The Trouble with Burning Out...

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One of the commonest things we see at the clinic is burn out. Also known as adrenal fatigue (not recognised in conventional medicine). When presented to your regular doctor, most people are given a sick note to take time off work; antidepressants is a common crutch plus the advice to take it easy.

“Take a holiday!”

Easier said than done. After all, in today’s world, one big cause of burnout is overworking and money constraints. So taking time out is quite a tough option. Especially if you are the responsible type and understand that by you taking time out, others get the brunt of your workload. Not an ideal situation. This is worse when the buck stops with you.

So, does traditional management work? Yes, certainly to an extent. Rest is highly important and time away gives one the right perspective and a better ability to prioritise. It also clears the mind and hence performance is enhanced. So you end up working smarter, not harder. Most people notice that their performance and work enjoyment increases after a break.

What about antidepressants? This does make a difference. I’m not a huge fan of it but nevertheless, there is a place for it. Especially when burnout causes other symptoms like raised anxiety, difficulty falling and maintaining sleep; anger, depression and a feeling of helplessness or lack of control over one’s life. To boil things down to the very basics- antidepressants numbs a person. This means that nothing feels as bad as it potentially would. This is a very useful crutch and should not be underestimated. It buys time until your body has healed enough to take over. The danger is a reliance on antidepressants for too long.

So what is it that we do, as functional and hormonal practitioners, that make our approach different from conventional medicine? The clue is in the underlined sentence above. We go to the root of the problem and help the body heal itself; therefore speeding up recovery. I also use this approach to prevent getting to a burnt out state; or in some extreme high stress situations, to delay getting there (not ideal but life is life).

We deal with the ‘burning out’ of the adrenals, which are small glands above the kidneys that release the hormones adrenaline and cortisol amongst others. A normal reaction of stress hormone (cortisol) release is excessive production when you are stressed, to cope with the increased demands on the body. When this happens consistently over a prolonged period of time, something happens. The body now goes into a state where it cannot produce enough cortisol to meet demand. At this point, you now start producing too little cortisol, contrary to popular believe. During a burn out, you produce too little to be useful. This is when you feel the need to crawl under the duvet, turn the lights off, sleep or to try to sleep and shut the world off. This is the body’s way of trying to heal the glands, so that it is able to once again produce cortisol in the right quantity to deal with your body’s needs.

This phenomenon happens to other glands too- the most commonly known of which is the pancreas which produces insulin. Early stages of diabetes signifies a problem with too much insulin release. These people need tablets to manage their sugar intake and keep their insulin low. Late stage diabetics need insulin injections. Because they now have the opposite problem where the excessive demand on the gland has caused it to burn out and the body can no longer produce enough insulin to meet demand.

We manage adrenal fatigue or impending fatigue with the right adrenal support and hormones where necessary. This will be covered in another blog. We also educate our patients so that they can see the signs and know when to self manage because that it the end goal- for you to understand your body to such an extent that you can read what your body is trying to tell you.

One problem with this, and the reason for writing this blog, is that when we most need help is when we are at our highest point in stress and time constraints and when we are most liable to forget these principles. We forget to utilise the support. I see this again and again. This blog is a reminder that when things get tough and you need a little guidance and for someone else to steer the boat- reach out for practitioners such as ourselves. We are in a position to help your body help itself. Don’t get to burn out. Its really not worth it. It takes a really long time to heal once you’re burnt out. Don’t do that long run or that very tiring HIIT session. Just rest, be lazy, day dream, order take out if need be (short term only) and allow yourself to just be. Which reminds me, I need to take my adrenal support now….

Vitamin C – The Revisit

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I have had to come back to discuss vitamin c following the August 2017 article Vitamin C – What else does it do for us? as a result of consultation queries which warrants a universal response and obviously, restriction in word limitation given for my last vitamin c topic.

In this article, I will try to further emphasize and keep in mind the relevant clinical outcome instead of the biological explanations behind vitamin c’s effectiveness on health. Whilst there isn’t a surge in vitamin c deficiency in the United Kingdom, it is worth appreciating its influence or response when one is unwell.  

The 4 most common questions I have come across in our clinic since August 2017:

  1. What is the maximum dose of vitamin c I can take in a day?

  2. When is it important to consume vitamin c?

  3. Do I have to get intravenous injections all the time to acquire more vitamin c?

  4. Does vitamin c treat common colds?

These answers to the above questions exist, but I feel that we need a legislated update for the good of mankind. My responses are:

  1. The UK recommendation is 80 mg per day, which is about an orange and a half. However, some cases of chronically ill patients have taken doses up to 50 grams safely, under the supervision of trained clinicians.

  2. It is a daily recommendation, therefore, its recommended you take that minimum a day. When unwell, I would like to suggest that more should be added to one’s diet.

  3. No, you don’t necessarily have to have injections all the time. You can acquire more through eating foods with vitamin c, particularly fruits and vegetables. Unless there is a clinical diagnosis of malnourishment/deficiency, inadequate or unsafe oral intake, food can’t pass through the intestines or there is malabsorption syndrome.

  4. As it stands, the answer is unclear, however, what we currently know is that vitamin c does not decrease the average incidence of colds in the general population, yet it halves the number of colds in physically active people.

I feel vitamin c is just as an important nutrient as the others and contributes to one’s wellbeing. In an ill patient, it has an important role to play and clearly, the traditional “low doses” are useful, but to what degree? Some controlled trials have found statistical dose-response for the duration of the common cold symptoms, with up to 6 – 8g/day of vitamin c. Other studies have even found that vitamin c prevented and benefitted patients with pneumonia and may alleviate respiratory symptoms caused by exercise. This doesn’t mean it treats it, but obviously warrants further investigations and possibly changes in recommendations of vitamin c intake.

Secret Behind Off Label or Unlicensed Medications

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As a private practice, we are frequently approached by patients who require certain medications “off label” or “unlicensed”. This can sound quite scary for the average person who is deciding to undergo this route or for carers of the patient who may be nervous about what this may entail.

Here's a little background on these off label medications....

Every drug is developed and tested for treating certain conditions. Clinical trials are conducted and the drug is deemed “safe” to use for its intended purpose. Occasionally, the initial purpose a drug is being developed becomes null and void when one of their “side effects” then becomes the more interesting feature of the drug. A good example is Viagra. Viagra was originally developed to treat high blood pressure and angina (chest pain). Its side effect- causing erections- became an unexpected and highly lucrative venture for the manufacturers. Another good example is Botox- initially developed to treat facial tics and spasms. When they had a side effect of decreasing wrinkles, this became its main and highly lucrative use.

Pharmaceutical companies are then allowed to patent the drug for a certain number of years. This is to allow them to claw back their investment in research and development that has gone into making those drugs. It is also to enable them to make a profit- they are a business after all. This system works well. If you consider the number of drugs that don’t make the cut for human use- which translates into millions of dollars of lost revenue for the drug manufacturer, its only fair that the risk they take gets rewarded when one of their experimental drugs do work.

So let’s say that viagra was indeed licensed for high blood pressure. Now according to the medical guidelines, we as doctors, should only prescribe them for that purpose. But we are highly trained and frequently have to use our judgement in every individual case to decide the best course of action for that particular person. Guidelines exist for a reason but at the end of the day, the reason our job is not done by a computer is because of the human quality, experience and instinct that we are able to hone over the years- that beats the computer. This means that I can now decide that for my patient with an erection issue, I can give him viagra in a suitable dose to help with his erection, but not any blood pressure issues (which he may not have). That would be a classic off label use of a drug.

Some examples of off label use medications are low dose naltrexone, clemastine, various hormones, aspirin, cholestyramine and metformin amongst others.

Now lets say that a drug that has been long approved and deemed safe for a purpose has now been found to have another use. A good example is LDN (low dose naltrexone). Initially developed for addictions, it is now used in a very low dose for immuno-modulation amongst other things. This benefit has been stumbled upon. Our challenges as practitioners are listed below:

  • Someone needs to inform other practitioners about this

  • Other practitioners may well be quite sceptical as there are no large trials to “prove” this fact

  • Big pharma are not very interested in conducting large trials. These things cost money and since the initial drug has already lost its patent, there’s no money to be made.

  • So its up to individual practitioners, happy patients and word of mouth to get the word out

  • There are risks and we know it. And there’s a lot we don’t know regarding potential side effects, other uses, risks and benefits. But we’re willing to take the chance and happy to monitor closely

  • In an ideal world, we will all do research and audits on all our patients. Sample sizes will be small but something is better than nothing. However, this does mean tons of paperwork and potentially increase in staff size which unfortunately translates into increased costs for the practitioner. One reason why there are so few trials for off label medications. Its simply a few good doctors and too much work.

  • We as practitioners, also take the risk of being thought to be unsafe by fellow doctors who may not understand our reasons for going off label. This is a big issue and concerns us gravely as it can lead to suspension of our practising privileges.

I hope that this article puts things into perspective a little so that it can be more clearly understood where we- as practitioners- stand when we take the decision to use an unlicensed medication and so that you- as a patient or carer of a patient- will be able to make an informed decision as to how to decide if its the right option for you. It will probably mean more paperwork as we try to safeguard ourselves, we may ask you to participate in trials and we may even ask you to volunteer your time to help us analyse data and eventually make things more available in the future.

Do let us know if you would like to contribute anything at all ie ideas, time, money to help towards pushing these ideas forward. We have recently registered our charity Fighting Chance Foundation. But I envisage that its going to take quite a long time to get anything going mainly due to lack of time and staff at present. We would however, love to hear from you and know that we have some support.

Benefits of CQ10 – Another Antioxidant?!

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When patients ask the benefits of Coenzyme Q 10 also known as Ubiquinone, it is easier to explain the lexical meaning, however, a brief explanation on the deficiency causes and the reasons of supplementing it when or if needed is just as important.

The causes of deficiencies are suggested to be genetic, lack of nutritional content, oxidative stress caused by free radicals and ageing.

Three key CQ10 Benefits:

  • It is a powerful antioxidant, which regenerates Vitamin E, another critical antioxidant.

  • Hunts the bad free radicals and prevents cell damage to proteins, fats and other molecules.

  • Essential for the proper functioning of the energy production in the cells.

Whilst I have mentioned only the 3 benefits above, we know it that it has been proposed for use in patients with Type 2 Diabetes, Mitochondrial Diabetes, treatment of hypertension and statin- related myopathy.

Why CQ10 now?

Ubiquinone has always existed and important for the proper functioning of enzymes in our body. It’s name describes best its availability within us. It is ubiquitous, meaning it is found everywhere. I guess when science publishes consistent interesting findings of wellbeing to mankind; a social media trend tends to follow, maybe the same thing with CQ10.

If it’s everywhere, then do we need it?

Yes, we need it. Like everything else in our diet, there should be a recommended daily allowance that we should take, which hasn’t not yet been established for CQ10. However, we do know that doses ranging from 50mg – 1200mg have been used safely in adult studies. The higher doses being suggested for ill patients, from neurological disorders to cardiac disease statin users. And the lesser for the general wellbeing. It would be wise to discuss taking this supplement with your practitioner.

From my own personal opinion which is evidence based and users’ feedback, CQ10 is thought to be generally safe, with no adverse side effects reported when appropriately taken.

10 Little Known Vitamin D Facts

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To commemorate this day, I thought I’d share some interesting Vitamin D facts that are not so commonly known…

 

  1. Vitamin D is not technically a vitamin. Vitamins have to be consumed as they cannot be created in the body. It is better classified as a hormone. Or more accurately, a pre-hormone which has to be converted to its active, hormonal component

  2. It regulates the activity of over 200 different genes

  3. You don’t get much Vitamin D from dairy. The main reason is because animals, just like people, need sunlight to make Vitamin D. So if you eat mainly intensely farmed animals and their milk products, it won’t be high in Vitamin D. Look out for free range, grass fed animals. One good example is Kerrygold butter which claims to be from grass fed animals

  4. Lower fat foods fortified with vitamin D won’t be as good as full fat products. Its a fat soluble vitamin and as such, being delivered in a fattier format aids absorption

  5. Obesity is associated with lower Vitamin D levels. The hypothesis here is that the Vitamin hides out in the fat cells. Would be interesting to see more research here

  6. Most Vitamin D rich foods are from an animal source. Hence, vegetarians and vegans need to pay extra attention to supplementing with Vitamin D

  7. Tanning beds can help raise Vitamin D levels- but we are not advocating it!

  8. Darker skin tones or skin that tans easily make less vitamin D compared to paler skin. This is probably a necessary adaptation due to migration of our ancestors into colder regions with less sunshine. In fact, darker skin tones may require 3-6 times more time in the sun to make the same amount of Vitamin D compared to paler skin tones

  9. Older people make less Vitamin D. There may be a few reasons for this. Its believed that absorption may be poorer in older skins. The body also is less efficient in converting it to its active form. Another reason could also be that older people don’t go outdoors as much

  10. Sunscreen with SPF of 30 effectively blocks out UVB rays, hence indirectly reducing Vitamin D production by up to 95%. This piece of info was gleaned from the Journal of Clinical Endocrinology and Metabolism 2011.

 

Hope this has given you some food for thought. I personally recommend a Vitamin D shot into the muscle 4-6 times/year for paler skins and 6-8/year for darker skin tones; spaced out more during summer months. Some people prefer taking higher dose Vitamin D orally. I personally prefer injections as they are easy to administer and receive. Plus I don’t have the hassle of having to remember to consume them. For me, I always know when I’m running low on Vitamin D when my temperature regulation goes out the door. Cold feels too cold and hot feels too hot.

 

This reminds me, I think I’m due for my winter shot now….

What Should I Eat?

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Having joined Harpal Clinic in March 2017, it was made clear that in addition to on-going patient care; we also aim to educate our patients, which I have always strongly believed to be fruitful for a healthy lifestyle.

 


I was asked to write interesting, cultivating material, but this has been hard, as I have been strongly trained to write scientifically, methodically and mathematically.  

I have tonnes of issues I would like to share, but this question is raised time and time again by our patients “I have tried everything, what should I eat?”
Even with years of studying and working in the health industry, I have had to sit back and ask myself the same question.

The issue in itself is broad, somewhat, a silly question a clinician should be asking themselves. One would expect this to be a straightforward answer, but it isn’t. Personally, shopping for my weekly food in any London shop for me is like a mental challenge, deciding the shop, trolley or basket, which aisle to start with (even with a shopping list) and what to buy. After jumping that hurdle, the next thing is reading the food labels which I would guess, maybe 3 out of 10 shoppers would know the nutritional definition (without searching Google) and benefits of what they are about to consume.

Commonly, dietary factors have been associated with the cause or prevention of many diseases, including coronary heart disease, hypertension, cancer, birth defects, osteoporosis, and a variety of other chronic diseases. These associations are derived mainly from animal studies, epidemiologic studies on people and basic research concerning potential mechanisms. To simply break this information down to the general public, interpretation is often difficult and most of the times, conflicting. In light of this, what or who should you believe in?

In the age we live in, where there is a surge in Google Diagnostics with a dose of Twitter and Instagram guidance, people will always have a prognosis and diagnosis of their health concerns, what’s causing certain pains and if not in pain, how to get optimal health. Before I forget, despite of the NHS waiting times and your GP refusing to refer you to a Nutritionist/Dietician, stick to you GP’s and/or professional healthcare advisors advice. Put the Apps aside during consultation and respectfully discuss your issue. Yes, there are hundreds of Apps giving us advice on what to eat, but the concern here is, do you trust your source of information and do you trust what you are being told?

I do not condone the use of Google to search, “what am I eating tonight”, but I do worry about the toxicity of the content of some answers we are fed. As a modern day Google user, I am going to put a very reliable link at the end of this script, where I know the benefit outweighs the risk.

Without having to exhaust myself on calorie content, protein, carbs and sugar definitions, I may not have the exact answer but I am a firm believer of “you are what you eat”. I have taken a different approach, ignored the calorie and nutritional content and try to pick more of the fresh unrefined/unprocessed vs. refined/processed foods, consume your own hand-size portions, semi-caveman thinking. Keep it balanced. Simple.

Whilst using social media – think consciously about reliable sources of information. The link I promised below is this one: http://www.cgem.ed.ac.uk/research/rheumatological/calcium-calculator/ which I will discuss very soon.

Why Some Vegetarians or Vegans Thrive and Others Fail

I’ve started seeing more and more people coming in for injectables and intravenous drips like Vitamin B12, B Complex, high dose Vitamin C, glutathione, Magnesium, amino acids and D amongst others. However, new Vitamin B12 patients far outnumber the rest and many of them are vegetarians or vegans. Many of these patients have also chosen to eat this way later in life ie teens or later. There is a great deal of awareness within this community and they choose to eat this way, accepting that they need to do more to counter the potential nutritional shortfalls.

Surprisingly, I don’t see many who are born into vegetarian families (due to religion or culture) where they have eaten this way for generations. This suggests that they either are relatively unaware (I somehow don’t think that this is the issue), or that they are more ‘adapted’ to this way of eating. My believe is that epigenetics is at play here.

 

Coming from a culture where I’m familiar with vegetarianism for religion purposes, and knowing what I do now about some problems that vegetarianism brings about; this article that I’m about to share has always been a question in my mind and something that I’ve been meaning to explore. It’s so well written and researched that I don’t need to add much to it besides introducing you to the writer of that blog post and giving you my 2 cents about it.

 

The article discusses 4 points and is written by Denise Minger. Denise’s blog site https://rawfoodsos.com/  went viral after she published her findings regarding the China Study, which is possibly the most famous pro-vegan study out there. Her quest started when her usually perfect teeth was found to be full of cavities despite doing everything by the book to stay ‘healthy’. Being a naturally curious sort, she delved into the China Study and actually took the trouble to analyse the data. There she found many discrepancies which sadly enough does happen in the scientific world where data is ‘tweaked’ to fit in with the original hypothesis. Her work is relevant and needs to be read.

 

My personal opinion:

  • Veganism does not suit everyone

  • If this is how you choose to eat, do take extra care to ensure that you are getting all the relevant nutrition (possible from plant sources eg seaweed, natto, marmite etc) and constantly be on the lookout for symptoms of deficiencies

  • If you have indigestion, increased acid reflux, gas and bloating or prone towards soft or hard stools, you probably have some gut issues. This means that absorption of nutrients won’t be as good

  • If you constantly take antibiotics or have done so in the past, your gut bacteria may be deficient; again potentially leading to problems with gut nutrient absorption

  • Every so often, consider injectables as it won’t get lost in the gut.

  • If you already have symptoms, consider a course of injectables initially more frequently (eg weekly or fortnightly depending on which nutrient) before you taper it off. This is to allow your body to heal to a point where you won’t go back to ‘baseline’ so quickly. There’s also the problem of getting used to a certain level of energy. Most people with very low energy levels can never figure out how others go on. They also tend to be very happy with every little uplift in energy; forgetting what its like to have full functional energy. I just don’t think it makes good sense when cumulative additional changes make such a huge change in a person’s health. The time to stop would be when you start seeing negligible results. That usually means that you’re either optimised or if you’re still tired, that there is another reason for it.

 

I hope that you will enjoy this article…..

https://authoritynutrition.com/4-reasons-some-do-well-as-vegans/

 

Vit D- My Unbelievable Labs

This is a slightly more personal blog post as I’m still a little flustered about it.

 

I’ve been taking patient’s bloods and interpreting their labs for a long time now. My personal health, alongside my patients, has increased leaps and bounds (I do take a bit of my own advice!!). I have good hair and glowing, clear skin, good gut and good energy levels. On the whole, I’m in a pretty good place. Recently, I had the opportunity to get my blood drawn and decided to see what my labs look like.

 

Results came back and most things were as expected, except for my Vit D which was below normal. This annoyed me that the labs would make a mistake. So we called them up and asked them to retest it. I had had a Vit D injection, the whole 300,000 IU of it, just a couple weeks before. The results were clearly a lab error.

 

They retested it and it came back still in the red- very, very low, but a different number to before. This got me thinking. I’ve been raving about the benefits of Vitamin D to all my patients. I’ve asked them all to get an injection as I’d personally seen the benefits in myself and my patients. What was going on?

 

In 2015/2016, I’ve probably had 4-5 injections of Ergocalciferol, or Vit D2. Each time 300,000 IU. I haven’t taken any extra supplements at home. I went on a 2 week outdoorsy holiday in July/August and still have the tan from it now (November). The first injection was a life changer. I was extremely hot the night of the injection. Next day, I was bouncing. Similar but not as dramatic improvements with the next few injections. I needed very few clothes compared to others, could handle cold more than others (no coat in summer and only lightweight coats in autumn versus others who needed much more). In fact, I still go out with bare legs now.

 

My symptoms which made me think that I may be low in D again:

 

  • Energy levels were good but I started to find it slipping

  • I wasn’t recovering from night outs as well as usual

  • I also started noticing quite significant hair loss

  • My skin was simply not as smooth and blemish free as before. It was also duller

  • More importantly, I felt colder than I thought I should be feeling

  • I was feeling too hot or too cold suddenly- temperature regulation wasn’t right. This was a classic red flag for my own body and I recognised it

 

After my last injection, once again I didn’t feel the cold that much and temperature regulation improved. Energy levels came back but I was still more tired than usual. Yesterday- after the shock of my horrendous results- I had another D shot. I slept very well at night. Hands and feet are still cool but not cold. I feel good and fresh. I’ve had a birthday since with wonderful friends and parties for most nights of the week last week. And I’m still up and raring to go.

 

What hits me is that despite doing this for a living, I was oblivious to how low my own levels were. It must have been dangerously low when I first did a D shot. I come across as being bouncier and more energetic than most people. Even I realise that I’ve higher energy levels than others. So where does that put others? I think personally, because I make sure I’m balanced in other ways, it has not been obvious that I was so deficient. But its a cautionary tale nevertheless and I know that I will be making much more efforts to get myself tested more regularly and to make sure that I’m optimised nutritionally. Since my body cannot seem to make enough from all the sun I get (more than many others and usually without SPF on my body). I will also look into simpler and more cost effective ways to test for it so that patients can get themselves tested without too much effort. Watch this space…..

FYI, we have now introduced many more injectable services like our B cocktail (B12+B Complex), C, Magnesium, Glutathione etc as an injection or an intravenous push (for larger volumes). Do check our website more for info. My patients seem to love it as they keep coming back, despite the slight ouch!