The Emerson Extra

EMERSON ECOLOGICS LAUNCHES 2016 EMERSON GRANT PROGRAM

Now Accepting Applications for 2016 Awards

 

MANCHESTER, NH – March 2016 – Emerson Ecologics, LLC announced earlier this month that it is accepting applications for The 2016 Emerson Grant. The Emerson Grant Program is aimed at supporting the work of integrative health practitioners while also promoting integrative medicine in the United States.

 

The Emerson Grant is a competitive, discretionary award ranging from $500 to $10,000, with the 2016 Grant Program totaling awards up to $25,000. Projects may include legislative efforts, public awareness campaigns or enhancements to education or clinical training, but all projects are focused on expanding or improving integrative medicine.  “Each year we look forward to the launch of the Emerson  Grant Program and the opportunity to help integrative organizations further their dream projects to increase the delivery and reach of integrative medicine to all those in need,” expressed  Tina Beaudoin, ND and Senior Medical Educator at Emerson Ecologics.

In 2015, Emerson Ecologics awarded 3 grants to:

  • Michigan Association of Naturopathic Physicians: $10,000 award to support the effort to obtain full licensure for naturopathic doctors in Michigan. Currently only 18 states, four of which are located in New England, have licensing laws for naturopathic physicians.
  • Maryland University of Integrative Healthcare, Dispensary Department: $7,500 grant to aid in developing a training program for current Good Manufacturing Process (cGMP) requirements. The University’s project also supports the development of Quality Assurance programs for new herbalists and small-size herbal supplement companies.
  • Natural Doctors International (NDI): $7,500 grant awarded to assist NDI in expanding its recruiting efforts for additional integrative disciplines, including acupuncture, massage therapy, nutrition, herbalism and conventional medicine. NDI, one of the oldest naturopathic health organizations in North America, is dedicated to bringing integrative medicine to underserved populations.

 

Tabatha Parker, ND, the current President of NDI, shared “we are so grateful that the Emerson Grant Program has allowed NDI to attract a larger variety of medical students and professionals. This not only means greater integrative learning opportunities during our medical brigades but also better holistic health care for the patients of the rural communities that we serve.”

 

Emerson Ecologics is inspired each day by the hundreds of volunteer-driven organizations that work tirelessly to support integrative medicine. As the premier resource of professional quality products and services for the integrative healthcare community, Emerson Ecologics is committed to supporting the integral work and vision of these incredible organizations. For more details on The Emerson Grant program or to download an application, visit http://www.emersonecologics.com/grant.

 

About Emerson Ecologics Founded in 1980, Emerson Ecologics, LLC is committed to the success of integrative healthcare practitioners as they deliver unsurpassed patient care. As a dedicated partner, Emerson Ecologics offers its customers the broadest selection of professional-quality products, and continues to expand its comprehensive suite of educational and practice management tools to help practitioners achieve success. Headquartered in Manchester, NH with distribution centers in Virginia and California, Emerson Ecologics is NSF certified, VAWD accredited and is the founder of the Emerson Quality Program® (EQP). For more information, visit emersonecologics.com. Contact: Tracy Eames Director of Marketing, Emerson Ecologics 603-206-9425 pr@emersonecologics.com

 

Treasuring Turmeric: The Benefits of Curcumin and the Ingredient Meriva®

Homemade turmeric capsule from freshly grounded turmeric roots

If you asked integrative practitioners what is their favorite botanical, the majority of them would say turmeric.  Why? Because nearly every patient can benefit from inflammation modulation.  The benefits of curcumin are vast and the research continues to pour out on new and diverse clinical applications.  It is a powerful antioxidant and regulator of the inflammatory response.    Whether you are looking to downregulate excess cytokines, kinases and growth factors or to upregulate specific transcription factors, curcumin has been shown to exhibit many diverse beneficial biochemical influences[1].

I love going to integrative medical conferences, spending a few days with my peeps and hearing the latest research and clinical pearls.  True to form, many of us have pill boxes or baggies with our ‘never-travel-without-them’ supplements.  Odds are high that many of these boxes and baggies will have beautiful bright orange pills of curcumin.  Whether in a gelatin capsule, softgel or veggie capsule, the orange pigment is a tell-tale sign.  Mood support, cardiovascular health, bone and joint health, blood sugar regulation, gastrointestinal wellness, antimicrobial support and complementary oncology benefits are just some of many ways curcumin helps our patients. [2],[3],[4],[5],[6]

Since we know that it is basically easier to think of curcumin in terms of helping maintain balanced inflammatory action in virtually any and all body systems, how do we choose among the many options available?  Absorption rates are the keys to making that decision.  Meriva® is a patented formulation of combining curcumin with soy lecithin (non-GMO soy) creating a phytosome, to shuttle the beneficial constituents found in curcumin across your cell membranes and into your blood stream.  It is shown to have a 5-20 fold increase in systemic levels.[7],[8]  Meriva® is not exclusive to one supplement company but rather it is available to all manufacturers and it is used by many professional brands as a single herb extract and in combination formulas.

I want to point out the one caveat in which I would NOT use Meriva® and instead go with an unformulated curcumin:  when the gastrointestinal tract is primary focus of treatment.  Take a moment to think about this and it will make sense.  If we are working with a patient who has temporary inflammation in their gut, we want the curcumin to hang around in the GI tract rather than being super-absorbed and moved throughout the body.  The same research that found higher plasma levels in the Meriva® group versus the plain curcumin group also found lower concentrations in the gastrointestinal mucosa.[9]  In these cases, it is more beneficial to use a plain curcumin product rather than one with enhanced absorption.

Fortunately, we offer a variety of professional-grade curcumin and Meriva® products by many of your favorite brands, to meet all of your patient’s needs.

Healthy regards,

Dr. Tina Beaudoin, N.D.

 

[1] Cancer Lett. 2008 Oct 8;269(2):199-225.

[2] Chin J Integr Med. 2015 May;21(5):332-8.

[3] Altern Med Rev. 2010 Dec;15(4):337-44.

[4] Molecules. 2015 May 20;20(5):9183-213.

[5] Bonekey Rep. 2016 Mar 2;5:793.

[6] Appl Microbiol Biotechnol. 2016 Mar 10.

[7] J Nat Prod. 2011 Apr 25;74(4):664-9.

[8] Panminerva Med. 2010 Jun;52(2 Suppl 1):55-62.

[9] Cancer Chemother Pharmacol. 2007 Jul;60(2):171-7.

*Meriva® is a registered trademark of Indena S.p.A., Milan.

A Synergistic Approach to Supporting Digestive Health

Woman's Fingers Touching her body parts, heart shaped fingers

By Kevin Lamberg via INNATE

Many holistic-minded practitioners believe optimal gastrointestinal health is the first step in maintaining and restoring the innate healing potential of the body.  Sadly, poor lifestyle choices make up approximately 70 percent of the burden of illness and the associated costs.[1] An increase in stress levels, excessive sugar intake and daily consumption of low-quality refined foods all contribute to the growing problem. Consequently, dietary choices can disrupt gut mucosal tissue and immune homeostasis over time, and as a result, researchers are focusing more of their attention on the intestinal barrier.[2] Thus, lifestyle modifications and therapies that cultivate optimal permeability may soon become a widely accepted standard of care in natural medicine.

 

The structure of the intestinal outer wall, referred to as the mucosa, functions as an absorbent unit. The small intestine is extensively folded to increase the surface area capacity for absorption.  The villi that line the outer wall further increase the surface area and act as specialized units that both absorb and secrete.  The villi themselves consist of a thin layer of epithelial cells that cover an inner core of blood and lymph vessels.[3]  In a healthy example, nutrients are assimilated by the absorptive cells, reach the inner core and are taken up by these blood and lymph capillaries. These cells are fused together by tight junctions so that nutrients only pass across the cells, not between.[4]  A wholesome diet made up of adequate, high-quality fruits and vegetables may play a significant role in maintaining the proper function of this system.

 

Gut Mucosa and Immune Health

 

The connection between the gut mucosa and health has not always been clear, but newly identified immune cells called innate lymphoid cells (ILCs) found in high numbers in mucosal tissue may be providing new insight. “Innate lymphoid cells are a family of immune cells that selectively accumulate in mucosal tissues serving as sentinels at the vanguard of host protective immunity.”[5] These mucosal cells respond to environmental influences that include diet and can change and remodel immune function.[6]  However, they may be implicated as cellular mediators in immune-mediated pathology.[7] Ultimately, an altered epithelial barrier function may contribute to intestinal inflammation and the “sounding” of the immune alarm.[8] “Dysregulation of the epithelial barrier function can lead to increased intestinal permeability and bacterial translocation across the intestinal mucosa, which contributes to local and systemic immune activation.” [9]

 

Lately, there has been growing interest in immunomodulatory nutrients like L-Glutamine that may regulate host immunity, the inflammatory response and thereby support the intestinal barrier.*[10]  Researchers became interested in studying individuals who are subjected to high-intensity exercise because it has been shown to increase gut permeability.[11] A recent survey on L-Glutamine described its role in reducing exercise-induced permeability by inhibiting the NF-kB pro-inflammatory pathway in human peripheral blood mononuclear cells.*[12]  By providing a seven-day dosing plan during intense exercise, the epithelial tight junction protein complex in the gastrointestinal tract was supported, encouraging optimal permeability.[13]

 

Sustamine®, a revolutionary dipeptide that combines pure L-Glutamine and L-Alanine adds a groundbreaking option for supporting gut health.[14]  Ultra-pure, clinically tested, Sustamine is produced through a novel enzymatic process that creates a unique, readily absorbed dipeptide. Since a dipeptide is simply a bonded chain of two amino acids rather than a more complex protein, the body can quickly transport it into intestinal cells.  A study published in the Journal of the International Society of Sports Nutrition demonstrated that the dipeptide had a positive impact on electrolyte absorption and improved transport channels in the GI tract.*[15]

 

Intestinal Microflora, Fiber and Mucosa

 

An extremely refined diet often lacks a meaningful quantity of dietary fiber from fruits and vegetables.  Therefore, supplemental sources of complex polysaccharides may be indicated.  Arabinogalactan, a complex polysaccharide derived from the larch tree, is an excellent source of dietary fiber.  The fermentation of carbohydrates into short-chain fatty acids by intestinal microflora is essential to maintain the health of the large intestine.[16]  Commonly available sources of arabinogalactan in the diet include carrots, radishes, pears, and tomatoes.

 

Marshmallow (Althea officinalis) and Slippery Elm Bark (Ulmus fulva) have been traditionally used to support irritated mucosa.* We now understand that the mucilaginous compounds present in both plants in high amounts account for their historical use. Both may occasionally help soothe mild aggravation of the gastric mucosa.* An in-vitro study published on Marshmallow in 2010 revealed that “aqueous extracts and polysaccharides from the roots of A. officinalis are effective stimulators of cell physiology of epithelial cells which can prove the traditional use of Marshmallow preparations for the treatment of irritated mucous membranes within tissue regeneration.”[17] Modern science continues to prove out the wisdom of past generations concerning human health.

 

Part of the protective advantage of vegetables may be due to the high amount of fiber present in them that confers the benefit to the digestive system.[18] As with Arabinogalactan, these plant fibers can be fermented by the microbes present in the intestinal tract to produce short-chain fatty acids and other metabolites. Recently, attention has been given to the impact of diet on the intestinal barrier and the regulation of host immunity, and inflammation.  The mucilaginous compounds present in demulcent herbs help to soothe the gastric mucosa in cases of mild irritation. Whereas, L-Glutamine may be beneficial for supporting the optimal permeability of the intestinal tract in situations that require a more specific approach.*  Overall, it seems reasonable to conclude that a strategy that supports gut health with a combination of lifestyle modifications, targeted herbs, and amino acids may produce the most benefit.

 

Bio: Kevin has 15 years’ experience in the nutritional supplement industry.  His conviction that good nutrition is the cornerstone of health fuels his passion for sharing his nutrition knowledge.  Kevin educates and inspires readers with a powerful blend of science, professional experience and personal commitment.

[1] J Fries et al.Reducing Health Care Costs by Reducing the Need and Demand for Medical Services. N Engl J Med 1993; 329:321-325.

[2] Buela KG, Omenetti S, Pizarro TT. Cross-talk between type 3 innate lymphoid cells and the gut microbiota in inflammatory bowel disease. Curr Opin Gastroenterol. 2015 Sep 21.[Epub ahead of print] PubMed PMID: 26398682.

[3] Kapit, W., Macey, R., Meisami, E., The Physiology Coloring Book, HarperCollins College Publishers, 1987, Pg. 74.

[4] as referenced earlier Kapit, W., The Physiology Coloring Book.

[5] Goldberg R, Prescott N, Lord GM, MacDonald TT, Powell N. The unusual suspects–innate lymphoid cells as novel therapeutic targets in IBD. Nat Rev Gastroenterol Hepatol. 2015 May;12(5):271-83.

[6] Buela KG, Omenetti S, Pizarro TT. Cross-talk between type 3 innate lymphoid cells and the gut microbiota in inflammatory bowel disease. Curr Opin
Gastroenterol. 2015 Sep 21. [Epub ahead of print] PubMed PMID: 26398682.

[7] As references earlier, Buela, Curr Opin Gastroenterol. 2015

[8] Geremia A, Biancheri P, Allan P, Corazza GR, Di Sabatino A. Innate and adaptive immunity in inflammatory bowel disease. Autoimmun Rev. 2014 Jan;13(1):3-10.

[9] Andrade ME, et al. The role of immunomodulators on intestinal barrier
homeostasis in experimental models. Clin Nutr. 2015 Jan 23. pii: S0261-5614(15)00034-5.

http://www.ncbi.nlm.nih.gov/pubmed/25660317

[10] As referenced earlier. Andrade ME, et al. Clin Nutr. 2015

[11] Lambert GP, Broussard LJ, Mason BL, Mauermann WJ, Gisolfi CV. Gastrointestinal permeability during exercise: effects of aspirin and energy-containing beverages. J Appl Physiol.2001;90(1985):2075–2080.

[12] Zuhl M, et al. The effects of acute oral glutamine supplementation on exercise-induced gastrointestinal permeability and heat shock protein expression in peripheral blood mononuclear cells. Cell Stress & Chaperones. 2015;20(1):85-93. doi:10.1007/s12192-014-0528-1.

[13] As referenced earlier, Zuhl M et al. Cell Stress & Chaperones. 2015.

[14] Hoffman et al. L-alanyl-L-glutamine ingestion maintains performance during a competitive basketball game. Journal of the International Society of Sports Nutrition 2012, 9:4Med. 2010 Oct;16(10):1065-71.

[15] As referenced earlier. Hoffman et al. Journal of the International Society of Sports Nutrition 2012.

[16] Kelly. G ND. Larch Arabinogalactan: Clinical Relevance of

a Novel Immune-Enhancing Polysaccharide, http://www.altmedrev.com/publications/4/2/96.pdf

[17] Deters A, et al. Aqueous extracts and polysaccharides from Marshmallow roots (Althea officinalis L.): cellular internalisation and stimulation of cell physiology of human epithelial cells in vitro. J Ethnopharmacol. 2010 Jan 8;127(1):62-9.

[18] Li F, Hullar MAJ, Schwarz Y, Lampe JW. Human Gut Bacterial Communities Are Altered by Addition of Cruciferous Vegetables to a Controlled Fruit- and Vegetable-Free Diet. The Journal of Nutrition. 2009;139(9):1685-1691.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Partnering with Dietitians, Nutritionists & Health Coaches

 

By Lisa Murray, RDN, LD

The reward and satisfaction received from helping people improve their health may drive your desire to provide effective care, but honestly, your reputation and the growth of your business rests on your patients’ success.

A person coming to see an integrative practitioner, perhaps for the very first time, can be overwhelmed with what lies ahead of them, the things they have to learn, and the changes they may have to make, if they want to get well and stay well. As you know, it can be very difficult for a busy doctor to meet the needs of those patients requiring a higher level of direct help and support to make lifestyle changes and follow their treatment plan. This is when a dietitian, nutritionist or health coach can be invaluable to you, your patient, and your business. Because what is more important than your patients’ success?

Dietitians, nutritionists and health coaches are able to provide diet and nutrition education, meal plans, shopping lists and recipes, and are trained in methods facilitating behavior change. Their expertise is in determining what areas a patient requires more education, providing it in a way the patient can understand, identifying obstacles to compliance and providing strategies to overcome those obstacles. For a patient who is confused and struggling with changes, they can segment a treatment plan into smaller, progressively achievable goals, monitor their compliance and provide proactive outreach to help motivate patients toward greater success. They can offer health and wellness classes, run support groups and write articles for your website, blogs or newsletters. Their contributions as members of the healthcare team can bring added value to your patients. How this works for you and your practice depends upon what you want, what your patients need and the person you choose.

Dietitians are licensed healthcare providers, and insurance companies will pay for them to provide nutrition counseling for patients with diagnoses such as diabetes, heart disease and renal disease. Insurance may also pay for weight management counseling individually, and for group education. You may decide to develop a referral partnership, or invite a dietitian to join your integrative practice to provide nutrition counseling for your patients, teach classes and also accept outside referrals.

The mission of a health coach is to drive success. They will help your patients develop a manageable plan for reaching their health goals, track their progress and help them overcome roadblocks along the way. Greater availability and more frequent contact with patients allow a health coach the opportunity to ask and answer questions, coaching and motivating patients to stay on track.

Education and experience varies widely so interview and choose carefully. Someone knowledgeable about supplements and integrative therapies will understand your work, and know how to align their approach with yours. Whether you decide to form a referral partnership or hire someone within your practice to provide these services to your patients, your partnership will be more successful if you communicate clearly about your expectations and parameters. Be clear about what you want for your patients, as well as what you don’t want! As in any good relationship, communication is the key to success!

15_11_lisa_meetbios

Lisa Murray, RDN, LD

 

Natural Personal Care: The Importance of Going Clean!

By Tina Beaudoin, ND

While many of us avoid pesticides in our produce, scrutinize food labels and drink out of glass or steel containers, how would you rate what sits on the shelves in your bathroom and in your shower? There are over 10,000 unique chemical ingredients that go into personal care products! The government does not require health studies, pre-market safety testing or FDA approval before these products end up in our shopping carts.

While many of our patients don’t readily think of personal care products as a source of toxin exposure, we know that the skin readily absorbs whatever we rub, rinse, lather or spritz onto it in our daily routines. For this reason, below are a few highlights to keep in mind or turn into a quick reference for your patients when discussing personal care products:

Parabens: endocrine disruptor with estrogenic activity, intact parabens can accumulate in human breast tissue at levels sufficient to increase the growth of breast cancer cells1

Forms: ethyl, methyl, butyl or propyl parabens

Frequently found in: cosmetics, moisturizers, hair care       products, shaving products

Phthalates: endocrine disruptor with estrogenic activity, decreased male fertility2, elevated levels found in autism spectrum disorder3, endometriosis4, pro-atherogenic and pro-senescence effects via severe lipoprotein modification5

Forms or common names: diethyl (DEP), diisobutyl, and bis (2-ethylhexyl) phthalates, MEHP, DEHP, note that ‘fragrance’ on an ingredient label likely contains phthalates

Frequently found in: personal care products as softeners and flexible plastics (recent study found phthalates can be absorbed from plastic milk containers with phthalates bound to milk proteins6 ), perfume, nail polish, adhesives, caulk, paint pigments and flooring

Bisphenol-A: endocrine disruptor with estrogenic activity that has been linked to higher risk of developing diabetes, infertility, cardiovascular disease and certain cancers (breast, prostate and testicular), found to neutralize the effects of tamoxifen and stimulate prostate cancer cell migration7, and influence resistance to cell death8

Forms or common names:  BPA

Frequently found in: nearly all beverage and food cans as epoxy lining, plastics with #7 recycling code, water bottles, composite fillings, various medical and dental devices, water supply pipes

The take home message is that while parabens, phthalates and BPA’s are ubiquitous in our environment and pose significant health hazards, it is possible to reduce your exposure by reading labels, minimizing plastics and staying informed. You can purchase products with natural ingredients, and a couple of great resources are Dr. Walter Crinnion’s book Clean, Lean and Green and the Environmental Working Group’s online database (www.ewg.org). Be sure to stayed tuned for ‘Part 2’ as there is definitely more to come!

Tina Beaudoin
Tina Beaudoin, ND

References

Charles, AK, Darbre, PD. Combinations of parabens at concentrations measured in human breast tissue can increase proliferation of MCF-7 human breast cancer cells. J Appl Toxicol. 2013; 33(5): 390-8.

 Dodge LE, Williams PL, Williams, Missmer SA, Souter I, Calafat AM, Hauser R.  Associations between paternal urinary phthalate metabolite concentrations and reproductive outcomes among couples seeking fertility treatment.  Reprod Toxicol. 2015; Oct 6. [Epub ahead of print].

 Kardas F, Bayram AK, Demirci E, Akin L, et al. Increased Serum Phthalates (MEHP, DEHP) and Bisphenol A Concentrations in Children With Autism Spectrum Disorder: The Role of Endocrine Disruptors in Autism Etiopathogenesis. J Child Neurol. 2015; Oct 8. [Epub ahead of print].

 Kim SH, Cho S, Ihm HJ, et al.  Possible role of phthalate in the pathogenesis of endometriosis: in vitro, animal, and human data.  BMJ Clin Endocrinol Metab. 2015; Oct 6. [Epub ahead of print].

Kim SM, Yoo JA, Baek JM, Cho KH.  Diethyl phthalate exposure is associated with embryonic toxicity, fatty liver changes, and hypolipidemia via impairment of lipoprotein functions.  Toxicol In Vitro. 2015; Sep 28.   [Epub ahead of print].

Lin J, Chen W, Zhu H, Wang C. Determination of free and total phthalates in commercial whole milk products in different packaging materials by gas chromatography-mass spectrometry. J Dairy Sci. 2015; Oct 7.  [Epub ahead of print]

 Dairkee SH, Seok J, Champion S, Sayeed A, Mindrinos M, Xiao W, Davis RW, Goodson WH.  Bisphenol A induces a profile of tumor aggressiveness in high-risk cells from breast cancer patients.Cancer Res. 2008; 68: 2076–2080.

 Narayanan KB, Ali M, Barclay BJ, et al.  Disruptive environmental chemicals and cellular mechanisms that confer resistance to cell death. Carcinogenesis. 2015; 36: S89-110.

PAIN NEUROSCIENCE—TEACHING PEOPLE ABOUT PAIN—PART 2

By Julie Beck, DC, MS, CSCS

In my first article in this two-part series on pain,  I outlined conventional medicine’s central dogma’s about pain—how pain is perceived, categorized, identified and treated.

 A summary of these conventional dogmas included:

  1. Pain has patho-anatomical origins. Or more simply put, pain is an “issue with your tissues” and the degree of pain is correlated with the degree of tissue irregularity or “damage”.
  2. Since pain is generated by damaged tissues, imaging (x-ray, CT, MRI) can identify the pain generating tissue(s).
  3. If the pain generators can be identified with imaging surgical measures are utilized to excise damaged tissue and pharmaceuticals can be used to manage or interrupt the experience of pain until (hopefully) appropriate healing occurs.
  4. If damaged tissues cannot be identified (as Fibromyalgia or Chronic Fatigue Syndrome) or if post-surgically pain is unchanged —continued use of opioids, anti-depressants and anti-inflammatories are utilized and additional or repeated surgical options may be explored.

(Note: It is important to remember that the above scenario is primarily referring to non-acute, non-traumatic pain events.)

So where did this approach come from?

Enter the Cartesian Model of Pain (Rene Descartes 1596-1650). This model is likely to blame for many of our current misconceptions about pain, and  is still a driving force in how medicine is delivered today.1

If you’ve investigated neurology, you’ve likely seen the classic picture Descartes drew to describe what he believed to be the events that occurred for the experience of pain to be felt.

Briefly, the picture depicts a man with his foot perilously close to a fire; Descartes proposed that this event triggered a message (some type of “spirit”) that traveled up a hollow tube within the body to the brain and rang a bell that produced pain.

Not bad for his time, but we definitely should be able to do better than this now. Let’s start unpacking this by remembering one of neurosciences most progressive definitions of pain:

 “Pain is a multiple system output activated by the brain based on perceived threat.2

Ankle sprains are a common injury. And I don’t think anyone would argue that they are painful, but what if you sprained your ankle while crossing a street and out of the corner of your eye see a car heading straight for you.

 In that moment, does your ankle hurt?  Likely not.

When you get to the safety of the sidewalk does your ankle hurt?  Likely so.

What just happened? 

The only message the ankle can send the brain is a “danger message”. The car heading toward you in the above example  is unarguably much more dangerous to your survival than your ankle sprain. Once safely on the sidewalk, the brain is now cleared to receive the messages from various ankle nociceptors (A-delta and C-fibers), activated by inflammatory chemicals and mechanical tissue inputs, passed to the spinal cord and ultimately the brain. OUCH.

Two important concepts here:

1) Pain is a construct of the brain or a brain output, and

2) Nociceptors are not pain fibers—the human body arguably does not have pain fibers. A-delta and C-fibers are listed in neurology texts as “pain” or “pain-conducting” fibers, but if this were true, you would have felt the unmodulated pain of your ankle in the middle of the street.

Note: Some have argued that a central nervous system sympathetic overdrive is at play and accounts fully for the above phenomena.  This has been refuted.2,3 

Recap thus far: Pain intensity does not strongly correlate with tissue damage, we have nociceptor not pain-fibers, and pain is a brain construct and it therefore decides when you will experience pain.

Next big concept: Since we have established that pain is produced by the brain, then altering the information that the brain receives can potentially alter “threat” perceptions and thus the experience of pain.

This is one of the reasons massage or bodywork can work so well for reducing pain, it is really reducing the brains overall assessment of threat.

There are representational body maps within the brain that are dynamically maintained and negatively influenced by neglect (decreased quantity and variety of movement) and pain. This means that increasing the amount and variety of movement can greatly reduce the brain’s threat perception. (Each case should of course be individually assessed by an appropriately trained professional for the most appropriate quantity, quality, type and duration of movement intervention).

What if your patient is afraid of movement, because some unknowing health care practitioner told them it was “bad” for them to move a certain way (ex. lumbar spine extension or flexion), or load a joint too much (stay off your feet), or that they have a really low pain-threshold?

(And pain-thresholds per se don’t exist, sensitized movements, positions or activities do exist).

This is where education fits in. Experts agree that the experience of pain is influenced by a large number of biological, psychological and social variables. The biological variables are familiar: our dietary, exercise and sleep habits, our inflammatory state, and how well our HPA-Axis is regulated (remember the hypothalamus and pituitary are brain structures) all affect our perception of pain. Rarely considered are the psychological and social variables: quantity and quality of our community social structures, belief about pain in general or associated with previous or familial experiences of pain.

Psychologically, I encourage you to examine the language you use, or more often incorrectly repeat, regarding pain especially in front of someone in pain. A few common examples: “bone-on-bone”, “fragile-spine”, and any version of “bulging or herniated-disc”. Think how these terms might inadvertently be negatively supporting someone’s pain state.

To close, remember pain is not a reliable indicator of anatomical damage. Chronic pain is a mix of multiple variables, with layers of brain-generated perceptual complexity. And patient education about what pain is, and is not, can be a top-down therapeutic intervention for your patients in pain.

juliehs5.1 (1).jpg
Julie Beck, DC, MS, CSCS

 

References

Goldberg, LS. “Revisiting the Cartesian model of Pain”. Medical Hypothesis, (2008) 70(5):1029-1033.

Moseley, GL. “A Pain Neuromatrix Approach to Patients with Chronic Pain”. Man Ther, (2003) 8(3):130-140.

Melzack, R. “Pain and the Neuromatrix in the Brain”. Journal of Dental Edu,   (2001)65:1378-1382

 

 

A “SUPERFOOD” FOR HEALTHY AGING

By Lisa Murray, RDN, LD

Traveling around the globe has exposed me to a wide variety of cultural cuisines. As a “bonafide foodie”, I can find something wonderful about each and every one. I am truly happy to live in America where we have so many advantages, and such a high quality of life in comparison to many other parts of the world. But as integrative practitioners, we know that one of our own cultural disadvantages is the Standard American Diet, which is truly “SAD” indeed. What makes it so sad, is that our cultural cuisine does not support healthy aging, and in fact, as most of us are aware, it has created a wide variety of health problems instead. It’s interesting to note that in one source for “World Ranking of Life Expectancy for 2015″1, the US ranks 53rd! Being one of the wealthiest nations in the world, how can that be?

Most of the countries ranking in that top 10, have something interesting in common…..and that something is the ocean, coastal proximity and….you guessed it…..FISH! Is this the secret to healthy longevity? Japan, Singapore, Macau (China), Hong Kong, Monaco, Guernsey, San Marino and Italy are coastal or island countries, with fish featuring prominently in their diets. We have all come to understand the importance of Omega-3’s to our health……but are we really giving it the importance it deserves?

Fish is truly one of the most powerful therapeutic and antiaging foods. I have witnessed the transformational healing power of a therapeutic diet including fish and cooked greens on a daily basis.  A diet rich in fish, vegetables and berries is powerfully anti-inflammatory, immune enhancing, lipid balancing and supports healthy aging in a wide variety of ways that we know about, and probably many more we don’t know yet.

A study published in the American Journal of Clinical Nutrition, November 20072, concluded that in the elderly, a diet high in fish and fish products is associated with better cognitive performance in a dose-dependent manner. Maximum effect was observed at an average intake of ≈75 g/d (or 2.5 oz/day). And guess what? Nothing has changed! The OmegAD Study, published this month in the Journal of Alzheimer’s Diseases3, shows a positive dose-response relationship between plasma levels of Omega-3 Fatty Acids, and preservation of cognition. Advancements in our studies of antioxidants, flavonoids, polyphenols, anthocyanidins and all the other beneficial phytochemicals still doesn’t change the basic fact that fish is one of nature’s premier anti-aging foods.

Each ounce of salmon contains roughly 500 mg of Omega-3. Most of us would consume a 4oz portion yielding about 2000mg of Omega-3. Unfortunately the issue of mercury contamination cannot be ignored, and the “Dietary Guidelines for Americans” published in 2011 underscores this by recommending consuming only up to 12 oz. of seafood per week. The Environmental Working Group website4  is a good source for up to date information on fish safety. Salmon, mussels, rainbow trout, mackerel and sardines top the list for being the highest in Omega-3s and lowest in mercury, so don’t be afraid to recommend consuming 4oz of wild caught Salmon, three times a week!  When that may be impractical, we can still get the Omega-3s we need every single day from supplements.  So whether or not you like fish, live in Alaska or Iowa, are Paleo or Vegan, we all have the opportunity to reap most of the benefits of Omega-3s, even if we don’t buy fresh fish and cook it at home!

Lisa E Murray, RDN, LD

Lisa Murray, RDN, LD

 

References

Geoba.SE, Top 100 Rankings, The World: Life Expectancy 2015, Web. October 6, 2015; http://www.geoba.se/population.php?pc=world&type=15

Nurk E, Drevon CA, Refsum H, et al. Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study. Am J Clin Nutr 2007; 86: 1470–8.

Eriksdotter M, Vedin I, Falahati F “Plasma fatty acid profiles in relation to cognition and gender in Alzheimer’s Disease patients during oral Omega-3 Fatty Acid supplementation: The OmegAD Study”  J Alz Dis, Oct 2015; Vol.48: p805-12

“EWG’s Consumer Guide to Seafood”; The Environmental Working Group, Consumer Guides, Web. October 6, 2015; http://www.ewg.org/research/ewgs-good-seafood-guide, Accessed October 6, 2015

Emerson Ecologics Celebrates VAWD Certification

As we look to a new year, it is  a time of reflection, transition, and if you are in a climate like ours, preparedness for the cold. Here at Emerson, we continue to hold our focus on two areas we know are vital to your practice: delivering the best quality products to you and your patients and expanding our service offerings that help you run a better business and focus on what you really love to do—work with patients!

One huge accomplishment of our team which I’m thrilled to share is receiving our accreditation as a “Verified Accredited Wholesale Distributor” (VAWD). This is the top accreditation for a facility that holds and distributes drugs, including controlled substances, and the application and audit process takes months to achieve. While Emerson Ecologics has only a very small offering of prescription drugs, we feel the investment to achieve VAWD status is right in line with our mission to ensure that only the best products available are offered to you (http://tiny.cc/EmersonVAWD).

VAWD certification is one more way we can provide you with the assurance that your products will get the “white glove treatment” from us. So, as you transition into a new year, I hope that you continue to rest assured that we’ve got your back!

Healthy regards,

Jaclyn Chasse, ND

Jaclyn Chasse, ND

REFLECTING ON A SUCCESSFUL INAUGURAL IGNITE CONFERENCE

No matter a practitioners credentials, specialty or practice size, it is unanimously agreed upon that there is not enough business education provided in traditional medical educational programs. This lack of attention on something that is so foundational for any small business owner makes it no surprise that having discussions around things like achieving financial success still go mostly unspoken.

In 2014, the team at Emerson Ecologics began shedding light on the topic through the launch of a series of one-day workshops and webinars, but we knew there was more work to be done to bring these important business discussions to the forefront. Recognizing this gap in the education, led the team to make the bold decision to create a different kind of integrative event — one solely focused on providing business education.

Now that we are a few weeks post-conference, the buzz of positivity and excitement only continues to build. Seeing people working together on-site to solve their challenges and hearing them say that they no longer feel alone in the struggles they face when trying to build and optimize their practice, makes daring to be different feel very much worthwhile.

The conference featured inspirational keynotes from Jeffrey Bland, PhD and Lise Alschuler, ND, who stepped in for Tieraona Low Dog, M.D. who couldn’t attend do to an injury. Additionally, there were hands-on workshops taught by experts in the field of integrative medicine and plenty of time for fun and networking, both with peers and some of Emerson’s most loved brands. While there was a lot to love about the event, the most valuable takeaway for many was the message that is necessary for all practitioners to hold their time and knowledge as precious. Setting boundaries, holding space for personal fulfilment and focusing on the areas you are passionate about, is not just okay, it is necessary for true success.

This shift in mindset is the perfect foundation for how practitioners will help integrative medicine emerge as the primary form of healthcare in our country. To be even a small part of the change that puts integrative medicine over that tipping point is exciting and will surely bring about “the dawn of a new age” that Dr. Bland spoke about in his keynote presentation even faster. We at Emerson can’t wait to continue to support this change and look forward to announcing 2016 conference details in the next few weeks! We hope you will join us.

To learn more about IGNITE, visit us at eeignite.com 

Close Encounters of a Therapeutic Kind – Pain Neuroscience Introduction

By Dr. Julie Beck,  DC, MS, CSCS

Dogma is a principle or set of principles laid down by an authority as incontrovertibly true. It serves as part of the primary basis of an ideology or belief system, and it cannot be changed or discarded without affecting the very system’s paradigm, or the ideology itself.  -wikipedia

The central dogma of orthodox biology was the belief that DNA controlled life, period.

The anti-climax of the Human Genome Project, the costly effort to sequence our genetic code, taught us that there is more to the story of our individual uniqueness than can be found in our 25,000 protein coding genes.  This awakening gave birth to the field of epigenetics (i.e., how environmental, nutritional, lifestyle, stress, sleep and other variables effect how are genes are expressed), leaving the DNA-emperor looking a tad chilly.

Pain similarly has its central dogma(s), and although they may not be as explicitly expressed as its biological-DNA counterpart, they are implicitly entrenched in the education, language, management, perceptions and societal understandings of pain.  Here are several pain dogma’s:

  1. Pain has patho-anatomical origins and patho-anatomical perpetuators [meaning that the origin of pain is in tissue(s), and the primary perpetuator of pain is “damaged” tissue(s).)
  2. Pain generators can be elucidated via imaging (x-ray, CT, MRI) by identifying imperfections in tissue(s) (i.e., bone, joint, muscle, tendon, etc.) This behavior is strongly entrenched even though there are many evidence-based clinical guidelines that would strongly suggest that MRI and x-rays should not be the first line approach in the assessment of musculoskeletal pain.
  3. Pain should be treated by surgical means and if surgery is unsuccessful should be managed with pharmaceuticals (primarily opioids, anti-inflammatories and anti-depressants.)
  4. And potentially the most damaging of all – if no peripheral pain generator (i.e. damaged tissue, inflammatory mediator) can be found, the pain (and patient that has it) is dismissed as a malingerer (fabricating for secondary gain), or the pain is summarily dismissed as “less real” or somehow imagined (“all in your head”). Which is medical scape-goating at its unsavory worst.

 

The scientific research clearly indicates a disconnect in the medical world – a disconnect between commonly-held beliefs about pain and the treatment of pain, and the evidence that refutes them.1,2,3

A large component of managing chronic pain is clarifying our patients understanding of what pain is and what it isn’t; and by doing so positively influence the direction of their pain trajectory.4,5

I’ll close for now with neurosciences current definition of pain (Moseley, 2003):

Pain is a multiple system output activated by the brain based on perceived threat.

In Emerson’s 4th Quarter Element magazine, I will cover how to reframe your discussions about pain with your patients or clients and in doing so positively facilitate the modulation of their pain perceptions.

1.Thorlund, et, al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015 Jun 16;350:h2747. doi: 10.1136/bmj.h2747.

2. Deyo RA and Weinstein JN. Low back pain. N Engl J Med 2001 344:363-370.

3. Nachemson AL. Newest knowledge of low back pain. A critical look. Clin Orthop Relat Res 1992 Jun;(279):8-20.

4.Butler, Moseley. Explain Pain. 2003.

5. Louw, Puentedura. Therapeutic Neuroscience Education – Teaching Patients about Pain. 2013

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