Terry Wahl’s diet for Multiple Sclerosis

shutterstock_227550832At the Bioceuticals Symposium in Melbourne recently I was fortunate to hear from keynote speaker, Dr Terry Wahl’s on the program which put her Multiple Sclerosis into remission. One of the refreshing things about this presentation was the strong focus on diet first, then exercise second and then supplements. The benefit of this approach is that it isn’t just suitable for MS but also anyone suffering from an autoimmune disease and current indications are that this could be in excess of 20% of the population.

Dr Wahl’s was diagnosed with MS in 2000 and used conventional therapies to manage the symptoms. She deteriorated to the extent that she was in a tilt wheelchair and needing to resign from her position at the hospital. Motivated by the downward spiral and with a background in clinical research she started looking for options in the medical literature and looked more broadly at other degenerative conditions such as Parkinson’s and Huntingdon’s disease. The drug therapies being tested were decades away so her research then led her to vitamins and supplements. What she found was a number of nutrients that slowed the pace of her MS but did not resolve the underlying condition. After discovering Functional Medicine in 2007 she decided to redesign her diet to try and incorporate those nutrients from food. This had such a significant impact that she went from a wheelchair to walking in one year.

The basis of her program is significant dietary change, basically flooding the body with nutrients. This is done by removing gluten, dairy and sugar and replacing it with a lot of nutrient dense vegetables and phytochemical rich fruit as well as small amounts of good quality protein and fats. The program encourages the use of butter which has been demonised for so long although ideally only the butter of grass fed cows so its rich in nutrients. It also includes small amount of organ meats, ideally organic, for their nutrient density. So pate is back on the menu but you can’t eat it with bread!

Key components of the diet are as follows;

  1. Up to 9 cups a day of vegetables and fruit of which ideally 3 cups are green leafy vegetables and 3 cups are sulphur containing vegetables and the remaining are brightly coloured vegetables and fruit.
  2. Small quantities of good quality protein ideally grass fed or organic.
  3. Fermented foods in small quantities initially to assist in feeding beneficial gut bacteria.
  4. Seaweed to provide adequate amounts of the essential mineral iodine
  5. Organ meats such as liver or heart once or twice a week, these should ideally be organic but particularly important to have organic liver as many toxins can be stored in the liver.
  6. Good quality fats such as olive oil and  grass fed butter.

For more information on the specifics of this diet her book is invaluable and she also has many resources on her website including meal plans.

In addition to the dietary changes, adequate sun exposure for Vitamin D as well as regular exercise are critical. Typically exercise is often difficult for MS patients however she recommends working with a suitably qualified exercise therapist to ensure that activity is appropriate and builds up gradually. The advantage is that regular exercise increases the number of mitochondria which assist in building energy, so this is helpful with the fatigue associated with MS and other auto-immune conditions.

Christine Pope is a Naturopath based at Elemental Health at St Ives and can be contacted for appointments on 8084 0081. Christine works with clients to optimise the diet and support them with supplements and herbal medicine.

Are you reacting to your dinner ?

If you constantly have an upset stomach, headaches or skin problems chances are you have thought about whether something you were eating was triggering your symptoms. So what options are there for finding out whether a food is upsetting you ?

The medical testing for allergies consists of either skin prick testing to determine if a substance provokes a reaction or blood testing for antibodies to Immunoglobulin E known as RAST testing. Naturopathically there are a number of other options including an Elimination Diet,  Food Intolerance Panel or Bio Compatability Hair Testing. So what are the advantages of each of these forms of testing ?

Skin prick testing involves scratching the skin with a range of allergens to see what generates a reaction. Usually done by a specialist you do need to be under supervision if a topical reaction causes full on anaphylaxis to an allergen so that you can be treated appropriately. Understandably many parents are not enthusiastic about this option however it does accurately identify  true allergens. A blood test to detect antibodies can be done where the skin prick testing is too invasive. It detects antibodies to specific allergens such as dust, pollens and foods.

Another option for determining intolerances is to use an elimination diet. Basically you eat very simple plain foods for 7-10 days  and then gradually introduce new foods to determine if it provokes a reaction. The elimination diet generally takes up to 6 weeks but has the advantage of being focussed on real food. Ideally you would also exclude any of the foods below that triggered a reaction.

What you can eat on a food sensitivity elimination diet:

  • Vegetables, well-washed (preferably organic), eliminate nightshade vegetable (such as eggplant,tomato and capsicum) if you suspect they are a problem
  • Fruits, well-washed (preferably organic), start with berries initially
  • Meat and fish (preferably organic and free range meats and wild fish)
  • Fats and seasonings – Extra-virgin coconut oil for cooking, and extra-virgin olive oil for dressings and other low-temperature applications, sea salt, herbs
  • Drink: only water (filtered if possible)

Naturopaths often conduct a food intolerance panel which looks for an immunoglobulin G reaction. It’s useful but will usually only tell you about foods you have been eating in the past few months. So if you haven’t had wheat for a year it may not show up.

Recently I have also looked at Biocompatibility Hair Testing conducted by Naturopathic Services. It has the advantage of not requiring a blood test and covers 500 widely available foods including a significant list of health foods. The test is reasonably priced and far less invasive for young children. It also has the advantage of covering foods which the client isn’t currently consuming. Blood testing will only reveal antibodies to a food that you are currently eating.

Other practitioners I know who use the test advised that it was making a big difference in cases involving skin and irritable bowel syndrome, two conditions I see frequently in clinic. Certainly in the last few months I am already seeing some significant changes in symptoms simply from removing aggravating foods from the diet.

If you have any questions about testing for food intolerances email me at Christine@elementalhealth.net.au or you can make an appointment on 8084 0081.

 

 

 

 

 

http://kidshealth.org/en/parents/test-ige.html

Back to grassroots

bigstock_homeopathy_7963486Spending a weekend in Hobart for a homeopathic conference is a good way to really focus on your practice. You query whether there is a better or faster way to get people well. Is someone else going to give you a gem that makes homeopathy crystal clear and straightforward? Well like a lot of homeopathic practice there were a few insights but I still feel I need to do more work and study.

Dr Joe Kellerstein, the keynote speaker, pvovided a good structure for case taking with his four quadrant approach. Reassuringly I recognised most of the key areas and took out of it some useful ways to drill up or down with questioning.

For perhaps the first time at a conference I also quickly recognised the homeopathic medicines presented. Now it was fairly easy with the Solomon Island’s homeopathy by numbers however identifying a homeopathic medicine I rarely use in a complex case was a bit more exciting.

The other aspect of any conference which is always useful is catching up with colleagues, particularly interstate ones who I haven’t seen since the last conference. The last night a few of us headed down to the Lark Distillery for a whiskey tasting and a great seafood meal at The Drunken Admiral. This was a real highlight for me as like so many small business people homeopaths are often isolated and it is good to be reminded that you have a “tribe” .

Usually with courses I am happy if I get one or two useful things which improve my practice. So what did this conference give me? I guess reassurance that I was on track with my case taking and remedy knowledge and perhaps a reminder to reconnect with my homeopathic roots a little more often.

Water Medicine in the Solomons

Island

At the 2014 Australian Homeopathic Medicine Conference in Hobart, Jane Lindsay, a Queensland homeopath, shared her experiences in the Solomon Island’s. Homeopathy was originally brought out by the missionaries from the South Sea Evangelical Church as a way of looking after their own health and that of their congregations over a hundred years ago. Today is is prescribed by 150 dispensers as a primary form of health care for over 60,000 people in the Solomon’s. They use a simple numbering system as the common language is a form of Pidgin English. Symptoms can include such gems as “Belly Stop” and “Belly Run”.

The homeopathic medicines are numbered and the dispensers have simple symptom descriptions to decide which medicine is appropriate. Originally starting with 36 remedies now it has expanded to 51 as changes in the population’s diet and the introduction of vaccines has created the need for additional homeopathic medicines. (Jane also shared that they would love any materia medica’s that were no longer needed as they don’t have access to a lot of books)

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I really resonated with the idea of a simple number of medicines as I am always surprised by how many clients, once they do my first aid workshop, are able to successfully treat a range of illnesses and injuries. My favourite story was a client who travelled to Israel with her small first aid kit and treated her family’s headaches, PMS and stomach upsets.

This system seems to work reasonably well and it really brings into question for me why as homeopaths we seem to have so many medicines (I have over 600 in my own dispensary!!). I really think we might be better off focusing on a smaller group of better understood medicines rather than trying to choose own of the 1000 in our books. Are we over complicating it for ourselves as homeopaths and making it harder to practice?

So what do you think?

How to ensure your child gets the best gut flora.

Beautiful pregnant woman relaxing on grass
Most people think that a baby gets its gut flora during delivery and that C section means they don’t acquire the same beneficial flora. Actually a baby can develop gut flora up to about age four and there are a number of factors that can affect it.

First up it seems that the uterus is not sterile and there is already some gut flora distributed in utero. So if you already have a child with allergies, or you have them, make sure during your pregnancy that you supplement with a good range of probiotics or consume fermented foods regularly but at a minimum for at least two months prior to the delivery.

Spoon Of Yogurt With Blueberries On Top

Breast feeding also passes useful flora to the baby and you don’t really need to breastfeed for that long to see a significant benefit. Solely breast feeding to 4 months was shown by a large scale South Australia study to reduce allergies by at least 25%. I know its often challenging breast feeding and if you have difficulties its really worth speaking with either the nurses at the Early Childhood Centres or the Nursing Mother’s Association, both sources of invaluable support.

If you end up having intervention like a C section or you can’t breastfeed , it may be useful to add a specific probiotic for children, as well.

Minimising antibiotic use during the first few years is also an important way to ensure a stable and resilient gut flora. Homeopathic medicines can make a great alternative treatment for children during the early stages of illness. I often use a combination called ABC mix for parents to assist with fevers and ear infections. ABC mix is three homeopathic medicines known as Aconite, Belladonna and Chamomila and can be a good combination to use with mild fevers or ear pain.

Christine Pope is a homeopath and nutritionist based at St Ives at Elemental Health. She is also Head of Nutrition at Nature Care College at St Leonards. She runs regular workshops on health related topics at her practice and her next workshop is on “Managing Stress” on July 15 with Coach, Cheryl Alderman .

Are probiotics worth the money?

Spoon Of Yogurt With Blueberries On Top

Probiotics seem to one area where even doctors and pharamacists seem to be comfortable recommending that patients take a probiotic with or after an antibiotic. However regular probiotics can help you avoid the need for the antibiotics in the first place.

The Cochrane Collection, which is the gold standard of scientific research, has reviewed 14 clinical trials on probiotics involving over 3454 people. Overall they concluded that probiotics reduced the risk of developing upper respiratory tract infections and reduced the need for antibiotics. Nice to have the scientific evidence however I know from my own practice that a good general preventative through winter is a daily probiotic plus Vitamin C, particularly if your children are in daycare.

Home Made Cultured Or Fermented Vegetables

Probiotics for the whole family may be an expensive option (although getting sick is often more expensive) and some other great ways to include a good range of gut bacteria are to introduce fermented foods. This can be through a good quality yoghurt without a lot of sugar and additives or through regular consumption of fermented vegetables such as kim chi and sauerkraut. If you are interested in making your own fermented foods there are a number of people running workshops – have a look at Georgia at Stirring Change on facebook or Pinkfarm. The ladies at Pinkfarm even provide lists of people with starter cultures who are happy to share.

There are quite a few different strains of probiotics and we are just beginning to understand all the different roles that they can play in terms of keeping our immune system strong as well as in supporting effective digestion. The advantage in using foods is that often there are up to 50 strains or good bacteria in keffir whereas a commercial probiotic will only have a few strains.

There are several strains that we know are useful in the gut and often because they help crowd out problematic strains, such as candida. Some strains are known to be anti-inflammatory such as the lactobacillus plantarum which is often recommended to people with IBS. The predominant strain researched in the Cochrane collection was lactobacillus rhamnosus. If you do have more specialised health problems you may need advice on tailoring the strains to suit your particular needs.

Christine Pope is a nutritionist and homeopath who practices at Elemental Health at St Ives. She can be contacted on (02) 8084 0081. If you are looking for practitioners in other areas of Australia have a look at the metagenics website which lists practitioners who are experienced at working with probiotics and natural medicine.

Research – can we research natural medicine?

A recent blog talked about how easy it was to poke holes in research so with this one I will look at some of the challenges when you are researching natural medicine interventions, such as homeopathy.

First up most clinical trials are set up on the basis of giving a patient one treatment and seeing how it compares to another or to placebo. Most of the time in natural medicine we don’t just give one thing so that does make it difficult to see how a more complex treatment works.

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The first part of a consultation is really listening to your client for 45 minutes to an hour, depending on how long that initial consultation takes. Think about the value of really being heard for up to an hour. This process gives the practitioner time to think about how the whole person is affected by what is happening to them and what may need treatment. Sometimes I find in that time the solutions become clear to the patient and just that process alone can be invaluable in helping them heal.

How do we measure this?  There are tools in which natural medicines such as homeopathy perform quite well .  Valid forms of evidence  including case studies, patient reports of satisfaction , quality of life and observational studies. Here, homeopathy does much better than in Randomised Controlled Trials.

One of the largest observational studies was undertaken by the National Health Service in the UK. It involved a total of 6544 consecutive follow-up patients who were given outcome scores. The patients were all using homeopathic treatment for chronic diseases. Of the patients 70.7% reported positive health changes, with 50.7% recording their improvement as better or much better (1). A similar study undertaken at an Italian hospital in Lucca also showed 74% of patients reporting improvement with the most common conditions being respiratory, dermatological and gastrointestinal.

Isn’t this a better way to assess the value of a treatment like homeopathy?  A research tool which looks at the outcomes for the patient in terms of quality of life and improvement in their health.

 

 

(1) Spence DS1, Thompson EA, Barron SJ., J Altern Complement Med. 2005 Oct;11(5):793-8., Homeopathic treatment for chronic disease : a 6 year University- Hospital  outpatient observational study.

Meta analysis?? Where homeopathy has been shown to work!

 

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Meta analysis – more research jargon I’m sorry but its not really tricky to understand.

Basically a meta analysis can be done when you have a number of studies that look at treatment of the same condition. So if you have a group of clinical trials on childhood diarrhea for example you can then conduct an analysis to see if it was effective across all the groups. This can be useful when the original groups were quite small (a common criticism of natural medicine trials).

There have been seven meta-analysis conducted of homeopathic trials of which six have shown homeopathy to be more useful than placebo. One of the older studies is on childhood diarrhea where there were three studies analysed. Basically what the meta analysis showed was that homeopathy reduced the average duration from 4.1 to 3.3 days as measured by the number of loose stools (1) .  Most people when they have some form of gastro bug are happy for a reduction in the time they spend suffering.

The major homeopathic medicines used in those trials were Podophyllum, Arsenicum album, Sulphur, Chamomilla and Calcarea carbonica – which were used for 78% of cases.

So what other conditions have been shown in meta analysis to be effectively treated by homeopathy? Meta analysis have been conducted for conditions such as allergies, hay fever and upper respiratory tract infections showing homeopathy to be more effective than placebo. Most people who have used homeopathy for those conditions would happily confirm that this is the case.

How do you find out which homeopathic medicine to use to treat acute conditions? I run regular Homeopathic Workshops at my practice in St Ives so come along to a short two hour workshop on May 1 , 2014 from 10-30-12.30  if you are interested. The cost is $99 and you can book in on (02) 8084 0081. Alternatively if you aren’t local  I find the book Homeopathic Self Care a great resource and the author is Reichenberg Ullman – you normally need to order it online from Amazon, but it does cover how to prescribe and up to 70 conditions with self naturopathic suggestions as well.

 

(1)  Jacobs J1Jonas WBJiménez-Pérez MCrothers D., Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials, Pediatr Infect Dis J. 2003 Mar;22(3):229-34. 

 

Research – is it all lies, lies and damned statistics?

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A recent press release by the National Health and Medical Research Council (NHMRC) stated that where there was evidence to support the use of homeopathy the trials were too small and not well designed. Its kind of damning with faint praise isn’t it?? By the way most of the headlines were a lot less favourable but I read the detail of the report.

So I decided to write about research and try and explain what is contained in the report and perhaps shed a little light on the whole process. I did try and avoid a lot of maths in this discussion but this is going to be a little longer than my usual blog as it covers a fair amount of information.

Research – hierachy and different types

First up there is a hierachy in terms of research evidence in western medicine. At the top of the research hierachy is the randomised controlled trial (RCT) , which is regarded as the gold standard of evidence. Unfortunately it takes a lot of gold to meet the gold standard and it will always be more difficult with natural medicine which can’t really patent its findings to generate the types of revenues that fund this standard of research.

How much of western medicine is based on the gold standard of RCT’s? Surprisingly a lot less than you would think. Back in the 1980’s when the Cochrane Collection was established only 10- 15% of drugs in use had been subject to this research. The rest of the time they relied on long term clinical use (kind of like a lot of natural medicine). That number has at least doubled in part due to the efforts of the Cochrane Collection which is an independent research body promoting the use of evidence based research in clinical decision making.

Before you get to the RCT however there are other forms of research which contribute to the picture , this can include case study reports, in vitro research (cells in a test tube), animal studies and cohort studies, case control studies and clinical use. A case study report is usually a report which can highlight problems with an existing treatment or a way of dealing with a case which yields some new information. Studies on cells in test tubes or animals may be done at the start of research. They are  not considered as reliable as human trials as humans may react differently to animals.

Case control studies try to identify what is different between a group who have developed a condition and those who didn’t. They tend to be more cost effective but not always as reliable as a Cohort study where participants are tracked over a long period of time. Try remembering what you were eating like ten years ago? See? Its really not that easy. A Cohort study that tracks it over time can document what you were eating at different times in your life and see if the group who develop a condition were eating differently or eating more of a particular food group.

How do we design an RCT?

Whilst the RCT is the gold standard its fairly hard to find any RCT that is perfect. Typically an RCT is set up to compare one treatment against another or against placebo. You then recruit a group of people to your trial who need treatment for that condition – therefore you need to make sure they have the type of condition that will respond to your drug. To avoid complications you try to exclude people in the research who have other conditions as well. In the US students are often happy to participate in those trial’s as its a good way to earn some extra money.

So is that group of people you have just recruited to your study the same as the group of people who will ultimately take your drug? Quite often people as they get a little older are on multiple medications and they aren’t as robust as the group of students who did the trial.

So in your analysis you have just looked at the recruitment of participants and already you may not be that happy with the design.

See how easy it is to start to poke holes in the design of any trial and I haven’t even looked at numbers of participants yet?

Size of trial

To determine how many people you need in a trial you need to look at what the size of the treatment effect is and then a calculation is done (called a power calculation) to determine how many participants you need in your trial at the end to be able to see that the treatment effect is actually statistically significant.

This means a bigger group doesn’t add up to better research. It tends to mean that the smaller benefit someone gets from treatment the larger the group you need to show that it was  statistically significant and didn’t just occur by random chance. When newer drugs are being trialled against older drugs you often see only small improvements in the treatment so large scale trials will be needed.

Most natural medicine trials are quite small as funding is usually restricted however there are processes in place to ensure that the size of the group is adequate to measure the treatment effect. The NHMRC was generally negative about the fact that so few of the homeopathic trials had in excess of 500 participants but neglected to explain why that may not be necessary. They completely omitted the explanation of power calculations or whether in fact these indicated that smaller studies were still reliable evidence. Sometimes its not all about size!

Natural Medicine and RCT’s

In the next blog I will look at some of the reasons why natural medicine doesn’t fit well into the world of RCT’s. I was going to cover it here but its already a bit long!! Would love to hear your thoughts so please feel free to comment.