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This workshop:

• Is only for practitioners who attend the main Saturday presentation on the 10^th March
• Will be held at the same venue, the RSM, 1 Wimpole Street, London, W1g 0AE in the Marcus Beck Library
• Will run from 9.30am – 11am
• Is limited to 25 places.
• Costs £20 plus VAT
• Does not have any CPD points attached to it.

More information

A paper published in the esteemed journal GUT looked to see if there was a relationship between two commonly occurring conditions – IBS and CFS and giardia.[1]

Abstract

Background Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications.

Objective To estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis.

Design Controlled historic cohort study with 3 years’ follow-up. Data collected by mailed questionnaire.

Setting Waterborne outbreak of giardiasis in the city of Bergen, Norway.

Participants 817 patients exposed to Giardia lamblia infection verified by detection of cysts in stool samples and 1128 matched controls.

Main outcome measures IBS and chronic fatigue.

Results The prevalence of IBS in the exposed group was 46.1%, compared with 14.0% in the control group, and the adjusted RR=3.4 (95% CI 2.9 to 3.8). Chronic fatigue was reported by 46.1% of the exposed group and 12.0% of the controls, the adjusted RR was 4.0 (95% CI 3.5 to 4.5). IBS and chronic fatigue were associated and the RR for the exposed group of having a combination of the two outcomes was 6.8 (95% CI 5.3 to 8.5). The RR was also increased for having just one of the two syndromes, 1.8 for IBS (95% CI 1.4 to 2.3) and 2.2 for chronic fatigue (95% CI 1.7 to 2.8).

Conclusions Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness, and the risk was significantly higher than in the control group. This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic.

Comment

As Nutritional Therapists or practitioners looking to support the recovery from infection or aid elimination of the infective agent, the role of probiotics is often explored. To determine effectiveness or proof of principle mice are sometimes used.

The probiotic Lgg Culturelle has been studies as an effective agent for the removal of giardia and whilst mice are not men this suggests there may be a role in the earlyinfective stage for a supportive supplementation with Lgg.[2],[3]

References

[2] Goyal N, Tiwari RP, Shukla G. Lactobacillus rhamnosus GG as an Effective Probiotic for Murine Giardiasis. Interdiscip Perspect Infect Dis. 2011;2011:795219. Epub 2011 Jun 2. View Abstract

[3] Shukla G, Devi P, Sehgal R. Effect of Lactobacillus casei as a probiotic on modulation of giardiasis. Dig Dis Sci. 2008 Oct;53(10):2671-9. Epub 2008 Feb 28. View Abstract

The team of experts analysed the conditions and diseases that are associated with vitamin D deficiency and recommended the intake of supplements in postmenopausal women. As well as stimulating calcium and phosphorus absorption, the vitamin D system has numerous functions. Low vitamin D levels are linked to rickets, osteomalacia, osteoporosis and the risk of bone fracture, cardiovascular disease, diabetes, cancer, infections and degenerative diseases.

“In healthy postmenopausal women, we have seen that a good level of vitamin D is linked to good physical fitness and has an effect on body fat mass as well as muscle strength and balance,” state the authors of the article published in the Maturitas journal.

The researcher explains that patients with risk factors associated with hypovitaminosis (obesity, pigmented skin, intestinal malabsorption syndromes and living in regions close to the North and South poles) should increase their intake to up to 4,000 IU per day. There is scientific evidence that a daily dose of 4,000 IU/day is not poisonous in healthy people.

Reference

This is further compounded by vested interests and the usual scrum of sceptics, some of whom are very astute and mostly fair, others, or perhaps the majority have long since lost a position of equanimity (a state of mental or emotional stability or composure arising from a deep awareness and acceptance of the present moment) and have their own axes to grind. The result is a plethora of cutting and pasting of the standard rhetoric and statements that suggest lack of comprehension and certainly lack of scientific openness.

To provide two examples of investigation and publication that suggest the role of micro-nutrients extends well beyond the increase in the value of your urine I have selected two studies, the first is a recent one, on mice – and whilst I agree that mice are not men, this is the fertile ground for early studies that may then lead to the more involved human studies.

In particular this first paper adds weight to the discussion that shows a multi-nutrient adds to brain functionality in aging mice.[2]

Abstract

httpv://youtu.be/rL3lgAG2RuEWe developed a complex dietary supplement designed to offset five key mechanisms of aging and tested its effectiveness in ameliorating age-related cognitive decline using a visually cued Morris water maze test. All younger mice (<1 year old)learned the task well. However, older untreated mice (>1 year) were unable to learn the maze even after 5 days, indicative of strong cognitive decline at older ages. In contrast, no cognitive decline was evident in older supplemented mice, even when ∼2 years old.
Supplemented older mice were nearly 50% better at locating the platform than age-matched controls. Brain weights of supplemented mice were significantly greater than controls, even at younger ages. Reversal of cognitive decline in activity of complexes III and IV by supplementation was significantly associated with cognitive improvement, implicating energy supply as one possible mechanism. These results represent proof of principle that complex dietary supplements can provide powerful benefits for cognitive function and brain aging.

The second paper looked at the role of supplements in the management of outcomes in patients with diagnosed bladder cancer. This is an older paper, published back in 1994, although as you are aware there remains considerable controversy in the oncology world about the role of food supplements by patients undergoing cancer therapy.[3]

Abstract

Epidemiological and laboratory studies suggest that vitamin supplements may be helpful in the prevention of some cancers but clinical trials to date have failed to demonstrate protection with naturally occurring vitamins.

Without substantiation of the highly touted benefits of vitamins, few physicians who care for cancer patients have recommended their use.

A total of 65 patients with biopsy confirmed transitional cell carcinoma (The most common tumour arising from the urothelial lining of the bladder usually consisting of transitional epithelium) of the bladder enrolled in a randomized comparison of intravesical bacillus Calmette-Guerin (BCG) with or without percutaneous administration was also randomised by closed envelope to therapy with multiple vitamins in the recommended daily allowance (RDA) versus RDA multivitamins plus 40,000 units vitamin A, 100 mg. vitamin B6, 2,000 mg. vitamin C, 400 units vitamin E and 90 mg. zinc.

The addition of percutaneous BCG did not significantly lessen tumour recurrence but recurrence after 10 months was markedly reduced in patients receiving megadose vitamins.

The 5-year estimates of tumour recurrence are 91% in the RDA arm and 41% in the megadose arm (p = 0.0014, Mantel-Cox). Overall recurrence was 24 of 30 patients (80%) in the RDA arm and 14 of 35 (40%) in the high dose arm (p = 0.0011, 2-tailed Fisher’s exact test).

Megadose vitamins A, B6, C and E plus zinc decrease bladder tumour recurrence in patients receiving BCG immunotherapy. Further research will be required to identify which ingredient(s) provide this protection.

Comment

As health professionals in a young and developing profession we can often feel overwhelmed with the long arm of science being used to beat us up about lack of evidence and risk management. The whole experience of all professions is that they mature, evidence once seen as weak may become magnified or lost and visa versa, to leap all over claims of benefit with a blind outlook does no service to the scientific community. Let’s be thankful that many bright and energetic clinicians and researchers are not prepared to be fed the diet of skeptics and are prepared to ask questions and work with patients to help them recover lost health and maintain optimal function.

References

[2] Aksenov V, Long J, Liu J, Szechtman H, Khanna P, Matravadia S, Rollo CD. A complex dietary supplement augments spatial learning, brain mass, and mitochondrial electron transport chain activity in aging mice. Age (Dordr). 2011 Nov 27. [Epub ahead of print] View Abstract

[3] Lamm DL, Riggs DR, Shriver JS, vanGilder PF, Rach JF, DeHaven JI. Megadose vitamins in bladder cancer: a double-blind clinical trial. J Urol. 1994 Jan;151(1):21-6. View Abstract

Processed meats such as sausage, bacon, and cold cuts may increase the risk of pancreatic cancer, but only slightly, researchers found. For every 50-gram serving of processed meat per day — a couple of slices of ham, for instance — relative risk of the disease rose by 19%, – is that a modest risk increase? I know that if I had a 20% reduction in risk, that I would be feeling quite smug, so why should we regard a 20% increase as ‘slight’. Red meat also posed a 29% greater relative risk of pancreatic cancer to men, they found.[1]

Obviously the word relative is key, as pancreatic cancer is comparatively rare, but it is also the most aggressive and has the highest rate of death linked to it and is the fourth most frequent cause of cancer death in males and females.

The researchers conducted a meta-analysis of 11 studies totaling more than two million patients, 6,643 of whom had pancreatic cancer.

The scientists found that eating at least 120 grams per day of red meat — determined to be a “standard” serving — was associated with a 13% increased relative risk of the disease, but it wasn’t significant, and there was major heterogeneity between studies (P<0.001).

However, when those findings were assessed by subgroup, that serving of red meat was associated with an almost 30% increased risk of pancreatic cancer in men (RR 1.29, 95% CI 1.08 to 1.53), and there wasn’t significant heterogeneity between studies.

Interestingly red meat didn’t raise the risk of pancreatic cancer in women, and as we know men generally eat more red meat. This might mean that the link is between the big red meat eaters and pancreatic cancer risk.

Processed meat, on the other hand, was associated with a significant increase in pancreatic cancer risk all around. For every daily 50-gram standard serving, relative risk of the disease rose 19% (95% CI 1.04 to 1.36). Again, there wasn’t significant heterogeneity between studies.

That increase is likely related to the nitrites and N-nitroso compounds found in processed meats, which have been shown to be carcinogenic and to induce pancreatic cancer in animal models.[2]

References

[2] Risch HA (2003) Etiology of pancreatic cancer, with a hypothesis concerning the role of N-nitroso compounds and excess gastric acidity. J Natl Cancer Inst 95(13): 948–960 View Full Paper

The last 120 years or so has predominately favoured what is referred to as the western or reductionist approach, during which time we have seen tremendous gains in knowledge and comprehension of physiology, biochemistry and immunology. The results have been seen in the development of vaccines, medicines and sewerage management, all of which have contributed to substantial benefits in limiting the destruction wreaked on our populations from numerous diseases, infectious agents and trauma.

Although these therapeutic interventions have been the key element in saving millions of lives each year and in reducing some of the serious complications that often follow infection, they actually do not modify the probability of becoming ill (except in so far as early treatment reduces the risk of spread of infection to others). In chronic diseases, this type of intervention actually produces the paradoxical effect of increasing the absolute morbidity level. Non communicable diseases including cardiovascular diseases, diabetes, obesity, cancer and respiratory diseases account for a frightening 59% of the 57 million deaths annually and 46% of the global burden of disease (WHO 2008).

In the last few decades this ‘Western’ style of medicine has run into some troubled waters, in particular the well verbalised and heavily defended concept of ‘one disease – one target – one-size-fits-all’ is slowly shifting towards a more personalised medical approach in which medicines become tailored to individual needs. In part this is driven by the pharmaceutical industries ‘dirty little secret’ that drugs work in less than 50% of people who use them and their need to redevelop long exhausted patents by tailoring drugs to specific genes.

“The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people,” Dr Roses worldwide vice-president of genetics at GlaxoSmithKline (GSK) said. “I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30 to 50 per cent of people.” (Dec 8 2003. Independent)

Interestingly, and in the context of balance we should also understand that these variations exist in response to natural medicines such as herbs and nutrients. This variation reflected in response to herbs and medicines are also driven by the genetic code found in the commensal bacteria we harbour in our digestive tract. Let’s take the herb ginseng as an example, for although the human gut can’t absorb the ginsenosides, some of the bacteria that live there can, and it is their partially broken down products that then deliver their therapeutic benefit.

As we know the human gut is home to trillions of individual microbes representing thousands of species of bacteria and non-bacterial organisms called archaea.[1] The exact membership of this highly complex ecosystem, known as the microbiome, varies from person to person and is affected by the foods, drinks and medications as well as our early life and on-going life’s exposures and stresses.

The new evolving approach to health care exemplified by the philosophy of functional medicine may now include the use of multiple therapeutic agents including drugs and the concomitant or stand-alone use of nutritional, psychological and lifestyle factors when deciding the best course of treatment.

In particular this approach has become favoured for the prevention and management of chronic non communicable diseases. The intellectual underpinnings for such a transition in medical practice are being laid in the discipline of systems science – and systems biology in the biomedical domain.

Systems science aims to understand both the connectivity and interdependency of individual components within a dynamic and non-linear system, as well as the properties that emerge at certain organisational levels. The relation to medicine is clear. Systems biology is particularly useful when it comes to describing homeostasis – the regulation of a system’s internal environment to maintain a stable condition. In turn, the ability to cope with changing environments and stress is encompassed in the principle of allostasis – the physiological or behavioural changes required to stabilise the biological system and maintain health.

‘Health’. The current World Health Organisation definition of the term is based on a 1948 consensus: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” However, an emerging concept of health in the scientific literature describes an ability to adapt and self-manage in the face of social, physical and emotional challenges.[2] These concepts are embodied in the techniques and strategies that underpin the functional medicine approach to clinical care.

What is Functional Medicine

Functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms.

Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease.It seeks to understand how major body processes have been challenged over a lifetime and how changes in diet and lifestyle may better support these vital body functions. While the strength of the approach is prevention it has a powerful application in the management of symptoms and illness. n this way, functional medicine supports the unique expression of health and vitality for each individual.

The Institute for Functional Medicine in conjunction with its lead sponsor Nutri-Link and Clinical Education are once again bringing their unique 5 day training to the UK. Applying Functional medicine in Clinical Practice™ (AFMCP™-UK).

Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs.

The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defence; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include the following key body systems and are addressed during the AFMCP™ in a coordinated and integrated fashion:

What is the AFMCP™-UK

This 5 day course is an intensive learning experience. It is designed to teach you how to apply the fundamental principles of functional medicine in clinic.

AFMCP™-UK is not a typical medical meeting. Now in its 15th year, this five-day course has been rigorously designed, critically evaluated, and continuously refined by an outstanding core faculty, each of whom brings diverse and subject-specific clinical expertise to the application of functional medicine.

Applying Functional Medicine in Clinical Practice™ (AFMCP™-UK) teaches healthcare practitioners to more effectively integrate science, research, and clinical insights to treat and prevent disease and maintain health. Established and emerging diagnostics, therapeutics, and prevention strategies are extensively covered, including the use of diet, nutraceuticals, exercise, body/mind techniques, and the adaptation of lifestyle to an individual’s genetic risks and environmental exposures.

AFMCP™-UK is a well-orchestrated, comprehensive, patient-centered education program that helps you deepen your clinical understanding and practical application of the Functional Medicine Matrix Model.

Topics include:

• Gastrointestinal dysfunction and its links to chronic disease
• Inflammation and immune dysregulation
• Hormonal imbalance including adrenal, thyroid, and sex hormones
• Insulin resistance and cardiometabolic syndrome
• Oxidative stress, mitochondrial dysfunction, and neurological disorders
• Toxins, toxicity, and impaired biotransformation
• Food sensitivities, allergies, and intolerances
• Nutrition assessment and the Nutrition Physical Exam

Attendees at the 1^st UK symposium stated:

“The faculty speakers managed to present a vast amount of scientific information in a very short time. Their extensive knowledge and insight into the world around them was inspiring. I hope we can follow their lead.”

“The toolkit is an absolutely wonderful gift from this week’s course. I am looking forward to using the timeline and matrix with my clients as well as the various other hand outs. The timeline and matrix in particular will be so beneficial in getting a more in-depth insight into what may be going on and helping to keep track, as well as a very valuable instrument in putting a treatment protocol in place.”

If this is something you are interested in learning about or simply updating your current knowledge, as well as meeting and networking with peers and colleagues, then do visit www.afmcp-uk.org to learn more, or call Nutri-Link direct on 08450 760 402 to find out more about this course being held in London from the 30^th April until the 4^th May 2012.

This will be the only AFMCP course held outside of the United States in 2012 and will not be repeated until 2013, unless you travel to the USA.

References

[1] Jia W, Li H, Zhao L, Nicholson JK. Gut microbiota: a potential new territory for drug targeting. Nat Rev Drug Discov. 2008 Feb;7(2):123-9. View Abstract

[2] Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, van der Meer JW, Schnabel P, Smith R, van Weel C, Smid H. How should we define health? BMJ. 2011 Jul 26;343:d4163. doi: 10.1136/bmj.d4163. View Abstract

The freely available Web site ‘healthmap.org’ and mobile app ‘Outbreaks Near Me’ deliver real-time intelligence on a broad range of emerging infectious diseases for a diverse audience including libraries, local health departments, governments, and international travelers. HealthMap brings together disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions and validated official reports, to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. Through an automated process, updating 24/7/365, the system monitors, organises, integrates, filters, visualises and disseminates online information about emerging diseases in nine languages, facilitating early detection of global public health threats.

Learn More

To track infectious dieseases visit: http://healthmap.org/en/

To watch a short video summary: http://vimeo.com/27433633

Registration is free and takes just a few seconds, then you can also utilise mobile apps or simply visit the site on line.