Tag Archives: Diet

Gluten sensitivity and fibromyalgia… is there really a link?

Marcusby Holistic Osteopath, Marcus Webb

By the time you read this little article I am sure you will have heard about a study linking gluten sensitivity with fibromyalgia and reporting on how ‘remarkable clinical improvement can be achieved with a gluten-free diet in patients with fibromyalgia (FM) even if coeliac disease has been ruled out’. The conclusion also goes on to say that ‘non-coeliac gluten sensitivity may be an underlying treatable cause in FM syndrome’.

However, the plot thickens; in all 20 of the FM subjects studied biopsies of their intestine revealed a pathological change known as intraepithelial lymphocytosis, a finding the authors use to help support their hypothesis that gluten sensitivity is a causal agent and underlies FM. This cause and effect relationship that this latest study hints at does sound convincing especially when we keep in mind that intraepithelial lymphocytosis has been associated with gluten sensitivity in the past but should we be jumping to such a definitive conclusion; what about those FM patients who don’t have intraepithelial lymphocytosis, were they removed from the study because they did not respond to a gluten-free diet? Don’t get me wrong, I am not trying to discredit or down play the study or the potential benefits of a gluten free diet in cases of FM but I am aware that many FM sufferers may read this and feel that they have to follow a gluten-free diet in order to get better but before going on it may be good to lay out a little additional information about intraepithelial lymphocytosis.

Within the tissue of the gut known as (epithelial tissue) special white blood cells known as lymphocytes reside waiting like guard on duty to be triggered into life by an invading army. In the case of the gut this is would normally be a bacterial infection. In around 3% of routine biopsies increased levels of lymphocytes can be observed (ie. intraepithelial lymphocytosis) and between 9-40% of cases celiac disease has eventually been diagnosed. In some cases intraepithelial lymphocytosis occurs in other multi-system disorders such as Hashimoto’s thyroiditis, Graves’s disease, rheumatoid arthritis, psoriasis, multiple sclerosis, Systemic lupus erythematosus, ankylosing spondylitis and autoimmune enteropathy. The other cases tend to be viewed as a non-specific finding related to other health issues such as bacterial overgrowth (SEBO), inflammatory damage secondary to non-steroidal anti-inflammatory drug use or other chronic inflammatory bowel disease. In other words, the presence of intraepithelial lymphocytosis is not diagnostic of gluten sensitivity but in the absence of other causes gluten sensitivity could be a possibility since it has been reported to account for around 10% of the cases of intraepithelial lymphocytosis but it should be kept in mind that hypersensitivity to other non-gluten components of food may also trigger this tissue change. Interestingly, a good number of the 20 subjects had co-existing health problems that have also been linked with the bowel tissue chances characteristic of intraepithelial lymphocytosis such as psoriasis (in 2 cases), hypothyroidism (in 3 cases), inflammarory/irritable bowel (in 5 cases) and gastric reflux (in 10 cases) which is a problem that commonly receives PPI drug therapy. As a drug class, PPI’s are also known to trigger intraepithelial lymphocytosis. However you critique this study as much as you want but what you can’t ignore is the outcome; for many, great relief of their chronic and disabling symptoms using a drug-free approach.

For many FM sufferers having a condition that is resistant to conventional therapies places them in a real corner when it comes to treatment and management options. From my experiences working with FM/CFS sufferers we tend to do what works or what works for that person! Science tends to take its time in catching up with the clinical observations but while it is catching up in many cases there is no real harm in exploring options that appear to have some evidence to support their use such as a trial of a gluten-free diet. From the results of the current study the gluten-free diet was followed for 16 months on average but in one case (a FM sufferer for 20 years) improvement in pain, fatigue and gut symptoms were felt after just 5 months and in another case (a sufferer for 10 years) complete remission of FM and improvements in gut and migraine was also observed after just 5 months. In some cases significant improvements and a return to normal life activities and work were seen after more prolonged (over 30 months) exposure to the gluten-free diet. However you look at it, cutting the gluten has made a dramatic difference to many sufferers in this small study.

If you feel that a gluten free approach is something you fancy trying its not a diet to be taken on lightly… so many foods contain gluten! Despite this, I would advise that you seriously consider going gluten free if your FM is of long standing and you have exhausted all other approaches. Keep in mind that you may have to stick to it for many months before you feel any tangible benefits but again, for what its worth, I can support the observations that many ill-defined inflammatory and pain related conditions simply improve with the elimination of gluten.

To help get you started you should avoid Barley, bulgar wheat, couscous, durum wheat, rye, semolina, spelt, wheat, all biscuits, breads, cakes, chapattis, crackers, muffins, pastries, pizza bases, muesli, wheat based breakfast cereals and anything made from wheat, rye or barley flour. By no stretch of the imagination is this a complete gluten free diet but it’s a start and something you can instigate today. Sitting down with an experienced nutritionist or naturopath should be your next step so you can get a more complete understanding of the complete gluten free diet and what it involves. In the early days of a gluten free diet I tend to recommend the use of a special dietary enzyme supplement based in a blend of plant derived gluten splitting enzymes. In addition to the cellulose digesting enzyme known as cellulase the key ingredient in Gluten Relief is Dipeptidyl Peptidase IV (or DPP-IV for short). DPP-IV is a type of protein splitting enzyme, known as a protease, and has been shown to break down the wheat protein gluten and milk protein casein. This combines with alpha-galactosidase to aid in the digestion of long chain sugars found in beans, broccoli, cabbage, sprouts etc… Using an enzyme preparation such as Gluten Relief (by the Canadian manufacturer Natural Factors) does not replace in anyway a gluten free diet but when you are unsure or are out and about with limited choices it may help to ‘defuse’ a potential gluten containing meal.

Link to study: Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. 

Link to Gluten Relief product

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Don’t miss the window

Our skeleton starts off life as a delicate membrane-like template late in the second month of pregnancy but soon after the third month a primitive skeleton can be easily seen. Our bones form relatively early on because they are a key factor needed in the healthy growth and development of the growing baby. We tend to forget just how important a skeleton is but without it there would be nowhere for our muscles to attach and our vital internal organs would be extremely vulnerable to damage.

Throughout pregnancy, Mums-to-be are told to eat well and to get plenty of bone forming nutrients such as calcium. This advise extends to breast and bottle feeding and well into the weaning months and early years for good reason; the skeleton of a growing child is highly active and demands a plentiful supply or raw materials. However, there appear to be a gap somewhere between the early to mid teens and late 30’s where the focus of attention is taken away from skeletal health as other health priorities take the lime light and centre stage. For a growing number of people in this age bracket, weight management becomes an issue along with the trend for very restrictive diets in an attempt to drop the excessive weight. It’s not uncommon for levels of physical activity drop off especially in the school leaver population who either choose to avoid sports altogether or are forced into a more restrictive lifestyle that is so common in the digital workplace. Combine this with an increasing tendency to rely on processed and convenience foods and a lack of basic food, cooking and nutritional knowledge in many people and its quite easy to see how and why the early teen through to late 30’s are potentially hazardous to long term health. If we remain focused on the skeletal system, this phase of life is especially important considering that 90% of a girls skeletal mass is acquired by the age 18 and in boys by the age of 20. However, our bones keep developing reaching their lifetime peek mass by the age of 30 in both sexes. After this the skeleton remains quite stable until, in the case of women, the menopause starts when there can be a significant loss of bone mass. Men tend to loose bone mass slowly around the same phase of life but because of their greater skeletal size the effects are less noticeable in most cases. So, there appears to be window that can swing open for an opportunity to optimise skeletal health or slam shut, placing the maturing bone in jeopardy. Its rather like paying into a long term savers account or pension, you should have some reserves for later in life but it does mean you have to contribute early on and for many years to come with no real obvious outward signs of any benefit but in general you will be better off for the efforts.

The bare bones of skeletal nutrition We all know that calcium is important for bone health but it has been rather over played in the past. Our diets abound with calcium and the mature skeleton stores 99% of the bodies calcium reserves. In fact, our blood calcium levels are kept within such tight parameters that any fluctuation above or below the normal is considered a key sign of an underlying hormone disease rather than anything to do with dietary excess or deficiency. In saying that, calcium is still a vital bone mineral and one that is needed on a daily basis to maintain health. Despite many people having a problem in regards to sensitivity to allergy, milk and dairy products still provide a reliable and cost effective source of dietary calcium and protein. There have been some concerns raised about the intake of milk and an increased risk of thin bone disease but these claims have not been substantiated. In brief, the anti-milk theory suggests that the protein and phosphate naturally found in milk and dairy products make them ‘acid-producing’foods causing a shift in the bodies acid (pH) levels and triggering an accelerated loss of calcium from the bones and body; this process is not supported by any scientific evidence. Moreover, studies have confirmed that a higher phosphate intake was actually associated with decreased urine calcium and increased calcium retention. The theory then goes on to link this process with observations of thin bone related fractures in people from countries that consume a lot of milk and dairy foods; this is a case where correlation and causality can be misleading. Studies involving populations living and working in urban and rural environments yield quite different outcomes probably more related to their physical activity levels rather than to their milk and dairy food intake. While some people may find dairy foods a problem for those who do not a sensible level of intake would not appear to have any real detrimental effect on bone health and for some groups of people could be an important source of readily available protein and minerals. Check the tables below and see if you are getting enough calcium from your food (Table 1) compared to the recommended daily intake levels based on Western European, American and Canadian figures (Table 2).

Table 1: Calcium in common foods (apporoxamate)
Food Serving size Calcium (mg)
Milk, whole 236 ml 278
Milk, semi-skimmed 236 ml 283
Milk, skimmed 236 ml 288
Goats milk 236 ml 236
Yoghurt, low fat, plain 150 g 243
Yoghurt, low fat, fruit 150 g 210
Yoghurt, Greek style, fruit 150 g 189
Cheese, cheddar 40 g 296
Cheese, cottage 112 g 142
Tofu, soya bean, steamed 100 g 510
Soya drink 236 ml 31
Soya drink, calcium enriched 236 ml 210
Broccoli, cooked 112 g 45
Curley kale, cooked 112 g 168
Apricots, raw 160 g (1 fruit) 117
Orange 160 g (1 fruit) 75
Figs, ready to eat 220 g (4 fruits) 506
Almonds 26 g (12 whole) 62
Brazil nuts 20 g (6 whole) 34
Sardines, canned in oil 100 g (4 fish) 500
Pilchards, canned in tomato sauce 110 g (2 fish) 275
Whitebait, fried 80 g 688
Bread, white sliced 30 g (1 slice) 53
Bread, wholemeal, sliced 30 g (1 slice) 32
Pasta, plain, cooked 230 g 85
Rice, white, basmati, boiled 180 g 32
Table 2: Recommended daily intake of dietary calcium
Age Calcium (mg/day)
0-6 months 300-400
7-12 months 400
1-3 years 500
4-6 years 600
7-9 years 700
10-18 years 1300
Women
90 years to menopause 1000
Post menopause 1300
During pregnancy (1st trimester) 1200
Lactation 1000
Men
19-65 years 1000
65 + years 1300

As you can see from Table 1, getting adequate dietary calcium is not difficult but you need to know what too eat! A strict vegetarian who also avoids dairy foods will find it much harder to meet the minimum requirements for calcium without consuming specialist foods such as Tofu or taking a calcium supplement. Equally, someone following a strict weight loss may also fall short especially if they choose to follow the diet over a long term basis rather than modify their intake level across a balanced diet. Calcium is important but it is by no stretch of the imagination is it the key nutrient. What needs to be kept in mind is the fact that bone is a living tissue, its not simply a hard calcified mass. If it was it would be very prone to fracture because there would not be any flexibility or ‘give’in the skeleton when we jumped or ran. Proteins give bone its flexibility as well as a framework onto which the minerals (calcium, magnesium, phosphorous) can be deposited. A diet low in dietary protein is also detrimental to bone health. Fad diets that restrict proteins and poor general eating habits can that rely heavily on processed foods and carbohydrates starve the body of the essential protein building blocks of life known as amino acids. Key proteins from meat, fish, and eggs generally form the corner stone to human protein intake in Europe. In essence, there is nothing wrong with animal protein but there is no need to over consume from this food group since there are many great vegetable protein sources as well. Vegetarians and those seeking to rely less on animal proteins need to choose carefully but can increase their vegetable protein intake easily by eating more lentils, kidney beans and broad beans as well as soya, tofu, grain, nuts and seeds. By increasing the intake of vegetable proteins you will also be increasing the levels of other key bone nutrients including magnesium, zinc, B-vitamins (such as folic acid) and vitamin A generating beta carotene especially if you regularly eat the coloured vegetables such as orange, yellow and red peppers.   Absorb it or loose it In order to benefit from the calcium in your diet or from your supplement adequate levels of vitamin D are required. Over the past few years vitamin D has become a hot-topic in the press where it has been associated with many health problems ranging from MS through to certain types of cancers and even depression and psoriasis when levels are grossly deficient. The situation involving vitamin D and it’s involvement in such a variety of health problems is complex, poorly understood and undoubtedly linked to genetic susceptibility but when it comes to bone health the cause and effect relationship is very well understood and established. Vitamin D is not an easy vitamin to get in Northern European countries simply because of the lack of intense sunlight (more specifically the ultraviolet-B rays) needed to stimulate its production within the skin. Here we hit another controversy, by recommending sun exposure are we now putting people at risk of skin cancer? The simple answer is no! Just remember that sun exposure is healthy, sun burn is not. Getting 15-20 minutes of sun light per day, best between 10am and 2pm when the sun is at its peek, is all that is needed to boost natural vitamin D levels. For those of us at work stuck inside, shift workers or people confined to inside living some vitamin D can be obtained from a few foods (for example; salmon, mackerel, tuna, sardines, egg and liver) but to get enough you will need to eat quite a lot of it and on a very regular basis to meet the requirements for health let alone optimal health and there is no real vegetarian food option that delivers any vitamin D. In regards to vitamin D the only real option is a supplement especially over the winter periods. Intake recommendations for vitamin D vary greatly but supplements should be in the vitamin D3 form and need to be between 400iu (10mcg) to 1000iu (25mcg) in strength per day unless you have had a vitamin D blood test and need to significantly boost your levels under supervision. If you can’t get a blood test from your own GP we can always arrange this for you but the private lab will carry a lab fee of around £60 per test for a calcium and vitamin D test. You can take your own blood sample at home (a finger prick) and posted off to the lab for analysis. Another vital vitamin for bone health is vitamin K. This is required for the formation of specific bone proteins that actively help to build and strengthen the framework needed a healthy skeleton. Vitamin K is obtained from dark green leafy vegetables such as kale, cabbage and spinach as well as from lettuce. There are more specialist foods made from fermented soybeans that deliver high amounts of vitamin K. A good bone supplement should supply vitamin K but this needs to be avoided in anyone taking anticoagulant medication such as warfarin. Those on warfarin should not increase their vitamin K containing foods form the same reason.

Special situations The window for optimising bone health can be significantly helped by diet and lifestyle choices but there are a few occasions when other health issues can complicate things. People with certain digestive problems that adversely affect nutrient absorption, such a Coeliac disease and some inflammatory bowel problems, need special individualised attention and advise. This may also extend to the long term use of steroid based medications because of its adverse impact on bone health.

Dietary supplements While we have placed great emphasis on food, diet and what can be achieved through lifestyle adjustment, the use of a specific dietary supplement aimed at optimising bone specific nutrition may be appropriate in many cases. The bone specific supplement Calci-D-min delivers a highly absorbable plant calcium known as Aquamin (derived from red algae) that’s easy on the stomach and quickly absorbed and assimilated by the body. Aquamin also delivers magnesium and 74 other naturally occurring trace elements contained in the red algae. The Calci-D-min supplement has been formulated to supply effective levels of vitamin D3, K1 and K2 along with boron selenium and zinc. Depending on the diet, as food supplement two to four capsules are recommended taken with food. Because of the vitamin K ingredient, Calci-D-min is not recommended for anyone taking the anticoagulant drug warfarin. The product is 100% vegetarian and fully approved by the Vegetarian Society.

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Green vegetables directly influence immune defences and help maintain intestinal health

The discovery will also enable scientists to ask fundamental questions about the frequent interactions of cells of the immune system with external environmental factors. This work may provide a rationale for the reported association between some intestinal and skin disorders, the most frequent of which is psoriasis, as well as diet choices.

Read the research background and view the movie here :http://bbsrc.ac.uk/news/health/2011/111014-pr-green-vegetables.aspx.

Scientists confirm ‘greens’ are good for you

Not that we really need science to tell us that greens and vegetables are good for us but its nice to know that the age old advise to ‘eat your greens’ still holds up. Leafy greens, widely recognized as healthy because they contain essential ingredients for ensuring optimum health and wellbeing. The latest research has now thrown light on the influence these foods have on our intestinal health. It appears that greens delivering a protective factor to certain cells of the immune system. These findings, reported online in the journal Cell, have implications for better understanding the basis of intestinal inflammatory disorders such as inflammatory bowel disease (IBD) and may even offer new opportunities for therapeutic intervention.

Scientists at the UK’s Babraham Institute and the Medical Research Council’s National Institute for Medical Research have been working on chemical components of greens found in the cruciferous vegetables like broccoli. Their research has focused on how these compounds regulate the survival of a special type of white blood cell (known as intra-epithelial lymphocytes or IEL’s for short), part of the body’s front line defence against infections and important in wound repair.

The IEL’s live just under the cells that line digestive tract and play a crucial role in protecting us from disease causing microbes that naturally inhabit the intestine. The research demonstrated that mice fed a diet low in vegetables quickly loose the IEL cells within the intestine. However, a low vegetable diet did not appear to affect other immune cells elsewhere in the body. Despite the low vegetable still delivering all other essential vitamins and minerals around 70-80% of the protective IEL’s simply disappeared within 2-3 weeks!

A key discovery that helped to unlock the mystery centered around the discovery of a special receptor on the surface of the IEL cells known as AhR (short for arly hydrocarbon receptor). A receptor is a special structure on a cell that acts rather like a combination lock. It needs the correct sequence of events to function or influence the function of the cell its found on. In the case of the IEL’s the receptor is activated by compounds found in vegetables. One such compound is called indole-3-carbinol (or I3C for short) and is found in cabbage, broccoli and mustard. Mice fed a low vegetable diet demonstrated low AhR activity while those on a low vegetable diet but supplemented with I3C maintained normal AhR activity and normal healthy IEL function. Interestingly, population studies have linked a diet low in fruit and vegetables with an increased risk of inflammatory bowel disease with results of the present study providing a molecular basis for the importance of cruciferous vegetable-derived phyto-nutrients as part of a healthy diet.

In addition to the influence of IEL cells and intestinal health the scientists also found that IELs present in the mouse skin crucially depend on the activation of AhR. While the nature of the interactions preserving skin IELs is currently unknown, it may provide a rationale for the reported association between some intestinal and skin disorders, the most frequent of which is psoriasis, as well as diet choices. The bottom like here would appear to be “eat your greens” and possibly to look at supplements that contain a booster of nutrients found in greens such as Garden Veggies made by Nature’s Way. Even though a serving of vegetables should never be replaced by a supplement, using Garden Veggies in addition to your daily diet may help ensure optimal levels of the important health promoting vegetable derived compounds.

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Diabetes is reversible!

One of the fastest growing health problems facing us is diabetes. A brief look at the statistics (from Diabetes UK) for the UK clearly reflects a worrying trend with the year on year prevalence of diabetes on the steady increase. The chart below, constructed from figures readily available from Diabetes UK clearly shows the trend.

While diabetics should never radically change their treatment plan on their own, fascinating new results have just been published showing how powerful diet can be in influencing this growing health crises. Researchers from Newcastle University have clearly shown that a strict low calorie diet can actually reverse the condition by normalizing blood glucose levels, reducing cholesterol levels and even stimulate the pancreas’s insulin producing cells (beta cells) to return to normal!

However, this was a small-scale study and involved just 11 people; 9 men and 2 women. The participants followed a very low energy (calorie) diet based on a special liquid diet formula along with 3 portions of non-starchy vegetables so that the total daily energy intake was about 600 kcal. They were also encouraged to drink around 2 liters of water a day and avoid all sugary or high-energy drinks.

At the end of the 8-week diet trial the study demonstrates that the twin defects of beta cell failure and insulin resistance that underlie type 2 diabetes can be reversed by the very low energy diet alone. Over the trial the average blood glucose levels of those involved fell from 9.2mmol/l to 5.7mmol/l.

While this study involved a drastic dietary change and can’t be considered as a gold standard for managing type-2 diabetes on a daily basis it does dramatically highlight the importance of diet and the power of modifying it. With 50% of diet control diabetics requiring insulin injections after 10 years of diagnosis long term management through diet modification and exercise would be the most sensible way forward for the UK type-2 diabetic population and especially for those with pre-diabetic or borderline test results. The full study was published in the June issue of the journal Diabetologia.

More on the growing prevalence of diabetes

Read Sugar Rush published in the Economist online. The number of adults with diabetes more than doubled between 1980 and 2008, according to a new study led by Professor Majid Ezzati of Imperial College London and Goodarz Danaei at Harvard University and published in the Lancet…

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Support grows for antioxidant protection in heart disease

There is a lot of talk about “oxidative stress” and heart disease. This process results from an imbalance between excessive formation of reactive oxygen species (ROS) and/or reactive nitrogen species and limited antioxidant defences. Endothelium (the lining found within blood vessels) and nitric oxide (NO) are key regulators of vascular health. NO bioavailability is regulated by ROS that degrade NO, uncouple NO synthase, and inhibit its production. Cardiovascular risk conditions contribute to oxidative stress, causing an imbalance between NO and ROS, with a relative decrease in NO bioavailability. Dietary flavonoids represent a range of polyphenolic compounds naturally occurring in plant foods. Flavonoids are potentially involved in cardiovascular prevention mainly by decreasing oxidative stress and increasing NO bioavailability.
Diet and nutrition play a fundamental role in cardiovascular prevention and in maintaining physiological homeostasis. Recent literature emphasizes the potential therapeutic effects of micronutrients found in natural products, indicating positive applications for controlling the pathogenesis of chronic cardiovascular disease. In this context, cocoa, some chocolates, red wine, and tea received much attention, because they are particularly rich in flavonoids, phytochemicals with strong antioxidant properties. In addition, polyphenols are the most abundant antioxidants in our diet and are common constituents of foods of plant origin and are widespread constituents of fruits, vegetables, cereals, olive, dry legumes, chocolate and beverages, such as tea, coffee and wine.
The full study is available for down load (click here) where the reaserchers conclude that these key antioxidants exert a protective and preventative finctio in the battle against atherosclerosis and cardiovascular disease.
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