Positive Psychology and Ways to Love Your Stress

Dr. JoAnn Yanez, AANMC executive director, joins Dr. Trevor Cates on The Spa Dr. Podcast to share her top stress management practices and the power of positive psychology.

Full Transcript of Interview Below.

Dr. Trevor Cates: Hi there. I’m Dr. Trevor Cates. Welcome to The Spa Dr. Podcast. On today’s podcast, we’re covering positive psychology and ways to love your stress. My guest is Dr. JoAnn Yanez, who is the Executive Director of the Association of Accredited Naturopathic Medical Colleges and the Chair of the Academic Collaborative for Integrative Health. Dr. Yanez oversees research, advocacy efforts, and the joint academic endeavors of the accredited colleges of naturopathic medicine. She also helps spread awareness of naturopathic medicine as a viable and satisfying career path. Dr. Yanez lives in Southern California with her husband and son, and enjoys music, dancing, eating good food, and belly laughs.

In today’s interview, she shares her top stress management practices and the power of what she refers to as positive psychology. All of this is truly important right now, as people have been under both physical and emotional stress during the pandemic. So, please enjoy this interview.

Dr. Yanez, it’s so great to have you on my podcast. Welcome.

Dr. JoAnn Yanez: Thank you so much for having me on. I really appreciate the opportunity.

Dr. Trevor Cates: We’re talking today about stress. It’s something that we all have and it’s normal part of life. It’s certainly something, that at this time during the pandemic, that it’s certainly even more prevalent because of the changes that we’re all having to make in our lives. So, tell us why is this so passionate for you? Why is this so important to you?

Dr. JoAnn Yanez: Well, like you said, stress is endemic. Stress is always a part of our life. Sometimes stress is even a good thing. It motivates us. But as we’ve learned in naturopathic school… and for those of you who don’t know, Dr. Cates and I go a little way back. As we learned in naturopathic school, it all boils down to balance. When you are out of balance, when stress is impacting your quality of life, when it’s impacting your sleep, when it’s impacting your relationships, that’s a clue to us that we’re out of balance and we need to do something.

I think I always relate it back to the principles that we learned in naturopathic medical school. The foundation for our education. First do no harm. Treat the cause. Treat the whole person. Stress is so core, and how we manage and respond to stress is so core to our overall health, that if that’s off, a whole lot else can be off too.

Dr. Trevor Cates: Right. I know some people say that they don’t have time to do stress management. How do you feel about that?

Dr. JoAnn Yanez: It’s really funny. If you don’t have time to take care of stress management, eventually it’s going to make you. That’s just my personal experience with myself and with patients that if you keep putting it off, ultimately there’s going to come a time where it gets so in your face that you can’t avoid it.

Dr. Trevor Cates: Can you give an example of that? I’ve seen it in my practice. I definitely know it, but just as a good reminder for people to know what we see in our clinic.

Dr. JoAnn Yanez: Sure. I had a patient who was having some family relation stuff. There was some dynamic going on with parents and how they were interacting. It had gone just under the rug for years, and years, and years. In her 30s, it started manifesting as palpitations, as anxiety. This person came in, and she was anxious about the heart palpitations because that’s going to get your attention when your heart’s pounding in your chest for no reason. But ultimately, when we started to dig deeper, there were all of these unresolved family issues that came to play. The patient had already had more serious cardiac conditions ruled out.

I was like, “Okay, we need to talk about this. This is obviously disturbing and distressing. Let’s figure out a way to resolve all of the stress that this family dynamic is playing and how it’s playing out in your life.” We have supplements, we have things that we can do for palpitations and anxiety, but the root cause was this underlying pain that this family dynamic was causing her. And until that was handled, the anxiety and the palpitations were still going to be there.

Dr. Trevor Cates: Yeah, yeah, absolutely. I’ve definitely seen that in my practice too. I remember a patient. She came to me with a number of health problems. Of course, I gave her the naturopathic approach and naturopathic treatment. But one of the things that she said to me was, “I hate my job. I hate going to work every day. I can’t stand it.” So, I gave her the treatment protocol, and I said, “Just so you know, as a naturopathic doctor, I am always looking for the underlying cause, address the root cause. And I really think that the biggest root cause that you have going on is your job.” She never came back to see me. And I thought, “Oh, she didn’t like what I had to say.”

And then forward, I think it was about three, four months, I ran into her, Park City’s a small town. I ran into her at a holiday party. She came up to me. She just like came straight at me and I was like, “Oh.” She said, “Dr. Cates, I want to let you know that after I saw you, I quit my job, and my health returned to normal. I feel great. I’m so grateful for you. I always thought I should call and let you know, and I never did. And so, I’m so glad I ran into you to tell you that I didn’t need to come back because I quit my job.”

Dr. JoAnn Yanez: It’s really funny. Those things that sometimes seem inconsequential to us, that’s just part of how we would interact with the patient. We’re just going to say those things because it’s so core to us. But it’s interesting because I’ve had those interactions with patients too, where they don’t come back, or you don’t really know the impact that you had in someone’s life until much later, or sometimes you never know. So for me, I think that that ultimate kindness, that helping is so vital that we just live our lives in this spirit of giving back and being helpful. You never know who you’re going to touch or how deeply you’re going to touch them.

Dr. Trevor Cates: Right. And I do want to comment that it’s not like it’s that easy to just quit your job, right?

Dr. JoAnn Yanez: No. Sometimes that can bring on even more stress. Like there are many people right now that are out of work or underemployed. Because of the situation, they can’t work safely. I know I’m seeing the stressors in a lot of my friends and colleagues and it’s definitely a big deal. But if, like you said, if that job or what is the root of that issue, and until you can get to that and figure it out, that is going to be there. It’s the thorn in the foot.

I always give the example of the check engine light in your car. You have this check engine light, and it means that you need to take your car in, but it’s a symptom. It’s just something that’s telling you that something is wrong and needs to get checked on. So, you can unplug the cord to the check engine light, or you could go and take your car in. Naturopathic medicine is like going in, taking the car in, and getting to the root cause.

Dr. Trevor Cates: Yeah, absolutely. Okay, so let’s talk about what are some of your favorite things to do that you recommend to help with stress?

Dr. JoAnn Yanez: Oh gosh, there are so many. But I think, for me, I talked about giving back. Gratitude is one of them that I think is a little underrated. People are just starting to talk about gratitude. I’ve been lecturing on positive psychology for years. I know they didn’t really cover positive psychology too much in my program. It’s come to light much more lately. Are you familiar with that term? I don’t want to assume that your listeners are.

Dr. Trevor Cates: Why don’t you go ahead and explain it to us so that we’re up to speed.

Dr. JoAnn Yanez: Positive psychology is basically the study of being happy. In naturopathic medical school, we learned all of the ways of diagnosing people who are ill, what causes illness, what causes a disease and manifestation of that, and symptoms. But positive psychology is the study of what makes us happy. What are the characteristics, the common thread of people who are happy and content in their lives? What can we do to learn more about those things, so that we can then foster more positivity? Does that make sense?

Dr. Trevor Cates: Absolutely. I love it.

Dr. JoAnn Yanez: It’s very naturopathic in the way that it’s focusing on the positive, and cultivating wellness and health, mental health, rather than just an illness-based approach to healthcare and mental health. And so for me, gratitude is key to that. There’s literature that supports it mitigates stressors and improves quality of life. It can help strengthen our relationships and help our health. There’s growing research right now that it can be helpful in a host of conditions like anxiety and depression, and even heart disease and cancer.

When all of this hit, when the coronavirus first hit, my work was increasingly stressful. All of the naturopathic schools basically within a couple of days’ time had to move everything online, close all clinics to conventional patient care, and basically take care of all of their communities. It was really, there was a lot going on. At the same time, my husband, who is a hospital administrator, was working easily 12-14-hour days and my son was home from school. I’m like, “Oh my God, I’m getting overloaded. Where’s my own practice?”

I started doing that with us every night when I put my son to sleep. I said, “Okay, today we’re going to think of three things that we’re grateful for. I’m going to start because I need it just as much as you do probably.” I started this and it really just set the intention of, “Okay, yes, this is awful. This is really stressful. But within all of this, there are some things that we can find that are good.” It was very, very intentional to do that every single day. I even had my son, he’s still learning how to write, and I said, “Here’s a journal. Start writing in it. Just, you don’t have to write a whole lot, but write down something.” We just started that practice of incorporating gratitude and thankfulness.

In my neighborhood, our neighbors started chatting. I don’t know how your neighborhood is, but folks were checking in on each other. “Do you need anything? Hey, I got a grapefruit tree. You need some food? I can swap some grapefruits for something else you’ve got.” We just started checking in on each other and I was really grateful for that support system, for friends and that compassion. That gratitude is something that you can develop. It’s like a muscle. You have to practice at it. Because we can easily go mentally dark if we’re not careful and mindful of that.

The second thing, so gratitude is one, mindfulness is the other. I think mindfulness is so core to our awareness of being able to address things. Mindfulness lets us tune in to our body, and to our condition, and to our surroundings, and let us know, “How are we doing? Do we need to change anything? Is anything out of balance right now?” In the midst of being at my computer for lots and lots of hours, I started having some neck tension like, “All right, I need to check in. What’s different? What’s going on?” I realized I was wearing my shoulders as earrings again I’m like, “Oh, I haven’t done that since medical school.”

It was like, where do we hold the tension? Everyone is different, and tension and stress is going to manifest in your life in different ways. For me, it was my traps, and my neck, and my headaches all coming back and like, “Okay, I got to tune in.” I started be more mindful about my ergonomics and my computer, standing more at my desk rather than sitting down. I took steps and it’s gone. Rather than going a whole course of needing medication for pain, and all that kind of stuff, I allowed that mindfulness practice. I’m giving myself as an example right now, but I allowed that to guide the next things that were going to happen. Those, to me, are very, very powerful, but there are so many others.

I know you know this as an ND, getting outside, and right now we have to be safe about getting outside. But if you have the ability to get outside safely and get some sun on your skin, that’s a really good thing. If you can get outside and sweat and move, that’s another really good thing. I forced myself, even in the midst of this, to make sure that I putted around in my garden. I’ll get out there a couple of times a week and pull out weeds, and sweat a little bit, and it’s all good. So, however that looks for you or your listeners, it’s really putting together the plan that keeps you sane. For everybody, that’s going to be different.

Dr. Trevor Cates: Yeah, absolutely. I know that I travel, I used to usually travel a lot. I’ve always wanted to have a garden. I’ve made attempts before, but it usually ends up dying because I travel so much. Right now, I’m working on getting that going and I’m so excited. I’m grateful for having that allowance of, “Okay, now I have the time and opportunity to actually do this.” So yeah, being creative and patient, I think is certainly something to think about during this time, right?

Dr. JoAnn Yanez: Be gentle with yourself too. I know that a lot of folks have that self-talk. The brain inside your brain that talks to you and says things that may not be so positive. Part of that mindfulness, I think also is listening and being attentive to that self-talk and what’s your brain saying to you when no one else is looking? What’s that inner dialogue that goes on, and either puts yourself down, or you didn’t do a good enough job, and all of that mental stuff? Mindfulness isn’t just about the physical symptoms, but it’s also that inner voice too, and being mindful if those types of things are trying to creep in.

Dr. Trevor Cates: Right. Sort of like making an investment in your health, and because like you have to put some money into your bank account to keep it alive, and you can pay your bills, and all of that. You got to do this for your health too because you have to think ahead for things. It’s not just right now. Stress management of course helps in the moment, but it’s even more powerful for what it can do for the future, right?

Dr. JoAnn Yanez: It is. Stress management and just being attuned to the impact. So, we know physiologically the stress hormones do a whole lot in our body. It’s fight or flight. It’s the bear is chasing you in the woods and you need to go get safe, and so stress serves a purpose. Like I said earlier, there’s good stress. There’s the good part of if you see a car is about to hit you, your heart starts pumping faster. It gets blood to your legs. You can run across that street and get to safety. But those same hormones when they go overkill, and they’re used in a way that is too ongoing or too continuous, they’re going to start to do damage to our body over time.

So, it is really important to be attuned to that stress and know your triggers, know the types of things that can help you manage those triggers better or avoid them altogether. Some people, I brought up that family example, and some people have family dynamics that are very stressful, and sometimes it makes more sense to stay away from those, or minimize those if they are going to be more detrimental to your health.

Dr. Trevor Cates: Right. Yeah, it’s not always possible to do that, but certainly it’s about balance. Doing what you can. And certainly coping mechanisms, any suggestions on for people who, especially if they’re forced to be with their family right now, and maybe they can’t really get away. Are there things that you can recommend that to help people sort of through that time?

Dr. JoAnn Yanez: That’s a really great point. Right now I know we’re starting to see some data coming out that there’s increase in risk for domestic violence, increased risk for verbal abuse, and all of that right now. I think all of the things that we can do under normal circumstances to cope and to manage. We talked about gratitude. We talked about journaling. Social support is important, having a network of people you can rely on. Then physical exercise, all of the things that you can do, mindfulness practices, gratitude practices.

I spoke maybe a month ago on a radio show and there was a big uptick in alcohol sales when all of this occurred (click here to listen to the podcast). They were starting to see a lot of increase in people relying on alcohol as a coping mechanism to deal with what’s going on here. Again, it’s awareness of what are the positive coping mechanisms that you can rely on and what are some ones that may have detrimental effects? If you’re being mindful and you’re recognizing, “Oh, I used to have a glass of wine like a couple of times a week, and now it’s every night. Is that a practice that I want to continue?” Check in with yourself and say, “I don’t know if that’s a practice I want to continue. So how can I change that for myself?”

Like you said, you have to invest in yourself. If you’re checked out on yourself, nobody can do this for you. This is the type of thing that we can, as naturopathic doctors, help patients and educate them to what’s healthy and what can be a help for them. But we can’t do it for you. That’s when that investment in yourself kicks in.

Dr. Trevor Cates: Can you explain why drinking alcohol is a negative coping mechanism? Because I think it’s such a cultural thing, a big factor of that is it’s cultural. It just becomes such a pattern for people that they don’t really realize that it’s a negative coping mechanism, so can you talk to that a little bit?

Dr. JoAnn Yanez: Sure. From a biological perspective, alcohol turns into very readily available sugar. From a physiology perspective, not even talking about the impacts on brain tissue and all of that, but just the basics, it’s going to raise blood sugar, which if you’re trying to manage weight, if you’re trying to manage your hormones and all of that is going to cause a challenge or can cause a challenge. It can impact our sleep cycle. There are so many different physiological things that we learn about with alcohol and its metabolism that it can impact it. There’s a greater impact in some cases on females than males, just because of body mass, and metabolism, and so on.

When you think about coping mechanisms, your coping mechanism for a stressor shouldn’t put more stress on your body. It should be the relieving of stress, not adding to it. If that coping mechanism for you… I would venture, I would even throw in excess exercise, excess anything. If that coping mechanism, too much shopping, too much whatever, is if it’s going above and beyond, if it’s adding more stress, then it isn’t an appropriate coping mechanism. That’s the sort of thing that we should just be mindful of, again, that mindful word. But if that stressor is going to add more into the bucket in the terms of stress on your body and on your system, then it probably isn’t the best coping mechanism to be thinking of. I hope that that made sense.

Dr. Trevor Cates: Yeah, it does. What do you think is too much alcohol just in general? I know this is in part, it’s a very personal thing and it depends on the individual, but do you have like something you recommend to your patients? That’s like try not to drink more than blank?

Dr. JoAnn Yanez: I don’t make any recommendations for folks regarding that. It’s a very sensitive topic, for some people with history of alcoholism, one drink is too much. Or with family histories, I’ve had folks over the years who have family histories of alcoholism, and they just prefer, “You know what? I don’t need that in my life. It’s represented too much negativity and there are so many other good things, that I don’t need to bring that into the situation.”

I think it’s a personal check-in. That’s the type of thing that somebody should probably be checking in with their own practitioners to make sure that where they’re at is good for them, and their metabolism, and where their body is at that time, their coping mechanisms, and so on. For some folks, that might be a drink or two a week. Some folks, that might be none. I think it just very much is individualized.

Dr. Trevor Cates: Yeah, okay, great. Thank you.

Dr. JoAnn Yanez: Yeah.

Dr. Trevor Cates: The positive coping mechanisms are more, like you said, the gratitude, the mindfulness, getting out in nature, getting some exercise, but not overdoing it. I do have some patients in Park City that have overdone it with exercise, that are people that just they go too hard. It can have a negative impact on the body too. Since you mentioned that, again, what is that tipping point? How do people know when it’s too much of a good thing has become a bad thing?

Dr. JoAnn Yanez: That’s a really good question. Again, not to be totally putting it off, but it is going to vary somewhat on the individuals, and your age, and your body health. I think ultimately if we go back to that point I made earlier, if this is the type of thing that is adding to the stress of your body, then it’s moved into more of the negative bucket. Some physical wear and tear is to be expected as we age, with exercise, and so on, but that little tipping point is really going to be listening to your body.

And okay, this running was fabulous. Running was a stress reliever, but now running is turning into my knees hurt every single time, and I can’t walk afterwards for a day. Now we need to start looking at okay, what’s the impact of this exercise? What is it maybe triggering or causing us to pay attention to? Maybe there’s some other underlying issues that this is just bringing to the surface.

I think for everybody, it’s going to be somewhat individualized. It’s going to depend on your conditioning. There are extreme athletes. When I was in training, I had the pleasure of working with the team doctor for the Phoenix Suns and the Phoenix Coyotes. It was so much fun, but I remember standing in awe of the physicality of what these folks were able to do. Their heart rates were at levels where, I was standing with a cardiologist and he said, “If you ever see this on anyone else, call 911 because this is not normal heart rhythm.” But it was the sort of thing that I think it is going to vary somewhat on the person’s athletic conditioning, on their age, on their underlying medical conditions, and so on. But again, if something starts causing more stress and more strain, that’s your sign to maybe check in and say, “Is this really as good a thing as I thought it was?”

Dr. Trevor Cates: Yeah, absolutely. All right. Well, this has been so fascinating talking about stress. Anything else that you want to tell people about it, like where to start with stress management, if they’re just trying to find? Because you mentioned, it’s something people have to train themselves to do. Like the gratitude is something, especially like you got to reprogram yourself. Any tips on how to getting into that for people who it’s kind of a new thing for?

Dr. JoAnn Yanez: So, on the AANMC website, I’m the executive director for the Association of Accredited Naturopathic Medical Colleges, and we have lots of blogs and tips and tricks for this. But I always tell folks, “Start small. You don’t tackle Mount Everest the first time you go hiking. This is the sort of thing that you have to build into it and you have to practice.”

And so, with gratitude, you can start with just three things every day that you’re grateful for. It’s pretty easy. It’s pretty low hanging fruit. That’s something most of us can commit to doing. The mindfulness practice that I like personally, I do it at night. I will just as I’m laying in bed, getting myself ready for sleep, it’s just a real quick check in. I start at my head and I start just kind of okay, scanning my body from top down. How am I feeling? What are my thoughts? What am I feeling in my body?

And without judgment, and the judgment part is the most important part. So it’s not, “Oh man, I got pain in my neck. I’m such a dumb wad for not knowing about ergonomics and not listening to my own advice.” You banish all that judgment stuff. It’s just listen, feel, scan without all the judgy stuff. Let that go. What I’ll do every night before bed is just scan top to bottom. The other bonus is that it starts to relax you, so that hopefully you can go to sleep a little bit easier.

Dr. Trevor Cates: Yeah, that’s a great tip. I love that one. That’s fantastic. Well, it’s been so great having you on. Tell everybody where they can learn more about you and the association.

Dr. JoAnn Yanez: Sure. So, I’m Dr. JoAnn Yanez, and AANMC.org is our website. We’re also all over social media, Instagram, and Facebook, and Twitter, and so on, so check us out. If you are, or any of your loved ones are interested in learning more about naturopathic medical school, like Dr. Cates and I did, feel free to check out our website. We’ve got lots of information. We also host free monthly events on our website on all different types of health topics like allergies, and oncology/cancer, and women’s health, and stress.

Dr. Trevor Cates: Right. So, even if you’re not interested in becoming a student, there’s still plenty of information for the general public on the website. That’s fantastic. I love that. And it’s so funny, so you and I met while we were in naturopathic medical school. We were at different schools, but we were the first group to do the International Naturopathic Student Association.

Dr. JoAnn Yanez: INMSA.

Dr. Trevor Cates: We had representatives from the different schools, and we all met up in Canada at the Canadian school that was there, and started to brainstorming in how to help our colleges communicate better. Right?

Dr. JoAnn Yanez: It was. I remember we had to send things by mail and that was challenging. I think we probably would have had a lot more luck getting it off the ground with today’s internet connectivity.

Dr. Trevor Cates: Yes, definitely. This was 24 years, 23 years? Okay. That one didn’t survive, but then it got revived and turned into something new. And I’m so glad that you’re still involved in an aspect of this, so it’s really fantastic. Thank you for all the work that you do.

Dr. JoAnn Yanez: Oh, well, thank you so much for having me on, and for raising awareness for patients and folks all over about how they can stay healthy naturally.

Dr. Trevor Cates: Yeah, thank you. I hope you enjoyed this interview today with Dr. Yanez, and to learn more about her and the AANMC, the association that she was talking about, you can go to the spadoctor.com, go to the podcast page with our interview, and you’ll find all the information and links there. And while you’re there, I invite you to join The Spa Doctor community, so you don’t miss any of our upcoming shows and information. If you haven’t taken the skin quiz yet, you can go to theskinquiz.com. It’s a free online quiz to help you figure out what your skin is trying to tell you about your health and what you can do about it. Just go to theskinquiz.com. I also invite you to join The Spa Doctor on social media. We’re on Facebook, Twitter, Instagram, YouTube, and Pinterest. And I will see you next time on The Spa Dr. Podcast.

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Gluten – What is All the Buzz?

If it seems like everyone and their dog is avoiding gluten lately, rest assured, it is not all in your head. The food market is exploding with gluten-free alternatives from shampoo, body care, and cosmetics to gluten-free bread, cereal, and vodka. Even the Girl Scouts have joined in with the release of a gluten-free chocolate chip shortbread cookie! The food industry reports that the gluten free market is projected to balloon from about $7.28 billion in 2016 to over $16 billion in 2025.1

The exact reason for the increasing numbers of gluten intolerant people is unknown, but there are several theories as to why the prevalence has increased so much, including hypotheses like the so-called “old friends” theory where it is believed that the loss of contact with the very bacteria, fungi, parasites, and other microbes that humans evolved with has resulted in intolerance to natural compounds like gluten. Research with celiac patients found that those who were intentionally infected with hookworms could then tolerate digestive exposure to gluten without problems.2 Other hypotheses include the presence of too much wheat in the diet, overuse of antibiotics, treatment of conventionally grown wheat with pesticides, and of course misdiagnosis of the problem altogether.

To gain a more complete understanding of gluten and its potential impact on health, there are a few questions that must be answered.

What is gluten anyway?

Gluten is a general term for a large family of proteins found in several types of grains like wheat (all types including wheat berries, durum, semolina, spelt, faro, graham, etc.), rye, and barley. Gluten can also be found in derivatives of these grains like malt and brewer’s yeast. It is used by the plant as a source of nourishment during seed germination. Gluten acts as a glue, helping foods maintain their shape and elasticity, and also allows bread to rise during baking. Gluten is often found in unexpected places like soy sauce, pickles, cosmetics, medications, supplements, and even in naturally gluten-free products like rice, oats, or french fries via packaging or processing cross-contamination.

What does it mean to be “sensitive” or “intolerant” to gluten?

People that are sensitive or intolerant to gluten are those who develop any number of symptoms when they consume gluten or gluten containing products. Often termed, non-celiac gluten sensitivity, these people may experience many of the same symptoms such as brain fog, gas, bloating, constipation, headaches, joint pain, etc. as someone with celiac disease yet they do not test positive for the condition. Such individuals may see benefit including resolution of symptoms from adhering to a gluten-free diet.

What is the difference between a gluten “sensitivity” or “allergy” versus an “intolerance”?

An allergy to a particular food happens when the body produces an immune response upon exposure to that food. The resulting symptoms can be mild like a stuffy or runny nose and/or headache, to moderate symptoms like hives, itchy mouth, or a rash, to severe reactions like throat tightening, difficulty breathing and even life-threatening anaphylactic reactions. It is estimated that upwards of 32 million Americans have true food allergies, and the Center for Disease Control reports that food allergies have increased in children by 50% in recent years.3

Another type of food reaction is an intolerance (though people often mistakenly call these allergies). This type of reaction is not initiated by the immune system and does not result in anaphylactic reactions. Food intolerances are often related to the absence or decreased activity of specific chemicals or enzymes that are required to digest certain substances. A classic example of this is lactose intolerance. People who suffer from lactose intolerance lack sufficient amounts of the enzyme lactase which is needed to digest lactose resulting in digestive disturbance.

In conclusion, the difference between an allergy and an intolerance comes down to the type of biochemical reaction that drives them within the body. The treatment in many cases may be the same (avoidance) regardless of the type of reaction causing the symptoms.

What are the signs and symptoms of gluten sensitivity/intolerance?

The reactions an individual has to gluten consumption can vary. This is by no means an exhaustive list, and not every person will have every symptom, but typical symptoms include:

  • Bloating
  • Flatulence
  • Constipation
  • Diarrhea
  • Irritable Bowel Syndrome (IBS)
  • Iron deficiency anemia
  • Joint pain
  • Skin problems
  • Asthma
  • Mood imbalance
  • Fatigue
  • Weight loss
  • Delayed puberty (in children)
  • Slowed growth (in children)
  • Infertility
  • Osteoporosis

What is celiac disease?

The most well-known and serious type of gluten reactivity is an inflammatory gut disease known as celiac disease. Celiac disease is often thought of as a food allergy, but since celiac is a genetic autoimmune disease caused by activation of certain genes, this is an inaccurate representation. About 33% of people in the Western world, carry the gene for celiac disease.4 But since celiac disease has a prevalence of only about 0.5-1%, the cause is beyond simple genetics and disease manifestation in susceptible individuals likely must also include an environmental trigger.5

As in other autoimmune diseases, people with celiac disease may have periods of exacerbation of symptoms or remission, where they are asymptomatic.6 However, celiac disease is a chronic condition. If someone with celiac disease consumes gluten, an abnormal immune response is triggered that results in significant inflammation and damage to the lining of the small intestine, which then impairs the absorption of nutrients of the small intestine.5 The damage to the small intestinal wall  and inflammation of the intestinal lining can lead to malabsorption and malnutrition, which in turn, can lead to osteoporosis, anemia, and delayed growth.

Are celiac disease and gluten intolerance the same thing?

No. Although the symptoms can often be the same, celiac disease and gluten intolerance are driven by different biochemical processes within the body. Celiac disease is an autoimmune condition that results in an immunologic response to gluten in the intestines. An intolerance is not immune-mediated and may be related to lack of key enzymes or chemicals required for digestion of gluten.

Can a gluten free diet help?

Yes! In the case of celiac disease, a strict gluten-free diet is an absolute must. A gluten-free diet means that the protein gluten is excluded from all foods consumed. Label reading is very important when taking on a gluten-free diet. Some people are exquisitely sensitive to gluten and may not see improvement of symptoms with a gluten-free diet if they are exposed to even small trace amounts of gluten. For this reason, some people may need to be very conscientious of hidden sources of gluten, as well as cross contamination of typically non-gluten containing foods. Such individuals would need to consume gluten-free products from facilities and growers who are strictly dedicated to being gluten free.

Be sure to consult your naturopathic doctor if you are considering switching to a gluten-free diet. Click here to find an ND in the US and Canada.

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Dr. JoAnn Yanez on KCAA 05/13/20

Dr. JoAnn Yanez, AANMC executive director, joins KCAA’s NBC LA affiliate On the Brink to discuss naturopathic approaches to allergies.

Full Transcript of Interview Below.

Topics Include:

  • The various causes of allergies – nature vs. nurture
  • The burden allergies place on your system
  • Environment, nutritional and lifestyle changes for allergy prevention and management
  • How naturopathic medical education is responding to COVID-19

Erin Brinker: Welcome back. I’m Erin Brinker.

Todd Brinker: And I’m Todd Brinker.

Erin Brinker: And we are On the Brink, the morning show on KCAA, AM 1050, FM 106.5 and FM 102.3. I’m super excited to welcome back to the show- (LONG PAUSE)

Todd Brinker: Somebody from somewhere.

Erin Brinker: Oh my God. I have allergies so bad.

Todd Brinker: Dr. JoAnn Yanez.

Erin Brinker: Dr. JoAnn Yanez, and I’m just kidding. I love to welcome back Dr. JoAnn Yanez from the Association for Accredited Naturopathic Medical Colleges. She joins us once a month to talk about health and wellness and just everything feeling good from a naturopathic perspective. Help me with my allergies, Dr. Yanez.

Dr. JoAnn Yanez: You bet. That was the best intro I think I’ve ever gotten. Oh, my goodness.

Erin Brinker: I have allergy brain. I really do. And while I was joking, just then it’s happened to me in meetings where I know what I want to say, and I can’t get it out because my head feels like it’s full of cotton balls.

Dr. JoAnn Yanez: Gosh, you know, allergies affect so many people, and we don’t always really know the full cause of allergies. There are genetic susceptibilities and environmental factors that play a very important role. When we’re looking at the reasons and the heritability rates for allergic disease, a lot of times it’s in your family. Erin, did you have any family members who had allergies?

Erin Brinker: I think my dad has some. Yes. I’m going to say yes, I do.

Dr. JoAnn Yanez: Very often we’ll see this hereditary component. It can be as high as 95% for asthma, 84% for atopic dermatitis, which are like skin rashes and so on. It’s clear that genetics account for a good chunk of this, but a lot of this is nature and nurture. I don’t know if you’ve ever heard of that before, but how much is our genetics, and then how much is our interaction with our environment?

Erin Brinker: Right.

Dr. JoAnn Yanez: Allergies are a topic where avoidance helps a whole lot. If you know what you’re allergic to, that makes it a heck of a lot easier to avoid things that will trigger your system. What are allergies? It’s basically just an overreaction of your immune response. Your immune response is set up to detect what is self and what is not self – what’s me and what’s not me.

All the stuff that’s ‘me’ is good, friendly, let them be. And all the stuff, that’s not ‘me’, we’re going to attack like viruses and bacteria and molds and pollen and things of that sort. But the body sets up this extra response to things that would be in our environment like pollen, like maybe some foods or cat dander, animal dander and things of that sort. And then, as a result, you get itchy eyes, the runny nose, the foggy brain.

Erin Brinker: I am allergic to just pollen, so in the spring, and here it’s not as bad as other places. The year that I was an exchange student in Austria, I thought I was going to die in the spring because there were beautiful flowers everywhere, and I was miserable. So, yeah. I don’t know if it’s because I don’t live in that local area normally. And so, maybe it was because it was new to me?

Dr. JoAnn Yanez: There are a lot of different theories behind that. The other theory that is often discussed when we’re talking about this allergy topic is total load, and that’s the total burden on your system. Think of it like that proverbial hair that broke the camel’s back. You may be fine with a low level of the things that you’re allergic to, and there might be things in your environment right now that you have more mild sensitivities to that maybe don’t get to that level of the itchy eyes, but there might be a low grade inflammation in your body as a result of being exposed to certain types of things.

When you add that one extra little piece on top of the camel and boom, the camel tips over. I think that’s very often what we see in allergies, and so in general, a naturopathic approach to allergies is going to be looking at the whole person, looking to decrease the overactive inflammatory response and lower that burden wherever we can.

We’re going to be identifying maybe even some of those lower level allergens and getting those out of the system and decreasing the burdens so that if and when you are exposed to some extra pollen, that doesn’t throw you over the edge. Does that make sense?

Erin Brinker: It makes total sense. If you find out, which is my greatest fear, that you’re actually allergic to cats, but it’s not so bad that it makes you really sick, but then you walk outside and there’s pollen falling from the trees and you go bananas. The issue may really be more the cats than the trees.

Todd Brinker: It could be both.

Dr. JoAnn Yanez: Like I said, it’s, it’s that total load. You bring up this cat example and it’s hilarious. When I was in medical school, medical school’s hard and I was thinking of stress release, and I went and I got myself a cat. She was amazing and beautiful and so fun to have around the house, but I was a medical student. I wasn’t home a whole lot, but I started noticing … I had some really funny friends in medical school, a naturopathic school, and they would tell these amazing jokes and all of a sudden when they would joke, I would laugh and then start coughing. I never put it together that it was the cat that was creating extra inflammation in my lungs. They would tell a joke and it would jostle up the phlegm that was in there, and I would start to cough.

I didn’t put it together. And let me tell you, I had the cat until she was about 18, so you can see where we’re going with the story. But as a medical student and then as a young doctor, I was not home a whole lot. And so, I might’ve been home really just to sleep and then go back out to work again, and so it wasn’t until we moved to South Dakota, and I was home with her pretty much all day long. I was working from home, and my husband started noticing every night I would start coughing. He’s like, you need to go get tested. Figure it out.

At that point, I’d probably had her for about, I don’t know, 13, 14, 15 years. It was just this total load of building up over time, and the fact that I was with her now all day long was that straw that broke the camel’s back. And so I go to an allergist and I get all the allergy testing and, lo and behold, trees and cats.

You know what? I’m looking at my little fur baby. I’m like, I’m not getting rid of you after 16 years, so I did as much as I could to keep the house clean, so there are environmental things that you can do. Get rid of your carpets. Get rid of your drapes. Get rid of any fabrics that you can’t wash in your home that attract and hold onto that.

We got a bunch of air purifiers to clean out the air, and then I started working on my own diet and taking anti-inflammatories as much as I could. I got pregnant around the same time, so that limited the amount of things that I could take, but it was one of those where, all right, I’m not going to put my cat down because I’m coughing and sneezing.

Erin Brinker: Right.

Dr. JoAnn Yanez: So, what are the other options?

Todd Brinker: Are there some natural anti-inflammatories that you maybe took as an alternative?

Dr. JoAnn Yanez: There are natural anti-inflammatories and this is not a diagnosis or promotion of anybody taking anything. Make sure to check with your doctor to make sure that you’re taking the right things for you. But there are things like stinging nettle, quercitin, fish oil. You could do turmeric, which is a natural source of anti-inflammatories. There are a lot of things that you can do, making sure your bioflavonoids are up, and then allergen avoidance. Just really avoiding the types of things that are inflammatory so paying attention when you eat, how do you feel after a certain food? Do you get a little extra phlegmy in your throat after you’ve eaten something?

Paying attention to those signs and removing those things from your diet. A food journal or a rotation diet, a rotation and elimination diet is an easy way, not easy, but it’s probably of the more effective ways to figure out that. So journaling, removing things from your diet, and then adding them gradually back in and seeing the symptoms that pop up.

I think when it comes to allergies, it is a comprehensive approach. There isn’t a one-size-fits-all answer. It’s going to be very variable for folks, but it can be extremely, extremely effective. We have a webinar coming up on May 26th with Dr. Jonathan Beatty, who’s going to speak about his own journey, which is hilarious. He was a kid. He used to work at Dairy Queen, and had horrible eczema, only to find out that he was allergic to dairy.

Erin Brinker: Oh, wow.

Dr. JoAnn Yanez: He’s going to tell his story and journey to ridding himself of horrendous eczema, and also share some other patient cases and some other ways that naturopathic medicine works with patients with allergies, but it’s really one of those things where, with my cat it’s like, okay, she was 16 at the time. I can’t put down an animal.

Erin Brinker: No. She’s your baby. I’m a cat lover, and I’m remembering now, my father is allergic to cats, so I’m probably allergic to my cats, but I love them so much, and I’ve had them for 14 years, 13 years.

Dr. JoAnn Yanez: It’s really tough. My cough was bordering turning into asthma, though, so it’s like, okay, this is getting to a point where, after my cat naturally passed away, “all right, not getting near any cats anymore.” Now I’m so sensitive that my nose starts itching as soon as I walk into a home that has cats.

Erin Brinker: Interesting. Interesting. Wow.

Dr. JoAnn Yanez: Total load. Total load.

Erin Brinker: Total load. And I have to tell you, I was constantly sick for years, constantly sick, and in January I became a vegan. I have cut, because of that, just wanting to be healthier, with no dairy I get little colds. I had kind of a sore throat last night, but I’m fine this morning. I haven’t been consistently sick since I gave up dairy. I’m quite certain that these consistent colds that I had were because my body’s like – Stop. Eating. Dairy. Knock it off, Erin.

Dr. JoAnn Yanez: Step away from the cheese.

Erin Brinker: But it’s so hard to do that.

Dr. JoAnn Yanez: I know, but you have to open it, and you just highlighted, these nutritional changes, the lifestyle changes are some of the hardest to make, you know? And so, I think for people, I always guide folks, all right. What’s your goal?

When you make decisions about eating, is that decision moving you closer to your goal of health or farther away? Just be conscious about it so that you can make that decision of, all right, yes, cheese is really tasty but every time I eat it, I end up sick, or my colds don’t go away, or my colds turn into longer flus or pneumonia or whatever.

Erin Brinker: Or I get cold sores over and over and over again.

Dr. JoAnn Yanez: Is that really worth this slice of cheese?

Erin Brinker: No, it’s not. I can tell you right now, no.

Todd Brinker: Says the now vegan eater.

Erin Brinker: Exactly. Exactly. So, Dr. Yanez, this is a great topic. How do people see your webinar and learn more about this and at the Association for Accredited Naturopathic Medical Colleges?

Dr. JoAnn Yanez: Well, we’re at AANMC.org. Instagram, we have a whole site on there for our events as well. We update events every month. This month is allergies. Next month is cancer. Every month we’ve got events for free to the public. I kind of caught the tail end of you talking about education.

We’re in naturopathic medical education, and that’s something that we’ve also been working on as all of our schools have had to emergently move online, and what can be done online long-term and what really cannot, so I applaud you for taking on that topic. It’s definitely something, all of us in education, are chewing on really thoughtfully right now.

Erin Brinker: These are discussions I think that people have been having because we’ve had online education, but it’s like, oh, we want to consider everything, and then all of a sudden, bam, we’ve got to make these decisions now. And oh my gosh, what does this mean?

Nobody’s had time to really think things through, and we’re kind of working through things out. This is true in K-12 education, too, because I’m married to a teacher. It’s working in some ways and really not working in others. Yeah, we got to talk about it.

How are you all doing? How are your member colleges or universities doing their online education because it’s a medical school, so all of the labs and all of the science that has to take place, how do you do that online?

Dr. JoAnn Yanez: It’s been a very quick trial by fire and emergency effort. I applaud my member schools and deans and educators for getting their programs online and getting the students transitioned, especially the ones that were getting set to graduate, where they were just about done.

We’ve been working with our accreditors, our testing agencies, the deans. There are emergency measures that have been implemented (with permission from the accreditors and Department of Education) right now that we recognize. Like you said, there are some things that are working and there are some things that were emergency measures. All of the schools are working right now on transition plans of how do we safely get students back on campus to do some of that hands-on learning that really needs to be hands-on, although I will say that there are some amazing technology simulation labs that have been created that, while it isn’t the same as face-to-face, there are some amazing technology feats that have been created.

Some of our schools have gotten really inventive to where, like for botanical medicine labs, they’ve sent boxes home to students with herbs and you all of the things that they need to do the experiments and the procedures and such at home. And so, what’s that? Necessity is the mother of-

Erin Brinker: Invention.

Dr. JoAnn Yanez: Exactly. We’ve really been getting very inventive in trying to ensure the continuity of our students’ education. So, while yes, there are some things like delivering babies and phlebotomy and all of that that have to have to have to be face-to-face, we’re also securing protective equipment. Several of our schools have been able to be providers during this time either with protective equipment or telemedicine.

Every single one of our schools has gotten telemedicine up and running because the other thing is you have patients. You have patients at all of our clinics that rely on our clinics for medical care. You can’t just abandon your patient because now there’s no way to continue with their care. So telemedicine was something everyone stood up very quickly. Many of the schools, almost all of them, already had very active tele-med programs, but this was something that really got ramped up to full capacity quickly.

Erin Brinker: Well, it sounds like everybody’s working hard to keep the quality of the education as high as possible to meet the needs of their students, and I think that’s wonderful.

Dr. JoAnn Yanez: Harder than we’ve ever worked in our lives.

Erin Brinker: I can imagine. I can imagine. So, Dr. Yanez, it’s always, always, always a treat to have you on the show. Thank you so much for joining us today.

Dr. JoAnn Yanez: You bet. Thank you both and stay safe and healthy and happy.

Erin Brinker: Thank you. You too. So with that, it’s time for a break. I’m Erin Brinker.

Todd Brinker: And I’m Todd Brinker.

Erin Brinker: And we are On the Brink, the morning show on KCAA. We will be right back.

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Dr. Gurdev Parmar – CCNM

Gurdev Parmar, ND, FABNO is the co-founder and medical director of the largest Canadian integrated health care facility – Integrated Health Clinic located in Fort Langley, British Columbia. Dr. Parmar is a leader in integrative cancer care, supervisor of a naturopathic oncology residency, and the author of the Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care.

Laying the groundwork to become an ND

“I wanted to pursue a career as a primary healthcare provider that was knowledgeable in both conventional and natural medicine. Naturopathic medicine fulfilled my scope of practice wishes and desires. I knew it would provide a lifetime of cerebral excitement and learning.”

CCNM as a springboard

“My time at Canadian College of Naturopathic Medicine (CCNM) was some of the most memorable and transformative years of my life. I met my life partner Karen Parmar, ND with whom I have had the pleasure and honor of walking this path with. From second year at CCNM until now with 20 years of practice together, I could not have achieved all that I have professionally or personally without her.

Karen and I came out to British Columbia as interns at CCNM and spent three weeks exploring my favorite areas of the province; the lower mainland, Sunshine Coast, Guld Islands, Victoria, Tofino, and the Okanagan Valley. We found Fort Langley and fell in love with it. After graduation we drove across Canada and began preparing for the Naturopathic Physicians Licensing Exam (NPLEX). While studying we met with a banker, qualified for a loan, and started construction on our clinic. Daily visits to the construction site motivated us to get back and study as hard as possible. The doors to our clinic opened within a week of receiving our NPLEX results. Integrated Health Clinic is now home to 13 naturopathic doctors, medical doctors and a doctor of Traditional Chinese Medicine.”

Contributing to naturopathic oncology

While taking a six month sabbatical to recharge from the demands of a booming practice and raising four young boys, Dr. Parmar started writing the Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care.

“I wrote for six months day and night and was not close to being finished. After several years of writing and asking colleagues to write sections for the book, and three distinct rounds of editing – the textbook is done! I truly believe that all ND students, all NDs that treat cancer, all Fellows of the American Board of Naturopathic Oncology (FABNOs), and all those practicing integrative or conventional oncology will benefit from having this resource that contains has 2,800 references and contributions from almost 40 of our most esteemed colleagues.”

Advice for aspiring NDs

“If you are interested in a profession that challenges you daily, gives you a vast toolkit, provides a lifetime of learning, and allows you to dive into the lives and health of your patients, naturopathic medicine is the choice for you!”

To read more about other naturopathic doctors’ success stories, click here.

Learn more about the textbook

Textbook website

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Dr. Tammy Ashney – NUNM

Tammy Ashney, ND is an associate professor at National University of Natural Medicine (NUNM), attending physician at NUNM Clinics, clinical supervisor for residents and student interns, and the medical editor for Women in Balance Institute monthly newsletter. She shares her path to naturopathic medicine that started with a baccalaureate degree in Anthropology and a minor in Women’s Studies. Her practice has come full circle, building on her undergraduate passions.

Why did you choose to become a naturopathic doctor?

“Naturopathic medicine beautifully combines my deep anthropological interest in people, my love of teaching embodied in the naturopathic principle of docere, and my deep belief in the healing power of nature. I became a vegetarian at the age of 12 and then subsequently became very interested in environmental health and herbal medicine. I found naturopathic medicine after a circuitous journey that included waiting tables, teaching kids, fine art and photography studio work, and cross-country travels.”

What topics in naturopathic medicine are you passionate about?

“I love being able to help women understand their bodies more deeply, discuss sensitive topics and utilize natural therapeutics to help support them.”

Dr. Ashney also has a special interest in environmental medicine. “In the fall of 2019, I petitioned the Portland mayor’s office and the Oregon governor’s office to create city and state proclamations to celebrate, in accordance with the Children’s Environmental Health Network (CEHN), the second Thursday in October as Children’s Environmental Health Day. October 10, 2019 marked the first Children’s Environmental Health Day in Portland and in the State of Oregon. Moving forward, I hope to work with others to create community events to invite parents, families, patients, and the community at large into fun educational opportunities about how to prevent and protect children from environmental exposure that can affect their health.”

Finding fulfillment as an ND and educator

Dr. Ashney has been teaching since her graduation from NUNM and the start of her residency. She is the course director for the Parenteral Therapy and Environmental Medicine, lectures in women’s health, and teaches the reproductive lab.

“I am humbled by student engagement and their ability to bring forth new information and collaboration with their peers.” Often times, Dr. Ashney learns from her students as well.

A note of gratitude

“I am a mother of two young children and have been married to my husband for 18 years. While this article is mostly meant to discuss my professional role, these are the people who constantly humble me, inform my humanity and keep me grounded in the here and now.  I am a better person because of them and a remarkably better teacher and physician because of the lessons they impart on me every single day.

Additionally, I am also the culmination of all the learning and mentoring of the teachers who have come before me. I would be remiss if I did not take a moment to honor some of them who believed in me. The saying, ‘I am standing on the shoulders of giants’ seems particularly relevant. Immense gratitude to: Kim Winstar, Tori Hudson, Walter Crinnion, Nancy Scarlett, Melanie Henriksen, Steven Sandberg-Lewis, Heather Zwickey, Rich Barrett, Sheryl Estlund, Wayne Centrone.”

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Daniella Remy – CCNM ND Student

Daniella Remy is a second-year naturopathic medical student at the Canadian College of Naturopathic Medicine (CCNM). She shares her unique path and why she fell in love with naturopathic medicine.

Why did you choose naturopathic medicine?

Following the completion of her master’s degree in Family Relations and Human Development in Ontario, Daniella moved to France to study at the University of Nice. While in France, she taught English in three elementary schools. Her goal was to engage in language development in five countries over five years to collect data for a PhD thesis on improving ESL programs. In this “whirlwind of experiences” in Europe and Australia, Daniella was involved in research, edited a book, prepared manuals and courses, established a clinic in Austria, helped with an herbal shop in Italy, learned how to make products in Switzerland, sat in on clinic sessions to translate for patients and became involved in the development of an app called ph360. The app uses a person’s anthropometry and health assessment questionnaire to estimate current health and disease trends. It then provides personalized, evidence-based, lifestyle recommendations.

After nearly a decade abroad, Daniella returned to Canada to be closer to family. She continued to work for ph360 but desired to have deeper understanding of medicine. When Daniella’s mother’s breast cancer was successfully treated with integrative cancer care, “the power of naturopathic medicine was truly brought to light,” and she fell in love with the profession.

“Though I wasn’t consciously aware of it, everything I had experienced had been leading to naturopathic medicine. While speaking to my partner about my frustrations of having a lack of medical knowledge and considering going back to school, his response was ‘Finally! It’s obvious to everyone that you should be a doctor, but it was important for you to decide this for yourself.'”

Daniella Remy practices taking blood pressure readings during class, pre-COVID-19.

How did you prepare for ND school?

“In my mind, there was no point in doing something so important unless I could do it well. Taking the time to prepare and make sure I could be fully engaged from the very first day was vital to me.” Daniella chose to begin naturopathic medical school in January instead of September so she could get her affairs in order, finish prerequisites, wrap up ongoing projects, make a financial plan, and speak with her employer about limiting her hours to support her academic goals.

What is your favorite thing about school? What surprised you?

“The CCNM community fosters learning and encourages excellence in the naturopathic profession. Students can create clubs and interest groups, engage in mentored research, provide feedback to the school that is truly taken to heart, and participate in many lectures and webinars for their professional and academic development. Students are offered an environment for collaboration and cohesiveness, and that is inspirational to me.

Daniella Remy and her classmates enjoy a CCNM event, pre-COVID-19.

Naturopathic medicine is like a start-up business – it needs highly motivated and driven people to establish it. Whether it’s through advocacy, quality research, evidence-based practice, interdisciplinary collaboration, or any number of engagements, there is a type of camaraderie in the profession that can be quite powerful. There is no shortage of opportunities for students and professionals to grow, be creative and explore their passion.”

How do you maintain a school/life balance?

Daniella is the student governor for the Naturopathic Student Association and the vice president of professional development for the Naturopathic Medical Student Association.  On top of that, she maintains good grades, participates in research, and works a part-time job with the unending support of her family and partner. She prioritizes self-care by finding time in nature, eating a nutritious diet, getting enough sleep, and taking care of her body and mind.​

What advice do you have for prospective ND students?

“You are responsible for your energy, so look on the bright side and make what you want from your experiences. Life can take many twists and turns but it always leads to a place that is right for you. Embrace it, make the most of the journey and stay positive – even with the challenges we are currently facing with COVID-19. Look for solutions and better outcomes rather than complaining or letting others bring you down. This is a time to focus on priorities. Learn something about yourself and the ones you love. Step up and take on challenges, engage in positive change and help foster a supportive community. Student life is not easy, but nothing that is worthwhile usually is. Studying for exams is much easier when you think about them as necessary stepping stones to your ultimate purpose.”

Click here to learn about other naturopathic doctors’ paths to naturopathic medicine.

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