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For this issue on Best Naturopathic Therapies, I have excerpted part of the section on the natural treatment of pain from my new book Pain Free 1-2-3!-A Proven Program to Get You Pain Free . The book teaches a Comprehensive Medicine approach to overall pain management for both prescribing and non-prescribing practitioners. Acupuncture, manipulation, etc are discussed elsewhere in the book and therefore are not in this article.

Natural therapies

Many natural therapies can be very helpful for pain. My 3 favorite pain relieving herbals are willow bark, Boswellia, and tart cherry. All 3 of these can be found in combination in the End Fatigue “Pain Formula” by Integrative Therapeutics.

Begin with 2 tabs 2-3 times a day as needed until maximum benefit is achieved (4-6 weeks) and then you can use the lowest effective dose. Let’s look at these 3 herbals.

Willow bark is the original source of aspirin, but when used as the entire herb it has been found to be much safer and quite effective. The active ingredient is salicin, and Willow bark has been shown to be effective in both osteoarthritis and back pain. People who are severely allergic to aspirin (e.g. aspirin induced asthma or anaphylaxes–which is very unusual) should not use Willow bark. Like aspirin and Celebrex, it acts as a COX (Cyclooxygenase enzyme) inhibitor, decreasing inflammation. There are clearly a combination of other factors in Willow bark that markedly enhance its effectiveness and safety–which can be a major benefit over aspirin and NSAIDs (e.g.–Motrin) which cause an enormous amount of gastritis and ulcer bleeding, to the point of killing 15,000-20,000 Americans yearly! The studies on Willow bark are quite consistent in their effectiveness in reducing pain.

The Clinician’s Handbook of Natural Medicine is a handy reference guide, “giving the busy clinician easy access to decision-making material.” It covers 74 of the more commonly seen conditions in clinical practice, from ache vulgaris to viral pharyngitis. Each chapter covers a diagnostic summary, general and therapeutic considerations, a concise therapeutic approach, and flowchart for the condition in question. The treatment sections integrate the most well-researched botanical and nutritional approaches. Flowcharts allow the clinician to quickly determine the need for conventional intervention, rule out obstacles to the cure or contributing factors to the condition, and tailor a natural approach, suitable for each patient’s needs. When indicated, essential laboratory diagnostic assessments are also outlined.

The book is designed to be used as a quick reference guide in conjunction with the more extensive Textbook of Natural Medicine by the same authors. For those wishing a more extensive discussion of pathophysiology, mechanisms of action of nutrients and botanicals noted, and lengthy reference lists, the “Texthook” should be referred to. The “Handbook” is to be used when the patient is in the office and decisions need to be made quickly.

“It’s a popular reference book, utilized by student clinicians. I often see student clinicians carrying it in their medical bags. As a physician, it prompts me to remember the options when putting together a treatment plan in the midst of my busy practice days,” says Dr. Hazel Philp, clinical supervisor at Bastyr’s Center for Natural Health.

In addition to botanicals and nutrients, other alternative treatments are often noted, including hydrotherapy, acupuncture, IV therapy, and natural hormones. The best-researched treatments are discussed in more detail. Besides natural therapeutic options, the book also briefly discusses conventional options. For example, the section on hyperthyroidism briefly discusses drug therapy, surgery, and radioactive iodine.

This book is a valuable addition to the library of any practitioner of natural medicine.

Nutritional deficiencies are common in the elderly. Perhaps 10 to 20 percent of dementias in the elderly are reversible, and malnutrition is an important cause of reversible dementia. In addition to inadequate nutrient intake, other factors — such as impaired nutrient absorption through the gut lining — contribute to the deficient nutriture. (1) As an example of nutritionally-caused dementia, we will review the contribution of the vitamin B complex.

Vitamin B12

A deficiency of vitamin B12 is one of the most common nutritional causes of reversible dementia. Although a B12 deficiency is also associated with a megaloblastic (enlarged red blood cell) anemia, the vitamin may be deficient even in the absence of anemia or macrocytosis.

To evaluate the possibility of a vitamin B12 deficiency by lab testing, see if a macrocytic anemia is present and if the neutrophils are hypersegmented. While the serum cobalamin level should be measured, the vitamin may still be deficient even if the serum level is at the low end of the normal range. (2) Inactive cobalamin analogs may be included when serum cobalamin is measured using the popular radioisotope dilution method, so a microbiological assay is preferable. (3)

Other useful lab tests include measurements of serums levels of methylmalonic acid and homocysteine, two metabolites of vitamin B12-dependent pathways which are highly sensitive indicators of deficiency. (4) Finally, serum folate levels should also be measured.

As with all vitamin deficiency syndromes, there is a spectrum of severity ranging from the often isolated findings of marginal deficiency to the full deficiency syndrome. Since the B12 deficiency syndrome includes neurologic deterioration, neurologic findings in a person with dementia should raise the index of suspicion and encourage more complete laboratory testing.

When adequate laboratory testing is unavailable, consider a trial of supplementing vitamin B12 by injection, say 1000 mcg IM twice weekly for several weeks. Even if the injection of vitamin B12 is ‘a shot in the dark,’ it is both safe and inexpensive.

YOUR JOB SHOULD OFFER more than a paycheck. It should satisfy your desire to do good and make a difference. It should leave you invigorated, even after a long, busy day. And it should embody your, passion. If your current position lacks these qualities, it maybe time to move on. Changing your work might sound scary, but switching to a career in natural medicine can be one of the best decisions you’ll ever make. You’ll learn (and practice) what it takes to feel healthy and vibrant. You’ll help others achieve the same. And you’ll find yourself in a growing field with lots of job openings (many of them lucrative).

Your future patients are waiting for you; Americans make more than 600 million trips a year to natural medicine practitioners, which is more than they make to conventional doctors, according to a 1998 report in the Journal of the American Medical Association. More generally, employment in the health services industry is expected to increase by more than 25 percent through 2010–exceeding the average growth rate of all industries, according to government statistics.

We asked experts what it takes to train for and land a career in 10 popular fields in natural healing (depending on the profession, it may be easier than you expect). Use our guide and your passion to get a head start on your new job.

Find Your Best Field

Deciding what kind of healer you’d like to become takes a careful self-assessment. For example, would you thrive in an emerging field or a more accepted one? Would you mind touching your patients as a massage therapist or chiropractor would? For details on what to expect from 10 healing professions, read on. To learn more specifics about each career, like the salary you can earn, see “Natural Careers at a Glance,” opposite.

Acupuncturist

Despite the needles involved, acupuncture is a much gentler science than you might think. Practitioners believe that people possess a life energy called qi, which may cause illness if blocked or unbalanced. To correct the flow of qi, acupuncturists insert hair-thin needles into specific points on the body; the needles cause little or no pain. Some acupuncturists prescribe herbal remedies as well. Most patients seek this therapy to resolve pain-related conditions like headaches and chronic back pain; acupuncturists also commonly treat digestive and gynecological ailments.

Nutrition has become a popular topic of public discussion, but the conventional medical community has largely been caught wearing no clothes. In his electronic response to Vickers and Zollman’s article on nutritional medicine in the ABC of complementary medicine,[1] Stargrove points out that somehow nutrition fell “out of the medical bag.”[1 2] Commercial health care simply grew with the industrial economy. Now we are experiencing waves of more loudly expressed alternative medicine, which recognises a fundamental centrality in nutrition.It seems to me that this complex discussion is in many ways a cover story for an enormous, often unspoken, public discourse on religion, politics, personal identity, group process, and public and private angst or joy. The many issues addressed by the authors[1] unwrap briefly some of the pieces. But the authors do not seem to do more than read the names of the cities from the map. They do not address where we are trying to go or what we might achieve by trying to go there.

Nutritional insights, therapeutics, and protocols offer genuine healthcare benefits for literally millions of people who presently lack at least some portion of the wherewithal to achieve them. Vickers and Zollman’s article seems unconcerned with this and is instead drawn to the subject as if it were reviewing arcane fashions.

One of the most effective therapies for intractable seizures in children is the ketogenic diet. Introduced by Wilder in 1921, this diet has been shown to decrease the number and severity of seizures for more than two-thirds of children who have tried it. The diet consists of approximately 70% to 90% of energy from fat, with the remaining energy from protein and carbohydrate. There are two main types of the diet. The first is the classic ketogenic diet that produces ketosis by limiting intake of carbohydrate and protein to less than 10% of energy combined. The second type is a medium chain triglyceride diet (MCT), which uses medium-chain triglyceride fat to produce ketosis. The MCT diet allows for a greater percentage of intake from carbohydrate and protein (approximately 29% combined). While the benefits of the diet have been well established, little is known about the nutritional risks of the diet and potential impact upon growth.

The objective of a recent study was to use a prospective, nonrandomized study design to assess growth velocity and potential nutritional risks for children on both types of ketogenic diets. Admission criteria for the study included age between 1 and 16 years and at minimum two unsuccessful trials with different anticonvulsant medications. The subjects were assigned to one of the two diets based upon their individual and family preferences, the family’s financial situation, and the medical team’s assessment of which diet would likely achieve greater compliance and tolerance.

Sixteen subjects were placed into the classic ketogenic diet and 14 in the MCT ketogenic diet. Before starting either diet, the children fasted until their urine becomes strongly saturated with ketones. The children’s diets were supplemented with sugar-free multivitamin and mineral preparations, calcium tablets with magnesium and zinc, and iron tablets or liquid iron. The initial energy prescription was estimated to be 75% of estimated total energy expenditure from basal energy expenditure calculation plus an activity factor. Protein requirements were figured at 1 gm/kg body weight per day.

There are many reasons why controlling our weight is important for most of us. We like to have a trim body for our own vanity, self-esteem and to be more attractive to others. However, if those were the only reasons then we, as nutritionists, would not have created a diet product. An overweight body is not a really healthy body. Clinical studies repeatedly show overweight individuals have a much higher incidence of diabetes, heart disease, hypertension and a myriad of other serious complaints. These are matters that have little to do with vanity and everything to do with health. Health is our business and the slim good looks that go with a healthy body is a fringe benefit.

While there are many so-called meal substitute products on the market, none properly take into account all the nutritional factors necessary to make them really work. Unfortunately, eating fewer calories alone does not guarantee you will lose weight. When you severely reduce your caloric intake, you may well be depriving your body of the many nutrients it must-have to maintain good health. When your body is missing these vital nutrients it thinks you are starving. This triggers a survival mode response. Your body holds on to fat so you won’t starve. That is why Lewis Laboratories developed Weigh Down[TM]. It is truly a nutritionists’ diet plan that covers all the bases. It provides at least 100% of all vitamins, minerals and proteins plus digestive enzymes and fiber. Weigh Down[TM] also contains an effective level of three important lipotropic factors:–choline, inositol and carnitine which actually help burn fat deposits. Weigh Down[TM] provides every nutritional element for a successful diet with only 108 calories per serving.

Each serving of Weigh Down[TM] also contains an effective quantity of Lewis Laboratories’ special blend of fruit, grain and vegetable fiber. By providing the necessary bulk material your body needs, it helps to ensure proper digestive functioning and gives you the full feeling of having had enough to eat.

Sugar

Sugar intake increases plaque accumulation while decreasing chemotaxis and phagocytosis of polymorphonuclear leukocytes. (1) For example, in a double-blind study, 21 dental students consumed a 75 gram glucose drink 3 times daily, while 21 controls were given an artificially sweetened drink. On the fifth day, mean sulcus depth in the experimental group had increased significantly while the mean sulcus depth in the controls was unchanged. (2) Similarly, mean gingival inflammation in the experimental group significantly increased, while mean gingival inflammation in the controls was slightly reduced. (3)

Vitamins

Folic Acid

Folic acid nutriture has been shown to be directly related to gingival health. In one study, following 30 days during which patients with normal plasma folate levels ingested 2 mg folic acid twice daily or placebo under double-blind conditions, folate increased the resistance of the gingiva to local irritants leading to a reduction in inflammation–even though plasma folate levels were unchanged. (4) Folate mouthwash is also effective, and may be even more effective than dietary supplements. (5)

Vitamin A

A deficiency of vitamin A is well known to predispose to periodontal disease. (6) For example, a group of pregnant women was found to show maximal inflammatory changes of the periodontium in the 8th month when the mean physiologic level of vitamin A declined. Shortly after delivery, by contrast, vitamin A levels became markedly elevated and periodontal inflammation improved, raising the question of whether periodontitis of pregnancy is related to changes in the levels of the vitamin. (7)

Vitamin C

Ascorbic acid protects the oral mucosal epithelium against the infiltration of antigenic materials such as bacterial endotoxins, (8) so it is not surprising that serum vitamin C levels have a significant (although weak) inverse association with periodontitis. (9) Dietary vitamin C intake shows a similar relationship, at least up to an intake of 180 mg daily. (10) Also, 500 mg daily of the vitamin for 90 days has been shown to reduce both dental plaque and stain. (11)

Vitamin E

When 800 mg of vitamin E in capsule form was bitten open and swished in the mouth before swallowing for 21 days, gingival inflammation was reduced. (12) This is a good example of the vitamin’s effects on the inflammatory process in general.

People with addictions to alcohol and drugs may be considered some of the most under-nourished and nutrient deficient populations in healthcare. Treatments for these groups typically involve pharmacotherapy (medications), counseling support services, and perhaps acupuncture (depending on the treatment center). The use of supplemental vitamins and minerals for these patients generally falls under the area of diet and perhaps rest, instead of actually advising them on “adequate” nutritional supplementation. Research suggests that specific vitamins may actually be used as an “add-on” treatment (similar to medications) for these individuals irrespective of whether a person is deficient or not. For example, the B-vitamin niacin (B3) is typically used by physicians to improve cholesterol levels in patients and not for the prevention or treatment of vitamin B3 deficiency. Moreover, evidence also suggests that nutritionalr without a statement regarding upper safe limits.

As has been stated in previous communication with the US CODEX delegation, there is an assumption that there is a problem that needs to be fixed. Exactly what are the documented side effects of food supplements consumed in high doses and what is their incidence in the general population? Is CODEX protecting two percent of the mega-dose vitamin E users from headaches, or what? Would the establishment of an “upper limit” be expected to eliminate or just reduce the occurrence of side effects?

The CODEX Draft notes that the Codex Guidelines for Vitamin and Mineral Supplements will not, in any way, adversely affect the availability of safe and truthfully labeled supplement products in the US marketplace or to US consumers. While this sentence is encouraging to consumers of food supplements, it is incomplete. There are other concerns regarding the effect of CODEX.

During my 30-year career in nutritional medicine, one relative constant has been the resistance in medical academia to the notion that nutritional therapy, particularly micronutrient supplementation, can be useful for the prevention and treatment of disease. This bias against nutrition was the topic of an editorial in the Archives of Internal Medicine several years ago.’ The lack of knowledge about, or interest in, nutritional therapy among conventional physicians markedly decreases their therapeutic options. Moreover, sensing that their doctor is indifferent or even hostile to natural medicine, patients frequently keep their doctor out of the loop with regard to the nutritional supplements and herbs they are taking, thereby increasing the risk of drug-nutrient or drug-herb interactions.

In an editorial in Lancet, Tim McAlindon, MD, from the Arthritis Center, Boston University Medical Center, stated: “It is time for the profession to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large.”(2) Fortunately, it appears that at least some members of the academic community are beginning to take that suggestion seriously.

In March, more than 100 scientists and practitioners, many from academic institutions, attended the week-long “Food as Medicine” conference in Florida, sponsored by the Center for Mind-Body Medicine in Washington, DC, and organized by James Gordon, MD, and Susan Lord, MD. The conference was designed to provide medical school professors with the tools to bring state-of-the art information about diet and micronutrients back to their institutions. As one of the presenters, I was impressed with the excitement and awareness of new possibilities that resulted from the attendance at this course.

Among the many whole-foods snacks and healthful meals served at the conference, not a crystal of refined sugar was to be found, and none of the fatty acids were present in the transform. Indeed, the only trans-formation was in the hearts and minds of those attending the conference.