2011 AANP Conference Abstracts

Stress, Exercise, and Obesity are the Strongest Predictors of Workplace Productivity: A Naturopathic Window of Opportunity

Author: Amber Fyfe-Johnson, ND

Abstract

Data Source/Study Setting: Primary data were collected on 2,814 adults who: (1) were employed at least half time, (2) had no history of diabetes or heart disease, and (3) completed a cardiovascular risk screening in 2009. Data were collected as part of baseline assessments in the broader Heart of New Ulm demonstration project, which aims to reduce the attack rate of myocardial infarctions in New Ulm, MN. Screenings were done at various community and worksite venues.

Study Design: A cross-sectional research design was used. The outcome was overall health-related workplace productivity loss, which included the percent of all work hours lost due to absenteeism (i.e., job unavailability) and presenteeism (i.e., job impairment) combined. The primary predictor was perceived stress level. Other covariates included age, sex, education, fruit/vegetable consumption, physical activity, smoking, alcohol use, and body mass index (BMI). Negative binomial regression modeling was used to examine the association between stress and productivity loss, and to account for confounders or effect modifiers of this relationship.

Data Collection/Extraction Methods: Absenteeism and presenteeism were collected from the Work Productivity and Activity Impairment questionnaire and reported as the percent decrement in total work time over the previous week (0% to 100%). Stress was assessed with the 4-item Perceived Stress Scale (PSS), which captures life challenges, as well as personal stress management abilities over the previous month. Higher scores (0–16 points) indicate higher levels of perceived stress. With the exception of BMI, all covariates were collected from self-report surveys.

Principal Findings: After adjustment for BMI, there was a significant interaction between stress and physical activity (Χ2=5.43, p=0.02). Among participants with a relatively low PSS score of 1, productivity loss was –2.8% for those who were physically active 0 min/wk and –1.9% for those who were physically active 420 min/wk. In contrast, among participants with a relatively high PSS score of 10, productivity loss was –11.4% for those who were physically active 0 min/wk and –16.7% for those who were physically active 420 min/wk.

Conclusions: Perceived stress was the major driver of workplace productivity loss, but this association varied by physical activity level. At lower levels of stress, more physical activity was modestly protective against productivity loss. At higher levels of stress, however, more physical activity seemed to hasten productivity loss. Reasons for this interaction are unclear, but may indicate that some individuals compensate for stress by exercising more and working less. These findings should be confirmed in prospective cohort studies in order to examine if changes in stress and physical activity indeed co-vary for sustained periods of time and continue to impact productivity.

Implications for Practice or Policy: Along with BMI, stress and physical activity were the only significant predictors of workplace productivity loss in the final multivariate model. If this relationship holds true in prospective studies, it suggests that other lifestyle habits (e.g., smoking), though obviously important for health, may be less economically relevant targets of intervention. Because comprehensive worksite wellness initiatives aim to improve productivity in the workforce, these findings provide evidence for naturopathic physicians to play a role in large-scale public health proposals. Furthermore, these results emphasize the value of addressing stress for individualized naturopathic patient care.

Efficacy of Pelvic Floor Muscle Manual Therapy and Low-Level Laser Therapy for Management of Childbirth Perineal Tears and Post-Partum Pain

Authors: Isa Herrera MSPT, CSCS, Luz Perez MSPT, Rachel Schneiderman DPT, ATC

Abstract

Background: Perineal tears are common with spontaneous vaginal birth and are often a significant source of pain for new mothers. In addition to pain, perineal tears are also associated with an increased risk of dyspareunia, urinary and fecal incontinence, damage to the pudendal nerve and development of scar tissue and soft tissue adhesions. This case report describes the successful physical therapy treatment of a patient following surgical repair of a fourth-degree perineal tear.

Study Design: Case Report

Case Description: A 33-year-old female underwent multiple repairs of a fourth- degree perineal tear following vaginal childbirth. Upon physical therapy evaluation, the patient reported severe rectal pain with sitting, walking, gynecological care, defecation and wearing tight clothing. The patient also reported incomplete emptying during bowel movements and urinary incontinence. The patient was found appropriate for the “Herrera Pelvic Pain and Laser ProtocolTM,” which includes manual physical therapy techniques and low-level laser light therapy (LLLT) for the management of pelvic pain conditions.

Outcomes: The patient attended 13 physical therapy sessions. At time of discharge, the patient demonstrated a 90% improvement in pain levels and 100% improvement in scar mobility, pelvic floor muscle tone and pelvic floor voluntary muscle release. The patient also reported resolution of her urinary and fecal incontinence.

Discussion: Studies show that as many as 85% of women experience injury to the perineum and genital tract during spontaneous vaginal birth. Genital trauma from episiotomy or spontaneous laceration can result in significant pain and loss of function for the post-partum woman. The “Herrera Pelvic Pain and Laser Protocol^TM” is uniquely effective in reducing pain and restoring function in the post-partum population.

Building Bridges: Qualitative Assessment of a Clinical Faculty Exchange between a Naturopathic and an Allopathic Medical Training Program

Authors: Rachelle L McCarty, ND MPH, Robin Fenn, PhD, Barak Gaster, MD, Wendy Weber, ND PhD MPH, Jane Guiltinan, ND

Abstract

Background: A clinical faculty exchange program between Bastyr University and the University of Washington School of Medicine was developed to promote the acceptance and use of evidence-based medicine (EBM) principles and tools in naturopathic medical training.

Objective: To assess the participants’ perceived benefits of a clinical exchange program.

Methods: Nine faculty members participated in a focus group (n=6) or a structured interview (n=3) to assess experience in the program. Investigators independently analyzed transcribed notes for common experience themes.

Analysis and Interpretation: Major themes included strengthened professional relationships, improved use of clinic resources, and innovative approaches to teaching EBM in the clinic setting.

Main Results: A clinical exchange program is an effective way to promote EBM appreciation within the CAM educational community and to foster improved clinical experiences for faculty and their students and patients.

Enhancement of Natural Family Planning, by Pinpointing the Fertility Window

Author: Alfred Shihata, MD

Abstract

Objectives: To simplify, and eliminate the misconceptions of natural family planning (NFP) to women who need it, due to contraindication to available contraceptive methods, cultural or religious reasons. B) To minimize the time and effort for clinicians to teach and women to learn NFP. C) To enhance understanding, compliance and thus the effectiveness and of this method of contraception.

Design and Methods: Natural family planning is the safest and yet the least practiced method of contraception. We conducted a prospective pilot single center study to test the efficacy of NFP. We recruited 40 women ages 21-38, who were motivated by contraindication to available contraceptive methods, religious, or cultural reasons. The investigator photographed the cervical changes and the cervical secretions collected in a cervical cap at the same time every day of the menstrual cycle. This is to visualize the difference between fertile and infertile days. We provided participants with photographs, and the explanations detailing the cervical changes and secretions, coinciding with the basal body temperature that occurs during the menstrual cycle. Subjects then monitored their own basal body temperature, cervical position, secretions and consistency of the cervix and cervical os for three months prior to the start of the study. We instructed women to wear the cervical cap every day, from day six to three days post ovulation, and examine their own cervical secretions collected in the cervical cap. We excluded women who were breast feeding, had irregular periods, or recently stopped hormones. Participants used NFP and the cervical cap during the fertile days, exclusively for six cycles.

Results: Thirty two women followed the protocol and completed six cycles of the study. Five women deviated from the protocol by using the cervical cap, 2-3 days longer than their fertile days. One woman got pregnant. Based on this study, the typical failure rate (Pearl index) of the NFP and cervical cap combination was estimated to be 6.6 per hundred women per year.

Conclusion: Photographs of the dynamic cervical changes and its secretions associated with the menstrual cycle greatly enhanced learning, compliance and thus effectiveness of NFP. The cervical cap empowered women and allowed forspontaneous and more natural sexual sensations to both partners and thus increased the effectiveness of NFP. The cervical cap and NFP combination is safe and appears to have increased effectiveness with only one failure in the population studied.

Treating Male Menopause: The Second String in the Symphony of Hormone Balancing

Author: Sara Wood, ND

Description: Hormone changes in men are common and can have dramatic effects on their quality of life as well as their health. Declining testosterone levels are linked to many common conditions including metabolic syndrome, diabetes and cardiovascular disease.

Abstract

Hot flashes, depression, weight gain . . . these symptoms aren't unique to women. Testosterone levels start to decline in men at age 30, and continue to decline at a rate of more than 1% per year without any exacerbating factors! Diet and lifestyle choices and many disease processes can aggravate the process leaving many men with levels far below those of their peers. While testosterone levels fall, estrogen levels rise which leads to prostate related problems, cardiovascular decline and weight gain.

Symptoms of declining testosterone levels such as erectile dysfunction, depression, apathy, loss of libido, weight gain, night sweats and anxiety have a dramatic effect on quality of life but the real danger of low testosterone is its link to metabolic syndrome, coronary artery disease and diabetes.

Restoration of optimal levels of testosterone through bio-identical hormone replacement or stimulation of endogenous production with diet, exercise and botanicals can reverse insulin resistance and protect men of all ages from catabolic processes that lead to many chronic diseases.

Marine Sea Plasma: The Quintessential Nutritional Solution To Maintaining Homeostasis in Our Internal Bio-Terrain

Author: Dr. Louisa L. Williams, MS, DC, ND

Description: In this talk the clinical use of seawater harvested from phytoplankton blooms in the world’s oceans, known as “marine plasma,” will be described. Since 1897 in France, Rene Quinton’s marine plasma has been effective in treating conditions from acne to cholera, and restoring balance and homeostasis in our bodies’ biological terrain. Clinical case examples and research studies will be cited.

Abstract

In 1897, a young French scientist, René Quinton, was fascinated with Darwin’s emerging theory of evolution that all life on earth originated from a single-celled oceanic organism. He therefore began to explore oceanic environments and became interested in plankton, the single-celled small organisms found in various depths in the ocean. Quinton was especially intrigued with the phenomenon of the enormous plankton blooms that arise seasonally in the world’s oceans – one of which was just off the coast of France in the Atlantic Ocean.

These whirlpool-like plankton blooms are hundreds of miles wide at the ocean’s surface, and much narrower at the ocean floor, where the vortex stirs up minerals, nutrients, and microbes that help seed the growth of the phytoplankton within the bloom. Within these huge oceanic plankton blooms fish lay their eggs, the great blue whales (the largest mammals) travel thousands of miles to swim, and krill rich in fatty acids thrive. Further, since the plankton vortex provides a “virtual wall” of protection, this nutrient-rich water has been independently tested to contain negligible traces of mercury - less than fish or even drinking water. René Quinton further found that this oceanic soup full of minerals, RNA, DNA, and micro-enzymes was an excellent supplement for our internal biological terrain, since it almost perfectly matched the 7.4 to 7.6 alkaline pH of human blood plasma and extracellular fluid in our bodies.

For over a century, Quinton and other scientists and physicians have clinically demonstrated in hundreds of case studies that what he termed, “marine plasma,” has been able to assist healing a diverse number of conditions, and even dramatically so in life-threatening extreme circumstances including cholera and WWI battle wounds. Although many holistic practitioners have studied the works of Beauchamp and Bernard, few realize the contributions from this other French scientist who developed the protocol for harvesting, processing, and administering this quintessential marine plasma solution for maintaining homeostasis in our bodies’ biological terrain.

Although drinking the oral vials is the most typical mode of application, Quinton’s marine plasma has also been successfully implanted rectally or vaginally, sprayed into the nasal sinuses, inhaled into the lungs with a nebulizer, and used as a dental rinse to restore healthy teeth and gums.

Quinton’s marine plasma vials are an essential part of repleting depleted minerals post-amalgam removal. Incidentally, these vials are also important to restore needed minerals when patients have depleted minerals from excessive DMPS and DMSA supplementation. (Many well-meaning holistic doctors and practitioners strip too many minerals with these medications - as well as using too-aggressive, and therefore imbalanced, nutritional products, rendering many patients so mineral-deficient that their metabolic ability to detoxify becomes significantly impaired.)

Quinton is also indicated after dental cavitation surgery to help re-mineralize the jawbone and surrounding teeth and gums, and to help normalize the bleeding and heal the tissues in the surgery site.

Finally, Quinton is one of the few supplements that is very effective, yet can be used without fear of strong reactions or a healing crisis by even the most sensitive patient. Thus, it is well tolerated by weaker environmentally ill patients even at the very beginning of treatment.

Twelve Useful Prescriptions

Author: Michael Traub, ND

When, Why and How

1. Compounded Red Yeast Rice

• For hyperlipidemia not controlled with diet, exercise and stress management
• Compounded safer and more effective than commercial sources; some RYR contains a toxin (citrinin) and variable levels of 14 monacolins that inhibit hepatic cholesterol synthesis
• Just as effective as statins, no adverse effects
• Malama Compounding Pharmacy
• RYR 300 mg/Niacin 25 mg/CoQ10 5 mg: 2 bid
• Recheck lipids q 3 mo

2. Compounded BiEst/Progesterone transdermal cream

• For post-menopausal women at low risk of breast/endometrial/ovarian cancer with hot flashes not sufficiently controlled with foundational naturopathic medicine (diet, exercise, stress management) and botanical medicine (e.g. Black Cohosh)
• BiEst is estradiol and estriol
• Progesterone can be used even if woman has had hysterectomy
• Dosage varies depending on severity of symptoms
• Start with moderate dosage and adjust as necessary (e.g. BiEst 1.5 -2 mg/mL, Progesterone 40 mg/mL, applied to forearms q hs; discontinue 4-5 days each month)
• Withdraw periodically to assess need for continuing
• Malama Compounding Pharmacy
• Mina Pharmacy

3. Compounded Estriol vaginal cream

• For postmenopausal atrophic vaginitis (vaginal dryness, lack of lubrication)
• Very safe – estriol is cancer protective; very effective
• 2 mg/0.5 mL qd x 2 wks, then 2x/wk for maintenance

4. Mupirocin topical antibiotic ointment (Bactroban, Centany)

• More effective for serious and/or resistant bacterial skin infections than triple antibiotic and bacitracin and most herbal preparations with possible exception of Allimed (garlic) cream
• Also useful for intranasal use to eradicate staph carriage
• Derived from Pseudomonas fluorescens
• Blocks bacterial protein synthesis
• 2% ointment, 22 gram tube, apply tid to affected area/s

5. Imiquimod (Aldara, Zyclara)

• For actinic keratoses and basal or squamous cell carcinomas
• Stimulates interferon and other cytokines that lead to inflammatory cell influx into AKs and BCC/SCC and subsequent apoptosis and immune cell-mediated destruction of lesions.
• Strong correlation between complete clearance rates and severity of local skin reactions.
• More durable response than topical 5-FU; no guarantee of complete removal with escarotics (Black Salve)5
• Aldara 5% cream hs 2-3x/wk for AK, depending on face/scalp or hands/arms; 5-7x/wk for BCC; 7x/wk for SCC; average course is 6 wks.
• Zyclara 3.75% cream for AK; hs 2 weeks on, 2 weeks off, 2 weeks on Monitor response at 2 week intervals. 10 second visit: use more often or use less often or continue same frequency or stop.
• Dispense only as many packets as needed due to expense of medication.

6. Azithromycin (Zithromax)

• Short-course antibiotic for acute infections
• For acute bacterial sinusitis, community-acquired pneumonia, acute pharyngitis/tonsillitis, uncomplicated bacterial skin infections(500 mg PO x 1, then 250 mg qd x 4 days: Zpak)
• For gonorrhea: 2 g PO x 1
• For NGU/cervicitis: 1 g PO x 1
• To prevent antibiotic-associated diarrhea and vaginitis, always prescribe probiotic concurrently with antibiotic but separate by as long as possible, and continue probiotic for 2 weeks following antibiotic.

7. Ciprofloxacin

• For acute bacterial sinusitis, infectious diarrhea, intraabdominal abscess (diverticulitis), lower respiratory tract infection, bacterial skin infections 500 mg PO q12h x 5-7 days
• For acute uncomplicated UTI 250 mg PO q12h x 3 d
• For mild/moderate UTI 250 mg PO x 7-14 d
• For severe/complicated UTI 500 mg PO q12h x 7-14d
• Gonorrhea 250 mg PO once

8. Prevpac (Clarithromycin-Amoxacillin-Lansoprazole)

• Combination therapy to eradicate Helicobacter pylori infection associated with gastric ulcer, dyspepsia
• Clarithromycin 500 mg
• Amoxacillin 1 g
• Lansoprazole 30 mg
• Take all 3 PO BID for 10-14 days, plus lansoprazole for additional 14 days
• Less expensive alternative is to prescribe the antibiotics plus OTC Prevacid
• Perform urea breath test 4-12 weeks after end of treatment

9. Famciclovir (Famvir)

• For herpes and shingles
• Single-Day Famvir (1500 mg PO qd x 1) stops or shortens recurrent genital herpes simplex and oral-facial HSV (1000 mg PO BID x 1 d)
• Can be used as suppressive treatment 250 mg qd up to 12 mo. for frequent genital HSV.
• Famvir converts to penciclovir, which inhibits viral DNA replication
• Adverse reaction with qd dose: headache in 39%
• Acute herpes zoster: 500 mg PO q8h x 7d, most useful when started in first 72 h

10. Valacyclovir (Valtrex)

• Acyclovir ester, converted to acyclovir, works 33% faster than acyclovir
• Inactivates herpes-virus specific DNA polymerase
• Herpes labialis: 2 g PO q12h x 1 day
• Genital herpes: initial episode: 1 g PO BID x 10 d
• Recurrent genital herpes: 500 mg BID x 3d
• Chronic suppression: 1 g PO qd
• Herpes zoster: 1 g PO TID x 7 days

11. Cyclobenzaprine (Flexeril)

• For acute torticollis, bulging lumbar disc
• Muscle spasm 5 mg PO TID; may increase dose to 7.5 -10 mg PO TID prn
• Off-label use for Fibromyalgia
• Causes drowsiness in up to 39%, dry mouth in up to 27%, dizziness in up to 19%

12. Albuterol (Proventil HFA, Ventolin HFA)

• For asthma, COPD
• Aerosol 90 mcg/puff; 108 mcg/puff
• Acute broncospasm: 2 puffs q4-6h
• Exercise-induced bronchospasm: 2 puffs inhaled 15-30 minutes before exercise
• Maximum dose: up to 12 puffs/24 hrs
• Inhaler should be shaken well and test-sprayed into air before initial use or if it has not been used for prolonged time
• Place inhaler well into the mouth, lips firmly closed around it

The Documented Health Risks of Genetically Modified Foods—Overwhelming Evidence of Harm

Author: Jeffrey M. Smith, MBA,

Desription: Based on the evidence that now links genetically modified organisms to serious disorders, the American Academy of Environmental Medicine urges doctors to prescribe Non-GMO diets to everyone. This session reviews that evidence, including adverse findings and theoretical risks, and shows how physicians can effectively help patients choose healthier non-GMO alternatives.

The hijacking of the FDA and thwarting of independent scientific investigation

Documents show how political influence and corporate manipulation allowed dangerous GMOs onto the market, in spite of strong opposition from FDA scientists.

The five main risk categories from GM food:

1. The damage to the host DNA resulting from the gene transformation process

The process of inserting transgenes creates significant collateral damage in the host plant’s genome. Natural genes at the insertion site may become mutated, deleted, altered or permanently turned on or off. Up to 5% of the hosts’ genes may also change expression levels. And growing out GM cells in tissue culture can cause hundreds or thousands of additional genome-wide mutations. These changes can alter RNA, proteins, and primary and secondary metabolites in the plant, any one of which may prove harmful. Examples of GMOs with increased allergens, toxins, and anti- nutrients will be presented.

2. Adverse effects from the protein produced by the inserted transgene

The transgene itself introduces a new protein into our diet, which may be allergenic or toxic. The Bt toxin produced in corn, for example, has been shown to promote allergic and flu-like symptoms in humans, and immune system reactions and tissue damage in animals. Now studies and on-farm experience show that the Bt crops may promote disorders and disease.

3. Unpredicted changes to the structure and function of that protein

The structure and function of the protein may change unpredictably when processed in the new organism. In addition, the transgene sequence may be altered, truncated or mixed with other DNA during insertion, or it may rearrange spontaneously years later—creating proteins with amino acid sequences that were never intended. Even if the amino acid sequence is in tact, the protein may be folded incorrectly or have added molecular attachments that can change a harmless protein into a deadly one.

4. Accumulation of toxic residues such as herbicides, in the GM plants

The use of herbicides in the US jumped by over 380 million pounds in the first 13 years of GMO use. The greatest jump was Roundup, which is associated with birth defects, endocrine disruption, cancer, and lowered trace mineral content in the food. New evidence now implicates Roundup in excessive myco toxins in food and feed.

5. Horizontal gene transfer into gut bacteria

The only human feeding study ever published on GMOs shows that genes transfer into the DNA of human gut bacteria and continue to function. The implications are discussed for each of the genetic constructs that could transfer.

Psychoneurointracrinology: Its Role in Mind-Body Medicine

Authors: Susan Gordon, PhD and Andrew L. Rubman, ND

Description: This presentation explores: 1) Psycho-neuro-intracrinology, 2) Autopoietic role of estrogen, progesterone, and DHEA in the ovary, adrenal gland, and brain, 3) Corticolimbic system, 4) HPO-HPA axes, 5) Theories of psychoneurointracrine autopoiesis and emergent global states, 6) Theoretical and clinical: Assessment, implications, and research, 7) Natural HRT and psychopharmacology for perimenopause.

Abstract

Psychoneurointracrinology is the study of psychological, neurological, and intracrinological processes forming a mind-brain continuum within the person. Psycho (psychological) refers to constructs variously referred to as psyche, self, soul, mind, and consciousness. Neuro (neurological) refers to the composition and reactions within the nervous system. Intracrine (intracrinological) refers to the intracellular biosynthesis of steroids-- the binding of receptors and the formation of enzymes that catalyze the creation of hormones within the cell. Intracrinology involves the allosteric regulation of enzymes and steroids that bind to peripheral target sites and modulate feedback from downstream or feed-forward from upstream substrates. A steroid’s biological activity depends on its ability to interact with a specific binding site on a corresponding receptor. The theory of psychoneurointracrine autopoiesis explains how the regulation of a steroid’s receptor is modulated by the person’s perception of experience and sense of well-being. Second, the theory of emergent global states explains how reciprocal limbic projections from the hypothalamic-pituitary-ovarian and adrenal (HPO-HPA) axes; paraventricular nucleus to the median eminence [ME], govern the person’s reactive and anticipatory response to stress; and the mind-brain relationship. Theoretical and clinical implications of this model and their application to naturopathic psychopharmacology are advanced. While the example of women at midlife is given, theories pertain to women across the lifespan and to men through similar neurohormonal mechanisms.

Theory of Psychoneurointracrine Autopoiesis

Follicular-stimulating hormone, lutenizing hormone, estradiol, and progesterone fluctuate rhythmically across the normal menstrual cycle. The equilibrium of hormones within this autopoietic system depends on the phase of a women’s cycle; follicular, ovulatory, or luteal balanced by her need for progesterone’s synthesis of glucocorticoids and mineralcorticoids to meet the demands of stress. While a steroid’s biological activity depends on its ability to interact with a specific binding site on a corresponding receptor, up and down regulation of receptors throughout the cycle, suggests a functional competition between neurointracrine steroids to maintain the menstrual cycle and respond to anticipatory and reactive stress. In the normal 28-Day menstrual cycle, DHEA initiates the cycle by its down conversion to estradiol in the ovarian granulosa cells midcycle via its metabolic intermediary androstenidione. In addition to its contribution to the estrogens at ovulation, DHEA, converted from DHEAS, its storage form in peripheral circulation, is synthesized by the adrenal gland and created de novo in ten-fold quantities by neurosteroids in the brain, serving a role in the regulation of adrenocortical function; both primary and secondary. While at ovulation DHEA’s ovarian contribution to circulation increases to twice that of the adrenal cortex, it is synthesized by the adrenal gland throughout the cycle. DHEA’s role may be best summarized as governing the catalyzing of enzymes, the synthesis of neurotransmitters, and the receptor sensitivity of neurosteroids. Change in receptor sensitivity, enzyme titer, and nutritional needs affects the adequacy of the synthesis of progesterone and DHEA, which plays a major role in the ability to stabilize nerve function and adapt to stress. Due to decreased availability of DHEA during the early years of the menopausal transition, there is a dramatic fall in the formation of androgens and estrogens in peripheral circulation. As the ovary produces less DHEA, its synthesis, receptor sensitivity, and down-conversion may increase at adrenal and extra-ovarian sites to maintain the menstrual cycle. As DHEA produces less estrogen during the follicular phase from its metabolism through androstenidione, progesterone and 17hydroxyprogesterone may be recruited to metabolize to estrogen via enzymatic cross-conversion utilizing 17α-hydroxylase and 17, 20-Lyase—contributing to deficiencies in progesterone and adrenocortical metabolites. Although estradiol and progesterone continue to sensitize receptors for each other throughout the cycle, when estradiol, which is normally bound to its receptor midcycle by progesterone, becomes deficient, circulating estrogen levels drop prematurely before the luteal phase begins. When this happens, estrogen is released from its receptors before adequate enzymes, which convert estradiol to estrone and estriol, are present. If this pattern becomes chronic, it can lead to a state of progesterone deficiency and relative estrogen excess. The shift in the balance of estrogens with increased dependence on progesterone for its synthesis, and upregulation of adrenal enzymes due to the increased demand on the body’s DHEA, progesterone, and glucocorticoid reserves at ovulation and at the mid-luteal peak, challenge a woman’s resiliency and can lead to a state of adrenal insufficiency.

Theory of Emergent Global States

The HPA axis is keenly sensitive to fluctuation in gonadal steroids. The neurointracrine system regulates hormones in peripheral circulation through the modulation of excitatory and inhibitory neurotransmitters synthesized by the brain inflecting sympathetic and parasympathetic arousal. Neurosteroids affect cognition by exerting biological actions in the brain through genomic or non-genomic pathways governing nuclear receptors for neurotransmitters. They display antagonistic, agonistic, or mixed properties through which they bind receptors for

GABA, glutamate, and N-methyl-D-Aspartate within the central nervous system (CNS), which cross the blood-brain barrier through circumventricular organs, such as the ME. Estrogen, progesterone, and DHEA in peripheral circulation affect the brain’s level of neurotransmitters. Modulation of the stress response affects calcium uptake, CNS function, autonomic regulation, and nutritional reserves. Biosynthesis, inflection, and receptor sensitivity then depend on gastrointestinal and liver function for recycling of hormonal metabolites affecting mood, emotion, and behavior.

Efficacy and Safety Review of the Extract of Rheum Rhaponticum L. in the Management of Perimenopausal Complaints

Author: Deanna Minich, PhD

Description: This presentation will provide an overview of the botanical extract from Rheum rhaponticum L., from its clinical evidence in relieving menopausal symptoms to in vitro and in vivo data illustrating its potential biological mechanism(s).

To date, the most effective and reliable therapy for menopausal vasomotor symptoms such as hot flushes is the hormone therapy (HT). Many women are either hesitant to consider this option or are not candidates for HT due to the increased risk of hormone-related cancers and cardiovascular disease. In Germany, clinicians have been recommending a purified and standardized extract of Rheum rhaponticum L. known as ERr731 since 1993. Clinical studies demonstrated that one tablet (4 mg) daily of ERr731 offered significantly effective relief for the most common menopausal symptoms (including hot flushes) compared to placebo. Participants reported symptom reduction that continues over 3 to 24 months. Through improvements in sleep quality and reduced anxiety and depression, participants reported better quality of life. ERr731 appears to be a safer option for long-term use than HT and other herbals. In toxicology studies, the no-observable-adverse-effect level (NOAEL) was determined to be 1000 mg/kg body weight/day. Unlike HT, ERr731 and its major constituent aglycones (rhapontigenin and desoxyrhapontigenin) do not contain estrogen or potent activators of estrogen receptor (ER) α, but have stronger ERβ specificity. In ovariectomized female rodents fed with ERr731 (at 1, 10 and 100 mg/kg body weight per day for 3 days), none of the tested doses stimulated uterotrophy. Experimental data suggest that ERr731 and its constituents exhibit SERM-like properties.

In conclusion, ERr731 offers a more natural and safe approach to relieving menopausal symptoms with long-term safety and no associated serious adverse events.

An Evidenced Based Approach to the Evaluation and Management of Cardiovascular Risk for the Naturopathic Physician in Primary Care

Author: Richard Malik, ND

Description: An evidenced based review of accepted measures in the evaluation of cardiovascular risk and treatment. including diet, exercise, over-the-counter medicines, and prescription medication. This presentation will help naturopathic physicians in primary care roles accurately identify patient populations likely to benefit from treatment, understand how to monitor treatment, and help decide which treatments are most likely to be beneficial for individual patients.

Evaluation of cardiovascular risk will include and compare total cholesterol, cholesterol ratio, Framingham risk assessment, and other risk measures used to identify patients populations that may benefit from treatment.

Management of cardiovascular risk will include and compare diet, exercise, over-the-counter medicines, and prescription medicines. A discussion of expected effect and numbers needed to treat will be included.

Abstract

The evaluation and management of cardiovascular disease risk is a confusing matter for many primary care physicians. This confusion frequently leads to treatment that is often unnecessary and sometimes even harmful. Stratification of patients for risk of heart attack and stroke is made difficult by multiple measures for cardiovascular risk, including total cholesterol, LDL cholesterol, VAP cholesterol, cholesterol ratio, and Framingham Risk Assessment. If a patient falls into a population that is likely to benefit from medical management for hypercholesterolemia, many physicians do not know the expected number needed to treat for prevention of cardiovascular events and comparative safety and efficacy of treatment options.

Some over-the-counter and prescription approaches for improving hypercholesterolemia require medical monitoring while others have specific methods of dose titration to ensure both efficacy and safety. While the published medical literature provides adequate information so that the primary care physician can provide high-quality recommendations to their patients, many physicians do not have the time to review the evidence. This presentation provides a reference for physicians to make evidence based recommendations to their patients and to provide the best-quality care available.

Reversing and Preventing Coronary Artery Disease

Author: Thomas E. Levy, MD, JD

Description: Focal scurvy of the endothelial cells of the coronary artery intima is the common denominator among all the most important coronary disease risk factors. Without such a focal deficiency of vitamin C, atherosclerosis will not develop. Proper supplementation, diet, and toxin avoidance are needed to restore arterial vitamin C levels to normal.

When there is a generalized and severe deficiency of vitamin C throughout the body, the disease known as scurvy will eventually manifest itself and rapidly result in death if the deficiency remains uncorrected. Today such generalized scurvy remains well-known to medical educators, yet it is rarely seen. Most diets throughout the world, even in third-world nations, contain enough vitamin C to prevent generalized scurvy from occurring. However, most cases of scurvy are not generalized conditions. Instead, they are focal. Focal scurvy occurs when there is a severe deficiency of vitamin C in only a part, or one tissue, of the body. Typically, there is absolutely no evidence of a generalized condition of scurvy in such a body, and plasma levels of vitamin C might even still be in the normal range. Two common examples of focal scurvy are the severe vitamin C deficiencies seen in cataracts and periodontal disease. Often, possibly more common than not, cancers will get their foothold because of local tissue conditions secondary to severe vitamin C deficiency. One the most common forms of focal scurvy is coronary arterial scurvy. This occurs when the intimal lining of the coronary artery becomes sufficiently depleted of vitamin C that the process of atherosclerosis begins and continues to develop. All of the most important coronary artery disease risk factors will be examined, and the scientific case will be made that each of those risk factors invokes such a focal scurvy in the development of atherosclerosis.

After the evidence is presented linking focal vitamin C deficiency to the onset and evolution of coronary artery disease, practical suggestions will be made for helping the health care practitioner in treating this condition. While proper vitamin C supplementation is an integral part of this therapy, it will usually not suffice as a monotherapy in the effective treatment of this focal scurvy. Toxin exposure must absolutely be minimized, since they always are prooxidant or cause increases in reactive oxygen species, which reliably consume stores of vitamin C and any other antioxidants present in the susceptible tissues. All of these treatment issues will be examined in detail.

Baby Boomers, Belly Fat and Bedroom Boredom

Author: Robyn Kutka, ND

Description: Discussion of the hormonal changes associated with aging and sequelae including weight gain, insulin resistance and decreased libido. The presentation will include mechanisms of action, methods of diagnosis and common and emerging treatment options.

Abstract

This year, the Baby Boomer population will reach ages 47-65; at the same time, the life expectancy continues to climb (currently 79 years up from 49 years at the beginning of last century). This leaves millions of women living MANY years beyond the primary declline in their hormone levels. In addition to the more classic hot flashes and night sweats, symptoms such as weight gain, insulin resistance and los of libido are common complaints of menopause. It is estimated that at least 20% of the population age 65 and older will develop type 2 diabetes; a preventable condition if insulin resistance is recognized and treated early.

In peri and post-menopausal women the development of insulin resistance only perpetuates an already altered hormone picture, increasing testosterone and contributing toward estrogen dominance and adrenal hypofunction. These changes may exacerbate the symptoms commonly associated with menopause and bring new symptoms including hirsutism and central obesity.

Commonly experienced in peri and post-menopause, decreased libido is a complaint of more than 30% of people with insulin resistance and, in women, is associated with dyspareunia, lowered self confidence and relationship discords. Often overlooked by the practitioner, low libido in peri and post-menopausal women can be successfully treated by addressing hormonal imbalance, exercise, diet, stress relief and relationship counseling.

Mind-Body Syndrome: Integrating the Psycho-Physiological Model of Neural Plasticity Into Naturopathic Practice

Authors: Stefan Kuprowsky BSc., MA, ND, and Paul Epstein, BA, ND

Description: Mind-Body Syndrome is a concept explaining how past traumas and stress create neural conditioning that results in chronic disease states. These can be unlearned via neural plasticity of the brain using techniques that have been proven to change psychophysiology such as mindfulness, the healing intention, compassion and creation of a healing relationship.

As NDs treating the whole person and underlying causes, it is important to recognize and address aspects of post-traumatic stress

disorder that may be present in patients presenting with pain and other chronic diseases. While we are not experts in treating post-traumatic stress, we need to recognize that symptoms of trauma may not resemble PTSD in its classic presentation but contribute causally to many chronic disease conditions. The lessons learned from mind-body medicine and psychoneuroimmunology indicate that biography can become biology. Research in neuroplasticity indicates that just as pathways in the brain can result in chronic pain; these pathways can be re-configured to create healing. This seminar presents current research that reveals that many disparate disease states share the same neurophysiological determinants of what is called Mind-Body Syndrome or Psychophysiological Disorder. Treatments options include techniques that are compatible with naturopathic philosophy such as physician as healer, mindfulness, compassion, intentional healing and healing from within.

Mind-Body Syndrome (MBS) is a simple, yet revolutionary concept first introduced by Howard Scheubner, MD to explain the etiology of chronic pain, PTSD, fibromyalgia and other unrelated chronic diseases. Other related concepts include: Tension Myositis Syndrome (TMS) by Dr. John Sarno; Automatic Overload Syndrome by Dr. Scott Brady; Stress Illness by Dr David Clarke. In 2009 a consensus conference of practitioners of TMS renamed it: Psychophysiologic Disorder or PPD.

Clinical syndromes previously categorized as nonphysiological, psychosomatic or functional are in fact based on demonstrable, dynamic neurophysiological changes in the brain.

• Stress and unresolved emotions create real, physical pain by triggering nerve pathways
• There is no disease process in the body: physiological changes, but not pathological ones
• Symptoms are created by subconscious processes and psychosocial conditioning
• Pain and other symptoms can persist for years due to learned nerve pathways
• Reversal of mind body symptoms can occur by cognitive, affective and consciousness interventions

Mind-Body Syndromes

Chronic pain syndromes: Tension headaches, Migraine headaches, Back pain, Neck pain, Whiplash, Fibromyalgia, TMJ syndrome, Chronic abdominal and pelvic pain syndromes, Chronic tendonitis, Vulvodynia, Piriformis syndrome, Sciatic pain syndrome, Foot pains syndromes, Repetitive stress injury, Myofascial pain syndrome

Autonomic nervous system related disorders: Irritable bowel syndrome; Interstitial cystitis (Irritable bladder syndrome), Postural orthostatic tachycardia syndrome/Inappropriate sinus tachycardia, Reflex sympathetic dystrophy, Functional dyspepsia

Other syndromes: Insomnia, Chronic fatigue syndrome, Paresthesias (numbness, tingling, burning), Tinnitus, Dizziness, Spasmodic dysphonia, Chronic hives, Anxiety, Depression, Obsessive-compulsive Disorder Post-traumatic stress disorder

The NeuroBiology of Pain as a Model of Mind-Body Syndrome

Recent studies in brain science have shown that pain is processed in the brain and can be a learned response, i.e. neuroplasticity.

Nociceptors are peripheral pain sensory fibers that can get sensitized to pain over time (ie, are more sensitive to pain stimuli). Pain is a learned response. Painful experiences, including injuries, create changes in the brain called “pain memories” (just as regular memories are created). MRI studies show regions of pain in the brain in those with chronic pain. These remain even when the original process in the body is healed Early life experiences create autonomic system responses that persist into adulthood. Life stressors trigger the ANS, amygdala, and anterior cingulated cortex. Thoughts and emotions affect the location, experience, and duration of pain.

Conclusion

This talk will focus on the importance of the role of the naturopathic physician in creating an optimal healing environment and creating a healing intention in the treatment of Mind-Body Syndrome. The healing relationship fosters a healing intention through a mindful, accepting attitude of love and compassion. Cultivating mindfulness and compassion and bringing those qualities into the healing relationship and all therapeutic interventions has been shown to have enormous impact on health outcomes.

Engaging the patient in a relationship with themselves and their health concerns, stress, pain and illness that is mindful and compassionate serves as the source of healing intentionality. We can elicit self healing powers from the patient through the inner attitudes of the physician.This approach has shown to be especially effective for the approach to treatment of Mind-Body Syndromes like PTSD, chronic pain and Fibromyalgia.

Evaluating Product Quality in Dietary Supplements (EPQinDS)

Author: James A. Kinsinger, Ph.D

Description: A significant portion of many naturopathic physicians’ practice involves the prescription of dietary supplements. The EPQinDS program will assist in educating prospective and practicing practitioners on how to evaluate the quality of a marketed dietary supplement.

The program teaches participants the rules and regulations that manufacturers of dietary supplements are required to follow, as well as what is involved in manufacturing a quality dietary supplement in a “seed to shelf” format. This information is then presented in a way that will assist participants in asking manufacturers the questions that will enable them to better determine whether or not the product(s) they are reviewing are “of quality,” as well as understand the answers they receive in response.

Abstract

Health care practitioners who prescribe and administer medications, herbal remedies, or dietary supplements, such as naturopathic doctors, herbalists, acupuncturists, medical doctors, etc., have a responsibility to their patients to recommend or prescribe products that are or can be expected to reasonably and consistently be considered of good or high quality. Because of the nature of botanicals and variety of quality aspects involved in both the raw materials, formulas and manufacturing processes, it can be difficult to determine the overall quality of a particular dietary supplement or herbal remedy. Few can take the time or afford what would ultimately provide more definitive knowledge in terms of quality, which would include visiting the manufacturer’s facility, monitoring the purchasing of raw materials and inspecting the manufacturing processes to ensure the products are made using those same ingredients and to established specifications.

The question is therefore: How can everyday health care practitioners evaluate product quality in dietary supplements? The American Herbal Products Association has developed this program, Evaluating Product Quality in Dietary Supplements, to assist health care practitioners in making more reliable determinations when it comes to the general quality of a dietary supplement. Thorough greater knowledge of the process by which dietary supplements are made, and by becoming more aware of the regulations that manufacturers of dietary supplements are required to comply with, participants can expect to leave the program with a greater base of knowledge and understanding for what questions to ask of product manufacturers in order to evaluate the quality of their dietary supplement(s). In addition, participants will also have a more reasonable understanding for how to interpret the answers they receive from manufacturers and be better able to make such product quality determinations.

HCV Induces Oxidative and ER Stress, and Sensitizes Infected Cells to Apoptosis in SCID/Alb-uPA Mice

Authors: Michael A. Joyce, Kathie-Anne Walters, Sue-Ellen Lamb, Mathew M. Yeh, Lin-Fu Zhu, Norman Kneteman, Jason S. Doyle, Michael G. Katze, D. Lorne Tyrrell

Abstract

Hepatitis C virus (HCV) is a blood-borne pathogen and a major cause of liver disease worldwide. Gene expression profiling was used to characterize the transcriptional response to HCV H77c infection. Evidence is presented for activation of innate antiviral signaling pathways as well as induction of lipid metabolism genes, which may contribute to oxidative stress. We also found that infection of chimeric SCID/Alb-uPA mice by HCV led to signs of hepatocyte damage and apoptosis, which in patients plays a role in activation of stellate

cells, recruitment of macrophages, and the subsequent development of fibrosis. Infection of chimeric mice with HCV H77c also led an inflammatory response characterized by infiltration of monocytes and macrophages. There was increased apoptosis in HCV-infected human hepatocytes in H77c-infected mice but not in mice inoculated with a replication incompetent H77c mutant. Moreover, TUNEL reactivity was restricted to HCV-infected hepatocytes, but an increase in FAS expression was not. To gain insight into the factors contributing specific apoptosis of HCV infected cells, immunohistological and confocal microscopy using antibodies for key apoptotic mediators was done. We found that the ER chaperone BiP/GRP78 was increased in HCV-infected cells as was activated BAX, but the activator of ER stress–mediated apoptosis CHOP was not. We found that overall levels of NF-kB and BCL-xL were increased by infection; however, within an infected liver, comparison of infected cells to uninfected cells indicated both NF-kB and BCL-xL were decreased in HCV- infected cells. We conclude that HCV contributes to hepatocyte damage and apoptosis by inducing stress and pro-apoptotic BAX while preventing the induction of anti-apoptotic NF-kB and BCL-xL, thus sensitizing hepatocytes to apoptosis.

Currently Available Laboratory Testing For Xenobiotics, and How Testing Can Help You Reduce A Patients Toxic Burden Without Cleansing.

Author: Walter J. Crinnion ND

Description: This talk will cover all currently available lab testing for toxic presence, their strengths and weaknesses, how to interpret them, how to determine a current exposure from body burden. Testing for rapidly metabolized toxins will be covered along with how these can be used to clear help reduce ones toxic load without having to do cleansing

Abstract

Many physicians are wanting to measure the toxic burden of their patients. While much has been addressed regarding heavy metals, very little has been covered about the common xenobiotic chemical toxins. Currently a number of different testing options are available for the clinician to utilize. By the end of this talk each participant will have a clearer understanding of the strengths and weaknesses of each test. They will also understand which tests may be most appropriate to choose for each individual patient and how to best interpret them. Utlilizing the newly published CDC ranges, each participant will be shown how to use available testing to determine when a current exposure to PCBs and Chlorinated pesticides is occurring. Testing for bioaccumulating persistent toxins will be covered, along with testing for toxins that are cleared more rapidly. Each participant will gain an appreciation for the benefit of testing for the rapidly cleared toxins that all of their patients are getting daily exposure to daily. Methods of identifying the sources of those toxins and eliminating them will be addressed. Each participant will leave with a greater appreciation for the toxic load that these rapidly cleared compounds comprise for their patients.

Riding tandem: An Exploration of the Synergistic Holism of Naturopathic Medicine with Cancer Care

Author: Lise Alschuler, ND, FABNO

Description: As our understanding of cancer winds its way deeper into the intricacies of DNA, the holism of the naturopathic approach helps us to understand carcinogenesis from a multidimensional systemic perspective and offers a layered and multifaceted solution to the ongoing complex equation of cancer.

Abstract

Cancer is truly a multifactorial, multidimensional, and hauntingly brilliant expression of the entangled forces of both life and death. The complexity and unpredictability of carcinogenesis calls upon us to understand this disease from both reductionist and holistic perspectives. As our understanding of cancer winds its way deeper into the intricacies of DNA, the interconnectedness of whole body health, and in fact, environmental health to the dynamic state of our DNA has become paramount. The holistic approach to healing that is the core of naturopathic medicine allows us to see into the carcinogenic process with broad acknowledgement of the multi dimensional nature of this condition. Rather than focusing on one narrow point of understanding, such as one molecular pathway, naturopathic oncology regards the carcinogenic process as a layered composition of DNA instability, altered molecular pathways, persistent epigenetic pressures, sporadic tissue homeostasis, stromal and immune hyper- or under-responsiveness, inflammatory influences and environmental conditions. This interdependent arrangement of forces is echoed in the foundational principles of naturopathic practice, the Vis Mediatrix Naturae (healing power of nature), Tolle Causam (identify and treat the cause), and Tolle Totum (treat the whole person), suggesting an exquisite harmony between the application of naturopathic medicine and cancer treatment. From this pivotal vantage point, the therapies of naturopathic medicine offer a layered and multifaceted solution to the ongoing complex equation of cancer.

Antibiotics, Herbals and Nutritionals: Can Allied Forces Combat Infectious Disease in the 21^st Century

Author: Nigel Plummer, PhD

Abstract

Antibiotics have undoubtedly been the most successful and widely used drugs of the modern medical era. Their use has saved millions of lives, and relieved almost incalculable amounts of suffering. However, their ubiquitous availability is being increasingly questioned resulting in their use limited due to global resistance of many major and more minor pathogens to most front line antibiotic groups. An example of this is the recent European ban on the use of antibiotics as growth promoters in animal feed, and guidelines against use for simple viral infections in man. Adding to this is the increasing but little publicized evidence that antibiotics can either trigger disease or constitute an important risk factor to a number of prevalent and/or serious conditions. These include; birth defects, breast cancer, irritable bowl and leaky gut syndromes ; allergic diseases, food and chemical intolerances, chronic fungal infections, lupus, liver damage, as well as the extensively documented secondary infections (C. difficile, MRSA etc) caused by antibiotic use. This increase in risk can be 2-3 times for allergy in children to up to over 1000-fold increase for secondary infections. These issues with side effects and in particular the problems with decreasing effectiveness of antibiotics has prompted the reappraisal of traditional anti-infectives including plant microbials, such as essential oils, and garlic as well as heavy metals such as silver. In addition to this are biotherapeutic agents, such as probiotics which are used to combat the negative effects of antibiotics. Indeed their effectiveness in many of the above chronic disease situations is linked to their ability to mitigate or repair these unwanted effects. Perhaps most interesting in this approach is the potential for powerful synergistic activity involving the three pronged combination of antibiotics, plant antimicrobials, and probiotics. This combination not only enhances antimicrobial potency and potentially reduce side effects, but also reduces the levels of antibiotic resistance.

In summary, we are entering a new era where use of natural antimicrobials and biotherapeutic agents now firmly in the domain of naturopathic medicine and nutrition will combine with a more considered approach to the use of antibiotics. The more holistic approach to antimicrobial therapy will result in both more effective and safer treatment regimes.