Oxtail Caserole, country style

✓Gluten-free ✓Grain-free ✓Sugar free ✓Low-carb ✓Cow-Dairy-free

This dish was incredibly easy to make, and super delicious to eat! What more can one desire when it comes to food?

The Ox tail was from Goodwood Farm and consisted of all different sizes, as you would expect, from the tail of the animal. There was thick fat round one side of the larger pieces, which can be seen in these photos, and it tasted very good indeed. Real melt-in-the-mouth fat, not chewy tough stuff at all. And all I had to do was chuck it in some hot ghee (which is great for high heat cooking as it doesn’t burn, as butter would. See how I make ghee here), add some carrot and celery sticks, some red wine and bone broth, and, Bob’s your uncle, dinner! I didn’t have much time that evening so just flung some cauliflower in a pan to accompany this classic dish, and it was a perfect match.

  • About a kilo or so of oxtail (which, at Goodwood’s wholesale prices is only £4 per kilo, or Waitrose – not organic though – £6.99 per kilo)
  • Two or three large onions, chopped
  • A handful of organic carrots, cut into thick batons
  • A few sticks of organic celery, cut into thick batons
  • Ghee – a large chunk

Season the oxtail chunks with plenty of salt and pepper. In a large cast iron pan heat the ghee, add onions and gently fry for 5 minutes. Add the seasoned pieces of oxtail, gradually turning them as they brown. Sling in the carrots and celery, and let them feel the heat for some minutes, moving it all around slowly. Crack open a jar of bone broth (I must write up how to make this… watch this space) and add it to the pan, then chuck in a glass or two of organic red wine. Stir. Cover with the lid and pop the pot in the oven at about 140°C and leave for a couple of hours.

Done.

Gone!

Neanderthal Herbal Medicine

Our closest, extinct, cousins the Neanderthals are often thought of as thuggish and unsophisticated, but evidence over the last decade has began to challenge this picture, indicating that they had a broad range of skills, knowledge and, yes, sensitivity.

There is a lot of evidence from bone assemblages that Neanderthals often behaved as top predators, hunting a wide range of animals including deer, rhinoceroses, bisons and even brown bear. In this pursuit they were highly skilled and more successful than hyenas with whom they competed, indicating a high level of strategic intelligence and cooperation.

  • Read more about Neanderthal hunting prowess here: ScienceDaily

As well as a good knowledge of animal behaviour Neanderthals also used botanical material. Skeletons excavated in the 1950’s from Shanidar cave in northern Iraq indicate that Neanderthals buried their dead with flowers. These skeletons also showed evidence of injuries that had been tended and healed indicating that the sick and wounded had been cared for effectively. Continue reading

March News Round-Up

Happy Easter!

Ten reasons why you should eat chocolate

Lets start off with some good news! The Mail Online (Mar 25th) makes the case for eating chocolate. We have covered most of their points before, but it doesn’t hurt to remind yourself of the health benefits. Our message: for the greatest benefit make sure its dark chocolate (70% cocoa solids or higher). Oh, and if you suffer with acne, then you might be better making your Lent abstinence permanent.

Continue reading

Aloe vera plants – why every home should have one

aloe-vera-plant

We always have a few Aloe vera plants growing in our house. They are easy to look after, drought tolerant succulents that do best in a sunny window but are surprisingly adaptable to lower light levels too.

Aloe is often touted for it’s health and beauty functions, from skin cleansing to collagen support when ingested. However, the stand out function, and the reason I make sure I always have a plant in my house, is for treating burns.

When it comes to first aid when someone has been burned or scalded, nothing beats Aloe vera. The standard hospital treatment for burns is silver sulfadiazine cream. Indeed medical students are taught that silver sulfadiazine is the most effective treatment for minor burns, but this is simply not true. Another common burns treatment is Nitrofurazone, but again this standard of care is beaten hands down by aloe vera. The published literature shows that there are many superior treatments, and aloe vera frequently comes out top. Here is what just a small selection of such studies found:

  • These results clearly demonstrated the greater efficacy of aloe cream over silver sulfadiazine cream for treating second-degree burns. [Khorasani, 2009]
  • Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with silver sulfadiazine regarding early wound epithelialization, earlier pain relief and cost-effectiveness. [Shahzad, 2013]
  • Speed of healing was better in aloe vera group than silver sulfadiazine… In terms of wound surface area maximal improvement was observed… in the second degree wound of aloe vera. [Akhoondinasab, 2015]
  • In patients treated with Aloe Vera gel, epithelialization and granulation tissue of burn wounds were remarkably earlier than those patients treated with nitrofurazone [Irani, 2016]

So, how would I use Aloe vera with a burn?

It depends on the severity of the burn, but essentially I always try to cool down the site first, with cold water if available, for a good few seconds/minute then I find my Aloe plant and with a clean damp cloth I clean a leaf to remove dust, which can easily be present, then I either cut just the tip off the leaf and dab the cut end on the burn to get some of the clear gelatinous contents of the leaf directly on it, or, if the burn is more extensive I will cut the whole leaf off the plant near the base, with a clean sharp knife. I then lie the leaf on a chopping board and cut off the tooth-like serrations down both edges. Then I slit the whole leaf open, revealing a trove of cool, kind, healing jelly which can be removed with the knife or a spoon and applied directly to the burn or scald.

Scalds: an accidental n=1 trial

On one occasion I poured boiling water onto three fingers of one hand and was convinced I would have very serious and painful blisters the next day. However, I quickly took three finger length leaves off a plant, cut them in half lengthwise and encasing each of my very painful and hurt fingers in a leaf, like three finger puppets, lightly fixing them in place with elastic bands. I kept them on over night (a bit awkward, but I managed). Incredibly, in the morning my fingers were very nearly normal! This astonished me as I had on a previous occasion, some years earlier, managed to similarly scald a finger with boiling water and even though I kept it in cold water all day, I didn’t use aloe. On that occasion my finger was extremely painful for many days afterwards, and it resulted in my nail growing deformed for a time. The Aloe vera was SO much more effective, and the pain vastly reduced.

Sunburn

For sunburn Aloe is a real workhorse. Try not to get sunburnt in the first place, but if you do, simply prepare a leaf as I have described above, trimming off the sharp thorns first, cutting the leaf in half lengthwise, and rubbing the opened up gel onto the shoulders/forehead/thighs or wherever is sore. It works as an ‘after sun’ treatment even if you have not burnt. Skin just loves Aloe vera!

Tongue burns

Coffee too hot? Soup scalded your tongue? Aloe vera to the rescue! A burnt tongue can interfere with eating for days afterwards, so the quicker you can heal it the better. Just wipe any dust off your chosen Aloe vera leaf, cut the tip off, or the next bit down if you have already used the tip, and dab the jelly onto your poor tongue. Hold it outside your mouth for as many seconds as you can manage (which won’t be many) and then carry on, swallow it, re-apply a couple of times if you can, then try to forget the burn. Although you might be aware of the tender area for the rest of that day, it will have resolved by the next day. I am not sure how that happens, but I can assure you that is the pattern I have seen, many times.

Internal use

Internally this ancient healing plant is wonderful for soothing the digestive tract when inflammation occurs for any reason. It speeds up healing, soothes, cools, and restores. You can eat the gel straight from the leaf, with a spoon, or purchase the many refined versions found in health food shops. They will have varying degrees of preservative in, but seek out the most pure. The taste is rather bitter, but if a comfortable stomach is what you are looking for, the taste will be the least of your concern. Obviously, cereal grains are by far the main cause of inflammation in the digestive tract, but this gel is really helpful for all causes of gut inflammation.

In the inner leaf area of the plant, is the ‘latex’ or aloin. This contains high levels of a chemical called anthraquinone, which is a pretty powerful laxative, causing greater peristaltic acton of the colon. Some commercial Aloe vera juices contain this portion as well as the jelly, and others have this part removed. If you are seeking a laxative effect along with the soothing healing properties then seek out a product that contains the latex. Pregnant women, however, should not use this as the action on the colon can also activate the uterus, which is, of course, undesirable. Instead they should seek aloe gels that have had the latex/aloin/anthraquinones removed if they wish to use them internally. Of course externally all versions are safe and excellent on burns.

Conclusion

Every household should ensure they have one of these superb plants at hand, because accidents will happen! Quick, safe, cheap and reliable solutions like having fresh Aloe vera on the spot are invaluable. They look nice too.

Thanks for reading. Give me your comments and Aloe vera experiences below!

Cardiologist attacks diet dogma at 2017 Symposium

Video

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Dr Salim Yusuf speaking at the Cardiology Update 2017 symposium gives preliminary findings from the PURE study which followed 140,000 people in 17 countries, designed to address causation of cardiovascular disease.

He explains that the results indicate:

  • Greater fat intake is protective
  • Carbohydrates are harmful
  • High fat dairy is beneficial
  • Saturated fat from meat is neutral
  • Fruit is beneficial, but no additional benefit over 2 portions per day
  • Legumes are beneficial
  • 3 to 6 g/day sodium* intake optimal (vs US guidelines of 1.5g)
  • Eggs, fish and vegetables were neutral

*Edit 10/03/2017
Correction: I previously wrote 3 to 6 grams of salt per day, but have corrected this to 3 to 6 grams of sodium per day. This is equivalent to 7.5 to 15 g of salt per day.

February News Round-Up

It’s the 2nd anniversary of our News Round-Ups!

For two years we have put together a monthly distillation of the health and nutrition articles in the media. In the era of Fake News and with the declining power of traditional print media it is interesting to note that more and more of the stories are found on non-mainstream sites. Perhaps it’s time to change our header image…  

Organic Food Sales Soar

Demand for organic food is at its highest for more than a decade. The Guardian (Feb 19th). Yay!

Vitamin D

This month the vit-D story focused on the research indicating that supplements can help beat acute respiratory infections aka cold and flu’ (Sky News, Feb 16th). The identified effect was, unsurprisingly, more pronounced in people who had low levels initially.

Exercise less important than diet for avoiding weight gain

Newsweek (Feb 12th) reports on a study that found:

Exercise-focused weight loss regimens yield low success rates… This suggests calorie expenditure doesn’t really count for much.

Alzheimers linked to high blood sugar

For years I have heard researchers referring to Alzheimer’s disease as ‘type 3 diabetes’, so I was initially unsurprised by an article in Medical News Today (Feb 24th) claiming that the condition has been linked to high blood sugar. However, on closer inspection I realised this article is a bit different reporting on a study identifying a direct causal link in which glucose damages an enzyme in the pre-clinical stage. Another reminder, perhaps, why you want to avoid a high carb diet, especially refined carbs, like breakfast cereals, cake, biscuits, sweets etc.

Eating chocolate regularly linked to improved cardio metabolic health

Good news: In a study reported in Knowledge (Feb 17th) people that ate more chocolate had better liver enzymes and reduced insulin resistance than those who ate less.

Bad News: This association may be due to other associated lifestyle factors, such as higher socioeconomic status. However, the authors conclude:

Given the growing body of evidence, including our own study, cocoa-based products may represent an additional dietary recommendation to improve cardio-metabolic health.

Proton Pump Inhibitors (PPIs) linked to ‘silent’ kidney damage

News Medical (Feb 22nd) reports on a study that followed 125,000 new users of PPIs for 5 years. In this time nearly 10% developed chronic kidney disease or end stage renal disease. In most cases there were no early signs of kidney damage. These dangerous drugs are handed out like smarties by GPs all over the UK and USA, and elsewhere, no doubt. Acid reflux (or silent reflux as it is sometimes called, when all the patient has is a cough!) is all it takes end up with a PPI in your pocket. The main reason for acid reflux is, however, the eating of cereal grains. The solution is obvious. Cereal grains, especially wheat, can also cause kidney disease, so removing cereal grains from the diet and not taking PPIs could save many a person from real suffering and further unnecessary drugs, with their attendant side effects.

Coeliac without gut symptoms

DailyMail (February 10th) has a story about a boy who left doctors baffled after repeatedly suffering broken bones. Although he did not have the typical gut symptoms, he was eventually diagnosed with coeliac disease and placed on a gluten free diet. His bone mineral density improved, and he suffered no further breaks in the four year follow up. His older brother, who had no symptoms, was also found to have coeliac disease. The authors of the case report said: ‘It is essential to diagnose celiac disease as early as possible in order to minimise the compromise in bone health and prevent other complications of the disease. First-degree relatives should always be screened for the disease, even asymptomatic ones.’ (BMJ report here). I couldn’t agree more.

Gluten-free products may be high in heavy metals

If you read our posts on the gluten-free diet you will know that we strongly advocate replacing gluten-containing products with real foods, not ‘free-from’ versions made from other grains or unpronounceable ingredients. Science Daily (Feb 13th) reports on a study that found that people eating a gluten-free diet had arsenic levels almost twice as high for people eating a normal diet, whilst mercury levels were 70 percent higher! These toxic minerals are suspected of coming from alternative grains – especially rice – used in gluten-free biscuits, cakes, bread etc. Just eat real food, please, i.e. things without an ingredients list.

Gluten-free products like those shown on the left are promoted by coeliac charities and the NHS, but contribute to sub-standard nutrition [ref]. Real foods that are naturally free of gluten are a better choice and can lead to an overall improvement in dietary quality.

Gluten-free products like those shown on the left are promoted by coeliac charities and the NHS, but contribute to sub-standard nutrition [ref]. Real foods that are naturally free of gluten are a better choice and can lead to an overall improvement in dietary quality.

Sleep health

A Norwegian longitudinal population-based study found that over an eleven year period adults with chronic symptoms of insomnia were up to three times as likely to be diagnosed with asthma than those without sleep issues. (MedPageToday, Feb 2nd). Critics point out that the association may be either way as both conditions have multifactorial causes.

A second sleep-related study was reported in the Mail Online (Feb 9th), in which researchers found that women undergoing IVF are more likely to have a miscarriage if they have it during the spring or autumn. They believe it is due to the slight changes in the circadian rhythm – the body’s internal clock – caused by the clocks going forwards or back. The one-hour difference has previously been reported to increase the risk of heart attacks, but this study was the first of its kind to assess its impact on successful pregnancy.

Evolutionary medicine

The paleo diet is one response to the presumed mismatch between our evolved physiology and the modern world. The Independent (Feb 21st) explores a number of these ‘paleo deficits’, in an interesting article titled ‘Mismatch between the way our senses evolved and modern world is making us ill, experts warn’

Grass-fed, pasture-raised, ancestral knowledge

The Creswell Chronical (Feb 17th) has a nice interview with a researcher and author on the benefits of grass-fed meat for health. Meanwhile, the McGill Reporter (Feb 7th) has a fascinating article about the traditional animal foods of First Nations people. The article is stimulated by a pioneering encyclopedia of more than 500 animal species that form the traditional diet of First Nations has just been published online (Traditional Animal Foods of Indigenous Peoples of North America).

“The food and biodiversity knowledge of Indigenous Peoples is incredible in its depth and its breadth. Even though this publication is big, we have only scratched the surface of this knowledge,”

This remarkable work follows on from an earlier publication Traditional Plant Foods of Canadian Indigenous Peoples also available free online.

Restoring the Palaeolithic megafauna?

cave-painting
(Cave paintings of wild horse, bison and mammoth, Pech Merle cave, France. 20 thousand years old)

Are we on the way to restoring the Palaeolithic megafauna? Last month we reported on attempts to breed a wild bovine to replace the recently extinct European auroch. This month the BBCs Discover Wildlife magazine (Feb 14th) tells us that bison are being reintroduced to Banff National Park, Canada. Meanwhile, The Guardian (Feb 16th) explains how scientists are on the verge of bringing back the woolly mammoth. Crikey!

Of MICE and MUMS

mice-mum

Three pieces of health and nutrition news for mums this month… although all three studies were actually carried out on mice not women!

Adverse effects of antibiotics in (mouse) pregnancy

The Mail (Feb 9th) reports on a study that found pregnant mice who were given antibiotics had offspring who were more susceptible to pneumonia. The researchers called for a change in practice to the routine administration of antibiotics during caesarians. I could not agree more with the quote below from the study author Dr Hitesh Deshmukh who said:

It is time to begin pushing back on practices that were established decades ago, when our level of understanding was different. To prevent infection in one infant, we are exposing 200 infants to the unwanted effects of antibiotics. A more balanced, more nuanced approach is possible.

Unhealthy maternal (mouse) diet affects three generations of offspring

pregnancy-cartoonIt has been known for a number of years now that maternal diet can influence later generations via epigenetic changes.

Knowledge (Feb 17th) reports on new research which suggests that mothers who eat obesogenic diets even before becoming pregnant can predispose multiple generations to metabolic problems, even if their offspring consume healthy diets.

The researchers showed that the changes took place in ovaries prior to fertilisation and were inherited through changes to the mitochondrial DNA which is passed through the female blood line.

Our data are the first to show that pregnant mouse mothers with metabolic syndrome can transmit dysfunctional mitochondria through the female bloodline to three generations. Importantly, our study indicates oocytes – or mothers’ eggs – may carry information that programs mitochondrial dysfunction throughout the entire organism.

Pregnant (mice) should avoid drinking from plastic bottles

The Mail (Feb 7th) claims ‘pregnant women who drink from plastic bottles are more likely to have obese children’. The study they were reporting on was actually carried out in pregnant mice who were exposed to low levels of Bisphenol A (BPA) which is found in rigid polycarbonate plastics. Their offspring had reduced sensitivity to leptin

Our findings show that bisphenol A can promote obesity in mice by altering the hypothalamic circuits in the brain that regulate feeding behavior and energy balance.

Low level prenatal exposure to BPA delays a surge of leptin after birth that allows mice to develop the proper response to the hormone. BPA exposure permanently alters the neurobiology in the affected mice, making them prone to obesity as adults.

It should be pointed out that most drinks bottles are made of PET not polycarbonate, and are therefore not sources of BPA (I’ve made a table of common sources of BPA below) . PET bottles do, however, contain phthalates, but that is another story.

Sources  of BPA*
Canned foods Many cans are coated inside with BPA-containing epoxy films which can leach BPA into the food
Polycarbonate water bottles and food containers Rigid polycarbonate containers leach BPA into food and drink. Glass containers are a safer oftion.
Drinks cans As with food cans, drinks cans leach BPA, although usually at lower levels than in food cans.
Fast food Fizzy drinks and burgers from fast food outlets have been identified as significant sources of BPA
Cash register receipts Typical cash register receipts contain BPA which can be absorbed into the skin. Shop workers are at particular risk.

*Source: University Health News Daily

Gluten – what we learned in 2016 (part 2) – the Great Imitator

20+ conditions related to gluten – a review of some 2016 papers

gluten-related-disorders-2016-20🔍 Please feel free to share this infographic or the whole post!

In part 1 we looked at some of the key developments in understanding gluten sensitivity (coeliac and non-coeliac gluten sensitivity) that emerged in 2016. In part 2 now we take a look at some case studies, and small trials that link gluten to a wider range of conditions.

Read time: 18 minutes (2400 words)

Some of the conditions that were linked to gluten in 2016

When I did my medical training I was examined on clinical diagnostic skills. We students of herbal medicine, like other medical students, were taught that whatever symptoms a patient presented with, our list of possible diagnoses we could always include tuberculosis and syphilis. These two systemic diseases were called the great imitators due to their potential for affecting any tissue or organ. From back pain, to skin rashes and mental illness, these ancient adversaries of Man could be the cause. Misdiagnosis could be serious in that the wrong treatment might be pursued, and the effective treatment missed. What we are seeing with gluten related disorders is another great imitator at play. The conditions that follow will leave you in no doubt that gluten and/or other factor in cereal grains, can play havoc with every corner of the body and should always be considered, properly tested for,m and ruled out by the responsible and updated clinician.

In reading this post there are several points to bear in mind: (1) This is far from an exhaustive list, even of 2016 papers. (2) Gluten related disorders often go unsuspected, undiagnosed and therefore untreated for many many years and 80% of coeliacs remain undiagnosed! (3) Gluten can affect any system or tissue type of the body and should always be considered as part of a differential diagnosis even if there are no intestinal symptoms. A full gluten blood test, not just the standard NHS coeliac tests, should be used, or a minimum of a 6 week exclusion diet. (4) The true extent of the gluten iceberg’s sub-surface volume has yet to be established. These reports give some insight into the extent of the murky mass.

I have seperated these reports into those related to coeliac – where there is adaptive immunity and/or autoimmune factors involved and non coeliac gluten sensitivity (NCGS) – where the innate immune system is principally involved. The latter is particularly important as it indicates the propensity of gluten to affect potentially anyone.

1. Coeliac (autoimmune) related

Coeliac hepatitis: hepatic fibrosis, advanced steatohepatitis and cirrhosis
In a Nov 2016 case study, a 20 year old woman with coeliac disease and severe liver cirrhosis had a near complete reversal once placed on a gluten-free diet.The author called this a “hepatomiracle” [Gaur, Nov 2016]
Epilepsy
An Iranian study published in Jul 2016 found that the prevalence of coeliac disease among patients with epilepsy was 6% – about five times higher than in the general population. [Bashiri, Jul 2016]
Chronic Hepatitis C Virus (CHV)
CHV infection can lead to autoimmune diseases and shares one of the same genetic loci as coeliac disease (HLA-DQ2). Liver disease also leads to anti-tissue transglutaminase antibodies (anti-tTG). Some CHV patients develop coeliac disease during interferon therapy. There is a complex relationship with many overlapping features between these two conditions, although it is not yet clear whether the incidence of coeliac disease is higher in CHV or not [Association between celiac disease and chronic hepatitis C, 2016].
Distal Renal Tubular Acidosis Associated with Celiac Disease and Thyroiditis
A case report of a 12 year old girl with a particular form of kidney disease, (distal renal tubular acidosis, RTA) with autoimmune diseases, which is extremely rare in children. [Indian Pediatrics, Nov 2016] “Despite resolution of acidosis on bicarbonate, she continued to have poor growth and delayed puberty. Investigations revealed autoimmune thyroiditis and celiac disease. Levothyroxine and gluten-free diet were initiated. Child gained height and weight and had onset of puberty after gluten withdrawal.”
Psychiatric Case
The BMJ recently published a case study of a girl admitted to a psychiatry ward suffering with suicidal behaviours who then developed an agitated catatonic state. She was unresponsive to antidepressants, anxiolytics, antipsychotics and electroconvulsive therapy, but improved significantly when a gluten-free diet was started [Oliveira-Maia, Dec 2016]. Another recent paper The progression of coeliac disease: its neurological and psychiatric implications, Campagna G, Dec 2016, explores the current understanding of the neurological implications of coeliac disease.
Burning Tongue
An elderly woman presented with complaints of a burning tongue for the past two years as well as occasional loose stools and fatigue. Tests revealed iron deficiency anemia, zinc deficiency and an abnormal celiac panel. Ten weeks on a gluten free diet led to complete symptom resolution [Sherman, Jun 2016].
Macrophage activation syndrome
A case report in Pediatric Rheumatology Online Journal, reports on a six year old girl who was diagnosed with Macrophage activation syndrome – an autoinflammatory or rheumatic disease involving hyper inflammation and an ineffective immune response. Serology indicated coeliac disease and symptoms stabilised with the introduction of a gluten-free diet. Authors state that “Clinicians should have a low threshold for screening children with other autoimmune diseases for coeliac disease.” [Palman, Dec 2016].
Coeliac like disease in dogs
The Veterinary Record [Lowrie, Dec 2016] reports on a case of “gluten-sensitive dyskinesia (previously termed canine epileptoid cramping syndrome) is a condition of Border terriers in which the leading manifestation is neurological… responsive to a gluten-free diet.” As such, the authors suggest that gluten sensitivity in Border terriers “may manifest as a multisystem disease in a similar manner to that seen in human beings.” There is another paper on this topic: Gluten exposure and multisystem disease in dogs [Davies M, Dec 2016], but I have been unable to access it.
Gluten free diet in pregnancy and type 1 diabetes in offspring
As we have previously discussed, gluten has a significant role in the development of type 1 diabetes. A study in the Journal of Diabetes Research [Antvorskov JC, Aug 2016] investigated the a mouse model of type 1 diabetes. Withholding gluten during pregnancy prevented the subsequent development of type 1 diabetes in offspring, even when exposed to gluten after birth. However, the effect disappeared if the mother received a gluten-free diet prior to pregnancy.
Aortic stiffness may explain increased cardiovascular risk
Many studies show an increased risk of cardiovascular disease in coeliac patients which cannot be explained by traditional risk factors. A study from Antalya, Turkey used echocardiograms to compare the aortic function of 81 coeliac patients with that of 63 healthy volunteers. They found an increased level of aortic stiffness and inflammation in coeliac patients. Whilst inflammation decreased with adherence to a gluten free diet, aortic stiffness did not, suggesting that increased cardiovascular risk may persist despite a gluten-free diet. [Bayar, Mar 2016]
Hemophagocytic lymphohistiocytosis
Hemophagocytic Lymphohistiocytosis and is a life-threatening immunodeficiency. It affects people of all ages and ethnic groups. Common symptoms are fevers, enlarged spleen, low blood counts and liver abnormalities. [ref] A recent paper [Fordham NJ Sep 2016] reports a case that did not respond to standard treatment, but following blood tests established undiagnosed coeliac disease. “She initially responded to chemoimmunotherapy specific for hemophagocytic lymphohistiocytosis but relapsed within a few months of cessation of treatment and then achieved complete remission on gluten withdrawal alone.”
Down’s Syndrome
A study in Poland identified high levels of diagnosed coeliac disease among patients with Down’s syndrome (5.4% vs 1% in general population). The authors emphasise that tests for coeliac disease should be carried out in all (Polish) patients with Down’s syndrome, regardless of the clinical picture. [Szaflarska-Popławska, 2016]
Multiple autoimmune syndrome with celiac disease
Reumatologia published a case report of a 32 year old woman who had four co-existing autoimmune diseases: autoimmune hypothyroidism, Sjögren’s syndrome, systemic lupus erythematosus (SLE) and celiac disease which leads to the final diagnosis of multiple autoimmune syndrome type 3 with celiac disease. The authors point out that patients with single autoimmune disorders are at 25% risk of developing other autoimmune disorders. The case emphasises the need for continued surveillance for the development of new autoimmune disease in predisposed patients. [Harpreet, Dec 2016]

2. Non-coeliac Gluten Sensitivity (NCGS)

NOTE: I am using NCGS as a looser category than is currently accepted to include any studies where withdrawal of gluten or wheat showed clinical benefit.

Intestinal cell damage and systemic immune activation in NCGS
A study published in the BMJ’s journal Gut at the end of 2016, examined serum from 80 individuals meeting the criteria for NCGS (although the authors use the term Non Celiac Wheat Sensitivity). They found increased levels of lipopolysaccharide binding protein – indicating that these patients had raised levels of gut bacteria products passing through a damaged gut wall, known as ‘leaky gut’. Associated with this was raised markers of systemic immune activation. The researchers went on to find raised levels of fatty acid binding protein, indicative of intestinal cell damage. As NCGS patients do not have villous atrophy (which is characteristic of celiac disease) it had been assumed that there is no intestinal damage taking place in NCGS, however, this study shows that damage is indeed taking place. The authors speculate that damage in NCGS may be taking place in the mid section of the small intestine, the jejunum, rather than the first section, the duodenum, from which biopsies are usually taken. Finally, these markers were found to improve with the initiation of a gluten free diet. [Melanie Uhde, 2016]
Psychotic Illness
Schizophrenia has previously been linked to raised kynurenine and reduced tryptophan [Chiappelli, Nature, 2016], both of which are related to the production of Vitamin B3. Researchers hypothesised that this imbalance could be caused by inflammatory immune mediators such as gluten. They found schizophrenic patients had raised levels of anti-gliadin antibodies (IgG) which correlated with kynurenine/tryptophan ratios. They concluded “Our results connect nonceliac gluten sensitivity with the KYN pathway of TRP metabolism in psychotic illness” [Okusaga, 2016]. This links to an long used treatment of schizophrenia which is goodly doses of Vitamin B3 (niacin), the production of which may be getting interfered with by gluten in these patients.
Atopic Dermatitis (Eczema)
A recent study sent 169 atopic dermatitis patients a 61-question survey asking about dietary modifications they had tried and their perceptions and outcomes of such trials. The most common foods eliminated were ‘junk foods’ (68%), dairy (49.7%), and gluten (49%). The best improvement in skin was reported when removing white flour products (37 of 69, 53.6%), gluten (37 of 72, 51.4%) and the nightshade family of vegetables, i.e. potatoes, tomatoes, aubergines, peppers, chilli and paprika (18 of 35, 51.4%). [Nosrati, 2017]
Lymphocytic colitis
(This condition is characterised by chronic watery diarrhoea yet with normal colon cells when sent to the histology lab, but with an accumulation of lymphocytes in the colonic epithelium/lining)
A study in the journal PLoS One found that 91% of lymphocytic colitis patients who were identified as NCGS responded to a double blind gluten challenge indicating a causative role for gluten in these patients. [Rosinach M, Jul 2016]
Nephrotic Syndrome
This is a rare condition in childhood that presents with proteinuria, hypoalbuminemia, and oedema. Kidney function is usually normal however. Most children (>90%) respond to an initial course of oral steroids and are designated as having steroid-sensitive nephrotic syndrome (ssNS). A study in Pediatrics placed 8 children with difficult-to-manage disease (characterized by steroid dependence or frequent relapses) on a gluten-free diet. They all had clinical improvement enabling reduction or discontinuation in steroids. The role of gluten in this condition was confirmed through relapse following re-exposure to gluten. The authors conclude “Elimination of gluten from the diet, may reduce the need for potentially toxic immunosuppressant therapies” [Lemley KV, Jul 2016]
Microscopic colitis
– A new clinical and pathological entity (“lymphocytic enterocolitis”)?
Of patients with Marsh 1 duodenal damage, but no coeliac serology (i.e. negative for anti-endomysium and anti-tissue transglutaminase), half were found to have microscopic colitis. Although this study was not specifically looking at gluten, 14 patients tried a gluten free diet for at least one month and 3 of them (21%) had improvements. [Bonagura, Nov 2016]
Postural orthostatic tachycardia syndrome (POTS)
A study published in the European Journal of Gastroenterology and Hepatology found that 4% of PoTS patients had coeliac antibodies, yet 42% reported gluten sensitivity, suggesting that many POTS patients are NCGS. [Penny HA, Dec 2016]
Eosinophilic oesophagitis
Eosinophilic oesophagitis (also called EoE for those who spell oesophagus without the ‘o’) is a chronic inflammatory oesophageal disease triggered predominantly by food antigens. Although considered a food allergy, EoE is unique in not involving the immunoglobulin IgE antibody response. A recent review identifies milk and gluten elimination as the most promising cure strategies. [Molina-Infante, Dec 2016] How is EoE caused? Until recently it was considered that the oesophagus was relatively impermeable to food antigens and allergic diseases of the oesophagus were unknown. Researchers from the Mayo Clinic wondered if food antigens were present in the oesophageal tissue of sufferers. In a recently published paper they report finding increasing levels of gliadin (gluten) in the oesophageal tissue with increased severity of disease, whilst none was present amongst controls. This suggests a direct causative role of gluten in EoE.

gliadin-staining-in-eosinophilic-oesophagitis

Comparison of total anti-gliadin staining (y-axis) in patients on a gluten free diet (GFD), control patients and patients with inactive and active EoE on gluten (x-axis, 63x). E. V. Marietta, AP&T Nov 2016

Effect of a gluten-free diet in children with autism spectrum disorders
In this randomised clinical trial [Ghalichi F, Nov 2016] 80 children with ASD were randomised to gluten-free diet [40] or regular diet [40].

“In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly (P<0.05) after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37, P<0.05) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24).”

Alcohol related cerebellar degeneration
Alcohol-related cerebellar degeneration is one of the commonest acquired forms of cerebellar ataxia, however, the mechanism by which alcohol causes this damage is unknown. The cerebellum is the back part of the brain, responsible for many basic things including walking. ‘Ataxia’ is difficulty in walking. In a recent study from Royal Hallamshire Hospital, Sheffield, England, a group of 38 patients with ataxia were studied. 34% were found to have circulating antigliadin antibodies vs. 12 % in healthy controls, and 39 % were found to have antibodies to transglutaminase 6 (which are neurological antibodies) vs. 4 % of healthy controls. The authors suggest that chronic alcohol abuse increases gut permeability exposing the immune system to increased levels of gluten peptides to which these two antibodies are raised. They conclude “Alcohol induced tissue injury to the central nervous system leading to cerebellar degeneration may also involve immune mediated mechanisms, including sensitisation to gluten.” [Shanmugarajah PD, Oct 2016]

Conclusion

We are in the middle of an epidemic of gluten related disease that have crept up on us over the last few decades. Our European culture has lived with wheat and its associated diseases, for thousands of years, and we have named and described them, yet only now are we becoming aware of the true cost to our health. At the same time, many Central America countries (Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama), which historically have had very low rates of coeliac disease, are transitioning from a diet based on maize to one increasingly centred around wheat. Maize too has its problems but the prolamine in maize, zein, is less likely to cause immune reactions than is the prolamine in wheat, namely gluten.

A paper published in the journalNutrients  [Amado Salvador Peña* and Jakob Bart Arie Crusius, Sep 2015] provides a salutary reminder of the scope of the problem:

[these] changes permit a prediction of an increase of celiac disease and other autoimmune diseases such as type I diabetes and thyroid disease.

The aim of this review is to… alert authorities responsible for the planning of education and health, to find possibilities to avoid a rise in these disorders before the epidemics start.

– Amado Salvador Peña and Jakob Bart Arie Crusius, Central America in Transition: From Maize to Wheat. Challenges and Opportunities (Nutrients, Sep 2015)

2017 January News Round-Up

I’ve been a bit tardy with getting this post out on time, but that lets me sneak in an article from February, which sums up so much of what natural medicine is all about… so lets go!

Plastic chopping boards much LESS hygienic than wooden ones

“Study found that bacteria thrived on plastic boards overnight but died on wood” (Mail Online, Feb 3rd)

Do you remember a few years back the authorities in the UK attempted to ban wooden chopping boards in restaurants, insisting plastic ones were more hygenic? After all, those grooves in the wood must surely harbour many more bugs than a smooth, inert surface of a plastic board, no? Well no. It turns out that there are natural antiseptics in wood that actually make them excellent for food preparation, whereas plastics have no such built in protection.

A similar over-reaction by the authorities in the USA nearly prevented cheese manufacturers from ripening their wares on traditional wooden shelving (Guardian, Jun 2014) Thank goodness that ordinary people put the authorities in their place!

FSA gives cooked carbs a kicking… (try saying that with a mouthful of roast tatties)

“Eating crisps, well-browned roast potatoes and toast that is more than lightly grilled can increase the risk of cancer”  according to a public health campaign by the Food Standards Agency.

When starches are overcooked a potentially cancer-causing acrylamide is produced. I looked into this five years ago, but didn’t write about it, as the science seemed to say that there was no evidence it actually raised cancer risks in humans at the quantities people consumed them. It would have been easy to use it for a bit of carb bashing, but I resisted the urge. Can’t quite believe the FSA has suddenly taken up the cudgel! (The Guardian, Jan 23rd)

acrylamide-intake

Eggs don’t scramble brains

‘Having eggs for breakfast does not increase risk of dementia’ – OK. glad to hear it.

‘…egg intake was associated with better performance on neuro-psychological tests of the frontal lobe and executive functioning.’ Even more gladder to hear it! (Mail Online, Jan 11th)

american-egg-brainSkipping breakfast linked with heart disease and obesity.
Hold it Fido, hold it! They said ‘linked’ not ’caused’…

The Telegraph (Jan 31st) discusses research that found that people that skipped breakfast were more likely to have raised cholesterol and blood pressure. We have written about the topic of meal timing before (see here), and think that breakfast is, generally, a good thing (no!… put down the cereal packet!). However, the science is not unanimous as reverse-causality confounds the picture (i.e. overweight people probably avoid breakfast more often).

Indeed the researchers found that people who skip breakfast tend to eat more snacks, underlining that it is as much about what you eat as when you eat it. The most significant part of the article IMHO is the idea that eating late in the evening or night disrupts body clocks. Screw with your circadian rhythm(s) at your peril.

The article finishes with eight breakfast egg recipes. (Just watch out – they are not all gluten free). Alternatively, here is our ever popular post Ten Low Carb Breakfast Ideas

Paleo diet improves symptoms in Multiple Sclerosis study finds

A small study of patients with relapsing-remitting multiple sclerosis—RRMS— randomly assigned eight to follow the paleo diet, while the remaining nine ate as usual and acted as the control group.

Those on the diet experienced “reduced fatigue, increasing mental and physical quality of life, increasing exercise capacity, and improving hand and leg function.” (Bel Marra Health, Jan 20th)

Microplastics getting to us via seafoods

As the world wakes up to the environmental disaster of half a century of dumping plastic left right and centre, it looks like those microscopic fragments that affect the bottom of the marine food chain are passing up and into us.

“Now we’ve established that they do enter our body and can stay there for quite a while, we do need to know the fate of the plastics,” (Telegraph, Jan 24th)

Old drug being considered for fighting brain cancer by starving it to death.

Knowridge (Jan 11th) covers the possible use of flavopiridol to fight glioblastomas. Why are we interested in this pharmaceutical drug? Because it’s putative mode of operation is by starving cancer cells of glucose – a route which may well be open to a dietary approach . (We are closely following the trialing of the ketogenic diet in cancer treatment, see our post here)

Bring back the Auroch!

You probably wouldn’t want to bump into this fellow when walking in the woods, but that’s just what they are planning in Central Europe!

The Mirror (Jan 10th) has a nice article about a breeding programme attempting to bring back the original wild European bovines from which domestic cattle were reared. This is a real paleo-project as the aurochs, which only became extinct a few hundred years ago, have featured in European mythology since prehistory appearing in early cave paintings as well as Greek and Roman pottery. They are considered a linchpin of ecosystem health.

For a more modest English approach to rewinding, see our article Rewilding our Food about the Knepp Rewilding Project here in Sussex.

Take statins even if you are healthy, say experts (Telegraph Jan 18th)

Really? I mean really?

When Michael Gove said during the Brexit Campaign that people have had enough of experts many laughed. But Brexit then Trump proved that the public no longer accept ‘facts’ sold to us on the basis of appeals to faceless authority. Those days have gone. Citizen journalism is the new kid on the block, speaking truth to power. So here goes…

  • The clinic trial data for statins has never been released. You can’t look at it. Only one ‘expert’ can and his name is Professor Rory Collins FRS. You have to trust him.
  • In trials comparing the efficacy of one brand of statin to another, surprise, surprise, the statin belonging to the company running the trial usually comes out best.
  • Patients, their families and often their doctors witness adverse reactions to statins which disappear when they stop taking them. Experts, however, say there are very few side effects, but for those of you whiners they have a second drug that counteracts the side effects of the first. Eat up your pills like good little health consumers.
  • Experts say that the benefits of statins are “unequivocal”. The British Medical Association, however, begs to differ. The deputy chairman, Dr Chand, himself a victim of statin side effects, warned that giving the drugs to low-risk patients was “a commercialisation device” and not in their interests. Clearly he is no expert ignore him.
  • Last August, a Mediterranean diet was shown to be more effective than statin therapy. But you can’t patent and monetize the Mediterranean diet, so ignore that too.
med-diet-v-statins

An Italian study finds cardiovascular disease patients who consumed this diet were 37 percent less likely to die than patients who didn’t. This effect trounces into the dust the 18 percent supposed reduced risk of death attributed to statins by a 2013 review. read more

“Statins might alter what is written on your death certificate but they are extremely unlikely to change the date.” (Express, Mar 2014)

Vitamin D supplements reduces respiratory infections

In people over the age of 65, acute respiratory infections – such as the common cold, influenza, or pneumonia – can lead to potentially life-threatening complications. In a recent study, participants in long-term care facilities placed on monthly high dose vitamin D supplement had 40% fewer repiratory infections requiring hospital attention than those given placebo. (News Medical, Jan 5th)

Vitamin D supplementation improves metabolic syndrome in mice

Metabolic syndrome can be induced in rodents fed a high fat or high carb diet. However, a new study has shown that the risk is significantly modified by vitamin D supplementation. In a new study (NewsMedical, Dec 22nd) mice given vitamin D at levels equivalent to human dietary recommendations had a reduction in metabolic syndrome.

The beneficial action appears to be via gut bacteria which utilise vitamin D for production of defensins – anti-microbial molecules that help the good bacteria maintain dominance.

“Remarkably, an insufficient supply of vitamin D aggravates the imbalance in gut flora, contributing to full-scale fatty liver and metabolic syndrome.”

That’s all this month folks. Spring is in the air and snowdrops are peeping over the cold ground. UVB 311nm (the light wavelength needed for skin to produce vitamin D) is still a few months off though, so hang tight for a bit.