The Natural Therapist Autumn 2020 Edition

The EDITION 35 NO. 1 | AUTUMN 2020

Natural

Therapist ISSN 1031 6965

Autumn 2020 Aromatherapy in Practice

The Hevert

Collection

The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION

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Contents Edition 35 No. 1

| Autumn 2020

ANTA News

From the Chair 6

Ambassador Perspective of the International Congress on Naturopathic Medicine Inside Now!

8 Virtual Consultations and more 12 ANTA Executive and Directors for 2020 14 2019 Bursary Award Winners 15 2019 Graduate Award Winners

Executive Officer Report

27

Ayurveda and Gut Health Neerja Ahuja explores the causes and diseases associated with Leaky Gut and how Ayurveda can help improve this digestive condition.

17

22

A Brief Review of the Therapeutic Properties of Fucoidans

Introducing: The Hevert Collection

Dr. Mark Waddingham and Dr. George Thouas

comprehensive compiling of essential historical

briefly describe some of the main reported

practice techniques spanning the history of

clinical applications of fucoidans.

naturopathic medicine writings.

35

42

The Clinical and Pharmacological Actions of the TCM Formula 'Yi Gan San' (Restrain the Liver Powder)

Aromatherapy in Practice

Dr Sussanna Czeranko completes a

Elizabeth Greenwood answers the commonly asked questions about using aromatherapy and essential oils in clinical practice, herbal education and product development.

Tony Reid explores the Traditional Chinese herbal formula 'Yi Gan San' and its clinical efficacy in dementia, anxiety and other conditions.

The

Natural Therapist

The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers. Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.

VOLUME 35 NUMBER 1 – AUTUMN 2020

ISSN 1031 6965

ANTA BRANCH CHAIR PERSONS

Elizabeth Greenwood – National President • Director of ANTA • National Naturopathy Branch Chair • CPE Chair • Registration Chair • Media Chair • Ethics Committee Member Jeanetta Gogol – National Vice-President • Director of ANTA • National Multi-Modality Branch Chair • Health Fund/WorkCover Chair • ANTAB/ANTAC Committee Member • Ethics Committee Member • AHPRA Representative Justin Lovelock - National Treasurer • Director of ANTA • National Homeopathy Branch Chair • ANTAB/ANTAC Committee Member • CMPAC Director • Constitution Policy Chair • ANRANT Committee Member • Ethics Committee Member Shaun Brewster • Director of ANTA • National Myotherapy Branch Chair • Ethics Committee Member • ANTAB Chair

• ANTAC Committee Member Warren Maginn • Director of ANTA • National Nutrition Branch Chair • TGA Chair • Ethics Committee Chair • ANTAB/ANTAC Committee Member • ANRANT Committee Member Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair Mark Shoring • Director of ANTA • National Chinese Herbal Medicine Branch Chair Tony Reid • National Council Advisor Jim Olds • Executive Officer • Company Secretary of ANTA & CMPAC • Business Plan Chair • Ethics Committee Member

The

Natural Therapist

Marketing/Production Tasha Kemsley Circulation Enquiries 1800 817 577

Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au

ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 australiannaturaltherapistsassociation.com.au

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 5

ANTA News Autumn 2020

From the Chair Natural Therapies Review 2019-20

The third Meeting Outcome Summary from the Natural Therapies Review Expert Advisory Panel (NTREAP) tranche 1, was due and details will be published on the ANTA website for access to all members, once it becomes available.

Background Since 1 April 2019, the following natural therapies have been excluded from complying health insurance products: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, Western herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi, and yoga. The Natural Therapies Review 2019-20 will examine additional evidence which has emerged since the previous review and provide advice to Government on whether any of the natural therapies should be covered by private health insurance and therefore eligible for subsidy through the Private Health Insurance Rebate.

Studies on the clinical effectiveness of the above natural therapies in preventing and/or treating health conditions, disease or injuries in humans are being sought. Updates in relation to the outcomes of this review will be published on the ANTA website as they become available.

Bushfires

Our sympathy and thoughts go out to the Australian public, including ANTA members and clients who have experienced the loss of family members, livestock, pets, businesses, property, personal belongings and livelihoods as a result of the bushfires and unusual weather events continuing to sweep Australia. We ask that any ANTA member suffering hardship as a direct or indirect effect of these catastrophic events to advise us of your contact details so we can provide support and guidance toward recovering your practice status and assist directly with those needs.

The ANTA Board and Administration

Protection and promotion of our member services to the Australian public is the primary objective of the ANTA National Administration Office and the National Board of Directors. The recently expanded Board consists of practitioners and educators currently practising in their specialised fields. It is through the standards and criteria we promote that the ANTA Board leads our members in a consistent approach to providing ethical practices to our clients.

As a result of this, ANTA attracts the best personnel to its

Autumn 2020

Board. ANTA's experienced staff and service providers also strengthen our aims to fortify our members' professional standards and clinical practice. We are constantly seeking bespoke services to ensure our members receive relevant, fit for purpose support, guidance and leadership. Your National Council has recently undergone significant changes to improve communications and responses to your needs. We experienced strong support from our dedicated practitioners, eight of whom were sworn in as Directors at the ANTA Annual General Meeting in Melbourne during November 2019. We acknowledge the outstanding commitment our current serving Directors continue to make and we welcome the newly appointed Branch Chairs to represent your modality as members of the ANTA National Council. The complete list of Directors will be published in this edition of The Natural Therapist (page 12).

Your ANTA National Administration Office staff are also a well-trained and experienced team of professionals.

The administration leadership has been streamlined to specialise in key functions of professional association operations. Each staff member is an expert in their field of operations such as new membership, continuing membership, membership standards, terms and conditions.

Professional Insurance & Health Fund Administration

The coverage and cost have also been reviewed and your feedback has been taken seriously. Please watch this space for news of innovative changes and benefits we have secured for all members going forward. Health Fund administration has also been improved to comply with the Australian Private Healthcare Association member funds. Read the ANTA News and eNews to get updated information on membership and Health Fund compliance.

It is through the strength of compliance we demonstrate as a registered, multi-modality peak body that we maintain credibility and professionalism to maintain the recognition you deserve as an ANTA member. To this end we have entered into collaborative arrangements with other peak bodies to share information relating to the latest challenges to traditional and natural therapy training and services in Australia. Our specific modality leaders are engaged in national advisory committees and board representation to protect and promote your specific allied health practices. We continue to represent you through the appointment of National Councillors with specialised skills to take your case to private health funds, national review committees, government departments and inter-association consultation groups to share common challenges and solutions.

PAGE 6 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

ANTA News Autumn 2020

The Future

As professionals in traditional medicine and natural therapies, we are all required to maintain continuing professional education and development to inform ourselves where technical and clinical innovation is heading. It is clear that the training we undertook to achieve practitioner level was incomplete in relation to the future landscape we will be working in for the foreseeable future. This phenomenon is common across all professions on a global basis as a result of technological and professional advances in clinical practice and practice management. It is also clear that to withdraw from relevant lifelong studies and technical skill development would see us being surpassed in professional practice within a short period of time. ANTA continues to build member services that will support and assist members to grow their businesses and maintain clinical relevance in the future.

The future is also dependant on ANTA maintaining its integrity and relevance to current and future qualifications and practices, we do this through an active program of collaboration both in Australia and abroad to inform ourselves of international trends, innovations and professional advances.

Continuing Professional Education

When joining ANTA in 1996 I was introduced to a number of unique standards and criteria to qualify and maintain membership with ANTA. One of these was to satisfy a verifiable continuing professional education and development criterion of 20 hours each calendar year. With a background in sports coaching, I was familiar with this "continuous improvement" process to ensure our practices are state of the art and we are across any innovations and developments vital to maximum performance. I was pleased to see the same standards applied to practitioners of Traditional Medicine and Natural Therapies. This era preceded Private Health Fund recognition and provider access.

CPE/CPD is a globally recognised requirement for maintaining currency as a practitioner, teacher, coach, accountant, doctor, engineer, lawyer etc. Almost every trade and profession require practitioner members to maintain and upgrade skills and knowledge on an annual basis. The private health funds found this standard to be vital to association members acquiring the knowledge and

ability to comply with their requirements for Private Health Fund provider recognition and membership.

The greatest incidence of risk to Private Health Fund providers is now known as Health Fund Fraud. Whether it be committed through billing for services not delivered and over-delivery of services and rebates claimed for no services. Practitioners recognised as providers have been found allowing untrained, non-recognised therapists to use their details to provide benefits to otherwise ineligible subscribers, this practice is in breach of the health funds' terms and conditions. Through ANTA's provision of free CPE Seminar/Webinars across Australia and its online resources we assist and support our members to understand and comply with current CPE and professional standards.

ANTA members are encouraged to access these resources to either fulfil or complement the compulsory ongoing training that is part of the terms and conditions of their membership with ANTA. Of course, the Private Health Funds audit our member records regularly to assure we are complying with their respective terms and conditions.

Any members becoming concerned about their CPE status should contact the ANTA office to clarify their membership eligibility.

Association failure and members' loss of Health Fund accreditation and ability to practice

ANTA is currently experiencing an increase in applications from other massage associations that failed Health Fund audits based on a deficiency in Continuing Professional Education records during September 2019. This unfortunate event highlights the severe disadvantage any member of a professional association may experience when they are non-compliant with association and external stakeholder requirements. ANTA will admit any applicant meeting the ANTA entry standards, we will support and assist new members changing situations that do not meet their needs.

Regards

Jim Olds

ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM.

ANTA FREE National Seminars

ANTA Seminars feature high profile presenters who are regarded as authorities in their field of expertise and are free for all ANTA members and student members, practitioners and natural therapists. Members will receive an invitation and notice prior to the seminar being held in their state. Full details of ANTA seminars will be posted online closer to the event date. Make sure you visit this site regularly to keep abreast of latest developments.

Members, graduates, and students are invited to attend FREE! THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 7

ANTA News Autumn 2020

ANTA News

Virtual Consultations Virtual Consultations are generally regarded as contact with patients or the provision of services to patients that are not face-to-face or in the physical presence of the patient. Virtual consultations may be conducted by telephone, email, internet, webcam or by any other non-face-to-face medium.

Practitioners must be aware that when providing any services or information virtually, the absence of a face-to-face meeting or physical assessment/examination means that critical clinical information necessary for safe and efficacious treatment is unavailable. Practitioners must therefore act within the limitations of the non-face-to-face medium being used and must also refrain from prescribing medication.

Virtual consultations should not be used as a substitute for personal face-to-face consultations. Members should notify patients that Health Funds as a general rule do not offer rebates for virtual consultations and advise patients to contact their Health Fund if they have any questions or require any further information.

ANTA has some guidelines around Health Funds, insurance and virtual consultations in the ANTA News sections on the website home page.

2020 Bursary Awards The ANTA Bursary Awards have been established to encourage and assist students to maximise the opportunities provided in their education and assist students to achieve their aims and goals in natural therapies. ANTA believes that as far as possible a student’s financial situation should not be an impediment in the pursuit of a career in natural therapies. ANTA selects 12 students to receive an ANTA Bursary Award of $1,000 and also 12 months free ANTA membership (to be taken up when course completed).

How it works

If you are an ANTA student member you are eligible to apply for an ANTA Bursary Award. All you have to do to apply is send ANTA an assignment you have completed as part of your studies.

The opportunity for students to receive an ANTA Bursary Award has significantly increased and students are encouraged to lodge their Bursary submission before 31 July.

PAGE 8 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

ANTA News Autumn 2020

Important!

New Condition of Membership Working with Children's Check or National Crime Check

ANTA has been advised by Health Funds that all members will now require a Working with Children's Check (paid or voluntary) or a National Crime Check to be eligible for Health Fund recognition and this will now be a condition of ANTA Membership going forward.

your Health Fund and Membership status might be in jeopardy.

Please be aware that all Australian States have different policies and procedures when it comes to these Checks.

Please visit ANTA's website for details of which Check you need to do in your State. ANTA requires your document to be either emailed or uploaded within the ANTA Member Centre by 30 June 2020. If this is not completed

As an association recognising practitioners within the healthcare industry, ANTA has an obligation to ensure the public's safety by ensuring all members, whether Health Fund modality accepted or not, have a completed and clear criminal history checks.

AHPRA registered members do not need to complete this requirement as it a condition of AHPRA registration.

2020 Graduate Awards The ANTA Graduate Awards have been established to reward achievement and to assist graduates with their careers. ANTA Graduate Awards consist of 12 months complimentary ANTA membership and $200. A total of 12 ANTA Graduate Awards will be provided each year (six awards in the January-June period and six awards in the July-December period).

The ANTA Graduate Awards are open to all graduates in all disciplines/modalities accredited by ANTA and who have completed course(s) recognised by ANTA. Students who have

graduated and join ANTA will be automatically included and assessed for an ANTA Graduate Award.

How it works

When a graduate joins ANTA, their academic transcript will be assessed by a panel in the categories of course unit achievement, consistency, clinical practicum and overall achievement. All graduates are considered for the ANTA Graduate Awards.

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 9

ANTA ICNM Overview Autumn 2020

6th International Congress on

ICNM

Naturopathic Medicine 5 - 7 JULY 2019, LONDON, UK

The Role of the Association in the Future of Natural Medicine

Associations provide a primary role in providing ongoing context for Naturopathic philosophy and treatments by means of progressing view points on both tradition and research through integrating a multi-modality approach with a focus on bringing the traditional view of medicine confidently into the modern scientific paradigm.

Professional status through affiliation with a respected accreditation body identifies an unregistered natural health practitioner as being adequately qualified to practice.

Association membership is a current measure of safety for the public in many countries where Naturopathic medicine is not a registered profession3. Statutory registration is a fundamental issue in the future of professional Naturopathic practice and safeguarding the public4.

Associations support multi-modal natural health professions and act on the practitioner's behalf in many ways. Predominantly, they form strong connections and actively liaise with government bodies in regards to progressing registration in the form of submissions, advising on policies and procedures and are sought out for opinion on legislative decisions related to natural health.

Associations maintain professionalism with enforcing adherence to a national code of conduct to safeguard the public1.

Associations accredit and advise College and University natural health educational institutions in course recognition, content and guidelines3. They uphold levels of educational standards, ensuring new members have the highest qualification available in their modality2.

Associations may provide financial bursary or graduate awards to students to support professional careers.

Research is undoubtedly a cornerstone requirement to secure Naturopathic practice alongside modern medicine2.

Associations actively support research through promotion of published clinical trials, cultivating research at various institutions and providing financial support for research projects.

Associations provide a Code of Professional Ethics and an Ethics Committee who are required to conduct a natural justice review of a complaint to determine unethical practice.

Membership with an association in Australia gives providence of a Therapeutic Goods Administration certificate that enables exclusive ability to extemporaneously dispense herbal extracts and nutritional remedies as therapeutic goods.

Associations advise Health Funds on policies, procedures and key components of professional practice requirements.

Building affiliations with organisations in the profession allows associations to create benefits and discounts for members.

Continuing Professional Educational (CPE) requirements are upheld by members and enforced by associations. CPE events also give members networking opportunities.

The current healthcare landscape provides an opportunity for association accredited natural medicine practitioners to exhibit our professional practice.

Actions ANTA have provided to Australian Natural Health Practitioners include but are not limited to: • The only association to lodge an official submission with the Federal Government for Statutory Registration for Naturopathy, Western Herbal Medicine, Nutritional Medicine, Remedial Massage and Myotherapy

PAGE 10 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

ANTA ICNM Overview Autumn 2020 • Being represented and involved with all levels of Federal and State Government • Removal of GST from certain modalities within the "GST Act" • Advising Health Funds and governing bodies on policies • Submissions to Health Funds for Nutritional Medicine recognition • Petition response to Health Fund rebate removal (10,000 signatures) • Setting of standards for clinical practice • Regular audits and assessments of clinics, colleges and practitioners • Insurance premiums and benefits including complementary access to advice • Free full access to world class scientific research databases • Research support and financial contributions • High quality free CPE professional development with online webinars and national seminars • Continual assessment and accreditation of courses and institutions to maintain the highest standards of education and course guidelines • Presence on Course Advisory Committees of major Colleges and Universities • Annual ANTA Bursary Award program (12 x $1000 plus 1-year complimentary membership bursaries available

The International Congress on Naturopathic Medicine (ICNM) is a non-profit devoted to education, uniting alternative and natural medicine healthcare experts worldwide. ICNM began with the mission of providing high quality continuing medical education for healthcare professionals dedicated to patient care all over the world. Today, ICNM has become the International Organisation for Global Cooperation.

Elizabeth Greenwood

ANTA National President Master of Herbal Medicine, Naturopath, Aromatherapist ICNM Australia/New Zealand Ambassador Lecturer BHSc Naturopathy For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

to represent an inspiring, dedicated and passionate group of practitioners, educators, researchers and presenters who gather from all areas of the world to share their experiences and knowledge of Naturopathic medicine.

At ICNM you can expect to see inspirational presentations on cutting edge and leading topics that incorporate both the traditional practices and the latest in clinical research to inform your best practice and optimal patient outcomes. ICNM is supportive of the natural health profession throughout the world.

ANTA is a GOLD Sponsor of the International Congress on Naturopathic Medicine. The ANTA President, Elizabeth Greenwood, is the Australian Ambassador and International representative for Australian Natural Therapists. She is proud

annually, over $140,000 to date) • ANTA Graduate Awards program (12 x $200 plus 1-year complimentary membership bursaries available) • Personalised Practitioner webpage on website searchable by the public • Creation of the first public searchable Natural Therapy App • The Natural Therapist educational journal (published quarterly) • Monthly technical book giveaways and educational resources • eNews with current and updated regulatory information • Ongoing professional advice and support from experienced Directors

7th ICNM WORLD CONFERENCE 2021 Perfect Health! Restoring Balance Naturally 9th – 11th July 2021 Paris, France For more information, register and to stay updated please visit: www.icnmnaturopathy.eu Follow us on social media: #icnmcongress See you there!

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 11

ANTA News Autumn 2020

Meet the ANTA Executive

Jim Olds - ANTA Executive Officer

Jim is a Myotherapist who has operated clinics in New South Wales and Queensland for over 27 years.

He is a trainer, educator and the Executive Officer and Company Secretary of ANTA. His advocacy for the profession is founded on ethical practice focusing on public health and safety.

Elizabeth Greenwood - National President

Elizabeth is a Master of Herbal Medicine, Naturopath and Aromatherapist. She has spent many years in the profession of Naturopathic medicine and has seen the multi-factorial aspects of holistic practice first hand. Elizabeth is dedicated to the strength and professionalism of Naturopathy through education, mentoring and international recognition of Naturopathy as a viable and reliable method of healthcare.

Jeanetta Gogol - National Vice-President

Jeanetta is a dedicated Myotherapist with over 30 years' experience in the industry. She is dedicated to her career and has worked in a number of environments within the healthcare industry including clinics, hospitals and nursing homes. Jeanetta has training in both Australia and China and holds qualifications from both countries. She provides training workshops and has been involved in mentoring practitioners within the industry. In addition to this, Jeanetta is also heavily involved in local and federal government regulation and registration.

Justin Lovelock - National Treasurer

Justin is a dedicated practitioner and has been practising since 1988 and lecturing since 1992. Justin believes we all can either support and hinder our health. The body has an innate ability to heal itself through the foods we consume, the lifestyles we lead and the attitudes we hold. Justin believes we all have a unique 'constitutional' tendencies of body and mind. What is good for one may not be good for another. Knowing our 'type' is the key.

Warren Maginn

Warren is a Clinical Nutritionist and college lecturer, specialising in the individualised management of chronic health conditions through the principles of Functional and Nutritional Medicine. Warren mentors naturopathic and medical practitioners around Australia and New Zealand in their use of functional laboratory testing, nutritional compounding and clinical nutraceuticals, as a basis to holistic and integrative health management.

PAGE 12 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

e and Directors for 2020

ANTA News Autumn 2020

Shaun Brewster

Shaun is a Myotherapist, Exercise Physiologist, educator and clinician. For over 20 years Shaun has dedicated his career to working clinically with clients, providing education in both higher education institutions and in post graduate training, and working closely with industry groups to help move the quality and standard of healthcare forward.

Kaitlin Edin

Kaitlin is an Acupuncturist with extensive knowledge and use of different styles of Acupuncture.

She began her studies informally in Japan and completed her Bachelor of Health Science (TCM) in Australia in 2008. Since 2009, Kaitlin has worked for an industry partner to the natural therapies and acupuncture profession providing clinical and administrative support to practitioners during that time.

Her experience within education institutions, industry and clinical practice provides her with a broad base of knowledge, to best support her branch members.

Isaac Enbom

Isaac specialises in the area of Myotherapy with extensive experience as both a clinician and educator.

He has completed additional studies in Health and Exercise Science and believes in a holistic approach to healthcare. With over 10 years of experience in the field, his Myotherapy practice has allowed him to work in various settings, along with mentoring other practitioners. Isaac is committed to the industry and ensuring the highest quality education of manual therapists.

Mark Shoring

Mark has been a leader within the natural medicine profession for the past 20 years. While working extensively as a clinical practitioner, he has also worked across the profession through corporate, operations, governance and education sectors. Mark was also deeply engaged at the college level for more than 15 years. Mark went on to accept the role of National Program Leader with responsibility for the delivery of the Bachelor of Health Science (Acupuncture) degree across six campuses in Australia.

Tony Reid - National Council Advisor

Tony is a graduate of the Sydney Institute of Traditional Chinese Medicine and holds a Master degree in Acupuncture and TCM. He has been involved in the profession as a clinician, lecturer, administrator, course designer and industry consultant since the early 1980s. Tony is currently a Director of Sun Herbal Pty Ltd, focussing on product design, practitioner education and regulatory affairs. Tony enjoys writing academic articles, exploring the strengths and weaknesses of the evidence-based medicine paradigm and complementary approaches to healthcare, with a specific focus on TCM. THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 13

ANTA News Autumn 2020

ANTA Bursary Award Winners for 2019 ANTA is pleased to announce the ANTA Bursary Award Winners for 2019. ANTA Bursary Awards consist of $1,000 which can be used towards becoming a practitioner. Congratulations to all winners.

ANTA Bursary Awards for 2020 are open and more information can be found at www.anta.com.au.

Bridget Backhouse

Cameron Turco

Jessica Bonnitcha

Kristy Te

Kellie Melia

Laura Wilson

Marissa Moloney

Melanie Connell

Nicole Isaacson

PAGE 14 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

ANTA News Autumn 2020

Reiko Fujiike-Stirling

Sophie Cutler

Suzanne Shields

Round 2 ANTA Graduate Award Winners for 2019 ANTA is pleased to announce the second round of ANTA Graduate Award Winners for 2019. ANTA Graduate Awards consist of 12 months complimentary ANTA membership and $200. ANTA Graduate Awards are ongoing throughout the year, and more information can be found at www.anta.com.au.

Ann-Louise Barrett

Cassandra Snape

Chunyang Lin

David George

Mareike Haidn

Joanna Smartt

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 15

Advertorial Autumn 2020

Scar Tissue, the most overlooked issue in Healthcare

By Marjorie Brook What do all of the following have in common? Caesarean "C" section, breast reduction, breast augmentation, appendectomy, laparoscopy, arthroscopy.

Well, that is easy right? They are all surgeries. But would it surprise you to know that 6 out of 10 women who walk into my office do not consider C-sections or breast work surgeries?

There is an alarm going off in my head. When a new client comes to see me, I have them fill out a medical history intake form. It is very common for people to "forget" about past injuries, illness and, yes, even a minor surgery. It has always amazed me nonetheless, how does one forget they broke an arm or an ankle? During a session I will observe a scar and inquire as to its origin. The client inevitably says, "What scar? Where? Oh right? ...That’s from when I wiped out on my motorcycle...".

I have been a licensed massage therapist for over 20 years and, in all that time, a recurring theme seems to have prevailed. The presence of scar tissue can have a lifelong physiological effect on the body. This realisation, combined with my clinical experience, education, teaching and research, has led to me developing the STRAIT (Scar Tissue Release And Integrated Therapies) Method to release restricted tissues and restore balance and freedom of movement.

I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had. While not every scar presents a problem, often they can. This is due to the fact the body is one large, three-dimensional piece of fascia that envelops us like an intricate spider web. Any kink, pull or restriction in one area affects the whole matrix.

Scar tissue and adhesions are the result of our body's natural healing process and it occurs both internally and externally.

The process, if working correctly, is supposed to eliminate the scars and adhesions once the wound is healed. In some cases, a person's body does not break down the scar tissue. In others, adhesions have built to help support the body due to poor posture, repetitive use or injury. The adhered tissue continues to spread which can trigger a cascading effect of compensations throughout the body.

The STRAIT Method is a series of fascial techniques that release and realign the restrictive tissue from the starting point (visible scar) to the end point (where the line of frozen fascia stops). This release system, which I have developed and now use with my clients, differs from traditional methods because it approaches the multi-faceted matrix of fascia three dimensionally.

Marjorie Brook is an International Instructor/Therapist. She is the creator of the STRAIT Method, a specialised therapy for fascial scars and adhesions.

She will teach the STRAIT Method in Australia in May 2020, more information at terrarosa.com.au

PAGE 16 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020 Dr. Mark T. Waddingham & Dr. George A. Thouas Max Biocare Pty. Ltd

A Brief Review of the Therapeutic Properties of Fucoidans Introduction Fucoidans are a family of high molecular weight, sulphated polysaccharides that are abundant in various species of edible marine algae including kelp, kombu (Laminara japonica), mozuku (Nemacystus decipiens), wakame (Undaria pinnatifida), hijiki (Hizikia fusiforme) and bladderwrack (Fucus vesiculosus), in addition to many other species1. Fucoidans can also be found in some marine invertebrates such as sea cucumber and sea urchin. In parts of East Asia such as China, Korea and Japan, brown algae are routinely consumed as part of a normal diet, and fucoidan

Mechanisms of action

Fucoidans are rich in the monosaccharide, fucose, which is used in the activation of specific cell-surface proteins (e.g. selectins) that regulate cell-to-cell adhesion and signalling at sites of injury and inflammation. This action regulates anticoagulant and anticlotting effects that form part of the wound healing process. Fucosylation is also involved in the ABO blood antigen system that is responsible for immune mediated blood coagulation. Fucoidan extracts have shown a wide variety of other biological actions, including antiviral, neuroprotective, antiarthritic, antiulcer and antioxidant effects1. More controversially, fucoidans display anti-neoplastic effects through their ability to inhibit cell migration and control molecular pathways involved in cell survival and apoptosis, such as p53 (tumor protein)3,4. They are also implicated in the complex biology of fucosyltransferase enzymes.

Clinical evidence

Fucoidans have been researched across a broad range of health areas, including cardiovascular and metabolic health, immunity and even the more challenging field of oncology. In relation to cardiovascular health, analysis of a

extracts derived from commonly farmed species continue to be used in traditional medicine paradigms. As such, they are frequently referred to as functional or medicinal foods. Given the typically lower rates of chronic disease (cardiovascular disease, diabetes, obesity and cancer) in East Asian countries, relative to Western countries2, there has been considerable interest in the therapeutic potential of brown algae bioactives internationally. In this article, we briefly describe some of the main reported clinical applications of fucoidans.

national cross-sectional health and nutrition survey from Korea revealed that an increased frequency of brown algae consumption was positively correlated with the intake of a healthy diet (legumes, fruit, fish and dairy) and decreased fast-food and carbohydrate consumption in both men and women5. Furthermore, a stratified analysis found that men who consumed the highest amount of brown algae exhibited a moderately reduced risk of type-2 diabetes mellitus5. These observational studies were supported in another study of 28 Japanese patients with type-2 diabetes mellitus, who were administered 1620mg of high molecular weight fucoidan for 12 weeks6. When compared to placebo, fucoidan treatment increased gastrointestinal function, including elevated stool frequency and heightened taste sensitivity (both P<0.05)6. The enhanced gastrointestinal function (in particular taste sensitivity) was thought to be a key driver of the improved diabetes control in the long-term, as evidenced by significantly decreased HbA1c and plasma glucagon-like peptide 1 (both P<0.05) in the fucoidan-treated patients6. In a double-blind, randomised, placebo-controlled clinical trial in a small cohort of overweight or obese Mexican patients (n=25), it was reported that 500mg of fucoidan extract from Saccharina THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 17

Member Article Autumn 2020 japonica daily for 3 months significantly reduced diastolic blood pressure (P<0.05) and low-density lipoprotein cholesterol (LDL-C; P<0.01) compared to pre-treatment baseline values7. Although somewhat paradoxically, fucoidan appeared to increase plasma insulin secretion and HOMA-IR (both P<0.05) compared to the baseline values7.

It should be noted though, the relative change in plasma insulin levels were comparable over the course of the study, suggesting that fucoidan may not have necessarily worsened the progression of metabolic disease.

In relation to immune health, fucoidans have been reported to stimulate the mobilisation of circulating hematopoietic progenitor stem cells. In a single-blind, randomised, placebo-controlled clinical trial (n=37), 2250mg of daily administration of fucoidan from Undaria pinnatifida was reported to significantly enhance the circulating CD34+ progenitor cell count over the 12-day treatment period, compared to pre-treatment values (P<0.05)8. Furthermore, a significant increase in the expression of the CD34+ receptor, CXCR4 was also shown after the 12 days (P<0.001 vs baseline). Moreover, significant increases in stromal derived factor 1 (SDF1) and the cytokine interferon gamma (IFN-γ) were observed over the treatment period (both P<0.01)8. Overall, this study indicates that fucoidan helps to stimulate a healthy immune response. In another combined safety and efficacy, open-label study, participants (n=10) were randomised to receive a mixture of fucoidan extracts from Fucus vesiculosis (85% w/w), Macrocystis pyrifera (10% w/w) and Laminara japonica (5% w/w) at either a dose of 100mg or 1000mg per day for 4 weeks9. In the short-term, a significant increase in cytotoxic T cells and natural killer cells were observed (P<0.05), followed by elevated phagocytic activity and decreased interleukin (IL)6 expression in the long-term. Fucoidan extracts have also been reported to "prime" the immune system prior to a seasonal influenza vaccination. In elderly Japanese subjects (n=70), a randomised, double-blind, placebo-controlled trial demonstrated that consumption of fucoidan (300mg/day) for 4 weeks before being vaccinated against the influenza virus tended to promote a moderate increase in natural killer cell activity in the longterm (9-weeks post-treatment, 5-weeks post-vaccination)10.

By contrast, such differences were not observed in the placebo group, where natural killer cell activity tended to decline more so after the 9-week timepoint10.

Taken together, fucoidan supplementation appears to confer beneficial effects upon the immune system and may be particularly useful in states of immunodeficiency.

Fucoidans have been demonstrated safe for use as

adjuvants in the oncology setting. When patients with malignant breast carcinoma were administered 1g/ day of fucoidan for 3 weeks, it was reported that in combination with letrozole or tamoxifen (n=10/group) resulted in no adverse effects or changes in treatment efficacy11. In another study, a small cohort of patients with advanced or recurrent colorectal carcinoma (n=20), consumption of 4g of fucoidan daily for 6 months, significantly improved the tolerance of chemotherapy (increased number of treatment cycles, P<0.05), reduced fatigue associated with chemotherapy (P<0.05) and showed a trend toward increase survival at 25 months follow-up12. In a larger (n=54), prospective, double-blind, placebo-controlled study, 8mg of fucoidan daily for 6 months significantly improved the disease control rate (P<0.05 vs. placebo)13. Additionally, fucoidan tended to improve the overall survival rate as well as the probability of disease-free progression, although these differences did not reach statistical significance13. There were no overall differences observed in quality of life (QOL) scores13. Takahashi and colleagues have recently reported that short-term (4 weeks) consumption of 4g of fucoidan daily resulted in an initial significant reduction in level of proinflammatory cytokines IL-1β, IL-6 and TNF-α after 2 weeks (all P<0.05 vs. baseline levels) in patients with advanced metastatic cancers (n=20)14. However, these differences were no longer significant at the 4-week timepoint14. Interestingly though, the authors conducted a univariate analysis which revealed reduced IL-1β after 2-weeks of fucoidan treatment is an independent predictor of survival14. Despite the small sample size and the relative heterogeneity of the patients, this study indicates that fucoidan may indeed provide beneficial effects to oncology patients through potentiation of an anti-inflammatory mechanism14.

Consumption of fucoidan is also associated with amelioration of other more manageable health problems such as atopic dermatitis15 and menstrual irregularity (specifically, elevated estrogen with shortened menstrual cycles)16 and possibly prevention of gut dysbiosis17. To this end, fucoidans may assist in gut health by breaking down into oligo-saccharides to feed intestinal microflora, by preventing adhesion of microbes that cause gut infections and protecting the intestinal lining. Pre-clinical research has demonstrated that fucoidan from Undaria pinnatifida almost completely restored intestinal thickness and motility in vivo, following pharmacologically induced gut damage. In relation to musculoskeletal health, a small pilot study (n=12) examined the effect of a fucoidan extract complex (Fucus vesiculosis, 85%; Macrocystis pyrifera, 10% and Laminara japonica, 5%) on patients with knee osteoarthritis18. Participants were randomised to receive either a 100mg or 1000mg dose of the fucoidan extract for 12 weeks. Comprehensive arthritis test (COAT) scores showed a dose-dependent decrease over the course of the study, however both doses were effective in reducing osteoarthritic symptoms18. Despite the improvement in COAT scores, circulating levels of the cytokine tumour necrosis factor-α (TNF-α) were not different to the pre-

PAGE 18 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020 treatment levels or between the groups18. This suggests that the improvements experienced by these patients may be independent of the modulation of the inflammatory system.

would certainly help to determine their therapeutic efficacy in more defined treatment applications.

Conclusion

Here, we have highlighted some of the main clinical findings of fucoidan supplementation. Fucoidans appear most promising in the areas of immune modulation and oncology support, however clinical reports to date have been relatively sparse, across multiple plant species, and subject to a wide degree of methodological heterogeneity, despite a much larger body of work in preclinical and experimental research. Considering this and the diversity of health benefits and biological effects of fucoidans, further large-scale, double-blind, placebo-controlled clinical trials

Table 1. Summary of selected clinical studies reviewed that have used fucoidan extracts Fucoidan Species

Study Design

Dose

Outcome/Effect

Reference

Macrocystis pyrifera

Randomised, double-blind, placebo-controlled, crossover

810mg, administered twice per day as a 30mL beverage (60mL/day) for 12 weeks

↑ stool frequency, ↓ HbA1c (P<0.05), ↓ fasting plasma GLP-1 (P<0.05), enhanced taste sensitivity

Sakai C et al., 2019

Saccharina japonica

Randomised, double-blind, placebo-controlled

500mg per day for 3 months

Compared to baseline ↓ diastolic blood pressure (P<0.05), ↓ LDL cholesterol (P<0.01), ↑ plasma insulin and ↑ HOMA-IR (P<0.05)

HernándezCorona DM et al., 2014

Not specified

Cross-sectional survey on dietary algae consumption

Not applicable

Consumption of dietary algae may reduce the risk of developing type-2 diabetes in Korean men

Lee HJ et al., 2010

Macrocystis Open-label dosing study, pyrifera, participants randomised to Laminaria japonica different doses & Fucus vesiculosis

100mg or 1000mg per day for 12 weeks

A significant dose-dependent reduction in comprehensive osteoarthritis test scores with no adverse events

Myers SP et al., 2010

Undaria pinnatifida Randomised, double-blind, placebo-controlled

300mg per day for 24 weeks

After the administration of the influenza vaccine, ↑ antibody production in all strains in the vaccine, ↑ natural killer cell activity

Negishi H et al., 2013

Fucus vesiculosis, Macrocystis pyrifera & Laminaria japonica

Open-label dosing study, participants randomised to different doses

100mg or 1000mg per day for 4 weeks

Both doses were safe. There were significant immunomodulatory effects

Myers SP et al., 2011

Undara pinnatifida

Single-blind, randomised, placebo-controlled

3g of 10% or 75% (w/w) fucoidan preparation for 12 days

A significant increase (P<0.05) in CD34+ cells, CXCR4 on CD34+, stromal derived factor (SDF)-1 and interferon (IFN)-γ were observed in the 75% fucoidan group

Irhmeh MR et al., 2007

Cladosiphon novae-caledoniae

Prospective, open-label, single-arm

4000mg/d for up to 4 weeks, administered as a beverage (400mL/ day, 10mg/mL)

Advanced metastatic cancer patients (n=20), ↓ IL-1β, ↓ IL-6 and ↓ TNF-α vs baseline values (all P<0.05)

Takahashi H et al., 2018

Undaria pinnatifida Open-label, non-crossover

500mg twice per day for 3 weeks

Fucoidan is a safe adjunct supplement for standard anticancer therapies in patients with breast cancer

Tocaciu S et al., 2018

Not specified

Prospective, randomised, double-blind, placebocontrolled

8000mg per day for 6 months

Fucoidan improved the disease control rates in colorectal cancer. No improvement in survival outcomes or QOL

Tsai HL et al., 2017

Cladosiphon okamuranus

Randomised

4050mg per day for 6 months as a 150mL beverage

Fucoidan supplementation ↑ tolerance of chemotherapy (P<0.05), ↓ patient fatigue and tended to improve survival

Ikeguchi M et al., 2011

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 19

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Member Article Autumn 2020

Introducing: The Hevert Collection

The Hevert Collection includes 12 volumes that bring the very best literature from the remarkable Lüst journals of the early 20th Century to contemporary naturopathic doctors.

Dr Sussanna Czeranko has spent the last 10 years working on these 12 books. The Hevert Collection spans the history of naturopathic medicine writings that are in the National University of Natural Medicine university rare books library.

This is a truly comprehensive compiling of essential historical practice techniques giving natural health practitioners a depth of holistic understanding that can be applied to present day naturopathic practice.

Origins of Naturopathic Medicine: In Their Own Words

Classic articles framing key clinical and professional issues affecting naturopathic doctors. A historical overview drawn from the Benedict Lüst journals published between 1900 to 1923. These classic articles, meticulously researched and selected, frame the key clinical and professional issues that have affected naturopathic doctors to this day.

Philosophy of Naturopathic Medicine: In Their Own Words

The philosophy of naturopathic medicine recognises that nature is inherently wise. In choosing the philosophy of naturopathic medicine, the Naturopath recognises that nature is inherently wise — and that abiding by its laws, we can reinforce and sustain physical and mental health. The naturopathic movement was founded by pioneer Benedict Lüst and led by him through 50 years of publishing advocacy and patient care.

Dietetics of Naturopathic Medicine: In Their Own Words

Writings of early naturopaths who scrupulously examined and documented the role of diet and food.

What we choose to eat is arguably the most important factor in producing and sustaining health. Diet was a cornerstone for the early Naturopaths as they charted a course for health reform. This volume is a review of the writings of these early Naturopaths who scrupulously examined and documented the role of diet and food. As important today as when these pioneers first brought forward their discoveries into clinical practice, their dietetic knowledge is a precious resource for the modern Naturopath.

PAGE 22 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020

Principles of Naturopathic Medicine: In Their Own Words

The transformation of the six contemporary naturopathic principles that began as 12 in 1902. This book helps contemporary Naturopaths understand how their principles transformed over time. Understanding the roots and evolution of the naturopathic principles is critical to ensure the success and unique character of naturopathic medical practice.

Practice of Naturopathic Medicine: In Their Own Words

Clinical practices of naturopathic pioneers including heliotherapy, surgery, and more! The very best of naturopathic pioneers' clinical practices. This book explores their modalities and methodologies ranging from heliotherapy, Nauheim baths, bloodless and orthopaedic surgery, earth cure, water cure, botanical medicine and dietetics.

Vaccination and Naturopathic Medicine: In Their Own Words

Vaccinations have been controversial since they first appeared in Western medicine. The topic of vaccination is fraught with intrigue and complexities. Since vaccinations first appearance in Western medicine, the controversy between those warning of its dangers and those espousing its utility has endured. Perhaps no professional body has been more consistent in articulating its concerns than the Naturopaths of the early 20th Century. Indeed, the issue of vaccination safety and efficacy has a special place in the history of naturopathy not only because of the strong energies, convictions and polarities it conjures, but also because the very issue galvanised the early Naturopaths and helped shape the profession.

Physical Culture in Naturopathic Medicine: In Their Own Words

A chronicle of the physical exercise movement that joined forces with Naturopathy in the early 20th Century. Physical Culture in Naturopathic Medicine, the seventh volume of 12 in the Hevert Collection, documents the physical exercise movement that joined forces with Naturopathy at the beginning of the early 20th Century. The early Naturopaths got fully behind the vision and efforts of the "Physical Culturists" in their endorsement of physical exercise, both for young people in schools and for their parents and other adult patients whose increasingly stressed lifestyles were being affected by a rapidly urbanising environment characterised by poor nutrition, environmental toxicity and commonplace poverty.

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 23

Member Article Autumn 2020

Herbs in Naturopathic Medicine: In Their Own Words

A peek into the Naturopathic Herbal Armamentarium of the very early 20th Century. We can trace the central role of herbal medicine in North American naturopathic practice back to Benedict Lüst who introduced the rich legacy and tools of Father Kneipp to his American colleagues. Herbs in Naturopathic Medicine pulls back this historical curtain giving us a peek into the Naturopathic Herbal Armamentarium of the very early 20th Century.

Mental Culture in Naturopathic Medicine: In Their Own Words

The prescient writings about mind-body medicine at the very inception of Naturopathy. Mental Culture In Naturopathic Medicine presents Naturopaths' writing in the early 1900s about the body-mind connection in health and healing. Articles on the role of emotions on health, the physical effects of thoughts, the interaction of body and spirit, benefits of sleep for efficiency, are topics that continue today in scientific studies and in self-actualisation and self-help material. There are articles by Helen Wilmans, who first introduced "The Law of Attraction". Students of women's studies will find articles on how Naturopaths differed from the medical establishment on treating female "hysteria". One finds a profound belief in the power of thought and the higher good. The body and the mind are one. As a part of nature, man has great potential for awareness, happiness, transformation, and relief from ignorance.

Hydrotherapy in Naturopathic Medicine: In Their Own Words

The very best early naturopathic literature chronicling the power of Hydrotherapy. The use of water for healing and health is the very foundation of Naturopathy. Hydrotherapy in Naturopathic Medicine, the 10th book in the twelve-volume Hevert Collection, gathers together the extraordinary water therapies celebrated in Benedict Lüst's publications from 1897 to 1923. Inclusive of the pioneering, powerful work of Vincent Priessnitz and Sebastian Kneipp — who championed hydrotherapy as instrumental in alleviating suffering using simple water applications — this collection offers best practices for rediscovery. Medical doctors in the eras of Priessnitz and Kneipp flocked to preceptor with them, wishing to ferret out clinical secrets that had led to celebrated, remarkable cures. They discovered that the principle at the centre of hydrotherapy is reverence for the power of nature in healing and wellness. This volume presents the crème de la crème of early naturopathic literature chronicling the power and persistence of hydrotherapy in our armamentarium.

Clinical Pearls in Naturopathic Medicine, Vol. I: Acute Diseases

Presenting "pearls of wisdom" well known by the early 20th Century Naturopaths. This volume presents a substantial range of successful case histories, therapies, theory and practice related to acute presentations well known by early 20th Century Naturopaths. The confidence and depth of the voices here are compelling.

PAGE 24 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020

Clinical Pearls in Naturopathic Medicine, Vol. II: Chronic Disease

A remarkable array of cases, therapeutic tools and healing approaches for chronic disease. The final volume of the Hevert Collection assembles a remarkable array of cases, therapeutic tools and healing approaches for chronic disease as practiced by the Naturopaths in the first decades of the 20th Century as Naturopathic Medicine took root in North America, predicated on its European and global roots.

The collection is edited by Sussanna Czeranko, ND, BBE, NUNM Rare Book Room Curator.

Dr. Czeranko is a licensed Naturopathic Physician in Oregon, USA, since 1994. She is a faculty member at National University of Naturopathic Medicine in Oregon, working as the Rare Books Curator. She incorporates 'nature cure' approaches into her primary care practice using Balneotherapy, Hydrotherapy, Breathing therapy and nutrition. She is a founding Board Member of the Buteyko Breathing Educators Association. Dr. Czeranko has established a traditional naturopathic clinic, Manitou Waters, in Manitou Beach, Saskatchewan, which opened in August 2019.

To purchase The Hevert Collection, please visit: https://nunm-press.com/product-category/hevert-collection/ For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

Vitamin K2: An Essential nutrient for bone health.

Should everyone have some?

How does poor bone health affect the body?

Healthy bones are essential to good overall health. Our bones help us to perform essential and enjoyable activities. Poor bone health can impact on day-to-day life in a significant way. That's why it is so important to keep them healthy.

Healthy bones need Vitamins and Minerals Calcium is crucial for bone metabolism and bone health, but alone, it is not enough. Healthy bones need an adequate supply of vitamin K2. Studies show that rather than going directly to bones, calcium can build up in arteries and soft tissues. Calcium needs vitamin K2 to get it into the bones.

Vitamin K2 and bone health Healthy postmenopausal women (n=244) received either placebo or MenaQ7 (180 mcg/day) for 3 years1. MenaQ7 favourably affected bone strength.

MenaQ7 significantly decreased age-related decline in bone mineral content and bone mineral density at the lumbar spine and femoral neck. MK-7 significantly decreased the loss in vertebral height of the lower thoracic region at the mid-site of the vertebrae.

Knapen, M.H., et al., Osteoporos Int, 2013;24(9):2499-2507.

1

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 25

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Member Article Autumn 2020 Neerja Ahuja

AdvDip Ayurveda, Dip Human Values, M.A. (Maths Statistics), Grad Dip (Computing) Ayurveda Awareness Centre (AAC)

Ayurveda and Gut Health What is Leaky Gut

exactly what causes it.

"You aren't just what you eat, but also how you digest".

The father of modern medicine, Hippocrates, said it himself: "All disease begins in the gut".

Gut health is the current buzz word at the moment. Here we are looking at one of the gut issues, called Leaky Gut, also known as increased intestinal permeability. It is a digestive condition in which bacteria and toxins are able to "leak" through the intestinal wall.

When the gut is "leaky" and bacteria and toxins enter the bloodstream, it can cause widespread inflammation and possibly trigger a reaction from the immune system.

The gastrointestinal GI tract or digestive tract is where food is broken down and nutrients are absorbed.

The walls of the intestines act as barriers, controlling what enters the bloodstream to be transported to your organs.

The lining of your gut is similar to a fine net, built of just a single layer of cells. It is this barrier that keeps food in your digestive system until it can be broken down safely.

If your gut is healthy, tiny holes in the lining allow nutrients to pass through, while blocking the passage of harmful substances. This is how your body absorbs vitamins, minerals and other vital nutrients.

Intestinal permeability refers to how easily substances pass through the intestinal wall.

When there is an inflammation in the gastro-intestinal mucosa, the intestinal wall becomes excessively permeable, and the tight junctions of intestinal walls become loose - a condition called Leaky Gut. The gut becomes more permeable, which may allow bacteria and toxins to pass from the gut into the bloodstream. This phenomenon is commonly referred to as "Leaky Gut".

What causes Leaky Gut

Leaky gut syndrome remains a bit of a medical mystery, and medical professionals are still trying to determine

Some of the common causes of both Leaky Gut and digestive dysfunction are: • Inflammation: Chronic inflammation throughout the body can contribute to Leaky Gut syndrome.

• Stress: Chronic stress is a contributing factor to many GI disorders, including Leaky Gut. • Poor gut health: There are millions of bacteria in the gut, some beneficial and some harmful. When the balance between the two is disrupted, it can affect the barrier function of the intestinal wall.

• Yeast overgrowth: Yeast is naturally present in the gut, but an overgrowth of yeast may contribute to Leaky Gut. • Nutrient deficiencies: Deficiencies in vitamin A, vitamin D and zinc have each been said to play a role in increased intestinal permeability.

• Excessive sugar intake: An unhealthy diet high in sugar, particularly fructose, may harm the barrier function of the intestinal wall.

• Excessive alcohol intake: Excessive alcohol intake may increase intestinal permeability.

• Non-steroidal anti-inflammatory drugs (NSAIDs): The long-term use of NSAIDs can increase intestinal permeability and contribute to Leaky Gut. • Parasites: Parasites can cause extensive damage and can produce symptoms like allergies, constipation, diarrhoea, wind, bloating, irritable bowel syndrome, joint and muscle aches, anaemia, skin problems, sleep disturbances, chronic fatigue, and gradual immune dysfunction. Parasites release toxins that damage tissues, resulting in pain and inflammation, particularly in the gastrointestinal tract and they can depress, the immune system.

Diseases associated with Leaky Gut

Many studies have connected increased intestinal permeability with multiple chronic diseases like Celiac Disease.

Celiac disease is an autoimmune disease characterised by a severe sensitivity to gluten.

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 27

Member Article Autumn 2020 Several studies have found that intestinal permeability is higher in patients with Celiac Disease, Diabetes, Crohn's Disease, Irritable Bowel Syndrome and food allergies.

Typical health issues that are linked to Leaky Gut: • Food allergies • Inflammatory skin conditions • Bloating and gas • Autoimmune Disease • Inflammatory Bowel Disease • Thyroid conditions • Lethargy after eating • Brain fog

Ayurveda and Leaky Gut

Two important concepts in Ayurveda that we need to understand for improving gut health are ama and agni.

Ama is the sticky waste-product of incomplete digestion that builds up in the digestive tract when your digestion is either weak or overloaded with the wrong foods. Ama can be thought of as the ultimate result of a disrupted microbiome and injured gut lining, allowing undigested food, bacteria, or environmental toxins to enter the bloodstream. Ama is a precursor of disease.

When our gut bacteria are disrupted, the gut wall becomes more vulnerable. Antibiotics, poor food choices, and other factors can then lead to damage in the gut wall, which results in increased intestinal permeability and Leaky Gut syndrome. What this means is that undigested or semidigested food, harmful bacteria, and environmental toxins are able to enter our bloodstream.

Ama is not one single thing; it can be different types of foreign substances or toxins that get into the body and triggers our immune system, leading to chronic inflammation and disease.

In Ayurveda, agni means the fire of digestion, which can be translated as the digestive enzymes that break down different foods. This definition can be extended to include the digestive power of the bacteria in our lower gut. The combination of specific bacteria with the sensitivity of our gut determines how much gas we produce and whether we experience bloating, pain, constipation, diarrhea, or comfort and ease.

We aim to reduce ama and enhance agni for improved gut health, and to repair Leaky Gut. How to improve your gut health and support the resolution of Leaky Gut There are steps you can take to improve your gut health.

Here are a few strategies to support a healthy gut: • Remove food triggers: This is probably not forever, just for some time so the gut lining has time to heal and rejuvenate.

• Reduce inflammation: Herbs like turmeric, amalaki, aloe vera or licorice root can be typically used.

• Support liver in detoxing: The liver is responsible for removing toxins from the body. Herbs like turmeric, barberry, guduchi and bhumiamalaki can be typically used.

• Change diet with anti-inflammatory and healing foods according to your dosha, and to remove ama from the body.

• Restore longevity by improving gut flora for better gut health with supplements etc.

Ama reducing diet

We would typically start with couple of weeks of ama reducing diet that included foods to favour and foods to avoid.

Avoiding food triggers is very important for improving your gut health. Avoid the inflammatory foods, which can trigger bloating, gas, heartburn, constipation, and diarrhea.

Some typical ones are wheat, gluten, processed meats, snacks, foods, sweets, dairy, artificial sweeteners, alcohol, and sugary drinks.

Foods to favour includes focus on the foods that offer antiinflammatory and antioxidant properties that are nutrientrich and whole. Typically, fresh vegetables and fruits, gluten-free grains, healthy fats, some herbs and spices e.g. cardamom, cumin, fennel, coriander, turmeric, and parsley.

Amongst herbs, the first choice is typically a traditional herbal mix called 'triphala'. It is named from two Sanskrit words that literally mean 'three fruits'. Triphala is a mixture of the dried and powdered amalaki, haritaki and bibhitaki.

A simple khitchari meal, ama reducing broth and herbs like triphala are important part of our ama reduction plan.

Specifics are then determined for each individual, tailored to their needs and their prakruti or mind-body complex.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles Neerja started her first Ayurveda Registered Training Organisation (RTO) in 2001 in Western Australia offering qualifications up to Advanced Diploma. She is the Principal Consultant at Ayurveda Awareness Centre (AAC) and has regularly led educational seminars and workshops and weekend residential retreats. She has published a variety of articles in national health professional journals.

Neerja consults clients for diet, lifestyle routines for physical, mental and emotional hygiene, offering a variety of Ayurvedic detoxification and de-stressing treatments. As a course facilitator for nationally recognised courses, seminars, workshops, retreats and consultations for over thousands of clients, she has acquired a deep understanding of human psychology and how emotional and mental hygiene helps to reverse the disease process and improve the quality to life.

PAGE 28 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

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And the best part? Consumers are willing to pay more for products that really matter to them. Donâ&#x20AC;&#x2122;t miss out on the latest trends and product offerings from Australiaâ&#x20AC;&#x2122;s most innovative and emerging businesses. Join us in Sydney and make sure your business benefits from the Natural Advantage.

Courses & Seminars Autumn 2020

Natural health products to star at this year's Naturally Good 2020 Expo With the arrival of a new, more conscientious decade, 2020 is set to be the most influential year yet for the natural products space in Australia and the world - particularly when it comes to the natural health sector.

It is predicted that trends towards health and wellness, clean labels and plant-based products will continue to forge ahead demanding more innovation than ever before. With environmental issues now of the utmost importance, it's expected consumers will increasingly buy with a higher level of altruistic, conscious intent.

Returning to Sydney's International Convention Centre on Monday 1st June and Tuesday 2nd June for a sixth big year, the Naturally Good expo will this year be more innovative than ever, featuring over 370 exhibitors and 15 presentations showcasing the hottest products and trends.

Partnering with key industry bodies like the Australian Natural Therapists Association, Complementary Medicines Australia and Australian Organic, industry visitors at the business-to-business event can check out the most diverse businesses, retailers and producers across health, personal care, beauty, home, lifestyle, food and beverages.

This year, the natural health zone will feature close to 40 exhibitors showcasing vitamins, supplements, herbal remedies and complementary medicine products. Key exhibitors will include THS Nutrition, Fiji Kava, Kiwi Manuka, Bluegum Pharma, Glimlife Hab Shifa and Oborne Health Supplies.

Trade visitors will also have the opportunity to hear from Anastasia Lloyd-Wallis from Retail Doctor Group; Michael Fox from Fable Food; Chris Mackey from Retail Veteran and Action Business Coach; Thomas King from Food Frontier; and Niki Ford from Australian Organic. The free to attend speaker series will cover key areas such as emerging consumer trends, practical tips from leading retailers, insights into key consumer segments and marketing strategies. A highlight session will be on Australia's growing complementary medicines market including chronic diseases, trending ingredients, growing categories and opportunities for retail. This session will be hosted by Complementary Medicines Australia (CMA) CEO Carl Gibson and Economic Policy Advisor Aiden Essery.

Anastasia Lloyd-Wallis

Thomas King Food Frontier

Niki Ford

Australian Organic

Retail Doctor Group "Consumers are now clearly demonstrating that they are willing to pay a premium for natural, organic and healthy products," Jon Perry, Group Event Director of Naturally Good said "The Naturally Good expo is therefore fast becoming a critical event for brands, retailers and small business owners looking to take advantage of this trend."

"It's beneficial nowadays for retailers to stock natural and organic products, as those stores will always draw in more customers as opposed to stores that donâ&#x20AC;&#x2122;t stock such items. So, it's worthwhile for business owners to learn more about the industry's 'natural advantage'."

Other exhibitors will include leading food brands such as Spiral Foods, Ceres Organics and The Healthy Chef. Returning will be the Start Up Zone featuring the most innovative products from emerging brands that have launched within the past two years including Cobram Harvest, Nutty Bay and My Provincial Kitchen.

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 31

Courses & Seminars Autumn 2020 Meanwhile, new for 2020 will be a seminar stage dedicated to the beauty and living sector – one of the fastest growing areas within the natural and organic space. This stage will feature key brands including Weleda, Dr Bronner's and Grants of Australia who will share their journey and explain how they are responding to ever-changing consumer demand.

This year's Pitch Fest competition will be held on the show floor allowing all trade buyers to sit in on the industry's most enthusiastic product pitches alongside industry judges and hear live from the masterminds behind these emerging brands.

The Business Summit will also be held Friday 29th May. Aimed at manufacturers and brands in the natural and organic space, the summit will cover consumer strategy, capital raising and e-commerce, as well as the always popular topic of upcoming trends and insights in 2020.

"The natural way of living is fast becoming the new norm," said Mr Perry.

"The expo continues to grow year on year with trade visitors and sheer volume of brands exhibiting. This a reflection of high market demand in the natural products space as the natural way of living is fast becoming the new norm. It’s a great opportunity to learn from leading experts, see emerging products and build long-lasting connections."

"Last year we had a fantastic turn out for our comprehensive seminar program and had great feedback from exhibitors, visitors and partners alike. We expect nothing less from this year."

The expo is free to attend for all ANTA members by registering online.

Event Details: Monday 1st – Tuesday 2nd June 2020 ICC Sydney, Darling Harbour, Halls 3 & 4 10am-5pm daily Register online at naturallygood.com.au PAGE 32 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Making a difference in the life of a person with cancer BioMedica Oncology Summit 2020

The Summit is designed to equip practitioners with the knowledge and confidence to make a difference in the life of a person with cancer.

2 MAY 2020 ICC SYDNEY

Speakers and synopsis at biomedicasummit.com.au

Proton pump inhibitors: re-emerging safety concerns

By Wendy McLean BHSc(Nat), BAdvSc(Hons), PhD

Proton pump inhibitors (PPI) are used for the management of a variety of gastrointestinal disorders, including gastro-oesophageal reflux disease and functional dyspepsia. Since their introduction in the early 1990s, the use of proton pump inhibitors has increased by more than 1000% in Australia, with over 19 million prescriptions written in 2013â&#x20AC;&#x201C;14.1 Over the last decade, at least two PPIs have featured in the top 10 most prescribed PBS-subsidised medicines every year.2

PPIs, the gut microbiome and disease

A significantly lower abundance in gut commensals and lower microbial diversity has been found in PPI users, with an associated significant increase in the abundance of oral and upper GI tract commensals. In particular, Streptococcaceae is significantly increased in PPI-users.17 These alterations to the gut microbiota increase the risk of enteric infections such as Clostridium difficile, Salmonella spp, and Shigella spp.18,19 Currently, long-term PPI use is approved for the prevention and symptom control of Gut microbiota can resist or promote colonisation of C. difficile and other enteric gastroesophageal reflux disease (GORD), for Barrettâ&#x20AC;&#x2122;s oesophagus, and as prophylaxis infections through mechanisms that either directly inhibit bacterial growth or enhance for nonsteroidal anti-inflammatory drug (NSAID)â&#x20AC;&#x201C; associated bleeding.3 However, the immune system. Furthermore, changes in gastric acidity and gastric motility can result in increased microbial density in the small intestine (known as small intestinal several studies suggest that a substantial proportion of PPI users do not have a clear bacterial overgrowth (SIBO)).20 Several recent population studies have associated indication for therapy.3,4 Not surprisingly, there is concern over the unnecessary PPI use, through secondary changes in microbiota composition, with a risk of major personal and healthcare costs associated with their increasing use. depression, 21 childhood obesity,22 irritable bowel syndrome 23 and allergic disease.24

Adverse effects of long-term PPI use

Recent observational studies suggest that taking PPIs is associated with several serious adverse events including myocardial infarction and ischemic stroke,5 osteoporosis and bone fractures,6,7 acute kidney injury,8 chronic kidney disease,9 dementia,10,11,12 Clostridium difficile infections13 and acquired pneumonia.14 The results of a recent longitudinal cohort study suggest an increased risk of all-cause mortality with PPI use, including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer.15 While observational studies may not provide sufficient evidence to prove direct causation, the accumulating evidence does require consideration and highlights the need to promote awareness of potential adverse events related to long-term use, for better pharmacovigilance and the need to limit the prescription of PPIs to patients where the benefits outweigh potential risks. Furthermore, there is enough evidence to indicate a high probability of causality between PPIs and increased risk of gastrointestinal infection, nutrient deficiencies (vitamin B12 and magnesium) and small intestinal bacterial overgrowth.3,16 BioMedica Nutraceuticals P 1300 884 702 For technical support simply register for an account at www.biomedica.com.au

Herbal, nutritional and lifestyle support for upper digestive complaints The evidence from all available studies suggests that long term PPI use is associated with serious adverse events, including an increased risk of all-cause mortality. In addition, evidence indicates that more than half the people taking PPIs do so without a medical need, exposing themselves to unnecessary health risks. Given these risks, alternative therapies for the treatment of gastrointestinal disorders such as GORD and functional dyspepsia should be considered. The naturopathic treatment approach aims to address the individual causative and modifiable risk factors for functional dyspepsia, GORD and related conditions while providing relief of symptoms. Diet and lifestyle interventions are combined with evidence based and traditional nutritional and botanical medicines such as licorice,25 meadowsweet 26 and zinc l-carnosine 27,28,29 to provide symptom relief, support normal gastrointestinal function and repair and protect oesophageal and gastrointestinal mucosa.

For further research insights contact the BioMedica technical support team on technicalsupport@biomedica.com.au. Full reference list available upon request.

Member Article Autumn 2020 Tony Reid

M.Ac (Acupuncture) M.TCM (Traditional Chinese Medicine)

The Clinical and Pharmacological Actions of the TCM Formula 'Yi Gan San' (Restrain the Liver Powder) Introduction

The traditional Chinese herbal formula 'Yi Gan San' (YGS) was recorded by Xue Kai (a.k.a. Xue Liang-wu) in the Bao Ying Cuo Yao (Synopsis of Caring for Infants), 1555. It was originally intended for pediatric use in cases with spasms, feverishness, bruxism, anxiety with palpitations, and restless sleep with terrifying nightmares. In contemporary practice its clinical applications have been expanded to include temper tantrums, irritability, impatience aggressiveness and insomnia1. In Japan, it is approved for clinical use by the Ministry of Health Labour and Welfare and is covered for reimbursement under the National Health Insurance program2.

The conditions for which this formula is approved are: neurosis and insomnia (in adults or children), as well as irritability and night crying in children2,3.

In recent years this formula has been the subject of considerable clinical research in Japan, centred on its application in patients with dementia. There is a growing body of evidence confirming its efficacy in the treatment of the extreme emotional symptoms exhibited by dementia patients, including aggression, agitation,

irritability, screaming, wandering, disinhibition, apathy, hallucinations and delusions. These symptoms are collectively referred to as 'behavioural and psychological symptoms of dementia' (BPSD)2,4,10.

The formula appears to be one of the few available treatments (both Western and traditional) that is able to provide clinically significant results in dementia patients. As a result, the Japanese Society of Neurology has listed it in the Japanese Guidelines for the Management of Dementia, 2010. Additionally, Japanese research has been providing evidence that it may also be effective in the following conditions: sleep disorders, anxiety disorders, pre-operative anxiety, tardive dyskinesia, borderline personality disorder, diseases related to schizophrenia, depression and neuropathic pain2. Concurrent with the accumulating clinical evidence, Japanese and other Asian researchers have been exploring the neuropharmacological effects of this formula. This paper aims to summarise the clinical as well as the neuro- and psycho-pharmacological actions of this unique herbal formula.

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 35

Member Article Autumn 2020 The Formula: Yi Gan San (Restrain the Liver Powder)

The original formula was made up of seven ingredients: Bupleurum, Uncaria, Chinese Angelica, Ligusticum Chuanxiong, Atractylodes, Poria and Chinese Glycyrrhiza, to which Cirus peel and Pinellia are generally added.

Yi Gan San Ingredients Bupleurum falcatum, root (chai hu) Uncaria rhyncophylla, stem (gou teng) Angelica polymorpha, root (dang gui) Ligusticum wallichii (a.k.a. Ligusticum straitum), rhizome (chuan xiong) Atractylodes macrocephala, rhiz. (bai zhu) Poria cocos, hyphae (fu ling) Pinellia ternata, tuber (ban xia) Citrus reticulata, fruit pericarp (chen pi) Glycyrrhiza uralensis, root (gan cao)

In TCM, this formula has the following actions: calms the Liver and clears Liver Heat to extinguish interior Wind; nourishes the Liver Blood and strengthens the Spleen5. The synergistic actions of the individual ingredients are as follows1,5: • Bupleurum and Uncaria: Calm the Liver and clear Liver Heat, to extinguish interior Wind.

• Chinese Angelica and Ligusticum: Nourish the Liver Blood and soften the Liver.

• Bupleurum and Citrus peel: Disperse stagnant Qi. • Atractylodes and Poria: Strengthen the Spleen.

• Citrus peel and Pinellia: Dry Damp and resolve Phlegm.

• Chinese Glycyrrhiza: Harmonises the formula and protects the Stomach from the harsh actions of the other herbal ingredients.

In terms of pathogenesis, the formula is directed at conditions due to deficiency of the Liver Blood. As a result of this deficiency, the Liver is unable to adequately perform its function of regulating the Qi, which then tends to become stagnant.

Stagnation of the Qi may lead to the development of Heat (referred to as 'stagnant Heat') as well as Damp and Phlegm (due to stagnation within the fluid pathways). Concurrently, the state of Blood deficiency within the Liver may generate interior Wind, as well as Heat. Thus, we have a pattern of mixed deficiency and excess: Liver deficiency on the one hand, and a combination of Heat, interior Wind, Phlegm and Damp on the other. The pathogenic Heat tends to exacerbate the interior Wind and Phlegm, creating a vicious cycle. Because of their unique physiology and life-stage experiences, both children and the elderly are particularly susceptible to this kind of imbalance.

As we are mainly concerned with mental-emotional effects, let us now focus on the psychological aspects of this formula's clinical actions and the specific pattern of imbalance that it treats. The syndrome-pattern, towards which this formula is directed, is a combination of Liver excess and deficiency. Thus, it represents both polar extremes of Liver functioning. This may be understood

in reference to the Wood phase of the Five Elements. The Wood aspect of our psyche is concerned with the ability to make plans and decisions based on a sense of one's place and purpose in life. This group of related psychological functions provides the impetus for self-assertion, and the capacity to forcefully push through obstacles and other types of inertia. The central concept here is one of smooth and effective movement carried out in a forceful, but not harsh, manner. When balanced and harmonious, Liver-Wood fosters patience and endurance, allowing the expression of kindness towards oneself and others. The feeling of righteous indignation that leads to constructive action is also within this sphere. It follows that once these functions become extreme, we have low self-esteem on the one hand and anger on the other. Moving further away from the harmonious centre, we have a sense of shrinking anxiety (the deficiency state) and unbridled rage (the excess state)6,7.

Thus, when Liver Blood deficiency has reached a stage where it begins to generate interior Wind, we have the psychological manifestations of severe anxiety, centred around a lack of selfesteem. One can readily understand how people at the two extremes of life may experience this condition. The very young are confronted with a strange new world, interacting with which they find that only very few of their actions meet with parental approval, while the vast majority are pronounced as either 'bad' or 'wrong'; nor are they physically able to do most of the things that the adults around them appear to accomplish with ease. The elderly, on the other hand, and particularly those with dementia, find that their grasp on the world around them is inexorably slipping away, as they understand less and less of it and their ability to do things progressively diminishes.

Considering the excess side of the equation, Liver Heat tends to rise up and disturb the Spirit and may also exacerbate the interior Wind; these pathogenetic pathways correlate with extreme irritability, restlessness and angry outbursts. The Phlegm, which is directed to the upper body due to the influence of both Heat and Wind, correlates with the loss of a rational perspective and selfcontrol that generally accompanies such emotional disturbances.

The clinical efficacy of 'Yi Gan San' (Restrain the Liver Powder)

A search on PubMed, in January 2020, for articles published since 2005 that include the name of this formula in the title, brought up 207 papers (using the Japanese or Chinese names: yokukansan, yokukan-san, yi-gan san, yi gan san). Mostly from Japanese researchers, these papers explore the formula's clinical efficacy, potential applications, neuropharmacology and interactions.

Dementia

As discussed previously, although there are several different pathological processes that may underlie a patient's dementia (e.g. amyloid plaques or cerebral infarct), the diagnosis of dementia is a clinical one and for the most part the diagnosis of 'Alzheimer's disease', 'vascular dementia', etc. may neither be valid nor clinically useful8. Dementia is currently diagnosed according to the clinical features of Neurocognitive Disorder (NCD) in the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5). NCD is subdivided into two types: Minor and

PAGE 36 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020 Since this time there have been several high-quality studies that have confirmed these findings, showing efficacy in improving sleep, and in reducing delusions, hallucinations, agitation and aggressive behaviour in dementia patients2,10,16. Additionally, YGS has fewer and much less severe adverse effects compared to the antipsychotic and antidepressant drugs that may be used to control BPSD, as well as compared with the standard pharmaceutical regimens17,18.

Anxiety

Since 2008 there have been many studies supporting the role of YGS in the alleviation of anxiety (due to a variety of causes), stabilisation of mood and reduction in aggressive behaviour.

Studies on pre-operative anxiety have found that YGS was as effective as diazepam, without causing undesirable sedation19,20.

Moreover, the use of the herbal formula was without serious adverse effects. Animal studies have demonstrated that the anti-anxiety action of YGS may be due to its effect on cerebral serotonin receptors and glucocorticoid receptors, normalising HPA axis activity following stress exposure21,22.

Other conditions

Controlled studies in humans have demonstrated the effectiveness of YGS to ameliorate symptoms in the following conditions: schizophrenia, the extrapyramidal side effects of antipsychotic drugs, borderline personality disorder (positive effect on low mood, impulsivity and aggression), pervasive developmental disorders and Asperger's syndrome23,24,25,26,27,28.

Major. Minor NCD is the same as 'mild cognitive impairment' (MCI), while Major NCD is synonymous with dementia. Major NCD is defined as a substantial decline from a previous level in one or more of six cognitive domains; the cognitive deficits are sufficient to interfere with independence; and the cognitive deficits are not attributable to other physical or mental causes (e.g. delirium or schizophrenia)8,9. While earlier definitions of dementia, privileged memory loss, it should be noted that according to the most recent definition, the cognitive deficit does not need to be in the domain of 'learning and memory' for the diagnosis of dementia to be valid. Thus, if a patient's executive ability is the only domain affected, and if the deficit is sufficient to curtail independence, requiring assistance with the instrumental activities of daily living, then the patient may be diagnosed with dementia9.

As discussed previously, the current pharmaceutical interventions for dementia (i.e. cholinesterase inhibitors such as donepezil, and memantine, a non-competitive N-methyl-D-aspartate receptor antagonist, which prevents neuronal excitotoxicity), do not provide clinically significant improvement in any of the various signs and symptoms of dementia – in spite of the multitude of industry sponsored clinical trials that purport to find statistically significant outcomes8,14. The important thing to bear in mind when assessing a study on an intervention for dementia is this: does the intervention give clinically significant results? Complicated statistical analyses that show a statistically significant outcome (often less than or equal to the margin of error in measuring that outcome) are all too common11,12,13,14. In these instances the 'improvements' do not make an appreciable difference to the course of the illness nor do they ease the burden on the patient's caregivers.

While there are no available treatments that are able to slow, stop or reverse the cognitive deficits in patients with Major NCD (i.e. full blown dementia), there is one medicine that has been shown to dramatically (in comparison to other pharmaceutical 'treatments' for dementia) improve the behavioural and psychological symptoms of dementia (BPSD) as well as the activities of daily living (ADL). This was shown in the first controlled study of the formula Yi Gan San (YGS) in Japan in 200515.

Neuropharmacology

Most of the neuropharmacological studies conducted on YGS are on rats and mice (for obvious reasons), so there are a number of caveats when assessing the major findings. These caveats may be summarised as: differences in metabolism between animals and humans, inferring a psychological state based upon the animal's behaviour, assuming that a receptor agonist or antagonist that has been administered to the animal only affects one specific receptor (i.e. not taking into account the possibility of multiple or unforeseen effects), assuming that the herbal medicine's actions are only due to the effects on the neurotransmitters and receptors that are being considered in a particular study. Therefore, we need to bear in mind that these studies can only provide an incomplete and possibly misleading picture of the herbal formula's effects.

The neurotransmitter systems affected by YGS include the glutamatergic, serotonergic, cholinergic, dopaminergic, adrenergic and GABAergic. In addition, it has neuroprotective effects and promoting effects on neuroplasticity, including neurogenesis29.

Specific effects of YGS are as follows17,29,30,31: • Increasing the density of serotonin (5-HT) 1A receptors in the prefrontal cortex (PFC) to reduce anxiety and aggressiveness.

• Reversing the age-related decrease in dopamine neurotransmission in the prelimbic region of the PFC to preserve or restore working memory and learning.

• Increasing neuronal activity in the prelimbic region of the PFC to reduce stress related anxiety.

• Suppression of stress induced neuronal activity in the amygdala, to alleviate anxiety.

• Amelioration of neuronal and astroglial degeneration in the hippocampus (which may occur in patients with dementia), to alleviate aggressive behaviour.

• Inhibition of the inflammatory response, oxidative stress and subsequent neuronal death in the hippocampus due to transient ischaemia, preserving spatial memory and reducing locomotor hyperactivity after ischaemic injury.

• Amelioration of the age-related decrease in the proliferation and migration of neuronal stem cells in the hippocampus, to

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 37

SUPPORTED BY CLINICAL EVIDENCE ANXIETY, IRRITABILITY AND MOOD SWINGS

To find out more, log on to sunherbal.com

Member Article Autumn 2020 preserve emotional balance and reduce over-excitation.

• Reducing stress induced changes within the corpus callosum.

• Neuroprotection within the basal ganglia, to reduce dyskinsesia.

• Protection against stress induced changes within the thalamus and hypothalamus.

• Attenuation of glutamate neurotransmission within the spinal cord to alleviate neurophathic pain.

The pharmacological effects of YGS on various types of brain cells may be summarised as follows30,31: • Actions on neurons: Neuroprotective, neurogenic, promotes neurite outgrowth, prevents stress induced apoptosis and facilitates autophagy (for recycling of nutrients).

• Actions on astrocytes: Promotes removal of excess glutamate.

• Actions on oligodendrocytes: Promotes proliferation and differentiation.

• Actions on the microglia: Reduces the inflammation that is associated with microglial activation (i.e. suppresses excessive activation of microglia in response to injury).

and excitability, particularly in conditions involving injury (i.e. dementia) or stress (i.e. mood disturbances).

Dosage

Most of the studies on humans have used water soluble concentrated granules, provided by Tsumura & Co., Tokyo, Japan, referred to as Yokukansan 'TJ-54'2,16,17,19,20,21,22,23,24,25,26. Dosage is in the range of 2.5g for a single dose and 5 – 7.5g for a daily dose31. This is equivalent to 8 capsules for a single dose and 16 – 25 capsules for a daily dose of the prepared formula, *Yi Gan San33. Pediatric doses are generally half to ¾ of the adult dose; adjustments to the dose in adults may be made in accordance with body size32,34; a higher dose is generally given initially, and then reduced to a maintenance dose once clinical results have become apparent33,34. *Yi Gan San is available as 'Settle the Emotions CM187' from Sun Herbal Pty Ltd. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

Taken together, the above actions of YGS on the various aspects of cerebral functioning help to provide possible mechanisms for the formula's efficacy in reducing aggression, anxiety

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THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 39

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Program features

Member Article Autumn 2020 Elizabeth Greenwood

Master of Herbal Medicine, Naturopath, Aromatherapist ANTA National President

Aromatherapy in Practice Elizabeth Greenwood is a qualified Aromatherapist, Naturopath and Master of Herbal Medicine. She is very passionate about the therapeutic use and traditional practice of Aromatherapeutic essential oils. Elizabeth holds workshops and training for those wishing to incorporate essential oils into their existing natural health practice.

Aromatherapy and essential oils have been an integral part of my natural health practice and daily life experience since completing my formal qualifications in 1995. By using them in clinical practice, herbal education and product development, I am often asked about the validity and appropriate use of essential oils. The questions I have heard are often the same, so I have structured this article to answer the most common questions received about Aromatherapy and essential oils. There has never been a more important time in natural health for us to understand the benefits and therapeutic parameters of essential oils.

Essential oils can be incorporated into many existing modalities and the information presented is designed to transverse the broad presentations of natural health modalities with a focus on client safety and practitioner efficacy. Join me, as I highlight to you the fundamental aspects of the amazing world of scent.

1. What is Aromatherapy?

Aromatherapy is a respected natural therapy that has been practiced throughout the world for centuries. It lends itself to a variety of application methods and therapeutic strengths to achieve a desired outcome. Traditional evidence dates the usage of essential oils to Hippocrates as well as Greek and Chinese text. The first methods of essential oil distillations were shown in historical Egypt. The renowned Aromatherapist, Gattefosse, coined the term 'Aromatherapy' in 1937. Aromatherapy is the term applied to the external application of essential oils such as inhalations, baths or massage, whereas Aromatic Medicine is related to the practice of ingestible essential oils.

2. What are Essential Oils?

Essential oils are one of the purest forms of plant chemistry.

Essential oils contain many known and unknown phytochemical constituents. It is estimated that each essential oil contains up to 300 â&#x20AC;&#x201C; 400 synergistic active constituents, of which only a portion have been identified. These constituents tend to be categorised by chemical structure, behaviour and therapeutic action. Plants contain many different types of constituents such as tannins, flavonoids, alkaloids and one of those chemical groups is the large and diverse group of essential oils. Acquired commonly through steam distillation, essential oils themselves contain many subgroups, including sesquiterpenes, oxides, ketones and phenols. These groups can further be divided into individual chemicals such as the well-known linalool, menthol and1,8 cineol.

Every step of extraction and isolation yields a pronounced therapeutic activity from a miniscule dose. Aromatherapists traditionally use the whole essential oils extract as they adhere to the understanding of synergism within the naturally derived substance. Whereas modern science primarily studies the individual isolated active constituent and the subsequent therapeutic effects it offers. Therefore, once their inherent complexity and synergistic actions are understood, essential oils have the ability to bridge the understanding of therapeutic plant compounds between traditional and modern interpretive use.

There is a substantial amount of research on the wide range of therapeutic benefits of isolated active constituents and we are only at the relative beginning of this particular scientific wave of understanding.

3. Are essential oils and volatile oils the same thing?

Yes. The terms essential and volatile are interchangeable when discussing the aromatic oils. They are highly volatile as a chemical group which means they react to light, heat and oxygen. They can evaporate relatively quickly when exposed to heat, and can oxidize, hydrolyse or degrade over a relative period of time when exposed to oxygen and light.

4. Can I add essential oils directly to my water?

Essential oils for the most part, are hydrophobic and lipophilic,

PAGE 42 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020 meaning they are largely soluble in fats, oils and alcohol. They do not dissolve readily into water. The concern here is that if you add essential oils to a bath or other vessel for water, then the oil drops will naturally attract to each other through their non-polarised lipophilic ability and form large concentrations on the surface area of water. When getting into a bath, this undiluted concentration of oil has direct application to the skin and has a higher chance to cause skin irritations. A dispersant, or emulsifier, is recommended to be used. Essential oils must be added to the dispersant and properly diluted before adding to the water to ensure an even distribution. Therefore, it is not recommended to add directly to water (i.e. bath, water bottle, etc.).

5. What is your favourite example of essential oil to use?

Back in the time of highly contagious and infectious diseases essential oils had notable documented benefits. In the 14th Century, during the Black Plague, aromatherapists were sought out for their knowledge and skills. The physician to King Louis XIII created the plague doctor mask to help prevent the infection of visiting doctors. The masks had a long beak that was able to contain a number of essential oil containing plants which are well recognised for their potent antimicrobial, decongestant and analgesic properties amongst others. The actions of the chosen plants are scientifically proven today.

Physically, we have covered the profound observed effects that the essential oils have on physical molecules. They are also frequently applied in body work to relieve pain, muscle spasms and improve circulation, and many more actions! Common essential oils for the body are Ginger, Clove, Black Pepper and Peppermint.

The main active constituent of Peppermint is menthol which is used in popular creams to treat muscle aches. Essential oils can be added directly to creams for topical

Emotionally, it is well established that essential oils can help to shift a darker mood through their mood enhancing effects. It is important here to choose an essential oil that you, or your client personally likes as everyone has their own preferences, especially in scent. Lavender is an excellent mood enhancer although not everyone’s cup of tea. Try Rose, Jasmine, Orange, Lime or Cedarwood.

7. Is there any scientific basis to Aromatherapy?

It is common for the essential oil enthusiast to come across a 'Thieves' blend which is a modern interpretation designed on this original blend of plants. It is called 'Thieves' because at the time of the plague, thieves were known to copy the mask and its contents so they could enter the houses of the deceased and steal their belongings without getting ill. This blend commonly contains: Syzygium aromaticum (Cloves), Cinnamomum zeylanicum (Cinnamon), Eucalyptus spp. (Eucalyptus), Citrus limon (Lemon), Rosmarinus officinalis (Rosemary). Perhaps we need to incorporate this mask into mainstream health revolutions again?

Steampunk designers have some great options available.

Aromatherapy is a truly holistic modality due to the fact that essential oils have a pronounced effect on the physical, emotional, mental and spiritual aspects of an individual.

Mentally, essential oils have a long use in enhancing memory and concentration by simply placing a few drops in a diffuser or on a tissue while studying or working. Popular essential oils used in this method include Basil, Lemon and Rosemary. Rosemary in particular has been shown to improve memory recall during educational examinations when used during preliminary study times. Rosemary is for remembrance.

Spiritually, essential oils have a long history of use within places of worship. The deep grounding scents of Frankincense and Sandalwood have been used to purify sacred areas for prayer as well as to enhance meditation.

The traditional Plague Doctor masks contained the following plants: Rosa centifolia (Rose), Mentha spicata (Spearmint), Syzygium aromaticum (Cloves), Cinnamomum camphora (Camphor), Juniperus communis (Juniper), Papaver somniferum (Laudanum), Commiphora myrrha (Myrrh), Liquidambar orientalis (Storax), Ambergris.

6. Does Aromatherapy treat the emotions?

application in certain infections or irritations, for example Lemon balm Melissa officinalis for Herpes simplex lesions.

A very common question in the face of natural medicine popularity is the conversation around scientific evidence.

There is a healthy database of clinical studies and each year an exponential amount of essential oils are being reviewed and published. I have chosen to list a few that you might find interesting.

• Essential oil from Pinus koriaensis pinecones inhibits Gastric Cancer cells via the HIPPO/YAP signaling pathway. Chinese Pine cones (a-pinene 40%, limonene 24%, b-pinene 7%) showed anti-tumour effects5.

• Grapefruit essential oils inhibit quorum sensing of Pseudomonas aerunginosa. Citrus paradisi research used to prevent food contamination where the whole essential oil was shown to have a more potent effect than limonene alone, highlighting the synergistic action6.

• Study on antibacterial and quorum-sensing inhibition activities of Cinnamomum camphora leaf essential oil. Large number of terpene compounds identified (linalool 51%, eucalyptol 22%) in tests showed significant inhibition rates of biofilm formation and swarming movement of up to 77%7.

• Chemical composition and in vitro cytotoxic screening of sixteen commercial essential oils on five cancer cell lines.

Including Boswellia spp., Citrus limon, Litsea cubeba, Foeniculum vulgarem Syzygium aromaticum, Thymus vulgaris all showing potential anti-cancer properties and involved in further research8.

• Frankincense essential oil suppresses melanoma cancer through down regulation of Bcl-2/Bax cascade signaling and ameliorates hepatotoxicity via phase I and II drug metabolizing enzymes. Dose dependent cytotoxic effect shown with further

THE NATURAL THERAPIST VOL 35 NO. 1 | AUTUMN 2020 | PAGE 43

Member Article Autumn 2020 11. What are the basic safety concerns when using essential oils?

research being carried out9.

8. Why do certain scents invoke old memories?

We have all had the experience of smelling a particular scent and being reminded of a long-lost memory. This can be a wonderful experience when a fun family celebration or a loved one's cooking is the memory, but scent can also evoke distressing recollections where the scent is linked to a more negative event. This is the reason I do not diffuse essential oils in a classroom or community gathering as the responses can be unpredictable. The essential oils that tend to elicit generally more positive responses in people are the citrus such as Orange, Lemon or Lime. They are refreshing and uplifting for the emotions in most people and can be used in waiting rooms for example. The link to this fascinating release of memory has been found through the olfactory nerve and its direct innovation to the limbic system. The discovery of neuroplasticity can further lend itself to explaining the patterns of memory and when neuro pathways are triggered by the molecules of scent, they encourage the replay of the emotional reaction to released memories. This effect can be so powerful that some people will have a physical reaction or get a clear image of the memory moment in their mind. When choosing an essential oil in professional practice, I may offer 3-4 essential oils to the client and they can choose their most favourite oil to use on that particular day.

9. Personality profiles of essential oils

I believe that everyone has an essential oil that is their life long scent destined to be a travel partner alongside them for lifelong support and encouragement. It is exciting to find your scent. It is one that you will have always liked, find yourself always coming back to and when you smell it, it feels like an old friend. Perhaps you like a number of different blends and wonder why. This will be because there is a particular essential oil in each blend that you are drawn to. Every essential oil has a unique personality and energetic type to it, which you will find highlights characteristics within you! This is all part of the amazing world of scent and a particular favourite pastime of mine is helping people to discover their own essential oil best friend and personal expression.

10. Can I use essential oils in practice?

Due to the somewhat lack of regulation of essential oil practice, they are available for many people to use. Practitioners abide by the oath of First do no harm, so keeping this in mind you can build your confidence in using essential oils within your practice.

Here are some suggestions of common oils for use in certain modalities.

Modality

Every essential oil has a safety parameter which are quite individual. Here are some general safety recommendations for all essential oils.

• Do not use heat.

• Do not dilute in water alone.

• Caution with negative memories and associations with scent.

• Caution with sensitive skin. Some oils may cause photosensitivity, it is generally recommended to avoid citrus in photosensitive people and exposure to sunlight.

• Caution in pregnancy as some essential oils can be used and are very effective, however the general advice is to best not use in pregnancy unless by a trained Aromatherapist.

• Do not use out of date or oxidised oils.

• Do not use topically on dogs or cats.

12. How much essential oil do I put in a blend?

A very common question to which I recommend the following dilutions. Keeping in mind that on average 20 drops equals approximately 1mL. • Baby = 0.5%-1% • Face = 1.5% • Body blend = 3% • Concentrated treatment blend = 5% Higher concentrations can be used by qualified Aromatherapists in certain situations for short term if deemed applicable.

13. What are some good base oils I can use?

Almond, Apricot, Macadamia, Avocado, Jojoba oils are great mediums to use. Experiment with aloe gel, base creams and even Manuka honey.

14. What are some reputable Australian essential oil suppliers?

We are proud and lucky to have an amazing array of high quality essential oil suppliers in Australia. Each of these companies prides themselves on providing outstanding pure essential oils, essential oil products and some provide ongoing educational opportunities and community support. This list is an introduction, in no particular order and not exhaustive. Support Australian essential oils!

• Perfect Potion • Essential Therapeutics • Essentially Australia • Native Oils Australia • Sydney Essential Oil Company • The Oil Garden • Sunspirit

Essential Oil

Application Method / Therapeutic Strength

Remedial Massage

Ginger, Nutmeg, Eucalyptus, Kunzea, Peppermint

Relieves muscle spasms, rubefacient, analgesic

Naturopath, Herbalist

Oregano, Thyme, Clove, Garlic

Infections (Lungs, digestion, repro, skin), sedative, congestion

General use in clinics

Eucalyptus, Lemon, Basil, Peppermint

Antiseptic, antimicrobial, congestive enhancing

Aged care

Lavender, Mandarin, Sandalwood, Rose, Neroli, Frankincense

Relaxing, pain relieving, uplifting

Body workers

Lavender, Rosemary, Frankincense, Peppermint

Improve circulation, detoxification, cellular regeneration

Forest bathing

Lemon scented Eucalyptus

Prevention of ticks, mosquitos

Spa, Beauty Therapists

Rose, Cedarwood, Rosewood

Lymphatic congestion, skin health, relaxant, massage, tonifying

Other clinical uses

Compress, inhalation, foot bath, full bath

Ointment, room spray, cleaning products

PAGE 44 | AUTUMN 2020 | THE NATURAL THERAPIST VOL 35 NO. 1

Member Article Autumn 2020 • Thursday Plantation • Bosisto’s

15. What are some essential oils containing herbal medicines?

There are some common therapeutic benefits that essential oil containing herbs share, that being improving blood and lymphatic circulation, broad spectrum antimicrobial, carminative, antiinflammatory and wound healing properties among others. Herbs that contain a high percentage of essential oils include: • Thymus vulgaris (Thyme) • Origanum vulgare (Oregano) • Allium sativum (Garlic) • Boswellia carterii (Frankincense) • Zingiber officinalis (Ginger) • Melissa officinalis (Lemon balm) • Mentha X piperita (Peppermint) • Matricaria chamomilla (Chamomile)

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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