by Dr. Talia Marcheggiani, ND | Nov 22, 2014 | Detoxification, Evidence Based Medicine, Genetic testing, Medicine, Mental Health, Preventive Medicine
Rosalind Franklin: She might have been left out of the Nobel, but at least she gets the honoured spot as the featured image of this post. Lucky her. (Sorry, readers, just a little inside joke for the molecular biologists out there). Image source: wikipedia.org
“Do you find yourself easily able to bounce back from emotionally-charged situations?” Dr. Emily Fitzgerald, ND, asked while sitting across from me at her white desk. “The fact that this part of the gene is present and not deleted means that you are the ‘cool and collected’ type, the ‘Wolf of Wall Street’, if you will.” She went on, “We find here through our testing that most naturopathic doctors have the other version of this gene.”
Great, I thought, I was genetically unfit to practice naturopathic medicine; it was like something out of the movie GATTACA. I couldn’t help but feel let down by my genetic coding. I had always thought of myself as an empathetic and caring person and yet science was telling me the opposite. Wolf of Wall Street? Seriously? I hated the movie. In fact, I felt more at home sharing a collective vegan lunch with protesters occupying Wall Street than bidding on stock options. Surely this doctor must be mistaken. But alas, it wasn’t her fault. She was simply a messenger, reading out to me what was clearly spelt out in my nucleic acid.
Genes are funny things. We inherit one set from our mothers and another from our fathers. They don’t change throughout our lives and they are responsible for coding all of the proteins, enzymatic reactions and cellular structures that make up our beautiful bodies. However, I once read that interpreting the human body through genetic code is analogous to interpreting Shakespeare’s works by studying the alphabet; it’s not even a recipe, but a mere grocery list.
Dr. Mohammed, the CEO of YouNique Genomics, a Canadian lifestyle genomics company, will also assert that “genes aren’t everything.” Our environment has a lot to do with how they are expressed and this simple fact can explain why, despite the fact that I am missing part of the “emotional gene”, I am still able to regard my patients with positivity, appreciate literature and cry at sappy love stories.
Despite the Nature vs. Nuture debate, there is still a lot that can be garnered from looking at genetic coding. By studying my expression of SNPs (single nucleotide polymorphisms), or small variations in DNA, on only 14 of my 23,000 genes, Dr. Fitzgerald was able to tell me that I am a passionate person, I am capable of regulating my emotions when confronted with difficult situations, I can drink espressos after dinner without affecting my sleep and the Paleo Diet will only lead me to overeat. She told me how dopamine is metabolised in my brain, how my liver detoxifies and how my body digests cholesterol and lipids, giving me information about my long-term risk for heart disease. And she did all of this without looking at her crystal ball, not even once.
I previously associated genetic testing with detecting the risk for diseases such as early-onset Alzeimer’s or breast cancer. I had always thought that knowing one’s genetics was dis-empowering. After all, you’re born with your genetic code; what is the use of learning about something that you can’t change? It seemed to me as useful as tying yourself to a set of train tracks, powerless to stop yourself from being crushed under the freighter speeding towards you.
My mind changed when I learned about functional genomic testing like the kind offered at YouNique. Functional, or lifestyle, genomics don’t predict disease risk but rather only test for genes whose expression can be affected by lifestyle. The test I received was called the SNaP Shot. It looks at 14 genes, including those that code for dopamine metabolism, liver detoxification, methylation pathways and cardiovascular health.
One of the noteworthy pieces of information I learned was that my detoxification pathways are like a leaky faucet with a clogged drain. The enzymes that run Phase I liver detoxification, which make many toxins more toxic, are over-expressed, meaning that they work better than the average person’s. However, I have less than optimal Phase II detoxification, which is responsible for neutralizing these toxins and allowing them to be safely eliminated from the body. This means that I need to start supporting my liver and increasing my production of glutathione, an important antioxidant. If I don’t do this? It’s written in my DNA, and perhaps that stars, that my risk of cancer from toxin exposure could be higher than normal. I bought a bottle of milk thistle the next day.
I also learned that my body has a 30% reduced ability to use folate, meaning that I need to increase my intake of this vitamin or else risk problems with inflammation, which has wide-spread affects. I also found out that I respond poorly to saturated fat intake: it makes me hungrier by stimulating ghrelin, the appetite hormone, and can lead to weight-gain if my diet is uncontrolled. This is relevant in the natural health world because the Paleo Diet involves eating a diet high in saturated fats to achieve the exact opposite aim: controlling hunger. Genetic testing is the future!
What was the immediate result of the information I received by donating a vial of blood and an hour’s consultation time to YouNique? I learned that I need to support my liver (hence the milk thistle) and increase my folate intake. The truth of my long-term disease risk is there, written in my genome, which won’t change, that much is true. What I hadn’t considered, however, is our power to rewrite the future, by using naturopathic medicine to work with the building blocks we inherit. Our genes will always be the same but what we learn about how they are expressed will continuously evolve. Genomic testing, as Dr. Mohammed pointed out, is a living and breathing test. With the same test results, our treatment plans can evolve as our knowledge in the area grows. The more science learns about how lifestyle affects our genes, the more we can work with what we’ve got.
To end off, Dr. Mohammed told me a story in which he was examining a rather unfavourable genetic report before meeting the patient it belonged to, a naturopathic practitioner. When the ND entered the room, Dr. Mohammed was taken aback. Surely this healthy, spry, attractive individual was not the same person whose genes indicated an increased risk of obesity, inflammation, toxic exposure and heart disease? However, this individual had chosen to “walk the talk”, as we say in the field, and live his life in a healthy and holistic way. And, by doing so, he was able to change the course of his own personal health history; a great novel whose prologue began being written moments after his conception but whose conclusion he will be able to co-write. Shakespeare was given the alphabet. We are given a crazy combination of four nucleotides. Shakespeare wrote Hamlet. Through lifestyle genomics, I’ve come to realize that what we write with the information we’re given just might be up to us.
To learn more about lifestyle genomic testing and how it can help you affect your own health, contact me.
by Dr. Talia Marcheggiani, ND | Oct 4, 2014 | Chronic pain, Evidence Based Medicine, Medicine, Mental Health, Nutrition, Preventive Medicine
Dear Medical Doctor,
I am a naturopathic physician. On a Facebook page hosted by some peers in my profession, a young naturopathic doctor expressed distress at having her attempt to forge ties with one of her patients’ medical doctor thwarted. Needing her patient to obtain the diagnostic testing covered under provincial insurance only when ordered by a medical doctor, she wrote a letter to the patient’s MD, explaining the case, her assessment, the natural treatments that the patient was taking and her reasons for asking for diagnostic testing to be done. She expressed her hope to work collaboratively with this professional in order to provide better care for their mutual patient.
The response was less than ideal. The MD wrote a short, snappy letter, making clear his disinterest in “working collaboratively” with “alternative health practitioners”. He told her, bluntly, that he would not welcome further communications regarding their mutual patient.
Rookie mistake.
Whether a patient seeks consult from a naturopathic doctor or not, natural medicine is here to stay. The good news for medical doctors, however, is that naturopathic doctors can help make their lives easier and contribute significant benefits to patient management. Here are some reasons for working with naturopathic doctors:
1. Naturopathic doctors are highly trained.
NDs go through 4 years of undergraduate education, taking prerequisite courses in biochemistry, biology, psychology, physiology and chemistry. Naturopathic medical school consists of an additional 4 years of intense, full-time study that includes the completion of two licensing exams, one board exam, 3 clinical exams and a 12-month clinical internship working with patients in an out-patient setting. NDs are trained in medical diagnostics, physical exams and can perform procedures such as taking blood, injections, pelvic exams and prostate exams. With extra training NDs are being certified in IV therapies, minor surgery and pharmaceutical prescribing.
Naturopathic doctors speak the same language as medical doctors and our training and medical opinions can be trusted.
2. Patients that see naturopathic doctors in addition to medical doctors do better overall.
In a 2013 randomized clinical trial by the Canadian Medical Association Journal, it was found that high-risk patients decreased their risk of heart disease when using both naturopathic medicine and conventional treatments together rather than just conventional medicine alone. NDs have the time to teach patients how to make changes that benefit their long-term health. Adding a naturopathic doctor to your patient’s healthcare team can help decrease their risk of chronic diseases, such as cardiovascular disease, the leading cause of death among Canadians.
3. Naturopathic medicine decreases the burden on the healthcare system.
A colleague of mine practised as a registered nurse in Ontario for several years before deciding to begin studies at the Canadian College of Naturopathic Medicine and become licensed as a naturopathic doctor. When I asked her why she told me that she was tired of the “revolving door.” “The revolving door?” I asked, puzzled. She explained that, as a nurse she would often see the same patients time and time again – patients with diabetes who were having trouble managing their blood sugar and mental health patients, for instance – who would come into the emergency room, receive treatment and leave, only to return again after a short time. There was no one addressing the root cause of these patients’ ailments and, therefore, it was only a matter of time before they returned to the emergency room. Working with a naturopathic doctor helps patients take responsibility for their health, addresses the root cause of disease and assists patient in learning how to manage chronic disease more effectively, freeing up the emergency room for actual emergencies.
4. Naturopathic doctors address family physician shortages.
Many Canadians do not have a family doctor and many medical doctors are far too busy to take on new patients. Referring patients to be co-managed by a naturopathic doctor can reduce their need for doctors visits, reduce medical clinic wait-times and allow medical doctors to take on more patients on their rosters. Also, by focussing on lifestyle changes, finding the root cause of disease and anticipating health issues such as seasonal allergies, colds and flu or traveller’s diarrhea, NDs can help patients prevent disease. We can effectively take on the ailments that are not appropriately treated with pharmaceuticals (viral colds, for instance), freeing up time and space in medical clinics.
5. Naturopathic doctors can take on chronic, long-term cases.
Chronic acne, digestive concerns, musculoskeletal pain, fatigue and mental illness, cardiovascular disease, hormonal imbalances such as uterine fibroids, PMS, PCOS and endometriosis are all chronic conditions, difficult to treat with medications, that benefit hugely from lifestyle changes. Many patients who suffer from these conditions experience immense benefit when treated with gentle, natural therapies and lifestyle changes. Naturopathic doctors excel at treating chronic, long-standing conditions that are upsetting to patients but often aren’t “serious” enough to warrant conventional care or perhaps aren’t responding to conventional care.
6. There is someone managing drug-nutrient or drug-herb interactions.
It is estimated that more than 70% of Canadians have used a natural health product. That number is only increasing as the public recognizes the need for nutritional and herbal supplementation. However, interactions between natural remedies and medications are real. Naturopathic doctors are trained in pharmacology and are prepared to anticipate interactions and avoid products that have the potential to interfere with certain medications and medical procedures. Collaborating with an ND also means that there is a recorded history of all the natural products your patient is taking and your patient is far less likely to self-prescribe remedies that have the potential for harm.
7. NDs excel at providing stress relief.
“My doctor told me it’s just stress,” a family friend told me over dinner. No surprise. What can sound to some patients like a back-handed dismissal is actually a concrete truth; some sources estimate that 90% of physician visits are stress-related. Naturopathic doctors offer a wide range of therapies such as talk therapy, lifestyle counselling, homeopathy, acupuncture, botanical therapy and nutritional supplementation all of which are effective at helping reduce stress and improve the body’s response to stress. As a society we tend to focus on physical health and lifestyle and neglect the importance of mental health. Naturopathic doctors are well-positioned to offer that kind of care.
Dear medical doctor, we naturopathic doctors appreciate everything that you do. We would love the opportunity to work with you as part of a collaborative team for the benefit of our mutual patients. So please, no more of the above-mentioned letters.
In the words of Vanilla Ice, “Stop. Collaborate and Listen.” Your patients will thank you for it.
Sincerely,
Talia Marcheggiani, ND
by Dr. Talia Marcheggiani, ND | Mar 20, 2014 | Canadian College of Naturopathic Medicine, Health, Medicine, Motivation, Naturopathic Principles
I remember sitting in the walk-in clinic. I’d been waiting for over an hour, not to mention the time lost denying my symptoms, waiting until they got bad enough to warrant the visit in the first place. Finally, it was my turn. I walk into the treatment room, where a thin, middle-aged doctor was seated, her hair short and grey, her eyes encased in dark, baggy skin. She didn’t smile. “How can I help you?” She asked, bored already. I began where I thought the story began, at the beginning. I got a few sentences out before she cut me off. I was surprised; couldn’t she see that all this information was relevant? I didn’t just have fatigue, it was a part of me. It was woven into the fabric of my life; it had a back-story. This doctor needed to know when it began, what my life was like at the time, what I’d tried to do to treat it myself, when it felt better, when it felt worse. I didn’t believe she could treat me without that information. Surely it all mattered.
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