Event Update, FODMAPs, Ashwagandha, Doctor as Teacher
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Image by Lindsay Crowder @lec101

Late July Health News

Michelle Crowder, ND - Licensed Naturopathic Physician

(The closer you live to trees, the better off you may be!)

July has been an eventful month with a nice balance of work and time off. I have had the chance to visit family, spend time in northern Michigan, and focus on my running practice. At work, I have been busy seeing patients, always learning and developing new tools. Troy Naturopathic and I recently co-sponsored the Growing Up Green Festival (see article below).  

Next week, I will be attending the 2014 Annual Conference of the American Association of Naturopathic Physicians. The theme this year is "Naturopathic Primary Care: The Future is Now!" The conference will be a great chance to connect with my colleagues from around the world and learn about new research and clinical insights in areas such as women’s health, nutrition, oncology, and pharmacy. I hope to come back inspired with new ideas to help you all!    

If you have not already, please "like" my page on Facebook to get more frequent updates on classes and presentations, local events, and of course the various health-related articles I find on the web each week.  I am still on Twitter, as well. Thank you for your support!

Click here to view the last newsletter from June 2014.
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En salud,

75 Barclay Circle, Suite 225
Rochester Hills MI 48307

Event Update

Troy Naturopathic and I sponsored the first annual Growing Up Green Festival in Shelby Township last weekend. It was great to chat with people (including some of my patients!) about Naturopathic Medicine and the work that the MANP is doing to gain licensure for our profession in Michigan. We gave a brief talk on Immunizations, in which we reviewed the history, the science, and some of the controversy surrounding this hot topic. I learned so much! One interesting tidbit: perhaps the oldest records of immunization come from Buddhist nuns around 1000 CE - they dried old smallpox scabs, pulverized them with specific plants, and then used silver tubes to blow the powder into the nostrils healthy people. Incredible! We were not promoting any particular stance on the issue, but rather providing information to help people make decisions on their own. We created a resource list that I would be happy to share – just ask!


A Part of the Integrated Solution to IBS
When a patient presents to me with digestive issues or a diagnosis of Irritable Bowel Syndrome (IBS), I want to know WHY. Instead of giving medications to suppress diarrhea or decrease intestinal spasm, I strive to understand the factors contributing to these symptoms in each individual case. We discuss history and symptoms at length, and we may order testing. Common factors that contribute to IBS include emotional stress; imbalances in gut flora (which can be a result of stress), including infections; and individual variation in capacity to digest various food molecules, such as lactose, or milk sugar.

What Are FODMAPs?  
There are certain foods that are just more difficult to digest, no matter who you are. In an otherwise healthy person, these partially indigestible foods feed gut bacteria, which ferment them to produce short-chain fatty acids that nourish the cells that line our intestinal tract. So we do need them to an extent. Some gas is released during this reaction, but for most people it is not as issue. Problems may arise when (1) We consume too many of these foods at once, or too frequently; (2) We can’t digest them as well as the average person; or (3) We have an overgrowth of certain bacteria in the digestive tract, leading to too much fermentation (one example of this is SIBO, or Small Intestinal Bacterial Overgrowth). Fermentation produces gas, which can lead to pain, bloating, diarrhea, and constipation, some of the hallmarks of IBS. Furthermore, if these substances reach the large intestine undigested, they pull water into the colon, which can lead to diarrhea (1, 2). There is also evidence that people with IBS are more sensitive to the minor muscle contractions and gas produced during normal digestion that go unnoticed by most people. 

So what are these potentially pesky substances? They are known as FODMAPs, which stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols.” These are carbohydrates found in many common, healthy foods. Let’s take a closer look --
  • Fermentable: Means that these carbohydrates are digested by gut flora via the process of fermentation. This can happen in the small intestine and/or the large intestine. Gas is a byproduct.
  • Oligosaccharides: Include fucto-oligosaccharides (fructans) and galacto-oligosaccharides (galactans). These are commonly included in probiotic supplements as “pre-biotics” intended to feed intestinal bacteria (inulin and chicory are two common examples). Again, this is considered to be a beneficial process in healthy people, but it can exacerbate IBS. Fructans are high in wheat, rye, barley, artichoke, asparagus, garlic, onion, and leek (especially raw). Galactans are high in beans and lentils.
  • Disaccharides:  Lactose is the issue here. It is found in dairy products such as milk, cheese, and some yogurt (learn how to make lactose-free yogurt).
  • Monosaccharides: Fructose seems to be most problematic. It is high in honey, apples, pear, mango, watermelon, and of course, high fructose corn syrup.
  • Polyols: These are sugar alcohols such as sorbitol, mannitol, xylitol, and isomalt; high in apples, pears, avocados, mushrooms, and “stone fruit” such as apricots, cherries, nectarines, and plums.
Fructans, Galactans, and Polyols seem to be more generally problematic, while Lactose and Fructose seem to contribute to IBS in a minority of people. Hydrogen breath tests are available to identify whether you have Lactose or Fructose intolerance.

What is the Evidence? 
Multiple studies have shown a reduction in symptoms of IBS when foods containing FODMAPs are reduced or eliminated from the diet (1, 2, 3, 4). FODMAPs are likely one piece of the puzzle and not the whole story.  For example, gluten, a protein found in wheat, rye, and barley, also may contribute to IBS in some people (this is separate from celiac disease). Stress management and other mind-body approaches are also essential in the treatment of IBS.

How To 
To determine if FODMAPs are contributing to your IBS symptoms, it is generally recommend that you avoid high FODMAP foods completely for at least 4 – 6 weeks, and then possibly reintroduce them in a systematic way, keeping track of your symptoms along the way. The Low FODMAP Diet was developed by researchers Susan Shepherd and Peter Gibson. It shares many features with the Specific Carbohydrate Diet and the GAPS Diet, two other therapeutic diets for people with digestive disorders. These diets help to alleviate symptoms and promote healing while we work on addressing the root cause of digestive upset.  
It is important to realize that there is nothing inherently “bad” about any of these foods. Many are extremely healthy! They simply can be difficult for some people to digest at certain points in time. My goal is to identify and treat the causes of FODMAP intolerance, so that these foods can someday be enjoyed in moderation, and do their work to promote healthy intestinal cells via their “pre-biotic” quality.    
For more information on FODMAPs

Featured Therapy: Ashwagandha (Withania somnifera)

Withania somnifera, commonly known as Ashwagandha, is a member of the Solanaceae family and native to dry regions of India, northern Africa, and the Middle East. It is among the most important herbs in Ayurveda, the traditional system of medicine in India, in which it is known as a “Rasayana,” or tonic. In Sanskrit, Ashwagandha means “smell of the horse” and is thought to instill a horse’s vitality to the consumer. In Western botanical medicine, this plant is known as an “adaptogen,” meaning that it helps people adapt to stress and cope with fatigue, improves general immunity, and promotes balance of a wide variety of physiological functions. As the scientific name suggests, it has been used to induce sleep, but it is also known to improve energy, a testament to its balancing quality.   
Evidence to Support the Use of Ashwagandha in Clinical Practice (all studies were done in animals, except where noted):

How To 
The root is most commonly used, and various preparations are possible. The root can be dried and ground into a powder, encapsulated, or decocted and consumed as tea; it can also be soaked in alcohol to make a tincture. I commonly formulate Ashwagandha with other adaptogens such as Eleutherococcus, Rhodiola, and Tulsi. Traditionally, the root powder was combined with milk and honey or ghee and consumed as a tonic or to help with sleep induction. Try mixing 2 Tbl of Ashwagandha powder with 1/3 cup of raw coconut butter and 1.5 to 2 Tbl honey to make a sweet, creamy, medicinal paste.

Principles of Naturopathic Medicine Series

In 1989, a group of Naturopathic Doctors met to define our profession. The Six Principles of Naturopathic Medicine were born out of these meetings.  The principles have been refined over time, most recently in 2011, and serve as a framework for both defining our medicine and influencing clinical decision-making.  As a way to further relate what I do, I will be reviewing one principle per newsletter for the next several months.
5. Doctor as Teacher
6. Prevention 

Doctor as Teacher

The word "Doctor," is derived from the Latin, "Docere," which means "to teach." A significant portion of each visit with a Naturopathic Physician is devoted to education. Based on history and laboratory workup, we discuss the various processes operating in your body, how they relate to what you are feeling, and how they are influenced by lifestyle, environment, medications, and natural substances. We discuss lab results at length, so that you understand what they mean. We discuss the various options for treatment, and what to expect in terms of outcomes. We also provide resources so that you can make healthy decisions on your own.

The result is an informed, empowered patient, able to take responsibility for his or her own health. This scenario promotes sustained health and more robust positive outcomes. Compare this with the conventional medical model, in which the patient spends minutes with their provider with minimal time for questions and discussion, and often leaves with a prescription for medication - they may have no clue what the medication does, or what health concern it is intended to address. 

I was an educator in various capacities before pursuing Naturopathic Medicine, and education continues to be a passion of mine (can you tell from my newsletter?). Part of what drew me to this medicine was its commitment to educate and empower. It is so rewarding to watch my patients learn as they progress on their journey towards health. They in turn teach others along the way, further promoting an awareness that is the first step towards better health for all.

What is Naturopathic Medicine?

In short, Naturopathic Medicine combines the best of conventional and alternative medicine into an individualized, whole-person approach to primary health care. NDs are trained as primary care providers with an emphasis on natural and common sense approaches including clinical nutrition, lifestyle counseling, and botanical medicine.

What to Expect from Your Visit

I work with my clients to identify the root causes of disease, taking into account the various factors that influence health, including lifestyle, genetics, physiology, and mental-emotional state. First visits are 90 minutes and include a thorough health history, followed by discussion of my preliminary assessment and recommendations. I may order conventional or specialty lab work to aid in my understanding of your condition. We work together to devise a plan that will meet your health goals.

Follow-up visits generally last 30-45 minutes and are important so that I can better get to know your unique physiology, track your progress, and refine my recommendations. I can consult with your other health providers and make referrals as necessary.

Integrative Medicine

I am fortunate to work in an integrative primary care practice, alongside a D.O. (Doctor of Osteopathy), N.P. (Nurse Practitioner), and P.A. (Physician's Assistant).  We share patients and regularly consult with each other to coordinate care. 

I believe this approach benefits patients by offering them the best of both worlds - conventional and natural.  These two worlds are not mutually exclusive; in fact, many health concerns are best addressed by a multifaceted approach.  The power of Integrative Medicine is backed by research, especially for chronic conditions such as heart disease.
I am now offering Gift Certificates for my services. They are available for a 90 minute New Patient appointment, 1 hour Follow-Up, and 30 minute Follow-Up.  Please call my office with questions, or to order one for a friend or family member.

FYI: Licensing and Regulation of Naturopathic Medicine

Licensed Naturopathic Physicians attend a 4-year post-graduate medical school accredited by the Council on Naturopathic Medical Education and recognized by the U.S. Department of Education. They must pass basic science and clinical licensing exams administered by the North American Board of Naturopathic Examiners. Currently, 16 states license Naturopathic doctors as primary care providers. National and state legislative efforts are organized by the American Association of Naturopathic Physicians.  Because NDs are not currently licensed in Michigan, they function as complementary providers.

For more information about the active legislative efforts to license Naturopathic Medicine in Michigan, visit the Michigan Association of Naturopathic Physicians.


About Michelle Crowder, ND

Michelle Crowder, ND is a licensed Naturopathic Physician with a focus in holistic and preventative primary care.  She works with people of all ages to identify and treat the root causes of disease, empowering her clients with the tools they need to understand and take control of their own health. Areas of special interest include digestive health, hormone imbalance, and immune dysfunction, including thyroid disease.

National College of Natural Medicine, Doctorate of Naturopathic Medicine, High honors
University of Vermont, Master of Science in Botany, Summa Cum Laude
University of Michigan, Bachelor of Science in Biology, Summa Cum Laude
Copyright © 2014 Michelle C Davila, ND, All rights reserved.
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