Nutritional

1
Nutritional Environmental Medicine Putting all
the pieces together.

• Blake Graham, B.Sc (Honours), AACNEM
• Clinical Nutritionist
• www.nutritional-healing.com.au
• [phone]
• February 16th 2008

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What causes disease?

• Genetics.
• Gastrointestinal abnormalities.
• Nutrient imbalances/diet.
• Environmental. (e.g. heavy metals)
• Allergies/intolerances.
• Chemical imbalances. (e.g. hormones)
• Disordered sleep.
• Psycho-social factors.
• Lifestyle factors.

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Multi-factorial model.
All disease is multi-factorial!
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Web of inter-relationships and vicious cycles.
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Ripple effect.
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Spectrums.
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Self healing.

• Complex corrective mechanisms.
• Identify and remove
• Causes.
• Impediments to healing.
• Reduce burden of stressors on the body below the
  threshold which the body can restore balance.

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Disease treatment models.

• Treat symptoms
• Nausea anti-nausea medication
• High cholesterol cholesterol lowering
  medication
• Dry skin moisturizer
• Insomnia sedatives
• Address underlying causes
• e.g. nausea caused by gastrointestinal infection
• e.g. high cholesterol caused by poor diet
• e.g. dry skin caused by fatty acid deficiency
• e.g. insomnia caused by anxiety

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Disease treatment models.

• Person centred diagnosis.
• Nutrient deficiencies.
• Sleep deprivation.
• Food intolerances.
• Intestinal infection.

• Disease centred diagnosis.
• Irritable bowel syndrome.
• Chronic Fatigue Syndrome.
• Migraines.
• Depression.

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Genetics.
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Genetics.

• Inter-relationship between genetics and
  environment.
• Environment influences genetic expression.
• Genetics influence reaction to environment.

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Genetics.

• Specific links of interest
• Environmental chemical metabolism.
• Nutrient imbalances.
• Gastrointestinal health.
• Allergies/intolerances.
• Chemical imbalances. (e.g. hormones)
• Immune integrity.

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Genetics.

• Family history
• Eczema/asthma/hay fever/hives ? Allergies
• Depression/anxiety/OCD ? Neurotransmitters
• Crohn's Disease ? Increased intestinal
  permeability
• ADD/ADHD ? Abnormal zinc metabolism

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Genetic testing.
Huge genetic variation!
Reference www.genovations.com/
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Gastrointestinal health.
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Gastrointestinal imbalances.

• Imbalanced gastrointestinal flora ('dysbiosis').
• Gastrointestinal infections (bacteria, parasitic,
  yeast).
• Increased intestinal permeability ('leaky gut').
• Maldigestion/malabsorption.
• Stomach acid deficiency (hypochlorhydria).
• Pancreatic enzyme insufficiency.
• Bile acid deficiency.

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Intestinal flora.

• Functions of healthy flora
• Produce short chain fatty acids which are needed
  by the intestinal mucosa for energy
• Produce biofilm (mucus barrier) to protect
  intestinal mucosa
• Interact with the gut associated lymphoid tissue
  (GALT) 70 of immune system, e.g.
• Improves antibody formation
• Reduce allergies (eczema and asthma)
• Regulate cytokine levels / inflammation
  modulation
• Synthesize nutrients (certain amino acids and
  vitamins)
• Improve digestion/absorption
• Inhibit the overgrowth of harmful bacteria,
  yeast, viruses and parasites
• Improve intestinal motility and stool formation
• Influence genetic expression
• Assist the detoxification of various substances
  and convert some toxins into less toxic forms
• Mercury
• Hormones (e.g. estrogen)
• Potentially carcinogenic chemicals
• Drugs
• Lipids (e.g. cholesterol)

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Harmful bacteria.

• Produce toxic chemicals as metabolic by-products
  which have systemic effects, e.g.
• Ammonia ? Hyperammonemia
• D-lactic acid ? D-lactic acidosis
• Decrease production of short chain fatty acids
• Produce antigens which disrupt immune function
• Reduce levels of healthy flora
• Impair nutrient digestion/absorption
• Degradation/consumption of nutrients
• Damage intestinal wall

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Intestinal flora testing.
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Gastrointestinal health Yeast.

• Opportunistic/secondary.
• Great exacerbating factor.
• Releases harmful chemicals.
• Lab tests are notoriously unreliable.

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Yeast symptoms/signs.

• Genital thrush
• Vaginal itching or redness, vaginitis or 'jock
  itch' often scratching/itching at genital area
• White or grayish-white coating on your tongue or
  inner cheeks, or white patches in the mouth
• Nasal congestion or stuffiness, swelling of the
  nasal membranes or sinusitis
• Previously noticed a decline in your health
  following antibiotics or antibiotics exacerbate
  your current health problem
• Fungus infections of the skin (e.g. athletes
  foot) or nails
• Psoriasis, eczema or hives
• Puffiness/bloating/swelling in the hands, face
  and feet
• Sugar cravings
• Eating sugar make you feel worse/worsens certain
  symptoms
• Negative reaction to certain dietary yeasts/molds
• Very high fondness for yeasty foods
• Chemical sensitivities (e.g. car exhaust, petrol,
  cigarette smoke, perfumes, etc.)
• Multiple food sensitivities
• Lower abdominal bloating
• Gas, frequent constipation, loose/unformed
  stools, diarrhea or foul smelling stools
• Itchy rectal/anal area or red ring immediately
  around the anus
• Attention problems
• Feel spaced out /or brain fogged

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Yeast testing.
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Gastrointestinal health Parasites.

• Remarkably common.
• Under-diagnosed due to
• Lack of consideration.
• Inadequate laboratory techniques.

Giardia intestinalis
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Intestinal parasite symptoms/signs.

• Current illness began with diarrhea/food
  poisoning
• Frequent diarrhea
• Loose/unformed stools
• Abdominal bloating
• Abdominal pain/discomfort
• Excessive flatulence
• Visible mucus or pus in stools
• Itchy anal/rectal area
• Foul smelling stools
• Frequent constipation
• Frequent nausea and/or vomiting
• Food allergies/intolerances
• Teeth grinding (bruxism) while sleeping
• Skin conditions (bluish cast around lips, hives,
  psoriasis, eczema, skin ulcers)
• Fatigue/weakness
• Forgetfulness or unclear thinking
• Nervousness, apathy, depressed, anxious or
  headaches
• Dizziness

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Parasite testing.
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Maldigestion/malabsorption.

• Stomach acid deficiency (hypochlorhydria).
• Pancreatic enzyme insufficiency.
• Bile acid deficiency.

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Digestive function testing.
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Hypochlorhydria symptoms/signs.

• Undigested food in stool
• Trouble digesting red meat
• Food or water sits in stomach
• Poor appetite or feel overly full easily
• Stomach aching/pain/discomfort or bloating after
  meals
• Reflux /or heartburn
• High fat foods cause nausea/stomach upset
• Nausea/reflux after supplements (e.g. fish oil)
• Feel unwell/fatigued right after meals
• Lemon juice improves digestion
• Low iron levels

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Heidelberg pH Diagnostic System.
Reference www.phcapsule.com/
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Gastrointestinal treatments.

• Probiotics/prebiotics.
• Anti-microbials.
• Dietary changes.
• Digestive enzymes.
• Stomach acid supplement (Betaine HCl).
• Bile acids.

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Nutrients.
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Nutrient status continuum.
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Nutrient status continuum.
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Nutrition Nutritional status.

• Intake
• Food choices
• Soil levels, food storage, food processing
• Digestion/assimilation
• Genetics
• Synthesis (vitamins K D)
• Other factors (hormone imbalances, toxic
  chemicals, infections, other nutrient levels,
  medications, oxidative stress, emotional stress,
  activity levels, kidney/liver problems, etc.)

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Nutrient supplementation uses.

1. Optimizing levels.
2. Therapeutic value.

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Fatty acid deficiency symptoms/signs.

• Dry skin (e.g. feet/face/general)
• Scaly or flaky skin (e.g. legs)
• Cracking/peeling fingertips skin (e.g. heels)
• Lackluster skin
• Small bumps on back of upper arms
• Patchy dullness /or color variation of skin
• Irregular quilted appearance of skin (e.g. legs)
• Thick or cracked calluses
• Dandruff or cradle cap
• Dry, lackluster, brittle or unruly hair
• Soft, fraying, splitting or brittle fingernails
• Dull nails - lack of surface shine
• Slow growing fingernails
• Dry eyes
• Menstrual cramps or premenstrual breast
  pain/tenderness
• Excessive ear wax
• Excessive thirst
• Allergic (e.g. eczema/asthma/hay fever/hives)
• Crave fats/fatty foods

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Magnesium deficiency symptoms/signs.

• Muscle cramps, spasms or pain (e.g. back ache,
  neck ache, leg/foot cramps)
• Muscle tension
• Muscle twitches, tics or jerks
• Muscle weakness
• Muscle tremors
• Restless legs
• Fatigue / sighing
• Breathlessness / chest tightness
• Heart palpitations / arrhythmias
• Numbness or tingling of skin or creepy-crawly
  feeling under skin
• Sensitivity to loud noises or sudden bright light
  
• Menstrual cramps
• Headaches / migraines
• Frequent constipation or anal spasms
• Difficulty falling asleep and/or restless sleep
• Irritable, depressed, anxious, nervous or panic
  attacks

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Hair mineral analysis.
Reference www.doctorsdata.com/
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RBC fatty acid analysis.
Reference www.metametrix.com/
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Plasma amino acids.
Reference www.doctorsdata.com/
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Nutrient imbalance treatments.

• Nutrient supplementation.
• Dietary changes.
• Correct absorption problems.

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Nutrient supplementation case study.

• Symptoms
• Frequent urination
• Night time urination
• Night thirst
• Blurred vision after heavy exercise
• Mineral supplementation
• From one day to the next at least 90 of my
  symptoms vanished. These are symptoms I have
  lived with and have worsened for more than 10
  years. Quite amazing.

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Toxic chemicals.
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Increased toxic chemical exposure.

• Lead levels of human bones are 1000 times higher
  than pre-industrial bones.
• Cadmium 500 times higher.

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Heavy metal sources

• Food
• Soil
• Pesticides
• Cooking items
• Water
• Air
• Medical
• Amalgam fillings
• Vaccines

• Direct contact with heavy metal containing or
  contaminated substances
• Paints
• Cigarettes
• Household chemicals
• Body products
• Many many others!

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Autism mercury Study 1.

• 221 children with ASD vs. 18 controls
• Post-DMSA urine levels
• Mercury was 3.15 times higher!!

Jeff Bradstreet, M.D. David Geier, B.A. Jerold
Kartzinel, M.D. James Adams, Ph.D. Mark Geier,
M.D.,Ph.D. A Case-Control Study of Mercury
Burden in Children with Autistic Spectrum
Disorders. Journal of American Physicians and
Surgeons Volume 8 Number 3 Fall 2003
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Autism mercury Study 2.

• 14 children with Autism vs. 11 controls
• Mercury was 3 times higher in baby teeth!!

Adams JB. A Review of the Autism-Mercury
Connection. Conference Proceedings of the Annual.
Meeting of the Autism Society of America, July
2004.
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Toxic chemical treatments.

• Chemical avoidance.
• Chelation agents.
• Supportive nutrients/herbs.
• Far infrared (FIR) saunas.

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Other environmental influences.
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Electromagnetic radiation (EMR).
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EMR testing.
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Toxic mould.
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Mould testing.
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Sick building syndrome symptoms/signs.

• Ongoing or frequent coughing / dry throat or
  mouth
• Irritated, stinging or burning sensation of
  throat or mouth
• Throat hoarseness / changed voice (e.g. raspy)
• Metallic taste in mouth
• Wheezing, irritated lungs or bronchitis
• Shortness of breath / chest tightness
• Irritated, sore or burning eyes
• Red or watery/tearing eyes
• Sensitivity to bright light / blurred vision
• Nasal congestion / running or stuffy nose /
  sneezing / nose bleeds
• Irritated, stinging or burning nose or nasal
  passage / nasal itching
• Sinusitis / sinus congestion or pressure
• Stinging, burning or itchy skin / skin
  sensitivity to light touch
• Skin rash or reddening of skin
• Dizziness / vertigo
• Headaches
• Fatigue / weakness

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Allergies/intolerances.
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Food reactivity.

• Many reasons why a person may react negatively to
  specific foods.
• Allergy
• Intolerance
• e.g. lactose intolerance or fructose
  malabsorption
• e.g. impaired ability to metabolize salicylates,
  etc.
• e.g. gut flora/leaky gut mediated
• e.g. pharmacologic properties of the food -
  aspartame
• e.g. toxins in foods
• ? No one lab test for diagnosis of all negative
  reactions.

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Food intolerance or allergy symptoms/signs.

• Itchy, tingly, irritated or burning
  tongue/lips/palate/throat during or after meals
• Swollen lips/mouth or recurrent mouth ulcers
• Frequent hives - generally or around mouth/lips
  (e.g. rash or ring around mouth )
• Increased mucus production in throat / regularly
  clearing throat
• Excess drooling / excess saliva production /
  spitting during speech
• Irregular patches on tongue (geographic map-like)
  or mottled tongue
• Puffiness or bags below eyes or puffy or
  swollen nose/face
• Dark circles under eyes (allergic shiners)
• Inner corners of eyes itch or whole eyes itch /
  eye rubbing or scratching
• Watery, glassy or glazed eyes or red eyes
• Itchy nose / nose rubbing or scratching (nasal
  salute)
• Nasal or sinus congestion / sinusitis / runny or
  snuffly nose / sneezing
• Postnasal drip (nasal mucus draining down the
  back of the throat)
• Abnormally red and/or flushed appearance of
  cheeks or nose (e.g. red tip nose)
• Red ears / hot or burning earlobes
• Eczema or wool intolerance / psoriasis
• Itchy arms, ear canals, hands, legs or skin in
  general
• Puffy or swollen hands/knuckles/feet
• Asthma or recurrent wheezy bronchitis / infection
  or exercise induced wheezing

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Elimination/provocation testing.

• GRAINS - Whole grain rice
• MEAT - 100 unrefined lamb
• VEGETABLES - Cabbage, kale, carrots, cauliflower,
  squash, broccoli sweet potatoes
• FRUIT Pears
• OILS/SEASONINGS - Olive oil sea salt

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Inhalant allergies.

• Dust.
• Cats/dogs.
• Pollen.
• Grass.

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Food intolerance case study.

• Fibromyalgia.
• Elimination diet ? 50 drop in symptoms.
• Lactose intolerance.

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Chemical imbalances.
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Neurotransmitter hormone imbalances.

• Neurotransmitters
• Serotonin
• Dopamine
• Noradrenaline
• GABA
• Acetylcholine
• Endorphins

• Hormones
• Adrenal hormones
• Thyroid hormones
• Sex hormones
• Growth hormone

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Biochemical continuum.
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Serotonin deficiency signs/symptoms.

• Depressed
• Nervous/anxious
• Worrier
• Fears/phobias
• Negative/pessimistic
• Irritable/impatient/edgy
• Obsessive compulsive tendency
• Think about the same things over over again
• Self destructive or suicidal thoughts/plans
• Low self esteem/confidence
• Rage/anger/explosive behavior/assaultive
• Sleep problems/light sleeper
• Crave sugar/carbohydrates/alcohol/marijuana
• Use these substances to improve mood relax
• Feel worse in dislike dark weather
• Chronic pain (e.g. headaches, backaches,
  fibromyalgia)

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Serotonin pathway.
Reference Bioconcepts. www.bioconcepts.com.au/
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Adrenal Rhythm.
Reference www.diagnostechs.com/
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Mild adrenal insufficiency signs/symptoms.

• Fatigue/lethargy not relieved by sleep
• Trouble getting up in the morning
• Crave salt or salty food
• Low blood pressure
• Light-headed or dizzy when getting up to stand
  from laying or sitting
• Feel unwell during/after emotional stress, e.g.
  exhausted, shaky or confused
• Decreased ability to handle stress/pressure
• Tendency for low blood sugar
• Intolerance to cold / frequently feel cold
• Unstable body temperature
• Light sensitivity
• Increased frequency/severity of allergies
• Dark brown spots on face/neck/shoulders
• Poor exercise tolerance
• Increased time to recover from infection
• Thin, can't gain weight or weight loss
• Insomnia / sleep disturbance
• Anxious or panic attacks

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Saliva Adrenal Stress Profile.
Reference www.gdx.net/
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Adrenal hormone case study.
I am feeling so much better than when we first
consulted over 6 months ago for the last month I
have been doing about 500 metres of swimming 2
kms of walking about 5 times a week. This
compares to just barely struggling to do the
weekly shopping! The feelings of exhaustion are
not very common anymore. Depression and anxiety
totally under control. Sleeping is much better.
Overall, I am beginning to feel like a completely
different person.
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Sleep.
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Sleep.

• Inadequate sleep quantity and quality are
  extremely common.

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Sleep.

• Functions of sleep
• Rejuvenation/Repair
• Growth
• Detoxification
• Memory storage
• Energy conservation

Reference Dr. Reza Samvat, www.sleep4health.com.a
u/
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Sleep treatment.

• Remove causes.
• Supportive lifestyle, environment and sleep
  routine.
• Dietary changes.
• Herbal/nutritional supplements.
• Relaxation techniques.

See www.nutritional-healing.com.au ? Articles
for more info.
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Stress.
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Psycho-social stress.

• Universal disease exacerbator.
• Known effects
• Impairs immune function.
• Increase nutrient requirements (e.g. magnesium).
• Impair digestion.
• Impair sleep.
• Impair neurotransmitter balance.
• Impair hormone (e.g. cortisol, DHEA, thyroid
  hormones, sex hormones) balance.

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Psycho-social stress Management.

• Treatment options
• Eckhart Tolle www.eckharttolle.com/.
• Emotional Freedom Techniques (EFT).
  www.integrative-clearing.com.au/
• Breathing/muscle relaxation exercises.
• Biochemical.
• Exercise.

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Lifestyle.
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Lifestyle factors.

• Smoking.
• Alcohol.
• Drug use.
• Exercise.
• Rest.
• Fun.

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How to put it all together.

• Optimize basics
• General diet.
• Sleep.
• Stress.
• Lifestyle.
• Healthy environment.

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How to put it all together.

• Optimize basics
• General diet.
• Sleep.
• Stress.
• Lifestyle.
• Healthy environment.
• Identify contributing factors
• Gastrointestinal issues.
• Nutrient imbalances.
• Environmental.
• Allergies/intolerances.
• Neurotransmitters hormone imbalances.

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Questionnaire.
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Nutritional Environmental Medicine Putting all
the pieces together.

• Blake Graham, B.Sc (Honours), AACNEM
• Clinical Nutritionist
• [phone]
• February 16th 2008

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