How do I select a practitioner? (Part 3)

My decision of moving to Arizona to become a Naturopath was made after I grew frustrated with our current health care system. I believe that prevention of disease is the best way to combat morbidity, but once disease settles in, you have to remove obstacles to health rather than suppress symptoms to achieve true cure.

The focus of this series of articles is to help my family and friends sort through the murky waters of our current health care system, and to help them find a practitioner that will provide the best preventative care, but most importantly, that will help them find real cures when they are afflicted with an acute condition like a cold, or a chronic condition like diabetes.

In my first post I discussed strategies to find a practitioner, in the follow-up, I talked about the qualities and intangibles your practitioner should have. In this third post, I will discuss the concept of removing obstacles to health.

Imagine driving your car and that pesky “check engine light” turns on. You are worried, since your car has been pretty reliable, and you’ve made the oil changes every three thousand miles, you check your coolant and have your tires aligned. You know whatever is going on under the hood is probably minor, and you take it in for a checkup. The mechanic takes in your vehicle and tells you “yes, I’ve seen this before”, and he promptly disconnects the light behind the dashboard. The symptom is gone, you no longer have a “Check Engine” light on your dashboard, but you know that there must be something wrong. The mechanic just deactivated the alarm that tells you to check your car.

Would you pay your mechanic? Most importantly, maybe the problem with your car was simple, but disabling the annoying light and not correcting the actual problem will most likely create a bigger problem. 

Now imagine you have a headache. You’ve been working outside all day long and forgot your water bottle. You have two options, you could go inside and take some aspirin and get rid of the headache, or you could drink some water. Both options will remove your symptom. But only one will fix the problem. The problem that created the headache was a water deficiency.  There is even a medical term for it: dehydration.  I have never heard of anyone having an aspirin deficiency. Both options will get rid of the pain. Taking a medication that suppresses symptoms is like that mechanic disabling the check engine light. Now imagine all of the different symptoms that are suppressed in our conventional medical model. Fatigue, blood sugar dysregulation, pain. The list is endless. Every time a practitioner dismisses or suppresses symptoms (such as fatigue, headaches, chronic pain) they are silencing your internal alarm, and thus maybe creating a bigger problem.

Why do we settle for a system of medicine that is not correcting the actual problem? You should select a practitioner that focuses on removing the obstacles to health, and not just suppression of symptoms.

Sometimes suppression of symptoms is necessary. Have you ever broken a bone? If you have a bone fracture, your body will tell your brain there is a problem with localized pain. The course of treatment for a broken bone is simple. Pain (the symptom) is controlled with pain medication,  and a doctor will set the bone fracture (the underlying cause for the symptom) using a splint, a cast or even surgery. The pain will be present until complete resolution; but the pain medication will not fix the broken bone. Pain medication is given to help the patient deal with the symptom, because no one should suffer through pain.  The suppression of the symptom (in this case pain) will help the patient heal faster, but the patient will only heal if the obstacle to health (in this case the fracture) is removed. Most importantly, no practitioner would ever recommend to be on pain medication long term, in fact, we should encourage the patient to reduce pain medication as quickly as possible. In this case, the obstacle to health is so clear, that our current system of practice works perfectly.

What happens when the obstacle to health is not clear? Let's talk about a common chronic disease: diabetes. Diabetes is a common disease, either you or someone you know suffers from diabetes. Type II diabetes (DMII) affects blood glucose regulation (actual problem), and presents with very clear symptoms polydipsia, polyurea and polyphagia. What causes DMII is not so clear, and if you are reading this blog, you are probably in the camp that believes that DMII is caused by lifestyle choices and genetics and not just dumb luck. How do we treat diabetes? If someone suffers from DMII, they might need an insulin sensitizer in order to get the blood sugar back under control, but medication should never be used as a crutch to allow patients to continue eating a high sugar diet. Medications should be prescribed with the goal of amelioration of symptoms - in the short term, until homeostasis is reached. In this case, the real culprit is lifestyle, and correcting lifestyle choices is the real problem, no amount of metformin or insulin will ever replace the need for a proper diet coupled with optimized lifestyle decisions.

In our current system of healthcare, the symptoms of DMII are treated with insulin sensitizers. When the insulin sensitizer stops working and the symptoms come back, we add insulin to the problem. When that stops working, we increase the dose. How many people do you know that have cured themselves from DMII? And of those people, how many did it by losing weight vs. adding more medications? 

Beware, you could also fall into a trap with holistic practitioners that might want to treat using more "natural alternatives". One example comes to mind: one of my friends told me “My doctor is very natural, before he prescribed anything to help reduce my blood sugar, he recommended a cinnamon supplement”. Substituting a natural product for a medication does not make a better practitioner. My friend did not have a cinnamon deficiency, my friend needed lifestyle modifications to fix his “check engine light”. Your practitioner should be able to identify when medications, supplements and lifestyle modifications are appropriate, and be able to recognize the patterns and obstacles to your health.

If your practitioner is prescribing a medication or a supplement for a condition that could be avoided with a lifestyle modification, the practitioner is focusing on symptoms not disease. If your practitioner tells you “you will have to be on this medication for the rest of your life” you should ask for clear clarification. This is not to say that “health” means not taking any medications or supplements. Some diseases such as genetic conditions, surgeries, viral infections, hormonal problems, cancer and many might be incurable or they might have to be constantly managed with medications. In other words, some medications have to be taken forever, because we might not have cures for certain diseases. For all the other disease processes, we should focus on correcting the problem, rather than the elimination of symptoms in order to prevent an acute illness from becoming chronic or even worse, incurable.

In summary, find a practitioner that has clear goals to health, that has ideas on how to measure true health outside of the numbers on your lab report. Look for a practitioner that is practicing with a focus on preventative medicine, well within their scope of practice. Your practitioner should keep up with research and most importantly change the approach to disease as the evidence changes. Your practitioner should focus on removing obstacles to health, not just symptom suppression. And finally, your practitioner should be your ally, not your boss. They should show compassion and they should be open minded. It might take you some time to find a good practitioner, but once you find your practitioner, you will have an indispensable ally in your journey to health.   

There are many reasons this article could be helpful to you or your friends; maybe you feel that there is room for improvement in your health, maybe you have an acute condition that needs to be checked or maybe you were diagnosed with a chronic disease. In any case, you should never settle for cookie-cutter healthcare. You should empower yourself to find a practitioner that will work with you to bring true cure.

How do I select a practitioner? (Part 2)

I came to Arizona to become a Naturopath, because I want to help my patients find true health from a holistic and science based approach. I want my patients to enjoy true health, not just suppression of symptoms. Since I still have a year and a half until I can practice, I wanted to publish a guide to help my friends and family find their doctor.

It is unfortunate that I can’t just tell my friends “go find a functional medicine doc” or, just look for a Naturopath. For the most part, the way we practice medicine (as a whole) is not conducive to true health. We have to be selective when we trust our health to a practitioner. Most importantly, every profession has practitioners that lack the tools to truly help their patients. This is not to say that conventional medicine is malicious, or that holistic doctors are superior. Every practitioner that is true to their profession has the best interest for their patient, it just means that sometimes you need more than just a prescription or a specific modality to find real health.  

How will you find a practitioner that is concerned with true preventative medicine? Or, maybe you developed or know someone with a chronic condition such as cancer, MS, Alzheimer’s, diabetes, etcetera, and you want to look at complementary options.

In my previous post I discussed simple steps to narrow down the pool of practitioners. In this follow up post, I will discuss why the letters behind the name are sometimes not as important as the type of practitioner selected.

When I first started learning about the Paleo diet, one of the most informative podcasts I listened was “The Paleo Solution” with Robb Wolf. It was during one of his episodes that I learned about Chris Kresser a licensed acupuncturist. Chris Kresser has influenced my philosophy of health more than any book, doctor, talk, or documentary. He practices functional medicine, or a type of medical practice or treatments that focus on optimal functioning of the body and its organs, usually involving systems of holistic or complementary medicine. In other words, a type of care that optimizes your body, even if you are not sick.

Having the appropriate philosophy of practice will be more important than the type of degree your practitioner holds. Your doctor should focus on true cure, they should address the illness and not just the symptoms, and they should be concerned on all aspects of health (emotional, physical, social) and not just concerned with the numbers printed on your lab report. There are other intangibles that your practitioner should have. For example, if your doctor holds a doctorate degree from an Ivy school, but is not willing to listen, is not up to date with the literature and is not compassionate, he might not be the best practitioner for you. On the other hand, you could go to an acupuncturist, that has experience dealing with your concerns, is willing to work with you and has the right approach to correct illness.

Beware, your practitioner must practice within the limits of their scope of practice. This is very important, you want to be treated by someone who is honest and practices well within the scope of their professional training. This might be limiting, for example, an acupuncturist might not be able to order labs or prescribe medications. Sometimes these obstacles can be circumvented. Functional medicine practitioners might have associations with other licensed practitioners that have laboratory or prescription rights. Having those associations allow for truly integrative care, and having more than one practitioner working on your case has advantages. The integrative approach allows for more scrutiny and it prevents one practitioner from over prescribing labs or over utilizing drugs or supplements.

Health can come from many different places. I believe that the best place to start the healing is the kitchen, and Mom can be the catalyst of healing the whole family. You can also find inspiration from family members, friends, bloggers or writers. I am enrolled in Naturopathic school because of the influence people like Robb Wolf and Chris Kresser have had on me. Do not get confused, only a licensed professional can prescribe you pharmaceuticals, supplements, order labs and diagnose you with a disease. But a health coach can guide you to better health. Your health coach can be a nutritionist, a personal trainer or your yoga instructor. They are not your doctor. The same goes for podcasts or blogs, they can guide you on your quest for health, but never use podcasts, blogs or videos to come up with your own diagnosis or to treat yourself.  

Finally, make sure your doctor has an open mind. No matter who you chose as your practitioner, make sure that they use the latest research to treat you. Your doctor has to know the limitations of treatment, and have to be aware of not being confounded by their expertise or method of practice. For example, using an herb might be gentler than using a prescription drug, but, botanicals do not have the same level of quality control as pharmaceuticals, their dosage guidelines are very murky, and therefore they might not be as effective as a prescription drug. Acupuncture might be amazing for chronic pain, but it will probably do little for a broken bone. Same with surgery, removing your gallbladder might be one of the worst things you do to fix gallstones. Never let practitioner confirmation bias be the reason your health does not improve.

In my final post of the series, I will talk about removing obstacles to health, and how that is the basis of finding true health. Thanks for reading!

 

 

 

 

 

How do I select a Practitioner?

I want to become a doctor to help correct the way medicine is being practiced, I am tired of medicine by the numbers, or standardized treatments for complicated conditions.  When I explain to my family and friends the reasons I moved across the country to become a Naturopath, they get super excited and then they ask me “Where can I get a doctor like that?”

Unfortunately, the number of sick people is far greater than the amount of practitioners that are available. And even if you have a practitioner, maybe you just visit your doctor once per year to get “your numbers” or when you have an acute condition. How will you find a practitioner that is concerned with true preventative medicine? Or, maybe you developed a chronic condition such as cancer, MS, Alzheimer’s, diabetes, etcetera, and you want to look at complementary options.

In this blog post series, I will talk about some important guidelines I have shared with family and friends to help them find a practitioner. In this first part, I will discuss how to select a qualified practitioner and some pointers that I believe help identify effective practitioners. Part two will cover the different practitioners that could be part of your quest for health, and why I believe evolutionary science is more important than the letters after your practitioner’s name. Finally, on the last part of the series, I will discuss how your practitioner should tackle disease. I hope you find the series helpful.

Over a period of years, I was able to identify that wheat does not agree with me, that some carbohydrates are better in smaller doses and that my lipid profile looks better when I use avocado oil (monounsaturated fat) over coconut oil (saturated fat). This came after countless hours reading through literature, listening to podcasts and self experimentation. But, not every one has the luxury (or the patience) to experiment. I am reasonably healthy, and my health has been more like a fun project to look for ways to optimize my performance.  Even after being able to correct most of my ailments, I still need a practitioner to care for me.

“The doctor who treats himself has a fool for a patient.”

-William Osler

In order to find my practitioner, I had to do a ton of investigation. I don’t have time or patience to explain to my practitioner the reasons I eat paleo, and I don’t want my practitioner telling me to eat low fat or to “eat healthy”. I especially don’t want a practitioner who will make me feel like I am crazy or that I am problematic or hypochondriac.

Let me be clear, everyone needs a practitioner. You need a person that makes the observations from the outside, and can make recommendations without bias. In order to achieve perfect health, we should seek advice from a qualified and licensed professional practitioner. Your practitioner should be up to date with the current literature, and your practitioner should be willing to work with you in order reach the lofty goal of health.

When looking for a practitioner, we should look for someone that is accredited by a reputable body. Where do we find these “unicorns”? It might take some digging, looking through websites such as “AANP” or the “Paleo Physicians Network” might be a good starting point. Once you identify someone, then the fun begins. Making a phone call to the office might give you an insight on their philosophy of practice. Many times they might offer a free over-the-phone consult or a brief one-on-one introductory meeting.

Maybe you selected a particular practitioner to try complementary therapies for a chronic condition. If that is the case, they probably have appeared on podcasts, given interviews or presented their theories at conferences. Before your consult, you as a good patient, could listen to the presentations and get a better idea of the way they practice.

Your doctor should be your ally, not your boss. Your practitioner should understand limitations to your diet choices, such as your job, your exercise concerns, religious beliefs, etc. A good practitioner should be able to accommodate your needs; they should be able to prepare an action plan that will be achievable. That does not mean that they should be “pushovers”, your practitioner might have legitimate reasons for strict guidelines.

For example, even though I have some level of gluten sensitivity, my life is not going to come to a halt if I accidentally consume some gluten. On the other hand, a person suffering from cancer, seizures or autism could derail months of progress by careless gluten cross-contamination. In those cases, a good practitioner should be able to explain with concise and clear language the importance of his recommendation.

I have overheard stories of practitioners asking questions like “what is your favorite thing to eat?” Or “what is the one thing that you can’t live without?” and then asking their patient to stop eating or doing that item. The theory is that if a patient agrees, it will gauge the level of commitment or compliance. Such practices raise red flags for me. If your practitioner asks you to modify your diet, to add a supplement or to change something in your daily routine, they should have a good reason other than to test your metal.

The medical community is not free from “that’s just the way we’ve always done it” style practices. I am learning so much everyday in school, and very often I just put it in the back of my head. That does not mean that I should not be liable for understanding all that I learn, but it becomes overwhelming. A good practitioner will always investigate common practices, and improve or change them as legitimate evidence arises.

Before this post gets overly lengthy, look for a practitioner with compassion. Even though the healthcare profession is often rewarding, it can also be very frustrating. The most difficult part of treatment will always be habit modifications, and your practitioner should be compassionate and understanding even when you as a patient are not complying to the prescribed treatment.

I am constantly learning approaches for lifestyle modification from my professors, and it goes deeper than that. At AANP, I learned about mind-body techniques to remove mental obstacles to weight loss. I am also learning psychological approaches such as motivational interviewing to become a more effective practitioner.

In short, we should not take our health advice from infomercials, billboards, multi-level marketing operations or good old Dr. Google. We should look for a practitioner that is licensed, a practitioner who is up to date with research and a practitioner that is compassionate. In my next post I will explain why the philosophy of the practitioner is sometimes more important than the letters after a name. 

Autism: When nutrition could be the key.

Amino acid supplementation sounds like a strategy that a body builder might use to get jacked, but in reality, amino acids are used for more than just building muscle. Amino acids form proteins, and proteins form many different important molecules that are used in your body [1]. Sure, proteins build muscle but amino acids also form enzymes, neurotransmitters, can be used as energy and are essential for many biological processes.

It is not surprising that an amino acid imbalance could have devastating effects to a person’s health. When we think of an amino acid deficiency we might think about a protein deficient diet, but what if your body did not have the genetic code to create these important amino acids? [2]

At AANP I attended a talk on the importance of amino acid testing as a treatment for autism. It is fascinating how a simple amino acid can have so many devastating effects on the body, Dr. Jared Skowron spoke about the current methods he uses at his clinic to test for amino acid imbalances, and the different recommendations he makes that have changed people lives. [3]

During his talk I learned that eating a whole foods diet that includes easily absorbable protein could be enough to maintain a good balance of amino acids. There might be many obstacles to this absorption, for example, poor digestion, low quality protein, intestinal permeability [4] or even genetic mutations that prevent you from using these building blocks.

What I took from that talk is that nutrition is very complicated, and you could have a perfect diet but you could still have obstacles that are not addressed by your diet. Yes, you should correct your diet and try to eat the healthiest and most anti-inflammatory diet you can achieve, but what if your diet does not get you to an optimal state of health? That’s where practitioners become indispensable, a trained physician will be able to order labs, diagnose and suggest strategies to correct the underlying problem. Does that mean that we can supplement ourselves out of sickness? No, what it means is that in specific diseases, you might need some supplemental amino acids that you might not be able to get from a normal diet.

My biggest take was, that sometimes difficult diseases such as autism could be just a couple of amino acids away from a resolution. It makes me so excited to be in a profession that allows me to think outside the box, and eventually it will let me help those patients that many think are beyond help.

1.-  Erdmann, R. & Jones , M., (1987) The Amino Revolution, First Fireside Edition, p2.

2.- http://www.nature.com/news/amino-acid-deficiency-underlies-rare-form-of-autism-1.11375

3.- http://www.naturopathicanswer.com/naturopathic-medicine/dr-jared-m-skowron-n-d/

4.- Rapin JR, Wiernsperger N. Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine. Clinics (Sao Paulo). 2010;65(6):635-43. 

The August Wrap up

What a crazy month! My month started with a bang, in between experiments and preparing for presentations I had to take my first set of boards, the dreaded NPLEX. NPLEX tests everything you learn during the first two years of naturopathic medical school. I decided to approach this huge test by dedicating a minimum of five hours every day to review the material learned. I used videos (The Pathoma videos helped me through GENMED class), flash cards and the USMLE Step One (this was invaluable to my preparation) to make sure I covered as much material from different perspectives. All in all it was a beast. But the test came, and my preparation paid off. All those quizzes, midterms and finals served a purpose, and thankfully, that was over.

Then the real fun began. The following week I flew to Oakland California and had the privilege of presenting at the 30th annual convention of the American Association of Naturopathic physicians. The conference was amazing; I learned many pearls of wisdom from practitioners and profession elders, I learned about new treatments for autism and even witnessed a hookworm inoculation for the treatment of autoimmunity. Dr. Mark Davis gave a fantastic presentation on fecal transplants and Dr. Jaren Skworon shared his experience using amino acids to treat autism spectrum disorder.

My presentation took place on Friday evening, and it focused on the bulk of my research at the Southwest College of Naturopathic Medicine. I presented on the Antibacterial Activity of Botanical Tinctures, and their Possible Mechanisms of Action, the presentation was well received and I received a ton of support for our work!