PTSD and the Six Principles of Naturopathic Medicine

PTSD and the Six Principles of Naturopathic Medicine

Join Radley Ramdhan, ND, MsAc, former Specialist in the United States Army Corp of Engineers, New York Army National Guard for an informative session on naturopathic approaches to PTSD. Hear about his firsthand journey as a doctor and veteran in navigating traumatic issues with patients.

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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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Dr. Radley Ramdhan – UBSNM

“The experience of serving in the military has provided me with a deeper appreciation for life, a stronger desire to help others, the flexibility of thinking outside the box, and has shown me the importance of patience and humility, all of which helped me through medical school and now in practice. Often times, I am able to draw on military experiences to relate to patients, and as a result, I can help them more effectively. Resiliency, flexibility, and adaptability are some qualities from the military that have made me a stronger naturopathic doctor.”

Laying the groundwork to become an ND

Radley Ramdhan’s childhood dreams were to be a pilot and serve in the United States Army – never did he dream of becoming a doctor. It wasn’t until later in high school when his grandfather was dying, that Dr. Ramdhan recognized his calling, “I saw how the health care system in Trinidad and Tobago was lacking, and decided I wanted to pursue a career in medicine to help fill that void and make a difference.” Dr. Ramdhan describes his grandfather’s treatment as “a pill for every ill.” At last it was determined that his continuous decline was due to the amount of medication he was on. Unfortunately, by that point, his kidneys and liver were damaged, and he was addicted to sleep medication. Dr. Ramdhan was determined to become a doctor who could offer patients pharmaceutical and non-pharmaceutical options, educate them on both and then make a mutual decision on the best course of treatment for their unique case.

Balancing the military and naturopathic medical school

Recognizing that the principles of naturopathic medicine aligned with his personal beliefs, Dr. Ramdhan pursued his naturopathic medical education at the University of Bridgeport School of Naturopathic Medicine. Following his childhood dream of serving in the US Army, he completed Army Basic Training during his first summer break.

When school started up again, he struggled to balance military duty and school. “It wasn’t always easy to balance both, sometimes between weekend classes, clinic, seminars, and military obligations I would go a month without having any days off. It boiled down to some of our military teachings of adapting and overcoming, never quitting, and Army values being applied to my daily life.” As a result, he decreased his course load to part-time. “After some time and hard work, I was able to balance both, returned to being a full-time student and decided to push myself to complete a dual-degree in naturopathic medicine and acupuncture. Support from family, and friends both in school and the military helped with motivation especially when I felt overwhelmed.”

Dr. Ramdhan and his unit were deployed to the Middle East during what was supposed to be his final year of medical school. With prior knowledge of the possibility of deployment, he worked ahead to complete courses and exams prior to his deployment and leave of absence.

“The experience of serving in the military has provided me with a deeper appreciation for life, a stronger desire to help others, the flexibility of thinking outside the box, and has shown me the importance of patience and humility, all of which helped me through medical school and now in practice. Often times, I am able to draw on military experiences to relate to patients, and as a result, I can help them more effectively. Resiliency, flexibility, and adaptability are some qualities from the military that have made me a stronger naturopathic doctor.”

Finding fulfillment as an ND

Following graduation, Dr. Ramdhan returned to Trinidad and started a naturopathic medicine and acupuncture practice. “I network and integrate with other health care providers to ensure the best options, care, and results for my patients.” Dr. Ramdhan describes his passion as uncovering the root cause with his patients and teaching them to become independent.

Dr. Ramdhan also presents free lectures and workshops on various topics in health. In his free time, he enjoys playing cricket and being involved in the community.

Advice for aspiring NDs

“People are becoming more aware of their health and are trying to take control of it, so now more than ever naturopathic medicine has its time to shine. There are several career opportunities in naturopathic medicine and the future career outlook is great, but we need more people to join the profession and spread the knowledge. I would advise anyone with an interest in naturopathic medicine to not only talk to NDs and patients, but also attend events such as Lobby Day or DC Federal Legislative Initiative (FLI) as they give you a different perspective and inspiration about the potential for our medicine. Like all great things in life, it is not an easy road, but if you have the passion, drive, and a why for choosing naturopathic medicine, you will be successful.”

Dr. Ramdhan continues, “There shouldn’t be any us versus them mentality; we are in a paradigm that allows medicine to be integrated to provide the best patient care. Start building your network from day one as a student and support your classmates along the way. Remember the principles of naturopathic medicine as you go along your path of growth, for the deeper rooted a tree, the stronger it can withstand any storm.”

CLICK HERE to watch Dr. Ramdhan’s PTSD and the Six Principles of Naturopathic Medicine webinar on demand!

Learn more about Dr. Ramdhan

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Naturopathic Doctors as Part of the Health Care Team

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

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

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

Arvin Jenab, ND

Graduate, Canadian College of Naturopathic Medicine

Uncovering the Root Cause

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

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

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

Sunita Iyer, ND, LM

Adjunct Faculty and Graduate, Bastyr University

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

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

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

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

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

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

Lisa Taulbee, ND

Graduate, National University of Natural Medicine

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

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

Jacob Wolf, ND, LAc, Dipl. OM

Graduate, Southwest College of Naturopathic Medicine

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

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

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

Dawn Siglain, ND, LAc

Graduate, University of Bridgeport School of Naturopathic Medicine

Doctor as Teacher

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

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

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

Dan Rubin, ND, FABNO

Graduate, Southwest College of Naturopathic Medicine

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

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

Heather Bautista, ND, CNS, LDN

Graduate, National University of Health Sciences

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

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

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

Erica J. Joseph, ND, LAc, FABNO

Graduate, Bastyr University

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

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

Interprofessional Feedback

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

Intrigued by whole-person approach

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

Open to new approaches

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

Surprised by extent of patient care

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

Patient Success Stories

Naturopathic doctors share success stories of interprofessional patient care.

Cancer

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

Dan Rubin, ND, FABNO

Graduate, Southwest College of Naturopathic Medicine

Breast Cancer and Hypothyroid

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

Erica J. Joseph, ND, LAc, FABNO

Graduate, Bastyr University

Lower Back Pain

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

Jacob Wolf, ND, LAc, Dipl. OM

Graduate, Southwest College of Naturopathic Medicine

Women’s Health

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

Lisa Taulbee, ND

Graduate, National University of Natural Medicine

Weight Loss

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

Heather Bautista, ND, CNS, LDN

Graduate, National University of Health Sciences

Pregnancy and Birth

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

Sunita Iyer, ND, LM

Adjunct Faculty and Graduate, Bastyr University

Psoriasis

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

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

Mental Health

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

Dawn Siglain, ND, LAc

Graduate, University of Bridgeport School of Naturopathic Medicine

Continuous Learning and Excellence in Patient Care

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

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

Tegan Moore, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

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

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Therapeutic Benefits of Laughter and Humor

Laughter is extremely powerful and few things are as emotionally satisfying as a good, deep, belly laugh. Mark Twain said, “Against the assault of laughter, nothing can stand.” Many people became familiar with laughter as medicine thanks to the work of Robin Williams in the movie Patch Adams. The film is based on the true story of Dr. Hunter “Patch” Adams who, in 1972, established the Gesundheit Institute dedicated to spreading humor, fun, and joy to patients.

There is so much literature specific to the beneficial effects of humor on health, but one truly advantageous benefit that is often missed is the impact on the doctor patient relationship. We are social individuals by nature, and humor is such an efficacious tool to allow a patient to feel comfortable and establish a sense of connection.  Humor has the ability to transform a dry and stagnant interaction to one that embodies the opportunity for trust, conversation and most importantly, compliance.  Patients want a chance to be heard and be themselves: a good joke, laugh and smile is many times the simple answer!

Joseph Vazquez, ND

Assistant Professor and Attending Clinician, National University of Health Sciences

The use of humor and laughter as an integral part of the healing paradigm began long before Gesundheit Institute, however. The earliest physicians in Ancient Greece, prescriptions were made for visits to the hall of comedians and the theater as part of the overall healing process.1 In the 1300s, French surgeon Henri de Mondeville felt so strongly about the role humor played in healing that he told jokes to his patients in the recovery room.2

Humor is a free, easy, noninvasive, and scientifically supported therapy that provides many health benefits. Laughter encourages the release of the body’s natural “feel good” hormones that promote a sense of well-being as well as increase immune cells to provide resistance to illness.

Krystal Crawford, ND, MS, AHG (RH)

Dr. Krystal Crawford Consulting

But perhaps the most influential account of the health benefits of laughter come from the book, Anatomy of an Illness by Norman Cousins. The text was an anecdotal account of Cousins’ return to health after being diagnosed with a devastatingly painful, inflammatory condition known as ankylosing spondylitis for which he was told there was nothing doctors could do. The book was so profound that Cousins was eventually hired as a professor and researcher at UCLA School of Medicine where he spent the next 20 years teaching and researching the true merits of laughter in healing.1 As it turns out, that old adage of “laughter is the best medicine” may actually ring truer than once thought and there is even science to prove it! Here are five scientifically supported health benefits of laughter:

Laughing is an ab workout

As anybody who has had a good laugh the day after a hard-core ab workout will tell you, laughing causes the abdominal muscles to contract and relax in much the same manner as intentional workouts do. In a study of laughter yoga (a yoga practice focused on breath and laughter), researchers found that compared to traditional crunch and back lifting exercises, engaging in laughter yoga resulted in significant activation of five different muscle groups found in the trunk. The study further concluded that the activation level of the internal oblique muscle group during laughter yoga was higher compared to the traditional exercises.2

Laughing lowers blood pressure

High blood pressure is a very insidious condition that many people only find out they have incidentally at an appointment for something else entirely. It has few outward symptoms early on, but make no mistake, it is wreaking havoc on cells and organs inside the body.3 High blood pressure is a known precursor to more severe cardiovascular disease including death or serious disability due to heart attacks and strokes and the earlier one develops the condition the higher these risks are.4 Luckily, a number of studies have shown the beneficial impact of laughing on blood pressure. One 2017 study evaluated the impact of laughter on the blood pressure of patients undergoing hemodialysis treatments. Participants saw a decrease in blood pressure after listening to 16-30 minutes of recorded comedy over an eight-week time period.5 Another study exposed participants to either laughter or music and found that immediately following the sessions, the laughter group’s blood pressure was lowered by 7mmHg vs only 6mmHg in the music group.6

Laughter reduces stress hormone levels

Stress is associated with changes in levels of both hormones and neurotransmitters including dopamine, serotonin, and cortisol.7 Research reveals that humor and laughter have been shown to stimulate several physiological mechanisms known to decrease levels of stress hormones like cortisol and epinephrine and to increase activation of the dopamine producing reward system in the brain.8 Additional studies that involved viewing a comedic film found reductions in a variety of hormones related to the stress response.9

Laughter supports immune function

While getting the flu is nothing to laugh about, the next time flu season rolls around might be a good time to start laughing it up more often! Several studies have shown how powerful laughter can be when it comes to enhancing the power of the immune system. Researchers have found that in some instances, laughter has shown the ability to positively impact the function of a particular type of immune cell, the natural killer or NK cell.10 NK cells are specific cells that are best known for killing virally infected cells, and detecting and controlling early signs of cancer.11 Another study where college students viewed either a humorous video or an instructional video revealed that those that saw the humorous video had increased levels of salivary IgA (a marker of immunoenhancement).11

Laughing is good for your heart

The American Heart Association supports the use of laughter as a means to protect heart health.12 They go on to say that laughter has positive benefits on cholesterol levels as well as reducing arterial inflammation. Additional research found powerful benefits of laughter on the heart and cardiovascular system. The study exposed participants to comedy clips like Saturday Night Live or bleak scenes known to increase stress such as the opening scene from Saving Private Ryan. They then used a special ultrasound to assess brachial artery reactivity. Participants who watched the stress inducing scenes experienced a 35% reduction in flow mediated dilation (FMD). FMD is a measure of how blood vessels dilate or contract and a reduced rate is associated with increased risk for atherosclerosis. However those who viewed the comedy clips experienced a 22% increase in FMD meaning their blood was flowing better.13

NDs share success stories of patients treated with humor

A male teenager and his mother came to me for weight management issues.  He was overweight and had a family history of diabetes and obesity.  He performed well academically and was an avid fan of video games and water polo; however, he recognized that his health and weight were becoming an issue.  Actually, his mother recognized this.  In fact, it was his mother who answered the majority of my questions, interjected with stories and clinical caveats, while he sat there, and didn’t say much besides an occasional “Yes,” “No,” or teenage head nod.  I was able to speak with him more when his mother left the room, and he confirmed that he wanted to lose weight, eat healthy and become active again.  He had already taken initiative and was proactive about the process, eating meals that his mother prepared for him and getting more movement throughout the day.  From my assessment, he was on the right track!  I asked if his mother was helping with the process and he agreed.  I asked if she was helping “too much” and he finally cracked a smile.  When I was ready to deliver the treatment plan with both of them in the room, I asked a few more questions directed to the mother.  “Are you preparing healthy meals for him?” to which she animatedly said “Yes!”  I said “great,” and immediately moved on to the next question, “Does he suffer from any hearing loss or impediment?”  Again, she vehemently denied, but now seemed curious as to my line of questions.  I again said “good” and asked my next question, “Do you remind him that he needs to eat healthy and exercise?”  Her eyes grew big and enthusiastically said “Oh yes, absolutely!”  I quickly asked “How many times a day?”  She paused and then answered, “A few.”  I smiled and asked again, “Does he suffer from any hearing loss or impediment?”  At that point, the mother began to laugh out loud and quickly covered her mouth.  Her son looked at me with open eyes and a big smile, surprised that I “caught” his mother in the act, so to speak.  We continued to have a long discussion on how to best support her son and for him to acknowledge and show appreciation.  There were both tears and laughter on her part, but by the time the visit was over, she gave me a big hug and delivered a heartfelt “Thank you.”  Her son shook my hand, with the same smile that never went away 10-15 minutes prior.  The visit was so much more than a plan addressing weight loss and lifestyle modifications, rather, addressing the relationships that either get in our way or support the process.

Joseph Vazquez, ND

Assistant Professor and Attending Clinician, National University of Health Sciences

Humor serves as a great communication tool to relieve stress and facilitate a healthy doctor-patient relationship.  I use laughter in my consultations to lighten the mood which is helpful for my patients during dark times. Humor distracts patients from their fears and reduces their stress allowing them to open up about the challenges they’ve faced with their illness and diffuse their feelings of sadness, fear, and anger.

Krystal Crawford, ND, MS, AHG (RH)

Dr. Krystal Crawford Consulting

In the words of Patch Adams, “The most radical act anyone can commit is to be happy,” so let yourself be and remember to take time to fill your days with laughter. 

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