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Is modern life responsible for skin conditions?

Posted on March 5, 2018 by Ananda Mahony

The skin is a protective barrier between the outside world and our internal processes. Living on the skin is a whole world of microbes otherwise known as the skin microbiome. This bacterial world plays a key role in maintaining skin health and those that inhabit our skin surface have many beneficial roles, both topically and more internally. Significantly the impact of dysbiotic, out of balance bacteria on the skin isn’t just felt locally either. Skin dysbiosis has been associated with local and systemic immune dysregulation and allergic conditions such as eczema, food allergy, psoriasis, rosacea, acne and skin ageing.

Healthy skin microbes have many beneficial roles:

Inhibits pathogen overgrowth e.g. staph, strep or p. acnes.
Enhances immune activity
Maintains healthy skin cell development and integrity
Modulates local skin stress responses including cortisol production
Regulates inflammation
Supports the skins innate antioxidant system, which helps protect against the impact of environmental toxins and allergens.

Similarly to the gut, the microbiome of the skin is greatly influenced by the environment and behaviour. Recent research suggests that modern life practices can disrupt of the delicate microbiome balance, altering barrier function and immunity and driving the overgrowth of detrimental bacteria. The combination of such factors helps in turn to drive the development of skin disorders.

So what are the key factors that disrupt our normal skin microbiota?

In infants, early bathing and the use of soaps, detergents and body washes can disrupt normal skin microbe colonisation and predispose infants to skin disorders.
The use of anti-bacterial body care products including hand washes can reduce skin barrier protection potentially allowing toxins and pathogens to pass through the skin and into the body. Such products are commonly used in healthcare for necessary hygiene but also more recently they have been widely promoted in schools e.g. anti-microbial hand washes.
Overuse of antibiotics can change the balance of skin bacteria.
Reduced exposure to nature impacts on the skin microbiome. Both the soil and plant materials are a source of bacteria. Those living in urban environments have less exposure to and contact with nature. Those living in close contact with nature have less skin disorders. (N.B. the impact of nature on stress responses may also impact on this relationship).

Time spent in nature is always well spent!

Based on this review, what then can we do to support our skin microbiome?

Spend more time in nature or green spaces in urban environments e.g. visit a national park or reserve, build or create a garden, transform vacant lots in your local area or contact your local council about natural streetscapes or kerbside gardens.
Grow indoor plants. They help with air quality as well as ‘bringing the outside in’.
Reduce the use of anti-microbial body and hand washes. Use regular soap instead.
Clean effectively but avoid anti-microbial sprays or cleansers in the home.
Avoid excess or early bathing with soaps or detergents in young infants. In very young infants a wet flannel wash or bath once a week is often enough. No soap is needed.
Avoid anti-microbial nappy wipes.
Avoid over-washing as an adult. Use soap where necessary on the body (armpits, groin, feet as necessary) but don’t use it on body parts that just don’t need it.

Reference:

Prescott SL, Larcombe DL, Logan AC, et al. The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organ J . 2017;

Posted in acne, Psoriasis, Rosacea, Sensitive Skin, Skin Health | Tagged healthy microbiome, Psoriasis, skin microbiome, well-being

A new culprit in Type 2 Diabetes

Posted on March 1, 2018 by Ananda Mahony

Fat rather than sugar may be the most significant culprit in the development of diabetic neuropathy in Type 2 diabetics. Diabetic neuropathy is the most common complication of diabetes. It can occur anywhere but commonly in legs and feet leading to symptoms such as numbness, loss of sensation and pain. The accepted understanding of peripheral neuropathy in both Type 1 (T1D) and Type 2 diabetics (T2D) is that chronically high blood sugar levels cause it, which results in damage to nerves.

In a study of TID and T2D, magnetic resonance images (MRI) were used to see if there were different associations between neuropathic symptoms and metabolic indices including blood sugar control and lipid metabolism. What emerged is that there are differences in the type of nerve damage between T1D and T2D and further that the damage is likely to be caused by different metabolic factors. In TID the association between loss of nerve conduction and poor blood sugar control was strongly confirmed. However in T2D the predominant nerve lesions were associated with changes in lipid metabolism including elevated serum triglycerides and reduced HDL (healthy cholesterol) rather than poor blood sugar control. It is important to note that in T2D poor blood sugar control and unhealthy lipid metabolism occur hand in hand, which means that improving glycaemia control is still central to effective management of T2D overall. However, it now seems that focussing on healthy lipid metabolism may also become a central treatment focus in T2D with the aim of helping to prevent the progression of diabetic neuropathy.

While this research is still in the investigative stages there is great benefit from eating a diet that promotes healthy cholesterol ratios including these suggestions:

Choose olive oil instead of margarine, butter or mayonnaise.
A daily serving of nuts or avocado promotes a healthier cholesterol ratio.
A Mediterranean style-eating pattern also promotes health ratios.

Article Reference:

Jende, J. M., Groener, J. B., Oikonomou, D., Heiland, S., Kopf, S., Pham, M., … & Kurz, F. T. (2018). Diabetic neuropathy differs between type 1 and type 2 diabetes Insights from magnetic resonance neurography. Annals of neurology.

Posted in Chronic pain management, neuropathy | Tagged diabetic neuropathy, fat and sugar, nutrition

You are what you eat in chronic pain

Posted on February 20, 2018 by Ananda Mahony

Over the last decade we have seen a flood of evidence linking a poor diet with chronic health conditions. But what about chronic pain? Until recently the role of diet in relation to chronic pain in most areas has been marginalised particularly when it comes to treatment strategy. However, we are now seeing some directly links between diet and pain and the importance of diet is emerging. The research highlights below are from a recent neuroscience conference in the USA:

Omega 3 and 6

A diet high in omega 6 from processed and fried foods may directly interact with danger sensing neurons by boosting the activity of a protein called TRPV1. This protein detects hot temperatures and potentially harmful substances such as capsaicin from chili peppers (e.g. hand under boiling water, hot chili burning skin). Researchers have hypothesised that a diet rich in processed omega 6 fatty acids leads to increased pain by interacting with these proteins and increasing their activity.

By contrast other research has shown that a diet rich in omega 3 fish oils may have the potential to improve pain thresholds and reduce sensitivity in neuropathic pain in a diabetes model.

Dietary Pattern

An interesting study looking at the impact of diet on recovery times after injury compared the Standard American Diet (SAD) to both an Anti-Inflammatory Diet (AID) rich in omega 3 and plant-based foods and a regular diet. The results showed that a regular diet shorted recovery by up to 50% and an AID even sooner. However, when a regular diet was eaten during the week but a SAD eaten on weekends, recovery times were the same as eating a SAD all week.

Gut Bacteria

Following up from the above researchers then wanted to determine how the AID makes such a positive impact on recovery times. The key may be gut bacteria. Those eating an AID have a broader category of healthy bacteria compared to those eating a SAD. Essentially the percentage of bacteria in the gut is skewed towards bacteria that promote inflammation in a SAD.

Sugar & Sweeteners

By now we all know sugar is addictive but researchers have also shown it impacts on the pain-relieving effect of medication, specifically oxycondone (an opioid). Animal research warning! Rats fed a diet high in corn syrup had a blunted response to oxycondone (i.e. less pain relief) and in addition had a increased risk of addiction to the drug itself.

On a practical level take outs from the above research could be distilled as below:

Shift the balance of fatty acids in your diet by consuming fresh, cold pressed vegetable oils such as olive oil (as opposed to seed oils) and eat oily fish regularly (salmon, tuna, mackerel, anchovies and trout). I choose the smaller fish to reduce the risk of environmental toxins.
Avoid processed oils and foods generally.
Have an anti-inflammatory eating pattern. For those in acute or chronic pain it might mean eating this way for 95% for a period of time at least. For general health, choose to eat an AID for at least 19 of 21 meals a week (3 meals x 7 days).
Take a leaf out of Sarah Wilson’s book/s and give up or at least reduce sugar. It is addictive and may increase addiction to other substances.
Support your microbiome with foods rich in polyphenols and prebiotics e.g. wild rice, blueberries, stewed apple, cooked and cooled starchy vegetables and rice, garlic, onion and a wide variety of vegetables.

Posted in Chronic pain management, nutrition | Tagged chronic pain, diet, fruit and vegetables, healthy nutrition and diet

Stress impacts our gut bugs

Posted on December 7, 2017 by Ananda Mahony

A new study from Nature Scientific Reports indicates that stress may be as unhealthy to our gut microbiota as a bad diet. The study was carried out on animals but may have implications for humans. The researchers set out to evaluate the factors that impact on the gut microbiota and found that female mice exposed to stress showed significant changes to their microbiota: the changes in the composition of gut bugs looked like they had been eating a high fat diet.

While we often think that stress has a mostly psychological effect, this study highlights the physical impacts. Interestingly male mice didn’t respond in the same way as females. As opposed to the female mice, higher anxiety and a negative stress response was seen in male mice fed on a high-fat diet. Only in the female mice did stress shift the microbiota as if the animals were being fed high fat foods.

So apart from eating a gut-healthy diet, stress management may be a powerful way of helping to maintain a healthy gut microbiota, thus reducing the risk of the growing list of diseases linked to gut dysbiosis.

Go outside and play!

Reference:

Bridgewater, L.C., Zhang, C., Wu, Y., Hu, W., Zhang, Q., Wang, J., Li, S. and Zhao, L., 2017. Gender-based differences in host behavior and gut microbiota composition in response to high fat diet and stress in a mouse model. Scientific Reports, 7(1), p.10776.

Posted in Health Tips, IBS, Stress | Tagged gut bugs, microbiota, stress

Holistic Pain Management Podcast 2

Posted on November 22, 2017 by Ananda Mahony

This podcast is a follow up to Holistic Pain Management Part 1 and in it Andrew Whitfield-Cook and I discuss some of the treatment strategies that are employed as part of a holistic approach to chronic pain.

Holistic Pain Management Part 2

From FxMedicine: “Chronic Pain affects around 15-20% of the population, with huge monetary and psychosocial burdens on the patient and the community around them.

Today we welcome back Ananda Mahony to cover Part 2 of Holistic Pain Management. Today Ananda dives in to the evidence-based herbal and nutritional interventions for pain as well as the other modalities that can be employed successfully to help improve patient’s wellbeing and quality of life.”

If you missed it, you can find Part 1 here.

Covered in this episode:

[00:45] Welcoming back Ananda Mahony
[02:26] A multi-modality approach to pain
[03:59] The costs of pain management
[07:23] Evidence for herbal medicine for pain?
[08:58] Evidence and mechanisms for curcumin
[15:16] TLR4 and gut health links
[17:29] Anxiolytics: modifying pain perceptions
[20:05] The mechanisms of magnesium
[22:41] Quelling immune involvements in pain
[24:53] Neuroplasticity
[26:10] Exercise and pain management
[30:31] Role of “mini brains”
[33:06] Mitigating opioid dependence using herbs
[38:24] Drug therapies: opportunities or issues?
[41:44] Resources for further education

Posted in Chronic pain management, neuropathy, nutrition, pain psychology | Tagged chronic pain, chronic pain treatment, low back pain, mindfulness, nutrition, wellbeing

Orange glasses improve sleep

Posted on October 16, 2017 by Ananda Mahony

Over the last few years my sleep can go through bad patches and during these times I can have difficulty falling asleep or wake through the night. I no longer feel stressed by this as I once did and I have done much to improve my sleep however I am always interested in research about improving sleep quantity and quality. So as someone that can be found on my ipad watching SBS Nordic Noir of an evening I read this recent trial published in Ophthalmic & Physiological Optics with interest.

The study followed 22 people between the ages of 17 and 42. For 2 weeks the participants wore blue light blocking glasses for 3 hours before bed while participating in usual digital screen activities (TV, phone, tablet or other). The outcomes were significant and showed an average of 58% increase in melatonin levels, an effect that is greater than over the counter melatonin supplements. Melatonin is our key sleep hormone and it signals to our bodies when it is time to sleep. During the trial the participants reported better sleep, decreased sleep latency (faster sleep onset) and increased sleep duration of up to 24 minutes per night.

Blue light exposure comes from sunlight and LED devices. Exposure during the day is healthy as it boosts alertness and regulates our internal body clock (circadian rhythm) essentially telling us when to sleep and when to wake. However artificial blue light exposure at night has been shown to reduce sleep quality and quantity, as well as the regenerative quality of sleep. Artificial blue light activates photoreceptors in the brain which suppress melatonin, which is ideal during the day but at night impacts on our sleep regulation. Less melatonin is produced or it is produced later in the evening, which in the short term means we get reduced sleep signals or get them later in the evening and in the long term can disrupt sleep and wake cycles.

Based on this study I am participating in my own clinical trial with an ‘n’ of 1 (n = 1 means there is only one person in the trial so this is a bit of a nerdy research joke). A very un-cool pair of orange glasses arrived in the mail and I have been wearing them as per the trial over the last week. They look particularly good over my reading glasses! The first few nights of wearing them I was feeling sleepy up to an hour earlier than usual. Time will tell if they are effective in the long term but when I give into the sleep signals I am getting to sleep earlier and thus sleeping longer overnight. So far so good. I think orange glasses may just become de rigueur in my household!

Posted in Insomnia | Tagged blue light blocking, Insomnia, orange glasses

Black Seed Oil – the skin wunderkind

Posted on October 9, 2017 by Ananda Mahony

nigella Corticosteroids are a cornerstone of topical treatment in most inflammatory skin conditions. However, this treatment comes with the potential for significant risk including thinning of the skin, development of spider veins and suppression of normal stress responses via the hypothalamic-pituitary-adrenal axis. So recently when a client of mine (thank you!) sent through a study outlining the use of Nigella sativa seed oil (Black seed oil) on psoriasis-like lesions I was thrilled. I then went searching for other reports of its use for similar conditions and came up with lots of research with great potential.

Black seed oil is native to Asia and has been used traditionally in the Middle East and Southeast Asia as a topical and oral herbal medicine. Studies on Black seed oil have showed that it has a wide range of potentially therapeutic effects: immune-stimulatory, anti-inflammatory, antimicrobial and antioxidant. Even more significant, the specific potential of Black seed oil with regard to skin health is extensive:

Anti-microbial – studies have shown Black seed oil to be anti-microbial against a wide range of microbes, particularly multiple-antibiotic resistant bacteria (Staphylococcus aureas, pseudomonas and e. coli). A study in newborn babies with pustular Staph infections showed that use of a low dose 33% concentration of Black seed oil was nearly as effective as a standard topical antibiotic with no side effects.
Anti-fungal against Candida yeasts.
Promotes wound healing by reducing inflammation and local infection, allowing the skin to heal.
Anti-inflammatory in a range of skin conditions including psoriasis and acne (10% lotion over 2 months reduced lesion counts and resulted in satisfaction of 67% of patients).
Black seed oil inhibits histamine release in the skin and as such can be used to reduce hypersensitivity reactions.
A study in hand eczema showed significant improvement in quality of life and severity when Black seed oil ointment was applied twice daily for 4 weeks.
Cosmetically it also showed benefit when combined with Borage oil, reducing skin irritation and improving skin hydration and barrier function when compared with a placebo.

Some of these studies don’t outline specific topical concentrations and none of the studies compare it to corticosteroids however, the risk profile of Black seed oil is minimal. So overall I think the potential benefit for such a wide range of skin conditions is heartening and assessing individual clinical benefit may be the key until we see more specific research in this area. If you have used Black seed oil to help manage a skin condition, I would love to hear from you – please comment below.

References:

Aljabre, S.H., Alakloby, O.M. and Randhawa, M.A., 2015. Dermatological effects of Nigella sativa. Journal of Dermatology & Dermatologic Surgery, 19(2), pp.92-98.

Rafati, S., Niakan, M. and Naseri, M., 2014. Anti-microbial effect of Nigella sativa seed extract against staphylococcal skin Infection. Medical journal of the Islamic Republic of Iran, 28, p.42.

Yousefi, M., Barikbin, B., Kamalinejad, M., Abolhasani, E., Ebadi, A., Younespour, S., Manouchehrian, M. and Hejazi, S., 2013. Comparison of therapeutic effect of topical Nigella with Betamethasone and Eucerin in hand eczema. Journal of the European Academy of Dermatology and Venereology, 27(12), pp.1498-1504.

Posted in acne, Psoriasis, Sensitive Skin, Skin Health | Tagged black seed oil, nigella seed, Skin Health

Holistic Pain Management – Part 1

Posted on September 24, 2017 by Ananda Mahony

In this podcast I discuss the origins and assessment of chronic pain with Andrew Whitfield-Cook. It was important for me to get across that chronic pain persists for reasons beyond peripheral input. While that may be part of the issue, or even the origin, the reason chronic pain persists is about a myriad of factors including central nervous system input, neuro-inflammation, attention, beliefs, emotions, lack of human connection to name a few. This podcast discusses some of these factors.

Transcript and content:

The agony of chronic pain is a huge burden on many, on both a personal and societal level. Today, in part one of Holistic Pain Management, we welcome back Ananda Mahony, an expert in the assessment and treatment of pain. In this episode, Ananda takes us through the neurobiology and theories of pain, various assessment tools and the issues of pain in our society. Ananda also discusses what worsens and what alleviates the sensation of pain, and we’ll gain some insight into integrative treatments which can offer help, especially when orthodox measures fail to relieve pain.

Covered in this episode:
[01:02] Welcoming back Ananda Mahony
[02:39] What is the societal burden of pain?
[07:56] Contributors to pain mismanagement?
[11:18] How should pain be assessed?
[16:54] What actually is pain?
[20:41] Theories of pain
[24:21] Factors influencing pain perception?
[35:19] Why medical care misses the mark
[40:58] Holistic approaches to care
[42:26] Inviting Ananda back to continue to discussion for Part 2.

Subscribe to the podcast: fxmedicine.com.au

Posted in Chronic pain management, pain psychology | Tagged Chronic pain management

Awe-inspiring

Posted on August 23, 2017 by Ananda Mahony

Im significant For Christmas I received a subscription to New Scientist. It is my favourite magazine and prior to getting my own copy each week I regularly pilfered my Mum’s copy (thanks for the present Mum). In a recent edition (Issue 3136) I read an article about the benefits of feeling small as a human when compared to nature, Earth, the sun, other planets and space itself. The article goes onto discuss the concept of awe, not just with things bigger than us but anything that truly inspires awe; a full moon rising, a stunning view, a beautiful piece of music, art or an idea.

The feeling of being awestruck has powerful effects not only our mind and body but also on our sense of self. True awe can dissolve our sense of self, allowing a greater sense of connection with others and nature. It can lower stress, boost creativity and even make us nicer people. So what is the feeling exactly? Researcher’s studying awe describe it as ‘an emotion that combines amazement with an edge of fear’, and is a feeling we get when ‘confronted with something vast, that transcends our frame of reference’.

Part of feeling awe is a move of focus away from our own self-interests and to a bigger picture, which has shown to help us feel happier, less stressed and even improves immune function by reducing inflammation. This effect doesn’t just last in the moment, if cultivated, awe can have lasting effects. It can also help switch us out of ‘fight or flight’ mode by stimulating parasympathetic nervous system responses (rest and digest mode).

Contemplating awe I thought back over recent history to moments that I identified with feelings of awe and a few came to mind; St Peter’s Basilica in Vatican City, a recent full moon rising that seemed to take up half the skyline, and every time I really think about what it would be like to be Dr Who’s companion in the Tardis (yep, I’m a fan and it’s a big concept!).

There are ways of cultivating awe on a regular basis. The article infers that we could stop looking at images of nature and space on our smart phones and starting looking at the real thing. Yes, yes we all say! Fortunately awe isn’t necessarily rare and can be manifested in more ways than just seeing amazing things. To do this we need to raise our expectations of feeling awe in the first place, and then think about what we individually find awe-inspiring, whatever that may be. Then we can make it part of the every day.

Feel free to comment below – what makes you feel awe?

Reference:

Marchant, Jo. Awesome Awe, New Scientist ISSUE 3136 | MAGAZINE COVER DATE: 29 July 2017

Posted in Uncategorized

Stress gets under the skin

Posted on August 22, 2017 by Ananda Mahony

From a health perspective, my skin is my vulnerable organ; for me everything shows up on the surface. Stress in particular is a ‘skin trigger’. I have changed my health significantly since the days of breakouts and chemical sensitivity so they aren’t issues anymore, but my skin still tends to be reactive in response to stress looking drier and flushing easily.

Skin Stress

Skin is one of the key defence systems of the body with the outermost layer providing a natural barrier to water loss and potential toxins or microbes. It is exposed to numerous daily stressors such as infections, toxic agents (artificial fragrances), allergens, UV light and mechanical damage and is usually well equipped to respond and protect from these environmental factors. However, in those with skin conditions such as psoriasis, chronic itching, eczema and rosacea, both environmental and psychological stress can be a trigger for acute flare-ups as well as sustaining chronic issues.

Stress impacts aren’t just about major life events. It is often the ongoing daily pressures of life that creates a chronic stress burden, eventually leading to less overall stress resilience. The depth of this impact is in part a reflection of genetics, but also of cumulative experiences over time. Of considerable influence are individual health behaviours such as sleep, hygiene, activity levels, diet and substance abuse (alcohol, excess sugar intake, recreational drugs, cigarettes etc). The more we move away from healthy practices such as enough sleep, regular exercise and a healthy diet, the more burden on the body and the more likely maladaptive stress responses will develop.

When stress is constant, individuals with skin conditions can lose resilience at a local skin level as well. As a consequence there is less innate ability to regulate immune and inflammatory responses within the skin. Essentially stress leads to increased inflammation and potentially worse disease severity.

The specific impacts of stress on skin include:

Reduced skin barrier leading to trans-epidermal water loss (TEWL) so skin looks and feels dry and dehydrated. Dry/dehydrated skin skin also becomes more sensitive to environmental stressors e.g. topical creams or temperature changes.
Reduced local antimicrobial defence leading to greater risk of infection from microbes residing on the skin e.g. staphylococcus aureus, a common cause of secondary infection in those with eczema.
A significant increase in pro-inflammatory chemicals in the skin contributing to both acute and chronic inflammatory responses – skin may present as more red, more reactive, itchier or with increased plaques in the case of psoriasis.
Delayed recovery time.

For example, the general psoriasis population is vulnerable to the exacerbation of inflammation such that a stressful event/s can significantly aggravate the course of the condition. Up to 80% of individuals with psoriasis report a stressful life event prior to a flare up and 45% prior to the onset of the disease.

Fortunately there are many positive skin benefits associated with improved stress resilience and while there is no doubting the benefit of enough sleep, a healthy diet and exercise, adding regular mindfulness practice to usual treatment can have significant benefit. For example, in a group of psoriasis patients’ regular mindfulness practice led to a 4 fold increased clearing rate of skin lesions. Mindfulness based practice has also been shown to reduce post-stress inflammatory responses and increase symptom relief following skin damage.

There are numerous ways to improve stress resilience using self care and mindfulness but I find while many may work in the short term, sustained practices are those that really make the difference…practices that, while they may take time and effort, really make you feel good. I find that implementing mindfulness and self-care is less prescriptive and more a journey of discovery, trying new techniques or remembering things you used to do regularly and enjoy. Many of the practices are quite simple:

Green therapy – a favourite of mind, which is spending time in nature
Mindful breathing practices
Meditation
Mindful walking – being present and observing your movement
Head to toe scanning to tap into body sensations
Regular magnesium baths or foot soaks
Journalling – thoughts, frustrations, things to be thankful for
Practicing gratitude
Reading for pleasure

I generally encourage patients to pick one and ‘try it on to see if it fits’. While it may take sustained effort something will feel good. The aim then is to make it part of a daily, weekly or regular practice and this is when the benefits will be felt, and seen on the skin.

Posted in Uncategorized

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