitivities and include the glycaemic index of foods. High glycaemic foods may cause hyperinsulinaemia which affects insulin-like growth factor-1 (IGF-1). Insulin and IGF-1 stimulate the synthesis of androgens and inhibit the synthesis of sex hormone-binding globulin (SHBG), both of these factors leading to an increase in free testosterone.

    The consumption of milk has also been shown to increase IGF-1 levels. A diet that is high in ω-6 polyunsaturated fatty acids promotes proinflammatory cytokines which may play a role in the inflammation aspect of acne. It has been shown that a diet that is free of processed food, cereal grains, dairy products, refined sugar and refined oil has beneficial effects in treatment of acne. Diets of traditional civilisations (not including processed foods) are associated with the absence of problems such as acne.

    • Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007 Jul;86(1):107-15. http://tinyurl.com/pk2yhy8
    • Kaimal S, Thappa DM. Diet in dermatology: revisited. Indian J Dermatol Venereol Leprol. 2010 Mar-Apr;76(2):103-15. http://tinyurl.com/ohl5t55
    • Cordain L. Implications for the role of diet in acne. Semin Cutan Med Surg. 2005 Jun;24(2):84-91. http://tinyurl.com/lr2tg38
    • Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90. http://tinyurl.com/nu6yhaj
    • Melnik B. Milk consumption: aggravating factor of acne and promoter of chronic diseases of Western societies. J Dtsch Dermatol Ges. 2009 Apr;7(4):364-70. http://tinyurl.com/q2umcew

    Propionibacterium acnes (P. acnes) is part of the normal flora that lives on our skin. Sebum composition has been shown to be connected with acne. In individuals who experience acne some aspects of sebum composition enables P. acnes to grow and multiply. A low glycaemic index diet has also been shown to affect sebum composition.

    • Ottaviani M, Camera E, Picardo M. Lipid mediators in acne. Mediators Inflamm. 2010;2010. http://tinyurl.com/mftay4p
    • Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci. 2008 Apr;50(1):41-52. http://tinyurl.com/oxxy863

    Androgens are capable of stimulating the growth of sebaceous glands in the skin and can augment sebum production, each characteristics that may contribute to lesion formation in acne. Saw palmetto and other botanicals and nutrients which are often used for the support of male prostate and testosterone / DHT issues also may be supportive for the resolution of androgen associated acne. Green tea and the active agent in it (ECGC) have been shown to be effective against acne via a variety of mechanisms including having an effect on androgens, cell proliferation, and lipogenesis.

    • Zouboulis CC, Degitz K. Androgen action on human skin — from basic research to clinical significance. Exp Dermatol. 2004;13 Suppl 4:5-10. http://tinyurl.com/p9nkxch
    • Liao S. The medicinal action of androgens and green tea epigallocatechin gallate. Hong Kong Med J. 2001 Dec;7(4):369-74. http://tinyurl.com/mppmrg5
    • Liao S, Hiipakka RA. Selective inhibition of steroid 5 alpha-reductase isozymes by tea epicatechin-3-gallate and epigallocatechin-3-gallate. Biochem Biophys Res Commun. 1995 Sep 25;214(3):833-8. http://tinyurl.com/n8zy66g
    • Im M, et al. Epigallocatechin-3-gallate suppresses IGF-I-induced lipogenesis and cytokine expression in SZ95 sebocytes. J Invest Dermatol. 2012 Dec;132(12):2700-8. http://tinyurl.com/md5xke4
    • Fisk WA, et al. Botanical and phytochemical therapy of acne: a systematic review. Phytother Res. 2014 Aug;28(8):1137-52. http://tinyurl.com/mjv59ea

    Flaxseed (linum) is a source of phytoestrogens and lignans and has been shown to help improve cholesterol and blood sugar regulation in the body. Phytoestrogens and lignans may increase levels of SHBG and help to balance estrogen. Support for the liver in regards to hormone metabolism also may be beneficial.

    • Lignans. Linus Pauling Institute. Accessed July 2014. http://tinyurl.com/crx5dm7
    • Pino AM, Valladares LE, Palma MA, Mancilla AM, Yáñez M, Albala C. Dietary isoflavones affect sex hormone-binding globulin levels in postmenopausal women. J Clin Endocrinol Metab. 2000 Aug;85(8):2797-800. http://tinyurl.com/mfh55rf
    • Adlercreutz H, Höckerstedt K, Bannwart C, Bloigu S, Hämäläinen E, Fotsis T, Ollus A. Effect of dietary components, including lignans and phytoestrogens, on enterohepatic circulation and liver metabolism of estrogens and on sex hormone binding globulin (SHBG). J Steroid Biochem. 1987;27(4-6):1135-44. http://tinyurl.com/kfnsn5o

    With cycling women I find it useful to utilize seed cycling and essential fatty acid cycling to encourage healthy hormone metabolism through the menstrual cycle and to reduce symptoms of inflammation such as breast swelling and other oedema during the cycle. Flax or pumpkin seeds, 2 tablespoons freshly ground and/or fish oil 2000mg combined EPA/DHA should be taken from day 1 of the cycle to day 15; and 2 tablespoons of sunflower or sesame seed and/or 2000mg of borage, black currant, or evening primrose oil (supplying approximately 400mg of gamma-linolenic acid) taken the second half of the cycle from days 16 through 28 (or until next menses begins). With this simple protocol I have seen symptoms of breast tenderness improve in many of the individuals I work with.

    Iodine has also been shown to reduce symptoms of cyclical breast pain. If symptoms are not improved with seed and/or fatty acid cycling this may be an additional thing to investigate.

    • Kessler JH, et al. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. Breast J. 2004 Jul-Aug;10(4):328-36. http://tinyurl.com/lakcwa5

    The gastrointestinal tract microbiotia also has associations with inflammation and the development of acne. Supplementation of lactoferrin, which supports microbial balance in the gut, has also been shown to improve symptoms of acne as well as sebum composition.

    • Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathog. 2011 Jan 31;3(1):1. http://tinyurl.com/pv5peqc
    • Kim J, Ko Y, Park YK, Kim NI, Ha WK, Cho Y. Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris. Nutrition. 2010 Sep;26(9):902-9. http://tinyurl.com/og4r6q3

    The distribution of acne and possible associations with different systems having deficiency or excess can be viewed from multiple perspectives and such consideration may improve the resolution of symptoms. I have found the approaches of Chinese medicine and homeopathy to also be supportive for the resolution of symptoms.

    There are many other discussions on the Clinical Education group which you may find useful by search querying the terms “acne” and “hormonal” or “testosterone.” Please do view the detailed response to a similar question about acne at: http://tinyurl.com/cur2uxz

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Flax seed: 2 Tbsp freshly ground, Days 1 – 15 of menstrual cycle. Supports regular stool habits and hormone modulation.

    • Sesame or sunflower seeds: 2 Tbsp freshly ground, Days 16-28 of menstrual cycle. Supports hormone modulation.

    • ProOmega™ (NN): 2 soft gels twice daily (2000 mg total combined EPA/DHA), Days 1 – 15 of menstrual cycle. http://tinyurl.com/7t9myqe Supports reduction of inflammation.

    • GLA Borage Oil (ARG): 2 softgels with breakfast and dinner, Days 16-28. http://tinyurl.com/6np89zb

    Potential therapeutic agents to support reduction of acne:

    • Laktoferrin (ARG): 1 capsule daily before bed. http://tinyurl.com/bmq83p9 Supports gut flora and healthy sebum.

    • DIM Palmetto (ARG): 2 softgels one to two times daily with food. http://tinyurl.com/76c5av3 Regulates testosterone metabolism.

    Hormone metabolism support:

    • NAC Enhanced Antiox Formula (ARG) – 1 with each meal. http://tinyurl.com/593phw Supports liver detoxification.

    • Ca D-Glucarate (BRC): 1 capsule twice daily. http://tinyurl.com/mbfbb6e Supports liver detoxification and hormone metabolism.

    • L-Methionine 500mg (ARG): 1 capsule daily between meals. http://tinyurl.com/klwxcl4

    Supports liver detoxification and liver fat metabolism.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Tamoxifen and DIM #17781

    Hello Diane,

    Thank you for posing this question. The issue of vasomotor symptom management in women with a history of breast cancer is a common concern.

    Diindolylmethane (DIM) is a metabolite of indole-3-carbinol (IC3), which influences metabolism of oestrogen into safer end products. Tamoxifen is an antineoplastic, oestrogen receptor antagonist and a selective oestrogen receptor modulator (SERM).

    • Alschuler L. Breast Cancer in The Definitive Guide to Cancer. 2010. Pg, 265-76.

    Oestrogen balance isimportant to consider when supporting an individual with hormonally sensitive cancers such as breast cancer often is. DIM has also been shown to have an effect of modifying oestrogen balance, increasing 2-hydroxyoestrone levels which may be beneficial. Diindolylmethane (DIM) also has been shown to have anti-proliferative effects on breast cancer cell lines, independent of oestrogen receptor status. DIM has also been shown in vitro to stimulate the destruction and decrease the invasive potential of breast cancer cells.

    • Dalessandri KM, et al. Pilot study: effect of 3,3′-diindolylmethane supplements on urinary hormone metabolites in postmenopausal women with a history of early-stage breast cancer. Nutr Cancer. 2004;50(2):161-7. http://tinyurl.com/n88a8kd
    • Hong C, et al. Bcl-2 family-mediated apoptotic effects of 3,3′-diindolylmethane (DIM) in human breast cancer cells. BiochemPharmacol. 2002 Mar 15;63(6):1085-97. http://tinyurl.com/lybaqj2
    • Hsu El, et al. CXCR4 and CXCL12 down-regulation: a novel mechanism for the chemoprotection of 3,3′-diindolylmethane for breast and ovarian cancers. Cancer Lett. 2008 Jun 28;265(1):113-23. http://tinyurl.com/ak8u7wk

    There is some question of whether oestrogen metabolite ratio, primarily between 2-hydroxyoestrone and 16-alpha hydroxyoestrone, is as relevant it has long been emphasized as multiple recent studies have not shown epidemiological evidence to verify theories which often attribute a “harmful” status to 16-alpha hydroxyoestrone and “beneficial” status to 2-hydroxyoestrone. However, clinical experience from many individuals working with people in remission from oestrogen-related cancers continues to suggest this is of importance.

    • Schor, J. Estrogen Metabolite Ratios: Time for Us to Let Go. Townsend Letter. January 2013. http://tinyurl.com/l2subbj
    • Klug, T. Response to Dr. Jacob Schor’s Article ‘Estrogen Metabolite Ratios: Time for Us to Let Go’. Townsend Letter. April 2013. http://tinyurl.com/nsmfnay

    Calcium-D-glucarate may also be considered. Calcium-D-glucarate has been shown to have effects of modifying oestrogen balance, promoting detoxification of carcinogens, and has been shown to induce apoptosis and suppress cell proliferation in mammal tumour lines.

    • Zółtaszek R, et al. The biological role of D-glucaric acid and its derivatives: potential use in medicine. PostepyHig Med Dosw (Online). 2008 Sep 5;62:451-62. http://tinyurl.com/6ftyxm9
    • Zoltaszek R, et al. Dietary D-glucarate effects on the biomarkers of inflammation during early post-initiation stages of benzo[a]pyrene-induced lung tumorigenesis in A/J mice. Oncol Lett. 2011 Jan;2(1):145-154. http://tinyurl.com/kq6zz7r
    • Walaszek Z, et al. Dietary glucarate as anti-promoter of 7,12-dimethylbenz[a]anthracene- induced mammary tumorigenesis. Carcinogenesis. 1986 Sep;7(9):1463-6. http://tinyurl.com/q5scnsx
    • Walaszek Z, et al. Metabolism, uptake, and excretion of a D-glucaric acid salt and its potential use in cancer prevention. Cancer Detect Prev. 1997;21(2):178-90. http://tinyurl.com/bk2ql3c
    • Hanausek M, et al. Detoxifying cancer causing agents to prevent cancer. Integr Cancer Ther. 2003 Jun;2(2):139-44. http://tinyurl.com/n6f6t47

    Dietary interventions to consider are an anti-oestrogenic diet, diet high in organic fruits and vegetables, particularly cruciferous vegetables and rich in organic green tea. Another matter which may provide benefit, especially if taking tamoxifen, is the use of flaxseed lignans. Human trials have shown that high plant lignin intake is associated with reduced risk of postmenopausal cancer and flax can reduce the hot flashes that are a common side effect of tamoxifen.

    • Velentzis LS, et al. Lignans and breast cancer risk in pre- and post-menopausal women: meta-analyses of observational studies. Br J Cancer. 2009 May 5;100(9):1492-8. http://tinyurl.com/avseq3f
    • Tamoxifen side effects. Drugs.com. Accessed 8/2015. http://tinyurl.com/ap9blyz

    Additional focuses to consider when supporting someone with a personal history of cancer or a strong family history of cancer include decreasing oxidative damage and inflammation and supporting immune system function. When working with individuals with cancer I prefer to utilize botanicals and nutrients with research that supports their use as much as possible. Occasionally the “alternative” approach of natural medicine for cancer care is an unnecessarily controversial topic, made so by too many individuals claiming to cure cancer rather than support the individual in health by utilizing the aforementioned tactics.

    Immune system function is also an important aspect of the body’s function as it operates for cancer surveillance. Medicinal mushrooms are an agent which have shown benefits of anti-tumour and immunomodulating properties and are often a part of protocols for reducing cancer risk.

    • Wasser SP. Medicinal mushrooms as a source of antitumor and immunomodulating polysaccharides. ApplMicrobiolBiotechnol. 2002 Nov;60(3):258-74. http://tinyurl.com/ktpsghj
    • Ren L, et al. Antitumor activity of mushroom polysaccharides: a review. Food Funct. 2012 Nov;3(11):1118-30. http://tinyurl.com/o5sm88r

    Green tea contains polyphenols, primarily being epigallocatechin gallate (EGCG), as well as epicatechin and others. EGCG has been shown to have more benefits in terms of anti-cancer activities when utilized in combination with epicatechin and whole green tea, and also has been shown to act synergistically with Tamoxifen (pertaining to in vitro studies with human breast cancer and lung cancer cell lines).

    • Chisholm K, et al. Tamoxifen and epigallocatechin gallate are synergistically cytotoxic to MDA-MB-231 human breast cancer cells. Anticancer Drugs. 2004 Oct;15(9):889-97. http://tinyurl.com/kadfj3a
    • Suganuma M, et al. Synergistic effects of (–)-epigallocatechin gallate with (–)-epicatechin, sulindac, or tamoxifen on cancer-preventive activity in the human lung cancer cell line PC-9. Cancer Res. 1999 Jan 1;59(1):44-7. http://tinyurl.com/ogff27b

    Curcumin, resveratrol, indole-3-carbinol (I3C), proanthocyanidin, and vitamin D, are other agents which have also been shown to enhance the antitumor activities of chemotherapeutic agents. A combination of I3C and tamoxifen synergistically inhibit the growth of MCF-7 breast cancer cells more effectively than either agent alone, and also has been shown to have effects by both estrogen-dependent and independent pathways. Curcumin has been shown in vitro to induce cell death and restore tamoxifen sensitivity in certain anti-oestrogen-resistant breast cancer cell lines.

    • Sarkar FH, et al. Using chemopreventive agents to enhance the efficacy of cancer therapy. Cancer Res. 2006 Apr 1;66(7):3347-50. http://tinyurl.com/mb8ble3
    • Cover CM, et al. Indole-3-carbinol and tamoxifen cooperate to arrest the cell cycle of MCF-7 human breast cancer cells. Cancer Res 1999; 59: 1244–51. http://tinyurl.com/o4ff7px
    • Meng Q, et al. Suppression of breast cancer invasion and migration by indole-3-carbinol: associated with up-regulation of BRCA1 and E-cadherin/catenin complexes. J Mol Med (Berl). 2000;78(3):155-65. http://tinyurl.com/kk8wn9a
    • Jiang M, et al. Curcumin induces cell death and restores tamoxifen sensitivity in the antiestrogen-resistant breast cancer cell lines MCF-7/LCC2 and MCF-7/LCC9. Molecules. 2013 Jan 8;18(1):701-20. http://tinyurl.com/pfcrgjv

    Topical castor oil to the breast region before bed may improve aspects of residual pain, breast tenderness, lymphatic drainage, and tissue changes which individuals experience with lumpectomy or mastectomy. I have seen multiple clients return to my practice after only a couple weeks of utilizing topical castor oil on the breast who are overjoyed that the tissue has returned to a normal consistency and pain-free status. I generally instruct clients to utilize a simplified castor oil pack by simply massaging castor oil into the region, applying a cotton cloth to protect other garments from the oil, and utilising the body heat to draw the oil internally. A warm water pack may also be applied for a period of 15 – 20 minutes.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Green tea: 2 – 4 cups daily from certified organic source.

    • Ca D-Glucarate (BRC): 1 cap, 1-2 times daily, taken away from tamoxifen by at least 2 hours. http://tinyurl.com/b9329n6

    • DIM Enhanced Delivery System (ARG): 1 cap, 1-2 times daily, taken away from tamoxifen by at least 2 hours. http://tinyurl.com/3xv4ycm

    • Flax Seed powder (ARG): 2 tablespoons freshly ground at bedtime; or at least 2 hours away from tamoxifen. Can be placed in smoothies, apple sauce, salads, etc.

    Additional support to consider:

    • Fast & Be Clear (ARG): 2 scoops daily in 8oz liquid. http://tinyurl.com/387opphProtein powder supplement which supports detoxification and antioxidant status.

    • Wholly Immune (ARG): 1 scoop daily in 8oz liquid. http://tinyurl.com/33v5um9 Contains nutrients, botanicals, and mushroom extract to support immune function.

    • Pro-Greens (ARG): 1 scoop daily in 8oz liquid. http://tinyurl.com/27uruzy Greens powder high in antioxidants that supports healthy system function and detoxification.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Swine flu #17778

    Hi Natalie,

    Thank you for asking this question here.

    It sounds like your friend is still in the fairly acute stage of recovery from this illness. At this stage, unless there are reasons to anticipate difficulty recovering (immunocompromised, chronic fatigue syndrome, or other susceptible condition) I would not assume that there is a high risk of experiencing further complication. However, there is evidence that influenza alters the innate immunity for up to 6 months subsequent to infection, and one way to reduce the risk of prolonged problems is to support the body (particularly the mucosal immune system) in recovery. This will help to reduce the risk of subsequent additional infections.

    You are correct to think of humic acid in terms of viral support, however, I tend to think of this when helping the body resolve from more chronic viral infections, or for prevention of such. You may already have read these articles about Humic Acid but they are well worth reading if you have not: http://tinyurl.com/p2h6dky.

    Much has been written to address the topics of viral infection, including information particular to the swine flu (H1N1 A 2009) infection – http://tinyurl.com/mzeo5n4. There also is a resource available for download here pertaining to the support of the body and mucosal immunity in response to this and other viral infections. Please do review this information particularly the section pertaining to “Natural Interventions for the Acute Phase of H1N1 Infection” as it will be very helpful in supporting your friend’s recovery.

    Similar to what has been observed with seasonal influenza, shedding of pandemic H1N1 influenza A has been observed to begin the day prior to symptom onset and often to persist for five to seven days or longer in immunocompetent individuals. If your friend has had the infection for a week already it is not likely that the virus is highly contagious. That said, avoiding infants, pregnant women, the elderly, and those who are immunocompromised for a bit more time may be prudent.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Saccharomyces boulardii (ARG): 1 – 2 capsules twice a day away from food. http://tinyurl.com/knbvdgs

    • Bio-D-Mulsion Forte (BRC): 2000IU per kg per day for 7 days from day 1 of positive diagnosis. May continue at up to 10,000IU for one additional week before resuming previous dosage. http://tinyurl.com/kfpjyw6

    • Laktoferrin (ARG): 3 caps (1050mg) in divided dosage per day. http://tinyurl.com/m9xt7ay

    • Green tea: 2 – 4 cups daily.

    • Russian Choice Immune (ARG): 1 – 2 capsules once or twice daily away from food. http://tinyurl.com/jw6k43q Contains lactobacillus cell wall fragments which have been shown to have significant immune system supporting properties.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Help with suppression of TSH production #17760

    Hello Catherine,

    Thank you for posing this question.

    I’m glad you have had a chance to do the Genova Thyroid Plus panel and assess for abnormalities including thyroid hormone, thyroid antibodies, andreverse triiodothyronine (T3). Given that she historically had thyroid problems and abruptly discontinued her medication it is important to make sure that thyroid has not become a problem again. Low levels of iodine also may play a role in deficient thyroid function, and supporting this may help her on a long term basis to not return to a state of hypothyroidism particularly if it was associated with iodine deficiency. Do also add in selenium and its value in TSH function, explain its role in thyroid health..

    There are several other things which may be the cause of her fatigue, and I am glad you are working with her digestive health as this may be one of them. If you haven’t done so you may wish to investigate the possibilities of food sensitivities or gastrointestinal imbalance with a stool test or small intestinal bacterial overgrowth (SIBO)breath test if any of these things are suspected as contributors. Sometimes there are outright symptoms of abnormalities that lead to testing (eg hives or gastrointestinal symptoms) however other times symptoms are subtle and non-specific such as fatigue and difficulty with cognition. There are several different options of stool panels to consider for assessment of both digestive health and gastrointestinal gastrointestinaldysbiosis – http://tinyurl.com/abfqmcb or http://tinyurl.com/bqjdssk , and SIBO can be assessed for with a breath test through Regenerus Labs – http://tinyurl.com/p9bgoqf.

    Other potential issues that may present with symptoms of fatigue include autoimmunity, anaemia, and adrenal dysfunction. A normal workup for fatigue also should also include a chemistry screen (CMP), a complete blood count (CBC) with differential (to rule out possibility of anaemia as well as assess for infection or abnormal immune system function), and an erythrocyte sedimentation rate (ESR) to assess for inflammation, which if elevated may lead to further work-up to rule out autoimmune disease or other conditions.

    I’m not sure of the age of this woman, but anaemia is common both among younger menstruating women as well as in the older population. In an aging population anaemia can be associated with functional problems such as low levels of hydrochloric acid and poor absorption of iron, B12, and other nutrients, or it may be associated more significant pathology such as cancer or blood loss from things such as peptic ulcer disease or hemorrhoids. There are many other possible causes of anaemia, and screening for this with a CBC and ferritin levels would be the first step in determining if this is a problem.

    Additionally, with chronic fatigue, malaise, and lassitude her general practitioner may be willing to also test her morning salivary cortisol levels. If not, in the future you may consider an adrenal stress index – http://tinyurl.com/7n8nqpm- as abnormal cortisol levels are connected with fatigue and decreased thyroid function as previously mentioned. Although assessment of her rT3 levels assesses somewhat indirectly for cortisol elevation, with fatigue that is considerable and persistent it is likely appropriate to considerthat she is experiencing some aspect of adrenal imbalance. This may be primary or secondary to other issues, but if testing of her CMP, CBC, ESR, and ferritin levels do not reveal abnormality this often is the next thing to assess in absence of other symptoms other than fatigue.

    Do consider these things in light of your client’s signs and symptoms and history, and direct further testing as is appropriate. Occasionally in the absence of testing results that indicate issues such as adrenal dysfunction, infection, or anaemia you may find that supplements such as a greens formula, B complex vitamins, antioxidants, or essential fatty acids do support resolution of fatigue by supplying necessary nutrients, supporting adrenal function, and reducing inappropriate inflammation which often can be underlying contributors to such problems in absence of frank pathology.

    In addition a good deal of research was undertaken on the the role of lipid replacement therapy (LRT) for the resolution of persistent fatigue. LRT is the use of a composite mix of lipids extracted from non GMO soya and then blended to match the lipid mix found in cell membranes and mitochondrial membranes. Human studies have shown a consistent increase in energy against prior fatigued state of approx.30%. Some of the details on the use of LRT have been written up by Michael Ash on the Clinical Education web site.http://tinyurl.com/qxthtee

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • NT Factor® ATP Lipids Powder (ARG): ½ scoop twice daily with liquid or food. http://tinyurl.com/c6vok8z Supports mitochondria, energy levels, and cellular function.

    OR

    • ProGreens Vitality with NT Factor (ARG): 1 scoop once or twice daily with liquid. http://tinyurl.com/lfvnmqc Greens formula containing NT Factor as well as adrenal supportive botanicals.

    • Liquid Iodine (BRC): 2 – 3 drops daily with meals (150 – 225mcg). http://tinyurl.com/obql3nl

    • Bio-B Complex (BRC): 1 tablet in AM with meal. http://tinyurl.com/lfrr7h4

    • ProOmega™ (NN): 2 soft gels once or twice daily (2000 mg total combined EPA/DHA). http://tinyurl.com/7t9myqe Supports reduction of inflammation.

    • Saccharomyces Boulardii (ARG): 1 capsule twice daily with breakfast and dinner. http://tinyurl.com/35392bw Supports mucosal immune function and reduction of inflammation.

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Bulimia and binging. #17749

    Hello Beatrice,

    Thank you for contributing this discussion here.

    There are significant risks of medical complications when an individual has bulimia, some of which are very severe. Depending on the level of involvement that this individual has with her bulimic and binging patterns it may be necessary to recommend hospitalization. Regardless, seeing a primary care doctor to rule out some highly concerning issues such as cardiovascular complications and electrolyte abnormalities should be recommended.

    As with all health conditions, there are a combination of factors including genetics and environmental influence that make one more susceptible to developing binge eating disorder. Twin studies have shown heritability, other candidate genes that play a role in eating behavior also have been shown. Our gut microbiota also is similar to that of our parents and siblings, and connections have been shown between obesity and microbiota. Similar studies have not been performed in relation to Binge Eating Disorder but as there is significant overlap between obesity and Binge Eating Disorder it is likely similar findings would exist.

    • Bulik CM, et al. Genetic and environmental contributions to obesity and binge eating. Int J Eat Disord. 2003 Apr;33(3):293-8. http://tinyurl.com/q5jqres
    • Branson R, et al. Binge eating as a major phenotype of melanocortin 4 receptor gene mutations. N Engl J Med. 2003 Mar 20;348(12):1096-103. http://tinyurl.com/nfvn4ls
    • Raoult D. Obesity pandemics and the modification of digestive bacterial flora. Eur J ClinMicrobiol Infect Dis. 2008 Aug;27(8):631-4. http://tinyurl.com/p822xa2

    Binge eating patterns are common secondary to the increased intake of food in individuals with anorexia nervosa, or even in other settings after a period of starvation. This may be associated with nutritional deficiencies as well as other factors leading to carbohydrate cravings. There is a high degree of self-blame and self-criticism in individuals with eating disorders particularly when eating behaviours seem out of control. Encouraging her that this is not her fault and to support her body by making improved nutritional choices will help her to eventually not fall into these patterns.

    • Polivy J, Herman CP. Dieting and binging. A causal analysis. Am Psychol. 1985 Feb;40(2):193-201. http://tinyurl.com/l9z4gzo
    • Pankevich DE, et al. Caloric restriction experience reprograms stress and orexigenic pathways and promotes binge eating. J Neurosci. 2010 Dec 1;30(48):16399-407. http://tinyurl.com/nc38j2b

    There are many reasons why people crave foods. Some of the common things that contribute are subclinical malnourishment, imbalanced blood sugar, imbalanced gut flora, lack of sleep and fatigue. We also associate certain foods mentally and emotionally with being safe and comforted (ie foods from childhood). Some people are addicted to stimulants that include caffeine, drugs, and sugar. I see this commonly even with children who have attention deficit hyperactivity disorder – they crave sugar because it makes them feel more alive and have more “fun” – even 7 year olds will tell me this. There are many studies about the addictive properties of sugar and how it affects brain chemistry, and an increasing amount about how the gut flora plays a role in our cravings. Milk protein fragments have been shown to stimulate opioid receptors, possibly eliciting mild opioid effects.

    • Avena NM, et al. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. NeurosciBiobehav Rev. 2008;32(1):20-39. http://tinyurl.com/qz8w9c8
    • Alcock J, et al. Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays. 2014 Oct;36(10):940-9. http://tinyurl.com/q4qtzy9
    • Teschemacher H. Opioid receptor ligands derived from food proteins. Curr Pharm Des. 2003;9(16):1331-44. http://tinyurl.com/o6be73g

    Processed foods and food additives are also a significant contributor. It is hard to find a research paper to show this, but that is the response that many food companies try to elicit with the foods that they advertise. “Can’t put it down,” “once you start, you can’t stop,” and variations on these slogans are common, but such is true. Part of the work they do in food processing labs is to make these “foods” more desirable as that positively impacts a company’s bottom line. We don’t see many companies out there advertising how satisfied you will feel after a single serving of their food! Each and every one of these things may be an issue for anyone with overwhelming food cravings that lead to binges. However when individuals experience these things to the level of being classified as having an eating disorder, the patterns have themselves become addictive and habitual which must be dealt with.

    There are many things I use to support people in recovery from binge eating behaviors. One of the first things I emphasis is that nutritional deficiencies and food sources can be contributors. I usually advise people who struggle with binging and carbohydrate cravings to include a complete greens formula on a daily basis, and even taking it up to three times a day when having struggles with cravings. The use of such can help people get over the “binging hurdle” or overwhelming desire to binge. Some people find it useful to take as needed if carbohydrate cravings arise, or after periods of eating more high carbohydrate or nutritionally lacking foods. I often recommend one that includes probiotics and does not have a significant amount of added sweeteners as eating sweet things only further promotes cravings for sugar. A broad spectrum probiotic also may offer long term benefit to both food cravings and mental response to stress, especially when taken on a longer term basis.

    • Messaoudi M, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011 Mar;105(5):755-64. http://tinyurl.com/35cawey
    • Ait-Belgnaoui A, et al. Probiotic gut effect prevents the chronic psychological stress-induced brain activity abnormality in mice. NeurogastroenterolMotil. 2014 Apr;26(4):510-20. http://tinyurl.com/pz3z7ya
    • Dinan TG, Cryan JF. Regulation of the stress response by the gut microbiota: implications for psychoneuroendocrinology. Psychoneuroendocrinology. 2012 Sep;37(9):1369-78. http://tinyurl.com/pl387g2

    There are also supplements I use in my practice which support reduction of the underlying challenges of anxiety or depression which often contributes to binge eating. Individuals with chronic depression are often poor methylators and require more available methylated forms of Vitamin B12 (methylcobalamin) and/or methylated folate. A vitamin B complex may also support the improvement of energy and adrenal function. Turmeric, an anti-inflammatory agent, also has some evidence for reducing symptoms of depression. Antioxidants and nutritive support also have some evidence for reducing symptoms of depression. Having her vitamin D levels tested and supplementing if they are low also may help reduce symptoms of depression. In the absence of vitamin D testing it still may be beneficial to support her with 1000 – 2000IU of vitamin D3 daily, particularly if she has limited sun exposure and during the winter.

    • Tiemeier H, et al. Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Am J Psychiatry. 2002 Dec;159(12):2099-101. http://tinyurl.com/krn6jtz
    • Tsuchimine S, et al. Decreased serum levels of polyunsaturated fatty acids and folate, but not brain-derived neurotrophic factor, in childhood and adolescent females with depression. Psychiatry Res. 2015 Jan 30;225(1-2):187-90. http://tinyurl.com/ltdz96e
    • Almeida OP, et al. Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. Int Psychogeriatr. 2015 May;27(5):727-37. http://tinyurl.com/ov5hqat
    • Atmaca M, et al. Serum folate and homocysteine levels in patients with obsessive-compulsive disorder. Psychiatry ClinNeurosci. 2005 Oct;59(5):616-20. http://tinyurl.com/pkf8spp
    • Sanmukhani J, et al. Efficacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial. Phytother Res. 2014 Apr;28(4):579-85. http://tinyurl.com/q2mqxws
    • Moretti M, et al. Ascorbic acid treatment, similarly to fluoxetine, reverses depressive-like behavior and brain oxidative damage induced by chronic unpredictable stress. J Psychiatr Res. 2012 Mar;46(3):331-40. http://tinyurl.com/njzh8ch
    • Anglin RE, et al. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013 Feb;202:100-7. http://tinyurl.com/cvw439c

    Obsessive compulsive behaviours are also common with eating disorders, and often are seen as food obsessing, counting, and other food associated rituals. Imbalances with glutamate are associated with obsessive compulsive disorder, and working to address this possible imbalance may improve obsessive behaviours around food as well. N-acetyl cysteine has some evidence for reducing obsessive compulsive behaviour via modulation of glutamate. N-acetylcysteine is an antioxidant which has been studied in many settings of depression and addiction, and may offer long term support in reduction of compulsive behaviors. Supporting the excitatory – inhibitory neurotransmitter balance with GABA also may be beneficial.

    • Pittenger C, et al. Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. PharmacolTher. 2011 Dec;132(3):314-32. http://tinyurl.com/nsb2lef
    • Grant JE, et al. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009 Jul;66(7):756-63. http://tinyurl.com/oepm2xr
    • Deepmala, et al. Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review. NeurosciBiobehav Rev. 2015 Aug;55:294-321. http://tinyurl.com/p8urvkh
    • Russo AJ, Pietsch SC. Decreased Hepatocyte Growth Factor (HGF) and Gamma Aminobutyric Acid (GABA) in Individuals with Obsessive-Compulsive Disorder (OCD). Biomark Insights. 2013 Aug 18;8:107-14. http://tinyurl.com/ngspy9c
    • Abdou AM, et al. Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. Biofactors. 2006;26(3):201-8. http://tinyurl.com/bj593xc

    The use of relaxing and balancing agents such as L-theanine, chamomile, magnesium and lavender also may be helpful. These supplements help to balance out day-to-day stressors that leave people in the fight-or-flight mode which may promote binges.

    • Kimura K, et al. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45. http://tinyurl.com/krz335a

    Avoiding the purchase of processed foods by changing shopping habits to only focus on the periphery of stores (where meat, produce, and other necessities are found) will help to improve food selections. Taking time to cook for oneself and learning how to utilize an array of vegetables or whole food based ingredients will improve intake of phytonutrients (plant based nutrients) which are not quantified on food labels yet have a significant impact on health.

    Starting the day with a nourishing breakfast is a great way to reduce binging behaviours. I generally recommend that people with binging tendencies start the day with a complete meal as well, including at least 1 – 2 ounces of protein, a healthy fat, and a fruit or vegetable. Keeping coffee to a minimum also will help as it may lead to blood sugar imbalance as well as increases anxiety.

    Other food-directed therapies that may assist in reducing cravings for high carbohydrate foods include bitters and natural sources or probiotics. Taking time to eat, chewing foods fully, and including bitter foods in the diet all will support digestive function and food awareness. Bitter foods include greens such as arugula, kale, brussel sprouts, dandelion, and radicchio, as well as artichoke. Bitterness also comes from the other parts of fruits which are often discarded such as orange peels. Having some aspect of bitter foods at the start of each meal will help to promote improved digestion and reduce carbohydrate cravings. Alternatively, bitters can come directly from something such as cocktail bitters, and drank with a small amount of water and citrus before meals to support the digestive process.

    Food sources of probiotics include sauerkraut, kefir, kimchi, and kombucha. Eating more foods such as these will also help improve gastrointestinal flora balance and may reduce sugar cravings.

    Digestive dysfunction is very common in individuals with eating disorders. The normal parasympathetic state necessary for digestion often is quite the opposite as food is one of the primary things which provoke stress. With centrally mediated digestive dysfunction such as this not enough can be said about working to reduce stress associated with food consumption. Support for stress reduction related to meals and food consumption, possibly including deep breathing techniques, gentle yoga or grounding poses, and flower essences may be helpful.Often with anxiety deep breathing techniques can also help.

    Seeking out a combination of support to address the conscious and unconscious psychological and emotional issues is important. The can include working with a therapist, psychologist, energetic healing practitioner (Reiki, acupuncture, cranial sacral, and Zero balancing are a few), or other support group are all options that can be used in combination. Finding a therapist or counselor who has experience working with patients with eating disorders is recommended. Getting outside in nature and community and decompressing from the food focus also plays an important role. We greatly underestimate the ability nature has to heal – finding a place to sit or walk on the grass, listen to the sounds, and opening our eyes and senses to the experience can help the toxicity of addictive patterns subside.

    There are various support groups and recovery programmes such as Overeater’s Anonymous – http://tinyurl.com/7ohtq9m – that many individuals who struggle with eating disorders attend and find support from. She may wish to try this as well, as it is a place where she can find other people to reach out to when she is struggling as this often is a very acute need for support.

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    Nutritional support to reduce cravings:

    • ProGreens (ARG): 1 scoop up to three times daily with liquid. http://tinyurl.com/oaqnlux Complete greens formula including probiotics support.

    Support for mood and reduction of binging patterns:

    • NAC (BRC): 1 capsule (500mg) two to three times per day, with meals. http://tinyurl.com/k4cy8r2

    • 200 mg of Zen (ARG): 1-2 capsulesup to three times a day as needed for anxiety. http://tinyurl.com/89vstsf Supports reduction of stress and GABA/glutamate balance.

    N.B. The liquid Liposomal Zen (ARG) may have more benefit than the capsules, and the benefits may be more swiftly experienced. In many instances, the speed of effect can be significant. One squirt in the mouth two to three times daily may be a suitable dose.

    • Solution of Magnesium Liquid (ARG): Increase dose gradually as tolerated up to 1 tsp twice per day. http://tinyurl.com/nx3u2vh

    • 5-MTHF Plus Forte (ARG): ½ tablet daily. Supports normal folate and B12 levels. http://tinyurl.com/kkp8ore

    • Bio-D-Mulsion (BRC): 2 – 5 drops daily. Supports normal vitamin D levels. http://tinyurl.com/p7glm74

    Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Accumulation of gas in the stomach #17743

    Hello Christina,

    Thank you for posing this question. Gas, whether it manifests as belching, flatulence, bloating, or abdominal spasm and pain is a common symptom. Depending whether this is something which one experiences rarely or chronically, the manner which you may chose to address it will vary.

    The symptoms of gas in the gastrointestinal tract may have various causes, however commonly this is due to small intestinal bacterial overgrowth (SIBO). SIBO commonly exists in individuals who have been diagnosed with irritable bowel syndrome. SIBO can manifest with a variety of systemic symptoms including foggy brain, joint pain, fatigue, skin problems, and anemia. SIBO can be assessed for with a breath test through Regenerus Labs (codes which cover SIBO are CMI26 and CMI27), and they can be contacted at http://www.regeneruslabs.com or by email on info@regeneruslabs.com or tel +44 (0)333 9000 979. Biolab in London also offer a breath test for SIBO and can be contacted at http://www.biolab.co.uk or tel 020 7636 5959 / 5905.

    If SIBO is present, you may find the Route to Resolution document for SIBO extremely useful. This shows an action flow chart of the general approach for treatment and can be viewed here: http://tinyurl.com/kdb8kox.

    Dietary changes in general to support the reduction of gas include the reduction / elimination of FODMAPS foods (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). These foods tend to worsen symptoms of gas in sensitive individuals. In addition to watching for these items in foods, reducing exposure to these items in supplements also may be important. There often is sorbitol (or other –ol ending natural sweetening substances) as a sweetener, and prebiotics (fructoligosaccharides (FOS), inulin) may worsen problems.

    Sensitive people also may have problems with mucilaginous herbs such as marshmallow, licorice, or aloe; as well as common supplements including flax, chondroitin sulfate, psyllium, and gums. Keeping a diet diary may help your client understand if some of these foods are causing symptoms.

    What are your client’s stress levels like? High levels of stress can worsen digestion and lead to gastrointestinal symptoms. A parasympathetic state is necessary for digestion, and you may want to further question them about this. The botanical chamomile is both a mild bitter, a carminative (improves digestion), and anti-spasmodic, and relaxing nervine which may be helpful in many ways. You may wish to instruct that your client brew up a double strong chamomile tea to drink a bit of before and after meals to reduce symptoms.

    Under stress we secrete less of the digestive juices which are critical for appropriate digestion of food. This affects stomach acid and pancreatic secretions. Supporting your client with digestive enzymes and possibly digestive bitters herbs like dandelion, burdock, gentian will support the normal production of digestive juices. Gentian can most easily be found in cocktail bitters, and depending on the time of year dandelion can be found in many places! Each of these would be taken a bit of time (15 – 30 minutes) before meals to promote digestion of foodstuff to follow.

    In addition to fennel and chamomile, other digestive antispasmodics which may improve symptoms of gas include peppermint, ginger, and anise. Each of these may be prepared in a strong tea or other fashion to be consumed when symptoms occur. Ginger also can be made as a chew (one recipe for such – http://tinyurl.com/p72lq63), and easily taken when symptoms occur away from home.

    Caricol (ARG) is a slow prepared papaya preparation which supports digestion and the reduction of inflammation, and may be helpful taken with or away from meals for the reduction of gas and other gastrointestinal symptoms. Hydro-zyme (BRC) is a digestive enzyme containing betaine hydrochloride, pepsin, pancreatin; Gluten-Gest (ARG) is a digestive enzyme more specifically formulated for the digestion of gluten; Beta-TCP™ (BRC) supports individuals who need bile support. A variety of other combinations as well as pancreas glandular are also available on the Nutri-Link site.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

    • Hydro-zyme™ (BRC): 1 tablet 10 – 15 minutes before each meal. http://tinyurl.com/mxqmd6h Supports digestive function.

    • Caricol (ARG): 1 -3 sachets per day until pattern of stability attained then 1 a day or as required. http://tinyurl.com/p5gjrkk

    Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

    In health,
    Dr. Decker

    in reply to: Trauma and general anaesthetic #17734

    Hi Fiona,

    I’m sorry to hear of your unfortunate turn of events subsequent to your dental procedure. With an infection such as this the risk of complications such as osteomyelitis of the jaw and bacteremia are high, hence drainage and the use of antibiotics is necessary.

    The most important therapeutic modality for pyogenic (pus forming) odontogenic infections is surgical drainage and removal of necrotic tissue. Antibiotic therapy can halt the local spread of infection and prevent hematogenous dissemination. Antimicrobial agents are generally indicated if fever and regional lymphadenopathy are present, or when infection has perforated the bony cortex and spread into surrounding soft tissue. In such situations antibiotic therapies are often given intravenously for three to five days, and then treatment is stepped down to oral antibiotics for a period of 7 to 14 days until local inflammation has resolved. If osteomyleitis of the jaw has occurred treatment will be much more prolonged, often for weeks to months.

    Although the use of antibiotics and drainage in your situation is imperative to recovery, there are other things you can do to support your body and the area locally to support the resolution of this infection.

    A saline gargle is one thing which you may wish to consider. Timing of this may be after food consumption to rinse and clean the oral cavity, or otherwise up to 4 times daily. A saline gargle is performed by dissolving approximately 1/4 teaspoon of salt per 8-ounce glass of warm water, and using this solution to gargle with and spit out. This may aid with hygiene of the oral cavity and provide analgesia, and is used in similar settings such as pharyngitis.

    Hydrotherapy also is a tool that may be beneficial. Hydrotherapy is the use of water to support healing. You may find that you prefer hot, cold, or a combination thereof. Some variations of this include a cold compress, a warming compress, or alternating hot and cold. A cold compress (an ice water soaked towel) may be useful locally in the jaw region to reduce pain and inflammation. A warming compress (a warm water soaked towel) may be used externally in the vicinity of the region, or on the throat. The use of a warming compress on the throat or neck acts to reflexively increase the circulation and decrease congestion in the head. It also is effective for analgesia, and has a sedating action and may help with sleep.

    Alternating hot and cold is another variant that I recommend to clients after at least 3 days of local cold compress applications. In your case you may want to wait longer as it sounds like the local infection and inflammation is somewhat severe. As the signs of local infection (redness, swelling, pain) begin to subside the use of alternating cold may be helpful to increase circulation to the region. To do this, a warming and cold compress are both to be available – utilize two washcloths and two basins, one with cold and one with warm water. Apply warm to the region for approximately 2 minutes and then cold for a shorter period of about 30 seconds. The alternating hot and cold stimuli causes the blood vessels to alternating expand and constrict and improves blood flow to the region in support of healing.

    You also may also wish to try lymphatic massage to support drainage from the region. Lymphatic massage or drainage supports the circulation of lymph and white blood cells. There are various videos on the internet with instructions and demonstrations of this technique; one can be found here – http://tinyurl.com/pk5caje. I often recommend this for a variety of ear, nose, and throat infections. You may find that some modification is necessary for your case, but the more general maneuvers in the neck region will still be supportive.

    Concerning the use of supplements, the use of agents which support the immune response may be beneficial to you. As your dietary patterns are likely altered with this infection and the drainage configuration, you may find a combination of nutrients in a protein powder format to be beneficial to meet your nutritional needs and as a means of immune support. Support for immune function including probiotics, nutrients, and medicinal mushrooms also may help your immune system to overcome underlying infectious processes. Colostrum as well as proline-richpeptidesand lactoferrin extracted from colostrum also support a normal immune response.

    • Semba RD. Vitamin A, immunity, and infection. Clin Infect Dis. 1994 Sep;19(3):489-99. http://tinyurl.com/pkfy2ns
    • Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl). 2010 May;88(5):441-50. http://tinyurl.com/m88xcjd
    • Isolauri E, et al. Probiotics: effects on immunity. Am J Clin Nutr. 2001 Feb;73(2 Suppl):444S-450S. http://tinyurl.com/pj4nlxm
    • Bagwe S, et al. Bovine colostrum: an emerging nutraceutical. J Complement Integr Med. 2015 Sep 1;12(3):175-85. http://tinyurl.com/ndsm4js
    • Korhonen H, et al. Bovine milk antibodies for health. Br J Nutr. 2000 Nov;84 Suppl 1:S135-46. http://tinyurl.com/nl2ddt4
    • Mulder AM, et al. Bovine lactoferrin supplementation supports immune and antioxidant status in healthy human males. Nutr Res. 2008 Sep;28(9):583-9. http://tinyurl.com/opy4nee

    Clove in tincture, oil, or strong tea form may also be something you wish to try for management of the local pain. Clove is a numbing topical anesthesia which has been shown to be comparable to benzocaine.

    • Alqareer A, et al. The effect of clove and benzocaine versus placebo as topical anesthetics. J Dent. 2006 Nov;34(10):747-50. http://tinyurl.com/ojmt7co

    I have also find homeopathy useful in addition to nutritional and botanical support. You may wish to find a homeopath to consult with concerning your case specifics. However one remedy which I would consider given the severity of your infectious presentation is Mercurius, particularly if you have any issues of temperature sensitivity. If so you may wish to take this remedy in a potency of 30C daily or 6C multiple times a day.

    SUGGESTED SUPPLEMENTS

    The following supplements are suggested for you to consider in light of your relevant expertise. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for (yourself in this case!).

    • Wholly Immune (ARG): 1 scoop twice daily in 8oz liquid. http://tinyurl.com/33v5um9 Contains nutrients, botanicals, and mushroom extract to support immune function.

    OR

    • Bio-Immunozyme Forte (BRC): 2 capsules once or twice daily. http://tinyurl.com/pb2t45t Contains immune supportive nutrients and glandulars.

    With

    • PRP Cytokines (ARG): 3 sprays up to 5 times a day during acute infection. http://tinyurl.com/kpkkgdg

    OR

    • Laktoferrin With Colostrum (ARG): 4 capsules at night before bed. http://tinyurl.com/q6snpn6

    And

    • ProGreens (ARG): 1 scoop twice daily with liquid. http://tinyurl.com/ptkkpzw Supports intake of phytonutrients while food consumption is limited. Also contains probiotics.

    Also consider additionally:

    • Bio-D-Mulsion Forte (BRC): 2 drops daily. http://tinyurl.com/kfpjyw6

    Please consider these suggestions in light of the other clinical information pertaining to your health. I hope this information is helpful, and if you have any further questions or information specific to the problems you are experiencing, please do provide feedback.

    In health,
    Dr. Decker

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