Naturopathic Approaches to Type 2 Diabetes – How to Regulate Blood Sugar Naturally

by | Nov 6, 2019

Join Chris Habib, B.Sc. (Hons), ND to learn how powerful naturopathic medicine can be for Type 2 Diabetes!

During this jam packed webinar Dr. Habib will cover:
– How to improve blood sugar regulation naturally
– Common supplements for diabetes and related complications
– Diet and lifestyle approaches for Type 2 Diabetes
– A patient who was safely able to go off diabetes medication with ND supervision

*Webinar does not qualify for CE

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To view the archive of past webinar recordings, please click here.

About the Presenter

Educated at the Canadian College of Naturopathic Medicine as an evidence-based naturopathic doctor, Chris Habib, B.Sc. (Hons), ND is the Chief Financial Officer of a highly successful herb company. He is an entrepreneur and investor who has bought and sold numerous businesses. Dr. Habib also manages health clinics, teaches, works in telemedicine, and oversees an online medical publication.

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*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 .

Naturopathic Doctors as Part of the Health Care Team

by | Apr 25, 2019 | 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 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.”

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Naturopathic Approaches to IBS

by | Apr 16, 2019 | Featured Articles, News

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!

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Dr. Chris Habib – CCNM

by | Mar 19, 2019 | Featured Articles, News, Success Stories

“When you become an ND, you are automatically an entrepreneur. That means you can start any business that interests you and nurture it into something that can make a real impact for others.”

Laying the groundwork to become an ND

Prior to pursuing naturopathic medicine, Dr. Habib completed an Honours Bachelor of Science degree at the University of Toronto, with a double major in Life Sciences and Psychology. “I knew I wanted to be working in medicine so that I could do something meaningful and connect with people. I also wanted to implement improvements to the way healthcare was being provided to Canadians through the conventional medical system.” Naturopathic medicine seemed to bridge the gap.

Dr. Habib openly admits that at first, he didn’t know naturopathic medicine was the right path for him. “I jumped in without knowing what I was getting myself into, but it turned out to be a fantastic learning experience in an industry ripe with diverse business opportunities.”

CCNM as a springboard

Dr. Habib chose to pursue his naturopathic medical education at the Canadian College of Naturopathic Medicine because of its location in Toronto, where he lives. He also saw that CCNM was the largest naturopathic institution in Canada and thus would include a high-quality curriculum.

“My experience at CCNM was pivotal to my development into a professional, as well as helping me becoming a better version of myself. In hindsight, the ability to complete such a meaningful stepping stone in my education was a huge personal achievement.” Dr. Habib found that the immense amount of learning was motivating and provided an ongoing source of intellectual stimulation.

“Living the dream” after graduation

“Planning for success is difficult when you don’t know what you don’t know. We all try our best. I typically think I want something, go and try to achieve it, only to leave me wanting more when I succeed. I’m on a path of continual self-discovery.” After graduation, Dr. Habib became the first naturopathic research resident in Canada, working at CCNM. He wanted to be a teacher and went on to become an academic instructor and clinic supervisor.

After completing his residency, Dr. Habib discovered his love of business. “Aside from teaching, I opened a clinic, worked for a naturopathic publication, built online courses, saw patients in private practice, started an herb company, bought and sold various businesses, I couldn’t get enough!” Dr. Habib currently spends most of his time as the CFO of the herb company he founded, Perfect Herbs. What started as a side hustle has grown and developed into a fulfilling full-time role, in which he happily serves the naturopathic community.

Finding fulfillment as an ND

Dr. Habib loves the diversity of career options in naturopathic medicine. “When you become an ND, you are automatically an entrepreneur. That means you can start any business that interests you and nurture it into something that can make a real impact for others.” Dr. Habib found that private practice was rewarding, but not ideally suited for his skills. He wanted to help others on a larger scale, which is why he runs companies that help optimize the work and lives of other NDs.

The flexibility of naturopathic medicine allows Dr. Habib to work remotely. He’s able to manage his business on his preferred schedule and has also developed passive business income streams so that he can generate revenue even when he’s not directly putting in hours. It took a lot of work, and a lot of trial and error to get to where he is now.

Advice for aspiring NDs

“My advice to prospective students has changed over the years as I’ve had the opportunity to connect with so many graduates through my work. Here’s what I’ve found: Those who work hard will be successful no matter what they do and those who love their work will be successful no matter what they do. So, my largest piece of advice is to first realize that you will be an entrepreneur and second that you need to have one of those things going for you.”

Dr. Habib encourages prospective students to spend time exploring what they might like doing for work, or to shadow NDs to find out what the day-to-day is like. “The more you can find out about what you’re getting into, the more you can be sure it’s right for you. I wish you the utmost success in your journey.”

Learn more about Dr. Habib:

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Dr. Ellen Wong – CCNM

by | Feb 22, 2019 | Featured Articles, News, Success Stories

 I help my patients shift perspectives, so they can empower themselves to make the health changes they want to see.

Laying the groundwork to become an ND

After completing her undergraduate degree in biomedical sciences, Dr. Wong considered graduate programs in cognitive psychology and molecular genetics until she found naturopathic medicine. “Naturopathic medicine is the perfect blend of concepts I love – how the human body works and how the human mind thinks. So much of what naturopathic medicine is, is to motivate people to change behaviors.”  Dr. Wong loves the opportunity to work one on one with patients to gain an understanding of their health condition and offer individualized treatment plans to support their healing. “I love that naturopathic medicine embodies health as a combination of physical, mental and emotional aspect.” More importantly, the doctor-patient relationship, “allows the patient to feel heard and understood,” explains Dr. Wong, which is a huge component to unveiling the root cause of illness.

CCNM as a springboard

Raised in Toronto, Dr. Wong chose to pursue her naturopathic medical education at the Canadian College of Naturopathic Medicine to stay close to her friends, family and community. She saw opportunity in the teaching clinic and felt an immediate sense of belonging.

“Anytime you pursue something that challenges you, you grow and you learn. At CCNM, I grew as a person and learned a lot – about naturopathic medicine and myself.” The clinical internship offered hands on experience in patient care along with the mentorship of experienced supervisors. “The challenging pace of the curriculum combined with the humbling patient stories, really taught me a lot about empathy and compassion. It put a lot of what I considered to be stressors into perspective.”

“Living the dream” after graduation

Following graduation, Dr. Wong was accepted into CCNM’s two-year clinical residency program. Shortly after graduation from the residency program, she transitioned into a full-time faculty role at CCNM. In addition to serving as a faculty member, Dr. Wong worked at two practices before establishing her own in Whitby, Ontario.

Dr. Wong continues to explore different ways to offer care to a larger audience through group programs and speaking engagements. “I think there are many ways I can improve the health of those around me, not just in a one-on-on setting of a traditional practice. The longer I practice, the more I realize that I need to adapt and learn to a changing environment. That’s not a bad thing at all, I’m quite excited to see where medicine will go in the next 10, 20, 50 years!”

Finding fulfillment as an ND

Dr. Wong finds fulfillment in her career through treatment and career options.

From a treatment perspective, naturopathic medicine offers many approaches to patient care guided by the principles of evidence-informed practice. “That means we have to make decisions encompassing best available evidence, our clinical expertise and our patients’ values and beliefs. I firmly believe that no matter what tools we have, the most important one is the ability to help motivate our patients (who are willing) to develop healthy physical, mental and emotional habits. You simply cannot have a patient eat a particular diet, exercise a particular way or take a particular pill and expect to change the way your patient thinks. Our thoughts create our reality so at the absolute core of what I do, I help my patients shift perspectives, so they can empower themselves to make the health changes they want to see.”

Dr. Wong appreciates the flexibility of her career. As newlyweds, Dr. Wong and her husband recently returned from their honeymoon. “Traveling is a huge passion of both mine and my husband’s, so the career I chose had to align with that. The great thing about balancing work at CCNM and my own private practice is that it has allowed me the flexibility to pursue the things that matter to me. In my private practice, I do my best to make sure my patients are equipped with that they need (from a health perspective) while I am away. They know they can receive care, should they need it, from a fellow ND.”

Advice for aspiring NDs

As a student, Dr. Wong reflects, “Sometimes I worked hard, sometimes I worked smart. I think that’s how it has to be – both in school and in life.” She dove into the subjects that she loved and recognized her responsibility for understanding parts of the curriculum that did not come as easy to her. “I stayed physically and socially active; put pressure on myself to study and do reasonably well but also recognized that if I didn’t perform as well, it was my responsibility to figure out how to improve.”

She focused on the end-goal of motivating her patients to better heath and contributing to CCNM. “I stayed curious and was both excited and at peace with the fact that I would never learn all there is to learn about medicine.” Knowledge of how to access resources is a valuable tool for successful naturopathic practice.

“When you first step into the halls of any naturopathic college, understand that you are about to learn the foundations of naturopathic medicine. Once you have experience with it all, you can choose to pursue what you deem as valuable and set up your career the way you want to.”

Dr. Wong encourages prospective students to explore career options. There are so many career paths in the naturopathic medical field. You have the flexibility to be your own boss, set your own hours and determine the work-life balance that is right for your family and lifestyle. Your schooling will teach you the foundations of naturopathic medicine, however a great deal of the learning comes from experience. “Choosing medicine as a career means you are choosing to continue to learn. This applies to both the science and the art of practice.”

Learn more about Dr. Wong:

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