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Heart Stents Fail to Ease Chest Pain

A new study has found that while stents can be lifesaving in opening arteries in patients having a heart attack, the devices are ineffective in relieving chest pain. A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them, researchers reported on Wednesday.

Their study focused on the insertion of stents, tiny wire cages, to open blocked arteries. The devices are lifesaving when used to open arteries in patients in the throes of a heart attack.

But they are most often used in patients who have a blocked artery and chest pain that occurs, for example, walking up a hill or going up stairs. Sometimes patients get stents when they have no pain at all, just blockages.

Heart disease is still the leading killer of Americans — 790,000 people have heart attacks each year — and stenting is a mainstay treatment in virtually every hospital. More than 500,000 heart patients worldwide have stents inserted each year to relieve chest pain, according to the researchers. Other estimates are far higher.

Several companies — including Boston Scientific, Medtronic and Abbott Laboratories — sell the devices, and inserting them costs from $11,000 to $41,000 at hospitals in the United States.

The new study, published in the Lancet, stunned leading cardiologists by countering decades of clinical experience. The findings raise questions about whether stents should be used so often — or at all — to treat chest pain.

“It’s a very humbling study for someone who puts in stents,” said Dr. Brahmajee K. Nallamothu, an interventional cardiologist at the University of Michigan.

Dr. William E. Boden, a cardiologist and professor of medicine at Boston University School of Medicine, called the results “unbelievable.”

Dr. David Maron, a cardiologist at Stanford University, praised the new study as “very well conducted” but said that it left some questions unanswered. The participants had a profound blockage but only in one artery, he noted, and they were assessed after just six weeks.

“We don’t know if the conclusions apply to people with more severe disease,” Dr. Maron said. “And we don’t know if the conclusions apply for a longer period of observation.”

For the study, Dr. Justin E. Davies, a cardiologist at Imperial College London, and his colleagues recruited 200 patients with a profoundly blocked coronary artery and chest pain severe enough to limit physical activity, common reasons for inserting a stent.

All were treated for six weeks with drugs to reduce the risk of a heart attack, like aspirin, a statin and a blood pressure drug, as well as medications that relieve chest pain by slowing the heart or opening blood vessels.

Then the subjects had a procedure: a real or fake insertion of a stent. This is one of the few studies in cardiology in which a sham procedure was given to controls who were then compared to patients receiving the actual treatment.

In both groups, doctors threaded a catheter through the groin or wrist of the patient and, with X-ray guidance, up to the blocked artery. Once the catheter reached the blockage, the doctor inserted a stent or, if the patient was getting the sham procedure, simply pulled the catheter out.
Jim Stevens, a lawyer in Troy, Mich., was about to have a stent put in, but the new study gave his cardiologist pause. He advised against inserting the stent, and Mr. Stevens concurred.

Credit Sean Proctor for The New York Times

Stent
Neither the patients nor the researchers assessing them afterward knew who had received a stent. Following the procedure, both groups of patients took powerful drugs to prevent blood clots.

The stents did what they were supposed to do in patients who received them. Blood flow through the previously blocked artery was greatly improved.

When the researchers tested the patients six weeks later, both groups said they had less chest pain, and they did better than before on treadmill tests.

But there was no real difference between the patients, the researchers found. Those who got the sham procedure did just as well as those who got stents.

Cardiologists said one reason might be that atherosclerosis affects many blood vessels, and stenting only the largest blockage may not make much difference in a patient’s discomfort. Those who report feeling better may only be experiencing a placebo effect from the procedure.

“All cardiology guidelines should be revised,” Dr. David L. Brown of Washington University School of Medicine and Dr. Rita F. Redberg of the University of California, San Francisco, wrote in an editorial published with the new study.

Clinical guidelines in the United States say stenting is appropriate for patients with a blocked artery and chest pain who have tried optimal medical therapy, meaning medications like those given to the study patients.

But those guidelines were based on studies in which patients simply said they felt better after having stents inserted.

“It was impressive how negative it was,” Dr. Redberg said of the new study. Since the procedure carries some risks, including death, stents should be used only for people who are having heart attacks, she added.

Stents came into wide use in the 1990s and became the treatment of choice because they were less invasive than bypass surgery. But there have long been questions about their effectiveness.

A large, federally funded study with Dr. Maron as a co-principal investigator, which does not have an untreated control group, is now underway to determine whether medications can be just as effective as stenting or coronary bypass in preventing heart attacks.

In 2007, another large study led by Dr. Boden — also without an untreated control group — found stents did not prevent heart attacks or deaths from heart disease.

The explanation, researchers said, was that atherosclerosis is a diffuse disease. A few arteries might be blocked today, and then reopened with stents. But tomorrow a blockage might arise in another artery and cause a heart attack.

Relieving chest pain, though, seemed a different goal to many cardiologists. After all, the heart is a muscle, and if a muscle is starved for blood, it aches.

Many patients have coronary arteries that are 80 to 90 percent blocked. Surely opening those vessels should make the patients feel better.

Mr. Stevens was on the operating table to receive a stent through his wrist when his cardiologist, Dr. Brahmajee K. Nallamothu, had second thoughts and ended the procedure.

The idea that stenting relieves chest pain is so ingrained that some experts said they expect most doctors will continue with stenting, reasoning that the new research is just one study.

Even Dr. Davies hesitated to say patients like those he tested should not get stents. “Some don’t want drugs or can’t take them,” he said.

Stenting is so accepted that American cardiologists said they were amazed ethics boards agreed to a study with a sham control group.

But in the United Kingdom, said Dr. Davies, getting approval for the study was not so difficult. Neither was it difficult to find patients.

“There are many people who are open to research, and if you tell them you are exploring a question, people agree,” he said. Nonetheless, it took him three and a half years to find the subjects for his study.

Ethics boards at many American hospitals probably would resist, since giving such patients fake procedures “flies in the face of guidelines,” Dr. Boden said.

Placebo effects can be surprisingly powerful, said Dr. Neal Dickert, Jr., a cardiologist and ethicist at Emory University.

A few years ago, researchers — at the insistence of the Food and Drug Administration — did a study to test an invasive procedure to treat high blood pressure. The control group got a sham procedure.

The method was becoming popular in Europe, but the study found that blood pressure dropped just as much in those who had the fake treatment.

Dr. Dickert said he hoped the new stent study will show cardiologists that they need to do more studies with sham procedures.

“This may turn out to be an important moment,” he said.

But getting them underway in the United States may not be easy. Ethics boards at hospitals and universities are likely to resist, as are patients.

“It’s not just up to us,” said Dr. David Goff, director of cardiovascular sciences at the National Heart, Lung and Blood Institute.

Still, the results of the new research have at least one heart specialist rethinking his practice.

Dr. Nallamothu got an advance look at the new paper on Tuesday. Coincidentally, he had a patient, Jim Stevens, 54, a lawyer in Troy, Mich., scheduled to receive a stent that day.

Mr. Stevens had a blocked artery, but the new report gave Dr. Nallamothu second thoughts. “I took him off the table,” he said.

He explained to Mr. Stevens and his wife that he did not need a stent. “I was surprised,” Mr. Stevens said.

“But I feel better not needing it.”

Credit GJLP, CNRI, via Science Source The New York Times, 2nd November 2017
RELATED COVERAGE

MENDING HEARTS
A Sea Change in Treating Heart Attacks JUNE 19, 2015

MENDING HEARTS
Putting Stents to the Test JUNE 22, 2015

MENDING HEARTS
A New, Life-or-Death Approach to Funding Heart Research OCT. 16, 2015

 

Two major studies identify ‘significant concentrations’ of mercury in the red blood cells of autistic children

Mercury is a potent neurotoxin. Even the smallest amounts can cause cumulative adverse effects. Two of the most widespread forms of mercury exposure come from the organic compounds methylmercury (found in fish) and ethylmercury, which makes up 50% of the vaccine preservative thimerosal. The Agency for Toxic Substances and Disease Registry (ATSDR) affirms that young children and fetuses are particularly sensitive to harmful mercury-related effects such as “brain damage, mental retardation, incoordination, blindness, seizures and inability to speak.” This calls into question public health authorities’ aggressive peddling of annual flu shots—many of which contain thimerosal. The influenza vaccine guidelines target all children who are at least six months of age, with two closely spaced doses recommended for very young children in their “first season of vaccination.” They also target pregnant women and women who “might” be pregnant.

Organic mercury can cross the blood-brain barrier, and numerous studies have fingered it as a major offender in increasing the risk of neurodevelopmental disorders such as autism spectrum disorder (ASD), tic disorders, delayed language and attention-deficit/hyperactivity disorder (ADHD). Shamefully, the Centers for Disease Control and Prevention (CDC) refuses to admit that mercury is an ASD risk factor. Instead, it has been left up to other researchers to continue to focus attention on the compelling relationship between mercury and ASD.

Taking stock across studies

Two 2017 studies perform a valuable service by systematically reviewing the totality of published mercury-ASD evidence that has accumulated over the past dozen or so years, in particular. The two studies both come out of Iran, and both employ a technique called meta-analysis, which is a quantitative systematic review. Meta-analytic studies seek to take a step back and draw rigorous conclusions about comparable studies as a group. A key benefit of this approach is that it can consolidate “a large, and often complex, sometimes apparently conflicting, body of literature.”

The meta-analysis approach is a very appropriate tool for taking stock of published studies that compare mercury levels in ASD individuals and healthy controls without ASD. The first meta-analysis (published in the Journal of Trace Elements in Medicine and Biology by Tina Jafari and other researchers at Iran’s Shahrekord University of Medical Sciences) focuses exclusively on mercury. The second study (published in Progress in Neuropsychopharmacology and Biological Psychiatry by Amene Saghazadeh and Nima Rezaei at the Tehran University of Medical Sciences) examines mercury along with other heavy metals such as lead. Both research teams used state-of-the-art statistical techniques to produce unbiased results.

The table below summarizes the key features of study #1 (Jafari et al.) and study #2 (Saghazadeh and Rezaei):

Both studies found significantly higher concentrations of mercury in the red blood cells of ASD patients versus healthy controls, and the first meta-analysis found significantly higher levels in the whole bloodof ASD patients.

The two meta-analyses examined mercury levels for each type of specimen or tissue. Both studies found significantly higher concentrations of mercury in the red blood cells of ASD patients versus healthy controls, and the first meta-analysis found significantly higher levels in the whole blood of ASD patients. (The second study also found higher levels of lead in both the red blood cells and blood of individuals with ASD, which is suggestive of possible combined or synergistic effects.)

There were no significant differences in urinary mercury levels in ASD and healthy individuals, but there were interesting findings for mercury levels in hair. In study #1, mercury concentrations were significantly lower in ASD patients compared with healthy subjects—but when the investigators analyzed their results by continent, this result held only for America but not for Asia, Africa or Europe. Similarly, study #2’s comparison of developed and developing countries found that mercury levels were significantly lower in the hair of ASD patients in developed but not developing countries—and the preponderance of developed-country studies came from the U.S.

Study #1 also affirmed significantly higher mercury levels in ASD brain tissue. However, the number of brain studies identified for the meta-analysis was very small and also somewhat unclear. The authors report pooling the results of three studies, but their reference list and table include just two studies published by Harvard researchers in 2008 and 2014, respectively. (World Mercury Project has asked the authors to clarify this discrepancy.) The 2008 study found a 68.2% increase in cerebellar mercury in autistic brain tissue (from 3.2 to 80.7 pmol g-1) compared with brain tissue of controls (from 0.9 to 35 pmol g-1), but the increase was not statistically significant. On the other hand, there was a statistically significant elevation in a key marker of oxidative stress in the ASD group that was significantly and positively correlated with elevated mercury. The 2014 study detected no difference in mercury levels but again noted elevated oxidative stress in the ASD group.

Interpreting the findings

Researchers note that a properly conducted systematic review or meta-analysis “allows the reader to take into account a whole range of relevant findings from research on a particular topic” and “establish whether the scientific findings are consistent and generalizable across populations [and] settings…and whether findings vary significantly by particular subgroups.” In addition, “mathematically combining data from a series of well-conducted primary studies may provide a more precise estimate of the underlying ‘true effect’ than any individual study.”

In this instance, the two Iranian teams used a variety of techniques to mitigate the potential weaknesses of meta-analyses. These included using multiple databases, search terms and search strategies to identify relevant studies; following established guidelines to assess the quality of each study; investigating sources of and (where appropriate) adjusting for heterogeneity; analyzing subgroup differences (i.e., the distinction between developed and developing countries); and screening for publication bias. The substantial overlap in the individual studies included in each meta-analysis and the comparability of the two teams’ findings offer a further degree of confidence in the results.

To explain the seemingly counterintuitive finding that hair mercury concentrations are lower (rather than higher) in ASD patients versus healthy individuals, Jafari et al. point to the evidence that those with ASD have impaired detoxification pathways and mechanisms.

As a result, ASD individuals retain mercury inside the cells rather than being able to effectively excrete it through the hair, stool or urine. The Iranian authors do not delve into the question of why ASD patients in developed (primarily U.S.) versus developing countries are less likely to excrete mercury and more likely to retain a heavy body burden. However, one conspicuous factor that differentiates the U.S. from other developed countries (as well as the rest of the world) may help explain this result: the U.S. promotes a far more burdensome vaccine schedule, laden with heavy metals such as thimerosal and aluminum, and annually insists that moms accept thimerosal-containing flu vaccines for themselves and their young children.

Moreover, some common flu vaccines contain the emulsifier polysorbate 80, which disrupts the blood-brain barrier and helps create an extremely effective delivery system for escorting neurotoxic ethylmercury and other heavy metals straight to the brain.

Research by Burbacher and colleagues compared blood and brain mercury levels in monkeys exposed to methylmercury and ethylmercury. That work showed that ethylmercury, in particular, goes to the brain, gets metabolized into even more toxic inorganic mercury and remains in the brain for years. Moreover, some common flu vaccines contain the emulsifier polysorbate 80, which disrupts the blood-brain barrierand helps create an extremely effective delivery system for escorting neurotoxic ethylmercury and other heavy metals straight to the brain.

Unfortunately, the majority of published studies only measure total mercury, and very few have examined brain tissue. This makes it challenging to zero in on the specific effects and mechanisms associated with exposure to ethylmercury. Given young children’s widespread exposure to ethylmercury in vaccines, there is no excuse for failing to address this research gap—and even less excuse for failing to remove thimerosal from all vaccines.

Courtesy: Nexus

 

Video Presentation  Holistic View of The Liver
– by Matthew D’haemer ND

A fascinating video presentation for practitioners on using iridology and energy healing for Liver issues as presented at the 19th Annual Symposium in April 2016..

 

Hydrotherapy – by Abigail Francis and Roger Gross

We are grateful to Abigail and Roger for offering us the opportunity to upload their presentation on Hydrotherapy which was recently presented at the GNI Symposium in April 2016.  It contains much up to date information on Hydrotherapy and draws from their visits to the Germany Kneipp site.  There is a 4th section yet to update but there is much to go on for the moment.  Enjoy!

HYDROTHERAPYGNI042016 Part

1HYDROTHERAPYGNI042016 Part

2HYDROTHERAPYGNI042016 Part 3

 

Stress and The Liver Presentation  Stress and the Liver – by Hakim M. Salim Khan, M.D. (M.A.), M.H., D.O., F.G.N.I.

 

Cereal Concerns?
– by Gabi Heyes

photo credit: Bob.Fornal via photopin cc

photo credit: Bob.Fornal via photopin cc

Question: The safety of cereal was recently brought to my attention in the book Nourishing Traditions. Is cereal safe?

Answer: There are two unpublished studies regarding the safety of cereal, one involving puffed wheat and the other involving corn flakes. Both of the studies were performed on laboratory rats. The first experi- ment had results that are quite startling, involving dysfunction of the pancreas, liver, kidneys and eventually death. The sec- ond experiment had neurologi- cal and psychological outcomes such as schizophrenia, convul- sions, aggression and death.

Foods for arthritis relief
– by Georgie O’Connor

Cauliflower. Photo credit: OliBac via photopin cc

Cauliflower. Photo credit: OliBac via photopin cc

There are lots of fabulous foods to choose from that will provide oodles of phytonutrients, antioxidants and anti-inflammatory compounds, such as pears, apples, berries, spinach, carrots and sweet potatoes…Two
to three portions of oily fish a week such as salmon, mackerel or sardines will provide the necessary essential fat, omega-3, that will ensure any inflammatory response is appropriate. If you’re vegetarian, use ground flaxseed or chia seeds. Onions, garlic, turmeric and ginger will add depth and zing to each and every meal and pack a powerful anti-inflammatory punch. You can also use ginger to flavour teas or just steep it in hot water with lemon for a refreshing alternative to regular tea. Consider increasing your consumption of green tea, to keep the anti-inflammatory nutrients coming between meals…. read more

Fatigue & Iridology Video Presentation
– by Matthew D’haemer ND

A fascinating video presentation for practitioners on using iridology for cases with energy problems and fatigue… view video here

Thinking of studying naturopathy – but do you know what it is?
by Jackie Day ND, DNI, MH, FGNI

It’s not nutritional therapy and it’s not functional medicine: or is it? Naturopath Jackie Day, ND, MH, NI, FGNI, FNNA, MAMH, chair of the General Naturopathic Council, explains the scope of modern naturopathic practice – and introduces a new opportunity for qualified practitioners to earn an ND.

Sometimes you get an answer you didn’t bargain for. When preparing this article I asked several people “What does a naturopath do?” A response I didn’t see coming was “Aren’t they all hippytrippy?” So that’s who all those people ramping through the muddy fields at the Glastonbury Festival are. My question was a serious one, because in the UK the huge benefits f consulting a naturopath seem to be poorly understood, but why?… read more

Naturopathic assessment – investigating biochemical, structural and emotional integrity
by Jackie Day ND, DNI, MH, FGNI

photo credit: The Infatuated via photopin cc

photo credit: The Infatuated via photopin cc

“My GP thought it was hyperthyroidism.  A week later she confirmed it was an autoimmune disorder called Graves Disease. I felt so ill, I didn’t think this could happen to me.”

Sarah was a busy working mother of two young children in her mid-forties. Her stressful job as a consultant carried a great deal of responsibility. She would arrive home at 19.15, get the children ready for bed and then she’d work again, feeling that if she didn’t put in this extra time it compounded the stress the next day. At times her digestive system felt so locked up that she couldn’t eat and felt nauseous. She started to become breathless easily and people thought she was unfit, though previously she’d been a keen runner. By August 2010 she felt she couldn’t cope any longer and ended her contract in November…. read more

 

Naturopathic Identification of a Life-Threatening Condition
– by Angela Bradbury D.Hom., MBRI, FGNI, ND, MAMH, FICNM

photo credit: JeremyMP via photopin cc

photo credit: JeremyMP via photopin cc

Eighteen-year-old Sam had been labelled ‘a malingerer’ by the medical profession. He had been offered a place at university to study Economics and Politics but over the period of a few months he had become increasingly unwell, with severe stomach pain. When I met him, he was on the verge of losing his place at university because he was unlikely to be well enough to commence his studies.

Repeated medical investigations, including a gastroscopy and tests for Helicobacter pylori had been carried out as a stomach ulcer had been suspected, but each test came back negative, and there was no suspicion of gall-stones. Antacids proved to be of no help whatsoever. His pain was an intense burning sensation that frequently was so bad that he needed to lie down…. read more

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Eat Right & Be Slim
– by Hakim M. Salim Khan, M.D. (M.A.), M.H., D.O., F.G.N.I.

Vegetables. Photo credit: computix via photopin cc

Vegetables. Photo credit: computix via photopin cc

Natural medicine, especially Tibb, takes a genuinely holistic view of food and health. The human being at the centre of the discussion is classified by their unique temperament and body type (mizaj). It also recognises that each person metabolizes food in their own specific way. Being over-weight or suffering obesity is an indication of your imbalance from this natural temperament.

Modern nutrition classifies foods by their material and chemical forms hence grouped into proteins, carbohydrates, fats, vitamins & minerals.  Although this grouping provides us with some information in practice, apart from a few benefits, this simplistic and artificial classification is not much of use, therefore ignoring the most important factors: the human being and their individuality… read more

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The Naturopathic Assessment
by Jackie Day ND, DNI, MH, FGNI

photo credit: HereIsTom via photopin cc

photo credit: HereIsTom via photopin cc

All too often digestive problems are misdiagnosed. An accurate assessment of these conditions can bring not just rapid relief of longstanding symptoms but, as this naturopathic case study shows, much wider health benefits.

Sally had spent over half her 62 years plagued by increasing food and chemical allergies. The almost immediate reaction is swelling of her fingers, causing the skin to burst open, leaving painful cuts; hydrocortisone cream and dressings provide limited relief. She had almost come to terms with having to put up with allergies for the rest of her life so her reason for a naturopathic consultation had more to do with tiredness, skin rashes, gall-bladder gravel, and low immunity… read more

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Integrated Naturopathy – homeopathy, herbs and nutrition
– by Angela Bradbury D.Hom., MBRI, FGNI, ND, MAMH, FICNM

photo credit: dorena-wm via photopin cc

photo credit: dorena-wm via photopin cc

Anne, aged 70, had a considerably overloaded gall-bladder. Her medical specialists were reluctant to treat her surgically because of high blood pressure and an inherent cardiac weakness. She was also dramatically susceptible to reactions from drugs. Hence the medical referral, my hands not being tied, and the bonus of medical monitoring.

Anne is a retired nurse who is stoically stubborn with a great sense of humour. Although born and bred in Jamaica, she had trained and worked in the UK all her working life. Partly thanks to her Caribbean upbringing, Anne taught me a lot. For example, when I explained… read more

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Cauliflower. Photo credit: OliBac via photopin cc

Cauliflower. Photo credit: OliBac via photopin cc

 

Making Friends with Food
– by Hakim M. Salim Khan, M.D. (M.A.), M.H., D.O., F.G.N.I.

It is through proper use of food and good digestion that a person builds and revitalises their self and body. In order to have and maintain the right weight a person needs to have a positive and healthy relationship with food. These guidelines will help you to achieve this.

read more

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SAD – Winter Blues:  the ‘other’ culprit
– by Jackie Day ND, DNI, MH, FGNI

photo credit: Nietnagel via photopin cc

photo credit: Nietnagel via photopin cc

Episodes of Seasonal Affective Disorder (SAD) develop during winter and improve in spring so reduced exposure to sunlight due to shorter winter days is the usual culprit. But, if we don’t think further than ‘light’, we may miss opportunities to help sufferers. Typical symptoms being low mood and lack of energy, SAD is classified as a type of depression; the conventional treatment is likely to be antidepressants such as Prozac. Is the trigger just reduced exposure to light, or could there be other contributory factors?

Let’s look first at the sunlight connection. One theory relates to the effect light has on the hypothalamus which controls mood, appetite and sleep. In people with SAD, a lack of sunlight and a problem with certain brain chemicals inhibits the hypothalamus… read more

 

 Weight management – a problem as old as time  
– by Jackie Day ND, DNI, MH, FGNI

photo credit: Alan Cleaver via photopin cc</a

photo credit: Alan Cleaver via photopin cc

We all know that most people who are overweight have eaten too much, or eaten the wrong types of food, or a combination of both. But what about those people who have genuinely stuck to the dieting rules but the weight insists on sticking to them? Experts have put forward varying explanations over the years. Current theories include genetics and chronobiology.

It is accepted that some people are genetically susceptible to weight gain, though no-one is genetically doomed to obesity, they just need to follow a genetically appropriate diet and exercise regime. Nutrigenomics is the identification of genes that are involved in physiological responses to diet and the genes in which small changes, called polymorphisms, may have significant nutritional consequences. Nutrigenetics is concerned with the effects of our individual genetic variations in response to diet and other sources of nutrients. It is the study by which dietary components communicate with the genetic material and how genetic variations affect interactions between these bioactive dietary components and the health and disease potential of a person… read more

 

Case Studies

Naturopathic Case Study: Hypothyroid & Food Cravings

Read how a female patient diagnosed with hypothyroidism, with symptoms of headaches and lethagy, felt inspired to take control of her health through dietary.  This lead to a greater sense of wellbeing and improved energy levels… read more

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Naturopathic Care for Type 2 Diabetes

A study reported on the reasons for the successful diabetes self-care approaches provided by Naturopathic practitioners.  Although this particular study focused on type 2 diabetes, the naturopathic approach is consistent.  Elements common to the success of the naturopathic approach were stated to be… read more

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Naturopathic Case Study: Chronic Fatigue

A mother of two children with debilitating chronic fatigue decides to consult a naturopath for her condition.  She learns that her strict vegan diet may need adjusting in order to help promote healing of her condition… read more

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Naturopathic Case Study: Depression, Anxiety, Panic Attacks

A mother suffers from depression, anxiety and panic attacks after escaping a violent relationship.  Through dietary changes, homeopathy, herbs and EFT she managed to overcome her condition… read more

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