Functional approach to cognitive decline (brain neurodegeneration)

The 21st of September was word’s Alzheimer’s day, a form of incurable neurodegeneration. But what happens before one develops a condition that cannot be reversed? The gray area between subtle mental decline and receiving a diagnosis is where prevention takes place.

We live in a toxic world, leading fast paced lives. As a result, all of us deal with neurodegeneration to some degree. Symptoms can be confused with natural ageing or blamed for having ‘too much on’ so it’s easy to ignore them, especially that the brain can send non-specific signals. We also live in a world of lifestyle diseases, and all chronic health conditions eventually result in neurodegeneration because disease is a matter of the whole body.

DEFINITION, SIGNS AND SYMPTOMS

Neurodegeneration is the progressive loss of structure or function of neurons (nerve cells), leading to their death. For most people, advanced stages of neurodegeneration like Alzheimer’s are irrelevant. Yet, the symptoms of diminished brain function are experienced by many on a daily basis and are often neglected. They include:

• Failing memory (where have I put my keys / phone? what was I looking for?)

• Inability to focus / concentrate

• Brain fog

• Difficulty retaining new information

• Poor spacial orientation or sense of direction

• Lack of motivation

• Brain fatigue – falling asleep while watching TV, reading, engaging in conversations or any mental work

• Depression, lack of enjoyment

• Anxiety

• Inability to relax, disorganised attention

• Inability to fall asleep in the evening and get up in the morning

• Constant need for stimulation: music, caffeine, company of other people

CAUSES

Neurodegeneration can be considered brain inflammation. Once initiated, the inflammatory cascade in the brain is difficult to control. Glial cells, the immune cells of the brain, should normally only gobble up debris but under certain conditions, they ‘digest’ healthy brain cells as part of the inflammatory process. Inflammation is body’s defense and repair mechanism, therefore it’s not the inflammation itself but its cause that requires addressing. Some of these include:

• Brain injury: concussion, falls, bangs – even the ones you may have forgotten

• Gut-brain axis dysfunction: poor digestion, detoxification, gut dysbiosis and the ‘leaky gut’ can lead to the ‘leaky brain’ where the toxic flow from the gut (e.g. undigested proteins or pathogenic toxins) affects brain function

• Cross-reactivity of own tissues with harmful agents (i.e. autoimmunity): antigens tagged by the immune system as harmful, e.g. gluten, virus or gut pathogens, can trigger brain autoimmunity because they share a similar protein sequence with the brain. In other words, when the immune system attacks the invader, it can mistakenly attack the brain at the same time. People usually develop multiple autoimmune conditions at once and it’s very common to see advanced neurodegeneration in people with Hashimoto’s thyroditis

• Poor oxygen flow to the brain: anaemia, injury, lack of physical activity (cold hands and feet or snoring are a signs of impaired brain oxygenation)

• Heavy metal toxicity, e.g. mercury, aluminium, high copper and low zinc: chronic exposure to metals, impaired detoxification and the lack of beneficial microbes that support heavy metal detoxification may cause their accumulation in the brain

• Stress and high cortisol levels: these damage temporal lobes of the brain, which decreases the ability to dampen stress and causes further damage to the area.

• Lack of sleep: the body regenerates while we sleep, and the brain especially loves a break. Inability to sleep can be caused by blood sugar imbalances, high cortisol in the evening and lack of natural light exposure during the day – all of which affect melatonin production. Melatonin has strong anti-inflammatory properties. Also, lack of sleep due to social factors or lifestyle demands (e.g. long working hours) will eventually disrupt the circadian rhythm which will further negatively affect cortisol cycle

• Diet rich in carbohydrates: the brain can become insulin resistant like any other tissue. Too much circulating glucose and insulin are damaging to neurons. Unstable blood glucose levels also negatively affect neurotransmitter production

• Nutrient deficiencies: amino acids due to improper protein digestion and absorption, essential fats, fat soluble vitamins A and D, B vitamins, zinc, betaine, choline

• Defective DNA methylation: the genetic code doesn’t define our destiny. Rather, it’s the environment that influences genetic expression which is called ‘epigenetics’. Methylation is one of such epigenetic factors. When impaired (which depends on nutrient status and absence of candida), it can impact the expression of neurodegenerative diseases like Alzheimer’s, Parkinson’s, Huntington's disease and amyotrophic lateral sclerosis (ALS)

• Hormonal imbalance: oestradiol, which is an oestrogen steroid hormone, has brain protective properties. Women who are low in oestradiol are at a greater risk of neurodegeneration. Menopause is can certainly be a factor but hormonal imbalances are common with young women

WHAT TO DO

Neurodegeneration requires a holistic approach. Thorough health history gathering, symptom analysis, observation of physical reflexes and functional diagnostics are invaluable tools for personalising the therapy. Nevertheless, it’s often the basic dietary and lifestyle changes that can bring profound effects, before moving on to removing entire food groups and diving into the sea of isolated nutritional compounds, not to mention medication.

It’s always tricky to give recommendations for a wide audience because everyone is different. While someone may benefit from antioxidants, others may need to improve fat absorption or go on a proper elimination diet. Blood sugar imbalances and gut dysfunction are always central to brain supporting nutritional therapy and require an individual approach.

Nevertheless, the below are generally associated with improved brain function:

• Fat, cholesterol: the brain is the hungriest organ, and its most efficient fuel source is fat which burns slowly, providing sustainable energy. Cholesterol is a powerful antioxidant and is an important component of the myelin sheath that protects nerves

• Essential fatty acids:

  1. Omega 3 (specifically DHA): oily fish like sardines, salmon, herring, anchovies, mackerel, sprats, meats from grass fed animals, egg yolks from free range birds

  2. Arachidonic acid, especially in conjunction with vit A and D: animal fats in general, organ meats, butter, eggs

• Choline: eggs from free range chickens, liver, full fat quality cheeses

• Antioxidants: a rainbow of seasonal vegetables, fruit, organic dry red wine, cold pressed olive oil, vitamin D, turmeric

• Fermented foods: olives, cured hams, fermented dairy (yoghurt, kefir, cheese), vegetables (sauerkraut, kimchi, gherkins, natto, tempeh)

• Prebiotics (food for gut microbes): best sources incude resistant starch (e.g. cooked and chilled potatoes or white rice, like in a potato salad or sushi), vegetable fibre

• Sleep: while it can be challenging to sleep when you have other commitments, at least do your best when you’re able to. Sleep is such a given that it’s often underestimated, and yet one of the most powerful healing aids. Whenever you can, do your brain a favour and go to bed by 23:00. Inability to sleep is a separate matter altogether that needs addressing

• Outdoor physical activity: hiking, walking, swimming in natural waters, cycling, walking barefoot, yoga outside

• Mental stimulation: key for brain plasticity. One of the most effective strategies is practicing what you’re not good at, for example languages or reading maps

On the contrary, pro-inflammatory foods and lifestyle are a significant driver behind mental decline and are best to be avoided. They include:

• Anything your body reacts to: it can even be anything from the above food list, and may not give you any digestive symptoms. Food reactions can be just as much ‘mental’ as physical. This is why the ‘one size fits all’ approach doesn’t work

• Sugar and glucose syrup: present in most processed foods, even those where they’re least expected (e.g. pesto or pate). A diet rich in sugar or carbohydrates in general can cause reactive hypoglycaemia and / or insulin resistance – either state is undesirable for the brain

• Industrial vegetable oils, e.g. sunflower or rapeseed oil that is not cold pressed and kept in the fridge

• Commercial cow’s milk, cream, ice cream: ultra pasteurisation renders milk pro-inflammatory and allergenic. It is best to stick to fermented and aged cow’s dairy or get raw, unhomogenised milk

• Wheat: gluten and glyphosate are common neurotoxins. For baked goods, it is best to shop in traditional and artisan bakeries, preferably for leavened bread

• Working hard, playing hard: constant brain stimulation is a major stressor, especially with concomitant diet that is poor in the essential nutrients and fuel

There is also a wide range of brain supporting botanicals and supplements:

• gingko biloba

• huperzine

• galantamine

• vinpocetine

• SAMe

• TMG

• B vitamins (esp. Folate, B12, B6 and B2)

• phosphatidyl serine

• fish oils (DHA)

• cod liver oil (vit A and D plus DHA)

• Udo’s oil (GLA)

• zinc

• antoixidants, e.g. curcumin, resveratrol, vit D

Always consult a professional for possible interactions, and get your individual needs assessed.

Why am I tired all the time?

The need for coffee to start the day, tea addiction, afternoon slumps, regular sugar injections in the form of baked goods, fizzy drinks or snack bars followed by more caffeine all indicate unstable energy. Such behaviours are common in various society groups like workplaces (including yachts) and families which falsely makes them ‘normal’. However, lack of energy that is not relieved without a 'booster' can be a sign of hidden dysfunctions. Due to the complexity of energy production and maintenance, fatigue requires a truly personalised approach. Some of the causes include the following:

1. Inability to extract energy from food

Energetic properties of foods are an individual matter and depend on food quality, preparation method, digestive capacity and cellular function. In order to convert food into energy, various nutrients are required, and in order to extract and utilise these nutrients, food has to be digested well. These nutrients include B vitamins, magnesium, manganese, carnitine and amino acids from protein breakdown. Interestingly, digestive issues are common in chronically fatigued people who always express symptoms of various deficiencies. The more digestive work a food requires, the less energy remains for other functions. Problems usually start with low stomach acid, leading to decreased secretions of pancreatic enzymes and bile. Consequently, protein, fats and carbs are maldigested and therefore not absorbed properly. Moreover, processed foods are devoid of nutrients which they still require to be metabolised so they are being ‘robbed’, leaving a person depleted and wrecked.

2. ‘Leaky gut’, toxins, infections and damaged mitochondria

Compromised digestion, drugs, environmental toxins, toxins released by gut microbes and chronic stress contribute to an increased intestinal permeability commonly called ‘the leaky gut’. The leaky gut is a gateway for undigested proteins and toxins to enter the blood stream and wreck havoc. These toxins can attach themselves to mitochondria, energy producing components of cells which will negatively impact energy production. In fact, toxins can attach to any tissue which is the trigger for autoimmunity, and all autoimmune conditions create fatigue. Mitochondria can also be damaged by the following:

• chronic infections (e.g. yeast like candida and mould, parasites, viruses like EBV or CMV, bacteria like borrelia or strep). Chronic infections and the leaky gut always go hand in hand

• oxidative stress: lack of antioxidants, high blood glucose levels

3. Blood sugar roller coaster and stress

Stimulants and processed carbohydrates cause a blood sugar spike, followed by a rapid drop. Each time blood glucose drops, stress hormones are released in order to raise blood glucose so that we can function normally. For example, a breakfast consisting of a bun and coffee or cereal with milk or just coffee will give an instant energy boost followed by a drop. Again, this drop stimulates cortisol and adrenaline to raise blood glucose to a normal level. However, when nutrient-poor dietary choices or skipped meals become a habit, one becomes resistant to stress hormones and can´t raise blood glucose any longer - sugar cravings and fatigue kick in. Therefore, relying on caffeine and processed cabrs to keep going is like whipping a dead horse.

Moreover, chronic emotional stress, chronic infections (as above) and the consequences of the leaky gut are all stressors which over-engage the adrenals in the same way, leading to fatigue.

4. Hungry brain

As a result of poor digestion and absorption or a nutrient-poor diet, the brain is missing sustainable fuel to deal with everyday tasks, not to mention stress, emotions and lack of alignment with oneself (i.e. doing anything that’s mentally draining), which can deprive the entire body of energy. The brain doesn't like blood sugar roller-coaster, and thrives on fat. But again, in order to extract the essential fatty acids and fat soluble vitamins from the ingested fat, digestion has to be optimal. The main organs responsible for proper fat breakdown are the liver, gallbladder and pancreas.

5. Underactive thyroid

The thyroid controls the speed and intensity of all bodily processes. Depending on the signals coming from the external and internal environment, the brain and adrenals signal the thyroid if it should speed things up or slow them down. Although full thyroid assessment is key when establishing the cause of fatigue, it’s usually not just the thyroid that requires support but body’s whole biochemistry, ecosystem and lifestyle influences that affected the thyroid in the first place.

6. Anaemia – it’s not just about iron

Iron, vit B12 and folate are responsible for red blood cell oxygenation and maturation. Deficiency of these nutrients results in poor oxygenation of cells, called anaemia and can stem from a poor diet, absorption issues resulting from impaired digestion, gut dysbiosis, or poor methylation.

7. Root canals

Those who have failed to improve their energy despite trying everything may want to look into removing their root canals and replacing them with zirconia bridges. I recommend working with a holistic dentist who will carry out proper preparation for the procedures and apply a detoxification programme afterwards. Root canals are a major source of toxicity which can directly impact energy production by the mitochondria - the same mechanism as in the leaky gut.

What to do?

The priority is identifying the individual cause of fatigue, addressing digestion and gut ecology. In each case however, it’s as a sign to listen to your body as it’s trying to tell you that it needs to be looked after.

1. Chronically fatigued people should focus on foods that are easy to digest: soups, stews, curries and stir fries. Fermented foods will also be easier to digest than their unfermented counterparts. Improving digestion is always my go-to strategy to lay a solid foundation of energy improvement.

2. Vegetable juice doesn’t require much digestion and provides easily absorbable nutrients, which makes it an energising food-based supplement.

3. Hot water with fresh ginger, stock, broth, miso soup and digestive enzymes taken prior to meals can help to extract more energy from food.

4. Targetted probiotic therapy will help to rebalance the gut but it's counterproductive without dietary adjustments that suit a particular individual.

5. Best to start the day with a protein and fat based breakfast like eggs and quality bacon, which will prevent from blood sugar roller coaster.

6. Sipping on mineral water with a pinch of sea or rock salt and a sqeeze of lemon juice is a fabuous drink that supports the adrenals.

8. Last but not least is lifestyle: good sleep hygiene, relationships, satisfying work, contact with nature, movement, spiritual connection.

Sleep is especially important as it helps to lower inflammation and improve stress response. However, it's not just the length of sleep but also the hours of going to bed and getting up that really matter. The later one goes to bed and gets up, the bigger the chances of lower blood pressure and poor energy throughout the day.

Starting with small steps of lifestyle changes should certainly be the first call of action before looking deeper for physiological causes.

Shorter version of the article was published in The Islander, September’18 edition

Why can't I lose weight

'I'm eating well and exercising but nothing seems to be working' – a common complaint I hear in my clinic. Losing weight is often associated with food restrictions and exercising but the popular belief of 'eating less than you burn' doesn’t always work. What’s more, even with the best of dietary plans, progress can be slow or stalled. If you dream about long lasting weight loss, this article will uncover some of the potential road blocks to achieving that success.

1. Expectations: holistic weight loss is not an overnight solution. For long term success, it is best to get healthy to lose weight rather than lose weight to get healthy. This, however, means time and patience. A healthy weight loss is between 0.5-1 kg per week but that doesn’t happen every week and make take a while to kick in, for one of the reasons discussed below. Moreover, there will always be times of plateau and more rapid weight loss, which is controlled by various hormones. Cherish the success and patiently go through the less productive times. Try and keep up the good work - it will pay off eventually.

2. When it comes to weight loss, hormones matter more than calories: there are 11 hormones which dictate how efficiently you will burn fat, maintain or grow healthy muscle mass to replace fat tissue, and impact hunger and satiety signalling. These are: insulin, leptin, ghrein, cortisol, thyroid, growth hormone, CCK, peptide YY, estrogen and testosterone. In order to regulate these, we need ample amounts of protein, some good fats, fibre from vegetables and micronutrients.

4. 7. Nutrient deficit: for calories to burn, we need robust ‘fire’ (good metabolism) which is fuelled by nutrients. No nutrients, no fire. Weight loss diets often restrict fat, which limits not only fat soluble vitamins and essential fatty acids necessary for weight loss, but also disturbs hunger and satiety signalling. Eating empty calories leads to an overfed body and a starving brain which induces appetite. You provide a lot of energy but no fire. Nutrient-poor diets result in the storage of ingested energy as fat for future use because the body senses a potential famine - it's a protective mechanism. Nutrient deficit may also result in specific cravings, depending on deficiencies, e.g. neurotransmitter imbalance can cause emotional eating. Digestive problems also warrant a mention because if digestion is malfunctioning, nutrients cannot be extracted from food and utilised by the body. In short, the less nutrients, the slower metabolism becomes. If you wish to reduce calories, you will have to increase nutrient density or optimise nutrient extraction from food by improving digestion and gut function.

3. Sleep: Hormonal health is closely related to the circadian rhythm, sleep quality and sleep window. For example, growth hormone, which regulates metabolism, is most active between 22:00-24:00pm. Many people miss this window by not getting to bed early enough.

Main lifestyle habits that prevent from getting a good night’s sleep are:

• exposure to blue light, which blocks melatonin activity: looking at the computer / laptop / phone / tablet till late - reduce the effect by stopping exposure 30 minutes before bed or wearing blue light blocking glasses

• eating sugary or starchy foods late, which causes a glucose drop at night. This will stimulate the release of adrenaline, which will wake you up

• doing cardio exercise in the evening

  If you had a bad night’s sleep, you will induce insulin resistance the next day and make very different food choices altogether. You ill most probably want to get out of bed later than is optimal for kicking off metabolism, or get up feeling groggy. You may reach out for something sweet or stimulanting to wake up but this will get your blood glucose out of balance for the whole dday

4. Insulin resistance and inflammation: insulin's main function is to transport glucose from blood to cells. Too much glucose is inflammatory to cells, so the body responds by employing a protective mechanism called insulin resistance, resulting in cells becoming unresponsive to insulin for fear of more glucose. When too much glucose is present in blood because it’s not getting into cells, the cells are striving for energy. Constant hunger, cravings and tiredness are key symptoms of insulin resistance. Inflammation of any sort (especially silent, low grade inflammation unreflected by standard inflammatory markers like CRP and ESR) induces insulin resistance. It means that all chronic health issues may contribute to slow metabolism. I see chronic inflammation as the main reason for reaching weight a loss plateau.

Insulin is also the fat storage hormone. Every time insulin is present in blood, fat burning is blocked. Constantly circulating insulin in blood (as it happens with insulin resistance) makes it impossible to burn fat.

5. Chronic stress: the body does not recognise the source of stress but all sources of chronic stress will elevate blood glucose so that we can have fuel for ‘fight or flight’. The more chronic the stress is and the more glucose in blood, the more possible insulin resistance is, also because chronic stress is inflammatory. Stress sources include: nutrient deficiency, emotional stress, skipping meals, starting the day with a coffee on an empty stomach, going to bed late, unrefreshing sleep, over exercising (usually too much cardio), exercising after 6pm, chronic health issues, unstable blood sugar, food sensitivities, work and unhappy relationships. In the absence of dietary glucose, stress hormone cortisol stimulates the break down of muscle tissue to create glucose. And the less muscle, the more fat one accumulates. Muscles are metabolically active and by just having muscles, fat burns. The foundation of true weight loss is burning fat - not losing water or muscle.

6. You recenty had a baby: female body changes significantly after birth - mostly in relation to stress and metabolic hormones. What once came without much effort may now pose adrenal stress or increased need for stimulants, especially if sleep is broken. If your weight has stalled, try and rethink your daily routine. Do you go to bed early enough (22:30 max)? Do you sleep well? Do you have breakfast that is protein dense? Do you start your day with caffeine? Do you still ´go go go´ even though you have lots of new duties of being a mum so now you have twice as much responsibilities? The immune system also shifts and many women develop Hashimoto´s thyroditis which can stall weightloss, too. More on that below.

7. Nutrient deficit: metabolism is fuelled by nutrients. Diets often restrict fat, which limits not only the fat soluble vitamins and essential fatty acids necessary for weight loss, but also disturbs hunger and satiety signalling. It's a syndrome of an overfed body and a starving brain. Animal fat has a vital role of protein assimilation. In other words, eating low fat but a high protein diet reduces the chances to properly assimilate that protein. Nutrient-poor diets result in the storage of ingested energy as fat for future use because the body senses a potential famine - it's a protective mechanism. Nutrient deficit may also result in specific cravings, depending on deficiencies, e.g. neurotransmitter imbalance can cause emotional eating. Digestive problems also warrant a mention because if digestion is malfunctioning, nutrients cannot be extracted from food and utilised by the body. In short, the less nutrients, the slower metabolism becomes. If you wish to reduce calories, you will have to increase nutrient density or optimise nutrient extraction from food by improving digestion and gut function.

8. Toxicity: fat tissue stores toxins. When fat burns, toxins are released into blood stream. When detox pathways are not working optimally, toxins stimulate the immune system which then turns on inflammatory processes. Again, inflammation will result in insulin resistance which can cause stall weight loss Supporting detox pathways is key, and that includes the liver, kidneys, bowels and sweat.

9. Snacking: we used to be told to eat little and often. While eating less when increasing nutrient density is great, snacking can stall weight loss due to the constantly circulating insulin. If you feel that you snack or pick on food often, pay more attention to how you compose your main meals. Are they big and satisfying enough? Is there sufficient protein, fat and fibre? Generally, eating 3 proper meals a day is preferable. When you’re ready, you may even want to try the ketogenic diet, with 2 meals and intermittent fasting.

Snacking on nuts is especially tricky. While nuts are a source of good fat and protein, they can quickly contribute to extra weight by significantly increasing calorific intake. Having max 10 nuts a day as part of meals is a better strategy.

10. Underactive thyroid: although it is commonly known that an underactive thyroid can slow down metabolism, thyroid disorders can be left undiagnosed. Often upon sole inspection of Thyroid Stimulating Hormone (TSH), one may arrive at a wrong diagnosis. Not only does this not present a full picture, but also diagnostic ranges vary between countries, labs, conventional and functional medicine. Hashimoto's thyroiditis is an autoimmune condition, and autoimmunity often goes hand in hand with insulin resistance, and insulin resistance is the main block to fat burning. Yet, thyroid antibodies are dismissed in routine health check-ups. I have clients with optimal TSH, and yet high anti-thyroid antibodies.

11. Estrogen dominance: having too much estrogen compared with the balancing hormone progesterone causes weightloss resistance, especially around the hips and arms.

12. Gut microbes: certain strains of bacteria are associated with weight gain. One experiment showed how implanting gut bacteria from obese into sterile mice made them put on weight. Moreover, beneficial gut bacteria guard the small intestine from becoming 'leaky'. Leaky gut is associated with chronic inflammatory processes and again, inflammation results in insulin resistance. Also, some organisms (e.g. candida) drive cravings towards starch and sugar, which can also result in a blood sugar roller coaster and ultimately, insulin resistance.

13. Lifestyle and beliefs: diet is only a portion of the holistic approach to long term weight loss. Both, under and over exercising are associated with metabolic disorders, and so is the wrong type of physical activity or lack of variety. Go for HIIT, resistance training like pilates and dynamic yoga. Cardio can stall fat burning by increasing cortisol. Spending too much time indoors, little contact with nature, exposure to blue light after 8pm, being a 'night owl', sleeping less than 7 hours, lack of hobbies, life goals or not being part of a community, misconceptions about what really is healthy may all slow down weight loss.

Maybe you are losing weight, after all?

Using regular scales can be misleading because even when you burn fat, you may weigh the same because muscle is heavier than fat. Again, it is desirable to build muscle. The key is to get into the fat burning mode.

The best strategy for staying on track is measuring how much fat you burn. I recommend a body composition monitor as opposed to scales. It will measure your water, fat and muscle. What you want to see is a steady decline in fat tissue until you rich your optimum.

Alternatively, you can use a measuring tape. Measure your waist, hips, thighs and arms every week or two. See if clothes fit any different, too.

What do do?

Get healthy to lose weight, and that may take some time. Fixing metabolism scan take 1 year so having realistic expectations is key.

A weight loss plan should be personalised, with thorough diagnostics and health evaluation. ‘Template’ plans taken from the internet or advice from someone who’s had amazing results on a certain diet (often fad diets) is not a successful strategy because they don't take any individual aspects into account. Food can be both medicine and poison, depending on who eats it and in what circumstances. Lack of sufficient knowledge on bodily processes, physiology and metabolism can do more harm than good – this is where professional help can be invaluable. A food and symptom diary is a great place to start. By observing how your body reacts to foods in terms of energy, sleep, cravings and bowel movements can be an fantastic tool to guide you down the right path.

Article published in The Islander, August 2018 edition

Conscious tanning, part III: tanning in pregnancy and skin discolouration

This post wasn't planned but after my last two articles a couple of people asked me about tanning during pregnancy which is an important matter that deserves attention.

Some doctors recommend that women avoid sun exposure during pregnancy due to the potential skin discolouration called melasma, chloasma or 'pregnancy mask'. The most commonly affected areas are the forehead, cheeks and upper lip. Thus, for fear of  a blotchy face some pregnant women don't sunbathe.

Causes of melasma

While the sun gets all the blame, the cause of melasma lies in hormonal imbalances and nutrient deficiencies that start way before pregnancy. Oestrogen stimulates melanocyte stimulating hormones (MSH) which increase skin pigmentation. If a woman is oestrogen dominant (high oestrogen or low progesterone), the chances of developing melasma in pregnancy is higher not only due to the influx of hormones but also because women with oestrogen dominance tend to detoxify hormones at a slower rate, which causes a build-up. The more oestrogen, the greater the chance of skin discolouration.

Pre-pregnancy signs of oestrogen dominance include:

• PMS
• endometriosis
• fibroids
• anger
• tender / painful breasts
• migraines
• irregular menstruation
• heavy / long periods
• moodiness
• larger thighs and hips
• low libido
• fertility issues

Insufficient intake of animal fats may also increase the risk of developing melasma. It is interesting to see that omega 3 fatty acids (especially EPA) and fat soluble vitamins A and D derived from animal sources not only help to restore hormonal balance, but can also prevent and even reverse melasma.

Vitamin D in pregnancy

I have already described the importance of the sun in synthesising sulfated vitamin D. The growing baby uses maternal vitamin D to incorporate minerals into the skeleton and  build the immune system. One theory is that strong and healthy babies are born relatively small but are heavy due to dense bones. Vitamin D reserves are also needed to support mother's mental wellbeing during and after pregnancy, and to ward off infections. Women can obtain vitamin D and its precursors from food which I have also explained in the first article. However, given the modern aversion to animal fats and conflicting information on diet in pregnancy, I see many women deficient. Moreover, the minimum threshold for vitamin D is at around 30 ng/ml and is the same for pregnant women who obviously need more. Functional optimum ranges between 50-80 ng/ml which is rare to see.

What to do?

The  sun is key for expecting mums to build up sufficient reserves of vitamin D and enjoy the pregnancy. For all expecting mothers I suggest sensible sun exposure, a traditional, nutrient dense diet rich in animal fats, and doubling up on quality cod liver oil - quite the opposite to what is commonly advised. A nourishing diet will keep hormones in check and protect the skin from inside out. Using opaque mineral sunscreen on the face is a great option if still worried about discolouration. I certainly discourage avoiding the sun because sunbathing brings benefits to the mum and baby that no supplementation can replace.

Conscious tanning, part II: sensible sunbath

In my last article I discussed the importance of certain nutrients in the prevention of sunburn, sun allergy and reactions to sunscreen. In the second part, I will cover the importance of sun exposure without heavy sunscreen use, along with building tolerance to the sun, choosing the right skin protection and sunburn remedies.

Most importantly, I think that if the sun was bad for humans, we would not evolve on a planet that’s exposed to sunshine.

Sulphate

The sun is essential to wellbeing as it helps to produce an important (but often ignored) nutrient in the skin called sulphate. Only when sulphate attaches itself to vitamin D, cholesterol and melatonin, can we properly benefit from them. Without adequate sulphate, health issues may arise, ranging from general immune dysregulation, chronic inflammation, high cholesterol, insomnia and cancer, including skin melanoma.

It is the sulphated vitamin D that brings about the countless health benefits which include:

• immune and inflammatory modulation

• detoxification

• insulin sensitivity

• cancer prevention

• skeletal health

• mental health

• heart health

In general, we produce vitamin D when cholesterol in the skin is exposed to UVB rays, which are the strongest at noon - exactly when we are told to prioritise the use of sunscreen. Conventional sunscreen blocks UVB rays, which analogically inhibits the production of both sulphate and vitamin D to a smaller or larger extent, depending on sunscreen factor, frequency of application and sunscreen ingredients. The ones most commonly known for such inhibition include:

• dioxybenzone

• oxybenzone

• p-aminobenzoic acid (PABA)

The vast majority of people don't even understand these names which is a good enough reason on its own not to put them on the skin. They also mimic our own hormones, contributing to endocrine imbalances.

Melatonin sulphate can only be produced when looking at natural sunlight before the sun gets high, without any barriers like sunglasses or windows. Melatonin is generally associated with sleep but it is also our master ´sunscreen´!

Those who are exposed to sunlight in the morning build up their melatonin sulphate, which prevents from burning later in the day (and helps to sleep better). I wondered why I didn’t tan as deeply as I used to until I learned about this and realised that I always go to the beach early. It is also a major antioxidant, which means it will protect your skin from ageing, not just burning.

The best thing to do is slowly build resistance to sunlight and support nutrient deficiencies that are a common cause of photophobia and being addicted to sunglasses. Eventually, you should be able not to squint as much. Hats with a brim work great. If you spend a lot of time in a place where the sun is reflected, e.g. by the water or in the snow, you will have to protect your eyes with polarised sunglasses but try and not wear them in the early hours.

Skin is a semi-permeable membrane

The skin selectively allows some substances in and out, and this is why we can sweat or benefit from the likes of Epsom salts baths. This also means that some of the ingredients in conventional sunscreen may get into the bloodstream. Eating cosmetics may sound crazy but ultimately, it has a similar effect as putting them on the skin. When substances are ingested, they get to the liver where at least they are neutralised to some degree. When they are put on the skin, they directly reach the circulation before getting to the liver (this is why skin patch medications are so effective). Not all substances in sunscreen will reach the bloodstream but whatever gets through, is not indifferent to our health. Especially if you think how many other products people may use on a daily basis.

Building tolerance to the sun

Everyone loves a nice sunny day which is a primitive instinct that the sun is life and energy giving. One of the most effective ways to get health benefits from sun exposure is sunbathing in small doses without any sunscreen until you rich a point when you don't tan anymore. It may mean you start with 5 minutes but eventually will be able to work it up.

Saying that, we are not supposed to spend a long time exposed to direct sun anyway, with or without sunscreen. 30-60 minutes is more than enough, after which it is best to sit in the shade, wear light clothing and a hat, or use natural sunscreen. This is especially important for those who know they're going to be exposed to the sun for long hours or when the sun reflects; e.g. on boats, in the snow or construction sites. Those can benefit from natural surfing sunblocks. Building sun resistance is especially important for children - the earlier it’s done, the better. Do not start them off in sunshield onsies and sunblock because you will make them intolerant to the sun! Even the most delicate of skins loves natural sun exposure within reasonable limits.

Choosing the right sunscreen

Health stores offer a wide range of more natural alternatives. The most commonly used ingredients are minerals:

• titanium dioxide

• zinc oxide

Both leave a white layer on the skin to reflect the sun. Some brands offer products with nano particles which makes them transparent but the smaller particles are associated with free radical damage. If you decide to go for natural sunscreen, the opaque ones are the safest.

Other common ingredients in natural sunscreen formulations:

• carrot seed oil (SPF 35-40)

• raspberry seed oil (SPF 25-50)

• wheat germ oil (SPF 20)

• almond oil (SPF 5)

• coconut oil (SPF 4-6)

• shea butter (SPF 4-6)

You can use these individually or mixed together. However, you may have to build a good base to rely solely on the oils. Some of the most commonly available brands of ready made preparations around Europe include:

• Badger (my favourite for children)

• Dr Haushka

• Green People

• Lavera

• Tropic

• Weleda

However, new products appear on the market all the time so it is best to read ranks on the internet each year. For the most reliable information on sunscreen, visit this website. You can also use the Yuca app.

After sun care

Even if you do not burn, it's still recommended to eat well and moisturise the skin  to prevent skin damage. Some of the best natural moisturisers include:

• Cocoa butter (also deepens the tan)

• Coconut oil

• Olive oil

• Shea butter

For mild to moderate sunburn, the following can be very effective:

• 100% aloe vera

• Bach Flowers Remedies: Rescue Cream (cabinet essential for healing any external problems)

• Yoghurt or kefir compressions

• Coconut oil (most cooling of all oils)

Summary

Sensible tanning means not overdoing it and understanding your limits. By fooling the nature, we often go against ourselves. Sometimes all it takes is a little lifestyle change, and the results can be profound. Trusting that we are naturally equipped in everything we need to happily live on planet Earth can dissipate the confusion around skin cancer. It`s always about the context, dose and timing. Happy sensible sunbathing!

Conscious tanning, part I: Eat your sunscreen

The sun has such a bad reputation these days that reliance on sunscreen has become an accepted norm. This is especially common with those who are not able to go out to the sun during the week and want to ‘safely’ make up at weekends or during holidays. But even with the use of the best of products and high filters, some people still burn, react to the sun, and even the sunscreen itself. Ideally, people should practice rational sunbathing without sunscreen and neither burn nor break out in sun rash. In this post, I will discuss the most important nutrients that help to make the most of sun exposure from inside out.

Vitamin D, calcium and essential fatty acids

Vitamin D (really a steroid hormone) belongs to the group of fat soluble vitamins, and all fat soluble vitamins are stored in the liver for future use. Therefore, sufficient reserves can be built up during the summer and used throughout winter months. When cholesterol in the skin is exposed to UVB rays (the highest concentration is around noon, just when tanning is supposed to be most dangerous), the liver and kidneys convert it into vitamin D3, the active form. Vitamin D helps with calcium absorption from the gut into blood, and then the essential fatty acids - omega 3 and 6 - drive calcium into tissues, such as the skin. Calcium not only prevents from UV rays but also helps skin cells to regenerate and keep the skin moist. Vitamin D, calcium and essential fatty acids also modulate the immune system and as a result, they mitigate the risk of skin cancer and allergic reactions, such as sun allergy.

Sources of vitamin D

We can provide vitamin D3 form animal fats, and it’s interesting to see that foods with high concentrations of cholesterol are also high in vitamin D3. As always, nature knows best. It is imperative to eat ample amounts of vitamin D3 rich foods in winter:

• egg yolks

• cod liver oil

• liver

• lard, pastured

• oily fish, shellfish, fish eggs

Vegans should be emphasising sun exposure even more because they cannot obtain either vitamin D3 or cholesterol from plant food sources. But even with ample amounts of the sun, often they are still low, due to the lack of cholesterol in the diet.

Sources of calcium:

• mineral water, especially ‘hard’ water

• dairy from grass fed animals, not highly processed

• bone broth

• sesame

• dark leafy greens

Sources of essential fatty acids

There are a number of different types and sources of essential fatty acids but the ones associated with prolonged resistance to burns are GLA, type of omega 6 and EPA, type of omega 3. Some people claim that they fully reversed skin discolouration (melasma) with ongoing intake of EPA. In part III of the ‘conscious tanning’ series, I discuss the importance of sun exposure in pregnancy and the prevention of melasma.

Sources of EPA:

• cod liver oil

• fish oil

• grass-fed meat (grain fed meat is richer in omega 6 fatty acids)

• oily fish

• pastured eggs / chickens (not fed with corn or any other grains as these will be richer in omega 6 fatty acids)

Sources of GLA:

• evening primrose oil

• borage oil

• backcurrant seed oil

Vitamin A

Vitamin A works in tandem with vitamin D, and one can be toxic without the other. True vitamin A is called retinol, which is a well known ingredient in anti-ageing skincare. Just like vitamin D, it is also a fat soluble vitamin that is stored in the liver. Some of retinol’s functions include immune modulation (sun allergy and reactions to sunscreen), repair (sunburn) and assimilation of protein (skin elasticity and repair).

Beta carotene is often called ‘vitamin A’ but in fact, it’s a precursor and only a small percentage of beta carotene can be converted to retinol, given your liver works well and you’re not deficient in zinc. Children under the age of 5 cannot convert beta carotene to retinol at all, and this is why their skin turns orange from carrot juice. Saying that, beta carotene has strong anti-oxidant properties, which is anti-ageing. Regular consumption is highly protective from sun damage and can also help to achieve deep, golden tan.

Sources of retinol

...are very similar to cholesterol and vitamin D rich foods:

• cod liver oil

• liver

• eggs (especially egg yolk)

• butter and ghee

Sources of beta carotene:

• carrots

• sweet potato

• pumpkin

• butternut squash

• apricots

• cantaloupe

• spinach

• kale

If your diet is rich in sun-friendly nutrients but you still have symptoms of deficiency, you may want to look at your digestive health where nutrients are extracted from food and absorbed. You may also want to quit low fat foods as these are devoid of the key fat soluble nutrients.

Summary

Tanning is extremely beneficial to health in many ways. If the sun catalyses the production of vitamin D - one of the strongest antioxidants and immune modulators - then paradoxically, the sun can actually help with conditions that we blame it for, from skin cancer to allergy. Moreover, it is not the sun or sunscreen themselves that cause skin reactions and skin cancer but an immune imbalance, stemming from multiple underlying factors. For example, in Australia, the use of sunscreen with a high factor is an everyday norm. Yet, a lot of people suffer from skin cancer and have low vitamin D. Australia has one of the highest rates of asthma in the world!

Along with a nutrient dense diet that is rich in good fats, quality cod liver oil is my recommended panacea for healthy sun exposure.

In part II I will address external sun protection, along with building tolerance to tanning.

Happy mum, healthy baby

Making the right decisions for your baby is a priceless investment with life-long returns. However, the modern world doesn’t make it easy with conflicting information coming from all angles and cheaply mass-produced goods, including food. Since the beginning of capitalism we’ve seen an increase in c-sections, no or short period of breastfeeding, increased use of medications and supplements, environmental toxins, electromagnetic field, epidemic use of plastic and parental diet devoid of truly nutritious foods. Although they have become an accepted norm, all can affect baby’s immunity, often leading to allergies, intolerances, skin conditions, autoimmunity, diabetes and later on in life – decreased focus or behavioural issues. Every parent would like to avoid these but what to do when there is so much information out there to filter through?

And what about stepping into the role of a mum as such? Do you feel prepared? It can be both exciting and challenging. Mums want the best for their baby, therefore it’s easy to get fully absorbed in the new duties. At the same time, it’s just as easy to forget about yourself. As a result, mums can end up exhausted, depressed or feeling unattractive, However, looking after your own needs can help to build the strength and energy necessary for mums to bring up a healthy, happy child, and to keep a happy relationship going. Would you like to know how?

There are also other challenges for new mums, namely the many difficult decisions they have to make as soon as the baby arrives. Delayed or immediate cord cutting, vit K shot, hepatitis B vaccine, what to do with vernix caseosa, antibacterial eye drops, sugar water, further vaccinations... And future countless decisions: which formula is the best when breastfeeding doesn’t go well, how about donated breast milk, how to wean the baby and what foods are truly best to start with – these are some of the stressful dilemmas.

On thing is certain, no one can tell the parents what is best for their baby because no circumstances are identical. Overall outcome depends on the factors affecting genetic expression, mother’s diet before and during pregnancy, way of delivery and emotional wellbeing. It’s the duty of parents to analyse these various factors from their individual perspective, in order to make educated decisions. What’s important though is not neglecting any signs and symptoms, even if they are considered ‘normal’. Bloated belly, constipation, dry skin, sleeping problems or lack of appetite are all signs of underlying imbalances which require attention.

In collaboration with OsteoPalma I invite you to an interactive and practical event that will help you with future decisions as a parent. Details below:

Pregnancy - from the perspective of nutritional therapy, functional medicine and naturopathy

When talking about pregnancy, general awareness comes down to a ‘balanced diet’, increasing calorific intake, folic acid and iron. For a woman of the 21 century (and especially after the age of 35), this is simply not enough. I often hear arguments that some women don’t look after themselves and yet give birth to healthy babies. The question is – will they grow into healthy adults? Will they have childhood eczema, chronic colic or asthma? Unfortunately, these have been accepted as a norm in the western world, and prevention in this area is basically nonexistent in conventional medicine. A doctor may say that ‘the baby will grow out of it’ and symptoms often do subside. However, they may turn into seemingly unrelated issues in future life – perhaps inability to concentrate in school or depression in adulthood.

Indeed, cetain genetic predispositions cannot be avoided. But the vast majority of genetic expression depends on the environment, both internal and external. Mother’s diet, lifestyle, social interactions, rest, forgiveness and most importantly – microbiota – can optimise future baby’s DNA. This is great news for aspiring parents. Similarly, the likes of morning sickness, high blood pressure, putting on a lot of weight or gestational diabetes – although common – don’t have to happen in pregnancy. It’s interesting to see that they are not common in undeveloped civilisations.

It’s easy to drown in the sea of conflicting nutrition and lifestyle recommendations. Therefore, in collaboration with OsteoPalma I’ve organised an interactive and practical seminar on the journey through pregnancy care, to help future mothers to navigate through the maze of truths and myths about what really matters during the 9 months. Nutritional therapy, functional medicine and naturopathy are all powerful tools that help to understand physiological changes that take place and your individual requirements in pregnancy – to maximise your baby's health and happiness.

The seminar is aimed at expecting mothers, fathers, those who plan on a family in the future, doulas, midwives, doctors, nurses, therapists, and will cover the following aspects:

Two remaining events at OsteoPalma:

‘The bump – a journey through pregnancy care’, 16th of June 10:30-12:30

‘Happy mum, healthy baby – postnatal care of baby and self’, 30th of June 10:30-12:30

€40 for one or €70 if you sing up for both. Tickets available at OsteoPalma. Confirm attendance here.

Holistic approach to fertility and preconception care

Despite greater wealth and easier access to healthy pursuits - fertility problems, uncomfortable pregnancy, recurrent miscarriages, modern childhood diseases and disorders are on the rise.

The need for convenience, fast-paced lives and changes in life priorities have paradoxically resulted in greater stress, inadequate nutrition and as a result, imbalanced physiology. More and more cases of infertility and recurrent miscarriages are unexplained, leaving couples in desperation. One thing is certain: more than ever is the period of preparation for pregnancy key to produce healthy children who will grow into healthy adults, generation after generation. In other words, the state of both parents’ health at the time of conception will affect the health of the offspring, from birth to adulthood. And the state of mother’s health will also affect the course of pregnancy, birth and post-natal wellbeing.

Nature always knows best and simply will or won’t allow the body to carry a baby if the environment is or isn’t favourable. And this is where nutritional therapy, naturopathy and functional medicine can be help: they naturally change the environment according to individual circumstances, to create the right conditions to conceive. Therefore, when conventional medicine isn’t able to find the cause, it is worth availing of complementary healthcare in order to uncover hidden imbalances.

From the naturopathic and functional medicine perspective, there are numerous factors that influence reproductive capacity that go beyond the reproductive system itself. Throughout my clinical practice I have learned that when addressing other body systems or processes that are evidently weak, conception happens without extra effort. In the clinic, I look at the following aspects:

- presence of other chronic health conditions which have to be managed

- digestion

- microbiota diversity

- diet and nutrient deficiencies

- stress and adrenal function

- glucose metabolism

- lifestyle

- immune function

- hormonal imbalances

- exposure to environmental toxins

- inflammatory factors

- balance between detoxing and ‘building’, especially now that veganism is a growing trend

- past trauma, ideas about sex, sex quality, quality of relationships

But the most important aspect of therapy is giving the right tools and control back to the person so that with appropriate guidance, they can help themselves at home.

If you would like learn lots of practical tips, OsteoPalma and GLOW invite you to a 3-part nutrition and functional medicine series that will bring you from preconception through pregnancy, birth, to childcare and beyond.

‘Fertility booster' – holistic approach to family planning, 2nd of June 10:30-12:30

‘The bump' – a journey through pregnancy care, 16th of June 10:30-12:30

‘Happy mum, healthy baby' – postnatal care of baby and self, 30th of June 10:30-12:30

Address: OsteoPalma, Gilbert de Centelles 19, 3°, Palma de Mallorca

€40 for one or €100 if you sing up for all three. Tickets available from OsteoPalma. Confirm attendence here.