Naturopathic Medicine- Naturopathic Medicine- Treating the Whole Treating the Whole

Scleroderma PatientScleroderma Patient

Dr. Sara Korsunsky, B.Sc., N.D.The Centre for Natural Medicine1218 Lorette Avenue

www.naturalmedicine.mb.ca

WHAT IS WHAT IS NATUROPATHIC NATUROPATHIC MEDICINE?MEDICINE?

What is Naturopathic What is Naturopathic Medicine?Medicine?

A primary health care professionCombines effective traditional therapies with current advances in modern medicineFocuses on prevention and treatment of illness

What is a Naturopathic What is a Naturopathic Doctor?Doctor?Licensed Naturopathic Doctor's

(ND's) are the most highly trained practitioners in the broadest scope of natural medical treatments. ND's are required to complete at least 3 years of standard pre-medical studies at a recognized university before going on to 4 years at an accredited Naturopathic medical school.

Principles of Naturopathic Principles of Naturopathic MedicineMedicine

First, do no harm. Address the causes of disease. Heal the whole person. Cooperate with the healing

power of nature. Teach the principles of healthy

living and preventative medicine.

Naturopathic Medical Naturopathic Medical TrainingTrainingBasic medical sciencesMedical diagnosticsFull physical examsLaboratory diagnosticsPhlebotomyPharmacologyRadiology

Naturopathic Treatment Naturopathic Treatment OptionsOptions

◦Herbs ◦Clinical Nutrition & Neutraceuticals◦Homeopathy

symptom specific, no interactions with medications

◦Acupuncture◦Lifestyle Coaching

stress reduction, balance, wellness◦Prevention

early screening and education, proactive medicine

The Naturopathic ProfessionThe Naturopathic Profession

Today:Increased demand

For supportive medications and alternatives

Treatments for stress related illnessesPreventative medicine

Covered by private health insuranceRegulated, safe

◦ Canadian Association of Naturopathic Doctors (CAND), Manitoba Naturopathic Association (MNA)

What is Health?What is Health?- Health IS NOT the absence of dis-ease- Having a diagnosis does not exclude health

• Physical• Mental• Emotional• Energetic

BALANCE

What is Health?What is Health?

A state of balance and good function that permits a person to achieve their ultimate purpose of existence. A place where there is spiritual fulfillment. It is a changing process that requires persistent effort to maintain.

Education,

Commitment,

Choices

HEALTH AND HEALTH AND DISEASE- A NEW DISEASE- A NEW PARADIGM FOR THE PARADIGM FOR THE 2121STST CENTURY? CENTURY?

TM

The River of Health The River of Health ProgramProgramHealth and wellness is a process

1-The Source- optimal physical, mental, emotional health, healthy lifestyle and self care

2- Upstream- good physical health, underlying mental or emotion issues, lacking in some self care and healthy lifestyle habits

The River of Health The River of Health ProgramProgram3- Mid stream- moderate physical health with several symptoms, mental or emotional issues, poor mood or energy, unhealthy lifestyle choices

4- Down stream- polluted body, many symptoms, unhealthy lifestyle choices

5- End of the river- degeneration or death, body cannot cope

The Source of the River:Clean, clear, ideal terrain

Midstream- Impurities, toxins

Downstream- Polluted waters

End of the River

Where are you….Where are you….

In the River of Health?

Where would you like to be?

The Foundations of HealthThe Foundations of HealthProper HygieneRegular Movement/ ExerciseAdequate Rest & Quality SleepHealthy Nutrition & DigestionEffective Stress ManagementFunctional Organs = Anti-inflammatory lifestyle

Factors that Contribute to Disease

◦ Poor digestion (malnutrition) and elimination

◦ Immune system malfunction or suppression

◦ Toxic exposure◦ Unhealthy lifestyle ◦ Genes◦ Stress

Factors that Contribute to Disease◦ Poor digestion and elimination

Bad breakdown- bloating and promotion of unhealthy microbes

Bad absorption- low levels of nutrients, weight loss or obesity

Bad bowel movements- toxins reabsorbed or nutrients blood lost, pain.

◦ Immune system malfunction or suppression Poor recovery, autoimmunity, sclerosis,

◦ Both can present through skin

Factors that Contribute to Disease

◦ Environmental toxins Chemical, pollution, pesticides, etc.

◦ Unhealthy lifestyle Lack of movement, poor mental health,

drugs, alcohol Unhealthy diet- low in nutrients, high in

fat/ sugars/ salt, skipping meals or overeating

Factors that Contribute to Disease

◦ Lack of rest or quality sleep Affects adrenal stress glands Increases inflammation

◦ Genes Not a definitive outcome, can be turned

on or off

◦ STRESS! Contributes to every single disease Is inflammatory

The Root Causes of The Root Causes of SclerodermaScleroderma

Genetics (HLA) Infections Toxins (environmental) Stress- oxidative, other?

Scleroderma Problems and Scleroderma Problems and ImmunityImmunity Overactive T- lymphocytes- T helper,

CD +, IL-2 (infections and self- non-self)

Fibroblasts display cell growth abnormalities- proto oncogene c-myc

Platelet derived growth factor alpha receptors are increased (accelerates growth of collagen, regulator of cell division)

Natural medicines can influence these

Infections & Poor Infections & Poor Microbiology (Microbiome)Microbiology (Microbiome)Bacteria VirusesParasitesFungiLack of healthy levels of good bacteria/

overgrowth of poor microfloraVery commonDiagnosis by stool culture (CSDA) or ELISA/ PCR bloodwork

Infections & Poor Infections & Poor Microbiology (Microbiome)Microbiology (Microbiome)Research shows distinct improvement

using probiotics in Scleroderma◦ After 2 months use, significant

improvements were seen in scores of total gastrointestinal symptoms, reflux, and bloating/distention.

Frech TM, Khanna D, Maranian P, Frech EJ, Sawitzke AD, Murtaugh MA. Probiotics for the treatment of systemic sclerosis-associated gastrointestinal bloating/distention. Clin Exp Rheumatol 2011;29(Suppl 65):S22-S25.

Nutritional Medicine, a textbook by Dr. Alan R Gaby M.D.

InfectionsInfectionsRelease inflammatory toxins Steal nutrientsBlock immune systemSuboptimal bacterial levels lead

to greater risk for infections

Immune support is important

ToxinsToxins Environmental Chemicals Ingested Medications

◦Detoxification to relieve the body of toxins and impurities can benefit pathophysiology of autoimmunity1

1. Crinnion WJ. Results of a decade of naturopathic treatment for environmental illnesses: a review of

clinical records. J Naturopathic Med 1997;7:21-27.

StressStressAdrenal gland- deals with stress

dailyDysfunction caused by chronic:

◦Anger, sadness, grief◦Insomnia◦Overwork◦Surgery◦Trauma, injury, chronic illnesses

Symptoms of Stress Gland Symptoms of Stress Gland DysfunctionDysfunctionFatigue, Sleep disturbancesAnxiety/ low moodOverweightHeart palpitationsPoor memory/ focusHeadachesDizziness standing upLow blood pressurePropensity for autoimmune and liver

diseases

Naturopathic Approach to Naturopathic Approach to HealthHealthNo referral needed60-75 minute initial visit

◦Thorough history◦Physical Exam◦Review records ◦Appropriate laboratory testing◦Diagnosis

TreatmentsVisits may be weekly, monthly,

seasonally

Clinical Nutrition- Why?Clinical Nutrition- Why?Better function (enzymes, energy)Malnutrition in Scleroderma

Of 160 consecutive Italian patients with systemic sclerosis, 15% had evidence of malnutrition. Malnutrition was significantly associated with disease activity, and was nonsignificantly associated with gastrointestinal involvement. Caporali R, Caccialanza R, Bonino C, Klersy C, Cereda E, Xoxi B, et al. Disease-related malnutrition in outpatients with systemic sclerosis. Clin Nutr 2012;31:666-671

Vitamins, minerals, other nutrientsOral or injected

Nutritional Tips for HealingNutritional Tips for HealingAvoid inflammatory foods

◦Trans fats, deep fried foods, charred foods

◦Sugar- stops white blood cell response- The Loma Linda study

◦Refined grains and flours (ie Not WHOLE)

◦Red farmed meats◦Secondarily: dairy, nightshades

(tomatoes, potatoes, eggplants), corn◦Food sensitivities or intolerances

Nutritional Tips for HealingNutritional Tips for HealingWhole GrainsHealthy fats and oilsNatural sugars onlyFish, lean meats, vegetarian

proteinIncreased organic vegetable

intakeWater, water, waterGreen or herbal teas

Nutritional Tips for HealingNutritional Tips for HealingDiets rich in bioflavonoids

benefit inflammation, immunity, blood vessels◦Virtually all fruits, vegetables, herbs

and spices contain antioxidants◦Non-toxic, best absorbed with food◦Avoid overcooking foods◦Examples: quercetin, carotenoids,

isoflavones◦Caution with high fiber diets!!

Nutrition:http://www.med.umich.edu/scleroderma/patients/nutrition.htm

Scleroderma SpecificsScleroderma SpecificsVitamin D: often low in scleroderma,

autoimmunity and MB. Vitamin E supplementation resulted in

improvements in the skin of scleroderma patients, including morphea, calcinosis cutis, and Raynaud’s phenomenon.

Zinc improves MorpheaDon’t self- prescribe high doses. ND’s check interactions with

medications!!!

Natural TreatmentsNatural TreatmentsTREATMENT DOSAGE RATIONALE

Fiber Use with cautionDecreased colonic motility

Para-aminobenzoic Acid (PABA)

12 g/day KPABA (potassium-PABA)

Anti-fibrotic

Vitamin E200-1,200 IU/day orally; topical application

Antioxidant; anti-fibrotic, dermatologic improvements

Vitamin D0.25-1.25 mcg/day calcitriol OR 1,000-4,000 IU/day D3 (not studied)

Immunoregulatory; inhibition of fibroblast growth and collagen synthesis

GLA (sources; black currant, borage, or evening primrose oil)

540 mg/day GLA (evening primrose oil used in the studies)

Converts to prostaglandin E1 to increase capillary flow and decrease inflammation; especially for patients with concomitant Raynaud’s phenomenon.

Estriol2 mg/day orally OR 10-20 mg/week subcutaneously

Mechanism unknown

N-acetylcysteineIV infusion of 15-150 mg/kg/hour for five days.

Mechanism unknown

S-adenosylmethionine (SAMe)

IV infusion of 600 mh/day followed by 400mg three times daily

Mechanism unknown

Bromelain50-160 mg/day enterically coated

Mechanism unknown

Avocado/Soybean Extract (unsaponifiable)

300-600 mg/day Mechanism unknown

Zinc/copper15-60 mg/day zinc; 1-4 mg/day copper

Correct a deficiency, aids morphea

Stop inflammation Stop inflammation Fish oils- high dosageTurmeric- bonded to a lipid (fat)Boswellia, cayenne, licoriceFlaxseed, hempGingerStress management- counselling,

spirituality, energy medicineMeditation

Improving Energy and Improving Energy and SleepSleepTreat Adrenal gland dysfunction

◦Testing- Adrenal Stress IndexTreat AnxietyCorrect dysfunction (gut, brain)Natural options:

◦Lifestyle◦Herbs, vitamins◦Homeopathy◦Acupuncture

Why Consult an ND?Why Consult an ND?Integrative

◦ Science, medical technology and nature◦ Work with MDs to support health

Safe ◦ NDs do not remove medications◦ NDs know interactions and side effects◦ Standardized training, licensure

Options ◦ where possible, fewer medications is

advantageousImproved lifestyle

◦ Improved body physiology means reduced symptoms

Naturopathic MedicineNaturopathic Medicine

IS IT FOR ME?A medical process, not a magic quick

fixReduces toxins and harm from

medicationsPatient-centered care & participationWhole person focusedTime taken to listen, discuss

Naturopathic medicine Naturopathic medicine treats all health concerns:treats all health concerns:

from pediatric to geriatric, from irritating symptoms to chronic

illness and from physical to the psychological.

ND’s attend to your individual physical, mental & emotional harmony

Optimal Health CareOptimal Health CareND’s work with you to meet your

health goals

Results:◦Better energy◦Fewer symptoms◦Treatment options◦Empowered patients◦Reduced disease

Contact InformationContact Information

Dr. Sara Korsunsky BSc, N.D.The Centre for Natural Medicine

1218 Lorette Avenuewww.naturalmedicine.mb.ca

204-488-6528info@naturalmedicine.ca