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Neurology

Attention-Deficit/Hyperactivity Disorder

Todd Roach, DC, FIAMA
The National Survey of Children’s Health reports that 1 out of 11 school-aged children have a current diagnosis of ADHD and that the prevalence of ADHD has been steadily increasing by an average of 5% each year between the years of 2003-2011.

ADHD is characterized by symptoms of inattention, hyperactivity, or impulsivity that affect academic or social functioning. Conditions that may coexist with ADHD include anxiety, depression, behavior disorders, learning disorders, sleep disorders, or tics. Although ADHD is most often diagnosed in children, it is now recognized that symptoms of ADHD extend into adulthood in as many as 60% of cases. Conventional treatments rely on behavior therapy and medications to achieve long-term symptom management.

Dr. Todd Roach, DC, views ADHD as an expression of underlying genetic, biochemical, and neurological dysfunction. In this discussion, Dr. Roach explains how to identify and treat the underlying causes ADHD and how to empower patients for lifelong change.

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Autism Spectrum Disorder

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Elizabeth Mumper, MD, FAAP
The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent years, from 1 in 5000 (1975) to 1 in 2500 (1985) to 1 in 500 (1995) to 1 in 250 (~2001) to a current rate of about 1 in 50 children in the United States. A diagnosis of ASD is given to individuals who meet the criteria for autism disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS). Diagnosis relies on the presence of persistent deficits in social communication and social interaction with restricted or repetitive patterns of behavior. ASD can occur with or without intellectual impairment, language impairment, a known genetic condition, or other medical or developmental disorders.

Whereas ASD has conventionally been viewed as a neurological disorder, a new medical paradigm is emerging to help understand and treat this disorder. Here we interview Elizabeth Mumper, MD, about her approach to patients with ASD. She views ASD not as a brain disorder, but rather as a multisystem disorder associated with numerous medical problems that, when resolved, can improve patient outcomes dramatically. Some of these medical problems include gastrointestinal disease, immune dysregulation, oxidative stress, metabolic impairment, and mitochondrial dysfunction. In this interview we focus on metabolic patterns observed in ASD, including problems with methylation, transsulfuration, and mitochondrial function.

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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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Contemplative Cancer Care

Matt Mumber, MD
According to estimates from the American Cancer Society, there will be more than 1.6 million new cases of cancer diagnosed in the United States in 2015. In addition, almost 15 million Americans alive today are cancer survivors. Cancer is a diagnosis that can create distress, depression, anxiety, and other psychological challenges for patients, family members, caregivers, and the community. Standard therapies focus on eradicating the physical disease through surgery, chemotherapy, and radiation, but there are no definitive guidelines to address the emotional and psychosocial aspects of this disease. Evidence-based psychosocial interventions and mindfulness-based therapies show promise in their potential to improve the quality of life for cancer patients and cancer survivors. In this discussion, Dr. Matt Mumber shares his unique perspective on the importance of what he calls “contemplative care” in cancer.

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Depression

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Kelly Brogan, MD
The Centers for Disease Control and Prevention estimates that 1 in 10 American adults meet the criteria for a diagnosis of depression. Most of these people are prescribed antidepressant medications, which are now the third most commonly prescribed drugs in America.

Adverse effects and poor clinical outcomes have caused innovative integrative physicians to evaluate and treat depression differently and to move away from the model of care dependent on selective serotonin reuptake inhibitors (SSRIs). Kelly Brogan, MD, is one of those physicians. Here Dr. Brogan discusses the rationale, strategy, and outcomes associated with her integrative treatment plan, which addresses the underlying causes of depression.

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Depression and Cardiovascular Disease

Decker Weiss, NMD
Cardiovascular disease is the number 1 cause of death in the United States and in the world.   According to the 2015 update by the American Heart Association (AHA), cardiovascular disease claims more lives than all forms of cancer combined, with 1 in every 3 deaths in the United States resulting from heart disease, stroke, or other cardiovascular disease. The AHA promotes 7 key behaviors that this organization hopes will reduce the risk of cardiovascular disease by 20% by the year 2020: not smoking, increasing physical activity, following a healthy diet, maintaining a healthy body weight, controlling cholesterol, controlling blood pressure, and controlling blood sugar.

Depression as a risk factor for cardiovascular disease has also attracted increasing attention, with the AHA listing depression as a risk factor for adverse events after acute coronary syndrome (ACS) in 2014. Here Dr. Decker Weiss discusses how the functional pathophysiology of depression and cardiovascular disease overlap, how to assess these conditions with functional labs, and how to approach their treatment. This information is critical for any clinician who treats patients with either depression or cardiovascular disease.

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Fibromyalgia

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David Brady, ND, DC, CCN, DACBN
Fibromyalgia is a condition characterized by chronic widespread pain and fatigue that can be accompanied by additional symptoms, such as sleep disturbance, depression, anxiety, and/or irritable bowel. Fibromyalgia affects predominantly women, with a female to male ratio of 7:1. Diagnostic criteria for fibromyalgia were first developed in 1990 and have evolved over time.

David M. Brady, ND, proposes that the current diagnostic criteria lead to inappropriate diagnosis in a large number of patients whose symptoms are better explained by other causes. For example, musculoskeletal disorders, organic diseases, and functional metabolic disorders can all create chronic pain and fatigue. He suggests that the fibromyalgia diagnosis should be reserved for those who truly experience a global hypersensitivity to pain with underlying central nervous system dysfunction. He uses the term “classic fibromyalgia” to describe this subset of patients. In the following discussion, Dr. Brady explains his approach to the accurate diagnosis and treatment of classic fibromyalgia.

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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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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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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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Psychological Pain Management

Beth Darnall, PhD
Chronic pain, defined as pain that persists longer than 6 months, affects more than 100 million people in the United States and more than 1 billion people around the world. Prescription opioids are commonly prescribed to manage pain, putting patients at risk for side effects, addiction, and even death. Dr. Better Darnall, Ph.D., leads research efforts at Stanford University aimed at reducing patient need and use for prescription opioids by empowering them with skills to self-manage pain. Here she discusses the science and emerging research in the field of psychological pain management. 

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The Therapeutic Relationship

Paul Epstein, ND
As we face an epidemic of chronic illnesses and lifestyle diseases, many medical professions are coming to realize that a shift is needed in the way we deliver care. The Pew Fetzer Task Force proposed the concept of “relationship-centered care” in 1994, referring to a clinical approach that relies on partnership and shared decision-making. Then in a 2004 report, the US Institutes of Medicine (IOM) emphasized the importance of teaching communications skills related to patient-physician interactions in medical schools. In the following discussion, Dr. Paul Epstein, ND, shares his insights on the value of the therapeutic relationship and offers guidance on how clinicians can cultivate their abilities to be more mindful, compassionate, and present in clinical interactions.

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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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