Perhaps you think of honey in general as a healthy food. But with industrialization, genetic modification of so many plants, and the widespread use of pesticides, most of the honey available in supermarkets now is not very healthy.
In anticipation of my annual Thanksgiving feast last November, I was at the Union Square Greenmarket in New York City sampling cheeses from a farm called Consider Bardwell Farm. The cheeses tasted like real food, alive with probiotics and free from toxic stuff. All the cheeses from this farm in Vermont are hand made from the raw milk of pasture-raised cows and goats. The vendor was saying how misguided it is for doctors to tell pregnant women to avoid raw milk in any form when pregnant woman especially need all the probiotics they can get to produce healthy babies.
I couldn’t agree more and decided to do some research on how raw milk and raw milk products benefit our health and why they’re so hard to find in the US.
A recent article called The Surprising Way to Beat Spring Allergies by Michelle Schoffro Cook, PhD, DNM, ROHP, one of my favorite writers on probiotics and the gut microbiome, caught my eye and I want to share its information with those of you who suffer from allergies, seasonal or otherwise.
Her article starts out this way:
“Before you grab that decongestant to subdue your sinus congestion or antihistamine to stop the sneezing linked to spring allergies, you might want to give your gut some attention. More and more research shows that probiotics can reduce allergy symptoms and may even prevent allergic conditions altogether if they are started early in life. But not just any probiotic will do; with thousands of probiotic strains available, it’s important to choose the ones that have an anti-allergy effect. The right probiotic strains can heal the intestinal walls and reduce low-grade inflammation in the gut, but also prevent or reduce allergies.” (Cook, 3/17/2016)
(Source: www.internetbillboards.net)
The most common symptoms of allergic rhinoconjunctivitis are inflammation in the nose, sinuses and eyes. You inhale some pollen or other allergen and your nose and sinuses become congested or blocked. Maybe your eyes itch, burn, tear up or become red. Maybe your eyes become hypersensitive to light. Your nose may itch and discharge watery mucus. Your ear canals may get irritated. You sneeze a lot, feel physically depressed and generally miserable.
ALLERGIES & ME
In my case, decades of year round chronic allergies resulted in the growth of nasal polyps in my sinuses that dropped down into my nose every time I inhaled, causing me to have to breathe only through my mouth. I was exhausted all the time, had frequent sinus infections, a tenderness in the bridge of my nose that made wearing glasses painful, and such swollen nasal and sinus tissue that I could never blow my noise. And I had to wear tinted glasses even indoors to deal with light sensitivity.
The chronic inflammation and difficulty breathing made me physically depressed and, as a result, I also believed I was emotionally depressed. Basically, I was and felt like an inflamed mess – and the number of things I was allergic to kept growing: cat dander, dust, cigarette smoke, foods, scents.
I went to allergy doctors who prescribed decongestants (they made my heart race) and antihistamines (most of them severally sapped the little energy I had). I remember lying on our living room couch once after taking a prescription pill containing both a decongestant and antihistamine, my sinuses so dried up I could hardly breathe and my heart beating so rapidly I thought I was going to die, unable to lift my head or get up to call for help … long before cell phones.
I told my ENT doc, after the second surgery to remove nasal polyps (the chronic inflammation caused them to grow back), that I was going to find a non-pharmaceutical/ non-surgical way to fix both my allergies and sinuses. He was a good guy and asked me to please let him know when I’d found the information I was seeking.
(Source: www.dailymail.co.uk)
Thankfully, I’ve been tenacious over several decades in seeking that information and choosing helpful health care providers to work with, never grew another nasal polyp, and am no longer done in by upper respiratory allergies.
This website, Allergies And your Gut, is a by product of that determined quest to feel well.
BACK TO MICHELLE SCHOFFRO COOK’S ARTICLE
“The ideal time to be introduced to beneficial allergy-preventing strains of bacteria is actually before birth. Research in the Journal of Allergy and Clinical Immunology shows that when a pregnant woman consumes probiotic-rich milk or yogurt during pregnancy, an infant or child is less likely to suffer from allergic conditions such as eczema or rhinoconjunctivitis.” (Cook, 3/17/2016)
Of course, we’re not able to go back and make sure we got sufficient beneficial microbes during our fetal development but we can provide ourselves now with pertinent probiotics to prevent or reverse our allergy symptoms and conditions.
The milk and yogurt products used in this study contained three types of probiotic bacteria:
Lactobacillus acidophilus
Bifidobacterium lactis
Lactobacillus rhamnosus
Cook reports on work done by scientists at the Osaka University School of Medicine that found ingestion of another probiotic, Lactobacillus casei (L. casei), delayed the occurrence of allergy symptoms and reduced allergic nasal and sinus congestion. The double-blind, placebo-controlled study results were published in the International Archives of Allergy and Immunology.
And finally, Cook cites 2009 research results from a 12-week, randomized, double-blind, placebo-controlled clinical trial published in the medical journal Advanced Therapeutics demonstrating the benefits of consuming a dried, fermented probiotic yeast called Saccharomyces cerevisiae.
Study participants consisted of 96 healthy people with a recent, clinically documented history of seasonal allergies. The researchers were testing the efficacy of 500 mg of a fermented, dried Saccharomyces cerevisiae product during the highest recorded concentrations of total pollen counts for the Midwest area where the study was conducted and found it reduced allergy symptoms, especially nasal congestion. Saccharomyces cerevisiae is also known as ‘brewer’s yeast’.
Following up on Scott Moshen’s helpful COMMENT below, I found Bragg Nutritional Yeast Seasoning for a reasonable price at my local health food store. It’s also available from Amazon.com. Bragg is also the long time maker of other raw, organic products that many health conscious people swear by, including an Organic Raw Apple Cider Vinegar that’s unfiltered and contains the ‘mother’.
PROBIOTICS VS DRUGS FOR ALLERGIES
If you’re like me, you prefer consuming foods and natural substances to taking pharmaceutical drugs whenever possible to prevent inflammatory, autoimmune problems – or to treat them if they have already developed.
The authors of the 2009 Advanced Therapeutics article described above noted:
“Allergic rhinitis (AR) impacts around 25% of the worldwide population. However, cost, safety, and a high dissatisfaction rate with numerous conventional medications continues to be an issue in the largest patient surveys, due primarily to a lack of efficacy on nasal congestion.” (Moyad et al, 2009)
And Cook has this to say on the subject:
“Unlike drug products, antihistamines and decongestants you take when symptoms are severe, the probiotic-based approach works differently. Probiotics are best taken on a daily basis (follow package instructions of the specific product(s) you select) before and during allergy season. Select products that contain the specific probiotic strains mentioned in this article, as others have not been tested for effectiveness against seasonal allergies.” (Cook, 3/17/2016)
I want to add to all the above what Professor of Geomorphology David R. Montgomery and Biologist and Environmental Planner Anne Biklé have to say about why allergies have become so prevalent. They are husband and wife – and the authors of an engaging and timely new book called The Hidden Half of Nature: The Microbial Roots of Life and Health.
Their book began with a desire to create a garden in the yard of their house in Seattle. They soon discovered the soil had become barren, depleted of nutrients, dead – so they started feeding it a steady diet of organic matter (coffee grounds, wood chips, leaves, home-brewed compost – lots and lots of it). Soon the soil was teeming with microbial life and supporting a lush garden supplying them with nutrient-rich organic plants.
As scientists, they were fascinated by this experiment. Then Anne was diagnosed with cancer and they turned their attention to the question of what supports health in the body. They began to move away from the view of microbes as mostly pathogenic and toward understanding that the vast arrays of invisible micro-organisms (pounds of them) that live in and on us are actually what maintain our health – or make us ill if they’re not well nurtured.
They’d seen this interaction at work in the relationship between the soil in their miraculous garden and the plants that grew in it. Now they were able to start understanding that the same relationship exists between the health of the micro-organisms in the various human microbiomes and the health of the host’s body.
Here’s part of what they have to say about gut micro-organisms and allergies:
“Growing up in the 1960s and 1970s, neither of us can recall classmates or friends with severe enough allergies and asthma that it required hypervigilant parents and teachers to help them avoid near-death experiences. We also don’t recall today’s prevalence of common gut dysfunctions like Crohn’s disease and irritable bowel syndrome.
“In the past fifty years researchers have seen not just an uptick in the incidence of gut dysfunctions, but a fortyfold increase…. While our genes may make us more or less susceptible to such ailments, changes in our gut microbiome are increasingly implicated as well.
“Gut dysfunctions and autoimmune diseases like asthma and allergies are turning out to be, at least in part, consequences of an immune system gone alarmingly awry. The hallmark symptom of all these diseases is an over-the-top immune response that damages our own cells and tissues.
“How does our own immune system turn against us? Increasingly, it seems that a major contributing factor is a severe case of atrophy for our efficient and evolutionarily honed immune system. Without a challenging workout and the help of beneficial microbes, our specialized immune cells and tissue grow lazy, or one might say, hazy. It is the day in, day out saturation of the inside and outside of our bodies with microbes that tones and sharpens the various feedback loops that drive our immune system to learn and recognize microbial friends from foes. A too-clean environment, ultrasanitized food and water, repeated doses of antibiotics, and minimal contact with soil and nature all work against us. These factors interfere with communication between microbes and our immune system. And this throws off the balancing act of meting out inflammation that our immune system evolved to do.” (Montgomery & Biklé, 2016, 189-190)
I highly recommend this book to you. Some comments from reviewers:
“I love this book! It’s genial, erudite, and wise. Using their personal story, historical fact, and cutting-edge science, Montgomery and Biklé have given us a great gift – a deep understanding and appreciation of our relationship with the microbial world.”
“The Hidden Half of Nature reads like a fast-paced novel but tells the true story of the workings of soils, and even our own bodies.”
“I wish I had learned this in medical school.”
” The Hidden Half of Nature draws a straight line from the microbes that live in healthy soil to those that live in healthy guts, skillfully blending the personal and the scientific. This is a must-read for anyone concerned with their own health.”
(Source: farmviability.wordpress.com)
REFERENCES
Bertelsen, R.J. et al. (2014). Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases. Journal of Allergy & Clinical Immunology, 133:1, 165-71. See: http://www.ncbi.nlm.nih.gov/pubmed/24034345
Moyad, M.A. et al. (2009). Immunogenic yeast-based fermentation product reduces allergic rhinitis-induced nasal congestion: a randomized, double-blind, placebo-controlled trial. Advanced Therapeutics, 26:8, 795-804. See: http://www.ncbi.nlm.nih.gov/pubmed/19672568
Tamura, M. et al. (2007). Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized double-blind, placebo-controlled clinical trial. International Archives of Allergy and Immunology, 143:1, 75-82. See: http://www.ncbi.nlm.nih.gov/pubmed/17199093
That’s not so easy to answer for two reasons: First, the whole field of gut bacteria is quite new. And second, many if not most doctors don’t know a whole lot about the gut microbiome and its role in keeping us healthy or making us sick.
That doctors often don’t know much about the gut microbiome is clearly related to it’s being a new field – but the situation is also made worse by the enormous pressures the pharmaceutical industry and what is sometimes referred to as the “medical–industrial complex” exert on doctors to continue along the current path of treating symptoms with drugs and/or surgeries while ignoring the symptoms’ underlying causes.
Let’s hope the paradigm will shift.
MY MEDICAL JOURNEY – AND PERSONAL BIAS
It took me many decades to identify the underlying source of my own gut microbiome imbalance and autoimmune conditions and figure out how to correct them. On this journey, the types of professionals who were the most helpful have been Chiropractors who do Applied Kinesiology and know how to support health with nutrition (foods and nutritional supplements), Functional Medicine docs, Integrative Medicine docs, Naturopaths, Energy Medicine practitioners, and Nutritionists.
I’ve pretty much stopped relying on mainstream MD specialists – except for the rare ones who understand that pharmaceuticals only suppress symptoms but don’t correct any underlying problem.
When I have blood work done by my Internist (who’s a devoted doctor and a lovely man whom I enjoy seeing), I know I’m probably not going to take any pharmaceutical he might prescribe so ask to be emailed the results and take them to the Chiropractor who’s my main health care provider. She reads the report, discusses the meaning of the results with me, and recommends what I can do about any problematic findings. For example, I have an under active thyroid (hypothyroidism) and sometimes Hashimoto’s thyroiditis (an autoimmune thyroid problem). She has successfully regulated my thyroid functioning with nutritional supplements for many years.
Before asking my Internist for blood work, I also get my Chiropractor’s recommendations for exactly what blood work will be helpful. The Internists and Endocrinologists I’d seen in the past were likely to order only the basic thyroid tests. My Chiropractor orders those to see if my thyroid is under functioning, tests to measure whether my pituitary and adrenals are involved, and thyroid antibody tests to see if my thyroid is also having an autoimmune problem again.
So that’s where I’m coming from as I try to answer the question about what tests to request from a traditional medical doctor.
INCREASED GUT PERMEABILITY – AKA LEAKY GUT
When your intestinal mucosal lining (the place that’s home to your gut’s good bacteria and other probiotic micro-organisms) becomes abnormally permeable (a condition known as intestinal hyperpermeability), tiny leaks develop from your intestines into your bloodstream. These openings allow things (bad bacteria and their toxins, incompletely digested proteins and fats, and other substances) to pass through the intestinal walls directly into your bloodstream instead of being propelled further along your GI tract to where they can be neutralized and/or excreted.
Your immune system reads these substances leaked into your bloodstream as dangerous invaders, triggering an autoimmune reaction. As the leaks continue to allow more and more substances through the gut lining directly into the bloodstream, your body becomes chronically inflamed … and chronic inflammation is a precursor to autoimmune diseases and a long list of other serious health problems. (Axe, 2016) & (Weil, 2005)
DR JOSH AXE’S RECOMMENDATIONS
Dr Josh Axe’s article What Kind of Leaky Gut Test Should You Take? may help you figure out what tests to ask for if you suspect you have a leaky gut that’s causing various chronic autoimmune conditions and diseases – including dark circles under your eyes. Dr. Axe is a Doctor of Natural Medicine, a Clinical Nutritionist, and a Chiropractor.
The tests he recommends are:
(Source: draxe.com)
See Dr Axe’s article for more information on these tests.
TESTS FOR ADRENAL FATIGUE
(Source: therestlesslegsblog.wordpress.com)
In an article called Testing For Adrenal Fatigue, Wellness Coach and author Fawne Hansen discusses the types of tests needed to measure adrenal functioning. Among them are:
A series of cortisol measures
An ACTH Challenge
A variety of thyroid tests
Hansen says, “Diagnosing Adrenal Fatigue from a single test or symptom is impossible. To make an accurate diagnosis, doctors and naturopaths need to look at a range of tests, sometimes conducted multiple times, and take note of every symptom. This requires experience and a thorough knowledge of the various systems in our bodies, as well as some patience too. It may require two or three visits to the doctor before you can be sure that you have Adrenal Fatigue.” (Hansen, 2016)
Chronic inflammation in the body is a precursor to most kinds of diseases. C-reactive protein (CRP) is a substance produced in the liver that increases when there’s inflammation in the body.
There are two blood tests for elevated CRP: One test can detect a general elevation of CRP, associated with general inflammatory changes in the body and considered a non-specific marker for disease. The other test, called hs-CRP (highly sensitive CRP), is a measure of inflammation in blood vessels and is used to help establish heart disease risk.
Integrative Medicine doc Andrew Weil, MD’s article Elevated C-reactive Protein (CRP) explains the meaning of elevated CRP, its symptoms and causes, how it’s diagnosed, how conventional medicine treats it, and how he treats it with an anti-inflammatory diet. (Weil, 2016)
Gut dysbiosis (sometimes called gut dysbacteriosis) is the technical term for a microbial imbalance in the digestive tract. MaryAnn Copson, who has worked in the Alternative, Functional, Holistic, and Energy Medicine fields for over 35 years, offers a DYSBIOSIS METABOLIC MARKERS KIT for comprehensive testing of gut dysbiosis.
Her extensive training includes:
Neuro-Reproductive Endocrine Certification
Certified Licensed Nutritionist
Robertson Research Institute Level II Verified Biochemical Profile Clinician for the Brain Chemistry Optimization Program
Board Certified Holistic Health Practitioner
Certified Reflexologist
Herbal Apprenticeship
Practitioner Byronomics Energy Management and Diagnosis
Nutritional Treatment for Mood Disorders
Metabolic Typing and Nutritional Planning
Supplements and other Natural Remedies
Vitamin D Deficiency Assessment and Nutritional Treatment
Genetics of Mood Disorders
See Testing for Dysbiosis to read more about the causes and effects of gut dysbiosis and to purchase a test kit. You collect the specimens in the privacy of your home and mail them in the kit directly to the independent medical lab she uses. She’ll forward a copy of your results to you when she’s received them and you then schedule a time for the two of you to talk. She’ll interpret your results for you and discuss their implications along with possible nutritional and lifestyle treatment programs for re-balancing your gut flora.
From Copson’s site (Copson, 2014):
“Why test for Dysbiosis?
“Dybiosis can be a significant factor in many health problems. The Dysbiosis Metabolic Marker Test, because it measures the by-products of microbial metabolism which are excreted in the urine, is particularly useful in detecting the presence of pathogenic microbial overgrowth and in guiding and monitoring therapy.
“Treatments for dysbiosis may involve removal of the offending organisms with anti-microbials. Dietary changes and food supplements are used for replacement of beneficial bacteria, restoration of digestive function, and mucosal repair.
“A repeat test should show improvement within 90 days.”
The Dysbiosis Metabolic Marker Test measures the following:
Creatinine
Bacterial/Protozoal
Benzoate
Hippurate
Phenylpropionate
p-Cresol
p-Hydroxyphenylacetate
Tricarballylate
Clostridial
Dihydroxyphenylpropionate
Yeast/Fungal
Tartarate
Citramalate
B-Ketoglutarate
“All of the above compounds reported are produced by bacteria, yeast, fungi and protozoa that may colonize or grow in the small intestines. Dysbiosis involves overgrowth of one or more species leading to increased production of these compounds that are absorbed and excreted in the urine.” (Copson, 2014)
I don’t know if the kit, the lab work, and working with her (via phone or in person – she’s in Shipman, Virginia) on what to do about your results would be covered by your health insurance (if you’re lucky enough to have any).
ADDITIONAL INFORMATION ON TOPICS MENTIONED IN THIS POST
See IntestiNEW TO STRENGTHEN YOUR DIGESTIVE LINING to read about IntestiNEW, a nutritional supplement that improves the condition of your gut’s intestinal lining and reduces chronic inflammation in the body.
AUTOIMMUNE DISEASES & CONDITIONS
In autoimmune diseases and conditions, the immune system misreads healthy cells as if they were dangerous invaders and attempts to destroy them. An autoimmune process can affect one or more types of body tissues and organs.
If you wish to learn more, here are two lists of autoimmune diseases and conditions:
There are autoimmune conditions and diseases that don’t appear on these two lists.
Another note:
I was searching for a helpful article on autoimmunity to include here and was only finding ones claiming that autoimmune diseases are incurable but their symptoms could perhaps be reduced by pharmaceuticals. Then it occurred to me to google “autoimmune diseases alternative” and found this article by Functional Medicine doc Mark Hyman, MD: How to Stop Attacking Yourself: 9 Steps to Heal Autoimmune Disease. (Hyman, 2015)
Dr Hyman is the Director of the Cleveland Clinic Center for Functional Medicine.
From Dr Hyman’s article:
“INFLAMMATION IS A “HOT” TOPIC IN MEDICINE. It appears connected to almost every known chronic disease — from heart disease to cancer, diabetes to obesity, autism to dementia, and even depression.
“Other inflammatory diseases such as allergies, asthma, arthritis, and autoimmune disease are increasing at dramatic rates. As physicians we are trained to shut off inflammation with aspirin, anti-inflammatory medication such as Advil or Motrin, steroids, and increasingly more powerful immune suppressing medication with serious side effects.
“But we are not trained to find and treat the underlying causes of inflammation in chronic disease. Hidden allergens, infections, environmental toxins, an inflammatory diet, and stress are the real causes of these inflammatory conditions.
“Autoimmune diseases, specifically, now affect 24 million people and include rheumatoid arthritis, lupus, multiple sclerosis, thyroid disease, inflammatory bowel disease, and more.
“These are often addressed by powerful immune suppressing medication and not by addressing the cause. That’s like taking a lot of aspirin while you are standing on a tack. The treatment is not more aspirin or a strong immune suppressant, but removing the tack.
“It you want to cool off inflammation in the body, you must find the source. Treat the fire, not the smoke. In medicine we are mostly taught to diagnose disease by symptoms, NOT by their underlying cause.”
********************
Autoimmune conditions are connected by one central biochemical process: A runaway immune response also known as systemic inflammation that results in your body attacking its own tissues.
– Functional Medicine doc Mark Hyman, MD
********************
INFORMATION ON THYROID FUNCTION TESTS
(Source: stpetersburgchiropractordirectory.com)
See Thyroid Function Tests for what the American Thyroid Association says about commonly ordered thyroid tests. (American Thyroid Association, 2014)
Chiropractor and Nutritionist Dr David Dahlman’s article Thyroid Tests discusses how the thyroid works, which tests are needed to assess its function, and how to interpret those tests. (Dahlman, 2015)
See MEDICAL-INDUSTRIAL COMPLEX for more information on how and why the US’s health care industry remains wedded to its focus on using pharmaceuticals and surgeries to treat symptoms rather than helping us stay healthy.
From the article:
“The concept of the medical-industrial complex was first introduced in the 1971 book, The American Health Empire (Ehrenreich and Ehrenreich 1971) by Health-PAC. The medical-industrial complex (MIC) refers to the health industry, which is composed of the multibillion-dollar congeries of enterprises including doctors, hospitals, nursing homes, insurance companies, drug manufacturers, hospital supply and equipment companies, real estate and construction businesses, health systems consulting and accounting firms, and banks. As employed by the Ehrenreichs, the concept conveys the idea that an important (if not the primary) function of the health care system in the United States is business (that is, to make profits) with two other secondary functions, research and education.”
The University of Colorado at Boulder is offering a fascinating free online course on the human microbiome called
GUT CHECK: EXPLORING YOUR MICROBIOME
This course is going to cover many of the topics I’ve written about on this Allergies and Your Gut site/blog – but you’ll get to hear it and much more from the horses’ mouths: Prof. Rob Knight, Dr. Jessica Metcalf and Dr. Katherine Amato.
Rob Knight is a Professor in the Department of Chemistry and Biochemistry, and the BioFrontiers Institute at the University of Colorado, Boulder. He also works on the Human Microbiome Project.
Professor Rob Knight. (Source: knightlab.colorado.edu)
Dr. Jessica Metcalf is an Evolutionary Biologist and Senior Research Associate at the BioFrontiers Institute, University of Colorado at Boulder.
Dr. Jessica L. Metcalf
Dr. Katherine R. Amato is a Postdoctoral Research Associate in the Department of Anthropology and part of the BioFrontiers Institute at the University of Colorado, Boulder. She also contributes to the American Gut Project.
Dr. Katherine R. Amato
From the course’s website:
Imagine if there were an organ in your body that weighed as much as your brain, that affected your health, your weight, and even your behavior. Wouldn’t you want to know more about it? There is such an organ — the collection of microbes in and on your body, your human microbiome.
ABOUT THE COURSE
The human body harbors up to ten times as many microbial cells as human cells. What are these microbes and what are they doing? How can we study them to find out? What do they tell us about ourselves? Just as our human genome records traces of who we are and the conditions we have adapted to during evolutionary history, our microbial genomes may record traces of what we have eaten, where we have lived, and who we have been in contact with. The microbial ecosystems in different parts of our bodies, which differ radically from one another, also supply a wide range of functions that affect many aspects of human health.
Join us on a guided tour of the human gut and its microscopic inhabitants. We will first review what microbes are and how they get into our bodies. We will then discuss the methods we use to study microbial communities and briefly explore how gut microbiome data are analyzed. This information will provide us with a foundation to explore current microbiome research. We will cover topics such as the influence of the gut microbiota on our nutrition, health and behavior. Did you know that gut microbes may influence how sick we get or the way we feel? The course will culminate with an in-depth review of the American Gut Project, the world’s largest open-source, crowd-sourced science project, from how it works to what it’s taught us up until now.
COURSE SYLLABUS
Week 1: Introduction to microbes and the human microbiome
Meet Professor Rob Knight, Dr. Jessica Metcalf, and Dr. Katherine Amato as they introduce the human microbiome. Key topics this week are:
* What are microbes?
* The human microbiome
* Where do you get your microbes?
Week 2: How we study the microbiome
We will discuss the history of microbial research and review cutting-edge techniques used to examine microbial communities today. Key topics this week are:
* The history of studying microbes
* Basics of high-throughput DNA sequencing
* ‘Omics’ and other useful technologies
Week 3: Making sense out of microbial data
We will briefly review techniques used for analyzing microbiome data. This information will serve as a foundation for exploring recent discoveries in microbiome research later on. Key topics this week are:
* How do we identify a microbe?
* Basics of alpha-diversity
* Beta-diversity, and visualizing differences
Week 4: The human gut microbiome and your health
We will discuss major factors affecting the gut microbiome. We will also explore in detail what we currently know about diet, nutrition, health, and the gut microbiome. Key topics this week are:
* Impact of diet and age on the gut microbiota
* Obesity and the gut microbiota
* Human microbiome and gut disease
* Manipulating the microbiome through fecal transplants
Week 5: Gut microbe-host interactions: Beyond nutrition
We will talk about how the gut microbiome can affect your body outside of the gut, including interactions with the immune system and the brain. Key topics this week are:
* Gut microbiota interactions with the immune system
* Gut microbiota, autoimmune diseases, and allergies
* The gut-brain axis
* Post-mortem human microbiome
Week 6: What’s in the American Gut?
We will re-introduce the American Gut Project and describe results both at an individual and a population level. Key topics this week are:
* The American Gut Project and crowd-funding
* Collecting samples
* Michael Pollan vs. Jeff Leach: American Gut results explained
The first 6-week session starts next Monday, October 6 2014 and runs through November 14 2014. You can also sign up to be notified when the next session will begin. They say it will involve 3-5 hours of work/week.
If you take the course, please let me know how you like it. I’m super busy this fall so am going to wait until the next time it’s offered.
* HEALTHY INFLAMMATION vs EXCESSIVE INFLAMMATION (the kind that produces allergies, asthma, all the other types of autoimmune diseases and conditions – and worse)
******************
This workshop will be relevant for you even if you don’t have a full blown allergy, a sinus problem or asthma. You very likely have inflammation or an autoimmune condition going on somewhere in your body. Allergies, sinus conditions, asthma, and autoimmune conditions are the result of excessive inflammation – and that starts in an unbalanced gut microbiome.
After receiving a handy wallet-sized card called QUICK TIPS FOR SAFER COSMETICS: A GUIDE TO NAVIGATING PERSONAL CARE PRODUCT LABELS, from the Environmental Working Group’s SKIN DEEP project, I decided to revisit the important topic of the unsafe ingredients in our personal care products:
Soaps
Skin moisturizers
Lip products
Hand sanitizers
Sunscreens
Hair care products
Toothpastes
Nail polishes
You too can get a copy of this nifty card if you donate $5 to the Environmental Working Group. EWG does excellent work trying to protect us from harmful ingredients. I hope you’ll help support them with a donation of $5 or more. Here’s a link to their site.
The EWG has done extensive research on over 69,000 personal care products to compile the safety information in their SKIN DEEP Cosmetics Database. Their research standards are well above the government’s standards. They examine product concerns such as:
Overall hazards
Cancer links
Developmental and reproductive toxicity
Allergies
As the EWB points out:
Our cosmetics and personal care products are under regulated and often include chemicals that have not been well tested.
The US government allows cosmetics’ manufacturers to include almost any ingredient in their products.
The US Federal Food and Drug Administration (FDA) does not have the authority to require safety tests on these products or recall any product that proves to be harmful.
OTHER EWG GUIDES
The EWG also publishes other useful guides:
Healthier Cleaning Products
Good Food on a Tight Budget
A Meat Eater’s Guide to Climate Change + Health
A Guide to Summer Sun
A Shopper’s Guide to Pesticides in Produce
EWG’s Guide to Pesticides in Produce
THE EWG’S SKIN DEEP MOBILE APP
Sample information from EWG’s SKIN DEEP project’s mobile app that lets you obtain hazard on over 69,000 personal care products by scanning their barcodes
ALL THE INFORMATION BELOW IS FROM EWG’S SKIN DEEP DATABASE – AS POSTED ON THEIR WEBSITE
The American government doesn’t require health studies or pre-market testing of the chemicals in personal care products, even though just about everyone is exposed to them. Through Skin Deep, we put the power of information in consumers’ hands. When you know what’s in the products you bring into your home and how those chemicals may affect your health and the environment, you can make informed purchasing decisions — and help transform the marketplace. At the same time, we advocate responsible corporate and governmental policies to protect the most vulnerable among us.
EWG created our Skin Deep database as a way to combat the serious deficiencies in cosmetics regulation.
Still navigating store aisles can be difficult. Environmental Working Group researchers have evaluated hundreds of safety studies and thousands of ingredient labels to bring you our top recommendations for what not to buy.
SHOPPING TIPS
By Product Type:
Soap
Avoid: triclosan and triclocarban.
Skin moisturizer and lip products
Avoid: Retinyl palmitate, retinyl acetate, retinoic acid and retinol in daytime products
Hand sanitizers
Pick: ethanol or ethyl alcohol in at least 60% alcohol
Sunscreen
Just say no:
SPF above 50
Retinyl palmitate
Aerosol spray and powder sunscreen
Oxybenzone
Added insect repellent
Say yes to:
Hats and shade in mid-day sun
Zinc Oxide or Titanium Dioxide as active ingredients, otherwise Avobenzone (at 3%)
SPF 15 to 50, depending on your own skin coloration, time outside, shade and cloud cover.
Use a lot and reapply frequently
Hair Care
Avoid or limit:
Dark permanent hair dyes
Chemical hair straighteners
Toothpaste
Avoid: triclosan
Nails
Avoid:
Formaldehyde or formalin in polish, hardeners or other nail products.
Toluene and Dibutyl phthalate (DBP) in polish.
Pregnant? Skip polish
Tips for babies and young children
Children are not little adults. Pound for pound, kids are exposed to more contaminants in air, water, food, and personal care products than adults. Immature organ systems are often less capable of fending off chemical assaults. Subtle damage to developing bodies may lead to disease later in life.
Parents can make healthy choices by using fewer personal care products for their children, ignoring ad hype and following these tips:
Baby wipes
Avoid:
Bronopol
DMDM hydantoin
Fragrance
Diaper cream
Avoid:
BHA
Boric acid
Fragrance
Toothpaste
Use a small amount of fluoride-free toothpaste until kids can reliably rinse and spit (none for kids under 2). Use child-strength toothpaste for children 6 and younger. Use only a pea sized amount and supervise child’s brushing and rinsing (to minimize swallowing)
Sunscreen
Infants under 6 months don’t belong in the sun and they shouldn’t wear sunscreen. For older babies and children, use protective clothing and sunscreen that provides good UVA and UVB protection. Use enough and reapply often.
Baby powder
Skip it! Just like auto exhaust or secondhand smoke, tiny airborne particles can damage baby’s delicate, developing lungs
Tips for teens and tweens
Teens use cosmetics. Sometimes lots of them. From hair gels and straighteners to eye make-up, body wash and lotions. And then some! Knowing which ones are healthy — and which ones aren’t — is important. Why? EWG found that adolescent girls’ bodies are contaminated with chemicals commonly used in cosmetics and body care products. In fact, we detected 16 potentially toxic chemicals — phthalates, triclosan, parabens, and musks — in blood and urine samples from 20 teen girls. Studies link these chemicals to potential health effects including cancer and hormone disruption.
To make matters worse, teens may be particularly sensitive to exposures to hormone-disrupting chemicals, given the complex role they play during puberty – precisely when girls typically experiment with an increasing number and variety of body care products. When we surveyed them, our teen study participants reported using an average of 17 personal care products each day, 40 percent more than an adult woman.
Teens can easily make safer choices by reducing the number of body care products they use, viewing marketing claims with skepticism, always checking the ingredients for toxics (a good lifelong habit!), and following EWG guidelines to select safer products:
Acne products
Avoid:
Triclosan
Parabens
PEG/cetearetj/polyethylene
Perfume, cologne, and body spray
Avoid:
Diethyl phthalate
“Fragrance” (listed as an ingredient)
Make-up
Avoid:
Loose powders
Vitamin A (listed as: retinol, retinyl palmitate, retinyl acetate) in skin and lip products
Choose:
Safer make-up using Skin Deep
Sun protection
Be sun smart! Sunburns in children and teens increase your risk of the most deadly form of skin cancer–melanoma.Avoid tanning beds. Tanning booths expose the skin to 15 times more UV sun. The use of tanning beds before age 30 can cause a 75 percent increase in melanoma.
Tips for women
The average woman uses 12 products containing 168 different ingredients daily. Many cosmetic chemicals are designed to penetrate into the skin’s inner layers, and they do. Consequently, some common cosmetic ingredients turn up in people’s bodies. Among them: industrial plasticizers called phthalates; parabens, which are preservatives; and persistent fragrance components like musk xylene.
Are levels found in our bodies causing biological damage? Only more research can say. Several studies have linked feminization of American baby boys to a common fragrance chemical called diethyl phthalate.
Anti-aging products
Avoid: Alpha and beta hydroxy acids (lactic acid and glycolic acid)
FDA-sponsored studies find UV-caused skin damage doubles for users of products with alpha hydroxy acid. Regular sunscreen application is the best way to avoid sun-damaged skin.
Hair dye
Minimize use of dark, permanent hair dyes. Many contain coal tar ingredients, including aminophenol, diaminobenzene, and phenylenediamine, linked to cancer.
Skin lighteners
Avoid skin lighteners with hydroquinone. FDA warns that this skin-bleaching chemical can cause a skin disease called ochronosis, with “disfiguring and irreversible” blue-black lesions on exposed skin.Illegally imported skin lighteners can contain mercury, which can poison adults and children and is especially toxic during pregnancy. Be wary of imported skin lighteners, don’t buy products without ingredients clearly labeled, and always avoid products with “mercury,” “calomel”, “mercurio” or “mercurio chloride”.
Chemical hair straighteners
Many hair straightening treatments use harsh or toxic ingredients, and make misleading safety claims. We recommend you avoid chemical hair straighteners.If you choose to use, avoid keratin treatments.
Tips for men
The average man uses 6 products daily with 85 unique ingredients. Some ingredients are hormonally active; some of these are specifically linked to male reproductive system disorders. For instance, phthalates have been associated with altered hormone levels in men and boys and sperm damage.
After shave
Avoid:
“Fragrance”
Oxybenzone
PEG/ceteareth/polyethylene
Parabens
Shaving cream
Avoid:
DMDM hydantoin
“Fragrance”
PEG/ceteareth/polyethylene
Triclosan
Sunscreen
Wear sunscreen. Surveys show just 34 percent of men wear sun protection, compared to 78 percent of women. Chose a sunscreen with UVA and UVB protection and reapply often. SeeEWG’s annual sunscreen report for good choices.
Shopping tips by ingredient
BHA: The National Toxicology Program classifies butylated hydroxyanisole (BHA) as “reasonably anticipated to be a human carcinogen.” It can cause skin depigmentation. In animal studies, BHA produces liver damage and causes stomach cancers such as papillomas and carcinomas and interferes with normal reproductive system development and thyroid hormone levels. The European Union considers it unsafe in fragrance. It is found in food, food packaging, and personal care products sold in the U.S.
Boric acid and Sodium borate: These chemicals disrupt hormones and harm the male reproductive system. Men working in boric acid-producing factories have a greater risk of decreased sperm count and libido. In animals, high doses cause testicular damage to mice, rats, and dogs. Both the European Union and Canada restrict these ingredients in body care products made for children under three years of age and require that products containing these ingredients be labeled as not appropriate for broken or damaged skin. No similar safety standards are in place in the United States. The cosmetic industry’s own safety panel states that these chemicals are unsafe for infant or damaged skin, because they can absorb readily into the body. Despite this guidance, boric acid is found in some diaper creams.
Coal tar hair dyes and other coal tar ingredients (including Aminophenol, Diaminobenzene, Phenylenediamine): Coal tar, a byproduct of coal processing, is a known human carcinogen, according to the National Toxicology Program and the International Agency for Research on Cancer. Hair stylists and other professionals are exposed to these chemicals in hair dye almost daily. Europe has banned many of these ingredients in hair dyes. While FDA sanctions coal tar in specialty products such as dandruff and psoriasis shampoos, the long-term safety of these products has not been demonstrated.
Formaldehyde: A potent preservative considered a known human carcinogen by the International Agency on Research on Cancer. Formaldehyde, also an asthmagen, neurotoxicant and developmental toxicant, was once mixed into to many personal care products as antiseptic. This use has declined. But some hair straighteners are based on formaldehyde’s hair-stiffening action and release substantial amounts of the chemical.
Formaldehyde releasers – Bronopol, DMDM hydantoin, Diazolidinyl urea, Imidzaolidinyl urea and Quaternium-15: Cosmetics preservatives that slow form formaldehyde to kill bacteria growing in products. Formaldehyde is a known human carcinogen. The preservatives and the formaldehyde they generate can trigger allergic skin reactions. Formaldehyde releasers are widely used in US products. Not surprisingly, more Americans develop contact allergies to these ingredients than Europeans.
Fragrance: It may help sell products from face cream to laundry detergent, but do you know what’s in it? Fragrances are in everything from shampoo to deodorant to lotion. Federal law doesn’t require companies to list on product labels any of the chemicals in their fragrance mixture. Recent research from EWG and the Campaign for Safe Cosmetics found an average of 14 chemicals in 17 name brand fragrance products, none of them listed on the label. Fragrances can contain hormone disruptors and are among the top 5 allergens in the world. Our advice? Buy fragrance free wherever possible.
Hydroquinone: A skin bleaching chemical that can cause a skin disease called ochronosis, with blue-black lesions that in the worst cases become permanent black caviar-size bumps. In animal studies, hydroquinone has caused tumor development.
Lead: A neurotoxin in popular hair dye Grecian Formula 16 and other black hair dyes for men. Lead from hair dyes travels from hair to doorknobs, cabinets and other household items, where children can ingest it.
Methylisothiazolinone, methylchloroisothiazolinone and benzisothiazolinone: Preservatives, commonly used together in personal care products, among the most common irritants, sensitizers and causes of contact allergy. Lab studies on mammalian brain cells suggest that methylisothiazolinone may be neurotoxic.
Nanoparticles: Zinc oxide and titanium dioxide nanoparticles appear to be among the safer and more effective active ingredients in U.S.-marketed sunscreen creams because they do not penetrate the skin. But avoid sprays and powders containing these nanoparticles, which could penetrate your lungs and enter your bloodstream. Many other nanoparticles have received very little testing, yet they readily penetrate the skin and contaminate the body. Cosmetics manufacturers are not required to disclose the presence of nanoparticles in products.
Oxybenzone: Sunscreen agent and ultraviolet light absorber, found in the bodies of nearly all Americans, according to the U.S. Centers for Disease Control and Prevention. In human epidemiological studies, oxybenzone has been linked to irritation, sensitization and allergies. A study of 404 New York City women in the third trimester of pregnancy associated higher maternal concentration of oxybenzone with a decreased birth weight among newborn baby girls but with greater birth weight in newborn boys. Studies on cells and laboratory animals indicate that oxybenzone and its metabolites may disrupt the hormone system.
Parabens (specifically Propyl-, Isopropyl-, Butyl-, and Isobutyl- parabens): Parabens are estrogen-mimicking preservatives used widely in cosmetics. The CDC has detected parabens in virtually all Americans bodies. According to the European Commission’s Scientific Committee on Consumer Products, longer chain parabens like propyl and butyl paraben and their branched counterparts, isopropyl and isobutylparabens, may disrupt the endocrine system and cause reproductive and developmental disorders.
PEGs/Ceteareth/Polyethylene compounds: A family of conditioning and cleaning agents that go by many names. These synthetic chemicals are frequently contaminated with 1,4-dioxane, which the U.S. government considers a probably human carcinogen and which readily penetrates the skin. Cosmetics makers could easily remove 1,4-dioxane from ingredients, but tests documenting its common presence in products show that they often don’t.
Petroleum distillates: Petroleum-extracted cosmetics ingredients, commonly found in mascara. They may cause contact dermatitis and are often contaminated with cancer-causing impurities. They are produced in oil refineries at the same time as automobile fuel, heating oil and chemical feedstocks.
Phthalates: A growing number of studies indicate that chemical family damages the male reproductive system. Pregnant women should avoid nail polish containing dibutyl phathalate. Everyone should avoid products with “fragrance” indicating a chemical mixture that may contain phthalates.
Resorcinol: Common ingredient in hair color and bleaching products; skin irritant, toxic to the immune system and frequent cause of hair dye allergy. In animal studies, resorcinol can disrupt normal thyroid function. The federal government regulates exposures to resorcinol in the workplace, but its use is not restricted in personal care products.
Toluene: Volatile petrochemical solvent and paint thinner and potent neurotoxicant that acts as an irritant, impairs breathing and causes nausea A pregnant woman’s exposure to toluene vapors during pregnancy may impair fetal development. In human epidemiological and animal studies, toluene has been associated with toxicity to the immune system. Some evidence suggests a link to malignant lymphoma.
Triclosan & Triclocarban: Antimicrobial pesticides in liquid soap (triclosan) or soap bars (triclocarban), very toxic to the aquatic environment. Often found as contaminants in people due to widespread use of antimicrobial cleaning products. Triclosan disrupts thyroid function and reproductive hormones. American Medical Association and the American Academy of Microbiology say that soap and water serves just as well to prevent spread of infections and reduce bacteria on the skin. Overuse may promote the development of bacterial resistance.
Vitamin A compounds (retinyl palmitate, retinyl acetate, retinol): Vitamin A is an essential nutrient but not necessarily safe for use on skin. Studies show that when applied to sun-exposed skin these compounds can increase skin sensitivity. Furthermore sunlight breaks down vitamin A to produce toxic free radicals that can damage DNA and hasten skin lesions and tumors in lab animals. These ingredients are widely used in sunscreens, skin lotions, lip products and makeup. EWG urges consumers to avoid leave on skin and lip products with vitamin A.
Animal-based ingredients: Many consumers are asking manufacturers tough questions about ethical sourcing of their ingredients. Vegetarians, vegans, and people concerned about animal welfare frequently seek to avoid ingredients derived from animals. However a number of animal-based substances are found in cosmetics, and might not be clearly labeled as such. If you are concerned about avoiding animal products the best bet is to choose brands claiming to be vegetarian or vegan or labeled with the PETA and Leaping Bunny logos.
Extreme weather events, from coastal flooding, intense heat, record amounts of rainfall in some areas and historic droughts in others, are becoming increasingly common as the Earth’s average temperature rises. The World Meteorological Organization has linked some of 2013’s most extreme weather events – think back to Typhoon Haiyan in the Philippines as well as flooding in central Europe and record high temperatures in Australia, Asia and Africa to human-induced climate change. “There’s been a general disruption of nature,” says Kim Knowlton, a senior scientist in the Natural Resources Defense Council’s health and environmental program. In may, the U.S. Global Change Research Program (GCRP) released a comprehensive report on the impacts of climate change. It bluntly states: “Over the last 50 years, much of the United States has seen an increase in prolonged periods of excessively high temperatures, more heavy downpours, and in some regions, more severe droughts.”
This is very bad news for people with allergies and asthma – more moisture and higher temperatures mean increased levels of mold, pollen and air pollution.
Temperatures across the U.S. are projected to increase anywhere from 5-10 degrees Fahrenheit by the end of the century so the challenges we encounter from climate change are likely to get worse. (Gagne, 2014)
AIR-BORNE ALLERGENS ARE EXPECTED TO INCREASE
According to the EPA’s report on climate change and air-borne allergens, A Review of the Impact of Climate Variability and Change on Aeroallergens and Their Associated Effects (EPA, 2011):
Aeroallergens include pollens, which can be produced by weeds, grasses and trees, as well as molds, dust particles, ash and indoor allergens.
Aeroallergens such as dust, ragweed, pollen and molds impact half of all Americans.
Treatment for allergies in the US costs $21 billion annually.
Three major allergic diseases have been associated with exposure to aeroallergens: hay fever, asthma and eczema. Collectively, these three allergic diseases rank sixth for annual expenditures among chronic health conditions in the United States.
Beyond the direct cost of medical care are the indirect, but substantial, costs associated with lost time at work, school and play.
Increases in temperature, carbon dioxide and precipitation will cause the proliferation of weedy plants that are known producers of allergenic pollen. Higher levels of CO2 in the atmosphere act as a fertilizer for plant growth. Warmer temperatures and increased precipitation will cause some plants to grow faster, bloom earlier and produce more pollen.
Climate-related temperature changes are expected to increase the potency of airborne allergens, increasing the concentration of pollen in the air, the length of the allergy season and the strength of airborne allergens.
Climate change will allow allergen-producing plant species to move into new areas.
Wind-blown dust, carrying pollens and molds from outside of the United States, could expose people to allergens they had not previously contacted. Exposure to more potent concentrations of pollen and mold may make current non-sufferers more likely to develop allergic symptoms.
Wildfires in Colorado, 2012
Drought in California, 2014
HEAVIER, MORE FREQUENT RAINS PRODUCE MORE MOLD
Flooding from Super Storm Sandy, 2012
Molds can cause serious health problems in susceptible individuals. Here’s information from the New York City Department of Health and Mental Hygiene on the city’s health crisis following Hurricane Sandy (RebuildAdjustNY.org, 2013):
Toxins produced by mold, known at myotoxins, can cause headaches, nausea, loss of appetite, fatigue, inability to concentrate and memory loss.
Chronic exposure to mold can lead to permanent lung disease
According to the Institute of Medicine, “There (is) sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people.”
According to a World Health Organization-cited study, building dampness/mold increases the occurrence of respiratory and asthma-related health incidents by 30-50%.
A second study estimated that 21%of the cases of asthma in the United States could be attributable to dampness and mold in housing, for a total annual national cost of $3.5 billion.
Sandy-impacted neighborhoods are especially vulnerable to health effects from mold.
According to then Mayor Bloomberg, 70,000 – 80,000 homes suffered water damage due to Hurricane Sandy.
About 180,000 – 210,000 New Yorkers could be currently exposed to Sandy-related mold.
Mold is especially dangerous for 45,000+ children under the age of 5 and senior New Yorkers who are considered highly vulnerable to mod-related ailments.
Mold is especially dangerous for individuals suffering from asthma and other respiratory ailments.
Sandy-affected neighborhoods reported more than 30,000 asthma-related emergency room visits between 2008 and 2010.
Children and seniors comprise about 25% of the population in Sandy-affected neighborhoods.
Asthmatics comprise more than 25%of the Sandy-affected neighborhood of Red Hook, Brooklyn.
Mold growth inside a home after Hurricane Sandy
Mold damage is not always as easy to detect as in the photo above. It can be growing inside walls or behind wallpaper so not necessarily be visible.
Mold growing behind wallpaper
And dead mold spore can still cause allergic reactions in some people so killing the mold may not be sufficient – it must also be removed. (EPA, 2012)
SO HOW CAN WE REDUCE OUR CHANCES OF INCREASED SUFFERING FROM ALLERGIES AND ASTHMA?
We know that 80-90% of our immune system resides in the mucosa of our guts. An unbalanced, impaired gut microbiome produces chronic inflammation in the body. Over time, this inflammation produces autoimmune conditions (such as allergies and asthma) – as well as gum disease, repeating UTIs, heart disease, nail fungus, some cancers, and much more.
Mast cells located in our skin, connective tissues, and the mucosal linings of our stomachs and intestines, are an essential part of our immune defenses. These unique cells are tasked with activating the immune system to defend us from harmful invaders.
In people with allergies, the immune system misidentifies innocuous substances as dangerous pathogens and sends out mast cells to combat them – as if Attila’s Huns were at the gate and needed to be attacked at all costs, even to the point of destroying the body in the process.
The real solution for both allergy and asthma sufferers isn’t just treating the symptoms but working to restore the health of the friendly bacteria living in the gut with the goal of normalizing the immune system. A healthy, balanced gut immune system will stop producing inflammation and allow a return to health.
As climate change exposes us to increasing numbers of molds and other allergens, we’re all going to need immune systems that are up to dealing with the challenge.
For more information on allergies, asthma, autoimmune conditions, the role of inflammation in these problems, and how to strengthen your immune system, see:
THIS WORKSHOP WAS A SUCCESS SO I MAY GIVE IT AGAIN IN MAY OR JUNE 2014. USE THE CONTACT BOX BELOW TO LET ME KNOW IF YOU’RE INTERESTED IN ATTENDING:
WORKSHOP ON ALLERGIES, SINUSES, ASTHMA, AUTOIMMUNITY & THE GUT
We’ll cover practical things you can do to fix your allergies, sinus problems, asthma, and autoimmune conditions – and also learn how they all originate in our intestinal tracts
Joan Rothchild Hardin, PhD
SATURDAY 18 JANUARY 2014
2:30 – 5:30 PM
NEW YORK CITY
LIMITED TO 20 PEOPLE
COST: $45
DISCLAIMER: Not intended to provide medical advice, diagnosis or treatment.
