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Salmon, asparagus, prawns

Before we embarked on the AIP diet I considered that my family’s lifestyle was pretty healthy. We don’t eat takeaways (okay, we’ll have fish and chips every three or four months), we don’t eat fast food, we don’t eat out in pubs or restaurants often. We are all involved in team sports and go to the gym. I started making my own baked goods when the children were small because it was easier to bake than bundle up three kids into the car, drive and navigate a shop with them. I’ve baked sourdough bread for the last decade, switching to gluten free in 2014. If we have pizza it’s homemade. As a family we cook from scratch 90% of the time, and all of the kids who are now teenagers can cook.

Prescription: AIP diet

So when a Functional Medicine doctor prescribed the AIP for my son to address his alopecia I thought that it sounded interesting and was keen to try it. In fact, we started the very next day. There was none of this phased approach, we dived straight in. It seemed to make sense for the whole family to go on the diet as three out of the five of us were dealing with autoimmune conditions, and I figured that it would be easier to cook one meal for everyone than multiple meals for the two without AI conditions.

My supermarket shopping reduced dramatically as when you’re only buying meat, fish, veg and fruit there are literally two aisles in the whole shop which are of interest. I became a label reading expert. Why, oh why do food makers take a perfectly healthy food like organic olives, and then add industrially processed sunflower seed oil? Oh, cost, that’s why. I found some great dairy free milks that weren’t full of thickeners and gums. But probably the most interesting part was getting pushed out of my comfort zone to try foods that I’d not eaten much before like plantain and cassava flour.

Will it fix everything?

I know that many people hold out the AIP diet as a panacea to fix any AI issue, but that wasn’t my experience. I found the constant shopping, prepping, cooking and cleaning up to be really time-consuming and tedious. It was also expensive. My shopping habits changed… before AIP I’d visit the same one or two supermarkets each week, I started to visit my local butcher and greengrocer each week. I’d also have an organic veg box delivered. I’d buy fish from the market on the weekend. Plus trekking down to the local ethnic store… Like I say it was time-consuming.

I used the Autoimmune Paleo Cookbook as the basis for our meals. It was fine. Some dishes were better than others! We were trying the diet in the Summer so lots of the soups and stews just weren’t appealing. It was very easy to keep making the same dishes. I reached the point where I couldn’t even look at another sweet potato. Our experiment was further compromised by a trip to France which coincided with our final week on the elimination diet. We were self-catering but our food bill went through the roof. The kids were not enjoying the food at all and couldn’t wait to start the re-introductions.

Reintroductions

After a month we started to reintroduce the foods that we’d been excluding. It’s really funny how much you miss different things, for example eggs. I never thought that I had such a close relationship with eggs until they went away. So what happened to our various AI diseases? Well it was only a month after all… there was no improvement to my daughter’s ulcerative colitis, my Hashimoto’s felt the same and with regards to alopecia Harrison didn’t lose his eyebrows during that month. So that’s sort of a positive, but as we reintroduced foods (still avoiding gluten and dairy), his eyebrows did slowly fall out too.

Recommend it?

Would I recommend trying the AIP to people with AI diseases? Yes, but… only if you have a LOT of time to invest. I found that the stress of the experience likely mitigated any positive effects. I found that I was having to think about food all of the time which I didn’t enjoy. (It reminded me of when I lived in a converted garage in the South of France with no kitchen – I lasted just over a week before moving). Plus my kids were complaining about being hungry, and they weren’t enjoying the food flavours. Every time we sat down to eat someone would be unhappy, it didn’t make for a relaxing eating experience. AIP just felt too extreme and I feel that it would be extremely triggering to anyone who has a less than great relationship with food already. If you’re just cooking for one person and enjoy meal planning and batch cooking then it’s probably worth a try.

My kids and I fondly remember those plantain waffles, to be honest I should maybe try those again. They had a unique flavour (in a good way!) When I hear about people who eat this way long-term it sets off alarm bells because it’s so limiting. The whole point is to start making reintroductions to see what you’re able to tolerate. There’s a danger that the diet starts to define people and it’s quite easy to fall down a rabbit hole with it. If you’re trying it as an elimination protocol I’d start with 30 days and if you feel good after those 30 days then start the reintroductions. If your autoimmune symptoms are still apparent you could perhaps extend an additional month and then check in and perhaps start reintroductions at that point.

Do you need a coach for the AIP diet?

In my experience I’ve found that adopting a paleo template to eating is much less extreme and gives comparable benefits. I also found it considerably less stressful than AIP. I’ve written about it here https://practicalhealthcoach.uk/thirty-day-paleo-reset/ If you’re looking for support with AIP there are coaching programs out there, but there’s no reason why you wouldn’t be able to manage this diet by yourself. The paleo template that I use is modified for autoimmune conditions and has been a proven route to managing multiple autoimmune diseases within my family. I have a Hashimoto’s diagnosis that is in remission, my daughter’s ulcerative colitis is no longer flaring and my son is having amazing hair regrowth (without loss) despite having previously lost all of his hair. Another positive is that meal times are no longer traumatic, and I’m able to spend time on other things apart from just food shopping/prepping/cooking and cleaning.

If you’d like to get your autoimmune condition under control then let’s talk. Here’s a link to my calendar https://calendly.com/practicalhealthcoach/45-min.

Tree with extensive root system

One of the areas that I work on with clients is getting to the bottom of the root cause of hair loss. Once we figure out what the cause is we can address it and support your hair regrowth. It could be caused by an autoimmune disease, poor nutrition/absorption, infections, chronic stress, a traumatic event, hormones or histamine intolerance. And that’s just for starters! Clearly you are not going to get the bottom of this in a 12 minute GP appointment, or just by using a topical steroid prescribed by a dermatologist.

Genes load the gun…

If we acknowledge the widely accepted concept that genes load the gun, but environment pulls the trigger with regards to disease, then it makes sense to start here. Let’s put it another way, if we both have the same autoimmune condition e.g. Hashimoto’s, mine could have been caused by extreme stress which kept the body in fight or flight mode for sustained periods of time. While yours could have been created by inadequate sleep and eating foods that your body doesn’t tolerate well.

We have the same disease with (potentially) an identical impact on our thyroid functions causing hair loss among other symptoms. Our doctors will likely have prescribed the same dose of thyroid hormone. However, our treatment strategies to resolve the root cause of disease would be completely different. Mine would include stress management techniques, yours would incorporate a sleep hygiene protocol and a food diary to track the impact of the food that you’re eating.

Root Cause of Hair Loss

If we look at the root cause for alopecia any of the below list could be a trigger:

  • A car accident
  • An infection
  • A hormonal imbalance (e.g. pregnancy)
  • Chronic stress
  • Environmental toxicity (e.g. mold, heavy metals)
  • Histamine intolerance

This could be compounded with gut dysbiosis and/or leaky gut. As you can see all of these triggers are completely different and yet create the same end result of hair loss.

Alopecia

I’m frequently asked about the root cause for my son’s alopecia. I’ve concluded the following:

  • Genetics: We have a family history (both maternal and paternal) of AI disease.
  • Gut problems: Intolerance to dairy leading to leaky gut AND antibiotics wiping out gut bacteria
  • Triggers:
    • Underlying Stress – Moving internationally and attending 3 schools in 3 years
    • Trauma – 2016, Broken leg (nasty spiral fracture), 2017 Broken arm, 2018 Broken finger
    • Mindset – All of the breaks occurred while playing rugby, each recovery necessitated not playing rugby (which he loves) for between 6-15 weeks. I think that this had a negative impact on mental health.

I hope you can see that this particular scenario is unique to my son, just as your root cause will be completely unique to you.

It takes time to get to the bottom of the reasons for your hair loss, and it’s highly likely to be multi-factorial. Your hair is not a separate part of your body, it’s all connected. For example, if your nutrition/absorption is poor your body will prioritise your essential organs over your skin (the body’s largest organ) and hair.

I hope that this brief article has provided an insight into how figuring out your root cause can help you to regrow your hair. My program is naturally tailored to your precise circumstances because one size does not fit all.

If you’d like to find out how I can help you please book a call following this link: https://calendly.com/practicalhealthcoach/45-min

Sunshine on flowers

While talking with some of my Functional Health Coach chums, I asked what their favourite vitamin was. After the initial shock, this question is a bit like asking who your favourite child is… more than 70% of those asked for my highly unscientific poll agreed on vitamin D. We then delved into minerals, but that’s a whole other story.

Unless you live under a very large rock with no access to the outside world you’ll have seen that vitamin D has been in the news recently. This is due to the first randomised controlled trial which showed that administering vitamin D almost completely removed the risk of needing admission to the ICU for patients who’d tested positive for Coronavirus. https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub This is obviously fantastic, although more research is needed as the study was small.

However, that’s not why this vitamin would always be top of my vitamin charts. Firstly, most people know of its role in supporting calcium absorption. It also helps to prevent rickets, osteoporosis and stress fractures. Vitamin D deficiency is linked to increased risk of heart disease, cancer, type 2 diabetes and death from all causes. While these are all great reasons to optimize your vitamin D levels, my interest lies in the immunomodulatory effects of the vitamin.

Immunomodulatory impact

Part of the conclusion from The Implication of Vitamin D and autoimmunity: A Comprehensive Review states:

“Due to its unique capability to bind to VDR* and serve as a transcriptional factor, vitamin D can regulate gene expression and further exert its immunomodulatory effects on immune cells.”

*Vitamin D receptor

It goes on to state that additional studies are required to fully understand the potential capacity of vitamin D to prevent and ameliorate autoimmunity. https://pubmed.ncbi.nlm.nih.gov/23359064/

So what does this mean for those of us who are living with an autoimmune disease? Anecdotally, I’ve noticed that clients report hair regrowth after the Summer when they’ve tended to be outside more, or been on holiday to a sunny place. That said given that vitamin D is toxic at high levels the answer isn’t just to  take a supplement. First you need to understand what your levels actually are, and retest after 3 to 4 months. You can ask your GP to run the test or use one of the private companies to get this information. I like Medichecks or Tiny Tests.

Sunshine is simplest

The easiest (and cheapest) way to obtain vitamin D is from sunlight, but in the UK that’s only possible between the end of March and September. I like the Dminder app which helps you to track depending on your location, your skin colour and amount of exposed skin. The image below is from September 22nd 2020 in North West England. We only have a few more weeks remaining after which time you’ll need to look for other sources until late March/early April 2021 when it becomes available from the sun again.

Snapshot from Dminder app

Food

Good sources are cod livers and cod liver oil. Other fatty fish include herring, fatty tuna, rainbow trout, salmon, sardines, and mackerel. Other good food sources are egg yolks with free range eggs containing more (approx 4-6 times more) than eggs produced by chickens without access to pasture.

Supplement

While you could argue that cod liver oil is a supplement. Here I’m talking about the ones which are not food-based. Ideally you’re looking for an over the counter supplement which also contains vitamin K2 as they work together synergistically.

Toxic

As stated earlier too much can be toxic so don’t start to supplement without first knowing what your personal level is. There’s a fair amount of debate regarding what optimal levels are. Generally in the Functional Medicine Community 50ng/ml is regarded as optimal, but that doesn’t mean that would be the perfect level for you.

To wrap up I make sure that I obtain vitamin D from sunlight in the first instance, and then food. Given the risk of toxicity I don’t think this is a supplement that you should take without medical advice. If you’re interested to find out more take a look at this article by Chris Kresser. https://chriskresser.com/vitamin-d-more-is-not-better/

Swab

Dr Ingrid Wilson is an experienced GP who specialises in hair and skin conditions and is also a trichologist. Her practice, Crewe Hair and Skin Clinic, provides an oasis of high tech solutions for skin and hair problems. I was fascinated to hear about a new test for alopecia that she’s offering called TrichoTest. Using your DNA profile (obtained from a simple swab) it can provide the most likely roadmap to support your hair regrowth. This means that you don’t waste time, money and effort pursuing solutions that are unlikely to help you. I had some questions for Dr Wilson about this new technology.

Does TrichoTest work for everyone regardless of age and sex?

That’s a very good question.

The information from the company indicates that it can be used by everyone regardless of age, gender or race.  I would only offer it to over 18s in the clinic  though for reasons of informed consent.

There is a very helpful frequently asked questions section on the  Fagron TrichoTest website which also provides a lot of helpful background information about the test https://fagrontrichotest.co.uk/faqs/

The test has been widely used across the world, including parts of Europe, the USA and Africa.  It came to the UK in the  autumn of 2019. 

My son was first diagnosed in 2016 although he wasn’t offered any test for alopecia at that time. I think that he could potentially have avoided losing all of his hair if this test for alopecia had been available then. For example, he experienced no regrowth at all using Minoxidil, and when we were chatting you mentioned that Minoxidil will only work for 40% of people with hair loss. How can this test help both these groups of people?

The main way that Minoxidil works is by prolonging the growth phase of the hair. Topical minoxidil, which is available over the counter as Regaine is the mainstay treatment for androgenetic alopecia (balding in men and women) and is also used as an off-label treatment for other hair loss conditions such as traction alopecia. Despite its widespread application, the exact mechanism of action of minoxidil is still not fully understood.

In the past, without the test I would advise appropriate  people to try Minoxidil for at least 6 months, and to give up if there is no improvement after one year.    They can buy it over the counter – and there is a lovely version produced by the compounding Pharmacy I work with that supplies Minoxidil in a really pleasant foam called Foamil which supports hair growth.

I find that sometimes people give up on Minoxidil too early because they experience excess hair shedding at around the 4th month – which ironically is actually a good sign because it is transient and  actually leads to better results overall!

With the Trichotest some time can be saved because it will identify whether there are alternatives to Minoxidil which are likely to be more effective based on the genetic profile.

The positive effect of Minoxidil on hair growth is mainly due to its metabolite, minoxidil sulfate, and the enzyme responsible for this conversion is sulfotransferase, which is located in hair follicles and varies in production among individuals.  There are two phenol sulfotransferases responsible for minoxidil sulfation in the human scalp, and patients with higher enzyme activity respond better to topical minoxidil than those with lower enzyme activity do.  

Sulfotransferase activity is one of the areas looked at in the test.  However what is even more exciting is that the enzyme can actually be upregulated by a short course of topical tretinoin. Tretinoin is a prescription only medicine and cannot be used in pregnant or breastfeeding women.

I am pleased to say that I shared this research finding with the company when I first started doing the test at the clinic earlier on in the year, and they now incorporate this into their treatment algorithms.  I had heard about this exciting finding at different professional conferences to do with hair over the past year: one aimed at dermatologists and one aimed at hair restoration surgeons.  (St Johns Dermacademy Alopecia Masterclass and the British Association of Hair Restoration Surgery event).

When is the best time for a client to take this test for alopecia? For example, at the first hint of hair loss or after a few months when the hair loss is really visible?

It is best to do this as early as possible.  This is because overall the treatments work better if started at an early stage.  Your genetics are not going to change, but the appearance of your hair will if nothing is done about it.

What do you see as the main advantage of this type of DNA test for alopecia over other methods of obtaining a diagnosis (for example, a biopsy).

DNA testing should be seen as a part of the assessment of certain hair disorders.  I strongly believe that it needs to take place alongside a full assessment.  When I assess a hair loss patient as well as the online questionnaire that needs to be completed for the test, I ask more questions as these may have a bearing on the advice I give after the consultation.

This test is best for those with the  potentially reversible and treatable disorders: androgenetic alopecia (balding), alopecia areata and telogen effluvium.  As Minoxidil can be used in other conditions such as traction alopecia – patients may want to weigh up whether they want to know whether Minoxidil is likely to work for them based on their genetic profile.

I have learned that the test cannot be done in isolation.  A comprehensive history needs to be taken to provide context to interpreting the result.

I am aware that some trichology clinics offer it, but the majority of trichology clinics do not have a prescriber.  As the prescriber I take responsibility for the prescription and have found that it has been really important that I have undertaken a detailed assessment with the patient before recommending a prescription.    Sometimes issues have  been identified during the consultation which may not necessarily have been identified by the online questionnaire.

The DNA testing is pretty straightforward to do,  and non invasive.  The hardest thing is the wait of 2-4 weeks for the result, and then reading the detailed report that comes back!  I write to the patient with a summary of the main findings.

A scalp biopsy is not something I offer at the clinic, although I was actually taught how to do it by a dermatologist at a supervised approved hair clinic session at a hospital.  It is invasive as it involves cutting a small sample out of the scalp and then stitching up the small area. A biopsy needs to be done in the right setting with facilities for the correctly trained person to look at the slides under the microscope (a dermatohistopathologist)

A biopsy needs to be done for the right reasons, particularly in cases of potentially permanent (known in the profession as scarring) alopecia such as lupus or lichen planopilaris. 

As for medical conditions, the type of test done will depend on the range of signs and symptoms the patient presents with.

Once you receive the test results back what would be the minimum length of time that a patient would undertake a treatment protocol?

This is a personal choice.  The treatment would need to be continued for as long as one wishes to medically treat the hair loss.

Some people  may decide to continue long term with the medical treatment. Others may decide to have a hair transplant for balding which using this as an adjunct. I am aware that some hair transplant surgeons are starting to use this test to help produce better long term outcomes after surgery.

For more information please do get in touch with Dr Ingrid Wilson at https://linktr.ee/CreweAnd

01270 747 393 or info@crewehairandskinclinic.uk

Hand Sanitiser: Coronavirus and BPA

As a Functional Health Coach one of the areas that I work on with clients is cleaning up their home environments. This is a key step towards recovery for those suffering from autoimmune disorders like alopecia or Hashimoto’s. For starters we look at water and indoor air. Together we examine other areas that have the potential to create problems: for example, fire retardants on new furniture, metals leaching from cooking equipment, toxins in skincare, etc. Everyone’s home environment is unique, it’s key to have a systematic approach to this.

I don’t just talk about these issues! I do actually apply everything that I’ve learned in my training to minimise these daily risks that we encounter. Last week I went shopping with my daughter in the Trafford Centre and noted that every single shop had hand sanitiser near to their entrances. This is a sensible approach to minimise the risk of catching coronavirus after you cautiously leave your home following weeks of lockdown. That said, hand sanitiser can produce some unwanted side effects when combined with other chemicals.

BPA

We’ve known about BPA and it’s negative health impacts for years. I remember first hearing about it with regards to, specifically, the lining of tomato cans. BPA or bisphenol A is found in plastics, aluminium cans used for foods, and critically thermal paper e.g. cash register receipts. It’s an endocrine disruptor which means that this chemical can interfere with your endocrine (hormonal) system. What does this mean? Studies have shown links with this chemical and insulin resistance and type 2 diabetes, cardiovascular disease, asthma, cancer, liver damage and ADHD. (1)

The National Institute for Environmental Health Sciences states that even low doses of hormonal disrupting chemicals may be unsafe. This is because your body’s normal endocrine functioning involves very small changes in hormone levels, yet these small changes can create significant developmental and biological effects. An endocrine disruptor like BPA can increase or decrease normal hormone levels, mimic the body’s natural hormones or alter the natural production of hormones. (2)

Unfortunately chemicals which were supposed to remove BPA from our environment, like TPP (triphenyl phosphate) which enable manufacturers to use the ‘BPA free’ label on plastics still produce estrogenic activity (EA). (3)

Coronavirus and BPA

Perhaps the area that we should be most focused on today given the fact that we’re living through this time of coronavirus is that of thermal paper (commonly used for till receipts, transport tickets, restaurant orders from front of house to the kitchen). In 2014 a study showed that people who were handling lots of receipts had increased levels of BPA in their urine and blood. (4) While another 2014 study found that “data show after holding a receipt for 60 sec, there was 185-times more BPA transferred to a wet hand due to holding thermal receipt paper immediately after using hand sanitizer with penetration enhancing chemicals as opposed to when the hands were dry”. (5)

Given that we are all using hand sanitisers significantly more in an attempt to remain safe during this pandemic, we should be aware of this increased risk. Let’s face it we’ve already ran out of sanitiser once in the UK, I even have a quick recipe on my site giving instructions on how to make your own. https://practicalhealthcoach.uk/how-to-make-hand-sanitiser-at-home-using-ingredients-that-you-probably-already-have-lying-around/Other cosmetics like lotions and moisturisers also enable lipid-soluble chemicals like BPA to be absorbed by the skin.

More recently last year, a study examined BPA and BPS (bisphenol S) in receipts from Brazil, France and Spain and found that hormone-like activity was found in >80% of the paper, and that the BPA levels were 30 to 100 times higher than the EU recommended level of 0.2mg/g. The United States currently has no minimum recommended levels for these endocrine disrupting chemicals. (6)

What can you do?

So what can you do to minimise your contact with thermal paper while still following safety protocols for CV-19:

·        Have a receipt emailed to you if that’s an option.

·        Leave the receipt!

·        Use gloves.

·        Don’t keep receipts in pockets, or lying around the bottom of your bag.

·        Don’t touch thermal paper if you’ve just used hand sanitiser.

·        If you must take a receipt, fold it inwards on itself and put in a rubbish bin as soon as practicable.

·        Exercise caution if you’re in a vulnerable group: for example, pregnant women, pre-conception couples, working in an environment which has significant contact with thermal paper, children and adolescents.

Notes:

  1. https://chriskresser.com/re-examining-the-evidence-on-bpa-and-plastics/
  2. https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063249/
  4. https://jamanetwork.com/journals/jama/fullarticle/1832525
  5. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110509
  6. https://www.sciencedirect.com/science/article/abs/pii/S0013935118306820#!