C • O N T E N T S - Clint Publications€¦ · NutriClear® Plus 15-Day Metabolic Cleanse Program NutriClear® Plus is a science-based metabolic cleanse program that supports the

C • O • N • T • E • N • T • S

VOL. 25, NO. 4 · ISSN 1529-4722 · DECEMBER 2018

CLINT PUBLICATIONS

CALENDAR OF EVENTS .............................................................................. 98

FROM THE EDITOR’S DESK ................................................................... 101 Virginia Kessinger

THE LEGACY CONTINUES ...................................................................... 103 A. Jay Kessinger IV, DC, ND, DABCI, DACBN

AVOIDING BOTANICAL MEDICINE IN INTEGRATIVE ONCOLOGY .................................................................... 105

Wayne Sodano, DC, DABCI, DACBN, BCTN

UNHEALTHY? MAYBE IT’S YOUR BIOME! ........................................... 109 Jason Nardi, DC, DABCI

THOUGHTS AT LARGE: CONTROVERSIES IN CLINICAL NUTRITION STILL ANOTHER UNDERAPPRECIATED SUPPLEMENT– DHA ....................... 113

Jeffrey Moss, DDS, CNS, DACBN

INTERMITTENT FASTING ON THE KETOGENIC DIET ................... 117 Robert G. Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC

DIETARY SUPPLEMENTS FOR OSTEOARTHRITIS AS AN ALTERNATIVE TO NSAIDS ...................................................................... 121

Adrian Isaza, DC, DACBN, CCAP

BARIUM AND HEALTH .............................................................................. 124 Eleonore Blaurock-Busch, PhD

A NATURAL APPROACH TO MANAGE ELEVATED BLOOD LIPIDS: A PILOT STUDY ............................................................. 127

Thomas Hobbs, MD, DC, PhD, ND, RND, DABCI, DACBN, ABDA, PScD

A PROBIOTIC LOZENGE TO SUPPORT OTOLARYNGOLOGIC HEALTH .............................................................. 129

Rachel Olivier, MS, ND, PhD

DABCIs AND WHERE THEY ARE ............................................................ 138

Original Internist T H E

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THE ORIGINAL INTERNIST

Research Editors

Philip A. Arnone, DC, DABCI Debasis Bagchi, PhD, FACN Paul Basile, DC Scott Bautch, DC, SC, DACBOH Eleonore Blaurock-Busch, PhD Cindy Howard, DC, DABCI Robert C. Kessinger, DC, DABCI, DACBN Darren Kirchner, DC, ND, DABCI Charlyn Marcusen, PhD Duane Marquart, DC, DACBR Edward W. McDonagh, DO Christopher Murray, DC, DABCI Doran Nicholson, DC, DACBR Harry G. Preuss, MD, FACN, CNS Timothy Ray, DC, FACO, CCSP, CSCS Delilah A. Renegar, DC, MS, DACBN, DABCI Sidney Stohs, PhD, FACN, FATS, FASAHP Jon A. Sunderlage, DC, Dipl Ac (NCAOM) Jeremy Thornton, DC, DABCI, DCBCN Sharon A. Vallone, DC, DICCP David Wickes, DC, DABCI T. J. Williams, DC, PhD, DABCI Jonathan V. Wright, MD

Editor-in-Chief

Virginia Kessinger Managing Editor

A. Jay Kessinger IV, DC, ND, DABCI, DACBN Production Manager

Virginia Kessinger Director of Advertising & Marketing

Carrie Camenisch Editorial Staff

Tara Arick Katrina Werline

Clint Publications 720 Oak Knoll Rolla, MO 65401 Telephone: (573) 341-8448 Fax: (573) 341-8494 E-mail: [email protected] www.clintpublications.com The Original Internist is published quarterly. Publication months are March, June, September and December, barring any unusual or unforeseen circumstances. News items and/or letters pertaining to natural health care are welcome. The editorial staff reserves the right to edit and/or reject all material received. Letters to the editor may be condensed in order to fit the allotted space. An address and telephone number where the author may be reached during normal business hours should also be included for verification purposes. Deadline for article submission is the 5th of the month preceding publication. SUBSCRIPTION & ADDRESS CHANGES A subscription to The Original Internist is $50. A free one-year subscription will be given to anyone who submits a case study or scientific article which is accepted for publi-cation. (This does not include letters to the editor.) Please notify Clint Publications if you change your address or office name, or we cannot be responsible for proper de-livery of your journal. ADVERTISING Advertising deadline is the 5th of the month preceding pub-lication. For advertising rates or information, contact Clint Publications. DISCLAIMER The opinions expressed in The Original Internist are pre-sented for the purpose of providing an open forum for unbi-ased case studies, contemporary ideas and discussion of matters relevant to natural health care. Its primary mission is to educate and inform those especially interested in pro-moting natural health care as a primary treatment. The opinions expressed in The Original Internist do not neces-sarily reflect the opinions and policies of Clint Publica-tions or The Original Internist.

THE ORIGINAL INTERNIST DECEMBER 2018 97

CALENDAR OF EVENTS FOR ALL DABCI SEMINARS ……. VISIT OUR WEBSITE ……. www.ProHealthSeminars.com

December 1-2, 2018 St. Louis, MO 1011 Pharmacognosy - Utilizing Botanicals in a Functional Practice Dr. Delilah Renegar December 8-9, 2018 Kansas City, MO 1026 Review of Systems, History and Physical Exam Dr. Robert Kessinger December 15-16, 2018 Orlando, FL 1008 Blood Interpretation Workshop Dr. Bill Kleber January 5-6, 2019 St. Louis, MO 1008 Differential Diagnosis Interpretation Workshop Dr. Robert Kessinger Not Available Online January 11-13, 2019 24 hrs Orlando, FL 1010,1021 Diagnostics of the Cardio-Pulmonary System Dr. Kleber January 12-13, 2019 Chicago, IL 1006 Natural Strategies in Laboratory Testing Dr. Cindy Howard January 18-20, 2019 24 hrs Charlotte, NC 1010, 1021 EKG and Diagnostic Training for Cardio-Respiratory Disorders Workshop Dr. Delilah Renegar January 25-27, 2019 24 hrs Berthoud, CO 1016, 1008 Diagnosis and Detoxification of Hepatic Renal, Blood Interpretation Workshop Dr. Bill Kleber & Dr. Bret Wisniewski February 2-3, 2019 St. Louis, MO 1007 Additional Blood tests and Tumor Markers with Homeostatic Values Dr. Robert Kessinger February 2-3, 2019 24 hrs Chicago, IL 1024-06 Gastrointestinal Health and Protocols Dr. Cindy Howard & Dr. Delilah Renegar February 8-10, 2019 24 hrs Orlando, FL 1004-5 Pelvic Classroom and Workshop Dr. Jordan & Dr. Kleber February 22-24, 2019 Berthoud, CO 1027A Endocrinology - Functional Approach, Disorders, Thyroid, Adrenal, Hormones Dr. Kleber Dr. Lundell Dr. Wisniewski March 2-3, 2019 St. Louis, MO 1016 Detoxification and Diagnosis of Hepatic and Renal Systems Dr. TJ Williams

March 15-17, 2019 24 hrs Orlando, FL 1027B, 1015 Advanced Endocrinology and Mental Health Dr. Lundell & Dr. Wisniewski March 16-17, 2019 Chicago, IL 1017-18 Alleriges, Sensitivities, & Autoimmune Dr. TJ Williams March 22-24, 2019 Berthoud, CO 1011 Pharmacognosy and Pharma Reactions Dr. Roy Settergren April 6-7, 2019 St. Louis, MO 1029 Infectious Disease and Emergency Disorders in a Functional Practice Dr. Robert Kessinger April 6-7, 2019 Orlando, FL 1030 Dermatology Dr. Jeurink April 26-28, 2019 24 hrs Berthoud, CO 1004, 1005 Pelvic Classroom and Workshop Dr. Michelle Jourdan & Dr. Bill Kleber April 27-28, 2019 Chicago, IL 1009 Cardiovascular Disease Dr. Delilah Renegar May 4-5, 2019 St. Louis, MO 1010 EKG Interpreting EKG-ECG Dr. Delilah Renegar Not Available Online May 4-5, 2019 Chicago, IL 1009 Endocrinology Clinical Application Dr. TJ Williams May 4-5, 2019 Orlando, FL 1013 Pediatrics Dr. Kleber

SAVE THE DATES March 8-10, 2019 Nashville, TN CDID Symposium/Getaway Science, Research, and Effective Treatment of Obesity April 11-14, 2019 Santa Fe, NM ACA Council on Nutrition Influencing the HPA Axis

THE ORIGINAL INTERNIST Spring 2006 05 98 THE ORIGINAL INTERNIST DECEMBER 2018

ProHealth SeminarsThe Leader in Integrative Health Care Education

ProHealth SeminarsProHealth SeminarsProHealth SeminarsThe Leader in Integrative Health Care Education

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PROHEALTH SEMINARS — the leader in chiropractic continuing education IS BRINGING THE DABCI PROGRAM TO A CITY NEAR YOU IN 2019.In this world-class chiropractic continuing education program, you will learn how to build a unique practice by gaining the current, evidence based, knowledge in functional medicine and laboratory testing.

TWO LOCATIONS WILL BE ADDED TO OUR2019 SCHEDULE BASED ON YOUR VOTE.

12 CE HOURS PER SESSION EMAIL: [email protected]: (573) 341-8448

RSVP WITH YOUR VOTE!

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TULSA, OK LOS ANGELES, CA

HARTFORD, CT MADISON, WI

OTHER:

for the

573-341-8448 [email protected] [email protected]

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For a List of Topics go to www.ProHealthSeminars.com

Visit our Website for Live Stream Dates St Louis Only www.ProHealthSeminars.com

DABCI Program Locations: *Most St. Louis dates are available as “Live Stream”

Online CEUS are not available in all states.

Live Stream* Seminars

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300 HOUR DABCI DIPLOMATE PROGRAM (WEEKENDS 1-26)

100 HOUR CERTIFICATE Of COMPLETION Weekends 1-9

Visit our website www.ProHealthSeminars.com

Live Stream available from St. Louis!

Charlotte, NC Kansas City, MO Chicago, IL

Orlando, FL Berthoud, CO St. Louis, MO - Live and Online

Weekend ID # Topics 1 1001 Foundations of Chiropractic Family Practice - Must Attend in Person for DABCI* 2 1002-03 Patient Consultation and Evaluation 3 1006 Natural Strategies in Laboratory Testing 4 1024-25 Gastrointestinal Health and Protocols for a Healthy Gut 5 1017-18 Allergies, Sensitivities and Autoimmune Response 6 1009 Cardiovascular Disease 7 1027A Endocrinology Clinical Application 8 1011 Pharmacognosy - Utilizing Botanicals in a Functional Practice 9 1008 Differential Diagnosis Interpretation Workshop - Not Available LiveStream

10 1007 Additional Blood tests and Tumor Markers

11 1016 Detoxification and Diagnosis of Hepatic and Renal Systems

12 1029 Infectious Disease, Emergency Disorders

13 1010 EKG - Must Attend in Person for DABCI 300 Hours* 14 1019-20 Common Diseases Affecting the Arterial System 15 1014 Pulmonary Disease & Lung Function 16 1021 Diagnostic Training Cardio-Respiratory Disorders - Not Available LiveStream 17 1015 Geriatrics and Mental Health 18 1013 Pediatrics 19 1030 Dermatology 20 1028 Pharma Reactions 21 1027B Advanced Endocrinology 22 1022 Neoplastic Disease and Cancer I 23 1023 Neoplastic Disease & Cancer II 24 1004 Male and Female Pelvic Classroom 25 1005 Male and Female Pelvic Workshop* - Must Attend in Person at NUHS 26 1026 Review of Systems, History and Physical Exam - Not Available LiveStream

Live Stream

573-341-8448 DABCI


100 HOUR CERTIFICATE Of COMPLETION Weekends 1-9

Visit our website www.ProHealthSeminars.com

Live Stream available from St. Louis!

Charlotte, NC Kansas City, MO Chicago, IL

Orlando, FL Berthoud, CO St. Louis, MO - Live and Online

Weekend ID # Topics 1 1001 Foundations of Chiropractic Family Practice - Must Attend in Person for DABCI* 2 1002-03 Patient Consultation and Evaluation 3 1006 Natural Strategies in Laboratory Testing 4 1024-25 Gastrointestinal Health and Protocols for a Healthy Gut 5 1017-18 Allergies, Sensitivities and Autoimmune Response 6 1009 Cardiovascular Disease 7 1027A Endocrinology Clinical Application 8 1011 Pharmacognosy - Utilizing Botanicals in a Functional Practice 9 1008 Differential Diagnosis Interpretation Workshop - Not Available LiveStream

10 1007 Additional Blood tests and Tumor Markers

11 1016 Detoxification and Diagnosis of Hepatic and Renal Systems

12 1029 Infectious Disease, Emergency Disorders

13 1010 EKG - Must Attend in Person for DABCI 300 Hours* 14 1019-20 Common Diseases Affecting the Arterial System 15 1014 Pulmonary Disease & Lung Function 16 1021 Diagnostic Training Cardio-Respiratory Disorders - Not Available LiveStream 17 1015 Geriatrics and Mental Health 18 1013 Pediatrics 19 1030 Dermatology 20 1028 Pharma Reactions 21 1027B Advanced Endocrinology 22 1022 Neoplastic Disease and Cancer I 23 1023 Neoplastic Disease & Cancer II 24 1004 Male and Female Pelvic Classroom 25 1005 Male and Female Pelvic Workshop* - Must Attend in Person at NUHS 26 1026 Review of Systems, History and Physical Exam - Not Available LiveStream

Live Stream

Chicago, ILOrlando, FL

Berthoud, COSt. Louis, MO - Live and Online

Another year is coming to an end. The flu season has been a big headline again. Now we have a new crisis looming. Small children are being afflicted with unexplained “polio like symptoms”. A curious virus is being suspected as the culprit. This sent chills up my spine since, many years ago, my 12-year old brother was one of the unfortunate few who had polio. He lived within an iron lung, paralyzed and unable to breathe on his own. That was in the late 40’s era, pre-polio vaccine discovery. He lived to be in his 50’s, but was always confined to a wheelchair, only able to move his fingers and toes. He controlled the movements of his head, learning to oil paint with a brush in his mouth. My brother had the best of medical care. At 14 he was selected to enter the Shriner’s Hospital in Salt Lake City for extensive study and surgeries to help him become more self sufficient. They selected to shorten the muscles and tendons in his arms so, aided by slings, he would be able to swing his arms in a circular motion. This was to help him be able to feed himself. I was 13 at the time and my curious mind wondered if this was a great solution to a horrible problem. Being an eternal optimist, I prayed that somehow a miracle would happen and he would be able to walk right out of that wheelchair! Common sense told me that now his ability to be well had been compromised greatly by this drastic surgical procedure. When I was 15, I met my future husband, Dr. Jack Kessinger, in high school. He had a story that shook me to the core. The same year my brother came down with polio, he was having challenges also. He told me about being sick that summer, feeling lethargic for several days. Then one day he could not get out of bed.

He was paralyzed. His father was the local chiro-practor. He told me how his Dad treated him between every patient. Within a couple of weeks he began to regain his strength and could feel his limbs. I will always believe he had polio! Jack told me how he spent the entire summer re-cooping, learning how to walk normal again and building his strength. His only residual sympton from his illness was a bit of paralysis in the throat, if he tried to swallow too large of a bite of food. That symptom followed him throughout his life. When I look back on these two parallels I cannot help but wonder how different my brother’s life might have been if the approach to his care had been less invasive?? However…. The iron lung did save his life during his initial medical emergency. Today, one of our staff came in devastated over news that her five-year-old son needed immediate surgery for a dental problem. He was seen yesterday by a local dentist for a tooth ache in one of his front “baby teeth.” That tooth was determined to be fine but the dentist told her that the x-rays showed a dire problem with all his back teeth. Every one of them showed cavities so the dentist made an appointment at the hospital for her to take him there for a procedure to fix the problem. The doctor tells my staff that her son will need to be under anesthesia so they can grind all of his teeth down and crown them. The surgery was scheduled for tomorrow!! Whoa, I said. What about a second opinion? I convinced her that her son’s teeth were not going to fall out in the next 30 days and that she has time to do some research and go for other opinions and options. I am totally in favor of options. When the general public is told, by a doctor, they have to follow a procedure or protocol, more times than not, they are going to follow that direction. It is a sad state of affairs when the advice given by a professional is different than they would give to their immediate family and loved ones. I hate to question ethics but sometime I wonder if more surgeries could be avoided, less prescriptions could be written and quality time could be spent per patient to get to the root of their problems. Then I wonder why some think we are born with a deficiency of drugs and too many parts?? This was one of my favorite lines from the memories of Dr. Jack Kessinger.

From the Editor’s Desk by: Virginia Kessinger


573-341-8448 DABCI ST. LOUIS, MO


*Every attempt is made to offer these seminars as publicized; however, we reserve the right to adjust seminar locations, dates, times, etc. due to circumstances beyond our control. Program continuation is contingent upon adequate attendance. No audio or video tape recorders are allowed, and no portion of the seminar may be reproduced in any manner without expressed written consent. Pre-registration is required. Pro Health Seminars shall not be held responsible for any expenses incurred by registrar if a program must be altered and/or cancelled. Seminar fee is non-refundable. Credit cards will not be billed until we have the minimum number of attendees (20). If the Doctor is unable to attend after pre-registering and payment has been received, the seminar fee will be transferred to another Seminar (attended within 12 months of the original seminar) for an administration fee of $25. Any seminar fee not transferred and used within 12 months will be forfeited.

Weekend Dates ID # Topics Instructor 1 April 7-8, 2018 1001 Foundations of Chiropractic Family Practice - Must Attend in Person for DABCI* Dr. Robert Kessinger 2 June 2-3, 2018 1002-03 Patient Consultation and Evaluation for a Functional Medicine Patient Dr. Robert Kessinger 3 July 7-8, 2018 1006 Natural Strategies in Laboratory Testing with Homeostatic Lab Valies Dr. Robert Kessinger 4 August 4-5, 2018 1024-25 Gastrointestinal Health and Protocols for a Healthy Gut Dr. Delilah Renegar 5 September 8-9, 2018 1017-18 Allergies, Sensitivities and Autoimmune Response Dr. Robert Kessinger 6 October 6-7, 2018 1009 Cardiovascular Disease - Diagnosis and Prevention Dr. TJ Williams 7 November 3-4, 2018 1027A Endocrinology - Functional Approach, Disorder, Thyroid, Adrenal, Hormones Dr. Robert Kessinger 8 December 1-2, 2018 1011 Pharmacognosy - Utilizing Botanicals in a Functional Practice Dr. Delilah Renegar 9 January 5-6, 2019 1008 Differential Diagnosis Interpretation Workshop - Not Available Online Dr. Robert Kessinger

10 February 2-3, 2019 1007 Additional Blood tests and Tumor Markers with Homeostatic Lab Values Dr. Robert Kessinger 11 March 2-3, 2019 1016 Detoxification and Diagnosis of Hepatic and Renal Systems Dr. TJ Williams

12 April 6-7, 2019 1029 Infectious Disease, Emergency Disorders in a Functional Practice Dr. Robert Kessinger

13 May 4-5, 2019 1010 EKG Interpreting EKG-ECG - Must Attend in Person for DABCI 300 Hours* Dr. Delilah Renegar 14 June 1-2, 2019 1019-20 Common Diseases Affecting the Arterial System Dr. Robert Kessinger 15 July 13-14, 2019 1014 Pulmonary Disease & Lung Function - Diagnosis and Prevention Dr. Chris Murray 16 August 3-4, 2019 1021 Diagnostic Training for Cardio-Respiratory Disorders - Not Available Online Dr. Delilah Renegar 17 September 7-8, 2019 1015 Geriatrics and Mental Health Dr. Robert Kessinger 18 October 5-6, 2019 1013 Pediatrics - Functional Lab Values & Approaches to Children’s Health Dr. Delilah Renegar 19 November 2-3, 2019 1030 Dermatology - An Internists Guide to Skin Conditions Dr. Tobi Jeurink 20 December 7-8, 2019 1028 Pharma Reactions - Nutritional Supplements and Pharma Dr. Roy Settergren 21 January 4-5, 2020 1027B Advanced Endocrinology Dr. Robert Kessinger 22 February 1-2, 2020 1022 Neoplastic Disease & Cancer I Dr. Robert Kessinger 23 April 4-5, 2020 1023 Neoplastic Disease & Cancer II Dr. TJ Williams 24 May 2-3, 2020 1004 Male and Female Pelvic Classroom Dr. Cindy Howard 25 June 6-7, 2020 1005 Male and Female Pelvic Workshop** - Must Attend in Person at NUHS Dr. Cindy Howard 26 July 11-12, 2020 1026 Review of Systems, History and Physical Exam - Not Available Online Dr. Robert Kessinger

Location:

Hilton St Louis Airport 10330 Natural Bridge Road St. Louis, MO 63134 314-426-5500 Special Room Rates: Ask for Chiropractic Family Practice

Hours: 12 Hour Weekends Saturday 9:00 am to 6:00 pm Sunday 9:00 am to 1:00 pm

**For NUHS Campus Weekend, contact Dr. Cindy Howard 708-479-0020

Special Pricing Applies Due to Live Models

Send Registration to: ProHealth Seminars 720 Oak Knoll Road Rolla, MO 65401

Phone: (573) 341-8448 Fax: (573) 341-8494 [email protected] or [email protected]

Registration Information: $395 per Weekend* if received 10 days prior to seminar $425 per Weekend* Less than 10 days out, or at the door Chiropractic Students* $199 DABCI Doctors* $250

100 HOUR CERTIFICATE Of COMPLETION

The Legacy Continues

by: A. Jay Kessinger IV, DC, ND, DABCI

Grandad told me that when you understand the mechanics of anything, you’ll have the basic under-standing of how to fix it. As a chiropractor I’m enabled to diagnose and see how intersegmental articular bio-mechanics of the human body in general, and in the spinal column in particular, effect the functionability and level of health each patient enjoys. I have an intimate knowledge of (and experience with) the improvement in mental and physical health via specific manual adjusting of intersegmental/congruent articulations in the restoration of normal mobility and function. As a chiropractic internist I’ve learned how to more accurately keep score of the physiological level of health each patient I have the privilege to serve. I use this knowledge in the determination of which treatment protocol is the most advantageous, and to more effect-ively communicate it. Biomechanical aberration, resultant of one spinal level being more important for survival’s sake, effects another level which effects another, ad nauseum. It is because of this physiological phenomenon that it behooves us to look at the overall picture of cause and effect. Regardless of which came first, the biomechanical complaint or the visceral dysfunction, all three aspects of the human body are affected; i.e. the physical, chemical, and mental (spiritual) elements. Mental de-pression causes undo stress upon the physical and chemical aspects of life’s triune. Biochemical stress puts pressure upon the mechanical and psychological

aspects as well. You rarely see anyone in poor health who is jubilant and joyful. Some of the hardest people to deal with are burdened with an unknown load of cares within their circle of life. Where do you start to begin a healing rejuvenative sojourn? I often give patients the following advice; Since you can’t go back to the beginning and undo the choices made in the past, you have to do the next best thing. Start from the present and make the choices most beneficial for the future. How do you do that? Gather all the facts possible from your past, including hard-copy data with all diagnostic biochemical measure-ments possible from laboratory findings and physical examinations. From this information I can develop a treatment protocol, including lifestyle modification and nutraceutical intervention with time sensitive landmarks and follow through. Exercise programs are put in place and systems not working properly are addressed. The secret to a compliant patient is to keep score of their health conditions and the progress they are making. Normally, as the pain of acute inflammation is reduced medicinally, the underlying biomechanical and nutri-tional aspects of the original cause of the inflammation are not fully resolved before victory is proclaimed by the patient. Sometimes a patient will be out of pain and not realize the core problem has not been resolved. If this is the case, the results are often an ongoing chronic low-level inflammatory process, which is the primary cause and a significant contributor of a whole host, if not most of all chronic degenerative diseases. Those conditions include arthritides (osteoarthritis, degenerative disk disease, etc.), autoimmune disorders (Hashimoto's, IBS/crohn’s disease, rheumatoid arthri-tis, psoriasis, asthma, etc.), diabetes, cardiovascular disease, and even many cancers. When you take your automobile to the “car hospital” for a check-up, you don’t want to be instructed to just add more oil when the oil light comes on. It is to your advantage, in the long run, to find out where the oil is going and how to stop the problem. My Grandad was a great mechanic, as well as a legendary and brilliant chiropractic physician. He taught me many lessons in life. For that I am grateful.


You will not want to miss this exciting seminar! “Influencing the HPA Axis”, April 11-14, 2019 at the Inn and Spa in Loretto, Santa Fe, NM. Doctor Registration is only $500 – Hotel is only $169 per night for a single or a double!

The ACA Council on Nutrition will be seeking 16 hours of CEUs in all applicable states through Palmer College, of-fering 4 hours of ethics, coding, etc., and offering 3 hours of “How to Build a Functional Clinical Nutrition Practice”. We will also be giving educational hours for the DACBNs and the DCBCNs. DABCIs, please check with your board to see if you will earn educational credit by attending this seminar. This seminar promises to be packed full of exciting speakers and topics. Plus – you will have Friday and Saturday evenings to enjoy the hotel amenities and explore Santa Fe and its local activities. You will receive continental breakfast, two luncheons, a cocktail party and morning and af-ternoon breaks! We will be holding our seminar at the iconic Inn and Spa at Loretto in historic Santa Fe, NM. This is an award-winning urban spa sanctuary dedicated to healing, education and mind, body and spirit renewal. We hope you will attend!

REGISTRATION FORM FOR DOCTORS

Name _______________________________________Address

City, State and Zip

Telephone # Fax Email Second Attendee Method of Payment: o VISA o MasterCard o AM X o Discover o CheckCredit Card# _______________________________________________________Exp. Date ___________CVC# __________

Signature

September 1, 2018 – February 28, 2019: Members $500 Non-Members $650After February 28, 2019: Members $600 Non-Members $750 Spouse/CA/Student half of the member fee

For registration, please contact Maria Scholl at 516 546 0399 or 660 Merrick Road, Baldwin, NY 11510.Call Claudia Rabin-Manning @ Trump Travel 516 546-0300 NOW for travel & reservations at the Inn and Spa in Loretto, Santa Fe, NM Single or Double $169 with continental breakfast.

The ACA Council on Nutrition and Trump Travel are not liable for any loss or accident.

ACA COUNCIL ON NUTRITION

“Plants have been used as medicines since the dawn of animal life. The initial use of plants as medicines by humans is thought to have been a result of ‘instinctive’ dowsing. Animals in the wild still provide evidence that this phenomenon occurs. Animals, with a few nota-ble exceptions, eat plants that heal them and avoid plants that do them harm.”1

“The use of botanicals in oncology is based on the syn-ergistic hypothesis – that combinations of well-selected active constituents from one or more botanical species will together have a synergistic anticancer effect. Some of the ancient Traditional Chinese Medicine combina-tion therapies have been shown to improve efficacy of chemotherapy in pancreatic and colon cancer pa-tients.”2 Unfortunately, but not surprisingly, the use of whole plants or combination plant constituents has not been pursued by mainstream oncology research (mainly in the U.S.).3 “Even those who have pursued whole-plant botanical oncology have been stymied by the absence of adequate taxonomic, chemical, and bioassay validation of the natural products used in research.”4

“Botanicals are used in naturopathic oncology in sev-eral ways: to prevent cancer and metastasis in high-risk patients, to manage side effects of conventional cancer therapy, as adjuvants to improve efficacy and safety of chemotherapy agents, and as immune modulators to prevent cancer relapse after treatment.”5

Integrative clinicians in several ways use plant medi-cines6:

In primary prevention of cancer at high risk for malignancy (anti-inflammatory via multiple path-ways, pro-apoptosis actions and inhibition of proliferation pathways, antioxidants, and immuno-modulators).

Botanical Medicine in Integrative Oncology by: Wayne L Sodano, DC, DABCI, DACBN, BCTN

(Continued on next page)

As phytopharmaceuticals with direct tumori-cidal and apoptotic effects.

As adjuvants to improve the cytotoxic activity of cancer drugs.

As immunomodulators to enhance endogenous immunological tumoricidal activity.

To treat radiation-related reactions and fatigue. To mitigate the homological, neurologic, and

gastrointestinal toxicities of U.S. FDA- approv-ed chemotherapy pharmaceuticals.

To improve survival and quality of life in survivorship.

It is my opinion that prescribing a healing substance(s) for chronic conditions in isolation (i.e. scientific reduc-tionism) without using a holistic, integrative medicine approach to care, generally produces little to no posi-tive healing effects. For example, substituting a natural anti-cholesterol or anti-inflammatory for a pharmaceu-tical drug may have fewer side effects, but it does not address any of the etiological factors and/or triggers known to cause the conditions. In addition, few clinical trials have demonstrated conclusive cancer prevention benefit.7 The majority of the clinical trials use a single substance (e.g. vitamin C, vitamin E, selenium, vitamin D, beta-carotene, curcumin, soy, green tea, fish oils, probiotics, and medicinal mushrooms) when conduct-ing research on the chemoprotective qualities of natural products without giving consideration to the subject in an integrative/holistic medicine manner.

I would like to someday read about clinical trials that studied the effectiveness of restoring a major system of the body (gastrointestinal, immune and detoxification system, etc.) and/or reducing the toxic load via detoxi-fication protocol or using an anti-inflammatory diet with concomitant use of a natural product such as immune enhancing medicinal mushrooms as it relates to cancer prevention. For example, the immune system and tumors cells are often concurrent in a dynamic equilibrium and both have a complex interaction and are interlinked.8 An immune system dysfunction can alter the functioning of the natural killer (NK) cells. These cells can lyse tumor cells and viruses infected cells and play an important role in immune surveillance of cancer and are accomplished to prevent cancer growth. “The ligand on the surface of target cells (infected or tumor cells) triggers NK cell cytotoxicity and activates the receptors on the NK cells. These ligands are absent on normal cells. NK cells modulate activity of other leukocytes such as dendritic cells and T cells through cytokines.”9 There are several natural


agents that can increase the cytotoxic activities of the NK cells and increase the level of tumor necrosis factor alpha while decreasing the DNA damage in patients with late stage cancer.10

The research study below highlights the potential use of a nutraceutical approach for the treatment of cancer by boosting the immune system. Although there was no mention of concomitant treatment of any of the body systems or other dietary changes, I believe the study can serve as an inspiration for future studies, even though conventional medicine appears not to be in fa-vor the natural approach to cancer treatment at this time. (As of this writing, I could not find any signifi-cant cancer research studies that assess and treat the body systems in combination with prescribing nutra-ceuticals.) Studies confirmed that clinical results could be im-proved by a combination of nutraceuticals. Twenty patients of stage IV (bladder, breast, prostate, lung, neuroblastoma, mesothelioma, lymphoma, ovarian, gastric and osteosarcoma) cancer were treated with natural products such as transfer factor plus (contains bovine colostrum, mushroom extracts and other ingre-dients), immune modulator mix, ascorbic acid, IMU plus, Agaricus blazei teas, nitrogenated soy extract and Andrographis paniculata. After nutrient application, the function of NK cells, TNF-α and receptor levels were measured by phytohemagglutinin (PHA) and ELISA. Complete blood count and chemistry panels were daily counted. After 6 months, 16 of the 20 pa-tients were alive, which showed maximum efficiency of NK cell function and TNF-α level in all four cell popu-lations. It was observed that hemoglobin; hematocrit and glutathione levels were prominent in investigated patients. It was concluded that an aggressive combina-tion of immuno-active nutraceuticals was effective in late stage caner; while the clinical outcome evaluation are ongoing. “Study on various plant constituents revealed that most of the phytochemicals are widely used as immune modulators against cancer and tumors. The important anti-cancerous natural plant products are apigenin (e.g. parsley), crocetin (e.g. saffron), curcumin (e.g. tur-meric), cyanidins (e.g. grapes, cranberries, raspberries,

etc.), epigallocatechin gallate (e.g. green tea), fisetic (e.g. strawberries and apples), diindolylmethane (e.g. Brassica vegetables), genistein (e.g. soybean), gingerol (e.g. ginger), kaempferol (e.g. grapefruit, tea and broc-coli), lycopene (e.g. tomatoes), resveratrol (e.g. grapes), sulforaphane (e.g. cruciferous vegetables), ros-marinic acid (e.g. rosemary), vitamin D (e.g. mush-rooms), and vitamin E for various plant oils.”4 It should be obvious that incorporating these foods in the diet and avoiding “junk food” can produce profound posi-tive health benefits. In closing, we must also recognize that cancer is a mul-tifactorial disease that requires a multifaceted approach to treatment that integrates mind, body and spirit. “If we are to treat cancer and heal the whole person, it will be imperative for the practitioner to recognize that the mind plays a powerful part in the success of the pa-tient’s healing and to take this into consideration when talking with the patient and to also bring this knowl-edge to the patient in a way they can utilize.”5

About the Author

Dr. Wayne Sodano is a Board Certified Chiropractic Internist, Diplomate of the American Clinical Board of Nutrition, Certified Functional Medicine Practitioner, and is Board-Certified in Traditional Naturopathy. He is a former instructor of the DABCI program and cur-rently dedicates his time to research and development in the areas of integrative and functional medicine as the Director of Medical Education at the College of Integrative Medicine (www.CollegeofIntegrative Medi-cine.org) and serves as Director of Clinical Support and Education at Evexia Diagnostics. Dr. Sodano frequent-ly lectures live through other venues both nationwide and internationally. Dr. Sodano is also the creator of iMedLogics a compre-hensive health history analysis and patient management software program (www.iMedLogics.com).

References: 1. Murray MT. Botanical Medicine – A Modern Per-

spective. In: Pizzorno JE, Murray MT. Textbook of Natural Medicine. 4th Ed. St. Louis: Elsevier; 2013. P. 257.

2. Standish LJ, Alschuler lN, Ready AB, Torkelson C, Sivam G, Wenner C. Botanical Medicine in Integra-tive Oncology. In: Abrams D, Weil A. Integrative Oncology. Oxford; Oxford University Press; 2009. p.104.

3. Standish LJ, Alschuler lN, Weaver M, Nezami M. Botanical and Mycological Medicine in Integrative

(Continued on page 126)


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As you can guess, these tiny communities of living things can be influenced by outside factors too. Things like infections and chemicals have adverse effects on these little critters, and that can lead to adverse effects in us, their hosts. When they get depleted or pushed out by non-friendly organisms it is called dysbiosis. Study adds to evidence linking gut bacteria and obesity:

Metabolic syndrome is rampant. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. It increases a person's risk of heart attack and stroke. The numbers of people with it keep growing. The problems that stem from metabolic syndrome lead to more deaths now than smoking. That's shocking! But when you think about the individual risks associated with heart disease, arterial disease, obesity, and diabe-tes they are not good - They are even worse when they are combined. “A new Johns Hopkins study of mice with the rodent equiva-lent of metabolic syndrome has added to evidence that the intestinal microbiome -- a "garden" of bacterial, viral and fungal genes -- plays a substantial role in the development of obesity and insulin resistance in mammals, including hu-mans. A report of the findings, published Jan. 24, 2018 in Mucosal Immunology, highlights the potential to prevent obesity and diabetes by manipulating levels and ratios of gut bacteria, and/or modifying the chemical and biological pathways for metabolism-activating genes.”1 Dysbiosis increases cancer risks

Cancer is a big problem and it is the second highest cause of death in the USA and getting closer to pushing out heart disease for the number one spot. Colorectal cancers are the third most common cancers. It will af-fect 135,430 Americans this year, equally affecting men and women.2 Cancers of the head and neck affect the face, oral cavity, larynx, and pharynx. These will affect

500,000 people this year worldwide and claim 380,000 lives.3 New research is showing that our good bacteria help prevent these life-threatening diseases. When we talk about this stuff most people automati-cally think of the gut bacteria and rightfully so; there are several papers published weekly that better explain the mechanisms that happen between our cells and these micro organisms. A paper published in 2014 by The Wistar Institute showed that bad bacteria in our gut biome increase bowel cancer risks by decreasing a pro-tein called ZRANB3, a protein that is responsible for DNA repair. If a colon cell cannot repair its DNA the increase in mutations in cells increases the risk of colon cancer.4 The bacteria in the mouth is often only associated with tooth decay, but new studies are proving there are plenty of good guys in the oral cavity. A JAMA Oncol-ogy report entitled, Association of Oral Microbiome with Risk for Incident Head and Neck Squamous Cell Cancer published in January, 2017 showed a “greater oral abundance of commensal Corynebacterium and Kingella is associated with decreased risk of HNSCC (Head and Neck Squamous Cell Carcinoma), with po-tential implications for cancer prevention.” 6 Microbiome-Gut-Brain connection

For me, as a doctor of chiropractic, one of the fascinat-ing things researchers have discovered is the Micro- biome-Gut-Brain Axis or MGB. That is essentially a communication pathway between our gut and our brain. How it works is complex and understanding the mecha-nism is still unfolding. Simply put, the condition of the intestines and the communities of bacteria in them, both good and bad, have a direct link to the brain via the Vagus Nerve. This communication can influence mood and cognitive function. Changes to the microbiome-gut-brain axis could be associated with the etiology of different neu-ropsychiatric disorders such as depression.5 Studies using animal models showed that a properly balanced gut microbiota have a benefit in anxiety, memory, and socialization.6 Other evidence appears to show certain signals from the MGB can create anti-inflammatory responses from the immune system and increase the number of beneficial neurotransmitters like acetylcho-line.7 Many studies are showing the link between intestinal microbes and the regulation of the neuroendocrine-immune system and central nervous system (CNS).

(Continued on next page) THE ORIGINAL INTERNIST DECEMBER 2018 109

Unhealthy? Maybe it’s Your Biome! by: Jason Nardi, DC DABCI

ers. About the Author: Dr. Jason Nardi received his doctor of chiropractic de-gree from Life University in Atlanta, Ga. He is one the few Board Certified Chiropractic Internists in the State of Alaska. He received his Diplomate of the American Board of Chiropractic Internists in 2017. When he is not helping people get well, he enjoys exploring the outdoors of Alaska with his fiancé Jessica. References: 1. P Lu, C P Sodhi, Y Yamaguchi, H Jia, T Prindle, W B Fulton, A

Vikram, K J Bibby, M J Morowitz, D J Hackam. Intestinal epi-thelial Toll-like receptor 4 prevents metabolic syndrome by regulating interactions between microbes and intestinal epithe-lial cells in mice. Mucosal Immunology, 2018.

2. Common Cancer Type (February 26, 2018). Retrieved from https://www.cancer.gov/types/common-cancers. 3. Hayes RB, Ahn J, Fan X, et al. Association of Oral Microbiome With Risk for Incident Head and Neck Squamous Cell Cancer

JAMA Oncol. 2018;4(3):358–365. 4. The Wistar Institute. (2014, April 4). Bacterial gut biome may

guide colon cancer progression. ScienceDaily. Retrieved May 1, 2018 from

www.sciencedaily.com/releases/2014/04/140404140407.htm. 5. Lima-Ojeda, J. M., Rupprecht, R., & Baghai, T. C. (2017). “I

Am I and My Bacterial Circumstances”: Linking Gut Micro biome, Neurodevelopment, and Depression. Frontiers in Psy chiatry, 8, 153.

6. Timothy G. Dinan, Roman M. Stilling, Catherine Stanton, John F. Cryan, Collective unconscious: How gut microbes shape human behavior, Journal of Psychiatric Research, Volume 63, 2015, Pages 1-9.

7. Forsythe P, Bienenstock J, Kunze WA. Vagal pathways for mi crobiome-brain-gut axis communication, Advances in Experi-mental Medicine and Biology, 2014;817:115-33.

8. Stilling RM, Dinan TG, Cryan JF. Microbial genes, brain & behaviour - epigenetic regulation of the gut-brain axis. Genes Brain Behavior, 2014 Jan;13(1):69-86.

9. Houser MC, Tansey MG. The gut-brain axis: is intestinal I flame mation a silent driver of Parkinson’s disease pathogenesis NPJ Parkinson's Disease, volume 3, Article number: 3 (2017). 10. Susan S. Schiffman, Kristina I. Rother. Sucralose, A Synthetic

Organochlorine Sweetener: Overview Of Biological Issues. Journal of Toxicology and Environmental Health, Part B, 2013; 16 (7): 399.

11. Sonnenburg ED, Smits SA, Tikhonov M. Diet-induced extinct tions in the gut microbiota compound over generations. Nature, volume 529, pages 212–215 (14 January 2016).

12. Conlon, M. A., & Bird, A. R. (2015). The Impact of Diet and Lifestyle on Gut Microbiota and Human Health. Nutrients, 7(1), 17–44.

13. Jernberg C, Löfmark S, Edlund C, Jansson J. Long-term impacts of antibiotic exposure on the human intestinal microbiota. Mi-crobiology 156(11):3216-3223.

14. Francino, M. P. (2015). Antibiotics and the Human Gut Micro biome: Dysbioses and Accumulation of Resistances. Frontiers in Microbiology, 6, 1543.

15. Langdon, A., Crook, N., & Dantas, G. (2016). The effects of antibiotics on the microbiome throughout development and alter-native approaches for therapeutic modulation. Genome Medi-cine, 8, 39.

Changes in the biome are associated with disorders such as multiple sclerosis,8 autism, depression, schizo-phrenia and Parkinson's Disease (PD).9 Some research-ers feel that changes in certain bacterial communities in the GI tract may be the earliest signs of Parkinson's Disease and that digestive health may be a solid indica-tor of PD. Studies have suggested that constipation is more than twice as common in people who develop PD and that they are twice as likely to develop PD within 10 years. Constipation symptoms usually began 15 to 24 years before a diagnosis of Parkinson's Disease was given.11 How to be a good host

Excuse the pun, but seriously you need to be the best host you can to keep these helpful organisms happy. There are a few things you can do really benefit them and your health:

Stop using the artificial sweeteners! On top of be-ing a cause of weight gain and sugar-handling problems, they also reduce the number and balance of beneficial bacteria in the gastrointestinal tract. They also change the DNA in GI tract and that, as I mentioned earlier, can lead to colon cancers.10

Up your fiber. In a research paper entitled “Diet-induced extinctions in the gut microbiota com-pound over generations” discussed the lack of fiber in our modern “convenience foods” may cause an irreplaceable loss of our gut flora. What's worse is according to the research team at Stanford Univer-sity, these deficiencies will be passed down to fu-ture generations.11

Take a high-quality pre- and probiotic. Increases the beneficial flora in your digestive tract will increase the viability and diversity of microbes.12 Probiotics are es-pecially critical after taking any antibiotic.13,14,15 Probiotics are not all the same. Some require refrigera-tion, others need to be taken at specials times like at night or with food. Prebiotics also are not all created equal. There is a large variation in the quality of both these types of products - many brands available over the counter and online do not survive the stomach and have little to no therapeutic value. Therefore, you should purchase them from a knowledgeable healthcare professional. Important closing information:

If you are suffering from irritable bowels diseases, like IBS, Colitis, Crohn's disease, do not make changes in your diet without consulting your health care provid-


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DHA in the diet and in the nerve cell membrane and the risk of dysfunction of the central nervous system in the form of anxiety, irritability, susceptibility to stress, dyslexia, stereotypic behaviour, aggressiveness, re-duced learning capacity, impaired memory and cogni-tive functions, and extended reaction times.” The next two quotes discuss the impact of DHA on cognitive function in more detail, the first addressing from a more theoretical standpoint: “DHA plays an important role in ensuring healthy ag-ing, by possibly thwarting macular degeneration, AD and Parkinson’s disease, and other brain disorders at the same time as enhancing memory and strengthening neuroprotection in general. A reduced level of DHA in the blood is associated with cognitive decline during ageing.” The following quote looks at the impact of DHA in healthy populations: “Some interesting studies, either observational or ran-domised controlled trials (RCT), have been carried out with healthy populations. For instance, in a community-dwelling cohort, levels of α-linolenic acid (ALA), EPA and DHA were assessed in serum phospholipids (PL) of volunteers not taking fish oil supplements. It was found out that only the association between serum PL DHA and non-verbal reasoning and working mem-ory remained after adjustment for participant education and vocabulary. Moreover, DHA increased cognitive performance in an RCT involving mentally healthy in-dividuals older than 55 years. Daily supplementation of 900 mg of algal (Schizochytrium sp.) DHA for 24 weeks was associated with significantly lower paired associative learning errors than the placebo case. Simi-lar results were attained by an RCT study on executive functions and neuroimaging in a group of healthy sub-jects whose age ranged between 50 and 75 years.” THE BIOCHEMISTRY AND PHYSIOLOGY OF DHA AS IT RELATES TO BRAIN FUNCTION

As you will see, the biochemistry and physiology of DHA is significantly different in the brain compared to the rest of the body, with emphasis on the idea that the brain preferentially favors the presence of DHA. This fact is supported by the following quote: “For those studies involving AD patients, it has been observed that though DHA intake is low, brain DHA levels are frequently similar to controls, thus suggesting that low DHA intake leads to low plasma DHA, but does not necessarily decrease brain DHA.” The next quote provides more detail as to how impor-


Thoughts at Large: Controversies in Clinical Nutrition and Functional Medicine

Issue # 10

STILL ANOTHER UNDER-APPRECIATED SUPPLEMENT DOCOSAHEXAENOIC ACID (DHA)

by: Jeffrey Moss, DDS, CNS, DACBN

Continuing with my theme of underappreciated supple-ments, I would like to now discuss docosahexaenoic acid (DHA). Why? Even though it has gained a fair amount of popularity in the clinical nutrition community, I find that its sales still pale in comparison to fish oil, which, as most of you know, is a combination of eicosapentaenoic acid (EPA) and DHA. In addition, compared to fish oil, a large body of research has demonstrated that DHA is especially beneficial for brain function, particularly in relation to cognitive function. Therefore, I would now like to highlight a fascinating paper that focuses on the role of DHA with cognitive function. The paper is enti-tled “Dietary DHA and health: cognitive function age-ing” by Cardoso et al (Cardoso C et al. Nutr Res Rev, Vol. 29, pp. 281-294, 2016). AN OVERVIEW OF DHA RESEARCH IN RELATION-SHIP TO BRAIN FUNCTION

The first quote I would like to feature from the Cardoso et al paper provides an overview of research on the im-pact of DHA on behavior: “DHA, one of the most important marine n-3 PUFA, may have a strong influence on brain health. Indeed, consumption of larger amounts of n-3 PUFA, particu-larly DHA, appears to reduce the risk of depression, including postpartum depression, bipolar disorder (manic depression), schizophrenia, and mood and be-haviour disorders.” The next quote refers to both behavioral and degenera-tive disorders: “It has also been hypothesized a connection between

that PUFAs such as DHA are essential in this regard. SOME COMMENTS ON THE IMPORTANCE OF DHA METABOLITES

As we all know, EPA can be metabolized to form eico-sanoids such as prostaglandins that have important anti-inflammatory functions. Similarly, DHA can be me-tabolized to form what are known as “docosanoids”: “Differently from EPA, DHA is not a source for eico-sanoid synthesis, rather exerting influence directly and indirectly. DHA can also be converted to EPA by a ret-roconversion reaction, thereby leading to the formation of various eicosanoid metabolites. The DHA deriva-tives produced by oxidation reactions also have impor-tance and are usually termed docosanoids.” Unlike eicosanoids that have an impact on inflamma-tion, docosanoids act as neuroprotective agents: “Docosanoids include neuroprotectin D1 (NPD1), maresins, neuroprostanes (NeuroPs), and related 22-C derivatives. The NeuroPs are structurally related to prostaglandins and constitute a large family of oxidized cyclopentanoid derivatives.” What are important roles of docosanoids? One, NPD1, appears to play an important role in protecting against cognitive decline: “Different mechanisms for the DHA role as a protec-tive agent against cognitive decline have been put for-ward. Namely, NPD1 may support brain cell survival and repair through neurotrophic, anti-apoptotic and anti-inflammatory signaling. Indeed, many of the effects of DHA on the neurological system may be related to sig-naling connections…” In completing this discussion on docosanoids, it should be pointed out that NSAIDs such as aspirin, which are known to inhibit pro-inflammatory arachidonic acid byproducts via inhibition of cyclooxygenase, can also inhibit important docosanoids: “…it has…been shown that lipoxygenase inhibitors block the synthesis of many docosanoids.” DHA AND INFLAMMATION

Of course, no discussion on DHA would be complete with a mention of the function of DHA with which we are most familiar, as an anti-inflammatory. Concerning the role of DHA and inflammation as it relates to neu-rologic activity, Cardoso et al state: “A further mechanism relating to DHA dietary intake and cognitive function ageing may involve the role of DHA in inflammatory processes. Indeed, DHA and EPA are deemed to display some anti-inflammatory

tant DHA is to healthy brain function: “In the mechanistic analysis of the link between DHA and cognitive function, it should be noted that DHA is by far the main n-3 PUFA present in the brain – its con-tent with brain fatty acids (FA) is 12-15% - where it is predominantly located in neuronal membranes of the grey matter, especially in synapses. In addition, the brain FA-binding protein preferentially binds DHA (and other n-3 PUFA), leading to higher levels of DHA incorporation in the molecular structures of the mem-branes.” How does DHA get to the brain? According to Cardoso et al: “DHA is supplied to the central nervous system by the liver, where DHA attained from food is taken up and distributed to other organs. Besides, though there is evidence suggesting the expression and functional role of FA transporters at the blood-brain barrier, DHA can reach the brain by simple diffusion through this bar-rier.” Of course, as we all know, DHA can be made in the body from the essential fatty acid ALA, primarily found in flax seed oil. Unfortunately, this conversion does not readily occur in the human body, making DHA supplementation advisable in certain situations: “…the dietary level of α-linolenic acid (ALA; 18:3n-3), a precursor of DHA, does not correlate well with the level of DHA in the human body, making it advisable, for instance, to supplement the nursing mother’s diet with DHA.” DHA AND SPECIFIC BRAIN PHYSIOLOGY

The next quote considers the specific role of DHA in the brain: “DHA is highly enriched in the phospholipid (PL) of the synaptic plasma membrane and synaptic vesicles. Regarding this issue, it is worth analyzing the pathways leading to the synthesis of some important PL. Phos-phatidylcholine (PC), a fundamental brain PL, is syn-thesized through the Kennedy pathway from three pre-cursors: choline, a pyrimidine, and, typically, a PUFA (either DHA or other PUFA). Phosphatidylethanola-mine (PE) may be synthesized from a PUFA and a pyrimidine.” Of course, we are all aware of phosphatidylcholine, which can be provided as a supplement. However, while supplementation of this substance can be helpful, it is always ideal to also introduce interventions that will optimize the patient’s ability to produce their own phosphatidylcholine. Therefore, it is important to note



weekly meals of 150g may also be enough.” However, as noted in the next quote, ingestion of opti-mal amounts may not equate to bioaccessibility: “The level of DHA in a portion of food that is eaten may be quite different from the bioaccessible level, that is, the DHA concentration that is released from the food matrix into the intestinal lumen after digestion and is available for absorption.” Therefore, with the assumption that many, if not most, of our patients will demonstrate suboptimal digestive and absorptive capacity at some level, supplementation may be necessary even with ideal dietary DHA intake. MORE INFORMATION ON THE ABILITY OF THE BODY TO PRODUCE DHA

As was briefly mentioned above, even though DHA can be produced from ALA in the body, this pathway is not particularly efficient. This pathway is discussed in more detail in the next quote: “Besides dietary DHA and the bioaccessibility/bioavailability issues, DHA may be biosynthesized in the human body. However, for healthy and non-vegetarian humans, despite the availability of the nec-essary enzymes, there is extremely limited synthesis of DHA in adults. Unless induced by several years of a vegetarian diet, the human enzymatic machinery is very inefficient in converting, for instance, ALA to EPA and DHA. Even with a diet deficient in DHA, the brain cells’ ability to synthesise DHA from ALA is very low. One study indicates a very low share of plasma ALA (below 0.2%) is deployed to the synthesis of DHA via EPA. Indeed, it has been claimed an extremely low level of conversion of the precursor ALA to EPA,

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(Continued on page 120)

chini. In moderation, eat protein in the form of grass-fed meats, pasture-raised poultry, cage-free eggs, and wild-caught fish. When it comes to fish, choose fatty fish by remembering the acronym SMASH: salmon, mackerel, anchovies, sardines, and herring. Finally, if you want to reach for something sweet, a small amount of 90% dark chocolate is your best option. On the list of what not to eat? For starters, remember that the keto diet restricts the intake of carbohydrates to achieve a shift from glucose to ketones as a primary fuel source. In order to avoid food high in carbs, limit fruit consumption, as it’s higher in sugar content, and forego fruit juice altogether. You should also avoid grains or starches such as rice or pasta, beans or legumes, root vegetables, and any low-fat or diet products, as they are typically high in added sugars and highly processed. What is intermittent fasting? While there are different types of intermittent fasting, such as daily, weekly, and alternate day, the most common involves only eating during a specified window of time each day. That window typically spans between four and seven hours of feeding during the day, but it can be reduced or expanded depending on your dietary needs. Of its many benefits, intermittent fasting works on both sides of the calorie equation.6 It increases the amount of calories you burn by boosting your metabolic rate and reduces the amount of calories you consume by limit-ing the food you eat. According to a 2014 review, intermittent fasting can cause weight loss of 3-8% over 3-24 weeks.7 A study also showed that intermittent fasting caused less muscle loss than continuous calorie restriction.8 What are the benefits of fasting on the keto diet? Individually, the keto diet and intermittent fasting are effective weight loss tools that help people lead healthier lives. However, there are also a number of health benefits that can be optimally achieved when the two are combined:

Intermittent fasting activates autophagy—a phenomenon where the body eats its own cells and tissues—in a good way.9 Autophagy helps the body remove harmful and toxic compounds, recycle damage-ed proteins, and increase the production of ketones quicker than on the standard keto diet. Different processes of autophagy occur when either the body is starved or protein and carbohydrates are restricted. Both of these occur when intermittent fasting is combin-ed with the keto diet.6 Combining the two allows you to reap the benefits of autophagy in an efficient way.

Fat is your friend, not your foe—a claim that followers of the ketogenic diet have been supporting for almost 100 years. Compared with the Standard American Diet (SAD), the ketogenic diet is not only safe for helping overweight and obese people lose weight, it also supports brain health and improves energy levels.1,2,3 Those who have experienced the benefits of the ketogenic diet, or keto diet, might also be curious about trying intermittent fasting and whether it’s feasible to combine the two. Good news: It’s not only possible, it’s a weight loss strategy I highly recommend. Here, I explore the two dietary approaches and discuss their individual and combined health benefits. Be sure to consult with your own healthcare practitioner before embarking on any new diet plan. What is the ketogenic diet? The keto diet is based on the idea that eating mostly healthy fats, consuming high-quality protein in moderation, and restricting carbo-hydrates to less than 50 grams per day can cause your body to go into a metabolic state called nutritional ketosis.4,5 During ketosis, your body no longer relies on glucose as a primary energy source. Instead, your liver converts fat into ketones—-which are an alternative source of fuel for your brain. On the keto diet, you’ll get most of your calories from healthy fats found in foods like avocados, grass-fed butter, olives, olive oil, medium-chain triglyceride (MCT) oil, coconut oil, nuts, and seeds. However, keep in mind that some nuts and seeds are better than others. Choose those that are high in fats and lower in carbs; brazil nuts, almonds, walnuts, chia seeds, and flaxseed are all good options. You can also eat all of the non-starchy, leafy vegetables you want, as well as other low-carb vegetables like broccoli rabe, peppers, bok choy, cauliflower, spinach, asparagus, cucumber, and zuc-

Intermittent Fasting on the Ketogenic Diet by: Robert G. Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR


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The combination of intermittent fasting and eating a keto diet can help you get into ketosis faster. The keto diet makes intermittent fasting more manageable because your body is already adapted to fasting with ketones. In addition, most people naturally eat less frequently on keto because of the high satiety level, so you’re likely already used to bigger windows without food.

One of the foremost reasons people turn to inter-mittent fasting on the keto diet is to lose weight faster.10 Fasting can help you break through weight loss plateaus in a few different ways: Eating a high-fat keto diet and being in ketosis reduces appetite and increases satiety levels.11 It’s much easier to do intermittent fasting when this is the case, versus a diet of carb-filled foods that often increases cravings.

Combining the keto diet with intermittent fasting can help decrease oxidative stress and inflammation in the body.12,13 Inflammation is part of the body’s complex biological immune response to illness, infec-tions, and injury.14 Up to a point, inflammation is normal and even desirable. But chronic inflammation can lead to joint pain, digestive issues, and other long-term health problems.

The combined efforts of intermittent fasting and the keto diet lead to enhanced cognitive performance and neuroplasticity. Cognitively, the brain operates better on ketones versus glucose from sugar or carbs.15,16,17 Ketones are an efficient, slow-burning fuel source with preserved uptake by the brain–lending itself to heightened levels of concentration and longer periods of focus.18 Ketones also increase the brain-derived neurotrophic factor (BDNF), which works to support the brain’s existing neurons while encouraging new neuron and synapse growth.5,6

Finally, using both these strategies together can help stabilize blood sugar levels as compared to intermittent fasting alone.4 Alternating between glucose and ketones for energy can cause spikes in blood sugar, leading to brain fog, mood swings, low energy, and other side effects. Someone eating the SAD might experience this with intermittent fasting; however, during keto-adaptation, liver and muscle glycogen deposits are maintained. With the absence of glucose to burn, you won’t experience the peaks and valleys of varying blood sugar levels. While intermittent fasting is not a necessary part of following a keto diet, I definitely recommend the approach if you want to double down on benefits, achieve previously unattainable results, and meet new health goals. Alone, each has its weight loss and healthy lifestyle benefits. Together, they can help you

achieve your optimum health from the inside out. About the Author

Dr. Robert G. Silverman is a chiropractic doctor, clinical nutritionist and author of Inside-Out Health: A Revolutionary Approach to Your Body, an Amazon number-one bestseller in 2016. The ACA Sports Council named Dr. Silverman “Sports Chiropractor of the Year” in 2015. He also main-tains a busy private practice as founder of Westchester Integrative Health Center, which specializes in the treatment of joint pain using functional nutrition along with cutting-edge, science-based, nonsurgical approaches. Dr. Silverman is a seasoned health and wellness expert on both the speaking circuits and within the media. He has appeared on FOX News Channel, FOX, NBC, CBS, CW affiliates as well as The Wall Street Journal and NewsMax,

References

1. Gibas, MK, et al. Diabetes Metab Syndrome, 2017. 2. Stafstrom CE et al. Frontiers in Pharmacology 2012; 3:59. 3. Hoyer S. Annals of the New York Academy of Science 1991;

640:53-8. 4. Volek J, et al. Comparison of energy-restricted very low-carbo

-hydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Met. 2004 Nov;1:13.

5. Abbasi J. Interest in the ketogenic diet grows for weight loss and type 2 diabetes. JAMA. 2018;319(3):215-217.

6. Klempel MC. Dietary and physical activity adaptations to alter-nate day modified fasting: implications for optimal weight loss. Nutr J. 2010 Sep 3;9:35.

7. Barnosky A. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Science Direct. Oct 2014;164:4:302-311.

8. Varady K. Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Obes Rev. 2011 Jul;12(7) :e593-601.

9. McCarty M et al. Med Hypotheses. 2015 Nov;85(5):631-9. 10. Johnstone A. Fasting for weight loss: an effective strategy

or latest dieting trend? Int J Obes. 2015 May;39(5):727-733.

11. Van Wymelbeke V et al. The American Journal of Clinical Nutrition 2001; 74:620-30.

12. Mattson M et al. Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebro-vascular systems. Nutr J. Mar 2005;16.

13. Johnson J. Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma. Free Radic Biol Med. 2007 Mar 1;42(5):665-674.

14. Faris M. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutr Res. 2012 Dec;32(12):947-955.

15. Zhao W et al. PLoS ONE 2012; 7(11):e49191. 16. Kim DY et al. PLoS ONE 2012; 7(5):e35476. 17. Henderson S et al. Nutrition & Metabolism 2009; 6:31. 18. Adapted from: Volek et al. European Journal of Sport Science

2015; 15(1):13-2019. 19. Lee J. Dietary restriction increases the number of newly

generated neural cells, and induces BDNF expression, in the dentate gyrus of rats. J Mol Neurosci. 2000 Oct;15(2):99-108.

Adapted from The Art and Science of Low Carbohydrate Performance by Jeff S Volek and Stephen D. Phinney.


placebo rofecoxib was associated with the highest risk of myocardial infarction, followed by lumiracoxib. Ibu-profen was associated with the highest risk

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