Naturopathic Approaches to Arthritis

Arthritis is a well-known condition that causes extreme, debilitating, life-altering pain. According to the Arthritis Foundation, arthritis impacts over 50 million Americans, making it the number one cause of disability in the country.1 That means 1 in every 5 adults, 300,000 children, and countless families deal with the ramifications of this painful condition every day. The Centers for Disease Control report that more than 43% of adults with arthritis have work or leisure related activity limitations due to pain.2 Arthritis is really an umbrella term for more than 100 different conditions.3 While all types exhibit the same general symptoms of pain and joint inflammation, each has a unique etiology, some better understood than others. The most common forms of arthritic conditions include osteoarthritis (OA) and inflammatory arthritis types including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and gout.

Osteoarthritis

The concept of the pathophysiology of OA is still evolving, from being viewed as a cartilage-limited to a multi-factorial disease that affects the whole joint.4 Traditionally considered “wear and tear damage” to the joint cartilage, OA is a degenerative joint disease caused by breakdown of the physiological pathways that affect the cartilage and other joint structures. The physiological events that occur in OA result in progressive joint degeneration including destruction of cartilage, joint space narrowing, cysts, spinal disc and facet joint changes, and changes to synovium, joint capsules, ligaments, muscles, meniscus, fat pads, and the layer of bone beneath the cartilage.5  Symptoms of osteoarthritis can include joint pain, loss of mobility, and deformation.6 Currently, only symptom modifying drugs are licensed by the FDA for use. These are largely pain reducing therapies that are limited in efficacy and can have life-threatening side effects as well as significant toxicity.5

“Our goal is to prevent disease before it even begins.  Osteoarthritis can be prevented by maintaining a healthy body weight and by reducing the risk of injuries in young adulthood, such as in those playing athletics.  By teaching safety measures and proper body mechanics to young athletes, we can reduce the risk of injury and the risk of developing osteoarthritis later in life.  Avoiding overuse of joints may also reduce the risk of developing arthritis, so teaching patients proper ergonomics and proper posture is an important prevention measure, as well.  Lastly, evaluating for and treating vitamin D deficiency is another possible preventative measure. The treatment goals for a patient with osteoarthritis include controlling pain and improving joint function.  In order to accomplish these goals, naturopathic treatments include anti-inflammatory and analgesic interventions to reduce pain and ideally reduce dependence on NSAID pain relievers. To improve joint function, the naturopathic physician aims to slow cartilage loss and ideally restore cartilage quantity within the joint space.”

Kimberly M. Sanders, ND

Assistant Professor of Clinical Sciences and Graduate, University of Bridgeport School of Naturopathic Medicine

Inflammatory Arthritis

Inflammatory arthritis is a category of arthritis, containing diseases characterized by inflammation of the joints and other tissues.6 Most conditions classified as inflammatory arthritis are also autoimmune conditions. In autoimmune diseases, the immune system, which is supposed to protect the body, begins attacking the body instead. Symptoms of inflammatory arthritis can include pain, swelling, warmth and tenderness in affected joints, as well as morning stiffness that lasts over an hour.7 Inflammatory forms of arthritis are systemic and impact the entire body. Because of this, inflammation related symptoms might appear, including skin rashes, development of lumps or nodes under the skin, eye inflammation, hair loss, dry mouth, and fever.6 The prevailing current theory supposes exposure of a genetically prone person to an environmental trigger as the most likely mechanism for initiation of inflammatory arthritis.7

“Setting the foundations of health such as getting sufficient sleep, drinking enough water, and trying to reduce stress are always a good place to start to help reduce the inflammatory burden.  Identifying and removing triggers that stimulate the immune system such as food allergies, improper balance of the gut microbiome, hormonal imbalance and other environmental toxins are the next best approach to help prevent inflammatory arthritis and improve symptoms. Symptoms such as gas, bloating, frequent or urgent stools, constipation, fatigue, irregular menstrual cycles, early menopause, chronic headaches, chronic congestion or allergies can be indicating factors for underlying triggers.  Helping to correct these other symptoms is part of the approach to reduce inflammation and prevent arthritis. Something to note though is that if there is already damage to the joint, bringing down the inflammation will only partially help the pain and prevent further damage.  Depending on how much damage has been done to the joint, further treatment (if possible) should be pursued to help minimize pain.”

Jennifer Bennett, ND, LAc

Adjunct Faculty and Graduate, Bastyr University

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis.7 It affects more than 1.3 million Americans, about 75% of whom are women.8 RA is characterized by persistent synovitis (inflammation of the joint lining), systemic inflammation, and auto-antibodies (particularly to rheumatoid factor and citrullinated peptide).9  The small joints in the hands and feet are most commonly affected, and sometimes RA can even impact organs, such as the eyes, skin or lungs. Over time, persistent inflammation can break down the joint and lead to permanent joint deformity and damage.

Psoriatic Arthritis

Psoriatic arthritis is a type of autoimmune inflammatory arthritis that occurs in some patients with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.10 Psoriatic arthritis is most often seen in the larger joints. It is especially prominent in the joints of the lower extremities, as well as the distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis.

Gout

Gout is a form of non-autoimmune inflammatory arthritis that impacts over 8 million American adults and is the most common inflammatory joint disease in men.11 The incidence of gout has more than doubled over the recent 20 years, likely tied to dietary changes and the increased prevalence of obesity.12 Fortunately, it does not result in the system-wide inflammation seen in RA or psoriatic arthritis.3 In gout, the joint inflammation is the result of elevated levels of uric acid in the blood stream (hyperuricemia) leading to the deposition of uric acid crystals inside the joints. The chances of developing gout are increased with a rich diet (red meat and wine are common culprits leading to the increase of uric acid). The outcome is extremely painful joint inflammation. The most common site for gout is the large joint at the base of the big toe, but it can also affect other joints as well.

Naturopathic management and treatment

Although the various forms of arthritis cause pain in different ways, the basics of naturopathic management and treatment options are quite similar across all types.

“Arthritis is a metabolic and systemic condition, therefore lifestyle modifications such as diet, exercise and targeted nutritional supplements are key. Decreasing sugar, increasing healthy protein and fats, balancing hormones and getting adequate daily movement and strengthening for the joint are my go-to. Beyond that I employ regenerative injection therapies like prolotherapy and platelet rich plasma as my heavy hitting treatments of choice. But these injections simply do not work or last if the other factors are not addressed.”

Tyna Moore, ND, DC

Graduate, National University of Natural Medicine

Diet

Of the non-pharmacological treatment approaches, dietary interventions are among the most common. In recent years, the role of dietary antioxidants in arthritis management is increasingly being addressed by researchers in reported studies. Although the underlying cause of arthritis is largely unknown, a number of nutrient and non-nutrient components of food have been shown to affect the inflammatory process and, in particular, to influence clinical disease progression.13 Emerging research demonstrates a protective role of fruits and their polyphenols in pre-clinical, clinical and epidemiological studies of multiple forms of arthritis.14 Berries and berry extracts have shown protective qualities with regard to joint structures and overall inflammation levels.14,15 There is also some evidence on the role of specific fruit polyphenols, such as quercetin and citrus flavonoids in alleviating arthritis symptoms.14

“Proper nutrition is needed for joint health. Getting patients to change to a whole foods diet, mostly plants, helps reduce pain and inflammation in as little as two weeks. These benefits are amplified when you remove processed foods such as bread, sugar and dairy products. Foods like salmon contain essential fatty acids and vitamin D, berries are rich in anti-oxidants and one of my favorite supplements to give to people with joint and muscle pain is Vitamin D. So many people are low in vitamin D and it often can make a big difference.”

Joanne Gordon, ND, MSPT

Graduate, Southwest College of Naturopathic Medicine

Movement as medicine

Exercise is recommended as a first-line conservative intervention approach for arthritis, particularly osteoarthritis and strong evidence supports that aerobic and strengthening exercise programs are beneficial for improving pain and physical function in adults with mild to moderate OA.15 Arthritis can be a barrier to physical activity with studies reporting that 43.5% of adults with arthritis reporting arthritis associated activity limitations.16 However, movement may also be preventive in the development of arthritis. Research has found that when adjusted for age, the prevalence of arthritis among adults reporting no leisure time physical activity is significantly higher at 23.6% than the prevalence of arthritis among adults who report meeting basic physical activity recommendations at 18.1%.16

“As with all cases, naturopathic physicians seek to find the underlying cause of osteoarthritis.  If the patient carries excess weight, then weight loss may slow down the progression of the disease by reducing the amount of stress on the joints.  Properly strengthening the muscles around the affected joint is also encouraged to support the joint and improve functioning. Low-impact exercises, especially swimming, are quite beneficial for management of osteoarthritis symptoms as well.”

Kimberly M. Sanders, ND

Assistant Professor of Clinical Sciences and Graduate, University of Bridgeport School of Naturopathic Medicine

Acupuncture

The philosophy behind Traditional Chinese Medicine and acupuncture involves the belief that energetic forces circulate in the body on pathways known as “meridians.” When the free-flowing circulation of the energy in the meridian is blocked or hampered, disease and dysfunction occur. Acupuncture, which involves the stimulation of an individualized aggregate of acupoints found along the meridians, is a means by which energy circulation is restored and health and balance are restored. Acupuncture has been reported as an effective treatment for many chronic pain conditions, including arthritis.17 The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life in those with arthritis.17

Supplements and Herbs

There are a number of supplements and herbs that have been studied for their benefits on various factors involved with arthritis. Some focus on inflammation, others on supporting cartilage regeneration, and others on factors such as immune balancing. Among the most common supplements utilized for joint pain are glucosamine and chondroitin. This duo has been evaluated in several trials, both as separate supplements and in combination. Studies of glucosamine alone have found it to be equivalent or superior when compared directly to ibuprofen.18 Chondroitin has consistently been found to be superior to placebo.18 Trials examining the two together revealed moderate to large benefits that were relatively consistent for both pain and functional outcomes.19

Omega 3 fatty acids are well known for their inflammation modulating activity and studies using experimental models have shown benefit in a variety of inflammatory conditions.20 With regards specifically to arthritis, research has found omega-3 fatty acids to be superior to placebo in improving outcome measures and decreasing the long-term requirements for non-steroidal anti-inflammatory drugs.21 Omega 3 fatty acids have also been shown to have a therapeutic role in decreasing pain in arthritic patients, particularly those with rheumatoid arthritis.22 Other fatty acids like gamma linolenic acid (GLA) have also been studied. GLA-Rich oils have been shown to have anti-angiogenic, anti-inflammatory, and anti-oxidant activities.23 A meta-analysis of studies investigating the impact of GLA-rich oil found that taking GLA resulted in a near 33% decrease in pain intensity and a 15% improvement in disability.24

Herbal supplements have also shown benefit for those with arthritis. Studies of the impact of the herb Boswellia serrata on osteoarthritis, indicated that a 90-day treatment with 100 mg of enriched Boswellia serrata extract improved symptoms such as pain and physical function compared to placebo.25 Studies have also demonstrated that the herbal extract curcumin has both defensive and therapeutic effects on the occurrence and development of RA.26 A curcumin extract was evaluated for its impact on inflammation and synovial hyperplasia in rheumatoid arthritis in an experimental model. Researchers found that curcumin inhibited the RA induced infiltration of inflammatory cells into the synovium as well as synovial hyperplasia.26 Further, the study found that curcumin reduced the levels of pro-inflammatory markers in both the serum and synovium.26 Green tea and green tea polyphenols have also been investigated for their benefits in those with arthritis. Green tea impacts inflammation via multiple pathways. Consuming green tea polyphenols prevented both the onset and progression of arthritis.27

Of course, because naturopathic medical protocols always seek to find and remove the cause, there will be individual variances in treatment based not only on the specific condition and its cause but more importantly, on the individual patient as well. These might include therapies like hydrotherapy, homeopathy, orthopedic regenerative injection therapy with stem cells or platelet-rich plasma (PRP) in patients with OA, immune balancing therapies in cases of inflammatory arthritis like RA or psoriatic arthritis, or very specific dietary considerations in those who experience gouty arthritis.

 

Naturopathic doctors share patient success stories

Inflammatory Arthritis

“Connie, a retired health professional, had painful arthritis in her left thumb and knee such that she could no longer knit, spin yarn, or take care of her new 8-week-old puppy because of pain. Connie eliminated some of the common inflammatory foods like sugar and dairy, got her vitamins and hormones in check and then received a few sessions of prolotherapy. Connie noticed a significant difference in her pain levels and she is now able to knit, care for two Cairn terriers and take care of her other farm animals.”

Joanne Gordon, ND, MSPT

Graduate, Southwest College of Naturopathic Medicine

Rheumatoid Arthritis

“Many patients show improvement in their arthritis symptoms, and some are even able to come off their medications with time. One patient of note was a woman diagnosed with rheumatoid arthritis when she was 32.  She had been on a combination of Leflunomide and methylprednisolone for many years with limited success.  Her other symptoms included irregular menstrual cycle (cycles swinging from 65 to 33 days), chronic migraines and chronic stress.  After one year, we were able to regulate her menstrual cycles with herbs like flax and vitex to every 31 days, which consequently reduced her chronic migraines and joint pain.  We also worked on implementing an anti-inflammatory diet and corrected her gut microbiome with berberine and high dose probiotics.  We were eventually able to taper her off her steroid with minimal joint pain or flares, and we are currently working to taper her off her Leflunomide dosage.  To date, she remains relatively pain free and recent imaging shows no progression of joint damage after a year and a half.

Jennifer Bennett, ND, LAc

Adjunct Faculty and Graduate, Bastyr University

Osteoarthritis

“Steven is a 56-year-old male who first presented in June 2018 for management of left knee osteoarthritis which he rated a 5/10 in severity.  He was morbidly obese with a BMI of 47.8.  Upon physical exam, I noted mild effusion in the left knee but no erythema or pain upon palpation.  There was restricted flexion of the left knee noted as well.  The right knee examination was normal.  On his first visit, I ordered basic labs to evaluate his blood sugar and cholesterol levels, along with vitamin D and thyroid panels.  His fasting glucose returned slightly elevated at 101 mg/dL, A1C at 5.8%, and his insulin was high at 21.8 uIU/mL.  His vitamin D was also low at a 25 ng/mL.  His cholesterol panel was within normal limits.  Based on these findings, I determined that insulin resistance was contributing to his obesity, which was a likely underlying cause for his left knee osteoarthritis.  In addition, his vitamin D insufficiency could also be an obstacle to cure, as lower vitamin D levels may be related to worsened osteoarthritis progression.  My focus for the patient was on symptomatic control in the short-term with a long-term goal to improve insulin sensitivity and promote weight loss to reduce tension on the joint.  He was given an exercise and dietary plan to improve insulin sensitivity along with vitamin D replacement therapy, a bioflavonoid complex, high EPA omega-3 preparation, and a curcumin preparation for symptom control and anti-inflammation.

Steven returned in August 2018 with updated labs.  His fasting glucose remained elevated at a 103 mg/dL but his insulin was now an 11.6 uIU/mL.  His A1c% was not re-run since only two months had passed.  He had not yet noticed weight loss or pain reduction, but also admitted to irregular compliance with the diet.  He did comply regularly with the exercise regimen, which is likely responsible for the drop in insulin noted.  After another two months, his fasting glucose remains elevated at a 106 mg/dL but his A1c% is now a 5.5%.  His insulin is still an 11.1 Uiu/mL, and his vitamin D is now a 31 ng/mL.  Most notably, however, is a 30% improvement in his knee pain and function at this visit.  He noted that the combination of curcumin and high EPA fish oil preparation seemed to provide great relief after consistent use, despite not yet losing weight.  At our last visit with Steven in February 2019, his insulin continues to hold at 11.2 Uiu/mL and his A1c% is now 5.3%.  Now that the holiday season has passed, he notes better compliance with his dietary plan since the new year, and has already noted a 16-pound weight loss.  His knee pain remains a 2/10, and he has reduced his dependence on ibuprofen by instead using curcumin and high EPA preparation.”

Kimberly M. Sanders, ND

Assistant Professor of Clinical Sciences and Graduate, University of Bridgeport School of Naturopathic Medicine

Inflammatory Arthritis

Helping my patient find relief from their pain is my passion. My favorite case was a patient with a frozen and painful shoulder. She could barely use her arm or raise it more than a foot off the side of her body. She wanted platelet-rich plasma, but I knew better. Too much, too fast, too strong can make that type of condition much worse. We started slow and low with more gentle regenerative injection types, incorporated hormonal balancing and general care, worked our way up from there with the strength of the injections, incorporated rehab and strengthening, and within a few treatments she was 100% pain free and able to enjoy full range of motion. She threw her arms fully above her head, and shouted “Look at me!” Seeing her relief from pain brought a lot of joy to my heart.

Tyna Moore, ND, DC

Graduate, National University of Natural Medicine

Naturopathic medicine has a large and deep toolbox to draw upon to help those suffering with any form of arthritis. Click here to find an ND near you in the US and Canada.

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Tips from a Naturopathic Medical Student

Tips from a Naturopathic Medical Student

Join the AANMC and President of the Naturopathic Medical Student Association – Blake Langley for an informative session on what it takes to thrive as an ND student!

Here’s what you can expect to learn:
-A day in the life of a naturopathic medical student
-What to expect from naturopathic medical school
-How to balance school and life responsibilities
-How to build your resume and experience as a student to prepare for a career you will love
-Advice for prospective students

Learn More About Becoming a Naturopathic Doctor

Receive information from the accredited schools of your choice located across North America!

Tips from a Naturopathic Medical Student

Join the AANMC and President of the Naturopathic Medical Student Association – Blake Langley for an informative session on what it takes to thrive as an ND student!

Here’s what you can expect to learn:
-A day in the life of a naturopathic medical student
-What to expect from naturopathic medical school
-How to balance school and life responsibilities
-How to build your resume and experience as a student to prepare for a career you will love
-Advice for prospective students

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About the Presenter

Blake Langley is in his sixth and final year of studies in naturopathic and Chinese medicine at the National University of Natural Medicine. Hailing from the southeastern United States, he was raised in an area of the country underserved by naturopathic medicine. He serves as President of the Naturopathic Medical Student Association and represents the voice of naturopathic students at the Integrative Health Policy Consortium and the American Association of Naturopathic Physicians. He additionally serves as the Founding Co-Chair of the Student Committee of the American Society of Acupuncturists. With his passion for students, advocacy, and administration, Blake hopes to integrate these into the next journey in his career as a physician.

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Asthma, Allergies, and Naturopathic Medicine

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

What causes allergies and asthma?

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

Naturopathic approaches to allergies and asthma

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

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

Fraser Smith, ND, MATD

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

Diagnostic testing

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

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

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

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

Jenn Dazey, ND, RH (AHG)

Core Faculty in the Department of Botanical Medicine, Bastyr University

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

Balancing the gut microbiome

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

Using supplements

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

Stinging nettles

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

Omega 3 fatty acids

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

Quercetin

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

Sublingual immunotherapy

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

Dietary considerations

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

Environmental modification

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

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

Dr. Dazey shares a patient success story

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

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

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Stinging Nettle 101: The Naturopathic Kitchen

Welcome back to The Naturopathic KitchenAs always, our efforts are centered on introducing ways to bring new, fun, and healthy foods into our home kitchens. Today we will take a closer look at a delightful green with a scary sounding name – stinging nettles!

Stinging Nettle 101

Stinging nettle (Urtica dioica) is commonly called “nettle.” In modern times, stinging nettle is often considered a nuisance weed, popping up in gardens, flowerbeds, and yards every spring. However, stinging nettle has a rich history of varied uses across many cultures. Chief among the oldest uses of stinging nettles is as a fiber for fabric, sail cloth, cordage and fishing nets. In Denmark, burial shrouds made of stinging nettles date back to the Bronze age some 4000 plus years ago.1 Similarly, stinging nettle was used by Europeans and Native Americans as material for sailcloth, sack material, cordage, and fishing nets.1 The cloth produced from stinging nettle is called “nettle cloth” with a silken, linen-like quality.2 During wartime, raw textile material shortages were quite common. German military uniforms worn during World War I were 85% nettle fibers.1 The fibers of the nettle plants were not the only part used in textile production. Decoctions of the nettle plant’s rich chlorophyll are used to produce green dye used for clothing as well as a food coloring agent.1

Stinging nettle has also been traditionally used as food for livestock. In fact today, stinging nettle is often fed to chickens to increase egg productivity.3 It is also used as a source of vegetarian rennet during the cheese making process and is still included in Passover herbs. Nettle is a very popular wild edible plant in some developing countries and contributes to both community food security and in some cases, the local economy.4 Nettle is often used in curries, soups, and vegetable dishes as well as an additive to breads and pastas. In Georgia, a former member of the Soviet Republic, boiled nettle with walnuts is a common meal.

From the leaves to the seeds, stinging nettle plants have been used medicinally throughout history. Nettle leaves have traditionally been used for scurvy, anemia, arthritis, seasonal allergies, wound healing, and general fatigue, and as a diuretic and to stimulate pancreatic secretion.4 Stinging nettle tea has been used historically as a cleansing spring tonic and blood purifier. The juice of nettle leaf has been used as a hair rinse to control dandruff and to stimulate hair growth.1 Among the oldest medicinal uses of stinging nettle is in the process of urtication. Urtication involves flogging the skin with a frond of a fresh nettle, allowing the tiny hairs or trichomes to pierce the skin. The trichomes are tiny, hair-like projections that cover the leaves and the stem of the plant. They have a bulbous tip that breaks off when touched, revealing needle-like tubes that pierce the skin and inject their serum of acetylcholine, formic acid, histamine, and serotonin resulting in an itchy, burning red rash that can last for half a day.5 This practice has been documented by many cultures and has been in use for thousands of years. Urtication was prescribed for a variety of maladies from chronic rheumatism, lethargy, coma and even for infectious diseases such as typhus and cholera.1 Additional uses of nettle have included soaking the stems and leaves in water then applying the water as an organic/natural pesticide to plants that are infected with mites or aphids. Nutrient-rich nettle also helps to restore the vitamin and mineral content of soil used for growing crops which can help enhance the vitality of the plants. It also helps to speed along the composting process.

Where do stinging nettles come from? Where can I find it?

Nettle is native to a large region spanning northern Africa, Europe, and Asia but has been found widespread across the Western world as well from northern Mexico to northern Canada for hundreds of years.3 Nettles are reported to be among the tastiest cooked greens with a flavor similar to spinach but a bit sweeter. Nettle is a good source of several vitamins and minerals including vitamins A and C, iron, potassium, and calcium as well as a balanced source of omega 3 and omega 6 fatty acids. 3

Fresh nettle can be difficult to find commercially; however, you may be able to find them at farmers markets, local food co-ops, or online. Also, they grow wild in abundance, and the tender young tops can be gathered for free, particularly during the early spring months. If foraging for nettle though, be sure to wear gloves to avoid the “sting!” It is important to note that once dried, wilted or cooked, the trichomes become denatured and are no longer capable of stinging.3 Fresh nettles can be boiled, steamed, stir-fried and consumed as a standalone vegetable or they can be added to any number of savory dishes including baked goods.

How do stinging nettles help my health?

Stinging nettle has long been recognized for its medicinal qualities. Hippocrates utilized 61 different remedies that contained nettle.1 Nettle is an extremely valuable medical herb that is often used in the spring months as a gentle detoxifying agent.6 Among the most recognized benefits of nettle is its benefit for benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate.7 There have been multiple studies examining the effects of nettle on the prostate and all produced favorable results in terms of symptom reduction as well as safety when compared to placebo.8,9,10

Nettle has a significant research profile as a treatment for allergies and allergic rhinitis.11 Portland, Oregon based National College of Naturopathic Medicine (now National University of Naturopathic Medicine) published a double-blind, placebo-controlled randomized study examining the use of freeze-dried nettle leaf for treatment of hay fever, asthma, and seasonal allergies found that the freeze-dried preparation was rated higher than placebo in relieving symptoms after just one week’s time.12

Osteoarthritis is the most common form of arthritis and is a debilitating and painful condition impacting the lives of millions of Americans.13 Nettles can also help alleviate the symptoms of osteoarthritis and ease joint pain.7 Studies also show that consuming nettle can reduce the need for NSAID type pain medication by producing a synergistic effect.14

What medical conditions/symptoms are stinging nettles used for?

When should stinging nettles be avoided?

Outside of outright allergy or sensitivity to the plant itself, nettle is very safe and has been consumed for thousands of years with no issues. However, while nutrient-rich dried nettle and nettle infusions are often recommended as a nourishing tonic during pregnancy, fresh nettle has been reported to have stimulatory action on the uterus and should be avoided. 15

Let’s try out stinging nettles with these delicious and nutritious recipes!

Stinging Nettle Pesto

INGREDIENTS

Salt and freshly ground black pepper
1/4 lb. stinging nettles
1/4 c fresh mint leaves
1 clove garlic, minced
1/2 c pine nuts, toasted
2 T lemon juice
1/3 c olive oil
1/4 c firmly packed grated Parmigiano Reggiano cheese (can omit for vegan pesto)

INSTRUCTIONS

Fill a large pot halfway full with water. Add 1/4 cup salt and bring to a boil. Fill a sink or a large bowl with cold water. Using gloves or tongs, submerge the nettles in the water and let them sit for 5 minutes. Remove the nettles and discard the water. Wearing rubber gloves, pull the leaves from the stems and discard the stems. Put the nettles in the boiling water and boil for 1 minute. Drain and spread the nettles on a baking sheet. Let cool completely. Squeeze out as much of the water as possible and coarsely chop. Place the nettles in the bowl of a food processor with the mint, garlic, pine nuts, and lemon juice. Process until the mixture has formed a paste. With the machine running, pour in the olive oil. Transfer to a bowl and fold in the cheese. Taste and adjust the seasoning with salt and pepper.

Thank you to SplendidTable.org for this wonderful recipe!

Chicken Nettle Soup

INGREDIENTS

6-7 c bone broth
3 large handfuls of cubed or shredded chicken
4 T grass fed butter (or substitute with olive oil)
1 large onion, diced
4-6 large carrots, diced
2 large ribs of celery, diced
6-8 cloves of garlic, chopped
1/4 c dried nettle
Fresh flat leaf parsley, chopped for garnish
Fresh scallion, chopped for garnish
Salt and pepper to taste

INSTRUCTIONS

  • Add the butter to a pot and swirl around the bottom until it foams
  • Add the onion, garlic, carrot, and celery and sauté for 5 minutes on med heat
  • Add chicken and cook for one minute
  • Season with freshly cracked black pepper and sea
  • Add the bone broth and dried nettles to the pot and turn up the heat until the soup begins to simmer
  • Turn the heat down and gently simmer for 10-12 minutes until the carrots are fork tender
  • Serve and garnish with fresh parsley and scallions

Thank you to holistichelathherbalist.com for this tasty recipe!

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