Naturopathic Approaches to Anxiety and Depression

Millions of people experience depression and anxiety, and often feel their only option is to take medications that may not completely resolve the issues. Studies show that anxiety and depression are related both to our genetic tendencies and our exposure to various stresses in life. We can address our genetic tendencies and help our bodies recover from stress using natural approaches such as mindfulness, dietary changes, nutrients, amino acid therapy, as well as optimizing hormones, blood sugar, and gut bacteria. Naturopathic doctors can serve this population and help people resolve mood-related issues once and for all.

*Webinar does not qualify for CE

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About the Presenter

Donielle (Doni) Wilson, is a doctor of naturopathic medicine (Bastyr University alumna), natural health expert, nutritionist, midwife and author who believes it is possible to be healthy, even when we are stressed. After experiencing and recovering from stress herself, Dr. Doni wrote a book called The Stress Remedy. In that book she redefines stress to include toxins, food sensitivities, and lack of sleep. She explains how stress causes adrenal distress, leaky gut, and blood sugar imbalances. And she offers expert guidance on how to reclaim optimal health with the approach she has used to help thousands of patients. She specializes in gluten sensitivity, intestinal permeability, adrenal stress, insulin resistance, neurotransmitter imbalances, hypothyroidism, women’s health issues, autoimmunity and genetic variations called “SNPs”, such as MTHFR, which can have a profound impact upon your health. For nearly 20 years, she has helped women, men and children overcome their most perplexing health challenges and achieve their wellness goals by crafting individualized strategies that address the whole body and the underlying causes of health issues. Dr. Doni is frequently called upon to discuss her approach in the media, as well as at both public and professional events. She writes a blog that you can find at DrDoni.com.

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The Role of Naturopathic Medicine in Cancer Care

Over 1.5 million people are diagnosed with cancer every year in the Unites States. More than 80% of cancer patients incorporate natural medicine in their treatment. Join the AANMC and Oncology Association of Naturopathic Physicians President – Dr. Heather Wright to learn about naturopathic approaches to cancer care.

Here’s what will be discussed:
-Defining naturopathic medicine  and naturopathic oncology
-Patient statistics for naturopathic cancer care
-Training and goals of naturopathic oncology
-Research
-Case studies

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About the Presenter

Heather Wright, ND, FABNO is president of the Oncology Association of Naturopathic Physicians (OncANP) and co-research director for the KNOW project – a searchable database of integrative oncology clinical trials. Dr. Wright is board certified in naturopathic oncology with 12 years of experience working in hospital-based oncology teams and 14 years in clinical practice. During her career, Dr. Wright became an expert in the co-management of pancreatic cancer and on intravenous vitamin C for people with advanced cancer. As a specialist in naturopathic oncology, Dr. Wright has worked diligently with countless families to improve quality of life and longevity.

Dr. Wright is a volunteer and clinical board member for Gilda’s club and Cancer Support Community and is a lecturer, writer, and consultant for research and publication project in integrative oncology. Dr. Wright has published articles on intravenous vitamin C as supportive care in Current Oncology, on the power of the placebo effect in The Journal of Alternative and Complementary Medicine and on tools for integrating natural approaches into conventional care for pancreatic cancer in Natural Medicine Journal. Dr. Wright also consults with organizations to incorporate integrative providers and approaches into clinical settings.

In 2017, Dr. Wright founded Good Apple Wellness, located in Philadelphia, PA which offers private consultations for integrative care and provides specialized expertise for families affected by cancer. Dr. Wright works with clients in person and by tele-consultation.

Dr. Wright is a graduate of Bastyr University.

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Asthma, Allergies, and Naturopathic Medicine

“I’m okay, it’s just my allergies,” is a phrase heard all too often. Allergic symptoms and allergic disease are among the most common, yet most often disregarded symptoms. Allergies and allergic diseases such as allergic rhinitis, atopic dermatitis, food allergies and allergic asthma are extremely common, impacting tens of millions of American men, women, and children each year.1 Asthma Canada reports 1 in 5 Canadians suffer from respiratory allergies. The symptoms associated with allergies occur when the body is exposed to something that the immune system over-reacts to.  The appearance of allergy symptoms can be associated with any number of triggers such as foods, creams, touching certain materials (even other people!), insects, pets, pollen, dust, and mold. The body’s immune response causes the symptoms we commonly refer to as allergies. The immune response results in effects on the body which can be mild or severe and can range from sneezing, coughing, itchy eyes, watery eyes, runny nose (often called rhinitis), and a scratchy throat, to rashes, hives, swollen respiratory passages, lowered blood pressure, breathing difficulty, asthma and even death in the most extreme cases.

What causes allergies and asthma?

The cause of this immune overreaction is largely unknown, but we have noted both genetic susceptibility as well as environmental influences.2 Heritability rates for susceptibility allergic disease can vary but have been found as high as 95% for asthma, 91% for allergic rhinitis, and 84% for atopic dermatitis.3 It is clear that genetics only account for an increase in susceptibility, and cannot be attributed fully for the dramatic increase in allergic disease worldwide.4 Food Allergy Research and Education reports a CDC statistic showing a 50% increase in food allergy prevalence in children between 1997 and 2011, and a 300% increase in peanut allergies during 1997-2008. 5 Environmental influences and triggers must also play a role. Large studies such as the International Study of Asthma and Allergies in Childhood and the European Community Respiratory Health Survey Study have revealed striking patterns showing increased prevalence of asthma in first world, English speaking countries and non-English speaking Western European countries over developing nations. These studies have further shown that asthma incidence increases in developing nations as they begin to embrace more “Westernized” lifestyles.4 All of these factors combined make it clear that lifestyle and environment play a role in the development of allergic disease and asthma.

Naturopathic approaches to allergies and asthma

From a naturopathic medical perspective, allergic symptoms are quite often associated with disruption to the microbiome in the gut, as well as to dysfunction of other systems including the adrenal glands, digestive disturbance beyond the microbiome, and altered immune responses. Determining the cause of a patient’s allergic symptoms including allergic asthma is at the forefront of a naturopathic treatment protocol and may involve laboratory testing combined with diet-symptom tracking via logs and observations as well as special diets called elimination and challenge diets. In terms of management and treatment, dietary avoidance, environmental modifications such as home air purifiers and specific cleaning routines, as well as a variety of herbs and supplements may be implemented.

“Allergies and asthma arise from a complex interplay of genes, food introduction, breast feeding or not, the gut and of course the greater environment. Some patients are hard-wired to develop allergies to pollen and mold. This can cause miserable symptoms, and is sometimes the real culprit driving asthma, but not always. It’s important to keep in mind that diet, home environment, stress, hydration, sleep and chemical exposure all play a role in how reactive someone is. Although allergy is definitely mediated by the immune system in well understood ways, we also want to examine someone’s toxic burdens in terms of how highly fired their system is from day to day. The Environmental Protection Agency has more than 85,000 chemicals listed in its registry, and processed foods contain many of them. Without oversimplifying matters, we do have to think about the impact of all this on someone’s allergic experience. As a naturopathic doctor I think about the whole person and how to restore health and, in that sense, allergies as sometimes a symptom of deeper problems I can help someone with.”

Fraser Smith, ND, MATD

Assistant Dean of Naturopathic Medicine and Associate Professor, AANMC President, National University of Health Sciences

Diagnostic testing

Uncovering the root cause of allergic symptoms is imperative,  and at the same time, can be challenging. There are several testing methods that are commonly employed to assess what a person’s specific allergies are. These include blood testing using various techniques to assess antibodies and immune reactions, testing blood levels of biomolecules associated with allergic responses such as allergen-specific IgE, histamine, and tryptase, scratch testing, and others. The type of testing most appropriate can also vary by the type of allergy being tested for.

When examining aeroallergen sensitization, testing is often done in a combination approach to ensure all sensitized allergens are accounted for. Although there have been many recent advances in testing allergen specific IgE levels, it has been found that using only one testing method may lead to a misdiagnosis with every fourth allergically sensitized patient as being found non-reactive.6 Many studies show that there is discord between testing for serum-specific IgE and skin testing results suggesting that the two methodologies act in a complimentary manner and should not be used interchangeably.

In regard to food allergies, there are numerous laboratory assays that can be performed such as radioallergosorbent tests (RAST), immunoblotting, basophil activation (BAT), leukotriene LTC4 release, cellular allergen stimulation tests (CAST), and others. Other methods such as skin prick testing and fecal testing are also common. Skin prick tests are quite common as they are inexpensive, and relatively low risk, however skin prick testing to foods has a low specificity with a low positive predictive value.7 This means that a positive result, unless confirmed by other clinical data such as a diet-symptom log, does not allow for a definitive diagnosis food allergy. There is also a non-standardization of measurement of positive reactions as evidenced by the identification of cut-off values for the SPT reaction diameter for certain food allergens (milk: 8 mm, egg: 7 mm, peanut: 8 mm) but not their universally acknowledgement.7 Allergen specific IgE testing is also common, but can be extremely costly. Specific IgE levels exceeding a certain value (considered a “diagnostic cut-off”) showed a 95% predictive value for a symptomatic allergy.7 When combined with compatible clinical history, this gives this type of testing the advantage of being able to confirm a diagnosis of food allergy without the need for further challenge testing. However, it is important to note that there are a number of variables that can impact the outcome of such testing such as age and the length of time the person has been avoiding the food. Not all food reactions are mediated by IgE as is true of many cases of sensitivities to foods. In these cases, an elimination diet followed by a re-challenge phase are critical for the identification and proper treatment of food sensitivities.8 This type of testing is considered the gold standard for diagnosis of food allergy.9

“The goal of naturopathic medicine is to reduce the exaggerated immune response to allergens, and bring tone to the mucus membranes of the respiratory and digestive systems. The side effects of the naturopathic treatments include increased energy and nutritional status, greater resistance to colds and flus, and increased cardiovascular health. The side effects of conventional treatments commonly include drowsiness and diminished sense of taste, smell, and sight, rebound congestion leading to dependency on medications, and progression of inflammatory disease processes (especially eczema and asthma). The naturopathic approach is more complicated, and can, in some cases be more expensive, so it is up to the allergy sufferer to decide which is better for them. Often, people elect to manage symptoms for a short transitional period while beginning the naturopathic treatments, just to find they no longer need the antihistamines after a few days or a week and feel more energetic than anticipated.”

Jenn Dazey, ND, RH (AHG)

Core Faculty in the Department of Botanical Medicine, Bastyr University

Naturopathic treatment of allergies can involve multiple pathways including treating alterations to the gut micro biome, using supplements, instituting sublingual immunotherapy, implementing dietary considerations, and environmental modifications.

Balancing the gut microbiome

In humans, the gastrointestinal tract is inhabited by a large, complex group of microbes that play a distinguished role in maintaining health. Collectively, this group includes trillions of bacteria, fungi, parasites, and viruses that are known as the microbiome. A person is first exposed to microorganisms as an infant, during delivery in the birth canal and through the mother’s breast milk.10 As time goes on, the microbiome evolves with the individual and exposures to various environmental factors as well as variations in diet can impact the microbiome leading to improved health benefits or increased risk of disease. The microbiome has numerous important functions including producing various nutrients such as vitamin K, prevention of colonization by intestinal pathogens, and modulation of the immune response to name a few.11 The diverse role of the micro biome has led to the idea that its modification may be a target used to restore and maintain balance of the overall individual. Introducing probiotics and prebiotics are a means to accomplish this. Probiotics and prebiotics may be consumed in the form of raw vegetables and fruit, fermented pickles, or dairy products. Another source may be supplemental formulas and functional food. Studies examining the use of probiotics in patients with allergic rhinitis (hay fever) found that adjuvant use of probiotics resulted in improvement in quality of life.12 Probiotic use has also resulted in increased symptom control as evidenced by decreasing scores on questionnaires designed to assess control of allergic rhinitis and asthma symptoms.12 Additionally, a meta study examining the use of probiotics in the treatment of allergic rhinitis examined 22 double-blind, placebo-controlled studies. Seventeen trials showed significant benefit of probiotics clinically, whereas eight trials showed significant improvement in immunologic parameters compared with placebo.13 All five studies with Lactobacillus paracasei strains demonstrated clinically significant improvements compared with placebo.13

Using supplements

Supplements can provide targeted therapeutic options for the treatment and prevention of allergies. Supplements can address many different factors involved in the expression of allergies and asthma including immune system dysregulation, high levels of inflammation, and oxidative stress among many others. Some examples of supplements commonly used in treatment of allergies and asthma include:

Stinging nettles

Stinging nettles (Urtica dioica) is also commonly called simply “nettle.” Nettle has a significant research profile as a treatment for allergies and allergic rhinitis.14 National College of Naturopathic Medicine (now National University of Naturopathic Medicine) published a double-blind, placebo-controlled randomized study examining the use of freeze dried nettle leaf for treatment of hay fever, asthma, and seasonal allergies found that the freeze-dried preparation was rated higher than placebo in relieving symptoms after just one week’s time.15 Further studies on the use of nettle in preventing the lung inflammation associated with asthma have also been promising. Studies using an experimental model of allergic asthma have shown positive benefit in both immune modulation as well as reduction in inflammatory markers with administration of an aqueous extract of stinging nettle.16

Omega 3 fatty acids

The omega 3 fatty acids docosohexaenoic acid and eicosapentaenoic acid, better known as DHA and EPA respectively, are found in fish oil and are known for their anti-inflammatory properties and protective effects in inflammatory diseases including asthma and allergies.17 Studies examining fish oil supplementation during pregnancy and lactation have shown to reduce both the prevalence and severity atopic dermatitis and food sensitization during the first year of life for the offspring with a possible persistence until adolescence with a reduction in eczema, hay fever, and asthma.17 A six month study conducted by Johns Hopkins University examined the role of omega 3 fatty acids in the prevention of environmentally triggered asthma symptoms and found that having more omega-3 fatty acids in the diet results in fewer asthma symptoms triggered by indoor air pollution.18

Quercetin

Quercetin is among the most abundant polyphenols representing the flavonoid subgroup. It is naturally occurring in plant foods such as onions (the most studied quercetin containing food), broccoli, capers, apples, berries, and grapes, herbs like dill and is also found in tea and wine.19 Quercetin has been utilized in a number of studies examining factors underlying the development of allergies. Quercetin is known for many different properties including its anti-allergic properties such as inhibition of histamine release, decrease in pro-inflammatory compounds, immune system modulation, and inhibition of antigen-specific IgE antibody formation.19 All of these mechanisms can contribute to addressing the underlying cause of allergy symptoms and asthma. In an experimental model of allergic rhinitis, quercetin has been shown to reduce antigen specific IgE levels and well as mitigate the expression of allergic rhinitis symptoms.20

Sublingual immunotherapy

In years past, allergy sufferers were often subjected to extensive series of allergy shots. These were injections designed to aid in reducing the expression of allergy symptoms. Sublingual immunotherapy is a method of allergy treatment that does not involve injections, rather small tablets or liquid drops containing small amounts of specific allergens to build up tolerance and reduce symptoms. This type of immune modulation aims to decrease the pathologic immune response rather than to cause a return to an immunologically naive or unresponsive state.21 Numerous studies have shown that sublingual application of allergen specific immunotherapy is an adequate, safe and efficient substitution to the injection route of allergen administration in the treatment of IgE-mediated respiratory tract allergies.22 Meta analysis studies have shown that sublingual immunotherapy reduces both the symptoms of allergic diseases and the use of medications, and improves the quality of life of children with the diseases.22

Dietary considerations

The diet constitutes an important source of nutrients and non-nutrient components with multiple properties that present a potential opportunity to modulate the risk of asthma and allergies. Elimination diets wherein the offending food is completely avoided can be difficult to follow long term. Contemporary studies have shown that nutrition trends during the early childhood years may produce changes that have a lasting impact on human health at later ages particularly on the respiratory, GI, and immune systems.23  Western diets are characterized by the consumption of highly refined, overly processed, energy-rich foods and beverages, typically high in fat, sugar, and salt but low in dietary fiber and other nutrients. Changes in dietary habits mainly the decreased intake of fresh fruit and vegetables and a higher intake of processed foods have previously been linked to an increasing prevalence of asthma and allergies.24Multiple studies have highlighted evidence of a beneficial effect of fresh fruits, and antioxidant vitamins on asthma.25 Additional studies have specifically looked at the quality and quantity of dietary fats as a source of allergenic response. Research has shown that a high fat diet potentiates food-induced allergic responses associated with dysregulated intestinal effector mast cell responses, increased intestinal permeability, and gut dysbiosis.26 The quality of fat has also been shown to play a role in increased risk of allergenic response. In a pediatric asthma study, researchers found that for each additional gram of omega 6 fats consumed, children had a whopping 29% increased risk of being in a more severe asthma category.18 Fiber is another nutrient that is consistently lacking in the standard American diet as well as many dietary patterns of many other developed/“Westernized” countries.27 Consistent with the reported health benefits on other immune cells, dietary fiber (especially polysaccharides and oligosaccharides) and its metabolites (SCFAs) have been shown to regulate mast cell function and mast cell activation can be downregulated by pretreatment with these substances.27 Mast cells play a central role in initiating and maintaining inflammation, particularly in allergies and asthma.28

Environmental modification

Some parts of our environment are out of our control, particularly outside the home. We cannot control the amount of mold, pollen, or other allergenic inhalants that are in outdoor air. But there are steps we can take inside the home to manage our exposure indoors.

  • Rugs, drapes, wall-to-wall carpet, and even overstuffed, upholstered furniture are tremendous collectors of dust and pollen. Removing them or changing styles can help reduce exposure.
  • Using specialized air filters like HEPA filters particularly in the bedroom can be helpful. In some cases, whole house filtration systems may also be recommended.
  • Avoiding toxic inhalants like perfumes, body sprays, scented candles, room sprays, air fresheners, dryer sheets, and other scented products, especially those with synthetic ingredients.
  • Have your home tested for the presence of mold and remediate the source if mold is detected and found.
  • Use zippered, allergen resistant covers on mattresses and pillows. According to the Asthma and Allergy Foundation of America, encasing mattresses works better than air cleaners to reduce allergy symptoms.28

Dr. Dazey shares a patient success story

“One of my patients suffered from severe, debilitating spring allergies that started each April, and lasted until the end of August. Since he was a young boy, he used an inhaler for asthma, antihistamines daily, and avoided physical activity and being outdoors. This was not enough to stop the symptoms, as he still suffered miserably with irritated eyes, constant dripping nose, sneezes, headache, and generalized fatigue. His allergy symptoms became inseparable from his moderate depression. As an adult, he began looking forward to a Prednisone prescription each June, but dreaded when the effects wore off. He began to notice changes to his body, his mood, and how less effective and long-lasting it seemed each time. When he learned about the long-term health risks of Prednisone, he sought alternative management approaches. He came and saw me at age 55. The first thing I did was to let him know he could continue using all the conventional medications he needed to function and feel comfortable. He was about 50 pounds overweight, with high blood pressure, high cholesterol and triglycerides, high fasting blood sugar, and mild benign prostatic hypertrophy (BPH). We began with the standard protocol of fish oil, nettles, and quercetin, as well as soup broth that was simmered with Astragalus membraneceus root, Ganoderma lucidum powder, and Pacific bull kelp. Since he was a regular soup eater, this was more agreeable than tea, and he was motivated to use the broth in a variety of different soup recipes. The first season that he tried this protocol, he reported much reduced symptoms in April and May. When June came, he got his prescription for Prednisone but later decided it was not needed – he never filled his prescription! He also used an herbal tincture formula that relaxes the airway and found it unnecessary for weeks at a time to use his inhaler. (I am reluctant to list the herbs in the formula because they should be dispensed correctly and used under a physician’s care). He began walking outdoors with his dogs every day and eventually did not need the inhaler at all.”

To learn about natural approaches to combating allergies and asthma, contact your local naturopathic doctor. Click here to find an ND in the US and Canada.

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Naturopathic Doctors as Part of the Health Care Team

While many naturopathic doctors work in private, solo practices, there is increasing demand for NDs as vital members of the health care team. Interprofessional healthcare occurs when different disciplines collaborate to collectively provide patient care. Patients benefit by having the right expert advice at the right intervention point. Improved cross-profession communication also decreases care delays, medication interactions, and promotes team members working together for optimal patient care. Naturopathic doctors are an integral part of interprofessional healthcare delivery in many types of patient care settings. We speak with nine naturopathic doctors in various interprofessional healthcare settings to learn how they work to uncover the root cause of illness, coordinate care with numerous professionals, and ultimately educate and empower patients toward wellness.

One of the nine doctors we interviewed is Dr. Arvin Jenab, a naturopathic doctor at the Susan Samueli Center for Integrative Medicine (SSCIM) at the University of California-Irvine Health. He serves as the Medical Director of Naturopathic Medicine and the Director of the Naturopathic Residency Program. He works directly with medical residents and patients and is actively involved in research and education. Dr. Jenab also works to develop new programs to increase access to integrative medicine by underserved communities across Orange County, California.

Interprofessional healthcare benefits patients and doctors alike – the days of one doctor treating one condition are behind us – we have moved into an era where patients need a village of doctors and doctors need a team of colleagues!  Interprofessional healthcare results in team-based, patient-centered, compassionate care. Patients feel heard and more extensive efforts and resources go into determining the cause of illness and developing the most effective treatment plan. With the complexity of chronic diseases and overwhelming number of influences that impact health, it is increasingly important to create opportunities for interprofessional healthcare whereby both patients and doctors can engage in meaningful exchanges aimed at changing the context of health.”

Arvin Jenab, ND

Graduate, Canadian College of Naturopathic Medicine

Uncovering the Root Cause

Naturopathic medicine is grounded in the inherent belief that is better to prevent illness and get to the root cause than to suppress symptoms. This is why initial visits with naturopathic doctors are likely to last between 60-90 minutes. Topics such as nutrition, digestive health, family history, stress, sleep, and mental health will be addressed regardless of the issue presented with the understanding that the body functions as a complete system, and that each of these pieces are components and contributors to overall health.

Dr. Sunita Iyer is the Clinic Director and Founder of Eastside Natural Medicine, PLLC where she and her colleagues see primarily perinatal and pediatric patients, offering midwifery care, mental health care, acupuncture, lactation management, minor surgery, and primary care for all ages. Dr. Iyer’s specialties are the Five Ps: preconception, pregnancy, postpartum, parenting, and pediatrics.

“When patients have each part of their body addressed by a separate health care provider, there is a presumption that health and well-being happen in isolated systems.  We know this isn’t true. When working as an integrated and interdisciplinary team, we can better understand our roles, contributions, and limitations to communicate more effectively about the person we are treating rather than the systems. Patients know that we are all working toward their health together, and that when something isn’t working, we will all problem solve together.”

Sunita Iyer, ND, LM

Adjunct Faculty and Graduate, Bastyr University

Dr. Tegan Moore is the Executive Medical Director and Co-Founder of WHEELHOUSE Center for Health and Wellbeing. Her practice sees a variety of patients from pediatrics to oncology who are looking for a team-based approach and personalized healing solutions for chronic illness. Dr. Moore’s team works together to provide a one-stop-shop for genomic and microbiome analysis, personalized nutrition and lifestyle interventions, acupuncture, and cognitive/behavioral health.

“Naturopathic doctors are trained to search out and address imbalances in the body that cause symptom patterns—a method of doctoring that often requires unique treatment strategies catered to the needs of the patient. This approach to treatment often stands in contrast to allopathic protocol-based treatment plans and can act to augment care plans and improve health outcomes.”

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

Many times, these conversations with patients reveal symptoms or health issues that may have not otherwise been addressed, and can act as a first line of defense against chronic disease, greatly reducing the need for future healthcare intervention.

Dr. Lisa Taulbee is a primary care provider who specializes in women’s health and gynecology. She works for ZoomCare, which is an on-demand interprofessional health care clinic with specialists who are available to see patients without referrals seven days a week .

“Patients often require multiple approaches and therapies to best manage health conditions.  All the providers on a patient’s care team are able to provide input in regards to their own specific areas of expertise, including naturopathic doctors.  Natural therapies can augment conventional therapies and even prevent the need for conventional therapies that may have adverse risks associated.”

Lisa Taulbee, ND

Graduate, National University of Natural Medicine

Dr. Jacob Wolf serves as a naturopathic provider at Lake Health Integrative Medicine, a practice which consists of osteopathic physicians, medical doctors, and chiropractors.

“With current heavy reliance on opioids and polypharmacy, a growing number of patients are looking for non-drug alternatives that an ND can offer.”

Jacob Wolf, ND, LAc, Dipl. OM

Graduate, Southwest College of Naturopathic Medicine

Furthermore, “NDs are investigative diagnosticians. They take the time to gather a fair amount of information including labs and imaging, analyze and interpret based on defining and guiding principles of naturopathic medicine, develop hypotheses, and follow through with sometimes complex treatment strategies.  Our uniqueness is our systems-based approach to health and disease, and our consideration of the mental and emotional factors that influence patients’ health,” adds Dr. Jenab.

Dr. Dawn Siglain specializes in autoimmune, pulmonary, and renal health at Inner Source Health in New York City. She also is trained as a Reiki instructor and acupuncturist.  Dr. Siglain describes a visit at Inner Source as unlike any other doctor appointment, with an in-house variety of providers for women’s health, pediatrics, mental health, chronic pain, neurodegenerative disease, cardiovascular health and metabolic syndromes, Chinese Medicine, Lotus Physical Therapy, Pelvic Floor Therapy, and massage therapy.

“Naturopathic medicine extends beyond what labs may reveal about a current physical state.  Using a preventative eye, I assess labs with a narrower reference range which allows for detection of imbalance in the body before symptoms of discomfort may arise.”

Dawn Siglain, ND, LAc

Graduate, University of Bridgeport School of Naturopathic Medicine

Doctor as Teacher

The first step to treatment is providing patient education with medical professional insight. Naturopathic doctors take the time to explain how factors could be contributing to illness so that the whole person is treated, not just the symptoms. In doing so, naturopathic doctors may collaborate with other medical professionals to provide the most comprehensive care available. Most importantly, the patient is involved and given options in each step of the process.

Dr. Dan Rubin is a board-certified naturopathic oncologist, founding president of the Oncology Association of Naturopathic Physicians, and Medical Director at Naturopathic Specialists, LLC., where many of his oncology patients are sent to him on referral from medical doctors. His team of interprofessional healthcare providers sees patients for pain management, diet and nutrition, IV therapy, and more.

“As part of an interdisciplinary team, each physician is presented with the same patient, but each physician, given their specialty, is going to see the patient a little bit differently. NDs are very attuned to identifying the cause of illness rather than just addressing the symptoms.  This focus on asking “Why did you become ill?” rather than jumping straight to “do this to get better,” helps to facilitate patient education and draw attention to the patient’s accountability in maintaining their own health.  It’s that vital step that makes personalized medicine and care possible.”

Dan Rubin, ND, FABNO

Graduate, Southwest College of Naturopathic Medicine

Dr. Heather Bautista is a naturopathic provider at Edward-Elmhurst Integrative Medicine Clinic. She works alongside medical providers to offer holistic patient care.

Simply put, interprofessional healthcare gives patients options. Being in an outpatient hospital setting, I often get statements like ‘I don’t want to go on medication’ or ‘I don’t want to be on this certain medication’ followed by ‘What can I take instead?’  It is not about replacing a medication with a supplement, but giving the patient options of what they can do at home with their lifestyle, food choices, possibly looking into environmental exposures, stress levels, detoxification pathways, etc.”

Heather Bautista, ND, CNS, LDN

Graduate, National University of Health Sciences

If the patient desires care outside the specialties or training of one health care provider the naturopathic doctor will make referrals to another.

Dr. Erica Joseph is a naturopathic oncologist at Seattle Integrative Oncology. In this busy practice, naturopathic doctors offer patients additional care in addressing symptoms and side effects from their treatments – a service that other providers do not have time to offer.

“Within the realm of oncology, each practitioner has a very specific role that they play and the different modalities can be quite separate, from radiologists who provide imaging, to surgeons who perform biopsies or curative surgeries, on to medical oncologists or radiation oncologists who provide their respective treatments. As a naturopathic doctor, I work with patients through each of these different stepping stones and help them to have a cohesive and optimal health care plan. By having the option to see multiple providers, patients gain more knowledge about their health and are given more options for treating their health conditions.”

Erica J. Joseph, ND, LAc, FABNO

Graduate, Bastyr University

Many times, naturopathic doctors can work with patients to incorporate lifestyle changes such as exercise, diet, nutrition, and stress management that provide a more natural approach to healing and longevity.

“From a family medicine perspective, the interdisciplinary model is priceless. Being able to see a child, and also take care of the parents, and even grandparents, provides insight not only into the symptoms in that moment; we gain a critical view of all of the social dimensions of health which often supersede the healthcare encounter in terms of effects upon a child’s or family’s health,” Dr. Iyer adds.

Interprofessional Feedback

Naturopathic doctors share the feedback that they have received about their naturopathic approach from their interprofessional team members.

Intrigued by whole-person approach

Dr. Jenab states, “My colleagues are intrigued and interested in learning more about the naturopathic approach to patient care.  Specific feedback is that we are thorough, hold a lot of information in context, are effective at engaging patients, and create a therapeutic space that encourages patients to speak openly about their health including their emotions, thoughts, and beliefs.”

Open to new approaches

As a licensed naturopathic doctor who practices in a pre-licensed state, I am always surprised by the positive feedback I get. My day-to-day interaction in my practice is with osteopathic physicians, medical doctors, and chiropractors who fully understand and appreciate the training of naturopathic doctors and value my approach to patient care. Other colleagues outside of my practice have occasionally been skeptical of treatment or diagnostic techniques that I have used, but have been open to trying new approaches,” says Dr. Wolf.

Surprised by extent of patient care

Dr. Iyer provides a different context on feedback she’s received. “I have a lot of friends who are other healthcare providers: nurse practitioners, surgeons, dentists, and physical therapists.  When they heard that I am a naturopathic physician and midwife, they hesitated.  They aren’t sure what that means.  Do I run wild in the countryside with scissors? Am I anti-vaccine? Am I anti-medicine altogether?  The way I describe my approach is as ‘natural-lite.’  Which isn’t to say that I don’t find natural therapies incredibly powerful or effective in my practice.  What I mean is that my approach is very much a marriage of methods.  All are welcome. Over time, I subject both natural and conventional therapeutics to scrutiny.  I don’t think one side is ‘better’ than the other.  I don’t think that there are sides.  We live, as do our patients, in a system. For our patients to be healthy but also well-resourced, we must work within the system to get their needs met.  Other providers are surprised that the naturopathic approach and the holistic approach involves the larger healthcare context of our patients, and not just using herbs or supplements to treat symptoms.”

Patient Success Stories

Naturopathic doctors share success stories of interprofessional patient care.

Cancer

“As a cancer specialist, I see the benefits of interprofessional healthcare firsthand. I really believe that ‘it takes a village’ when it comes to the treatment of a person with cancer.  If a patient only sees one physician, there’s realistically only so much care that they can receive. By involving medical, surgical, radiation, and naturopathic oncologists, the care they receive is more rounded and the patient is well-supported; it’s a team effort to provide the best care possible. I also believe the principle that ‘iron sharpens iron.’ The interactions and experience that I’ve had with my multidisciplinary colleagues over the years has made me a better physician, and enhanced the care that I provide by expanding my own knowledgebase.”

Dan Rubin, ND, FABNO

Graduate, Southwest College of Naturopathic Medicine

Breast Cancer and Hypothyroid

“I am treating a patient with metastatic breast cancer who has been on a trial drug for about two years. During this time, she has had multiple joint pain, severe fatigue, as well as insomnia. We had been attributing her fatigue to treatment side effect, however upon deeper investigation we found that she was hypothyroid, likely due to the variety of treatments she has received. By improving her thyroid function, she has regained significant energy as well as improved sleep. She was also starting to develop elevated liver enzymes due to her treatment and although she has been responding well, there was concern she might not be able to continue. Working together with her medical oncologist, we were able to come up with a plan to stabilize her liver enzymes which has allowed her to continue treatment. Additionally, I provided her acupuncture, which has greatly improved her pain level and daily functioning.”

Erica J. Joseph, ND, LAc, FABNO

Graduate, Bastyr University

Lower Back Pain

“A patient came to me for acute low back pain on referral from a neurologist. His symptoms were initially concerning for a potentially emergent condition, cauda equina syndrome, but there was no evidence on MRI. Since a surgical treatment was not an option, he was referred for acupuncture. I used a combination acupuncture techniques and targeted supplements to resolve the majority of symptoms including peri-anal numbness, thigh and groin pain, and low back pain. However, he still had a “stuck” feeling in his right sacro-iliac joint when moving from seated to standing. He began a series of biweekly manipulation sessions. Additionally, he began treatment with a massage therapist available in our practice. He now has complete resolution of symptoms and is back to full function.”

Jacob Wolf, ND, LAc, Dipl. OM

Graduate, Southwest College of Naturopathic Medicine

Women’s Health

“A 39-year-old female patient presented initially for an evaluation of acute abdominal pain. She was ultimately diagnosed with NSAID-induced gastritis.  After questioning the patient, she revealed that her high NSAID use was due to severe dysmenorrhea from stage 4 endometriosis.  She had previously desired to preserve her fertility and declined contraceptive options and hysterectomy for treatment.  We initiated numerous natural therapies to help control her pain as well as counseling her on all options, including surgery.  Her pain was so severe and limiting her life to such a degree that ultimately, she made the decision to move forward with hysterectomy.  I referred her to a surgeon I frequently work with who was able to perform the surgery. Though it was not natural therapies that ultimately resolved her issue, I believe that having the time to try multiple options as well as counsel her on the risks associated with surgery and answer her questions as well as address her fears, she was able to make the decision that freed her from the excruciating pain she had been dealing with for decades.”

Lisa Taulbee, ND

Graduate, National University of Natural Medicine

Weight Loss

With hopes of making a full recovery after a work-related back injury, my patient considered the advice of his physical therapist to start exercising and lose weight and was referred to me to help with this lifestyle change. After four months, he lost 84 pounds. You may learn more about his weight loss journey here. Since this story was published, this patient has started intermittent fasting with continued weight loss.

Heather Bautista, ND, CNS, LDN

Graduate, National University of Health Sciences

Pregnancy and Birth

“One of my favorite stories is of a new mother that was in the care of a midwife at my clinic. During her care, she came to me for management of her thyroid with medication, lifestyle, and nutrition, which was very different than what her prior primary care physician was able to offer.  Given the nature of my working relationship with her midwife, we were able to jointly manage her care plan, labs, and follow up.  In the course of her pregnancy, she required a TDaP vaccine, which she was then able to walk right upstairs and receive with our team.  After her baby was born, she was having lactation difficulties.  I was able to step in to help with some botanical lactation support, she was able to see our acupuncturist for milk supply augmentation, and was able to connect with our mental health counselor and psychiatric nurse practitioner to assist with her postpartum anxiety and depression.  I was able to work with both her mental health team members to offer nutritional and supplemental support, and to ensure that her treatments were synergistic, not overlapping, and certainly not antagonistic and causing harm.  Most importantly, she was able receive all of this care in one place. She came in with her baby and was able to move between appointments seamlessly, with each of us shifting rooms to accommodate her while she breastfed or pumped.  While there are so many stories like hers, what we have created in our clinic in terms of interdisciplinary and integrated care that holds families is an incredible experience for us as providers, and for the families that we care for.”

Sunita Iyer, ND, LM

Adjunct Faculty and Graduate, Bastyr University

Psoriasis

“A recent success was the complete remission of an intractable case of psoriasis that presented in the ear canals and genitals and produced chronic and constant itching and irritation that was very distressing to the patient. The team approach included naturopathic internal medicine techniques including specialized genomic analysis of the patient’s inherited gene single-nucleotide polymorphisms that were potential contributors to immune dysregulation, genomic analysis of the patient’s microbiome to address inflammation that could be contributing to the immune activation, personalized nutrition offered by our skilled nutritionist as well as process cognition sessions with our hypnotherapist to support anxiety and improve the patient’s stress management skills. I am happy to report that the patient’s skin lesions healed within six weeks after treatment began and they are still symptom free to this day!”

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

Mental Health

“I had a patient suffering from mental health concerns which were severely impacting his personal and work life.  He wanted only all-natural treatment; however, he was taking medications to keep his mood stable.  He had an appointment with his prescribing physician, but told me that he wasn’t going.  I strongly advised him that it was in his best interest to go to the appointment, explain his desires to his medical doctor and continue taking the medication as prescribed.  For him, naturopathic medicine could only work in conjunction with conventional medicine.  With the patient’s consent, I reached out to his psychiatrist and sent him my recommendation plan for this patient’s naturopathic appointment. It was so important in this case to have continuity of care including clear communication with his prescribing physician.  We were both concerned for the patient’s well-being.  In addition, this patient needed the support of naturopathic medicine combined with allopathic care to achieve his optimal state of mental wellness.”

Dawn Siglain, ND, LAc

Graduate, University of Bridgeport School of Naturopathic Medicine

Continuous Learning and Excellence in Patient Care

Naturopathic medicine serves as a key component to interprofessional patient care. With the collaboration of health care professionals, naturopathic doctors serve as a teacher and guide in navigating patients through their healthcare options. Furthermore, interprofessional care encourages open-mindedness and continued education between providers to establish the best care possible for each unique patient.

I consider myself an idealist and hold a personal vision for an integrated model of care where the naturopathic paradigm helps to inform the overall team approach. Although many integrative health settings currently offer naturopathic care as a ‘supportive’ or ‘complementary’ modality, it is my hope that the heightened interest in holistic and functional approaches to healing makes room for naturopaths to act more often as the central hub in integrated clinical settings.”

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

In the words of Dr. Rubin, “In the end it’s all about the medicine and supporting the patient in a positive way. Having a community of health care providers, each with their own perspective and experience, looking at one person and weighing in on what options they have while supporting and enhancing treatment is a wonderful standard of care to aspire to.  In my opinion that’s how medicine should be delivered and exactly the care I would want to receive.”

Click here to find a naturopathic doctor near you in the United States or Canada.

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Naturopathic Approaches to IBS

With a worldwide prevalence of 10-20%, irritable bowel syndrome (IBS) is an exceedingly common functional bowel disorder.1 Diagnosis is complex because IBS is typically made as a diagnosis of exclusion. This means that all other potential causes need to be ruled out before the diagnosis is confirmed. Symptoms of IBS can include: abdominal pain, irregular bowel habits, alternating constipation and diarrhea, gas, and bloating.2 Often times, these symptoms can be quite restricting to an individual’s quality of life. People who suffer from IBS report having to limit their activity levels about 20% of the time, and also experience a poor health-related quality of life.3 Pharmaceutical-based treatment options are minimal, with only two strongly recommended drugs available.4 An IBS diagnosis can also result in significantly increased medical costs. IBS patients incur around 50% more health care costs than those without IBS.1 In the US alone, IBS costs are estimated at some $20 billion annually.5 The combination of loss of quality of life, limited medical treatment options, and elevated costs of treatment lead many to seek out other means of treatment, including naturopathic medicine.

“IBS is a disorder with a complex set of triggers, none of which would be individually sufficient to produce symptoms, but may do so when combined. Food sensitivities, unbalanced flora, and improper fermentation can set up a condition in the gut that then only takes a trigger, like emotional or physical stress or a dose of sensitive food, to cause reactions and symptoms. Natural treatment is based on the concept of ‘The Four Rs’: Remove, Replace, Re-inoculate, and Restore.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

IBS can be a frustrating condition to manage, with at least half of sufferers turning to therapies outside of conventional allopathic medicine. In one survey, approximately 10% of individuals who used alternative medicine for a gastrointestinal complaint reported using naturopathy.6 The systematic approach and individualized care provided by naturopathic physicians involves the integration of modern medical knowledge with natural treatment options. Research confirms that naturopathic approaches to IBS are distinct from those offered in a conventional medical setting.1

“When I see a new patient, I give them a very detailed digestive health questionnaire that helps me to understand their risk factors for various GI conditions, their current symptoms picture and what kinds of things trigger their symptoms. I then spend about an hour speaking with them, going over their history and performing a physical exam to make sure I fully understand the picture. If I find that additional testing or referrals are necessary, I may also order these at the first visit.”

Lela Altman, ND, LAc

Graduate, Bastyr University

“Most patients who visit my practice have tried eliminating foods from their diets, seen many providers, performed numerous GI tests and still don’t have answers for why they don’t feel well. IBS generally does not start over night. So, I try to determine, what has brought the patient to this point? I like to consider myself trained as a detective as well as a naturopathic doctor to understand the why this person has developed IBS. An initial patient visit should be extensive. I cover a thorough time line of health history, evaluate past health records, document treatments tried and understand who my patient is as a person. It’s my goal to think outside of the box for events that could have led to the development of IBS. Once I have an understanding of the most likely reason for their distress, I systematically start there, while working through other possibilities.”

Crane Holmes, ND

Graduate, National University of Natural Medicine

“I take a complete history, including other systems that may be disturbed by the digestive imbalance. I look at dental history, NSAID and antibiotic use, other allergies and diagnoses, immune and liver function and microbiome condition. When necessary I will order lab tests, food sensitivities and allergy panels, SIBO breath tests, flora and stool analysis, micronutrient assays, as well as any indicated standard testing. The aim is to find which set of symptoms that the patient is showing and to tailor an individualized treatment plan to meet the root cause.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Though not all treatments work for all individuals, there are a number of means by which naturopathic medicine addresses the underlying functional imbalance associated with IBS.

Manage Mental and Emotional Stress

The gut is home to the “enteric nervous system” also known as the ‘second brain’.7 This intricate neuronal network allows us to feel the inner world of the gut and its contents. Digestion is the main duty of this system, which includes breaking down ingested foods, absorbing nutrients, and eliminating wastes, and the synchronized muscular contractions that move it all along. As many experience, digestion can be intimately related to an emotion or stressor. It is very common for chronic digestive issues to be connected to an emotional or stress component. Those with IBS often present with accompanying disorders including those impacting the mental/emotional state. Studies have shown that patients with IBS report an average of five (four physical and one mental-emotional) additional conditions.8  Researchers went on to note that specific diagnoses, such as generalized depression, anxiety, insomnia, and tension headaches, were associated with decreased quality of life, greater impairments to mental and physical function, distress, more severe symptoms of IBS, and worse pain symptoms.8 Developing a strategic program to help manage stress and realign the balance of the nervous system can be integral to managing chronic digestive disturbances. Implementing activities such as mindful breathing, yoga, earthing, qigong, tai chi, journaling, and many other techniques can be helpful in reducing stress and reconnecting with the body.

“I ask the patient to keep a diet diary that includes symptoms, bowel movements, and self-care, like meditation and exercise. This serves as an educational tool for them to become aware of what they are eating and how it relates to their digestive health.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Dietary Considerations

The use of food as medicine is as old as the practice of medicine itself. When it comes to IBS, food plays a central role in that many people with IBS note significant association between the foods they eat and the appearance or exacerbation of their symptoms. More than 60% of patients with IBS report the onset or worsening of symptoms after meals, alterations happened within 15 minutes in 28% and within three hours in 93% of these patients.9

“Identification and elimination of food sensitivities and allergies is the first thing that should be addressed. I commonly use an elimination/challenge diet because it is diagnostic and therapeutic at the same time, but some patients prefer lab testing. We also need to eliminate foods and habits that irritate the gut alone, like alcohol, coffee, smoking and not coping well with stress. The basis of the diet for this period of time should be whole food, plant centered, and properly prepared (cooked), to provide rest for the digestive system.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Some examples of dietary considerations that may be helpful in IBS management include:

Assess and address food sensitivities, intolerances, and allergies

Although it can be extremely difficult to identify single, specific food items that are causing a reaction, a staggering 84% of IBS patients report consumption-related symptomatology to at least one food item.9 A food intolerance is a nonimmune-mediated adverse reaction to food that can be caused by any (non-protein) food component, and is much more common than food allergy. 10 Studies have shown that those with IBS will try to extrapolate which foods cause them the most issues, revealing that 62% of IBS patients limit or exclude foods from their diet.11 Among the most common methodologies for determining adverse food reactions is an elimination and challenge trial. This is typically a multi-phase protocol that involves short term (typical time frames are three to six weeks but it can be longer) elimination of a specific food, category of foods, or even several categories of foods then consuming the suspected foods again one at a time to monitor for potential reactions. The impact of elimination diets can be very profound. One study of IBS patients who underwent an elimination diet demonstrated statistically significant improvements in stool frequency, pain, and quality of life scores.12

Increase fiber Intake

Inadequate fiber intake is extremely common in modern society with less than 5% of people actually getting the recommended basic 19-38 grams daily.13 Fiber is well known to improve a number gastrointestinal complaints, and is among the most often suggested dietary interventions in primary care.9 Fiber helps to support normal bowel function and elimination habits. A note of caution however, in some instances fiber may cause an increase in gas and bloating due to bacteria in the digestive tract producing gas as they metabolize the fiber. In these instances, balancing gut bacteria with adequate probiotics can be helpful.

Special diets

Food elimination through various dietary protocols provides structure and can help patients identify and remove food allergies or sensitivities. Examples of dietary systems that include an elimination component include gluten free, Paleo and low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol better known as low-FODMAP. Patients who reduce their FODMAP intake have noted improvement in abdominal pain, bloating, and flatulence. Some studies have reported that a gluten-free diet reduces diarrhea as well as abdominal pain and bloating.10

The standout therapy when it comes to managing IBS is the low-FODMAP diet. This dietary system was developed by Drs. Peter Gibson and Susan Shepherd of Monash University. FODMAPs are short chain polysaccharides that are limited in small intestine absorption but are highly fermentable by the bacteria in the small intestine to form short-chain fatty acids.14 The low-FODMAP diet has been shown in at least 10 randomized trials to result in a positive clinical response in 50%-80% of patients with IBS, with improvements in bloating, flatulence, diarrhea and global symptoms being among the most notable.15  A low-FODMAP diet involves three stages.16 Stage one is classified as an elimination phase, which lasts between three and eight weeks and involves strict elimination of all high-FODMAP foods. Stage two is the re-introduction phase where high-FODMAP foods are reintroduced one at a time for cycles of three days each. This phase allows an individual to both determine which selective FODMAPs they are sensitive to (since it is uncommon to be sensitive to all of them) and how much FODMAP they can tolerate. In stage three, a long-term personalized FODMAP protocol is implemented based on the findings from stage two. This final stage is important for supporting long term compliance through dietary variety and flexibility, which are linked to improvements in both quality of life and overall gut health.17

Supplements and Herbal Options

It is always the goal in naturopathic medicine to find and remove the cause of disease, however in some chronic conditions, this can take time and patience. While naturopathic therapies are at work, supplements and botanicals may be used to manage and decrease the expression of symptoms.

“I will often prescribe herbs to help the gut heal and restore to proper function. The goal of botanical medicine in this is always aimed at restoring function and reminding the body to heal itself. The herbal combinations are chosen for the individual’s symptoms. Demulcent herbs like Deglycyrrhizinated licorice and slippery elm coat and soothe the mucosa layer, allowing the underlying cells to heal. Glutathione directly feeds the gut cells.  Anti-microbial herbs like mahonia (Oregon grape root) and hydrastis (goldenseal) to help balance yeasts and bacterial overgrowth. Enteric coated peppermint or valerian root can address cramping and spasm in the bowel. Fiber sources like flax, chia and psyllium pull double duty as fiber and mucilage.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

The use of herbs and other supplements can help relieve symptoms. The following herbs/supplements have been shown to help manage IBS:

Probiotics: Probiotics have long been a go-to therapy for intestinal conditions, and IBS is no exception. There is a growing body of scientific evidence connecting the response to changes in the enteric microenvironment to IBS symptoms, suggesting that strategies that modulate the gut microbiome could be beneficial in IBS. Additional studies delineating the role of gut bacteria in influencing function such as gut motility, intestinal and colonic barrier integrity, visceral sensation, as well as reciprocal actions between the gut and the brain further support the role of the micro biome in IBS.18 People with IBS can have a variant composition of commensal gut bacteria including Bacteriodes spp., Bifidobacterium spp., Lactobacilli spp. and others compared to healthy controls.19 Improving the balance of gut bacteria with probiotics can help modulate IBS symptoms via multiple mechanisms. Because microbes in the intestinal microbiome compete for both nutrients and space, probiotics can limit the availability of both to pathogenic bacteria. Probiotics also leave fewer binding sites for pathogenic bacteria and secures substances that create an inhospitable environment for pathogenic microbes.19 Probiotics have also been demonstrated to enhance and protect gut barrier function as well as produce an anti-inflammatory effect.19 There is ample evidence to suggest that probiotics would benefit those with IBS.

Berberine: Berberine is not an actual herb, but an alkaloid compound derived from plants such as Oregon Grape, Barberry, and Goldenseal. It has a long history of use in both traditional Chinese and ayurvedic medicine. Berberine is available in extract form as a dietary supplement. Traditional use of berberine has been proven to have many pharmacological effects, including antimicrobial, anti-tumor, anti-inflammatory and blood glucose–lowering effects.20 Studies examining the use of berberine in patients with IBS found that berberine was well tolerated. It also reduced the frequency and urgency of bowel movements as well as the frequency of abdominal pain. Non-digestive quality of life measures such as anxiety and depression also showed improvement trends.21

Peppermint Oil (Mentha piperita): Peppermint is a carminative herb. It prevents the formation of gas or promotes expulsion of gas from the intestines. Reduced ability to expel intestinal gas with consequent gas trapping and bowel distension may contribute to abdominal discomfort/pain and bloating associated with IBS.22 Peppermint oil has a broad range of medicinal properties that may be relevant in treating the IBS patient including acting as an antispasmodic, antimicrobial, anti-inflammatory, and antioxidant as well as having immunomodulating and anesthetic activity.23 A double blind study of enteric coated peppermint oil revealed a 40% reduction in total IBS symptom scores compared to baseline.23 Additional studies confirm the benefit of peppermint oil for statistically significant treatment of abdominal symptoms of IBS. 24,25

Artichoke (Cynara scolymus): Cynara scolymus is a plant native to the Mediterranean region and is a member of the thistle group of the sunflower family.26 Artichoke has been used as an herbal medicine since ancient times and has a number of beneficial properties. It is well known for its use as a digestive support- aiding in the formation and secretion of bile which helps support the digestion of fats. It also has antioxidant, anti-inflammatory, liver protective and cholesterol lowering properties.27 Interestingly, although we eat the flower bud of the plant as food, the compounds associated with its medicinal qualities are concentrated in the leaves rather than the favored bud.28 Cynara scolymus leaf extract has also demonstrated both curative and preventive roles when it comes to management of IBS. In a study of individuals who suffered digestive disturbance, but were otherwise healthy, treatment led to a 26.4% decrease in IBS incidence and a 41% decrease in IBS type digestive symptoms.29 This included a significant shift in bowel habits to a more regular pattern versus the oscillating diarrhea and constipation that is common in IBS. Additional studies of artichoke leaf extract in individuals diagnosed with IBS revealed that over a six week treatment period, there was a significant reduction in the severity of symptoms with 96% of participants rating artichoke leaf extract as equal or better than previously administered therapies.29

Move that body!

Exercise is an essential part of a healthy lifestyle. The benefits of exercise for systems such as the cardiovascular system are well-known. Perhaps lesser known are the benefits to the digestive system. One study revealed that after six weeks of treadmill-based aerobic exercise, there was a significant improvement in the severity of IBS symptoms and quality of life scores compared to a control group as well as compared to before and after exercise intervention.30 Additional studies have confirmed the benefit of exercise on both IBS symptomatology as well as quality of life measures such as emotion, sleep, energy, physical functioning, and social and physical role were significantly improved in IBS sufferers who exercised regularly.31

NDs share IBS patient success stories

“I have a 28-year-old female patient who is in a master’s program and enjoys spending time working outside raising animals. She had a history of IBS associated with heavy, painful menses but otherwise normal GI health. After foreign travel, increased stress and some general illnesses, she developed urgent IBS-d. This urgent diarrhea greatly affected her daily life, making tending animals and leaving the house for school difficult. She had tried multiple food eliminations, herbal teas, probiotics and other supportive therapies she could find online without much improvement. Her main strategy was to avoid eating which could prolong her day away from a restroom until she was home at night.

Homeopathic podophyllum provided immediate relief for the explosive, urgent diarrhea which allowed her to feel more comfortable leaving the house. Further work revealed issues with GI dysbiosis and pancreatic insufficiency. After a few different herbal and pharmaceutical treatments to correct the dysbiosis, discovering the right pancreatic enzyme and focusing on stress reduction/sleep improvement, one year later she is having one-two non-urgent, well-formed stools per day while maintaining a healthy diet.”

Crane Holmes, ND

Graduate, National University of Natural Medicine

“A 38-year-old male patient presented with symptoms of IBS which included abdominal pain and distension. These symptoms were relieved with bowel movements that were urgent, frequent, and loose. He had been experiencing these symptoms for six months, and his quality of life was slowly deteriorating. He stopped going to restaurants with his family, as he felt extreme anxiety at the thought of being unable to control his pain and bowel movements. He traveled for work frequently, and would not eat meals with his colleagues, surviving on ginger ale, nut bars and Imodium. When he came to see me, his anxiety was heightened as his wife was asking for a separation. After gathering a full history and completing a physical exam, the assessment of IBS was made. I recommended dietary changes, botanicals and supplements to control his anxiety and GI symptoms, and counseling was provided to help him grieve the end of his relationship. After three months, his symptoms were better controlled, and while he was still struggling with the divorce, his quality of life had improved, he had started his own business, was relying less on Imodium. He was able to travel and control his IBS and anxiety with botanicals and supplements. Today, he is in a new relationship, and although his IBS symptoms flared up briefly when he started dating, he enjoys his life, eats a variety of foods, and travels without anxiety. This case really helped me understand the gut-brain axis and its influence on the balance of health.”

Poonam Patel, BSc, ND

Graduate, Canadian College of Naturopathic Medicine

“A female in her mid-40s presented with a six-month history of abdominal pain, loose stools and nausea.  Her symptoms started around the same time that the she had undergone significant stress with work and family. She was diagnosed with IBS-D and recommended to take Imodium as needed for the loose stool and to reduce stress. She did this, however the symptoms never really resolved which brought her in to see me. I gave her a gut healing protocol with glutamine, herbs and digestive enzymes which helped a little, but also did not resolve her symptoms. It became clear that her symptoms were worse with some meals so we investigated food intolerances and found that she reacted to wheat, dairy and eggs. She eliminated these from her diet and her symptoms improved slightly more, but not completely. At this I ordered a small intestinal bacterial overgrowth (SIBO) breath test, which was positive. Of note, the only risk factor she had for SIBO was stress.  I treated her SIBO and all her GI symptoms resolved. While she still had mild reactions to wheat, dairy and tomatoes, she was able to tolerate them much better after SIBO treatment.

Depending on the study, somewhere between around 60-80% of patients with IBS test positive for SIBO. This may be what is causing all their digestive symptoms and, in my opinion, is important to consider when determining treatment approaches. If SIBO is present, it is the first thing I work. If SIBO is missed, you won’t generally get very far with the IBS treatment until it is addressed.”

Lela Altman, ND, LAc

Graduate, Bastyr University

“I had a patient that had been treated for years for IBS exclusively with medications, to little effect. She had what she called ‘unpredictable’ gas and stool urgency, with many loose bowel movements a day, constant cramping, and bloating after meals. She also suffered from headaches and depression, insomnia and fatigue, and had different medications for each. She was told she would have to deal with the symptoms, and that they would likely get worse as time went on. She called me in what she saw as a last-ditch attempt to get some relief. She was on a diet of mostly processed foods; particularly wheat-based. I convinced her to do a basic elimination for two weeks, focusing on eliminating wheat and increasing vegetables. We also addressed the daily stress she was under and gave her some good ways to deal with it in a healthy way.

She left hopeful for the first time in years. A month later she reported having had solid bowel movements consistently through the weeks, and significant improvement in gas and bloating. She was sleeping better and hadn’t had a headache since the second week. She even found the energy to start an exercise routine. She had seen the immediate effect from removing offending foods, and using enzymes and probiotics, and found it was worth the effort. At six months she was thriving for the first time in decades and had become a vocal advocate for gut health. She even led a meditation group for her stress-filled office in an effort to improve her surroundings.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Due to the complexities of IBS and the intricacies of the workings of the human digestive tract, a single treatment is unlikely to be fully beneficial for managing IBS symptoms effectively. Using a multi-pronged approach that takes advantage of the various approaches available is more likely to result in adequate symptomatic control and management of the condition long term.

For questions about how naturopathic doctors treat patients with conditions like IBS, click here to find an ND near you in the United States or Canada. The Gastroenterology Association of Naturopathic Physicians (GastroANP) is also a great resource!

Learn More About Becoming a Naturopathic Doctor

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