by AANMC | Mar 17, 2020 | Featured Articles, News, Student Spotlights
Hailing from Baker City, Oregon, Tanya Denne is a third-year naturopathic medical student at Bastyr University – Washington. She shares her path to naturopathic medicine and as an ND student with a special interest in Parkinson’s and Mucuna research.
Why did you choose naturopathic medicine?
“In a similar path to how many arrive to here, chronic illness and running into dead ends within conventional medical systems led me to naturopathic medicine. My father worked as a liaison between the Forest Service and tribal populations so I grew up with exposure to Native American medicine. My favorite books as a child were the ones describing how Native Americans used the plants around them to create medicines. Since childhood I was unknowingly searching for this medical system of sustainability and prevention. I was thrilled when I found out there were medical schools and degrees dedicated to treating the whole person, and removing the obstacles to cure!
Field collection, India, 2015
“Being a naturopathic doctor will allow me to bridge the gap between patient care and bench research. I’ve always wanted to use the natural world around me as medicine. Naturopathic medicine allows me to do this. I can focus on researching Mucuna pruriens for Parkinson’s Disease, and develop my skills as a student clinician. Naturopathic medicine inspires hope. I want to be part of this dynamic group of unique forward-thinking individuals that come together to form an eclectic and vibrant healing community.”
How did you prepare for ND school?
Tanya prepared to become a strong candidate for naturopathic medical school by volunteering and working at Oregon Health & Science University. She researched botanical medicine, Parkinson’s Disease and childhood developmental disorders. Before making the decision to become a naturopathic doctor, she shadowed NDs, attended medical conferences, interned with MD and NDs, volunteered in herb shops, and worked as a florist. “These experiences allowed me to sort through what I was really passionate about. I realized a career in naturopathic medicine would give me the freedom to combine all of my interests in a creative way to care for patients.”
“It was important to me to continue my botanical research on Mucuna and attend a school that was open to collaborative research. Being around mentors that were doing what I am interested in was my top priority. When trying to decide on a school, “I listened to a podcast featuring Dr. Laurie Mischley, where she mentioned Mucuna pruriens for Parkinson’s Disease treatment…which was the very plant I was studying at OHSU at the time. I was thrilled to find a like-minded researcher at Bastyr. I interviewed Dr. Mischley and knew Bastyr University was the right fit for me!”
“Bastyr University has been great; we continue to conduct collaborative research with OHSU. We actually just finished a very successful pilot study demonstrating the neurorestorative potential of Mucuna. I am happy to be at school that has supported me through these endeavors.”
What is your favorite thing about school? What surprised you?
“Parkinson’s Disease Summer School (PDSS) at Bastyr University is one of my favorite weeks of the year. We spend multiple weekends preparing and getting to know our patients based on their extensive lab tests, and required paperwork. We then get to meet and spend a full week, developing that relationship, facilitating their learning, and fine-tuning treatment plans. The patients leave feeling grateful for all the knowledge and care that has been shared. Translating my research skills to clinical ones, specifically with PDSS, working with patients to help them understand how to implement Mucuna in their PD treatment plan has been very important to me.”
Tanya notes her surprise with enjoying classes that she was hesitant to take. She encourages others to keep an open mind, and to enjoy the adventure.
Lab extractions, Bastyr University Tierney Lab, 2018
Lab extractions, Bastyr University Tierney Lab, 2017
Lab extractions, Bastyr University Tierney Lab, 2016
How do you maintain a school/life balance?
“I keep moving! I enjoy hot yoga and running with my dogs that together weigh a total of 200 pounds. It can be hard to stay motivated in the rain in Seattle, but my dogs push me to get outside and we all are better for it. Animals are my balance, and caring for them brings me joy.”
Additionally, “I attend conferences, network, and give poster presentations. These experiences renew me, and I always leave with new collaborations and possibilities. At the most recent Movement Disorder Society Conference in France, I made a connection to the Parkinson’s Institute in Italy. We are now collaborating on a manuscript and Mucuna farming manuals for Indigenous populations in Africa where conventional Parkinson’s medications are expensive and mostly inaccessible.
Poster presentation, Movement Disorder Society Congress, France 2019
What advice do you have for prospective ND students?
Tanya encourages future students to seek out mentors who share your passions. Learn about their career paths by taking the time to interview them and build a connection. Networking and mentorship are huge pieces of professional development. Tanya’s mentor is skilled researcher and clinician – Dr. Traci Pantuso. Together, they are conducting QAQC research surrounding Mucuna pruriens. Their plan is to work in the SH-SY5Y neuroblastoma cell line to expand on what is known about the neurorestorative potential of Mucuna. Click here to learn more about Tanya’s Parkinson’s and Mucuna research campaign.
“Dr. Pantuso is living proof of my career aspirations; bridging bench research and clinical practice, I am very grateful our paths have crossed.”
Finally, remember to take time for self-care. Naturopathic medical school will test you in many ways. “Choose a school that resonates with your mission and interests,” to ensure that you have the support that you need to be successful.
Click here to learn about other naturopathic doctors’ paths to naturopathic medicine.
by AANMC | Mar 13, 2020 | Featured Articles, News
While many naturopathic doctors work in private, solo practices, there is increasing demand for NDs as vital members of the health care delivery 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 several 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 NDs 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 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 develops 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.”
Graduate, Canadian College of Naturopathic Medicine
Uncovering the Root Cause
Naturopathic medicine is grounded in recognizing the power of identifying the root cause and limiting suppression of symptoms to only when necessary for patient safety or comfort. 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.”
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.”
Graduate, University of Bridgeport School of Naturopathic Medicine
Many times, conversations with patients reveal symptoms or health issues that may have not otherwise been addressed, and can serve 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 system 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.”
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.”
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.”
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.”
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.”
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.”
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.”
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.”
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.”
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.”
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. This patient has started intermittent fasting with continued weight loss.
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.”
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!”
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.”
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.”
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.
by AANMC | Mar 12, 2020 | News, Success Stories
Traci Pantuso, ND, MS is adjunct clinical faculty and research investigator at Bastyr University, Washington. She and her collaborator John Macmillan, PhD – a well-known natural products researcher at the University of California, Santa Cruz are the recipients of a Collaboration-Innovation Pilot Award from the National Institute of Health-funded Institute for Translational Health Sciences at the University of Washington. Funding will go towards their research project: Translating High-Throughput Cytological Profiling and FuSiOn Platform Technology Data from the complex Oplopanax horridus extract into Basic Science and Pre-clinical Research Models.
Dr. Pantuso is the first ND in about 10 years to receive a Pilot Award. She shares her path to naturopathic medicine with a focus on research.
Laying the groundwork to become an ND
“Naturopathic medicine was the right path for me because I am not only interested in medicinal plants, but I am also interested in providing excellent health care. I am passionate about research in botanical medicine and the field of naturopathic medicine as a holistic, multidimensional medical model. The flexibility of being able to work in both clinical medicine and basic lab science is challenging and rewarding.”
Bastyr as a springboard
“I chose Bastyr University because it is a leader in naturopathic medical education and research. During my time as a student, the research department was conducting a number of National Institutes of Health (NIH)-funded studies. I received a clinical education, and had the opportunity to conduct research with experienced mentors as part of a NIH-funded T32 pre-doctoral program.
As a student, I was focused on continuing with research after graduation; however, in my last year of school I realized that I would need to change my goal as there would not be research funding to continue that path. In my last year, I focused on preceptoring and making myself a competitive candidate for a residency position.
After graduation, I completed a clinical residency at the Bastyr Center for Natural Health. Following residency, I started and operated a naturopathic medical clinic in Bellingham, Washington for four years. During that time, I recognized the opportunity to increase research on dietary supplements and other natural products, and as well as outcome-specific research on naturopathic medicine.”
Finding fulfillment as an ND
“I am focused on my clinical teaching and research projects. I am conducting research, presenting at conferences and writing grant proposals to further research projects.
In regards to her collaborative research, “Dr. Macmillan and his consortium of laboratories have developed new technologies to assist in better understanding complex medicinal plant extracts. Through this project, we will generate data to design further research experiments that will inform clinical research.”
Aside from research, Dr. Pantuso is proud to provide naturopathic care that is based on education and a strong patient-doctor relationship. She has found work/life balance since the completion of her schooling and residency, and enjoys spending quality time with her family and in nature.
Advice for aspiring NDs
“I recommend working and/or volunteering in a naturopathic clinic to get an idea of what naturopathic medicine is like. I developed a wonderful relationship with a mentor, and started volunteering in her office, and eventually worked for her during naturopathic medical school. This experience was invaluable and helped me to have a better understanding of what life would be like as a naturopathic doctor. I recommend that all students and recent graduates find a mentor.”
To read more about other naturopathic doctors’ success stories, click here.
by AANMC | Mar 10, 2020 | Featured Articles, News
With a prevalence of 10-20% worldwide, irritable bowel syndrome (IBS) is an exceedingly common digestive disorder characterized by abdominal pain and distension, changes in bowel habits (constipation, diarrhea, or both), and is usually a long-term affliction.1 In order for a diagnosis to be made, the symptoms must be present for at least six months, occurring at least once per week.2
What Causes IBS Symptoms?
IBS is part of a category of digestive disorders known as functional gastrointestinal disorders (FGDI), which means that a clear pathology cannot necessarily be determined, even though the patient may be quite ill. It is a syndrome with a certain constellation of symptoms common to sufferers, but a diagnosable, named disease cannot be determined, e.g. celiac disease, inflammatory bowel diseases such as Crohn’s or ulcerative colitis. Because of this, IBS has historically been considered a “disease of exclusion”, meaning that an organic cause cannot be found through lab work or imaging, and that the diagnosis is made after all other causes have been ruled out.
Conventional medical care may be inadequate for these patients because a definitive cause cannot be determined. A handful of drugs are currently on the market to help alleviate symptoms, but they do not address the root cause in the way that naturopathic medicine can. 3, 4
“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. 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 why this person has developed IBS. An initial patient visit should be extensive. I cover a thorough timeline 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.”
Graduate, National University of Natural Medicine
Mechanisms
Until more conclusive diagnostic testing can be developed, common features, aside from symptoms, have been observed in IBS patients which give insight into the underlying cause of the syndrome. Understanding the mechanisms behind a health concern is an ND’s first step toward effective treatment and hopefully, cure.
- Low grade inflammation of the gut has been implicated in IBS, not to be confused with irritable bowel diseases. Inflammatory cells of the intestinal lining have been detected in IBS patients, and they have an increase in inflammatory markers called cytokines in both the blood and lining of the colon. 5
- Histamine, which we typically think of for allergic reaction is also produced in the gut and is thought to contribute to the “visceral hypersensitivity” of IBS patients. 6
- Post-infection IBS is the development of IBS in the aftermath of an intestinal infection that can last long after the infection itself resolves. This is thought to create abnormal gastrointestinal motility and increased contractility of the smooth muscle, perhaps due to inflammatory processes.7
“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.”
Graduate, National University of Health Sciences
IBS Triggers
- Food sensitives/intolerance – 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. Inflammation of the gut lining may be a common result of food sensitives/intolerance, which may trigger IBS.
- Dysbiosis – A characteristic of IBS appears to be a reduction in the diversity of the gut microbiome. One study showed that those patients with the most severe symptoms had fewer different strains of gut flora than of those with milder cases or healthy control. 8
- Stress – The gut-brain connection appears to be particularly important in the development of IBS, and many cases of IBS began with a traumatic life event. 9
- Hormones – Because women tend to develop IBS more often than men, female sex hormones are thought to play a role. In fact, estrogen dysregulation has been shown to create an immune response in the gut, contributing to the symptomology. 10
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.”
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, completing a physical exam and ruling out other causes, 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.”
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.”
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.”
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!
by Jami Tanner | Feb 6, 2020
Nearly 30 million Americans will struggle with disordered eating at some point in their lives, and millions of others with food and weight preoccupation. These serious illnesses affect individuals across the spectrum of gender, ethnicity, age, and socioeconomic status. Join the AANMC and Dr. Lily Stokely for an intimate view into the sensitive topic of disordered eating.
Dr. Stokely will cover:
– the role of a naturopathic physician in an integrative outpatient approach to eating disorder treatment
– diagnosis and naturopathic treatment of eating disorders
– eating disorder prevention
– a patient story of overcoming disordered eating
*Webinar does not qualify for CE
*The information you submit in this registration will be used to inform you of updates to this event and will enroll you in the AANMC newsletter. The AANMC values your privacy. Please see how we protect your data in our privacy policy .
To view the archive of past webinar recordings, please click here.
About the Presenter
Dr. Lily Stokely is the founder of One Connection Healthcare, in addition to the serving as lead physician for eating disorder treatment at Rooted Heart Healthcare. She is a licensed primary care naturopathic physician who studied naturopathic medicine at Bastyr University, receiving extra curricular training in intuitive eating, kinesio taping, craniosacral therapy, visceral manipulation, biofeedback, trigger point injection therapy, homeopathy, as well as completion of a two-year counseling internship as a student counselor at the University. She completed a two year residency under the supervision of Dr. Molly Niedermeyer at Emerald City Naturopathic Clinic.
Dr. Stokely holds a bachelors of science degree in dietetics from The University of California, Berkeley where she gained additional training in teaching Health at Every Size and Intuitive Eating models. Additionally, she is a yoga teacher with experience instructing private and public classes as well as yoga teacher trainings. Dr. Stokely is a group facilitator for support groups of varying topics including eating disorders, intuitive eating, relationships and movement/exercise.
She lives and practices from the perspective that every individual has their own unique definition of what it means to be healthy. Dr. Stokely is passionate about aiding people in their exploration of health and works from an integrative, whole body, mind, spirit perspective. She believes that it is important to practice what she teaches and does her best to live from a place of self-care, kindness, and compassion as she hopes to help others do the same.
Prior to her work in health, Dr. Stokely grew up in a very small, rural community in the far northern mountains of California. She was raised learning to care for the land through gardening and tending to the farm animals. This childhood allowed her to develop a deep appreciation for nature and a passion for discovering the human connection within it. In her spare time she currently enjoys spending time with family, hiking, camping, skiing, gardening, and playing frisbee with her German Shepherd.
*The information you submit in this registration will be used to inform you of updates to this event and will enroll you in the AANMC newsletter. The AANMC values your privacy. Please see how we protect your data in our privacy policy .
