Tuesday, July 27, 2010

Probiotics Reduce Inflammatory Response of Gluten

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In a very recent study, March 1, 2010, an article entitled “Bifidobacteria inhibit the inflammatory response induced by gliadins in intestinal epithelial cells via modifications of toxic peptide generation during digestion” was published in the Journal of Cellular Biochemisty [2010 Mar 1;109(4):801-7.].
The Spanish researchers utilized different strains of Bifidobacterium, a friendly probiotc found in healthy intestines, to counteract the inflammatory effects of gliadin on intestinal epithelia [cells]. This was an in vitro study meaning that it was done in the laboratory, not in live human or animal subjects.
There are several classic pro-inflammatory markers that the body of a gluten intolerant patient typically produces when exposed to gliadin. However, in this particular study, when cell cultures were inoculated with bifidobacteria first, these inflammatory markers were produced in a much diminished amount. In fact one marker was not produced at all!
This confirms something we’ve been discussing recently and that is the importance of restoring balance to those trillions of microorganisms called the microbiota or probiotics that are responsible for much of the actions of our immune system.  And recall that the vast majority, estimated 80%, of our immune system is housed in the gut.
It is my intention with patients to not only diagnose those who shouldn’t be eating gluten but also to restore the health of the intestines of all patients.  It is not just the gluten intolerant who suffer from unhealthy intestines. In fact, I believe that it is likely that those people who seems to “develop” a gluten intolerance with age may very well do so as a result of the dwindling health of their GI tract.
So normalizing the function of the GI tract could not only ensure the more optimal health of the gluten intolerant patient, but it might prevent its development in others.
Recall that the immune system is the only defense one has against hostile organisms, toxins, and the like.  Ensuring that the immune system is strong and optimally functioning is mandatory for good health. This study confirms that theory well.
It truly only makes sense that supporting the immune system would make the body better to fend out toxic chemicals, which is what gluten is to many.
So please do eliminate gluten from your diet if appropriate, but also get an evaluation of your probiotic population and support that critical population of “good guys” with a human strain of probiotics that suit you best based on the results of your test.
I hope you find this helpful.  Please let me know if I can be of further assistance.
To your good health,
Dr Vikki Petersen                                                                                                                                 Founder of HealthNOW Medical Center                                                                                            Co-author of “The Gluten Effect”

Wednesday, July 21, 2010

How Fruits & Vegetables Create Health

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There’s good news and bad news on the fruits and veggie front.  The good news is that there definitely seems to be increased awareness of the importance of consuming fruits and vegetables.  How do I know this?  More and more commercials and ads are stressing the fact that their food contains a full serving of fruits and/or vegetables. Of course these products are such things as canned meat sauce, sugary cereals and enriched beverages.  Not the best choices but the emphasis confirms that as a society we do know the importance of these foods and marketing companies are playing to it.

I thought I would shed some facts on how to best get one’s daily recommendation of fruits and vegetables, why it’s important and some simple ways to accomplish it.  (Sorry but I won’t be recommending any of the products you see on TV or in magazine ads.)

Whether you’re gluten intolerant or not, I think this particular post has universal benefit for most Americans.  Simply said, we fail miserably in eating our vegetables!

A comment about drinking one’s fruits and veggies vs. eating them: Unless you have a juicer that retains all the fiber and pulp, drinking fruits and vegetables loses much of the benefit found within these vital foods. I recommend drinking purified water, green or white tea but eating your fruits and vegetables.

The United States Department of Agriculture (USDA) states that a serving size for fruit or vegetables is equal to about half a cup. Greens like spinach and lettuce have a serving size of one cup. One serving of sliced fruit is equal to one-half cup; however a single piece of fruit, such as an apple or an orange counts as one serving. How did the USDA decide half a cup being a serving size? It was based on the portion sizes that people typically eat and the nutritional content of fruits and vegetables.

Health experts suggest that depending on our age and activity level we should eat a total of 5 to 9 servings of fruits and vegetables every day. Children, teenage girls, most men and active women should eat at least 4 servings of vegetables and 3 servings of fruit every day – that is 7 total servings. Teen boys and active men should eat at least 5 servings of vegetables and 4 servings of fruit – that is 9 total servings. Unfortunately many people fail to eat even a small fraction of that recommendation.

Fruits and vegetables contain important vitamins, minerals, phytochemicals, antioxidants and fiber. They are usually low in calories as well. Generally speaking, those with the most color -- green, red, yellow, and orange -- have the highest nutrient content. Organic produce is by far the best choice in that they contain the highest quantities of these beneficial nutrients.

The unique substances found only in fruits and vegetables can help provide detoxification, immune support and prevention of many diseases. They are naturally anti-inflammatory which is important in helping to prevent chronic diseases such as heart disease, cancer and diabetes.

Eating at least 7 to 9 servings of vegetables and fruits each day may be less daunting when you see how small one serving is: 

  • 1/2 cup of sliced fruit
  • 1 medium piece of fruit – about the size of a tennis ball
  • 1 cup of leafy vegetables – this would be 4 large leaves of lettuce or the size of a baseball.
  • 1/2 cup of cooked or raw vegetables

VEGETABLE SERVINGS: SIZES

  • Asparagus, fresh - 5 spears
  • Avocado Half
  • Broad beans - 3 heaping tbsp (1/2 cup)
  • Broccoli - 2 large florets
  • Brussels sprouts - 8
  • Cabbage - 3 heaping tbsp shredded, (1/2 cup)
  • Carrots - 1 large
  • Celery - 3 sticks
  • Cherry tomatoes - 7
  • Chickpeas - See Pulses
  • Curly kale - 4 tbsp (1/2 cup)
  • Eggplant - One-third of a large one
  • French beans - 4 heaping tbsp (1/2 cup)
  • Kidney beans - See Pulses
  • Lentils - See pulses
  • Mixed salad - Cereal bowl full (1 cup)
  • Mushrooms, button - 14
  • Onion - 1 medium
  • Parsnip - 1 large
  • Peas, fresh - 3 heaping tbsp (1/2 cup)
  • Potatoes - Never count towards your daily vegetable servings, in any form
  • Pulses, cooked: kidney beans, chickpeas, lentils etc  - 3 heaping tbsp (1/2 cup)
  • Salad leaves, lettuce etc - Cereal bowl full (1 cup)
  • Scallions - 8
  • Snowpeas - Handful
  • Spinach, cooked - 2 heaping tbsp (1/2 cup)
  • Spring onions - 8
  • Sugarsnap peas - Handful
  • Tomato - 1 medium
  • Vegetable soup - 1 serving of fresh or canned soup
  • Vegetable sticks - Handful of mixed - celery, pepper, carrot etc
  • Zucchini - Half a large one

FRUIT SERVINGS: SIZES

  • Apple, fresh 1 medium
  • Banana 1 medium
  • Blackberries Handful
  • Clementines 2
  • Cherries, fresh 14
  • Figs, fresh 2
  • Fruit salad, fresh  3 heaped tbsp, (1/2 cup)
  • Kiwi 2
  • Grapefruit Half
  • Grapes Handful
  • Mango 2 slices
  • Melon 1 large slice
  • Peach, fresh 1 medium
  • Pear 1 medium
  • Pineapple, canned 2 rings
  • Pineapple, fresh 1 large slice
  • Plums 2 medium
  • Nectarine 1 medium
  • Raspberries 2 handfuls
  • Strawberries 7

Healthy Tips for Getting Your Daily Serving of Fruits & Vegetables

 1:  Enjoy fruit for dessert. In season, fruit can taste like “candy”. Eating seasonally not only provides variety, but you can get organic varieties that provide higher nutritional value. Blueberries, raspberries, blackberries, citrus and pomegranate are all excellent choices.

 2: When cooking a main dish add some extra grated or chopped vegetables. Those that will add nutrients and vitamins include organic carrots, zucchinis, broccoli, bell peppers, mushrooms and onions.
 3: When the afternoon munchies hit, reach for a quick but healthy snack. Opt for a small bowl of cherries, berries or apple and a handful of nuts or some nut butter. Or try some of your favorite sliced vegetables with a healthy olive oil and vinegar dressing. A hardboiled egg is another possible addition for additional protein.
4: Eat a few servings of green vegetable every day. An organic dark and leafy green vegetable is recommended. Choose from dark green lettuce, chard, kale, spinach, asparagus, broccoli and cabbage to begin. If you haven’t tried them since you were a kid– give them one more shot. If you sauté or steam them lightly such that they are still bright green and a little firm and top with some organic butter and seasonings, you may be presently surprised. Adding onions, garlic and mushrooms can create a nice flavorful medley.
5: When eating out ask for an extra serving of vegetables. When they arrive eat them first. If there isn’t a vegetable served with the meal, ask for a salad.
6: Keep a bowl of fresh fruits and veggies on the kitchen counter. 
7: If time is a consideration, try the prewashed, precut organic vegetables at the grocery store.

I hope you find this helpful. I truly can’t think of a better health recommendation than dramatically increasing your consumption of these vitally nutritious foods.

To your good health,
Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”

Monday, July 12, 2010

Constipation in Kids Caused by Gluten and Dairy

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Anyone who has had a problem with constipation knows that it’s a miserable experience.  The body is supposed to eliminate its waste products at least once or twice per day in a healthy colon and that elimination process should be easy and painless. What’s worse than being an adult with constipation is witnessing it in your child.

Children can be in pain from constipation plus be fearful of having to go to the bathrooms as they associate the experience with discomfort, thus compounding the problem.

Here in the clinic we’ve always had success treating constipation in adults and children alike. We find the root cause is frequently a food intolerance.  The small intestine is designed to breakdown the food we eat and absorb it into the bloodstream that in turn delivers vital nutrients to all of our cells.  With certain food intolerances, food is unable to be properly broken down and much of it remains in the small intestine due to maldigestion and malabsorption.  This unabsorbed food is then “dumped” into the large intestine creating a problem known as colonic dumping.

This refers to the fact that too much undigested foodstuffs are being “dumped” into the large intestine or colon resulting in a slower rate of transit and thus constipation.

We therefore always begin the diagnostic process with the digestive tract and endeavor to discover what the person may be eating that is not being adequately digested and absorbed. Subsequent to that we also evaluate for infections, poor liver function and imbalanced probiotics.

A very recent study in the American Journal of Gastroenterology, March 2, 2010, noted that the younger a child was when gluten was introduced into their diet, the more likely they were to develop constipation. A population study cited the incidence at 12% for children to develop functional constipation by 24 months of age.

Children who were introduced to gluten before the age of 6 months were more likely to develop constipation (37%) than those who were not so introduced (27%). The correlation was deemed to be significant.

A finding of cow’s milk allergy was also associated with functional constipation of childhood.  However there was no association found between the timing of introduction of other foods such as eggs, soy, peanuts and tree nuts and constipation.

I concur with the findings of this study as we have seen the exact same thing clinically for over 20 years.
The 6 month mark is one that has come up in several studies. Waiting beyond 6 months allows for a more mature immune system and is highly correlative of increased risk for celiac when not honored.

Personally, in addition to waiting a 6 month minimum, I would assess for a family history of celiac, gluten sensitivity and any autoimmune history before introducing any gluten to a child.  To be on the safe side I would likely wait closer to one year in a child with no obvious risk factors plus be extremely aware of any negative reactions to the initial introduction. Often we are too quick to dismiss tummy aches, runny noses, itchy skin and crankiness as “normal” when the body of a sensitive child is using those exact symptoms to communicate its distaste for a newly introduced food.

Constipation is not only very uncomfortable but it’s a sign that dangerous toxins are remaining in the body too long.  It does have long term negative effects but fortunately it is not difficult to handle.

I hope you find this to be helpful.  Please let me know if I can assist you in any way.

Also please check out my YouTube video on this subject.  YouTube

Yours in health,

Dr Vikki Petersen

Friday, July 09, 2010

Negative Lab Tests for Celiac

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The following question comes from a student studying nutrition.  My book “The Gluten Effect”, as well as a lecture that I presented to the students is part of the curriculum at Hawthorn University.

"I just completed the Understanding Gluten Intolerance and Preventing Celiac Disease course through Hawthorn University.  Your book and lecture through Hawthorn were so informative.  It seems as if you have the most up to date information on this topic-more so than many other books, articles and websites out there.

My question is about diagnosis of Celiac Disease.  What if someone has not had any tests or their tests were negative, yet a gluten elimination diet has improved their symptoms?  They may have celiac but without the diagnosis of villous atrophy through an intestinal biopsy, it cannot be proved, is this correct?   Is the diagnosis of celiac that important, if the patient knows that they are sensitive to gluten?

One of my concerns is that given our current health care system, many people barely see a doctor and when they do, it seems unlikely that the doctor would recognize symptoms as being related to gluten sensitivity. Is suggesting an elimination diet the best way to determine gluten sensitivity or celiac, in the absence of proper health care?  It seems as if a patient who responds well to a gluten free diet might be likely to acknowledge that gluten is problematic for them if the diet shows promising results."

I think this student really cuts to the heart of the matter where we are failing so many millions of people in our country.  It is quite true that most doctors do not recognize the symptoms related to gluten intolerance.  All too many clinicians are stuck in the model they were taught as students that labels celiac disease as a disease causing extreme weight loss, severe diarrhea and digestive pain.  If they don’t see those particular symptoms, most will not consider gluten intolerance as a potential diagnosis. 

While I haven’t conducted a study to this effect, I would wager based on the vast number of people who contact me from around the country, that most patients are diagnosing themselves and then trying to encourage their doctor to corroborate what they suspect.  All too often I hear from these frustrated individuals who have proven to themselves that gluten is an enemy to their health but they are unsuccessful in getting their doctor to order any tests to confirm whether it is celiac or gluten sensitivity.

It is a double edged sword and both sides can cut deeply.  First we have the desire to diagnose celiac definitively as it is a serious autoimmune disease linked to other autoimmune diseases as well as cancer.  Would we like to identify every celiac?  Of course!  But as our student so correctly points out, all too often testing is negative despite the person feeling better on a gluten-free diet. Whether it’s a blood test (tTG or deamidated gliadin) or intestinal biopsy, the problem is the lack of sensitivity of available testing. I am hopeful that the future will bring labs that are highly sensitive for both celiac and gluten sensitivity, allowing an early diagnosis for one and all.

And now the other side of that sword - what should we do in the meantime?  I feel very strongly about this point and I know that traditional gastroenterologists disagree with me.  But my viewpoint is not a research-based one, but rather a clinical one.  In other words my sole interest is in the patient’s health and improving it as rapidly as possible.  That cannot be done by encouraging someone to continue eating gluten simply because the test was negative or because their symptoms don’t fit the model of what one thinks celiac “looks like”. 

Might they have celiac but it just hasn’t been identified yet? Do they have gluten sensitivity?  Does it matter which? There’s the debate in a nutshell.  But I come back to the patient.  Could I ever possibly recommend that someone continue eating gluten when they have a negative response to it?  Never. My concern is that during the time frame of continued gluten consumption the body might break through the threshold of beginning an autoimmune disease or cancer – a threshold that is almost impossible to come back from.

This concern is based on clinical experience.  Too often I’ve seen the gluten intolerant patient go back to consuming gluten and then develop a serious condition that couldn’t be reversed.  I wouldn’t wish that for anyone.  And the frustration of having this happen because a gastroenterologist insisted that a known gluten intolerant patient restart gluten consumption for 6 weeks in order to be able to perform an intestinal biopsy, is beyond my tolerance.  Usually these patients crawl into their GI’s office after 1 to 3 weeks begging them to do the test early because they feel so horrible.  And when that gluten ingestion results in the development of a serious secondary disease it is very sad because it was all so preventable.

There is genetic testing available but that isn’t foolproof either.  Genetic testing for HLA-DQ2 and DQ8 only rule out celiac and there is no agreed genetic profile for gluten sensitivity, though some are currently working on it.

I do initially recommend a comprehensive blood test that evaluates both for celiac and gluten sensitivity in a person currently consuming gluten.  Certainly if either test is positive then we have our diagnosis.  And it does seem to be the case for many people that having that piece of paper from the lab showing a positive result helps with compliance. But if the tests are negative or borderline I still recommend a gluten-free trial for 30 days due to the aforementioned lack of sensitivity.  The true gold standard test is this dietary one. The body won’t lie.  If you completely eliminate gluten and you feel better, you ARE gluten intolerant – end of story.

Lastly I believe we also fall down in our lack of education of our patients.  It if for this reason I write this blog, and tape YouTube videos – it’s all in the name of education.  If someone is diagnosed with gluten intolerance and they are not educated to the dangers of cheating and exactly how gluten can cause ill health, they will most certainly lapse on their diet to one degree or another.  I strive to keep that education as comprehensive and easy to understand as possible for just that reason.

I hope you find this helpful and please let me know if I can be of further assistance.

To your good health,

Dr Vikki Petersen




Friday, July 02, 2010

Antibacterials and Leaky Gut

We all grew up with the warning to "wash your hands", "keep your body clean" or some variation on the theme. The message was easy: Clean was good, dirty was bad. With that as our foundation no particular red flag was raised when more and more antibacterial products hit the market. A wide array of products including toothpaste, deodorant, soap, clothing, furniture, cosmetics, toys and the like are available with a total of more than 700 antibacterial products currently on the market.
Parents have grown more concerned about dirt as it regards their children's health and safety. The concern is no doubt fostered by the many commercials showing enlarged bacteria on the TV screen that are shown to be lurking on countertops, bathrooms and children's toys. One begins to wonder how any of us survived prior to these "life saving" antibacterial products.
It just makes sense that killing these evil microscopic beasties would be a good thing doesn't it? On the face of it, it does make sense; the facts however state otherwise.
Let's take a look at some factors:

1. Antibacterials kill "good bacteria"

Antibacterial cleansers suppress the immune system. The body's ability to protect itself from offending organisms is in part predicated upon maintaining a balanced microbiome with plenty of health-promoting good bacteria from probiotics.

In order for our GI tract to protect us from pathogenic organisms and remain healthy and strong itself, it must ideally contain about 85 percent good bacteria. Unfortunately when you use an antibacterial cleanser, you're killing good and bad bacteria.

When you kill the good bacteria you have weakened your immune system and put your GI tract at risk – the exact opposite of what we need to do.

Perhaps it's better to wash more frequently with hot water and regular soap than to weaken our immune system.

A common chemical used in antibacterial products is triclosan. Scientists worry that bacteria that become resistant to triclosan will also become resistant to antibiotics. Triclosan, by killing normal bacteria, creates an environment where mutated bacteria that are resistant to triclosan are more likely to survive and reproduce. Laboratory studies have found a number of different strains of mutated bacteria that are resistant to triclosan as well as certain antibiotics.

2. Resistant bacteria are being created that antibiotics can't kill

The reality is that all these germ-killing products may end up leaving us even more vulnerable to infection, says a Tufts University microbiologist. Similar to the concerns over using antibiotics too much, the worry is that overuse and misuse of these antibacterial products will kill off good bacteria and weak bacteria, leaving only the strongest and most resistant bacteria behind.

Antibiotic resistance has become an increasingly serious problem worldwide and the link to antibacterials may prove to be very significant.

3. Hygiene Hypothesis and development of allergies, eczema and asthma

"The image that germs should be destroyed, and kids should be raised in a sterile home is a mistake. If we over-clean and sterilize, children's immune systems will not mature," says Dr. Stuart Levy, the director of the center for adaptation genetics and drug resistance at the Tufts University School of Medicine in Boston. He says recent studies have shown an increase in asthma and allergies in homes that are overly clean.

The "hygiene hypothesis," theorizes that there is a correlation between too much hygiene and increased allergies and asthma. This hypothesis is based on studies that have found an increase in the frequency of allergies, asthma, and eczema in persons who have been raised in more sterile and hygienic environments. In one study, children who grew up on farms had fewer allergies than did their counterparts who did not live on farms.

Levy says the only place for antibacterials is in caring for the very ill whose immune systems are compromised. He recommends that hospitals only use them around very weakened patients.

People should clean with chlorine bleach, hydrogen peroxide or alcohol, he says. While these products can also be considered antibacterials, Levy says once you have cleaned with them, they are gone. Newer antibacterials, however, leave behind a residue that continues to kill bacteria for some time after you use them, which doesn't give good bacteria a chance to reestablish themselves.

4. Antibacterials not effective in normal household – Efficacy Questioned

According to the American Medical Association, "Despite their recent proliferation in consumer products, the use of antimicrobial agents such as triclosan in consumer products has not been studied extensively. No data exist to support their efficacy when used in such products or any need for them. . . may be prudent to avoid the use of antimicrobial agents in consumer products."

Further, a study of over 200 healthy households found that those households that used antibacterial products did not have any reduced risk for symptoms of viral infectious diseases. The Centers for Disease Control and Prevention says that antibacterial soaps are not necessary in everyday use, and washing hands with ordinary soap and warm water is an effective way to ward off infections.

5. Triclosan can cause hormonal imbalance

A Swedish study found high levels triclosan in three of five human milk samples, indicating that the chemical does get absorbed into the body, often in high quantities. Triclosan is also able to bioaccumulate in fatty tissues.

Concerns over triclosan interfering with the thyroid gland's hormone metabolism led to a study that discovered triclosan had a marked hypothermic effect [lowered the body temperature], and overall caused a "nonspecific depressant effect on the central nervous system" of mice.

Research also shows that antibacterial soap can change the hormonal makeup of human and animal cells in laboratory tests. University of California, Davis scientists found that triclosan "increased gene expression that is normally regulated by testosterone," and caused glands that rely on testosterone, including the prostate, to grow larger. As a result, the scientists concluded that antibacterial soap is an endocrine-disrupting substance [it causes hormonal imbalance].

On April 8, 2010, the FDA announced a formal inquiry into the safety of triclosan. It announced its review after queries from Rep. Edward J. Markey, chairman of the House Energy and Commerce Committee's subcommittee on Energy and the Environment. In a letter the FDA said it shares Markey's concern about the potential effects of triclosan and triclocarban as "endocrine disruptors" that can adversely affect the function of hormones. Evidence of these effects emerged since 1994, the last time the FDA last addressed the use of triclosan in consumer products. The FDA is unsure of triclosan's impact on internal organs, but laboratory animal tests show distortions in thyroid hormones. Infertility was also evident, as levels of testosterone and estrogen in the body were diminished.

The agency said its safety review would take about a year. It is also writing a proposed rule that could potentially limit use of triclosan in consumer products, but couldn’t say how soon the rule would be finished.

For now, it added, it doesn't have evidence that triclosan in antibacterial soap offers a benefit beyond soap and water.

And if all of the above "good news" wasn't bad enough…

6. Triclosan transforms into Dioxin

There have been a number of concerns about triclosan and its link to dioxin. Dioxin can be highly carcinogenic and can cause health problems such as weakening of the immune system, decreased fertility, altered sex hormones, miscarriage, birth defects, and cancer.

Triclosan is listed as "could be" and "suspected to be" contaminated with dioxins in the EPA's Dioxin Reassessment. In addition to being formed during the manufacturing process, dioxin may also be formed upon incineration of triclosan . Researchers who added triclosan to river water and shined ultraviolet light on the water found that between one and twelve percent of the triclosan was converted to dioxin in the water, leading to fears that sunlight could transform triclosan to dioxin naturally. An even more serious health threat may stem from treatment of triclosan-tainted water at water treatment plants -- sunlight could convert chlorinated triclosan into highly toxic forms of dioxin.

Well, that is quite a lot of data to take in, I know. I researched many sources to find current data that covered the many facets of health and safety that are potentially affected by these substances. I hope I have presented a compelling argument against their use. I truly don't think we need to wait until the FDA bans their use. How much damage could occur in the interim?

If your child's school uses these products, show them this article. If you have many such products in your household consider getting rid of them. This isn't a hygiene issue, clean is still good. It's how we achieve clean that is a matter we must reconsider. Good old fashioned soap (with no antibacterials present), water, alcohol and hydrogen peroxide do the job just fine with no nasty side effects.
Please, please share this data with friends and family and, as always, let me know if I can be of any further assistance.
Also check out a video of Dr Vikki Petersen speaking on this topic.
Antibacterials and Leakey Gut

Yours in health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co Author of "The Gluten Effect"