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weeks. These social networks are incredibly powerful means of telling the world what Nutritional Therapy is about. Use them wisely. For example, please use the hashtag #nutritionaltherapy after your Twitter posts, and make sure to link your Twitter profile with your Facebook page or your website. The more of us who use #nutritionaltherapy as a hashtag, the more it will “trend”, and the more visibility it’ll give us on the web. Also, please “like” us on Facebook, “follow” us on Twitter, join our LinkedIn group, subscribe to our YouTube channel and share and retweet all of our Facebook and Twitter posts, keeping our LinkedIn discussions as “internal”. Tell everyone you’re a BANT member by making a feature of this on your social media profiles, particularly if you volunteer for us. All members volunteering for BANT should add their position to their profile and add details of what it entails. Let us tell the world BANT and Nutritional Therapy are here to stay, and that “we mean business”. And last, but not least, I wanted to thank all of you who bought tickets to the CAM Conferences 2013 in collaboration with BANT. Tickets are selling fast so you should book your place soon. The whole of BANT Council is really looking forward to seeing you on Saturday 9th March at the BANT AGM, to be held at the Cavendish Conference Centre, London. This is a free event, but you must book a place in order to attend. Thank you so much for your ongoing support.
Warm regards,
Miguel Toribio-Mateas
Chair BANT Council
Chair’s Report and Update
British Association for Applied Nutrition and Nutritional Therapy ISSUE 42 • NOV 2012
27 Old Gloucester Street
London WC1N 3XX
T 0870 606 1284
F 0870 606 1284
www.bant.org.uk
CHAIRS REPORT 1
BANT AGM 2013 1
WEBINARS FOR BANT MEMBERS 2
ESSENTIAL MEMBER INFO 2
UPDATE BANT PROFILE 2
MEMBERS FEE INCREASE 3
STRATEGIC UPDATE 5
PPC UPDATE 6
CPD UPDATE 6
COMMUNICATIONS AT BANT 7
BANT SOCIAL MEDIA 8
REGIONAL CO-ORDS UPDATE 9
ANH INTERNATIONAL UPDATE 10
SURVEY ABOUT VEGETARIANS 11
CLASSIFIEDS & RECIPE 11
CAM CONFERENCES 12
CAM AWARDS 13
FEATURED ARTICLE -
COMPROMISED THYROID AND
ADRENAL FUNCTION PART 2 -
BY JANE NODDER & CATHERINE
HONEYWELL
15
CPD AND EVENTS LISTINGS 26
Inside This Issue
DISCLAIMER - BANT does not endorse any products,
services, jobs or seminars advertised in the newsletter.
Dear Members, Hope you are well, happy and prospering. October has been an incredibly busy month for BANT Council. We have now shared with you our mission and vision. BANT is here to serve you, and we will do that by championing Nutritional Therapy so it becomes a viable primary healthcare option. The work required to achieve the vision involves projects that are new or improve existing activities, and this comes at a cost. This cost is reflected in the fee increase we informed you about recently. We’ve defined 11 strategic objectives which specify what BANT needs to do as a professional association, when we need to do it and how we’ll measure that we’re achieving it. This will guarantee that we’re making the best use of your membership fees. Putting £10 a month away will guarantee you’ve got enough to cover your membership renewal at the end of each year. Most of us are happy to pay around £2 for a hot drink, so there’s an opportunity to cut down your caffeine intake and do your bit for the profession. I appreciate it’s hard for some to justify any more expenditure, but the future of your profession really does depend on BANT’s ability to achieve the recognition we all deserve as healthcare providers. BANT Council is truly grateful for the many positive comments we’ve received so far. I’m particularly enthused by the opening of new social media channels of communication with you all. We have new Facebook, Twitter, LinkedIn profiles, plus a YouTube channel. On LinkedIn, we have a closed group, i.e. members-only, which has got 400 members in only 4
BANT - the seal of excellence for nutrition health professionals
BANT AGM 2013 We are delighted to announce that
we are working in collaboration
with CAM Conferences for a series
of three CAM Conferences in
2013. The first conference will be
run straight after our BANT AGM
on Saturday 9th March 2013. The AGM is for BANT members only and you can book your place for
our free AGM at this link: www.targetpublishing.com/subscriptions/camconf/book.htm
CAM Conferences will be inviting internationally-recognised speakers at the forefront of nutritional
research to bring a first-class day of education and networking that is designed exclusively for
nutritional therapists.
Use this link to book your place for conferences:
www.targetpublishing.com/subscriptions/camconf/book.htm
Use this link to download the conference flyer/booking form:
www.bant.org.uk/bant/pdf/CAMCONFFLYER2013.pdf
Page 2
BANT - the seal of excellence for nutrition health professionals
Webinars for BANT Members Coming Soon
A new document has now been released to help members navigate their way around all the information BANT has made available to them. It is called Essential Member Information and that is exactly what it is!
All members must take time to download and look at the document as it covers everything about your responsibilities as a BANT member and all the tools available to you.
You can access this document by logging on to the BANT website and on your homepage you will find a link to it next to your CPD summary box and above the CPD help documents.
www.bant.org.uk/bant/jsp/member/pdf/INFO/ESSENTIAL_INFORMATION_FOR_BANT_MEMBERS.pdf
Update and Improve your BANT Member Website Profile We would like to suggest that all members spend a few moments checking their current BANT practice listings. It is important to make sure that your
details are up to date. You can list up to a maximum of 5 practice addresses, providing your email, website, telephone, mobile and fax contact
information. We have also added a new feature allowing you to list your Skype, LinkedIn, Twitter and Facebook contact details. If you would like to add
a photo please email a good resolution jpeg image to [email protected]. Please email any changes or additions to your profile to the
[email protected] in a similar format to the layout below by using this practice information document:
www.bant.org.uk/bant/pdf/memberForms/PRACTICE_DETAILS.doc
If you have entered Special Interests and
Further information you need to make
sure that both sections meet the ASA
Rules and the Rules and Regulations as
published on our members pages. Both
sections are limited to a maximum of 30
words each.
www.bant.org.uk/bant/jsp/member/
ASARules.faces
www.bant.org.uk/bant/jsp/member/
rulesRegulation.faces
From the middle of this year we will be
setting up a Website Analysis Team with
a remit to check BANT members’ NT
websites to make sure they meet the ASA
Rules and the Rules and Regulations as
published on our members pages. If the
content does not meet these standards,
members will be contacted and ask them
to make the appropriate changes within a
certain time limit.
Essential Member Information
As part of the new strategic plan for BANT, we plan to be offer webinars for members in
2013. These will be a combination of pre -recorded and live seminars. Before we
progress, it is really important to find out from you which subjects you would like to see
covered. Please send your ideas to [email protected]. We are also looking for
members to join the Webinar Team. Meetings will take place monthly and will be via
skype. If you feel you could make a contribution and are CNHC registered, please send
your CV to Karen MacGillivray-Fallis at [email protected].
Look forward to hearing from you.
Page 3 Membership Fee Increase Notification
BANT - the seal of excellence for nutrition health professionals
You will have seen in the October newsletter that there are a lot of strategic developments happening as part of a process to 'upgrade' BANT. Being
part of a membership body that represents the Seal of Excellence for the Nutritional Therapy profession is a good thing and it's getting better!
Please watch the short video message from our Chair, Miguel Toribio-Mateas where he explains some of the exciting new developments -
www.youtube.com/watch?v=wjJxDbVl64I
Our new vision is also our pledge to our members:
"We shall champion professional excellence in the practice of nutritional therapy and drive industry
policy to ensure the availability of nutritional therapy as a primary healthcare option."
Together, we are BANT - the Seal of Excellence for Nutrition Health Professionals.
Find out more by downloading our 5 year Strategic Plan
What is coming and how will this benefit you?
A new communications framework that is focused on raising the profile of nutritional therapy at an industry level, in the media and to the
public. Social media has now been launched and a new-look e-news will be coming in the new year.
A Learning Zone including Toolkits to guide members on how to do your own PR and marketing as well as guiding you through the Regulatory
Framework.
New look CPD support to help you with Compulsory CPD starting in 2014, including webinars available from an online BANT shop and BANT
seminars.
A brand new structure for volunteering at BANT.
The Clinician's Engagement Toolkit aimed at providing guidance to members on building working relationships with GPs and other clinicians.
A Centre of Excellence for sharing best practice, technical guidance, latest research reviews, case histories, a learning zone and other
educational material.
Supervision scheme to provide support to members when starting up in clinic.
A comprehensive market research series to you to understand the changing market for Nutritional Therapy and how to reach it.
These are all exciting projects, and to see more about the new-look BANT strategy please read the October newsletter and visit this
link: www.bant.org.uk/bant/jsp/member/strategy.faces
We also want to take this opportunity to remind you about the great benefits that already exist for BANT members.
Being part of the only Membership body dedicated to the Nutritional Therapy Profession
Acknowledgement of professional status by the CNHC
A detailed listing in the BANT Directory available on the BANT website
Use of BANT’s code of Professional Practice Handbook
Free access and use of the online learning zone and CPD logging system
A fantastic Regional Co-ordinators network that is growing all the time
Discounts that are being added to regularly (every little helps!)
Free licensed access and use of the professional version of the Natural Medicines Comprehensive Database
A monthly e-newsletter (because its good to keep in touch!)
Continued on the next page
Page 4 Membership Fee Update - Continued
BANT - the seal of excellence for nutrition health professionals
For a full list of benefits please visit:
www.bant.org.uk/bant/pdf/memberForms/BENEFITS_OF_BANT_MEMBERSHIP.pdf
For further details about provision of member services please visit this link:
www.bant.org.uk/bant/pdf/memberForms/BANT_TIMELINE_AND_PROVISION_OF_MEMBER_BENEFITS.pdf
How much will it cost?
You will no doubt understand that some of the very important projects we have in the pipeline need funding. We cannot progress without an increase in
membership fees. The fee due on Jan 1st 2013 is £118.75 for Full Members. This is made up of an fee increase of £25 making the new fee £100 plus
the three month bridging payment for Oct-Dec 2012 (due to the change of start date for the membership year from October to January). Discounted
Member fees (those over 65) will increase to £50 plus the bridging payment of £6.25. Student members will need to pay a bridging payment of £5
added to their £20 renewal fee. This is the first time in 8 years that fees have been raised and this new price is a first step to bring us more in line with
the industry standard for professional membership bodies.
How do I renew?
You will be sent a renewal notice via email on 1st of December 2012 and this will contain instructions on how to renew your membership online. You
will have between 1st December 2012 and the 31st January 2013 to renew your membership once you receive your renewal notice.
For now, if your membership certificate has an expiry date of 30 September 2012 - you can access your
interim membership certificate which will be valid up to and including 31 December 2012. You need to log onto the BANT Website and then access
your new interim certificate via your Account Details link.
Regards
BANT Council
Page 5 Strategic Update
BANT - the seal of excellence for nutrition health professionals
Last month BANT launched its 5 year strategic plan and we pledged in our vision to “champion professional excellence in the practice of nutritional
therapy and drive industry policy to ensure the availability of nutritional therapy as a primary healthcare option”.
BANT has published its 4 critical success factors (CSF) which state what we will strive to achieve on behalf of the profession. The Strategic Plan
expands this into 11 strategic objectives and from these emerged a delivery framework made up of the following 6 key workstreams:
1. Centre of Excellence – promoting excellence in nutritional therapy and professional
practice for NTs and the nutrition profession (CSF1, CSF2, CSF3)
2. Communications –raising the profile of Nutritional Therapy and BANT focused on
increasing market demand for nutritional therapy and engaging with members (CSF2,
CSF3)
3. Clinical Governance – driving up standards of professional practice in the nutritional
therapy profession (CSF1)
4. Professional Standards – driving up educational standards applied to all BANT
members (CSF3)
5. Stakeholder Engagement – Actively engaging with the industry, training providers,
regulators, Government to drive forward the nutritional therapy profession (all CSFs)
6. Regulatory Framework – working on behalf of members to stay abreast of legislative
changes and educate BANT members. (CSF1, CSF4)
Over the next few month’s we will feature each of the above workstreams and how these will impact and benefit you as members and the wider nutrition
profession. This month we feature the Centre of Excellence led by Karen Slattery and Communications led by Louise Carder which also includes the
exciting new series of market research led by Catharine Trustram Eve that will help further inform the strategic direction of BANT over the next few
years.
Centre of Excellence
One of BANT’s strategic objectives is to become the Centre of Excellence (CoE) for nutritional therapy in the industry by September 2014.
The CoE aims to promote excellence in nutritional therapy and professional practice by facilitating knowledge sharing, creating a repository of best
practice and learning including case studies, research reviews and ultimately an online journal.
The CoE aims to support nutritional therapists in practice through learning zones and toolkits but also aims to become the main resource and point of
reference, to which clinicians, the media, the public and other interested parties can refer for robust information on nutritional therapy.
Whereas BANT has traditionally been very much a member focused organisation, we now need to think bigger and widen our focus to represent
nutritional therapy in the industry as a whole. Nutritional therapy is still little known in the healthcare profession and by the public and the CoE is one
part of how BANT plans to change that.
Toolkits for members on Marketing, Public Relations and a legislation are due for release over the next few months. Learning zone modules will be
launched for members next year and a public blogsite to start the ball rolling on knowledge sharing prior to the full launch of the CoE in September 2014.
Communications
BANT recognises that nutritional therapy currently has limited ‘brand’ presence and this must change in order to generate increased demand for
nutritional therapy consultations (CSF2). Hence the main focus of the Communications team over the next 5 years will be to raise the profile of
nutritional therapy nationally. The Communications team has set up the following 3 workstreams to accomplish this:
1. External PR – focused on raising the profile of nutritional therapy to the public and media organisations, improving the standing and
perception of NT
2. Internal PR – focused on equipping nutritional therapists to effectively promote themselves to raise their own profile. This team will also
focus on communicating standards and engaging with members (CSF 1).
3. Marketing – a professional team supporting the PR teams to get across their messages effectively.
You will have seen in the regular communications updates in our newsletter that social media was launched in October. There will also be a big push
on media engagement coming up. A media register is now also in place to manage this and key BANT council members and nominated nutritional
therapists will undergo media training. Branding will be updated in March and BANT will ensure a more active presence at key events to represent
nutritional therapy.
Market research is also an important component of the communications plan. Traditionally BANT has not identified or proactively engaged target
markets however, in order to increase the demand for nutritional consultations, market segmentation and targeting becomes an integral part of the plan.
A series of market research will be rolled out over the next year and will positively drive the direction of BANT over the following years.
These are exciting times ahead. You can keep up to date with our plans by following us on social media – BANTOnline or reading continue
this Strategic Update column each month. Please let us have your feedback too either through social media or by email to BANT Admin at
4 Critical success factors
CF1. Nutritional therapy consultations must be effective, safe, evidence-based, national occupational standards-compliant and up to date.
CF2. The demand for nutritional therapy consultations must increase.
CF3. The number of regulated members must increase.
CF4. Future legislation must enable nutritional therapy to be a viable and valid healthcare option.
Page 6 Professional Practice Update
BANT - the seal of excellence for nutrition health professionals
Welcome to the November PPC update
It has been brought to our attention that there are still members using the terms ‘treat’ and ‘diagnose’ in their practice and also in promotional material.
The PPC would like to remind all members that as nutritional therapists we are not allowed to diagnose medical conditions - this is the sole domain of registered healthcare professionals. Naturally, we will come across symptom clusters that suggest certain conditions may be present.
However, when this is the case, it is imperative that members refer such clients to their GP for a formal diagnosis. Simply to inform a client that they have a particular medical condition and then give them nutritional advice for this amounts to diagnosing and doing this is a breach of the Code of Practice.
We would like to take the opportunity to remind you about how important it is to identify red flag signs and symptoms and referring clients to their GPs.
It is vital, not only for the client’s health, but also for your own protection that if your client reports any of the red flag signs and symptoms outlined below, you are quite clear that they must seek a medical opinion. Be sure to record it in your case notes and put it in writing to the client. This does not mean that you cannot continue to work with them, but on subsequent appointments be sure to follow up that they have been to see their doctor. This is all part of improving professional standards of BANT members and enhancing public confidence in the NT profession.
www.bant.org.uk/bant/jsp/member/pdf/professionalPractice/RED_FLAG_REMINDER.pdf
The Autumn has seen a wide variety of CPD activities from chronic fatigue to sports nutrition, gum disease to children's health. These are offered in a similarly wide variety of formats so that everyone should be able to fit CPD learning into their busy schedules. These include webinars you can do from home to attending conferences many of which are repeated in different parts of the country. You can keep up-to date with all BANT CPD events on the web-site: www.bant.org.uk/bant/jsp/member/CPDandconferences.faces A CPD Evaluation Form can be found on the same CDP and Conferences BANT web-site page and you are reminded to fill this in after attending an event. This provides valuable feed-back to BANT that helps us evaluate future meetings and ensure the quality of BANT CPD approved events.
Elizabeth Foot Chair of CPD Committee [email protected]
Pain
any pain which is persistent, particularly if severe or in the head, abdomen or central chest
pain in the eye or temples, with local tenderness, in the elderly, rheumatic patient
pain on passing urine in a man
cystitis recurring more than three times in a woman
absence of pain in ulcers, fissures etc.
sciatic pain if associated with objective neurological deficit
Bleeding
blood in sputum, vomit, urine or stools
vomit containing “coffee grounds” (coagulated blood, twisted bowel)
black, tarry stools (cancer)
non-menstrual vaginal bleeding (intermenstrual, postmenopausal, or at any time in pregnancy)
vaginal bleeding with pain in pregnancy or after missing one period
Psychological
deep depression with suicidal ideas
hearing voices
delusional beliefs
incongruous behaviour
Sudden
breathlessness
swelling of face, lips, tongue or throat
blueness of the lips
loss of consciousness
loss of vision
convulsions
unexplained behavioural change
Change
in bowel habit
in a skin lesion (size, shape, colour, bleeding, itching, pain)
Difficulty
swallowing
breathing
Persistent
vomiting &/or diarrhoea
vomiting &/or diarrhoea in infant
thirst
increase in passing urine
cough
unexplained loss of weight (1lb per week or more)
Others
pallor
unexplained swelling or lumps
neck stiffness in a patient with fever
unexplained fever, particularly if persistent or recurrent
brown patches (Addison’s disease)
CPD Committee Update
Catherine Honeywell Chair of Professional Practice Committee [email protected]
Page 7
BANT - the seal of excellence for nutrition health professionals
Communications at BANT Welcome to the November newsletter Communications update This last weekend in October has seen BANT host a ‘BANT Lounge’ at CAMExpo. We had lots of enquiries about where one can study Nutritional Therapy, how to join BANT and lots of interest in CPD and what will be new for BANT in 2013. We were giving out the new BANT Flyer which gives information about the new link with CAM Conferences for our AGM on the 9th March and two further CAM/BANT Conferences on 22nd June and 9th November at the Cavendish Centre. www.bant.org.uk/bant/pdf/CAMCONFFLYER2013.pdf CAMExpo went very well and were inundated with visitors to the stand - so thank you to everyone that popped in to say hi and thanks also to our fabulous volunteers for making the event possible. Thanks to Judith Orrick for setting up the stand and volunteering her time on-stand on Saturday morning, I enjoyed the morning on-stand with Judith and May Lauder. Also volunteering on Saturday were Val Hemmings, Kate Delmar-Morgan and Tatiana Rodriguez. On Sunday Deborah Colson, Tajinder Hayre, Daniel O’Shaugh-nessy and Tatiana were on-stand and again a special thanks to Tatiana for not only helping out both days but also agreeing to pack up after a long second afternoon!
VOLUNTEERING AT BANT
If anyone came to the CAMExpo stand and was inspired to give their time to BANT then please visit: www.bant.org.uk/bant/jsp/volunteering.faces
We are always looking for volunteers and if you would like further information please email [email protected]
PR AND MARKETING
Social Media Launch- Reminder
In case you didn’t see last months e-news for more information about how it all works, please visit: www.bant.org.uk/bant/jsp/socialMedia.faces And for the individual website links please visit:
LinkedIn Group – Members Facebook www.linkedin.com/groups/BANT-4633986 www.facebook.com/BANTonline LinkedIn Group – Students Twitter www.linkedin.com/groups/BANT-Student-Members-Group-4061266 https://twitter.com/BANTonline LinkedIn – follow company YouTube www.linkedin.com/company/british-association-for-applied-nutrition-and-nutritional-therapy www.youtube.com/user/BANTNT
We will be sending out more information in the coming weeks so keep an eye out!
E-news
The plans for the new-look e-news are continuing. If you would like to be involved in producing or contributing to the e-news then please let me know by emailing me at: [email protected]
REGULATORY FRAMEWORK This month the advice from the Regulatory Teams is to start to familiarise yourselves with the changing Claims Legislation coming in December. ANH Intl have devoted this issue to writing about the legislation update but please do visit the register of claims, where you can use the search function to start to work your way around authorised and non-authorised claims: http://ec.europa.eu/nuhclaims Anything authorised is of course fine, anything that hasn't been is not. I attended a recent ASA online marketing seminar and will now be writing about that in the December newsletter when we will be doing a feature on Regulations to co-incide with the updated EU Claims Regulations. As ever, if there is anything you want to know or still don’t understand please email [email protected] and we will do our best to answer, and to add your questions to the upcoming FAQs item on the site.
MEDIA REGISTER
Finally, we are still looking for anyone who has a client with, or has personal experience of PICA
(the abnormal craving usually seen in pregnancy with a drive to eat items such as coal/chalk etc)
- if you can help then please let me know by emailing: [email protected]
Louise Carder
Head of Communications
Picture below features BANT Volunteer Val Hemmings on stand at the BANT Lounge
Comms Tip of the month
Get on Twitter!
Sign up to Twitter and follow BANT
https://twitter.com/BANTonline
We are following over 150 BANT members and we
have over 50 BANT members following BANT, not
bad after just a couple of weeks. Stick a ‘hashtag’
on your message and let’s try and get trending!!!
Page 8 BANT’s Social Media Information Page
BANT - the seal of excellence for nutrition health professionals
Welcome to BANT's Social Media Information Page. On this page you will find information about LinkedIn, Facebook, Twitter and You Tube. BANT is
utilising these forms of Social Media to not only provide better support to its members, but also to raise the profile of both BANT and Nutritional Therapy
to the general public. www.bant.org.uk/bant/jsp/socialMedia.faces . Get online and start to follow us!
For those of you using Twitter, please add #nutritionaltherapy as a hashtag as much as possible.
LinkedIn is a business orientated social networking site. LinkedIn connects you to your trusted contacts and helps you exchange knowledge,
ideas, and opportunities with a broader network of professionals. BANT have set up a LinkedIn page that will allow anyone to find out more
about BANT, get the latest updates and see which friends and colleagues are also connected to BANT.
As this is a public page, you need to opt to 'follow' BANT. To do this long on to LinkedIn (you will need to create an account if you don't already have
one), click on 'Companies' in the horizontal menu bar then search for 'BANT'. Alternatively, access the BANT group using this link:
www.linkedin.com/company/british-association-for-applied-nutrition-and-nutritional-therapy. Once you reach this page, click the 'Follow Company' button.
LinkedIn Groups
In addition to the BANT page, a members only group has been set up to create a forum between BANT members. Once you have joined the
group you can start a conversation about a particular topic and receive advice from other members or BANT itself. You can contribute as much
as you want and it is a good idea to keep checking in to read the latest updates. As a member of the BANT LinkedIn group, you are automatically sent
an email containing the popular discussions taking place in the group.
As this is a closed group, you need to request to join. To do this log on to LinkedIn (you will need to create an account if you don't already have one),
click on 'groups' in the horizontal menu bar then search for 'BANT'. Alternatively, access the BANT group using this link:
www.linkedin.com/groups/BANT-4633986. Once you reach this page, click the 'Join Group' button. Your request will then be received by a moderator
who will confirm that you are a BANT member. Once you have joined the group you can view and contribute to existing discussions or start your own.
BANT also has a Student member LinkedIn site: www.linkedin.com/groups/BANT-Student-Members-Group-4061266
The BANT Student Group on LinkedIn provides a private community (we only allow BANT Student Members and newly qualified practitioners to join)
where we can ask questions, share thoughts and recommendations, and get support from like-minded individuals when we need it. We've discussed
topics as diverse as recommendations for good textbooks, where's the evidence for health claims for rapeseed oil, and recommendations for good CPD
events based on our experiences. To join the group please apply via LinkedIn. You can find the group by searching for BANT Student Members Group.
If you have any questions about the group please email Ann, the regional co-ordinator for student members, at [email protected]
Facebook's 'mission is to give people the power to share and make the world more open and connected'. Millions of people around the world
use Facebook to stay connected with friends, clients, share photos, links, videos and find out more about people and companies.
The BANT Facebook page is viewable by the public (unlike the LinkedIn group which is for members only). To follow BANT on Facebook, log in with
your Facebook account and search for 'BANT Online' and click on the listing. Alternatively go to: www.facebook.com/BANTonline.
Once you find our page, click 'Like' to see BANT updates in your news feed and tell us what you think by clicking on our posts, entering text in the
comments box and pressing Enter.
Twitter is a micro-blogging and social networking site, which allows its users to send and read other users' messages called tweets. A Tweet
is a text-based post of up to 140. To find us on Twitter, all you need to use Twitter is an internet connection or a mobile phone. When you
create an account, you can search for BANTonline, click on the BANT logo on the left hand column under 'People' and click 'Follow'. Alternatively go to:
https://twitter.com/BANTonline By 'following' BANTOnline or anyone else, you are subscribing to their Twitter updates, so ever time they 'tweet' it will
appear on your Twitter home page. Once you start following BANT you can join a discussion by re-tweeting orreplying.
Hashtag # - Hashtagged words that become very popular often 'Trend' as topics, which means they are widely read. Users use the hashtag symbol
before a key word or phrase to draw attention to their tweet.
YouTube
YouTube is a video-sharing website, on which users can upload, view and share videos. This site uses Adobe Flash Video and HTML5
technology to display a wide variety of user-generated video content, including movie clips, TV clips, and music videos, as well as amateur
content such as video blogging and short original videos.
BANT will be adding short video messages for members over the coming months. The link you need to use to access the BANT account is:
www.youtube.com/user/BANTNT
Page 9 Regional Co-ordinator Update
BANT - the seal of excellence for nutrition health professionals
Your Chance to be heard as a BANT Member
We are very excited to announce that we developed an evaluation form for BANT members through which you can let us know your positive suggestions
and concerns about your regional meetings and the Regional Co-ordinator in your area.
We feel that by having this evaluation system in place it will ensure the quality you receive as a BANT member but also help set the standards for which
we hope all our Regional Co-ordinators are maintaining.
We welcome your feedback and hope that you will download the evaluation form from the BANT website for your next local meeting. It can be
downloaded here: www.bant.org.uk/bant/jsp/member/pdf/RC_MEETING_EVALUATION_FORM.pdf
New Positions Available in the Regional Co-ordinators Team
We currently have the following positions available. If you are a FULL BANT member you will qualify for this role.
A Regional Co-ordinator for the West Sussex PCT
A Regional Co-ordinator for the Cornwall And Channel Islands PCT
A Regional Co-ordinator for Brighton & Hove
Please email Louise if you are interested in the position (full briefing included) to [email protected]
Student Group
The BANT student group resumes its activities from 19th November, kicking off with an introduction to functional testing webinar run by Nutrition
Geeks. We are also launching a New Practitioners' Group, designed to support those who have just finished their studies and are facing the challenges
of setting up a clinic for the first time. This group kicks off with a presentation from Graham Botfield, on the subject of how to engage with schools.
This year both groups are supported by Nutrition Geeks, who distribute Metametrix functional tests and Designs for Health supplements - see
www.nutritiongeeks.co.uk for more information. They are providing webinar software to enable more people to get involved in more events. Last year
the student group was constrained in what it could do because of the limitations of Skype, and other similar free technologies.
To join either of these groups please email Ann Sinclair, regional co-ordinator for students, on [email protected].
Fourth Quarter RC Conference Calls
Please sign up for the next round of conference calls! Please let us know which call you can make: [email protected]
Monday 19th November 2pm-3pm
Tuesday 20th November 7-8pm
Thursday 29th November 7-8pm
Friday 7th December 12pm-1pm
Moving Abroad & Practicing as a Nutritional Therapist
For those of you who are about to emigrate or are thinking about emigrating outside the UK please contact Nicola Pearson (International RC) for informa-
tion about how to practice in a foreign country and who you need to register with for insurance and what legal requirements you need to fulfil for practicing
as a Nutritional Therapist there. Nicola Pearson can be emailed at: [email protected]
Other & Some Reminders
We would like to encourage Regional Co-ordinators to get regular update for their list of members in their areas, which they over from Mel, as members
join and members leave. Be persistent at keeping BANT members on your overall distribution list unless they tell you to stop of course. This list may be
different from your core group members. Contact Melanie at [email protected].
If you wish to attend any of your regional groups, please have a look at our website to find a BANT co-ordinator in your area:
www.bant.org.uk/bant/jsp/regionalCoordinators.faces
Should you not be able to find a group in your area, please let us know if you either like to become a Regional BANT Co-ordinator yourself or know some-
one in your area who would; contact us [email protected].
Other things you as Regional Co-ordinators can encourage your members to do and some guidelines for RCs:
Remember to log your CPD hours - www.bant.org.uk/bant/jsp/member/memberHome.faces
It is also worth checking out other useful documents including the Regional Co-ordinator Guidance document at:
www.bant.org.uk/bant/jsp/regionalCoordinators.faces.
Louise Jenner-Clarke Ann Sinclair
BANT Regional Co-ordinator Team Leader BANT Student Regional Co-ordinator
Page 10
BANT - the seal of excellence for nutrition health professionals
ANH International Campaign Update Will your food and supplement claims be ‘authorised’ or ‘non-authorised’ after 14th December?
How to find your way around the EU Register of Nutrition and Health Claims.
The date 14th December this year is probably in your calendar, signifying when many ‘general function’ (Article 13(1)) health claims about the benefits of
foods and nutrients will become illegal. These are claims on labels, but also claims in any other medium, including — in law — the spoken word. This is
courtesy of the EU Nutrition and Health Claims Regulation (NHCR): www.anh-europe.org/files/110325_ANH_A5_flyer_4_EU_NHCR_v2.pdf. Of the
claims that have already been evaluated by EFSA www.efsa.europa.eu, the only ones that will be permitted are the 222 that have been specifically
authorised by the European Commission (EC). This has been done via Commission Regulation (EU) 432/2012 http://eur-lex.europa.eu/LexUriServ/
LexUriServ.do?uri=OJ:L:2012:136:0001:0040:en:PDF. Whilst practitioners will still be able to speak and write about the health benefits of food and food
constituents generically, they will be technically breaking the law if they speak or write about a specific commercial product in association with a so-called
‘non-authorised’ health claim.
So how will practitioners know which claims are ‘authorised’ and which are ‘non-authorised’?
The EC has established a website that is referred to as the ‘EU Register of Nutrition and Health Claims’: http://ec.europa.eu/nuhclaims. This includes
nutrition claims as well as health claims, the latter being in one of four categories: general function (Article 13(1)), emerging science (Article 13(5)),
disease risk reduction (Article 14(1)a) and children’s health claims (Article 14(1)b). Authorised claims are very limited in Article 13(5) (e.g. water-soluble
tomato concentrate) and 14(1)a claims over only a narrow range of nutrients (e.g. stanols/sterols and oat beta glucan for cholesterol reduction, xylitol in
chewing gum). In practice, this means that general function claims are by far the most numerous and useful group for practitioners. An example of an
authorised general function claim is: ‘Magnesium contributes to normal muscle function, whilst an example of an non-authorised claim is: ‘Coenzyme Q10
maintains a healthy heart’.
How to use the EU Register of Nutrition and Health Claims
Once on the Register’s homepage http://ec.europa.eu/nuhclaims, click on the blue ‘EU Register of Nutrition and Health Claims’ tab. You will then be
directed to a small ‘Terms and Conditions’ box, which you are required to read before proceeding. This summarises the law with regard to health claims,
so that the reader is in no doubt about what is and is not permitted.
You may then find it helpful to use the register in the following way:
The ‘Claim status’ box: Click on ‘Authorised’ or ‘Non-authorised’ depending on whether you wish to see a list of permitted or non permitted health
claims. Leaving the word ‘Status’ in this box will bring up both Authorised and Non-authorised lists according to the other variables entered in the
other boxes. The ‘Authorised’ claim is all anyone is permitted to say or write about that nutrient or substance. Anything else is illegal, unless it is a
botanical or probiotic that has yet to be evaluated fully by EFSA.
The ‘Type of claim’ box: Click on ‘Art.13(1)’. This will bring up the ‘general function’ claims, which will be of the most relevance to practitioners.
The ‘Legislation’ box: Entering ‘Commission Regulation (EU) 432/2012 of 16/05/2012’ in this box will also bring up the 222 authorised Art.13(1)
general function claims.
The ‘Search’ box: You may use this box to search for individual nutrients or substances, but you may need to check both in the ‘Authorised’ and
‘Non-authorised’ lists. If something does not appear on the ‘Non-authorised’ list it doesn’t follow that it will be on the ‘Authorised’ list. The majority
of ‘botanical claims’ have yet to be evaluated (the vast majority of claims relating to herbs, many phytonutrients, mushrooms, algae and bacteria,
notably probiotics) and do not yet feature on the EU Register. If it has yet to be fully evaluated, transitional measures will apply, which will permit
the claim to be used under transitional measures, assuming the claim was already used before 1 July 2007.
We suggest that practitioners familiarise themselves with this EU Register, and with the 222 currently authorised and non-authorised general function
health claims, especially if you are going to be making claims about products in an environment which may result in your claim being brought to a
regulator’s attention. It is obviously particularly important that websites and printed marketing materials only use authorised and transitional measures
health claims for commercial products. However, we also strongly recommend that product recommendations made to clients/patients should also be free
of non-authorised health claims.
Recent ANH stories of relevance to BANT practitioners:
CAM conference in European Parliament breaks new ground:
http://anh-europe.org/news/cam-conference-in-european-parliament-breaks-new-ground
UK medicines regulator explains ‘Echinacea in kids’ warning:
http://anh-europe.org/news/safety-of-echinacea-products-for-children-uk’s-mhra-responds-to-anh-intl-questions
Is mainstream medicine ready to turn itself on its head?:
http://anh-europe.org/news/anh-feature-is-mainstream-medicine-ready-to-turn-itself-on-
its-head
The WHO’s Health 2020 vision of globalised European healthcare:
http://anh-europe.org/news/the-who’s-health-2020-vision-of-globalised-european-
healthcare
Are you British and happy to have your medical records sold?:
http://anh-europe.org/news/are-you-british-and-happy-to-have-your-medical-records-
sold
Would you consider making a small regular donation?
ANH-Intl is a donation funded not-for-profit organisation. We're currently one of the only
organisations working to future-proof sustainable and natural approaches to healthcare
at a regulatory level. Please help us to help you, by making a small regular donation
[http://anh-europe.org/donate]. Thank you!
Page 11
BANT - the seal of excellence for nutrition health professionals
Recipe of the Month
TERIYAKI SALMON (SERVES 2)
http://www.bbc.co.uk/food/recipes/
teriyakisalmon_66107 by Mike Robinson
Ingredients 2 salmon fillets
4-5 tbsp dark soy sauce
1 limes, zest and juice
1 small chilli
2 tbsp maple syrup
1 fat garlic clove, finely chopped
1 chunk of ginger, finely chopped
1 sheet of egg noodles
bunch of coriander, chopped
1 tbsp sesame oil
extra lime juice
Preparation Method
Heat some olive oil in a pan and fry the ginger, garlic and chopped chilli.
Add the zest and juice of the lime and pour in the soy sauce. Add the maple syrup and cook for 1 minute or until reduced and sticky.
Meanwhile, pan-fry the two pieces of salmon for 2 minutes each side in a hot griddle pan.
When the sauce is reduced add the salmon to the teriyaki sauce frying pan.
Cook and drain the noodles, adding the sesame oil, seasoning and coriander and a squeeze of lime. Serve the salmon on a bed of noodles with
more chopped coriander.
Shopping List
Survey - Calling All Vegetarians School of Psychology, Social Work and Human Sciences
HELLO ALL VEGETARIANS Your diet is generally recognised as being a healthy one that protects against cardiovascular disease, probably due
to reduced saturated fat, lower cholesterol, lower prevalence of obesity and slightly lower blood pressure. However, vegetarian diets are notorious for being deficient in vitamin B12 due to a lack or absence of animal produce, which can elevate homocysteine levels. Homocysteine is a potentially dangerous sulphur containing amino acid that is produced in the human body.
Research strongly shows that elevated homocysteine can increase the risk of developing primary cardiovascular disease due to its apparent destructive affect on the cardiovascular system.
We are recruiting volunteer vegetarians who would be interested in participating in a University of West London PhD related Pilot Study to test the effectiveness of supplementation of vitamin B12 to normalise plasma total homocysteine in those people who may be vitamin B12 deficient. This would also potentially enhance the health benefits of the vegetarian diet. It is not essential for participants to attend the University as homocysteine tests can be conducted by a self-sampling system that is returned to a laboratory by post.
If you would like to know more about this study or be considered for participation, please contact:
Derek Obersby [email protected] 01889 881 014
1 limes, zest and juice
1 small chilli
1 fat garlic clove, finely chopped
1 chunk of ginger, finely chopped
bunch of coriander, chopped
extra lime juice
1 sheet of egg noodles
4-5 tbsp dark soy sauce
2 tbsp maple syrup
1 tbsp sesame oil
2 salmon fillets
Classifieds CHAMPNEYS FOREST MERE, HAMPSHIRE
Freelance Nutritional Therapist Required
Minimum 16 hours p/w (hours to be
agreed)
To carry out nutritional consultations and
food sensitivity tests (own equipment required)
Rates of pay are £20 per hour for
nutritional consultations and £36 per hour
for food sensitivity testing
Please forward your details to: [email protected] For more information, please contact: [email protected]
Page 12 CAM Conferences in Collaboration with BANT
BANT - the seal of excellence for nutrition health professionals
Page 13
BANT - the seal of excellence for nutrition health professionals
Graham Botfield
Christine Bailey
Michaela Jezzard
Charlotte Watts
On behalf of BANT, we would like to congratulate the following BANT members who recently won an award at CAM Awards 2012.
Graham Botfield CAM Awards, sponsored by BioCare® - Outstanding Contribution to the Community Winner Graham had funded and built a not-for-profit business and website ntgraduate.com which he updates and promotes with his own money and own time. The service provides a platform for graduates to access careers in nutrition and source information for clinical and business development. He also offers free mentoring packages for college graduates and free talks around the country. He cited that winning the award would help him further fund and develop future initiatives that he has planned and we’re delighted to help him achieve this. Comment from Graham about the award:
I am hugely honoured to receive this year’s CAM Award for Outstanding Contribution to the
Community. This award gives a huge boost to the project www.ntgraduate.com in providing
significant exposure and credibility. I would like to thank CAM Magazine and Biocare for
organising and sponsoring the Awards and recognising the value of this venture.
Christine Bailey CAM Awards, sponsored by BioCare® - Outstanding Contribution to the Community Highly Commended Well-known lecturer, author and writer, also has successful clinical practice, she has had a major impact on the CAM community, but less well-known is her work for local communities: running cookery days for children in local primary schools, teaching in secondary schools as well as giving talks to local groups on health and nutrition. She runs supermarket store tours for free and writes for local magazines providing free recipes and advice. She is particularly passionate about children and teenage nutrition and supports local athletic groups providing on-going advice and support for clubs and coaches. Comment from Christine about the award:
I am thrilled to be given this CAM Award - I am so passionate about raising awareness of the
importance of nutrition and making healthy, tasty food accessible to everyone. Running
cookery days, talks, health checks, supermarket tours to the local community is just part of
what I do but so rewarding. If we can in particular inspire our children to love healthy, great
tasting food and how good it makes them feel then we can really say we are making an
impact to the next generation.
Michaela Jezzard CAM Awards, sponsored by BioCare® - Student of the Year Winner The judges were blown away by the support for Michaela. A final year graduate at ION, she has been the outstanding student in the year, achieving distinctions in every module and all assignments. Not only that, she has looked after so many other students who were struggling during the year. Her kindness and willingness to devote time to others has been appreciated by so many at ION, so we are delighted that we can reward her hard-work and effort with a CAM Award. Comment from Michaela about the award:
I'm overwhelmed by the fact that so many people have taken the time to write such lovely
things and I'm grateful to all of them. I started this journey looking for answers but found so
much more. I am so inspired by all the tutors and students at ION and all the speakers at the
amazing conferences and seminars I've been to. It is such a supportive community and such
a privilege to be a part of it. It is fantastic to know that what I've done so far has been
appreciated and I hope to contribute more in the future.
Charlotte Watts CAM Awards, sponsored by BioCare®, Outstanding Practice Winner Nutritional therapist and yoga teacher, Charlotte runs clinics, classes and workshops - helping everyone from corporate clients to low-income. She has her own books, media presence and is involved in a funded Case Review project overseen by Dr Richard Fuller, GP, homeopath and research specialist of Southampton University’s Complementary and Integrated Medicine Research Unit. The judges were incredibly impressed with her nomination, citing the fact she has helped literally thousands of people make positive changes with her natural, innate gift for tuning into what motivates them. Comment from Charlotte about the award:
Winning this year's CAM Award for Outstanding Practice is an amazing feeling! I found my
absolute passion when I started down the CAM route many years ago and am very proud to
be part of such a caring, committed and ethical group of people. I know this award will help
my work moving towards integrating CAM disciplines accessibly for all, so we really are
working holistically and for best health for individuals.
Page 14
BANT - the seal of excellence for nutrition health professionals
CAM Magazine Special Offer to members
About the GI Module
The Institute for Functional
Medicine is the world leader
in teaching the principles and
practices of functional
medicine. In April 2013 they
are presenting for the first
time in the UK their
advanced gastro intestinal
practice module. Modern
science has validated what
ancient healing traditions
have known for centuries:
the GI tract has a central role
in chronic, systemic disease.
From intestinal pathogens
and allergens, to intestinal
permeability and imbalances
in colonic microbiota, gut
dysfunction compromises
a patient's health and
diminishes vitality. It is often
the first place to start in
improving overall health.
This Advanced Practice
Module takes a whole-
systems approach to
evaluating and treating not
only local gastrointestinal
disease, but many systemic
diseases that are linked to GI
dysfunction. To learn more
please visit:
www.apm-uk.org
Page 15
Compromised Thyroid and Adrenal Function
- Part 2 Adrenal Function
Jane Nodder
MSc Nut. Med., Dip ION, mBANT, NTCC and CNHC Registered
Catherine Honeywell
BSc (Hons) Food Science, Dip RAW, MBANT, NTCC and CNHC
Registered, Recognised PruHealth Provider
In this second article in our series on thyroid and adrenal function, Jane Nodder and Catherine Honeywell
consider the debate surrounding the concept of adrenal fatigue and explain how nutritional therapists can
support patients with adrenal concerns with safe, effective, evidence-informed nutritional interventions as
part of an integrated approach to care.
The Adrenal Glands
The two adrenal glands are situated in the
abdomen, above the kidneys. They have a high
cholesterol content giving them a yellowish
colour. They are contained within the same
membrane as the kidney but separated from
them by a fibrous layer of tissue.
The right gland is tetrahedral in shape and lies
lower than the left, which is semilunar in shape
and usually the larger of the two. The glands
consist of:
an outer cortex which has three distinct zones: the zona glomerulosa, the zona fasciculata and the zona reticularis and
an inner medulla which consists of a mass of neurons that form part of the sympathetic branch of the autonomic nervous system. These neurons
release neurotransmitters into the blood rather than at a synapse, making the adrenal medulla part of the endocrine, as opposed to the nervous,
system.
Adrenal Hormones
The adrenal glands secrete over 50
regulatory hormones and chemical
messengers in total (see Table 1).
These help to control:
energy production, via the
conversion of carbohydrate,
protein and fat to blood glucose
fluid and electrolyte balance in
cells, interstitial fluid and the
blood stream
fat storage
production of sex hormones,
particularly post-menopause in
women
Table 1 Continue on the Next Page
Featured Article - Compromised Thyroid and Adrenal Function
BANT - the seal of excellence for nutrition health professionals
Jane Nodder Catherine Honeywell
Table 1: The Main Adrenal Hormones Adrenal Cortex (3 Zones)
Zone Main Hormones Main Functions
Zona glomerulosa Aldosterone Mineralocorticoid that principally maintains blood pressure by regulating sodium, potassium and fluid volume.
Zona fasciculata Cortisol under the influence of adrenocorticotropin (ACTH)
Glucocorticoid that regulates a wide range of effects in tissues and organs. In particular, mobilises and forms glucose from proteins and fats and maintains vascular tone to regulate blood pressure (BP).
Zona reticularis Progesterone, oestrogen precursors and androgens - dehydroepiandros-terone (DHEA), dehydroepiandros-terone sulphate (DHEA(s)) & an-drostenedione
Sex hormones that support the development of sexual characteristics. DHEA is also involved in the metabolism of protein, carbohydrates and fats, blood sugar control and the regulation of body weight, BP and immune function. Low levels of DHEA(s) are an indicator of adrenal fatigue.
Page 16
Table 1: The Main Adrenal Hormones - Continued
Cortisol – The ‘master’ stress hormone
Cortisol is a particularly important glucocorticoid (steroid) and
one of the primary stress hormones. Production is stimulated
within the hypothalamic-pituitary-adrenal (HPA) axis.
Cortisol acts on many tissues and organs with a wide range
of effects:
increases blood sugar through gluconeogenesis
breaks down tissue such as muscle, skin and bone to
release amino acids, some of which can also be used to
produce more glucose.
breaks down fat into fatty acids and glycerol
modulates the immune system. Cortisol is released in
response to infection or injury. Excess cortisol causes
decreased white blood cell production and activity
resulting in an impaired ability to fight infection and heal
wounds
acts like aldosterone, which has the effect of raising blood pressure by the constriction of small arteries and the retention of fluid by the kidney. This
effect is limited however by the inactivation of cortisol to inactive cortisone by the 11 beta hydroxysteroid dehydrogenase .
controls the body’s response to stress by increasing blood sugar, mobilising fats and proteins for secondary energy, modifying heartbeat, blood
pressure, brain function and responses In both the nervous and immune systems.
The amount of cortisol circulating at any particular time is regulated by a negative feedback system involving the hypothalamus, the pituitary and the
adrenal glands (the HPA axis) and ACTH. Cortisol levels follow a daily pattern (or circadian rhythm) in which cortisol concentrations are at their lowest
between midnight and 4am, rise to a peak between 6am and 8am and fall throughout the rest of the day. Under ideal conditions, cortisol levels should be
neither consistently high nor low, but should fluctuate in a fairly rhythmic pattern. A cortisol rhythm that is keeping balance, adjusting to BOTH stress and
relaxation is most desirable and considered a healthy response (Wilson 2001). The circadian rhythm of cortisol production is frequently disrupted in
adrenal fatigue.
Aldosterone and cortisol also need to be in balance for good health. A high aldosterone:cortisol ratio can lead to inflammatory conditions e.g. gastritis,
colitis, arthritis, sinusitis. A high cortisol:aldosterone ratio may result in conditions such as diabetes, immune-deficiency syndrome, infection, arterio- and
atherosclerosis, cataracts, glaucoma and cardiovascular disease.
DHEA - dehydroepiandrosterone
Under stress dehydroepiandrosterone (DHEA) is produced from dehydro-epiandrosterone sulfate (DHEA-S) in the zona reticularis of the adrenal cortex
and in the liver. Serum concentrations of these two hormones gradually decrease from age 30, indicating that levels may be markers for the effect of
stress on the endocrine function. Adults with adrenal insufficiency often have low levels of both DHEA and DHEA-S and levels may also be low in
adrenal fatigue (Wilson 2001).
Disorders of the Adrenal Glands
Disorders of the adrenal glands interfere with the normal functioning of the glands (Merck 2007) and are related to:
Featured Article - Compromised Thyroid and Adrenal Function
BANT - the seal of excellence for nutrition health professionals
Adrenal Medulla
Main Hormones Main Functions
Catecholamines - adrenaline and noradrenaline Non-steroid hormones that act on a wide range of tissues to manage heart rate and BP, gut motility, pupil and airway dilation and the break down of glycogen and fatty acids.
Adrenomedullin Regulatory peptide required for the vascular, endocrine, kidney and nervous systems and for growth and development. It may also control activity in the adrenal cortex.
Source : Biochemical Imbalances in Disease: A Practitioner's Handbook 2010
Page 17 Featured Article - Compromised Thyroid and Adrenal Function
BANT - the seal of excellence for nutrition health professionals
adrenal hyperfunction characterised by a chronic increase in the production of cortisol usually due to Cushing’s Syndrome a condition that affects
just five in one million people in the UK (www.nhs.uk/conditions/Addisons). Women are five times more likely to develop Cushing’s Syndrome
than men with most cases affecting people in the 25-40 year age group .
adrenal hypofunction or insufficiency characterised by a reduction in the production of adrenal hormones, particularly cortisol, due to Addison’s
disease a rare condition which affects around 4 people in every 100,000 in the UK across all age groups and both genders
(www.nhs.uk/conditions/Addisons).
Adrenal Fatigue
Cushing’s Syndrome and Addison’s disease are rare and challenging to diagnose and can be life threatening if left untreated. The disorders are usually
managed in primary and secondary care. Patients who present to functional medicine and complementary health practitioners with a range of signs and
symptoms that can be managed by supporting adrenal function.More commonly Adrenal fatigue characterised by less acute variations in hormone output.
Although adrenal fatigue does not constitute an accepted medical diagnosis and is not recognised by most medical practitioners.
Adrenal Gland Dysfunction
Adrenal fatigue is typically related to a maladaptation to stress as first described by Hans Selye in the General Adaptation Syndrome (GAS) theory (Selye
1956). Selye outlined the body’s response to short and long term stressors (Selye 1979) and identified a number of key stages in the stress response.
For many years, the GAS theory has provided a useful model of stress-induced illness offering clinicians some insight into how to manage stress-related
conditions in their patients.
Adrenal Fatigue
Although well recognized in some parts of the world, the term ‘adrenal
fatigue’ is not an accepted medical diagnosis since the concept of low
adrenal function is usually limited to Addison’s disease. In addition,
there is scepticism about it within conventional medical circles in both
the UK and the US. Nevertheless, the term is used by functional and
complementary medicine practitioners to describe ‘sub-optimal or low
adrenal function characterised by a poor response to any kind of
intermittent or sporadic stressor’ (Heim, Ehlert and Hellhammer 2000).
The hypothesis behind adrenal fatigue is that the adrenal glands fail to
produce a normal quantity of the stress hormones adrenaline,
noradrenaline, cortisol and DHEA leaving an individual less able to
cope with stressful situations. A reduction in adrenal function is often
accompanied by an autoimmune inflammatory response that results in
a range of nonspecific signs and symptoms, such as aches and pains,
fatigue, low mood, nervousness, sleep disturbances and digestive
problems that can be managed by supporting adrenal function (Wilson
2001). Adrenal fatigue should not be confused with medical conditions such as adrenal failure, adrenal insufficiency or Addison’s itself where the adrenal
glands are not functioning.
Table 2: Adrenal Hormone Patterns in the different stages of stress
Stage of Stress Pattern of Adrenal Hormones
Stage 1 – Acute or alarm
Stage 2 – Resistance /adaptation
Stage 3 – Exhaustion
Normal ‘fight or flight’ response to short terms stress. Levels of adrenaline,
cortisol and DHEA rise and then return to normal once the stressor is
removed.
State of adrenal overstimulation. Cortisol levels continue to rise at the
expense of DHEA which initially stay stable (early compensation response)
and then starts to drop (late compensation stage).
Later phase of the compensation response in which falling levels of DHEA
are followed by a subsequent drop in cortisol levels.
Source : Biochemical Imbalances in Disease: A Practitioner's Handbook 2010
Page 18 Featured Article - Compromised Thyroid and Adrenal Function
BANT - the seal of excellence for nutrition health professionals
Adrenal fatigue may be implicated in other chronic conditions such as depression, other mood disorders, chronic fatigue and fibromyalgia. It is therefore
very important to ensure that an individual who presents with non-specific symptoms is referred to their medical practitioner for further investigation.
Most GPs will not pursue an adrenal-related diagnosis when a patient complains of fatigue on the grounds that if the adrenals have no major damage,
then they are fine. Consequently adrenal fatigue is often diagnosed as fibromyalgia or chronic fatigue syndrome or a mood or sleep disorder. Part of the
issue may lie in the conventional approach to testing for adrenal function. Current tests for adrenal dysfunction are very good for detecting the furthest
extremes of adrenal imbalance: Cushing’s syndrome at one end of the spectrum and Addison’s disease at the other. They do not detect reduced adrenal
function that falls between these two disease states as a ‘subclinical’ manifestation. As a result, any degree of adrenal imbalance that isn’t Cushing’s or
Addison’s falls ‘within normal limits’.
This is unfortunate as many patients certainly suffer debilitating symptoms of adrenal imbalance that seriously compromise their quality of life.
Overwhelming fatigue, inability to cope with stress, sleep disturbances, light-headedness, recurrent infections, ‘fuzzy’ thinking, low libido, marked
irritability, and many other symptoms can and do arise even when the results of conventional tests appear normal. A patient may feel unwell and know
something is not right, yet conventional health care practitioners can find nothing medically wrong.
When conventional lab results appear normal, many healthcare practitioners move on to other possible diagnoses, missing an opportunity to deal with the
underlying causes of adrenal imbalance. As a result, some patients may progress to diseased states, others may remain in limbo, and still others will
continue to decline slowly. But all are left wondering might be wrong with them!
Development of Adrenal Fatigue
A number of factors may contribute to the development of the various stages of adrenal fatigue including:
1. genetics and congenital weakness
2. nutritional deficiencies due to an inadequate diet or poor digestion, absorption and elimination. The production of stress hormones requires a
number of important co-factors nutrients particularly magnesium, vitamins B1, B2 and B5 and Vitamin C. These nutrients, in particular the B
vitamins, are also required for energy production (DoH 1991). Stress hormones also influence levels of sodium, potassium and calcium which
may impact on liver and kidney function (Wilson 2001)
3. physical stimulants such as alcohol, caffeine, medical or recreational drugs or a high glycaemic load shift the HPA axis towards sympathetic
overactivity with increases in cortisol, ACTH and noradrenaline (Tentolouris et al. 2003; Vicennati et al. 2002).
4. emotional or psychological stress which constantly provokes the production of adrenal hormones in the fight or flight response
5. food allergies/intolerances and infections. Most allergic responses and infections involve the release of histamine and other pro-inflammatory
mediators. Cortisol is an anti-inflammatory hormone that mediates histamine release and inflammatory reactions. However, the more
histamine is released, the more cortisol must be produced from the adrenal glands to control the inflammatory response. As this vicious cycle
continues, histamine contributes even more to an inflammatory state.
6. presence of toxic substances, e.g. pollution, chemicals and pesticides, food additives and preservatives, heavy metals, dusts, moulds and
pollens, may result in allergic reactions. These reactions can be controlled with steroid drugs, but such treatment may in itself create further
hormone imbalance.
Signs and Symptoms of Adrenal Fatigue
The many possible signs and symptoms of the different stages of adrenal fatigue can affect all systems in the body and can vary from mild to extreme.
Many of the symptoms also overlap with the symptoms of hypothyroidism since the adrenal and thyroid glands work together to maintain metabolism.
Common signs and symptoms are outlined in Table 3.
Table 3: Signs & Symptoms of Adrenal Imbalance
Fatigue Poor circulation Allergies
Decreased tolerance to cold Low blood sugar General depression & anxiety
Subnormal body temperature Hypotension Poor exercise tolerance
Poor response to thyroxine Joint aches and pains Low levels of hydrochloric acid
Tendency to constipation Muscle weakness Need for excessive sleep
Prolonged or slow Achilles reflex Salt cravings Lowered resistance to infection
Skin pigmentation Loss of body hair Unstable papillary reflex
Page 19 Featured Article - Compromised Thyroid and Adrenal Function
BANT - the seal of excellence for nutrition health professionals
Effects of Adrenal Fatigue Over Time
The main effect of adrenal fatigue over time is to disrupt the individual’s capacity to produce adrenaline, DHEA and cortisol. The initial impact of this
disruption is often on energy levels as cortisol and DHEA are required to keep blood sugar at adequate levels to meet energy needs. Although each
individual will have their own pattern (Wilson 2001), a typical daily energy pattern in adrenal fatigue would be:
1. morning fatigue – with particular difficulty waking early in the morning
2. improvement after midday
3. afternoon low (2-4pm)
4. improvement after 6pm
5. second wind late at night (after 11pm).
Chronically elevated cortisol and catecholamine levels lead to immunosuppression and decreased cellular immunity (McEwen 1998). High levels of
cortisol also affect the consistency of the gastrointestinal mucosal barrier and reduce the production of white blood cells (e.g. SIgA) and antibodies which
help to fight infection and allergic responses (Wilson 2001). Pathogens can therefore establish themselves more easily affecting the structural integrity of
the gut wall, increasing the risk of intestinal permeability and upsetting the balance of beneficial and less beneficial bacteria in the intestine. Intestinal
permeability and gut dysbiosis can reduce the liver’s capacity to detoxify and break down spent hormones leading to further imbalance. Treatment of any
stress and immune symptoms with drugs e.g. anti-depressants, analgesics, sedatives, antihistamines, bronchial dilators etc. can further disrupt adrenal,
digestive and liver function. Individuals in this vicious cycle may need a period of recovery to restore adrenal function, or risk serious illness and a forced
period of recovery (Baschetti 2001; Racciatti et al. 2001).
During long-term stress, the parasympathetic nervous system will be dominant in an attempt to slow the body down (Tsigos and Chrousos 2002). This
may partly account for the mental health symptoms that patients with adrenal fatigue may describe. Symptoms of depression have been linked to a
pattern of elevated morning cortisol and decreased DHEA production (Plotsky, Owens and Nemeroff 1998; Portella et al. 2005; Tafet and Smolovich
2004). In animals, sustained stress reduces serotonin turnover and the response of the 5-HT1A receptor system which is involved in depression and
other mental health conditions (van Praag 2004). The production of serotonin is also inhibited by depletion of B vitamins (especially pyridoxine and
biotin), and magnesium, nutrients that are also important for the adrenal cascade. Symptoms of low serotonin status may include depression, anxiety,
low energy, poor concentration, insomnia and food cravings (Birdsall 1998).
Insulin, cortisol and adrenaline also interact in an immediate and direct feedback system to influence sex hormone production (Hyman 2005 cited in
Jones and Quinn 2005 p357). Elevated adrenaline may depress production of oestradiol in the ovaries, while high cortisol levels decrease the effects of
oestrogen centrally as well as peripherally (Hays 2005 cited in Jones and Quinn 2005 p229). In addition, although sex hormones are primarily produced
in the ovaries and testes, some production takes place in the zona reticularis of the adrenal glands using the precursor pregnenolone. Sex hormones are
also produced via the peripheral conversion of DHEA particularly after menopause or gynaecological surgery. Disruption in adrenal function can lead to
disturbances in sex hormone and DHEA production which may result in symptoms ranging from menstrual and menopausal irregularities in women, to
infertility in both sexes (Wilson 2001).
Adrenal Hormone Testing
Blood Tests
Blood tests can be used to measure circulating hormone levels related to adrenal function. However, because of the wide variation in what is considered
to be normal levels, many symptomatic patients may not show irregularities, since in most cases of adrenal fatigue, the cause is a functional lack of
reserve, as opposed to outright Addison’s Disease.
Nevertheless, routine blood screening may be useful to identify other markers e.g.
sodium and potassium levels
glucose status
elevated blood urea nitrogen (BUN)
thyroid status
cortisol levels.
Urine Tests
Cortisol levels can also be tested by a 24hr urine collection. However the interpretive value of this test can be limited because all the urine for this 24hr
period is collected in one container. It therefore does not include important information about the surges or drops in hormone levels at specific times of
the day which many patients suffering from adrenal fatigue experience. This making it difficult to evaluate any diurnal variation and many tests will look
‘normal’ (Wilson 2001).
Page 20 Featured Article - Compromised Thyroid and Adrenal Function
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Saliva tests
Whilst blood tests measure hormones circulating outside the cells, and
urine measures the ‘spill over’ of hormones out of the blood and into the
urine, saliva indicates the amount of a hormone inside the cells where
hormone reactions take place. As such hormone levels in saliva
represent the amount of ‘unbound’, active hormones delivered to
receptors. The Adrenal Stress Index Profile is a precise non-invasive
salivary assay that can be completed by the patient at home to evaluate
bioactive levels of cortisol and DHEA. Samples are taken at set times
over 24 hours to measure levels of free DHEA and cortisol and the ratio
between the two hormones. The results are shown against a reference
range for normal adrenal function. Levels of DHEA and cortisol are
indicators of an individual’s longer term response to stress that are less
influenced by the daily output of adrenaline released to cope with
short-term stressors. Low DHEA levels indicate that an individual is likely
to experience reduced capacity to endure physiological or psychological
stress. The respective levels of DHEA and cortisol, and the relationship
between the two, indicate where an individual is in the stress cycle.
ACTH Challenge Tests
The ACTH stimulation test (also called the cosyntropin test, tetracosactide test or Synacthen test) is recognized as the main gold standard test for
endocrinologists to diagnose or exclude primary and secondary adrenal insufficiency, Addison's disease and related conditions such as pituitary
impairment (Dorin et al. 2003). The test measures the adrenal response to adrenocorticotropic hormone (ACTH) which is produced in the pituitary gland
and stimulates the adrenals to release cortisol, dehydroepiandrosterone (DHEAS) and aldosterone. It can distinguish whether the underlying cause of
adrenal insufficiency is adrenal (low cortisol and aldosterone production) or pituitary (low ACTH production) (Dorin et al. 2003). The test is extremely
sensitive (97% at 95% specificity) to primary adrenal insufficiency, but less so to secondary adrenal insufficiency (57-61% at 95% specificity).
Conventional treatment approaches for adrenal conditions
Nutritional Therapists should understand the standard treatment approaches for adrenal conditions as patients often have many questions and issues in
this area. Endogenous Cushing’s syndrome is usually managed in primary/secondary care by cortisol-inhibiting medication, surgery and/or radiotherapy.
Addison’s disease is generally managed by oral corticosteroid (steroid) and mineralocorticoid replacement therapy for life.
Further details of conventional approaches to managing these conditions can be found through resources such as NHS Choices and websites such as
Patient.co.uk plus various patient support organisations (see references and resources).
Adrenal Fatigue & Related Health Conditions
Like the thyroid, the adrenal glands play such a central role in overall metabolic function. It is therefore important to consider and address all the other
possible biochemical balances that may be present in the individual when working to balance adrenal function, e.g. balance of sex hormones, essential
fatty acid status, presence of gut dysbiosis and/or intestinal permeability, food intolerances, poor absorption and detoxification.
Links between adrenal fatigue and thyroid function
There are many important ways in which thyroid and adrenal function are linked. Both too much and too little cortisol can affect thyroid function. A
certain level of cortisol is required for the peripheral conversion of T4 to T3 in the liver and kidneys and for thyroid hormone uptake into cells. In adrenal
fatigue, supplies of cortisol may be depleted (Pizzorno and Ferril 2005 cited in Jones and Quinn, 2005 p645). Individuals may therefore produce sufficient
T4 but be functionally deficient in thyroid hormone (Pizzorno & Ferril 2005 cited in Jones and Quinn, 2005 p644).
Elevated levels of cortisol suppress the release of TSH and blunt the response of TSH to TRH (Kelly 2000). Where inflammation is present, cytokines
can bind to thyroid peroxidase, thyroglobulin and TSH receptors reducing the production of T4, inhibiting the conversion of T4 to T3 and again increasing
the production of rT3 at the expense of T3 (Pizzorno and Ferril 2005 cited in Jones and Quinn, 2005 p645; Vantyghem, Ghularn and Hober 1998). The
stress response also results in an increase in levels of lipo-protein lipase and free fatty acids (FFAs), and FFAs may displace thyroid hormone from its
carrier (Pizzorno and Ferril 2005 cited in Jones and Quinn, 2005 p645). Elevated cortisol levels suppress immune function and may be linked to
conditions such as thyroiditis and Graves’ disease due to a possible increase in the production of thyroid antibodies (Arem 1999).
Adrenaline and thyroid hormones stimulate cardiac function (Carvalho-Bianco et al 2004; Zhong and Dorian 2005). When adrenaline is chronically
elevated, T4 output may fall to reduce the negative effects on the cardiovascular system. This may lead to modest elevation in TSH with symptoms of
hypothyroidism. Adding thyroxine does not improve the situation as the requirement is to balance adrenal function. High levels of adrenaline also inhibit
the function of T3 at receptor level (Hays 2005 cited in Jones and Quinn, 2005 p229).
Adrenal fatigue can be part of the aetiology of hypothyroidism or it can be concurrent. Either way, it is vital to support adrenal and thyroid function
Page 21 Featured Article - Compromised Thyroid and Adrenal Function
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together. In some cases, it may be necessary to support adrenal function before addressing thyroid function depending on the patient’s presentation
(sub-clinical hypothyroidism v overt hypothyroidism). As the adrenal function improves, patients experience rising body temperature, increased energy,
reduced need for medication and improved weight control.
Nutritional Support for the Modulation of Adrenal Function
Dietary Interventions - eating well and eating on time
When addressing imbalances in adrenal function through nutritional approaches, it is usually necessary to support both the thyroid and adrenal glands
together through one overall dietary protocol, tailored to the needs of each individual. As with thyroid function, the main aims for the nutritional
management of adrenal function are to:
provide adequate precursors for the production, transport and tissue receptor uptake of adrenal hormones
support the immune system to reduce the potential for the development of autoimmune conditions
support hepatic and intestinal detoxification and elimination.
To re-establish balance, the diet should provide macro- and micronutrients for blood sugar control, hormone production, immune support, digestion, ab-
sorption, detoxification and elimination. Blood sugar control is central to the dietary protocol since patients with adrenal fatigue often struggle to balance
their blood sugar levels where their cortisol output is below normal. It is therefore important for patients to eat nutrient-dense foods at frequent, regular
intervals.
Please refer to article one in this series (BANT Newsletter July 2012) for further information on dietary approaches for supporting adrenal function.
www.bant.org.uk/bant/jsp/member/pdf/eNewsletter/BANT_ENEWS_JUL2012_ISSUE_38.pdf
utritional Supplements for Adrenal Function – Use and Cautions
As with thyroid function, it is equally important to maximise dietary changes to improve nutritional status, digestion, detoxification and elimination in
support of the adrenal glands before considering the use of any dietary supplements. This is particularly the case where individuals may be in an
advanced stage of the stress cycle and where digestion and detoxification may be considerably compromised. Any supplement programme should
always be managed in collaboration with the patient’s medical practitioner. Nutrients to consider for supporting adrenal function include those listed
below.
B Vitamins: The entire B-complex is needed in small amounts throughout the adrenal cascade. Useful food sources of B vitamins include whole grains,
cereals, Brewer’s yeast, almonds, miso, liver, milk, fish, sprouts and green leafy vegetables.
Vitamin B1 (thiamine) is an essential cofactor for the production of adrenal hormones, for glucose metabolism and for mental health. (Dunne 2002,
Roberts 2001, Murray 1996)
Experimental and clinical trials have shown that thiamine effectively protects the adrenal gland before and after surgery. Injection of 120mg/day of
thiamine several days prior to, and within two hours of, surgery reduced the cortisol reaction both before and at the height of the surgery. Continued
administration of thiamine post-surgery prevented the normal post-surgery reduction in blood cortisol levels. (Vinogradov et al. 1981).
Vitamin B5 (pantothenic acid) plays an important role in overall adrenal cortex function (Dunne 2002) and cellular metabolism particularly with regard to
the conversion of glucose to energy, the synthesis of coenzyme A (CoA) and the production of cortisone. CoA is needed to convert choline into
acetylcholine, an important neurotransmitter involved with neuromuscular reactions, attention, memory and learning (Murray 1996, Wisneski, 2000).
There is correlation between pantothenic acid tissue levels and function of the adrenal gland. (Dunne 2002, Kelly 1999).
Vitamin B6 is also an essential cofactor in the production of adrenal hormones. It plays a critical role in brain function and is important for the
manufacture of all amino acid neurotransmitters required for optimal function of the nervous system and for cognitive performance (Braun & Cohen 2005,
Murray 1996). Vitamin B6 may also increase the intracellular concentration of zinc (see below) and is required with zinc for protein metabolism. (Murray
1996).
Vitamin C (ascorbic acid) is especially concentrated in the adrenal glands where it is required, with magnesium and pantothenic acid (B5) (Lukaski 2000)
for the production of cortisol and all of the adrenal hormones in both the adrenal cortex and the medulla (Patak et al. 2004). High cortisol production
depletes vitamin C from the adrenal cortex. Vitamin C is also required for neurotransmitter synthesis particularly the hydroxylation of tryptophan to
serotonin (Braun & Cohen 2005) and may act as an antioxidant in the adrenals themselves (Peters et al. 2001). Intake of vitamin C should always be
increased and decreased with caution particularly if the patient is on anti-coagulant medication.
Vitamin E is indirectly essential in key enzymatic reactions in the adrenal cascade. With vitamin C, it also helps to neutralize free radicals produced in
the manufacture of adrenal hormones. Food sources of vitamin E include nuts and seeds, almonds, olive oil, green, leafy vegetables, peanuts and whole
grains. Mixed tocopherols are the most useful supplement form. Vitamin E should not be supplemented with anti-coagulant medication.
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Magnesium is used in many enzyme reactions in the body and in the metabolism of carbohydrates, fats and proteins. It is required with vitamin C and
pantothenic acid to support adrenal function (Lukaski 2000). Magnesium is also important for glucose homeostasis (Paolisso and Barbagallo 1997;
Rosolova, Mayer and Reaven 1997). Useful food sources of magnesium include brown rice, beans, nuts, seeds and sea vegetables.
Zinc is easily depleted by factors such as illness increased thyroid activity, hyperadrenal function, medication and toxic metal accumulation resulting in
reduced immunity and increases in opportunistic infections (Braun & Cohen 2005, Kelly 1999). Zinc is also essential for genetic expression, for the
synthesis of thyrotropin releasing hormone (TRH) and for the conversion of T4 to T3.
L-tyrosine, phosphatidyl serine or precursors may reduce high cortisol levels. Supplements should be used in conjunction with test results to ensure
that low levels of cortisol (e.g. in the exhaustion phase of stress) are not further reduced. Supplements should be taken at the meal preceding the high
point of cortisol production. Note that tyrosine may potentiate thyroid replacement hormone (van Spronsen et al. 2001).
DHEA
DHEA is frequently presented as something of a ‘wonder hormone’ for a wide range of conditions and scenarios linked to ageing and there is increasing
public enthusiasm for purchasing DHEA via the internet for self-administration. However, very few clinical trials have been done on the safety of the
long-term use of DHEA. Arlt et al. (1999) did demonstrate that DHEA replacement in women with adrenal insufficiency had some positive effects for
depression, anxiety, general well-being, cholesterol status and the physical aspects of sexuality. However, since DHEA is a precursor to androgens,
many women and particularly those who may be hyperandrogenic, may not do so well with DHEA unless their adrenal fatigue is considerable (Wilson
2001). In the UK, only a qualified medical practitioner may prescribe or administer hormones.
Adrenal glandulars/adrenal cortical extracts
These are liquid or powder extracts of the adrenal cortex usually from bovine adrenal glands. They can support normal adrenal function by providing
essential constituents for adrenal function (e.g. nucleic acids, concentrated nutrients, tiny amounts of adrenal hormones). However, the evidence for
their use is complex and controversial and this issue will be the subject of a further BANT Newsletter article to be published in May 2013.
Herbal Medicine
A wide range of herbal products, particularly Panax ginseng, rhodiola (Rhodiola rosea) and liquorice root and have been investigated for their role in
supporting adrenal function. Adaptogens are defined as a pharmacological group of herbal preparations that increase tolerance to mental exhaustion
and enhance attention and mental endurance in situations of decreased performance (Panossian and Wikman 2009).
Licorice root contains triterpenes, glycyrrhizic acid and carboxenolone. It can mimic. adrenal corticosteroid activity and increase the half-life of
circulating cortisol. Animal studies have shown that components of licorice can reduce inflammation and counteract some of the adverse immune-
suppressive effects of excess cortisol (Kim et al. 2006). Glycyrrhiza may be most appropriate for cases of inadequate cortisol production that correlate
with the fourth stage of ‘exhaustion’ as described by Seyle (Kelly 1999).
Licorice may deplete potassium and increase sodium levels which can impact any existing heart problems. Always consult a GP before using licorice to
manage a medical condition.
Supplements containng licorice root should always be used in conjunction with the results of an Adrenal Stress Index (ASI) test to ensure that high
cortisol levels are not raised inadvertently increased further.
Zingiber officinale (Ginger root) is an adrenal adaptogen that helps modulate cortisol levels, increase energy, and metabolic rate and stimulate
digestive enzyme secretions for proteins and fatty acids. (Thomsen 2005).
Panax ginseng appears to act mainly on the hypothalamus and the anterior pituitary to have a sparing action on the adrenal cortex particularly in phase
1 (alarm reaction) and phase 2 (resistance phase) of the GAS. It can affect physical performance, cognitive function, alertness, mood, and metabolism
(Mills & Bone 2000). A multivitamin preparation containing ginseng root extract improved subjective parameters in a population exposed to the stress of
high physical and mental activity (Bone 1996).
Rhodiola (Rhodiola rosea)
In their review article, Panossian and Wikman (2009) identified strong scientific evidence for rhodiola rosea extract SHR-5 in improving attention,
cognitive function and mental performance in fatigue and in chronic fatigue syndrome. Rhodiola has also shown encouraging results for the
management of mild to moderate depression, and generalized anxiety. These effects seem to occur via several mechanisms of action associated with
the hypothalamic-pituitary-adrenal axis and the control of key mediators of the stress response and defense mechanism proteins (Panossian et al. 2010).
In their phase III randomised, double-blind, placebo-controlled, clinical study with parallel groups, Olsson et al (2008) identified significant improvement in
a number of parameters in male and female participants with fatigue syndrome who received rhodiola rosea extract SHR-5 compared with the placebo.
The authors concluded that repeated administration of rhodiola rosea extract SHR-5 reduced fatigue and increased mental performance, particularly with
regard to concentration. It also decreased the cortisol response to awakening stress in patients with fatigue syndrome.
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As rhodiola does not appear to have any adverse side effects or interactions with other drugs it may well be helpful for use alongside other medication.
Herbal products should be prescribed by an appropriately qualified practitioner of herbal medicine.
References
Arem, R. (1999) The Thyroid Solution. New York: Ballantine Books.
Arlt, W., Callies, F., van Vlijmen, J.C., Koehler, I., et al. (1999) ‘Dehydroepiandrosterone replacement in women with adrenal insufficiency.’ New England
Journal of Medicine 341, 14, 1013-20.
Baschetti, R. (2001) ‘Chronic fatigue syndrome, decreased exercise capacity, and adrenal insufficiency.’ Archives of Internal Medicine 161, 12, 1558-9.
Birdsall, T.C. (1998) ‘5-Hydroxytryptophan: a clinically-effective serotonin precursor.’ Alternative Medicine Review. 3, 4, 271-80.
Bone, K., (1996) Clinical Applications of Ayurvedic and Chinese Herbs. Phytotherapy Press, Qld Australia.
Bone, K., 2003) A Clinical Guide to Blending Liquid Herbs. Churchill Livingstone, USA.
Braun, L., & Cohen, M. (2005) Herbs and Natural Supplements. Elsevier: Australia Marrickville, NSW.
Carvalho-Bianco, S.D., Kim, B.W., Zhang, J.X., Harney, J.W., et al. (2004) ‘Chronic cardiac-specific thyrotoxicosis increases myocardial beta-adrenergic
responsiveness.’ Molecular Endocrinology 18, 7, 1840-9.
Department of Health. (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects
41. London: TSO.
Deshpande, U.R., et al. (2002) Effect of antioxidants (vitamin C, E and turmeric extract) on methimazole induced hypothyroidism in rats. Indian Journal of
Experimental Biology. 40(6): 735-738.
Dorin, R.I., Qualls, C.R., Crapo, L.M. (2003) Diagnosis of adrenal insufficiency. Anals of Internal Medicine. 139(3):194–204.
Dunne, L.J., (2002) Nutritional Almanac – Fifth Edition. McGraw-Hill. USA: New York.
Hays, B. (2005) ‘Female hormones: the dance of the hormones, part 1.’ In D.S. Jones and S. Quinn (eds) Textbook of Functional Medicine. WA: Gig
Harbour.
Heap, L.C., Peters, T.J., Wessely, S. (1999) ‘Vitamin B status in patients with chronic fatigue syndrome.’ Journal of the Royal Society of Medicine 4, 183
-5.
Heim, C., Ehlert, U., Hellhammer, D.H. (2000) ‘The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders.’
Psychoneuroendocrinology 25, 1, 1-35.
Hyman, M. (2005) ‘Clinical approaches to environmental inputs.’ In D.S. Jones and S. Quinn (eds) Textbook of Functional Medicine. WA: Gig Harbour.
In-Tele-Health. (2007) Vitamin B1 (Monograph from Hyperhealth Pro CD-ROM).
McEwen, B.S. (1998) ‘Protective and damaging effects of stress mediators.’ New England Journal of Medicine 338, 3, 171-9.
Kelly, G.S. (1999). Nutritional and botanical interventions to assist with the adaptation to stress. Alternative Medicine Review. 4(4):249-265.
Kelly, G. (2000) Peripheral metabolism of thyroid hormones: A review.’ Alternative Medicine Review 5, 4, 306-33.
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Kim, J., et al. (2006) Anti-inflammatory effect of roasted licorice extracts on lipopolysaccharide-induced Inflammatory responses in murine macrophages.
Biochemical and Biophysical Research Communications. 345(3):1215-23.
Lukaski, H.C. (2000) ‘Magnesium, zinc, and chromium nutriture and physical activity.’ American Journal of Clinical Nutrition 2 (Suppl), 585S-93S.
Merck Manual. Home Health Handbook. (2007) Overview of the Adrenal Glands: Adrenal Gland Disorders: Merck Manual Home Health Handbook.
http://www.merckmanuals.com [Accessed 15 October 2012]
Mills,S., & Bone, K. (2000). Principles and Practice of Phytotherapy. UK: Churchill Livingstone.
Murray, M.T. (1996) Encyclopedia of Nutritional Supplements. Prima Health.
Nicole, L., & Woodriff Beirne, A. (eds). (2010) Biochemical imbalances in disease: a practitioner’s handbook. London: Sing ing Dragon.
Olsson, E.M., von Schéele, B., Panossian, A.G. (2009) A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract
shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Medica. 75(2):105-12.
Panossian, A., Wikman, G., Sarris, J. (2010) Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy.
Phytomedicine. 17(7):481-93.
Panossian, A., Wikman, G. (2009) Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective
activity. Current Clinical Pharmacology. 4(3):198-219.
Paolisso, G., Barbagallo, M. (1997) ‘Hypertension, diabetes mellitus, and insulin resistance: the role of intracellular magnesium.’ American Journal of
Hypertension 10, 3, 346-55.
Patak, P., Willenberg, H.S., Bornstein, S.R. (2004) Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocrine Research.
30(4):871-5.
Peters, E.M., Anderson, R., Nieman, D.C., Fickl, H., Jogessar, V. (2001) ‘Vitamin C supplementation attenuates the increases in circulating cortisol,
adrenaline and anti-inflammatory polypeptides following ultramarathon running.’ International Journal of Sports Medicine 7, 537-43.
Pizzorno, L. and Ferril, F. (2005) ‘Thyroid.’ In D. S. Jones and S. Quinn (eds) Textbook of Functional Medicine. WA: Gig Harbour.
Plotsky, P.M., Owens, M.J., Nemeroff, C.B. (1998) ‘Psychoneuroendocrinology of depression. Hypothalamic-pituitary-adrenal axis.’ Psychiatric Clinics of
North America 21, 2, 293-307.
Portella, M.J., Harmer, C.J., Flint, J., Cowen, P., Goodwin, G.M. (2005) ‘Enhanced early morning salivary cortisol in neuroticism.’ American Journal of
Psychiatry 162, 4, 807-9.
Racciatti, D., Guagnano, M.T., Vecchiet, J., De Remigis, et al. (2001) ‘Chronic fatigue syndrome: circadian rhythm and hypothalamic-pituitary-adrenal
(HPA) axis impairment.’ International Journal of Imunopathology and Pharmacology 14(1):11-15.
Roberts, A.J., et al. (2001). Nutraceuticals: The Complete Encyclopedia of Supplements, Herbs, Vitamins and Healing Foods. Berkely Publishing Group.
USA: New York.
Rosolova, H., Mayer, O. Jr, Reaven, G.J. (1997) ‘Effect of variations in plasma magnesium concentration on resistance to insulin-mediated glucose
disposal in nondiabetic subjects.’ Journal of Clinical Encocrinology and Metabolism 82, 11, 3783-5.
Selye, H. (1956) The Stress of Life. New York, NY: McGraw-Hill.
Selye, H. (1979) Stress and the reduction of distress. J S C Med Assoc. 75(11):562-6.
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Tafet, G.E., Smolovich, J. (2004) ‘Psychoneuroendocrinological studies on chronic stress and depression.’ Annals of the New York Academy of
Sciences 1032, 276-8.
Tentolouris, N., Tsigos, C., Perea, D., Koukou, E., et al. (2003) Differential effects of high-fat and high-carbohydrate isoenergetic meals on cardiac
autonomic nervous system activity in lean and obese women.’ Metabolism 52, 11, 1426-32.
Thomsen, M. (2005). Phytotherapy Desk Reference (3rd ed.) Self Published).
Tsigos, C., Chrousos, G.P. (2002) ‘Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress.’ Journal of Psychosomatic Research 4, 865-
71.
Van Praag, H.M. (2004) ‘Can stress cause depression?’ Progress in Neuro-Psychopharmacology and Biological Psychiatry 28, 5, 891-907.
Van Spronsen, F.J., van Rijn, M., Bekhof, J. (2001) ‘Phenylketonuria: tyrosine supplementation in phenylalanine-restricted diets.’ American Journal of
Clinical Nutrition 73, 153-7.
Vantyghem, M.C., Ghularn, A., Hober, C. (1998) ‘Urinary cortisol metabolites in the assessment of peripheral thyroid hormone action: overt and
subclinical hypothyroidism.’ Journal of Endocrinological Investigation 21, 219-25.
Vicennati, V., Ceroni, L., Gagliardi, L., Gambineri, A. Pasquali, R. (2002) ‘Response of the hypothalamic-pituitary-adrenocortical axis to high-protein/fat
and high-carbohydrate meals in women with different obesity phenotypes.’ Journal of Clinical Endocrinology & Metabolism 87, 8, 3984-8.
Vinogradov, V.V, et al. (1981) Thiamine prevention of the corticosteroid reaction after surgery. Probl Endokrinol. 27:11-16, 1981.
Wilson, J.L. (2001) Adrenal Fatigue. The 21st Century Stress Syndrome: Petaluma, CA: Smart Publications.
Wisneski, L.A. (2000) The Professional Reference to Conditions, Herbs and Supplements. Integrative Medicine Communications.
Zhong, J.Q., Dorian, P. (2005) ‘Epinephrine and vasopressin during cardiopulmonary resuscitation.’ Resuscitation 66, 3, 263-9.
Useful Websites:
www.adrenalfatigue.org
www.drlam.com - The Adrenal Fatigue Center (Michael Lam)
www.patient.co.uk
www.nhs.co.uk – NHS Choices
www.labrix.secure.force.com/InformationResearch - for information relating to the validity of saliva testing
Patient support organisations:
www.addisons.org.uk
CUSH - http://www.cush.org (USA)
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Activity Details Activity
Org. / Author Type of
CPD Further Information Activity Hours
CPD
cert
NUTRITIONAL BREAKTHROUGHS FOR STRESS WEBINAR Location Not Applicable (Listing Date - 15/03/2012)
NUTRI LTD Self-directed www.nutri.co.uk 0800 212 742 Sarah Gill - BSc (Hons)
DVD / Web-based Me-dia
1.00 Yes
OSTEOARTHRITIS WEBINAR Location Not Applicable (Listing Date - 15/03/2012)
NUTRI LTD Self-directed
www.nutri.co.uk 0800 212 742 Jane Jones - Nutritionist
DVD / Web-based Me-dia
1.00 Yes
STRESS WEBINAR Location Not Applicable (Listing Date - 15/03/2012)
NUTRI LTD Self-directed www.nutri.co.uk 0800 212 742 Chris Perry - Nutritionist
DVD / Web-based Me-dia
1.00 Yes
BIOCARE ME CONFERENCE DVD WITH DR SARAH MYHILL Not Applicable - (Listing Date - 15/10/2012)
BIOCARE Self-directed
£30 Dr Sarah Myhill Anna Duschinsky Tanya Page Helen Lynam Dr Megan Arroll Alessandro Ferretti
DVD / Web-based Me-dia
3.50 Yes
INCORPORATING LIVING FOODS AND ALKALISING INTO NT PRAC-TICE 3 November, 2012 9.30AM-4.30PM Institute for Optimum Nutrition, Avalon House, 72 Lower Mortlake Road, Rich-mond, TW9 2JT T 020 8614 7800 E [email protected] W www.ion.ac.uk/education/
shortcourses/courselist
ION Active
£65 Practitioners £45 Students Gareth Edwards - BSc, Dip ION
BANT Listed Seminar
5.50 Yes
THE EPIGENETIC LIFESTYLE AND THE ROLE OF VITAMIN D IN HEALTH 3 November, 2012 Royal College of Physicians, Regents Park, London NW1 4LE T 01380 814 781 E [email protected]
W www.metabolics.com
METABOLICS Active
£75 Dr William Davey - LVO, MD, LRCR, FFHOM Dr Michael Holick - PhD, MD
BANT Listed Conference
7.00 Yes
THE UK'S MAGNESIUM CRISIS 6 November, 2012 2PM-5.15PM York - The Park Inn Hotel, North Street, York YO1 6JF T 01892 554 358 E [email protected]
W www.lambertshealthcare.co.uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certificate. FREE DVD Pack (Seasonal Affective Dis-orders) when attending the FULL day. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Registered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered
BANT Listed Seminar
3.00 Yes
NUTRITIONAL FOCUS ON GUM & DENTAL HEALTH 6 November, 2012 9.30AM-1PM York - The Park Inn Hotel, North Street, York YO1 6JF T 01892 554 358 E [email protected]
W www.lambertshealthcare.co.uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certificate. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Registered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered Sonia Williams - PhDMDSc, BDS, Hon MFPH, DDPH, Dip ION, MRSS
BANT Listed Seminar
3.00 Yes
Page 27 BANT Listed CPD and Conferences
BANT - the seal of excellence for nutrition health professionals
Activity Details Activity
Org. / Author Type of
CPD Further Information Activity Hours
CPD
cert
INCORPORATING LIVING FOODS AND ALKALISING INTO NT PRAC-TICE 10 November, 2012 9.30AM-4.30PM The Orchard, Town Street, Hors-forth, Leeds LS18 5BL T 020 7223 8865 E [email protected]
W www.food-for-life.co.uk
GARETH ED-WARDS
Active
£65 Practitioners £45 Students Gareth Edwards - BSc, Dip ION
BANT Listed Seminar
5.50 Yes
THE UK'S MAGNESIUM CRISIS 14 November, 2012 2PM-5.15PM Suffolk - The Self Centre, 4 Kempson Way, Bury Saint Ed-munds, Suffolk IP32 7AR T 01892 554 358 E [email protected]
W www.lambertshealthcare.co.uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the semi-nar and BANT certificate. FREE DVD Pack (Seasonal Affective Disorders) when attending the FULL day. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Registered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered
BANT Listed Seminar
3.00 Yes
NUTRITIONAL FOCUS ON GUM & DENTAL HEALTH 14 November, 2012 9.30AM-1PM Suffolk - The Self Centre, 4 Kempson Way, Bury Saint Ed-munds, Suffolk IP32 7AR T 01892 554 358 E [email protected]
W www.lambertshealthcare.co.uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the semi-nar and BANT certificate. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Registered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered Sonia Williams - PhDMDSc, BDS, Hon MFPH, DDPH, Dip ION, MRSS
BANT Listed Seminar
3.00 Yes
FROM AUTISM TO ALZHEIMER'S INTERNATIONAL CONFERENCE - 2 DAY EVENT 17 November, 2012 8AM-5PM The Holiday Inn London Regents Park, Carburton Street, London W1W 5EE E [email protected] W www.londonconference2012.c
om
BIOLAB Active
£200 if booked before 15th October 2012 £250 normal price Student discounts available if the event is not fully booked 14 days prior to 17th November James Greenblatt, MD William Shaw, PhD Stephen Davies, MA, BM, BCh, FACN Kurt Woeller, DO Nicholas Miller, MA, MSc, PhD, CSci, MCB, FRCPath
BANT Listed Conference
12.00 Yes
Page 28 BANT Listed CPD and Conferences
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Activity Details
Activity Org. /
Author Type of
CPD Further Information Activity Hours
CPD
cert
THE UK'S MAGNESIUM CRISIS 20 November, 2012 9.30AM-1PM London - Royal Society of Medi-cine, 1 Wimpole Street, London W1G 0AE T 01892 554 358 E [email protected] W www.lambertshealthcare.co.
uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certifi-cate. FREE DVD Pack (Seasonal Affective Disor-ders) when attending the FULL day. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Regis-tered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered
BANT Listed Seminar
3.00 Yes
NUTRITIONAL FOCUS ON GUM & DENTAL HEALTH 20 November, 2012 2PM-5.15PM London - Royal Society of Medi-cine, 1 Wimpole Street, London W1G 0AE T 01892 554 358 E [email protected] W www.lambertshealthcare.co.
uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certifi-cate. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Regis-tered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered Sonia Williams - PhDMDSc, BDS, Hon MFPH, DDPH, Dip ION, MRSS
BANT Listed Seminar
3.00 Yes
THE UK'S MAGNESIUM CRISIS 21 November, 2012 9.30AM-1PM Southampton - Jurys Inn South-ampton Hotel, Charlotte Place, Southampton, SO14 0TB T 01892 554 358 E [email protected] W www.lambertshealthcare.co.
uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certifi-cate. FREE DVD Pack (Seasonal Affective Disor-ders) when attending the FULL day. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Regis-tered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered
BANT Listed Seminar
3.00 Yes
NUTRITIONAL FOCUS ON GUM & DENTAL HEALTH 21 November, 2012 2PM-5.15PM Southampton - Jurys Inn South-ampton Hotel, Charlotte Place, Southampton, SO14 0TB T 01892 554 358 E [email protected] W www.lambertshealthcare.co.
uk
LAMBERTS Active
£19.99 per person per seminar Delegates receive a £20 product voucher after attendance at the seminar and BANT certifi-cate. Lorraine Nicolle - BA (Hons), DipBCNH, MBANT, MCIM, MSc Shoela Detsios - BSc (Can), ND (Aus) Justine Bold - BA (Hons), DipBCNH, MBANT Lara Just - BSc (Hons) DipCNE, CNHC Regis-tered, MBANT, MANLP Katie Sheen - FdSc, DipION, MBANT, NTCC, CNHC Registered Sonia Williams - PhDMDSc, BDS, Hon MFPH, DDPH, Dip ION, MRSS
BANT Listed Seminar
3.00 Yes
METAMETRIX TRAINING WORKSHOPS 10 December, 2012 London - 14 Basil Street, Knights-bridge, London SW3 1AJ E [email protected]
W www.nutritiongeeks.co.uk
NUTRITION GEEKS Active
£19.50 per session 10% discount on all test ordered by participants on the day Angela Walker - BSc Nut. Med, MBANT, CNHC Registered
BANT Listed Seminar
3.00 Yes