Mind Over Matter

This month I have been delving into New Scientist again and one article in particular really sparked my interest. Called “Mind Over Matter”, the author David Robson outlines and supports the assertion that changing your attitude can have profound benefits on your health (Robson, 2018). In this day and age of metaphysical thinking this may not seem like a mind-blowing-ly new concept, however I often find the mind over matter approach being thrown about without a lot of research to back it up. So when the article outlined studies to support this concept I suddenly got a bit more interested.

One researcher in this area, AliaCrum had a key insight to mind over matter when she was studying the placebo effect. She realised that if the effectiveness of a drug can be influenced by expectations, then perhaps expectation could influence other situations as well. Yes, it seems so, and in particular our physiology. The article goes on to cite a number of examples of mindset and expectation influencing physiology including:

  • positive mindsetExplaining to half of a group of cleaners that their work burnt 200 calories every hour, meeting the daily requirements for exercise. Over the next month thecleaners lost about 1kg and their blood pressure had dropped from elevated to normal. The control group showed no change.
  • Feeling fit or perceiving fitness can influence physical fitness. People who were more pessimistic about their level of fitness were more likely to die during the survey period than those who were more optimistic.
  • How you think about food impacts the way our bodies respond to it. Feeling deprived or thinking food is overly healthy (i.e. most diets) can lead to an increase in hunger hormones resulting in less satiety and more fat storage. The key is to mindfully eat, savouring and enjoying each mouthful so it becomes more like an indulgent treat, which can lead to lower hunger hormones and a greater sense of satisfaction.
  • Focusing on stress as having negative effects is actually more debilitating and leads to greater fluctuations in the stress hormone cortisol, than seeing stress as a positive, motivating factor.
  • Even ageing can be a healthier process if you have a positive outlook about it. Those who report feeling positive about getting older live on average 7.5 year longer and are less likely to respond to stress or develop inflammation than those who have negative associations.

The research that really impacted me was about sleep and insomnia. Those that fit into the category of ‘complaining good sleepers’, that is, those who think they are insomniacs or believe they have poor sleep even though monitoring suggests otherwise are more likely to experience increased daytime sleepiness, higher blood pressure, depression and anxiety. By contrast ‘non-complaining bad sleepers’ have less of these effects, so to confirm, less sleep but less side effects. By contrast, I consider myself a ‘complaining bad sleeper’ based on absolutely no monitoring (!) and so as an experiment I decided that for 1 week I would have a positive mindset no matter how much sleep I had had the previous night. Specifically, for me the issue is daytime fatigue, specifically mental fatigue. During the week I found that choosing to over-ride my concern about lack of sleep allowed me to get on and perform tasks I usually keep back until I have slept well (or at least, think I have slept well). I felt quite liberated from my own worry, and the researcher who showed the above effects indicated that worry about sleep has more negative effects on our health than poor sleep alone. Positively alarming!

So how can we use mindset to improve our health? I have jotted down a few ideas but I think there are many other empowering ideas in this field.

  • Savour your food
  • Start embracing the concept of growing older, in whatever way you can. I have a great role model in my mother, who at 70+ is going on 45.
  • Think about and if possible set a positive expectation prior to exercising or eating
  • Let go of sleep worry! Note to self! I did this by setting a positive intention for mental clarity and energy for the day

If you have any empowering ideas to contribute please comment below.

Reference:

Robson, D. (2018, August). Mind Over Matter. New Scientist, issue 3192, pp. 29-32.

Posted in Mindset, Stress | Tagged ,

The connection between our gut health and skin

The Gut-Skin Axis

The health of the gut microbiome and its impact on wider health has seen an explosion of research, and with the advent of DNA sequencing our understanding of the microbiome and its effects on health is growing. We now understand that the influence of the gut microbiome extends beyond the gut, impacting on distant organs and systems either positively or negatively depending on the composition of microbiota. These wider effects are known to influence skin health, and this article will review the specific influence on acne.

A cardinal function of the microbiota is to maintain intestinal barrier function as well as being important regulators of immune function and inflammatory responses. Changes in composition of the microbiota, leading to a state of microbial imbalance (dysbiosis) are associated with gut barrier dysfunction and permeability, or leaky gut. Dysbiosis can also activate the immune system and lead to inflammation, both at a local gut level and systemically, and this is effect is thought to be modulated by the degree of gut ‘leakiness’.

So how does this influence the skin? Dysbiosis has the potential to negatively impact skin health in numerous ways. The presence of pathogenic bacteria in the gut leads to an accumulation of toxic metabolites, which can access systemic circulation. These metabolites can accumulate in the skin and disrupt skin barrier integrity, reduce skin moisture content and disrupt the production of healthy skin cells (Salem, et al. 2018).

Gut skin axis

Image: Kelly, et al. 2015

Acne is an inflammatory skin condition and it is now known that inflammation precedes pustule development, even in preclinical micro-comedones (Mochtar, et al. 2018). The concentration of certain inflammatory molecules is also linked to the severity of acne. Both the overgrowth of commensal (normal) bacteria and/or the presence of pathogens can drive inflammation systemically, which leads to increased inflammatory chemicals in the skin and thus driving acne progression (Salem, et al. 2018). This implies that they degree of dysbiosis may also influence the severity of acne in susceptible, however this has not been firmly established as yet.

There is a brain connection involved in acne pathogenesis also, and so rather than just the gut-skin axis, it can be extended to the brain-gut-skin axis. This concept is supported by the frequent association of mood disorders such as anxiety and depression, coupled with gastrointestinal complaints and acne (Kelly, et al. 2015). Psychological stress is thought to drive the gut microbiota to produce different neurotransmitters, or trigger the release of neuro-chemicals such as substance P from the specific intestinal cells. Substance P can trigger inflammatory mediators both locally and within the skin. The net effect is increased leaky gut, leading to inflammation systemically and within the skin.

So what influences negative changes in the gut microbiota? Well as mentioned above stress plays a role. Also well known is that acne is particularly influenced by both high fat and high glycemic carbohydrate diets. This pattern of eating has a strong negative influence on the gut microbiota, which thrives on high fibre, complex carbohydrates and polyphenol rich foods. Other negative influencers include alcohol, food additives, certain medications such as non-steroidal anti-inflammatory drugs and too much or too little exercise.

The dietary pattern that supports a healthy skin has been well established and correlates well to the foods that support a healthy microbiome. For more on the specifics of what to consume to help prevent or manage acne click here: Dietary Influences on Acne. However, if eating all the ‘right’ foods and avoiding those that drive acne and a dysbiotic microbiome still aren’t reducing acne severity, then the factors influencing acne development and severity may be broader. If you you need more support to heal your acne I can support you to make the changes you need to feel better in a way that is manageable and works in your life. To read more about my Skin Healing Program click here.

References:

Kelly, J. R., Kennedy, P. J., Cryan, J. F., Dinan, T. G., Clarke, G., & Hyland, N. P. (2015). Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Frontiers in cellular neuroscience, 9, 392.

Mochtar, M., Murasmita, A., Irawanto, M. E., Julianto, I., Kariosentono, H., & Waskito, F. (2018). The Difference in Interleukin-19 Serum on Degrees of Acne Vulgaris Severity. International journal of inflammation, 2018.

Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Frontiers in microbiology, 9.

Posted in acne, Acne and diet, nutrition, Skin Health, Stress | Tagged , ,

Acne is more than skin deep

The burden of acne is more than skin deep. Strongly impacting on negative self-image and perceived stress, acne not only causes stress but is also made worse by stress. It is now well established that stress contributes to the development of acne but until this year there have been no studies looking at stress management as a direct treatment intervention. A report published this year in the International Journal of Dermatology details the methods and results of an 8-week experimental study in 30 women with acne undergoing a specific stress reduction process called the Pythagorean Self-Awareness Intervention (Chatzikonstantinou, et al. 2018)

While there was a treatment group and a control group in the study, the study was non-blinded meaning that those who didn’t partake in the self-awareness program knew they weren’t receiving treatment. In both groups each woman’s clinical acne stage was measured, as well as acne-related quality of life (i.e how the acne impacted them), their perceived stress, and positive and negative affect i.e their mood and emotions.

stages of acne

After 8 weeks 14 out of 15 women in the treatment group showed improvement in their acne stage, and this improvement was regardless of baseline acne stage and age. There were also significant improvements in perceived stress as well as negative thoughts and emotions. There were no reported side effects. In the control group only 4 women showed improvement in their acne stage, which reinforces that the improvement in the treatment group is not just related to the natural course of the condition, rather the results of the active self-awareness intervention.

Given the results it is astounding that there has been no previous research in this area. While this is a small pilot study, the outcomes are significant and strongly reinforce that stress and its impacts on our bodies and overall health is not to be ignored, and further that working to reduce stress can have profound healing effects on our mental physical wellbeing.

The study did not discuss the specific physiological mechanisms of the self-awareness intervention however two possibilities come to mind. Firstly this could be a top down effect on the gut-brain axis. Stress negatively impacts the gut microbiota, and a dsybiotic microbiota has the potential to drive the skin inflammatory processes, which in turn drive acne (Salem, et al. 2018). Secondly, stress impacts the skin-brain-immune axis locally within the skin, influencing the expression of sebum receptors and effectively supporting an environment that favours the growth of P.acnes, the bacteria that contributes to acne formation (Dreno, 2017).

To the specific intervention, the Phythagorean method has previously been used to effectively reduce stress in Multiple Sclerosis and insomnia. Once the process has been taught it can be used on an ongoing basis and incorporated as a health management strategy at any time in the future. The basis of the technique is daily cognitive processes that support self-awareness and self-control including techniques such as self-reflection and introspection, reviewing the day’s events and importantly the thoughts and emotions that accompanied those events, and then developing strategies for changing responses that weren’t productive. Questions that could be asked include; ‘What did I do well’, ‘What could I improve’, ‘Is there something I should have done but didn’t do’?

When studied in other conditions such as multiple sclerosis many benefits have been shown including improvements in memory and cognition, reduced stress and anxiety, improved sleep and the adoption of healthy habits including better eating habits and more exercise.

While the Phythagorean method was used in this study, what the study shows overall is that stress reduction helps to improve acne, which leads to the tantalising thought that perhaps other stress reduction techniques, when applied daily and consistently will also help. Mental food for thought!

References:

Chatzikonstantinou, F., Miskedaki, A., Antoniou, C., Chatzikonstantinou, M., Chrousos, G., & Darviri, C. (2018). A novel cognitive stress management technique for acne vulgaris: a short report of a pilot experimental study. International journal of dermatology.

Dréno, B. (2017). What is new in the pathophysiology of acne, an overview. Journal of the European Academy of Dermatology and Venereology, 31, 8-12.

Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Frontiers in microbiology, 9.

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Posted in acne, Skin Health, Stress | Tagged , , , , ,

A high fat diet worsens post-operative pain and inflammation

Obesity commonly correlates with increased pain. One of the mechanisms for this is relatively straightforward; having central adiposity (fat around the stomach region) or being obese is associated with low-grade chronic inflammation, and this, in turn, is associated with a greater incidence and severity of chronic pain conditions. In the recent study authors (Song. et al, 2018) wanted to study the effects of diet and obesity on postoperative pain. There were 2.7 million surgeries performed in 2016 according to the Australian Institute of Health and Welfare. Each surgery is associated with some degree of acute pain, and the severity and duration of acute pain experienced is a risk factor for the development of chronic pain. So any modifiable factor that increases pain intensity or duration post surgery is worthy of note, as it may help to reduce progression to chronic pain.

surgery

The study had some interesting findings, one of which was that negative outcomes occurred with greater frequency in males than females. To summarise the findings, a high-fat diet:

  • Resulted in prolonged pain particularly in males.
  • Delayed skin wound healing and rates of nerve regeneration.
  • Caused increased macrophage (immune) activity and sensitivity, leading to increased inflammation.

Alarmingly the study implied that even 1 week of high-fat eating in the lead up to surgery can contribute to the above effects. However, on the flip side, a moderate fat diet in the two weeks leading up to surgery can help mitigate the effects even if no weight loss is achieved.

The authors noted that changes to the composition of the gut microbiome are proposed to play a role in the low-grade inflammation in obesity or during high-fat diets. The changes in composition lead to increased endotoxin production, which is seen as a danger by the immune system leads to increased immune activation and as such inflammation in both the peripheral and central nervous systems. The authors also note there are likely other factors that account for the effects of dietary fat on post-operative pain but the above mechanism has a potentially significant role.

So what are the potential take-home points from this study?

  • For both men and women, but men, in particular, prepare for surgery by consuming a lower fat diet (30% of total kilojoule intake or less).
  • Of the 30% or less fat intake, choose a predominance of healthy fats including monounsaturates (olive oil, avocado, nuts & seeds) and polyunsaturates (SMASH fish – salmon, mackerel, anchovies, sardines and herrings, chia seeds, flax seeds).
  • Increase vegetable intake to at least 5 serves (cups) per day, legumes and whole grain intake, which will provide fibre to bind fats and help eliminate before they are absorbed. These foods will also support a healthy microbiome, with less endotoxin production e.g all vegetables, rolled oats, brown bread, wholemeal pasta, quinoa, lentils, and beans.

Reference: Song, Z., Xie, W., Strong, J. A., Berta, T., Ulrich-Lai, Y. M., Guo, Q., & Zhang, J. M. (2018). High-fat diet exacerbates postoperative pain and inflammation in a sex-dependent manner. Pain, 159(9), 1731-1741.

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Posted in Chronic pain management | Tagged , , , ,

Relief with opioid discontinuation

Managing persistent or chronic pain is complex. Frequently there is a lack of objective reason for persistent pain yet it is real, personal and subjective and people with persistent pain are of then desperately seeking effective pain relief. I recently attended an “Explain Pain” course in Cairns (which was lovely and warm), which looks at ways to reconceptualise pain from a modern neuroscience perspective. How does this help? Well knowledge is power. There is a growing body of research showing that we can target our natural analgesic systems with simple but effective education about pain. This is particularly pertinent given the numbers of people suffering with persistent pain and the failure of common pain medications to effectively manage pain.

In Australia opioid prescribing is frequent, with up to 72% off people with both cancer and persistent non-cancer pain taking prescription opioids. However, unlike those in acute pain, in those with persistent pain the prescription and ongoing use of opioids may not be wise. There is significant evidence of ineffectiveness in persistent pain along with risk of dependence. The mechanisms behind the loss of effectiveness with long term use of opioids are gradually coming to light and include factors such as the metabolites of opioids being perceived as a threat to the body resulting in ‘alarm’ signals and loss of opioid receptors over time, leading to less effective pain relief.

Discontinuation of opioids for those who have been on long-term therapy may be seen as a risk due potential changes in pain intensity. Little was known about the potential changes until a recent study looked at this very issue. Following opioid discontinuation in 551 patients, which chronic pain researchers sought to characterise pain intensity over a 12-month period. To make effective comparisons researchers also compared pain intensity data from the participants 12 months prior to discontinuation. A 0-10 pain numeric rating scale was used to compare pain scores over time.

Pain-scale

Researchers identified for pain classes, which were characterised by their post discontinuation pain levels:

  • no pain
  • mild clinically significant pain
  • moderate clinically significant pain
  • severe clinically significant pain.

The changes in pain intensity over time showed a small but statistically non-specific reduction over 12 months in all characterised pain trajectory classes, with those with mild and moderate pain experiencing the most significant pain reductions post-discontinuation. Importantly pain did not increase in any of the groups, and may slightly improve in those with mild to moderate pain at the time of discontinuation. This research is significant as it indicates that those in persistent pain may actually be better off without opioid medications.

Over the next few months I will write more about persistent pain and how it can be more than just managed but also effectively treated.

Reference:

McPherson, S., Smith, C. L., Dobscha, S. K., Morasco, B. J., Demidenko, M. I., Meath, T. H., & Lovejoy, T. I. (2018). Changes Ii Pain Intensity Following Discontinuation of Long-Term Opioid Therapy for Chronic Non-Cancer Pain. Pain.
Posted in Chronic pain management, Uncategorized | Tagged , , , ,

Food marketing to kids?!?

UPFHave you ever perused the food options on the shelves of the supermarket looking for the healthiest option, and then read the ingredients only to find it was loaded with sugar…or something that sounds like sugar but you just can’t be sure? A recent Australian study (Pulker et al., 2018) sought to understand the impact of nutrition marketing and health claims found on the packaging of ultra-processed foods (UPF). An UPF is an industrially processed food, which may include colours, flavours, sweeteners and processing aids, or undergoes processing for which there is no domestic equivalent i.e. we can’t recreate these foods in our own kitchen. They are also described as hyper-palatable and are commonly marketed at children. Examples include breakfast cereals, snacks, confectionary items and breakfast meal replacements.

 

To carry out the assessment the researchers looked at the packaging information of UPF from 5 different manufacturers. The ingredient lists were examined for the addition of sugar as well as nutrition and health related claims, and food marketing.

The results were alarming. Ninety-five percent (95%) of UPF contained added sugar. There were 34 different terms used to describe sugar (I can’t even come up with half that amount). Just over half of UPF were moderate health star rated or had nutrition claims…yes these were the same foods that had added sugar. Almost all used food marketing, with half of those reviewed using marketing techniques aimed at children. So despite many foods containing sugar and being less than health options they are being marketed as nutritional.

The researchers were concerned about the inappropriate or inaccurate statements (in some cases) particularly those aimed at children. They recommended that surveillance of UPF be increased with the aim of reducing deceptive marketing practices. Additional recommendations include clear identification of sugar, correct identification of nutritional quality (or lack of quality), and a raft of other suggestions to increase clarity around food choices with relation to UPF.

From my perspective I hope these changes come about. In the meantime when shopping in the middle aisles (instead of around the edges of the supermarkets where the fresh food is located), aim to choose minimally processed foods or those with less ingredients e.g. muesli or rolled oats instead of cereals that contain added sugar. Another approach I take is to choose healthy daily basics such as rolled oats for breakfast and then when I want to indulge in a sweet treat (chocolate peanut butter icecream anyone?), I really go for it but the choice is mine rather than being hidden under layers of marketing guff.

Reference: Pulker, C. E., Scott, J. A., & Pollard, C. M. (2018). Ultra-processed family foods in Australia: nutrition claims, health claims and marketing techniques. Public health nutrition, 21(1), 38-48.

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Posted in Health Tips, nutrition, Uncategorized | Tagged ,

Throwing the baby spinach out with the bath water

Recently I went into a well known supermarket looking for some leafy greens to go with the dinner I was cooking. I scanned the shelves and all I could see was packets of baby spinach, rocket or mixed greens, neither on their own, both mixed with baby spinach. I felt like I was in a monoculture world of greens and wanted to run screaming from the veggie aisle (not really, it was more of a sigh and start to think of alternative dinner plans). Dramatics aside, I did on the spot decide to boycott baby spinach for life…well for a little while anyway. I probably need to admit at this point that I am not a fan of baby spinach, I think it is overrated, over consumed and I would love to see more alternatives. While this opinion goes against the advice found in the popular media, which is ‘eat spinach, its a super green’, it isn’t isn’t an uninformed opinion so I have outlined my reasons for boycotting baby spinach below:

1. We are missing out on variety, which has an impact on the health of our microbiome. Not just through the over consumption of baby spinach, but generally reducing our food choices down to a few varieties that are available in the supermarket. I do think greens are an important part of our nutritional intake so consuming them regularly is ideal but mixing it up is key. Add some good old iceberg to your smoothie, celery, zucchini, rocket or even mixed leaves with baby spinach (see a more extensive list of alternatives at the end of the article). This will give you a wider intake of plant nutrients and an interesting start to the day!leafy-vegetables

2. It is high in oxalates or oxalic acid. Oxalic acid is a naturally occuring molecule which if eating in too large quantities can bind up minerals such as calcium and magnesium from other foods eaten forming oxalates and render the minerals inabsorpbable. In excess oxalates are also linked to kidney stones and inflammation in various body systems. This isn’t necessarily an issue if you have a healthy microbiome but a quick look at the avalanche of research about the health of our microbiome as a population and I think this is an issue we all have to consider. So how do we feed the health of our gut bugs? The key is, yes you guessed it, variety. Of course oxalates aren’t a big issue for most of us if we only consume them occasionally or as part of a varied diet but if your work lunch routinely consists of baby spinach, then it may become an issue, particularly if coupled with digestive health issues.

3. Baby spinach can cause the body to release histamines, a chemical produced by the body that in excess or those sensitive to histamine is linked to headaches, allergic responses, itchiness and rashes. I had one client who was a FIFO worker in a remote mine. This client made every attempt to be healthy in a location with limited supply of fresh fruit and vegetables and so avoided the canteen and instead made his own lunches. Every day for lunch at the mine he ate a spinach and tuna salad. Over a couple of months he started to develop a hive like rash all over his body, which cleared up when he came home and ate a varied, but in his words ‘less healthy diet’. We worked out quickly that the spinach and canned tuna were the culprits, encouraging the release of histamine and leading to the full body rash. A few simple changes in diet including cutting out the spinach and canned tuna and increasing variety saw his rash clear up.

4. Finally and I have to admit it I don’t like the flavour! I know I am already biased however I would love to see more variety next time I go to the supermarket and in the meantime I am fighting the chooks for my garden greens, bug free and delicious but slightly pecked!

So the key take home I would love you to take from this diatribe against spinach is to please consider vegetable and greens variety. Apart from the nutritional value, it will make for some interesting smoothies and salads and hopefully your palate will agree.

P.S. some alternative greens – all lettuce varieties – cos, iceberg, Romaine, butterhead, oakleaf, loose leaf lettuce, field lettuce, Asian greens, rocket, kale, chard, beet green, broccoli microgreens, mustard greens, endive, curley endive, chicory, radiccio (yes it’s red/purple but still), Japanese greens (found in lettuce mixes), escarole, cress, rosette bok choy, broccoli rabe, watercress, dandelion.

Asian greens

Posted in Health Tips, nutrition | Tagged , , ,

Is​ ​modern​ ​life responsible for skin conditions?

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).

 

pexels-photo-255441.jpeg

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 , , ,

A new culprit in Type 2 Diabetes

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.

olive-oil-salad-dressing-cooking-olive.jpgArticle 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 , ,

You are what you eat in chronic pain

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.

Western-diet.png

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.

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