Naturopathic physician... you're going to school to be a what???

It dawned on me last night in the shower (a place where great epiphanies always seem to hit me) that I hadn't done a blog on exactly what a naturopathic physician is. I realize that here in Portland, and even Oregon for that matter I am sort-of in a natural health bubble where most people you meet on the street have seen a naturopathic physician and at least have a general idea of how we practice medicine. However, when I leave the bubble it's definitely more of a puzzled look on people's faces when I say I am a med school student studying naturopathy. So if any of you are less than familiar, here's a blog for you!

First off, how did I get here? I think we need to take a journey back to when I was in highschool, although in reality many of my inclinations probably started much earlier, but for the sake of the story let's not go too far back. My freshman year was a rough one (who's isn't?). I had grown up in the company of some very nice friends, albeit of relatively conservative backgrounds. In Utah this isn't uncommon, although I like to say Moab was and is a liberal hot spot in an otherwise very conservative state. I was an early bloomer and definitely started exploring and experimenting with various things before many of my peers. My parents tended to be more open to allowing me the freedom to learn lessons for myself, a thing which I am in retrospect very grateful for (since I am one of those hard headed people who need to be thunked hard before the lesson gets through). This culminated with a mediator led meeting between my friends and I one afternoon early in my freshman year where they voiced their concerns that I was "throwing my life away" by not sticking straight on the moral pathway that I had previously tried to adhere to. I was questioning religion, authority, law, sexuality, etc... and they took this as a very bad sign. The meeting ended with my former friends essentially "disowning" me. As hard as this was at the time, in the long run it was incredibly liberating. I started hanging with a new crowd, the "alternative" kids. Many of them had been homeschooled before starting high school and many lived in homes where parents practiced sustainable living and did not conform to the "normal" standard of living. I was in heaven. I started taking Tai Chi lessons with some of them (from a wonderful man who I later discovered was an ND, although I didn't understand what this was at the time). I started seeing a traditional healer who first introduced me to herbal medicine and taught me much about body work as I was having significant growing pains and problems with my hips and lower back. I found a fabulous herbal book in the used book store, a book I still reference at least weekly to this day, and I started cooking up my own herbal concoctions every time I, or anyone I knew, got sick. They worked too!

Fast forward to my senior year. After spending my junior year in Australia (such a fabulous country that I will someday get back to visit!) I came home more independent and stubborn than ever. I quit soccer after having a heated run-in with the new coach and I decided that my senior year classes would consist of Youth Garden and Spanish, as I had been such an overachiever previously that I had no more required classes to graduate. I also decided in the winter of my senior year that I did not want to go to college. Bless my parents for being so calm when I made this announcement and for allowing me the freedom to make this decision. Even though I graduated as Valedictorian I was determined that college was not my path, at least not right away. I strongly contemplated attending an herbal school in New York that I had heard about, but didn't quite know what steps I needed to take to get there. I got a job working at a local cafe that served smoothies, fresh made juices, and yummy wraps. However, after about six months I had the epiphany (can't remember if it was in the shower or not) that I did not want to work minimum wage jobs forever and that I was feeling mentally stagnant. I decided to apply for college. I heard great things about a little town in Oregon called Ashland from one of the alternative families I was friends with who moved from Moab to Ashland. In fact, I think a total of about ten people I knew from Moab ended up moving to Ashland within a couple year period. I did a little research and found Southern Oregon University and applied. I also applied to several other larger schools in Oregon and got much higher scholarship offers, but decided in the end to attend SOU. It was a smaller school (approx 5000 student body when I started) and was in a smaller town (Ashland has about 20,000 which was still a big step up from Moab's 8,000) and it had a nice faculty to student ratio of about 17:1. I did not want to be a number and wanted to actually know my professors. It ended up being a perfect fit. The beauty of taking that year off had given me the time to figure out what I wanted to do and I knew it had to involve plants. I initially started at SOU with the intention of studying biology and getting an additional certificate in botany. I also played bassoon and after some intense recruitment (and offer of additional scholarships) decided to do a second major in music.

Some time in my second or third year at SOU I became infatuated with the idea of going to med school. Several of my friends were in the pre-healthcare society and so I joined too. I decided to change my emphasis to biomedical science and took extra chemistry and med school prep courses. I bought an MCAT study guide and diligently began working my way through it towards the end of my fourth year. Due to my double major I ended up going a fifth year and during this year I also got a job working in research as a Clinical Research Coordinator. They are the ones who actually work one-on-one with patients doing trials for pharmaceutical companies. I worked on numerous trials studying medications for asthma, COPD, allergy, and helped with a few diabetes studies as well. It was absolutely fabulous experience and several coordinators would work there for a few years and then go off to medical school. I learned how to do ECGs, spirometry, blood draws, IVs, and a whole host of other procedures. I also got great experience working directly with patients and developed several lasting friendships. I continued to work there the year after I graduated (during which I also go married and pregnant). When we decided to do a home birth I started seeing a wonderful midwife who also had a naturopathic physician working out of her office. At this point I was still considering conventional med school, although I was having a really hard time staying focused on my MCAT studying and kept putting off taking the test. I considered applying to PA school, but after a particularly gnarly week I realized that I really did NOT want to work under a doctor, but rather work for myself. That week (in the shower) I had the epiphany that I needed to return to my roots in herbal medicine. I did a quick google search for herbal medicine schools and found, much to my surprise and delight, that Portland had the oldest naturopathic school in the country. It turned out that the naturopathic physician at my midwife's office had graduated from NCNM (National College of Natural Medicine) and had also gone through the program having two kiddos. She convinced me that it was a totally doable program with kids as NCNM is very family friendly. I now think she was slightly crazy for actually having her babes while going through the program (we are waiting until I finish to have a second), but the school really is incredibly family friendly and supportive of moms and dads.

At this point I applied to NCNM but still really had no idea what all naturopathic medicine entailed. I just knew that I would get a chance to study the herbs that I loved and that it would allow me the freedom to be a doctor in my own right. NCNM gives the option of completing the program as a 4, 5, or even 6 year degree. They also have a Chinese medicine program which many students study alone, or in combination with the ND (naturopathic doctor) program. The year I started they had also just began accepting students for a research degree (masters in integrated medical research) which I initially was part of, but later dropped as it was too much piled on top of the ND degree program, which I was determined (and still am) to complete in four years. At this point I am the only mama I know of in my class who is still on the four year track. It's brutal, but I can't stand living in this rainy, foggy, soggy, wet.... you get the idea... for more that I absolutely have to. My desert roots are getting swamped and I can't wait to move back to a dryer climate!

Okay, back to naturopathic medicine. Not only do naturopathic physicians learn all about herbs (botanical medicine as we call it), but also learn all the same basics about health and disease that any primary care doctor learns. At this point naturopathic physicians are licensed in 17 states, with legislation pending in several more. Naturopathic physicians are usually general practice physicians, but some focus in on certain patient populations ranging from cardiology to pediatrics. At this point there is only one recognized and board approved "specialty" and that is in oncology and requires a two year residency after completion of the program, although a cardiology specialty is also in the works here in Oregon. Basically, the first year of the ND program is mostly basic science courses to get us all onto the same foundation. Luckily for me, most of these were classes I had taken before as an undergrad such as anatomy and physiology, biochemistry, microbiology, immunology, etc. I was very grateful for my background as it made that first year so much easier. The classes were definitely different, and included much more of a clinical (read: disease/patient) approach. Also in the first year was a Naturopathic Philosophy course in which I finally learned the history behind naturopathic medicine and what the founding philosophies are.

Naturopathic medicine, in it's modern incarnation, really started in the mid 1800's, although it's roots were based in traditional medicine reaching back for millennia. It was initially a combined approach between Nature cure and homeopathy (nature cure+ homeopathy= naturopathy!). Nature cure was a system of medicine developed in Europe based on following the inherent laws of nature. Some of these were things we take for granted now: eating a good and wholesome diet, getting regular exercise, getting fresh air, and understanding and trusting the body's ability to heal itself when confronted with disease or various stressors. Homeopathy is a whole 'nother topic (future blog?) but was founded in the 1700's and is based on giving tiny doses of medicine to correct imbalances in the body. These two systems, being very complementary to each other, merged into naturopathy in the US after being brought over from Europe and became very popular towards the end of the 19th century. In fact in the early 1900's there were over 200 naturopathic colleges in the United States! There were also many strictly homeopathic schools, chiropractic schools, osteopathic schools, as well as a newer type of medical school called allopathic.... these are the MDs we are all familiar with today. Each of these schools of medicine had different approaches to healing but were all considered valid at the time and physicians from each school were endowed with similar privileges to diagnose and prescribe. However, in the 1920's with the formation of the AMA (American Medical Association) this was all about to change. The MDs were becoming ever more popular and believed that their form of medicine was really "the" way. The AMA hired a guy named Flexner (http://en.wikipedia.org/wiki/Flexner_Report) who produced a report (with the Carnegie foundation's help) which essentially discredited medical schools who did not follow the allopathic tenants of practicing medicine. This led to the closure of most of the naturopathic schools, who at this time did not have the science to back the medicine (which we now have much of!). Many of the chiropractic schools survived, but only by giving up their right to diagnose and prescribe, and essentially losing their general medicine aspect and focusing just on what we are all familiar with today as chiropractic adjustments. The osteopaths conformed to enough of the allopathic tenants that they squeaked through and eventually won back their right to diagnose and prescribe. The naturopaths refused to give up their rights to diagnose and prescribe and were essentially persecuted to the point where in the 1940's a "good" naturopath had usually spent some time in jail for practice of their medicine. Sadly the last naturopathic school in the US closed in 1955. However in 1956 NCNM was founded in Portland. The first few years were rough and graduating classes were in the single digits, however thanks to the hard work of the remaining old school naturopaths it slowly grew and continues to regain popularity. There are now 8 accredited naturopathic schools in the US and Canada. Most are on the West Coast as this has become a haven for natural medicine and alternative lifestyles. Naturopaths are licensed to practice medicine now in 17 states, with varying scope of practice (meaning what they are legally allowed to do) depending on the state. Unfortunately, because they are not licensed country wide there are still many people who claim to be "naturopaths" in unlicensed states who have not graduated from an accredited four year program and many of them give the profession a bad name by failing to follow the accepted tenants of naturopathy. There is still a "war" between allopaths and naturopaths on many levels, but it's slowly shifting as more natural medicine is becoming mainstream and patients are wanting to treat disease with fewer toxic pharmaceuticals. Here in Oregon there are many examples of what we call "integrated" medicine where MDs and NDs are working hand in hand. In Portland there is more and more collaboration between the major allopathic medical school (Oregon Health and Science University), NCNM, the chiropractic school (Western States Chiropractic), and the Chinese medicine school (Oregon College of Oriental Medicine). A big part of this "war" is based largely on mis-information and misunderstanding between the professions and hopefully as time moves forward and communication pathways are opened the AMA will appreciate the value that naturopaths can bring to medicine.

Naturopathic physicians study not only herbal medicine, but also learn body work and adjustment techniques (similar to chiropractic), physiotherapy, orthopedics, hydrotherapy, along with conventional pharmacology. NDs are able (in most licensed states) to prescribe the same drugs that primary care physicians are allowed to, although we are taught to use these pharmaceuticals as a last resort and only for extreme cases. Most patients come to NDs expecting to get something other than drugs, and in many cases natural remedies are just as effective (if not more so) and far less toxic than the conventionally prescribed pharmaceutical for a given condition. This especially comes in handy as more diseases are becoming resistant to antibiotics. MDs don't have the training in herbs and natural remedies and are often at a loss when the antibiotics fail, but NDs have a plethora of other treatments that we can offer to patients to help conditions from pneumonia, tuberculosis, sinus infections, to cancer, diabetes, and heart disease. Just look at our country. As we have continued to follow the advice of MDs from the early 1900's on has our overall health improved? Why continue with a system that largely fails when it comes to treating chronic disease? I strongly believe that there is a time and place for allopathic intervention. If I get in a car accident and have a severe injury you better believe I will be heading straight to the closest allopathic hospital. However, allopaths have a far less impressive track record when it comes to treating things like diabetes and heart disease. For far too long their approach has simply been to manage the symptoms of these chronic disesases rather than find and treat the underlying cause of disease. Most conventional medical schools offer very little in the way of nutrition training, so how can we expect a MD to know how to counsel a patient on their diet and lifestyle? NDs receive a ton of this very kind of training and can offer patients very concrete ways to manage, and often reverse the course of chronic diseases based largely in behavior changes and gentle natural treatment approaches.

This brings me to the founding tenants of naturopathic medicine:

First do no harm. This means that with EVERY patient and EVERY treatment a naturopath will give incredible thought and consideration to the possible risks, side effects, and any other possible harm that may come to a patient as a result. We look at the statistics of how effective a treatment really is before prescribing it. Since most naturopathic visits are about an hour long (how long was your last appointment with an allopath?) we actually have the TIME to consider all these factors before recommending a treatment.

Trust the healing power of nature. The human species has survived and thrived for millennia relying on no more medicine than what we could find in nature. The human body is AMAZING! Given the right nutrients and environment it can do remarkable things in regards to healing itself and correcting disease. Naturopaths are taught to measure a person's vitality and to base treatment approaches on supporting the body's inherent ability to heal itself. This also allows us to understand that often symptoms are the body's way of alerting us to disease and that they are often beneficial (take a runny nose which is flushing the bacteria/virus out of your sinuses). If you take away the body's ability to cleanse itself you often force the disease to go deeper and manifest in more severe ways.

Treat the whole person. Why do we spend at least an hour with every patient? Naturopaths are taught to get the whole story. To really get a thorough picture of a patient's history, their family history, and a complete picture of what is happening in their health. Not only will a naturopath treat the current complaint, but will try and improve the body's whole health and vitality. We are taught to treat the person, not the disease. If two patients come in with the same disease they will very seldom receive exactly the same treatments. Every person is different and their body responds differently to disease and treatment. Naturopathic physicians recognize and honor this.

Doctor as teacher. Another reason appointments are so long! Conventional medicine has held power over their patients for far too long. So many people expect to go to a doctor and receive a prescription for their current ailment and that's it. Naturopaths are taught to counsel patients as to why they may have developed a particular disease. We try to empower patients to make educated steps towards improving their own health.

Identify and treat the cause. I mentioned this above but the heart of naturopathic care is in getting to the root of the problem, not just treating and masking the symptoms. The more I learn about natural medicine the more I am convinced that there are very few diseases (exception for some genetic in nature) in which an underlying cause cannot be established and, if you can correct the underlying problem, you can stop and even reverse the disease. This applies even to things like autoimmune disease which allopathic medicine is at a complete loss in treating. Seriously, I am witness in my own family to the ability to reverse disease course, even in long standing and severe autoimmune disease. 

Prevention. It is far far easier to prevent disease than to cure it. Easy enough said, but like I mentioned above, most allopaths have very little training in nutrition and behavioral approaches which can often divert disease course before it has even begun. In our modern society as healthcare costs for chronic disease soar this is becoming ever more important. It goes back to teaching patients what they can do to avoid developing diseases like cancer, diabetes, and heart disease. Truly these are avoidable diseases!

Ahhh... okay I feel as if I have written a novel and shared enough for one day. I am thankful every single day that I have found this medicine and am lucky enough to study it. I love what I learn and cannot wait to have my own practice where I can help to heal and put into effect all the above tenants. I hope you learned a little something too and the next time you hear the word "naturopath" you wont be confused. Here's to health!

Gluten free- why the craze?

By now I'm sure everyone has heard of gluten. Most people either know someone who is gluten free or maybe have even tried it themselves. It's estimated that Americans will spend over $7 billion on GF labeled foods this year, so there must be something to this little protein. Let's take a deeper look.

Gluten is a protein that is found in wheat, barley, and rye. It's a unique protein that allows the flours in these grains to get stretchy. Have you ever kneaded dough? Without gluten you could not bend and stretch it and the dough would just fall apart. It also helps to trap the gas from yeast gobbling up the starch in the flour to puff up the dough and allow it to rise. So what? This all sounds great right? Where's the problem and why do so many people avoid gluten like the plague?

Well, the problem does not lie in the gluten so much as it does in the body's reaction to it. Gluten, among many other things, can be a pretty severe allergen, meaning that it can trigger an allergic reaction in people who are sensitive to it. Along with soy and dairy it is in the top ranking food allergens. The most serious reaction results in celiac disease. With celiac the body's reaction to gluten is so severe that it causes serious damage and destruction in the intestines. This damage then compromises the gut's ability to absorb nutrition from food in general, and untreated celiac folks often wind up very malnourished and with severe vitamin deficiencies even though they are eating a completely balanced diet. If the damage is not too far along eliminating gluten from the diet can often completely reverse the damage, but unchecked celiac can lead to many very unhappy consequences. Approximately 1.8 million Americans are currently diagnosed with celiac disease, with another estimated 1.4 million undiagnosed. There are additionally an estimated 1.6 million Americans who buy gluten free foods without having received any kind of gluten related diagnosis, but do it for their own reasons or comfort.

 Many other diseases besides celiac may have a gluten related component. Autoimmune and inflammatory diseases can often be triggered or exacerbated by food allergies, and gluten is no exception. Gluten "sensitivity" is the label given to people who have a secondary condition which seems to benefit from eliminating gluten. Often this is attributed to antibodies that the body makes against gluten in the gut which then travel to other parts of the body and can react against other tissues. In my own case I have been diagnosed with autoimmune thyroiditis (Hashimoto's) which basically means my body creates antibodies against my thyroid gland and is slowly destroying it. Antibodies against gluten have been identified as being cross reactive against thyroid too, basically amplifying the destruction that is already happening. When I stay off gluten my thyroid levels are much more balanced and it has probably allowed me to stay on lower doses of thyroid medication then what I would need if I was still eating gluten like I used to (I am a self-admitted pastry nut). My dad was told by his neurologist in 1974 when he was first diagnosed with MS that he should avoid gluten (based on research at the Mayo Clinic about gluten and autoimmune disease even back then). He tried and failed as at that point there was no such thing as gluten free labeling and it was almost impossible to avoid. When he tried again last year (after testing very positive for a real gluten allergy) it was a million times easier and he has been successful this time! Many people also find that eliminating gluten leads to weight loss, whether it be from a eliminating an underlying inflammatory reaction or simply cutting down on refined carbs, it's hard to know, but this is another reason people often seek out gluten free foods.

So why the rise in gluten intolerance? I recently was discussing this with my doctor. She said that many doctors are completely puzzled and astounded by the number of patients they are seeing who, after eliminating gluten, report feeling remarkably better from any number of ailments. In fact, it's often joked about in naturopathic circles that the first thing any naturopath will do is tell you to cut gluten out of your diet. Of course, this isn't true as naturopaths take every case on an individual basis, but it is true that the rates of gluten sensitivity are rising. Like I mentioned above, even conventional gastroenterologists will tell you that they are seeing far more celiac patients than they were twenty years ago. So why are more and more people reacting to something that we, as a species, have been consuming for literally thousands of years?

My hubby loves those shows like "How it's Made" and recently put one on that was all about wheat. At first, it seemed like torture developed by pro-wheat propaganda (for those of us who don't tolerate wheat well), but the more we watched the more I was fascinated by the information it contained. It gave a long history of agricultural use of wheat and then went into great detail about how many things in our modern world are made using this amazing grain (did you know that it is a common component of fire-resistant furniture?). It also gave a run-down of the top six varieties of wheat that are grown in modern agriculture. Here is where the light bulb popped on in my head and I had to stop and rewind it several times. There are six major varieties of wheat grown in large scale agriculture. The top two varieties of wheat grown in the United States have purposefully been bred over the last fifty years to have high gluten contents to allow them the largest range of uses! The same fabulous agricultural breeding that brought us gorgeous strawberries with no taste (maybe a future blog there) and tomatoes that have fish genes to survive cold also have designed a wheat that is incredibly good looking, hardy, and produces plump grains, but is also much higher in gluten content than other varieties of wheat. Not only has the gluten content gone up, but wheat and wheat based gluten are found in an amazing array of foods that you would not ever suspect to contain them until you start reading labels! Since allergies are often related to high levels of exposure it makes perfect sense that this abundance of gluten in our modern American diet is directly related to the increasing rates of gluten intolerance. I did a little searching after finishing the show and, of course, I was not the first one to think of this link. In fact it is one of the current hypothesis behind the rising rates of celiac disease. Darn, well so much for my fabulous medical discovery, but it was nice validation and gave me some good food for thought (no pun intended!).

If you suspect that you may have a gluten intolerance I highly recommend talking with your naturopath about it (it seems hit or miss on conventional docs being highly knowledgeable about it at this point although gastroenterologists see enough of it they should be). It isn't easy to avoid gluten, but the options are a million times better now than they were twenty, or even ten years ago and if it helps what ails you it is incredible motivation to stay away from those pesky grains. There is always more to learn, but I hope this provides you with a better understanding of why gluten free is all the current rage. Happy eating!

Here is an article I found that talks about a lot of the research in regards to rising rates of celiac (where I got my stats) and the breeding of higher gluten wheat: http://www.cbsnews.com/8301-504763_162-57483789-10391704/gluten-free-diet-fad-are-celiac-disease-rates-actually-rising/