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Disease Determinants

Advanced Lipid Testing

Bret Scher, MD
Standard lipid tests evaluate total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). These are well established and accepted biomarkers to assess and manage cardiovascular risk. These standard tests are reliable for predicting risk in most cases, but an estimated 15% of patients suffer a heart attack, stroke, or another cardiovascular event despite achieving target levels. Dr. Bret Scher, MD, is a cardiologist who favors advanced lipid testing as a way to refine risk assessment. The following discussion helps clinicians understand what advanced lipid tests can be ordered, how to interpret the results, and what interventions might improve advanced lipid biomarkers to reduce cardiovascular risk.


Cancer: Biomarker Guided Risk Reduction

Nalini Chilkov, LAc, OMD
Three adults out of every 1,000 will experience a diagnosis of cancer each year in the United States. There are 14 million cancer survivors in the United States today and 18 million predicted by 2022. Practitioners are routinely faced with patients at risk of cancer occurrence or recurrence, yet many have limited knowledge of how to approach risk reduction in these patients. In the following discussion, Dr. Nalini Chilkov educates practitioners on value of using biomarkers to both assess and manage cancer risk in the general practice setting. Selected biomarkers can guide the use of interventions aimed at altering the bioterrain in order to reduce the risk of cancer incidence and recurrence.

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Clinical Testing Through Applied Biochemistry

John Neustadt, ND
Applied biochemistry refers to the concept that metabolic reactions throughout the body determine health and disease and that those metabolic reactions respond to both genetic and lifestyle factors. The concept of biochemical individuality—that each person has unique nutrient and metabolic needs—is foundational to the practice of applied biochemistry.

The concept of applied biochemistry began more than 100 years ago, when Archibold Garrod, MD, described the idea of biochemical individuality in the Lancet in 1902. Roger Williams, PhD, popularized the idea in his 1956 publication, Biochemical Individuality: The Basis for the Genotrophic Concept. Bruce Ames then demonstrated this concept in his lab in Berkeley, CA, by showing that single nucleotide polymorphisms (SNPs) alter enzymatic activity, requiring different levels of cofactors.

Clinical testing of vitamins, minerals, amino acids, fatty acids, hormones, and intermediary compounds of metabolic pathways can help clinicians tailor targeted and individualized treatment plans for their patients. In this discussion, Dr. John Neustadt, ND, shares his insights on the practical applications of clinical testing through applied biochemistry.


Culinary Strategies for Appetite Stimulation

Rebecca Katz, MS
Medical interventions, cancer, chronic diseases, and even aging can create changes in taste perception and appetite. Appetite loss can lead to cachexia, which worsens the prognosis of any chronic illness. Clinicians encourage their patients to eat more, and caregivers struggle to find ways to make this happen. In this discussion, Rebecca Katz describes culinary strategies to successfully stimulate appetite and provide nutrient-dense foods to patients who are compromised and under duress.


Detoxification Protocols

Marianne Marchese, ND
Environmental pollutants are pervasive in our air, water, food, and household items. Many chemicals that people are exposed to daily are endocrine-disrupting chemicals (EDCs), which increase the risk of chronic disease. Detoxification, also called cleansing, refers to the processes of both eliminating environmental toxicants from the body and neutralizing their adverse effects on health. In this discussion, Marianne Marchese, ND, explains the indications for detoxification as well as a stepwise detoxification protocol to reduce the body burden and improve symptoms in patients affected by environmental exposures.

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Dietary Management of the Microbiome

Liz Lipski, PhD, CCN, CNS, CHN, LDN, CFM
The human microbiome refers to all of the microorganisms that live synergistically on and in the human body. The Human Microbiome Project, funded by the National Institutes of Health (NIH) is currently underway. Among the goals of this project are to identify 3000 microbial gene sequences, differentiate between the microbiomes of different parts of the human body, and identify relationships between the microbiome and health and disease.

Dr. Liz Lipski, PhD, educates consumers and professionals on the effects of diet on the microbiome. She teaches that the diets of healthy individuals should be different than the therapeutic diets needed for those with an imbalance in their microbiota. In this discussion, Dr. Lipski describes the dietary management of the microbiome in both health and disease.


Emotional Eating

Deanna Minich, PhD
Emotional eating is defined as either eating instead of feeling, or as experiencing negative feelings about eating. In its most severe form, emotional eating manifests as pathological eating disorders, such as anorexia nervosa or bulimia nervosa. In milder forms, emotional eating manifests as binge eating, overeating, under-eating, or choosing unhealthy foods as a way to avoid or self-medicate emotional distress.

Deanna Minich educates practitioners on approaches to help patients overcome emotional eating patterns. In the following discussion, she provides streamlined techniques, tips, and tools that clinicians can incorporate seamlessly into routine patient care.

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Endocrine Disruptors

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Sara Gottfried, MD
You’ve probably heard the term diabesity in recent years, which refers to the spectrum of blood sugar dysfunction ranging from moderate abdominal fat gain to obesity and type 2 diabetes.

Despite efforts to control diabetes and obesity, these conditions have escalated to epidemic proportions. The Centers for Disease Control and Prevention (CDC) report that one third of all Americans are considered obese (BMI >30) and nearly 26 million Americans have diabetes. Based on current trends, the CDC reports that by 2050, 1 in 3 American adults will have diabetes. Millions more are prediabetic and aren’t even aware of it.

When the root causes of diabesity are identified and addressed, patients are more likely to lose weight, get lean, and reverse diabesity. For those patients struggling with weight loss, an integrative approach that emphasizes effective detoxification and reduction of endocrine disruptors, known to act as obesogens, could benefit them greatly. By focusing on the obesogen pathways and supporting liver detoxification, these patients can successfully lose weight and in the process regain their health.


Heavy Metal Testing and Interpretation

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Marianne Marchese, ND
Heavy metals, including arsenic, cadmium, lead, and mercury, are ubiquitous in modern environments. Food, water, air, soil, and dust provide low levels of heavy metal exposure on a daily basis. Heavy metals can adversely affect the body, they can disrupt neurological, endocrine, and immune functions. Determining if a patient has been exposed to heavy metals is an important part of patient care.

The phrase ‘heavy metal toxicity’ typically refers elevated levels of metals in the body due to high dose occupational exposure or acute poisoning. The phrase’ body burden’ of metals is commonly used to describe the presence of metals in the body due to low dose current exposure and/or long-term chronic exposure. Adipose tissue testing for metals is what truly measures stored levels or body burden. In the literature, blood, urine and stool test results are also used to describe body burden of metals.

Clinicians rely on a variety of lab tests to determine the presence of heavy metals that may be affecting a person’s health. Dr. Marianne Marchese, ND, proposes that we take a fresh look at the current practice of heavy metal testing and interpretation. She provides resources to identify heavy metal exposure and evidence to guide an updated approach to the interpretation of heavy metal test results.


Hydrotherapy in Health Restoration

Jared Zeff, ND
Hydrotherapy refers to the therapeutic use of water. It is sometimes referred to as balneotherapy, water therapy, or aquatic therapy. The applications of hydrotherapy are numerous and include baths, showers, pools, Jacuzzis, saunas, stream treatments, moist compresses, and internal hydrotherapy (colonics). Constitutional hydrotherapy is a specific form of hydrotherapy that is used extensively in the naturopathic medical tradition. In this discussion, Dr. Jared Zeff, ND, discusses the role that constitutional hydrotherapy plays in stimulating self-healing mechanisms and restoring patients to health. The origins, applications, mechanisms of action, efficacy, and contraindications of constitutional and other forms of hydrotherapy are described.


Insulin Dysregulation

Credentialed Through 2020

Corinne Bush, MS, CNS
Insulin regulation has become a foundational health issue. Healthy cells naturally have sensitivity to insulin. A combination of dietary factors, sedentary lifestyle, and stress, however, can result in chronically elevated blood glucose and insulin. Cells that are constantly exposed to high levels of insulin adapt by reducing the number and sensitivity of receptors on their surfaces. The result is insulin resistance, a prediabetic condition that creates metabolic dysfunction and accumulation of visceral adipose tissue. Visceral adipose tissue acts like an endocrine organ, releasing disrupted levels of adipokines (e.g., decreased adiponectin and increased leptin, TNF-α, and IL-6). This pattern of dysregulation not only further promotes insulin resistance but also creates systemic inflammation.

Decades ago diabetes was considered to be the only clinical ramification of insulin resistance. Since then the scientific literature has highlighted prediabetes and metabolic syndrome. In this interview, nutritionist Corinne Bush expands the continuum even further with a discussion of early insulin dysregulation that can occur before the clinical manifestation of other metabolic syndrome components.


Integrative Approaches to Neuroscoliosis

Marc Lamantia, B.S., M.S., D.C., DACNB
Scoliosis is defined as an abnormal lateral curvature of the spine, measuring 10° or more. Scoliosis affects 2-3% of the population, or an estimated 6 to 9 million people in the United States. Scoliosis can develop at any age, but most often progresses during the rapid growth of adolescence. In the United States, scoliosis is managed by orthopedic specialists, who “watch and wait” until the spinal curvature is significant enough to warrant bracing or surgery. In the conventional medical model, scoliosis is understood to be strictly a musculoskeletal condition that will not respond to nutritional, lifestyle, or other metabolic interventions.


Intestinal Permeability

Credentialed Through 2020

Gaetano Morello, ND
Increased intestinal permeability is a condition in which intestinal lining is damaged or changed in such a way that allows relatively large particles to leak through the intestinal mucosa into the bloodstream. These particles can include toxins, undigested food, and waste. This can result in an inflammatory response, as the immune system responds to the perceived threats.

A weakened endothelial lining in the gastrointestinal tract can lead to a wide variety of health issues. Because of this, repairing the intestinal lining can be a key strategy creating significant positive clinical outcomes. An integrative approach employs natural alternatives to H2 receptor antagonists, as well as supplements to help strengthen the intestinal lining and reverse permeability.


Metabolic Syndrome

Metabolic syndrome, initially described in 1988 as syndrome X, is a condition that involves multiple cardiovascular risk factors: obesity, hypertension, hyperlipidemia, and blood sugar dysregulation. Central to the metabolic abnormalities of this condition are insulin resistance and hyperinsulinemia. Patients with metabolic syndrome have an increased risk of type 2 diabetes, atherosclerosis, and death from cardiovascular disease. According to National Health and Nutrition Examination Survey (NHANES) data through 2012, the overall prevalence of metabolic syndrome in US adults is 33%, with higher rates in women than in men and higher rates in Hispanics than in other ethnic groups. Among US adults over the age of 60, the prevalence of metabolic syndrome is as high as 50%.


Methylation and Pregnancy

Ben Lynch, ND
Methylation is defined as the addition of 1 carbon and 3 hydrogen atoms to a compound. This biochemical reaction influences innumerable functions in the body, including genetic expression, neurotransmitter synthesis, and detoxification.

During pregnancy, with the increased production of maternal hormones and rapid multiplication of cells in the developing baby, the demand for methylation increases dramatically. Impaired methylation during pregnancy can result in spontaneous abortion, pregnancy complications, or birth defects.

Ben Lynch, ND has a unique perspective on methylation during pregnancy. Not only does he emphasize the importance of methylation assessment during prenatal screenings, but also emphasizes the need to address any impairments with a whole-body approach. The following discussion provides Dr. Lynch’s perspective on the assessment and treatment of methylation defects during pregnancy.


Prenatal through Postnatal Nutrition

Tieraona Low Dog, MD
The prenatal and postnatal periods are critical times in a woman’s life, accompanied by dramatic increases in energy and nutrient demands. A woman who is normal weight before pregnancy will gain between 25 and 35 pounds, and her blood volume will increase by 50% (or 1.25L). At the same time, she will nourish the growth of a baby from a single-celled zygote to a 6-8 pound human being. Caloric needs increase to 300-500 calories above preconception needs beginning in the 2nd trimester of pregnancy and continuing through lactation. Conventional guidance for pregnant women advises them to follow a healthy diet, take a prenatal vitamin, and avoid foods like raw fish that might cause Listeriosis or food poisoning. In addition, research conducted within the last decade has revealed information about common nutrient deficiencies during pregnancy and lactation. Tieraona Low Dog, MD, suggests that nutritional guidelines should be refined and updated to more accurately reflect current scientific knowledge related to nutrient demands and deficiencies during pregnancy and lactation.


Psychological Pain Management

Beth Darnall, PhD
Chronic pain, defined as pain that persists longer than 6 months, affects more than 100 million people in the United States and more than 1 billion people around the world. Prescription opioids are commonly prescribed to manage pain, putting patients at risk for side effects, addiction, and even death. Dr. Better Darnall, Ph.D., leads research efforts at Stanford University aimed at reducing patient need and use for prescription opioids by empowering them with skills to self-manage pain. Here she discusses the science and emerging research in the field of psychological pain management. 


The Therapeutic Relationship

Paul Epstein, ND
As we face an epidemic of chronic illnesses and lifestyle diseases, many medical professions are coming to realize that a shift is needed in the way we deliver care. The Pew Fetzer Task Force proposed the concept of “relationship-centered care” in 1994, referring to a clinical approach that relies on partnership and shared decision-making. Then in a 2004 report, the US Institutes of Medicine (IOM) emphasized the importance of teaching communications skills related to patient-physician interactions in medical schools. In the following discussion, Dr. Paul Epstein, ND, shares his insights on the value of the therapeutic relationship and offers guidance on how clinicians can cultivate their abilities to be more mindful, compassionate, and present in clinical interactions.


Vestibular System Dysfunction

Monika Buerger, DC
The vestibular system processes sensory information related to motion, equilibrium, and spatial orientation to create a sense of balance and proprioception. One important anatomical part of the vestibular system is the vestibular apparatus, located within the inner ear. The vestibular apparatus is the collection of structures in the inner ear that include the utricle, saccule, and 3 semicircular canals. Sensory information from this vestibular apparatus as well as other inputs is processed in the vestibular nuclei within the brain stem. Whereas the vestibular system has historically been thought of as a balance apparatus, emerging research suggests that its effects are much more far-reaching. In the following discussion, Dr. Monika Buerger, DC explains the relationship between stress, vestibular function, and other body systems. She explains practical ways for clinicians to identify and address vestibular dysfunction.