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

bantchair@bant.org.uk

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

theadministrator@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 theadministrator@bant.org.uk. Please email any changes or additions to your profile to the

theadministrator@bant.org.uk 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 webinars@bant.org.uk. 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 webinars@bant.org.uk.

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

theadministrator@bant.org,uk.

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 cpd@bant.org.uk

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 bantpractice@bant.org.uk

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 communications@bant.org.uk

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: communications@bant.org.uk

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 communications@bant.org.uk 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: communications@bant.org.uk

Louise Carder

Head of Communications

communications@bant.org.uk

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

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 students@bant.org.uk

Facebook

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

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 pr-regions@bant.org.uk

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 students@bant.org.uk.

Fourth Quarter RC Conference Calls

Please sign up for the next round of conference calls! Please let us know which call you can make: pr-regions@bant.org.uk

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: nicola@nutrition-within.com

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 theadministrator@bant.org.uk.

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 pr-regions@bant.org.uk.

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

pr-regions@bant.org.uk students@bant.org.uk

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 d.obersby025@btinternet.com 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: jennifer.eagles@champneys.com For more information, please contact: louise.day@champneys.com

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).

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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

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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 monika.tratnik@ion.ac.uk 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 philly@metabolics.co.uk

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 marcelle.salter@lambertshealthcare.co.uk

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 marcelle.salter@lambertshealthcare.co.uk

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

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Org. / Author Type of

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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 Gareth@food-for-life.co.uk

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 marcelle.salter@lambertshealthcare.co.uk

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 marcelle.salter@lambertshealthcare.co.uk

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 conference@biolab.co.uk 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

BANT - the seal of excellence for nutrition health professionals

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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 marcelle.salter@lambertshealthcare.co.uk 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 marcelle.salter@lambertshealthcare.co.uk 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 marcelle.salter@lambertshealthcare.co.uk 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 marcelle.salter@lambertshealthcare.co.uk 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 info@nutritiongeeks.co.uk

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