My 22 year old daughter in law, 6 months pregnant, has had a score of 36 for GFR kidney function.
Can she be tutored in naturopathic approaches to stabilising/ improving?
Kidney function, or the ability of the glomeruli (capillaries around the end of the kidney tubule) to filter waste products from the blood, is measured by creatinine blood levels. Higher levels of creatinine indicate a lower glomerular filtration rate (GFR), and GFR tends to gradually decline with age. There are 5 stages of kidney disease, and a GFR of 36 is classed as stage 3 kidney disease. Women who become pregnant when they have serum creatinine values above 124 μmol/l have an increased risk of faster decline in renal function and poor outcome of pregnancy.
As a result, all women with chronic kidney disease should be referred early in pregnancy to a specialist to plan care during the pregnancy. Regular monitoring of maternal renal function (serum creatinine and serum urea) is necessary, as well as blood pressure, urine (for infection), protein in the urine, and when appropriate ultrasound (to detect obstructions to the urinary tract). Vitamin D levels should be monitored, as the kidneys normally increase blood levels during pregnancy.
Use of non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided, as these can damage renal function. Other drugs should be checked for their influence on kidney function as well as on the fetus.
A naturopathic physician experienced in treating patients with kidney disease should be consulted alongside conventional care, to recommend strategies for improving kidney function. One potentially useful supplement might be trehalose, a natural disaccharide sugar. Trehalose is known to be safe during pregnancy, and may even prevent neural tube defects in mothers with diabetes. Trehalose may also be useful to repair damage to kidney podocytes, the cells that encapsulate the glomeruli.
1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39: Suppl 1: S1-S266.
2. Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;336:211–215. PMCID: PMC2213870.
3. Williams D. Renal disorders. In: James DK, Steer PJ, Weiner CP, Gonik B, eds. High risk pregnancy. Management options. 3rd ed. Philadelphia: Elsevier Saunders, 2006:1098-124.
4. Xu C, Li X, Wang F, Weng H, Yang P. Trehalose prevents neural tube defects by correcting maternal diabetes-suppressed autophagy and neurogenesis. Am J Physiol Endocrinol Metab. 2013 Sep 1;305(5):E667-78. doi: 10.1152/ajpendo.00185.2013. PMCID: PMC3761168.
5. Kang YL, Saleem MA, Chan KW, Yung BY, Law HK. Trehalose, an mTOR independent autophagy inducer, alleviates human podocyte injury after puromycin aminonucleoside treatment. PLoS One. 2014 Nov 20;9(11):e113520. doi: 10.1371/journal.pone.0113520. PMCID: PMC4239098.
German-language speakers will be able to get GenoTyped at several locations in Germany, Austria and Switzerland in a trans-national GenoTyping Day on February 22nd 2014. Some of the venues are also offering informative lectures the previous evening for visitors to learn about personalised nutrition.
The GenoTyping Days will be held by IfHI-certified practitioners in seven locations simultaneously: München, Hamburg, Untergruppenbach, Siegenburg (Germany), Rum (Austria), Langenthal and Herisau (Switzerland).
The lectures are on Friday, February 21st in Hamburg, Untergruppenbach, Siegenburg and Austria.
In addition, a blood group and GenoType training seminar is scheduled for Friday 28 March to Sunday, 30th March 2014 in Stuttgart, Germany.
Watch for an interview with heilpraktiker Stefanie Siebinger, other IfHI Fellow-certified practitioners and Silvia Neumann MIfHI on the Swiss TV station TimeToDo.ch on Tuesday 21st January at 8pm Central European time.
The British Naturopathic Association's annual Study Day on June 23rd 2012 will have the theme of Naturopathic Approaches to Endocrinology. MIfHI graduates, Drs. Tom and Jacqueline Greenfield, are presenting a lecture entitled: A Nutrigenomic Approach to Endocrinology. A summary of their lecture follows:
Medical endocrinologists typically deal with major hormonal imbalances pharmacologically. A reductionistic approach to the body perceives the organ which is producing increased or decreased levels of hormones as the source of the organic dysfunction; the "cure" is either hormone replacement therapy, suppression of excess hormone production or blocking receptor sites. In the same way, nutritional supplementation can be used to make up for deficiencies or excess to directly enhance or suppress the function of specific hormonal pathways. However this is not necessarily treating the patient as a whole: it could be seen as linear thinking, not looking for the reason behind the disturbance in homoeostasis, or whether the cause of the imbalance is still there. As naturopaths how can we support health in the patient with endocrine-related disorders using natural methods and a more holistic approach?
Nutrigenomics has brought a growing awareness of the potential for modification of food intake to promote health and reduce the risk of diet-related diseases. It is a way of altering the expression of genes through nutrition: a nutrigenomic perspective views nutrients as cell-signalling mechanisms which are detected by sensors in the cell: a variation in nutrient levels triggers a cellular mechanism which changes gene expression, protein and metabolite production. This can restore balance in many body systems where the individual's genes have been programmed during gestation to survive in an environment in which they no longer find themselves.
In our presentation we discuss ways of influencing hormonal pathways through diet and nutritional supplementation at the level of the gene using the example of types of thyroid dysfunction and diabetes. We also look at a commonly-supplemented hormone in detail: vitamin D, it's role in many disease processes; we review a hypothesis for the role of vitamin D3 and it's metabolite in dysregulation of androgen and glucocorticoid receptors in autoimmune disease.
Knowing what diseases to prevent and how to address existing illness is the key to individualised medicine. As naturopaths we can target prevention to the specific disease tendencies of the individual rather than assume everyone will get the same illnesses. We present a system devised by Dr. Peter D'Adamo ND which looks at three overriding responses to the environment: reactive, thrifty and tolerant, further refined by gene clusters, or haplotypes, in proximity to the blood group gene on 9q34. We discuss simple in-clinic biomarkers that can be used to assess the patient's epigenetics: how to determine their disease susceptibilities and which preventive measures may be the most appropriate for them; in the presence of an existing disorder, how to know which pathways to upregulate or downregulate through dietary intervention. We also discuss an educational opportunity for practitioners and the informed public to become certified in human individuality.
Other speakers at the event are Dr. Marilyn Glenville Ph.D., nutritionist specialising in women’s health, Alison Cullen, education manager at Bioforce UK, and Marian Baartz MSc., Iridologist. The event is open to non-members of the British Naturopathic Association.
A research article published (provisionally) online yesterday in BMC Complementary and Alternative Medicine  disclosed the results of a pilot clinical trial which gave 60 mg of Ginkgo biloba twice per day to people with vitiligo.
Vitiligo is generally thought to be an autoimmune condition in which melanocytes, or skin pigment cells, are attacked by the body's own immune cells and stop producing pigmentation. There are other theories including the interaction and contribution of biochemical, oxidative stress, genetic, neuronal and environmental factors. The condition results in patchy depigmented areas of skin which are more prone to sunburn. Treatment includes frequent and lengthy ultraviolet phototherapy; traditionally dermatologists will prescribe a topical steroid cream. Side-effects of topical steroids can include diabetes mellitus, osteoporosis, dermatitis and dermatoses.
Effectiveness of the clinical trial was assessed using the Vitiligo Area Scoring Index (VASI), the authors found "The progression of vitiligo stopped in all participants; the total VASI indicated an average repigmentation of vitiligo lesions of 15%." This was a small study over 12 weeks, with eleven participants completing the trial, two experienced no change and one experienced a very small 0.4% improvement. The remaining eight participants experienced significant improvement. No significant adverse effects were experienced and serum coagulation was unaffected.
Possible side effects of Ginkgo biloba include gastrointestinal disturbance, allergic reaction (to those sensitised to poison ivy), and Gingko biloba should be used with caution by people taking MAO inhibitors or SSRI antidepressants.
The authors conclude "Larger, randomized double-blind clinical studies are warranted and appear feasible."
Previous studies using Gingko biloba on patients with vitiligo include a double blind randomised trial in 2003  over six months, which found a similar dosage of Ginkgo biloba arrested the spread of vitiligo in 20 out of 25 participants in the active group, and induced marked (75% or greater) repigmentation in 10 of those participants.
Gingko biloba is one of the top selling herbal medicines in the United States; Gingko biloba accounts for 1% of total prescriptions in Germany; The World Health Organization reports that the medicinal uses of ginkgo biloba supported by clinical data include treatment of the effects mild to moderate cerebrovascular insufficiency. Gingko biloba has a comparatively good safety record, making it tempting to self-administer in cases of vitiligo. The authors cautiously recommend that any attempt to use ginkgo in the management of vitiligo should be carefully monitored by a health care practitioner "given that there are still many questions about the correct dose, its true effectiveness, interactions with other conditions or therapies, and possible adverse reactions." 
1. Szczurko O et. al: Ginkgo biloba for the treatment of Vitiligo vulgaris: an Open Label Pilot Clinical Trial. BMC Complementary and Alternative Medicine 2011, 11:21doi:10.1186/1472-6882-11-21
2. Parsad D, Pandhi R, Juneja A: Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clinical & Experimental Dermatology 2003, 28(3):285-287.
A study by Karlic et. al.  found that a vegetarian diet has a significant impact on a gene regulating carnitine metabolism. Carnitine is an amino acid (protein constituent) and a conditionally essential nutrient that plays a vital role in energy production and fatty acid metabolism. A “conditionally essential” nutrient is one that can be manufactured in the body, but the requirements of individuals might exceed dietary intake during specific disease states. Carnitine not obtained from food is synthesized in the body from two essential amino acids, lysine and methionine. Carnitine is found in higher levels in meat products as it is present in high levels in muscle tissue.
Vegetarian diets therefore contain less carnitine, and also often contain more carbodydrate than omnivorous diets as sources of concentrated vegetable proteins are not so readily available as animal proteins.
The study found increased expression of a gene  called Organic Cation Transporter 2 (OCTN2) in vegetarians which caused elevated levels of OCTN2 in cell membranes, compensating for lower carnitine levels obtained from the diet. Thus a vegetarian lifestyle has an impact on fat metabolism causing a remarkable stimulation of carnitine uptake.
The bioavailability of L-carnitine varies due to dietary composition. Bioavailability of L-carnitine in vegetarians who are adapted to low-carnitine diets is higher (66% to 86% of available carnitine) than regular red-meat eaters adapted to high-carnitine diets (54% to 72% of available carnitine). Carnitine influences carbohydrate metabolism. Abnormal carnitine regulation is implicated in complications of diabetes mellitus, cardiomyopathy, obesity, endocrine imbalances and other disorders. 
According to The Blood Type Diet and The GenoType Diet, individuals with a particular genetic characteristic and the associated metabolic consequences may be recommended to reduce the amount of red meat in their diets. This may be due to specific disease susceptibility and/or reduced ability to digest and metabolise red meats. Some of the consequences of increased carbohydrate intake in these individuals may be compensated for by the natural epigenetic effect of lowered carnitine intake on the gene that enhances the concentration of this nutrient and resultant increased bioavailability.
1. Karlic H, Schuster D, Varga F, Klindert G, Lapin A, Haslberger A, Handschur M: "Vegetarian Diet Affects Genes of Oxidative Metabolism and Collagen Synthesis." Ann Nutr Metab 2008;53:29-32. Pubmed 18772587
2. OMIM OCTN2
3. Flanagan JL, Simmons PA, Vehige J, Willcox MDP, Garrett Q: "Role of carnitine in disease." Nutrition & Metabolism 2010, 7:30 doi:10.1186/1743-7075-7-30