Natural Medicine is the Best Medicine

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2012-10-11T09:05:00.001-07:00

Hello readers! Well, I warned that it would be a long time before I'd be back blogging. It's been a really interesting year! With the birth of baby Krumbeck in March, graduation in June, boards in August, moving to Montana just following boards, starting to open a private practice - I've been busy!

I'll be back up blogging at my new site soon. Please take a visit: www.mtwholehealth.com /blog. All your favorite posts are up, and I'll be writing some new content soon. There will be a significant shift - now that I'm a licensed physician I will be writing about helpful health tips, as well as my musings on life with a little one.

Hope to see you at the new site!

Welcome Baby Blogger!

2012-04-12T11:52:00.001-07:00

My readers may have noticed that it has been a number of weeks since I have posted. No, I haven't been slacking off, nor have I been scared away by the heated arguments of earlier this year. There has been something else brewing in the life of this blogger!

My husband Jason and I are pleased to announce the arrival of our beautiful daughter on March 22nd, 2012. Baby Krumbeck was 6 lbs 15 oz, 20.5 inches long after a relatively short, wonderful natural birth.

For privacy reasons I won't be posting pictures of her face or announcing her full name. If you know me personally feel free to friend me on Facebook to see more cute-as-a-button pics.

So, there may be another break from blogging for a while. I'm due to graduate this June, then studying for the boards takes priority until mid-August. Jason and I will be moving east and I plan on opening a private practice in Montana in late 2012 or early 2013. I'll let you know the progress as we get a little closer.

For now, back to burping, feeding and changing!

In Health,

Erika

Thanks for your readership...

2012-01-29T22:09:00.000-08:00

Thank you, my readers, for your readership. It looks like 2012 is shaping up to be an interesting year for this blog.

Whether you are an avid supporter of naturopathic medicine, or an equally avid opponent, I welcome your questions, comments and suggestions. Currently I'm having a hard time keeping up with monitoring comments and responding, so I apologize if there is a delay.

As always, I will post any comments that provide reasonable questions or debate. That said, I will not publish comments that are obvious personal attacks or provide no content whatsoever. Come on, folks, lets keep it clean.

I invite you to browse my past posts, especially my introduction. Please feel free to ask questions and I will try my best to cover them in future posts.

In Health,

Erika

Finally! Indian Health Services includes ND's in Loan Repayment Program

2012-01-25T18:48:00.000-08:00

Way back in May I wrote a blog post about my experience lobbying for naturopathic medicine in Washington DC. Every year a group of naturopathic physicians and naturopathic medical students gather in Washington DC to talk to their state representatives about naturopathic medicine, primary care, and our role in the national health crisis. The last nine years our list of "asks" to our representatives has included a request to ammend the Indian Health Services Loan Repayment Program to include naturopathic physicians as eligible providers.

Finally, finally, our request has been granted - naturopathic physicians are now listed as one of the "priority health professions," paving the way for inclusion in many loan-repayment programs. Awesome news for our profession and for patients who want access to naturopathic physicians!

For the full press release from the American Association of Naturopathic Physicians (AANP), read here. You can also read the full announcement from the Department of Health and Human services here. If you're confused as to why this is important, I highly recommend reading my blog post from May (hyperlinked at the top of this post).

Congratulations ND's!

Gluten-free Christmas cookies!

2011-12-20T11:29:00.000-08:00

Merry Christmas, Happy Hanukkah and Joyful Holidays!
Many of you know that I have been dairy-free, gluten-free and soy-free for a number of years now (with much improvement in my health). Being on a restricted diet in the holiday season is not always fun, so I thought I would share with you some of my favorite Christmas cookie recipes. Enjoy!

Gluten-free, dairy-free Svenska Pepparkakor (Swedish Gingersnaps)
Making Pepparkakor at Christmas time is a longstanding tradition in my family. It typically requires two days - a few hours to prep the dough, and one long afternoon with the family spent reminiscing, listening to choir carols and rolling out dough. When I first went gluten-free I missed out on the festivities - it only took one season of being left out to know that I needed to develop a gluten-free, dairy-free version.

1 1/3 cups Spectrum Spread or butter
2/3 cup light corn syrup (not so healthy, I know, one year I’m going to try molasses)
1 3/4 cups sugar
2 teaspoons ground cinnamon
2 teaspoons ground ginger
2 teaspoons ground cloves
3 eggs
2 teaspoons baking soda
4 cups sweet sorghum flour
1 1/2 cups tapioca flour
3 teaspoons xantham gum
~2 cups brown rice flour for rolling out dough (I’ve found brown rice flour the best for rolling out dough - but you can use any GF flour you’d like).
Several tablespoons extra spectrum spread or butter (or cooking spray) for greasing cookie sheets.

Melt 1 1/3 cups Spectrum Spread or butter in a saucepan over low heat with syrup, sugar, and spices. If using butter, wait until sugar has dissolved before removing from heat (sugar will not completely dissolve in Spectrum spread, but wait until it is somewhat homogenous without caramelizing the sugar - it will look a bit like syrup). Pour into a large heat-safe mixing bowl and let cool in an ice bath or at room temperature until just slightly warm to the touch.

In the meantime mix baking soda, sorghum flour, tapioca flour and xantham gum and set aside.

Add eggs to sugar/shortening/spice mixture, mix well. Add in flour mixture 1/2 cup at a time, stirring well, until all the flour is incorporated (using a lot of arm power near the end!). Cover with plastic wrap and refrigerate 8 hours or overnight.

Next day:
Preheat the oven to 375. Turn on some Swedish Christmas carols on your ipod or CD player (this is very important).

Keep the dough in the fridge, but scoop out a small handful at a time and roll paper-thin on a well-floured board (use a wooden board, wooden rolling pin and lots of brown rice flour for the best results). These cookies are designed to be extremely thin, so take your time rolling them out. Cut out shapes with metal cookie-cutters (hearts, pigs and stars are traditional Swedish shapes), and transfer to a well-greased cookie sheet (use Spectrum spread or butter for best results). Bake at 375 for 5-10 minutes until dark golden brown. Caution - keep a close watch on your first batch or two - these cookies darken and can burn extremely quickly.

Let cookies cool for 30 seconds on the pan before dislodging with a metal spatula. Do NOT wait for the cookies to cool completely. (These gluten-free cookies have a tendency to stick to the pan and turn into cookie crumble - which makes for some tasty bites to snack on while making the rest of the cookies).

Makes 8-15 dozen cookies, depending on how thin you roll the dough and how small the cookie cutter is.

Gluten-free, dairy-free Pseudo-Sablé Cookies
These delicious, finely textured cookies are not exactly healthy (6 egg yolks!) - but can be made for a special treat this time of year. Use organic, DHA-containing eggs for the best health and taste results. (“Sablés” are french butter cookies. Since these don’t technically have any butter, I call them pseudo-sables). I also make these cookies in two batches - one with the vanilla bean, and another with vanilla substituted for the grated rind of 1 lemon plus 2 tablespoons of lemon juice. Delicious!

1 cup Spectrum Spread (or butter)
3/4 cup sugar
6 large egg yolks (brown eggs seem to have better looking yolks)
1 vanilla bean
4 ounces blanched almonds
1 teaspoon salt
1 tablespoon baking powder
1 1/2 cups Sorghum flour
1/4 cup Tapioca flour
Optional: 2 drops “Umami” flavoring* (see note)

Beat the Spectrum Spread with the sugar until creamy. Add egg yolks. Cut a slit in the vanilla bean and scrape the seeds into the mixture. Beat yolks, vanilla bean and creamed sugar until smooth.

In a food processor combine almonds, salt, baking powder and flour and process until the almonds are finely ground. (If you do not have a food processor you can finely grind the almonds in a coffee or spice grinder in small batches). Add the dry ingredients to the rest of the mixture and mix until smooth. Pat the dough into 2 disks, wrap in plastic and refrigerate 1 hour (overnight is okay too).

Preheat the oven to 350 degrees and line 2 baking sheets with parchment paper. Lightly flour a wooden cutting board with more Sorghum flour (brown rice flour also works very nicely). Roll the dough (working in small batches) to 1/4” thick. Cut out cookies using ~ 2” round cookie cutters and place on lined baking sheet. Bake for 10-15 minutes, or until the bottom and edges are lightly browned. Let cool, then transfer to a platter. Store in a closed container in the refrigerator (keeps up to 1 month).

* Erika’s note: In cooking “umami” is considered to be the 5th “taste” (along with sweet, salty, sour and bitter), and is responsible for the savory flavor in foods. I noticed early on in dairy-free cooking that foods taste bland in comparison to those cooked with butter. The reason is that butter has that delicious, rich, savory component to it that enhances the natural flavor of nearly all foods - the “umami” taste! It was my botanical medicine instructor who inspired me to add small amounts of umami flavoring to my cooking, whether it was a savory or sweet dish. He adds a few drops of mushroom tincture to all of his botanical formulas to make them taste better. Most people don’t have mushroom tincture laying around, but many of us do have tamari sauce (if there are no soy allergies), or fish sauce. Personally, I add 2 drops of fish sauce to my Spectrum Spread as I am creaming the butter. It sounds crazy, but it really adds a smidge of savory flavor to the cookies, and makes them taste like they were made with real butter. Give it a try!

Give the gift of good health...

2011-12-05T16:22:00.001-08:00

'Tis the Season!

'Tis the season of giving, sharing, loving and being mindful of others less fortunate than ourselves. Unfortunately it also is the season of overconsumption (of both the digestive and financial variety). 'Tis the season where our waistlines and pocketbooks feel the stretch, our poor adrenal glands go into crisis-mode, and many of us get lost in the tide, forgetting the deeper spiritual implications of the holidays.

So, I'm sending you (my readers) a challenge: spread health instead of just wealth! This year, consider giving the gift of good health for Christmas or Hanukkah. I've compiled a mini-list of gift ideas that promote health, play, and well-being.

1. A Tea ball and Thermos. Prepackaged teas in disposable bags are neither economical nor ecologically friendly. Buying bulk teas can save a lot of money, and are typically fresher and higher quality than the pre-packaged kinds. A thermos is a great way to keep a whole batch of tea with you (or your loved one) all day long. For a special gift, give a batch of "homemade" mixed tea; Lemon Balm, Chamomile and Peppermint (equal parts of each) is my favorite relaxing herbal blend.

2. Give a massage! Everyone loves the gift of touch... give your loved ones and best friends a special treat - in a gift basket or bag combine a Massage tool, some Massage lotion or oil and a handmade certificate for a massage, back-rub, or foot-rub. Consider adding a book on reflexology so your gift-recipient can pass along the health benefits.

3. Give a local or healing foods basket. Local wild honey is delicious and extremely healthful, a perfect substitute for sugar. Make garlic or herb-infused olive oil for your culinary-minded friends. Or, pick up some local organic produce at your nearest health-food store or farmer's market. Include fruits and veggies in a basket with some toasted nuts (cinnamon-roasted almonds or spicy pecans).

4. Give kids toys that support health. Children's toys are notorious for containing harmful chemicals, including lead, BPA and phthalates. These chemicals can lead to nervous system and endocrine dysfunction. When looking for children's toys, check for the Made in USA label, and make sure any plastic products are labeled BPA-free. I really like Green Toys products which are made with BPA-free, recycled plastic (all USA-made!). These toys also support imaginative play, an essential part of childhood development. My favorites: Green Toys jump rope (for less than $10!), and their stacking cups, which teach math in addition to eye-hand coordination.

5. Give. Give your time, money or other resources to those who need it most. There is no greater gift to yourself than the healing that giving to others brings. Though we do not all have the resources to give large sums of money, we can all give a smile, a prayer, or a helping hand to those in need.

Shifting gears...

2011-11-30T15:43:00.001-08:00

I'm going to take a bit of a break from the headier naturopathic philosophy for a few months. Those posts take a lot of energy to write because I like to put quite a bit of thought into them - especially because what I write seems to affect the way people view naturopathic medicine as a whole (that's a big responsibility!).

I would love to get feedback from you, my lovely readers, about what you would like to hear next. At this point, though I am just a handful of credits away from graduation, I am still considered a naturopathic medical student, so no requests for medical advice please (they can kick me out of school for that). Writing about herbs, general nutrition, recipes, naturopathic modalities (like counseling or manipulation), or medical conditions (with no health advice) are still fair game. I also have plenty of patient stories (no, I won't name them by their real name), personal stories, and random/fun experiences with naturopathic medicine. You may even twist my arm into writing about myself (gasp!) if you ask nicely...

So what'll it be? You name it, I'll think about it/research it and write it.

Why should I see a naturopathic physician?

2011-11-09T08:28:00.000-08:00

I've been writing a lot about the philosophy of naturopathic medicine because I want the general public (and especially my own future patients) to understand the vast difference in approach between conventional and naturopathic medicine. This is another reason why I wrote a post on what ND's are not - naturopathic physicians are not simply doctors who prescribe natural things instead of synthetic ones. Our entire curriculum and practice is centered around a philosophy of treating the whole person, addressing the cause of illness and allowing the body to restore health naturally. It is this fundamental philosophical difference which directs our treatment approach.

So why should you see a naturopathic physician?

To understand the difference between naturopathic medicine and conventional medicine, let's first look at the conventional medical model:

Disease is equated to pathology and disability
Healing is removing pathology, suppressing symptoms and decreasing disability
Therapies are mostly used AFTER the appearance of symptoms (retroactive care)

Conventional medicine excels at treating patients within this model. In fact, I will unashamedly say that natural treatments are vastly inferior to conventional treatments for suppressing symptoms, and often for removing pathology.

What conventional medicine doesn't address is health.

Naturopathic physicians recognize that good health is more than a mere absence of symptoms. We also recognize that healing and creating health is a process that goes beyond simply removing pathology. I like to use this diagram of a staircase or ladder to describe the stages of health and illness:

On a gradient of health, most patients come to their doctor when they are at least 2/3rds of the way "down" the ladder - when they reach the point of having symptoms of a problem. The issue with the conventional model is that the treatments are aimed at merely getting patients off of that step, not restoring health. Many patients spend their entire lives at the "dysfunction" stage of ladder, fully medicated in order to suppress their symptoms, but completely unaware that they are only one step away from symptoms and disease progression.

Similarly, most patients not aware of the potential for restoration! I have seen countless patients now, who after months of naturopathic treatment proclaimed "I never knew I could feel this good!"

This is why naturopathic medicine has an entirely different approach. Naturopathic physicians are experts in adding health, not removing symptoms. We focus on optimizing the body's own healing process in order to reach a point of complete restoration.

So why see a naturopathic physician? Please don't come to see us to remove your disease. Rather, come to see us to regain your life!

What is Adrenal Fatigue?

2011-10-29T18:39:00.000-07:00

Adrenal Fatigue is a term often used by naturopathic physicians, but frequently misunderstood by patients and conventional medical doctors.

What are the adrenal glands?
The adrenal glands are small endocrine (hormone-producing) organs that sit on top of the kidneys. Each adrenal gland has two parts - the cortex (outside) and the medulla (inside). The medulla makes up only 10% of each adrenal gland and secretes epinephrine and norepinephrine, or "catecholamines." Catecholamines are the "fight or flight" hormones that are secreted in response to acute stress. These hormones are responsible for the racing heart and sweaty palms you may have experienced after a fright.

The cortex makes up 90% of each gland and produces a number of hormones in different zones of the adrenal. Glucocorticoids are made by the outer layer and act to maintain blood sugar and regulate immunity. The hormone cortisol is the most active in this group. Cortisol is strongly anti-inflammatory and immune-supressing, which is why it is often used as a drug to treat many autoimmune conditions. Mineralocorticoids, including the hormone aldosterone, are produced in the middle layer and are used by the body to regulate fluid and electrolyte balance. Lastly, the inner layer makes adrenal androgens, particularly testosterone and DHEA, which regulate sexual organ function in partnership with the reproductive organs (the ovaries and testes), which also produce sex hormones.

It is also important to note that though all these hormones are produced in the adrenal gland, they are regulated in the brain (the brain tells the adrenal glands what/how much hormone to produce). This means that an imbalance in the adrenal hormones can be caused either by the adrenal gland or by the brain.

The Stress Response
The adrenal gland is intimately involved in the body's response to stress. The best model we have to demonstrate the stress response is from an old study by Hans Selye in the 1950's. Dr. Selye measured acute (short-term) and chronic (long-term) stress markers in animals (white rats) after placing them in stressful situations. He found that the stress response typically consisted of three phases, which he named the General Adaptation Syndrome:

1. The first phase of the stress response Dr. Selye termed The Alarm Reaction. Selye's team stressed the rats by either tying their legs to the side of the cage, or forcing the rats to swim in water (not so humane, I agree). During the Alarm Reaction the rats struggled and had a significant increase in cortisol and epinephrine. Both of these hormones act to increase sugar in the blood (to provide fuel for the muscles and heart), and epinephrine vasoconstricts to shift blood toward the vital organs (the heart to pump faster, and the lungs to get more oxygen into the body). The animals reacted in a way that is beneficial to an acutely stressed body - these hormones were secreted to increase strength and stamina, all of which can help the animal escape from the situation.

2. The second phase of stress occurred when the rats continued to be subjected to stress and the rats recognized they would be unable to escape. Dr. Selye termed this the Stage of Resistance. In this stage the animals adapted behaviors in order to decrease acute stress: the swimming rats developed a more efficient swimming stroke, and the rats tied to the cage stopped struggling against their restraints. In this stage the epinephrine levels declined to normal, but the cortisol levels remained high to adapt to the stress. Many of these animals looked healthy until they suddenly dropped dead.

3. The final stage Dr. Selye called the Stage of Exhaustion. With long-term, continued stress, the animals were unable to maintain their adaptation. Many of the rats developed chronic diseases, or declined in health until they died. In the final stage of exhaustion cortisol levels decrease. In humans a drop of cortisol can lead to chronic fatigue, autoimmune conditions, or inflammatory conditions (remember that inflammation can cause or exacerbate many common conditions, like heart disease, alzheimer's, asthma, and more).

Adrenal Fatigue
Naturopathic physicians call the final two stages "Adrenal Fatigue." During either of these stages the body is headed toward a state of chronic disease. Unfortunately, cortisol dysregulation ("Adrenal Fatigue") is a ubiquitous problem in modern society for a number of reasons - from the use of artificial lights, to sedentary lifestyles, to the presence of a multitude of stressors that our bodies were never designed to handle. Though humans handle stress similarly to other animals, in some ways we are more disadvantaged by our ability to think, plan, and worry, all of which are a constant source of stress.

Diagnosis and Treatment
Naturopathic physicians can diagnose the presence and extent of Adrenal Fatigue by taking a thorough history and doing laboratory testing. Naturopathic doctors often measure blood and salivary levels of cortisol, often at multiple times during the day to determine the severity of cortisol dysregulation. Naturopathic treatment is personalized for each patient depending on their lab values and specific needs. ND's have a variety of treatment options, including specific botanical medicines and supplements help re-establish a normal balance of cortisol. Often naturopathic physicians combine these with different lifestyle changes to optimize health. Many patients report increased energy, better sleep, better work performance and less anxiety after beginning a naturopathic adrenal support protocol.

What naturopathic physicians are NOT

2011-10-04T08:47:00.000-07:00

Naturopathic physicians are NOT:

1. Doctors who prescribe herbs instead of drugs. Naturopathic medicine is not about using a natural substance in place of a medication. True naturopathic medicine is based on a philosophy that the human body is capable of healing itself, given the proper environment. In order to facilitate healing we use a range of therapies, anything from lifestyle changes (on one end of the spectrum) to drugs and surgery (on the other end), and many things in between. For more about naturopathic philosophy, see some of my other posts (here and here).

2. Homogenous. Naturopathic physicians, though we are all trained in primary care medicine, have a variety of sub-specialties, niches, and treatment approaches. Some ND's focus on treatment of musculoskeletal compaints and practice similarly to a Chiropractic doctor. Some of my colleagues specialize in mind-body medicine and use counseling, psychotherapy, or biofeedback as their primary treatment approach. Some practice conservatively, giving mostly medications. All of the above are therapies or modalities that we learn in naturopathic medical school. Other naturopathic doctors use esoteric therapies they learned outside of school. [Unfortunately, there is a huge double-standard in the medical world when it comes to judging our profession - a medical doctor who practices a bizarre, unproven therapy would be labeled a "rogue MD," whereas a naturopathic doctor who does the same would be automatically lumped with the rest of the profession.]

3. Dreadlocked hippies who couldn't make it into medical school. While some of my colleagues do have dreadlocks, and I suppose we are all somewhere on the "hippie" spectrum, all of us chose naturopathic medicine not because it was "easier" than medical school but because we believe it has the greatest potential to help people. Perhaps in Bastyr's 30 year history there has been a student who couldn't make it in allopathic medical school - but personally I know of not a single one. Many of my friends were pre-med/biology/chemistry majors, some who were already accepted (and granted scholarship!) to well-known medical schools. A few of my student-colleagues actually transferred out of an allopathic program to escape the corrupt, hierarchical structure that characterizes many medical schools. Many students end up in naturopathic medicine after years in another career path, some with advanced degrees already. Since we end up taking the same, or more credits than a medical school, going to Bastyr isn't exactly an "easy" option either!

4. Against conventional medicine. Though we prefer to use natural therapies to prevent and treat diseases, our naturopathic medical training tells us when it is appropriate to refer to conventional specialists. Dr. Bastyr himself, the namesake of our university, said "Give the patient what the patient needs." For most this will be nutrition, exercise, sunshine, counseling and perhaps some herbs or a manipulation. For some patients this will be major surgery or chemotherapy. Naturopathic physicians are uniquely suited to meet the patient where they are at.

5. The same as MD's. I consider medical doctors to be my professional colleagues, but not my equals. I fully recognize that medical doctors have training that exceeds my own in many areas, just as my training in natural therapies exceeds theirs. Naturopathic physicians are not trying to be medical doctors - we have our own set of professional and philosophical guidelines which inform our practice. We are naturopathic primary care specialists, nothing more and nothing less.

All naturopaths are against vaccinations, right?

2011-09-07T12:08:00.000-07:00

Continuing on the hot-button issues in the field of Complementary and Alternative Medicine (CAM) is that of vaccinations. Once again I'm going out on a bit of a limb with this one, because I'm presenting my personal views and not necessarily those of the profession as a whole. I can, however, share my experience of what I've seen most naturopaths advocate...

So all naturopaths are against vaccinations, right? Certainly there are vehement opponents of vaccination amongst naturopathic physicians. Conversely, our community of physicians also has a group who are vocal supporters of rigidly following the CDC schedule. Most naturopathic physicians, especially those who specialize in naturopathic pediatrics, take a third stance, which I call the knowledge-based approach.

The knowledge-based approach is based on educating the parents to make an informed decision on which vaccines to administer, and allows parents to choose the timeline. Naturopathic doctors clearly list the risks of each vaccine, based on actual scientific evidence, not heresay or celebrity endorsement. Physicians also clearly state the risks of each disease, and the potential consequences of not vaccinating. Parents are informed of which age group benefits from each vaccine (meningitis and pertussis are typically more deadly in early infancy), so they are aware of appropriate timing. Parents are given the CDC guidelines and explained the rationale behind the CDC schedule's timing. Physicians will often point toward alternative vaccine schedules if the parents are so inclined (like Dr. Sears' vaccine schedule).

The drawbacks to this approach are somewhat obvious - Yes, this explanation takes time! This is another reason why office visits to a naturopathic pediatrician are double or triple the length to a conventional pediatrician. It also requires intelligent and responsible parents to weigh many options and make difficult decisions, especially if they decide on an alternative vaccine schedule.

Sound like too much? Personally, I don't think so. Most parents are happy to be given hard data. It makes the decision less vague, less based on the nebulous fears of "what if I do this," or "what if I do that?" Parents, after all, only want what is best for their child.

So, after highly promoting the "knowledge based approach," here is my opinion with regards to vaccination:

1. Ignorance is never a valid reason to either vaccinate or not vaccinate your child. Frankly, I've been surprised by some of the experiences I've had with parents in the clinic. One parent brought in her 6-month girl (who was sick, of course), and when I asked her about the child's vaccinations she replied "I haven't decided whether to vaccinate yet." Yet? Parents should know that there is a window of protection given by certain vaccines, that some cannot be given at all after a certain age, and that some are most necessary in early infancy. Also, vaccines should be planned well in advance, because they cannot be administered when a child is ill.

On the other hand, I believe parents should be informed before they blindly follow a physicians recommendation to use a certain vaccine schedule. Friends, Facebook, and the Internet are a wealth of misinformation that are bound to leave an uninformed parent terrified (whether they vaccinate or not). Parents should also know what ingredients are in each vaccine, and whether the virus is "live" or not. They should also know what to expect, what to do if their child has a bad reaction, and what not to do under normal circumstances (like give Tylenol - but that's another blog post by itself).

2. All children should have a vaccine plan in place by the age of 2 months. 2 months is when the CDC recommends initiating the vaccine schedule (with the exception of those given at birth). If parents are going to delay vaccinations they should have a schedule completed - in writing - by the age most children begin vaccinations. One copy of the vaccine schedule should be kept at home (for planning and appointment purposes), and another signed copy should be given to the child's pediatrician. This is for practical and legal reasons - the child's physician needs to have documentation of any delayed vaccines both to avoid potential lawsuits and to always have record of when the child is due for what vaccine.

The document is also helpful for pediatricians in managing sick kids. Parents who plan to delay or refuse certain vaccines (like pertussis or those for meningitis) need to be aware of the warning signs of those diseases. The child's physician should educate the parents on what to look for, and to let the parents know that kids who are unvaccinated may need to be taken to urgent care a little earlier than a vaccinated child. This isn't to scare the parents, but rather to be practical so parents know what to expect. The child's vaccine schedule is incredibly useful for the physician when managing sick kids - it helps the doctor know what disease the child is likely to have or not have, and when the child may need to be referred to a specialist.

3. Every child should see a naturopathic physician. Just kidding. Picking a pediatrician should be based on many factors, and it is essential for parents to have a doctor they can trust. If you feel that your doctor isn't giving you the time you deserve - give me a call!

Photo credit: piyaphantawong / FreeDigitalPhotos.net

What is homeopathy? (Insert controversy here)

2011-09-01T18:07:00.000-07:00

Easily the most misunderstood and explosively controversial subject in Complementary and Alternative Medicine is that of homeopathy.

Before I begin, let me say that I'm going out on a bit of a limb with this post, because I'm sure to tick off both advocates and vehement opponents of homeopathy with this discussion. As with all my posts, I welcome dialogue in the comments section. However, please keep it civil - there is enough hatred in the world as it is, there is really no reason to get so inflamed over a subject like homeopathy. I'm trying to present a neutral view of homeopathy for the readers so they can decide for themselves.

First, the history:

Homeopathy was founded by Dr. Samuel Hahnemann in the late 18th century as a reaction to the highly invasive procedures that were standard in the medical community at that time (bloodletting, purging, and the use of toxic metals as "medicines"). The story goes that Dr. Hahnemann became fascinated with the properties of Cinchona bark which was a relatively new medicine for the treatment of malaria. Hahnemann noticed that if he took the cinchona bark in the absence of malarial illness that it produced symptoms remarkably similar to malaria. This formed the basis of Hahnemann's theory of "similars" - that substances which produce a certain set of symptoms in an otherwise healthy person should be used to treat a sick person with those same symptoms. In other words: "Let likes be cured by likes" (Hahnemann's words, translated from latin).

Hahnemann noticed that large doses of the curative substance were not necessary to produce a reaction in a susceptible person. He experimented with cures by diluting substances further and further, a process called "potentizing" (I'll explain more later). Hahnemann claimed that diluting reduced the toxic effects of the drug, while still allowing the body to recognize the substance and produce a cure.

I should note here that Hahnemann calls the ability of the body to heal the "Vital Force" of a person. According to Hahnemann it is the vital force which recognizes a homeopathic treatment, and the vital force which precipitates change. Obviously this concept is a little outdated in modern science, but I think it can be a good metaphor for the way our bodies heal and produce homeostasis (see my article on The Vis Medicatrix Naturae). In my opinion, the vital force can include all the biochemical, mechanical, electrical, and neurological processes which cause change.

Hahnemann expanded his formulary from cinchona to hundreds of homeopathic remedies by testing out each substance on dozens of volunteers (mostly students). His dutiful subjects recorded each and every symptom they experienced when taking a particular substance, and these were compiled into a detailed Materia Medica. The symptoms that appeared consistently amongst subjects were noted in the process. These common symptoms are what dictate what remedy a patient should have. For example, a patient with a sudden onset high fever, throbbing and congested headache with a red face and dry mucous membranes would receive the homeopathic remedy Belladonna.

Okay back to potentizing - the least understood and most controversial aspect of homeopathy. Hahnemann originally diluted substances just a few times using a process of "potentizing". This involved "succussion," or vigorously shaking the substance by striking it (like pounding a glass bottle full of liquid against your hand). Homeopaths claim that each time the substance is diluted and subsequently succussed that it actually becomes stronger. They claim that the "energy" of the substance becomes transferred to the water (or ethanol) each time it is succussed. This is the part that scientists hate, because homeopaths often prescribe preparations that have been diluted so many times that there is a high likelihood that not a single molecule of the original substance remains.

The concept of high-dilution remedies is controversial even amongst homeopaths. Some believe lower dilutions to be preferable to high-dilution remedies. Personally, I think it is a misnomer to say that high-dilution (highly "potentized") remedies are stronger. I think it is more accurate to say that high-potency remedies are more specific. Potentized remedies elicit the greatest change in a person whose symptom picture fits precisely with the given remedy. Low-potency remedies are often given more broadly (like Arnica for bruising), and tend to act more superficially.

Obviously, for homeopathy to be scientifically plausible there must be some aspect of quantum-mechanics or some bio-physical force that has not been discovered. I can truthfully say that the mechanism of action for homeopathy has not been uncovered. Many scientific skeptics say that homeopathy works because of the "placebo" effect. Proponents of homeopathy say that the drastic change they see in patients cannot be fully explained by the placebo effect alone.

What does the research say about homeopathy? The research is decidedly mixed. Nearly all large meta-analyses of homeopathy for a given condition (e.g., acne) are negative. In some ways this makes sense - these double-blind placebo controlled trials typically give one remedy to every patient with acne (for example), regardless of the other symptoms that the patient exhibits. This completely goes against the whole theory of homeopathic prescribing - each remedy should be given to a particular patient based on the totality of the patient's symptoms, not on one symptom alone. Thus 30 people with acne would have 30 different remedies based on their particular characteristics. Currently there are very few research studies that use individualized remedies in a double-blinded fashion (I list several in my references section for anyone who is interested - one negative, several positive).

Interestingly, there is some research that does show therapeutic benefit. My favorite head-scratching article is on the use of homeopathy in vitro for prostate cancer. The authors used homeopathic Saw Palmetto and showed a 33% reduction in prostate cancer cell proliferation. Another article showed positive results when adding a homeopathic preparation to a plant growth medium in a double-blinded trial. The plants treated with one particular homeopathic showed increased growth over other treatments. These articles are particularly interesting because they have eliminated the possibility of the placebo effect.

What are my experiences with homeopathy? Because homeopathy is required curriculum in the naturopathic medicine program at Bastyr, I have some practice in prescribing homeopathic remedies. My experiences are similarly mixed. Some patients I have seen little to no change, whereas others have noticed a dramatic near-reversal of their condition. I have some patients who swear by homeopathy, others who never notice a difference.

Is homeopathy placebo? Efficacious therapy? Pseudoscience? A miracle pill?

Ultimately this is for patients to decide, and physicians not to judge. Homeopathy is extremely safe, and as long as it is not used in lieu of an obviously life-saving therapy, I will continue to support my patients in their use of it.

References:

MacLaughlin et al. "Effects of homeopathic preparations on human prostate cancer growth in cellular and animal models." Integrative Cancer Ther. 2006 Dec;5(4):362-72.

Jager T, et al. "Effects of homeopathic arsenicum album, nosode, and gibberellic acid preparations on the growth rate of arsenic impaired duckweed (Lemna gibba L.)." Scientific World Journal 2010 Nov 4;10:2112-29.

Chikramane PS, et al. "Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective". Homeopathy. 2010 Oct;99(4):231-42.

Alder UC, et al. "Homeopathic individualized Q-potencies versus fluoxetine for moderate to severe depression: double-blind, randomized non-inferiority trial." Evid Based Complement Alternat Med 2009 Aug 17. [Epub ahead of print] PMID [19687192]

Jacobs J, et al. "Homeopathy for attention-deficit/hyperactivity disorder: a pilot randomized controlled trial" J Altern Complement Med 2005 Oct;11(5):799-806.

Jacobs H, et al. "Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial" J Altern Complement Med 2005 Feb;11(1):21-7.

Bell IR, et al. "Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo." Rheumatology (Oxford). 2004 May;43(5):577-82.

Gluten-free backpacking meals

2011-08-16T15:22:00.000-07:00

As I discovered this summer, gluten-free dehydrated meals are extremely hard to find and very expensive (unless you want to live on jerky and spongy freeze-dried scrambled eggs). But good food doesn't need to be expensive or unhealthy - here are some of my favorite recipes that I tried out this summer. I bought most of the dehydrated ingredients on Amazon.com, where you can get good deals if you're prepared to buy in bulk. Since the food lasts nearly indefinitely I didn't mind the fact that I ended up with way more food than I needed.

All of these meals are non-gluten-free husband endorsed (he swore we ate better on our trip than we did at home). Many are dairy-free, soy-free and vegan as well.

Breakfasts:
Carrot Cake Oatmeal
- 1/2 c GF oats (Bob's Red Mill has certified GF oats), whirled in blender until 1/3 of original size.
- 2 tbs dried carrot, also whirled in a blender until it approximates shredded carrot. (I used Harmony House Foods for my dried vegetables.)
- 2 tbs raisins or other dried fruit
- 1 tbs dried coconut milk (a wonderful find on Amazon!)
- 1/2 tsp ground cinnamon
- salt to taste (1/8 tsp)

In campground: add boiling water to cover, stir well, let sit tightly for 5 minutes. Reheat if necessary. Serves 1-2.

Blueberry Almond Quinoa
- 1/3 cup instant Quinoa Flakes (found at PCC)
- 2 tbs dried blueberries
- 2 tbs slivered almonds
- 1 tbs powdered coconut milk
- 1 tsp sugar, or to taste (1 tsp is mildly sweet)

In campground: add boiling water to cover, stir well, let sit tightly for 2-5 minutes. Reheat if necessary. Serves 1-2.

Blueberry Mango Oatmeal
- 1/3 c GF oatmeal, whirled in blender until 1/3 size.
- 1 tbs dried blueberries
- 1 tbs dried mangoes, chopped
- 1/4 tsp ground nutmeg
- 1 tsp brown sugar
- 1/8 tsp salt

In campground: add boiling water to cover, stir well, let sit tightly for 5 minutes. Reheat if necessary. For a calorie-dense breakfast in the backcountry add 1-2 teaspoons of oil (light olive oil or other cooking oil). Serves 1-2.

Lunch & Dinner
Cashew Chicken
- 1 cup instant rice
- 1 7-oz pouch of canned chicken (a little hard to find, but I got mine at QFC)
- 1/3 cup dehydrated bell pepper (also Harmony House)
- 1/2 cup dehydrated mushrooms
- 1 cup unsalted cashews
- 2 tsp garlic powder
- 2 tsp ginger powder
- 1 tsp crushed red pepper
-1/2 tsp cumin
-3 tbs cooking oil.

At home:
In one plastic baggie mix cashews and spices, mix rice and veggies in another bag. Keep oil chicken in the pouch until at the campground.

In campground: "saute" cashews and spices in 1-2 tbs oil (careful! it burns quickly!). Add chicken pouch and 2 cups of water - bring to a boil and add rice/veggie mix. Cook until water is absorbed. Delicious! Serves 2-3.

Mashed potatoes & jerky (husband's favorite recipe)
- 1 2 oz package dried potatoes (I used Edward & Sons Organic Mashed Potatoes)
- 2 tbs shelf-stable parmesan cheese
- 1 tsp parsley flakes
- 1 tsp dried sage
- 3-5 strips gluten-free beef or elk jerky, torn into small pieces

In campground: combine with ~ 2 cups boiling water (until covered), stir well and enjoy. Also extremely tasty. Add black pepper to season if desired.

Sun dried tomato pasta
- 1/2 cup GF spaghetti (I like the corn spaghetti the best), packaged separately from sauce ingredients.
- 4 tbs tomato powder (Harmony House again)
- 1 tsp garlic powder
- 1/2 tsp salt
- 1/3 cup chopped sun-dried tomatoes
- 2 tsp basil (preferably freshly dried and fragrant)
- 1/2 tsp oregano
- 1/2 tsp thyme
- 1/4 tsp black pepper
- Parmesan cheese to taste

In campground: cook GF spaghetti according to manufacturer's directions. For sauce: add boiling water to tomato mixture to rehydrate, add to spaghetti and mix well. I noticed this turns out to be more of a pesto-like texture rather than a sauce, but still quite delicious. Serves 1-2.

Chicken chow mein
- 1 cup rice noodles, broken in 1/3's (use thin noodles for fast cooking)
- 1 7-oz pouch canned chicken
- 3 tbs dried shiitake mushrooms
- 2 tbs dried mixed vegetables
- 1 tsp GF chicken of vegetable bouillon (this can be tricky to find, I ended up using a vegan bouillon).
- 1 tsp garlic powder
- 1 tsp ginger powder
- crushed red pepper to taste, OR sliced dried hot pepper (like you find in Mexican markets).

In camp: bring 1 1/2 cups water to boil, add noodles and vegetables, simmer until noodles are cooked. Add chicken and heat through before serving. Serves 2.

Well folks - tell me what you think!

This is the best medicine...

2011-07-20T19:23:00.000-07:00

(A Rainbow at the Arctic Circle)

This blogger is going on vacation!

2011-06-26T15:03:00.000-07:00

Well readers, up until this time this blog has been devoted to all things philosophical and instructional in the world of naturopathic medicine. Time for a little change...

In celebration of my husband's graduation from physical therapy school (he beat me in the race to becoming a doctor first!) we have decided to take a long, adventurous road trip. This means several weeks away from Twitter, Facebook and Blogspot, while we enjoy the glorious creation of the Canadian Rockies and the Arctic.

The Arctic, did you say? Yes, for some reason we got it into our heads to take a roadtrip to the arctic circle (we'd like to drive to the arctic ocean, but the road just doesn't go quite that far). We'll be driving from Missoula, Montana to Inuvik in the Northwest Territories, passing through Alberta, British Columbia and the Yukon. Here's a little map of the route we will (hopefully) take:

There are a few extra challenges in our travels, since I'm gluten, soy, egg, and dairy intolerant. I'm packing a bunch of home-made backpacking meals just in case. I've had several requests to share these, but since they have gone un-taste-tested so far, I think I'll wait until after the trip to share my favorites.

Since this blog post really had nothing to do with primary care, prevention, or naturopathic medicine, I'll leave you with a few good articles about physician burnout and the importance of physician wellness:

First, an article published in the Lancet in 2009, titled Physician Wellness: a missing quality indicator. I'll quote their abstract: "When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care."

Next, a document by the Medical Board of California on Physician Burnout: "burnout is characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. Preventing burnout--a responsibility of all physicians and of the healthcare organizations in which they work--entails the explicit promotion of physician well-being."

For all my readers: Peace and Health, and enjoy your vacations! You'll hear from me in about a month...

How do I find a well-trained naturopathic physician?

2011-06-18T13:30:00.000-07:00

Despite my many blog posts about our educational level, I realize that there is still some misinformation about naturopathic physicians. Many people want access to naturopathic medicine and well-trained naturopathic physicians, but it is still a little confusing as to who's who. Here's my guide to finding a legitimate naturopathic doctor and supporting our profession:

1) Check out the American Association of Naturopathic Physicians (AANP) website: www.naturopathic.org. Click on the link "find a naturopathic doctor near you". This is the quickest and easiest way to find a licensed naturopathic physician. All ND's listed on the AANP website have graduated from 4-year medical schools.

2) The AANP maintains an up-to-date list of which states license naturopathic physicians. Why is this important? In unlicensed states any person can call themselves a "naturopath" regardless of their training. Are you in an unlicensed state? Be extremely cautious when interacting with someone who claims to be a naturopath or naturopathic doctor. Always ask where they received their training (it should be from one of 6 schools: Bastyr, Boucher, Bridgeport, Canadian College of Naturopathic Medicine, National College of Natural Medicine, or Southwest College of Naturopathic Medicine). Note that there are many "diploma mill" type colleges that offer "Naturopathic Doctor" degrees. These are typically online or distance learning courses, and these graduates can only call themselves "doctor" in unlicensed states. These graduates have not had hands-on coursework (like a cadaver lab, or training in minor surgery or physical exam techniques), or supervised interaction with real patients (minimum 1,200 hours for licensed ND's). There are qualified ND's in unlicensed states; most practice very conservatively (as a "healthcare consultant" or something similar), and simultaneously hold a license in a licensed state. This is because there is no governing body in that state.

In licensed states, you can simply search for any Naturopathic Physician or Naturopathic Doctor to find a well-qualified medical professional. Ask around to find one that suits you - many ND's have additional training in certain areas, or tend to focus on a specific patient population (like pediatrics, or physical medicine/body work, or cardiology patients). Different naturopathic physicians have different personalities just like everyone else.

3) Get involved! Are you in an unlicensed state? Call/e-mail your state senator or representative and ask to draft legislation requiring the licensure of naturopathic physicians. Check the AANP website for updates regarding the status of your state. Currently New York, North Carolina, Massachusetts and Pennsylvania have legislation in the works, in addition to Maryland, Virginia, Colorado and Iowa - states whose legislative sessions have ended for the year.

Remember, you can make a difference when it comes to a patient's right to choose appropriate, effective, preventive healthcare.

So what's the difference, really? (Naturopathic Medicine and the Therapeutic Order)

2011-06-03T11:27:00.000-07:00

This morning I had a fascinating conversation with a current medical student who wants to transfer from her allopathic school to Bastyr's ND program. This young woman wants to be a primary care provider, and after much soul-searching decided it was in the best interest of herself and her future patients to study naturopathic medicine rather than the current medical model taught at allopathic school.

All this talk brought up a good question: so what is the difference really? What makes naturopathic medicine different from conventional medicine? What is the advantage of studying naturopathic medicine?

I touched upon this a little bit in my last post on naturopathic medical education. First, naturopathic physicians are experts in the treatment of primary care conditions, since our entire education focuses on primary care. Secondly, naturopathic doctors have extensive training in natural treatments options not taught in a traditional medical school, including hundreds of additional hours in botanical medicine, nutrition, osseous manipulation, homeopathy, and counseling. (Don't believe me? Check out the curriculum on Bastyr's website)

But the most striking difference between an allopathic primary care physician and a naturopathic physician is the philosophy that governs the treatment of our patient. Naturopathic medicine is characterized by six philosophical principles: 1) Treat the Whole, 2) Treat the Cause, 3) The Healing Power of Nature, 4) Prevention, 5) First Do No Harm, 6) Doctor as Teacher. I have previous blog posts on each of these (follow the links).

Now many healthcare practitioners will argue that these principles are not unique to naturopathic medicine, but that they follow these maxims as well. What is unique to naturopathic medicine? The Therapeutic Order. The Therapeutic Order is a set of guidelines to help physicians follow the philosophical principles. The goal of treatment is to completely resolve the patient's symptoms and address the underlying cause while using the least force possible. Here is my illustration:

The Therapeutic Order helps physicians prioritize treatments and ensure that the least harm is done to the patient. Naturopathic physicians recognize that good health is the natural state of the body, and that disease results as a disturbance in the body's environment. The first step of the Therapeutic Order aims to address what we call the "determinants of health," the things which are necessary to create an environment of optimal health. These include things like adequate hydration, a healthy whole-foods based diet, sufficient exercise, a clean space to live in, safe and nourishing relationships, and a fulfilling spiritual practice. Naturopathic physicians seek to re-establish this foundation because any disturbance in the determinants of health will inevitably create disease, or "dis-ease". There is much more to say about the determinants of health, so perhaps I will devote an entire blog entry to this in the future...

The next step in the order is to stimulate the Healing Power of Nature, or the Vis Medicatrix Naturae. Sometimes re-establishing the foundation of health is not enough to correct pathology. I like to think of this as the body's version of Stockholm Syndrome - sometimes the body has been held hostage by pain and pathology for so long that simply restoring the foundation is not enough to provoke a healing response. In this case we can provide encouragement for the healing process to begin - things like constitutional hydrotherapy (I'll explain later), acupuncture and homeopathy have been used by healers for centuries. I would also like to add prayer to that list, as prayer is a modality (one that I particularly like) that can also stimulate the healing process.

Next is to aid damaged organ systems. The American lifestyle that many of us practice (sometimes unwillingly!) can lead to sluggish or damaged organs because we are inhaling or ingesting products that are difficult for the body to process. Some examples: air pollution leading to lung damage, processed foods causing gut permeability, over-the-counter drugs producing kidney or liver deterioration. Naturopathic physicians have many tricks to rehabilitate organ systems (things like probiotics and flavonoids for the gut, or Silybum marianum for the liver).

The next step in the therapeutic order is to restore structural integrity to the body. This is the one step of the therapeutic order that can really fit anywhere in the order, and can be addressed at any point in the disease process. Structural misalignment of the spine and extremities can cause significant strain, and may be an obstacle in the path to cure. The goal of treatment is to realign the physical structure using the least force necessary. This may be a manual adjustment (similar to a chiropractice adjustment), a simple stretch, or a more subtle visceral manipulation.

Step up from this is our naturopathic symptom relief. This is what many people believe naturopathic medicine is about: using herbs, nutrients and natural products to reduce discomfort. As you can see, symptom relief is pretty high up the therapeutic order - natural symptom control is not curative, and does not fulfill the ultimate goal of naturopathic physicians: to see all our patients regain complete, optimal health, without the use of any substance. Using things like herbs and nutrients may be helpful for a period of time to decrease pain, or to suppress pathology until the foundation of health can be re-established. Some people, of course, may always need symptom relief for one reason or another, and this is completely appropriate as long as the underlying cause is not neglected.

Next in the therapeutic order, similar to the last step, is synthetic symptom control. This step constitutes the bulk of conventional medication, which typically prescribes pharmaceuticals for a myriad of conditions. When natural methods are either unavailable or insufficient, synthetic drugs may be used to relieve pain, lower blood pressure, suppress inflammation, etc. Naturopathic physicians are well versed in the appropriate use of pharmaceuticals, and will prescribe them when necessary to aid in healing the patient.

The highest step in the order is high force interventions. This includes chemotherapy, radiation therapy, and any surgery. Some naturopathic physicians call this "suppress pathology". Though we use this step as a last resort, it may be the most appropriate for certain patients. Surgery, chemotherapy, and radiation can be life-saving, life-prolonging, or hugely quality-of-life improving measures for many patients. When pathology is unlikely to resolve on its own, these interventions may be a good choice.

Lastly I should point out that although naturopathic physicians clearly prioritize treatment by starting at the bottom of the therapeutic order, in actuality treatment may begin at any step at any time. It was Dr. Bastyr, the namesake of my university, who said (in my paraphrase) "always give the patient what the patient needs". Whether that be water or chemotherapy, naturopathic physicians are experts at creating an individualized treatment plan that is perfect for each person.

"So you're going to be, like, almost a doctor, aren't you?"

2011-05-19T15:18:00.000-07:00

I talk about Bastyr and naturopathic medicine a lot. By now all of my friends and most of my family's friends are well-versed in naturopathic medicine, our role as primary care providers, and my educational level. I was having one of these conversations with a family-friend (my parent's generation) who finally asked me "so, you're going to be, like, almost a doctor, aren't you?" Ouch.

After nearly four years of medical school, dozens of 12-hour days, hundreds of patients seen, and more information than I can possibly fit in my brain, I certainly hope I will become a doctor. This brings up a common misconception: that naturopaths are quacks who get online degrees and don't know what they are talking about.

So what is our educational training?

Naturopathic physicians attend four-year graduate schools that are nationally accredited by the Council for Naturopathic Medical Education (CNME). The CNME is recognized by the U.S. Department of Education, which classifies the ND degree as a Doctorate-Professional degree, on par with MD and DO. Currently 6 schools in the US and Canada are accredited through the CNME to provide naturopathic medical education.

The naturopathic program consists of at least 4 years of study with over 4,100 clock-hours in the classroom or clinic. A minimum of 1,200 hours are spent in clinical education with direct patient contact under supervision.

The first two years of the ND program are very similar to an allopathic program. We learn all the basic sciences including anatomy, biochemistry, immunology, microbiology, histology, pathology and physiology. Here is a breakdown of the curriculum:

University of Washington medical students average over 70 credits per year (72 and 78 credits for the first and second years), which is similar to Bastyr's ND program (74.5 and 77 credits for the first and second years, respectively).

The main difference in education between allopathic and naturopathic physicians in the the area of specialization. By definition naturopathic physicians are specialists in natural treatment of primary care conditions. From the beginning of our education we focus on primary care - diseases and conditions that a practitioner would encounter in an outpatient clinic. We touch upon emergency medicine, surgery and high-force pharmaceuticals (like chemotherapeutic drugs) in the context of referrals and co-management. However, unlike allopathic students we do not go through rotations in these areas. While MD students do rotations in specialty fields in their 3rd and 4th years (like Oncology, Obstetrics, Surgery, etc), ND students do clinical work in naturopathic primary care only*. We see people in an out-patient setting, directly managing the care of "our" patients under the supervision of a licensed naturopathic physician.

Also, naturopathic medical education differs in that we have a broad scope of practice with multiple modalities that we can offer our patients as treatment. Throughout our education we have multiple courses in pharmacology, botanical medicines, homeopathy, counseling, nutrition, and naturopathic manipulation. In the state of Washington naturopathic physicians can prescribe most medications, perform minor surgery, offer counseling services (just like a licensed mental health counselor), offer nutritional advice (like a dietician), and perform osseous manipulations of the spine and extremities (like a chiropractic physician).

Naturopathic medical students also take board exams comparable to the USMLE boards taken by allopathic students. These tests are called the NPLEX exams - naturopathic physician licensing examinations, and are governed by NABNE. Only students from accredited schools of naturopathic medicine are eligible to sit for these exams. Students must complete two sets of examinations, one after the first two years of the ND program (the basic science boards), and one after graduation (the clinical science boards). Just for a comparison, our basic science boards are similar to USMLE Step 1 exam, and the clinical science boards are similar to the Step 3 exam. The USMLE Step 2 exam, which evaluates physical exam and clinical skills, is similar to our Clinical Entry exam, which is governed by the school (Bastyr) itself - we must do a complete intake, physical exam, and differential diagnosis on a standardized patient (actor), graded by a member of the clinical faculty. We must pass this exam (after our 2nd year) in order to see patients in the clinical setting.

Only after completing all 4,100 hours, passing both sets of board exams, and getting a diploma is a naturopathic student eligible for licensure. This is in contrast to some so-called "naturopaths" who receive online or distance-learning degrees. In all 17 states that license naturopaths, only those who graduated from an accredited 4-year school can call themselves naturopathic physicians or doctors.

So to clarify, YES, I am going to be a doctor! A naturopathic doctor, that is.

References:
Source: "Basic Science Curriculum." UW Medicine. University of Washington, 2011. Web. http://uwmedicine.washington.edu/Education/MD-Program/Current-Students/Curriculum/Basic-Sciences-Curriculum/Pages/default.aspx. 19 May 2011
Source: "Program Tracks and Curricula for Doctor of Naturopathic Medicine." Bastyr University.
Bastyr University, 2011. Web. http://www.bastyr.edu/education/naturopath/degree/curricula.asp. 19 May 2011.
Association of Accredited Naturopathic Medical Colleges. AANMC, 2011. Web. http://www.aanmc.org/. 19 May 2011.

(*with a few exceptions - we can do adjunctive care for cancer patients, but not primary treatment).

Lobbying in DC!

2011-05-02T09:44:00.000-07:00

This morning I am in Washington DC preparing to speak with my senators and representative about naturopathic medicine.

Every year the American Association of Naturopathic Physicians, the AANP (www.naturopathic.org), hosts an event called the DC FLI, where hundreds of naturopathic medical students and naturopathic physicians travel to DC to support federal legislation for ND's.

Naturopathic physicians are primary care and preventive medicine specialists. ND's are fully trained primary care providers, completing 4-years of medical school and over 1,200 hours in direct clinical patient contact. In fact, the U.S. Department of Education considers the ND degree as a First Professional Degree, on par with MD and DO. Naturopathic students, including myself, receive federal funds for student loans, yet somehow do not qualify for federal loan repayment programs. We also are excluded from the Public Health Service Act, and are not eligible for residencies paid by the federal government (the majority of residencies that MD and DO graduates participate in).

With the enormous healthcare disparity in this country, naturopathic physicians (including myself in just 13 months) are willing and qualified providers of primary care. Considering the fact that less than 4% of medical students plan on pursuing primary care, it is essential that naturopathic physicians be utilized to fill the gap.

In the state of Montana, where I plan on practicing, 40 out of 56 counties have a Health Professional Shortage Area (HPSA) designation, meaning there are not enough primary care providers to fill the need for the county. Additionally, 12 of the counties in Montana are absent of a single primary care provider. I am an eager and willing future physician who could fill a very real need in the state of Montana.

Please consider contacting your members of Congress to support me, my profession, and a solution to the current healthcare crisis. Patients have a right to have access to healthcare.

Follow this link to send an e-mail to your members of Congress, it is incredibly easy and takes less than two minutes (come on, you know you have 120 seconds to spare).
http://capwiz.com/naturopathic/issues/alert/?alertid=44021501

In Health,
Erika

My story...

2011-04-18T19:32:00.000-07:00

I have had several requests to speak a little about myself and how I came to Bastyr and the ND program. I would love to share with you my journey to naturopathic medicine...

I was born and raised in a Swedish-American family in the Pacific Northwest. My relationship with nature grew at an early age, and thanks to the encouragement of my parents much of my childhood took place outdoors. I spent my summers picking blueberries and wild strawberries in Sweden, swimming and playing in Lake Washington and hiking to alpine lakes in the Cascade mountain range. Winters were dominated by my love of snow, with plenty of adventures by skiing, snowshoeing and sledding. These activities laid the foundation for my appreciation of nature, and eventually led to my decision to become a naturopathic physician.

As a right-brained child, I gravitated to various art and music classes. At age 6 I joined an internationally touring children’s choir, and at age 8 I began learning classical piano. I took drawing, painting and ceramics classes throughout my youth to feed my desire for creativity.
Music and art became my therapy during adolescence, a healing power that I still value.

As a teenager I retained my love of the arts but also discovered the pleasure of solving puzzles, especially in math and science. I followed both of these passions throughout my undergraduate education at Gonzaga University where I finished my bachelor’s degree with a double major in visual arts and biology. Originally I planned to become a medical illustrator but soon realized that a career in an isolated cadaver lab was not for me. I realized that I love people and that I thrive in an environment where I can develop relationships with others. Because my biology degree closely mirrored the premedical curriculum, I started thinking about attending medical school to pursue a field where I could help and heal others. Taking some time off of school, I moved to Nashville after graduation to participate in an AmeriCorps program in a low-income health clinic.

In 2005 my family and I had our lives dramatically changed when my father had a major stroke. After weeks of hospitalization and months of physical therapy, his insurance stopped paying for rehabilitation. At this point my parents turned to several alternative therapies, including acupuncture, warm-water physical therapy and Feldenkrais. On one weekend home I had the opportunity to take my father to his acupuncture appointment with Dr. Yuanming Lu, who also happened to be a professor at Bastyr University. My parents, wanting me to move back home to Seattle, encouraged me to check out the naturopathic medicine program at Bastyr. In 2006 I visited Bastyr and immediately fell in love with the campus, the community, and the philosophy of naturopathic medicine. My eyes were opened to a completely new type of medicine - a natural, holistic and truly patient-centered model of practice.

At the same time it was becoming apparent that I had my own health issues that were getting progressively worse. After multiple rounds of imaging and medication trials to find the cause of my stomach pain, I was finally diagnosed with Irritable Bowel Syndrome and was told by my medical doctor that there was nothing more I could do. Being a motivated patient, I searched for answers on my own, and learned of the link between food sensitivities and IBS. After my doctor refused to do the testing, I called the Bastyr Center for Natural Health, and the year before I began the ND program I had my first experience as a naturopathic patient. I learned that I had multiple food sensitivities, including gluten, soy and dairy. Eliminating these foods from my diet, in addition to other naturopathic therapies, changed my health and changed my life. I am happy to report that I am now 99% symptom-free, and my health continues to improve year after year.

In 2007 I began my education at Bastyr University in their Doctor of Naturopathic Medicine program. The journey continues to amaze me, and every day that I am in school I fall more deeply in love with this incredible medicine. I am excited to become a Physician, a Counselor and a Healer, and I am honored to be a part of the lives of patients as they are transformed.

“A restricted diet should be part of standard of care for all children with ADHD”

2011-04-15T14:05:00.000-07:00

Whaaaaaat? This was my response as I read this summary article in BlackBag, a free medical app that has dozens of medical news articles delivered daily to your smartphone or ipod. The title of the summary article was exactly as I typed it above, and the author’s conclusions were based on a study recently published in the Lancet, an excellent randomized controlled trial now known as the INCA trial (“The Impact of Nutrition on Children with ADHD”).

For years naturopathic physicians have been huge proponents of the allergy (or, more accurately, the “intolerance”) elimination diet. In fact, elimination diets have become such a mainstay in naturopathic medicine that it has become a bit of a running joke in school - when in doubt, the answer to a test question is always “eliminate gluten” (worth 1/2 credit, at the very least).

ND’s have used the elimination diet to treat everything from IBS to hypertension, often with astounding results. In pediatric practices elimination diets are routinely prescribed for recurrent otitis media, constipation and a variety of behavioral problems, including ADHD. I’ve heard my professors tell stories of children who had dramatic changes on restricted diets to the point where the children were nearly unrecognizable - bouncing off the walls and breaking furniture on one occasion, and playing quietly the next.

This summary was published just as I was finishing my preceptorship with a pediatrician in Seattle, an MD with an excellent reputation and known for being alternatively minded. I learned a great deal about the medical management of children in that preceptorship, and I am very thankful for that opportunity. It was striking to me, however, to see the large number of children on stimulant medications for ADHD. These medications carry significant risks, from anorexia and weight loss to addiction, abuse and diversion, not to mention the black-box warning for increased likelihood of sudden cardiac death. I give credit to the pediatrician - he never took this lightly, and always made the prescription only after a lengthy discussion of risks and benefits with the parents.

I sent the original article to him; I sincerely hope that medical doctors like him see the scientific validity of elimination diets and the huge benefit this intervention could have in terms of risk reduction.

And, for my medical doctor readers out there who have no idea how to counsel their patients through an elimination diet: please feel free to contact a naturopathic physician near you. The American Association of Naturopathic Physicians has an excellent website: www.naturopathic.org, click on the link that says “Find a Doctor,” and search for an ND in your area.

Reference:
Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet 2011; 377: 494-503

Naturopathic medicine: the best preventive medicine

2011-03-02T16:29:00.000-08:00

I strongly believe that prevention is the answer to our current healthcare crisis.

I have heard a lot of discussion in the media lately saying preventive services are too expensive and significantly add to the enormous cost of healthcare in this country. As I’ve mentioned in a previous post, the concept of prevention has become confused with screening. Most primary care physicians now only practice screening, not prevention. Screening is not cost-saving even though it is certainly life-saving, as it allows for early detection of many diseases. Preventive medicine is, by definition, cost-saving, since it prevents diseases that need to be treated at all. Though preventive services may cost a couple hundred dollars for extra visits to a primary care physician, this is a tiny drop in the bucket compared with the cost of treating, say, cancer or cardiovascular disease.

The art of preventive medicine seems to be lost in much of the allopathic community. This is more the fault of the healthcare system rather than the physicians. Because of poor reimbursement rates for primary care, most physicians have extremely short patient visits which simply do not allow enough time for a discussion of prevention. Physicians are paid for the diagnosis or management of a condition that the patient currently has; any extra time spent with a patient is not reimbursed (with a few exceptions).

Many medical doctors also have limited training in therapies like nutrition, exercise prescription, or the preventive effects of many botanicals and micronutrients. With the huge influence of the pharmaceutical industry in medical schools, discussion of disease treatment typically focuses on the use of drugs (or surgery). The result: more patients are prescribed drugs than lifestyle changes.

For a naturopathic physician, prevention is foundational to our practice. In fact, prevention is one of the six philosophical principles of our profession. Bastyr University describes this principle as such: “Naturopathic physicians emphasize disease prevention, assessment of risk factors and hereditary susceptibility to disease and making appropriate interventions to prevent illness. Naturopathic medicine strives to create a healthy world in which humanity may thrive.”

Prevention is a huge passion of mine. Though I am happy treating people when they get sick, I would much rather forestall my patients from getting ill in the first place. Naturopathic medicine is unique in that we have the tools to develop an individualized health plan that promotes wellness and prevention of future diseases.

Naturopathic medicine is the solution!

Docere - Doctor as Teacher

2011-02-04T13:20:00.000-08:00

We are in the age of passive medicine.

Our current medical model reimburses physicians for investigating/making a diagnosis, and managing treatment of that particular diagnosis. Physicians get paid for the diagnosis or treatment, not for the amount of time spent with patients (with some exceptions). This leads to short patient visits and very little time discussing the rationale behind the treatment or the implications of the diagnosis. The result is what I call "passive medicine," because the patient has almost no active role in the healing process.

The role of the naturopathic physician is to fulfill the original meaning of the word doctor. "Doctor" derives from the Latin "docere," which means "To Teach". The process of education shifts the role of participation back to the patients so they can take control of their own health.

Bastyr University describes the principle of Docere as such:

"Naturopathic physicians educate the patient and encourage self-responsibility for health. They also acknowledge the therapeutic value inherent in the doctor-patient relationship."

This definition of Docere is really describing empowerment. Naturopathic physicians teach so patients can reclaim authority over their own bodies. Empowered patients are savvy healthcare consumers and are better able to stay safe and prevent mix-ups in the medical system. Educated patients also tend to have more success in completing treatments, and feel more confident in their health.

The concept of Doctor as Teacher is really about shifting the balance of power back to the patient. Personal empowerment is the only prescription that can create permanent change leading to better health.

The Vis Medicatrix Naturae - Vitalism, Evolution, Creation or Homeostasis?

2011-01-11T12:33:00.000-08:00

I love the philosophical principles of naturopathic medicine: Treat the Whole, Treat the Cause, Prevention, First Do No Harm, and Doctor as Teacher. I find these concepts easy to discuss with patients, colleagues and my peers in the medical profession.

Then we get to The Vix Medicatrix Naturae, translated The Healing Power of Nature. Opponents of naturopathic medicine have used this philosphical principle to label naturopaths as "vitalists," a term which many in the scientific field equate with quackery or fraud. I would like to offer multiple interpretations of this principle.

Bastyr University provides the following explanation for the Vis Medicatrix Naturae: "Naturopathic medicine recognizes the body's inherent ability, which is ordered and intelligent, to heal itself. Naturopathic physicians act to identify and remove obstacles to recovery, and to facilitate and augment this healing ability."

In this definition there is no mention of the concept of vitalism, despite the use of the term by many who are antagonistic to naturopathic medicine. Vitalism, as defined by Merriam Webster dictionary is "1. a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces 2. a doctrine that the processes of life are not explicable by the laws of physics and chemistry alone and that life is in some part self-determining." Vitalism is a theory which forms the foundation of many branches of traditional and alternative medical approaches (for example, the concept of "qi" in Traditional Chinese Medicine, or the concept of the vital force in Homeopathic medicine).

Bastyr's definition of the Vis Medicatrix Naturae also provides room for the concepts of evolution or supernatural creation. Creationists can accept the "order" and "intelligence" to be governed by a higher power or deity. Evolutionists can appreciate that much research has shown evolutionary advantages to many nonspecific symptoms like fever and inflammation. The "intelligence" of the human body, to an evolutionist, is simply a result of natural selection that favors organisms that have mechanisms for healing tissues, combating infections, and restoring disrupted processes.

The concept of homeostasis may also be relevant to the discussion of the Healing Power of Nature. All physiologic processes aim to create and maintain homeostasis in the body. The maintenance of homeostasis is a dynamic process, where each change in the body is countered by a "force" which precipitates movement back to equilibrium.

Regardless of philosophical views, the role of the naturopathic physician is to support each individual in their path toward better health. Naturopaths should encourage the self-healing ability of the body by removing barriers to cure and assisting the process for swift recovery.

Treat the Whole AKA psychoneuroimmunology and its effects on physiology

2010-11-08T14:25:00.000-08:00

Another philosophical principle that guides naturopathic physicians is called Tolle Totem or "Treat the Whole".

Naturopathic physicians have long been advocates of treating the whole person, including mind, body and spirit. Addressing the emotional, mental, and physical problems simultaneously is often the key to uncovering the true cause of a disease (see my last post about treating the cause!). This is one reason why ND's have counseling in our scope of practice. We are trained in motivational interviewing, cognitive behavioral therapy, and sometimes biofeedback to help our patients bridge this gap between mind and body.

New scientific evidence is also showing support for our long-held theory. The branch of science is called psychoneuroimmunology, and it studies the link between the psyche, the nervous system, and the immune system.

Some interesting recent findings: researchers at UCLA found that social rejection was linked to an increase in inflammation in the body! Since inflammation is tied to diseases like depression, asthma, heart disease, and cancer, some are suggesting that rejection or other social stress can be a cause of these illnesses.

Another reason to treat the whole person!

Slavich GM, Way BM, Eisenberger NI, Taylor SE. Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci U S A. 2010 June. 107 (44)
http://www.pnas.org/content/early/2010/07/26/1009164107.abstract