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Epigenetics and Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:25:00 PM EST by Alyssa Tait

How targeted nutrition can affect your pain experience

Epigenetics: it’s a bit of a buzzword floating around at the moment, but what does it actually mean?

Epigenetics is the study of how environmental factors influence what genes your body ‘’decides to express’’. We all know about our genes – in fact we often resign ourselves to a medical condition or symptom because it’s ‘’in our genes’’. However, it’s also the case that you can have the gene for something but not get the disease. This is because of epigenetics – the way our environmental influences affect our gene expression.

These environmental factors are not just the obvious ones: exposure to radiation from a nuclear disaster, exposure to chemicals in a factory accident, exposure to too many UV rays sunbaking on the beach. Environmental factors start in utero (that is, as a baby in the womb), and don’t stop as long as you are still breathing!

One important chemical processes in our cells that influence epigenetics is DNA methylation. The effects of diet on DNA methylation have been well studied. Your ‘’methylation status’’ greatly affects your likelihood of developing certain conditions that may be ‘’in your genes’’, such as heart disease, cancer and depression. The field of nutrition medicine (practised at Equilibria) focuses on optimising individual health via nutrition, and optimising methylation status is one way we do this.

A 2012 study in the journal Pain Medicine discussed the role of methylation and other epigenetic processes in chronic pain. Specifically, it focussed on how acute pain (which is normal in healing) turns into chronic pain (which is a living nightmare for millions of people).  How does epigenetics affect whether your pain will hang around and turn ugly?

Here are three mechanisms whereby improving your epigenetics (such as via nutrition) can reduce the transition of acute pain to chronic pain:

  • By altering your sensitivity to opioids, your natural pain-relieving chemicals
  • By altering the production of inflammatory chemicals, called ‘’cytokines’’
  • By altering how responsive your cells are to steroids (important hormones, such as vitamin D – so there’s a clear nutritional lead already!)

As a physiotherapist and nutrition medicine practitioner immersed in chronic pain, I treat people every day with chronic pelvic pain using not just physical techniques alone, but targeted nutrition strategies. It seems that research is heading more into this area. In the meantime, has your pain been affected by your nutritional status? I would be interested to hear people’s personal stories.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Minimising Pain Via Healthy Scars: How Nutrients Help

Posted: Thursday, July 17, 2014 at 4:34:24 PM EST by Alyssa Tait

Injury, trauma and surgery leave their mark.

It’s inevitable – scars are a normal part of the healing process.

Sometimes this is obvious – like Caesarean scars or the abdominal scar after a hysterectomy. These are easy to see (which doesn’t always make us happy! Scars that are painful are also obvious – like, for some women, episiotomy scars that make sex more painful.

Movement is an important part of healthy scar healing - you really need to play with your scars! However, an often-neglected factor in healthy tissue and scar healing is nutrition.

Why is nutrition relevant in scar healing?

Availability of certain nutrients has an impact on various aspects of healing and scar formation:

  • “Cleaning up” the initial inflammatory process
  • Preventing infection
  • Laying down healthy tissue
  • Manufacturing new blood vessels
  • Increasing the strength and flexibility of the scar

The “Clean-Up” and preventing infection

  • Vitamin A – immune effects for healthy inflammation
  • Vitamin C – acts as an antioxidant to “sweep up debris”; higher doses help counter constipation from pain medications
  • Zinc – deficiency results in poor healing
  • Bromelain – reduces swelling and pain, speeds up resolution of bruising
  • Protein – a deficiency results in prolonged inflammation and delayed healing
  • Glutamine – promotes healthy inflammation

Rebuilding the House: Laying down healthy tissue

  • Vitamin A and vitamin C – improves collagen production
  • Bromelain – speeds up healing
  • Glucosamine – leads to production of hyaluronic acid to hasten healing
  • Gotu Kola – a herb that increases collagen production

Getting the Plumbing In: Manufacturing new Blood vessels

  • Vitamin C and copper – help produce down blood vessels

Bouncing Back: Strength and flexibility of the scar

  • Vitamin A
  • Zinc – deficiency results in a weaker scar
  • Glucosamine – leads to production of hyaluronic acid for a stronger scar
  • Protein – a deficiency results in a weaker scar
  • Gotu Kola – a herb that improves strength of the scar

I was very aware of all of this when I recently had surgery for a broken ankle. This was a serious injury with a very decent scar. To cover my bases, I have taken all of the above nutrients each day in addition to a high protein, high vegetable diet. The body has amazing healing capacity – but it still appreciates a helping hand by having plenty of raw materials on-hand for rebuilding!

If you have had or are planning surgery, and want to really get off on the right foot, contact us at Equilibria for a tailored nutrient program.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Why Aren't You Taking Fish Oils?

Posted: Wednesday, December 18, 2013 at 12:04:22 PM EST by Alyssa Tait

There is really only one good answer to this question.

But in order to get to that answer, we need to understand what  omega-3s are.

Omega 3 fatty acids belong to a group known as essential fatty acids. This means exactly what it sounds like: our bodies cannot function effectively without them. (Compare this with essential amino acids, the building blocks of protein that we must take in for growth and repair of our cells).

Here is a very summarised list of potential effects of low essential fatty acids:

Reproductive problems, dry, scaly skin, depression, anxiety, learning difficulties, behavioural problems, coronary artery disease, inflammation.

Our bodies are very versatile, and can often make substances from other substances. For example, if you don’t get enough vitamin B3, your body can make it from the amino acid tryptophan. However, the important point about essential fatty acids is this:

Your body is unable to make essential fatty acids.

This means that the only way you are going to get these substances (which, don’t forget, are essential to human health) is to take them in through your diet. The only meaningful sources of omega-3s in the diet are oils from cold water fatty fish, including salmon and sardines, and flaxseed or linseed. There are also small amounts of omega-3s in dark leafy greens. (You can imagine how small these amounts are, as leafy greens are not exactly what you’d describe as oily).

So that’s easy! You eat salmon (or its less effective cousin, tuna) three times a week already. Safe!

If only it were that simple!

Eating other fats and oils interferes with the amount of omega-3s that reaches your cells. There are two major fatty acids that compete. One is called arachidonic acid. This is a non-essential fatty acid, the major source of which is meat. The second is the other group of essential fatty acids, the omega-6s. Omega-6 fatty acids are found in all nuts and seeds, and all oils made from nuts and seeds.

That’s lucky, you might think. You don’t eat almond oil, or sunflower oil, or sesame oil, or peanut oil, and only eat nuts occasionally.

Even if this is the case, you may be getting a lot more omega-6s than you think. Anything marked “vegetable oil” will almost certainly be high in omega 6s. This includes “blended vegetable oil”, all margarines and soft butter blends, and also the increasingly popular rice bran oil. It also includes any packaged items that contain vegetable oil. Have a look at the packet – even when they’re baked, not fried – you might be surprised to see that many packaged foods contain vegetable oil.

Furthermore, the trans fats present in any oil-containing food that has been heated at a high temperature also compete with omega-3 in the body.

So getting enough omega-3s is not just about eating omega-3 rich food regularly.

Doing that is rarely enough. It is much more so about reducing the competitors to omega-3s in the diet, including vegetable and seed oils, margarine, nuts, seeds and any food containing these, such as muesli. In fact, reducing the omega-6-rich foods can have an enormous impact on cellular levels of omega-3.

Reducing omega-6 intake to just 2.5%  of daily calories can increase tissue levels of omega-3 by over 50%(that's without taking any fish oil tablets!) On the other hand, we may need over 3000mg of omega-3 EPA and DHA to counter high intake of omega-6s in the diet. This is not a "one-size-fits-all" approach.

It’s worth doing a close study of your diet to see whether the balance of omega-3s to omega-6s is as good as you think it is. There is a website where you can go to find the “omega-3 score” of a huge number of foods. This is a score that takes into account both its omega-3 and omega-6 content – in other words, that which adds points and that which takes points away!

Go to www.fastlearners.org and see whether your diet consists of foods in the positive or in the negative.

 If your diet is made up of a lot of the positive foods, it increases the likelihood that your tissue levels of omega-3s are good, but it doesn’t guarantee this. The only way to really know what your tissue levels are like (which depend on your lifetime eating habits) is to have a blood test done through a functional laboratory. I can order this for you here at Equilibria.

And that brings us to the answer to the question.

The only reason to not be taking omega-3s as a supplement is that you are confident of your tissue levels of omega-3s, and you are eating a diet that will maintain them. This diet would consist of a high intake of oily fish – probably daily – and some flaxseed. ALA from flaxseed has some benefits, but does not convert well to the required EPA and DHA. The enzyme that aids this conversion can be slowed down by lack of zinc, magnesium, B vitamins and vitamin C.

If, like most of us, maintaining this diet at times becomes a little too arduous, you should be taking omega-3 supplements, ideally from fish oil or algae rather than flaxeed. Your skin, your brain, your heart and arteries, your memory and your hormones will thank you.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Nutrition: Nothing In Moderation (Except Moderation)

Posted: Wednesday, December 18, 2013 at 11:37:14 AM EST by Alyssa Tait

“You’re a nutritionist, tell us what we should all be eating!”

Well, I might be a nutritionist for short, but in actuality I’m a nutrition medicine practitioner.

Nutrition medicine: I’ve been practising this for nine years now, but still struggle to explain to people what it is. My patients know – because they are collaborating in a treatment program involving it. But the elevator spiel to the person next to me? I have yet to perfect it, or even create it.

So now let me make an attempt with a short anecdote.

I was in Melbourne recently, presenting at a conference on constipation and herbal medicine. I was on the bus back to the airport eavesdropping on a conversation next to me between an older man and a younger woman. The woman was a sports nutritionist, and the man was interested in the relevance of this to his horses.

The woman had to race off before the bus set off, as she’d left a package on her last bus. She got back on just in time and we exchanged joking pleasantries about her close call. The older man then chided her on the nature of the package, which was chocolate. The young woman defended herself by saying

“I’m a dietitian – I preach everything in moderation!”

Now I’m not sure whether she was speaking for all dietitians, but I thought this an interesting place to start on trying to explain what nutrition medicine is – and how it differs from dietetics.

I would describe nutrition medicine as an approach that counsels the opposite, that is:

Nothing in moderation (except maybe moderation)!

Nutrition medicine is based on individual nutrient requirements. I don’t recommend one diet for all people at all times. In fact, I am not in the business of giving general guidelines at all – and the closest I would go to this might be “eat more vegetables, especially greens”.

We are not all identical. We have different genes, different health issues and different “weak spots”. Nutrition medicine is about pinning down which of these weak spots are impacting on our health. Technically, we aim to identify what processes in the body are malfunctioning to allow symptoms to arise. These might be neurological (e.g. neurotransmitter production), endocrinological (e.g. thyroid hormone action) or biochemical (e.g. nutrient availability in the relevant tissue). All of these – not just the last – are influenced by the raw materials we provide the body with (that is, food and, specifically, nutrients). We can influence these pathways by the way in which we facilitate the availability of different nutrients.

That’s why I don’t believe in moderation.

Several pieces of fruit a day? Not if you have fructose malabsorption-related irritable bowel syndrome.

400ug folate for all? Not if you have the MTHFR gene polymorphism.

Daily protein requirement = body weight x 0.8g? Not if you’re recovering from surgery.

Just take a multivitamin? Not if you have a relative copper overload.

Six slices of wholegrain bread a day? Now, don’t get me started…

Nutrition medicine is a rational, scientifically-based adjunct to physiotherapy (or any medical, paramedical or non-medical therapy, for that matter) based on individual requirements. These individual requirements are determined from a combination of general or functional laboratory testing and the clinical picture. Yes, they are guided by research…but then modified for the individual.

But if anyone can come up with a good elevator spiel on what nutrition medicine is, I would be very open to hearing it!

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Going Gluten-Free: What You Should Do First

Posted: Tuesday, December 17, 2013 at 5:04:05 PM EST by Alyssa Tait

Gone are the days (I hope) that people believe gluten-free is just the latest fad.

It’s undeniable that many people, for many different reasons, feel much better on a gluten-free diet.

It is important that a person has a coeliac screen before going gluten-free. The reason for this is that if they go on a gluten-free diet and feel fabulous, they are likely to never let so much as a wheat cracker pass their lips again (which is great) - but this precludes ever doing a coeliac test again, as you need to be eating wheat in fair quantities for a coeliac blood test to be reliable.

 So why does the coeliac test matter?

It matters because there IS a difference between being coeliac and non-coeliac gluten sensitive. Coeliac disease brings with it some well-documented significantly increased risks of things like bowel cancer and osteoporosis. Non-coeliac gluten sensitive doesn't (though keep in mind research is in its early days.

So you need to know why you are removing gluten.

If you are coeliac, you need to be much stricter in order to avoid these risks. If you are non-coeliac gluten sensitive, you may choose not to consume gluten, but chances are, the occasional crumb from someone else's toast is going to find its way into your butter, and that may not do you serious  harm. If you are coeliac, this WILL do you harm, and you need to take extra measures to avoid it.

The second comment is this: non-coeliac gluten intolerance may be on the rise, but so is FODMAPS intolerance, which also causes digestive symptoms when bread is consumed. In one recent study of a group of patients with functional gastrointestinal disorders (e.g. irritable bowel syndrome), 60% had a FODMAPS intolerance! It is important we don't label ourselves as "non-coeliac gluten intolerant" when it is actually a FODMAPs intolerance we have, as this creates confusion and  scepticism about the concept of gluten intolerance, which doesn't help the kid with autism, the kid with diabetes, and all the rest of the people with genuine non-coeliac gluten intolerance. This is a bit like the impact that "pescovegetarians" or fish-eating vegetarians have on the genuine vegetarian movement - it dilutes the concept and makes it much harder for genuine vegetarians to defend their stance.

By all means let's get rid of the wheat and/or gluten out of our diets because it's great for our health and makes us feel good.

 But - let's leave it at that and not use research that may not apply to us to convince others. Or, alternatively, get yourself tested - make sure you are not coeliac, which carries its own special health risks due to unintended ingestion of tiny amounts of gluten - and see if the reason you feel better without wheat is a FODMAPs intolerance, which may then lead you to realise you also feel a lot better on a true low-FODMAPs diet, which requires exclusion of more than just gluten-containing foods.

I do need to add the caveat that coeliac testing is not as straightforward as it appears to be either. But that’s the topic for another post.

In the meantime, here is a link to a great educational web-event called the Gluten E-Summit, part of which is still being aired free, for around the next 24 hours. For access to an economical digital package which I would thoroughly recommend as providing some of the most up-to-date information on gluten from some top researchers, click here.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Paralysed By Choice: Three Steps to Working Out What Diet is Right for You

Posted: Thursday, May 29, 2014 at 8:38:00 AM EST by Alyssa Tait

Gluten-free, Paleo, grain-free, low-FODMAPs, Specific Carbohydrate Diet, GAPs, raw, liver detox, low-salicylate/amine/glutamates, high-fibre, high-protein, low-carbohydrate, anti-Candida, low-oxalate, alkalising, Weston A Price, vegetarian…how do you sift your way through?

Some of these diets can be questionable, especially the way they are described or interpreted on some websites or by less experienced practitioners.

But most of these diets can be helpful – even ideal – for some people for short or long periods of their life. It is rare that one diet will cover all of your needs for your whole life. So where do you start in working out what diet will suit your body’s needs right now?

There is a wealth of information on the Internet about ideal diets for gut health, thyroid health, autoimmune disease, hormone-balancing, weight loss, best energy, you name it, as well as testimonials from people who are convinced of the benefits of these diets. There are sites galore promoting interstitial cystitis diets, IBS diets, diets for SIBO (small intestinal bacterial overgrowth), anti-Candida diets. But sometimes, the wealth of information can leave you feeling no closer to figuring out what is right for your body’s needs at this stage of your life.

Let me give you a simple formula to work out what is right for you.

Listen to your body.

This may sound obvious, but it’s amazing how often people ignore it. These are just a few of the comments I hear all the time:

“I feel bloated if I eat too much wheat”.

“Too much dairy gives me diarrhoea”.

“When I eat eggs, they go straight through me.”

An integrative nutritionist can help you joint the dots on factors in your history that give important clues. For example, chronic sinus issues are often associated with a dairy intolerance, as is bedwetting in children and acne (in fact, a 2014 review in the Journal of Clinical and Experimental Dermatology) comments on the link between acne and dairy, which requires further investigation). The link between gluten sensitivity and thyroid disease is also well established in the research.

Don’t ignore these clues! Without wishing to oversimplify, it is important to start somewhere – and following the already-established links is a good place to start.

Testing, testing, testing

Going in the direction that has helped others with your condition is only a starting point at best – and at worst, it can take you for a ride on the “health website merry-go-round”, where you half-follow one diet after the other without ever systematically measuring the results.

Working with a practitioner experienced in testing is essential. Choosing the right tests is important, as is choosing the right order of tests. Which are most important? Which ones should you prioritise? Are there key ones you should include before a dietary change? (One example is in making sure you do the right testing before you try going gluten-free.) Some of the key tests in establishing what kind of diet is appropriate to your body include:

  • IgG food sensitivity testing
  • Lactulose breath testing
  • Fructose breath testing
  • Coeliac screening
  • Bioimpedance (Body Composition) testing

In some cases, further important information is gained from tests such as:

  • Functional Liver Detoxification Profiles
  • Hormonal Testing
  • Autoimmune marker testing, such as thyroid antibodies
  • Adrenal Hormone Testing
  • Red Cell Essential Fatty Acids

A functional medicine practitioner will be able to order any of these tests that are appropriate to your situation. Much of this testing is done through what is known as “functional pathology” as opposed to “general pathology”. This usually means reasonable out-of-pocket expense. Some of these tests can cost a few hundred dollars. However, they will probably save you far more in consultation and supplement expenses, not to mention medical expenses over the years as undiagnosed problems turn into more serious medical conditions.

Put your history and test results together with a skilled functional medicine practitioner or integrative nutritionist.

It’s important to find an experienced practitioner to help you navigate the territory. This may be a naturopath, a clinical nutritionist or a medical doctor. Look for someone who uses or understands the terms “functional medicine”, “nutrition medicine” or “integrative nutritionist”. Generally, if they provide rebates, the rebates will be under naturopathy, not dietetics.

Self-treating is a minefield, even when you have good knowledge and awareness of your body. In fact, functional medicine practitioners (FMPs) often see other FMPs to help them with their own health!

Improving your health through optimal nutrition is anything but  a one-size fits all approach. It requires commitment on your part, a skilled and experienced functional medicine practitioner, and the careful collection of information from your history, your symptoms and specific testing. The great news is, you’ll find that the effort pays off, helping you achieve the best health possible.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

How Badly Is Stress Affecting Your Physical Health?

Posted: Wednesday, June 11, 2014 at 8:59:36 AM EST by Alyssa Tait

A Simple Method to Quantify the Effects of Stress on You on a Daily Basis

We all know that stress is bad for our health. Sometimes the pressure to squeeze “de-stressing” in to our already chaotic lives is a source of stress in itself! But how do you know when the stress is so significant that it is a major factor in your low energy, youar sleep problems, or your health issues?

There is a simple test you can do yourself at home without going to your doctor.

This test is especially useful if you have anxiety or depression, insomnia, headaches, low energy, fatigue, hormonal imbalance, poor immunity or blood sugar problems. I also see evidence of adrenal issues in women with vulvodynia, irritable bowel syndrome and chronic pain.

The test looks at your cortisol levels as they change through the day. As you can see from the diagram below, cortisol is high to start the day, then gradually drops into the evening, so that you develop a nice, natural tiredness as a signal you need sleep to recharge your body and mind. Cortisol then begins to slowly rise in the hours before 6am to ensure you wake up again – ideally, bright-eyed and bushy-tailed!

 

A number of things can go out of balance with this system. As stress causes you to release cortisol, if your stress rises towards the evening, the cortisol can spike or fail to drop as low as it should.

This can result in sleep problems:

  • Difficulty falling asleep
  • Unrefreshing sleep
  • Early waking

The last one is especially common. If you have a busy, stressful or active evening, the cortisol spike may result in you waking at 4 or 5am, even though you actually need more sleep for your health.

If you are constantly busy, overcommitted and stressed, you are under great demand to produce cortisol. Your cortisol may actually be too high, making you feel edgy and overstimulated, and as though you can’t sit still without doing something. If this continues on too long, you start to drain your adrenal glands, a bit like using the mobile phone without recharging it. If your battery starts to run low, you can then, over time, have trouble producing enough cortisol, and approach “burnout”.

Classic signs of these kind of energy problems include:

  • Feeling groggy and unable to get going in the morning
  • Low energy despite plenty of sleep
  • Feeling unrefreshed after sleep
  • Low mood and difficulty getting motivated for anything

A simple test that can track your cortisol rhythm is the Adrenal Hormone Profile.

This is completed at home by spitting into a test tube four times per day – 8am, 12pm, 6pm and 10pm. The cortisol is then measured by the lab.

This test is not ordered by your doctor, who will tend to order only a morning cortisol, which will not give the full picture. The Adrenal Hormone Profile needs to be ordered by an integrative practitioner who is experienced at interpreting the cortisol patterns.

Contact us now if you would like to order this test and gain some insight into the impact of your adrenal function on your health.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Alkaline Diet for Good Health: Myth or Reality?

Posted: Wednesday, August 20, 2014 at 10:45:44 AM EST by Alyssa Tait

There is a lot of talk about the balance between acidity and alkalinity for good health – at least in the natural health world.

“Alkalinity” is often equated with good health, and “acidity” something to avoid. The world of chronic pelvic pain occasionally enters the debate as well, especially websites and forums devoted to interstitial cystitis or painful bladder syndrome.

lemon

So is “becoming more alkaline” really a goal we should have in mind – and is it more important if there is chronic pelvic pain? And if it is, how to we go about achieving it?

While this is a pretty big topic, my aim in this blog post is to make this concept as simple as possible, in order to make a “murky” kind of topic more clear.

This first post will cover the alkaline-acid theory in general. My next post will relate it to chronic pelvic pain and interstitial cystitis.

So let’s start with the first question.

Is alkalinity-acidity a genuine concept, or something that some strange naturopaths have inherited from folk wisdom with no basis in fact?

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That one is easy. Acidity/alkalinity are concepts accepted by mainstream medicine as well as the natural health world. In mainstream medicine, being on the end of either spectrum is usually linked with fairly serious diseases. The blood pH (acidity level) is kept in a fairly narrow range in good health (7.35-7.45).  Based on blood test findings, it is possible to be placed in one of five categories:

Normal – most of the general population. No excessive alkalinity or acidity.

Metabolic acidosis – the blood is too acidic, and the reason is something to do with the metabolism (such as uncontrolled diabetes)

Respiratory acidosis – the blood is too acidic, and the cause is something to do with the respiratory system, such as hypoventilation

Metabolic alkalosis – the blood is too alkaline, and the reason is something to do with the metabolism

Respiratory alkalosis – the blood is too alkaline, and the reason is something to do with the metabolism.

The great thing about this system is that it is nice and obvious, and can lead to a medical diagnosis of a serious illness. However, it is important to note that there is a difference between blood acidity and tissue acidity, and this test specifically measures blood acidity. Naturopaths often argue for the benefits of measuring tissue acidity, to see what is really happening inside the body tissues. This is a good point, as things need to be really out of balance in order to show up on this test. It is a reasonable argument to look for more subtle problems in the tissue itself to help reach optimal health. However, the measures often suggested to achieve this, such as testing the pH of the saliva, have no research support whatsoever and are not reliable. So even if measuring tissue acidity is the ideal, we lack reliable measures for it.

What influences acidity or alkalinity level of the tissue?

Although we can’t measure it, there are known influences on tissue alkalinity. One major one is mineral level. Another is the general composition of the diet. A third is digestive function. A fourth is level of inflammation in the body.

Composition of the diet

Traditional naturopathics often recommends a high vegetable, low animal diet to achieve an ideal level of alkalinity of the body. Sometimes there is an 80:20 ratio described: 80% of the diet should be vegetables, especially leafy greens. Meat is often demonised as being “acidifying” and discouraged if good health is desired. However, there are much stronger food influences on tissue acidity than meat. Sugar and refined carbohydrates are the major one, as well as coffee, alcohol and dairy products. It is sometimes assumed that food that is acidic in nature causes acidity, but this is not necessarily the case. Lemon and orange are high-acid fruits, but do not have a significant effect on the body’s acidity.

freshfood

Influence of minerals on alkalinity

A number of essential minerals have an effect of increasing alkalinity level. These include potassium (the major alkalising mineral of the body), iodine (a major alkalising mineral), calcium and magnesium level. If levels of these are low, it doesn’t matter whether you  have the “cleanest” of  raw food vegan diets – your system will still tend towards acidity.

The converse of this is the role of heavy metals. Heavy metals, such as mercury, lead and cadmium, have an extremely acidifying effect on the tissues. Mercury, for example, is a metal that is toxic to the body's cells. In order to deal with mercury, a high amount of acidic hydrogen atoms are produced. Additionally, by blocking zinc, mercury also blocks the enzyme carbonic anhydrase, which leads to increased acidity as well.

Digestion

There is often confusion, when discussing the relative merits of “alkalinity”, between tissue alkalinity and alkalinity of the digestive system. It is important to distinguish between the two. In fact, when the digestive system is functioning well, it is very acidic: the stomach has a high level of acid to digest effectively, and to absorb alkaline minerals effectively, which – you guessed it – are important for tissue alkalinity.

As well as this, a healthy colon is characterised by high levels of short chain fatty acids, such as butyrate, which are protective against bowel cancer.

So in short, an acidic digestive system is a requirement of tissue alkalinity. Taking bicarbonate-based supplements will have the short-term effect of alkalising the system – including the urine, helpful at times in painful bladder syndrome or interstitial cystitis – but if consumed close to eating, will actually counteract the normal gastric acidity and can have a counterproductive effect on tissue alkalinity.

Inflammation

A key concept of good health to understand is that inflammation, by virtue of the underlying tissue biochemistry, always tends to promote acidity in the tissue. The cause of the inflammation doesn’t matter: it can be inflammatory bowel disease or obesity – but there is always associated acidity.

Read my next blog post to find out what, if anything, acidity/alkalinity has to do with chronic pain in general, and pelvic pain, vulvodynia and interstitial cystitis in particular.
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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Do Probiotics Work?

Posted: Tuesday, December 2, 2014 at 10:22:50 AM EST by Alyssa Tait

A (Greatly Truncated) Response to the Question of Whether Probiotics are Overrated

Probiotics: myth or miracle?

It’s the kind of grab-your-attention, oversimplified, dichotomized headline we are used to in the media. But, I was grateful to be asked for my opinion on an article of this name:

http://www.theguardian.com/lifeandstyle/2014/nov/30/probiotics-myth-or-miracle-prebiotics

So here is the quick 10-minute version of my opinion on this, straight from my Facebook response.

This article is better than I expected from the headline - at least they correctly cited some conditions there is evidence for treating with probiotics, such as IBD and traveller's diarrhoea. Until the concluding line! Just focus on consuming good quality yoghurts, my foot! Do they exist?! Aside from the ones you make yourself, that is. There are two problems with this statement.

Problem number one: numbers in yoghurt are too low.

For therapeutic effect - that is, not just to "stay healthy" (never mind that most people trying to "stay healthy" have symptoms or conditions they could be treating nutritionally) but to treat a condition, you simply need higher numbers than are in yoghurt - especially standard store-bought yoghurt. Problem number two: strain specificity. While a healthy gut has hundreds of different species and strains (and by extension we can assume we need to be consuming these, unless of course we have a perfect gut microbiome handed down from a mother with a perfect microbiome, have never had antibiotics etc) to actually treat a health condition (such as ulcerative colitis) the specific strains used in the research are necessary. Assuming that taking Inner Health is going to correct all our microbiomial shortcomings is analagous to taking a multivitamin and expecting it to correct the health problems arising from the epigenetic problems from the MTHFR polymorphism (i.e. doesn't work).

probiotics

This article has picked and chosen a couple of conditions there is evidence for. Actually, there is evidence for probiotic treatment of urinary tract infections, thrush, bacterial vaginosis, (for more information on these, subscribe to our newsletter and tick "vaginal health, thrush and BV") allergic rhinitis, eczema, diarrhoea from chemotherapy, cow's milk protein allergy, irritable bowel syndrome, lactose intolerance, diarrhoea from radiation, viral gastroenteritis. The bottom line is strain specificity.

Asking "do probiotics work?" is like asking "does physiotherapy work, or is it overrated?" Work? For what? What kind of physiotherapy approach/technique? We don't give staged basal expansions (i.e. breathing exercise) for patellar maltracking (i.e. a biomechanical problem at the knee). Choose the intervention according to clinical reasoning, basic science, clinical experience and, ideally and where available, the evidence base. We need to remember that a lack of available evidence to show effect is not the same as availability of evidence showing no effect.

And make no mistake: with the very real problem of antibiotic resistance, the price we pay for being too skeptical about probiotic therapy is prohibitively high.

Sure, there's a lot more research to be done. But there is research available, and not making ourselves aware of it (and thus failing to educate our patients) is a mistake. I am so glad to see physios interested in the concept of the microbiome and probiotic therapy. What I find discouraging is the idea that people will read an article like this on probiotics and fail to change their habits (overusing antibiotics, failing to incorporate fermented foods into the diet, not considering probiotics and adjuncts to therapy for their particular health condition) due to a misinterpretation that the probiotic thing is overrated and a fad.

And by the way, as the article points out, prebiotic foods ARE incredibly important...but they can only feed what is there. If you lack bifidobacteria - as I see frequently on stool analyses of my patients - then eating artichokes and onions is not going to make them magically materialise. Take home message: don't just lucky dip and hope for the best. See a functional medicine practitioner! Or at least read their blogs :)

Perhaps start with this one on the role of the microflora in a healthy and balanced vagina.

http://www.equilibriahealth.com.au/Blog/equilibria-blog/Post/the-healthy-and-balanced-vagina

And please…tell me about your experience with probiotics by commenting below!

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

The Essential Fertility and Preconception Test Your Doctor Will Not Send You For

Posted: Tuesday, December 9, 2014 at 10:57:16 AM EST by Alyssa Tait

Epigenetics: it’s more than a buzzword.

It’s the way you can influence your genes.

It’s the element of control you have over whether you inherit your mum’s endometriosis or your dad’s bipolar disorder.

And when you are planning for a baby, the idea of being able to influence the genes for the health of your baby takes on a whole new significance.

Conventional preconception care is pretty basic at best. Sexually transmitted infections and general blood screens are sometimes the limit, maybe with minimal thyroid function screen and iron studies. You are told to take a preconception supplement containing folic acid, and to just let nature take its course.

But what if you have the MTHFR gene polymorphism?

(The what?)

In a nutshell, MTHFR is an enzyme used in a process in your body called methylation, and is critical for folate metabolism. As with other genes, you can have one or more copies of a mutation. In this situation, a mutation or polymorphism results in diminished activity of this important enzyme. The end result is an increased risk of just about any disease you care to name (but more accurately, cardiovascular disease, cancers, neurological diseases, diabetes, autoimmune disease and CIN – or a bad result on a Pap Smear, and a precursor to cervical cancer). Elevated homocysteine in the blood (or homocysteine at the upper end of the range) can be a marker for this.

Specifically relevant to conception is the issue that the MTHFR polymorphism increases risk for:

  • Male infertility
  • Recurrent miscarriage
  • Hypertension in pregnancy
  • Pre-eclampsia
  • Pre-term labour
  • Health issues in the infant, such as neural tube defects (e.g. spina bifida) or Down syndrome

But there are two pieces of good news:

Finding out your MTHFR status is easy, and cheap.

I frequently send patients for this test as a cheek swab (what a bonus, no blood test needed!) and is around $50. A small price to pay for a critical piece of information about your own and your future baby’s health.

Even better, there’s something you can do about your risks if you do have the polymorphism.

It involves judicious supplementation with certain B-vitamins to offset your risk.

And what about the recommendation to take folic acid supplements from 4 weeks before a pregnancy? A 2014 study pointed out this is not long enough to normalise homocysteine, optimise red blood cell folate and reduce risk in the majority of women, and that only 20% of women are doing this. It is critical to get good folate intake in the diet.

So there’s no way out of it girls – eat your greens! And see my blog post for a delicious way of getting folate in your diet.

So why not just take megadoses or folic acid, like those available over the counter at the pharmacy?

As in many cases, something that sounds like a bad idea IS a bad idea! Taking too much folic acid can mask a vitamin B12 deficiency, which is very bad news for a pregnancy. Folic acid is also not the optimal form of folate for use by the body. Folic acid is a synthetic form, which must be metabolised to tetrahydrofolate by the body in order to be of use. And you guessed it, there are multiple factors that influence this – so taking folic acid is by no means a complete solution.

Ideally, all women should ascertain their MTHFR gene status before falling pregnant and work with their functional medicine practitioner or integrative doctor to support their health.

Genetics can be slightly scary or overwhelming – but hooray for epigenetics, which means we can do something about it!

Do you know your MTHFR status?

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
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