To practice physiotherapy in Nova Scotia the therapist must have a Bachelor of Science in Physiotherapy and be a member in good standing with the Nova Scotia College of Physiotherapists.

Physiotherapists treat people of all ages and all fitness levels. They are trained to assess musculoskeletal, neurological and cardiopulmonary conditions and together with the patient, develop a treatment plan that meets the specific needs and goals of the patient. The aim of treatment may be as simplistic as to eliminate pain, reduce swelling or restore mobility. In contrast it may be more functional such as a return to a specific sport within a month, climb stairs to a bedroom within 2 weeks or return to work in 3 months.

The assessment is done through thorough history taking and physical evaluation. Examples of treatment include modalities like ultrasound, inferential and moist heat or exercise prescription, manual soft tissue releases, joint mobilization, balance re-education and patient education.

A typical first visit is approximately an hour long. This often, but not always, includes some treatment. The therapist will explain their findings and discuss their recommendations during this first visit. You can expect to attend treatments anywhere from three times per week to once every two weeks. Occasionally the time between visits can be even longer as it is very patient specific. Don’t hesitate to ask questions during this initial visit as the therapist can not possibly anticipate every potential query.

You will find that physiotherapists do not advertise many, if any specialties, but if you call their office and ask, you may find certain therapist have an “interest” in certain conditions. Generally you can assume that their interest is something they feel confident in treating and have had success with in the past. If you find a therapist you like and who was successful in assisting you in your recovery, please tell your friends. Many of us prefer to build our clientèle through “word of mouth” and appreciate the referrals.

Happy National Physiotherapy Month.

What is gluten?

Gluten is a protein found in grains and cereals such as wheat, barley, triticale, rye, etc. It provides elasticity to dough, allowing it to rise and take on its characteristic chewy, soft texture.  It is also added as a thickener to many prepared foods such as imitation meats, sauces and gravies.  Once you start looking for gluten – it’s everywhere!

Types gluten intolerance

1.  Celiac Disease

• Celiac disease is an autoimmune condition, not an allergy or intolerance.  The presence of gluten triggers the production of antibodies resulting in damage to the mucosa of the small intestine.  This can result in loose stool (but not always), weight loss, fatigue and various nutrient deficiencies such as B12 and iron defeciency.  Screening for celiac disease can be done through bloodwork, but can only be diagnosed with a biopsy of the small intestine.
• A new in-office/home test is now available, allowing for more convenient screening.  The Biocard test can be purchased online, or at our office.  During the month of May we will be offering the Biocard test at a reduced rate – $45.
• Gluten avoidance is mandatory for those with celiac disease, otherwise damage will continue to occur. Individuals with celiac disease must avoid all gluten-containing grains such as wheat, barley, rye, spelt and kamut.

2.  Wheat allergy

• Wheat allergy is an IgE bound histamine reaction of the immune system.
• Unlike celiac disease, the reaction is usually only to wheat, so other grains (such as rye and barley) may be ok. Spelt and Kamut should also be avoided though as they are wheat relatives.
• Also unlike celiac diease, allergies are sometimes outgrown, so an allergic child may not become an allergic adult.

3.  Wheat/Gluten Intolerance

• Symptoms of a wheat and/or gluten intolerance can vary quite a bit.  Some people may experience digestive symptoms such as diarrhea, gas or constipation, but others may experience headaches, fatigue, anxiety or depression.
• Unlike celiac and wheat allergy, there is no reliable testing available to detect intolerance.  The gold standard “test” is an elimination diet.  By eliminating all wheat and/or gluten for a minimum of 3 weeks, intolerance can be ruled in or out based on the return of symptoms with a subsequent challenge.  Often times, other foods are eliminated as well and the patient is put on a strict hypoallergenic diet.  While not difficult per se, this diet does require a bit of planning and guidance, which an ND is qualified to provide.

More Information:

• Canadian Celiac Association
• http://www.celiac.com/
• About.Com – Info page on Celiac Disease/Wheat allergy

The goal of any suncreen is to block the sun’s rays (UVA and UVB) from penetrating the skin and causing a sunburn. Simple enough, right?  Well, yes, but along with the active ingredient in the suncreen, you may be getting a whole lot more than you bargained for.

1.  Look for a zinc based suncreen. Zinc based sunscreens sit on top of the skin and don’t penetrate that way that non-zinc based creams do.  The problem is that these “other” types of sunblock may contain parabens, which are known to mimic estrogen.  Examples of zinc-based sunscreens include ‘Green Beaver’, ‘California Baby’, and ‘Badger’.  And, they’re available locally at Nurtured Products for Parenting, which is great.

2. Avoid ‘Retinyl Palmitate’. This Vitamin A derivative may speed the growth of some skin cancers, according to an FDA study.

3.  Avoid ‘Oxybenzone’. This is another ingredient that can mimic estrogen, so best to stay away.

4. More isn’t always better. Many people reach for the highest SPF they can find, but there’s no research to support that using anything beyond SPF 50 is of benefit.  Most people are fine with an SPF of 30, reapplied every 2 hours.

5.  Don’t rely on sunscreen. If you’re going to be outside during the hottest part of the day, stick to shaded areas and cover up.  Long sleeved clothing and hats can go a long way.

6.  Don’t fear the sun. As much as we talk about sun safety, we must remember that the sun is essential to human health as we are able to make vitamin D from the sun, but only on areas of skin that aren’t covered up (by clothing or sunscreen). Avoid sunburns at all costs, but don’t avoid the sun. Experts are unclear about how much is safe; the American Medical Association has recommended 10 minutes of direct sun (without sunscreen) several times a week (AMA 2008), while the American Academy of Dermatology holds that “there is no scientifically validated, safe threshold level of UV exposure from the sun that allows for maximal vitamin D synthesis without increasing skin cancer risk” (AAD 2009).

Need more information?  Have a look through the EWG’s Sunscreen Guide. It’s published every year and ranks products according to ingredients and safety.

But, isn’t sugar naturally found in foods?  How can it be so bad for us?

Fruit contains naturally occurring fructose, which is very different than sucrose (table sugar) or even fructose added to foods during manufacturing.   And, fructose from fruit (sometimes called levulose) is balanced out by the vitamins, minerals, fiber and enzymes naturally present in the fruit.  When sucrose or fructose is added to foods, it’s often paired with refined white flours, colourings and flavourings.  Not such a great combo. So, the two can’t really be compared.

If sugar is so bad, can I use sugar substitutes?

Artificial sweeteners are definitely out, as they still raise the threshold for sweetness which can trigger sugar cravings.  And, they’re chemicals. Natural sweeteners like honey, coconut sugar and maple syrup are better, but still contain sugar. And agave nectar, which many people believe to be healthier, isn’t – it’s actually high in fructose and is heavily processed.  So, while natural sweeteners are better than white table sugar, they still have the potential to cause harm. In other words, moderation is key.

Ok, I’m an addict – what do I do?

1.  Start the day with a low-glycemic, protein rich breakfast.  Resist the urge to have toast in the morning as high carbohydrate meals can trigger mid-morning slumps in blood sugar, resulting in the need for a “quick fix”

2.  Avoid anything “white” – no white bread, rice, potatoes or crackers.

3.  Protein at every meal.  Protein, along with fat and fiber help to reduce the glycemic load of a meal, resulting in a more stable rise and fall of blood sugar levels.

While the above measures can help some people stave off their sugar cravings (or at least help get them under control), many others need to go cold turkey.  In that case, a visit to an ND can help you formulate a plan.  There are also a few key nutrients involved in blood sugar metabolism that can help. And, since dopamine receptors are involved in sugar addiction, some people need a lot of support, which an ND can provide.

Gluten is a protein found in wheat, barley, rye, triticale, and spelt. Because gluten binds ingredients together and helps baked goods to rise, it is commonly used in processed foods. Reactions to gluten vary from the extreme of celiac disease to mild digestive upset. While people with celiac disease or gluten allergies have to avoid all amounts of gluten including contamination from kitchen utensils and toasters, most people with gluten sensitivities can tolerate trace amounts up to about 1/8 tsp.

Common sources of gluten

bread

pasta

baked goods including cakes, biscuits, muffins, and cookies

cereal

crackers

pizza dough

tortilla wraps

breaded meats

beer

Gluten is often used as an additive in soups, broths, baking powder, spice mixes, soy sauce, gravy, sauces, marinades, and imitation seafood (especially crab).

What to look for on labels

If any of these ingredients are in a product, it contains gluten: flour, enriched flour, wheat, whole wheat, bran (unless from a gluten free source), barley, rye, triticale, spelt, bulgar, semolina, frumento, durum, kamut, graham, einkorn, farina, couscous, seitan, matzoh, matzah, matzo, malt (assume it is derived from barley unless otherwise specified) and gluten.

Naturally gluten free

Most foods are naturally gluten free including vegetables, fruit, beans, nuts, seeds, seafood, and poultry. There are a number of gluten free grains and starches that can be eaten on their own or used to make pasta, cereal, bread, and baked goods including:

Amaranth

Arrowroot

Buckwheat/kasha

Chickpeas/garbanzo beans

Corn

Millet

Potato

Quinoa

Rice (any variety including glutinous rice)

Tapioca

Teff

Although naturally gluten free, oats are often contaminated with gluten and may be an issue for some people.

Gluten free products

Fortunately gluten free products can be easily found at your local supermarket in the health food section. Farmers’ markets, health food stores and the Bulk Barn are also great resources. There are a wide range of breads, pastas, cereals, baked goods, crackers, baking supplies, and even pizza! Just remember that gluten free does not necessarily mean healthy- many products are based on starches (such as potato) which lack nutrients and fiber, and are loaded with sugar. Try to choose products with either a whole grain or a bean flour base. For baking purposes, you can buy mixes for pizza dough, bread, and desserts or simply purchase a gluten free all purpose flour and use your favorite recipes. You may need to add some xanthum or guar gum to the mix to help it bind and rise- check the label for directions.

Alcohol

Avoid beer, malt beverages, and cider that contains barley.

Gluten free options include gluten free beer, gin, rum, schnapps, tequila, vodka, whisky, wine, and Champagne.

Eating Out

Many restaurants offer either a gluten free menu (you may have to ask for it) or have gluten free (GF) indicated beside some of the menu options. Even if they do not specifically advertise it, if you can tolerate trace amounts of gluten you should be ok with a main course of protein (non-breaded meat, fish, etc.) with some vegetables and rice or potatoes. Salads are usually fine too- minus the croutons.

Resources

celiac.ca A comprehensive guide to going gluten free.

glutenfreegoddess.blogspot.com Fantastic recipes, especially for desserts.

celiackids.com Information on celiac disease, tips for educating caregivers, and meal suggestions.

theceliacscene.com Search Halifax to find local restaurants that have gluten free options.

schoolhouseglutenfreegourmet.com A local gluten free bakery that provides a number of local restaurants with gluten free bread. Search the “where to buy” section for a list of places with gluten free sandwich options.

www.urbanspoon.com/tn/235/1/27000/Atlantic-Provinces/Gluten-Free-Friendly/Halifax-restaurants Another listing of local gluten free friendly restaurants.

My interest in BLW was piqued after we my first daughter was born, 4.5 years ago.  We had such success with it that we subsequently used it to introduce food to our twins, who are now almost 2!  When asked about the benefits of BLW, I tend to be a little emphatic!  I think it encourages family time at the table, requires less prep and care (don’t have to worry about running out of baby food!), introduces new flavours and tastes and encourages self-control.  And, a recent study echoes these sentiments – kids weaned using BLW were leaner and enjoyed a greater variety of foods than those fed traditional purees.

What is BLW?

In a nutshell, BLW is a method of introducing solids that generally doesn’t involve purees or spoon feeding.  By providing developmentally appropriate foods (right size and texture), spoon feeding becomes unnecessary as baby is capable of feeding him/herself!  It’s quite amazing really. That’s not to say it has to be all or nothing, but it can be a stand-alone method of introducing “real” food to babies.

What’s wrong with rice cereal and purees?

Rice cereal is suggested as a “first food” because it is fortified with iron, and breastfed babies need a reliable source of iron by 6-9 months of age as the stores of iron they’d gotten from Mom will start to run out.  But, if iron is the concern, why not offer great sources of iron such as meat and fish, both of which are recommended first foods?  The other concern is that white rice, in particular, isn’t very nutritionally dense.  We recommend a whole-grain diet for adults, why not babies? And finally,  the other concern I have with rice cereal is that I often see babies suffering from terrible constipation, especially if they’re already receiving iron fortified formula. While not advocating BLW per se, Dr. Greene has launched a “White Out” campaign which encourages whole grains (vs. white rice cereal) as a first food. It’s a start!

Purees, if made from whole foods (ie just fruits and vegetables) are healthy.  But, why not introduce baby to foods that the whole family is eating? BLW is cheap and easy compared to buying/preparing jarred foods! Purees were introduced at a time when infant feeding guidelines were recommending a much earlier introduction of solids foods (ie 3 months old). We know better now, and most babies are perfectly capable of feeding themselves by approximately 6 months of age. There’s nothing special about purees, and if baby is showing signs of readiness (able to sit up, loss of tongue thrust reflex, etc) then they can feed themselves!

But what about choking?

Gill Rapley, author of the ‘Baby Led Weaning‘ book sums it up nicely:

Many parents worry about babies choking. However, there is good reason to believe that babies are at less risk of choking if they are in control of what goes into their mouth than if they are spoon fed. This is because babies are not capable of intentionally moving food to the back of their throats until after they have developed the ability to chew. And they do not develop the ability to chew until after they have developed the ability to reach out and grab things. The ability to pick up very small things develops later still. Thus, a very young baby cannot easily put himself at risk because he cannot get small pieces of food into his mouth. Spoon feeding, by contrast, encourages the baby to suck the food straight to the back of his mouth, potentially making choking more likely.

It appears that a baby’s general development keeps pace with the development of his ability to manage food in his mouth, and to digest it. A baby who is struggling to get food into his mouth is probably not quite ready to eat it. It is important to resist the temptation to ‘help’ the baby in these circumstances since his own developmental abilities are what ensure that the transition to solid foods takes place at the right pace for him, while keeping the risk of choking to a minimum.

Tipping a baby backwards or lying him down to feed him solid foods is dangerous. A baby who is handling food should always be supported in an upright position. This ensures that food that he is not yet able to swallow, or does not wish to swallow, will fall forward out of his mouth.

Getting Started with BLW

Do your research!  Read sites such as www.babyledweaning.com, and pick up a copy of Gill Rapley’s ‘Baby Led Weaning’.  If you think BLW is right for you and your baby, join me for a workshop at Nurtured, or schedule a BLW consult in our Dartmouth office.

Here are a couple pictures of my kids loving food!

Avoiding phthalates is a great start. Other ingredients to watch out for include parabens, triclosan, and sodium lauryl sulfate. Environmental Defence Canada has put together a pocket shopping guide of Toxic Ten Ingredients as part of their Just Beautiful campaign that you can download from justbeautiful.ca. You can also visit lesstoxicguide.ca for lists of non-toxic products that you can find in Nova Scotia.