Lawmakers Agree: Naturopathic Doctors are a Solid Choice to Combat Chronic Pain for Veterans

It’s a fact, many patients now prefer to use integrative health care approaches, especially to treat chronic pain. This trend has given licensed Naturopathic Doctors (NDs) even greater leverage to push for veterans and others who suffer from chronic pain to have access to the full range of treatments – and physicians.

Members of Congress have made clear their interest in licensed NDs becoming employed by the Veterans Health Administration (VHA). It won’t be long. The American Association of Naturopathic Physicians is working to clarify the role NDs would play within the VHA. The Agency’s Office of Patient Centered Care is taking the lead, as the bridge between conventional doctors and more holistic practitioners.

Check the stats: according to a 2015 national survey, 64 percent of veterans would prefer their doctor prescribe natural therapies before drugs or surgery – and 73 percent would consider seeing a ND if staffed at the VHA.¹ Moreover, the focus on disease prevention provided by naturopathic care – especially in chronic and stress related illnesses – has been found to reduce the cost of seeing a specialist by 30 percent.

If the VHA were to employ licensed NDs tomorrow, here are the majority benefits:

• Increase access to primary care physicians
• Reduce costs for the VHA through a greater focus on illness prevention
• Reduce primary care out-of-pocket expenses for veterans
• Lessen use of prescription drugs by relying on natural modalities
• Improve patient outcomes and quality of life

Chronic pain can often result in opioid addiction and depression – both of which are major problems in the U.S., especially for veterans. Naturopathic Doctors are poised to help.

There are over 5,000 licensed NDs in the U.S., who are well trained in natural, non-invasive, non-toxic approaches to health. Their orientation is on finding the underlying cause of a condition and not medicating the symptoms.

1. Pournadeali, K.; et al. (May 2016). Serving Veterans within the VHA: A Role for Naturopathic Physician. Retrieved from
http://www.naturopathic.org/nds%20in%20the%20va

Diet and the Microbiome

By Isaac Eliaz, MD, MS, LAc

New findings in the field of human microbiome research have the potential to change how we prevent, diagnose and treat illness. Genetic sequencing and the Human Microbiome and Metagenomics of the Human Intestinal Tract (MetaHIT) Projects have given us specific language and tools to dig deeper into the classification and functionality of the thousands of microbial species that reside within our bodies.

Of course, more work needs to be done regarding practical and clinical applications in enhancing health and treating disease. Part of the challenge lies in identifying and maximizing the dietary, environmental and other factors that contribute to a healthy microbiome, and in turn, how to influence our microbiomes for specific health outcomes. But what we do know so far is shedding important light on these relationships and points the way to a more sophisticated model of integrative health care — one that harnesses the power of our friendly bacteria to support numerous areas of health.

We know that our microbiome has far reaching impact on immune health, inflammation, genetic expression, cellular signaling, neuro-hormone production, and the synthesis of essential nutrients and cofactors. We also know that certain foods and other components act as fuel for specific microbiota species. For example, dietary changes have been shown in a number of studies to alter the microbial composition of human fecal samples. ¹ These findings explain the underlying differences in microbiota species observed among populations with different dietary habits (e.g., standard Western, fiber-rich plant-based, vegetarian).

Vitamin Synthesis
The evolving data on the genetic capabilities of specific bacteria to biosynthesize vitamins and nutrients holds promise for individualized nutritional interventions. B vitamins (including biotin, cobalamin, folates, nicotinic acid, pantothenic acid, riboflavin and thiamine) as well as vitamin K can be synthesized by certain bacteria such as Bifidobacterium (of which at least 39 species have been found). These microbial metabolites constitute an important, naturally-derived source of these nutrients, depending on which strain is present. Genetic analysis has identified high-folate producing strains such as Bifidobacterium bifidum and Bifidobacterium longum infantis and low-folate producing strains such as Bifidobacterium breve and Bifidobacterium adolescentis.²

Some Bifidobacteria species are also found to convert certain dietary compounds into bioactive molecules such as conjugated linoleic acid. Probiotic microorganisms in cultured foods can also synthesize B vitamins and provide another important source of essential vitamins within the emerging “functional foods” or “medical foods” categories.²

Polyphenol Metabolism
There is also emerging evidence showing complex interactions between polyphenols from fruits and vegetables, and colonic microbiota. These polyphenol compounds are metabolized by microbiota enzymes and form complex metabolites that influence cell signaling, genetic expression and other functions. Studies also demonstrate alterations in gut microbiota from certain dietary polyphenols.³ For instance, flavonols found in cocoa are shown to increase Bifidobacteria and lactobacilli populations, resulting in reduced triglycerides and C-reactive protein in human plasma samples.⁴ Previously, it was believed that bioavailability and antioxidant capacity of polyphenols was limited; however, emerging research in this area helps further our understanding of the pharmacokinetics and mechanisms of these important phytonutrients.⁵

Dietary Influences
Most of the enzymes needed to break down carbohydrates are not part of mammalian genomes; instead they’re provided by intestinal microbiota. In general, carbohydrates are the preferred energy source for most bacteria, though proteins can also be utilized. Carbohydrate fermentation by microbiota can result in the production of short chain fatty acids (SCFAs), depending on the type of bacteria. For example, Furmicutes bacteria produce SCFAs such as butyrate, which in turn promotes healthy cell differentiation and gut health. Decreased butyrate-producing bacteria in the gut is associated with Crohn’s disease.⁶

The microbial metabolism of fiber phytochemicals is associated with reduced incidence of several chronic diseases. A groundbreaking study compared the fecal microbiota of a group of African children who ate a fiber-rich, plant-based diet, with the microbiota of a group of Italian children on a standard Western diet. The African group had lower levels of phylum Firmicutes and higher levels of bacteria in the Bacteroidetes phylum, specifically Prevotella and Xylanibacter. The Italian group had higher levels of Enterobacteriaceae. This is significant because Prevotella and Xylanibacter are associated with increased levels of SCFAs and protection against inflammation and infectious diseases. Other studies have shown that a vegetarian diet is associated with increased production of SCFA by gut microbes and reduced intestinal pH as well as protection against pathogenic bacteria, such as E. coli. ^{1, 7}

Diet-driven changes in microbiota composition and function help substantiate previous research on the protective value of dietary fibers in reducing the incidence of inflammatory diseases, particularly in the gastrointestinal tract.

Future Applications
Future recommendations for probiotic and prebiotic supplementation along with dietary interventions are likely to be highly individualized based on a person’s unique microbial makeup. New diagnostic assays may utilize the species composition of an individual’s microbiota, along with other potential risk factors, to aid in the screening, diagnosis and prognosis of various illnesses. As research in this field continues, stay tuned for exciting discoveries that will expand our understanding of bacterial commensals and their countless roles in health and disease.

References

1. Power SE, O’Toole PW, Stanton C, Ross RP, Fitzgerald GF. Intestinal microbiota, diet and health. Br J Nutr. 2013 Aug 12:1-16.
2. LeBlanc JG, Milani C, de Giori GS, Sesma F, van Sinderen D, Ventura M. Bacteria as vitamin suppliers to their host: a gut microbiota perspective. Curr Opin Biotechnol. 2013 Apr;24(2):160-8.
3. Bolca S, Van de Wiele T, Possemiers S. Gut metabotypes govern health effects of dietary polyphenols. Curr Opin Biotechnol. 2013 Apr;24(2):220-5.
4. Tzounis X, Rodriguez-Mateos A, Vulevic J, Gibson GR, Kwik-Uribe C, Spencer JP. Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study. Am J Clin Nutr. 2011 Jan;93(1):62-72.
5. Manach C, Scalbert A, Morand C, Rémésy C, Jiménez L. Polyphenols: food sources and bioavailability. Am J Clin Nutr. 2004;79(5):727-47
6. Russell WR, Hoyles L, Flint HJ, Dumas ME. Colonic bacterial metabolites and human health. Curr Opin Microbiol. 2013 Jun;16(3):246-54.
7. De Filippo C, Cavalieri D, Di Paola M, et al. Impact of diet shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci USA. 2010; 107: 14691-14696.

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