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Why You Should Meditate

In a conversation with a patient yesterday, we discussed the ways in which a meditation practice may help him resolve his health concern.

In the course of this discussion, I found myself referring to different articles I had read on the various benefits of meditation.

It occurred to me, much like my post of last week on natural health product quality, that I should put this to “paper”, so it exists as a resource for persons interested in gaining information on the science behind this very valuable health practice.

Here are some interesting, easily digestible articles on the value to health, wellness and performance, of meditating.

Benefits to general health and a range of health conditions:

Benefits to children’s resiliency and school performance:

Effects on brain health and architecture; and biochemical responses:

For those inclined to more academic/scholarly reading, a quick search for “meditation” (as of the time of this posting) at PubMed yields 4389 results, and PLoS One yields 688 results, so, knock yourselves out!

Jonah Lusis, ND

 

Posted: 2017 May 17

 

Is It Worth It to Spend More on Nutritional Supplements?

When I started writing this, the intent was to quickly summarize a conversation I’ve had on a number of occasions with patients trying to make educated decisions when choosing nutritional supplements and botanical medicines, but it turned into a bit of a manifesto.

There is a huge difference in the level of quality between a “professional grade” nutritional supplement or botanical medicine, and products sold at most national drug stores, Costco®, etc.

To offer a sense of perspective, The Comparative Guide to Nutritional Supplements evaluates multi-vitamins/minerals on a range of standards, including some of the topics discussed below, and awards each product a rating. In the 3rd edition of the Guide, Douglas Laboratories® UltraPreventative® X earned a rating of 95.4 (of a possible 100), and Jamieson™ Power Vitamins for Men rating was 3.51.

The bottom line: you get what you pay for.

For those with stuff to do, here’s a summary of what I discuss below in detail:

  1. Raw materials – More potent raw materials result in a more effective end products
  2. Nutrient form and absoption – Vitamins and minerals are available in a range of forms, some cheaper and some more expensive for manufacturers. Does the product use well-absorbed, potent forms of each nutrient?
  3. Manufacturing quality – High-quality manufacturers take extra steps throughout the development and production process to guarantee quality of the end product. Has the product been manufactured in such a way that quality ingredients maintain their potency and absorbability?
  4. Formulation – Is the “recipe” for the product developed by someone with actual clinical experience, or is it simply a haphazard “sum of it’s parts”?
  5. Non-medicinal additives – Does the product contain undesirable (even toxic) ingredients as fillers, flavouring agents, etc.?
  6. Dosage and potency – Although cheaper at time of purchase, does low product potency result in having to use many doses daily to obtain meaningful amounts of nutrients?

For those with less stuff to do, read on!

Whenever I have a new patient intake appointment, part of process of gathering complete information includes not only identifying what other treatments a patient may have used in the past or are presently using, and with what amount of success, but if nutritional supplements are being used, who are the manufacturers?

This is important information for me to have, because there is a wide range in quality between nutritional supplements.

Unfortunately, nutritional supplements are not regulated particularly rigorously. The main emphasis of regulation is safety, and reliability of advertising claims (i.e., “This product cures cancer” is not an allowable claim for a product to make unless they can provide scientific evidence of this fact). Importantly, product efficacy (unless the manufacturer is making specific health claims about their product) is not a consideration.

Individual pharmaceutical drugs each have a very specific chemical composition. If choosing to use a “generic” version of the drug, rigorous standards guarantee that the amount of active ingredients and the rate at which the drug is absorbed into the body are the same as the original. This provides some assurance that quite similar performance can be expected2.

The actual quality between two, for example fish oil products, can vary widely – a low-quality fish oil product and a high-quality fish oil product are really, the same in name only.

Not achieving the desired health results with the use of a low-quality nutritional supplement or botanical medicine does not necessarily mean that the specific nutrients or herbs are not potentially helpful to that patient, it may indicate they are using an ineffective product.

These are some of the differences between high-quality nutritional supplements and botanical medicines and their low-quality counterparts:

Raw Materials

Unlike generic and brand name pharmaceuticals, there is no “standard” starting point for nutritional supplements and botanical medicines.

Botanical medicine tinctures (those bad-tasting liquid medicines sold in amber bottles) are prepared by macerating (soaking) plant materials in a solvent (usually alcohol). The proportion of plant to alcohol, by weight, is usually included on the label, and gives the user a sense of how potent the medicine is. Only some companies use dried herbs (as opposed to “fresh/wet” herbs) as their raw material: dried herb = lower weight = more herb used in the tincture = more concentrated plant medicine.

A second example is standardization of ingredients. In many cases, the specific chemical responsible for a desired action in a plant is known. For example, important ingredients in the therapeutic effect of St. John’s Wort are chemicals in the hypericin family3. Products including St. John’s Wort should therefore include known, consistent amounts of hypericin in each dose.

Lastly, again in the realm of botanical medicines: how were ingredients grown? Agricultural research has demonstrated that organically grown/raised produce is more nutrient dense than it’s conventional counterparts4. It follows that organically grown plants will yield more potent botanical medicines – does a manufacturer use organically grown raw materials?

Nutrient Form and Absorbtion

Minerals (e.g., calcium, magnesium, zinc) are absorbed into the body attached to acids, for example amino acids or other organic acids (e.g., magnesium carbonate – the carbonate is added for magnesium absoption).

The efficiency of absorption of a particular mineral is greatly influenced by the organic acid it is bound to. Inorganic mineral salts are less expensive to use in production, but offer poor nutritional value, under some conditions potentially causing net loss of a particular mineral from the body5. Magnesium carbonate or magnesium glycinate? One is cheaper, but not necessarily the better value.

Forms of nutrients are not only relevant in nutrient absorption. Alpha-tocopherol is the most common form of vitamin E used in nutritional supplements. It is available in a natural, d-alpha tocopherol form, and a synthetic d/l-alpha tocopherol form. The synthetic form is less expensive for manufacturers to source, but is also less bioavailable, and has only half the biological activity of the natural form of vitamin E5. Which form do you think Costco®’s Kirkland Signature™ brand vitamins use?

Manufacturing Quality

Raw materials aside, a company’s manufacturing standards can result in wide differences in quality of end products.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the key active ingredients in fish oil products, and are concentrated in fish oil supplements by a process called “esterification” (EPA and DHA do not naturally occur in fish in the concentrations found in higher-quality fish oil supplements).

For optimal absoption in the body, however, the EPA and DHA should be “un-esterified” back into their natural, “triglyceride” form, which increases absoption by some 70%6. An “esterified” fish oil product may appear to be very concentrated, but will not ultimately offer the benefits a well-manufactured, “triglyceride form” product will, information not available on a product label.

In general, manufacturers who are quality focused will “go the extra mile” to ensure their products offer maximum benefit (and protect their reputation):

  • Metagenics® performs clinical trials on many of their products (most nutritional supplements are simply a combination of nutrients that have been identified as having some effect in a particular health condition, but the final combination/product itself is not evaluated).
  • MediHerb®7 and Douglas Laboratories®1 use a process called liquid chromatography to confirm potency of end products.

Formulation

In some cases, particularly in the case of botanical medicines, the formulation (recipe) plays as important a role in the effectiveness of the medicine as the specific medicinal ingredients included. Much like a recipe, which is more than the sum of it’s parts, a successful botanical medicine will often include herbs that act as “synergists”, plants that do not include chemicals acting directly on the primary health concern, but that increase the effect of the other plants included in the formula (e.g., cayenne acts as a circulatory stimulant, which when included in a formula can increase rate of delivery of other chemicals in an herbal medicine).

Both Viriditas Herbal Products and MediHerb® products are created by herbalists having decades of compounding experience. Can this be said of all brands?

Non-Medicinal Additives

Nutritional supplements include more than nutrients alone, in fact, in many cases the medicinal ingredients are less than the “other” ingredients. Are the “other” ingredients desirable or undesirable?

High-quality products will often have included “helpful” substances, for example vitamin E, an anti-oxidant, added to a fish oil product to prevent naturally occurring rancidity of any oil.

In contrast, Flintstones™ Complete Chewables Multivitamins include as “non-therapeutic” ingredients:

  • Aspartame (safe8, but none-the-less controversial) as it’s most plentiful ingredient
  • Sugar as three of the first seven ingredients (labeled as confectioner’s sugar, corn syrup solids, dextrose monohydrate)
  • Sorbitol, which may cause digestive upset
  • Several food colorings, including Red 40 and Yellow 6, both of which contain the carcinogen benzidine9

Potency, Dosage and Amount Needed for Effect

Sometimes the actual cost of a product is hidden in the dosage required for benefit.

For example, the “standard” daily dose recommended for many higher quality fish oil products offers, in the neighbourhood of 1’500 mg of combined EPA and DHA in each dose, the generally recommended “meaningful” dose for these recognized by experts10.

One capsule of 1000 mg Kirkland Signature™ Fish Oil contains 250 mg of combined EPA and DHA, a minimal dose11, 12, meaning one would have to take six capsules daily to meet the requirement for the “meaningful” recommended dose. (The label on the Kirkland Signature™ Fish Oil further suggests swallowing the capsules with water, which will reduce absorption of fat-soluble chemicals).

The bottom line (again): you get what you pay for.

The above is likely daunting. Even to person such as myself for whom this is my “job”, conversations with manufacturer’s representatives are often frustrating, like comparing apples to oranges: is a liquid fish oil including an anti-oxidant to prevent rancidity preferable to a fish oil in a supposedly more stable capsule form? It’s a rabbit hole (that you can continue down if you want to learn more about fish oil quality issues).

Self-serving as this may sound, my best advice is to trust your naturopathic doctor.

Although obviously a source of income for our office, the items in our dispensary are a quality-control mechanism for us, and selected after hundreds of hours of education, research and product meetings.

Or at the very least, don’t buy on price alone.

Good luck!

Jonah Lusis, ND

References

  1. MacWilliam L. Comparative guide to nutritional supplements™. 3rd professional ed. Northern Dimensions Publishing; 2003. pp. 68, 111, 117.
  2. US Food and Drug Administration [Internet]. Facts about generic drugs. [cited 2017 May 10]. Available from: https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.ht.
  3. Drugs.com [Internet]. St. John’s Wort. [cited 2017 May 10]. Available from: https://www.drugs.com/npp/st-john-s-wort.html.
  4. Średnicka-Tober D, Barański M, Seal CJ, et al. Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol and iron, but lower iodine and selenium concentrations in organic milk: a systematic literature review and meta- and redundancy analyses. The British Journal of Nutrition. 2016;115(6):1043-1060. doi:10.1017/S0007114516000349.
  5. MacWilliam L. Comparative guide to nutritional supplements™. 5th professional ed. Northern Dimension Publishing; 2014. pp. 54-7.
  6. Dyerberg J, Madsen P, Moller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fatty Acids. 2010 Sep;83(3):137–141.
  7. MediHerb [Internet]. Quality assurance of herbs. [cited 2017 May 10]. Available from: http://www.mediherb.com/about-us/quality-assurance.aspx.
  8. Arnarson A. Aspartame: good or bad. Authority Nutrition: An Evidence-based Approach [Internet]. [cited 2017 May 10]. Available from: https://authoritynutrition.com/aspartame-good-or-bad/.
  9. Potera C. Diet and nutrition: the artificial food dye blues. Environmental Health Perspectives. 2010;118(10):A428.
  10. Burford-Mason A. Using nutritional supplements in practice part 2 – recap and update. Nutrition for Docs 2009; 2009 May 30-31; Toronto, ON: Ontario Society of Physicians for Complementary Medicine and The Complementary Medicine Section, Ontario Medical Association; 2009.
  11. Hjalmarsdottir F. How much omega-3 should you take per day? Authority Nutrition: An Evidence-based Approach [Internet]. [cited 2017 May 10]. Available from: https://authoritynutrition.com/how-much-omega-3/.
  12. Mayo Clinic [Internet]. Omega-3 fatty acids, fish oil, alpha-linolenic acid. [cited 2017 May 10]. Available from: http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-acids-fish-oil-alpha-linolenic-acid/dosing/hrb-20059372.

 

Posted: 2017 May 10

Should You Pay More for Better Fish Oil Supplements?

A while ago we were interviewed on fish oil supplements in general, but practically, is there a difference in quality between products (which, as with most things, is generally reflected in cost of products on the market).

Ultimately, the interview wasn’t published, but the information is useful, so here it is:

Do you think all fish oil supplements are created equal?

No. As with all things, you get what you pay for.

From a safety perspective, any product sold at a major retailer in Canada is “safe enough”.

However, there are important differences between “retail” products available at major pharmacies (e.g., Swiss Natural®) and “professional” products (e.g., Metagenics®) available through healthcare professionals or selected health stores.

A key question is: are you getting what you’re paying for? The “point” of using fish oil is that it is rich in eicosapentaenoic Acid (EPA) and docosahexaenoic Acid (DHA). These are the specific chemicals present in fish oil that have been demonstrated to provide the various benefits associated with fish oil consumption. Higher quality products will usually have a much greater standardized (“guaranteed”) amount of these chemicals in every dose.

As an example, a common retail brand’s (Swiss Natural® Wild Salmon and Fish Oil 1000 mg) product contains only 180 mg of EPA and 120 mg of DHA per capsule, approximately 1/5 the generally recommended daily dose. A higher quality product (e.g., Nordic Naturals® Ultimate Omega® Xtra; 800 mg of EPA and 200 mg of DHA per capsule) contains more than three times as much EPA and DHA. Fewer required daily doses means lower (or at least comparable) “true cost”, and in most cases, improved patient compliance.

Higher quality products will more likely contain EPA and DHA in “triglyceride” form (as opposed to ethyl ester form). Fish oils are “esterified” in the process of concentrating EPA and DHA from the raw material. To return them to their natural, triglyceride form is costly, but at least one (small-size) study found that this measure increases absorption in the body by approximately 70% (note: some manufacturers claim esterified EPA and DHA are not less absorbed, but only more slowly absorbed, and owing to the relatively long life of fatty acids in the cell membrane, the speed at which they are absorbed is not relevant). Whether or not a product contains ingredients in esterified or triglyceride forms is not a labeling requirement, so you will have to check the manufacturers web site to confirm this. If a company’s product is in triglyceride form, they will be keen to let consumers know this, so it should be easy to determine.

Higher quality products will often also contain added, beneficial nutrients, for example vitamin D, which is a very important bone health, and is well-absorbed in an oil base; or plant sterols, which are beneficial for cardiovascular health (the reason many use fish oil supplements).

Finally, EPA and DHA have different benefits. I alluded to a generally recommended dose above, but research supports the use of different amounts of EPA or DHA as being beneficial for different conditions. Higher-quality brands often offer “high-EPA” or “high-DHA” options that better suit a patient’s specific requirements.

Are there processes in the manufacturing of omegas that make one brand cleaner than another?

“Molecular distillation” is considered the most effective method purifying fish oil products. Some reputable companies (Metagenics®) refer to “proprietary processes” which, for obvious reasons, can’t be assessed.

For the purpose of assessing safety, the most reasonable approach is to see if a company’s product is evaluated for a safety and purity by some third party.

A second consideration with regard to “cleanliness” of fish oil products is how well it is preserved after production. High quality products should contain anti-oxidants that protect the finished product from rancidity during the time it moves from producer to retailer to consumer.

What are some of the concerns or dangers with brands that do not have certifications? Do we even need to worry about this in Canada when products have an NPN?

I wouldn’t say there are “dangers” associated with products not having independent certifications, but “concerns” are all those listed above with regards to quality.

Natural Product Numbers (NPNs) offer only the most basic protections, primarily against false claims (e.g., preventing a fish oil manufacturer from claiming that their product can make you taller), but does not much address true differences in quality between products.

An analogy may be regulations regarding automobiles sold in Canada: there is a basic safety and quality threshold that must be met for a manufacturer to sell their car in Canada, but there is a definite “gap” in quality between (most) luxury cars and (most) economy cars.

How do we know a product is free from heavy metals. For example, if a fish oil is derived from Tuna which can be high in mercury is it safe to assume that if it’s molecularly distilled it will be free from contaminants?

“Molecular distillation” is considered the most effective means of purifying fish oils. It does not guarantee 100% purity (which, I don’t know if is possible), but reduces contaminants (e.g., mercury, polychlorinated biphenyls [PCBs]) to very, very low, safe levels (to the order of less than 0.01 parts-per-million mercury).

Is there an advantage to taking a liquid omega vs a capsule?

There are several considerations when choosing between liquid and capsule forms of fish oils:

The advantages of capsules include that they are more stable/less prone to rancidity (the capsule material provides a barrier between the fish oil and oxygen; liquid forms often contain anti-oxidants that protect against rancidity – there is research that supports this, but I can’t recall the reference), and may be more palatable to some.

Fish oils in liquid form often contain higher levels of EPA and DHA than capsules, and therefore are more cost-effective. From a taste perspective, many are now quite good-tasting, and for this reason may be preferred by persons who can not swallow large capsules.

Anything else you want to add?

Fish oils are best absorbed from fish itself, certainly if when compared to esterified supplements. Although fish oil supplements allow for greater concentration of EPA and DHA than dietary fish, they should not be considered a substitute for fish consumption.

Fish oil is best absorbed with oily foods. If adding a liquid fish oil supplement to a smoothie, do not use water as the smoothie base.

If your fish oil supplement has a “fishy” taste or smell, it is likely compromised and should be replaced.

Vegetarians often substitute flaxseed oil for fish oil, because it is rich in alpha-linolenic acid (ALA) which is converted to DHA in the body. ALA, however, is a poor substitute for fish oil because only 1-9% is converted to DHA, and it does not, ultimately, result in increased levels of DHA in the blood.

An effective alternative for vegetarians is microalgae oil, the EPA and DHA of which offers the same benefits as the EPA and DHA from fish.

Lastly, there is no “perfect” fish oil product. As a guideline, select a fish oil supplement that:

  • Is tested for purity by a third party
  • Offers EPA and DHA in triglyceride form if possible
  • That you tolerate well

 

Posted: 2017 May 9

The Birth of Esmé

This the story of the birth of our oldest daughter, written by Jonah, the day of her birth. We’re posting it today, in celebration of her 8th birthday.

Du La, ND, Traditional Chinese Medicine Practitioner, Acupuncturist, Birth Doula

May 8, 2009

Little Friend,

You’re Esmé now. You were born this morning at 8:08 am – very good fortune (all these eights). You had a full head of hair – a sign of vitality. Although unexpectedly early, your birth went very well.

Fortunately, earlier this week, your Vepa (grandfather) was here and helped me finish clearing your room and building ramps for your stroller into the yard and house. Our friend, Rocky, bought you a car seat and planned to drop it off next Sunday but happened to be in the area Wednesday (yesterday) and brought it by then. Just yesterday, I picked up bed pads and gauze. Then at around 9:30 pm last night, your mom’s water broke.

We called Sarah and she came by around 10:30 pm and confirmed your water had broken. Your mom emailed the people at Choices Childbirth and they (very kindly) offered to bring the tub over immediately. In the hour it took them to arrive, I was able to put the house in order and prepare almost everything. By around 6:00 am your mom’s contractions were strong enough that we started to time them but within 30 minutes it was obvious se should call Sarah.   Her contractions were over one minute and less than four minutes apart. Sarah arrived by around 7:00 am and your birth progressed so quickly we didn’t even have time to adequately heat the birth tub. You were born at 8:08 am in your bedroom on a mattress. It was beautiful sunny morning with sunlight streaming in the window. Sarah, Li (her back up midwife) and Megan (midwifery student) did an excellent job delivering you. Minutes after your birth you were lying on your mom’s chest, swaddled in blankets.

Your Aunt Mandy arrived shortly after your birth – she was expecting to help out, but you were born so quickly she just visited. Your APGAR scores were good (9 and 10). You were 6 lbs 5 oz and around 19” long. Your mom had an amazing experience. After you were born, she was as though it was any normal day (physically). She could have gone grocery shopping I think…

See you later,

Jonah Lusis (Dad)

 

Posted: 2017 May 8

To Flu Vaccine, Or Not Flu Vaccine: Natural Approaches to Flu Prevention

This blog entry is in support of our Wellness Wednesday video of this week, and a continuation of last week’s topic of flu vaccine decision-making.

Flu vaccine prescription is outside the scope of practice of naturopathic doctors: we do not prescribe it, or dissuade people from it’s use. Our responsibility is, offering reliable information in service of making an informed decision

Last week we began to work through the four (often unconscious) factors people consider when making a health decision, in this case with respect to flu vaccination:

  1. What are the risks of not vaccinating?
  2. Is the vaccine effective?
  3. Is the vaccine safe?

Today we review:

What are my alternatives to vaccination for prevention of flu?

To be clear: there are no “natural flu vaccines”.

A vaccine has a very specific mechanism of action – it “pre-raises” antibodies to a particular microbe in order that your body has a ready-made immune response to that specific microbe should you come into contact with it.

There are however other means of preventing infection – the most important example of a “natural alternative” to infection prevention, whether by the flu or any other infection, is hand-washing.

Natural Medicines for Flu Prevention

There are a range of natural medicines, primarily botanical medicines, that can be used to prevent flu infection.

Plants have over 124 confirmed pharmacological actions1, and approximately 40% of prescription medications have as their root a plant1, so it is reasonable that plant medicines can be used to protect against flu.

The primary actions to look for in an herbal medicine for prevention is plants that are:

  1. Immune- “boosting” (to increase your resistance to all infections, including the flu)
  2. Anti-viral (the flu is a virus)

A quick Google search will yield many results, here’s a more academic listing, but any product at the health store for “flu prevention” is likely to include some of the plants your Google search has turned up.

Botanical medicines however have nuance: for the initiated, they have “best ways” to be of use. To demonstrate this:

Echinacea spp. (Purple Coneflower)

Echinacea is an important “immune-modulating” plant. Immune modulating plants can be used daily through-out the season to support what-ever response your immune system is mounting (as opposed to “immune stimulating” plants that stimulate a specific action in the body determined by the plant/prescriber, rather than precisely what your body has “identified as it’s need”).

There are more than one species of Echinacea: the main one for infection prevention is one called Echinacea angustofolia. If buying a product in pill form, it should be “standardized” for chemicals called alkylamides.

Golden Seal (Hydrastis canadensis)

Golden seal is a plant that is most effective in treatment of infections at the mucous membranes – the pink skin in your nose and mouth (among other locations).

Practically, these types of infections are often experienced as runny nose, sore throat, etc. Sound familiar? Golden seal.

Garlic (Allium sativum)

Garlic is a plant that is useful in infections of the gastrointestinal tract, but has it’s strongest reputation as an herb for respiratory infection. The flu is a respiratory infection, therefore, garlic may be a better choice for flu prevention than some of the other plants that have demonstrated anti-viral activity.

Garlic, if purchased in pill form, should be standardized to a chemical called alliin, and be sold as enterically-coated capsules.

St. John’s Wort (Hypericum perforatum)

St. John’s Wort has an anti-viral action against enveloped viruses, a specific design category of virus that the flu falls into. Similarly to garlic, this may make St. John’s Wort a better choice for flu prevention than some other anti-viral plants.

Do we have specific product recommendations?

Yes we do.

We do not usually recommend products in this forum, but as the above demonstrates, purchasing herbal medicines (and natural medicines in general) is much more complex than purchasing conventional medicines (e.g., aspirin), from both a “knowledge-required” and quality control perspectives.

If you are able to find them, MediHerb™ makes very high-quality botanical medicines. They are intended to be available only by prescription by a health care practitioner, and are available via our Online Dispensary. MediHerb™ produces Echincea-, garlic- and St. John’s Wort-based botanical medicines.

Viriditas Herbal Products are only available through naturopathic doctors, but if you are a patient of a naturopathic doctor, ask them if they are able to organize purchase of a tincture called “Children and Adults Cold and Flu Elixer”, which we’ve found to be excellent for both prevention and treatment of flu.

Viriditas Herbal Products also makes a tincture called “Herbal First Defense” which is very reliable for when you sense a tickle in your throat, and may or may not wake ill tomorrow. Taken at this juncture, “Herbal First Defense” will ensure you wake hale and hearty.

Lastly, our office offers a “Flu Clinic” – a “one-off”, one-hour consultation in which we can review with you flu prevention strategies in your/your family’s lifestyle and a botanical medicine regimen to help you have a happy and healthy winter season.

References

  1. Fabricant DS, Farnsworth NR. The value of plants used in traditional medicine for drug discovery. Environ Health Perspect [Internet]. Mar 2001 [cited 2016 Dec 14];109(Suppl 1):69–75. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240543/pdf/ehp109s-000069.pdf.

Posted: 2016 December 14

 

To Flu Vaccine, or Not Flu Vaccine

… that is the question: Whether ’tis Nobler in the mind to suffer. The Slings and Arrows of public pressure, Or to take Arms against flu infection, …

It’s flu season again, and with that our busiest season of answering the question: Should I get the flu vaccine?

To be clear, the flu vaccine is not within a naturopathic doctor’s scope of practice, and as such, it is not appropriate for us to either prescribe the flu vaccine, or advise a person not to have it.

We do endeavour to be helpful, and offer people the information they need to make an educated decision in matters of health they may be confused by, and in search of some manner of “expert” opinion.

This blog entry is actually in support of a Wellness Wednesday video we posted last week, but because it’s so “numbers heavy”, we decided to lay out the numbers (and our references here so readers can follow-up if they want to learn more).

Let’s get started!

Weighing whether or not to make any health decision based on research is not simple, and the flu vaccine is no exception.

In order to gather this information, I considered the four questions most people are considering (even if unconsciously) when making this (or any) decision:

  1. What are my risks if I don’t have the flu vaccine?
  2. How effective is the flu vaccine?
  3. What are the risks associated with having the flu vaccine?
  4. Do I have any alternatives?

What are the risks of not having the flu vaccine?

Getting the flu: an unpleasant, but usually short-lived infection that resolves on it’s own.

The worst case scenario is development of “flu-related complications”, which can result in death.

The number of Canadian deaths attributed to flu annually according to Health Canada is 3’5001, but this number is based on computer models, not confirmed cases of flu that resulted in deaths. An investigative report by the CBC in 2012 reported that in 2009 when confirmation of suspected flu cases was mandated in response to H1N1 flu- tracking, the number of confirmed flu-related deaths was 4282.

Considering this range of possibilities, and assuming the population of Canada is 35’000’000, your risk of death from flu is between:

  • 0.001% if 428 deaths yearly is an accurate estimate, or
  • 0.01% if Health Canada models are accurate

Will having the flu vaccine help me avoid flu infection?

Firstly, there are complexities inherent to reviewing medical research. In the case of the flu vaccine, among the complicating factors:

  1. The flu virus mutates. As such, a new vaccine has to be prepared annually before manufacturers know which strain of flu will be circulating. As such, some years the flu vaccine will be “well-matched” with the circulating virus, and therefore relatively more effective; and other years it will be poorly-matched, and not particularly effective.

As of 2014, the vaccine had been deemed well-matched in seven of the previous 14 years3.

  1. There is a technical difference between “efficacy” (how effective a vaccine is in a controlled, experimental setting) and “effectiveness” (how well it prevents infection in practice), and different research will focus on different “outcomes”.

Studies are not always “comparing apples to apples”.

  1. There is more than one version of the flu vaccine, but in broad terms, there is a vaccine made from “inactivated” (“dead”) virus and one made from “weakened live virus” (called “live attenuated vaccine”).

Again, not an “apples to apples” comparison.

  1. Much of the research on the flu vaccine is paid for by vaccine manufacturers. Research paid for by manufacturers has been demonstrated to be biased in favour of positive results, a fact known by reviewers of research, but not quantifiable.

To find research findings that are useful for answering this question, I considered three factors:

  1. Using “review articles”. Because new research is published daily, and studies on the same treatment may have differing and even opposite outcomes from study to study, “review articles” attempt to summarize “the bottom line” for readers.

Creation of a review article involves gathering all available research on a topic, removing studies of poor quality, assigning greater weight to more meaningful studies, and finally producing “a final answer”.

  1. Referring to review articles that present their final determinations in “number needed to treat” (NNT), which is the most meaningful way to present effectiveness of a treatment.

NNT considers not only the people who benefit from a treatment (which is usually how the media reports on medical research), but also other factors such as placebo effect.

For example, if 95% of patients in a group given a particular treatment recover, it would appear that the treatment is very effective. But, if 90% of patients given placebo also recover, the studied treatment is actually contributing very little to recovery (i.e., it’s only 5% better than doing nothing).

Statistically, NNT for this treatment is 20, meaning the first 19 people receiving this treatment would not benefit from it – 20 people have to receive this “very effective” treatment before anyone actually benefits from it.

In the case of the flu vaccine, the NNT represents the number of people who need to receive the flu vaccine to prevent one case of flu.

In order to prevent one case of flu infection, “this many people” need to be vaccinated:

  • Limited information indicates the inactivated flu vaccine is no more effective than placebo in children younger than two years (i.e., the vaccine has no effect)3
  • 6 – children younger than six years (using weakened live virus)4
  • 28 – children older than six years (using inactivated vaccine)4
  • 37 – adults (16 to 65 years), in years the vaccine is well-matched3
  • 77 – adults (16 to 65 years), in years the vaccine is poorly-matched3
  • 40 – adults older than 65 years3

Vaccination using the flu vaccine also:

  • Decreased sick days by 0.5 days (in years vaccine was well-matched)

What are the risks associated with having the flu vaccine?

Common side effects of having the flu vaccine are flu-like symptoms lasting one to two days5.

Rare side effects include life-threatening allergies, and development of an autoimmune condition in which nerves are damaged called Guillain-Barre syndrome5.

Are there alternatives to the flu vaccine?

Well, this is where it gets dicey. Yes and no.

There is no “natural flu vaccine”. A vaccine has a very specific mechanism of action of “pre-raising” antibodies to a specific infection that cannot be replicated by any other known means.

There certainly are other means to prevent flu infection. Hand-washing is considered by public health professionals an uncontroversial “alternative” means of preventing infections, including flu infection.

There are natural medicines that will stimulate general immune system activity that can be similarly used to reduce (all, not specifically flu) infections.

I will discuss these next week (this video and blog entry are already waaay too long).

Anything else?

Yes. If you plan to have the flu vaccine:

  1. Get it at the beginning of flu season (November or early December) so your body has time to create antibodies before you might encounter the virus. Getting the vaccine at the end of the season in response to late-season advertising will confer limited or no protection during flu season itself.
  2. Get the “live attenuated” vaccine which is inhaled, not the “flu shot”. Research has demonstrated that the live vaccine is more effective.

Until next week.

References

  1. For health professionals: Flu (influenza) [Internet]. Government of Canada. [cited 2016 Dec 5]. Available at: http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/flu-grippe/professionals-professionnels-eng.php.
  2. Flu deaths reality check [Internet]. CBC. 2012 Nov 25 [cited 2016 Dec 5]. Available at: http://www.cbc.ca/news/health/flu-deaths-reality-check-1.1127442.
  3. Kolber MR, Lau D, Eurich D, Korownyk C. Effectiveness of the trivalent influenza vaccine. Canadian Family Physician. 2014;60(1):50. Available at: http://www.cfp.ca/content/60/1/50.full.pdf+html
  4. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD004879. DOI: 10.1002/14651858.CD004879.pub4.
  5. Seasonal flu shot: questions and answers [Internet]. CDC. 2016 Aug 25 [cited 2016 Dec 7]. Available at: http://www.cdc.gov/flu/about/qa/flushot.htm.

Posted: 2016 December 8

 

The Birth of Roland

The start of the holiday season always brings to mind the following birth story. As a naturopathic birth doula, I am always honoured and grateful my patients allow me to to be a part off this very special moment in their lives, a feeling that I am reminded of each time I recount the story of this birth.

Du La, ND, Traditional Chinese Medicine Practitioner, Acupuncturist, Birth Doula

Erika had called me for the third time since her contractions had begun, two days previous. She had felt a noticeable change in her contractions and asked me to come to her home, the setting in which she had decided to birth. It is pretty amazing how a little experience (this was her second birth) made such a difference. She knew things were really happening now. She knew she needed her support people in place. Her husband was with her, her midwife, Nicole, was on the way, and I completed the birth team. Erika’s mother had come and picked up Erika’s daughter so she could focus solely on her needs and those of her new baby.

I arrived at her home soon after the call. It was a beautiful snowy, Christmas Eve morning. When I entered her home, I was aware of how comfortable Erika was and how relaxed everyone was together. We had all been present for her first birth and excited to be part of her second.  Erika was labouring well.

Erika had decided to have a water-birth. The birth tub was in place, and her husband, Adam, busied himself with the final steps of inflating and filling it with warm water. Birth tubs are great for the labouring mother’s comfort, but also as a means involving dads or partners (and keeping them busy if they’re anxious).

That morning, after two days of mild cramping, Erika’s cramps required more effort to ignore and were not subsiding, a sure sign of the “official” beginning of labour. With increased intensity of cramping, we began to employ comfort measures: Focus on breathing with each contraction, “hip squeezes” during contractions, and pressure applied to the low-back and over the sacrum. After two hours, Nicole checked her dilation. At “3–4 cm dilated” she was entering “active labour”, a relief to a labouring mom because it means the longest portion of labour is behind her.

Although longest portion is over, active labour is most physically intense portion of the birthing experience. During active labour contractions are strong, and are often characterized by a “peak”. The onset of more intense pain will sometimes undermine a labouring mothers’ confidence. With her contractions increasing in intensity, we guided Erika to the birth tub. The warm water offered immediate pain-relief, helping her entire body to relax. Once relaxed, Erika was able to center again and we were back on track.

After a couple of hours in the tub, Erika experienced a sudden change in emotion, and began suddenly to cry. Pulsatilla nigrans is a homeopathic medicine that can be given to persons who have the tendency to be overwhelmed by emotions by responding, specifically, by crying (rather than, for example, with anger). Erika fit that description at that moment, and after a few pellets of Pulsatilla nigrans and a few moments, she felt calmer.

The final stage of active labour, just before birthing, is called “transition”. Fear is another commonly experienced emotion during labour, and in my experience, it often occurs at transition. It is essential to offer mothers at transition a lot of support and reassurance. We reminded Erika of her strength, we coached her in her breathing to help her feel relaxed, but the fear was becoming difficult to control. Gelsemium sempervirens is a homeopathic medicine that can be used to calm a person in an acute state of fear, specifically fear with an anxious quality (e.g., “I don’t know what to expect/how this will turn out”).

With the fear receding, Erika began to feel a natural urge to “push”. The intensity of her body’s natural urge surprised her, and her baby was out with three strong, well-controlled pushes. He was born into the water of the tub (baby’s are still supplied oxygen through the umbilical cord) and placed immediately, skin-to-skin, on Erika’s chest. Immediate skin-to-skin contact with their mother is essential to a newborn in so many ways: They are happier, their temperature, heart and breathing rates are more normal, and they are able to be colonized by their mothers’ bacteria (an important preventative measure against developing allergies later in life). They are also able to exchange sensory information with their mothers, stimulating the development of “baby behaviours” such as rooting for the breast when hungry and natural breathing, as well as developing emotional attachments that cannot be quantified. Immediate skin-to-skin contact is not a given in many hospital environments.

Adam joined Erika and baby Roland in the tub, where they spent their first time together as a family.

As a doula, I recognize this as an essential time for family bonding. Her midwife and I receded into the background to let it happen. I stayed with Erika until her placenta was birthed, and until Roland had had his first and second “feeds”, to ensure he was latching to her breast well. As I left for my own family Christmas Eve celebration, Erika, Adam were beaming, and Roland was sleeping.

Thank you Erika, Adam and Roland for allowing me the honour of participating in your beautiful birth.

Magenta Quinoasotto (Gluten-free)

The holidays are full of festive gatherings and this gluten-free, delicious and nutritious recipe is sure to be a hit with any party crowd. Sharing is caring! (for more great recipes, click here)

Serves: 4

Ingredients:

Quinoa

  • Beets, diced – 1 ½ cups
  • Carrots, diced – 1 ½ cups
  • Shallots or onions, diced – 3/4 cup
  • Garlic, chopped – 3 tbsp
  • Coarse salt – 1 tsp
  • Coarse pepper – 1 tsp
  • Dried oregano – 1 tbsp
  • Olive oil – 1 tbsp
  • Quinoa – 1 cup
  • Parmigiano Reggiano, grated – ½ cup

Dressing

  • Olive oil (or clarified butter) – 2 tbsp
  • Lemon, juiced – ½ medium-sized
  • Lime, juiced – 1 full-sized
  • Cracked pepper – to taste

quinoa-2

 

Directions:

  1. Preheat oven to 450°F.
  2. In a baking dish, combine beets, carrots, onion, and garlic with salt, oregano, pepper, and oil. Toss gently to coat and roast in oven until soft and slightly browning (approximately 25 minutes).
  3. Meanwhile, cook quinoa as per the directions on the package.
  4. Combine all dressing ingredients in a bowl and mix.
  5. Stir dressing and roasted vegetable mixture into the hot quinoa, including all the juice in the pan. If you have made the quinoa ahead of time, put the whole mixture back in the oven until hot.
  6. Remove from heat and fold in grated parmesan until the whole mixture is gooey. It should be a brilliant shade of magenta that will add stunning visual appeal to your plate.

quinoa-1

Adapted from Pure Green Magazine
Vol. 4 / Food & Drink

Your guide to healthy snacking

This week on our Instagram, our practitioners are sharing their favorite snacks to help motivate and inspire you to snack smart. Wonder what an ND looks for when choosing what to snack on? In this post we will share our tips for selecting the best items to nosh on.

During the day, you should aim to enjoy three larger meals, making sure they are properly balanced. Hunger between meals is natural as your blood sugar declines and it is your opportunity to nourish your body just enough to get you to your next meal. Let’s break down the components of a well-rounded, nutritious snack

Effects on blood sugar:

First and foremost, balancing out your blood sugar is key to having a smart snack. The reason for moderate hunger between meals is in fact our body alerting you that your blood sugar is dropping.

The worst thing you can do is send it soaring as it will quickly crash leaving you tired, moody, and hungry, again!

When choosing a snack, consider its effects on your blood sugar. You should aim to balance so pair good carbs with healthy fats and clean proteins.

Healthy carbs:

Reaching for a muffin, donut, or other “white” flour, high sugar snack will send your blood sugar soaring only to have it crash. The good carb component of your snack should be a healthy “slow” burning carb such as whole fruit or whole grains.

Healthy fats:

Fat is your friend, as long as it’s the right kind of fat. Polyunsaturated fats are utilized heavily in the body and keep you feeling full longer. These are the fats you want to include in with your snacks. Choose nuts, seeds, or fish for your healthy fat option.

Proteins:

Proteins are essential building blocks for our body.  Choosing clean proteins for snacking will further help balance blood sugar and provide good nutrition. Ideal snack options for clean proteins are nuts, seeds, legumes and pulses, and hard boiled eggs.

Here are some quick ideas for snacks from clinic co-owner, Du La, ND :

  • Home-made muffin + fruit
  • Pretzels + fruit + nuts
  • Vegetable sticks + hummus
  • Corn chips + guacamole
  • Cheese + whole grain crackers
  • Kale chips
  • Roasted chick peas
  • Smoothie
  • Yogurt with fruit
  • Trail mix with dried fruit, dried coconut and seeds
  • Seaweed with brown rice and avocado

Our ND’s are ready to assist you with a properly balanced diet plan to support your overall health and wellness – Get in touch!

Recommendations for added sugar

The W.H.O. recommends that not more than 10% of a child’s daily caloric intake should come from added sugars.

Wonder what that looks like practically speaking?

You would be shocked! Check out this #WellnessWednesday video to find out just how much fruit juice is too much.

Warming Carrot, Garlic, Ginger Soup (Vegan, Gluten-free)

In Traditional Chinese medicine cooler weather means we should select warming foods to nourish our body. Du La, ND gave us a short list of her favourite everyday warming foods and this easy recipe to incorporate them into your weekly meals. Enjoy!

Serves: 4-6

Ingredients:

  • Carrots, peeled and thinly sliced – 6 full-sized
  • Sweet onion, diced – 1 medium-sized
  • Garlic, minced – 2 cloves
  • Cashews, raw or unsalted – ½ cup
  • Ginger, freshly grated – 1 tbsp (if you are like me, and LOVE Ginger, add more!)
  • Coconut oil – 1 tbsp
  • Coconut milk – 1 can
  • Water, unsweetened almond milk, or vegetable stock – 1-1½ cups
  • Maple syrup – 1-2 tbsps (or to taste)
  • Ground cinnamon – 1½ tsps
  • Ground cumin – 1½ tsps
  • Nutmeg, freshly ground – ½ tsp
  • Sea salt – to taste

Directions:

  1. Warm the coconut oil in a sauce pan over medium heat.
  2. Add the sliced carrots, onion, garlic and spices and sauté until carrots are soft and onions are slightly caramelized.
  3. Once the carrots and onions have softened add the coconut milk, cashews, ginger, and maple syrup.
  4. Bring to a low bubble over medium heat, don’t let it boil!
  5. Allow soup to simmer 20 minutes.
  6. From here, place the contents of the pot into a high powered blender and start blending on low. Add your liquid of choice in small amounts until you have your desired consistency. If you do not have a high powered blender, you can use an immersion blender instead.

Love this recipe? You can find more recipes, and other fantastic food ideas on my Instagram!

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