Fall 2016 Health News

Hello! I hope you all are having a wonderful transition from summer to fall. The last several months have been filled with a flurry of activity and change, and I am excited to share news and updates with you.

I am currently accepting new patients at 3 locations in Metro Detroit. I continue to maintain my naturopathic practice within the family practice of Colleen Kennedy DO in Rochester Hills, where I have been since 2013. I have been at Beaumont Integrative Medicine in Grosse Pointe since 2014, and as of January 2016 am also at Beaumont Royal Oak. Please see below or my website for relevant contact information.  

Now that I am in clinic five days per week, I have not set aside as much time for writing as I would like. Hence, the less frequent newsletters. However, the flip side of this is that I am gaining valuable clinical experience, finding myself more quickly able to recognize patterns of dysfunction and know how to approach them more efficiently and effectively in order to promote positive, sustainable change. This is particularly the case for peri-menopause concerns like anxiety and insomnia, thyroid dysfunction, and many chronic gastrointestinal disorders. One of the main things I have learned over the last few years is that change takes time! Short term solutions to complex problems do not generally lead to robust, lasting change. But wow, given enough time and the right conditions, the body sure does have an immense capacity to heal! 
 

I am thrilled to be part of the new 2016-2018 core team for the Michigan Chapter of the Academy of Integrative Health and Medicine (AIHM). We are a community in Michigan in which holistic professionals and health seekers come together to transform the experience of personal wellness by providing opportunities for education, collaboration and healing. We hold bi-monthly events from September to May that include structured networking activity, CME presentation, and open social time. Our first event of the season is September 14 and will feature Robert Hoss M.S., who will speak on the neuroscience of dreaming, psychological theories of dreaming, and dreamwork in a therapeutic setting. See here for more information on this event. 
 

Last May, I attended a 10-day silent meditation retreat with the Vipassana Association of Michigan. I gave up my phone, internet connection, running, books, music, TV, and meat for 10 days and dedicated myself to learning this beautiful meditation technique. Vipassana, which means "to see things as they truly are," is an ancient technique from India, and is thought to have been the precursor to modern mindfulness practice. While I believe meditation is something that could benefit anyone, the retreat really underscored for me the potential of meditation to help profoundly with chronic pain (which I plan to write more on in the future), addictions, ADD/ADHD, and anxiety. I believe that meditation helps to modify root causes for these issues in a way that I as a practitioner am not able to do with my patients. We are so lucky to have an active chapter in Michigan. Their 10-day retreats are free of charge and run solely based on donations from past participants.

If you are interested in pursuing mindfulness meditation but are not able to attend a 10-day retreat at this time, here are some resources that may help: 

In December 2015 I traveled to rural Ecuador with Paramos de Esperanza, a group of physicians who have been providing free medical care to the local people for over 30 years. They have posted photos of us working in clinic on their Facebook page and I added some to mine. In the past, I have worked with organizations in rural areas of Nicaragua and Guatemala. This work is one of my greatest passions and a primary reason I chose to pursue medicine, so I am always grateful for the opportunity to serve.

 

Proton Pump Inhibitors (PPIs) are one of the most prescribed medications by internists and family physicians, and now that they are available over the counter, use is widespread. These medications inhibit production and release of hydrochloric acid by the stomach to reduce heartburn and reflux. Although PPIs are intended to be used for short-term relief (4-12 weeks), many people take them for years. Because they are so effective at controlling symptoms, abrupt discontinuation of PPIs can cause rebound reflux that can be severe and make it difficult for people to come off these medications. Chronic PPI use is associated with adverse health outcomes including nutrient deficiency, decreased bone mineral density, increased risk disease including Clostridium difficile diarrhea, small intestine bacterial overgrowth (SIBO), and community acquired pneumonia. I have written more extensively on this topic before (click here to read). Within the past year, studies have been published linking PPIs to other chronic health conditions, including dementia, and chronic kidney disease. (There was also a study linking them to adverse cardiac events but I am not convinced that the association is significant.) As a result, many of my patients come to me with the goal of reducing or eliminating chronic PPI use. There are so many wonderful naturopathic options for addressing the root cause(s) of reflux, and there are a variety of safe natural therapies to help control symptoms while we work on identifying and treating these underlying cause(s). Naturopathic doctors are well equipped to help people wean off PPIs safely when indicated.
 
All of that being said, there are of course cases when a PPI is needed, and discontinuing it is not an option. In these cases, it is wonderful to have tools to help prevent and treat some of the longer-term sequelae of PPI use. One of these tools is probiotics. In this very interesting study, it was shown that when people start taking a PPI, the main gastrointestinal symptoms reported are, as you might expect, heartburn and reflux. Within 6 months, the symptom picture shifts, and we see more bloating, gas, and irregularity in bowel movements, all of which are irritable bowel syndrome (IBS) symptoms. It seems that the reduction in gastric pH helps heartburn and reflux, but as a trade-off, it may promote symptoms of IBS. As an aside, chronic PPI use is considered to be a risk factor for SIBO (1, 2), which is itself thought to be an underlying cause for IBS (1, 2, 3). Indeed, I have seen this in my practice. "The heartburn is gone, but now I have all this gas and bloating." But all hope is not lost! - this neat study demonstrated that probiotics can mitigate these long-term side effects of PPI use, reducing IBS symptoms. So - If a patient comes to me taking a PPI with IBS and/or SIBO, and he or she is in a position to discontinue the PPI, we will work on this concurrently. However, if PPI therapy must be continued, probiotics (particularly Lactobacillus paracasei F19) would be one of the top integrative therapies I would consider for these patients.
 

Vitamin D is important for a variety of functions in the body, including maintenance of bone mineralization, immune function, insulin secretion, and blood pressure. Multiple studies have reported an association between Vitamin D status and a variety of chronic conditions including autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus, as well as cognitive decline and neurodegenerative disease. In addition, multiple population based studies have shown an inverse relationship between Vitamin D levels and risk of various cancers, including breast, colorectal, and prostate. (It is thought that Vitamin D may be protective against cancer due to its role in regulation of cell differentiation and growth.)

Despite all this wonderful knowledge, there is still quite a bit of disagreement about what should be considered an “optimal level” of Vitamin D in the body. The Institute of Medicine considers a serum Vitamin D 25 Hydroxy above 20 ng/ml adequate for bone and overall health. However, some studies suggest that higher levels of Vitamin D may be more protective against cancer and other chronic diseases (1, 2, 3). Yet at a certain point, higher levels (even within normal range) are associated with adverse outcomes like increased risk of kidney stones. So there is probably an optimal middle ground.

My colleagues and I discuss the complexities of Vitamin D regularly. One of our current general guidelines is that optimal Vitamin D status seems to be in the range of 40-60 ng/ml Vitamin D 25 Hydroxy. This new study, sent to me by my colleague Dr Jen Green, supports that notion, concluding that “Vitamin D levels above 40 ng/ml were associated with a substantial reduction in risk of all invasive cancers combined.” That is, women with Vitamin D concentrations > 40 ng/ml had a 67% lower risk of cancer than women with concentrations < 20 ng/ml. This result is particularly strong, because it combines data from two cohorts, including a 4-year randomized controlled trial of 1,169 people, and a prospective population-based study of 1,135 people. A limitation of the study is that it was done in non-Hispanic white women aged 55 years and older, and so it is unknown whether results can be generalized to other ethnicities, age groups, or to males. I am sure Vitamin D will continue to be an active area of research and I continue to update as new information arises.   
 

I have written before on some of the most important hormones for optimal weight management. I feel compelled to share a bit more on the topic of weight, as it is such a common concern in my practice, and very complex. As mentioned before, I am a believer in the “Health At Every Size” concept, which celebrates body diversity, encourages compassionate self-care, and promotes the adoption of healthy lifestyle behaviors for the purposes of improving health and well-being, rather than solely for weight control. I recently watched a short, wonderfully inspiring interview (please view here) with naturopathic physician Dr. Paul Epstein that reinforced these very important ideas. In the video, he describes a patient that came to him for weight loss. When he asked Ms Jones, “why do you want to lose weight?” she replied that she feels “fat and ugly and hates herself.” The doctor said, “Ms Jones, I think I will be able to help you, I can give you a better diet and individualize, but before we do that, I want you to be able to look me in the eye and say ‘I want to lose weight because I love myself.’’

I find this so powerful. I believe that our thoughts, feelings, and intentions behind our goals and actions are just as important if not more important than the actions themselves. For example, forms of movement that are enjoyable to the individual are more sustainable long-term and therefore lead to better outcomes. I encourage people to find joyful ways to move - this might be dance, or swimming, or walking with a dog, rather than going to the gym. Similarly, we can obsess over “healthy” food, but if we do not enjoy the food we are eating, not only do we not digest and absorb it as well, but the negative mindset promotes destructive mental-emotional patterns. Instead of promoting dietary perfection, I start by working with people to be more mindful of the food they are eating - the flavors, textures, smells, and to eat slowly without distractions; not only does this promote optimal digestion, but it helps one to become attuned to true signals for hunger and satiety, and to differentiate these from other signals for eating, such as anxiety, sadness, or boredom.

Below is one of the recipes that Dr. Armstrong and I demoed with our Integrative Medicine Detox group earlier this summer. It would be a great one to enjoy mindfully! It is delicious, satisfying, beautiful, and packed with phytonutrients, healthy fats, and fiber. I like to serve it on a bed of lightly dressed greens like arugula, topped with grilled chicken, an egg, or goat cheese.