A-Z WHAT WE TREAT

Naturopathic functional medicine specializes in treating the whole body. So when people ask us “What do we treat?” we say “We treat people!” But here’s some information on a naturopathic approach to some of the more common health concerns that people we see have.

Acid Reflux - Gastroesophageal Reflux Disease

 

Gastroesophageal reflux disease (GERD) is a disorder in which contents of the stomach or small intestine repeatedly move back up into the esophagus (tube connecting the throat to the stomach). This regurgitating action is called reflux. Reflux causes heartburn. Substances in the digestive juices from the stomach (namely, acid, pepsin, and bile) move up into the esophagus and can damage the inner lining. Although it is common to think this is due to too much stomach acid and acid blockers tend to be the pharmaceutical used to treat the symptoms, we know it is actually due to too little stomach acid, the acid is just in the wrong place.

 

A naturopathic approach to treating someone with acid reflux would be to remove all sabotaging eating habits and foods, repair the stomach and intestinal barrier to reverse the regurgitating action and over time add in specific clinical nutrients to help the body produce a healthy amount of stomach acid, pepsin and bile.

 

 

Alzheimer's Disease

Adapted from the book “BrainRecovery.com” by David Perlmutter, MD Board-Certified Neurologist

At present, approximately 4.5 million Americans have Alzheimer’s disease. By the year 2030, it has been estimated that this number will approach 9 million. Prevalence of Alzheimer’s disease has been estimated to be 50% in individuals 85 years or older—the most rapidly growing segment of our population. Costs associated with treatment and management of Alzheimer’s disease are high, but the emotional costs borne by families and caregivers are immeasurable. In a recent issue of Archives of Neurology (June 1999), the lack of usefulness of the drugs used to treat Alzheimer’s was eloquently described in a guest editorial by Dr. William Pryse-Phillips.

Our society focuses on treating medical problems with precious little attention paid to disease prevention. But it seems appropriate to first explore some of the emerging theories surrounding the causes of Alzheimer’s disease.

Electromagnetic Fields

In these days of hand-held cellular phones, personal computers, and an abundance of other electronic devices, the general public seems to be at least marginally concerned about the possible health risks of electromagnetic radiation exposure as evidenced by articles appearing not only in alternative medical publications, but in mainstream journals as well. In 1995, the American Journal of Epidemiology, researchers at the University of Southern California School of Medicine confirmed a direct relationship between occupations exposing individuals to higher levels of electromagnetic radiation and the risk of developing Alzheimer’s disease. The December 1996 issue of Neurology, revealed a substantial increased risk of developing Alzheimer’s disease in individuals whose occupations exposed them to higher than average levels of electromagnetic radiation.

Aluminum

Another generally unnoticed but certainly important risk factor for the development of Alzheimer’s disease is exposure to aluminum. The science relating to Alzheimer’s and aluminum appears in our most highly respected medical journals. Reporting in the journal Neurology in 1996, researchers from the University of Toronto found an astounding 250% increased risk of Alzheimer’s disease in individuals drinking municipal water high in aluminum, for a 10 or more year period of time. “The findings from epidemiological studies, coupled with the large body of

experimental evidence of aluminum neurotoxicity and elevated concentration in the Alzheimer’s disease affected brain, argue that priority should be given to consideration of lowering, and maintaining, acceptable limits of residual aluminum. One could certainly argue the rationale for reducing aluminum exposure “particularly for older age groups at risk for Alzheimer’s disease” since aluminum accumulates over many years regardless of age, and we will all be members of the “older age group” eventually.

 

Medications high in aluminum include many buffered analgesic products. See the following list for additional aluminum containing medications.

  • Acid-X • Maalox Plus Extra Strength tablets• Alenic Alka tablets • Maalox Plus tablets• Alkets tablets • Maalox tablets• Almacore tablets • Marblen tablets• Calglycine Antacid • Megalox tablets• Duracid Tablets • Mi-Acid gelcaps• Extra Strength Alenic Alka tablets • Mintox Plus tablets• Extra Strength Genaton tablets • Mintox tablets• Extra Strength Maalox tablets • Myalgen gelcaps• Foamicon tablets • Mylanta Double Strength tablets• Gaviscon Extra Strength Relief Formula Tablets • Mylanta gelcaps• Mylanta • Gaviscon tablets• RuLox #1 tablets • Gaviscon-2 Double Strength tablets• RuLox #2 tablets • RuLox Plus tablets• Gelusil tablets • Tempo tablets• Genaton tablets • Titralac Extra Strength tablets• Titralac tablets

Homocysteine

In The Lancet, May 8, 1999, from the Department of Neurology and Clinical Chemistry at the University of Heidelberg, researchers revealed that the second most frequent cause of dementia in the elderly population after Alzheimer’s disease was so called “vascular dementia”, or brain dysfunction as a consequence of disease of the small blood vessels. What was more striking was the finding of elevation of a particular chemical in the blood of these individuals called homocysteine. The conclusion of the report provided very strong support for the effectiveness of dietary supplementation with the B-complex group of vitamins in terms of reducing risk of

dementia.

Insulin

Along the same lines as homocysteine is elevated insulin caused by chronic elevated blood sugars and the end result is inflammation…in the brain. Alzheimer’s is now considered the 4th arm of cardiometabolic syndrome which includes obesity, type II diabetes and cardiovascular disease. Dementia’s in general cost the health care system more than either cancer or cardiovascular disease in 2012.

 

A naturopathic approach to treating someone with Alzheimer’s disease depends on what I think may be contributing to the underlying cause(s) of their disease. For some I may suspect aluminum toxicity and will recommend a toxic element test and help their body detoxify the offending toxins. For other’s I may test their insulin response and recommend an anti-inflammatory diet and clinical nutrition to repair their insulin receptors. For other’s I may recommend anti-oxidant support using specific nutrients that can cross the blood brain barrier and show efficacy in brain cell health.

Attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect between 3% and 5% of school-aged children. The core symptoms of ADHD include inattention, hyperactivity, and impulsivity. Although many people occasionally have difficulty sitting still, paying attention, or controlling impulsive behavior, these behaviors are so persistent in people with ADHD that they interfere with daily life. Generally, these symptoms appear before the age of 7 years and cause significant functional problems at home, in school, and in various social settings. One- to two-thirds of all children with ADHD (somewhere between1% and 6% of the general population) continue to exhibit ADHD symptoms into adult life. Diagnosis is difficult, but from a naturopathic perspective, we don’t get too focused on the diagnosis, but most focused on the underlying cause of their inability to focus and relax their body.

 

A naturopathic approach to treating someone with ADD/ADHD depends on other factors that may give me insight as to what may be contributing to their symptoms. For some, I’ll do food sensitivity testing, for other’s a gut restoration program, for other’s I may support the adrenal glands, for other’s I may test their neurotransmitters being excreted in the urine and use clinical nutrition to help the individual rebalance there neurotransmitters.

Autoimmune Diseases

Examples of autoimmune conditions include the following:

  • Rheumatoid arthritis (RA) • Lupus (e.g., systemic lupus erythematosus [SLE])
  • Type 1 diabetes • Inflammatory bowel disease (IBD)• Crohn’s Disease • Ulcerative Colitis
  • Hashimoto’s thyroiditis • Grave’s disease• Neurological diseases • Myasthenia Gravis

is now widely accepted that tight junction dysfunction, commonly referred to as “leaky gut”, plays a role in the pathogenesis of several diseases, particularly autoimmune diseases.

Emerging scientific findings from mucosal biopsies of IBD patients have shown altered expression of critical tight junction proteins, possibly due to the effects of pro-inflammatory cytokines on barrier integrity. This suggests a vicious cycle is created , in which increased intestinal permeability allows further leakage of intestinal contents, contributing to a pro-inflammatory immune response on intestinal tissue that in turn promotes further gut leakiness.

Microflora Balance

A healthy intestinal tract harbors a large variety of beneficial microflora, or “friendly” bacteria, residing in close proximity to rapidly renewing intestinal epithethial cells and other components of the mucosal immune system. Components of beneficial microflora are essential to maintain a balanced immune and inflammatory response; when this balance is disrupted, excessive immune activation could pose a risk to the development of intestinal or systemic inflammation.

A naturopathic approach to treating someone with an autoimmune disease, certainly depends on the autoimmune disease and mostly on the person who has it. Regardless, since it is an immune disorder, a good place to start is with the immune system – 60%-70% of which is in the gut. Often a modified elimination diet along with a gut restoration program is recommended along with clinical nutrition to help rebalance the immune system and put health back in the body to support the resolution of symptoms or minimize progression. Autoimmune disease is considered to be an inflammatory disease, so strict focus through food, movement, stress and trigger elimination, herbals and nutrients that support an anti-inflammatory environment are often prescribed.

Cancer

There are many theories as to the cause of cancer, all of which I think have the potential to play a certain role in one or many types of cancer, but I do not believe there is just one thing that causes all cancers. Although there is not one accepted number as to the percentage of cancers that are genetic, it is generally accepted that a good estimate is 5%-10% of all cancers are genetic in cause. When I see/hear of cancer in young children, it is usually a genetic driven cancer. In most adults cases, cancer is environmentally driven and the estimates are that what we eat contributes to 30% – 35% risk of cancer, smoking 25%-30, infections 15%-20%, obesity 10%-20%, alcohol 4%-6%, miscellaneous 10%-15% (like electromagnetic fields, chlorinated water, pharmaceutical use…).

A naturopathic approach to treating someone with cancer of course depends on the type of cancer, what we thing may have contributed to your cancer and what conventional treatment you will/have chosen to do. I let the oncologist treat your cancer, and I help you protect your health cells and boost your own body’s ability to keep the cancer in check. I request a battery of tests that will help track key biomarkers we see associated with health changes. Although consider fairy new research, there are now plenty of studies showing the efficacy of natural treatment along with conventional treatment of cancer for better outcomes. In fact in 2014 the largest-ever North American grant of 3.85 million dollars to research the effectiveness of naturopathic medicine in conjunction with conventional medicine was rewarded to researchers in Ottawa, Canada. Some key things on my list I run through with each case is: the need for EPA DHA, are there signs of inflammation, are there signs of low ATP production and mitochondrial damage, are there signs of parasites or other infections, I research top tissues and organs your type of cancer may metastasize to and we keep those cells as healthy as possible, I test for anemia and treat accordingly, I test for specific genetic SNP’s that may be associated with your type of cancer and use clinical nutrition to change the expression of those genes, your immune system is strongly supported with herbal, mushroom and specific vitamins and mineral combinations, anti-oxidants are often recommended, proteolytic enzymes may be recommended, a no/low sugar, alkalizing, ketogenic meal plan is co-created with you and the lifestyle educator is always recommended and is considered the first line of defense against “feeding” the cancer.

 

Canker sores

Apthous stomatitis is the “medical” term for the mysterious sores that most people have experienced at least once in their life. It is inflammation of the oral mucosa due to local or systemic factors which may involve the buccal mucosa, palate, tongue, floor of the mouth, and the gingivae. The most common contributing factors I have seen in my clinic are food sensitivities, especially gluten, dairy and sugar, sodium lauryl sulfate sensitivity which is found in toothpast (when individuals with canker sores changed to a tooth paste that did not

contain sodium lauryl sulfate, the number of aphthous ulcers fell by 64%), a weakened immune system due to a chronic low grade infection or food sensitivities, and trauma to the tissue like when you “bite your tongue” , braces rubbing etc.

 

A naturopathic approach to treating someone with canker sores is to find out what the underlying cause is. Since food sensitivities seem to be the number one contributor from what I’ve seen, I may recommend a food sensitivity test or a modified elimination diet. I may recommend oil pulling if a bacterial overgrowth is suspected or a gut restoration program since the food tube starts in the mouth.

Cataracts

Cataracts are clumps of protein that collect on the lens of an eye and interfere with vision. Normally, light passes through the lens (the clear tissue behind the pupil) and focuses on the retina. The retina is the light-sensitive layer of the eye that sends visual signals to the brain. A cataract occurs when the normally clear lens becomes cloudy. Most cataracts develop slowly over time and are a natural result of aging. Once cataracts become large enough that vision loss interferes with everyday activities such as driving, reading, or watching television, they

should be surgically removed. Signs and symptoms include decreased or blurred vision (often described as a “fog”) double vision, halo around lights, “Second sight” – when an individual who normally wears reading glasses can suddenly read without them, brown spots in the visual field. It is not clear what causes these proteins to clump together, but some researchers speculate that cataracts may develop as a result of chemical changes in the lens that occur with aging. Other researchers believe that there may be several causes of cataracts, including smoking, diabetes, and excessive exposure to sunlight, or in summary – any free radical damage to the eye will cause the proteins to clump faster.

 

A naturopathic approach to treating someone with cataracts is to investigate which free radicals they’ve had most exposure to that may have contributed to their cataract formation. Then specific antioxidants may be prescribed to help minimize further progression of the cataracts.

Common Cold

The common cold is an upper respiratory infection caused by a virus. In the United States, adults have between 3 and 6 colds a year, and children have as many as 8 to 10. Signs and symptoms include sneezing and runny nose from nasal congestion, sore throat, cough, hoarseness, fever (102 F or lower), headache, and overall grumpiness. More than 200 different types of viruses cause colds. You can get a cold by touching a person with a cold, colds are also

transmitted through the air. Exposure to cold outdoor air and fatigue do not make you more likely to get a cold, although psychological stress may. People more likely to get colds include if they under 12 years old and over 65 years old, children who have parents who smoke, children who attend day care, smokers and those exposed to second hand smoke, those exposed to industrial smoke, toxic fumes, or other air pollutants, people with immune system disorders, like HIV, AIDS, or cancer, or compromised immune function, like those taking steroids for a long time, people under a fair amount of stress.

Colds generally go away on their own after about 7 to 10 days, although there are certain things that you can do to shorten the duration and minimize the symptoms as you work through your infection. As well, there are a few things that you can do that may help improve your immune system and make you less susceptible to getting colds: Exercise regularly, eat a proper diet rich in fruits and vegetables and low in unhealthy trans and some saturated fat, get sufficient rest at all times, minimize your stress and your reaction to stress. Wash your hands frequently, especially after coming into contact with someone who has a cold.

 

A naturopathic approach to treating someone with a cold includes various combinations of clinical nutrition to boost the immune system, botanical medicine to boost the immune system and minimize symptoms, essential oils and homeopathic remedies to resolve the symptoms as quickly as possible. Lifestyle changes such as eliminating sugar and dairy from you diet for the period of time your immune system is fighting the “bug”, getting adequate sleep and rest, taking hot, hot baths nightly, steam inhalation, Chinese wet sock treatment and drinking hot fluids, are regularly recommended.

Depression

Depression is a major problem in the United States. Nearly 15 million Americans will suffer true clinical depression each year. Depression is also a big business for drug companies, especially for the maker of Prozac—Eli Lilly and Company. The good news is that there are natural measures to deal with depression that are both safer and more effective.

Prolonged, persistent depressed mood may be accompanied by one or more of the following: poor appetite, increased appetite, insomnia, excessive sleeping, fatigue, hyperactivity, constant nervousness (jitters), decreased sexual drive, feelings of low self-esteem, inability to concentrate, or recurrent suicide compulsion. The presence of five or more of these symptoms definitely indicates depression. Most of the health problems of Americans are related to lifestyle and dietary practices. Depression is no different. At the root of many cases of depression is an addiction to nicotine, caffeine, and other stimulants. According to Joseph Beasley, M.D., the primary investigator involved in the famous Kellog Report: The Impact of Nutrition,

Environment, and Lifestyle on Illness in America, the United States is a nation of addicts. In many instances, people claim that they smoke, drink alcohol, or take drugs because it calms them. In reality, these substances actually complicate matters. The relaxation or chemical high from these drugs is short-lived and ultimately leads to adding even more stress to the system. Individuals suffering from depression or other psychological conditions would greatly benefit from the cessation of smoking, drinking alcohol, and ingesting coffee and other sources of caffeine.

Smoking and depression: Cigarette smoking is a significant factor in depression. Central to the effect of nicotine is the stimulation of adrenal hormone, including cortisol, secretion. Elevated cortisol levels are a well-recognized feature of depression. One of the key effects of cortisol on mood is related to activating an enzyme (tryptophan oxygenase). When activated, this enzyme results in less tryptophan being delivered to the brain. Since the level of serotonin in the brain is dependent upon how much tryptophan is delivered to the brain, cortisol dramatically reduces the level of serotonin and melatonin. In addition, cortisol also “down regulates” serotonin receptors in the brain, making them less sensitive to the serotonin that is available. Smoking also leads to a relative vitamin C deficiency, as the vitamin C is utilized to detoxify the cigarette smoke. Low levels of vitamin C in the brain can result in depression and hysteria.

Alcohol and depression: Individuals with depression would do best to avoid alcohol. Alcohol is a brain depressant. It also increases adrenal hormone output, interferes with many brain cell processes, and disrupts normal sleep cycles. Alcohol ingestion also leads to hypoglycemia. The resultant drop in blood sugar produces a craving for sugar because it can quickly elevate blood

sugar. Unfortunately, increased sugar consumption ultimately aggravates the hypoglycemia. Hypoglycemia aggravates the mental and emotional problems of the alcoholic.

Caffeine and depression: Caffeine is a stimulant. People prone to feeling depressed or anxious tend to be especially sensitive to caffeine. The term “caffeinism” is used to describe a clinical syndrome similar to generalized anxiety and panic disorders that include such symptoms as depression, nervousness, palpitations, irritability, and recurrent headache. The intake of caffeine has been positively correlated with the degree of mental illness in psychiatric patients. In other words, the more caffeine that is consumed the greater the mental illness in these patients. The combination of caffeine and refined sugar seems to be even worse than either substance consumed alone. Several studies have found an association between this combination and depression.

Exercise and depression: Regular exercise may be the most powerful antidepressant available. Various community and clinical studies have clearly indicated that exercise has profound antidepressive effects. These studies have shown that increased participation in exercise, sports, and physical activities is strongly associated with decreased symptoms of anxiety (restlessness, tension, etc.), depression (feelings that life is not worthwhile, low spirits, etc.), and malaise (rundown feeling, insomnia, etc.). Furthermore, people who participate in regular exercise have higher self-esteem, feel better, and are much happier compared to people who do not exercise. Much of the mood elevating effects of exercise may be attributed to the fact that regular exercise has been shown to increase the level of endorphins. When endorphin levels are low, depression occurs. Conversely, when endorphin levels are elevated, so is one’s mood. There have been at least 100 clinical studies where an exercise program has been used in the treatment of depression. It was concluded that exercise can be as effective as other antidepressants including drugs and psychotherapy. More recently, even stricter studies have further demonstrated that regular exercise is a powerful antidepressant. The best exercises are either strength training (weight lifting) or aerobic activities such as walking briskly, jogging, bicycyling, cross-country skiing, swimming, aerobic dance, and racquet sports. The important thing is to train with an intensity that will keep your heart rate in the training zone.

Nutritional factors in depression: There are a number of important nutritional factors to consider in the depressed individual. First of all, since the brain requires a constant supply of blood sugar, hypoglycemia must be avoided. Symptoms of hypoglycemia can range from mild to severe, and include such things as depression, anxiety, irritability, and other psychological disturbances; fatigue; headache; blurred vision; excessive sweating; mental confusion; incoherent speech; bizarre behavior; and convulsions. The association between hypoglycemia and depression is largely ignored by most physicians—they simply never even consider it as a possibility, despite the fact that several studies have shown hypoglycemia to be very common in depressed individuals. There is no explanation for this oversight by so many physicians, especially since dietary therapy (usually simply eliminating refined carbohydrates from the diet) is occasionally all that is needed for effective therapy in patients that have depression due to reactive hypoglycemia. In addition to glucose, the brain also requires a constant supply of other nutrients. It is a well established fact that virtually any nutrient deficiency can result in impaired mental function. To function optimally the human brain requires virtually every known nutrient. Correcting an underlying nutritional deficiency can restore normal mental function and relieve depression. However, according to Dr. Werbach, the leading expert in the field of nutrition

and mental function, “Even in the absence of laboratory validation of nutritional deficiencies, numerous studies utilizing rigorous scientific designs have demonstrated impressive benefits from nutritional supplementation.” A high potency multiple provides a good nutritional foundation upon which to build. When selecting a multiple vitamin and mineral formula it is important to make sure that it provides the full range of vitamins and minerals at high potency levels. Deficiencies of a number of nutrients are quite common in depressed individuals. The most common deficiencies are folic acid, vitamin B12, and vitamin B6. According to research published in Lancet and Arch Gen Psychiatry, the genetic inablity to efficiently convert folic

acid into its two active forms (L-5-MTHF and 5-Formyl THF) is associated with anxiety and depression.

Endocrine and neurotransmitter imbalances may be contributing. The adrenal glands and sex hormones when hyper or hypo may contribute to symptoms of depression. Once balanced, moods return to a more happy state. Neurotransmitter such as serotonin, melatonin, dopamine play an important role in mood dysfunction.

 

A naturopathic approach to treating someone with depression starts first with modifying lifestyle behaviors that may be contributing to their depression. Clinical nutrition, botanical medicine, essential oils and homeopathic may also be prescribed to address underlying causes such as poor sleep, poor digestion, blood sugar dysregulations, candida over-growth or dysbiosis, hyper or hypo coritisolemia, thyroid dysfunction, sex hormone dysregulation, and to enhance gene expression of those gene participating in the role of neurotransmitter balance

Ear Infection (Otitis Media)

Acute otitis media is a viral or bacterial infection of the middle ear, usually secondary to a URI. It is most common in children six to 36 months old and then again at 4-7 years old. It is the most frequent diagnosis of children in a clinical setting, and it is estimated that about 2 billion dollars spent each year for conventional medical and surgical treatment of the condition.

Etiology

The eustachian tube is the focal point of concern in most cases of acute otitis media. The eustachian tube protects the middle ear from nasopharyngeal secretions, regulates gas pressure in the middle ear, prevents bacteria and viruses from having easy access into the middle ear from the mouth and nasopharynx, and clears secretions from the middle ear. In the child, the tube is at a horizontal level in the head (the tube becomes slightly vertical in the adult), making it easier for organisms to move from the nasopharynx into the middle ear. The tube opens during the act of swallowing due to the contraction of the tensor veli palatini muscle. Obstruction of the tube and/or abnormal patency are the initiating factors causing acute otitis media. Obstruction may be:

Function: Due to an abnormal opening mechanism and/or increased tubal compliance.

Mechanical: Due to abnormal hyperplasia of the tissues around the tubes opening into the nasopharynx or swelling of the tube itself.

Infection/Allergy: Affecting nearby tissues causing them to swell and occlude the tube.

In infants, the bacteria most involved are E. coli and S. aureus; in older children (but less than eight years old), the most common bacteria are S. pneumonia, H. influenza, Group A-beta hemolytic streptococci, and S. aureus. Over eight years of age H. influenza is less involved in infections of the ear and the other three bacteria are the main causes. Otitis media usually begins when a viral URI or acute otitis media experiences secondary invasion by one of these bacterial organisms. Causative factors involved in susceptibility include substituting early bottle feeding for breast feeding. Human breast milk seems to have a prophylactic effect on a baby, although the exact reason why is not understood: that is, whether it has more to do with an intolerance to the cow’s milk or the natural immune boost provided by mother’s milk, or a combination of both. A related factor to bottle feeding is that supine feeding with the bottle has been shown to cause regurgitation of the milk which then has a chance of entering the eustachian tube. Another

very common etiological factor in children is one or more food or inhalant allergies. Allergens may cause acute otitis media by causing mucous production and mucous membrane swelling. Once the allergens are discovered and removed from the child’s environment or diet, health can greatly improve. Common food allergens in children include cow’s milk, wheat, soy, corn, citrus, and egg, although other foods may be implicated on an individual basis. Inhalant allergies include molds, dust, animal dander, and hay fever. Pre-teen otitis media seems to be related to

true food allergies, while otitis media in adults (20 years and older) seems to be mostly food sensitivities.

 

A naturopathic approach to treating someone with an ear infection is to first eliminate all dairy and sugar from their diet until the symptoms has subsided. If the ear infections are chronic or frequent food sensitivity testing may be recommended to see if there are other offending foods that may be compromising their immune system. This may be done in kids over the age of 3. Garlic oil ear drops are often recommended as an anti-microbial and anti-inflammatory for the tissues of the ear tube. Immune boosting nutrition and botanical medicine may be recommended to the immune system best fight the likely virus and prevent a bacterial infection for co-occurring.

Fertility / Sexual Dysfunction - Male and Female

10-15% of couples experience the inability to conceive, and the percentage is growing. Men account for 40% of failures to conceive. Of the women who are responsible, failure to ovulate accounts for 30% of infertility problems; pelvic factors (such as tubal disease and endometriosis) account for 50%; cervical pathology is responsible 10% of the time; and in 10-20% of the women no reason is found. Contributing factors include — Female: Poor diet, too low or too high body fat, increased caffeine consumption, increased alcohol consumption, nutrient deficiency of the following: vitamin C, zinc, B12, folic acid (especially is they have the MTHFR genetic SNP which is easily tested), selenium, and iron, endometriosis, tubal obstructions, immunologic problems, polycystic ovary syndrome, Infertility — Male Poor diet, increased alcohol consumption, aflatoxin in semen, impotence, exposure to environmental (estrogen-mimic) chemicals, exposure to radiation (i.e., 1986 Chernobyl Power Station accident in the Ukraine), oxidative stress, exposure to organic solvents, exposure to toxic metals (i.e., lead, mercury), nutrient deficiency of the following: vitamin C, zinc, copper, B12, selenium, L-arginine, glutathione, carnitine.
Impotence — Male • Poor diet • Thyroid disease• Atherosclerosis • Low testosterone •Prescription drugs • Prostate disorders• Alcohol • Peyronies disease• Tobacco • Decreased HDL ratio• Diabetes • Bicyclists (bicycle seat blockage of penile artery).

A naturopathic approach to treating someone with having difficulty conceiving or sexual dysfunction requires a multifactorial approach. First, time needs to be spent investigating what may be the underlying cause(s) to the dysfunction, and in some cases, the list can be long. Once the list is determined, an individualized plan must be created to address all of the underlying causes all at the same time in both partners for a successful conception. Strict focus is placed on lifestyle changes, which takes much effort, time and participation for both individuals.

Fingernails -Disorders That Show Up in the Nails

Nail changes may signify a number of disorders elsewhere in the body. These changes may indicate illness even before the rest of the body does. The following nutritional/health problems can be indicated by the following:

Thick nails à May indicate that the vascular system is weakening and the blood is not circulating properly

Lengthwise grooves or ridges à May indicate a kidney disorder and is associated with aging. An iron deficiency may also cause ridges.

White moon area turns slate blue à Indicates overexposure to silver or lung trouble.

Brittle nails àSignify possible iron deficiency, thyroid problems, impaired kidney function, and circulation problems.

Flat nails à Can denote Raynaud’s disease (see Autoimmune Section)

Yellow nails à Can indicate internal disorders long before other symptoms appear. Some of these are problems with the lymphatic system, respiratory disorders, diabetes, and liver disorders.

White nails à Indicate possible liver or kidney disorders and/or anemia.

Dark nails and/or thin, flat, spoon-shaped nails à Are a sign of vitamin B12 deficiency or anemia.

Nail beading àIs a sign of rheumatoid arthritis. (see Autoimmune Section)

Pitted red-brown spots and frayed split ends àIndicate psoriasis

Nails that chip, peel, crack, break easily à Show a nutritional deficiency and insufficient hydrochloric acid, protein and minerals.

Brittle, soft, shiny nails without moon à May indicate an overactive thyroid (see Autoimmune Section)

Thinning nails à May signal an itchy skin disease

Nails separated from nail bed à May signify a thyroid disorder

Ridges running up and down nail à Indicate a tendency to develop arthritis.

White spots on nails à Zinc deficiency

White lines on nails à selenium deficiency

Additional Recommendations:

A high-protein diet with a protein supplement is necessary for healthy nails about 30% of the total calories for the day should come from protein and 40% from carbohydrates, consisting mostly of fruit and vegetables. 30% should be from non-inflammatory fats like fish and some nuts and seeds.   If you expose your hands to too much water and soap, the nail may become loose from the nail bed. Water causes the nails to swell, and they shrink when dry, resulting in loose and brittle nails. Do not cut cuticles. Uncovering the nails this way is harsh and irritating, causing infection. Use castor oil and gently push them back. If you have diabetes, see your doctor if the cuticles become inflamed because the infection can spread. Do not repeatedly immerse your hands in water that contains detergents or chemicals; this results in split nails. Discolored nails can be caused by prolonged illness, stress, nicotine, allergies, or diabetes.

Use a base coat before using nail polish to prevent yellowing. If nails are green, it could be a bacterial infection or a fungal infection which separates the nail from the bed.

Wear cotton-lined gloves when doing housework such as dishes and laundry or when using furniture polish. This protects your hands against harsh chemicals.

 

Gout

Gout is a type of arthritis that occurs when too much uric acid builds up in the body, causing crystals to form in joints and joints to become inflamed. It can be hereditary or the result of another condition. Gout usually affects men over 40 with a family history of gout, but it can occur at any time and also affects women, especially after menopause. Excessive intake of food and alcohol, surgery, infection, physical or emotional stress, or the use of certain drugs can lead to the development of gout symptoms. Signs and symptoms include extreme pain in a single joint, usually the base of the big toe, but other joints can also be affected (such as the feet, fingers, wrists, elbows, knees, or ankles). The joint is shiny red-purple, swollen, hot, and stiff. You may even develop a fever as high as 39°C (102.2° F) with or without chills. Symptoms can develop very quickly, with the first episode often occurring at night, then go away after 5 – 10

days only to come back later. In later attacks, you may see lumps (called tophi) just under the skin in the outer ear, hands, feet, elbow, or knee. The body either produces too much uric acid, doesn’t excrete enough uric acid, or both, so that the acid accumulates in tissues in the form of needle-like crystals that cause pain. Gout generally occurs because of a predisposition to the condition, but is most commonly linked to an underlying blood sugar imbalance. Once the blood sugar is balanced, the gout quickly resolves. Risk factors include: Family history of gout, high levels of triglycerides (also a down- stream effect of elevated blood sugar), drinking too much alcohol (which will increase blood sugars), eating foods rich in purines, such as meat, shellfish, and sweetbreads.

 

A naturopathic approach to treating someone with gout is to first address underlying lifestyle habits that may be contributing. By following a meal plan that improves blood sugar balance, optimizes body composition, includes plenty of water, has low purines in the diet, has no or minimal alcohol (especially beer) and is anti-inflammatory quite often the gout is then no longer an issue. However, implementing this plan may be harder than it seems, so clinical nutrition can be added to fill in some of the weak spots. Things like vitamin C, taken in high doses, can help decrease blood uric acid levels. Folic acid inhibits xanthine oxidase, which is required for uric acid production. Bromelain, an enzyme found in pineapple, is an anti-inflammatory. Quercetin, a bioflavonoid, is an anti-inflammatory that may also help reduce uric acid levels. EPA (eicosapentaenoic acid), found in fish oil, inhibits pro-inflammatory leukotrienes.

Herpes Simplex/Cold Sores/Fever Blisters

A spreading cutaneous eruption. Any inflammatory skin disease caused by a herpes virus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster.

Herpes simplex, caused by Type 1 virus and primarily spread by oral secretions, usually occurring as a concomitant of fever, but sometimes also developing in the absence of fever or prior illness, and commonly involving the facial region, especially the vermilion border of the lips and the nares; the vesicular lesions are self-limited. Also called cold sore and fever blister.

Herpes simplex, a group of acute infections caused by herpes simplex virus Type 1 or Type 2, characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane, and occurring as a primary infection or recurring because of reactivation of a latent infection. Type 1 infections usually involve nongenital regions of the body, whereas in Type 2 infections the lesions are primarily seen on the genital and surrounding areas. Precipitating factors include fever, exposure to cold temperature or to ultraviolet rays, sunburn, cutaneous or mucosal abrasions, emotional stress, and nerve injury.

 

A naturopathic approach to treating someone with herpes starts with supporting the immune system and removing all barriers to the immune system doing its job as well as possible. Are you sleeping well? Are you eating well (as in no sugar!)? Are you under a lot of stress? These things must first be addressed to remove the barriers to the immune system doing its best job. L Lysine has been shown in the medical research to help block viral replication. Specific nutrients like vitamin C, mushroom combinations etc. may be prescribed to help boost the immune system to keep the virus under control and the body free of symptoms.

Insomnia

Insomnia is the inability to sleep when sleep should normally occur. Sufficient and restful sleep is a human necessity. The average adult needs slightly more than eight hours of sleep per day and only 35% of American adults consistently get this amount of rest. People with insomnia tend to experience one or more of the following sleep disturbances: Difficulty falling asleep at night,

waking too early in the morning, waking frequently throughout the night. Insomnia may stem from a disruption of the body’s circadian rhythm, an internal clock that governs the timing of

hormone production, sleep, body temperature, and other functions. While occasional restless nights are normal, prolonged insomnia can interfere with daytime function, concentration, and memory. Insomnia increases the risk of substance abuse, motor vehicle accidents, headaches, and depression. Recent surveys indicate that 50% of people suffer from sleep difficulties and 20 – 36% of them struggle with such difficulties for at least 1 year. Other studies show that one out of three people in the United States have insomnia, but only 20% bring it to the attention of their physicians. Signs and symptoms associated with insomnia include: Not feeling refreshed after sleep, inability to sleep despite being tired, daytime drowsiness, fatigue, irritability, difficulty concentrating, and impaired ability to perform normal activities, anxiety as bedtime approaches.

Primary insomnia is not caused by any known physical or mental condition. There are numerous causes and risk factors. Everyday anxiety and stress, coffee, and alcohol are the most common culprits. Secondary insomnia is often caused by underlying medical or psychological condition such as depression. About 50% of insomnia cases have no identifiable cause. Some conditions or situations that commonly lead to insomnia include: Substance abuse — consuming excessive amounts of caffeine, alcohol, recreational drugs, or certain prescription medications; smoking can cause restlessness and quitting smoking may also cause temporary insomnia. Disruption of circadian rhythms — shift work, travel across time zones, or vision loss; circadian rhythms are

regulated, in part, by release of a hormone called melatonin from the brain. Menopause — between 30% and 40% of menopausal women experience insomnia; this may be due to hot

flashes, night sweats, anxiety, and/or fluctuations in hormones. Hormonal changes during menstrual cycle — insomnia may occur during menstruation; sleep improves midcycle with ovulation. Advanced age — biological changes associated with aging, underlying medical conditions, and side effects from medications all contribute to insomnia. Medical conditions — gastroesophageal reflux (return of stomach contents into the esophagus; frequently causes heartburn), fibromyalgia, or other chronic pain syndromes, heart disease, arthritis, attention deficit hyperactivity disorder, and obstructive sleep apnea (difficulty breathing during sleep)

Psychiatric and neurologic conditions — anxiety, depression, manic-depressive disorder, dementia, Parkinson’s disease, restless leg syndrome (a sense of indescribable uneasiness, twitching, or restlessness that occurs in the legs after going to bed), post-traumatic stress disorder, certain medications — decongestants, bronchodilators, and beta-blockers, excessive computer work, partners who snore.

 

A naturopathic approach to treating someone with insomnia starts with a list of all the things they feel could be contributing to their insomnia. Once the underlying cause(s) is identified, clinical nutrition may be prescribed to help the body resolve the underlying cause. Like using specific nutrients to help increase GABA and decreasing glutamate for the person who’s mind spins and cannot fall to sleep. Or decreasing cortisol with adaptogenic herbs for the person who is anxious due to much stress in their life. Or prescribing melatonin for the person who works shift work to establish new circadian rhythms to better match their work life. Lifestyle studies reveal that healthy sleep habits are essential for treating insomnia. The following strategies (in addition to the steps mentioned in the Preventive Care section) may help treat the condition:

  • Maintaining a consistent sleeping and waking time
  • Establishing the bedroom as a place for sleep and sexual activity only, not for reading, watching television,
  • or working
  • Avoiding naps, especially in the evening
  • Taking a hot bath about two hours before bedtime
  • Keeping the bedroom cool, well-ventilated, quiet, and dark
  • Avoiding looking at the clock; this promotes anxiety and obsession about time
  • Avoiding fluids just before bedtime
  • Avoiding television just before bedtime
  • Eating a carbohydrate snack, such as cereal or crackers, just before bedtime
  • Moving to another room with dim lighting if sleep does not occur within 15 to 20 minutes in bed
Liver/Gallbladder

Hepatopathy: any disease of the liver.

Hepatotoxin: a toxin that destroys liver cells.

Liver health is easily tested through various blood tests including AST, ALT (liver enzymes) and GGT an enzyme that tells the liver to produce more glutathione in times of need. “Toxicity” is generally more of a functional issues and shows up as chemical sensitivity, fatigue, chronic aches and pains, brain fog, fluid retention, headaches (think “hung over”).

Cholestasis: stoppage or suppression of bile flow, due to factors within (intrahepatic cholestasis) or outside the liver (extrahepatic cholestasis). Symptoms include: intolerance to greasy foods; headaches after eating; light colored stool; foul smelling stool; less than one bowel movement daily; constipation; hard stool; sour taste in mouth; grey colored skin; yellow in whites of eyes; bad breath; body odor; fatigue and sleepiness after eating; pain in right side under rib cage;

painful to pass stool; retain water; big toe painful; pain radiates along outside of leg; dry skin/hair; blood in stool; have had jaundice or hepatitis; high blood cholesterol and low HDL cholesterol; cholesterol level above 200; triglyceride level above 115.

 

A naturopathic approach to treating someone with liver or gallbladder concerns involves lifestyle changes towards a low glycemic, anti-inflammatory meal plan and a low toxicity environment. Using natural soaps, cleaners, avoiding fragrances, foods highly sprayed with pesticides. Clinical nutrition may be prescribed to help put health back into the liver, support optimal bile production, help “thin out” the gunky bile (think Drano, but a health kind) and help break down fats easily.

Lyme Disease

Chronic Lyme disease is considered an autoimmune condition by most natural medicine practitioners. Although anti-biotics can be a helpful adjunct to treatment for those with chronic Lyme disease, my patients have taught me that alone, anti-biotics are not very helpful once Lyme disease is in the chronic stage. Many patients who have been diagnosed with Lyme disease (confirmed by Western Blot blood testing), will state that they do not recall a specific tick bite that might have led to their infection. A very common scenario in my clinic is that their symptoms most associated with chronic Lyme disease (fatigue, joint pain, foggy brain, muscle pain, bone pain, gastrointestinal issues, nervous system issues, anxiety, depression are among the most common), show up following a “traumatic event” ie: loss of a loved one, divorce, high stress time at work/with family/with friends, a motor vehicle accident, abuse, financial loss… Symptoms can show up gradually or all of a sudden in any order and progressively get worse with more and more symptoms showing up with time. Often times, conventional medicine tests for Lyme disease are considered negative and Lyme disease is ruled out given the high percentage of false negatives our current main-stream Lyme testing produce. Additional testing through IgenX, Neuroscience or Advanced Laboratory Services Inc. – all with their own specific way of testing for Lyme disease may be necessary to truly rule in/out Lyme disease.

 

A naturopathic approach to treating someone with Lyme disease is a multifactorial and complex process. I once heard someone say “if you’ve met one person with Lyme disease, you’ve met one person with Lyme disease”, meaning everyone’s symptoms and what works for them for treatment is always different and unique to the individual. One underlying theme that does seem to come up in every Lyme book, Lyme course, Lyme seminar I’ve ever taken is detox. So that may be where I start. If fatigue is the main issues, I may start with clinical nutrition for mitochondrial support. If heart burn is the main symptom, I may start with a gut restoration program. If new symptoms have recently shown up following a long course of anti-biotics, I may start with an anti-candidia plan. The treatment is slow and long as together we work to put health back into your most affected tissues, to support your immune system to best fight the bug and to support overall health.

Multiple Sclerosis

Nearly 350,000 Americans are affected by one of medicine’s most misunderstood diseases, multiple sclerosis. Although there is no known cure, alternative medicine has recognized a number of contributing factors. Often, the early detection and identification of underlying causes combined with strict dietary and life-style guidelines can stabilize or reverse the symptoms.

Multiple sclerosis (MS) affects the central nervous system and usually occurs in early adult life. Normally, nerve fibers are surrounded by a layer of insulation called myelin. MS results when the nerve fibers of the central nervous system develop multiple patches of demyelination (removal of the myelin sheath). Nerve transmission is disrupted, leading to feelings of pins and needles in the hands and feet, numbness, loss of balance, clumsiness, sensitivity to heat and cold, blurred or double vision, and difficulty walking. Patrick Kingsley, M.D., of Leicestershire, England, a specialist in nutrition and environmental medicine who has treated over two thousand multiple sclerosis patients, states that, “In advanced stages of MS, walking becomes more difficult, movements become more spastic, arms and hands may become weak, speech can become slurred, and chronic urinary urgency or incontinence may develop. Fatigue, one of the “silent” and most disabling symptoms of multiple sclerosis, may render even the smallest tasks difficult.” Dr. Kingsley adds, “Although the stereotype of an MS sufferer is that of a person in a wheelchair, many people with MS are able to walk and continue working. The disease can be benign, with a few minor attacks spread over many decades, or deterioration can be rapid. Most cases fall somewhere between these extremes.” Multiple sclerosis is often described as a relapsing/remitting disease, where attacks are followed by remission, leaving the MS sufferer worse off than he was before the exacerbation. Because no two cases of MS are identical,

the severity of attacks and the state of health following a remission period differs from patient to patient. Unless steps are taken to slow or halt the disease, patients with will probably become progressively worse. The cause is considered idiopathic; though there are theories about autoimmunity, slow viruses, and myelinic enzymes, Lyme disease etc.; no specific mechanism has been proven. Most cases begin between 20 and 40 years old, and rarely after 50. Females are affected slightly more than males. MS seems to be a disease of temperate latitudes, in either the

Northern or Southern hemispheres, and is rarely seen in equatorial regions. The characteristic lesion in MS is one of patchy demyelination of the myelin sheaths in the CNS, particularly in the white matter. Alternative medicine regards MS as a complex, multi-factorial disease involving several causes. When these causes are addressed, the symptoms may be alleviated or even reversed. Signs and symptoms of the disease is much noted by its apparently random exacerbations and remissions. As the disease progresses, the remissions become less complete and permanent deficit is apparent. Onset is almost always insidious. Symptoms are vague and the diagnosis is often missed in the early stages. Optic neuritis: Partial or total loss of vision in one eye with pain on moving that eye Diplopia and other visual disorders Tic doloureaux in a young person, ataxic gait, tingling or tightness in the extremities and the perception of a band across one’s middle, bladder dysfunction: Urgency, hesitancy, etc., depression, apathy, lack of judgement, hysteria, increased deep reflexes, (+) Babinski Charcot’s triad: In advanced disease: Nystagmus, intention tremor and scanning speech among other symptoms more specific to the individual. People with multiple sclerosis typically have nutritional deficiencies. Studies show that essential fatty acids, the building blocks of the brain and nervous system, are lacking in many MS patients. Multiple sclerosis is most common in Western countries where people consume large amounts of meats, dairy products, processed foods, and coconut and palm oils—all foods low in essential fatty acids, and is least common in countries where diets are high in unsaturated fats, including seed oils, olive oil, oily fish, fresh fruits, and vegetables—all foods high in essential fatty acids. The connection with saturated fat intake was first noted in 1950 by Roy Swank, M.D., ofOregon Health Sciences University in Portland, Oregon, and has been confirmed in more recent studies. Stephen Davies, B.M., B.Ch., who runs the Biolab Medical Unit in London, England, has found that even with a balanced diet, MS patients have difficulty absorbing essential nutrients. Although these differ from person to person, says Dr. Davies, the most common deficiencies are B1, B6, B12, magnesium, zinc, folic acid, amino acids, manganese, selenium, as well as essential fatty acids. Itolerance to certain foods is common in patients with multiple sclerosis. Among the most frequent are milk and dairy products, caffeine, tannin, yeast, sugar, fungi, wheat, gluten (found in wheat, barley, oats, and rye), corn, food additives, and fermented products such as ketchup, vinegar, and wine. In a 1986 study it was found that of 135 MS patients, 65.9 percent had histories of sinusitis (inflammation of the

sinus) a classic symptom of intolerance to milk and dairy products. Candidiasis, an overgrowth of the yeast Candida albicans, is a major cause of food intolerances and, like nutritional

deficiencies, can add to the stress on individuals with multiple sclerosis. William G. Crook, M.D., of Jackson, Tennessee, first made the connection between MS and the yeast Candida albicans, documenting several cases in which symptoms improved once the candida was treated.

Environmental toxins can be an underlying cause for those with MS. Gary Oberg, M.D., past President of the American Academy of Environmental Medicine, notes several ways

in which environmental toxins may contribute to multiple sclerosis. “Toxins may cause metabolic poisoning, interrupting the body’s normal metabolic pathways and damaging the myelin sheath of nerves, which is the basic defect in MS. Certain substances, while not toxic to everyone, may initiate an autoimmune reaction in susceptible individuals. These individuals make antibodies to the foreign substance which cross-react with myelin, thus damaging the nerves and inducing symptoms characteristic of multiple sclerosis.” According to Dr. Oberg, some of the substances that can produce or aggravate symptoms include chemicals in food and tap water, carbon monoxide, diesel fumes, fumes from domestic gas water heaters, solvents, aerosol sprays, and chipboard and foam in furniture and carpets. Dr. Oberg adds that MS symptoms may also be caused by internal toxins—toxins produced by bacteria and fungi in the gastrointestinal tract, including Candida albicans. An underlying viral infection may be the cause the MS in some cases. Medical researchers have long suspected a viral involvement in MS. Recent research on patients infected with the Epstein-Barr virus (a form of herpes virus believed to be the causative agent in infectious mononucleosis) shows that levels of essential fatty acids are very low after the illness, similar to the low levels found in MS patients.

This virus interferes with the body’s ability to metabolize essential fatty acids, causing a partial breakdown of the body’s immune system. An acute episode of infection with the Epstein-Barr virus during adolescence could leave the door open to chronic illness such as MS some years later. Mercury is a highly toxic metal that, when used in dental amalgam fillings, can seep into body tissues where it accumulates and becomes capable of producing symptoms in the body that are indistinguishable from those of multiple sclerosis. According to Hal Huggins, D.D.S., of Colorado Springs, Colorado, mercury poisoning often remains undetected because patients’ symptoms do not necessarily suggest mercury as the initiating cause, but the effects of mercury toxicity are potentially devastating. Mercury has been recognized as a poison since the 1500s,

yet mercury amalgams have been used in dentistry since the 1820s. Mercury has been shown to bind to the DNA of cells and cell membranes, causing cell distortion and inhibited cell function. When this happens the immune system no longer recognizes the cell as part of the body and initiates an autoimmune reaction, destroying myelin in the process. MS patients have been found to have over seven times the levels of mercury in their cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) as compared to neurologically healthy patients.

 

A naturopathic approach to treating someone with Multiple Sclerosis starts with an early diagnosis as an essential first step. For the best rate of success, treatment of the disease should begin as soon as possible after diagnosis. Once the disability has gained a hold, it becomes

harder to reverse the damage. Because multiple sclerosis affects each patient differently, treatment programs are individualized. Dietary and nutritional needs are to be addressed, as are food sensitivities and environmental toxins. Recommendations may be made for detoxification therapy, as well as for the removal of mercury amalgam dental fillings. Among practitioners of alternative medicine, there is a degree of consensus—not generally shared by conventional doctors—that multiple sclerosis can be controlled. This type of approach involves fundamental nutritional, environmental, and life-style change in work, relationships, and environmental conditions.

Osteoporosis

A decreased density of bone compared to normal bone mass of age and sex matched controls. It is the most prevalent bone disease in the world. There are many factors that can contribute to osteoporosis, the most common is postmenopausal, estrogen deficient osteoporosis. More than one-half of women in the United States who are 50 years of age or older will have documented osteoporosis, with major orthopedic consequences common. Diet-related bone loss is caused by chronic dietary deficiencies in calcium, magnesium, boron, vitamin C, vitamin D, and protein. Absorption of these nutrients becomes inefficient as one ages and not easily assessable from the

diet. In most cases they must be supplemented with high quality professional food supplements. Specific bone building factors such as microcrystalline hydroxyapatite (MCHC) and ipriflavone have had strong documentation to significantly regenerate bone.

 

A naturopathic approach to treating someone with osteoporosis starts with lifestyle. Osteoporosis is an inflammatory disease, so following an anti-inflammatory diet is key to addressing the underlying cause of osteoporosis. Bones also do best in a more alkaline environment, so eating a more alkaline diet is helpful as well as very close to the anti-inflammatory diet. Clinical nutrition can also be added to help minimize inflammation. Weight bearing exercise is needed for strong bone. What you don’t use you lose, and if you never “stress out your bones” why would they bother staying strong? Walking, weight lifting, aerobics exercise like jumping, stomping, squatting etc. are all weight bearing exercises. Although optimal calcium is important for bone health, there are actually over two dozen things that go building strong bones, therefore often a complete bone is recommended along with vitamin D if your vitamin D tests low. For postmenopausal women who’s hormones test low, bio-identical hormones may be suggested along with adrenal support.

Prostatitis (Prostatic Hypertrophy, Benign)

A common entity which occurs in about four out of every five men in America over the age of 50 years. It is characterized by the growth of multiple fibroadenomatous nodules enlarging the prostate gland and compromising the urethra causing variable degrees of bladder outlet obstruction. Progressive urinary frequency and urgency, with incomplete emptying and rapid refilling of the bladder, hesitancy and intermittency and decreased size and force of the urinary stream are the common diagnostic signs. Hormones typically involved are increased estrogens and DHT (dihydrotestosterone) which become elevated with increased belly fat, poor detoxification, and insulin resistance.

 

A naturopathic approach to treating someone with BPH includes thorough hormones testing to best evaluate if a hormone imbalance could be contributing to symptoms. Once established, clinical nutrition and botanical medicine may be prescribed to help rebalance the hormones. A low glycemic index meal plan may be prescribed if insulin resistance is suspected or confirmed on testing. An aggressive short term estrogen detoxification program may be prescribed if elevated estradiol is found on testing. Clinical nutrition and botanical medicine may be prescribed to put health back into the prostate.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory condition that affects the entire body but especially the synovial membranes of the joints. It is a classic example of an “autoimmune disease,” a condition in which the body’s immune system attacks the body’s own tissue. Although rheumatoid arthritis is a systemic disease, it affects primarily the joints. The joints typically affected by rheumatoid arthritis are the hands and feet, wrists, ankles, and knees. Involved joints will characteristically be quite warm, tender, and swollen. The skin over the joint will take on a ruddy purplish hue. As the disease progresses, joint deformities result in the hands and feet. Somewhere between 1% and 3% of the population is affected; female patients outnumber males almost 3:1; and the usual onset is 20 to 40 years, although rheumatoid arthritis may begin at any age. Symptoms may include: fatigue, low grade fever, weakness, joint stiffness, and vague joint pain may proceed the appearance of painful, swollen joints by several weeks. Severe joint pain with much inflammation that begins in small joints, may progressively affects all joints in the body. X-ray findings usually show soft tissue swelling, erosion of cartilage, and joint space narrowing and the presence of rheumatoid factor may be found in the serum. Systemic manifestations are common, including: inflammation of the blood vessels (vasculitis), muscle wasting, skin nodules, inflammation of the heart and lungs, enlargement of the spleen, anemia, and depressed white blood cell counts. The onset of rheumatoid arthritis is usually gradual, but occasionally it is quite abrupt. Several joints are usually involved in the onset, typically in a symmetrical fashion, i.e., both hands, wrists, or ankles. In about one-third

of persons with rheumatoid arthritis, initial involvement is confined to one or a few joints. Most persons with rheumatoid arthritis feel fatigued as a result of the anemia that usually accompanies the disease. Other common findings include carpal tunnel syndrome (tingling and pain in the fingers caused by pressure on the nerve as it enters the hand through the wrist), and Raynaud’s phenomenon (a condition where the blood flow through the fingers is severely reduced when they are exposed to cold). In some cases, soft nodules develop beneath the skin over bony surfaces. There is abundant evidence that rheumatoid arthritis is an “autoimmune” reaction, where antibodies develop against components of joint tissues. Yet what triggers this autoimmune reaction remains largely unknown. Speculation and investigation has centered around genetic susceptibility, abnormal bowel permeability, and microorganisms, as well as dietary factors. In short, rheumatoid arthritis is a classic example of a multifactorial disease where there is an interesting assortment of genetic and environmental factors which contribute to the disease process. A specific genetic marker (histocompatibility antigen HLA-DRw4) is found in 70% of patients with rheumatoid arthritis compared to 28% in the general population. This strongly implies that the likelihood of developing rheumatoid arthritis is influenced by genetic factors which govern immune response. Severe rheumatoid arthritis is also found at four times the average rate in children of parents with rheumatoid arthritis. As strong as these genetic associations are, environmental factors are necessary for the development of the disease. This is perhaps most evident in studies with identical twins. These studies show that it is quite rare for both twins to develop rheumatoid arthritis. An interesting association between rheumatoid arthritis and abnormal bowel function exists that may provide a unified theory as to the cause of rheumatoid arthritis. What is currently known is that individuals with rheumatoid arthritis have increased intestinal permeability. This means that their intestines are too “leaky.” Food sensitivities are thought to contribute greatly to the increased permeability of the gut in rheumatoid arthritis. The release of histamine and other allergic compounds after eating an allergic food greatly increases the “leakiness” of the gut. The result of a leaky gut is an increased absorption of large dietary and bacterial molecules. Normally these molecules are prevented from being absorbed because they are too large. In rheumatoid arthritis, however, they

are absorbed into the body. The body’s response to these molecules is to form antibodies to bind them. Antibodies are released by our white blood cells to bind to foreign molecules such as those found on bacteria, viruses, and cancer cells, resulting in the formation of an immune complex.

In the case of rheumatoid arthritis, food and bacterial molecules are acting as antigens that are being bound by the antibodies. The resulting immune complex then triggers the immune system to release compounds to destroy it. These compounds work great when antibodies bind to bacteria and viruses, but when immune complexes are deposited in joint tissues these compounds actually destroy not only the immune complex, but also surrounding joint tissue. Another way in which the body may develop antibodies to its own tissue is by developing “cross-reacting” Antibodies. The increased gut permeability and altered bacterial flora result in the absorption of antigens that are very similar to antigens in joint tissues. Antibodies formed to these antigens would “cross-react” with the antigens in the joint tissues. Increasing evidence appears to support this concept as well. Clinically, physicians use the presence of immune complexes to monitor the patient as the serum and joint fluid of nearly all individuals with rheumatoid arthritis contain the “rheumatoid factor” (RF). The rheumatoid factor represents the formation of multiple immune complexes. Most of the rheumatoid factor is formed locally in the affected joints by white blood cells. The level of rheumatoid factor can be measured in the blood and usually

correlates with the severity of arthritis symptoms. That is, when rheumatoid factor levels are high, severity is high, and when rheumatoid factor levels are low, severity is low.

 

A naturopathic approach to treating someone with RA would be very similar to the treatment for anyone with an autoimmune condition. I focus on the immune system, which since 60%-70% of the immune system resides in the gut, that is typically where I’ll start. Stool analysis looking for good bacteria, bad bacteria, yeast overgrowth, parasites may be ordered as there are specific organisms that have been linked to RA. Lyme disease would need to be ruled out. A food sensitivity panel may be ordered and these results along with the stool analysis results would directly dictate the treatment plan. Clinical nutrition and botanical medicine may be prescribed to help manage the inflammation and put health back into the joints to minimize destruction as the underlying cause is treated.

Skin Conditions

A naturopathic approach to treating someone with skin issues, regardless of the skin issue is usually very similar since we know that what is going on outside the skin is a direct reflection of what is going on inside the intestines. Therefore, although the exact protocol with certainly depend on the individual, a 4 ‘R’ gut restoration program as described in the gastrointestinal section is most commonly prescribed. Some skin conditions are more immune system realted like Impetigo and scleroderma in which case an approach similar to that in the autoimmune/infection section may be prescribed. Listed below are some specific details in regards to some of the more common skin issues I see at the clinic, however, this is by no means a complete list of all of the skin conditions I have seen people with.

Acne Vulgaris

An inflammatory disease most commonly seen in teenagers. It affects areas where sebaceous glands are largest, most numerous, and most active. Mild cases consisting of few residual signs except possibly dilated pores, and the development of the comedo, or blackhead, may progress through more pathological stages of ruptured sebaceous ducts, pustule formation, atrophy and scarring, to more extensive lesions involving the shoulders, trunk, and upper arms. In extreme cases the inflamed nodules and infected cysts canalize and become infected sacs. Bacterial and chemical irritation of the tissues occurs, with destruction and displacement of epidermal cells,

and eventually, intense scarring and deformity. The effect of the androgenic hormones on the pilosebaceous follicular apparatus is considered to be the basic cause of acne. It is not seen in eunuchs, but it can be induced in them by androgen therapy. Acne is so common at puberty that it may almost be considered a physiological disturbance. It affects more than 80% of teenagers.

The most important contributory factor in this condition is diet. Certain foods appear to aggravate, or induce the onset of inflammation. Chocolate, certain grains, various proteins, cola drinks, and milk have been implicated. Above all, sugar and foods heavily laden with refined sugar, processed, packaged, and chemical-containing foods are responsible for much distress during the adolescent years. Refined, devitalized foods upset the endocrine balance and produce stress. Contributing factors include: • Hypochlorhydria • Alcohol • Low fiber intake • Anxiety

  • Bowel toxicity • Stress • Endotoxins • Environmental toxins • Food sensitivities (Especially egg, soy, peanut, chocolate, milk, potato), • sex hormone imbalance.

 

Eczema

Eczema, also called atopic dermatitis, is a chronic, inflammatory skin disorder. Its main features are blisters that dry to become scaly, itchy rashes. The skin becomes dry and itchy because too much moisture is lost from its upper layer. This leaves the skin without protection, making it easy for bacteria and viruses to penetrate. The disease occurs episodically; in other words, there may be periods when symptoms are severe (flares) and times when there are no symptoms at all (remission). Eczema is not contagious, but nevertheless it is very common— estimates are that more than 15 million people in the United States have eczema. People with eczema often have a personal or family history of allergic conditions like asthma or hay fever. There is no cure, but treatments can reduce symptoms and help prevent outbreaks. Signs and symptoms include dry, extremely itchy skin, blisters with oozing and crusting, redness of the skin around the blisters

raw areas of the skin from scratching which may even lead to bleeding, dry, leathery areas with more or less pigment than their normal skin tone (called lichenification). Eczema in children under 2 years old generally begins on the cheeks, elbows, or knees. In adults, it tends to be

located on the inside surfaces of the knees and elbows. The cause of eczema is thought to be a combination of hereditary (genetic) and environmental factors. This means that factors such as allergies can cause eczema in susceptible people. Exposure to certain irritants and allergens

in the environment can worsen symptoms as can dryness of the skin, exposure to water, temperature changes, and stress. Young age—infants and young children are most affected by eczema (about 65% of cases occur before age one, and approximately 90% occur before age 5).

Stress can make eczema worse, irritants that may worsen eczema include: Wool or synthetic fibers, certain soaps and detergents as well as perfumes and some cosmetics, dust or sand

cigarette smoke.

 

 

Impetigo

A superficial vesiculopustular skin infection mainly seen in children. Also called “impetigo contagiosa” and “ecthyma” (when the impetigo is ulcerative). The associated microorganism is primarily Group A beta-hemolytic streptococcus, although staph aureus is being implicated in a growing number of cases (in the past staph was limited to only bullous impetigo). Impetigo is

primarily seen in children under 5 years old, and appears on exposed areas like the lower legs, arms or face. The infection may follow trauma to the skin, scabies, insect bites, fungal infections, fleas, various kinds of dermatitis, or may just appear on normal skin.

Skin Conditions

Psoriasis

Psoriasis is a skin disorder that appears as raised, reddish-pink areas covered with silvery scales and red borders. Psoriasis usually appears on the scalp, elbows, knees, groin, and lower back. It “comes and goes,” and may appear as a few spots or involve large areas. It is not contagious, either to other body parts or to other people. More than 6 million people in the United States have psoriasis, which is seen in both sexes and all age groups. It can be triggered by emotional stress and can run in families. Most cases are not painful, although severe ones can be. Approximately 5 percent of psoriasis sufferers develop psoriatic arthritis, which involves painful and swollen joints. Signs and symptoms of psoriasis include: Raised skin lesions, deep pink with red borders and silvery surface scales, may be cracked and painful in severe cases, blisters oozing with pus (usually occurs on the palms or soles), pitted, discolored, and possibly thickened fingernails or toenails, itchy skin in some people, joint pain (psoriatic arthritis) in some people.

The cause of psoriasis is unknown, and most natural doctors consider it an autoimmune disease, but researchers do know that it involves a higher-than-normal rate of skin cell, production. Dead skin cells accumulate and form thick patches. Some researchers believe there is a genetic

component, and that a faulty immune system may be involved. Several underlying factors may trigger the disorder or flare-ups, including the following: Emotional stress, obesity, skin injuries or sunburn, streptococcal (strep) infection (symptoms sometimes first appear 2 weeks after strep throat), cold or dry air, certain drugs (gold, lithium, beta-blockers), alcohol.

Skin Conditions

Scleroderma

Is a chronic disease of unknown etiology characterized by inflammatory, vascular, and fibrotic changes of the skin, internal organs (G.I. tract, esophagus, thyroid, kidney, heart, and lungs) and articular structures. It is also called Progressive Systemic Sclerosis (PSS). The skin thickening and restriction follows an idiopathic overproduction of collagen. The disease is highly individual

in terms of severity and progression. Some patients may experience only skin changes and restrictions in the hands and face for decades before visceral or organ involvement begins. Others may rapidly develop generalized cutaneous thickening and often lethal internal organ disease. The full manifestation of the disease is known as the CREST Syndrome: Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactylia, and, Telangiectasia.

Scleroderma is seen in women four times as often as in men, and is rare in children. It is found worldwide but more rarely in Asia. The usual age of onset is around 20-40. Although the course of the disease is variable and unpredictable, it is characterized by a slowly progressing

involvement of the skin and/or visceral organs. Remissions are rare but do occur. The disease is typically very gradual: 80% of patients will be alive after 2 years and 20% will be alive after 10 years. The disease is most severe in black women; in whites, men are often affected worse than women. The usual causes of death are renal, cardiac and/or lung complications. Symptoms

Initial complaints include: Raynaud’s phenomenon, skin thickening of the fingers, swelling of the extremities, as the disease progresses: skin becomes hyperpigmented, skin of the whole upper body may become firm, leathery; the face looks mask-like; the lower extremities are not usually affected much. Flexion contracture of the fingers, wrists, elbows, subcutaneous calcifications or ulcers develop on the bony prominences, telangiectasias, skin becomes dry and rough and loses hair and the ability to sweat, restricted opening of the mouth, esophageal dysfunction: the esophagus is the most commonly involved visceral organ: dysphagia, regurgitation of stomach contents, and peptic esophagitis often occur, joint pain, swelling, stiffness of fingers and knees

small intestine involvement: malabsorption, steatorrhea, weight loss, bloating, abdominal pain

large intestine involvement: chronic constipation and fecal impaction, Respiratory/cardiovascular involvement: fibrosis of the lungs causes exertional dyspnea, dry cough, pleurisy; cardiac problems: causing 15% of PSS deaths: include arrhythmias, pericarditis, and conduction

disturbances, renal involvement: causes half the deaths of PSS.

Stress

There are many “faces” of stress as stress manifests differently depending on the individual, influencing many biological processes that begin in the brain and spread through nearly all body systems – including the adrenals, thyroid, neurotransmitter systems, digestive system, and heart. Consistent stress over long periods of time can become a serious threat to maintaining lifelong wellness as so much energy is channeled into coping, ultimately leading to exhaustion.

The Stress Response: A Coordinated Series of Events

Neurotransmitters (or chemical messengers) are released, triggering an increase in emotional response, and influencing memory, concentration, inhibition, and rational thought.

The adrenal glands pump out a group of hormones known as glucocorticoids – including the primary stress hormone cortisol – which marshal the heart, lungs, circulation, metabolism, and immune system.

The thyroid gland when imbalanced pumps out hormones that accelerate metabolism, producing symptoms such as occasional sleeplessness, nervousness, and exhaustion.

Sex hormone levels may be reduced with stress, thereby reducing libido and sexual function. Acute stress may also cause a woman’s menstrual cycle to be irregular.

Glucose metabolism may fluctuate with stress as the liver releases stores of glucose into the bloodstream and the pancreas decreases insulin secretion, increasing blood sugar levels for needed energy. This may cause weight loss is very high acute stress or weight gain in chronic low grade stress.

Heart rate increases during stress as the heart pumps more blood throughout the body.

Respiratory function may be altered with stress. In some individuals breathing rate increases.

The coordinated activities involved in digestion can be slowed down as energy is diverted in the stress response, possibly resulting in stomach discomforts. The small intestine slow down (constipation) and the colon speeds up (diarrhea) making stress one of the triggers and underlying causes for irritable bowel syndrome.

 

A naturopathic approach to treating someone seeing physiological symptoms of acute or chronic stress includes an in-depth inquiry as to how stress manifests in that particular individual. Although many time the individual cannot simply get rid of the stress, certain coping mechanisms can be taught in put in place to help the individual better respond to their stress. Adaptogenic herbs can be used to help nourish the adrenals glands, clinical nutrition can be used to best support neurotransmitter imbalances and insomnia, and botanical medicine and clinical nutrition can be used to put health back into the organ systems most affected by the stress.

 

Thyroid Conditions

Hypothyroidism

Hypothyroidism occurs when your thyroid gland, at the front of your neck, doesn’t produce enough thyroid hormone or when your body fails to use thyroid hormone efficiently. There are several types of hypothyroidism. The most common is Hashimoto’s thyroiditis, an autoimmune disease in which the body attacks the thyroid gland. The disease affects both sexes and all ages, but is most common in women over age 50. Because the thyroid gland is involved in regulating metabolism, low thyroid levels cause your body to slow down and can affect everything

from appetite to body temperature. Left untreated, hypothyroidism can cause serious health complications. Signs and symptoms include slow pulse, lethargy, hoarse voice, slowed speech

Goiter (caused by swollen thyroid gland), intolerance to cold, weight gain, constipation, dry, scaly, thick, coarse hair, numbness in fingers or hands, confusion, depression, dementia, headaches, menstrual cramps or other menstrual disorders. The various forms of hypothyroidism have different causes. In Hashimoto’s thyroiditis, antibodies in the blood mistakenly attack the thyroid gland and start to destroy it. Post-therapeutic hypothyroidism occurs when treatment

for hyperthyroidism leaves the thyroid unable to produce enough thyroid hormone. And hypothyroidism with goiter results when your diet lacks iodine. The addition of iodine to salt in the developed world has made this rare, though it still happens in undeveloped countries.

 

A naturopathic approach to treating someone with hypothyroidisms starts with a full thyroid lab panel to determine if the hypothyroidism is due to an autoimmune disease or just an under functioning thyroid. This will directly dictate the type of treatment prescribed. Comprehensive test above and beyond just the TSH is essential to determine overall thyroid function. Glandulars, clinical nutrition and botanical medicine may be prescribed to put health back into the thyroid so it can do its best job possible to regulate metabolism.

 

Hyperthyroidism

Hyperthyroidism is when your thyroid gland, located at the front of your neck, produces too much thyroid hormone, causing your metabolism to speed up. Hyperthyroidism has three forms that share several symptoms. The most common form is Graves’ disease. Hyperthyroidism can also be caused by taking too much thyroid hormone when you are being treated for hypothyroidism. Hyperthyroidism is more common in women than men and usually occurs between the ages of 20 – 40. It often starts after times of extreme stress or during pregnancy.

Signs and symptoms include rapid heart rate and palpitations, shortness of breath, goiter (swelling of the thyroid gland), moist skin and increased perspiration, shakiness and tremor, anxiety, increased appetite accompanied by weight loss, insomnia, swollen, reddened, and bulging eyes (in Graves’ disease). Researchers suspect that Graves’ disease (the most common form of hyperthyroidism) is caused by an antibody that mistakenly stimulates the thyroid to produce too much hormone.

 

A naturopathic approach to treating someone with hyperthyroidism starts with balancing the immune system and potentially a detoxification program depending on the underlying cause of the autoimmune disruption. Since the most common form of hyperthyroidism is due to Grave’s disease which is an autoimmune condition, see our section on Autoimmune for more information.

 

Zinc deficiency

Zinc is involved in over 100 metabolic enzymes, is an important mineral for immune function and is a rate limiting mineral for the conversion of T4 to T3 in thyroid conditions. White spots on the fingernails may be a sign of zinc deficinency.

A naturopathic approach to treating someone with zinc deficiency is to have them eat zinc containing foods and to give them zinc! Really I just want to end my list of what we treat with something that began with a “z”.

Anxiety / Nervousness

There is “explained” anxiety ie: stress at work, stress in a relationship – psycho-social anxiety or nervousness which is when the body is feeling exactly how it should be feeling given the situation or the environment. Although it can be “explained” it’s not a nice feeling and often adrenal support can be added to a nutritional regiment to help the body best handle the stressor and be less reactive to it. Then there is the “unexplained” anxiety or nervousness, which is when the body feels anxious or nervous but there is nothing significant enough going on in life to feel anxious or nervous about. Those are the tougher cases and quite often we have to look beyond the adrenals to the neurotransmitters. Some of the more common imbalances include: GABA & Glutamate imbalance with the GABA being the calming influence and glutamate having a more excitatory effect. Anxiety is a common symptom associated with peri-menopause or early post menopause most often associated with low progesterone.

 

A naturopathic approach to treating someone with anxiety or nervousness is to first assess what the underlying cause of the anxiety is. To help objectively determine this I may order an adrenal stress profile test which is a saliva test that is collected at four set times throughout the day and the results show if the individual is hypercortisolemia normal cortisol or hypocortisolemia. If the adrenals do in fact appear to be an issue, breathing exercises, meditation exercises, physical exercise may be prescribed along with adpatogenic herbal and nutritional support to nourish the adrenals. I may order a thyroid panel to rule in/out hyperthyroidism. I may order a female hormone panel if I am suspecting an imbalance in her estrogen/progesterone is contributing to the anxiety. I may order a neurotransmitter test to see imbalances in the neurotransmitters. Once the underlying cause is established, an individual clinical nutrition and botanical plan will be created to help reestablish balance in the body to resolve the anxiety or nervousness.

 

Asthma

Asthma is a disease in which inflammation of the airways restricts airflow in and out of the lungs. The word asthma comes from the Greek word for “panting.” The panting and wheezing sound characteristic of asthma occur because of the restricted flow of air. Normally, when you breathe in an irritant or are subjected to a stressor such as exercise, your airways relax and

open, allowing the lungs to get rid of irritants or take in more air. In a person with asthma, muscles in the airways tighten and the lining of the air passages swells. The immune system gets involved, but instead of helping, it causes inflammation. Asthma is a disease of both adults and children. In fact, asthma is the most common chronic childhood illness. About half of all cases of asthma develop before the age of 10. Many children with asthma also have allergies, which in most cases appears to be the underlying cause.

A naturopathic approach to treating someone with asthma would start with rebalancing their immune system. Sometimes this includes screening for potential food allergies and/or sensitivities, rebalancing the gut flora, and using clinical nutrition to quiet down the cytokines associated with histamine release, boost the immune system, and decrease inflammation in the respiratory system.

Blood Sugar Dysregulation-Metabolic Syndrome-CardioMetabolic Syndrome

Blood Sugar Dysregulation / Metabolic Syndrome / CardioMetabolic Syndrome

General nutritional support strategies for individuals with any dysglycemic response. i.e. Metabolic Syndrome (lnsulin Resistance and Hyperinsulinemia), Type II Diabetes, Reactive Hypoglycemia. NOTE: “Type 1 Diabetes” see Autoimmune Section

Metabolic Syndrome Definition: Metabolic Syndrome describes a cluster of two or more related health problems. Central to the syndrome is insulin resistance, the inability to efficiently use insulin to help burn blood sugar. It is often accompanied by abdominal obesity. Here’s how it develops: The more refined carbohydrates you consume, the faster your blood sugar rises after a

meal. In response, your body pumps out large amounts of insulin to help move that blood sugar into cells. But insulin (a powerful hormone) also promotes fat storage, increased blood pressure and elevated cholesterol and triglyceride levels. Approximately 55% of Americans are overweight, a sign of metabolic syndrome. In addition, 25% of thin people have insulin resistance, the cornerstone of metabolic syndrome. Based on these numbers, more that 65% of

American adults either have or are at risk of metabolic syndrome. All of this blood sugar and insulin generates large numbers of hazardous free radicals, which age the body and set the stage for heart disease, cancer, Alzheimer’s and other diseases.

How is Metabolic Syndrome Diagnosed?

There are no well-accepted criteria for diagnosing the metabolic syndrome. The criteria proposed by the National Cholesterol Education Program(NCEP) Adult Treatment Panel III(ATP III), with minor modifications, are currently recommended and widely used. The American Heart Association and the Nation Heart, Lung, and Blood Institute recommend that the metabolic

syndrome be identified as the presence of three or more of these components:

Elevated waist circumference: Men – Equal to or greater than 40 inches (102 cm) Women – Equal to or greater than 35 inches (88 cm)

Elevated triglycerides: Equal to or greater than 150 mg/dL

Reduced HDL (“good”) cholesterol: Men – Less than 40 mg/dL Women – Less than 50 mg/dL

Elevated blood pressure: Equal to or greater than 130/85 mm Hg

Elevated fasting glucose level Equal to or greater than 100 mg/dL

Ideal Laboratory Indices

Fasting Insulin 0-4 mcIU/ml

Fasting Glucose 80-90 mg/dl

Fasting Triglycerides 80-115 mg/dl

Fasting Cholesterol 150-200 mg/dl

2-Hr Postprandial Insulin Less than 30 mcIU/ml

2-Hr Postprandial Glucose Less than 120 mg/dl

Diabetes Definition

A syndrome characterized by abnormal insulin secretion and elevated blood glucose levels, accelerated atherosclerosis, neuropathy and thickened capillary membranes, resulting from a variable interaction of hereditary and environmental factors. NOTE: Diabetes Mellitus is classified as Type 1 (insulin dependent) or Type 2 (non-insulin dependent). As Type 1 patient is treated, they should be warned that insulin requirements may diminish, and care should be taken to titrate the dose according to need, not habit.

Hypoglycemia Definition

A condition characterized by sudden drops in blood sugar, associated with symptoms such as fatigue, headache, irritability, depression, nausea, rapid heartbeat, blurred vision, muscle pain, arthritis, or tinnitus.

A naturopathic approach to treating someone with blood sugar dysregulation, regardless if it is early in the progression with hypoglycemia, or later in the progression with metabolic syndrome or very late in the progression, Type II diabetes, we always start with food first as what you eat day in and day out will have a far greater impact on your blood sugars, than any nutritional supplement I could suggest. We start with a body composition test to measure your weight compartments, then a low glycemic index, anti-inflammatory meal plan is co-created with you that will support your lean dry mass (mainly muscle mass), yet balance your blood sugars and insulin response. Clinical nutrition to repair the insulin receptor sites may also be suggested and a personal training session may also be part of your plan if being sedentary in one of the things contributing to your blood sugar dysregulation.

Body Composition

Body Composition

All experts agree that obesity, even being overweight, contributes heavily to all degenerative disease. The United States Surgeon General stated that a failure to address excessive weight and obesity “could wipe out the gains we’ve made in areas such as heart disease, several forms of cancer, and other chronic health problems.” Although attempts to lose weight are common in the U.S., the prevalence of obesity has increased dramatically since the 1980’s. However, the weight on the scale only tells a part of the story. We want to know what is making up your weight compartments. Is it muscle? Fat? Water? To measure this, we us the Bio-Electrical Impedance technology, a fast, inexpensive, non-invasive, painless test that gives us accurate information about your cell health and weight compartments. We then use this information to develop a specific eating plan will best support your healthy tissues while helping you lose unwanted tissue (like fat) and to objectively track your results as you continue on your program.

 

A naturopathic approach to treating someone with obesity is to investigate what may be the underlying causes contributing to someone’s obesity. We screen for optimal thyroid function, adrenal function, toxicity patterns, food sensitivities, candida overgrowth, estrogen dominance, insulin resistance, inflammation, consider medications that may be contributing, acknowledge the stress connection with obesity, binge eating, night eating syndrome, and food addictions. Once we can determine what the underlying cause(s) are we can devise a specific individualized plan for you.

Candida Albicans

Candidiasis is an infection with a fungus of the Candida strain, usually limited to the skin and mucous membranes, but sometimes is systemic and life-threatening. Candida albicans are a single cell yeast/fungus that is found in practically 100% of the population. It lives on the mucous membranes of the body, the digestive/intestinal tract, vagina and the skin. Most important , in the proper environment, Candida albicans will co-exist with no negative side effects. So to understand, diagnose, and treat “candidemia,” we must understand what causes the Candida albicans relationship in our bodies to change from a saprophytic to a parasitic one.

Most researchers agree that the pathogenesis of “candidemia” is primarily due to an altered/improper balance of gut microflora. This is a result of primarily: 1) the indiscriminate use of antibiotics in both people and animals/food, 2) high beef, fat, sugar, and low fiber diets, 3) use of birth control pills, cortisone, cortisone-like drugs and immunosuppressant drugs.

As a result we end up with a drastic imbalance of the microecology in our body. This allows the Candida yeast and other “enemies” to over-populate, convert into a fungal form which produces some 70 neurotoxins, and irritate the gut lining to the point of allowing macromolecular absorption of many things not designed to enter into the circulatory system including the Candida albicans, toxins, and potential allergens. It is therefore extremely important to identify and implement a program designed to approach this problem. Symptoms include headache, heartburn, yeast vaginitis, fatigue, Hay fever, depression, gastritis, irregular menses, joint pain/stiffness, sinusitis, lethargy, colitis, cramping, cold hands/feet, earaches, agitation, distension/bloating, endometriosis, increased body hair, hives, hyperirritability, gas, cystitis, numbness/tingling, asthma, memory loss, constipation, urethritis, food cravings, food/chemical, inability to concentrate, diarrhea, kidney/bladder Infections, loss of libido, environment and food sensitivities.

 

A naturopathic approach to treating someone with candida over-growth includes more than the standard medical approach to candidemia which is the idea of finding something that “kills off” only Candida albicans and doing nothing else. This is not a very logical approach since even if you COULD kill them off completely, they would just come back as soon as treatment would stop. Since they are found practically everywhere it is essentially impossible to prevent their re-entry into the body. A more logical focus of nutritional treatment protocols should be to create an environment which keeps this naturally occurring yeast form at an appropriate saprophytic population concentration as well as keeping it in its yeast form by preventing its conversion to the mycelial/fungal form of the organism. This includes following an anti-candida meal plan specific for creating an environment in which candida does not live well, but supports the growth and colonization of your good bacteria, anti-microbials to minimize the growth of the candida, probiotics to colonize good flora, detox supports since it is the mico-toxins that the yeast releases that give you the most symptoms.

Cardiovascular Disease

Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all annual deaths. More than 910,000 Americans die of cardiovascular diseases each year, which is 1 death every 35 seconds. Although these largely preventable conditions are more common among people aged 65 or older, the number of sudden deaths from heart disease among people aged 15–34 has increased. In addition, more than 70 million Americans currently live with a cardiovascular disease. Coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce. Stroke alone accounts for disability among about 1 million Americans. More than 6 million hospitalizations each year are because of cardiovascular

diseases. The economic impact of cardiovascular diseases on our nation’s health care system continues to grow as the population ages. The cost of heart disease and stroke in the United States is projected to be $403 billion in 2006, including health care expenditures and lost productivity from death and disability.

(http://www.cdc.gov/nccdphp/ publications/aag/pdf/aag_cvh2006.pdf)

Definitions of Cardiovascular Disease Risk Factors

Total cholesterol: Cholesterol is a waxy fat like substance. Total cholesterol refers to the sum of the different sub-fractions of cholesterol that are measured in the blood. Total cholesterol is an independent risk factor for cardiovascular disease. The National Cholesterol Education Program says 240 is considered high. A person with this level has twice the risk of heart disease compared with someone whose cholesterol is 200 mg/dL. Total cholesterol 200- 239 is borderline high cholesterol. Any cholesterol level of 200 mg/dL or more increases your risk. (More than

half the adults in the United States have levels above 200 mg/dL)

LDL cholesterol: Low density lipoprotein (LDL): A subfraction of total cholesterol. (Like oil and vinegar, cholesterol and blood do not mix well. So, for cholesterol to travel through, it is coated with a layer of protein to make it a lipoprotein. Hence the name LDL-cholesterol) LDL is the ‘bad’ or athrogenic cholesterol fraction. More directly correlated with risk for CVD then total really. Excess LDL builds up in your arteries (simplistically). The higher the level of LDL, the

greater your risk for heart disease. Generally above 130 is considered high, but some high risk individuals should have that even lower.

HDL cholesterol: High density lipoprotein: a subfraction of total cholesterol. The ‘good’ or non arthrogenic cholesterol fraction. General thought that the higher the better as it appears to ‘pick up’ or remove athrogenic LDL from the bloodstream.

Triglycerides: Another type of fat carried in the blood. Most of the body’s fat tissue is in the form of triglycerides, stored for use as energy. High triglyceride levels also are associated with increased CVD risk. In fact the number one risk factor is your triglyceride to HDL ratio. Take your total number of triglycerides and divide that by your HDL cholesterol. If that number is >3.5 you have an increased risk of having a cardiovascular event. If it is <3.5, your cholesterol numbers a whole are not as significant. The Cholesterol/HDL Ratio (tChol/HDL-C) is not as well known, and is often not calculated in conventional medicine, but we know it is a good predictor of insulin resistance or Metabolic Syndrome, and has been used by some (importantly Gerald Reaven) as a surrogate marker for insulin resistance. But there’s even more to the story than that, and that’s the sub-fractionations of cholesterol which must be included in the overall findings to truly know if your bad cholesterol is really all the bad and if your good cholesterol is really all that good. These are “specialty” labs not offered by conventional medicine but can offer an abundance of clarity in the overall cholesterol “story” and are readily done at our office.

Fat Mass: % body fat is pretty self explanatory. Once a woman goes over about 30% fat, there is a dramatic correlation with illness and disease, which is why we test every new patient with a body composition test.

High sensitivity C-reactive protein (hs-CRP): A very sensitive marker of systemic inflammation in the body. It’s actually an inflammatory mediator produced in the liver. This sensitive test measures ‘sub acute’ inflammation. That is, someone with rheumatoid arthritis would have a very high level. That’s not sub acute. However, if this marker is used to measure inflammation in individuals who don’t have overt inflammatory conditions it can pick up sub acute ‘smoldering’ if you will. It could be anything smoldering, but there has been a lot of work done in the past 10 years that suggests that many people with no overt inflammatory condition and who have elevated levels (not as high as RA mind you) are at increased risk for CVD. Hence this is an independent risk factor for CVD and the general acceptance that CVD is an inflammatory mediated condition.

Homocysteine: Another metabolite measured in the blood. Homocysteine is actually a by product of certain normal metabolic amino acid breakdown and processing. However, if it is elevated it suggests a ‘sluggish’ conversion or reconversion from one amino acid to another. (This conversion is controlled by enzymes and these enzymes are driven in part, by certain vitamins that act as cofactors. Hence you can often drive or quicken this process with folic acid, B6, B12

etc.) The problem here is that homocysteine, akin to LDL cholesterol, appears to be athrogenic, i.e. it damages the vessel wall. Thus high levels are independently associated with CVD. Additionally high levels appear to be independently associated with strokes and dementia as well as other things. Homocysteine is a simple blood test that I often recommend in my office.

Hemoglobin A1C (HbA1C): This is a measure of long term blood sugar control. It is actually measuring changes in the hemoglobin molecule brought about by bouncing against glucose in the blood stream. Essentially glucose in the blood is bumping up against red blood cells (which contain hemoglobin). The more glucose ‘bumps’ against RBC’s the more ‘pock marks’

it makes on that molecule. You can measure these marks as HbA1C. So you can see the higher the number, the higher glucose is overall in the blood. Since RBC’s stay around for 120 days, you can get a good assessment of long term blood sugar control. It is generally used in diabetics; however, it is now very clear that even modestly elevated HbA1C-within the normal range-is actually an increased risk for CVD.

Fasting insulin: Insulin is a hormone secreted by the pancreas in response to glucose levels in the blood. Insulin’s main action is to open up, or unlock the cellular ‘door’ to allow glucose to get into cells. Glucose needs insulin to get into a cell. In Insulin resistance (Metabolic Syndrome) insulin is not working efficiency and so the pancreas pours out more insulin. This is good, because then in many people their blood sugar remains in the normal range. However

it is also bad as insulin has various other metabolic effects-it causes, increased triglycerides, decreased HDL, increased blood pressure etc. So higher levels of insulin are associated with Metabolic Syndrome and CVD.

Blood Pressure: Pressure exerted by the blood upon the walls of the blood vessels, measured by means of a sphygmomanometer (BP cuff), and expressed in millimeters of mercury. The numerator is the maximum pressure that follows systole (pumping) of the left ventricle of the heart and the denominator the minimum pressure (that accompanies cardiac diastole). (Adult) blood pressure is considered normal at 120/80 where the first number is the systolic pressure and

the second is the diastolic pressure. Hypertension (there are different stages) starts at greater then 140/90.

Fasting glucose: The level of glucose or ‘blood sugar.’ Fasting, anything below 100 mg/dl is considered normal, 100-125 is considered ‘impaired glucose tolerance’ (IGT) and 126 or greater is considered diabetic. IGT just means, as with many things, there is a continuum, and this is in the danger zone. Some people consider this ‘prediabetic.’. Therapeutic Lifestyle Changes (TLC)

Therapeutic Lifestyle Changes (TLC) are recommended as a first line treatment for a variety of common health problems by many national health organizations, including: National Institutes of Health (NIH), National Cholesterol Education Program (ATP III Guidelines), American Diabetes Association, North American Menopause Society, American Heart Association, American Association of Clinical Endocrinologists, among many others, therefore this should be prescribed and implemented FIRST for a minimum of 3 months before any drugs are considered. Even when drug are necessary for the management of symptoms, the underlying cause must still be addressed through therapeutic lifestyle changes.

 

A naturopathic approach to treating someone with cardiovascular disease or risk would therefore include the implementation of a low glycemic, anti-inflammatory meal plan based specifically on your body composition results, so it would be an individualize, unique to you plan. Personal training may be recommended if being sedentary is part of the underlying cause of your cardiovascular risk. Clinical nutrition, and or botanical medicine may be prescribed in addition to the lifestyle changes, to enhance and support a speedy return to health in your cardiovascular system.

Chronic Fatigue Syndrome

Chronic, persistent or relapsing debilitating fatigue or easily fatigued, that does not resolve with bed rest and that is severe enough to reduce or impair average daily activity below 50% of premorbid activity level. Associated symptoms: mild fever, sore throat, painful lymph nodes, muscle weakness, myalgia headaches, arthralgia, neuropsychological complaints, sleep disturbances.

International CFS Study Group Definition of Chronic Fatigue Syndrome

  1. Clinically evaluated, unexplained persistent or relapsing chronic fatigue that:

is of new or definite onset (has not been lifelong).

is not the result of ongoing exertion.

is not substantially alleviated by rest.

results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

  1. The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue:

self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities sore throat tender cervical or axillary lymph nodes muscle pain multi-joint pain without joint swelling or redness headaches of a new type, pattern, or severity unrefreshing sleep post-exertional malaise lasting more than 24 hours.

Suspected Etiologies for Chronic Fatigue Syndrome: Viral infections and the post-viral fatigue syndrome, Fibromyalgia, Neurally-mediated hypotension, psychogenic biological dysfunction, low natural killer cell syndrome.

Factors Suspected of Promoting Chronic Fatigue Syndrome: Hypoxemia, endocrine dysfunction, immune dysfunction, stress-related dysfunction, somatoform disorder, marginal nutritional deficiencies, intestinal hyperpermeability. overgrowth of pathogenic intestinal flora (dysbiosis), food and chemical sensitivities, chemical toxicity, heavy metal toxicity.

Symptoms

Fatigue: The degree may be mild, being able to perform at work or home but easily fatigued from it; or it may be intense, causing patients to give up their jobs and greatly curtailing other activities. Sometimes they may be bedridden, and slight activities such as housecleaning or going for a walk may necessitate a recovery period of 2-3 days. Usually more strenuous exertion and exercising are impossible. Frequently, though, patients have alternating periods of fatigue and normalcy. The disease usually begins gradually, with the fatigue slowly growing until it becomes overwhelming.

Lab Findings

While laboratory diagnosis of this condition used to be prohibitively expensive and inadequate, some labs now provide reasonably priced comprehensive panels showing titers of different causative agents, usually Epstein-Barr virus, Cytomegalovirus, toxoplasmosis, Candida. Subtyping of antigens allows accurate diagnosis of present, chronic, active or inactive infections, but severity of symptoms do not always correlate with the lab findings. Some patients with extremely high titers for a particular agent may be symptom-free while others with low titers may be extremely symptomatic. Many see decreased WBC count, increased lymphs or atypical lymphs on peripheral smear.

 

A naturopathic approach to treating someone with chronic fatigue, starts with asking the right questions to put together the puzzle of what may be the underlying cause(s) of their chronic fatigue. Multiple lab tests are ordered to find objective data as to the underlying cause(s) and together with the subjective findings an individualized clinical nutrition plan is put together along with the implementation of lifestyle changes to bring health and energy back into the body.

Conjunctivitis

An acute infection of the conjunctiva, which may be viral, bacterial or allergic. Only 25% of cases are caused by bacteria. Allergies and viruses (esp. adenoviruses) are responsible for most of the rest, along with other irritations to the eye and cornea, such as smoke, dust, wind, sunlamps, reflection of the snow, the common cold, exanthems and contact lenses. Bacterial infections may superimpose viral or allergic conditions. Allergic conjunctivitis is likely to persist until the season is over (e.g. from hay fever in spring), until the allergen is identified and removed from the patient’s exposure, or the symptoms are addressed with homeopathic desensitizing drops and nutritional support.

Viral conjunctivitis is usually self-limiting in 1-2 weeks, but is highly contagious and care should be taken to not spread the infection from one eye to the other or to another person. For example, the infected person should use separate towels. In bacterial conjunctivitis, treatment should be initiated promptly to avoid eye damage. Contact wearers should discontinue wearing their contacts for a few days, support nutritionally and begin wearing them again slowly.

If the irritating factor is not removed a chronic conjunctivitis may develop with symptoms less severe than that of the acute disease but still quite noticeable (redness, itching, smarting, feeling of foreign body).

Symptoms

Viral: Clear discharge; minimal or absent lid swelling; no itching; often, lymphadenopathy of periauricular node is present.

Allergic: Clear, mucoid discharge; high eosinophils; mild to marked lid swelling; severe itching with increased lacrimation; no nodal involvement.

Bacterial: Purulent, green discharge; high polymorphonuclear leukocytes; moderate lid swelling; no itching; no nodal involvement; possible fever.

In any of these cases, the patient may wake up in the morning with eyelids agglutinated shut.

 

A naturopathic approach to treating someone with conjunctivitis includes first, investigating the underlying cause. Very often I see this following cataract surgery. Topical application such as colloidal silver or a salt water eye ball flush may be prescribed as well as clinical nutrients, botanical medicine to boost the immune system. Homeopathic remedies for eye health may be recommended as well.

 

Detoxification

Low-level, long-term exposure to toxins such as heavy metals (e.g. lead, mercury, PSP, and cadmium), pesticides, industrial compounds, and pollutants is associated with chronic fatigue syndrome (CFS), multiple chemical sensitivities (MCS), fibromyalgia (FM), neurodegenerative diseases such as Parkinson’s disease and atherosclerosis as well as many types of cancers. Common signs and symptoms of environmental toxicity include acne, rashes, headaches, aches and pains, fatigue, muscle weakness, tinnitus, fertility problems, memory loss, and chronic

immune system depression.

Common Clinical Symptoms and Conditions Associated with Environmental Toxicity:

  • Headaches • Mineral Imbalances• Fertility Problems • Depression• Multiple Chemical Sensitivities • Non-Responsive or Recurrent Yeast Infections• Learning Disorders • Chronic Fatigue Syndrome• Fibromyalgia • Contact Dermatitis• Broad Mood Swings • Unusual responses to Medications or Supplements• Memory Loss • Parkinson’s Disease• Tinnitus • Muscle Weakness• Worsening of Symptoms After Anesthesia or Pregnancy • Cancer• Fatigue • Panic Attacks• Abnormal Pregnancy Outcomes • Chronic Immune System• History of increasing sensitivity to exogenous exposures, odors, or medications.

Toxins may remain in the body for many years, therefore we are exposed to much higher toxin doses than present environmental concentrations suggest. Research suggests that we all maintain toxin contamination within our bodies on a regular basis due to this lifetime of exposure.

How does the body remove toxic substances? An individual’s ability to remove or detoxify toxins is a primary factor in susceptibility to toxin-related conditions. In order to remove (excrete) the multitude of diverse toxins, the body has a complex system that converts them

into non-toxic molecules for removal. This complex system occurs in two phases- Phase I and Phase II, that convert (biotransform) a toxic molecule into a non-toxic molecule that can be easily excreted. The majority of detoxification occurs in the liver, however all tissues have some ability to detoxify, including the intestines, skin and lungs.

In Phase I, a functional group is added to the toxic molecule, producing an intermediate that needs to be further transformed. Phase II detoxification involves a process called conjugation in which various enzymes in the liver attach protective compounds to the intermediate, making it less harmful and more readily excretable. Because the products of Phase I can be highly reactive and more harmful than the original compound, achieving and maintaining a balance between Phase I and Phase II processes is critical. Furthermore, a significant side effect of all this metabolic activity is the production of free radicals as the toxins is transformed, resulting in oxidative stress. Nutrients that help protect us from oxidative stress include vitamins

C and E, zinc, selenium and copper.

Achieving Balanced Detoxification Optimal detoxification requires that both Phase I and Phase II pathways function correctly and in balance with each other. Bifunctional modulators are phytonutrients that support balanced detoxification by modulating Phase I and promoting Phase II. This minimizes damage by reactive intermediates and free radicals. Fruits and vegetables contain many bifunctional modulators, which is one reason these foods are associated with reduced susceptibilities to cancer and degenerative diseases.

 

 

A naturopathic approach to Detoxification starts with recognizing that detoxification is an energy-requiring process that puts a metabolic burden on the body. Therefore, water or juice

fasts are not recommended because they deplete the body of the essential nutrients required for healthy detoxification. These fasts have many adverse health effects, including decreased energy production, breakdown of lean tissue instead of fat, increased oxidative stress, and unbalanced detoxification. Rather than decreasing nutrient support, a focused, high-impact, low allergy potential source of micro and macronutrients should be provided. This is done through the prescription of a modified elimination diet – which eliminated potential food immune reactions and foods that are inflammatory. Medical foods designed specifically to support both phase I and II detoxification are also used to give your main detoxification organs (liver and kidneys) all the nutritional support they need to do their best work.

 

Estrogen Metabolism

An interesting aspect of the observations concerning estrogens and autoimmunity relates to estrone metabolism and to the 16α-hydroxylated metabolite—a mitogenic estrogen that appears to increase estrogen-induced autoimmunity—in relation to levels of the 2-hydroxylated metabolite, which is not mitogenic or immunogenic. A number of studies on patients with RA and SLE have demonstrated elevated levels of the mitogenic 16α- hydroxyestrone ( 16α-OHE), likely contributing to the cellular proliferative state observed in these autoimmune diseases. Gastrointestinal Research suggests there is a correlation between mucosal barrier function and autoimmune disease. The GI tract is responsible for regulating the traffic of molecules between the environment and the body through a barrier mechanism. Together, the GI barrier with its selectively permeable intracellular tight junctions, lymphoid tissue, and neuroendocrine network control the balance between tolerance and immunity to potential antigens. When the precise trafficking of molecules becomes dysregulated, autoimmune disease can occur.

Intestinal Permeability The permeability of the intestinal barrier depends on the regulation of intercellular tight junctions, which are responsible for selectively trafficking beneficial and potentially harmful molecules—such as nutrients and antigens, respectively — between the environment and host. It is now widely accepted that tight junction dysfunction, commonly referred to as “leaky gut”, plays a role in the pathogenesis of several diseases, particularly autoimmune diseases. Emerging scientific findings from mucosal biopsies of IBD patients have shown altered expression of critical tight junction proteins, possibly due to the effects of pro-inflammatory cytokines on barrier integrity. This suggests a vicious cycle is created , in which increased intestinal permeability allows further leakage of intestinal contents, contributing to a pro-inflammatory immune response on intestinal tissue that in turn promotes further gut leakiness.

Microflora Balance A healthy intestinal tract harbors a large variety of beneficial microflora, or “friendly” bacteria, residing in close proximity to rapidly renewing intestinal epithethial cells and other components of the mucosal immune system. Components of beneficial microflora are essential to maintain a balanced immune and inflammatory response; when this balance is disrupted, excessive immune activation could pose a risk to the development of intestinal or systemic inflammation.

A naturopathic approach to treating someone with an autoimmune disease, certainly depends on the autoimmune disease and mostly on the person who has it. Regardless, since it is an immune disorder, a good place to start is with the immune system – 60%-70% of which is in the gut. Often a modified elimination diet along with a gut restoration program is recommended along with clinical nutrition to help rebalance the immune system and put health back in the body to support the resolution of symptoms or minimize progression. Autoimmune disease is considered to be an inflammatory disease, so strict focus through food, movement, stress and trigger elimination, herbals and nutrients that support an anti-inflammatory environment are often prescribed.

Female Conditions

Amenorrhea

Absence of menstruation. Amenorrhea may be primary (the girl has never begun her periods) or secondary (the woman had her periods once and then stopped having them). Physiologic amenorrhea is the lack of menses before menarche, during pregnancy and early lactation, and after menopause (all considered normal). All other causes of amenorrhea are pathologic. Causes of Primary Amenorrhea Physiologic delay: The late onset of menses in a physiologically normal female. No workup is necessary in the female who has secondary sexual characteristics but no menstrual cycles until she is 18; however, if no secondary characteristics appear by age 14 and no menses has occurred, then a workup should be started earlier. The age of menarche of the mother will often provide clues as to when the female child should expect to begin. Primary ovarian failure: These patients are divided into two groups: those with normal but infantile genitalia (e.g. Turner’s syndrome), and those with ambiguous genitalia (e.g. hermaphrodites). Karyotyping is necessary. Causes include: hypothalamic or pituitary failure (insufficiency or organic disease of either of those organs); congenital abnormalities (vaginal agenesis, vaginal septa, cervical atresia, uterine agenesis, uterine septi, or bicornuate uterus); imperforate hymen (This could impede the outflow of the menstruum. The girl will report monthly cyclical abdominal cramping due to the buildup of the menstrual flow. Treatment includes opening the hymen after a needle aspiration of the area behind the hymen demonstrates that a vagina exists.) Causes of Secondary Amenorrhea Endometrial sclerosis: This usually occurs as a result of a D&C after which the tissues heal by fibrosis. Cervical stenosis: This can occur after a cervical conization where the cervix scars or the os cannot be found. Intrauterine growths must be ruled out. Anovulation: This may be sporadic or constant. These can be causes for anovulation: Hypothalamic causes*: The organ disorder may be due to organic lesions (tumors, scars) or insufficiency (polycystic ovarian disease, hyperprolactinemia amenorrhea). Pituitary causes *: Including insufficiency (Sheehan’s syndrome) or organic disease (tumors, adenomas). Ovarian causes*: From scarring, tumors, cysts. Low Body Fat from Excess Exercise*: (less than 10% body fat). Although this form of anovulation is similar to that which is induced with anorexia nervosa, in this type, when the patient regains weight or stops exercising excessively, the period will return. Adrenal Dysfunction*: Hyperplasia, adenomas, tumors. Systemic Causes of Anovulation: Cushing’s disease; post oral contraceptive agent syndrome; hyperprolactinemia; both over and underactive thyroid problems; and other disease (ulcerative colitis, diabetes mellitus, steroid use for autoimmune diseases, celiac disease). Usually when these diseases are corrected the menses will return to normal.   A naturopathic approach to treating someone with amenorrhea starts with determining the underlying cause(s). Most often in my practice, what I see as the underlying cause is estrogen insufficiency due to either low body fat weight or chronic adrenal stress which may too be accompanied with hypothyroidism. Nutritional support for the ovaries/adrenals/thyroid, along with ensuring optimal body composition are the most frequent interventions offered.

Cervical Dysplasia

Dysplasia of the uterine cervix. Epithelial atypia involving part of the squamous epithelium; more common in young women. Cervical dysplasia is now considered a sexually-transmitted disease because of the implicated role of human papilloma virus (HPV) in bringing about tissue changes. It is considered a precancerous lesion, since dysplastic changes often precede malignant transformation. Risk factors include: sexual exposure to men who have HPV (Human Papilloma Virus) and cofactors in development of cervical cancer include: • Smoking • Poor Diet• Long-term Oral Contraceptive Use • Chronic Cervicitis• HSV Infection • Immune Compromise

  • Environmental Carcinogens. This is a microscopic finding usually found routinely with a PAP smear. Prognosis is excellent with appropriate treatment. Conventional treatment includes laser surgery, but does not address the underlying causes. Regular PAP smears are essential to monitor cervical status.

A naturopathic approach to treating someone with cervical dysplasia should she test positive for HPV would be natural anti-virals and nutrients to suppress viral replication, along with addressing any co-factors. For example if prolonged birth control pill had been used, and estrogen detoxification may be prescribed. If she had been eating similar to the standard American diet, I may prescribe an anti-inflammatory, high anti-oxidant meal plan. Conditions

Dysmenorrhea / Excessive, painful Menstrual Cramps

Dysmenorrhea, or painful menstruation, is the second most common gynecologic complaint, superseded only by premenstrual tension. Dysmenorrhea has been described as a discrete clinical entity, characterized by “labor-like” pains. The morbidity attending this condition is manifested in the voluminous hours lost in the workplace and schools as a result of dysmenorrhea. There are three types of dysmenorrhea. The first type is primary, characterized by the absence of an organic etiology. This most commonly occurs in adolescence, about 6 to 10 months post-menarcheal. Dysmenorrhea almost invariably is associated with ovulatory cycles. Thus, women taking oral contraceptives rarely experience dysmenorrhea. It is ameliorated in many women by pregnancy due to a decreased excitability of associated nerve fibers. However, some women experience an increase of primary dysmenorrhea after pregnancy, with some women continuing to experience dysmenorrhea throughout most of their reproductive years. Another type is classified as secondary dysmenorrhea, the pain being secondary to specific pathologies. These include endometriosis (the most common secondary cause and misdiagnosis of primary dysmenorrhea), ovarian cysts, adhesions, pelvic inflammatory disease, fibroid polyps, adenomyosis, cervical stenosis, and possibly uterine displacement with fixation. Membranous dysmenorrhea describes the third and most infrequent type. It is characterized by the passage of an intact cast of the entire secretory endometrium through a non-dilated cervix. The prevalence according to investigations by Moos, Coppen, and Kessel have noted moderate or severe dysmenorrhea in 45% of women surveyed. Additional studies have described similar prevalence rates. A survey of 113 patients from a family practice setting revealed the incidence of dysmenorrhea to range from 29% to 44% in any given two-month period. Extrapolations from currently available data indicate that approximately 10% of women of child-bearing age suffer from severe primary dysmenorrhea, rendering them unable to continue their normal work tasks at employment, school, or home. Budoff reports that dysmenorrhea is a major cause of work absence, totaling 140 million work hours annually. One study revealed that 10 to 15% of teenage girls missed one to two days of school each month due to dysmenorrhea.   A naturopathic approach to treating someone with dysmenorrhea would most often include addressing underlying estrogen dominance which clinically seems to be the most common contributor to a painful menses. Other nutritional deficiencies such as magnesium, or omega 3 fats may be considered, and botanical medicine – herbs like cramp bark, passion flower, valerian root, may be used to help manage symptoms. Dietary changes such as implementing a low glycemic index and/or anti-inflammatory meal plan are also often recommended.

Endometriosis

The ectopic occurrence of endometrial tissue is a common problem which has no known etiology but a higher occurrence is seen in women who defer pregnancy until later in life. Fiberoptic laparoscopic techniques allow a direct look at the problematic tissue. Endometriosis is a painful, devastating disease in which small islets of endometrial tissue somehow migrate into the muscular wall of the uterus, out along the Fallopian tubes, and even to the surface of the ovaries and the pelvic contents, including the nearby colon. When observed at surgery, these small islets appear as tiny chocolate-colored blobs scattered here and there, some so small as to be nearly invisible to the unaided eye. Being endometrial tissue, they respond to the monthly surges of estrogen and progesterone exactly like the endometrium within the uterus, i.e., they swell with blood during the month and then bleed at menses time, causing considerable pain starting shortly before menstruation and not subsiding until after menstruation. The small drops of blood trapped in the tissue in which the endometrial islets are embedded become chocolate-colored over time. When confined to the muscular wall of the uterus, the condition is called adenomyosis and can cause significant pain with menstruation, otherwise known as dysmenorrhea. The cause of this disorder is presently unknown. There is no mechanism known by which endometrial tissue could migrate throughout the pelvis as some cancers are able to. The hypothesis that scattered islets of endometrial tissue persist from embryonal time likewise is unproved. Further, the disorder appears to be of modern origin; it is difficult to imagine that such a painful disorder could have existed a century or two ago without some medical comment of it being made. Some have hypothesized that it has something to do with the long time (and the many menses) between menarche and the first pregnancy. Until this century, women in the Northern hemisphere typically experienced only two or three years of menstruation before becoming pregnant, menarche being at about age 16 and first pregnancies at about age 18 or 19. Now, menarche is common at age 12 and pregnancy is often delayed until after the mid-20’s. It has been calculated that the number of menses between menarche and first pregnancy was typically less than 30, whereas now it customarily exceeds 150. The outward migration of endometrial cells may somehow result from such a long run of menstrual cycling in sexually active women without the hormonal “rest” of pregnancy. Further study is obviously needed. Medical treatment of this disorder has included low-dose synthetic estrogen (to suppress endogenous estrogens), high-dose synthetic progestins taken daily or as long-acting IM injections of synthetic progestins (to suppress menses), and analgesics, including codeine and narcotics, for pain. The results are generally unsuccessful. Surgical treatment attempts to resect all visible endometrial lesions is also rarely successful. Almost invariably, it becomes necessary to ablate (remove or destroy) both ovaries, tubes, and the uterus, regardless of the patient’s age. When confined to the uterus (adenomyosis), hysterectomy is usually recommended. Natural progesterone offers a more benign alternative since sufficient serum progesterone inhibits FSH and LH.   A naturopathic approach to treating someone with endometriosis would start with ordering a complete hormone panel to evaluating the balance of the hormones. Most often women with endometriosis are estrogen dominant and see fantastic results with an estrogen detoxification program. Also frequently I see low progesterone, mostly as a result of insulin resistance. Therefore a low glycemic anti-inflammatory meal plan is implemented and at times either bio-identical progesterone or Chaste berry is prescribed to bring progesterone levels back into normal range. Proteolytic enzymes may be used to help with the destruction and re-absorption of the excess tissue. Quite often castor oil packs can offer relief at the most symptomatic times.

Fibrocystic Breast Syndrome

Multiple names exist to describe cyclical breast tissue changes and the clinical symptoms that occur monthly under the hormonal influence of the menstrual cycle. The names include: cyclic mastalgia, fibrocystic disease, aberrations of normal development (ANDI), benign breast disease, fibrous disease, benign breast syndrome, cystic breast disease, and mammary dysplasia. In this nutritional handout this phenomenon will be referred to as Fibrocystic Breast Syndrome (FBS), as this term coins the two most common breast changes which occur (cystic, fibrous), and defines the condition as a syndrome and not a disease. The condition of fibrocystic breasts has been labeled a syndrome, and is no longer recognized or properly referred to as an actual disease manifestation. Indeed, Hutter in 1985 posed the question, “Is it reasonable to define as a disease any process that occurs clinically in 50% and histologically in 90% of women?” Additionally, the fibrocystic breast was classified as a manifestation disease, based upon the spurious belief that women with this condition were at 2 to 4 times the risk of developing breast carcinoma. This is currently not considered to be the case. Most women with cyclical fibrocystic breast changes are not at increased risk of cancer. Rather it is a special subset of these women who are at risk. Dupont and Page, in 1985, demonstrated in a study of 10,366 breast biopsies over a period of 17 years, that women are at increased risk of cancer only if the breast syndrome is histologically atypical hyperplasia and/or there is a familial risk factor; the majority of women (70%) who underwent breast biopsy were not at risk. The incidence of FBS peaks in 30 to 40 year old women, occurring more frequently in the left breast. In most women it is experienced as a mild to moderate aching, burning, or intermittent sharp discomfort in one or both breasts during the premenstruum, at any time from ovulation to the onset of the menses.   A naturopathic approach to treating someone with fibrocystic breast syndrome most often consists of assisting the body with the detoxification of estrogen. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. Increased insulin due to insulin resistance also contributes to the estrogen dominance, therefore a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Iodine may be recommended to help bind up the estrogen receptor sites in the breast tissue to “bump” the estrogen off and minimize the symptoms of FBS. Castor oil packs and proteolytic enzymes may also be prescribed to help manage the symptoms and address the underlying cause(s).

Menopause — Hormone Dysregulation

Due to the early termination of the National Institutes of Health (NIH) research on Hormone Replacement Therapy (HRT), many women who are either on HRT, or are considering it, have a difficult decision to make. Whether or not to go on HRT is a critical decision because estrogen imbalance is responsible for many of the adverse effects associated with menopause. Estrogen may be, on occasion, a woman’s best friend, but its fluctuation throughout life causes a host of problems for some women. It has been documented that in the United States, synthetic estrogen pharmaceuticals are among the most commonly prescribed and dispensed drugs in community practice. However, there are significant risks associated with this form of therapy. The NIH study (Press Release: Tuesday July 9, 2002) and additional studies, including several published in theJournal of the American Medical Association (JAMA) and in the New England Journal of Medicine, have indicated that the risks associated with HRT far outweigh the benefits. Some of the adverse side effects associated to long term use of HRT are invasive breast cancer, ovarian cancer, endometrial cancer, endometriosis, heart attack, stroke, blood clots, insulin resistance, type II diabetes, adult onset asthma and a wide range of other frequent adverse effects, such as abdominal bloating, migraine, or other kinds of headache, weight gain, anxiety, depression and breast tenderness. With these obvious, documented risks, alternative therapies to HRT should be considered before any decisionis made. Some of the Natural Alternatives to Hormone Replacement Therapy Women who decline to use HRT may choose from a variety of natural remedies that are available. These include: plant hormones called phytoestrogens, which are found in soy based products, and herbs such as black cohosh, ginseng, dong quai, and licorice root which have been used safely for centuries to eliminate menopausal symptoms. Past research has indicated that phytoestrogens may prevent heart disease, and slow bone loss without the risks associated with HRT. Creams containing wild yam extract offer enzymatically converted hormones with molecular structures that are identical to what the body produces. Menopausal symptoms such as hot flashes and vaginal dryness can be addressed using these bio-identical natural hormones. Natural versus Synthetic Estrogens: To test the effect of natural estrogens, called phytoestrogens (found in soy foods and herbs such as Black Cohosh), researchers at Tufts University School of Medicine in Boston exposed estrogen-dependent breast-cancer cells to a variety of synthetic estrogens (the same hormones found in traditional hormone replacement therapy). They found that the synthetic estrogens promoted cell proliferation in the breast cancer cells, while the natural estrogens inhibited breast cancer cell growth. Nutrition and Cancer, 1998;30;232-9. The Benefits of Soy Isoflavones in Menopause: Considerable evidence appears to indicate that soy isoflavones in the diet exert “weak” estrogenic effects that may confer anti-aging benefits, help prevent bone and joint disease, and cancer. They also promote cardiovascular wellness, help to maintain a healthy urinary tract, and modify the symptoms of menopause. Earl Mindell, PhD, in his popular consumer book titled Earl Mindell’s Soy Miracle, points to the value of soy in suppressing menopausal symptoms. Dr. Mindell clearly reports the results of studies by Canadian researchers of Japanese women where menopausal complaints such as hot flashes are much less prevalent in Japanese than Western women. Dietary supplementation with soy phytoestrogens offers a possible alternative to the commencement of synthetic hormone replacement therapy with all its known drawbacks. The prospect of using a natural means with soy isoflavone supplementation to reverse these adverse associations of menopause is very exciting.Phytoestrogens for a Healthier Menopause by Steven Holt, MD published in Alternative and Complementary Therapies-June 1997. The Benefits of Natural Estrogen and Progesterone Creams in Menopause Transdermal cream of naturally derived progesterone and estrogen can be useful in coping with the symptoms associated with the decrease in hormone production during perimenopause, menopause, and following a hysterectomy. The formula should be designed to match the natural pattern of circulating estrogens found in the female body; 80% estriol, 10% each of estrone, and estradiol. Progesterone should be no less than 480 mg per ounce of cream. The advantage of transdermal application is better absorption. It goes directly into the bloodstream, thereby bypassing the problems associated with poor digestion and liver breakdown that can occur with oral supplementation. Wright, JV., Morgenthaler, J. Natural Hormone Replacement. Smart Publications, Petaluma, CA, 94955, 1997. Lee, JR., Hopkins, V. What Your Doctor May Not Tell You About Menopause, Warner Books, Inc., 1271 Avenue of Americas, New York, NY 10020, 1996.   A naturopathic approach to treating someone in menopause, would start with a complete hormone panel to evaluate the current status of the hormones, to know what treatment would be most beneficial to bring the hormones back into balance. Although it is common for most post- menopausal women to have no detectable amounts of most sex hormones, we know that that is not normal. Normal is that females should have detectable amounts of all of the sex hormones well into old age. Why it is common to not have detectable amounts of sex hormones, is that, when the ovaries “time out” it is up to the adrenal glands to kick in the extra hormones. If the adrenal glands (which are responsible for producing all of our stress response hormones) are worn out – it’s like trying to get water out of a rock. They have nothing to give and the sex hormones register non-detectable. Therefore the long term treatment is to nourish and replenish the adrenal glands, while the short term treatment is to get some hormones back into the body! This can be done through the use of bio-identical hormones or natural botanical hormones. The hormone panel is then re-tested 6 months later to see if the appropriate balance has been established. As the adrenals are replenished and start producing the sex hormones on their own, the use of bio-identical or botanical hormones will be discontinued.

Menorrhagia / Excessive Menstrual Blood Flow

Dysfunctional uterine bleeding accounts for 30-40% of all gynecological visits, and 60% of all dilatation and curettage procedures. Fifty percent of patients undergoing hysterectomy for menorrhagia in Oxford, England, were scheduled for surgery because of regular heavy menstrual bleeding of unknown cause. The most commonly occurring causes of true excessive menstrual bleeding are: leiomyomas (fibroids) of the uterus, pelvic inflammatory disease, endometriosis and adenomyosis, lesions in the uterine cavity, such as submucous leiomyoma, intrauterine polyps, and intrauterine contraceptive devices. In the absence of any clinically apparent pelvic disease as described above, excessively heavy menstrual bleeding is called “dysfunctional uterine bleeding.” Benjamin and Seltzer describe dysfunctional uterine bleeding as “abnormal uterine bleeding in which there is absolutely no organic pathological condition to be detected on clinical pelvic examination.” In one study, 42 women who underwent hysterectomy for excessive menstrual blood losses were found to have no obvious pathology, nor an excessive number of arteries for abnormal glandular distribution. In other words, it is common for women to suffer from excessive menstrual bleeding for no known organic cause. Often the cause is due to biochemical imbalances produced by vitamin and mineral deficiencies and/or essential fatty acid imbalances, which may be systemic or tissue-specific.   A naturopathic approach to treating someone with menorrhagia would start with a complete hormone panel to discover any hormone imbalances. Most often the imbalance is estrogen dominance and this can be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. Increased insulin due to insulin resistance also contributes to the estrogen dominance, therefore a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low. Botanical medicine combination may also be prescribed to help slow down the flow of bleeding at the time of menses.

Ovarian Cyst

A cyst on an ovary or when associated with other disorders of the hypothalamic-pituitary-ovarian axis, and many cysts are present, it is termed Polycystic Ovary Syndrome (aka Stein-Leventhal Syndrome). Ovarian cysts may be due to endometriosis, follicular or corpus luteum cysts, malignancy, or dermoid cysts. In Polycystic Ovary Syndrome, follicular cysts develop as a result of pituitary overproduction of LH to try to initiate ovulation. Ovarian cysts are products of failed or disordered ovulation. One or more ovarian follicles are developed monthly by the effects of follicle stimulating hormone (FSH). Luteinizing hormone (LH) promotes actual ovulation and the transformation of the follicle (after ovulation) into the corpus luteum which produces progesterone. In young women, during the early years of menstrual cycles, ovulation may coincide with a small amount of hemorrhage at the follicle site. This will cause abdominal pain, often with a slight fever, at the time of ovulation (in the middle days between periods) is commonly called mittelschmerz (German for “middle” and “pain”). Treatment consists only of mild analgesics, reassurance, rest, and perhaps a warm pack. It is unlikely to recur and portends no future problems. Later in life, usually after her mid-30’s, a woman may develop an ovarian cyst which may be asymptomatic or may cause variable pelvic pain. Palpation may detect a smooth, tender mass at one ovary site or a cyst may be found by sonogram visualization. The cyst may simply collapse and disappear after a month or two; or it may persist and increase in size and discomfort during succeeding months. Such cysts are caused by a failed ovulation in which, for reasons presently unknown, the ovulation did not proceed to completion. With each succeeding month’s surge of LH, the follicular site swells and stretches the surface membrane, causing pain and possible bleeding at the site. Some cysts may become as large as a golf ball or lemon before discovery. Treatment may require surgery during which the entire ovary may be lost. An alternative treatment for ovarian cysts is natural progesterone. Biofeedback mechanisms dictate that sufficient gonadal hormones inhibit hypothalamic and pituitary centers, such that FSH and LH production are also inhibited. That is, in the usual circumstances, the successful response to FSH and LH hormones is the rise in progesterone from the corpus luteum. If sufficient and natural progesterone is supplemented prior to ovulation, LH levels are inhibited and regular ovulation does not occur. This is the effect of contraception pills, for example. Similarly, the high estriol and progesterone levels throughout pregnancy successfully inhibit ovarian activity for nine months. Therefore, adding natural progesterone from day 10 to day 26 of the cycle suppresses LH and its luteinizing effects. Thus, the ovarian cyst will not be stimulated and, in the passage of one or two such monthly cycles, will very likely regress and atrophy without further treatment.   A naturopathic approach to treating someone with ovarian cysts would start with a complete hormone panel to discover any hormone imbalances as well as a fasting blood sugar and insulin test followed by a two hour post prandial blood sugar and insulin test to rule out underlying insulin resistance as a cause to the ovarian cysts. Most often the imbalance in the hormones is estrogen dominance which can also be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low. Castor oil packs may be prescribed to help manage symptoms as the underlying cause is addressed.

PMS (Premenstrual Syndrome)

Premenstrual tension has been described as a progressive symptom complex occurring seven to ten days premenstrually, thereafter improving with menses. Clinical experience now shows that PMS may encompass one to 150 different symptoms that occur cyclically in women during their estrogen active years. Dr. Susan Lark describes PMS to be one of the most common problems afflicting younger women. It is believed to affect between one-third and one-half of all American women between the ages of 20 and 50—in other words, 10 to 14 million women. Dr. Penny Budoff succinctly states, “It is curious that in this day and age when we are probing outer space that we permit more than 50% of our population of the world to suffer.”   A naturopathic approach to treating someone PMS would start with a complete hormone panel between days 19-24 when PMS symptoms are most prevalent to discover any hormone imbalances. Most often the imbalance in the hormones is estrogen dominance. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Clinical nutrition to help manage more specific symptoms associated with PMS may also be included as part of the treatment plan, as the individual works on the underlying cause.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) may be the most common endocrine disorder in women. It is estimated to be present in 5% to 10% of premenopausal women. Despite its prevalence, the etiology of PCOS has yet to be determined. The diagnosis of PCOS, also known as Stein Leventhal Syndrome, is complicated by the lack of standard diagnostic criteria, and the fact that very few patients present with identical clinical symptoms. PCOS is a loosely defined, heterogeneous disorder. It is characterized by the presence of polycystic ovaries associated with one or more of the following conditions: hirsutism, obesity, anovulation, infertility, menstrual disorders, hyperinsulinemia, insulin resistance, and hormonal imbalances. Included in the differential diagnosis of PCOS is Cushing’s syndrome, hyperprolactinemia, congenital adrenal hyperplasia, idiopathic hirsutism, and androgen-secreting tumors. In addition to the distressing symptoms of PCOS, patients with this syndrome are at increased risk for a variety of serious medical complications. These include non-insulin dependent diabetes mellitus (NIDDM), hyperlipidemia, hypertension, cardiovascular disease, endometrial cancer, ovarian cancer, and possibly breast cancer. As a result, the proper diagnosis and treatment of this syndrome is vitally important. The presence of polycystic ovaries is a primary diagnostic criterion of PCOS. Polycystic ovaries are detected by transvaginal ultrasound. They appear as increased ovarian central stroma with the presence of eight or more peripheral follicular cysts 10mm or less in diameter. It is important to remember, however, that polycystic ovaries may be present in women without PCOS, or may be indicative of syndromes other than PCOS. The role of insulin resistance is that insulin resistance, a condition characterized by decreased tissue sensitivity to insulin, is a key component of the clinical picture of PCOS. Insulin resistance leads to increased insulin production (hyperinsulinemia), progressive pancreatic beta-cell deficiency, and impaired glucose tolerance, eventually leading to the development of NIDDM. Obesity is highly correlated with insulin resistance, and approximately 50% of women with PCOS have central obesity (belly fat). In addition to obesity, genetic predisposition, pregnancy, drugs (such as corticosteroids), and lifestyle factors (such as smoking) contribute to insulin resistance. As it relates to PCOS, a growing body of evidence points to insulin resistance as a cause of the hormonal disturbances seen in the hypothalamic-pituitary-ovarian axis in patients with PCOS. Typically, the hormonal profile in PCOS shows increased gonadotropin-releasing hormone (GnRh), increased luteinizing hormone (LH), pulse frequency, increased LH, normal follicular-stimulating hormone (FSH) (resulting in increased LH/FSH ratio), elevated testosterone, and elevated insulin. Additionally, about 50% of women have elevated DHEA-S levels, and approximately 20% of PCOS patients have elevated prolactin levels. Other lifestyle factors in PCOS include weight management and exercise as top priorities in a PCOS treatment plan.   A naturopathic approach to treating someone with PCOS would start with a complete hormone panel to discover any hormone imbalances as well as a fasting blood sugar and insulin test followed by a two hour post prandial blood sugar and insulin test to rule out underlying insulin resistance as a cause to the PCOS. Most often the imbalance in the hormones is estrogen dominance which can also be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance, as well as an individualized exercise program. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low.

Pregnancy

Achieving a Healthy Pregnancy (adapted from the seminar “Achieving a Whole Pregnancy: Bringing Holism into Birth” by Joel M. Evans, M.D. Because pregnancy is physically demanding, it’s useful to think about reasonable changes to diet and lifestyle that you might make in order to improve your general health and well-being and prepare the way for pregnancy.

  1. Reducing your chemical load: When you eat foods that have a lot of additives and preservatives, you consume chemicals that are more difficult for the body to break down.

If you want to begin your pregnancy with your body functioning as well as it can, it’s better to eat foods with fewer chemicals. Overall, that means eating whole grains and five to seven daily servings of (preferably organic) fruits and vegetables, and avoiding foods with artificial sweeteners as well as packaged foods (like snack foods) with a long shelf life. And, if possible, detox before pregnancy!

  1. Preparing for pregnancy: Once you become pregnant, you need more vitamins and minerals like calcium, iron, zinc, folic acid, choline, and the omega-3 fatty acids (EPA-DHA). How important is detoxification/reducing your chemical load and increasing your vitamins, minerals and fatty acids? Of the 287 chemicals detected in umbilical cord blood, 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests. Fetuses of women who ate an “imprudent” diet (including high intakes of chips/crisps, sugar, confectionary, white bread, soft drinks, and red meat and low intakes of fruit/vegetables, rice/pasta, yogurt, and wholemeal bread) had reduced ductus venosus shunting and increased liver blood flow, which have longer-term detrimental

consequences for lipid and clotting factor homeostasis. Recent research has established that acute lymphoblastic leukemia (ALL), the most common childhood cancer, and the second most common cause of mortality in children aged 1-14 years, can originate in utero, and thus maternal diet may be an important risk factor for ALL. Nutritional roles of omega-3 fatty acids during pregnancy and neonatal development reported positive effects of omega 3’s in pregnancy: promote brain and eye development, encourage fetal weight gain, reduce preterm labor, preeclampsia, gestational diabetes, increase the nutritional value of breast milk, impact the immune system to decrease childhood atopy, allergy and asthma stabilize mood and prevent depression. Choline, is a vitamin that is a precursor for acetylcholine, phospholipids, and betaine. It is required for the structural integrity of cell membranes, cholinergic neurotransmission, lipid and cholesterol metabolism, and transmembrane signaling. Rat studies show significant improvements in memory and brain development. Dietary intakes of choline were associated with reduced neural tube defect (NTD) risks. NTD risk estimates were lowest for women whose diets were rich in choline, folic acid, betaine, and methionine. Pregnancy and lactation are periods when maternal reserves of choline are depleted. At the same time, the availability of choline for normal development of brain is critical. Thus, memory function in the aged is, in part, determined by what mother ate during her pregnancy. Folic Acid, also known as folate, is a nutrient in the B-complex vitamin group (there are eight B vitamins altogether). It has been shown to reduce the rate of fetal abnormalities, particularly defects to the brain and spinal cord such as spina bifida (an opening in the spine), by 50 to 70 percent. It also reduces the recurrence rate of these defects in subsequent children by as much as 80 percent. In addition, animal studies have shown that prenatal folic acid reduces the incidence of childhood cancers. Folic acid also offers important health benefits to adults, lowering the risk of heart disease, certain cancers, depression, and abnormal Pap smears. Because the spinal column and brain begin to develop almost immediately after conception, it’s ideal to have been taking folic acid while trying to conceive — no matter how long it takes. However, if you haven’t been taking prenatal vitamins while trying to conceive, increasing your folic acid right after you learn you’re pregnant is still a good idea for you and your developing child. Calcium, as you may already know, you and your baby both need calcium for strong teeth and bones. But calcium does more than build healthy bones—among other things, it helps the body maintain regular circulation, muscle action, and nerve function. Since the baby will take the calcium he needs from you no matter what, you need to replenish your own stores of the nutrient.

Uterine Fibroids

Myometrial growths of the uterus. Also termed “fibromyoma” or “leiomyoma.” These occur in 25% of women over age 35 and are often asymptomatic, discovery being made during the pelvic exam. They may, however, cause excess menstrual bleeding and/or pelvic pain or bloating. Their growth is increased during pregnancy and with estrogen therapy, and they tend to atrophy after menopause. They may either grow into the lumen, into the pelvic cavity, or remain in the wall of the uterus. Otherwise known as myoma of the uterus, fibroids are the most common neoplasm of the female genital tract. They are discrete, round, firm, benign lumps of the muscular wall of the uterus, composed of smooth muscle and connective tissue, and are rarely solitary. Usually as small as an egg, they grow gradually to orange or grapefruit size commonly. The largest fibroid on record weighed over a hundred pounds. They often cause, or are coincidental with, heavier periods (hypermenorrhea), irregular bleeding (metrorrhagia), and/or painful periods (dysmenorrhea). Due to their mass, they may cause a cystocele (dropped uterus) later in life when pelvic floor supports weaken, leading to stress urinary incontinence. After menopause, they routinely atrophy. Contemporary medical treatment usually is surgical. Some particularly skillful surgeons are adept at excising only the myoma, leaving the uterus intact. Generally, however, hysterectomy is performed. Here again, natural progesterone offers a better alternative. Fibroid tumors, like breast fibrocysts, are a product of estrogen dominance. Estrogen stimulates their growth and lack of estrogen causes them to atrophy. Estrogen dominance is a much greater problem than is recognized by contemporary medicine. Many women in their 30’s begin to have anovulatory cycles. As they approach the decade before menopause, they are producing much less progesterone than expected but still producing normal (or more) estrogen. They retain water and salt, breasts swell and become fibrocystic, they gain weight (especially around the hips and torso), become depressed and lose libido, their bones suffer mineral loss, and they develop fibroids. All are signs of estrogen dominance, i.e., relative progesterone deficiency. When sufficient natural progesterone is replaced, fibroid tumors no longer grow in size (generally they decrease in size) and can be kept from growing until menopause, after which they will atrophy. This is the effect of reversing estrogen dominance. Anovulatory periods can be verified by checking serum progesterone levels the week following supposed ovulation. A low reading indicates lack of ovulation and the need to supplement with natural progesterone. The cause of anovulation is uncertain but probably attests to premature depletion of ovarian follicles secondary to environmental toxins and nutritional deficiencies common in the U.S. today.     A naturopathic approach to treating someone with uterine fibroids, would be to start with a complete hormone panel to discover any hormone imbalances as well as a fasting blood sugar and insulin test followed by a two hour post prandial blood sugar and insulin test to rule out underlying insulin resistance as a cause to the fibroids, especially if overweight or obesity is an issue. Most often the imbalance in the hormones is estrogen dominance which can also be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low. Castor oil packs may be prescribed to help manage symptoms as the underlying cause is addressed.

Vaginitis / Leukorrhea

Inflammation and/or infection of the vagina with possible concurrent inflammation of the vulva. Vaginitis typically occurs one of two ways: 1. The overgrowth of a normal part of the vaginal flora, or the introduction of a foreign microorganism through sexual relations. Normal flora that can cause disease: yeast (often Candida albicans) may also spread from the intestines or sexually; Hemophilus vaginalitis/Gardnerella vaginalitis: often called “nonspecific vaginitis.” Foreign microorganisms: Trichomonas vaginalitis, Neisseria gonorrhea. In young girls it may be also caused by E. coli, strep, or staph due to poor hygiene. 2. Reaction to an external agent causing allergic or chemical reaction. Signs and symptoms include Vaginal discharge – white and curdish (yeast); creamy white or off-white (Gardnerella); greenish-yellow, frothy (Trichomonas). Itching – may be severe. Odor – None (yeast and Trichomonas); fishy (Gardnerella). Vulvar irritation and redness – possible with all three infections; however, Candida is typically the worst irritant and can cause fissuring and swelling. Vagina – normal, except for the presence of mild to extreme amounts of discharge. Lab Findings: (+) Wet prep and/or culture for microorganism identification. Pap smear may show inflammatory signs. While Trichomonas, Candida, and Gardnerella are benign infections causing no severe or life-threatening pathology, they can cause significant and unrelenting morbidity. Trichomonas, in particular, should be treated in a sexually active woman to prevent her passing it on to other individuals. Conventional treatment usually consists of nystatin (yeast); metronidazole (Trichomonas), and oxytetracycline (Hemophilus). Women treated this way have a high recurrence rate (especially of yeast and Hemophilus).   A naturopathic approach to treating someone with Vaginitis / Leukorrhea would consist of vaginal douches, apple cider vinegar baths and possibly vaginal suppositories to either “kill” the offending bug or to reinocculate good flora. Although vaginitis is typically seen as a localized issue, the offending pathogens are most commonly “opportunistic” pathogens, and therefore in a healthy body, they cannot flourish to the point of symptoms. Therefore an anti-candida, low/no sugar meal plan, anti-inflammatory, alkalizing meal plan would be prescribed along with anti-microbials, probiotics and clinical nutrition to address underlying health concerns that contributed this outcome.

Fibromyalgia

Adapted from “Nutritional Therapies for Fibromyalgia Syndrome”, by Kristi Hughes, ND

Fibromyalgia is a syndrome characterized by generalized musculoskeletal pain and stiffness, chronic aching, fatigue, and multiple areas of local tenderness that can be identified during physical examination. Research studies suggest that fibromyalgia pain may be the result of a combination of factors affecting the activity of muscle cells and the central nervous system. Various conventional treatment modalities have been tested in fibromyalgia patients; unfortunately, these are often ineffective and may result in adverse side effects. A natural approach that incorporates nutritional support for the body processes implicated in the pathenogenes is of fibromyalgia holds great promise for the millions suffering from this chronic syndrome. Fibromyalgia (FM) is a syndrome that presents with concurrent signs and symptoms characterized by fatigue; widespread musculoskeletal pain; and tenderness at specific sites in the neck, spine, shoulders, and hips referred to as “tender points”. Sleep disturbances, morning stiffness, headaches, irritable bowel syndrome (IBS), depression, and anxiety are also commonly associated with this syndrome. Pathology Because FM is a multi-factoral syndrome that involves a wide range of bodily processes, treating biochemical pathology is helpful. A good treatment program addresses the four main areas that have established roles in the etiology or progression of the disease. These include mitochondrial dysfunction, hypothalamus-pituitary-adrenal (HPA) dysregulation, toxicity, and intestine/nervous system abnormalities.

 

A naturopathic approach to treating someone with fibromyalgia would start with a lengthy initial office visit to best determine what the underlying cause(s) might be that are contributing to the individuals FM. The most common underlying causes are:

Mitochondrial Dysfunction

Malfunction of mitochondria is believed to be a primary factor in the etiology of FM, and abnormalities of the mitochondrial membranes in these patients have been reported. Mitochondria, which are concentrated in muscle tissue, are often referred to as the “powerhouses” of the cells due to their role in energy (ATP) production. Compromised mitochondrial activity can result in alterations in muscular function, as well as nervous, immune,

and cardiac dysfunction. Certain nutritional factors play a role in maintaining the integrity and proper functioning of the mitochondria. The following formulas have been used in FM patients in clinical settings:

Mitochondrial Antioxidant Formula: A combination of nutrients known to positively influence mitochondrial energy production, along with antioxidants, may support a higher rate of ATP synthesis, as well as protect mitochondria from free radicals. Nutrients such as lipoic acid and B vitamins serve as cofactors for cellular energy production and metabolism; thiamin supports the activity of enzymes that influence citric acid cycle activity and activities of the respiratory chain; amino acids like creatine allow muscles to regenerate ATP, and N-acetyl-L-carnitine helps transport nutrients (i.e. fatty acids) into the mitochondria for energy production. Furthermore, antioxidants such as coenzyme Q10, L-glutathione, N-acetylcysteine, and vitamins C and E help prevent oxidative damage that can affect cellular and/or mitochondrial function negatively.

Malic Acid/Magnesium Aspartate Complex: Malic acid is a natural compound that is necessary for ATP production.8 Combined supplementation with 1,200 mg of malic acid and 300 mg magnesium administered in a dose-escalated fashion produced significant reductions in the severity of 3 primary pain/tenderness measures in FM patients. In another study, supplementation with malic acid (1,200-2,400 mg) and magnesium (300-600mg) resulted in subjective improvements in myalgia within 48 hours and reduced tender point index scores were

recorded at 8 weeks.9

Magnesium/Potassium Aspartate Complex: Magnesium, potassium, and aspartate have roles in intermediary metabolism (enzyme-catalyzed processes that extract energy from nutrients to build new cells) that may mitigate physical fatigue. In a study examining the effects of potassium, magnesium, and aspartate (1,000 mg potassium aspartate and 1,000 mg magnesium aspartate per day for 1-2 weeks) on 4 subjects undergoing extremely fatiguing physical exercise, non-athletes demonstrated improved physical endurance.10 Potassium-magnesium-aspartate

supplementation of 1.75 g every 6 hours for 4 days was shown to prolong exercise capacity. Researchers postulate that the mechanism behind this anti-fatigue effect was the resynthesis of ATP and phosphocreatine.

HPA Dysregulation

Many patients with FM have had exposure to significant life stress and/or have inordinate responses to daily life stressors. Altered reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in hyposecretion of adrenal androgens (e.g. cortisol) has been observed in these patients. One study has postulated that HPA dysfunction may involve serotonergic neurotransmission and alterations in the activity of arginine-vassopressin (AVP) and corticotrophin-releasing hormone (CRH). HPA dysregulation is far-reaching and can interfere with proper functioning of the hypothalamus-pituitary-thyroid (HPT) axis. Neuroendocrine abnormalities along the HPT axis are also common in FM patients. Furthermore, due to the association between hypothyroidism and fibrositis and myalgia, it is recommended that FM patients be given a comprehensive thyroid hormone test. The use of adaptogens—herbs that help normalize bodily processes and increases the ability to “adapt” to stress—and B vitamins provide a general approach to managing stress.

Traditional Holy Basil Combination: Adaptogens such as holy basil (Ocimum sanctum), ashwaganda (Withania somnifera), and brahmi (Bacopa monnieri) have a history of use in Ayurvedic medicine and are scientifically well supported to improve stress tolerance.   Ashwaganda was shown to enhance adaptability to both physical and chemical stress in animals, showing the ability to suppress adrenal enlargement, as well as adrenal ascorbic acid and corticosterone depletion. Ashwaganda also produces positive changes in stress-related prostaglandin and catecholamine production. In other animal testing, brahmi was shown to improve adaptations in sensory, motor, and motivational systems.24 In humans, it exhibits beneficial effects on anxiety, as well as mental functions such as mental fatigue.

B6/Pantothenic Acid Complex: The B vitamins, pantothenic acid and B6 are important in energy production and the response to stress by supporting adrenal hormone production and regulation. In conjugation with ATP and cysteine, pantothenic acid plays an integral role in the synthesis of coenzyme A, which initiates various metabolic processes including the production of glucocorticoids.27 In an animal study, vitamin B6 was found to stimulate the secretion of adrenal catecholamines.

Thyroid Support: While normalizing stress-induced changes in HPA function will have a positive influence on the HPT axes, some patients may need additional thyroid support. Several nutrients are known to support healthy thyroid hormone synthesis, to promote the conversion of thyroxine (T4) to the more bioactive triiodothyronine (T3), and to address receptor dynamics and the expression of thyroid hormone sensitive genes. Such nutrients include iodine, selenium, zinc, and vitamins E, A, and D.

Toxicity

Toxin exposure has been suggested to play a significant role in the development and progression of both FM and CFS, as approximately 47-67% of patients with FM and 53-67% of patients with CFS have reported at least one episode of symptom exacerbation after specific chemical exposure. (see Detoxification Section)

Intestine/Nervous System Support

Another area of interest is the link between intestinal dysfunction and FM. Although statistics vary, research suggests that up to 70% of patients with FM complain of symptoms associated with irritable bowel syndrome (IBS). IBS is a functional disorder characterized by chronic abdominal pain with alternating diarrhea, and constipation.34 In comparison with healthy subjects, patients with IBS also tend to experience extra intestinal symptoms that overlap with FM complaints, including increased nerve sensitivity, morning stiffness, headaches,

sleep disturbances, and fatigue. Improved GI health can be achieved with a nutritional regimen known as the 4R® GI Restoration Program, which addresses the four primary stages of healing: Remove, Replace, Reinoculate, and Regenerate. (see Gastrointestinal Section)

 

Gastrointestinal issues

I believe the gut is the corner stone of health. We often hear “death begins in the colon”, which I think can be expanded to “health begins in the food tube” which is from the mouth all the way to the anus. I have treated people with all sorts of GI disorders from simple gas and bloating to chronic pancreatitis. Some of the more common and chronic GI concerns are IBS which is an acronym for irritable bowel syndrome, SIBO which is an acronym for small intestinal bacteria overgrowth, and ulcers which can be in the stomach or small intestines and is usually due to a chronic H. Pylori infection or use of NSAID medication. Stress can contribute to all of the above. Heart burn, change in appetite, constipation, diarrhea, nausea/vomiting, belching, gas, bloating, gallstones, distress from eating fatty foods, undigested food in the stool, ulcers, stomach or abdominal pain, irritability if a meal is missed, tired after eating, hiccups, bad breath, hemorrhoids, fissures, black stool, blood in stool, itchy rectum are all signs of gastrointestinal distress.

 

A naturopathic approach to treating someone with a gastrointestinal disorder quite often entails a “gut restoration program”. Although each program is uniquely specialized to meet the needs of the individual, I use the 4 ‘R’ frame work to organize the treatment plan for each individual. The 4 R’s stand for Remove, Replace, Reinoculate and Repair. In the remove phase, I may prescribe a specialized meal plan that removes, gluten, dairy and eggs, or other inflammatory foods or potential food sensitivities. I may also prescribe anti-microbials to remove the bad bugs from the gut. In the Replace phase I may prescribe digestive enzymes to replace depleted one. In the Reinoculate phase I may prescribe good bacteria to establish health flora in the gut. In the Repair phase I may recommend glutamine or arabinogalactans to repair damages tissue in the gut. There is no “cookie cutter” plan that fits all situations, so each plan is different and may or may not include all phases of the 4 R program.

Headache: Vascular / Migraine

Headaches are a common but not normal symptom to have. There are many different reasons for getting a headache, and when this is a main concern, I go through my list of all the things that could be contributing to the patients headache to decipher what the best treatment plan would be for that individual. Is it structural – from ergonomics at work, from stress and our shoulders creeping up to our ears, from being cold and clamping are armpits down? Is it from our sinuses – due to a low grade infection, allergies, inflammation? Is it a toxicity headache from a food, a fragrance, a chemical? Is it hormonal – you know those headaches that should up on day 21 through 28 of a menstrual cycle. Is the headache from a vascular disturbance? There are several types of vascular headaches:

Migraine: Periodic throbbing headaches. The prodrome seems to be due to a vasoconstriction of the cerebral blood vessels (or the vessels leading into the brain), while the headache itself seems to be due to a vasodilation of the blood vessels with subsequent congestion of tissues; seen more often in women and is thought to affect up to 20-30% of the population; usually begins between the ages of 10-30, and remissions commonly occur after age 50, suggesting a hormonal cause; definite familial component.

Hypertension: The headache is typically throbbing and located in the occiput or vertex. It is paroxysmal. There is a history of renal or cardiovascular disease.

Cluster (histamine headaches): Much more frequent in men; associated histaminic symptoms.

 

A naturopathic approach to treating someone with headaches is to first narrow down the list of possible underlying causes. Once the cause is known, treatment may consist of dietary changes, a detox, anti-inflammatory support through food and clinical nutrition, hormone balancing with the use of botanical medicine, or supporting the vasculature. Each plan is unique and specialized to meet the needs of the individual and the underlying causes to their headaches.

 

Inflammatory Bowel Disease (IBD) Crohn's Disease, Ulcerative Colitis, Irritable Bowel Syndrome, and Celiac Disease

Crohn’s disease (CD)

A chronic condition characterized by patchy areas of inflammation and ulcers (open sores)

along the innermost layer of the digestive tract. Such lesions can develop anywhere from the mouth to anus, but the majority of cases involve the small intestine or the first part of the large intestine. Between these patches of inflammation and ulceration there remain stretches of normal, healthy tissue. CD is closely related to a similar condition known as ulcerative colitis (UC). Both CD and UC are considered inflammatory bowel diseases (IBD). CD affects between 2 and 7 out of 100,000 people and researchers believe that these numbers are growing. CD develops mostly between the ages of 15 and 40, although children and older adults may also develop the condition. People of Jewish heritage are up to six times more likely to develop CD

than are people in the general population. Although medication and strict diets can reduce the inflammation of CD, most people with the condition will require surgery to remove part of the digestive tract at some point in their lives. Unfortunately, however, surgery does not completely cure or eradicate the disease.

Ulcerative colitis (UC)

Is a chronic disease that causes inflammation and ulcers (open sores) in the innermost layers of the large intestine. UC is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. In UC, swelling typically occurs in the rectum and lower colon, but the inflammation can spread throughout the entire colon. The ulcers bleed and produce pus and mucus, and the inflammation causes the colon to empty frequently, resulting in diarrhea. UC is a rare, but serious disease that affects 50 out of every 100,000 people in the United States. Although the condition most commonly affects those between the ages of 15 and 35, children and older adults may also develop the disease. UC occurs five times more frequently in those with a Jewish heritage than it does in the general population. Although most people with UC can be successfully treated without surgery, roughly 25% will need a colectomy (surgical removal of the colon).

Irritable Bowel Syndrome (IBS)

Occurs when muscles in your intestines contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation. There are two types of IBS. People who suffer from spastic colon IBS experience constipation, diarrhea, or both, and often have pain after eating. Painless diarrhea IBS involves the sudden onset of diarrhea during or after meals, or upon waking. Between 10 – 20% of the population has IBS at some time. The syndrome often starts in adolescents or young adults. It affects almost twice as many women as men, and is often associated with stress.

Celiac Disease

Celiac disease, also called celiac sprue, is an inherited disease that damages the small intestine and interferes with digestion. People with this disease cannot tolerate a protein called gluten, and as a result, they have trouble absorbing nutrients from food. Gluten is found in wheat, barley, rye, and possibly oat products. Some vitamins and medicines also contain gluten. The small intestine is lined with fingerlike projections called villi, which help absorb nutrients. In celiac disease, these villi become flattened, so they don’t work as well and the person becomes malnourished. Researchers don’t know the exact cause of celiac disease. Once thought rare, recent research suggests that an estimated 1 of every 133 Americans has celiac disease. However, in the United States, only a small fraction of people living with the disease are diagnosed. People who have a family history of celiac disease are at greater risk for developing the condition. It is most common in Caucasians and those of European ancestry. Women are affected more commonly than men.

 

A naturopathic approach to treating someone with inflammatory bowel disease starts with a Comprehensive gastrointestinal restoration program –the 4 ‘R’ program.

Removing offending substances from the diet. Food allergens and other materials that negatively influence the intestinal environment can cause localized irritation or trigger the release of damaging chemicals into general circulation, affection other tissues and organs. (IBD)

Replacing digestive enzymes and stomach acid where necessary. Digestive factors and enzymes facilitate the breakdown of food. An insufficiency of these compounds is very common, especially as we age, which inhibits optimal digestion and utilization of nutrients, as well as the elimination of waste.

Reinoculating the bowel with pre- and probiotics. Reintroducing health-promoting, “friendly” bacteria such as Lactobacillus acidophilus NCFM® helps maintain a desirable balance of GI microflora. This balance is critical to intestinal tissue (mucosal) health, immune function, intestinal barrier function, and digestion.

Regenerating the gastrointestinal mucosa through proper nutritional support. Regeneration of GI mucosal cells is necessary whenever there has been a loss of integrity of the GI mucosal structure or function, as may be caused by any GI insult.

 

Kidney Stones

Urinary calculi occurring in any part of the urinary tract are abnormal concretions usually composed of mineral salts such as mixtures of calcium oxalate, calcium phosphate, and magnesium ammonium phosphate. They vary in size from microscopic to several centimeters in diameter. About 80% of all urinary stones contain calcium. The majority of these are composed of calcium oxalate. Contrary to previous notions, dietary calcium is seldom closely linked to the development of urinary oxalate stone formation. “Dietary Influences on Serum and Urinary Oxalate in Healthy Subjects and Oxalate Stone Formers,” Butz M, et al, Urol Int, 1980:35:309-315. 32760 In fact, calcium restriction may be contraindicated in calcium stone formers.

 

A naturopathic approach to treating someone with kidney stones first involves investigating which type of stone they have developed. A person with uric acid stone would follow a similar treatment as described in the gout section. A person with a calcium oxalate stone would follow a meal plan high in fruits and vegetables, a high alkalizing and low in inflammation meal plan. Clinical nutrition may be used to increase tissue calcium and magnesium levels. Botanical medicine may be used to support health kidney function.

Lupus (Erythematosus)

This is a chronic, inflammatory, autoimmune (the body is attacking itself) disease that affects connective tissue (tissue that binds and supports various structures of the body and also includes the blood). Discoid lupus erythematosus (DLE) is a less serious type, affecting exposed areas of the skin and sometimes the joints. Systemic lupus erythematosus (SLE) is more serious, potentially fatal, and affects more organs of the body. Symptoms vary according to the severity of the illness and which organs are affected. SLE may occur very abruptly with a fever and mimic an acute infection or it may occur very slowly over months and years with only

several episodes of fever and fatigue. Most people with SLE complain of pain in various joints that mimics arthritis, or in children simulates growing pains. In adults, there is often a history of growing pains. Over time, muscular contraction may deform the joints. Many patients have rashes on the face or other areas, such as the neck, upper chest, and elbows. In DLE, the rash starts as red, circular, thickened areas that leave scars, most often affect the face and scalp, and may cause permanent hair loss. In SLE, there is a characteristic “butterfly-shaped” rash that occurs on the cheeks and over the bridge of the nose. Rashes in SLE patients do not scar and do not cause permanent hair loss. Ulcers on mucous membranes such as the mouth and nose are common. Rashes and swelling of the hands and fingers may occur. Sensitivity to light (photophobia) occurs in 40 percent of people with SLE. Other problems may be kidney disorders, repetitive episodes of pleurisy (inflammation of lining of the lungs), pericarditis (inflammation of the membrane surround the heart), iron deficiency, anemia, and pulmonary hypertension (high blood pressure). Swelling of several or more lymph nodes is common especially in children. SLE is classified as mild if the symptoms are mainly fever, joint pain, rash, headaches, pleurisy, and pericarditis. It is considered severe if it is associated with life-threatening diseases. SLE occurs mostly in young women (90 percent of cases) and in young children.

 

A naturopathic approach to treating someone with SLE would start with ruling out other conditions that may mimic or share a lot of the same signs and symptoms as SLE does. Things like food sensitivities, rheumatoid arthritis, other connective tissue diseases, Lyme disease, parasites, candidiasis. Specific labs would be ordered to rule in/out all of the above and SLE.

For example blood tests for antinuclear antibodies (ANA) and sometimes skin biopsies are diagnostic for this condition. According to the American Rheumatoid Association there must be four of the following eight symptoms present for lupus to be diagnosed: ANA antibodies in the blood, low white blood cell or platelet count or hemolytic anemia, joint pain in the number of joints (arthritis), butterfly rash on cheeks, abnormal cells in the urine, light sensitivity,

mouth sores, seizure or psychosis. Since Lupus is an immune condition (autoimmune), and 60%-70% of the immune system is in the gut, a gut restoration program is often prescribed along with aggressive detox support and support for the organs and tissues most effected like kidneys, liver and digestive system.

Memory Loss / Cognitive Function Decline

Persons over 65 years old now comprise 12-15% of the U.S. population. Memory loss is one of the most common symptoms and the USA spent more on Alzheimer’s in 2012 than cardiovascular disease or cancer. Contributing factors include poor diet, alcoholism, high blood pressure, prolonged use of tranquilizers and sleep medications and key nutrient deficiencies like choline, inositol, vitamin B6, vitamin B3, vitamin B12, folic acid, protein, and zinc

Mild Cognitive Impairment: Forgetful, memory lapses, less attentive, change in sleeping habits, noticed problems finding the right words to communicate

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. It is a joint disease caused by the breakdown of cartilage – the firm, rubbery tissue that cushions bones at joints. Healthy cartilage allows bones to glide over one another and cartilage absorbs energy from the shock of physical

movement. In OA cartilage breaks down and wears away. As a result, the bones rub together causing pain, swelling, and stiffness. OA may also limit the range of motion in affected joints. Most often, OA develops in the hands, knees, hips, and spine. The disease affects men and women nearly equally. More than 20 million people in the United States have OA. Symptoms tend to appear when individuals are in their fifties and sixties. Symptoms may include joint pain (often a deep, aching pain) that is worsened by movement and improved with rest (in severe cases, a person may experience constant pain), stiffness in the morning or after being inactive for more than 15 minutes, joint swelling, joints that are warm to the touch, crunching or crackling noise when the joint moves (crepitation), limited range of motion, muscle weakness, abnormal growth of bony knobs near joints which cause deformities (such as Heberden’s nodes, in which

bumps appear on the outermost finger joints). Contributing causes to OA include wear and tear (which comes with age), obesity, chronic infections or inflammation, trauma, metabolic dysfunctions like elevated insulin and glucose, genetic, and environmental causes like chemical (toxins), and mechanical factors can play a role in its development. There is no single test to diagnose OA, so most doctors use a combination of methods to diagnose the disease and rule out the possibility other causes. A physical exam can show limited range of motion, grating of a joint

with motion, joint swelling, and tenderness. An x-ray of affected joints will show loss of the joint space and, in advanced cases, wearing down of the ends of the bone and bone spurs.

 

A naturopathic approach to treating someone with OA starts with preventive care which includes things like protecting an injured joint from further damage, exercising, losing weight,

avoiding excessive repetitive motions, healthy nutrition. The goals of treatment are to relieve pain, maintain or improve joint mobility, increase the strength of the joints, minimize the disabling effects of the disease and put health back into the joint. Lifestyle approaches, including exercise strengthen, stretch, and relax muscles around affected joint, a low inflammatory meal plan, a meal plan to help the individual achieve optimal body composition, clinical nutrition which may include things such as, glucosamine, hyaluronic acid, chondroitin sulfate, Methyl-sulfonyl-methane (MSM), Vitamin D, calcium, antioxidants, anti-inflammatory herbs to name a few. Everyone’s nutraceutical plan will be unique to them depending on what the underlying cause(s) are to their OA.

Polymyalgia Rheumatica

Polymyalgia rheumatica is a type of arthritis that affects the muscles. It does not affect the bones, or the joints. It causes muscles to become stiff, tender and very sore and inflamed.

Even though the muscles are sore they do not become weak. Polymyalgia rheumatica affects the muscles of the neck, shoulders, lower back, hips and thighs. It is believed that the pain is caused by the swelling and inflammation of blood vessels in the muscles. The name polymyalgia rheumatica actually comes from Greek words. In Greek, ‘poly’ means ‘many,’ ‘my’ means

‘muscle,’ and ‘algia’ means ‘pain’ (many muscle pain) and ‘rheumatica’ refers to ‘muscle and soft tissue. Women develop polymyalgia rheumatica more often than men. It most often appears in women over the age of 50. There is no known cause, but stress, poor nutrition, trauma, toxicity, and infection all seem to play a role as potential underlying causes to this condition.

 

A naturopathic approach to treating someone with Polymyalgia rheumatica quite often starts with minimizing the side effects of common medications prescribed for this condition. Polymyalgia rheumatica in some cases can be so debilitating aggressive medications such as prednisone, NSAIDS are prescribed to help manage the symptoms which then leads to other medications such as proton pump inhibitors and sedatives or anti-anxiety medication. Naturopathic medicine tries to get to the underlying cause of the polymyalgia rheumatic and put health back into the body, supporting the blood vessels, muscle tissue, immune system adreanals, and clinical nutrition and botanical medicine to help quiet down inflammation and minimize pain.

Restless Legs Syndrome and Leg Cramps

Nocturnal leg cramps constitute a relatively common complaint in the general practice of medicine and may be very distressing to the patient. Not only is the cause obscure and the treatment relatively unsatisfactory, but even its proper medical name, systremma (anything twisted up together), is unknown to most physicians.

Restless Leg Syndrome:

Classic restless leg syndrome is a mixed sensorimotor form in which pain, numbness, and lightning stabs of pain in the lower or even the upper limbs are relieved by movement or local massage.

 

A naturopathic approach to treating someone with RLS often includes supplementing you’re the patient’s diet with a specific form of magnesium that has the most affinity for the muscle tissue. Magnesium is America’s #1 mineral deficiency with an estimated 98% of the population being deficient. Since stress will cause the body to excrete magnesium in the urine, saliva, sweat and tears, this then makes perfect sense that most of us are deficient. RLS may also be caused by low dopamine. Iron is the rate limiting mineral for dopamine production. Simple blood tests including a Complete Blood Count and ferritin level will confirm if there is an iron deficiency.

Sinusitis / Hayfever / Allergic Rhinitis

An inflammation or infection in the paranasal sinuses. The most common inciting agent of sinusitis is a viral upper respiratory infection, although bacteria, fungi, and allergic reactions may also be responsible. Any factor that creates edema of the nasal tissues resulting in obstruction and the lack of proper drainage of the area will often lead to sinus infection. As the obstruction continues, oxygen is resorbed back into the blood vessels, causing a painful relative negative pressure that draws transudate from the mucous membranes. The transudate is an excellent

medium for bacteria, especially Streptococcus, pneumococcus, hemo-philus influenza, and Staphylococcus, which are the bacteria most implicated in acute sinusitis. The bacterial overgrowth leads to an influx of serum and leukocytes to fight the infection, setting up a painful positive pressure.

Chronic sinusitis is often associated with an allergic individual, and dental infections account for 25% of chronic maxillary sinusitis. Swimming and diving, and injury to the area (especially fractures to the ethmoid or frontal sinuses) are other precipitating factors. Chronic sinusitis may present as acute sinusitis or may be relatively asymptomatic presenting with only mild postnasal discharge, recurrent headaches, musty odor, or a nonproductive cough. X-rays may reveal a thickening of the mucous membranes, though cultures of the nose and nasal discharge uncover no pathogenic organisms. Note: With chronic sinusitis that seems to go away after an antibiotic then returns consider Candidiasis. (See Candida Albicans section.

Signs and symptoms include tenderness to palpation, swelling, redness, and opaque trans-illumination of involved sinuses, fever, chills: suggest expansion of the infection beyond the sinuses, nasal congestion and serous or mucopurulent discharge (usually yellow or green, and can often excoriate the nasal tissues), malaise, headache and/or dizziness that changes with position and is worse lying down or bending over, history of upper respiratory infections, dental problems, nasal allergies, or injury to the area, nasal mucosa is erythematous and edemic, and the exudate may be seen in the turbinates corresponding to the infected sinus(es)

Lab findings include, X-rays that will clearly show the sites of involvement and to what degree: the radiograph will pick up the swollen mucous membrane or the exudate. X-rays of the apices of the teeth are mandatory to rule out a periapical abscess when there is chronic maxillary sinusitis. Cultures not reliable.

 

A naturopathic approach to treating someone with sinusitis includes supporting the immune system regardless if that is to “quiet” it down if the sinusitis is due to allergies, or nourishing the immune system if the sinusitis is due to infection. A specific diet that is both anti-inflammatory and hypoallergenic may be prescribed. Clinical nutrition and botanical medicine may be used to decrease inflammation, congestion and to support tissue repair.

 

Sprain/Strain

Sprain: Wrenching or twisting of a joint with partial rupture of its attaching ligaments.

Strain: Over-stretching a muscle.

Invariably, both conditions are trauma-induced. Of the two, the sprain is the more serious. There are three classifications of a sprain:

Grade 1: Mild/minimal sprain with no ligamentous tear. There may be pain, swelling and tenderness.

Grade 2: Moderate sprain with an incomplete or partial rupture of ligaments or tendons. There is marked pain, swelling, bruising, decreased range of motion, and minor instability of the joint.

Grade 3: Joint injury with complete tearing of the associated ligament. Presents as severe pain, swelling, hemorrhage, significant joint instability, and no range of motion.

Symptoms: History of trauma; pain; swelling; tenderness; bruising; decreased joint range of motion; degree of instability depends on grade.

 

A naturopathic approach to treating someone with a sprain or strain includes clinical nutrition and botanical medicine to decrease congestion, decrease inflammation and maximize optimal tissue healing. Heat or ice applications, gentle stretching and strengthening exercise and rest.

 

Tendinitis

Inflammation of the tendon and the lining of the tendon sheath. The sheath is typically the focus of the involvement, but the body’s inflammatory response usually involves the tendon, too. The etiology is unknown, although repetitive or forceful trauma, exercise or strain, systemic diseases (rheumatoid arthritis, gout, Reiter’s syndrome) and hypercholesterolemia are implicated.

Most frequently affected tendons: shoulder capsule tendons, flexor carpi ulnaris, flexor digitorum, hip capsule tendons, hamstrings, and Achilles. Localized tenderness (may be severe); swelling over the area; pain on moving the tendon.

 

A naturopathic approach to treating someone with tendinitis includes physical modalities such as castor oil packs, ice, and active release technique. Clinical nutrition and botanical medicine may be prescribed to help decrease inflammation, break down scar tissue and tissue congestion and optimize tissue healing.

 

 

Urinary Tract Infection (UTI) / Bladder Infection (Cystitis)

Symptoms include Urinary urgency, urinary frequency, painful urination. These are relatively common symptoms of a urinary tract infection (UTI), although only about half of those who acquire a UTI are symptomatic. People most prone to UTIs are women of childbearing age.

The major components of the urinary tract include the following: kidneys, bladder, urethra, and prostate (in males). A UTI may involve any of the above structures. If it involves the kidneys, it is termed an upper UTI; if it involves the others, it is a lower UTI.   Bladder infections can also cause lower abdominal pain, fever, chills or visible drops of blood in your urine. In 90% of cases, UTIs are caused by the Escheichia coli (E. Coli) bacterium, a certain number of which are necessary in our intestines for proper digestion. E. coli, however, doesn’t belong in the urethra or bladder. Normally, the bug lives at the end of the digestive tract. It can get easily swiped forward to the opening of the urethra, which is the tube that goes up to the bladder. In women, this tube is much shorter and closer to the rectum. Inadequate sexual hygiene is responsible for many UTIs. Women who suffer from recurrent bladder infections, however, should be tested for the presence of other bugs, especially Chlamydia trachomatis, a sexually transmitted disease that typically doesn’t cause any symptoms in men. Another common irritant to the urinary tract is synthetic estrogen, in the form of birth control pills or postmenopausal hormone support. If you are on the pill and suffer from frequent UTIs, you need to find another form of birth control.

Other factors that can increase your chances of getting a bladder infection include pregnancy, diaphragm use and diabetes.

Avoiding an Infection as always, disease prevention is the best approach to health management. Since many UTIs flare up after sex, especially with a new partner, good sexual hygiene is the first step toward prevention. Here are some basic tips to remember: Wipe from front to back every time you use the toilet. Try to avoid using perfumed soaps or lotions on your genital area because they may irritate your skin and make you more susceptible to a bladder infection.

Make sure your partner has clean hands, fingernails, mouth, private parts, etc., before engaging in sexual activity. Try to empty your bladder before and after sex, to help wash bacteria away from the bladder. Drink plenty of fluids, especially pure water, which helps encourage frequent urination. Fluids also help dilute the urine, which makes it less attractive to bacteria, and keep the mucous membranes (which includes the bladder) moist and healthy. Try to drink a cup (8 oz.) of water for every 25 lbs. of body weight daily, ideally between meals so as not to dilute digestive enzymes. Wear loose clothing that isn’t too tight around your genital area, and choose 100% cotton underpants, or at least lingerie with a cotton crotch.

 

A naturopathic approach to treating someone with an UTI/Bladder infection usually involves a referral to a medical doctor for anti-biotics. If the infection can be caught in the first 48 hours, aggressive treatment with probitoics, anti-microbials, cranberry extracts and a modified elimination diet may be successful in treating those with an UTI, however if symptoms are not at least 50% better in 24 hours, anti-bitoics may still be necessary to avoid the infection spreading to the kidneys.