ALC is a naturally occuring compound. It helps fats, an important energy source, get into the cell. This energy goes to themitochondria, which provides energy for cell division, cell activities and importantly clean up. This helps cells function better and minimise disease. ALC has been associated with a reduction in depression, circa 30% ALC has been discussed for use in brain injuries, like concussion, but evidence is lacking ALC Le vels increase during sperm maturation in the epididymis High concentration of ALC in the epididymis (in the testicle) helps boost energy supplies for sperm production. Human trials have found Carnitine therapy at 2-3g daily to be effective in increasing semen quality, motility Using ALC over 6 months will improve sperm test results

Adenosine is a curious molecule. It is traditionally used in medicine to treat patients with a certain kind of arrhythmia (funny and uncontrolled heart beat rhythm) called SupraVentricular Tachycardia or SVT. During this treatment of IV adenosine, many patients described a sensation that ‘they were about to die’ as the medicine slowed down their heart rate and brought it to normal.
Adenosine is a key regulator of neuronal, or brain activity. It gradually rises throughout the day and leads to deep sleep at night; it tends to slow down nerve excitement. Generally, it is depressant and sedative. We upregulate (increase the number of) adenosine receptors in times of stress or trouble; it tends to moderate behaviour, control impulses and lead to sleep.
Caffeine is an adenosine blocker; this is the main reason caffeine increases alertness. THC, the psychoactive component of cannabis, increases adenosine and thus inducing deep sleep.
Allopurinol (a drug used for gout), THC (Cannabis), anticonvulsants, SSRIs (a kind of depression medication) and electroshock therapy all increase adenosine; allopurinol has actually been trialled for use against mania, a disrupted psychiatric state where a person has more excitation in the brain causing abnormally elevated mood.
Adenosine is broken down to uric acid; which is commonly tested in blood tests. Uric acid levels can thus reflect the adenosine activity of the brain. Uric acid reflects lower adenosine activity. Furthermore, uric acid has behavioural effects including; impulsivity,

Adiponectin is a hormone. It helps improve the activity of insulin and causes glucose to be taken up in the fat cells. Adiponectin reduces lipid collections in certain cells.
Adiponectin is anti-inflammatory and antioxidant. Very low levels of adiponectin in the blood are considered a higher risk for certain kinds of cancers; although more research is needed.

Albumin is a protein made by the liver. It travels around the body as a part of blood, where it binds to proteins and carries them. Albumin is excreted by the kidneys and so is seen in urine. When albumin is low, this will impact how the body carries important chemicals. This is seen in malnourishment, dying, albumin losing disorders of the kidneys, liver disease to name a few. If the albumin is low, less hormones and other molecules are carried by the albumin and this causes stress to the body. If low, this is correlated with a higher risk of death after surgery.

Albumin and Globulin are both proteins that circulate in the blood. They are often involved in carrying other hormones and substances in the body. It is possible to measure the albumin and globulin in a blood test and look at the ratio of them to tell us a bit about health.
The albumin:globulin ratio is a urine test. It is typically done to test for kidney filtration function, whether the kidney is reabsorbing these proteins or allowing them into the urine.
Traditionally, the albumin to globulin ratio is used to see if the kidney is working well. However, the albumin to globulin ratio is also able to tell us a bit about inflammation.
Globulins rise in the setting of inflammation and so the ratio tends to look lower. Typically, Albumin to Globulin goes from ~40:20 to less than this (because the globulin, as the number on the bottom, will rise).
Albumin tends to drop in the setting of inflammation or chronic stress. Monocytes, ESR, CRP can also be used to assess for chronic inflammation. An albumin to globulin ratio of <1.2 is considered significant.
If an albumin level of below 35 is found on a repeated basis, there will be a functional zinc deficiency. Albumin carries zinc and at these low levels, it cannot carry enough, leading to a functional zinc deficiency.

Alzheimer’s disease is a degenerative brain condition that causes 70% of all cases of dementia. Dementia is a brain disease, often seen in the elderly, that involves significant memory loss. Alzheimer’s disease is a typical disease of ageing in that it involves progressive cell dysfunction in the brain. This leads to deposits of ‘amyloid plaque’ in the brain which severely limit nerve to nerve connections. This can be seen on brain MRI.

The exact cause of Alzheimer’s is multifactorial and not fully understood, however it is considered a disease of inflammation and cell dysfunction over time.

There are a number of risk factors for Alzheimer’s

ApoE, a gene influencing cholesterol, is the strongest genetic risk factor for AD.
Alzheimer’s Disease is strongly associated with inflammation; oxidative stress, nutritional deficiency, metabolic derangement, toxicity, methylation disorders, and is inherently linked to mitochondrial dysfunction as a hallmark of the disease etc.
Alzheimer’s is associated with IL-6, an inflammatory signal that is also implicated in chronic fatigue, lupus, rheumatoid arthritis amongst many other inflammatory diseases.
Preventative measures include assessing the above factors, minimising inflammation and treatment is multifactorial with a focus on inflammation and IL-6.
Anybody at risk of Alzheimer’s disease by virtue of genetics or family history should consider IL-6 measures as well as optimisation of other areas of the health. For further reading: Inflammatory Cytokines.

ALP is a commonly performed blood test item to check for liver function. ALP is an enzyme commonly found in the body, but particularly in the liver and bile duct. If the ALP is elevated, it may represent the liver being inflamed such as from fatty liver, viral hepatitis, post viral, alcohol etc. In particular cases, it may signify the spread of a cancer into the liver; but please remember that this is not the only cause.
Whilst it is commonly used for liver function tests, 50% of ALP comes from the bones and so it may elevate from this cause, such as a fracture. In this case, a specific bone form of ALP or liver form of ALP can be tested to see where the source is. Weight lifters seem to have a higher ALP and the number may be higher after eating, which is why you should generally have your blood tests fasted.

The Apolipoproteins are molecules that carry fat in the body. ApoB is one of the proteins that is found in VLDL, VDL, IDL which are also known as the ‘bad cholesterols’; the ApoB protein binds to the LDL receptor. The ApoB is particularly active in causing plaques in arteries, these are inflammatory deposits which clog up arteries and lead to strokes and heart attacks.
ApoB is often tested in the blood to assess cardiac risk. Usually LDL is done as it is cheaper however for some people ApoB may be offered. Lipoprotein A, another apolipoprotein, is bound to ApoB and is also associated with plaques. Lipoprotein A and ApoB are often tested together to assess the risk of somebody ending up with cardiovascular disease (heart attack and stroke).
In patients with known coronary artery disease (CAD), or suspected of being in a high risk group for CAD, treatment target levels for Apo B are <0.9 g/L, and treatment target levels for Apo A1 are >1.15 g/L for males and >1.25 g/L for females.
Lipoprotein A levels greater than 0.30 g/L have been associated with an increased risk of coronary artery disease.

The Apolipoproteins are molecules that carry fat in the body. Apolipoprotein E is the main cholesterol carrier in the brain. There are several variants of ApoE protein with ApoE4 being implicated as the largest known genetic risk factor for Alzheimer’s disease. ApoE4 mutation is associated with higher LDL (a bad cholesterol) and also higher Alzheimer’s. It modifies how cholesterol is transported.

Simvastatin, a cholesterol drug, is lipophilic and there is evidence that it will cross the blood brain barrier where high cholesterol can lead to dementia risk. Some studies have shown a preventative effect of simvastatin, but not other statins, and the ability to prevent Alzheimer’s is more pronounced in APOE4 carriers.
A person with two copies of ApoE4 has approximately a 50-70% chance of dementia at age 70 Other measures to optimise health should be undertaken as well A mediterranean diet helps lower the risk of cardiovascular disease.

References

Geifman, N., Brinton, R.D., Kennedy, R.E. et al. Evidence for benefit of statins to modify cognitive decline and risk in Alzheimer’s disease. Alz Res Therapy 9, 10 (2017). https://doi.org/10.1186/s13195-017-0237-y
Liu CC, Liu CC, Kanekiyo T, Xu H, Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy [published correction appears in Nat Rev Neurol. 2013. doi: 10.1038/nmeurol.2013.32. Liu, Chia-Chan [corrected to Liu, Chia-Chen]]. Nat Rev Neurol. 2013;9(2):106-118. doi:10.1038/nrneurol.2012.263
Shepardson NE, Shankar GM, Selkoe DJ. Cholesterol level and statin use in Alzheimer disease: II. Review of human trials and recommendations. Arch Neurol. 2011;68(11):1385-1392. doi:10.1001/archneurol.2011.242

Aquaphore is a topical moisturising treatment sometimes used for wounds, burns, irritation for skin or protection of it. It has some unique features

Arabinogalactan comes from plants and helps the immune system.

Dr Tu Youyou won the Nobel prize for the discovery of Artemisinin in China. Extracted from a plant, this substance exploited parasites’ taste for blood and was instrumental in saving countless lives from malaria. Artemisinin is a drug that is effective against malaria and worms that infect the gut.

Artemisinin helps with tapeworm, roundworm, schistosomiasis, trematodes and other organisms which can enter the body by the gut and cause infestation that causes weight loss and malnutrition. Artemisinin works against a range of parasites.

Artemisinin can be used in malnutrition in case somebody has a gut parasite; however it is used in functional medicine for lupus as it has the chemical effect of acting against NF-κB signal; an inflammatory chemical in the body.

Astragalus is a herb commonly used in traditional and alternative medicine. It is an antiinflammatory herb.

Athletic Hemolysis, also known as foot-strike, is a phenomena whereby red blood cells fragment or burst open due to the impact of exercise. This usually occurs from the squishing of the blood cells at the bottom of the foot as the foot hits the ground.

Hemolysis means the bursting open of a red blood cell. This usually only occurs in certain medical conditions such as autoimmune attack or G6PD deficiency (Favism) whereby the red blood cell has a defect in coping with damage from certain medications or substances.

In athletic hemolysis, mechanical trauma as well as muscle stress lead to the rupture of red blood cells. Athletes tend to have a shorter red blood cycle by 40 days. Athletic hemolysis is something doctors call ‘a diagnosis of exclusion’; that is, if somebody has lower levels of red blood cells and evidence on tests that they are bursting, other causes need to be ruled out before we can blame the sport as a cause.

Beta alanine is an ‘amino acid’, a key building block of many proteins. Beta alanine helps to create Carnosine which neutralises lactic acid in the muscle. We all know lactic acid as being a byproduct of cell activity in sports; it builds up in the muscle and can cause cramping and fatigue.

Beta alanine is used as a sports supplement. It is most useful in high intensity bursts of activity (e.g rowing). It can cause tingling in some forms; it is best to take with sodium bicarbonate in a timed release and is loaded for a few weeks at 3-6g per day.

Betaine is a kind of ‘relative’ of a class of vitamins called B vitamins. The B vitamins help cells function, survive and reproduce. Betaine is also known as trimethylglycine or TMG In addition to other B vitamins and folate (or Tetrahydrofolate), betaine can help provide methylation substrates (things that help methylation).

Methylation is where a methyl group is transferred from one molecule to another. It is a fancy term to describe a common chemical pathway cells use to turn on genes, make proteins, form enzymes, drive detoxification chemical reactions, influence hormones and also helps the body maintain health. It’s a kind of motor oil for cells that requires B vitamins.

Methylation is impacted negatively by oxidative stress, toxins, poor nutrition, infections and genetic metabolic defects. All of these cause the body to have to use up more B vitamins and methylate more to tidy up the damage.

Betaine is often taken alongside NAD+ Boosters to help excrete byproducts and give cells adequate energy to clean up debris and damage.
Betaine has been shown to help athletes mildly improve body composition however its main role is methylation.

There are four common foods that are known to cause inflammation, gut illnesses, metabolic diseases etc.
Sugar (especially fructose in sucrose) leading to insulin resistance, obesity and heart disease risk Cow’s milk; when not fermented, contains multiple mRNA and proteins which inhibit methylation in the body Processed trans fats; which are inflammatory in the body Wheat: which contains lectin and gluten (a lectin like substance) which binds the sugar molecules of the gut wall to stimulate an inflammatory reaction.

Traditional diets consumed far less processed and refined sugars and trans fats, far less wheat with fermented wheat products with less lectins and cow’s milk was typically fermented. These were less damaging to the body. Mass production of refined and processed foods has altered the molecular structure to the disadvantage of health.

Bile is a green liquid produced by the liver, stored in the gall bladder and released into the intestine to digest fats. It is composed of bile salts, bilirubin, fats and salts. Bile is dark green to yellow in colour; it gives the brown colour of faeces.
Bile is released after eating, especially in response to fatty foods. It carries waste products out of the body as well as helping absorption of the fat soluble vitamins A, D, E and K. People with biliary insufficiency may describe fatty, floating stools.
Traditional herbal bitters are liver bile stimulants and we need that to keep the bowel functional well and avoiding overgrowth of the wrong bacteria in the gut (see dysbiosis). Bile is also an antioxidant, helping to repair biochemical damage at the cellular level.

Bilirubin is a breakdown product of heme. Heme is the molecule that carries oxygen inside a red blood cell. When red blood cells break down, the heme is converted to bilirubin and excreted by the liver and kidneys. Bilirubin is present in bile, a green liquid produced by the liver, stored in the gallbladder and released into the intestine to digest fats.
Bilirubin can be elevated if there is a blockage of bile from the liver or gallbladder, increased breakdown of red blood cells and certain genetic conditions such as Gilbert’s Syndrome. In this event, somebody can become yellow, especially in the eye, and this is called jaundice.

Heme happens to be an antioxidant; as is bilirubin. Bilirubin is highest in the fasting state and thus should be tested at such a time. Bilirubin also rises after exercise; athletes tend to have higher fasting bilirubin (>14micromol per L). Men have higher bilirubin than women, probably due to greater red blood cell production which is triggered by testosterone. Chinese have higher bilirubin than westerners, perhaps due to more vegetable matter in the diet.

Australians have a low level of antioxidants in the diet and so a low level of bilirubin. Whilst bilirubin is considered a beneficial antioxidant, in higher amounts it might reflect issues with metabolism which have consequences for the rest of the body; typically, excretion of other chemicals by the same pathway by which bilirubin is excreted. Estrogen is one such substance. Good bile flow is needed to get rid of extra estrogen; plants in the diet help excrete estrogen and may contribute to the observation that a diet rich in vegetables is associated with a lower breast cancer and blood clot risk.
Bilirubin can only exit the body by glucuronidation; a chemical process to process metabolites in the liver.

Gilbert’s syndrome patients, patients with isolated high levels of bilirubin, tend to have genetic abnormalities in the genes that control ‘glucuronidation’, the pathway that controls bilirubin excretion. Depending on what else this enzyme will not clear from the body, this may have consequences for the patient’s health and there are some associations between Gilbert’s, or elevated bilirubin, such as gut symptoms and ambiguous mental health problems. It may be that Gilbert’s patients just cannot clear toxins as well.

Gilbert’s syndrome can sometimes be confusing; for practical purposes, it is better to compare the non fasting to fasting bilirubin. If the latter is >50% higher than the former, then genetic studies are not needed to confirm the diagnosis. A bilirubin above 14 micromol/L may warrant consideration of glucuronidation issues whilst Gilbert’s tends to me above 20 micromol/L. A bilirubin <10 micromol per Liter is suggestive of inflammation, such as smokers, whereby the antioxidants are being consumed.

Treating Gilbert’s is about assisting detoxification of any compounds which may accumulate. The bilirubin may remain high despite treating toxicity; there are many inputs to bilirubin and so treating the toxicity may still yield improvement even if the bilirubin does not decrease. Often people in this category will respond very well to detoxification but prolonged fasting will increase bilirubin.

(Insert picture: google: neurotransmitter synthesis)

This chart is quite complex but identifies how clear biochemical pathways are reliant on vitamins; even relatively minor defects in enzymes and vitamin insufficiencies will upset a careful balance of these cycles with a resulting health impact.

Key minerals involved in mental health,
Zinc (from shellfish, seaweed),
Lithium oratate (Found in soils, used in very low doses for mental health),
B vitamins, water soluble vitamins,
Fats: anti-inflammatory ‘good fats’ (DHA, EPA, Omega 3, Fish Oil),

Vitamin D (10 minutes in the sun, with the sun at least 45 degrees in the sky, each day and not just on one day).

Vitamin B12 is one of the most important vitamins in the body. It is the biggest vitamin in the body by size and also one of the ones used in the highest volume.
B12 is used in a range of body functions. It is essential for methylation, a process that cleans up cells, detoxes and helps build new DNA structures. It is also needed to make serotonin, which regulates our mood, and low B12 is associated with fatty liver, metabolic syndrome, depression, neurological issues to name a few.
B12 can be tested in the blood in the active form, however functional B12 testing is important. When B12 is low, homocysteine may be high which reflects issues in the process by which cells repair and create DNA (called methylation).

Useful tests include:

Active B12
Homocysteine
MMA (Methylmalonic acid).

There are several forms of B12.

Methylcobalamin is naturally occuring and more easily absorbed.
Adenosylcobalamin is a co-enzymes form of B12 and is better at supporting the mitochondria, the powerhouses of the cell, which methylcobalamin cannot do.
Hydroxocobalamin is naturally produced by bacteria in the gut. It can be injected and the body will turn it into methylcobalamin and  adenosylcobalamin.
Cyanocobalamin is a synthetic B12.
There is no clear consensus on which B12 to give, however Adenosylcobalamin and methylcobalamin can be used together.
Factors for low B12 include.
Poor absorption; good levels of stomach acid are required to absorb B12. The use of a PPI, zinc deficiency or gut issues will impair B12 absorption.
Gut issues such as irritable bowel; will hinder the gut bacteria production of B12,
Alcohol consumption is powerful at inhibiting B12 absorption,
An autoimmune condition called Pernicious Anaemia, will cause low B12. Sometimes the doctor will check for antibodies for this condition,
A lack of dietary fiber; good bacteria in the gut eat fiber and give us B12 in return.
B12 is a very important vitamin. It is essential for methylation, a process that cleans up cells, detoxes and helps build new DNA structures.
B12 is poorly absorbed if there are stomach issues, such as low acid B12 deficiency impairs neurological function.
B12 cannot be synthesised by plants and animals, only by bacteria and archae.
B12 is best administered by injection into muscle; it is poorly absorbed if somebody drinks alcohol.
Low B12 causes high homocysteine, which is linked to alzheimer’s and vascular diseases.

Clinical Tips:
B12 is not well absorbed from the gut in many people and injections are preferable If oral, both cyanocobalamin B12 and methylcobalamin are good however cyanocobalamin is synthetic, better absorbed Activated (serum) B12 is best tested when fasted.

Black Cohosh is a popular herbal treatment for a range of hormonal conditions. Black Cohosh:
Reduces menopausal symptoms Has Gentle phytoestrogen (good estrogen) action,
Reduces luteinising hormone (a hormone in a higher ratio in polycystic ovarian syndrome),
reduces hot flashes, night sweats, vagina dryness and thinning, sleep issues.

Blood tests are commonly performed to analyse many aspects of your health, or your treatment. The specific preparations for different blood tests are unique to that blood test and you should speak with your doctor or nurse prior to having it.
Having said that, some common guidelines are:

For almost all blood tests, fasting from midnight with nothing but water and having the blood test first thing in the morning is preferred,
Avoid heavy exercise, excess caffeine prior to the test Refrain from taking your vitamins ideally 2 days before the blood test as many vitamins or supplements can interfere with results If you are taking estrogen or progesterone, abstain from taking any hormones the night before or the day of the blood test Bioidentical hormones, often used as a cream, often do not show up in a blood test well and a saliva test is preferable If you are having injectable testosterone either twice weekly, weekly or every few months, aim to have the blood test the day before your next dose.

If you are taking daily testosterone gel or cream, the best test is usually 2-4 hours after your morning application.

(Insert picture: google: Light wavelength and intensity LED

Figure 1: Tosini et al (2016) Accessed 23rd August 2021

A comparison of the power spectrum of a standard white-light
LED, a tricolor fluorescent lamp, and an incandescent source.’
Note how they all look the same to the human eye.
Blue light sits at 420-460nm on the electromagnetic spectrum
Blue light induces cortisol, sympathetic tone which causes
stress and poor sleep
It suppresses melatonin, which helps us sleep and make
thyroid hormone
Blue light Increases Alertness
Raises core body temperature
It shifts the sleep cycle later
Exposure to blue light may represent a risk for the
development of eye problems
Minimising or indeed blocking blue light 2 hours before bed
has been shown to improve sleep
*Consider using a blue light blocker on your computer or phone screen
before bed.

Brain natriuretic peptide is a hormone released by the heart when it stretches. It is used to diagnose heart failure. A level of above 100pg/mL is associated with a much higher heart attack event if undergoing surgery. Levels above 500pg/mL are suggestive of heart failure; however interpretation is required. There are other tests for heart failure including echocardiogram, stress ECG and nuclear medicine if necessary.

Breastfeeding and Drugs

Breastfeeding is by far the best way to feed a new baby. It has lactoferrin, IgA, and good species of bacteria such as L. Rhamnosus which protect and help the baby grow. It is essential to check any drugs you might be prescribed or substances before you take them as they may enter the breastmilk and thus the baby.
Formula has less variety of good gut bacteria; formula feeding is a last resort but if necessary it might be worth adding a probiotic either to mother or baby. L. Rhamnosus GG is a good pick but it is wise to get expert advice.
The following database is one of many in common use:
https://www.ncbi.nlm.nih.gov/books/NBK501922/?term=lactmed

Caffeine increases alertness in the central nervous system.
It influences neurotransmitters such as dopamine, serotonin and adrenalin.
Caffeine helps fatty acid oxidation which helps break down fats.
Caffeine increases athletic performance in most studies.
Caffeine increases the rate of perceived exertion.
Caffeine is broken down differently in each person due to genetic difference. CYP1A2 gene (AA, AC, and CC) determines if somebody metabolises caffeine quicker or not. CC subtype often do not get an increase in energy.
It is best taken without sugar and in the morning.
200mg per day (one espresso) for fat burning and 500mg for bodybuilding; it takes 20 days to get tolerant to the agitation.

(see article Candida and Thrush)

Cannabinoid compounds have gained recent media attention for their broad health effects.

Cannabinoids are a class of chemicals found in the marijuana plant. They are not psychoactive; it is the THC component of the plant that is psychoactive. CBD has been found to have a range of beneficial effects in the body. These include anti-inflammatory, calming and neuroprotective elements.
CBD receptors are found in the brain and also nerves throughout the body including the gut, immune system and heart, lungs etc. and so it plays a broad role in the body Endocannabinoids serve a protective role in the body. They regulate inflammation, and decrease the release of pro inflammatory cytokines, including IL 1B, IL6, IFN, LPS activated microglial cells.
Studies have demonstrated a reduction in anxiety and improvement in sleep quality amongst small cohorts of people taking CBD.

Ceruloplasmin is a protein linked to copper. It is made in the liver and helps to transport copper. Copper is an important element in the body for many enzyme reactions. Copper tends to exist in a balance to zinc, another element. If copper is high, it can lead to neuroinflammation. If there is low ceruloplasmin then there tends to be more free copper, as there is not enough ceruloplasmin to bind copper.
Ceruloplasmin tends to be higher when there is excess copper or copper toxicity which may be related to a zinc deficiency. Ceruloplasmin tends to be low in Wilson’s disease which is a copper storage disorder as well as copper deficiency or zinc deficiency.

The nutrition of children is an extraordinary concern in the western world. In countries such as Australia, 40% of children’s calories are coming from ultra processed foods. These foods lack the fibrous material to stimulate good gut bacteria leading to higher inflammation in the body, and thus the brain.
Vitamin deficiencies, obesity, mental and behavioural disorders are conspicuously high in western children. There is a tendency towards low iodine, low zinc, low B12 to name a few as well as the concepts of ‘leaky gut’ and ‘ leaky brain’. These are loose terms describing the impact of inflammation due to inadequate nutrition on the brain and gut in children.
14% of Australian children aged 4-17 have a mental disorder, 1 in 10 will self harm and 1 in 13 will have serious thoughts of suicide. This is a damning statistic (source: The Australian Child and Adolescent Survey of Mental Health and Wellbeing 2014). Studies also show that children who eat unhealthy food have a smaller hippocampus, an important part of the brain.
The western diet is particularly high in sugar and processed carbohydrates. Accordingly, more people in the west are overweight than normal weight and this has skewed the ‘norm’. Sugar encourages the survival of gut bacteria which produce endotoxin; this in turn causes more sugar craving and behaviours to seek and demand more sugar. These children often have behavioural issues.
The take home point is that highly processed foods, purchased from a supermarket rather than cooked, are not nutritionally adequate and lead to adverse mental health and physical health conditions.
Parents and families should be counselled to consume whole foods, to ignore the spurious health warnings on many boxed and packaged products and resist the effect of marketing preying on their children’s health.
Breakfast cereals, juices, milk, chicken nuggets and white bread are particularly unhealthy foods for children and their mental health. Whilst they may be consumed in small amounts, they do not constitute a serious form of nutrition and should not constitute the bedrock of a family or child’s meal plan. They are not real foods.
Children suffering from attention or behavioural disorders are best to see a nutritionist, naturopath or integrative doctor to address their diet, nutrition and look at areas for improvement alongside conventional treatments.
Children and Adolescents who eat a healthy diet are 50% less likely to have depression than those who do not (Jacka et al 2010) highlighting the importance of this message. Those children who eat healthy foods but also unhealthy foods still experienced mental health issues.

Summary Points

Processed foods are not real foods and are harmful
High sugar diets encourage behavioural issues
Iodine, magnesium, selenium, B12, iodine and iron are often low
Packaging on foods that are in a box is marketing and not professional advice
Low iodine is the leading cause of preventable learning difficulties in children
Fortification with folate in foods is not necessarily useful as it is synthetic and may not be converted to a useful form without other vitamins.
Copper can often be high and zinc low
Low fiber diets and dysbiosis tend towards food allergies, which can trigger bad behaviours
The DASH diet is often employed, it helps with good gut bacteria. It is associated with a 30% reduction in depression

Cholesterol
Cholesterol is a well known risk factor for heart disease.
Cholesterol describes a range of fats and molecules carrying fats in the body. Whilst it is true that higher levels of cholesterol are associated with higher rates of heart attacks and stroke, the nature of the cholesterol also matters.

If cholesterol is ‘oxidised’, that is that inflammatory free radicals have altered the molecule, it is more likely to stick to the inside of an artery wall and thus, over time, block the artery leading to downstream heart attack or stroke etc.
LDL: Describes the ‘bad’ cholesterol. This kind of cholesterol is known to stick to the inside of arteries and clog up blood vessels. LDL, especially when oxidised, is well known to cause heart disease. Ideal is 1.8-2.4mmol/L.
VLDL: This cholesterol transports useful fats to the cell membranes
HDL: This cholesterol is the return molecule for fat transports; it is the ‘good cholesterol’. Ideal is >1.5 mmol/L.
TAG: Triacylglycerides are the main form of fats released into the blood after we eat a fatty meal. If they are raised throughout the day, they also deposit in blood vessels. Ideal is <1.3 mmol/L
73% of people who have heart attacks have normal cholesterol. Further tests to see if the cholesterol is oxidised include oxidised LDL testing.
Usually a cholesterol test is done after fasting from midnight however some doctors advocate doing a non fasting TAG; if you are fasted for a very long time, a high TAG might be missed as you have not eaten for a while and it falls unusually low for your normal level.

Choline comes from meat, dairy and some vegetables. It is not technically a vitamin but acts as one with important nutritional value to the body, the liver and the brain.

What does Choline do?

Choline does a range of things. It is an important part of the wall of cells. It is necessary to make cholesterol and move it out of the liver. It is needed for acetylcholine, a neurotransmitter.
Importantly, it is used for ‘methylation’; the chemical process that the body uses to switch genes on and off for healthy cell function and growth. A deficiency is associated with high homocysteine (a marker of poor methylation) and fatty liver.

How do we get choline?

Humans can make choline but not enough. It is typically obtained from beef, hen eggs or liver. Of interest, estrogen lowers the requirement for choline in women. After menopause, there is less estrogen and so the requirement for choline increases.

What happens if there is a lack of choline?

Choline is involved in the methylation pathway. If somebody has low folate, B12 etc. then the body may use up more choline in response. Because choline is needed to make VLDL (a kind of cholesterol) and release it from the liver, low choline can be associated with fatty liver which is a disease of fat retention in the liver. Fatty liver can be a hint of a lack of choline.

Similarly, a lack of choline in conjunction with other vitamin problems impairs methylation and this can have theoretical risks in cancer, heart disease and dementia; all of which we want to avoid.

Higher choline intake has been associated with lower inflammatory markers, less neural tube defects in babies, lower rates of breast cancer however these are broad associations and other factors would have been at play.

How much choline should I have per day?

The adequate intake for choline, enough to prevent fatty liver, is considered to be >550mg per day for men and >425mg per day for women. It should be noted that different sources may vary.

Whilst many people are deficient in choline, more attention should be paid to patients with fatty liver, impaired digestion or intestinal problems or high homocysteine as this may be a clue.

There are genetic differences between people that determine how sensitive they are to low choline intake. This is a complex area of research called nutrigenomics.

How and when to take choline?

Choline supplementation is possible however animal products are a rich source. If there is a reason to take choline due to deficiency, or fatty liver/high homocysteine then supplementation is possible; however diet should be the long term aim as always.

It should be noted that over consumption of the supplement can cause sweating and a fishy odour due to breakdown of the choline into other chemicals.

Chromium is a trace metal used by the body in small doses. It is required for enzyme reactions and plays a role in the treatment of insulin resistance due to its activity at various enzymes.
It is typically dosed at 500 micrograms per day when administered by a doctor.

Clinoptilolite is a natural mineral with aluminium and silica. It is used for the detoxification of heavy metals. It is also referred to as Zeolite in some compounds. Detox involves the use of many agents, as well as lifestyle and dietary change, and Clinoptilolite would be used in conjunction with other agents. Clinoptilolite can bind to histamine, toxins and other agents of disruption.

Coenzyme-q-10, also known as ubiquinol, is an enzyme found in the body. It is involved in redox reactions, the donating and accepting of electrons. Oxidation is a body chemical process that changes the chemical nature of a molecule; an imbalance can cause ‘oxidative stress’. (see oxidation).

CoQ10 suppresses the harmful oxidation of LDL, the bad cholesterol, and helps prevent it causing artery clogging that leads to heart attacks and stroke. It is also used to protect against muscle damage from statins, medications commonly used to lower cholesterol.

See also: Alzheimer’s disease.

Cognitive decline describes the decline in thinking abilities, such as dementia. There are multiple causes including brain trauma, poor health, poor nutrition and genetics. Alzheimer’s is a subset of cognitive decline.
Prevention is better than the cure however brain function can always be optimised:
Ensure a good diet Aim for a low inflammation diet, such as mediterranean Reduce cardiovascular risk factors (Blood pressure, diabetes, cholesterol) Look after methylation
Look after mitochondria Dementia is a disease of aging, look after your aging (antiaging) Genetic tests to assess risk: ApoE, COMT,

Collagen is a structural molecule and when taken with vitamin C enhances recovery of microdamage in bones and tendons.
This is similar to how it is used within the beauty industry.
Studies show an increase in fat free mass Collagen peptides have been shown to improve ankle instability
Collagen peptides have been shown to improve muscle soreness post exercise 1200mg can help joint pain over 6 months and 10g, taken consistently, improves joint mobility in those with arthritis.

Colostrum is the first bit of milk from a new mother to a newborn; in any mammal.
Bovine colostrum has a higher protein content than standard milk (13% vs 3%) and has a high concentration of immune positive compounds.
Bovine colostrum has been shown to protect against an upset stomach when taking anti-inflammatories Vaginal application of bovine colostrum (vaginal tablet called Ginedier) has been shown to help reduce HPV which is human papilloma virus; a kind of wart infection that is associated with cervical cancer.

Bovine Colostrum has lactoferrin, and immune positive proteins called: IgA, IgM and IgG, TNF alpha, growth hormone and crude protein.

Bovine Colostrume has been used to treat fatty liver by improving the health of the gut bacterial ecosystem.

COMT is an enzyme which helps breaks down adrenalin, noradrenaline, dopamine. This enzyme is often tested genetically for people with stress, cognitive decline or mental health symptoms. Magnesium is an important
cofactor for this enzyme. The western diet is deficient in magnesium, especially refined foods, and so it is often given to improve anxiety and sleep.

(see also, Ceruloplasmin)

Copper is found in the diet and is present in the body in small amounts. Raised free copper is associated with mood changes. If zinc is low, copper tends to be higher; zinc is thus a regulator of copper. Copper is falsely elevated in infections, in the presence of estrogen and stress. Copper is linked to the production of the neurotransmitter noradrenalin which is a fight or flight hormone.
Ceruloplasmin is the protein that carries copper. When copper is not attached to ceruloplasmin it is called free copper. Free copper can irritate the body, similar to iron, and this is seen in a disease called Wilson’s Disease. In Wilson’s disease, not enough ceruloplasmin is made and so free copper attacks the body.
It is hard to accurately test for free copper as there are multiple vectors at play in the binding of copper including how much copper is bound and other proteins which may play a role.
High free copper is treated with molybdenum (Tetra-thio-molybdenate or promoter), zinc, vitamin C and treating any underlying source of inflammation.
During an infection, the body hides away zinc and iron in the liver to deprive any invading bacteria of their use. Copper is sent out to the blood to help fight the infection. Copper and zinc need to be thought of together and also as neurotransmitters and inflammatory modulators in their own right. An excess of either is toxic.
Copper: higher in infection, linked to noradrenalin, inflammation signal
Zinc: lower in infection, linked to GABA, anti-inflammatory

Australian soil is low in zinc and higher in copper. The best way to test copper is serum copper as it correlates more with liver copper levels. Conversely, plasma zinc is superior as serum zinc tends to overestimate the level.
For more information, see pyrrole disorder

Cow’s milk is a staple part of the western diet. Whilst cow’s milk is very popular today, it should be noted that historically humans did not consume cow’s milk anywhere near the scale of today and nor in the form it is available today.
Typically, humans would consume goat, sheep and other forms of milk in a fresh or semi fermented format; fermented meaning that they contained live bacteria which conferred benefit to humans (aka, probiotics).

Furthermore, non-cow milks tend to have less casein 2 and 7, proteins which are inflammatory to the poorly adjusted human gut compared with cow’s milk. Casein acts a lot like gluten; the body cannot tolerate it particularly well and they can cause a long term gut and body issue such as celiac disease. Non cow’s milk, is generally less processed than cow’s milk with more good bacteria, more diverse proteins and easier on the stomach.
Currently, pasteurisation, sterilization and other processes are mandatory so that cow’s milk is generally safe and free from bacteria when it is produced in a commercial quantity. Unfortunately though, this destroys a lot of the important parts of milk, such as proteins and enzymes, that make it nutritious. Less processed milk is generally healthier.
Much is talked about lactose intolerance. Lactase is the enzyme that breaks down lactose; it is found in babies but diminishes soon after birth. True lactose intolerance due to lactase insufficiency usually results in bloating, diarrhoea and stomach cramps after having milk. It may be that the lactase enzyme is insufficient, however it should also be noted that many healthy gut bacteria such as lactobacillus also produce lactase.

Lactose intolerance is different to cow’s milk intolerance. In cow’s milk intolerance, the casein is inflammatory and the highly processed cow’s milk provides too little nourishment and nurture of the gut. This results in a ‘gluten’ like sensitivity that is more subtle than lactose intolerance. It is a low grade inflammatory reaction whilst lactose intolerance is usually explosive milky diarrhoea.

Also, cow’s milk can bind and diminish many minerals if taken close to meal times. In medicine, children who consume a lot of cow’s milk are often found to be iron deficient called ‘Cow’s Milk anaemia’.

Cow’s milk also has a high relative sugar and calorie content; hence dairy products including ice cream, cheese and cream.
In general, cow’s milk is not as nutritious as fresh, natural, fermented milks from goats or sheep. The mediterranean diet for example has a greater variety and use of these than simple highly processed, pasteurised cow’s milk.

Summary

Cow’s milk in the current form today is not the same as milk consumed historically Whilst lactose intolerance can exist in some people, it may have more to do with a lack of good gut bacteria or that humans are poorly adapted to cow’s milk Casein 2 and 7 represent other inflammatory proteins which may induce a reaction to milk Cow’s milk often binds nutrients and makes digestion less efficient Fermented milks, from other animals, with less casein and live cultures are preferable for their positive gut content and lower inflammatory profile

Creatine is an amino acid found in protein and seafood. Creatine lives in our muscles and some of it is routinely broken down due to muscle metabolism; thus it has to be replaced each day. It is made in the liver or obtained from the diet.
Studies about creatine show:
Creatine increases ATP, which is the energy molecule in cells.
Creatine can be helpful for mitochondrial energy and brain cleanup
Creatine is associated with better recovery from injury

Creatine helps muscles retain water and so helps with training in the heat
Creatine has some protective injury against brain injury such as concussion
It provides 12-20% improvements in strength and power.
It is obtained from meat sources but is generally supplemented for weight lifting at 2.5-5g per day after a higher loading dose of 25-30g per day for a week.
It contains antioxidants which help cell recovery as well as arginine which helps blood flow. This can help brain function and mood.

C reactive protein is an inflammatory marker; it is commonly measured in blood tests to look for inflammation as it is very sensitive.
CRP is typically linked to interleukin 6, a common inflammatory marker. It is the first to appear when CRP is high, however it can also fall before other inflammatory markers; so a negative CRP does not mean that the body has no inflammation.
Whilst CRP tends to be highest in the setting of severe acute illness, a low level of mildly raised CRP can signal underlying health imbalances. Inflammation, even chronic, is associated with a higher chance of death.

Cystic Fibrosis is a genetic disease affecting children. It is autosomal recessive, which means that two copies of the disease gene need to be inherited together (one from each parent, who will not have the disease with only one copy of the gene rather than two) in order to manifest.
Cystic Fibrosis is a disease affecting how cells use salts to clear mucous; it leads to an increase in thick secretions in the ‘exocrine’ glands such as pancreas and in the lung. Patients with cystic fibrosis have severe malnutrition leading to a range of problems that can be life threatening. The diagnosis is to look for an increased sweat chloride (salt) concentration or perform a genetic test.
Cystic Fibrosis is often screened for before and during pregnancy to inform choices.

Dehydroepiandrosterone or DHEA is a hormone present in men and women. It is made in the adrenal gland and plays an important role in vitality.
It has a role in:
Elevating mood
Assisting in depression and memory
Reducing TAG or cholesterol levels
Improving insulin sensitivity
Increasing muscle mass and strength
Reducing fat
Relieving chronic fatigue syndrome
Reducing joint pains
Assisting immune function
Increasing growth hormone
Increasing bone mineral density in women
DHEA exists as DHEA and then DHEAS in the blood; the latter is commonly treated with a goal for above 200 microgram/dL. Supplementation is started at 15-25mg per day; side effects include testosterone like changes like aggression and oily skin if too much is taken.
Stress, or high cortisol, can lower DHEA. Similarly, as we age, we produce less DHEA.

When we exercise, blood volume will contract as we sweat out the water but keep the rest of it. Over the next few hours, the body will compensate for this by dragging fluid in from the body tissues and or drinking it.
There will be an expansion in the ‘water content’ of the blood, between 6-25% which makes the blood look a bit dilute.
This can often alter blood tests making it look like a low iron, low sodium etc. and thus look like anaemia or low red blood cells and or iron. It is something to consider when reading blood test results in people who recently exercised. The body may expand plasma in exercise to help clear toxins, help the heart pump more blood (preload) and deliver oxygen; studies are ongoing.

Di-indomethane or DIM is a compound from broccoli and cruciferous vegetables more broadly. It is associated with a reduced risk of breast and prostate cancer. It is anti-inflammatory and is associated with a reduction in fat in obese women and a reduction in estrogen.
DIM shifts estrogen metabolism from 16-hydroxyestrone (a bad pathway with more cancer causing estrogens) to 2-hydroxyestrone and 2 methoxyestrone (good) estrogens.
A direct result of 2-hydroxyestrone and 2 methoxyestrone in premenopausal women is to increase progesterone production from ovarian cells. This helps balance estrogen and produce an easier period cycle.
In post menopausal women, DIM results in safer estrogen metabolites, linked to a reduced risk of breast cancer.
In men, DIM inhibits PSA production (less prostate inflammation) and increases free testosterone via competition between 2 hydroxyestrone and testosterone for protein binding. It also helps reduce estrogens in males and DIM has been used to treat male breast tissue.

Dr Shade’s Bitters refers to a compounded product for the use of heavy metal detox. In general, plant chemicals are good at binding toxins and increasing bile flow. This helps carry off toxins out of the body via the sweat, the urine and the stool.

Dr Shade’s bitters will often be used with other detoxification methods based on the circumstances.

Detoxification Plans often include:
Mixture of Phosphatidyl Choline (methylation pathway) and Dandelion Root, Gentian, Myrrh, Sweet orange

Dopamine is a neurotransmitter, a chemical in the brain. It is involved in a wide range of brain functions including alertness, energy, mood as well as the reward pathway. Low dopamine is implicated in depression. Often, these patients have lost enjoyment in pleasurable activities.
Nutrients required for dopamine include:
Zinc 15mg twice per day,
Vitamin B6 (or P5P) 40mg per day for adults,
Magnesium (such as Magnesium citrate 500mg twice per day),
L Tyrosine (a precursor amino acid to Dopamine),
Rhodiola (红景 天) and
curcumin which is anti-inflammatory.

An echocardiogram is a 4D ultrasound scan of the heart; multiple 2D pictures are put together to form 3 dimensions (3D) and constantly updated in live time (4D). It is the gold standard of dynamic heart imaging and for diagnosing most
structural heart diseases such as: heart valve problems, an enlarged heart, heart pump failure as well as holes in the heart in children.
Echocardiogram is painless, minimally invasive and effortless; the patient will lie reclined whilst a gel is applied to their chest. After this, an ultrasound probe is placed on their chest wall to take images. The probe has to be moved over several areas to gain all the required angles and there may be some pressure. After 10-20 minutes, the gel is then wiped off and the patient goes home to resume normal life immediately without restrictions. The report usually takes a week.

Collagen is a kind of connective tissue in the body. It is most famous for being present in the skin and thinning as we age, contributing to sag, however it is also found in joints, muscles, tendons and blood vessels to name a few.
Ehlers Danlos describes a set of genetic conditions which affect the construction of collagen. People with this syndrome often have a high arched palate (high roof of the mouth), flat feet and very bendy joints due to looser collagen. Some subtypes of this predispose to eye problems and heart problems; although on the whole, this is rare.
People with this syndrome are recommended to have a high dietary intake of collagen such as bone broths or to take collagen as well as vitamin C which is required for collagen synthesis. In general, collagen is also helpful in the diet or as a supplement to maintain collagen as we age.

See Dysbiosis
Lipopolysaccharide, LPS or endotoxin is a toxin produced by certain gut bacteria such as staphylococcus, streptococcus etc. They tend to rise in abundance in the setting of poor digestion, low fiber diet, high processed food diet to name a few. The excess LPS contributes to fatty liver, leaky gut, metabolic syndrome, higher cholesterol and reduced clearance of toxins.
Clinically, this may present as mental health or concentration issues, behavioural issues as well as metabolic syndrome.
Endotoxin interrupts the conversion of tryptophan to serotonin; a key neurotransmitter involved in mood. It instead diverts to glutamate which is excitatory in the brain leading to anxiety, insomnia in some cases.

Treatment involves addressing the underlying issues such as digestion, poor diet, low fiber, removing processed carbohydrates and assisting the liver. Berberine and probiotics are often employed.
Bacteria which produce endotoxin tend to also consume bile; this can lead to more oxidative stress in the gut and suggests a need for more healthy fats such as fish oils. Saturated fats tend to encourage sulfur reducing bacteria and thus consume bile.

Pinworm, also known as threadworm, is a parasitic worm. It is classified as a nematode (roundworm) and tends to infect children, which is its natural host. It spreads by the fecal oral route and so can spread due to poor hand hygiene. Pinworm is sometimes used to describe a different, less common, worm infestation called strongyloides. The common threadworm will be discussed here.
The worm will be ingested often from biting fingernails, scratching the anus or poor hand hygiene. It mates in the small intestine before settling in the colon and feasting there. The female leaves eggs on the way out at the anus causing itching.
Not all patients have itching, however non specific gut complaints, mood issues, malabsorption, itching reactions or a raised eosinophil may point towards a pinworm infestation. It requires treatment of the whole family, ideally twice with a ten day interval.

Summary

Enterobius vermicularis is the most common childhood parasitic worm It can cause an itchy anus or non specific gut related issues Treatment is usually with combantrin with mebendazole twice, ten days apart (or albendazole)

Finasteride was originally developed for the treatment of an enlarged prostate, however it has found its home in the prevention of hair loss. See the article Hair Loss for further information.
Finasteride, or propecia, is a medication that blocks the conversion of free testosterone to DHT (Dihydrotestosterone if i’m not mistake) DHT is something like 100 times more potent at the receptor. It grows beards, enhances libido and also puts pressure on hair falling out.
Critically, it has a role in the brain. So we don’t want to block too much of it Finasteride acts on an enzyme that converts testosterone to the more potent DHT. This enzyme is called 5 alpha reductase.

Fatty Liver is a metabolic disorder whereby fat gets deposited in the liver. Fatty Liver has the capacity to directly harm the liver and potentially cause end stage liver disease; however it is also a general sign of poor metabolic and general health.
The causes include: microbiota imbalances, poor diet, being overweight as well as some genetic conditions. The essential link here is that the liver is stressed and unable to detoxify its environment. There is a link with low B vitamins, a lack of dietary fiber and inflammatory foods.
Fatty Liver should be treated with weight loss, dietary change and fixing any underlying issues. Omega 3 and Berberine are often used. It is diagnosed by blood tests and ultrasound or MRI.

How to diagnose fatty liver?

Homocysteine >12 micromol/L has a link with fatty liver A kind of liver test, a GGT which is above 30 U/L is associated with fatty liver. When somebody’s GGT reaches 40 U/L , the heart attack risk is doubled and by 50 U/L it is tripled Berberine is a starting point herb to help with gut inflammation and fatty liver. Berberine is a herb that helps detoxify the liver and improve the gut microenvironment.

Fat ratios can help hint at fatty liver such as the ratio of Triglycerides to HDL: TG/HDL-C
Fatty liver is a hallmark of metabolic syndrome Ferritin is a blood test reflecting iron storage as well as liver inflammation. A normal result is 70-100 ng/mL, 200 ng/mL is often mild fatty liver and 250ng/mL is often moderate fatty liver.
The ratio of AST, a liver enzyme, to platelet ratio is often used to predict if the liver will become fibrotic; an end stage progression that comes before liver failure  SAMe, a support for our B vitamin driven methylation pathways, is often used if there is a concern of methylation problems.

Folate is an important vitamin. It is a B vitamin, B9 and has similar functions in enzymatic and cellular processes such as B12
It is found in dark green, leafy vegetables, nuts, legumes Folate is essential for methylations and in particular nerve cell turnover
Folate is converted to tetrahydrofolate; this requires B12.
B12 deficiency causes a functional folate deficiency as the folate is not able to be converted to a useful form.
B12 should therefore be replaced before giving more folate One warning is that folate can also contribute to demethylation, the removal of a chemical group that the body needs. For this reason, it should be used with caution when there are symptoms. Ideally, folate is given by food.

Genetics plays an important role in how well our cells can use B vitamins to achieve ‘methylation’. Methylation is a chemical process that cells rely on to reproduce, function and clean up damage.
If somebody has a defective MTHFR gene, a gene involved in processing folate, they should have methylfolate as they cannot convert folate to methyl folate.
Tips on giving Folate
Saturates beyond 1g
Really best to stick at 0.4mg
Test red cell folate, and when fasted

Fructose is a common sugar that is used by the body. It is one sugar, like glucose but is a part of another common sugar, sucrose which is table sugar.
Our ability to break down fructose is genetic. Primary fructose intolerance is where somebody does not have the genes to break down fructose well. The fructose then travels to the large bowel where it is fermented. Interestingly, only 50% of people who are fructose intolerant have symptoms. It is thought that this is due to how their body reacts to the fructose intolerance, so called ‘visceral hypersensitivity’. This is often treated with prebiotic, fiber and
galactooligosaccharides.

Main article: Neurotransmitters

Neurotransmitters are chemicals that the body uses to regulate brain activity. We are familiar with many common ones such as:
Serotonin: 95% of this is made in the gut. It is helpful for mood, memory, pain perception and being low is implicated in depression.
Noradrenalin: as the name suggests this works on our fight or flight sympathetic nervous system in the body but also has multiple roles in the brain. It is particularly found in reward pathways, pain moderation and focus this is also produced in the gut.
Glutamate and GABA: Glutamate is an excitatory neurotransmitter whilst GABA is an inhibitory and thus calming neurotransmitter. Exercises releases GABA, as does a number of supplements.
GABA is often supported by treating any gut inflammation as well as using certain amino acids, herbs and vitamins
Vitamin B6 or P5P (the activated version)
L Theanine 100mg
Taurine 250mg
GABA itself (150mg)
Inositol (antiinflammatory and insulin sensitising) Alcohol releases GABA, as does valium. As such, this is an anxiety neurotransmitter and the above measures are often used for anxiety.

Gamma Glutyl Transferase, called GGT for short, is a common liver test. GGT reflects an enzyme led process in the liver whereby some chemicals are processed for excretion or regulation. If the liver is under stress, or there is a blockage of GGT excretion into bile, the GGT will rise.
The GGT can be indicative of inflammation and metabolic syndrome. A raised GGT, above 30U/L, represents twice the risk of a heart attack whilst a level above 40U/L represents a greater magnitude of risk.
GGT is also elevated if there is a higher oxidative stress on the body. Oxidative stress represents inflammation in the body from how cells get rid of toxins. Oxidative stress is seen after alcohol consumption and also in the setting of non specific inflammation. This is often linked to fatty liver in terms of causation.

Ghrelin is nicknamed the hunger hormone. It is produced and released by the gastrointestinal system. It stimulates food intake (makes you hungry), fat deposition and also growth hormone release. Ghrelin is also made in the ovary; during polycystic ovarian syndrome (which involves high insulin) the signalling is further disturbed.
Gilbert’s Syndrome
Gilbert is a genetic condition affecting bilirubin. In Gilbert syndrome, there a genetic alteration (Single Nucleotide Polymorphism which is the switching of one genetic base enough to modify an enzyme) affecting an enzyme that gets rid of bilirubin through the liver (glucuronidation process).

The condition is autosomal recessive, meaning you need two copies of the gene to have the syndrome and it can be carried widely. Gilbert’s reduces this enzyme’s activity by a substantial 80%.
Gilbert’s Syndrome results in a higher bilirubin level on blood tests, as well as a possible mild jaundice or yellowing of the skin if there is an increased turnover of red blood cells for any reason. This is due to the higher amount of haem being broken down and turned into bilirubin.

It is mostly a mild condition although it should be noted that in those with Gilbert’s Syndrome there may be added stress on the liver if certain toxins or medications are used. Interestingly, unconjugated bilirubin, which is higher in Gilbert Syndrome patients, is an antioxidant and Gilbert’s patients are noted to have lower cardiovascular disease.

Many chemicals in our body need to be excreted. Typically, this is via the gut and liver, the kidney or the skin via sweat. The liver is a major organ for detoxification of multiple chemicals. Thus, it receives the ‘first pass’ of dissolved stomach contents in blood prior to sending it to the rest of the body via the heart.
Glucuronidation is one such pathway by which chemicals are modified for excretion. Enzymes will ‘glucuronidate’ a compound and it will exit the liver, typically in bile which is a liquid made by the liver to pass into the gall bladder and then be released into the gut. Other pathways of toxin excretion include methylation, which is also important in functional medicine.

Bilirubin is a byproduct of haem (from red blood cells) which is glucuronidated. Some people have issues with glucuronidation; typically from genetic abnormalities or chemical interference such as from gut bacteria producing unhelpful enzymes or a backlog of other toxins. Fasting also decreases the process of glucuronidations whilst eating enhances the clearance of bilirubin and other compounds, and increases bile production.
Some disorders with glucuronidation manifest as a high bilirubin. This is called Gilbert’s syndrome and is diagnosed if there is no other cause found for high bilirubin. It is clinically significant as it may represent that body having difficulty clearing other important compounds, such as estrogens.
Glucuronidation is a Phase II breakdown pathway; that means that external and internal compounds like estrogen, androgens, hormones, pollutants etc. get ‘glucuronidated’ aka put into a form that the liver and kidneys can then excrete them from the body.

Thus, glucuronidation is a detox pathway

Glucuronidase is an enzyme that breaks down glucuronidated compounds; undoing the glucuronidation step and thus bringing them back into the body High glucuronidase causes an estrogen problem as it stops estrogen being cleared out by the liver; this is equally true for any compound that is being excreted by this pathway Gilbert syndrome people have an issue with glucuronidation and so estrogen, melatonin, thyroid and testosterone get glucuronidated;

If glucuronidase enzyme activity is higher due to gut infestation with klebsiella, E Coli, Morganella then many compounds are not excreted properly and may accumulate in the body High glucuronidase activity can cause higher bilirubin, this can cause people to have itchy skin and yellow eyes Take Home Point Glucuronidation is not just the breakdown of estrogens but of androgens, pollutants, fatty acids etc. It is influenced by the gut microbiome; a sick microbiome will make it harder to break these things down. This plays a role in the genesis of PCOS, estrogen dominance, hair loss and metabolic syndrome.

Glucose
Glucose is a common sugar used by the body. It is used by every cell to create ATP, an important energy molecule. Glucose is typically consumed alongside fructose in the combined molecule sucrose, or table sugar. (see sugar)

Glutamate

Glutamate is an excitatory neurotransmitter in the brain. It generally leads to increased nervousness and alertness. It converts to, or stimulates the release of, GABA which is relaxing and diminishes nerve activity.

In fact, GABA is the chemical resulting from alcohol ingestion. Caffeine stimulates the release of glutamate and dopamine. Adenosine, which is promoted by magnesium, zinc, TCH (marijuana) and accumulates at the end of a day, tends towards GABA release.
If there is infection, stress or inflammation, glutamate decarboxylase is less active and there is thus less GABA. Glutamate may be relatively unbalanced in this setting.

Summary

Glutamate is excitatory whilst GABA is inhibitory
Excess glutamate is implicated in schizophrenia, with higher downstream dopamine
Magnesium is an antagonist of glutamate (Magnesium citrate, glycinate, threonate)
Zinc is pro -GABA, thus opposing glutamate
Caffeine stimulates glutamate and dopamine

Treatments

Enhancing GABA (L theanine, GABA, Inositol, Glycine, Taurine, Inositol)
N Acetyl Cysteine can help with high glutamine
Avoiding high glutamate foods
Supporting glutamate sensitivity using broccoli sprout extract, Zinc, vitamin B6

Glutamine is an amino acid. It is linked to Glutamate, which is an important neurotransmitter in the brain. Glutamine is a conditional amino acid (protein building block) and has many properties.
Glutamine, as a sports and gut supplement. is typically used for gut repair, immune modulation but also has antioxidant and healing properties in the muscle itself and helps manage fluid.
Glutamine stimulates glutathione and so is an antioxidant Glutamine is depleted in athletes under chronic training

A diet rich in glutamine was shown to improve physical performance

Glutamine is anti inflammatory and helps muscle cells become resistant to accumulation of CK and LDH, markers of muscle fatigue
When used with Alanine it helps cells retain sodium and thus helps with dehydration
L-alanine and L-glutamine combinations improve the ability of either to cross from the gut into the body

Gluten is a protein found in Rye, barley, oats, wheat and therefore in bread and many other food products. There is much more gluten in the modern diet due to cross breeding farming techniques. It is a seed storage molecule.

Gliadin is the breakdown product of wheat. Gliadin acts a bit like lectin, a protein that attaches to sugars in the gut leading to gut wall changes and potential allergy or a wide spread inflammatory bowel condition called celiac disease.

Celiac disease may cause:

iron deficiency due to poor absorption at the gut wall
A lumpy bumpy red rash
Fatigue
Bloating
Poor nutrient absorption
Failure to thrive
Chronic fatigue
Gluten sensitivity describes any adverse reaction that the body has to gluten or its derivatives at a functional level whilst celiac disease describes a gluten induced bowel wall disease. The latter requires a gastroscopy to take a tissue sample of the small gut to prove this.
Sourdough, if properly made, involves the use of lactobacilli bacteria to break down the gluten. Therefore, probiotics and sourdoughs often reduce the lectin like inflammation of the gut lining. It should be noted that wheat, not just gluten, causes intestinal permeability due to the lectin-like effect causing leaky gut.

Glyphosate is used in weed killer. It’s a very common chemical. It is potentially bad for your health; it interrupts glucose metabolism, substitutes glycine (an amino acid) which is a part of important molecules that help heal the body such as glutathione. There is a link to diabetes and PANS (Paediatric acute onset neuropsychiatric Syndrome), which is a behavioural syndrome in children.
Glyphosate exposure is often seen alongside low zinc, low magnesium and issues with using glucose by cells. Glyphosate toxicity can be tested for. Low manganese is often thought to be a marker for glyphosate exposure

Grape Seeds are hardy and designed to last long enough for the grape to reproduce. The extract is used commonly in medicine; it is a polyphenol (antioxidant plant compound). Grape Seed extract is an antioxidant, antimicrobial and has a positive effect on our metabolism. It is used for gut conditions and sometimes in diabetes to lower inflammation.

Heart Rate Variability describes the change in the average heart rate over time. In some people, the heart rate will stay in a narrow range, whilst in others it will move around.
Heart rate variability is a marker of parasympathetic tone. It is considered good to have more heart rate variability as it signals more ‘parasympathetic’ activity.
The parasympathetic nervous system is used for ‘rest and digest’; it slows the heart rate, encourages relaxation and digestion. Conversely, the sympathetic nervous system is the fight or flight system.
Higher heart rate variability is associated with higher parasympathetic nervous activity whilst a reduced heart rate variabilty is associated with less.

Commonly, patients will use a smart watch or Aura ring or other device to monitor the heart rate variability. Interpretation depends on your total health and is something to discuss with your health care provider.

Some formulations are able to impact the nerves in the brain to calm down mood. Some formulations enhance the GABA pathways, this is a set of signals that slow down nervous activity similar to diazepam or the class of medications known as benzodiazepines.

One such recipe from the naturopathic canon is:

Chamomile 40ml,
Lemon Balm 40ml,
Nettle Leaf 40ml,
passionflower 60ml,
Withania 20ml-
*Make to a total of 200ml.
Directions- 5ml twice per day.

Note: only used approved products, store appropriately and seek naturopathic advice.
High Blood Pressure
Blood pressure describes the pressure of the blood flow in the blood vessels taking blood away from the heart to parts of the body. It is created by the force of the pump of the heart and the elastic recoil of the aorta, the biggest and first blood vessel leaving the heart.
The units of measurement are millimetres of mercury of mmHg for short. Normal is 120/80; the first number is the ‘systolic’ which is the pump of the heart whilst the second number is the diastolic, which is the elastic recoil of the engorged aorta after the heart beat.
Hypertension describes a higher blood pressure, usually significant if above 150/90mmHg (or lower if there are other medical conditions present).

Hypertension is still a silent killer. About 25% of people will have high blood pressure and of those, there is a 40% increase in the chance of a cardiovascular event such as stroke or heart attack.
Pre-industrial societies rarely had high blood pressure and so it is an environmental disease in a sense.

Each case is different and should be addressed as a whole; the benefits of blood pressure treatments are beyond doubt.

The best way to measure blood pressure is at home, in a quiet room, after being seated for 2 minutes. This will give a more accurate reading. Often it is necessary to measure the blood pressure several times per day for a week to look at the total trend. This is to ensure that high readings are different times of the day are not missed.

Histamine is a naturally occurring chemical in the body that causes allergy. It can have a wide range of effects in the body including hives (itchy red skin blotches), mouth swelling, asthma and anaphylaxis, a life threatening allergy, if in excess.

Some people find themselves having more histamine than others and experience chronic symptoms of redness, allergy, rash, hives and sometimes headaches, gut discomfort and fatigue.

Histamine is made in high quantities in the gut, especially if there is a gut problem like an overgrowth of the wrong kind of bacteria (dysbiosis) or a parasite infection. This is why one cause of chronic hives or allergies is a gut parasite. Interestingly, high levels of vitamin B6 can also cause hives. Niacinamide, a supplement used to lower cholesterol, can also trigger the release of histamine however this is temporary and goes away over time.
In general, a poor diet and lifestyle such as high carbohydrate, processed foods and a lack of vegetables will cause greater inflammation in the gut. This is why some people describe being itchy after eating certain foods or drinking alcohol the day before.
Histamine is broken down by an enzyme called DAO. Some people have a deficiency in the efficiency of this enzyme leading to more frequent allergic symptoms; DAO enzyme activity can be tested for. Furthermore people with gut issues may have impaired DAO and gut bacteria which produce histamine.
Histamine can cause PMS and high estrogen, as well as playing a role in generalised itch.

High histamine activity causing symptoms can be treated by

⦁ Achieving a clean diet with lots of vegetables and fiber
⦁ Minimising inflammatory foods such as processed foods, synthetic additives, alcohol
⦁ Quercetin is a herbal treatment that lowers histamine
⦁ Ensuring good liver function
⦁ Treating any underlying gut issue

Methylation is a chemical process used by every cell to clean up damage, reproduce and make proteins. It involves a chemical group being added to various molecules to switch genes on or off. Methylation relies on a good supply of B vitamins. IF somebody has more toxins or inflammation in the body, the methylation pathway has to work harder to clean up and so may run out of the required vitamins to do it. Problems with methylation result in cell distress that can lead to functional brain problems, low energy, metabolic disease (fatty liver and high insulin) to name a few.

Homocysteine is a chemical in the blood. It results from the breakdown of an amino acid called methionine. This takes place in a part of the methylation process and is important for balancing the chemical processes that keep cells healthy.

High homocysteine often results when somebody has difficulty in this methylation pathway.
This might be due to a deficiency in the diet of important vitamins which help this pathway; such as folate, Vitamin B12 or choline. On the other hand, this can result from a higher consumption of these factors in a toxic environment where a lot of methylation has to take place.

When there are methylation problems, homocysteine tends to be higher.

High homocysteine is important in medicine as it irritates blood vessels. It leads to hardening of the vessels (atherosclerosis) as well as blood clots in the veins. Clinically, high homocysteine is often a sign of body stress, oxidative stress, low B vitamin issues (often from gut issues) and is associated with metabolic syndrome, high blood pressure, nervous and mental health issues to name a few.
It should be noted that many environmental factors can negatively impact methylation. This includes a diet high in animal proteins, saturated fats, coffee, sugar and alcohol, a deficiency in zinc, magnesium, certain medication like antacids, poor digestion or leaky gut, smoking, heavy metals, yeast or taking too much SAMe.
Another category of causes is a genetic issue with folate processing, a nutrient, in this pathway. This is regulated by two genes called MTHFR. Somebody can have two altered copies of this gene, one altered and one normal or two normal. If somebody has the abnormal genes, they may have difficulty processing folic acid to the useful form, methylfolate, and may have a raised homocysteine.
Much is made of MTHFR genetic abnormalities however, If the homocysteine is normal, there is usually no need to treat people with MTHFR genetic abnormalities. However, if the homocysteine is high then often methylfolate will be used to assist the pathway For women, high homocysteine levels are observed more often with certain complications including pre-eclampsia, placental abruption, recurrent miscarriage and intra-uterine growth restriction. Some doctors will recommend a higher dose of folate during pregnancy for these women as well as investigation and treatment of any other clotting disorders such as Factor V Leiden. This topic is not the focus of this article and all women should seek the advice of an Obstetrician if appropriate.
Low homocysteine is also problematic. If the body is low in sulfur foods or needing more sulfur, homocysteine can be low. This can starve the methylation pathway and lead to issues. Another pathway involves a relative excess of B vitamins, high oxalates from foods such as tea and fruit and sometimes low magnesium. Omega 3 is often used for this. If the homocysteine is too low, the body may not have enough glutathione, which is a chemical that helps to detox the body. Often doctors will use NAC to assist this.
High homocysteine is addressed by treating any clear vitamin deficiencies such as folate, or B12 deficiency. Some patients required methylated B12 if there is an issue in their methylation. Other patients benefit from a chemical called SAMe, another intermediary in the pathway that is involved as a critical ‘methyl donor’ to help the end process of the entire methylation cycle.

Summary Points

⦁ Methylation is an important chemical processes that cells need to function well
⦁ Methylation is about using B vitamins and other vitamins to transfer chemical groups around so that cells can make new proteins, clean up damage and reproduce
⦁ Homocysteine is high when there are problems with methylation
⦁ High homocysteine is associated higher blood pressure, more body inflammation, a higher chance of clots and body stress
⦁ Methylation can be treated by detoxifying the body, achieving a healthy diet full of vegetables and minimally processed foods, replacing key vitamins like folate and B12
⦁ Sometimes methylation needs to be treated with more advanced treatments like SAMe
⦁ Choline and N acetyl Cysteine help produce glutathione and reduce homocysteine

Resources

Bansal P. Factor V Leiden and MTHFR mutations as a combined risk factor for hypercoagulability in referred Patients population from Western India. Mol Cytogenet. 2014;7(Suppl 1):P28. Published 2014 Jan 21. doi:10.1186/1755- 8166-7-S1-P28 Moll S, Varga EA. Homocysteine and MTHFR Mutations. Circulation. 2015;132(1):e6-e9. doi:10.1161/CIRCULATIONAHA.114.013311

Iberogast is a compound of multiple herbal treatments for dysbiosis, irritable bowel syndrome and other gut complaints. It has an effect on binding endotoxin, reducing methane (which causes constipation) as well as reflux. It needs to be taken for at least 3 months to be effective.

Inositol

Inositol is a sugar used by cells in the body to balance chemical pathways. It is commonly used for certain conditions that involve cell stress and metabolic dysfunction. Metabolic dysfunction means the way in which cells use energy and function.

On area that inositol is used is in problems with insulin sensitivity. Insulin helps glucose get into cells to be used as energy. When there is inflammation, this process is less efficient and the insulin rises and glucose may rise. This has a range of downstream impacts on cells and is associated with diabetes and polycystic ovarian syndrome.

Myo-inositol (MI) and D-Chiro Inositol (DCI) both mediate the downstream effects of insulin and have been shown to improve insulin sensitivity. Their main role is in a disorder called PolyCystic Ovarian Syndrome, a common hormone issue affecting many women. PCOS manifests as delayed periods, increased male hormones and cysts in the ovary.
MI and DCI have both been shown to help the ovary become more sensitive to insulin, to lower testosterone levels and induce ovulation. In general, the body has a ratio of MI: DCI about 40:1. Insulin itself causes Mi to convert to DCI in the ovary which may impair ovulation.

Some key points about inositol

Inositol is used to treat depression and PCOS.
It works on insulin sensitivity and is also able to help neurotransmitters bind to its receptor. It has been used in anxiety.
It is made from sugar and can be tested.
It is given as myo inositol 500mg once daily and increased to 2g twice per day DCI at 1200mg once per day has been associated with lower testosterone levels, increased ovulation and better insulin sensitivity; with >75% achievement of ovulation in one study group.
It is best to treat with 4g of MI (broken into two doses) with a smaller dose of DCI (1200mg) in a ratio of 40:1. It is reasonable to add folate if homocysteine is high.

Our cells send chemical signals to each other. These are called cytokines and there are many of them in the body.

IL-6 is a cellular messenger, a cytokine, that is associated with multiple diseases of inflammation. These include: Chronic fatigue, arthritis, lupus, multiple myeloma, allergies, Alzheimer’s Disease, Rheumatoid Arthritis, Asthma, Atherosclerosis, Cancer).
Many efforts are underway to design medications against IL-6 for these diseases such as the monoclonal antibodies like Actemra.

Some natural therapies against IL-6 include:

Andrographis,
Fish oils, (used in depression and alzheimers)
Curcumin especially as Theracurmin,
Tocotrienols,
Boswellia,
Black Cumin Seed Oil/Thymoquinone,
vitamin D3, and
some probiotics eg B. infantis, L. casei, L. salivarius, S. boulardii,
Anti IL-6 agents are being sought in asthma, prostate cancer, rheumatoid patients
Actemra (IL6) is used for this.

Andrographis is the most potent inhibitor of IL6, and is used for many conditions that involve higher levels of IL-6.
Of note, andrographis was used by the Thai government in a formal trial for the treatment of Covid. In parts of south east Asia it is served as an aperitif, to enhance digestion.
Interleukin 6 is typically related to a raised CRP in blood tests. CRP is a non specific marker of inflammation and goes up when IL-6 goes up.

Iodine is an important mineral for the body. Iodine is particularly important for thyroid hormone, which helps regulate the metabolic system of the body. Iodine is found in multiple foods but often at low levels; it is most often found in maritime foods. Interestingly, populations living further from the ocean tend to have lower levels.

Iodine deficiency is a substantial risk factor for low thyroid function. Potentially 30% of people are iodine deficient.

Children and babies are particularly susceptible to iodine deficiency as they require more per kilogram. Worldwide, iodine deficiency is the most prevalent preventable cause of intellectual disability. There is a link between iodine deficiency in the newborn period and intellectual difficulties in children in multiple studies. Iodine deficiency has been linked to slower school performance, however the impact is not always clear.
Adults need about 100-200 mcg of iodine per day. In many countries, iodine is added to salt to achieve this.
Children <1 year need 110-130 mcg per day
Pregnant women need at least 200mcg of iodine per day
It can be difficult to diagnose iodine deficiency. In adults, a blood test can be done an ideal iodine is above 90 ng/mL.
In children, Iodine deficiency is diagnosed using a range of tests. A patient should be examined for a goitre (thyroid lump in the throat) and their thyroid function measured, including the hormone thyroglobulin which is low when iodine is deficient. A selenium test should also be done (see below) to assess this.
A urinary iodine less than 100mcg/L (or 150mcg/L in pregnant women) is suggestive of deficiency however it often needs to be repeated,
A thyroglobulin level less than 40ng/mL is suggestive of low iodine and thyroid tests otherwise need to be interpreted.
Some doctors will screen for autoimmune thyroid conditions as these may make interpretation of results difficult.
Finally, examining a child’s overall wellbeing and potentially measuring the thyroid gland on ultrasound may be advised.

Supplementation of iodine should be given at 100mcg per day and higher based on the clinical need. Blood tests should take place regularly to ensure that too much iodine is not being given.
It should be noted that Selenium, another important mineral, should be checked and replaced if there is a concern about iodine. Selenium is also important for the thyroid gland and consumption of less than 90 mcg per day can lead to a deficiency. It can be assessed by a blood test.

REFERENCES

Eastman CJ, Zimmermann MB. The Iodine Deficiency Disorders. [Updated 2018 Feb 6]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK285556/
Imre Zoltán Kun, Zsuzsanna Szántó, József Balázs, Anisie Năsălean and Camelia Gliga (May 8th 2013). Detection of Iodine Deficiency Disorders (Goiter and Hypothyroidism) in School-Children Living in Endemic Mountainous Regions, After the Implementation of Universal Salt Iodization, Hot Topics in Endocrine and Endocrine-Related Diseases, Monica Fedele, IntechOpen, DOI: 10.5772/54188. Available from: https://www.intechopen.com/chapters/44427
Shreenath AP, Ameer MA, Dooley J. Selenium Deficiency. [Updated 2021 Jul 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482260/
https://www.who.int/data/nutrition/nlis/info/iodine-deficienc
WHO. Urinary iodine concentrations for determining iodine status deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2013
http://www.who.int/nutrition/vmnis/indicators/urinaryiodine.

Iron is an important metal that the body needs to make red blood cells. It is found in many foods, especially meat, and is absorbed in the gut.

Blood tests are useful for looking at a person’s iron stores. These tests are commonly called ‘iron studies’.

Iron studies should be interpreted with caution during inflammation or infection. This is because they are impacted by other conditions in the body and can give false looking results.

During inflammation or an infection, the liver will take in and store zinc and iron, away from blood. This is to deprive bacteria of important minerals that they might use as energy to attack us. In return, the liver will release more copper into the blood, as it is antibacterial.

If an iron studies test is taken during an infection or inflammation, it might show a low iron (and associated transferrin) as the iron is hidden away in the liver and high ferritin, a marker showing a good iron store in the liver. However, this just shows where the iron is being stored at this moment, not the total true picture of how much the body has totally.

Normally, iron deficiency is associated with a low ferritin. But as we can see, if there is an infection or inflammation, the available iron is being stored in the liver and registers as a normal or high ferritin which incorrectly suggests that there is no iron deficiency.

In summary, iron tests should be interpreted with caution and by checking also if there is inflammation in the body, often using another blood test marker such as CRP.

In some cases, a person’s body may have chronic inflammation. In this setting, the liver will store up more iron and have a persistently high ferritin.
Transferrin saturation over 30% is a blood test marker that might suggest retention of iron and zinc in the liver. These patients often benefit from bleeding therapy to reduce the iron in the liver as long term iron storage in the liver can irritate the liver.

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The ketogenic diet is becoming more and more popular as it is associated with less inflammation as a form of fuel. It involves avoiding carbohydrates and running of fats primarily as the fuel source.

Ketones describe a breakdown product of fats.
In a state of starvation, or extremely low carbohydrate diet, the body will use an enzyme called ‘lipase’ to break down fats into free fatty acids such as Triglycerides or TAG. These are then turned into molecules called ‘ketones’ which can be used by the cell for energy.

When this happens, molecules like glucose (a carbohydrate) are not being used by the cell for energy. Therefore, there is not a buildup of glucose or insulin. Insulin and glucose, even if temporarily raised after eating, are inflammatory and can cause fatigue as well as metabolic syndrome in extreme stress.
Ketogenesis occurs when the body is in a state of starvation or extremely low carbohydrate intake; as a diet, it is hard to achieve and requires high fat intake and regular testing.
Interestingly, before the invention of synthetic insulin, type 1 diabetes was treated by a ketogenic diet. The objective was to ensure that there was a fuel source for cells (fats) whilst avoiding the problems associated with high levels of glucose in the blood.

Key points

At starvation, TAGs, a kind of fat, are mobilise by lipase into free fatty acids into the liver and turned into various ketones for cell energy.
Insulin goes down, and ketones are used as energy.
This can only take place if there is an extreme reduction in carbohydrates.
Ketogenesis provides acetylcholine directly to the cells and avoids a build up of glucose and fats.
Ketogenic diet lowers insulin; it used to be used as the treatment for type 1 diabetes prior to the invention of therapeutic insulin Those on a ketogenic diet end up having lower fats after eating; this is because they have switched on their fat burning.

As this website emphasises, the health of the gut is intertwined with the health of the body. More can be read from ‘the gut and dysbiosis’.
One of the main reasons for gut dysfunction is a lack of fiber. Fiber are insoluble compounds that we eat, but cannot absorb. They provide food for good bacteria which in return send out anti-inflammatory signals of benefit to the whole body as well as a range of vitamins.
The combined effect of this is greater health not just in the body itself (more energy, better brain function, more vitamins, better liver, lower blood pressure) but also the gut.
Prebiotics describe forms of fiber that are taken to feed our good bacteria. They have the effect of helping the body but are also directly used to minimise symptoms of irritable bowel disease, a localised version of gut bacteria imbalance.

Lactulose is a non-absorbable sugar commonly used for the treatment of constipation and liver disease. The lactulose is actually able to promote good bacteria, such as akkermansia, to help heal the gut. Lactulose also binds lipopolysaccharide or endotoxin which is a toxin produced by certain strains of gut bacteria, particularly after eating junk food, which cause issues in the body.

Lactulose can be used at 10mL twice per day to help with endotoxin (a common bad bacteria toxin) and gut health, or a higher dose if there is constipation.

Lactulose is also useful to decrease E Coli, a gut bacteria promoted my a meat diet which can lead to endotoxin and thus metabolic disease.

Increasingly, lactulose is being used for other conditions such as chronic fatigue, fatty liver and Attention Deficit Disorder. It is cheap, well tolerated and widely available.

Lead is a metal and is a toxin for the body. There is no safe level of lead in the body. It often comes from paint, petrol and traffic exposure, industrial exposure or traffic to name a few. It can present with depression. Blood tests are available to test for lead.

Lectins, alongside Gluten and casein in milk, are a food protein that sometimes cause problems for certain patients.

Lectins are proteins widely occurring in nature and especially in wheat. They act as a form of defence for organisms; they catch bacteria and other pathogens. Lectins tend to bind sugar elements of cell walls; however when they are eaten and go into the gut, they tend to bind similar molecules on the gut walls which can lead to an inflammatory gut reaction similar to gluten sensitivity.
Lectins are found in wheat, Rye Barley, tomatoes, legumes, soy, dairy, eggs and chickpeas.
A comment on wheat
Wheat germ agglutinin is a lectin
Cereal lectins, not just gluten, bind to the gut wall and lead to zonulin release and intestinal permeability.
There is more gluten in the diet due to inbreeding of wheat
Wheat, not just gluten, causes intestinal permeability.

Leptin is one of the many hormones that control appetite.

Leptin is a peptide hormone produced by fat cells. They provide a signal to the body that we have enough energy as fat and cause us to eat less. When people have a lot of fat, they have elevated levels of leptin and the body may become less sensitive to leptin; this is called leptin resistance. High levels of leptin may have pro-inflammatory effects and is associated with arterial damage.

Fiber intake reduces leptin
Reducing carbs will reduce leptin

Leptin is one of the many hormones that control appetite.

Leptin is a peptide hormone produced by fat cells. They provide a signal to the body that we have enough energy as fat and cause us to eat less. When people have a lot of fat, they have elevated levels of leptin and the body may become less sensitive to leptin; this is called leptin resistance. High levels of leptin may have pro-inflammatory effects and is associated with arterial damage.

Fiber intake reduces leptin
Reducing carbs will reduce leptin

Lymphocytes are white blood cells. They comprise of B cells, which make antibodies and T cells, which grow to respond to infection and threat. Lymphocyte levels may often appear at the low level of normal in the setting of Vitamin B6, Zinc and protein deficiency. However, this should be interpreted in a clinical context.

Magnesium is an important mineral. A mineral is a metal that is dissolved into water and is used by the body for important cell processes. The western diet typically has less magnesium in it compared with traditional plant based diets. Many people end up magnesium deficient, especially athletes and potentially those who are overweight or have diabetes.
In a sports context, ensuring minerals like magnesium and sometimes potassium are replenished with a broad diet and sometimes hydration drinks helps optimise performance. Magnesium is a common constituent of workout powders. Iron and Magnesium have the most evidence for use in sports; with rectifying any deficiencies otherwise recommended.
For those with metabolic syndrome, meaning obesity, fatty liver, high blood pressure and insulin or glucose etc. magnesium has been associated with better control of the blood sugar.
Magnesium is sometimes used for muscle and body relaxation, sleep, low energy or as a part of treatment for low testosterone or polycystic ovarian syndrome. This reflects the broad impact of magnesium deficiency.
There are multiple kinds of magnesium on the market for supplementation. Debate continues as to the best form. Magnesium oxalate is poorly absorbed and is often used to treat constipation.

Melatonin is a sleep hormone. It is released by the pineal gland, in the brain in response to a number of stimuli. It is used for sleep, as well as to reduce stress hormones such as cortisol and to improve thyroid hormone levels.

For more information, please read the article ‘sleep’
Melatonin is released at night, about 0.3mg, in response to falling cortisol and stimuli of night time (lower lights, temperature)
It is implicated in seasonal depression (winter blues, called SAD) as well as ageing and shift work
Melatonin it reduces stress hormones
Melatonin is made from tryptophan (Tryptophan —> 5HTP —> Serotonin — > Melatonin)
This requires cofactors of B6, SAMe (methylation) iron and THB (Tetrahydrobiopterin- turns up for multiple neurotransmitters)
Causes of low levels of melatonin include: poor sleep hygiene, blue light, not enough light, too much alcohol or caffeine, Not enough tryptophan or serotonin or not enough B6, SAMe, iron and folate.
Melatonin can be used with Taurine, GABA, zinc, magnesium, 5HTP and B6 to enhance rest.
Melatonin has theoretical anticancer properties

Foods that are rich in melatonin include:

Tall fescue
Grass juice
oats
sweet corn
rice
Japanese radish
Ashitaba
Ginger
Tomatoes
Bananas
Chungiku
Barley
Almonds
Peanuts
Milk
Tryptophan containing foods
Insomnitol: B6, Valerian, Passion flower, Lemon Balm, Chamomile, GABA, LTheanine, 5HTP and melatonin

References

Savage RA, Zafar N, Yohannan S, et al. Melatonin. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534823/
Tordjman S, Chokron S, Delorme R, et al. Melatonin: Pharmacology, Functions and Therapeutic Benefits. Curr Neuropharmacol. 2017;15(3):434-443. doi:10.2174/1570159X14666161228122115

Methylation is a biochemical process in the body vital for DNA reproduction, gene reading and also cellular clean up. Methylation is linked to fatty liver, metabolic syndrome, mental health and also cancers.

The chemical process of methylation is needed for cells to unlock and read DNA, clean up proteins and thus function and reproduce. It will be mentioned many times in this website.
How well somebody ‘methylates’ will have an impact on their health.

Methylation can be tested by homocysteine. A raised homocysteine suggests poor methylation.
Another blood test is more specific for methylation; SAMe (an end product of methylation) can be tested and compared with SAH (the exhausted SAMe) to give us more information on how well somebody methylates. This is called the SAMe/SAH ratio.
If methylation is not adequate, the histones (chemicals wrapped around our DNA to keep the genes silent and not read) are not as tightly bound. This can activate genes that are detrimental for our health such as dementia, cancer risk etc. In other words, poor methylation causes cells to be stressed and this impacts our health.
Some people undermethylate (and their cells do not function well) and some people can overmethylate and have too much of this process.
Undermethylators often have hyperactive or worry style personalities. This can be treated with methionine, or SAMe, B12 for example. Undermethylators often do well on SSRIs.
Overmethylators are often very creative. They do poorly on SSRI and are more likely to commit suicide on an SSRI; however this research is not comprehensively framed to reflect all people.

More can be found at Methylation

Metformin
Metformin is a drug used for antiaging and diabetes. It works on AMPK, a pathway that helps mitochondria produce more energy for cellular cleaning. This minimises wear and tear diseases of the body like Alzheimer’s, inflammation, vascular disease and associated metabolic conditions.
Metformin is indicated for people with higher blood glucose, insulin or vascular disease It is also used for antiaging
Fasting is also recommended It is started at 500mg in the morning and increased to 1g extended release per dayIt may cause nausea in the first week however this usually settles.

For further reading please find an article on Metformin and AMPK.

Monocytes are one of our white blood cells. Like all white blood cells, they are made in the bone marrow (Primarily) and then circulate in the blood to respond to infections.
Monocytes play a particular role in immune defence by stimulating other immune responses. They release inflammatory markers, especially Interleukin 1 and 6. When this inflammation is chronic, these markers and this monocyte activity can portend chronic inflammation. Often, the C reactive protein (or CRP) is elevated in blood tests if this takes place.
A typical blood level is 0.3 (expressed as 10^9/L) however if there is inflammation, there might be a higher level and also more immature monocytes swimming around the blood.
Monocytes can be higher, or proliferating, in the setting of
Sedentary lifestyle
Lack of exercise
Infection
Obesity

*All of these encourage inflammation and do not activate the body’s cleanup pathways.

Naltrexone is a drug which blocks the opioid receptors which naturally occur in our brain. It has been used to reverse heroin overdose or morphine overdose. In low doses, it has been shown to assist with the recovery of inflammation in the brain.
Naltrexone increases endogenous opioids by blocking the receptor downstream; this can help with brain inflammation
Low dose Naltrexone (1-5mg) is used for chronic infections and chronic immune conditions; such as Chronic Fatigue Syndrome, Chronic Regional Pain Syndrome, Fibromyalgia, It blocks the opiate peptides from stress induction
It suppresses Natural Killer immune cells and thus modulates immunity About 30% of fibromyalgia patients report improvement in pain In Multiple Sclerosis patients 60% reported an improvement in energy and a significant improvement in mental health Fibromyalgia patients reported an improvement in mood; the size of this effect is unclear
Higher dose naltrexone at 50mg is used for alcohol abuse.
References
Toljan K, Vrooman B. Low-Dose Naltrexone (LDN)-Review of Therapeutic Utilization. Med Sci (Basel). 2018;6(4):82. Published 2018 Sep 21. doi:10.3390/medsci6040082

For further reading, see ‘the Body and the Mind’

Neuroinflammation describes inflammation and impaired function of the brain. It is implied to be a pathological pathway that results in a range of brain disorders such as depression, anxiety, dementia, cognitive impairment, sleep troubles, brain fog or confusion as well as psychotic illnesses such as bipolar.
There are several key features of neuroinflammation
A disruption in the blood brain barrier
Predominance of excitation nerves (often involving the excitatory neurotransmitter glutamate) versus inhibitory nerves (often involving the GABA neurotransmitter)
A tendency for higher histamine, an inflammatory chemical that causes itchiness and allergies as well as mood problems.
Treatment patterns
The treatment of brain inflammation is very broad and incorporates reducing inflammation and treating any imbalances in the body more generally. Typical domains of therapy include:
Improving gut integrity to prevent inflammatory mediators being produced: glutamate, probiotics, GI map and SIBo testing, Magnesium, antimicrobial herbs such as berberine, oregano, garlic, rosemary and tumeric
Balancing zinc and copper.
Assisting the liver to detox any inflammatory compounds; better digestion such as bitters or pepsin, Broccoli sprout extract or DIM to assist glucuronidation and bile excretion, NAC to bring up antioxidant ‘glutathione’ levels
Fish oil, B6, Zinc, Magnesium to help neurons function better Folate and restoration of the methylation pathway; including SAMe if needed.
Mitochondrial optimisation with regular fasting, insulin control, optimum hormone levels and NAD+ boosters
Good quality sleep: melatonin, early morning light therapy, mindfulness, Vitamin b6, Magnesium. This aids Brain Derived Neurotropic Factor to clean up the brain.
Optimising a neuroprotective diet: eat herbs and green things and fish.

For further reading (all the core topics)

Methylation
Mitochondria and aging
Gut and dysbiosis
The Body and the Mind.

Neurotransmitters are chemicals that the body uses to regulate brain activity. We are familiar with many common ones such as:
Serotonin: 95% of this is made in the gut. It is helpful for mood, memory, pain perception and being low is implicated in depression.
Noradrenalin: as the name suggests this works on our fight or flight sympathetic nervous system in the body but also has multiple roles deeper in the brain. Particularly found in reward pathways, pain moderation and focus this is also produced in the gut.
Glutamate and GABA: Glutamate is an excitatory neurotransmitter whilst GABA is an inhibitory and thus calming neurotransmitter. Exercises releases GABA, as does a number of supplements

What can impact our neurotransmitters?

Neurotransmitters require certain vitamins and minerals to be made such as: Vitamin B6, B12, zinc, magnesium and vitamin D to name a few. Hormones also play a role with our neurotransmitters, such as testosterone and progesterone having a calming impact by boosting GABA.
Very important are our gut bacteria. Our gut have 100 trillion bacteria, far more than number of cells the body has. The gut produces 95% of our serotonin and a great deal more neurotransmitters. It is also the source of inflammation as the gut’s complex environment is the check point between the outside world and our body.
Antioxidation is a process of protecting cells against oxidative or natural chemical damage. This facility declines over life.

Lactobacillus and bifidobacteria are good gut bacteria which produce calming GABA.
Eschericia, Saccharomyces Boulardi, Bacillus are good bacteria/yeasts and produce noradrenalin.
Bacillus can produce dopamine
For further reading
Biochemistry of Mental Health
Glutamine & GABA
The Body and the Mind

Common Treatments

Restore the levels of neurotransmitters; Tryptophan can convert into melatonin and serotonin but require Magnesium, Zinc, Vitamin B6, Vitamin C and Iron
Deal with inflammation: restore glutathione in the liver (NAC, or liposomal glutathione), detox the gut, antioxidant diet (Flavonoids) and anti inflammatory fats such as fish oil
Optimise sleep; REM is an important hormonal cycle phase of sleep where many neurotransmitters are made
Minimise caffeine; caffeine helps burn fat however it prevents quality sleep and thus brain rehabilitation over night
Restore any vitamin deficiencies such as Vitamin D
A Keto diet has been used to assist with neurotoxic disorders; it has been shown to increase dopamine production

Ketones also promote higher GABA to glutamate ratio, calming nerves down

Nitazoxanide is an antibiotic for the treatment of clostridia, dientamoeba and cryptosporidium diarrhoea.

Nitric Oxide, not to be confused with dental laughing gas nitrous oxide, is a molecule that helps blood vessels dilate. This reduces blood pressure, helps nutrients get around, aids muscle recovery, assists erections and looks after our vascular system.
Green leafy vegetables, and betroot, have nitrites which bacteria in our gut are able to convert to Nitric Oxide and assist sports performance.

Olive Oil is a common oil originating from the mediterranean diet. It is a very anti-inflammatory oil and good for our health.

The benefits of olive oil are in the extra virgin biophenols and their neuronal and antioxidant properties and how they lower LDL and atherosclerosis consequently.
Extra Virgin Olive Oil has no refining and is the healthiest version of olive oil.
Contains oleocanthol, a phenolic compound with strong antioxidant properties. It behaves like ibuprofen and lowers IL6 and COX.
25-50mL of an extra virgin olive oil daily will give the anti-inflammatory, brain protection and cardiac protection effects For further reading, see ‘Olive Oil’

References:

Parkinson L, Keast R. Oleocanthal, a phenolic derived from virgin olive oil: a review of the beneficial effects on inflammatory disease. Int J Mol Sci. 2014;15(7):12323-12334. Published 2014 Jul 11. doi:10.3390/ijms150712323
Scientific Opinion on the substantiation of health claims related to polyphenols in olive and protection of LDL particles from oxidative damage (ID 1333, 1638, 1639, 1696, 2865), maintenance of normal blood HDL-cholesterol concentrations (ID 1639), maintenance of normal blood pressure (ID 3781), “anti-inflammatory properties” (ID 1882), “contributes to the upper respiratory tract health” (ID 3468), “can help to maintain a normal function of gastrointestinal tract” (3779), and “contributes to body defences against external agents” (ID 3467) pursuant to Article 13(1) of Regulation (EC) No 1924/2006
EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) European Food Safety Authority (EFSA), Parma, Italy
DOI:
https://doi.org/10.2903/j.efsa.2011.2033

This is a semisynthetic bile acid analogue used to treat fatty liver and may help in bile acid diarrhoea. It helps the body to release more bile which aids digestion and cleans up toxins from the gut. It can be uncomfortable if you first take it as extra bile can cause nausea however it usually settles. It has also been used to lower cholesterol and occurs in foods.

Omega 3 and 6 are both fatty acids, a kind of fat molecule in food. Fatty acids are often described as saturated, unsaturated, polyunsaturated etc. Saturated fatty acids are more often found in animal meats, dairy whilst unsaturated fats are found in vegetables, fish oil and so on. Unsaturated fats are considered better for us whilst saturated fats are linked to cardiovascular disease.
One such group of polyunsaturated fats includes the Omega 3 and 6 fats. The ratio of these in the diet is considered to have an impact on inflammation and disease in the body A high ratio of omega 6 to omega 3 shifts the body towards multiple inflammatory diseases including inflammatory and pro-blood clot states.
Omega 3 and 6 are both broken down by the same enzyme; if the ratio is affected, an imbalance can lead to inflammation.
More typically, the western diet is widely deficient in Omega 3 fatty acids with too many omega 6.
Omega 3 are known to help with cholesterol levels.
There is mild evidence on improving mood and balance.
The optimal ratio is thought to be < 4:1 for Omega 6: Omega 3 with the western diet being as high as 30.

The Omega 3 index describes the amount of EPA + DHA in erythrocyte fatty acids; ideal is >3.2% and negative consequences occur at 20% or above.
Omega 3 is found in figs, fish, chia seeds to name a few.

Osteocalcin is a blood marker for bone formation. It is used to monitor the efficacy of osteoporosis treatments. Osteocalcin is correlated with a greater bone mineral density for patients undergoing treatment with bone formation medications.

Oxalate is a natural chemical in the body and is also found in many foods. It is a breakdown product of vitamin B6 and so can rise if too much B6 supplementation is used. Certain gut bacteria, if overgrown, can also increase the production of oxalates. Vitamin C is often used in this process and so will also look low on testing.
Clinically, high oxalates can crystallise and cause problems. It causes bladder pain and dysuria (pain on urination), recurrent thrush and gut pains and joint pains. Oxalate dumping, from nuts and seeds, will cause flu like symptoms as there is too much oxalate acutely.
Some people with high oxalates can have a urine and or blood test to assess the levels. Combined calcium and magnesium citrate is used to bind the excess oxalates however the root cause should also be sought and amended. Crohn’s disease can lead to high oxalates due to its interruption of the gut.

PEA: Palmitoylethanolamide is a food compound that is used for chronic pain syndromes.

PEA is related to the endocannabinoids, a series of fatty chemicals in the body with receptors in the brain. It has some impact on PPAR-a. PPAR-a is involved in the metabolism of lipids and fats in the liver. It is triggered under a situation of energy deprivation. Fibrates, a drug used to treat TAG kinds of cholesterol, targets PPAR-a.
In chronic inflammation, the endocannabinoid system is imbalanced. This imbalance is implicated in neuroinflammation such as dementia and also fibromyalgia.
The use of PEA has been associated with anti-inflammatory, analgesic (pain relief), neuroprotective and other properties. It is primarily used for fibromyalgia. Fish oil tends to be prescribed alongside this due to its antiinflammatory fat balances via Omega 3 content.
The dose is typically 300-1200mg per day.

This describes eczema around the eye. It is often due to a gut allergy to dairy, such as casein proteins.

This test measures the activity of neutrophils. Neutrophils are a major white blood cell, cells which help fight infections. Neutrophils ‘eat up’ foreign particles and pathogens by subsuming them into their own cell. This test looks at this function to determine whether neutrophils seem to be working normally or not to predict the severity of complications from some pneumonias.

Phosphatidyl choline is a common supplement used for a range of issues. It can encourage a good gut bacteria, akkermansia, which helps diabetic patients lose weight. Choline, from this supplement, helps B12 and folate in the methylation pathway which cleans up damage in the body and helps cells reproduce. Phosphatidyl choline is made by the body in tiny amounts and so it is needed in the diet. Phosphatidyl choline is also useful in fatty liver via multiple mechanisms.

Phytic acid is a compound found in nuts, grains, pulses (E391 as a preservative) which binds calcium iron and zinc. It can cause poor absorption of zinc and calcium if somebody eats a lot of unsoaked grains.
It should be considered as a dietary risk for zinc deficiency and calcium deficiency
You should consider over consumptions of these foods for somebody with zinc deficiency

Prebiotics describe fiber or food used by our good bacteria, that we can take to help boost their abundance and function. Typically, they include fibers which are big molecules that our digestive system cannot break down.
Fibers and prebiotics are vital for health; they assist in encouraging helpful bacteria to produce more vitamins, lower inflammation and moderate harmful bacteria.
Typically, they are used for treatment of dysbiosis, metabolic syndrome, hormone regulation and also mental health issues.

Examples of prebiotics commonly used

Partially Hydrolysed guar gum (PHGG)
Modified citrus pectin (MCP) (used for fibrotic diseases)
Fructo-oligosaccharide powder (FOP)
Galactooligosaccharide powder (GOS)
Prebiotics are best taken on the basis of evidence from the clinical presentation or microbiome (E.g estrogen dominant, liver congestion, glucuronidation, species)

Vegetables are good for us as they are basically mostly prebiotics.

Probiotics are bacteria which do us good. Typically this describes the collection of good bacteria in our gut. We inherit this bacteria largely from our mothers through vaginal delivery, breastfeeding and proximity; some is also taken from the environment. Babies on formula have less good bacteria. Giving L Rhamnosus, a useful probiotic, to infants has been shown to have
lower antibiotic associated diarrhoea
better tolerance of cow’s milk if allergic
Decreased gut infections
Decreased colds

References

Jin L, Deng L, Wu W, Wang Z, Shao W, Liu J. Systematic review and meta analysis of the effect of probiotic supplementation on functional constipation in children. Medicine (Baltimore). 2018;97(39):e12174.
doi:10.1097/MD.0000000000012174
Szajewska H, Kołodziej M. Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015;42(10):1149-1157. doi:10.1111/apt.13404
Progesterone in Men
In men, there are hormones other than testosterone playing a role in health and ageing.

Pregnenolone, and the related hormone DHEAS, are adrenal gland hormones linked to androgen like activity, brain health and other neurotransmitters in the body.
Some men will have elevated levels of estrogen compared with other men; this is typically seen if overweight, high consumption of alcohol or taking medications or other drugs such as marijuana. Estrogen balance in both men and women relies on having a good diet, good gut bacteria, good vitamins and a healthy liver. Any imbalance will lead to higher estrogens.
Estrogen is counteracted by progesterone. When men might have higher estrogen due to other problems, they might be ‘functionally’ progesterone deficient. That means that they might benefit from a small dose of progesterone to manage the symptoms of a relatively higher estrogen.
Some doctors have given men progesterone to help with sleep and anxiety however the evidence base of this form of medicine is lacking.

Psyllium seeds and husk are often taken to help produce butyrate, an important gut ‘Short Chain Fatty Acid’.
Short Chain Fatty Acids (SCFA) are compounds produced by good gut bacteria that are good for our health; SCFA enhances gut healing, digestion and reduction of endotoxin. All of this helps with weight management, gut symptoms, fatty liver and other metabolic diseases.

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Saccharomyces cerevisiae is a common yeast. In fact, it has historically been used for the baking of bread and brewing of beer; it gives bread its unique smell. This yeast is strongly associated with Crohn’s disease, a disease which causes ulcers on the inside of the bowel wall. Some of these ulcers can be very serious and lead to emergencies such as bowel bleeding and bowel rupture; so it is best to diagnose it early and manage it. About 70-80% of Crohn’s diseases are associated with a rise in ASCA and so may assist the diagnosis.

Some doctors will test this antibody to see if this yeast is present in the gut and leading to gut problems.

S-adenosylmethionine, or SAMe, is a chemical involved in the methylation pathway. Critically, it donates a ‘methyl group’ in reactions that the body really needs such as:
Making melatonin, an important sleep and recovery hormone
Converting noradrenalin to adrenalin
Making phosphatidylcholine which is essential for cell walls
Metabolism of estrogens, to avoid a toxic build up
DNA methylation, to clean up broken damage
assisting antioxidant function

As discussed elsewhere, methylation is a critical chemical process that our cells need to function well, reproduce, clean up damage and help our brain function.

When the SAMe molecule transfers, or ‘uses up’, its methyl group, it is converted to S-adenosylhomocysteine, or SAH. SAH inhibits the SAMe trying to provide methyl groups and achieve the important body processes.

In general, we want a good amount of SAMe compared with SAH.
SAH is converted into homocysteine. Homocysteine is associated with poorer health including high blood pressure. Elevated homocysteine also suggests that there is a methylation problem.
If the homocysteine is high, less SAH will break down into homocysteine and SAH levels will rise and inhibit the activity of SAMe. At the same time, homocysteine itself is irritating to blood vessels causing high blood pressure, blocked arteries and clots.
That means that high levels of SAH and homocysteine themselves lead to poor methylation; if found, treating methylation is likely to improve health.
Doctors will often order a test looking at the level of homocysteine and the ratio of SAMe: SAH. A ratio of SAMe:SAH<4.5 is indicative of poor methylation. 5 methylfolate is measured at the same time to determine if it is a factor.
SAMe can be supplemented enhance methylation. In clinical practise it used for difficult methylation cases, often in the context of mood and depression. Studies have shown that it is equivalent to many older antidepressants and some new ones; albeit with greater results in men compared with women.
SAMe improves serotonin turnover, inhibits noradrenaline turnover, improves dopaminergic activity, lowers brain inflammation
SAMe has the ability to produce glutathione and detox the liver
SAMe has been shown to be equivalent to many older antidepressants and has shown effect in treating depression that has not responded to other antidepressants; with a 30-60% efficacy rate.

SCFA are compounds made by the good bacteria in our gut. They play a vital role in the body to feed colonocytes, cells of the bowel wall, and to send signals through the body. Choline, for example, is necessary for cell walls, liver health and methylation whilst butyrate is anti inflammatory. They are largely made in the large intestine or colon.
Athletes also have a vested interest in consuming high fiber diets; an increase in SCFA means you have a higher pH, or more alkali.

Sedating medications
Many medications can make you sleepy. This list includes:
Melatonin
Topiramate or Topamax
One tip for managing any residual tiredness or grogginess the next day is to lower your dose or take the dose earlier.

one tip is to time how long it takes to get drowsy after you take the medication.

Adjust the time you take the medication forward from your bedtime to match this measured onset of action time
This might help minimise any lingering residual drug effects the next morning by giving the drug longer to leave your system

Selenium is an important mineral in the body, particularly for adequate thyroid protection. It is often replaced alongside iodine and if there is a question about thyroid function. Adequate selenium intake is at least 90 mcg per day. A blood test can be used to assess deficiency.
Selenium is often given as a supplement for people low in selenium.

Serotonin is a neurotransmitter. It is a chemical involved in multiple parts of the brain including attention, mood, attachment and enjoyment. It has been implicated to be low in depression and also anxiety.
The majority of serotonin is made in the gut; those with poor diets tend to have lower serotonin. Good sleep and adequate melatonin levels are required for serotonin production. Also if a patient has dysbiosis, a derange gut bacterial balance, some of the toxins resulting from this will drive precursors to make excitatory glutamate rather than serotonin.
Nutrients behind serotonin include: 5HTP, Magnesium, Saffron, Vitamin B6 or P5P.

Spirulina is an algae consumed by the Aztecs; it is popular as it is an ecologically sound rich source of multiple vitamins and nutrients. It is particularly high in proteins:
Spirulina has been shown to lower lipids by between 10-30%
The LFTs in patients with fatty liver have dropped by about 30% when inflamed
It has been used for malnourishment

Some studies have shown a reduction in sneezing and nasal allergy

Stablon or Tianeptine is an atypical antidepressant and anxiolytic. It is increasingly used for chronic fatigue syndrome, fibromyalgia and similar disorders. It works on the endogenous opioid receptors, similar to Naltrexone in a roundabout way. It has minimal side effects and is well priced.
It released Brain Derived Neurotropic Factor (a helpful brain chemical that heals the brain overnight) Modulates the glutamate receptor (which sends stress signals to the amygdala) Mildly dopaminergic, which helps mood.

Sucrose is a molecule made of glucose and fructose bound together. Sucrose is the typical table sugar used in most foods. Despite having glucose, the molecule is mostly fructose which can cause a range of poor metabolic outcomes.

Sulfur is an important element used by the body in multiple pathways. It is used to detoxify many things from the body including adrenalin, cyanide, neurotransmitters, hormones, steroids, bile acids, amines and phenols.
When there is not enough sulfur, the body obtains it from homocysteine. Homocysteine is an important molecule involved in multiple body pathways that typically help with detoxification.
If homocysteine is used up so that the body can grab sulfur, it can end up making methylation worse. With low homocysteine, SAMe and methionine are depleted and these are essential for cleaning up inflammation in the body, brain and major organs. This can result in confusion, muscle aches, lethargy, gut problems to name a few.

Sulfur is found plentifully in animal products. A good supply of B6 and serine is required to obtain the right kind of sulfur for metabolism.

If there is an issue with sulfur metabolism, there is an increased leakiness of the intestine and the body has trouble detoxifying in general.
People with low sulfur tend to accumulate histamine which can cause issues with sleep and allergic like symptoms. There is a finding of disrupted sulfur metabolism in children with autism.
Total and free sulfur in urine gives information about the loss of sulphate in the urine. Other tests which give a clue include homocysteine (<5.5 is typical of sulfur deficiency), molybdenum and urine thiocyanide which will be higher if there is insufficient sulfur metabolism.
Sulfur metabolism issues are associated with gut yeasts, gut dysbiosis (irritable bowel syndrome) as well as molybdenum shortage.

Sugar describes a common carbohydrate, typically used as energy in the body. There are multiple kinds of sugars:
Monosaccharides; simple sugars with one sugar molecule
Glucose
Galactose
Fructose
Disaccharides, combination of sugars
Sucrose (made of glucose and fructose bound together)

Sugar is not the same as glucose. 90% of sucrose, which is table sugar, is fructose. Glucose is the sugar form used for energy in the body whilst fructose itself has a different metabolic outcome.
Whilst all cells in the body can use glucose to make ATP, the energy molecule, fructose does not help make ATP and can deplete it. Fructose also mobilises fatty acids and can lead to poor metabolic outcomes.
A high fructose diet is associated with:
Fatty liver
obesity
Insulin resistance
High blood pressure
Heart disease

It is worth remembering that nutritional status does not just depend on our diet. It depends on our entire state of health, environment and habits. Minerals and nutrients will be more or less available for our body based on what we are asking our body to do.
For example, iron and zinc are sequestered and stored in the liver during inflammation to deprive an invading bacteria of their use. Copper is then put into the rest of the body to fight infection. Does this represent a nutritional deficiency or a nutritional response? Will supplementation help in this case or make things worse for a responding body?

Fixing nutritional health problems is not simply about supplementation but assessing what is actually going on and fixing the root causes. Supplementation is rarely useful nor safe unless there is a full diagnostic understanding of a person’s health.

Tyrosine is the precursor to Dopamine, an important neurotransmitter. Dopamine is then converted into adrenalin and noradrenalin; key hormones released by the adrenal gland.
Tyrosine is found in a range of foods such as pumpkins. It is also required for the synthesis of thyroid hormones.
Tyrosine ingestion is shown to help cognitive performance in the short term in young adults.

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