Adapted from Human Givens Vol1 2013Journal of Health Psychology 2013.
Facial expression is the best way to communicate to health care professionals if you are in pain and how severe the pain is.
Patient vignettes were assessed by health care professionals. Sometimes they were told that the pain source was due to arthritis or cancer and sometimes that the pain source was unknown.
When asked to assess pain levels from facial expression, what the person said and how they said it, avoidance of movement and posture, and interpersonal contact, doctors, nurses and health care assistants all paid much more attention to the patient’s facial expression than to the other factors, particularly if the pain source was unknown.
My comment: I have come across this situation myself as a patient. Being very factual and stoical doesn’t seem to work!
The fantastic news this spring is that ALL type one adults and children are to be offered real time blood sugar monitors in the NHS.
These machines encourage testing without the finger pricks, tell you the trend of your blood sugars, and make it much more accurate, easier and less painful to adjust your insulin to your blood sugar.
The monitors will also be offered to type two patients who use insulin.
NICE estimates that a quarter of a million type one patients alone will be put on the device. Research suggests that HbA1c levels tend to drop when using the technology without increasing the risk of hypoglycaemia.
My comment: My son Steven, was an early adopter or this method of blood sugar monitoring. I paid for the device and sensors for the first 18 months because it gave me more peace of mind, especially as he was living on his own away from home. It seemed crazy to me that he was excluded from NHS funding by virtue of having very tight blood sugar control mainly from his own efforts. Although it is a charge on the NHS for the sensors, the benefit is that there should be less hospitalisation from hypos and fewer complications later on.
Currently the NHS spends ten billion pounds a year on diabetes, which is ten percent of the total budget.
For those type ones or type twos on insulin who do not yet have this device they are asked by NICE to approach their diabetes teams.
Cambridge University professor of biostatistics, David Spieghalter, has produced an easy to understand tool that can help you quantify your daily habits in terms of added or reduced life expectancy.
If you have got to 35 years of age, you could reasonably expect to live till age 80 if you are a man and age 83 if you are a woman.
For men this is how to live a shorter life:
Smoke 15-24 cigarettes a day cut 7.7 years For women cut 7.3
have one drink of alcohol a day ADD 1.1 years For women ADD 0.9 years
have another one up till six more CUT 0.7 years per drink For women CUT 0.6 years
For every 5 units above a BMI of 25 cut 2.5 years For women cut 2.4 years
for every 5kg above your optimal weight cut 0.8 years For women cut 0.9 years
Spend two hours watching the television cut 0.7 years For women cut 0.8 years
For every red or processed meat portion you eat, equivalent to a burger 3 oz cut 1.2 years Same for women
Now for the good news:
If you eat 5 or more fruit or vegetable portions a day men add 4.3 years For women add 3.8 years
If you drink 2-3 cups of coffee a day add 1.1 years. For women add 0.9 years.
For the first 20 minutes of exercise add 2.2 years. For women add 0.81 years.
For the next 40 minutes add 0.7 years. For women add 0.5 years.
Take a statin add 1 year for men. For women add 0.8 years.
If you live in a relatively unpolluted area, less than London for example, add 0.6 years for both genders.
The Alcohol Health Alliance UK has called for better labelling on alcoholic drinks after an analysis found that wine from the ten leading brands contained as much as 59g of free sugars per bottle.
None of the bottles had the sugar content on the label.
Government guidelines recommend no more than 30g of free sugars a day for an adult (My comment: they conveniently forget about starch though!) This is equivalent to 6 teaspoons of sugar and it can be contained in just two medium glasses of wine.
In February at the Low Carb USA conference in La Boca, Florida, Gemma Kochis, who is a qualified Sommelier, who works at Keto-Mojo, presented information for those on a ketogenic diet who would still like to drink wine.
She says that for the most part, wines with the highest alcohol content will tend to have the highest sugar content. If you want to drink wine and stay in ketosis, you will need to test your blood ketones about 2 hours after trying a new wine.
In general she recommends wines that grown in cooler climates, mainly old world compared to new world. She thinks that you have to stick below 12.5% alcohol wines and that even then you may have to go lower.
Red wines that can be fruity and have a low alcohol content include Beaujolais and Gamay.
Reisling, Vinho Verde and Muscadet are good white wine choices and Champagne Brut is a good sparkling wine choice.
In an observational study reported in JAMA 1,746 type one patients were compared with 272 type two patients. All had developed their diabetes before the age of 20. My comment: It is not clear whether the duration of diabetes was adjusted for, as the onset of type one diabetes tends to cluster around puberty, although it can occur as early as soon after birth, and the onset of type two diabetes tends to arise in later teenage years. Thus if average 30 year olds were compared head to head in the study, for instance, one would expect the type 1 patients to have more complications purely based on having had the condition much longer on average than the type 2s.
Nevertheless, the prevalence of diabetic kidney disease, retinopathy and peripheral neuropathy was significantly greater in the type two group compared to the type one group, even after they adjusted for differences in glycated haemoglobin, body mass index, waist to height ratio, and mean arterial blood pressure.
This study provides information that early age of onset of type 2 diabetes is a real problem, as once established, it does a lot of damage, that is difficult to control with standard therapies.
Adapted from Update on Advice for Physical Activity in Type 2 Diabetes by Marlene Busko http://www.medscape.com 11 Feb 2022
The American College of Sports Medicine has updated advice from The ACSM/ADA joint statement in 2010 for type two diabetics. Their recommendations have been published in full in the February issue of Medicine and Science in Sports and Exercise.
The key information is that everyone with type two diabetes should engage in regular physical activity, reduce sedentary time, and break up sitting with frequent activity breaks. Workouts can be modified if necessary. Anyone who wants to lose weight should consider workouts of moderately high volume 4 or 5 times a week.
Regular aerobic exercise improve glycaemic management. Blood sugar spikes are reduced and you can expect a reduction in A1c between 0.5-0.7%.
High intensity resistance exercise, when performed safely, is better than low to moderate intensity resistance exercise for glucose management and to reduce the amount of insulin you need to take. You can expect to an improvement in strength of 10-15%, improved bone mineral density, lower blood pressure, improved lipid profile, higher skeletal muscle mass and improved insulin sensitivity.
Exercise after meals, such as taking an after dinner walk, at an easy pace, helps stabilise blood sugar levels.
You should reduce sedentary time by taking regular activity breaks. These will result in small improvements in post meal blood sugars particularly in those who have more insulin resistance or who are overweight.
To prevent low blood sugars during or after exercise, people who take insulin, or drugs that promote insulin release, should reduce the amount injected if they can, reduce the medication, or if necessary increase carbohydrate intake.
If you are on beta blockers, you can’t rely on a heart monitor to measure your workout intensity. You can use a perceived exertion scale instead, eg Borg. Be guided as to the required intensity by a certified exercise professional.
Weight loss of more than 5% can improve A1c, lipids, and blood pressure. Visceral fat can be reduced by moderate exercise 4 or 5 days a week.
In young people who have type two diabetes, intensive lifestyle interventions plus metformin were no better than metformin alone for blood sugar control. Their physical activity goals should be the same as non diabetic individuals.
Those who did regular exercise before and after bariatric surgery, got better surgical outcomes.
In 2017, more than 17 million American adults reported experiencing at least one major depressive episode. (1) In 2020, as we deal with the COVID-19 pandemic, racial injustice, and increased stress and uncertainty, those numbers appear to be rising. According to one study, stressors related to the pandemic led to a three-fold increase in the rates of depression across all demographic groups studied. (2) If you’re struggling, you’re not alone. Embracing a root-cause-based Functional Medicine approach to depression may help you get relief, potentially without the use of antidepressants.
The Functional Medicine approach to depression involves identifying the root cause, like chronic stress or sleep deprivation. iStock/PeopleImages
While antidepressants can be life-saving for some people—and, if you’re currently taking antidepressants, you should not stop doing so without the guidance and support of your doctor—they’re not a good fit for everyone. For some people, they don’t alleviate depressive symptoms, and for others, they cause a new set of disruptive side effects. Other people don’t want to take antidepressants long-term or they can’t afford the financial investment to do so. Whatever your reason, there is a way to address the root cause of your depression directly, without long-term antidepressant usage: Functional Medicine.
The Functional Medicine approach to depression—and in fact, the Functional Medicine approach to any chronic condition—is to identify and address the root cause of the problem. That means treatment is focused on fixing the reason for your depression, whether that’s gut dysbiosis, chronic stress, infection, or another of the 10 possible causes I discuss below. Keep reading for more information on what could be causing your depression and how a Functional Medicine-based approach can help.
The Conventional Treatment for Depression: Antidepressants
Depression takes a heavy toll on physical health, day-to-day functionality, and relationships. It causes symptoms like: (3)
Profound feelings of sadness
Hopelessness
Fatigue
Feelings of guilt or worthlessness
A loss of interest in activities
Changes in sleep and appetite patterns
Irritability
Difficulty concentrating
Moving or talking more slowly than normal
Restlessness
Unexplained aches, pains, cramps, headaches, and even digestive problems
Thoughts of death or suicide
And while some people may experience just one depressive episode in their lives, multiple episodes are common. (4)
Antidepressants are the most common conventional treatment for depression. In fact, between 2011 and 2014, one in eight Americans aged 12 and up reported taking an antidepressant the previous month. (5)
Some research suggests that antidepressants are not as effective as they’re often claimed to be. Initial treatment may be effective at mitigating symptoms only around half the time, and antidepressants may not have any benefit over placebo for mild and moderate depression. (6, 7, 8, 9, 10) What’s more, these drugs can also cause side effects, like: (11)
Anxiety
Decreased libido
Nausea
Weight gain
Dry mouth
Constipation
Dizziness
Tiredness and/or insomnia
Sweating
I’m not here to say that antidepressants have no place in treating depression. That’s because, for some people, they are effective at alleviating their symptoms without causing worrying side effects. Put simply, they work for them. But unfortunately, that isn’t true for everyone, and even if they do relieve symptoms, antidepressants do nothing to address the underlying cause of depression.
For those of you who haven’t found relief in antidepressants, a Functional Medicine-based psychiatric approach may offer the help you’re looking for. And a key component to that approach? Identifying the root cause of your depression.
10 Root Causes of Depression
Most of us are familiar with the conventional explanation for depression: the chemical imbalance theory. This theory states that depression is caused by imbalanced neurotransmitters in the brain, and antidepressants are needed to manipulate the levels of those neurotransmitters—which should, in theory, correct the problem.
There’s quite a bit wrong with the chemical imbalance theory—namely, research indicates that only 25 percent of people with depression have low levels of neurotransmitters, and others have high levels of them. (12) It also fails to recognize the link we see between chronic inflammation and depression. This means if you’re not part of that comparatively small group of people experiencing a neurotransmitter imbalance, antidepressants won’t correct the problem. For that, you’ll need to address the real root cause of your depression.
1. Blood Sugar Dysregulation and Obesity
Insulin influences your central nervous system, impacts neuronal circuitry formation, and affects synaptic plasticity—meaning it plays an important role in your mental health. If your blood sugar is dysregulated and you’re experiencing insulin resistance, your brain will feel the effects along with the rest of your body, and anxiety and depression may result. (13, 14)
Obesity is closely tied with blood sugar dysregulation and depression. This connection is likely multifactorial and complex; but, as obesity is an inflammatory state, and we see evidence that people with obesity have higher levels of inflammatory signaling molecules called cytokines, it’s probable that inflammation plays a critical role in the obesity-depression connection. (15, 16)
2. Chronic Stress
Chronic stress can also have an inflammatory effect on your body. Your nervous system mediates inflammation and the body’s immune response; if something goes awry, depression, anxiety, and other mood imbalances can result. (17, 18, 19)
The relationship between your stress levels and your hypothalamus–pituitary–adrenal (HPA) axis is complex. In a healthy relationship, an acutely stressful event should spur your sympathetic nervous system into action, triggering the HPA to release stress hormones to help you respond to the stressor. After that event, your parasympathetic nervous system should take over, decreasing activity in your HPA axis and reducing stress hormone production. (20) However, if you’re experiencing chronic stress, your sympathetic nervous system and HPA axis can remain chronically activated, causing a host of health problems (depression included).
Your HPA axis also acts on your thyroid gland—any stress-related disruption in HPA axis function could lead to problems with your thyroid, which can also cause symptoms of depression.
3. Environmental Factors
Environmental toxins can also impact your mental health.Indoor mold exposure can trigger a complex inflammatory response that leads to several cognitive side effects, including depression. (21, 22) Mold exposure can trigger the release of inflammatory cytokines and impair neuronal plasticity (which can both lead to symptoms of depression). (23, 24, 25)
Air pollution is another toxin that can impact mental health (and your overall well-being and longevity). Ambient air pollution can lead to neuroinflammation, which increases the risk of depression. Those effects appear to be especially significant for people who encountered air pollution during the first 10 years of their lives. (26)
Some research also suggests that radiation produced by electromagnetic fields (EMFs) may also have a connection with depression. EMFs may contribute to depression by changing the activity of voltage-gated calcium channels in the brain. This can lead to a host of neuropsychiatric symptoms, like fatigue, headaches, insomnia, irritability, and a depressive mood. (27, 28)
4. Genetics
Certain genetic variants are potentially associated with depression:
The methylenetetrahydrofolate reductase (MTHFR) gene: Variants in the MTHFR gene are linked to depression (as well as anxiety, autism, and schizophrenia). (29)
The glutamic acid decarboxylase (GAD) gene: GAD variants may decrease the conversion of glutamate to gamma aminobutyric acid (GABA), which can result in major depressive disorder. (30)
I want to note here that our understanding of the genetic risks associated with depression is far from complete. If you have one of these variants, take that information with a grain of salt—consumer genetic testing has its own potential pitfalls, and your genes aren’t the only factor that influences your health. Often, the exposome (all of those external health determinants like your diet, lifestyle, and environment) is the primary driver behind your overall well-being.
5. Infection
Research suggests that several chronic infections are associated with depression, including:
The mechanism behind this connection could be described by the pathogen-host defense theory of depression (credit to the very forward-thinking Dr. Charles Raison for this theory). According to this idea, some of the behavioral symptoms of depression may actually be behavioral responses to infection, suggesting that human depression evolved out of sickness. (35, 36) Chronic infections are also associated with chronic inflammation, which is linked to symptoms of depression. (37)
6. Leaky Gut and Gut Dysbiosis
Your gut health impacts your mental health through the gut–brain axis. This axis transmits messages to and from the gut and the central nervous system via inflammatory mediators, gut microbial metabolites, stress hormones, neurotransmitters, and the vagus nerve. (38)
Intestinal barrier integrity and a balanced gut microbiome are two crucial components of a healthy gut—if these are disrupted, your gut health (and, potentially, your mental health) will be impacted.
Leaky gut is a condition where the intestinal barrier allows undesirable and incompatible substances from the gut to “leak” into the bloodstream. This includes endotoxins called lipopolysaccharides, which provoke the release of inflammatory cytokines after entering the bloodstream. (39) Robust research also shows that changes in the makeup of our gut microbiome are associated with major depressive disorder. (40) Factors shown to disrupt the intestinal barrier and gut microbiota may increase the risk of future mental illness. (41)
7. Loneliness, Trauma, and Social Determinants of Health
Our social support system plays an enormous role in our ability to maintain our health. That can include our network of friends, loved ones, and family, and it’s impacted by social determinants of health, like our race and socioeconomic status.
Social isolation is linked with greater incidences of depression (among other serious health conditions), while those who have a strong social support network tend to have better health and lower levels of inflammation. (42, 43) Loneliness is linked with a higher risk of death, even after controlling for factors like physical health, alcohol consumption, and smoking. (44)
Trauma can also be a trigger for depression. Experiencing trauma during childhood (including even childhood bullying) can strongly predict future risk of depression and other mental health disorders, possibly by altering the function of the HPA axis long-term and contributing to chronic, systemic inflammation. (45, 46, 47) Trauma experienced during adulthood can also cause depression; that can include things like:
Serving in the military
Involvement in a serious accident or natural disaster
The COVID-19 pandemic can also be defined as a traumatic event in and of itself, and experiencing things like the death of a loved one, job loss, and financial trouble can all certainly be traumatic. (48, 49)
Social determinants of health also have a major impact on our risk level when it comes to developing depression. These can include:
Access to healthy food
Local air and water quality
Education
Neighborhood
Socioeconomic status
Education
Race
Gender
It’s well worth discussing these determinants of health now, as we grapple publicly with social justice and racism. Health and social inequality are connected—in fact, research shows that experiencing racism or even anticipating racist encounters contributes to chronic stress and low-grade inflammation, both risk factors for depression. (50, 51, 52)
8. Sedentary Lifestyle
Regular exercise is linked to good mental health, but a sedentary lifestyle is associated with depression in people of all ages. (53, 54) As an interesting side note, while exercise initially produces inflammatory cytokines (which are associated with depression), an induction of anti-inflammatory substances quickly follows. (55) This is known as a hormetic effect, where an initial stressor creates a compensatory response in the body—and that has positive, long-term consequences for health. (56)
9. Sleep Deprivation and Artificial Light Exposure
As more and more of us spend most of our waking hours in front of a screen, our modern lives are becoming progressively more marked by increased exposure to artificial light. That has worrying effects on our sleep. Nighttime light exposure suppresses the production of melatonin and leads to increased sleeplessness, and is linked to an increased risk of depression, even after controlling for sleep quality and chronic health conditions. (57, 58, 59, 60)
10. Standard American Diet
Research shows that the consumption of ultra-processed foods is associated with depression—and the Standard American Diet is chock-full of them. (61, 62) The Standard American Diet harms the gut microbiome and can lead to leaky gut. (63) Nutritional deficiencies are also a concern with this diet.
Functional Medicine Treatment Options for Depression
Your diet and lifestyle habits impact every facet of your well-being, mental health included, so making adjustments in these areas is an important step if you are struggling with depression. As our understanding of the mechanisms behind depression grows, other potential treatments are coming to the forefront, as well, like bright light therapy, Eye Movement Desensitization and Reprocessing (EMDR), cognitive behavioral therapy, and even psychedelics. Building up your personal resilience can also help weather stressful situations in the future—and this is an especially useful tool for getting through the stress and uncertainty caused by the COVID-19 pandemic.
Change Your Diet
As I mentioned, a diet rich in ultra-processed foods is linked with depression; however, an anti-inflammatory, ancestral diet is associated with robust mental health. (64) An ancestral diet is also nutrient dense, making it a great option for ensuring that you get the nutrients that are beneficial for mental health, like:
An ancestral diet is also a gut-healthy diet. It’s rich in healthy fiber and free from foods that exacerbate gut conditions—and I recommend adding fermented foods for additional probiotic benefits.
Adopt Healthy Lifestyle Interventions
Picking up healthier habits can also help alleviate your depression. That could include:
Cognitive behavioral therapy is a form of talk therapy that is focused on changing patterns of thinking and behaviors that don’t support mental health. People who undergo this form of therapy learn new methods for coping, like: (75)
Facing their fears
Developing confidence
Learning to calm the mind
Using problem-solving skills to deal with tough situations
There are also several emerging treatments for depression available, like:
Bright light therapy: This involves daily exposure to a full-spectrum, 10,000 lux light, and has been shown to help relieve seasonal affective disorder and depression. (76)
EMDR: This form of therapy stimulates the two hemispheres of the brain, often through eye movements or specialized devices. Originally intended as a treatment for trauma, it’s been shown to be effective for recurrent depression. (77)
Psychedelics: When used in controlled, therapeutic environments, research suggests that people with depression may experience some benefit from psilocybin, LSD, or ketamine. (78, 79, 80)
Build Your Ability to Adapt in Any Circumstances
Cultivating more adaptability can be a powerful tool to use in dealing with depression. This is a crucial trait we all need to deal with uncertainty—and clearly, we need it now more than ever. We can each develop the internal and external resources needed for this, often described with the acronym “HERO.” (In positive psychology, this is known as “psychological capital.”) HERO stands for:
Adapted from article by Chris Kresser 16 April 2021
We seem to be told on a regular basis that eating red meat is bad for our health. Recent studies have clarified this stance somewhat.
A study published in the American Journal of Clinical Nutrition examined both fresh and processed meat intake from almost 135,000 participants from 21 different countries.
They found no association with fresh red meat intake and the risk of early death, heart disease, cancer and stroke but did find a small association between processed meat consumption and a higher risk of cardiovascular disease and death. A strength of the study is that they carefully matched the groups that ate more or less meat with each other so that they were similar in sex, age, body mass index, smoking and drinking.
Another study was a meta-analysis of 59 systematic reviews published in the Annals of Nutrition and Metabolism which examined the association of dietary fat intake and a variety of health outcomes.
They found no association with total fat, monounsaturated fatty acids, polyunsaturated fatty acids, and saturated fatty acids with risks of chronic diseases.
Since we don’t eat food in isolation, there could be important differences depending on whether you eat red meat in a dietary background of highly processed and refined foods or with a whole foods diet.
The contextual importance of meat as part of an overall dietary pattern is important and here are some information to explain this.
Some amines in meat have been shown to increase cancer risk but eating cruciferous vegetables and spices, and cooking meat at lower temperatures such as stewing or low temperature roasting, lowers amines too.
The increased absorption of iron from meat from the gut has also been flagged as a possible reason for excess cancer risk, but eating fruits and vegetables reduces iron absorption in the gut.
Eating vegetables with meat seems to have a protective effect against cancer. Thus eating a nutrient dense, whole foods diet with a broad variety of both animal and plant food is probably the best diet for the majority of the population. If you do choose to eat a lot of red meat or processed meat, keep cooking temperatures low if you can, and enjoy vegetables as part of your meal.
Adapted from Westergaard et al Cephalalgia 23 June 2021
People with a history of chronic headache are significantly more likely to have poor social support and loneliness than those without a headache history.
Other chronic illnesses, mental illness and indeed death, are also more common when a person lacks social relationships.
This study was undertaken in Denmark in over 55 thousand people.
2.7% of people reported chronic headache and in 66% of these medication over use was a major factor. Poor social support was cited by 20 % of the participants who did not have chronic headache and in almost 37% of those who did.
Loneliness was reported by almost 8% of the people without headache and in almost 24% of those who did have chronic headache.
Stress was reported by 24% of those with no headache and in almost 61% of those who did.
The researchers did not differentiate between different headache diagnoses such as migraine and tension headaches.
My comment: As a GP, I was surprised that only 2.7% of the population said they had chronic headache, because it feels like a lot more in the surgery. It is a very common presentation to GPs. I can understand why poor social support could make stress more difficult to bear and produce headaches, and I can also see that people with headaches may want to limit social interaction. What doctors don’t tend to do is to look at improving social interaction as a means of ameliorating headache in patients.
Adapted from Zhang Y et al. Frontiers of Cardiovascular Medicine 1 Jan 2021
Just under two hundred thousand participants in the UK Biobank with data on birth weight were studied. Researchers looked at the correlation between birth weight and hypertension as adults. They also looked at the patients’ obesity indexes.
They found that the lower a baby’s birth weight, the higher the risk for hypertension as an adult. The highest risk was for babies under 2.88kg which is 6 pounds 2 oz.
When it came to adult obesity and hypertension risk, those with a BMI of over 30 were at the highest risk.
This is a lot of babies and adults!
They think that a birth weight of between 3.43 kg and 3.80 kg is the most healthy. This is between 7lbs 5 oz and 8 lbs 4 oz.
We can’t really choose our birthweight, but we can do something about our weight as adults, so you will be pleased to see that adult BMI was a lot more influential in producing hypertension than low birth weight.
My comment: I was only 2 pounds 3 oz when I was born, so I was very pleased to make it past babyhood at all. The association between low birth weight and hypertension and metabolic syndrome in adulthood has been studied for many years. Factors that make the baby more likely to survive placental failure unfortunately programme the body to respond less favourably in adulthood.
Diabetes Diet 