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Kidney Function in Pregnancy

Thu, 25 Feb 2016 22:00:00 +0000

My 22 year old daughter in law, 6 months pregnant, has had a score of 36 for GFR kidney function.
Can she be tutored in naturopathic approaches to stabilising/ improving?
Thanks, Les.

Kidney function, or the ability of the glomeruli (capillaries around the end of the kidney tubule) to filter waste products from the blood, is measured by creatinine blood levels. Higher levels of creatinine indicate a lower glomerular filtration rate (GFR), and GFR tends to gradually decline with age. There are 5 stages of kidney disease, and a GFR of 36 is classed as stage 3 kidney disease.[1] Women who become pregnant when they have serum creatinine values above 124 μmol/l have an increased risk of faster decline in renal function and poor outcome of pregnancy.[2]

As a result, all women with chronic kidney disease should be referred early in pregnancy to a specialist to plan care during the pregnancy. Regular monitoring of maternal renal function (serum creatinine and serum urea) is necessary, as well as blood pressure, urine (for infection), protein in the urine, and when appropriate ultrasound (to detect obstructions to the urinary tract). Vitamin D levels should be monitored, as the kidneys normally increase blood levels during pregnancy.[3]

Use of non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided, as these can damage renal function. Other drugs should be checked for their influence on kidney function as well as on the fetus.

A naturopathic physician experienced in treating patients with kidney disease should be consulted alongside conventional care, to recommend strategies for improving kidney function. One potentially useful supplement might be trehalose, a natural disaccharide sugar. Trehalose is known to be safe during pregnancy, and may even prevent neural tube defects in mothers with diabetes.[4] Trehalose may also be useful to repair damage to kidney podocytes, the cells that encapsulate the glomeruli.[5]

References:
1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39: Suppl 1: S1-S266.
2. Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;336:211–215. PMCID: PMC2213870.
3. Williams D. Renal disorders. In: James DK, Steer PJ, Weiner CP, Gonik B, eds. High risk pregnancy. Management options. 3rd ed. Philadelphia: Elsevier Saunders, 2006:1098-124.
4. Xu C, Li X, Wang F, Weng H, Yang P. Trehalose prevents neural tube defects by correcting maternal diabetes-suppressed autophagy and neurogenesis. Am J Physiol Endocrinol Metab. 2013 Sep 1;305(5):E667-78. doi: 10.1152/ajpendo.00185.2013. PMCID: PMC3761168.
5. Kang YL, Saleem MA, Chan KW, Yung BY, Law HK. Trehalose, an mTOR independent autophagy inducer, alleviates human podocyte injury after puromycin aminonucleoside treatment. PLoS One. 2014 Nov 20;9(11):e113520. doi: 10.1371/journal.pone.0113520. PMCID: PMC4239098.




Dark Chocolate Protects DNA and the Heart

Thu, 24 Dec 2009 10:00:00 +0000

A recent study in the British Journal of Nutrition [1] has found that dark chocolate contains antioxidants that are protective to DNA, but this effect only lasts for a day. Researchers in Milan, Italy, measured plasma epicatechin levels, DNA damage in mononuclear blood cells, and plasma total antioxidant activity in 20 volunteers on a balanced diet with standardised levels of antioxidants. After a washout period the subjects were given 45g of either dark chocolate (DC, containing 860 mg polyphenols, of which 58 mg epicatechin) or white chocolate (WC, no epicatechin). The results found that increased levels of epicatechin in the blood of those who had eaten the dark chocolate lasted for nearly a day; between 2 hours and 22 hours after DC intake. This corresponded with lower levels of DNA damage to the blood cells, but eating the dark chocolate did not affect total antioxidant activity. Eating WC did not make any difference to the factors measured. The researchers conclude: "DC may transiently improve DNA resistance to oxidative stress." They add: “the present results are clinically encouraging especially in the field of the diet therapy of obesity, pathology related to greater incidence of cardiovascular disease and cancer”. Unfortunately regular consumption of dark chocolate does not increase long-term epicatechin levels, so according to this study, dark chocolate must be consumed daily to get these benefits. Chocolate has long been known to be an important part of a healthy diet According to Donatella Lippi of the Department of Anatomy, Histology and Legal Medicine, University of Florence, Italy [2]: The Aztecs believed that cocoa pods symbolized life and fertility, and that eating the fruit of the cocoa tree allowed them to acquire wisdom and power. Cocoa was said to have nourishing, fortifying, and aphrodisiac qualities. One well-researched benefit of chocolate is improving the health of the heart. In a Data from The Stockholm Heart Epidemiology Study showed how of 1169 non-diabetic patients having their first heart attack, those who were regular consumers of chocolate were more likely to survive. [3] A study on dark chocolate published in the International Journal of Cardiology [4] measured the effect of 45g of dark chocolate on blood circulation in the coronary arteries as measured by doppler ultrasound. After two weeks of daily intake the researchers conclude: Flavonoid-rich dark chocolate intake significantly improved coronary circulation in healthy adults, independent of changes in oxidative stress parameters, blood pressure and lipid profile, whereas non-flavonoid white chocolate had no such effects. Epicatechins are a type of polyphenol antioxidant in the catechin family. Catechins are found in tea, wine, fruits and vegetables as well as dark chocolate. However it is the bitter principles in the chocolate that contain the beneficial antioxidants: An editorial in The Lancet [5] points out that some chocolate manufacturers may darken the natural cocoa solids and remove the bitter flavanols, "so even a dark-looking chocolate can have no flavanol". In addition, cacao colouring can contain more than the maximum EU permitted level of mercury (1 mcg/g). [6] Manufacturers rarely label their products with this information. In addition, 45g of dark chocolate contains about 200 calories, so calorific intake must be taken into account as part of the risk/benefit calculation. One way round that might be to use raw cacao nibs which contain no sugar and are also unheated, thereby likely to have a higher catechin content, although the consumer may not see the benefit of this over drinking red wine, for example. Therefore the amount of chocolate consumed is not necessarily proportionate to it's health benefits: Another paper from the British Journal of Nutrition [7] demonstrated that even doubling the the polyphenol content in the same size dose of chocolate had no significant dose-related benefits: It was observed that the 500 mg polyphenol dose was equally effective in reducing [...]



Raw Milk Arrives in The UK

Wed, 16 Dec 2009 23:00:00 +0000

Breaking News:

From today, unpasteurised, raw or 'green' milk is now commercially available in the UK for the first time in a vending machine-style dispenser. The milk is being dispensed in a farmers' market in Canterbury, Kent, The Goods Shed, so called because it is housed in a disused railway shed. The milk comes from a small local herd at Badlesmere Farm, and the machine must carry the advisory notice: "Warning: This milk has not been heat treated & may therefore contain organisms harmful to health." [1]

(image)

Pasteurised milk and milk products are generally thought to be a healthier option due to the possibility of infection, although proponents of raw milk claim that if a small dairy herd is well managed then the milk produced can be safe. The Weston A Price Foundation promotes the use of raw milk over pasteurised, although they suggest that soya milk is unsafe. [2] As a generalised dietary theory this does not take into account individual differences in requirements, metabolism and disease susceptibility, as detailed in the Blood Type Diet. Francis Pottenger MD conducted a famous series of experiments on generations of cats between 1932 and 1942, one of them focussed on the dramatic differences in health effects between raw and pasteurised milk. [3] This is often used as evidence of health benefits by proponents of raw food.

In Italy, green milk is available from similar vending machines in hundreds of farmers' markets throughout the country. The dispensers keep the milk at a suitable temperature, constantly stirring the cream into the milk, and cleaning the dispensing area. Buyers place a coin in the slot and a bottle under the spout, and the milk is dispensed at the amount requested.

Although unpasteurised cheeses are still available, the law in the UK is restrictive on the sale of green milk, generally being sold only by the producers (there are 102 registered producers in the UK in 2009):

The milk may only be sold direct to consumers by registered milk production holdings (at the farm gate or in a farmhouse catering operation) or through milk roundsmen. Sales through other outlets have been banned since 1985 (although sales by the farmer at farmers markets are allowed). [1]

Raw milk has been illegal in Scotland since 1983 following a number of milk-related illnesses and 12 potentially associated deaths.

References:
1. UK Food Standards Agency, Raw drinking milk and raw cream control requirements in the different countries of the UK. 11 May 2009.
2. Weston A Price Foundation Campaign for Real Milk Website accessed 16th Dec 2009
3. Pottenger, F. Pottenger's Cats: A Study in Nutrition Pub. Cancer Book House, 1983, p.15 ISBN 0916764060