Studies of identical twins have established that genetics contributes about 30% of disease whilst environmental factors account for the remaining 70%. Environmental factors include toxins, infectious agents, physical trauma, sleep patterns, stress, exercise and diet. Of these diet is by far the biggest environmental factor affecting general health and is also one of the most easily modified. And whilst we manage to avoid traumatic injury and infectious disease through most of our lives no one avoids eating for long.
One of the biggest breakthrough’s in the last two decades has been an understanding of epigenetics – the study of how environmental factors can switch genes on and off. Some of these changes are passed on to offspring, meaning that your parent’s diet influences your health and even the health of your children – which is one of the reasons I ask new patients about their family’s health and diet.
The ability of diet to modify health at the gene expression level is illustrated in the following experiment. Mother lab mice were fed a toxin, bisphenol-A (BPA) which is found in polycarbonate plastics. This induced epigenetic changes in the offspring, making them obese and tending to have a yellow fur colour. This alone is a good example of how environmental factors (toxins) can effect health. What is really interesting is that when the experiment was repeated, but the mother’s diet was supplemented with methyl rich foods (e.g. high in choline, folate & B12) the offspring were more likely to be normal coloured and healthy. In other words the diet was able to undo the damage caused by the BPA toxin.
Quite simple shifts in diet, even in healthy people, can lead to thousands of genes being switched on and off. This new gene expression can alter the risk of disease or the course of an existing condition. For example, scientists at the Norwegian University of Science and Technology found that when carbohydrates exceed 40% of the energy in a diet (i.e. more than 200g of carbs per day) genes promoting metabolic inflammation are activated. The researchers point out that:
“Genes that are involved in type 2 diabetes, cardiovascular disease, Alzheimer’s disease and some forms of cancer respond to diet, and are up-regulated, or activated, by a carbohydrate-rich diet,”
Studies like these make it clear that diet is pivotal in health management – something that most doctors and their patients have yet to appreciate. My job is to stay up to date with the science so that I can provide targeted, evidence based dietary advice for my patients to help them get on top of their health.
The science on nutrition and health is advancing with enormous speed. Keeping up with it all takes a considerable amount of time and energy. I read hundreds of scientific papers each year as well as attending dozens of live and online seminars. One of the reasons I write a nutrition blog is to help me assimilate and link up some of the new information.
There are many popular diets that appear in the newspapers and get celebrity endorsements such as the Paleo, Zone, South Beach or DASH diets. These are often promoted in the media as weight-loss or ‘healthy’ diets and are often over-hyped one month only to be knocked down the next, leaving the public bewildered and sceptical. In my work as a clinician such a superficial understanding has no place and I certainly do not promote any one diet as a the Ideal. People are far too individual for that.
However, what few people realise it that behind the headlines some of these diets or aspects of them, have profound disease altering properties. Here are a few examples:
Based around real foods inc. fruit, vegetables, nuts, fish, olive oil
Improved metabolic and cardiovascular functioning. Associated with extended life. A basic healthy diet for everyone and the starting point for all the other diets below
Very low carbohydrate, very high fat
Neuroprotective. Used to treat intractable epilepsy, brain trauma, neurodegeneration and as an adjunct to cancer therapy. Role in mitochondrial conditions, endurance sports and diabetes.
Can provide some of the benefits of the ketogenic diet but is less restrictive. May be used as a follow-on diet for recovering epileptics and diabetics.
Gluten-free, Grain free, Pulse free
Zero gluten / zero grains of all kinds / zero beans and legumes
Can help in immune and autoimmune conditions which may involve digestive, skin, joints and/or neurological problems
Zero milk products
As for gluten-free. In mild cases switching from cow to goat and sheep products can be enough.
Omega 6/3 balancing
Reduced use of vegetable oils, increased fish, grass-fed meat, flaxseed
Helps in inflammation, reproductive disorders, brain development.
Low pesticide and chemical residue diet
Recommended in all the above diets. Specific in cases where environmental toxins have been identified as problematic
Incorporates many of the above, but carbohydrate levels are more flexible
Elimination diet often starting with bone broth
An approach suitable for autism spectrum and other conditions that involve the gut-brain axis. Also effective in difficult cases of Crohn’s and ulcerative colitis.
No sugar, low carbohydrate. Probiotics and anti-candida herbs
Incorporates many of the above, but carbohydrate levels are more flexible
Despite having their own names these diets are not used in isolation and often a combination of several diets will be necessary. For example a gluten-free diet consisting of gluten-free bread, cakes and biscuits, will have a very different effect to a gluten-free Mediterranean diet based around fresh ingredients.
As well as the named diets above I use foods with specific actions in the following:
Increasing or decreasing intestinal fermentation (e.g. FODMAP, probiotic, prebiotic)
Altering gut permeability
Reducing histamine levels
Increasing antioxidant status
Increasing liver or gall bladder function
Altering methylation pathways and gene expression (epigenetics)
Addressing specific mineral or vitamin imbalances
My dietary recommendations will depend on the individual condition, symptoms and background, and can be informed by lab tests (e.g. genetic testing, organic acid test and food reactivity tests). In some cases lab testing is crucial if dietary changes are to be effective. In some situations nutritional supplements and herbal medicines have a clear role alongside diet.
The term ‘doctor’ originally meant ‘teacher’, and in making dietary recommendations for my patients I spend considerable time explaining the reasons behind the changes. Knowledge, as they say, is power. Empowering patients is what it is all about and is why I run workshops and talks.
My Presentations are thoroughly researched and fully referenced. I cover nutrition, herbal medicine and clinical approaches to specific diseases.
Examples of professional talks, lectures & CPD I have given
Herbal Medicine in Primary Care CMEC St Richard’s Hospital for GPs and Consultants
The Gut and Autoimmune Diseases CMEC St Richard’s Hospital – Talk to GPs and consultants
Metabolic Diseases and Nutrition Medical Herbalists CPD
The HPA Axis and Metabolic Medicine; Why Some People Get Fat HerbFest CPD
Sugar & Fructose Metabolism The Chichester Deanery Group (GPs)
Nutrition for Maternal and Infant Health West Sussex Midwives, Littlehampton
Herbal Medicine and Stress Fibromyalgia, National Conference
Examples of my public talks & seminars
Nutrition from an Evolutionary Perspective Transition Chichester – Public talk HesFes Home Educators Summer Festival – Small group presentation
Traditional Foods; Fermented foods; Grains; Fats; Sugar; Stress; Vitamin D Food and Health Group, Chichester – Series of public talks (see posts here)
Milk – Super food or devil? – including guest speaker Melanie Bibby – A2 milk corporation
The Grass Fed Meat Revolution Public Seminar with guest speakers Lierre Keith, Graham Harvey & Charlie Burrell
Beyond gluten free Food and Health Group, Chichester – Series of public talks 2014
Cholesterol – why it does not and cannot cause heart disease Public seminar featuring Dr Malcolm Kendrick (see video of part of this talk)
Seafood It’s Evolutionary importance and nutritional value (see video here)
Examples of local group talks
Familiar Garden Herbs and their Medical Uses Touch for Health, Amicus, Probus, Havant Health Group, Breakaway
Healthy Aging using Correct Foods and Herbal Medicine Probus, Havant Health Group, Felpham U3A
The Emerging New Consensus on Healthy Eating Small teaching sequence – Private groups
Examples of demonstration workshops
Family cooking for autoimmunity Private patient group
Grain-free cooking Private patient group
Children’s paleo cooking workshop Two families, six kids, lots of fun!
Going deeper into Nutrition (3 sessions) Private study group
Hi Afifah, Thank you very much for another spellbinding talk! I learnt so much – literally food for thought. Thanks for all the effort you put into the research and presentation.
Dear Afifah, What an enlightening evening ! We always learn so much at your talks. I love the thoroughness of your research and the way your conclusions are so irresistably feasible!! I concentrated on every fact ( but can’t remember all if it now! ). It was great and really makes you think- which I like very much …
– Jane and Michael
Hi Afifah, Many congratulations on your talk last Saturday – you certainly excelled yourselves and my 5 pages of notes are testimony to that!!
If you would like me to give a talk for your group please phone me on
The Organic Acid Test is an invaluable means of identifying certain bodily and microbial metabolites from a urine sample as well as break down products of certain vitamins and nutrients. It is a bit like taking your car to the garage, having it put up on the rolling road and having the exhaust materials analysed to work out how the engine is functioning. From a simple urine sample this test identifies 75 different compounds and their origins and interprets them, significantly aiding the clinician in diagnosis and therapeutic approach. These compounds include waste products from your own cellular functions, and from the cells of undesirable microbes that may have taken up residence in a patient, such as yeasts, fungi and bacteria. These microbes produce their own waste products and by identifying them one can obtain great insight into several key areas of health. It also identifies disruptions in the ability to produce certain neurotransmitters such as dopamine, which can guide treatment greatly.
I will often suggest this test in cases of autism and similar conditions in that spectrum, in chronic gut disorders, which often have tenacious yeast infections, or in certain other situations whereby symptoms persist and have not responded to sensible measures already taken. Diagnostic tests of this ilk are extremely useful in my experience.
Autism and similar behavioural dysfunction
Suspected fungal and yeast and bacterial infestation