Nutritional Environmental Medicine: Putting all the pieces together.

1. Nutritional & Environmental Medicine: Putting all the pieces together. Blake Graham, B.Sc (Honours), AACNEM Clinical Nutritionist www.nutritional-healing.com.au (08) 9381 4112 February 16th 2008

2. What causes disease? Genetics. Gastrointestinal abnormalities. Nutrient imbalances/diet. Environmental. (e.g. heavy metals) Allergies/intolerances. Chemical imbalances. (e.g. hormones) Disordered sleep. Psycho-social factors. Lifestyle factors.

3. Multi-factorial model.

5. Ripple effect.

6. Spectrums.

7. Self healing. Complex corrective mechanisms. Identify and remove: Causes. Impediments to healing. Reduce burden of stressors on the body below the threshold which the body can restore balance.

8. Disease treatment models. Treat symptoms: Nausea = anti-nausea medication High cholesterol = cholesterol lowering medication Dry skin = moisturizer Insomnia = sedatives Address underlying causes: e.g. nausea caused by gastrointestinal infection e.g. high cholesterol caused by poor diet e.g. dry skin caused by fatty acid deficiency e.g. insomnia caused by anxiety

9. Disease treatment models. Disease centred diagnosis. Irritable bowel syndrome. Chronic Fatigue Syndrome. Migraines. Depression. Person centred diagnosis. Nutrient deficiencies. Sleep deprivation. Food intolerances. Intestinal infection.

10. Genetics.

11. Genetics. Inter-relationship between genetics and environment. Environment influences genetic expression. Genetics influence reaction to environment.

12. Genetics. Specific links of interest: Environmental chemical metabolism. Nutrient imbalances. Gastrointestinal health. Allergies/intolerances. Chemical imbalances. (e.g. hormones) Immune integrity.

13. Genetics. Family history: Eczema/asthma/hay fever/hives ? Allergies Depression/anxiety/OCD ? Neurotransmitters Crohn's Disease ? Increased intestinal permeability ADD/ADHD ? Abnormal zinc metabolism

14. Genetic testing.

15. Gastrointestinal health.

16. Gastrointestinal imbalances. Imbalanced gastrointestinal flora ('dysbiosis'). Gastrointestinal infections (bacteria, parasitic, yeast). Increased intestinal permeability ('leaky gut'). Maldigestion/malabsorption. Stomach acid deficiency (hypochlorhydria). Pancreatic enzyme insufficiency. Bile acid deficiency.

17. Intestinal flora. Functions of healthy flora: Produce short chain fatty acids which are needed by the intestinal mucosa for energy Produce biofilm (mucus barrier) to protect intestinal mucosa Interact with the gut associated lymphoid tissue (GALT) � 70% of immune system, e.g. Improves antibody formation Reduce allergies (eczema and asthma) Regulate cytokine levels / inflammation modulation Synthesize nutrients (certain amino acids and vitamins) Improve digestion/absorption Inhibit the overgrowth of harmful bacteria, yeast, viruses and parasites Improve intestinal motility and stool formation Influence genetic expression Assist the detoxification of various substances and convert some toxins into less toxic forms : Mercury Hormones (e.g. estrogen) Potentially carcinogenic chemicals Drugs Lipids (e.g. cholesterol)

18. Harmful bacteria. Produce toxic chemicals as metabolic by-products which have systemic effects, e.g. Ammonia ? Hyperammonemia D-lactic acid ? D-lactic acidosis Decrease production of short chain fatty acids Produce antigens which disrupt immune function Reduce levels of healthy flora Impair nutrient digestion/absorption Degradation/consumption of nutrients Damage intestinal wall

19. Intestinal flora testing.

20. Gastrointestinal health: Yeast. Opportunistic/secondary. Great exacerbating factor. Releases harmful chemicals. Lab tests are notoriously unreliable.

21. Yeast symptoms/signs. Genital thrush Vaginal itching or redness, vaginitis or 'jock itch' � often scratching/itching at genital area White or grayish-white coating on your tongue or inner cheeks, or white patches in the mouth Nasal congestion or stuffiness, swelling of the nasal membranes or sinusitis Previously noticed a decline in your health following antibiotics or antibiotics exacerbate your current health problem Fungus infections of the skin (e.g. athletes foot) or nails Psoriasis, eczema or hives Puffiness/bloating/swelling in the hands, face and feet Sugar cravings Eating sugar make you feel worse/worsens certain symptoms Negative reaction to certain dietary yeasts/molds Very high fondness for yeasty foods Chemical sensitivities (e.g. car exhaust, petrol, cigarette smoke, perfumes, etc.) Multiple food sensitivities Lower abdominal bloating Gas, frequent constipation, loose/unformed stools, diarrhea or foul smelling stools Itchy rectal/anal area or red ring immediately around the anus Attention problems Feel �spaced out� &/or �brain fogged�

22. Yeast testing.

23. Gastrointestinal health: Parasites. Remarkably common. Under-diagnosed due to: Lack of consideration. Inadequate laboratory techniques.

24. Intestinal parasite symptoms/signs. Current illness began with diarrhea/food poisoning Frequent diarrhea Loose/unformed stools Abdominal bloating Abdominal pain/discomfort Excessive flatulence Visible mucus or pus in stools Itchy anal/rectal area Foul smelling stools Frequent constipation Frequent nausea and/or vomiting Food allergies/intolerances Teeth grinding (bruxism) while sleeping Skin conditions (bluish cast around lips, hives, psoriasis, eczema, skin ulcers) Fatigue/weakness Forgetfulness or unclear thinking Nervousness, apathy, depressed, anxious or headaches Dizziness

25. Parasite testing.

26. Maldigestion/malabsorption. Stomach acid deficiency (hypochlorhydria). Pancreatic enzyme insufficiency. Bile acid deficiency.

27. Digestive function testing.

28. Hypochlorhydria symptoms/signs. Undigested food in stool Trouble digesting red meat Food or water �sits in stomach� Poor appetite or feel overly full easily Stomach aching/pain/discomfort or bloating after meals Reflux &/or heartburn High fat foods cause nausea/stomach upset Nausea/reflux after supplements (e.g. fish oil) Feel unwell/fatigued right after meals Lemon juice improves digestion Low iron levels

29. Heidelberg pH Diagnostic System.

30. Gastrointestinal treatments. Probiotics/prebiotics. Anti-microbials. Dietary changes. Digestive enzymes. Stomach acid supplement (Betaine HCl). Bile acids.

31. Nutrients.

32. Nutrient status continuum.

33. Nutrient status continuum.

34. Nutrition: Nutritional status. Intake: Food choices Soil levels, food storage, food processing Digestion/assimilation Genetics Synthesis (vitamins K & D) Other factors (hormone imbalances, toxic chemicals, infections, other nutrient levels, medications, oxidative stress, emotional stress, activity levels, kidney/liver problems, etc.)

35. Nutrient supplementation uses. Optimizing levels. Therapeutic value.

36. Fatty acid deficiency symptoms/signs. Dry skin (e.g. feet/face/general) Scaly or flaky skin (e.g. legs) Cracking/peeling fingertips & skin (e.g. heels) Lackluster skin Small bumps on back of upper arms Patchy dullness &/or color variation of skin Irregular quilted appearance of skin (e.g. legs) Thick or cracked calluses Dandruff or cradle cap Dry, lackluster, brittle or unruly hair Soft, fraying, splitting or brittle fingernails Dull nails - lack of surface shine Slow growing fingernails Dry eyes Menstrual cramps or premenstrual breast pain/tenderness Excessive ear wax Excessive thirst Allergic (e.g. eczema/asthma/hay fever/hives) Crave fats/fatty foods Stiff or painful joints

37. Magnesium deficiency symptoms/signs. Muscle cramps, spasms or pain (e.g. back ache, neck ache, leg/foot cramps) Muscle tension Muscle twitches, tics or jerks Muscle weakness Muscle tremors Restless legs Fatigue / sighing Breathlessness / chest tightness Heart palpitations / arrhythmias Numbness or tingling of skin or �creepy-crawly� feeling under skin Sensitivity to loud noises or sudden bright light Menstrual cramps Headaches / migraines Frequent constipation or anal spasms Difficulty falling asleep and/or restless sleep Irritable, depressed, anxious, nervous or panic attacks

38. Hair mineral analysis.

39. RBC fatty acid analysis.

40. Plasma amino acids.

41. Nutrient imbalance treatments. Nutrient supplementation. Dietary changes. Correct absorption problems.

42. Nutrient supplementation case study. Symptoms: Frequent urination Night time urination Night thirst Blurred vision after heavy exercise Mineral supplementation: �From one day to the next at least 90% of my symptoms vanished. These are symptoms I have lived with and have worsened for more than 10 years. Quite amazing.�

43. Toxic chemicals.

44. Increased toxic chemical exposure. Lead levels of human bones are ~1000 times higher than pre-industrial bones. Cadmium 500 times higher.

45. Heavy metal sources: Food: Soil Pesticides Cooking items Water Air Medical: Amalgam fillings Vaccines Direct contact with heavy metal containing or contaminated substances Paints Cigarettes Household chemicals Body products Many many others!

46. Autism � mercury Study 1. 221 children with ASD vs. 18 controls Post-DMSA urine levels Mercury was 3.15 times higher!!

47. Autism � mercury Study 2. 14 children with Autism vs. 11 controls Mercury was 3 times higher in baby teeth!!

52. Toxic chemical treatments. Chemical avoidance. Chelation agents. Supportive nutrients/herbs. Far infrared (FIR) saunas.

53. Other environmental influences.

55. EMR testing.

57. Mould testing.

58. Sick building syndrome symptoms/signs. Ongoing or frequent coughing / dry throat or mouth Irritated, stinging or burning sensation of throat or mouth Throat hoarseness / changed voice (e.g. raspy) Metallic taste in mouth Wheezing, irritated lungs or bronchitis Shortness of breath / chest tightness Irritated, sore or burning eyes Red or watery/tearing eyes Sensitivity to bright light / blurred vision Nasal congestion / running or stuffy nose / sneezing / nose bleeds Irritated, stinging or burning nose or nasal passage / nasal itching Sinusitis / sinus congestion or pressure Stinging, burning or itchy skin / skin sensitivity to light touch Skin rash or reddening of skin Dizziness / vertigo Headaches Fatigue / weakness

59. Allergies/intolerances.

60. Food reactivity. Many reasons why a person may react negatively to specific foods. Allergy Intolerance e.g. lactose intolerance or fructose malabsorption e.g. impaired ability to metabolize salicylates, etc. e.g. gut flora/leaky gut mediated e.g. pharmacologic properties of the food - aspartame e.g. toxins in foods ? No one lab test for diagnosis of all negative reactions.

61. Food intolerance or allergy symptoms/signs. Itchy, tingly, irritated or burning tongue/lips/palate/throat during or after meals Swollen lips/mouth or recurrent mouth ulcers Frequent hives - generally or around mouth/lips (e.g. rash or ring around mouth ) Increased mucus production in throat / regularly clearing throat Excess drooling / excess saliva production / spitting during speech Irregular patches on tongue (geographic map-like) or mottled tongue Puffiness or �bags� below eyes; or puffy or swollen nose/face Dark circles under eyes (�allergic shiners�) Inner corners of eyes itch or whole eyes itch / eye rubbing or scratching Watery, glassy or glazed eyes; or red eyes Itchy nose / nose rubbing or scratching (�nasal salute�) Nasal or sinus congestion / sinusitis / runny or snuffly nose / sneezing Postnasal drip (nasal mucus draining down the back of the throat) Abnormally red and/or flushed appearance of cheeks or nose (e.g. red tip nose) Red ears / hot or �burning� earlobes Eczema or wool intolerance / psoriasis Itchy arms, ear canals, hands, legs or skin in general Puffy or swollen hands/knuckles/feet Asthma or recurrent wheezy bronchitis / infection or exercise induced wheezing Abdominal pain, bloating or vomiting Increased frequency of stools / unformed bowel movements / frequent constipation Feel best when don�t eat or skip meals Feel worse (energy, mood, concentration, etc.) or look pale/red after some meals Strong particular food cravings and dislikes / fussy eater Recurrent ear infections and/or recurrent glue ear Headaches/migraines

62. Elimination/provocation testing. GRAINS - Whole grain rice MEAT - 100% unrefined lamb VEGETABLES - Cabbage, kale, carrots, cauliflower, squash, broccoli & sweet potatoes FRUIT � Pears OILS/SEASONINGS - Olive oil & sea salt

63. Inhalant allergies. Dust. Cats/dogs. Pollen. Grass.

64. Food intolerance case study. Fibromyalgia. Elimination diet ? 50% drop in symptoms. Lactose intolerance.

65. Chemical imbalances.

66. Neurotransmitter & hormone imbalances.

67. Biochemical continuum.

68. Serotonin deficiency signs/symptoms. Depressed Nervous/anxious Worrier Fears/phobias Negative/pessimistic Irritable/impatient/edgy Obsessive compulsive tendency Think about the same things over & over again Self destructive or suicidal thoughts/plans Low self esteem/confidence Rage/anger/explosive behavior/assaultive Sleep problems/light sleeper Crave sugar/carbohydrates/alcohol/marijuana Use these substances to improve mood & relax Feel worse in & dislike dark weather Chronic pain (e.g. headaches, backaches, fibromyalgia)

70. Adrenal Rhythm.

71. Mild adrenal insufficiency signs/symptoms. Fatigue/lethargy not relieved by sleep Trouble getting up in the morning Crave salt or salty food Low blood pressure Light-headed or dizzy when getting up to stand from laying or sitting Feel unwell during/after emotional stress, e.g. exhausted, shaky or confused Decreased ability to handle stress/pressure Tendency for low blood sugar Intolerance to cold / frequently feel cold Unstable body temperature Light sensitivity Increased frequency/severity of allergies Dark brown spots on face/neck/shoulders Poor exercise tolerance Increased time to recover from infection Thin, can't gain weight or weight loss Insomnia / sleep disturbance Anxious or panic attacks

72. Saliva Adrenal Stress Profile.

73. Adrenal hormone case study.

74. Sleep.

75. Sleep. Inadequate sleep quantity and quality are extremely common.

76. Sleep. Functions of sleep: Rejuvenation/Repair Growth Detoxification Memory storage Energy conservation

77. Sleep � treatment. Remove causes. Supportive lifestyle, environment and sleep routine. Dietary changes. Herbal/nutritional supplements. Relaxation techniques.

78. Stress.

79. Psycho-social stress. Universal disease exacerbator. Known effects: Impairs immune function. Increase nutrient requirements (e.g. magnesium). Impair digestion. Impair sleep. Impair neurotransmitter balance. Impair hormone (e.g. cortisol, DHEA, thyroid hormones, sex hormones) balance.

80. Psycho-social stress � Management. Treatment options: Eckhart Tolle [www.eckharttolle.com/]. Emotional Freedom Techniques (EFT). [www.integrative-clearing.com.au/] Breathing/muscle relaxation exercises. Biochemical. Exercise.

81. Lifestyle.

82. Lifestyle factors. Smoking. Alcohol. Drug use. Exercise. Rest. Fun.

83. How to put it all together. Optimize basics: General diet. Sleep. Stress. Lifestyle. Healthy environment.

84. How to put it all together. Optimize basics: General diet. Sleep. Stress. Lifestyle. Healthy environment. Identify contributing factors: Gastrointestinal issues. Nutrient imbalances. Environmental. Allergies/intolerances. Neurotransmitters & hormone imbalances.

85. Questionnaire.

86. Nutritional & Environmental Medicine: Putting all the pieces together. Blake Graham, B.Sc (Honours), AACNEM Clinical Nutritionist (08) 9381 4112 February 16th 2008