The results are in. This (2019) study involved 20 adults following either an ultra-processed (UPF) or unprocessed diet for 2 weeks at the NIH Clinical Centre. This was followed immediately by 2 weeks of the alternate diet. The diets were matched for nutritional composition: calories; energy density; macronutrients; sugar; sodium and fibre and participants were free to eat as much as they liked.
Despite composition matching, subjects on the UPF diet consumed an average of 508 extra calories per day, comprising more carbohydrate and fat, but not protein. Participants gained more weight during the UPF diet, an average of 1kg, and lost weight during the unprocessed diet. This implies that there is something about the processing itself which causes a metabolic issue.
Other interesting points to note were:
During the UPF diet
• The eating rate was faster
• Sodium consumption increased
• To compensate for the lower fibre level and match fibre intake for both diets, beverages with dissolved fibre were given
• Body fat mass increased
During the un-processed food diet:
• Appetite suppressing hormone increased
• Hunger hormone decreased
• Total cholesterol decreased
• Inflammation markers decreased
• Fasting glucose and insulin levels decreased
One thing is clear. Whilst there is much conflict about which diet is the ‘best’ the whole world seems to agree that avoiding processed foods is a good thing.
Refs: Hall, K. D. (2019) Ultra-processed diets cause excess calorie intake and weight gain: An inpatient randomised controlled trial of ad libitum food intake. Cell Metabolism; 30(1) pp. 67-77. e3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946062/
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).
Fed up with snoring?
Nighttime snoring can range from being a mild embarrassment and nuisance to a more serious chronic problem. It can sometimes be a potential indicator of more serious health issues such as obstructive sleep apnea (OSA). There are essentially two reasons snoring can happen, either breathing is too forceful or the upper airway is too narrow.
During sleep the tissues of the throat relax which can partially block the airway. This tissue vibrates as air flows past it and it is this vibration and turbulence in the airway which leads to snoring. The more this airway narrows the more forceful the airflow becomes increasing vibration and therefore the snoring volume. There are two types of snoring mouth snoring and nasal snoring.
Mouth snoring
If you wake with a dry mouth then you are probably mouth breathing during the night and this won’t refresh you properly. If you mouth breath during the day you will build neural pathways regarding this behaviour pattern which will continue during sleep. This can often be a habitual pattern rather than an anatomical requirement especially where children are concerned. To re-establish full-time nasal breathing Patrick McKeown founder of The Oxygen Advantage breathing programme and author of the book by the same name recommends using lip tape. You can use any tape suitable for skin contact such as Mircropore but if the idea of covering your mouth with tape is stressful you can use MYOTAPE. This tape uses elastic tension to bring the lips together without covering the lips completely. You can purchase this tape here https://myotape.com. It may seem rather alien but a new 2020 study revealed that even full-time mouth breathers could often lip-tape providing there wasn’t any nasal obstruction. They also concluded that in children full-time nasal breathing is critical for craniofacial and airway development.
Nasal snoring
If you are nasal breathing during sleep but still snoring then this can be due to a number of different reasons summarised below.
The way we breathe during the day affects the way we breathe at night which affects how we sleep and whether or not we snore. The lower and upper airways are mechanically connected. Diaphragmatic breathing tones and opens the throat area minimising the risk of collapse to cause snoring. The exercises I teach look to reset the day to day breathing pattern. When we breathe light and well during the day we can also breathe light during the night.
The exercises
The breathing exercises correct dysfunctional breathing patterns and help to:
Decongest the nose
Retrain nasal breathing during the day and night
Recalibrate the breathing centres in your brain
Improve lung volume and activate the diaphragm
Stimulate your vagus nerve and activate your parasympathetic nervous system
Reduce stress hormones
Insomnia
There is a lot of crossover between snoring and insomnia. Insomnia affects between 25 and 30% of the general population and for about 10% this is a chronic complaint requiring medical help. Insomnia is linked to many health complaints such as hyper arousal of the autonomic nervous system (ANS), stress, irritability, daytime fatigue, anxiety, emotional dysregulation, difficulty concentrating, depression and even high blood pressure.
Obstructive sleep apnea (OSA)
If OSA is present or if chronic snoring progresses to OSA this can lead to more serious health consequences. If you suspect OSA you should consult your GP who will probably recommend a sleep study to identify if OSA is present and if so which type.
For help with any of these issues or if you have any questions regarding the Oxygen Advantage breathing programme please get in touch today. I may be teaching or consulting but will return your call as soon as possible. I always do my best to fit clients in if they are ready to invest in their health.
For help with any of these issues or if you have any questions regarding the Oxygen Advantage breathing programme please get in touch today. I may be teaching or consulting but will return your call as soon as possible. I always do my best to fit clients in if they are ready to invest in their health.
References
McKeown, P. (2015) The Oxygen Advantage; Harper Collins, New York.
McKeown, P. (2021) The Breathing Cure; Amazon, GB.
Zaghi, et al. (2020) Assessment of nasal breathing using lip taping, a simple and effective screening tool; International Journal of Otorhinolaryngology; 6(1), 10.
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.
Acid or Alkaline?
There are so many controversies in nutrition and one of these is the theory around the acid-alkaline balance of the diet. This blog explores the science and debate around this topic.
If you want to calculate the acid/alkaline of your meal ‘The PRAL’ (Potential Renal Acid Load) scale calculates how acid or alkaline a food is per 100g consumed. This scale is determined by measuring the pH of the ash remaining once the food has been burnt. It is however the subject of debate as the high temperatures used far exceed those of digestion and also burn off the sugar which is thought to cause acidity in the body itself.
The simple way to understand this topic is that alkaline forming foods include all vegetables especially spinach, all herbs and most fruit. Acid forming foods include all grains, cheese, meat, fish and peanuts as well as processed foods. Pure fats, sugars, and starches are neutral, because they don’t contain protein, sulphur, or minerals. A source of confusion is that some foods such as lemons and citrus taste acidic but have an alkalising effect on the body. Examples of highly alkaline vegetables are spinach, broccoli, kale, cucumber and parsley.
When we digest protein acids are produced however these are buffered by bicarbonate ions in the blood. This reaction produces carbon dioxide which is exhaled and also salts which are excreted by the kidneys. The kidneys produce ‘new’ bicarbonate ions which are returned to the blood. So as with most things in the body a cycle is created which enables the body to maintain blood pH within a range of 7.35 to 7.45. So whilst food is linked to acidosis through the potential to place a more acid or alkaline ‘load’ on your body, this is quickly resolved to maintain a stable blood pH.
It is important to keep in mind that sufficient protein intake is important for health generation as well as facilitating acid excretion. So a very low protein diet can in fact increase acidosis and have adverse health effects.
However if our body’s are in a constant acid-base disequilibrium this is a type of systemic stress. If compensatory mechanism’s diminish a persistent acidogenic diet may increase the likelihood of an H + surplus and lower levels of serum bicarbonate. The scientific term ‘acidosis’ refers to a process, a dynamic compensatory response not just a change in blood pH. Many health conditions such as osteoporosis, kidney disease and muscle wasting are associated with a chronic low-grade level of metabolic acidosis. Although the mechanisms are not fully understood it is thought that there is a trade-off for constantly countering the effect of acid foods. Over time this may deplete buffering reserves of alkaline minerals especially in bones and tax muscle, kidneys and endocrine systems.
Some researchers suggest our contemporary Western diet has a higher acid load relative to that of our ancestors. Minich and Bland (2007) suggest that the root of this may lie in the agricultural revolution, processed food and grain products and more recently popular diets such as Atkins and Paleo. The latter are high protein diets which increase our net dietary acid load. They are often accompanied by a decrease in the micronutrient and phytochemical intake from fresh fruits and vegetables.
However other researchers dispute these claims. For example the famous researcher and dentist Weston Price found the diet of primitive Eskimos to contain an acid/alkaline balance of 707:382. He was specifically interested in dental caries which in the modern Eskimo diet have increased from 0.9 to 130 per 1000 teeth, whilst the acid/alkaline diet balance reduced to 382:227.
What is clear is that our bodies strive to maintain homeostasis including normal blood pressure, normal blood sugar and normal blood pH.
If pH falls to below 7.35 then the body regulates acid-alkaline balance via the following:
Chemical reactions generating or consuming H+ at the cellular level
In the blood with bicarbonate and amino acids
Systemically through the release of carbon dioxide (acidic) from the lungs and hydrogen ions from the kidney.
Patrick McKeown author of ‘The Oxygen Advantage’, points out that acid forming foods stimulate breathing to off load carbon dioxide via the breath. Metabolic bicarbonate buffering processes occur over several days whereas adjustment via the breath can occur within minutes to hours. However this stimulus can cause people to resort to mouth breathing rather than nasal in order to restore homeostasis within the body. This aspect of pH adjustment is often ignored in nutrition articles but it’s one of the key reasons I trained in the Oxygen Advantage technique. Unfortunately mouth breathing or over breathing via hyperventilation can quickly become habitual which can then result in pH moving in the opposite direction causing respiratory alkalosis (Brinkman and Sharma, 2021). Symptoms are wide and varied and can include: shortness of breath (dyspnea); fever; chills; peripheral edema; weakness; confusion; light headedness; dizziness; anxiety; chest pain; asthma; abdominal pain; nausea; vomiting or weight loss.
Similar to most things in life it seems to be about balance. Indeed Sagen Ishizuka (1851-1910, founder of the macrobiotic diet, linked the equilibrium of acid and alkaline foods with the Chinese ideas of Yin and Yang. Natural balance not radical consumption of either or.
For help with nutrition or breathing advice and training please call me on 07740 876233.
I am receiving lots of enquiries about how to support their immune system and health through the winter season. I’ve put together some information on key nutrients to consider for support and why, together with some practical suggestions of what and how much to take. There is no substitute for eating a healthy nutritious diet but if you regularly suffer from colds, flu or infections over the winter season this extra support may be useful. As always please consult your GP or health practitioner if you are already taking medication or supplements to ensure there are no contraindications.
Vitamin D3
Recent studies show vitamin D3 supports the immune response to infection and protects against respiratory tract infection especially in vitamin D deficient people1,3. UK NHS guidelines recommend 400 IU per day 2 but many researchers recommend more especially if you aren’t getting at least 10 minutes sunshine per day. I usually recommend 1000 IU but it’s always a good idea to test first. Finger prick tests are available. I use a company called FORTH but you can also ask your GP to test. Use this link to benefit from my discount code:
Has been shown to stimulate antiviral immunity 4. Best taken with copper, 15mg per day should be sufficient for prevention 4. Lower serum concentration of both vitamin D3 and zinc have been detected in patients suffering with moderate Covid 19 symptoms as compared to mild or asymptomatic patients5.
Propolis
Propolis honey bee resin is formed from the resins which the bees collect from trees which form part of the plants natural immune system. It contains more than 300 naturally derived bio-active compounds. These flavonoids and phenolics are what make Propolis a powerful natural defence which may soothe sore throats and support upper respiratory tract infections.
Mushrooms
Mushrooms are fascinating powerhouses of nutrients and compounds that provide many positive health promoting actions including antiviral and antibacterial. We share 40% of their DNA making them more similar to us than plants. Many mushrooms have anti-viral properties and can inhibit viral replication. They can improve T-lymphocyte proliferation and increase Natural Killer cell activity to increase our natural defences against cancer and provide immunomodulatory benefits 6.
Quercetin
Quercetin is a flavonoid found in plants such as onions, brassicas, apples, grapes and berries. It is known to stimulate the immune system to generate aniviral activity and decrease pro-inflammatory cytokines and inflammatory mediators. It has also been shown to reduce the incidence of upper respiratory tract infections (URTI) due to exercise and can be utilised in URTI’s such as asthma and allergic reactions. 7
Ginger
Ginger has been shown to possess anti-inflammatory benefits and positive effects on acute respiratory distress syndrome.8
Ginger tea - take a large palm sized piece of ginger and cope into a few pieces. Bash each piece to release the flavour better or grate it and boil in 1 litre of water for 30 minutes. Optional - add 1/2 tsp of ground turmeric and a tiny pinch of cayenne pepper. Once it has cooled a little you can add the juice of 1/2 a lemon about 3 tbsp. Strain if desired and pour the liquid into a flask to drink when desired.
Get in touch for more information on nutrition to support your health and immunity. Call 07740 876233 or email me at helen@helenmaxwellnutrition.co.uk. https://helenmaxwellnutrition.co.uk/contact-2/
Please use this link to access product information and immune boosting juice and smoothie receipes
References1 Calder, P.C. et al. (2020) Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections Nutrients 12(4) p1181. 2 https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ 3 James, P.T. et al. (2021) The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. The Journal of Nutrition;151 pp.1554-1878. 4 National Academies Press (US) (2001) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Institute of Medicine (US) Panel on Micronutrients. Washington (DC)5 Golabi, S. et al. (2021) The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study Nutrients 13(10) pp. 3368.6 Chan, G.C-F. et al. (2009) The effects of beta-glucan on human immune and cancer cells; Journal of Hematology and Oncology 2(25) DOI: 10.1186/1756-8722-2-25 7 Micek, J. et al. (2016) 7 Nyguen, H.A. et al. (2020) Quercetin and its anti-allergic immune response; Molecules 623; doi:10.3390 8 Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials 12(1) 157 https://doi.org/10.3390/nu12010157
