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Endocrinology

Bipolar Disorder: Integrative Management

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Corey Schuler, MS, DC, LN, CNS
In any given year, the Brain & Behavior Research Foundation reports that nearly six million American adults have bipolar disorder. This brain and behavioral illness is characterized by a spectrum of severe shifts in the patient’s energy and mood. Mood swings are described as episodes and can be expressed as either being manic (typically very high) or depressive (typically very low). Normal mood is present between episodes.

There is no specific blood test or brain scan that can detect bipolar disorder. It is diagnosed by evaluating symptoms and family history and ruling out other medical conditions.

While this can be a challenging patient population to treat, these patients are in desperate need for efficacious treatment. An integrative approach lends itself well to this type of challenge and can certainly help many individuals with bipolar disorder.

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Diabetes: Integrative Management of Type 2 Diabetes

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Mona Morstein, ND, DHANP
Characterized by insulin-resistance and loss of glycemic control, type 2 diabetes accounts for more than 90% of all adult diabetes cases. In the United States, more than 1 in every 10 adults is affected by diabetes, and for older adults (aged 65 and older), that figure rises to 1 in every 4. Obesity, sedentary lifestyle, and poor diet are strong predictors of type 2 diabetes, making lifestyle interventions critical tools for the management and reversal of this disease. In the following discussion, Dr. Mona Morstein, ND, DHANP, emphasizes the need for strict glycemic control achieved through structured and monitored diet, lifestyle interventions, supplements and medications, in order to attain excellent glucose control, establish weight loss, and prevent complications of type 2 diabetes.

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Endocrine Disruptors

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Sara Gottfried, MD
You’ve probably heard the term diabesity in recent years, which refers to the spectrum of blood sugar dysfunction ranging from moderate abdominal fat gain to obesity and type 2 diabetes.

Despite efforts to control diabetes and obesity, these conditions have escalated to epidemic proportions. The Centers for Disease Control and Prevention (CDC) report that one third of all Americans are considered obese (BMI >30) and nearly 26 million Americans have diabetes. Based on current trends, the CDC reports that by 2050, 1 in 3 American adults will have diabetes. Millions more are prediabetic and aren’t even aware of it.

When the root causes of diabesity are identified and addressed, patients are more likely to lose weight, get lean, and reverse diabesity. For those patients struggling with weight loss, an integrative approach that emphasizes effective detoxification and reduction of endocrine disruptors, known to act as obesogens, could benefit them greatly. By focusing on the obesogen pathways and supporting liver detoxification, these patients can successfully lose weight and in the process regain their health.


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Generalized Anxiety Disorder

Lise Alschuler, ND, FABNO
Generalized anxiety disorder affects approximately one third of all adults. It is associated with several different mental, emotional, and physical symptoms. Because of the diverse and individualized symptom profile, it can be challenging to diagnose and treat. An integrative approach focusing on scientifically validated nutrients and herbs can provide healthcare providers with safe and efficacious options to prescription pharmaceutical drugs.

The foundation of the integrative treatment protocol for GAD is addressing underlying causal factors with a focus on correcting neurotransmitter imbalance in the limbic system. Hypothalamic-pituitary-adrenal (HPA) axis dysfunction should also be addressed.

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Hidden Faces of Post-Traumatic Stress Disorder

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Nancy Gahles, DC, CCH
The American Psychological Association defines post-traumatic stress disorder (PTSD) as anxiety associated with a traumatic event. The memories, flashbacks, nightmares, or other anxiety issues can be so disruptive it can significantly impede quality of life.

This type of trauma is typically associated with combat, crime, accident, or natural disaster. However, many experts feel PTSD can occur with many other traumatic events. Expert Nancy Gahles, DC, CCH, calls this expanded population the “hidden faces” of PTSD because they are often marginalized, overlooked, or under treated. Her innovative collaborative treatment strategy brings together key disciplines to ensure the best outcomes possible for this patient population.

While the National Institutes of Mental Health estimates that PTSD affects nearly 8 million American adults, Gahles and other experts argue that the number is much higher. In this interview Gahles defines the hidden faces of PTSD and outlines the collaborative, non-pharmaceutical approach she uses to successfully address this issue in clinical practice.

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Hypothyroidism

Holly Lucille, ND, RN
An estimated 20 million Americans have some form of thyroid disease, and many cases remain undiagnosed. In diagnosed cases of thyroid disease, we still lack a clear understanding of causes and the accuracy of laboratory testing. Because an underactive thyroid can be so hard to diagnose, and lab tests aren’t a reliable measure of optimal thyroid function, integrative practitioners need to be aware of

the diverse symptoms and contributing factors.

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Infertility

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Jaclyn Chasse, ND
Primary infertility is defined as a couple’s inability to conceive after trying for one year. It is estimated that about 10 to 15 percent of couples in the United States are infertile. Infertility affects men and women equally and in most cases, evaluation of both partners is necessary to determine the reasons for a couple’s infertility. The National Institutes of Health defines secondary infertility as a couple’s inability to get pregnant after having a live birth. With this definition, infertility can also be used to describe a woman’s inability to carry a pregnancy to full term, as is the case with multiple pregnancy losses. If standard infertility evaluation results are normal, the couple is diagnosed as having unexplained infertility. A 2008 paper revealed that 15 to 30 percent of couples have unexplained infertility. According to integrative fertility expert Jaclyn Chasse, ND, this is an area where an integrative practitioner can play a key role. Not only do the expanded integrative treatment tools lend themselves to enhancing fertility, but the integrative practitioner can likely uncover underlying causes that are contributing to unexplained fertility using functional diagnostic testing.

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Insulin Dysregulation


Corinne Bush, MS, CNS
Insulin regulation has become a foundational health issue. Healthy cells naturally have sensitivity to insulin. A combination of dietary factors, sedentary lifestyle, and stress, however, can result in chronically elevated blood glucose and insulin. Cells that are constantly exposed to high levels of insulin adapt by reducing the number and sensitivity of receptors on their surfaces. The result is insulin resistance, a prediabetic condition that creates metabolic dysfunction and accumulation of visceral adipose tissue. Visceral adipose tissue acts like an endocrine organ, releasing disrupted levels of adipokines (e.g., decreased adiponectin and increased leptin, TNF-α, and IL-6). This pattern of dysregulation not only further promotes insulin resistance but also creates systemic inflammation.

Decades ago diabetes was considered to be the only clinical ramification of insulin resistance. Since then the scientific literature has highlighted prediabetes and metabolic syndrome. In this interview, nutritionist Corinne Bush expands the continuum even further with a discussion of early insulin dysregulation that can occur before the clinical manifestation of other metabolic syndrome components.

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Integrative Approaches to Neuroscoliosis

Marc Lamantia, B.S., M.S., D.C., DACNB
Scoliosis is defined as an abnormal lateral curvature of the spine, measuring 10° or more. Scoliosis affects 2-3% of the population, or an estimated 6 to 9 million people in the United States. Scoliosis can develop at any age, but most often progresses during the rapid growth of adolescence. In the United States, scoliosis is managed by orthopedic specialists, who “watch and wait” until the spinal curvature is significant enough to warrant bracing or surgery. In the conventional medical model, scoliosis is understood to be strictly a musculoskeletal condition that will not respond to nutritional, lifestyle, or other metabolic interventions.
 
In contrast to the conventional view of scoliosis, Dr. Marc Lamantia, D.C., approaches scoliosis as a whole-body disease—a disease that is influenced by internal and external epigenetic factors. In the following discussion, Dr. Lamantia explains that scoliosis is more accurately termed “neuroskeletal scoliosis.” He encourages integrative clinicians to become educated about this condition and to educate patients on the need for integrative care.

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Irritable Bowel Syndrome

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Adam Rinde, ND
Irritable bowel syndrome (IBS) has a population prevalence of 10%-15% in the United States, with the majority of diagnoses made between the ages of 20 and 39 years. IBS is diagnosed when there are characteristic gastrointestinal symptoms in the absence of organic disease. Features of IBS include disordered bowel habits, bloating, abdominal pain, and aggravation of symptoms after eating. Symptoms are often intermittent or changing over time. Concerning symptoms that require specific diagnostic testing to rule out organic disease include onset after age 50, severe or progressively worsening symptoms, unexplained weight loss, nocturnal diarrhea, rectal bleeding, or unexplained iron-deficient anemia. Conventional treatments for IBS are aimed at symptom control. An integrative approach addresses the whole patient, including the hypothalamic-pituitary-adrenal (HPA) axis, immune factors, dysbiosis, and function of the migratory motor complex (MMC). In this discussion, Dr. Adam Rinde, ND, details emerging tests and protocols for the integrative management of IBS.

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Metabolic Syndrome

Sheila Dean, DSc,RD,LD,CCN,CDE,IFMCP
Metabolic syndrome, initially described in 1988 as syndrome X, is a condition that involves multiple cardiovascular risk factors: obesity, hypertension, hyperlipidemia, and blood sugar dysregulation. Central to the metabolic abnormalities of this condition are insulin resistance and hyperinsulinemia. Patients with metabolic syndrome have an increased risk of type 2 diabetes, atherosclerosis, and death from cardiovascular disease. According to National Health and Nutrition
Examination Survey (NHANES) data through 2012, the overall prevalence of metabolic syndrome in US adults is 33%, with higher rates in women than in men and higher rates in Hispanics than in other ethnic groups. Among US adults over the age of 60, the prevalence of metabolic syndrome is as high as 50%.

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Nutritional Management of Diabetes

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Daemon Jones, ND
Diabetes includes type I diabetes, a condition where the pancreas produces insufficient insulin, and type 2 diabetes, a condition of insulin resistance or of insufficient insulin production. According to the Centers for Disease Control and Prevention (CDC), diabetes affects more than 29 million individuals in the United States (9.3% of the population). The incidence of diabetes increases with age, with an estimated prevalence of more than 25% in Americans aged 65 or older. Moreover, for every American with diabetes, there are at least 2 more with pre-diabetes. Complications from diabetes include cardiovascular disease, myocardial infarction, stroke, retinopathy, renal failure, neuropathy, and amputation.

One of the most challenging aspects of managing cases of type 2 diabetes is patient compliance with foundational lifestyle changes. Restricted diets and lifestyle changes can be daunting; patients might initially comply and then slip back into their old habits. In this discussion, Dr. Daemon Jones, ND, shares specific approaches to optimize compliance in this patient population.

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Osteoporosis

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John Neustadt, ND
The World Health Organization defines osteoporosis as a disease of low bone mineral density (BMD), diagnosed by a T-score of −2.5 or less. In the United States, more than 10 million people are living with osteoporosis, and that number is expected to increase to 14 million by the year 2020. Osteoporosis is a serious health concern because it increases the risk for fractures, leading to disabilities, chronic pain, or even death. Hip fractures are particularly debilitating, putting patients at a 20% risk of death within 1 year. It is estimated that the annual number of hip fractures in the United States will rise to 289,000 by the year 2030, making fracture prevention a priority in the treatment and management of osteoporosis. In this discussion, Dr. John Neustadt, ND, explains the importance of treating not only bone density but also bone flexibility to achieve the most important clinical endpoint in osteoporosis: fracture risk reduction.

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Perimenopausal Insomnia

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Tori Hudson, ND
Insomnia is associated with quality of life, productivity, depression, anxiety, cognition, and even safety.

Individuals with insomnia have significantly greater impairment in their living than people without insomnia. Psychomotor and cognitive performance, attention, response time, unstable work performance, errors and accidents are all disrupted and altered in patients with sleep disorders. Insomnia may also be associated with an increased risk of developing cardiovascular disease. The good news is that the impairments and risk associated with insomnia are reversible with effective treatment. Patients may need in-office testing, or may need to be referred for specific evaluations. Given the prevalence of insomnia, the impact on quality of life of insomnia, and the unique aspects in women, and in perimenopausal/menopausal women in particular, a practitioner who has a comprehensive understanding of sleep problems, and of midlife women, will enhance their ability to provide effective solutions.

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Polycystic Ovarian Syndrome

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Jane Guiltinan, ND
Polycystic ovarian syndrome (PCOS) was originally described in 1935 by Stein and Leventhal, who reported several cases of women with polycystic ovaries, amenorrhea, and accompanying obesity, hirsutism, or acne. PCOS is now recognized as a metabolic and endocrine disorder that affects between 1 in 10 and 1 in 20 women of childbearing age. The condition is diagnosed when 2 of the following 3 characteristics are present: androgen excess, ovulatory dysfunction, and polycystic ovaries. Clinical features can include amenorrhea, oligomenorrhea, acne, hirsutism, male-pattern baldness, mood disorders, or obesity. PCOS is an important cause of infertility, is strongly associated with insulin resistance, and increases the risks for diabetes mellitus, cardiovascular disease, and endometrial cancer. In the following discussion, Jane Guiltinan, ND, reviews evidence-based integrative therapies for PCOS.

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Traumatic Brain Injury

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Brandon Brock, DC, RN, NP-C, DACNB
Traumatic brain injury (TBI) is defined as any damage to the brain resulting from external trauma such as an impact injury or penetration of the skull. Of the many forms of TBI, concussion, or mild traumatic brain injury (mTBI) is one of the most common. Causes of TBI include falls, vehicular accidents, violence, sports injuries, or combat injuries. Physical manifestations of TBI can include skull fractures, hematomas, subarachnoid hemorrhage, contusions, or diffuse axonal injury. Symptoms of TBI range in severity from disorientation or headache to loss of consciousness or coma.

 

Long-term consequences of TBIs can include cognitive deficits, seizures, and neurodegenerative disease. Because the brain has an effect on all body systems, and all body systems have an effect on the brain, Dr. Brandon Brock views TBI as the “pinnacle of all metabolic disease.” In this discussion, he explains his comprehensive approach to the assessment and treatment of patients with TBI.

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Vestibular System Dysfunction

Monika Buerger, DC
The vestibular system processes sensory information related to motion, equilibrium, and spatial orientation to create a sense of balance and proprioception. One important anatomical part of the vestibular system is the vestibular apparatus, located within the inner ear. The vestibular apparatus is the collection of structures in the inner ear that include the utricle, saccule, and 3 semicircular canals. Sensory information from this vestibular apparatus as well as other inputs is processed in the vestibular nuclei within the brain stem. Whereas the vestibular system has historically been thought of as a balance apparatus, emerging research suggests that its effects are much more far-reaching. In the following discussion, Dr. Monika Buerger, DC explains the relationship between stress, vestibular function, and other body systems. She explains practical ways for clinicians to identify and address vestibular dysfunction.

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