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HE www.naturalpractitionermag.com January February 2018 AL THE VIS TH IN IT C T U BO AR EG S A OT E S RA T H YM TIV 2 P E 15 OS IU M A VRM Media Publication Don t miss a single issue of NP in 2018...go online to renew your free subscription today NaturalPractitionerMag.com JanFeb18 Go to www.naturalpractitionermag.com protocolforlife for info about this advertiser Go to www.naturalpractitionermag.com americasfinest for info about this advertiser TABLE OF CONTENTS January February 2018 VOLUME 7 NO. 1 20 24 36 FEATURES 20 Conquering Cardiovascular Health Cardiovascular-related issues are no laughing matter. Here s how practitioners can help their patients prevent or combat problems of the heart. COLUMNS 4 Editor s Note 36 Supplement Science 8 Practitioner Corner 32 Product Focus Multivitamins 24 Solutions for Sounder Sleep A good night s sleep is one of the cornerstones of a healthy lifestyle. DEPARTMENTS 13 Health Industry News 19 INM Update 34 Practitioner Chat 39 Natural Health Studies 42 Natural Marketplace 43 Media Corner 44 Conferences & Events 44 Advertiser Index 28 Probiotically Speaking Many Americans understand that probiotics are good for their digestive and overall health--and that s it. Practitioners can help provide more precise therapy. Visit NaturalPractitionerMag.com FreeProductInfo for FREE Product Information or Samples from All Natural Practitioner Advertisers FREE Subscription (Print Digital or BOTH) FREE E-newsletter Visit NaturalPractitionerMag.com Copyright 2018. Natural Practitioner (ISSN 2331-2580) Volume 7 Number 1 January February 2018. Natural Practitioner is published monthly (except for bimonthly January February March April June July and September October) by VRM Media 431 Cranbury Road Suite C East Brunswick NJ 08816 USA Phone (732) 432-9600 Fax (732) 432-9288. All rights reserved including the right to reproduce in whole or in part. Not responsible for unsolicited material. Opinions expressed in by-lined articles or advertisements are not necessarily those of Natural Practitioner or its owners. Publisher is not liable for advertiser product claims or representations. Advertisers assume total responsibility for the contents of their advertisements. No portion of this magazine is intended to diagnose treat cure or prevent any disease. Printed in U.S.A. Basic annual subscription rate is 50.00. POSTMASTER Send address changes to Natural Practitioner P.O. Box 15246 North Hollywood CA 91615-5246. Subscription Customer Service Natural Practitioner P.O. Box 15246 North Hollywood CA 91615-5246 USA Phone (818) 286-3169 Fax (800) 869-0040 nprcs magserv.com www.naturalpractitionermag.com. Back Issues & Single Copies For order information contact (732) 432-9600 or info naturalpractitionermag.com. December issue is 25.00. All other issues are 10.00 each. 2 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Go to www.naturalpractitionermag.com livon for info about this advertiser EDITOR S NOTE Sleep Solutions am not what you would call a morning person nor am I the type of person that can just get up and go--it takes me some time to adjust and truly wake up. I am a night owl through and through and even when I try to go to bed early I often end up staring at the clock. As an adult I ve created a routine that works for me but during my years in elementary and middle school getting up was often a nightmare--for everyone involved. However when I got to high school that all changed. All of the high schools in my area were grouped together into one school district and all six schools had to share buses which meant each school had different start and dismissal times--and my school got the latest start. The bell that signaled the start of homeroom didn t ring until 8 45 a.m. and my first class didn t begin until after 9 a.m. I was convinced that being able to get more sleep allowed me to function better during the day. Apparently I wasn t imagining it. According to a recent study published in the journal Sleep Health researchers at Penn State University found that high school start times after 8 30 a.m. increased the likelihood that teens obtained the minimum recommended amount of sleep benefiting their overall health and well being. And while the researchers did find that teens with the earliest school start times were going to bed earlier than those with 8 30 a.m. or later the teens with earlier start times still did not get the recommended amount of sleep. Only I those teens with schools that had a start time of 8 30 a.m. or later actually got the recommended amount of sleep said lead author Orfeu Buxton associate professor of biobehavioral health at Penn State. According to Buxton one theory is that despite going to bed earlier than their peers teens with the earliest school start times didn t get enough sleep possibly due to anticipation of an early wake time the following morning. Further the investigators considered other research that looked at teens sleep debt where teens make up for lost sleep on non-school days leading them to wake up consistently and significantly later than those on school days. Buxton noted that both anticipation and sleep debt can misalign teens circadian clocks from expected early wake timing on school days interfering with having consistent sleep. And it s not just kids who benefit from a good night s sleep. According to the National Sleep Foundation adults ages 18 to 64 should be getting approximately seven to nine hours of sleep each night. In the Solutions for Sounder Sleep feature (see page 24) Dr. Jorge Angel medical advisor for Equisalud Laboratory explained that going to bed late at night rising at different times each morning and using mobile devices in the bedroom are all habits that can cause an individual to have trouble sleeping. So let s all start the New Year off right and make a resolution to attempt to create better sleep habits in 2018. Join me in committing to a bedtime to ensure that the required amount of sleep is achieved and leave the mobile devices out of the bedroom. PUBLISHER DANIEL MCSWEENEY EDITORIAL DIRECTOR DanM VRMmedia.com ASSOCIATE PUBLISHER RUSS FIELDS RussF VRMmedia.com ADVERTISING GARY PFAFF SALES MANAGER GaryP VRMmedia.com EDITOR-IN-CHIEF SHARI BARBANEL ShariB VRMmedia.com ASSOCIATE EDITOR NICHOLAS SARACENO NicoS VRMmedia.com CONTRIBUTING EDITOR JANET POVEROMO JanetP VRMmedia.com ART DIRECTOR ROBERT CERTO PRODUCTION MANAGER RobertC VRMmedia.com PRODUCTION ASSISTANT BRYAN ZAK GRAPHIC ARTIST BryanZ VRMmedia.com CIRCULATION MANAGER ROSIE BRODSKY Rosie StarkServices.com PHONE FAX E-MAIL WEBSITE PRESIDENT VRM MEDIA 431 Cranbury Road Ste. C East Brunswick NJ 08816 (732) 432-9600 (732) 432-9288 info VRMmedia.com www.naturalpractitionermag.com DANIEL MCSWEENEY DanM VRMmedia.com MISSION STATEMENT Natural Practitioner magazine provides alternative complementary and integrative health care professionals information about natural products market trends industry news health research and other content designed to benefit their practices and improve their business results. Subscription Customer Service To order a subscription or manage your account please contact us at Natural Practitioner P.O. Box 15246 North Hollywood CA 91615-5246 USA Phone (818) 286-3169 Fax (800) 869-0040 nprcs magserv.com www.naturalpractitionermag.com Connect With Us www.twitter.com www.facebook.com www.linkedin.com www.instagram.com www.pinterest.com vitaminretailer vitaminretailermagazine company vrm-media vitaminretailermagazine vrm_media Back Issues See the Table of Contents page for price and order information. 4 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Go to www.naturalpractitionermag.com kyowa for info about this advertiser Meet Natural Practitioner s Editorial Advisory Board Shailinder Sodhi ND Growing up near the Himalayas Dr. Shailinder Sodhi developed an early interest in ayurvedic plants and herbs and received his BAMS (bachelor in ayurvedic medicine and surgery) degree from Dayanand Ayurvedic College in Jalandhar India in 1985. In 1993 he received a naturopathic medicine degree from Bastyr University as well as a degree in diagnostic ultrasound from Bellevue College. Dr. Sodhi practices naturopathic medicine along with his wife Dr. Anju Sodhi and his brother Dr. Virender Sodhi at the Ayurvedic and Naturopathic Medical Clinic in Bellevue WA which he established in 1989. In addition Dr. Sodhi serves as president of Ayush Herbs Inc. a manufacturer of high-quality ayurvedic herbal formulas is an adjunct faculty member at Bastyr and has been published in several natural health magazines. In its search to provide readers with insight and perspective that will help them build and better their practices Natural Practitioner has culled together an Editorial Advisory Board of authoritative practitioners willing to do just that. You will see our Board members present in key editorial as well as each authoring their own column Practitioner Corner throughout the year that highlights their expertise and professional experiences. They will also lend us their perspective on trends and topics that Natural Practitioner will be covering in issues to come. Natural Practitioner s Editorial Advisory Board is comprised of Holly Lucille ND Dr. Holly Lucille is a nationally recognized licensed naturopathic physician lecturer educator and author of Creating and Maintaining Balance A Women s Guide to Safe Natural Hormone Health. Her private practice Healing From Within Healthcare focuses on comprehensive naturopathic medicine and individualized care. Outside of her practice Dr. Lucille holds a position on the American Association of Naturopathic Physicians board of directors and is on the faculty of the Global Medicine Education Foundation. She is the past president of the California Naturopathic Doctors Association where she spearheaded a lobbying effort to have naturopathic doctors licensed in the state of California. A graduate from the Southwest College of Naturopathic Medicine Dr. Lucilles commitment to naturopathic medicine has been recognized with the Daphne Blayden Award and more recently the SCNM Legacy Award. Amber Lynn Vitale BA LMT CN Amber Lynn Vitale BA LMT CN majored in economics with postgraduate work in medical sciences and additional certifications in bodywork ayurveda and holistic nutrition. Her journey in the healing arts developed richly as she worked for years in practices with integrative physicians acupuncturists chiropractors and nurses. Ultimately she developed an integrated modality of ayurvedic medicine yoga advanced bodywork and integrative nutrition. Vitale uses her 19 years of experience in integrative medical practices to educate on the consumer mindset and to distill these wisdoms into digestible information bytes. In 2014 she joined the Garden of Life team as their Northeast regional educator. Adam Killpartrick DC Dr. Adam Killpartrick earned his degree from Palmer College of Chiropractic in Davenport IA. His primary practice focus has been a synergistic blend of NUCCA (upper cervical chiropractic) with Cranial Release Technique for which he has attained lead instructor status. Dr. Killpartrick furthered his education in clinical nutrition functional diagnostics and lifestyle medicine and has since successfully integrated this blend of specialized chiropractic care and functional medicine into his New Hampshire private practice. This practical experience led him to clinical consulting for numerous nutritional supplement companies. He is currently the chief scientific officer for DaVinci Laboratories. Jared M. Skowron ND Dr. Jared M. Skowron is a national expert in natural medicine for children. Author of the best-selling 100 Natural Remedies For Your Child his lifes work is dedicated to the optimal health of children. A faculty member at University of Bridgeport and founder of their Pediatric & Autism Clinic Dr. Skowron has helped thousands of children fulfill their optimal potential. He is vice president of the Pediatric Association of Naturopathic Physicians and his expertise is in pediatrics autism ADHD and acute and chronic EENT conditions. Jacob Teitelbaum MD A recognized authority on chronic fatigue syndrome (CFS) and fibromyalgia Dr. Jacob Teitelbaum is medical director of the Fibromyalgia and Fatigue Centers nationally and does phone consultations with CFS fibromyalgia patients worldwide. He is the author of the popular iPhone application Cures A-Z and author of the best-selling book From Fatigued to Fantastic (3rd revised edition Avery Penguin Group) and Pain Free 1-2-3--A Proven Program for Eliminating Chronic Pain Now (McGraw-Hill). His newest book is Beat Sugar Addiction NOW (Fairwinds Press 2010). Dr. Teitelbaum does frequent media appearances including Good Morning America CNN Fox News Channel the Dr. Oz Show and Oprah & Friends. Isaac Eliaz MD MS LAc Dr. Isaac Eliaz is a recognized expert in the field of integrative medicine since the early 1980s with a specific focus on cancer immune health detoxification and mind-body medicine. He is a respected formulator clinician researcher author and educator. As part of his commitment to the advancement of integrative medicine Dr. Eliaz partners with leading research institutes and has co-authored numerous peer-reviewed papers on innovative therapies for immune enhancement heavy metal toxicity and cancer prevention and treatment. He is founder and medical director of Amitabha Medical Clinic and Healing Center in Santa Rosa CA where he and his team of practitioners pioneer individualized treatments for cancer and chronic illness. Serena Goldstein ND Serena Goldstein ND is a naturopathic doctor in New York NY specializing in hormonal concerns such as weight mood stress PMS peri menopause and andropause. Dr. Goldstein creates customized plans utilizing nutrition botanical medicine and homeopathy while educating her patients around conventional care and supplements to address symptoms and then discover how and when they feel their best. She believes in instilling a proper foundation of health through diet sleep stress and lifestyle as any form of medicine should supplement not replace an unhealthy lifestyle. Dr. Goldstein has been published in wellknown health and wellness resources such as MindBodyGreen Better Nutrition and Bustle and spoken at places such as Lehman College and the American Cancer Society. Dr. Goldstein also lends her expertise to fellow doctors at NYU-Hospital Poison Control Center. 6 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 PRACTITIONER CORNER Improving DIGESTION IN & OUT of the GUT By Serena Goldstein ND he gut can literally be central to medical concerns (located in the middle of our body) as digestive issues are some of the most prevalent variety of conditions over the past many decades. Unfortunately sometimes the gut is not always considered as part of the culprit (such as a headache or joint pain) that could be due to a certain food. Or gut issues could be triggered by a disease in other organ systems (e.g. high estrogen compromises the walls of our gut) and in turn worsen the original symptoms that turned the person into a patient. A multifaceted approach to optimize healing is imperative for conditions in current times because of the vast amount of contributing factors implemented post 1950s industrial revolution. The general decline of food quality increased stress and poor sleep contribute to both gut and non-gut issues though in turn each feed back into each other unless proper steps are taken from a multifaceted T approach to encourage healing. We are incredibly interconnected and complex beings as even our highly functioning brain processes are at about 20 percent and various conditions can begin or worsen during a certain life event or trauma (ever cry on a massage table or during yoga ). Studies have shown that the gut is like our second brain as it makes about 95 percent of serotonin (our happy hormone) as further evidenced when a course of antibiotics can alter someone s mood due to destruction of gut bacteria. Our gut also makes 400 times more melatonin (our sleep hormone) than the pineal gland and other neurotransmitters that affect our mood such as GABA (calming) dopamine (our reward center) and oxytocin (bonding). Furthermore we may still get sick despite copious amounts of vitamin C because 70 to 80 percent of our immune system is in our gut. Our 4 lbs. of gut bacteria help synthesize vitamin K (protects against blood clots) but can also contribute to heart disease by synthesizing a substance called TMAO that encourages artery blockage.1 It can also increase estrogen activity and promote hormone sensitive cancers and other concerns (e.g. missed periods man boobs ) when someone consumes phytoestrogen foods (plant-based foods that act like estrogen yet can be antiestrogenic) like soy ground flaxseed other seeds chocolate and some fruits and vegetables for example due to how it gets metabolized.2 Just as gut integrity and the microbiome can contribute to non-gut related health concerns there may be some sort of gut issue that has to be addressed while prioritizing the person s main concern. One of the etiologies to autoimmune disease is leaky gut (when those tight junctions get too loose) where the body s immune system becomes overactive in figuring out if those food particles that fell through are part of our body. Hormone imbalances like elevated estrogen (or 8 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Go to www.naturalpractitionermag.com americanbiosciences for info about this advertiser PRACTITIONER CORNER normal estrogen in case of low progesterone) such as from beauty products obesity poor nutrition and stress is a common issue that affects both males and females to varying degrees (e.g. mood weight gain infertility poor sleep) and can lead to leaky gut. Thyroid health can impact our bowel transit as it may slow down if the thyroid is underactive (toxins recirculate) or increase (food may not be properly digested) if the thyroid is overactive. In addition while most T4 (inactive hormone) gets converted to T3 (active hormone) in the liver about 20 percent of conversion occurs from healthy gut bacteria. Gastroesophageal reflux disease (GERD) peptic ulcer disease (PUD) irritable bowel syndrome (IBS) inflammatory bowel disease (IBD) like Crohn s disease (CD) ulcerative colitis (UC) and celiac disease are some of the most common gut-related concerns with multiple etiologies. Too little stomach acid and the loosened lower esophageal sphincter can contribute to symptoms of reflux though some people can have too much acid or an underlying bacterial imbalance especially if poor diet and high stress are issues. Also a long-standing history of proton-pump inhibitors can increase someone s risk for small intestinal bacterial overgrowth (SIBO). IBS is a functional bowel disorder (poor signaling between brain and gut) generally has a strong emotional stress component and perhaps underlying gut bacterial imbalance. PUD has been linked to gut bacteria imbalance of high levels of H.pylori while IBD and celiac disease are autoimmune (the body attacks itself). One of the many studies with CD and its microbiome demonstrated that those with CD had a lower diversity of organisms like Bifidobacteriaceae and increased abundances of species like Enterobacteriaceae Neisseriaceae Clostridiales and Bacteroidales. Furthermore antiobiotic use amplifies their dysbiosis.1 Stress can be an overarching factor in gut health as well as various endocrine systems as mentioned above like hormone and thyroid health. It can stem from ruminating thoughts chemical exposure poor diet poor lifestyle sedentary lifestyle and mounting diagnosis. Proper digestion requires enough blood flow and resources to our digestive system ( rest and digest vs. fight or flight where we proverbially run from a bear) so there s enough acid production to consume food enzymes to break down food and a wide variety of gut bacteria. Going to bed between 10 and 10 30 p.m. optimizes melatonin our most potent endogenous antioxidant and facilitates the drop of cortisol (our stress hormone) which will then wake us up in the morning. Thus regularly staying up late can lead to chronically elevated levels of cortisol. for underlying or therapeutic support as various strains may address specific concerns. Streptococcus Boulardii could relieve some active CD symptoms while a mixture of four lactobacilli (acidophilus bulgaris casei and planatrum) three bifidobacteria (breve infantis and longum) and S. thermophilus could reduce relapse especially of pouchitis in those with UC. Lactobacillus plantarum has also been shown to have a positive effect on those with IBS while various lactobacilli and bifidobacterium strains work well to quell diarrhea. Prebiotics help stimulate growth of probiotics but can be counterproductive in those with other GI (gastrointestinal) concerns like SIBO.5 There are many more supplements in the form of herbs homeopathics and other modalities to improve gut health however it s best to address pathology and multiple contributing factors especially under the care of a knowledgeable professional. There are also other important supplements for general health that will work to address a wide variety of contributing issues to why someone may have or have worsening gut issues. Magnesium known as nature s relaxer (reduces stress) acts on multiple levels to improve gut health by softening stool for regular bowel movements (all forms except glycinate) improving sleep mood hormones and protecting against heart disease amongst many others. Nutritionally foods like dark leafy greens nuts seeds and legumes are great sources and perhaps incorporate Epsom salt baths (e.g. Natural Calm lavender for extra relaxation) into your lifestyle as some added time just for you. B vitamins (with activated folate though may need to test MTHFR) are involved in more than 300 reactions in the human body complement cycles that also involve magnesium and have similar benefits. A liquid form may be more appropriate if there s a lot of gut concerns to help ensure proper absorption. In addition if there s an outstanding mental emotional component or gut health-related-issues happened around a certain event then energetic modalities like flower essences homeopathy and craniosacral as well as herbs and therapy may be considered as part of someone s treatment plan in their trajectory of health. Optimize blood test ranges by tightening the suggested ranges such as vitamin D to about 50 to 60 ng mL or perhaps higher in autoimmune as it can improve Gastroesophageal reflux disease (GERD) peptic ulcer disease (PUD) irritable bowel syndrome (IBS) inflammatory bowel disease (IBD) like Crohn s disease (CD) ulcerative colitis (UC) and celiac disease are some of the most common gut-related concerns with multiple etiologies. Supplements are meant to supplement not replace an unhealthy lifestyle. As they work to incorporate ideal lifestyle habits L-glutamine is essential for cell proliferation and enhancing the immune system and vital to help rebuild and repair leaky gut.3 It also helps improve metabolism IBS and diarrhea occurrences and curbs sugar and alcohol cravings. Methylsulfonylmethane (MSM) is most commonly known as an anti-inflammatory agent where it helps down regulate inflammatory markers like cyclooxygenase-2 (COX-2) through suppression of NF-kB improve cartilage and musculature and supports immune health due to its sulfur-containing compounds.4 Those same sulfur-containing compounds can improve a variety of digestive issues too and are also synonymous to improving the absorption and permeability capacity of your digestive tract. Probiotics can also be helpful depending on the dose and strain 10 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Go to www.naturalpractitionermag.com probioticsinternational for info about this advertiser PRACTITIONER CORNER health on numerous levels. Large red blood cells for example may indicate the person does not have enough B12 or folate though it could also be an issue around diet. Further special testing around stress levels stool tests hormone tests breath tests etc. may be warranted depending on the person s main concern and other significant symptoms. The microbiome is incredibly important to health but there s a delicate balance in addressing the gut and underlying concerns and can sometimes feel overwhelming. A gestalt approach to care both acknowledges the root cause of disease as the practitioner also works to educate their patient on the many potential reasons of how and why they are sitting across from them as two people can walk in with the same issue and leave with completely different plans because how they arrived at that concern. It s also important to emphasize that we re not in an era of one treatment to one concern as implementing these lifestyle changes and educating the patient to truly listen to their body is imperative to not only heal but to double as preventative care. References 1 Shreiner A.B. Kao J.Y. & Young V.B. (2015). The gut microbiome in health and in disease. Current Opinion in Gastroenterology. 31(1) 69-75. www.ncbi.nlm.nih.gov pmc articles PMC4290017 . 2 Landete J.M. et al. (2016). Bioactivation of phytoestrogens intestinal bacteria and health. Critical Reviews in Food Science and Nutrition. 56(11). www.tandfonline.com doi full 10.1080 10408398 .2013.789823 scroll top&needAccess true. 3 Newsholme P. (2001). Why is L-Glutamine metabolism important to cells of the immune system in health postinjury surgery or infection The Journal of Nutrition. 131(9) 2515S-2522S. http jn.nutrition.org content 131 9 2515S.full. 4 Butawan M. Benjamin R.L. & Bloomer R.J. (2017). Methylsulfonylmethane applications and safety of a novel dietary supplement. Nutrients. 9(3) 290. www.ncbi.nlm.nih.gov pmc articles PMC5372953 . 5 Tuohy K.M. Probert H.M. Smejkal C.W. & Gibson G.R. (2003). Using probiotics and prebiotics to improve gut health. Drug Discovery Today. 8(15) 692-700. www.biol.unlp.edu.ar bromatologia probioticos.pdf. Serena Goldstein ND is a naturopathic doctor in New York NY specializing in hormonal concerns such as weight mood stress PMS peri menopause and andropause. Dr. Goldstein creates customized plans utilizing nutrition botanical medicine and homeopathy while educating her patients around conventional care and supplements to address symptoms and then discover how and when they feel their best. She believes in instilling a proper foundation of health through diet sleep stress and lifestyle as any form of medicine should supplement not replace an unhealthy lifestyle. Dr. Goldstein has been published in wellknown health and wellness resources such as MindBodyGreen Better Nutrition and Bustle and spoken at places such as Lehman College and the American Cancer Society. Dr. Goldstein also lends her expertise to fellow doctors at NYU-Hospital Poison Control Center. Go to www.naturalpractitionermag.com womensinternational for info about this advertiser 12 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 HEALTH INDUSTRY NEWS Natural Industry Responds to FDA Proposed Enforcements of Homeopathy O n December 18 2017 the U.S. Food and Drug Administration (FDA) proposed a new risk-based enforcement approach to drug products labeled as homeopathic. According to the FDA to protect consumers who choose to use homeopathic products this proposed new approach would update the FDA s existing policy to better address situations where homeopathic treatments are being marketed for serious diseases and or conditions but where the products have not been shown to offer clinical benefits. It also covers situations where products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices the agency stated. In recent years we ve seen a large uptick in products labeled as homeopathic that are being marketed for a wide array of diseases and conditions from the common cold to cancer. In many cases people may be placing their trust and money in therapies that may bring little to no benefit in combating serious ailments or worse--that may cause significant and even irreparable harm because the products are poorly manufactured or contain active ingredients that aren t adequately tested or disclosed to patients said FDA Commissioner Scott Gottlieb MD. Our approach to regulating homeopathic drugs must evolve to reflect the current complexity of the market by taking a more risk-based approach to enforcement. We respect that some individuals want to use alternative treatments but the FDA has a responsibility to protect the public from products that may not deliver any benefit and have the potential to cause harm. The FDA s proposed approach prioritizes enforcement and regulatory actions involving unapproved drug products labeled as homeopathic that have the greatest potential to cause risk to patients. Under this approach the agency said many homeopathic products will likely fall outside the risk-based categories described in the new draft guidance and will remain available to consumers. The FDA intends to focus its enforcement authorities on the following kinds of products Products with reported safety concerns Products that contain or claim to contain ingredients associated with potentially significant safety concerns Products for routes of administration other than oral and topical Products intended to be used for the prevention or treatment of serious and or life-threatening diseases and conditions Products for vulnerable populations and Products that do not meet standards of quality strength or purity as required under the law. In response to the FDA s proposal the American Association of Homeopathic Pharmacists (AAHP) Natural Product Association (NPA) Christian DeRivel and Nobel Prize winning physicist Brian D. Josephson released the following statements The American Association of Homeopathic Pharmacists shares the FDA s commitment to protecting public health and applauds the agency s plan to take quick action against illegal or unsafe homeopathic medicines AAHP wrote. In fact the association encouraged FDA to do just that in its comments at the regulatory body s April 2015 workshop on the topic. The AAHP is confident that the current Compliance Policy Guide provides FDA with ample opportunity to take such action right now. AAHP also notes that the draft guidance would not materially affect the vast majority of homeopathic drug products available in the United States given these products wide margin of safety and manufacturing according to current good manufacturing practices (cGMPs). The association further underscores that the current Compliance Policy Guide 400.400 remains in effect. AAHP looks forward to providing extensive comments to FDA on the new draft guidance during the open comment period. As always AAHP is committed to ensuring that consumers have access to natural safe homeopathic medicines in the United States and throughout the world. Risk based is generally good because it keeps focus on fly by nights and scam artists selling junk masquerading as natural products and those criminals should be caught and penalized to the full extent of the law said NPA President and CEO Daniel Fabricant PhD in a statement. So that is a win for consumers and safety and taxpayers. Still homeopathic products have been used safely since the 1700s and we re sure the agency will factor that into any regulatory decisions and balance the risk to benefit with legitimate industry for the millions of Americans looking to those responsible companies for safe alternatives in the marketplace. Some manufacturers took issue with FDA s proposition specifically its comment Until relatively recently homeopathy was a small market ... Over the last decade the homeopathic drug market has grown exponentially resulting in a nearly 3 billion industry ... said Christian DeRivel of California-based Green Pharmaceuticals. The consumers that the FDA wants to protect have already proven with their pocketbooks the safety and efficacy of these medications. Yes success might produce a few bad apples so the FDA should focus its attention on enforcing already existing policies (serious disease claims adulterated ingredients and GMPs in place for the few dozen U.S. labs manufacturing homeopathic medicine) not updating them or scaring the public with risk-based enforcement priorities to protect the public from potentially harmful unproven homeopathic drugs. We object to the broad accusatory description that lumps together the good (almost 100 replicated experiments over 1 000 published clinical trials and over 10 000 experiments demonstrating hormesis) with a few bad. Josephson emeritus professor of physics at the University of Cambridge added My own experience as an experienced physicist is that it is the people who are against homeopathy who do it on the basis of religious belief more than a scientific one. As I sometimes put it the idea that water can have a memory can be readily refuted by any one of a number of easily understood invalid arguments. Note the following nugget if as commonly (but incorrectly) asserted homeopathic dilutions are such that the alleged remedies can have no effect then a fortiori they can have no harmful effects. For more information visit www.fda.gov or www.aahp.info. JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 13 HEALTH INDUSTRY NEWS NUNM Food as Medicine Institute Partners with St. Luke s Hospital to the Midwest and welcome Saint Luke s Western biomedicine and naturopathic medicine he National University of Natural Medicine Hospital as a founding member of the FAMI (NUNM Portland OR) has announced it has by using nutrition to prevent and treat disease. NUNM s Food as Medicine Institute was estab- Alliance. formed an educational partnership with Saint Many women are unaware that Luke s Hospital in Kansas City MO to collaborate lished in 2014 to promote nutrition eduheart disease is the No. 1 killer of cation not only among the public but in the delivery of clinical and community educawomen in the U.S. We know that one also among health care professionals tion nutrition workshops and research in the in four women will die of some form seeking to expand their understanding Midwest. The Food as Medicine Institute Alliance of cardiovascular disease added of the relationship between health and was created to help expand community-based Marcia McCoy RN MSN director of nutrition as a means of preventing and nutrition education by promoting better dietary Saint Luke s Muriel I. Kauffman reducing chronic disease. The popular choices to reduce chronic diseases. Women s Heart Center. Our Center is FAME program is a 12-week series of The new Food as Medicine Institute (FAMI) taking a proactive approach to help workshops comprised of nutrition lecAlliance will help establish the growth of the Marcia McCoy empower women to take charge of tures followed by hands-on cooking NUNM Food as Medicine Everyday (FAME) their heart health and to address it before it demonstrations of simple whole-foods meals that series of community workshops through the becomes a problem. The FAME workshops proparticipants help prepare and share at the end of Muriel I. Kauffman Women s Heart Center at grams and research we ll undertake with NUNM the class. Naturopathic physicians or graduates of Saint Luke s Hospital. The workshops are based are ideal complements to the other tools we ve NUNM s Master of Science in Nutrition program on the NUNM FAME nutrition and cooking curdeveloped at Saint Luke s to help assist women in teach the 90-minute classes. riculum which was launched in their health journeys. Dr. Briley said that nutrition is a Portland in 2011. The first series of McCoy said Lucas Schubert MScN an NUNM key component of naturopathic medFAME workshops at Saint Luke s are nutrition graduate and trained FAME educator ical training as graduates are licensed scheduled to begin February 13 2018. will spearhead the FAMI Alliance at Saint Luke s as primary care physicians. We have Leading the FAMI Alliance is Julie Muriel I. Kauffman Women s Heart Center as its long known that nutrition is a founBriley ND the co-founder of FAMI and nutritional health coordinator developing and dational building block to helping the FAME workshops. Dr. Briley who teaching the FAME series workshops providing patients achieve and maintain better co-authored Food as Medicine Everyday individual nutritional consultations and overseehealth she explained. The FAMI Reclaim Your Health with Whole Foods Julie Briley ing additional nutritional programs. Alliance will expand community(NUNM Press 2016) with FAMI coFor more information visit based nutrition education and help reduce chronfounder Courtney Jackson ND said the partnerwww.saintlukeshealthsystem.org food-medicineic diseases using food as medicine. We re very ship with Saint Luke s Hospital is a collaboraeveryday-fame-program. excited to expand the FAME series of workshops tion that s helping to bridge the gap between T THE GO TO RESOURCE FOR ALTERNATIVE & INTEGRATIVE HEALTHCARE PROFESSIONALS NP s Upcoming Issue Highlights March April May 3 6 18 ad closing 4 17 18 ad closing Bone Joint & Muscle Health Healthy Aging CAM Innovations Women s Health June July August 5 31 18 ad closing 7 12 18 ad closing Digestion AANP Show Issue Quality Company Profiles Reproductive Health Our 2018 Media Planner Is Available At NaturalPractitionerMag.com 2018-Media-Planner Contact One of Our Ad Specialists Today Russ Fields at (732) 432-9600 ext. 102 or e-Mail RussF VRMmedia.com Gary Pfaff at (732) 432-9600 ext. 103 or e-Mail GaryP VRMmedia.com 14 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 ACPM Announces National Diabetes Prevention Program Grant Winners T he American College of Preventive Medicine (ACPM) has selected six health care organizations to receive grants to develop new practice setting models that address the national type 2 diabetes epidemic. The awardees will develop and test new models to increase prediabetes awareness and screening testing and referral of patients with prediabetes to diabetes prevention programs recognized by the Centers for Disease Control and Prevention (CDC). The work will include referral models focused specifically on populations covered by Medicare as the Medicare Diabetes Prevention Program and is scheduled to become a covered benefit starting April 1 2018. The grant awardees--two from each of three provider categories--include South Nassau Community Hospital Oceanside NY (Integrated Delivery System) Portland Family Medical Center Portland ME (Integrated Delivery System) Griffin Faculty Physicians Derby CT (Independent Practice Association) Accent on Health Washington D.C. (Independent Practice Association) Northeast Missouri Health Kirksville MO (Federally Qualified Health Center) Christopher Rural Health Planning Corporation Mulkeytown IL (Federally Qualified Health Center) The grants are part of ACPM s partnership with the CDC Division of Diabetes Translation and are supported through a cooperative agreement with CDC Office of State Tribal Local and Territorial Support. This is the second group of grantees charged with developing models to increase enrollment in the National Diabetes Prevention Program (National DPP) as part of this grant program. The need to raise awareness and promote physician referrals to the program is critical said Robert Carr president of ACPM. There is tremendous value in the National DPP for preventing one of our nation s most prevalent and growing conditions. We need to increase the number of patients who are referred by their physicians to the CDC-recognized diabetes prevention programs. We are excited about the innovative ideas and models that the grantees will develop to amplify and accelerate uptake in this important effort. According to the CDC 84 million American adults are living with predia- betes--a serious health condition that can increase a patient s risk for type 2 diabetes heart attack and stroke. The National DPP was founded on the science of the Diabetes Prevention Program research study and multiple translation studies which showed that making modest behavior changes helped adults with prediabetes lose 5 to 7 percent of their body weight and reduce the risk of developing type 2 diabetes by 58 percent. Each grantee organization will work closely with ACPM to develop and document the best practice methods for increasing prediabetes awareness screening and referral with- in the practice setting. The work will result in case studies and toolkits that will be utilized by other health delivery organizations across the country. At the conclusion of the project grantees will present their findings at a day long Diabetes Prevention Institute being held in coordination with Preventive Medicine 2018 ACPM s annual conference on May 22-26 2018 in Chicago IL. For more information visit www.acpm.org dpp NattoPharma & Ortho Molecular Products Form Exclusive Partnership N attopharma (Oslo Norway) has announced that it has been selected by Ortho Molecular Products a leader in practitioner-specific nutraceuticals as its exclusive vitamin K2 supplier partner. The company will transition the seven products in its line currently featuring vitamin K2 to MenaQ7 PRO a unique line extension available only to Ortho Molecular. For more than 25 years Ortho Molecular Products has researched and manufactured high-quality efficacious nutraceuticals sold exclusively to thousands of health care professionals nationwide and in Canada. With headquarters in Chicago IL the company has U.S. Food and Drug Administration (FDA)-audited current good manufacturing practice (cGMP)-certified manufacturing facilities in Stevens Point WI where the company will work to transition the following products to include NattoPharma s MenaQ7 PRO Vitamin K2 Vitamin K2 with D3 Vitamin K2 180 mcg Liquid Vitamin D3 with K2 K-FORCE Pro Bono Alpha Base Capsules without Iron Alpha Base Capsules with Iron We are proud of our 25-year tradition of successfully combining evidence-based formulations and superior raw ingredients to develop efficacious supplements that notice- ably enhance patient health said Aaron Bartz president of Ortho Molecular Products adding that MenaQ7 was chosen based on the significant data confirming its ability to help the body properly utilize calcium supporting bone health while simultaneously protecting cardiovascular health. This partnership with NattoPharma reinforces that commitment allowing us to provide the practitioner community with the best quality clinically validated Vitamin K2 as MK-7 available. We believe we earned the attention of Ortho Molecular Products--and ultimately were selected as a partner--because NattoPharma has been driving the scientific discovery behind the benefits of vitamin K2 added Dan Rosenbaum NattoPharma CEO. We could not be happier to have Ortho Molecular Products with its demonstrated years of excellence providing only the best ingredients available join the NattoPharma family. And we were excited to make available a line extension with MenaQ7 PRO that would speak clearly to the practitioner market. The reformulated Ortho Molecular Products will be available in 2018. For more information visit www.orthomolecularproducts.com www.nattopharma.com or www.menaq7.com. JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 15 HEALTH INDUSTRY NEWS BASF to Enter U.S. Medical Foods Market With DIEM Labs ASF Corporation (Florham Park NJ) and DIEM Labs LLC (Buffalo WY) have entered into a distribution agreement to commercialize BASF s first U.S. medical food product for the dietary management of patients with non-alcoholic fatty liver disease (NAFLD). As part of this agreement BASF will use its scientific expertise and state-of-the-art manufacturing capabilities to provide a first-to-themarket medical food product to patients with NAFLD. DIEM Labs will market the product to health care professionals in the U.S. and sell it through an online hub. The product will be available to U.S. patients who are under the supervision of a physician for NAFLD management. NAFLD is defined as fat accumulated in the liver representing more than 5 percent of its weight. This condition has an estimated prevalence of 20 to 30 percent in the Western population and is closely linked to obesity and metabolic syndrome. Diagnosis often starts with abnormal liver function test results or detection of hepatic steatosis during incidental imaging. If the condition is not managed it can progress to more severe liver damage such as fibrosis and cirrhosis. By manag- B ing the condition at an early stage called simple steatosis the disease can be controlled. Currently there is no dedicated product available on the market specifically targeting patients with NAFLD and patients are left with no solution to improve their condition other than undergo extensive lifestyle changes. BASF acknowledged the significant unmet need and developed a new medical food product for the dietary management of patients with NAFLD. A product-specific human intervention trial including more than 170 patients has been conducted by BASF to show that the product is effective and safe in the dietary management of patients with NAFLD. The tobe-launched product will therefore add to the current standard of care for NAFLD. It is anticipated that it will be commercially available throughout the U.S. in the first half of 2018. Specially formulated foods are increasingly used as part of the overall management regimen for certain diseases or associated conditions and play a vital role in supporting a patient s nutrient requirements. With this step BASF is entering an attractive new market segment in the space between human nutrition and pharma said Fran ois Scheffler head of BASF s Global Human Nutrition and Pharma Solutions Businesses. This further supports our mission to enable people to live a healthy and fulfilling life. We are delighted to work together with such a renowned company as BASF in the medical foods market added Cai Berg CEO of DIEM Labs. The new product will offer a solution to patients who currently have no other alternative than lifestyle modifications to turn their NAFLD around. For more information visit www.basf.com or www.diemlabsllc.com. 16 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 New Paper Calls for Establishment of Dietary Reference Intake for Lutein L utein is ready to be considered for intake recommendations asserted the authors of a new paper published online in the European Journal of Nutrition. Lutein a carotenoid found in egg yolks colorful fruits and vegetables and dietary supplements has gained attention from the nutrition research community for its potential role in reducing the risk of age-related macular degeneration (AMD) and other eye issues and the paper s authors noted that establishing a recommended dietary reference intake (DRI) value for the bioactive is critically important for advancing and improving public health. AMD is the leading cause of age-related blindness in industrialized countries said Jim Griffiths PhD vice president of scientific and international affairs for the Council for Responsible Nutrition International (CRNI) and one of the paper s six coauthors. Establishing intake guidelines for lutein could encourage the consumption of luteincontaining foods and subsequently decrease the risk of age-related visual degradation and improve overall visual health. We hope policymakers and stakeholders take note of the strong research supporting the benefits of lutein and move forward with setting a DRI. In the paper the authors cited a previously developed set of nine criteria used to determine whether a bioactive is ready to be considered for DRI-like recommendations and illustrate the ways in which lutein satisfies each. These criteria include 1) an accepted definition 2) a reliable analysis method 3) a food database with known amounts of the bioactive 4) cohort studies 5) clinical trials on metabolic processes 6) clinical trials for dose-response and efficacy 7) safety data 8) systematic reviews and or meta-analyses and 9) a plausible biological rationale. Based on the careful review of the literature supporting the criteria the authors concluded that lutein should join the roster of those nutrients that already have DRI recommendations. Establishing a DRI recommendation for lutein would provide the public with yet another reason to eat more of the colorful fruits and vegetables lacking in our diets wrote the co-authors. Many consumers purchase products containing lutein [...] but they may not be aware of the science that supports its role in health or know the appropriate intake level. For more information visit www.crn-i.ch. The Len Cerullo Method Clinic Opens First Location EnerHealth Launches Professional Line of Herbal Hemp nerHealth Botanicals a Colorado-based manufacturer of natural and organic herbal supplements has announced the launch of its new line Helix Herbs formulated for health professionals who practice holistic alternative and natural medicine methodologies. The line of full-spectrum raw whole plant extracts includes 1-oz. pure hemp extracts available in four potencies and four unique 2-oz. hemp blends. EnerHealth a longtime leader in artisan-quality herbal extracts and other products developed the practitioner line in response to the rising demand for wellness products made from hemp and the growth in alternative medicine. According to the National Center for Complementary and Integrative Health in a March 2016 analysis approximately 38 percent of adults and 12 percent of children use complementary and alternative medicine. The perceived therapeutic attributes of hemp extract rich in phytocannabinoid compounds have become extremely popular as people search for alternative ways to alleviate what ails them. According to market research compiled by Hemp Business Journal the hemp industry is projected to grow to 1.8 billion in sales by 2020 led by hemp food body care and extract-based products. The goal with Helix Herbs is to assist people in their quest to find achieve and maintain optimum health says Steve St. Clair founder and CEO of EnerHealth. People are increasingly turning to chiropractors naturopaths traditional herbalists and other practitioners for natural health care options and we want to provide efficacious hemp extracts for the practitioner s toolbox he added. The hemp used in EnerHealth s extracts comes from farms that follow organic production practices. Using a specialized spagyric technique that utilizes only organic grape alcohol and pure water the company said it uses this innovative extract technology and a low temperature technique to preserve the living constituents of the original raw hemp plant. For more information visit www.helixherbs.com. T he Len Cerullo Method clinic recently opened the doors to its first location in downtown Chicago IL. Pioneering a personalized and holistic approach aimed at alleviating pain-- with surgery as the last option--founder Len Cerullo MD a neurosurgeon has dedicated his career to improving patient mobility reducing pain and promoting optimal health and wellbeing. The Len Cerullo Method care plan treats the whole person-- mind body and spirit said Dr. Cerullo. I am proud to open the doors to the clinic alongside an exceptional team of holistic health care practitioners dedicated to providing patients individualized treatment plans that integrate the best of Western and Eastern medicine. We strive to help patients live their best healthiest life whether that means running a marathon recovering from an injury or treating chronic conditions or persistent pain. When appropriate we aim to avoid surgery. And when it s not possible we strive to help patients recover as quickly as possible getting them on the road to long-term health and wellness. Located at 680 N. Lake Shore Dr. The Len Cerullo Method clinic is home to physicians nurses and practitioners specializing in Pilates acupuncture nutrition injections meditation yoga physical therapy occupational therapy and behavioral medicine. Dr. Cerullo s innovative and personalized approach to health and wellness is what many of my patients have been asking for said clinical psychologist Von Shade-Zeldow PhD. Whether someone is striving to recover from a recent surgery looking for alternative therapies for chronic pain or researching how gentle exercise and nutrition can help with arthritis The Len Cerullo Method approach is uniquely geared toward helping patients achieve long-term success for a variety of concerns and conditions. For more information visit www.thelencerullomethod.com. E JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 17 HEALTH INDUSTRY NEWS Nestl Acquires Garden of Life & Pure Encapsulations O n December 5 Nestl announced that it agreed to acquire privately held Atrium Innovations a global leader in nutritional health products from a group of investors led by Permira Funds for 2.3 billion in cash. Atrium s 2017 sales are expected to reach almost 700 million. The move supports Nestl s pursuit of growth opportunities in consumer health care to complement the company s focus on its high-growth food and beverage categories. The transaction is expected to close in the first quarter of 2018 following the completion of customary approvals and closing conditions. Upon closing Atrium with its corporate offices in Quebec Canada will become part of Nestl Health Science. Its existing management team will continue to manage the business led by Peter Luther Atrium Innovations president and CEO. We value Atrium s history as a highly successful company and welcome its 1 400 employees to the Nestl family said Greg Behar Nestl Health Science CEO. Their brands are a natural complement to our Consumer Care portfolio which offers nutritional solutions in the areas of healthy aging healthy growing gut health and obesity care. Atrium s portfolio will extend our product range with valueadded solutions such as probiotics plantbased protein nutrition meal replacements and an extensive multivitamin line enabling consumers to address their health and wellness goals. Atrium s established brands are in attractive categories and have the potential for continued strong growth as part of Nestl through category channel and geographic expansion Behar added. It also represents additional offerings in the segment for non-GMO (genetically modified organism) organic and natural supplements a fast-growing consumer trend as well as a new sales channel. Atrium s largest brand Garden of Life is headquartered in Palm Beach Gardens FL manufactures certified organic non-GMO supplements that are sold in more than 14 000 health food stores and online in the U.S. as well as select markets internationally. Pure Encapsulations is a full line of hypoallergenic research-based dietary supplements and is the No. 1 recommended brand in the U.S. practitioner market according to the company. Headquartered in Sudbury MA the Pure Encapsulations product line is free from common food allergens GMOs fillers binders and artificial colors and is sold in the U.S. via health care practitioners online as well as in pharmacies in several markets in Europe. Since Atrium was established in 1999 we have been dedicated to providing premium-quality science-based professionally recognized products to consumers and health care practitioners said Luther. We are very pleased to be joining Nestl Health Science as we share a common purpose of helping people lead healthier lives by providing good-for-you products made with the highest standards for quality and efficacy. Nestl will provide Atrium with the resources to accelerate the growth of our brands and reach more people globally. The remainder of the Atrium portfolio includes specialty brands such as Wobenzym Douglas Laboratories Genestra Brands Orthica AOV Minami Klean Athlete Pharmax and Trophic. For more information visit www.nestle.com. OANP Appoints New Executive Director he Oregon Association of Naturopathic Physicians (OANP) announced the appointment of Beth Martin as the new executive director for the OANP. The announcement comes as former executive director Laura Farr transitions to take the helm of the American Association of Naturopathic Physicians (AANP) after 12 years of service. Martin comes to the OANP from a consulting practice which focused on helping the businesses of holistic health practitioners thrive and expand through community connections and strategic marketing. Prior to this she worked at Reed College in the public relations department where she managed many of their community outreach projects and events. At Reed Martin was known for her skills as a collaborator organizer and an inspirational leader. Laura Farr lead OANP through tremendous growth and many legislative victories for the naturopathic profession and we re thrilled to bring Beth s skills in public relations and community outreach to make naturopathic medicine accessible to all Oregonians stated OANP Board President Carrie BaldwinSayre ND. Martin began her role as executive director at the end of October. In her new role she will focus on advancing OANP s strategic plan which includes increasing public awareness of naturopathic doctors (NDs) and creating an obstacle free environment in which NDs can practice. For more information visit www.oanp.org. SFI Invests in a Bright Future for Klaire Labs T F ollowing the acquisition of Klaire Labs and sister companies ProThera Inc. and Complementary Prescriptions Soho Flordis International s (SFI) investment in a brand new purposebuilt facility in Reno NV is tangible evidence of its vision to empower clinicians with the highest quality pure and potent natural supplements. SFI s investment is pivotal to continuous improvement efficient scaling and ready assimilation of new products and increased demand said Global Head of Operations Eric Dripps who oversaw the development of the new facility. The 75 000-square-foot manufacturing facility boasts state-of-theart automation greatly expanded air and temperature-controlled probiotics storage as well as increased capacity to support and fuel the company s aggressive new product development and expansion strategies well into the future. Starting with the very early planning and development phases we kept both our philosophical vision and practitioners expectations at the forefront said Dripps. The technology we have employed vastly reduces the potential for human error integrates cGMP (current good manufacturing practice) quality practices throughout and allows us to expand efficiently in response to the growing demand for high-quality reliable natural health care options. For more information www.meetklaire.com. 18 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 INM UPDATE Leading Industry Organization Speaks Directly to Natural Practitioner Readers Primary Care Physician Shortage Spurs Collaboratively Funded Naturopathic Residency Program By Michelle Simon PhD ND W e have a growing U.S. public health crisis a shortage of primary care providers (PCPs). To fill this gap the Institute for Natural Medicine (INM) and Bastyr University have partnered to launch a uniquely collaborative program to fund graduate residency for naturopathic physicians. Naturopathic medicine continues to grow as a distinct practice of medicine today there are approximately 6 000 licensed naturopathic doctors in the United States throughout 23 regulated states and territories. Naturopathic medical education is designed to result in a graduate trained in providing primary care medicine as such NDs are a valuable addition to the national PCP pool. Using the Therapeutic Order NDs employ a unique approach that identifies the natural order in which therapies should be applied to provide the greatest benefit to the patient with the least potential for harm. Emphasizing diet lifestyle and nutrition this approach leads to improved outcomes and lower health care costs. For the third year in a row the Association of American Medical Colleges is projecting that physician demand will outpace supply resulting in a PCP projected shortfall ranging between 7 300 and 43 100 physicians by 2030.1 One offsetting factor is the growth of the PA and APRN fields serving in PCP roles. The physician-to-APRN ratio will fall from 3.6 1 in 2015 to 1.9 1 in 2030. Adding to this growing workforce of non-MD PCPs are naturopathic doctors. pathic residencies have been funded directly by educational institutions or approved clinical sites. The INM Residency Program has been designed with a unique funding model to scale over time. Eventually it will help narrow the gap between ND and MD postgraduate training. Unique Collaborative Funding Model Designed for Scale New graduates from one of the five accredited naturopathic colleges in the United States who have passed the Naturopathic Physicians Licensing Examination are eligible to apply for the year-long residency. Up to 10 residencies are available in the pilot year initially in the greater Puget Sound region. The program is intended to expand to California Oregon and Arizona in coming years. Funding is secured through a first-of-its-kind collaborative model with contributions from Bastyr University individual clinics and a residency fund developed by INM with generous contributions from RLC Labs Standard Process Thorne Research Inc. and Integrative Therapeutics. The collaborative funding model decreases the financial demand on the individual clinics which will lower the financial disincentive to developing a residency. This removes what has historically been the biggest obstacle to an increase in the pool of ND residency sites ND residents and ultimately successfully practicing NDs who will help The Institute of Natural Medicine (INM) In 1992 a leadership core of naturopathic doctors established INM as a not-for-profit organization dedicated to advancing natural medicine. The purpose of the INM is to increase awareness broaden the public s access and encourage research of natural medicine and therapies. Among its milestones the INM counts the launch of the Association of Accredited Naturopathic Medical Colleges as an independent organization leading California s efforts to obtain licensure for naturopathic physicians and funding graduating naturopathic medical students in studies that advance the profession. The INM has joined forces with the American Association of Naturopathic Physicians serving as its charitable arm to deepen access to naturopathic care public education and research. Dr. Michelle Simon is a licensed naturopathic physician clinician educator and leader in many organizations dedicated to improving the quality and delivery of healthcare. In addition to holding a Naturopathic Doctorate from address the PCP clinician shortage. The clinic sites residency application process and curriculum are being managed through Bastyr University s residency program which follows guidelines established by the Council of Naturopathic Medical Education (CNME) and The Association of Accredited Naturopathic Medical Colleges (AANMC). A residency academic committee that includes the residency directors from accredited naturopathic colleges across the U.S. provides oversight of the program. This is an exciting time for the naturopathic medicine profession as we offer new graduates comprehensive clinical and business experience from which they can make an immediate difference in the primary care delivery system at the local level. Our goal is to expand patient access to a naturopathic primary care model that utilizes a personalized approach emphasizing wellness and prevention and focuses on identifying root causes of illness. In doing so we are helping naturopathic doctors foster a health care system that is safe productive and cost effective. Reference 1 2017 Update The Complexities of Physician Supply and Demand Projections from 2015 to 2030. https aamcblack.global.ssl.fastly.net production media filer_public a5 c3 a5c3d565-14ec48fb-974b-99fafaeecb00 aamc_projections_ update_2017.pdf. Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill. Dr. Simon serves as president of the Institute for Natural Medicine (INM) treasurer of the American Association of Naturopathic Physicians (AANP) and a director of the Naturopathic Physicians Research Institute (NPRI). Dr. Simon served nine years on the Washington State Health Technology Clinical Committee which is part of the Health Technology Assessment Program (HTA) that examines the scientific evidentiary basis for efficacy safety and cost effectiveness of health care technologies. Dr. Simon has served as an Ambassador to the Academy of Integrative Health and Medicine (AIHM) an international inter-professional organization that educates and trains clinicians in integrative health and medicine and as an invited participant for health care economics at Summit on Integrative Medicine and the Health of the Public at the Institute for Medicine (IOM) in 2009. Dr. Simon also serves on the Advisory Board for Natural Partners Inc. For more information contact msimon naturemed.org. Narrowing the Gap Between MD and ND Post-graduate Training In response to the demand for ND s in primary care the INM Residency Program aims to train graduates of accredited naturopathic medical colleges in a unique clinical training model designed to support both clinical skill development as well as practice management and business skill development. In recognition of the large preponderance of private practice clinical models for delivery of naturopathic primary care especially in rural communities this program aims to provide the residents with a solid foundation in business management. Combining both business skills with clinical training is designed to enable the residents to establish their own private practice health care clinics quickly and efficiently or join a group or hospital based practice. The Federal government provides funding through the Medicare program for all MD and DO postgraduate residencies. NDs not yet a part of the Medicare system are ineligible for this program. This has resulted in a shortage of residencies for all ND graduates. Up until now naturo- JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 19 C ardiovascular issues can pose their will in various ways whether it is in the form of high cholesterol high blood pressure heart disease and more. John Hopkins Medicine revealed that approximately 84 million people in the United States suffer from some form of cardiovascular disease. This includes an estimated 2 200 deaths each day or one death every 40 seconds. To add even more perspective nearly one out of three deaths in the U.S. result from the disease and cardiovascular disease causes more deaths than accidents cancer and chronic lower respiratory diseases combined. Further it is the number one killer of both men and women. So what can be done Using a plethora of natural tools at their disposal practitioners can assist their patients in finding a solution that will help them avoid becoming another statistic. Common Cardiovascular Issues Matters surrounding the cardiovascular system can vary and sometimes can differ depending on factors such as age and gender. Interestingly enough emotions can also play a role according to Serena Goldstein ND who serves on Natural Practitioner s Editorial Advisory Board. In children heart issues tend to be murmurs or arrhythmias commonly due to genetic abnormalities or structural defects in the heart said Dr. Goldstein. Concerns like high blood pressure high cholesterol strokes etc. generally tend to be due to poor lifestyle habits over a period of decades. Stroke hypertension and congestive heart failure are more common in women due to their decline of estrogen (helps protect blood vessels and against high blood pressure) especially in their 40s and 50s. Anxiety and depression also raise these risks and women are more likely to be diagnosed than men and tend to have a broader range of emotional [focus] (it s just biology). In fact I had a patient who would have chest pains whenever she thought of her ex-boyfriend--she had a complete workup of physical exam labs and imaging but in this case treatment had to have a more mental emotional focus. Unsure of why men tend to have higher cholesterol. As previously mentioned heart disease is the dominant force among U.S. adults and it is often molded by one s diet and lifestyle. Heart disease is the leading disease of adult men and women in the U.S. with obesity and diabetes following closely behind 1 mentioned Keegan Sheridan ND education contributor for Nevada-based Klaire Labs who manufactures CoQ10. In each case cardiovascular health influences the progression of disease and risk factors associated with each disease influence the status of cardiovascular health. They are all intertwined in this way and fundamentally they are linked by diet and lifestyle. Dr. Sheridan also discussed the rising epidemic of child obesity which is resulting in a slew of problems. Rates of obesity and diabetes are rapidly increasing among children in the U.S. 2 she said. Risk factors such as hypercholesterolemia and hypertension previously almost unheard of in a pediatric population are now present and growing.3 Sedentary lifestyle and calorie-dense yet nutritionally deficient diets are fueling an epidemic in our children that has them on a path to be the first generation with a shorter expected lifespan than their parents. 4 20 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Another underlying factor is chronic stress which can be a catalyst for those aforementioned problems. High cholesterol and high blood pressure remain the most common problems among people and we feel strongly that unmitigated chronic stress lies at the heart of the both of these issues noted Stacey Littlefield product formulator and master herbalist with Illinoisbased Redd Remedies. Chronic stress or more specifically the allostatic load--creates imbalances in basic biological pathways that lead to these problems with blood pressure and cholesterol. Moreover chronic stress can lead to poor eating habits and poor coping skills such as cigarette smoking or alcohol use in adults. To help maintain normal levels of homocysteine (a pro-oxidant and irritant to the lining of the arteries that leads to microinjury and atherosclerosis) vitamin B12 and folate can help--and the methylated forms methylcobalamin and methylfolate are preferred for anyone who may have impaired methylation status she continued. In fact Vital Nutrients offers a plethora of products for cardiovascular health including magnesium citrate. But why are the popular omega-3s magnesium and CoQ10 effective patients may ask For one omega-3s can help fight inflammation while the latter pair are energy producers. Natural Solutions With diet being a focal point in the quest for heart health it is recommended the patients are conscious of not only what they are consuming but what they are avoiding as well. Following a heart healthy diet is very important including eating fiber-rich fruits and vegetables lean poultry fish nuts and whole grains suggested Hilton Hudson MD FCCP FACS with Omax Health in Indiana who offers Omax3 Professional Strength containing omega3 fatty acids. Patients should limit consumption of red meat whole-fat dairy shellfish saturated fats and high cholesterol foods. We recommend eating nuts for heart health Brazilian nuts and walnuts specifically and steer patients away from any processed foods. Dr. Hudson also recommends that patients Use an application called Fooducate.com which lets them scan food labels to determine good and bad foods. Incorporate 30 minutes of aerobic exercise three or more days a week such as walking biking hiking or swimming. Supplement with high-quality omega-3s with a 4 1 ratio of EPA to DHA (if they are not eating fatty fish two or more times a week). Omega-3s can help reduce inflammation in the body which can help lower triglycerides reduce blood clotting and help prevent the risk of coronary heart disease. For patients looking for additional options omega-3 fatty acids CoQ10 and hawthorn extract are some of the natural solutions that can help combat blood pressure. Some of the best researched natural therapies for maintaining normal lipid levels and preventing lipid peroxidation include omega-3 fatty acids garlic niacin CoQ10 and various antioxidants such as green tea flavonoids and other plant polyphenols such as those [found] in hawthorn extract noted Beth Baldwin-Lien ND director of medical affairs and education with Connecticut-based Vital Nutrients. For blood pressure support omega-3 fatty acids and mineral supplementation (calcium magnesium potassium) can have modest effects along with garlic hawthorn extract and CoQ10. High cholesterol and high blood pressure remain the most common problems among people and we feel strongly that unmitigated chronic stress lies at the heart of the both of these issues. -- Stacey Littlefield Redd Remedies Omega-3 fish oils are anti-inflammatory and reduce [the] likelihood of plaque rupture magnesium and CoQ10 are critical for energy production said Ross Pelton RPh PhD CCN scientific director for Essential Formulas in Texas. CoQ10 is usually critically deficient in patients with congestive heart failure--[the] heart cannot produce enough energy to drive fluids through the vascular system. Magnesium is also a natural muscle relaxant. Magnesium deficiency increases muscle cramps--a muscle cramp in the heart is a heart attack. Essential Formulas offers Reg Activ Cardio Wellness which happens to contain CoQ10 and Lactobacillus fermentum ME-3 which has been found to support healthy glutathione levels in the cardiovascular system. Omega-3 fatty acids can even be described as multipurpose as they not only help with inflammation but can be effective toward improving immunity and mood among other issues. Without a doubt omega-3 fatty acids have shown remarkable benefits said Cheryl Myers chief of education and scientific affairs for Wisconsin-based EuroMedica. Essential fatty acids (EFAs) hold cells together and protect them against invaders. EPA and DHA from fish oil improve heart health and blood profiles relieve pain through anti-inflammatory action enhance immunity elevate mood alleviate the symptoms of ADHD (attention-deficit hyperactivity disorder) and menstrual pain promote brain and vision development in infants and children and help treat depression. So getting omega-3s is truly essential she continued. But the delivery of these nutrients is also essential and can make the difference between patients actually getting the therapeutic benefits they need or giving up on a regimen because they find it unpleasant or ineffective. One product Myers mentioned that has been widely recommended by practitioners is EuroMedica s EurOmega-3 which provides omega-3s bound to phospholipids for better absorption and utilization by the body plus the additional benefits of the phospholipids themselves and peptides. Practitioners may also want to consider the Reishi mushroom. New Jersey-based Mushroom Wisdom utilized the Reishi mushroom when creating its Super Reishi product which like omega-3s can help combat various deficiencies. There are many herbal and nutritional remedies that support cardiovascular health but one that stands out for its very holistic activity is the Reishi mushroom explained Mark J. Kaylor a consultant for Mushroom Wisdom and founder and guide at Radiant Health Project in Georgia. Most commonly thought of as an immune supporting remedy (like medicinal mushrooms in general) Reishi because of its supportive whole body and systemic actions makes it a useful remedy for not only prevention but for maximizing health and vitality of the cardiovascular system. For these same reasons Reishi is a strong choice to consider including in a Western medicine or natural medicine approach. If the body s overall vitality is enhance[d] then treatments in general will tend to be better received regardless of the type of treatment. Also a number of Reishi s benefits are useful holistically to help with cardiovascular health for instance its stress balancing actions--we all are aware of the costs that chronic stress places on the heart. Market Status For a number of reasons many patients are beginning to look to natural alternatives that support cardiovascular health. People are starting to realize that standard medications to treat cholesterol are minimally effective at decreasing heart attack deaths for those without a history of heart attack or angina noted Jacob Teitelbaum MD a member of Natural Practitioner s Editorial Advisory Board and the author of numerous books such as From Fatigued to Fantastic and Pain Free 1-2-3. For example statins for primary JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 21 prevention (treating a high cholesterol with no history of heart disease) only decreases heart attack deaths about 5 percent. In comparison owning a cat associated with a 30 percent lower risk of heart attack death and eating a small bit of chocolate every day with a 45 percent lower risk. Meanwhile medications for heart failure are also not adequately effective. On the other hand natural remedies are very effective. In fact since diet is highly involved in maintaining proper heart health consumers are continuously looking to implement dietary supplementary techniques--a significant percentage of supplement purchases are in the cardiovascular category. Heart disease is largely influenced by diet and lifestyle and for this reason many people are interested in diet-based therapies including dietary supplementation to address cardiovascular risk factors and promote heart health said Dr. Sheridan. According to recent estimates over 70 percent of condition-specific dietary supplement purchases are focused on heart health with the total market of heart health supplements estimated at 2.5 billion. 5 Indeed the natural market presents promise and this could not be possible with out patients curiosity to explore beyond the mainstream. Tips and Research The significance of eating the proper foods cannot be stressed enough as Dr. Goldstein recommends focusing on the foundation of healthconsuming whole foods with a focus on a rainbow of vegetables quality meat and fish (if not a vegetarian or vegan) healthy fats (e.g. nuts seeds olive oil avocado coconut oil) getting to bed before 11 p.m. stress management regular movement and drinking at least half your body weight in ounces of water. The good news is that these recommendations can span improvement for many other conditions while doubling as preventative care. If you d like to try all these take tasks on little by little as it s more about incorporating it into your lifestyle so it becomes habit. Touching upon similar points as Dr. Pelton concerning plaque Myers noted that Diet is where everything should start. Cutting back on inflammatory foods like sugars and refined grains will help reduce the conditions that can lead to arterial damage and the likelihood of plaque formation and blockage. Then I would consider healthy fats as an integral part of a heart-healthy regimen. For some patients that might sound counterintuitive but because healthy fats make up the flexible and strong cellular walls of arteries and blood vessels they are absolutely necessary in the diet. Manufacturers such as Vital Nutrients constantly monitor studies in the field to see how certain products may be progressing. For instance back in 2015 a double-blind randomized clinical trial involving 244 healthy postmenopausal women was conducted. The women were randomly selected to receive either a placebo or 180 mcg of vitamin K2 menaquinone-7 (MK-7) daily for three years. Results indicated significant benefits in helping to prevent stiffening of the arteries as it relates to age by pulse wave velocity (PWV) and echotracking according to Dr. Baldwin-Lien. The researchers determined that using MK-7 supplements long term may improve arterial stiffness in healthy postmenopausal women especially in women having a high arterial stiffness to begin with. Although traditional medicine still ranks at the top in terms of popularity holistic medicine is also beginning to pick up steam. In Littlefield s eyes with the cardiovascular system being such a major outlet to other highways of the body it is only appropriate that holistic products receive the attention they deserve. The approach really has not evolved and that was a hurdle that we at Redd Remedies felt needed to be cleared she explained. Fish oil and single nutrients such as CoQ10 remain the dominant products in this category however what these nutrients and products lack is a holistic approach to cardiovascular health. The heart muscle itself and the vessels that serve it reach every inch of every body system. From this perspective we felt it was long overdue for an approach that recognized the connectedness between these body systems and created formulas that address the negative effects of chronic stress overall cardiovascular function and a specific cardiovascular problem--like cholesterol or blood pressure. Redd Remedies offers Circulation VA a product containing MenaQ7 that can provide circulatory system support. Myers also recognized alternative medicine s need for more recognition as well but at the end of the day is optimistic about where research in this field is headed. I think that there is a growing appreciation for a more holistic approach to cardiovascular health. In part there is a sense that inflammation is one of the major culprits of heart disease and that cholesterol isn t necessarily the enemy. I fully recognize that talking about cholesterol levels is still very much the standard for most patients and for conventional practice so it ll be a while before people at large come to understand that inflammation and oxidation are the twin targets of stopping disease she concluded. But we re getting there thanks to the leading-edge research being done with botanical compounds and the in-the-trenches work done by practitioners every day. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose treat cure or prevent any disease. 1 Leading causes of death National Center for Health Statistics. Centers for Disease Control and Prevention. Available at www.cdc.gov nchs fastats leading-causes-ofdeath.htm [Accessed 12 11 2017]. 2 Pulgaron ER Delamater AM. Obesity and Type 2 Diabetes in children epidemiology and treatment. Curr Diab Rep. 2014 Aug 14(8) 508. 3 Weiss R Dziura J Burgert TS et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3 350(23) 2362-74. 4 Overweight in children. American Heart Association. Available at www.heart.org HEARTORG HealthyLiving HealthyKid s ChildhoodObesity Overweight-inChildren_UCM_304054_Article.jsp .Wi8JRkqnHIU [Accessed 12 11 2017]. 5 Moloughney S. Getting to the heart of cardiovascular health. Nutraceuticals World. Available at www.nutraceuticalsworld.com issues 201704 view_features getting-to-the-heart-of-cardiovascular-health [Accessed 12 8 17]. John Hopkins Medicine revealed that approximately 84 million people in the United States suffer from some form of cardiovascular disease. Concerns like high blood pressure high cholesterol strokes etc. generally tend to be due to poor lifestyle habits over a period of decades. According to recent estimates more than 70 percent of conditionspecific dietary supplement purchases are focused on heart health with the total market of heart health supplements estimated at 2.5 billion. References Healthy Take Aways FOR MORE INFORMATION Essential Formulas Incorporated www.essentialformulas.com EuroMedica www.euromedicausa.com Jacob Teitelbaum MD www.vitality101.com Klaire Laboratories www.klaire.com Mushroom Wisdom Inc. www.mushroomwisdom.com Omax Health Inc. www.omaxhealth.com Redd Remedies www.reddremedies.com Vital Nutrients www.vitalnutrients.net Serena Goldstein ND www.drserenagoldstein.com 22 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Solutions for Sounder Sleep A good night s sleep is one of the cornerstones of a healthy lifestyle. By Karen Morse MPH A long with a well-balanced diet and regular exercise sleep is essential to good health. However according to the American Sleep Association (ASA) approximately 40 million Americans suffer from some kind of chronic long-term sleep disorders while another 20 million Americans experience occasional problems with sleep. At least seven hours of sleep per day is recommended for adults between the ages of 18 and 60 to stay healthy. Getting the recommended amount of restful sleep helps keep stress levels balanced supports mood and increases alertness while sleep deprivation can result in bouts of depression and increased risk of chronic diseases. There are many underlying issues that could result in a sleep disorder. Highlighted below are some of the most common causes as well as natural treatment solutions for patients. What Causes a Sleep Disorder Dr. Jorge Angel medical advisor at Equisalud Laboratory based in Spain shared that going to bed late at night rising at different times each morning and using mobile devices in the bedroom are all habits that can cause an individual to have trouble sleeping. The ASA reports that insomnia tends to increase with age affecting about 40 percent of women and 30 percent of men. For most people the cure is to practice better sleep habits but for others it could be the sign of an underlying medical disorder. Dr. Angel also shared that per recent findings from the Centers for Disease Control and Prevention (CDC) the American Academy of Sleep Medicine and the Sleep Research Society say that certain demographics may be more affected by sleep issues than others. For example survey respondents who were unemployed or unable to work reported a lower healthy sleep duration than employed respondents. The healthiest sleepers were those who had a minimum of a college degree and married survey respondents reported a healthier sleep duration than those who were never married divorced widowed or separated. Lifestyle changes such as going to bed at the same time each night rising at the same time each morning and turning off or removing televisions computers and mobile devices from the bedroom can help people get the healthy sleep they need stated Dr. Angel. In my experience a synergic combination of natural products using low doses is a great adjuvant to support and regulate sleep disorders. Carolyn Dean MD ND a medical advisory board member of the Nutritional Magnesium Association agreed. Our lifestyle is stressed more than ever before with a more complex environment and digital technology at our fingertips 24 7 our bodies have less time for proper rest and sleep she asserted. We are having a harder time to flip the off switch. As such supplement aisles selling sleep and calming aids are on the rise. When asked about trends in the sleep dis- 24 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 orders category Andreas Koch influencer in marketing and partnerships for Nutranext family of brands including the Texas-based Natural Vitality agreed with Dr. Dean that technology and smart phone use are causing great sleep disturbances. Digital technology and smart phones are always attached to our bodies and even up to bedtime with alerts and text messages even pinging us during sleep and keeping us out of deep sleep more often he mentioned. So a wider population is shopping for solutions to regain a normal sleep cycle. Using the very devices that have hindered our sleep are conversely also helpful tools to research natural solutions such as magnesium-related products and other sleep products. Another common cause of sleep difficulty affecting approximately 18 million Americans is sleep apnea. Sleep apnea is linked to high blood pressure cardiac issues and changes in mood such as depression and irritability. Around half the people with obstructive sleep apnea are overweight said Dr. Dean explaining that fat deposits around the upper airway may obstruct breathing. Another cause is a narrowed airway. You may inherit naturally narrow airways or your tonsils or adenoids may become enlarged which can block your airway. Other causes of sleep apnea include hypertension chronic nasal congestion smoking and diabetes. Recent research has also found an association between asthma and the risk of obstructive sleep apnea Dean added. Patients experiencing sleep apnea could benefit from a referral to a specialized sleep center. Sedatives or sleeping pills are not recommended for patients with sleep apnea but lifestyle changes such as weight loss or alternating sleep positions could provide some relief. rise increase consumption of plants and plant-based proteins and fats to balance blood sugar levels address anxiety and reduce caffeine and alcohol consumption McKelvey asserted. Become very protective of your sleep routine. We have a pill popping culture that tends to want quick solutions and so I always include lifestyle changes in addition to remedies so that people understand how they can directly impact their sleep health. Not getting enough sleep and then drinking coffee all day and taking sleep medication at night is a recipe for disaster. Mark A. Kaye DC senior manager of medical information at California-based Metagenics Inc. shared ways that alternative medicine can help patients who experience sleep disorders. Integrative care suggests integration into the standard medical care that [a] patient is also seeking to fully understand why a patient may be experiencing a sleep disturbance may require multiple health professionals--from family practitioners to chiropractors to mental health professionals to occupational therapists. Prescriptive agents work well when the specific need is defined--similar for nutritional compounds. They work very well when a proper determination of need is made in the individual patient. Supplements for Better Sleep In addition to lifestyle changes patients may find supplements supporting sleep to be beneficial. According to Brendan Gaughran president of Florida-based Liver Medic Inc. magnesium is the most depleted mineral in the body and simply getting more is a great start to addressing an underlying sleep issue. Gaughran recommended using supplements containing the magnesium glycinate form of magnesium as it has the highest absorbency levels with the added benefit of reducing midbrain hyperactivity via glycinate. The mineral magnesium facilitates sleep regulating melatonin production relieves the muscle tension that can disrupt sleep and prevent[s] restful sleep and activates GABA the main Treatment Approaches Sleep is complex and getting to the root cause of sleep disturbances is key stated Amy McKelvey an integrative herbalist and CEO of California-based her vital way. The most successful approaches incorporate a comprehensive plan that includes all of the following increase exercise read before bed and put down all devices so that the environment is dark and calm use herbal support go to bed earlier and awake before sun- inhibitory neurotransmitter of the central nervous system explained Dr. Dean. Magnesium is known as the anti-stress mineral. Numerous studies have shown its effectiveness in boosting mood lowering anxiety and reducing stress levels as well as helping with deeper more restful sleep. Natural Vitality s Natural Calm is a fruity effervescent drink formulated with magnesium citrate powder a highly-absorbable form of magnesium that can be mixed with hot or cold water. Natural Calm promotes healthy magnesium levels and balances calcium intake resulting in a more relaxed state of being. For patients who need extra sleep support Natural Vitality s Calmful Sleep contains rest-promoting magnesium glycinate Suntheanine (a patented form of the relaxing amino acid L-theanine) calm-enhancing GABA (a non-protein amino acid) and melatonin which helps the body ease into restful sleep. Melatonin is well known for its sleep benefits. The melatonin hormone secreted by the brain is what regulates the body s sleep wake cycle. Normally melatonin levels begin to rise in the evening stay high during the night and decrease in the morning. Travel stress and other lifestyle factors can disrupt the normal melatonin cycle making it difficult to fall or stay asleep. Benesom from Metagenics is a sleep and relaxation formula with melatonin as well as herbs and minerals for additional support. The formula delivers 3 milligrams of melatonin per serving to help relieve occasional sleeplessness as well as plant extracts passionflower and valerian to promote calm and minerals for enhanced relaxation. Dr. Angel also supported the use of herbal supplements or phytonutrients in treating sleep issues. In my experience the synergic combination of California poppy chamomile folic acid inositol Larginine niacin passionflower valerian vitamin B6 and zinc gluconate is very interesting to support these patients he shared. Dormisol is a product from the Holoram line (manufactured in Spain by Equisalud Laboratory and distributed in the U.S. by Welife Naturals) containing the blend of vitamins minerals and other nutrients mentioned by Dr. Angel. One of the ways the product works is by controlling the body s response to stress. The formula also contains L-tryptophan which is a precursor of serotonin. Serotonin JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 25 directly stimulates the production of alpha brain waves creating a state of deep relaxation it also reduces anxiety. McKelvey shared that a 2004 study published in the for Journal of Human Psychopharmacology showed that L-theanine was more effective than a standard benzodiazapene at reducing resthas general sedative effects said Angel. In ing anxiety. Anxiety is one of theory raising the level of L-tryptophan in the main causes of sleep disorthe brain will cause increased production of ders and that L-theanine is more powerful serotonin and natural sedation especially if than Valium and Xanax and natural is very this amino acid is low. Serotonin is then impressive. converted in to melatonin with the proper her vital way provides L-theanine in its micronutrients. Supplementation could corpurest form as AlphaWave an amino acid rect these deficiencies that are found in green tea leaves that not uncommon in our induspromotes relaxation without trialized society. drowsiness while reducing To reduce anxiety and nervous tension. These vegeimprove the quality of sleep tarian capsules can be taken one of McKelvey s go-to remewith a meal or on an empty dies is L-theanine. L-theanine stomach. is an amino acid found in Sleep Z-z-zen from green tea leaves and is one of Rainbow Light (in the nature s most effective natural Nutranext family of comparelaxants she explained. It nies) uses a blend of wellstudied ingredients to promote relaxation and healthy sleep. Don t miss a single issue of NP in 2018... The formula includes go online to renew your free subscription today melatonin L-theanine and GABA as NaturalPractitionerMag.com JanFeb18 well as botanicals used in traditional medicine to support relaxation. Additional products supporting relaxation and sleep include Zen Calm and Zen Sleep from the Zen Herbalists brand owned by Liver Medic. The two products contain organic adaptogenic herbs magnesium glycinate and B vitamins while taking care to avoid toxic fillers. We often get physicians that will give [these products] to patients they believe have adrenal fatigue or HPA axis imbalance and that s a fine application too said Gaughran. Lastly if stress is a reason for a patient s sleep issues homeo- Solutions Sounder Sleep pathic medicines may be an effective remedy. Homeopathic medicines like Boiron s Sedalia allow health care providers to offer a safe and simple solution to stressrelated problems reserving the usage of anxiolytics to more severe cases stated Christophe Merville DPharm director of education and pharmacy development at Boiron USA in Pennsylvania. Sedalia targets both physical symptoms and inner feelings such as irritability feeling of being overwhelmed fatigued nervous and hypersensitive to any additional stimuli. It offers a non-sedative solution that calms you down but yet allows you to remain alert and focused to react and accomplish on what you need to do during stressful situations. It s perfect for stress that comes on very quickly. Sedalia combines six single active homeopathic ingredients in its formula Aconitum napellus (Monkshood) Belladonna (Deadly nightshade) Calendula officinalis (Garden marigold) Chelidonium majus (Greater celandine) Jequirity and Viburnum opulus (Guelder-rose). References Lu Kristy et al. The acute effects of Ltheanine in comparison with alprazolam on anticipatory anxiety in humans. Human Psychopharmacology Clinical and Experimental 19.7 (2004) 457-465. Adults between the ages of 18 and 60 should get a minimum of seven hours of sleep daily to support good health. Insomnia typically increases with age affecting about 40 percent of all women and 30 percent of all men. Sleep apnea affects approximately 18 million Americans. Magnesium is a mineral found to be effective at boosting mood reducing stress levels and promoting a deeper and more restful sleep. L-theanine is an amino acid found to be an effective natural relaxant. Healthy Take Aways FOR MORE INFORMATION Boiron boiron.com her vital way www.hervitalway.com Liver Medic livermedic.com Metagenics Inc. www.metagenics.com Nutranext nutranext.net WeLife Naturals www.welifenaturals.com 26 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Many Americans understand that probiotics are good for their digestive and overall health--and that s it. Practitioners can help provide more precise therapy. By Lisa Schofield T he field of probiotic research and development has grown so rapidly and expansively in the past decade alone perhaps more than any other classification of dietary supplements or natural health remedies. Such growth often brings out misconceptions misunderstandings--and misuse. Naturopathic physician Steven SandbergLewis ND DHANP of 8 Hearts Health and Wellness and National University of Natural Medicine Portland (Oregon) observed that many consumers think that by taking a specific probiotic for any duration will ensure it becomes a robust part of their microbiota and thus be able to provide long-term benefits. And although this is possible it s likely not true for all. Because our individual microbiota is likely established in fetal development and infancy significant changes to the microbial fingerprint later in life by consumption of a short-term probiotic supplement may be rare. More likely the daily use of probiotic and or prebiotic-containing foods may have the salient effects that last. The metabolic byproducts of a probiotic microorganism may have the greatest effect on a person s digestive health or on reduction of health issues than does the intake of a probiotic supplement. Eric Yarnell ND RH(AHG) professor Department of Botanical Medicine Bastyr University and president of Heron Botanicals in Washington asserted that consumer understanding is moderate. He outlines three key misconceptions and their realities Misconception Lactobacillus and bifidobacteria are the main and most important bacteria in the gut. Reality By sheer number these are actually extremely minor members of the gut but can tolerate oxygen and therefore can be ingested via capsules. The most prolific bacteria in the gut by huge margins are obligate anaerobes these can t tolerate oxygen and can t be economically produced in capsules. Misconception They should not be taken with food. Reality Ostensibly the stomach acid would kill the bacteria. But many studies support that taking them with food results in more making successful journeys to the colon. Presumably this is because that is how bacteria get to the colon in the first place (in food) and that they have adapted to use the food to help protect them from the many antimicrobial defenses in the upper GI (gastrointestinal) tract he explained. Misconception The dose. People basically don t seem to know how much to take and the amounts between products vary enormously. Reality Most people take significantly less than they need. Minimum doses for most applications based on positive clinical trials are 50 billion organisms a day even for children. Tina Anderson CEO and co-founder of Illinois-based Just Thrive Probiotic related six additional misconceptions that Americans have about probiotics. Misconception A probiotic with 50 billion cells is better than one with four billion cells. Reality In microbiological terms more is not always better she emphasized. Having 28 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 50 billion CFUs in a probiotic is only helpful if you can confirm that 50 billion CFUs are surviving in the digestive tract. Unfortunately she added survivability studies with several probiotic products (some as high as 250 billion CFUs) have indicated that more than 99 percent of the strains cannot survive digestion. While lactobacillus or bifidobacteria do reside in our gut commercially produced strains are shockingly poor stomach survivors and gut colonizers. This explains why so many people find common probiotics ineffective. Misconception You need a probiotic with at least 15 different strains. Reality Most probiotic studies are done with a single strain and there hasn t yet been a study demonstrating that more strains create better results. The quality of the strain is significantly more important than quantity she noted. When a company creates a kitchen sink formulation with dozens of strains they often have to use cheaper lower quality strains to keep costs down. Furthermore the manufacturers of some of these products have no idea if these cocktails will be synergistic or if the bacteria will actually compete with one another possibly producing a negative result. Instead seek to recommend a product with only a few strains and whose synergy has been verified. Misconception Probiotics needs to be refrigerated to be considered a good probiotic. Reality Refrigeration is actually a sign of a weak probiotic. Think about it Anderson emphasized. If a probiotic cannot survive at room temperature how do you think it will survive in a 98-degree body much less through extremely acidic digestive tract Short answer it won t. Before recommending ask for gastric survivability test results proving the probiotic arrives alive in the intestines and a gut model study showing that it colonizes. Misconception A probiotic can be improved by being enteric coated or in a special capsule. Reality This is simply marketing Anderson declared. If a probiotic needs a special enteric or seaweed coating or special technology in order to survive digestion then it will most likely be too weak to compete with the other 80 trillion bacteria already residing in the gut. Misconception You need to rotate probiotics to create diversity and maintain efficacy. Reality According to Anderson the idea of rotating probiotics originated from the realization that many probiotics stop working after a month or two of use because many probiotics are too weak to cause any lasting change in the gut. A truly effective probiotic she underscored will not stop working over time. A quality probiotic will continue to cleanse and heal the gut from daily assaults with every dose. Its effect multiplies it does not go away she said. Thankfully related Natural Practitioner Editorial Advisory Board member Amber Lynn Vitale there is a gradual yet definitive shift in consumer mindset from thinking that a probiotic is only for either digestive support or after antibiotic treatment to the understanding that probiotics are useful for maintaining nearly all aspects of health. However she still hears certain misconceptions such as Won t all the strains compete in the capsule Won t they fight for resources in my body How can these strains make it to my small intestine alive if they aren t enteric coated How do I know these are human strains What if these bacteria mutate and make some super bug that cannot be killed by antibiotics increasing public awareness of the fascinating life of our gut microbes and in relating new research showing use of probiotics in specific conditions and results. For example TV advertising by numerous yogurt brands has grown the awareness of ingesting probiotics to improve digestive health. Additionally said Lamb many bloggers are sharing their positive experiences of using commercial probiotic supplements for digestive health issues as well as many conditions throughout the body including popular use for children in allergies food intolerances skin conditions and behavior issues. A Rapidly Evolving Category With probiotics seemingly breakthroughs and innovation occur at a pretty rapid clip. One such ingredient is a compound that mimics a probiotic--Saccharomyces boulardii is a non-pathogenic yeast that functions like a probiotic according to Kathy McIntee vice president of Patient One Formulas New York. She explained that S. boulardii acts as a temporary flora that quickly achieves high concentrations in the GI tract. It also remains unaffected by antibiotics that don t discriminate in killing both good and bad bacteria. As a result co-administration with antibiotic treatment is recommended to protect and promote recovery of healthy gut flora. What s more it helps prevent antibiotic-associated diarrhea as a secondary benefit. Further she said S. boulardii effectively competes against the bacterium C. difficile which is known to flourish during antibiotic use and is often the cause of GI disturbances following antibiotic therapy. S. boulardii has also been shown to compete against candida colonization. In addition to preventing antibiotic-related diarrhea it helps prevent recurrent C. difficile-related diarrhea and colitis traveler s diarrhea acute bacterial and viral diarrhea inflammatory bowels and irritable bowel syndrome (IBS). Vitale pointed out that Lactobacillus GG is now off patent and available for use by other companies it boasts numerous compelling studies showing benefits in neurological balance for children and adults alike making for exciting possibilities. Also she said Lactobacillus rhamnosus strains like HN001 for balancing immune function show great promise. New research Anderson is excited about is the first double-blind human clinical trial on leaky gut (metabolic endotoxemia) that was published in the World Journal of Gastrointestinal Pathophysiology in August 2017 showing that a group of bacillus sporeforming bacteria can heal leaky gut in only 30 days. Spore-forming bacteria (bacillus endospores) is where the probiotic marketplace is heading because of their history of While lactobacillus or bifidobacteria do reside in our gut commercially produced strains are shockingly poor stomach survivors and gut colonizers. This explains why so many people find common probiotics ineffective. --Tina Anderson Just Thrive Probiotic She added that NIH s (National Institutes of Health) Human Microbiome Project has created a new definition of what a probiotic is and it is much more specific than the former WHO (World Health Organization) definition that says a probiotic must be 1) A species that can normally be found in a healthy human microbiome 2) Supplemented in an amount significantly greater than it occurs in the human microbiome in order to stimulate a boost in healthy immune response 3) Must be able to tolerate the natural environment of the human microbiome. Natalie Lamb technical advisor for Protexin (Bio-Kult) Florida observed that the media has played a significant role in JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 29 safety and efficacy for over 60 years she stated adding that while these strains have been used in Asia and Europe for decades they are new to the U.S. supplement market. Lamb has observed some very interesting work expanding this year (2017) on the microbiota-gut-brain axis raising the possibility that treatment with probiotics could be an effective therapeutic strategy for managing neurodegenerative disorders. For example the first human trial in Alzheimer s disease (AD) was published researchers found that supplementing with Lactobacillus acidophilus Lactobacillus casei Bifidobacterium bifidum and Lactobacillus fermentum positively affected cognitive function and some metabolic statuses in the only human trial in AD patients. This is particularly interesting to me as AD is a chronic neurodegenerative disorder affecting millions of people worldwide for which there is currently no pharmaceutical treatment that can successfully reverse its progression and available drugs appear to only ameliorate some symptoms once the pathology is diagnosed. As the population ages cognitive behavior including learning and memory is of growing concern she added. This brings the fact that probiotics are becoming more condition-specific. For example noted Jared Paulson MTCM sales and education manager Washington-based Ayush Herbs dermatologists are starting to prescribe topical probiotics that are formulated with slightly different microbes or microbial ratios than oral probiotics and are seeing successful results. Further emerging research is showing auto-immune disorders may be alleviated with the improvement of the human microbiome. Cancer researchers have noticed better clinical outcomes with the administration of probiotics in those being treated with chemotherapy or radiation therapy he said. Dr. Yarnell commented that he has seen Renadyl show specifically to help patients with chronic kidney disease. I think we will see more of this in the future. If someone could figure out a cheaper way to make oxygen-impermeable capsules we would likely see an explosion of specific organisms for specific conditions most obviously right away Oxalobacter formigenes for people with oxalate-containing kidney stones and Faecalibacterium prausnitzii for people with IBD (irritable bowel disease). Lamb revealed that 2018 is when the largest IBS probiotic trial to date using the multi-strain probiotic Bio-Kult 14-strain will be published. The randomized doubleblind placebo-controlled trial in 360 moderate-to-severe symptomatic diarrhea-predominant IBS adults was associated with a statistically significant consistent improvement in overall symptom severity in patients with IBS-D and was well tolerated. I foresee both single and multi-strain probiotic formulations continuing to be published in an ever-widening range of specific conditions and being considered alongside conventional pharmaceuticals as research grows she predicted. I foresee both single and multi-strain probiotic formulations continuing to be published in an everwidening range of specific conditions and being considered alongside conventional pharmaceuticals as research grows. --Natalie Lamb Protexin (Bio-Kult) Products to Consider According to Anderson Just Thrive Probiotic & Antioxidant contains pharmaceuticalgrade bacillus strains (not with lactobacillus and bifidobacteria strains found in other probiotics). The company s bacillus sporeforming bacterial strains are licensed exclusively from the Royal Holloway University of London from probiotic expert Dr. Simon Cutting. Just Thrive she stated has the only published study showing that these strains are healing leaky gut within 30 days of use and nine human clinical trials on the product are currently underway. Just Thrive Probiotic s hardy strains have been shown by gastric survivability studies to pass through all digestive acids to reach the intestines completely alive and to actually colonize the gut as shown through a gut model study. All four proprietary strains are pharmaceutical- grade and DNA-verified by an independent third-party lab. Patient One s Flora Maintenance probiotic is described by McIntee as a multi-strain identity-confirmed probiotic with a potency of 25 billion live bacteria per capsule. Ten compatible well-researched strains (seven found in the small intestine and three found in the large intestine) are combined with the prebiotic fructo-oligosaccharide. The combination of a prebiotic and a probiotic has been clinically proven to promote enhanced effectiveness she said. McIntee added that as strain identity is necessary to link a culture to a specific health effect the strains in Flora Maintenance are genetically identified by a the RiboPrinter microbial characterization system. Patient One s bacteria cultures she said are produced with a proprietary system that promotes increased viability over an extended shelf life and are provided in an acid-resistant delayed release capsule to survive stomach acids for effective delivery to the intestinal tract where the organisms can colonize and replicate. New York-based N D s Bare Biotic helps support healthy digestion and well-being according to COO Naomi Ostrove. It features the company s Probiotic Blend Complex that includes maltodextrin Lactobacillus acidophilus Lactobacillus Lactis Bidfidobacterium longum Bidfidobacterium bifidum Lactobacillus bulgaricus and fructooligosaccharides. Ayush Probiotics 100B contains seven strains of bacteria and all the strains are from human origins which makes them well suited to adapt to the human body as they are naturally bile- and acid-resistant according to Paulson. The cultures are manufactured through a fermentation process. The bacteria are then freeze-dried and nitrogenpacked into vegetarian capsules producing a room-temperature stable product good for two years (longer if refrigerated). Ayush Probiotics 100B is also free of common allergens. In addition Ayush Probiotics 100B can be activated with food or on an empty stomach. Bio-Kult Advanced Multi-strain contains 14 probiotic strains according to Lamb. She explained that the formula delivers high concentrations of beneficial bacteria to the colonization sites in the gut and is thus able to help a more diverse range of GI issues. The Bio-Kult strains have shown significant antimicrobial activity good colonisation properties and an ability to stimulate the innate immune system. She noted that several clinical trials have been conducted using some of the Bio-Kult strains that have addressed support in areas of constipation 30 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 intestinal inflammation abdominal cramps non-alcoholic fatty liver disease and nonalcoholic stretohepatitis. Bio-Kult also offers Cand a a multi-strain probiotic supplement with added garlic and grapefruit extract to bolster the body s natural defenses against Candida overgrowth and may help to prevent it changing from its yeast-like form to the invasive filamentous fungus form by helping to prevent candida from finding sites in the gut to grow according to Lamb. Addressing urinary tract health is the goal of Bio-Kult s Pro-Cyan which contains cranberry extract standardized to give a minimum of 36 mg proanthocyanidins (PACs containing A-type) known to restrict the adhesion ability of bad (pathogenic) bacteria and two probiotic strains as well as vitamin A which contributes to the normal function of the immune system and the maintenance of mucous membranes. Nevada-based Hyperbiotics has developed probiotic products that focus on oral health as research shows that the health of the oral microbiome is closely associated with both digestive and overall health emphasized Jamie Morea co-founder. This is in large part because the mouth is the gateway to the gut and any bacteria living in the oral microbiome can make their way deep into the intestinal tract where up to 80 percent of the immune system resides. Additionally undesirable oral bacteria can escape into the bloodstream via the gums leading to issues with heart health blood glucose regulation and brain function. To keep the oral microbiome balanced with plenty of beneficial bacteria Hyperbiotics developed PRO-Dental an oral probiotic with strains chosen for their ability to combat the inhospitable bacteria that can lead to dental upper respiratory and systemic issues. In the recent clinical study Morea pointed out subjects who took PRODental daily for four months experienced significant reductions in levels of harmful oral bacteria that can cause gum-related health issues. A companion product is Hyperbiotics Activated Charcoal Probiotic Toothpaste which according to Morea contains xylitol to fight pathogenic bacteria activated coconut charcoal to whiten teeth and balance pH and probiotic L. paracasei to support a healthy oral microbiome. In fact research shows that the L. paracasei in Dental-Lac can help maintain healthy teeth and gums by directly increasing the number of probiotic bacteria and reducing the number of Streptococcus mutans (undesirable bacteria) in the mouth. Of course there are many probiotic products and probiotic-fortified foods such as yogurts that you can recommend to your clients patients. But keeping these guidelines in mind will help you recommend the most qualitative and effective ones that will encourage your patient client to assert that he she feels much better. The metabolic byproducts of a probiotic microorganism may have the greatest effect on a person s digestive health or on reduction of health issues than does the intake of a probiotic supplement. Researchers found that supplementing with Lactobacillus acidophilus Lactobacillus casei Bifidobacterium bifidum and Lactobacillus fermentum positively affected cognitive function and some metabolic statuses in the only human trial in AD patients. Dermatologists are starting to prescribe topical probiotics that are formulated with slightly different microbes or microbial ratios than oral probiotics and are seeing successful results. Emerging research is showing auto-immune disorders may be alleviated with the improvement of the human microbiome. Healthy Take Aways FOR MORE INFORMATION Ayush Herbs www.ayushherbs.com Bio-Kult www.bio-kult.com Hyperbiotics www.hyperbiotics.com Just Thrive Probiotic www.thriveprobiotic.com N D www.nudtrition.com Patient One www.patientoneformulas.com JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 31 PRODUCT FOCUS The Importance of Multivitamins hen it comes to recommending multivitamins to patients there are different vitamins and minerals that are catered to each person s needs. However what is more definite is the fact that some individuals are not taking them. According to the National Institutes of Health Office of Dietary Supplements W By Nicholas Saraceno more than one-third of Americans take multivitamin mineral (MVM) supplements. The rest of the breakdown is as follows Approximately one in four young children take MVMs while adolescents are considered least likely to take them. As one ages as an adult usage increases by the age of 71 more than 40 percent of individuals are taking MVMs. Knowing this patients can carefully consider their options including those that may better suit their vitamin or mineral deficiencies. Practitioners can suggest some of the possibilities below. AyushMulti Washington-based Ayush Herbs AyushMulti has been blended to ensure improved bioavailability optimal absorption and utilization. Very little absorption competition occurs in the gut due to the carefully formulated multivitamin. AyushMulti now includes methylfolate assisting in energy and neurotransmitter production. It is fortified with antioxidants including CoQ10 lycopene and lutein providing protection from daily toxins. AyushMulti contains higher concentration of bioflavonoids and the addition of trikatu (a blend of ginger black pepper and long pepper) enhances absorption power making this multivitamin a unique and powerful delivery of nutrients. A bottle of 90 capsules has a suggested price of 34.60. For more information call (425) 637-1400 or visit www.ayush.com. Daily Best Ultra This DaVinci Labs once daily multivitamin (by the Vermont-based FoodScience Corporation) features biologically active B vitamins including Quatrefolic the gold standard form of folate as well as vitamin K2 coenzyme Q10 and alpha lipoic acid making this an ideal choice for those in need of core foundational support to those who have more specific needs such as cardiometabolic support according to the company. A bottle of 60 capsules has a suggested price of 32.40. For more information call (800) 325-1776 or visit www.davincilabs.com. Vibrance Women s Multivitamin plus Stress Support Rainbow Light Vibrance Women s Multivitamin plus Stress Support by Nutranext (formerly Wellnext with its headquarters in Florida) is an advanced research-based formula specifically formulated to support a woman s distinct health needs with a wide variety of vitamins and minerals plus targeted nutrients to ease daily stress levels. Made with natural purity tested ingredients and no artificial preservatives colors flavors or sweeteners it is also vegetarian gluten free and certified non-GMO (genetically modified organism). To promote bone health patients get 100 mg of calcium 1 mg of boron and 1 000 IU of vitamin D. For support of estrogen metabolism the formula includes diindolylmethane (DIM). Patients get a comprehensive B-vitamin complex and magnesium to support a healthy stress response. Plus to ease digestive complaints and promote gut health the formula includes 75 million CFU of probiotics prebiotics and a full spectrum of plantsourced digestive enzymes. It is available in a 120-capsule bottle which has a suggested price of 57.99. For more information call (800) 635-1233 or visit www.rainbowlight.com. Vita-Min Vita-Min by Arkansas-based Bio-Tech Pharmacal Inc. is a unique multivitamin mineral product that contains essential nutrients needed for optimal health according to the company. Having a broad range of nutrients in one capsule is a simple and convenient way to fill the areas of nutrition that are lacking in people s diets. Vita-Min s comprehensive formula includes vitamins A C D E K1 and K2 as well as many different B vitamins including thiamine riboflavin niacin pyridoxine biotin folic acid and B12 (methylcobalamin). Several minerals are also used in the formula including magnesium iodine zinc selenium copper manganese and potassium among others. These ingredients and more are all combined in one capsule to make a comprehensive product that supports one s daily diet. Each 100- and 180-ct. bottle retails for 39.90 and 59.90 respectively. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose treat cure or prevent any disease. For more information call (800) 345-1199 or visit www.biotechpharmacal.com. 32 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Ultra Preventive X Ultra Preventive X is Pennsylvania-based Douglas Laboratories signature formula and the most comprehensive multivitamin and mineral supplement with an organic fruit vegetable and phytonutrient blend. This unique formula provides antioxidant support and many beneficial nutrients including carotenoids flavonoids polyphenols and bioavailable forms of vitamins and minerals that may contribute to optimal health. Counts of 120 and 240 have suggested prices of 42.80 and 76.60 respectively. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose treat cure or prevent any disease. ProThrivers Wellness Multivitamin ProThrivers Wellness Multivitamin by Integrative Therapeutics in Wisconsin supports overall health by emphasizing key pathways that have the strongest influence on the body. It contains a combination of nutrients that support the health of thrivers. A unique and important aspect of this formula is what it does not contain. ProThrivers Wellness Multivitamin does not contain beta-carotene alphatocopherol copper or boron. The ProThrivers line of products has been specifically designed with the guidance of Lise Alschuler ND FABNO a respected naturopath for 20 years and an expert in thriver care. The 60-ct. bottle has a suggested price of 45. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose treat cure or prevent any disease. For more information call (800) 245-4440 or visit www.douglaslabs.com. Women s Multivitamin New York-based N D s Women s Multivitamin is an all-in-one collection of premier vitamins for women designed with B vitamins to aid in the metabolism of fats carbohydrates and proteins. It also helps maintain healthy skin hair and nails with biotin beta-carotene vitamins A C and E and supports normal immune function with antioxidants such as vitamin C E beta carotene and zinc. Furthermore it supports daily energy needs. Sixty tablets have a suggested price of 14.99. For more information call (855) 683-8748 or visit www.nudtrition.com. For more information call (800) 931-1709 or visit www.integrativepro.com. Klean Multivitamin Klean Multivitamin by Klean Athlete in Pennsylvania provides important vitamins and minerals plus powerful antioxidant support in just two easy-toswallow tablets daily. NSF Certified for Sport ensures a safe and effective multivitamin supplementation to support the body s optimal performance. Klean Multivitamin has been carefully created to contain the proper proportion of vitamins minerals trace elements and other nutrients. Its unique fruit and vegetable blend along with antioxidants such as lutein lycopene zeaxanthin astaxanthin and pterostilbene are not typically found in other multivitamins making Klean Multivitamin a one-of-akind ally in an athlete s ongoing quest for optimal health and performance. Sixty tablets have an MSRP of 36. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose treat cure or prevent any disease. VitaSpectrum Powder Klaire Labs VitaSpectrum Powder by SFI USA in Nevada is a vitamin and mineral supplement developed specifically for children on the spectrum. A highly bioavailable blend of 28 essential nutrients VitaSpectrum addresses commonly observed nutritional imbalances. The formulation includes bioactive forms of folate B12 and B6 along with naturally sourced carotenes vitamin E and vitamin D for optimal absorption and utilization. Iron and copper are excluded. VitaSpectrum is free of common allergens milk casein fish shellfish tree nuts peanuts wheat gluten yeast and soybeans. No starch maltodextrin stearates artificial sweeteners colors flavors or preservatives are used. Available in berry pomegranate and citrus flavors the powder form of VitaSpectrum (5.8 oz.) has a suggested price of 30.95 while a 180capsule bottle is also available for 32.95. For more information call (888) 488-2488 or visit www.klaire.com. For more information call (855) 255-5326 or visit www.kleanathlete.com. Organic Life Vitamins Natural Vitality s Organic Life Vitamins by Nutranext (formerly Wellnext with a location in Texas) has 800 IU of vitamin D3 322 mg of trace mineral complex key vitamins and amino acids from organic quinoa seed. It also contains 24 organic superfruits 23 grams of premium organic aloe vera in each serving. A 30-oz. bottle is available for 36.95. For more information call (800) 446-7462 or visit www.naturalvitality.com. JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 33 PRACTITIONER CHAT WITH SHARI BARBANEL L inda Abbit founder of TenderLovingEldercare.com is a Baby Boomer and family caregiver with more than 20 years of hands-on experience. In 2009 she received the Caregiver of the Year Award from the Caregiving website. Abbit holds bachelor s and master s degrees in education and continues to be an advocate for older adults especially those with dementia and Alzheimer s disease. She was a support group facilitator for adult children and spouses of people with memory loss for her local Alzheimer s Association chapter. Abbit is also the author of The Conscious Caregiver A Mindful Approach to Caring for Your Loved One Without Losing Yourself. Also conscious caregivers acknowledge and honor the fact that they re not only caregivers but are also a spouse son daughter parent friend and or neighbor. They deliberately choose to serve all of these roles simultaneously. Conscious caregivers learn how to search within themselves to find the beauty caregiving brings. They manage to see the positives such as tenderness gratitude love and intimacy even under the most difficult circumstances. Please talk about caregiver burnout. What steps should caregivers take to avoid it anyone suggested to you that you might be burning out To avoid burning out caregivers first need to become aware of their physical emotional and mental states and take action if they start showing even one or two signs of burnout. If they see themselves slipping towards burnout they can let go and delegate tasks to family and friends asking to help seek out respite care in order to get a well-needed break join a support group and take time away from work or other commitments in order to create time for some muchneeded self-care. Linda Abbit (714) 343-8252 www.tenderlovingeldercare.com My goal was to ease the way for current and future family caregivers by sharing what I learned personally as a family caregiver and professionally through my work in the eldercare field. One of my most important messages is it s vital for caregivers to put themselves first and not feel guilty doing so. Both caregivers and care recipients benefit physically emotionally and spiritually when caregivers practice self-care. Q A What was your goal when deciding to write The Conscious Caregiver Conscious caregivers choose to allot time energy and compassion to themselves as well as their loved ones. They recognize the quality of caregiving improves when they care enough about themselves to take time away for activities that make them feel happier fulfilled and refreshed. Q A What is conscious caregiving Caregiver burnout occurs when caregivers find themselves in a state of physical emotional and mental exhaustion. Caregiver stress or burnout makes it difficult for a person to make decisions reason clearly and even get through the day. It worsens or increases the risks of many health problems such as a weakened immune system (leading to more illnesses and possibly a longer recovery time after surgery or other medical procedures) higher levels of anxiety or depression higher risk of chronic diseases such as stroke heart disease cancer type 2 diabetes arthritis obesity digestion problems headaches body aches and pains as well as substance abuse. The following are some questions caregivers can ask to determine if they re approaching burnout Have your sleep patterns changed Do you feel constantly irritated Are things upsetting you that didn t before Do you find yourself speaking sharply to your care recipient or your family Do you feel resentment toward them Are you less social and more isolated Are you avoiding social activities you used to enjoy Do you feel tired most of the day Has it been harder to make decisions Has your appetite and or weight changed Has Q A Self-care is any action taken intentionally to improve your mental physical emotional or spiritual health. Some popular self-care choices are meditation listening to music allowing yourself a good cry doing a physical activity pampering yourself (i.e. a date night with your spouse massage manicure pedicure bubble bath) and finding a way to laugh daily. When practiced regularly even if only briefly self-care will decrease caregivers chances of burnout. Self-care benefits include improvement in physical health better sleep patterns lowered stress levels decreased feelings of guilt anxiety and sadness and improved self-esteem. Plus doing something enjoyable goes a long way towards helping you rediscover a positive perspective overall about caregiving and life. Mindfulness is another part of selfcare. It s the ancient art of practicing self-awareness in the present moment without judgment. It means pausing in the midst of any situation and taking time to pay attention to yourself your environment and the overall experience. You don t try to assess judge or control what s happening. You simply observe. Pause. Observe. Reflect. And only after Q A What is self-care and what benefits does it offer caregivers 34 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 that respond or act. Taking these steps allows you to check in with yourself catch your breath assess your state of being and use this oasis in time to change your thoughts attitude or behaviors if needed. Mindfulness helps you realize you have the power to take charge of how you view and more importantly respond to any caregiving situation. In the book you talk about creating a Happiness L.I.S.T. Explain what it is as well as the significance of creating one I like to suggest caregivers create a Happiness L.I.S.T. where L.I.S.T. stands for Likes Interests and Satisfying Things that bring fulfillment. Write down five to 10 things and keep it with you to refer to. To make one think about the things you love to do those things you lose yourselves in and lose track of time when doing. What are hobbies and interests you did either during childhood or at any time throughout your life that you d reach for when you had free time These are most likely your biggest passions. Each person s L.I.S.T. will be personal and unique. For example some people like gardening playing a musical instrument dancing or enjoying the beach. If you only have a few minutes you can probably find something on your list to do as a break. For example even if you re bedside with a loved one in the hospital there are usually hospital grounds a courtyard or garden where you can get outside and take a brief walk alone to get some fresh air and sunshine. Or bring along a magazine with the article marked you ve wanted to read and immerse yourself in that as a treat. Can you talk about mindful communication Why is this so important It s important because clear and open communication with your care recipient as well as with other family members and the medical team makes caregiving go more smoothly on a dayto-day and long-term basis. Mindful or conscious communication is made up of three things--listening speaking and nonverbal communication. Mindful listening means taking time to create a setting where you can focus on Q A the conversation at hand. Yes it might take a little longer but being quiet and truly listening to your parent or spouse is important. There s an adage that says we have two ears and only one mouth for good reason. Focus on what words are being said as well as how they re being expressed. This will show your loved one you respect their ideas and desires. As long as they have the cognitive ability to make decisions their input is paramount. The words you speak can have a subtle but powerful effect on those around you. For example I use the word care recipient instead of patient. That s a deliberate choice because patient usually refers to someone who is ill or in need of health care. Not all care recipients are in poor health some just need assistance with activities of daily living (ADL s). In my mind care recipient is a more inclusive and kinder description. Nonverbal communication is expressed through body language and includes facial expressions eye contact or lack of it touch posture gestures and proximity to those you re speaking with. Nonverbal signals can add meaning far beyond the words being said. What advice would you tell practitioners to give to their patients caregivers I implore practitioners to ask caregivers about their caregiving situation and concentrate on their responses try to gauge their level of stress and provide resources to help them (i.e. support group therapist clergy respite care etc.). Research shows that caregivers needs are often not addressed at all or are overlooked or marginalized. Q A I d like to repeat for family caregivers Make yourself a priority every day. Find time to live love and laugh. And don t overlook any caregiver you meet who may be sliding unknowingly toward caregiver burnout. Help them become aware of and begin the practice of self-care. Q A Is there anything else you would like to add Q A JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 35 SUPPLEMENTSCIENCE By Gene Bruno MS MHS RH(AHG)--Professor of Nutraceutical Science Huntington College of Health Sciences I nflammation is a major mechanism involved in many human diseases. Since prolonged inflammation is detrimental to the host higher organisms have evolved protective mechanisms to ensure resolution of the inflammatory response in a limited and specific time- and space-manner. Once thought as a mere passive process of dilution of inflammation resolution is today envisioned as a highly orchestrated process coordinated by a complex regulatory network of cells and mediators.1 Alzheimer s. Evidence from recent research suggests that by inhibiting NF- B a wide range of diseases and conditions in which inflammation plays a critical role can be treated.2 Andrographis paniculata Background and Animal Research Enter Andrographis paniculata an herb with a history of use in both ayurvedic and traditional Chinese medicine. Called the king of bitters in Asia andrographis contains a number of bitter constituents which appear to have both immune-modulating and anti-inflammatory activity.3 Specifically during the screening of a plant extract library of traditional Chinese herbal medicines researchers found that NF- B activity was potently inhibited by andrographolide an abundant component of the plant andrographis.4 Subsequent research verified this effect and further demonstrated that andrographolide also reduced the expression of other pro-inflammatory proteins such as COX-2.5 In fact a recent arti- Nuclear Factor-kappa Beta One such mediator is nuclear factor-kappa Beta (NF- B) a protein that acts as a sort of switch to turn inflammation on and off in the body. In response to threats like free radicals and infectious agents as well as injury NF- B turns on genes that produce inflammation. As we age NF- B expression in the body increases provoking widespread chronic inflammation and setting the stage for diseases ranging from arthritis and atherosclerosis to diabetes and cle in the scientific journal Biochemical Pharmacology suggested that andrographolide and its analogs have great potential to be the next new class of antiinflammatory agents ... 6 The anti-inflammatory effects of andrographis were examined in various types of animal studies. In a study7 with mice andrographis extract significantly inhibited myocardial inflammation-related proteins caused by a high fat diet. In another mouse study 8 andrographolide ameliorated druginduced diabetic retinopathy by reducing inflammation including NF- B. In other research9 with mice andrographolide was found to be an effective anti-inflammatory agent for lung inflammation. Andrographis paniculata In-vitro Joint and Cartilage Research The demonstrated anti-inflammatory effect of andrographis and its andrographolides also have a direct effect on cartilage. This has important ramifications for joint health. 36 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Osteoarthritis is characterized by progressive and permanent cartilage degradation. Cartilage erosion can cause inflammation and pain decreased mobility and reduced athletic performance. This degradation is caused by Interleukin-1 (IL-1 ) cytokines which trigger the over-production of cartilage-degrading enzymes called matrix metalloproteinases (MMPs) in the synovial cells and the chondrocytes. Likewise in rheumatoid arthritis aggressive fibroblast-like synoviocytes (FLSs) are found in the synovial tissues. These FLSs invade and destroy joints and cartilage by actively releasing pro-inflammatory cytokines. They also produce massive amounts of cartilage-degrading enzymes especially matrix MMPs which contribute to the invasive growth of FLSs and subsequent joint destruction. Recent research has shown that andrographolide inhibits MMPs in IL-1-treated human chondrocytes (cells that produce collagen materials) while increasing the natural inhibitors of these enzymes via the NF-B pathway. A study found that andrographolide suppressed MMPs that were induced by IL-1 in equine cartilage.10 Andrographolide further slows cartilage degradation by dramatically reducing the loss of collagen hyaluronic acid and other key substances caused by IL-1. In addition the research also showed the ability of andrographolide to increase the production of cartilage biomolecules including collagen and hyaluronic acid. Furthermore blocking the action of FLSs will directly protect joints from cartilage destruction.11 In a study published in Cell Biology Toxicology synovial tissues were collected from 15 RA patients who had undergone a total knee replacement therapy the cells were treated with andrographolide for 48 hours.12 The study found that andrographolide induced cell death in these human RA-FLSs (rheumatoid arthritis fibroblast-like synoviocytes) which play key roles in cell death. The author suggested that andrographolide could be a potential therapeutic in supporting against joint destruction in both osteoarthritis and rheumatoid arthritis. These studies while interesting were the forerunners to impressive human clinical research. ducted in 60 patients with rheumatoid arthritis using a placebo or an Andrographis paniculata extract providing 50 percent total andrographolides (ParActin HP Ingredients). Subjects received tablets with 100 mg of the extract three times a day for 14 weeks. The primary outcomes were pain intensity measured using a horizontal visual analog pain scale (VAPS). In addition other joint and clinical parameters were recorded. The results were that those using the andrographis extract experienced a significant improvement in Standardized Andrographis paniculata Extract Rheumatic Disease and Human Research A prospective randomized double blind and placebo-controlled study13 was con- Tender joints (p 0.001) Number of swollen joints (p 0.02) Total grade of swollen joints (p 0.010) Number of tender joints (p 0.033) Total grade of swollen joints (p 0.01) Total grade of tender joints (p 0.002) Health assessment quality (p 0.001) Short form health survey (p 0.001) In addition use of the andrographis extract was associated to a reduction of rheumatoid factor a protein produced by the immune system that can attack healthy tissue in the body. The authors of the study concluded that andrographis extract could be a useful natural complement in the treatment of rheumatoid arthritis. Likewise andrographis extract can be used in combination with certain medications for rheumatoid arthritis for a superior outcome. To understand the significance of this integrative approach consider that there is no specific or etiological cure for rheumatoid arthritis and other rheumatoid conditions at this time. Treatment aims to limit joint damage prevent loss of function and decrease pain. The American College of Rheumatology (ACR) Guidelines recommends the administration of disease-modifying anti-rheumatic drugs (DMARDs) within three months of diagnosis and the immunosuppressant drug methotrexate (MTX) as the standard treatment in monotherapy or in combination with other DMARDs.14 However while MTX provides significant improvement in the number of tender and swollen joints pain and functional status starting at three months and plateauing after six to 12 months it can result in adverse events such as cytopenia (a reduction in the number of mature blood cells) serious infections liver damage and muco-cutaneous problems. The long-term use of MTX is associated with prevalence of significant liver enzymes in about 13 percent of the patients and 3.7 percent of the patients discontinue MTX permanently for liver toxicity.15 Now consider the results of a small human clinical trial16 with six individuals with various rheumatoid conditions who were given 300 mg day of Andrographis paniculata extract providing 50 percent total andrographolides (150 mg twice daily ParActin HP Ingredients) for four years. The group consisted of three male and three female patients all with a long history of active rheumatoid diseases. The results showed that supplementation with andrographis extract significantly improved in the number of swollen joints total grade of swollen joints total grade of tender joints and quality of life. Also noted were significant reductions in RF erythrocytes sedimentation rate and C-Reactive Protein (CRP). Furthermore serum immunological parameters of inflammation were reduced progressively during 48 months of supplementation with andrographis extract. Of particular interest was that after 24 months of treatment the six patients were able to discontinue other medications having progressed to supplementing with ParActin as their only therapeutic agent. No side effects were observed indicating that the andrographis extract was safe nontoxic and well tolerated. Standardized Andrographis paniculata Extract Muscle Recovery Heretofore this article has discussed the use of andrographis extract for the treatment of serious joint conditions. However andrographis extract also has role to play in another type of less serious injury muscle JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 37 SUPPLEMENTSCIENCE recovery in the gym. For those of us who work out in the gym are used to a certain amount of muscular wear and tear resulting in the well-known adage No pain no gain. Nevertheless as we age the muscular repair process can take longer and the additional pain can last longer as well. Furthermore as we age our musculoskeletal system (i.e. bones joints tendons ligaments and muscles) changes by gradually losing muscle mass connective tissues (i.e. tendons ligaments cartilage and other support structures) flexibility and the resilience that was present at a younger age. As it turns out andrographis extract may be able to help. A study17 was conducted in which mice were treated with andrographis extract (ParActin HP Ingredients) for three months and tested for muscle degeneration and regeneration. Results showed that the andrographis extract Reduced inflammation in the skeletal muscle via NF- B inhibition as well as by reducing the COX-2 enzyme which in turn reduces of inflammatory chemicals that causes pain and inflammation. Reduced fibrosis and pro-fibrotic factor which might otherwise have inhibited the skeletal muscle regenerative processes. Reduced muscle damage and lowered serum creatine kinase an enzyme whose presence may reflect muscle breakdown. The breakdown in muscle proteins might otherwise cause an inflammatory response by the immune system leading to swelling and pain. Improved skeletal muscle strength and exercise performance. The study author concluded that the supplement group exhibited less severe muscular dystrophy performed better in an exercise endurance test and had improved muscle strength compared to control mice. use of certain medications with serious side effects. Finally research on mice suggests that this andrographis extract may also help with muscular pain and recovery in the gym. Together all of this makes a significant case for the use of supplement as a naturally anti-inflammatory agent. cal cardiac hypertrophy and apoptosis in high-fat diet fed mice. J Ethnopharmacol. 2016 Nov 4 192 170177. 8 Yu Z Lu B Sheng Y Zhou L Ji L Wang Z. Andrographolide ameliorates diabetic retinopathy by inhibiting retinal angiogenesis and inflammation. Biochim Biophys Acta. 2015 Apr 1850(4) 824-31. 9 Abu-Ghefreh AA Canatan H Ezeamuzie CI. In vitro and in vivo anti-inflammatory effects of andrographolide. Int Immunopharmacol. 2009 Mar 9(3) 313-8. 10 Tangyuenyong S Viriyakhasem N Peansukmanee S Kongtawelert P Ongchai S. Andrographolide Exerts Chondroprotective Activity in Equine Cartilage Explant and Suppresses Interleukin1 -Induced MMP-2 Expression in Equine Chondrocyte Culture. Int Sch Res Notices. 2014 (2014) 8. 11 Doody KM Stanford SM Sacchetti C Svensson MN Coles CH et al. Targeting phosphatase-dependent proteoglycan switch for rheumatoid arthritis therapy. Sci Transl Med. 2015 May 20 7(288) 288ra76. 12 Yan J Chen Y He C Yang ZZ L C Chen XS. Andrographolide induces cell cycle arrest and apoptosis in human rheumatoid arthritis fibroblast-like synoviocytes. Cell Biol Toxicol. 2012 Feb 28(1) 47-56. 13 Burgos RA Hancke JL Bertoglio JC Aguirre V Arriagada S Calvo M C ceres DD. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms a prospective randomized placebo-controlled trial. Clin Rheumatol. 2009 Aug 28(8) 931-46. 14 Guidelines for the management of rheumatoid arthritis (2002). UpdateArthritis Rheum. 2002 46(2) 328-46. 15 Salliot C Van Der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis a systematic literature research. Ann Rheum Dis. 2009 68(7) 1100-4. 16 Hidalgo MA Hancke JL Bertoglio JC Burgos RA. Andrographolide a New Potential Drug for the Long Term Treatment of Rheumatoid Arthritis Disease. In Matsuna H (ed). Innovative Rheumatology. Rijeka Croatia InTech 2013 247 270. 17 Cabrera D Guti rrez J Cabello-Verrugio C Morales MG Mezzano S Fadic R Casar JC Hancke JL Brandan E. Andrographolide attenuates skeletal muscle dystrophy in mdx mice and increases efficiency of cell therapy by reducing fibrosis. Skelet Muscle. 2014 Mar 21 4 6. Gene Bruno MS MHS the dean of academics for Huntington College of Health Sciences is a nutritionist herbalist writer and educator. For more than 30 years he has educated and trained natural product retailers and health care professionals has researched and formulated natural products for dozens of dietary supplement companies and has written articles on nutrition herbal medicine nutraceuticals and integrative health issues for trade consumer magazines and peer-reviewed publications. He can be reached at gbruno hchs.edu. As we age our musculoskeletal system (i.e. bones joints tendons ligaments and muscles) changes by gradually losing muscle mass connective tissues (i.e. tendons ligaments cartilage and other support structures) flexibility and the resilience that was present at a younger age. As it turns out andrographis extract may be able to help. References 1 Cl ria J. Resolution of Acute Inflammation and the Role of Lipid Mediators. Scientific World Journal. 2010 10 1553 1555. 2 Lawrence T. The Nuclear Factor NF- B Pathway in Inflammation. Cold Spring Harb Perspect Biol. 2009 Dec 1(6) a001651. 3 Bone K. Clinical Applications of Ayurvedic and Chinese Herbs Monographs for the Western Herbal Practitioner. Queensland Australia Phytotherapy Press 1996 96 100. 4 Xia YF Ye BQ Li YD Wang JG He XJ Lin X Yao X Ma D Slungaard A Hebbel RP Key NS Geng JG. Andrographolide attenuates inflammation by inhibition of NF-kappa B activation through covalent modification of reduced cysteine 62 of p50. J Immunol. 2004 Sep 15 173(6) 4207-17. 5 Hidalgo MA Romero A Figueroa J Cort s P Concha II Hancke JL Burgos RA. Andrographolide interferes with binding of nuclear factor-kappaB to DNA in HL-60-derived neutrophilic cells. Br J Pharmacol. 2005 Mar 144(5) 680-6. 6 Tan WSD Liao W Zhou S Wong WSF. Is there a future for andrographolide to be an anti-inflammatory drug Deciphering its major mechanisms of action. Biochem Pharmacol. 2017 Sep 1 139 71-81. 7 Hsieh YL Shibu MA Lii CK Viswanadha VP Lin YL Lai CH Chen YF Lin KH Kuo WW Huang CY. Andrographis paniculata extract attenuates pathologi- Conclusion The effect of Andrographis paniculata and its andrographolides on NF- B and inflammation is impressive as is its effects on reducing collagen breakdown in joint tissue. Of even greater significance however is the human clinical research on Andrographis paniculata extract providing 50 percent total andrographolides (ParActin HP Ingredients) on safely and effectively reducing joint inflammation (i.e. swollen joints) and joint tenderness in arthritis sufferers. In addition human clinical research showed that supplementation with this andrographis extract eventually allowed arthritis patients to discontinue the 38 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 NATURAL HEALTH STUDIES Camelina Oil Improves Blood Lipid Profile he use of camelina oil reduces overall and LDL cholesterol levels in people with impaired glucose metabolism according to a new study from the University of Eastern Finland. The findings were published in Molecular Nutrition & Food Research. The study analyzed the associations of camelina oil fatty fish and lean fish with lipid and glucose metabolism and lowgrade inflammation. Camelina oil is rich in alpha-linolenic acid (ALA) which is a plant-based omega-3 fatty acid. Earlier research has shown that fish protein and long-chain omega-3 fatty acids found in fish have beneficial effects on several risk factors associated with cardiovascular diseases. Research evidence relating to the T effects of ALA on these risk factors however remains scarce. The study involved 79 Finnish men and women with impaired fasting glucose concentrations aged between 40 and 72. The study participants were randomly divided into four groups the camelina oil group the fatty fish group the lean fish group and the control group. Depending on their group the study participants were instructed to eat either fatty or lean fish four times a week or to take a daily 30 mL dose of camelina oil for a period of 12 weeks. People in the control group were allowed to eat fish once a week and the use of camelina oil or other oils containing ALA was prohibited. The researchers found that camelina oil had a positive effect on blood cholesterol levels but no similar effects were observed for fatty or lean fish. Moreover there were no significant differences in glucose metabolism or low-grade inflammation between the groups. (Source Molecular Nutrition & Food Research--December 2017) Diet Rich in Apples and Tomatoes May Help Repair Lungs of Ex-smokers study from the Johns Hopkins Bloomberg School of Public Health found the natural decline in lung function over a 10-year period was slower among former smokers with a diet high in tomatoes and fruits especially apples suggesting certain components in these foods might help restore lung damage caused by smoking. The researchers found that adults who on average ate more than two tomatoes or more than three portions of fresh fruit a day had a slower decline in lung function compared to those who ate less than one tomato or less than one portion of fruit a day respectively. The researchers inquired about other dietary sources such as dishes and processed foods containing fruits and vegetables (e.g. tomato sauce) but the protective effect was only observed in fresh fruit and vegetables. The paper which is part of the Aging Lungs in European Cohorts (ALEC) Study funded by the European Commission and led by Imperial College London also found a slower decline in lung function among all adults including those who had never or had stopped smoking with the highest tomato consumption. Poor lung function has been linked with mortality risks from all diseases including chronic obstructive pulmonary disease (COPD) heart disease and lung cancer. A The findings appear in the December issue of the European Respiratory Journal. This study shows that diet might help repair lung damage in people who have stopped smoking. It also suggests that a diet rich in fruits can slow down the lung s natural aging process even if you have never smoked said Vanessa Garcia-Larsen assistant professor in the Bloomberg School s Department of International Health and the study s lead author. The findings support the need for dietary recommendations especially for people at risk of developing respiratory diseases such as COPD. For the study the research team assessed diet and lung function of more than 650 adults in 2002 and then repeated lung function tests on the same group of participants 10 years later. Participants from three European countries--Germany Norway and the U.K.--completed questionnaires assessing their diets and overall nutritional intake. They also underwent spirometry a procedure that measures the capacity of lungs to take in oxygen. The test collects two standard measurements of lung function Forced Exhaled Volume in one second (FEV1) which measures how much air a person can expel from their lungs in one second and Forced Vital Capacity (FVC) the total amount of air a person can inhale in six seconds. The study controlled for factors such as age height sex body mass index (an indicator of obesity) socio-economic status physical activity and total energy intake. Among former smokers the diet-lungfunction connection was even more striking. Ex-smokers who ate a diet high in tomatoes and fruits had around 80 mL slower decline over the 10-year period. This suggests that nutrients in their diets are helping to repair damage done by smoking. Lung function starts to decline at around age 30 at variable speed depending on the general and specific health of individuals explained Garcia-Larsen. Our study suggests that eating more fruits on a regular basis can help attenuate the decline as people age and might even help repair damage caused by smoking. Diet could become one way of combating rising diagnosis of COPD around the world. (Source European Respiratory Journal-- December 2017) JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 39 NATURAL HEALTH STUDIES Drinking Hot Tea Every Day Linked to Lower Glaucoma Risk rinking a cup of hot tea at least once a day may be linked to a significantly lower risk of developing the serious eye condition glaucoma finds a small study published online in the British Journal of Ophthalmology. But drinking decaffeinated and caffeinated coffee decaffeinated tea iced tea and soft drinks do not seem to make any difference to glaucoma risk the findings show. Glaucoma causes fluid pressure to build up inside the eye (intraocular pressure) damaging the optic nerve. It is one of the leading causes of blindness worldwide and currently affects 57.5 million people and is expected to increase to 65.5 million by 2020. Previous research suggests that caffeine can alter intraocular pressure but no study so far has compared the potential impact of decaffeinated and caffeinated drinks on glaucoma risk. Researchers looked at data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) in the U.S. This is a nationally representative annual survey of approximately 10 000 people that includes interviews physical examinations and blood samples designed to gauge the health and nutritional status of U.S. adults D and children. In this particular year it also included eye tests for glaucoma. Among the 1 678 participants who had full eye test results including photos 84 (5 percent) adults had developed the condition. They were asked how often and how much they had drunk of caffeinated and decaffeinated drinks including soft drinks and iced tea over the preceding 12 months using a validated questionnaire (Food Frequency). Compared with those who didn t drink hot tea every day those who did had a lower glaucoma risk the data showed. After taking account of potentially influential factors such as diabetes and smoking hot tea-drinkers were 74 percent less likely to have glaucoma. But no such associations were found for coffee--caffeinated or decaffeinated-- decaffeinated tea iced tea or soft drinks. This was an observational study so no firm conclusions can be drawn about cause and effect and the absolute numbers of those with glaucoma were small. Information on when glaucoma had been diagnosed was also unavailable. Nor did the survey ask about factors like cup size tea type or the length of brewing time all of which might have been influential. But tea contains antioxidants and antiinflammatory and neuroprotective chemicals which have been associated with a lowered risk of serious conditions including heart disease cancer and diabetes said the researchers. Further previous research has suggested that oxidation and neurodegeneration may be involved in the development of glaucoma they added concluding Further research is needed to establish the importance of these findings and whether hot tea consumption may play a role in the prevention of glaucoma. (Source British Journal of Ophthalmology--December 2017) Caffeine Level in Blood May Help Diagnose People With Parkinson s Disease esting the level of caffeine in the blood may provide a simple way to aid the diagnosis of Parkinson s disease according to a study published in the January 3 2018 online issue of Neurology. The study found that people with Parkinson s disease had significantly lower levels of caffeine in their blood than people without the disease even if they consumed the same amount of caffeine. Previous studies have shown a link between caffeine and a lower risk of developing Parkinson s disease but we haven t known much about how caffeine metabolizes within the people with the disease said study author Shinji Saiki MD PhD of Juntendo University School of Medicine in Tokyo Japan. People in the study with more severe stages of the disease did not have lower levels of caffeine in the blood suggesting T that the decrease occurs from the earliest stages of the disease according to David G. Munoz MD of the University of Toronto in Canada who wrote an editorial accompanying the study. If these results can be confirmed they would point to an easy test for early diagnosis of Parkinson s possibly even before symptoms are appearing he said. This is important because Parkinson s disease is difficult to diagnose especially at the early stages. The study involved 108 people who had Parkinson s disease for an average of about six years and 31 people of the same age who did not have the disease. Their blood was tested for caffeine and for 11 byproducts the body makes as it metabolizes caffeine. They were also tested for mutations in genes that can affect caffeine metabolism. The two groups consumed about the same amount of caffeine with an average equivalent to about two cups of coffee per day. But the people with Parkinson s disease had significantly lower blood levels of caffeine and nine of the 11 byproducts of caffeine in the blood. The caffeine level was an average of 79 picomoles per 10 microliters for people without Parkinson s disease compared to 24 picomoles per 10 microliters for people with the disease. For one of the byproducts the level was below the amount that could be detected in more than 50 percent of the people with Parkinson s disease. In the statistical analysis the researchers found that the test could be used to reliably identify the people with Parkinson s disease with a score of 0.98 where a score of 1 means that all cases are identified correctly. (Source Neurology--January 2018) 40 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 Underactive Thyroid Within Normal Range May Affect Woman s Ability to Conceive N ew research suggests that a slightly underactive thyroid may affect a women s ability to become pregnant--even when the gland is functioning at the low end of the normal range according to a study published in the Endocrine Society s Journal of Clinical Endocrinology & Metabolism. The study found women who have unexplained infertility were nearly twice as likely to have higher levels of a hormone that stimulates the thyroid gland than women who did not conceive due to known issues with their male partner s sperm count. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland at the base of the brain and tells the thyroid gland to produce more hormones when needed. Elevated TSH levels can be a sign that the thyroid gland is underactive. Unexplained infertility occurs when couples are unable to get pregnant despite months of trying and a medical evaluation shows no reason for their infertility. Approximately 10 percent of American women between the ages of 15 and 44 have difficulty becoming or staying pregnant according to the Office of Women s Health in the U.S. Department of Health and Human Services. Further between 10 and 30 percent of affected couples have unexplained infertility according to the study. When couples who are ready to start a family are unable to conceive despite extensive planning multiple doctor s visits and expensive treatments it can be emotionally devastating said the study s senior author Pouneh K. Fazeli MD MPH of Massachusetts General Hospital and Harvard Medical School. Since our study shows that women with unexplained infertility have higher TSH levels compared to women experiencing infertility due to a known cause more research is needed to determine whether treating these higher TSH levels with thyroid hormone can improve their chances of getting pregnant. As part of the cross-sectional study the researchers analyzed data from female patients between the ages of 18-39 years of age who were diagnosed with infertility at Partners HealthCare System hospitals in Boston between 2000 and 2012. Only women with regular menstrual cycles and a normal fertility evaluation were included. The researchers looked at TSH levels taken as part of the fertility evaluation from 187 women with unexplained infertility and 52 whose partners had severe male factor infertility. The researchers found that women with unexplained infertility had significantly higher TSH levels than women with infertility due to a known cause. Nearly twice as many women with unexplained infertility had a TSH greater than 2.5 mlU L compared to women whose partners had male factor infertility. Since we now know from our study that there is an association between TSH levels at the high end of the normal range and unexplained infertility it is possible that a high-normal TSH level may negatively impact women who are trying to get pregnant Fazeli said. This could open up new avenues for possible treatments. The next step will be to see if lowering TSH levels will help this group conceive. (Source The Journal of Clinical Endocrinology & Metabolism--December 2017) Health Benefits of Swapping Animal Proteins for Plant Proteins ubstituting one to two servings of animal proteins with plant proteins every day could lead to a small reduction in the three main cholesterol markers for cardiovascular disease prevention a new study suggests. The health benefits could be even greater if people combined plant proteins with other cholesterol-lowering foods such as viscous water-soluble fibers from oats barley and psyllium and plant sterols said lead author Dr. John Sievenpiper of St. Michael s Hospital in Canada. Dr. Sievenpiper led a systematic review and meta-analysis of 112 randomized control trials in which people substituted plant proteins for some animal proteins in their diets for at least three weeks. The results were published online in the Journal of the American Heart Association. Dr. Sievenpiper said the review indicated that replacing one to two servings of animal proteins with plant proteins every day--primarily soy nuts and pulses (dried peas and S beans lentils and chickpeas)--could reduce the main cholesterol markers by about 5 percent. That may not sound like much but because people in North America eat very little plant protein there is a real opportunity here to make some small changes to our diets and realize the health benefits said Dr. Sievenpiper a clinician scientist with the hospital s Clinical Nutrition and Risk Modification Centre. Dr. Sievenpiper added previous studies have shown the cholesterol-lowering benefits of individual foods or food groups but that this paper looked at the benefits of substituting any plant proteins for animal proteins. Most of the randomized control trials they studied used soy (plant) proteins to replace dairy (animal) proteins. We are seeing a major interest in plantbased diets from Mediterranean to vegetarian diets in the supermarket and the clinic and this comprehensive analysis of the highest level of evidence from randomized trials provides us with more confidence that these diets are heart healthy he explained. The study looked at the impact of replacing animal protein with plant protein of three key markers for cholesterol low-density lipoprotein cholesterol (LDL or bad cholesterol which contributes to fatty buildups in arteries and raises the risk for heart attack stroke and peripheral artery disease) non-high density lipoprotein cholesterol (non-HDL-C or total cholesterol minus HDL or healthy good cholesterol) and apolipoprotein B (the proteins in bad cholesterol that clog arteries). (Source Journal of the American Heart Association--December 2017) JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 41 NATURAL MARKETPLACE NATURAL MARKETPLACE PROVIDES INFORMATION ABOUT NEW PRODUCTS AVAILABLE TO THE NATURAL HEALTH CARE INDUSTRY. ALL STATEMENTS CLAIMS AND PRODUCT INFORMATION ARE PROVIDED BY THE MANUFACTURER. NATURAL PRACTITIONER DOES NOT ENDORSE ANY PRODUCTS INCLUDED IN NATURAL MARKETPLACE OR ATTEMPT TO CORROBORATE ANY CLAIMS MADE BY THE MANUFACTURER. To have a new product included in Natural Marketplace please send a press release and photograph to Natural Practitioner by email to ShariB VRMmedia.com. NerveCare FARMINGDALE NY--Patient One s NerveCare by MediNutritionals Research LLC provides a synergistic blend of bioavailable natural compounds designed to support healthy glucose metabolism along with the health of the nervous system. NerveCare works on virtually all components of the nervous system from tissue health to circulation and maintenance and helps defend against diabetic-related concerns. Thirty servings (90 vegetable capsules) are available for a suggested price of 42. For more information call (877) 723-0777 or visit www.patientoneformulas.com. Greens First Female Line BOCA RATON FL--Greens First Female by Wellness Watchers is an evidencedbased professional-grade line of natural products developed and recommended by notable OB GYN s to support reproductive health from the time a woman starts menstruating through post-menopause. Each product contains clinically supported high-quality ingredients that specifically target symptoms at their source. Greens First Female is a no nonsense line of products for women who aspire to take control of their life and seek natural options to bring about balance and support wellness. One month supplies on all products consisting of capsules powders or stick packs range from a suggested price of 21.95 to 42.99. For more information call (844) 433-3625 or visit www.greensfirstfemale.com. FAMILY OF PRINT AND DIGITAL MEDIA Branch Out With VRM s NaturalPractitionerMag.com VitaminRetailer.com NIEmagazine.com FitnessTrainerMag.com Contact One of Our Ad Specialists Today Russ Fields at (732) 432-9600 ext. 102 or e-Mail RussF VRMmedia.com Gary Pfaff at (732) 432-9600 ext. 103 or e-Mail GaryP VRMmedia.com 42 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY FEBRUARY 2018 MEDIACORNER The Wellness Center Solution How Physicians Can Transform Their Practices Their Income and Their Lives Author Dr. Raj Gupta (DC) Pages 132 Price 16.95 (paperback) 25.95 (hardcover) Publisher Soul Focus Contact Cathy K. Hayes cathy newsandexperts.com Private practices in America are disappearing and you a private practice business owner struggle to stay afloat. Insurance reimbursements are decreasing every year and so is your revenue. Sell retire or drastically cut payroll and overhead. These are your choices right now as a physician-owned private practice but it doesn t have to be your future. What practice owners need is a new profitable business model. That model is now here. The Wellness Center Solution shows practice owners and would-be practice owners not only how to open a wellness center but also why they should. Stop accepting less pay for more work. The Soul Focus model is for building not just the practice of the future but also the wellness center of tomorrow so you can take back control of your practice your income and your life. The Better Brain Solution How to Start Now--at Any Age--to Reverse and Prevent InsulinResistance of the Brain Sharpen Cognitive Function and Avoid Memory Loss Author Steven Masley MD FAHA FAAFP FACN CNS Pages 384 Price 27.95 (hardcover) Publisher Knopf Contact Erinn Hartman ehartman penguinrandomhouse.com Alzheimer s disease is the number one most terrifying disease today. Despite billions of dollars of research there are no significant cures for dementia or Alzheimer s (the most common form of memory loss) which accounts for up to 70 percent of all dementia. Almost six million Americans have been diagnosed with Alzheimer s with an annual cost of dementia care and research in the United States of 215 billion more than what is spent on cancer or heart disease. In The Better Brain Solution Dr. Masley writes of the two urgent epidemics we are facing now--escalating rates of disabling memory loss and rapidly increasing rates of diabetes and pre-diabetes--and yet both conditions are largely preventable. Most people today understand the effect that elevated blood sugar has on their cardiovascular health but few understand that insulin resistance is significantly damaging to the brain. In the book Dr. Masley offers a program that in the fight against diabetes memory loss and cognitive decline can reverse insulin resistance enhance cognitive performance and stop cognitive decline before it is too late. Dr. Masley gives the reader the tools he has developed for his own private patients to prevent and reverse this metabolic syndrome and to achieve normal blood sugar levels (below 95 mg dL). He explores the impact of insulin resistance on the brain and the heart brain diabetes connection explaining how cognitive function and memory work and he discusses the risk factors for memory loss. The Better Brain Solution offers the reader a comprehensive plan for achieving optimal brain health providing information on brain-boosting foods and supplements as well as providing a practical way to assess cognitive function with 50 recipes for foods that improve brain and body and are easy to prepare. CSU Nutrition Team Rolls Out New App for Eating Smart Being Active A host of tools created at Colorado State University (CSU) to help people lead a healthy lifestyle are now just a smartphone tap away. A new app has been developed for Eating Smart Being Active the acclaimed curriculum developed a decade ago by a team led by CSU professor and Extension Specialist Susan Baker of the Department of Food Science and Human Nutrition. Eating Smart Being Active targets low-income families and is widely used by nutrition education programs in 41 states Puerto Rico and Guam. Baker s team developed the new smartphone application to reinforce the information and skills taught in the ninelesson classes. In addition to a daily step tracker the app features recipes found in the Eating Smart Being Active Let s Cook Cookbook and includes shopping lists for each recipe. The app also has simple exercises taught in the classes that don t require any special equipment and can be done anywhere. The exercises are demonstrated with simple GIF animations that don t burn data which is an important consideration for anyone on a budget. Also included in the app is a unit price calculator to help people quickly and easily find the cost-per-ounce of a food product so that prices can be compared at the grocery store. The app is available to Colorado State University Extension EFNEP (Expanded Food and Nutrition Education Program) class participants but anyone can download it for free by searching for Eating Smart Being Active in the Apple App Store or Google Play for Android. Eating Smart Being Active updated in April 2017 reflects the 2015-2020 Dietary Guidelines for Americans from the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. In addition to the guideline changes the curriculum helps low-income individuals learn how to cook healthy and inexpensive meals at home--and incorporate more physical activity into their daily routines. The 90-minute classes taught by CSU Extension EFNEP educators at schools health clinics and human service agencies covers how to choose healthier foods stretch food budgets and be more physically active. Cookbooks are free to all class participants but individual copies of the Eating Smart Being Active Let s Cook Cookbook can be purchased through CSU Extension at www.csuextstore.com. For more information visit http eatingsmartbeingactive.colostate.edu. JANUARY FEBRUARY 2018 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 43 CONFERENCES AND EVENTS February 10-11 GPL Academy Practitioner Workshops Austin TX Learn how to better integrate specialty diagnostic testing into your practice for greater patient health outcomes. This workshop will review organic acids testing toxic chemical testing and mycotoxin testing. For more information visit www.greatplainslaboratory.com. February 22-24 Integrative Healthcare Symposium New York NY This clinically relevant evidence-based medical conference program is designed to educate inspire and engage integrative practitioners and those interested in learning more about alternative and complimentary approaches to heath care. Speakers at this year s event include Woodson Merrell MD founding executive director of the Center for Health and Healing in New York and founding member of Bravenet a practiced-based ingregrative medicine research network of the Bravewell Collobrative Heba Elnazer MD founder of director of Revive Medical and many more. For more information visit www.ihsymposium.com annual-conference. February 24-25 GPL Academy Practitioner Workshops Los Angeles CA Learn how to better integrate specialty diagnostic testing into your practice for greater patient health outcomes. This workshop will review organic acids testing toxic chemical testing and mycotoxin testing. For more information visit www.greatplainslaboratory.com. April 6-8 Southwest Conference on Botanical Medicine Tempe AZ Held at the Southwest College of Naturopathic Medicine this conference will teach attendees how to manage surgery with botanicals including cancer surgery pros and cons. It will also cover Botanical Medicine for Mood Disorders in Children and Teens Herbal Nootropics Enhancing Memory Focus and Concentration and Promoting Lymphatic Health with Botanicals. If one arrives on April 6 there will be various pre-conference events including Kenneth Proefrock ND who will discuss Botanical Therapies for Substance Abuse and Addiction. CE credits are available for health professionals and early bird registration is open until March 1. For more information visit www.botanicalmedicine.org. April 13-15 GPL Master Practitioner Workshops Chicago IL This special three-day workshop will provide in-depth information about some of GPL s most popular and clinically useful tests so you can better incorporate them into your practice. Tests covered in this workshop include the Organic Acids Test GPL-TOX (Toxic Non-Metal Chemical Profile) Glyphosate Test GPL MycoTOX Profile and more. For more information visit www.greatplainslaboratory.com. June 1-4 Medicines from the Earth Herb Symposium Black Mountain NC Held at Blue Ridge Assembly presentations on clinical applications of botanical medicine will include COPD and Women How Herbs Can Help Mycotoxins--The Health Effects of Mold and How to Diagnose and Treat Combining Essential Oils and Aromatherapy with Herbs (three-part series) including a pre-conference intensive with Amanda McQuade Crawford titled Botanical Medicine in a Clinical Psychology Practice--Chronic Pain PTSD Anxiety and Depression. CE credits are available for health professionals and early bird registration is open until February 22. For more information visit www.botanicalmedicine.org. June 5-10 Holistic Nursing Creating & Expanding Global Presence Niagara Falls NY Held at The Conference & Event Center Niagara Falls the American Holistic Nurses Association s 38th annual conference will allow attendees to connect with more than 500 holistic nurses who may be seeking products and services to enhance their practice. They will also have 30 open hours to network with the conference s highly specialized group of nurses. If exhibitors pay in full by January 31 they can save 20 percent. For more information visit www.ahna.org. ADVERTISER INDEX ADVERTISER American BioSciences Inc. America s Finest Inc. Daiwa Health Development Kyowa Hakko USA LivOn Laboratories Natural Partners Inc. Nordic Naturals Protexin Inc. 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