Here’s some simple easy changes to boost your nutrition. Check my website for recipes and to sign up to my newsletter.
Salad dressings - swop salad dressing for olive oil and lemon/apple cider vinegar (ACV) or balsamic vinegar. Mixing 1 tbsp of tahini with 6 tbsp olive oil plus 1 tbsp of lemon juice or ACV is a delicious alternative to mayonnaise. Thin with water if needed.
Crispy stuff – make your own popcorn with popcorn and olive oil plus some butter or ghee and a little salt. Alternatively roast pumpkin seeds with paprika, salt and a dash of cumin or cayenne pepper, Remember all crisps tend to contain trans-fats as they are deep fried with non-stable vegetable oils.
White for brown – this goes for rice, bread, pasta and crackers. The glycaemic index may still be high, although this is depends on the individual. But whole grain foods will retain more micro-nutrients the glycaemic response is likely to be lower, they will contain more fibre and protein and some folks do fine with them. If you soak brown rice overnight it will cook almost as quick as white.
Oats – go for steel cut or larger flakes. They are less processed and will take the body longer to breakdown, supplying a source of energy to longer.
Rice – for cauliflower rice. It’s actually very easy and it works, I’ve tried it. More fibre, more veg and less processed than rice.
Baked beans – swop your standard variety for low sugar and salt or make your own and freeze in portions.
Cow milk – for oat, rice, almond, soya or coconut. Cow milk is a major source of allergens, which are inflammatory and growth promotors. Plus many of us do not possess the lactase enzyme to digest lactose properly. It is also associated with an increased risk of osteoporosis, heart disease and auto-immunity.
Snacking on cakes, biscuits and pastries – switch to oat cakes and nut butter, nuts and seeds, one piece of fruit or a handful of berries with yogurt and hemp seeds, apple slices with a squeeze of lime juice, some nuts or seeds and a dollop of nut butter. Cakes and biscuits are full of processed ingredients and high in sugar so they will spike blood sugar and therefore insulin. They are also addictive, one is never enough.
Bread – switch to breadmaker bread and use rye flour or ancient grains such as spelt or kamut which have less gluten. You need a breadmaker that has these specialist options and it can take a while to perfect the recipe. If you are really up for the challenge switch to flax seed bread –I guarantee one slice will take you about 5 minutes to eat and you will struggle to eat a second.
Dessert – make a rule it has to be home made. I made this rule for all cakes and puddings when I first got into nutrition and as I am a lazy baker this immediately cut our consumption. Dessert, pudding, biscuits, cakes etc. need to be the exception not an expectation. But hey rules are made to be broken and a paleo crumble now and then is a great option. See my website for the recipe.
Staying alive in toxic times
This month I did a fascinating webinar with Dr Jenny Goodman, author of Staying Alive in Toxic Times, and more recently Getting Healthy in Toxic Times. Jenny is an ecological Doctor, very well respected author and rigorous researcher. The webinar was about her top 7 strategies, based on her up to date findings and research. The book will cover many more issues of course.
We all know now that everything is connected and we need to become kinder and more loving to everything, and everyone, especially nature. But how do we tackle this on an individual and daily basis? Her top three were nutrition, water filtration and cleaning up the home from indoor pollution. The issues covered in the book can cause overwhelm but as a practising Doctor she is an advocate of what I call ‘meeting people where they are’. So she includes advice regarding prioritisation and practical suggestions and ideas to tackle each area.
For example the first area ‘nutrition’ is a subject close to my heart but not everyone can afford top quality organic produce. My advice is always to buy the best you can afford. If you eat meat this is critical as animals concentrate toxicity through a process called bio-transformation. The body stores these toxins in fats to try to shield the body from harm.
There are useful strategies though such as avoiding those vegetables grown with the most pesticides such as grapes, strawberries and lettuce. You can sign up for a list of the ‘dirty dozen’ here https://mailchi.mp/pan-uk/dirty-dozen-23. There is of course also a prioritisation issue. According to Tim Spector we are one of the sickest countries in Europe but little attention is being paid to this. 33% of our income used to be spent on food, today just 8% so this is no doubt part of the problem.
Water filtration seems to be a rapidly developing area. I do have a hand-out on this if anyone is interested I am happy to send it out. She doesn’t give specific recommendations anymore because the companies themselves change what their products filter so the advice dates very quickly. What she outlines in her book are the questions which need to be checked before making a buying decision. The challenge of course is to filter out the harmful toxicity but retain or replenish the mineral content that can be lost in the process.
I was fascinated to learn that the Netherlands use physical filters and ultraviolet light to kill bacteria rather than chlorine as per the UK. This means they don’t drink ‘disinfection by- products’.
Where the home is concerned Jenny highlighted chemicals from cookware and soft furnishings, which are relatively easy to address. The most at risk are pregnant women and young children but pre conception couples should also take note here. Again there are options so if you can’t afford the organic mattress, you buy them in the summer and leave them to ‘detox’ with the windows open. Don’t paint the nursery very close to the birth etc.
I should add that there is also a lot of encouraging work being done by enterprising individuals, organisation’s and companies all of which is covered in the book. Her website if of interest is www.drjennygoodman.com.
Photo credit: Photo by Demure Storyteller on Unsplash Acera Palm known for it's ability to absorb toxic VOC compounds from the air.
The role of cholesterol and fats in cardiovascular disease (CVD)
Cholesterol and fat receive a lot of attention in the health and wellness media especially in connection with cardiovascular disease (CVD). Most of it is negative and places the blame for heart disease on high fats diets in general and more specifically the cholesterol molecule. Of course there are numerous CVD risk factors such as age, genetics, sedentary lifestyles, obesity, diabetes and so on but this blog is focused on clarifying the role of cholesterol and fats.
Where does cholesterol come from and what does it do?
Only about 20% of our cholesterol comes from diet, the remaining 80% is made by the liver. So why does our body make it, if it’s harmful?
Cholesterol is an essential component of many processes in the body including the formation of every cell membrane. Our cell membranes consist of 1/3 saturated fat, 1/3 polyunsaturated fat and 1/3 cholesterol and it is here that all cellular activity (metabolism) takes place.
Cholesterol is the raw material of hormone production and we manufacture vitamin D from it, via the action of sunlight. We also need it for bile, which facilitates fat absorption and toxin excretion. It’s a key component of the myelin sheath surrounding our nerve fibres making it important for brain and nerve function. The list goes on, but you can see how important it is for many critical functions.
How does cholesterol go wrong?
The problem occurs when there is damage to the delicate lining of our blood vessels. The immune system steps in creating plaques to try and repair the situation and over time they can narrow our arteries. This process can result in an oxidised cholesterol molecule (LDL-c), which depending on the size, density and number of them can increase cardiac risk.
If our cholesterol metabolism is working correctly however LDL-c should be picked up by HDL-c and returned to the liver for excretion. For this process to work properly it requires a consistent supply of antioxidants.
So as is often the case it’s a question of balance.
What causes blood vessel damage?
The biggest culprits are high blood pressure from stress, sugar, trans fats and inflammation. This is because:
High blood pressure caused by the stress hormone adrenaline causes turbulent blood flow, which can easily damage the delicate blood vessel lining. Adrenaline can be triggered by any stressor such as: erratic blood sugar, lack of sleep, financial or emotional difficulties.
Refined carbohydrates and refined sugar are pro-inflammatory and can form ‘advance glycation end products’ (AGE) which stick to plaques further narrowing the arteries.
Trans fats which are contained in most biscuits, cakes and ultra processed food, raise LDL-c as well as making these particles more dangerous (atherogenic).
Inflammation arises from various sources such as infection and toxicity but vascular cell damage is also inflammatory so a vicious cycle emerges.
What if cholesterol is high? WHAT IF TOTAL CHOLEST
This may or may not be a problem but it’s always wise to investigate. Ideally our total cholesterol:HDL-c ratio should be less than 4.5 for men and less than 4 for women. The other important ratio is the HDL:LDL - c ratio and this is kept in balance by our level of antioxidants.
Preliminary check
An easy way to assess if there might be an issue is to calculate your waist to hip ratio (WHR). This is a good indicator of the presence of fat around the organs (visceral fat). Women should be 0.8 or more with a waist measurement below 90 cm (35 inches). The ratio for men is 1.0 or more with a 102 cm (40 inch) waist or less.
Can nutrition and lifestyle help?
The good news is there is so much you can do with nutrition, lifestyle and supplements to balance cholesterol metabolism and reduce risk. Medication may be necessary especially if there are genetics at play but this can often be minimised if every thing else is addressed.
Nutritional therapy is always very unique and personalised but it tends to focus on the following:
Nutrition
Lowering inflammation levels - through dietary change and supplements if required. Levels of omega 3 in the diet are important to evaluate.
Making sure sources of fat in the diet are good quality and that fats used in cooking are very stable. Trans-fats should be eliminated as much as possible. Digestion and absorption of fats is assessed and improved if needed.
Is the diet high in processed carbohydrates and refined sugar? Any excess will be converted to fat. Fat in the body doesn’t only come from the fat we eat.
Ensuring sufficient Vitamin D levels – these are highly protective against heart disease.
Balancing the antioxidant status in the body and levels of B3 – testing can be useful here
Adjusting levels of fibre in the diet to facilitate cholesterol excretion.
Checking sulphur intake in the diet. We are often low due to soil deficiency or we may not convert it to sulphate so cholesterol circulates as LDL-c. Some diets such as FODMAP can be low in this nutrient.
Testing and supplementation
A preliminary urine and blood spot test can be done to gage risk, before making the decision to invest in a more expensive, comprehensive CVD profile. The latter does help to establish blood lipid (fat) levels and direct priorities. The number and size of LDL-c particles and whether or not they are oxidised also helps to pinpoint risk.
Appropriate supplementation to fill any dietary gaps and tackle priorities.
Lifestyle
Stress management - 75% of people admitted with heart attacks have normal cholesterol with LDL levels below average (Dr. Aseem Malhotra FRCP).
Improve sleep for physical and mental recovery.
Improving breathing function to maximise nitric oxide production. This relaxes the blood vessels, improving blood flow to deliver nutrients and oxygen to the tissues, including the heart and the lungs.
Exercise – the right sort appropriate for age.
References:
Samsel, A and Seneff, S. (2013) Glyphosate, pathways to modern diseases II: celiac sprue and gluten intolerance. InterdisciplinaryToxicology 6(4): 159–184. doi: 10.2478/intox-2013-0026
Wannamethee, G. et al. (1995) Low serum total cholesterol concentrations and mortality in middle aged British men. British Medical Journal 12:311(7002): pp. 409-13. doi: 10.1136/bmj.311.7002.409.
Can't lose weight? 10 things to consider
This is a summary of some of the core reasons for why weight loss can be so difficult for some people. It’s a complex area involving biology, physiology, emotions and psychology to name just some. However if you feel like you have tried everything you could have a think about the list below which summarises some of the key areas to address.
Appetite regulation system, poor eating habits and compromised digestion.
This can include things like eating too fast. The satiety hormones take time to register and react to food intake. If we eat fast we can over eat before the feedback mechanism has time to respond and let us know we are full. Similarly, if we eat on the run or with our attention elsewhere such as the computer or TV, studies show that we eat more.
New research is showing that there are more stretch (mechano) receptors in the small intestine than the stomach. They tell the brain we are full via nerve feedback. If digestion is compromised in any way then food will take longer to reach the small intestine. It is now thought that this delays signals to the brain that we have eaten enough and extracted the nutrients we need. So improving digestive function can be part of the solution.
Eating slowly and chewing properly as well as other simple changes to the way we eat can make a big difference here. It takes an effort to change habits which are our default way of thinking about and consuming food. But once you correct them and the new habits are ingrained you can go back onto autopilot, it’s just one that serves you better.
Lack of movement and too few muscle cells.
The more muscle cells you have, the more mitochondria you will have. These organelles are responsible for turning food into energy. The more you have the higher your basic metabolic rate (BMR) will be. This is the amount of calories you burn to maintain your body’s function at rest. It is generally thought that our BMR accounts for 70%+ of our daily energy requirements. So another aspect of weight loss can be adjusting our training schedule to improve mitochondria numbers and function.
Lack of nutrition knowledge and understanding about how the body works.
This can result in a poor quality diet perhaps including a lot of ultra processed food (UPF) or a very low calorie diet and yo-yo dieting. Sometimes we need to keep an eye on portion size and plate content and a calorie assessment can be useful here. However I tend to focus initially on the nutrient and micronutrient content of the diet. Once we get this right and the body is nourished then we can take a look at tweaking plate content and construction. I think a lot of ‘diets’ fail because if the body isn’t nourished properly there maybe micronutrient deficiencies so the body craves food in an attempt to resolve this. This is interpreted as hunger.
There is no one method to lose weight. Different methods suit different people’s lifestyles, individual preference sand health status. To some extent they all work, at least initially. What’s important is to establish a baseline that keeps weight stable and the body healthy. This helps to make the body feel safe. Then we can mix and match different weight loss strategies to get the body to adapt. Remember we want it to do something it wouldn’t naturally want to do, based on evolution, which is to lose weight.
The problem with very low-calorie diets (VLCD) and yo yo dieting is the body does something called adaptive thermogenesis. It adapts to the altered calorie intake. It’s also very hard to maintain these over the long term and it can be stressful for the body. It is not a time to lose weight when we are stressed (see BLOG here https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/
Lack of hormetic challenge.
Exposure to hormetic stress builds resilience and occurs when we are challenged without overly exhausting ourselves. It includes such physical activities as high intensity interval training, cold exposure (showers or ice baths) and fasting. It’s the use it or lose it principle. It’s an adaptive response to a challenge generated by the environment. Even our response to drugs is a hormetic challenge of sorts. Modern life has evolved to reduce many of our physical hormetic challenges, think central heating, air conditioning and our indoor lifestyles. There are many simple ways to introduce this such as cold showers, breathwork and exercise.
This is probably the most useful starting point for most people. You need stable, well managed blood sugar (glucose) if you want to lose weight. If glucose levels in the blood are too high it has to be removed. Insulin takes glucose into the cells to use for energy but if there is no demand it will be taken to the liver where the majority will be stored as fat. Hence insulin is often referred to as the fat storage hormone. So we want to try and keep our levels of insulin low and there are numerous nutritional strategies and supplements that can help with this.
Equally if blood glucose is too low this is stressful for the body. Stress raises cortisol which triggers the release of glucose stores, known as glycogen, from the liver or muscle. Alternatively the body will make glucose by breaking down tissue. Initially this can trigger weight loss but if cortisol stimulation is ongoing, as in chronic stress, this can lead to sustained high blood sugar levels which will necessitate more and more insulin. If the cells become resistant to insulin from stress, poor diet, high sugar intake or poor liver function then insulin resistance can develop which is associated with fat storage (see https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/).
Poor thyroid and/or hormone function leading to a dysregulated metabolism.
Our thyroid regulates our metabolic rate which is how we make energy. If thyroid hormone production is low this effectively slows the metabolism causing symptoms such as ‘tired and wired’; anxiety; poor sleep; negativity and depression; shakiness between meals; irritability and a very short fuse. This often leads to abdominal weight gain. This kind of symptom pattern usually requires professional assistance from a qualified nutritional therapist and the medical profession to try to resolve the underlying hormone malfunction. Overproduction of cortisol can play a role in this so stress management is crucial, see below.
Stress and overload.
If the body is chronically stressed then it won’t be able to lose weight. To lose weight requires good digestion, good liver function and good blood sugar and insulin management. All of this requires energy for your internal organs to work properly. Chronic stress takes the energy away from internal function to the extremities, (arms and legs) and the heart so we can run, fight or hide. The body won’t undertake remodelling or restructuring when it’s focused on survival. It’s the same as life. When you are in a stressful life situation you focus on the essentials and the body is the same. You can read more on this here https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/
Gut and liver function.
The microbiome (bacteria) in our gut facilitates nutrient extraction from and absorption of food. The importance of nourishing the body in order to lose weight is covered in point 3 above. Most studies seem to point to the ratio of Firmicutes to Bacteroidetes being significantly higher in overweight and obese subjects (Ley, 2010; John and Mullin, 2016). In addition lean subjects appear to have a more diverse and complex microbiome (Kasai et al., 2015; Lv et al., 2019).
The gut microbiota plays a major role in energy generation (metabolism) from the fermentation of fibre and protein in the colon to produce short chain fatty acids (SCFA’s). SCFA’s affect body weight, glucose regulation and insulin sensitivity as well as playing roles in satiety and appetite. Hence the microbiome impacts weight in a number of complex ways through influencing food intake (type and quantity), gut microbiota, nutrient levels and metabolism.
Liver function is critical to maintain a healthy weight. It plays a major role in managing blood sugar (see 5). It controls the the conversion of excess glucose to fat and the breakdown of fat for energy. If liver function is impaired then this system can struggle, fat metabolism deteriorates, and as a result fat accumulates in the liver. This can lead to non-alcoholic fatty liver disease (NAFLD) and/or weight gain. The liver is of course the major detoxification organ of the body. If it malfunctions toxins can build up which can interfere with hormone function and affect metabolism, which often leads to weight gain.
Good gut and liver function are therefore key for successful weight loss. Focusing on improving both of these is often a significant part of any weight loss programme.
Sleep.
Modern lifestyles often mean insufficient sleep. Insufficient sleep causes stress which has already been discussed above. Stress and lack of sleep can lead to comfort eating which tends to be carbohydrate. This can easily become a vicious cycle as carbohydrates, if not wholegrain or good quality, elevate blood glucose quickly. This triggers a lot of insulin very quickly followed by a sudden drop which results in low blood glucose (hypoglycemia) and we end up with poor management of blood sugar (see 5).
The association between lack of sleep and being overweight is well known and shift workers are a prime example of this. Ideally we need 8-9 hours of sleep between 9:30pm and 6:30am. The emerging science of how circadian rhythm interacts with nutrition and health is called chrononutrition and adapting meal timing and structure to take account of our circadian rhythm can really help support weight loss and health.
Change and the brain.
Losing weight involves change on many levels and the organ of change is the brain. It contains the most neurons and the greatest potential to create change. There will often be a lot of negative thinking and slef around excess weight. We have 50-60 thousand thoughts a day and most are the same as the day before. To lose weight we want to start interrupting these thought patterns and changing our focus from what we don’t want, to what we do. Pictures of how you want to look, vision boards to remind you of your goals, even just taking a few minutes each day to tune into how you want to look and feel. Working with other therapists can help such as CBT, NLP, hypnotherapy, whatever it takes to keep on the right track. If meditation is your thing then Dr Joe Dispenza offers many options and this link talks about the brain and how to change https://www.youtube.com/watch?v=EpOMk1jOzgk&t=47s
References
Aoun, A. (2019) The Influence of the Gut Microbiome on Obesity in Adults and the Role of Probiotics, Prebiotics, and Synbiotics for Weight Loss. Cell: 179: pp.1129-1143. https://doi.org/10.1016/j.cell.2019.10.031
Kasai, C. et al. (2015) Comparison of the gut microbiota composition between obese and non-obese individuals in a Japanese population, as analyzed by terminal restriction fragment length polymorphism and next-generation sequencing. BMC Gastroenterology: 15(100). doi: 10.1186/s12876-015-0330-2
Muller, M.J. et al. (2016) Changes in Energy Expenditure with Weight Gain and Weight Loss in Humans, Current Obesity Reports: 5(4): pp. 413-423. doi: 10.1007/s13679-016-0237-4
Rattan, S.I.S and Demirovic, D. (2010) Hormesis can and Does Work in Humans. Dose-Response: 8(1) pp.58-63. doi:10.2203/dose-response.09-041.Rattan
A lot of my clients rely on white rice or pasta for quick meals. I thought I would write this blog about the benefits of brown rice and how to prepare it. Hoping to convince you all that brown rice is the way forward.
Brown rice is a whole grain and a major source of complex carbohydrate, fibre, minerals and B vitamins. Once the husk is removed the rice is sold as whole or brown rice. Otherwise it is milled and polished at least three more times to remove the bran and the germ from the endosperm, producing white rice.
1. Slower energy release
White rice is quickly digested to sugar increasing the potential for blood sugar spikes which are associated with increased risk of type 2 diabetes and insulin resistance. The carbohydrate in brown rice is wrapped in fibre which our bodies can’t digest. This means brown rice is digested to sugar much more slowly with a much slower release of energy.
2. Fitter and fuller with fibre
Whole grains and fibre keep us full for longer which can help with weight management and keep our gut bacteria happy. This is turn supports our immune system, mental health and risk of multiple chronic diseases.
3. Good for the heart
The British Heart Foundation says: “Higher intakes of fibre are also associated with a lower risk of heart and circulatory disease, and some cancers.” Brown rice may therefore improve heart health due to its fibre content as well as another specific compound found in its outer layers.
4. Packed with nutrients
Most of the nutrients in a whole grain of rice can be found in its outer layers which are removed during the production of white rice. So brown rice is more nutritious being a better source of vitamins and minerals, including calcium, iron, phosphorous, magnesium, selenium, vitamin B1 (thiamine) and vitamin B6 (pyridoxine). Brown rice has 10 times the amount of B1 compared to white rice unless it is fortified. Vitamin B1 deficiency (beriberi) has been known to affect populations with a heavy reliance on white rice. This affects the heart, nerves and the muscles.
The protein content and the quality of whole grains is also much greater than that of refined grains.
5. Antioxidant supply
In January 2023, researchers identified the main antioxidant of brown rice as cycloartenyl ferulate (CAF). This not only protects cells it also boosts the production of antioxidants within other cells.
CAF is hybrid compound of two different types of antioxidant (polyphenols and phytosterols) which may help lower cholesterol levels, suppress inflammation and reduce chronic disease risk.
6. Soaking
This not only reduces cooking time but lowers the arsenic content which can be high in rice according to the FDA. The soaking also makes the nutrients in rice more absorbable because it helps to remove the phytic acid content. The latter can combine with minerals such as magnesium and zinc and block their absorption. Whole grains are effectively seeds so they contain enzyme inhibitors which are activated by water and warmth in preparation for growth. Soaking in essence pre-digests the grain making it’s nutrients more readily available.
I personally soak brown rice overnight if possible with water and a dash of lemon juice or apple cider vinegar. Even a few hours is helpful if I forget the night before. I am constantly surprised when discussing this with my older clients how many will tell me that their parents used to do this. We seem to lose many of our food traditions with the speed of modern life.
7. Leftovers
Cool quickly and store in fridge within an hour of cooking. Eat within 24 hours or you can freeze it. Defrost it in the fridge and reheat thoroughly.
There are two major forms of vitamin D from two different sources.
Vitamin D3 (cholecalciferol) is our main source (80-90%) and it is produced in the skin following sunlight exposure but it is also found in foods of animal origin. Technically this makes vitamin D a pro hormone.
Vitamin D2 (ergocalciferol) is found in foods of vegetable origin and supplements
In the UK our main dietary sources of vitamin D are food of animal origin, foods fortified with vitamin D and supplementation. Naturally rich food sources include egg yolk and oily fish such as salmon, mackerel, herring and sardines.
Absorption
We probably absorb between 62 to 92% of our dietary vitamin D. It is fat soluble and absorbed in the small intestine from where it is transported via the lymph into the circulation. Vitamin D produced under the skin enters the fluid between our cells (extracellular) before defusing into the circulation and being transported to the liver.
Common food sources of vitamin D
Food sources
International Units (IU)
Salmon 140g
408
Sardines canned 140g
184
Mackerel 140g
476
Mushrooms 80g (enriched)
128
1 egg
64
Tuna 140g
60
Beef mince 100g
24
Lamb 90g
20
Butter 10g
4
Vitamin D content is taken from British Nutrition Foundation ‘Vital vitamin D’ resource sourced from McCance and Widdowson's The Composition of Foods: Seventh Summary
Total vitamin D production depends on a combination of factors:
Intake via the diet and from sunlight
The amount of vitamin D absorbed and then delivered to the liver
The amount produced by the liver
It’s half-life in plasma.
Uptake by body fat and muscle mass.
Rate of conversion to other metabolites
Levels of acute inflammation in the body appear to adversely affect vitamin D levels.
The body appears to store vitamin D in adipose tissue (fat cells) and possibly muscle tissue. Studies suggest that levels of vitamin D decline as our body mass index (BMI) increases, and increase as BMI decreases. However the ability of the body to access these stores is unclear and it may be sequestered rather than stored.
There are in fact, a whole lot of factors that affect how much vitamin D our bodies can make including:
how much skin we expose to the sun
the height and angle of the sun in the sky
the time of year
the duration of exposure
the health (and age) of our liver and kidneys
excess weight
Role in the body
The main role of vitamin D is to help regulate the absorption and metabolism of calcium and phosphorus from the gut. To a lesser extent it also regulates magnesium absorption.
Vitamin D is therefore vital for bone mineralisation, bone growth and bone health. Without it bones will be soft, malformed, and unable to repair themselves normally. This results in the disease called rickets in children and osteomalacia in adults. Vitamin D also plays an important role in musculoskeletal health and neuromuscular function because of its’ role in calcium homeostasis.
However evidence is emerging of other roles for vitamin D including:
Appropriate muscular function
Better brain health and improved mood
Stimulation of anti-inflammatory pathways
Good gut function
Proper functioning of the immune system (immune-modulation)
Prevention of acute respiratory infections
Optimisation of blood sugar levels and weight loss
Cardiovascular health
Healthy pregnancy and reduction in pre-eclampsia risk
Reduction of cancer risk, heart disease, autoimmune disease and osteoporosis
Healthy aging
Latterly, more data is emerging for post-covid vaccine support
Measurement
Both vitamin D2 and vitamin D3 are converted by the liver to 25-hydroxyvitamin D written in shortform as 25(OH)D and then to the active hormone 1,25 dihydroxyvitamin D. Tests measure 25(OH)D to estimate the status of vitamin D in the body because it is the most useful indicator. It remains in the blood longer and is present at much higher concentrations than the active form.
The National Osteoporosis society (NOS) guidelines (UK, 2013) and the Institute of Medicine (US) classify vitamin D results as follows:
Less than 30 nmol/L is deficient
30-50 nmol/L may be inadequate in some people
Greater than 50 nmol/L is sufficient for almost the whole population.
The Scientific Advisory Committee Report (SACN) report (2016) considers levels in the UK below 25 nmol/L to be inadequate with an increased risk of rickets and osteomalacia.
However the Endocrine Society Task Force concluded 50 nmol/L as the cut off for deficiency and recommended that concentration “should exceed 75 nmol/L” for maximum benefit on calcium, bone and muscle metabolism. Other researchers have proposed thresholds between 50-120 nmol/L to reduce the risk of adverse non-skeletal outcomes.
Dr Damien Downing, president of the British Society for Ecological Medicine and vitamin D expert, recommends a vitamin D blood level of at least 75 nmol/L for immune support and levels over 100 nmol/L to lower your risk of cancer and autoimmune disease. Grassroots Health (vitamin D global expert Group) suggest anything below 100 nmol/L is inadequate and recommend optimum levels of 100-150 nmol/L.
Your magnesium and vitamin K2 intake can also influence your vitamin D absorption. Magnesium is required for the conversion of vitamin D into its active form. If your magnesium level is too low you may store vitamin D in its inactive form.
How to supplement if blood levels are low
Low blood levels of vitamin D may mean that you are not getting enough exposure to sunlight or enough dietary intake or that there is a problem with its absorption from the intestines.
In the UK most people should be able to obtain enough vitamin D from sunlight from the end of March to the end of September.
During autumn and winter as many of us don’t get enough sun exposure a supplement may be required. The best way to determine your requirement is to measure your vitamin D (https://www.vitamindtest.org.uk/) level and then use the Grassroots vitamin D calculator to work out the correct dose. https://www.grassrootshealth.net/project/dcalculator.
Grassroots Health also suggest taking 600mg of magnesium and supplemental K2 of 90 mcg for women and 120 mcg for men daily. This helps to support bioavailability of your vitamin D as well as conversion to the active form.
Elderly people, those with darker skin tones, overweight or obese individuals or those exposed to limited sunlight have a much higher risk of becoming deficient. The Department of Health and Social Care recommends a daily supplement containing 10 micrograms (400IU) of vitamin D for higher risk groups like these.
You can also get some idea of where your level might be by using the D Minder Pro app from the App Store. This app is expertly designed to help you track and manage your vitamin D levels. It also provides other useful data related to your geographical location.
How much to supplement
Official recommendations on how much to supplement vary widely. In the UK it's 400 IU (international units) or 10mcg (micrograms). The EU and many countries go for 400-600 IU, the exception is Italy's 2000 IU (50 mcg), in the USA its1000 IU (25 mcg). Some vitamin D researchers and experienced clinicians, such as Professor Hollick, recommend 4000 to 5000 IU (125 mcg) for daily maintenance. A general guideline for adults over the age of 18 is between 50-100 mcg (2000 – 4000IU) for the colder months. It is recommended to work with a healthcare practitioner before supplementing at these levels.
Which form of vitamin D to supplement
Clinicians usually recommend vitamin D3 for supplementation as D2 isn’t so effective at raising vitamin D levels in the blood.
Toxicity
Commercially vitamin D is synthesised by UVB irradiation of 7DHC (from sheep wool) and ergosterol (from fungi). Prolonged sunlight doesn’t cause excess production but high dose supplementation can be toxic and can cause hypercalcaemia (soft tissue deposition of calcium). High levels will usually reflect supplement intake.
To evaluate how your sun exposure and/or supplement dose is working for you it’s a good idea to re measure your vitamin D level after three to six months.
N.B. 1 microgram of vitamin D is equal to 40 International Units (IU). So 10 micrograms of vitamin D is equal to 400 IU.
References
Alliance for Natural Healthhttps://www.anhinternational.org/campaigns/test-take-vitamin-d/
Bikle, D.D. (2009) Vitamin D and immune function: understanding common pathways; Curr Osteoporos Rep; Jul; 7(2); pp.58-63. doi: 10.1007/s11914-009-0011-6.
Haddad, J.G. et. al (1993) Human plasma transport of vitamin D after its endogenous synthesis; Journal of Clinical Investigation; June; 91(6) pp.2552-5. doi: 10.1172/JCI116492.
Holick, M.F. (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline; J Clin Endocrinol Metab; July; 96(7); pp.1911-30. doi: 10.1210/jc.2011-0385.
Ovesen, L. et. al (2003) Geographical differences in vitamin D status, with particular reference to European countries; Proceedings of the Nutrition Society; Symposium on optimal nutrition for osteoporosis prevention; 62 pp. 813-821.
SACN (2016) Vitamin D and Health; The Scientific Advisory Committee on nutrition; Available from https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition. (SACN)
Intermittent fasting and fasting for health
Intermittent fasting is in the limelight at the moment but many traditions have been incorporating fasting for millennia. Humans have historically fasted overnight, for religious reasons or during periods of food scarcity. Some monks have a precept called ‘no meals after noon’ and religions such as Taoism, Sikhism, Hinduism, Christianity, and Buddhism all fast.
Fasting principles
What we eat at mealtimes is our primary fuel source for 3-4 hours. After 4-12 hours we utilise sugar (glycogen) stored in the liver, muscle and brain. Somewhere between 10 or 12 hours we will start to burn fat out of the liver to produce glucose for energy (gluconeogenesis). It takes 2-3 days for fat to become the predominant fuel source.
The body will often store toxins in fat cells waiting for an opportune moment to detoxify. It’s a bit like us putting things in cupboards, pending a rainy weekend for a clear out. When we are constantly digesting this moment doesn’t materialise. The body never gets chance to undertake any longer term regeneration or deep cleaning projects and our cells and guts can become overwhelmed.
"fasting is the body's equivalent of spring cleaning your house or servicing your car"
The digestive system
The inside of our gastro intestinal (GI) tract is still considered external to the human body. The cells lining the GI tract act as the gatekeeper to our body’s internal environment. The lining is delicate about half the width of a human hair. Nevertheless it underpins all of our health by protecting our immune system and blood stream from toxins and pathogens. The lining is covered in a mucus layer which contains our gut flora (microbiome) and this forms a selective barrier between us and the outside world.
Host microbiome axis: Interaction between the GI tract, the mucus layer and our immune system
Source: Esser, D. et al. (2019) Functions of the microbiota for the physiology of animal metaorganisms; Journal of Innate Immunity; 11(5), pp. 393-404
The immune system
Just behind our gut lining sits our gut associated lymphoid tissue (GALT) which is host to the majority of our immune system. Most people eat at least 3 meals a day plus snacks. This means our immune system is on duty 14 hours a day assessing anything that filters through the gut lining for potential toxins and pathogenic material.
With constant stimulation and no rest, our immune system can’t build up reserves of antioxidants or take care of any long-term building projects. It then risks developing faults or errors of judgment which scientists believe can make us susceptible to:
Gut inflammation
Food sensitivity
Asthma/eczema
Allergy
Autoimmune issues
Diabetes
Cancer
Types of fasting
There are a number of different types of fasting (see below)*. There are also hybrid diets such as the fasting mimicking diet (FMD). This is low in calories and protein but high in fat and maintains micronutrient content. Time restricted feeding (TRF) when food is kept to an eating window of 12 hours (7am to 7pm) or 8 hours (8am to 6pm) will provide an overnight fast of 12 and 14 hours respectively. These variations may be more suitable for some people depending on their state of health and unique physiology.
Longer fasts of up to 5 days can promote autophagy which is a process of programmed cell dissolution. This takes place once all of our glycogen stores have been utilised c. 24-72 hours around the 4th or 5th day. With this process the body breaks down any damaged cells such as mis-folded proteins, ameloid plaques, damaged DNA etc. It’s a process of self-eating where the body recycles damaged materials for alternative use. Shorter fasts such as Intermittent fasting help the body to train into longer fasting periods. Fasting shouldn’t be undertaken without due consideration of your current health status and reference to your health practitioner or GP.
“You get rid of the junk during starvation — and once you have food, you can rebuild… The damaged cells are replaced with new cells, working cells — and now the system starts working properly.”
Dr Valter Longo
What fasting does
Your autonomic nervous system (ANS) carries out all the functions which basically run your body on a day to day basis. Fasting seems to press the reset button on your physiology and all the functions of your ANS including:
Gut / immune system reset - fasting appears to reset our metabolism and rejuvenate the immune system as it gets chance to rest and recover and restore our antioxidant reservoirs.
Gut hormone/stress reset – fasting resets our hormonal systems and avoids the constant adrenaline state to which so many of us have become accustomed.
Gut / brain reset – fasting can help to change our emotional relationship with food as we challenge the body to adapt to different levels of food supply.
Liver reset – fasting facilitates detoxification as we burn fat and sugar out of our liver compartments.
How fasting improves health
Studies in humans and mice of different types of fasting demonstrate improvement in multiple health indicators such as:
Weight loss
Reduced insulin resistance
Lower insulin levels
Decreased oxidative stress
Lower cardiovascular risk factors
Lowers blood pressure
Resets our microbiome
Decreases inflammation
Protective for cognitive function
Anti-ageing
My approach and cautions
I don’t introduce fasting until I believe the client is sufficiently healthy to follow the protocols safely. My approach is personal to each client. Before starting to restrict food intake we work to ensure that they are well nourished from a micronutrient perspective, have a well functioning liver and detoxification pathways and are hormonally stable. In addition they will preferably be trained in the breath-work I teach. This helps clients to work with their autonomic nervous system to manage their stress levels and emotional state in general, but also around food.
We typically start with 2-3 days of intermittent fasting. Usually it’s from the last evening meal at around 7 pm until about 1 pm or lunchtime the next day. This provides an 18 hour break for both the digestive and the immune systems.
Hydration is also important. I have a specific hydration protocol for clients to follow when they are preparing for or undertaking a fast or intermittent fast. There are some contraindications to fasting so I always recommend working with a health practitioner.
What the research shows
Most of the research is currently in mice but it seems to demonstrate:
There are metabolic benefits from fasting including time restricted feeding even if no weight loss is recorded.
As well as quality and quantity the timing of food intake appears to be a key parameter for nutritional and metabolic health. Circadian rhythm and metabolic processes are linked and their disruption can lead to weight gain. Gut bacteria appear to have their own circadian rhythm and fasting benefits this.
Get in touch on 07740 876233 for more information or if you would like or to discuss your health concerns and how I might be able to support you.
Please note: This article is intended for information purposes so readers can gain an understanding of the benefits of fasting for health. I highly recommend working with a health practitioner if you plan to try this as there are many aspects to take into consideration.
References
Chaix, A. (2022) Time-restricted feeding and caloric restriction: two feeding regimens at the crossroad of metabolic and circadian regulation; Methods Molecular Biology; 2482 pp 329-340 DOI: 10.1007/978-1-0716-2249-0_22
Longo, V.D. and Panda, S. (2016) Fasting, circadian rhythms, and time restricted feeding in healthy lifespan; Cell Metabolism;14; 23(6); 1048-1059.
Mattson, M. P., Longo, V.D. and Harvie, M. (2018). Impact of intermittent fasting on health and disease processes. Ageing Research Reviews: 29 pp. 46-58.
Rangan, P. et. al. (2019) Fasting-mimicking diet modulates microbiota and promotes intestinal regeneration to reduce inflammatory bowel disease pathology; Cell Reports; 5;26 (10); pp. 2704-2710.e6. doi:10.10.16/j.celrep.2019.02.019
Sutton, E.F. (2018) Early time-restricted feeding improves insulin sensitivity, blood pressure and oxidative stress even without weight loss in men with pre diabetes; Cell Metabolism; 5; 27(6); 1212-1221,e3.
Wei, M. et al. (2017) Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease; Science Translational Medicine; 15;9(377)
Vaughn, K.L and Mattison, J.A. (2018) Watch the clock not the scale; CellMetabolism, 27 pp.1159-1160.
Training
Zach Bush Biology Basecamp (2020)
Pending:- Intermittent fasting: personalization for better outcomes by Amanda Swaine, DipION, BANT, CNHC
* Fasting types:- intermittent fasting (60% energy restriction on two days or more), fasting mimicking diet, time restricted feeding (8 hour food window) and periodic fasting (5 day diet providing 750-1100 kcal).
All about the menopause
Bullet point summary
Menopause can be reframed as an opportunity for a health drive, a new stage in life experienced by generations of women classified by the Japanese as the “renewal’ years or a return to the freedom and zest of the girl inside.
There are many physiological reasons for symptoms but they are temporary. It’s a transition phase and there are many options to explore both natural and medical – don’t suffer in silence.
Your brain and your immune systems both recalibrate. You have to do more with less. This can create some issues but with the right interpretation there are many options that can support the body with these challenges.
It is harder to stay slim post menopause. There can be up to a 15% drop in metabolic rate from the combined effects of muscle loss, androgen excess and insulin resistance.
If insulin resistance is present it will amplify peri menopausal and menopausal symptoms. The good news is that diet and lifestyle are super effective at resolving this.
Chronic inflammation will aggravate menopause symptoms and must be rectified to avoid longer term health issues such as autoimmune conditions.
Metabolic flexibility underpins a smooth physiological transition. Exercise, intermittent fasting and a healthy gut are key to achieving this.
A well functioning digestive system and healthy liver function play a significant role in navigating the menopause.
The adrenal glands are also important for both their stress hormone and oestrogen producing functions. If possible ovaries should be retained.
Finally a healthy circadian rhythm together with soothing the nervous system and vagus nerve stimulation complete the package of support required.
Peri menopause – the window of opportunity
Lots of women dread the menopause. It’s often viewed as a process of ageing and associated with uncomfortable symptoms ranging from heavy periods to weight gain, anxiety and night sweats. Lara Biden, author of the ‘hormone repair manual’, reframes this as a “window of opportunity” to resolve issues which left unaddressed might become problematic later in life.
This blog aims to explain what’s going on physiologically and why. The key things to know are:
It’s temporary
It’s a transition phase
It’s a window of opportunity for health
There are many options to explore for help with this transition
What is perimenopause?
Perimenopause begins 2-12 years before periods stop so the late 30’s to early 40’s. Hormonally the picture resembles a second puberty as the transition is made to a high oestrogen/low progesterone scenario. The only difference is the decline and loss of progesterone whereas in puberty progesterone is gained. Finally oestrogen will return to childhood levels which is just right for this new phase of life.
Symptoms are largely caused by oestrogen as it fluctuates erratically before settling to a new but lower normal. Progesterone also drops which means that the formally stable oestrogen to progesterone ratio is now much higher than in ovulatory years. . Eventually we lose almost all progesterone but we continue to make some oestrogen. This scenario of high but wildly fluctuating oestrogen and low or no progesterone can trigger or exacerbate a number of health symptoms. It also places extra demands on important physiological systems such as our immune system and how we make energy and detoxify the body. During this transition period the body has to learn, or remember, a new way of operation.
Strong symptoms
Strong symptoms are usually due to a combination of genetics, general health status and the condition of your menstrual cycle prior to peri-menopause. If you have a history of menstrual mood symptoms you may be hypersensitive to hormonal variation.
Opportunity for health
Even if you don’t experience symptoms it’s still a time to take extra care of your health as it’s a period of physiological flux. The brain and the nervous system have to work differently. They have to work without oestrogen and progesterone. The brain recalibrates and the immune system remodels. This increases the risk for anxiety, depression and memory loss. Together with sleep disturbance this can lead to chronic pain if no action is taken. All of this is associated with increased vulnerability to heart disease and insulin resistance. There is often a slight temporary cognitive decline and there is a slightly increased risk of mental health issues.
Physiology of perimenopause
Once menopause occurs women have to revert to intracrinology having previously relied on ovarian oestrogen production. This is a process of localised oestrogen production which takes place in tissues such as the heart and brain. This will produce oestrogen at about 10% of previous levels via the enzyme aromatase. Aromatase converts androgen hormones to oestrogen. So oestrogen production continues via increasing androgen production for conversion to oestrogen and up regulating aromatase activity. Androgen hormones include androstenedione from the ovaries and DHEA from the adrenal glands. Hence healthy adrenal glands are essential for a healthy menopause and ovaries should be retained if possible.
Once menopause occurs women revert to a process of localised oestrogen production in tissues such as the heart and brain. An enzyme called aromatase converts androgen hormones to produce about 10% of previous levels of oestrogen. Androgen hormones are produced by the ovaries and from the adrenal glands. Hence healthy adrenal glands are essential for a smooth menopause transition and ovaries should be retained if possible. This process of change may take from months to years hence the variation in symptom length.
Abdominal weight gain
This is a common complaint and has a number of contributing factors. Metabolism slows down without oestrogen and progesterone to stimulate it. Oestrogen helps the body to build muscle so lower levels are associated with less muscle mass and this also slows metabolism.
When oestrogen levels decline this can trigger insulin resistance. This refers to chronically elevated levels of insulin in the blood. Insulin is the hormone that causes cells to accept glucose. If glucose cannot get into cells it will be stored as fat. Insulin resistance is therefore a key factor in abdominal weight gain.
There is a natural shift to androgen excess during this period which perpetuates a cycle of insulin resistance and weight gain. There can be up to a 15% drop in metabolic rate from the combined effects of muscle loss, androgen excess and insulin resistance.
If insulin resistance is present or develops this can lead to over production of an oestrogen called oestrone. This is a risk factor for cardiovascular disease, fibroids, pelvic pain, abnormal uterine bleeding and breast cancer. So eliminating insulin resistance is critical for a healthy menopause.
Neurological symptoms: anxiety, depression, memory loss, mood, insomnia and migraines
Your brain is the source of most menopause symptoms because it has to learn to work in a different way. It's a neurological transition as well as a reproductive one. Following menopause there can be a drop in the brain’s activity and energy levels of up to 25%. Up to now the brain has utilised glucose as its primary source of energy and oestrogen has helped brain cells with this. Now the brain has to shift to using ketones so it utilises fat rather than glucose as its primary fuel source.
Progesterone and oestrogen both play numerous roles in brain function.
Little wonder then that the brain needs some time to adjust to its new status and that difficulties sometimes arise during this adjustment period. The loss of progesterone can reduce the ability to cope with stress as well as increase the risk of anxiety, depression, memory loss, mood symptoms and sleep disturbance.
Metabolic flexibility is key to help with this adjustment. The body has the enzyme pathway to burn ketones but it’s often switched off from lack of use. This stems from the provision of regular food (glucose) and frequent snacking. The cornerstones to reinstate this pathway are exercise, intermittent fasting, stable blood sugar and a healthy gut with a diverse microbiome.
During menopause the thermoregulatory mechanism in the brain narrows and there is far less tolerance to temperature changes. Researchers believe hot flashes are caused by the temperature sensor in the brain called the hypothalamus. Falling oestrogen levels and lower amounts of serotonin and adrenaline all affect the hypothalamus. This means that in the task of managing menopause symptoms the importance of stress management cannot be overstated.
The final symptom the brain may trigger is migraines. This is attributed to oestrogen fluctuations and the loss of progesterone’s calming influence. Iron deficiency from heavy periods can also be a factor here.
The immune system
The immune system also has to recalibrate during perimenopause. Progesterone calms the immune system and during the reproductive years your body is used to regular doses of oestrogen and progesterone. Losing the anti-inflammatory properties of both hormones can cause problems with the immune system including chronic inflammation or triggering autoimmune issues such as autoimmune thyroid disease. Any inflammation has to be addressed as it will make menopause symptoms worse and increase insulin resistance.
It is also essential to sort out any issues with digestion and liver detoxification as both of these can contribute to sources of inflammation. Most of your immune system is located around your gut and it constantly communicates with your gut bacteria. If anything goes wrong this activates your immune system causing inflammation. Your liver is responsible for deactivating oestrogen which is then removed from the body via the bowel. If your gut bacteria aren’t healthy you can get something called ‘gut-liver-recirculation’ where oestrogen gets reactivated and reabsorbed in a more toxic form.
Autoimmune thyroid disease
The loss of progesterone can be a trigger for autoimmune thyroid problems as it reduces the availability of thyroid hormone. There is a lot of overlap between symptoms of perimenopause and thyroid issues so this can easily be missed. In addition both of these conditions overlap with symptoms of insulin resistance because of the interplay between the hormones involved. Thyroid disease is more common in women and increases over the age of 40 with a one in ten chance of incidence. This is a complicated area and practitioner help is recommended.
Heavy or painful periods and breast pain
During perimenopause oestrogen can spike up to three times its normal level and fluctuates erratically. Oestrogen thickens the uterine lining and without progesterone to counteract this the menstrual flow can increase along with pain. For both heavy periods and severe pain it is essential to see your doctor for an assessment. The most common cause is anovulatory cycles where oestrogen is made but not progesterone. However there are other possibilities that need to be ruled out the main ones being endometriosis; adenomyosis; fifibroids; anovulatory bleeds; thyroid disease; bleed disorders. Heavy periods can also result in iron deficiency which manifests in fatigue, breathlessness, hair loss and easy bruising.
Period pain such as cramping which is inconvenient but less severe is usually caused by prostaglandins. These hormone type compounds constrict blood vessels which contributes to period pain. They can be triggered by high levels of oestrogen as it fluctuates during perimenopause. The latter can stimulate high histamine and mast cell activation both of which can cause prostaglandin release. Before perimenopause this activity was often regulated by progesterone. It might be worth trying a dairy free diet as this may reduce prostaglandins, histamine levels and mast cell activation. Fortunately diet and lifestyle and key micronutrient supplementation can often resolve this.
Breast soreness or tenderness can be caused by high oestrogen levels but can also be a sign of iodine deficiency. Addressing the core strategies already highlighted will generally resolve this.
How to navigate the menopause
Nutrition including micronutrients
Exercise
Sleep and stress management
Tackle any current health issues such as insulin resistance, poor digestion, thyroid issues, poor oestrogen detoxification and chronic inflammation.
Medication - HRT
I can help you
To identify where you are in the stages of perimenopause/menopause and what you need to consider to support your health.
To assess if you have insulin resistance and how to reverse this if it’s caught early enough. This is key for abdominal weight loss.
The importance of exercise for insulin resistance and which type is best.
How to use nutrition to maximise hormone balance and stabilise your levels of oestrogen and androgen production.
How to include phytoestrogens in your diet – what they are and how they can help.
How to stabilise your blood sugar levels.
How to cultivate metabolic flexibility and undertake intermittent fasting and why this might be helpful.
Understand why dairy can be an issue.
The pro’s and con’s of HRT and which is right for your individual situation.
Why your liver function is so important and how to revitalise it.
How to breathe to stimulate your vagus nerve and also improve your parasympathetic nervous system and heart rate variability to build resilience.
Check your micronutrient levels in case you need to temporarily supplement to optimise these especially in relation to cognition and sleep.
The importance of a healthy thyroid gland and sufficient thyroid hormone and if there is a thyroid issue why it is critical to know if your condition is autoimmune.
The importance of healthy adrenal glands and how to support these.
References
Briden, L. (2021) The hormone repair manual. Greenpeak Publishing
Dong, T. A. (2020) Intermittent Fasting: A heart healthy dietary pattern; The American Journal of Medicine:133(8):pp.901-907 DOI: 10.1016/j.amjmed.2020.03.030
Labrie, F. ( 2017) Science of intracrinology in postmenopausal women; Menopause: 24(6); pp.702-712; doi: 10.1097/GME.0000000000000808.
Mosconi, L. (2021) Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition; Nature:11:10867; https://doi.org/10.1038/s41598-021-90084-y
Wilcox, G. (2005) Insulin and insulin resistance; The Clinical Biochemist reviews; 26(2):pp.19-39
Histamine and histamine intolerance.
Histamine
Histamine is an important immune molecule which certain foods trigger the immune system to release. As part of our immune response to bacteria, viruses or other pathogenic microorganisms it increases vascular permeability. This allows white blood cells and proteins access to pathogens through mechanisms such as runny eyes or nose, sneezing, coughing and itching, diarrhoea and cramps, acid reflux and also headaches.
Histamines are also found in certain foods especially those which are aged, cured or fermented such as cheese, sauerkraut and cured meats.
Histamine intolerance
Some people have difficulty degrading histamine in order to eliminate it from the body often due to a deficiency in the main enzyme responsible known as diamine oxidase (DAO). If the balance between histamine accumulation and degradation is upset then histamine intolerance can result. People seem to have different levels of tolerance for the amount of histamine accumulating in the body which can be due to a number of issues including: genetic predisposition; gut dysbiosis; damage to the gut lining; medications; chronic inflammation; gender; ageing; autoimmune diseases; pulmonary diseases and heavy metal toxicity. It is possible to test for genetic single-nucleotide polymorphisms (SNPs) to the DAO encoding gene and more than 50 SNPs have been identified.
Symptoms of histamine intolerance
Symptoms are multifaceted and diverse due to the distribution of histamine receptors throughout the body. Research shows that the most frequent are gastrointestinal including: abdominal distension; postprandial fullness; diarrhoea; abdominal pain and constipation. Nervous and cardiovascular impairments include dizziness, headaches and palpitations. Respiratory and dermatological symptoms were also common. Researchers estimate incidence at 1-3% of the population but it is frequently unrecognised as symptoms can mimic other common issues such as respiratory problems, food allergy or intolerance as well as general gut issues, vertigo and even arrhythmias. Random reactions to food can be a key indicator. One day a glass of wine and some cheese is fine but the next day it causes a strong gut reaction. This can be due to the level of histamine that has accumulated in your body.
Other signs that you may be histamine intolerant are:
Itchy and blotchy especially after eating or drinking alcohol.
Headaches especially after dark chocolate, wine or coffee.
Degradation of histamine by individuals in different situations.
Comas-Baste, O. (2020), Histamine intolerance: The current state of the art; Biomolecules 10(8); 1181.
Low histamine diet
If required this will ideally be a temporary measure whilst root causes are addressed. Commonly these include gut health especially issues with the small and large intestine such as SIBO and mycotoxin /mould issues. It can also be related to the microbiome as some gut bacteria are histamine producers.
Even if there is an underlying genetic issue reducing our histamine intake can give the body time to recover and heal. Genetic expression is not static genes are like Christmas tree lights they turn on and off all the time according to your environment. When we restore our gut lining to a healthy state this supports the body to produce the enzymes necessary to degrade and eliminate excess histamine.
Certain nutrients are required for histamine metabolism such as vitamin B6, vitamin C and copper. Supplementation can be helpful although particular care must be taken with pre and probiotics to avoid promoting histamine producing strains.
Support
This is a complicated area. A low histamine diet can be difficult to implement on your own and is quite restrictive. If you would like help with this or to discuss working with me on any other issue please take advantage of my free discovery call 07740 876233. We may need to work on gut dysbiosis, gut permeability, microbiome diversity or reducing toxic load and improving liver function amongst other areas.
