During Naturopathic Medicine Week this year, each day I hope to elaborate on each of the 6 principles that define the practice of Naturopathic Medicine. The reason being that these principles are what unite our profession. Licensed Naturopathic doctors (NDs) may choose to include some or all of the modalities in their practice such as, clinical nutrition, botanical medicine, homeopathy, hydrotherapy, pharmacology, IV nutrition and physical medicine, but the treatment plans are still created based on the six guiding principles.
Today we begin the first and foremost principle which is familiar to people as a being a part of the original Hippocratic Oath: “First, do no harm”
Sounds simple enough and may seem self-explanatory - the treatment recommended by a doctor should not cause further harm to the patient. However, this simple phrase has a much deeper meaning when applied in Naturopathic Medicine. Two main implications of this principle are:
The initial intake visit with most NDs is at least an hour long in order to assess how multiple factors in a patient’s life may have contributed to and shaped their current state of health. This is what provides the context. This includes recording past injuries, surgeries, major illnesses, major life changes such as job change/loss, current living conditions & strain/status of relationships, dietary habits, drug & food allergies, exercise routine, social & lifestyle preferences and spiritual practices. This gives the doctor a 360 degree view of what makes the patient who they are and what changes can be made to stop further harm.
After a thorough history, physical examination and assessment, treatment recommendations that follow the use of the least invasive therapies come into 4 major categories:
"The art of medicine consists in amusing the patient while nature cures the disease"
Please be sure to call us for any of your health needs and will be happy to assist you. Thank you for reading and be sure to share if you would like to join me in creating more awareness about licensed Naturopathic Doctors!
This year the onset of seasonal allergies in the Bay Area was earlier than it’s usual time frame of late March to early April. Many of my patients, were caught off-guard and rushed for various combinations of over-the counter anti-histamines, supplements, homeopathic remedies, nasal sprays in a desperate attempt to seek relief. The common symptoms of seasonal allergies such as headaches, uncontrollable sneezing, post-nasal drip, sore throats, itchy eyes & runny nose, and fatigue are a source of major discomfort for many people and frequently result in low productivity or even time-off from work and school. The rates of occurrence for allergies has been steadily increasing and in the US, nasal allergy symptoms are known to affect about 6.1 million children and 20 million adults.
Have you ever wondered why you experience these symptoms while others such as your colleagues (and maybe even your boss!), friends and family members cruise through spring without so much as a sneeze or sniffle? Why do even the best of medications seems ineffective in some years and force you to find a new source of relief? What could you do to prevent these symptoms from returning each year, other than take pills for symptom relief?
The answers to those questions may be inside you...in your gut.
For me, as a naturopathic doctor, investigating the digestive system is part of treating the whole person. It provides an ‘inside-out’ picture of the system which is the primary source of our sustenance. It holds answers to the underlying cause of multiple health issues including seasonal allergies.
Connection between seasonal allergies and the digestive system
Numerous studies have shown that there is a link between gastrointestinal (GI) inflammation and an allergic response to environmental triggers such as pollen. Studies have also tried to investigate whether there is a correlation between the intensity of inflammation in the GI tract with hay fever symptoms. In my practice, I am yet to see a case where allergies are not linked to the GI tract.
Treating the underlying GI inflammation results in a corresponding decrease in the severity of allergic symptoms. Based on patient feedback, their need for allergy medication and supplements decreases over time, and becomes limited to days with a high pollen count rather than all throughout the change of season. The sustained GI inflammation often causes the person’s immune system to remain in an up-regulated or over-stimulated state. Once this immune activation is addressed, the inflammation decreases and can lead to a higher threshold for allergies to environmental triggers.
To be clear, safe and effective allergy medications such anti-histamines, and supplements such as quercitin, vitamin C, nettle extract, should definitely be used when needed for an allergy attack and for immediate symptom relief. However, after years of chronic use, most people report the need to change the type of medication, increase the dose of the medication or change in the combination of allergy shots that they have been receiving, as the previous combination of treatments starts to seem ineffective. Therefore, when the underlying overactive immune system is addressed, a lower dose of these medications may still be effective, when used on an as needed basis.
Causes of inflammation in the gut.
The inflammation in the GI tract can stem from one or more of the following, and each factor needs to be addressed in order to lower the inflammation:
On a side-note, the concept of ‘histamine-intolerance’ is being investigated by researchers. Some people have a genetically reduced ability to breakdown histamine and may need anti-histamine medication on a regular basis to keep their allergies at bay. More research is needed to support this idea. Also, as already established research indicates, genes are not your destiny. They can be turned on and off with changes in the cellular environment, which in turn can be affected by a myriad of factors, including your microbiome and overall, gut health.
In conclusion, keeping your gut healthy by eliminating common food allergens and attending to other gut health factors, can have a tremendous impact on your tolerance to the seasonal increase in pollen,mold and other environmental triggers. You do not have to suffer from allergies! To take control of your health, initiate the first step and begin the healing your gut inflammation. As your gut/GI inflammation improves, you may actually become that person who gets through allergy season without a sneeze or a sniffle!
If you have any comments or questions regarding treatment of allergies at our clinic, please post them in the comments section or you can email us at firstname.lastname@example.org.
Wishing you an allergy-free spring!
1) Georgios Rentzos,1 Vanja Lundberg,2 Per-Ove Stotzer,3 Teet Pullerits,1 and Esbjörn Telemo2 Intestinal allergic inflammation in birch pollen allergic patients in relation to pollen season, IgE sensitization profile and gastrointestinal symptoms Clin Transl Allergy. 2014; 4: 19. Published online 2014 May 30. doi: 10.1186/2045-7022-4-19
2)Eigenmann PA1, Oh JW, Beyer K. Diagnostic testing in the evaluation of food allergy. Pediatr Clin North Am. 2011 Apr;58(2):351-62, ix. doi: 10.1016/j.pcl.2011.02.003.
3) Legatzki A1, Rösler B, von Mutius E. Microbiome diversity and asthma and allergy risk. Curr Allergy Asthma Rep. 2014 Oct;14(10):466. doi: 10.1007/s11882-014-0466-0.
4) Ho MH1, Wong WH, Chang C. Clinical spectrum of food allergies: a comprehensive review.Clin Rev Allergy Immunol. 2014 Jun;46(3):225-40. doi: 10.1007/s12016-012-8339-6.
5) Muir AB1,2, Benitez AJ3, Dods K1, Spergel JM2,3, Fillon SA4,5. Microbiome and its impact on gastrointestinal atopy. Allergy. 2016 Sep;71(9):1256-63. doi: 10.1111/all.12943. Epub 2016 Jun 23.
Being a naturopathic doctor, I frequently get asked questions regarding supplements. Questions such as, what supplements need to be taken on a regular basis, or which supplements can help boost the immune system or prevent onset of long term disease. Sometimes I get questions about safety, brand recommendations or whether a specific product making headlines in the news is really as good as it sounds.
For most of these questions, my immediate answer is usually the same: it depends.
It depends on multiple factors such as your lifestyle factors, your current underlying health concerns and dietary habits. I then continue to explain that all of this information combined is what helps me make the right recommendations for my patients. With my patients, I have the privilege of being able to evaluate their needs and then choose exactly what supplements they will need to take and for how long. Some maybe necessary for a short while to help recover from acute symptoms but some may need to be taken for much longer in order to resolve nutrient deficiencies or correct an underlying functional disruption. With friends and new acquaintances, I do my best to educate them about the need for such a complete evaluation to accurately assess the right supplements that would benefit them.
However, I recently realized that when someone asks ‘what should I take for …..?’, the explanation for need for evaluation aggravates rather than helps the person asking the question (I have been there!). This is the reason that I spent a some time thinking about how I could answer these supplement related questions. The first question that I asked myself was: Are there any supplements that I could potentially recommend to anyone without an elaborate history? The answer is yes!
I realized that there are three supplements – or categories of supplements- that I usually prescribe with specific dose and brand recommendations for my patients (who have had a formal evaluation) and these can also be recommended at a maintenance dose to family, friends and general acquaintances, after obtaining just a few details. These 3 types of supplements are often a part of many of my patients’ long term disease prevention and optimal living health plans. Since optimal health begins in the gut, it is no surprise that 2 of these 3 supplements support the digestive system.
Based on my review of research studies and clinical experience, I believe that these can be beneficial for most people to support good health:
This is the one supplement group from which almost everyone can benefit. Probiotics are available in capsule, powdered and even in health drink forms and all have different combinations of bacterial strains. These are the strains of bacteria present naturally in our intestinal tract and science is just beginning to understand the complete impact of our symbionts or ‘house guests’.
For many reasons including super-clean environments, liberal use of antibiotics and chronic stress, most people have either low levels of these beneficial strains or an unhealthy gut environment that allows foreign, disease causing strains to grow rapidly compared to the healthy strains. A proper balance of these microbes, can help with keeping the immune system up to speed, having healthy skin, improving allergy symptoms, alleviating IBS symptoms (irritable bowel syndrome) and in general, in optimal digestion and absorption of nutrients. This ecosystem of microbes in our gut is very dynamic and can change depending on the person’s diet, lifestyle, medication intake, stress and environmental exposures.
How do you choose one that is right for you? Assuming you do not have any major diseases relating to the digestive system (parasites, bacterial overgrowth, infectious diarrhea), choose a probiotic supplement that is appropriate for your age, gender and mild symptoms like constipation or gas. If taken correctly, symptom relief is observed in two weeks to a month, usually with many ‘side-benefits.
Two commonly used the phrases: ‘fight or flight’ and ‘rest and digest’ define how our body reacts to internal and external stimuli. These are evolutionary mechanisms that are designed to help our body focus on the task at hand when necessary or relax and enjoy our meals. Our busy lifestyles demand that we fit more and more in our daily schedules and balance various responsibilities, rarely allowing us to be free of stress and in the rest-digest mode. When we are under stress constantly, our digestive system and reproductive systems are ‘put on a back burner’ and priority is given to ensuring a rapid heartbeat and blood supply to the brain, lungs and organs vital for a good stress response. Chronic stress therefore, can lead to sub-optimal function of our digestive system and taking digestive enzymes with meals, while simultaneously working on stress management and incorporating a good lifestyle, can help prevent nutrient deficiencies and other diseases.
Choosing an enzyme is more work than probiotics, however, start with a combination that contains enzymes that help with digesting different food groups like carbohydrates (lactase, amylase), proteins (proteases) and fats (lipases).
The recommendation of this supplement is related to the stress response mentioned above. I often recommend a B-complex over a multivitamin because the vitamins in the B group (B1,B2,B3,B5,B6,B12) tend to be rapidly utilized by our fight or flight system, physiologically known as the sympathetic nervous system. Taking Vitamin B’s in their active form is important for proper absorption and assimilation to feel their benefits. Women who are on birth control pills and people with acid reflux that have been on acid-suppressing medications (proton-pump inhibitors such as Prevacid) tend to lose B-vitamins rapidly and a proper repletion will prevent some of the side-effects of these medications. Additionally, B-vitamins are water soluble and are readily discarded from the body when an excess is detected, making them highly unlikely to accumulate in tissues and cause negative effects.
For choosing a B-complex, speak with your doctor first, especially if you are on any prescription medications, to ensure there are no interactions.
Many of you are probably thinking: why is a multivitamin not mentioned in the above supplements?
There are many reasons for this but I will mention some that are most critical:
I hope that this post is helpful in making decisions about supplementation but as always speak with your health care provider before you start any new supplements. I have tried to highlight the importance of gut health and stress management in staying healthy and to emphasize the need for choosing supplements based on a thorough evaluation and taking into consideration many different factors. One does not fit all. I will be sure to write another blog post on how to identify a good, clean brand and difference between over the counter and doctor’s office supplements.
If you would like to know more about what a health evaluation involves and would like specific guidance with your health, you are always welcome to request a free consult through our website or call my office: 408.724.1486.
Wishing you good health!
Just like that it’s the end of February! And it is that time when you are beginning to get frustrated with your weight loss program; the latest, best rated, trending weight-loss plan that everyone is raving about on social media, the one you have been diligently following since the new year began has not helped you one bit. You are discouraged and think it is time to quit. This might sound familiar but instead of giving up, it is would be best to stop and reflect - reflect on why this trending weight-loss plan seems to be working for everyone (or so it seems!) but not for you. This blog attempts to provide some insights regarding this topic and identifies some critical components, that may be missing in popular weight-loss programs.
In my experience, a weight-loss plan is successful only if it is truly customized for each patient, based on his/her medical and social history. There is no ‘one fits all’ plan. Scientific literature heavily supports the fact that weight-loss programs based solely on ‘Eat Less, Exercise More’ or ‘Calories in versus Calories out’ are not the most effective, especially long-term. Programs that address behavior modification and provide sustainable lifestyle recommendations seem to provide effective, long-term weight loss.
I explain to all my weight-loss patients that it is not enough to shed extra pounds and get a pat on the back when you return to the Normal BMI range of 18.5- 24.9 (Body Mass Index= Weight in Kg/ Height squared in meters). It is more important that you lose the weight and are able to keep it off without having to count calories and have 2-hour work-out sessions on a daily basis. It is also important that you feel healthy once you have reached your target weight. What does ‘feel healthy’ really mean? As per the World Health Organization’s definition, it means "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". In my practice, this translates to feeling energized throughout the day, being productive at work, looking forward to time with friends and family and getting restful sleep. Additionally, it means not having chronic complaints such as headaches, joint pain, gas, bloating, anxiety or mood swings on a daily basis. This may sound unrealistic at first, but my patients who have achieved their weight loss goals will tell you that they would not opt for anything less.
Based on my research and clinical experience, I have identified these 5 factors that seem to be critical for a weight-loss program to be successful:
1.Focus on nourishment from food, not on counting calories
Though reducing calories may be important for some morbidly obese patients, the body will not continue to shed weight if the focus remains only on caloric values of the food and not on its nutrient content. The lack of essential nutrients can be one of the reasons for resistance to weight loss. What are calories and what are nutrients?
Calories are calculated by estimating the amount of energy released by metabolizing the three main macronutrients in food: carbohydrates, fats and proteins. The caloric value of the food does not take into account, its micronutrient content: vitamins, minerals, anti-oxidants and breakdown products of the caloric food groups: amino acids from proteins, fatty acids from fats and glucose from carbohydrates. These micronutrients including the 20 different amino acids and fatty acids such as Omega-3s are building blocks of enzymes, connective tissues, cell membranes, immune cells, cytokines and hormones in our body. Your body requires that you have a constant, balanced and adequate supply of all these nutrients for the creation, maintenance and functioning of healthy cells and tissues. The preferred fuel for energy required for all metabolic activities in the body is glucose from carbohydrates. If you lack adequate carbohydrates, then the body will burn fat- this is the basis of the low carbohydrate diets. Though this makes sense intuitively and works in the short-term, if you continue deprive your body of essential nutrients, its ability to metabolize fat will be comprised due to the lack of nutrients that help in this process.
To summarize, if you restrict calories and ignore nutrients, your body may become nutrient-deficient and malnourished leading to a decreased metabolic rate hindering your weight loss efforts.
2. Correct hormonal imbalance with the help of your Doctor. As per the American Thyroid Association, up to 60% of the people with a thyroid problem are undiagnosed and therefore, at risk for various cardiovascular and metabolic diseases. A study published in 2015 revealed that a sub-optimally functioning thyroid could be a contributing factor to insulin resistance, which can eventually lead to Type 2 diabetes. Obesity and Type2 diabetes are like a ‘chicken-egg’ syndrome – there is always a question of ‘what came first’. A thyroid imbalance often signals some form of adrenal gland deficit as well.
Adrenal fatigue is a term that is used by integrative doctors to indicate an imbalance in cortisol, a hormone produced in times of stress. Cortisol can be helpful if produced in right amounts only when needed. A high demand for cortisol due to chronic stress can lead to adrenal dysfunction and eventually exhaustion. With adrenal dysfunction, fat tends to deposit around the central part of your body (casually known as ‘muffin-top’ or ‘beer-belly’) as protection for covering the vital organs for survival.
Hormones produced by the adrenal glands and thyroid are part of the endocrine system in the body and are known as endocrine hormones. The levels of these and many other endocrine hormones such as insulin, melatonin, estrogen, progesterone have an effect on multiple organs and organ systems; any disruption in the feedback mechanisms, which affect the optimal levels of these hormones, can make it difficult to lose weight. Once there is a good understanding of which hormone pathways need attention and help with balancing, a strategy can be implemented to correct the imbalances, consequently helping your body to lose excess weight.
3.Find the right type of exercise for your body
When I speak of individualizing a treatment plan, each aspect of your lifestyle has to addressed, including regular exercise. Adhering to long, high-intensity workouts might seem possible in the beginning of a weight loss program but may not be sustainable long term. Choose a form of exercise that you enjoy and can would look forward to rather than avoid. Some people might enjoy a Zumba class or others might prefer to join a yoga or Pilates group. Make it the 30-minutes or hour that you will dedicate to help your body rejuvenate. If you exercise the way you like and consistently, you will begin to see that your body will crave workout sessions! Keep it simple- simple does not mean you do not challenge yourself or push to the next level of intensity, but it means simple to follow through.
It is important that you choose the right intensity of exercise for your health:
4. Keep a positive attitude-especially towards food
As a classic example of Mind-Body medicine, if you are constantly feeling deprived –deprived of eating your favorite foods, deprived of spending quality time with your friends and family because you have to be at the gym- your body will simply just ‘not let go’. It is very critical that you understand the importance of the healthy changes you are implementing by educating yourself. This will help you keep a positive and motivated attitude towards your weight-loss goals. Staying positive does not mean you will never be sad or annoyed since these are healthy emotions when expressed appropriately. However, when these emotions become your predominant state of mind, an unhealthy attitude towards food will develop, and if not caught early can lead to eating disorders like bulimia and anorexia.
With adequate counseling and support from your health care providers, staying positive should not be a challenge. Additionally, if the focus remains on nourishing the body rather than counting calories, as the body gets healthier, your internal biochemistry will start to favor and harbor a positive attitude.
5.Build a strong support system
The best way to stay motivated is to have both a personal and professional team helping you.
Your personal team could and should include anyone who matters to you: your spouse, parents, siblings, friends, co-workers and pets. Educate them as to why it is important for you to be healthy and lose weight. You can have them remind you of your goals as often as you want- they will be your cheerleaders when you make progress towards these goals. The value of a good social support network must not be underestimated when trying to achieve your health goals.
Your professional team should include the doctor who has designed and is supervising your weight-loss plan, plus, one or more of the following: physical therapist, trainer, dietitian, therapist or other healthcare providers. This team will help you analyze the objective data and can provide action oriented solutions and resources to help you succeed. Simple recommendations such as increased water intake may have a huge impact on your progress rate, but to detect inadequate hydration would be the first step, and that is why your professional team is important.
Typically, once all of the above factors are addressed and adhering to a weight loss program designed specifically for you, will be much easier. Challenges will show up but with the help of your support teams, you will overcome them and be successful.
Now go ahead, re-assess your weight-loss plan, address the above factors and start working towards your new goals.
If you would like help regarding these factors and would like me to be a part of your professional support system, schedule a free consult through our website.
Keeping it simple,
Preeti Kulkarni, ND
Dr.Kulkarni will be writing on various health topics. Please sign up to receive updates.