The Natural Therapist Vol37 No3 2022

From the Chair

10Body-Mind Healing and Your Practice

Annie Meredith, Acupuncturist, Author and Educator writes about an exploration of flower essences across modalities and how they can help your clients.

Fucoidans: Five Benefits for Healthy Ageing Thouas, Head of Research & Innovation at Max BioCare the benefits of fucoidans to help with health, immunity, brain digestive and skin in relation to healthy ageing.

Setting Context for Ayurveda Appreciation - Some Unique and Key Concepts of Ayurveda Ahuja, ANTA National Ayurveda Branch Chair, explores Ayurveda its many concepts.

The Terrain of the Body in Wonderland

Kaitlin Edin, ANTA National Acupuncture Branch Chair, writes about her near death and how this experience sent her across the world to live in Japan.

37 Bitter Herbs and Foods: The Latest Research Findings

Kerry Bone, Founder and Director of Research at MediHerb, provides the latest research findings on bitter herbs, including Gentiana lutea, Andrographis paniculata, Humulus lupulus, Brassica and root vegetables.

Neuroendocrinology and Fatigue Management: Case Study Booth, ANTA Member, compiles a case study on fatigue management. Comparing chronic fatigue syndrome, fibromyalgia and hypothyroidism, this article explores the conventional and naturopathic understandings, as well as providing methods for each.

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.

Keep and Carry On

Panicky and low mood Anxious and tense Anxious and poor sleep

Alleviates mild anxiety, soothes the nervous system, and supports healthy mood balance.

Exerts anxiolytic effects during times of stress and modulates GABA and neurotransmitter pathways.

Fast acting, high strength, non-habit forming herbs for a restful sleep, to get to sleep faster and stay asleep longer.

From the Chair

I will open this report by thanking the staff and the Directors of ANTA for their world class efforts to deliver our professional association operations to the new normal. We have our members’ needs at top of mind and are working toward building all services to a higher standard through members’ feedback and our industry partners’ support. Our transition from pandemic conditions to business as usual progresses steadily and we are ever mindful your safe clinical environments take us all forward.

Through our better understanding of how quickly the health of the broader community is recovering, we continue to take precautions to minimise risk. We are supporting therapists now with getting their clinics up to speed and to that end we will have a new platform on offer: “Find an ANTA Practitioner” courtesy of Media Heroes that will provide an avenue to wider circulation of every member’s clinical and business details for health-service seekers. Once embedded into our system this innovation will assist to locate the therapist of choice, free of charge, through the ANTA website. Our marketing partners at Media Heroes constantly assess our needs to get our therapists back to optimum performance as quickly as possible. The new platform is currently being populated with the most recent essential data available to them.

The ANTA National Council Directors have been listening to their Branch Members through face-toface connections at the ANTA Continuing Professional Education Seminars. We are trialing a new timetable for our seminar offering and adding new speakers and topics at these events around Australia. To view past seminars, log into your ANTA Member Centre, search for ‘Seminars/Webinars’, and the past years seminar presentations will be revealed. ANTA recently delivered the Sydney CPE Seminar for 2022. It has been more than two years since we were able to offer a public seminar in Sydney and we enjoyed meeting old friends and new members with a first-class lineup of presenters. These video-recorded presentations are now available on the ANTA website for those who were unable to attend in person.

We continue to achieve membership levels clearly above pre-Covid level, and we look forward to

Spring 2022

delivering higher standards of service to you in return for your support and loyalty through the difficult times you endured. Please contact your ANTA Branch Chairs to inform them of your current situation and seek support where you need it most. Please remember we have all been therapists in the field and most, if not all, Directors have experience in education and training. We stand ready to provide support and guidance wherever needed. We have increased administration services and our committed staff remain ready to assist you with the essentials for your success.

ANTA member resources and support services are at their highest level, and we are keenly aware our strength comes from the quality and integrity of our members. I look forward to meeting up with you again at the next seminar in Melbourne during November to support and gather your feedback about what you need from your professional association. ANTA staff and Directors remain in constant communication with the private health funds to secure the services members need to cement professional relationships with their clients.

I look forward to releasing the news our new operating Member Management Platform is available for all to use. It will add power, speed and utility to your online contact with ANTA.

Yours in Health.

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 News

Spring 2022

ANTA involved in Steering Committee for the Advanced Diploma of Myotherapy

ANTA’s Myotherapy Branch Chair, Shaun Brewster and Remedial Therapy Branch Chair, Isaac Enbom have both been busy participating in the Advanced Diploma of Myotherapy Steering Committee. This committee exists to update, improve and reaccredit the Advanced Diploma of Myotherapy for the next five years. VET courses are taken through a process of re-accreditation where the training package is reviewed and improvements applied to ensure it is current and applicable to today’s healthcare landscape. Please be aware that those currently studying Myotherapy or have a Myotherapy qualification do not need to get re-accredited.

Continuing Professional Education Points Due Soon!

Continuing Professional Education (CPE) is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care. CPE is an important part of providing professional health care services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

ANTA requires Members to complete 20 CPE hours annually (January to December). CPE hours need to be lodged within the ANTA Member Centre before the 31st December 2022. Please see the instructions below to help update your CPE points.

1. Once you have logged in, hover over the word Member Centre (below our logo) and click on My Member Management System.

2. Then click on CPE Activity.

3. Then, after reading the instructions, click on Add a new CPE Activity.

4. You can now record your CPE activity, ensuring that you complete all fields correctly. Enter the actual date you completed the activity; enter the year you completed the activity; enter the mode you completed the activity (e.g. book, webinar, seminar etc); enter a full description of the activity that includes the name of the book, webinar, etc including the name of the author or institution if relevant; enter the number of hours you took to undertake the activity which will be your points, i.e. 1 hour of activity = 1 point.

5. Click ‘Save & Close’ then proceed to Step 2 to enter the next activity.

Are you following ANTA on our socials?

ANTA Membership for Non-AHPRA Registered Members - invoices will be issued soon!

For the majority of ANTA Members (those that are not registered with AHPRA), invoices for your 2023 ANTA Membership will be issued in October 2022. Please check your junk/spam folders within your emails or sign into your ANTA Member Centre to view the invoice.

Payments need to be made by the 31st December 2022. ANTA offers payment plans for those that wish to pay either bi-annual or monthly. Please contact ANTA on 1800 817 577 to discuss your options.

ANTA also offers non-practising membership for those that will not be practising in 2023. Please contact ANTA on 1800 817 577 to discuss your options.

When

Mood disorders are the product of a complex interplay of biological, social and psychological influences. While states such as depression and anxiety can be an adaptive response to certain external circumstances, for some people they can become disproportionate and remain unresolved, causing deleterious impacts on social and occupational function as well as physical health. Some of the most common mood conditions presenting in Australian patients are the anxiety disorders.1 These conditions can take many forms ranging from specific phobias to generalised anxiety disorder. They can affect people at all stages of life and can often co-occur alongside other mood disorders such as posttraumatic stress disorder and depression.

Although anxiety may be classified in several different ways according to the presentation, the underlying neurobiology shares some common features. Namely, the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, alterations in the levels of various neurotransmitters and disruptions in the signalling of the endocannabinoid system all play a role in the development of anxiety disorders.2

The HPA axis is the primary regulator of our stress response system. In times of danger, it activates our ‘flight, fright or fight’ responses to help protect us from external threats. At other times, the function of the HPA axis is down-regulated, allowing us to return to a state of ‘resting and digesting’ where our body is relaxed and can focus on functions such as digestion, cellular repair and reproduction. For those with anxiety, the HPA axis becomes inappropriately activated in response to everyday activities, leading to the symptoms commonly seen in these disorders including a racing mind, hyperventilation, elevated heart rate and sweating.3

Emerging evidence suggests that the endocannabinoid system (ECS) is intimately involved in the regulation of mood and stress, and that perturbations in this system may exacerbate anxiety disorders. The ECS is a widely distributed system comprised of various endocannabinoids, receptors and enzymes. While its function is still being fully elucidated, the ECS plays a key role in maintaining homeostasis in the central nervous, metabolic and immune systems.4 Lower levels of endocannabinoids have been observed in those with depression and anxiety, while animal studies have demonstrated that the anxiolytic effect of several therapeutic substances is mediated through their action on the ECS.5

Given the complexity of neurochemistry, the HPA axis and ECS, it can be confusing to know how to address them in relation to those presenting with anxiety and/or depression. Thankfully, we are now learning that many of the herbs traditionally used for these conditions help to modulate targets across all these systems. These new understandings provide insight into the mechanisms that make these herbs so clinically effective.

One such herb is lavender, which has been shown in numerous clinical trials to be an effective treatment for anxiety and depression. Lavender inhibits the enzyme fatty acid amide hydrolase (FAAH), which breaks down endogenous cannabinoids.6 The inhibition of this enzyme helps to raise endocannabinoid levels and has been shown to be a useful target for anti-anxiety therapeutics.7 Lavender oil also contains a substance called beta-caryophyllene, which binds to and activates the CB2 receptor. Outside of the ECS, lavender modulates the HPA axis, having a demonstrated normalising effect on various markers of HPA axis dysfunction, including plasma cortisol levels, salivary immunoglobulin A (IgA) and heart rate variability.8 Additionally, lavender can increase the levels of neurotransmitters including serotonin and norepinephrine, which can help in providing additional support when the patient is presenting with both anxiety and depression.9

Lemon balm, another time-honoured herbal anxiolytic, additionally helps to modulate the activity of the HPA axis by reducing neuronal excitability.10 Both animal and human studies have demonstrated lemon balm’s ability to improve markers of chronic stress (including plasma cortisol) and attenuate the physical symptoms associated with anxiety such as rapid heartbeat and excessive sweating.11

L-theanine derived from green tea has also been shown to be an effective intervention for anxiety, exerting a similar modulating effect on the HPA axis, while promoting alpha brainwave activity and acting on the gamma-aminobutyric acid (GABA) receptor directly, to provide rapid relief for anxiety symptoms.12 Systematic reviews have confirmed that the effects of l-theanine are comparable to the benzodiazepine alprazolam in both efficacy and time to effect, while causing fewer adverse effects.13

Using a combination of evidence-based herbal therapeutics in conditions such as anxiety and depression allows us to focus on multiple therapeutic targets simultaneously. Employing this approach may confer several advantages over traditional pharmacotherapy, including the modulation and restoration of homeostatic mechanisms achieved through the pleiotropic effects of medicinal herbs, a reduction in unpleasant side effects and consequently enhanced treatment compliance. Additionally, many herbs can be used alongside conventional treatments, for enhanced outcomes.14

As our understanding of neurobiology and network pharmacology develops, the mechanisms by which herbal medicines work to support a healthy mood and stress response are coming to light. Accumulating evidence demonstrating the efficacy of these compounds in the form of clinical trials and meta-analyses provides additional confidence in our traditional methods and opens new horizons for effective, integrative mental health care.

Annie Meredith

Body-mind Healing and Your Practice

An exploration of flower essences across Modalities

We are not just our physical body, we are much, much more. As conscious beings our wholeness is supported by the interaction of all the bodies which together create health: physical, which we can touch, feel, see, hear and taste, and mental, emotional and spiritual (or attitudinal) all of which reside in the energetic subtle anatomy, the vehicle for the vital force. When each of these bodies is working harmoniously and in tandem, human consciousness is clear alive, awake and aware, decisions are made effortlessly and life flows smoothly.

Easily identifiable when we compare a live body to a dead one, it is the vital animating life force that moves, warms and grants the living body intelligent functioning as compared to the stillness and inability to respond to stimuli of a person who is dead.

The vital force for the individual is present from the moment of conception acting as a guiding template for the physical body to develop through gestation, infancy, childhood, the developmentally fast-forward growth spurt that occurs in teenagehood and into Housedadulthood.inand

around the body, the vital force is intelligently structured. Known as the subtle energy system, it is made up of seven embodied chakras,

known as energy centres (or seas) that lie along the front of the spine and 12-plus meridians (the rivers), which distribute life-giving energy from the chakras to every single cell in the tissues, fluids, organs, bones, brain and nervous system of the body.

The chakras, with their meridian counterparts are tiered, from the base of the trunk through to the crown of the head, along with meridian conduits that carry the resonance of the chakra for which they are distributing energy.

The various chakras and meridians vibrate at different frequencies, with those at the base of the trunk resonating at the longest wave length and slowest vibrational rate, while those at the top of the body with the shortest wave length and fastest vibrational rate. The chakras and meridians in between, are graduated or stepped up in resonance incrementally, creating a continuum of vibrational resonance throughout the whole of the body from the lowest at the base of the trunk to the highest at the crown of the head.

In an awesomely magnificent example of the intelligence of the vital force, each chakra and its associated meridians governs not only a specific set of physical functions, but also emotional, attitudinal

and developmental qualities that make up the whole human being. It is these aspects that help determine our personality and personal identity.

As a whole, the subtle energy system of the body, consisting of the bio-electrical energy that flows through the chakras and the meridians, creates an electro-magnetic field that surrounds the body, known as the aura. This electro-magnetic field that differentiates us from others and both protects us from harmful energies whilst connecting us discriminately to the whole unified field of life.

It is this whole subtle energy system, including the chakras, meridians and the aura, that flower essences work so effortlessly and effectively with.

So, what are flower essences and how do they work on the unseen energy system?

Flower essences are pure healing gifts from nature that work on the human subtle energy system, which underpins the physical body. Prepared in a manner similar to homeopathy, they are potentised to match the resonance of the chakras and meridians, elements of the subtle energy system that distribute vital force throughout the body. Because flower essences act directly on the energy system they address aspects of the whole human that are invisible to the human eye – our feeling and thinking body, clearing distortions and blockages in the meridians and chakras and supporting the free flow of energy, which results in optimal wellbeing and wholeness.

The process of potentisation that occurs during the making of a flower essence creates a natural medicine that has no physical attributes, but rather simply the vibrational resonance of the physical form. In other words, it contains the energy of the flower it is made from, rather than the form. Similar to the notion used in making homeopathics, whose basic tenet is that ‘like cures like’. This is a simple way of saying that a flower medicine’s energy or resonant vibration, when matched with a similar vibration in the human body, will harmonise any distorted energy within the human body in the area to which it is targeted. ‘Like energy cures like energy’.

In the human being, where energy is blocked, distorted, repressed, compressed, stagnant or excessive, problems arise not only in the physical body, but in the emotional, attitudinal and spiritual world of the individual. Emotions are often referred to as ‘energy-in-motion’ and they arise based on the individual’s world view – or rather, the way we perceive the world.

If we see the world as an unfair place where we are victimised, we will regularly suffer from resentment or feelings of victimhood. These feelings then impact on the energy system of the body, in this case the gallbladder, by causing inharmonious energy flow. For example, resentment means we continuously recycle thoughts of ‘unfairness’ towards another person or situation causing the energy of our thoughts to go around and around in a loop, the same thoughts tumbling over one another ceaselessly with no way

out. This creates a knot in the energy flow in the gallbladder which causes energy to stagnate and slow, potentially initiating the beginnings of a disease process, as the gallbladder, along with the liver and associated tissues etc become deficient in energy or Ifvitality.weapply

a flower essence, whose healing energy causes the knot to unwind, relax and start to move freely, then the organs and tissues in the physical body are able to function freely and openly again with sufficient energy and blood to nourish and connect them to the rest of the system. And the emotional and attitudinal bonus is that resentment gives way to letting go and, if needs be, to forgiveness, freeing up the emotional and mental bodies.

‘Disease begins in the mind’ is a statement that profoundly rings true within the field of natural medicine. It is the attitudes and values we hold in the mind (most often due to our early programming) that govern the way we perceive the world. Attitudes in turn drive emotions in response to our belief system. If there is a disconnect with the world outside of us and the expression of our inner world, then we are often thrown into emotional turmoil. Long-held emotional states (which block and stagnate) and their predisposing attitudes are powerful disturbers of energy flow within the body leading to disease or lack of ease in physical functioning. The beauty of flower essences is that they address rebalancing disturbed energy while simultaneously opening the mind to ‘seeing’ another way, solution, approach or facet that will take us beyond our limited world view, thus allowing us to recognise a range of wider options and to find ways of being that work for us.

Flower essences therefore benefit all natural therapy modalities, which, each from their own unique perspective, are geared towards realigning and harmonising the body and bringing it back to its most healthy expression. Because flower essences target the way we think (our attitudes) and our emotions, they complement natural therapy modalities in a couple of very pertinent ways: firstly, they can assist with compliance in regard to any post treatment suggestions made by the practitioner to support clinical work. Secondly, they provide effective and real on-going emotional and attitudinal support, especially if there is a situation creating stress in the home environment. Thirdly, they precipitate healing, by helping to erode barriers or shift attitudes blocking the effectiveness of clinical treatments by resetting fixed views and emotional holdings that are getting in the way of whole wellness for the client.

So, in effect, they potently augment the practices of such modalities as naturopathy, nutrition, acupuncture, osteopathy, manual therapies, and massage especially in cases where lifestyle changes and emotional harmony are recommended by the HeartRadiancepractitioner.

Flower Essences are unique because they are heart-centred, softly transmuting, promote connection and support the inner journey towards wholeness and wellbeing. As a valuable adjunct to clinical practice they are safe, effective and easy to use for the practitioner. They can be prescribed as a single, pure essence to target a specific issue, or as a pre-formulated blend to provide a more general, wider feeling of wellbeing and harmony relative to the client’s current life circumstances. The Pure Practitioner Kit enables tailored blends to be crafted by the therapist for the unique emotional and wellbeing needs of each client.

Different ways to use the pure essences and blend essences, for example, might include a client who complains of fuzzy thinking and has digestive issues. Dandelion as a pure essence, might be the essence of choice, as it grounds, focuses and clarifies thinking while at the same time energetically supports liver function. On the other hand, a client who is pregnant and feeling she’s on an emotional roller-coaster, lacks confidence and is unsure about how well she is going to manage motherhood, the pre-formulated blend of choice would be Pregnancy Support. This encouraging essence blend will help her to transit smoothly and gracefully through the experience.

HeartRadiance Flower Essences are such a gentle and easy healing method to use and provide an important bridge between the physical and the emotional. Try incorporating flower essences into your practice and start seeing the benefits for yourself. To view the HeartRadiance Australian Flower Essence range and the healing qualities that each unique essence offers visit https://heartradianceaustralia.com.au where you will find a downloadable product guide.

As teacher, author, acupuncturist, and vibrational healer of 40 years standing, Annie Meredith’s passion is awakening people to their highest potential through understanding the powerful biological underpinnings that drive and compel them on all levels - physical, emotional, mental and spiritual. Working with the perfected elements of Nature, Annie developed HeartRadiance Australian Wild Flower Essences in order to empower people to live their best lives and infuse all their relationships with radiant love.

George Thouas, PhD Head of Research & Innovation Max Biocare Pty Ltd

Fucoidans: Five Benefits for Healthy Ageing

Introduction

According to the World Health Organisation (WHO), the percentage of people over 60 has been steadily increasing, from 1 billion in 2019, to a projected 1.4 billion by 2030 and 2.1 billion by 20501. Aside from ethnicity and genetics, there are many factors that impact on health and quality of life as we age, which cumulatively affect life expectancy, with more pronounced impact seen in later years. These include the level of physical activity, dietary habits, quality of nutrition, social factors, and state of mind. An example is osteoporosis, where gradual reduction in bone mineral density over time is a predisposition to sudden fractures in advanced age groups. Countries such as Japan and Korea have amongst the world’s highest life expectancies2, and one interesting feature of them is their habitual intake of kelps, which has

been estimated to be up to four to six grams per day in dried form3, and which includes a rich variety of species including kombu, mozuku, wakame, hijiki and nori. Many of these provide an important source of nutrients, including micronutrients (e.g. iodine), protein, fatty acids, carbohydrates, phytochemicals (e.g. polyphenols, chlorophylls) and fibre. Within the water-soluble carbohydrate fraction are the fucoidans, a unique family of protective polysaccharides. As we have discussed in earlier issues, fucoidans have multiple functional activities that scientists believe may be beneficial to healthy ageing. Here are five areas where fucoidans may contribute to this growing health need.

Cardiometabolic Health

Problems of the cardiovascular system, especially the

heart, are a priority area of ageing health globally because they are the leading cause of mortality worldwide4. The good news is that many associated symptoms, such as elevated blood pressure, elevated blood fats or cholesterol, metabolic syndrome, and insulin resistance, are largely preventable by adopting a balanced nutritional and lifestyle approach. Fucoidan extracts have been found to lower lipogenesis and promote lipolysis in response to intakes of diets with a high fat load, with accompanying decreases in blood cholesterol, blood lipids and fatty liver5 Combined with metabolic benefits6, vasoprotective, and blood-pressure lowering effects of fucoidans, it is believed that these and other active compounds such as fucoxanthins, may thus promote a healthy cardiovascular system. In a study by HernandezCorona et al. (2014)7 involving obese individuals (up to 60 years) who were given 500mg/d of fucoidan for three months, or a placebo, test subjects showed improvements in insulin production, a mild reduction in blood pressure, and significant lowering of lowdensity lipoprotein (LDL) cholesterol levels. These results confirm earlier epidemiological evidence suggesting that increased dietary intake of brown kelp (especially Undaria pinnatifida) is associated with a decreased risk of type-2 diabetes in Korean men (up to 60 years)8

Immunity

The immune system also begins to wane as we get older, as we have seen with the increased severity of COVID-19 disease in over 60’s age groups in 2021/20229. Changes in adaptive immunity, such as decreased T-cell production and T-cell memory have been reported10. These, combined with alterations in lung function, increases in baseline inflammation, and delays in healing rates, are believed to manifest as an increased risk of upper and lower respiratory infections, among other problems. While in other parts of the body, decreased immune surveillance is also associated with autoimmunity, chronic inflammation, and cancer formation. Fucoidans interact with the immune system on many levels. On a cellular level, they have been shown to stimulate natural killer (NK) cells11,12, a white blood cell type that attacks bacteria and viruses. Fucoidans also activate macrophages another cell type that absorbs infected cells and removes debris during infections. On a deeper molecular level, fucoidan polysaccharides bind to selectins, which are special receptors that attract white blood cells to areas of infection and injury. Fucoidans also co-activate Toll-like Receptors (TLRs), which have complicated signalling roles on the surface of

most white blood cell types and epithelial cells. TLR’s recognise foreign pathogens in the body, including bacterial proteins, enabling infected cells to be destroyed and cleared14. Furthermore, fucoidans have an antimicrobial barrier-like function that physically blocks the binding of viruses and bacteria Influenza A virus16. In an open-label trial involving healthy adults (up to 65 years) the intake of a fucoidan micronutrient supplement was associated with an immune stimulating effect17. This was indicated by a rise in levels of cytotoxic T-cells, B-cells, NK cells, and phagocytes (debris removing cells), together with a decrease in pro-inflammatory IL-6 production after four weeks. Another randomised, placebo-controlled pilot study found that fucoidan from Undaria pinnatifida significantly increased white blood cell progenitors and dose-dependently increased the antiviral cytokine, interferon-gamma (IFN-γ)18. A similar antiviral response was evident in a Japanese study19 involving elderly nursing home residents (67-102 years) who underwent vaccination for Influenza virus. Post-vaccine supplementation with fucoidan was associated with a significant elevation in antibodies against three different influenza strains (H1N1, H3N2 and Brisbane) compared to the placebo group.

Brain Health

Declines in cognitive function, including memory deficits, and loss of coordination, are a well-known hallmark of ageing. Many age-related changes in the brain are associated with a complex variety of gradual processes that come under the umbrella of “neurodegeneration”. This is a deterioration in the structure and activity of neurons and has been linked to overconsumption of high fat/sugar/protein diets, and nutrient deficits, through mechanisms such as oxidative damage, disrupted cellular metabolism, and vascular inflammation20. Fucoidans have been hypothesised to play a role in protecting against these processes, through their antioxidant and antiinflammatory properties, although research in their roles in this aspect of health is still in its infancy21. In a randomised, double-blind, placebo-

controlled study22 , a group of 40 elderly people (65-80 years) were given a fermented kelp supplement for six weeks and asked to participate in a range of short-term memory and neuropsychological tests. The supplement group showed significant improvements in numerical memory, visual memory, and general IQ, compared to the placebo group. Subjects in the test group also displayed increased serum antioxidant activity and decreased oxidative free radical levels, compared to the placebo group. In another randomised, double-blind, placebo-controlled study23, a brown kelp extract was tested for its effect on episodic memory and attention in 60 healthy adults (up to 55 years). The supplemented group specifically showed significant improvements in accuracy of attention, and reaction times for numerical tasks, compared to control subjects.

Digestive Health

Alterations in the health of the digestive system also occur with age, and this provides an indirect link to brain health through the gut-brain axis. In terms of digestive function, the stomach of older adults looses its contractility with age, making it less effective to digest solid food24. The stomach is also less responsive to appetite signals from the brain, and is less able to repair mucosal damage within the stomach lining25. This may partly explain the development of intolerances to some foods, such as those higher in saturated fats, protein, sugars, spicy foods, and food additives. The ability of the small intestine to absorb nutrients may also decline with age26, which in combination with lower intake of nutrient rich foods, leads to a depletion of micronutrient stores around the body, and hence undernutrition. New research is even shedding light on how the microbiome of the large intestine changes with age, showing that some strains of bacteria become altered or even lost27, which can impact on biodiversity. Fucoidans may be preventative against digestive dysfunction, through their ability to protect against gut injury and infection, and through their prebiotic effect28. Chua et al. (2015)29 found that fucoidans directly blocked the adhesiveness of the gastric ulcer bacteria, Helicobacter pylori (H. pylori). While Lean et al. (2015)30 found that fucoidan helped to repair inflammation of the stomach lining in an experimental model of colitis. In a randomised, doubleblind, placebo-controlled clinical study, fucoidan supplementation, combined with wheat proteins,

resulted in significant reductions in gastric mucosal damage, pain, bloating, acid reflux and appetite loss, while also modulating selected species within the colon microbiome in sufferers of gastritis31

Skin Health

Lastly, skin condition is perhaps the most recognisable outward indicator of ageing, as well as general health. Skin naturally loses its structural integrity, including its elasticity, thickness, and evenness of colour32, due to a lifetime of factors such as UV light exposure, nutrient deficiencies, stress, sleep deprivation, dehydration and toxins (e.g. alcohol, tobacco smoke, preservatives). Functionally, ageing skin becomes more prone to damage from injury or infections, and slower to heal. In post-menopausal women, there is a further impact from the sudden cessation in the production of estradiol, a reproductive hormone that controls the normal growth and turnover of skin, connective tissues and blood vessels33. Pre-clinical studies have revealed that different forms of fucoidan provide antiinflammatory, antioxidant, and growth promoting effects on damaged skin34, with significantly faster repair rates, as well as decreased production of proinflammatory cytokines and lipid peroxides reported. Fujimura et al. (2002)35 found that topical fucoidan significantly increased skin thickness and elasticity of the cheek, compared with untreated controls. While Fitton et al. (2015)36 showed that fucoidans from brown kelp contributed to a reduction in age spots, wrinkle density and gloss factor over two months, with a shorter-term improvement in moisture content and erythema over the first 48 hours of use.

Conclusion

As a food substance, and an emerging natural expandsglobalhealthybenefitshowcontinuesapplications.andinfucoidansmedicine,aresurprisingtheirversatilityrangeofpossibleEvidencetogrowastothesebroad-reachingmaysupportageing,astheageingpopulationatanexponential

rate.

“We’ve never needed to be large. We’ve always wanted to be significant”

Neerja Ahuja Principal Consultant at Awareness Centre

Setting Context for Ayurveda

Appreciation - Some Unique and Key Concepts of Ayurveda

Ayurveda – The Science of Life

Ayurveda is made up of two words “Ayur” and “Veda” meaning “Science of Life”. The Word Health Organisation (WHO) recognises Ayurveda as a most ancient and holistic system of health care with texts said to be about 6,000 years old. Ayurveda is said to be in existence in oral form for about 4,000 years. Suppressed during years of foreign occupation, Ayurveda has been enjoying renaissance in both India and in the world. Ayurveda has greatly influenced health care practices in the East and the West. Tibetan Medicine and Traditional Chinese Medicine both are considered to have their roots in Ayurveda. Early Greek Medicine also incorporated many concepts originally described in the classical Ayurvedic medical texts dating back thousands of years.

According to the WHO, around 80% of the world’s population use traditional medicine in one form or another, eg. herbal medicine, acupuncture, yoga, ayurveda and others. Over 40% of pharmaceutical formulations are based on natural products and landmark drugs including aspirin, originated from traditional medicine, according to the WHO website.

The philosophy of Ayurveda teaches that disease/ health results from the interconnectedness between the self, personality, and everything that occurs in the mental, emotional, and Spiritual being. It works to heal the sick, to maintain health in the healthy, and to prevent disease to promote quality of life and long life. To be healthy, harmony must exist between the purpose for healing, thoughts, feelings, and physical action.

The Future of Ayurveda and Modern Medicine

Modern science has a detailed knowledge about parts of physical and biological nature, whereas traditional knowledge systems have a holistic knowledge of the physical, biological, and Spiritual fields of nature.

Western medicine is extremely efficient in acute conditions that need potent medications, hospital care, or high technological support.

Ayurveda is experiential, intuitive, and holistic, whereas the modern medicine is based more on experimental, analytical and reductive reasoning.

Modern medicine treats mostly external factors or intervenes in the biochemical chain of events, e.g., by eliminating bacteria, substituting hormones, or supplementing nutritional deficiencies. In contrast, Ayurveda analyses the person apart from the disease by looking at people with distinct characteristics and innate tendencies that determine the type of treatment required.

While accepting the reality of the physical body, Ayurveda also emphasises the role of mind and consciousness in both health as well as disease. This contrasts with biomedicine, which relates physiology to structures. In Ayurveda it is considered that one’s thoughts create health or illness which is similar to the quantum physics’ concept that thoughts create the physical reality.

Ayurveda understands the human body as interconnected within as well as outside. By integrating the role of mind and consciousness in the human body, Ayurveda is distinctly different from biomedicine’s perception of the organism as a structural entity made up of fundamental units of building blocks, that is, atoms and molecules.

We are living in a transitional moment in medicine. New studies are emerging that will help us make better choices. The field of integrative medicine represents an important achievement since it combines the best of modern medicine with the best of traditional system of natural health, such as

OneAyurveda.ofthe

greatest challenges of modern time will be integrating the reductionist framework of science with the holistic framework of traditional knowledge systems to see the whole in the part and the parts in the whole.

Integration of Predictive, Preventive, and Personalised Medicine and Ayurveda Historically, medicine has given special attention to the already diseased individual, focusing on a disorder rather than one’s health. Currently, medicine is undergoing a paradigm shift from the realtime diagnostics and treatment to prediction and prevention. The PPPM model (Predictive, Preventive and Personalised Medicine) is expected to transform the nature of healthcare from reactive to preventive.

So, we see that the philosophy of health care is moving from illness to wellness, from treatment to prevention and early diagnostics and from generalised approach to personalised medicine. There are many similarities between the concepts of PPPM and Ayurveda. Both do not just consider concept of disease in isolation but consider the diseased ‘person’. A collaborative project based on concepts of PPPM and Ayurveda may help to better understand disease progression and predictive diagnosis of diseases e.g. like cancer and diabetes.

Ayurvedic medicines can contain sophisticated therapeutic formulations. Ayurveda is also a personcentred medicine (PCM), which deals with healthy lifestyle, health promotion and sustenance, disease prevention, diagnosis, and treatment.

Ayurveda has a personalised approach involving constitutional assessment or Prakruti, which can guide primary prevention, diagnosis, and therapeutics. Ayurveda also offers detailed guidance about food, nutrition, and diet according to the individual

constitution or Prakruti as well as seasons. The scientific value of basic principles of Ayurveda like Prakruti is being studied in context to biology and Ayurvedagenomics.

is uniquely patient-oriented where the Ayurvedic physician diagnoses, treats and dispenses medicine to every individual patient. This important principle can form the basis for a form of personalised medicine which will give maximum therapeutic efficacy and high safety to a particular person with a particular disorder, under specified conditions depending on individual constitution, and properties of materials. Prakruti specific prescription may also include supportive therapies, diet and lifestyle advice to regain physiological balance, finally resulting in the removal of the disease.

While accepting modern tools and technologies, it is equally important to respect epistemological value of knowledge system like Ayurveda. Increased recognition of disciplines like systems biology is indicative of modern science moving towards holistic concepts. So, this may be a good time to facilitate integration of Ayurveda, Western biomedicine, and modern science.

For understanding Ayurveda from modern terms, one also needs to understand its epistemology.

Ayurveda Epistemology

The epistemology of Ayurveda is based on the relation between microcosm and macrocosm involving five basic elements (mahabhuta), three dynamic principles (dosha), similar to humours, seven types of tissues (dhatus) and many other unique concepts. An introduction to basic concepts may be useful for those who are not familiar with epistemology of Ayurveda.

Prakruti – The Mind Body Type

The evolved and explicit human physiology and behavioural science have been described to have their seeds in the philosophy of Ayurveda.

Ayurveda classifies humans based on three major constitutional types (Prakruti) based on distinct morphological or structural, metabolic, and psychological characteristics, based on doshas: Vata, Pitta, and Kapha. These types may offer phenotypic datasets suitable for analysis of underlying genetic variation. The prognosis, diagnosis, and therapeutics in Ayurveda are Prakruti specific and have similarities with modern concepts of pharmacogenomics (a field of research that studies how a person’s genes affect how he or she responds to medications). Ayurveda

can provide the data sets for phenotypic classification irrespective of ethnicity, geography, and race.

Ama – The Source of Disease

Ayurveda explains that most diseases are caused by an accumulation of ama or undigested food. Ama literally means “uncooked food”, but it can be understood from a scientific perspective as endogenous toxins resulting from imbalanced or incomplete digestion. Ama can be formed as a result of reduced Agni, or digestive power.

The ability to manage or reduce these may be helpful for the prevention and treatment of many diseases. Ayurveda gives focus on removing ama for preventative health.

Nutrition

Ayurveda has a holistic concept of food. In Ayurveda, “food” has a very broad meaning which is transformed from the heterologous into the homologous Nourishmentsubstance.

should bring a profound physical and psychological effect, and so, even a substance containing all necessary vitamins and minerals may still not be considered “nourishing”. There is concept of “ahara”, that means “life supporting diet” and may include physical food as well as mental and emotional “food”.

Concepts of Srotas

Ayurveda generally considers the Srotas (channels), which have physical expressions, as nutrients/ biological fluid transporting channels. Examples of channel systems being digestive system and circulatory system. Within the circulatory system there are macro and micro channels, arteries and capillaries. The body is free from disease when the srotas functions normally. If the srotas gets blocked or malfunctioned due to internal or external factors, the altered flow creates an accumulation of products, mainly toxic, leading to functional, and later, organic alterations.

Ayurvedic Genomics and Epigenomics

According to Ayurveda constructs, doshas are the dynamic principles, which govern a person’s physical, physiological and psychological functions including metabolism. Ayurveda describes three doshas namely vata, pitta, and kapha. The proportional domination of doshas in an individual is expressed as Prakruti, which broadly mean a mind-body type or individual nature. An Ayurvedic physician determines the Prakruti of a patient to personalise treatment. The Ayurvedic

description clearly suggests that the innate nature is represented by individual Prakruti, which represent phenotypes.

Ayurvedic Concept of Predictive Diagnosis

Modern biomedicine recognises progressive nature of diseases like cancer and diabetes. It is known that slow yet progressive pathophysiological changes result in a transition from a healthy state to diseased state. Ayurvedic concept of shatkriyakaal elaborates a six-stage progressive transition from balanced to unbalanced stage leading to disease manifestation in a person. These six stages are unique and may help early recognition and early diagnosis much before onset of measurable clinical symptoms of diseases.

Concept of Rasayana

Ayurveda also presents some unique clinical applications of its fundamental concepts. Rasayana is one such concept having extensive potential applications. Rasayana herbs are described to have anti-ageing effects. Rasayana represent anything, e.g. herbs, thoughts, lifestyle, foods that are supportive to the qualitative improvement of tissues. A qualitative improvement essentially refers to the functional and constitutional specifications of a tissue altered by age. Such tissue would typically have optimal functions and resist premature ageing. Rasayana herbs are used to promote tissue longevity through mechanisms like reduction of toxin/ metabolic waste load within the cell through their reduced production or increased scavenging, ensuring efficient use of energy within the cell, requiring less consumption leading to reduced energy requirement and reduced waste production, initiation of micro-repair by providing essential nutrients by participating in regeneration directly or through promotion of latent enzyme systems.

Shatavari, Guduchi, Haritaki, Amalaki, Brahmi, Kumari and Ashwagandha are some very well known Rasayana herbs.

In the End, and Summary

Holistic treatment is the way of treatment in Ayurveda. It says that one herb or one drug would not cure the imbalance of “Dosha”. Therefore, traditionally, in most of the cases, a combination of herbs and plants (which are even part of staple food) are recommended for treatment. It is quite possible that a herbal formulation has a combination of compounds, where one compound either potentiates the effect of other, or increases the bioavailibilty, or reduces the toxicity. A good example is the use of turmeric with black pepper as a spice. It is now known that the bioavailibity of curcumin (active ingredient of turmeric) is increased by piperine (an active compound in black pepper) by preventing the glucuronidation of the Contemporarycurcumin.

cell biology of pathogenesis could benefit greatly by appreciating the ancient concepts of “srotas”, “srotodushti”, “agni”, “ama”, “mala”, and others. Such Ayurvedic descriptors can enable the correlation of subtle changes in organ, tissue, and cell and molecular biology parameters to the “shatkriyakal” process—the six stages of progress towards disease—described first in Sushruta Samhita. The adaptation to environmental changes that the human body accommodates to maintain good health and mediated by cellular processes could well be seen through and studied by using such descriptors.

At Ayurveda Awareness Centre, we are starting a new “Ayurveda Appreciation” short course program to bring appreciation of Ayurveda to community, including for medical and other health practitioners other than the community in general. Total time is about 30 hours range.

The program is combination of online LIVE and recorded videos. It will be available from September 2022. You can add your name to the waiting list so you can be the first one to be informed when the program is launched. Early bird pricing applicable for enrolments received before launch.

Please email neerja.ahuja@ayurveda-awareness. com.au for any enquiries, or to make a booking.

For references log into Journal Articles

ProgramAppreciationAyurveda

In this course, we will be learning some concepts of Ayurveda so we can appreciate the ancient wisdom of this “Science of Life” and see how this can be applied in modern life

The program is curated for

Health professionals, including GPs, with practitioner only component and provision for CPD points from some professional associations.

The layperson who is interested in learning ayurveda for incorporating ayurvedic principles in daily life for optimal health.

How the program will be run?

This workshop will help you learn, preserve, promote and restore your health, appreciating it by incorporating ayurvedic principles in daily life for optimal health.

This course is for you if you are keen to make conscious life choices for yourself; details are as follows:

9 weekly online LIVE sessions of 2 hours

Audio/ videos to listen or watch before and/or after May have documents to read before and/or after

Total expected hours are approx. 30 hours

At least one year access to audios and videos

For those looking for CPD or enhance their understanding further for themselves, extra component in form of any or all of quiz/ reflective journal/ video feedback/ QA discussions

To know more about the Modules, Scan here

Register expression of interest now for updates and discounted price on course launch.

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Healthy Recipes

Rachel Knight is a Chef and Nutritionist in Melbourne. Her passion for seasonal and locally sourced produce has led her to a career in recipe development aimed at optimal health. Rachel currently works for Lamanna Supermarket as a Nutritionist and Product Developer.

Protein Packed Banana Bread

• Gluten-free

•

•

RecipeCategories:Data:

Serves: 10 Preparation: 10 minutes Cook / Chill: 45 minutes - 1 hour

Ingredients:

• 300g Banana, mashed

• Eggs

• Maple Syrup

• 1 Vanilla

• Olive Oil

• 2 Cinnamon

• 200g Almond Meal

• 25g Flaxseed, ground

• 1 tsp Baking Powder

• ½ tsp Bicarb Soda

• 1 tbsp Lemon Juice

• 60g Walnuts, roughly chopped

Optional

• 2 tbsp Protein Powder

• Pumpkin Seeds

Method:

1. Preheat oven to 160°C (fan forced). Grease and line a loaf tin with baking paper.

2. Combine banana, maple syrup, oil, cinnamon, vanilla, eggs, bicarb soda and lemon in a bowl. Whisk to combine.

3. Add the almond meal, flaxseed, baking powder and protein powder. Mix to combine.

4. Gently fold through the walnuts until combined.

5. Spoon the batter in to the tin and sprinkle with pumpkin seeds. Bake for 45 minutes - 1 hour. The banana bread is cooked when a skewer inserted comes out clean.

6. Remove from the oven and allow to cool in the tin.

Nutritional Information Tips/Tricks:

• If the banana bread is browning too much, cover the top with foil.

• Nutritional information is per slice calculated without protein powder.

Chimichurri

RecipeCategories:Data:

• Dairy-free

• Raw / No Bake

• Diabetic Friendly

• Quick to Make (<30min)

• Gluten-free

• Low Carbohydrate

• Vegan

Serves: 4 as a sauce / 2 as a marinade

Preparation: 10 minutes Cook / Chill: 30 minutes

Nutrition: Carbohydrates Protein Fats Energy (KJ) Calories Serving Size 8.5g 10.4g 4.6g 508KJ 121 100g

Ingredients:

• 125ml Olive Oil

• 40ml Red Wine Vinegar

• 50g Parsley

• 3 Garlic Cloves, finely chopped

• 1 small Chilli, finely chopped

• 2 tsp Dried Oregano

• 1 tsp Salt

• ½ tsp Pepper

Method:

1. Finely chop the parsley and place in a small bowl.

2. Add the oregano, garlic and chilli.

3. In a seperate bowl combine the red wine vingear and olive oil, whisk to combine.

4. Add the olive oil mixture to the herbs and whisk again.

5. Season with salt and pepper and set aside at room temperature for 30 minutes before using.

Nutritional Information Tips/Tricks:

• Chimichurri can be used as a sauce for beef, chicken and/or grilled vegetables.

• Marinade chicken or tofu in chimichurri overnight before grilling.

• Exchange the red wine vinegar for lemon juice and drizzle over cooked fish.

• To store, keep in a sealed glass jar for up to four days in the fridge. Let it come to room temperature before using.

• Nutritional information is per 100g as a sauce.

Kaitlin Edin Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner ANTA National Acupuncture Branch Chair

The Terrain of the Body in Wonderland

At the age of 21, I met death for the first time. An accident injured my pelvis. After lengthy investigations, I was told that the damage to my reproductive capacity wasn’t resolvable. The once clear path into adulthood and the rites of career, partnering and children took a sudden and profound turn into uncharted and unwelcomed territory.

The colour drained out of things, life seemed more shadowy, beset with anguish and anxiety.

Feeling like Alice, I tried to find my way back onto the path I had been on, but I was so altered, and the way back swallowed up, that I started to believe I would never get out of Wonderland. Then, at 24, I came to a crossroads. I could continue raging against the loss of a dream due to fate and injury, or I could embrace life with a different set of expectations.

My choice sent me, with a backpack as big as my torso and heavy with burdens I didn’t yet understand, into another country.

I went to live in Japan.

Strangely, Japan seemed like its own kind of Wonderland. I had barely been across state borders in Australia let alone overseas. Never before had I navigated international customs or handled foreign currency. I couldn’t speak the language, and the only in-country contact was two degrees of separation

Iaway.wasplunged

into the high-density crush of cities that never sleep. Through a landscape of people, bicycles, concrete, steel, noise, incense, humidity and filth, I was propelled by the shock of the new. The postcardperfect fragments of old Japan, with its pottery roofs, bamboo and paper windows, cherry blossoms and prayer trees, mixed, in the slippery, surreal ways of a dream, with the modern conveniences of plastic model food, alcohol vending machines, Elvis impersonators, talking elevators and squat toilets. Train timetables ran to the second, guards with white gloves stood ready to push you into overpacked cabins like one might squeeze an unruly handful of worms into a sock. There were different kinds of trains too, that looped night and day presenting rice and fish in ways that looked more like race-day fascinators than food

to an ever-hungry and relentlessly moving citizenry. For the first several years, I couldn’t process what was happening to me at any level. My body was on autopilot and my head took over. It’s only now I understand the mad Queen of Hearts’ penchant for taking off heads. The head can really get in the way of the body’s experience, mostly because we tend to value what they tell us over other ways of knowing and being. Sometimes it takes the shock of the new to restart the heart to a different reality, and a shifted alignment to wake us up to our bodies and ourselves.

For many, the experience of our national culture is as ubiquitous as the air we breathe. It’s only when we step into the wash of another nation’s way of living and doing and being that we get an inkling of what cultural expectations, practices and norms we have absorbed from our home places or families of origin without even knowing it. It is a hidden dimension in our lives. For First Nations people, migrants or refugees, the experience of ‘being at home’ in a national culture foreign to their own can be fraught, because the very idea of home is so contested. But most of us can relate to the curious and exciting experience of being foreign in a foreign land, how it might allow us to see ourselves in a new way, as though we are looking down the wrong end of a kaleidoscope. It doesn’t only happen when we travel to different countries, it can happen when we are invited into a gathering of people whose rituals, language and values are ones we don’t immediately recognise. In these moments we experience ourselves differently (often anxiously) and may begin to see ourselves as others see us, and this can be both fascinating and unsettling.

James Spradley, an American Professor of Anthropology, posited that every individual is a carrier of the culture. While it doesn’t sound that radical now, given that we live in the era of social media influencers and technology which suggests a democratisation of cultural access, there are still those

who would argue from the more classical position that it is only the work and output of the great artists (or dynasties) of any particular time that determine, shape or illustrate the culture. But this suggests work that survives its time does so because it is inherently better or representative. And there may be many reasons for why this is not the case. The culture of the everyday might be something we value or recognise today, but it wasn’t always the case. Interestingly in Japan there is a deep reverence for the work of the unnamed artisan who made everyday objects. These items made by hand for daily use without artifice, by artisans who are unknown, are spoken about as ‘objects born, not made’. It is an aesthetic about valuing the craft of folk; ‘everyday’ people and the beauty in functional design. But I also like to think of it as valuing the individual in the most abstract of ways. It is a subtle way of resisting an imperial monopoly on beauty and cultural ownership, by recognising labours of those who have no ‘brand’. It is a nod to that concept of Spradley’s that all individuals carry culture, whether they are named, remembered or not, for ‘culture is the acquired knowledge people use to interpret experience and generate behaviour’. The individual experience and choices, conscious and unconscious knowledge acquired over generations and across time shapes the way families and kinship systems, peer groups, gender groups, neighbourhoods and nations story themselves.

To understand this notion of carrying culture, we also need to appreciate ‘the way the autonomic nervous system takes in information without involving the thinking part of the brain. It responds to the cues of safety and danger inside ourselves and around us in the environment and between people’. What Deb Dana calls neuroception, means we are incredibly good at adapting to the milieu we find ourselves in without thinking about it, whether we recognise it as dangerous or not.

When we are no longer located in our place of cultural safety, the dominant (sometimes hostile) cultural response is to ‘other’ those it deems as different and ‘not from here’. As individuals we adapt in a myriad of ways (not always well) and this affects every part of our physical and emotional body, our mind and

Inpsyche.thelate

1970s George Engel conceptualised the biopsychosocial model of health and wellbeing, which suggested that you couldn’t consider only the biological factors involved in a person’s illness or disease. The psychological, emotional, social, gendered, cultural and economic factors must also be considered. It’s a modern attempt, after Descartes

broke the egg, to put Humpty Dumpty back together Noelagain.Hershfield, a clinical professor of medicine in Canada, tells us that this field of study now called ‘psychoneuroimmunology … gives us compelling evidence, advanced by scientists from many fields, that an intimate relationship exists between the brain and the immune system … An individual’s emotional makeup, and the response to continued stress, may indeed be causative in the many diseases that medicine treats but whose [origin] is not yet known …’.

Dr Gabor Mate reminds us that ‘disabling the immune system with chronic emotional stress can have as much impact on our bodies as the ravages of radiation, drugs or viral infections like untreated HIV … our immune system does not exist in isolation from daily Emotionsexperience’.are part of and shape our stress responses, emotions are as necessary for survival as the immune and nervous systems, and yet they are subject to the greatest cultural repression and interpersonal Itjudgement.isareliefthat the modern leaders and healers in medicine, as well as some of their institutions now at least have some language to identify and recognise the interactions of the mind-body-psyche. That adaptation by the human body to the imprint and currents of culture is as significant a factor as the biological causes of disease. For despite the clarifying benefits of reductionism, and the cultural and historical assertion that the practice of ‘good science’ is to strip away context and objectify the subject, the insistence on it as the only scientific way of knowing has disenfranchised so many from their embodied experiences and healing, and ignored the language of connection. Indeed, it is something that Mate astutely points out with particular regard to health and medical science; “medicine is not simply a science, it is much more than that, it is an ideology. It’s a way of looking at human beings. So, when we look at human beings as individuals without understanding the importance of the social relationships and their emotional, psychological interactions with others – that is actually a manifestation of the entrepreneur, who says that ‘only I matter, what I control and what I gain matters, and we’re all in competition with one another’. So, you see the economic perspective also shows up in its own particular way in the practice of medicine”.

Kevin Bridges the Scottish comedian, had this to say recently through his strong Scottish brogue, on the connection of his previously heavy physique, and the

culture and economics of his childhood, “As soon as I made a few quid… I lost weight, simple as that…. I hear the politicians, I hear the health minister say… uhh is there a link between poverty and obesity, we’re not really sure? …We’re not really sure... Aye there’s a f*cking link, you don’t get avocados (or quinoa) in a foodbank…”. In the same stand-up routine, he goes on to describe how most days as a child he would eat hot chips and then ice cream, both sold from a van. The picture it paints of his early life, despite the laughs it gets, is depressingly relevant to those working within lower socioeconomic environments. Live with the powerlessness that a lack of money, agency and recognition give you for long enough and the stress of disadvantage, disenfranchisement and poverty play out on the body and then across the generations and the broader cultural expectations.

Meaning gives us purpose, and identity often gives us power, or at least a perception of citizenship to the terrain we embody. Power, or the lack of it, is the primary engine that creates and defines the context within which stress is created or soothed. And yet power has many faces and the lack of it is not uniformly experienced.

Young women in the United States and elsewhere, now know this trespass to their individual sovereignty all too well in the rolling back of their rights to reproductive choice. And yet other women are actively supporting this trespass upon the gendered body for their own claim at power. The bloated corporate wealth structures that value automation, nonstop productivity, expanding technological surveillance and fragmented, casualised working conditions render a different transactional trespass on the human bodies they employ. And yet without consumer power, we have the disenfranchisement and disadvantage that Bridges’ illustrates in his comedy.

So what happens to the body (and our health) when we engage with broader cultural environments so different from our own, over long periods of time? What might it mean for how we recognise and manage stress and its impacts when we feel foreign, or worse still, alienated? How might it feel to have to adapt to a culture rapidly changed by occupation, colonisation or war?

Our answers to those questions are both personal and societal, drawn from the human ecologies of personality, family, work and community, and determined in small and broad ways by available resources including money, class and influence. But they all impact the nervous and immune systems of the human. Eastern medicine practitioners understand

these resources within the body as an individual’s jing, ying and hun/shen.

It wasn’t until I lived, worked and studied in Japan that I understood what it meant to be culturally Australian and a woman. The experience of being foreign placed demands on my identity and cast me into such embodied difference that it revealed to me not only my cultural lenses, but the ways in which my individual cultural responses to perceived threats were undermining my ability to adapt.

On the broad brushstrokes of understanding, Japan is not a culturally diverse place, and by that, I mean it is not multicultural. Difference is tolerated within narrow bands, and oneness, not diversity, is collectively valued. Colonisation is not a defining part of its identity, although a response to occupation, war and nuclear holocaust is etched into the national character. Perhaps because of its history, the Japanese present to outsiders a very coherent national identity. There is a kind of extraordinary tidiness, order and ‘safety’, expressed in their social arrangements. From the outside, it seems to be contained, elegant, and unreachable. As you get further in, this perception changes, but initially, in the face of such a welldeveloped sense of national self, I felt that much of my own national cultural identity was an array of tropes and immature stereotypes.

Australia is a nation of occupation and colonisation and I had absorbed a level of cultural shame and polarisation around my national identity. I was not Indigenous but I also did not identify with the

colonising ‘white bread’ attitude of the mainstream, no matter how much being white facilitated my opportunities. At that time, the stain of our nation’s trespass on the Indigenous population hadn’t even been formally acknowledged. Even now, when the national character is more nuanced, the national stereotype of Australian identity is still tightly bound within the masculine ANZAC legacy. This is seen and glorified in that ‘Australian’ (male) sense of mateship and egalitarianism. As a cultural currency it has been used (not always convincingly) to smooth over the very real fracture lines of class and privilege. And it is not because it is primarily a white male template of identity that it is problematic, it is because it often seems to be the only one that is referenced, remembered and exalted. War traumas as we know, deeply seal the bonds of connection between people and place. But so does empathy.

In my twenties, I couldn’t fully appreciate that my confusion about what it meant to be Australian was partly because I didn’t fit the defining norms of my own nationality. I felt proud when I reflected that the Australia I knew embraced (if awkwardly) plurality, fairness and multiculturalism, and that before the scar of colonisation and cultural tyrannies, we were also a country of many nations and languages. But it seemed a jumble in comparison to the streamlined and sleek Japanese profile so readily presented.

Comparison is a lazy marker, but it helped me gain a clearer picture of what I valued about being Australian: the deep sense of irony that imbues the cultural narrative, the way we ‘act the goat’ and laugh at ourselves, (honestly could Celeste Barber be anything but Australian?) the physical space and freedom, the

way physical and everyday competency is understood to minimise the ways an individual might otherwise be othered, and how when the surface is scratched, we can be a rowdy defiant mob. And while this is poorly represented by the power structures that see it as a challenge to their mandates, it is this irrepressible energy that has at its heart, resistance.

I found, like the Japanese, that Australians have a strange grasp of both resistance and obedience, and that we strive to equalise. The Japanese say that the ‘nail that sticks up gets hammered down’, while in Australia there is a strong dislike for ‘tall poppies’.

The more I listened to my friends, the more I heard them telling me that they weren’t ‘good’ Japanese citizens. They knew what it meant and what was expected of them, but somehow they believed they didn’t or couldn’t measure up to the ideal, even though to my eyes they were exemplary national citizens. While the cultural expectations didn’t seem to fit them, they couldn’t openly challenge those requirements without getting ‘hammered down’ somehow; so they simply tried to work with them as best they could. Perhaps as a result of this strategic way of navigating the currents, some of the most interesting, creative and unusual subcultures are found in Japan, where the significant repression and the consequential leakage of individualism is met with a kind of half-in half-out ambivalence. In this way, where Australians can be a little bit punk the Japanese are

Whatcool.kind

of stress must it play out on the body though? And what does this sense of incapacity do to the psyche? Suicide rates are high in Japan, and not only among the young. Mate tells us, along with a wealth of scientific research, that the stress predisposes us to certain kinds of illnesses and Unsurprisingly,addictions.

I had never been more acutely or routinely sick in my life than when I lived in Japan. My second meeting with death wouldn’t happen there, but I know now that the constant levels of stress caused by my sense of foreignness, isolation and alienation were working against my immune system in such a way that I was susceptible to pathogens and illness that I had never been at home. How I managed those layers of stresses probably didn’t help, I worked too hard and drank too much, which were all culturally acceptable in my place of foreign residence, and I found little time for the self-restorative practices of mindfulness, journaling, art and music. When I did, they always helped.

During my years in Japan, my digestive system was simply unable to metabolise what I ate, both physically and metaphorically. My gut and bowels were constantly inflamed. It wasn’t the food or bacteria of the local environment; it was the stress with which I swallowed everything down. My eyes always seemed full of grit and my ears would become congested, as though what I was seeing, hearing and sensing just couldn’t adapt into the right kind of balance. My vagus nerve probably couldn’t keep up with information it was trying to process, like muscles and the immune system, the nervous system stores memory at its cellular level too.

The creepy misogyny of exotic otherness was another particular current of my experience there. What is so interesting about this kind of othering is that it occupies a space, that is not location or nation specific. I was a young woman with blue eyes, blonde hair and yet my only relationship with the dominant culture, was as an insignificant foreign resident. Yet Japanese women friends who had relationships with foreign men were othered in this way too. This particular way of othering was the same two-dimensional flattening that comes from what I now recognise as the pornographic male gaze.

My lower back was constantly sore, partly due to old injuries and sleeping on the floor, but also because the experience was threatening to overwhelm my capacity to take it in my stride. When we are standing on our own two feet, the strength of our back is paramount. Much like shouldering a burden, the spine and lower back represent our ability to carry ourselves and the weight of our head. It was the physical burden of stress that was playing out.

This is, of course, true for us all, so while the stories we tell and the kinds of impacts on the body may change with the cultural location, the underlying theme is universal. Stress unravels us all.

Having said that, I have only love for Japan, my friends and my experiences there. Wisdom and the gift of hardship were an invitation into another way of seeing, which I did my best to heed, and I wouldn’t want to lose those insights or have it any other way.

Once you have been down the rabbit hole and met the mad, bad, peculiar and brilliant aspects of another version of the world, and your Self in it, it is virtually impossible to lose the curiosity, creativity, rage, wonder and friends that helped you survive it all.

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

Ascorbic acid (vitamin C) 100 mg

Pyridoxine hydrochloride 100 mg equiv. to pyridoxine (vitamin B6) 82.3 mg

Pyridoxal 5-phosphate monohydrate (P5P) (active vitamin B6) 26.8 mg equiv. to pyridoxine (vitamin B6) 17.1 mg

Zinc citrate dihydrate 77.8 mg equiv. to zinc 25 mg

Magnesium amino acid chelate 100 mg equiv. to magnesium 20 mg Manganese sulfate monohydrate 15.4 mg equiv. to manganese 5 mg Biotin 500 micrograms

Lactoferrin: an essential regulator of iron homeostasis

Beneficial bacteriaPathogen

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Bitter Herbs and Foods: The Latest Research Findings

Several herbs and foods contain plant chemicals that stimulate bitter receptors. These receptors were originally thought to only exist on the tongue. Now we know they are found throughout the digestive tract, especially on the enteroendocrine cells that regulate digestive function, appetite and insulin release. Also, bitter receptors have been discovered in many other tissues in the body, including the lungs and immune system.

I previously wrote on this fascinating topic in The Natural Therapist in 2016, but since then some intriguing and compelling discoveries make this subject worthy of an update.

When enteroendocrine cells are stimulated by bitter plants, they release a variety of gut hormones, but in particular cholecystokinin (CCK) and the incretin hormone glucagon-like peptide 1 (GLP-1). CCK has numerous important functions in the digestive tract: it promotes secretion of pancreatic enzymes and bile, slows down stomach emptying, increases gastric digestive mixing and secretions, and creates a sense of fullness, so you stop eating. GLP-1 also slows gastric emptying and creates a sense of fullness (indicating a role in helping weight loss), but equally importantly it stimulates the release of insulin (hence the name incretin). In fact, there are two new classes of type 2 diabetes (T2D) drugs based around this gut hormone: GLP-1 analogues given by injection, and the oral gliptins that enhance the action of naturally released GLP-1 by inhibiting the enzyme that breaks it down, dipeptidyl peptidase-4 (DPP-4). The big question was whether bitters can stimulate the release of GLP-1 from enteroendocrine cells in a clinically meaningful way.

We saw an inkling of this in late 2016. A microencapsulated bitter ingredient (EBI) with a core of bitter Gentiana root extract and a coating of ethylcellulose-stearate was developed and mixed into a vanilla flavoured microencapsulated bitter studyAmaskedpuddingingredient-enriched(EBIP).Thecoatinganybitternessinthemouth,allowingthereleaseofbittercompoundsinthegastrointestinaltract.cross-overrandomisedwasperformed:20

healthy people consumed at breakfast either EBIP (providing 100mg of the bitter Gentian secoiridoids) or a control pudding (CP) on two different occasions. Energy intakes were measured at lunch three hours after breakfast and over the rest of the day (post lunch) through food diaries. There was a trend for a higher release of GLP-1 after EBIP than after CP. In addition, eating the bitter-containing pudding resulted in a significantly 30% lower energy intake over the post-lunch period compared with CP1 This increase in GLP-1 release is now supported by two more trials.

It may surprise you to learn that the bitter herb Andrographis paniculata has been reported to have an antidiabetic effect in mice models and has a significant traditional use for T2D. The exact mechanism of Andrographis in decreasing plasma glucose was unclear, so researchers decided to investigate its impact on the incretin pathway in healthy and prediabetic people. They conducted a randomised, placebo-controlled, crossover, double blind trial. It

included 38 people who were healthy and 35 people who prediabetes.hadAll were randomly assigned to receive either Andrographistheextractoraplacebo.Theprimary

outcome was the GLP-1 concentration, and secondary outcomes were fasting insulin, 2-hour postprandial insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose, 2-hour postprandial blood glucose, dipeptidyl peptidase-4 (DPP-4), and glycated albumin before and after the treatment. After the intervention with Andrographis, the GLP-1 concentration significantly increased in prediabetes people by 19.6% compared to the placebo (p=0.043)2. There were no significant differences in any of the other parameters tested.

The other trial investigated hops (Humulus lupulus)3. Nineteen healthy-weight men completed a randomised three-treatment, double blind, crossover study. Treatments comprised of either placebo or 500mg of hops extract administered in delayed-release capsules (duodenal) at 11:00am, or quick-release capsules (gastric) at 11:30am. Ad libitum energy intake (EI) was recorded at the lunch (noon) and afternoon snack (2:00pm), with blood

and pancreatic polypeptide responses were reduced in gastric and duodenal treatments without affecting blood sugar levels. In addition, gastric and duodenal treatments produced small but significant increases in subjective measures of GI discomfort (such as nausea, bloating, abdominal discomfort) with mild to severe adverse GI symptoms reported in the gastric treatment only. However, no significant treatment effects were observed for any subjective measures of appetite or meal palatability.

Vegetables rich in bitter-tasting phytochemicals may also exert beneficial effects on T2D via their interaction with enteroendocrine cells containing bitter receptors. A Danish study investigated whether selected cultivars of bitter and strong-tasting (BST) Brassica and root vegetables exerted greater health benefits for T2D patients compared to an equivalent modern, mild and sweet tasting (MST) vegetables.

A 12-week randomised, controlled, parallel intervention study involved 92 T2D patients who were allocated to three different diets: (A) 500g daily of BST vegetables; (B) 500g daily of MST vegetables; (C) 120g daily of MST vegetables (normal diet control). The root vegetables and cabbages were handed out once a week during a verbal meeting to ensure the participants followed their respective diets. Groups A and B received 7kg of root vegetables and cabbages weekly in pre-packed boxes, ensuring an adequate quantity for each week. Groups A and B also received easy recipes for inspiration to help them prepare, cook and consume the high daily amounts of root vegetables and cabbages.

mood assessed throughout the compared with the placebo

stimulated pre-lunch ghrelin

Both diets high in vegetables significantly reduced participants’ total Body Fat Mass (BMI) and Hemoglobin A1C (HbA1c) levels compared to the control diet. However, only in the BST group were significant (and clinically relevant) beneficial differences also observed for the oral glucose tolerance test (OGTT) and fasting blood glucose

Therelevels4is

responses compared with

now good clinical evidence that bitter herbs (and foods) can reduce energy intake and blood glucose by increasing the post-prandial release of GLP-1. This opens an exciting new chapter in the therapeutic use of bitters, especially since GLP-1 in being implicated for other health benefits, including for the liver, brain, heart, muscle and bone5.

Courtney Booth ANTA Member BHSc (Naturopathy)

Neuroendocrinology and Fatigue Management: Case Study

Introduction:

Joanna, 42-year-old female presented with severe ongoing fatigue alongside muscle and joint pain, atopic allergies and various food intolerances. While her symptomology and physical examination (Appendix 1) indicated obvious systemic disease, the conditions which most comprehensively explained Joanna’s health state were Chronic Fatigue Syndrome, Fibromyalgia and Hypothyroidism Disease.

These three conditions have been investigated in terms of pathophysiology, diagnostic criteria and strategies for tracking improvement of the client’s health. Both conventional and naturopathic understandings of the aetiology and pathophysiology have been considered as both paradigms have unique strengths. Conventional medicine allows for necessary

advancement in understanding the disruption of the biochemicals or physical biomechanics within the body that lead to particular symptoms or diseases1. Naturopathy, and complementary medicine systems, while taking this into consideration, will give further emphasis to the balance of the various bodily systems which all interact to determine the over-all health state, and will also analyse how lifestyle and dietary choices, emotional/mental health, social and environmental factors may impact a person’s well-being1,2. The simultaneous existence of, and relationships between multiple conditions or syndromes is also given great consideration in naturopathy3.

Differential Diagnosis:

Chronic Fatigue Syndrome: Conventional Understanding:

Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis, is disabling fatigue not ameliorated by sleep lasting >6 months which fluctuates sporadically, often presenting with patient-reported sleep disturbance, cognitive impairment and various musculoskeletal pains after minimal amounts of mental or physical exertion; CFS is commonly experienced with a wide variety of ‘overlapping’ functional disorders which can cause the same symptoms4,5. CFS most commonly affects women aged 30-39 years6. Conventional medicine offers little solid evidence in terms of exact aetiology or pathomechanisms and no biomarkers are yet directly linked to the condition however many contributing factors are recognised; diagnosis requires patientreporting of concomitant symptoms such as joint pains, engorged lymph nodes, headaches, and sore

Thesethroats4.secondary

symptoms support theories that CFS results from disturbance of the immune or central nervous systems, genetic predispositions and environmental toxin exposure7,6. CFS is experienced after viral infections in >50% of patients suggesting vulnerability when the immune system is weakened

by viruses remaining dormant in the body6; impaired function of natural killer or T-cells, increases in autoantibodies or an excessive production of inflammatory cytokines are thought to lead to CFS symptoms7. Extreme fatigue possibly results from poor energy production at cellular level and/ or inappropriate activation of various metabolic pathways, such as oxidative phosphorylation7

Nervous system irregularities align with recognised patterns of sufferers often having pre-existing mental health concerns or having experienced significant traumas/stress, both mental or physical, prior to CFS onset6. Despite this, CFS remains recognised as a biological disorder rather than psychological as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis reflected in inappropriate cortisol profiles is also thought to be a common cause7.

Naturopathic Understanding: Naturopathy acknowledges the largely multifactorial nature of CFS, requiring biochemical disturbance and neuropsychiatric factors be explored; while viral triggers are again most commonly suspected, infection by non-viral pathogens are also recognised as possible causes3. The characteristic long-term lethargy with cognitive impairment indicated “low vitality” suggesting the body’s own abilities to maintain health are depleted and need stimulating2 .

Naturopaths may give greater consideration to causative factors of disease, recognising nutritional deficiencies, anaemia and significant ill-health in childhood as predisposing factors alongside various disruptions of the HPA axis and serotonin pathways due to stress, medications, other illnesses or sleep disturbance as increased reports of CFS are found amongst shift workers3. Hechtman (2014)3 also highlights potential involvement of a ‘sluggish’ liver, unable to maintain adequate detoxification processes resulting in amplified toxic load systematically, decreasing energy production, impairing metabolism and causing improper synthesis of hormones and neurotransmitters. Recent studies suggest manmade organosilicon compounds, widely used in consumer products, may also contribute to CFS due to hormonal-disruption impacting Deoxyribonucleic acid (DNA) expression, thus impairing immune defences 8

Rationale:

Joanna’s previous bout of Ross River fever, and high self-reported stress levels may have caused the development of CFS according to

both health-care paradigms. Her musculoskeletal pain is consistent with increased inflammation theories, while her environmental allergies and food intolerances also suggest immune dysregulation. The reported cognitive impairment with ‘brain fog’ is also consistent with presentation of many CFS sufferers.

ConventionalFibromyalgia: Understanding:

Fibromyalgia is an affective spectrum disorder which causes chronic musculoskeletal pain throughout the body particularly at several tendons or joints, often accompanied by general fatigue, and disturbances of sleep, mood and cognitive functions and is considerably more prevalent in women aged 20-50 years9. Pathophysiology of fibromyalgia is multifactorial, involving disruption of normal functioning of the autonomic nervous and endocrine systems specifically the HPA axis, alongside environmental and psycho-social factors (stress, trauma) and genetic predisposition which cause increased sensitivity at thermoreceptors and mechanoreceptors to stimuli10. In sufferers, stimuli causes painful sensations at intensity levels which would not ordinarily be expected to do so; abnormal neurotransmitter levels may also contribute due to their vital roles in endogenous pathways of pain inhibition10.

Rationale:

Joanna’s ongoing muscle and joint pain, fatigue, headaches, cognitive impairment are also recognised symptoms of fibromyalgia; her age, gender and history of stress are also considered predisposing factors for the condition.

ConventionalHypothyroidism:Understanding:

Suboptimal functioning of the thyroid gland may occur for various reasons including iodine deficiency or autoimmune causes (Hashimoto’s Thyroiditis) which alter the production of thyroid hormones within the Hypothalamic-Pituitary negative feedback loop, causing disruption of various bodily functions including metabolism, adrenal and other HPA axis mediated endocrine processes, plus cardiovascular, musculoskeletal and reproductive mechanisms5. Characteristic symptoms of fatigue, weight gain, heightened sensitivity to cold, dry skin and brittle hair, pain or swelling of joints, impaired memory, constipation, goitre development, menorrhagia, and muscle weakness are common in sufferers5

Naturopathic Understanding:

Naturopathic practitioners agree with the underlying mechanisms of the symptoms but may consider dietary changes or supplementation of nutrients such as selenium or iodine, both vital for catalysing thyroid hormone conversions and production, to stimulate thyroid function to ease symptoms

addressedwhichcausingHypothyroidismautoimmunitywantthewhichdietarypatientmanagementhormoneswithsupplementationbeforeexogenous12.Wholisticofthewouldalsoconsiderandlifestylechangesmaybecontributingtosymptomology,andwouldtoidentifythecauseofinHashimoto’sasthiswouldbesystemicinflammationwouldalsoneedtobe3.

Rationale:

Joanna’s symptomsoffatigue,

Table 1: Comparison of Differential Diagnosis Options Compared to Client Presentation

Possible Associated Symptoms and Risk Factors

Fatigue, not relieved by rest

Patient Reported Symptoms Conditions

ChronicSyndromeFatigue Fibromyalgia Hypothyroidism

Ongoing; worse for stress 5/10 - 2/-10, fluctuates Y Y Y

Mild Fever ‘Running hot’ Y N N

Sore Throat, or hoarseness Y N Y

Lymphadenopathy Y N N

Muscle or joint pain

Ongoing; fingers, knees Y Y Y

Headaches Migraines Y Y Y

Cognitive impairment

Brain fog, memory issues Y Y Y

Sleep disturbance Y Y Y

Mental Health Concerns (Depression, PTSD, etc.) Y Y Y

Body Temperature Dysregulation ‘Running hot’ Y N Y Allergies or sensitivities (food, odours, chemicals)

Irritable bowel type symptoms

Integumentary (various); food intolerances (various); certain smells trigger nausea and headache Y N Y

Food intolerances (various); fatty meals cause nausea & upper left right quadrant pain Y Y Y

Tingling/numbness in hands and feet N Y N

Pain in face/jaw N Y N

Female gender Yes Y Y Y

High stress levels or trauma Stress 6/10 Y Y N

Repetitive injuries (to a particular joint) N Y N

Family history N Y Y

Obesity BMI 28 N Y Y

Post-viral onset

History of Ross River Fever Y N N

Weight changes Central adiposity, BMI 28 N N Y

Dry skin At elbow and ankles N N Y

Brittle nails and hair Nails break easily N N Y

Cardiovascular disease links

Inflammatory condition

Serum cholesterol 5.7mmol/, triglycerides 1.5mmol/L N N Y

Homocysteine levels 10.7 Y Y N

(Bellato et al., 20129; Bradley, 200910; Brawer, 20188, Centres for Disease Control and Prevention, 20187; Grossman & Porth, 20144; Hechtman, 20143; Horowitz, 201511; Lonardo et al., 201913; Onumah, 201612; Rasa et al., 20186; Walker et al., 20145; Wang et al., 201514)

headaches, dry skin and musculoskeletal pain could all be explained by Hypothyroidism. Disruption of appetite and metabolic functions including insulin sensitivity from underactive thyroid function can lead to more significant complications such as NonAlcoholic Fatty Liver Disease, which many also explain Joanna’s abdominal pain13. Furthermore, endocrinological disruption of insulin sensitivity from hypothyroidism may be contributing to Joanna’s weight concerns, thyroid nodules and vascularisation14

Diagnostic Methods: Chronic Fatigue Syndrome:

As CFS symptoms overlap with many other conditions, the diagnosis process involves categorically ruling out other possible causes and may involve various serum tests focusing on various hormones, and liver function, or neurological imaging15,16

Diagnostic Criteria One:

The Centre for Disease Control and Prevention Chronic Fatigue Syndrome questionnaire for the diagnosis of chronic fatigue requires clinical evaluation by practitioners in conjunction with patient reported symptoms to make a diagnosis; the characteristic fatigue, lasting >6 months, be accompanied by any four of eight recognised concomitant symptoms, which are:

1. Sore throat

2. Cognitive problems (memory, concentration) Troubled sleeping Ongoing muscle pain lymph Fatigue exacerbated by exertion7,17.

Joanna’s reported symptoms of ‘ongoing tiredness’ which is worse for exertion, cognitive impairments, headaches and musculoskeletal pains suggest that she may well fit this criterion for a CFS diagnosis.

Diagnostic Criteria Two:

Coeliac serology and genetic screening may be used in patients suspected of having CFS as coeliac and noncoeliac wheat sensitivities can cause similar symptoms of fatigue, varying gastrointestinal discomforts, headaches and cognitive issues18,19

Joanna reports various food intolerances, abdominal pain and recurrent nausea, which combined with her symptoms of fatigue would warrant the need to rule out coeliac-type sensitivities under both conventional

and naturopathic philosophies3,20

DiagnosticFibromyalgia:Criteria

One:

The American College of Rheumatology Classification and Diagnostic Criteria21 (Appendix 2) are considered the gold standards for diagnosis. The criteria encompass musculoskeletal pain elements of the condition, as well as fatigue and sleep factors, and cognitive impairments while recognising the potential for fluctuations of symptoms with severity scaling22 . Assessment includes results of the patient-reported Fibromyalgia Symptom Severity scale combined with practitioner’s assessment11. Pain is assessed in terms of number of locations throughout the body and frequency of pain, while severity of fatigue, waking energy levels and cognitive symptoms are scaled to create a numerical result, which indicates existence of the condition or not, in conjunction with symptoms having existed for >3 months, and elimination of other likely diagnoses21. As a somatic condition categorical diagnosis is difficult due to lack of objective pathology or physical examinations that can be performed thus the importance of acknowledging the patientreported symptoms21

Joanna’s reported symptoms meet various elements of this diagnostic criteria, including multiple sites of joint and muscular pains, lethargy and cognitive impairment. The inclusion of subjective and objective criteria may increase her likelihood of meeting the diagnostic definition of Fibromyalgia.

Diagnostic Criteria Two: The Fibromyalgia Impact Questionnaire (Revised) (Appendix 3), is able to be completed in a few minutes either online or on paper, and also considers pain/tenderness and cognitive symptoms, but also assesses balance and environmental sensitivities while weighting the severity of function impairment more heavily compared to overall impact and symptoms23. The questionnaire focuses largely on how day-today life activities are being affected by the patient’s symptoms, and this more wholistic consideration of the patient’s quality of life may make it a more appealing assessment tool for practitioners of complementary medicines where patient assessment may give greater consideration to lifestyle factors, the patient’s interpretation of their own ill-health and consultations may have a more relaxed or conversational tone23,3.

This questionnaire, with its use of many ‘real life’ situations may allow for Joanna to more clearly describe the impact of her symptoms on her

life, but also allows for a distinct determination between Fibromyalgia and other conditions with some overlapping symptoms, such as Rheumatoid Arthritis23

DiagnosticHypothyroidism:Criteria One:

Serum pathologies measuring levels of the various thyroid hormones are most commonly used to diagnose hypothyroidism; if thyroid-stimulatinghormone is high, and thyroxine low hypothyroidism is diagnosed, this is because if the thyroid is underactive, the pituitary gland will increase thyroid-stimulatinghormone to try to correct this24. Serum pathology is quick, easy and cost effective to perform and in Joanna’s case would allow for other serum tests simultaneously to check for thyroid antibodies to confirm a more specific hypothyroidism diagnosis and rule out nutritional deficiencies or viral causes of her symptoms3

Diagnostic Criteria Two:

Urinary iodine levels may be checked to determine whether dietary iodine is sufficient or whether the paitent benefit would benefit from increased consumption/supplementation3. This test seeks to estimate iodine consumption through measuring output as approximately 80% is excreted in urine; inadequate iodine consumption can lead to poor metabolism of proteins, fats and carbohydrates, which may directly correlate with Joanna’s abdominal pain issues, as well as affect electrolyte balance, which may account for the headaches she experiences25

Outcome Monitoring:

At regular intervals throughout treatment, the monitoring of the patient’s health-state helps to ascertain whether improvement is being achieved which is particularly important in chronic conditions to maintain patient commitment to treatment protocols; these measurement strategies should remain consistent for the most effective comparison of results and may involve pathology testing or PatientReported Outcome Measures (PROM) which allow for subjective or qualitative case facts to be interpreted as quantitative data3.

Chronic Fatigue Syndrome:

The Chalder Fatigue Scale, a self-administered PROM, measures both the severity and extent of fatigue and is a cost-effective, quick and widely recognised monitoring tool for use in the clinical setting which is also simple for patients to use26. This PROM allows for simple comparison of results during consultations and assesses both physical and psychological fatigue26

which would be particularly appropriate for Joanna as she reports both.

Fibromyalgia:

The Fibromyalgia Impact Questionnaire (Revised) whilst helpful in diagnosis, is also suitable for monitoring patient progress in terms of symptom characteristics and impact of these through 21 questions designed in a self-administered PROM which can be performed weekly in less than 5 minutes27. This widely used PROM is designed to be efficient and cost-effective to utilise in clinical settings and is designed in easy to understand language for patients; as Joanna reported ongoing musculoskeletal pains and fatigue, this questionnaire would allow both patient and practitioner to clearly understand the impact of treatment protocols on her symptoms over the long and short term23

Hypothyroidism:

As such a multi-faceted condition with systemic symptomology Hypothyroidism requires outcome measures which reflect this; the Thyroid-related quality of life assessment tool (ThyPRO) encompasses assessment of physical, somatic, social and psychological implications of the conditions in a standardised PROM format which is specifically designed for the often long treatment timeframes of the disease28. As in Joanna’s case, where many bodily systems are experiencing disease and symptoms fluctuate, this PROM will be able to simply help and track changes to her health-state. Hypothyroidism monitoring should also involve regular thyroid panel serology to adequately assess the patient’s health5.

Conclusion:

Presenting with multi-systemic disease, Joanna reported ongoing fatigue and other symptoms which could be attributed to a variety of chronic and somatic conditions. By considering the patient’s health through both conventional and naturopathic frameworks, greater understanding of the aetiology and pathophysiology of her illness, along with the impact of symptoms on her day-to-day life, could be gained. While many chronic conditions may cause overlapping symptoms making diagnosis difficult, thorough investigation of potential differential diagnoses allows for the creation of individualised treatment plans and outcome measurement strategies to help patients along their road to wellness.

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

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ANTA CPE Guidelines

What is CPE

Continuing Professional Education (CPE) is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.

Why is CPE Necessary

CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

ANTA requires members to complete 20 CPE hours annually (January to December). Completion of 20 CPE hours annually is a requirement for your ongoing ANTA membership. It is also a requirement

for provider recognition with all health funds and WorkCover authorities (if applicable). Note: If you do not complete 20 hours of CPE annually, your ANTA membership will be suspended until you have completed the 20 hours required. If you are registered with health funds and WorkCover authorities they will terminate your provider recognition.

Please note that 1 hour of CPE activity = 1 CPE point.

For members registered with health funds, please note that they carry out audits of your records each year to ensure 20 hours of CPE have been completed.

By the end of each calendar year ensure that you lodge details of 20 hours of CPE on your personal profile within the ANTA Member Centre. We

recommend that you also keep a copy of your CPE records (e.g. attendance certificates) in the event of an audit by a health fund (if applicable).

Other Benefits of CPE

• Members are kept informed and up-to-date with the latest developments

• Facilitates communication and networking

• Encourages further study

• Enhances professional standing within the community

Required CPE Hours

ANTA members must accumulate a minimum of 20 CPE hours per annum (January to December). At least 50% of CPE hours undertaken must be related to the modalities you are accredited in by ANTA. Note: hours in excess of 20 completed in the current year are not permitted to be carried over to subsequent years.

Members registered with CMBA/AHPRA must abide by the CMBA/AHPRA CPD/CPE Guidelines for the modalities of Acupuncture and Chinese Herbal Medicine and must also submit their CPE to ANTA (http://www.ahpra.gov.au/chinese-medicine.aspx).

CPE Activities

Members can undertake CPE hours in many ways including the following:

• Attend ANTA free seminars

• Research scientific information within the ANTA Member Centre on:

* IMGateway

* eMIMS Cloud

• Participate in research projects involving, or related to, natural therapies

• View seminar recordings and seminar presentations

• Complete courses on ANTA eLearning Centre

• Give lectures/tutorials

• Give CPE seminar presentations

• Undertake further study

• Complete short courses

• Contribute an article to the ANTA journal “The Natural Therapist” and ANTA website

• Contribute an article to other relevant journals, magazines and publications

• Read articles in the quarterly ANTA journal “The Natural Therapist”

• Subscribe to and read other professional publications and journals

• View webinars

• View online DVDs or recordings on relevant topics

• Listen to recordings on relevant topics

• Radio/TV broadcast on relevant topics

• Read and research information on topics relevant to

your practice

• Attend local practitioner groups/workshops

• Conduct volunteer work with community groups involving natural therapies

Note: First Aid and CPR courses are not recognised or accepted as CPE by ANTA or Health Funds.

ANTA Seminars

ANTA seminars are held in each state annually and are free for all ANTA members.

ANTA and other CPE seminars are communicated to members via the ANTA website, ANTA eNews and in “The Natural Therapist”. Members should regularly check the ANTA website for details of seminars.

Maintaining your own personal online CPE Record

ANTA provides members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained with the ANTA Member Centre (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records as ANTA may be required to present them to health funds if requested).

To submit/edit/view your CPE hours online with ANTA

• Sign into your membership portal on the ANTA website and click on “Member Centre”

• Click on “Submit/Edit CPE Points”

• Click on “Add a new CPE Activity” to add a new record or “Edit an existing CPE Activity record” to edit or delete a record

Enter the following details for each activity:

• Date of activity

• CPE year (for auto calculation)

• Resource, e.g. Book, Course, Seminar, Webinar, etc

• Short description of activity (including author or link where applicable)

• Number of hours of activity (if an activity is 30 minutes record as 0.5)

For further information or assistance contact ANTA at admin@anta.com.au or 1800 817 577.