Aging Well with Naturopathic Medicine

1
Aging Well with Naturopathic Medicine

• Jen Green
• Hallie Armstrong, Diana Quinn,
• Naturopathic Doctors
• Beaumont Integrative Medicine
• jengreenND_at_msn.com
• Royal Oak 248-551-9990
• Troy 248-964-9200

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What is Naturopathic Medicine

• Licensed Naturopaths are the general
  practitioners of natural medicine.
• A licensed Naturopath has completed four years of
  pre-med, four years of graduate school at an
  accredited Naturopathic medical college, and has
  successfully passed North American-wide licensing
  exams (NPLEX).
• Our scope includes nutrition, herbal medicine,
  homeopathy, lifestyle counseling and mind-body
  medicine.
• Training includes a Western medical understanding
  of the body eg. differential diagnosis, physical
  diagnosis, lab work, pathology, microbiology etc.
• We have a focus on evidence based complementary
  and alternative medicine (EBCAM).

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Goals with Healthy Aging

• Maintain healthy immune system, wound repair,
  stamina, mental wellness, tolerance to
  environmental stressors, sensory acuity,
  flexibility and nutrient absorption.
• Prevent and minimize the impact of cardiovascular
  disease, stroke, neurodegenerative disease,
  macular degeneration, osteoporosis,
  osteoarthritis, cancer and diabetes.
• And according to Robert Rountree MD Aging well
  means enjoying this emotional depth and
  experience that comes with time while keeping the
  body and mind healthy enough to do the things we
  want to do and maintaining the freedom to enjoy
  life.

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Aging

• Aging is a breakdown in the ability to self
  repair
• Injuries include oxidative stress, inflammation,
  lipotoxicity, glucose toxicity and environmental
  toxins.

5
Glucotoxicity

• According to Robert Rountree MD Glucotoxicity is
  the long-term total burden of sugar . When we eat
  too much sugar, then the mitochondria leak a lot
  of free radicals that damage tissues. Some of
  those damaged tissues will go on to damage other
  tissues in what is called the propagation
  process.
• High levels of fructose are converted in the
  liver to triglycerides, and those triglycerides
  basically pack the liver with fat, which then
  interferes with insulin sensitivity. So,
  glucotoxicity contributes to lipotoxicity
• Recommendation Eat whole unprocessed foods. When
  indulging in alcohol or high sugar foods, combine
  with protein, fat and fiber to minimize the
  impact on blood sugar. Avoid fat-free foods high
  in sugar. Say no to candy and pop. Say yes to The
  Mediterranean Diet.

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Lipotoxicity

• Decrease trans-fatty acids which are found in
  processed food, baked goods and anything that has
  crackled when you fry it. Transfatty acids
  increase heart diseasei.
• Decrease arachidonic acid in pork, red meat and
  peanuts. Arachidonic acid fuels inflammation,
  decreases efficacy of COX inhibitors (goes to
  LOX) and contributes to mucous, edema and lung
  constriction.
• Steam foods, stir-fry in water and add oil at the
  end, and olive oil to sauces after high heat
  cooking is complete. Fiber fiber fiber ?
• Include omega 3 oils which preferentially replace
  bad fats in cell membranes. Take fish oil, use
  cold-pressed olive oil liberally and eat walnuts.
  Use canola, organic butter or coconut oil for
  high heat cooking.
• i Association between trans fatty acid intake
  10-year risk of coronary heart disease in the
  Zutphen Elderly Study a prospective
  population-based study. By Oomen CM, Lancet, 2001
  Mar 10 Vol. 357 (9258), pp. 746-51

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Environmental Exposures

• Persistent low level environmental toxins may
  have larger impacts than acute high level
  exposures with respect to aging
• The total toxic burden increases slowly over time
• Consider screening for heavy metals with a
  urinary heavy metal test following oral DMSA.
• Pesticides in well water increase risk of
  Parkinsons (NEUROLOGY TODAY January 21, 2010)
• Recommendation Use a water filter, avoid heating
  in plastic, take shoes off at the door, avoid
  lawn pesticides, use green cleaning products,
  choose organic meat, dairy, eggs and oil (higher
  on the food chain so accumulate more toxins),
  avoid high mercury fish such as tuna. Water!
  Water! Water! to support elimination of toxins
  (early in the day to avoid night urination) .

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Conventional vs. Organic
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Water

• Necessary for all body functions eg. digestion,
  body-temperature maintenance, electrolyte
  balance, detoxification
• May benefit people with respiratory diseases (by
  thinning mucous secretions), urinary tract
  infections (by increasing their urine flow and
  removing bacteria), back, and may help reduce
  cancer risk of the colon, kidneys, bladder.
• Increased requirements with sweating, sun
  exposure, diarrhea or vomiting, certain
  medications
• An Environmental Working Group analysis of tap
  water tests from 1998 through 2003 for 1,446
  communities across Michigan shows 69 pollutants
  were found in drinking water across the state.
  www.ewg.org/tapwater/statereports/statereport.php?
  stateMI
• Consider getting a carbon block or reverse
  osmosis filter system for drinking water.

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Oxidative Stress

• In a study of 20,000 participants, the mortality
  risk for people who are nonsmokers, who exercise
  regularly, have a moderate alcohol intake, and
  who have a plasma vitamin C level gt 50 mmol/L
  (indicating fruit and vegetable intake of at
  least five servings a day), was the equivalent of
  being 14 years younger in chronologic age,
  compared with people who engaged in none of these
  behaviors.
• Dont smoke and avoid second hand smoke
• Minimize alcohol use
• Exercise Regularly
• Khaw K-T, Wareham N, Bingham S, et al. Combined
  impact of health behaviours and mortality in men
  and women The EPIC-Norfolk Prospective
  Population Study. PLoS Med 20085(1)e12correctio
  n20085(3)e70.

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Antioxidants- Eating the Rainbow

• Eat seven servings of fruit and vegetables daily
• Yellow-red-orange vegetables and fruits
• Carotenoids
• Red-purple-blue vegetables and fruits
• Lycopene tomatoes, guava
• Lutein tomatoes, red peppers, green leafy
  vegetables
• Zeaxanthin
• Anthocyanidins berries, grapes
• Dark leafy greens
• Cruciferous vegetables
• Broccoli, cauliflower, Brussels sprouts, cabbage,
  collard greens
• Allium
• onion, garlic
• Green, white, red, black tea
• Curcumin/turmuric
• Bioflavinoids
• Quercetin, Hesperidin

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Antioxidants

• Drink organic green tea and eat blueberries
• If supplementing, consider food or herb-based
  antioxidants eg. New Chapter brand Supercritical
  Antioxidants, Green drinks eg. Enzymatic
  Therapies Earths Promise, New Chapter Berry
  Greens, Designs for Health Paleogreens.
• Extra vitamin C is helpful, but be aware that
  chewable vitamin C promotes tooth decay if you
  dont brush after ?

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Antioxidants

• Antioxidant concentrations (Vitamin C, E and beta
  carotene) in the blood correlate positively with
  physical performance and strength in the
  elderlyi.
• Vitamin C and E in combination decrease risk of
  Alzheimers diseaseii
• Low vitamin C and E levels are also found in
  Parkinsons patientsiii.
• Vitamin E has been shown to help with
  memory/cognition in elderly women (70-79
  yrs)iv. The only concern with Vitamin E is that
  it can increase bleeding in high doses (so stop
  it 1 week before surgery), and it may also
  increase severity of respiratory infectionsv
  (so stop taking it during an acute cold or flu).
  Make sure patients are taking mixed tocopherols
  or vitamin E succinate rather than plain alpha
  tocopherol.

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Antioxidant References

• i Antioxidants and physical performance in
  elderly persons the Invecchiare in Chianti
  (InCHIANTI) study. By Cesari M, Am J Clin Nutr,
  2004 Feb Vol. 79 (2), pp. 289-94
• ii .Reduced risk of Alzheimer disease in users
  of antioxidant vitamin supplements the Cache
  County Study. By Zandi PP, Cache County Study
  Group, Arch Neurol, 2004 Jan Vol. 61 (1), pp.
  82-8
• iii Plasma levels of antioxidant vitamins C and
  E are decreased in vascular parkinsonim.By
  Paraskevas GP, J Neurol Sci, 2003 Nov 15 Vol.
  215 (1-2), pp. 51-5
• iv High-dose antioxidant supplements and
  cognitive function in community-dwelling elderly
  women By Grodstein F. AM J CLIN NUTR, Apr 1,
  2003 77(4) 975-84
• v Vitamin E increases severity of respiratory
  infections. By Gaby, Alan R.. Townsend Letter
  for Doctors Patients, Feb/Mar2003 Issue
  235/236, p32,

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Supplement Considerationsin the Elderly

• Good quality multivitamin capsule, powder or
  liquid instead of tablet because of absorption
  issues/possible low stomach acid
• Multivitamin should contain selenium 200mcg for
  glutathione support, chromium 200mcg for blood
  sugar stabilization, zinc for wound repair, and a
  B complex. Consider cancer risk when deciding
  whether to use natural or artificial folic acid.
• Do not supplement with iron unless iron
  deficiency is present because iron can increase
  inflammation (eg joint pain). Use ferrous
  glycinate/Gentle Iron instead of ferrous sulfate
  if supplementing.
• "Ten-year trends in vitamin intake in free-living
  healthy elderly people the risk of subclinical
  malnutrition," Toffanello ED, Inelmen EM, et al,
  J Nutr Health Aging, 2011 15(2) 99-103.

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Fish Oil

• Fish oil decreases inflammation, lubricates the
  bowels, improves memoryi, decreases heart
  disease and strokeiiiii, helps address mild
  to moderate depression v, lowers blood
  pressureiv, improves bone density vi and
  helps prevent cancer.
• i Alzheimer's Disease is Largely Preventable.
  By Grant, William B.. Townsend Letter for
  Doctors Patients, May98 Issue 178, p72.
  Thirteen-Year Prospective Study between Fish
  Consumption, Long-Chain n-3 Fatty Acids Intakes
  and Cognitive Function," Jesse Guyot E, Peneau S,
  et al, J Nutr Health Aging, 2011 15(2) 115-20.
• ii Changes in fatty acid composition, platelet
  aggregability and RBC function in elderly
  subjects with administration of low-dose fish oil
  concentrate and comparison with younger subjects
  By Terano T, Nippon Ronen Igakkai Zasshi, 1994
  Aug Vol. 31 (8), pp. 596-603)
• iii The effect of the short-term administration
  of fish oil on serum lipoproteins in old people.
  By Lehtonen A, Gerontology, 1989 Vol. 35 (5-6),
  pp. 311-4
• iv A low-sodium diet supplemented with fish oil
  lowers blood pressure in the elderly. By Cobiac
  L, J Hypertens, 1992 Jan Vol. 10 (1), pp. 87-92
• v "The effect of low-dose omega 3 fatty acids
  on the treatment of mild to moderate depression
  in the elderly a double-blind, randomized,
  placebo-controlled study," Tajalizadekhoob Y,
  Sharifi F, et al, Eur Arch Psychiatry Clin
  Neurosci, 2011 Feb 12
• vi Protective effects of fish intake and
  interactive effects of long-chain polyunsaturated
  fatty acid intakes on hip bone mineral density in
  older adults the Framingham Osteoporosis Study,"
  Farina EK, Kiel DP, et al, Am J Clin Nutr, 2011
  March 2

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Omega 3 Fatty Acid Supplementation

• Fish Oil Considerations Quality of Supplement
• Third-party testing eg. www.consumerlabs.com
• Hexane free
• Free of oxidative damage
• Free of heavy metals and impurities
• Good brands include Carlson Labs, Nordic
  Naturals, Designs for Health.
• Goal is at 900mg of EPA and 400 DHA.
• Algae EPA EPA/DHA concentrations in fish are
  derived from the algae they consume consider
  Algae EPA supplementation for vegetarians
• Eggs chickens fed flax (ALA)
• Simonopoulos AP, Salem N. n-3 fatty acids in
  eggs from range-fed Greek chickens. N Engl J Med.
  19893311412.

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Dietary Fish

• Wild caught vs. Farmed fish Farmed fish has
  lower omega-3omega-6 ratio than wild fish
• Good fish (low mercury fish that are high in
  omega 3 fatty acids) include anchovies, sardines,
  herring, wild Atlantic salmon, Sable fish,
  whitefish, flounder, haddock, farm-raised rainbow
  trout catfish.
• Avoid tuna fish, shark, swordfish, tilefish and
  king mackerel because of mercury contamination.
• If pregnant or a young child, avoid grouper,
  marlin, orange roughy, bass (sea and large
  mouth), halibut, red snapper, spanish mackerel,
  bluefish, lobster, pike and walleye.
• Canned fish Canned salmon EPAAA ratio 251, EPA
  5x higher than tuna
• Ginsberg G., Toal B. Quantitative approach for
  incorporating methylmercury risks and omega-3
  fatty acid benefits in developing
  species-specific fish consumption advice. Environ
  Health Perspect 117267275 (2009).
• See also www.healthychildhealthyworld.org
• http//www.hc-sc.gc.ca/english/protection/warnings
  /2001/2001_60e.htm
• van Vliet T, Katan MB. Lower ratio of n-3 fatty
  to n-6 fatty acids in cultured than wild fish.
  Am J Clin Nutr. 1990511-2.

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Vitamin D

• Vitamin D is a common deficiency in the elderly
  communityi. It is endemic in Michigan.
• Statins further decrease absorption of fat
  soluble vitamins (vitamin A,D,E, K).
• Supplementation with vitamin D 800 IU/day
  decreases fallsii.
• Vitamin D deficiency is linked with osteoporosis,
  hypertension, asthma, diabetes, seasonal
  depression, frequent viral infections, cancer,
  and autoimmune conditions.
• Evidence from epidemiologic studies and small
  clinical trials suggests an association between
  25(OH)D concentrations and systolic blood
  pressure, risk for CV disease-related deaths,
  symptoms of depression, cognitive deficits, and
  mortality.
• i High prevalence of vitamin D insufficiency in
  healthy elderly people living at home in
  Argentina. (eng includes abstract) By Oliveri B,
  Eur J Clin Nutr, 2004 Feb Vol. 58 (2), pp.
  337-42
• ii A randomised, controlled comparison of
  different calcium and vitamin D supplementation
  regimens in elderly women after hip fracture The
  Nottingham Neck of Femur (NONOF) Study. (eng
  includes abstract) By Harwood RH, The Nottingham
  Neck of Femur (NONOF) Study, Age Ageing, 2004
  Jan Vol. 33 (1), pp. 45-51
• AND, Alfacalcidol reduces the number of fallers
  in a community-dwelling elderly population with a
  minimum calcium intake of more than 500 mg daily.
  By Dukas L, J Am Geriatr Soc, 2004 Feb Vol. 52
  (2), pp. 230-6
• 5Vieth R. Vitamin D supplementation,
  25-hydroxyvitamin D concentrations, and safety.
  Am J Clin Nutr 199969842856.
• Extraskeletal effects of vitamin D in older
  adults cardiovascular disease, mortality, mood,
  and cognition. Barnard K, Colón-Emeric C. Am J
  Geriatr Pharmacother. 2010 Feb8(1)4-33. Review.

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Vitamin D Recommendations

• Screen 25 OH Vitamin D routinely and aim for a
  serum level of 40-60.
• Any brand of D3 is fine, but taking it with a
  fatty meal or fish oil improves absorption.
• Use 2000 IU dailyv.
• Watch for cumulative dosing between multivitamin,
  calcium supplements and plain vitamin D.
• Numerous brands now offer Vitamin D drops in 400,
  1000 and 2000 IU/drop. Good to decrease number of
  pills and for anyone with swallowing issues.

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Vitamin D and Brain health

• According to Dr Perlmutter, Vitamin D
  supplementation is essential in Alzheimers and
  Parkinsons because it is a membrane-bound
  antioxidant that enhances neurotrophins,
  increases hippocampal density (rodent), supresses
  expression if inflammatory cytokines and is
  antimicrobial.
• Perlmutter links herpes simplex infection with AD

22
Calcium/Magnesium Supplementation

• Supplementing calcium alone eg. Caltrate or
  CalciChews can create a magnesium deficiency!!!
• 2 g/day of calcium (citrate) decreased Mg
  absorption and plasma Mg levels in healthy
  volunteers. Clin Sci 19673211-18
• Calcium supplements should be balanced with
  magnesium in a 21 ratio and a maximum of 500mg
  calcium is absorbed at once.

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Forms of Calcium

• Calcium carbonate is mildly constipating
• Calcium citrate can encourage bowel movements
• Calcium glycinate and hydroxyappatite are bowel
  neutral and well-absorbed
• Coral calcium is a poor choice environmentally
• Dietary sources of calcium include dairy, tahini,
  seaweeds, almonds, calcium-enriched foods and
  green leafy vegetables.

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Magnesium

• Magnesium helps insomnia (if taken away from
  calcium), reduces heart palpitations, reduces
  blood pressure, supports cardiac bone health,
  helps to normalize glucose metabolism stabilize
  moods.
• According to Dr Alan Gaby, Magnesium is a
  cardioprotective nutrient that inhibits platelet
  aggregation, dilates blood vessels, has
  anti-arrhythmic activity, is required for ATP
  synthesis, promotes intracellular potassium
  uptake, possibly lowers BP and increases HDL-C.
• Magnesium Deficiency is common NHANES 1999-2000
  50 of Caucasians consumed lt 75-80 of the RDA
  Mg intake was about 25 lower in African
  Americans than in Caucasians. - J Nutr
  20031332879-82

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Forms of Magnesium

• Magnesium oxide and magnesium hydroxide (milk of
  magnesia) are laxatives
• Magnesium glycinate/chelated magnesium is bowel
  neutral and helps with chronic pain and muscle
  stiffness
• Magnesium taurate has an affinity for the heart
• Dietary sources soy, nuts, sunflower pumpkin
  seeds, beans, avocados, leafy green vegetables,
  broccoli.

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Stomach Acid

• Antacids can wreak havoc on the acid barrier to
  infection and protein/mineral absorption. Dose
  vitamins/minerals away from antacids.
• Stomach acid naturally declines as we age, which
  can cause excess bloating and gas, poor protein
  digestion and poor mineral absorption (calcium,
  magnesium, zinc etc).
• Bitters The esophageal sphincter can be
  re-educated to close properly by using herbal
  bitters for 2-3 weeks. Use Herbpharm Digestive
  Bitters or Natures Answer Bitters with Ginger
  3-4 drops before meals. Discontinue immediately
  if heartburn is aggravated. Bitters often retrain
  the sphincter to close in response to stomach
  acid/food rather than staying lax.
• Careful with reducing stomach acid blockers
  because many people experience rebound
  hyperacidity

27
Melatonin

• Deep phase sleep (high melatonin) is when the
  body repairs tissues
• Melatonin activates the immune system, helps to
  prevent and treat cancer and seems to increase
  HDL levels in peri and post menopausal women.
• Melatonin 3-20mg half hour before bedtime to
  treat insomnia. Start with 3mg nightly and slowly
  increase every few days until you reach a dose
  where you sleep for seven hours and wake
  refreshed.

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Melatonin References

• Lissoni P, Chilelli M, Villa S, Cerizza L,
  Tancini G, Five years survival in metastatic
  non-small cell lung cancer patients treated with
  chemotherapy alone or chemotherapy and melatonin
  a randomized trial. Journal Of Pineal Research,
  2003 Aug Vol. 35 (1), pp. 12-5
• Tamura H, Nakamura Y, Narimatsu A, Yamagata Y,
  Takasaki A, Reiter RJ, Sugino N.Melatonin
  treatment in peri- and postmenopausal women
  elevates serum high-density lipoprotein
  cholesterol levels without influencing total
  cholesterol levels. J Pineal Res. 2008
  Aug45(1)101-5. Epub 2008 Feb 19.
• Vijayalaxmi Thomas CR Jr Reiter RJ Herman TS.
  Melatonin from basic research to cancer
  treatment clinics. Journal of clinical oncology
  official journal of the American Society of
  Clinical Oncology J Clin Oncol 2002 May 15 20
  (10), pp.2575-601.

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Probiotics

• Treat both constipation and diarrhea in elderly
  patients
• Help prevent upper respiratory tract infections
  in the elderly
• Help prevent antibiotic associated diarrhea and
  yeast infections following antibiotic use
• Supplement Considerations
• Single versus multiple strains
• Ability to colonize the gut
• Quality control is a huge issue! Trusted brands
  include Klaire Labs, Genestra, Orthomolecular
  Products.
• Must be stored correctly.
• Probiotics Improve Bowel Movements in
  Hospitalized Elderly Patients - The PROAGE
  Study," Zaharoni H, Rimon E, et al, J Nutr Health
  Aging, 2011 15(3) 215-20. (Address H.
  Zaharoni, Harzfeld Geriatric Medical Center,
  Gedera, 70750 Israel.
• 2004. Green, J. Probiotics in Pediatric Health
  Conditions A Systematic Review. CAMLine.ca.
  Open access copy available at http//www.camline.
  ca/professionalreview/pr.php?NHPID43

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Drug-NHP Interactions

• Basic steps to avoid interactions
• Dont take any medication or supplement with
  absorbent substances such as Fiber, Bentonite or
  Charcoal
• Beware of caffeine, charbroiled food, St. Johns
  wort (Hypericum perforatum) and grapefruit
  because they effect liver clearance of
  medications
• Check drug induced nutrient depletions eg.
  Magnesium, CoQ10, melatonin. Drug-Induced
  Nutrient Depletion Handbook by Ross Pelton, James
  B. LaValle, and Ernest B. Hawkins
• Pharmacists are our friends!!!!

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Case Study CoQ10 Interactions

• Oral Coenzyme Q10 with other anti-hypertensives
  can provide an additional blood pressure lowering
  effect.
• Hodgson JM, Watts GF, PlayfordDA, et al. Coenzyme
  Q10 improves blood pressure and glycaemiccontrol
  a controlled trial in subjects with type 2
  diabetes. EurJ ClinNutr.2002561137-42.
• Singh RB, NiazMA, RastogiSS, et al. Effect of
  hydrosolublecoenzyme Q10 on blood pressures and
  insulin resistance in hypertensive patients with
  coronary arterydisease. J Hum Hypertens.1999
  13203-8.
• Administration of coenzyme Q10 to heart
  transplant candidates led to a significant
  improvement in functional status, clinical
  symptoms, and quality of life. Study group showed
  significant improvement in the 6-min walk test
  and a decrease in dyspnea, New York Heart
  Association (NYHA) classification, nocturia, and
  fatigue. However, there were no objective changes
  in echo measurements.
• Berman M, ErmanA, Ben-Gal T, et al. Coenzyme Q10
  in patients with end-stage heart failure awaiting
  cardiac transplantation a randomized,
  placebo-controlled study. ClinCardiol.200427295-
  9.

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CoQ10 Interactions

• Statins can reduce serum coenzyme Q10 levels by
  blocking the synthesis of mevalonicacid, which is
  a precursor of coenzyme Q10. Statins' effect on
  coenzyme Q10 appear to be dose-related.
• Atorvastatin(Lipitor) 10 mg/day or
  pravastatin(Pravachol) 20 mg/day doesn't decrease
  levels of circulating coenzyme Q10 in healthy
  people
• Mortensen SA, LethA, AgnerE, et al. Dose-related
  decrease of serum coenzyme Q10 during treatment
  with HMG-CoAreductaseinhibitors. Mol Aspects Med.
  1997 18S137-44.
• BleskeBE, Willis RA, Anthony M, et al. The effect
  of pravastatinand atorvastatinon coenzyme Q10. Am
  Heart J. 2001142E2.
• Statin-induced myopathy Coenzyme Q10 might
  lessen muscular adverse effects caused by
  high-dose HMG-CoAreductaseinhibitors
• ThibaultA, SamidD, Tompkins AC, et al. Phase I
  study of lovastatin, an inhibitor of the
  mevalonatepathway, in patients with cancer.
  ClinCancer Res.19962483-91.

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CoQ10 Negative Interactions

• CoQ10 / Warfarin Interactions
• Concomitant use might reduce anticoagulation
  effects. Coenzyme Q10 is chemically similar to
  menaquinoneand may have vitamin K-like
  procoagulant effects
• Four cases exist of decreased warfarin efficacy
  likely due to coenzyme Q10
• Preliminary clinical research suggests coenzyme
  Q10 might not significantly decrease the effects
  of warfarin in patients that have a stable INR
• Warfarin-induced hair loss There is some
  preliminary evidence that coenzyme Q10 might be
  helpful for preventing warfarin-induced hair loss
• Heck AM, DeWitt BA, LukesAL. Potential
  interactions between alternative therapies and
  warfarin. Am J Health SystPharm. 2000571221-7.
• SpigsetO. Reduced effect of warfarincaused by
  ubidecarenone. Lancet. 19943341372-3.
• EngelsenJ, Nielsen JD, WintherK. Effect of
  coenzyme Q10 and Ginkgo bilobaon warfarindosage
  in stable, long-term warfarintreated outpatients.
  A randomized, double blind, placebo-crossover
  trial. ThrombHaemost. 2002871075-6.
• Nagao T, IbayashiS, FujiK, et al. Treatment of
  warfarin-induced hair loss with ubidecarenone.
  Lancet.i 19953461104-5.

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Putting it all TogetherAssessment Screening

• Quality of sleep (sleep hygeine, deep breathing
  before bed, melatonin supplementation if needed)
• Emotional fluidity and expression (screen for
  depression then check for hypothyroidism, B12
  deficiency, folate deficiency, add fish oil)
• Optimal nutrition with appropriate caloric intake
  (dentition and food issues, social vs solo
  eating, avoiding empty calories, screening for
  zinc deficiency if low appetite, use digestive
  bitters if low stomach acid)
• Appropriate dietary supplementation as indicated
  (multivitamin, vitamin D, fish oil,
  calcium/magnesium, melatonin, probiotic if needed)

35
Best Medicine Individualized Medicine

• Two patients of mine, Betty and Philip both 82
  yrs old
• Betty Diagnosed with senile dementia, history
  of angina with stent, frequent night waking, high
  cholesterol, low HDL, anemia, high uric acid,
  chronic constipation, morning headaches, loss of
  appetite with low caloric intake, mild
  depression, cared for by loving husband.
• Philip Hypertension, gout, gas, breast cancer
  in 1984, polynephritis (incomplete bladder
  emptying) with chronic kidney failure, kidney
  stones, headed for dialysis, poor balance,
  constipation, recent fatigue, recent anxiety with
  early night sleep disturbance since wife passed
  away, lives in FoxRun

36
Naturopathic Recommendations for Betty

• Cardiac rehab three times weekly for heart health
  and to improve memory
• Increase water early in the day, try juice on
  waking to see if low blood sugar is causing
  headaches
• Switch iron to ferrous bisglycinate
• Nutrient-rich smoothies Coconut milk (medium
  chain triglycerides), Whey Cool protein powder,
  Fish Oil 1 TBSP, ¼ cup cherry juice for uric
  acid, Calcium magnesium liquid 1 TBSP, frozen or
  fresh fruit (especially organic blueberries,
  raspberries)
• Chocolate chewable CoQ10 100mg by ITI
• Designs for Health Twice Daily Multi
• Vitamin D3 2000IU
• Digestive Bitters 4 drops before meals for 2
  weeks to try to stimulate appetite and proper
  digestive function

37
Naturopathic Recommendations for Philip

• Balance calcium with magnesium, add extra
  magnesium glycinate 200mg for kidney function
• Nettle seed tincture 1 dropper twice daily to
  improve kidney function. BUN and Creatinine
  gradually improving so dialysis unnecessary.
• Switched iron to ferrous bisglycinate,
  constipation resolved
• Eliminated daily cabbage and gas resolved
• Replace flax oil with fish oil 3000mg/3 capsules
• Theanine 200mg before bed eliminated night
  disturbance and calms down anxiety. (Patient
  added melatonin of his own accord)
• Increased thyroid dosage after detailed testing
  (TSH was normal, fT4 was not). Fatigue better
  with new thyroid dose.
• Amalgamate and streamlined many supplements,
  especially with high doses possibly effecting
  kidney function.