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Irritable Bowel Syndrome & Giardia – A Q&A with Susan Koten

What was the inspiration behind your book?

Experiencing the trauma and desperation of my life being turned upside down with the sudden onset of IBS symptoms fifteen years ago, and the lack of help available. This experience stayed with me and when I started to see and treat patients in my clinical practice who were going through the same experience, I knew I would one day write a book about it and Irritable Bowel Syndrome & Giardia is the end result of all that experience.

What was the most challenging part of writing the book?

This is my first book and when I started the project 10 years ago, I had no idea the amount of work that lay ahead to finally get it published.  This book has the potential to change people’s lives for the better so it was important extreme care and research went into writing it. With a busy practice to run, I would often start writing at 10pm and finish at 2am – this has always been my quiet time and I could concentrate with no interruption.

What has been the most satisfying part of the writing process?

My aim is to pass my knowledge on to those who need it and as I delved deeper into the subject matter, to understand how and why the clinical observations and patterns of my patients were presenting themselves, I have found writing it down and putting all this information together in a manuscript, has allowed me to achieve this.

Did anything surprise you while writing IBS & Giardia?

About seven years ago I changed my treatment strategy to a more gentle approach and the results surprised and amazed me which is reflected in the book.

What sort of people would benefit most by reading your book?

This book is for anyone who is struggling with the health of their digestive system and other related disorders. It is also aimed at health professionals, both allopathic and alternative, who are treating these patients.  It is my hope that the information contained in this book, and the personal testimonies of my patients who were suffering with what is currently a chronic and untreatable diagnosis, (IBS), will bring hope and healing to those who are unwitting hosts to the Giardia parasite. Of course I appreciate this parasite is not responsible for all digestive issues but in my experience a Giardia infestation is very often overlooked as the cause of digestive problems and this then leads to misdiagnosis and a life of misery for those affected.

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Understanding BRCA: The breast cancer gene

BRCA (pronounced ‘bracka’) stands for BReast CAncer susceptibility gene. There are two BRCA genes – BRCA1 and BRCA2. These genes function as tumour suppressors, helping to prevent the formation of cancer. When either of these genes carries a mutation, a woman has a high risk of developing breast and ovarian cancer, and men with these mutations are also at increased risk of breast and prostate cancer. Mutations in these genes have also been associated with a small increased risk of several additional types of cancer.

At the age of 35, I was found to carry a harmful mutation in the second breast cancer (BRCA2) gene and statistics suggested that I had a 45-85% chance of developing breast cancer and a 10-30% risk of developing ovarian cancer during my lifetime, which is much higher than in the general population.

Finding out that you carry a BRCA mutation is hard, and if this happens to you, you will have a great many questions that you will feel desperate to find the answers to. I felt overwhelmed and scared of the future that lay ahead. I desperately wanted to connect with other women who were going through the same thing as me and to find answers to my many questions. I looked for a BRCA support group locally, but there were none. I also looked for a book but none seemed to offer what I was looking for. I was eager to meet with the consultants that I had been referred to, but this process takes time and it was frustrating waiting for these appointments. I hoped they would be able to answer all of my questions but, in reality, even the consultants didn’t have all the answers as we do not yet fully understand the BRCA genes and their impact.

I felt very frightened, alone and frustrated that there seemed to be so little help and support and I wanted this to change. I decided, therefore, that once I had come through my own journey, I would write a book with the aim of helping others.

This book aims to improve your understanding of BRCA gene mutations and the various ways in which a carrier can manage his/her mutation, including screening, risk-reducing surgery and chemoprevention, with reference to relevant research. In the last part of this book, I share with you my own personal journey of undergoing risk-reducing surgery, including the removal of my ovaries and fallopian tubes (known as a bilateral salpingo-oophorectomy, pronounced oo-for-ek-tuh-mee) and the removal of my breast tissue while retaining my nipples (known as a bilateral, nipple-sparing mastectomy).

I detail, openly and honestly, the emotions I felt before, during and after my surgeries, along with the physical experience of undergoing these operations and the surgically-induced menopause which follows the removal of both ovaries. I will share the effect, if any, that these operations have had on my body image, identity and sexual functioning.

This book aims to answer the many questions that I personally had, including those that you may feel are simply too uncomfortable to ask. I felt anxious about so many things but, having come through my own journey, I realise now that I needn’t have worried anywhere near as much as I did. I really wish I had known then what I know now; it would have spared me a lot of fear and anxiety.

If you have been found to carry a BRCA gene mutation, I hope that by sharing my journey with you, you will see for yourself that this journey, albeit very tough, may not be as terrifying and as insurmountable as you may be feeling right now. You will get through this – I did and you can too. And, while I appreciate you may not be feeling this way now, you may even be nicely surprised by the positive ways in which this journey may change you as a person.

I am an Advanced-level Human Biology teacher and have experience of teaching both GCSE and Advanced-level (A-level) Human Biology. I also have experience of medical writing and have drawn from both of these skills throughout the writing of this book. My desire to help others has inspired me not only to write this book, but also to set up a website to offer my support to women and men worldwide who have been found to carry, or who believe they may carry, a BRCA1 or BRCA2 gene mutation.

 

This blog was taken from Clarissa Foster’s new book Understanding BRCA: Living with the breast cancer gene is now available on the Hammersmith Health Books website.

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Why Diets Fail You

Nowhere is hope over experience more prevalent than in the world of the multimillion-dollar diet industry.

There is a growing amount of evidence suggesting that for many people going on a diet which restricts what you eat as a way of achieving enduring weight loss does not work and is not sustainable in either the mid or long term.

If restrictive or calorie-controlled diets worked, then by now one ‘super diet’ would have emerged and it would work for everyone, but this is definitely not the case. Hundreds of diet books are published every year and no doubt this trend will continue.

Any diet that encourages you to eat fewer calories, or to radically cut out whole food groups, in order to achieve weight loss is scientifically flawed. Denying yourself food to the point of going hungry convinces your subconscious mind that you are living in a time of food shortage or famine and passes messages to your body to hold onto its fat as your mind is not sure for how long the food shortage will continue. As you can imagine, this is counter-productive to good health as the body feels under stress.

If you have dieted in the past, and most people have, your mind will have a ‘memory’ of experiencing those periods of reduced food intake. Periods of self-induced calorie reduction where you experience hunger pangs are very difficult to maintain and are often the trigger for a stint of bingeing or excessive eating. This is what is meant by ‘yo-yo dieting’. Yo-yo dieting like this can negatively affect your metabolism, making it even harder in the future to regulate your weight. If you recognise you have a pattern of dieting and bingeing, then it is even more vital that when you commit to eating real food as part of nutritionally balanced meals that leave you satisfied, and that you do not go hungry, as this will quickly plunge your metabolism back into fat-storing mode.

A holistic, all-body approach to eating real food means that there is no advantage to going hungry or feeling deprived. This approach is diametrically opposed to the usual diet model. In How to Feel Differently about Food, we encourage a way of eating that promotes reassuring your mind that nutritious food is available to you and that your body is no longer under threat of impending food shortage. This reassurance enables habitual stress levels around food to be reduced and when the stress symptoms of emotional eating are reduced, your body reduces its production of cortisol – the stress hormone that can also inhibit weight loss. Feeling less stressed also ensures that the nourishment in the foods that are eaten becomes more ‘bio-available’ and advantageous. Later in the book we explain how stress shuts down many of the processes of digestion, leaving sufferers deprived of essential nutrition.

Our methodology promotes resetting your metabolism into fat-burning mode instead of fat-storing mode and this is achieved through selecting appetising and tasty foods that encourage satiety. In addition, this approach HOW TO FEEL DIFFERENTLY ABOUT FOOD 10 focuses on the effect of refined sugar as a key cause of weight gain. Sugar and simple carbohydrates are rapidly absorbed into your bloodstream and affect your body’s production of insulin. Rapid spikes in blood sugar cause insulin levels to rise and take sugar out of the bloodstream and into storage in the liver, muscles and (if they are full) fat cells; the high glucose level is therefore followed by a rapid drop in blood glucose levels. This in itself can be the cause of sugar cravings and the trigger for compulsive eating. The cumulative effect of eating in ways that spike insulin production eventually leads to what is called ‘insulin resistance’. This is a condition in which the cells of the body become unresponsive to increasingly high levels of insulin and this is a key predictor of diabetes.

The latest figures from the Centers for Disease Control (CDC, 2014) in the US show that almost 10 per cent of the US population has been diagnosed with diabetes. The equivalent figures from Diabetes UK (2015) show figures approaching 3.5 million in 2015 and all predictions expect these numbers to grow year upon year. In addition, many, many more people the world over have ‘pre-diabetes’ (also known as metabolic syndrome) and remain undiagnosed until their health deteriorates with associated serious health problems – heart, circulation, eyesight and kidney damage – that bring them to medical attention and the confirmation of type 2 diabetes. Going back to health risks associated with being overweight, the incidence of pre-diabetes and diabetes itself is higher in patients who are classed as obese.

There are two other important hormones found to affect a person’s ability to manage his/her weight. The first is called leptin. It is made by fat cells and works to decrease appetite. This can become unbalanced in response to insulin resistance caused by spikes in blood sugar levels. Leptin is responsible for sending messages to your brain that you’ve eaten enough and feel sated. When leptin’s signalling goes awry, the hormone stops being produced so the messages that you have eaten enough are no longer sent, which leads to an inability to determine satiety. This is called ‘leptin resistance’. Medical professionals are now focusing more on the part leptin plays in the development of obesity, and how the hormone responds may actually be the result of obesity.

The second key involved with appetite is called ghrelin and its job is to signal to you that you are hungry. It also influences how quickly you feel hungry again after eating. Ghrelin naturally increases before meal times and is then designed to reduce after eating for around three hours until it once more naturally increases to signal the need to eat again. However, this hormone too can become unbalanced and send hunger signals more frequently, encouraging a reduction in the time between meals or even promoting the habit of constant grazing on food. One way that ghrelin becomes out of balance is through stress, which disturbs sleep patterns. This can affect workers who work unnatural hours such as night shifts. Not getting enough sleep has been shown to increase levels of ghrelin and cause an increase in appetite.

In simple terms, the hormonal responses that help manage appetite and weight are like a house of cards that are all interdependent on each other to maximise your health, weight management and wellbeing. Although designed to be perfectly in balance, a key element that can cause the whole house of cards to collapse is the eating of sugar and simple carbohydrates. It doesn’t take long before sugar spikes begin to undermine the complex hormonal interactions.

The good news is that by reducing stress levels, improving sleep patterns and changing the types of food eaten it is possible to re-calibrate the hormones’ signals to the brain to promote a feeling of fullness and enhanced wellbeing. On the food front this is achieved by cutting out refined sugars, simple carbohydrates and processed foods and replacing them with real foods, including plenty of good fats, such as olive oil, oily fish and nuts that your body can naturally process.

 

This blog was taken from Sally Baker and Liz Hogon’s book How to Feel Differently About Food

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Rethinking Type 2 diabetes

Type 2 diabetes has always been defined by high blood glucose levels. Most people now think of Type 2 as a lifelong battle against high blood glucose levels, usually beginning with tablet treatment, then more tablets, and finally possibly insulin. After twenty years of basic scientific research and some recent clinical trials, we’re now in a good position to understand what drives Type 2 diabetes, and to start using more logical approaches to the basic abnormalities of the condition – and perhaps to change this standard, and feared, course of diabetes towards ever more treatment.

The real problems lie in the liver and pancreas, the two key organs that process our food after it’s absorbed from the intestine. We know that both these organs have been struggling for ages, perhaps as long as 30 years, before the fasting glucose level peeps above 7 mmol/l, the blood glucose definition of diabetes. They’ve been struggling because of overeating, especially carbohydrates. Although they’re robust organs, they weren’t intended to cope with patterns of modern eating, which floods them with food every 4 hours or so during the usual working day, often with snacks between. The liver and probably the pancreas respond to the food-carbohydrate overload by accumulating fat. Eventually the liver can’t store carbohydrate efficiently, and starts breaking it down into glucose again which escapes into the circulation, especially during the night. The pancreas struggles too, by not producing insulin efficiently enough to bring glucose levels promptly down after meals. The heroic liver and pancreas have been battered for years before they finally fail to keep blood glucose levels normal.

Overeating is the problem, but as with most of the population, individuals developing diabetes are usually overweight. But they aren’t necessarily obese. However a combination of genetics and a strong family history of Type 2, low (or high) birth weight, and many other factors, all contribute to their being more easily overloaded with the same amount of food compared with others. Years, before blood glucose levels climb into the diabetic range, important conditions, intimately linked to Type 2 diabetes, can come to light, though they aren’t sufficiently recognised as such: these include fat in the liver that we’ve just mentioned, but also hypertension, gout, polycystic ovarian syndrome in women and obstructive sleep apnoea – all linked to inefficient insulin action and grouped together as the metabolic syndrome. Because we are so focused on blood glucose levels, these conditions are considered separate from Type 2 diabetes: but they are much more sensitive indicators of metabolic abnormality than blood glucose levels, which at this stage are likely to be completely normal.

Recognising that the roots of Type 2 are in our internal organs becoming fat overloaded has stimulated some remarkable research, especially by the team in Newcastle. They stopped thinking about Type 2 as a blood glucose condition, and focused on the liver and pancreas. They used a simple approach. Reduce over-nutrition by restricting calories to 600-800 a day, compared with our usual intake of 2000-2500, see whether fat in the liver and pancreas also reduce, and as a result expect to see blood glucose levels fall, and all the other complicated metabolic blood tests improve as well. As predicted, after 8 weeks of the very low calorie diet, which resulted in about 15 kg weight loss, all the metabolic machinery was rebooted back to near-normality, nobody needed any diabetes medication, and not surprisingly they felt hugely better. Of course, this radical approach didn’t work in everyone, especially if diabetes had been around for a long time, but a recent report found that everything remained stable for at least a year, even when the liquid diet had been replaced by normal food containing the same low calories.

Type 2 diabetes is therefore not a condition of high blood glucose, but one of fat accumulation resulting from long-term overeating that eventually can lead to high glucose levels, by which time the associated high blood pressure and abnormal cholesterol levels may already have caused serious complications – for example heart attack or stroke. Focusing mainly on glucose levels means that we don’t always concentrate on these other factors, which are more important in causing the long-term complications of diabetes.

The second major recent research theme is the type of diet we should adopt. There is no topic more controversial, but there is now encouraging clinical research to guide us. The PREDIMED study showed that a true Mediterranean diet with added extra-virgin olive oil (or nuts) had a huge effect in reducing cardiovascular disease, whether or not you had diabetes. Because most people in this study didn’t have Type 2, there was no particular focus on blood glucose levels, nor actually on weight reduction – but the Mediterranean portfolio reduced the medical complications that really matter – stroke and heart attacks. The earlier DASH diet which has a lot in common with the Mediterranean diet also nicely reduced blood pressure – an opportunity for Type 2s to reduce their blood pressure medication with support from their healthcare team.

Sadly, no individual ‘superfood’ (current hero is the avocado) has any long-term beneficial effects except on the bank balances of people promoting the latest one. Though there’s no shortage of candidate herb and spice extracts that have shown real potential for treating glucose levels in Type 2 they haven’t had big enough trials. Exercise? There’s no doubt that the recommended weekly 2½ hours of moderate exercise improves cardiac and respiratory health, and that after losing weight, this level of exercise might help reduce the tendency to regain weight. Exercise itself doesn’t prevent prediabetes developing into Type 2, and doesn’t help much with weight loss, but fatty liver seems to respond well to structured exercise. Gentle walking is fine for taking in the view, but in clinical trials people with Type 2 needed to do moderate or vigorous exercise to reduce long-term complications of diabetes – and if they managed that, the heart attack rates were much lower.

In summary: too much fat in the liver and pancreas caused by years of food overload can be detected way before blood glucose levels rise to ‘diabetic’ levels, and is associated with the health problems associated with the metabolic syndrome. Weight loss of 15 kg in weight often reverses these abnormalities. We need to focus as much on blood pressure and cholesterol levels to reduce the long-term complications of diabetes as we do on blood glucose measurements. Evidence-based portfolio diets such as the Mediterranean and DASH approaches will reduce diabetes complications: superfoods don’t.

David Levy, physician at the London Diabetes Centre, was formerly consultant physician at Whipps Cross University Hospital (Barts Healthcare NHS Trust) and Honorary Senior Lecturer at Queen Mary University of London. He has written extensively on diabetes for healthcare professionals, most recently the Hands-on Guide to Diabetes Care in Hospital for trainee doctors (Wiley Blackwell, 2016), which was highly commended at the 2016 British Medical Association Book Awards, and the 4th edition of Practical Diabetes Care (Wiley Blackwell, 2018). His book on Type 1 diabetes (Oxford Diabetes Library, Oxford University Press) is now in its 2nd edition (2017). Get Tough With Type 2 Diabetes (Hammersmith Publications) is his second book for people with Type 2 (Available Spring 2018).

 

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The Health Benefits of Going Alcohol Free for Dry January

To coincide with the public health campaign ‘Dry January’, which urges people to abstain from alcohol for 31 days, we bring you three brief extracts from Hammersmith Health Books which touch upon just a few of the reasons for avoiding alcohol:

Drug and alcohol misuse

Drug and alcohol abuse can cause great distress, leading to social isolation, low self-esteem, loss of work or school, and estrangement from family and friends – all events that can build a core of stresses that may lead to suicidal thoughts and contemplation. Substance abuse also can increase impulsiveness and decrease inhibitions, making the teenager more likely to act on suicidal thoughts.

Overcoming Self-Harm and Suicidal Thoughts: A practical guide for the adolescent years
By Liz Quish

Alcohol always leaves an acidic residue in the body and aggravates many conditions. It has no place in the health seeker’s diet. Alcohol has been proven over time to be a potent destroyer of bone structure. Alcoholics have a four-times greater incidence of osteoporosis than the normal population. In addition to rotting the bones, it causes considerable damage to liver and brain cells.

Make no mistake: alcohol is a drug, and a rather dangerous one at that. In addition to destroying liver and brain cells via its breakdown pathway which produces acetaldehyde (chemically similar to formaldehyde), it has been demonstrated to be exceptionally damaging to bone health. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol interferes with calcium and bone metabolism in several ways. Acute alcohol consumption can lead to a transient parathyroid hormone deficiency and increased urinary calcium excretion, resulting in a loss of calcium from the body.

Love Your Bones: The essential guide to ending osteoporosis and building a healthy skeleton
By Max Tuck

Hazards to Human Health – Alcohol

‘Alcohol’, or rather ethyl alcohol (ethanol), refers to the intoxicating ingredient found in wine, beer and spirits. Alcohol arises naturally from carbohydrates when certain micro-organisms metabolise them in the absence of oxygen, in the process called fermentation.

Recent studies show that moderate use of alcohol, especially red wine due to its reservatrol content, may have a beneficial effect on the coronary artery system. In general, for healthy people, one drink per day for women, and two drinks per day for men, would be the maximum amount of alcohol consumption to be considered moderate. This is pretty impossible to implement, because most people drink for the relaxing effect, which generally takes more than one or two glasses to work.

Nature Cures: The A-Z of ailments and natural foods
By Nat H Hawes

 

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Psoriasis: Natural Remedies

Natural remedies for Psoriasis

Psoriasis is a chronic skin disorder that affects 1% to 3% of the world’s population. It is characterised by periodic flare-ups of well-defined red patches covered by a silvery, flaky scale on the skin and the scalp. There are several variations of psoriasis, but the most common type is chronic plaque psoriasis. The exact cause is unknown, but it is believed that a combination of several factors contributes to the development of this disease. In a normally functioning immune system, white blood cells produce antibodies to foreign invaders such as bacteria and viruses. These white blood cells also produce chemicals that aid in healing and fighting infective agents. With psoriasis, though, special white blood cells called T-cells become overactive; they attack the skin and set off a cascade of events that make the skin cells multiply so fast they start to stack up on the surface of the skin. Normal skin cells form, mature and then are sloughed off every 30 days, but in plaque psoriasis the skin goes through this whole process in three to six days.

DAMAGE
Sometimes an injury to the skin can cause the formation of a psoriasis patch. This is known as the Koebner phenomenon, and it can occur in other skin diseases, such as eczema and lichen planus. It can take two to six weeks for a psoriasis lesion to develop after an injury. Types of damage that can trigger a flare include: abrasion – even mild abrasions; increased friction from clothing or skin rubbing against skin in folds, such as armpits or under breasts; sunburn; viral rashes; drug rashes and weather damage.

DIET
Alcohol, sugar, coffee, fatty meats, refined processed foods, additives and deficiencies in minerals and phytonutrients can induce attacks of psoriasis.

DRUGS THAT CAN INDUCE OR WORSEN PSORIASIS

  • Chloroquine – used to treat or prevent malaria.
  • ACE inhibitors – angiotens in converting enzyme inhibitors, used to treat high blood pressure. Examples include fosinopril, captopril, and lisinopril.
  • Beta-blockers – used to treat high blood pressure. Examples include metoprolol tartrate (Lopressor) and atenolol (Tenormin).
  • Lithium – used to treat bipolar disorder.
  • Indocin – an anti-inflammatory medication used to treat a variety of conditions, including gout and arthritis.

INFECTIONS
Infections caused by bacteria or viruses can cause a psoriasis flare. Streptococcal infections that cause tonsillitis, or strep throat, tooth abscesses, cellulitis, and impetigo, can cause a flare of guttate psoriasis in children. The human immunodeficiency virus (HIV) does not increase the frequency of psoriasis, but it does increase the severity of the disease.

PSYCHOLOGICAL STRESS
This has long been understood as a trigger for psoriasis flares, but scientists are still unclear about exactly how this occurs. Studies do show that not only can a sudden, stressful event trigger a rash to worsen; the daily struggles of life can also trigger a flare. In addition, one study showed that people who were categorised as ‘high worriers’ were almost two times less likely to respond to treatment compared to ‘low worriers’.

WEATHER
Weather is a strong factor in triggering psoriasis. Exposure to direct sunlight, which usually occurs in the warmer months, often improves the rash. On the other hand, cold, short days seen in the winter months can trigger the rash to worsen.

NATURE CURES FOR PSORIASIS
Raw juice therapy can effectively improve psoriasis. The best organic natural foods to juice are: apricot, beetroot, carrot, celery, cucumber, grapes, lemon, spinach and tomato.

EXTERNAL REMEDIES FOR PSORIASIS
The following can be used as external remedies for psoriasis: burdock root, Chinese rhubarb root, egg white (beaten to fluffy stage), mango, oats, parsley, pine needle tea bath and tamanu oil.

 

This extract was taken from Nature Cures by Nat Hawes. Check out her website at http://www.naturecures.co.uk/about.html

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Pumpkin Power: Your Halloween Health Kick

Pumpkin Recipes

It’s the one and only time of year where we see hundreds of pumpkins lining supermarket shelves and garden paths, often with a rather wicked smile grinning back at you. But don’t be fooled, they’re actually one of the greatest superfoods out there. Pumpkin seeds are one of the best plant-based sources of zinc, which works wonders for the human body by improving the immune system, preventing osteoporosis and reducing cholesterol. Pumpkin seeds are also a fantastic source of protein, fibre and magnesium. They help with weight loss, relaxation and increased fertility in both men and women, and their high levels of L-tryptophan make them an effective mood booster – particularly useful as the cold weather sets in!

Extracted from her book, Love Your Bones, Max Tuck provides two delicious recipes to help you make the most of this Halloween superfood:

 

Pumpkin seed pesto

In this recipe pumpkin seeds replace the traditional pine nuts that can be so very expensive. For optimum nutrition and digestibility it is important to soak the pumpkin seeds for a few hours beforehand.

  • In a food processor mix all of the following to a smooth paste:

½ cup soaked pumpkin seeds

¼ cup water

The juice of ½ lemon

Optional: splashes of tamari or Bragg’s Liquid Aminos to taste

A medium clove of garlic

¼ cup of cold-pressed olive oil

 

  • Separately, chop a medium-sized bunch of fresh basil leaves very finely. Stir them into the pumpkin seed mixture or pulse for a second.
  • Serve the pesto stirred into pasta, preferably into ‘courgette pasta’ made from thin shavings of courgette cut with a potato peeler.

 

Pumpkin seed and walnut loaf

2 cups pumpkin seeds, soaked for six to eight hours

2 cups walnuts, soaked overnight

1 cup carrot, chopped

1 cup red pepper, deseeded and chopped

1 cup onion, diced

1 cup parsley, chopped

1 cup dried mushrooms

2 cloves garlic, crushed

1 tablespoon raw tahini (optional)

Sprig of parsley to garnish

 

  • Process the pumpkin seeds, walnuts and carrot in a food processor until smooth. Remove and place in a bowl.
  • Pulse the remaining ingredients except the parsley together in a food processor until they are of a chunky consistency. Place in the bowl with the pumpkin seed mixture and combine thoroughly.
  • Place on a serving dish and mould into the desired shape. Garnish with parsley.

 

These recipes were taken from Love Your Bones by Max Tuck.

 

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The PK Cookbook: PK bread recipe

PK Cookbook

The single biggest reason for lapsing from the PK diet (Paleo-ketogenic) is the absence of bread. To secure the diet for life you must first make PK bread. I have searched and nothing is currently available commercially which passes muster. Loaves will become available as demand builds, but in the meantime you have to make your own bread. If you do not have the energy to do this yourself but have any friends or family offering to help you, then top of the list must be, ‘Please make my daily bread’. PK bread consists of just linseed, sunshine salt (see Chapter 13, page 93) and water.  Americans, and others, may be more familiar with linseed being referred to as flax or flaxseed or common flax. There is technically a subtle difference – flax is grown as a fibre plant that is used for linen.  Linseed is grown for its seed. The flax plant is taller than linseed and is ‘pulled’ by hand, or nowadays by machine.

How to make a PK bread loaf in five minutes

Please forgive the tiresome detail, but you must succeed with your first loaf because then you will be encouraged to carry on. I can now put this recipe together in five minutes (proper minutes that is – not the ‘and this is what I did earlier’ TV version). I have spent the last six months making a loaf almost every morning – there have been many revisions and the version below is the current recipe which I think is perfect!

Equipment needed:

  • Cooking oven that gets to at least 220 degrees Centigrade
  • Weighing scales
  • Nutribullet (or similarly effective grinding machine – do not attempt to do this with a pestle and mortar; I know – I have tried and failed)
  • Mixing bowl
  • A 500 gram (or one pound in weight) loaf baking tin
  • Measuring jug
  • Cup in which to weigh the linseed
  • Wooden spoon
  • Wire rack for cooling
  • Paper towels

Ingredients needed:

  • 250 grams of whole linseed (use dark or golden linseed grains)
  • One teaspoon of sunshine salt (can be purchased from www.sales@drmyhill.co.uk) or unrefined sea salt
  • Dollop of coconut oil or lard
Actions Notes
Take 250 grams of whole linseed You could purchase linseed in 250 gram packs and that saves weighing it. Use dark or golden linseed grains – the golden grains produce a brown loaf, the dark a black one.Do not use commercially ground linseed – the grinding is not fine enough, also it will have absorbed some water already and this stops it sticking together in the recipe.If you purchase linseed in bulk then you must weigh it really accurately in order to get the proportion of water spot on.
No raising agent is required.
Pour half the linseed into the Nutribullet/grinder together with one rounded teaspoon of PK ‘Sunshine’ salt (see page 93).
Grind into a fine flour.
Use the flat blade to get the finest flour.Grind until the machine starts to groan and sweat with the effort! You need a really fine flour to make a good loaf. This takes about 30 seconds.The finer you can grind the flour the better it sticks together and the better the loaf.I do this in two batches of 125 grams or the blades ‘hollow out’ the mix so that half does not circulate and grind fully.
Pour the ground flour into a mixing bowl.
Repeat the above with the second half of the seeds and add to the mixing bowl. Whilst this is grinding, measure the water you need.
Add in exactly 270 ml water (not a typo – 270 it is). Chuck it all in at once; do not dribble it in.Stir it with a wooden spoon and keep stirring. It will thicken over the course of 30 seconds.Keep stirring until it becomes sticky and holds together in a lump. The amount of water is critical. When it comes to cooking, I am a natural chucker in of ingredients and hope for the best. But in this case, you must measure.Initially it will look as if you have added far too much water, but keep stirring.
Use your fingers to scoop up a dollop of coconut oil or lard. Use this to grease the baking tin. Your hands will be covered in fat which means you can pick up your sticky dough without it sticking to your hands
Use your hands to shape the dough until it has a smooth surface.
Drop it into the greased baking tin
Spend about 30 seconds doing this. Do not be tempted to knead or fold the loaf or you introduce layers of fat which stop it sticking to itself. This helps prevent the loaf cracking as it rises and cooks (although I have to say it does not matter two hoots if it does. It just looks more professional if it does not!)
Let the loaf ‘rest’ for a few minutes …so it fully absorbs all the water and becomes an integral whole. This is not critical but allows enough time to…
…rub any excess fat into your skin, where it will be absorbed There is no need to wash your hands after doing this – the basis for most hand creams is coconut oil or lard. (Yes, lard. It amuses me that rendered animal fat is a major export from our local knacker man to the cosmetic industry.)
Put the loaf into the hot oven – at least 220°C (430°F) – for 60 minutes Set a timer or you will forget – I always do!I do not think the temperature is too critical – but it must be hot enough to turn the water in the loaf into steam because this is what raises it. I cook on a wood-fired stove and the oven temperature is tricky to be precise with. That does not seem to matter so long as it is really hot. Indeed, I like the flavour of a slightly scorched crust.
Wipe out the mixing bowl with a paper towel. This cleaning method is quick and easy. The slightly greasy surface which remains will be ideal for the next loaf. The point here is that fat cannot be fermented by bacteria or yeast and does not need washing off mixing and cooking utensils. My frying pan has not been washed for over 60 years. I know this because my mother never washed it either.
When the timer goes off, take the loaf out of the oven, tip it out and allow it to cool on a wire rack.
Once cool keep it in a plastic bag in the fridge.
It lasts a week kept like this and freezes well too.It is best used sliced thinly with a narrow-bladed serrated knife.

Fry your freshly made PK bread in coconut oil or lard and add the following for a delicious PK breakfast;

  • 2-3 boiled eggs
  • Smoked fish, tinned fish, tinned cod’s roe
  • Paté or rillette
  • Nut butter
  • Vegan cheese (check the carb content of this) and tomato
  • Coyo yoghurt

This blog was taken from Sarah Myhill and Craig Robinson’s new book The PK Cookbook

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How to cope with IBD at work

How to cope with IBD at work

Sometimes it seems that living with IBD is a full-time job (albeit one with zero pay or benefits!). Time spent at the hospital, recovering from flares and trying to live a healthy life can all add up. Unfortunately, most of us are not millionaires and work is a necessity, and for lots of us a fulfilling part of our lives. Working with IBD isn’t always easy but for the vast majority of us it is possible. However, you may need to talk to your employer and have adaptions made.

 

Be honest

It is very important that you are honest with your employer about your condition and what it involves. IBD, like any chronic illness, is covered under the 2010 Equality Act since it is a physical and long-term impairment (definition of disability under the Equality Act 2010, 2015). This means employers must make necessary adaptions to help you in your role. This could include flexible working hours, access to a disabled toilet or a fridge to store your medicine in. Most employers are accommodating if you talk to them and explain what your condition actually entails (and if this is disclosed at interview, employers cannot discriminate against you in the recruitment process).

 

Be realistic

Many people with inflammatory bowel disease have really high expectations of themselves, which is also reflected in their careers. However, it is important to reflect on your career path and whether it is adaptable to life with IBD. Does it involve lots of travel? Is it stressful? Are you often on the go? Having IBD doesn’t mean giving up on your career dreams but just making sure the job is right for you.

 

Be informed

Reading the paperwork and the terms and conditions that comes with a job is more important than ever with IBD. Here are some things you need to find out:

  • What is the sick pay entitlement?
  • What is the policy for long-term periods of sickness?
  • How flexible are the working hours?
  • If you are working abroad, is medical insurance included and does this include pre-existing conditions?
  • Will you get regular breaks? (This can be easy for office workers; not so easy for those in retail.)
  • Is there the possibility of reduced hours or going part-time further down the line?

Keep records

It may be worth having a notebook to keep a list of any time you have had to take off work for IBD and the corresponding symptoms and hospital trips.

 

My experience of working with IBD

I am a teacher by trade and have taught both in the UK and abroad. In every job, I’ve been honest about my conditions from day one and luckily all my employers have been great. When I was on infliximab, my employers were great at giving me time off to go to hospital appointments and in my previous role I had surgery and the school arranged for me to come back on a phased return. It can be really hard teaching with IBD – I have had days where I felt like I wanted to faint in front of a class – but luckily most of the time I’m fine. In some ways doing a demanding job means I often forget about my symptoms, but I have had to dash out of class on a few occasions. I think this is why talking with colleagues about your condition is so important – it has meant they have been able to quickly step in if needed. Yet over the years, I think I’ve also become more realistic about my teaching career and this year I’ve reduced my workload to three days a week, aiming to spend more time on my health and my writing. I don’t see this as a step down but a necessary adaption to help me live as balanced a life as possible; hopefully I can combine the security of a teaching job with my other passions in life – writing and nutrition.

This blog is taken from Managing IBD: A balanced guide to inflammatory bowel disease by Jenna Farmer.

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Back Pain: Myths and Misconceptions

Chapter 4

Myths and Misconceptions

Back pain, as the statistics demonstrate, is extremely common. In the same way that everybody has a view and advice to give on the best way to cope with and eliminate the symptoms of a head cold, personal experiences of back pain also bring forth theories and guidance without necessarily the professional knowledge to support it. From this inevitably grow myths and misconceptions which, although given with good intention, give rise to a great deal of conflicting information and confusion.
There is also much evidence to suggest that the way in which we overwork our spines and the connecting muscles can do us a great deal of harm. Add this to the many misunderstandings about back care and we not only inhibit our ability to recover speedily from injury, but can also subject ourselves to unnecessary weakening of our back muscles. How to assess the risk involved in a manual task and carry it out safely is more fully discussed in Chapter 8; here I will tackle the most common misunderstandings about what is good and bad for backs.

‘Put your back into it’

Seldom do the sayings and proverbs of past generations convey anything but good sound advice but one such phrase, ‘Put your back into it’, can certainly be misinterpreted. This saying might suggest that increasing physical effort by using enormous force to push, pull or lift something, will help the desired task to be better achieved. It is more likely, however, to have the opposite effect and even give you an injury. Its inference, that the spine is always the strongest part of the body, sometimes leads us to undertake physical effort far beyond our safe capability.

The following commonly believed myths and misconceptions lead many of us to take the wrong sort of action. This is usually at a time when we most need to follow the best possible advice.

‘You should sleep on a hard mattress’

How often have we been enticed to purchase an extra firm ‘orthopaedic’ mattress, believing it to be good for our backs? A mattress that is too hard and does not yield slightly to the contours of our spine can put considerable strain on that small area in the lower lumber region which is left with no base on which to rest. The back muscles, when they should be completely relaxed, are therefore given the work of supporting the weight of the lower organs of the body throughout the night. This can result in stiffness and pain in the mornings. A slightly gentler mattress, therefore, will not only provide consistent support along the length of the natural curvature of the spine, but will aid more restful sleep.

It is important when buying a mattress to take plenty of time to try it out for comfort before making your choice. Lie on the bed. All good stores provide shoe protection on their display beds. Mattresses should be neither too hard nor too soft. Slide a hand under the small of your back and feel if there is a gap. Lie on your side or in the position which you normally find most comfortable at night to establish whether the whole line of your body is straight and will be adequately supported during the hours of rest and sleep. A mattress which sags is equally bad for you. Spending many hours curved like the shape of a slice of melon will mean that you will not only start the next day with a stiff, aching back but with lethargy as well from insufficient quality sleep.
It is a very good idea to try a range of beds from different manufacturers before making your choice. A bed should be one of our most important purchases, especially as we spend almost one third of our lives in bed, so don’t be afraid to be fussy. You will be spending many hours of every day either appreciating or regretting your eventual choice.

‘I hurt my back because I got tired’

One fact which often causes surprise is the time of day when you are most likely to strain your back. It is not always in the late evening when you are tired, but more likely to be in the early morning before the muscles have had time to warm up. The pain, however, may not be felt until later in the day or even when you eventually sit down to rest. Unfortunately, before embarking on household tasks or ‘DIY’ jobs, we seldom consider that we should ‘warm up’ our muscles like a sportsman. It may seem a little extreme to be stretching and carrying out a few exercises before hanging wallpaper or digging the garden, but it can be the difference between a successful day and one which results in misery.

‘I’ve put my back out’

Another misconception is that a sudden, severe onset of back pain is always as the result of a ‘slipped disc’. Intervertebral discs do not just carelessly slip out of position and in fact less than 5% of all back pain suffered is the result of a disc becoming displaced or squeezed between the bones of the spine. The vast majority of back pain is caused by the distressing spasm resulting from over-stretched muscles.

However, if the symptoms appear more serious than just muscle spasm with generalised aching, and involve leg pain, severe immobility or numbness/pins and needles down the legs, then the possibility of a prolapsed disc should be considered. This should be examined by a medical practitioner as the situation requires accurate diagnosis before embarking on any programme of rehabilitation. Very occasionally, as the result of severe trauma such as a fall or sporting injury, a fracture dislocation is possible, but this is a matter requiring urgent medical attention.

‘I need to lie on the floor for six weeks’

At one time, when back pain struck, it was common practice to lie on the floor for perhaps up to six weeks, or to go to bed and stay there until the pain subsided. Although initially rest and analgesics (pain-killers) for a day or two will help to relax the injured muscles and relieve spasm, prolonged bed rest has now been proven to worsen the pain and delay recovery. Walking and gentle exercise should be resumed as soon as they can be tolerated. If the spasm is so bad that walking is too painful, frequent stretching and rotation of your ankles will help to stimulate the circulation to your legs and lower part of your body.
‘I’m too young to get back ache’

A popular misconception held by young and fit individuals is that they cannot harm their backs because they are supple and their muscles well-developed. Although youth and fitness are of enormous benefit, nobody can be said to be exempt from a back injury. A single movement repetitively carried out, such as stooping to polish a car, or maintaining an awkward position, for example, sitting slumped in a chair, can bring about the first signs of weakness.

Contrary to common belief, back pain is not infrequent in 30-50 year olds. This is often a time when poor posture and inappropriate lifting techniques which have persisted during the earlier years eventually reveal a physical weakness in the back muscles. Good practice learned in childhood is the best protection against harm. In later years, although natural degenerative processes are responsible for a slight shortening of the spine, reduced muscle tone and decreased bone strength and thickness, elderly people are less likely to over-estimate their ability to move or lift a heavy item. Young men in particular are often reluctant to ask for assistance with a heavy load, perhaps fearing that to do so may appear weak in the presence of their peers.

‘I hurt my back once, so I know it is weak’

Back problems developed in youth or middle age do not have to be an indication that it is the start of a slippery downhill slide into a world of disability, walking sticks or wheelchairs. Strengthening exercises, improved posture and more accurately assessing the tasks to be carried out, will help to prevent recurrence.

‘If I ignore it, it will go away’

Back pain is not something in your imagination or which can easily be ‘worked off’ by persevering with a strenuous physical task. All pain is real and a symptom that something is wrong. By ignoring the pain and continuing with the activity in the hope that eventually it will go away, will more likely exacerbate the problem and delay healing of the strained tissues.

‘An operation is the only answer’

Unfortunately there is no ‘quick fix’ for back pain. Surgery to the back does not guarantee to cure all types of back pain in the long term. Statistics show that up to 30% of patients may suffer in some way from the effects of the surgery or may not even gain adequate relief from their original backache. Your orthopaedic surgeon will discuss both the need and implications of any kind of invasive procedure to make sure that you fully understand the anticipated outcome of such surgery. He will also want to be sure that all other more conservative treatments have been thoroughly explored first.

‘You can see that I am in pain’

There are very few signs, if any, to the casual observer that someone is suffering from constant, nagging back pain. Recovering from back pain can take anything from a few days to several weeks. This sometimes means that sympathy and patience can wear a little thin, even drawing accusations of laziness or being ‘workshy’. Back pain is not, however, a problem that you have to live with. There are many solutions, appropriate to individual circumstances, including both orthodox medical treatments and alternative therapies, which can be very helpful.

Positive conclusion

Back pain that is not actively challenged is unlikely to be a ‘once-in-a-lifetime’ event. It is important to keep that in mind – it is not a myth! However, when life is back to normal and full mobility restored, the whole event and its accompanying misery may be quickly forgotten. Do not drop your guard – it is a recognised fact that following one episode of back pain, you are three to four times more likely to suffer its wrath again. Therefore, as soon as full mobility has been restored is the time to make the conscious decision to improve your everyday posture and lifting techniques. This makes muscle-strengthening exercises (see chapter 12) all the more important to prevent that recurrence. First, however, we will look at the causes of back pain.

This blog is taken from ‘The Smart Guide to Back Care’ by Janet Wakley.