Tuesday, May 29, 2012

The Invisible Inflammation: Leaky Gut and a Possible Connection to Hot Flashes

Written by Holly Lucille, ND, RN
Chair of Public Education and Media Outreach Committee

We had a saying in Naturopathic Medical School that stated, “if you want to heal a person, heal the gut." It's fitting that I have written about digestive issues like intestinal permeability or “leaky gut syndrome” and all of its complications at various times in the past decade and the time has come again.

Intestinal permeability describes a cascade of symptoms and disorders that stem from small intestine’s semi-permeable membrane becoming excessively permeable for a variety of reasons, allowing infiltration of microbial and metabolic toxins (as well as undigested food) into the bloodstream. The symptoms and disorders include fatigue, immune deficiency, food allergies, asthma and eczema. Intestinal permeability may also be a contributor to other modern illnesses such as insulin resistance, obesity, neurotransmitter disorders, autoimmune disorders and cancer. In fact, it may account for 50 percent of chronic illness.

One symptom that I have not linked to intestinal permeability in the past, which has been getting my attention lately, is the vasomotor symptoms such as hot flashes and night sweats, an overlooked aspect of inflammation. Here's the story as I see it: Intestinal permeability stimulates a classic hypersensitivity response to the undigested foods and to components of the normal gut flora that are “leaked” into the bloodstream. This creates a “non-specific” activation of inflammatory pathways through inflammatory mediators. TNF Alpha, produced mainly by macrophages mediates acute inflammation, by helping to stimulate inflammation in the endothelial tissue cells; it also helps WBC migrate into the tissue space and helps macrophages secrete IL1 and PGE2. This is all a part of the body’s response to inflammation. Another function of inflammation is something called, “diapedesis”. This is the passage of blood cells through the intact wall of the capillaries and it accompanies an inflammatory reaction. It is basically vasodilatation!

Sure, it is helpful for women to avoid spicy foods, alcohol, dairy products and sugar when experiencing the vasomotor symptoms but I have been getting fantastic results by going back to core of my curriculum and “healing the hole”!

Tuesday, May 22, 2012

Missed Conversations

Written by Jacob Schor, ND, FABNO
Poppy and I paused this morning on our walk around Ferril Lake in City Park of Denver, Colorado.  It being Sunday, there wasn’t the usual weekday commuter traffic rushing toward downtown on 17th Street.  We stood along the south bank to listen to and watch the nesting birds on the tiny island close to shore.
Colonies of Double-crested Cormorants share the island with Black-crowned Night Herons. Canadian geese nest on the ground.  Like a modern political discourse, it seemed that one and all were talking at the same time and no one was listening–at least not to my ear.  What Poppy heard may have been different.
I imagined that the clamor involved the difficulty in finding good nesting spots.  The island is tiny, it’s total footprint smaller in square feet than that of the new house going in on the lot a few blocks east of us on 22nd Street.  Real estate has always been expensive for these colonies of birds. The city drained Ferril Lake a few years back for needed dredging and other improvements.  The lake is used to store treated sewage water that is then used for irrigating the city parks.  The older and larger trees that the birds nest in on the island appear to have died while the lake was dry, possibly because their abundant water supply was cut off.  Several trees have fallen.  The branches of the two that remain are brittle and a good wind may topple them as well.  This history and the current difficulties in squeezing a nest onto these branches and the uncertain future of their nursery pre-occupy the birds.
At least that’s the sort of conversations that I make up in my mind to provide meaning to the various squawking I listened to.  You might argue against my interpretation as anthropomorphist and you would probably be correct.  Perhaps the birds are simply competing for space, chanting, “My spot stay away” over and over again.  Or, perhaps they are complaining about the crawdads they are catching, “Tastes like sewer water!”  I don’t honestly know what they were saying.  Yet, I suspect it would be an error to underestimate their ability to communicate.
As I write this I find myself recalling a program about Constantine Slobodchikoff that aired on National Public Radio in January 2011.  Professor Con (for short), from Northern Arizona University, has made a career of studying prairie dogs. In particular, he has tried to learn their language.  What he and his students have found is, to me, rather fascinating.
When prairie dogs spot a predator they sound an alarm, "It sounds kind of like 'chee chee chee chee,'" said Con.  At first, Con couldn't really hear a distinction between the prairie dog calls. Yet he noticed that prairie dogs responded to the different calls with specific and unique behaviors, like diving into their burrows or standing erect to see what was happening.  Obviously these seemingly identical “chee” sounds had different meanings.
Computer analysis of audio recordings of the calls that prairie dogs made provided translations.  The computer separated out the component tones and overtones.  It was found that prairie dogs don’t just call, “Danger!”  They describe the threat: hawk, human, coyote, or dog.
Through a series of experiments Con discovered that the prairie dog calls were describing these threats in greater detail than we would have guessed.  For example, the dogs described humans approaching the colony in great detail; they could describe what color shirt the humans were wearing and their height (e.g. short fat bald guy with a beard wearing a blue shirt walking a blond dog). Other experiments suggested that prairie dogs described abstract shapes such as the difference between circles and triangles.
As I listened to the discourse between the birds on Ferril Lake, I may have been wrong about what they were saying, but correct in that they were saying something.
The world we live in is filled with conversations besides our own.  Continuing our walk through the park, I found myself entertaining a few questions:  How much meaning do we recognize at some subconscious level?  How much does hearing those conversations give us a sense of belonging and connection to our world or impart depth to our lives?  How much does harm does the constant background hum and drone of our civilization, which drowns out these conversations, detract from the richness of our own lives?
As Poppy and I continued through the park and back toward home and I ruminated upon these thoughts, I noticed something else.  Perhaps again it was because it was early on a Sunday morning and the city was relatively quiet, and I was already thinking about what people hear and don’t hear.  Of the people I passed, the joggers, walkers, stroller pushers, those sitting with fishing poles, well pretty much everyone I saw perambulating, they were all listening to some artificial sounds.  Everyone was wearing earbuds or earphones. 
Traffic sounds or not, for them the bird conversations were totally drowned out.  So for the rest of the way home I pondered whether the near universal desire (or is it addiction) for background music stems from a deficiency of nature, a lack of natural sounds.  Obviously there is a disparity between what people listen to through these amplified digital recordings and true nature, but perhaps the effects on the brain are closer to the effect natural sounds might have compared to traffic, trains, sirens and overhead airliners.
We know from a large body of scientific evidence that exposure to what is termed “Green Space” provides health benefits.  I do not know if anyone has attempted to test whether providing a personal sound track that blocks out the ambient sounds of nature impacts these benefits.  One could argue that music might augment the benefit.  Could listening to a symphony in the park have a synergistic benefit?  I would think yes.  Does jogging through the world inside one’s own sound bubble hearing little of what is going on in the world have equal benefits?  I have a hard time thinking it would.  These are questions though that I don’t have answers for.
But I have my suspicions of course. 

Tuesday, May 15, 2012

DC FLI Report

Written by Michael Cronin, ND, AANP President

But you must remember, my fellow-citizens, that eternal vigilance by the people is the price of liberty, and that you must pay the price if you wish to secure the blessing.  It behooves you, therefore, to be watchful in your States as well as in the Federal Government. 
- Andrew Jackson, Farewell Address
March 4, 1837
The AANP had its 9th DC Federal Legislative Initiative May 7, 2012. It was attended by nearly 140 NDs and students with 529 visits organized.  Our goal is to find legislative allies to work with to improve federal recognition of NDs which will empower our state legislative efforts.  

Our legislative asks at the DC FLI were simple and straight forward. We asked legislators to write a letter on our behalf urging Secretary Sebelius, of the Department of Health and Human Services, to include naturopathic physicians in all HHS programs.  When NDs are recognized by HHS, jobs for NDs in community health centers, tuition forgiveness and federal programs may begin to open up. We also requested legislators to contact Secretary Shenseki and recommend that NDs be included in the Department of Veterans Affairs programs. We could still use your help. Please take action and contact your Members of Congress today!

The Affordable Care Act enables the “inclusion of licensed naturopathic physicians as full participants in all federal initiatives and programs relating to citizen access to health care is in alignment with the federal government’s goals concerning access to health care.” Implementation of Articles 2706 (non-discrimination), 3502 (medical homes), and 5101 (workforce) would increase choice, potentially leading to citizens choosing less costly interventions and providing greater access to those clinicians capable of providing those interventions.  NDs can play an important role in addressing the national shortage of primary care providers which is expected to significantly worsen in the immediate future.

Good work is being done with your membership dollars. We recently saw a great success with the inclusion of NDs in the Indian Health Services Loan Repayment Program.

NDs are a small but effective community with a large mission. The AANP needs more members so that we can do more. Help the naturopathic profession’s progress by asking your colleagues to join our AANP.

If you read this, please drop me a note at mjcronin@earthlink.net.

Michael Cronin, ND
AANP President

Thursday, May 10, 2012

Wanted: Physicians Who Speak

Written by Bill Benda, MD
2011 Naturopathic Champion
Each time I am asked to write for this blog I find myself a bit taken aback, given the discrepancy between my particular choice of topics and those of the other thought leaders of your profession. As many of you likely know, I am not an ND, and after a decade or so working with the AANP and various medical schools I no longer sit on any naturopathic committee, or council, or board (OK, I am still on the board of Natural Doctors International, out of love and respect for Tabatha Parker). But I still write for this blog, even though I have become more cantankerous and curmudgeonly with time, regaling you dear readers not with tidings of comfort and joy but with rhetoric more akin to Cormac McCarthy. And as I sit at my computer seeking yet another offering for Physicians Who Listen, I find myself asking my same self, “Why?” Why do I continue to poke and prod rather than pacify and protect? It certainly isn’t adding to my circle of naturopathic friends.

Well, I’ve come up with an answer. Two, actually. The first being that it fits my particular personality (oh, well). But the second is the more cogent reason: Because nobody else seems to want to. Poke and prod, that is. In a world, and a health care system, so ripe with dilemmas and disparities, we in the healing arts tend to remain quiet on the most controversial issues of the day. I am not talking about topics such as affordability, access, third party vs. universal coverage, or legislative inroads – I have attended enough DC FLIs and state and national conferences to hold extraordinary respect for the battles that have been and are being fought by your leadership. I am instead referring to less tangible, but perhaps far more socially consequential, issues of the day: abortion, war, gun control, the media, our political process, recent Supreme Court rulings. Catholic nuns, for God’s sake.

Of course I am fully aware of the futility of thinking any of us can influence the historical aftermath of such intrinsically impossible issues. But this is not about aftermath – it’s about the internal effect, both personally and professionally, that such discussions can have on the future of naturopathic medicine. As each of our professions, whether allopathic or naturopathic or homeopathic or traditional Chinese medicine, mature within the structure of our social and political systems, we must pay attention to the need to mature from within as well.

A couple of weeks ago I wrote a piece for the online Wellness Times, Karolyn Gazella’s quite popular natural medicine offering to the lay public, entitled “Till Death Do Us Part.” It was a treatise on the death of my mother a month or so ago, although the gist of the article had more to do with the concept of physician-assisted end of life than with my own personal/familial experience. Here is an excerpt:

“I am talking about South Florida here, home of the elderly, and perhaps the epicenter of nursing homes—not a realm where I have spent much of my professional career. Each time I visited her during her last two weeks, I walked through hallways filled with wheelchairs containing men, and even more women, talking to no one and often crying for help. Some were holding stuffed animals as comfort—these especially broke my heart. Really, seriously, broke my heart.

They broke my heart because for the first time I realized that I had helped put so many like them in this purgatory of lingering between life and death. We in healthcare tend to remember those we save, and repair, and then release to return to a full life among their families and loved ones. But sometimes we go too far, and our unprecedented longevity, courtesy of our pharmaceuticals and surgical procedures, often brings with it incalculable suffering. I clearly recall the doctor-as-god mentality of the ’70s and ’80s, with white-coated knights heroically battling death by whatever means available, unaware of and unchallenged by the wishes of the afflicted patient. The physician dictated, the patient followed—to the last breath. This mindset has not disappeared from the medical professional ethic, as doctors feel compelled to combat the incurable cancer, tube-feed the severely compromised preemie who will never recover, or pump the ancient heart trying so desperately to stop beating. I believe we doctors need to stop.

With us baby boomers heading over the hill like lemmings in the next few decades, and Alzheimer’s predicted to be epidemic by the year 2020, I believe we who call ourselves healers must reconsider our role in the facilitation of a good death as the appropriate ending to a good life. I contend that we serve each patient best by respecting their authority over what is to be their final earthly possession—their physical body. Of course the topic is fraught with legal, political and moral jeopardy. But I am certain that this is a conversation whose time has come. It’s time to seriously discuss the issue of physician-assisted death.”*

Controversial? Yes. Risky? Yes. More important than the entire agenda of August’s upcoming conference?

Mom says yes.

So speak up, people! Spread out a bit from commenting on who the new executive director is going to be or whether your particular state organization is getting enough attention from the national – and toss around a topic that seems inconsequential to the future of naturopathic medicine. What about the upcoming election cycle? What about Syria? What about Trayvon Martin?

What about those nuns?