Thyroid Information for Healthcare Practitioners

CONDITIONS ASSOCIATED WITH REDUCED THYROID HORMONE TRANSPORT

Many conditions are associated with impaired thyroid transport, including insulin resistance, diabetes, depression, bipolar disorder, high cholesterol and high triglycerides levels, chronic fatigue syndrome, fibromyalgia, and diseases of the brain and nervous system such as migraines, Alzheimer’s, Parkinson’s and multiple sclerosis. Low intracellular thyroid hormone can result from stress, anxiety and chronic dieting and aging (Holtorf, 2014b).

Toxins and other substances produced by the body in response to physiologic stress and calorie reduction interfere with cellular uptake of thyroid hormones. Since thyroid hormone uptake in the pituitary is relatively unaffected by outside factors, drugs such as benzodiazepine medications, including diazepam (Valium®), lorazapam (Atavan®) and alprazolam (Xanax®) can prevent T3 uptake into the cells of the body, but have no effect on movement of T3 into the pituitary (Kragie & Doyle, 1992).

THYROID FUNCTION INFLAMATION, LOW IRON AND BACTERIA

Eighty metabolic genes responding to thyroid all need iron, which is lower when hepcidin from your liver is elevated in response to inflammation. High inflammation also interrupts the conversion of inactive T4 to active T3 inside tissue cells of the body. The result is a cellular hypothyroidism, even in the presence of normal T4 and T3, and is known as Peripheral Tissue Hypothyroidism.

On a lab test you will see: TSH is normal, T4 is normal, T3 is low and RT3 is high, indicating that inflammation is a problem, possibly due to autoimmune disease. In these scenarios, the elevations in inflammatory cytokines are depressing thyroid receptor site responsiveness while the hormones create a normal appearance of thyroid markers (TSH, T4 and T3).

Many autoimmune patients will not notice any difference even when taking T4 thyroid hormone because of decreased receptor site sensitivity and decreased conversion of T4 to T3 (Kharrazian, 2009). As you correct the underlying inflammation, these patients do better with glandular thyroid or bioidentical hormones which contain time released T3.

ENZYMES THAT CONTROL THYROID HORMONES

Figure 6.29 Abnomal thyroid physiology

Thyroid hormones enzymes, known as deiodinases, control activation and deactivation of thyroid hormones cells.

Three different deiodinase enzymes present in different tissues in the body (Holtorf, 2014a):

Type 1: D1 deionodase converts inactive T4 to active T3 throughout the body. (Bianco, Salvatore, Gereben, Berry, & Larsen, 2002).
Type II: D2 deiondinase activity determines pituitary T3 levels (Kaplan, 1984).

D2 is 1000 times more efficient at converting T4 to T3 than the D1 enzyme present in the rest of the body (Zavacki et al., 2005) and is much less sensitive to suppression by toxins and medications. In contrast to the rest of the body that is regulated by both D1 and D3, the pituitary contains little D1 and no D3 (Silva, Dick, & Larsen, 1978).

Additionally, D2 in the brain has an opposite response from that of D1 in the tissues to physiologic and emotional stress, depression, both dieting and weight gain, PMS, diabetes, leptin resistance, chronic fatigue syndrome, fibromyalgia, inflammation, autoimmune disease, and systemic illness. Pituitary D2 is stimulated and up-regulated in response to such conditions, increasing T4 to T3 conversion while the rest of body suffers from dropping levels of active T3.This causes the TSH to remain normal despite the fact that there is significant cellular hypothyroidism present in the rest of the body.

On the other hand, with reduced T4 levels, the activity and efficiency of D1 in the target cells decreases (Berry, Banu, & Larsen, 1991), resulting in a reduction in cellular T3 levels while the TSH remains unchanged due to the ability of the pituitary D2 to compensate for the diminished T4.

Type III: D3 deiodinase reduces cellular thyroid activity by converting T4 to the anti-thyroid reverse T3 (reverse T3)¹^–⁹ (Peeters et al., 2005).

The pituitary is the only tissue that does not contain D3, which converts T4 to reverse T3 and D3 competes with D1 that converts T4 to T3 (Islam, Yesmine, Khan, & Alam, 2008).

Reverse T3 is a competitive inhibitor of T3, blocking the active thyroid hormone T3 from binding to its receptor and blocking T3 effect. This reduces metabolism, suppresses D1, reducing conversion of T4 to T3, (Tien, Matsui, Moore, & Negishi, 2007) and blocks T4 and T3 uptake into the cell (Mitchell, Manley, Rowan, & Mortimer, 1999).The result is a reduction of intracellular T3 levels and thyroid activity as the result of the abundant presence of D3 enzyme in tissues levels and complete lack of pituitary D3 enzyme (Kaplan, 1984).

Thyroid hormonal interactions

STANDARD THYROID TESTS ARE INACCURATE

The inhibitory effects on the peripheral tissues causing hypothyroidism are not reflected by TSH testing. Because increased serum and tissue level of reverse T3 blocks the thyroid receptors, even small increases in reverse T3 can result in a significant decrease in thyroid action and result in severe hypothyroidism not detected by standard blood tests (Santini, Chopra, Hurd, Solomon, & Teco, 1992).

T4 supplementation will contribute to more reverse T3; T4 only treatments should not be considered optimal thyroid replacement in the presence of high or high-normal reverse T3 levels (Samuels, Schuff, Carlson, Carello, & Janowsky, 2007); the use of T3 is beneficial and should be used in these conditions (Pingitore et al., 2008).

New information on differences in at the cellular level between the pituitary cells in the brain and the cells that make up the tissues in the rest of the body has lead to new standards for addressing thyroid disease.

The reliability of what has historically been considered standard thyroid testing for TSH and T3 is obsolete when cellular hypothyroidism is a result of low intracellular T3 and elevated blood levels of T4. New standards for evaluating and treating thyroid disorders are discussed in Volume 8, Master Hormones.

NEW TESTING STANDARDS FOR THYROID FUNCTION

Traditional thyroid screening involves testing blood levels of circulating thyroid hormones. Thyroid hormone transport across cellular membranes is called autocrine or intracellular signaling. This form of hormone communication plays an important role in intracellular thyroid hormone levels and is proving to have considerable clinical significance.

Thyroid hormones can be prevented from entering the mitochondria by low cortisol as a result of adrenal fatigue.

Your body down regulates thyroid in the presence of heart disease to protect the heart. It is not wise to stimulate the thyroid gland before diagnosing potential problems with the heart.

Increases in rT3 levels are mainly a result of reduced transport of T4 into the cell and not due to increased T4 to rT3 conversion by D3 deiodinase enzyme.

High reverse T3 is a condition reflecting either an inhibition of reverse T3 uptake into the cell and/or there is increased T4 to reverse T3 formation (Hennemann, Vos, de Jong, Krenning, & Docter, 1993).

Due to rT3 and T4 transporters being equally energy dependent, a high serum rT3 has been shown to be a marker for reduced uptake of T4 into the cell (Hennemann et al., 1993). Reverse T3 is a reliable marker for identifying reduced cellular T4 and T3 levels that would not normally be detected by TSH or serum T4 and T3 tests (Hinz et al., 2015).

When this occurs, T4-only replacement is not advised. While a high rT3 can occasionally be associated with hyperthyroidism, as the body tries to reduce cellular thyroid levels. More often, identifying symptoms and using the free T3/rT3 ratio, which correlates with intracellular thyroid levels leads to a better analysis of the problem (van den Beld et al., 2005). A physician should test for indications of mitochondrial disease an analysis of imbalances of thyroid hormones, as low ATP production would affect active transport of these hormones

Symptoms to look for when diagnosing hypothyroidism include fatigue, weight gain, depression, cold extremities, muscle aches, headaches, decreased libido, weakness, cold intolerance, water retention and PMS. It is best to use a combination of both clinical and laboratory assessments to determine the likely overall thyroid status.

A free T3/reverse T3 ratio of less than 0.2 being a marker for tissue hypothyroidism (when the free T3 is expressed in pg/mL (2.3–4.2 pg/mL) and the reverse T3 is expressed in ng/dL (8–25 ng/dL), (van den Beld, Visser, Feelders, Grobbee, & Lamberts, 2005).

NEW TREATMENT APPROACHES TO HYPOTHYROIDISM

A therapeutic trial of straight time released Liothyronine (SRT3) or Nature-Throid (T4/T3 combination therapy) can then be instigated in the presence of an elevated TSH.

In 2009, the 11^th European Congress of Endocrinology released research showing that T3 supplementation can be significantly beneficial (Batterham, Le Roux, et al., 2003) in the presence of high or high-normal reverse T3 levels (Gomberg-Maitland & Frishman, 1998) compared to standard T4. Sustained release T3 is available from compounding pharmacies such as Liothyronine SR. When combined with supplemental ATP to drive transporter uptake by the cells, sustained release T3 can be extremely beneficial. Following up with immune system support and detoxification can further restore proper thyroid hormone balance.

VITAMIN D3 AND AUTOIMMUNE DISEASE

CONFLICTING TREATMENTS FOR AUTOIMMUNE DISEASE

Vitamin D proponents have failed to recognize that many of the positive effects of vitamin D are due to the immunosuppressive effect of elevated 25(OH) D3or to make the connection with the fact that immunosuppression is contraindicated because of the probable presence of intracellular infection underlying autoimmune disorders. When the immune system is suppressed, clinical disease markers and symptoms are reduced but immunosuppression does not address an underlying cause of persistent bacteria, thus relapse is common (H. M. Kim, Chung, & Chung, 2010).

Much of current research focuses on finding drugs to suppress inflammation associated with autoimmune disease (Collins, 2011), 95 % of these studies have failed to find drugs to suppress inflammation. It seems clear a better direction is needed. Immunotherapy which restores VDR competence, corrects dysregulated vitamin D metabolism and eliminates intracellular bacteria could be the answer.

Studies report that Vitamin D appears to have a positive effect on autoimmune disease due to immune system suppression (Griffin, Xing, & Kumar, 2003).

Immune suppression is behind the proposed positive effect, as vitamin D inhibits LPS bacterial activation and cytokine production in monocytes/macrophages (Y. Zhang et al., 2012).

Encouraging use of vitamin D and touting the benefits of Immune suppression, is still considered by “experts” to be therapeutically beneficial for autoimmune diseases (Böhm, Luger, Schneider, Schwarz, & Kuhn, 2006).

The current medical model buys into these studies, causing poor treatment protocols and widening the gap between treatment and effective outcome. Vitamin D is frequently prescribed by rheumatologists to prevent and treat osteoporosis. Several observations have shown that vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction (Ishizawa et al., 2008).

This information supports a health restoration protocol that includes the discontinuance of vitamin D3 supplements in the treatment of these conditions.

MEASURING VITAMIN D3 DYSREGULATION

Vitamin D3 dysregulation can be identified by rising levels of active vitamin D (1-25 D) and lower levels of inactive vitamin D (25-D).

(Blaney, Albert, & Proal, 2009)

HIGH VITAMIN D AND AUTOIMMUNE DISEASE

The current recommendations for adequate vitamin D3 and lab normal ranges are based on levels found in unhealthy populations. These populations are over supplemented, overweight, undernourished, immune suppressed and toxic study subjects. This “madness” must be ended if we are to change healthcare and the poor outcomes of our overpriced so called healthcare system. New research is now revising the current medically recommended levels.

Vitamin D supplementation makes autoimmune disease worse due to its steroidal suppressive effect on the immune system (Y. Zhang et al., 2012). However, vitamin D proponents have failed to recognize that these suppressive effects are due to the immunosuppressive effect of elevated 25(OH) D and seemingly fail to grasp the scientifically backed fact this very same immunosuppression is contraindicated because of the probable presence of intracellular infection. When the immune system is suppressed, clinical disease markers and symptoms are reduced but immunosuppression does not address an underlying cause of persistent bacteria, thus relapse is common (H. M. Kim et al., 2010). Unfortunately, immune suppression is considered therapeutically beneficial for autoimmune diseases (Arnson, Amital, & Shoenfeld, 2007).

High levels, not low levels of Vitamin D are associated with autoimmune disease which does not follow our model for Vitamin D being protective. Elevated levels of serum Vitamin D3 were found in 85% of patients in the Pacific Northwest diagnosed with autoimmune disease. The treatment of inflammatory disease had poor result with the use of vitamin D supplementation over long periods of time (Blaney et al., 2009).

This can be explained as the result of the presence of L forms. High levels of 1,25-D result when dysregulation of the VDR by bacterial ligands prevents the receptor from expressing enzymes necessary to keep 1,25-D in a normal range (Blaney et al., 2009).

ASSOCIATION DOES NOT EQUAL CAUSATION

ACTIVE VITAMIN D3 IS A MORE ACCURATE FOR DIAGNOSING CHRONIC INFLAMMATORY DISEASE THAN STORED VITAMIN D3.

Why are levels of Vitamin D3 often elevated in patients with autoimmune diagnosis when we expect them to be low? When inflammation goes down, we see that the active levels of vitamin drop into a normal range. The active 1,25-D rather than the stored 25-D serves as a more accurate measure of a chronic inflammatory disease state (Blaney et al., 2009). In the presence of L-form bacteria and a compromised immune system, the tissues start to convert any stored D3 to active D3, making the active D3 elevated in the blood as overflows from the tissues. Unlike a healthy state, this tissue dominance of D3 production, in not regulated by the kidneys and requires a unique approach to measurement and analysis.

This is the result of tissue cells producing high levels of the steroid active vitamin D in an effort to stimulate the VDR which are blocked by the L-form bacteria, the stored form of vitamin D can be low or negligible. It is important to measure the active vitamin D3 as well as the stored vitamin D count. An abnormal ratio of stored to active D3 ratio will tell the story. Do not supplement Vitamin D until ratios normalize as steroidal vitamin D suppresses the immune system and leads to higher levels of infection (Blaney et al., 2009).

SECTION V: THE HUMAN MICROME AND AUTOIMMUNE DISEASE

Antibiotics interfere with cell wall replication. Bacteria survive the antibiotics by loss of the cell wall and become intracellular. They act like terrorist bacteria as they take over the VDR of the cell nucleus in order to suppress immune system function. Antibiotics are now unable to kill the L-form bacteria because they have become cell wall deficient (CWD) and the immune system becomes ineffective in killing them because it is now suppressed.

A good discussion of this can be found on The Marshall Protocol website mpkb.org/. Effective antibiotics were discovered in the early-mid 20th century and came into wide use after World War II. Antibiotic use has increased dramatically with rates approximating one course of antibiotics per year for the average child in the USA (McCaig, Besser, & Hughes, 2002).

ANTIBIOTICS IN CHILDHOOD AND RELATED CHRONIC DISEASE

Chronic conditions such as asthma and skin disorders have been associated with childhood antibiotic use. The long-term consequences of such disruption for the human-microbial population are more difficult to discern but result from an altered intestinal microbiota (Kozyrskyj, Ernst, & Becker, 2007; Marra et al., 2006; Noverr & Huffnagle, 2005; Prioult & Nagler-Anderson, 2005).

FURTHER UNDERSTANDING VITAMIN D3

Comprehensive vitamin D3 analysis

THE FORMATION OF VITAMIN D

The term vitamin D refers to a family of compounds that are derived from cholesterol. What we know as vitamin D is essentially a collective term for two types of calciferol: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D3 is made in the skin of all vertebrates when exposed to sunlight, while D2 is produced by invertebrates such as fungi and plants when exposed to sunlight.

CLARIFYING THE SOMETIMES CONFUSING NAMES FOR VITAMIN D

Stored or inactive vitamin D3 is sometimes referred to as D2, and active vitamin D3 is sometimes referred to simply as D3. Technically, Vitamin D2 (ergocalciferol) is the form of vitamin D from plants.

The story of vitamin D3 begins when a pre-vitamin D precursor is eaten or generated from exposure from sunlight. The precursor we get from plants is called ergosterol and the precursor we get from eating animal tissues is called 7-dehydrocholesterol. The animal origin substance is converted to what is called vitamin D3 or cholecalciferol, while the plant substance becomes vitamin D2 or ergocalciferol. The animal origin hormone as it is the most metabolically active. Both of these compounds are inactive precursors of potent metabolites and therefore fall into the category of prohormones. This is true not only for cholecalciferol and ergocalciferol obtained from the diet but also for cholecalciferol that is generated from 7-dehydrocholesterol in the skin during exposure to ultraviolet light (Bikle, 2014).

Vitamin 25(OH)D3 circulating in the blood is bound to vitamin D binding protein (DBP) and can travel to the liver or be activated by enzymes in the kidneys and tissues when needed. Supplemented D2 or D3 must be absorbed from the intestines, with the help of bile salts, and be transported in the lymph by chylomicrons to the liver.

STORED VITAMIN D2 FROM PLANTS AND D3 FROM ANIMALS

Vitamin D2 (ergocalciferol) can be synthetically made from radiating a compound (ergosterol) from the mold ergot. Vitamin D2 is inefficiently metabolized by humans (Allain & Dhesi, 2003). The plant form of vitamin D2 (ergocalciferol) has potency that is less than 30% of that of vitamin D3 (cholecalciferol) in humans, and has a much shorter duration of action (Houghton & Vieth, 2006). The active vitamin D3 is present in small amounts and is more efficiently metabolized than D2 (ergocalciferol from plants) (Armas, Hollis, & Heaney, 2004).

Cholecalciferol is more than three times as effective as ergocalciferol in elevating 25-hydroxyvitamin D3 and maintaining those levels for a longer time. Cholecalciferol metabolites have superior affinity for vitamin D-binding proteins in plasma, relative to ergocalciferol (Allain & Dhesi, 2003).

“PARACRINOLOGY” IS LOCAL CONTROL OF CELL SIGNALLING

Over 36 tissues, particularly within the immune system and various epithelial cells of the tissues, are able to express 1-α-hydroxylase enzymes and to synthesize calcitriol locally. Activation of Vitamin D3 is facilitated by these hydroxylase enzymes

The amount of active Vitamin D3 calcitriol that tissues can produce locally depends on the availability of the stored form, 25(OH) D3.

FUNCTIONS OF VITAMIN D3

The more recent description of the function of vitamin D includes three concepts:

(1) The bulk of the daily metabolic utilization of vitamin D is by way of the peripheral pathway.

(2) Locally synthesized concentrations of the stored 25(OH) D3 calcitriol are higher than typical serum concentrations of active 1-25(OH)2 D3 (calcitriol) which is broken down immediately after it acts, and no calcitriol enters the circulation due to action of the degrading enzyme 24-hydroxylase. However, blockage of the receptors by L form bacteria results in dramatically elevated production of the active D3 in the tissues which is reflected in elevated levels in the circulation.

(3) Vitamin D is biphasic. Low levels of the active vitamin D3, calcitriol stimulates the cell to produce the proteins needed for tissue-specific responses. High levels of active 1-25(OH) 2 D3 bind to the VDR with a resulting inhibitory reaction the immune system. Immune system signaling is downregulated, resulting in suppressive action, similar to steroids.

The downregulated VDR, greatly reduces the ability of the cell to respond adequately to pathologic and physiologic signals, (Heaney, 2008). For example, the ductal epithelium of the breast requires vitamin D3 to mount an adequate response to cyclic variation in estrogen and progesterone (Zinser, Packman, & Welsh, 2002). Dysregulation of cellular cycles results in abnormal cell proliferation and disease.

KIDNEY ACTIVATION OF VITAMIN D3 INCREASES CALCIUM UPTAKE

Inactive vitamin D3 is further metabolized by the enzyme CYP27B1 in the kidney to produce the active 1-25(OH) 2 D3 (calcitriol) in response to calcium needs. When dietary calcium intake is inadequate to satisfy the body’s calcium requirement, 1, 25(OH) 2 D3, along with parathyroid hormone (PTH), mobilizes calcium stores from the bone. In the kidney, 1, 25(OH)2D3 increases calcium reabsorption by the distal renal tubules (Institute of Medicine (US), 2011).

“AUTOCRINOLOGY” IS INTRA-CELLULAR CONTROL OF CELL SIGNALLING

Vitamin D has roles in a variety of biological actions such as calcium regulation, cell replication and cell differentiation. Most of these biological actions of vitamin D are now considered to be exerted through the nuclear vitamin D receptor (VDR)-mediated control of target genes (Kato, 2000).

The vitamin D receptor binds several forms of vitamin D3. Its affinity for active vitamin D3 is 1000 times more than inactive vitamin D3.

Vitamin D metabolism in the nucleus acts like a genetic switch, and is needed in the interaction of Vitamin D – VDR – RXR activation in the vitamin D response element (VDRE) complex of the DNA. Binding of this complex activates the RNA polymerase stimulation and suppression functions in the genetic transcription of DNA within the nucleus.

The Vitamin D Receptor (VDR) is also known as Calcitriol Receptor. It is also termed the NR1I1 (nuclear receptor subfamily 1, group I, member 1).The Vitamin D receptor (VDR) is a nuclear receptor and a member of the steroid hormone receptor family of nuclear receptors.

IMMUNE CELLS HAVE VITAMIN D RECEPTORS (VDR)

It is now recognized that vitamin D plays a critical role in the regulation of the innate and the adaptive immune systems (Aranow, 2011). The discovery of VDRs in activated immune cells particularly has stimulated research into the role of vitamin D in immune function (Schwalfenberg, 2011).

The binding of 1, 25-dihydroxyvitamin D3 (1, 25(OH) 2D3) with the Vitamin D Receptor (VDR) results in the modulation of many biological activities in tissues and systems including:

CNS – neural tissue
The immune system
The Endocrine (hormonal) systems, including calcium and phosphorous homeostasis
Cellular control, including apoptosis and cell differentiation

HORMONAL OR GENE ACTIVATION BY ACTIVE VITAMIN D3 IN THE TISSUES

The active calcitriol vitamin D3 binds to vitamin D receptors in the nucleus of the cell and works in conjunction with a retinoid X receptor (RXR) partner, binding to the vitamin D response elements (VDRE) located in the promoter regions of genes. This entire group then allows the binding of co-activator protein complexes linking the RXR-VDR group to transcription sites. The resulting enzymes can alter the function of the tissues (“Monograph: Vitamin D,” 2008). This is called the endocrine function of D3 because the hormone moves into the circulation to affect cells distant from the source of production (J. Zhang et al., 2011).

MITOCHONDRIA AND VITAMIN D RECEPTORS

Note mitochondria location proximity to VDR indicating that mitochondrial function is very important to the proper functioning of the VDR and mitochondrial disease will affect this main nuclear receptor leading to many diseases.

Recent findings show that mitochondria possess vitamin D receptors. The receptors for vitamin D are controlled by the Permeability Transition Pore in Human Keratinocyte Cell Line (Silvagno, Consiglio, Foglizzo, Destefanis, & Pescarmona, 2013).

Mitochondrial dysfunction leads to disease (adapted from (Marcovina et al., 2013)

STRESS AND MITOCHONDRIA DISEASE

Mitochondria are the main producers of reactive oxygen species (ROS) leading to the development of hypertension and insulin resistance which contribute to cardiovascular disease. Reactive oxygen species /ROS is the common denominator in regulating the immune system. Hypertension and vitamin D diabetes is also associated with oxidative stress from ROS. High levels of ROS damage cells, having the potential to trigger both mitochondrial-mediated apoptosis (cell death) and the degradation of the mitochondrial DNA (Ferder, Inserra, Manucha, & Ferder, 2013; Min, 2013; Montezano & Touyz, 2012).

Vitamin D receptors and Angiotensin Type II receptors in the cell are located in close proximity to mitochondria (Abadir et al., 2011; García et al., 2012; Silvagno et al., 2010).

A key to understanding the interaction of mitochondria and chronic diseases, such as hypertension and diabetes, is understanding how mitochondria are affected by VDR through ATP/energy related diseases. In the big picture, mitochondrial support of the vitamin D receptors is important in maintaining proper microme balance as these receptors modulate immune function.

OBESITY AS AUTOIMMUNE DISEASE

Obesity meets three out of four requirements to be designated as an autoimmune disease, lacking only the expression of auto antibodies (Autoimmunity Research Foundation). Obesity is a chronic disease which involves the following dysfunctions which indicate autoimmune disease.

Extensive infiltration of adipose tissue by immune cells;
The cloning or increase of T cell receptor (TCR);

Hi levels of Th1 cytokine secretion, activation of the complement system, activation of inflammatory M1-macrophages and low numbers of regulatory T (Treg) cells. Obesity results in elevated inflammatory markers which show up for both in women and men (Mortensen et al., 2009; Nijhuis et al., 2009).

Obesity lacks only the expression of a self-antigen in the adipose tissue targeted by auto reactive immune responses to be officially classified an autoimmune disease.

Both experimental and clinical evidence involve stress response that activate the body’s system for controlling blood pressure called the Renin Angiotension System (RAS). Activation of RAS induces insulin resistance, resulting in increases in reactive oxygen species (ROS) levels. High levels of ROS are harmful to cells, having the potential to trigger both mitochondrial-mediated apoptosis and the degradation of the mitochondrial DNA (Seddon, Looi, & Shah, 2007).

This points to the relevancy of vitamin D receptor status and hypertension. When imbalanced, stress leads to imbalance in the microme and is a direct cause of the proliferation of opportunistic L-form creation (Markova, Slavchev, Michailova, & Jourdanova, 2010). Under stress bacteria can undergo drastic morphological and functional changes, leading to L-form conversion whereby the bacteria now exist without rigid walls (Glover, Yang, & Zhang, 2009).

The mutation of the bacteria in the microme is due to the response elicited by the microbes to nitric oxide stimulation released under stress (Yan & Kustu, 1999). The beta receptors stimulate release of nitric oxide by the enzyme eNOS (Fleming, 2010).

Genetics and Bioenergetics

Genes function as blueprints used to make proteins. Enucleated cells eventually die, not due to an immediate absence of genes, but because they cannot replace their worn-out proteins. The nucleus functions as the equivalent of the cell’s gonads, its reproductive system to produce new cells and proteins.

Myth: The DNA that is located in the cell’s nucleus functions as the brain of the cell.

Fact: The DNA in the nucleus provides the cell’s reproductive function. The double walled cell membrane surrounding the cell functions as the cell’s brain. This double wall could be more aptly named the cell “mem-brain”, as it coordinates responses to the environment by providing communication and control.

YOU INFLUENCE GENETIC EXPRESSION

You are never simply a victim of your genetics. According to Bruce Lipton, world renowned microbiologist and author of The Biology of Belief, your perceptions, thoughts, emotions and other elements that make up your environment provide control of the expression of your genetic makeup (Lipton, 2005). Environmental and nutritional factors modulate the genetic risk of obesity and disease patterns-but you also influence the expression of your genes by your thoughts, beliefs and lifestyle choices.

Figure 3.1 Chromosome in nucleus of cell showing chromatid with DNA

MITOCHONDRIAL DNA

In addition to our 23 chromosomes, human cells have separate genome of mitochondrial DNA (mtDNA), inherited from the mother. Mitochondrial DNA is a circular genetic code located on membrain inner of the mitochondria. Mitochondria organelles occupy the cellular cytoplasm and therefore the mDNA is outside the cell’s nucleus in contrast to our nuclear chromosomal DNA.

Mitrochondondrial DNA

SECTION VI: EPIGENETICS

Another layer of complexity has been added to mystery of DNA operations. In addition to the nucleotide code producing the enzymes needed to operate the cell, DNA expression is influenced by chemical reactions locked in place over generations and affected by nutrition and other environmental influences.

Epigenetics is defined as inherited changes in gene activity and expression, without the presence of changes in DNA sequence (Bird, 2007).

These non-genetic-sequencing alternations are regulated by two major chemical modifications; DNA methylation modifications and modification by histone proteins associated with DNA (Bernstein, Meissner, & Lander, 2007). Destructive patterns of DNA methylation influence many aspects of disease processes (Ozanne & Constância, 2007).

Advances in the understanding of epigenetics, histone modifications (Li, Carey, & Workman, 2007) and DNA methylation (Jaenisch & Young, 2008) include changes in other pathways by which epigenetics can affect genetic expression.

CHROMATIN BUNDLES

Chromatin bundles are protein complexes of Genomic DNA wrapped up with other special proteins termed histones.

The basic unit of chromatin is the nucleosome, which is composed of approximately 146 base pairs (bp) of DNA wrapped around the four core histones. This organization of chromatin allows DNA to be tightly packaged, accurately replicated and sorted into daughter cells during cellular division (Koch et al., 2007).

The shape of the chromatin architecture in the genome is organized into “open” and “closed” chromatin territories which represent higher-order functional domains and patterns of the epigenetic markers. This was discovered by scientists in a pilot project called the Encyclopedia of DNA Elements (ENCODE).

The importance of chromatin architecture plays a major role in supporting a diversity of genetic regulation by opening up opportunities for modification through epigenetic changes that control expression of health and disease (Ruthenburg, Li, Patel, & Allis, 2007)

HISTONES

Histones, also known as nucleosomes, are special proteins that bundles found on the DNA strands. Technically, the little ball-like groups of histones resemble beads on a string. DNA wraps around these little balls and coils up to regulate genetic expression. Histones are one of the specific proteins involved in cell division and cancer. (NHGRID) During cell division the DNA strands can replicate and form chromosomes which are made up of this replicated material known as RNA.

The quality control provided by histones affect the cell’s health. It is important that DNA be copied and transported correctly during cell division in order to keep genetic mistakes from occurring. DNA being wound tightly around the histones in the presence of methyl groups blocks the gene reading machinery in the epigenome.

The illustration below shows histones interacting with sections of chromosomal DNA sequences. The histones can be seen regulating genetic expression by winding around the DNA and keeping it hidden from expression by the epigenome.

Figure 3.11 Histones winding around DNA material

QUALITY CONTROL OF DNA EXPRESSION

The epigenome is signaled by chemical tags which mark the DNA genome building blocks. Epigenetic tags act like switches to turn gene expression off and on. These tags consist of compounds; some of these compounds are ingested naturally when we eat plants and animals as food; others come from man-made sources like medicines and pesticides.

DNA and epigenetics have their own pathways of activation and inhibition. The genetic expression of DNA protein is inhibited by methylation and enhanced by acetylation.

1. Methylation is addition of methyl groups (CH3) to molecules inhibit the expression of DNA. Methionine and SAMe promote methylation of DNA and histones.
2. Acetylation is the process of adding an acetyl group (CH3CO) to a molecules and enhances the expression of DNA proteins. Folates and niacin promote acetylation at DNA and histones.

HISTONE TAILS CONTROL DNA EXPRESSION

For example, the chemical known as acetyl attaches to the histone tail causing DNA to be wound more loosely around the histones resulting in more DNA replication whereas the attachment of methyl groups to the histone tails blocks DNA replication.

Epigenic tags which turn genes off and on are responding to cell signals. This is basically the control of the DNA that we are referring to as the epigenome.

DNA CONTROL IN THE BRAIN IS BY METHYLATION AND ACETYLATION

In the brain, methylation enzymes deliver methyl groups to histones surrounding the DNA located on the chromosomes in the nucleus of the cell. Methylation is achieved by adding CH3CO and removing COOH groups which causes the histones to close up tight, preventing DNA from making the transporters and receptors for reuptake into the storage vesicles of the neurons. The result in an increase in the neurotransmitters remaining in the cleft between neurons. The fewer transporters and receptors, the more brain neurotransmitters can accumulate. Pharmaceutical drugs which act as reuptake inhibitors work on this principle. Acetylation does the opposite, allowing for expression of transporters and receptors, thereby reducing the concentration of neurotransmitters in the synaptic cleft.

TISSUES AND BLOOD PATHWAYS ARE DOMINATED BY METHYLATION

The functional activity of methyl groups provides protection and control against arbitrary gene expression in the blood and tissues differently than in the brain. Methylation acts primarily by activating enzymes related to the activity of vitamins, cell signaling and the break-down of neurotransmitters such as catacholamines like histamine.

S-Adenosyl methionine (SAM-e) is made in the liver from adenosine triphosphate (ATP) and methionine by the enzyme methionine adenosyltransferase. SAM-e is involved in methyl group transfers, transsulfuration (which results in the transfer of sulfur from methionine to serine to form cysteine), and amino propylation (to synthesize polyamines in the blood and tissues (Jung, 2015). More than 40 methyl transfers from SAM-e are known, to various substrates such as nucleic acids, proteins, lipids and secondary metabolites.

Problems associated with improper methylation that might interfere with the formation of functionally proper histone beads. Scientists have discovered numerous DNA methylation markers that are correlated with cancer. It is possible that disorders related to histone distortions could also lead to premature aging, chronic diseases such as obesity, and cell death.

QUANTUM GENETICS

ENERGY AND DNA

The human body emits biophotons, also known as ultra-weak photon emissions (UPE), with a visibility 1,000 times lower than the sensitivity of our naked eye. While not visible to us, these particles of light are part of the visible electromagnetic spectrum (380-780 nm) and are detectable using modern instrumentation (Schwabl & Klima, 2005).

It is hypothesized that energy, matter and consciousness are related. Consciousness and vocalization may affect wave-activated DNA. DNA is apparently at least an important source of proton emission by cells. DNA is an ultraviolet light system producing information to run the cells (Dotta, Saroka, & Persinger, 2012). We can affect our genetic expression by our thoughts being translated into light energy in the form of photons. We also can affect our DNA expression by our words which are translated into sound or vibrational energy. (Popp et al., 1984) Scientists are exploring the possibility that DNA is positively affected by the vibration of 528 Hz. In the future, medicine may rely on the physics of quantum mechanics to make changes in the expression of DNA to restore health and re-pattern bioenergy.

SCALER WAVES (http://www.k-meyl.de/go/Primaerliteratur/Scalar-Waves.pdf)

One hundred years ago the famous physicist Nikola Tesla discovered and patented his experiments concerning the wireless transmission of energy through the use of scalar waves. (1900)1. Nikola Tesla: Apparatus for transmission of electrical energy.

(US-Patent No. 645,576, N.Y. 20.3.1900).

Prof. Konstantin Meyl, teacher and researcher in physics at a university in southern Germany is the leading scalar wave researcher. Prof. Meyl has organized a revival of Tesla. After more than 100 years on-going cover up against scalar waves, he decided 1999 to construct an experimental kit, used by thousands of researches all over the world, that that shows how Nicola Tesla worked in the late 1890’s to detect scalar waves, which are longitudinal waves, not transversal, as the electromagnetic waves. (Meyl, 1999)

According to the well-known wave equation rules of vector analysis, waves consist of two parts:

The vectorial part described by the Maxwell equations waves. The Maxwell

Equations only describe transverse waves, for which the field pointers oscillate perpendicular to the direction of propagation (Herz electromagnetic waves).

The scalar part of the wave equation describes longitudinal electric waves (Tesla plasma waves).

Maxwell’s field theory also describes vortices of the electric field. These so-called potential vortices are able to form structure and they propagate in space by reason of their particle nature as a longitudinal shock wave. The model concept bases on the ring vortex model of Hermann von Helmholtz, popularized by Lord Kelvin. These very fast vortices contract in the dimensions allowing them to tunnel. Therefore speed faster than light occurs at the tunnel effect.

Prof. Meyl extended Maxwell’s field theory for vortices of the electric field to explain scalar waves. These so-called potential vortices are able to form structure and they propagate in space for reason of their particle nature as a longitudinal shock wave. Field vortices with particle nature exhibiting high-frequency oscillation become neutral as they are permanently changing their polarity from positive to negative and back, and overtime they don´t have a charge. As a result they are able to penetrate solids unhindered. Particles with this property are called neutrinos in physics.

A Faraday cage is an aluminum case that blocks electromagnetic waves. Prof. Meyl proved that the scalar wave penetrates the Faraday cage with a speed 1.5 times the speed of light by tunneling. No Faraday cage is able to shield fast vortices. Scalar waves are able to penetrate solids unhindered. (Meyle) Konstantin Meyl: Scalar Waves, INDEL-Verlag.

(see: http://www.k-meyl.de).

SCALAR TECHNOLOGY IN EVERYDAY USE

Scalar technology is used at the entrance of department stores, where the customer

Passes between scalar wave detectors. Cell phones operate using scalar and computers run by scalar waves have much better efficiency than even quantum computers. Applications of scalar waves include wireless transportation of electric energy without losses. Tesla’s physic has been applied to the invention of electric cars with motors which do not require a battery can be charged through the air while running without pollution.

DIFFERENCES BETWEEN ELECTROMAGNETIC AND SCALAR WAVES

Prof. Meyl has outlined the difference between the electromagnetic waves defined by Heinrich Hertz in 1888 and the scalar waves as defined by Nikola Tesla in 1897:

Scalar waves are able to propagate much quicker than the speed of light.
2. Scalar waves can act as transporters for wireless electricity.
3. Scalar waves can increase by collecting neutrinos which are the equivalent of free energy.
4. A scalar wave transmitter is experienced directly, if the receiver is in resonance
5. There are no shields against scalar wave.
6. Scalar waves do not decay over distance, you can send them through the earth to the other side without loss of signal.

MAGNETIC SCALAR WAVES

Prof. Meyl detected a third kind of wave, the magnetic scalar wave, which is biological relevant. So there are three different kind of waves: the electromagnetic (Hertz), the electric scalar wave (Tesla) and the magnetic scalar wave (Meyl).

Magnetic scalar waves define the science of scalar bioresonance, also called radionics. Information transported on a scalar wave can correct dysfunctional biosystems, resulting in a re-informed bio-energetic field and energetic restructuring. The energetic information is capable of initiating a complex energetic transformation in the biological system evidenced by changes in matter (cells) which respond by morphing according to these changes in the energetic field.

MEDICAL APPLICATIONS OF SCALAR TECHNOLOGY

Scalar waves are able to explain DNA and cell communications in terms of physics giving opening up an entire new field of medicine and affordable energy.

Scalar waves are able to transmit medical information to the body in a positive context (bio resonance/frequency medicine. Scalar waves are able to be used for the negative in mind control and remote killing.

All biological systems have an electromagnetic field associated with a morphic field, together these fields control all changes at the cellular level. The DNA double helix, chromosomes, and microtubules are the antennas for our body which is a bioenergetic system. All biological systems are bioresonance systems obeying the laws of stochastic mathematic (highest probability) and can be processed by using computers called cybernetics. Medical devices combining sound, light, pulsed magnetic field and scalar bioresonance have enormous potential to diagnose and treat disease in the body.

For example, if you are in a motor vehical accident, you may experience multiple emotions including anxiety and fear. These emotional toxins become trapped in you connective tissues and gases and can lead to deterioration at a cellular level. You may also experience skelatal misalignment such as whiplash, which must also be addressed or dysfunction may follow.

Family traumas, toxins and accidents can trigger stress which blocks energy and leads to disease over time. Genes are not the mechanism of disease, but genetics are affected by energetic messages from their environment. Genes express health or disease as a response to their environment. We call this epigenetics.

Traditional Chinese Medicine utilizes this understanding of the human body to open cycles and restore health. We can use an evolving system of computer programs in modern medicine to do accomplish this goal.

The modern world has many applications of Tesla’s scalar waves for guiding information. WIFI,cell phones and the internet are prime examples of transporting energetic information without wires to a specific receiver tuned to certain vibrations. Electomagnetic waves carry general information and must travel over wire as they lose energy over time. Telephones and electrical wires currently employ this technology.

Scalar bioresidence uses the science of cybernetics, the computer genereated informational waves to re-form the bioenergetic field. The new information (energetic) starts a complex and almost instantaneous restructuring process, allowing the cells (matter) to morph, reestablishing organ (matter) health.

RADIONICS

The use of computers to restore health is called scalar bioresonance or radionics. Medical devices currently use this new technology by combining sound, light, magnetic field and scalar bioresonance. The use of scalar waves allows for remote diagnostics and therapy, reduces costs and is a non invasive and individualized approach to restoring health on all levels of the biosystem by harmonizing the patient’s own vibrations.

Old fashioned devices working with strong frequencies shaped as squared or spiked are not able to resonate with human cells, and can damage tissues. Another consideration is energetic pollution such as emissions from satellites which emit communication at around 27 KHz, the freqency controlling the glucose switch in all living cells. Degenerative diseases, cancer, metabolic disorders including diabetes and metabolic syndrome X are following the same growth curve as the increase in the number of satellites. Wireless technologies create additional negative effects on the function of hemoglobin and cellular oxygen. Applying digitalized information to balance and repair the body at the cellular level, we can overcome the negative effects of our environment. Digitalized information transmitted to the cellular matrix in cellular water, can change the inversed polarity of sick cells into the regular polarity of healthy cells. Sick cells are then able to be identified and removed by the immune system. The Geno62 is the first device to apply this technology to reactivate the self healing process.

Modern naturopathic medicine utilizes funtional medicine to regulate and support the bodys own healing force. Systemic Functional Biofeedback uses the body’s frequencies and triggers self-healing by balancing the autonomic dysreglation. An increasingly large number of patients complain of disorders that do not correspond to any pattern recognized by the diagnostic tests used in conventional medicine; these patients require additional diagnostic and therapeutic techniques offered by complementary medicine.

Heart Disease for Healthcare Practitioners

TRUTH ABOUT CHOLESTEROL

Turbulence results in creation of a blood clots that can block blood flow to the brain and heart. Because plaque contains cholesterol, it was theorized that dietary cholesterol would raise blood cholesterol which would infiltrate into the walls of the arteries and cause a blockage. The theory was falsely confirmed by a physiologist named Ancel Keys in 1956.

In 1997 Dr. Keys admitted that this cholesterol based turbulence theory was flawed. He said, “…there is no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along.”

After nearly seventy years, the then current director of the 1948 Framingham Heart Study admitted that your diet has nothing to do with your cholesterol levels.

This study of 5,000 patients, done under the direction of the National Heart Institute, had concluded that cholesterol levels were related to risk for coronary artery disease

In 1976, another large study of over 4,000 patients in Tecumseh, Michigan was published showing that there is no relationship whatsoever between the amounts of saturated fat eaten (animal fat, coconut oil, palm oil) and the levels of blood cholesterol. As a side note, it is important to clarify that these studies did not address the plastic fat called transfat.

Figure 6.15 Cholesterol metabolism and statin drugs

HMG (HYDROCYMETHYLGLTARIC ACID) ENZYME PRODUCTS

Cholesterol is one of three products produced from HMG (Cholesterol, CoQ10 and Dolichol). The enzyme HMG-CoA Reductase is required to start the process of cholesterol metabolism. Statin drugs inhibit this enzyme. The above diagram illustrates the cholesterol pathway and the resulting substrates.

The cholesterol pathway process begins with the two carbon molecule, acetyl-CoA to form hydrocymethylglutaric acid (HMG). Statins are known as HMG-CoA Reductase inhibitors because they prevent the formation of HMG-CoA, and they thereby also block cholesterol production. Unfortunately, statins also interfere with the formation of important metabolic processes and can lead to numerous adverse effects.

DRUGS FOR LOWERING CHOLESTEROL MAY NOT PREVENT HEART DISEASE

Studies prove no relationship between cholesterol and coronary artery disease. According to The Center for Practice Management and Outcomes Research, current clinical evidence does not demonstrate that titrating lipid therapy to achieve proposed low LDL cholesterol levels is beneficial or safe (Hayward, Hofer, & Vijan, 2006). In addition, litigation has taken place against manufacturers of statin drugs for allegedly failing to warn doctors and patients about the increased potential risk for type 2 diabetes in women.

CHYLOMICRONS

As VLDL chylomicrons lose triglycerides, they become smaller and smaller and are gathered up by HDL cholesterol which takes them back to the liver. Because HDL reduces the small remnants of VLDL cholesterol in the blood, HDL has been labeled as “good cholesterol”.

THE PROTECTIVE ROLE OF LDL AND VLDL CHOLESTEROL

LDL cholesterol acts like a sponge for toxins in your gut. More than half of the bacterial toxin lipopolysaccharide (LPS) is bound up in these chylomicron particles to help remove them from your body and protect you from disease. Blood serum LPS toxin is found to bind predominantly to LDL and VLDL. The binding of LPS to LDL and VLDL emphasizes their crucial role in the scavenging of LPS bacterial toxins that lead to inflammation.

ASSOCIATION IS NOT CAUSATION

The so called “bad cholesterol” has gotten a bad reputation by association with vascular calcification or hardening of the arteries. (Vreugdenhil, Snoek, van ‘t Veer, Greve, & Buurman, 2001).

Association is often confused with causation, a situation of mistaken identity in this case, often distracting medical professionals from treating the underlying causes contributing to the formation of the plaque.

Fire engines are often present at the scene of the fire, but they do not cause the fire and are there to help put it out; inflammation in your gut leads to an elevation in cholesterol as protection of the digestive tract from the inflammation.

TREAT THE WHOLE PERSON AND NOT JUST THE LAB RESULTS

Typically, statins are prescribed in cases of cardiovascular disease. The doctor measures cholesterol and gets cholesterol numbers from the lab report. The patient is given a prescription drug to decrease cholesterol if it is over 200 mg/dl. Most labs currently recommend that cholesterol levels be lower than 200 mg/dl. This practice instills a protocol for treating a number and not the individual and therefore the inflammation that is triggering elevated cholesterol remains. Inflammation can lead to an increased risk of stroke and cancer if cholesterol is not present in sufficient quantities to protect the body.

CASE STUDY: CHOLESTEROL REMOVES TOXINS Dr. Turcotte

In one case study my patient came in after having received six rounds of the antibiotic Cipro.

She developed high cholesterol a year later from gastrointestinal dysbiosis because all her good bacteria were killed off. She also consumed foods that caused inflammation in her digestive system, and her own body was making cholesterol to carry away the toxins.

Serrapeptase, an enzyme derived from silkworms, which has anti-inflammatory effects and can help prevent blood clots and can also dissolve biofilm. The natural antibiotic SuperNatent Plus was added to kill the pathological bacteria. A strong probiotic of 100 billion friendly bacterial strains was given to restore the health of the gut. Food sensitivity testing with ALCAT revealed which foods should be avoided as a source of an inflammatory response for her individual genetics.

Her cholesterol dropped down to normal, and no statin drugs were required.

SMALL DENSE CHOLESTEROL AND RISK FOR CARDIOVASCULAR DISEASE

Lp (a), LDL IV and Very Dense LDL are the small dense LDL. They are easily oxidized and are more dangerous than other types of cholesterol. Lp(a) does not respond to traditional LDL-lowering drugs.

Lifestyle modifications such as diet, weight loss, and exercise generally have little or no effect on Lp(a) levels. Compared to the well reported LDL-lowering effects of statins and bile acid sequestrants (resins), these drugs generally have little, or no effect on Lp(a) levels (McKenney et al., 2007; M. Miller, 2009). Niacin supplements has been proposed as the most effective option to treat Lp(a) elevations (McKenney et al., 2007).

STANDARD CHOLESTEROL TESTING IS OUTDATED

Current standard cholesterol testing does not provide an adequate assessment of cardiovascular risk. A true risk assessment for the development of plaque must address the size and density of the particles in the blood that make up the LDL cholesterol count. Researchers now know that plaque accumulations are related to the percentages of the small dense cholesterol that become oxidized.

ASSESSING CHOLESTEROL RISK

Plaque risk can be assessed using lab work that can identify the risk of cardiovascular disease such as the subclasses of lipids that are known and emerging risk factors for cardiovascular disease, such as LDL particle size and lipoprotein (a).

Figure 6.14 Lipoprotein sizes and density

CHOLESTEROL PARTICLE SIZE AND RISK

The pie chart below shows the risk levels associated with the cholesterol components found in plaque. Interpretation of particle size helps the doctor to individualize treatment based on the underlying cause of the problem within the lipid metabolism.

Table 6.3 Risks associated with cholesterol particle size

THE LITTLE GUYS ARE THE PROBLEM

The only lipoproteins found in plaque at biopsy are IDL, LDL-R and the Lp(a).

These need to be addressed appropriately with NiaCel (riboside nicotinamide) and lifestyle choices to reverse mitochondrial damage, address genetic mutations and correct gut imbalances. These first restorative steps should be implemented before considering the use of statins as statin drugs may not lower Lp(a) and cause potentially cause additional unwanted dangerous side effects.

UPDATED TESTING

The NMR LipoProfile test is a diagnostic tool used to identify and manage risk for lipid-related heart disease. The NMR LipoProfile test has proved to be a superior predictor of CHD outcomes than standard lipid tests in clinical trials. Prediction by the number of LDL particles (LDL-P) was independent of traditional lipids (www.labcorp.com).

Lyme Disease for Healthcare Practitioners

Internal toxicity is like a swamp

DISEASE RESULTS FROM CHANGES IN MICROBIOME

Inflammatory diseases are now being recognized as associated with shifts in microbiome composition and not typically due to any single pathogen. Inflammatory diseases result from alternations in the complex microbial communities found inside out body (Proal, Albert, & Marshall, 2014). Disease causing microbes are capable of living inside immune cells and altering these cells’ ability to identify and kill microbial invaders. Microbial imbalance is now associated with many chronic diseases including Crohn’s disease, ulcerative colitis (Morgan et al., 2012), irritable bowel syndrome (Franceschi et al., 2009), psoriasis (Giongo et al., 2011), type 2 diabetes (Larsen et al., 2010) and cardiovascular disease (Rajendhran, Shankar, Dinakaran, Rathinavel, & Gunasekaran, 2013).

LYME DISEASE

burgdorferi (Bb), Lyme Disease, can exist in at least two and possibly three different forms including a spirochete or spiral bacteria, a spheroblast or L form and a cystic form, possible the same as the L form (Burrascano, 2008).

Bb can also shift among the three forms during the course of the infection, making it necessary to cycle different classes of antibiotics during the course of treatment or to prescribe a combination of dissimilar agents. The cyst is able to remain dormant and cannot be killed by antibiotics which kill Lyme. When the environment is favorable to its growth, it reverts back to the spirochete.

Let’s consider how the nervous and immune systems react to an invading virus such as the bacterium Borrelia burgdorferi (Bd) which is transmitted to humans through the bite of infected blacklegged ticks. Lyme disease is thought to affect 300,000 people annually in the USA alone (“Cardiff University T-cell modulation group,” 2009).

Over 250 peer-reviewed scientific articles demonstrate the causal association between Lyme/tick-borne disease and mental illness. Thousands of peer-reviewed journal articles demonstrate the causal association between infections and mental illness and inflammation (Bransfield, 2012).

Ongoing infection and inflammation lead to encephalopathy and gradually increasing mental symptoms. Cognitive symptoms begin as executive dysfunction and mild cognitive impairments and may gradually progress to dementia while emotional symptoms begin with insomnia, reduced frustration tolerance, irritability and dysthymia and may progress to anxiety disorders, depression, impulsivity and personality disorders and subsequently psychosis and/or suicidal and homicidal tendencies. Many of these symptoms appear to be mediated by immune mechanisms (Bransfield, 2012).

Lyme disease, caused by the bacterium Bb, has been recognized to cause multi-systemic signs and symptoms, including peripheral and central nervous system disease. Some immune mediated pathophysiology seen in Lyme disease is a failure to shift from Th1 to Th2 immune balance. The ongoing immune activation causes the cytokine storm in chronic Lyme. In these patients, the innate immune system is not turned off. Specific genetic types are more prone to this phenomenon (Newell et al., 2010).

There are some other immune pathological processes associated with Lyme disease. The neuropsychiatric Herxheimer reaction appears to be an adverse immune reaction to treatment although the exact mechanism is not well clarified (Maloy, Black, & Segurola, 1998). Anti-neural antibody reactivity was found to be significantly higher in the Lyme patients with prior treatment and persistent symptoms. Over time, the Lyme spirochete Bb may be driving production of these antibodies (Stricker & Johnson, 2010).

Borrelia produces neurotoxins which cause symptoms of encephalopathy, ongoing inflammation, virus like symptoms in late Lyme and blockage of hormone receptors. Fibers such as Welchol pills can trap the neurotoxins before it is reabsorbed after being excreted via bile into the intestinal tract. Symptoms will flare in cycles of every four weeks and the symptoms are exaggerated when Bb is in a vulnerable growth phase and being killed off several days after onset of appropriate therapy. Repeated treatment failure is a sign of an immune deficiency. Absolutely no immunosuppressant treatment, especially local steroids or injections, should be used as this allow Bb to further damage the immune system and entrench itself without restriction. I use bentonite clay for my clients to absorb bacterial toxins and prevent Herxheimer reactions. Taken from a half hour before to two hours after food or medication, the fibers help clear the body of toxins.

No coffee or alcohol, low carbohydrates, enforced rest, food sensitivities must be ruled out. Sugar, flours soft fruits, fruit juices, starchy vegetables and artificial sweeteners are not allowed. Stevia is fine. Three meals per day and only carbohydrate free snacks can be taken at night. Blood sugar and insulin must be maintained.

Exercise is good, along with nutritional supplements. Lyme patients will not return to normal unless they exercise. Bp will eventually die if exposed to oxygen and are is also very sensitive to heat. Exercise can increase tissue perfusion and increase core body temperature. Gentle intermittent non aerobic exercise can also enhance T-cell function to kill the Bb. One hour sessions should include light resistance training with many repetitions or stretch and tone. Exercise days must be separated by 3-5 days of total rest and quality sleep. As stamina improves, less days of rest are allowed, but never consecutive exercise days until the Lyme disease is completely cleared because physical rest for recovery is essential for the healing process.

Co- infections need to be addressed including tick born bacteria, viruses, chlamydia and mycoplasmas (yeast and fungi). Multiple systemic infectious disease syndrome (MSIDS) must be addressed in chronic illness, including Lyme disease. There is more to chronic Lyme disease than Lyme alone (Horowitz, 2013).

There is a connection between those struggling with chronic Lyme disease and ongoing exposure to toxic molds and mycotoxins. Exposure to mold can make one more susceptible to Lyme disease and vice versa. Environmental exposures to toxic molds, biofilms colonization from fungal infections and immune system challenges must be addressed in addition to Lyme as contributors to both the severity and duration of the illness (Ritchie C. Shoemaker, 2010; Ritchie C. Shoemaker, Schaller, & Schmidt, 2005).

TESTING FOR LYME DISEASE

Provoked Urine PCR Lyme Panel is considered the most reliable test. The panel will demonstrate the presence of Lyme and coinfection DNA. PCA does not depend on the immune system to produce antibodies. Traditional PCR Lyme testing uses blood sampling, but lyme does not live in blood and the testing is often negative. Lyme lives mainly in connective tissue. Deep bodywork or rigorous movement will stimulate movement of the Lyme pathogens from the connective tissue through the lymphatic system. The lymph is moved into the blood and then excreted through the urine. The first urine following a Rolfing session is the ideal test sample.

DNA Connections offers the Lyme Urine panel tests four different genes associated with Borrelia burgdorferi and eight coinfections. They also offer a DNA Connections Full View Panel which includes over 88 pathogens, including bacteria, viruses, fungi, and parasites along with HPV16, HPV18, botulism and tetanus.

DNA Connections

5082 List Drive

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http://www.dnaconnections.com

719-219-2826; fax 888-843-5832

info@dnaconnexions.com

The IgM and IgG western blot lab detects the presence of antibodies to Lyme and coinfection. IgG and IgM oscillate back forth in chronic Lyme and IgM can be positive throughout the course of the infection.

CD57 is a blood test that can be used to guide clinical treatment.

The iSpot Lyme test measures T lymphocyte activity against Borrelia burgdorfer and can be used to monitor the effectiveness of treatment.

iSpot Lyme

http://ispotlyme.com

TOXICITY RELATED IMMUNOSUPPRESSION AND LYME DISEASE

Chronic Lyme disease is a complex problem equivalent to cancer which cannot be cured by antibiotics or targeting the pathogen directly. Factors such as heavy metals, toxins and immune suppression must be addressed in an overall approach, much like treatment of cancer.

Chronic Lyme disease is also known as multiple systemic chronic infection syndrome (MSCIS) and involves multiple infections including viruses, parasites, bacterial, spirochetes, fungi, and mold. These infections further immune deficiency, damage mitochondria and lead to multiple disturbances in physiology. Antibiotic therapy often leads to biofilm formation, disturbance of gut microbiology and acidic conditions allowing for growth of mold, fungi and parasites. Silver nanoparticle therapy provides broad spectrum antimicrobial therapy, immune and inflammation modulating benefits and biofilm disruption, making it effective in treatment for MSCIS.

Toxic tissues are not able to mount an immune response. Bacterial DNA and antibiotics can remain lodged in tissues, damaging mitochondria and preventing the body to heal. Computer and microwave emission of electromagnetic fields (EMF) can weaken the immune system by adding to the increasing burden of toxins accumulating in our society over the past 40 years.

The glymphatic system is a brain wide pathway the removes fluid waste products through an exchange of cerebrospinal fluid with interstitial fluid. Glial cells called astrocytes form conduits to move the toxins out of the brain through veins and into the deep cervical lymph nodes. During sleep brain cells shrink by 40% increasing the space for toxin removal. If waste is not removed at night during sleep, neurodegenerative disease is a result. Lyme is a noted neurological pathogen and the glymphatic system must be optimized in addressing treatment for Lyme. Deep Purple from Biopure contains powerful antioxidants to help with detox, along with homeopathic drainage and lymphatic massage to reduce toxic loads on the central nervous system.

The hormone melatonin has been shown to remove mercury, aluminum, cadmium, viruses, parasites and bacteria such as Lyme from the brain through the glymphatic system channels. Melatonin induces sleep and is the most potent antioxidant used by the brain to heal itself.

Environmental exposure to aluminum is increased by exposure to glyphosphate, the active ingredient in the herbicide Roundup used to harvest wheat. Aluminum and glyphosphate disrupt the detoxifying enzymes called CYP450 which plays a role in the production of melatonin. Glyphosphate also disrupts the production of the amino acid tryptophan by gut microbes. Tryptophan is needed to produce melatonin. This disrupted melatonin production impairs the brain’s ability to detoxify. Seneff, Aluminum and glyphosphate (Swanson & Li, 2015) Mercury toxicity leading to suppression of the immune system can result in an inability to clear Lyme infections. Mercury exposure is associated with reduced cytokine release from immune cells called T cells in response to Lyme infection. (Ekerfelt, Andersson, Olausson, Bergstrom, & Hultman, 2007)

BIOFILMS AND LYME DISEASE

Researchers have found that Lyme disease from the bacteria Borrelia burgdorferi has biofilms (Brihuega, Samartino, Auteri, Venzano, & Caimi, 2012). Therefore biofilms must be addressed if the Lyme disease and its co infections are to be eradicated by the immune system.

BIOFILMS AND LYME DISEASE

Biofilms form when there are enough bacteria present to reach a critical mass called quorum sensing. Quorum sensing bacteria then are able to use signaling molecules to communicate with each other from cell to cell. This chemical communication, via signaling molecules throughout the biofilm, provides a competitive advantage because these bacteria are collaborating for activities such as finding nutrients. Biofiom formations help the pathogens to grow more rapidly and fight off competing bacteria, and this same biofilm provides protection against the body’s natural immune system responses and the effects of antibiotics (Annous, Fratamico, & Smith, 2009).

Figure 10.3 Biofilm protecting bacteria from antibiotics and immune system cells

BIOFILM FORMATION

Biotoxins are toxins created by living organisms. Mycotoxins are a type of biotoxins produced by molds and yeasts, which are both are fungal organisms. Some of the more common mycotoxins include aflatoxin, ochratoxin and trichothecene, which can be measured in a urine sample for those suspected of having a mold associated illness.

Stachybotrys is the most known pathogenic mold. It is black mold which produces the mycotoxin tricholthecene. It grows indoors and is best tested with dust sampling using ERMI by Mycometrics (Forsgen et al., 2014).

In addition to an acute allergy or infection, chronic symptoms can be caused by mold toxicity from external mycotoxin exposure or internal colonizing fungal organisms. Mold toxicity can damage the immune system as a result in uncontrolled outpouring of inflammatory cytokines producing the same symptoms seen in Lyme disease. Molds can also affect the endocrine system including sex hormones, thyroid function and adrenal function. Myotoxic exposure can lead to food allergies, chemical sensitivities and postural orthostatic tachycardia syndrome (POTS) (Forsgen et al., 2014).

Fibromyalgia and chronic fatigue syndrome (CFS) have both been associated with mycotoxin exposure. Research shows that mycotoxins are a possible cause of mitochondrial dysfunction in CFS patients resulting in fatigue and cognitive issues. Many symptoms of CFS overlap with mycotoxin exposure, including abnormal cytokine profiles, autoimmunity, immune deficiency, endocrine abnormalities and oxidative stress (Brewer et al., 2013).

A disrupted intestinal immunity can result in dysbiosis allowing the entry of endotoxins into the bloodstream. The resultant low grade chronic inflammation can lead to mitochondrial damage and lowered fat burning L form bacteria interfering with the functioning of the vitamin D receptors and causing excessive production of the biphasic steroid 1-25(OH)2 D3. This in turn leads to autoimmune disease, and suppression of other nuclear receptors that signal for fat burning and detoxification signaling. The importance of balancing the gut flora and establishing the functional capacity of the VDR are paramount in restoring health and solving obesity.

MYCOTOXINS CAN CAUSE CO-INFECTIONS

CO INFECTINS WITH LYME DISEASE

burgdorferi (Bb), Lyme Disease, can exist in at least two and possibly three different forms including a spirochete or spiral bacteria, a spheroblast or L form and a cystic form, possible the same as the L form (Burrascano, 2008).

REVISED GUIDELINES FOR TREATING LYME DISEASE

Experts are proposing new treatment guidelines for Lyme disease (D. Cameron et al., 2004; D. J. Cameron, Johnson, & Maloney, 2014).

The 2014, an International Lyme and Associated Diseases Society (ILADS) evidence based treatment guidelines working group, led by Cameron, DJ, Maloney B and Johnson (with contributions from the entire ILADS board of directors and outside reviewers), indicated that the effectiveness of treatment for persistent symptoms following standard antibiotic therapy alone for Lyme disease to be lower than commonly believed.

In a well-designed trial of antibiotic retreatment in patients with severe fatigue, only 64% in the treatment arm obtained a clinically significant and sustained benefit from the additional antibiotic therapy, and results were substantially different from the effectiveness rates seen in the four NIH-sponsored retreatment trials using more varied approaches. The experts recommended that providers offer therapeutic options based on clinical judgment instead of a single approach and that antibiotic treatment may not always be the best way to treat Lyme disease. (D. J. Cameron et al., 2014).

In treating Lyme’s Disease we must correct the malfunction of multiple body systems:

Address brain, nervous system and genetic antibody deficiencies results within 12 hours to prevent complicating conditions due to the Lyme spirochete which if left untreated can invade the brain and every cell in the body/immune system (leading to depression, anxiety and cognitive disruption). IV: Sarsaparilla Root, specifically Smilax Glabae, which helps to bind neurotoxins and flush them out of the body. Sarsaparilla was used in the 1800s to successfully treat the spirochete bacteria syphilis. Available at http://hawaii-pharm.com/
Treat biofilm-producing drug resistant microorganisms resulting from aggressive antibiotic therapy. Intestin-ol from Otho Molecular Products provides a blend of three essential oils that act in synergy to promote healthy microbial balance and immune support of the gastrointestinal (GI) flora by promoting balanced immunity, Intestin-ol contains potent thyme, oregano and clove essential oils. These have been used for centuries to promote microbial balance and to help protect the immune system from microbial stressors. The oregano oil used in Intestin-ol is standardized to contain up to 75% carvacrol, a powerful antioxidant and potent microbial balancing agent in the GI system. Essential oils from thyme, clove, and oregano interfere with the starting phases of Candida biofilm production as well as with mature biofilms.

III. Address leaky gut, VDR blockage and dysbiosis and other sources of suppression of the immune system. In addition to high potency probiotics, IgG Protect from Ortho Molecular Products is a highly concentrated (40%) immunoglobulin G (IgG) formula from colostrum extracts that provides essential nutrition for improved immune health. Colostrum naturally contains immune factors, amino acids, nucleotides and growth factors which provide several benefits to human immune health by functioning against pathogenic organisms.

Provides Concentrated Immunoglobulins to Enhance Mucosal Immunity
Stimulates the Body’s Normal Gut Repair Mechanisms
Helps to Enhance the Elimination of Microorganisms
Helps Maintain Microbial Balance

IV: Broad-Spectrum Antimicrobial: ACS 200 EXTRA STRENGTH by Results RNA is the only immune system support formula proven to achieve 99.9999% (complete) kill against 660 microorganisms; including Borrelia burgdorferi, Bartonella henselae, Powassan virus, Rhinovirus, Legionella pneumophila, Pseudomonas aeruginosa, Salmonella bongori, Candida albicans & MRSA as proven via in vitro, kill-time studies.

How do naturopathic doctors treat patients with diabetes?

Licensed naturopathic doctors are trained in both conventional and integrative approaches to treating all types of diabetes, including types 1 and 2, gestational diabetes, and prediabetes.

Focusing on the whole person, naturopathic doctors take the time to identify and address the genetic, environmental and behavioral/lifestyle factors that play significant roles in diabetes. Lifestyle changes around diet and exercise are essential in the treatment of all types of diabetes. However, many patients have a difficult time making such changes. Advanced training in nutrition and counseling enables naturopathic doctors to be highly effective in engaging patients to take control of their own health.[1] Additionally, because they emphasize educating the patient, naturopathic doctors are often successful in helping individuals with diabetes to make and sustain shifts in nutrition and physical activity that can improve or reverse progression of the disease.2
Naturopathic doctors are also trained in the pharmacological treatments which are commonly prescribed by conventionally trained MDs. In some states, NDs have scope/authority for prescription pharmaceutical management, which may be necessary depending on the patient’s condition. In many cases, NDs will work in conjunction with conventional endocrinologists and diabetes specialists to co-manage patient care.

Diabetes is one of the most common health conditions in the United States. On the rise for the last decade,3 today an estimated 30.3 million people—representing 9.4 percent of the population—live with the disease.4 There are several types of diabetes: gestational, which occurs when a woman develops diabetes during her pregnancy; type 1, caused by an auto-immune disease that destroys cells in the pancreas, and; type 2, caused by lifestyle choices and occurring in 90-95 percent of people with diabetes, including children. Prediabetes is a condition in which blood sugar levels are higher than normal, but not yet high enough to be considered full-blown type 2 diabetes. Without lifestyle changes like those advised by naturopathic doctors, most people with prediabetes go on to develop type 2 diabetes.

Type 2 diabetes is related to insulin resistance, which means the body’s cells are no longer able to get glucose out of the blood and use it properly. Therefore glucose levels in the blood stay high. Over time, having glucose levels too high in your blood can cause serious health problems such as heart disease, nerve damage, eye problems, and more.

Regardless of the type of diabetes, naturopathic treatment strategies aim to get a patient’s blood sugar levels back within a healthy range. For example, even though type 2 diabetes is caused by a number of factors, most of them are controllable, including diet, physical activity, stress, eating habits and behaviors, and obesity. Nutritional deficiencies, environmental toxins and hormonal imbalances can also contribute to insulin resistance, and require special training to evaluate. A naturopathic doctor explores all of these factors to determine which ones should be prioritized and how they can be modified.

A visit with a naturopathic doctor to address diabetes will include a comprehensive intake and physical exam, along with review of health history, diet, and lifestyle factors. Any recent lab work will be reviewed, and new labs will be ordered if needed.

Generally, a naturopathic treatment approach for diabetes includes a combination of:

Review of diet diary and/or blood sugar log
Dietary guidance to strive for more balanced blood sugar throughout the day
A thorough review of other systems impacted by diabetes, including the heart, kidney, liver, and brain
Lifestyle counseling strategies to engage patients in their own disease management and encourage lifestyle improvement
Preventative strategies to avoid disease worsening
Herbs and/or nutritional supplements to correct nutritional deficiencies and/or support blood sugar management
Consultation on medication management (including insulin)

Following an initial appointment, a naturopathic doctor will determine which areas are the highest priority to address and which approaches are likely to be most effective. These will be used to create a personalized treatment plan.

How do naturopathic doctors help people manage chronic pain without highly addictive opioids?

Anyone who has ever experienced chronic pain knows how debilitating it can be. Yet the most commonly recommended conventional medical solution—prescription opioid painkillers—is turning out to be worse than the problem. Opioids may stop the pain, but at a high price: growing numbers of deaths due to opioid overdose and higher rates of addiction and misuse.

As a medical discipline that emphasizes a holistic approach and natural treatments, naturopathic medicine offers safe and effective alternatives to highly addictive drugs for managing chronic pain. Licensed naturopathic doctors are educated at four-year, post-graduate medical schools to start with non-drug approaches to chronic pain management, and use opioid painkillers as a last resort.

Naturopathic doctors are also trained to develop personalized pain management treatment plans. These plans take into account each individual’s lifestyle, nutrition, work and leisure activities, current and past stressors, and relevant previous injuries—in other words, the root causes of each person’s pain and all its manifestations. The plans use various combinations of dietary recommendations and nutritional supplements along with botanical medicines to help reduce inflammation and the pain it causes. Exercise, physical rehabilitation, and mind-body approaches that are known to reduce perception of pain are also included in the plans.

In addition, naturopathic doctors recognize the value of working closely with conventional and alternative medical providers and will make appropriate referrals for further diagnostic work-up, treatment support, or surgical intervention as indicated. In turn, a growing number of conventional medical doctors refer patients and colleagues looking for a fresh perspective for difficult-to-treat chronic pain to naturopathic doctors.

Perspective: a national crisis that is only getting worse

Drug overdose is the leading cause of accidental death in the United States. Of the more than 52,000 deaths due to drug overdose in 2015, prescription opioid painkillers such as oxycodone, hydrocodone, codeine, morphine, and fentanyl accounted for about 20,000. Of the 20.5 million Americans over the age of 12 who had a substance use disorder in 2015, 2 million involved prescription opioids.

How did this happen? According to the National Institute on Drug Abuse, in the late 1990s, pharmaceutical companies reassured health care providers that people would not become addicted to prescription opioids. As a result, physicians began to prescribe them at greater rates, leading to widespread misuse. Between 21 percent and 29 percent of people who are prescribed opioids for chronic pain misuse them; between eight percent and 12 percent develop an opioid use disorder.

Opioids aren’t the only dangerous pain management drug. Numerous studies link aspirin to a broad range of side effects ranging from gastric ulcers to cerebral bleeding. And a growing body of research links ibuprofen to adverse health effects, including increased risk of heart attack and stroke, gastrointestinal complications including ulcer, acute kidney failure, anemia, DNA damage, hypertension, and miscarriage.

The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year.

Naturopathic doctors play an important role in the opioid wars

Along with medical professionals from other disciplines, naturopathic doctors are actively engaged in collaborative efforts to solve America’s opioid problem. This includes participating in working groups to develop better pain management practices and modify national prescribing habits to limit the overuse of opioids. One example is the policy brief for the PAINS project, “Never-Only Opioids: The Imperative for Early Use of Non-Pharmacological Approaches and Practitioners in Pain Care.” Naturopathic doctors played a leading role in the development and dissemination of the brief.

What is the difference between a licensed naturopathic doctor and an unlicensed naturopath?

Licensed naturopathic doctors, sometimes referred to as naturopathic physicians, are regulated at the state level to practice naturopathic medicine. Naturopathic medical students attend accredited, four-year, in-residence, naturopathic medical schools where they study biomedical sciences such as anatomy, physiology, biochemistry, pathology, and pharmacology. Their medical education incorporates the latest advances in science and natural approaches to illness prevention and management. Students complete a minimum of 4,100 hours of class and clinical training, including over 1,200 hours of hands-on, supervised, clinical training.

Naturopathic doctors can order diagnostic tests such as blood tests, X-rays, MRIs, and, in some states, prescribe prescription drugs and hormones and perform minor surgery. According to the Association of Accredited Naturopathic Medical Colleges (AANMC) 2015 survey of alumni, 50 percent of naturopathic doctors practicing full-time self-report as primary care physicians, while 28 percent report working as natural health specialists. In addition, like conventional medical doctors (MDs), a growing number of naturopathic doctors choose to focus their practices in specialty areas. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Intravenous Therapies, Pediatrics, Primary Care Medicine, and Oncology.

A naturopathic doctor must pass rigorous professional board exams prior to being licensed or regulated in a state that regulates the practice of naturopathic medicine. State mandated regulatory bodies oversee standards of practice, complaints, and discipline for all licensed jurisdictions. Licensed naturopathic doctors also carry malpractice insurance and maintain a commitment to lifelong learning through continuing education. These requirements are safeguards to ensure patients’ rights to quality naturopathic care.

The exam required to qualify for naturopathic doctor licensure is administered by the North American Board of Naturopathic Examiners (NABNE). The Naturopathic Physicians Licensing Examinations (NPLEX) is a two-part examination. Only students and graduates from accredited or candidate naturopathic programs are eligible to sit for the NPLEX.

In some states with laws regulating naturopathic doctors, the use of the term “naturopath” or “naturopathic physician” by anyone other than a licensed naturopathic doctor is prohibited. However, not all states regulate naturopathic doctors and not all states that do protect the term “naturopath.”

Therefore, unlicensed naturopaths can have varied levels of education and experience, often from a purely online or correspondence format. Such education is not accredited by an agency recognized by the U.S. Secretary of Education and does not qualify students to take the NPLEX examination or apply for licensure in any regulated jurisdiction in North America.

Be aware that while the terms may be used interchangeably, they are not the same

As a patient, you should also know that the terms “naturopathic doctor”, “naturopathic physician” and “naturopath” are often used interchangeably by medical practitioners in other disciplines and the public, even though unlicensed naturopaths do not have the same training or privileges. Knowing the difference between licensed naturopathic doctors and unlicensed naturopaths can help you make informed decisions about which type of provider can best help you.

For more information on how naturopathic doctors are educated, trained, and licensed, see FAQ#1 in this service, available here.

How are naturopathic doctors educated, trained, and licensed?

Accredited naturopathic medical schools are four-year, in-residence, hands-on medical programs consisting of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention and clinical techniques.

In addition to a standard medical curriculum, schools require their graduates to complete four years of training in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed professionals.

Given the importance of hands-on, clinical experience for naturopathic medical students, the accrediting body for naturopathic medical colleges does not recognize degrees from online programs of study.

Differences between how MDs and DOs and naturopathic doctors are trained

The general educational structure for naturopathic doctors is comparable to that of conventional medical doctors (MDs) and osteopathic doctors (DOs). In all three medical programs, the first year emphasizes biomedical sciences such as anatomy and biochemistry. Second year classes focus on the diagnostic sciences, including areas such as evidence-based medicine and physiological assessment. All programs progressively increase students’ problem-based learning and integrated coursework, enabling students to learn how different concepts affect one another.

After the first two years, the curricula of the three medical programs focus on applying medical knowledge to real-life situations with simultaneous classroom studies supporting this training. Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

A major difference between the training of the MDs and naturopathic doctors is medical residencies. MD residencies are mandated and regulated by conventional medical schools. As a result, many opportunities for residencies exist at a wide variety of medical facilities and are funded by the federal government.

Naturopathic medical residencies are not nearly as common because they are not yet required by most states (Utah is an exception) or funded by the federal government. In place of a residency, many new naturopathic doctors choose to practice with or shadow an experienced doctor before setting up their own practices.

Like MDs, a growing number of naturopathic doctors choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology. In addition, while practicing Family Medicine, many naturopathic doctors choose an area of focus based on a therapeutic, condition, or population subset.

Prerequisites

Prior to admission into an accredited naturopathic medical school, the typical entering student has completed three years of pre-medical training and earned a bachelor of science degree. Students are expected to have completed courses in English and the humanities as well as math, physics, and psychology, with a strong emphasis on chemistry and biology. In addition to prerequisite course work, prospective students must demonstrate appropriate observational and communication skills, motor function, intellectual-conceptual abilities, integrative and quantitative abilities, and behavioral and social maturity.

Accredited schools

There are currently seven accredited schools with eight campus locations in the United States and Canada. A degree from an accredited medical school is required for licensure or certification by a state.

The following accrediting institutions provide accreditation services for naturopathic medical schools:

College accreditation is issued by the U.S. Department of Education (ED). All AANMC member schools have been accredited or are in candidate status for accreditation by an ED-approved regional accrediting agency.

Programmatic accreditation is issued by the Council on Naturopathic Medical Education (CNME). All AANMC member schools have also been accredited—or are candidates for accreditation—by the CNME, the recognized accrediting body for naturopathic medical programs in North America.

Licensure and certification

Licensure and certification are the highest forms of regulation. They are designed to protect the public by ensuring that certain minimum competency requirements are met. They also set standards for the profession.

Currently 20 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands offer licensure or certification for naturopathic doctors. The American Association of Naturopathic Physicians maintains a list of states and territories that license or certify naturopathic doctors.

How to Cure the Sick Health Care System: An Open Letter to President Trump from Leaders in Functional/Integrative/Natural Health and Medicine

Joseph Pizzorno, ND, Editor in Chief (Republished from Here)

President Trump:

One of the biggest and most important challenges you face is our failing health care system. Although the United States spends far more per capita on health care than the next closest country spends, our outcomes are dismal. Virtually every measure shows that Americans suffer poorer health and more chronic disease than those in most other advanced countries.

Unfortunately, almost all the health care reform initiatives being discussed are merely rearranging the chairs on the Titanic: arguing about who pays, who has control, and how to subtly ration. The problem is not how we make health care available. Rather, the problem is the health care being provided.

The key reasons for this growing crisis are as follows:

We have a disease management and symptom relief system, not a health care system.
We treat end-stage disease rather than the health of each unique individual.
Virtually all the passive determinants of health— nutrition, toxicity, and social—now promote disease.
Government, at all levels, has supported competition-preventing regulations and crony capitalism.

The solution to the ailing disease management system is to address the real causes of disease. We have several recommendations to accomplish this:

A broader definition of public health that includes such critical concepts as helping and supporting farmers to grow foods with higher nutrient density and working with industry to decrease the presence of disease-inducing metal and chemical toxins in the air, water, food, packaging materials, health and beauty aids, home and yard chemicals, etc.
Primary care that addresses the true causes of disease rather than simply short-term relief of symptoms.
Personalized health promotion rather than generic care for disease.
A reimbursement and regulatory system that prioritizeshealth promotion and disease prevention rather than expensive drugs and procedures.
Creation of a presidential commission— composed of change agents rather than vested interests—to provide the US Congress with guidance for creation of a real health care system.

Please be clear: We do not want to “throw out the baby with the bathwater.” Conventional medicine is miraculous in so many areas. Injury, life-threatening situations, developmental disabilities, overwhelming infection, organ failure—the list of successes is long. Unfortunately, the medical model that works so well for these kinds of conditions has failed for everyday health and chronic disease. We have invested huge resources researching, promoting, and rewarding the end-stage disease treatment model. The time has come to reconsider our priorities.

As widely recognized leaders in functional, integrative, and naturopathic medicine who have dedicated their professional lives to reforming medicine, we present here our suggestions on how to cure our sick health care system. Accompanying this summary letter are articles by each of us supporting our key recommendations. Following are a few select quotes from each article.

Jeffrey Bland, PhD, FACN, cofounder Institute for Functional Medicine

Personalization and Wellness

Presently our health care system focuses almost exclusively on the diagnosis and treatment of disease, and it lacks effective promotion of recovery, restoration of function, and promotion of wellness.

To create a value-based health care system that better manages chronic disease, we need to have a restructuring of care to focus on the genomic, lifestyle, environmental, and social determinants of disease in the individual.

The need to improve health care is much more than changing access to and finances of care, but it requires a significant change from the disease-centric approach to introduce a scientific wellness component to the system.

Dr Jeffery Bland, PhD, CNS, FACN, FACB, is known as the “Father of Functional Medicine,” a medical approach that focuses on the personalized prevention and treatment of chronic diseases. During the past 35 years, Dr Bland has traveled more than 6 million miles teaching more than 100 000 health care practitioners in the United States, Canada, and more than 40 other countries about functional medicine. He has been a university biochemistry professor, a research director at the Linus Pauling Institute of Science and Medicine, the cofounder of the Institute for Functional Medicine in 1991, and the founder/president of the Personalized Lifestyle Medicine Institute. He has authored more than 100 scientific publications and 11 books for the health professional and health consumer. He lives in Seattle, Washington, with his wife Susan, and near his 3 sons and their families while pursuing his hobbies of boating, surfing, scuba diving, and a life-long passion for learning.

Mimi Guarneri, MD, FACC, ABOIM, president, Academy of Integrative Health and Medicine Prevention, Integration, and Collaboration

Although Western medicine excels in the treatment of acute conditions such as heart attack and stroke, it does not empower people toward optimal health through prevention and the management or elimination of chronic disease.

Through interprofessional collaboration, research, and education, we will be able to transform health care to a more economical model that promotes the creation of health, as well as the delivery of evidence-based comprehensive, affordable, and sustainable person-centered care.

We know that the key components of health promotion include mind-body practices, sleep and physical activity, nutrition, achievement of ideal body weight, reduced exposure to toxins, and substance abuse and social connection. Although acute care frequently requires lifesaving interventions and pharmaceutical therapy, chronic disease demands a new model that extends beyond the “ill to the pill approach.”

Dr Mimi Guarneri, MD, FACC, ABOIM, is an integrative cardiologist, president of the Academy of Integrative Health and Medicine, past president of the American Board of Integrative Holistic Medicine, and serves on the Founding Board of American Board of Physician Specialties in Integrative Medicine and is clinical associate professor at University of California, San Diego. She is cofounder and medical director of Guarneri Integrative Health, Inc., at Pacific Pearl in La Jolla, California. A cofounder of Scripps Center for Integrative Medicine, she served 15 years as medical director. She is board-certified in cardiovascular disease, internal medicine, nuclear cardiology, and integrative holistic medicine.

Joseph Pizzorno, ND, Editor in Chief of Integrative Medicine: A Clinician’s Journal and Stacie J. Stephenson, DC, Chairwoman of Functional Medicine at Cancer Treatment Centers of America The Health Care System and Addressing the Determinants of Health

We do not have a health care system in the United States. We have a disease management and symptom relief system that primarily provides short-term solutions while allowing the underlying real causes to continue unabated. One way to understand what health care is actually being provided is to look at which drugs are most commonly prescribed. Nine of the top 10 only relieve symptoms while allowing the actual causes to continue unabated.

We will continue to have an ever-more expensive health care until we reprioritize to an actual health care system. This means a system that addresses the real reasons that people are sick.

Virtually all the determinants of health are now instead promoting disease. Our foods are not only depleted of nutrients, but they are now contaminated with herbicides, pesticides, and toxic metals. Health depends on the enzyme machine that we call our body working properly. Inadequate nutrition plus enzyme poisons means not only poorer health and vitality but a heavy burden of degenerative disease.

Dr Joseph Pizzorno, ND, is a world- leading authority on science-based natural medicine, a term he coined in 1978. A licensed naturopathic physician, educator, researcher, clinician, and lecturer, he is founding president of Bastyr University, editor in chief of Integrative Medicine: A Clinician’s Journal, treasurer of Board of Institute for Functional Medicine, cofounder of American Association of Naturopathic Physicians, board member of American Herbal Pharmacopeia, and a member of the science boards of Hecht Foundation, Gateway for Cancer Research, and Bioclinic Naturals. He was appointed by Presidents Clinton and Bush to 2 prestigious commissions advising the US government on how to integrate natural medicine into the health care system. He is recipient of numerous awards and honors and author/coauthor of 12 books, including the best-selling Encyclopedia of Natural Medicine (2 million copies in 6 languages) and the principal textbook in the field, the Textbook of Natural Medicine. His newest books, The Toxin Solution, will be released February 2017 by Harper Collins and another textbook for physicians, Clinical Environmental Medicine, will be released by Elsevier in January 2018.

Dr Stacie Stephenson, DC, CNS, DABAAHP, FAARM, is a recognized physician, lecturer, and national lecturer on nutrition-based medicine, and she was the host of the “Health News with Dr Stacie” radio program. Dr Stephenson is board certified in anti-aging and functional medicine, and she is a board- certified nutrition specialist. She has worked with the Northwestern Health Science University Clinic, Abbot- Northwestern Hospital, and the Macari Clinic for Functional Medicine, where she also served as medical director and chief executive officer. In 2006, Dr Stephenson founded the Carmel Clinic for Functional Medicine—the first clinic to provide hyperbaric oxygen therapy for children with autism. She understands the unique ways in which a person’s health is influenced by lifestyle, diet, environment, family, and beliefs, and she is dedicated to educating men and women on prevention and therapeutic interventions to heal and maintain health. She is chairwoman of functional medicine at Cancer Treatment Centers of America, and she is a member of the Gateway for Cancer Research Board.

Ruth Westreich, President, The Westreich Foundation

Personal Responsibility and Consumer Engagement

We cannot be healthy and thrive as a nation if the only options we have are to wait for disease to occur, and then we treat with pharmaceuticals, devices, and surgery.

We must have access to food and water that supports our body being in natural homeostasis. We must limit the poisons and pesticides where our food is grown. We must NOT be mandated by the state or federal government to inject substances into our bodies or the bodies of our children that we know are harmful and can cause permanent disability or death.

Our young people will not be the young brains that will change the world. And our national debt in health care, Medicare and Medicaid will be our society’s downfall. We are depending on you to speak for us and we are also willing to do our part to change the course of our “disease care” system to one of prevention and true health.

Ruth Westreich is president of The Westreich Foundation. She is a leader of leaders in the integrative/ functional medicine space. She has been active in strategic planning, program development, and execution in the complementary and alternative medicine field since it was first codified by Congress as a division within the National Institutes of Health. She is working a strategic level to develop collaborations in a system’s-based model as the entry point for integrative/ functional medicine into the health care dialogue at the National level. She has been a major force behind the integrative medicine movement and local and national academic institutions and organizations, including the Academy of Integrative Health and Medicine, Academic Consortium for Integrative Health, Academic Consortium for Integrative Health and Medicine, American Nutrition Association, Bastyr College of Natural Medicine, Samueli Institute, San Diego Hospice and the Institute for Palliative Medicine, Scripps Center for Integrative Medicine, UCSD Center for Integrative Medicine, and UCLArts and Healing.

What Should We Tell Our Patients About Marijuana (Cannabis indica and Cannabis sativa)?

Joseph Pizzorno, ND, Editor in Chief (Republished from Here)

Abstract
With several states allowing medicinal use of marijuana and a growing number decriminalizing recreational use, many of our patients are using this herbal drug. Approximately 43% of US adults have tried marijuana, with 13% using it regularly. These users are seeking help from integrative medicine practitioners regarding safety. They are looking for advice based on research and clinical experience, not politics or philosophical bias. The major health problems caused by marijuana appear to be bronchial irritation, decreased motivation, learning difficulties, and injuries. However, less well appreciated are the toxicity problems caused by contamination with pesticides and solvent residues. We have important guidance to help prevent unnecessary toxicity in our patients who choose to use marijuana. This editorial reviews toxicity and safety. Medicinal use will be addressed in the future.

Long-time readers of IMCJ are well aware of the many editorials I have written on how a growing body of research is showing that toxins have become a major cause of chronic disease. As I study toxicity, my understanding has broadened to include not only environmental metals and chemicals but also endogenously produced toxins such as those from homocysteine, gut bacteria and nonoptimally detoxified hormones. To this list I now add what I call “toxins of choice.” Few of our patients are intentionally exposing themselves to neurotoxic organophosphate pesticides, endocrine disrupting polychlorinated biphenyls (PCBs), insulin receptor site-blocking phthalates, or lung-damaging mold from damp buildings. However, many of our patients are intentionally consuming known toxins such as alcohol and marijuana and are unlikely to realize that at modest dosages, salt, high-fructose corn syrup, phosphates, and nonsteroidal anti-inflammatory drugs (NSAIDs) are toxic as well. Added to this that by also considering genetic susceptibility, even sources of gluten, can be toxic. The huge load of environmental, endogenous, and choice toxins add up to deplete stores of protective glutathione and cause physiological and structural damage in many ways.
Table 1 shows my current list of the many toxins that stress physiology and cause disease in our patients. Where I have written an editorial on the topic, the issue is included in parentheses.

Table 1. The Many Sources of Toxins

Exogenous Toxins
OTC and prescription drugs (see editorial in IMCJ 7(3))
Chemicals
Inorganic
Organic
Fluoride
Persistent organic pollutants (see editorial in IMCJ 12(2))
Solvents
Metals
Arsenic
Cadmium
Lead
Mercury (see editorial in IMCJ 8(1), 8(2), 9(4))
Microbial
Mold (damp building, 15.2, 15.3)
Particulate matter
Radiation
Light at night
Medical
Cell phone

Endogenous
Catecholamines, if COMT SNP
Gut-derived toxins
Homocysteine (see editorial in IMCJ 6(4))
Non-end product metabolites
Poorly detoxified hormones

Toxins of Choice
Alcohol (see editorial in IMCJ 11.(6))
Marijuana (see editorial in IMCJ 15(6))
Food constituents
High-fructose corn syrup
Phosphates
Salt (see editorial in IMCJ 14(1))
Smoking
Wheat, if zonulin producer (see editorial in IMCJ 12(6))

Cannabis (Marijuana)
Although the federal government has classified Cannabis as a controlled substance illegal for use, many states have now decriminalized its use. Twenty-four states and the District of Columbia have passed laws allowing medicinal use of marijuana and 14 states have decriminalized its use . The percentage of Americans who say they have tried marijuana has steadily increased from 4% in 1969 to 43% in 2016.1
Cannabis production has become a multibillion dollar industry in the United States, and legal markets for cannabis are projected to reach $11 billion by 2019.2 The federal illegality of Cannabis has resulted in not only limited clinical research but also a production environment with few standards and very little regulation. As most is currently grown indoors, heavy use of agricultural chemicals is common. Toxicity may be due to not only constituents of marijuana itself, but also contaminants such as solvents, pesticides, and heavy metals with most extracts adding solvent residues. This likely helps explain some of the discrepancies in the research.

Toxicity
Unadulterated Cannabis
Almost 500 compounds have been extracted from Cannabis, of which 65 are classified as cannabinoids. The most abundant cannabinoids include delta-9-tetrahydrocannabinoic acid (THCA), cannabidiolic acid (CBDA), cannabigerolic acid (CBGA), and their decarboxylated derivatives delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabigerol (CBG).3 These compounds are converted into their more active decarboxylated counterparts by heat (smoking, evaporation, baking), light, or natural degradation. THC is the most psychoactive component of cannabis and alters cognition primarily through the activation of CB1 receptors on presynaptic axons, though several other mechanisms have been identified.4,5 The content of THC in marijuana has increased from 3.1% in 1992 to 5.1% in 2002.6,7
THC itself has low toxicity and modest use has shown minimal long-term physical or psychological effectsâ€”when not used to excess.8,9 Acute high dose intoxication occurs quickly but is short term. Typical symptoms include nausea, anxiety, paranoia, short-term memory loss, confusion, and disorientation.10 THC impairs gonadal function by blocking gonadotropin-releasing hormone (GnRH) release. This results in lower levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which causes reduced testosterone production by the testicular Leydig cells.11
The research on the toxicity of whole plant marijuana is inconsistentâ€”probably due to lack of control for contaminants, poor assessment of dosage, small sample sizes, limited number of heavy users, mode of use, and not adjusting for other factors such as alcohol, tobacco, and other recreational drugs.12
The method of use significantly affects the toxicity of marijuana. The most common use is inhalation of the smoke of the dried plant. This results in higher risk for adverse effects.13 The whole-plant smoke contains many hazardous compounds such as ammonia, cyanide, heavy metals, carbon monoxide, mutagens, carcinogens, and polycyclic aromatic hydrocarbons.14 Surprisingly, the tar from a Cannabis cigarette contains higher concentrations of carcinogens such as benzanthracenes and benzopyrenes than does tobacco smoke.15

Contaminants
Pesticides. For most of the 20th century, the majority of marijuana produced in the United Sates was grown outdoors. With more aggressive law enforcement, marijuana agriculture moved indoors. Although this provided the benefit of year-round cultivation, it also required the use of agricultural chemicals, typically synthetic fertilizers and pesticides.
Because Cannabis cultivation is illegal, there are no pesticides registered for use on Cannabis in the United States, meaning there is little research on their use for this purpose.16 The limited research suggests that this results in higher chemical residue levels.17 There are apparently no direct studies on how pesticides in Cannabis affects consumers of the product. Table 2 shows a list of the toxic contaminants that have been found in in both medical and recreational marijuana. Research has shown that Cannabis extracts (see Solvents section below) contain considerable amounts of pesticides.18

Table 2. Toxic Agricultural Chemicals Found in Cultivated Marijuana19,20,21,22

Pesticides	Bifenthrin, chlorpyrifos, diazinon, methamidophos, teflubenzuron
Fungicides	Tebuconazole
Growth regulator	Ethephon
Mosquito repellant	DEET, Malathion

Abbreviation: DEET, N,N-diethyl-meta-toluamide.

Solvents. Many methods are used to concentrate the active constituents in Cannabis. The organic solvents benzene, hexane, naphtha, petroleum ether, and butane pose a significant risk of toxic chemical concentration.23 Hexane and benzene are neurotoxic, and naptha and petroleum ether are potential carcinogens. Research has shown significant residues in these products.24 A process called dabbing uses butane to produce higher THC content.25
Safer alternative methods of concentration use ethanol and olive oil. Perhaps best is the use of supercritical CO2 to extract volatile oils from Cannabis as this leaves no residue. Although there is limited research on the efficacy of these methods, nontoxic solvents are clearly preferable.
Heavy metals. Cannabis has been shown to be especially effective in absorbing metals such as cadmium and copper from contaminated soils.26 Making matters worse, Cannabis is also intentionally contaminated with metals to increase the market weight. In 2008, 150 people in Germany developed lead poisoning as the result of using adulterated cannabis.27
Microbial. Indoor growth results in increased susceptibility of Cannabis to contamination by microbes such as fungi, bacteria, and plant viruses. Growing and drying also increase the risk of microbial contamination.28 Penicillium species are the predominant microbe contamination in marijuana grown indoor.29 Cannabis has even been shown to be contaminated with human pathogens such as hepatitis A,30 hepatitis B,31 and salmonella.32 Chronic pulmonary aspergillosis has been found in immunocompromised individuals using medicinal marijuana.33

Synthetic Cannabinoids
There is limited research on synthetic cannabinoids (SCBs) such as “Spice,” “K2,” “herbal incense,” and others. Toxicity reports include tachycardia, hypertension, tachypnea, chest pain, heart palpitations, hallucinations, racing thoughts, and seizures.34 The most common clinical signs of toxicity are neurologic including agitation, central nervous system depression/coma, and delirium/toxic psychosis.35 There have been reports of acute renal failure associated with the use of these synthetic analogues.36 These compounds appear significantly more toxic than cannabis and should be avoided.37

Detoxification
The liver metabolizes THC through hydroxylation and oxidation reactions catalyzed by cytochrome P450 enzymes, especially CYP2C9 and CYP3A4.38,39,40 Approximately 65% is excreted in the feces and 20% in urine.41 THC is excreted in the urine primarily as the glucuronic acid conjugate THCCOOH, which has a half-life between 30 and
44 hours.42
Clinical Indications of Toxicity
Long-term smoking of marijuana leaf has been shown to cause airway obstruction43; squamous metaplasia44; impaired psychomotor performance; increased incidence of schizophrenia45; cancer of the mouth, jaw, tongue, and lung; and leukemia in children of marijuana smoking mothers.46 Although marijuana smoke has been shown to contain carcinogenic compounds, research is unclear about whether a link with lung cancer exists.47
Population studies in adults show that heavy cannabis use increases the risk of accidents, can produce dependence and has been associated with poor social outcomes and mental health.48 Long-term daily use has been associated with decreased motivation, impaired ability to learn, and reduced sexual desire.49,50 Daily heavy inhalation can produce bronchial irritation and may lead to long-term pulmonary damage secondary to the associated hydrocarbon residues.51

Intervention
As noted previously, marijuana can be considered a “toxin of choice.” This means dosage and toxicity are under the control of the user. Abstinence is, of course, the most effective way to decrease cannabis toxicity. However, for most patients, management to prevent excessive use and education to choose the least toxic forms is more likely. Research has shown little benefit treating cannabis dependence with prescription drugs such as selective serotonin reuptake inhibitor (SSRI) antidepressants, mixed-action antidepressants, atypical antidepressants (bupropion), anxiolytics (buspirone), and norepinephrine reuptake inhibitors.52
N-acetyl-cysteine (NAC) at 1200 mg BID has shown benefits because its induction of glutathione synthesis helps mitigate many of the toxic effects and improve the odds of abstinence.53,54
Vaporization (“vaping”) of extracts appears the preferred method of use as it reduces respiratory exposure to toxic particulates and carcinogens.55 For those smoking the dried plant (buds, leaf, flowers, etc), the type of filtration significant affects toxic chemical residue. Hand-held glass pipes allow the most toxins, unfiltered water pipes are intermediate, and the lowest quantity is found with filtered water pipes.56 Heating may make many of contaminants more toxic.57

Conclusion
Many of our patients are using, and in some cases abusing, Cannabis. Our key clinical responsibility is to help those who choose to use marijuanaâ€”for whatever reasonâ€”to do so responsibly and as safely as possible. The most common ways of obtaining and using marijuana clearly result in clinical toxicity. Interestingly, most of this toxicity appears to be determined by contaminants and the consumption method.
We need to advise our patients to carefully avoid marijuana which is contaminated with agricultural chemicals, metals, microbes, solvents, etc. In addition, damage can be decreased by recommending the least toxic ways of consuming marijuana. Because the primary psychoactive constituent of marijuana, THC, appears to have little toxicity (though it likely plays a major role in the psychological issues), our guidance should focus on ways to limit exposure to everything else. This suggests recommending organically grown product, CO2 extraction, and vaporization rather than smoking agricultural chemical-laced dried plant.

Joseph Pizzorno, ND, Editor in Chief
drpizzorno@innovisionhm.com
Tweets by drpizzorno

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