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www.naturalpractitionermag.com March April 2019 A VRM Media Publication Don t miss a single issue of NP in 2019 go online to renew your free subscription today NaturalPractitionerMag.com MarchApril19 Go to www.naturalpractitionermag.com protocolforlife for info about this advertiser Go to www.naturalpractitionermag.com balchem for info about this advertiser MARCH APRIL 2019 TABLE OF CONTENTS VOLUME 8 NO. 2 20 30 40 FEATURES COLUMNS 20 Of Sound Mind 4 Editor s Note 38 Nutrition & Science 8 Practitioner Corner 40 Supplement Science 36 Product Focus Multivitamins Brainstorming ways to boost memory and concentration. 27 Enter Sandman Americans are more stressed than ever for a multitude of reasons and stress disrupts the ability to relax unwind rest and sleep. Here s how to help your patients chill and welcome a hesitant sandman. 30 Walking the Digestion Trail Practitioners can share the word about the up-to-date ways their patients can keep their digestive tracts healthy. DEPARTMENTS 13 Health Industry News 19 INM Update 43 Practitioner Chat 44 Natural Health Studies Visit NaturalPractitionerMag.com FreeProductInfo for FREE Product Information or Samples from All Natural Practitioner Advertisers 46 Natural Marketplace 47 Conferences & Events 48 Advertiser Index FREE Subscription (Print Digital or BOTH) FREE E-newsletter Visit NaturalPractitionerMag.com Copyright 2019. Natural Practitioner (ISSN 2331-2580) Volume 8 Number 2 March April 2019. 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. 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All other issues are 10.00 each. 2 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com livon for info about this advertiser EDITOR S NOTE Matters of the Mind y mother constantly loses things or as she likes to say misplaces them when she puts them away because she knows that she ll eventually find what she was looking for even if it takes years. This is nothing new an elementary school teacher once told her that her head would roll away if it weren t attached to her body. While discussing this with a family friend who is a neurologist he noted that forgetting where you put something when you were trying to hide it or misplacing your keys may not be the problem. But when you find said keys and don t know what they are used for that would be a real cause for concern. In the cognitive health feature (see page 20) Isaac Eliaz MD MS LAc medical director of Amitabha Medical Clinic and Healing Center explained that the term cognitive impairment is really a continuum from mild impairment where people may notice changes such as trouble remembering learning new things concentrating or making decisions to more severe levels various types of dementia or Alzheimer s with loss of ability to function independently. Dr. Pauline Jose added that mild cognitive impairment (MCI) needs to be differentiated from early dementia. Patients with MCI in contrast to mild M dementia usually have no interference with daily activities but doing more complex tasks like paying bills may take more time she said. Patients with mild dementia are able to do basic activities of daily living like bathing grooming and eating but more than one domain is affected. These domains include learning and memory language psychomotor visuospatial and executive. Dementia always progresses and patients decline while some patients with MCI may improve cognitively probably because the cause was reversed like a medication with cognitive side effects or a medical illness. Having MCI though is certainly a risk factor for developing dementia. This month s Practitioner Corner article (see page 8) also addresses cognitive function. In the column Amber Lynn Vitale BA CN mentioned the Blue Zones which are five geographical areas around the world where people live well into old age with none of the physical or cognitive decline that are common with aging. All five Blue Zones have lifestyle factors in common including moderate but consistent exercise moderate caloric intake dietary focus on plants moderate polyphenol-rich alcohol intake absence or reduction of stress and a purpose to one s life with social engagement spiritually and family. And while it s not always possible to control what is happening around us we can all take a cue from these Blue Zone lifestyle factors. PUBLISHER DANIEL MCSWEENEY EDITORIAL DIRECTOR DanM VRMmedia.com ASSOCIATE PUBLISHER RUSS FIELDS RussF VRMmedia.com ADVERTISING BARRY YOUNG SALES MANAGER Barry 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 Connect With Us 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 www.twitter.com vitaminretailer www.facebook.com vitaminretailermagazine 4 NATURAL PRACTITIONER www.linkedin.com company vrm-media www.instagram.com vitaminretailermagazine www.pinterest.com vrm_media go.vrmlink.com youtube Back Issues See the Table of Contents page for price and order information. WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com euromedica for info about this advertiser Meet Natural Practitioner s Editorial Advisory Board 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. Lucille s commitment to naturopathic medicine has been recognized with the Daphne Blayden Award and more recently the SCNM Legacy Award. Amber Lynn Vitale BA CN Amber Lynn Vitale has practiced as a certified nutritionist ayurvedic specialist advanced bodyworker and yoga therapist since 1996. Much of her nutrition practice was in collaboration with functional medicine doctors and other integrative practitioners. Since 2008 she has produced written and video educational content for many publications as well as for her own clients and an interested public audience. By 2012 she had realized that raw materials sourcing labeling transparency legitimate certifications and educational support were the criteria that would set quality natural products companies apart from others and she made it her mission to educate the public on the importance of education before supplementation. In 2014 Vitale became the north east regional educator for Garden of Life and continues to write lecture and produce online content on health and wellness topics important to the practitioner and the patient alike. 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 life s 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. 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. 6 NATURAL PRACTITIONER 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. Adam Killpartrick DC CNS Dr. Adam Killpartrick is a chiropractor specializing in upper cervical chiropractic and cranial work and a certified nutrition specialist. While in private practice Dr. Killpartrick began working as a clinical consultant and medical educator in the nutritional supplement industry and then moved on to a director of product development role. Currently he is the chief science officer for FoodScience Corporation makers of DaVinci Labs and VetriScience products overseeing research and development for both the human products as well as pet product lines. 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 (McGrawHill). 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. 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. WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com childlife for info about this advertiser PRACTITIONER CORNER Aging Without Disengaging BRAIN HEALTH FOR LIFE By Amber Lynn Vitale BA CN very one of us knows someone or has at the very least heard of someone who is well into their 80s 90s or even 100s who is as sharp as a tack. Their cognitive functioning has not significantly declined with age while the majority of others has lost long- and short-term memory processing and certainly the ability to absorb and retain new information. The exciting thing is that this means it is possible to gain years without losing brain power If some people manage is it not a possibility for all of us Wouldn t we all love to be honored and revered for our wit wisdom and intelligence in our later years What the scientific community cannot agree upon is exactly what makes the difference between those who truly experience golden years and those who stumble deeper into a painful and undignified decline. Indeed up until recently most of the efforts in looking for a cure for or even a way to halt the progression of different kinds of dementia have focused on undoing cellular abnormalities observed in brain tissue. Strangely this did not help patients get E 8 NATURAL PRACTITIONER better. It turned out those abnormalities were there as a result of the brain trying to protect itself. Protect itself From what Is it inflammation Is it poor diet the SAD (standard American diet) Is it lack of exercise Is it toxins like in air pollution mercury in our fish or fillings or aluminum cookware Studies show that like autism any and all of these can be contributing factors. Is Alzheimer s disease caused by a deficiency of neurotransmitters or a deficiency of acetylcholinesterase inhibitors If you look at the current pharmacological treatment available after hundreds of millions of dollars of research over the years you would think so. According to the Alzheimer s Association Alzheimer s disease is the sixth-leading cause of death in the United States and the only cause of death among the top 10 in the United States that cannot be prevented cured or even slowed and no current pharmaceutical drug can treat the underlying disease or delay its progression. Interestingly there are well-established Blue Zones in five geographical areas around the world in which people live well into old age with none of the physical or cognitive decline we seem to have come to expect. What do these five areas have in common Lifestyle It is really not that difficult and yet it must be rocket science or everyone would be doing it no According to journalist Dan Buettner who co-developed this anthropological theory on the back of demographic work done by Gianni Pes and Michel Poulain there are several factors that each of these areas have in common moderate but consistent exercise moderate caloric intake dietary focus on plants moderate polyphenolrich alcohol intake absence or reduction of stress and a purpose to one s life with engagement socially spiritually and with family. Of course in our reductionist culture we all jumped on the alcohol A glass of red wine every day I can do that But I cannot reduce my stress when my life is so stressful So how do we create a Blue Zone in our own living rooms First of all many of us cannot completely control the environment in which we live. Whether for financial physical WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com emerson for info about this advertiser PRACTITIONER CORNER reasons social or family reasons or other reasons many of us may be unable to move to a place with abundant sunshine fresh air access to good clean food and a less urgent pace. Secondly even if we could move there we may be unable to make the kinds of social connections that are important we might not fit in. Or we might just bring our problems with us. Thirdly we can all make excuses for not eating better I don t live near a good supermarket I can t afford healthy foods I don t know how to prepare that kind of food my husband wife children won t eat the same things I want to eat I don t have time it stresses me out to try to make those changes it s all just a bunch of baloney anyway. Furthermore can we really create good family and social connections where they don t exist in our lives Can we come up with a purpose to our lives when we just don t feel like we ever really had one And stress it s just like insomnia the more you try to get rid of it the more of it you have. As practitioners we ve heard all this and probably more. But here s the thing all the experts we ve been reading and hearing from over the last decade and more in the integrated health field of natural practitioners have all been saying the same thing. There are certain changes our patients absolutely must make in order to improve and ideally get better from whatever conditions they are suffering. In his newly released and now best-selling book Dr. Dale Bredesen lays out The End of Alzheimer s. It is the culmination of decades of his own work and research as well as compiling the tireless efforts of other pioneers before and alongside him. The diet is not something new and earth shattering but it is in the context of other important lifestyle changes that are specially tailored to each individual s particular combination of risk factors that has put them on the path of unnecessary cognitive decline. This is what is complicated each of us possesses biochemical individuality each of us begins our life in our own way with our own genetic pre-programming each of us has our own path through life with its unique insults and challenges (epigenetics) and each of us possesses our own capacity or inability to change. While we all know that exercise can be as effective as any pharmaceutical or nutraceutical anxiolytic or anti-depressant there is no ethi- 10 NATURAL PRACTITIONER cal way to force an anxious or depressed person into regular moderate exercise. While we all know that vitamin D3 is crucial for so many areas of our health and wellness including memory and mental functioning and it is best when we make it from exposure to photons of light there are so many reasons why so many people fail to achieve an optimal level of D3. We all know that more vegetables are so important in our diets and yet most of us fail to include them at the level necessary to make a real lasting health impact. With years of consulting nutrition clients under While we all know that vitamin D3 is crucial for so many areas of our health and wellness including memory and mental functioning and it is best when we make it from exposure to photons of light there are so many reasons why so many people fail to achieve an optimal level of D3. my belt I and so many of my colleagues have learned that the main reason people don t get better is because of an inability or unwillingness to change the inputs. And so I ve learned to simplify it. If you cannot do the simple stuff then you certainly don t need to read the whole book Interestingly enough many of the recommendations for cognitive health as we age are the same as for anxiety and depression when we are younger. Here are the basics BDNF (brain derived neurotrophic factor) has been found to play an instrumental role in neurotransmitter balance and thus protection and regeneration of brain cells neurons really. BDNF is like growth hormone for the brain and has been the most important neuroprotective protein discovered in neurology. While there are an increasing number of supple- ments on the market to improve BDNF levels there are several things we can do every day to make sure we produce it naturally 1. Exercise just like in the Blue Zones consistent daily moderate exercise. 2. Sleep no electronics no blue lights no TV noise deep proper sleep. 3. Meditate to compensate for poor sleep to manage stress to floss the mind. 4. Hold your breath breathing exercises pranayama calming breath work. 5. Sunshine to bathe the pineal gland for better biorhythms and to make vitamin D3. 6. Community be a part of something greater stay connected laugh. 7. Eat flavonoid-rich polyphenols in foods herbs and spices berries coffee (fruit especially) dark chocolate turmeric green tea grape seeds and skins broccoli onions spinach tomatoes and legumes. 8. Eat proper fats all cell membranes are composed of a phospholipid bilayer balancing omega-3s with healthy plant saturated fats and anti-inflammatory plant monounsaturated fats give us the best cellular building materials to support the making of new neurons and the repair of damaged ones. 9. Feed your minions growing a healthy microbiome probably ensures that those polyphenols you eat get properly translated at the gut lining to encourage BDNF production. A healthy microbiome ensures we get more nutrients from both our foods and our supplements and supports both detoxification and healthy inflammatory pathways. This is where the plant-based and low-sugar diet becomes important and is a major factor for people in the Blue Zones. Simple enough yes Nobody gets out of having to make these changes. The complicated stuff is identifying each person s toxic exposures that may be putting them at risk and supporting their bodies in coping with and eliminating them. Additionally other health concerns put some people at higher risk for anxiety depression and all forms of dementia. Metabolic syndrome for example with escalating levels of insulin due to insulin resistance not only is associated with lower levels of BDNF but also allows the formation of amyloid-beta plaques while the enzyme that would break them down is distracted with dismantling excess WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com kaneka for info about this advertiser PRACTITIONER CORNER insulin. Being on a statin pharmaceutical medication to lower cholesterol levels has now been correlated with increased risk of Alzheimer s as the LDL (low-density lipoprotein) and total cholesterol levels are reduced. Lack of exercise lack of sunshine and the elevation of inflammatory cytokines produced by abdominal adipose tissue all contribute to cognitive decline not to mention the recent correlation between an increasing waistline and a shrinking hippocampus. Thus it is obviously important for each person to be assessed as an individual relevant to their own health issues that may be contributing to cognitive decline. Decline in brain function does not have to be a part of aging. But like every other system in our body the brain is not an island. It should come as no surprise that the health of the brain is intimately intertwined with the health of all systems organs and tissues. Gone are the days of Rene Descartes and the belief that the mind and the body are separate and only merge in the pineal gland. Now we under- stand that all aspects of health and disease in our body can and will affect our mental capacity. We also now have a better scientific grasp of the ancient observations of Chinese and ayurvedic medicine that all health and disease have an origin in the digestive tract. Most of the dietary recommendations for overall brain health especially the intake of polyphenols result in lowered inflammatory markers. The correlation between less inflammation and better overall health is demonstrated in hundreds of studies and when we take a look around the world as in these Blue Zones and places like them we find less chronic degenerative disease of all types. It s simply time to bring these ideas home to our own patients there is no magic pill but there is certainly an answer. References https bluezones.com live-longer-better . http ijphjournal.it article view 5886. www.ncbi.nlm.nih.gov books NBK3795 78 . https docs.wixstatic.com ugd 1a2e49_a6311 e25b2e844c2986b03143356f415.pdf. Amber Lynn Vitale has practiced as a certified nutritionist ayurvedic specialist advanced bodyworker and yoga therapist since 1996. Much of her nutrition practice was in collaboration with functional medicine doctors and other integrative practitioners. Since 2008 she has produced written and video educational content for many publications as well as for her own clients and an interested public audience. By 2012 she realized that raw materials sourcing labeling transparency legitimate certifications and educational support were the criteria that would set quality natural products companies apart from others and she made it her mission to educate the public on the importance of education before supplementation. In 2014 Vitale became the north east regional educator for Garden of Life and continues to write lecture and produce online content on health and wellness topics important to the practitioner and the patient alike. Go to www.naturalpractitionermag.com americannutraceuticals for info about this advertiser 12 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 HEALTH INDUSTRY NEWS New Congress Focuses on Integrative Health & Wellness he bipartisan Congressional Integrative Health and Wellness Caucus has been registered with two new co-chairs at the helm for the 116th Congress. Representative Judy Chu (CA) will serve as the Democratic leader with Representative Jackie Walorski (IN) as the Republican leader replacing former Caucus co-chairs Colorado Congressmen Polis and Coffman respectively. The Caucus held its first meeting of the new Congress on March 6 on Capitol Hill with an education program and active demonstrations of integrative treatments provided to House Members and staff. Given the recent passage of the HR6 SUPPORT Act addressing the country s opioid crisis the focus of the event was integrative models of care for pain management. Both representatives sit on the powerful Committee for Ways and Means which ultimately governs Medicare along with payments to health care providers delivering care to Medicare beneficiaries such as those working in hospitals surgery centers and outpatient departments. Both new Caucus co-chairs were instrumental in crafting language for the HR6 SUPPORT Act and are involved in seeking T legislative solutions regarding patient access to nonpharmacologic treatments and services for pain and addiction. The opioid epidemic in our country has made it more important than ever to explore non-opioid alternatives to pain management stated Congresswoman Chu. That is why I am so pleased to be a cofounder of the Integrative Health and Wellness Caucus. Through this caucus we hope to educate our colleagues about safe alternatives like acupuncture which for millennia has been successful at treating a number of health conditions in addition to pain. I am hoping we can help make more health care options available and accessible to all Americans. Integrative health care approaches are critical to treating pain one of the biggest health challenges Americans face added Congresswoman Walorski. As co-chair of the bipartisan Integrative Health and Wellness Caucus I look forward to working with my colleagues to combat the opioid crisis and help patients by improving access to innovative and multidisciplinary approaches to pain management. I am committed to working across the aisle to ensure patients and providers have access to non- opioid alternatives and the comprehensive care they need. The event sponsored by the bipartisan Representatives is open to all members of Congress and their staff. Hosted by the Integrative Health Policy Consortium speakers will educate lawmakers on what integrative health models of care look like what current barriers to access for these care models are as well as hold demonstrations of services designed to treat chronic neck and back pain with nonpharmacologic methods. IHPC applauds the efforts of the Integrative Health and Wellness Caucus cochairs in addressing the current opioid crisis and looking for innovative ways to deliver health care services and treatment options that include nonpharmacologic options for the millions of Americans that struggle with pain and addiction stated IHPC Director of Government Affairs Kallie Guimond. We look forward to working with the cochairs to build Caucus membership and to be a resource for its members for many years to come. For more information visit www.ihpc.org whats-missing-from-healthcare. A4M Announces First-ever Conference in New Delhi he American Academy of Anti-Aging Medicine (A4M) has announced a new partnership with India as part of the company s continued commitment to international expansion with upcoming events in 2019 spanning the world s largest urban metropolises. Following nearly three decades of successfully developing and spearheading the anti-aging movement poised to become one of the largest businesses worldwide A4M s expansion in India cements its ever-increasing international impact and scope. The first event marking this important partnership will occur in January 2020 in New Delhi featuring the field s most accomplished and renowned clinical experts researchers and investigators sharing the most current cutting-edge research. As a foundational meeting in the fundamental tenets of anti-aging medicine the conference will highlight the most recently emerging therapeutic practices and protocols in personalized and preventive care with a specific focus on how to customize and individualize medicine and address root causes in order to generate enhanced patient outcomes and more effective care. T Developed in partnership with Bhupendra Kumar Modi (Dr. M) a successful social entrepreneur and a global thought leader who is the promoter of Modi Mediciti India s largest upcoming premier health care ecosystem in New Delhi and who has recently launched the Smart Metabolic AntiAging Centre in Saket as part of the Mediciti A4M India is a continuation of collective efforts to celebrate and advocate breakthrough transformations in the everchanging landscape of health care. With the Smart Metabolic Anti-Aging Centre s focus on long-term solutions through integrative approaches including regenerative medicine techniques plant-based nutraceuticals hormonal therapies and lifestyle support & recommendations India is well poised to become a designated hub of integrative well- MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM ness and proactive health care. Quoted in a recently published article in Business Standard Preeti Malhotra president of Modi Mediciti and GMHRC stated Our vision behind bringing this concept to India was to disrupt the health care model in the country. Health care services currently offered across the country are essentially based on reactive care and not preventive care. We want to completely transform this dynamic. Through a holistic and comprehensive approach the Centre and A4M s mutually aligned goals will redefine today s practice of health care. With the medical field s evolving emphasis on disease prevention before symptoms occur A4M s expansion in India marks an important step in facilitating the goals of preventative medicine. As A4M s international offerings increase globally along with its longstanding focus on treatment of symptoms and root causes A4M is uniquely positioned to advance the landscape of modern medicine in partnership with health care practitioners and professionals throughout the world. For more information visit www.a4m.com. NATURAL PRACTITIONER 13 HEALTH INDUSTRY NEWS American Nutriceuticals Celebrates 20th Anniversary NutritionFacts.org Launches Free Downloadable Healthy Living Guide merican Nutriceuticals (Vancouver WA) has announced that the company is celebrating its 20th Anniversary. Founded in 1999 by the late Bill Coury a bone cancer survivor who researched innovative therapies and supplementations American Nutriceuticals started as a health and integrative wellness center and for the past 10 years has been dedicated to supporting health practitioners. It s so rewarding to see my father s work continued by outstanding doctors and clinics said Chairman Rob Coury. American Nutriceuticals success is based on providing the highest quality proven physician grade supplements and protocols with unsurpassed customer service for leading health professionals nationally. For more information visit www.888vitality.com. onprofit science-based health organization NutritionFacts.org has released a free downloadable evidence-based eating guide geared toward assisting the public as well as allied health professionals with providing comprehensive nutrition information to their patients. This allinclusive resource is available to download for free at www.nutritionfacts.org healthkit. This Evidence-Based Eating Guide A Healthy Living Resource from Dr. Greger & NutritionFacts.org is a tool backed by the most balanced evidence of current research regarding nutrition and human health and it is designed to simplify the switch to a healthier lifestyle. It is an easy-to-follow guide with valuable applicable information for eating healthier including a breakdown of Dr. Michael Greger s Traffic Light Eating tips for using Dr. Greger s Daily Dozen checklist sample menus and resources. For more information visit www.nutritionfacts.org healthkit. A N NUNM Celebrates Completion of Naturopathic Medicine Book Series he National University of Natural Medicine (NUNM) and its NUNM Press has announced the completion of The Hevert Collection In Their Own Words a 12-volume anthology that presents original writings from the early literature of the founders of the naturopathic profession. The scholarly and painstaking efforts of Dr. Sussanna Czeranko a naturopathic physician and Rare Book Room curator of the NUNM Library restore and reintroduce to contemporary doctors the words and wisdom of the early 20th century naturopathic medical pioneers. Ten years in the making the writings have been researched culled edited and compiled into the 12-volume Hevert series bringing back to life the foundational information about the philosophy and history of naturopathic medicine. Benedict Lust a leading pioneer of naturopathy in the U.S. published medical journals to which he and his colleagues contributed extensively. In 1986 NUNM received a bequest from the Lust family containing the entire historical collection a treasure trove of writings from hundreds of early naturopathic practitioners and teachers including Sebastian Kniepp Louis Kuhne Emanuel Felke and Henry Lindlahr in addition to Lust and his wife Louisa. NUNM President David J. Schleich PhD said that this vast output of historical record was seminal in the emergence of naturopathic medicine. Dr. Czeranko s mission was formidable to select and order from the huge formational literature the very best of the clinical historical T 14 NATURAL PRACTITIONER and philosophical materials of naturopathic medicine from the early 20th century. Dr. Schleich noted that the Hevert series taps into clinical wisdom from an earlier era of medicine one that has been virtually inaccessible to today s naturopathic clinicians. It s a significant resource for our students and graduates to better understand where naturopathic medicine originated and how it developed with assiduously researched and cross-referenced historical citations. The nearly 6 000-page series of publications cover topics from the origin and founding principles of the early 20th century profession to detailed accounts of the therapeutic practices that relied on natural elements. The books describe the successful treatments of patients with conditions ranging from life-threatening and acute illnesses to chronic diseases. These volumes carefully examine topics such as herbs dietetics hydrotherapy mind-body medicine vaccinations and more. Dr. Schleich noted that the series would not have been possible without early generous support and funding from Hevert Pharmaceuticals of Germany. The Hevert Collection affirms NUNM s commitment to the roots of traditional naturopathic medicine by making the best of the early literature available again. It s fitting that the wealth of healing wisdom in these valuable publications is available through assistance from Lust s homeland. The massive undertaking has been a labor of love for Dr. Czeranko who has donated all book copyrights and proceeds to NUNM where she has worked since 2007 and will soon retire returning to her home in the Canadian province of Saskatchewan where she will open a nature-cure clinic Manitou Waters. Dr. Czeranko will embark on an international book tour in March to launch and promote The Hevert Collection with stops in in cities throughout the U.S. and Canada culminating with a presentation to the 2019 International Congress on Naturopathic Medicine to be held this July in London UK. For more information visit https nunm-press.com. Dr. Sussanna Czeranko WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 ACPM and ICHWC Partner to Develop a Diabetes Prevention Program Group Coaching Certificate ith funding from the Centers for Disease Control and Prevention (CDC) the American College of Preventive Medicine (ACPM) is partnering with the International Consortium for Health & Wellness Coaching (ICHWC) a nonprofit subsidiary of the National Board of Medical Examiners (NBME) to develop group coaching competencies a training program and a certificate examination that supports wide dissemination of the National Diabetes Prevention Program (National DPP) lifestyle change program. NBME representatives will also participate and lend their expertise in producing high-quality certification examinations. This collaboration marks the beginning of a multi-year concerted effort to improve the skills and outcomes of National DPP lifestyle coaches. The CDC-led National DPP is a scientifically proven program to help prevent or delay type 2 diabetes among at-risk adults. The lifestyle change program is a critical component that helps participants develop lasting healthy lifestyle changes. The CDC funding allows ICHWC to combine our passion and leadership in developing a coaching workforce skilled in helping people engage in W healthy lifestyles to prevent type 2 diabetes and other chronic diseases at scale said Margaret Moore co-founder and board member of ICHWC. One in three American adults are living with pre-diabetes and 90 percent of them don t know they have it. Pre-diabetes is a condition in which blood sugar is higher than normal but not high enough yet to be diagnosed as diabetes. In response CDC developed the evidence-based National DPP lifestyle change program now a covered benefit of Medicare and many private insurers. The National DPP lifestyle change program is a year-long lifestyle coaching program for people with pre-diabetes designed to improve eating habits increase physical activity and lose 5 percent or more of body weight. This program is founded on the science of the Diabetes Prevention Program research study and subsequent translation studies which showed that making realistic behavior changes helped people with pre-diabetes lose 5 to 7 percent of their body weight and reduce their risk of developing type 2 diabetes by 58 percent (71 percent for people over 60 years old). In order to elevate NDPP lifestyle coaching skills nationwide the collaboration has gathered together the top master coaches in group coaching including National DPP coach trainers and coaches and National Board Certified Health and Wellness Coaches said ICHWC board member and subject matter expert Tim Cline who is developing the group coaching curriculum with National DPP Master Trainer Greg Hottinger. ACPM collaborates with CDC on several capacity-building projects to support health care providers in helping their patients live healthier lifestyles. Group coaching skills are in high demand by health care providers interested in delivering group medical visits and or referring their patients with pre-diabetes to the National DPP lifestyle change program offered by coaches who are credentialed and have acquired advanced skills training. We are excited to support the creation of the program and wide dissemination of these valuable skills in clinical and community settings to stem the epidemic of type 2 diabetes and other chronic diseases related to unhealthy lifestyles said Danielle Pere vice president of programs and education at ACPM. For more information visit www.acpm.org. Go to www.naturalpractitionermag.com womensinternational for info about this advertiser MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 15 HEALTH INDUSTRY NEWS Bauman College Celebrates 30 Years ow celebrating its 30th anniversary Bauman College (Berkeley CA) continues to be at the forefront of the holistic health movement. It was a pioneer who championed ideas now widely accepted in the whole-foods movement and its renowned Nutrition Consultant and Natural Chef programs are grounded in a scientific evidence-based approach. Dr. Ed Bauman founded the school in 1989 when the American food scene was at a low point. Processed food was the norm he explained. Graduate schools were still teaching nutrition professionals the Standard American Diet (SAD) and the four basic food groups which later became the Food Guide Pyramid. Appalled by this I was determined to develop an alternative so I designed Eating for Health a diversified non-dogmatic whole-food system that created the foundation for a new and better educational process that has brought many to Bauman College. Dr. Bauman s acclaimed Eating for Health system seeks to strategically develop food plans for people rather than relying on a cookie-cutter food model that only works for a small portion of the population. It also serves to clear up the confusion caused by the endless stream of fad diets. It features fresh whole foods that align with people s needs preferences access time N and financial constraints and ethnic and cultural backgrounds with attention paid to changes in seasons situations aging and health challenges. The goals of this unique system are first to provide optimal nutrient density that can be most efficiently digested and assimilated. Eating for Health also seeks to reconnect people with the intrinsic pleasures to be gained from choosing delicious nourishing foods and eating them mindfully and with gratitude. This allows for better digestion and assimilation of nutrients along with a sense of having nourished oneself not only physically but emotionally and spiritually as well. Eating for Health embraces two powerful maxims food is the best medicine and know thyself creating a synergy that opens the way to wellness and service. Bauman College Director of Academics Rosie Ueng MS agreed. When Bauman College was founded it was the only program of its kind a pioneer in the field of holistic health and nutrition. Dr. Bauman offered an individualized and inclusive whole-foods perspective that hugely contributed to revolutionizing the paradigm of wellness. The school has since paved the path to an increased collective awareness of food as medicine. Dr. Bauman s ideas have been reinforced by a breadth of research and the college s curricula are constantly updated to incorporate additional findings from the most current scientific studies. Ueng is determined that Dr. Bauman will continue to change the world through nutrition. The humanitarian and planetary health concerns we face today are more imminent than ever before she said. In the face of these concerns Bauman College will continue to be a leader in promoting healing on individual community and global levels. Celebratory events and curriculum news will be announced throughout the year. For more information visit https baumancollege.org. OmegaQuant Launches the First Prenatal DHA Blood Test for Pregnant Women megaQuant Analytics (Sioux Falls SD) producer of the original omega-3 blood test The Omega-3 Index has launched its newest test the Prenatal DHA Test. Developed to help expecting moms monitor their omega-3 DHA (docosahexaenoic acid) level the company believes this tool will help women figure out how much of this important nutrient they need in order to support a full-term pregnancy. Approximately 10 percent of babies are born too early each year and the medical community is still uncertain as to all the reasons why. New research suggests a nutrient deficiency might be at least partly to blame. DHA has been the subject of several recent studies specifically connecting it with a risk of early preterm birth (before 34 weeks) which is one of the top concerns for doctors and pregnant women. One study showed that taking DHA could reduce this risk by 42 percent while O 16 NATURAL PRACTITIONER another study showed that women with low blood levels of DHA are 10 times more likely to deliver a baby prematurely than women with healthy DHA levels. Researchers believe assessing a mother s DHA status could be instrumental in identifying women at increased risk for preterm birth. In other words if a woman knows her DHA level is low then she can make the necessary dietary modifications to bring those levels into an optimal range. The DHA level a pregnant woman should strive for is at least 5 percent (i.e. 5 percent of her red blood cell fatty acids are DHA). If a woman falls below 5 percent she can easily increase her DHA level by eating more fatty fish like salmon or taking an omega-3 supplement that contains at least 200 mg of DHA. DHA levels in pregnant women of 4.3 percent are described in the research as very low with 3.5 percent defined as exceedingly deficient. In a study we published in December we estimated that 70 percent of women of childbearing age in the U.S. are below the 5 percent DHA cutoff. There are no known risks to having a DHA level that is too high in pregnancy except for the potential of carrying a baby past 40 weeks. Still the longer a baby can stay in the womb the lower the chances are for complications said Kristina Harris Jackson PhD RD a research associate at OmegaQuant Analytics. It s hard to think of a more important biomarker than prenatal DHA levels that can be safely and easily modified and has such potentially consequential outcomes. For more information visit https omegaquant.com prenatal-dhatest . WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Noted Pharmaceutical Compliance Expert to Develop Quality Training Workshops at AAHP Summit omeopathic manufacturers attending the American Association of Homeopathic Pharmacists (AAHP) Quality & Safety Summit this summer will gain valuable insight during three sessions developed by George Bernstein PhD a wellknown compliance expert for both homeopathic and allopathic companies. The limited-seating workshops will also provide easy access to this notable consultant for specific questions during this time of change for the industry. Dr. Bernstein president of MAI Consulting Inc. in Chapel Hill NC will draw upon his more than 30 years of pharmaceutical manufacturing and compliance consulting experience to help homeopathic manufacturers prevent inspection problems before they arise and address compliance issues if they do arise. As a pharmaceutical consultant he works to improve the efficiency compliance and quality of small medium and large domestic and global pharmaceutical companies. Dr. Bernstein his family and H their pets have been using homeopathic medicines for more than 30 years. The AAHP Summit will feature three tracks Quality Safety and Regulatory. As the leader of the Quality Track Dr. Bernstein will work with other knowledge leaders to develop and present practical recommendations that will deliver the most value to attendees. The three Quality Track sessions are 1. Establishing Analytical Specifications 2. Process Validation 3. Finished Product Testing Content Uniformity Now more than ever it is time for the homeopathic industry to come together and learn best practices and new approaches for manufacturing our products said Mark Land AAHP president. The focused program should provide attendees ample interaction with knowledgeable leaders like George all at a fraction of the cost it would require for individual companies to hire consultants. MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM Dr. Bernstein has shared his expertise with AAHP members in the past through an address at the association s semiannual meeting last March and webinars on preparing for an FDA (U.S. Food and Drug Administration) audit ( The FDA is Coming March 2018) and process validation ( The Validation Master Plan in 2009). He has helped many pharmaceutical companies including homeopathic manufacturers to address and resolve 483 and Warning Letter observations and with FDA communications. The AAHP Summit Challenges and Solutions in Quality & Safety of Homeopathic Drug Products Keeping Your Business Compliant under FDA s New Proposed Guidance is scheduled for June 28 2019 in Baltimore MD in conjunction with NCH and AIH s Joint American Homeopathic Conference. Registration will open in the coming weeks. For more information visit www.theaahp.org events. NATURAL PRACTITIONER 17 HEALTH INDUSTRY NEWS Nobel Laureate to Speak at Conference Hosted by OSU s Linus Pauling Institute Nobel laureate whose discoveries have advanced treatments for heart disease and impotence will deliver a keynote public address at Oregon State University (OSU) this summer part of the Linus Pauling Institute s biennial conference on vitamins minerals and natural products and their effects on human health. Registration is open to hear the presentation by Dr. Louis Ignarro who earned the Nobel Prize in Physiology or Medicine in 1998 and is best known for his work with nitric oxide. Dr. Ignarro s discoveries regarding nitric oxide as a signaling molecule in the cardiovascular system made possible new medications for heart patients and men who experience impotence. A The three-day conference to be the University of Minnesota. He has held at the CH2M Hill Alumni been on the faculty of UCLA Center on OSU s Corvallis campus (University of California Los Angeles) features scientific presentations on since 1985. dietary supplements such as vitaDr. Ignarro s keynote lecture The mins minerals and plant-derived Road to Stockholm A Nobel compounds and the role of reducMission is scheduled for 5 to 6 30 tion-oxidation signaling in diseases p.m. on Aug. 16 the final day of the like cancer and neurodegeneration. conference at Oregon State s LaSells Dr. Louis Ignarro This year s event the Linus Pauling Stewart Center 875 S.W. 26th St. Institute s 10th International Corvallis. The presentation is free but Conference takes place as a joint effort with the those wishing to attend must register online to Society for Redox Biology and Medicine. reserve their seats. Dr. Ignarro a Brooklyn NY-born son of Italian For more information visit https apps.idealimmigrants studied chemistry and pharmacology logic.com cms key F3T9-25VWY_K9KHat Columbia University and earned a doctorate at 5PTF_bd5b8708. ACHS Chosen as One of the Top 100 Companies to Work For merican College of Healthcare Sciences (ACHS) an accredited online integrative health college based in Portland OR has been recognized as one of the 2019 Top 100 Best Companies to Work For in Oregon by Oregon Business Magazine. This marks the third year ACHS has been honored with this distinction. Final rankings were be announced on Feb. 28 2019 at the Oregon Convention Center in Portland. The much anticipated ranking of the top 100 Best Companies to Work For will be listed in the March 2019 issue of Oregon Business Magazine along with a countdown of the 2019 top 10 companies. The rankings are based on the confidential input of employees who answered questions about A workplace satisfaction such as benefits management trust work environment and career development. The survey was voluntary and free of charge results are independently calculated by research partner Checkpoint Surveys. As a wellness-focused college and Certified B Corporation our mission is to educate our students as well as our staff and community about how to live healthier lives said ACHS Founding President Dorene Petersen. We are committed to operating with integrity deserving of the trust of our students customers suppliers community and staff so it s a great honor to be recognized by our family of employees for our efforts to make working at ACHS a healthy rewarding experience. ACHS policies reflect the value of each staff member to the overall team and demonstrate the social impact that thoughtful corporate policies can have in the workplace. Creating policies like its paid parental leave and telecommuting options help ACHS valuable trusted and committed long-term employees balance work family and other pursuits. In a knowledge-based industry like ours that adds significant value and that is the heart of the B Corp supporting the triple bottom line of people and the planet as well as profits. ACHS was the first accredited higher education institution specializing in holistic health and wellness to become a Certified B Corporation. For more information visit www.achs.edu. You re Hired Jeff Hilton BrandHive s (Salt Lake City UT) co-founder and chief marketing officer has been invited to join Southwest College of Naturopathic Medicine & Health Science s (SCNM) Advisory Council. The council consists of a select group of leaders within the Natural Products Industry appointed by the president CEO of SCNM. CV Sciences Inc. (Las Vegas NV) has announced the appointment of Douglas Duffy MacKay ND as senior vice president of scientific and regulatory affairs effective March 18 2019. Dr. MacKay will oversee the company s scientific and regulatory affairs department ensuring CV Sciences continues to pioneer the development of hemp-based cannabidiol (CBD) products driven by rigorous science innovation and regulatory compliance. Go to www.naturalpractitionermag.com livon for info about this advertiser 18 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 INM UPDATE Leading Industry Organization Speaks Directly to Natural Practitioner Readers Naturopathic Doctors Combat Cognitive Decline at Every Stage By Michelle Simon PhD ND here is no absolute cure for Alzheimer s and cognitive decline. Both naturopathic and conventional medical doctors are constantly trying to find effective treatments to prevent and cure these devastating diseases. Currently more than five million Americans are living with Alzheimer s alone and by 2050 that figure is expected to rise to 14 million.1 Much as there is no definitive cure there is no definitive cause for these degenerative diseases that also include Lewy-Body disease Parkinson s disease and frontotemporal degeneration. But fortunately we do know a number of causes and some effective treatments. Studies have suggested that one-third of dementia cases worldwide could potentially be prevented through better management of health and lifestyle factors.2 This is an area where naturopathic medicine excels. Naturopathic doctors (NDs) help prevent cognitive decline with therapeutic nutrition behavioral medicine botanical medicine and an emphasis on addressing the underlying causes of disease.3 T Lifestyle Support Helps Prevent Cognitive Decline While genetics may be one of the uncontrollable predisposing factors food exercise and overall health are problems that we all can tackle. NDs help support patients to obtain a healthy weight and physical fitness decreasing the risk obesity which has been shown to play in cognitive decline.4 NDs can prescribe supplements including curcumin resveratrol and Bacopa monnieri as a way of boosting the immune system and optimizing brain health. Creating healthy sleep habits and reducing stress are also considered beneficial in the fight against decline and NDs have an opportunity here too in the prevention of these degenerative conditions. Other research is supporting the use of a multifactorial personalized approach to cognitive decline which includes addressing the gut microbiome heavy metal levels neurotransmitters and mitochondrial health.5 Understanding a patient s genetic predisposition helps in developing a personalized approach to treatment. Yet prevention is only part of the support naturopathic medicine can provide. Listening to Patients Leads to Early Diagnosis The Alzheimer s Foundation reports that early and accurate diagnosis could save up to 7.9 trillion in medical and care costs.6 These facts are based on known data that shows that when caught early the mental and physical decline can be slowed. Unfortunately by the time most doctors see a patient they have reached a moderate to severe stage of this illness with moderate diagnosis experiencing the swiftest decline after identification.7 But why are so many cases diagnosed late Awareness of a patient matters when diagnosing inconsistencies in behavior. While conventional care appointments are often limited to 20 minutes a naturopathic doctor typically spends between one to two hours on initial appointments and 30 to 60 minutes on subsequent appointments.8 In fact just one in seven seniors (16 percent) receives regular cognitive assessments for problems with memory or thinking during routine health checkups and only 47 percent of Primary Care Providers (PCPs) report that performing brief cognitive assessments for all patients age 65 or older is their standard protocol according to the 2019 Alzheimer s Disease Facts and Figures report.9 NDs get to know their patients and have a better understanding of what behaviors are typical and which are inconsistent with behavior. Another barrier to care involves gender. While women represent the majority of Alzheimer s patients they are frequently diagnosed later in the disease than the minority of male patients.10 Late diagnosis can prevent much-needed treatment to slow degeneration. A huge reason for this is standardized testing based on verbal memory where even women with disease symptoms tend to score higher than men. Without observing the whole patient in mind body and spirit women may be able to present a false negative based on verbal tests alone. Supportive Care as Decline Progresses While certain functions are lost to these devastating diseases there is still a person a patient at the root of it all. While specifics may get lost researchers believe that Alzheimer s patients still have an emotional memory and benefit from visits from wellwishers and loved ones.11 Even when they may not remember details all people can get lonely and dementia patients are just the same as anyone else in needing social interaction.12 Supportive ND care can help provide some of this social feedback. Additionally physical body health also matters. As specialists in patient-focused unique care NDs can help preserve physical ability and a feeling of physical well-being. NDs are great advocates for suggesting safe and gentle approaches to support whole patient health as well. An example could be a prescription for music therapy. University Health News reports that Listening to music helps more than just memory. In patients with dementia music therapy can help to decrease depression anxiety and agitation while improving cognitive function quality of life language skills and emotional wellbeing. 13 Another example is seen in the plantbased compound Yerba santa. A 2018 study by the Salk Institute indicates that sterubin derived from this botanical may have potent neuroprotec- MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM tive qualitites.14 It s clear that cognitive decline is a huge problem in our communities. A devastating and degenerative illness this condition affects millions of households in the U.S. alone. And while we can t cure this problem yet as NDs we can provide preventive and supportive care. We are uniquely positioned to reach cognitive decline patients across every stage of this illness working to improve daily health and happiness. For the full list of references visit www.naturalpractitionermag.com. Michelle Simon PhD ND President & CEO Institute for Natural Medicine In 1992 the leadership core of naturopathic doctors established the Institute for Natural Medicine (INM) as a not for profit organization dedicated to advancing natural medicine. The purpose of the INM is to increase awareness of broaden public access to and encourage research about natural medicine and therapies. Among its milestones the INM counts the launch of the Association of Accredited Naturopathic Medical Colleges (AANMC) as an independent organization leading California s efforts to obtain licensure developing an interactive childhood education program focused on healthy eating and lifestyles called Naturally Well in 2017 and expanding residency access by establishing and funding a residency program in 2018. INM has joined forces with the American Association of Naturopathic Physicians (AANP) serving as the charitable arm to deepen access to naturopathic care public education and research. Dr. Michelle Simon serves as president and CEO of INM is a licensed naturopathic physician clinician educator and leader in many organizations dedicated to improving the quality and delivery of health care. In addition to holding a naturopathic doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill. Dr. Simon has served on the boards for the Integrative Healthcare Policy Consortium (IHPC) the AANP and the Naturopathic Physicians Research Institute (NPRI). Dr. Simon also served nine years on the Washington State Health Technology Clinical Committee which is part of the Health Technology Assessment program that examines the scientific evidentiary basis for efficacy safety and cost effectiveness of healthcare technologies. She was also 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. She was recognized as the 2018 Physician of the Year by the AANP. NATURAL PRACTITIONER 19 W here did I leave my car keys Why did I walk in the room What is the name of that actor who was in that movie about that thing It s not uncommon to have the occasional memory lapse or senior moment no matter your age. However as people get older they are concerned about maintaining their cognitive health for as long as possible. Cognitive health is more than just remembering facts and being able to call upon the right words for objects. It is also the ability to learn to communicate to process new information concentrate make decisions problem-solve and generally to think. The term cognitive impairment is really a continuum from mild impairment where people may notice changes such as trouble remembering learning new things concentrating or making decisions to more severe levels various types of dementia or Alzheimer s with loss of ability to function independently said Isaac Eliaz MD MS LAc medical director of Amitabha Medical Clinic 20 NATURAL PRACTITIONER and Healing Center in Santa Rosa CA. Mild Cognitive impairment (MCI) needs to be differentiated from early dementia. They both have objective deficits in cognitive domains that are more than expected for age and educational background but in dementia there are deficits in more than one domain noted Dr. Pauline Jose a family medicine doctor practicing in Santa Monica 30 percent of her patients are over 65. Patients with MCI in contrast to mild dementia usually have no interference with daily activities but doing more complex tasks like paying bills may take more time she continued. Patients with mild dementia are able to do basic activities of daily living like bathing grooming and eating but more than one domain is affected. These domains include learning and memory language psychomotor visuospatial and executive. Dementia always progresses and patients decline while some patients with MCI may improve cognitively probably because the cause was reversed like a medication with cognitive side effects or a medical illness. Having MCI though is certainly a risk factor for developing dementia. The Centers for Disease Control and Prevention (CDC) has said that there are 16 million people living with some form of cognitive impairment. These include not only people with dementia and Alzheimer s but also people who have a broad range of disorders stemming from a variety of etiologies. Dementia affects an estimated four to five million older adults in the United States and is expected to grow up to three-fold by 2050 worldwide owing to the large increase in the size of the elderly population. Cognitive impairment without dementia is more prevalent in the United States than dementia said Dr. Eliaz. Cognitive dysfunction has greater implications than for the individual it can greatly impact family members. Even younger people are becoming more aware of their cognitive health especially if they ve witnessed a family member struggle with cognitive impairment. However while cognitive decline may be seen as an inevitable part of the getting older WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com kyowa for info about this advertiser there are many preventative actions to take even for younger adults to slow down the aging process and hence strengthen cognition. Risk Factors Causes for Cognitive Impairment There are a number of risk factors and causes of cognitive decline not all of which can be modulated. The greatest risk factor for cognitive impairment is something over which you have no control and that is the passage of time. People over the age of 65 are most susceptible and the risks only increase. However even mild cognitive impairment has been reported in people as young as their 40s. Still it is not a foregone conclusion to expect memory loss as you age but seniors are at higher risk. It is also important to recognize that not every memory decline is associated with dementia or Alzheimer s. Age is considered the primary risk factor for cognitive impairment but in my practice I look carefully at age since we have the knowledge to move into a healthy aging process with specific interventions that support systemic health said Dr. Eliaz. Other risk factors that are not within your control are genetics having suffered a prior brain injury having suffered a stroke certain previous bacterial infections or diseases that can negatively impact cognition such as Parkinson s or Huntington s disease. Some modifiable behaviors and conditions are also linked to cognitive dysfunction. These include said Dr. Jose smoking high cholesterol obesity a high-calorie diet physical inactivity and drug or alcohol abuse. Likewise deficiencies of many nutrients like zinc thiamine folate and vitamins B6 and 12 may play a role. Consumption of omega-3 fatty acids and iron from the diet have affected neurocognitive performance positively according to some studies she said. Mental health concerns are among the most common reasons people visit natural health practitioners said Bree Ponton BHSc(Nat) technical educator with the Australia-based manufacturer BioCeuticals. Mental health conditions such as anxiety and depression in turn can impact cognitive function. In the brain methylation plays a 22 NATURAL PRACTITIONER crucial role and is responsible for the production and metabolism of hormones and neurotransmitters such as melatonin serotonin cortisol adrenalin and noradrenaline. If methylation is impaired the critical equilibrium between hormone and neurotransmitter production and breakdown is affected adversely impacting mood and cognition explained Ponton. Dr. Eliaz added that exposures to certain toxins or pesticides might increase the risk as well. Then there are those factors that are modifiable lifestyle. More research is indicating that there is a tie-in between physical health and cognitive health. Importantly certain chronic inflammatorydriven conditions such as heart disease obesity hypertension stroke and diabetes have also been linked to cognitive impairment. In fact Alzheimer s has been dubbed type 3 diabetes Age is considered the primary risk factor for cognitive impairment but in my practice I look carefully at age since we have the knowledge to move into a healthy aging process with specific interventions that support systemic health. improve cognitive functioning. The U.S. Food and Drug Administration (FDA) already has approved a number of these drugs including donepezil (Aricept) rivastigmine tartrate (Exelon) galantamine HBr (Reminyl) and memantine (Namenda). In addition the new psychostimulant modafinil (Provigil) improves alertness a key factor in cognitive performance. Some of these drugs have been found to improve cognition in healthy individuals as well said Dr. Eliaz. Long-term effects of these drugs are still unknown however and as Dr. Eliaz pointed out that while these drugs may have value it is unwise to support the maintenance of an unhealthy lifestyle and then rely on expensive and potentially risky medications. What I believe would make more of an impact is prevention. Everything that we do for prevention are also the same things we should do when we are afflicted with it to delay progression said Dr. Jose. Some of these include Being active Supplements Challenging the brain reading Reducing intake of saturated fatty acids and increasing intake of legumes fruits fish and olive oil Consuming green and black tea Avoiding excessive sugars and animal fat consumption Drinking coffee which is associated with decreased risk Get six to eight hours of sleep Meditating Natural Approaches Dr. Isaac Eliaz due to the role of insulin and glucose function in neurological and brain health said Dr. Eliaz. Recent research on the effects of inflammation on aging and cognitive decline indicate that chronic inflammation is a primary driving force behind the development chronic degenerative diseases that affect every major system metabolic cardiovascular kidney immune and neurological he continued. As cognitive decline is slow and progressive it makes sense to address these issues when patients are still young or middle-aged. Preventing or mitigating as many risk factors as possible then is crucial. Conventional Treatments Currently there is no effective treatment to reverse dementia but researchers are working on it. The war on Alzheimer s disease and other cognitive conditions is stimulating an intensive effort to develop new smart drugs to When it comes to cognitive health as with other health concerns practitioners look at genetics health history diet lifestyle toxin exposure stress etc. said Laurel Sterling MA RD CD N nutrition and educator at Carlson Laboratories an Illinois-based manufacturer. There are many natural supplement options available she added. Some are single nutrient remedies some are herbal and others are combination formulas. What remedies a practitioner decides to use depends on the person their health issues what other medications they may be on and so much more she said. Some of the most exciting research on this subject points to galectin-3 a signaling protein that at elevated levels in the body drives numerous inflammatory and pathogenic processes through multiple unique mechanisms of action. More than 8 000 published clinical and preclinical studies show that blocking galectin-3 s pro-inflammatory actions is a critical and effective way halt and reverse some of the most dangerous degenerative and pro-aging processes in the body WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com gnosis for info about this advertiser said Dr. Eliaz. Recent research has pointed to lifestyle habits that can have a direct and indirect impact on brain health including exercise such as as yoga and meditation. There is research that shows exercise benefits brain health through lowering risk factors of cognitive decline. These cognitive health risk factors are similar to that for cardiovascular disease such as hypertension high blood cholesterol level type two diabetes obesity consuming heavily processed food lack of physical activity and smoking. Therefore being physically active confers dual protection over brain and heart health practitioners could advise patients over the benefits of exercise as a natural preventative measure for a Healthy Heart Healthy Mind lifestyle said Bryan See business development manager with ExcelVite based in New Jersey Numerous studies demonstrate the importance of physical activity for protecting and preserving cognitive health added Dr. Eliaz. The positive effects on circulation mitochondrial function glucose and insulin balance cellular respiration and oxygenation and others offer critical benefits for cognitive and neurological health. Therefore natural practitioners should encourage exercise and other healthy lifestyle Identifying Cognitive Impairment t may be challenging for patients and practitioners to diagnose the extent of cognitive impairment and whether it even exists or is just a matter of sporadic forgetfulness. Kevin Wolfe is the founder and managing member of Healthy Practice Solutions LLC a company based in Wisconsin. Healthy Practice Solutions LLC is contracted by Screen Inc. to distribute the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment also called the CANS-MCI a test that was marketing after seven years of development and several clinical trials. Wolfe explained the mechanics of the test which can be used by practitioners The CANS-MCI is unique because it talks to the patient who responds by using their finger to touch the computer screen no computer knowledge or skills are required which makes it very user-friendly. Simply enter basic patient demographic information and the computer will verbally instruct the patient how to take the test and provide practice examples for the patient to make sure the patient understands the instructions. When the patient has demonstrated they understand the computer administers the test. This process is repeated for eight separate tests to comprehensively measure a person s cognitive skills in memory symbol fluency and executive functions. By combining tests of these separate cognitive dimensions into a single test battery the statistical ability to predict MCI of all kinds is greatly enhanced. At the end of the testing process the computer instructs the patient to exit the room and uploads the data to neuropsychology testing experts with graduate degrees who score the results and create the reports. The report is delivered promptly and tracks changes. I 24 NATURAL PRACTITIONER If a patient has previously taken the CANS-MCI the patient s test results are plotted longitudinally so that any changes in cognitive ability from their baseline can be detected. This is extremely important because longitudinal results allow for precise predictive detection of early cognitive decline in people who still test above average despite their decline and would not likely be identified as MCI by a neuropsychologist until the decline eventually results in below average performance. The results are plotted on easy-to-understand graphs providing an objective measurement of decline over time or a positive response to treatment. The report also provides recommendations for follow up testing need for further medical neuropsychological evaluation and support resources. Wolfe said that the CANS-MCI is important and groundbreaking in part because 1. The CANS-MCI can objectively and affordably identify patients who are in need of the Bredesen protocol or similar cognitive therapy programs which create ancillary revenue for your practice. 2. The CANS-MCI can objectively and affordably measure the patient s response to your cognitive impairment treatment program to document your success and bring peace of mind to your patients. 3. It is an opportunity for people to receive a confidential objective evaluation of their cognitive health patients who elect to take the test on their own will receive the results confidentially from HPS. If a provider orders the test then the provider will receive the results. 4. Because it measures decline from the patient s baseline the CANS-MCI can identify a patient in the earliest stages of decline when the likelihood of reversal is the greatest and long before the patient is seriously impaired. habits in their patients as that will benefit everything from cardiovascular function to brain function. Supplements The purpose of supplements is to bolster any nutrients in the body and brain that may be lacking naturally or that cannot be achieved through diet alone. Many experts agree that omega-3s are effective brain-boosters and manufacturers have responded with products. These include fish oils and other antioxidant formulas such as vitamin E and CoQ10. Some other options include acetyl-L-carnitine phosphatidyl serine MCT oil (coconut sourced) fish or cod liver oil (containing EPA and DHA) methylB12 methylfolate and vitamin D3 said Sterling. Dr. Jose listed other ingredients in supplements that can be effective such as vitamins B6 12 A D and C folate beta carotene lycopene and selenium. She also named some potentially helpful herbs and nonherbal supplements such as Gingko biloba turmeric choline glutamine vinpocetine (or periwinkle) serine and Crocus sativus. Popular cognitive-friendly ingredients according to See include gingko almonds fish oil omega-3s and vitamin E. Natural supplements such as fish oil omega-3s not only benefit cognitive health but it also helps the heart forming a beneficial healthy aging regime he said adding that naturopaths chiropractors and herbalists can incorporate it for maintenance of general wellness and antioxidant enhancement. He added that natural full spectrum vitamin E which comprises all eight isoforms of vitamin E tocopherol and tocotrienol have been found to lower the risk for cognitive impairment in the elderly. His company s flagship ingredient for cognitive health is EVNol SupraBio a bio-enhanced natural palm tocotrienol complex and has been supplying this ingredient to natural product manufacturers worldwide for more than 15 years. The main unique selling points for these product are the full spectrum tocotrienols and coupled with the SupraBio SEDS system (self-emulsifying delivery system) which ensures the tocotrienols are consistently and significantly absorbed (bioavailable) as well as accumulated in vital human organs for efficacy said See. Companies that utilize See s company s ingredients in the manufacturing of their own products for the practitioner market include Carlson Labs (Tocomin SupraBio) Jarrow Formulas (Toco-Sorb) Life Extension (Super Absorbable Tocotienols) and Swanson Ultra (Tocomin SupraBio) to name a few. Omax Health in California manufacturers products for the practitioner market that WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com mindyourmemory for info about this advertiser Market Status The market for products has been shaped by the alarming statistics and media coverage of Alzheimer s and other cognitive impairments particularly as this issue personally touches many people. Cognitive issues affect populations as a whole. As See pointed out People are living longer these days. Many countries are facing population aging issues namely in developed countries like the U.S. Japan Singapore and E.U. This particular sector of aging consumers is driving the demand for cognitive health 26 NATURAL PRACTITIONER Many countries are facing population aging issues namely in developed countries like the U.S. Japan Singapore and E.U. This particular sector of aging consumers is driving the demand for cognitive health products in terms of maintaining acuity reducing risk of suffering debilitating stroke and age-related memory loss. Bryan See ExcelVite boost their brain power they are looking to become sharper clearer and smarter. Millennials tend to be concerned about memory mood focus and concentration. Tips for Practitioners If a practitioner suspects that his or her patient may be suffering from a cognitive impairment there are several tests that can be done including the CANS-MCI test (see sidebar on page 24). Another test used by Dr. Jose is the Folstein MMSE which tests for all cognitive domains. Laboratory testing and brain imaging are done as well as a referral to a neurologist but all these are more for determining the cause of the dementia or MCI she said. An entire physical workup including information about family history is in order to determine if the patient is lacking any specific nutrients and a holistic outlook one that examines emotional and psychological health as well as physical concerns and lifestyle will be the most beneficial. However even if a patient does not share any concerns or maybe not even have any concerns about his or her cognition practitioners should consider broaching the subject regardless particularly as intervention and prevention is key as is the first step education and helping patients see the larger picture. Understanding what causes inflammation and how to reduce it with lifestyle diet and targeted researched supplements such as MCP to inhibit galectin-3 a broad-spectrum probiotic to promote a healthy microbiome and time-honored botanicals and other nutraceutical agents can make a clear difference in mental emotional and physical health over the long-term said Dr. Eliaz. Before a practitioner can educate his or her patients about preserving or treating cognitive function self-education is key. Some manufacturers such as See s company makes scientific studies available to practitioners nutritional supplement companies and end consumers. It is also important for practitioners to realize that physical health mental health and cognitive health are all intertwined which is why a holistic approach is warranted said Sterling. Also when practitioners carry products to help boost cognitive function they can usually rely on manufacturer support in the way of educational materials dosage charts clinical guidelines and access to studies. Cognitive health is a broad spectrum term that covers everything from memory loss due to aging or diseases to concentration and processing issues. The mind-body connection warrants taking a holistic approach in treating and preventing cognitive decline practitioners should recommend exercise and other healthy life habits to help stave off cognitive impairment. Supplements such as those with omega-3s can play an important role in boosting cognitive function. Healthy Take Aways targets brain health Omax3 Professional Strength Omega-3 supplement and Omax Alpha-Omega Cognitive Boost Supplement. Kristin Chadwick CEO said that omega-3 DHA is an absolute must for brain health as most people are deficient and it directly impact s the brain s structure and signaling systems. It facilitates neurotransmitter activity and promotes the ability to think quickly focus intently and remember clearly. Another ingredient alpha-GPC a precursor to choline also plays a critical role in neurotransmitters. Her company intentionally combines the two ingredients to create what she says an advanced brain health cocktail and allows for maximum bioavailability. Carlson Labs manufactures several products that are aimed at boosting cognitive health such as the recently introduced Super DHA with Lutein which contains three carotenoids as well as omega-3 DHA sourced from deep cold-water fish. Other products are Acetyl L- Carnitine Elite DHA and Phosphatidyl Serine. BioCeuticals focuses on products that are complementary specifically those that address both mood and cognition. With BioCeuticals launch into the U.S. market in 2016 the following practitioneronly cognitive products were introduced AnxiPlex Cognition Support MTHF Pyrrole Complex Liposomal GABA with L-Theanine and RestoraCalm said Arina Pogossian head of marketing. Each does something a little different but all contains established ingredients. For example the company s Cognition Support product contains GinkgoSelect a ginkgo extract which supports memory and brain function. products in terms of maintaining acuity reducing risk of suffering debilitating stroke and age-related memory loss. We observed that it is rising steadily as consumers become better educated. In order to keep our brain and mind healthy and alert while we are extending our lifespan cognitive health supplements play an important supporting role for this group. And the market for supplements is not limited to seniors. The category of brain health has been surging and it s not just the Baby Boomers. Senior citizens tend to be worried about their aging brains and the possibility of losing their mental sharpness or getting dementia. They are looking to maintain brain health and prevent disease said Chadwick. On the other hand she said Entrepreneurs professionals and active people are looking to FOR MORE INFORMATION BioCeuticals www.bioceuticals.com.au Carlson Labs www.carlsonlabs.com Excelvite www.excelvite.com Healthy Practice Solutions www.healthyps.com Omax Health https omaxhealth.com WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Enter Sandman Americans are more stressed than ever for a multitude of reasons and stress disrupts the ability to relax unwind rest and sleep. Here s how to help your patients chill and welcome a hesitant sandman. By Lisa Schofield Y ou re getting sleepy. Unfortunately for an increasing number of people that line uttered by every B-movie hypnotist is a seriously fervent wish. And as practitioners you are likely dealing with more people of all ages and demographics complaining that they can t seem to unwind and let it all go. Both Serena Goldstein ND and Robert Kachko ND LAc of InnerSource Health practice in the city that never sleeps which noted Dr. Goldstein is a spot-on nickname now more than ever. In general I notice people going to bed too late waking up at least once or twice a night and their inability to relax is not just at night but also during the day. It may not be their main concern but I ve noticed it is something we still need to work on in varying degrees in more and more people she related. Dr. Kachko who also is the AANP (American Association of Naturopathic Physicians) president-elect agreed. I practice in New York City and it seems that people are as stressed and unable to relax as they ve ever been. He added that he sees more and more adults reporting inability to fall asleep quickly and to remain asleep without interruptions. Jacob Teitelbaum MD author of the Cures A-Z phone app observed that anxiety is especially prevalent in Millennials many of whom are dealing with crushing student loan debt and trying to launch careers. Overall he stated As the perfect storm for the human energy crisis continues to build we are seeing a marked increase in insomnia and anxiety. It is critical to remember that the hypothalamic sleep center requires more energy for its size than any area in the body. So insomnia is a key symptom of energy depletion. One person s inability to relax can be quite different than another s. For example Dr. Goldstein offered in women hormonal imbalances during peri-menopause tend to cause sleep issues and in men reduced testosterone production does the same thing. In all adults however blood sugar insufficiency (not just diabetes type II but pre-diabetes where there s a gradual increase or elevated MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM blood sugar markers) are a common cause of waking up in early morning. But there are increasingly common factors that are responsible for adults who are missing quality sleep more frequently. Our bodies are operating in a world that is misaligned with our evolutionary needs opined Dr. Kachko. As a diurnal species he explained we are physiologically programmed to wake with the sun and sleep when night falls which is what our ancestors did. A 24 7 access to artificial light plus fullplate schedules that don t allow for easy unwinding at the right times the biological clock circadian rhythms are disrupted and not operating properly. Add to this the fact that we regularly strain against our natural sleep drive (Tired Have coffee.) and add in loads of beta brain wave-inducing blue light (that also blocks our ability to make the sleep hormone melatonin) and it is not a surprise that people struggle he commented. Dr. Teitelbaum added that modern diets composed mostly of processed foods that are NATURAL PRACTITIONER 27 Enter Sandman devoid of viable amounts of micronutrients and exposure to chemicals in the environment also contribute to insomnia. According to the Centers for Disease Control and Prevention up to 70 million Americans are believed to suffer from sleep disorders and many turn to prescription medications to summon the sandman out of hiding. According to Statista 31 percent of respondents in a survey asserted they regularly used sleeping medications as they reported difficulty falling asleep three to seven nights in a typical week. That s a lot of sleeplessness going on. And more than likely if you have a patient client complaining of tossing and turning and waking up in the wee hours of morning he or she likely has tried and may still be using either an OTC (over-the-counter) sleep medication or a prescription. While OTC and prescription sleep medications can provide short-term relief dependence (and sometimes addiction) to sleeping pills is common according to Dr. Kachko. Taking them can help while addressing other core components of sleep hygiene but should never be the only solution he emphasized. Side effects as always vary as well and sources encourage probing to find out what side effects the patient client may be experiencing if he or she is taking sleeping pills. For example Dr. Goldstein explained that individuals can experience adverse reactions such as overstimulation or daytime sluggishness fogginess. Some people may rely upon them so that eventually they need higher doses to achieve the same lulling effect. A high enough dose can depress breathing during sleep potentially being fatal she warned. Further they can also cause serious withdrawal actions with ongoing use if stopped suddenly such as seizures or long-term anxiety as they may alter our physiology. Dr. Teitelbaum added that even some overthe-counter sleeping pills like Benadryl (diphenhydramine) have been associated with increased risk of Alzheimer s disease. Treatment Concepts Because causes of insomnia tension and inability to relax unwind are many and an individual can have multiple causes taking the time to investigate and assess can help dramatically in recommending the most 28 NATURAL PRACTITIONER effective solutions. For example Dr. Goldstein said she asks such clients what time they re going to bed when they wake up if they sleep fully throughout the night. She looks to identify any patterns such as waking up at a certain time of night the reason (i.e. if people get up to urinate regardless of age sometimes they drink liquids too late at night) if they have vivid dreams to discern if they are in deep sleep or if there s some sort of unresolved trauma how long it takes them to fall asleep and how they feel when they wake up (i.e. if they need coffee or another stimulant then this is a clue to their adrenal function). I also According to the Centers for Disease Control and Prevention up to 70 million Americans are believed to suffer from sleep disorders and many turn to prescription medications to summon the sandman out of hiding. ask about their daily routine if there is one as chances are if their life is chaotic or they feel like they re always doing and going their sleep will suffer. Her solution is to help them establish a natural rhythm by suggesting lifestyle strategies such as drinking water earlier in the day finish eating two to three hours before bedtime writing their tasks down for the next day and limiting screen time all which should help encourage quicker sleep onset. An Epsom salt bath magnesium supplements (usually the glycinate form) lavender pillow and essential fatty acids are usually my other go-to s to help them relax she added. Dr. Teitelbaum first asks if the individual is hangry or irritable when hungry if so he said this is a signal of adrenal fatigue and will recommend EuroMedica s Adrenaplex. He will also suggest avoiding sugar and increase salt especially if the client patient has low blood pressure as well as increase protein intake. Anxiety also causes inability to relax and interferes with sleep. It can be intense and the individual may not know he or she has it so Dr. Teitelbaum then asks if the person has problems taking deep breaths which usually indicates hyperventilation. This typically stems from burying feelings such as worry. These feelings then bubble to surface during periods of relative calm in the form of hyperventilation ( panic ) attacks. He also noted he would rule out hyperthyroidism which is a less common cause. An excellent anxiety herbal is EuroMedica s Anxiocalm he said. This unique fraction of echinacea has been shown to be as effective as Librium after six weeks of use. In addition Dr. Teitelbaum pointed to cannabinoids which can greatly help both sleep and anxiety. He likes EuroMedica s hemp oils which contain more than 60 cannabinoids that address insomnia anxiety and pain. I recommend three at a time (which contains 30 mg of CBD) for anxiety and up to five capsules for sleep. This works brilliantly for most people. And finally I like to strongly suggest a good high-potency multivitamin including magnesium (e.g. the Daily Energy Enfusion By Integrative Therapeutics or Clinical Essentials). This takes care of nutritional deficiencies that may be contributing. Dr. Kachko said he and his team always begin with a very thorough intake which focuses on the person s sleep history current sleep hygiene stress trauma history dietary fluid intake. They may also test hormone levels (cortisol neurotransmitter melatonin). It s helpful when people come in having done a sleep study as this allows us to be more precise early on he related. Similarly if a person has sleep apnea and needs a CPAP machine or other oral device they simply will need that support before they can get better. Every patient at InnerSource Health he stated is educated about essentials of sleep hygiene and the concepts of sleep debt biological clock. Stimulants Avoid stimulants after dinner or stimulating activity (mental or physical) two hours before bed. Don t consume caffeine after about 1 p.m. Power Down Turn off devices that emit blue light such as TVs smartphones and tablets as this light interferes with the production of melatonin the sleep-inducing hormone. Black Out Try to keep your sleep environment as dark as possible as any light from the outside interferes with our circadian rhythms. Whenever this is not possible sleeping masks may be recommended. Unwind and Let Go Choose something WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Natural Solutions Patients clients who want natural solutions to help lull them into restful slumber have several strong choices that you can recommend. Texas-based LifeSeasons offers three products that help ease anxiety and promote relaxation. Adrenal-T is a foundational product to reduce cortisol levels and relieve stress described Robin Rogosin vice president product development. It features adaptogens rhodiola holy basil schisandra ashwagandha plus B vitamins antioxidant-rich yerba mate and goji berry along with the nervine avena (oats). Adaptogens have been shown in sever- al studies to promote a feeling of well-being lessen fatigue and some may improve cognition. Anxie-T promotes relaxation by nourishing the brain and nervous system with L-theanine GABA (gamma-amino butyric acid) theobromine magnesium kava kava which has anxiolytic and muscle-relaxant properties as well as the adaptogen ashwagandha. Rogosin said that LifeSeasons Rest-ZZZ is specifically effective for sleep and good sleep is required in order to maintain good health. It includes GABA a calming neurochemical the relaxation-inducing herbs valerian root passionflower chamomile hawthorn berry and lemon balm along with melatonin. The result is restful and restorative sleep without morning grogginess she explained. For clients patients with periodic or ongoing sleeplessness Rogosin recommends two capsules of LifeSeasons Rest-ZZZ in the evening 20 to 30 minutes before bedtime. The suggested dosage is simply a guideline and some people take one capsule (if they are especially small statured or have a sensitive constitution) or three capsules (if they have a larger build) she explained. Rogosin recommends Adrenal-T as a daily supplement for clients patients with ongoing stress and Anxie-T periodically as needed. Some individuals have certain times of day when they feel anxious such as commuting on the highway public speaking attending meetings or social situations which she noted are good times to use Anxie-T. Texas-based Natural Vitality s CALM contains magnesium (citrate and glycinate) along with GABA L-theanine and melatonin to provide sleep support according to Susan Piergeorge MS RDN nutrition education MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM manager. Natural Vitality conducted a survey of its customers and one of the most common reasons for taking CALM was for sleep she related. As magnesium plays a role in nerve function maintaining adequate levels is also of importance in relation to neurotransmitters such as GABA. GABA is an inhibitory neurotransmitter associated with calming nerve activity in the brain she explained. Magnesium is an ally of GABA production. L-theanine is an amino acid found primarily in green tea. Research suggests it promotes slower alpha brainwaves which may be responsible for the calming effect attributed to L-theanine ingestion. Many of these supplemental solutions are effective at tackling short-term solutions (more immediate results) as well as long-term support the two-pronged approach will likely be what you recommend along with specific lifestyle adjustments relevant to the individual. It also may take some time to find the causes of the person s inability to achieve restful sleep and anxiety so it may be trial and error which isn t unusual. Keep in mind too according to Harvard Medical School s Healthbeat newsletter nearly half of insomnia cases stem from psychological or emotional issues. Stressful events mild depression or an anxiety disorder can make falling asleep and staying asleep difficult. Ideally once the underlying cause is treated the insomnia improves. The hypothalamic sleep center requires more energy for its size than any area in the body. Up to 70 million Americans are believed to suffer from sleep disorders. Studies show that a slightly cooler room can be helpful in achieving restful sleep. As magnesium plays a role in nerve function maintaining adequate levels is also of importance in relation to neurotransmitters such as GABA. Research suggests L-theanine promotes slower alpha brainwaves which may be responsible for the calming effect. Healthy Take Aways relaxing (a warm bath light reading) to enjoy before going to bed it will promote relaxation setting the stage for quicker sleep onset. Cool Down Studies show that a slightly cooler room can be helpful in achieving restful sleep. Suggest setting the temperature between 67-69 degrees Fahrenheit. For some making these changes is sufficient Dr. Kachko asserted. When that is not the case a combination of carefully selected calming nutrients herbs before bed and acupuncture tends to do the trick. Most patients are also given guided meditations recorded specifically for them and their situation during acupuncture sessions to listen to before bed and in the morning. If there are issues with blood sugar or cortisol abnormalities throughout the night we ll work to repair those things as well. A novel approach to helping people define why they are sleeping poorly is Sleep & Me an application that helps users discover the right sleep habits for them according to founder Ben Coleman. By answering several questions each time they use the application they will receive insights about their tendencies eg. I sleep for 18 percent longer when I work out in the morning and can evaluate new habits the new pillow actually decreases my REM sleep. Coleman explained that there is a great deal of science behind the various changes we may suggest as we learn more about our users needs but our main ingredient is the scientific method itself we allow users to apply real statistical scrutiny to their sleep to identify solutions hidden in plain sight. Coleman said he developed the Sleep & Me app to create a simple system that sets users on a clear path to better sleep. As they interact with the app each day they learn more about their needs and can make small adjustments to fill those needs especially with the help of their natural practitioner. It s designed to give direction to those who don t necessarily know where to start or make following the process easier to those who are struggling to keep up he said. FOR MORE INFORMATION LifeSeasons www.lifeseasons.com Natural Vitality www.naturalvitality.com Sleep & Me www.sleepandme.com NATURAL PRACTITIONER 29 Walking the DIGESTION TRAIL Practitioners can share the word about the up-to-date ways their patients can keep their digestive tracts healthy. By Nicholas Saraceno T he importance of one s digestive system is unquestionable the number of gut issues that can occur ranging from constipation to irritable bowel syndrome (IBS) seem immeasurable. In a study published in February 2019 in Nature Microbiology the manuscript titled The Neuroactive Potential of the Human Gut Microbiota in Quality of Life and Depression describes the first populationlevel study on the relationship between gut bacteria and mental health determined specific gut bacteria that is linked to depression which reportedly provides evidence that a range of gut bacteria can generate neuroactive compounds. The relationship between gut microbial metabolism and mental health is a controversial topic in microbiome research said Professor Jeroen Raes (Belgium-based Flanders Institute for Biotechnology VIB-KU Leuven) who alongside his team put together the manuscript. The notion that microbial metabolites can interact with our brain and thus behavior and feelings is intriguing but gut microbiome-brain communication has 30 NATURAL PRACTITIONER mostly been explored in animal models with human research lagging behind. In our population-level study we identified several groups of bacteria that co-varied with human depression and quality of life across populations. These results still have to be confirmed experimentally but this study at the very least demonstrates just how impactful the gut can potentially be towards overall health. Keeping this in mind practitioners can consider a multitude of supplements and remedies that can help patients not only feel better but also have a healthy digestive tract. Making an Impact As previously noted there are a plethora of health issues that can affect one s digestive system some of which revolve around a lack of enzymes and our modern-day diet and can result in a domino effect of other complications. There are so many I don t even know where to start explained Liz Cruz MD a holistic gastroenterologist who practices in Arizona under her company Dr. Liz Cruz Partners in Digestive Health. Not digesting our food properly in the stomach (due to a lack of enzymes) can cause heartburn reflux gas bloating constipation and or diarrhea. Other side effects that come with not digesting our food properly is an increase in food allergies due to having leaky gut syndrome. There are so many more food allergies today than ever before because of the types of foods we are eating (processed foods fast foods not real food) which the body doesn t know how to digest. This food does not get broken down in the stomach and in turn creates small tears in the small bowel causing the body an immune function reaction. On a separate note not having enough good bacteria in the gut can cause gas bloating constipation and or diarrhea. It can also be the precursor to very bad digestive diseases such as colitis and or Crohn s. Peter Huang R&D manager with California-based Bio Essence Herbal Essentials who offers DigestionCE natural enzymes that are derived from MCP ginger fennel turmeric and peppermint was in agreement. He also illustrated that problems with the gut can be tied to a weakened WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 immune system. The most common form of problems with gut health is bloating gas and diarrhea he said. These are the most common forms of problems in the number of healthy bacteria living inside your digestive tract. Gas in particular is a sign that food in your gut is starting to ferment as there is not enough stomach acid to break down the foods you ve eaten. The most impactful of gut health problems is diabetes and a suppressed immune system. This is caused by the inability of the gut to break down glucose and gluten respectively from their systems leading to the suffering of those gut health problems. However the silver lining is that these conditions have raised cognizance when it comes to stomach concerns. Food insensitivities such as gluten-intolerance celiac disease and leaky gut syndrome have also helped to drive customer awareness of digestive health issues commented Hank Cheatham vice president of marketing and sales at Daiwa Health Development Inc. (California) manufacturers of Daiwa Gastro Health. Leaky gut syndrome is said to have symptoms including bloating gas cramps food sensitivities and aches and pains. But it s something of a medical mystery. Sales of food products for gluten sensitivity are estimated to reach 14.4 billion in 2019 according to NBJ (Nutrition Business Journal). Luckily patients need not fear there are a plethora of solutions at their disposal. take time to take effect most enzymes are felt very rapidly. This is important because the digestive health consumer expects fast results. One recent innovation we are excited about is the Enzymedica formula (Enzyme Science is a subsidiary of the company) Heartburn Relief. It combines alginic acid with a series of other ingredients to stop occasional heartburn. Many individuals feel results in seconds and the formula lasts for up to four hours. It s important for practitioners to keep in mind that the proper solution to solving gastrointestinal difficulties will have to be determined on a case-by-case basis. Once this is determined recommending the proper diet could be a potential starting point. The use of probiotics is not like taking two Advil and your headache goes away. It takes time to build a concentration in the gut for the full benefits of the bacteria to have an impact. Alternative Solutions In terms of remedies Huang provided various suggestions including peppermint dandelion and ginger Peppermint (Mentha piperita) known to help with indigestion stomach ache and colicky diarrhea peppermint oil can be used to treat IBS (helping to ease bloating cramps spasms) Dandelion (Taraxacum officinalis) has diuretic properties that have been scientifically confirmed. Promotes a healthy digestive system and restores potassium and described by Huang as one of the best herbs for digestion. Can also be used to treat premenstrual bloating that occurs as a result of excess fluid before a menstrual period. Ginger (Zingiber officinale) used to relieve nausea upset stomach and stomach cramps Another option to consider is digestive enzymes supplements that patients can expect a quick turnaround with. Digestive enzymes are the go-to for many consumers looking for digestive support opined Ryan Sensenbrenner director of marketing at Enzyme Science Inc. Florida. Unlike many other supplements that may Terrence O. Tormey Kibow Biotech Inc. The most beneficial remedy or supplement for each individual will vary depending on the digestive issues at hand Hannah Braye registered nutritionist (Dip CNM mBANT CNHC) and senior technical advisor at Florida-based ADM Protexin pointed out. There are numerous contributing factors to digestive discomfort. For example pathogenic overgrowth hidden food intolerances suboptimal hydrochloric acid digestive enzyme or bile secretion dysbiosis (an imbalance of bacteria in the gut) increased intestinal permeability or mechanical issues may all be playing a role. Consulting a qualified nutrition professional who is trained to take a full case history identify relevant imbalances and can provide a suitable protocol may therefore be beneficial and should help prevent you from wasting time on money on remedies that don t work. The starting point with any digestive condition is always to improve the diet. Processed foods contain many hidden sugars additives and emulsifiers thought to have a negative MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM impact on the balance of bacteria in our gut and a pro-inflammatory effect.1 Many people notice a rapid improvement in their digestion just by cutting out processed foods and instead switching to home-cooked wholefoods diet. A nutritional professional will also be able to offer guidance as to whether certain aggravating foods should be eliminated for a period of time. Braye also went on to provide some general supplements to consider stating that there are numerous digestive aids on the market which may be beneficial for example antimicrobial agents designed to eradicate pathogenic overgrowth prebiotics to feed beneficial species of bacteria in the gut digestive enzymes betaine hydrochloride (the building blocks for stomach acid) bitters and bile supplements designed to help us better digest our food and nutrients which help to strengthen the gut lining. In particular fermented foods and probiotics (live bacterial supplements) are showing particular promise in many digestive conditions due to their ability to support multiple aspects of digestive function. Probiotics have continued to receive praise but if choosing to use them quality must be considered. Patience is also key. Simply put do your homework exclaimed Terrence O. Tormey CEO of Kibow Biotech Inc. (Pennsylvania). Not all probiotics are the same Not all strains are the same. The amount of beneficial bacterial delivered is not the same. Finally give it some time. The use of probiotics is not like taking two Advil and your headache goes away. It takes time to build a concentration in the gut for the full benefits of the bacteria to have an impact. Dr. Cruz who also stressed the use of probiotics enzymes and diet also advocated for daily consumption of water which can often be forgotten. Take a medical grade probiotic every day preferably on an empty stomach take medical grade enzymes with every meal she advised. Try to eat cleaner (less food that comes from a bag box or can and more real vegetables or minimally processed foods). Finally the absolutely best thing you can do for your health is drink more water and less of everything else. At least half of your body weight in ounces per day has changed people s lives. The Market Looks Bright The digestive health market is continuing to thrive mainly due to consumers diets and the challenge of modern-day living. Market value is expected to grow as demonstrated by the numbers. People look to digestive remedies to help with the side effects of unhealthy diets and NATURAL PRACTITIONER 31 Walking the DIGESTION TRAIL stressful lifestyles Cheatham noted. These trends in addition to greater health consciousness and literacy among consumers are likely contributing to the increased popularity of fiber and probiotics supplements according to Euromonitor International. Dietary supplements and health and wellness products positioned for digestive health are among the most popular platforms by value trailing behind only general health wellbeing weight management (for health and wellness) and heart health (for dietary supplements). Significant growth is anticipated in the digestive health category. With the awareness of the connection among gut health and overall health and cognitive function as well as athletic performance growth seems to be a sure thing. In addition researchers have only just begun to identify methodology to define a healthy microbiome as this investigation evolves growth in the market will occur [not only] potentially in personalized medicine but overall. Furthermore consumers are becoming aware of the connection between probiotics and digestive health and therefore the demand is increasing global sales of probiotics foods and supplements are predicted to grow 6.8 percent every year through 2019. This product category has increased 48 percent from 2011 through 2016. Probiotic foods were a nearly 7 billion industry in 2013 according to NBJ and is projected to jump to nearly 10 billion by 2019. The probiotics supplements market which brought in approximately 1.2 billion in 2013 is expected to almost double in size by 2019. The change in focus is driven by the research that suggests that digestive and overall health are driven by a balanced microbiome. As for Kibow Biotech the company is observing rapid growth in this regard with technology playing a major role. From our perspective it is growing exponentially The world is waking up to the importance of what is commonly referred to as the gut and the role probiotics play Tormey said. Their role is not limited to just digestion or even immune boosting. Here at Kibow Biotech we have shown that select strains of beneficial bacteria (probiotics) can reduce the circulating blood levels of uremic toxins impaired kidneys are not filtering. The Kibow scientist[s] discovered this over a 32 NATURAL PRACTITIONER decade ago and have patented the technology and it is called Enteric Dialysis. Our technology is helping thousands of patients across the world with kidney illness by using the gut to removing toxins like BUN uric acid creatinine and even reducing levels of C-reactive protein All of this is done with a non-Rx allnatural non-GMO (genetically modified organism) and readily available product called Renadyl. From a broader point of view natural medication in the digestive sphere is being impacted due to quality issues and the abundance of over-the-counter options. There are a myriad of natural supplements on the market that support digestion Dr. Cruz pointed out. For example probiotics and digestive enzymes. The problem is most of them are very cheaply made and have a lot of fillers. There are by far more over-the- counter medications (not natural) available today which is what most people depend on to manage their digestive issues. For example Imodium GasX Tums Miralax PPIs (proton-pump inhibitors) like Pepcid Pantoprazole etc. Although these medicines can eliminate symptoms they are unfortunately making the process of digestion worse over time therefore doing more damage to the body than good. Research ADM Protexin utilizes research as a major component when it comes to creating new products especially since it can serve as an indicator of how effective they will be towards patients. Research forms the basis of new product development at ADM Protexin and we work with various leading researchers across the globe investigating the microbiome and the potential beneficial effects of our strains on human health Braye said. For example the 14 strains in our Bio-Kult Advanced Multi Strain Formula were recently used in the largest-ever double-blind randomized controlled trial of probiotics in IBS-diarrhea type patients ever-conducted. The study in 400 people found that Bio-Kult significantly improved overall symptom severity in IBS patients and was well tolerated. Abdominal pain and frequency reduced by an average of 69 percent and 34 percent of participants were completely symptom free at the end of the five-month trial. Significantly though as well as relieving IBS-D symptoms Bio-Kult was also shown to markedly improve all aspects of Quality of Life. This includes psychological issues such as anxiety about health depression lack of enjoyment of life and feelings of having to avoid stressful situations. The Bio-Kult strains have also been shown to be of benefit in numerous other clinical trials for a range of digestive conditions including constipation 2 acute gastroenteritis 3 colic4 and h-pylori infection 5 and we have a number of other trials currently underway in other digestive and non-digestive conditions for example anti-biotic associated diarrhea and urinary tract infection prevention. According to Huang Bio Essence is particularly interested in studies where enzymes and botanical herbs show the most benefit for gut health and a healthy digestive system a majority of the company s studies on digestion come from the ingredients that are utilized in its formulas. Interestingly he noted that the approach to digestive health research initally focuses on western diet followed by the importance of probiotics and enzymes. Recently he said the most active research in gut health is associated with the Westernization lifestyle of higher intakes of processed meats butter fats and refined sugars. The leading fields are finding new enzymes that would help better break down the excess in diets that would lead to becoming overweight. With currently the largest topic around natural medication that supports digestion surrounds the amount of colony-forming units (CFU) and enzymes. These CFUs are what create the prebiotics and probiotics that create a healthier gut bacteria environment. This would help in giving the body more time to digest and absorb the nutrients from meals. The enzymes are generally used to help break down gas bloating and other general stomach discomforts. The gut is the forgotten organ impacting health and disease conditions including digestion inflammation and immunity to obesity. There is also strong evidence that the gut communicates with the central nervous system through neural endocrine and WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com bio-kult for info about this advertiser Walking the TRAIL immune pathways. Probiotics and prebiotics can affect the microbiota-gut-brain axis and regulate mood anxiety cognition and pain. However sometimes it can be a challenge for practitioners to treat with alternative solutions due to the lack of scientific substantiation. Most doctors are not doing what we are doing in our office with the more holistic approach Dr. Cruz pointed out. Doctors are taught how to diagnose and how to treat with medicine. We aren t even taught about enzymes and probiotics in med school. When I talk to colleagues about what I m doing they think it s fine for me but they wouldn t consider it because the studies just aren t there. It s too bad because my approach that has shifted from medicine-based to natural supplement based has helped so many of our patients get well. And isn t that the point Despite the hurdles companies such as 34 NATURAL PRACTITIONER References 1 Chassaing B Koren O Goodrich J et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature 2015 519 92. 2 Fateh R Iravani S Frootan M Rasouli MR Saadat S. Synbiotic preparation in men suffering from functional constipation A randomised controlled trial. Swiss Med Wkly 2011 141 1 7. 3 Yala ET. The clinical efficacy of multi-strain probiotics (Protexin) in the management of acute gastroenteritis in children two months to years old. Pidsp 2010 11 86 91. 4 Kianifar H Ahanchian H Grover Z et al. Synbiotic in the management of infantile colic A randomised controlled trial. J Paediatr Child Health 2014 50 801 5. 5 Khodadad A Farahmand F Najafi M Shoaran M. Probiotics for the treatment of pediatric Helicobacter pylori infection a randomized double blind clinical trial. Iran J Pediatr 2013 23 79 84. Sales of food products for gluten sensitivity are estimated to reach 14.4 billion in 2019 according to NBJ. Pathogenic overgrowth hidden food intolerances sub-optimal hydrochloric acid digestive enzyme or bile secretion dysbiosis (an imbalance of bacteria in the gut) increased intestinal permeability or mechanical issues may all be playing a role in digestive discomfort. Global sales of probiotics foods and supplements are predicted to grow 6.8 percent every year through 2019. Healthy Take Aways DIGESTION Enzyme Science are doing what they can to make sure that they successfully impact as many customers as possible. While we do believe that enzymes are central to digestion we have done extensive research on the human microbiome and its impact on all functions of the body Sensenbrenner concluded. Recently we launched a suite of omega-3 fish oil formulas that are the first of their kind they are optimized to support the microbiome. Consumers and practitioners alike are appreciating this groundbreaking work. FOR MORE INFORMATION ADM Protexin www.bio-kult.com Bio Essence Herbal Essentials www.bioessence.com Daiwa Health Development Inc. www.dhdmed.com Dr. Liz Cruz Partners in Digestive Health www.drlizcruz.com Enzyme Science Inc. www.enzyscience.com Kibow Biotech Inc. www.kibowbiotech.com WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Go to www.naturalpractitionermag.com kibowbiotech for info about this advertiser PRODUCT FOCUS The Impact of Multivitamins ietary supplements continue to soar in popularity. In fact according to data gathered from the 2018 CRN (Council for Responsible Nutrition) Consumer Survey on Dietary Supplements which was commissioned by CRN and conducted by Ipsos Public Affairs from Aug. 24-28 2018 75 percent of U.S. adults are taking dietary supplements a 10 percent increase from 2009. It consisted of a national sample of 2 004 adults ages 18 and above. This increase can be attributed to modern-day society beginning to explore alternative solutions to Western medicine. This year s data provide further evidence that dietary supplements are mainstays in modern-day health and wellness regimens D By Nicholas Saraceno said Brian Wommack senior vice president communications CRN. Three-quarters of Americans take dietary supplements and the steady increase in use observed over recent years speaks to society s shift toward a more holistic personalized approach to health care. Not only does the 2018 survey reaffirm positive data we ve seen before but the results also paint a clearer picture of a changing industry guided by the needs and wants of American consumers today. Specifically the survey revealed that in the 18-34 age group 83 percent of supplement users take a multivitamin which is an increase in 8 percentage points from the previous year. Further in the 35-54 and 55-plus brackets 75 percent and 70 percent users take a multivitamin respectively. Overall these numbers demonstrate that multivitamins are the top choice among supplement users the top reason why females and males takes supplements is for overall health wellness. If they have not done so already practitioners can consider sharing the various benefits of multivitamins with their patients. Below are products that practitioners can consider recommending to those who may be in need of additional overall health wellness benefits. Women s One Non-GMO Multivitamin Daily Best Ultra Women s One Non-GMO Multivitamin by Floridabased Rainbow Light is a once-daily multivitamin designed to nourish energize and support a woman s body making a difference in energy and vitality. This comprehensive women s multivitamin is now NonGMO (genetically modified organism) Project Verified and delivers scientifically studied ingredients in potencies that meet or exceed the daily value of many key nutrients. A high-potency B complex promotes natural energy production and nervous system health. Vitamin D and calcium support bone health combined with zinc vitamin C and probiotics to support immune health. The essential nutrients are combined with a rainbow blend of superfoods which include nutrient rich spirulina beet broccoli kale spinach blackberry blueberry carrot and cranberry. The Women s Vitality Blend includes chlorella pomegranate grape extract and lutein to fuel vitality at the cellular level. The formula contains a digestive support blend and is easy on the stomach. This product is made with natural purity tested ingredients and no artificial preservatives colors flavors or sweeteners. The product also does not contain eggs fish gluten milk dairy peanuts shellfish tree nuts or wheat. Bottles are available as 45- 75- and 180-counts bottles for suggested prices of 16.49 25.50 and 53.99 respectively. Daily Best Ultra a vegetarian and gluten free formula by Vermont-based DaVinci Laboratories is a one-a-day multiple vitamin supplement that combines 27 nutrients for adults. Daily Best Ultra offers vital nutrients for support of bone health by providing intake of all the B vitamins along with vitamins D & K2 boron and zinc cardiovascular health by providing coenzyme Q10 lycopene lutein zeaxanthin vitamins A C E and mixed carotenoids metabolic functions such as proper blood glucose levels which is supported by vitamins C E B6 B12 niacin and biotin as well as chromium alpha lipoic acid (ALA) and manganese antioxidant support due to vitamin A C E mixed carotenoids lutein ALA lycopene and zeaxanthin and lipotropic factors like choline and inositol which support fat metabolism and myelin sheath health. It is available in a 60-capsule bottle for a suggested price of 34.40. 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) 635-1233 or visit www.rainbowlight.com. 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) 325-1776 or visit www.davincilabs.com. OcuDyne II The OcuDyne formulas were originally formulated for California-based Allergy Research Group by Jonathan Wright MD and Alan R. Gaby MD. OcuDyne II includes QuatreActiv Folate (Quatrefolic the glucosamine salt of 5methyltetrahydrofolate [5-MTHF]) gamma-tocopherol tocotrienols vitamin D alpha-lipoic acid and lycopene as well as antioxidants key amino acids minerals bioflavonoids such as quercetin FloraGLO lutein and zeaxanthin and extracts of ginkgo and bilberry. This new expanded formula may be used as a multivitamin multimineral formula. A bottle of 200 vegetarian capsules has a suggested price of 66.17. This statement has not been evaluated by the U.S. Food and Drug Administration. The product is not intended to diagnose treat cure or prevent any disease. For more information call (800) 545-9960 or visit www.allergyresearchgroup.com. 36 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Ayush Multi MultiThera 1 According to the Washington-based company Ayush-Multi (by Ayush Herbs) delivers the RDI (recommended daily intake) or more of nutrients ensuring daily needs are met with two capsules per day. To improve bioavailability and utilization this is crafted to ensure no nutrient competes for absorption in the gut. This formulation contains methylfolate and coenzymated B vitamins. Fortified with antioxidants such as CoQ10 lycopene and lutein this multivitamin helps optimize cellular function to utilize the supplemented nutrition. Unique to Ayush-Multi is trikatu a traditional blend of ginger black pepper and long pepper helping absorb the nutrient packed capsules while helping to improve general digestion. Now made soy free it is free of all common allergens. It is available in a bottle of 90 vegetarian capsules for a suggested price of 37.50. For more information call (425) 637-1400 or visit www.ayush.com. Klaire Labs (manufactured by Nevada-based SFI) offers MultiThera 1 Capsule Formula which is a complete multivitamin and mineral supplement containing more than 30 essential nutrients in clinically meaningful amounts and ratios. It is developed based on scientific evidence clinical research and bioavailability with specific attention to safety efficacy and clean and hypoallergenic label claims. The 1 1 calcium to magnesium ratio high amounts of vitamins E C D3 and Bcomplex bioactive forms of folate and vitamin B12 extra pantothenic acid for adrenal support and a full complement of trace elements distinguish this formula from ordinary multiple vitamins. Copper is included to support SOD (superoxide dismutase) antioxidant enzyme activity and to maintain a healthy balance with zinc. A clear easy-to-swallow water-soluble cellulose coating protects ingredient stability and each batch is tested to USP (U.S. Pharmacopeia) standards for capsule disintegration and bioavailability. A 180-capsule bottle is available for a suggested price of 42.99. Super 2 Daily Super 2 Daily by Carlson Labs (Illinois) is a super-strength iron-free twice-daily supplement packed with essential vitamins and minerals that support overall health. The formula also contains lutein and omega-3s. Lutein is a carotenoid found in fruits and vegetables that promotes healthy vision. Omega-3s are essential fatty acids meaning the body can t make them so you can only get them through food or a supplement. Since many of us consume less than the recommended amount of two full servings of fish per week a multivitamin that includes fish oil is a great option. It is available as 60- (suggested price 29.90) 120- (suggested price 54.90) and 180 soft gels (suggested price 92.50). For more information call (800) 323-4141 or visit www.carlsonlabs.com. 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 (888) 488-2488 or visit www.klaire.com. Don t miss a single issue of NP in 2019 go online to renew your free subscription today NaturalPractitionerMag.com MarchApril19 Minimal & Essential Minimal & Essential by Connecticut-based Vital Nutrients is a full-spectrum one- or two-a-day multivitamin mineral formula that provides the minimum daily requirements of vitamins and some essential minerals. This formula contains a potent antioxidant complex including vitamins A C E and the mineral selenium. It contains a range of B vitamins which are used in the metabolism of protein and fats and maintenance of muscle tone in the gastrointestinal tract. B vitamins also support healthy nerve cells and maintain homocysteine levels that are already in the normal range. It is also approved for sale in Canada. Ninety- and 180-ct. bottles are available for suggested prices of 35.95 and 63.95 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 (888) 328-9992 or visit www.vitalnutrients.net. MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM NATURAL PRACTITIONER 37 NUTRITIONANDSCIENCE The Various Benefits of Pre- and Probiotic Supplements By Nicole Avena PhD robiotics have been in the spotlight in recent years with specialists touting the benefits of probiotics on gut health and much more. Prebiotics aren t talked about quite as much but definitely deserve recognition all the same and we are starting to see more and more products on the market that include prebiotics. Both pre- and probiotics offer a variety of benefits to our health and wellbeing but it can be confusing to figure out which ones you need and how you can incorporate these into your daily life. Let s find out how. P What are Prebiotics Although their names are similar prebiotics are not bacteria like probiotics but rather they are nutrients in the foods we eat that feed the bacteria found in our gut. These nutrients (specifically plant fibers) can t be digested by our own bodies and instead become food for the probiotic species living in our intestines. So even though they don t 38 NATURAL PRACTITIONER have a direct benefit on our health they are critical to the development of a healthy gut and indirectly benefit us in many ways. How are Prebiotics Beneficial to Human Health There are two ways to look at it. On the one hand prebiotics help us improve our health by promoting the growth and diversity of good bacteria in our guts (among a slew of other health benefits). On the other consuming prebiotics requires that we consume foods that are already healthy for us in many ways such as beans asparagus bananas onions garlic lentils and most other plant foods. Just to clarify not all dietary fibers are considered prebiotics however we can classify the majority of prebiotics as fibers. The rest are other types of indigestible carbohydrates found in plant matter. Although prebiotics have been extensively studied there is still some debate on all of their health benefits. However based on current research it is suggested that con- sumption of prebiotics increases the amount of good bacteria in our gut specifically Bifidobacteria and Lactobacilli decreases the population of harmful bacteria increases calcium absorption decreases allergy risk improves gut barrier permeability improves immune function and aids in the prevention and treatment of chronic illnesses.1 What is definitely clear is that increasing the fiber in your diet (thus increasing prebiotic consumption) is capable of altering the gut microbiome. In fact switching from a meat-based diet with virtually no fiber to a plant-based diet high in fiber ( 30 g per day) can cause these changes in just 24 hours.2 These changes include an increase in the amount of Bifidobacterium and Lactobacilli which are likely the reason why we see so many potential health benefits from the consumption of prebiotics. For example the relationship between calcium absorption and prebiotics likely lies in the interaction between prebiotics and the microorganisms in our gut.3 WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 Probiotics Basics While we re on the topic of beneficial bacteria let s discuss what probiotics are. Like Bifidobacterium and Lactobacilli probiotics are bacteria that are beneficial to our health. We can consume them in the form of food and supplements and they can also be found naturally in our gut. There are a variety of bacteria species that are considered probiotics but Bifidobacterium and Lactobacilli are some of the most widely used probiotics on the market. Sources of probiotics include yogurts kefir fermented vegetables tempeh and even infant formula in addition to over the counter supplements. Probiotics help us in a variety of ways. They boost our immune system and help protect against infectious diseases. They show promise in treating gastrointestinal problems (such as inflammatory bowel diseases and irritable bowel syndrome) asthma and they may even play a role in weight loss.4 5 As mentioned earlier probiotics are natural to our systems. Our gut microbiome is naturally full of the beneficial bacteria that we can find in different foods and supplements. In fact Bifidobacterium colonizes the gastrointestinal tract just days after birth. As we grow up and are exposed to our surroundings more and more bacteria continue to colonize the gut. Considering that dietary changes can affect our gut microbiome in just 24 hours we know that the gut is sensitive to the environment and changes even in adulthood. your system they also indiscriminately wipe out beneficial bacteria too. What About Shelf Stable vs. Refrigerated Versions Which is Better This is a good question that isn t talked about enough. Although there are a lot of factors about the environment that can destroy probiotics like temperature and moisture the truth is it s hard to say if the shelf stable or refrigerated type is actually better than the other. There exist such techniques that allow us to produce and maintain probiotics on a shelf without killing them or losing their health promoting properties. For example freeze-dried probiotics can be placed in specialized capsules which are then typically Why Supplement With Pre- and Probiotics Although both are naturally (and sometimes through processing) found in food pre- and probiotic supplements can be essential to good health. Taking supplements is a great way to get a controlled (and often larger) amount into your system. In addition with supplements you can typically choose the type of probiotic you want to ingest to target particular health issues whether it s something specific like ulcerative colitis or more general like trouble digesting your meal. When we say supplements we don t always mean taking pills either. For example the company inner- co offers fresh coconut water probiotic drink and frozen smoothie packs made with coconut fruits and added probiotics. Both pre- and probiotic supplements can also be a good option for those who may not have a diet high in fiber those who avoid fermented and dairy foods and for those who are taking antibiotics. Although antibiotics are meant to get rid of harmful bacteria in stored in a blister pack (the silver packaging that you push the pill out of). These probiotics are processed to be shelf-stable and viable. The key is to follow the instructions on the box for storage and don t remove the capsule from the blister pack until the moment you are going to consume it. Refrigerated probiotics similarly will be packaged in a different way that allows them to be viable while kept cool. The only potential downside to refrigerated capsules is that you may not be able to easily carry them with you while traveling if needed. It s also possible to find prebiotic supplements but typically these don t need to be stored in a refrigerator. In many cases like with Wonder Drink Kombucha you can supplement with prebiotics without a pill. Products like Wonder Drink kombucha are actually a great idea because although you can get prebiotics from food you would have to eat a lot (like a pound of asparagus) to get MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM the amount of prebiotics that you can get in just one can. Taking pre- and probiotic supplements is generally recognized as safe and there is sufficient research to suggest that there are no adverse effects associated with taking pre- or probiotics in supplement form. With that in mind plus the potential health effects there s no better time than the present to try it out for yourself References 1 Carlson JL Erickson JM Lloyd BB Slavin JL. Health effects and sources of prebiotic dietary fiber. Curr Dev Nutr. 2018 2(3) nzy005. 2 Holscher HD. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 2017 8(2) 172 184. 3 Whisner CM Castillo LF. Prebiotics bone and mineral metabolism. Calcif Tissue Int. 2018 102(4) 443 479. 4 O Neill I Shofield Z Hall LJ. Exploring the role of the microbiota member Bifidobacterium in modulating immune-linked diseases. Emerging Topics in Life Sciences. 2017 1(4) 333-349. 5 John GK Wang L Nanavati J Twose C Singh R Mullin G 2018. Dietary alteration of the gut microbiome and its impact on weight and fat mass a systemic review and meta-analysis. Genes (Basel). 2018 9(3) 167. Dr. Nicole Avena is a research neuroscientist and expert in the fields of nutrition diet and addiction with a special focus on nutrition during early life and pregnancy. Her research achievements have been honored by awards from several groups including the New York Academy of Sciences the American Psychological Association and the National Institute on Drug Abuse. She is an assistant professor of neuroscience at the Ichan School of Medicine at Mount Sinai in New York NY and is a visiting professor of health psychology at Princeton University in New Jersey. Dr. Avena has written several books including What to Eat When You re Pregnant and What to Feed Your Baby and Toddler. She regularly appears as a science expert on the Dr. Oz Show Good Day NY and The Doctors as well as many other news programs. Her work has been featured in Bloomberg Business Week Time Magazine for Kids The New York Times Shape Men s Health Details as well as many other periodicals. Dr. Avena blogs for Psychology Today is a member of the Penguin Random House Speakers Bureau and has the No. 2 most watched TED-ED Health talk How Sugar Affects Your Brain. You can follow Dr. Avena on Twitter ( DrNicoleAvena) Facebook (www.facebook.com DrNicoleAvena) and Instagram ( drnicoleavena) or visit www.drnicoleavena.com. NATURAL PRACTITIONER 39 SUPPLEMENTSCIENCE Cardiovascular Health Benefits of Pomegranate Whole Fruit Extracts By Prof. Gene Bruno MS MHS RH(AHG) Huntington University of Health Sciences few years ago I was asked to write the chapter Pomegranate Juice and Extract for the new textbook Fruits Vegetables and Herbs (2016 Academic Press Oxford) which I did. Since that time additional significant research on pomegranate extract has come to my attention leading me to write this article to serve as an update on the importance of this botanical especially for its cardiovascular health benefits. A A Brief History of Pomegranate Let s start with a brief history of pomegranate (Punica Granatum L.) which for thousands of years has been used as a food and traditional medicine. Originating in the Middle East it can now be found as a crop in the Far East India the Mediterranean and the Americas where it is utilized fresh and in processed form as juice wines flavors and extracts. Pomegranate s use as a medicine is also 40 NATURAL PRACTITIONER ancient originating from the folk medicine of cultures in the Caucasus and Mediterranean basin and discussed in the Ebers Papyrus from Egypt (c. 1500 BCE) one of the oldest medical texts.1 the peel including up to 30 percent punicalagins which are among nature s most powerful antioxidants. Now let s dive into the research on pomegranate s cardiovascular benefits. Plant Parts Cardiovascular Benefits The parts of pomegranate that have been used medicinally include the fruit fruit juice seed seed oil bark pericarp (aka rind or fleshy peel) root stem leaf and the flower.2 3 The active phytocompounds in pomegranate primarily consist of a range of polyphenols such as punicalagins. Perhaps the most active parts are the juice and pericarp since they contain a range of antioxidant polyphenols and other phytocompounds.4 Much of the research I ll be reviewing in this article was conducted using a whole-fruit fullspectrum extract obtained through a water-only extraction technology (Pomanox by Euromed) containing phytocompounds from pomegranate juice and In research studies whole-fruit fullspectrum pomegranate extract (Pomanox) improved the health of the endothelium (the inner layer of the arteries) by counteracting vascular inflammation and oxidative damage.5 6 Unpublished research conducted at La Paz University Hospital Madrid Spain on modulation of gene expression of markers associated with cardiovascular disease (CVD) confirmed 12 genes to be differentially expressed after administration of the extract to subjects with high waist circumference. In conclusion Pomanox supplementation was found to hinder hyperlipemia-induced coron-ary endothelial dysfunction by activating the Akt endothelial nitric oxidesyn- WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 thase pathway and favorably counteracting vascular inflammation and oxidative damage.7 Importantly normalization of BP (blood pressure) has been reported in five published academic trials and two that have been submitted for publication.8 9 High blood pressure is the greatest contributor to CVD worldwide and one of the most common CVD risk factors. A recent meta-analysis confirms the benefits of whole-fruit full-spectrum pomegranate extract (Pomanox) and pomegranate juice consumption on BP.10 Following is a discussion of one animal study and two human clinical trials on Pomanox. bo-controlled exploratory study11 was conducted to investigate the effect of consuming pomegranate extract (PE) as Pomanox on BP insulin resistance (HOMA-IR) stress hormone levels (cortisol cortisone) and quality of life in 29 healthy human volunteers. All participants consumed either one PE or a placebo capsule daily after a meal for four weeks. Each capsule provided the following naturally occurring pomegranate compounds 210 mg punicalagin (the recommended daily intake to provide the beneficial High blood Animal Study To investigate whether supplementation with a pomegranate extract rich in polyphenols imparts beneficial effects on coronary function and to characterize the underlying mechanisms a study was conducted in which pigs were fed a 10-day normocholesterolemic or hypercholesterolemic diet (normal and high cholesterol respectively). Half of the animals were given a supplement of 625 mg day of a pomegranate extract (Pomanox 200 mg punicalagins day). Release of nitric oxide (a natural compound that stimulates vasodilation) oxidative DNA damage in the coronary artery and lipoprotein resistance to oxidation were evaluated. Results were that in dyslipidemic animals (i.e. pigs with abnormal blood lipid levels) Pomanox supplementation prevented dietinduced impairment of endothelial relaxation reaching vasodilatory values comparable to normocholesterolemic animals. In other words their blood vessels expanded in a healthy way promoting good circulation. These beneficial effects were associated with the activation of endothelial nitric oxide-synthase and subsequent release of nitric oxide. Pomanox supplementation reduced systemic oxidative stress (higher high-density lipoprotein-antioxidant capacity and higher low-density lipoprotein resistance to oxidation) and coronary DNA damage. In conclusion Pomanox supplementation helps reduce hyperlipemia-induced coronary endothelial dysfunction by activating the Akt endothelial nitric oxide-synthase pathway and favorably counteracting vascular inflammation and oxidative damage. Human Study 1 Since evidence suggests that pomegranate juice consumption may alleviate CVD risk factors a double-blind randomized place- pressure is the greatest contributor to CVD worldwide and one of the most common CVD risk factors. effects of these antioxidants) 328 mg other pomegranate polyphenols (e.g. flavonoids and ellagic acid) and 0.37 mg anthocyanins. Dietary history and habits and the health-related quality-of-life questionnaire were recorded. BP salivary cortisol and cortisone levels were assessed and fasting blood was also obtained and compared to glucose insulin and insulin resistance parameters. Results were that systolic BP was significantly reduced following PE from 120.3 to 115.6 mmHg (P 0.012). Also there was a 27 percent reduction in the insulin resistance (P 0.045) and glucose insulin and uric acid all decreased from baseline. No significant changes were recorded in volunteers taking the placebo. PE consumption caused a significant drop of salivary cortisol levels of 19.6 percent in the AM (P 0.001) and 32.3 and noon 43.1 32.3 percent (p 0.016). Likewise those taking the PE capsules experienced significant improvement in physical (P 0.018) and MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM social functioning (p 0.021) pain (p 0.003) general health (p 0.008) and overall Quality of Life score (p 0.007). In conclusion these results suggest that PE intake rich in aforementioned polyphenols may ameliorate cardiovascular risk factors reduce stress levels and improve perceived health related quality of life. The reduction in salivary cortisol levels may prove beneficial for people suffering from chronic stress. Human Study 2 This randomized double-blind placebocontrolled clinical trial12 investigated the effect of PE as Pomanox on blood pressure and body composition measures in 55 healthy adults. Participants enrolled were assigned to either PE capsules (same composition as in the previous study) or placebo capsules for eight weeks. Results were that there was a significant decrease in diastolic blood pressure after eight weeks (by 2.79 points P 0.05) with no changes in body composition. In conclusion PE may reduce blood pressure and possibly prevent hypertension in the normotensive population. Other Benefits In addition to cardiovascular benefits whole-fruit full-spectrum pomegranate extract has demonstrated other benefits as well. These include the treatment of hair loss and effects as a prebiotic. Hair Loss Study A longitudinal randomized clinical trial13 was conducted to evaluate the healthy properties and tolerability of ingestible PE as Pomanox (two capsules day providing 366 mg) and a hair lotion containing Pomanox (4 ml day) for the prevention of hair loss in people with non-scarring hair loss. The main objective was evaluation of hair regeneration by phototrichogram. Secondary objectives were anti-hair loss capacity (strength of the hair) by pull test and the presence of sebum and or dandruff by scalp evaluation. Participants were 20 males aged between 34 and 60 who showed non-scarring alopecia in stages II to IV according to the Hamilton scale. Participants were divided into two groups of 10. Results are (for the ingestible PE only) that by visit three there was a 40.8 percent reduction in hair loss per the hair pull test (P 0.0002) a significant increase in hair density (P 0.000) a reduction in thin hair (24.46 percent on visit 1 and 19.47 percent on visit 3 P 0.000) and a 14.4 percent increase in hair NATURAL PRACTITIONER 41 SUPPLEMENTSCIENCE grow rate (P 0.000). In conclusion supplementation with PE prevents hair loss in people with non-scarring hair loss the regeneration of hair and higher strength of the hair. (83.3 percent) reported achieving an unusual regularity in their intestinal transit. The remaining individual reported not having observed any changes in his habits which were already regular. Prebiotic Study Conclusion Prebiotics are natural substances that help beneficial bacteria that is probiotics to grow and be healthy in our gut. This study14 was performed with six healthy subjects aged between 28 and 53 years old. Each individual took one capsule daily of PE as Pomanox at lunchtime. The volunteers were told to avoid consuming other probiotic products (e.g. fructooligosaccharides inulin etc.) as well as prebiotic products (e.g. yogurt fermented milk drinks etc). Fecal samples were taken from each of the individuals at time 0 (after 14 days prior to the administration of the PE) and also after 28 days of the administration of PE. The stool sample was used to assess the number of beneficial bacteria in the feces expressed as percentage Lactobacillus bacteria total bacteria or percentage Bifidobacteria total bacteria. The researchers also assessed the amount of potentially pathogenic bacteria in the stool. The results were that five out of six individuals (83.3 percent) showed a significant increase (p 0.05 or p 0.01 depending on the case) in the percentage of beneficial bacteria after 28 days of PE supplementation. In addition five out of six individuals (83 3 percent) showed a significant decrease (p 0.05 or p 0.01) in the percentage of Clostridium perfringens (pathogenic bacteria) in 28 days. Likewise four out of six individuals (66.7 percent) showed a significant decrease (p 0.05 or p 0.01) in the percentage of Bacteroides (also pathogenic bacteria) after 28 days of pomegranate extract administration. Furthermore all individuals (100 percent) reported no digestive problems during the treatment and five individuals Pomegranate has an extensive history of use as a food and as a medicinal agent. Important research has been conducted on a whole fruit full-spectrum pomegranate extract obtained through a water-only extraction technology and containing phy- tocompounds from pomegranate juice and the peel including up to 30 percent punicalagins. This research suggests that this pomegranate extract may ameliorate cardiovascular risk factors (especially help reduce blood pressure) reduce stress levels improve perceived health related quality of life promote healthy hair growth and function as an effective prebiotic agent increasing levels of beneficial Lactobacillus and Bifidobacteria species. References 1 Bruno G. Pomegranate Juice and Extract. In Fruits Vegetables and Herbs. Oxford Academic Press 2016 293-312. 2 Schubert SY Lansky EP Neeman I. Antioxidant and eicosanoid enzyme inhibition properties of pomegranate seed oil and fermented juice flavonoids. J Ethnopharmacol. 42 NATURAL PRACTITIONER 1999 66 11 17. 3 Huang TH Yang Q Harada M et al. Pomegranate flower extract diminishes cardiac fibrosis in Zucker diabetic fatty rats modulation of cardiac endothelin-1 and nuclear factor-kappaB pathways. J Cardiovasc Pharmacol. 2005 46 856 862. 4 Bruno G. Pomegranate Juice and Extract. In Fruits Vegetables and Herbs. Oxford Academic Press 2016 293-312. 5 Mart n-S nchez F Diamond C Zeitler M et al. Inflammasome-dependent IL-1 release depends upon membrane permeabilisation. Cell Death Differ. 2016 Jul 23(7) 1219-31. 6 Al-Dujaili E Smail N. Pomegranate juice intake enhances salivary testosterone levels and improves mood and well being in healthy men and women. Endocrine Abstracts. 2012 28 P313. 7 Vilahur G Padr T Casan L et al. Polyphenolenriched Diet Prevents Coronary Endothelial Dysfunction by Activating the Akt eNOS Pathway. Rev Esp Cardiol (Engl Ed). 2015 68(3) 216-25. 8 Tsang C Smail NF Almoosawi S et al. (2012) Intake of polyphenol-rich pomegranate pure juice influences urinary glucocorticoids blood pressure and homeostasis model assessment of insulin resistance in human volunteers. J Nutr Sci. 2012 1 e9. 9 Emad A S Al-Dujaili EAS Good G Tsang C. Consumption of Pomegranate Juice Attenuates Exercise - Induced Oxidative Stress Blood Pressure and Urinary Cortisol Cortisone Ratio in Human Adults. 4(6) 982995. 10 Sahebkar A Ferri C Giorgini P Bo S Nachtigal P Grassi D. Effects of pomegranate juice on blood pressure A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2017 Jan 115 149-161. 11 Stockton A AS Al-Dujaili E McDougall GJ et al. Effect of Pomegranate Extract Consumption on Cardiovascular Disease Risk Factors Stress Hor mones and Quality of Life in Human Volunteers An Exploratory Randomised Double-Blind PlaceboControlled Trial. EC Nutrition. 2015 2.4 396-411. 12 Stockton A Farhat G McDougall GJ Al-Dujaili EAS. Effect of pomegranate extract on blood pressure and anthropometry in adults a double-blind placebocontrolled randomised clinical trial. J Nutr Sci. 2017 Aug 9 6 e39. 13 Randomized clinical trial to evaluate the healthy properties and tolerability of two treatments for the prevention of hair loss in people with non-scarring alopecia. Unpublished. Euromed. 14 In-vitro and in-vivo studies on the Bifidogenic effect of Pomanox. Unpublished. Euromed. 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. WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 PRACTITIONER CHAT WITH SHARI BARBANEL H eidi Schauster MS RDN CEDRD-S is a certified eating disorders registered dietitian and consultant with more than 20 years of experience. She is the founder of Nourishing Words Nutrition Therapy based in the Greater Boston MA area and an instructor in the Eating Disorders Institute graduate certificate program at Plymouth State University in New Hampshire. Schauster is also the author of Nourish How to Heal Your Relationship with Food Body and Self which she wrote from the perspective of her clinical practice and lived experience. She is a Health-at-Every-Size (HAES) practitioner who encourages embodied eating and living for all. Schauster facilitates the No Diet Book Clubs and supervises other dietitians locally and virtually who treat clients with disordered eating. not want us to know this but most of my clients who have been on the diet roller coaster for decades know it well. I don t believe we can be at peace with food and our bodies if we are dieting. Heidi Schauster MS RDN CEDRD-S (617) 877-2202 heidi anourishingword.com www.anourishingword.com Q A What was your goal when deciding to write Nourish Throughout my years of practice I ve often been asked if I can recommend a good basic book on nutrition. I haven t been able to in good conscience as most books about nutrition are diet books in disguise or have information that might be triggering to someone recovering from an eating disorder. My aim with Nourish was to create a book about having a healthy relationship with food body and self that anyone could benefit from whether someone is recovering from disordered eating or just feels they have a funky relationship with food and could use a little guidance. I ve also become aware recently of the immense privilege that we have in the Boston MA area as far as resources for those who want to do this healing work. My book makes some of what I do more accessible for a wider audience who may not have those resources nearby or who wants an extra resource for the journey. Q A Why do you advise that people ditch dieting for good The research shows that 96 percent of people who go on a weight-reducing diet will gain the weight back eventually. What I see in practice is that dieting tends to create a longer greater struggle with food and the body. Dieting also contributes to weight-cycling which is more damaging to physical and mental health and overall well-being. The 60 billion diet industry does Q A You talk about body acceptance. Why is it such an important step and how is it achievable This is such a hard step on the journey and it s one that is often revisited again and again because we live in a culture that is just not supportive of body diversity. I have found that it is not possible to change our behaviors around food in a way that is sustainable and ultimately aligned with self-care if we are loathing our bodies. This doesn t mean that we have to love every nook and cranny but we do have to accept that this is the body we have right now and make a daily decision to take good care of it. Change flows better from acceptance instead of rejection. Q A What is mindful eating with nutrition common sense I talk about mindful eating and nutritional common sense in step five of Nourish. It s hard to describe in a nutshell but I ll do my best. Mindful eating is being present with the sensations in the body while eating hunger fullness pleasure etc. and using the body not just the mind to make decisions about what to eat. That said a little bit of nutrition information can be helpful in order to understand the fuel sources that the body needs in order to function well. Too much nutrition information can be confusing and I hear this from so many of my clients. My aim was to provide some common sense nutrition information that helped me on my own healing journey when I realized that I had misunderstood how much my body needed in order to be healthy. No matter someone s size I generally find that most of my clients are not eating enough. Sometimes they compensate for it later in the day or by the end of the week which is a survival instinct that others might call a binge. Evening out these cycles of under- and over-eating or adding more food if a person is consistently undereating and feeling low energy can be life changing on so many levels. When the MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM body gets enough to eat of the right balance of nutrients it frees up the body and mind to do other more meaningful things in life. It s so basic yet we miss the boat on good nutrition all the time because the messages in the media are so confusing. Q A What is a self-connected eating style and how does someone go about developing one A self-connected eating style is a way of eating that resonates with you and your lifestyle and values instead of the latest prescription from a health guru. After all you know your body better than anyone else It can take a fair amount of work to get to this kind of attuned embodied eating if someone has been used to following others lead about food for most of their life. This way of eating involves slowing down paying attention and sometimes getting support from a nutritionist or therapist who specializes in helping others move toward a more body-connected eating style. (Be discerning about whom you entrust with this guidance and beware of anyone who tells you how to eat ) This work involves reconnecting the mind and body and perhaps understanding with compassion why that disconnection happened to begin with. Finding the way to eat that works just for you and your life can be one of the most profound acts of selfcare but it has to come from your own exploration and deep embodied listening. Q A Is there anything else you would like to add I enjoy helping people on this journey and watching lives blossom when the relationship with food becomes more nourishing and less chaotic. If you are in the Boston area please reach out and contact me about my individual and group work. If you are not local and you would like to work through the steps of my book Nourish with like-minded others I m creating an online version of some of my live work in the year to come. I d love to hear from you and understand how I can help you on your journey. Life is too short and beautiful to be preoccupied with food and your body. NATURAL PRACTITIONER 43 NATURAL HEALTH STUDIES Decreased Deep Sleep Linked to Early Signs of Alzheimer s Disease P oor sleep is a hallmark of Alzheimer s disease. People with the disease tend to wake up tired and their nights become even less refreshing as memory loss and other symptoms worsen. But how and why restless nights are linked to Alzheimer s disease is not fully understood. Now researchers at Washington University School of Medicine in St. Louis MO may have uncovered part of the explanation. They found that older people who have less slow-wave sleep the deep sleep needed to consolidate memories and wake up feeling refreshed have higher levels of the brain protein tau. Elevated tau is a sign of Alzheimer s disease and has been linked to brain damage and cognitive decline. The findings published in the journal Science Translational Medicine suggest that poor-quality sleep in later life could be a red flag for deteriorating brain health. What s interesting is that we saw this inverse relationship between decreased slow-wave sleep and more tau protein in people who were either cognitively normal or very mildly impaired meaning that reduced slow-wave activity may be a marker for the transition between normal and impaired said first author Brendan Lucey MD an assistant professor of neurology and director of the Washington University Sleep Medicine Center. Measuring how people sleep may be a noninvasive way to screen for Alzheimer s disease before or just as people begin to develop problems with memory and thinking. The brain changes that lead to Alzheimer s a disease that affects an estimated 5.7 million Americans start slowly and silently. Up to two decades before the characteristic symptoms of memory loss and confusion appear amyloid beta protein begins to collect into plaques in the brain. Tangles of tau appear later followed by atrophy of key brain areas. Only then do people start showing unmistakable signs of cognitive decline. The challenge is finding people on track to develop Alzheimer s before such brain changes undermine their ability to think clearly. For that sleep may be a handy marker. To better understand the link between sleep and Alzheimer s disease Dr. Lucey along with David Holtzman MD the Andrew B. and Gretchen P. Jones Professor and head of the Department of Neurology and colleagues studied 119 people 60 years of age or older who were recruited through the Charles F. and Joanne Knight Alzheimer s Disease Research Center. Most (80 percent) were cognitively normal and the remainder were very mildly impaired. The researchers monitored the participants sleep at home over the course of a normal week. Participants were given a portable EEG monitor that strapped to their foreheads to measure their brain waves as they slept as well as a wristwatchlike sensor that tracks body movement. They also kept sleep logs where they made note of both nighttime sleep sessions and daytime napping. Each participant produced at least two nights of data some had as many as six. The researchers also measured levels of amyloid beta and tau in the brain and in the cerebrospinal fluid that bathes the brain and spinal cord. Thirtyeight people underwent PET brain scans for the two proteins and 104 people underwent spinal taps to provide cerebrospinal fluid for analysis. Twenty-seven did both. After controlling for factors such as sex age and movements while sleeping the researchers found that decreased slow-wave sleep coincided with higher levels of tau in the brain and a higher tauto-amyloid ratio in the cerebrospinal fluid. The key is that it wasn t the total amount of sleep that was linked to tau it was the slow-wave sleep which reflects quality of sleep Dr. Lucey said. The people with increased tau pathology were actually sleeping more at night and napping more in the day but they weren t getting as good quality sleep. (Source Science Translational Medicine January 2019) Effects of Linoleic Acid on Inflammatory Response Depend on Genes T he effects of linoleic acid on the human body are largely dependent on genes a new study from the University of Eastern Finland shows. Linoleic acid is an essential fatty acid. People carrying different variants of the FADS1 gene had a different inflammatory response and different changes in their fasting glucose levels when supplementing their diet by linoleic acid rich sunflower oil. This was the first time these associations were studied in humans. According to Postdoctoral Researcher Maria Lankinen the findings warrant speculation on whether the recommended intake of linoleic acid and possibly other fatty acids should be tailored to match a person s genes. The FADS1 gene regulates the body s fatty acid metabolism and also plays a role in glucose metabolism. A person s diet in turn has a major impact on the concentrations of different fatty acids in the body. Linoleic acid is found in plantbased oils nuts and seeds and it is the most 44 NATURAL PRACTITIONER common polyunsaturated omega-6 fatty acid. A high intake and high levels of linoleic acid in the blood have been associated with a reduced risk of type 2 diabetes and cardiovascular disease. On the other hand however the metabolites of linoleic acid can mediate inflammation which is why a high intake of linoleic acid is regarded as a plausible factor contributing to low-grade inflammatory state. According to the newly published study these contradictory observations could be explained by genetic differences. The study explored whether point mutations in rs174550 of the FADS1 gene modify the effects of linoleic acid on serum fatty acid composition and on fasting glucose insulin and CRP levels. These were analyzed in more than 1 300 middle-aged men participating in the METSIM (Metabolic Syndrome in Men) Study. In addition 60 men participated in the FADSDIET intervention for carriers of two different gene variants. Over the course of four weeks they supplemented their daily diet by 30-50 ml of linoleic acid rich sunflower oil. Selecting the participants on the basis of their genes makes this a unique research setting which provides information on the interactions of diet with genes. The findings indicate that the effects of linoleic acid on the human body are largely dependent on which variant of the FADS1 gene a person is carrying. This has an effect on for example how effectively a linoleic acid supplement can lower fasting glucose levels. Moreover depending on the gene variant increased intake of linoleic acid can make a person s CRP levels go either up or down. The FADS1 gene variant also had an effect on the levels of inflammation mediators which are created from the metabolites of linoleic acid and other omega-6 fatty acids. (Source American Journal of Clinical Nutrition January 2019) WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 HRT Tablets Associated With Increased Risk of Blood Clots H ormone replacement therapy (HRT) tablets are associated with a higher risk of rare but serious blood clots (known as venous thromboembolism or VTE) finds a large study published in The BMJ. No increased risk was found for HRT skin patches gels or creams yet the vast majority of women choosing HRT continue to be prescribed oral preparations. The researchers say these findings provide important information for women and their doctors to help them make the best treatment choices. HRT is used to relieve menopausal symptoms such as hot flushes and night sweats. Different treatments are available depending on the symptoms. For example tablets containing oestrogen only or a combination of oestrogen and progestogen as well as transdermal treatments such as patches gels and creams. Previous trials have shown increased risks of blood clots in menopausal women using HRT but there is a lack of information on risks associated with different types of HRT. Yana Vinogradova a member of an epidemiological team at the University of Nottingham led by Julia Hippisley-Cox set out to assess the association between VTE risk and all available types of HRT in the U.K. between 1998 and 2017. Using two U.K. primary care databases (QResearch and CPRD) they compared HRT prescription records of more than 80 000 women aged 40-79 years who developed blood clots (cases) with those of more than 390 000 women who did not (controls). Other relevant factors such as lifestyle family history of blood clots and underlying conditions linked to blood clots were taken into account. Most HRT tablets were found to be associated with increased VTE risk (nine extra cases per 10 000 women per year) compared with no HRT. Tablets containing equine oestrogen including single and combined preparations were consistently associated with higher risks than tablets containing synthetic oestrogen. Higher doses of oestrogen were also associated with higher VTE risk. However no increased VTE risk was found for skin patches gels and creams. This is an observational study and as such can t establish cause and the researchers point to some limitations that may have influenced the results. Nevertheless they said that this study has provided a more detailed picture of the VTE risks for different HRT preparations and can help clinicians and women make treatment choices. They suggest greater consideration should be given to transdermal HRT particularly for women already at an increased VTE risk and in line with recent guidelines. (Source The BMJ January 2019) Frailty Could Make People More Susceptible to Dementia N ew research published in The Lancet Neurology suggests that frailty makes older adults more susceptible to Alzheimer s dementia and moderates the effects of dementia-related brain changes on dementia symptoms. The findings suggest that frailty should be considered in clinical care and management of Alzheimer s dementia. The study found that older adults (59 years and older) with higher levels of frailty were more likely to have both Alzheimer s diseaserelated brain changes and symptoms of dementia whilst others with substantial brain changes but who were not frail showed fewer clinical symptoms. By reducing an individual s physiological reserve frailty could trigger the clinical expression of dementia when it might remain asymptomatic in someone who is not frail explained Professor Kenneth Rockwood from Nova Scotia Health Authority and Dalhousie University Canada who led the study. This indicates that a frail brain might be more susceptible to neurological problems like dementia as it is less able to cope with the pathological burden. This is an enormous step in the right direction for Alzheimer s research. Our findings suggest that the expression of dementia symptoms results from several causes and Alzheimer s disease-related brain changes are likely to be only one factor in a whole cascade of events that lead to clinical symptoms. Understanding how individual risk factors work together to give rise to late-life dementia is likely to offer a new way to develop targeted treatment options. Most people who develop Alzheimer s dementia are older than 65 years and have several other health problems. Frailty a condition linked with reduced physiological reserve and increased vulnerability to other ailments is associated with age and higher rates of cognitive deficit and dementia but little research has explored how these conditions might be related. In this study researchers used modeling to assess relationships between frailty Alzheimer s disease-related brain changes and Alzheimer s dementia among 456 participants of the Rush Memory and Ageing Project (MAP) who had either no dementia or Alzheimer s dementia and who subsequently died and underwent brain autopsy. MAP is a longitudinal clinical-pathological study of older adults living in Illinois which began in 1997. Every year participants received neuropsychological and clinical evaluations which included detailed cognitive testing and neurological examinations. Clinical diagnosis of Alzheimer s dementia was based on clinician consensus with just over half (53 percent 242) the participants given a diagnosis of possible or probable Alzheimer s dementia at their last clinical assessment. Brain plaques and tangles were measured after death to quantify Alzheimer s disease-related changes. The researchers also developed a frailty index using a combination of 41 components of health status (eg fatigue joint MARCH APRIL 2019 WWW.NATURALPRACTITIONERMAG.COM and heart problems osteoporosis mobility meal preparation) obtained at each clinical evaluation. Overall 35 participants (8 percent) had substantial Alzheimer s disease-related brain changes without having been diagnosed with dementia and 50 (11 percent) had Alzheimer s dementia but had little disease-related brain changes. The analysis revealed that frailty and Alzheimer s disease-related brain changes independently contribute to dementia status after adjusting for age sex and education. The researchers also found a significant association between frailty and Alzheimer s diseaserelated brain changes after excluding activities of daily living from the frailty index and adjusting for other risk factors such as stroke heart failure high blood pressure and diabetes. While frailty is likely to reduce the threshold for Alzheimer s disease-related brain changes to cause cognitive decline it probably also contributes to other mechanisms in the body that give rise to dementia weakening the direct link between Alzheimer s disease-related brain changes and dementia said Rockwood. While more research is needed given that frailty is potentially reversible it is possible that helping people to maintain function and independence in later life could reduce both dementia risk and the severity of debilitating symptoms common in this disease. (Source The Lancet Neurology February 2019) NATURAL PRACTITIONER 45 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. Migraine Stick CBD Recovery Cr me WILMINGTON NC Migrastil Migraine Stick is an allnatural roll-on containing essential oils in a base of fractionated coconut oil. It is designed to be applied to the temples forehead and neck at the first sign of migraine. This Basic Vigor Nutraceuticals product acts as an anti-inflammatory and counter-irritant and its natural mint aroma helps with nausea. 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A 50-ml container has a suggested price of 70. For more information call (303) 495-2996 or visit www.elitetherapeutics.com. Annatto-E PALM COAST FL Designs for Health AnnattoE is a unique tocopherol-free tocotrienols-only product featuring tocotrienols sourced from the annatto tree. Annatto is the richest known source of tocotrienols containing 100 percent tocotrienols (90 percent delta and 10 percent gamma isomers) with no tocopherols. Commercial vitamin E supplements are typically rich in tocopherols and low or absent in tocotrienols however tocotrienol fractions have unique beneficial effects across a variety of tissues that make them desirable for supporting many aspects of health. Research indicates that tocopherols especially alpha-tocopherol may interfere with key therapeutic effects of tocotrienols so it may be best to dose tocotrienols alone without tocopherols. Made with non-GMO ingredients Annatto-E is offered in 150- and 300 forms (30 soft gels) for suggested prices of 21.79 and 41.34 respectively. For more information call (860) 623-6314 or visit www.designsforhealth.com. Clearity RENO NV Klaire Labs Clearity by SFI a proprietary formulation patented by Ford Albritton IV MD is an antioxidant blend designed to support auditory and vestibular function. The 13 active ingredients have been demonstrated to synergistically support hearing and related cognitive clarity. Clinical evidence suggests that Clearity may slow the rate of expected hearing loss progression over time. In a large cohort study it was demonstrated that hearing loss is independently associated with 30 to 40 percent of accelerated cognitive decline (JAMA Internal Medicine). Suggested use is two capsules twice daily with food or as directed by a health care professional. A bottle of 120 capsules (30-day supply) has a suggested price of 49. 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 (888) 488-2488 or visit www.klaire.com. MyPure MYcoMune 4x LAS VEGAS NV Pure Essence s MyPure are 100 percent certified organic non-GMO whole fruiting body mushrooms exactly what s been used for thousands of years in holistic health systems in Asia. Unlike Mycelia which are from the roots and typically grown on cheaper grain MyPure are real mushrooms which are part of the basidiomycete organism that grows above ground and are hot water treated to rupture mushroom cell walls and maximized nutrient bioavailability. Pure Essence MyPure MycoMune 4X provides 250 mg of mushroom extract and 250 mg of the company s 4 1 8 1 and 10 1 extracts of reishi cordyceps lion s mane maitake shiitake and chaga mushrooms about 4.5 times more than its original MyPure MycoMune. It is available in 30- (suggested price 33.59) and 60-ct. (suggested price 58.79) bottles. For more information call (888) 254-8000 or visit www.pureessencelabs.com. 46 NATURAL PRACTITIONER VibraCool FLEX ATLANTA GA Clinically proven drug-free solutions for pain relief on contact. Easy to use the FLEX is the newest and most versatile VibraCool (MMJ Labs d b a Pain Care Labs) option. FLEX offers choice of heat or ice therapy with our patented high-frequency vibration. Wear the FDA-cleared medical device 3x day where it hurts. The device blocks pain and improves movement for rapid relief and recovery without restricting movement. It has simple one-touch activation for home car or office use. Vibration pocket attaches with latex-free strap to fit any size back neck or shoulder. The FLEX which comes in one size with a pocket 50-inch latex-free strap vibration unit with 10-minute timer reusable ice pack reusable heat pack and two AAA batteries has a suggested price of 69.95. For more information call (877) 805-2899 or visit www.vibracool.com. WWW.NATURALPRACTITIONERMAG.COM MARCH APRIL 2019 CONFERENCES AND EVENTS March 29-31 Southwest Conference on Botanical Medicine Tempe AZ Held at the Southwest College of Naturopathic Medicine this conference will feature a weekend of education and inspiration in the blooming desert It offers a wide variety of presentations from clinical classes to medicine making and desert herb walks. It covers topics such as Nutritive Herbs Essential Therapeutics for a Nutrient-deprived World The Latest Research on Botanical Adulterants and The Role of Bitter Herbs for a Healthy Microbiome. For those arriving on March 29 there will be various pre-conference events including Jason Miller DACM LAc who will discuss Neurological and Cognitive Decline Integrating Traditional Solutions with the Latest Research on Brain Function. Various credits are available for health professionals. For more information visit www.botanicalmedicine.org. April 13-14 SIBOCON (Integrative SIBO Conference) Seattle WA This internationally recognized annual CE Conference for advanced topics related to Small Intestinal Bacterial Overgrowth (SIBO) hosted at The W Hotel in Seattle WA will showcase a new line up of topics related to SIBO and the Microbiome. Topics include Bacterial Toxins in Alzheimer s Disease Underlying Autoimmune and Treatment Implications SIBO and the possible connections with cancer SIBO in Dogs-the Veterinary approach to diagnosis and treatment and many other unique and integrative topics. There are 12 CEU CME credits to be applied for qualifies for MDs DOs NDs DCs and nurse practitioners. For more information visit www.synergycmegroup.com. April 26-27 GPL Academy Practitioner Workshops San Francisco 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 among others. For more information visit www.gplworkshops.com. May 31-June 3 Medicines From the Earth Herb Symposium Black Mountain NC Held at Blue Ridge Assembly presentations on clinical applications of botanical medicine will include Slow the Decline New Developments in Brain Boosting Herbs Treating Chronic Illness with Herbal Medicine Useful Plants and Formulas for the Practicing Herbalist Lyme Disease Long-term Mental Health Conditions and Pain Syndromes and more including a pre-conference event with David Winston titled Ethnobotanical and Native Plant Field Study with David Winston. Various credits are available for health professionals. For more information visit www.botanicalmedicine.org. June 2-7 39th Annual AHNA Conference Tulsa OK Held at the Hyatt Regency the American Holistic Nurses Association s (AHNA) 39th annual conference is a gathering of approximately 500 holistic nursing professionals from across the country with growing international attendance from Canada Japan China and Jamaica. This annual event is one of the largest and most valuable conferences dedicated to bringing together nurses who share a passion for holistic healing. The AHNA Annual Conference offers six days of top-notch continuing education workshops industry-leading keynote speakers networking with fellow holistic nurses an exhibit hall filled with vendors offering the latest products and services to complement your daily practice and time to nurture yourself and your connection to holism in an environment primed with energy and support of fellow healers. For more information visit www.ahna.org. June 21-22 GPL Academy Practitioner Workshops Minneapolis MN 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 among others. For more information visit www.gplworkshops.com. 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