There has been increasing public focus on the shortage of physicians to meet the health needs of the residents of British Columbia. By now, it is clear it’s not feasible to expect to hire enough medical doctors to meet demand. Moreover, there may be more realistic and more efficient ways to allocate resources that are already available. Health Minster Terry Lake has elaborated on this point by explaining that not every problem requires a medical doctor and many issues can be addressed by a “primary care team”. Naturopathic doctors can play an integral role in such a model of care.
Licensed naturopathic doctors in British Columbia are highly-trained medical professionals. While the profession has been regulated since 1923, in 2009 the B.C. Ministry of Health approved a new set of regulations which recognizes naturopathic doctors as primary health-care providers. The new regulations bestow on naturopathic doctors sweeping changes to their authority with respect to compounding, prescription authority, dispensing, ordering of laboratory and diagnostic services, and other privileges. This enables naturopathic doctors in British Columbia to have the widest scope of practice in Canada. For nearly a decade, patients have been able to choose an ND for primary care—already reducing the burden on the medical system.
Many British Columbians chose to see naturopathic doctors because they enjoy the personalized care that they receive and alternative treatment options to conventional drugs or surgery. Because NDs mainly practice in private clinics where their services are not publicly-funded, these patients enjoy their preferred method of health care without requiring taxpayer dollars. Also, treatment plans emphasize preventative health and optimal wellness which further reduces the frequency of visits to the medical doctor or hospital.
While the government has recognized naturopathic doctors as primary health care providers, there are still some remaining obstacles that prevent NDs from being an even greater part of the solution to the doctors shortage. Of these, the two most significant are that naturopathic doctors are not permitted universal access to tests run at diagnostic facilities (a commitment made by Health Minister George Abbott 10 years ago and stated in the government’s 2008 Throne Speech) and access to information in PharmaNet.
BCNA has outlined the diverse and extensive primary care on offer, province wide, in a detailed report to government titled Supporting a Sustainable Health System. A highlight of which is the collaborative, interdisciplinary support NDs bring to the provincial health care system, but which government has failed to capitalize on.
This post by BCNA Co-President, Dr. Victor Chan
What Your Reaction to Coffee Says about Your Liver and Why You Should Be Concerned
Olisa Mak, ND
I have a guilty pleasure: I love coffee, the smell of it, the bitter taste of it. Nothing wakes me up on a day off more than a fresh cup of dark roast coffee. I usually drink anywhere from two to four cups of coffee a week, but never more than one a day. Yesterday, I drank two cups of coffee, a latte that was quite strong and a dark roast two hours apart. The effect? A coffee overdose. For the rest of the day, I was restless, experienced chest pains, had chattering teeth, hands that were shaking, a headache and was unable to sleep. I was buzzed and overly stimulated. It wasn’t until five in the morning, roughly 14 hours after my second cup of coffee, that I stopped feeling the buzz. Although, this morning, I woke up feeling completely hungover like I had a night out drinking.
Although most people do not experience such an extreme reaction, it isn’t uncommon to hear people say that they can’t handle coffee, that they feel “jittery” after drinking it. On the other end of the spectrum, there are people who simply do not feel anything after drinking coffee; they can have several cups a day with no after effects.
So what does all of that mean? Why do some people, like myself, have such extreme reactions to coffee whereas other people feel nothing?
First we have to understand how coffee is metabolized in the body. When we drink coffee, it reaches our digestive tract where the coffee is modified and individual chemical constituents of coffee are absorbed by our small intestines. Once in the small intestines, the various chemical compounds found in coffee are absorbed and circulate throughout the bloodstream and reach the liver and other organs.
The liver metabolizes coffee in a step-wise manner and in each step, the compounds are chemically modified to become more and more water-soluble, to ensure proper elimination by the kidneys and bowels. here are two general steps in the liver detoxification process, which I’ll call phase one and two. When you’re overly sensitive to coffee, your phase one is sluggish whereas if you don’t feel anything from coffee, your Phase one is too active.
So how can you bring these two steps back into balance? If you’re overly sensitive to coffee, you need to give your phase one a boost. Phase one relies mainly on B vitamins (amongst other nutrients) whereas phase two mainly relies on amino acids from protein sources like good quality meat and fish. A diet abundant in colorful fruits and vegetables, rich in vitamins is key. There are also supplements that have been especially formulated to support liver function when changing your diet isn’t enough. Certain foods, especially cruciferous vegetables like kale, cabbage, broccoli and Brussels sprouts, are also great for giving your phase one a boost. If your phase one is overactive and you don’t feel anything from coffee, then you need to slow down phase one. You can do this with herbs, such as Calendula officinalis, or spices such as turmeric (in a supplement form it is sold as curcumin).
Other than feeling “jittery” after drinking coffee, why is it important to correct an imbalance between the two phases? At the end of phase one, reactive oxygen species are produced. If phase one is overactive or faster than the phase two pathway, you ultimately get an accumulation of reactive oxygen species because your phase two just can’t keep up with phase one. Reactive oxygen species are chemically reactive molecules known to cause inflammation and damage throughout the body, including cellular DNA damage. Reactive oxygen species or high oxidative stress have been implicated in chronic conditions including cancer, diabetes, atherosclerosis and aging, Having signs of an imbalance between both phases has long term consequences and should be addressed.
Figure 1. Your liver and Phase 1 and Phase 2.
Diagram created by Dr. Olisa Mak
Although the body naturally produces reactive oxygen species, the body has protective mechanisms in place to protect itself. By eating a diet rich in antioxidants such as vitamin C, zinc and thiols (e.g., NAC) which can be found in garlic, onions and cruciferous vegetables, the body neutralizes these harmful, reactive oxygen species.
The balance between both phases is important to understand as it plays a key role in the metabolism of everything that our bodies comes into contact with—not just coffee but alcohol, medications, supplements, pesticides on our foods, even chemicals we absorb through our skin from personal health care products. The rate at which these two phases function ultimately defines how well our liver protects us from everything that we are exposed to. The chronic illnesses associated with high oxidative stress may not appear right away but ultimately affect our ability to live healthy and happy lives. Love your liver by eating a well-balanced, organic diet, rich in antioxidants and nutrients.
My ordeal from drinking only two cups of coffee one after the other brought to my attention the imbalance between my liver’s phase one and phase two. I too will examine my diet and find a way to improve my liver’s functioning. Will you?
If you’re concerned about your liver function, book an appointment to see how your liver function can be improved. Make better, more informed, decisions about their health. Come in for an appointment and get started with an individualized treatment plan just for you.
Dr. Olisa Mak ND is at Inspirit Clinic in Yaletown, Vancouver, BC.
The Top Five Medications You Shouldn’t Take Without Trying a Natural Alternative First
Reuben Dinsmore BScH, ND
Natural supplements, or nutraceuticals, have been given a bad rap lately—which, in some cases, has been absolutely warranted. But natural formulas that actually contain what they claim on the label, and that are formulated to have maximal efficacy, can be equal to their pharmaceutical counterparts. Better yet, they can be just as effective without the laundry list of side effects.
Statins
Statins (the class of drugs prescribed to lower cholesterol) accounted for 3.8 per cent of all money spent on prescription drugs in Canada in 2013. High cholesterol is blamed for heart attacks and strokes via formation of arterial plaques. But the real culprit is inflammation, without which the plaques wouldn’t form in the first place. Bottom line: You can lower cholesterol all you want, but as long as there is inflammation present, plaques can still form.
Some common side effects of statins include muscle pain, cognitive impairment, sexual dysfunction, and increased risk of cancer and diabetes.
Nutraceuticals are an alternative to statins. These include: Omega-3 fatty acids (best sourced from wild-caught fish oils) and curcumin (the active component in turmeric). Both are excellent supplements to lower inflammation. Garlic extracts have been proven to improve cholesterol levels as well. Another option I discuss with patients is red rice yeast extract, which is the natural compound statins were derived from in the first place, and works in a similar manner. This product may have side effects; I find that it can be beneficial for some patients, but not all, something I deal with on a patient by patient basis.
Antacids
It’s said that five million Canadians suffer from heartburn symptoms weekly. Prescriptions for the acid-blocking drugs PPIs (proton pump inhibitors) accounted for $24 million in BC alone in 2013. Risks of taking these mostly involve nutrient deficiencies from poor absorption DUE TO LOW STOMACH ACID (see the problem here?). Examples include bone fractures from poor calcium absorption or anemia from decreased levels of vitamin B12 or iron. B12 deficiency can also cause dementia and neurological damage. There has also been a correlation shown between PPI use and C. difficile infection, which causes life-threatening diarrhea.
Nutraceuticals: Long story short, most people don’t have too much stomach acid. The problem is the acid they have is getting into the wrong place (the lower esophagus) where it burns. This can be from the muscle between the esophagus and the stomach not closing properly, either from poor tone or insufficient stomach acid, which is the signal for the sphincter to close. Limonene (an extract from citrus peel) helps strengthen this muscle and promotes movement of food downward to the stomach. DGL (an extract from licorice root) stimulates mucus production in the stomach, which acts to coat and protect the sensitive lining of the esophagus.
SSRIs
SSRIs (selective serotonin reuptake inhibitors) are the most common class of anti-depressant drugs. One in twelve Canadians will experience major depression in their lifetime, but it’s still one of the most misunderstood conditions. Standard treatment protocols typically target neurotransmitter activity (most commonly serotonin). However, new research indicates the underlying cause may actually be inflammation. Either way, natural medicine has you covered.
Some nutraceuticals to consider are 5-HTP, which is used to make serotonin, with the help of vitamin B6. The herb St. John’s Wort has been studied extensively and appears to work in the same way as SSRIs. Both 5-HTP and St. John’s wort have shown similar efficacy to SSRIs when given for mild to moderate depression. And as I mentioned earlier, omega-3 fatty acids and curcumin decrease inflammation throughout the body, including the brain.
Side effects of SSRIs include sexual dysfunction, weight gain, and worsened/chronic depression. St. John’s wort also has a side effect which should be considered if taking other medications—it impacts liver function, which can result in either higher or lower blood medication levels.
Anti-hypertensives
Hypertension (i.e., high blood pressure) affects 6 million Canadians, and is responsible for approximately 13 per cent of all deaths. Various classes of anti-hypertensives include diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs). Diuretics increase urine output, which can negatively affect sodium and potassium levels, which can cause muscle cramps. ACEIs and ARBs may both cause a chronic dry cough. All anti-hypertensives can cause dizziness, headache and low blood pressure.
Again, there are many nutraceutical options for patients to consider, such as CoQ10, magnesium, garlic extracts, omega-3 fatty acids, L-arginine and vitamin C. All of these have all been shown to lower high blood pressure by various means. Dandelion leaf is an effective diuretic that doesn’t lower potassium levels.
Benzodiazepines
Benzodiazepines are a class of drugs most often prescribed for anxiety disorders and insomnia. They work by binding to receptors for GABA, a neurotransmitter in the brain that calms activity of the nervous system. Interestingly, this is the same mechanism by which alcohol acts in the brain. One obvious effect of benzodiazepines is sedation—great when the treatment target is insomnia. Not so great when you just want to decrease your anxiety but still function. Other side effects include dizziness, loss of balance, and even cognitive impairment at higher doses. They also have a significant risk of developing physical or psychological dependence and rebound anxiety when discontinued.
This is an area where you should have a thorough workup with your naturopathic doctor and consider the options that are right for you. You can take GABA as an alternative (but there’s mixed evidence on whether or not it actually gets into the brain), or herbs such as passionflower (which has the same mechanism of action as benzodiazepines). Other herbs include valerian, chamomile, kava, and many others.
So now you think you’re ready to ditch all your pharmaceuticals and go natural? Not so fast—the examples used above are by no means the only supplements that have been used effectively for these conditions. And equally as important are diet, exercise, sleep habits, relaxation techniques and other lifestyle factors. The next step is to sit down with a naturopathic doctor and work together to develop a personalized approach that takes all your health concerns into consideration.
Dr. Reuben Dinsmore practices at Yaletown Naturopathic Clinic. Call 604-235-8068 or email info@yaletownnaturopathic.com
GERD and Proton Pump Inhibitors: Seeking Alternatives
Ingrid Pincott, ND
Proton pump inhibitors (PPIs) are one of the ten most prescribed drugs in North America. PPIs are used in the treatment of acid reflux or GERD. I see at least one patient every week who is taking PPIs and wanting to get off them.
Bob, age 45, is a typical example. He has been taking PPIs for years and his GERD symptoms were not completely under control. He also had developed a rash he could not get rid of through conventional treatment so he is ready to try and improve his health. Certainly if a person is in severe gastric pain due to hyper-secretion of stomach acid, these drugs are useful to treat the acute phase. The side effects of long term treatment include: Decreased blood flow to the stomach, bacterial overgrowth in the stomach, hyperplastic polyp formation in the stomach, increased bile reflux and increased food allergy because food is not digested properly. Hypersensitivity reactions that can occur include urticaria, contact dermatitis, and drug rashes.
One of the reasons an MD might recommend a PPI for life is due to Barrett’s esophagus which increases the risk of developing esophageal adenocarcinoma (EAC). However, in some recent research published by F. Hvid-Jensen, 2014, the risk of developing EAC increased with PPI use due to the increased formation of polyps while taking the drug!
Other complications of long term PPI use include: gastrin secretion increases, contributing to the risk of colon cancer, and esophageal adenocarcinoma; women taking PPIs have an increased risk of hip fracture, and reduction in bone density; there is also an increased risk of developing community acquired pneumonia especially in the elderly; and, finally, there is an increased risk to developing C. difficile as well as an increased risk of having a heart attack.
I recommended to Bob to come off PPIs gradually over six months to avoid rebound excess stomach acid. Some patients I have seen come off a lot faster than that because they did many other changes at the same time. For example removing wheat from their diet, eating a low carb diet, and eating food in proper combination helps a great deal to reduce GERD symptoms quickly. I put Bob on my candida program which addressed a lot of these recommendations in one protocol. The “yeast” killers help to kill off harmful bacteria and taking a strong probiotic away from the “yeast” killers helps establish a healthy microbiome. I told Bob this treatment program has helped many with chronic GERD.
I also have great success with a digestive aid containing licorice, marshmallow and slippery elm that is aimed to heal the stomach and help digest starches and fats without the use of protease, which can aggravate these cases in the early phases of treatment.
I saw Bob one month later. He was using the PPIs much less and was amazed. His skin was beginning to clear and he was much less itchy. He continued on the candida program for another two months and once he was off the PPIs I recommended a slightly stronger digestive enzyme. During this time I noticed on his blood work results that his liver and gallbladder were abnormal so I added a bile thinner and detoxifier for at least three months.
At the six month mark, Bob had lost 20 pounds due to the diet changes, his liver enzymes were back to normal and the only digestive aid he needed were the probiotics and the digestive enzyme. Often the symptoms of too much stomach acid are the same as too little stomach acid. The rest of his maintenance health program included B complex, vitamin B12, omega-3 essential fatty acids, vitamin D and a calcium magnesium complex. PPIs deplete magnesium and B12 so we had some catching up to do because he had been on them for so many years.
[A version of this article originally appeared in the Campbell River Mirror, March 25, 2016.]