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Advanced Clinical Naturopathic Medicine Leah Hechtman
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6 The microbiome
Overview
The dermatological microbiota
The nasopharyngeal microbiota
The oral microbiota
The breastmilk microbiota
The vaginal microbiota
The gastrointestinal microbiota
References
7 Methylation
Introduction
Developmental and evolutionary origins
Chemistry and biochemistry of the methyl group
Revision of key biochemical structures
Revision of basic molecular biology
Methylation and mitochondria
Transcription and translation
Protein synthesis
Protein methylation and post-translational modification
Epigenetics, methylation and gene expression
Metabolic pathways
Altered methylation patterns: hypomethylation and hypermethylation
Beyond genetics: methylation and our broader physiology
Key nutrients
Methylation deficits and associated conditions
Special topics
Laboratory assessment of methylation
Therapeutics and prescriptions
References
8 Genetics and epigenetics
The ‘omics’ revolution
Regulation of genetic screening
Introduction to DNA and gene expression
The role of genetic testing in healthcare
Putting it all together
References
9 Mind–body medicine
Introduction
Biomedicine
Mind–body medicine
Mind–body therapeutics
References
10 Sports naturopathy
Introduction
Exercise physiology
Energy requirements
Carbohydrates
Protein
Fats
Fuelling for training and recovery
Hydration and dehydration
Fuelling for competitions and race day
Drugs in sport
Evidence-based supplements
Working with sports clients
References
11 Fertility – Female and male
Epidemiology
Classification
References
Appendix 11.1 Fertility chart
Appendix 11.2 Timeline of embryonic development
Appendix 11.3 hCG interpretation
Appendix 11.4 General IVF protocol
Appendix 11.5 WHO criteria – semen analysis
Appendix 11.6 WHO Guidelines for Semen Analysis (2010, 5th edition)
12 Miscarriage
Overview and definition
Statistics
Risk of miscarriage by number of weeks of gestation of pregnancy
Risk of miscarriage by maternal age
Fetal heart rate as miscarriage risk determinant
Aetiology of miscarriages
Treatment approaches
Therapeutic rationale for botanical medicines
Nutritional medicine (dietary)
Therapeutic rationale for nutritional medicines
References
13 Pregnancy and labour
Introduction
Epidemiology
Models of antenatal care
The role of the naturopath
Modes of delivery
Emotional and psychological wellbeing
Epigenetics and the origins of disease
Safety issues in pregnancy
Nutritional assessment
Weight in pregnancy
Nutritional Medicine – Dietary
Nutritional Medicine – Supplementation
Trimester 1
Trimester 2
Third trimester
Labour and childbirth
Fourth trimester: the postnatal period
The pregnancy care plan
References
Appendix 13.1 Tools to assess NVP
Appendix 13.2 Edinburgh Postnatal Depression Scale (EPDS)
14 Breastfeeding
Introduction
The World Health Organization recommendations for breastfeeding
Historical context
Breastfeeding: barriers and enablers
Working with new mothers – the role of the naturopath
Functions of breastfeeding
Nutritional considerations for the breastfeeding mother
The breast milk microbiome
Anatomy and physiology of lactation
Breastfeeding initiation
Breastfeeding support
Common breastfeeding challenges
Medications/drugs and breastfeeding
Breastfeeding and HIV
Maternal infant sleep and breastfeeding
Conclusion
References
15 Infancy
Introduction
Good referral practice
The fourth trimester: the newborn 0–3 months
Arrival
Growth and development
Shaping the early intestinal microbiota
Infant gastrointestinal development
Nutritional requirements 0–12 months
Introduction of solids
Naturopathic management of common infantile presentations
Common infantile presentations
References
16
Paediatrics and adolescence
Introduction
Dosage calculations
Growth and developmental nutrition – 12–36 months – the toddler
Nutritional requirements – 12–36 months – the toddler
Growth and developmental nutrition – middle childhood – 36 months–10 years
Nutritional requirements – middle childhood – 36 months–10 years
Growth and developmental nutrition – adolescence – 10 years and older
Nutritional requirements – adolescence – 10 years and older
Specific conditions
Environmental chemicals and paediatric and adolescent health
References
Appendix 16.1 Dietary planning
Appendix 16.2 Essential oils
17 Geriatrics
Introduction
Epidemiology
Ageing
Assessment
Geriatric syndromes
Pharmacokinetics, polypharmacy and posology
Diet and nutritional issues
References
18 Autism spectrum disorder (ASD)
Epidemiology
Overview
Classification
Contributing factors
Diagnosis
The biomedical approach to autism and ASD
Attention deficit (hyperactivity) disorder – AD(H)D
References
19 Down syndrome
Introduction
Prenatal diagnosis
Diagnosis at birth: impact on parents
Improving cognitive potential through enhanced pregnancy care
Family
Infant care
Childhood–school-age years
Adolescence
Adulthood
End-of-life care
Specific health concerns
Therapeutic considerations
Therapeutic application
References
Appendix 19.1 Sexual health resources for parents, carers and health professionals working with people with Down syndrome and other learning disabilities
Appendix 19.2 Sexual health resources for people with Down syndrome and other learning disabilities, with the support of carers or family members
Appendix 19.3 Plymouth dementia screening checklist
20 The endocannabinoid system and cannabis
Introduction
Evolution of the endocannabinoid system
Anatomy of the endocannabinoid system
Physiology of the endocannabinoid system
The ECS and clinical challenges
The genus Cannabis
References
21 Cancer – Advanced I
Cancer pathogenesis and treatment
Scope of practice for the natural healthcare provider
Case studies of most common types of cancer to highlight approach
References
22 Cancer – Advanced II
Part A
Part B
References
23 HIV (human immunodeficiency virus)
HIV statistics (World Health Organization [WHO] HIV/AIDS statistics and data)
AIDS statistics,
Classification
AIDS definition
Aetiology
HIV overview
Differential diagnosis
Naturopathic diagnosis
Monitoring the patient
Specific naturopathic investigations
Historical perspective
Naturopathic perspective
Stages of treatment
Nutritional medicine (dietary)
Nutritional medicine (supplemental)
Herbal medicine
Lifestyle recommendations
References
24 Lyme disease and co-infections
Introduction
Broadening the definition of Lyme disease
Stages of Lyme disease
Epidemiology of Lyme disease
How is Lyme transmitted?
Signs and symptoms of Lyme disease
Testing for Lyme disease
Treatment of Lyme disease
Naturopathic approaches to Lyme disease and co-infections
Conclusion
References
Index
Interactions table
Herb/nutrient–drug interactions tables
References
Copyright
Elsevier Australia. ACN 001 002 357
(a division of Reed International Books Australia Pty Ltd)
Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067
Copyright 2020 Elsevier Australia.
All rights reserved. No part of this publication may be reproduced or transmi ed in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
ISBN: 978-0-7295-4265-4
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in
particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a ma er of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
Acknowledgments
It is with much gratitude that we birth Advanced Clinical Naturopathic Medicine (ACNM). ACNM was developed from a yearning to contribute more deeply to the naturopathic body of work, to support the development of the evolving profession and to guide clinicians and students through complicated areas of expertise and specialisation. ACNM brings together a team of true experts to achieve this vision.
As with CNM, a book of this depth requires the commitment and dedication of a number of individuals, and I am again deeply grateful to and humbled by those I have been privileged to work with to achieve this collaborative goal.
In order of their contribution, my appreciation to Natalie Cook, Nicole Bijlsma, Dr Joseph Pizzorno, Dr John Nowicki, Dr Kate Broderick, Dr Jason Hawrelak, Dr Joanna Harne , Annalies Corse, Dr Rhona Creegan, Dr Margaret Smith, Dr Brad Lichtenstein, Kira Sutherland, Angela Hywood, Jane Hutchens, Dawn Whi en, Tabitha McIntosh, Helen Padarin, Belinda Robson, Justin Sinclair, Dr Janet Schloss, Manuela Boyle, Teresa Mitchell-Pa erson and Dr Nicola McFadzean Ducharme. A special note of gratitude goes to Liesl Blo for her contribution of each of the interaction tables for each chapter; as well as Lisa Costa Bir for the dietary plans for each condition. It has been an honour to include your contributions, learn from you and understand your knowledge and expertise more deeply.
Additionally, my heartfelt thanks to Dr Sue Evans for writing the Foreword of this text. For this volume, I was intent on ensuring a balance of the sexes and ideally wanted someone Australian who I perceive as a wise elder, firmly rooted in the history and tradition of
p y y our treatments and philosophies and connected to and practising our evolving practice. Sue, you embody all of these admirable a ributes and your humble wisdom shines through as always. Thank you.
My sincere appreciation to the wonderful team at Elsevier. The integrity of those involved was highly evident and I am most appreciative of their respective kindness, commitment and dedication to producing the best possible text. Much gratitude to Larissa Norrie, Vanessa Ridehalgh, Shruti Raj, Katie Millar and others.
Thank you to Cheryl le Roux for your dedication and commitment to the project as my research assistant. Your ongoing enthusiasm, kindness and ethical core strove to ensure we produced the most accurate and thorough work. I am blessed to be able to work with you. Many thanks for pu ing up with my perpetual enquiring mind.
To my colleagues at UNSW, it is from my connections with you all that I am able to critically assess and contribute meaningfully in an academic context. You have supported me to seek and find answers to my enquiries which consistently provide foundational platforms with which to expand as a clinician and educator. Learning, growth and contribution are some of my core values, and my gratitude for these opportunities that you bestow on me are heartfelt and celebrated. Thank you.
To my fellow colleagues clinically and academically, lecturers past and present, mentors and friends, I am blessed to have connected with incredible people who challenge, inspire and guide me so that we can all contribute more meaningfully and help others.
A special thank you to my family, friends and spiritual family. Your love, compassion and kindness enrich and support me to be of greater service and contribution.
Finally, my gratitude to my patients – past, present and future. It is the relationships I share with my patients, their stories, journeys and experiences that drive me to seek out answers to understand
and to provide help and support. Without these heartfelt experiences, I would not be as moved or determined to push, to search, to seek and to find how I can help. When your heart is touched and a connection felt, it is the humility of the experience that opens up the universe to you to find answers. I am deeply grateful for each person I am privileged to treat.
Preface
The release of Advanced Clinical Naturopathic Medicine (ACNM) is a hallmark achievement supporting the evolving practice of the profession. No longer limited to merely general practice, clinicians have broadened and expanded into specialty practices. This shift in our treatment has seen more specific courses and sub-practices develop, with clinicians narrowing their focus to key areas of expertise.
That the contributors in ACNM are experts in their fields is evident. All have completed advanced training and have years of clinical experience and a deep love of their specialty areas. The chapters showcase the many diverse pathways within the profession and highlight both the opportunities for aspiring clinicians as well as the depth of practice required to truly excel in these specialty areas of expertise.
Each contributor elevates their knowledge. All aspects of their careers aptly highlight the commitment and dedication required to perfect and hone their craft.
ACNM offers both new and experienced clinicians, educators and researchers an opportunity to dive into the hearts and minds of these leaders. It showcases how truly transformative and effective naturopathy is and offers insight into the depth of our practice.
As with Clinical Naturopathic Medicine, the publishing of this text is an opportunity for the profession to reclaim and celebrate our vital role in the healthcare system. Our system of healing is unique and relevant; our treatments efficacious and therapeutic; our methodology and outcomes logical and supportive.
I hope this text provides assurance for clinicians and gives them confidence to take on more responsibility and be more active in the
welfare of their patients’ wellbeing; certainty to be more forthright and transparent with treatment strategies, methodologies and approaches; and determination to consistently strive for excellence and have the patient's best interests at heart.
Naturopathic core principles guide our intentions, with patientcentred care as the primary principle. Our elders always focused on the importance of the inter-relationship between clinician, patient and nature.
My hope is that ACNM provides the platform with which to seek answers and formulate the best care possible.
Leah Hechtman
March 2020
