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Key Nutrients for Immunity & Viral Resilience

What is the immune system?

The immune system refers to the complex collection of body tissues, cells, chemicals and processes that function synergistically to help us resist and recover from exposure to pathogens including bacteria, viruses, fungi, parasites, cancer cells and toxins (Marshall et al. 2018). How well we protect ourselves from daily exposure to pathogens and recover from illness is largely attributable to how well our immune system is functioning (Hechtman 2012).

The consequences of a malfunctioning immune system can include inflammation, autoimmunity, immunodeficiency and hypersensitivity which can lead to the development of illness and disease (Marshall et al. 2018). The ability of our immune system to defend and respond is influenced by many factors, including our genes, lifestyle, nutrition, environment, age, and prior infections (Hemilä 2017). It is however, possible to strengthen our immune system to improve its ability to perform surveillance and protection, recovery and return to homeostasis.

One of the most prevalent pathogenic burdens to our immune system are respiratory viruses of which the Rhinovirus (the common cold) and Influenza (the flu) are considered to be some of the most common infectious diseases to afflict humans (Lee et al. 2012; Tamerius et al. 2011). During the colder months of the year we typically see a seasonal spike in these viral infections, which makes the preceding months an ideal time to strengthen our immune system to reduce the frequency and severity of these infections (Tamerius et al. 2011). In this article, a number of simple nutritional and lifestyle strategies will be discussed which have proven benefits for supporting the immune system function and our defence against colds and flus.

Nutritional Strategies

Some nutrients have been shown to be helpful for reducing our susceptibility to pathogen invasion so it is important that the body has optimal levels prior to illness/infection (a preventative strategy). This means that the nutrients must be consistently consumed as part of the diet or in some cases supplemented prophylactically. Other nutrients have been shown to be especially valuable during an illness/infection to help the body to fight off the pathogen, allowing the body to recover faster (a treatment strategy).

Enjoying a diet comprised of a wide variety of nourishing foods provides the best chance of acquiring the array of nutrients essential good health including a healthy functioning immune system. The six major nutrients needed by the body are (The Department of Health n.d.):
  • Carbohydrates
  • Lipids (fats)
  • Proteins
  • Vitamins
  • Minerals
  • Water

Because these nutrients work synergistically in the body, it is usually unhelpful to focus on any single nutrient (unless there is a known deficiency or higher biological requirement). That said, some nutrients have been extensively studied over decades for their important activities within the immune system and as such, are widely accepted to be of significant value in promoting immunity. The three key nutrients that will be discussed are Vitamin D, Vitamin C and Zinc. These have been selected because of their well-established abilities to modulate both the innate and adaptive immune system (Rondanelli et al. 2018).

The three major immune nutrients

Vitamin D

Despite being commonly referred to as a fat-soluble vitamin, Vitamin D is in fact a pro-hormone which is largely produced by skin in response to ultra violet B (UVB) radiation (sunlight exposure). It then undergoes biological activation in the body with involvement from the liver and kidneys (Morris 2005). Perhaps most well-known for its role in regulating calcium metabolism to help maintain strong healthy bones to reduce the risk of osteoporosis. Vitamin D also holds other important roles in the body such as promoting muscle strength, skin health and fertility (Cancer Council Australia 2016).

Deficiency (levels less than 50nmol/L when tested) has been linked increased risk for certain diseases affecting the heart, lungs, brain and immune system (Cancer Council Australia). Vitamin D has been recognised to have abilities in regulating gene expression, cell growth and differentiation and as such has been researched for its abilities to favourably alter the risk, growth and invasiveness of certain cancers including those of the prostate, breast and colon (Morris 2005). A 2014 review of over 290 scientific studies in humans saw the majority concur that a moderate-strong link (an inverse relationship) exists between vitamin D concentrations and cardiovascular disease, inflammation, disordered glucose metabolism, weight gain, infectious diseases, multiple sclerosis, mood disorders, impaired cognitive and physical functioning and all-cause mortality (Autier et al 2013).

Increasing awareness of the broad biological activities of Vitamin D has seen it emerge as a crucial nutrient for immune function, with its real strengths laying with its major potential as a preventative strategy, coupled with its possible benefits as a treatment strategy for viral infections including influenza (Gruber-Bzura 2018).

A connection has been established between low serum Vitamin D concentrations (the amount circulating in the bloodstream) and higher susceptibility to acute respiratory infections (Martineau et al. 2017). This does not necessarily equate to a causative correlation, however it does suggest that maintaining optimal Vitamin D levels acts as a defence strategy.

A recent large-scale review of evidence indicated that supplementation with Vitamin D on a regular basis (daily or weekly doses) delivered the strongest protective benefits for reducing the risk of respiratory infections. The greatest benefits were observed in those who were deficient or had lower serum vitamin D levels, however people with higher vitamin levels also benefited. Reasons for this have been attributed to the following mechanisms (Martineau et al. 2017; Gruber-Bzura 2018; Vargas Buonfiglio et al. 2017):

  • Localised actions – Important biological functions taking place on the surface of the airways and by the cells that line the respiratory tract, including the transformation of inactive Vitamin D to its active form and the induction of antimicrobial peptides.
  • Systemic actions – Preventing overactivity inflammatory processes brought on by infection. This is important because the release of pro-inflammatory cytokines appears to correlate with illness severity.

Cold and flu viruses are most prevalent during winter and spring which also correlates with when Vitamin D levels tend to be at their lowest in people, which suggests that an opportune time to test and optimise Vitamin D status would precede this to allow time for levels to increase in the body. The preference is to aim for body concentration levels of 100nmol/L when tested (Papadimitrious 2017).

Despite the risk for toxicity being rare, supplementation should always be overseen by a clinician as contraindications with certain conditions do exist and doses for supplementation doses and duration are calculated with consideration given to individual factors including known conditions, sun exposure, skin colour, age, body mass index and dietary intake (Hechtman 2012; Papadimitrious 2017).

Vitamin D deficiency may display no overt symptoms and those who may be at risk of deficiency include (Cancer Council Australia 2016; Morris 2005):

  • People who have very dark skin (due to the presence of melanin, the pigment in the skin which filters out UVB light)
  • Those with little-to-no regular exposure to sunlight (eg; due to hospitalisation or being house-bound, indoor occupations and hobbies or practice sun avoidance behaviours for other reasons)
  • People who conceal their skin with clothing when outdoors (eg; during winter months, for religious/cultural purposes or wear protective clothing for outdoor occupations)
  • The very young (exclusively breast-fed babies when the mother has a deficiency)
  • Aging/elderly populations (the body becomes less efficient in producing vitamin D as the skin thins – however this can be mitigated by maintaining an outdoor lifestyle during older age)
  • Those whose level of exposure to UVB radiation is reduced by seasonal changes or the geographical location (latitude) in which they live
  • People with certain health conditions or who take medications that impair the body’s ability to produce vitamin D

It is thought that more than 80% of serum Vitamin D levels can be attributed to sunshine exposure and the remaining 20% (or less) to dietary intake (Cancer Council Australia 2016; Papadimitrious 2017). Food sources of Vitamin D are egg yolks, sun-exposed mushrooms, fortified beverages, wild fish including mackerel, herring, salmon and sardines.

Vitamin C

Vitamin C (ascorbic acid) is a water soluble vitamin that is essential for human health and fortunately tends to be prevalent in a healthy diet. Interestingly, humans are one of the only species who cannot manufacture vitamin C endogenously (from in the body). With a plethora of facilitating roles in promoting immune function, this extensively studied nutrient appears to have the ability to both prevent and treat respiratory and systemic infections, with key functions said to be (Carr & Maggini 2017):

  • Enhancing the epithelial barrier against pathogens (this is the surface layer of cells that lines skin, organs, vessels etc which is the body’s first line of defence)
  • Heightening the proliferation of immune cells (B and T cells) and antibodies
  • Concentrating in immune cells (including neutrophils) where it is used in processes that destroy microbes. This is important because neutrophils rapidly increase when infection is detected.
  • Modulating production of inflammatory molecules and protects healthy tissues against oxidative damage.

A deficiency in Vitamin C has been associated with impaired immunity leading to greater susceptibility to pathogenic infection, therefore maintaining adequate body levels is considered very important (Carr & Maggini 2017). Some common factors known to deplete body stores include (Carr & Maggini 2017):

  • Insufficient dietary intake (eg; overreliance on processed foods)
  • Exposure to air pollution and cigarette smoke (including passive exposure)
  • During an episode of illness/acute infection
  • Increased metabolic requirements due to inflammatory or oxidative diseases (such as Diabetes)
  • Age (the very young or very old population groups)

The strongest benefits of prophylactic supplemented Vitamin C are experienced by physically active people whereby the number of acquired colds has been shown to be halved as a result (Hemilä 2017). As a preventative strategy, the results have been less remarkable amongst the other less active population groups, however even modest daily doses (as little as 200mg) appears to be effective as a treatment strategy in reducing the severity and duration of a cold and importantly, reducing the risk of developing more serious complications such as pneumonia (Carr & Maggini 2017; Hemilä 2017).

As a therapy to treat an acute infection, significantly higher doses are required to compensate for the rapid depletion of Vitamin C that occurs due to the inflammatory response and metabolic demands associated with active viral infection (Carr & Maggini 2017; Gonzalez et al. 2018). Some scientific studies have shown doses between 6000mg – 8000mg to result in shorter cold duration by 17-19% respectively when supplemented as soon as possible after the onset of symptoms (Hemilä 2017). Supplementation is always best directed by a clinician and tailored to an individual’s requirements as adverse effects can occur from inappropriate doses.

Food sources of vitamin C include green and orange/red coloured organic fresh fruits and vegetables such as broccoli, cabbage, snow peas, kiwi fruit, parsley, guava, orange, pawpaw, tomato and strawberries.

Zinc
Zinc is an essential mineral with a number of important functions in the body associated with immunity due to its antimicrobial and antioxidant actions and necessity for tissue repair (wound-healing). It also has many other important biological functions beyond the immune system, for example zinc is a critical cofactor in the production of neurotransmitters and for activation of the body’s toxic metal scavenging system (metallothionein promotion).

The immune system has proven to be particularly sensitive to changes in levels of zinc (Skrainowska & Bobrowska-Korczak 2019). With an inability for the body to store zinc in reserve, a deficiency can manifest relatively quickly and unfortunately deficiency is common (Skrainowska & Bobrowska-Korczak 2019). This is often due to disease-mediated factors or the impact of aging, diet and lifestyle factors (Rondanelli et al. 2018) and consequently, the body’s immune defences are weakened and susceptibility to infection increases (Skrainowska & Bobrowska-Korczak 2019).

Zinc has been extensively studied its roles in prevention and treatment of viral infections, with efficacy established for significantly decreasing the risk of colds and frequency of other respiratory tract infections including pneumonia and particularly amongst children and the elderly, which are typically the most vulnerable populations (Rondanelli et al. 2018). Its major roles are believed to include:

  • Helping to maintain the integrity of both the external and internal physical barriers to pathogens (specifically skin and mucosal membranes). The latter lines the respiratory tract which is the site that inhaled pathogens adheres to.
  • Directly exerting antiviral effects to interfere with viral replication during a cold episode.
  • Acting as an essential catalyst for enzymes involved in immune function.
  • Playing a key role in the regulation of inflammatory cytokines and oxidative stress.

Large-scale reviews of the scientific evidence have demonstrated zinc may reduce the duration of colds by approximately 33% and it is recommended that supplement commences within 24 hours of the onset of symptoms (Rondanelli et al. 2018).

Food sources of zinc include oysters, red meats, poultry, shellfish, liver, nuts, seeds (sesame, sunflower, pepitas), tahini, oats, tomato (sundried and paste) and mushrooms.

Lifestyle strategies

While nutrient sufficiency is integral component for a healthy immune system, the impact of lifestyle factors and behaviours should not be underestimated. Consideration should be given to the following factors that have the ability to affect the ability of the immune system to perform surveillance and protection and recovery:

  • Maintain regular and appropriate physical activity or movement
  • Manage stress and emotions well.
  • Maintain a sound mindset. Maintain good social network.
  • Get regular sunlight exposure (even during the winter months)
  • Maintain a healthy body weight
  • Wash hand regularly and avoid unwell/contagious people where possible
  • Rest as appropriate and ensure adequate restorative sleep
  • Do not smoke tobacco and avoid passive smoking
  • Curb unhelpful dietary habits (especially consuming excessive sugar or alcohol)
  • Manage other existing health conditions
  • Maintain a hygienic home and work environment
  • Most importantly, be consistent with your healthy immune-boosting behaviours

References

Autier, P, Boniol, M, Pizot, C & Mullie, P 2014, ‘Vitamin D status and ill health: a systematic review’, The Lancet Diabetes & Endocrinology, vol. 2, no. 1, <www.pubmed.ncbi.nlm.nih.gov/24622671/>.

Cancer Council Australia 2016, Skin cancer statistics & issues: vitamin D, <www.wiki.cancer.org.au/skincancerstats_mw/index.php?title=Vitamin_D&oldid=>.

Carr, AC & Maggini, S 2017, ‘Vitamin C and immune function’, Nutrients, vol. 9, <www.ncbi.nlm.nih.gov/pmc/articles/PMC5707683/>.

Gonzalez, MJ, Berdiel, MJ, Duconge, J, Levy, TE, Alfaro, IM, Morales-Borges, R, Marcial-Vega, V, Olalde, J, 2018, ‘High dose vitamin C and influenza: a case report’, Journal of Orthomolecular Medicine, vol. 33, no. 3, <www.isom.ca/article/high-dose-vitamin-c-influenza-case-report/>.

Gruber-Bzura, BM 2018, ‘Vitamin D and influenza – prevention or therapy?’, International Journal of Molecular Sciences, vol. 19, no. 8 <www.ncbi.nlm.nih.gov/pmc/articles/PMC6121423/pdf/ijms-19-02419.pdf>.

Hechtman, L 2012, Clinical Naturopathic Medicine, Churchill Livingstone, Chatswood.
Hemilä, H 2017, ‘Vitamin C and infections’, Nutrients, vol. 9, no. 4, <www.mdpi.com/2072-6643/9/4/339/htm>.

Lee, W, Lemanske, RF Jr, Evans, MD, Vang, F, Pappas, T, Gangnon, R, Jackson, DJ & Gern, JE 2012, ‘Human rhinovirus species and season of infection determine illness severity’, American Journal of Respiratory and Critical Care Medicine, vol. 186, no. 9, <www.atsjournals.org/doi/pdf/10.1164/rccm.201202-0330OC>.

Marshall, JS, Warrington, R, Watson, W & Kim, HL 2018, 'An introduction to immunology and immunopathology', Allergy, Asthma & Clinical Immunology, vol. 14 (Suppl. 2), <www.ncib.nlm.nih.gov/pmc/articles/PMC6156898/>.

Martineau, AR, Jolliffe, DA, Hooper, RL, Greenberg, L, Aloia, JF, Bergman, P, Dubnov, G, Esposito, S, Ginde, AA 2017, 'Vitamin D supplementation to prevent acute respiratory tract infections: systemic review and meta-analysis of individual participant data', The BMJ, vol. 356, no. 8093, <www.bmj.com/content/356/bmj.i6583>.

Morris, HA 2005, ‘Vitamin D: a hormone for all seasons – how much is enough? Understanding the new pressures’, Clinical Biochemist Reviews, vol. 26, no. 1, <www.ncbi.nlm.nih.gov/pmc/articles/PMC1240026>.

Papadimitrious, DT 2017, ‘The Big Vitamin D Mistake’, Journal of Preventative Medicine & Public Health, vol. 50, no. 4, <www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/pdf/jpmph-50-4-278.pdf>.

Rondanelli, M, Miccono, A, Lamburghini, S, Avanzato, I, Riva, A, Allegrini, P, Faliva, MA, Peroni, G, Nichetti, M, Perna, S 2018, ‘Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc, and echinacea in three main immune interactive clusters (physical barriers, innate and adaptive immunity) involved during an episode of common colds—practical advice on dosages and on the time to take these nutrients/botanicals in order to prevent or treat common colds’, Evidence-Based Complementary and Alternative Medicine, vol. 2018, <www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172/pdf/ECAM2018-5813095.pdf>.

Skrainowska, D & Bobrowska-Korczak, B 2019, 'Role of zinc in immune system and anti-cancer defense mechanisms', Nutrients, vol. 11, no. 10, <www.ncbi.nlm.nih.gov/pmc/articles/PMC6835436>.

Tamerius, J, Nelson, Zhou, SZ Viboud, C, Miller, MA, Alonso, WJ 2011, 'Global influenza seasonality: reconciling patterns across temperate and tropical regions', Environmental Health Perspectives, vol. 119, no. 4, <www.ncbi,nlm.nih.gov/pmc/articles/PMC3080923>.

The Department of Health n.d., Nutrients, <www1.health.gov.au/internet/publications/publishing.nsf/Content/canteen-mgr-tr1~nutrients>.

Vargas Buonfiglio, LG, Cano, M, Pezzulo, AA, Vanegas Calderon, OG, Zabner, J, Gerke, AK & Comellas, AP 2017, ‘Effect of vitamin D 3 on the antimicrobial activity of human airway surface liquid: preliminary results of a randomised placebo-controlled double-blind trial’, BMJ Open Respiratory Research, vol. 4, no. 1, <www.bmjopenrespres.bmj.com/content/4/1/e000211>.

© 2020 Lifestyle Planning QLD Trust

Category: QIM

The Ketogenic Diet and its Application to Managing Chronic Disease

As the burden on our health system continues to grow, due to the ever-increasing rates of obesity and chronic disease, finding effective non-invasive solutions to treating and/or preventing these issues has never been more pertinent. As diet and lifestyle are key risk factors for many chronic conditions currently plaguing our society, it is only natural that many are searching for the ultimate dietary/lifestyle protocol that will effectively manage/treat these chronic health conditions. One such dietary protocol that has had a massive resurgence in popularity in recent years is the high fat, very low carb diet also known as The Ketogenic Diet. There is now strong evidence indicating that the ketogenic diet is in fact a very effective protocol for treating a range of conditions from obesity, type 2 diabetes, heart disease, hypertension, chronic inflammatory conditions, cancer, as well as neurological conditions like epilepsy that it was first designed to treat almost a century ago.

What is the Ketogenic Diet?

First developed by Dr Russel Wilder in 1924 for reducing seizures in patients with severe epilepsy the Ketogenic Diet has since been found to be a very effective method of achieving rapid weight loss as well as improving a range of other health markers. The Ketogenic diet consists of very small amounts of carbohydrates (20-50g per day), moderate amounts of protein and the majority of your daily energy intake from fats. The diet works by essentially depriving the body of carbohydrates (our preferred energy source) resulting in a reduction in insulin secretions, encouraging the utilisation of an alternative energy source - our body’s fat stores. When fats are broken down, the liver produces a by-product called ketones, hence the name “Ketogenic Diet”. The ketogenic diet restricts daily carbohydrate intake to somewhere between 20-50g per day, primarily from non-starchy vegetables. The Ketogenic Diet differs from other low carb diets such as the Atkins diet as the keto diet focuses on high fat intake instead of protein.

Why is it becoming so popular?

Reducing Inflammation in the body and brain: Studies have shown that burning the ketones for energy produced by the liver during ketosis, is far more efficient than burning carbohydrates, resulting in significantly less reactive oxygen species and secondary free radicals being created that can damage your cellular and mitochondrial cell membranes, proteins and DNA. In protecting the body from this cellular damage, there is the potential for the ketogenic diet to reduce inflammation and pain in the body and essentially prevent chronic inflammatory health conditions from developing (Masino & Ruskin 2014).

Successful Long-Term Weight Reduction: Though considered a relatively restrictive diet in terms of food choices, recent studies have shown very promising results not only in the diet’s efficiency in inducing rapid weight loss, but that it may also be more effective than other calorie-controlled diets in helping to keep the weight off long term (Bueno et al, 2013). This is thought to be related to the appetite suppressing powers of the diet (due to the satiating properties of the high fat intake) as well as possible changes in appetite-regulating hormones. Despite being allowed to eat to satiety it is thought that the Ketogenic Diet also may not have the same negative effects on our metabolism and metabolic rate that other weight loss diets, like the low-fat diet do (Bueno et al, 2013).

Chronic Disease Management: In addition to achieving effective, long term weight loss, the ketogenic diet has also proven to improve health markers for a range of other chronic health conditions such as diabetes and cardiovascular disease. A recent study by McKenzie et al (2017) for example found that a weight loss program inducing nutritional ketosis can be highly effective in improving glycaemic control and significantly decreasing medication use in adults with Type 2 Diabetes. Once thought to be inappropriate for those with high cholesterol or cardiovascular disease due to the high fat intake of the Ketogenic Diet, more recent studies are indicating this dietary protocol may in fact be cardio-protective. A meta-analysis completed in 2013 for example concluded that not only does a ketogenic diet achieve a greater weight loss than a low-fat calorie-controlled diet but it also results in significant reductions in cardiovascular health markers including LDL- cholesterol, triglycerides and diastolic blood pressure. Significant increases in cardio-protective HDL- cholesterol levels were also identified in the study (Bueon et al, 2013).

Other Benefits: In addition to these significant heath benefits, the Ketogenic Diet has also proven effective in treating and/or managing a range of other health conditions including certain types of cancer, neurological disorders (Stafstrom, C. E., & Rho, J. M. 2012). like epilepsy and also metabolic disorders such as those suffering from Polycystic Ovarian Syndrome (Mavropoulos et al 2005), though more study is needed in these areas to determine long term effectiveness.

Though more research is needed in these areas, most “Keto Dieters” report rapid improvements in a range of other areas of their health such as:

  • Memory and Concentration

  • Cognitive Function

  • Mood Regulation

  • Energy levels

  • Appetite Regulation

  • Skin and Hair Health

  • Joint pain and inflammation

Is the Keto Diet right for you?
If you suffer from any of the above health conditions, the Ketogenic Diet may well be the answer you have been looking for. It is important to note however, that the ketogenic diet is not suited to everyone as for some, certain determinants of their genetic make-up (which can be determined through Nutrigenomic Testing) may indicate that following a high fat diet is contraindicative for their health.  If you would like more information on the ketogenic diet or are interested to know if the diet is right for you, please speak to QIM Reception staff regarding booking an appointment with our one of our Clinical Nutritionists.

References

Masino, S.A. & Ruskin D.N. (2014). “Ketogenic Diets and Pain”Journal Child Neurology, 28(8): pp993-1001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124736/

Bueno, N., Vieira de Melo IF., Lima de Oliveira, S. & da Rocha Ataide, T. (2013) “Very Low carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials,” British Journal of Nutrition, 110(7), pp 1178 – 1187. http://doi.org/10.1017/S0007114513000548  

Dashti, HM., Mathew, TC., Khadada, M., Al-Mousawi, M., Talib, H., Asfar, SK., Behbahani AI. & Al-Zaid, NS. (2007). “Beneficial Effects of Ketogenic Diet in Obese Diabetic Subjects.” Journal of Molecular Cell Biochemistry. 302(1-2), pp 249-256. http://doi1007/s11010-007-9448-z

McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD. (2017). A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes, 2(1): p5. http://doi.org/10.2196/diabetes.6981

Mavropoulos, J. C., Yancy, W. S., Hepburn, J., & Westman, E. C. (2005). The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition & Metabolism, 2, 35. http://doi.org/10.1186/1743-7075-2-35

Stafstrom, C. E., & Rho, J. M. (2012). The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders. Frontiers in Pharmacology, 3, 59. http://doi.org/10.3389/fphar.2012.00059

© 2020 Lifestyle Planning QLD Trust

Category: QIM

Cancer and Polyphenols

Other than the obvious nutritional benefits of the added fibre and essential vitamins and minerals, it is the polyphenols, (which are a subgroup of phytonutrients of plants) that have really caught researchers’ and food manufacturers’ attention in recent years. There are over 8000 different polyphenols that have been identified and it is their antioxidant properties that are believed to assist in the prevention and treatment of diseases associated with oxidative stress such as cancer and cardiovascular disease.

Antioxidants basically work like mops in our body and help to neutralise free radicals, thereby protecting cells from free radical damage. When there is not enough protection from free radicals, normal cell function is compromised, which can lead to tissue degradation and increase the risks of developing chronic diseases like cancer, Alzheimer’s disease, cardiovascular disease and so on (Scalbert et. al, 2005).

As secondary metabolites of plants, polyphenols are generally involved in defence against ultraviolet radiation or deterrence of pathogens and may contribute to the bitterness, astringency, colour, flavour or oxidative stability of a plant. Of particular interest are a group of phytochemicals called phytoalexins that protect plants against insects, fungal attacks and UV damage (Tan et al, 2007).These particular compounds also support the destruction and elimination of damaged cells, before they have time to accumulate and make us sick.

Usually normal healthy cells stop dividing at the end of a natural life cycle and die, whereas those that are exposed to excessive free radical damage can start to replicate at abnormal rates, leading to abnormal cell growth that defies this natural cell cycle. Research indicates that these bitter phenolic compounds are used in natural cell cycle regulation through their ability to achieve apoptosis or cell death of abnormal cells (both cancer and pre cancer cells) whilst having no impact on normal healthy cells. This is believed to be due to their affinity for cells that contain a specific enzyme called CYP1B1 found only inside abnormal cells. When phytoalexins enter a cell containing CYP1B1, a process of molecular activation of the occurs, which ultimately results in the abnormal cell ceasing to grow or die. Therefore, this relationship between these bitter compounds and CYP1B1 results in a highly targeted, dietary rescue mechanism for killing cancer cells (Potter and Burke, 2006). This fascinating understanding may be the basis for our evolutionary defence against cancer development.

Phytoalexins are found in abundance in the outer layers and skins of fruit and vegetables and are what gives fresh produce their bitter taste. Unfortunately due to a range of factors including modern farming methods, pesticide spraying, genetic modification, food processing and preparation as well as environmental conditions, it is estimated that despite our efforts to eat plenty of fresh fruit and vegetables, we are consuming very little of these bitter compounds compared to that would have occurred in our diet 100 years ago (Tan et al, 2007).

Explanations for why our diets have become so deficient in these health-promoting natural bitter polyphenols include:

  • Modern Farming Methods: As these bitter compounds are our plants natural pesticides, commercial farming methods including pesticide spraying has led to a gradual decrease in the levels of these natural pesticide fighting compounds in our fruit and vegetables. This is why organic produce is far superior in nutritional quality than regular fruit and vegetables in our food supply.

  • Modern Crop Varieties: Human preferences has resulted in the selection of sweeter tasting plants over time that produce fewer of these bitter compounds over the more traditional bitter varieties that would be far richer in these natural compounds.

  • Harvesting: Crops are usually harvested before they have had time to ripen on the plant, effectively reducing their nutritional value, including the levels of these bitter compounds. Transportation and cold storage of produce negatively affects polyphenol levels in fruit and vegetables.

  • Food Processing and Preparation: Often the skin, pith and roots are discarded in modern day food preparation, which often contain the highest levels of these polyphenols. In addition to this, many of these compounds are water-soluble and leach out during cooking processes.

  • Insufficient intake: Most Australians simply do not eat enough fruit and vegetables. In fact, recent health survey statistics have shown that less than 6% of Australians consume sufficient serves of fruit and vegetables on a daily basis (AIHW, 2012).

Evidently, it is now very difficult in today’s society to consume enough of these life-saving bitter compounds through diet alone. This has led to comprehensive research in the area and the development of a range of supplements that are essentially concentrated versions of these compounds to help supplement our nutrient poor diets.

For more information on polyphenols and how to improve your overall health and nutrition please speak to your QIM health professional.

References

© 2020 Lifestyle Planning QLD Trust

Category: QIM

Nutrigenomics

Basic concepts of genetics

DNA is a term that most people have heard of, it is an abbreviation for deoxyribonucleic acid, which refers to the hereditary material contained within almost all cells in living organisms including the human body. The building blocks of DNA are chemical molecules called ‘bases’, of which there are four possible options. While all DNA contains these four bases, the sequence in which the bases are arranged varies from person to person and is not only responsible for our unique inherited traits, but is necessary to instruct all cellular processes for life. A critical function of DNA is to act as a template for duplication when new cells are created in the body, a process which continually occurs as part of normal growth and repair, so that new cells contain an exact copy of the DNA.
Genes containing DNA are inherited from the parents by their offspring. While our genes and 99.9% of DNA in humans is identical, slight variations in the sequence of the DNA bases occurs and this is what contributes to a person’s unique inherited traits (such as hair and eye colour, weight and susceptibility for disease). All genes collectively (estimated to be approximately 22,000 genes) form the human genome, which contains all necessary instructions for cells to build and sustain life.
Often genes are providing the instructions to create a particular enzyme or protein. Enzymes (which can be proteins themselves) participate in the synthesis of a protein or may catalyse chemical reactions to facilitate crucial functions taking place inside of cells. A protein is a chain of amino acids which is determined by the sequence that the bases were organised in. The significance of a protein being created is that proteins are tasked with carrying out precise functions within a cell. This genetic process which starts with DNA and resulting into a protein being built is known as gene expression.
Altered gene expression can occur for a number of reasons, including a genetic variation. Genetic variation is usually the result of a change to a single base which is known as a single nucleotide polymorphism. This commonly sees an interaction between the gene and the environment (which includes nutritional and lifestyle factors) which may affect the gene’s abilities and changes the resulting protein and its biological activities. This type of genetic variation alone is not sufficient to cause disease, but can convey susceptibility to disease. By altering the exposure to the environmental factor, it is possible to regulate the gene and it’s variation to influence disease susceptibility. This is leads us to the fascinating topic of nutritional genomics (nutrigenomics).
What is Nutrigenomics

Nutrigenomics is a fast growing field of science that studies the relationship between our unique combination of genes and their interaction with nutrients. The growing understanding of how biologically active compounds from food can positively or negatively influence our state of health has attracted a great deal of interest from researchers, nutritionists and medical professionals who strive to utilise genetic information to deliver a truly personalised approach to healthcare by treating at an epigenetic level.
Whilst it was once thought that very little could be done about the genes that we were born with, we now know this is not necessarily true. Nutritional and lifestyle factors act as epigenetic signals to alter gene expression, in other words, acting as a switch to turn on or off the activity of a gene.
Reasons for testing

The accessibility to affordable testing coupled with enhanced understanding gene expression enables clinicians insight into their patient’s unique genetic makeup which serves to build on the evidence base that guides clinical decision-making and enables uniquely customised treatments to be developed. It can improve the accuracy of clinical management decisions by targeting nutritional and dietary advice and nutrient therapy to the individual’s unique genome. Testing can help to:
  • Reveal your sensitivities and susceptibilities (including to foods, specific nutrients and environmental factors)
  • Predict your responsiveness to particular dietary and exercise protocols
  • Improve the management of chronic conditions
  • Individualise preventative healthcare to reduce the risk of disease development
  • Optimise athletic performance and recovery
  • Direct prescription of medications by estimating the rate of metabolism and likely response (pharmacogenomics)

How you could benefit

Unfortunately there is no easy ‘one size fits all’ approach to health and you may find you are doing all of the ‘right things’, yet you are still facing persisting health problems. Knowing your genetic makeup may provide the answers you have been seeking and the missing keys to finally make progress in a particular area of your health.Consider weight loss for instance. Many popular diets may work for some, but not for others. Signing up for a gym weight-loss challenge may see some people lose lots of weight but for others, they lose no weight at all. Sadly, it’s not uncommon for people to end up eating very little and exercising excessively to achieve a ‘calorie-deficit’ in a last ditch attempt to shift weight and still weight loss does not prevail.

Nutrigenomic testing could help inform:
  • The most appropriate weight-loss diet plan based on your genetics and scientific evidence
  • How your body responds to fats and carbohydrates – would you benefit from eating more or less?
  • How your body responds to exercise – how much and at what intensity is needed for weight loss?
  • Behaviours to be aware of - whether you are prone to having a sweet tooth or snacking, expected satiety levels after eating, addictive tendencies etc
  • Whether your circadian rhythm (sleep cycle) plays a key role in retaining weight
  • Whether your genes are playing a role in your weight management struggles – have this confirmed and learn the tools to work with your genes rather than against them
Detection of gene variants

Testing is primarily seeking to detect variants in your genes because these variants influence how genes function, affecting biological and metabolic processes that impact on our health. It could be that a variation leads to an amplified or supressed metabolic process for example. This in turn, may have an important bearing on a person’s state of health or risk of developing disease.

Example
A gene variation may result in the amplification of the enzymatic activity dominant in liver detoxification of caffeine and the person may be classified as a ‘rapid metaboliser’ which is associated with protective health benefits. An alternative variant of the same gene could result in supressed enzymatic activity and the person be classified as a ‘slow metaboliser’ which is associated with poor tolerance and the potential for adverse health outcomes.

Often we hear that patients are apprehensive about receiving their genetic testing result. We assure them that there is no need to be alarmed when a gene variation is detected it doesn’t necessary mean that it is detrimental for health. Many variations are actually beneficial to have.

Example
A gene variant could mean that your body more efficiently removes lipids (fats) from circulation in your bloodstream. This has been shown to correlate with lower triglyceride levels in blood testing, higher levels of ‘good’ HDL cholesterol and lower blood pressure compared to people who do not have the gene variant.

It’s important to remember that gene variants that have been found to correlate with undesirable health outcomes like risk of developing a disease, can usually still be regulated or influenced epigenetically (eg; using nutrients or other compounds from food) to potentially mitigate the effects of the gene and achieve the desirable health outcome.

Example
A gene variant that means that your body has increased potential to produce higher levels of C-reactive protein, which is a marker of inflammation that circulates in the bloodstream. This has been shown to correlate with an increased predisposition to chronic inflammatory disorders. This may mean that anti-inflammatory interventions may hold specific benefits for you, compared to a person who does not carry that gene variant. It could be as simple as including certain anti-inflammatory foods or nutritional supplements such as Omega-3 fats to reduce the inflammatory process and therefore modify the impact the gene could have on many disease processes.

Genomic testing offered by QIM

In the past, genetic tests accessible to the public have tended to be more geared towards quantity over quality. On occasion, QIM clinicians would be presented with a result that tested genes with seemingly little scientific evidence to inform of the gene’s biological activity or little was known about their implication for health. These tests held little practical value for patients. Other tests were found to provide excessive amounts of genetic information associated with health, but because so many genes were tested, it was overwhelming for the patient and we saw them struggle to make meaningful diet and lifestyle changes as a result. For those reasons, we took it upon ourselves to investigate the testing options to determine the Nutrigenomic testing that was best suited to QIM patients.QIM now offers various genomic testing ‘panels’ which clusters genes tested under the specific area of health they function in. This is ideal for patients who undertake testing to answer a particular health-related question or curiosity as the genes tested will be strictly relevant and avoids ‘information overload’. Furthermore, only highly-evidenced genes with well-understood health implications are included in these panels. We have found that this allows patients to understand the important information contained within their result which translates into practical and highly achievable diet and lifestyle changes.

Panels currently available include:

DNA HEALTH PANEL

This panel provides the broadest overview of various critical biological functions that are key contributors to assessing your chronic disease risk. This panel is ideal for new patients to the clinic as it provides a great foundation of valuable information for your Doctor.

DNA Health tests 36 genes involved with:
  • Cholesterol metabolism and cardiovascular disease risk
  • Osteoporosis risk and bone health
  • Cancer risk and methylation
  • Inflammation
  • Oxidative stress
  • Detoxification processes
  • Type 2 diabetes risk and insulin sensitivity
  • Vitamin requirements and metabolism
  • Gluten and lactose intolerance
  • Caffeine and alcohol metabolism
  • Salt sensitivity and blood pressure
  • Iron overload disorders

DNA SPORT PANEL
This panel helps you to optimise your athletic training by understanding your key athletic strengths and weaknesses to maximise your genetic potential and reduce injury. Providing valuable information for athletes to provide to their personal trainers for development of a personalised training strategy.

DNA Sport tests genes involved with:
  • Oestrogen metabolism and related compounds
  • Risks for the use of hormone replacement therapy (HRT), the oral contraceptive pill, bio-identical hormone supplements and IVF based on your genes.
  • Genetic variations associated with a high risk for oestrogen driven conditions (ideal for those who have been diagnosed with oestrogen receptor-positive breast cancer).
This test does NOT test for BRCA genes, instead it looks at highly modifiable genetic variants to reduce your breast cancer risk - with or without a family history of breast cancer.

DNA SKIN PANEL

This panel help you to improve your skin’s health and resilience and reduce the signs of ageing.
DNA Skin looks at 19 genes involved with:
  • The effects of UV radiation and damage based on your DNA
  • Collagen formation
  • Firmness and elasticity
  • Premature ageing and wrinkles
  • Sun sensitivity, pigmentation, damage, protection and repair
  • Antioxidant defence against oxidative stress
  • Skin inflammation

DNA MIND

This panel provides understanding of the genetics behind your mental health.
DNA Mind tests 30 genes associated with:
  • Mood disorders (depression, anxiety, bipolar disorder, post-traumatic stress disorder, risk-taking behaviour and stress sensitivity)
  • Neurodegenerative disorders (Alzheimer's disease, dementia, cognitive decline and mild cognitive impairment)
  • Addictive behaviour risk (alcohol, nicotine, cannabis addiction and psychosis response, opioids and eating disorder)

How to get tested

It is important that genetic testing is only undertaken in the context of a comprehensive health assessment and under the guidance of a trained clinician who:
  • Understands the science behind the genes
  • Is trained in how to accurately interpret the results
  • Knows your health and medical history
  • Is well-placed to make insightful diet, lifestyle recommendations, adjust treatment or arrange screening tests
Testing is quick and non-invasive. A saliva specimen is collected by the patient at home and only takes a few minutes to complete. The saliva specimen is then sent in the mail to the laboratory with results taking approximately 4 weeks to be received.

To order your genetic test, please speak to our friendly Reception staff, or if you have questions speak to your QIM clinician during your next appointment.

References:

DNALife 2019, <www.dnalife.healthcare/>.

Genetics Home Reference 2020, Help me understand genetics, <www.ghr.nlm.nih.gov/primer/basics/dna>.

Sales, NMR, Pelegrini, PB & Goersch, MC 2014, ‘Nutrigenomics: definitions and advances of this new science’, Journal of Nutrition and Metabolism, vol. 2014, <www.ncbi.nlm.nih.gov/pmc/articles/PMC3984860/>.

Morad, R 2017, ‘How diet can change your DNA’, Scientific American, <www.scientificamerican.com/custom-media/science-for-life/how-diet-can-change-your-dna/>.

© 2020 Lifestyle Planning QLD Trust

Category: QIM

Allergen Immunotherapy

Allergies are extremely common and are increasing in Australia, with studies showing they now affect around one in three people at some time in their lives.

Allergy is the result of an excessive reaction by the immune system upon exposure to specific substances in the environment that are generally harmless to most people. Some of these include house dust mites, moulds, animal hair, insects, tree pollens etc.

Those with an inherited or genetic tendency to develop allergic diseases are said to be atopic. When an atopic person is exposed to an allergen, their immune system is over-activated leading to increased histamine levels.

This can then cause symptoms in the:

nose and/or eyes - hay fever (allergic rhinitis/conjunctivitis)

skin - eczema, hives (urticaria)

lungs – asthma

Effective prevention and treatment options are available for most allergies.

Treatment: Pharmacotherapy Vs Desensitisation

While pharmacotherapy medications such as anti-histamines, eye drops and intranasal corticosteroid nasal sprays are effective for fast symptom relief, they do not provide long-term relief and are not able to “cure” allergies.

Allergen immunotherapy (also known as desensitisation) on the other hand, is a long-term treatment, which changes the immune system’s response to allergens.

It involves regular administration of allergen extracts over an extended period of time via daily drops under the tongue (sublingual).

Allergen immunotherapy changes the way the immune system reacts to allergens, by “switching off allergy responses”. Over time, this results in you becoming immune to the allergens, so that you can tolerate these substances with fewer or no symptoms.

Allergen immunotherapy is the closest thing we have for a "cure" for allergy. While it is not a “quick fix” form of treatment, it can quickly reduce the severity of symptoms (usually within 10 days from the onset of treatment) and the need for medication for many allergy sufferers

Those undertaking allergen immunotherapy need to be committed to at least 18 months – 2 years of treatment for it to continue to work effectively.

Treatment is available to anyone over 5 years of age.

Sublingual allergen immunotherapy is available from QIM. Please contact Reception on (07) 3831 5111 to make an appointment to see one of our Doctors to discuss treatment.

For more information please visit the ASCIA website www.allergy.org.au

© 2020 Lifestyle Planning QLD Trust

Category: QIM

HIIT Training – What is the research showing?

Want to get in shape but just don’t seem to be able to find the time to exercise?  Well, what if we told you that effective weight loss and improvements in a range of chronic disease markers can be achieved doing only 5-10 minutes of all-out exercise a couple of days a week? That’s less time than it takes to make your morning tea and toast!

There is now a large body of research showing that high-intensity interval training or “HIIT” training is proving to achieve similar if not greater health benefits in far less time than conventional steady state exercise. This type of training involves only very short bursts of physical activity followed by recovery periods. The short, sharp nature of this style of training makes it particularly appealing for the time poor, the elderly and those who do not generally enjoy regular exercise.

What are the benefits of HIIT?
HIIT training has been shown to improve:

Abdominal fat and body weight while maintaining muscle mass

Aerobic and anaerobic fitness

Blood pressure

Cardiovascular and Pulmonary health

Insulin sensitivity and Type II Diabetes

Cholesterol profiles

Cognition

How does HIIT training work?

So, once you choose your exercise method (ie exercise bike, running, etc) all that is required is 4-6 sets of all-out efforts of 30-60 seconds followed by short recovery periods of 1-4 minutes. Do this 2-3 times per week and you will see just how effective this type of training can be.  For example, a 2014 meta-analysis on individuals with life-style induced chronic diseases, found that improvements in cardiorespiratory fitness, as measured by VO2 max, of those individuals who completed a HIIT exercise program were nearly double that of individuals who completed a steady state exercise program

Why is HIIT so effective?

The benefits are believed to be related to the fact that HIIT workouts tend to burn more calories than traditional workouts, due to the increased energy demands and fat oxidation in the post exercise period (known as EPOC or >Excess Post Exercise Consumption). EPOC is higher after HIIT training as this is the period in which the body restores itself to pre-exercise levels, which generally requires more energy after all-out high intensity exercise.

IMPORTANT: For your own safety and well-being, please seek advice from your healthcare professional before commencing any style of HIIT training to ensure that it is right for you.

References

[1] (Weston KS, Wisloff U, Coombes JS (August 2014). "High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis". Br J Sports Med (Systematic Review & Meta-Analysis) 48 (16): 1227–1234. doi:10.1136/bjsports-2013-092576)

© 2020 Lifestyle Planning QLD Trust

Category: QIM