Understanding Chronic Sinusitis

Once again, time has proven naturopathic medicine to be way ahead of the game when it comes to effectively treating a condition before modern medicine finally acknowledges the truth. In this case, we’re talking about chronic sinusitis. As long as I’ve been practicing, we’ve always addressed this largely as an inflammatory condition. By removing underlying triggers of inflammation (food and environmental allergens in particular), and using natural anti-inflammatory treatments, along with treatments to help facilitate sinus drainage, patients almost universally have long-lasting relief. Now, modern medicine is recognizing that chronic sinusitis is indeed an inflammatory issue, rather than having a whole lot to do with infectious causes. If you’re stuck in a cycle of repeated antibiotics for recurring sinus infections, definitely consult with a naturopath for treatment advice. 

As a reference, please visit the following article: http://www.nytimes.com/ref/health/healthguide/esn-sinusitis-ess.html

Eczema and Kids

The discovery that DHA (docosahexaenoic acid) from breast milk promotes healthy brain, eye, and nervous system development was an important step towards understanding why breast milk is a perfect first food for babies. DHA is now commonly added to infant formulas, but it’s not the only fatty acid that is important for developing babies. A new study shows that other fatty acids in breast milk may protect them from allergies.

The sharp rise in allergic diseases like asthma, eczema, food allergies, and hay fever might be explained in part by a shift in the fatty acid balance in our diets. The widespread use of vegetable oils and the comparatively low intake of omega-3 fatty acids (mostly from fish) have tipped the scales in favor of omega-6 fatty acids, which contribute to inflammation in the body.

Does breast milk affect eczema?

As part of the KOALA Birth Cohort Study, scientists investigated the composition of breast milk and its relationship to eczema and allergy development in 310 infant-mother pairs. Based on earlier findings that organic dairy seems to protect against eczema during the first two years, some of the women included led “alternative lifestyles,” meaning that they ate organic foods and breast-fed for an extended period. Researchers were interested to see how the fatty acid composition of their breast milk compared with that of moms who ate a more conventional diet.

Information related to breast-feeding, eczema, and other allergic diseases was gathered from the women while they were pregnant and during the first two years after birth. Blood samples were taken from the babies at one and two years to determine the presence of allergies to things like hen’s eggs, cow’s milk, peanut, tree and grass pollen, dust mites, and cats and dogs.

Babies benefit from fatty acid combo

Compared with the conventional diet group, the breast milk of moms with alternative lifestyles had somewhat higher concentrations of the omega-3 fatty acids EPA (eicosapentaenoic acid), DPA (docosapentaenoic acid), and DHA. The breast milk from this group was also higher in ruminant fatty acids (those derived primarily from dairy fat), including the immune-enhancing fatty acid, CLA (conjugated linoleic acid).

“Differences in fatty acid status between mothers may modify the protective effect of breastfeeding,” said Dr. Carel Thijs, lead author of the study from the Department of Epidemiology at Maastricht University in the Netherlands. “This may explain inconsistencies between studies in different populations with different intakes of fish, ruminant fats, and trans fatty acids from other sources.”

More interesting results:

By age two, 31% of the babies had parent-reported eczema, and 42% of the children with eczema also had allergies as determined by blood tests.

The risk of eczema and allergies at one year was lowest among babies whose mothers’ milk was highest in omega-3 fatty acids.

The risk of eczema and allergies also decreased with increasing concentrations of ruminant fatty acids, independent of the effect of the omega-3 fatty acids.

“Ruminant fatty acids deserve further investigations for their role in early immune development and are potential candidates to explain the protective effects of dairy fat as well as organic dairy and possibly unpasteurized farm milk on the development of atopic (allergic) conditions in early life,” the researchers concluded.

How to protect your baby from eczema

Breast-feed, if you can. For some women breast-feeding isn’t feasible, but it’s worth it for your baby’s health if you’re able to.

Eat more fatty fish. This is important during pregnancy and while breastfeeding. Avoid high-mercury fish including swordfish, shark, albacore tuna, king mackerel, tile fish, grouper, marlin, and orange roughy.

Make it creamy. The latest study adds to a growing body of evidence of the inflammation-fighting potential of full-fat dairy products.

(The study comes from Allergy 2011;66:58-67)

The Definition of Holistic Medicine

I’m posting an article written by Dr. David Katz, as I think it is a fantastic summary of what I strive for in my own practice, which is to emphasize healing by relying on both clinical intuition and scientific research, as too much focus on one or the other is not in the best interest of the patient. 

 

Holistic Medicine: How To Define It

 

We are probably all familiar with things that are tough to define,
but that we recognize when we see them. No, I’m not planning on talking
about that one

The term I have in mind is: holistic.

I practice holistic medicine. Specifically, for the past decade, I have directed a rather unique clinic that provides what we call ‘evidence-based integrative care.’ We have published and presented details of the model.

People tend to have a strong sense of what holistic means, whether or not they can actually define it. Detractors see it as an indication of quackery
without looking past the label. Proponents embrace it as an emblem of
virtuous humanism. Holistic is good, and all else … less so.

But if that is really true — if holistic care is better (I’m among
those who believes it is) — then a workable definition is important.
First, so that people who want to sign up for holistic care — to give
it, or receive it — know what they are signing up for, exactly. And
second, and more importantly, because you can’t practice what you can’t
define. Unless we can say just what holistic care is, it can’t be
taught, tested, replicated, or improved.

The medical version of TheFreeDictionary tells
us that holistic care is: “a system of comprehensive or total patient
care that considers the physical, emotional, social, economic, and
spiritual needs of the person; his or her response to illness; and the
effect of the illness on the ability to meet self-care needs.”

I am comfortable with this in theory, but not in practice. In
practice, it begs the question: how, exactly, do you do that? What does
considering ‘physical, emotional, social, economic, and spiritual needs’
look like in a doctor/patient encounter? What is a clinician actually
supposed to do in a room with a patient so that the care that transpires
between them is holistically concordant with this definition?

Let’s acknowledge that platitudes don’t really help. Of course, a
holistic practitioner looks beyond a battered body part to the whole
body; looks beyond the body to the mind and spirit; looks beyond the
individual to the body politic of which they are an intimate part; and,
if responsible, looks at the body of pertinent scientific evidence as
well.

But a devotion to holism does not impart mystical prowess to
clinician, or patient. No one gets a magic wand that allows for a
complex array of medical problems to be fixed all at once. Holistic
care is, in fact, most important when it’s hardest to do — when there
is a lot that needs fixing. I suppose there may be a holistic way to
suture the finger of a healthy, young person lacerated while dicing
zucchini, but I doubt it would matter much. It does, however, matter a
great deal in complex cases of chronic illness, attendant despair,
social isolation, and hopelessness. And at such times, it’s really hard!

Here’s an illustration, based on any number of patients we’ve treated
over the years. Consider a woman of roughly 70, who comes to the
clinic ostensibly to get dietary advice because she wants to lose
weight. She is, indeed, obese — with a body mass index of 32. She has
high blood pressure and type 2 diabetes, and is on medication for these.
Her husband passed away 4 years ago, and she lives alone. She is
lonely, tends toward sadness, and is always tired. She sleeps poorly.

She eats in part because she is often hungry, in part to get
gratification she doesn’t get from other sources. She does not exercise
because she has arthritis that makes even walking painful. Her arthritis
has worsened as her weight has gone up, putting more strain on already
taxed hips and knees. Medication for her joint pains irritates her
stomach, and worsens her hypertension. There’s more, but you get the
idea.

I regret to say that medical practice propagates its own uncouth
vernacular, resorted to in part to relieve the pressure of 30 hour
shifts and life and death crises. Much of the slang is too shameful to
share, but one term is especially germane to a case such as the one
above: circling the drain. A complex array of medical, emotional and
social problems really can resemble a cascade in which each malady
worsens another, and the net effect is a downward spiral into despondent
disability. Circling the drain is crude, but apt.

I present the term here because it actually has hidden utility. If
you can descend one degenerating spiral at a time, you can reverse
engineer the process — and ascend the same way! In my view, that is
what holistic care — in its practical details — needs to be.

For the hypothetical case in question, and innumerable real people
like her, reversing a descent begins with one well prioritized move in
the other direction. So, for instance, it is likely that this woman has
markedly impaired sleep, due perhaps to sleep apnea. A test and
intervention to address this effectively may be the best first move for a
number of reasons.

Poor sleep can cause, and/or compound
depression; poor sleep invariably lowers pain thresholds, making things
hurt that otherwise might not, and things that would hurt anyway, hurt
more; poor sleep leads to unrestrained and emotional eating; poor sleep
leads to hormonal imbalances that foster hypertension, insulin
resistance, and weight gain; and poor sleep saps energy that might
otherwise be used for everything from social interactions, to exercise.

Whether a focus on sleep is the right first step will vary with the
patient, of course. But let’s imagine that in this case it is a good
choice, as I have found it to be on a number of occasions. So, we
intervene accordingly — just to improve sleep. So far, this doesn’t
sound defensibly holistic. But it does sound like something the patient
might be able to tolerate.

But as soon as sleep does improve, the benefits start to accrue. Ms.
Patient has a bit less pain, a bit more energy, and a slightly more
hopeful outlook. So now that she has some more resources, we ask more of
her. We now need her to invest these benefits back into herself! Let’s
use that energy to start a gentle exercise regimen (water-based if need
be to avoid joint strain); initiate some social activity of interest to
get some stimulation and purpose reintroduced; and perhaps begin the
process of dietary improvements to address the weight loss goals
initially espoused. We might also start a course of massage therapy or
acupuncture to further alleviate joint pain, now that Ms. P believes
feeling better is possible.

A little exercise further improves energy, and sleep, and
self-esteem; and actually helps ease joint pain. Less pain further
improves energy, sleep — and willingness to exercise. Social engagement
— perhaps a church or civic group — confers gratification that no
longer needs to come from food. Hormonal rebalancing that occurs with
restoration of circadian rhythms alleviates constant hunger. Diet
improves. Medication doses are dialed down. Helpful supplements may be
started.

Weight loss starts. Energy goes up. Joint pain improves some more.
Physical activity becomes less and less problematic, and increases
incrementally. Energy and sleep improve further, weight loss picks up.
With more hope, and more opportunity to get out, Ms. P establishes, or
reestablishes social contacts that restore friendship and love to their
rightful place in her life. Her spirit rises, and with it, the energy
she has to invest back into her own vitality.

And so on — with many time consuming details left out, of course.
This may sound like wishful thinking — but it’s a rewarding reality I
have been privileged to help choreograph innumerable times over the past
decade.

If the erosion of health is a degenerating spiral, then its reclamation is a spiral staircase.
Which leads to the good news, and bad, about holistic care, practically
— and practicably — defined. The good news is that with real
dedication and a commitment to one another and the process, almost every
clinician and patient can find a way to ascend at least some distance
toward the heights of holistic vitality. The bad news is that I’ve yet
to see a helicopter fly in to get anyone there in one fell swoop. We all
need to be realistic. The climb is made one step at a time.

Dr. David L. Katz; www.davidkatzmd.com

PMS and Essential Fatty Acids

Yet another case of naturopathic medicine being way ahead of the curve when it comes to using treatments for years before they’re eventually “proven” effective. 
Up to 95% of women suffer from at least one PMS symptom, and more than a third of these women have PMS severe enough to interrupt their routine activities. Fortunately, a new study may offer a way for women to get some much-needed relief from monthly bouts of PMS.
PUFA vs. PMS
The exact causes of PMS aren’t known, but health experts suspect that certain essential dietary fats, called polyunsaturated fatty acids, or PUFAs, may play a role. Not getting enough of and the right types of PUFAs may worsen PMS symptoms.
Researchers set out to test this theory by enrolling 120 women into a six-month study. The study authors randomly selected the women to receive a daily 1- or 2-gram PUFA supplement, or a placebo (no fatty acids).
Blood levels of cholesterol and prolactin, a hormone produced in the body that may affect PMS, were tested before and after the study. The women kept symptom diaries to track the details and severity of their PMS from month to month.
After 6 months, the researchers found that compared with the initial PMS ratings:

• Women taking the PUFA supplements had significant decreases in PMS symptoms at three and six months.

• Women taking 2 grams of PUFAs, the highest amount given, experienced the largest decrease in PMS symptoms over time.

• Women taking the placebo h
ad a small decrease in PMS symptoms at three months, but no improvement of symptoms at six months.

None of the women in the study experienced significant changes in blood levels of cholesterol or prolactin. This suggests PUFA supplements do not raise cholesterol in otherwise healthy women experiencing PMS, nor exert their anti-PMS effects through changes in prolactin levels.

Getting your essential PUFAs

If you are interested in trying a PUFA supplement, keep the following tips in mind:

• Talk to your doctor about whether PUFA supplements are right for you. Dietary supplements can interfere with medications, so err on the side of caution when adding new supplements to your self-care routine.

• The 2-gram PUFA supplements used in the study provided 420 mg of gamma linolenic acid, 350 mg of oleic acid, 690 mg of linoleic acid, 500 mg of other PUFAs, and 40 mg of vitamin E. Ask your doctor or dietitian to help you find a supplement with a similar mix of PUFAs.

• You can get more PUFAs from the food you eat as well. Try walnuts and other nuts and seeds, ground flaxseed, green leafy vegetables, tofu and other soy foods, and fatty fish, such as wild-caught salmon.

• Other lifestyle changes that may help ease PMS symptoms include getting enough sleep (seven to eight hours), exercising regularly, limiting intake of caffeine, alcohol, and sweets, and eating a healthy diet based around vegetables, fruit, whole grains, and legumes.

(Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Accessed January 20, 2011; Available at: NewsRelease_Essential_oil pill_prevents_PMS.pdf)

Pesticides and Brain Development

Toddlers whose mothers breathed more of a chemical often present in insecticides during pregnancy had slower brain development, according to a study from New York City.

On average, women breathing the highest amounts of piperonyl butoxide, or PBO, had babies who scored 3.9 points lower on a mental development test at age three (85 points and above is considered normal).

These changes are about the same as those seen in kids with low-level lead exposure, according to Megan Horton, a researcher at Columbia University who worked on the study.

“It means that these kids might not do as well in school” later on, said Horton, whose findings appear in the journal Pediatrics.

Baby brains are extra vulnerable to toxic chemicals, because they are not fully formed.

“If you alter the blueprint, there may be lasting long-term consequences,” Horton explained.

She and her colleagues analyzed air samples from a few hundred pregnant women’s environments to track the levels of PBO and another chemical called permethrin. The two compounds are commonly found in bug sprays for indoor use.

Permethrin wasn’t tied to the toddlers’ mental skills. But among the 42 women who breathed the highest levels of PBO — around 4 parts per trillion — nearly half had a baby with a lower-than-normal mental development score.

“For these toxic chemicals, there’s probably no such thing as a safe level during pregnancy,” said Dr. Philip Landrigan, who heads the Children’s Environmental Health Center at the Mount Sinai School of Medicine in New York, and was not involved in the new study.

He suggested that pregnant women who have an insect problem should make sure more bugs can’t get in through measures such as caulking cracks in walls, and that all food is cleaned up.

“Instead of spraying,” he said, “use little baits like roach motels because it’s contained.”

To me, this has been obvious all along, but in light of this information, I would disagree with using even “contained” pesticides, as there is still an exposure risk. Pregnant or not, this is further proof that pesticides promote serious neurological complications, and should be avoided at all costs. If you absolutely must use pesticides, make sure you wear gloves, a ventilator, and other protective gear to limit your exposure as much as possible. If you have been exposed to pesticides in the past, there are tests that can be performed to assess the levels in your system. Treatments can then be implemented to help your body excrete these harmful toxins. 

SOURCE: http://bit.ly/gZSdEU Pediatrics, online February 7, 2011.

Diet Soda and Heart Disease

As many of my patients know, I often discourage the use of diet sodas and other sources of artificial sweeteners. The reasons for this are numerous, but here is yet another suggestion that diet soft drinks may not be the best choice: 

http://www.latimes.com/health/boostershots/lat-heb-dietsodastrokeheartattack20110209,0,4324389.story

Supplements Shown To Reduce Breast Cancer Risk

In a randomized, placebo-controlled study involving 47 premenopausal and 49 postmenopausal women, results indicate that supplementation with a herbal formula may reduce the risk of breast cancer. The women were randomized to placebo or supplementation with a mixture of HMR lignan, indole-3-carbinol, calcium glucarate, milk thistle, Schisandra chinesis and stinging nettle, for a period of 28 days. At intervention end, a significant increase in urinary 2-OHE concentration and a trend toward an increase in 2:16alpha-OHE ratio was observed in the herbal group (Meaning that the “more harmful” form of estrogen was significantly diminished after use of this herb/nutrient combination).


While this proves that various supplements can certainly be beneficial in the prevention of breast cancer, 2 of the main ingredients (HMR lignan and indole-3-carbinol) can be found in flax seeds and cruciferous vegetables, respectively. Therefore, I would encourage all women to incorporate these foods into their diet on a regular basis, as well as supplementing with some of the herbs and nutrients mentioned above.

Source: “Effects of A Breast-Health Herbal Formula Supplement on Estrogen Metabolism in Pre- and Post-Menopausal Women not Taking Hormonal Contraceptives or Supplements: A Randomized Controlled Trial,” Laidlaw M, Sepkovic DW, et al, Breast Cancer (Auckl), 2010; 4: 85-95.

IBS and Exercise

People with irritable bowel syndrome may be able to find some relief by getting regular exercise, a small clinical trial suggests.

The study, of 102 adults with the disorder, found that those who were told to get some more exercise had better odds of seeing improvements in problems like cramps, bloating, constipation and diarrhea.

After three months, 43 percent of the exercisers showed a “clinically significant” improvement in their symptoms — meaning it was making a difference in their daily lives. That compared with a quarter of the participants who maintained their normal lifestyle.

For people who are currently less-than-active, even a moderate increase in exercise may curb irritable bowel symptoms, according to senior researcher Dr. Riadh Sadik, of the University of Gothenburg in Sweden.

In an email, Sadik said the researchers had told those in the exercise group to get 20 to 60 minutes of moderate-to-vigorous exercise — like brisk walking or biking — on three to five days out of the week.

That’s a level that is generally safe and achievable, Sadik said. On top of that, the researcher added, “it will also improve your general health.”

About 15 percent of Americans have irritable bowel syndrome, or IBS, which causes bouts of abdominal cramps, bloating and diarrhea or constipation.

It is different from inflammatory bowel disease, which includes two digestive diseases — ulcerative colitis and Crohn’s disease — that are believed to involve an abnormal immune system reaction in the intestines.

The exact cause of IBS is unknown, but people with the condition often find that they have certain symptom “triggers,” such as particular foods, larger-than-normal meals or emotional stress. From a naturopathic perspective, we also look at food allergies and dysbiosis (imbalances of gut bacteria) as major underlying causes of IBS.

According to Sadik, exercise may be helpful for several reasons. Past studies have shown that it can get things moving along in the gut, relieving gas and constipation. (Vigorous exercise, however, may worsen bouts of diarrhea.)

Regular exercise may also have a positive influence on the nervous and hormonal systems that act on the digestive tract.

None of the participants in the new study, reported in the American Journal of Gastroenterology, were regularly active at the outset. The researchers randomly asked about half to begin exercising over a 12-week period, with advice from a physical therapist. The rest stuck with their normal lifestyle habits.

At the end of the study, the exercise group reported greater improvements on a standard questionnaire onIBS symptoms. They were also less likely to show worsening symptoms.

Of the exercise group, 8 percent had a clinically significant increase in IBS symptoms, versus 23 percent of the comparison group.

That, according to Sadik, suggests that for a considerable number of people remaining sedentary may only worsen IBS.

“If you have IBS, then you can increase your physical activity to improve your symptoms,” Sadik said. “If you stay inactive, you should expect more symptoms.”  

Naturopathic medicine looks at IBS as a multi-factorial condition, involving physical, mental, and emotional issues, so it makes sense that exercise would have a positive impact when it comes to treating this “condition”. If you have symptoms of IBS, but have not yet explored naturopathic treatments, it would definitely be in your best interest. 

More Evidence That Olive Oil and Veggies Lower Heart Disease Risk

It’s no secret that eating well is good for both body and mind, so it may not come as a surprise that a new study finds women who eat more olive oil and leafy vegetables such as salads and cooked spinach are significantly less likely to develop heart disease.

A group of Italian researchers found that women who ate at least 1 serving of leafy vegetables per day were more than 40 percent less likely to develop heart disease over an average of eight years, relative to women who ate two or fewer portions of those vegetables each week.

Women who downed at least 3 tablespoons of olive oil daily – such as in salad dressing – were also 40 percent less likely to be diagnosed with heart disease, compared to women who ate the least olive oil.

It’s not exactly clear why specifically leafy vegetables and olive oil may protect the heart, study author Dr. Domenico Palli of the Cancer Research and Prevention Institute in Florence told Reuters Health. “Probably the mechanisms responsible for the protective effect of plant-origin foods on cardiovascular diseases involve micronutrients such as folate, antioxidant vitamins and potassium, all present in green leafy vegetables.”

Folate reduces blood levels of homocysteine, Palli explained, which is thought to increase the risk of cardiovascular disease by damaging the inner lining of arteries. Other studies have shown people who eat more potassium have lower blood pressure, which can protect the cardiovascular system. Virgin olive oil may be particularly effective at lowering heart disease risk because of its high level of antioxidant plant compounds, he added.

This is not the first study to link olive oil or vegetables to good heart health. Most famously, the traditional Mediterranean diet — rich in vegetables and monounsaturated fats from olive oil and nuts, but low in saturated fat from meat and dairy — has been tied to a decreased risk of heart disease.

Mediterranean-style eating has also been credited with lowering risk for some cancers, diabetes, and, more recently, with slowing brain aging.

Cardiovascular disease is a major killer, responsible for 30 percent of all deaths worldwide and the leading cause of death for both men and women in the U.S.

To look more closely at the role of foods in protecting against heart disease, Palli and colleagues reviewed dietary information collected from nearly 30,000 Italian women participating in a large national health study. Researchers followed the women, whose mean age was 50 at the beginning of the study, for an average of 8 years, noting who developed heart disease.

In that time, the women experienced 144 major heart disease-related events, such as heart attack or bypass surgery, the authors report in the American Journal of Clinical Nutrition.

Women who ate at least one daily serving (about two ounces) of leafy vegetables – such as raw lettuce or endives, or cooked vegetables like spinach or chard — had a 46 percent lower risk of developing heart disease than women who ate at most two portions per week.

Consuming at least an ounce of olive oil per day lowered their risk by 44 percent relative to women who consumed a half-ounce or less daily, the authors found.

The women’s intake of other types of vegetables, such as roots and cabbages, and their consumption of tomatoes or fruit did not seem to be linked to their risk for major heart events.

When visiting your Naturopathic physician, make sure you request homocysteine, cardio-CRP, and fractionated lipid levels, to make sure a thorough evaluation of your cardiovascular health is being performed. You can then use these levels to track your progress, especially if you’re just transitioning to a Mediterranean-style diet. 

Food Allergies-More Common Than You Think!

A study published in the October issue of the Journal of Allergy and Clinical Immunology estimated that nearly 2.5 percent of Americans have at least one food allergy. The study, which is believed to be the largest food allergy study to date, showed that the allergies were more common in children 5 years old or younger. 


“This study is comprehensive in its scope and is the first to use specific blood serum levels and look at food allergies across the whole life spectrum,” says study senior investigator Darryl Zeldin, M.D., acting clinical director at the National Institute of Environmental Health Sciences (NIEHS). 

In the study, children under the age of 5 were more than twice as likely as those older than 20 to have a food allergy and black people were three times as likely as white people to have one, while men were nearly 1.9 times more likely than women to be affected. Black boys were more than four times as likely as white women over 20 to have a food allergy. 

The findings also show that food allergies were more common in those with asthma. While the researchers did not study cause and effect between food allergies and asthma, having a food allergy appeared to compound the risk for asthma and vice versa. 

Those with asthma had nearly four times the risk of having a food allergy than those without it. Overall, people with food allergies were nearly seven times more likely than those without them to have required ER treatment for their asthma in the 12 months leading up to the study. 

“Our findings confirm a long-suspected interplay between food allergies and asthma, and that people with one of the conditions are at higher risk for the other,” says investigator Robert Wood, M.D., director of Allergy and Immunology at Hopkins Children’s. 

Wood notes that many children experience an “allergic march,” developing a food allergy first and getting asthma and hay fever later. 

While people with food allergies were somewhat more likely to be diagnosed with hay fever, the link between the two was not particularly strong, and they did not appear to have higher risk for eczema, the investigators found. 


If you or your child are suffering from asthma or other allergy-related conditions, you should definitely consider pursuing food allergy testing from a licensed naturopathic physician.