September 2010 Archives
Many of you know that I will be leaving next week for Oregon to receive certification for Applied Functional Medicine in Clinical Practice awarded by The Institute of Functional Medicine. Also, many of you are aware that I'm completely psyched about it, a full 9-12 hour day of biochemistry, individualized medicine, and basking in all of the famous integrative medicine professors' knowledge. I must confess, I use term "functional medicine" quite loosely, and know that many are unaware of what exactly that means, so I decided to blog a brief summary.
According to the Textbook of Functional Medicine, "Functional medicine is a dynamic approach to assessing, preventing, and treating complex chronic disease. Functional medicine helps clinicians identify and ameliorate dysfunctions in the physiology and biochemistry of the human body as a primary method of improving patient health."
It is based on the Principles of the Functional Medicine Paradigm:
1. Understanding biochemical individuality of each person, based on genetic and environmental uniqueness
2. Patient-centered rather than a disease-centered approach to treatment
3. Dynamic Balance among internal and external factors in a patient's body, mind, and spirit
4. Internal physiological factors with web-like interconnections (The hip bone is connected to the leg bone, in other words, how one symptom process in one area affects the whole body!)
5. Promotion of organ reserve (enhancing health span, not just life span)
Core Clinical Imbalances are focused on the following areas:
1. Hormonal and neurotransmitter imbalances
2. Oxidation-reduction imbalances and mitochondropathy (AKA effect of free radicals and oxidative stressors on the body)
3. Detoxification and biotransformational imbalances
4. Digestive, absorptive, and microbiological imbalances
5. Immune and Inflammatory Imbalances
6. Structural imbalances (from the cell to the musculoskeletal system)
What does that translate to in my practice?
A beautiful marriage of my naturopathic medical training (addressing the cause of the illness, treating the whole person, and honoring their vital life force) with current, individualized lab testing and biochemical analysis to expand integrative treatment protocols. This occurs at the core critical level of dysfunction, cellular and organ system. Furthermore, functional medicine teaches a way to analyze complex, chronic disease patterns in a systematic, evidence-based, as well as patient-based approach.
For many people with chronic symptoms, there is no medical "cure." Naturopathic and Functional medicines provide an approach to evaluate why someone may have chronic conditions without a diagnosis. It has the potential to intervene before the symptoms accumulate into massive dysfunction. Together, they provide the means to tailor and integrate the best of conventional and traditional medicine in a way that is based on one's unique biochemistry, incorporating the emerging field of genomics, systems biology, and upstream vs. downstream medicine. This creates an opportunity to catch the problem at the root rather than control the symptoms of the illness.
I believe it is part of the future of medicine. The burden of chronic disease is estimated to represent well over 15% of our gross national product (GNP). Although we have one of the most expensive health care systems in the world, our disease management system has been estimated to be the 1st to 3rd leading cause of death in hospitalized patients (hospital infections, atypical drug reactions, bedsores, medical errors, negligence, unnecessary procedures, and surgery).
As a trained Naturopathic Physician whose philosophy is rooted in the respect of an integrated, scientific, emotional, spiritual, and psychosocial approach to disease, functional medicine provides a logical additional approach to holistic health care. The United States' mechanistic approach to medicine is impeccable with acute disease and surgery, but has a bad score card for chronic disease management.
I look forward to sharing my new learning, without talking to much scientific gibberish, with all of you!
Jones, D. Textbook of Functional Medicine. Institute for Functional Medicine. Gig Harbor, WA. 2005.
Institute for Functional Medicine: www.functionalmedicine.org
Mark Hyman, MD, a functional medicine specialist, posted a very informative article on the importance of rest. You are probably aware of my disagreement of society's obsession on how production and effects are more important than being and allowing joy in. I'm not a big fan of the pursuit of happiness being related to how much we do versus how much we are comfortable in our own skin. Still, it's hard not to get sucked into the message predominant in society-- that you are your work, your appearance, your weight, or your specific role in a group or family
On the physical level, when one is caught up in this loop of do or die, the first thing that usually goes in the schedule is sleep. I can relate to Dr. Hyman's reference to MD meaning Medical Deity.
As an early Naturopathic Doctor, I was so passionate about helping my patients and having a successful practice, I pushed myself and tried to biochemically manipulate my body with supplements with 4-5 hours of sleep. The result- lots of great things (and great patients!) ,but lack of peace. What I've found is that it's possible to learn a lot, help people, and still accomplish your passion in a career/work, while enjoying life! I couldn't keep up the 12-14 hour days.
Sleep is important. Dr. Amen, a neurologist and psychologist, studies brain functioning using SPECT scans, and has found how the brain loses optimal functioning with less than 7 hours of sleep.
One of my favorite quotes in the recent film, Eat, Pray, Love, is "you Americans don't know pleasure, you know entertainment. You work hard all week, exhaust yourself, and then collapse on the couch at the end of the week, spacing out to TV. That is not pleasure, you confuse entertainment for pleasure!"
The famous holistic OBGYN, Dr. Christiane Northrup, focuses on the importance of pleasure and how it releases the feel good chemical, nitric oxide which is beneficial for your heart, mood, sexuality, and overall well-being; similar to the benefits of sleep.
Sleep has many benefits. Mark Hyman discusses this:
Your biological rhythms that keep you healthy produce cyclic pulses of healing and repair hormones, including melatonin and growth hormone. When those rhythms are disturbed by inadequate or insufficient sleep, disease and breakdown get the upper hand.
Most of us need at least 8 hours of restful sleep a night.
But meeting this goal has become more and more difficult.
We evolved along with the rhythms of day and night. They signal a whole cascade of hormonal and neurochemical reactions that keep us healthy by repairing our DNA, building tissues and muscle, and regulating weight and mood chemicals.
The advent of the light bulb changed all that.
In fact, when I learned that shift work (like I did in when I worked in the emergency room) leads to a shortened life expectancy, I quit.
Sleep can also help High Blood Pressure, according the Archives of Internal Medicine
Conclusion: Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.
Sleep has many benefits, and the lack of it can cause negative health effects. In the following reference, Tori Hudson, ND makes reference on how sleep deprivation can create an elevation of the chronic flight and fight response. This elevates the hormone cortisol and catecholamines. This results in anxiety, immune disruption, and pain.
Elevated brain NE levels and CRH have been implicated in sleep disturbances, including primary insomnia.3,4 NE levels have also been shown to directly correlate to CRH levels, whereby elevated NE results in elevated CRH and low NE results in low CRH.5,6 Along with its numerous actions in the body, cortisol has feedback inhibition on the PVN and anterior pituitary to decrease CRH and ACTH production and release, respectively.
Furthermore, the following study highlights how sleep deprivation is linked to overall all cause earlier mortality.
Results indicate that the adjusted hazard ratio for all-cause mortality was three times higher in people with chronic insomnia (HR = 3.0) than in people without insomnia. When examining individual subtypes of insomnia, the risk of death was elevated, regardless of which subtype people reported.
For more information on the many benefits of sleep, and further references, see my previous blogs:
How Sleep Can Help Headaches
Brain Health = Body Health
How Inactivity Decreases Belly Fat
Mark Hyman. Ultrawellness. http://www.ultrawellness.com/blog/get-more-sleep?utm_campaign=3502-09092010&utm_medium=email&utm_source=newsletter&utm_content=default
Hudson, T & Bush, B. The Role of Cortisol in Sleep. NMJ June 2010.
Science Daily. Long-Term Study Links Chronic Insomnia to Increased Risk of Death
Kristen L. Knutson, PhD; Eve Van Cauter, PhD; Paul J. Rathouz, PhD; Lijing L. Yan, PhD; Stephen B. Hulley, MD, MPH; Kiang Liu, PhD; Diane S. Lauderdale, PhD . Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study. Arch Intern Med. 2009;169(11):1055-1061. (abstract at: http://archinte.ama-assn.org/cgi/content/abstract/169/11/1055)
Christiane Northrup. Sleep: A Surprising Way to Lower Blood Pressure. http://www.huffingtonpost.com/christiane-northrup/sleep-a-surprising-way-to_b_431845.html
Dr. Amen. 12 Prescriptions for Creating a Brain Healthy Life. http://www.amenclinics.com/cybcyb/brain-health-club/12-prescriptions-for-creating-a-brain-healthy-life/
I recently had an emotional experience that most women can relate to, although not too happily during some times of the month. I cried, laughed, sighed, and got angry-- in a matter of a two hour span. Thankfully, this wasn't related to a hormonal shift, but rather my virtual transportation into Julie Robert's world on the big screen. That's right ladies; I saw the latest film, "Eat, Pray, Love". (Ok, men, stay with me here, it will give you some insight into the inner workings of the women you love, including your sisters, nieces, and mom).
The movie portrayed a stereotypical relationship-addicted female who ends up finding her true self through a one year excursion to re-igniting pleasure in Italy, finding peace and faith in India, and balance in Bali. I know, many of you are thinking, "I'd be able to find pleasure, peace, faith and balance if I could get away for a year and travel the world too." In fact, many of you may have heard me make reference to an all expense Sandals Resort get-away as a cure? I'm not joking when I say this. See, here's the deal, you don't have to travel the world; although it can helpful, in order to find what is already inside your body-the most powerful chemical producing factory that affects your health.
Our body releases an inordinate amount of chemical mediators to run our functions daily. In fact, it is estimated that number of one form of enzymes, protein kinases which are involved in biochemical pathways to signal changes in gene expression, protein activity, and various biological responses, is 518, about 1.7% of all known human genes. This is only one class of enzymes that make up your body! There are many others. Furthermore, your cells are exposed and interact with dozens of substances everyday including nutrients, sex and stress hormones, inflammatory mediators, and neurotransmitters.
How does this subject relate to Naturopathic and Functional Medicine, and what happened to Dr. Sarah's long list of references (don't worry, scroll down)? The more time I spend with people, and the more I study the effects of stress, the more I am convinced that stress is not just a contributor to many disease processes or symptomology, but also triggers and potentiates various issues.
According to last year's gallup poll, the percentage of Americans experiencing happiness without significant worry declined slightly from an average of 48.2% in 2008 to 47.4% in 2009. Furthermore, the inverse increased, meaning more Americans are stressed and less happy. What does this entail?
We know that obesity is at an all-time high. Stress has been shown to contribute to insulin resistance, the precursor of diabetes and a major contributor to weight gain. Stress causes an increase in catecholamines, such as adrenaline, which prolong the effects of the stress hormone cortisol, down-regulating hormonal response and affect the emotional center of the brain, leading to mood disorders.
According to webmd, depression can contribute to various physical symptoms from low libido to insomnia. Furthermore, "Major depression may directly damage the part of the brain associated with learning and memory via inflammation or the release of stress hormones." This can lead to the snippy, irritable, impatient, angry road rager who has a higher risk of cardiovascular disease and high blood pressure.
Furthermore, we know that chronic stimulation of the stress response, down-regulates the immune system, making you more susceptible to infection, affects the digestive processes by affecting absorption and toxin removal, and can cause weight gain! (Remember the non-stressful eating paradigm of the French)?
So, back to my take on the movie....women and men are affected by stress and emotions differently, and for women who have more hormonal pathways at play, mood ups and down can be overwhelming at times of stress. Still, it's vital for us to be aware of how stress affects us and use tools to modulate its effect.
I like to incorporate EFT, emotional freedom technique, deep breathing, and self-care practices in my protocols with my patients. However, the most important thing about stress to keep in mind, that this film summarized well, is that when our problem rests manly in our perception, and we lose our perspective, it's important to come back to center and realize that ultimately, we hold the key to our own choices for health, including emotional, and spiritual.
Jones, D. Textbook of Functional Medicine. 2005. WA. IFM
Witters, D. http://www.gallup.com/poll/124904/americans-less-happy-stressed-2009.aspx. January 2010.
Wales. Diabetic Medicine. Volume 12 (2):109-112. Published Online: 30 Jul 2009.
Hudson, T & Bush, B. The Role of Cortisol in Sleep. NMJ June 2010.
Horm Behav. 2010 Mar;57(3):276-83. Epub 2010 Jan 4. PMID: 20045413
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As a New York State Licensed Aesthetician, New York State Licensed Nail Specialist, and the Director of Living Well Healing Arts Center & Spa, Reisa combines her love of spa services and healing arts to achieve optimum skin and nail health, create greater overall wellness and bring forth our optimal, individual beauty.
"I believe that the day spa should be an instant getaway; a place that is quiet without being stuffy, relaxed, elegant and yet entirely comfy. You should feel warm and welcome, surrounded by people who care about you and what they are doing. This is the environment we strive to create at Living Well Healing Arts Center & Spa. Here, you are never just the "next" number; we allow ample time for your services, offer a flexible schedule and can be reached after hours. After all, to me, spa craft is not really a business, it's a lifestyle."