Friday, August 19, 2011

Naturopathic Medicine and Cancer Treatment

On a recent flight to the annual convention of the AANP, a fellow passenger asked me what I did for a living. Never one to balk at an opportunity to talk about naturopathic medicine, I enthusiastically gave her my ‘elevator speech’, highlighting all of the important points of my work. After a little more discussion, I mentioned that I occasionally work with patients in various stages of dealing with cancer. She had a family member battling breast cancer, so we spoke a bit more on the topic.

This encounter really got me thinking, so today’s entry is going to focus on what naturopathic doctors do for patients with cancer. All cancers are different, and there’s hardly enough room to discuss how I might work with every single kind of cancer, so this entry is going to be a bit broader, talking about cancer thematically rather than specifically.

Additionally, there’s an important point to make when discussing cancer – even in states where naturopathic doctors enjoy a broad scope of practice, we are often specifically forbidden to treat the cancer itself, that privilege being reserved for oncologists alone. So, then, if we can’t treat the cancer, how do naturopathic doctors benefit cancer patients?

1. Decreasing side effects. Many treatments for cancer come with heavy burdens of side effects, side effects which often take a serious toll on not only the patient, but the patient’s family and community as well. Unfortunately, these are frequently seen as just being part of the inevitable process of cancer treatment. While no naturopath can guarantee a painless course through chemotherapy or radiation, a licensed naturopathic physician with experience can help a patient have an easier time going through their conventional treatment, decreasing all manner of side effects brought on by chemo or radiation. In many cases, this supportive treatment can help a patient receive better results from their conventional treatment by decreasing side effects which might otherwise cause them to stop their chemo or radiation early. In a few ways, then, naturopathic treatment to decrease side effects benefits patients – it reduces suffering on the part of the patient, improves quality of life, and helps support conventional treatment, thus improving outcomes.

2. Prevention. Many patients seek naturopathic doctors when they are in remission and are seeking to prevent a recurrence of cancer. While again, there are no guarantees in preventing a recurrence of cancer, modern medicine has a strong understanding of what causes cancer to occur in the first place and what helps to prevent it – many of these factors hold true for preventing recurrence as well. A trained naturopathic doctor knows and understands these factors (along with factors unique for preventing recurrence), and can translate them into real-life recommendations for patients.

3. Humanizing the patient. Receiving a cancer diagnosis and undergoing treatment is one of the greatest challenges a person can undergo in life, and one which leaves many with stressed relationships, weakened bodies, and downtrodden spirits. Many feel less than human during and after the process, and with little sense of how to put their lives back together, let alone rebuild their strength. Here, above all else, our understanding of the importance of the doctor-patient relationship puts naturopathic physicians in a place to help patents not only make it through cancer treatment, but make it through feeling whole and healthy. We help humanize cancer patients by taking the time to listen and by providing them with empathy and care during an extremely difficult process. Additionally, for patients who have made it to remission, naturopathic doctors work hard to help them rebuild and become whole once again.

All patients are different and all doctors are different, so while treatments may vary for individual patients, all naturopathic doctors approach the treatment of cancer patients with these goals in mind. Though we don’t treat the cancer per se, naturopathic doctors are fond of saying, ‘We don’t treat disease, we treat people with diseases.’ Nowhere is this more true than with cancer – in a field wrought with fear, difficult treatments and uncertain futures, naturopathic doctors work to strengthen patients, helping them to cope better with side effects, prevent recurrences, and above all maintain their dignity and sense of self in the face of challenges.

Thursday, August 11, 2011

High Blood Pressure – Beyond Drugs

Recently, I had the privilege to go hiking in the Tahoe National Forest. Though we weren’t above the tree line, we were pretty far up there, shade was minimal, and the sun soon became oppressive. Fortunately, we’d picked a beautiful place to camp, right on the edge of a pristine lake, fed by melting snow.

It was odd to go swimming in the presence of so much snow, but the 90+ degree heat begged relief. Needless to say, having just written about the immune-enhancing effects of cold water, I was more than excited to tell everyone what I’d just learned, at least as excited as I was to jump back in the lake.

As I returned to civilization, I got to thinking that I’d left my study of hydrotherapy a little early, and that there was more that I could write on the topic. After all, while I’d discussed the effect of hydrotherapy on the immune system and on the body’s antioxidant enzymes, I’d left out the cardiovascular system.

Naturopaths often recommend contrast hydrotherapy to promote circulation by playing off physiologic responses to hot and cold water. Hot water causes blood vessels to dilate, cold water causes them to contract, and by thus alternating back and forth between hot and cold, you can stimulate circulation. This is frequently employed to encourage healing of chronic injuries, but also edema, a type of swelling that is a common effect of high blood pressure.

But what about high blood pressure itself? Can something as simple as finishing your shower with a spell of cold water be helpful with lowering your blood pressure? I took a quick look.

Well, according to a German study from the early 90’s, contrast hydrotherapy can help certain people with high blood pressure. Determining whether you may be helped by this therapy is best done by a licensed naturopathic doctor, as it’s a fairly specific subset of people who can benefit from this treatment. A Czech study done on high blood pressure and cold water therapy was a bit more ambivalent, indicating that diastolic blood pressure (the lower number) was decreased mildly by regular hydrotherapy. Taken together, these indicate some benefit from cold water therapy under certain conditions and for certain patients. As always, talk to your doc when considering this treatment.

In my searches, I found another German study which showed that home-based hydrotherapy produces significant benefits in both quality of life and symptoms for patients with chronic heart failure (CHF). While this is not high blood pressure per se, it can develop because of high blood pressure that goes untreated for long periods of time.

Not yet satisfied, I kept looking primarily to see if I could find perhaps another, similar treatment that was effective against hypertension.

Turns out that the humble sauna, a fixture of Scandanavian countries for centuries, improves high blood pressure (1, 2) and chronic heart failure (1, 2). This alone is reason enough for patients with hypertension to visit the sauna regularly. Additionally, and perhaps more importantly, regular sauna use improves endothelial vascular function (1, 2). It’s a rare lay person that knows why this is important, so here’s a brief, straightforward explanation of why endothelial vascular function matters: endothelial dysfunction contributes to atherosclerosis, which in turn contributes to coronary vascular disease, which in turn causes myocardial ischemia, which if it gets bad enough becomes a myocardial infarction, commonly called a heart attack. So regular sauna use may to prevent heart attacks – seems like a good enough reason to take a 15 minute session at the gym, doesn’t it? As an additional note, saunas of reasonable temperature, enjoyed for a moderate time are perfectly safe – the old notion of saunas provoking stroke or heart attacks isn’t quite accurate.

So there you have it. Saunas improve a number of cardiovascular diseases, cold water activates the immune and antioxidant defense systems. Anyone for a sauna followed by a quick plunge in the snow?

Friday, August 5, 2011

Food Allergy Testing – Limitations and Expectations

I’ve written several times on the topic of food allergies and food intolerances, but was recently asked by a friend about some food allergy testing she had had done, and so I’ve decided to devote today’s entry to food allergy testing. This is a very large topic and one I’m sure I’ll return to many times in the future.

Let’s start with a brief clarification about food allergy testing. There are two types of testing commonly referred to as food allergy testing – one tests IgE reactions, the other tests IgG reactions. IgE reactions cause classic allergic reactions, with swelling, difficulty breathing, and other symptoms. These symptoms come on strongly, suddenly and with clear provocation. Two of the best known offenders in this category are peanuts and shellfish. IgG reactions are more complicated, can cause more varied and subtle complaints, and are harder to test. It’s this second category that I’d like to talk about today.

A lot of healthcare providers (NDs, MDs, and others) are starting to use IgG testing in their practices, and so many of my patients come in either having done the labs, or asking questions about the labs. Many docs swear by it, and indeed, I recently wrote an entry about a study that used food intolerance testing to gain positive clinical results for ADHD. In no way do I mean to discredit these docs’ experiences, but my experience has mixed, and I think there’s a very clear reason why.

Let’s start by talking about what qualities make up a good lab test. LDL Cholesterol is a great example to use in discussing this topic. (For those who want a refresher course on LDL Cholesterol, read this blog entry from a few weeks ago.)

The first quality of LDL Cholesterol that makes it a high quality lab test is the specificity of the substance being tested. The blood is full of protein, fat, minerals, and a variety of cells – there are literally thousands of compounds that one could test for using a blood sample. LDL Cholesterol, however, tests a very specific component of the blood – a lipoprotein of a certain size and density. Because no other substances are being included in the sample, the lab results are very consistent and reliable.

A good analogy can be drawn between lab testing and tuning a radio. I know that no one uses analog radios any more, but those of us old timers who remember having to turn a knob understand what I mean. A radio works by selecting a very specific frequency of radio transmission, and excluding all others. Being able to tune precisely to 100.7 allows us to hear only one station at a time, and to hear it clearly. If we were only able to tune to 101, we’d hear stations broadcasting at 100.7, 101.2, 101.5 and all the static in between. Tuning to 100.7 gives us music, tuning to 101 gives us noise.

The second quality that makes LDL Cholesterol a good lab test is that there are very clearly established normals. What this means is that a very large number of people had this lab test done on them, and those lab test results were then compared to clinical results to establish a clear understanding of how the lab values relate to the clinical results. As a result, I can now run LDL Cholesterol on a patient and be able to tell how likely or unlikely they are to suffer a negative outcome. The more times the lab is run, and the more that information in compared to clinical outcomes, the better able we are to interpret the results by matching them to their most likely clinical outcome.

So bearing that in mind, here are my experiences with IgG food testing. In a small number of cases, the results are very clear. When this happens, a person is non-reactive to virtually everything but a very few foods – sometimes it is a specific food, like eggs or potatoes, sometimes it is a group of foods, like citrus, beans or nightshades (potatoes, tomatoes, peppers, etc.). This is a best case scenario, and one that’s easy to work with. More commonly, however, I see results that indicate that the patient is mildly reactive to everything, with a few moderate elevations here and there of unrelated foods. This result is equivalent to tuning into several stations at the same time – it’s noise, and it’s hard to tell what’s going on. I think that this situation can be best explained because of problems the criteria I mentioned previously.

The first criterion is specificity. IgG testing, rather than testing for a reaction to a very specific molecule, or set of molecules, tests for a wide variety of compounds. The result is that a large number of reactions take place, not all of which may have a negative clinical outcome. Without going into a full discussion of the IgG immune reaction, it’s important to note that not every activation of the immune system results in symptoms. To create lab tests of better clinical value, IgG food intolerance testing will have to move towards a more narrowly defined set of substances being tested, substances which are more strongly linked with symptoms.

The second criterion, which I believe is equally important, is that an agreed-upon set of normals has not been established. As I stated before, not every activation of the immune system results in symptoms, and without a larger pool of data (both lab results and clinical outcomes), it is hard to interpret the results. It may be that a certain degree of reaction against a food may be totally normal, and not correlated with clinical symptoms. However, under current testing, that food shows up as reactive, and a person avoids it needlessly. I would hope that as time goes on, the bar is raised on immune reactions, so that minor, normal reactions are not counted as clinically significant.

To conclude, all lab tests have kinks that need to be worked out. Nowhere is this more true than in the immune system – many cancer markers, for example, have taken decades to prove their clinical use. Understanding food intolerance is difficult, and the technology is in its infancy. As time goes on, the method of testing and the interpretation of results will improve, but this is still some time off. The current problems with the testing are due to a less-than-sophisticated manner of testing reactions, and a poor ability to interpret results. In some cases, positive clinical outcomes have been observed, but before these tests gain widespread acceptance and show their true importance, improvements will need to take place.