The Natural Therapist - ANTA Journal - July 2016

The Official Journal of the Australian Natural Therapists Association (ANTA) NE CK T R AC T IO N MU SHR OOMS B IT T E R HE RB S

GREAT ARTICLE Pain Relief

GREAT ARTICLE Holistic Health

GREAT ARTICLE Bitter Herbs - Better Health

The Natural Therapist

AYURVEDIC MEDICINE ACUPUNCTURE AROMATHERAPY CHINESEHERBAL CHIROPRACTIC COUNSELLING HOMOEOPATHY MYOTHERAPY NATUROPATHY ORIENTAL REMEDIAL THERAPY REMEDIAL MASSAGE THERAPY SHIATSU

Functional Gastrointestinal Disorders Part 1. Functional Dyspepsia. by Tony Reid Bitter Herbs Add some bitter to your diet. by Kerry Bone

PLUS ANTA News Updates ➲ p.7

News & Awards ➲ p.7

CPE Guidelines ➲ p.8

Quality Control ➲ p.9

BUPA News ➲ p.11

DNA Barcoding ➲ p.12

Holistic Health ➲ p.14

Case series of diets ➲ p.36

www.anta.com.au

JULY 2016 vol 31 no 2

Sports Injury Discover how ChinaMed can help ®

Practitioners can rest assured that when you prescribe Sun Herbal formulas, they are produced to the most rigorous standards.

Tony Reid Sun Herbal co-founder and Managing Director

YOUR SUN HERBAL DISTRIBUTORS: Acupuncture Australia 1800 886 916 Acuneeds Australia 1800 678 789 Bettalife Distributors 1300 553 223 China Books Melbourne 1800 448 855 China Books Sydney 1300 661 484 Chinese Herbal & Acupuncture Supplies 07 3852 2288 Ariya Health 07 4721 3666 Far North Qld Nutritional 07 4051 3310 Helio Supply Company 1800 026 161 Herbs For Health (NZ) 0800 100 482 Hong An Phat 03 9428 9982 Natural Remedies Group 1300 138 815 Oborne Health Supplies 1300 887 188 Rener Health Products 08 9311 6810 Winner Trading 1300 932 982 INNOV_15227

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TELEPHONE SUPPORT LINE 1300 797 668

CO N T E N T S TNT JOURNAL 5 Executive Officer’s Report A warm welcome to all ANTA practicing and student members

7 ANTA News & Award Honory Fellow Award. ANTA relationship structure

12 DNA Barcoding Integria Health DNA Barcoding Research

13 The Benefit Of Neck Traction

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Neck pain patients could benefit from traction.

14 Holism, Pain and Movement Effective treatment with a Holistic approach

26 Mushrooms Part 2 of the 3rd Food Kingdom

20 Public Liability/Personal Indemnity

23

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The true value of Public Liability and Personal Indemnity

23 Gastrointestinal Disorders Part 1 of Functional Gastrointestinal Disorders

34 Bitter Herbs Avoid the bitterness in your life by adding bitter to your diet

36 Case Series of Diets Part 2 of diets and food availability in Mayen and Hispanic villages

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Volume 31 Number 2 - June 2016 ISSN 1031 6965 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 Australian Laws. ANTA accepts no responsibility for breaches of Australian 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 authors.

anta branch chair persons Jim Olds - President National Multi-Modality Branch Chair Director of ANTA Director of CMPAC ANTAB/ANTAC Chair Ethics Panel Chair

Warren Maginn National Nutrition Branch Chair Director of ANTA TGA Chair ANTAB/ANTAC Committee Member ANRANT Committee member

Justin Lovelock National Herbal Medicine Branch Chair Director of ANTA Director of CMPAC Constitution & Policy Chair ANTAB/ANTAC Committee Member ANRANT Committee Member

Kevin McLean – Treasurer National Musculoskeletal Therapy & Myotherapy Branch Chair Director of ANTA CPE/Seminar Chair ANTAB/ANTAC Committee Member ANRANT Committee Member

Tanya Morris National Naturopathy Branch Chair Director of ANTA Media/Web Chair ANTAB/ANTAC Committee Member ANRANT Committee Member

Brian Coleman Company Secretary Executive Officer Director of CMPAC ANRANT Chair Business Plan Chair

Jeanetta Gogol - Vice President National Remedial Massage Branch Chair Director of ANTA ANTAB/ANTAC Committee Member

ANTA National Administration Office T: 1800 817 577 F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 australiannaturaltherapistsassociation.com.au

The natural therapist Executive Officer Brian Coleman Marketing/Production Steven Venter Circulation Enquiries 1800 817 577 Editorial & Advertising Enquiries steven@anta.com.au Membership Enquiries info@anta.com.au General Enquiries info@anta.com.au THE NATURAL THERAPIST Volume 31 No.2

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THE 2017 INTERNATIONAL CONGRESS ON

NATURALMEDICINE THE MOST SIGNIFICANT ANNUAL EVENT HELD IN THE NATURAL MEDICINE INDUSTRY

Saturday 10th - Monday 12th June | Crowne Plaza Hunter Valley

YOUR INVITATION The Metagenics International Congress on Natural Medicine has earned the privilege of being recognised as the most significant educational event in our industry.

We are pleased to invite you to join us in the Hunter Valley in 2017. This gives us the chance to come together as an industry with likeminded people for an enthusiastic and insightful long-weekend. By taking advantage of this early invitation you can secure your place in the Hunter Valley before the detailed invitation is released.

We encourage you to book in and pay in full now to secure your seat and avoid disappointment.

THE EVENT - MASTERING THE MICROBIOME In 2017, The Metagenics Congress on International Medicine will share the latest updates in this fast-paced field, explaining how the trillions of microorganisms living on us and inside of us are connected with everyday clinical presentations such as allergies, immune dysfunction, digestive disorders and chronic health issues such as cardiometabolic disease, obesity and psychological disorders. The rapid development of sequencing methods and analytical techniques which have allowed us to ‘map’ the microbial genome are enhancing our ability to define the characteristics of a healthy microbiome, and understand how it can be manipulated to trigger changes in human cellular activities to ultimately reduce susceptibility to disease or its progression...

Unite with leading global researchers and expert clinicians to unravel the complexity of the microbe-human relationship and the molecular mechanisms that govern pathological processes, gain deeper insight into evidence-based strategies for intervention and identify the areas where the science is still in its infancy. There are still many questions to be answered, however, by the time we come together in June 2017, we will undoubtedly know much more than we even do today...

PRESENTERS INCLUDE Dr Jeffrey Bland – Founder and President of the Personalized Lifestyle Medicine Institute, CEO – Kindex Therapeutics Dr Michael Ruscio – Functional Medicine Practitioner Prof Mimi Tang – Leading Allergy Researcher

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Early Bird price of $695.00 incl. GST (normal price $795.00 incl. GST) each per person.

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Early bird ends Friday 27th January 2017 or if sold out prior.

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For further information visit our website metagenics.com.au

THE NATURAL THERAPIST Volume 31 No.2

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E xec ut i ve O ff i ce r ’sR epo r t - Jul y 2016

Executive Officer’s Report – July 2016 A warm welcome to all new ANTA practicing members and ANTA student members.

If you require any information, advice or assistance please feel free to contact the team in the ANTA National Administration Office on 1800 817 577 or info@anta.com.au Accreditation and Quality Control There has recently been some discussion on social media and information circulated advising the discovery of the need to put in place quality controls and accreditation systems to ensure only appropriately trained practitioners join associations. Accreditation and quality control may be a new discovery for some associations however, ANTA has had in place quality assurance and accreditation systems for more than 40 years, which are an integral part of the ANTA membership package.

All ANTA members when they join are also accredited by ANTA under the ANTA Quality Control Program at no additional cost and in addition to an ANTA Membership Certificate also receive an ANTA Accreditation Certificate.

For further information on quality control and accreditation please see the article contained in this edition of The Natural Therapist.

Health Fund Rebates The federal election has come and gone and as we are aware, political parties make many statements during election campaigns. The Labor Party failed to gain enough seats to govern and their campaign to remove the tax payer funded portion of health fund rebates for natural therapies was not successful.

The LNP in its campaign advised there would be changes to streamline private health insurance, however there was no mention of changes to rebates for natural therapies. It appears rebates for natural therapies will remain however we will remain vigilant on this issue.

In April 2016 Bupa announced they were increasing the level of professional indemnity insurance required for provider registration from $1m. to $2m. ANTA members who were registered as providers with Bupa prior to the 30th April 2016 have until 30th June 2017 to increase the level of their insurance cover to $2m. to remain a provider with Bupa. Members who were registered as providers with Bupa post 30th April 2016 are required to update their PI Ins to $2m. by the 31st July 2016 to remain a provider with Bupa. Please see article in this edition about Bupa for more information.

Statutory Registration - National Regulation & Accreditation Scheme (NRAS) & Unqualified Practitioners ANTA continues to push for the inclusion of Naturopaths, Homoeopaths, Herbalists (Western), Nutritionists, Musculoskeletal Therapists, Myotherapists, Remedial Therapists, Shiatsu Therapists, Aromatherapists and Ayurvedic Medicine Practitioners under the NRAS. ANTA is continuing to work on an updated registration submission and will be presenting the submission to Ministers, government departments, government advisors and registration boards.

ANTA will also be attending further AHPRA meetings and will continue to engage in dialogue with AHPRA management, Ministers and government departments to achieve our goal of registration for natural therapists.

As discussions and developments occur on the push for registration, we will keep ANTA members informed.

Advanced Diploma’s Naturopathy, Western Herbal Medicine, Nutritional Medicine & Homeopathy We continue to remind members of the decision by ASQA to cease enrolment of students in these programs. Colleges have also been given an extension of time until 2018 in which to teach out these courses and award graduates with their qualifications.

ANTA has been in contact with colleges to advise graduates who

have completed accredited HLT Advanced Diploma courses that they will be eligible to join ANTA. ANTA members who joined with Advanced Diploma qualifications are not affected by the ASQA decision to cease delivery of Advanced Diplomas.

Members with Advanced Diploma qualifications are not required to upgrade to Bachelor Degree level qualifications. As long as members with Advanced Diploma qualifications maintain continuous ANTA membership and abide by health fund provider register requirements they will continue to be ANTA members and registered as providers with health funds.

Health Funds Audits Health funds will again be conducting audits of member’s records held by associations commencing in September 2016. The areas in which health funds audits will focus on in regard to members are: • • •

Completion of 20 hours of CPE Current Professional Indemnity Insurance Policy Current First Aid qualification

It is encouraging to see members have taken full advantage of the CPE facilities ANTA provides such as the ANTA e-Learning Centre, free ANTA webinars, free ANTA seminars, free access to IMGateway scientific and e-learning resources, EBSCO Host research database and eMIMS Cloud to name but a few.

It is also satisfying to see the new processes we introduced to ensure members renew their professional indemnity insurance on time with ANTA preferred supplier Arthur J Gallagher on time has paid dividends and this process has been instrumental in ensuring ANTA members are audit compliant.

We have received notification from health funds they will be continuing their ongoing program of detailed analysis of receipts issued by members of all associations to ensure compliance with health fund provider terms and conditions.

We have also received advice from Medibank that it is continuing to monitor claim and receipting profiles of all providers to identify any variations when compared with profiles of their peers.

If a practitioner’s receipting profile shows any abnormalities the practitioner will be required to provide additional information and meet with Medibank management to explain the variations in receipting practices. Important information regarding Medibank reviews of providers is outlined on the ANTA website and detailed in the previous edition of The Natural Therapist. We recommend members read this information and contact us if you require further clarification.

FREE ANTA National Seminars We have completed our first of our free seminars for 2016 in Brisbane and Perth. Both seminars have been an outstanding success and the free seminars planned for Sydney and Melbourne during 2016 will be bigger and better than ever. We will contact members by email to advise them when the next seminar is being held in their state. All ANTA members including students can register to attend ANTA seminars free of charge.

FREE ANTA Webinars We have recently added several fantastic webinars to the collection of webinars on our and website and I recommend members who are unable to attend the free ANTA National Seminars to log on to the members section of the ANTA website and check them out. Viewing of the webinars is a great way to keep up with the latest developments and earn CPE points.

Stay informed and up-to-date: Facebook, ANTA e-News and ANTA website

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Exec ut i ve O ff i ce r ’sR epo r t - Jul y 2016

To stay in touch with the latest information make sure you visit the ANTA website, members centre and ANTA Facebook.

Updates containing a wealth of information are also sent to members by ANTA e-News regularly.

Changes to your contact details or clinic addresses Don’t forget to let us know asap if you change your email address, postal address, telephone or clinic addresses. This information is essential for us to contact you, keep you updated by ANTA e-News, The Natural Therapist and to ensure your clinic addresses are current and registered with health funds.

ANTA National Student Bursary Awards for 2016 closed on the 31st July

indemnity policy with Arthur J Gallagher • Issues regarding professional indemnity policies and/or claims • Any other issues regarding your practice such as employment contracts, employment disputes, tenant agreements, leases, ownership of client records, restraint of trade etc To obtain 30 minutes of free legal advice contact the Arthur J Gallagher Specialty Risks team on: • free call - 1800 222 012 • email - specialtyrisks@ajg.com.au This offer is provided to ANTA members by Arthur J Gallagher in conjunction with White & Mason Lawyers

forward to introducing these benefits to members in 2016 as we progressively roll out this project.

Contact us if you require any advice, support or assistance – we value your feedback Any members requiring advice, support, assistance or has feedback on ways in which we can improve our member services please feel free to contact either myself or the team in the ANTA National Office at anytime on 1800 817 577 or info@anta. com.au Our Administration team is ready to assist you.

Regards Brian Coleman Executive Officer

We have commenced the task of assessing submissions received from students for ANTA Student Bursary Awards. The response from students has been fantastic and we look forward to announcing the names of the 12 recipients that will each receive a cheque from ANTA for $1,000.

We also look forward to presenting the 12 recipients with their cheques as we march towards the goal of providing $200,000 in bursaries to students since the ANTA National Student Bursary Awards commenced.

Advertising and Promotion of ANTA Members in National Magazines

Due to the success of our advertising and promotion of ANTA members in national lifestyle magazines, we have expanded our promotion to include banner advertisements on magazine, e-News and newsletters.

ANTA Financial Performance and Control This program has been successful in raising public awareness on the benefits I am pleased to advise that ANTA is again of consulting with an ANTA accredited on track to post another successful financial practitioner. result in 2016. The results ANTA has continued to achieve over many years are Natural Therapies App the envy of other associations and don’t happen by chance. ANTA has in place ANTA is the only association with an App excellent strategies and a regularly up that promotes natural therapies and ANTA dated Business Plan to ensure we deliver members to the public. The App is free and the best membership package available in the public can complete instant searches Australia. Unlike some other associations for an ANTA member on their phone and at who have been required to outsource their the same time set up an appointment with financial management and responsibilities an ANTA member in a matter of seconds. due to lack of adequate controls, ANTA has Member’s details are updated on the App the resources and expertise to manage its regularly. For more information go to www. financial systems and controls in-house. It is naturaltherapiesapp.com.au reassuring for ANTA members to know the governance of ANTA is in good hands.

Upgrade of Member Engagement Management Software Free Legal Advice for ANTA Members The facility provided to ANTA members through our supplier of professional indemnity insurance Arthur J Gallagher (incorporating OAMPS) has been a huge success with numerous members taking advantage of this free service.

30 minutes of free legal advice is available for: • ANTA members who have a professional

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THE NATURAL THERAPIST Volume 31 No.2

ANTA is continuing the development of software to provide members with a range of real time services and facilities including online communities, updating of member profiles, streamlined communications across all devices, automation of processes, real time updating of information, searchable online directories, interfacing with social media and much more. This is an exciting project which will provide members with a range of benefits not seen before in the natural therapy profession and we look

If you find that you cannot log in to the ANTA website, follow the steps described in this article.

1. Clear history for that site Start Google Chrome. To access the browsing information you need to click on the icon that looks like three vertical bars in the top right hand corner. In the menu that appears navigate to the “History” option.

This will open the “History” tab, from here you need to click on the “Clear all browsing data...” option.

Start Safari. Choose History > Clear History, then click Clear. Safari also clears caches and the list of recent searches, and removes the website icons that appear in the search and address field. Clear items: Choose History > Show History, select history entries and daily sets of entries, then press Delete.

Start Firefox. Tap the Menu button (either below the screen on some devices or at the top-right corner of the browser) and select Settings (you may need to tap More first) . Scroll down to the Privacy & Security section and choose Clear private data.

Select the items you want to clear and then tap Clear data.

In Internet Explorer. Open Internet Options by clicking the Start button, clicking Control Panel, clicking Network and Internet, and then clicking Internet Options.

Click the General tab, and then, under Browsing history, click Delete.

AN TA - N E W S N ews - J ul y 2016

Western Sydney University Honours Naturopathic Member of ANTA

On 9th April 2016 Western Sydney University conferred the award of Honorary Fellow on ANTA Life-member Judy Jacka. These awards were described by the Vice-Chancellor, Professor Barney Glover on the day as follows. “They are presented to distinguished individuals who have contributed to the advancement of knowledge, the betterment of society, and who have achieved eminence in their field of endeavour at local, state or international level.” Only about four of such awards are given annually. This particular award was granted to Judy Jacka in recognition of distinguished service to the field of natural therapies and complementary medicine.

This award may be the first time such recognition has been given by the University to a health practitioner and educator outside the university system. After the award was given Judy was asked to give the Occasional Address to the assembled gathering.

ANTA is very pleased to announce that all members now have 30 min of FREE legal advice

Free Legal Advice for ANTA members We are very pleased to announce that ANTA members who are insured through our preferred supplier of professional indemnity insurance Arthur J Gallagher (incorporating OAMPS), can now obtain 30 minutes of free legal advice.

30 minutes of free legal advice is available for: • ANTA members who have a professional indemnity policy with Arthur J Gallagher • Issues regarding professional indemnity policies and/or claims • Any other issues regarding your practice such as employment contracts, employment disputes, tenant agreements, leases, ownership of client records, restraint of trade etc

Western Sydney University is a research-led university and has over 40,000 students spread over six campuses. The National Institute of Complementary Medicine (NICM) is part of its Camperfield campus. It has already undertaken considerable research in the area of natural therapies including natural therapies for cardio-vascular health, age related problems, woman’s health and cancer. Research conducted within NICM has been granted an ERA status of 5 for several years and this is the highest level of Excellence in Research Australia (ERA).

NICM aims to provide leadership and support for strategically directed research into complementary medicine in Australia to promote better health outcomes and world class evidence-based research. It already has a significant relationship with a leading hospital in Beijing and there are plans to develop a collaborative clinic in Sydney.

To obtain 30 minutes of free legal advice contact the Arthur J Gallagher Specialty Risks team on:

• free call - 1800 222 012 • email - specialtyrisks@ajg.com.au

This offer is provided to ANTA members

by Arthur J Gallagher in conjunction with White & Mason Lawyers.

ANTA Relationship Structure

Judy Jacka is Vice-Chairman of the Jacka Foundation of Natural Therapies (JFNT) which is a registered charity. JFNT has been able to make a significant donation to NICM to help promote research using natural therapies for a wide range of chronic disorders. Debbie Schnepper, another long-standing ANTA member is Chairperson of JFNT and is on the Sponsors Advisory Group, a committee that meets 4 times years to offer research suggestions.

It is encouraging that the gap between our professional bodies and government institutions such as universities is lessening. We can look forward to a time when there will be free exchange in the areas of education, research and practice.

ANTA congratulates Judy on this wonderful achievement.

It’s your choice, Naturally THE NATURAL THERAPIST Volume 31 No.2

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AN TA - N E W S N ews - J ul y 2016

ANTA Continuing Professional Education (CPE) Hours Guidelines What is CPE: Continuing Professional Education is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.

Why is CPE Necessary: CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

ANTA requires members to complete 20 CPE hours annually (Jan-Dec).

Completion of 20 CPE hours annually is a requirement for ongoing provider recognition with all Health Funds and WorkCover Authorities. Note: If you do not complete 20 hours of CPE annually, Health Funds and WorkCover Authorities can terminate your provider recognition.

Each year Health Funds carry out audits of members records to ensure 20 hours of CPE are completed by all members annually.

Make sure you lodge online or send to ANTA, details of 20 hours of CPE you have completed by the end of each year.

CPE reinforces ANTA’s natural health philosophy.

Other Benefits of CPE: • members are kept informed and up-to-date with the latest developments • facilitates communication and networking • encourages further study • enhances professional standing within the community Required CPE Hours: ANTA members must accumulate a minimum of 20 CPE Hours per annum (Jan – Dec) At least 50 % of CPE hours undertaken must be related to the modalities your are accredited in by ANTA Note: Hours in excess of 20 completed in the current year are not able to be carried over to subsequent years.

Members registered with CMBA/AHPRA must abide by CMBA CPD/CPE Guidelines (http:// www.ahpra.gov.au/chinese-medicine.aspx) for the modalities of acupuncture and chinese herbal medicine and also submit their CPE to ANTA CPE Activities: Members can undertake CPE hours in many ways including the following: • attending ANTA free seminars – details of seminars are regularly posted on www. anta.com.au • researching scientific information on

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• • • • • • • • • • • • • • • • • • • •

IMGateway - free access for members on www.anta.com.au researching scientific information on EBSCO - free access for members on www.anta.com.au researching scientific information on eMIMS Cloud – free access for members on www. anta.com.au viewing seminar video’s and seminar presentations - free access for members on www.anta.com.au completing courses on ANTA e-Learning Centre -free access for members on www. anta.com.au giving lectures/tutorials giving CPE seminar presentations undertaking further study completing short courses first aid qualification renewal contributing an article to the ANTA journal “The Natural Therapist” and ANTA website contributing an article to other relevant journals, magazines & publications reading articles in the quarterly ANTA journal “The Natural Therapist” subscribing to and reading other professional publications and journals attending webinars viewing online, DVD’s or videos on relevant topics listening to recordings on relevant topics radio/tv broadcasting on relevant topics reading and researching information on topics relevant to your practice attending local practitioner groups/ workshops volunteer work with community groups involving natural therapies

CPE Seminars: ANTA National CPE seminars are held in each state annually and are free for all ANTA members ANTA & other CPE seminars are communicated to members via the ANTA website, ANTA e-News and in “The Natural Therapist”. Members should regularly check the ANTA website for details of seminars.

Maintaining your own personal online CPE Record: ANTA provides members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained on the Members section of the ANTA website (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records). ANTA members can as an example, undertake research on EBSCO, IMGateway scientific resources, view video’s of ANTA seminars etc and then record those CPE hours on their personal CPE record all in the one session via the ANTA website.

To submit/view your CPE hours online with ANTA: • Log onto the “Members Login” section of

• • • •

www.anta.com.au using your username & password click on “Your Profile” then click on “Submit CPE Hours” key in your CPE activity (date, description, hours) you can view your CPE hours recorded online at any time by clicking on “View CPE Hours”

Maintaining your own manual CPE Record: Members not wishing to take advantage of the ANTA online CPE record can keep their own manual CPE Hours record which should include the following minimum information shown in the example below: CPE Hours Record Year: (insert year) Name of Member: ANTA Member Number: Date of CPE

Description of CPE Activity Completed

C P E Hours

(Note: the following CPE activities are provided as examples) 22nd March

Attended ANTA Free Seminar

5

3rd April

Remedial Therapy research on EBSCO

5

4th May

Naturopathy e-learning module IMGateway

2

30th June

Read ANTA Journal – The Natural Therapist June edition

1

5th September

Completed short course Stress & Wellness

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TOTAL CPE HOURS

20

Members who do not record and maintain their CPE hours in their own personal online file via the ANTA website, can maintain their own manual record as shown in the example above and submit their CPE Hours Record to ANTA prior to the end of each year in the following ways: • by email to info@anta.com.au • by fax to (07) 5409 8200 • by post to ANTA PO Box 657 Maroochydore Qld 4558 (Note: members should keep a copy of their manual CPE Activity for their own records and for any audits of their practice undertaken by ANTA, Health Funds or WorkCover) Make sure you lodge online or forward to ANTA details of 20 hours of CPE you have completed by the end of each year. Health Funds carry out annual audits of members records and if you have not submitted 20 hours of CPE activity to ANTA, Health Funds will de-register you as a provider.

ANTA - N E W S N ews - J ul y 2016

MEDIA RELEASE

Medibank and HCF educational requirements.

Quality Control and Accreditation of Massage and Myotherapy

We note that AAMT have indicated it will be implementing the best education standards as part of its quality assurance program. We also note AAMT has not publicly made available on its website details of educational standards or course assessment requirements for membership and details of courses recognised by AAMT. In the interests of transparency we encourage AAMT to rectify this as soon as practicable.

There have recently been some discussions in social media regarding Quality Control and Accreditation of Massage Therapists and Myotherapists.

To correct some of the misinformation that has been circulating, ANTA has prepared the following: Quality Control and Accreditation of Massage therapists and myotherapists is not a new concept. ANTA has been leading the profession in quality assurance and accreditation and has had in place for more than 40 years a fully developed transparent national accreditation (certification) program that ensures/delivers a high level of quality control/assurance, maintains high levels of standards for all ANTA members and modalities including massage and myotherapy that safeguards public health and safety. The ANTA national accreditation/ certification program is part of the ANTA membership package and members are not charged any additional fees to be accredited/certified

by ANTA. In addition to receiving an ANTA membership certificate, all ANTA members receive an ANTA Accreditation certificate and are entered in the Australian National Register of Accredited Natural Therapists (ANRANT) www.anrant.com.au ANTA members and ANTA Accreditation is recognised by all health stakeholders.

We believe an important first step in any quality assurance program is to acknowledge failures and it is pleasing to see AAMT has identified shortcomings to their members in this area.

The cornerstone of any quality assurance program is the setting of high education standards and for more than 40 years ANTA has had in place high educational standards for membership and accreditation for all modalities/disciplines including massage and myotherapy.

Unlike many other associations representing the massage and myotherapy professions, ANTA has demonstrated over many years it has the skills, resources, systems and infrastructure to successfully manage and operate world class quality control processes. ANTA has set one national educational standard across the board for membership and accreditation based on ANTA and Medibank educational requirements. Many associations lacking the necessary skills, resources, systems and infrastructure to manage quality control processes have adopted a two-tiered system of educational standards and course recognition for massage that involves recognising courses that meet Medibank requirements and also recognising sub-standard courses that do not meet Medibank requirements.

The two-tiered course recognition employed by massage associations is not focused on achieving quality but is solely focused on achieving quantity (i.e. more members). The two-tiered course recognition process used by many massage associations continues to damage the profession and places the health and safety of the public at considerable risk.

Unlike many other associations representing the massage profession, ANTA does not operate a two-tiered massage course recognition system and has always set one minimum educational standard across the board for course assessment and recognition based on ANTA, Medibank and HCF educational requirements. The two-tiered massage course recognition system has created serious problems, is not in the interests of the profession, poses a considerable risk to the public and cannot be part of any legitimate quality assurance program.

The two-tiered course recognition system employed by many massage associations encouraged course providers to deliver sub-standard courses and also enabled graduates of sub-standard courses to be welcomed as members of many massage associations and registered as providers with health funds.

We encourage massage associations to follow ANTA’s lead and abandon the two-tiered course recognition system and to set one minimum educational standard based on ANTA,

Each state government is in the process of adopting the National Code of Conduct (the code) for unregistered health service providers and that the code will apply to all natural therapy practitioners including massage therapists. NSW, QLD, SA and VIC have in place codes of conduct that apply to massage therapists and other states are working to introduce the code. This initiative by State and Federal Governments also sets in place another level of quality assurance and a formal complaints system supported by robust legislation.

We are encouraged AAMT has decided to pursue the establishment of higher education standards and we look forward to seeing some positive outcomes. ANTA ceased recognition of certificate IV massage qualifications more than 10 years ago and if fully committed to quality assurance, AAMT must recognise that certificate IV qualifications cannot be part of a modern quality assurance program for AAMT members. We recommend that AAMT follow ANTA’s lead and cease recognition of certificate IV massage qualifications without delay.

In summary, ANTA as part of its national quality control process:

• Maintains a robust single-tiered course assessment and recognition process • Maintains a robust code of professional ethics and scope of practice • Maintains a robust Constitution • Maintains a robust accreditation & certification quality system • Maintains a robust Continuing Professional Education system • Maintains a range of robust policies and procedures • Maintains a robust complaints system • Maintains consistent good governance committed to high education standards and quality control • Provides all members with free national seminars/webinars • Provides all members with free access to the latest world class scientific reports and information incl. EBSCO, eMIMS, IMGateway and iTherapeutics • Conducts regular onsite audits of members • Ceased recognition of certificate IV qualifications more than 10 years ago • Participates on Course Advisory Committees • Participates on AHPRA Professions Reference Group • Is supported by the Australian Qualifications Framework regulatory and quality assurance requirements • Is supported by the Australian Natural Therapists Accreditation Board • Is supported by the Australian National Register of Accredited Natural Therapists • Is supported by the Complementary Medicine Practitioner Associations Council (established with Dept Health & Ageing funding) • Is supported by Health Fund Agreements • Is supported by the Govt. National Code of Conduct and complaints process • Is supported by Memorandum of Understanding with ASQA • Is supported by the Private Health Insurance (Accreditation) Rules 2011 • Is a Schedule 1 association listed in the Therapeutic Goods Act 1989 as part of the TGA national quality control system • Is recognised by the Australian Taxation Office as a Professional Association that has uniform national registration requirements for practitioners.

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New DiGest Forte Good health begins in the gut

MediHerb has reformulated our traditional bitters formula, DiGest. Feverfew and Wormwood have replaced Dandelion, Milk Thistle and Chamomile, in order to provide a broader range of bitter principles to interact with more bitter receptors.

Mode of Action

Each tablet contains:

Contains herbs traditionally used to strengthen and tone the upper digestive system by stimulating appetite, improving digestive function and secretion of digestive enzymes such as bile.

Citrus reticulata (Chen Pi) extract equivalent to dry fruit peel

500 mg

Zingiber officinale (Ginger) extract equivalent dry rhizome

250 mg

Indications

Tanacetum parthenium (Feverfew) extract equivalent to dry leaf

200 mg

Gentiana lutea (Gentian) extract equivalent to dry root

195 mg

Artemisia absinthium (Wormwood) extract equivalent to dry herb

100 mg

Mandarin Oil cold pressed (Citrus reticulata)

12.5 mg

Poor digestion, lack of appetite, dyspepsia.

R elief of indigestion symptoms including flatulence, belching and fullness.

Give your patients the digestive health support they need for optimal results.

Order yours today!

The coating of this tablet contains Gentian to provide a bitter taste when swallowed.

Dosage and Administration Adults: Take 1 tablet 3 times daily, 15 minutes before meals.

Children 6-12 years: Take 1 tablet daily, 15 minutes before meals.

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Phone: 1300 654 336

Clinical Support: 1300 211 171

THE NATURAL THERAPIST Volume 31 No.2

Order Online: www.myintegria.com

www.mediherb.com.au

AN TA - N E W S N ews - J ul y 2016

• Participates on the Complementary & Alternative Health Industry Reference Committee administered by Skills IQ under the Australian Industry & Skills Committee established by COAG ANTA has been leading the profession in Accreditation and has in place a fully developed high level national quality assurance program fully supported by government departments and regulations as outlined above and we look forward to AAMT setting similar standards in place.

On the 9th October 2012 massage associations were invited by Medibank to attend a meeting to discuss quality control issues including:

• issues surrounding RTO’s • graduates of sub-standard courses joining massage associations and being sent to Medibank to be registered as providers • ongoing recognition of remedial massage providers by Medibank Associations were encouraged at that meeting to work together to put in place quality assurance systems to ensure that only graduates of quality courses were accepted as members by associations.

It is worth reflecting on outcomes and discussions resulting from that meeting including the following documents: •

Rock and a Hard Place discussion paper 29/11/2013 – AAMT

•

Letter from ANTA in response to above discussion paper

The ANTA letter in response to the AAMT Rock and a Hard Place paper highlighted that it was the massage associations responsibility to put in place robust educational standards and quality control systems and that ANTA did not support the AAMT notion the profession was between a rock and hard place. Associations that did not have in place adequate and robust quality control systems in 2012 had a clear choice and could have implemented quality controls at the time if they were committed to high education standards and quality.

The massage associations had an opportunity in 2012 to put in place quality assurance systems and unfortunately very few associations accepted the challenge and continued to accept graduates who had completed sub-standard courses. As a result of many associations failing to put in place any quality control measures, Medibank and HCF decided to implement their own educational standards and quality control measures to ensure only appropriately trained massage therapists were registered as providers.

We are pleased to advise ANTA quality control systems and processes exceed Medibank and HCF requirements.

Several years ago we were invited to participate in a similar quality program being developed by AAMT in collaboration with some other associations. The program involved the establishment of the Natural Medicine Register (NMR) and associated complaints system.

Communications released by the NMR advised the NMR will promote high practitioner and educational standards across the natural therapy industry including massage and myotherapy.

We have not received any recent communications from the NMR, however we have been made aware that the NMR notified ASIC it had ceased on the 18th May 2016 and that the NMR President (also AAMT President) resigned as a director and president of the NMR on the 3rd March 2016. We have not received any advice on the demise of the NMR, however as it has ceased as an organisation we can only conclude the establishment of the NMR by AAMT to provide quality assurance and educational standards was a failure.

It is now more than 5 years since the issue of quality control systems for massage and myotherapy were discussed and the NMR was established and closed down. ANTA remains hopeful other massage and myotherapy associations take up the challenge and adopt the quality assurance and accreditation systems implemented by ANTA.

Further misleading information has also recently been circulated promoting and stating an association (AAMT) intends to trademark commonly used terms to describe modalities. Legal advice received on this issue from Trademark Lawyers is that it is not possible to trademark commonly used terms to describe modalities and any attempt by any association to trademark commonly used massage terms or titles will not be successful. Titles of practice can only be protected under government legislation in accordance with the National Registration and Accreditation Scheme statutory registration administered by AHPRA. Another piece of false information circulating is that it will be mandatory to be accredited under the quality assurance program proposed by AAMT and to pay them annual fees. ANTA has had in place for more than 40 years a high level accreditation program free of charge for all members to participate in when they choose to join ANTA. Under Australian Consumer Laws it is illegal to force anyone to join or pay to join an association or accreditation scheme. It is ludicrous for any association to suggest it will be mandatory to join their association or accreditation scheme.

ANTA members are already accredited by ANTA under a quality assurance program at no cost and there is no need for members to pay any fees to be part of any other proposed accreditation schemes.

Please feel free to contact the ANTA Administration Office at anytime for advice if you have any concerns regarding the massage and myotherapy professions.

Bupa Increases Professional Indemnity Insurance Requirement to $2m for Provider Registration Bupa recently notified Associations they have increased the level of Professional Indemnity Insurance required for provider registration from $1m. to $2m. for all natural therapy practitioners (excluding Chinese Herbal Medicine and Acupuncture which are required to have $5m).

Details of the increase are as follows: Members who were registered as providers with Bupa prior to 30th April 2016 and currently have $1m PI Ins cover do not have to upgrade their PI Ins cover to $2m until 30th June 2017.

Members who were registered as providers with Bupa prior to 30th April 2016 have until 30th June 2017 to decide if they want to upgrade their PI Ins to $2m. and retain their provider registration with Bupa post 30th June 2017.

Practitioners/graduates who have recently joined ANTA with $1m. of PI Ins through Arthur J Gallagher and have been registered as a provider with Bupa post 30th April 2016, are automatically covered for $2m.

ANTA has negotiated with Arthur J Gallagher an increase in PI Ins cover for new members until 31st July 2016 to $2m. at no additional cost.

Members who were registered as providers with Bupa after 30th April 2016 have until 31st July 2016 to decide if they want to upgrade their PI Ins with Arthur J Gallagher to $2m and remain a provider with Bupa.

Members who were registered as providers with Bupa after April 30th 2016 and are not insured with Arthur J Gallagher have until the 31st July 2016 to decide if they want to upgrade their PI Ins policy to $2m. and remain a provider with Bupa.

At this stage Bupa is the only health fund that has decided to increase PI Ins for provider registration to $2m.

The additional cost for members to upgrade their PI Ins policy with Arthur J Gallagher from $1m. to $2m is approx. $21.00 pa (this can vary slightly depending on stamp duty rates levied by State Governments).

If you require any further information or assistance please contact the team in the ANTA National Administration Office on free call 1800 817 577, info@anta.com.au or visit the ANTA website.

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A NTA - N E W S N ews - J u ly 2016

ANTA UPDATES - ANTA ADVICE, UPDATES AND RECOMMEDATIONS Integria Healthcare research shows limitations of DNA barcoding in authenticating herbal extracts Sydney, Australia – Thursday 28 April 2016: New research conducted by an Australian research consortium has identified major shortcomings in the use of DNA barcoding to authenticate herbal materials in finished products.

The study, instigated by Australian natural health company Integria Healthcare, was presented earlier this month at the 16th Annual Oxford International Conference on the Science of Botanicals, held at the University of Mississippi in the USA.

“

Questions about the veracity of DNA barcoding have been in the news since early 2015, when the New York Attorney General forced several major retailers to stop selling a variety of dietary supplements containing herbal ingredients on the basis that DNA barcoding had failed to identify the presence of the labelled herbal species or had identified the presence of unlabelled plant species.

containing extracts,” said Dr Wohlmuth.

“Further, we have shown that the absence of DNA barcodes does not indicate the absence of phytochemicals and active compounds.

Based on these results, we do not believe DNA barcoding using universal barcodes would make a valuable addition to our existing routine quality control program, which is extensive and based on specific morphological and chemical tests prescribed by pharmacopoeial monographs.”

“It is also important to realise that no DNA technique can provide information about which plant part was used or which phytochemicals are present,” added Dr Wohlmuth.

“When it comes to assessing the quality of herbal medicines, the important questions are (1) is the product derived from the correct species? (2)

species from which biological material is derived using a relatively short sequence from a standard part of the genome, i.e. the exact same part of the genome in all species.

The term DNA barcoding is sometimes used more loosely to refer to different, more specific DNA approaches; this is unfortunate and confusing.

In animals, DNA barcoding generally works very well, and the universal animal barcode, which is a sequence from the cytochrome c oxidase 1 gene, is being used successfully to identify various animal tissues and products, including fish species entering the food supply chain.

Finding a single universal barcode region that can be used to identify most plant species has proven elusive, and a combination of at least two barcoding regions is necessary to achieve a good identification rate for most plant groups.

With this work we have clearly demonstrated that DNA barcoding is not always appropriate for botanical extracts and finished products containing extracts

The researchers concluded that the most likely explanation for this is that DNA strands start to break up when plant material is dried and extracted, making it difficult to successfully amplify and sequence the universal barcode regions.

The results were presented by Hans Wohlmuth PhD, Research and Development Manager for Integria Healthcare and MediHerb.

“With this work we have clearly demonstrated that DNA barcoding is not always appropriate for herbal extracts and finished products

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“

The study examined four widely used universal DNA barcodes in 61 samples. The samples, which were also the subject of phytochemical analysis, included 17 dried herb raw materials, 17 MediHerb liquid extracts made from the same batches of raw materials, and 6 MediHerb tablets containing some of the dried liquid extracts. The results showed that while the phytochemical composition (assessed by chemical profile and the presence of active compounds) was preserved in both extracts and tablets, the DNA barcodes were not. DNA barcoding also performed poorly with respect the dried raw materials, with only just over half being correctly identified by at least one of the four barcodes used.

was the correct plant part used?, and (3) does it contain the active compounds in meaningful amounts? No DNA based method is able answer the last two, very important questions.”

“I have no doubt that various DNA techniques have the potential to make valuable contributions to the quality assurance of herbal medicines, but our study highlights what most experts agree on, namely that no single method can provide all the answers when it comes to the complex task of authenticating herbal medicines. Clearly, morphological and chemical tests, as prescribed by pharmacopoeial monographs, continue to form the basis for rigorous quality assurance of herbal medicines,” Dr Wohlmuth said.

The study was instigated by Integria soon after the regulatory events in New York with a view to determining the validity and utility of DNA barcoding as a tool for use in routine quality control.

The study involved the Australian Genome Research Facility, the Medicinal Plant Herbarium at Southern Cross University and the University of Queensland.

Additional information for editors: What is DNA barcoding?

DNA barcoding is a specific DNA technique, first described in 2003, that aims to identify the

Dr. Hans Wohlmuth, research and development manager for Integria Healthcare/MediHerb, presented the DNA barcoding research during the April 2016 Oxford International Conf. on the Science of Botanicals

The benefit of neck traction for neck pain Bing Wu

N

eck Traction (cervical traction) is a non-invasive treatment that stretches the soft tissues in the neck to separate spinal joint structures in order to relieve neck pain.

In my clinical practice, I find that combining massage and acupuncture treatment with neck traction reaches the best result especially, in cervical nerve pinched cases.

Fritz, Thackeray, Brennan, & Childs, 20141, have done a similar study.

In their study, 86 patients with cervical radiculopathy were divided into 3 treatment groups: exercise alone, exercise and use of an over-the-door home traction device, and exercise and mechanical traction delivered at clinic sessions. The researchers concluded that the combination of exercise and mechanical traction was more effective at 6 months and 1 year after treatment than the combination of exercise and over-the-door traction or exercise without traction.

Through their research and my clinical experience, we believe that it is the best medication-free therapy to relieve the cervical compression in an effective manner.

Benefits: Limit the cervical spine activity to help reduce the local inflammation.

• • • •

Relieve neck muscle spasm Increasing vertebral separation Reducing nerve conduction disturbances Improve blood flow

Some conditions achieve greater benefits from neck traction than others.

• • • •

Herniated or compressed intervertebral disc in the cervical spine Radiculopathy Osteoarthritis Neck tightness cause the headache

However, some conditions are contraindicated, such as:

• • • • •

Spinal infection RA or other acute inflammatory joint disorder Osteoporosis Spinal cancers or tumour Cervical spine fracture and dislocation

Sources: Fritz, J., Thackeray, A., Brennan, G., & Childs, J. (2014). Exercise Only, Exercise with Mechanical Traction, or Exercise with Over-Door Traction for Patients with Cervical Radiculopathy, With or Without Consideration of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy, 44(2), 45-57. doi:10.2519/jospt.2014.5065

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holism, pain AND Movement Holism Remember the concept of holism or being holistic? For some of us, the first session of the first day at college was spent talking about the concept of being holistic. Unfortunately, this concept often gets lost when working from a biomedical perspective. We can easily slip into a pathological or biomechanical model that reduces our thinking to pathological tissue only. Soon we are targeting a specific pathological process from the perspective of finding the appropriate intervention to correct the problem, instead of addressing the “whole of person” to gain the largest therapeutic benefit.

Many times, targeting a specific tissue will be an appropriate treatment, particularly with acute complaints. But when the research suggests that multiple body systems need to be considered, then holism becomes an essential process in treatment.

One place where there is often too much emphasis on one body system is in musculoskeletal health. And this is especially the case when looking at chronic pain. In most cases the focus is on finding the “dysfunctional” or damaged tissue, often via imaging such as MRI or complex biomechanical assessment. This works very well in cases of acute musculoskeletal injury but not as well when pain becomes chronic.

When it comes to chronic pain, holism becomes essential again.

The research tells us it is important to look at the human being as a multifactorial, complex interaction of many different systems.

Another way of describing this approach is the biopsychosocial perspective, and it has shown to be very relevant in chronic pain

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Aran Bright

managment. The risk in chronic pain management is that we become short sighted, focusing on minute structural asymmetry, apparent tissue damage or something that shows up on a diagnostic image. The problem here is that we have misunderstood the mechanisms behind pain and some therapeutic approaches may be creating more problems than solutions.

Pain Hopefully by now, you have heard the message that “pain is an output of the brain”. This simple statement is the result of many years of neurological, psychological and physiological study. The results of this research indicate that we should now be thinking of nociception not as pain, but “danger” signals to the brain that can be interpreted as pain. But pain can occur independent from nociception, and nociception can be blocked at the spine and sub cortical areas of the central nervous system. In other words, nociception does not equal pain.

As far back as 1994, a study published in the New England Journal of Medicine showed that diagnostic imaging in the lumbar spine was a poor indicator of pain. In this particular study it was shown that large percentages of asymptomatic individuals demonstrated disc bulges, tears and osteophytes on diagnostic imaging. In other words, they had significant damage to their spine that showed up on MRI but no pain whatsoever.

So it is possible to have tissue damage and no pain, what about

Hol i sm , Pai n An d M ovement

Ara n Br ight

pain without tissue damage? Absolutely, remember phantom limb pain? Phantom limb pain was thought of as triggered by nerve damage from an amputation site, until it was noticed that people born without limbs could still develop phantom limb pain.

term, but it is becoming clear that other treatments need to be used to get meaningful long-term changes for chronic pain sufferers.

So we now know that pain can occur independently from nociception, and is ultimately an output of the brain. Researchers such as Butler and Moseley explain that pain is a normal response that acts as the body’s warning system to danger. The brain takes in huge amounts of information from the body’s sensory organs all the time, including nociceptors. If the brain interprets this information as dangerous it will trigger a pain stimulus to force the body into a protective response.

Chronic pain is difficult to treat. Anyone that has worked with a chronic pain sufferer knows that it is complex and much more than a physical injury. Evidence grows to show that holistic or biopsychosocial approaches can get results for chronic pain sufferers as well as help preventing chronic pain from occurring in the first place. For natural therapists, holism has been a central value that sometimes becomes compromised with reductionist scientific approaches. So it is important to recognise, that when dealing with pain, the whole of person approaches, are actually what the science is recommending.

Nociception in most cases will be recognised by the brain as an unpleasant sensation and pain is a common response. This is generally what happens in acute injury, strong nociception and strong pain response. In most cases, acute injuries recover in 6 to 8 weeks. Fractures, sprains, even many surgeries heal in close to 6 to 8 weeks. But for many, pain can continue even after the tissues had healed.

This is what occurs with chronic pain, or neuropathy, a state where the brain has learnt to create a pain response, even though at the site of the injury, tissue healing has occurred. This can occur many ways including central changes to the brain or spinal cord. We now understand that factors such as emotion and environment play a huge part in changes that occur within the nervous system that can lead to chronic pain.

Biopsychosocial Factors It is now very well proven that psychological and social factors play a larger role in the recovery from certain injuries (such as lower back) as the amount of tissue damage that occurred. Organisations such as Workcover NSW are well aware of this, one of their standard outcome measures from lower back pain is the Orebro musculoskeletal screening questionnaire. This outcome measures asks more questions about someone’s belief around their injury, than it does about the damage that occurred to their back. This outcome measure is highly accurate to when predicting if someone will recover from the injury (95%), return to work in six months (81%) or fail to return to work (86%).

It is pretty clear from MRI studies that as chronic pain develops, the emotional centres of the brain tend to be more active while the sensory areas of the brain become less active. This triggers an increase in the levels of perceived threat to the body and the increased likelihood of a pain response. It could be thought of very simply, the more the brain responds to the perception of threat, the more likely it is to trigger a pain response. The opposite also appears to be true, the less the brain responds to stimulus from damaged tissue, the less likely there will be a pain response.

Summary

Words: Aran Bright B. HSc (MST) Adv Dip Myotherapy 1. Nijs, J. et al. 2014 A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition targeted motor control training. Physical Therapy, vol 94, pp730-738.

2. Butler, D. Moseley, L. 2013 Explain Pain NOI Group Publications.

3. Jensen, m. et al.1994 Magnetic imaging on the lumbar spine in people without back pain, New England Journal of Medicine, Vol 331 pp 69-73.

4. Melzack, R. et al. 1997. Phantom limb pain in people with congenital limb deficiency or amputation in early childhood.

Brain vol 120, pp 1603-1620.

5. Seminowicz, D. et al. 2009 MRI structural brain changes associations with sensory and emotional function in a rat model of long-term neuropathic pain. NeuroImage. Vol 47 No 3 pp

1007-1014.

6. Fersum, V. et al 2012. Efficacy of classification based cognitive functional therapy in patients with non-specific chronic lower back pain: a randomised controlled trial.

European Journal of Pain. Vol 19 No 6. Pp 916-928.

7. Searle, A. et all 2015. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. Vol 29 No 12 pp 1155-1167.

8. Veehof, M. et al. 2016 Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a metaanalytic review. Cognitive Behaviour Therapy. Vol 45 No 1 9. Cramer, H. et al. 2013. A Systematic Review and Metaanalysis of Yoga for Low Back Pain. Clinical Journal of Pain.

Vol 29 No 5 pp 450-460.

10. Chapparro, L. et al 2014. Opioids Compared With Placebo or Other Treatments for Chronic Low Back Pain: An Update of the Cochrane Review. Spine. Vol 39 No 7 pp 556-563.

Perhaps it could be put another way, your brain has the capacity to change how it will respond to information about tissue damage, and this is largely determined by previous experience.

Movement Movement approaches are being demonstrated as one of the best ways to address pain, and not just chronic pain. Movement in combination with client education, mindfulness strategies and lifestyle changes are showing clinical efficacy in areas where previous strategies have struggled. Once it becomes clear that pain is a complex interaction between body tissues and the central nervous system, then is becomes clear that a more holistic or biopsychosocial approach should be employed.

Active movement strategies that are targeted at making changes to brain function are becoming very popular amongst musculoskeletal therapists of all types and the efficacy of these approaches are growing, as are mindfulness interventions and integrated approaches such as yoga.

At the same time there is little to no evidence for some medical approaches such as opioid analgesia for chronic lower back pain as a long-term strategy. Opioid analgesia does have low to moderate quality evidence for disability and pain in the short THE NATURAL THERAPIST Volume 31 No.2

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M u shro om s - The 3 rd Fo o d K in gdo m

Mushrooms – the 3rd Food Kingdom Pt 2 Bioactive effects Since the turn of the century there has been exceptional interest in mushrooms and their influence on human health, in particular the common button mushroom. Scientists have long realised that mushrooms are not plants and reside in a separate biological kingdom known as fungi. So it was no surprise that mushrooms might be unique in their physiological action.

Immune system Wholesome eating generally improves our ability to fight disease.

White button mushrooms enhance the action of Natural Killer Cells and other immune responses in mice (Wu 2007; Xu 2013).

Other reports have shown that mushroom extracts given to mice decreased inflammation, assist gut bacteria to resolve infection, and increase the anti-cancer immune response (Yu 2009; Kuvibidila 2010, Varshney 2013).

Since then, researchers at the University of Western Sydney have shown that mushrooms increase the production of salivary Immunoglobulin A (IgA) in healthy humans, which serves as an indicator of IgA levels at other mucosal sites such as the intestinal and respiratory tract (Jeong 2012a).

The 2014 CSIRO independent Mushrooms and Health report states: Many of the potential therapeutic effects of mushrooms and mushroom components on a variety of diseases appear to be directly or indirectly mediated by enhancing natural immunity of the host via effects on natural killer (NK) cells, macrophages, via balance of T cells and their cytokine production, and via the activation of Mitogen Activated Protein Kinase (MAPK) pathways (Roupas 2014). These findings have led researchers to use mushrooms and their extracts in cancer research.

promote the development of breast cancer, especially in postmenopausal women. Currently, aromatase inhibitors are being used in the treatment of estrogen-dependent breast cancer.

An Australian study showed that two carbohydrates found in mushrooms inhibited breast cancer cell growth in the laboratory (Jeong 2012b).

Umami Umami is the reason you enjoy mushrooms. Well, about 85% of you enjoy mushrooms. Their rich savoury flavour, known as umami, comes primarily from the natural free glutamates in mushrooms.

Glutamate is an amino acid. There are glutamate receptors in the stomach and the intestine, signalling the presence of protein in food (Brosnan 2013). There is speculation that glutamate receptors in the intestines might be working in a feedback loop to diminish hunger and stop us from over-eating (Ghirri 2012; Burrin 2009).

“We suggest that controlled intake of foods which are rich in glutamate … could be useful in producing a sense of ‘healthy satisfaction’ after a nutritionally sufficient meal, inducing the subject to refrain from excessive food intake” (Ghirri 2012). Glutamates in food may be a key factor associated with the reduced appetite and kilojoule intake among mushroom consumers.

Weight control

FAST FACTS Mushrooms are comprised of 85-95% water Mushrooms have their own immune system Mushrooms are more closely related in DNA to humans than to plants

Cancer There are about 14,000 new cases of breast cancer diagnosed each year in Australia, with 3000 women dying of the disease annually (AIHW 2014 p105-106). Mushrooms could be part of the solution. Mushrooms took centre stage when three international studies linked women who eat mushrooms to a 5060% lower risk of breast cancer compared to those who had no mushrooms in their diet (Zhang 2009; Shin 2010; Hong 2008).

One study from the University of Western Australia showed that women who ate an average of only 10g of mushrooms a day had a 65% lower risk of breast cancer (Zhang 2009). Ten grams is about half a button mushroom. The remarkable finding has stimulated more research on how mushrooms might lower cancer risk. There have now been 10 good quality observational studies revealing that women who eat mushrooms regularly have a much lower risk of breast cancer. A 2014 meta-analysis states: “The protective effects of mushroom intake on risk of breast cancer were consistently exhibited in premenopausal and postmenopausal women.” (Li 2014) The CSIRO Mushrooms and Health report had a similar view: The most promising data appear to be those indicating an inverse relationship between mushroom consumption and breast cancer risk (Roupas 2014).

Although it is not clear how mushrooms might be lowering breast cancer risk it is known that the mushroom contains compounds that suppress the enzyme aromatase and reduce breast cancer proliferation (Grube 2001; Chen 2006; Martin 2010). Aromatase converts the hormone androgen to estrogen, which in turn can

Although mushrooms are low in kilojoules (a single serve of mushrooms - 100g or three button mushrooms - has only 103 kJs), they also seem to reduce the amount of food we eat. When meat was replaced with button mushrooms over four days, the meals became more filling (Cheskin 2008).

Although the mushroom meal had 100 fewer calories (420 kJs) than the meat meal, consumers actually ate 379 fewer calories (1590 kJs) a day over four days, suggesting that mushrooms have the ability to make us eat less.

In a follow-up study, people who regularly ate mushrooms significantly reduced their waist circumference (Poddar 2013). The study observed the effect of replacing part of the evening meal with a serve of mushrooms. After 12 months the mushroom consumers lost an average of 7 cm (about three belt holes) around the waist while the control group ultimately increased their waist circumference. The mushroom consumers also ate 123 fewer Calories (515 kJs) per day than the control group, backing up the earlier study suggesting mushrooms naturally fill us up.

Blood lipids & blood glucose The fibre in mushrooms is mainly chitin and glucans. This fibre is part of the cell wall, playing a similar role to the cellulose in plant cell walls. There is a strong suspicion that the glucans in mushrooms may also be acting like statins to lower blood cholesterol. A Spanish research group have found mushroom compounds responsible for inhibiting Hydroxy-Methyl Glutaryl CoA Reductase (HMGCR), the same enzyme targeted by statin medication (Gil-Ramirez 2013).

Local research at the University of Western Sydney showed that mushrooms helped lower both blood glucose and blood cholesterol in the laboratory (Jeong 2010). The authors also thought that this was due to the influence of glucans.

Further research in humans indicates that powdered mushroom reduces the blood glucose response after a meal, especially in young women (Marsales 2014).

Summary It is too early to state that mushrooms definitely reduce the risk of disease, although most of the research is very promising, especially regarding a lower risk of breast cancer, reducing THE NATURAL THERAPIST Volume 31 No.2

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M u shro o m s - The 3 rd Fo od K in gdo m

elevated blood lipids and making meals more satisfying. However, there is no dispute that mushrooms are nutrient-dense, have bioactive compounds that positively influence our physiology, and that the flavour of mushrooms has universal appeal. There have been two recent reviews on the mushroom’s effect on our health that offer more information than can be covered here (Roupas 2012; Feeney 2014). A summary of the nutrition and health research on mushrooms for the public resides here: www.powerofmushrooms. com.au.

References 1. Australian Institute of Health & Welfare 2014. Australia’s health 2014. Australia’s health series no. 14. Cat. No. AUS 178.

Canberra: AIHW 2. Burrin DG, Stoll B (2009). Metabolic fate and function of dietary glutamate in the gut. American Journal of Clinical Nutrition 90 (suppl): 850S-856S 3. Brosnan JT, Brosnan ME (2013). Glutamate: a truly functional amino acid. Amino Acids 45: 413-415 4. Chen S, Oh S-R, Phung S, Hur G, Ye JJ, Kwok SL, Shrode GE, Beluy M, Adams SL, Williams D (2006). Anti-aromatase activity of phytochemicals in white button mushrooms (Agaricus bisporus). Cancer Research 66 (24): 12026-12034 5. Cheskin LJ, Davis LM, Lipsky LM, Mitola AH, Lycan T, Mitchell V, Mickle B, Adkins E (2008). Lack of energy compensation over 4 days when white button mushrooms are substituted for beef.

Appetite 51: 50-57 6. Feeney MJ, Miller AM, Roupas P (2014). Mushrooms – biologically distinct and nutritionally unique. Nutrition Today 49 (6): 301-307Ghirri A, Bignetti E (2012). Occurrence and role of umami molecules in foods. International Journal of Food sciences and Nutrition 63(7): 871-881 7. Gil-Ramírez A, Clavijo C, Palanisamy M, Ruiz-Rodríguez A, Navarro-Rubio M, Pérez M, Marín FR, Reglero G, Soler-Rivas C (2013). Study on the 3-hydroxy-3-methyl-glutaryl CoA reductase inhibitory properties of Agaricus bisporus and extraction of bioactive fractions using pressurised solvent technologies. J Science Food Agriculture 93: 2789-2796 8. Grube BJ, Eng ET, Kao YC, Kwon A, Chen S (2001). White button mushroom phytochemicals inhibit aromatase activity and breast cancer proliferation. Journal of Nutrition 31: 3288-3293 9. Hong SA, Kim K, Nam SJ, Kong G, Kim MK (2008). A casecontrol study on the dietary intake of mushrooms and breast cancer risk among Korean women. International Journal of Cancer 122: 919-923 10. Jeong SC, Jeong YT, Yang BK, Islam R, Koyyalamudi SR, Pang G, Cho KY, Song CH (2010). White button mushroom (Agaricus bisporus) lowers blood glucose and cholesterol levels in diabetic and hypercholesterolemic rats. Nutrition Research 30: 49-56 11. Jeong SC, Koyyalamudi SR, Pang G (2012). Dietary intake of Agaricus bisporus white button mushroom accelerates salivary immunoglobulin A secretion in healthy volunteers. Nutrition 28 (5): 527-531 12. Jeong SC, Koyyalamudi SR, Jeong YT, Song CH, Pang G (2012). Macrophage immunomodulating and antitumor activities of polysaccharides isolated from Agaricus bisporus white button mushrooms. Journal of Medicinal Food 15 (1): 58-65 13. Kuvibidila S, Korlagunta K (2010). Extracts from culinarymedicinal mushrooms increase intracellular -defensins 1-3 concentration in HL60 cells. Int J Medicinal Mushrooms 12(1): 33-42 14. Li J, Zou L, Chen W, Zhu B, Shen N, Ke J, Lou J, Song R, Zhong R, Miao X (2014). Dietary Mushroom Intake May Reduce the Risk of Breast Cancer: Evidence from a Meta-Analysis of Observational Studies. PLoS One DOI: 10.1371/journal. pone.0093437 15. Marsales H, Williams BT, LaMacchia ZM, Rideout TC, Horvath PJ (2014). The effect of mushroom intake on modulating post-prandial glycemic response. Journal of the Federation of American Societies for Experimental Biology 28 (1) Suppl 647.48 16. Martin KR, Brophy SK (2010). Commonly consumed and specialty dietary mushrooms reduce cellular proliferation in MCF-7 human breast cancer cells. Experimental Biology & Medicine 235: 1306-1314 17. Poddar KH, Ames M, Hsin-Jen C, Feeney MJ, Wang Y, Cheskin

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LJ (2013). Positive effect of mushrooms substituted for meat on body weight, body composition, and health parameters. A 1-year randomized clinical trial. Appetite 71: 379-387 18. Roupas P, Keogh J, Noakes M, Margetts C, Taylor P (2012).

The role of edible mushrooms in health: Evaluation of the evidence. Journal of Functional Foods 4 (4): 687-709 19. •Roupas P, Krause D, Taylor P. Mushrooms and Health 2014: clinical and nutritional studies in humans (June 2014) http:// www.mushroomsandhealth.com/mushrooms-health-report/ 20. •Shin A, Kim J, Lim SY, Kim G, Sung MK, Lee ES, Ro J (2010). Dietary mushroom intake and the risk of breast cancer based on hormone receptor status. Nutrition & Cancer 62 (4): 476-483 21. •Varshney J, Ooi JH, Jayarao BM, Albert I, Fisher J, Smith RI, Patterson AD, Cantorna MD (2013). White button mushrooms increase microbial diversity and accelerate the resolution of Citrobacter rodentium infection in mice. Journal of Nutrition 143: 526-532 22. Wu D, Pae M, Ren Z, Guo Z, Smith D, Meydani SN (2007).

Dietary supplementation with white button mushroom enhances Natural Killer Cell activity in C57BL/6 mice. Journal of Nutrition 137: 1472-1477 23. Xu Y, Na L, Ren Z, Xu J, Sun C, Smith D, Meydani SN, Wu D (2013). Effect of dietary supplementation with white button mushrooms on host resistance to influenza infection and on in ice. British Journal of Nutrition 109 (6): 1052-1061 24. Yu S, Weaver V, Martin K, Cantorna MT (2009). The effects of whole mushrooms during inflammation. BMC Immunology 10: 12 doi:10.1186/1471-2172-10-12 25. Zhang M, Huang J, Xie X, Holman CDJ (2009). Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. International J Cancer 124: 1404-1408

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Public liability and professional indemnity ANTA members are required to have a current Professional Indemnity (PI) insurance policy of at least $1m (or $2m for BUPA Provider Registration), as well as Public Liability insurance to cover damages and legal expenses arising from personal injury to a third party, or damage to their property.

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Traditional Chinese Medicine and Functional Gastrointestinal Disorders Tony Reid

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TRADItiONAL CHINESE MEDICINE and FUNCTIONAL GASTROINTESTINAL DISORDERS Part 1 Functional Dyspepsia Introduction The common functional gastrointestinal disorders (i.e. functional dyspepsia and gastroesophageal reflux disease) occur with very high prevalence (40 – 60%) throughout the Western world, and although the nomenclature suggests that they be treated with the aim or restoring normal function, western medicine (WM) has not yet arrived at this relatively enlightened perspective. Instead they are regarded as ‘functional’ disorders in contradistinction to those disorders caused by structural abnormalities (e.g. tumor or trauma), biochemical abnormalities or the unwanted effects of pharmaceutical drugs. More than 50% of people suffering from these conditions self-medicate and do not seek medical help. However, most of them use over the counter medications that are inappropriate – even from a WM perspective (Niknam, et al., 2016). More importantly, these disorders are poorly diagnosed and treated by WM, the only saving grace being the potential for early detection of cancer, provided that the patient does in fact go to visit a GP. This leaves a large gap in the effective care for common digestive disorders. This paper explores the unique perspective of traditional Chinese medicine (TCM) in this regard, and provides protocols for treatment using prepared Chinese herbal medicines.

Key differences between the WM and TCM approach to digestive disorders The overall concept of the digestive system in traditional Chinese medicine (TCM) goes far beyond the mouth to anus anatomical and physiological expositions of its Western counterpart.

To say that Western medicine (WM) has only recently become aware of the elephant in the room (i.e. the influence of the mind and emotions on digestive functions) would be putting it mildly. There is, in fact, a small herd of elephants in the room, when it comes to the health and disorders of the digestive system, when we closely compare these two medical systems. While a detailed comparison is not the intention of this article, the main point is that in spite of the enormous amount of analytical detail encompassed by the Western paradigm, its understanding of the nature and scope of the digestive system in health and disease is quite limited. Whereas, TCM, on the other hand has a universal scope that places the digestive system at the centre of human physiology and highlights the important relationships between the various bodily systems, mental-emotional factors as well as environmental influences.

Although some of the following topics are beginning to receive an increasing amount of attention in WM, the key points of difference that characterise TCM are listed below. Each of these factors have a profound influence on the functioning of the digestive system, as well as the body as a whole: • Ingested foods and beverages, both in quantity and quality.

• Mental and emotional factors.

• Environmental factors.

• Behavioural factors, including work and leisure activities.

• Diseases outside of the digestive system.

• Internally generated pathogens within the digestive system.

Limitations of the WM paradigm As noted by W. A. Price, traditional (i.e. pre-industrial) societies understood the concepts listed above in the previous paragraph as a matter of basic survival,(Price, 1939). Although the so called ‘industrial revolution’ has enabled a large portion of humanity to extricate itself from dependence on the natural environment (read: ‘living in harmony with nature’), ultimately this is an illusion that has destructive consequences both on human health as well as the environment. Viewed in this light, the dominance of the analytic and reductionist approach in Western science only serves to perpetuate this illusion (as well as many others).

This phenomenon is strikingly illustrated by the emergence of two new ‘diseases’ in recent years: functional dyspepsia (FD) and gastro-oesophageal reflux disease (GERD). Both of these ‘symptoms-turned-into-disease-entities’ have their origins outside of the medical profession. They are prime examples of pharmaceutical industry marketing activities, centred around the promotion of their products: synthetic chemical drugs that are aimed at alleviating specific symptoms, but are unable to correct the underlying dysfunction. In addition, these drugs have harmful effects, all of which have been carefully hidden. These recent developments within WM represent the dark side of evidence based medicine (EBM) and may rightly be regarded as ‘collateral damage’ resulting from the so called partnership between the medical profession and the pharmaceutical industry in matters of medical research. (Goldacre, 2012; Healey, 2012; Gøtzsche, 2013; Ionnadis, 2005; Ionnadis, 2016, Kendrick).

Recent studies have pointed to the fact that both of these ‘diseases’ are in reality, functional disorders that are caused by lifestyle factors, i.e. improper management of the diet and manner of eating, particularly in relation to age and activity levels,(Randhawa, Gillessen, 2013; Randhawa, Mahfouz, Selim, Yar, Gillessen, 2015).However, this really does speak to the loss of common sense and respect for traditional knowledge within the medical profession: when empirical research is required as evidence for what should be common knowledge. As one author has pointed out, there is no need for a clinical trial when a substance is highly effective, (either in a positive or a negative sense), or when certain activities lead to specific consequences, (Healey, 2012). If one ingests a certain dose of cyanide, or if one jumps from a plane at altitude without a parachute, the results will be fatal; if a person continues to eat excessive quantities of food before the stomach has finished processing the previous meal, while also leading a sedentary lifestyle, functional disturbances will eventually follow.

Taking advantage of the empty space provided by the obsessive requirement for ‘clinical evidence’ before anything may be regarded as a fact, the pharmaceutical industry has continued to build ‘evidence’ for new ‘diseases’ that can be ‘treated’ by their products.

Moreover, by a process that may be regarded as statistical sleight of hand, the risks for developing more serious conditions (e.g. cancer) for those patients suffering from FD and GERD have been THE NATURAL THERAPIST Volume 31 No.2

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grossly exaggerated (principally through discussing ‘relative’ as opposed to ‘absolute’ risk). (Kendrick, 2013; Kendrick 2014, pp.41-75), making ‘preventative’ treatment the major ‘benefit’ of pharmaceutical intervention. However, the drugs involved mostly suppress troublesome symptoms and may have deleterious effects on the overall health of the patient. (Kesser, 2016; Heidelbaugh et al., 2012) Unfortunately, medical guidelines for the assessment and treatment of these disorders play down the risks of treatment and emphasise the ‘benefits’. (Internal Clinical Guidelines Team (UK), 2014; Patti, 2016; Talley & Vakil, 2005).

The TCM approach to digestive disorders: introducing the Spleen In TCM, the processes that are involved in the digestion and assimilation of nutrients are carried out through the harmonious interaction between the activities of the Spleen, Stomach, Lung, Heart, Small and Large intestines, Liver and Gallbladder. At this point we need to bear in mind that TCM is not concerned with precise anatomical structures so much as with groups of related functions that may be understood in the larger context of Qi and Blood production.

Central in importance is the Spleen, the main functions of which, together with the Stomach, center on the ‘transformation’ (i.e. digestion and assimilation) of nutrients. This includes the intake of food and beverages, as well as their break-down and absorption.

The Spleen extracts a crude ‘essence’ from foods that have been processed by the Stomach. This extract is referred to as the ‘food-Qi’, and it provides the basis for production of the normal physiological Qi (the ‘nutritive Qi’ or simply the ‘Qi’) that activates or vitalizes the internal organs, and is distributed throughout the body in the Channels and Vessels. The Spleen also contributes towards Blood production, as the food-Qi provides the basis for both the Qi as well as the Blood.

The Spleen subsequently sends this crude food-Qi upward to the Lung and Heart, where it is transformed into Qi (in the Lung) and the Blood (in the Heart). These two ‘substances’ are then distributed throughout the body to activate and nourish the internal organs, muscles, bones, tendons, skin, etc. The term ‘substances’ is used loosely here, as Qi may be regarded as both the foundation for as well as the expression of the various functional activities of body and mind. Whereas Blood, on the other hand, is the Yin counterpart of the Qi. The Blood nourishes body structure to support the Qi, and also exerts a tempering action upon it. This harmony between the Qi and the Blood ensures that the Qi flows smoothly and evenly, permitting all of the complex and highly coordinated physical and mental activities to occur in a normal, healthy manner.

When Spleen function is normal, the appetite, digestion, absorption and bowel movements are all regular; vitality is abundant; the flesh and muscles are firm and strong. Dysfunction manifests in poor appetite, indigestion, bloating and loose stools as well as fatigue and wasting of the musculature.

The Spleen also plays a key role in fluid metabolism. It ‘transforms’ the fluid portion of the ingested nutrients into the physiologically useful body Fluids, separates out the wastes, and moves all Fluids around the body. If this function is impaired, the Fluids that have been incompletely processed may accumulate internally, leading to the production of pathogens (referred to as ‘internally generated’ pathogens), such as Damp and Phlegm.

The retention of these pathogens may result in fluid retention and excessive body fat.

The Spleen is susceptible to injury by the following: • Inappropriate diet and mode of eating (e.g. food preferences; excessive intake of Cold natured foods; excessive rich and heavy foods, sweet foods or alcohol; eating at irregular times; eating while working or moving around) • Exposure to Cold and Damp environmental conditions • Intake of contaminated foods or beverages • Excessive physical activity with inadequate rest • Excessive worrying and anxiety

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• Excessive mental stimulation • Emotional strain or over-stimulation • Chronic illness It is important to note that the TCM concept of the Spleen is much broader and deeper that the Western physiological concept of the ‘digestive system’. The Spleen is the source of one’s acquired constitution. It is crucial that the Spleen functions well, both for the maintenance of good health and also to permit a complete recovery from an illness. Moreover, through the activities of a well-functioning Spleen one can make up for constitutional weaknesses and achieve a state of optimal health.

Therefore, care of the Spleen is an important component of health maintenance, disease prevention and disease treatment.

The Spleen and Stomach are often considered together as a single unit and are discussed in terms of ‘the middle Jiao’ or simply ‘the middle’. Indeed, many of their individual functions overlap, as it were, or may be seen as extensions of the one function. While the Stomach ‘receives and transmits’ and the Spleen ‘transforms and transports’ it is apparent that the Stomach shares some of the Spleen’s functions and vice versa. The Stomach’s transformation functions are picturesquely described as the ‘rotting and ripening’ of nutrients; while the Spleen’s functions are to ‘transform and transport’ nutrients.

The primary energetic function of the Spleen is to send Qi upwards to the Heart and Lung (in the process of Qi and Blood production) and also to provide the mind and senses with pure Yang Qi in order to activate and keep them open. The primary energetic function of the Stomach is to send the Yin Qi downwards (as in moving the remaining materials down the digestive tract for further processing, extraction and elimination).

However, the Stomach also sends clear Yang Qi upwards to nourish the eyes and nose, while the Spleen on the other hand, also sends turbid fluids (i.e. Yin type substances) downwards for discharge as part of its Yin functions.

In light of the above, the main presenting signs and symptoms of Spleen-Stomach disorders are: • Emaciation, weight loss or inability to gain weight • Poor appetite • Fatigue and muscular weakness • Mental fatigue • Digestive disturbances such as: epigastric discomfort or pain, epigastric or abdominal distention (i.e. bloating), nausea, reflux, vomiting, loose stools or diarrhea • Swollen tongue with tooth marks Functional Dyspepsia In WM, functional dyspepsia (FD) is defined as chronic (i.e. longer than 6 months) or recurrent (i.e. occurring at least once weekly) pain or discomfort centred in the upper abdomen,(Rome Working Teams, 2006). The Rome III criteria distinguish two separate subgroups: postprandial distress syndrome (PDS), characterized by postprandial fullness and early satiation, and epigastric pain syndrome (EPS), characterized by epigastric pain or burning. It should be noted that those with heartburn as the main symptom are mostly classified as having gastroesophageal reflux disease (GERD). The PDS subgroup have subjective negative feeling that is non-painful, including early satiety, bloating, upper abdominal fullness, or nausea; while the EPS subgroup experience subjective pain in the epigastrium. In recent years the clinical usefulness of this subdivision has been challenged as there may be considerable overlap between these two subgroups, (Tack & Talley, 2013).

Estimates of prevalence range from 20 – 40% of adult population.

However, in spite of having symptoms, less than half of these consult a physician, (Harmon & Peura, 2010; Talley & Ford, 2015). Although precise figures are lacking due to nature of the treatment protocols (i.e. restricted used of endoscopy and first line treatment of H. Pylori, as outlined below), it has been estimated that up to 25% of these have peptic ulcer disease (Grainger, et al, 1994, Anand & Katz, 2015) and less than 2% have localised

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cancer (Talley et al., 1998). Moreover, there is considerable overlap with other conditions (e.g. GERD, IBS) in 30-50% of patients, (Talley et al., 1993; Klauser et al., 1990).

Patients diagnosed with FD are first tested for the presence of H. Pylori and if they test positive, are given antibiotics. If H. Pylori is not detected they are treated with one or more of the following: over the counter antacids, H2 blockers, a proton pump inhibitor drug (PPI), or other anti-secretory drugs. Most commonly used are the PPI’s, such as Prilosec, Prevacid and Nexium. Antidepressants and anxiolytics may be prescribed in refractory conditions. In patients over age 55, and/or with ‘alarm features’ (i.e. unexplained weight loss, progressive dysphagia, odynophagia [painful swallowing], persistent vomiting, family history cancer, previous cancer, ulcer of the stomach, lymphadenopathy, abdominal mass) where the risk of malignancy has become significant, endoscopic investigation is carried out in order to rule out or confirm this possibility, (Internal Clinical Guidelines Team (UK), 2014: Tack, Masaoka, Janssen, 2011; Harmon & Peura, 2010; Talley & Vakil, 2005).

Outcomes of WM treatments The outcomes of the WM treatment approach are as follows: H. pylori eradication: Although eradication therapy was found to be superior to placebo, the number needed to treat (NNT) was 17 – i.e. out of seventeen people treated 16 will not have any symptom relief, which equates to a 5.9% effectiveness rate, (Moayyedi et al., 2004).

Acid reduction: PPIs are effective in treating patients with investigated functional dyspepsia, 6.8% effectiveness (NNT = 14.6) (Delaney et al., 2000; Wang et al., 2007).

Unwanted deleterious effects of PPI’s include an increased risk of: • Nutritional deficiencies (e.g. B12) • Food poisoning • Dysbiosis • Pneumonia • Bone loss • Hip fractures • Infection with Clostridium difficile • Dementia • Renal disease • Heart disease (Yepuri et al., 2016; Sukhovershin & Cooke, 2016; Zavros, et al., 2002 (a); Zavros, et al., 2002 (b); Heidelbaugh et al., 2012; FDA, 2016; Wedro & Anand, 2016; Harvard Health Publications, 2016; Gomm et al., 2016; Haenisch et al., 2015; Tennant et al., 2008; Marcuard et al, 1994; Bavishi, & Dupont, 2011; Laheij et al., 2004; Dial, 2009; Hvid-Jensen et al., 2014; Rosch, 2010; Lazarus et al., 2016; ie et al., 2016; de Wit & Numans, 2016; Haenisch et al., 2015, Shah et al., 2015) As discussed elsewhere, medical studies that use statistical methodology are ideally suited for assessing risks (as was their original purpose, within epidemiology) and are rather poorly suited for assessing efficacy of treatments, (Reid, 2015). In this light, the citations in the above paragraph point to risks, the seriousness of which (e.g. dementia, cancer, heart disease) require only a very small degree of increase to preclude the use of these drugs, particularly in a disorder that is not life threatening nor significantly disabling. It is doubtful that patients would consent to undergo prolonged treatment with PPI’s if they were presented with the above list of risks at the time of consultation. It is also doubtful whether or not patients receive a detailed explanation of how these drugs work and how they do not cure the condition, but require an indefinite course so as to suppress the symptoms of the underlying problem (thus maximizing exposure as well as the subsequent risks).

In summary, the WM diagnosis is not very specific and the treatments are very poor. The only redeeming feature of the WSM approach is the potential for early detection of cancer.

TCM Approach According to the symptomatology, functional dyspepsia correlates with the traditional disease categories of ‘epigastric pain’ (wei wan tong) and ‘epigastric distention’ (wei zhang). These disorders may

arise from various causes: invasion by exogenous pathogens, inappropriate or excessive food intake, stress and emotional strain, deficiency conditions of the Spleen and Stomach, or internally generated pathogens. (For the sake of brevity, the citations in this section are as follows: Maciocia, 1994, pp.383-417; Xu, 1994, pp.116-20; Bo, 2000, pp.365-70; Shi, 2003, pp.63-72; Maclean & Lyttleton, 2002, pp.338-80, 862-908; Bing & Zhen, 1995, pp.73-85) The pathways of pathogenesis are as follows: • Exogenous pathogens invading the Stomach: Commonly, this is due to the ingestion of Cold natured foods, in excessive amounts (i.e. in quantities that exhaust the Yang Qi of the Stomach).

Alternatively, exposure to cold temperatures for prolonged periods (e.g. wearing a wet, full body swimming costume in a cold and windy environment) may exacerbate or cause the Stomach to be overwhelmed by Cold Qi. This leads to the accumulation of pathogenic Cold in the Stomach. Depending on other factors, such as the passage of time, underlying constitution, other foods eaten and environmental conditions, the Cold pathogen may transform into Heat. Alternatively, exogenous pathogenic Heat may invade the Stomach directly, in ways analogous to those for exogenous Cold, leading to Heat in the Stomach. Thus, the above processes may lead to excess type syndrome-patterns where there are either Cold or Heat pathogens disrupting Stomach function. These syndromes are treated by dispelling the pathogen.

• Immoderate intake of food, exceeding the body’s digestive capacity: This may come about due to one or more of the following: overeating, eating too many varieties of foods at one meal, eating before the Stomach has emptied, eating excessive amounts of oily or fatty foods (particularly deep-fried foods), generally together with a sedentary lifestyle. The end result is that incompletely digested material accumulates in the Stomach, and acts as a pathogen, which, in turn generates further pathogens, such as Heat and/or Phlegm. This is referred to as food stagnation, and is treated with herbal combinations that promote digestion, regulate the Qi and dispel Phlegm.

• Liver Qi constraint: Prolonged or intense stress and/or emotional strain affect the Liver, resulting in failure of the Liver’s function to promote the smooth and even flow of Qi throughout the body, particularly in the digestive tract (i.e. the Stomach and Spleen).

This mostly leads to Qi stagnation in the Stomach and failure of the Stomach Qi to move downwards and drive normal peristaltic movements. This condition is treated by soothing the Liver and regulating the Qi. • Deficiency conditions: Deficiency of the Spleen and Stomach Qi may occur due to physical over-exertion with insufficient rest, malnutrition, chronic illness, or prolonged stress. In addition to the general symptoms of fatigue, poor appetite and lack of muscular strength, patients become more susceptible to environmental pathogens or inappropriate food intake. Another common deficiency, particularly in the middle aged and elderly, is Stomach Yin deficiency. This condition shares many features with Stomach Qi deficiency; however, it is characterized by Dryness (e.g. dry mouth and throat, constant unquenchable thirst, dry stools) and Heat (red tongue, vague burning epigastric pain). This condition looks similar to pathogenic Heat in the Stomach (see 1., above), the major difference being the concomitant signs of Stomach Qi deficiency. These conditions are treated by tonification of the Stomach and Spleen.

• Deficiency Cold of the Spleen and Stomach: Also referred to as Yang deficiency of the Spleen and Stomach, this may be regarded as a more severe form of Stomach Qi deficiency, in which the normal warming and activating functions of the Stomach Qi have and become reduced to the point where additional symptoms become manifest – all centered around lack of warmth and impaired movement of the Qi (i.e. cold limbs, cold sensation in the epigastrium, possibly also vomiting of clear fluid). This is treated by warm-tonification (i.e. tonification together with warming)

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All of the above pathological processes eventually lead to stagnation of the Qi, which then tends to cause Blood stasis. The former gives rise to mild, poorly localized pain or discomfort with a sense of distention, while the latter gives rise to localized pain.

The above pathways of pathogenesis highlight the effects of a Western or ‘Globalization’ lifestyle where food is abundant, much of the population works in sedentary employment and stress is a normal part of life. Thus, proper treatment protocols should be based upon appropriate lifestyle modifications that remove or ameliorate the causative factors, in addition to a limited course of suitable herbal combinations.

Note: the lifestyle modifications below are taken from: Bo, 2000; Bing & Zhen, 1995; Maclean & Lyttleton, 2002.

Clinical Protocols The commonly encountered syndrome-patterns in FD are listed below. It should be noted that in real life scenarios more than one may be present, e.g. food stagnation often accompanies deficiency conditions. Liver constraint is often accompanied by food stagnation and/or deficiency.

• • • • • •

Food stagnation Liver Qi invasion of the Stomach Stomach Heat Cold pathogen in the Stomach (Stomach excess Cold) Stomach Yin deficiency Spleen-Stomach Yang deficiency

Food stagnation Key clinical features: Dull pain with a sensation of fullness and distention, symptoms worsened or brought on by eating, malodorous belching, nausea that may be alleviated by belching or passing flatus, possibly also sour regurgitation, irregular bowel motions, thick and greasy tongue coat, slippery or wiry-slippery pulse.

Principle of treatment: Resolve food stagnation and promote digestion, redirect the Stomach Qi downwards.

Treatment formulas Bao He Wan (Citrus & Crataegus Formula) a.k.a. DIGEST-AID Formula (Bao He Xiao Shi Fang) Variations: With moderate pain, combine the above formula with Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula).

Lifestyle modifications: ‘Eating less and light food’. Reduce quantity of food eaten, select a light easily digestible diet (avoid excessive oil, deep fried foods, excessive meat, hard cheeses, combining too many different foods at one meal). Soups and stews based on grains (such as rice, barley or millet) and beans (such as mung, split mung or aduki) and a variety of vegetables and lean meats (if desired) are most suitable.

Liver Qi invasion of the Stomach Key clinical features: Recurring pain or discomfort brought on or aggravated by emotional strain or stress, pain may radiate towards the hypochondria, poor appetite, belching, sighing, tongue has a thin white coat, wiry pulse.

Principle of treatment: Soothe the Liver and regulate the Qi Treatment formulas Shu Gan Wan (Cyperus & Peony Formula) Variations: • With Heat or Fire, combine the above formula with Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a. STRESS RELIEF 1 Formula (Jia Wei Xiao Yao San)

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THE NATURAL THERAPIST Volume 31 No.2

• With pain, combine the above formula with Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula) Lifestyle modifications: ‘Regulate emotions and avoid irritation’. Introduce such measures as: stress management, meditation, relaxation, counselling, gentle exercise program, as appropriate. Reduce or avoid sour tasting foods, select a light and easily digested diet (as per above, under ‘Food stagnation’) with moderate use of strong flavours.

Stomach Heat Key clinical features: Sudden onset of pain, burning pain that is worse with pressure and hot natured foods, acidic regurgitation, halitosis, red tongue with dry yellow coat, wiry-slippery-rapid pulse.

Principle of treatment: Clear Heat from the Stomach to alleviate pain Treatment formulas Huang Lian Jie Du Wan (Coptis & Scute Formula) a.k.a.

ANTITOX 2 FORMULA (Huang Lian Jie Du Tang) + Wen Dan Tang (Bamboo & Hoelen Formula BP050) a.k.a.

CLEAR THE PHLEGM Formula (Wen Dan Tang) Lifestyle modifications: ‘Avoid pungent and greasy food’. Avoid the following: hot spices, deep fried food, cooking with excessive amounts of oil or fat.

Avoid: garlic, onion, lamb, alcoholic drinks, coffee, chocolate.

Cold pathogen in the Stomach Sudden onset of pain, pain is alleviated by the application of warmth, pain is aggravated by the application of cold, absence of thirst or (if thirsty) desire for warm drinks, tongue is normal or pale with a thin white coat, wiry-tight pulse.

Principle of treatment: Expel the Cold (pathogen) to alleviate pain.

Treatment formulas Ban Xia Hou Po Tang – Jia Wei (Pinellia & Magnolia Combination) Variations: With abdominal or epigastric distention: • + Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula) • With nausea: • + Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. CLEAR THE PHLEGM FORMULA (Wen Dan Tang) Lifestyle modifications: ‘Avoid raw and cold food’. Reduce or eliminate the intake of raw foods and refrigerated items; add ginger and crude (unrefined) sugar to cooking. Avoid watermelon, banana, cucumber, radish.

Stomach Yin deficiency Key clinical features: Chronic dull and vague pain with a burning sensation, hunger but feels full after eating very little or with aversion to eating anything, dry mouth and throat, dry stools, dry red tongue with little or no coat, or coat with bare patches, thready-rapid or thready-wiry pulse.

Principle of treatment: Nourish the Stomach Yin and generate the body fluids, regulate the Stomach Qi. Treatment formulas Zhi Yin Gan Lu Yin (Rehmannia & Asparagus Formula)

Digesti ve H e al t h

To ny R eid

Variations: • With Spleen Qi deficiency, combine the above formula with Shen Ling Bai Zhu San (Ginseng & Atractylodes Formula) • With constipation, combine the above formula with Run Chang Wan (Linum & Rhubarb Formula) • With Spleen Qi deficiency and constipation, combine the above formula with BOWEL MOVER Formula (Run Chang Tong Bian Fang)

REFERENCES

Lifestyle modifications:

Bing, O., Zhen, G., (1995). Traditional Chinese Medicine Treatment and Dietetic Restraint for Common Diseases. Jinan: Shandong Science and Technology Press.

‘Eat easily digested food. Avoid pungent, raw, cold, coarse and hard foods’. Avoid the following: hot spices, deep fried food, hard crusts on bread or baked items. Reduce fiber intake. Avoid: garlic, onion, lamb, alcoholic drinks. Eat smaller meals and eat more frequently during the day. Select a light easily digested diet as per above, under ‘Food stagnation’.

Spleen-Stomach Yang deficiency Key clinical features: Chronic mild, dull pain that is relieved by warmth and pressure (e.g. massage) and after eating, pain worsened by hunger, vomiting of thin watery fluids, poor appetite, fatigue, cold limbs, loose stools, pale tongue with a white coat, weak-slow and possibly also deep pulse.

Principle of treatment: Warm-tonify the Spleen and Stomach Treatment formulas Fu Zi Li Zhong Wan – Jia Wei (Dangshen & Ginger Formula) Lifestyle modifications: ‘Avoid raw and cold food and Cold Damp’. Reduce or eliminate the intake of raw foods and refrigerated items; add ginger and crude (unrefined) sugar to cooking. Avoid foods that generate Cold-Damp: ice cream, banana, watermelon, persimmon. Select a light easily digested diet as per above, under ‘Food stagnation’.

In addition to the above protocols, the following formulas may be used in combination with any of the above syndrome patterns.

Halitosis, nausea, severe reflux: Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. CLEAR THE PHLEGM FORMULA (Wen Dan Tang) Stress or emotional strain due to Liver Qi constraint (select one): Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a.

STRESS RELIEF 1 FORMULA (Jia Wei Xiao Yao San) – general use Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. STRESS RELIEF 2 FORMULA (Xiao Yao San) – with mild deficiency Chai Hu Shu Gan Wan (Bupleurum & Cyperus Combination) a.k.a. QI MOVER FORMULA (Chai Hu Shu Gan Wan) – with moderate to severe pain Stomach (or Spleen-Stomach) Qi deficiency (fatigue, muscular weakness, poor appetite, pallor): Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Formula) a.k.a. DIGESTIVE TONIC FORMULA (Xiang Sha Liu Jun Zi Tang) Stomach (or Spleen-Stomach) Qi deficiency with food stagnation: Jian Pi Wan (Ginseng & Citrus Formula) – with deficiency Bao He Wan (Citrus & Crataegus Formula) a.k.a. DIGEST-AID FORMULA (Bao He Xiao Shi Fang) – food stagnation only Note: The above Chinese herbal formulas are available from Sun Herbal Pty Ltd. Part 2 of this series will deal with gastroesophageal reflux disease (GERD), providing a critical review of the different approaches taken by WM and TCM, as well as clinical treatment protocols using prepared Chinese herbal medicines.

Anand, B., Katz, J. (2015). Peptic Ulcer Disease. From Medscape, Drugs and Diseases. Retrieved July 5, 2016 from: http://emedicine.medscape.com/article/181753-overview Bavishi, C., Dupont, H. (2011). Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 34(11-12):1269-81.

Bo, P. (Chief Ed.), 2000. University Textbooks of Traditional Chinese Medicine for Overseas Advanced Students: Traditional Chinese Internal Medicine. Beijing: People’s Medical Publishing House Delaney, B., Wilson, S., Roalfe, A., Roberts, L., Redman, V., Wearn, A. et al. (2000). Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care. Lancet 356: 965-1969. de Wit, N., Numans, M. (2016). New side effects of proton pump inhibitors; time for reflection? Ned Tijdschr Geneeskd.

160(0):D338.

Dial, M. (2009). Proton pump inhibitor use and enteric infections.

Am J Gastroenterol.104 Suppl. 2:S10-6.

FDA (2016). Proton Pump Inhibitors Information. From FDA Website: Drug Safety and Availability, Information by Drug Class. Retrieved June 29, 2016 from: http://www.fda.gov/Drugs/ DrugSafety/InformationbyDrugClass/ucm213259.htm Goldacre, B. (2012). Bad Pharma. How Drug Companies Mislead Doctors and Harm Patients. New York: Faber and Faber Inc. Gomm, W., von Holt, K., Thomé F, et al. Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol.

2016;73(4):410-416.

Gøtzsche, P. (2013). Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. London: Radcliffe Publishing.

Grainger, S., Klass, H., Rake, M., Williams, J. (1994). Prevalence of dyspepsia: the epidemiology of overlapping symptoms.

Postgrad Med J. 70:154-161 Harmon, R., Peura, D., (2010). Evaluation and management of Dyspepsia. Am J Gastroenterol. 99: 823–829 Harvard Health Publications (2016). Do PPIs have long-term side effects? From Harvard Medical School website, Digestive Health.

Retrieved June 29, 2016 from: http://www.health.harvard.edu/ digestive-health/do-ppis-have-long-term-side-effects Healy, D. (2012). Pharmageddon. Berkeley & Los Angeles: University of California Press.

Heidelbaugh, J., Kim, A., Chang, R., Walker, P. (2012).

Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012 Jul; 5(4): 219–232.

Haenisch, B., von Holt, K., Wiese, B., Prokein, J., Lange, C., Ernst, A., Brettschneider, C., et al. (2015). Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci. 265(5):419-28 * More reference sources available on request from ANTA

THE NATURAL THERAPIST Volume 31 No.2

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THE NATURAL THERAPIST Volume 31 No.2

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THE NATURAL THERAPIST Volume 31 No.2

33

BITTER HERBS

a new insight

Bitte r H e r b s

K er r y B o n e

In the past it was thought bitters mainly acted to stimulate the digestive processes of the upper gastrointestinal tract by a reflex initiated from the bitter taste buds on the tongue. In other words, the interaction of the bitter tasting phytochemicals in the herb with receptors on the tongue stimulated nervous impulses to the brain, which in turn initiated facilitatory signals via the vagus nerve to the upper digestive organs, especially the stomach. Hence, tasting a bitter herb before eating was essential to its activity and primed the digestive process by stimulating the release of gastric acid, digestive enzymes and bile.

Since then, there have been several important new discoveries. Firstly, we know much more about the bitter taste receptors themselves. A family of around 30 receptors (denoted as TAS2R, previously T2R) has been identified. Most TAS2Rs are broadly tuned to each detect a range of bitter substances, explaining how we can recognise hundreds of bitter compounds with only this limited set of receptors. Also, some very bitter molecules simultaneously stimulate more than one receptor. For example, amarogentin from gentian stimulates seven receptors: TAS2R1, 4, 39, 43, 46, 47 and 50. Absinthin from wormwood stimulates four: TAS2R10, 14, 46 and 47.

This could explain why herbs like gentian and wormwood are particularly good at boosting digestion.

However, the most intriguing new discovery is that bitter taste receptors are not restricted to the mouth. There are numerous reports of TAS2Rs being present further down in the gut in certain cells lining the gastrointestinal wall, including in the stomach. Cells with these receptors appear to be wired to elicit an aversive behavior, probably as a defensive mechanism because many toxic chemicals are bitter in taste. As a result of this defensive response of the digestive system, bitter taste receptors in the gastrointestinal tract appear to upregulate several metabolic and digestive functions.

In particular, bitter receptors have been found on enteroendocrine cells, the specialised hormone-releasing cells of the upper digestive tract. When stimulated, these cells release a variety of gut hormones, but in particular cholecystokinin (CCK) and glucagon-like peptide 1 (GLP1). CCK has numerous important functions in the digestive tract: it promotes secretion of pancreatic enzymes and bile, slows down stomach emptying, increases gastric digestive mixing and secretions, and creates a sense of fullness, so you stop eating. GLP1 also slows gastric emptying and creates a sense of fullness, but most importantly it stimulates the release of insulin. In fact, there is a new class of diabetes drugs (the gliptins) based on enhancing the action of GLP-1.

We now know that bitters can stimulate the release of these important hormones from enteroendocrine cells.

The new research above suggests that bitters can create a sense of fullness (satiety) and hence might actually help with weight loss. How does this sit with the traditional notion that bitters improve appetite? The answer is there is no contradiction, because bitters only seem to promote appetite when it is below par.

The discovery that bitter receptors occur throughout the gastrointestinal tract and appear to regulate a number of physiological functions has the potential to change our understanding of bitter herbs. Firstly, it means that bitter herbs do not need to be tasted to boost upper digestive function. While tasting may be desirable for optimum effects, it is not essential. In fact, clinical research on gentian dating from 1998 supports this concept, but now we understand why. This means that tablets or capsules containing bitter herbs will be clinically active, although higher doses are probably necessary. As noted above, support for this concept of direct activity in the stomach also comes from a multicentre, uncontrolled study of gentian capsules involving 205 patients. Six Patients took on average about five capsules per day, each containing 120 mg of a 5:1 dry extract of gentian root, and achieved rapid and dramatic relief of symptoms, including constipation, flatulence, appetite loss, vomiting, heartburn, abdominal pain and nausea. As early as 1956, Wolf and Mack carried out an excellent study on the direct action of various bitters on the stomach of their patient Tom (who had an occluded oesophagus and a gastric fistula), with golden seal (Hydrastis canadensis) proving to be the most potent direct-acting bitter.

Research has shown that the capacity to sense bitterness varies from person to person. Some people are highly sensitive and are known as supertasters. Since the stimulation of bitter receptors could exert a range of important health benefits, could people who have a low sensitivity to bitters be at a health disadvantage?

Epidemiological research suggests this could be the case. In fact, functional variants in bitter taste receptor sensitivity have been linked to alcohol dependency, adiposity, eating behavior disinhibition and high bodymass index (BMI). People with a lower bitter tasting sensitivity exhibited the poorer health measure.

The new research also suggests a role for bitter herbs in blood sugar control and managing insulin resistance. In support of this, 94 patients with prediabetes exhibited improvements in BMI, blood glucose control and body fat when given just 16 to 48 mg/ day of isohumulones (hop bitter acids) as capsules in a double blind, placebocontrolled clinical trial. However, it is early days here and more research is needed.

Blending bitters together will have more clinical impact, as a wider range of bitter receptors will be stimulated. This will help to

overcome the genetic variations in a person’s capacity to taste and respond to bitters.

For example, a combination of gentian, wormwood and feverfew will stimulate 12 out of the known 29 human bitter taste receptors.

In a sense, with our modern dietary focus on sweet, sour, savoury and salty foods, bitter has become the neglected taste. The latest research provides a compelling argument that we can all benefit from adding back bitter herbs and foods into our diet. Perhaps by including bitterness in our diet we might avoid bitterness in our life (in terms of physical health)?

References

• Meyerhof W. Elucidation of mammalian bitter taste. Rev Physiol Biochem Pharmacol 2005; 154: 37-72 • Meyerhof W, Batram C, Kuhn C et al. The molecular receptive ranges of human TAS2R bitter taste receptors.

Chem Senses 2010; 35(2): 157-170 • Behrens M, Meyerhof W. Gustatory and extragustatory functions of mammalian taste receptors. Physiol Behav 2011; 105(1): 4-13 • Valussi M. Functional foods with digestion-enhancing properties. Int J Food Sci Nutr 2012; 63(Suppl 1): 82-89 • Mills SY, Bone KM. Chapter 2: “Principles of herbal pharmacology” In: Principles and Practice of Phytotherapy: Modern Herbal Medicine. 1st Edition, Churchill Livingstone, Edinburgh, 2000.

• Wegener T. [Anwendung eines Trockenextraktes Augentianae luteae radix bei dyspeptischem Symptomkomplex]. Z Phytother 1998; 19: 163-164 • Wolf S, Mack M. Experimental study of the action of bitters on the stomach of a fistulous human subject Drug Standards 1956; 24(3): 98-101 • Wang JC, Hinrichs AL, Bertelsen S et al. Functional variants in TAS2R38 and TAS2R16 influence alcohol consumption in high-risk families of African-American origin. Alcohol Clin Exp Res 2007; 31(2): 209-215 • Tepper BJ, Koelliker Y, Zhao L et al.

Variation in the bitter-taste receptor gene TAS2R38, and adiposity in a genetically isolated population in Southern Italy. Obesity (Silver Spring) 2008; 16(10): 2289-2295 • Dotson CD, Shaw HL, Mitchell BD et al. Variation in the gene TAS2R38 is associated with the eating behavior disinhibition in Old Order Amish women. Appetite 2010; 54(1): 93-99 • Feeney E, O’Brien S, Scannell A et al.

Genetic variation in taste perception: does it have a role in healthy eating?

Proc Nutr Soc 2011; 70(1): 135-143

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Case Series of Diets and Food Availability of Mayan & Hispanic villages - Part 2 Guatemala, Honduras, Nicaragua & Costa Rica

Dr S im o n A Cic hel l o / S in is a Bubul j / S a l l y Len n ox

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Ca se S e r ie s O f D i e tsDr S A Cic h el l o /S Bubul j /S Len n ox

Table 5. Typical Diet of ‘Cindy’ a Hispanic/ Mestizo, from Copan, Honduras Meal

Food Type

Dietary Benefits / Deficiencys

Breakfast

Black beans, plantain, egg, cheese, tortilla (corn/ wheat flour blend) with butter, coffee

Mixed protein and carbohydrate intake

Lunch

Rice, black beans, cheese, lettuce salad with parsley, carrot, onion, tortilla

Mixed protein and carbohydrate intake, Magnesium and other minerals derived from salad

Snack

None

None

Dinner

Egg (1-2), plantain, tortilla (corn/ wheat flour blend) with butter, cheese

Mixed protein, carbohydrate source, butter and cheese maybe processed and not natural (i.e. high sodium)

Figure 9. Case Study 3 – ‘Erlin’ Mestizo/ Mullato male from Granada, Nicaragua

Figure 9 on the left shows that Erlin’s typical diet is below the recommended kilocalorie intake is below the recommended RDI (approx.

36%). The macronutrient intake of carbohydrate sources is below average, however protein intake is above average (approx. 166% of the recommended dietary intake). Fat/lipid intake is also below RDI which can result in a low intake of EFA’s in the diet with dietary fibre also low.

Vitamins B12, Folate, Vitamin E, Calcium, Magnesium, and Potassium are all deficient with excess sodium and vitamin A in the diet.

Table 6. Typical Diet of ‘Erlin’, Granada, Nicaragua Meal

Food Type

Dietary Benefits / Deficiencys

Breakfast

Gallo Pinto ‘Red Beans and Rice’

High Soluble fibre and protein combining from vegan sources

Lunch

Chicken or Black bean soup

Low EFA’s High protein and sodium intake

Snack

None

Improved glycaemic control

Dinner

Tortilla, Fried chicken, small vegetable salads

High protein Low EFA’s and soluble fibre

Figure 10. Case Study 4 – ‘Nat’ a young European of German descent male from Ometepe, Nicaragua

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37

Ca se S e r ie s O f D i e tsDr S A Cic h el l o /S Bubul j /S Len n ox

Figure 10., on page 37 shows us a dietary analysis of Nat who is European descent (German) living in Nicaragua and currently follows a vegan diet. As shown above Nat is achieving 95% of his kilocalorie intake through vegan sources and is achieving an even ratio of protein, carbohydrates and fats. As a vegan, Nat is managing to obtain a higher omega 3 to 6 ratio which can have positive health benefits (i.e. 24 g/ day of dietary fats in the form of omega 3 fatty acids). Further, he has higher micronutrient intake than the recommended daily intake for B1, B2, B6 and Vitamin C, compared to locals who consume nutrients from animal sources. However, being a vegan in Nicaragua, Nat does not appear to be from his diet record to ingest any Vitamin B12 but does take Spirulina/ Chlorella supplementation which may contain vitamin B12 depending on the brand and source. He also admitted to eating Tempeh as well. Compared to locals Nat is receiving optimum amounts of micronutrient and macronutrients and exceeds the recommended daily intake for important minerals such as, calcium, magnesium and potassium. The nutrient analysis shows us that optimum macro and micronutrient consumption (with the exception of vitamin B12) is achievable by following a vegan diet.

Table 7. Typical Diet of ‘Nat’, Vegan of European descent, Ometepe, Nicaragua Meal

Food Type

Dietary Benefits / Deficiencys

Breakfast

Chia, Oats, Banana

↑ fruit, vegetables, fibre, essential fatty acids

Lunch

Papaya, 5 bananas (plantains), cabbage, algal mixture (spirulina, chlorella, nori seaweed)

High potassium intake, fibre and antioxidants. Possible B12 intake via bacterial/ algal sources

Snack

Subject does not eat between meals

Dinner

Bowel of brown rice, lentils, vegetable soup, with linseeds on top of soup

Higher fibre, electrolytes and omega 3 consumption from vegan sources.

Figure 11. Case Study 5 – ‘Coralia’ a young Hispanic/ Peruvian Indian/ [Mixo] female from San Jose, Costa Rica

Figure 11 on the left shows us that Coralia’s typical diet is 50% of the recommended RDI for kilocalorie intake.

Similar to Erlin’s dietary analysis in table 6, we see that the highest amount of macronutrients comes from protein and the lowest from carbohydrates. In contrast to Erlin’s typical diet Coralia’s diet shows us that her cholesterol intake from food is above the RDI possibly due to the higher poultry consumption, which could be the cause of the higher omega 6 to 3 ratio in her diet (pro-inflammatory). Again micronutrient intake such as B2, B3 and B6 are above the recommended RDI. Vitamin C, Folate and B12 intake from dietary sources is quite low possible due to low citrus fruit, green leafy vegetable and red meat/fish consumption. As seen in Erlin’s dietary analysis Vitamin A is well above the RDI

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Table 8. Typical Diet of ‘Coralia’, San Jose, Costa Rica (Peruvian Indian Descent) Meal

Food Type

Dietary Benefits / Deficiencys

Breakfast

‘Gallo Pinto’ Red beans and rice, 1 egg (scrambled or fried), 1 piece of bread, 1 coffee

Low fibre and EFA’s.

High Sat fats and cholesterol.

Low H2O intake

Lunch

Chicken, rice, vegetables

Low EFA

Snack

Fruit or chocolate

Dinner

Chicken/ Egg, or beans, rice, mixed vegetables

Low EFA

Health status included previous, rheumatoid arthritis, and hepatitis B, with current health concerns polycystic ovarian syndrome.

Discussion Both the price and purchasing power are often functions of food quality and alter possible supply of food. Further, the intervention by governments to improve the lives of indigenous populations such as removal from native village life and agricultural systems and transferral to town compounds with subsidized or free food may have deleterious effects. These factors all effect individual dietary composition and diet quality leading to many acute and chronic illnesses. As table 2 depicts, both the indigenous populations of San Jorge in Guatemala and Ometepe Island on lake Nicaragua suffer a similar plight. Both have lower incomes, and lower purchasing power of almost -90% when compared with city populations in both Honduras and Costa Rica who have higher proportion of Hispanic/ Spanish populations. Further, the Kiche Indians of San Jorge had been supplied a ‘maize meal’ that did not comprise of maize and thus not reflective of traditional diets. Instead it contained soy protein from China, GMO corn meal from the U.S.A. and milk powder from New Zealand and thus non-reflective of the traditional diet. Moreover, Honduras, being the second poorest country in the western hemisphere has chief exports as agricultural and seafood, in yet their food affordability is twice as low as neighbouring Costa Rica which citizens have a better standard of living, food quality and purchasing power.

In addition to lower purchasing power and food quality, the indigenous Kiche of San Jorge did not have fresh food markets in their own town and had to travel 15 minutes by bus (paid) to obtain fresh fruit and vegetables from shops advertising soda/ soft drinks and selling soda and processed junk food. Most males were employed in the construction industry as there was no agriculture nearby. Antigua also had a high number of processed food outlets, but unlike San Jorge, these were catered for ex-patriot or tourist travellers, and the city did have a fresh food market. On the other hand, Ometepe Island even though agricultural, most stores sold processed goods, including sugar, soft drinks with non-sugar sodas not available, and also processed foods, and it was assumed that people would grow their own fruit, vegetables and livestock on small farming allotments. San Jose contained an abundance of fresh food markets and shops, and also

sophisticated processed food shops that contained ‘healthy’ options such as grilled meat and salads. Milk powders or nutrition powders supplied by the governments of the respected countries to indigenous serve to improve their diets and nutritional status but are by no means a substitute for the traditional diets of a high fruit, vegetables (i.e. fibre, vitamins and minerals) as well as a broad selection of plant based and animal protein.

The consumption of coffee, being a chief crop of Central America can be valued for its beneficial properties but also negative value when provided to children (Kain, et al, 2003).

Moreover, the mesmerizing nature of soda company brand advertising can be seen everywhere in indigenous populations from the Yucatan to Costa Rica, especially noted in San Jorge Kiche village, Chichicastenego market and also at Ometepe Island. Further, the increased use of oil and frying in cooking was seen in market places where further processed foods i.e. hot dogs, fried chicken and fries were sold. Good quality meat such as beef were mostly exported from the indigenous communities as a way of income generation and also due to the lack of electricity, and cold chain freezer facilities i.e. Ometepe Island. With education, and a profitable economy, Costa Rica has developed into a wealthier Central American country. This is reflected by the good quality dining establishments and health consciousness of the establishment of health gyms and health clubs, fresh food options and also central food markets with HACCP/ food safety certification evident and displayed as opposed to other countries.

At a microscopic level, the dietary surveys of individuals in different locations across Central America revealed a number of interesting findings. The indigenous Kiche Indians of San Jorge showed a major proportion of their macronutrient diet comprising of protein which may be beneficial i.e. body composition/ muscle mass, and the prevention of diseases such as obesity and possibly diabetes (Astrup, 2015), which may become prevalent due to the increased consumption of soda and sugary drinks. There were also dietary excesses of vitamins B1, B2, B3, B6, B9 (beneficial in carbohydrate metabolism, β-oxidation/ lipid synthesis & Krebs

cycle regulation) (Lonsdale, 2015), but also homocysteine regulation and also bone regulation and health (Fratoni & Brandi 2015).

Further, Iron, but may have been over reported due to the participants exaggerating the amount of food eaten and also eating more meat than vegetable protein such as beans as a matter of pride, which is a common trait in poorer indigenous communities (Kain, et. al. 2003).

Lower reporting of nutrients such as energy are a major concern with dietary surveys (Cook et. al. 2000).

B-vitamins and iron are all essential for optimal carbohydrate, fat and protein metabolism and are all essential for energy metabolism (Lonsdale, 2015) and are also important in the pathogenesis of diabetes (Riaz & Samreen, 2015). With the over-bearing, omnipresent nature of soda and sweet processed foods in the village and their possible regular consumption would increase their relative risk of diabetes development if processed foods continue to displace the traditional diet.

However, even though the family may have over reported, deficiencies are present in Vitamin B12, Vitamin D (through diet), calcium, magnesium and potassium. Vitamin B12 (cobalamin) is most commonly found in red meat, algal dietary sources and is digested and synthesised by healthy gut metabolism and gut flora (Franceschi, et. al. 2002). It is important for cardiovascular and neural health and the prevention of pernicious anaemia (Chhabra et al, 2015). Certainly, these nutrient deficiencies are implicated in the pathogenesis of cancer, cardiovascular disease and diabetes which are increasing in incidence rapidly in low- and middle-income countries (LMICs), such as Guatemala (Checkley et. al. 2014).

When compared with Hispanic children in nearby tourist cities, the children of the Kiche appear to have stunted growth and stature.

Further, the risks of deficiencies are greater in vegetarian diets and when the consumptions of red meat are low (Pawlak et. al. 2014) with the introduction of cereal based supplemental food in children showing a reversal in anaemia and stunted growth (Viteri et. al. 1995).

Cobalamin and folate are also important nutrients for regulating and reducing homocysteine levels; a key contributor in the development of cardiovascular disease and stroke (Ganguly & Alam 2015), which would be THE NATURAL THERAPIST Volume 31 No.2

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exacerbated by the high dietary sodium levels observed and would contribute to the development of diseases such as, hypertension, kidney nephritis (Salusky & Goodman 2002) and gout (Slot 2013) . Also sugar was present as an added ingredient in the maize flour mixture, with corn meal, soy protein and also the addition of dairy.

Both sugar and dairy consumption in indigenous communities where these foods are not traditional has shown deleterious effects (Cordain et. al. 2005). Also reliance on government maize meal makes the Kiche totally reliant upon outside food sources and also alters their nutritional status as they chiefly eat tortillas with every meal. The nutritional status and health of the Kiche is affected by the loss in agricultural knowledge, agricultural culture and nature balance, use of food raised using GMO technology, pesticides, herbicides, as well as the adulteration of the nutritional status of the diet due to consuming processed foods.

In Honduras, the Mestizo female Cindy (table 5) surveyed both worked and lived in a food shop/ café. The shift of rural/ agricultural communities to cities effects both incomes in a positive way but also food security and food variety in both positive and negative aspects.

One positive outcome of employment in a café/ food shop was that the workers could receive free meals thus saving money and having a wider selection of food to consume (Iannotti, et. al. 2012). This includes protein intake, and other nutrients which are deficiencies in Honduras and other third world countries, which are often caused by the concurrent incidence of parasitic infections (Sanchez et. al. 2013).

Also energy intake is minimal when compared with the U.S.A. RDI, but more so the quality of macronutrients such as fats i.e. essential fatty acids (Correia & Campos, 2003), which are also low in the diet of other Latin American countries such as Guatemala (Bermudez et. al. 2010), many due to limited intake of wholefoods containing these nutrients.

Also a broad range of vitamins were deficient including B-vitamins i.e. thiamin, niacin, B6, B12, Folate which are all important in red blood cell synthesis, metabolism, the maintenance of healthy skin, muscles, immune and nervous system function. Intake of vitamin B6, B12 and folic acid are associated with a reduced risk of cancer and CVD. Folic acid is also required to reduce the risk of neural tube defects during pregnancy (Sharma et. al. 2013). .B vitamins are required as cofactors for energy production within the mitochondria of the cells; thus inadequate dietary intake or depletion through exercise may result in reduced energy levels (Manore, 2000). Cindy may have a reduced energy requirement as her occupation is fairly sedentary in comparison to agricultural work. Further, dietary intake of the antioxidant vitamins C and E were low; these vitamins prevent oxidative injury to tissues and cells and have a role in the prevention of chronic diseases (Fletcher & Fairfield, 2002). Cindy’s vitamin D intake is only 29% of the recommended amount; Vitamin D has many essential roles in the body including regulation of cellular differentiation and growth. Vitamin D deficiency decreases calcium absorption which then results in an increase in parathyroid hormone production which causes calcium to be leached from the bones to maintain normal serum levels in the kidneys; this is defined as secondary hyperparathyroidism. Vitamin D deficiency is also strongly correlated with the incidence of osteomalacia, osteoporosis, increased bone fractures and neuro-muscular dysfunction (Staud, 2005). Cindy is only consuming around half of the required amount of calcium, magnesium and potassium which are all important minerals required to support bone health (Nieves, 2013). Cindy hasn’t reported intake of any meat in her diet thus her iron intake is low; in a dietary survey on Miskito (native American ethnic group) women in Honduras only 42.6% reported meat consumption, this may be due to the fact that many of these women had also experienced food insufficiency recently (Arps, 2011). Inadequate iron intake can lead to anaemia and thus decrease intellectual and work performance. Cindy is also low in zinc which is required for adequate immune system function.

Animal sources of iron and zinc are more bioavailable than plant sources (Sharma et. al. 2013). Cindy’s sodium intake is slightly high; increased sodium intake is strongly correlated with the development of hypertension which then often leads to cardiovascular disease and stroke (Perez & Chang, 2014).

In Nicaragua, table 6 shows that Erlin’s typical diet is below the recommended kilocalorie intake is below the recommended RDI (approx. 36%). The macronutrient intake of carbohydrate sources is well below average, however protein intake is above average (approx. 166% of the recommended dietary intake). The higher intake of protein can possibly compensate for the decreased carbohydrate

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intake in the diet as this macronutrient is required for energy production. Erlin’s lipid intake is also below RDI which can result in a low intake of EFA’s in the diet and thus inadequate intake of the fat-soluble vitamins A, D, E and K. Although in Erlin’s case vitamin A is consumed in excess. Chronic hypervitaminosis A can result in damage to the haematopoietic system, the organs involved in the production of blood and thus can lead to aplastic anaemia. Excessive vitamin A intake also increases decalcification of bones thus increasing the risk of osteoporosis. Patients with hepatic and renal diseases are also more susceptible to the adverse effects of hypervitaminosis A (Rutkowski & Grzegorczyk, 2012). The national sugar supply of Nicaragua, Guatemala, El Salvador and Honduras has been fortified with vitamin A since 1999; this was put into place to address the widespread vitamin A deficiency in Central America due to consumption of a mostly plant based diet (RibayaMercado et. al. 2004). However sugar and processed food consumption has increased dramatically in recent decades with a resultant increase in obesity and diabetes in Central America (Barcelo et. al. 2012), this may suggest that many people have an excessive intake of vitamin A. Further, other nutrients that are lacking in Erlin’s diet include vitamin B12, folate, vitamin E, calcium, magnesium, potassium and vitamin D intake appears non-existent. Vitamin B12 and folate are required for the metabolism of homocysteine to methionine; deficiencies of these vitamins can result in increased homocysteine levels which are associated with the occurrence of many diseases such as cardiovascular disease and age-related macular degeneration (Gopinath et. al. 2013). Calcium, magnesium and potassium are important in the maintenance of bone mineral density and the prevention of osteoporosis (Nieves, 2013). Vitamin D is required in many body functions such as the regulation of cellular differentiation, cellular growth and the maintenance of calcium metabolism. Thus vitamin D deficiency increases the risk of osteoporosis and neuromuscular dysfunction. Vitamin D deficiency is also associated with an increased risk of autoimmune conditions due to its role in the modulation of T cell function (Staud, 2005).

Table 7 above shows us a dietary analysis of Nat who is European descent living in Nicaragua and currently follows a Vegan diet. As shown above Nat is achieving 95% of his kilocalorie intake through vegan sources and is achieving an even ratio of protein, carbohydrates and fats. As a vegan, Nat is managing to obtain a higher omega 3 to 6 ratio which can have positive health benefits (i.e. 24 g/ day of dietary fats in the form of omega 3 fatty acids). Further, he has higher micronutrient intake than the recommended daily intake for B1, B2, B6 and Vitamin C, compared to locals who consume nutrients from animal sources. However, being a vegan in Nicaragua, Nat does not appear to be ingesting any Vitamin B12 according to his dietary record. Compared to the locals Nat is receiving optimum amounts of micronutrients and macronutrients and exceeds the recommended daily intake for important minerals such as calcium, magnesium and potassium.

The nutrient analysis shows us that optimum macro and micronutrient consumption (with the exception of vitamin B12) is achievable by following a vegan diet, through the cultivation and consumption of vegetables and fruit and their products organically grown on Ometepe Island on lake Nicaragua.

Table 8 shows us that Coralia’s typical diet is 50% of the recommended RDI for kilocalorie intake. Similar to Erlin’s dietary analysis in table 8, we see that the highest amount of macronutrients comes from protein and the lowest from carbohydrates. In contrast to Erlin’s typical diet Coralia’s diet shows us that her cholesterol intake from food is above the RDI possibly due to the higher chicken consumption, which could be the cause of the higher omega 6 (pro-inflammatory) to omega 3 (anti-inflammatory) ratio in her diet.

A large portion of Coralia’s diet consists of poultry and eggs which are high in omega 6 and low in omega 3. Coralia’s overall omega 3 intake may be very low as she didn’t report any fish or seafood intake in her dietary recall.

Humans would have consumed a ratio of 2:1 of omega 6 to omega 3 before the development of modern agricultural practices, this ratio is now approximately 10:1. Consumption

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of omega 6 linoleic acid has risen dramatically in the last 100 years due to the development of commercial refining of seed oils and the development of hydrogenation of vegetable oils to be used in margarines and shortenings.

Increased omega 6 intake has been associated with the development of chronic inflammatory conditions and mental health issues (Innis, 2014). Again micronutrient intake such as B2, B3 and B6 are above the recommended RDI. Vitamin C, Folate and B12 intake from dietary sources is quite low possibly due to low citrus fruit, green leafy vegetable and red meat/fish consumption. As seen in Erlin’s dietary analysis Vitamin A is well above the RDI (approx 300% above), with lower than recommended magnesium, calcium and potassium intake. Coralia reported rheumatoid arthritis as a previous health concern, which is a chronic inflammatory condition characterised by high levels of oxidative damage. Coralia has a low dietary intake of vitamin C and E, these vitamins are antioxidants which can help to reduce the inflammation associated with rheumatoid arthritis (Al-Okbi, 2014). Coralia has a very low intake of calcium and vitamin D, both of which are required to support bone health and prevent osteoporosis. Low vitamin D intake is also a causative factor in the development of autoimmune conditions such as rheumatoid arthritis (Nieves, 2013), (Staud, 2005) Health status included previous; rheumatoid arthritis, and hepatitis B, with current health concerns polycystic ovarian syndrome. Coralia’s iron intake is only approximately 50% of the RDI; which puts her at risk of developing iron deficiency anaemia. Iron deficiency anaemia is common in women and children in Costa Rica, to rectify this foods such as wheat flour, maize flour and milk have been fortified with various forms of iron (reduced iron, ferrous fumarate and ferrous bisglycinate). In 2011, 29% of non-pregnant women and 38% of pregnant women were anaemic worldwide. Inadequate iron intake may have detrimental effects on women of reproductive age such as fatigue, poor mental health, increased maternal mortality and adverse birth outcomes (Martorell, et. al. 2015).

Appendix 1: Dietary survey (Spanish)

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Limitations of the research paper The major limitation of the study was funding and also geographic concentration of market and dietary surveys. However, the market survey information and food affordability is important, and also the information recorded provides a rare insight into a cross spanning dietary survey of the Mayan and indigenous populations of Nicaragua and also Hispanic and European populations in central America.

This study lays the foundation for a follow-up prospective study where intervention using dietary counselling and possibly market/ community gardens are re-introduced into the Mayan settlements.

Conclusions Withstanding the previously mentioned studies, the present study aimed to survey the diet of urbanized Mayan and Hispanic people to understand the changes in diet away from traditional consumption of maize, fruit and vegetables, and also examine any current possible nutritional deficiencies. A further macroscopic study analysing food availability, especially affordability and also variation in food types was conducted to further interpret the results of possible nutritional deficiencies and/ or excesses. Lastly, identify any stakeholders influencing nutritional status including government subsidy programs, global corporations, and the impact of introduced processed food and beverages to the diet. Recommendations include the reporting of preliminary findings to the relevant health authorities and also WHO/ FAO. A follow up intervention study with dietary counselling will be required in the future for local Mayan populations to educate them about the adverse health effects of high refined sugar consumption especially soda drinks.

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References

Al-Okbi, SY 2014, ‘Nutraceuticals of anti-inflammatory activity as complementary therapy for rheumatoid arthritis’, Toxicology & Industrial Health, 30, 8, pp. 738-749 Arps, S 2011, ‘Socioeconomic status and body size among women in Honduran Miskito communities’, Annals Of Human Biology, 38, 4, pp.

508-519 Astrup A, Raben A, Geiker N. (2015). The role of higher protein diets in weight control and obesity-related comorbidities. Int J Obes (Lond).

2015 May;39(5):721-726. doi: 10.1038/ijo.2014.216.

Azcorra H, Wilson H, Bogin B, Varela-Silva MI, Vázquez-Vázquez A, Dickinson F. (2013). Dietetic characteristics of a sample of Mayan dual burden households in Merida, Yucatan, Mexico. Arch Latinoam Nutr. 63(3):209-17.

Barcelo, A, Gregg, EW, Gerzoff, RB, Wong, R, Perez Flores, E, Ramirez-Zea, M, Cafiero, E, Altamirano, L, Ascencio Rivera, M, De Cosio, G, Dinorah De Meza, M, Del Aguila, R, Emanuel, E, Gil, E, Gough, E, Jenkins, V, Orellana, P, Palma, R, Palomo, R, & Pastora, M 2012, ‘Prevalence of Diabetes and Intermediate Hyperglycemia Among Adults From the First Multinational Study of Noncommunicable Diseases in Six Central American Countries’, Diabetes Care, vol. 35, no. 4, pp. 738-740 Bellamy AS. (2013). Banana production systems: identification of alternative systems for more sustainable production. Ambio. 42(3):33443. doi: 10.1007/s13280-012-0341-y.

Bentley ME, Caulfield LE, Ram M, Santizo MC, Hurtado E, Rivera JA, Ruel MT, Brown KH. (1997). Zinc supplementation affects the activity patterns of rural Guatemalan infants. J Nutr. 127(7):1333-8.

Bermudez OI, Toher C, Montenegro-Bethancourt G, Vossenaar M, Mathias P, Doak C, Solomons NW. (2010). Dietary intakes and food sources of fat and fatty acids in Guatemalan schoolchildren: a cross-sectional study. Nutr J. 2010 Apr 23;9:20. doi: 10.1186/1475-2891-920.

Bogin, B & Varela-Silva, I (2015). The Case of the Maya of Mexico and Central America ‘Coca-Colonization’ extracted from http://www. gresham.ac.uk/print/9663 Brimblecombe JK, O’Dea K. (2009). The role of energy cost in food choices for an Aboriginal population in northern Australia. Med J Aust.

18;190(10):549-51.

Chappell, M.J., Wittman, H., Bacon, C.M., Ferguson BG, Barrios LG, Barrios RG, Jaffee D, Lima J, Méndez VE, Morales H, Soto-Pinto L, Vandermeer J, Perfecto I. (2013). Food sovereignty: an alternative paradigm for poverty reduction and biodiversity conservation in Latin America. F1000Res. 2: 235. doi: 10.12688/f1000research.2-235.v1. eCollection 2013.

Checkley W, Ghannem H, Irazola V, Kimaiyo S, Levitt NS, Miranda JJ et. al. Management of NCD in low- and middle-income countries.

Glob Heart. 2014 Dec;9(4):431-43. doi: 10.1016/j.gheart.2014.11.003.

Chhabra, Natasha, Steve Lee, and Elias G. Sakalis. ‘Cobalamin Deficiency Causing Severe Hemolytic Anemia: A Pernicious Presentation’.

The American Journal of Medicine (2015): n. pag. Web. 5 Sept. 2015.

Cook, A, Pryer, J., Shetty, P. (2000). The problem of accuracy in dietary surveys. Analysis of the over 65 UK National Diet and Nutrition Survey. J Epidemiol Community Health 2000;54:611-616 doi:10.1136/jech.54.8.611 Cordain, L, Eaton, S, Sebastian, A, Mann, N, Lindeberg, S, Watkins, B, O’Keefe, J, & Brand-Miller, J 2005, ‘Origins and evolution of the Western diet: health implications for the 21st century’, The American Journal Of Clinical Nutrition, 81, 2, pp. 341-354.

Crespin SJ, García-Villalta JE. (2014). Integration of land-sharing and land-sparing conservation strategies through regional networking: the Mesoamerican Biological Corridor as a lifeline for carnivores in El Salvador. Ambio. 43(6), 820-4. doi: 10.1007/s13280-013-0470-y.

Epub 2013 Dec 28.

Dewey KG, Romero-Abal ME, Quan de Serrano J, Bulux J, Peerson JM, Engle P, Fletcher, R, & Fairfield, K 2002, ‘Vitamins for Chronic Disease Prevention in Adults: Clinical Applications’, JAMA: Journal Of The American Medical Association, 287, 23, p. 3127.

Franceschi, F., Genta, R. M. & Sepulveda, A. R. Gastric mucosa: long-term outcome after cure of Helicobacter pylori infection. J. Gastroenterol. 37 (Suppl. 13), 17–23 (2002).

Fratoni V, Brandi ML. (2015). B vitamins, homocysteine and bone health. Nutrients. 7(4):2176-92. doi: 10.3390/nu7042176.

Frojo GA, Rogers NG, Mazariegos M, Keenan J, Jolly P. (2014). Relationship between the nutritional status of breastfeeding Mayan mothers and their infants in Guatemala. Matern Child Nutr. 10(2):245-52. doi: 10.1111/j.1740-8709.2012.00404.x.

Ganguly, P, & Alam, S 2015, ‘Role of homocysteine in the development of cardiovascular disease’, Nutrition Journal, 14, p. 6.

Gopinath, B, Flood, VM, Rochtchina, E, Wang, JJ, & Mitchell, P 2013, ‘Homocysteine, folate, vitamin B-12, and 10-y incidence of agerelated macular degeneration’, The American Journal Of Clinical Nutrition, vol. 98, no. 1, pp. 129-135 Hurley, J, & Eschedor Voelker, T 2014, ‘Conflict in the Early Americas: An Encyclopedia of the Spanish Empire’s Aztec, Incan, and Mayan Conquests’, Reference & User Services Quarterly, 53, 3, p. 274.

Iannotti, L. L. et al. ‘Food Prices And Poverty Negatively Affect Micronutrient Intakes In Guatemala’. Journal of Nutrition 142.8 (2012): 1568-1576. Web. 8 Sept. 2015.

Innis, SM 2014, ‘Omega-3 Fatty Acid Biochemistry: Perspectives from Human Nutrition’, Military Medicine, pp. 82-87 Jackson, SE 2014, ‘Domestication and Liberation: How We Relate to Our Data, and What It Means for Understanding the Maya’, Reviews In Anthropology, 43, 2, pp. 111-134.

Kain, Juliana, Fernando Vio, and Cecilia Albala. ‘Obesity Trends And Determinant Factors In Latin America’. Cadernos de Saúde Pública 19 (2003): S77-S86. Web. 8 Sept. 2015.

Krebs NF, Mazariegos M, Chomba E, Sami N, Pasha O, Tshefu A, Carlo WA, Goldenberg RL, Bose CL, Wright LL, Koso-Thomas M, Goco N, Kindem M, McClure EM, Westcott J, Garces A, Lokangaka A, Manasyan A, Imenda E, Hartwell TD, Hambidge KM. Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings.

Am J Clin Nutr. 2012, 96(4):840-7.

Note: Additional references listed. Contact ANTA

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Myofascial Release, Deep Tissue Massage, Anatomy, Trail Guide to the Body, Neuromuscular Therapy, Anatomy Trains,Fascial Fitness,Orthopedic Massage Positional Release, Fibromyalgia, Craniosacral, BodyReading, Stretching, Sports Massage, Taping, Lymphatic Drainage, Muscle Energy Techniques, Chair Massage,Pregnancy Massage,Stone Massage, Reiki, Polarity Therapy, Lomi Lomi, Equine, Canine, Ayurvedic, Shirodara, Shiatsu, Acupressure, Thai Massage, TuiNa,QiGong, Tai Chi, Reflexology, Cupping, Yoga, and more

Practice in The Perfect Location

Feel Good Health, Nobby Beach/Mermaid, QLD This successful, established Naturopathic practice and busy retail dispensary is located on the busy shopping and café strip at Nobby Beach on the Gold Coast. Hailed as the newest “it” suburb for the health and leisure conscious, this practice has seen significant client and profit growth over the past 18 months.

The business enjoys an extensive loyal and regular customer base, walk-ins and referrals from the local tourist accommodation as well as script fulfilment from other health practitioners. There is a Consultation room, retail health products and the dispensary stocks all “practitioner only” brands and over 190 liquid herbs.

This is an ideal opportunity for the new owners to take this well respected business to the next level.

Price on application + Stock at value

Telephone Sue or Carla on: (07) 5526 0224 Email: feelgood_health@yahoo.com.au www.feelgoodhealth.net.au

Visit www.terrarosa.com.au E: terrarosa@gmail.com

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