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Tame the Fires of Autoimmune Disease
Autoimmune Disease is a major health problem in our society. One in twelve people in general, and one in nine women, will be diagnosed with an autoimmune disease. There are over one hundred different autoimmune disorders, including multiple sclerosis, Lupus, Rheumatoid arthritis, Inflammatory Bowel diseases and Celiac disease. Together these conditions affect more people than cancer or heart disease and can rob patients of their quality of life, mobility and even take their lives.
Scientists worldwide are puzzled over the alarming rise in the rates of autoimmune disease, particularly in the Western world. The rates have more than doubled in the last three decades. Genetics can no longer be blamed as the only cause of autoimmune disease since our genetics can’t change that quickly.
As a naturopathic physician, I have treated many patients with a variety of autoimmune diseases in my years of practice. The familiar story is one of misdiagnosis, dismissal and frustration with limited treatment options. In half of all cases, women with autoimmune disease are told there is nothing wrong with them for an average of five years before receiving diagnosis and treatment. Once a diagnosis is made, treatment is focused on reducing symptoms but not treating the underlying factors that may have caused the disease. Commonly used immunosuppressant treatments can be lifesaving, but can also lead to significant long-term side effects.
The path to a long lasting recovery from autoimmune conditions focuses on correcting the underlying stress factors that may have caused the immune dysregulation that drives the disease.
Exciting research was recently presented at a gastroenterology convention I attended in Victoria. The immune system has well developed mechanisms to attack foreign invaders. In autoimmune disease, the immune system loses its ability to differentiate our own normal tissues from foreign invaders. That ability to temper the immune system’s inflammatory reactions to invaders is something our bodies must learn. And strangely enough, in fact, the teacher lives in our guts. The bacterial lining of the intestines (the intestinal microbiome) is responsible for educating our immune systems, letting them know when to attack and when to cease fire.
The delicate intestinal bacterial lining is made up of over 1000 species of bacteria and weighs about three pounds in an adult. We are created in a sterile womb, devoid of bacteria and acquire our first dose of beneficial bacteria in the birth canal. In the western world, there is an ever increasing trend towards delivering babies by C-section. Without that first dose of beneficial bacteria from the birth canal, the baby’s microbiome is different than a baby born via vaginal birth. Abundant research has shown that there are increased rates of asthma and autoimmune disease in those delivered by C-section. Researchers concluded that a C-section (or Caesarean section) raises the risk of type 1 diabetes by 20%. They also crunched the data from 23 studies and showed the same increased risk for asthma—20%—in children delivered by C-section.
Antibiotics are the other western phenomenon that disturbs the intestinal microbiome. We know not what we do when we take an antibiotic for an infection without consideration of the trillions of beneficial bacteria that form an integral part of our digestive and immune systems. Mice given antibiotics were more likely to develop inflammatory bowel diseases like Crohn’s and Ulcerative Colitis.
Naturopathic physicians have long emphasized the importance of correcting deficiencies in the intestinal microbiome. Programs to repair the intestinal mucosal lining, replenish probiotics and kill off harmful elements of the microbiome have long been a mainstay of the treatment of autoimmune disease.
Vitamin D deficiency in northern countries have also been linked with increased rates of autoimmune disease. As we spend more time indoors and lessen our exposure to sunlight, thus using sunscreen more often (as those with paler skin tend to do) when we are outdoors, we play an active role in depleting our Vitamin D stores. Vitamin D has also been shown to play a role in the regulation of inflammatory fires of the immune system. Vitamin D helps tell the immune system to tolerate our own cells. Some studies show that Vitamin C inhibits induction of disease in autoimmune encephalomyelitis, thyroiditis, type-1 diabetes, inflammatory bowel disease (IBD), lupus, rheumatoid and Lyme arthritis.
For my patients with joint pain associated with autoimmune disease, laser therapy is an excellent way to manage pain, reduce joint destruction and improve joint function. A recent Canadian expert panel determined that this painless laser therapy is an effective treatment for rheumatoid arthritis. I have been using a high tech laser light treatment for my patients for years. It is very effective for most patients with osteoarthritis and is part of an overall treatment for inflammatory arthritis too.
Natural anti-inflammatory medicines may reduce the dependence on harsh prescription drugs. A turmeric extract called Meriva has been shown to be a safe and defective pain reliever in arthritis. Fish oil is considered an essential part of auto-immune treatment in that it helps alleviate the inflammation that drives most symptoms. Most auto-immune disease involves high levels of oxidative stress, so sufferers who incorporate anti-oxidant foods and supplements into their daily regime are making a wise choice. Kale and blueberries are my favorite high anti-oxidant foods; grape seed extract and resveratrol are my favorite supplements.
Fatigue is often a crippling element of auto-immune disease. I also work with patients to support their adrenal gland through teaching them meditation and relaxation techniques using herbs like rhodiola.
Science is beginning to shed light on the complexities of the immune system and ways that we can influence the health of it. Take care of your immune system, and if you have an autoimmune disease, learn ways to tame your inflammation – naturally.
Dr. Deidre Macdonald is a naturopathic physician who has been practicing medicine for 16 years in downtown Courtenay. For more information, contact the Macdonald Centre for Natural Medicine at (250) 897-0235 or via this website.
Introduction to weight loss series – Part 1: Low thyroid function
Lose Weight, Feel Great!
If you have decided that it is time to get healthy, fit and lose weight you will need a plan of action to turn your resolutions into reality. Too often, weight loss goals turn into a familiar roller-coaster of short term success and eventual rebound. Now is the time to get clear on your strategy for long-term success. In my experience of helping hundreds of people to lose weight, I have found that there are three main areas that must be addressed in order to achieve lasting weight loss. First, there are physical reasons why some people are prone to weight gain. Until these issues are addressed, weight loss can seem frustrating, even impossible. Second, most people sabotage their dieting efforts with emotional eating. Coming to peace with our relationship with food is often the key to creating change. Third, education about nutrition and effective eating strategies help us make good choices and ultimately take pounds off. This article is the first of a five part series designed to explore these issues.
Why is it that some people seem to be able to eat everything they want and not gain weight, and others seem to pack on the pounds if they look at food? Genetics certainly play a role, but there are other physical issues that you have more control over that should also be looked at. Low thyroid function is sometimes the culprit. The thyroid gland is situated in the front of the neck and produces thyroid hormones that regulate our metabolism. If the thyroid is sluggish, so too is the rest of the body. When the metabolism is low, we don’t burn as many calories, so more are stored as fat (unless the diet is adjusted). Low thyroid function can affect anyone, but is common in menopausal or peri-menopausal women. Symptoms to look for are as follows:
Symptoms of Low Thyroid Function
Low basal body temperature
Cold hands and feet
Lack of energy
Easy weight gain
or difficult weight loss
Depression or anxiety
Dry skin – esp. shins
Dry hair or hair loss
PMS and/or menstrual problems
Fluid retention or leg cramps
Poor concentration / memory
Low sex drive
Carpal Tunnel Syndrome
Digestive problems –
The challenge in dealing with low thyroid function is that our current standard laboratory test, called the TSH test, can sometimes miss cases of mild low thyroid function and many people who don’t show a problem on standard lab tests may still need help to improve thyroid function. The Journal of the American Medical Association published an article on this phenomenon. Naturopathic physicians however assess thyroid function through both laboratory and clinical evaluation.
An often overlooked but related condition is Wilson’s Syndrome. It is a condition where the liver is unable to convert the inactive thyroid hormone, T4, to the more active hormone, T3. T3 is the form of thyroid hormone that actually acts on the cells, so it’s function is crucial to how the body operates. Wilson’s syndrome itself does not alter the thyroid hormone test (TSH and T4) so often goes undiagnosed. It may exist in association with true hypothyroidism but drugs prescribed to treat that condition may not entirely solve the problem. Why does Wilson’s syndrome occur? One reason is that prolonged stress can cause excess adrenal hormones (cortisol) to inhibit the conversion of T4 to T3. As a result, the chemical reactions of life slow down, our bodies are colder and we gain weight more easily.
The first step in an effective weight loss program is to do a thorough evaluation of the thyroid hormones to determine if they are the root of the problem. Naturopathic physicians then routinely recommend nutritional supplements to restore normal thyroid function. As a last resort, pharmaceutical drugs are sometimes necessary and are often used in conjunction with natural medicines to prevent atrophy of the thyroid gland. When the thyroid is working well, not only do people begin to lose weight, they also feel great.
Physical causes – blood sugar regulation
Blood Sugar and the Battle of the Bulge
The battle of the bulge is a war many people fight daily. With so many dieting philosophies out there, how does one decide which strategy is right? As a naturopathic doctor, I have had many patients come to see me, frustrated by their failed diet plans. In fact, some diets can set people up for cravings and bingeing. In order to lose weight and not feel too deprived at the same time, it is crucial to learn how to regulate your blood sugar.
Blood sugar problems can easily set people up for weight gain, especially fat around the abdomen. We often refer to hypoglycemia or low blood sugar, but the lows are usually the result of blood sugar fluctuations caused by the typical Western diet. The body tries to keep blood sugar within a tight range. If we eat high carbohydrate foods like sweets, breads, juices and pasta, the pancreas puts out a lot of insulin to quickly transport the glucose out of the blood into the cells. Because the human body is not intended to have such highly refined carbohydrate meals, it is confused by the onslaught of carbohydrates caused by these highly refined foods. Too much insulin is put out and the blood sugar plummets. That is when we feel the symptoms of low blood sugar such as confusion, lightheadedness and spaciness.
The brain then sends red alert signals to the adrenal glands telling them to produce adrenaline. This adrenaline rush accounts for the other hypoglycemic symptoms of shakiness, sweating, irritability, anger, heart palpitations, anxiety, insomnia and more.
Unless a person is just not eating and is running out of fuel, the most common cause of hypoglycemic symptoms is “reactive hypoglycemia”, or the crash after eating a high carbohydrate meal. Years of this pattern cause the body to have to put out excess insulin; often several times a day. The cells eventually tire of dealing with so much insulin, and insulin resistant diabetes, otherwise known as adult onset diabetes can result. The other health consequence of blood sugar imbalances is weight gain. Insulin is the hormone that tells the body to store fuel in several ways, including storing fuel as fat. The more insulin in a person’s body, the more likely one is to pack on the pounds. So keeping blood sugar down and in a healthy range will help to avoid that weight problem. Dietary control is the key to blood sugar management, and there are vitamins, minerals, herbs and healthy oils that can help too.
Key Steps for Balancing Blood Sugar:
Avoid refined carbohydrates. That means eliminating sugars, sweets, candy, desserts and minimizing fruit juices, breads, crackers and pasta. Increase grains like brown rice, millet and barley.
Eat regularly. Enjoy 3 regular meals a day and 2 snacks
Eat modest amounts of quality, low fat protein regularly (2-4 times a day). Protein provides nutrients and fuel without raising blood sugar. Examples of protein are nuts, seeds, beans, tofu, eggs, fish, chicken, red meat, and wild game.
Include healthy oils like olive oil, flax oil and fish oil daily
Chromium is a trace mineral that has been proven to assist the body to regulate blood sugar and is often deficient in the typical Western diet, but can be taken as a supplement.
Your naturopathic doctor may also recommend supplements to support your adrenal glands.
Recurring blood sugar ups and downs put stress on the adrenal glands and can lead to fatigue and burn out if measures are not taken to control the damage.
Using a strategy of eating whole, healthy foods in a balance of proteins and un-refined carbohydrates, many people lose weight effortlessly and feel more energized. Cravings for sweets and starches quickly fade away, leaving you better able to make healthy choices.
Emotional Eating and Weight Loss
If you know you need to lose weight but have difficulty staying on track to achieve your goals, it may be time to take a deeper look at your relationship with food and with your body. I have had hundreds of patients come to my clinic wanting help to lose weight. Many of them have tried and failed in the past, or lost weight on short term diets that left them feeling deprived, so their weight inevitably rebounded. With each failed “diet” their self-esteem faltered and they had more difficulty trusting themselves and their resolve. When patients tell me they find themselves unable to control their food intake, I know it is time to look at what is really driving the problem. In my personal experience, and with the knowledge gained from helping others to lose weight, I know that a person’s emotional relationship with food and their bodies is the number one factor that can make or break weight loss goals.
Eating well can be an enjoyable part of life, but nutrition needs to be the primary factor in ones food choices in order to achieve good health. When food is primarily a tool to make you feel better emotionally, you will never be able to get enough, and you will be riding the weight roller coaster.
Do any of the following behaviors sound familiar?
You say you want to lose weight, but find yourself raiding the fridge before bed.
You feel guilty after eating, then eat to make yourself feel better.
You sometimes go semi-unconscious and find yourself half way through a chocolate cake.
A stressful day at the office or conflict around the house sends you running to the cupboard for something to make you feel better.
You find yourself obsessing about what you are going to eat and when.
You eat not just for hunger, but for a quick energy boost.
You eat when you are tired, bored, angry, sad, hurt, embarrassed etc.
If you lose weight, you feel uncomfortable with receiving attention, and find yourself eating more.
You’ve read all the books on nutrition, but are unable to give up the “treats” that make you feel good.
If any or several of the above are “you” then you may be experiencing the turmoil of emotional eating and may need a new approach.
When emotional eating becomes a habit, you have entered the realm of addictive eating. I define addiction as the dependent use of a substance or activity to change the way you feel. Discomfort with feelings is the root of all addiction. Learning strategies for dealing constructively with feelings frees you to eat for the right reasons; not for comfort, punishment, social inclusion, safety etc. Here are some key areas to consider in looking more deeply at this issue.
1) Excess weight as a survival strategy:
We are wiser than we think. Sometimes being overweight is a conscious or unconscious strategy to stay safe or avoid pain in some way. Theresa (name changed) was a patient who said she wanted to lose weight, but feared that she would be ridiculed by her sisters and mother, all of whom were overweight. “We are cookin’ and eatin’ women!” was the message from her family. She didn’t want to stand out and make anyone uncomfortable if she lost weight. She had to confront her family patterns and challenge her beliefs about the need to hold herself back to avoid making others feel envious. Until these issues were resolved, any weight loss plan Theresa undertook would surely be sabotaged.
2) Excess weight can also become a survival strategy for women who are uncomfortable with sexual attention. For some women who have been sexually abused, deep down they feel that their extra weight keeps them unattractive to men and therefore safe from unwanted advances. Learning assertiveness skills and even self-defense can be very empowering. Once a woman learns that she has control over her body, she can feel comfortable at a healthy weight. These are not changes that happen overnight. Honor the process as you uncover how weight is serving you.
3) Family of origin patterns:
What were meal times like in your family? Did someone teach you to eat for comfort? Was food a treat for being a good girl/boy? What foods? Was food controlled or overindulged?
Answers to the above questions will shed light on the unconscious patterns and beliefs that may drive your behavior now. Once you are aware of these patterns, you can choose not to let them determine the rest of your life. Achieving and maintaining weight loss requires becoming ever more aware of yourself and your relationship with food. Awareness means that you can be the witness who watches what you are feeling and doing, instead of just blindly consuming and wondering what happened or why lasting change eludes you. Once you are aware and conscious, you can begin to make new choices and employ new strategies that serve your current needs and goals. This is called conscious eating.
The key to conscious eating is to slow down. Before you eat, take three deep breaths. Take that time to check into your body and assess your feelings. Are you drawn to eat for hunger or for emotional reasons? If you are having an emotionally based craving, be resourceful and find another way to deal with your feelings. I spend a lot of time in my practice counselling people on healthy ways to reduce stress and transform their emotional state. If on the other hand you are hungry, take 3 more deep breaths and consciously choose foods that serve your body as a whole, not just your tastebuds. Eat only when you are sitting down and relaxed, not distracted by TV or reading. Enjoy your food and be grateful for the nourishing goodness of whole, natural foods. Conscious eating takes practice and mindfulness, and it can lead you not only to weight loss but also to greater health, vitality and self-awareness.
Top 10 Strategies for Healthy Weight Loss –Part 1 – How to eat
Remember New Year’s Eve? Was this year supposed to be the year of the slimmer and healthier you? If you are still struggling to lose those extra pounds, I want to share with you the safe, common sense principles that have helped many of my patients lose weight. In this article series on weight loss, the first and second installments looked at the physical causes of weight problems such as thyroid and blood sugar disorders. The third article was dedicated to emotional eating. How many people know what to eat, but are unable to stick to the plan? Since emotional eating sabotages most people’s long term weight loss success, the first of my top 10 strategies for healthy weight loss will focus on ways to ensure you will stay on track and achieve your goals. Once we have tackled how to eat, next week we will look at what to eat.
Key Strategies for Weight Loss
#1 Eyes on the Prize: Write down why you want to be at a healthy weight. Do you want to have less joint pain so you can play with your grandchildren? Is it so you will feel better about yourself and have less negative self-talk? Is it to have more energy? You will need compelling reasons why you want to lose weight in order to get through the summer barbecues, Halloween candy, Christmas parties and sometimes just the supermarket checkout!
#2 Conscious Eating: Before you eat anything, take 3 deep breaths. Check in with your self and your body. Listen for what is motivating your desire to eat. Is it hunger or an emotion? If it is an emotion, a craving, or a body sensation other than hunger, keep breathing and find another outlet for your feelings. If it is hunger, then consciously choose nourishing food.
#3 Know your triggers for overeating: Chances are by now you know where the rough spots are. Does boredom send you to the fridge, or do pot-luck dinners result in some serious grazing? Make a plan for dealing with your known trigger situations. Since most diets fall apart when we are under stress, have a list on your fridge of 10 ways to reduce emotional stress without eating. Some good examples are: going for a walk, writing in a journal, reading a spiritual book, talking to a supportive friend, deep breathing, yoga… make your own list.
#4 Menu Plan: Many diet books recommend writing down what you have eaten. This strategy can be a helpful part of conscious eating. However, writing down what you are going to eat is also very important. Knowing there is a plan in place means less impulsive eating. Planning means shopping and cooking are more efficient and you will be more likely to stay on track.
#5 – Eat to 80% full: Many people who have dieted extensively have a “scarcity consciousness” when it comes to food and they feel they have to eat everything now because there may not be food later. Trust that it is okay to eat just enough to feel comfortably satisfied without feeling stuffed. If you do get hungry, don’t panic. If you find yourself saying, “I’m starving”, reframe that survival mode thinking with “I’m hungry, and when the time is right, there will be plenty of healthy food to eat”.
#6 Eat 3 meals a day plus planned snacks: Skipping meals makes conscious eating very difficult. It is hard enough to make good food choices without dealing with the brain fog of low blood sugar. Eat three balanced meals a day, and plan on healthy snacks for mid morning and afternoon. Doing so will keep your blood sugar and energy stable to avoid the temptation to eat sugar for “quick energy”. Nuts like raw almonds make a very good mid afternoon snack.
#7 Eliminate late night eating: In many cultures, the evening meal is quite small, thus not loading up the body with calories it can’t burn in the quiet of the evening. I advocate eating a modest meal in the early evening, brushing your teeth, and forgoing eating for the rest of the evening. This strategy eliminates some of the most disastrous eating patterns – eating in front of the TV and grazing all evening on quick, junk food.
Remember, our food becomes who you are. Let your food serve your health first and your taste buds second. Taking charge of your eating habits is an essential step to taking charge of your health.
Top 10 Strategies for Healthy Weight Loss –Part 1 – How to eat
Over the years we have all seen many diet fads come and go. Whether it’s the grapefruit diet, high carbohydrate diet, the Atkins (low carbohydrate) diet, the blood type diet, the Susan Summers diet, they all promise weight loss results. In my experience, any diet that you go on, you can also go off eventually. Most diets result in short term weight loss at best. How do you get off the roller-coaster of quick fix diets? My first goal is to educate people to understand how understand what the obstacles to long term weight loss are for them. (The previous installments in this article series addressed physical and emotional blocks to weight loss). Only then can they implement the long term eating strategies necessary to maintain a healthy weight.
Good food also takes time to prepare. That time is an investment in your health and that of your family. No one is exempt from the laws of nature that say that humans need real food on a regular basis in order to think and feel well. Healthy food can be pleasurable not only in terms of taste, but also in knowing that you are fueling your body well. When you eat healthy food, you are creating a body that will allow you to get the most out of life. Eating well does not have to be complicated. In fact, it is very simple. The following are not only common sense practices, they are all scientifically validated strategies for optimal health.
#1 Eat a nutritious breakfast: – Eating a healthy breakfast jump-starts metabolism to help you burn calories all day. It also helps you avoid the midmorning crash that can send you running to the coffee and donut cart. To provide stable energy for the morning I recommend having some protein for breakfast (eggs, chicken, fish, beans, tofu, nuts, nut butters, protein powder drinks).
#2 Avoid caffeine: Caffeine in the morning not only increases emotional stress, it causes excess acid secretions from the stomach that simulate hunger and can cause overeating. A few hours after the energy spike of caffeine, your energy will plummet and potentially set you up for eating sugar for “quick energy”.
#3 Eat whole, simple, unrefined foods: Whole foods consist of fruits, vegetables, whole grains (rice), beans and meats, nuts and seeds, and healthy oil like olive and flax oil. Whole foods are full of nutrients and are the foods that nature intended us to eat. Whatever great intelligence created the human body, provided us with exactly the foods and medicines we need right here on the earth. When we refine and package our foods, we destroy needed nutrients and add chemicals, often making the foods more addictive. Refined foods like flour products, store-bought juices, pre-packaged meals, and of course junk food, have less food value per calorie. Learn to enjoy the simple, delicious flavors of natural, unadulterated foods.
#4 Find physical causes of cravings:
a) Food allergies: Many of my patients have lost weight effortlessly by eliminating foods that they as individuals are allergic to. We tend to crave the foods we are allergic to thus setting up over eating. With proper coaching, my patients learn to make healthy substitutes for the foods they are allergic to and they feel much better without them.
B) Candida: A common cause of carbohydrate craving is a Candida yeast overgrowth in the intestine. This imbalance in the intestinal lining is caused by antibiotic use, oral contraceptive and hormone replacement therapy, or excess sugar consumption. Once yeast has taken over the intestine, it has a way of creating carbohydrate cravings to ensure its fuel supply. Yeast overgrowth also can cause digestive dysfunction, fatigue, skin, hormonal and other problems. In my practice I routinely evaluate my patients for intestinal yeast overgrowth and advise them on how to correct this problem. Once balance is restored, cravings quickly dissipate and weight loss is much easier to achieve and maintain. Avoiding sugars and reducing carbohydrates will help prevent and reduce yeast problems, so that is a great place to start. You will quickly be rewarded with fewer cravings and more energy.
#5 – Drink Water
We all know that drinking water is good for us, but did you know it could help you lose weight? Firstly, the body’s signal for thirst can be mistaken for hunger and you may think you need to eat when all you need it water. Secondly, drinking water increases your energy and mental clarity. If you drink lots of water, you’ll be less likely to grab a snack for quick energy. Thirdly, water can be used to fill your stomach until you have time to make a healthy meal, thus avoiding grazing while you cook.
You are now armed with powerful tools to help you lose weight. I look forward to hearing from any readers who wish to share their experiences following reading these articles. In addition, if you wish individual coaching or medical advice, please contact my office.
Naturopathic Medicine – What Patients Can Expect
Naturopathic medicine: What can patients expect?
Naturopathic care—covered by many major carriers—can complement customary clinical practice
Nancy Dunne, ND
President, American Association Naturopathic Physicians, Washington, DC
William Benda, MD
Institute for Children, Youth, and Families, University of Arizona
Linda Kim, ND
Medical Director, Southwest College Research Institute, Southwest College of Naturopathic Medicine, Tempe, Arizona
Paul Mittman, ND
President, Southwest College of Naturopathic Medicine
Richard Barrett, ND
National College of Naturopathic Medicine, Portland, OR
Pamela Snider, ND
Managing Editor, Foundations of Naturopathic Medicine; Adjunct Faculty; Bastyr University; Executive Director, Academic Consortium for Complementary and Alternative Health Care
Joseph Pizzorno, ND
President emeritus, Bastyr University
Patients who inquire about naturopathy will want to know that clinical tools typically include nutrition evaluation and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.
Advise patients who wish to seek naturopathic care to contact the state licensing authority to learn the scope of naturopathic practice allowed in their local area.
Naturopathic physicians (NDs) diagnose and treat conditions typically seen in a “first contact” setting. They are not trained in the advanced use of highly technical conventional therapies for life-threatening diseases. Rather, they focus primarily on health issues encountered in out-patient ambulatory care settings (see Naturopathic training).
Though some tools of naturopathic practice differ from those of conventional practice, the goals of naturopathic medicine parallel those of family medicine in providing for and maintaining the well-being of both the patient and the healthcare system as a whole.
Collaboration is growing between conventional and naturopathic communities to examine the safety and efficacy of naturopathic medicine in preventing and managing a broad range of common conditions, and to determine whether availability of naturopathic services will improve patient health in a cost-effective manner.
Naturopathic approach to one patient’s case: A summary
Martha S., a 39-year-old Asian-American
Presenting complaint: Has not felt well since onset of light-headedness, fatigue, muscle pain, and lassitude 4 years earlier/muscle tightness or tension and achiness come and go, often relieved by chiropractic treatment/some fuzzy cognition/dry gritty feeling in back of eyes/decreased libido/intermittent heart palpitations/sadness, easy weeping in conjunction with menses, lessens somewhat with St John’s Wort/disturbed, unrefreshing sleep 4 out of 7 days/body pain worse on waking
Three normal births and 3 spontaneous abortions with anticardiolipin antibodies that resolved after pregnancy/2 D&Cs, no other surgery/incidental finding of partially empty sella tursica on MS MRI investigation
Extensive specialty workups since 2001 have ruled out disease/internist who coordinated specialty consultations favors diagnosis of generalized anxiety disorder/some improvement with low doses Celexa, but unacceptable side effects (same with Effexor)/has tried amitriptyline/husband travels and she is uncomfortable with a “drugged sleep” when alone with the children
Fell off horse as teenager/no other physical injury or significant viral or bacterial illness/job exposes her to adversarial atmosphere and also requires occasional extensive hours at keyboard/infertility issues; experience of foreign adoption was a prolonged stressor
Maternal aunt and grandmother had breast cancer age 50+; both survivors/paternal grandmother had stroke/father had postoperative DVT
1–2 glasses wine/week; recreational drug use over 10 years in past/no regular exercise/attorney for city/married 11 years; husband 48, Euro/American, smokes, on anti-HTN medication/adopted sibs from Korea 1 year ago, 5-yr-old girl, 2-year-old boy, some malnutrition, parasites, now recovered
Patient is pleasant, articulate/no active disease/5’8”, 128#, BP 128/62, P 82/findings normal for HEENT, neck, chest, heart, abdomen, extremities, neurology, and skin/tender trigger points at bilateral trapezoids, paraspinal to subscapular, upper third gluteal and at hips
extensive records provided, essentially normal, none since 11/2003
Sensitive to drug side effects, but no known drug allergies
Management plan discussed with patient
In absence of other underlying disease, would like to treat you for fibromyalgia syndrome from long-term professional and personal stress/will work to recover your system from the physiologic effects of tension, worry, and hard work over past decade/if progress unsatisfactory after 3 months, we will revisit the diagnosis
Plan is to restore-rejuvenate your body, which knows how to right itself/think 6 months to a year for full recovery, after which you will have new knowledge of yourself and tools to maintain
your well-being/details of the plan will shift as you recover and learn to use developing self knowledge to protect yourself during new challenges/flexibility and resilience are key and develop continually from self awareness/note what works for you and what doesn’t
Hypoallergenic, whole-foods; small, frequent meals/adjust eicosanoid balance to increase systemic circulation, musculoskeletal flexibility, and cellular repair (patient given background article)/decrease production of pain-signaling chemistry, swelling that presses on nerves and creates the sensations of pain and stiffness; avoid sweets and refined carbohydrates, in order to maintain steady blood sugar levels
Use serotype diet (diet printed for patient) for the next 6 weeks/stick with best foods; dip into OK foods as little as possible/whet appetite for best food by “selfishly” focusing on your recovery/invite family to share meals, but primary purpose is your recovery; this can be hard for a mom to pull off; please invite your husband to call me if I can help him understand how he can enable you accomplish goal
Possible further steps
(see online version for details of action steps):
Support/restore digestive tract: May not be making optimal gastric acid and other digestive factors as a result of long term stress stealing circulation away from those tissues that produce it.
Eliminate simple sugars and refined flour products: Will help reduce pain/simple sugar creates hypoglycemic episode that can be experienced as nameless anxiety, weakness, fatigue, and dizziness/stable blood sugar essential for sense of well-being/eat pears, berries, or nuts if you need dessert.
Exercise: Aerobic exercise 45 to 60 minutes, 3 or more times/week
Sleep: Melatonin 250 μg to 500 mcg 30 or so minutes before bedtime/Deeper, assisted sleep will help, and you can adjust dosages to keep head clear in morning.
Fundamental supplementation: For general well being, including fish oils, vitamins, and minerals.
Adrenal recovery formula: We can presume your endocrine system has been affected by perceptions of threat (anxiety as related to the mystery of your physical pains) as well as long-term pain/recommend adrenal function test, to more closely determine optimal timing and doses of raw material that supports adrenal function
Generalized anxiety disorder: your internist is convinced of this diagnosis; let’s discuss.
Over 2 months: Sleep improved; trigger point pain diminished in upper body (by 30%), in gluteal and hips (80%)/able to manage diet “70% to 80% of the time”/exercise 3 to 5 times weekly, less when husband travels
Vacation interlude: Treatment plan jettisoned for vacation/return of rheumatic symptoms; dizziness and lassitude, however, continued to improve
Next 2 months: Continued improvement, with trigger point pain flaring only on long drives
Naturopathic physicians graduate from 1 of 6 naturopathic medical schools accredited by the Council on Naturopathic Medical Education (CNME) (TABLE 1). The CNME is a member of the Association of Specialized and Professional Accreditors recognized by the US Department of Education. Each school in the United States is also accredited by, or has candidacy status through, the specific regional agencies responsible for overseeing postsecondary institutions of higher learning.
Requirements for admission. The goal of naturopathic medical education is to prepare clinicians for the challenges of general practice, with a foundation in current medical science as well as traditional naturopathic theory. Candidates for admission to naturopathic medical school must earn a baccalaureate degree (or equivalent) prior to matriculation, including standard premedical undergraduate courses.
Naturopathic curricula. Subjects include inorganic and organic chemistry, physics, general biology and psychology. Other coursework is comparable to that of allopathic and osteopathic medical schools (TABLE 2). While the first 2 years of education combine courses in naturopathic principles with basic and diagnostic sciences, third and fourth year students focus on clinical practice, receiving training at naturopathic primary care outpatient clinics as well as conventional medical facilities (TABLE 3). Academic faculty at such institutions include NDs, PhDs, MDs, DOs, and other allied health professionals.
For information on postgraduate residencies, research, and collaborative opportunities for NDs, please see APPENDIX I. For additional information on naturopathic licensure, please see APPENDIX II.
Practice principles of Naturopathic Medicine – What Patients Can Expect
Naturopathic medical practice is based upon the premise that it is intrinsic to the nature of living organisms to heal. The naturopathic physician understands illness to be a disruption of normal orderly function. Healing therefore is the process by which living systems return to a resilient equilibrium, either unassisted or with the therapeutic support of the practitioner.
Standard review of systems is supplemented with patient reports of dietary habits, physical activities, etc
Western medicine rarely takes into consideration the inherent organizing forces underlying known physiologic processes such as metabolism or tissue repair. Naturopathic medicine calls this primary principle the vis medicatrix naturae, or the healing power of nature.
Another principle fundamental to the can complement customary clinical practice restoration of health is the understanding that any intervention employed should not further disrupt a system attempting to regain homeostasis. This is expressed as primum non nocere, the imperative to first choose interventions which do the least harm.
When confronted with an ill patient, the naturopathic physician seeks to understand the totality of fundamental causes disrupting the patient’s optimal equilibrium. In order to remove the cause of the illness (tolle causum), one must treat the whole person.
In pursuit of removing or moderating the insults and stressors that result in harm to the patient, the doctor becomes teacher (docere) and engages the patient in the essential responsibilities of self-care. Participation in the restoration of personal wellbeing prepares the patient to behave proactively in the future, when mutual efforts at prevention predominate in the physician-patient relationship.1
Although these practice principles form the foundation of the naturopathic approach to health and healthcare, the philosophic and conceptual approaches of conventional medical theory apply as well, including complexity science, quantum physics, medical ecology, public health, energy medicine, and the biological basis of healing. The above principles do not replace the foundation of biological pathology, but offer the practitioner an expanded perspective when treating each individual patient. Naturopathic medicine ascribes to a therapeutic hierarchy that integrates the full spectrum of modern biomedicine in a continuum that includes mental, emotional and spiritual therapies, as appropriate to each patient’s needs.2 Applied in this context, biomedical interventions are highly valued as both diagnostic and therapeutic approaches.
NDs often work with physicians to co-manage patients and help decide when to refer for evaluation by other practitioners
Clinical approach to patients
The ultimate goal of each clinical assessment is to obtain an in-depth understanding of the patient’s underlying condition (including his or her experience) and to effectively communicate relevant information to other healthcare providers participating in the patient’s care.
Essential to a comprehensive evaluation is the extended interview, which ranges from 60 to 90 minutes for new patients. Follow up visits range between 30 and 60 minutes. A standard review of systems is supplemented with patient-generated reports of daily activities, such as dietary habits, physical activity, and psychological issues (see Naturopathic approach to one patient’s case). NDs perform physical examinations appropriate to the patient’s presenting complaint and health history, and employ conventional laboratory and diagnostic imaging services as needed. Clinical evaluation is patient-centered and addresses a full range of factors that influence health as well as illness, generating a problem-oriented patient record based on International Classification of Diseases (ICD-9) criteria.
Modalities most often used in naturopathic practice include clinical nutrition and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.
Scope of practice. Depending on local licensure statutes, naturopathic physicians may be fully recognized as primary healthcare providers.3 Prescriptive authority varies, as do provisions for other procedures commonly associated with general medical practice.4
Details of the scope of naturopathic practice in each licensed jurisdiction can be accessed by contacting local licensing authorities, usually via a state or provincial agency website. In the majority of jurisdictions, licensed NDs are responsible for all public health regulations including reportable diseases and immunizations. Most ND practice acts require annual continuing education credits to maintain practice privileges.
Interdisciplinary collaboration. NDs are trained to recognize serious and life-threatening situations and to identify conditions outside of the scope of their professional or legal limitations. Appropriate referral mechanisms are indoctrinated during educational and clinical training. NDs often work with conventionally trained family practice physicians, internists, and specialists in co-managing patients, participating in decisions regarding referral for evaluation and treatment by other allopathic and complementary/alternative medicine practitioners.
Safety and effectiveness of naturopathic medicine
Naturopathic practice is distinguished by treatments individualized to a patient’s physical condition and environmental circumstances, requiring combination therapies adjusted over time as guided by patient response. Documenting the safety and efficacy of naturopathic interventions presents significant challenges—eg, the limitations of the reductionistic approach of allopathic research models when applied to complex interventions and inadequacy of available funding sources. Research on the clinical and quality of life outcomes, particularly evaluation of the actual, complex whole practice as opposed to single agent or specific modalities, is relatively scant.5
Responding to this challenge, in 2002 the NIH funded more than 1200 scientists and physicians from both conventional and naturopathic academic and professional communities in a 2-year effort to design the Naturopathic Medical Research Agenda (NMRA). Guided by the NMRA process, the research departments of naturopathic academic centers are systematically developing the collaborative infrastructure required to examine the theory and practice of naturopathic medicine.6 The recently inaugurated International Journal of Naturopathic Medicine (available at www.intjnm.org) provides access to naturopathic-specific, peer-reviewed research.
Documentation of safety is as relevant as documentation of efficacy. As the potential for harm does exist within the naturopathic scope of practice,7 licensure in the US requires that adverse medical events be reported to the federally mandated
National Practitioner Databank.8 The disciplinary records of naturopathic licensing boards provide scrutiny of practices regulated in those jurisdictions as well as documentation of specific offenses: over a 10-year period (1992–2002), 173 complaints were filed with state licensing boards from a total of 1805 licensees. During this period, 31 disciplinary actions were initiated, ranging from probation to fines or censure.9
Increasingly, NDs are covered as specialists and primary care providers under corporate reimbursement plans
Safety and efficacy are also of concern to third-party payers. More than 70 companies, trade unions, and state organizations offer health plans that cover naturopathic medical services,10–11 requiring utilization reviews incorporating documented patient outcomes. As NDs are increasingly covered as specialists and primary care providers under reimbursement plans of corporations such as Microsoft and Boeing, the credentialing processes required by their insurers (such as Blue Cross and Blue Shield, Kaiser Permanente, Connecticare, Oxford, and Healthnet) result in formal analyses of safety and efficacy of practice. Malpractice insurance industry data also verify incidents of harm that may occur related to naturopathic practice.
More about naturopathy
To access more in-depth information, including how to identify licensed NDs in a particular geographic area, contact the American Association of Naturopathic Physicians at www.naturopathic.org.
For information on naturopathic medical education, particularly the advanced standing programs available to degreed professionals, contact the American Association of Naturopathic Medical Colleges at www.aanmc.org.
An additional resource for degreed medical professionals interested in naturopathic professional practice is the website for the North American Board of Naturopathic Examiners at www.nabne.org.
The advent of integrated care has resulted in staff privileges granted to NDs at approximately 20 conventional hospitals and numerous integrated clinics. As a result, efficacy of peer review is strengthened as payers elect naturopathic medical directors to peer advisory committees charged with formulating reimbursement and case management policies.12
Snider P, Zeff J. Report of the Select Committee on the Definition of Naturopathic Medicine. Washington, DC: AANP; 1988.
Micozzi M. Fundamentals of Complementary and Alternative Medicine. 2nd ed. Philadelphia, Pa: Churchill-Livingstone; 2001;181–183.
Kim L, Mills E. Physicians’ Information and Education Resource (PIER). Naturopathic Medicine, American College of Physicians; American Society of Internal Medicine July 1 2003.
Hough H, Dower C, O’Neill E. Profile of a Profession: Naturopathic Practice. San Francisco, Calif: Center for the Health Professions, University of California, San Francisco; 2001;27.
Standish LJ, Calabrese C, Snider P. The Naturopathic Medical Research Agenda: The Future and Foundation of Naturopathic Medical Science. Kenmore, Wash: Bastyr University Press; 2005;10.
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