Your Health and the Environment

chemicaltoxicityMost of us realize that the environment we live in isn’t exactly pristine.  From chemicals in our water supply to the ubiquitous use of plastics, we’re constantly challenging our body’s ability to handle environmental pollutants.  The incidence of chronic disease in this country has continued to grow, and most any chronic disease you can think of (diabetes, autoimmune disease, cancer, endocrine disorders, you name it!) is influenced by the chemicals that surround us.  However, when it comes to the relationship between exposure to environmental toxins and disease, conventional medicine pays little to no attention to this connection.

Let’s just consider the effects of one chemical on the body: PCBs.  The use of these industrial chemicals has been banned since the late 1970s, yet continues to show up in our soil and water supply.  According to the EPA, PCBs have been linked to cancer, reproductive disorders, immune system disorders, endocrine disease, and nervous system disorders, among others.  Now, consider this: More than 80,000 chemicals are registered for use in the United States, with 2,000 new chemicals being introduced each year.  That’s pretty scary!  The point of this article is not to induce fear, but to demonstrate how serious this problem truly is, and how little conventional medicine is paying attention to it.

Many of the chronic diseases we see today, whether it be asthma, allergies, or autoimmunity, were virtually non-existent before the 1900s.  So, despite the ongoing advancement of medications to treat these diseases, why have they continued to become more prevalent?  Largely because modern medicine continues to focus almost solely on symptom management, ignoring the underlying causes of chronic disease.  Of course, it’s not practical to test every patient for every chemical under the sun.  But, by being more conscious of how chemicals can promote disease, and having a better understanding of how our bodies deal with these chemicals, we can make a significant impact on the incidence of chronic disease in this country.

I like to use the analogy of our bodies being a bucket, with toxins being the water that fills it.  At some point, our bodies’ innate abilities to metabolize these toxins hits the tipping point, and organ systems begin to break down.  This, in turn, leads to the development of a number of chronic diseases that are often considered “incurable” by the medical profession.  But, we all have metabolic pathways in place that are programmed to help the body eliminate a number of the toxins we become exposed to.  These pathways can be enhanced and nurtured with proper diet and nutrient supplementation, lessening the toxic burden, and bringing the body back to a more balanced state.  The terms detoxification and cleansing are often thrown around loosely, but there are more definitive methods of testing that can isolate dysfunctional metabolic pathways, allowing them to be corrected accordingly with the appropriate nutritional interventions.

So, if you’re suffering from chronic disease, there are a number of things you can do to help lower your toxic burden.  One way to look at it as offense vs. defense.  Your doctor may be prescribing drugs to diminish pain or other debilitating symptoms, which is the defense, but you can play offense by providing your body with adequate nutrition and substrates to help enhance your body’s ability to eliminate disease-causing toxins.

Heartburn Drugs Typically Not Necessary

gerdProton Pump Inhibitors (PPIs) such as Nexium, Prevacid, and Protonix, are some of the most widely prescribed drugs in the U.S.  They are typically given to patients who complain of heartburn or reflux (GERD), who are then kept on the medication indefinitely.  In fact, it’s not uncommon for many of the patients I see to think of being on this medication almost as an afterthought, because it’s so common in our culture.  What they may not realize is that long-term use of these medications can lead to long-term complications, and may be doing more harm than good!

When first approved by the FDA, the suggested use of PPIs was for 4-6 weeks, mainly for treating serious gastrointestinal issues, like ulcers and Barrett’s esophagus.  However, because these drugs are more effective for relieving symptoms of GERD than other medications, they became the treatment of choice for general complaints of “indigestion”.  While some doctors may be closely monitoring these medications, and weaning their patients appropriately, it’s more common for patients to be on PPIs for years without anyone questioning whether they still need them or not.  This is a serious problem, as a number of long-term risks have been associated with PPIs.  In 2012, the FDA issued warnings about Clostridium difficile-related diarrhea, which can be extremely challenging to treat, especially in the elderly population.  In 2011, the FDA warned doctors about the risk of magnesium deficiency with the use of PPIs, which can potentially lead to arrhythmia and seizures.  They even recommended that doctors screen their patients for low magnesium before prescribing PPIs.  In reality, how many doctors are actually following this protocol?  This doesn’t even include other documented risks of long-term PPI use, such as iron-deficiency anemia, vitamin B12 deficiency, increased fracture risk, and increased risk of pneumonia.

The guidelines established by the American Gastroenterological Association suggest that GERD or dsypepsia without any serious complications use PPIs for only 4-6 weeks, followed by the use of less potent acid blockers (ranitidine) as needed.  This greatly reduces the risk of long-term complications associated with these medications.  In my experience, there is typically an underlying cause for symptoms of GERD, whether it’s diet, stress, and/or medication side-effects.  Fortunately, it’s not impossible for you to wean off PPIs, it just takes patience to gradually taper the dosage, while simultaneously addressing underlying causes.  There are a number of natural agents, such as DGL, aloe vera, and D-limonene, that can help to heal irritated gastroesophageal tissue to make the transition of discontinuing the medication more tolerable.  Plus, these agents can be used for ongoing symptom management without having the harmful side-effects of PPIs.

Believe me, I’ve seen a number of patients who never thought in a million years that they would be able to stop their PPI medication, in fear of the reflux symptoms coming back with a vengeance.  But, with the proper guidance and attention to detail, it can be done!

 

IBS? It May Be Something Else . . .

SIBOPeople often come to my office saying they’ve been diagnosed with IBS.  They may complain of intestinal pain, constipation, diarrhea, or all of the above, yet all of their test results come back “normal”, so they are prescribed anti-spasmodic medications to manage their symptoms, and sent on their way.

In my experience, IBS is merely a symptom of other underlying causes, rather than  a definitive diagnosis.  Whether it’s food intolerances, poor eating habits, or restoring optimal production of stomach acid and digestive enzymes, naturopathic medicine has a lot to offer when it comes to identifying and treating the underlying cause of IBS.

One cause in particular that’s often overlooked is small intestine bacterial overgrowth (SIBO).  It’s thought that SIBO is responsible for over 50% of IBS cases, and possibly as much as 84%.  SIBO occurs when bacteria that normally live in the bowels (E. coli, Bacteroides, etc.) are allowed to replicate to excessive levels.  This can occur for a number of reasons, but poor gastric motility (especially due to the use of proton pump inhibitors) is usually the main underlying cause.  The main symptoms of SIBO include: Bloating, gas, abdominal pain, cramping, nausea, heartburn, joint pain, and/or fatigue.

Testing for SIBO can be easily performed using breath tests that detect abnormal levels of hydrogen or methane gas that are produced by excess levels of bacteria.  Once detected, it can be effectively treated with either naturopathic or pharmaceutical interventions.  Eradication of SIBO usually leads to a 75% reduction in IBS symptoms, and is even more effective when combined with dietary interventions (especially low carbohydrates) and motility agents.  Once treated effectively, preventive measures can be taken to reduce the risk of recurrence, which can be high if measures aren’t taken to correct the underlying imbalances that led to SIBO in the first place.

So, if you’ve suffered from IBS for years, see to it that your medical doctor or naturopath test for SIBO, especially since the testing is simple and affordable.  If there’s roughly a 75% chance of your symptoms resolving, your years of waiting for relief are hopefully over!

Does Arthritis Originate in the Gut?

I see quite a few patients with rheumatoid arthritis, and other autoimmune arthropathies, and what is the first thing I do?  Give them anti-inflammatory medications?  Give them immune-modulaters?  No!  Chances are, their rheumatologists have already done this.  The first thing I will always do with patients in this category is address their digestive health.  What does digestion have to do with systemic inflammation?  Everything!

If you think about it, the intestines are really the main barrier that separate us from the outside world.  They have to be extremely selective about what they let in and what they keep out.  Immune cells constantly patrol the intestinal barrier, attempting to keep foreign invaders from entering the circulation.  Enzymes and microbes help to break down foods, assuring that only the nutrients we need are allowed to pass through.  We take this whole process for granted, but the level of intricacy at which everything must stay in check is astounding!

When it comes to rheumatoid arthritis, our biggest concern with respect to intestinal health is an increase in permeability (“intestinal hyperpermeability” or “leaky-gut syndrome”).  The causes of this are numerous, but can include stress, food allergies, intestinal inflammation, medications, genetic influences, and exposure to environmental toxins.  Normally, your intestinal cells are bound by “tight junctions”, which are meant to prevent undigested foods from passing through the intestines into the bloodstream.  So, when your body is exposed to substances that are pro-inflammatory, the intestines can usually limit any negative effects with a localized immune response.  However, when various factors (as mentioned above) affect intestinal permeability, antigens are able to bypass the intestinal immune response, allowing them to mobilize throughout the body, causing a systemic inflammatory response.  The body then begins to attack itself because it’s primary defense (the intestinal barrier) has been compromised, forcing other parts of the immune system to become overactive.  Thus, it’s not surprising that a wide range of gastrointestinal and systemic disorders are associated with abnormal intestinal permeability.  According to a 2003 article in the Journal of Gastroenterology and Hepatology, systemic lupus (SLE), juvenile arthritis, eczema, sarcoidosis, psoriasis, inflammatory bowel disease, and a number of other chronic disorders can be linked to intestinal hyperpermeability.

So, what do most doctors instruct their patients with auto-immune disease to do?  Take NSAID medications.  What do these medications do?  Increase intestinal permeability!  They may temporarily relieve the pain, but the approach of using NSAIDs and immune suppressants is not sustainable, and is most likely worsening the long-term prognosis of auto-immune arthropathies.  While a number of respected journals have discussed the link between intestinal hyperpermeability and systemic inflammation, this concept is largely ignored by conventional rheumatologists.  Repairing the gut needs to be the first line of defense when dealing with auto-immune disease.  Otherwise, as long as antigens continue to be able to “slip past” the intestines, it will be impossible for the immune system to regain control of itself.

What should you do if you have an auto-immune disease, or if leaky gut is a potential concern?  If you want a more definitive assessment, there are tests that can be performed to measure the severity of intestinal permeability.  Comprehensive stool testing can also be performed to evaluate the bacterial environment of the intestines, including the overgrowth of any foreign microorganisms that may need to be dealt with.  A doctor who has experience with treating leaky gut will then need to determine which factors are contributing the most, whether it be food allergies, stress, or medications.  Once these underlying obstacles are removed, nutritional interventions which help to initiate intestinal healing can then be implemented.

The concept of a “leaky gut” is not new to naturopathic medicine.  Even though it has begun to gain traction in conventional medical journals over the last 10 years, it’s certainly far from being the “standard of care” in rheumatology practices.  If you are suffering from any form of auto-immune inflammation, whether it be inflammatory bowel disease, rheumatoid arthritis, or psoriasis, you seriously need to address the underlying causes that may be affecting your digestive health.  While the connection may not seem obvious at first, healing the gut will be the most important step you can take towards stabilizing any systemic form of inflammation.

 

 

Acid-Blocking Medications Aren’t Meant For Long-Term Use!

While I may have written about this more than once in the past, I feel like it’s a topic that continues to need revisiting.  A recent New York Times article (http://well.blogs.nytimes.com/2012/06/25/combating-acid-reflux-may-bring-host-of-ills/) highlights the many reasons why proton pump inhibitors (PPI’s), such as Prilosec, Nexium, and Prevacid, can cause more harm than good when used beyond the recommended window of 8 to 12 weeks.  While it seems to come as a surprise to the doctors who are handing out these medications like candy, our stomachs are supposed to make hydrochloric acid!  This is essential for initiating the digestive cascade that leads to the proper assimilation of nutrients.  As the article points out, blocking stomach acid production for an extended period of time can lead to a host of nutritional deficiencies, including iron, vitamin B12, and magnesium.  A decrease in stomach acid also takes away the protective barrier meant to protect us from harmful bacteria, setting up an environment that’s more prone to infection with Clostridium and other pathogenic bacteria.

I personally have seen countless patients in my practice who have been taking one PPI or another for years, and don’t even know why!  In many cases, I’ve seen young women who have persistent iron deficiency anemias, only to find out they have been on acid blocking medication for several years.  However, getting these patients to discontinue the offending medications proves to be extremely challenging, as the body increases the amount of acid-producing cells while on the meds.  Thus, the rebound production of acid is overwhelming, leading to more heartburn than the patient may have ever experienced before even starting the medication!

Fortunately, there are herbs and nutrients that can help to minimize the irritation that can occur when trying to wean off PPI medications.  Once you make the decision with your doctor to discontinue these medications, seek out a qualified naturopathic physician who can help to ease the transition.  Even if you were having legitimate symptoms before these medications were prescribed, it’s likely that diet and lifestyle changes will make a huge difference, without having to depend on a medication that is likely to be more risky than beneficial.

Patients With Type II Diabetes Benefit From Naturopathic Care

Diabetes is a complex, multi-factorial condition that takes many variables into account, including diet, exercise, and family history.  Typically, if certain markers are detected early enough (elevated blood glucose, increased hemoglobin A1C), lifestyle and/or pharmaceutical treatments can be implemented to slow or reverse the progression of type II diabetes before long-term complications arise.  Since the essence of naturopathic medicine is addressing core diet and lifestyle issues that may be contributing to disease, it’s essential for anyone who’s dealing with type II diabetes, or even “pre-diabetes”, to incorporate a naturopathic treatment protocol as part of their long-term strategy.

A new joint study by Group Health Research Institute and Bastyr University Research Institute found that type II diabetes patients who received naturopathic care (as an adjunct to conventional care) had lower blood-sugar levels, better eating and exercise habits, improved moods, and a stronger sense of control over their condition than did patients receiving only conventional care.  The findings, published in BMC Complementary and Alternative Medicine, show that complementary and alternative medicine (CAM) may have several positive effects on people with type 2 diabetes, which is very encouraging for patients who are seeking out alternatives to manage their symptoms.  Forty study participants received counseling on diet, exercise, and glucose monitoring from four naturopathic physicians (NDs) in addition to conventional diabetes care from their medical doctors, including prescription medications. Many of the participants also received stress-management care and dietary supplements. Researchers then compared these 40 participants with 329 patients receiving only conventional diabetes care.  After six months and about four naturopathic treatment visits, participants demonstrated improved self-care, more consistent monitoring of glucose, and improved moods. Hemoglobin A1c rates (a measure of blood-sugar control) were nearly a full percentage point lower for those patients. This compares with a drop of only 0.5 percent over the same time period for 329 clinically similar patients receiving only conventional diabetes care.

Hopefully, this will encourage medical doctors and patients alike to seriously consider the benefits of naturopathic medicine in the management of type II diabetes.  Doing as much as possible to get a handle on this disease is extremely important, as it’s one of the top 10 causes of death for Americans, racking up close to $178 billion per year in health care costs.  By making a collaborative effort, there’s no reason why we can’t be proactive about halting this epidemic from spiraling out of control!

Can Diet Reverse PCOS?

Polycystic ovary syndrome (PCOS) is a condition that affects the hormone balance in women, favoring the production of male hormones like testosterone over female hormones like estrogen and progesterone. This imbalance can lead to symptoms such as menstrual problems and infertility. Many women with this condition also develop insulin resistance, diabetes, obesity, and cardiovascular disease.  In a new study published in the American Journal of Clinical Nutrition, blood sugar control, weight loss, and cardiac risk were all improved when women with PCOS were put on a high protein, low carbohydrate diet.

The new study included data collected from 27 women with polycystic ovary syndrome. Participants were assigned to either a high-protein diet or a standard-protein diet for six months. Both groups received regular nutritional counseling and were guided to reduce their intake of sweets and soft drinks.

The aim of the high-protein diet was to get 40% or more of each day’s calories from protein and less than 30% of calories from carbohydrate. To achieve this, women in the high-protein-diet group were instructed to replace sugary and starchy foods with either protein-rich foods like meat, eggs, fish, and dairy foods, or with vegetables, fruits, and nuts. The aim of the standard-protein diet was to get less than 15% of calories from protein and more than 55% of calories from carbohydrate. There were no calorie restrictions with either diet.

At the end of the study, the following differences between the groups were seen:

  • Women on the high-protein diet lost 4.4 kilograms (10 pounds) more than women on the standard-protein diet.
  • Almost all of the extra weight lost by the women eating the high-protein diet was body fat, not muscle.
  • The high-protein diet was associated with a greater reduction in waist circumference, indicating a greater loss of abdominal or belly fat. This type of fat has a strong link to cardiovascular disease.
  • Women on the high-protein diet had lower blood glucose and C-peptide levels. C-peptide is a protein that is linked to insulin production. These findings show that blood sugar control improved more in this group than in the standard-protein diet group.

Implementing this type of diet is one of the first things I do with patients who have PCOS, and the results are consistently rewarding. Between these dietary changes and other nutritional and botanical interventions, I’ve witnessed the naturopathic treatment of PCOS being just as, or even more effective, than the medication regime often utilized in conventional medicine. Plus, these diet changes promote longer term health benefits, particularly with respect to cardiovascular health.

If you’ve been struggling with weight gain and other complications of PCOS, and you’ve only tried medications to address it, don’t feel like your options have been exhausted. Seek out a practitioner who can give you detailed dietary instruction, a method that has now been proven to work!

(Am J Clin Nutr 2012;95:39–48)

Rethinking Fat in the Diet

With all the hype surrounding statin medications this past week (see http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html), it’s a perfect opportunity to take a step back and discuss some basic diet fundamentals.  For the past 40 or more years, the “benefits” of low-fat diets have been ingrained in our consciousness, and advocated by a majority of the medical community.  The thinking behind this was simple: high fat in the diet must lead to a buildup of fat and plaque in the arteries, so the less fat you eat, the better.  In recent years, research evidence has overwhelmingly refuted this concept, yet it continues to be the mainstream recommendation for preventing heart disease.  Even the “Dairy” section in the USDA’s “My Plate” emphasizes low or non-fat sources of dairy.

A scientific analysis of 21 earlier studies showed “no significant evidence” that saturated fat in the diet is associated with an increased risk of coronary heart disease.  In fact, the dietary evidence collected from these thousands of participants found no difference in the risk of coronary heart disease, stroke, or coronary vascular disease between those individuals with the lowest and highest intakes of saturated fat.  The bigger issue appears to be the added amounts of sweeteners and carbohydrates that people are eating instead of fats.  More and more evidence is suggesting that it’s this continuous increase in carbohydrate consumption that is truly responsible for an increased risk in diabetes and coronary artery disease.

I think the main take-away message from this information is that you don’t have to be afraid of good quality sources of saturated fat.  We’ve been so trained to be suspicious of it for so long that it becomes difficult to change our perception of how healthy it can be.  Now, does this mean you should be eating nothing but cheese, bacon, and beef for the rest of your life?  Of course not!  If you’re already consuming low-fat sources of dairy (skim milk, low-fat yogurt, etc.), switch to organic whole milk sources, and use butter instead of margarine or other processed forms of fat.  In general, try to limit your saturated fat intake to 10% of your total diet, while discontinuing the consumption of hydrogenated oils, artificial sweeteners, and high-glycemic carbohydrates.  By doing this, and continuing to emphasize fruits and vegetables as a mainstay, you’ll be much better off in the long run!

Celiac Disease or Gluten Intolerance?

When people are experiencing nutritional deficiencies, anemia, weight changes, and/or other symptoms that seem to be of an unknown origin, it’s fairly common practice for doctors to rule out the presence of celiac disease with a small intestinal biopsy. While this is certainly considered the “gold standard” for identifying the pathological changes associated with celiac disease, many experienced physicians are finding that patients can still have a sensitivity to gluten containing grains, making celiac disease and gluten intolerance separate entities altogether.  This led experts at the recent International Celiac Disease Symposium to define the term gluten insensitivity for patients who don’t meet the criteria for celiac disease or wheat allergy, yet improve dramatically when following a gluten-free diet.

The incidence of Celiac disease has doubled since 1974, and gluten sensitivity alone is estimated to be 6 times the prevalence of celiac disease. Fortunately, for patients and doctors who have recognized this phenomenon for quite some time, there is finally a more established definition of gluten sensitivity. Some of the criteria being used to separate gluten sensitivity from wheat allergy and celiac disease include: Negative testing for the presence of IgE antibodies to wheat; Negative endomysial and ttg antibodies (typically present with celiac disease); Negative small intestinal biopsy; Resolution of symptoms following as gluten-free diet. Researchers have concluded that the genetic makeup and immune response of gluten sensitivity patients is unique, and may be more enzyme mediated (like lactose intolerance), rather than immune based.

Since objective testing is still lacking, people who are symptomatic should consider implementing a gluten-free diet. Some of the most common symptoms associated with gluten sensitivity include abdominal pain, rashes, headaches, “brain fog”, fatigue, depression, anemia, and joint pain. If your doctor tells you that celiac testing is negative, don’t give up hope!

 

PCOS and Diet

A recent study in the American Journal of Clinical Nutrition (Jan 2012) showed that women with PCOS who followed a higher protein diet (>40% of energy from protein), as opposed to women who consumed the “standard” amount of protein (<15% of energy from protein), were able to lose weight more effectively. The study also showed that the women on a higher protein diet were also able to maintain healthier blood sugar levels, even after adjusting for changes in weight.

This is the type of diet I’ve always emphasized with PCOS patients, and have found this to be one of the most effective means of helping these women lose weight. Clinically, I’ve also found that this diet is the single most important factor when it comes to controlling other PCOS-related symptoms, such as hirsutism and menstrual irregularities. In fact, most women are able to discontinue metformin and related prescription medications upon adhering to a higher protein diet. Other nutritional interventions (chromium, fiber, etc.) can also be incorporated, with the main emphasis being that of blood sugar control.

If you’re currently undergoing treatment with prescription interventions, and not responding well, don’t be discouraged. Seek out a practitioner who can guide you through a high protein diet, and offer some of the many other nutritional options that will be effective in the management of PCOS.