BPA was measured in urine samples of 244 mothers at 16 and 26 weeks of gestation and then in their children and 1, 2 and 3 years of age. Behavior and executive function were measured by using the Behavior Assessment System for Children 2 (BASC-2) and the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P).

The researchers concluded that gestational BPA exposure affected behavioral and emotional regulation domains at 3 years of age, especially among girls. Clinicians may advise concerned patients to reduce their exposure to certain consumer products, but the benefits of such reductions are unclear.

Clincians have a further option, to screen for BPA exposure for patients in that population group using the Metametrix Bisphenol A Urine Profile. This profile is available in the UK and Europe from Nutrition Geeks, please contact us at www.nutritiongeeks.co.uk for further information.

Study: Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children, Braun et al 2011 Pediatrics Vol. 128 No. 5 November 1, 2011
pp. 873 -882 (doi: 10.1542/peds.2011-1335)

Angela Walker BSc Nut Med mBANT CNHC registered

Technical Advisor, Nutrition Geeks

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

SS: I’ve been in practice as a Nutritional Therapist for 8 years and have specialised in the field of children and young adults with Autistic Spectrum Disorders (ASD) for the last 5 years.  I did my Nutritional Therapy training with Plaskett Nutritional Medicine College which became part of Thames Valley University.  I then went across the to US for 3 years running to do the Defeat Autism Now! Clinician’s training and to attend their annual conference.

NG: What was the first lab test you ran and what did you learn from it?

SS: My first experience of a lab test was as a consumer when a practitioner I consulted regarding my son suggested a Mineral Sweat Patch test to identify mineral deficiencies.  My son was diagnosed with Autism in 1996 and it was his positive reaction to dietary changes that led me to study Nutritional Therapy; I needed to learn more to understand how to help him.

NG: What’s your favourite test panel and why?

I’ve always used comprehensive stool analysis with parasitology with my patients but have recently been converted to the benefits of the DNA analysis used in Metametrix Gastrointestinal Effects Profile.  Many ASD children are non-verbal or have limited speech and understanding of questions, so functional testing is essential.

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

SS: Finding the right therapeutic diet is key, whether it is Gluten/casein/soya/corn Free, Feingold, Specific Carbohydrate, Low oxalate or GAPS.  Supporting the patient’s parent to implement the diet effectively so that it is nutrient rich and avoids preservatives and other undesirable substances is essential.  A lot of the gluten-free products in supermarkets leave a lot to be desired.

NG: Who is your favourite educator or guru in the nutrition or functional medicine field?

SS: In my specialist area, Dr Daniel Goyal is a great educator for parents and practitioners alike.  He is straight talking and is not afraid to ruffle a few feathers.  For me personally, my mentor and fellow Nutritional Therapist, Jean Muscroft has been an inspiration.

NG: What’s the best advice you’ve ever received?

SS: One of the Defeat Autism Now! Clinician’s training sessions was titled ‘Have I done everything I can for this patient?’ and this phrase has stuck in my mind.  It leads me to review case files and think strategically about my therapy plan for the patient.  It also makes me consider whether it is in the patient’s best interest to refer them to on to another specialist.

NG: What’s the secret of your success?

SS: Having a personal connection with autism makes me passionate about the subject and this motivates me immensely.  I also believe that investing in the very best continuous professional development pays dividends to both your patients and your practice.

NG: How do you switch off after a busy day in clinic?

SS: Going for a run by the river Thames with The Killers playing on my ipod does it everytime.

Find out more about Sue’s work at http://www.elementalnutrition.co.uk

When it comes to the toxic elements, the question is often asked, should specimens be taken with or without a challenge? Metametrix have recently change the reference ranges on the urine so that ranges are now provided for both challenged / chelated and non challenged specimens, providing clinicians with even more data to make their clinical judgements.

The Metametrix interpretation guide offers more detail on specimens all element assessments and provides a concise yet comprehensive overview of both; definitely recommended as a read and a great reference point.

The interpretation guide as well as new sample test reports with the new reference ranges can be found at http://www.nutritiongeeks.co.uk/cp8.php under Improved Metametrix Elements Profiles

Angela Walker BSc Nut Med mBANT CNHC registered

Technical Advisor, Nutrition Geeks

Definitions:

* The definition here of elements is the form of the chemical element found in the human body, either nutrients (i.e. minerals) or toxic metals, usually complexed to proteins or other biological macromolecules.

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

ML: My parents inspired my passion for food,  my mother cooking me food when she got back from work, and talking to me about it. My father – an acupuncturist and healer – showing me the power of food, herbs and the mind in terms of healing the body. Oh and Bruce Lee!

After a degree in political philosophy at Bristol, I couldn’t keep away from the health and fitness arena and qualified as a personal trainer, eventually running my own company in the city. This led to developing my other passion, nutrition, training at the Institute of Optimum Nutrition. I started working with the England Rugby Team in 2002 and was part of Clive Woodward’s team that lifted the world cup, I still work with England rugby as well as Tottenham football club and was recently asked to lead the Loughborough site English track and field team into the 2012 Olympics – co running the nutrition programme with Glenn Kearney. I have my own elite performance based company, based in London.

NG: What was the first lab test you ran and what did you learn from it? What’s your favourite test panel and why?

ML: I ran an ASI because I felt like I had adrenal fatigue – it came back positive which was a relief as I like many people like to have reasons and number to work out why I’m getting symptoms. I learned a lot about how to treat adrenal fatigue and thyroid issues along the way – self taught and based on my personal experiences. This has helped me enormously with other people suffering from adrenal fatigue and thyroid problems. Athletes commonly knock the HPA axis off tilt through pushing themselves in training.

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

ML: It has to be learning to train properly and learning to sleep properly! Most people don’t train! Or even lift weights. It should be one of the 10 commandments.

NG: Who is your favourite educator / guru in the nutrition or functional medicine field?

ML: Dr Eric Serrano

NG: What’s the best business / practice advice you’ve ever received?

ML: You cannot help everyone.

NG: What’s the secret of your success?

ML: I have a code of conduct, a principle centred approach to life and the way I practice. It’s to do with my company symbol and it means; Free, cheerful, hardy and god fearing. I’ve evolved these to mean; free to evolve and be creative in my programming, cheerful as successful athletes are happy athletes, hardy is my warrior code of conduct I stick to when things get tough – which they do and god fearing is nature respectful which means sustainable, natural, organic and things like that.

NG: Who are you client base?

ML: 50% elite rugby, but also Triathlon, golfers, track and field – boxers, UK bob sleigh – basically all kinds of athletes, both professional and recreational.

NG: How do you switch off after a busy day in clinic?

ML: I take sedatives I actually use a variety of things a chinese herbal tincture containing schinandra, astragalus, Siberian ginseng and rhodiola – it makes you totally calm and horny! Awesome for performance.  I also use magnesium, glycine,  inositol and glutamine – this tastes sweet so it helps with sugar craving and also addiction…..

Mostly I get home and the kids will generally be laughing a lot and if not then I make them laugh this is the best medicine.

Find out more about Matt’s work at sportsnutritionvlog.com

Q: When is sensitivity testing provided:

A: Sensitivity testing done when a yeast, fungi or opportunistic bacteria are identified on a stool test. Sensitivity testing is not performed for parasites or pathogenic bacteria.

Q: I’ve got a positive yeast result on my stool test, but the sensitivity page is blank, reporting “Unable to determine sensitivity to pharmaceuticals and botanicals due to the lack of growth of fungi / yeast in vitro”.

A: We identify the yeast /fungi by DNA. If something is found we do sensitivity testing by growing the yeast/ fungi in culture and then testing specific anti-fungal agents against it to see what may slow growth or kill the organism. Yeast are very difficult to culture (grow), they have specific preferences for nutrients, oxygen and pH, and all labs struggle with this issue. If it will not grow in vitro we cannot perform the sensitivity testing.

You will note that most labs utilizing culture as their means of identifying yeast also employ a visual or microscopic report of yeast for this very reason. Again, labs struggle to grow yeast. So they may tell you there is yeast present by microscopy but because it did not grow they cannot ID the yeast or provide a sensitivity report.

In the case that the yeast does not grow and no sensitivity report is available a product that contains a blend of known anti-fungal botanicals or pharmaceuticals like Fluconazole or Nystatin are commonly used.

Q: What about pathogenic bacteria – when the sensitivity page is blank for these, is it for exactly the same reason?

A: The pathogenic bacteria are mostly anaerobes (grow without oxygen) and therefore culturing them would be very costly (you must create anaerobic conditions to grow them). Regardless of what method is used to ID them, DNA or EIA tests you still have the same issue when performing a sensitivity test: labs must grow it. The recommended practice is to refer to a PDR or another reference for treatment options and dosages.

Q:  Why are sensitivities tests not conducted for parasites?

A: There are no commercial labs culturing parasites. The reasoning is twofold. First, they are very difficult to grow in vitro. Researchers can get them to grow and have for studies but at a high cost. The second reason is that unlike bacteria and even yeast to a smaller extent, protozoa evolve very slowly and therefore effective treatment options have remained the same for decades.

For more information on DNA Microbial Comprehensive Stool Testing in the UK www.nutritiongeeks.co.uk

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

HB: “My name is Heidi Bohrn (NT dip CNM mBANT AFMCP) and I have been practising as a nutritional therapist over the past 2 years. I studied at the College of Naturopathic Medicine in London and have conducted further studies via The Functional Medicine University as well as recently completing the AFMCP-UK course run by The Institute for Functional Medicine. I became interested in nutrition after being diagnosed with M.E, after 5 years of suffering with the debilitating illness I turned to nutrition and supplements to get myself better and have never looked back since. I am very happy to pronounce that I’m symptom free since turning to the powers of nutrition. Like many people in this profession I want to enlighten as many people as possible as to how food really does make an impact on people’s health and their overall wellbeing.  I am also a zest4life practitioner where I run weekly weight loss health seminars to the local community.”

NG: What was the first lab test you ran and what did you learn from it?

HB: “When at college studying, I released that I definitely wanted to take a more scientific approach in identifying underlying causes as I feel you can be more targeted in your treatment plan and you gain more compliance from your patients. My first test was a cardiovascular panel for one of my case study which so happened to be my mother. She had been suffering from high blood pressure and didn’t want to go onto statin’s. The test allowed me to be so targeted that within 6 weeks her blood pressure went from 168/80 to 139/80, even my teacher was surprised at such results.”

NG: What’s your favourite test panel and why?

HB: “For me it has to be the Metametrix Comprehensive Stool Test (Gifx), I find I am ordering a least 2 of these tests a week. Time after time I find positive results for pathogenic invaders; this is a must for anyone who is suffering from any digestive disorders. I really find this test so useful, it covers the whole spectrum of pathogens including H. Pylori and this is one key areas that I feel other stool tests are lacking. This stomach bacteria seems to rife in the UK and from once my patients have addressed their H. Pylori we find that lots of their symptoms seem to disappear, even symptoms that are not even related to digestive function such as high blood pressure and heart murmurs . I find this test to be so much more precise in picking up parasites as it tests the DNA rather than the culture that other tests analyse.”

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

HB: “To me balancing out blood sugar levels via a low GL diet is quick, effective and doesn’t cost your patient the earth. Installing clients with a low GL food protocol such as eating 3 times a day and eating protein with each meal is such an easy and cost effective way for patients to see many benefits.  Not only weight loss, but other health benefits such as better mood, less cravings, reduced PMS, reduce blood sugar markers, an increase of energy and the elimination of acid reflux are all benefits that can be gained from the installation of this healthy eating plan. I am a big advocate of a dietary plan as it integral to the Zest4life plan designed by Patrick Holford, which I teach on a regular basis.”

NG: Who are your favourite educators / gurus in the nutrition or functional medicine field?

HB: “Such a tough question…with so many experts to draw inspiration from I really would find it impossible to pick just one. However I do love experts who provide clinical expertise and deliver material in such a fashion that it can be immediately implemented into working practises so I would have to say that I’ve always been impressed with experts such as Dr Weatherby, Kara Fitzgerald and from IFM -Kristi Hughes and Mark Hyman.”

NG: What’s the best business / practice advice you’ve ever received?

HB: “Always start with digestion. They say the seed to good health starts in the gut and from a clinical view point this has been proven for me. When I first started my treatment plans I was all over the place, I was trying to fix all symptoms at once and not focus on being targeted.  I now initially focus on digestion and then (un)surprisingly a lot of the other areas of concern tend to calm down, for me it the quickest way to make an immediate impact on your client. Immediate success obviously helps with client retention and from once your client returns you can then focus on deeper routed health concerns.”

NG: What’s the secret of your success?

HB: “Keep learning!  In our profession you can never stop learning, we are in a sector where new research is becoming available on a daily basis and you need to be up to date with your research and protocols. I love to learn from the experts and believe it has allowed me to grow as a practitioner very quickly!”

NG: How do you switch off after a busy day in clinic?

HB: “I live in a beautiful village set in rural area just on the outskirts of greater London, so I try and go for a walk each night to switch off. I think it is important to cut yourself off from work as what we do can tend to be quite demanding. I also try not to see clients at the weekend as this is my time that I reserve for my family because without them I would not be able to help others.”

Find out more about Heidi’s clinic from her Alternative Nutrition.

Who should we feature next? Send your nominations (or nominate yourself) to support@nutritiongeeks.co.uk

Angela Walker BSc Nut Med mBANT CNHC registered

Technical Advisor, Nutrition Geeks

“Hi Don, Attached is a brief summary comparison of the two types of analytical techniques used to measure and report organic acids [download copy here]. We started years using GC/MS years ago when we pioneered the use of organic acid testing in integrative/functional medicine. In that sense you could say we have the most experience in the field, having introduced and written the book on this test. The reason it is so popular is that everyone realized how much useful information there is in this test after we came out with it. Everybody has pretty much copied us since.

We were attracted to the tandem mass spec methodology because of its robustness and flexibility, even though the equipment is significantly more expensive. We are very insistent on quality around here. This technology allows us to offer other compounds in the report that other labs do not have. These include 8-hydroxy-2-deoxyguanosine, a well documented marker of oxidant stress and damage to DNA. No other lab offers this in their profiles since it would add considerable additional cost. Also, we include D-Lactate, an important marker of gut dysbiosis. The LC/MS-MS (Liquid chromatography / Tandem mass spectrometry) allows us to report this. It cannot be done using the GC/MS methodology. Again, a value added service other labs don’t provide. We also are the only lab to report out the well documented Candida albicans marker, D-arabinitol. This is very useful to clinicians as it provides a reliable yeast overgrowth marker, again at no additional cost.

Finally, I would like to comment on the scientific inaccuracy some labs are perpetuating. This is the reporting on the “supposed” yeast dysbiosis markers of tartarate, citramalate and arabinose. I challenge anyone to find any support for these compounds as markers of yeast overgrowth in the medical literature. It simply does not exist and labs that say these are markers, I have no respect for. In fact, we published a paper in Clinical Chemistry on tartarate about this error. [download copy here]“
J. Alexander Bralley, Ph.D.
CEO – Metametrix Clinical Laboratory
3425 Corporate Way
Duluth, GA 30096 USA

Our conference, in conjunction with BANT is this coming Saturday, we have a number of exclusive offers for delegates.

5% discount on the Cardiovascular Health Profile (0161)

Normal Clinician price £215.04, discounted rate £204.29

In addition, all BANT delegates will receive a 5% discount on the GI Effects (2100) and Organix (0091) test kits

GI Effects: normal clinician price £249.48, discounted rate £237.01

Organix normal clinician price £219.24, discounted rate £208.29

If tests are ordered on account they must be ordered on the day or within the following 4 weeks after the conference and the test must be completed, returned and paid in full  by the 23rd December.

If tests are bought outright then they must be ordered and paid for on the day and must be sent back completed by the 29th Feb 2012. This is a great opportunity to bulk buy kits on the day e.g. if you pre-pay for 10 x 2100 GI Tests they will save an additional £124, covering the cost of the conference

On the day we will also be discounting all Metametrix Books by 10%. This was extremely popular at AFMCP in early October.

These offers give you a fantastic opportunity to recoup the cost of the conference itself so we hope you take advantage of them. There are very few tickets left for the event, so if you haven’t already, then please book straight away http://cvdandstress.eventbrite.com/

We look forward to seeing you on Saturday

The Nutrition Geeks Team

Kara will be speaking on this topic at our conference on 29th October, few seats are still available, book here.

A 62-year-old gentleman named Robert presented to my office recently with a diagnosis of hypertension and hyperlipidemia. He was about to retire from a lifetime of high-stress, demanding technical work. He was motivated to improve the quality of his health so he could maximize enjoyment of his later years with family and friends. (What a fabulous goal!) He presented to me as a relatively healthy American male, balding with mild abdominal adiposity. His blood pressure (left arm sitting) was 130/85. He had moderate hearing loss requiring hearing aids in both ears as a result of receiving ototoxic antibiotics as a small child. He had his hearing checked at regular intervals, which generally showed no change or a slight decline. He ate a relatively healthy diet, lots of nuts and seeds, good fish and veggies. He loved bread and frequently indulged the desire with rolls and baguettes. He enjoyed sweets occasionally.  As a former runner, he was of the mind that “carbo-loading” was a good thing, even though he wasn’t exercising with the same intensity or frequency of his youth. He took an ACE inhibitor and a statin at standard dosages. His family history included heart disease and diabetes. Significant symptoms are noted in his baseline Medical Symptom Questionnaire (MSQ) which can be viewed here.

In my practice, I cast a wide biochemical net with laboratory analysis and I use the IFM Matrix to “see inside” my patients to identify what they need to thrive. The Matrix is a systems medicine data sorting tool that is indispensable to my work (see: www.functionalmedicine.org for more information). The Matrix is an organized a set of core clinical imbalances that are linked to the basic physiological processes. These serve to marry the mechanisms of disease with the manifestations and diagnoses of disease. Many common underlying pathways of disease are reflected in these clinical imbalances. The Matrix components include: Assimilation Imbalances, Biotransformation and Elimination Imbalances, Defense and Repair Imbalances, Energy Imbalances, Communication and Transport Imbalances, Structural Integrity Imbalances and Mind, Emotions and Spiritual Imbalances. As the greater medical community embraces individualized, systems-thinking, this model (or similar) will likely be widely adopted.

With Robert, I ordered a comprehensive battery of standard labs, including: chemistry screen, complete blood count, lipid, thyroid and iron panels; insulin, celiac serology and HLA genes, fibrinogen, homocysteine, hs-CRP, Lp(a) and testosterone. Nutrient testing included: amino acids, organic acids, lipid peroxides, essential and toxic elements, vitamin D, E, CoQ10, A, beta carotene, fatty acids, stool microbiota analysis with digestive markers; IgG4 food sensitivities. To identify key areas of imbalance and treatment direction, I placed the significant laboratory findings along with his clinical history and treatment into a table comprised of the key Matrix imbalances (Table 1).

Robert adhered to all of the treatment recommendations. His complaints largely resolved, as seen in his follow-up MSQ below. He was able to discontinue his medications. His blood pressure was on average around 110/70. He lost over 20 pounds and became an avid hiker. His success inspired those around him, including his wife and sons, who all moved towards a healthier lifestyle.

As part of the Matrix model, questions we can ask while we are sorting the data that allow us to drill down into and differentiate between the causes and effects of the disease are: what are the ANTECEDENTS, TRIGGERS and MEDIATORS of the disease process in this individual? Understanding the “ATMs” helps us to zero in on areas needing evaluation. When designing treatments, ask: what does our patient NEED TO GET RID OF; what does our patient need to GET?

This case is interesting in that hypertension, Robert’s chief complaint when he presented to me, really didn’t require direct intervention. Rather, an investigation of ATMs led to the identification of a possible pre-celiac malabsorptive condition that likely caused the subtle nutrient deficiencies that contributed to his high blood pressure. A positive finding of the celiac genes without celiac serology has been termed gluten sensitivity and is associated with IBS and non-specific lymphocytic infiltration of the gastrointestinal mucosa (REF). Indeed, when Robert trialed a reintroduction of gluten, his GI symptoms returned and his blood pressure increased. Thus, we could say that the celiac HLADQ2 gene was an antecedent factor, as was his family history of heart disease and diabetes. A disease trigger and mediator in this case could be the ongoing consumption of gluten, which probably contributed to the malabsorptive state. He also noticed a clear correlation with sweets and blood pressure. Gluten intolerance-induced nutrient insufficiency and sugar ingestion have both been associated with hypertension.

Interestingly, it was noted that Robert had lost ½ inch in height at his annual physical exam. A bone density test (DXA scan) revealed osteopenia, also associated with celiac-induced malabsorption.

A final twist to this case is that Robert’s most recent hearing test revealed a mild, but significant improvement, a remarkable finding considering the duration and cause of the impairment. While it cannot be determined what contributed to the improvement specifically, a systems- rather than a symptom- approach to his treatment favors the occurrence of such an event.

For detailed, referenced cases using The Institute for Functional Medicine’s Matrix including extensive laboratory analysis and case discussion, see the updated Textbook for Functional Medicine. Also see: Case Studies in Integrative and Functional Medicine, Fitzgerald and Bralley, published by Metametrix Institute, 2011

This is a fantastic addition to the evidence base for a functional and integrative approach to medicine.

The book is a collection of case studies, taken from a wide range of clinicians, across a variety of complex medical conditions. Each case outlines how functional laboratory tests were used to reveal core imbalances linked to the basic physiology of the individual and how the treatment plans implemented led to significant improvements in symptoms.

Although the book is divided into sections based on type of condition (atopic, autoimmune, cardiovascular etc), what’s clear is that each of the individual case subjects were treated as individuals; the clinician in each case used their clinical skills, supported by insight from the laboratory testing, to consider the individual biochemical imbalances, and by working through those, was able to bring about real change and improvement.

Comprehensive discussion and reference are provided each case, so we have the blend of clinical experience and scientific evidence to support the decision-making.

As a UK clinician how can this book support you? It puts functional medicine, or a functional approach to health care into perspective; it provides practical and evidenced support on how to use this approach in dealing with complex cases. Whether you an experienced clinician or recently qualified, this book will provide insight on unlocking challenging cases. As Mark Hyman, IFM chair comments ‘Doctors must learn through apprenticeship, example and case histories. These functional medicine case studies are the next best thing to being a master’s apprentice, a window into the thinking behind the practical application of functional medicine”

I hope this book can also help to share the functional or integrative approach we take with other healthcare providers, to foster a collaborative approach to chronic health problems.

The book is available to purchase here

Angela Walker BSc Nut Med mBANT CNHC registered

Technical Advisor, Nutrition Geeks