It doesn’t require us to make a lot of complex decisions, but our ‘pharmacy’ does have some caveats for operating well.

Food

First and foremost, a well functioning ‘pharmacy’ requires sensible nutrition. That can look slightly different for each person, but it basically involves eating foods as close to their natural sources as possible.

Sensible nutrition ensures our bodies get the right ingredients, in the right amounts to make the chemicals we need. We have a saying in medicine, “the dose makes the poison.” Anything at a high enough dose can cause harm. The same is true for food, which is why a varied diet, avoiding extra calories is the best way to make certain our bodies operate at their highest potentials.

Foods can contain compounds that our bodies can’t make (or make inefficiently), but processed foods have often removed these beneficial molecules for one reason or another. This is why so many health professionals recommend eating a “whole foods diet.” (It’s not a suggestion that we need to shop at the grocery chain by the same name.)

Water

Along those same lines, adequate hydration can make a world of difference. Many of us (maybe most of us) are not drinking enough plain water throughout the day. I often have a tough time remembering this one too, especially when my schedule is very busy. Our notion of 64oz. (1.9L) of water a day is even a bit below what’s considered ‘adequate’ intake by a publication from the Institute of Medicine.

Water affects our bodies in so many ways, that even mild dehydration can have drastic effects. A study done in athletes showed even a 1.8 percent loss of water from our body had significant effects on their performance.

Physical Activity

Regular exercise is important too, ensuring we use our organs and calories in the ways nature intended. Exercise affects nearly every organ in our bodies, from our muscles and bones, to our hearts, lungs and even our immune systems.

In recent years, we’ve discovered that exercise also undoubtedly affects our moods, though we’re not exactly sure how it works. There’s a hypothesis it may stimulate the growth of new brain cells, which would also explain why it has been observed to improve our overall mental functioning.

Rest

If you’ve read any of my previous articles, you know I’m a big fan of exploring the science behind meditation. In relation to our internal ‘pharmacy,’ meditation has been found to influence a number of compounds in our bodies, the most prominent being dopamine, the reward molecule.

In recent years we’ve also come to appreciate that our brains are actually connected to the rest of our body (shocker, I know). For instance, it’s now well accepted in the medical community that our nervous and immune systems communicate and influence each other.

Sleep is the last big part of optimal functioning of our internal pharmacy. While we’re asleep, our bodies are still hard at work taking care of vital functions. Much of our bodies’ repair mechanisms and hormonal controls happen while we sleep. So it follows that regularly getting adequate amounts of sleep can have profound effects on our bodies self-regulation.

These basics of lifestyle medicine are at the heart of my practice as a primary care doctor. Often times my patients are unaware of imbalances in one or more of these areas, and therein lies the crux of changing their health. So we usually start with the basics. The changes can take a little time, but in the long run we come to realize that if we take care of our bodies, our bodies take care of us.

In Health,

Dr. Michael Stanclift

First, it’s helpful to understand that each area in the brain has a specific function. Though each brain is unique, they’re all (mostly) laid out in the same way. We each have areas dedicated to vision, hearing, our sense of touch, our movements, emotion, etc. We even have an area dedicated to only recognizing human faces (and it has a fun name, the fusiform gyrus).

We’ve discovered what these brain areas do through a variety of techniques. Before modern medical imaging, most of what we learned was through people with brain damage. When someone would have a stroke, a brain surgery, or an accident that damaged part of their brain, we’d pay close attention to what changed with them. We came up with some great experiments and figured out what was “missing” from their previous functioning. Also, if someone had some abnormal traits, sometimes we’d explore their brains during an autopsy and see if we could find any differences from what we considered normal. Then came imaging and electronic sensors.

With technologies like fMRI, EEG, and PET scans (don’t worry, there’s no test on these later) we gained the capability to peek inside the mysterious black box of our skulls. In real time we can now “see” brains as they work, kind of. We can sense an increase in activity within areas of our brains, but we can’t say precisely what that activity is down to a molecular level (which would give scientists much more information). It’s like flying a helicopter over a city and looking down. You can see people moving about, but it’s difficult to tell what people on the ground are talking about from several hundred feet up.

Animal experiments have revealed important findings about how brains work, too. Since we share similar structures to other mammals, especially primates, we can sometimes apply what we learn from them to us.

Our brains, like other organs in our bodies, have changing demands, and they are built to adjust to changes in demand. Our muscles are a classic example of a structure in our body changing from demands. Think of a bodybuilder. Their bodies don’t just come out that way on their own, they make tremendous adjustments based on the demands (like lifting more weight with specific muscle groups). When our brains adjust to demands, though, they don’t swell (not appreciably), because swelling inside the head is a very bad thing. Our skulls are hard and our brains are soft. So when they push against each other, the brain gets squished, which is bad. So instead of swelling, our brains adapt in a unique way — they restructure their connections.

The number and strength of the connections between our brain cells determine a helluva lot about how we behave and think. The other part of that equation is the chemicals present in our brains (but we’ll have to get into that some other time). So our connections have a lot to do with what we can do, the things we like and don’t like, and most importantly how we think.

Our brains are populations of cells. And their only role is to communicate messages throughout our body and mind. I separate body and mind here, because most of the communication that occurs in our brains doesn’t make it to our attention, and we mostly take for granted that it happens at all.

Each brain cell (neuron) communicates to the cells it is connected to. And like our social connections, our brain’s connections can change, even in adulthood. We call that ability to change connections “neuroplasticity,” and its discovery is something relatively new in science. Contrary to previous beliefs, our noggin really can learn new tricks.

By practicing or rehearsing something, we strengthen connections in our brains and that function becomes more efficient. It makes sense, right? You train to do something over and over, and it becomes faster and easier to do. Our brain cells are like a groups working together, the more often they work, the better they get at their tasks.

So what does all of this have to do with mindfulness? I’m glad you asked! Mindfulness is a very specific kind of mental exercise for our brains, and it develops certain areas of our brains. Since each little bit has its own unique function, we target specific functional areas and get predictable results from this kind of exercise (meditation and mindfulness).

The areas that are exercised when we practice mindfulness have to do with what we call ”direct experience.” When we’re experiencing something directly, we’re fully enveloped by whatever we’re doing. We are not thinking about the past, the future, or even about ourselves. Of course, direct experiences happen in our lives whether or not we practice mindfulness, and you can probably recall a time when you experienced this feeling of being completely enveloped. But studies have shown that people who practice mindfulness, even irregularly, have direct experiences more often. They also tend to have higher levels of happiness.

In my experiences with mindfulness, and teaching it to my patients, our life circumstances don’t even need to change outwardly to see the improvements in our quality of life. We tend to appreciate, and become more grateful for the way things are. By noticing more of what’s happening right now, we disengage from what happened in the past, and what might happen in the future. Our experiences feel enriched and have more meaning.

It makes sense why mindfulness interventions are being tried and investigated for a variety of conditions, like addictions, anxiety, depression, and post-traumatic stress disorder. A common symptom in these illnesses is that the person experiencing them has difficulty feeling connected to the current moment. Often, their past or worries of the future consume their thoughts, leading to strong negative emotions that influence their behaviors. With this in mind, the advantage of being connected to the current moment makes sense.

Of course, a mindful practice won’t just benefit people who are struggling with mental or psychological illnesses. The implications for people who are otherwise well are that they too will be more and more connected to the current moment, letting go of what already happened and what is yet to happen.

When I bring up meditation with my patients, they often have the misconceptions that it is about improving their mood, or completely stopping their thoughts. And when they practice and are not feeling an improvement in their moods afterward, or cannot help from noticing distracting thoughts, they assume they are doing it incorrectly, or that it’s not working for them. A mindfulness practice isn’t about being in a blissful mood all the time, it’s about being in touch with reality, and accepting that reality. And accepting isn’t the same as liking. Also, whether you’re a beginner or resurrecting a practice, expect distractions!

As our practices strengthen, we become better at simply noticing our judgements of liking/disliking that can skew our thoughts and actions. Then we are more likely to have patience between our emotions and our reactions. Our behaviors slowly become more rational, beneficial, and compassionate as we understand ourselves and our tendencies. We gain a greater sense of what we can and cannot control, and prevent much of the conflict that comes from confusing these things. As this happens, life flows and things just make sense.

In Health,

Dr. Michael Stanclift

This workshop is for people wondering if mindfulness and meditation might be something they’d like to weave into their life. Meditation has a long standing tradition in Eastern culture, and as the benefits of regular practice emerge in medical research, Westerners are becoming increasingly more interested.

Dr. Stanclift dedicates much of his clinical practice to teaching his patients to meditate as a foundation for living a healthy life. He has helped a wide variety of people, from homeless youths to retired professionals, learn the use their minds to their fullest potentials.

We begin the workshop with a brief presentation and then proceed with several short, simple, meditation exercises. We pause briefly in between to discuss our experiences, express insights, and answer any questions.

Depending on the group, the whole workshop will take between 60-90 minutes.

Testimonials for the Workshop:

‘I liked the down to Earth approach- i.e. not too “new age”‘

‘I like the information backing up the theory.’

‘I’ve done various meditations in the past and something clicked.’

‘I learned 5 minutes of meditation can be enough. I will definitely use the exercises’

When: 15:00, Saturday 9th February, 2013

Fee: £10/person, limited to 8 participants

Where: The Natural Health Clinic 143 London Road, EH7 6AE

To Schedule: [contact-form]

I ran across this infographic today and think it’s really interesting. (If you’re having difficulty reading it, “right click” and select “view image” …my technology abilities are not the best.) There’s some great information in here, and I’ll help you sort through it.

For full disclosure I think it’s always important to look at who funded or created an infographic like this. In this case it was Neal’s Yard Remedies and the Alliance for Natural Health International. Neal’s Yard is a retailer that sells natural medicines and the ANHI is an advocacy NGO, so obviously the display of information has a bias. That’s not to say the argument it makes is invalid, it’s only to to give context.

So what does this damn thing with bubbles say? Well, there are two measures being graphed here: individual and societal risk. The graphic explains this okay, but to make it much more clear let’s consider an example: Pistol duels.

In pistol duels (you know, from westerns, cartoons, and apparently how gentlemen settled agreements in the 1800′s?) 50% of the participants die. So if 1 million people duel, there will predictably be 500,00 resulting deaths. This has a high (1 in 2) “individual risk”of dying from a pistol duel. But, considering relatively few people duel with pistols, the death rate per 1 million people in society is really low. So even if 2 in 1 million people engage in a duel, only one of them will die. This is low (1 in 1 million) “societal risk.” So that helps sort that out. The closer the (centre of the) bubble is to the right, the greater the individual risk. The closer the (centre of the) bubble is to the top, the greater the societal risk. The size of the bubble represents the relative risk, which is compared to 1 in 1 million. So if 2 in 1 million die from something, it is said to have twice the relative risk.

I won’t get into the all the specifics of why relative risk is used, but to illustrate some of the shortcomings consider the lottery example: If you buy a lottery ticket you have say, 1 in 10 million chance of winning, but if you buy two tickets you double your chances of winning!!! (Oh boy right!?) Not exactly. Now you have a 2 in 10 million chance of winning… so you really haven’t improved your situation too much.

So back to the graphic, it’s important to consider the outcome they are graphing, which is death rate. In medicine, when we review the safety of something we consider at least two things, morbidity and mortality. Morbidity is sickness, and mortality is, well… death. So this infographic is only showing mortality, and it makes a good point: you’re much more likely to die from being hit by lightening than taking a probiotic (or any other natural medicine). But it doesn’t take into account adverse (side) effects, or subsequent illnesses, that may be caused by taking a natural medicine. And personally, I’ve seen that side of things in practice. In fact, it was a topic of a previous post I wrote (the link is at the bottom of this post).

So the take home message of all this is: herbal remedies and food supplements are EXTREMELY unlikely to kill you, but taking them without a trained professional opinion could be the reason you’re not getting the effects you were hoping to see. In fact, taking them incorrectly could make you more ill.

For more about this topic, read:

Is it a Bad Idea to Take Herbs and Supplements Without Medical Supervision

Eating, breathing, and exercising are some of the most basic things we do to keep our bodies functioning well, or not. Over time, our occasional unhealthy behaviors can become habits, and we feel like we’re doing it all wrong. I cannot count how my times I’ve personally had to start again with eating healthier, meditating/breathing, and exercising more regularly. As much as I wish I could be a shining beacon of health, one who never wavers, I’m just like my patients. I too need reminders and have to start with the basics.

Walking through the park today, I saw two men standing on stilts. Then I noticed they were juggling, tossing the juggling clubs back and forth to each other. I learned something: Try as they might, they couldn’t learn this feat without some help. They’d brought someone else along as an assistant, and every time they dropped a club, their assistant would hand it back. Though this post isn’t about juggling, the image of the jugglers is relevant.

Learning to do new things on our own requires assistance in the beginning, and when we’re struggling. I find this to be especially true for some of the easiest things in life, like eating, breathing, and exercising. We know how to do these things, kind of. Many of us are struggling. And we may not know where or why we’re struggling, which is exactly why outside assistance could help.

Being a doctor, like in many jobs, I spend a fair amount of time confirming what I already suspect. So it came as no surprise to me when a new study by French researchers added to the mounting body of evidence suggesting our eating habits and food choices have influence on our moods over the long term. In this study, they followed 12,000 people over 10 years, looking at their eating habits and depression symptoms. What’d they find? Not surprisingly, the healthier the diet, the less likely a person was to have symptoms of depression. The authors acknowledged there was a chance people were eating unhealthy diets because they were depressed, and not the other way around, but they were careful when reviewing their data to be fairly certain this wasn’t the case.

Depression is an interesting condition. In nearly every case, a single cause cannot be found. It’s likely that genetic, physical, mental, emotional, and societal factors all contribute to someone eventually experiencing a “depressive episode.” Likewise, effective treatments usually address it from more than one angle. The foods we eat and how often we eat them are one angle.

Our eating habits provide the building blocks (nutrients) for our bodies to create the chemicals we need. And each food has different amounts of particular blocks. If the building blocks aren’t provided in adequate amounts, our bodies react with symptoms.

Whether it’s unhealthy dietary habits causing depression or vice versa, it’s clear that they go together. Personally, I doubt there’s a one-way causation. Most things in biology and nature exist in cycles. The key to breaking cycles is intervening at a control point, where the cycle can be interrupted. Our dietary choices are control points. After all, we ultimately choose what foods we put into our and our families’ bodies. And food is arguably our best opportunity to introduce beneficial substances to our body. From personal and clinical experience, I can tell you, it’s easier to remember to eat than remember to take a pill. Though making a decision to eat healthy, for just this meal, is a little harder, it’s doable.

And eating healthy is no secret. It’s the same story that we’ve been hearing our whole life: Eating fruits, veggies, and fish are seriously healthy things to do. These foods are high in vitamins, minerals, fiber, and omega-3 fats like DHA and EPA. Avoiding and minimizing processed foods appears to be healthy, too. That’s probably because these foods are notoriously low in vitamins, minerals, fiber, and omega-3 fats. In the study cited, they also found that frequently eating low-fat items increased incidence of depression symptoms, though there could be a number of reasons for that. Fats, especially the omega-3s DHA and EPA, are crucial for our nervous systems to form and operate optimally, and that could be one reason. Another could be that people who ate those foods more frequently were obese, which is associated with depression.

In the coming years, I suspect we’ll also find our gut bacteria have major health consequences far beyond digestion, likely influencing our brains and thus our moods. Animal research is already hinting at that. Also a number of human diseases beyond the digestive tract are being researched for the role of gut bacteria. And this would agree with the whole fruits-and-veggies thing, because the beneficial bacteria in our guts thrive on the fiber found in these foods.

So what’s the take-home message from all this information? Well, in the study linking depression with dietary habits, they point out a World Health Organization report that forecasts depression to be the second leading cause of disability by 2020, just behind heart disease. But we can do something about this. We can change our eating habits, even if just for one meal a day (or, hell, just one meal a week!). We can ask for help, in the form of information, and accountability from our health-care providers.

Encouraging and supporting patients to have healthy eating habits is something I and many doctors are pushing for these days. My call to action is not only to the medical professionals out there, but more importantly, to you as a patient. When you go to see your doctor, ask them to help you eat healthier. Ask them to check in on your diet. By and large, we give patients what they ask for, as long as we feel it won’t harm them. And believe me, no doctor will think eating healthy is harmful (if they do, run like hell). So ask, and you shall receive. And if that kind of care is not covered by your insurance (if you’re fortunate enough to have it), do something about that. Call them and let them know you want preventative care that covers quality nutritional advice. If demand increases, they’ll find a way to meet it, or their competitors will. Alternatively, find those services on your own — it will be worth the investment.

In Health,

Dr. Michael Stanclift

Death is always a tough thing for us to deal with. Even when it comes to someone who has long been suffering, it’s hard for us to accept that we’ll no longer be creating memories with the ones we’ve lost. Tragic death is an even tougher circumstance for us to cope with, both mentally and emotionally. By “tragic death” I’m referring to when someone dies “before their time,” deaths we don’t see coming. We have no time to prepare for their impact, and they often disrupt our lives to a greater degree than a death we saw on the horizon.

Earlier this year, my social circle experienced a similar tragedy to the recent shooting in Connecticut. A cafe where my friends worked, and hung out, a place I often popped into to grab a cup of Joe, had a disturbed gunman come in on a murderous rampage. Several friends perished. Later that day the gunman took his own life, circumventing any hopes we had that justice would be served. In reality, there was no way we would have felt compensated for the loss of our friends.

A few months later another mass shooting occurred, at the opening night of the Batman movie. Though I didn’t know any victims there, I empathize with their friends and family. And now the news of two more mass shootings (one in Portland, the other in Newtown), challenges our thoughts and emotions again.

The first thing most of us think is “what motivates someone do something like that?” There’s no rational way to answer this question. It’s foolish to think something like this results from any kind of logical thinking. Often we wonder if we could have prevented what happened, but that’s futile too. Though we can make changes now, dwelling on the past is pointless because we can’t go back.

So what can we do? How can we return our minds to peace? My answer to these questions is to practice compassion and forgiveness, with everyone. I know, it’s easier said than done. I’m no saint. But I know connecting with, and acting from compassion is an immediate release from confusion and frustration. Actively forgiving is a long lasting release from anger and resentment. To return to peace we must use compassion and forgiveness as the guide for our actions with ourselves and toward others, especially in the circumstances we find it most challenging.

Anger, confusion, and frustration can be important signals to us, but they are poor states to make decisions from, and notoriously awful for guiding our actions. It goes without saying that we don’t want to be in these emotions for extended periods of time. If we continually make decisions and act from these feelings we generally end up in circumstances we regret.

The important part of this is moving beyond just thinking nice thoughts, or thinking we’re nice people and start (or continue) acting that way. Especially to people who piss us off! When situations or people challenge us, we need identify that we’re angry, confused, or frustrated. If we acknowledge that we’re likely to make poor decisions in these states, it’s easier to find the motivation to let these emotions go.

Our next move forward is to find our compassion (believe me, it’s in there somewhere). When we come from a place of compassion, we identify with our highest potential as humans and amazing things emerge. Even simple, seemingly small deeds can have huge impacts on us, and others from this intention. If we acknowledge that all humans (in fact all sentient beings) want to be free from fear and confusion, and exist in happiness, we can empathize with those who are seemingly different. Even the ones who cause us grief and pain wish to be happy, though they may be confused in their ways of finding happiness.

My challenge to you, my wonderful reader, is to practice compassion not only in your most challenging affairs, but in the times when you feel indifferent, too. Of course, practice compassion with those you love and who mean the world to you as well! But don’t forget the ones you don’t care about, and the ones who get on your nerves. They are here to teach you valuable lessons too, the kind of lessons that take effort and make you feel like a better person for doing.

There it is. Give it a think, try it out, see what happens.

I wish it didn’t take tragedy for me to write such things, but maybe it does. Hopefully, with some practice it won’t take a disaster to remind ourselves to act this way, all the time.

Thanks for reading.

It’s more than just willpower that determines whether we eat healthy, exercise regularly, and manage our stress well. Most of us have obstacles impeding our health in one way or another. And today’s doctors have the task of helping us remove or negotiate these obstacles so we can care for ourselves to the best of our ability. Sometimes our obstacles are changeable, and other times they aren’t.

In my last post, I explained who naturopathic doctors (NDs) are. Talking with people, I’ve found there’s some confusion about why someone might go see a naturopathic doctor. In this post I’ll address several reasons that bring patients through an ND’s door.

In states where naturopathic care is fully covered by health insurance, people see NDs just like they would any family doctor, for annual exams and specific illnesses. In places where our services are only partially covered by insurance, or in places where patients pay for our services completely, they usually come when they feel their care is incomplete.

I don’t intend to make the claim that we’re the only health-care providers out there with this approach, but by and large, these are the reasons patients come to see us and what they like about what we do.
“I Know I Could Be Healthier”

My wife is a great example. She had chronic sinus infections and whenever a cold came around, she would get it. And it would knock her out. For a week and a half, sometimes two, she’d be coughing constantly to the point of fatigue. Her immune system was bullied by viruses. Her viral respiratory infections would lay the foundation for becoming infected with bacteria, and eventually she’d need antibiotics. While I was in school at Bastyr, she asked if there was anything that she could do so she wouldn’t be sick all the time. Together, we went to see an ND at our teaching clinic.

My wife told the doctor about her long-standing sinus problems and how her respiratory infections over the years always ended up with her taking antibiotics. It turns out, in her lifetime (and my wife is nearly as young as she looks) she had taken nearly 50 courses of antibiotics. No wonder her immune system couldn’t stand up for itself! It never had. She hated to be reliant on antibiotics, but she didn’t know there was any alternative. Together with the ND, we came up with a plan to bolster her immunity.

It took some work, but gradually we saw her immune system strengthen. Her sinus infections became a thing of the past. When she’d get a cold her coughing and fatigue were no longer exhausting. And instead of being sick for 10 days or more, she’d only be ill for a week, then only five days. Now she hardly ever gets ill, even when handling loads of stress as a final-year veterinary student. When her classmates start to get under the weather, she has learned to listen to her body, support her immunity, and most colds to just blow right past her.

“I Have a Chronic Disease”

A lot of patients come in with a problem (or problems) they’ve had for years. Heart disease, diabetes, arthritis, allergies and digestive problems are the most common long-term conditions we see. These conditions are often responsive to changes in diet and specific lifestyle activities. By taking a close look at our patients’ diets and other habits, NDs help them take the small steps that get big results over time.

Often chronic mood disorders like anxiety and depression may be managed effectively without pharmaceuticals, even for patients who’ve been on medication for years. By tailoring treatments to our patients’ lives, and through careful monitoring, we see patients make changes they didn’t know were possible. That said, the process of getting off medication takes time (and in some cases cannot be done safely). And of course, should not be done without consulting health-care professionals. (Please don’t quit your meds today, call up a colleague in the morning, and mention you read this post!)

“My Medical Care Has Gaps”

The best health-care providers out there care for their patients as whole people. Our organs don’t just live together, they work together. Each organ in our body relies on the others to maintain health. In good care we also have to consider our thoughts, emotions, habits and rituals, and the communities or environments where we live. All these things have their contribution to our health.

I think this kind of thinking is why patients sometimes say, “You guys seem to get the whole picture.” To hear we haven’t lost sight of our patient along our path to diagnosis and treatment is a sign we’re doing what we’ve intended to do. People like some of that “old-fashioned” medicine, like attentive listening, counselling, and explanations. A lot of my colleagues, myself included, got into the field of medicine to bring some of those things back into the practice of modern health care. For many patients, their ND helps to bridge their medical care and their everyday life. When we take time to understand them, answer questions, and show how things are related, patients feel they are a partner in their health care, not merely a subject.
Another care gap NDs often fill is adjunctive cancer care. While we don’t treat cancer (that’s the job of oncologists and surgeons), we can be quite helpful for people while they are going through their cancer treatments. Surgeries, chemotherapy, and radiation are hard on our bodies, they have to be to fight cancer. NDs can focus treatments to prevent healthy tissues in the body from being hit so hard. Preventing and treating “chemo brain,” fatigue, and the disruption to the digestive tract are just some of the ways we can help someone going through cancer treatment.

“My Medical Care Just Hasn’t Been Working For Me”

For people who come in under this category, naturopathic doctors are often their last hope. Generally they’ve exhausted treatment options from every “conventional” provider they’ve seen, or they’ve been told their diagnosis is “all in their head.” Naturopathic doctors can’t always help these patients, but when treatment works these cases are remarkable. These cases highlight the value of the therapeutic order NDs use.

In situations like these, instead of battling an illness very specifically, we take a few steps back, and treat more generally. By supporting health broadly, we give our bodies the chance to sort things out “on their own.” Because these patients have yet to find anything that has helped them, they are often open to making big lifestyle changes such as dietary or environmental adaptations.
Like I said, we’re not the only ones helping patients with a holistic approach, but these are the most common reasons for people to seek the care of naturopathic doctors.

This post was originally published on the Huffington Post.

I get this question all the time. It’s not so surprising when it comes from someone I meet in a coffee shop or on an airplane, but I still hear it from other doctors, too. In fact, it’s more surprising when someone (outside of Seattle or Portland) has actually heard of what I do. To be fair, I’d never heard of an audiologist until one moved in as a housemate.

My profession is rather small, and we’re yet to be licensed in every state. Naturopathic doctors (NDs) are currently licensed to practice as medical professionals in 16 states, and two U.S. territories, and five provinces in Canada.

What we do probably wouldn’t make for a popular TV show like House or Grey’s Anatomy. Preventing heart disease and cancer through diet or helping someone break the pattern of insomnia is not nearly as exciting as rare diagnoses or ethically questionable emergency transplant surgeries. In fact, when some “alternative” health approach is portrayed on one of these shows, you can be fairly certain it’s why the patient is so ill. Ironic, considering the now-famous JAMA article reporting “medical treatment” as a leading cause of death in the United States.

When I say “naturopathic doctor,” to some folks it conjures up ideas of magic wands, potions, and Kramer’s holistic healer friend on Seinfeld. These sorts of clips (though hilarious!) highlight the misconceptions around what we do. Hopefully this article will help clarify what kind of training an ND gets and what they can do.

Licensed Naturopathic Doctors Have Scientific Medical Training:

Applicants to accredited naturopathic medical colleges need a bachelor’s degree and a competitive GPA in scientific prerequisites, just like applicants to “conventional” medical schools.

After admission, the course work of the first two years of naturopathic and “conventional” medical school is comparable both in subjects and in hours of training. We learn all the basic medical sciences like anatomy, pathology, and biochemistry. Unlike Kramer’s holistic healing friend, we learn to use the same labs, physical exams, and medical imaging (X-ray, CT, MRI) that hospitals and clinics utilize to diagnose diseases and monitor health. It’s pretty rare for me to have to break out the magic wand or have someone drink a cup of tea while wearing the pyramid hat!

Our clinical training is a bit different from “conventional” medical clerkships. As ND students, we spend all our clinical time in a family practice (outpatient) setting, under the supervision of an attending (usually ND) physician. Our training includes minor surgery, like removing a mole, but we don’t go into the major surgeries that happen in hospitals. Instead of rotating through a variety of medical specialties, we learn when and how to refer to specialists to diagnose or treat conditions beyond our scope, just like any other family doctor. There are few residencies available for NDs, and since all of our clinical time is spent in family medicine, we tend to go straight into private practice with other medical providers.

Depending on the state, our naturopathic medical license covers everything from dietary advice to pharmaceuticals and suturing wounds. For instance, in California my license is nearly identical to that of a nurse practitioner or physician’s assistant. In Washington and Oregon, the license covers a greater scope of practices and ND care is covered by nearly every insurance provider. Unfortunately, health insurance doesn’t cover ND services in every state we’re licensed to practice in, but our professional organization, the AANP, is working to change that.

Naturopathic Medicine Is Not the Same Thing as Homeopathy

Homeopathy means to give a medicine in a very small dose. Scientifically, we don’t know why it works, because the doses are so small. Naturopathic medicine is not how medicine is given specifically, but based on our six principles. Naturopathic medicine refers to an approach to treating people, and tends to favor natural and low-force interventions. Our treatments with patients might include dietary changes, supplementary nutrients, exercise, herbal medicine, pharmaceuticals or homeopathy. So homeopathy can be part of an ND’s treatment plan, but it’s not the only tool in the shed. That said, other medical providers may use homeopathy as well, and it doesn’t make them naturopathic doctors.

Naturopathic Doctors Work Alongside Medical Doctors

Some folks assume that NDs are against “conventional” medicine, but this isn’t true. Health care is best provided by a team, and NDs are only one part of the team. There are times when we shine, and times when specialists or other medical providers are best suited for the task at hand. We refer our patients to surgeons, cardiologists, and ERs when it’s clear their conditions are beyond of our scope of training.

Naturopathic Doctors and “Naturopaths” Are Different Things

This is probably one of the most confusing things in our field. Even in a state like California, where NDs are licensed as medical providers and the term “naturopathic doctor” is protected by law, people with questionable training can call themselves “naturopaths.” Someone operating as a “naturopath” can see clients as long as they don’t “practice medicine.” Luckily for patients, there are national and state professional associations for NDs, and departments in each state to check whether someone you’d like to see has passed their board exams and has a current license. Not every licensed ND will be a member of their professional organization (like me, since I live outside the U.S.), but they are a good place to start when looking for someone in your area.

Another thing patients need to look out for are people who advertise themselves as an ND (or NMD) without having a license. I’ve reported several people like this to California’s Naturopathic Medicine Committee in the last year. So the moral of the story is, check to see that your health care providers have current licenses issued by the state (they should also be displayed for you to see in their office).

What Makes Naturopathic Doctors Different

Our patients often tell us the face-to-face time we spend with them is a lot longer than other doctors they’ve seen. We spend that time getting to know each patient as a person. We ask about everything that’s going on with them physically, emotionally, and oftentimes spiritually. When making a specific recommendation or prescription, we spend time explaining treatment options and answering questions. We aim to teach our patients about their health, and how they can care for it.

Our treatments are advised using the therapeutic order, where we start by laying the basic foundations for healthy living, and use higher-force interventions (like specific nutrients, drugs and surgeries) as conditions become more severe. In this way, we also work with patients who haven’t developed a disease yet, and simply seek to improve their health whether it be physically, emotionally or spiritually. We consider the term “health care” from its true meaning.

We know our patients are literally atoms, molecules, cells and organs, but we appreciate that they are so much more those physical components. We each exist uniquely in the world, with different values and priorities, and as NDs we believe our health care should reflect that.

So yeah, some of us are a little “out there,” and “touchy-feely.” But that’s not all that guides our practice. Remember, naturopathic doctors go to real medical school. We take real board exams. Our “hippie” medicine works, and what we do is becoming less “alternative” and more “conventional” everyday.

This post was originally published on the Huffington Post.

A Professional Recommendation:

“I’ve been taking [some natural product] for a few weeks, but I can’t tell if it’s working. How will I know?” This is a common question I get and it nearly always comes from someone who is self-prescribing. Often they got an idea or recommendation for herbs or supplements from a friend, the Internet, a magazine, or someone working at the store where they bought it. But how much should they trust these recommendations?

To answer this, I ask more questions: Did the person making the recommendation have medical training? Did they ask about your medical history? Did they ask what else you’re taking? Did they ask about your diet, exercise and lifestyle habits? Did they have a plan for how long you would take this supplement/herb before they would reassess you? If you answer “no” to any of these questions, the recommendation was probably well-intentioned but not sound advice.

Taking Multiple Supplements:

It’s not uncommon for patients to come in taking a grocery list of supplements and herbs. Many times they are taking multiple products for the same reason, dosing them incorrectly, and purchasing low-quality supplements. For these reasons they are usually not getting the effects they wanted and may be wasting their money. The most common products I see taken incorrectly are fish oil, red yeast rice, St. John’s Wort, and Vitamin D. When someone comes to see me and takes more than three products I often suggest a “supplement holiday” so we can determine which, if any, supplements might work for them.

Interactions and Side Effects:

“It’s natural, so it’s safe.” I hear this all the time, and I understand the reasoning behind it. In fact, fewer undesired effects are a big reason I went into natural medicine. But just because something is natural doesn’t mean it will be safe for everyone. Dietary supplements and herbs can be powerful, and sometimes have serious consequences. The rule of thumb: If it can have a positive effect, it can also have a negative effect.

In some cases, taking a supplement or herb can have significant side effects* or interactions that could be quite risky. Supplements and herbs can interact with each other and medications you’re taking. Too much of one nutrient can cause a deficiency in another. More serious interactions happen when multiple substances work on the same biochemical pathways or use the same enzymes in the liver and kidneys. Major interactions can take days or weeks to occur and might lead to a visit to the emergency room. Although serious complications aren’t terribly common, they do occur.

*In the world of medicine we use the term “side effects,” but really there are just “effects.” Some effects are desired, others are undesired. I’m sure you can guess which ones we call “side effects.”

Conflicting Information or Evidence:

This is a tough one, and an area where I find myself often getting into discussions with other doctors. Sometimes studies come out showing that “This Herb is No Better Than Placebo” for a headline. If the study gets published in a well-respected journal the headline soon spreads across the news.

But there can be problems, even with studies from highly-respected, peer-reviewed journals. Conflicts of interest with funding, low dosage of medicine, or subjects with treatment-resistant diseases are just some of the limitations of studies I’ve seen reporting negative findings. Don’t get me wrong, there are truly negative studies on natural products, and these are good for the field because they lead to advancement. Sometimes we find out we’ve been using a medicine ineffectively for years, and negative studies help us to drop that from our practice. But it takes a skeptical (and professional) eye to find discrepancies that may explain the findings of medical studies.

The Bottom Line:

Supplements and herbs work, but they should be taken with appropriate medical guidance.
Think of them as short-term tools to help steer your health in the right direction. Ideally a balanced diet and healthy lifestyle will sustain your health. But there are times when we could use a little help, and a natural intervention is preferable.

Self-prescribing, or getting advice from anyone but a health care professional, can be risky to your health or a waste of money. If your primary care provider seems to be against the idea of you taking anything “natural,” consider finding the professional guidance from another licensed health care professional. Naturopathic doctors are specifically trained to give this kind of guidance, but many medical and osteopathic doctors, nurse practitioners, and physician’s assistants have undertaken special training.

Take excellent care of yourself, and seek sound advice.

This post was originally published on the Huffington Post.

In two studies, one done in men and another in women, researchers followed people’s eating patterns over decades.[1][2] They found people who regularly ate breakfast lowered their chances of developing Type 2 diabetes by over 30 percent. They found people decrease their risk of developing Type 2 diabetes by 5 percent for each day of the week they ate breakfast. Previous research in nutrition has shown that skipping even a single breakfast can cause insulin resistance, a distinctive feature of Type 2 diabetes, for the next meal.[3]

In another study, where their subjects were trying to lose weight by reducing calories, researchers found people who usually skipped breakfast and then started eating breakfast lost more weight than those who ate the same amount of calories in just two meals.[4] Though interestingly, if someone normally ate breakfast, they lost more weight if they then skipped it during the experiment. They also found that people who ate breakfast helped reduce snacking. Moral of the story, changing eating habits was predictive of losing weight in this study.

But not all breakfasts are created the equal. What we eat matters, too. Another study compared eating breakfasts either high in carbohydrates or high in protein. They found eating a breakfast high in protein increased satiety (the feeling of satisfaction from eating) by decreasing the amount of hormones that cause hunger.[5] I’ve found working with patients, and in my own life, that an adequate amount of protein (and fiber) in the morning can make a big difference with regards to feeling energetic and satisfied until lunch. I find it’s a good aim to get a third of our daily protein from breakfast. This calculator can help you find out how much that might be. That said, our needs for protein depend on our body weight, age, activity level and overall health, so check with a qualified health care professional before making drastic changes in your dietary habits to make sure they’re right for you.

If you’re someone who regularly skips breakfast, it might be time to restructure your morning to fit it in. The immediate and long-term effects are an investment in your health and well-being.

For more by Michael Stanclift, N.D., click here.

For more on personal health, click here.

Resources:

[1] Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB. Eating patterns and
type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking.
Am J Clin Nutr. 2012 May;95(5):1182-9. Epub 2012 Mar 28. PubMed PMID: 22456660; PubMed Central PMCID: PMC3325839.

[2] American Diabetes Association (ADA) 72nd Scientific Sessions: Abstract 1364-P. Presented June 10, 2012.

[3] Astbury NM, Taylor MA, Macdonald IA. Breakfast consumption affects appetite,
energy intake, and the metabolic and endocrine responses to foods consumed later
in the day in male habitual breakfast eaters. J Nutr. 2011 Jul;141(7):1381-9.
Epub 2011 May 11. PubMed PMID: 21562233.

[4] Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast
in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr. 1992
Mar;55(3):645-51. PubMed PMID: 1550038.

[5] Blom WA, Lluch A, Stafleu A, Vinoy S, Holst JJ, Schaafsma G, Hendriks HF.
Effect of a high-protein breakfast on the postprandial ghrelin response. Am J
Clin Nutr. 2006 Feb;83(2):211-20. PubMed PMID: 16469977.