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August, 2013 - VOL. 12, NO. 4  August, 2013
Zonulin! The Wheat Conundrum Solved (Well, Mostly …)
Joseph Pizzorno, ND
At the May 2013 Institute for Functional Medicine (IFM) conference on “Energy” in Dallas, Texas, I heard one of the most clinically important lectures ever. IFM honored Alessio Fasano, MD, with its highest honor, the Linus Pauling Award. His lecture was remarkable, and I now finally understand why so many of my patients with chronic disease became healthier avoiding gluten, even if they apparently did not have an immunological response to wheat proteins. The standing ovation in appreciation of his remarkable work was most deserved. Following is my evolving understanding. I say evolving as there are still important areas needing to be researched. Fasano’s team discovered zonulin, which regulates the opening of the tight joints between enterocytes. They also discovered that zonulin is released by gliadin, one of the primary components of gluten. And therein lies a remarkable story.
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August, 2013 - VOL. 12, NO. 4  August, 2013
Using the Least Invasive: Has Hippocrates Provided the Uniting Lever for Health Care Transformation? … plus more
John Weeks
Using the Least Invasive: Has Hippocrates Provided the Uniting Lever for Health Care Transformation? Comment: The medical principle to “above all, do no harm” seems a no-brainer. It’s been there since Hippocrates. The rule is restated in the core principles the naturopathic medical profession endorsed in that profession’s rebirth in the late 1980s.1 The chiropractors promote it through their advocacy of “conservative” treatment. The guidance is restated in one of the five bulleted principles defining the practice of integrative medicine. According to the American Board of Integrative Medicine (ABOIM), the members of this new specialty new should provide care in which “appropriate consideration (is) given to use of less-invasive and less-harmful interventions, when possible, while addressing the whole person in addition to the disease.” The reaffirmation is made for the very reason that conventional medicine promotes “evidence-base medicine.” Namely: our $2.8 trillion medical industry is not only often supported by little evidence, industry creates a putrefying level of harm. Since the Institute of Medicine produced To Err is Human in 2000, we’ve known that over 100 000 people per year die from the regular practice of medicine. These data do not even touch the harm done daily when people are moved immediately to drugs, or surgeries, without first consideration of options of food, lifestyle, supplements, counseling, acupuncture, massage, and more. Most conventional medical doctors are blind to these methods to support the Hippocratic idea. It is fair to state that a plague of errors infects our public health through ignorance of less harmful options.
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August, 2013 - VOL. 12, NO. 4  August, 2013
Presenters 2013: Alex Vasquez, DC, ND, DO, FACN: Mitochondrial Dysfunction and the Emerging “Mitochondrial Medicine”
Craig Gustafson
Alex Vasquez, DC, ND, DO, FACN, will present at the 2013 International Conference on Human Nutrition and Functional Medicine in Portland, Oregon, September 25-29, 2013. He is a clinician, lecturer, and author in the field of functional medicine. Dr Vasquez currently serves as program director for the master of science in human nutrition and functional medicine at the University of Western States, the first fully-accredited graduate program emphasizing the functional medicine approach to pathophysiology-assessment-treatment integration. He lectures doctors and health care professionals internationally and has also taught courses in pharmacology, orthopedics, and rheumatology at the University of Western States and Bastyr University. Dr Vasquez is author of more than 100 articles and 10 books, with publications appearing in several peer-reviewed medical journals including The Lancet, JAMA, the British Medical Journal, the Journal of the American Osteopathic Association, and Alternative Therapies in Health and Medicine.
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August, 2013 - VOL. 12, NO. 4  August, 2013
Teaching Meditation to Children as Part of Psychotherapy
Carolyn Williams-Orlando, PhD
Children are entering psychotherapy in growing numbers for attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), anxiety, and depression. Addressing the physical, emotional, and spiritual components of these conditions is important, as is teaching children lifelong skills that build intrapersonal and interpersonal intelligences. Meditation is one such skill, a mind-body intervention shown to develop neural circuitries associated with attention, relaxation, emotional regulation, positive coping, and compassion. Teaching meditation to children in psychotherapy requires a different process than teaching to adults. The key elements in teaching meditation to young children include (1) creating a conducive environment, and allowing play; (2) maintaining a routine; (3) simplifying the practice, such as reducing its duration, explaining it in suitable language, and modifying its forms; (4) giving choices, within clear boundaries; (5) relating with love and kindness; and (6) teaching the parent(s) or guardian(s). Ultimately, the goal is to attract children to rather than repel them from the experience of meditation, so as to lead to potential home practice and further exploration as they grow into adulthood.
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August, 2013 - VOL. 12, NO. 4  August, 2013
The Implementation of Dietary Approaches in Hyperuricemic Individuals: Alternatives to Drug Therapy to Decrease Serum Uric Acid
Mikhail Kogan, MD;  Amisha Mehta, MD;  Sara D. Murray, BS
Hyperuricemia, a high level of serum uric acid (SUA), is thought to be a marker of oxidative stress in the body. Traditional treatment of the condition is by xanthine oxidase inhibitors, powerful drugs that decrease the body’s production of purines and limit the amount of uric acid formed. Research shows that dietary changes in hyperuricemic patients with and without comorbidities can also lead to decreases in SUA levels. This article summarizes existing literature on nutritional interventions designed to lower the levels of SUA, primarily in asymptomatic individuals, and to support the use of this biomarker in clinical testing to monitor patients because of its low cost.
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August, 2013 - VOL. 12, NO. 4  August, 2013
“Recognizing” the Patient: A Reflection on its Role in a Clinical Encounter
Bruce Milliman, ND
As a naturopathic principle, the term docere refers to more than simply teaching or educating patients. In naturopathic medicine, docere also encompasses the concept of “being with” patients. In brief, it refers to recognizing patients as another human being and interfacing without judgment, but with unconditional positive regard. Importantly, it does not mean allowing emotion to override the physician’s objective clinical stance, but approaching patients with the knowledge and understanding that the patient is a reflection of the doctor and doctor a reflection of the patient. In treating a case of food addiction, the patient (Barry) was interested in entering a coaching relationship to help him overcome the diet and lifestyle issues that resulted in excess weight. Despite the fact that clinical markers of health were improved (weight, blood pressure, fasting blood glucose, HbA1c) and physical issues that prevented him from exercising were addressed, Barry was not able to free himself of the physical and emotional roots of his relationship with food and after initial weight loss quickly developed anxiety about regression. A roller coaster period of success and regression followed that spanned 5 y, during which it became evident that in this case the patient would require residential care in order to break free of his struggles and a referral was made. As Barry’s primary care physician, I not only provided consultation for his physical problems, but I also served as his advocate. A key contribution of our work was to continually hold hope in front of him, to help him realize he could reach a goal. Monitoring the patient’s physical health had been important; however, experiencing nonjudgemental, supportive acceptance was this patient’s main requirement to regain health. Within a therapeutic relationship, it is not enough for patients to have confidence and trust in the physician—the physician also must trust the patient. Then, things can happen that, in other circumstances, would require medications.
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August, 2013 - VOL. 12, NO. 4  August, 2013
Edward Levitan, MD: Visions of Modern Integrative Health Care Delivery
Craig Gustafson
Edward Levitan, MD, founded Visions HealthCare in 2008 and is responsible for overseeing many aspects of the business, including physician training, IT, and finances, in addition to maintaining his own patient practice. Dr Levitan focuses on creating structures that allow patients to heal in all of the five core areas of health: physical, biochemical, emotional, energetic, and spiritual. After graduating from Boston University Medical School with an MD, Dr Levitan completed his residency at Brown University. He took multiple courses in functional medicine after residency and was mentored by a local physician. He is also trained in shiatsu, Japanese bodywork, acupuncture, and massage. He holds a black belt in tae kwon do and has been practicing qigong for the past 15 years.
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August, 2013 - VOL. 12, NO. 4  August, 2013
BackTalk: Friends Without Benefits
Bill Benda, MD
Like most carbon-based life forms in the galaxy, I have a Facebook account. Not that I view it very often, but it does serve the purpose of informing me of weddings, births, deaths, and what you had for breakfast. With pictures. More and more it seems to be a repository of banal, useless details of boring lives. Just this morning I learned what Iona is wearing today, viewed a video of how cats like to watch moving things, and heard for the 137th consecutive day how happy Krystal is with her new boyfriend. Whoever she is. Some people enjoy perusing each detail of others’ lives, and others have the capacity to simply scroll down the page, picking out valuable flakes of information somewhat akin to panning for gold—and about as productive. Unfortunately, I fit neither category. I find myself actually becoming increasingly irritated by the spillage of chatter, not dissimilar to how I feel when looking at people I don’t care about or even recognize on the covers of People-style magazines in the Safeway checkout line.
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