Nutritional guide for patients and the general public.

Text extracted, condensed and summarised from the books “Third Millennium Homeopathy: the early decades”, “Elementary nutrition for

homeopaths” and “Elementary human nutrition for health practitioners” by Dr. Joe Rozencwajg, NMD.

© ™ ® to Dr. Joe Rozencwajg, NMD and Natura Medica, Ltd, August 2019.

PLEASE DO READ THIS BEFORE PROCEEDING: The following text is taken out of books for professional health practitioners. I have removed as much as possible of the specialised language, especially homeopathic one to simplify reading. Nevertheless, there are many “medicalese” concepts that you might not fully grasp or ask “what does that mean?”. It does not matter; skip it, don’t give up, read to the end and keep for reference. It will help. Thank you for reading.

 Colleagues regularly ask for my opinion or for help with some difficult cases. This feeds my ego, thank you very much, but it also made me realise that not too many of them have any real notion about nutrition and its importance in the maintenance of health. It sounds weird, but it is an unfortunate reality, that health practitioners do ignore the basic tenet of life: the need for proper and clean fuel to have our “engines” running, even though they would never dream of putting diesel in a petrol car. Neither would they try using an Apple programme on a Windows based computer. It sounded right to me to describe the basics of real human nutrition and to expand on how it influences the outcomes of our treatments for those who are still uncertain about it.

Recently, I had an “argument” on one of the homeopathic discussion lists of which I am a member: a colleague presented a case he was stuck with and asked for ideas; as usual I started with assessing and normalising nutrition, to which an extremely classical neo-Kentian pseudo-Hahnemannian rigid practitioner dryly commented “Similia similibus currentur, Sir!”, clearly meaning that the only way to treat is according to the Law of Similars, the rest being identical to bovine manure at best or treason at worst. I questioned this answer with this:

- Where does removing obstacles to cure (purely Hahnemannian) fit in with the Law of Similars?

- What about Hahnemann’s admonition about diet?

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- What about his recommendation about environment, removing patients from insalubrious conditions?

Needless to say, I never received any answer...amazing...

We spend a lot of time dealing with the effects of drugs, vaccines, environmental toxins, heavy metals, air and water pollution and whatever not to allow our remedies to work optimally. We practice Organotherapy, Drainage and Detoxification, sometimes using sophisticated methods, supplements and remedies. Yet all too often the basic daily diet is neglected, not investigated or the patient who says “I have a pretty healthy diet” is fully trusted, the concept of “healthy diet” not being assessed at all.

Toxic food is a major obstacle to cure, as my experience over the years has shown. Having the patient adopt a really human, healthy nutritional pattern before or during a deep-seated treatment will simplify it and make it “hold”. This is the purpose of this little work: proper, real human nutrition according to science, not to fad. This is not nutritional medicine, in which specific foods or supplements, often in doses well above what can be achieved by eating or drinking, are used to treat pathologies; that is the field of Clinical Nutrition, which is worth studying but is not main stream to the practice of Homeopathy. Although aimed mostly at Homeopaths, the information included here is valid for any other therapeutic modality, including Techno-Chemical Medicine. That information, with reference to homeopathy expunged, is available in the book “Elementary human nutrition for Health Practitioners”.

Of course, I could simply provide the reader with a few paragraphs recommending this or that. Eventually, that is what it would all be about in practice. As practitioners, we need to be able to back up our recommendations intelligently. Patients are doing their homework, searching the internet and receiving conflicting information. Our role is to dissipate the mist of fad diets, illogical and irresponsible feeding patterns and to provide our patients with well researched and grounded facts, not fancies. To do that, many references, studies and researches are included here. Not everybody will be interested in any of it, so feel free to skip, but when asked to “please explain” this will be a very handy tool.

Here is a list of complaints we often hear in our consultations:

• Daydreaming in school

• Difficulty in finishing sentences and finding words

• Speech delay

• In and out of Special Education classes

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• Delays in walking and talking

• Delayed puberty including menarche

• Vitamin deficiencies

• Non-epileptic seizures

• Arthritis and osteopenia

• Short term and long term memory is not good

• Many reports of struggles with school but score high in intelligence

• Misdiagnosis of fibromyalgia

• Visual and auditory delusions

• Anxiety problems, tummy aches

• Temporary dyslexia

If we add a few modalities and concomitants, some SRP symptoms, some other mental and emotional ones, we get a pretty good list of rubrics, don’t we? And we will surely find magnificently indicated remedies.

But here is what happened when a single compound was removed from the diet of this group of patients:

• Improved ability to learn

• Improved interest in school

• Improved concentration

• No more meds for depression problems

• No more avoidance of meeting people

• Expected full recovery of ataxia problems (inability to coordinate muscle movements)

• Improved gross motor skills (was delayed in some cases)

• Improved physical growth (was smaller than expected)

• Went from bottom of class to the top of his class after 3 months on diet

• Found a "hunger" for learning

• Improved mood with less “crossness” and “crankiness”

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• Improved development to catch up with peers

• Improved intellect with definite increases in intelligence

• Grade point average went from 2.5 to 3.9

• Many have acquired college degrees

• Came alive academically

• Improved ability to meet daily challenges

• Improved speed of learning ("quicker" in her studies)

• Absenteeism no longer a problem

• Lots of stories about coming out of withdrawn state socially to an outgoing one, running for student council, more motivated in doing well and meeting people

• Increased well-being and better brain chemistry

• No more "brain fog"

• Improved in reading (“noticeable”)

• Improved temperaments in children

The compound removed was gluten. Those results were reported in the following publications, highly conventional and peer-reviewed for those who find this notion of any importance:

1. K. Horvath, MD, PhD, et al; Gastroenterology, April 1996: “First Epidemiological Study of Gluten Intolerance in the United States”

2. Etty Benveniste, PhD.; American Journal of Physiology 263, 1992: “Inflammatory Cytokines within the central nervous system: sources, function, and mechanism of action”

One of our major, most pleasurable and vital daily activities is eating. Sounds like an oxymoron, doesn’t it? But think about it: most humans will eat whatever is on their plate (if they have a plate) as long as it gives them a sensation of fullness, quietens their hunger and tastes relatively good, without thinking twice. Yet, my cats and my dog would not do that. They are not really fussy eaters, on the contrary, more garbage disposing animals, but I learned that if they refuse to touch whatever is in their food bowl, there is something wrong with it. Our household has even developed a food safety procedure based on that fact: should we have any doubt about the edibility of any animal based food we have at home, we offer them a piece, raw or cooked; if they eat it, it is safe for us, if they snob it, we throw it out. Stop laughing! It works and it is more precise than lab analysis, although they do not provide us with a printout of their findings, unless we step in it. Indeed, they have a different immune system and would tolerate many things that would make us sick, but if

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even they refuse to eat something, there is definitely something wrong with it. Most humans seem to have lost that ability, although years of experience have shown me that after resuming the consumption of real human food for only a few years, we can again determine if something is safe to eat just by the smell or taste of a small bite. It is a normal, natural ability we all have, that has been suppressed by what I call “dysnutrition” since conception. No wonder the whole of humanity is getting sicker and sicker even without the help of pollution, petrol, fracking, EMF, Fukushima and Chernobyl.

This of course leads to treatment failures, no matter which type of medicine you practice. Ingesting toxic substances in cumulative doses is the major obstacle to cure by any means. Simply restoring a human nutritional pattern is often enough to make many symptoms, signs and complaints disappear, hence making our case taking, repertorisation and prescriptions a lot easier or even not necessary at times. Some people will need deeper and more aggressive approaches as has been described in the book and on-line video course “Organotherapy, Drainage and Detoxification” (see my website www.naturamedica.co.nz for details).

It goes further than that. During a consultation, the patients open to us and, we do hope, trust us. This is one of the best opportunities to teach them about healthy lifestyle and health maintenance, no matter whether they need a treatment for a condition or a situation or not, and no matter which type of therapy is used. It does not take very long. It is our duty to use every opportunity to enhance the well-being of the population one person at a time. Grass-root revolution works best.

When I began considering the impact of food on my patients’ health and ability to recuperate from surgery, last century, I started with the conventional food pyramid that was part of the impressive fully extensive one and a half hour of nutritional education I received in medical school. Little good did that do to them. It took some time until I realised I was approaching the problem through the wrong end. As is customary in Techno-Chemical Medicine, I was trying to forcefully fit people into a preconceived and incorrect format instead of finding out what each individual needed specifically. The question I needed to ask, and answer, was simply this one: “what type of nutritional pattern, or in simpler words “what type of foods”, is unique and optimal to human beings, to the human race in general?” The answer was found in anthropology: the nutritional pattern that we inherited and has not changed biologically since the time we were Neanderthals and Cro-Magnons. We still are Primates. Or if you despise evolution and prefer creationism, our metabolism, chemistry and biology is extremely similar, if not identical, to that of primates. Variations between humans are also similar to variations between races of primates: some of us need and thrive on a higher intake of animal proteins, like baboons, the hunters of the ape kingdom; others are happy with a vegan-like diet, like gorillas and orang-utans, who still will not reject a snack of insects or small frogs; and then we have those in-between, like the chimpanzees and bonobos, whom we think of as vegetarians but in fact actively forage for

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ants and other insects and do not hesitate to go on hunting trips (see some extraordinary movies on the National Geographic and Discovery channels!). The famous anthropologist Richard Leaky (The Origin of Humankind. Science Masters Series, Phoenix Press. ISBN 1857993349)

demonstrated that the evolution from a terrestrial bipedal primate like Homo Erectus into the modern human being was linked to the increase in brain volume, itself linked to the adoption of a more carnivorous diet. So, the answer was quite simple and obvious: we are still physiologically hunters-gatherers and our optimal diet is that of the caveman, known today as the Palaeolithic diet.

In order to implement it successfully we have first to understand and be able to explain to our patients which foods are not edible and why. This can be a difficult task at times and often needs the backup of well conducted research. Controversy is raging. Even prolific writers of naturopathic textbooks are defending the consumption of “non-human” foods with the backing of research coincidentally published in nutritional journals sponsored by industrial food consortiums...you will forgive me the sarcasm. Conventional dieticians and nutritionists, trained through grants and support coming from cardboard packaged foods and snacks that are new and improved as well as loaded with supplemental synthetic vitamins and grounded dirt called minerals, publicly lament and share their worry on radio, television and in newspapers about how we miss all the good nutrition contained in those boxes.

We will start our journey by looking at “foods” that must at all cost be eliminated, no matter what else is done, and no matter what other style of nutrition is later adopted. The main obstacle to their elimination is not scientific, but emotional: they taste good and they have been used by most of humanity for centuries. They are traditional foods as we will see, embedded in our cultures, our civilisations, our traditions, our folklores and often our religions. The main argument is that “humanity has consumed those products for thousands of years; they are part of us now”. This affirmation is correct, but it confuses biological evolution with social evolution. Our “machinery”/biology/genetics is flexible and adaptable but only up to a certain point. Whereas the occasional ingestion of a “forbidden” food is not problematic and is often a welcome reward and pleasure, especially in the healthy person, it is the continuous input of wrong substances for the wrong reasons that is leading to chronic disease and suffering. More on that later.

Gluten, wheat and other cereals.

Cereals, and especially wheat in the form of bread, have been with humankind since the transition from hunter-gatherer to pastoral and agricultural civilisation. Actually, this is not completely true. Like everything that can be found in nature, cereals have certainly been eaten by paleololithic humans when they were ripe and ready to be harvested. Why have

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they become the enemy now? While we go through their components and the associated problem, it will become clear.

Gluten.

Gluten forms 80% of the proteins contained in wheat. It is a combination of gliadins and glutenins. Proteins from the seeds of cereal grains (the family of grasses, Graminaceae, Triticum) are albumins, globulins, glutelins such as glutenin and prolamins. Prolamins found in cereals are gliadin in wheat, hordein in barley, secalin in rye, avenin in oats, oryzenin in rice, zein in corn, setarin in millet and kafirin in sorghum. There are multiple glutenin fractions and subunits. Gliadin itself is subdivided in alpha, beta, gamma and omega gliadins, and alpha gliadin itself has multiple sub-units. This enumeration immediately points to a diagnostic problem when patients tell us they have undergone tests for celiac disease and found negative: the test looks for antibodies against gliadin only. First, there is the need for gliadin to have penetrated the intestinal wall and gone into the blood stream, creating a general immune reaction, not only a local, intestinal one. Then which subgroup of gliadin is tested? Glutenin is not tested and the other prolamins are not tested. On top of that, different genes can be present or absent in different patients, coding for sensitivity. Even with no gene coding for any sensitivity, we are still left with the biochemical, toxic action of the prolamins, leading to a later, maybe “gentler” health problem, but still an avoidable pathology. Genes coding for gluten intolerance are now tested; but which genes? for gliadin, glutenin, prolamin? Which subunits? And genes for other proteins belonging to other cereals are not (yet) tested for. The blood test is therefore irrelevant unless it is positive, as are all tests. The only precise tests are through total abstinence followed by the disappearance of symptoms and signs and witnessing the return to normal of intestinal villosities by endoscopy. The list of prolamins also shows that, despite what is written in the literature about rice, corn, millet and sorghum being gluten-free hence safe to eat, there is a degree of cross-reactivity depending on the genetic make-up of each patient. Those cereals should also be avoided.

This is not a treatise about gluten and cereals, so I will avoid going into too many details, even though I imagine many readers will disagree with that affirmation after reading what follows. It is nevertheless important to understand what types of pathologies and diseases can occur with those and other “non-human” foods in order to give a proper explanation to the patients and not just an opinion. My experience is that showing to patients that proper research has been conducted by members of the “conventional” scientific community and published in the famous peer-reviewed journals is a criterion of acceptance. It works better than “trust me, I know what I am talking about”.

Gluten and the gastro-intestinal tract.

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The best-known and most obvious problem is Celiac Disease (CD). Gliadin forms an immune complex inside the intestinal mucosa, then damages it. Interestingly, even the Merck Manual, Seventeenth Edition, Chapter 30: Malabsorption syndromes, writes that CD “can be asymptomatic” at the same time as it says that there is no typical presentation. Diarrhoea, steatorrhea (diarrhoea with high fat content), abdominal pain, abdominal discomfort, distension and bloating, abdominal cramps are the major digestive complaints. This is often a main cause for consultation and generally automatically classified as Irritable Bowel Syndrome (IBS) if the anti-gliadin antibodies in the blood test are negative. Obviously, gluten intolerance/sensitivity has a wide spectrum of expression, ranging from full-blown celiac disease to minor inconveniences that are often dismissed as part of normal life.

Using one of those remedies might very well alleviate the symptoms and complaints, but it will not change the immunological reaction happening with exposure to gluten as well as the changes in the intestinal mucosa, if they occur at all, as evidence accumulates that CD can occur without villous atrophy in the intestinal mucosa (Celiac Disease Without Villous Atrophy,

Digestive Diseases and Sciences, April 2001, Volume 46, Issue 4, pp 879887, with 35 references). Simply removing gluten from the diet will not only make the symptoms disappear, it will allow a full repair of the mucosa, the disappearance of the immunological process and of any other pathology linked to gluten and leave us with the real symptoms, the deep disturbances of the patients, those that belong to him, not those created by toxic exposure. Those other gluten related pathologies are not benign! Of course, we can expect the usual ones linked with malabsorption of foods, minerals and vitamins, like all forms of anaemia, osteoporosis and osteopenia, fatigue, weakness, failure to thrive in children, etc......and we often wonder why our remedies have no effect, we start doubting homeopathy, whereas what we are confronted with is simply a very strong but unrecognised obstacle to cure.

Gluten and cancer.

There is a growing and alarming number of cancers in children. Is gluten to be blamed? Here are the conclusions of a study group:

Conclusions: Twenty-one new cases of cancer and CD in children in Europe were found. Cancer and CD in children are underreported. A remarkable number of thyroid and small bowel cancers were found, suggesting a possible relation with CD. It is important to evaluate whether these findings are coincidental. All cases of cancer and CD in children should be reported to the literature. (Cancer in Children With Celiac Disease: A Survey of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. Schweizer, Joachim J.*; Oren, Anath*; Mearin, M. Luisa*; The Working Group for Celiac Disease Malignancy of the European Society for Paediatric Gastroenterology. Hepatology Nutrition. Journal of Pediatric Gastroenterology & Nutrition: July 2001, Volume33, Issue 1, pp 97-100).

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Dermatitis herpetiformis is a skin pathology related to gluten and has a higher incidence of malignancy: In six of the seven patients who developed malignancies small intestinal biopsy specimens were macroscopically abnormal, giving a relative risk of 4.22 in this group, which is similar to that reported in adult coeliac disease. Patients treated with a gluten free diet appeared to have a reduced risk of developing malignancy compared with those taking a normal diet (relative risk with gluten free diet 1.01 and with normal diet 3.09). A small subgroup of eight patients with linear IgA dermatitis herpetiformis were also studied: three developed malignant disease and in one the tumour was a lymphoma.

(Increased incidence of malignancy in dermatitis herpetiformis. J N Leonard, W F Tucker, J S Fry, C A Coulter, A W Boylston, R M McMinn, G P Haffenden, A F, Swain, L Fry. BMJ 1983;286:16)

The thyroid is not spared as the following article shows.

Patients with celiac disease have an increased rate of malignancies that are not limited to lymphomas. Thyroid carcinoma has not previously been associated with celiac disease. However, among a cohort of patients with celiac disease, we identified an increased risk of papillary carcinoma of the thyroid, standard morbidity ratio of 22.52 (95% confidence interval 14.90–34.04; P < .001), compared to United States national surveillance data. These patients were on a gluten free diet. Only 1 had Hashimoto's thyroiditis, suggesting that mechanisms apart from autoimmune thyroiditis contribute to the increased risk of carcinoma of the thyroid in celiac disease. (Increased Risk of Papillary Thyroid Cancer in Celiac Disease. Digestive Diseases and Sciences, October 2006, Volume 51, Issue 10, pp 18751877).

And this conclusion is clear-cut: A significant decreasing trend in the excess morbidity rate over increasing use of a GFD was found. The results are suggestive of a protective role for a GFD against malignancy in coeliac disease and give further support for advising all patients to adhere to a strict GFD for life (GFD stands for gluten free diet). (Malignancy in coeliac disease: effect of a gluten free diet. G K Holmes, P Prior, M R Lane, D Pope, R N Allan. Gastroenterology Unit, General Hospital, Birmingham. Gut 1989;30:333338).

Who would have thought that Lymphomas and Gluten were associated? Objectives: Gluten sensitive enteropathy, including coeliac disease and dermatitis herpetiformis, is associated with non-Hodgkin lymphoma (NHL), and particularly enteropathy associated T-cell lymphoma (EATCL). We conducted a meta-analysis to quantify the association. Conclusions: Where gluten sensitive enteropathy was diagnosed using modern techniques, NHL risk was increased fourfold. At this level, one in 2,000 persons with gluten sensitive enteropathy develops NHL each year. (Non Hodgkin lymphoma and gluten sensitive enteropathy: estimate of risk using meta-analyses. Cancer Causes & Control. October 2011, Volume 22, Issue 10, pp 14351444).

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Doesn’t that qualify gluten as an easily avoidable cause of cancer? Our task is extremely more complicated when confronted with a cancer patient. Cancer is the final evolution of a disease; it is often a “one-sided disease” as it has become independent from the normal physiology’s control; and we all too often see those patients after they have been rejected by conventional medicine as having become incurable, after numerous bouts of destructive radiotherapy and chemotherapy. It is our ethical duty to prevent this outcome by educating our patients, no matter what their presenting complaint is, towards avoidance of a harmful toxin.

Gluten and the liver.

After having wreaked havoc in the gut, the next station for gluten will be the liver. Be aware that one of the actions on the gut is to open the tight junctions between the mucosal cells, therefore creating the famous “leaky gut”. This means that other substances that should not get into the blood stream and to the liver can now pass: foreign undigested proteins, part of dead bacterias, full bacterias, viruses, parasites, etc ...we will see later the importance of this phenomenon. For now, let us concentrate on the action of gluten on the liver.

Quoting from a few papers:

“Gluten sensitive enteropathy has been reported to occur concomitantly with liver abnormalities, such as primary biliary cirrhosis, chronic active hepatitis and primary sclerosing cholangitis.... Duodenal biopsy was performed in nine children (all with short stature, five with chronic diarrhea and three with hepatosplenomegaly of unknown etiology) with a possible diagnosis of gluten sensitive enteropathy..... Intestinal mucosal histopathology was compatible with gluten sensitive enteropathy in all patients. After a gluten free diet, levels of transaminases fell to normal within 3 months and remained so in seven of these patients. A second intestinal biopsy, which was performed after 1year of gluten free diet revealed normal intestinal mucosa in all patients. Conclusion: Gluten sensitive enteropathy should be considered when evaluating a child with elevated levels of serum transaminase and in cases with cryptogenic liver disease.” (AltuntaŞ, B., Kansu, A. and Girgin, N. (1998), Hepatic damage in gluten sensitive enteropathy. Pediatrics International, 40: 597–599.)

“Although the spectrum of liver abnormalities associated with celiac disease is particularly wide, two main forms of liver damage, namely cryptogenic and autoimmune, appear to be strictly related to gluten sensitive enteropathy. The most frequent occurrence is a cryptogenic hypertransaminasemia, present in about a half of untreated celiac patients..... characterised by a histological picture of non-specific reactive hepatitis (celiac hepatitis) reverting to normal after a few months of gluten withdrawal. (Liver dysfunction in

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celiac disease. Volta U. Department of Clinical Medicine, St.Orsola Malpighi Polyclinic, University of Bologna, Bologna, Italy. Minerva Medica [2008, 99(6):619629])

A few more references about the liver and gluten:

Liver involvement in celiac disease. The Indian Journal of Pediatrics. September 2006, Volume 73, Issue 9, pp 809811

Autoimmune Liver Disease Associated With Celiac Disease in Childhood: A Multicenter Study. Silvia Caprai, Pietro Vajro, Alessandro Ventura, Marco Sciveres, Giuseppe Maggiore, SIGENP Study Group for Autoimmune Liver Disorders in Celiac Disease. Clinical Gastroenterology and Hepatology. Volume 6, Issue 7, July 2008, Pages 803–806

Celiac disease in patients with severe liver disease: Gluten free diet may reverse hepatic failure. Gastroenterology. Volume 122, Issue 4, April 2002, Pages 881–888

Gluten and the skin.

The most frequent skin problem linked to gluten is Dermatitis herpetiformis:

REUNALA, T., BLOMQVIST, K., TARPILA, S., HALME, H. and KANGAS, K. (1977), Gluten free diet in dermatitis herpetiformis. British Journal of Dermatology, 97: 473–480.

Note the date, 1977: it is not a new problem.

In the Merck Manual, Seventeenth Edition, page 830, we can read this: “Asymptomatic gluten-sensitive enteropathy is found in 75 to 90% of patients and in some of their relatives”. Asymptomatic is the important word: no digestive complaints, nothing else but a skin problem. The clinical presentation of dermatitis herpetiformis is that of a chronic eruption of gradual onset with intense itching, vesicles, papules and urticaria-like eruption. The conventional treatment of this pathology consists of the drugs Dapsone and sometimes sulfapyridine or colchicine; a common side effect of Dapsone is haemolytic anaemia.

Many remedies that appear are polychrests and well known, we would not hesitate to use them, isn’t it? That is when we are confronted with the frustrating situation of an apparently well-indicated remedy not having any action, or minimal at best. Simply eliminating the aetiology, the maintaining cause, the obstacle to cure, which is totally in line with the so-called Classical Homeopathy of the purists, can at best cure the whole problem and at least put the deeper imbalance of the patient to the forefront, with symptoms and signs belonging to him and not created artificially by a toxic substance. Then we can proceed with real homeopathy.

I am not personally aware of any other labelled dermatological condition specifically related to gluten. Some cases have been reported where a direct link has been found:

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Psoriasis: Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet G. Michaëlsson, B. Gerdén, E. Hagforsen, B. Nilsson, I. Pihl-Lundin, W. Kraaz, G. Hjelmquist and L. Lööf. British Journal of Dermatology Volume 142, Issue 1, pages 44–51, January 2000

Vasculitis: Cutaneous vasculitis complicating coeliac disease.S Meyers, S Dikman, H Spiera, N Schultz, H D Janowitz. Gut 1981;22:61-64

Bullous Dermatosis: Linear IgA bullous dermatosis responsive to a gluten-free diet. Conleth A Egan MB, MRCPI et al, The American Journal of Gastroenterology (2001) 96, 1927–1929

SLE: Gluten-Sensitive Enteropathy and Systemic Lupus Erythematosus. Anil K. Rustgi, MD; Mark A. Peppercorn, MD. Arch Intern Med. 1988;148(7):1583-1584.

Remember the physiopathology: gluten creates a leaky gut; a leaky gut allows gluten and many other foreign toxic substances to penetrate the body; they need to be eliminated and the skin is one of the vicarious emunctories; therefore many cases of eczema, dermatitis or any other denomination of skin pathology could be and often are gluten related. We do not need any other way to prove it than to eliminate gluten from the diet and see what happens. Even if the skin situation does not change, the general health and long-term prognosis of the patient will improve.

Gluten and diabetes.

The number of cases of diabetes is continuously increasing. Obesity, simple sugars and carbohydrates excessive consumption are rightfully pointed out as culprits. Gluten, which comes with the carbohydrates, seems to be an essential contributing factor in most of the cases acting through pathological activity of the immune system and the interaction with a modification of the bacterial flora as well as a leaky gut.

The “Perfect Storm” for Type 1Diabetes. The Complex Interplay Between Intestinal Microbiota, Gut Permeability, and Mucosal Immunity. Outi Vaarala, Mark A. Atkinson and Josef Neu. Diabetes October 2008 vol. 57 no. 10 25552562

A gluten free diet seems then to be essential in the treatment of diabetes, but also in its prevention, as shown in this animal study:

Funda, D. P., Kaas, A., Bock, T., TlaskalováHogenová, H. and Buschard, K. (1999), Gluten free diet prevents diabetes in NOD mice. Diabetes Metab. Res. Rev., 15: 323–327.

Their conclusion is clear: “We showed that gluten free diet both delayed and to a large extent prevented diabetes in NOD mice that have never been exposed to gluten.”

Any parent knows how much bread, sandwiches, biscuits, cakes, crackers, buns, pancakes, muffins, donuts, pasta, pizza, and more children consume all day every day. Compound that with the amount of sugar those foods provide, and you have the perfect mix for the appearance of a metabolic syndrome in children and youngsters. Recent publications

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in the general press lamented that many young persons were now presenting “old age diseases”: diabetes, hypertension, osteoporosis and more. Do you still wonder why?

Gluten and neuro-psychiatric problems.

Here is part of the abstract of an important article:

“...Neurological manifestations of gluten sensitivity, with or without enteropathy, are also frequent, their pathogenesis including an immunological attack on the central and peripheral nervous tissue accompanied by neurodegenerative changes. The clinical manifestations are varied, but the most common syndromes are cerebellar ataxia and peripheral neuropathy.”. (Neurological disorders associated with gluten sensitivity. Rev Neurol. 2011 Sep 1;53(5):287300. Hernandez Lahoz C , Mauri Capdevila G, VegaVillar J, Rodrigo L.)

In another paper, we find this:

“...Neurologic complications are estimated to occur in 10% of affected patients, with ataxia and peripheral neuropathy being the most common problems. .... Conclusion: CD is commonly associated with sensory neuropathy and should be considered even in the absence of gastrointestinal symptoms.” (Celiac neuropathy R. L. Chin, MD, H. W. Sander, MD, T. H. Brannagan, MD, P. H.R. Green, MD, A. P. Hays, MD, A. Alaedini, PhD and N. Latov, MD PhD. Neurology May 27, 2003 vol. 60 no. 10 15811585).

Of course, there are other causes of cerebellar ataxia and peripheral neuropathy, diabetes being one of the major ones. Suddenly, here is another cause very simple to eliminate. Even though gluten elimination might not completely resolve the problem, at least a serious contributing synergistic factor is out of the picture and seriously simplifies our work, while at the same time avoiding the emergence of other problems.

For many of us, autism is an almost daily opponent. We delight in rightfully accusing vaccines and trying to neutralise their effects.

The University of Florida, Department of Pediatrics, Division of Genetics and Metabolism comes to our rescue. In a newsletter published 23/3/2015 and available at: https://www.peds.ufl.edu/divisions/genetics/programs/autism_card/casein.htm they write: “...The autism hypothesis involves, like celiac disease, the toxic effects of small peptides, generally in the range of five to seven amino acids in length (termed casomorphin and gliadorphin, as noted below). It is believed that these peptides from gluten, as well as certain peptides from cow milk protein (casein), can somehow cross the intestinal microvillus barrier and reach the blood stream. The theory purports that these peptides can then gain access into the brain by getting past the blood brain barrier. In the brain, certain amino acid sequences of these peptides then compete with the natural peptides (e.g. hormone/neurotransmitter

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peptides) of the body that bind to opioid receptors. Opioid receptors are G protein‐ receptors that are on the cell membrane surfaces of neurons and they have far reaching signalling effects. As the theory goes, binding to these opioid receptors leads to a perturbation of neuronal function that ultimately causes or contributes to the problem of autism.”

Note the association of cereals and milk, the foundation of a “healthy breakfast that gives energy and brain power for the day’s activities” (sarcasm included at no extra cost!). This simply means, based on the findings and research of a strictly allopathic university whose members will have a fit if and when they realise a homeopath has used their research, that before engaging in repertorisation or complicated protocols when treating autistic patients, our first task is to correct their nutrition; we might be surprised to see that suddenly there is no more autism.

A full thesis has been written about this subject:

Autism and the gut - brain axis. Herman van Veen. Department of psychofarmacology, Utrecht University, Utrecht, Netherlands. 16 June 2011.

Some patients are probably committed to psychiatric institutions for life because of gluten. Am I exaggerating? Here is a case report:

“Abstract: Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders. A 38 year old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for antigliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.” (Gluten encephalopathy with psychiatric onset: case report. Nicola Poloni*, Simone Vender, Emilio Bolla, Paola Bortolaso, Chiara Costantini and Camilla Callegari. Clinical Practice and

Epidemiology in Mental Health 2009, 5:16)

You can read the full article here: http://www.cpementalhealth.com/content/5/1/16

Isn’t that frightening? Moreover, obviously our best remedies would have failed.

But is this a rarity or a widespread occurrence? The Lancet has an answer, published in 1996:

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“Background: Antigliadin antibodies are a marker of untreated coeliac disease but can also be found in individuals with normal small bowel mucosa. Because neurological dysfunction is a known complication of coeliac disease we have investigated the frequency of antigliadin antibodies, as a measure of cryptic gluten sensitivity, and coeliac disease in neurological patients. Interpretation: Our data suggest that gluten sensitivity is common in patients with neurological disease of unknown cause and may have aetiological significance.” (Does cryptic gluten sensitivity play a part in neurological illness? M Hadjivassiliou, MRCP, A Gibson, PhD, G.A.B DaviesJones, MD, A.J Lobo, MD, T.J Stephenson, MD, A MilfordWard, FRCPath. The Lancet, Volume 347, No. 8998, p369–371, 10 February 1996)

There is more:

Writing about Gluten Ataxia: “We previously have described a group of patients with gluten sensitivity presenting with ataxia (gluten ataxia) and suggested that this disease entity may account for a large number of patients with sporadic idiopathic ataxia. We have therefore investigated the prevalence of gluten sensitivity amongst a large cohort of patients with sporadic and familial ataxia..... Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia. Antigliadin antibody testing is essential at first presentation of patients with sporadic ataxia”. (Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Marios Hadjivassiliou , Richard Grünewald , Basil Sharrack , David Sanders , Alan Lobo , Clare Williamson , Nicola Woodroofe , Nicholas Wood , Aelwyn Davies Jones. ‐http://brain.oxfordjournals.org/content/126/3/685)

The same author writes in “Gluten sensitivity as a neurological illness. Hadjivassiliou et al. 72 (5):

560 Journal of Neurology, Neurosurgery & Psychiatry” (J Neurol Neurosurg Psychiatry 2002;72:560563): “It has taken nearly 2000 years to appreciate that a common dietary protein introduced to the human diet relatively late in evolutionary terms (some 10 000 years ago), can produce human disease not only of the gut but also the skin and the nervous system. The protean neurological manifestations of gluten sensitivity can occur without gut involvement and neurologists must therefore become familiar with the common neurological presentations and means of diagnosis of this disease.”

Gluten is also involved in Multiple sclerosis: Shor, D. B.A., Barzilai, O., Ram, M., Izhaky, D., PoratKatz, B. S., Chapman, J., Blank, M., Anaya, J.M. and Shoenfeld, Y. (2009), Gluten Sensitivity in Multiple Sclerosis. Annals of the New York Academy of Sciences, 1173: 343–349.

It has even been called “The Gluten Syndrome”: “Hypothesis: Gluten causes symptoms, in both celiac disease and non-celiac Gluten sensitivity by its adverse actions on the nervous system.... Gluten can cause neurological harm through a combination of cross reacting antibodies, immune complex disease and direct toxicity. These nervous system affects include: dysregulation of the autonomic nervous system, cerebella ataxia, hypotonia, developmental delay, learning disorders, depression, migraine, and headache. If gluten is the putative harmful agent, then there is no requirement to invoke gut damage and nutritional deficiency to explain the myriad of the symptoms experienced by sufferers of

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celiac disease and gluten sensitivity. This is called “The Gluten Syndrome”. (Medical Hypotheses. September 2009Volume 73, Issue 3, Pages 438–440. Rodney Philip Kinvig Ford. The Children’s Gastroenterology and Allergy Clinic, P.O. Box 25265, Christchurch 8144, New Zealand.)

There is indeed a biochemical basis demonstrated: “Peptides with opioid activity are found in pepsin hydrolysates of wheat gluten and alpha-casein.... Substances which stimulate adenylate cyclase and increase the contractions of the mouse vas deferens but do not bind to opiate receptors are also isolated from gluten hydrolysates. It is suggested that peptides derived from some food proteins may be of physiological importance”. (Opioid peptides derived from food proteins. The exorphins. C Zioudrou, R A Streaty and W A Klee. Journal of Biological Chemistry. April 10, 1979 The Journal of Biological Chemistry, 254, 2446-2449.)

A recent important in-vitro experiment conducted using bread and pasta instead of purified gluten, therefore mimicking closely daily food ingestion reached this conclusion:

"Previous lab tests have been done on pure gluten, but for the first time we have simulated digestion using real bread and pasta bought from the supermarket to see if these molecules are produced. We show that not only are these molecules produced during digestion, but they can also pass through the gut lining, suggesting that they could indeed have a biological effect." (Milda Stuknytė, Margherita Maggioni, Stefano Cattaneo, Paola De Luca, Amelia Fiorilli, Anita Ferraretto, Ivano De Noni. Release of wheat gluten exorphins A5 and C5 during in vitro gastrointestinal digestion of bread and pasta and their absorption through an in vitro model of intestinal

epithelium. Food Research International, 2015; 72: 208). Note the date, April 2015.

I make no apology for force-feeding you all those references about gluten. It is present everywhere and hidden in many forms in most processed and some allegedly unprocessed foods. Once the patient understands the extent of the damage that can be caused by one single component of “modern nutrition”, it will become a lot easier to switch consciously and voluntarily to healthy eating. The homeopathic practitioner will also better understand the importance of proceeding with this change and the relevance this has to case taking and remedy prescription.

The press and other medias have been both friends and enemies when it comes to gluten. Some “dieticians” and “nutritionists” have come strongly against withholding it with the arguments that those who eat gluten-free will miss on essential minerals, on vitamins and on roughage. As if there were no minerals and vitamins in fruits and vegetables and no roughage either. One wonders if they got their “degrees” in a box of healthy breakfast cereals enriched with 12 minerals and 5 vitamins for strong bones and a healthy brain, instead of a plastic toy.

Then there has been a plethora of articles titled “Gluten free diets are unhealthy and can be dangerous for you!” When you read those papers, the authors do not deny the existence of gluten sensitivity, although they minimise its importance. They also correctly point towards the fact that many patients replace their usual bread, cookies, and pasta with gluten-free ones: those are made of other cereals, allegedly healthy, laden with

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carbohydrates, baked in unhealthy fats that do not tolerate heat and often laced with additives to make them more palatable. The calories load is extreme and the sugar load overwhelming; we will soon see what extreme damage this approach can create. Unfortunately, the authors do not reach the proper conclusion: ditch all cereals, which will be explained in the following paragraphs.

Wheat and other cereals.

As if gluten was not enough, wheat contains even more elements that are noxious. First and foremost, the “Wheat Germ Agglutinin” (WGA). A naturally occurring lectin protecting wheat from insects, yeast and bacteria. What effect does it have on mammals and especially humans?

“WGA was particularly effective; it induced extensive polyamine-dependent hyperplastic and hypertrophic growth of the small bowel by increasing its content of proteins, RNA and DNA. Furthermore, an appreciable portion of the endocytosed WGA was transported across the gut wall into the systemic circulation, where it was deposited in the walls of the blood and lymphatic vessels. WGA also induced the hypertrophic growth of the pancreas and caused thymus atrophy.” (Br J Nutr. 1993 Jul;70(1):313-21. Antinutritive effects of wheat-germ agglutinin and other N-acetylglucosamine-specific lectins. Pusztai A, Ewen SW, Grant G, Brown DS, Stewart JC, Peumans WJ, Van Damme EJ, Bardocz S.)

It appears it can directly cause damage to many tissues and organs and can penetrate easily through the intestinal wall. It resists metabolisation, accumulates in the tissues and creates havoc: inflammatory, immunotoxic, cytotoxic, cardiotoxic, mimics insulin and creates leptin resistance.

A sample of other references:

Effect of wheat germ agglutinin on the interleukin pathway of human T lymphocyte activation.(J C Reed, R J Robb, W C Greene and P C Nowell. The Journal of Immunology, January 1, 1985vol. 134 no. 1 314-323)

Effects of wheat germ agglutinin on insulin binding and insulin sensitivity of fat cells. (J. N. Livingston , B. J. Purvis. American Journal of Physiology - Endocrinology and Metabolism Published 1 March 1980 Vol. 238 no. 3)

Effects of wheat germ agglutinin on human gastrointestinal epithelium: insights from an experimental model of immune/epithelial cell interaction. (Toxicology and Applied Pharmacology 2009Jun 1;237(2):146-53.)

Wheat germ agglutinin induces NADPH-oxidase activity in human neutrophils by interaction with mobilizable receptors. (Infection and Immunity.1999 Jul;67(7):3461-8.)

Lectin glycosylation as a marker of thin gut inflammation. (The FASEB Journal. 2008;22:898.3)

Antinutritive effects of wheat-germ agglutinin and other N-acetylglucosamine-specific lectins. (The British Journal of Nutrition 1993 Jul;70(1):313-21.)

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Analysis of lectin binding in benign and malignant thyroid nodules. (Arch Pathol Lab Med.1989 Feb;113(2):186-9.)

Wheat germ agglutinin-induced platelet activation via platelet endothelial cell adhesion molecule-1: involvement of rapid phospholipase C gamma 2 activation by Src family kinases. (Biochemistry. 2001 Oct 30;40(43):12992-3001)

This tells us clearly that WGAs are yet another toxic component of wheat that will act in synergy with gluten to destroy heath. The references given for both gluten and WGA are fairly recent, but others are old in terms of scientific knowledge. All those side-effects have been documented for a long time and are known or are supposed to be known by the medical and nutritional community. Setting aside the usual conspiracy theories, why is it that wheat is still considered as “the staff of life”, widely touted as a health food and recommended by almost everybody but a bunch of lunatics like myself? I even witnessed a Professor of Homeopathy from an Asian country where Homeopathy is not at all dismissed by the conventional medical community promote the use of wheat as a dietary approach to Psora! It took some effort from one of the conference organisers to prevent me from publicly attacking him. After all, if any drug, remedy, herb or supplement was demonstrated to have this vast array of nocivity, it would be banned immediately, its sale and distribution forbidden and its possession even for personal use subject to prosecution and heavy penalties. Does that sentence sound familiar? Of course it does, simply because gluten is addictive; see the opioid activity in this article, previously referenced to: Opioid peptides derived from food proteins. The exorphins. C Zioudrou, R A Streaty and W A Klee. Journal of Biological Chemistry. April 10, 1979 The Journal of Biological Chemistry, 254, 2446-2449.

This ability to create addiction, combined with that same addictive property of sugar, as we will learn in a few pages, easily explains the cravings we all have for bread and baked goods. I still drool and enjoy the smell of fresh bread when I walk past a bakery. That feeling of bliss and calm we have after a fabulous piece of good cake is akin to the feeling experienced during a good drug trip, or so I am told as I never took any drugs. Then we have that urge to take a nap, “for good digestion”: do you see the similarity with falling asleep after a drug trip? It is definitely a comfort food, having some nutrition and lots of opioid stimulation while not really impairing basic functions: one is not “drunk” although can be feeling a bit tired, one can drive and use heavy machinery almost safely.

Some authors see the prevalence of wheat and other cereals in society as way of controlling the crowds: the Roman Empire used it to shield itself from the ire of the citizens by giving them “Panem et Circenses”, bread and games; loaves of bread were given out free to those attending the games. We see the same now: slouched in front of the television, watching games and competitions while wolfing down pizzas, donuts, sandwiches, crackers, cookies, burgers and rinsing it down with high fructose sodas or even worse, the so-called “lite” versions. Next time you go to a supermarket, have a peek at other people’s trolleys. Is it a coincidence that the country in which the “Hunger games” happen is called “Panem”?

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Excerpt from “The origins of agriculture: a biological perspective and a new hypothesis by Greg

Wadley and Angus Martin” Published in Australian Biologist 6: 96-105, June 1993.: “Cereals have important qualities that differentiate them from most other drugs. They are a food source as well as a drug and can be stored and transported easily. They are ingested in frequent small doses (not occasional large ones), and do not impede work performance in most people. A desire for the drug, even cravings or withdrawal, can be confused with hunger. These features make cereals the ideal facilitator of civilization (and may also have contributed to the long delay in recognizing their pharmacological properties).”

Here are a few more references; note the years of publication, this is not a new discovery:

Ashkenazi, A. et al. (1980). Immunological reaction of psychotic patients to fractions of gluten. Chapter 13, Biochemistry of Schizophrenia and Addiction, 1980. ISBN: 9789400987081

Dohan, F. C, Grasberger, J. C, Lowell, F. M., Johnston, H. T. and Arbegast, A. W. (1969).

Relapsed schizophrenics: More rapid improvement on a milk and cerealfree diet. Br. J. Psychiatry, 115, 595

Dohan, F. C, Martin, L., Grasberger, J. C, Boehme, D. and Cottrell, J. C. (1972).

Antibodies to wheat gliadin in blood of psychiatric patients: possible role of emotional factors. Biol. Psychiatry, 5, 127

Eterman, K. P., Hekkens, W. T. and Pena, A. S. (1977). Wheat grain: a substrate for the demonstration of gluten antibodies in serum of gluten sensitive patients. J. Immun.Methods, 14, 85

Hekkens, W. Th. J. M. (1978). Antibodies to gliadin in serum of normals, coeliac patients and schizophrenics. In Hemmings, G. and Hemmings, W. A. (eds.) The Biological Basis of Schizophrenia, pp. 259–261. (Lancaster: MTP Press)

Mascord, I., Freed, D. and Durrant, B. (1978). Antibodies to foodstuffs in schizophrenia. Br. Med. J. 1, 1351

The Role of Gluten in the Etiology of Neurodevelopmental Disorders: Opioid and Immunological Mechanisms. Source: Nutritional Perspectives: Journal of the Council on Nutrition . Apr2007, Vol. 30 Issue 2, p1625. Author(s): Loscalzo, Ritamarie

Can we correlate this with homeopathy?

My colleague Judy Coldicott published this article in the online journal Interhomeopathy, May 2012: “Triticum vulgare: widely used in Substance, little known in Dilution”. Triticum vulgare is the scientific name for wheat. She described many symptoms that were present in her patients, of whom I will extract just a few that correlate well with all the references quoted:

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Depression. Mood swings. Poor concentration and memory, feeling as if drugged or sleepy. Lethargy/tiredness. Lack of coordination, stumbling.

Those and many others were helped by the prescription of Triticum vulgare in potency. From her comments, it appears that the remedy acted as a drainage one, helping the body to get rid of any remaining traces of gluten. That is Isotherapy if the symptoms are related to wheat ingestion, which is something we can only exclude if and when the patient has been clear from wheat (and other cereals as we will soon see); then it becomes a Simillimum.

Trying to find Triticum vulgare in the homeopathic literature was another difficult task, solved with the help of our Homeopathic Pharmacist, Mike Dong, from Simillimum in Wellington (many thanks to him). One publication was found in the journal “The Organon”, 1880, a few cases, essentially menstrual problems, not a real proving. Looking in the modern repertories, there are 3898 rubrics in the Synthesis Repertory, but not a single mention in the Complete Repertory, which I find amazing. A full proving was done by Peter Fredrichs (Friedrichs?) in Germany: there are 93 pages of rubrics that seem to be those used in the Synthesis repertory. The first 50 pages are Mind rubrics and correlate well with the pathologies described by conventional research. Neither Mike nor I could find the original publication.

This points also to another important Hahnemannian principle: remove the cause, the obstacle to cure, otherwise the best indicated remedy will not help. No gluten at all, period.

Other cereals.

Whereas gliadin is found in wheat, avenin is in oats, hordein in barley, secalin in rye, oryzenin in rice, zein in corn, setarin in millet and kafirin in sorghum.

I tried to find tri-dimensional structural representations of the different molecules but was unable to do so. Even so, the chemical similarities between them are obvious (I could not find one for kafirin though) and allow us to understand the cross-reactions that happen in some patients when you remove gluten from their diets while keeping other cereals. Symptoms and complaints persist, leading the patients and the practitioners to conclude: “there is no demonstrable gluten sensitivity” even after a clinical trial of abstinence, which leads to a return to gluten consumption and a therapeutic dead end.

Has that been demonstrated by conventional research?

“…Thus, the unique amino acid composition of gluten and related proteins in barley and rye favors the generation of toxic T cell stimulatory gluten peptides by tTG. This provides a rationale for the observation that celiac disease patients are intolerant to these

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cereal proteins but not to other common food proteins”. (Specificity of Tissue Transglutaminase Explains Cereal Toxicity in Celiac Disease. L. Willemijn Vader, Arnoud de Ru , Yvonne van der Wal , Yvonne M.C. Kooy , Willemien Benckhuijsen, M. Luisa Mearin , Jan Wouter Drijfhout, Peter van Veelen , and Frits Koning . The Journal of Experimental Medicine, March 4, 2002 // JEM vol. 195 no. 5 643-649).

“…Celiac disease (CD) is an inflammatory disorder of the upper small intestine triggered by the ingestion of wheat, rye, barley, and possibly oat products. The clinical feature of CD is characterized by a flat intestinal mucosa with the absence of normal villi, resulting in a generalized malabsorption of nutrients…. The precipitating factors of toxic cereals are the storage proteins, termed gluten in the field of CD (gliadins and glutenins of wheat, secalins of rye, and hordeins of barley). There is still disagreement about the toxicity of oat avenins. The structural features unique to all CD toxic proteins are sequence domains rich in Gln and Pro. The high Pro content renders these proteins resistant to complete proteolytic digestion by gastrointestinal enzymes. Consequently, large Pro- and Gln-rich peptides are cumulated in the small intestine and reach the subepithelial lymphatic tissue. Depending on the amino acid sequences, these peptides can induce two different immune responses….” (The Biochemical Basis of Celiac Disease. Herbert Wieser and Peter Koehler. Cereal Chemistry. January/February 2008, Volume 85, Number 1 Pages 1-13).

Just a few more specific references, for the interested readers.

Oats: Cross-reaction was clearly demonstrated in this article:

“We conclude that some celiac disease patients have avenin reactive mucosal Tcells that can cause mucosal inflammation. Oat intolerance may be a reason for villous atrophy and inflammation in patients with celiac disease who are eating oats but otherwise are adhering to a strict gluten free diet. Clinical follow-up of celiac disease patients eating oats is advisable.” (The Molecular Basis for Oat Intolerance in Patients with Celiac Disease. Helene ArentzHansen, Burkhard Fleckenstein, Øyvind Molberg, Helge Scott, Frits Koning, Günther Jung, Peter Roepstorff, Knut E. A Lundin, Ludvig M Sollid. Published: October 19, 2004 DOI: 10.1371/journal.pmed.0010001. PLOS Medicine).

Rye: “…Six distinct γ- and ω-type secalins together with two new low molecular mass glycoproteins, have been identified as the major coeliac immunoreactive proteins from a chloroform /methanol soluble extract from rye endosperm.” (Identification of major rye secalins as coeliac immunoreactive proteins. Asuncion Rocher, Miguel Calero, Fernando Soriano, Enrique Mendez. Biochimica et Biophysica Acta (BBA) - Protein Structure and Molecular Enzymology. Volume 1295, Issue 1, 7 June 1996, Pages 13–22)

Millet: this is a gluten-free cereal touted as extremely healthy and much recommended in health shops. I could not find a specific name for its protein, whose composition is deficient in lysine. One controversial potential problem with it is that it seems to be goitrogenic. “These results provide direct evidence in vivo of C-GF antithyroid activity, strongly supporting the concept that C-GF are the goitrogens in millet.” (J Clin

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Endocrinol Metab. 1995 Apr;80(4):1144-7. Antithyroid effects in vivo and in vitro of vitexin: a C-glucosylflavone in millet. Gaitan E1, Cooksey RC, Legan J, Lindsay RH.)

Other references:

Nutrition. 1996 Feb;12(2):100-6. Flavonoids extracted from fonio millet (Digitaria exilis) reveal potent antithyroid properties. Sartelet H1, Serghat S, Lobstein A, Ingenbleek Y, Anton R, Petitfrère E, Aguie-Aguie G, Martiny L, Haye B. Am J Clin Nutr. 2000 Jan;71(1):59-66.

Am J Clin Nutr. 2000 Jan;71(1):5966. Endemic goiter with iodine sufficiency: a possible role for the consumption of pearl millet in the etiology of endemic goiter. Elnour A1, Hambraeus L, Eltom M, Dramaix M, Bourdoux P.

The consensus seems to be that people with known thyroid problems should avoid millet, although for others, the occasional consumption would not be a problem. As it contains 73 grams of carbohydrates per 100 grams, this seems to be a large overload in carbohydrates in any case.

Other papers I reviewed showed that many authors and experimenters found different results regarding cross-reactivity when ingesting oats. This can be linked to genetic variations in the types of oats used, as some of them show no reactivity and others a major one. The recommendations are to use specific species of oats for gluten sensitive patients. Is this really practical and cost effective? The logical suggestion is to abstain unless the patient is willing to support those costs, but this is not within the scope of our practices.

Other prolamins are bundled in papers related to gluten and gliadin, or not explored at all like kafirin. Similar to oats, the differences in tolerance, appearance of symptoms and cross-reactivity can be explained by different genetic variants of the cereals as well as different genetic backgrounds of patients. All this is very interesting, but from a clinical, practical point of view, total abstinence of all forms of cereals is the recommendation emerging from those studies. Next chapter will give even more weight to this prescription albeit for a different reason.

Another approach used to recommend eating cereals is now used in many publications, even appearing in the September 2015 issue of the New Scientist. It often reads like this: “Thinking about going Paleo? Hold on! Do not throw your porridge away yet! Here is the proof that hunters-gatherers ate cereals!” The most serious researches are based on finding traces of cereals embedded in teeth and are very accurate. Here is the catch: of course, cereals were part of the genus “Homo” diet, when available, meaning a few weeks every year; yes, some smart tribes dried them and carried them around as portable food; does that mean in quantities as large as we see today? Then the quality and content of the primitive cereals were very different from what we have today, with a minimal toxic load: this has been demonstrated by comparing the cultivated and wild varieties of many cereals. The practices of farming, selective hybridisation and intensive monoculture have modified the cereals, making them richer in proteins and in

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carbohydrates, increasing yield, income and unfortunately toxicity. Allowing for a very slight exaggeration, I would compare eating cereals today to eating blowfish, the poisonous tetradotoxin-containing species that needs to be carefully prepared by skilled and experienced cooks, lest the consumer dies; the delicacy of this meal seems to lie more in the thrill of potential poisoning than in the real taste of a piece of fish.

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Sugar and Carbohydrates.

I remember a commercial that was running on South African television showing a wide-grinning little boy furiously pedalling on his bike, reaching home, entering the kitchen, grabbing a bowl of strawberries and dipping one in a big bowl of white sugar, coating the berry in white armour, with the legend appearing on screen: “Sugar, Mother Nature’s Energy”. My birth country, Belgium, is the motherland of the world’s purest refined crystallised beet sugar, available in cubic lumps, so pure that it is used “as is” as a biochemical assay reference in laboratories and industries worldwide (Le Sucre de Tirlemont).

Why does that almost universal attraction to sugar exist, notwithstanding its addictive properties, as we will see? It is high-energy intake with almost immediate availability. Our ancestral physiology sees it as something to be acquired, stored and treasured: it does not know when the next meal, when the next “refuelling” will be available. It does not learn; it must be controlled by our mind. Therefore, the instinct is “it is sweet, it is good for me, let’s have more and more and more...” The sweetest food available to our ancestors was honey, and that was never easy or painless to procure. Sweet fruits exist only for a few weeks during fall and do not last long; like bears, we could gorge on it, store the sugar as fat and spend the coming winter in relative comfort. That ancestral instinct has not evolved and why should it have? We still witness famines all around the world; therefore, the ability to store energy is a very useful survival mechanism, not just an atavistic residue of a long gone past.

What is wrong with sugar? In theory, nothing. Glucose is the main physiological fuel we use; our brain depends on it as do our muscles and it takes a lot of effort to switch physiological fuel (i.e. switching to a ketogenic diet). We need sugar and carbohydrates, but we need to acquire them the proper way, the physiological way. Have you ever tried to put aviation fuel in a regular car and drive away? You will win a Darwin award for that! [Darwin Awards are posthumous prizes given to people who have killed themselves doing the most stupid things possible, and in doing so eliminated their genes from humanity’s pool, helping to improve our slim chances of survival in the long term.]

Here is why sugar is yet another forbidden food. But first a few details.

Sugar is a general term often associated with the sweetening substance added to our drinks and baking; they are monosaccharides (glucose, fructose and galactose) or disaccharides (sucrose, maltose and lactose); they are the simple carbohydrates. Oligosaccharides and polysaccharides are longer chains including glycogen, starches and cellulose.

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Like many natural substances, the usefulness or toxicity of sugar is a function of its purity, its speed of ingestion, the amount ingested, the form in which it has been ingested and the associated substances ingested concomitantly. The simplest example for comparison is water. We need between a litre to a litre and a half of water per day for a medium sized adult. Try drinking five times that amount regularly and you end up with diabetes insipidus. Try to do that in one go; you can do it on a bet, but you will soon eliminate most of it and be thirsty again, even though you had your daily-recommended dose. Try to use only pure distilled water; you will soon have electrolyte imbalances. Try to drink that amount in the form of brine, strong coffee and strong tea, and you will soon experience dehydration. I think you get my point. Rapidly absorbed sugars, which are the simple sugars, the purified ones and the concentrated ones that are used to sweeten hot drinks, baking and confectionery, sweets of all sorts and alleged healthy fruit juices with high content in fructose are the most harmful. The slow-release ones found in fruits and vegetables are perfectly suited to our metabolism, not only because their absorption is slow but also because they are mixed with other synergistic healthy components like fibres, vitamins and especially minerals.

Isn’t that the same with cereals?

Here is the carbohydrate content of some cereals, in grams per 100 grams (USDA):

Wheat: 71

Wheat flour: 72.57

White rice: 80

Corn: 74

Sorghum: 75

Compare with other major staple foods:

Potato: 17

Sweet potato: 20

Yams: 28

Carrots: 9.6

Broccoli: 6.64

Apple: 13.81

Banana: 22.84

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We immediately see the discrepancy in the carbohydrate load when eating those foods, even though this is often contested as not considering the difference between sugars and dietary fibres. Most of the cereals are used in their refined form, which increases the concentration of carbohydrates, even without taking into account the addition of sweetening agents.

There is now a worldwide agreement that inflammation is the common denominator for many if not the majority of the diseases. Like gluten, sugar is major inflammatory substance:

The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation. Karin de Punder and Leo Pruimboom. Nutrients 2013, 5(3), 771787.

Explaining How “High-Grade” Systemic Inflammation Accelerates Vascular Risk in Rheumatoid Arthritis. Naveed Sattar, MD; David W. McCarey, MD; Hilary Capell, MD; Iain B. McInnes, MD. Circulation, August 11, 201).

There are now thousands of references available, the two given here are as examples only. When blood sugar level increases, insulin is secreted to help the sugar enter the cells, fortunately. Although contested by some, it appears that insulin has also inflammatory properties (Hormonal control of inflammatory responses. Mediators Inflamm. 1993; 2(3):

181–198. J. Garcia-Leme and Sandra P. Farsky). As we will see later, milk is also inflammatory. And so it happens that the bowl full of frosty breakfast cereals sweetened with sugar and bathed in milk you just had is a quadruple whammy towards systematic inflammation for the next few hours and towards a vast array of chronic diseases when regularly repeated or exchanged for similar types of meals.

What about lower levels of sugar ingestion, “moderation” as it is called?

“Abstract:

Background: Sugar-sweetened beverages (SSBs) have unfavorable effects on glucose and lipid metabolism if consumed in high quantities by obese subjects, but the effect of lower doses in normal-weight subjects is less clear.

Objective: The aim was to investigate the effects of SSBs consumed in small to moderate quantities for 3 weeks on LDL particle distribution and on other parameters of glucose and lipid metabolism as well as on inflammatory markers in healthy young men...

Conclusion: The present data show potentially harmful effects of low to moderate consumption of SSBs on markers of cardiovascular risk such as LDL particles, fasting glucose, and hs-CRP within just 3 weeks in healthy young men, which is of particular significance for young consumers.”

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(Low to moderate sugar sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial.Isabelle Aeberli, Philipp A Gerber, Michel Hochuli, Sibylle Kohler, Sarah R Haile, Ioanna Gouni-Berthold, Heiner K Berthold, Giatgen A Spinas, and Kaspar Berneis. Am J Clin Nutr August 2011 vol. 94 no. 2 479-485).

The link between sugar and inflammation might be obvious enough for practitioners, and indeed is often convincing when dealing with patients whose presenting complaints are arthritis, fibromyalgia or other general inflammatory diseases.

Another general effect of high blood sugar, due to diabetes or to the constant ingestion of fast carbohydrates (eventually leading to diabetes) is glycation leading to the appearance of Advanced Glycation End-products (AGEs). The best known one is HbA1c used as a routine test to evaluate the quality of control of blood sugar levels over a longer period in diabetics. Many well-informed patients have heard and read about glycation; therefore, the practitioner should be aware of it.

Basically, glycation is a non-enzymatic reaction between simple sugars, like glucose or fructose, and proteins or lipids. Those chain reactions lead eventually to the production of AGEs in the tissues, which then develop specific pathologies: for example, the amyloid plaques seen in Alzheimer disease are AGEs. The good news is that quite often and especially when tissue damage is minimal, the glycation process is reversible, simply by reducing the blood sugar; this makes absolute sense because glycation being non-enzymatic, the chemical reaction is inverted if one of the component’s concentrations is lowered; that is basic chemistry that most patients will understand, often using the analogy of a balance. There are many good publications that give clear and detailed explanations; here are two of them:

Glucose, Advanced Glycation End Products, and Diabetes Complications: What Is New and What Works Melpomeni Peppa, MD, Jaime Uribarri, MD and Helen Vlassara, MD. Clinical Diabetes October 2003, vol. 21 no. 4 186-187.

Advanced Glycation End Products. Sparking the Development of Diabetic Vascular Injury. Alison Goldin, BA; Joshua A. Beckman, MD; Ann Marie Schmidt, MD; Mark A. Creager, MD. Circulation. 2006; 114:597-605.

Once again, pay attention to the dates, it is not new knowledge and it has been widely published even in the lay press. Yet the elementary notion of banning simple sugars and fast carbohydrates does not seem to have reached the consciousness of practitioners and patients alike. As you could read in the papers, the search for anti-glycation drugs continues….

Those general notions might be enough to convince our patients, but many will still contest the fact and want to pinpoint towards specific problems. That is what we will address now.

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Sugar and the immune system.

People often look at me as if I was a complete lunatic (they might be right, though….) when I tell them that sugar prevents the proper function of the immune system. I suggest they do the following experiment if they have access to a basic light microscope: after fasting, like first thing in the morning, prick you finger and put a droplet of blood on a microscope slide; have a look and you will recognize white blood cells moving around; swallow a teaspoon of sugar and examine a fresh droplet of blood 20-30 minutes later: you will see the white blood cells are not moving at all, they are paralysed. This means that swallowing the amount of sugar you would regularly put in your cup of tea or coffee (and often you put a lot more) completely neutralises the first line of defence against bacterias and viruses. The more sugar, the longer the dysfunction, so what happens with fruit juices and sodas? Here is an old reference, dated 1973:

Abstract. “This study was designed to test a) whether carbohydrates other than glucose decreased the phagocytic capacity of neutrophils in normal human subjects, b) the duration of this effect, and c) the effect of fasting on neutrophilic phagocytosis. Venous blood was drawn from the arm after an overnight fast and at 0.5, 1, 2, 3, or 5 hr postprandial and this was incubated with a suspension of Staphylococcus epidermidis. The phagocytic index (mean number of bacteria viewed within each neutrophil) was determined by microscopic examination of slides prepared with Wright's stain. Oral 100-g portions of carbohydrate from glucose, fructose, sucrose, honey, or orange juice all significantly decreased the capacity of neutrophils to engulf bacteria as measured by the slide technique.... The decrease in phagocytic index was rapid following the ingestion of simple carbohydrates. The greatest effects occurred between 1 and 2hr postprandial, but the values were still significantly below the fasting control values 5 hr after feeding (P < 0.001). The decreased phagocytic index was not significantly associated with the number of neutrophils. These data suggest that the function and not the number of phagocytes was altered by ingestion of sugars. This implicates glucose and other simple carbohydrates in the control of phagocytosis and shows that the effects last for at least 5 hr. On the other hand, a fast of 36 or 60 hr significantly increased (P < 0.001) the phagocytic index.” (Role of sugars in human neutrophilic Phagocytosis. Albert Sanchez, J. L. Reeser, H. S. Lau, P. Y. Yahiku, R. E. Willard, P. J. McMillan, S. Y. Cho, A. R. Magie, and U. D. Register. Am J Clin Nutr November 1973 vol. 26 no. 11 1180-1184).

Do you still wonder why cough syrups and antibiotics syrups are not very effective? Poor Johnny is in bed with a bad cold; let’s make him feel better with a lollipop, a cup of hot sweet chocolate and a few cookies. Difficult to convince Mum not to do that, isn’t it? Yet, I suggest this attitude is often an aggravating factor transforming a benign viral disease or childhood disease into a debilitating and sometimes deadly pathology...... “A spoonful of sugar makes the remedy go down, the remedy go down, the remedy go down....” Could Mary Poppins bear the guilt? Sugar is often replaced with artificial sweeteners that have their own problems, which we are not going to review here; this is not the place for that.

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Sugar and cancer.

Most authorities agree on the link between inflammation and cancer, obesity and cancer as well as immune dysfunction and cancer. Sugar is clearly an obvious common cause. It is also the almost unique food for cancerous cells, which forms the basis of the strict abstinence recommendation during all the cancer treatment protocols, with the lamentable exception of conventional ones. This sugar craving of tumour cells forms the basis of a new MRI testing using glucose uptake of cancer to detect simply and without any side-effects (other than eating the equivalent of half a bar of chocolate, to quote the author): Simon Walker-Samuel, Rajiv Ramasawmy, Francisco Torrealdea, Marilena Rega, Vineeth Rajkumar, S Peter Johnson, Simon Richardson, Miguel Gonçalves, Harold G Parkes, Erik Årstad, David L Thomas, R Barbara Pedley, Mark F Lythgoe, Xavier Golay. In vivo imaging of glucose uptake and metabolism in tumors. NatureMedicine, 2013.

Isn’t that proof enough?

Sugar and obesity.

I am going to skip comments and references on this one, nobody contests the association. Remember the old saying about pralines: “Five minutes in the mouth, five years in the butt”.

Sugar and dental health.

I did wonder if I really needed to insist on the link between sugars, carbohydrates and teeth problems. Despite the fact that it is one of the most talked about health subjects, many people either do not seem to get it or decide to ignore it, hiding behind the apparently well-intended argument: “how can I deprive ‘them’ of such a nice treat” One is reminded of the story of the man who wanted to help his friend to chase an annoying fly away, so he waited until the fly landed on his friend’s forehead and smashed it with a brick...it is the thought that counts.

Dental caries are a constant source of pain and suffering. Visits to the dentist rank extremely high amongst the most feared situations, and are expensive, making it even more painful, causing delays in treatment. Caries and gum disease (periodontitis) are also clearly linked to heart problems like bacterial endocarditis, where a mouth bacteria anchors itself on a heart valve and eventually destroys it, creating valvular stenosis or insufficiency. This is

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on top of the direct influence of sugar on the cardiovascular system, as we will soon see. Here is a study linking one of the many mouth bacterias to atherosclerosis:

“Chronic oral infection with the periodontal disease pathogen, Porphyromonas gingivalis, not only causes local inflammation of the gums leading to tooth loss but also is associated with an increased risk of atherosclerosis. A new study reveals how the pathogen evades the immune system to induce inflammation beyond the oral cavity .” (Connie Slocum, Stephen R. Coats, Ning Hua, Carolyn Kramer, George Papadopoulos, Ellen O. Weinberg, Cynthia V. Gudino, James A. Hamilton, Richard P. Darveau, Caroline A. Genco. Distinct Lipid A Moieties Contribute to Pathogen-Induced Site-Specific Vascular Inflammation. PLoS Pathogens, 2014; 10 (7)

The same type of bacteria can migrate to joints, creating local infection and destruction. Here is how it works: the short sugars or free carbohydrates are very quickly metabolised by the mouth bacterias (there is a normal bacterial flora always present in the mouth). This produces local acids that demineralise the teeth, whether you have put fluoride on them by any method, or not. The normal pH of the saliva is basic, not acid, for a good reason. Feeding the mouth bacterias increases the emergence of the cariogenic ones . (J Oral Sci. 2006 Dec;48(4):24551. Correlation of cariogenic bacteria and dental caries in adults. Nishikawara F , Katsumura S, Ando A, Tamaki Y, Nakamura Y, Sato K, Nomura Y, Hanada N.)

A main culprit is the Streptococcus Mutans. Twenty-five different species of Streptococcus live in the mouth, some harmless and some not. Streptococcus Mutans metabolises sucrose to lactic acid via the enzyme glucansucrase. The acidic milieu causes the tooth enamel to be vulnerable to decay. Sucrose is used to produce a sticky polysaccharide that allows S. Mutans to form plaque. The other sugars contribute only to local acidification. The plaque itself may contain more than 500 different species of bacterias. Even the notoriously unreliable Wikipedia writes: “...it is imperative to include the role humans have played and the coevolution that has occurred between the two species. As humans evolved anthropologically, the bacteria evolved biologically. It is widely accepted that the advent of agriculture in early human populations provided the conditions S. mutans needed to evolve into the virulent bacteria it is today. Agriculture introduced fermented foods, as well as more carbohydrate rich foods, into the diets of historic human populations. These new foods introduced new bacteria to the oral cavity and created new environmental conditions.... consuming more carbohydrates increased the amount of sugars available to S. mutans for metabolism and lowered the pH of the oral cavity. This new acidic habitat would select for those bacteria that could survive and reproduce at a lower pH... S. mutans is implicated in the pathogenesis of certain cardiovascular diseases, and is the most prevalent bacterial species detected in extirpated heart valve tissues, as well as in atheromatous plaques, with an incidence of 68.6% and 74.1%, respectively...”

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The major if not unique cause of caries in young children is not only the abuse of sugar in all forms and its general disease-generating properties, but essentially the fact that the sugars are remaining in the mouth for a long time, through the use of sugary drinks, often almost criminally given as a soothing night bottle to small infants. During sleep, the flow of alkaline saliva is diminished, which gives sugar the opportunity to remain in the mouth and to feed the local flora. Simple mechanical brushing is often enough to interrupt this process as long as the mouth remains sugar free. Some natural foods are helpful:

Simple tea, green, oolong or black (but of course no milk and definitely no sugar) and is the easiest way to use as a simple drink after a meal. It can also be used as a mouthwash.

Kaur H, Jain S, Kaur A. (2014. "Comparative evaluation of the antiplaque effectiveness of green tea catechin mouthwash with chlorhexidine gluconate." J Indian Soc Periodontol. 2014Mar;18(2):178-82.

Subramaniam, P.; Eswara, U.; Maheshwar Reddy, K. R. (Jan–Feb 2012). "Effect of different types of tea on Streptococcus mutans: an in vitro study". Indian J Dent Res 23 (1): 43–8.

Wahhida, Shumi; Aktar, Hossain; DongJune, Park; Sungsu, Park (September 2014). "Inhibitory effects of green tea polyphenol epigallocatechin gallate (EGCG) on exopolysaccharide production by Streptococcus mutans under microfluidic conditions". BioChip Journal 8 (3): 179–186.

Sangameshwar, M.; Vanishree, M.; Surekha, R.; Santosh, Hunasgi; Anila, K.; Vardendra, Manvikar (Jan–Mar 2014). "Effect of Green Tea on Salivary Ph and Streptococcus Mutans Count in Healthy Individuals". International Journal of Oral and Maxillofacial Pathology 5 (1): 13–16.

Hala Awadalla; et al. (December 2009). "A pilot study of the role of green tea use on oral health". International Journal of Dental Hygiene 9 (2): 110–116.)

Turmeric and Aloe Vera can be combined with Green Tea to create a simple, cheap and effective mouthwash, without chemicals that can also be swallowed for their general health effects.

Gupta RK1, Gupta D2, Bhaskar DJ2, Yadav A3, Obaid K4, Mishra S5. (2014). "Preliminary antiplaque efficacy of aloe vera mouthwash on 4 day plaque re-growth model: randomized control trial." Ethiop J Health Sci. 2014 Apr;24(2):139-44.

Pandit, Santosh; Kim, HyeJin; Kim, JeongEun; Jeon, JaeGyu (2011). "Separation of an effective fraction from turmeric against Streptococcus mutans biofilms by the comparison of curcuminoid content and antiacidogenic activity". Food Chemistry 126 (4): 1565–70.)

Waghmare PF1, Chaudhari AU, Karhadkar VM, Jamkhande AS. (2011) "Comparative evaluation of turmeric and chlorhexidine gluconate mouthwash in prevention of plaque formation and gingivitis: a clinical and microbiological study." J Contemp Dent Pract. 2011 Jul 1;12(4):221-4.)

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Liquorice seems active against the cariogenic bacterias and can be added to the aforementioned mouthwash. Hu Ch, He J, Eckert R et al. “Development and evaluation of a safe and effective sugar-free herbal lollipop that kills cavity-causing bacteria. Int J Oral Sci (2011 Jan) 3(1):13-20)

Simply brushing with baking soda helps maintain an alkaline pH.

I thought that a quick reminder of those simple measures was necessary. Patients always welcome that type of information.

Sugar and cardiovascular diseases.

The links sugar - obesity – hypertension – hyperlipidemia – cardiovascular diseases are well established. (Contemporary Reviews in Cardiovascular Medicine. Sugar Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. Vasanti S. Malik, MSc; Barry M. Popkin,

PhD; George A. Bray, MD; Jean-Pierre Després, PhD; Frank B. Hu, MD, PhD. Circulation. 2010; 121: 1356-1364).

Thousands of similar studies have been published, almost nothing happens.... conspiration theory anyone?

Even without coronary heart disease, sugar is linked to heart failure.

S. Sen, B. K. Kundu, H. C.-J. Wu, S. S. Hashmi, P. Guthrie, L. W. Locke, R. J. Roy, G. P. Matherne, S. S. Berr, M. Terwelp, B. Scott, S. Carranza, O. H. Frazier, D. K. Glover, W. H. Dillmann, M. J. Gambello, M. L. Entman, H. Taegtmeyer. Glucose Regulation of Load-Induced mTOR Signaling and ER Stress in Mammalian Heart. Journal of the American Heart Association, 2013; 2 (3): e004796).

Myocardial infarction and ischemic heart disease?

“Jakobsen et al. compared the association between saturated fats and carbohydrates with IHD risk among 53,644 men and women in a Danish cohort of the Diet, Cancer, and Health Study. During 12 y of follow-up, 1943 incident cases of myocardial infarction (MI) were diagnosed. Multivariate analyses showed that saturated fat intake was not associated with risk of MI compared with carbohydrate consumption—a finding consistent with the results from a recent pooled analysis and a meta-analysis (2, 3). However, replacement of saturated fat with high-GI-value carbohydrates significantly increased the risk of MI (relative risk per 5% increment of energy from carbohydrates: 1.33; 95% CI) .... This study is notable for its large size, long duration of follow-up, and detailed assessment of dietary and lifestyle factors. It is the first epidemiologic study to specifically examine the effects of replacing saturated fats with either high- or low-quality carbohydrates, and it provides direct evidence that substituting high-GI-value carbohydrates for saturated fat actually increases IHD risk.” (Are refined carbohydrates worse than saturated fat? Frank B Hu. Am J Clin Nutr June 2010 vol. 91 no. 6 1541-1542).

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There is clearly a direct influence of sugar both on the vessels and on the myocardium, on top of its indirect action through the metabolic syndrome and other general effects

Sugar and the brain.

Sugar and depression:

“A diet high in refined carbohydrates may lead to an increased risk for new onset depression in postmenopausal women, according to a study. The study looked at the dietary glycemic index, glycemic load, types of carbohydrates consumed, and depression in data from more than 70,000 postmenopausal women who participated in the National Institutes of Health's Women's Health Initiative Observational Study between 1994 and 1998.” (James Gangwisch, PhD et al. High Glycemic Index Diet as a Risk Factor for Depression: Analyses from the Women’s Health Initiative. American Journal of Clinical Nutrition, August 2015).

Schizophrenia? Really? Yes:

Abstract: Dietary variations are known to predict the prevalence of physical illnesses such as diabetes and heart disease but the possible influence of diet on mental health has been neglected.....A higher national dietary intake of refined sugar and dairy products predicted a worse 2year outcome of schizophrenia.....The dietary predictors of outcome of schizophrenia and prevalence of depression are similar to those that predict illnesses such as coronary heart disease and diabetes, which are more common in people with mental health problems and in which nutritional approaches are widely recommended. Dietary intervention studies are indicated in schizophrenia and depression. (Br J Psychiatry. 2004 May;184:4048. International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: an ecological analysis. Peet M.)

Alzheimer too, as we have seen when discussing Glycation. Excessive sugar intake creates insulin resistance, as witnessed in Type 2 Diabetes. Here is what JAMA published:

Importance: Converging evidence suggests that Alzheimer disease (AD) involves insulin signaling impairment. Patients with AD and individuals at risk for AD show reduced glucose metabolism, as indexed by fludeoxyglucose F 18–labeled positron emission tomography (FDG-PET). Objectives: To determine whether insulin resistance predicts AD-like global and regional glucose metabolism deficits in late middle–aged participants at risk for AD and to examine whether insulin resistance–predicted variation in regional glucose

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metabolism is associated with worse cognitive performance. Conclusions and Relevance: Our results show that insulin resistance, a prevalent and increasingly common condition in developed countries, is associated with significantly lower regional cerebral glucose metabolism, which in turn may predict worse memory performance. Midlife may be a critical period for initiating treatments to lower peripheral insulin resistance to maintain neural metabolism and cognitive function. (Association of Insulin Resistance with Cerebral Glucose Uptake in Late Middle–Aged Adults at Risk for Alzheimer Disease ONLINE FIRST. Auriel A. Willette, PhD; Barbara B. Bendlin, PhD. JAMA Neurol. Published online July 27, 2015. doi:10.1001/jamaneurol.2015.0613)

The New England Journal of Medicine links glucose and dementia:

RESULTS: During a median follow-up of 6.8 years, dementia developed in 524 participants (74 with diabetes and 450 without). Among participants without diabetes, higher average glucose levels within the preceding 5 years were related to an increased risk of dementia (P=0.01); with a glucose level of 115 mg per deciliter (6.4 mmol per liter) as compared with 100 mg per deciliter (5.5 mmol per liter), the adjusted hazard ratio for dementia was 1.18 (95% confidence interval [CI], 1.04 to 1.33). Among participants with diabetes, higher average glucose levels were also related to an increased risk of dementia (P=0.002); with a glucose level of 190 mg per deciliter (10.5 mmol per liter) as compared with 160 mg per deciliter (8.9 mmol per liter), the adjusted hazard ratio was 1.40 (95% CI, 1.12 to 1.76).

CONCLUSIONS: Our results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes. (Funded by the National Institutes of Health.) (Glucose Levels and Risk of Dementia. Paul K. Crane, M.D., M.P.H N Engl J Med 2013; 369:540-548August 8, 2013)

We have seen the link earlier on through the formation of AGEs, yet apparently rediscovering the wheel seems to be a favourite pastime in the conventional scientific world. Mind you, you get grants for those studies and they advance your academic career...

The most difficult part is that sugar is highly addictive. Interestingly, many patients with a “sweet tooth” will themselves proclaim they are addicted to sugar, sweets and treats. This type of addiction does not carry the stigma of drugs, cigarettes or alcohol. It is socially accepted and even encouraged since childhood through sugary rewards, cakes, biscuits, chocolate and other forms of brain numbing, especially in times of stress and upheaval. The sugary binges are even glamorised in movies and sitcoms, with role models perpetuating the damage.

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We could have expected that Saccharum album (officinale) would be the major remedy in this type of repertorisation. Yet it is by no means a Simillimum of the patient, or a Core or Constitutional remedy. The way I see it, it is the representation of sugar’s toxicity on the patient; it should be used as an isotherapic or a drainage remedy to hasten the detoxification and expose the real underlying needed remedy.

Does conventional science agree?

A study on rats comparing cocaine and sugar. (Abstinence from cocaine and sucrose self administration reveals altered mesocorticolimbic circuit connectivity by resting state MRI. Lu H , Zou Q, Chefer S, Ross TJ, Vaupel DB, Guillem K, Rea WP, Yang Y, Peoples LL, Stein EA. Brain Connect. 2014 Sep;4(7):499510.)

Another abstract:

The average consumption of sugar in the Malaysian population has reached an alarming rate, exceeding the benchmark recommended by experts. This article argues the need of a paradigm shift in the management of sugar consumption in the country through evidence derived from addiction research. "Food addiction" could lead to high levels of sugar consumption.... Preexisting health promotion strategies could benefit from the integration of the concept of sugar addiction. A targeted intervention could yield more positive results in health outcomes within the country. (J Prim Care Community Health. 2014 Oct;5(4):26370. Addiction to sugar and its link to health morbidity: a primer for newer primary care and public health initiatives in Malaysia. Swarna Nantha Y.)

A review:

PURPOSE OF REVIEW: To review research that tests the validity of the analogy between addictive drugs, like cocaine, and hyper-palatable foods, notably those high in added sugar (i.e., sucrose).

RECENT FINDINGS: Available evidence in humans shows that sugar and sweetness can induce reward and craving that are comparable in magnitude to those induced by addictive drugs. Although this evidence is limited by the inherent difficulty of comparing different types of rewards and psychological experiences in humans, it is nevertheless supported by recent experimental research on sugar and sweet reward in laboratory rats. Overall, this research has revealed that sugar and sweet reward can not only substitute to addictive drugs, like cocaine, but can even be more rewarding and attractive. At the neurobiological level, the neural substrates of sugar and sweet reward appear to be more robust than those of cocaine (i.e., more resistant to functional failures), possibly reflecting past selective evolutionary pressures for seeking and taking foods high in sugar and calories. (emphasis is mine).

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SUMMARY: The biological robustness in the neural substrates of sugar and sweet reward may be sufficient to explain why many people can have difficultly to control the consumption of foods high in sugar when continuously exposed to them.

(Curr Opin Clin Nutr Metab Care. 2013 Jul;16(4):4349.Sugar addiction: pushing the drug-sugar analogy to the limit. Ahmed SH, Guillem K, Vandaele Y. Université de Bordeaux, Bordeaux, France.)

More references:

Front Psychol. 2014 Sep 17;5:919. Dopamine and glucose, obesity, and reward deficiency syndrome. Blum K, Thanos PK , Gold MS .

Front Neuroendocrinol. 2012 Apr;33(2):12739. Feedforward mechanisms: addiction-like behavioral and molecular adaptations in overeating. Alsiö J , Olszewski PK, Levine AS, Schiöth HB.

Eat Behav. 2014 Aug;15(3):5058. Problematic intake of high sugar/low fat and high glycemic index foods by bariatric patients is associated with development of postsurgical new onset substance use disorders. Fowler L , Ivezaj V , Saules KK .

The last reference explains the many relapses and failures of gastric stapling and banding in the control of obesity: the addict finds ways to overcome the reduction of gastric volume, which eventually enlarges and allows for the return of binging.

I could not avoid quoting the following paper about the use of artificial sweeteners instead of real sugar, as this is a question that will be asked every time:

“The role of artificial sweeteners in the management of obesity is controversial. Observational data have suggested that non-nutritive sweeteners (NNSs) may promote weight gain through poorly understood mechanisms of cravings, reward phenomenon, and addictive behaviour via opioid receptors.” (Curr Gastroenterol Rep. 2015 Jan;17(1):423. The paradox of artificial sweeteners in managing obesity. Roberts JR.)

A recent study at UCLA reveals that consumption of fructose in high dose interferes with the repair and normal function of the brain after traumas. UCLA is certainly not known as a hub of friends of natural medicine; they have very strict research and publication standards, which makes the following extracts from their paper even more relevant.

From the Abstract:

“Fructose consumption has been on the rise for the last two decades and is starting to be recognized as being responsible for metabolic diseases. Metabolic disorders pose a particular threat for brain conditions characterized by energy dysfunction, such as traumatic brain injury. Traumatic brain injury patients experience sudden abnormalities in the control

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of brain metabolism and cognitive function, which may worsen the prospect of brain plasticity and function. The mechanisms involved are poorly understood. Here we report that fructose consumption disrupts hippocampal energy homeostasis as evidenced by a decline in functional mitochondria bioenergetics (oxygen consumption rate and cytochrome C oxidase activity) and an aggravation of the effects of traumatic brain injury on molecular systems engaged in cell energy homeostasis (sirtuin 1, peroxisome proliferator-activated receptor gamma coactivator-1alpha) and synaptic plasticity (brain-derived neurotrophic factor, tropomyosin receptor kinase B, cyclic adenosine monophosphate response element binding, synaptophysin signaling)...... These data imply that high fructose consumption exacerbates the pathology of brain trauma by further disrupting energy metabolism and brain plasticity, highlighting the impact of diet on the resilience to neurological disorders.”

They also explain in great detail the influence of fructose on mitochondrial physiology and its effect upon brain metabolism. (Rahul Agrawal, et al., “Dietary fructose aggravates the pathobiology of traumatic brain injury by influencing energy homeostasis and plasticity,” Journal of Cerebral Blood Flow and Metabolism, 2015;)

Sugar and Diabetes.

It seems quite ridiculous to feel compelled adding information about the relation between sugar, carbohydrates and diabetes. Apparently, that link has not been assimilated properly.

The common knowledge is that people suffering from diabetes, be it type I or type II, should not consume sugar. That knowledge stops at simple sugars, sugary treats, cakes and sugary drinks. The fact that complex sugars, oligosaccharides and polysaccharides, are first metabolised into simple sugars before anything else can happen does not seem to have sunk in, not only with patients but also with practitioners. When I treat diabetic patients, I am often confronted to their dietary recommendations made by either their specialist or the “diabetes education nurse”. Those recommendations include plenty of complex, wholegrain, “healthy” carbohydrates, so that their sugar levels are “balanced during the day”. I was once invited by the local diabetic association to give a talk about natural medicine. Of course, they had a small buffet too, full of “sugar-free” pastries, cookies, muffins, small sandwiches; not a fruit in view; that would be excessive sugar, not a vegetable like carrot or cucumber sticks. During my talk, I made some harsh comments about that. Needless to say, I was never invited again.

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If you have a problem processing sugar (or any other food), why would you keep ingesting it? I asked that very question to a few health professionals. The dialogue goes something like this:

- If they do not, they will have hypoglycaemia.

- How can they have hypoglycaemia if, by definition, their blood sugar is already high when fasting, which defines diabetes?

- Because they take insulin/drugs to control their high blood sugar, of course (condescending voice, they are talking to Mr. Stupid)

- But if they do not ingest fast carbohydrates as you recommend, that would help control their fasting blood sugar and they would not need insulin/drugs or at least a lot less!

- Then they would be nutritionally deprived of a healthy food (anger is building in their voice)

- How can that be a healthy food if that makes them sick?

- That is precisely why they have insulin/drugs, so that they can have carbohydrates and it does not make them sick (triumph in the voice)

Circular reasoning, no logic, no science. As soon as those patients stop their carbohydrates, their need for insulin or drugs drops, they lose weight, eventually their HbA1c comes back to normal, but that is not enough to convince their conventional practitioners.

Sudden peaks of blood sugar leads to sudden peaks of insulin with frequent overshoots and followed by decline in blood sugar, explaining the frequent complaint of mid-morning and mid-afternoon weakness that is “corrected” by a little snack, a sandwich, a muffin, a cookie. The merry-go-round keeps going for years until the pancreas’ beta cells cannot cope anymore and full-blown type I insulin dependent diabetes appears or until insulin resistance appears. Pathetic, especially as it is almost fully preventable.

What you have just read about sugar applies to fast-absorbed carbohydrates as found in bread and all cereals, including the allegedly gluten-free ones, but not in those found naturally in fruits and vegetables, unless their ingestion is gigantesque. The difference lies in the concentration of carbohydrates in the same mouthful and the speed of absorption. A cereal will not cause the same immediate spike in blood sugar as a spoon of sugar, but that is about the only difference. We will touch on the difference with fruits and vegetables later.

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Another type of scaremongering about cereals and carbohydrates has appeared is that not having carbohydrates in your diet, going “low-carb”, can lead to the dangerous ketoacidosis. One single case has been reported of a woman who consumed only 20 grams of carbohydrates in total in her diet (that includes those in fruits and vegetables) in order to lose weight after a pregnancy. From that distorted conception of proper nutrition has emerged the warning not to remove the “healthy” cereals from our diets. As if there were no carbohydrates in apples, pears, bananas, grapes, oranges, nuts, seeds, cabbage, broccoli, potatoes, carrots, etc, ... One must wonder wherefrom those pretended nutritionists have received their diplomas and certifications.

Milk and dairy products.

We have now to deal with a very emotional aspect of nutrition: milk.

Milk is of course associated with motherhood, comfort, nutrition and growth of babies across the spectrum of all mammalian species. Culturally, milk and cookies are always seen as a good, healthy, positive reward for good behaviour, a well-done task or simply for a warm, cosy, tender moment. Almost every civilisation has carried that notion since times immemorial. How dare I, and other scientists, challenge that backbone of human life? Let us try to remove the sentimental aspect here and remain as objective and rigorous as possible.

Throughout the entire mammalian phylum, we see one common thread: milk is for babies, and babies of the same species. The Homo species is the only animal that will consume milk from another species, not only as a baby through necessity at times, but as an adult. It is apparently a logical intellectual step of a clever thinking living being: the babies of all lactating animals thrive on milk and become adults with that food. We eat those animals; therefore, we can use their milk too for ourselves; it is a lot easier, less dangerous and a lesser effort than hunting and foraging for food in the wild. It makes absolute sense, doesn’t it? On the other hand, wild animals know instinctively what is good for them and what would make them sick or even kill them. Some carnivores will happily eat carrion as well as a fresh kill, whereas others would die if they ate rotten meat. Even the domesticated cat has maintained that ability. Pigs will eat anything, which is one of the reasons why many civilisations consider them improper as food. But would wild boars use milk or cereals? I doubt it. Dogs will happily gobble anything that lies around, including the chocolate that will kill them. Many have been so heavily inbred that they have lost their life preserving instincts. Wolves have not.

Let us start with the intended recipients of milk, babies and little children.

Everybody agrees that breast is best. Every type of milk has a specific profile that is optimal for the intended species.

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Here is a table courtesy of my friend and colleague Patricia Hatherly, as presented at the NZCH Conference 2015:

Constituents of the milk of various animals (g/100 mls):

Total solid Fat Total protein Lactose Ash

Ass 11.1 1.2 1.7 6.9 1.3

Cow 15.0 5.5 3.9 4.9 0.7

Human 13.6 5.5 1.0 7.0 0.1

Baboon 14.2 5.0 1.6 7.3 0.3

Monkey 14.5 3.9 2.1 5.9 2.6

Orang-Utan 11.2 3.5 1.5 6.0 0.2

Even within the primates, there are important variations, but it is clear that cow’s milk has too much protein and too little lactose. Despite their relative closeness, obtaining baboon’s milk for your baby might be a very difficult and perilous enterprise. Surprisingly, donkey’s milk and mare’s milk are very close to human composition, if the fat content can be tweaked with supplementation, which corresponds well with many nomadic traditions.

Here is another table:

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Composition of donkey’s, mare’s, human and cow’s milk (g/100 g)

composition donkey mare human cow

pH 7.0 – 7.2 7.18 7.0 – 7.5 6.6 – 6.8

Protein g/100g 1.5 – 1.8 1.5 – 2.8 0.9 – 1.7 3.1 – 3.8

Fat g/100g 0.3 – 1.8 0.5 – 2.0 3.5 – 4.0 3.5 – 3.9

Lactose g/100g 5.8 – 7.4 5.8 – 7.0 6.3 – 7.0 4.4 – 4.9

Total Solids (TS) g/100 g 8.8-11.7 9.3-11.6 11.7-12.9 12.5-13.0

Casein Nitrogen (CN) g/100 g 0.64-1.03 0.94-1.2 0.32-0.42 2.46-2.80

Whey protein g/100 g 0.49-0.80 0.74-0.91 0.68-0.83 0.55-0.70

Casein Nitrogen (CN) % 47.28 50 26.06 77.23

This clearly shows that there are three times more proteins in cow’s milk than in human milk, and three times more casein while almost only half of the lactose. Although present in human milk, casein is very difficult to digest and needs a specific enzyme, rennet, which unsurprisingly is found specifically in calves. Some farmers do forcefully inject rennet supplementation in the calves’ stomach to increase digestion, accelerate growth and weight gain, hence income.

Our sworn enemy, Wikipedia, published this about milk: “Whole cow's milk contains too little iron, retinol, vitamin E, vitamin C, vitamin D, unsaturated fats or essential fatty acids for human babies. Whole cow's milk also contains too much protein, sodium, potassium, phosphorus and chloride which may put a strain on an infant's immature kidneys. In addition, the proteins, fats and calcium in whole cow's milk are more difficult for an infant to digest and absorb than the ones in breast milk.” If “they” say so, it certainly must be completely true, isn’t it?

Let us first focus on the milk protein, casein.

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Casein and the immune system.

It creates inflammation in the intestinal mucosa and activates cell-mediated immunity: “Our results suggest that CMP (cow’s milk protein) initiates an immune response in the intestinal mucosa and may be responsible for the activation of cell-mediated immunity after enteric infection or inflammation.” (Ann Allergy Asthma Immunol. 2003 Mar;90(3):34850. Cow's milk protein induced changes in the expression of HLADR antigens on colonic epithelial cells. Chung HL, Lee JJ, Kim SG.)

We also know form the gluten studies that mucosal inflammation is the first step towards a “leaky gut syndrome”. Having both gluten and casein together multiplies the risk of this happening, especially with repetitive exposure, like every breakfast for example. It has even been included in the wider problem of “Dietary protein enterocolitis”:

“Dietary protein enterocolitis generally presents in the 1st year of life with diarrhoea, emesis, and irritability. When there is a delay in diagnosis, persistent exposure to the offending dietary antigen leads to increasing enteric inflammation manifesting as bloody diarrhoea, anemia, dehydration, and failure to sustain normal patterns of weight gain and growth. The extent of enteric inflammation may be limited to mild proctitis, pancolitis, or true enterocolitis with esophagitis, gastritis, enteropathy, and colitis. The offending antigen is usually cow's milk protein or soy protein.” (Curr Allergy Rep. 2001 Jan;1(1):769. Dietary protein enterocolitis. Lake AM .)

Pay attention to the fact that soy protein is also a guilty part in that pathology and is therefore definitely not a valid substitute, on top of other inherent problems. The inflammation is caused by a local allergic reaction.

The infamous “Irritable bowel syndrome (IBS)” that is often dismissed as being “all in your head” is associated in 25% of the cases to a food sensitivity, mostly gluten and casein: “Twenty-five percent of patients with IBS have FH (food hypersensitivity). These patients had increased levels of fecal ECP and tryptase, indicating that they might cause inflammation in patients with IBS. Fecal assays for ECP could be used to identify FH in patients with IBS.” (Clin Gastroenterol Hepatol. 2011 Nov;9(11):965971. Fecal assays detect hypersensitivity to cow's milk protein and gluten in adults with irritable bowel syndrome. Carroccio A , Brusca I, Mansueto P, Soresi M, D'Alcamo A, Ambrosiano G, Pepe I, Iacono G, Lospalluti ML, La Chiusa SM, Di Fede G.)

We are often consulted to treat diarrhoea and constipation in children. Are we wasting our time and using at times ineffective methods or techniques that allow the damage to continue without symptoms, when the answer is so simple?

“Chronic diarrhoea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and

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consequent constipation in young children.... Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response.......... they were also more likely to have anal fissures and erythema or edema at base line.......... evidence of inflammation of the rectal mucosa on biopsy.......... and signs of hypersensitivity, such as specific IgE antibodies to cow's milk antigens.... Conclusion: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.” (N Engl J Med. 1998 Oct 15;339(16):11004. Intolerance of cow's milk and chronic constipation in children. Iacono G , Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A.)

A diagnosis of “Allergic colitis” is sometimes made.

“Allergic colitis (AC) is an inflammatory condition characterized by eosinophils infiltrating the colonic wall. It can be a benign and/or severe illness among gastrointestinal diseases in infants.... Endoscopic biopsy specimens of intestine confirm the diagnosis of AC. However, allergen skin prick test and IgE antibody to milk protein components also provide helpful diagnostic tools for this rare disease in children .” (Pediatr Neonatol. 2013 Feb;54(1):4955. Allergic colitis in infants related to cow's milk: clinical characteristics, pathologic changes, and immunologic findings. Yu MC , Tsai CL, Yang YJ, Yang SS, Wang LH, Lee CT, Jan RL, Wang JY.)

The treatment is obvious and easy, but the whole “colitis” rigmarole and suffering could have been avoided.

Casein releases histamine (Int Arch Allergy Immunol. 1992;97(2):11520. A naturally occurring opioid peptide from cow's milk, betacasomorphine7, is a direct histamine releaser in man. Kurek M, Przybilla B,

Hermann K, Ring J.), a possible explanation to many weird causeless “allergic” situations that are symptomatically treated with anti-histamines, both in conventional medicine and homeopathy (e.g Histaminum, Apis, etc...) or herbal medicine. Although the symptoms are relieved the patient lives in constant fear of an allergic reaction, urticaria, Quincke syndrome or even anaphylactic shock of “unknown origin”. Why not just avoid them?

It is not always casein that is the guilty part:

“...Stimulation by cow's milk proteins caused the lymphocytes from infants with cow's milk allergy to release more tumor necrosis factor alpha TNF alpha than those from control infants. After appropriate antigenic stimulation, the cytokines released by the activated lymphocytes from these infants perturbed epithelial function, in particular its barrier capacity. Tumor necrosis factor alpha, together with gamma interferon are involved in these adverse effects. It is thought that bovine betalactoglobuline (emphasis mine) present in the intestinal lumen may be responsible for the secretory diarrhoea observed in children with cow's milk allergy, as a consequence of stimulation of electrogenic chloride secretion.” (Acta Paediatr Jpn. 1994 Oct;36(5):5926. Milk proteins, cytokines and intestinal epithelial functions in children. Desjeux JF, Heyman M.)

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Betalactoglobuline is in high concentration in whey, where casein is removed. It is not present in human milk that contains instead alphalactoglobuline. Could that be causing intestinal damage, leaky gut syndrome, absorption of foreign molecules to all the whey consumers that are lured into believing this is a healthy substance? I have not found any reference to that, yet, but also, I have not found any research about it. In doubt, I would say to body-builders, weight lifters and others: “if you want a good protein supplement, get an egg, some fish or a steak, for crying out loud...and if you are vegetarian or vegan, beans and peas, nuts and seeds will do”!

A few more words about Betalactoglobuline:

“Bovine beta-lactoglobulin (Blg) is a major cow's milk allergen. It is the main whey protein, without any counterpart in human milk. Blg chemical hydrolysates appeared to retain most of the immunoreactivity of the native protein.” (Clin Exp Allergy. 1999 Aug;29(8):1055-63. Allergy to bovine beta-lactoglobulin: specificity of human IgE to tryptic peptides. Sélo I, Clément G, Bernard H, Chatel J, Créminon C, Peltre G, Wal J.)

Here is an experimental paper explaining clearly the occurrence of allergies “since birth” that often baffles parents and paediatricians:

“Allergies are increasing, and despite deeper insights into the immunologic basis of these diseases, preventive measures are not yet efficient. As the induction of allergic diseases is often triggered in early childhood, perinatal or prenatal preventive strategies would be beneficial. We investigated the transfer of inhalant and nutritive allergens across the human placenta. For this purpose, the maternal side of a placental cotyledon was perfused in vitro with an allergen-containing medium, and a specific ELISA was used to detect the allergens on the foetal side. Both allergens evaluated, birch pollen major allergen Bet v1 and the milk allergen beta-lactoglobulin, could be shown to cross the placenta. The nutritive allergen beta-lactoglobulin was not only transferred across the placenta in all eight experiments but was also detectable within the first minutes of perfusion. The peak allergen concentration on the foetal side could be increased by addition of human immunoglobulin..... We conclude that allergens are actively and selectively transferred across the placenta. Therefore, controlled maternal allergen exposure might offer new ways to induce tolerance to specific allergens in the foetus.” (Pediatric Research (2000) 48, 404–407; Direct Evidence for Transplacental Allergen Transfer Zsolt Szépfalusi, Christine Loibichler, Josefa Pichler, Klaus Reisenberger, Christof Ebner and Radvan Urbanek).

The obvious solution and prevention are to recommend abstention of milk and dairy products to pregnant women. So simple, and yet.... To be completely fair, I have also found a few papers (no references given here) where the allergic outcome of babies has been compared when their mothers were allocated to either “normal” milk intake and reduced (but not totally eliminated) intake, with no difference. It is my opinion that total eradication would have demonstrated obvious and irrefutable differences.

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Casein and Diabetes.

“Abstract: The recent increase in both forms of diabetes must be caused by a modern change in the environment. Candidate agents must satisfy at least three criteria. Firstly, the agent must have increased in the environment recently, secondly that it causes diabetes in appropriate animal models, and thirdly that there is a plausible diabetogenic mechanism. Modern food processing can produce glycation end products, oxidised ascorbic acid and lipoic acid, all of which may cause diabetes. Infant formula in particular has high levels of glycation products and added ascorbic acid. A casomorphin released from A1 betacasein (but not the A2 variant) can become glycated and have adverse immune effects. Food processing and additives can be posited as a man-made cause of the increase in both forms of diabetes. This hypothesis does not exclude other environmental agents which meet the above three criteria.” (Med Hypotheses. 2006;67(2):38891. Diabetes a man-made disease. Elliott RB).

This paper makes a case for a less dangerous A2 type of milk. Do you know which one is in your supermarket?

This experimental research demonstrates that beta-casomorphine increases the post-prandial release of insulin: Endocrinology. 1983 Mar;112(3):8859. Effect of betacasomorphins and analogs on insulin release in dogs. Schusdziarra V, Schick A, de la Fuente A, Specht J, Klier M, Brantl V, Pfeiffer EF.

The relation between casomorphine (CM) and type 1 diabetes is demonstrated here: “An enhanced humoral immune response to various CM proteins in infancy is seen in a subgroup of those children who later progress to T1D. Accordingly, a dysregulated immune response to oral antigens is an early event in the pathogenesis of T1D. (Pediatr Diabetes. 2008 Oct;9(5):43441. Enhanced levels of cow's milk antibodies in infancy in children who develop type 1 diabetes later in childhood. Luopajärvi K , Savilahti E, Virtanen SM, Ilonen J, Knip M, Akerblom HK, Vaarala O.).

Although done on mice, this study shows that milk abstinence can prevent the appearance of IDDM: “Human epidemiological studies delineated early exposure to intact dietary protein (e.g., most infant formulas) as an environmental risk factor for the development of IDDM. The Trial to Reduce IDDM in the Genetically at Risk (TRIGR), an international IDDM prevention trial, has been designed to determine if avoidance of intact dairy protein in high risk infants < or =6 months of age can reduce the subsequent diabetes incidence...... Thus, diabetes prevention with the clinical trial diet is effective in NOD mice, where it affects some Tcell repertoires and allows development of regulatory cells that interfere with destructive autoimmunity.” (Diabetes. 1997 Apr;46(4):55764. Immunological aspects of nutritional diabetes prevention in NOD mice: a pilot study for the cow's milkbased IDDM prevention trial. Karges W , HammondMcKibben D, Cheung RK, Visconti M, Shibuya N, Kemp D, Dosch HM).

More references:

J Proteome Res. 2008 May;7(5):21657. Relation of time of introduction of cow milk protein to an infant and risk of type1 diabetes mellitus. Goldfarb MF .

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Pediatr Diabetes. 2015 Feb;16(1):318. The effect of childhood cow's milk intake and HLADR genotype on risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young.

Lamb MM , Miller M, Seifert JA, Frederiksen B, Kroehl M, Rewers M, Norris JM.

All those studies have in common that casein increases significantly the risk of developing diabetes, albeit not with the A2 variant. No wonder we see an exponential increase in the number of young diabetics. Other causes are certainly also present but this one is quite clear and easy to avoid.

Casein and the brain.

We have yet again another unsuspected relation with autism:

“Abstract: Elevated concentrations of circulating casomorphins (CM), the exogenous opioid peptides from milk casein, may contribute to the pathogenesis of autism in children. Because several mass spectrometry studies failed to detect casomorphins in autistic children, it was questioned whether these peptides can be detected in body fluids by mass spec. Here we demonstrated, using a novel high sensitivity ELISA method, that autistic children have significantly higher levels of urine CM-7 than control children. The severity of autistic symptoms correlated with concentrations of CM-7 in the urine. Because CMs interact with opioid and serotonin receptors, the known modulators of synaptogenesis, we suggest that chronic exposure to elevated levels of bovine CMs may impair early child development, setting the stage for autistic disorders.” (Peptides Volume 56, June 2014, Pages 68–71. Autistic children display elevated urine levels of bovine casomorphin-7 immunoreactivity. Oleg Sokolov, Natalya Kost.)

“Objective: This study was designed to highlight the degree of benefit in various aspects of development of autistic children upon elimination of cow's milk protein (CMP) from their diet and assess the level of specific IgE for CMP in their sera..........Conclusion: We report improvement in language, cognition and behavioural capabilities upon CM elimination in a group of autistic children. The higher CM specific IgE in these children may suggest that such adverse reaction to CM may have an allergic basis.” (Egyptian Journal of Pediatric Allergy and Immunology (The). Vol 4, No 1 (2006). Cow’s milk protein elimination in autistic children: language, cognitive and behavioral outcome Mostafa A ElHodhod, May F Nassar, Jilan F Nassar, Gihan M ElNahas, Soad M Gomaa.)

“We previously reported results based on the examination of a gluten and casein free diet as an intervention for children diagnosed with an autism spectrum disorder as part of the ScanBrit collaboration. Analysis based on grouped results indicated several significant differences between dietary and non-dietary participants across various core and peripheral areas of functioning. Results also indicated some disparity in individual responses to dietary

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modification potentially indicative of responder and non-responder differences. Further examination of the behavioural and psychometric data garnered from participants was undertaken, with a view to determining potential factors pertinent to response to dietary intervention. Participants with clinically significant scores indicative of inattention and hyperactivity behaviours and who had a significant positive change to said scores were defined as responders to the dietary intervention. Analyses indicated several factors to be potentially pertinent to a positive response to dietary intervention in terms of symptom presentation. Chronological age was found to be the strongest predictor of response, where those participants aged between 7 and 9 years seemed to derive most benefit from dietary intervention....” (Nutr Neurosci. 2014 Sep;17(5):20713. Data mining the ScanBrit study of a gluten and casein free dietary intervention for children with autism spectrum disorders: behavioural and psychometric measures of dietary response. Pedersen L, Parlar S, Kvist K, Whiteley P, Shattock P.)

There is also a correlation with the occurrence of epilepsy and brain inflammation:

“Adverse reactions after ingestion of cow's milk proteins can occur at any age, from birth and even amongst exclusively breastfed infants, although not all of these are hypersensitivity reactions. The most common presentations related to cow's milk protein allergy are skin reactions, failure to thrive, anaphylaxis as well as gastrointestinal and respiratory disorders. In addition, several cases of cow's milk protein allergy in the literature have documented neurological involvement, manifesting with convulsive seizures in children. This may be due to CNS spread of a peripheral inflammatory response. Furthermore, there is evidence that pro-inflammatory cytokines are responsible for disrupting the blood-brain barrier, causing focal CNS inflammation thereby triggering seizures, although further studies are needed to clarify the pathogenic relationship between atopy and its neurological manifestations. This review aims to analyze current published data on the link between cow's milk protein allergy and epileptic events, highlighting scientific evidence for any potential pathogenic mechanism and describing our clinical experience in pediatrics. (Expert Rev Clin Immunol. 2014 Dec;10(12):1597609. Epileptic seizures as a manifestation of cow's milk allergy: a studied relationship and description of our pediatric experience. Falsaperla R , Pavone P, Miceli Sopo S, Mahmood F, Scalia F, Corsello G, Lubrano R, Vitaliti G.)

Combine this with the effects of gluten and sugar on the brain described earlier on and you stop wondering why children are sleepy in class, do not pay attention, do not participate or have behavioural problems, only to be then classified as ADHD and heavily drugged. This is made even worse by the fact that going to class hungry, without a good breakfast can lead to the same situation. The generous people and programmes that try to feed children in the mornings, at school can then honestly say that even when fed “appropriately” some of the pupils have poor behaviour, leading to social service intervention, family enquiries about abuse, drugs and alcohol, all phenomena that surely occur but very often miss the target: toxic pseudo-food. Clearly all pharmacological, herbal,

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homeopathic, osteopathic interventions are bound to fail too, and yet the solution is so simple.

Casein and cancer.

“High intakes of dairy products, milk, low fat milk, cheese, and total, dietary, and dairy calcium, but not supplemental or non-dairy calcium, may increase total prostate cancer risk. The diverging results for types of dairy products and sources of calcium suggest that other components of dairy rather than fat and calcium may increase prostate cancer risk. Any additional studies should report detailed results for subtypes of prostate cancer.” (Am J Clin Nutr. 2015 Jan;101(1):87117. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Aune D , Navarro Rosenblatt DA , Chan DS , Vieira AR , Vieira R , Greenwood DC , Vatten LJ , Norat T).

If that was not scary enough, here is a study linking the presence of Bovine Leukemia Virus with breast cancer. Some extracts from the paper by the University of California, Berkeley: “........A 2007 U.S. Department of Agriculture survey of bulk milk tanks found that 100 percent of dairy operations with large herds of 500 or more cows tested positive for BLV antibodies.... The new paper takes the earlier findings a step further by showing a higher likelihood of the presence of BLV in breast cancer tissue. When the data was analyzed statistically, the odds of having breast cancer if BLV were present was 3.1 times greater than if BLV was absent.... (Gertrude Case Buehring, Hua Min Shen, Hanne M. Jensen, Diana L. Jin, Mark Hudes, Gladys Block. Exposure to Bovine Leukemia Virus Is Associated with Breast Cancer: A Case Control Study. PLOS ONE, 2015; 10 (9): e0134304 DOI: 10.1371/journal.pone.0134304).

You drink milk, you increase the risk of breast cancer. A good explanation for the explosion in the number of cases, as women are encouraged to have more milk in order to allegedly “prevent osteoporosis”, and we know that does not work either: “Conclusions: High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. (British Medical Journal BMJ 2014;349:g6015. Milk Intake and Risk of Mortality and Fractures in Women and Men: Cohort Studies Karl Michaëlsson, Alicja Wolk, Sophie Langenskiöld, Samar Basu, Eva Warensjö Lemming, Håkan Melhus, Liisa Byberg).

Casein and respiratory problems.

The occurrence of asthma, as well as other breathing problems, in children and later in adults is increasing. We tend to point towards vaccines as being one of the guilty parts and often treating their side effects leads to the disappearance of the respiratory problems. Yet there is a more insidious background that possibly enhances the other causes or even simply is the cause.

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“...The betacasomorphins decreased inspiratory drive and prolonged the expiratory phase by delaying the setpoint for inspiration.....All ventilatory effects induced by the betacasomorphins could be readily reversed or prevented by naloxone. Intra-cerebroventricular but not intra-peritoneal injection of betacasomorphin depressed ventilation in preterm new-born rabbits in a similar pattern with apnoeic periods to that seen in the adult rats. In addition, an irregular breathing pattern was elicited. Thus, the bovine betacasomorphins possess potent central respiratory depressive effects.” (Life Sci. 1987 Nov 16;41(20):230312. betaCasomorphins induce apnea and irregular breathing in adult rats and newborn rabbits. Hedner J , Hedner T.)

This could be one of the causes of sudden death in babies.

(Prog Clin Biol Res.1990;328:32730. Betaendorphin, human caseomorphin and bovine caseomorphin immunoreactivity in CSF in sudden infant death syndrome and controls. Storm H , Reichelt CL, Rognum TO.)

And:

“Sudden infant death syndrome (SIDS) is the most common cause of death in infants and its pathogenesis is complex and multifactorial. The aim of this review is to summarize recent novel findings regarding the possible association of betacasomorphin (betaCM) to apnoea in SIDS, which has not been widely appreciated by paediatricians and scientists. betaCM is an exogenous bioactive peptide derived from casein, a major protein in milk and milk products, which has opioid activity. Mechanistically, circulation of this peptide into the infant's immature central nervous system might inhibit the respiratory center in the brainstem leading to apnoea and death. This paper will review the possible relationship between betaCM and SIDS in the context of passage of betaCM through the gastrointestinal tract and the blood brain barrier (BBB), permeability of the BBB to peptides in infants, and characterization of the casomorphin system in the brain” (Peptides. 2003 Jun;24(6):93743. Relation of betacasomorphin to apnea in sudden infant death syndrome. Sun Z , Zhang Z, Wang X, Cade R, Elmir Z, Fregly M.)

Less dramatic but still at times life threatening and definitely limitating, asthma:

“...Compared with their controls, children with a history of IgEpositive CMA show signs of airway inflammation, expressed as higher FE(NO), and more pronounced bronchial responsiveness to histamine at school age. In contrast to IgEnegative CMA, IgEpositive CMA is a significant predictor of increased FE(NO) and BHR at school age .” (Clin Exp Allergy. 2010 Oct;40(10):14917. Cow's milk allergy as a predictor of bronchial hyperresponsiveness and airway inflammation at school age. Malmberg LP , Saarinen KM, Pelkonen AS, Savilahti E, Mäkelä MJ.)

Chinese Medicine considers milk as a Yin and Humid type of food that increases the production of mucus in the respiratory tract. Conventional practitioners and paediatricians do indeed recommend abstaining from milk and dairy during infection of the respiratory system in general.

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“Excessive milk consumption has a long association with increased respiratory tract mucus production and asthma. Such an association cannot be explained using a conventional allergic paradigm and there is limited medical evidence showing causality. In the human colon, betacasomorphin7 (betaCM7), an exorphin derived from the breakdown of A1 milk, stimulates mucus production from gut MUC5AC glands. In the presence of inflammation similar mucus overproduction from respiratory tract MUC5AC glands characterises many respiratory tract diseases. betaCM7 from the blood stream could stimulate the production and secretion of mucus production from these respiratory glands. Such a hypothesis could be tested in vitro using quantitative RTPCR to show that the addition of betaCM7 into an incubation medium of respiratory goblet cells elicits an increase in MUC5AC mRNA and by identifying betaCM7 in the blood of asthmatic patients. This association may not necessarily be simply cause and effect as the person has to be consuming A1 milk, betaCM7 must pass into the systemic circulation and the tissues have to be actively inflamed. These prerequisites could explain why only a subgroup of the population, who have increased respiratory tract mucus production, find that many of their symptoms, including asthma, improve on a dairy elimination diet.” (Med Hypotheses. 2010 Apr;74(4):7324. Does milk increase mucus production? Bartley J, McGlashan SR.)

Is that all? No, there is still another component in milk, lactose.

Lactose is a disaccharide, glucose + galactose. Babies have the enzyme lactase that allows them to digest it and thrive on it. Most adults have lost it, although it appears that in many traditionally pastoral cultures, there is residual lactase remaining during adult life that allows some degree of tolerance. However, the presence of D-galactose is apparently harmful in adult humans:

“A high intake of milk might, however, have undesirable effects, because milk is the main dietary source of D-galactose. Experimental evidence in several animal species indicates that chronic exposure to D-galactose is deleterious to health and the addition of D-galactose by injections or in the diet is an established animal model of aging. Even a low dose of D-galactose induces changes that resemble natural aging in animals, including shortened life span caused by oxidative stress damage, chronic inflammation, neurodegeneration, decreased immune response, and gene transcriptional changes. A subcutaneous dose of 100 mg/kg D-galactose accelerates senescence in mice. This is equivalent to 6-10 g in humans, corresponding to 1-2 glasses of milk. Based on a concentration of lactose in cow's milk of approximately 5%, one glass of milk comprises about 5 g of D-galactose. The increase of oxidative stress with aging and chronic low-grade inflammation is not only a pathogenetic mechanism of cardiovascular disease and cancer in humans but also a mechanism of age related bone loss and sarcopenia. The high amount of lactose and therefore D-galactose in milk with theoretical influences on processes such as oxidative stress and inflammation makes the recommendations to increase milk intake for

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prevention of fractures a conceivable contradiction” (Milk Intake and Risk of Mortality and Fractures in Women and Men: Cohort Studies, article quoted earlier).

This on top of the effects of high sugar intake we have seen before. The energy boost that bodybuilders claim to have from the whey protein shakes they consume after a workout comes from a high concentration of lactose (casein having been removed), which annihilates at least partially the calories burned during exercise.

We have reached the end of the most important part of any prequel treatment: what to avoid, what to eliminate in order to remove maintaining causes of pathologies and symptoms and in order to prevent evolution into complicated, difficult and often irreversible diseases, while at the same time allowing indicated remedies and other treatments to work to their full extent, without hindrances.

Again, I make no excuses for the accumulation of data and references. The nutritional recommendations we are going to make need to be firmly rooted in knowledge, science and clinical experience. To be the most convincing, the information has to come from sources that cannot be easily contested. Who better to provide us with that than the conventional medical and scientific world, those people who would have a fit of rage if and when they realise that we use their own research to contradict their recommendations and get rid of their drugs, to cure or at least profoundly relieve what they consider as incurable and unavoidable? Clearly the problems that we looked at separately combine and influence each other when those substances (I really cannot call them foods any more) are consumed together, in an exponential manner and in a cumulative manner, meaning that the occasional cookie will do no harm to a healthy person, but the regular western brown and white diet is a sure one-way ticket to disease and early death. There is a French saying that goes: “We are digging our grave with our teeth”. Need I say more?

In the light of what you just read, try this little exercise: here is a more or less standard answer I receive when asking patients to describe what they eat during the day, in general. Which pathologies and medical problems loom in their future? Which presenting complaints could they have as a reason for a consultation and how would you explain to them what is happening, what will happen and what to do?

- What do you have for breakfast?

Weet Bix or cereals with milk and one spoon of sugar; sometimes a toast or two with jam and margarine, coffee or tea with milk and just one sugar.

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- Mid morning?

Tea or coffee, a biscuit, sometimes a muffin or an apple.

- Lunch?

Sandwiches with cheese, ham, tomato, lettuce, or I buy a burger with a soda, diet soda, mind you. If I am at home, either leftovers or sandwiches, some pasta, or a take-away like pizza.

- Afternoon tea?

Tea or coffee with a biscuit.

- Evening meal?

Meat and vegetables, we try to eat healthy! Sometimes fried fish, spaghetti or raviolis, a salad, ice cream or some pudding.

One important and obvious question I am often confronted with is “if this is so noxious, how comes people are not dying in throws like flies exposed to insecticide?” Fair question indeed.

The effects of toxic food consumption are not acute, as if you were swallowing some cyanide; it is slow, often silent for a long time, has long-term consequences that are not immediately life threatening in most cases and can be attributed to other causes. There is almost a form of fatalism, of inevitability linked to the diseases encountered, which are often treated symptomatically and labelled “chronic and incurable” by the conventional medical system. Look around you:

Babies born with allergies and eczema, is that “normal”? Why does it happen? One of the answers could be the diet during conception and pregnancy. Easy to correct, if you are aware of that possibility.

Autism and ADHD: we rightfully accuse vaccines and environmental pollution. However, I just drowned you under articles and references regarding the dietary responsibility in creating and maintaining those pathologies. There is no “either-or” aetiology, no direct straight linear connection. Removing or avoiding one factor might mean the difference between health and disease even if the other factors are irreversible or unavoidable.

Obesity, metabolic syndrome, diabetes, hypertension, cardiovascular diseases are on the rise, called “epidemic” and the source of many well-funded research grants that are eventually all coming to the same conclusion: the cause and the solution are in your plate.

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Osteo-articular diseases, no matter what label is affixed to any of them, are the curse of old age. Says who? The longer you suffer from them, the worse they become. But any practitioner who uses nutrition as a therapeutic tool will tell you that pain and stiffness can be reduced if not totally removed, joints can be regenerated, bones can become solid once again once the food pattern has been normalised (yes you need more for repair, but this is out of the scope of this book).

I do not like conspiration theories. Nevertheless, look at your TV set: how often do you see advertisements for burgers, candies and sodas compared to simple, unprocessed organic food? Follow the money...

Yet another rock is thrown at those of us who avoid cereals, sugars and dairy. Reports appear, and a recent article was published in the lay press, describing patients, often children, who have been put on those restricted diets suddenly presenting with allergic reactions or even life-threatening anaphylactic shock when they eventually consume some of the “forbidden bounty”. It is fair to say that reading the multiple restrictions imposed, they are often excessive. Here comes the argument: having dietary restrictions prevents the establishment of tolerance to those foods and comes then with the risk of severe reaction when put in contact with them. Why would someone want to become tolerant to harmful substances, allowing them to penetrate our bodies without reaction and do all the harm you just read about? When it comes to food, I mean real food, it should always be well accepted even if having abstained from it for a while or if it is a new food. Reacting to something means the body, the physiology, the immune system recognises it as harmful, rejects it violently, warning you through the symptoms and the suffering not to ingest that anymore. That is how animals, and our ancestors, learned to recognise what is comestible, what is not, what is useful, and what is harmful. The reaction when I present that type of argument? “Come on, all experts agree!” Experts in what? Who made them experts? They seem to have forgotten, voluntarily erased or never learned properly human physiology.

Our duty as health practitioners of every ilk is to educate our patients and their families, one at the time, to understand what is happening, what has to be done and what are the possible outcomes depending on lifestyle choice. It is a slow grassroot movement; it is taking personal responsibility of our own lives.

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Now what?

What remains to eat when you remove all the cereals, the fast carbohydrates, the sugars, the milk and dairy products and the industrialised food? This is often the first question after having heard what to avoid and why, often asked in a whining and desperate voice.

The answer is simple: all the rest!

Traditional diets, like the Mediterranean one, the Ayurvedic cuisine, the Chinese or Japanese dishes are much healthier than the regular Western diet. Yet they are still using milk, cereals and sugars, albeit in significantly lesser amounts. How do those populations manage to produce healthy centenarians? Because most of those people are very active and burn the parts than can be of use (carbohydrates) while the rest of the food, the healthy parts, offer protection against the small amounts of toxic intake.

Most of the Western population is physically inactive and sedentary, unless you consider “hunting and gathering” by pushing a trolley in the supermarket aisle as a competition sport. Many of those who are active, run, swim, go to the gym, often end their session with a carbohydrate-loaded smoothie and added whey, or reward themselves with a large latte and a Danish, a croissant or another pastry...yes they are tasty and well deserved, and yes they neutralise and negate all the effort and pain you just went through.

Which leads us to the infamous Paleo diet.

The most frequent definition I found for it is “eating the way our hunter-gatherers ancestors did” or variations thereof.

Let’s be serious for a moment: this is obviously impossible; there are no more mammoths or wild aurochs to hunt; plants, fruits and vegetables have changed, mostly through human intervention or selection, either directly or indirectly through environmental changes; cavemen did not have fridges, freezers or ovens; there were no planes or refrigerated boats to transport foods from exotic places, so no pineapple, coconut or mangoes in Northern Europe; hunger and famines were commonplace; life was difficult, short and dangerous. Who would like to live like that today? Yet politics, wars and economics still plunge whole populations in this type of nightmare? The Westernised world is sick of an excess of wrong food, the rest of the world is sick of a lack of any food.

Paleo is not really a “diet”. It is a way of life and of nourishment based on understanding of human nutritional needs and digestive abilities, on avoidance of harmful substances wrongly labelled as food. It is definitely not “returning to the way of our ancestors” and living in a cave while foraging the best we can to survive. Neanderthals and Cro-Magnons did sing and dance and paint and create art and jewellery, trying to make their

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lives better and more enjoyable. Over the centuries, we have acquired the knowledge and the instruments to understand how our bodies function, what they need, what is beneficial or harmful. Now it is only a question of applying that knowledge to today’s world, not getting rid of our computers, televisions, cell phones, cars and airplanes, although it would not hurt to make them more life friendly and less business friendly.

The Paleo concept extends to other fields, for example that of sleep. A major complaint we hear in our consulting rooms is that of insomnia and especially waking up during the night. The desperate search for a “full night of sleep” is widespread and a goldmine for many who exploit the situation. Until now I regularly wake up at 1:30 AM, then 3:30 AM and finally 6:30 AM, fully awake. I attributed this lack of continuous sleep to my years of being on call, needing to be able to wake up immediately and being fully functional. However, I have not been on call for more than twenty years; that “habit” should have disappeared. Watching my pets sleep, I realised they have a similar pattern of sleep, waking up a few times at night, having a look around, then going back to sleep. So do most animals in the wild. The sheer number of people complaining about waking up at nigh made me think. What if this was the normal pattern and what if the full uninterrupted night of sleep was only correct when exhausted? Life is dangerous; what if a nocturnal predator came into the cave? What if the fire that keeps the predators away is going down? What if that fire is attracting another tribe and we are on the verge of being attacked? Once I considered that there was no problem with the way I sleep, I started enjoying waking up, realising that I still had so many hours to snooze and dream, finding a more comfortable position and looking forward to the next dream. I was exhilarated when I found out that a major Australian sleep specialist, Dr. David Cunnington (www.sleephub.com.au) was writing exactly the same thing. He writes: “It is normal to wake often during the night. It is common to wake up during sleep. In fact, most people wake two or three times during the night. In the old days, our ancestors would wake to stoke the fire, or ward off animals. They also had a period of “prolonged awakening”, a few hours between the two hours of sleep. Historically if you read about how human sleep has been described over thousands of years, it has been described as three to four hours of deeper sleep after the sun goes down followed by a period of being awake. That period of being awake in fact could last a couple of hours and was then followed by dozing through the remainder of the night until the sun came up. Human sleep was not described as a continuous block until industrialisation, and no mammals in their natural environment sleep in continuous blocks.” The Paleo system is all about restoring our physiological needs and functions, integrating them into modern society, not regressing into a non-existent “Golden Age”.

Another Paleo concept has come to town with exercise. A few gyms now offer “Paleo Fitness” aka “Cross-Fit” where the usual cardio and weightlifting are replaced by intensive motions imitating what could have been necessary in the life of a hunter-gatherer: short

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bursts of running (HIIT, high intensity interval training, cycling is allowed as a substitute), jumping, rope and rock climbing, weight throwing. Others add to that “imitating animals”: walking like a bear or a gorilla or a crab, jumping like a gazelle, etc,...which made me laugh: ever heard about the Chinese Qigong “Animal Frolics” and the Kung Fu animal schools, Mantis, Monkey, and so on? Nothing new under the sun. Paleo is really a lifestyle.

We know quite well what our needs are and what we are able to digest, what our digestive enzymes and our friendly bacteria can and cannot deal with. That information is available in any textbook of physiology, remembering that human physiology is different from animal physiology. Our pets are also suffering from dysnutrition courtesy of the demented manufacturing of pet food containing fruits, vegetables and spices destined to strict carnivores like cats and dogs...total madness! Please do refer to those textbooks; many of them are freely available on the internet.

Paleo-medicine, the medical or rather forensic study of mummies and ancient skeletons tends to confirm the above. Looking at X Rays and CT scans or MRIs of Pharaohs’ mummies often shows arterial calcifications and non-traumatic joint degenerations: yet they were the richest and most powerful people of their time, fed the most refined and succulent foods: milk, breads, cereals, sugar and honey. The lower casts and the slaves, when available for examination, do show traumatic pathologies, but very few if any at all of the pathologies of the rich and refined food-consuming people. Cro-Magnons hunter-gatherers had short traumatic lives; when compared to humans of the same age who lived in agricultural settings, the difference is clear. Even in those ancient times, when there were no preservatives, additive, colorants, GMOs, insecticides or pesticides, degenerative diseases already plagued the farmers but not the hunter-gatherers. Dental decay was present in both, but from different origins: traumatic for the hunter-gatherers, degenerative for the farmers (I am obviously simplifying a lot here). There is no need to travel back in time, though. Multiple studies on migrants have shown that when people from other countries, other civilisations where food is natural, often home-grown, prepared and eaten in a traditional way adopt Western food, they also adopt Western diseases. A recent experiment was conducted in Australia (apologies, I could not find the publication and copy the reference): a group of overweight, but not obese, people with abnormal blood tests, some with hypertension, some with borderline diabetes, went “bush” and lived in the Australian outback exactly like Aboriginals did, living from the land, eating what they could find or hunt. At the end of the experiment, not only had they lost weight, their blood tests came back normal, their diseases or pre-clinical status had disappeared.... normality restored with a pure Paleo diet...QED.

Here is a link about a Canadian man who did the same, while not living in the bush, and had the same results: http://news.nationalpost.com/news/yes-to-berries-no-to-salt-aboriginal-man-

goes-back-to-his-dietary-roots-in-order-to-lose-weight-live-healthier. An excerpt: “I’m not going to put anything in my body that was not here before the Europeans arrived, because there is

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something wrong here,” said Mr. Ducharme, a Métis from Duck Bay, Man. “Ever since colonization, my people went from being a fit, athletic race of people to the most sickly and lame. The most obese. The highest diabetes rate… We went from eating our natural food to a diet completely different from 100 years ago.” And also: “In mid-February, Mr. Ducharme began to add so-called regular food, in small portions, back into his diet. He says he wanted his documentary to show the effects of returning to a normal diet. “I gained 30 pounds in one month,” he said. It is indeed the experience of only one person, reproduced hundreds if not thousands of times; that makes it a statistically significant cohort, but of course, why should that be studied, published and promoted? There is no money in it.

Which groups of food are “human foods”?

Nuts.

Seeds.

Fruits.

Vegetables.

Animal proteins, including eggs, excluding milk and dairy.

Having told my patients what to avoid and what to choose, I pause. More and more people say: “that is what I expected you to tell me, but I needed that kick in the backside to get me started”. It is still a minority. So, we chat. What follows contains little references to research and science, unless really needed to understand the reason behind the recommendation, simply because this is not what I tell the patient at that time, unless he asks for it. Therapeutic and healing properties of foods, their contents, are not the focus of those dietary recommendations, unless I use the foods for specific pathologies: for example I spend a lot of time explaining the properties of different oils like coconut, walnut, avocado oils in the treatment and prevention of neurological problems when treating patient with dementia, Alzheimer, neuropathies, etc,...which is not our focus here.

Nuts.

All the nuts, no exception, even those that are technically not nuts, like the peanuts. Raw, not roasted, not salted. They are pretty versatile and can be used not only as snacks (careful not to overdo it, they are high in calories) but also as a substitute for flour when ground, and you can make your own “nut milk” instead of buying the highly diluted commercial almond milk. It is cheaper and you can control the consistency by diluting the “milk” to taste. Even better if using coconut water rather than plain water.

Speaking of coconut, coconut flour is also a great and tasty substitute, as is chestnut flour; chestnuts are technically seeds, not nuts; coconut milk and cream are ground coconut

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flesh with various degrees of dilution. Coconut water is the best “energy and mineral replacement” drink available; it is completely isotonic to the extent that it can also be used (after filtration) as a plasma substitute intravenously (don’t try this at home, please!). It was used to this purpose in WW2, if I remember well by British medics, but I do not have the references handy. We use coconut oil at home by the ladle: it is the only oil that can be safely fried because of its high flammable point, up to 630°C; it is also a known and demonstrated preventative and treatment for dementia and Alzheimer, it repairs the nerves and their myelin sheaths (please do remember that there are other causes, like vascular impairment, and mixed causes, that must also be addressed; do not take this as a prescription for dementia, although it will help). Olive, avocado oils are extremely healthy but cannot be heated.

This is what your patient wants to know, not really composition, minerals, vitamins, essential fatty acids, fibre contents and clinical uses. That information is important to the clinician when dealing with nutritional medicine; it is freely available in textbooks and online. I suggest you have a look at it and have the information handy if asked, but it is beyond the purpose of this book.

Seeds.

This word sometimes lands me in a lengthy argument about English semantics, especially with English teachers, and it is a problem for those of us for whom English is not their mother tongue. A seed is “a propagative portion of a plant”; “something that is sown or to be sown”; “the fertilised and ripened ovule of a seed plant” (Webster’s Third New

International Dictionary page 2055). Therefore, nuts are seeds; cereals are seeds; grains are seeds to the extent they are synonymous (and in French too, ‘graines’ and ‘semences’). Why do I forbid cereals when I recommend seeds? Some patients like to torture their practitioners...

The forbidden seeds, the cereals are a subgroup of seeds belonging to the family Triticum, the Graminacaes, the grasses, containing the harmful proteins like gluten that were described earlier on and an overload of fast absorbed carbohydrates. The other seeds are not only harmless but healthy and recommended, again with care taken about their amount, as they also are rich in slow carbohydrates: it is very easy to overload on carbohydrates by combining nuts, seeds, and tubers like potatoes, kumaras, sweet potatoes, carrots and other roots. This should be made clear to the patients.

On top of the well-known flaxseed, sesame seeds, pumpkin seeds, black cumin seeds and sunflower seeds, I include here the ancient grains, those that have survived agriculture and have not been modified: quinoa (soak before using as I had one patient who reacted to it, but was able to use it when soaked), amaranth, buckwheat (not a cereal despite the misleading name), teff, chia seeds. There are many ways of using them, please do refer to cookbooks. I personally like all of them together as a substitute for couscous, but that is just

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me. For those who claim they cannot live without bread, it is possible to make a form of very tasty “bread” out of flour made of a combination of those nuts and seeds with egg white to hold it together as there is no gluten, baked with coconut oil; it tends to crumble a bit, feels like pumpernickel bread and is extremely filling. Without describing how to make it (and I would be at a loss to do so), just by telling that to patients, I can see their faces illuminating and a smile appearing... “Ah, there is some “bread”....not everything is lost; the future is not that bleak...”

Fruits.

There is no problem with fruits, unless you make them your only staple food (fruitarians), in which case protein and fat deficiency will appear, or unless you are diabetic, and fruits should not be a major component but still can be present. This applies to whole fruits, not to fruit juices, even freshly squeezed ones: the amount of fructose that suddenly reaches the system and especially the liver can be enormous and become toxic if drinking fruit juices. I use the following example: a glass of orange juice is made of twelve squeezed oranges; can you eat twelve oranges in one go? Of course not, unless it is a bet, a challenge. Fruits can also be used when juicing vegetables to mask unpleasant tastes (for some) and render them more palatable; the same applies to smoothies. Dried fruits are good snacks or energy foods if and when needed, but their concentration in sugar is very high. They can give a needed boost but can also lead to weight gain when used as comfort food, especially when mixed with nuts and eaten almost automatically in front of the television, instead of popcorn. Awareness is always important, and it does not get in the way of enjoyment.

Vegetables.

Each and every single comestible vegetable is on the menu. That is the short version, generally followed by the question “which ones should I eat more?” There are two answers here: when there is a therapeutic approach to nutrition, the treatment of a disease, I definitely recommend the foods that have been shown beneficial in those pathologies, like broccoli and the whole cabbage (cruciferacae) family when dealing with cancer, in doses and presentations (e.g. four huge glasses of broccoli and cabbage juice per day) far away from normal daily cooking habits: this is nutritional medicine, not what we are dealing with here. In most of the cases the answer is again simple: eat what you like and enjoy; in any case, if I were to recommend a type of food that I personally like but my patient absolutely abhors, the end result would probably be conflict and abandonment of the diet. I just ask them to try new vegetables, new presentations, and in time to try again the foods they thought they could never eat, with surprising results. It is sometimes impossible: a very good friend of mine cannot tolerate red cabbage; not only the taste, or the smell, but the mere presence of red cabbage in the house is enough to provoke retching and vomiting.

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This is also when I introduce patients to spices, if they do not know them yet. Almost all spices have medicinal properties; once again, if there is a medical reason for a specific spice, like ginger in cancer prevention and treatment (especially prostate) or cinnamon in case of diabetes, emphasis is put on that spice; otherwise all spices are recommended in large quantities as all have positive impacts on health. I add some tips if larger amounts are needed: for example, if turmeric seems indicated, I recommend to dissolve it in coconut oil (curcumin and ar-turmerone are liposoluble and better absorbed) and to add to the mixture some black pepper, which increases absorption too. There are many books available about the medicinal properties of spices, get one, you will never regret that investment.

Inevitably, the question of carbohydrate-rich vegetables arises here: potatoes, sweet potatoes, carrots and other roots and tubers. They are certainly part of the Paleo diet, again within the range of normal behaviour. At times, the way they are prepared is relevant; for example, the glycemic index, or speed of sugar absorption, of mashed potatoes is higher than that of baked potatoes, simply because the carbohydrates are “caramelised” during the baking process and take more time to be digested and absorbed. It does not seem to be very relevant except for diabetics and, if they are consumed with other high fibre vegetables, there is apparently no real difference. The studies comparing mashed and baked potatoes were done with people eating only that during the experimental meal, which is not a real-life situation (hopefully).

Another question raised either by smart patients who have done their research or by those who are still not much better after respecting their new diet is the presence of anti-nutrients like lectins and saponins.

Lectins are proteins that bind specifically to sugars. Their presence is ubiquitous. Also present in mammals they have a role within the immune system. Eaten in large quantities, they are toxic to animals, therefore are considered as a form of defence of the plant, creating discomfort when eaten and in doing so, preventing the animals to try and eat them again. They can cause abdominal pain, nausea, vomiting and diarrhoea. An extreme example is the castor oil lectin ricin that can cause death when ingested. Lectins are found in cereals, but also in beans, nuts, seeds and potatoes. Is that a real problem? As always it is a question of quantity, sensitivity and preparation. Their amount can be much reduced by the processes of cooking, fermenting and sprouting; for nuts, the same can be done by soaking. Obviously, you are not going to eat uncooked beans and potatoes. Even with good preparation, a small amount of lectins will remain present; that is where individual sensitivity comes in, along with the amounts consumed. Most people will tolerate those small amounts without any problems, even those of us who eat raw nuts: I found it almost impossible to binge on nuts! Some patients will react even to small quantities and it is those who will unfortunately have to give up those excellent foods, at least until all systems are

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repaired. It is then possible to try again in small amounts and sometimes they regain the ability to enjoy nuts, seeds, beans and potatoes.

Saponins, like the lectins, are a plant defence mechanism. They are found in the same foods and also in the nightshade family other that the potatoes, the most eminent here being tomatoes. Not all are harmful, and some have been described as having anti-inflammatory properties, as being immune-stimulants or even having some antifungal and antibacterial properties without harming the consumer. Note that they are also present in the highly recommended quinoa, which accounts for the reports about its low tolerance in a few cases. Soaking, sprouting and fermenting do reduce the content in saponins the same way it does for lectins. Some authors have described research showing that only fermenting reduced the amount of saponins. Others disagree and even claim health benefits:

“Saponins are attracting considerable interest as a result of their diverse properties, both deleterious and beneficial. Clinical studies have suggested that these health-promoting components, saponins, affect the immune system in ways that help to protect the human body against cancers, and also lower cholesterol levels. Saponins decrease blood lipids, lower cancer risks, and lower blood glucose response. A high saponin diet can be used in the inhibition of dental caries and platelet aggregation, in the treatment of hypercalciuria in humans, and as an antidote against acute lead poisoning. In epidemiological studies, saponins have been shown to have an inverse relationship with the incidence of renal stones. Thermal processing such as canning is the typical method to process beans. This study reviews the effect of thermal processing on the characteristics and stability of saponins in canned bean products. Saponins are thermal sensitive. During soaking and blanching, portions of saponins are dissolved in water and lost in the soaking, washing, and blanching liquors. An optimum thermal process can increase the stability and maintain the saponins in canned bean products, which is useful for assisting the food industry to improve thermal processing technology and enhance bean product quality.” (J Med Food. 2004 Spring;7(1):67-78. Saponins from edible legumes: chemistry, processing, and health benefits. Shi J1, Arunasalam K, Yeung D, Kakuda Y, Mittal G, Jiang Y.)

Health claims about saponins can be found, with references, in specialised literature; for example, from Phytochemicals (www.phytochemicals.info):

“Saponins have many health benefits. Studies have illustrated the beneficial effects on blood cholesterol levels, cancer, bone health and stimulation of the immune system. Most scientific studies investigate the effect of saponins from specific plant sources and the results cannot be applied to other saponins.

Cholesterol reduction

Saponins bind with bile salt and cholesterol in the intestinal tract. Bile salts form small micelles with cholesterol facilitating its absorption. Saponins cause a reduction of blood cholesterol by preventing its re-absorption.

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Reduce cancer risk

Studies have shown that saponins have antitumor and anti-mutagenic activities and can lower the risk of human cancers, by preventing cancer cells from growing. Saponins seem to react with the cholesterol rich membranes of cancer cells, thereby limiting their growth and viability. Roa and colleagues found that saponins may help to prevent colon cancer and as shown in their article "Saponins as anti-carcinogens" published in The Journal of

Nutrition (1995, 125, 717s-724S). Some studies have shown that saponins can cause apoptosis of leukemia cells by inducing mitotic arrest.

Immunity booster

Plants produce saponins to fight infections by parasites. When ingested by humans, saponins also seem to help our immune system and to protect against viruses and bacteria.

Reduce bone loss

Studies with ovariectomized induced rats have shown that some saponins, such as the steroidal saponins from Anemarrhena asphodeloides, a Chinese herb, have a protective role on bone loss.

Antioxidant

The non-sugar part of saponins have also a direct antioxidant activity, which may results in other benefits such as reduced risk of cancer and heart diseases.”

As usual, nothing is entirely black and white, either or. Indeed, there will still be a small percentage of people highly sensitive to even traces of saponins that will have to give up those foods.

I do recommend juicing vegetables, using a slow juicer. That way the cells are broken down and their content is made available. This is where you find most of the enzymes, minerals, vitamins and specific healthy compounds that we are looking for. The pulp can be used in soups combined with full vegetables and spices, otherwise it is pretty unpalatable, or in “Paleo cakes” like carrot cakes using the Paleo flours like coconut, chestnut and the ancient grains: no need to waste the pulp. In order to increase the intake of fruits and vegetables, smoothies are a great way to go. Contrary to the advertisement that the new blenders (Magic Bullet, Nutri-Bullet, Ninja and others) “extract” the nutrients (this happens only with slow juicers), they allow a fine pulverisation of the fruits and vegetables, certainly breaking down a lot more cells that what we can do with our teeth, making contact with digestive enzymes easier and more complete, allowing an increased absorption of all nutrients. One example of breakfast smoothie would be a few handfuls of nuts and seeds, blueberries, a banana, an apple and some coconut water. Broccoli, tomatoes, cabbage,

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carrots and other vegetables are also a nice mix. Don’t try to juice or blend raw potatoes, though. Use your imagination, add spices, a few spoons of coconut oil, whatever you fancy; it is also a good way to ingest supplements, if you take some and do not like to swallow handfuls of pills. Of course, do not neglect fresh or steamed vegetables, sprouts, and all the roots and tubers. We all need a varied and colourful nutrition: the more real colours of foods on your table, the healthier and tastier it is. Before you recommend that to your patients, use it for yourself, so you know what to expect, you know what you are asking from your patients and you can answer any technical question truthfully. Education by example.

Animal proteins, including eggs.

Fortunately, eggs have been cleared from being a danger to health and the usual dietary recommendations regarding the avoidance of fatty foods as the solution to raised cholesterol been sent to the Museum of Idiotic Concepts by the conventional world.

Patients will ask about cholesterol and what to do with their still prescribed statins. I start by explaining that cholesterol is the necessary skeleton to many cellular constituents and especially those located in that blob of fat between our ears, called a brain, as well as most of our hormones. High cholesterol is, to make it simple, a symptom of chronic inflammation. Inflammation creates lesions in the vascular endothelium; those lesions are temporarily patched by cholesterol, like a Band-Aid, until repair happens. When the cholesterol patch becomes oxidised because of the presence of free radicals in the blood, minerals, especially calcium, precipitates and form the dreaded plaques. Hence, the need of a strict non-inflammatory diet, which, you guessed it, consists in avoiding cereals, sugars, dairy, and following the Paleo diet rigorously. Those simple measures restore lipids and cholesterol levels to normal without the need for statins.

Eggs are an ideal protein food, well balanced in amino acids and easy to digest, with many tasty ways to prepare them. They are an animal product, but because we eat them unfertilised, they are not alive and never were. This is an argument I often use with vegetarians and vegans when I try to convince them about the need to add animal proteins to their diet. Without that, it takes a large amount of gastronomic acrobatics to be able to maintain a balanced human diet. Some do manage very well and indeed those are the ones that are at the origin of the notion that vegetarians and vegans have less pathology, less cancer and are generally healthier. Unfortunately, most of those I met in the clinic are unhealthy and have underlying nutritional deficiencies. This sometimes drives me into philosophical debates about life and living beings. A useful book for that aspect of a consultation is “The Secret Life of Plants” by Tompkins and Bird in which the authors demonstrate that plants do have feelings, emotions and react to the presence of other animals and humans. I am fully aware that this has been allegedly debunked by the

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MythBusters...still, no vegan has been able to answer the question about the morality of eating a sentient cauliflower and sparing an unfertilised egg that was never alive in the first place. Eventually this has to be the patient’s choice, as usual.

Red meat, poultry, fish are part of the Paleo diet, as expected. Recently, the World Health Organisation has produced a report linking the consumption of meat to cancers and other diseases. That report has been summarised in the press as “If you eat bacon and meat you will get cancer” and equalling the dangers of eating meat to those of smoking.

Let us remove the hysteria and look at it reasonably. Most of the literature regarding the dangers of meat consumption is coming from North American studies. Their cattle are not free range, does not freely roam and eat their natural food; it is loaded with antibiotics and hormones to make it grow faster, fed cereals and soy or dried, dead, hay. Needless to say, their meat is also loaded with chemicals detrimental to human health. Personally, I do not consider those studies as having any validity. It would be interesting to have a study looking at hunters’ health, provided they eat only the meat they hunt or fish. I remember reading articles demonstrating that venison (wild meat) has the same amount of EFA than wild fish. Nevertheless, New Zealand and Uruguay also do have a high incidence of gastric and colon cancer and are big meat eaters countries, yet their cattle are free range and mostly (at least in New Zealand to my knowledge) free from hormones and antibiotics.

What is wrong? Proportions. The amount of meat is extremely high in relation to the amount of vegetables and fruits consumed simultaneously. Look at their barbecues or asados. Look at what they leave in their plates (hint: the green stuff...). The Vitamin C and other antioxidants in the fruits and vegetables tend to prevent the activity of the carcinogens that might be present in the meat, for example due to the method of preparation like barbecuing. The vegetable fibres also adsorb those carcinogens, accelerate the transit time and prevent long contact with the digestive mucosa. The movies’ representation of Palaeolithic people gorging on meat at every meal is of course completely wrong. Meat was more a cherished and sought-after treat than a daily staple; it was difficult and dangerous to acquire.

What about cured and processed meat and fish? The main suspect is the presence of nitrosamines, nitrates and nitrites in the diet. Even Wikipedia agrees albeit reluctantly: “Nitrosamines can cause cancers in a wide variety of animal species, a feature that suggests that they may also be carcinogenic in humans. At present, available epidemiological evidence from case-control studies on nitrite and nitrosamine intake supports a positive association with gastric cancer risk. Regarding oesophageal cancer, available evidence supports a positive association between nitrite and nitrosamine intake and gastric cancer (GC), between meat and processed meat intake and gastric cancer (GC) and oesophageal cancer (OC), and between preserved fish, vegetable and smoked food intake and GC”

Many other studies concur:

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“Processed meat consumption has been associated with an increased risk of stomach cancer in some epidemiological studies (mainly case-control). Nitrosamines may be responsible for this association, but few studies have directly examined nitrosamine intake in relation to stomach cancer risk. We prospectively investigated the associations between intakes of processed meat, other meats and N-nitrosodimethylamine (the most frequently occurring nitrosamine in foods) with risk of stomach cancer among 61,433 women who were enrolled in the population-based Swedish Mammography Cohort.... High consumption of processed meat, but not of other meats (i.e., red meat, fish and poultry), was associated with a statistically significant increased risk of stomach cancer.... Our findings suggest that high consumption of processed meat may increase the risk of stomach cancer. Dietary nitrosamines might be responsible for the positive association.” (Int J Cancer. 2006 Aug 15;119(4):915-9. Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of Swedish women. Larsson SC1, Bergkvist L, Wolk A.)

“The available evidence supports a positive association between nitrite and nitrosamine intake and GC, between meat and processed meat intake and GC and OC, and between preserved fish, vegetable and smoked food intake and GC, but is not conclusive.” (World J Gastroenterol. 2006 Jul 21;12(27):4296-303. Nitrosamine and related food intake and gastric and oesophageal cancer risk: a systematic review of the epidemiological evidence. Jakszyn P1, Gonzalez CA.)

Other studies do not find a correlation but emphasise the protective effect of vegetables:

“Intake of nitrate and nitrite was not associated with increased risk of stomach cancer. Consumption of vegetables was protective in general and independent of their estimated nitrate content.” (Eur J Epidemiol. 1995 Feb;11(1):67-73. Nitrosamine, nitrate and nitrite in relation to gastric cancer: a case-control study in Marseille, France. Pobel D1, Riboli E, Cornée J, Hémon B, Guyader M.)

Non-alimentary sources of nitrosamines are carcinogenic:

“Exposure to high concentrations of nitrosamines is associated with increased mortality from cancers of the oesophagus, oral cavity, and pharynx, but not with increased mortality from cancers of the stomach or lung.” (Occup Environ Med 2000;57:180-187 doi:10.1136/oem.57.3.180 Exposure to high concentrations of nitrosamines and cancer mortality among a cohort of rubber workers Kurt Straif, Stephan K Weiland, Martina Bungers, Dagmar Holthenrich, Dirk Taeger, Sun Yi, Ulrich Keil)

Knowing that humans are omnivorous, and that consuming animal protein is necessary to have the right proportion of amino-acids needed for our repair and maintenance without the need of having a degree in food technology, and knowing the protective effect of fruits and vegetables, the resulting menu becomes obvious. Add a few more pieces of lettuce and tomato to your BLT Paleo sandwich. Having bacon and eggs for breakfast? Complete it with a big fruit salad, real fruit not canned or tinned, or a fruit and vegetable smoothie. Ham or salami? Eat it with some melon like the Italians do. Think like

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Paleo-humans: did they have meat at every meal? Certainly not! Hunting was difficult and dangerous, sometimes coming back empty-handed after days of running around. No wonder that farming and pastoral care were so easily adopted. Those are not easy jobs, even today, but it certainly beats running after prey in the savannah or the forest, risking encountering other predators happy to make a meal of the hunter. Did they have smoked meat and fish? Of course they did! What better way to preserve it when there is no fridge? Their main staple food was fruits when available, vegetables, leaves and barks, nuts and seeds; and so should ours be with a variable amount of animal protein depending upon our needs. How do we determine that? By listening to our bodies once we have eliminated the artificial cravings created by modern alimentation patterns.

In simpler words: “what do I feel like eating today, what do I crave today?” and not emptying our plate when feeling comfortably full. It is that simple. Showing that simplicity and logic to your patients will go a long way in their confidence that your recommendations are correct, that it is not the end of the world and that they are going to discover a world of tastes and gastronomic delights they never dreamed existed. That is what my patients tell me when they respect 100% the recommendations, as well as feeling a lot better, even though many problems are not solved and need adequate homeopathic or herbal treatment.

I keep this intentionally simple and vague. Patients do ask me if I have a list of menus, or of specific foods. I do not want them to follow what I say, what the Guru ordered. I want them to understand what this is all about, to assimilate it, to integrate it in their lives, to change their lifestyle and to become real humans again. I want them to use their brains, their intelligence. I want to empower them and make them take control of their lives so that they do not need me anymore, once the real pathologies are unmasked and dealt with. A poor business choice, as most do not come back for many consultations, but an ethical one that allows me not to spit at the mirror every morning when I shave.

Writing a book is like a meal. There is lots of work and research going into it until you can deliver the goods. There are times when you come across another publication that unexpectedly says the same thing you are writing and confirms in all points what you wrote, helping to firmly anchor your work in truth and reality.

I was so lucky to be presented with such a dessert while researching references. It is a book in French by Dr. Jean Seignalet, “L’Alimentation ou La Troisième Médecine” (Nutrition or The Third Medicine, about 700 pages) published in 2012. An English translation is pending, and more information can be found at http://www.seignalet.fr/us.html. The late Dr. Seignalet, deceased in 2003, was a lecturer at the Faculty of Medicine in Montpellier (France), a pioneer in renal transplantation, a specialist in gastroenterology and haematology, as well as the director of the laboratory of histocompatibility that selected donors and recipients of organ transplants. In other words, a heavy weight in the world of conventional medicine for whom everything had to be proved, demonstrated and backed up

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by laboratory tests on top of the clinical outcome. I will try to summarise his work in a few sentences; it really pays to read his book though, even pre-order the English version at the website if you do not master French; it is a fascinating journey.

The basic premise is that toxic foods are creating a leaky gut syndrome. Those foods are milk and dairy product, cereals (he calls wheat “a real monster”!) and sugars. Meat and eggs are allowed only if raw, not cooked or at least not above 110°C. Sounds familiar?

Once the leaky gut is created, three types of pathologies can appear:

- Immune diseases, created through exposure of T Lymphocytes to nutritional peptides that should not have gone through the gut

- Diseases of clogging (“maladies d’encrassage”, the word says it all, although in French the term “crasse” has the connotation of dirt, filth) where molecules other than peptides are stored in and around cells and pervert their functions

- Diseases of elimination caused by the attempts of the body to get rid of the toxic load

The immune diseases of nutritional origin are: rheumatoid arthritis, ankylosing spondylarthritis and other arthritis and arthrosis like psoriatic arthritis, Sjogren syndrome, lupus, scleroderma and various connectivitis; Grave’s disease (Basedow for the French), multiple sclerosis, auto-immune hepatitis, primitive biliary cirrhosis, sclerosing cholangitis, celiac disease, Guillain-Barré, peripheral neuropathies and some renal diseases.

Clogging diseases would be: fibromyalgia, tendinitis, arthroses, osteoporosis, gout, some headaches, autism, schizophrenia, depression, Alzheimer, Parkinson, diabetes type II and others.

Elimination diseases are: colitis, ulcerative colitis, Crohn’s, gastritis, acne, eczema, urticaria, psoriasis, chronic bronchitis and asthma, allergies, polyps, canker sores and others.

There is no claim that this fascinating accumulation of pathologies, mostly modern diseases or diseases of “civilisation”, are caused only by nutritional factors and that no other aetiology is involved. Yet, the sheer accumulation of clinical cases, many of them presented in detail, and the very high rate of success obtained only through changes in eating patterns is compelling: there is no argument with success. As you would expect, Dr. Seignalet’s patients were recommended a Paleo diet (although he does not call it so), based on a scientific understanding of digestive physiology, and immune and metabolic problems that can occur when foreign substances are introduced in the system.

This work by a very conventional specialist, backed by his clinical results, entirely confirmed what I have witnessed in my practice for the last decade. I felt less lonely and less loony. I can repeat here what I wrote at the beginning of this book: once the nutrition is

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corrected and respected 100% by the patient, and as we will learn in the next pages, once the organs and systems are repaired (Organotherapy), their functions enhanced (Drainage) and the toxins on their way out (Detoxification), the residual pathologies, symptoms and signs are those that really belong to the patient, those that are created by the inner imbalances and those that our natural therapies can eventually deal with properly, without the hindrance of external assaults.

Almost a decade ago, I came across this book: “Mental and Elemental Nutrients. A Physician’s Guide to Nutrition and Health Care” by Carl C. Pfeiffer, Ph.D., M.D. (ISBN: 0-87983-114-6), 519

pages. Everything we have discussed previously is mentioned in this book, from nutrition as a therapy, to the legends and fairy tales about cholesterol, rehabilitating the egg, criminalising sugar and processed food, even linking some forms of meat to cancer similar to what the WHO just published.

What is so special about this book? It was published in 1975. The references it quotes date back to the sixties and early seventies. I graduated from medical school in 1976. This means that as I was studying, as I was taught in Paediatric Medicine that the best way to prepare a milk bottle for a baby was to dilute cow’s milk in half, add a cube (= a teaspoon) of sugar, warm, shake, serve, voilà, this is a perfectly healthy infantile meal, the knowledge about the harm this and other “nutritional” advices like low fat, high cereals diet was already present and widely published. This gave me lots of relief and lots of anger at the same time. Relief that what I had started advocating and “discovering” was not new, was not a fad, a lunacy. Anger at the thought that so many patients, whole populations, had been harmed and treated, often unsuccessfully, with drugs and surgeries that were bound to fail even if they provided temporary relief because the intoxication continued relentlessly. How disgusting and what a shame!

Mental and Elemental Nutrients is still a useful book to read. The nutritional knowledge at that time was more basic, there are no complicated biochemical pathways, only up to date for that period’s knowledge about nutrients, their effects, the real foods and healthy eating. It is simpler to read too and still everything in it is correct. Showing that book to patients also convinces them that the nutritional approach I advocate is ancient knowledge, not a figment of an attention-seeking sick mind. The recommendations are eerily like what you have read until now, with some minimal variations, for example from Seignalet’s raw meat to regular cooking as most of us know it. The clinical outcomes speak for themselves. There are probably quite a few other books like that, old or even ancient, gathering dust on shelves. It is a shame they have not become mainstream; we could have avoided so much pain and suffering.

A great concern for many patients is how difficult the switch will be, how painful suddenly removing the usual toast, corn flakes, muesli, skimmed or full milk, sugar, pasta, spaghetti, pizza will be. There is no doubt that for many it is not an easy task, especially

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when it is not to be a progressive transformation, as this is useless until totally achieved, but a sudden and brutal mental, emotional and physiological earthquake.

I tell them about my journey. You should tell your patients about yours. I tell them that it is a drug withdrawal, a real one, with physical and mental symptoms. I was addicted to caffeine. An artificial situation created by the need to stay awake when working in the emergency department, being on call more often than Health and Safety at the Workplace rules would permit, but what choice did we have...Coffee and Coca Cola were the main drugs. I became aware of my Coca Cola addiction when working in South Africa. We always had some at home. One week-end, we ran out; here I was, running in circles, in need of my dose, to the extent that I drove across the city (shops were closed) to my consulting rooms, had the security guard open the building where my rooms were located and had a glass of Coke from the clinic’s fridge. It then downed on me that I was hooked. About the same time, I participated to a seminar about “Touch for Health”. The instructor proudly claimed that she was able to diagnose almost everything with that method, so I publicly challenged her to find the cause of my chronic thoracic backache. She tested, and tested and tested until finally, with a tinge of surprise in her voice, concluding that caffeine was the cause of my backache. How was that possible, by which physiopathological mechanism, I could not understand, but I decided that in all fairness I owed her, and myself, to test this weird theory. I immediately stopped all sources of caffeine. I can tell you that I have intimate knowledge of drug withdrawal suffering...and so does my poor wife. It took a week until the symptoms started to abate, and another week until everything came back to normal...and the backache disappeared. A few months later, I attended my son’s graduation ceremony from kindergarten. Of course, there were cookies, and sweets, and... Coca Cola served for the celebration. There was a small cup of Coke next to me. After resisting for a while, I did what all addicts do: “just once, it will not hurt, after all I have been clean for so long”, and I took a few sips. Within a few minutes, my back seized, and I could not move my upper body and my shoulders, breathing was restricted. I do not know how I drove back home; I could not ask my five years old toddler to drive. That was the last time I touched Coca Cola.

A similar situation happened to one of my early patients: a woman in her fifties, whose every single joint was painful from arthritis and many deformed by many years of inflammation. A dairy addict. Everything she ate either was based upon dairy or contained some form of milk or cheese. It took some persuasion to have her stop; the only effective argument was that nothing else, including heavy painkiller drugs, had worked. She was improving until one day she called me saying that she could not move, she was completely paralysed. Controlling my panic, I asked her what she did: in her withdrawal from milk and dairy, she could not control the cravings anymore and had some milk and some cheese. The result was immediate, and the lesson fully learned.

I call this Pavlovian conditioning. I take great care to warn patients that it can happen, it will happen, there is nothing to feel bad or guilty about; it is a lesson that the

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body and the mind have to learn, a hurdle to overcome. For the first three to six months, and sometimes longer, the sensitivity to the forbidden foods is heightened. Any contact with even a minimal dose will create an over-reaction and the sudden reappearance of exaggerated symptoms. When warned, the patients can recognise it and not panic.

What about further down the track? There is hope! After two years (yes, that long) and a thorough treatment not limited to nutritional changes, we are allowed to cheat, to sin, at minimal doses. It does not mean that gluten, sugars and others have lost their toxicity, but that with health restored, our physiology is able to cope with minimal assaults without us noticing it. Therefore, the occasional small croissant, the monthly ice cream, the small slice of wedding cake is well tolerated and can be allowed. Interestingly, all the previous cravings disappear. Patients who were unable to forgo bread at every meal tell me they have no inclination whatsoever to have even a nibble, and I have experienced the same phenomenon: I have no caffeine craving whatsoever (even though I still love the smell of freshly brewed coffee and freshly baked bread) but I tried it on purpose. I took a small sip of Coke; it was tasty; the second sip was disgusting and there was no third sip. The physiological warning systems are back in place and clearly let you know that you are about to ingest a harmful substance. Our animal instincts are back and in case one is tempted to override them, the cost is elevated. A few years ago, I spent a week in Christchurch for a course, when the city was flooded. I had no way to walk to shops or to restaurants where I could find my regular food and had to eat what I assumed was a small but significant amount of gluten. On my way back home, abdominal cramps and an ineffective pressing need for stool appeared. It got worse and as I was sitting on my throne, trying in vain to empty contracted bowels, a bout of nausea came over. Fearing I would vomit, I stood up so I could turn around and take proper aim; next thing I know, I woke up on the floor with a bump on my head: for the first time in my life, I had fainted. That was my second Pavlovian conditioning. As I had been clear of gluten for years, the “alarm” signal for its presence had been reset and the tolerance I had because of exposure to it since birth had disappeared. I tell that story to my patients too. They are warned. They know what to expect. They also know that I have walked this road long before them and that not only I have survived but that I have thrived. I ask them to look at me and tell me if they think I am undernourished or malnourished (I promise I will lose those love handles… one day...). It is once again grassroot education through example.

Another, slower and more subtle process happens. After a few years, some patients do come back, asking for a repeat of their remedy or of whatever treatment they received. They all describe, as long as no dramatic intercurrent event happened, a slow recurrence of some symptoms, signs or complaints. Upon questioning, they will reveal that insidiously they have started consuming regularly small amounts of the “forbidden” foods. It is not the “cheating” I wrote about earlier on, it is ingesting regular small amounts, like a biscuit after supper, a sandwich a few times a week at work, things you do because you feel good and you stopped being focussed on the new nutritional habits. We go through the daily

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infringements together, write them down, then the patient realises what has happened, corrects it and that is the end of it.

Without exception, I recommend and explain in detail the needed abstinences and the Paleo diet to all my patients. All of those, one hundred percent of those, who follow the recommendations to the letter, describe a change for the better at the least, the disappearance of many symptoms and signs for some and quite often a clearer mind, the ability to reason better and faster and more energy. Of course, even for them, this is not a cure-all and further, deeper treatment is usually warranted. Those who try a progressive approach or cannot wean themselves from some food or another are also those who react poorly to well indicated prescriptions that need to be repeated often, sometimes changed and alternated, until they understand the whole picture. There are exceptions, as usual: those who have a maintaining cause for their food addiction, same as with tobacco and drugs. It could be a sense of worthlessness, self-punishment, suicide by gastronomy, a need for comfort not available otherwise or anything else. In those circumstances, insisting on a change in diet is not only useless but also dangerous, as it removes a support mechanism and leaves the patient hanging to dry without a safety net. It is an essential safeguard to keep that in mind and to recognise the situation, deal with it the same way one would deal with a deep-seated addiction: why did the patient start smoking/doing drugs/obsessing over food in the first place? Stay safe!

Without any specific order, here are a few of the frequently asked questions. This has no ambition of being complete or even scientific; the answers provided reflect more or less what I tell the patients, they are not meant to be textbook explanations.

What is the big deal with the fructose? You recommend fruits but not fruits juice! Remember the Advanced Glycation End products or AGEs? Fructose seems to create ten times more AGEs than glucose. Coming in fruits and bound with fibres, fructose is easily metabolised by the liver, but when it is delivered in one big load, the liver’s abilities are overwhelmed and fructose circulates before being metabolised, creating AGEs. Therefore, a glass of fruit juice that contains the equivalent of ten fruits in fructose load is a lot more toxic than those ten fruits eaten during the day.

I understand the need for carbohydrates restriction, yet fruits and vegetables are full of it. How does it make sense to eat them in abundance if you want to restrict carbohydrates? In fruits and vegetables, the carbohydrates are in a much lower concentration than in bread for example and are bound to fibres that slow their absorption. They certainly can raise the blood sugar, especially when eaten in excess. They also bring

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with them vitamins and especially minerals, one of them being Potassium (K). When blood sugar raises and insulin is released and causes the sugar to migrate into the cells, this event “drags” Potassium with it inside the cells: this is the basis for treating a dangerous scenario of increased level of Potassium in the blood (hyperkaliemia) by injecting glucose and insulin intravenously. The Potassium (and other minerals) assimilated with fruits and vegetables allow the metabolism to counterbalance this phenomenon. Therefore, for an equal amount of fruits and vegetables, we have less total carbohydrates, slow assimilation and the presence of other elements that are not only essential to the general health and function of the body, but do at the same time prevent wide variations that could be potentially harmful.

What about sweeteners? The short answer is dual: first, they all carry some form of chemical toxicity; there are links to neurological problems that you can find in the literature, especially with aspartame. Then, although they were introduced with the purpose of giving the sweet taste without perturbing the metabolism, recent publications show that in fact they do influence the secretion of insulin and in doing so, create havoc, as there is no substratum for the insulin to act. The only valid sweetener is Stevia. It comes from a South American plant that surprisingly grows well in colder climates, so you can grow one in your garden or balcony and use the leaves. They have a slight bitter aftertaste. If using commercial Stevia, take care that you buy only the pure one; too many brands are adulterated with xylitol and other sugars.

I am a very active person, practicing many sports, and I sweat a lot. My coaches push me to compensate with readymade sports drinks, like Gatorade. The theory is correct, but when you look at the contents, there is usually an excess of sugar and the electrolytes are imbalanced...not to talk about the cost. The best and only healthy sports drink I know is coconut water. If you are gushing sweat, add a pinch of pink Himalayan crystal salt to the coconut water. That salt contains 84 different minerals and will compensate any loss. Alternatively, if coconut water is not available, one teaspoon of pink Himalayan crystal salt to a litre of water will give you a balanced electrolyte solution. After training, my recommendation is a big glass of freshly made vegetable juice with the addition of the juice of one small or medium lemon.

What about soy? We hear so many good things about it and it is in all health food shops. The only good, healthy soy is fermented soy, i.e. miso, tempeh, natto. The rest was a fad created by the agro-alimentary industry, and we all fell for it. It was based on the notion that Asian women have less breast (and other) cancer, they eat soy as part of their traditional diet, therefore it must be good. What we did not know then is that unfermented soy contains anti-nutrients that, in short, prevent mineral absorption and especially zinc,

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destroy the immune system and cause hypothyroidism. Fermentation destroys the anti-nutrients. Tofu and soymilk are full of them.

I understand the no-milk approach, but I am pregnant. What do I do if I cannot breastfeed my baby, if I do not produce enough milk? If that happens, there are herbal and homeopathic approaches that can restore and increase milk production. Consult a practitioner! DIY is good for small things, but professional homeopaths, herbalists and naturopaths are trained to recognise the problems and treat them appropriately. If you have no access to them, the alternative is donkey milk, horse milk or even camel milk; goat milk is not that good (refer to the text and the composition table), but better than cow’s milk. I do know that in some places there are associations that gather human milk and distribute it to those in need, contact your local La Lèche society to find out. The other solution is to return to the age-old tradition of a wet nurse.

No milk! Where do I get my calcium from? From the same place all other mammals get it, from their natural food. When is the last time you saw a monkey, a cow, a bull, an elephant or a whale go shopping for a bottle of milk? Yet osteoporosis and osteopenia do not exist in wild animals, only in domesticated or captive ones if they are poorly fed. You will find calcium mostly in the green leafy vegetables, also the nuts and seeds. Remember also that calcium must be ingested in balance with other minerals, especially magnesium, but also boron, silica, and all the others too...and the only place you will find those is in real food, not in tablets or capsules or in non-human food.

I have correctly tried all the diets, including the Paleo and I still cannot lose any fat! That is a sure sign of toxicity overload. Most of the toxins, the heavy metals, the organic compounds, insecticides, pesticides, and herbicides are liposoluble. If the body cannot eliminate them, they must be stored safely where they can do the least harm possible; that is in the fatty tissues, and preferably in fat rather than the brain. As soon as you start losing fat through a correct diet, the toxins are released, and this is immediately recognised as dangerous. Feeling lousy, lethargic, lacking energy, being dizzy and nauseous are often indications of toxin release and not of improper diet or lack of nutrition. Therefore, the fat storage units are rebuilt, the toxins put in “protective custody” so that they cannot harm you, but in the meantime, the result is that you do not lose weight or change shape. The way out of this vicious circle is to go through a proper treatment of Organotherapy, Drainage and Detoxification, not just an off the shelf “detox protocol” that in most of the cases does not work properly anyway.

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I fully understand the diet and the reasons behind it, yet I cannot keep it, I cannot cope with it! This is the all too frequent situation where a treatment is needed before the nutrition can be addressed. We need to find the root of the attachment to comfort food, the same situation we face when dealing with tobacco or drug addictions. A proper history will often reveal this, drawing a timeline and allowing the patient to tell his story. Many patients have never been listened to properly; they are very grateful when somebody finally takes the time to shut up and listen without judging or commenting. Tears are often flowing...Whether it is abuse, abandonment, PTSD, rape, bullying, whatever, they often find refuge and comfort in food. We have seen all along this text that it is an addiction. Treating that cause, even many decades later, allows them to discard the eating crutch, restore a level of normality from which further treatment, if at all needed, becomes easier to implement.

What about sprouting? Sprouts are an excellent way to assimilate concentrated amounts of nutrients, which is especially effective and important when you use plants for therapeutic purposes, e.g. broccoli sprouts instead or on top of the whole vegetable. When it comes to sprouting cereals, the consensus is that the harmful parts are absent in the sprouts. Yet, I have not found any laboratory correlation of that notion. Therefore, when removing harmful foods from one’s diet, I would be careful not to use their sprouts. It might be an overkill and I might be totally wrong here, but why take a chance, find out the diet is not working only to see it work when the sprouts are removed? What a waste of time and resources. It is better to be even ridiculously strict at the beginning, slowly widening the diet within the permitted parameters later.

What is that acronym S.A.D. that I read in many food related articles? It does not seem to be Seasonal Affective Disorder. It stands for Standard American Diet...which is sad indeed. Apparently, many writers have the delusion that what is happening in North America is a human standard behaviour. They are amazed that other populations refuse to follow their example, and I am not talking politics. My suggestion is to use the acronym S.H.D. for Standard Human Diet. Like the metric system, SHD (aka Paleo if you did not get it yet....) should become the universal reference, the norm, for physiologically adapted human nutrition. Did you guess which country is the only one not using the metric system?

With that diet, how can I eat out with friend now? More and more restaurants and even small eateries are offering the beginning of healthy alternatives like gluten free (marked GF) or dairy free (marked DF) dishes, clearly indicated on their menus. It is quite easy to ask the waiter, when ordering, to slightly tweak the cooking of your meal. For example, ordering a salad, mention “no croutons, please, I do not eat bread”; a dish comes

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with a sauce “please do make sure there is no dairy in the sauce”. At times, this will appear as a gastronomic blasphemy; some traditional dishes have to be prepared in a certain way, anything else is treason, at least for a traditional Chef. Still, you are the one eating it, you are not going to frame it. You are the client, the consumer, you are paying for it. If the restaurant does not want to conform to my requests, I leave it and go somewhere else. My body, my health, my life.

“May the forks be with you!”

Basically, this is it. This is what your patient needs to do to start on his road to health. Hopefully, patients want to know more, to understand why, so that they can become creative with their daily meals without calling you every day asking if this or that is allowed or not. You might feel frustrated about the length of the first part of this chapter. Don’t be. Practitioners do need to understand what they practice (yes, I know, I keep repeating myself, old age must be creeping up on me) and understand it well. A successful treatment is not only based on a proper diagnosis and prescription but also, and I would even say mostly, on its acceptance by the patient. I mean intelligent acceptance, understanding, not blind following that leads to abandonment of the treatment as soon as there is the slightest setback.

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