The Vital Importance of Sleep

Sleep is such as important function for the human body that it can hardly be emphasised enough. Without deep restorative sleep it is hard to heal from chronic ill health, especially if the brain or neurological system is involved.

A 2015 study published in “Arteriosclerosis, thrombosis, and vascular biology” suggested an association between poor sleep quality and coronary arterial calcification in women only, but decreased brachial-ankle pulse wave velocity, an indicator of peripheral vascular disease, in both men and women.[1] Sleep deprivation is also known to be associated with higher rates of depression[2] and aggression and violence[3], likely due to the changes in brain neurochemicals which it induces.

Common causes for poor sleep quality include a deficiency of calcium and magnesium, poor liver and/or gallbladder function, noctural hypoglycaemia (low blood sugars) and stress or inflammation leading to high cortisol levels. Electromagnetic frequencies (EMF) from wireless internet, mobile phone towers and other sources is another important cause, due to the effect on melatonin production. Chronic inflammatory response syndrome (CIRS) is a cause of insomnia due to inhibition of melatonin production caused by MSH deficency.[4]
In melatonin, we have the most important remedy for sleep. Melatonin is naturally produced from serotonin in the pineal gland on exposure to darkness. It induces and maintains deep sleep. Other neurotransmitters such as GABA and serotonin are important as well.

Supplementing with relaxant minerals such as calcium, magnesium and zinc can assist with sleep. Many people respond to simple herbal tinctures with valerian, passionflower, zizyphys and skullcap, taken around 30 min before bed.

Simple lifestyle changes such as avoiding sweets and caffeinated beverages after around 2pm, plus having an early and light dinner, will often assist with sleep hygiene. Avoiding excessive computer or smartphone use at night is highly recommended. Use of “block blue” glasses at night is a useful strategy for preventing light-induced suppression of melatonin. Dietary changes increasing availability or uptake of tryptophan or foods assisting with production of serotonin and melatonin appear to also be helpful for promoting sleep quality.[5]

If not responding to these simple measures, melatonin can be taken as a slow release formula in dosages between 1mg and 35mg, 30 min before bed. Melatonin also appears to be a strong neuroprotective compound, preserving neurons in cases of stroke[6], traumatic brain injury and spinal cord injury[7]. Sleep deprivation has an effect on the blood brain barrier (BBB), increasing its permeability and susceptibility to heavy metals such as silver and copper.[8] Conversely, melatonin appears to protect the blood brain barrier, and specifically protect against the effect of inflammatory molecule MMP-9 [9], often elevated in CIRS patients. Other medications, such as SSRI or tricyclic antidepressant medications, are best reserved for refractory patients who are unable to sleep despite a trial of all other options.
Enhancing sleep is one of the most basic and important therapeutic inventions in clinical practice, and without it, it is difficult to make significant strides forward in chronic health problems. It is therefore a top priority in an integrative medicine treatment protocol.

[1] Kim CW et al (2015). “Sleep Duration, Sleep Quality, and Markers of Subclinical Arterial Disease in Healthy Men and Women.”. Arterioscler Thromb Vasc Biol 2015 Oc; 35(10); 2238-45.
[2] Jung KI et al (2015). “Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: the Rancho Bernardo study.” Sleep Med. 2013 Jan;14(1):12-9.
[3] Kamphuis J et al (2012). “Poor sleep as a potential causal factor in aggression and violence.” Sleep Med. 2012 Apr;13(4):327-34.
[4] http://www.survivingmold.com/diagnosis/the-biotoxin-pathway
[5] Peuhkuri K et al (2012). “Diet Promotes Sleep Duration and Quality”. Nutr Res. 2012 May;32(5):309-19.
[6] Shinozuka A et al (2013). “Melatonin-Based Therapeutics for Neuroprotection in Stroke.” Int J Mol Sci. 2013 May; 14(5): 8924-8947.
[7] Naseem M & Parvez S (2014). “Role of Melatonin in Traumatic Brain Injury and Spinal Cord Injury”. Scientific World Journal. 2014; 2014: 586270.
[8] Sharma A et al (2015). “Sleep Deprivation-Induced Blood-Brain Barrier Breakdown and Brain Dysfunction are Exacerbated by Size-Related Exposure to Ag and Cu Nanoparticles. Neuroprotective Effects of a 5-HT3 Receptor Antagonist Ondansetron.” Mol Neurobiol. 2015 Oct;52(2):867-81.
[9] Alluri H et al (2016). “Melatonin Preserves Blood-Brain Barrier Integrity and Permeability via Matrix Metalloproteinase-9 Inhibition”. PLoS One. 2016; 11(5): e0154427.

Metabolomics and Chronic Fatigue Syndrome

A ground breaking study took blood samples from a group of 84 clearly defined CFS patients and performed an analysis of 612 metabolites from 63 biochemical pathways.1 Such an analysis is called metabolomics. The metabolites measured were those part of normal biochemical pathways such as steroids, fatty acids, amino acids, vitamins and those related to methylation, mitochondria, microbiome, etc.

Of the 63 biochemical pathways studied CFS patients showed abnormalities in 20. This clearly indicates a state of disordered biochemistry in multiple areas. Pathways showing abnormalities included the following:

Sphingolipid, phospholipid, purine, cholesterol, microbiome, pyrroline-5-carboxylate, riboflavin, branch chain amino acid, peroxisomal, and mitochondrial metabolism.

Of the abnormal pathways 80% showed a decreased level of metabolites which suggests a hypometabolic syndrome. There is a general down-regulation of these biochemical pathways. The abnormalities found were distinctly different to those found in metabolic syndrome and the classic metabolic pattern found in infection, inflammation and environmental stress. The pattern in CFS was highly similar to that found in Dauer, a long term state of decreased metabolism induced in order to survive an environmental stressor.

“These facts suggest that CFS is an evolutionarily conserved, genetically regulated, hypometabolic state similar to dauer that permits survival and persistence under conditions of environmental stress but at the cost of severely curtailed function and quality of life.”

Furthermore a computer model was able to predict CFS vs. controls in 94% of cases in males and 96% of cases in females. This is striking and occurred despite highly variable initial illness triggers. Varied triggers appear to result in similar disordered biochemistry. This may result in a diagnostic test for CFS, something which has been sought after since the 1980s. Since this time CFS has remained a syndrome and a diagnosis of exclusion resulting in significant stigma. This study suggests CFS is a hypometabolic state which can be defined by metabolomics analysis.


  1. Naviaux RK, Naviaux JC, Li K, Bright AT, Alaynick WA, Wang L, Baxter A, Nathan N, Anderson W, Gordon E. Metabolic features of chronic fatigue syndrome. Proc Natl Acad Sci U S A. 2016 Aug 29. pii: 201607571.

Important New Study on CFS and the Microbiome

Researchers from New York recently published an amazing study in the journal Microbiome.1 With 48 ME/CFS patients and 39 controls a sophisticated technique (sequencing ribosomal RNA genes) was performed to comprehensively profile the bacteria within stool samples. Five different blood inflammatory markers were also measured. A number of key findings are as follows.

Firstly as a group all five inflammatory markers were higher than controls:

  • C-reactive protein (CRP) – general inflammation marker.
  • Intestinal fatty acid-binding protein (I-FABP) – marker for gastrointestinal tract damage.
  • Lipopolysaccharide (LPS) – an endotoxin produced from certain intestinal bacteria.
  • LPS-binding protein (LBP) – indicator of LPS stimulation.
  • Soluble CD14 (sCD14) – indicator of LPS stimulation.

The finding of elevated LPS and also elevated levels of markers indicating increased LPS levels is striking as LPS is a potent inflammation inducer. Elevated LPS levels indicate increased levels of intestinal LPS-producing bacteria and subsequent absorption of LPS and inflammation.

Furthermore stool bacterial levels in ME/CFS patients compared to healthy controls was distinctly different. Firstly the total bacterial diversity was low in ME/CFS patients. Increased diversity is generally considered a sign of a healthy microbiome. Secondly a few dozen bacteria were either specifically elevated or depressed in ME/CFS patients as compared to controls. In the image below the bacteria next to the purple bars were higher in ME/CFS patients and the bacteria next to the red bars were higher in healthy controls.

Gut and CFS

Another striking finding of this study is using a computer analysis based on the blood and stool markers, an individuals test results could be correctly predicted as either a control or ME/CFS result with an accuracy of 82.93%.

This study clearly demonstrates an abnormal intestinal microbiome in ME/CFS patients and suggests it’s associated with systemic inflammation. Research in this area is still in its infancy. Systematic inflammation however also affects the intestinal microbiome. Inflammation influences the terrain of the gut which causes an alteration of microbial balance. The findings of this study are likely bidirectional. An unhealthy microbiome triggers systemic inflammation and systemic inflammation from other sources alters the microbiome.

Either way it seems prudent to pay attention to this issue and to do what can be done to encourage a healthy microbiome. Microbiome modification through diet, prebiotics, probiotics, antimicrobial agents and correction of factors causing systemic inflammation will likely prove beneficial to at least some patients. The diet most beneficial for the intestinal microbiome is one which is predominantly whole plant foods.


  1. Giloteaux L, Goodrich JK1, Walters WA1, Levine SM, Ley RE1, Hanson MR. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Microbiome. 2016 Jun 23;4(1):30. doi: 10.1186/s40168-016-0171-4.

Could You Be Suffering from a Chronic Version of Sepsis?

I worked in intensive care medicine for around five years. During this training I was fascinated by sepsis syndrome, or what was now called “Systemic Inflammatory Response Syndrome” or SIRS.

This syndrome often started with a fairly mild bacterial infection which spread to the bloodstream, and triggered a cascasde of events, often causing very low blood pressure, which would require intravenous fluids, antibiotics and even special medications inotropes to raise the blood pressure.

Initially research focused on the initial infection and treating that, however later experience and research really showed that even when the bacterial infection had been treated, there was an inflammatory cascade that was doing most of the damage. It was literally like a fire consuming everything up that came in its way.

Sometimes patients had to be ventilated due to a condition called ARDS where the patient’s lungs filled up with water. Sometimes they needed dialysis due to kidney failure due to poor blood flow. The heart could be affected too at times.

Research found that there are a number of inflammatory markers which are elevated in this syndrome, such as C4a, C5a, TGF-beta and MMP-9. Over in the distant waters of Pokomoke, Maryland, USA, a GP called Ritchie Shoemaker started asking similar questions about why people were getting unwell through contact with the waters of the Chesapake Bay, where fish were dying at the rate of knots.

After a dramatic recovery with a patient prescribed the bile acid binding resin cholestyramine for secretory diarrhoea, the first semblances of a theory came into place. Was some kind of toxin triggering a chain reaction of events, similar to in sepsis, but in a more chronic fashion? Could cholestyramine be binding these toxins and thereby lessening this inflammatory cascade?

Later came alligator kills due to blue-green algae in waterways in Florida. Then patients who were unwell due to exposure to water-damaged buildings. Mould wasn’t supposed to make you sick!

He started testing the same inflammatory markers that the ICU guys checked in patients with sepsis. Most of them were elevated in these folk. Sometimes C4a was in the tens of thousands, which means a major complement cascade was taking place. Due to mould? Surely not…

So if there was a reliable mechanism causing this inflammatory cascade, surely that would mean that a reliable treatment protocol could be created. Hence the birth of the Shoemaker protocol. More importantly it could provide hope to those who had been diagnosed with a disorder such a Chronic Fatigue Syndrome, fibromyalgia and other disorders with no clear biomarkers for diagnosis. And a clear path to recovery.

In the late 2000s a nasal spray of vasoactive intestinal polypeptide (VIP) seemed to be a major breakthrough in lowering cytokine levels, particularly C4a, MMP-9 and TGF-beta-1.

The research has continued to the stage where we have around 20 peer reviewed papers, on what has now being called chronic inflammatory response syndrome (CIRS). And although the research is ongoing, the question needs to be asked with all chronically ill patients with multisystem disorders, “is your patient suffering with a chronic version of sepsis syndrome?”


  • Shoemaker, R.C. & House, D.E. (2005). A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and teratology, 27(1), 29-46. PMID 15681119Full text
  • Shoemaker, R.C. (2001). Residential and recreational acquisition of possible estuary-associated syndrome: a new approach to successful diagnosis and treatment. Environmental health perspectives109 (suppl. 5), 791-6. PMID PMC1240613Full text

Important New Findings on Gluten and Health

Comments from Sandeep Gupta:

I first experienced the fact that many patients who were not diagnosed as having Coeliac disease still appeared to experience significant improvement in their condition with excluding gluten-based grains from their diet around 10 years ago. At the time, the literature on this phenomenon was a little lacking. It’s encouraging to see that more studies are coming out to fill in some of the gaps in knowledge. In this article, nutritionist Blake Graham discusses the recent studies on gluten and health.


A recent case-control study examined the question of whether levels of gluten intake in early life affected risk of celiac disease onset in genetically susceptible children. This study assessed gluten intake at ages 9, 12, 18 and 24 months. Findings indicated those in the upper third of gluten intake had a significantly higher rate, at least two fold, of coeliac disease onset[1]. This study suggests in genetically susceptible children, higher gluten intake in early life is associated with higher rates of celiac disease. Until more research is done it would seem prudent to moderate gluten intake in genetically susceptible children in the first two years of life. Genetic susceptibility can easily be assessed via a blood test for HLA Coeliac gene studies looking for a DQ2 or DQ8 haplotype. Whether this means that adult patients with a genetic predisposition are better off to exclude gluten, it is not clear.

For years controversy has existed surrounding the condition known as non-coeliac gluten sensitivity (NCGS). This is a condition in which people react to gluten but do not meet the criteria for celiac disease. Some have doubted the existence of NCGS. The authors of a widely circulated Australian study in 2013[2] sparked much heated debate suggesting NCGS likely does not exist. However this study has significant limitations, including only sampling of a narrow group of patients; those meeting the diagnostic criteria for irritable bowel syndrome (IBS), and focusing on intestinal symptoms rather than a broad range of intestinal and non-intestinal symptoms. A more recent and broad study enrolled a group of people who believed they have NCGS and symptoms following even low doses of gluten.[3] They were given a gluten free diet for a week and then randomized into groups either receiving gluten or rice starch in capsules. The group receiving gluten capsules had significantly higher rates of abdominal bloating, abdominal pain, foggy mind, depression and mouth ulcers. This tends to strongly support the idea that NCGS is a real clinical entity, although more research will clarify the issue.

Connective tissue disorders such as systemic lupus erythematosus, systemic sclerosis and Sjögren’s syndrome have been considered commonly associated with gluten sensitivity in the functional medicine community for some time. A recent Italian study found a high incidence of celiac disease in this population.[4] Some had no intestinal symptoms. Fatigue and myalgia quickly reduced after gluten elimination. All patients with connective tissue disorders should be tested for celiac disease and also tested for NCGS via elimination/provocation. Well known functional medicine pioneer Dr. Leo Galland reported years ago almost 100% of his Sjögren’s syndrome patients had some form of gluten reactivity.[5]

A number of studies have helped more clearly elucidate the mechanism by which gluten can damage the intestinal lining in susceptible individuals.[6] In gluten sensitive people gluten molecules first bind to specific receptors called CXCR3 which then triggers the release of zonulin. Zonulin opens up the spaces between cells to allow more fluids to be flushed into the intestines to flush out the perceived toxins. This increased intestinal permeability then leads to chronic inflammation and auto-immunity.  Although this mechanism is probably protective in the case of bacteria such as cholera, in the case of gluten exposure, it appears to set up chronic intestinal inflammation. Blood tests for zonulin are now available through certain specialty functional medicine laboratories.

Clinicians such as Shoemaker have observed a connection between non-Coeliac gluten intolerance and low levels of regulatory hormones such as Melanocyte Stimulating Hormone. This is an area that deserves further research. More on this topic soon.

And finally a recent animal study showed that gluten may contribute to weight gain in those on a standard or high fat diet, by reducing thermogenesis of fat cells. [7]

 Closing comments from Dr Gupta:

Fascinating information. I do believe it is very important for patients to be properly checked for coeliac disease by a doctor before ceasing gluten grains of their own volition, as Coeliac disease calls for a very strict gluten free diet, and also has a risk of small bowel lymphoma that needs to be screened for regularly. So there is a difference between Coeliac and non-Coeliac gluten intolerance, and it pays to know it.


[1] Andrén Aronsson, C et al. Effects of Gluten Intake on Risk of Celiac Disease: A Case-Control Study on a Swedish Birth Cohort. Clin Gastroenterol Hepatol. 2016 Mar;14(3):403-409.e3.

[2] Biesiekierski, JR et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013 Aug;145(2):320-8.

[3] Di Sabatino, A et al. Small Amounts of Gluten in Subjects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Clin Gastroenterol Hepatol. 2015 Sep;13(9):1604-12.

[4] Cont,i V et al. High prevalence of gluten sensitivity in a cohort of patients with undifferentiated connective tissue disease. Eur Ann Allergy Clin Immunol. 2015 Mar;47(2):54-7.

[5] Galland, L. Gastrointestinal Dysregulation: Connections to Chronic Disease (Functional Medicine Clinical Monograph). 2008

[6] Pizzorno, J. Zonulin! The Wheat Conundrum Solved (Well, Mostly …). Integrative Medicine • Vol. 12, No. 4 • August 2013.

[7] Freire, RH et al. Wheat gluten intake increases weight gain and adiposity associated with reduced thermogenesis and energy expenditure in an animal model of obesity. Int J Obes (Lond). 2016 Mar;40(3):479-86.


How To Cope Emotionally With Chronic Illness

Introductory comments by Dr Gupta:

I have recently been struck by the tremendous amount of suffering that those with a chronic disease may go through. In addition to the direct effect of the symptoms such as pain, fatigue, insomnia, anxiety and depression, the additional burden of loss of employment, loss of financial security, isolation, loss of relationships and lack of understanding of chronic illness by those around the affected individual can also take their toll. I can feel the effect these factors also have on the chronically ill individual. This paints a pretty sad picture of chronic disease. However I have met several individuals who have managed to rise above this predicament, and find great meaning, insights, new friends and even contribution to the community through their brush with chronic illness. What separates an individual who succumbs to the suffering of chronic disease vs those who are able to rise above it? In this article nutritionist Blake Graham, himself a chronic disease sufferer, discusses some specific techniques which can help a person with chronic disease to move into the latter category.


  1. Mindfulness. Mindfulness is a state of detached awareness of the present moment, specifically of your thoughts and emotions. It is a skill that one can learn. A person can learn to recognize the thoughts in the mind as just a story in your head rather than becoming identified with them. It is simply observing the thoughts without identifying with them or trying to change them. Mindfulness can be done both as a practice during the normal moments of life and as a specific meditation where you spend a period of time simply being mindful of your thoughts. When a person notices they are stressed they may simply observe that there is a dialogue of stressful thoughts going on in their head. See ‘Mindfulness with Jon Kabat-Zinn’.1
  2. Non-resistance/surrender. A great majority of our mental suffering comes not from the situations in our life but from our mentally resisting and fighting these things. Non-resistance or surrender is a practice and a skill in which a person learns to let go of resistance to what is occurring. In the long term you are proactive in making positive changes, but in the present moment you specifically choose to accept and not resist whatever is occurring. If you are stressed or upset ask yourself “what am I resisting right now?”. Once you have your answer chose to let go of this mental resistance and accept the moment as it is. See ‘Eckhart Tolle – Acceptance and Surrender’.2
  3. Meditation. Meditation when done consistently has a cumulative effect on reducing the intensity of our negative emotions. What may have previously caused you 7/10 stress response, now may cause you only 2/10. There are countless forms of meditation – breathing, mantra, visual, kinaesthetic, mindfulness, etc. and forms which have combinations of multiple elements. Or if you are not the type to sit still you may prefer tai chi, often referred to as moving meditation. The key to benefiting from meditation is to find a style that you enjoy and find effective, and do it daily so you can see the cumulative long term benefits.
  4. Connection. Illness may result in a person not being able to work and impact heavily on their social and family life. A key to human happiness is connection with others. It is key to cultivate meaningful relationships, which may be in person, via phone, Skype or online.
  5. Fun/pleasure. Some people with chronic illness fall into a bad pattern of spending their days surfing social media and watching whatever is on TV. It’s important to do an honest assessment of how you spend your days and plan your day to emphasize things that you truly enjoy and provide you a deeper sense of pleasure than following a path of least resistance.
  6. Meaning/productivity. Humans require some sense of meaning in their life. If you spend your days doing nothing but watching TV and checking social media, then you will likely feel an emptiness. It is important to do something with your time that gives you some sense of meaning, passion and productivity. This could be you use your time to continue to gain knowledge in areas that relate to your future career or a passion of yours. Read inspiring books. Take up something you have always wanted to, such as art or meditation. Work on healing your past and personal development. Grow emotionally and become more involved in your spirituality. This will give you a sense of making the most of the situation and giving meaning in your life which will lift your mood.



  1. Mindfulness with Jon Kabat-Zinn. www.youtube.com/watch?v=3nwwKbM_vJc
  2. Eckhart Tolle – Acceptance and Surrender. www.youtube.com/watch?v=y9JgLgBtV-M


Closing comments by Dr Gupta:

While the above tools are extremely useful, I would like to point out that despite the best techniques and best intentions there may simply be times in life where one simply isn’t OK. Despite realising that suffering is impermanent, or that we “aren’t our story” and that attitude is a critical factor, there may be times when we simply can’t see a way forward or hope on the horizon. I do encourage you to reach out to other people when this is happening. There is no need to berate ourselves if we aren’t able to adopt a higher view of the situation in some circumstances. This is simply how it is, and we may need to listen to ourselves, give self-empathy, and simply be with our pain. Reaching out for professional help is also worth considering in such situations. Lifeline phone support line, utilising the services of a professional counsellor, and/or chronic illness support groups are worth considering.


Holistic Solutions For Menopause

Health-wise and also emotionally, menopause can be an extremely difficult period in a woman’s life. The menopause and peri-menopause (which includes the years leading up to menopause) can require a few tricks to navigate successfully from a health perspective. Important factors can include supporting the thyroid gland, ensuring optimal nutrition (including removal of toxic non-foods), including regular exercise, adequate fluid and detoxification techniques. Regular meditation combined with yoga can be highly beneficial as well.[1]


In addition, hormone balance can play an extremely important role for many women at the time of menopause. Although the Woman’s Health Initiative and other similar studies reported a high level of risk with synthetic hormone replacement therapy (HRT) several more natural approaches appear to be safe and beneficial.[2]


Supplementing with minerals such calcium, magnesium, silica and boron plus vitamin D and K plus vitamins C and B12 can greatly help with optimising bone density. The combination of the combination of resveratrol, tryptophan, glycine and vitamin E may represent an effective combination for treatment of sleep disturbance and irritability in the peri and post-menopause.[3]  Herbal formulas such as vitex agnus-castus to increase progesterone levels, black cohosh or red clover to optimise estrogens, and kava, passionflower, valerian and skullcap to help with anxiety and insomnia require more study, but may represent useful complementary approaches for dealing with menopausal symptoms in clinical practice.[4]


The use of bio-identical progesterone replacement for example has come under investigation recently and a recent review study showed that bio-identical progesterone as opposed to synthetic progesterone (MPA) enhances, or at least doesn’t negate favorable effects of oral estrogen on blood cholesterol levels. Bio-identical progesterone as opposed to synthetic progesterone also does not increase blood sugar levels when combined with oral estrogen.[2]


“Smaller controlled studies have shown a positive effect of micronized (bio-identical) progesterone on sleep, mood, and fluid balance diuresis, in contrast with MPA (synthetic oral progesterone) which may cause depression and fluid retention.”[2]


Why is this? Advocates have explained that while synthetic progesterone have a similar effect to natural, bio-identical progesterone in the uterus, the effects of the synthetic progestins are totally different outside the womb. This is because the molecules are totally different. So the key (the synthetic progesterone molecule) will only fit in the lock (progesterone receptors) in some cases, and in many cases blocks the lock, so that the bodily produced progesterone no longer works.


So while progesterone is a natural enhancer of a healthy cholesterol and blood sugar profile, is an anti-anxiety, fluid-removing and sleep-enhancing molecule, synthetic progestins such as MPA often do the opposite, and can cause depression and fluid retention. The answer seems to be to mimic nature.


Transdermal (cream) forms of estradiol, one of the natural forms of estrogen appear to also have beneficial effects as compared to oral synthetic estrogen. This may be due to the lack of high concentrations of hormone having to be metabolised by the liver, a step which is known as “first pass metabolism” and may put stress on liver function. Also levels of hormones tend to be much more constant when delivered by transdermal or troche (a chewable gum which acts like a cream for the mouth) rather than oral administration. [5]



“In conclusion, while all types of hormone replacement therapies are safe and effective and confer significant benefits in the long-term when initiated in young postmenopausal women, in specific clinical settings the choice of the transdermal route of administration of estrogens and the use of natural progesterone might offer significant benefits and added safety.”  [5]






[1] Cramer, H et al (2015). Yoga and meditation for menopausal symptoms in breast cancer survivors-A randomized controlled trial. Cancer. 2015 Mar 4. 121(13): 2175-2184
[2] Sood et al (2014). Prescribing menopausal hormone therapy: an evidence based approach. Int J Womens Health. 2014; 6: 47-57
[3] Parazzini, F. (2015). Resveratrol, tryptophanum, glycine and vitamin E: a nutriceutical approach to sleep disturbance and irritability in peri- and post-menopause. Minerva Ginecol. 2015 Feb; 67(1):1-5.
[4] Peng W et al (2014). Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making and communication. Menopause. 2014 May: 21(5): 536-48.
[5] L’hermite M et al (2008). Could transdermal estradiol and progesterone be a safer postmenopausal HERT? A review. Maturitas. 2008 Jul-Aug; 60(304): 185-201.

The Pros and Cons of Internet Chronic Illness Support Groups

I have been surprised to find that the internet, and particularly Facebook, now hosts a range of support groups for almost any type of chronic illness. Often there are no admission criteria, so the diagnosis may not have to be made formally for an individual to join a such support group. Instead the members may be self-diagnosing or dabbling with a diagnosis. On the upside sometimes there is quite innovative information available in these groups, but the information presented is not always balanced or scientific.


Depending on various factors being part of one of these support groups can have both positive and negative consequences for the patient. A systematic review of studies on online support groups found a lack of evidence to support their benefit or detriment due to a lack of quality studies evaluating their effect in isolation.1



  • Social support/easing loneliness. Many with chronic illness are unable to work, socialise and participate in family functions as they once did. Feelings of isolation and loneliness are common. Interacting with and forming friendships with people on Facebook or other forum platforms can help dramatically in this area and is a lifeline for many people. There is often comradery and closeness among fellow patients that is powerful and people discover an amazing source of support.
  • Understanding/recognition. Many people feel that their friends/family/partner do not understand what they are going through. Chatting online to others in similar situations can provide needed understanding about ones symptoms and the challenges that result from them.
  • Information. Facebook groups can be a valuable source of information. People may share books, videos, articles, health professional recommendations and treatments which have helped them in similar situations. This can be valuable in areas of medicine that are new, innovative or on which information is not readily available.



  • Identification with the sick role. If you frequent these groups a lot you may find that your identification with your illness, and the role of being unwell, increases. This can play a detrimental role mentally, as identifying with your illness and adopting it as part of your personality may be an obstacle to recovery. This is due to the fact that there can be a secondary gain in staying unwell, as it maintains this newly formed identity.
  • Politics. Some groups carry politics of different points of view, different camps, and there can be negativity and rivalry between groups.
  • Excessive use. Some people use these groups excessively, displacing non-health related and more enjoyable activities. In some instances people can end up spending the bulk of their time reading and talking about their illness, or chatting on Facebook, or being involved with awareness raising. Overly focusing on thinking about health problems and having a lack of more pleasurable activities in your day can have a negative effect on a person’s emotional wellbeing. Facebook and social media addiction are probably an under-recognised problem, particularly in teens and young adults. Here is another article about this phenomenon.
  • Negativity. Some groups are very negative. Depending on the group and your reaction, you may find scrolling through recent posts leaves you feeling hopeless, fearful or overwhelmed about your situation, or simply in a low mood due to spending your time reading negative posts.
  • Misleading or incorrect information. Of course not all information posted by others is good information or good for you. Some people have heard others speak about specific treatments and tried them only to worsen their health. Others have avoided treatments which may be beneficial to them due to reading inaccurate and one sided reports about them.
  • Information from people with a financial or other agenda. Some people may post information due to an agenda to gain sales, gain popularity for their book or website or to promote a personal theory. Their information may be lacking scientific or even anecdotal support.
  • Delaying seeking professional advice. In some instances posting to a internet support group about your symptoms can provide a false sense of reassurance, while really contacting your health professional is a much more appropriate line of action. In some cases, this could delay seeking life-saving emergency treatment or advice. Even though this may be rare, it is worth being aware of.



  1. Gunther Eysenbach et al. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ 2004;328:1166.

Recipe for a Healthy Home

Since I’ve last posted we have been through quite an adventure with finding a healthy home to live in and conduct our holistic medicine clinic from. This has included having to break a contract of purchase on an acreage which we had our hearts set on for a number of reasons related to home health. As a result I thought I’d share our learning so that all of you have the benefit of knowing what not to do when moving house.


Some of the important elements to look for in a home or office are:

  • The absence of previous water damage. This is probably the most important and relates to the fact that buildings which have been effected by the ingress of water have a number of different byproducts which can deleteriously effect health of the indwellers. These include:
    • mycotoxins, the biotoxins produced by mould species
    • bacterial exotoxins
    • microbial volatile organic compounds (mVOCs)
    • volatile organic compounds (VOCs) which have been produced by microbial effect on eroding building materials
    • mould fragments and spores
  • The absence of high levels of non-ionising electromagnetic fields including magnetic fields due to nearby power lines, electric circuitry or smart meters and electromagnetic fields due to nearby wireless internet, mobile phone towers etc
  • The absence of asbestos in building materials


These factors appear to be important to everybody however there are certain people that will need to be extra careful with regards to exposure to a water-damaged building. This includes those with impaired HLA genetics. HLA stands for “human leucocyte antigen” and relates to our ability to deal with and successful eradicate foreign substances from our bloodstream. Those with impaired HLA DQ/DR genetics (you can have this checked with a “Coeliac gene disease test” with Labcorp in the USA or from a Sonic group laboratory in Australia), exposure to a water-damaged building can be a recipe for health disaster. More about this soon….


Could You Benefit From An Urine Organic Acids Test?

Urine organic acid testing can be an amazing tool. The more I have delved into this test, the more I have started to feel that no other test exists which provides such a wealth of information about a broad range of issues.


In doing an organic acid test a first morning urine sample is collected and sent to a specialty lab. Urine is then analysed for levels of 40 different chemicals, depending on the laboratory you send it to. These 46 chemicals are naturally produced within our bodies. Elevated or low levels can point to blockages in specific chemical pathways. As one simple example, the active forms of the B-vitamin folate are required to convert FIGLU into glutamate (see figure 1). When folate is functionally lacking this creates a kind of “bottle neck” in this chemical pathway, causing a relative backlog or accumulation of FIGLU. Elevated FIGLU is a sensitive marker for folate deficiency. This is called functional testing, as it specifically tests the functioning of a nutrient or chemical pathway in the body.


Figure 1. FIGLU/folate pathway.




Figure 2. Sample section or organic acid report, B vitamins section. In this case xanthurenate was high indicating a B6 deficiency.


B complex vitamins








Along these lines the various substances tested for in the urine organic acid test can point to imbalances in the following areas:

  • Functional vitamin and mineral status
  • Amino acid insufficiencies like carnitine and NAC
  • Oxidative damage and antioxidant need
  • Phase I & Phase II detoxification capacity
  • Neurotransmitter levels (serotonin, dopamine, noradrenaline)
  • Mitochondrial energy production
  • Methylation sufficiency
  • Lipoic acid and Coenzyme Q10 status
  • Intestinal bacterial and yeast overgrowth


Organic acid testing can help elucidate the causes of a client’s symptoms. It helps take the guess work out of treatment. For example published research shows many people with migraines experience symptom reduction with Co-enzyme Q10 supplementation to improve cellular energy production. However this only applies to some with migraines, an organic acid test can assess if a specific intervention is relevant to an individual, thereby making treatment individually tailored rather than a one size fits all approach. We are able to prioritize treatments based which key issues are showing imbalanced in your test.



  1. Genova Diagnostics. Organix Comprehensive Profile. www.gdx.net/product/organix-comprehensive-profile-metabolic-function-test-urine
  2. Laboratory Evaluations for Integrative and Functional Medicine. 2008. Richard Lord.