What do Nutritional Therapists help with and how to find one?
You might be someone who gets bloated after every meal. Or someone who feels exhausted by mid-morning despite a full night’s sleep. Maybe your skin flares up regularly, or you’re dealing with unpredictable mood or energy changes.
These are just a few of the reasons people turn to nutritional therapists.
Common concerns supported by nutritional therapists include:
Digestive issues (IBS, bloating, reflux, gall bladder issues, gout etc.)
Fatigue or low energy
Pre diabetes and heart health especially cholesterol
Osteoporosis and issues with bone density
Skin conditions
Female hormonal health (PMS, perimenopause, PCOS)
Stress and mental wellbeing
Autoimmune conditions such as arthritis
Healthy ageing and preventive healthcare
Optimising athletic performance
You don’t need to be diagnosed with a condition to work with a nutritional therapist. Many clients seek support for prevention, performance, or simply to understand their bodies better.
Why People Seek Nutritional Therapy
Many people turn to nutritional therapists after trying multiple solutions—diets, supplements, or private testing—without clarity or consistent results. Others feel dismissed by standard medical care or overwhelmed by conflicting online advice.
Nutritional therapy offers a structured, evidence-informed approach to identifying patterns and making progress that lasts.
It’s ideal for anyone who:
Has symptoms that don’t have a clear medical diagnosis
Feels like they’ve tried everything but still don’t feel well
Wants to optimise health before issues become problems
Prefers natural, lifestyle-based strategies alongside medical care
How to Find a Qualified Nutritional Therapist
To ensure you’re working with a properly trained practitioner:
Look for CNHC registration – this confirms they are qualified and regulated
Check for BANT membership – this indicates high standards of ethics, education, and science-led practice
Discover the Value of Working with a BANT-Registered Nutritional Therapist
Nutritional therapists play a vital role in bridging the gap between general wellness advice and personalised healthcare. They take time to understand how your diet, genetics, environment, and lifestyle interact and use that insight to guide tailored, evidence-based recommendations that help you feel better, for longer.
Generic nutrition tips and one-size-fits-all plans can fall short. Working with a Registered Nutritional Therapist puts your individual needs at the centre. For many clients, it’s the first time their symptoms, history, and goals have been fully explored and connected into a clear plan.
This approach supports symptom improvement while also helping you reconnect with your body, increase daily energy, and take charge of your long-term wellbeing.
If you’re ready to stop guessing and start understanding what your body really needs, a Registered Nutritional Therapist could make all the difference. Please feel free to get in touch or book a call via my website.
What qualification dose a Nutritional Therapist have? Are they different from a "nutrionist"?
In the UK anyone can call themselves a “nutritionist”. The title is not legally protected so regardless of training anyone can call themselves a “nutritionist”.
However, Registered Nutritional Therapists including me are:
Fully trained in nutrition science and functional medicine
Required to register with the Complementary and Natural Healthcare Council (CNHC), a PSA-accredited regulatory body
Members of professional organisations like BANT (British Association for Nutrition and Lifestyle Medicine)
Required to follow a strict code of ethics and maintain Continuing Professional Development (CPD)
This level of regulation ensures clients are receiving safe, evidence-based advice from a qualified professional.It’s important to remember that only those registered with CNHC are recognised to deliver one-to-one clinical care.
In my case I trained with the Institute of Optimum Nutrition (ION) in London and gained a diploma (DipION, Distinction). I also did some preliminary training at the University of Westminster.
What does a 'Nutritional therapist' do?
What Does a Nutritional Therapist Do?
Have you been dealing with ongoing symptoms and feel like no one’s joining the dots? Maybe you’ve tried diets, supplements, or read endless articles online, yet nothing seems to stick. If this sounds familiar, you might be wondering if a nutritional therapist what could help.
With growing public interest in functional medicine and personalised, preventative care, nutritional therapy is gaining interest. There’s still confusion about the role, who is qualified, and how it differs from general nutrition advice. This blog explains it all.
Nutritional Therapists Offer Personalised, Evidence-Based Health Support
A nutritional therapist applies the science of nutrition and lifestyle medicine to support individuals with a wide range of health concerns. This can include digestive problems, fatigue, hormonal imbalances, immune issues, and more.
They work in a one-to-one setting, assessing each client’s health history, symptoms, diet, lifestyle, and environment to identify potential imbalances. Then they create a tailored plan that supports the body’s ability to heal and function at its best.
Nutritional therapy is:
Personalised – considering your unique biology, history, and lifestyle
Science-informed – based on the latest research in nutrition, epigenetics, and systems biology
Holistic – looking at the whole person, not isolated symptoms
The aim is not to diagnose or replace medical care, but to complement it with targeted nutritional and lifestyle recommendations.
What a Nutritional Therapy Consultation Looks Like
A consultation with a Registered Nutritional Therapist typically involves:
Detailed case history – exploring symptoms, medical history, family history, diet, lifestyle, and environment
Analysis of diet and nutrition status – sometimes supported by laboratory testing
Individualised plan – including food, supplementation, lifestyle changes, and referrals if needed
Follow-up support – adjusting the plan over time based on response and progress
This process helps the therapist and client build a picture of how different factors may be contributing to the client’s health status and how to support improvement in a structured, measurable way.
What fats can I cook with?
This blog is a reminder of which fats to use for cooking and which ones are best used cold in salad dressings. It also covers which ones to avoid.
Fatty acids are classified according to the presence and number of double bonds in their carbon chain. Saturated fatty acids (SAFA) contain no double bonds, monounsaturated fatty acids (MUFA) contain one, and polyunsaturated fatty acids (PUFA) contain more than one double bond.
This table above shows the fatty acid composition of various culinary oils.
You can see from the table above that oils tend to be classified according to their largest constituent. We need to cook with oils which are stable when heated and therefore have a high smoke point. The more double bonds a fatty acid has, the more unsaturated and unstable it will be, especially when heated.
The most stable fats are solid at room temperature, so lard etc. Olive oil (virgin/extra virgin) is pressed straight from the seed or fruit without further refining. There is research to show that the phenols in unrefined olive oil protect it from degradation during cooking (Ramirez-Anaya, 2015).
Oils such as rapeseed, sunflower and vegetable are obtained by washing and crushing the seeds, and then using processes such as heating, hexane, solvents, extraction, processing, bleaching, deodorization and peroxide to maximise production volume. As these oils are highly unsaturated (many double bonds) the risk of oxidation from processing is high, either during processing or if used to cook with. Most of these oils are also much higher in omega-6 than omega-3. As our diets tend to be more deficient in omega-3, I focus on hemp and flax (small amount) which have a 4:1 and a 0.3:1 ratio respectively (o-6:o-3) to try to redress this. I also advocate cold pressed and organic versions to preserve quality and nutrient content.
The following table is a guide Whether you wish to cook with animal fats will depend on various criteria including your health and dietary preferences as well as your ability to digest and absorb fat.
Which fat to cook with and which to use for dressings and drizzles
REFS: Del Pilar Ramírez-Anaya, J. et al (2015) Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques. Food Chemistry Vol 188; pp. 430-438.
Do your cells need an oil change?
Today’s modern diets can often mean we eat too much or too little fat, or frequently just the wrong type. Our cell membranes consist of lots of oil aka. fat. For optimal performance they require quite a specific ratio of different types of fats, especially with regard to the essential fatty acids (EFA’s), omega 3 and 6. If these are out of sync, cells can malfunction a bit like trying to run your car on the wrong type of oil or petrol.
Cell membranes are your cells’ border control. They control what gets in and what gets out. They act as both the gatekeeper and the hostess.
Every cell in your body has a cell membrane and your body has a lot of cells. Experts think we have in the region of 30 trillion, and we want every one of these to have a healthy cell membrane. If your cell membranes are working correctly, they will let micronutrients in and waste products out. As well as supervising which molecules can enter and exit, most cell metabolism takes place in, on, or around this location. It’s like your very own production line inside you, manufacturing energy and proteins, and churning out waste products such as urea and toxins.
The next thing to understand is that their structure is critical to how well they function. We don’t want them to be too rigid or nothing will get in, or out. We also don’t want them too soft and floppy. This might allow too much in or too much out and over time this could cause multiple issues.
So how can we nourish them and maintain their structure so they can function properly? Firstly, the fat they contain needs to be eaten, as the body cannot make it. Some of these fats have special functions such as the EFA’s. There are many arguments about the correct ratio of fats to eat in the diet but researchers generally agree that we tend to be more deficient in omega 3 which is found in fish, nuts, seeds and vegetable oils.
So by now I think you get the idea that I like my clients to achieve healthy cell membranes because “the stronger our cells the more resilient our selves”.
It’s easy to check our ratios with a simple finger prick test because the concentration in our blood has been found to strongly reflect our dietary intake. The current European average for our omega 3 percentage is less than 4% but research confirms that 8% is optimum, and that this ratio is associated with a 90% reduction in risk of sudden cardiac death.
There is nothing like analytics to demonstrate to my clients (and me) that we either need to work harder on our diet or take targeted supplements to give our cells what they need to function tip top.
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.
Suffering with acne; infertility; tiredness and irregular menstrual cycles? Could it be polycystic ovary syndrome (PCOS)
This is such a distressing condition especially for young girls. As I am seeing it in clinic and the incidence is rising I thought I would summarise some of the current scientific information and clinical approaches here.
Diagnosis
For a diagnosis two out of the following three factors are required:
Irregular menstrual cycles: for years rather than months and this can mean they are very close together or more than 35 days apart and may include random bleeding.
Androgen excess – this can include total testosterone, free testosterone Dehydroepiandrosterone-sulfate (DHEA-S) and androstenodione.
Polycystic ovaries on ultra-sound – these are not cysts but follicles with an egg inside. In teenagers there is a risk of mis-diagnosis due to very sensitive ultra sound scans which are no longer recommended for this age range. This is because they may just have a lot of eggs because they have not fully gone through puberty yet or due to high stress levels. In addition birth control can cause cysts. A higher than average anti-mullerian hormone may help to clarify this.
Presentation and symptoms
Irregular or absent periods
Androgen excess symptoms such as: acne especially jawline acne, hair loss or coarse hair on the face, male pattern baldness.
Other symptoms can include cravings, poor appetite control, some abdominal weight or general weight gain.
PCOS is also the most common cause of infertility in the Western World.
So what’s going on?
1. Insulin resistance
This occurs when cells stop allowing insulin to escort sugar (glucose) into the cells. It is very often but not always present in PCOS although the severity is variable. If glucose can’t get into the cell it gets deposited in the liver resulting in abdominal fat, hence insulin is often called ‘the fat storage hormone’. With no glucose (energy) in the cells clients often feel exhausted and hungry and therefore eat more, so a vicious cycle emerges. Food should generate energy but instead it’s stored as fat (weight) which the body doesn’t utilise, for various reasons, and the resulting lack of energy promotes more food intake. Weight gain, especially abdominal, is therefore a common feature of PCOS. Both glucose and insulin in the blood are undesirable over certain levels and will damage blood vessels.
Insulin resistance can be tested by measuring and testing for: fasting insulin; fasting glucose; an oral glucose tolerance test; Haemoglobin A1c and High sensitivity CRP levels. Some clients will react to very low glucose levels as the sugar levels in their blood drop, others will have low levels of insulin or may struggle to detox it from the body.
2. Low oestrogen
Oestrogen is required for many actions in the body including regulating metabolism and it is made from testosterone. The pituitary gland in the brain triggers luteinising hormone (LH) to signal testosterone which is converted to oestrogen by the ovaries. The conversion is carried out by an enzyme called aromatase which is initiated by a hormone called follicle stimulating hormone (FSH) also controlled by our pituitary gland. In PCOS this conversion isn’t working properly so oestrogen levels remain low and the brain keeps stimulating testosterone production. This then results in high testosterone levels which cause inflammation and overload the liver. Poor detoxification of testosterone and oestrogen can result and these metabolites tend to become toxic.
3. High androgens
High androgens such as testosterone will be an issue for most PCOS clients because of the hormone cascade detailed above. High testosterone alters the gut microbiome which in turn results in greater testosterone production. A vicious cycle emerges of low oestrogen triggering LH, FSH and testosterone production resulting in high androgens which cause distressing acne and hair growth or loss symptoms
4. Problems with immunity
There are many Immune cells lining the gut which also contain oestrogen receptors. Dr Gersh considers oestrogen the master of the immune system for men as well as women. Oestrogen helps to turn inflammation on and off as required but also modulates the reaction to avoid a strong inflammatory chemical cascade. In PCOS, compared to controls, the threshold for inflammatory process activation is much lower. This inflammation can create all sorts of gut issues including toxicity and permeability resulting in dysbiosis and it’s many associated issues.
The underlying cause
Genetically a mild defect in oestrogen production was an evolutionary benefit as slightly higher testosterone made women a little less fertile (fewer children) as well as stronger and braver. Modern times, chemical toxicity and the modern Western diet have twisted this advantage into a modern disease.
Many of the issues above start with metabolic dysfunction, which is the process of converting food into energy, in the gut and the liver.
The research is showing that plastics, phthalates (plasticisers), BPA, BPF, herbicides, heavy meals and air pollution present in the environment, in utero and during puberty cause hormonal and metabolic disruption, especially in women who are predisposed. These EDC’s can block, mimic or interfere with the body’s hormone system causing many health problems.
2. Microbiome
The gut lining and the enteric nervous system have oestrogen receptors which play a key role in the metabolism of food into energy. Low oestrogen levels can result in gut dysbiosis, gut permeability and poor gut motility (constipation). These factors in turn can lead to an increase in toxicity and inflammation for the liver to deal with.
3. Liver function and jet lag
Oestrogen is the master clock hormone and it co-ordinates our metabolic function in tune with our circadian rhythm. Over a third of our genes are clock genes and many others interact with these (60%). Dr Felice Gersh describes the body and it’s organs as an orchestra all tuned to our inbuilt circadian rhythm. Each and every one of your gut microbes (bacteria) has it's own circadian rhythm. So without sufficient oestrogen and poor absorption of what is produced, the body’s metabolism malfunctions. It thinks it’s day when its night and vice versa. Remember how awful you feel when you have jet lag? It’s the same scenario just a different cause.
The absence of food at the correct time is highly stressful, so the body will trigger cortisol. In response to this the liver will manufacture its own sugar (gluconeogenesis), for energy to respond to the ‘stressor’. This means the liver pours out sugar overnight thinking it is daytime, which triggers insulin which then stores as fat. In time this can lead to fatty liver. It is this overloaded and confused liver which results in the downstream effects of insulin resistance, poor detoxification and immune dysfunction known collectively as metabolic dysfunction.
Why weight gain and infertility are such a problem
1. Weight gain
PCOS sufferers are susceptible to weight gain for a number of reasons. Oestrogen regulates energy control (metabolism) and also appetite so low levels can result in increased appetite and poor energy generation. When we are tired we often over eat. In addition there may be insulin resistance which leads to fat storage. The metabolism and regulation of energy becomes very dysregulated hence the weight can increase. There are different types of PCOS however and a lean PCOS syndrome has also been identified.
2. Infertility
In addition to low oestrogen production the receptors for oestrogen often malfunction in PCOS sufferers. Every organ in the body has oestrogen receptors and oestrogen connects metabolic and reproductive mechanisms. Pregnancy is inherently a metabolic stressor and in PCOS there are already many metabolic issues. Infertility is therefore a common downstream issue.
Recovery strategy
It can seem like a rather depressing picture and PCOS sufferers do have a lot of work to do. But the good news is by paying attention to diet and lifestyle there is a great deal that can be done.
PCOS can be helped dramatically with resetting circadian rhythm via obtaining light at the right time and eating at the correct times. In one study insulin and testosterone fell by over 50% in one month just by changing the structure of meals.
There are also various eating strategies which can ease pressure on the liver and help to regulate insulin function. Eating a very nutrient dense diet helps the microbiome to flourish so it’s important to work on the quality of food as well as the diversity and quantity. There are lots of therapeutic ways to nourish and rebuild the gut lining which in turn helps with reducing toxicity and supporting the immune system. We also work to support the liver which controls insulin production and whether we burn glucose or fat for energy.
In addition there are several supplements which I have found can really support clients with their energy generation and regulation and help with cortisol regulation. This does two things. It gives the client hope and also with less fatigue they have more energy to make the changes required.
Finally stress management is key as nervous system sympathetic tone is important. So breath work and meditation, yoga or alternative techniques can all help with this.
So the message is one of positivity and hope. By working in a personalised way we can support the body to make the changes required in a way that suits each individuals physiology and lifestyle.
References:
Parker et al, (2022) Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment Int. J. Environ. Res. Public Health 2022, 19(3), 1336; https://doi.org/10.3390/ijerph19031336
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)
