TNT Vol 38 No. 1 Winter 2023

The

Natural

Therapist

EDITION 38 NO. 1 | WINTER 2023

ISSN 1031 6965

Winter 2023

The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION

WWW.ANTA.COM.AU

Contents Edition 38 No. 1 | Winter 2023

From the Chair

4 Executive Officer Report 6 N aturopathy Branch Chair Update 7 Bursary Award Winners 2022 8 Graduate Award Winners 2022

10

14

Lactic Acid - Friend or Foe?

The Inside Scoop on Homeopathic Medicine and How it is Being Used to Enhance Fertility

Anthony Evans, ANTA Member, explains lactic acid and its benefits and if it contributes to exercise performance.

Melissa Kupsch writes about homeopathic

18

Mindful Eating: What it is and Why do Most of us Not Do it?

Carla Hanlon, ANTA Member, explores Mindful Eating and why most of us do not do it.

medicine and how couples around the world are turning to homeopathic medicine to enhance fertility.

32

38

49

56

Ayurveda, a System of Preventative Healthcare and PPPM Model of Health

Can Yoghurt Reduce the Risk of Osteoporosis?

Balneotherapy Research Methodology and Mineral Content of Natural Thermal Spas: A Literature Review and Critical Appraisal

Case Study: Bowel Testing and Treatment in Clinical Practice

Miriam Cullen, ANTA Member, compares the literature and provides evidence for the consumption of fermented dairy products in

Neerja Ahuja, ANTA Ayurveda Branch Chair,

community dwelling older adults to see if it

writes about Ayurveda and how this modality

reduces the risk of osteoporosis.

can help with the use of the predictive,

Elizabeth Greenwood, past ANTA President,

preventive and personalised medicine model

explores the literature about balneotherapy

of health.

and how this has a strong traditional practice

Jasmine King, Founder of Path Lab Education, provides a case study from her clinical practice, including functional and pathology testing, result interpretation and recommendations as well as the treatment and results.

and is growing in the scientific research community.

The

Natural Therapist

The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers.

Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.

EDITION 38 NUMBER 1 – WINTER 2023

ISSN 1031 6965

ANTA BRANCH CHAIRPERSONS Shaun Brewster • National President • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair • ANRANT Committee Member • Health Fund Chair Warren Maginn • National Vice-President • Director of ANTA • National Nutrition Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Ananda Mahony • National Treasurer • Director of ANTA • National Naturopathy Branch Chair Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member

Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member Tino D’Angelo • Director of ANTA • National Chinese Herbal Medicine Branch Chair Neerja Ahuja • Director of ANTA • National Ayurveda Branch Chair Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • ANRANT Chair

The

Natural Therapist

Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577 Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au

ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au

ANTA Executive Welcome Winter 2023

From the Chair Minsinformation in the media - Australian Natural Therapists Association LTD (ANTA) Nutrition Branch:

ANTA is a professional association founded in 1955, a registered company limited and continues to lead the natural and traditional medicine professions through exemplary levels of compliance in quality, safety, clinical efficacy and cost effectiveness as its guiding criteria to all Members. Graduates seeking membership with ANTA must complete the highest standard of education currently available in Australia for each modality of practice, recognised by the Australian Natural Therapist’s Accreditation Board (ANTAB). This means that all single modality qualifications, for example, nutritionists seeking admission to ANTA currently, must have completed as a minimum; a three-year undergraduate degree, accredited through the Tertiary Education Quality Standards Agency (TEQSA) and recognised by the ANTAB. It is evident there is adverse messaging in circulation, on association websites and across various social media regarding the professional status of Clinical Nutritionists within Australia. The communication and types of messages in circulation have been presented in such a way that draws intemperate comparisons and dubious claims, seeking to influence the audience through false and misleading statements based on a biased and outdated perspective. For example, to claim their Members are the only ingestive therapists practicing “under regulation” was ruled out through the introduction of the National Code of Conduct with jurisdiction across all but one Australian State and one Territory. This “negative licensing” instrument has carriage over all health care workers not subject to AHPRA’s execution of the National Law. Open discussion surrounding Nutritionists and Dietitians in the tertiary education and professional landscapes is encouraged and welcomed, particularly to bring to light the nuances that exist between the two professions. Discussions of this nature should remain inquisitive, balanced, and impartial, excluding the need for circulating misinformation alleging any nutritionist/practitioner who is not their Member, may have no, or substandard training. This assumption appears to be aimed at discrediting or undermining

Winter 2023

other legitimate professional Associations and their practitioner Members. In the least, the negative campaign is designed to turn users away from all Associations that are not generating this information.

While claiming to be a credible professional Association for registered nutritionists, the index ingestive therapy Association has published negative, outdated and incorrect information that all nutritionists that are not their Members, are unregulated while seeking to practice in Australia. To address this situation, ANTA is providing corrections to clarify the factual position of its accredited, registered Nutritionists practicing under National Health Complaints Commission Regulations. Any graduate wanting to join ANTA from an AQF Level 7, three-year Nutrition degree in Australia must graduate from a course delivered by an Australian Government accredited institution, approved by TEQSA and recognised by ANTA. Registration for an ANTA Member is achieved on admission to ANTA following graduation, and each new Member is entered in the Australian National Register for Accredited Natural Therapists (ANRANT).

This is also a registered entity with ASIC. All ANTA Nutritionists are regulated under law once they commence practice, whether they are an ANTA Member or not. The law referred to in this case is the National Code of Conduct introduced to regulate any health worker who is not registered with the Australian Health Practitioners Regulation Agency (AHPRA). The code does apply to AHPRA registered practitioners who may practice modalities such as nutrition which do not fall under the regulation of the National Law. The National Code of Conduct is the instrument utilised by the Health Complaints Commission to regulate unregistered health workers through the Office of the Health Ombudsman in each State and Territory. ANTA Membership provides protection, promotion and compliance over all Members through its ongoing support through subject matter, expert leadership, continuing professional education, and free access to all internal regulatory literature such as the ANTA Code of Professional Ethics and an extensive library of multi-modal training materials for all Members to review at any time. ANTA also provides access to its internal quality policies that

PAGE 4 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

ANTA Executive Welcome Winter 2023

are in place to raise the compliance of members with all professional and regulatory legislation.

Nutritionists in Australia, regardless of their professional affiliations are all subject to the regulation of the National Code of Conduct in any State or Territory that has adopted this Code into its State or Territory legislation. What this means is that every ANTA Member is a registered Member listed in the Australian National Register for Accredited Natural Therapists and regulated under the jurisdiction of the Health Complaints Commission in each State where this legislation is alive.

These same circumstances apply to all of ANTA’s accredited, registered, and regulated Members, regardless of the modality they practice. Some course lengths may vary while maintaining the highest educational standing for that modality in Australia.

The recognition of Health Training Package courses and three - and four-year degree courses aimed at attaining ANTA Membership, may be granted to a college only after it has been reviewed by the Australian Natural Therapist’s Accreditation Board which consists of practicing, subject matter experts with undergraduate and post-graduate qualifications within their specific field of practice.

Further, these experts must be members of the ANTA National Council, elected democratically by their peers, to ensure compliance with all educational and professional standards are observed within the structure of the educational program. This oversite ensures that all Nutrition graduates have completed a minimum of 400 hours of supervised clinical practicum within the three-year degree program they have completed to qualify for admission to ANTA Membership. Clinical practicum subjects vary in volume depending on the length of each modality’s specific National Training Program.

The degree of misinformation regarding the education standards, qualifications, and clinical practice along with professional insurance and health fund eligibility of Nutritionists is something ANTA is aware of and addressing through the relevant industry bodies. To be clear, Clinical Nutritionists, Nutritional Medicine Practitioners and Dietitians are not registered under the jurisdiction of the Australian Health Practitioner Regulation Agency (AHPRA). Nutritionists and Dietitians are subject to the same regulations in Australia as all other non-AHPRA Registered health workers.

ANTA will continue to follow its due diligence to provide clarity to the questions and concerns raised as this episode unfolds. ANTA’s priority is to maintain compliance with all industry regulators and continue protecting and promoting the integrity and standards of our association Members.

Regards

Jim Olds

ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM

Some of the information published by the index source outlines “nutritionists” starting practice without any training or training programs of two weeks duration or diploma or advanced diploma training programs.

As outlined above, TEQSA does not approve ingestive therapy programs for practitioners that are shorter than three years full time. While ANTA does not recognise non-Health Training Package or non-TEQSA approved training programs it cannot deny they may be occurring, caveat emptor!

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 5

ANTA News Winter 2023

Naturopathy Branch Chair Update

Statutory Registration for Naturopathy and Western Herbal Medicine:

Last year I reported that ANTA had sent out a survey to ask if you were in favour of statutory registration and the response was overwhelmingly positive. Since then, the ANC (Australian Naturopathic Council) has put forward a draft submission, Naturopath Regulation Research Project with the intent of seeking inclusion to the National Registration and Accreditation Scheme (NRAS). The draft submission is open for comment and unfortunately, at the time I notified ANTA Members the page had temporarily closed but quickly opened back up for comment.

At the time of writing this the draft is still open for comment and I hope you take the opportunity to let your views about statutory registration be known.

Once the draft closes the Naturopaths Regulation Research Project (NRRP) will become an official submission. ANTA has been asked to support the submission to Parliament.

As your chair I am working to represent the interests of ANTA Members. We want to engage with you about this topic and I have had numerous phone conversations with Members that are pro-registration and other conversations with Members that have concerns about what statutory registration might mean for our profession. I have often held the idea that for those that contact me, there are many who might hold the same opinions but do not get in contact. With this in mind, I am liaising with other Associations to set up a collective online Town Hall meeting within the next few months to discuss the potential benefits, listen to concerns and consider pathways forward. All ANTA Naturopath and Western Herbal Medicine Members will be emailed with plenty of notice about the time of the Town Hall meeting. Please note that the Town Hall meeting will be recorded if you cannot attend live, and as an Association we invite further comment about your views.

vacated. At the time of writing this we are requesting applications from our Western Herbal Medicine Member base to fill this much needed position. I hope that I can report on this soon, or that you may have already heard the outcome from ANTA. I look forward to working closely with the new Director and promoting the interests of Western Herbal Medicine practitioners and Naturopaths alike.

Private Health Insurance Update:

There has been no recent update from NTREAP (Natural Therapies Review Expert Advisory Panel) however, the next meeting is scheduled for 19th of May 2023. Further progress will be noted in the branch chair report as it becomes available.

Education Themes:

As part of ANTA’s CPE days, we have an overarching theme this year of Supporting Best Practice. Already this year experienced Naturopath Elysia Humphries presented on interprofessional communication and supporting team care and Professor Michael Weir reported on recent updates in legislation and case law relevant to all complementary and alternative medicine (CAM) practitioners. In future talks we will be looking at group consults and how these have the potential to support patients and get across much needed education that is sometimes difficult to fit in during regular consults. We also aim to host a webinar about LGBTQI fundamentals so please keep an eye on your emails for information about dates and times. Please get in contact if there are other practice fundamentals you want to know more about.

Western Herbal Medicine Chair:

The ANTA Western Herbal Medicine Chair has been vacant since the highly regarded Elizabeth Greenwood PAGE 6 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

Regards

Ananda Mahony

ANTA Naturopathy Branch Chair

ANTA News Winter 2023

Bursary Award Winners 2022 Benjamin Lee

Brianna-Lee Schiefelbein

Emma van Leenen

Grace Hermocilla

Jodie Lagana

Kelly Westgarth

Lauren Wood

Lynn McCardle

Monica Mithen

Nicola Weddin

Terese Fazio

Victoria Jackson

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 7

ANTA News Winter 2023

Round 2 Graduate Award Winners 2022 Allison Buckley

Christine Smith

Erica Greenwell

Holly Wignall

Jessica Kramer

Kiera Puglia

Linda Overman

Min-Hsiu Hsu

Raquel Rebelo

Shae Cantrell PAGE 8 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

Wei Zhang

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ANTA Member Article Winter 2023

Anthony Evans

Bachelor of Sports Science (BSc) Diploma of Remedial Massage ANTA Member

Lactic Acid - Friend or Foe?

If you have ever exercised at high intensity, you will be familiar with that sensation of fatigued muscles. It can feel uncomfortable, but the cause – lactic acid – is actually your ally, helping you move faster and lift heavier.

intuitive that the body would produce something that actually reduces its ability to perform, it is not. It turns out that lactic acid is a natural defence mechanism that prevents us from over-doing it … and doing ourselves permanent damage.

When it comes to athletic performance, lactic acid has historically been viewed as a terrible thing – the reason behind DOMS (Delayed Onset Muscle Soreness) and fatigue. We see it as a waste product that holds us back and prevents us from achieving our best. But what if, I was to tell you that this is completely wrong.

Why is Lactic Acid Seen as Bad?

When we do strenuous exercise, we breathe faster in order to transfer more oxygen to the working muscles.

In most cases our bodies naturally prefer to generate energy using the aerobic system (‘with oxygen’).

However, when our bodies are under stress – trying to lift heavy weights or perform fast sprints – we switch to the anaerobic system (‘without oxygen’) to produce this energy. When this happens, the body produces a substance called lactate which allows the breakdown of glucose – and the production of energy – to continue.

We know now that this is not the case, as lactic acid has no direct role in causing these exercise-related symptoms.

High blood lactate levels actually slow down the muscle’s capacity for more work. If it seems counter-

The human body is extremely efficient and can recycle produced lactate for oxidation in the heart and brain.

The accumulation of lactic acid in the muscles has long been incorrectly associated with fatigue during exercise, as well being linked with DOMS. Even today you will hear sports commentators saying, “athlete X must be fatiguing/tiring because of lactic acid build up”.

More recent schools of thought consider that lactate is no longer a so-called ‘harmful waste product’, but rather is a supplemental fuel.

Lactate produced during exercise can be used as a fuel source both during the exercise itself, depending on intensity, and during rest.

PAGE 10 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

ANTA Member Article Winter 2023

What Are the Benefits of Lactic Acid?

The production of lactate serves to reduce acidity in the blood and muscle in an attempt to maintain an optimal pH level in the muscle, and to allow the muscle to keep contracting at high rates. However, this ‘buffering’ cannot last forever, so when pH in the muscle starts to drop and hydrogen ions accumulate, this is when the sensation of ‘burning’ is felt as the disruption to the muscle’s ability to contract starts to occur.

Lactate also helps to preserve other fuel stores and is a direct source of energy for the muscles, heart and brain. The body is efficient at re-using lactate and can even ‘shuttle’ lactate to different parts of the muscle and between tissues.

From a training perspective, lactate has been viewed as an important ‘signalling molecule’ for promoting adaptation. What I mean by that is, the production of lactate during exercise triggers a series of metabolic changes that will enhance the ability of the muscle to oxidise it.

How Does it Contribute to Exercise Performance?

It depends on the sport or exercise. For endurancebased sports you want to minimise the production of lactate and be able to clear it quickly. Endurance

cyclists and runners are the best at doing this because they typically have a high proportion of wellconditioned slow twitch ‘oxidative’ fibres containing lots of mitochondria and oxidative enzymes.

These help to produce aerobic energy without the accumulation of lactate.

Short duration/power athletes, however, often have more fast twitch ‘glycolytic’ fibres, and these fibres will naturally produce high amounts of lactate so they can perform high-intensity movements such as sprinting.

Do Better Athletes Produce More or Less Lactate?

In Olympic sports, two athletes who are quite physiologically different can achieve the same performance level but in a different way. For example, one may have a slightly lower ability to produce energy using the glycolytic system, and would likely have lower lactate levels, but can offset this by having a slightly higher aerobic ability that allows them to sustain a given power.

It is hard to say if more is better from a performance perspective, as each individual has a unique set of physiological/metabolic machinery that they have ‘tuned’ through habitual training.

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 11

Understanding Chronic Pain Management

The benefits of saffron and PEA and their influence on the endocannabinoid system Chronic pain is persistent pain lasting more than 3-6 months.1 Chronic pain is complex and it is often reported that chronic pain sufferers concurrently experience psychological distress and symptoms such as poor mood and sleep.1 The body is equipped with a variety of mechanisms and systems to alleviate and resolve pain, including the endocannabinoid system. Compounds, such as palmitoylethanolamide (PEA) and Crocus sativus (saffron), have the unique ability to influence the endocannabinoid system and in turn, manage chronic pain and its associated symptoms.

Chronic pain sufferers are more likely to experience psychological concerns such as depression, anxiety and sleep disturbances.

The endocannabinoid system is involved in the modulation of pain and inflammation.5 Whilst PEA is not a cannabinoid itself, it is a naturally occurring endogenous fatty acid that is produced in response to inflammation or injury. In conditions such as chronic pain, it has been noted levels have been altered, highlighting the benefit of PEA supplementation.3

PEA provides analgesic, anti-inflammatory and neuroprotective benefits Ultimately, PEA provides analgesic, anti-inflammatory and neuroprotective benefits. Due to its fatty nature, PEA has poor absorption.

Saffron is a notable adjunct therapy to PEA as chronic pain sufferers are more likely to experience psychological concerns such as depression, anxiety and sleep disturbances.1 Saffron has been shown to provide anti-inflammatory, antinociceptive, immunomodulatory, analgesic, antidepressant and anxiolytic effects.8

PEA works through: • Enhancing tissue levels of anandamide, a cannabinoid that acts upon CB1 and CB2 receptors, providing analgesic properties.6 • An affinity to PPAR-α receptors, which reduces inflammation and the secretion of pro-inflammatory signalling molecules.6 • An affinity to receptors GPR55 and acts to desensitise TRPV1 which is involved in the sensation of pain and heat.7 • Inhibition of mast cell degranulation and subsequent histamine release whilst controlling glial cell behaviours.3

Saffron works through the following mechanisms: • Attenuates pro-inflammatory mediators such as TNF-α and IL-68.

• Reduces eosinophils, neutrophils and lymphocytes, leading to a down-regulation of leukotrienes, prostaglandins, cytokines, ROS and NO.8,9 • Partial agonism and selective desensitisation of the TRPA1 channel.10 • Antioxidant activity reduces oxidative damage by attenuating endogenous ROS.11 • Reuptake inhibitor of dopamine, serotonin, and norepinephrine.11

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THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 13

ANTA Member Article Winter 2023

Melissa Kupsch

BSc Hons (Homeopathy)

The Inside Scoop on Homeopathic Medicine and How it is Being Used to Enhance Fertility

For many couples experiencing fertility issues around the world today, homeopathy is a system of medicine you will want to know all about. Homeopathy has seen an explosion of popularity in recent years, though many still are yet to become acquainted with this system of medicine and exactly what it can do.

To begin with the basics, homeopathy is the second largest system of medicine practiced in the world today according to the World Health Organisation.

It was discovered in 1796 by German medical physician Samuel Hahnemann, and at the height of its popularity in the United States we saw over 100 homeopathic hospitals at the turn of the 19th century completely devoted to the practice of homeopathic medicine. As the pharmaceutical industry gained traction we saw a big push away from homeopathy, but it appears that we are once again returning towards this holistic medicine. Popular among the rich and famous, even the British Royal family have their own homeopathic physicians.

So… What Exactly is it and How Does it Work?

Homeopathy is an energetic system of medicine which stimulates the vital force – the energy that circulates the body and gives life. In Chinese Medicine we call it Qi, in Ayurvedic Medicine we call it Prana – whatever you call it – this energetic force animates all living

things – and it is in this sphere that dis-ease originates and true restoration of health begins. When we match the energetic field of a substance found in nature with the imbalance currently being experienced in the human body, we see the vital force strengthen and symptoms disappear. It is based on the principles of ‘like cures like’ and uses microdoses of energetic substances processed in homeopathic pharmacies.

Einstein knew it, and all of the leading-edge scientists know it, energy precedes matter. When you influence the field of energy of the body, you influence the way that matter, organs and tissues function, directly impacting the physical body.

When it comes to hormone health and fertility, homeopathy has such a big role to play. We know that rates of infertility are high and climbing, with both men and women being severely affected. I see this every day in clinic from endometriosis, to Polycystic ovary syndrome (PCOS), amenorrhea, postpill anovulation, poor sperm count, motility, morphology and more. Many people have experienced recurrent loss, or

PAGE 14 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

ANTA Member Article Winter 2023

unsuccessful rounds of In vitro fertilisation (IVF) or Intrauterine insemination (IUI)’s.

To add to that, by the time I consult with most couples, they are often experiencing profound anxiety and grief over the journey they are unexpectedly finding themselves on.

The fertility protocol that I use in clinic is an adaptation of the original fertility protocol created by Melbourne homeopath Liz Lalor in 1999. Liz Lalor had 391 babies born out of 445 women who underwent her homeopathic protocol treatment. Since 1999, the protocol has been adapted to suit the needs of the current generation – who are seeing deeper imbalances and pathological presentations as a result of earlier onset of suppressive pharmaceuticals which have wreaked havoc on the body. Sperm has also taken a considerable dive since 1999 as environmental toxins and modern lifestyles weigh on us. We are seeing a need to treat with miasmatic remedies more frequently, with inherited chronic dis-ease states more prominent than ever before. I am also using Fibonacci series remedies in my fertility protocol, and I am very happy to say that over my years I have had profound success using homeopathy to help couples achieve healthy pregnancies.

The results that you can expect from homeopathic fertility treatment are generally rapid. It is common for a woman’s cycle to change within weeks of commencing homeopathic treatment. If the period had previously been too light and perhaps a brown murky colour, the period will often transition to a healthier bright red decent flow. For women who have a sporadic irregular cycle, this will typically regulate into a near 28 day cycle. Women who previously had no cervical mucous will often notice a great increase as they approach ovulation along with a boost in sex drive. This shows that estrogen levels are peaking correctly, and eggs are almost certainly being released.

Many of the issues that we see are the direct result of using the oral contraceptive pill or other hormonal contraceptives, for which almost all women in this generation did for a period. Energetically, the reproductive organs are often suppressed

and need to be reenergised- which the self-healing mechanism of the body is able to achieve with the correct stimulus.

We are finding that men make up for a large percentage of cases, almost half of fertility consults.

Constitutionally prescribed homeopathic medicines are the gold standard for improving male fertility. As you can imagine, a strong vital force has a big impact on how the body’s tissues and organs function. Not only is homeopathy used to stimulate higher sperm count production, better motility and morphology, but it also helps in the area of sexual performance. The stress of infertility can be destructive for even the strongest of relationships. A great portion of men coming through the clinic are experiencing sexual anticipatory anxiety, which can affect erectile function, performance and or ejaculation. I recently had a gentleman increase his sperm count by 4.5 times in the space of six months using only homeopathy – his fertility specialist was equally blown away.

We believe as homeopaths that the body has a vital force - an innate wisdom that tries to maintain health and balance. You can see how intelligent the body is when you consider this: when you eventually do fall pregnant, your body is going to knit together a tiny little baby perfectly, with no conscious effort from you. Your body will knit together your baby’s arms, legs, heart and brain, right down to the little eyelids and eyelashes. Your body is both extremely capable and wise. However, in this modern era it is easy to push your body out of its energetic alignment, and under stress, your body does not prioritise reproduction. Homeopathy is an incredible system of medicine that can help bring the body back into its true alignment, which allows many couples to conceive naturally. I cannot tell you how many patients I have treated who conceived naturally after being told that this would never happen. The moment the sperm and the egg collide, we see under a microscope a small explosion of energy referred to as the zinc spark. We want to power up all the cells, especially those involved in conception, to allow for that burst of energy needed to create new life. The truth is, given the right conditions and a strong vital force, your body has an extraordinary capacity to heal.

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 15

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ANTA Member Article Winter 2023

Carla Hanlon

BHSc (Naturopathy) Clinical Practitioner ANTA Member

Mindful Eating: What is it and Why do most of us not do it?

I was stopped at a set of traffic lights one day and I looked across at the car next to me and saw the driver eating a burger. I could see it was a McDonalds Quarter Pounder I was that close, and she was really chowing down. Then, the incongruity of eating and driving at the same time hit me. Another strike to the ‘fast food’ industry, ‘Drive Thru’ – which has completely normalised something that – for good reason – was not normal 30 plus years ago.

Today, we are racing around getting kids to school and activities, rushing to meetings, throwing back a soggy sandwich at our desk, driving in peak hour, too tired to cook… food has become an inconvenience – unless it is convenient. We want – and can access – anything we like and get it delivered Uber fast! Or, like the lady at the red light… we eat on the run (or in her case – drive).

From a health perspective, we are simply not designed to do an ‘active’ thing like driving at the same time as a ‘passive’ thing such as eating. Both these activities call on two different ‘players’ in our central nervous system – and these two do not play well together – in fact it is a physical impossibility for them to operate

optimally at the same time – a little like trying to keep your eyes open when you sneeze! Consequently, we wonder why we are stressed (Player A) and have digestive issues such as bloating and heart burn (Player B).

We cannot possibly eat mindfully and drive at the same time. Mindless Eating or Mindless Driving – you choose – but both have consequences – one maybe swifter or more catastrophic than the other – but there is a cost.

Food, throughout the world is historically and culturally significant and serves to bring people and families together. Our ancestors used to sit on logs or rocks around the community fire to eat and discuss the hunt or where they will forage the next day… later we sat around tables and said grace (as in being grateful for our food) while we chatted as a family about our respective days. Now, we are at restaurants on our phones or talking, or we eat on our lap in front of the TV and before we know it the plate is empty.

What about when we are eating alone, or on the ‘go’? What are our food choices – and motives? What

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ANTA Member Article Winter 2023

habits, learned behaviours from our childhood and guilty feelings do we eat through a filter of?

Mindful Eating comes from early Buddhist teachings.

It is eating when we are hungry. It is being in the moment – sitting, at a table with a plate or bowl of delicious food that we enjoy – for the nourishment it provides, for its freshness, flavour and beauty. We are thankful for the food and the energy it provides. We chew it – slowly – to activate our digestive enzymes to start the process of nutrient extraction, digestion and eventually waste elimination. Mindful Eating is stopping before we are full. Mindful Eating is choosing foods that nourish us – that are ‘energetically’ fresh and vibrant rather than processed and energetically empty.

What do I mean by the ‘energetic’ quality of food?

Take three burgers – one from the local fish and chip joint, one from McDonalds and one you make at home.

Which ‘tastes’ better? They’re all burgers after all so they should taste the same right? An apple picked straight off the tree, or one that has been sitting in cold storage at Coles? You can taste the energetic difference when something is fresh (a lot of which we refer to simply as flavour).

I have two beehives and apart from how relaxing it is just sitting watching the clever bees go about their busyness, the taste of honey straight from the hive is one thing – I swear I can ‘feel’ the goodness – the energy – of the bees in every spoonful. Grateful recipients of my honey report the same thing – especially if they have a sore throat or cough.

• Be present and enjoy the preparation of your food – no matter how complex or simple. Often we are rushed, stressed and see it as a chore. Food should never be a burden • Think about the last time you felt hunger. It is not a bad thing to feel hunger however we have been conditioned to believe it is – hence our constant eating to avoid that feeling we associate with being poor, or when we were too young to control when we had food – making us feel deprived and unloved • Mindful Eating takes practice and commitment – just like any other skill – until it comes easily.

• Be grateful for the food and picture it nourishing the cells in your body and providing energy and balance to your life • When you have finished, wait 20 minutes to gauge whether you are satisfied or still hungry before you have seconds – or dessert In this era of obesity, popping pills for heartburn, mood disorders, insomnia, digestive and other chronic diseases we only have to look at what we eat and when, and ask ourselves “How much of this has to do with more than just food… but how we eat it?”. Does food really ‘satisfy’ us anymore or is it an inconvenient necessity to fit in between bouts of ‘busyness’?

So, next time you are choosing ingredients to make a meal, or looking over a menu at a restaurant or sitting down to eat with friends and family, choose to be in the moment with your food – silently appreciate it, relax, breath and enjoy. As the French (who truly love their food) say, Bon Appetit!

Often our relationship with food determines how successful (or not) we are with weight-loss programs or ‘diets’. Eating mindlessly removes choice – and control. Eating mindfully gives us more control in what, when and why we eat, giving us a much better chance of success in losing those extra kilograms.

Discussing ‘Mindful Eating’ with clients is just as important as preparing meal plans and identifying and rectifying potential nutrient deficiencies.

Some tips for Mindful Eating: • Think about why you want to eat and what you want to eat • Notice when you want to eat ‘emotionally’ (such as sweet snacking to feel happier or raiding the fridge out of boredom) • If you feel you are hungry after 9pm, this may be a ‘sleep’ signal not an ‘eat’ signal so ask yourself; “Am I hungry or am I tried?”. If you have only eaten an hour or two before, chances are it is bedtime!

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 19

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THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 21

ANTA Member Article Winter 2023

Ibrahim Samaan

Founder and CEO, Purifas

Hygiene Practice Guidelines for Natural Therapists Hygiene practice has always been crucial to a therapist’s duty of care but, with a heightened awareness among consumers, good hygiene practice has never been so important!

may vary between diseases, the incubation period is usually between seven to ten days, with a carrier typically becoming infectious within the latter five days.

So, what are the go-to hygiene regulations therapists should follow in order to minimise the risk of infection in their clinics and therapy environments? The astonishing answer is that there are none!

While it is near impossible to monitor infection without symptoms, it should be made explicitly clear that a client with any symptoms, no matter how mild, should not attend therapy as they have the potential to be a carrier of an infectious pathogen. Extra caution may also be established by asking clients who have been exposed to people who are ill to also reconsider their attendance.

To date, therapists have been left to their own devices – to attend therapy forums, to navigate their way around numerous websites, to approach government bodies, to scour the media, to ask their colleagues and professional networks, etc. – in an attempt to determine the areas of risk in a clinical setting and how to manage them effectively.

It was this distinct lack of any clear and direct instruction that prompted practicing physiotherapist and founder of hygiene company Purifas, to develop a set of best practice guidelines (based on current research and evidence) specifically for natural therapy professionals.

These guidelines have been laid out below as five simple, yet essential, easy-to-follow steps:

1. Clients with symptoms of illness should be strongly advised not to attend therapy: It is well established1,1a,1b by virologists and medical experts that the infectious period after contraction of an infectious pathogen begins before the carrier becomes symptomatic (if at all). While the overlap

You can communicate this to your clients by: • Displaying signs in high-traffic areas of your clinic • Including a hygiene requirement section on your website • Promoting your policies on social media • Explicitly asking your clients either at the time of booking or when confirming their appointment

2. Clients and therapists should wash their hands before and after therapy:

The primary focus of hygiene research has largely been on hand hygiene and its effectiveness in diminishing the transmission of disease via contact2,3.

Hand washing is accepted as essential, especially in healthcare. However, the issue is compliance by therapists and attendants. Studies show the compliance rate to be as low as 10%4,5!

Natural therapy professionals must observe frequent and stringent hand washing at three critical points:

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ANTA Member Article Winter 2023

Image supplied by Purifas.

1. Upon entry to the clinic 2. Prior to treatment 3. Immediately following contact with a client Clientele should be given access to facilities to wash their hands upon entry to the clinic and at the completion of their treatment.

While thoroughly washing their hands, they must also limit the use of reusable towels, which have been shown to harbour bacteria despite repeated washing6.

Healthcare associated infections (HAIs) are a substantial contributor to the healthcare burden and preventable disease figures. With more than 12% of MRSA (methicillin-resistant Staphylococcus aureus) infections being contracted in a community setting, it is imperative that the increased hygiene practices implemented to mitigate the COVID-19 viral pandemic remain in place and become the new norm.

3. Within the therapy room, only apply singleuse, fit-for-purpose hygiene products to all shared surfaces and items:

Single-use protective materials are known to be more hygienic, quickly eliminating the trace of contact of the previous patient or potential infectious pathogens.

The main points on entry and exit of a pathogen are through the nasomucosal openings7. Prone therapies use a shared face hole, which can significantly increase a client’s risk of cross transmission via contact, droplet and potentially airborne microbes shed from the nose, mouth and even eyes. Through single-use solutions, like the recyclable Purifas FaceShield or BodyShield, the risk of cross contamination of any bacteria/flora/ microbes is dramatically reduced.

Research6 has shown that reusable materials – such as towels, pillowcases and bed linen – can harbour bacteria despite hospital-grade washing. In particular, it was shown that Staphylococcus aureus can survive up to three weeks in cotton towels, which are commonly use in traditional, complementary and

alternative therapy clinics, despite regular laundering6.

It was concluded that normal washing or laundering of towels, whether done in-house or externally, was not enough to remove all viable micro-organisms6.

4. Sanitise all shared surfaces after each therapy session:

All shared surfaces should be sanitised between each client to ensure the risk of cross contamination is minimised. To effectively sanitise a surface, research indicates it must first be cleaned with a detergent and then disinfected with an appropriate TGA-approved antibacterial or sanitising agent8,9 (remember to ensure that these agents are safe for use in a clinical setting).

5. All high-traffic areas and contact points should be cleaned regularly:

High-traffic contact points, such as door handles, arm chairs, waiting room areas and reception desks, are cross-transmission risks, especially in facilities with a high turnover of clients. All areas that customers come into contact with upon entry and exit of the clinic, such as bathroom areas, should be cleaned and sanitised regularly. There is evidence to show a significant reduction in HAIs when an employee is hired specifically to clean and sanitise high-traffic and common areas10. Depending on the size of your clinic, this may not be feasible. In which case, you should have these hygiene and safety tasks clearly assigned to the appropriate personnel, including clear outlines on what is needed to be done and the frequency. The Australian Commission on Safety and Quality in Health Care has provided some resources to assist business owners and health-related professionals develop an environmental cleaning program.

Making these five steps standard practice in your clinic or therapy setting will help maintain a safe and hygienic environment for your clients, and contribute to a reduction in community transmission of illness.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 23

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ANTA Member Article Winter 2023

Steph Lowe

The Natural Nutritionist Steph Lowe Mentoring

Starting Your Nutrition Practice

Starting your own nutrition practice is an extremely rewarding journey, however, it can also be a daunting and at times, overwhelming experience. This especially applies if you have just graduated and are new to applying your incredible volume of knowledge to real life scenarios. Here are my top three strategies to help guide your journey.

1. Find Your Niche:

It is a lovely concept to want to help everyone, but getting clear on your niche is one of the best ways to become laser focused in every decision you make in business. You may have already developed an idea of this throughout your studies, and now is the time to get really clear. A concept to consider is ‘to find your purpose, go where your heartbreak lies’. For example, like many practitioners, you may have had your own health challenges and be inspired to help others on a similar journey, or you may be frustrated by the lack of holistic support available to women with Polycystic ovary syndrome (PCOS) or perimenopause and be drawn to help change the landscape within these areas of health. It can also be important to remember that your niche is not written on stone and can be adapted once you carve out your voice and space in our industry and learn more about the pain points of your clients and online audience.

2. Understand Your Audience:

Once you know your niche, understand your audience.

What are their demographics? What areas of health do they most need support in? What social media

platforms do they use? This will then allow you to start to create content that speaks to them, and that allows you to reach them online. As you start to develop this content, you will also be creating blog and social media posts, client consultation summary content and so much more. For example, when it comes to recipes, what do you want them to eat? If you know your clients struggle eating a protein-rich breakfast, as many do, start to create these recipes.

When it comes to lifestyle changes, what are their priorities? If you are considering going on a podcast to increase brand awareness, what podcasts do your audience tune in to? Make sure you are always speaking to their pain points and needs in a sequential order, addressing the foundations of food and lifestyle first.

3. Consider A Mentor:

There are many reasons why a mentor can be beneficial, and especially when you have just graduated and are starting out on your own, it is an incredible way to fast track your business journey.

They can guide you through what they have learned, especially outside of a tertiary course, and provide valuable experience, accountability, and confidenceboosting. As the saying goes, “We all need someone who inspires us to do better than we know how”.

Even though you may be starting business solo, you certainly do not have to do it alone.

For more information, please visit thenaturalnutritionist.com.au/mentoring

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 25

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ANTA Member Article Winter 2023

Guinevere Quelch ANTA Member BHSc (Naturopathy) Bachelor of Nursing

Magnesium Supplementation for the Treatment of Hypertension Introduction:

This literature review examines magnesium supplementation for treatment of hypertension.

Optimising magnesium levels may reduce hypertension in particular clinical situations. An overview of the aetiology, pathophysiology and medical treatment of hypertension, along with the role of magnesium, is first provided. This is followed by a review and appraisal of the literature. The clinical relevance of findings and identification of gaps in the literature are identified.

Aetiology, Pathophysiology and Medical Treatment:

Hypertension is chronic, high blood pressure in the systemic arteries1. It is generally measured as a ratio of systolic blood pressure (SBP) (pressure in the arteries during contraction of the heart) to diastolic blood pressure (DBP) (pressure during heart relaxation)1.

While diagnostic parameters are frequently debated1, most guidelines define hypertension as above 140/90mmHg2. Hypertension is the main preventable risk factor for cardiovascular disease (CVD), chronic kidney disease (CKD) and cognitive impairment, and is the single largest contributor to all-cause mortality and disability globally3. Risk of CVD development rises incrementally after 115/75mmHg1.

The aetiology of primary (essential) hypertension is multifactorial. Many genes have been identified4.

Commonly associated environmental factors include excessive sodium intake, insufficient potassium intake, obesity, alcohol consumption and physical inactivity1.

Mental stress and poor sleep quality are closely correlated5. Ageing contributes to hypertension due to gradual arterial stiffening6. An adverse intrauterine environment can also contribute to risk of developing hypertension7.

The pathophysiology involves dysregulation of mechanisms within the neuro-hormonal network that govern blood pressure (BP) (see Appendix A, located in the ANTA Member Centre)1. Endothelial dysfunction as a result of oxidative stress and genetics, leads to reduction in secretion of important vasodilatory substances including nitric oxide (NO)8. A reduction in NO leads to salt sensitivity, because the compensatory vasodilatory activity that would normally occur in response to a rise in sodium and blood volume is lost1. Oxidative stress and inflammation, as mediated by obesity, also decreases natriuretic peptides that mediate vasodilation and plasma volume in response to increased sodium9. Renin-angiotensin-aldosterone system (RAAS) activation mediates angiotensin II release, leading to pathological changed including sodium retention and vasocontriction10. Activation is influenced by an array of factors, largely oxidative

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 27

ANTA Member Article Winter 2023

stress and organ damage10. Sympathetic nervous system (SNS) hyperactivity is associated with hypertension, increasing sodium reabsorption, endothelial dysfunction and vasoconstriction1.

A dysregulation immune response leading to upregulation of inflammatory mediators may also contribute to hypertension11.

The medical treatment of hypertension involves reduction of salt intake and increase of potassium intake, as specified in the dietary approaches to stop hypertension (DASH) diet, exercise, weight loss and reduction of alcohol intake1. First-line antihypertensive medications include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, dihydropyridine calcium channel blockers, and thiazide diuretics1. Selection should be based on clinical response and tolerability; a combination is often required1.

Proposed Therapeutic:

Magnesium is the second main intracellular cation, essential for energy production and hundreds of metabolic reactions12. Depletion may influence hypertension through a range of mechanisms (see Appendix B, located in the ANTA Member Centre).

It antagonises calcium, helping to reduce vascular constriction13. It assists the production of vasodilatory mediators including NO14. It is required to support expression and activity of various antioxidant enzymes and nutrients, helping to decrease endothelial dysfunction, vascular inflammation and ageing13.

Deficiency is associated with RAAS activation, contributing to sodium retention15. It may reduce SNS activation and catecholamine release13. There is a significant correlation between magnesium deficiency and metabolic syndrome, diabetes and obesity16. By acting as a calcium antagonist, it decreases beta cell secretion of insulin, and deficiency reduces insulin receptor sensitivity, contributing to insulin resistance17.

Insulin resistance contributes to atherosclerosis and CVD development18. In summary, magnesium is required at multiple levels of the neuro-hormonal network, to assist in regulation of blood volume, cardiac output, and arterial tone.

Literature Review:

The first meta-analysis to examine the effect of magnesium supplementation on BP was conducted

by Jee et al. (2002)19. Twenty clinical trials, including sixteen double-blind randomised controlled trials (RCT’s) were combined to pool 1220 hypertensive and normotensive adults, including some taking concurrent diuretics. A small pooled net estimate reduction in BP was found (-0.6mmHg SBP, and -0.8mmHg DBP). A significant dose-dependent

relationship was observed, with a reduction of 4.3mmHg SBP and 2.3mmHg DBP for every 10mmol per day increase in magnesium dosage.

A major limitation of the analysis was the heterogeneity of the studies. There were eight different forms of magnesium used at variable dosages, and length of therapy varied from three to 24 weeks. Additionally, many of the studies were small, no data was underpowered. The finding of the dosedependant relationship was heavily influenced by the result of one included study by Zemel et al. (1990)20.

In this study of just 13 patients, the baseline BP of the intervention group was significantly lower than the control group despite, randomisation, and this may have exaggerated the reduction in BP (due to use of change scores rather than final values in the statistical analysis)21.

Following this study was a Cochrane Collaboration systematic review and meta-analysis by Dickinson et al. (2006)21, examining magnesium supplementation for primary hypertension. 12 RCT’s met inclusion criteria, including eight also studied by Jee et al.

(2002)19, to combine 545 participants. Comparatively, Dickinson et al. (2006)21 excluded trials of normotensive patients, those with less than eight weeks follow-up, and trials that changed the antihypertensive medication within the study period.

They found a small, statistically significant reduction in DBP but not SBP (a mean reduction of SBP of -1.3mmHg and DBP of -2.2mmHg). They also found no adverse effects of magnesium supplementation.

The authors conclude that the BP reduction is likely to be due to bias, because the trials were small, short and had mixed results. Poor quality data can lead to over-estimation of the studied effect21. The findings of these two meta-analyses are therefore of limited value.

A larger meta-analysis was conducted by Kass et al. (2012)22. 1173 participants from across 22 RCT’s were combined to examine the effect of magnesium supplementation in normotensive and hypertensive adults, including those taking antihypertensive medications.

Magnesium dosages ranged from 120 to 973mg. A small but statistically significant reduction in BP was found (translating on average to 3 to 4mmHg for SBP, 2 to 3mmHg for DBP). Dosages above 370mg correlated with greater reductions BP. 13 of the studies reported mild side effects, including diarrhoea, or non-specific mild abdominal or bone pain.

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ANTA Member Article Winter 2023

Interestingly, the trials in this analysis that were cross-over design found greater reductions in BP. The authors suggest that cross-over studies are less impacted by unmeasured variables such as dietary magnesium intake. Patients with higher magnesium diets may show less benefit from supplementation. A weakness of all meta-analyses discussed so far is the absence of data regarding baseline magnesium levels and dietary intakes.

resistance, prediabetes and other conditions including type two diabetes and CVD.

Similar results were found in an even larger meta-analysis. Zhang et al. (2016)23 combined 34 double-blind RCT’s to pool 2028 hypertensive and normotensive participants, both treated and nontreated. Compared to previous meta-analyses, a strength of this study was observation of serum magnesium in response to supplementation. They found that a median dosage regime of 368mg magnesium/day for three months significantly reduced SBP by 2mmHg and DBP by 1.78mmHg, which correlated with a rise in serum magnesium of 0.05mmol/L. The authors conclude that the antihypertensive effect is therefore causal.

Since this meta-analysis, a double-blind RCT examining effect of magnesium on risk factors for CVD in patients taking diuretics was conducted by Cunha et al. (2016)18. 17 hypertensive women taking hydrochlorothiazide were given magnesium chelate 600mg/day for six months. Significant reduction in BP were found (SBP average change from 144 to 134mmHg, DBP 88 to 81mmHg), along with reduction in carotid intima-media thickness and improved endothelial function compared to control group.

A subgroup analysis of this data found that the hypotensive effect was only significant among those with magnesium deficiency. Additionally, it appeared more effective in treated patients, potentially due to depletion of magnesium from diuretic medications23.

As with the previous meta-analyses, heterogeneity of data was significant. This included trial quality, sample size and participant features. However, the antihypertensive effect was more evident in the trials that were of high quality with a low dropout rate, strengthening the validity of the causal relationship.

The authors speculate that the heterogenous results of studies on this topic may be due to differences in dietary magnesium intake, study duration and design, type and doses of magnesium used, use of other medications, and other individual differences between participants.

The hydrochlorothiazide (a diuretic) depletes magnesium, potentially contributing to the success of supplementation at reducing CVD risk in this trial18.

One meta-analysis achieved zero heterogeneity by gathering subsets of data from across four trials, to examine only hypertensive patients treated with antihypertensive medications for at least six months, with a wash-out period of at least two weeks and a starting SBP above 155mmHg24. They found a significant reduction in SBP and DBP (-18.7mmHg and -10.9mmHg respectively). However, the sample size was only 135, and some of the trials were not placebocontrolled, limiting the quality of the data.

Another meta-analysis limited patient heterogeneity by only examining supplementation in individuals with pre-clinical and non-communicable diseases, on the supposition that these populations may experience a more significant effect compared to healthy individuals25. 543 participants from across 11 RCT’s received 365 to 450mg magnesium/day for one to six months. They found a mean reduction of 4.18mmHg in SBP and 2.27mmHg in DBP in people with insulin THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 29

ANTA Member Article Winter 2023

Another meta-analysis examined the effect of magnesium supplementation on diabetic risk factors leading to CVD, including BP26. 1694 adults at risk of developing or already diagnosed with type two diabetes and taking magnesium for at least one month were examined. Improvement in fasting plasma glucose, high and low-density lipoproteins, plasma triglycerides and SBP were observed. Similar to other studies, effects were more pronounced in patients with hypomagnesaemia on subgroup analysis. Dosages of 300 to 400mg for greater than three months seemed to be more effective.

Identifying the heterogeneity of data on this topic, Rosanoff et al. (2021)27 systematically reviewed 49 clinical trials examining oral magnesium for hypertension, including six meta-analyses already discussed.

The effect of magnesium across four different populations were studied: untreated hypertensives, uncontrolled hypertensives (patients taking antihypertensive medications but still hypertensive), controlled hypertensives and normotensive individuals. The popular examined were adults, excluding pregnant subjects.

Overall, untreated hypertensives (20 studies) showed a decrease in SBP and DBP if doses were above 600mg/day. Magnesium oxide was the form used, however, dosage rather than form appeared to be the determining factor27. In uncontrolled hypertensives (ten studies), magnesium lowered BP regardless of dose. The remaining studies on controlled hypertensives, normotensives and magnesium-replete individuals did not show changes in BP regardless of dose. However, measurement of participants magnesium status before intervention was not considered by most studies. While a hypotensive effect was not observed in some studies, other cardiovascular risk factors were improved.

Encouragingly, no studies reported serious adverse effects of magnesium supplementation in doses up to 972mg/day, and side-effects were minor and short

term (i.e. mild gastrointestinal disturbances).

Clinical Relevance:

In light of these studies, evidence suggests that magnesium supplementation appears to modestly lower SBP and DBP in uncontrolled hypertensive patients taking antihypertensive medications, when given at dosages between 240 to 972mg/day. In untreated hypertensive patients, more than 600mg/ day is required. However, lower dosages may also exert other beneficial cardiovascular effects. Supplementation appears to only be effective in people deficient in magnesium.

Gaps in the literature include differentiating the effect of magnesium in specific populations, namely uncontrolled, controlled, and medicated hypertensive individuals, as proposed by Rosanoff et al. (2021)27.

Additionally, accurate assessment of magnesium status of participants before and during trials, and how this correlates with disease activity is a consideration for future research.

Addressing these factors will help reduce heterogeneity of data and provide stronger evidence. Additionally, further data regarding length of therapy, optimal magnesium dose and form are required for clearer clinical guidance.

Conclusion:

This literature review has examined magnesium supplementation for the management of hypertension. While the antihypertensive effect of magnesium supplementation is modest, it is a low cost, safe, and generally well tolerated therapy. The evidence suggests it offers a host of benefits beyond BP control, of particular note reducing the risk of CVD disease. It is therefore well placed as adjuvant therapy in hypertensive, magnesium-depleted individuals.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

PAGE 30 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

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ANTA Member Article Winter 2023

Neerja Ahuja

Ayurveda Awareness Centre ANTA Ayurveda Branch Chair

Ayurveda, a System of Preventative Healthcare and PPPM Model of Health

Introduction:

Ayurveda is an ancient system of healthcare that has been in existence for over 40,000 years. The World Health Organisation (WHO) recognises Ayurveda as the most ancient and holistic system of healthcare, with texts that are said to be about 6,000 years old.

Ayurveda is primarily focused on personalised health and deals with healthy lifestyle, health promotion and sustenance, disease prevention, diagnosis, and treatment for diseases in the early stages. Especially outside of India it is used for primary healthcare and for preventative health though it does have a strong therapeutic health aspect as well.

In this article, we will explore the concept of Ayurveda and its connection to the Predictive, Preventive, Personalised, and Participatory Medicine (PPPM) Model of Health.

Ayurveda - A Comprehensive System of Medicine:

Ayurveda is a comprehensive system of medicine that addresses all aspects of health and wellbeing.

Its principles and practices are based on a deep understanding of the human body and mind, as well as the interconnectedness of all things. At the core of Ayurveda are several key themes that inform its approach to health and healing. These themes provide a framework for understanding the principles and practices of Ayurveda and for applying them in practical ways to support optimal health and wellbeing.

Samhita - The Connectedness of Unity with Diversity:

Samhita means unity, wholeness, integration, and holistic functioning. Samhita embodies and describes the vast organising, creative, orchestrating, adaptive capacity of the directive intelligence within the human physiology - the atma (Soul). Ayurveda recognises that the human body is an intricate network of interconnected systems that work together to maintain balance and harmony. When these systems are in balance, the body can function optimally, and disease is less likely to occur. Ayurveda seeks to restore balance and harmony by identifying and

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ANTA Member Article Winter 2023

PPPM Model of Health:

treating the root cause of imbalances in the body.

Pragya Aparadha - The Mistake of the Intellect: Pragya Aparadha is the mistake of the intellect.

When the appropriate balance of the gunas in the mind (three different qualities or attributes of mind that ayurveda talks about, namely Sattva, Rajas and Tamas) is distorted by a dominance of rajasic and tamasic qualities, the mind loses conscious awareness of, or connectedness with, atma or pure consciousness. The mind, now no longer under the directive guidance of atma or pure consciousness, begins to make choices that are not in keeping with the laws of nature that govern life at the individual and collective levels. This leads to a disturbance in the balance of the doshas (vata, pitta, and kapha), which can result in disease. Ayurveda seeks to restore balance to the mind and body by addressing the root cause of imbalances and helping individuals make choices that are in harmony with the laws of nature.

Chitta Suddhi Yoga - Purification:

Chitta Suddhi Yoga is the practice of purification of the mind. Ayurveda recognises that the mind and body are intimately connected, and imbalances in the mind can manifest as physical disease. Chitta Suddhi Yoga involves practices such as meditation, yoga, and pranayama, other than diet, lifestyle, herbs and bodywork treatments like panchakarma, which help to calm the mind and restore balance to the doshas.

These practices can help to reduce stress and anxiety, improve mental clarity, and focus, and support overall health and wellbeing.

An important aspect of Ayurveda is its focus on preventive healthcare. Ayurvedic principles emphasise the importance of maintaining a healthy lifestyle and preventing disease before it occurs. This is achieved through various practices, including regular exercise, stress management, and a balanced diet as mentioned above, through Chitta Shudhi Yoga.

Ayurveda also recognises the importance of individualised healthcare, with treatments and recommendations tailored to meet the unique needs of each person. This personalised approach is achieved using various diagnostic techniques, including understanding of dosha imbalance, pulse diagnosis, tongue examination, and observation of the stool, urine, skin, hair, and eyes. An ayurvedic practitioner uses a personalised approach to healthcare, tailoring their treatments to the individual needs and circumstances of each patient to achieve the desired outcomes.

The PPPM Model of Health is a modern, Western approach to healthcare that integrates predictive, preventive, personalised, and participatory medicine.

This model aims to shift the focus from treating diseases to preventing them, by identifying an individual’s risk of developing a particular disease or health condition based on their genetic, environmental, and lifestyle factors. By using advanced technologies like genomics, proteomics, and metabolomics, healthcare providers can shift the focus from treating diseases to preventing them.

The PPPM Model of Health has its roots in the early 21st century, when advances in genetics and other technologies began to make personalised medicine a reality. The term “PPPM” was coined in 2009 by Leroy Hood, an American biologist and founder of the Institute for Systems Biology, to describe a new paradigm for healthcare that integrated predictive, preventive, and personalised medicine.

There are many similarities between the traditional systems like Ayurveda and the innovative approach of predictive, preventive, and personalised medicine.

Predictive:

The predictive aspect of the PPPM model involves identifying an individual’s risk of developing a particular disease or health condition based on their genetic, environmental, and lifestyle factors. By using advanced technologies like genomics, proteomics, and metabolomics, healthcare providers can predict an individual’s risk of developing a particular disease with greater accuracy.

Preventive:

The preventive aspect of the PPPM model involves taking steps to prevent the onset of disease or to slow its progression. This can involve lifestyle changes such as diet and exercise, as well as screening and early detection of diseases.

Personalised:

The personalised aspect of the PPPM model involves tailoring healthcare to meet the individual needs of patients. This can involve the use of personalised medicine, which considers an individual’s unique genetic makeup to develop personalised treatment plans.

Participatory:

There is participatory aspect of the PPPM model that involves empowering patients to take an active role in their healthcare. This can involve educating

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ANTA Member Article Winter 2023

patients about their health, providing them with tools to manage their health, and involving them in shared decision-making with healthcare providers.

Ayurveda is a traditional, holistic system of medicine that emphasises the interconnectedness of all things and the importance of individualised care.

PPPM Model of Health and Ayurveda are different in many ways, but they share some common principles and goals. Both emphasise the importance of preventive medicine and patient engagement in healthcare. Both also recognise the importance of

In spite of differences, there is potential for Ayurveda and the PPPM model to complement each other.

Ayurveda’s emphasis on preventive healthcare, personalised care, and the interconnectedness of all things aligns with the goals of the PPPM model.

Figure 1: The Interrelations Between the Basis of PPPM (Genomics, Proteomics, and Metabolomics) and Their Application for Global Molecular Profiling1

Image supplied from Bodrova et al. (2012). personalised healthcare and tailoring treatments to the individual needs of each patient.

Ayurveda has a strong focus on holistic health and wellbeing, which is in line with the PPPM model’s emphasis on a holistic approach to healthcare. Both Ayurveda and the PPPM model recognise that health is not just the absence of disease, but a state of complete physical, mental, and social wellbeing.

Both Ayurveda and the PPPM model recognise the importance of preventive medicine, patient engagement, and personalised healthcare.

By combining the strengths of both systems, we can create a more holistic, proactive, and personalised approach to healthcare.

While the PPPM model and Ayurveda have some similarities, they also have some differences. The PPPM model is a modern, Western approach to healthcare that emphasises the use of advanced technologies to predict and prevent disease, while

Ayurvedic principles can inform the development of personalised treatment plans, considering an individual’s unique genetic makeup (prakruti or mindbody type), lifestyle, and environment.

In conclusion, Ayurveda is a comprehensive system of medicine that has been in existence for thousands of years. The PPPM Model of Health is a modern, Western approach to healthcare that emphasises the use of advanced technologies to predict an individual’s risk of developing disease and develop personalised treatment plans, while also emphasising preventive medicine and patient engagement. Ayurveda’s emphasis on personalised care, preventive healthcare, and the interconnectedness of all things aligns with the goals of the PPPM model. By incorporating Ayurvedic principles into modern healthcare, we can develop more personalised and effective treatment plans that address the unique needs of each individual.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

PAGE 34 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

Ayurveda Courses

At Ayurveda Awareness, one of the services we have for health practitioners is that we provide education for them. Our core programs that will suit as study program for practitioners include:

• Foundation Training in Clinical Ayurveda (FTCA), a comprehensive certification course that aims to provide a strong foundation in the principles and practices of Ayurveda. The course is suitable for health practitioners, including yoga instructors, medical doctors, and natural health practitioners, as well as anyone interested in deep learning about Ayurveda. The course covers various topics such as Ayurveda, digestion, diet, activity, disease process, pulse diagnosis, herbal pharmacology, treatments, physiological detoxification procedures, and classical Ayurvedic texts.

Total 350 hours, duration one year. Done as hybrid program, online LIVE and selfstudy. Intake for this year is from May 2023.

• Ayurveda Appreciation Program (AAP), a beginner level program to begin to learn and appreciate some key concepts of Ayurveda and appreciate their importance in using this knowledge to keep us healthy. Suitable for other health practitioners, including yoga instructors, medical doctors, and natural health practitioners, for students of naturopathy etc. as one of the units of study, as well as anyone interested in learning to appreciate Ayurveda. Total 30 hours, duration nine to ten weeks. Done as online LIVE program and self study.

Please contact Neerja at neerja.ahuja@ayurveda-awareness.com.au for information and registration.

THE NATURAL THERAPIST VOL 38 NO. 1 | WINTER 2023 | PAGE 35

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ANTA Member Article Winter 2023

Miriam Cullen

ANTA Member DipHS (Nutritional Medicine) BHSc (Naturopathy) Master of Human Nutrition (current)

Can Yoghurt Reduce the Risk of Osteoporosis?

Introduction:

The aim of this report is to provide evidence for the consumption of fermented dairy products in community dwelling older adults to reduce the risk of osteoporosis. Osteoporosis is a common, chronic condition affecting 200 million individuals worldwide and is experienced by 6% of men and 21% of women aged 50-84 years1,2. It is a condition of having decreased bone mineral density, which can significantly increase fracture risk and overall morbidity and mortality1. Older adults are at an increased risk due to reduced intestinal calcium absorption, renal function and accelerated bone loss in females because of postmenopausal estrogen loss2,3.

Dairy foods can play a role in preventing this disease, as they contain many of the macro and micronutrients required to support bone health such as protein, calcium, magnesium, potassium, phosphorus and B-vitamins including B2 and B121,4.

Fermented dairy products such as yoghurt, kefir and cheese also contain bio cultures which are associated with improved bone health and have

beneficial anti-inflammatory effects1,2,3. In fact, there is emerging evidence that probiotic-based foods reduce proinflammatory cytokines involved in bone resorption2. Yoghurt appears to have higher levels of potassium, vitamin A and vitamin D than other forms of dairy4. What is more, the calcium in yoghurt has superior bioavailability than milk due to the acidic pH of yoghurt4.

Summary of Evidence:

Table 1 summarises six peer-reviewed journal articles that have been selected for review in this report, comprising of one systematic review and metaanalysis, three randomised controlled trials (RCTs) and two observational studies published between 2002 and 2020.

A 2020 systematic review which analysed the impact of fermented dairy products (FDPs) on bone health in postmenopausal women included three cohort studies that totalled 102,819 participants2. The authors concluded that daily yoghurt or cheese intake

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decreases bone resorption markers, and that higher yoghurt intake was associated with a 24% reduction in hip fractures2. However, cheese intake was not associated with this reduction in hip fractures2.

A 2002 randomised control trial involving 29 postmenopausal women with a mean age of 61 years compared the impact of three daily servings of yoghurt with a fruit-flavoured jelly snack on urinary calcium and markers of bone resorption5.

This study observed that urinary calcium rose significantly more in the treatment group (P<0.03).

Urinary N-telopeptide (NTx), a marker of bone resorption, was also significantly lower (22%) in the treatment group when compared to the control group (P<0.03)5. A more recent 2013 double-blind, randomised, placebo-controlled trial involving 56 institutionalised women (mean age = 85.5 years) observed a similar improvement in bone resorption markers with increased yoghurt intake5. The results of this study demonstrated improvements in serum vitamin D, parathyroid hormone (PTH), tartrateresistant acid phosphatase (TRAP 5b) and carboxylterminal cross-linked telopeptide of type 1 collagen (CTX) with yoghurt intake5. A 2015 randomised clinical trial involving 40 patients with osteoporosis (mean age = 66 years) not only saw improvements in serum markers of bone resorption, but also spinal bone mineral density (BMD) with kefir milk intake3.

This study also observed increases in serum calcium, parathyroid hormone (PTH), β C-terminal telopeptide of type 1 collagen (β-CTX) and osteocalcin with kefir intake3.

A 2017 observational and cross-sectional study involving 4310 community dwelling older adults aged over 60 years studied the correlation between the frequency of yoghurt intake and BMD and physical function1. The researchers observed that total hip and femoral neck BMD and Timed Up and Go (TUG) scores in females were higher in those with greater yoghurt intakes (P<0.05)1. In males, TRAP 5b, a marker of bone resorption, was also lower in those with higher yoghurt intakes (P=0.0001)1. In fact, each unit increase in yoghurt intake was associated with a 39% lower risk of osteoporosis in females and 52% in males1.

A similar observational study conducted on 3012 individuals aged 27 to 85 years in 2013 studied the correlation between milk and yoghurt intake and BMD and incident hip fractures4. This study showed that yoghurt intake increases bone mineral density and has a weak protective association with a reduction in hip fractures4.

Discussion and Interpretation of Evidence: Limitations of the Research:

Whilst there is a body of evidence that appears to support the intake of FDPs such as yoghurt, kefir and cheese for improving bone resorption markers such as osteocalcin, TRAP 5b and CTX, the data is lacking regarding whether these biochemical changes result in actual improved BMD and a reduction in osteoporosisrelated fractures1,3,5,6. After all, it is osteoporosisrelated fractures which decrease the quality of life, mobility, physical function and social well-being of older adults7.

In addition, there is limited clarification regarding which type of FDP yields the greatest benefits. Some studies do not even specify which type of FDP was used, what the fermentation process was or what cultures were used2. More specifically, studies which utilise yoghurt as the intervention do not necessarily stipulate whether the yoghurt was flavoured or sweetened, which could be considered a confounding variable1,4,6. In fact, a 2021 systemic review and metaanalysis observed an inverse relationship between sugar intake and BMD in adults8. The optimum quantity of FDP intake to optimise bone health without adverse effects is also unclear from the research base.

Much of the research in this area is solely conducted on postmenopausal women, due to their increased risk of osteoporosis as a result of estrogen loss2,3. This means that the results of multiple research studies are only generalisable to women, and it is uncertain whether the same benefits would be seen in men2,5,6.

Furthermore, the 2013 observational study involving 3012 adults aged between 27 and 84 years does not provide the ability for specific inferences to be made about the effect of FDPs on community dwelling older adults4. The 2013 double-blind RCT conducted on 56 institutionalised women that saw improvements in bone resorption markers with increased yoghurt intake also lacks generalisability to community dwelling older adults6.

Whilst there have been some RCTs conducted in this field, the majority of these studies have small sample sizes (n<60), limiting their statistical power3,5,6. In addition, the RCTs included in this report had short trial lengths (seven days to six months), impairing their ability to identify long-term benefits or disadvantages of elevated intake of FDPs3,5,6.

Moreover, all three RCTs included in this report did not have a placebo-control group included3,5,6. Rather, the control group were provided an alternative food or supplement such as a fruit-flavoured jelly snack or calcium supplement3,5,6. Without the facilitation

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Table 1: Summary of Evidence for Yoghurt Consumption and Reducing the Risk of Osteoporosis in Older Adults.

Author and Year

Study Type

Sample

Interventions

Ong et al. (2020)2

Systematic review of randomised 3 x cohort studies (n = controlled trials, prospective 102,819) cohorts and case-control studies

Intake of fermented dairy products (including yoghurt and cheese)

Tu et al. (2015)3

Randomised clinical trial

40 patients with osteoporosis (mean age = 66 years)

Kefir fermented milk (1,600mg)

Bonjour JP et al.

(2013)6

Double-blind randomised, placebo-controlled trial

56 institutionalised women (mean age = 85.5 years)

2 x 125 servings of vitamin D and calcium fortified yoghurt or nonfortified control yoghurt

Heaney et al.

(2022)5

Randomised control trial

29 postmenopausal women (mean age = 61 years)

3 x servings of fruit-flavoured yoghurt (Yoplait custard style)

Laird E et al.

(2017)1

Observation and cross-sectional study

4310 community dwelling older adults (>60 year old)

Frequency of yoghurt intake

Sahni S et al.

(2013)4

Observational study

3012 individuals aged 27 to Frequency of dairy foods (FFQ) 85 years (mean age = 54.9 including yoghurt intake years)

of a placebo-controlled study arm, it is impossible to determine with confidence the isolated effects of FDPs on osteoporosis risk factors9.

to identify yoghurt intake. This method depends on accurate recall, where there is a high risk of misspecification of dietary intake or recall bias1,2,4,10.

The cohort, observational and cross-sectional studies included in this report have much larger sample sizes than RCTs and demonstrate robust correlations between yoghurt intake and reducing the risk of osteoporosis, yet fail to identify a definitive causal link as a result of their study design1,2,4. In addition, these studies rely on food frequency questionnaires (FFQ)

Strength of the Research:

The research base in this area is fairly robust, with multiple high quality RCTs and large observational, cohort and cross-sectional studies available for analysis. Of the three RCTs included in this report, two included double blinding, minimising the possibility for bias and maximising result validity11. In addition,

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Outcome Measures

Results

• Fracture incidence • Bone mineral density • Percentage change in bone turnover markers

• Daily yoghurt or cheese intervention decreases bone resorption markers • Higher yoghurt intake associated with a 24% reduction in hip fracture (but not cheese intake)

• Bone mineral density • Serum β C-terminal telopeptide of type 1 collagen • Parathyroid hormone • Serum calcium • Osteocalcin

• Increased in serum calcium (P=0.251), parathyroid hormone (P<0.05), β C-terminal telopeptide of type 1 collagen (P<0.05) and Osteocalcin (P<0.05) • Significant improvements in spine bone mineral density • No significant difference between intervention and control group and improvements in spine, femoral or hip bone mineral density

• Serum vitamin D • Parathyroid hormone • Bone resorption markers (tartrate-resistant acid phosphatase and carboxyl-terminal cross-linked telopeptide of type 1 collagen)

• Improvements in serum vitamin D, parathyroid hormone, tartrate-resistant acid phosphatase, carboxyl-terminal crosslinked telopeptide of type 1 collagen in both groups • Serum vitamin D increase substantially more in the fortified yoghurt group than the control group (P<0.0001) • Parathyroid hormone, tartrate-resistant acid phosphatase and carboxyl-terminal cross-linked telopeptide of type 1 collagen markers improved considerably more in the intervention group

• Fasted, Urinary excretion of N-telopeptide, creatinine and calcium

• Urinary calcium rose significantly in the treatment group (P<0.03) • Urine N-telopeptide was significantly reduced in the treatment group (22% lower than control group, P<0.03), a marker of bone resorption

• Bone mineral density • Bone biomarkers (including tartrate-resistant acid phosphatase) • Timed up and go • Instrumental activities of daily living scale • Physical Self-Maintenance Scale

• Total hip and femoral neck bone mineral density in females was higher in those with higher yoghurt intakes (P<0.05) • Timed up and go scores were high in females with higher yoghurt intakes (P=0.013) • In males, tartrate-resistant acid phosphatase were lower in those with higher yoghurt intakes (P<0.0001) • Each unit increase in yoghurt intake is associated with a 39% lower risk of osteoporosis in females (P=0.012), 52% in males (P=0.38) • No significant changes observed for parathyroid hormone in higher yoghurt consumers

• Bone mineral density • Incident hip fracture

• Yoghurt intake increased bone mineral density (P=0.03) • Yoghurt intake has a weak protective but non-significant association with the risk of hip fracture (P=0.010)

five of the six included studies involved older adults and are thus generalisable to this age group1,2,3,4,5,6.

Encouragingly, two studies did identify a correlation between increased FDPs such as yoghurt intake and a reduction in fracture risk2,4. Three studies also identified improvements in BMD with yoghurt intake1,3,4.

In addition, all the studies included in this report had multiple outcome measures to evaluate the impact of FDPs on the risk of osteoporosis. Multiple objective

measures allow for corroboration between results.

Studies show that β-CTX, a marker of bone resorption, is higher in individuals with osteoporosis, making it a valid indicator for osteoporosis risk12,13. TRAP 5b is also considered a reliable marker for osteoporosis, as TRAP 5b results are directly correlated with BMD scans14.

Osteocalcin and PTH are also good markers of bone resorption or calcium homeostasis13. BMD was also measured using appropriate methods in the included research studies, such as through dual-energy X-ray absorptiometry15. Qualitative data such as TUG scores

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and the physical self-maintenance scale was collected in the 2017 observation and cross-sectional study involving 4310 community dwelling older adults, highlighting the potential benefits of FDPs on quality of life and mobility as well as biochemical bone resorption markers and BMD1.

Recommendation:

The body of research investigating the effect of FDPs on osteoporosis risk factors is convincing in its assertion that there is a correlation between increased FDP intake and a reduction in osteoporosis risk factors, especially in postmenopausal women. It appears that yoghurt and kefir are superior to cheese in their osteoporosis-related benefits1,2,4,5,6. Because yoghurt is a cost-effective strategy for improving BMD and reducing osteoporosis risk factors with a high tolerance rate, it is a food that all communitydwelling older adults should be including in their diets daily, provided they do not have an intolerance or allergy to lactose or dairy2. According to the research base, it is advised that older adults consume two to three servings of non-sweetened yoghurt daily5,6.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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ANTA Member Article Winter 2023

Michelle McCosker

Clinical EFT Practitioner and Trainer Naturopath

Emotional Freedom Techniques as a Tool for Supporting Your Patients

Introduction:

Emotional Freedom Techniques, also known as “tapping”, is a stress reduction technique and wholistic healing approach that combines aspects of Traditional Chinese Medicine with modern psychology including elements of cognitive and somatic therapy. Emotional Freedom Techniques is becoming increasingly popular in natural therapy circles for which efficacy has been established for depression, phobias, post-traumatic stress disorder1 and as a method for treating a wide range of physical and emotional issues, including food cravings, chronic pain, stress and anxiety.

How Emotional Freedom Techniques Work:

The basic idea behind Emotional Freedom Techniques (EFT) is that negative emotions and physical issues arise when previous negative emotions and experiences have not been acknowledged and correctly processed by the mind and body. The mindbody connection is becoming widely recognised and studies such as Adverse Childhood Experiences (ACEs) study shows how these events may present as physical health issues later in life2. EFT involves

tapping on specific meridian/acupuncture points on the body while focusing on a specific issue or problem.

Positive impacts in biochemistry such as blood pressure, immunity, salivary cortisol and epigenetic potential to affect gene expression in relation to posttraumatic stress disorder (PTSD) symptomology has been recognised3,4,5,6.

EFT incorporates modern psychology by encouraging people to focus on the negative emotions or thoughts that are related to their problems. By tapping on the acupuncture points while focusing on the issue at hand, people can reduce or eliminate the negative emotions associated with that issue. There are 48 techniques within EFT. There is a technique to suit every situation from a minor stressful event to trauma. Premium Accreditation to become a practitioner is essential for the safety of the client and correct application of the techniques to ensure resolution.

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ANTA Member Article Winter 2023

Research on Emotional Freedom Techniques and Food Cravings:

Food cravings can be a significant barrier to maintaining a healthy diet and achieving weight loss goals. EFT has been studied as a potential method for reducing food cravings, with promising results.

Brain Scan Study:

This was a pilot study of 15 obese adults; 10 were allocated to an EFT treatment, and five to a control group (where they received no intervention for their cravings). They were all scanned using functional magnetic resonance imaging (fMRI) before and after a four week EFT treatment phase. While they were in the machine, they viewed images of high-calorie food (e.g. chocolate cookies, burgers and fries, ice cream sundaes) the parts of their brains that activated, were recorded. After the four week EFT treatment, all were scanned again, with the same images of food to see if anything changed. There was a significant decrease in the activation in the EFT participants; and in some of them, there was no activation at all. The control group still had activation in the parts of the brain associated with reward and loss.

Skinny Genes Study:

Hospital Anxiety and Depression Scale (HADS) and the Revised Resistant Scale (RRS). Weight was recorded at home at baseline, post-intervention and six months post-intervention.

Statistically significant decreases were observed between those timepoints for weight and all selfreport measures (P<0.001). In addition to this, a 36.8% reduction in anxiety (P<0.001) and a 48.5% reduction in depression (P<0.001) were found at postintervention7.

Research on Emotional Freedom Techniques and Chronic Pain:

Chronic pain is a common problem that can significantly impact a person’s quality of life. It is frequently a presentation in naturopathic clinics and can be difficult to treat and resolve completely. EFT has been studied as a potential method for reducing chronic pain, with remarkable results.

In one study, researchers looked at the effects of EFT on chronic pain in people with fibromyalgia.

Fibromyalgia is a chronic pain condition that affects millions of people worldwide. The study found that

EFT reduced pain and improved overall quality of life in participants with fibromyalgia.

This intervention was a six-week online program using EFT to address cognitions, behaviours, and adverse experiences that contribute to emotional eating, binge eating, intermittent dieting and resistance to exercise.

Data was collected at baseline, immediately before week one of the program, post-intervention after six weeks of the program, and at six months postintervention via the Power of Food Scale (PFS), the

The most recent study conducted through Bond University on the Gold Coast incorporated fMRI scans as a pre- and post-intervention measure which showed a significantly decreased connectivity between the bilateral grey matter and the medial prefrontal cortex areas in the posterior cingulate cortex and thalamus post-EFT treatment. No brain areas showed increased connectivity8.

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Research on Emotional Freedom Techniques and Anxiety: Anxiety is now more than ever a common presentation in many clinical settings.

Anxiety can significantly impact a person’s daily life, including relationships, career and family. EFT has been studied as a potential method for reducing anxiety, with some promising results.

In one study, researchers looked at the effects of EFT on anxiety in people with generalised anxiety disorder. The study found that EFT reduced anxiety and improved overall quality of life in participants with generalised anxiety disorder.

Another study looked at the effects of EFT on anxiety in people with PTSD. PTSD is a condition that can develop after a person experiences or witnesses a traumatic event. The study found that EFT reduced anxiety and other symptoms of PTSD in participants with PTSD9.

Table 1 shows systematic reviews with meta-analysis using EFT for presentations in natural health care settings.

Table 1: Emotional Freedom Techniques Systematic Reviews with Meta-Analyses Published Since 2013.

Condition

Study Name

Anxiety

Clond (2016)10. Emotional Freedom Techniques for Anxiety

Depression

Nelms & Castel (2016)11. A systematic review and meta-analysis of randomised and non-randomised trials of clinical Emotional Freedom Techniques (EFT) for the treatment of depression

Post-Traumatic Stress Disorder

Sebastian & Nelms (2017)12. The effectiveness of Emotional Freedom Techniques in the treatment of post-traumatic stress disorder: A metaanalysis Mavranezouli et al. (2019)13. Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: A network meta-analysis Mavranezouli et al. (2020)14. Psychological treatments for post-traumatic stress disorder in adults: A network meta-anaylsis

Somatic Symptoms

Stapleton et al. (2021)15. Emotional Freedom Techniques (EFT) for somatic symptoms: A systematic review and meta-analysis

Pain, Anxiety, Depression, Burnout, Stress, Phobia

Church et al. (2018b)16. Is tapping on acupuncture points an active ingredient in Emotional Freedom Techniques? A systematic review and meta-analysis of comparative studies

Pain, Anxiety, Depression, Post-Traumatic Stress Disorder, Food Cravings, Phobia

Giolmen & Lee (2015)17. The efficacy of acupoint stimulation in the treatment of psychological distress: A meta-analysis

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Emotional Freedom Techniques and Fertility Issues:

When it comes to fertility issues, EFT can be used to address negative emotions such as anxiety, fear, and hopelessness, which can have a negative impact on fertility. Studies have shown that women undergoing fertility treatments who received EFT had significantly reduced levels of anxiety and depression compared to those who received standard care alone18.

Fertility is a complex and emotionally challenging issue that affects many couples around the world.

In addition to physical factors such as hormonal imbalances and structural abnormalities, emotional factors such as stress, anxiety, and depression can also play a role in fertility. This is where EFT can be a valuable tool in the management of fertility issues.

In addition to reducing negative emotions, EFT can also improve overall health and wellness, which can have a positive impact on fertility outcomes. Negative emotions such as stress, anxiety and previous miscarriages can have a negative impact on the body’s hormonal balance, which can interfere with ovulation and conception. By reducing negative emotions and promoting relaxation, EFT can help restore hormonal balance and improve fertility outcomes.

Furthermore, negative emotions during pregnancy can also have an impact on birth outcomes. Studies have shown that high levels of stress during pregnancy can increase the risk of preterm birth, low birth weight, and developmental delays in infants19. By addressing negative emotions and promoting relaxation, EFT can help improve pregnancy outcomes and support the health and well-being of both mother and baby.

Incorporating Emotional Freedom Techniques into Your Practice:

Treating the whole person, is the focus of health care professionals, including the patient’s physical, emotional, and spiritual health. EFT can be a valuable tool for naturopaths, herbalists, and nutritionists to use in their practice to improve client outcomes and compliance.

To incorporate EFT into their practice, health care professionals can attend a training program facilitated by a recognised EFT training provider. EFT can then be incorporated into patient treatment plans. Even though you can learn some basic techniques on the internet, it is not advised to apply EFT without appropriate training.

For clients struggling with weight loss, the practitioner may use EFT to help reduce food cravings and emotional eating. During a session, the practitioner can guide the client through the tapping sequence while focusing on the emotions and thoughts associated with their food cravings.

By reducing negative emotions associated with food, the client may find it easier to stick to a healthy eating plan. It can also be used to increase the desire for consumption of a beneficial diet. For example, if you are suggesting the patient start eating avocado and they understand the benefits but are opposed to it. The thing is not the thing, when it comes to applying EFT for physical issues.

Exploring when weight gain became an issue for the patient may reveal a stressful event that still has emotional intensity. Acknowledging and processing these memories creates the potential for weight loss success. Emotional aspects are commonly overlooked and once discovered can facilitate resolution of issues unconsciously contributing to weight and pain.

Pain sufferers often approach natural health care practitioners to alleviate their pain, due to a lack of resolution from previous attempts. Unfortunately, the difficulties associated with treating pain can lead to frustration and a sense of hopelessness for patients.

Without a clear diagnosis or treatment plan, patients may feel like they are left to suffer alone with no answers.

Another difficulty with treating pain is that it can be subjective and difficult to measure. Pain is a personal experience that is influenced by a variety of factors, including genetics, environment, and psychological factors such as stress and anxiety. This makes it challenging for healthcare providers to treat pain effectively.

The side effects and potential addiction to pain medications are another reason people continue to seek alternative answers to their pain. EFT can assist with reducing pain and improving overall quality of life. Pain is complex physiologically and emotionally.

Along with improving the ability to cope with pain, emotional connections can be found in relation to pain and in particular chronic pain through the application of EFT and then can also be resolved with EFT. Whilst there are very effective herbs and nutrients that can support the nervous system, they cannot reach the memories and events that may be an underlying cause of anxiety. EFT seems to have a direct effect on the autonomic nervous system to regulate the stress response and remove emotional intensity from these events. Used as part of a stress

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reduction treatment protocol, EFT can provide a long-lasting effect and allow the patient to behave positively and move forward in their life.

EFT is a tool for stress reduction and overall emotional wellness. By incorporating EFT into their practice, natural health care practitioners can provide patients with a holistic approach to healing that addresses both the physical and emotional aspects of their health. In addition to using EFT during sessions, this technique can be taught to patients so they can use EFT on their own. This can empower clients to take control of their own health and wellness and provide them with a tool to use outside of appointments.

EFT has been viewed in the past as a self-help tool.

Apps, websites and online events attract millions of people annually. This type of launch pad is a great foundation for learning the tapping points and uncovering what the real issue is. The limitations of these resources appear though, when an old memory with remarkable emotional intensity comes up. This is when an Accredited Clinical EFT Practitioner needs to

be engaged. It is understandable that the body may not want to take one step closer to that memory, that came out of nowhere and can also give the impression that EFT does not work or anchors traumatic memories. Self-taught practitioners may also achieve a palliative result when the techniques have not been applied correctly.

In conclusion, EFT can be a valuable tool for naturopaths, nutritionists and herbalists to use in their practice to improve client outcomes and compliance in relation to weight loss, pain, anxiety and a range of other physical issues.

Details about Emotional Freedom Techniques Trainings can be found at www.nurturehealthsolutions.com.au or emailing info@nurturehealthsolutions.com.au.

Upcoming in person 3-day EFT practitioner trainings are in July and November 2023.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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ANTA Member Article Winter 2023

Elizabeth Greenwood

ANTA Member ANTA Past President ICNM Australian Ambassador Master of Herbal Medicine

Balneotherapy Research Methodology and Mineral Content of Natural Thermal Spas: A Literature Review and Critical Appraisal

Introduction:

Balneotherapy is the act of bathing for therapeutic purposes in waters with enhanced properties such as mineral rich natural springs and may also include peloid (mud) therapy1,2. This practice has a strong traditional practice and empirical knowledge base and has recently gained a great deal of interest from the scientific research community wishing to validate its effects3.

Balneotherapy is a holistic practice that has beneficial effects on certain physical measures as well as notable psychological and emotional effects4. Blake (2010)5 presents a notable historical documentation of therapeutic bathing practice. Hydrotherapy is a well-researched area of water immersion therapy as shown by An, Lee & Yi (2019)6 and Wardle (2013)7, yet it differs from Balneotherapy due to the absence of mineral rich water content8.

Global Wellness Institute (2018)9 show an increase in practice of mineral bathing. This is partly due to availability as an effective concomitant intervention for chronic inflammatory musculoskeletal disorders2,10.

Trends towards cost effective preventative health practices, self-care retreats, mindfulness experiences and reconnecting with nature, are seeing an increase in spa therapy. The average annual growth rate for thermal springs in 2017 was calculated at 4.9%, with the use of natural spa facilities growing 9.9%. There is estimated to be 34,057 natural mineral springs in 127 countries9. This is significant considering the exact mechanisms of action for the known therapeutic effects of Balneotherapy are still being validated11,12.

Three primary research articles will be critically evaluated to determine the methodological strengths and limitations that may be considered when validating scientific evidence for Balneotherapy.

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Critical Appraisals:

Balneotherapy (BT) treatment interventions for Chronic lower back pain (LBP) is a clinically relevant area to apply qualitative research methods and understand the patient-centred lived experience13.

‘The effects of the calcium-magnesium-bicarbonate content in thermal mineral water on chronic low back pain: a randomised, controlled follow up study’ by Gati, Tefner, Kovacs, Hodosi & Bender (2018)14 addresses certain parameters that show the therapeutic effects of spa waters on chronic LBP. It was reviewed using the Greenhalgh checklist (2014)15.

Gati et al. (2018)14 discusses the differentiation of presentation between acute and chronic LBP in the introduction, along with the prevalence and common treatments. The authors also mention a need for more research on water therapy interventions for LBP. The prevalence of current statistically significant research articles on BT for LBP are reviewed, establishing context for this randomised, single-blind controlled study.

World Medical Association (2018)16 principles for ethical standards were referenced with approval sought from independent ethics committees. Patients were educated on the methodology and signed informed consent while patient recruitment and study location, were disclosed.

A large sample of participants were chosen with standardised inclusion criteria for chronic presentations of chronic LBP. These include pain sensitivity assessed by observation, timeline of persistent pain, impact on work parameters and quality of life measures17. Exclusion criteria was listed in detail. Furthermore, this is one of the few clinical trials on BT to highlight the general contraindications of water immersion therapy18.

The intervention was added to an existing treatment regime study to mimic real-life outcomes. Existing treatments are listed in the results, with exclusion of participants noted if additional medications were administered. However, it is not clear if these were new or continuing treatments for participants.

The study groups were homogenous and chosen following minimisation principles with details of each group listed. They were equally separated into the control and study groups by gender, with the mean age calculated. Paoloni et al. (2017)3 states that a large-scale study is needed to determine the effects of BT. With 105 participants, this is one of the larger studies on BT.

Strict parameters of bathing practice were identified for the control and test group during and post study, with exclusion if not adhered to. Patients knew the treatment they were getting and completed their own questionnaires, while independent examiners were used to assess patients during treatment to reduce interview bias. Only the researchers were blinded to create a single-blinded study19. Furthermore, standard measures for quality-of-life assessment were used that are ‘shown to be valid, reliable and responsive’ 20.

Patient reported questionnaires collected physical, emotional and lifestyle measures to give an understanding of the intervention on lived experience of LBP17. A combination of phenomenological standard outcome measures and case study data collection methods were described with analysis of data discussed in detail for replicability and reduction of bias21,22.

The frequency, duration and water temperature of BT treatment intervention was presented in specific detail. As stated by Varga (2016)23, it is important to consider the mineral content with an intervention that may distinguish therapeutic outcomes from either temperature, mineral content, or the act of physical submersion in water. Analysis of the geographical mineral water were included. A systematic review of BT studies conducted by Verhagen et al. (2007)24 shows many BT studies are conducted in a bath or sedentary setting, whereas patients were able to move freely while submerged. This is an important distinction to include when comparing subjective analysis for chronic musculoskeletal conditions.

The study was a standard length of time for BT with measures taken before and end of treatment. The post study intervention parameters were clearly defined for the participants with measurements taken at 12 weeks. Verhagen et al. (2015)1 and Guidelli, Tenti, De Nobili & Fioravanti (2012)25 demonstrate significant improvement at six months, therefore recommending a postintervention measure. The results average and standard deviation for each visit are detailed in a table with statistically significant

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measurements of burnout syndrome. The study does not identify how or where the patients were recruited.

Ethics approval or informed consent are not disclosed because this study is embedded within larger research with the particulars referenced in Stier-Jarmer et al. (2016)29. Inclusion and exclusion criteria are not described, although a detailed summary of participant type of work or educational qualifications and some baseline characteristics are listed.

There are no details listed for the ten participants excluded from the study. A significant sample size of participants remained after drop outs, with two subjects excluded from the analysis with explanations.

improvement measures listed against the control group.

The reason and number of patient drop outs are discussed in the study and presented in a flow chart for transparency. A ‘last observation carried forward’ generalised recording method was used when results were not available, yet as discussed by Lachin (2016)26, this is not specific to reliable outcomes and is not recommended. The incidence of people taking medications was reduced during treatment, however the details are not shown so relevance cannot be gained.

Stress, anxiety and depression was mentioned but not studied in detail, as the focus was on pain and quality of life measures. Including these parameters in the study would add to the detailed analysis as Rapoliene, Razbadauskas, Salyga & Martinkenas (2016)27 and Latorre, Rentero, Laredo & Garcia (2015)28 found that regular BT has a notable effect on stress and depression with a significant effect on pain reduction.

Peloid BT is investigated in ‘Effects of single moor baths on physiological stress response and psychological state: A pilot study’ by Stier-Jarmer, Frisch, Oberhauser, Berberich & Schuh (2017)29.

This quantitative pilot study is part of a larger multimodality study on chronic stress and preventing burnout syndrome and was reviewed using the critical appraisal skills programme (CASP) checklist (2020)30.

BT is often a concomitant treatment included in wellness programs with proven relaxation benefits11.

A brief history on moor mud bath therapy with an overview of the possible mechanisms of therapeutic action is presented. The discussion on existing clinical evidence for musculoskeletal conditions highlights the context and need for further study on BT and stress.

The key study area was prevention of burnout, yet there were no listed signs, symptoms or recognisable

Importantly, there was no control group present leading to results being influenced by the known relaxation properties of bathing and spa visits31,1.

Subjectivity bias concerns are raised due to no blinding as the researchers were aware of the treatment and were also experienced practitioners32.

There was a total of two moor baths with analysis before and after intervention, which created a study design focused on acute rather than chronic outcomes.

A 20-minute rest time post bath before testing was incorporated, however, no rationale for this was presented. It can be postulated that the waiting time could be to reduce parameters measured as Nagaich (2016)33 and Zamuner, Carolina, Eduardo & Mariana (2019)34 shows BT increases circulation post treatment. No post market surveillance measures to show long term outcomes were incorporated into the design35.

Details of the duration, time of day, frequency and temperature of the interventions were listed. It is not clear if the baths were full submersions, the patient could move around or other activities carried out. A practice such as mindfulness, deep breathing, or music could influence the outcome measures as noted by Rapoliene et al. (2016)27.

The quantitative analysis included salivary cortisol, heart rate and blood pressure tests. Advantages and disadvantages of salivary tests were identified, however using both salivary and serum testing will allay any false readings due to collection methods, dry mouths, or contamination. It was not noted if any of the samples were not evaluated in the results. Cortisol samples were taken within the same timeframe each day, which may show some variability as discussed

by Liening, Stanton, Saini & Schultheiss (2010)36.

Parameters that were shown by Hansen, Garde & Persson (2008)37 to influence cortisol measurements

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such as time of year, food intake before sample, alcohol or medications were not listed. Furthermore, hormonal levels such as progesterone need to be considered due to its correlation with cortisol and adrenal stress in men versus women38.

The participants were predominantly women of a certain age and it is not identified where the subjects were in their hormonal cycle. Herrera, Nielsen & Mather (2019)39 claim there is limited research on stress induced changes to female reproduction.

Patacchioli et al. (2015)40 indicates a link between hormone replacement therapy and salivary cortisol levels in menopausal women. In addition, Kasperczak, Lewandowska, Gnus & Borowicz (2019)41 present gender specific comparisons in lipid profiles from BT. A standard patient reported mood questionnaire was used. It was not identified if these questionnaires were self-reported or if the examiner performed the interviews. As Lavallee et al. (2020)13 shows, there may be interview bias if the practitioner supplying the baths was asking the questions.

Baseline cortisol for participants was not measured prior to study commencement. Geh, Beauchamp, Crocker & Carpenter (2011)42 note anxiety experienced prior to clinical performance, that could impact cortisol levels. The collation of results and statistical averages of pre- and post-bath measurements are clearly displayed in vertical bar graphs with whiskers and asterisks plotted outside of the percentiles average to highlight the variability significance43.

Due to the limited length of the trial it would be ideal to perform post market surveillance to understand the intervention in chronic stress conditions44.

A further study, ‘Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomised controlled trial’ by Karagulle, Kardes, Disci & Karagulle (2018a)45 utilised a mixed method approach on BT and rheumatoid arthritis (RA) and was analysed using Long (2005)46.

This study presents the case for BT by highlighting the prevalence, mortality and impact on quality-of-life measures with a lack of proven non-pharmacological treatments. Organisations related to the study are specified. Current research is presented and analysed, showing a large empirical knowledge base. A deeper understanding of mechanism of action is highlighted with the randomised, controlled study adding to existing evidence.

The inclusion criteria to select participants is mentioned and mapped to RA standards. Subjects were allowed to continue current medications, provided the usage had been for a minimum time period to enable a stable baseline measure. A welldefined exclusion criteria was listed, together with supplements and measures that had no explanation of rationale.

The mean age and predominantly female gender is listed. A computer was used to randomise the group of 50 participants, but the program used was not discussed. It is not clear how the participants were recruited, with no mention of patient education of the trial. Patients giving informed consent and ethics were mentioned in the footnotes of the study.

There was a large number of drop outs in this study and reasons were highlighted in results and a flow chart.

The spa location was identified with duration of stay. The frequency and duration of intervention was aligned to similar BT studies for RA1. The mineral water was analysed at an independent facility and provided in a table.

A range of eight reputable mixed method outcome measures were utilised, providing a triangulation of data to strengthen the study validity32,19. The study was single-blinded as the investigator was not aware of baseline measurements.

Measurements were taken at baseline, end of study, three and six months post study. Karagulle, Kardes & Karagulle (2018b)47 recognised the sustained effects of BT and a long wash out period of nine months was delineated. The cross-over design was seen to be unbiased when assessing results in comparison to other methodologies.

The placebo effect of spa accommodation on the control group was discussed. It was not clear what intervention the control group received, whether they participated in bathing or stayed at the spa resort, apart from their continuation with current medications.

Interestingly, Karagulle et al. (2017)48 presented a trial on RA which assessed the application of saline spa therapy on antioxidant markers. This was referred to earlier in the study, yet the analytical methods were not employed in Karagulle et al. (2018a)45 as it was published separately.

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Instead, there is a strong focus on the statistical analysis of results with the mean variation of outcome measures displayed for each assessment. The variance of tests and analysis of results were specified in detail. Furthermore, the results presented ‘statistically significant results from baseline compared to two weeks ... trends towards improvement at three months on all outcome measures. This measurement technique is a notable difference in statistical analysis that supports the positive long term outcomes of BT for musculoskeletal conditions’49,1.

Ethics:

Discussion on general risks and contraindications of BT were not commonly included in exclusion criteria.

Any potential side effects, sensitivities and allergic reactions during interventions must be included in the patient education and reasons for subject drop out.

According to Paoloni et al. (2017)3, there is often an absence of information on concomitant treatments in BT studies which can impact on the outcome measures. A study must identify the spa location due to the notable effects of a positive change in environment and time away from stressful influences31,1. Financial support and conflicts of interest are often disclosed, showing transparency and reducing hidden bias32.

Considerations of interview bias can occur with patient reported data collection. It was not always noted when the researcher or external investigator used an interview schedule, self-reporting face to

face or research instrument32. Qualitative credibility is achieved by a triangulation of data collection in mixed method BT studies19.

Alternative Research Designs:

Verhagen et al. (2015)1 advocates for more BT studies to be conducted due to the potential therapeutic outcomes and current low numbers of studies.

BT research poses a number of methodological considerations23.

Due to the proven mental, emotional and physical healing properties of general bathing practice, it can be challenging to validate outcome measures by purely quantitative or qualitative methodologies and a well-designed study must be constructed50.

Most recent studies are targeted towards measuring outcomes for specific conditions with a mixed method style to encapsulate the holistic benefits of BT. Gati et al. (2018)14 believes functional concerns and physical measures cannot be assessed in a qualitative study, likewise Paoloni et al. (2017)3 recognises the need for more quantitative measures to validate spa treatment of musculoskeletal conditions such as serum corticosteroids, catecholamines, tumour necrosis factor-α (TNF-α) and interleukin-1 β (IL-1β).

Detailed case reports and cohort studies from a single centre will enable valid information on disease related outcome measures related to local mineral water, particularly when compared to tap water8,3,51.

Furthermore, Varga (2016)23, Verhagen et al. (2015)1 and Paolini et al. (2017)3 recommend providing a large sample size in long-term randomised controlled crossover multi-centre trials to enable a greater understanding of mechanisms of action and therapeutic results.

A combination of face to face interviews with independent examiners and self-reported questionnaires are imperative to reduce interview bias and capture visual cues, compliance, attrition in qualitative parameters19,22.

In using certain measures for alertness post bathing, StierJarmer et al. (2017)29 observes that relaxation in standard mood measures may be misinterpreted

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as negativity. Potentially highlighting the need for triangulation or a BT specific questionnaire.

The beneficial effects of rest and relaxation are well documented and need to be taken into consideration with study design27. Clinical trials are often held at a spa facility that may positively influence outcome measures31,1. This could be addressed through a multi-centre trial or an in-home bathing practice with a standard mineral complex added to the bath water8.

Kasperczack et al. (2019)41 concluded that the chemical composition of mineral waters will affect metabolic outcomes. The possible mechanism of therapeutic effect is from the transdermal absorption of minerals from bathing, yet little evidence on this exists. In addition to the collection of metabolic mediators in blood, saliva or urine, specific minerals could be measured in body fluids at the same time.

Verhagen et al. (2015)1 acknowledges that it is challenging to create a blind study with mineral rich water against tap water as a control. Complications include the smell and colour. Hanzel et al. (2018)52 noted successful use of coloured tablets to disguise the difference between tap and mineral water, but could not mask the odour difference. Bender et al.

(2014)8 demonstrates a control group with tap water, whilst Dubois et al. (2010)53 uses standard drug treatments. Stier-Jarmer et al. (2017)29 recommends a control group be made up of an intervention proven for the same disorder.

Kasperczack et al. (2019)41 discovered the time of year has significant impact on outcomes and must be recorded to note relevance for this observation.

Positive outcomes for BT can be seen six months after the initial research has concluded49,1. Karagulle et al. (2018a)45 predicted results with trends towards improvement, showing the long-term implications of BT. Paoloni et al. (2017)3 noted recording follow up outcome measures will give clinically relevant information.

Accurate recording of gender is required due to differences shown in treatment outcomes29. Likewise, Kasperczack et al. (2019)41 highlights the need to have equally randomised groups due to gender specific results in lipid profiles from BT interventions.

Varga (2016)23 suggests the water temperature should be recorded. In addition, the ability for participants to be stationary or able to move around should be documented24,14.

The randomised, controlled cross-over design with multiple groups is applicable to studying BT 23,1. A long wash out period was utilised by Karagulle et al. (2018b)47 based on previous research, providing a valid outcome measure. Gati et al. (2018)14 used ‘last observation carried forward’ for missing results yet this method is not recommended for reliable outcomes.

Paoloni et al. (2017)3 recommends recording concomitant treatments in detail during and post treatment in chronic conditions. Measuring BT in a real-life context could have the participants continue their current treatment, recording any medications, existing treatments and lifestyle habits with patientreported questionnaires. A chart detailing additional treatments, including modality, frequency and length of time practised, would enhance the understanding of BT as a concomitant intervention.

Conclusion:

BT is a complex intervention to study with many confounding parameters. The effective blinding of a control group is challenging with thermal mineral water immersion. A multi-centred, randomised, crossover, mixed method study on a specific condition with a proven intervention used in multiple control group is an ideal approach to allay bias on result outcomes.

Incorporating a triangulation approach of data collection in long-term and post market surveillance studies in a randomised controlled methodology is required to validate the therapeutic effects of BT interventions.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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Jasmine King

Founder and Director - Path Lab Education Health Science Educator Naturopathic Doctor

Case Study: Bowel Testing and Treatment in Clinical Practice

Client Overview:

Sally presents to my clinic, female 83 years of age. Her primary health concern is that she is having trouble with her bowel motions. She tells me that for a good long while now she has had problems passing a stool in the morning. From what she describes, it sounds like her stools range from a Bristol type 1 to a 2. She says they are dark in colour and are always difficult to pass. This is the primary reason she has come to see me. It is always a stress in the mornings, and she finds it is getting more and more difficult. She has even said that on occasion she has had to use her fingers to pull stools loose when straining will not work.

This is a real concern, particularly at her age.

She also says that she gets abdominal bloating, excessive flatulence, some nausea, and tiredness.

The client does not smoke, or drink very regularly (2/60). Her energy level out of ten (10 being lots of energy, 1 being no energy) is 4/10 most of the time.

There is a history of: • Depression • Anxiety • Bladder/kidney issues – she susceptible to Urinary Tract Infections (UTIs) • Osteoporosis

Diet Snapshot:

• Breakfast Cereal (wheat bix) with milk and fruit • Lunch Sandwich – white bread with ham, cheese, and tomato or crackers and cheese • Dinner Meat and vegetables – lamb, beef and chicken are staples. Vegetables are boiled and comprise mostly potato, carrots, broccoli, and beans. Sometimes peas and corn as well • Snacks Fruit and milk chocolate • Drinks Tea, coffee, prune juice. Does not drink water regularly • Exercise Gardening when she has the energy

Current Medications:

The client is on several medications: • Diazepam for Anxiety • Esomeprazole EC capsule for Heartburn • Norvasc tablet for blood pressure • Prolia syringe for bone health (one dose every six months) • Telmisartan tablet for blood pressure The client was also taking an ongoing dose of antibiotics as a preventative for UTIs. I queried

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her about how long her General Practitioner (GP) planned to have her on these antibiotics and she said indefinitely.

I was concerned about this finding as chronic antibiotic use for whatever reason will have a huge impact on her digestive health. I immediately wanted to refer her for testing to assess her gut flora. Clearly this chronic use (she had been taking the antibiotics for at least a year) would be influencing her symptoms. I also asked her about whether her GP recommended probiotics to take alongside the antibiotics. She indicated that probiotic use was never mentioned.

Functional and Pathology Testing:

I referred her for digestive stool testing which looks at the bacteriology, mycology, and parasitology of her bowel. The test also looks at macro and microscopic appearance, metabolic markers, short chain fatty acids (SCFA), faecal occult blood and calprotectin. I wanted to find out how severely her lifestyle and chronic antibiotic use is influencing her gut health. I also wanted to check for any red flags that may indicate concerning bowel findings.

Testing for faecal occult blood and calprotectin can help point to whether more severe conditions may be contributing to Sally’s symptoms. Occult bleeding in the gastrointestinal system is a major red flag.

It can be associated with a number of conditions but the most concerning is gastrointestinal cancer.

Calprotectin is an inflammatory marker that is usually used as preliminary test for inflammatory bowel disease. However, calprotectin can be increased in other gastrointestinal conditions that cause intestinal inflammation. Positive results for either of these two biomarkers are indicators that a client should be referred for further testing. Usually, some form of endoscopy and biopsy along with more specific antibody and immune markers are indicated.

The results I received for Sally’s test are as follows:

Macroscopic Appearance Result

Reference Range

Colour

Dark Brown

Consistency

Formed

Fibres

3+

<3

Food Remnants

Nil

<3

Mucus

Nil

<2

Occult Blood

+

<+

The macroscopic appearance show that the stool is formed but there is an excess of fibres which may indicate issues with effective digestion. We can also see that Sally’s sample is positive for occult blood.

Microscopic Appearance Result

Reference Range

Starch Cells

Nil

<1

Meat Fibres

Nil

<1

Vegetable Fibres

2+

<1

Fat Globules

Nil

<1

Red Blood Cells

1+

<1

White Blood Cells 2+

<1

The microscopic appearance shows an increase in vegetable fibres. Again, an indicator that digestion may be impaired. We are also seeing that Sally has positive markers for red blood cells and white blood cells, which is unsurprising considering her occult blood result.

Metabolic Markers Faecal pH

Result

Reference Range

6.9

<7.3

Pancreatic elastase 217

>200 ug/g

Faecal pH and pancreatic elastase look okay. Ideally, I like to see pH at around 6.5.

Short Chain Fatty Acids Result

Reference Range

Total SCFA

19.3

>13.6 umol/g

SCFA Distribution: Acetate

60.5

44.5 - 72.4%

SCFA Distribution: Propionate

20.7

0.0 - 32.0%

SCFA Distribution: Butyrate

15.5

10.8 - 33.5%

Valerate

3.3

0.5 - 7.0%

SCFA look okay. Ideally, I like to see total SCFA at 20+.

That kind of reading helps to keep bowel pH just right and shows that the bowel flora and consumption of fibre are balanced.

Opportunistic and Dysbiotic Bacteria Organism

Growth

Reference Range

Classification

Klebsiella pneumoniae

4+

<4+

Possible pathogen

Streptococcus parasanguinis

4+

<4+

Possible pathogen

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The testing identified two possible bacterial pathogens. Klebsiella pneumoniae and Streptococcus parasanguinis. These are opportunistic bacteria that have likely taken advantage of the vacuum created by the ongoing antibiotic use.

Culture Result

Reference Range

Bifidobacterium longum 4+

2 - 4+

Bifidobacterium bifidum 3+

2 - 4+

Bifidobacterium animalis

2+

2 - 4+

Bifidobacterium pseudocaten

2+

2 - 4+

Bifidobacterium breve

2+

2 - 4+

Escherichia coli

4+

2 - 4+

Lactobacillus plantarum 1+

2 - 4+

Lactobacillus rhamnosus.

1+

2 - 4+

Lactobacillus paracasei

3+

2 - 4+

Lactobacillus casei

1+

2 - 4+

Lactobacillus acidophilus

2+

2 - 4+

Enterococci

1+

1 - 2+

Result Interpretation and Recommendations:

I asked Sally to speak with her GP about coming off the antibiotics whilst we treated her dysbiosis and bacterial/ yeast infections. Long term I wanted to have Sally rely on her own immunity and on supplements, diet and lifestyle choices that would support good flora and help fight off UTIs without the need to be on antibiotics long term.

I wrote Sally a letter to take to her GP. I also included in the letter a copy of Sally’s results and I highlighted the occult blood and increased calprotectin that was found in testing.

I asked her to increase her water to at least a litre a day. I also recommended that for every tea or coffee she drinks she must drink at least two additional glasses of water. I prescribed her a probiotic multiflora supplement to start addressing the low beneficial flora in her gut and I also prescribed a supplement to help sooth the gut and support good gut flora as well.

There are deficiencies of key beneficial bacteria that are also likely the casualties of chronic antibiotic use.

This finding is unsurprising, but testing helps me to identify which strains are suffering the most and this will inform my choice of probiotic prescription.

Other Organisms Identified Organism 1

The Klebsiella pneumoniae had significant sensitivities to Berberine, Caprylic acid, Citrus seed, Garlic, Golden Seal and Oregano. The Streptococcus parasanguinis had significant sensitivities to Caprylic acid, Citrus seed, Golden Seal and Oregano. The Candida kruseii had significant sensitivities to Berberine and Garlic.

Organism

Growth

Candida kruseii

1+

An opportunistic yeast, Candida kruseii has likely also taken advantage of the chronic antibiotic use.

Biomarker

Result

Units

Reference range

Calprotectin

80

ug/g

(<50)

This calprotectin reading is mildly elevated.

Calprotectin can increase generally in clients over the age of 60. But with the additional findings of occult blood, I need to investigate this further.

In the testing I also had sensitivity testing performed.

This is where the laboratory uses various antimicrobial agents (natural and sometimes pharmaceutical) and tests to see which agents the pathogenic flora is sensitive to. This helps to pinpoint what should be used in treatment.

I also prescribed her a flower essence blend for emotional distress. She had some traumas and an ongoing anxiety that seemed to plague her, and I was certain this was having an effect on her gut and immune health. I gave her a mix of specific bush flower essence. She responded to them so well that she asked me to make up another bottle before our next appointment!

I was not going to start the specific antimicrobial treatment with her until we had the all clear from her GP. I did not want to double her up on both my herbal treatment and her antibiotics.

She came back to me for an appointment after three or so weeks. She had been to see her GP who had reviewed Sally’s results and my referral letter. The GP had okayed stopping her antibiotics by the end of the month in order to receive my treatment protocol, which would address the flora dysbiosis.

The GP had also referred Sally for a Colonoscopy to check on the source of occult blood that came up in her stool analysis test. Sally provided me with a copy of her Endoscopy report.

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The colonoscopy found and confirmed the diagnosis of diverticulosis which was moderate in severity and was affecting the entire colon. There did not seem to be signs of current diverticulitis as seen in the colonoscopy. However, the client had previously complained of abdominal pain which may have been previous instances of diverticulitis.

Sally also had large internal haemorrhoids that were moderate in severity. These would also have contributed to the evidence of bleeding.

There were no biopsy specimens collected for testing.

There were no other signs of polyps or any other bowel disease.

This was a relief as both diverticulitis and internal haemorrhoids are manageable clinically. When we are looking into occult blood in a faecal sample, we are looking to rule out various inflammatory bowel diseases and gastrointestinal cancers. This colonoscopy found no signs of either.

Treatment and Results:

I was able to go ahead with treatment (a weed, seed, and feed treatment) to support her bowel flora and decrease the opportunistic pathogenic bacteria and yeast. I made Sally a herb mix to start treating the pathogenic overgrowths. The mix included herbal agents the pathogenic flora were sensitive to. These included: • Golden Seal – Hydrastis canadensis • Garlic – Allium sativum • Oregano – Origanum vulgare • Barberry – Berberis vulgaris • Black Walnut – Niglans jugla One important feature to note when treating Klebsiella spp. is that this genus thrives on starchy foods. It is necessary for the client to abstain completely from starchy foods whilst being treated.

This was rough on this particular client as she relied heavily on potatoes and bread in her diet. I had to keep reminding her that this was not a permanent change.

I gave her a protocol of several days on her antimicrobial herb mix. Then she would take a break from her herb mix for a couple of days and take probiotics and a digestive support powder. The digestive powder helped to soothe the gut lining and provide nutrition for the gut flora. Sally would then repeat this cycle for a month. After a month she would then come and see me again to report on changes in her bowel motions and symptoms.

With treatment of gut dysbiosis it is common to see symptoms of haemorrhoids improve. Haemorrhoids are aggravated by constipation and constipation is improved by repairing the gut flora and supporting a healthy bowel environment. Doing this will also help to sooth the diverticulosis and minimise the chances of infection and inflammation in those diverticulae.

I advised Sally to be cautious with granular foods that may easily be caught in the diverticulae of her large bowel. Food being caught will usually lead to diverticulitis.

With each treatment cycle, Sally’s bowel symptoms improved. The only issue was the stress over the diet changes. She had a lot of trouble adjusting to them. A large part of my care was reassuring her and advising her on what she could eat and what would help her gut health. I had to reassure her many times that the changes were only temporary.

Finally, after three rounds of weed seed and feed treatment, Sally reported a complete improvement in all her symptoms. Her bowel motions in the morning were easy. Bloating had gone away. There was no nausea at all, and flatulence was now less of a problem. Best of all she looked brighter and livelier.

Her energy had improved dramatically. She had gone from a 4/10 most days to a 9/10.

Now that we were seeing dramatic improvements across the board, I felt it was time to retest. Sally repeated her stool analysis test. The Klebsiella pneumoniae, Streptococcus parasanguinis and Candida kruseii were no longer presenting in the results. These opportunistic overgrowths had been effectively treated and her beneficial flora strains were now within healthy ranges. Her gut flora looked good.

Her SCFA had also increased, and her bowel pH had decreased to 6.5.

This was a fantastic result. She could now discontinue the protocol. I advised her to finish up what she had left of her gut powder and to continue her probiotics. I advised her to remain on the probiotics at her current dosing for at least another month. Then after that she could step down to a maintenance dose of once every second day for another two months to be on the safe side. She would need to keep up the probiotic and prebiotic sources in her diet indefinitely.

Sally was thrilled with her results, and she was more than happy to continue with what I had advised but she also asked me hopefully, “Can I have potatoes again now?”. I happily replied, “Yes, you can have potatoes again now”.

PAGE 58 | WINTER 2023 | THE NATURAL THERAPIST VOL 38 NO. 1

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