Document 23515

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© Elsevier Australia
Clinical Naturopathic Medicine
Leah Hechtman
MSci Med [RHHG] (USYD), BHSc (UNE), ND (NCC) MACNEM,
MASRM, MATMS, MESHRE, MFSA, MNHAA
President, The National Herbalists’ Association of Australia (NHAA)
Lecturer – UG and PG, School of Biomedical and Health Science,
University of Western Sydney, NSW
Faculty Member and Lecturer, Green Medicine Institute (GMI)
Director, The Natural Health and Fertility Centre, Natural Health and Fertility Pty Ltd
Private Practitioner, Sydney, NSW
Sydney
Edinburgh
London
New York
Philadelphia
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© Elsevier Australia
St Louis
Toronto
Churchill Livingstone
is an imprint of Elsevier
Elsevier Australia. ACN 001 002 357
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Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067
© 2012 Elsevier Australia
This publication is copyright. Except as expressly provided in the Copyright Act 1968
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This publication has been carefully reviewed and checked to ensure that the content is as
accurate and current as possible at time of publication. We would recommend, however, that
the reader verify any procedures, treatments, drug dosages or legal content described in this
book. Neither the author, the contributors, nor the publisher assume any liability for injury
and/or damage to persons or property arising from any error in or omission from this publication.
National Library of Australia Cataloguing-in-Publication Data
___________________________________________________________________
Hechtman, Leah.
Clinical naturopathic medicine / Leah Hechtman.
Revised ed.
9780729541510 (pbk.)
Includes index.
Naturopathy.
Clinical medicine.
Integrative medicine.
615.535
___________________________________________________________________
Publisher: Sophie Kaliniecki
Developmental Editor: Neli Bryant
Publishing Services Manager: Helena Klijn
Project Coordinators: Natalie Hamad and Stalin Viswanathan
Edited by Stephanie Pickering, Sylvia Sullivan, Julie Gorman & Harriet Stewart-Jones
Proofread by Sandra Slater and Annette Musker
Cover design by Modern Art Production Group
Illustrated by Rod McClean
Index by Jan Ross
Typeset by TNQ Books & Journals Pvt. Ltd.
Printed by CTPS, China
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© Elsevier Australia
Foreword
One of the greatest problems limiting the reemergence
of naturopathic medicine has been the lack of modern
textbooks, especially ones based on science. When I was
a student in the early 1970s, the most current textbook
in the US had been published the year I was born! For
almost a century the mantra of conventional medicine
has been that naturopathic medicine is not only not
scientific, it is misguided, giving patients ‘false hope’
at best and, at worst, delaying needed medical interventions. I still remember a debate I had with an MD
while I was working as a research associate at a medical
school before I decided to enter naturopathic school. I
had become a vegetarian and noticed many changes in
my body and health. I asked one of my fellow researchers what these changes meant and was told, ‘These are
errors in your observations, diet does not affect you.’!
The problem for me in the debate, however, was that I
did not have any research to refute him, only my experiences. Interestingly, when I asked a naturopathic doctor
the same question, he took Guyton’s Medical Physiology
– then a standard textbook for medical schools – off his
bookshelf and showed me what was happening. I was
very impressed that the naturopathic doctor knew physiology better than those I was working with in medical
research. I asked him if I could spend a few days with
him, watching him see patients. After seeing ‘incurable’
patient after ‘incurable’ patient get better with his care,
I was convinced that there was something special here.
Clearly diet and natural therapies – though discounted
by conventional medicine – were indeed effective. But
when I asked my mentor for research supporting his
therapies, or modern books on naturopathic medicine to
read, he had nothing to offer.
Happily, this problem is being addressed, albeit slowly.
The first modern textbook of naturopathic medicine was
co-authored in 1985 by Michael Murray, ND, and me.
The Textbook of Natural Medicine broke an almost four
decade hiatus. Now in its third edition, the Textbook’s
major contribution was beginning the documentation
of the research support for natural medicine. The 2000
page text cites over 10,000 references documenting the
efficacy of natural therapies. Another important contribution was that we brought together for the first time
naturopaths as the experts for a scholarly publication.
And finally, we developed and documented protocols for
the use of natural therapies in the treatment of a wide
range of diseases. Unfortunately, it has for far too long
been the lone standard for the profession. Finally, this
has changed with the emergence of Hechtman’s Clinical
Naturopathic Medicine.
The major contribution of Clinical Naturopathic Medicine
(CNM) that differentiates it from the Textbook of Natural Medicine (TNM) is that it is unabashedly focused
entirely on naturopathic medicine. Hechtman and her
colleagues expertly look at the historic origins of naturopathic concepts and therapies and then integrate these
with scientific research to provide a strong foundation
for modern clinical naturopathy. While there is plenty of
science, I especially appreciate how the authors carefully
considered traditional naturopathic approaches and
therapies in the context of modern science to provide
students and practitioners guidance on how to think
about and treat patients. This is key strength of CNM:
practical guidance.
As appropriate, almost every chapter covers not only
what to do, but how to do it and optimize for the uniqueness of each patient. Nutrient dosages, herbal combinations, potential adverse interactions with conventional
drugs, laboratory tests and clinical criteria identifying
patient characteristics that require modification of the
intervention, etc. are all covered. It is truly, a remarkable
compilation of how to practice naturopathic medicine
conscientiously, effectively and safely.
Another very interesting aspect of CNM is that it is systems, rather than disease, oriented. This means that most
of the content is oriented towards physiological systems
and what goes wrong rather than the disease the person
has and how to treat it. While there is plenty of guidance
on how to treat diseases, there is far more attention paid
to understanding the function of the system, why it goes
wrong and what to do about it. Included also is some
very sophisticated guidance on understanding the adverse
effects of the drugs used by conventional medicine for
each disease and how to mitigate their effects without
impairing their efficacy. This latter guidance is extremely
important as few realise the prevalence of adverse drug
reactions. Research has shown that 25% of patients suffer
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© Elsevier Australia
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vi
FOREWORD
an adverse event as a result of medical care.1 Worse, in
the US adverse reaction to properly prescribed drugs is the
fourth leading cause of death.2 Fortunately, many of these
adverse events can be prevented by the expert use of natural
therapies or alternative to the drugs – both fully described
in CNM. Don’t get me wrong here, as this is not a book
about alternatives to conventional medicine but rather of
naturopathic medicine as an integral part of the healthcare system. While there are plenty of examples of naturopathic therapies as alternatives to conventional medicine,
there are also many examples of how these medicines can
collaborate for the very best patient outcomes.
I am extremely impressed with this work and wish it had
been available when I was a student. Conscientious clinicians will use the great resource every day. My congratulations go to Leah Hechtman and her expert colleagues.
This outstanding book will have a profound impact
on improving the clinical quality and efficacy of our
profession.
Dr. Joseph Pizzorno, ND
Editor-in-Chief, Integrative Medicine, a Clinician’s Journal
Founder, Bastyr University
Commissioner, U.S. White House Commission on Complementary and Alternative Medicine Policy
Licensed naturopathic physician with prescriptive rights, State of Washington
1
Gandhi TK, et al. Adverse drug events in ambulatory care. NEJM 2003;
348:1556-64.
2
Lazaraou J, et al. Incidence of drug reactions in hospitalized patients:
a meta-analysis of prospective studies. JAMA 1998;279:1200-5.
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© Elsevier Australia
Contents
Foreword, v
Contents, vii
Preface, xi
Acknowledgements, xii
Contributors, xiii
About the Author, Special Contribution, Reviewers, xiv
Why do We Need to know about Herb/Nutrient–Drug
Interactions?, 44
About the Herb/Nutrient–Drug Interaction Tables in this
Text, 45
Considerations when Using the Herb/Nutrient–Drug
Interaction Tables, 45
Part 1: Principles of Naturopathic Medicine, 1
Part 2: Naturopathic Treatments, 47
Chapter 1 Naturopathic Philosophy, 2
An Ancient Tradition, 2
Nature Cure – Europe, 2
Naturopathy – North America, 3
Naturopathy in Australia, 4
The Principles of Naturopathy (the Six Maxims), 8
The Naturopathic Approach, 9
Chapter 5 Nutritional Medicine, 48
Introduction to Nutritional Medicine, 48
The Vitamins, 50
Minerals, 72
Essential Fatty Acids, 95
Chapter 2 Principles of Nutritional Medicine, 14
Naturopathic Nutrition, 14
Bio-Individuality, 14
The Functional Practitioner, 15
Naturopathic Nutritional Assessment, 15
Clinical Picture Assessment (CPA), 15
Dietary Analysis Methods, 16
Specific Nutritional Testing, 17
Naturopathic Nutritional Treatment, 18
The Future of Naturopathic Nutrition, 19
Chapter 3 Principles of Herbal Medicine, 21
A Brief History of Western Herbal Medicine, 21
Current Western Herbal Medicine –
Philosophical Principles, 24
Herbal Actions and Constituents, 25
Safety and Interactions, 28
Principles of Herbal Treatment, 29
Formulating a Herbal Prescription, 29
Constructing a Herbal Formula, 32
Preparation of Herbal Medicines, 33
Posology – Herbal Medicine Dosage, 34
Chapter 6 Herbal Medicine, 103
Introduction, 103
Herbal Medicine Classification, 103
Gastrointestinal System, 106
Hepatobiliary System, 110
Immune System, 112
Respiratory System, 117
Musculoskeletal System, 122
Integumentary System, 123
Urinary and Renal System, 125
Female Reproductive System, 128
Male Reproductive System, 131
Cardiovascular and Haematological
System, 132
Endocrine System, 140
Neurological System, 143
Psychological System, 147
Part 3: The Body Systems, 151
Chapter 4 Herb/Nutrient–Drug Interactions, 43
What is a Herb/Nutrient–Drug Interaction?, 43
Types of Interactions, 43
Factors Affecting Metabolism of Drugs, 43
Pharmacokinetic Interactions, 43
Pharmacodynamic Interactions, 44
The Complexity of Herb/Nutrient–Drug Interactions, 44
Chapter 7 The Gastrointestinal System, 152
Overview of The Gastrointestinal System, 152
Role of the Naturopath, 154
Investigations, 156
Potential Interactions, 158
Food Allergy and Hypersensitivity, 170
Irritable Bowel Syndrome, 178
Ulcerative Colitis, 183
Crohn’s Disease, 189
Diverticular Disease, 194
Gastro-Oesophageal Reflux Disorder, 197
Peptic Ulcer Disease, 200
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CONTENTS
Chapter 8 The Hepatobiliary System, 210
Overview of the Hepatobiliary System, 210
Role of the Naturopath, 212
Investigations, 217
Potential Interactions, 218
Cholelithiasis, 221
Cholecystitis, 230
Non-Alcoholic Fatty Liver Disease (NAFLD), 238
Viral Hepatitis, 248
Cirrhosis, 258
Leg Ulcerations, 672
Urticaria, 678
Chapter 13 The Urinary and Renal Systems, 689
Overview of the Urinary and Renal System, 689
Role of the Naturopath, 693
Investigations, 694
Potential Interactions, 701
Urinary Tract Infections (Cystitis), 708
Enuresis, 721
Renal Failure, 727
Chapter 9 The Immune System, 280
Overview of the Immune System, 280
Role of the Naturopath, 289
Investigations, 289
Naturopathic Treatment, 294
Potential Interactions, 299
Autoimmune Disease, 337
HIV (Human Immunodeficiency Virus), 354
Cancer, 385
Chapter 10 The Respiratory System, 418
Overview of the Respiratory System, 418
Role of the Naturopath, 421
Investigations, 425
Potential interactions, 432
Conjunctivitis, 448
Sinusitis and Allergic Rhinitis, 454
Acute Rhinopharyngitis and Influenza, 462
Pharyngitis and Tonsillitis, 469
Asthma, 476
Pneumonia, 485
Bronchitis, 491
Chronic Obstructive Pulmonary Disease (COPD), 498
Chapter 11 The Musculoskeletal System, 508
Overview of the Musculoskeletal System, 508
Role of the Naturopath, 511
Investigations, 512
Potential Interactions, 512
Osteoarthritis, 537
Gout, 551
Fibromyalgia, 561
Osteoporosis, 575
Rheumatoid Arthritis, 586
Systemic Lupus Erythematosus (SLE), 602
Chapter 12 The Dermatological System, 631
Overview of the Dermatological System, 631
Role of the Naturopath, 631
Potential Interactions, 635
Dermatitis/Eczema, 645
Investigations, 646
Psoriasis, 652
Acne Vulgaris, 660
Skin Infections, 665
Chapter 14 The Female Reproductive System, 734
Overview of the Female Reproductive System, 734
Role of the Naturopath, 736
Potential Interactions, 737
The Menstrual Cycle, 761
Premenstrual Syndrome (PMS), 768
Polycystic Ovarian Syndrome, 780
Uterine Fibroids, 794
Endometriosis, 805
Pelvic Inflammatory Disease, 829
Menopause, 842
Chapter 15 The Male Reproductive System, 872
Overview of the Male Reproductive System, 872
Role of the Naturopath, 873
Investigations, 874
Potential Interactions, 876
Benign Prostatic Hyperplasia, 882
Prostatitis, 894
Erectile Dysfunction, 904
Andropause, 918
Chapter 16 The Cardiovascular System, 936
Overview of the Cardiovascular System, 936
Role of the Naturopath, 938
Investigations, 943
Potential Interactions, 944
Hypertension, 963
Coronary Artery Disease (Atherosclerosis, Dyslipidaemia), 977
Cardiovascular Ischaemia (Angina), 993
Coronary Heart Failure, 1005
Chapter 17 The Endocrine System, 1025
Overview of the Endocrine System, 1025
Role of the Naturopath, 1030
Investigations, 1031
Potential Interactions, 1040
Hypothyroidism, 1052
Hyperthyroidism, 1068
Diabetes Mellitus, 1083
Hypoglycaemia, 1108
Stress, 1111
Addison’s Disease, 1124
Cushing’s Syndrome/Disease, 1126
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CO N T E N T S
Chapter 18 The Nervous System, 1138
Principles of the Naturopathic Approach to the
Nervous System, 1138
Role of the Naturopath – Neurological System, 1141
Role of the Naturopath – Psychological System, 1171
Potential Interactions, 1174
Investigations, 1180
Sleep Disorders, 1200
Headaches and Migraines, 1214
Multiple Sclerosis, 1232
Depression, 1248
Part 4: The Lifecycle, 1291
Chapter 19 Fertility, 1292
Epidemiology, 1292
Classification, 1294
Aetiology, 1296
Complications, 1304
Investigations, 1305
Therapeutic Considerations, 1313
Therapeutic Application, 1313
Growth and Development, 1422
Colic, 1428
Teething, 1430
Cradle Cap, 1430
Nappy Rash, 1431
Constipation, 1431
Diarrhoea, 1433
Fever, 1435
Recurrent and Chronic Infections, 1435
Otitis Media, 1438
Warts, 1441
Autism and Autism Spectrum Disorders (ASD), 1441
Attention Deficit (Hyperactivity) Disorder – AD(H)D, 1454
Immunisation, 1459
Special Diets, 1460
Appendices
Chapter 20 Pregnancy and Breastfeeding, 1367
Pregnancy, 1367
Introduction, 1367
First Trimester, 1377
Second Trimester, 1383
Third Trimester, 1390
Labour, 1393
Post Partum, 1395
Breastfeeding, 1397
Appendix 1: Herbal Medicine Dosage Chart, 1475
Appendix 2: Herbal Medicines During Pregnancy
and Lactation, 1487
Appendix 3: Nutrients: Lifespan Requirements
and Pharmacological Dosage, 1491
Appendix 4: Dietary Nutrient Sources, 1508
Appendix 5: Nutritional Assessments and Physical
Examination, 1510
Appendix 6: Symbols and Abbreviations, 1515
Appendix 7: Laboratory Reference Values, 1529
Appendix 8: Herbal Medicines and Laboratory
Investigation Interactions, 1540
Index, 1545
Chapter 21 Paediatrics, 1411
Dosage Calculations, 1411
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Preface
In Naturopathy, a clinician emerges whose sole intention
is to find the cause of a patient’s complaint, to educate and
empower them to understand their health manifestation,
and to support their presentation with a natural means
of treatment. This treatment has evolved over time to be
both clinically effective but also rigorously researched
and assessed. It is an essential part of the changing face of
modern medicine.
The practice of Naturopathy currently finds itself in a
unique position of change. Within Australia, our current
status is the one that is moving towards greater integration within the healthcare system and closer to registration. As such, our treatments require greater responsibility
and specificity and a willingness to share this information
amongst our colleagues. Without this, our treatments and
wisdom risk being lost to other disciplines. As naturopaths, we offer a unique perspective of health care and
provide significant support and relief for patients. Our
treatments encourage self-responsibility and involvement
in the healing process. They foster gentle, restorative and
ameliorating approaches to medical conditions. Their
validity is time-tested and long-standing.
The structure of the text was crucial to the design of the
project. It was important that the content was easily
accessible, logical and articulate. The textbook has been
divided into five sections: Part 1 – Principles of Naturopathic Medicine – providing an overview to our main
treatment approaches; Part 2 – Naturopathic Treatments –
a specific overview of the two main treatments, nutrition and herbal medicine; Part 3 – Body Systems – each
system of the body and relevant major conditions;
Part 4 – The Lifecycles – a naturopathic perspective to the
major lifecycle events; and Part 5 – Appendices Relevant
for the Student and Clinician.
Each section of this book has been arranged in a systematic manner; each chapter pertaining to a specific system
of the body or unique topic; and each condition organised according to specified pedagogy that ensures that the
content is comprehensively covered. Within each condition, the reader can view the content as an overview for
quick access or as a detailed discussion that may provoke
critical thought, reflection and consideration. The traditional approach to the topic has been incorporated and
integrated into the carefully researched content that has
followed. Each reference that was included was not solely
as it supported a statement, but was considered and
reflected to ensure that the content delivered was sound
and accurate. At the conclusion of each condition, the
reader is provided with a comprehensive case study. This
ensures that each contributor’s unique clinical perspective enriches the content and translates the theory into
realistic clinical practice.
At the heart of Naturopathy, we must lean on our elders
whose traditional system knew that the essence of our
treatment relied on the relationship that was formed
between the patient and the clinician. Evidence-based
medicine forms a component of our system of knowledge. It provides us with a lens to explain the efficacy of
our treatment but can never replace the healing relationship. The consultation room continues to be the greatest
environment for growth and understanding and ultimately the platform for change and healing.
Leah Hechtman, MSci Med [RHHG] (USYD), BHSc (UNE), ND (NCC) MACNEM, MASRM,
MATMS, MESHRE, MFSA, MNHAA
President, The National Herbalists’ Association of Australia (NHAA)
Lecturer – UG and PG, School of Biomedical and Health Science, University of Western Sydney, NSW
Faculty Member and Lecturer, Green Medicine Institute (GMI)
Director, The Natural Health and Fertility Centre, Natural Health and Fertility Pty Ltd
Private Practitioner, Sydney, NSW
W
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xi
Acknowledgements
As we near the end of this project, I continue to be inspired
at what a group of individuals can achieve. A book of
this magnitude is near impossible without the support,
dedication and commitment of everyone involved in the
project.
I have had the honour of working with some esteemed
professionals throughout this journey. In the order of their
contribution, my appreciation to Kylie Seaton, Rachel
Arthur, Ondine Spitzer, Dr Hanni Gennat, David Kirk,
Justin Sinclair, Jane Daley, Ses Salmond, Kathy Harris,
Karen Bridgeman, Michael Thomsen, Lisa Costa-Bir,
Dr Matthew Leach, Kathleen Murphy, Dr Tini Gruner,
Dr Suman Naik, Emily Bradley and Helen Padarin. A
special note of gratitude goes to Dr Hanni Gennat for
her contribution of both Chapter 4 and each of the interaction tables within each system or lifecycle chapter. I
have learnt much from working with you all. Your dedication to the project and commitment to sharing your
knowledge, experience and insight has been inspiring.
Additionally, my thanks to Dr Joseph Pizzorno. I am
honoured and privileged to include your foreword is
the text.
Due to the size of this text and the time involved in its
production, those involved have had their share of life
experiences. I can safely say that the team has experienced
almost all major life changes and I sincerely appreciate
each contributor’s integrity to the project. Heartfelt gratitude goes to Ruth Kendon whose contribution unfortunately had to be omitted due to time restrictions.
Ruth – your humility and grace made the process much
easier – thank you. The text was reviewed by a number
of individuals in the industry. Due to the review process,
I was not aware of their identity but sincerely appreciated their thoroughness, feedback and enthusiasm to
release the best text possible. To Jane Daley, your efforts
as technical advisor were supportive, valuable, informative and knowledgeable. I am humbled to consider you a
colleague and value your place in my life.
My sincere appreciation goes to the team at Elsevier
publishers. Their support, direction and dedication to
the project have been impeccable. Many thanks to Luisa
Cecotti, Neli Bryant, Sunalie Silva, Natalie Hamad,
Helena Klijn and everyone else who assisted with the
xii
project. I have utmost respect and gratitude to Sophie
Kaliniecki. Without her patience, support, motivation
and vision, this text would have been impossible.
Thank you to Marianne Trees and Nadine Campbell for
their contributions as research assistants. Your passion,
thirst for knowledge and enthusiasm is inspirational.
A special thank you to Lisa Costa-Bir as without her
research prowess I would have not been able to persevere
in the latter parts of the journey. She embodies one whose
passion for knowledge is the foundation of her strength
as a clinician. It has been a blessing to see her potential
unravel over the years and my gratitude is immense. To
my assistant and colleague Annmarie Cannone, your support and friendship especially when deadlines were tight,
has helped beyond words.
My colleagues on the board of NHAA educate, inspire
and challenge me in positive ways. Thank you all for
your unrelenting passion to drive our profession towards
excellence. To my colleagues at the University of Western
Sydney, Sydney University, fellow clinicians and other
colleagues, my past lecturers, teachers and mentors –
you each hold a place in my lineage and have provided
me with inspiration and guidance and have helped me
become the person and clinician that I am today.
To each patient who I have been fortunate enough to treat,
you are my greatest teachers. Theory holds limited place
in the consultation room and you have each reminded
me to respect the innate healing ability of the body, the
wisdom and gifts from nature and the tenderness and
humility of the human spirit.
Special thanks to Marie-Pierre Cleret whose supervision
provided grounding, stability and comfort; my friends
and family for their encouragement, patience and understanding; my cats for their company when writing into
the night and above all my husband, Justin Denes, without whom none of this would have been possible. Your
insight that this journey has been bigger than anticipated
and your continual love and respect helps me be the person that I am and achieve all that I do.
Finally, my gratitude to all herbalists and naturopaths
both past and present that continue the tradition – the
knowledge is not lost.
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Contributors
Rachel Arthur, BHSc, BNat(Hons) (SCU),
MACNEM, MNSA, MNHAA, MANTA
Lecturer, School of Health and Human
Sciences, Southern Cross University, NSW
Professional and corporate educator
Private Practitioner, NSW
Chapter 2, Principles of Nutritional Medicine
Emily Bradley, ND (SSNT), MHSc, NMed
(RMIT), MANTA
Lecturer, Faculty of Naturopathy, Southern
School of Natural Therapies and Endeavour
College of Natural Health, VIC
Private Practitioner, VIC
Chapter 20, Pregnancy and Breastfeeding
Karen E Bridgman, PhD M Sci (Hons), M Ed
(Higher Ed), M App Sci, ND, DBM, Dip Hom
Part-time Lecturer, Faculty of Pharmacy,
University of Sydney, NSW, Australia
Director, Starflower Pty Ltd and Starflower
Herbals
Chapter 9, The Immune System
Lisa Costa Bir, B App Sc (Naturopathy), Grad
Dip (Naturopathy), Certificate IV in Ayurvedic
Lifestyle Consultation, MATMS
Private Practice, Caringbah, NSW
Chapter 11, The Musculoskeletal System
Jane Daley BHSc(CSU), MClinSc(SCU),
DBM (NCC),
GradCertAppSc(Swinburne University),
MNHAA
Senior Lecturer Southern School of Natural
Therapies, Victoria
Private Practitioner, Victoria
Chapter 7, The Gastrointestinal System
Dr Hanni Gennat Dip App Sc (UNE), BSc
(UWA), PhD (UWA)
Medical Director, Global Natural Medicine
Pty Ltd
Health Consultant, Private Practice,
Australia
Chapter 4, Herb/Nutrient-Drug Interactions
Dr Tini Gruner, Dip.Teach, Dip.Psych.Ther, ND,
MSc, RNutr, AdjProf(SPCNT), MANPA, MNSA,
MNHCA, MISCMR, MNorphCAM
Course Coordinator Bachelor of Clinical
Sciences, Lecturer in Nutrition and
Naturopathy, Clinic Supervisor School of
Health & Human Sciences, Southern Cross
University
Private Practitioner, NSW
Chapter 17, The Endocrine System
Kathy Harris, MHScHMed (UNE), ND, BEd,
MNHAA
Lecturer, School of Biomedical and Health
Science, University of Western Sydney, NSW
Lecturer, Nature Care College, St Leonards,
NSW
Private Practitioner, NSW
Chapter 9, The Immune System
David A Kirk, Adv.Dip.Nat.
Writer, researcher, educator and
consultant to the Complementary
Medicines industry
Technical Support and Education Manager
with Nutrition Care Pharmaceuticals,
Victoria, Australia
Chapter 5, Naturopathic Treatments Nutritional Medicine
Dr Matthew J Leach, RN, DipAppSci (Nat),
DipClinNutr, BN (Hons), PhD
Research fellow, Health economics and
social policy group,
University of South Australia
Chapter 12, The Dermatological System
Kathleen Murphy, ND (ACNM) BA (UQ)
Private practitioner, QLD
Clinical tutor, Endeavour College of Natural
Health, Brisbane, QLD
Chapter 16, The Cardiovascular System
Helen Padarin, BHSc(Nat), ND, DN, DBM,
DRM, MATMS
Private Practitioner, Sydney Australia and
Wellington NZ
Chapter 21, Paediatrics
Ses Salmond, BA (MU), ND, DBotMed,
DHom, DNutr (NCC), FNHAA
Senior Lecturer, Western Herbal Medicine
Department, Nature Care College, Sydney,
NSW
Private Practitioner, NSW
Chapter 8, The Hepatobiliary System
Kylie Seaton, BA (GU) GradDip (QUT) BHSc
(UNE), MNHAA, Adv Dip Nat, Adv Dip WHM,
Adv Dip Hom, Dip Nut (ACNT)
Naturopath & Homeopath, Potts Point, NSW
Chapter 1, Naturopathic Philosophy
Justin Sinclair, ND (ACNT), BHSc (UNE),
MHerbMed (USyd), MNHAA, MATMS
Sessional Lecturer, Endeavour College of
Natural Health, QLD
Private Practitioner, QLD
Chapter 6, Naturopathic Treatments - Herbal
Medicine
Ondine Spitzer, MSocH (UM), BHSci (SSNT),
BA (LTU), MNHAA
Project Officer, Department of
Physiotherapy, University of Melbourne, VIC
Research Assistant, Department of Surgery,
Alfred Hospital/Monash University, VIC
Chapter 3, Principles of Herbal Medicine
Michael Thomsen, ND (NCC), MSc
(Swinburne) MNHAA
Medical Director, Global Natural Medicine,
Tasmania
Private Practitioner, Hobart, Tasmania
Chapter 10, The Respiratory System
Dr Suman Naik, MS [Ophth.][India], MBBS
[India], Adv.Dip. of Naturopathy/Herbal
Medicine/Homoeopathy, Dip. of Nutrition
Lecturer, Australasian College of Natural
Therapies, NSW
Naturopathic practitioner, NSW
Chapter 18, The Nervous System
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ABOUT THE AUTHOR
Leah Hechtman is Director of The Natural Health and
Fertility Centre in Sydney where she specialises in fertility support and mental health. In addition, she is
President of the National Herbalists’ Association of
Australia, lectures at the University of Western Sydney to
both undergraduate and postgraduate students. Leah is
also a contributor to various professional texts and journals, a presenter at conferences and seminars, and is a
media spokesperson for the industry.
SPECIAL CONTRIBUTIONS
Interactions Tables for each System/Lifecycle chapter,
researched and compiled by Dr Hanni Gennat, Dip App
Sc (UNE), BSc (UWA), PhD (UWA)
Medical Director, Global Natural Medicine Pty Ltd
Health Consultant, Private Practice, Australia
Technical Review of Clinical Naturopathic Medicine by Jane
Daley (BHSc (CSU), MClinSc (SCU), DBM (NCC), GradCertAppSc (Swinburne University), MNHAA
Senior Lecturer, Southern School of Natural Therapies,
Victoria
REVIEWERS
Anne Cowper, BHSc (CompMed) ND DBM FNHAA
Practitioner, Morisset NSW, Lecturer WEA Newcastle
Stepanka Dumas, ND Dip.herb
Clinic supervisor/lecturer, Australian Institute of Holistic Medicine
Karen Martin, ND (SACBM), BTeach (Adults) (UniSA), MDEd (Deakin)
Private Practitioner, SA
Brad McEwen, MHlthSc (Hum. Nutr.), BHlthSc, Grad. Cert. HlthSc
(Hum. Nutr.), ND (Adv.), DBM, DNutr, DSM, DRM, MATMS and MNHAA
PhD candidate (University of Sydney)
Lecturer in Nutrition (Nature Care College), seminar presenter
and researcher
Christine Sullivan, B.Soc.Wk (UQ), ND(ACNM), DHM (ACNM),
BN (ACNM), PGD H Sc Nutrition Medicine (UNE)
MNHAA, MANPA, AssMACNEM
Private Practitioner, QLD
Caroline van der Mey, Ad Dip Naturopathy, Dip Hom, Post Graduate
Diploma in Phytotherapy
Lecturer, AIHM (Australian Institute of Holistic Medicine), Perth, WA
Private Practitioner - Naturopathy, WA
Louise Zylan, ND (ACNM), MAIMA, MNHAA
Lecturer, Southern School of Natural Therapies, VIC
Lecturer, Endeavour College of Natural Health
Private Practitioner, VIC
Nicole Quaife, B.H.Sci.(Naturo)
Clinic Supervisor and Lecturer in Clinical Nutrition, Southern School
of Natural Therapies, Melbourne
Private Practitioner, Hampton, VIC
xiv
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PA R T
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PRINCIPLES OF NATUROPATHIC
MEDICINE
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Naturopathic Philosophy
Kylie Seaton
CHAPTER OUTLINE
An Ancient Tradition
Nature Cure – Europe
Naturopathy – North America
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AN ANCIENT TRADITION
Naturopathy is a term of recent origin; however, its philosophical basis is steeped in history. Its basic principles
are thousands of years old and retain a characteristic resonance today. The ancient Egyptian Ebers Papyrus dates
back to the 16th century BC. Historians suggest much of
the material it contained was orally transmitted from perhaps as much as five centuries before this. This 40-page
document contains the earliest written record of healing
practices. The Egyptians were well known for their holistic approach to treatment through the therapeutic use of
herbs and food, massage, invocations and rituals.[1]
The Greek universe was ordered and understood according to four elements: fire, water, earth and air. On the same
principle, Hippocrates (460–377 BC) understood that the
body was governed by four corresponding humours: sanguine, melancholic, phlegmatic and choleric. He viewed
health and disease in terms of fluid balance and classified herbs and food by their ability to affect this balance.
The fundamental principle of the Hippocratic approach
to healing was that the cure should be affected by nature
and that the physician should only endeavour to facilitate
and assist this natural healing process.[2]
Galen of Pergamum (AD 130–200) adopted the humoral
approach favoured by Hippocrates and in his most
famous work, On the Natural Faculties, furthered the
understanding of the development, nature and composition of the humours in man and introduced the qualities
of warmth, cold, dry and moist to the humoral doctrines.
Much of Galen’s work underpinned Western knowledge
of medicine throughout the Middle Ages.[3]
2
In AD 55 the Greek physician Dioscorides wrote a series of
botanical volumes entitled De Materia Medica, which classified drugs according to categories of action; herbs came
to be recognised for their warming, bitter, astringent,
Naturopathy in Australia
The Principles of Naturopathy (the Six Maxims)
The Naturopathic Approach
4
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9
diuretic or tonifying characteristics. This work became the
most authoritative source of information on therapeutic
substances and remained so through most of the Christian era until modern times.[4]
Ibn Sina (AD 980–1037), or Avicenna as he became known
in the West, was a Persian physician who lived during the
late 900s and early 1000s. Avicenna wrote the most complex medical encyclopaedia of the time, the Kitah al Qanun
(Canon of Medicine), which was the summation of the
medical knowledge of the time and influenced medical
education for more than 600 years. Developed from the
Galenic medical tradition, the Kitah al Qanun was translated into Latin in the 12th century and was used as medical text in French universities until the 18th century.[5]
Hippocrates, Galen, Avicenna and Dioscorides all
acknowledged the need for internal and external balance for health to prevail. Underpinning much of ancient
healing was recognition of the vital force that has been
variously understood in terms of chi, prana, the temperaments, the humours and the elements. Regardless of
semantics, the body’s energetics have always been considered important and the healing power of nature has been
a unifying thread woven through all traditional healing
practices.
NATURE CURE – EUROPE
Whilst there are a number of key players in the development of the European hydrotherapy and nature cure
movement, the two most influential figures include
Vincenz Priessnitz (1799–1852) and Sebastian Kneipp
(1824–97). Their pioneering work in hydrotherapy was
the subject of provincial rivalry and unrelenting professional jealousy from the medical community, yet laid
the foundation for the practice of hydrotherapy and the
nature cure movement throughout Europe.
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Born into a peasant family in Austrian Silesia, Priessnitz
received no official medical training. He began treating
injuries from local farmyard accidents with cold water applications, wet bandages and compresses. From these early
beginnings, Priessnitz experienced overwhelming clinical
success as he developed his art of water cure, with Chopin
and Napoleon III among those who sought his clinical
expertise.[6] His fame soon spread far beyond the confines
of Austria and patients from Britain, France, Italy, Constantinople, Philadelphia and Berlin soon sought his guidance.[7]
Like Priessnitz, Kneipp came from humble beginnings.
Too poor to afford medical help, he cured himself from
debilitating tuberculosis with cold water therapy; nightly
dips in the icy waters of the Danube during winter were
the key to his success.[6] Word of his successful water
cures spread and he combined this therapy with the judicious use of herbs to effect cure. Kneipp’s popularity soon
crossed the Atlantic and American institutions began
treating patients and teaching students the basis of his
healing system.[8]
NATUROPATHY – NORTH AMERICA
Naturopathy evolved from the European hydrotherapy
and nature cure tradition using the principles of nature
cure in combination with other modalities like massage,
homeopathy and spinal manipulation.
THOMSONIANISM, PHYSIOMEDICALISM
AND THE ECLECTICS
Samuel Thomson (1769–1843) developed a method of
healing that was heavily based on the use of Native American herbal remedies and sweat baths. His approach was
labelled heroic but was considered less harmful than the
orthodox medicines being used at the time. Thomsonianism developed from the over-enthusiastic use of bleeding,
mercury and arsenic by medical practitioners of the time
which left patients debilitated and often in a worse state
than they were before treatment. Thomson’s simple healing system was based around the concepts of heat and
cold; heat was considered life-supporting and cold was
considered life-threatening. Substances that stimulated
heat in the body, such as diaphoretics, were accepted
while substances that introduced cold into the body, such
as like mercury, aconite and opium, were avoided.[9]
Thomson had a strong belief in an individual’s ability
and right to self-treat and firmly believed that the practice
of healing should remain with lay people. Underpinning
his adamant belief that his system of healing should be
only practised by householders was his strong aversion
to medical education. He sold franchises to his healing
method which he called ‘friendly botanic societies’ up
until the time of his death, in 1843.[10]
The physiomedicalist movement was initiated by one of
Thomson’s assistants in reaction to Thomson’s rejection
of educational progression. In 1835, Thomson enlisted
the support of Alva Curtis, a young and popular practitioner from Ohio who claimed to have lost only one out
of 200 patients. Curtis used this position bestowed upon
him by Thomson to gather support for his own system
of healing and led a breakaway movement in 1838 with
the establishment of his Independent Thomsonian Botanic
Society.[11] In contrast to Thomson’s aversion to furthering
medical knowledge, Curtis established medical schools to
teach and develop his system of healing which was largely
based on the use of herbal medicine.
The physiomedicalist movement also initiated the use of
an energetic diagnostic system. Patients in deficient states
were regarded as ‘asthenic’ and those in excessive states
were regarded as ‘sthenic’. Diagnostic procedures such as
tongue analysis and pulse diagnosis were also employed
so that the most appropriate herbal remedies could be
selected. Although physiomedicalism did not flourish in
the United States,[12] the system of healing was exported
to Britain and was taught at the British School of Phytotherapy until the 1970s.
After initial work by Curtis and Cook, the physiomedicalist movement was further refined by Thurston[13] in 1900
as a:
medical philosophy founded on the Theorem of a vital force or
energy, inherent in living matter of tissue-units, whose aggregate
expression in health and disease is the functional activities of
the organism and whose inherent tendency is integrative and
constructive; resistive, eliminative, and reconstructive to inimical invasion, or disease-causations.
The detailed and comprehensive work of Thurston provided the physiomedicalist movement with a philosophical basis. In his 400-page document, Thurston provided
a rational outline of the failure of regular medicine and
went on to set out the theorems of physiomedicalism,
the principles of the physiomedicalist movement, and a
comprehensive manifesto on medical education, medical terminology, body systems, pathology, disease states,
symptoms, diagnosis, food, immunity and the role of the
physician.
Wooster Beach (1794–1868), established the ‘reformed
botanic movement’ which drew on the professionalism of
medicine and the heritage of indigenous herbal medicine
and European and American healing traditions.[14] As the
numbers of practitioners and the popularity of this new
movement increased, Beach’s influence diminished and
the practice of this system of healing came to be known
as the ‘eclectic’ movement. Beach is widely considered to
be the founder of eclectic medicine.[15] This movement
allowed practitioners to incorporate modalities of other
healing systems into their repertoire. Free to experiment
with a range of healing modalities, the numbers of eclectic practitioners soared. At its peak, eclecticism claimed
over 20,000 practitioners in the United States; these
numbers presented serious competition for the practice
of orthodox medicine.[16]
THE RISE AND FALL OF AMERICAN
NATUROPATHY
Naturopathy was formalised as a professional healing
modality in the United States of America under the guidance of Benedict Lust in the early 20th century. Lust was a
disciple of Kneipp and introduced the practice of Kneipp’s
hydrotherapy to the United States. Trained in osteopathy
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and chiropractic, he opened the first health food shop in
America and founded massage and chiropractic schools
in New York. Lust purchased the rights to the term ‘Naturopathy’ from Dr John Scheel in 1902.[17,18]
In the United States, the popularity of naturopathy continued to increase during the 1920s and 1930s, a period
often referred to as the ‘halcyon years’. Medicine had
offered the public little up until this time and the general
public were taken with this new healing art: when naturopathic conventions were held throughout the country,
both professionals and the public flocked to them. In
1924, a naturopathic convention in Los Angeles drew a
crowd of 10,000 people, naturopathic journals educated
the public on disease prevention and health promotion
and were widely read. Naturopaths began linking diet
and chemical exposure with chronic disease; this thinking was revolutionary for the time.[18]
The 1940s and 1950s, however, brought revolutions in
modern medicine and several definitive moments in modern medicine crippled the holistic approach to health.
Penicillin was introduced in 1941[19] and by the end of
1945, treatment for pneumonia, syphilis, gonorrhoea
and scarlet fever had become available. Streptomycin was
used to cure the first case of tuberculosis in 1950[20] and
any notion of preventative health care took a back seat with
the introduction of the intensive care unit[21] and new
methods of treatment for the polio epidemic.[22] The first
heart lung bypass was conducted in 1953[23] and the drug
chlorpromazine was used to treat schizophrenia in the
early 1960s.[24] Within 30 years, modern medicine had
become seemingly invincible. Such revolutionary developments transformed the public’s perceptions about the
value and possibilities of medicine.
Augmenting the impact of new technology, naturopathy
faced an impossible battle against the might of the American
Medical Association (AMA). Under the guidance of George
H. Simmons and Morris Fishbein, the AMA transformed
itself into a powerful hegemony from advertising revenue
derived primarily from drug companies and the tobacco
industry. The AMA established a propaganda department in
1913 headed up by Morris Fishbein; the media was used to
discredit, ridicule, suppress and quash any form of healing
not condoned by either Fishbein or Simmons.[25]
The Flexner Report, published in 1910, also severely
impacted the practice of both homeopathy and naturopathy in the United States. Although it has been praised
for unifying the training of medical practitioners at the
time,[26] the Flexner Report ensured that only schools
endorsed by the AMA survived.[27] Allopathic, naturopathic, eclectic and homeopathic institutions alike folded;
only one eclectic school and one homeopathic school survived. The Flexner Report saw the demise of eclectic, naturopathic and homeopathic medicine in the United States
and determined the future path for medical education.
The popularity of miracle medicine, the rise in power and
influence of the AMA, the Flexner Report, the death of
Benedict Lust in 1945 and an un-unified naturopathic
community plagued by inner conflict saw naturopathy in
America decline and virtually disappear.
NATUROPATHY IN AUSTRALIA
EARLY INFLUENCES, 1788–1861
The successful introduction of naturopathy into Australia
would not have been possible without the acknowledgment of medicine’s limitations since European colonisation. The prohibitive cost of medicines in the colonies
encouraged the practice of self-prescription as a necessary
form of primary health care; herbal cures for headaches,
venereal disease and rheumatism that were either known
as family recipes or found in English medical handbooks
were popular. The influence of women as healers during
the 1800s reveals a secret and hidden history of healing
in Australia kept within the walls of the family home;
the art of disease prevention, a tenet of naturopathy, was
regarded as women’s work.[28]
The migration of hydrotherapy from Europe to America
is well documented and early beginnings of naturopathy
in Australia can also be traced back to a pamphlet that
was published in Launceston, Tasmania, in 1846 detailing
Priessnitzian hydrotherapy.[29] The Victoria Hydropathic
Establishment opened for business in Malvern Hill in 1861
under the direction of Monsieur and Madame La Moile
and offered overnight or daily hydrotherapy treatments.
Turkish baths were also popular in central Melbourne and
were promoted for their ability to cure illness.[28]
Australian naturopathy also has its traditions in the practice of herbalism and homeopathy as the first reported
natural therapists in Australia were homeopaths and
herbalists.[30] A growing community of Chinese gold
prospectors saw Chinese herbalism introduced to the
goldfields; by the late 1850s, numerous Chinese herbal
shops had opened in central Melbourne. By 1867 it is
estimated that 50 Chinese medical practitioners were
operating on the Victorian goldfields alongside 25 legally
registered doctors.[31]
Perhaps one of the most famous European herbal practitioners in Victoria during the 19th century was John
Broadbent. Broadbent, the author of two publications,
The Australian Botanical Guide (1887) and Botanic Multim
in Parvo (1899),[32] established a herbal practice which
thrived until the 1930s. His clinical practice at 109 Bourke
Street, Melbourne, was famous for its shingle:
Botanic Laboratory: All Herbs Guaranteed Pure, Fresh, and
True to Nature. Importers of Medical Herbs from Every Part of
the Globe: Herbs, Roots, Barks, Seeds, Blossoms. Herbal remedies for all diseases: No Family Should Be Without Them.
Deeds Not Words.[33]
THE EMERGENCE OF AUSTRALIAN
NATUROPATHY, 1910–40
The period of emergence is marked by the presence of
Chinese herbalists on the Victorian goldfields; it has been
suggested that Chinese herbalists were the largest group
of practitioners using herbal medicines in Australia in
the early 1900s.[34] Although naturopathy was only in
its early incarnation, the popularity of herbalism at the
time was reflected in the formation of Australia’s oldest
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medical association, the National Herbalists Association of
Australia (NHAA), in 1920. In 1925, the Victorian parliament attempted to introduce a bill outlawing the practising
of herbalism by anyone but pharmacists; Chinese herbalists
in Victoria reportedly launched a publicity campaign and
using petitions managed to gather 6000 signatures from a
supportive general public. The bill was withdrawn.[31]
The herbal community in Sydney in the early 1900s was
influenced heavily by the Newton and Wheeler families.
Gilbert Wheeler was an early practitioner of herbalism in
Sydney and came from a family who had practised herbal
medicine in Australia from the days of early settlement.
Edward James Newton, the grandson of Edward Allen
Newton, was another popular herbalist and ran his clinical practice from an office in Pitt Street. Newton became
a major importer and supplier of herbs and the herbal
formulas handed down by his father were very popular
with the local community.[35]
Australian naturopathy as we know it today would not
have been able to develop without the insight, dedication and benevolence demonstrated by Frederick Roberts and Maurice Blackmore. Roberts (1892–1976)
played a key role in the development of osteopathy,
chiropractic and naturopathy in Australia. He trained at
the London School of Natural Therapies and in 1929
he established the Robert’s Naturopathic Institute in
Melbourne.[34] Roberts set up health clinics in Ballarat,
Geelong, Brisbane, Ipswich, Newcastle, Toowoomba,
Maryborough, Bundaberg, Mackay, Adelaide, Perth and
Fremantle, effectively bringing naturopathy to regional
Australia. Maurice Blackmore graduated from the British
Naturopathic College and immigrated to Australia in
1923. Blackmore was another pioneer of naturopathy
in Australia and opened both a naturopathic clinic and
Australia’s first health food shop, in Brisbane in 1934.[36]
THE POST-WAR PERIOD
The practice of naturopathy in North America was profoundly affected by the development of pharmaceutical
drugs and technological advances attributed to World
War II; the American naturopathic professional fell into
decline as great advances in technology dominated during this period. In Australia, the growing pharmaceutical
industry began to dominate and dictate orthodoxy and
the practice of Chinese herbalism in Victoria suffered with
the continuing impact of the white Australia policy following Federation. Although the impact of these changes
on naturopathy has not been specifically researched, natural therapies practitioners in Australia entered a difficult
time.
A herbal teaching hospital was established in Francis
Street near Hyde Park in Sydney in the early 1950s by the
NHAA. The teaching hospital was used to train herbalists and free herbal treatment was offered to patients who
queued for hours to receive treatment; those who could
afford to left donations so that the rent on the premises could be paid. The herbal teaching hospital kept its
doors open for 10 years, herbalists worked relentlessly for
free to serve the community and all medicines were dispensed at no cost. Despite the success of the clinic and
its increasing popularity with the local community, the
NHAA was forced to close the hospital in the early 1960s
as making repayments on the premises had become an
impossibility.[35]
Despite the closure of the herbal hospital in Sydney,
and difficult times faced in North America, naturopathy in Australia continued to grow through the 1960s as
early pioneers like Maurice Blackmore and Cyril Flowers
began to train other practitioners. Alf Jacka established
naturopathic clinics in Melbourne and in regional Victorian towns during the 1950s, 1960s and 1970s and, with
Blackmore’s encouragement, he established a naturopathic college in Melbourne in 1961.[34]
NATUROPATHY – BOOM FROM THE 1970s
ONWARDS
Naturopathy experienced a resurgence in the late 1960s
and early 1970s as the public became increasingly disillusioned with orthodox medicine. The tragic repercussions
of thalidomide treatment in pregnancy became apparent and for the first time, the reductionist approach of
medicine was being challenged. In 1962, Rachel Carson
published Silent Spring and as a result became an eminent
figure in the modern environmental movement. For the
first time, the general public were warned about the indiscriminate use of pesticides and fertilisers and the book’s
impact was not limited to North America. The 1960s and
1970s saw a worldwide interest in health and the evolution of human consciousness; the general public turned to
alternative medicine for answers. Jacka[34] estimates that
during the mid-1970s, the student intake at the Southern
School of Natural Therapies increased by 400%, reflecting
this worldwide trend.
The development of naturopathy in Australia has been
heavily influenced by the practice of herbal medicine in
particular. Denis Stewart established the Southern Cross
Herbal School and in 1978, the school awarded Diplomas
of Medical Herbalism to its first graduates. Since the original Friday night lectures at the Glebe Town Hall in Sydney,
Stewart has been involved with the training of hundreds of
students and some of Australia’s finest and most influential
practitioners, with Nick Burgess, Andrew Pengelly, Anne
Cowper and Christina Scalone all training under Stewart.
Stewart is well respected for his system of dosing which
evolved from what he considered to be a lack of discipline in existing dosing regimes. Stewart was impressed
by the dosing stipulations outlined in the British Herbal
Pharmacopoeia of 1983 and began to use those doses in
his formulations. Stewart has always maintained that
unless a herb is prescribed within the stipulated dose
range, maximum benefit from that benefit cannot be
achieved. He has been a great exponent of the use of
the 1:1 fluid extracts which were the basis of British and
Commonwealth Herbal Medicine practitioner’s formulations (personal communication from D. Stewart, herbalist, 29 June 2009).
Denis Stewart and Dorothy Hall have been two key players who have helped shape the clinical practice and training of herbalists and naturopaths in Australia. Despite the
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opposing dosage principles that underpin the philosophy
of their individual styles of clinical practice, their dedication to naturopathic training established precedents for
the movement of naturopathic training into the domain
of private colleges and eventually, the university system.
disorders (biography of H. Osiecki supplied by Bioconcepts, Brisbane (QLD), May 2009).
Australian naturopathy has also been heavily influenced
by the successes of several other individual practitioners.
Robyn Kirby (b. 1936) was a practising herbalist for 26
years and ran successful clinics on the central coast and
in Sydney. She was a student of Denis Stewart and the
first female president of the National Herbalists Association of Australia. Kirby is widely respected for her Sinus
Tonic, which is still manufactured and sold today. Kirby
authored several books during her career which added
valuable information to the practice of naturopathy in
Australia (personal communication from R. Kirby, herbalist, 15 June 2009).
The practice of naturopathy in Australia is evolving. From
its early beginnings with the practice of herbal medicine
in early settlements and on the goldfields to the more
formalised practice of herbal medicine within clinical
situations through the 1900s, the use of herbal medicine
has always been a key naturopathic modality. With the
influence of the European hydrotherapy movement and
the new interest in nature cure which was booming in
the United States, naturopathy in Australia came to represent the practice of herbal medicine and nutrition with
the flexibility of other modalities such as massage, flower
remedies, iridology, tissue salts and celloids.
The presence of naturopathy in Australia can also be
accredited to ongoing support provided by professional
associations such as the National Herbalists Association
of Australia. The success and popularity of the conferences
organized by Anne Cowper and the quality of research
published in the Australian Journal of Medical Herbalism,
edited by Cowper, has allowed naturopathy in Australia
to survive and grow underpinned by relentless and professional support. Cowper herself has also made significant contributions to the practice of herbal medicine in
Australia, writing several publications on herbal manufacturing, running a successful private clinical practice
since 1988 and teaching students at naturopathic colleges
(personal communication from A. Cowper, herbalist, 18
June 2009).
The formalised teaching of naturopathy programmes
in private colleges and universities has predominantly
influenced the practice of naturopaths in Australia.
With increasing emphasis on herbal medicine and clinical nutrition, underpinned with sound knowledge in
the health sciences (anatomy and physiology, pathology, pharmacology), naturopathy is becoming less of an
umbrella term for an array of modalities and is streamlining into a practice heavily driven by herbal medicine and
clinical nutrition. Naturopathy is taught at the advanced
diploma and Bachelor level at private colleges (accredited
through the Vocational Education and Training Accreditation Board (VETAB)) and in line with current health
training package requirements. A full time naturopathy
programme is also taught at undergraduate level at university in Australia. Postgraduate qualifications are available
through universities which recognise students’ undergraduate qualifications. This enables access to higher education
opportunities including Masters level training for herbal
medicine and nutrition and various PhD pathways.
In recent times, Kerry Bone has perhaps been one of the
most influential contributors to the practice of naturopathy in Australia. Bone trained at the School of Herbal
Medicine in the United Kingdom from 1980 to 1984 and
was heavily influenced by Simon Mills and Hein Zeylstra.
Over the last 20 years, Bone has relentlessly promoted the
value of herbal research to inform clinical practice, but
not at the expense of traditional knowledge, and his dedication to research has provided the naturopathic profession with six textbooks that illustrate this approach. He
established a masters course in clinical herbal medicine
at the University of New England, which was the first
of its kind in the world (personal communication from
K. Bone, herbalist, 27 May 2009).
Augmenting the very ‘herbal’ influence on naturopathy is
the nutritional approach to naturopathy. Henry Osiecki
has been one of the key contributors to both the national
and international naturopathic nutritional knowledge
base over the past 25 years. Osiecki was professionally
trained as a biochemist, dietitian and nutritionist and has
been heavily involved in research and product development during his career. He has written a number of textbooks and his Physician’s Handbook of Clinical Nutrition
has become a key undergraduate text and an important
clinical reference. More recently, Osiecki has brought
together medical models and traditional therapies to
form a comprehensive understanding of the biochemical processes involved in cancer development and mood
WHAT IS MODERN AUSTRALIAN
NATUROPATHY?
The eclectic and inclusive nature of the art of naturopathic healing, has seen the foundational modalities of
herbal medicine, nutritional medicine and nutritional
supplementation combined in clinical practice with
optional modalities including iridology, flower essences,
massage, chiropractic, osteopathy and homeopathy. This
integration and practice of several modalities is a definite
strength, allowing for flexibility in practice and multiple
treatment options that can be chosen and tailored to suit
the individual case presentation.
More recently, the term naturopathic medicine has
emerged and embraces the original European concept of
nature cure and the modalities of naturopathy and has
placed them within the framework of modern science
and medicine. Such placement has resulted in considerable focus on herbal medicine, nutrition and nutritional
supplementation as key naturopathic modalities, with
other modalities available as treatment electives. Such
flexibility means that the practice of naturopathy can,
however, be hard to quantify at times. Smith[37] regards
the practice of naturopathy as a unique system of primary
health care that is not limited to a single modality of healing that combines the art and science of medicine using
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traditional forms of healing and modern scientific knowledge to prevent and treat illness.
Notwithstanding the ability of the modern naturopath to
don any cap required is significant not only for the current practice of naturopathic medicine but also for the
development of the profession. With recognition of and
respect for the limitations of practice, the naturopathic
practitioner has the flexibility to direct and manage cases
with the most appropriate therapeutic techniques. Lifestyle modifications are essential, and it could be argued
that they often underpin the degree of clinical success in a
case. Change strategies are important, but more important
are the techniques that the naturopath uses so that longterm and life-altering change can be made by the client.
Motivational support is essential. For effective clinical
practice and results, there is increasing demand on the
practitioner to understand patient motivation and attitudes to health and success and to be able to fathom the
patient’s physical, emotional, spiritual, familial, social,
occupational and financial stressors. As such, it is important that the practitioner engage in the mindful practice
of self-awareness. Once an understanding of self begins
to develop, the practitioner then develops an ability to
be able to see a case presentation more objectively and
with greater clarity. The lived experience of the naturopath is an essential therapeutic tool; any work done on
the self will directly benefit the type of patient who presents and the outcome for that patient. The ability to give
and the extent of what is offered in a therapeutic situation
is directly related to the amount that the clinician invests
in his or her own health and self-awareness.
NATUROPATHY WITHIN THE AUSTRALIAN
HEALTHCARE SYSTEM
There are three forms of regulation available to health
practitioners in Australia. These include self-regulation,
statutory registration and co-regulation. Naturopathy in
Australia is self-regulated and is practised under common
law, which allows for the practice of naturopathy without any training whatsoever. However, because of the
strict educational and professional registration requirements imposed by health insurance companies, although
in theory it is possible to set up and practise as a naturopath without qualifications, it is much more difficult
in practice. Such unqualified practice also detracts from
the professionalism and legitimisation that naturopathy
practitioners seek from the health care system and public
perception.
Although there is no official recognition for naturopaths
within the Australian healthcare system, naturopathic
practitioners are already working within a primary and
allied healthcare network. Despite strong lobbying campaigns, naturopaths in Australia to this point have failed
to obtain statutory registration even though naturopathy
is taught at both a college and university level; chiropractors and osteopaths have managed to gain registration in
all states and territories and Traditional Chinese Medicine
practitioners have gained registration in Victoria. As such,
naturopaths in Australia continue to take a back seat
and are often relegated to being the ‘last port of call’ for
patients with chronic or unresolvable conditions or for
patients who suffer life-threatening illness and want to
make sure all treatment bases are covered.
At present, there is a prevalence of complementary and
alternative medicine use in Australia and research indicates that in 2006, 1.9 million naturopathic consultations
were conducted.[38] Australia is experiencing a quick evolution towards naturopathic professionalism, and, more
and more, naturopathy is being accepted as mainstream.
However, despite the progress in public awareness, a definite split within the profession is apparent. One sector
of the profession is rallying to retain the traditional principles of a healing art that has been viewed as a fringe
modality, a cottage industry of sorts, that has prevailed
throughout various political agendas of recent decades
because of its underground nature. The other sector is
striving for professional legitimisation of naturopathy
and is pushing for statutory registration, giving naturopaths recognition that has until now been reserved for
allied health professionals such as physiotherapists, podiatrists and osteopaths.
Such division within the profession leaves the practice
of naturopathy undefined; a lack of cohesion within the
profession provides an environment where therapeutic
imperialism can thrive. The existence of a multitude of
professional associations has stifled the voice of a unified
profession and it is this lack of unity that has made government negotiation difficult. The push towards registration surely provides a framework which will ensure the
survival of naturopathic practice. The movement towards
registration has already begun; rather than question
whether registration is in fact a necessity, the professional
should be asking whether they want to drive the process, or whether they are satisfied to be mere passengers.
A cohesive movement into the future is required to not
only preserve traditional practices but also to legitimise
current practice.
At present, increased interest in complementary medicine
has been attributed to a decline in faith in the previously
unquestioned power of modern medicine. Rather than
being pushed away from orthodox medicine, however,
studies have reported that the general public is pulled
towards complementary medicine.[39,40] The very foundations of naturopathy, once dismissed and ridiculed, are
now being accepted. The importance of fresh food, fresh
air, exercise, good quality sleep and rest are now accepted
as is the need to limit the body’s toxic overload. Integrative medicine conferences now refer to the six maxims
of naturopathy as fundamental principles of medicine.
They may be the principles of healing in the future, but
they certainly have not been the principles of medicine
in the past.
The failure of modern medicine explains the increased
popularity of integrative medicine. At present, integrative
medicine at its worst relies on cherry picking evidencebased medicines that can be used in conjunction with
or in place of pharmaceuticals. Its scope is overwhelmingly limited, but in effect still provides solutions to both
general practitioners and patients. At this point, orthodox
and integrative medicine cannot offer what naturopathy
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can. Integrative practitioners are for the most part still
dictated to by evidence-based research limited by the
current scientific paradigm. Time constraints and strict
medico-legal guidelines augment this. Naturopaths, on
the other hand, are freer to explore both empirical and
evidence-based knowledge from several healing modalities. The flexibility of naturopathic practice means that
the naturopath’s toolkit can assume a Tardis-like status
and naturopathic solutions to health problems far exceed
what the few evidence-based herbs or supplements can
offer.
We are perhaps, at this point, in the process of accumulating the research, ideas and concepts that will eventually instigate a shift in consciousness and a more evolved
understanding of human health. Until that point, those
players restricted by the paradigm within which they work
must continue to further their understanding of health
and disease. Those players not trapped by the paradigm
of modern medicine must also continue to seek answers
to questions that are so central to the human condition
but relegated to the ‘fringe’. Each player must keep with
them an appreciation of the limits of modern medicine
and an understanding of the infinite possibilities of healing which have been demonstrated in the past, and which
are still to be experienced. Each healer, whether orthodox or complementary, brings a unique set of experiences
and values to their work, and consequently will attract
patients who resonate with that experience.
THE PRINCIPLES OF NATUROPATHY
(THE SIX MAXIMS)
THE HEALING POWER OF NATURE
(VIS MEDICATRIX NATURAE)
An understanding of the first tenet of naturopathy necessitates both an acceptance and an appreciation of the
power of nature. This power exerts influence by dictating
how the body responds to internal mechanisms that direct
cure and external influences that support and encourage
cure. Naturopathy recognises that nature is both perfectly
balanced and organised intelligently to create, maintain,
repair and destroy matter synchronistically. The body
also has its own intuitive and sophisticated mechanism
of healing that operates in congruence with the laws of
nature. As nature regenerates itself without the need for
human intervention so too does the human body. The
use of nature’s healing agents (air, earth, water and sun)
in combination with a clean diet, exercise, good sleep,
relaxation, meditation and an optimistic outlook are
examples of external factors that can influence and support the body’s innate ability to heal. The naturopath’s
role is to support and facilitate the body’s natural ability
to heal.
IDENTIFY AND TREAT THE CAUSE
(TOLLE CAUSAM)
Underpinning this principle is the basic understanding that all illness must have a cause and for health to
be restored and optimised the cause or causes of the
disease state must be identified and removed. In this
sense, symptoms are regarded as indicators of disharmony. They can be viewed as direct indicators of the
cause of disease or as gross indicators of the intense
homeostatic effort required to adapt and repair. A
mechanic would never remove a warning light from
a car’s dashboard to correct a mechanical problem
detected during a service; in the same way symptoms
should never be removed or suppressed from the body
in order to restore health.
TREAT THE WHOLE PERSON (TOLLE TOTUM)
Health and disease are the results of an intricate and
intimate interplay of physical, emotional, mental, spiritual, social, familial and occupational factors. Failure to
address all aspects relevant to a patient’s pattern of health
and disease fundamentally ignores the complexity of the
human being. By its very nature, such ignorance motivates
healing interventions that are reductionist, short-sighted
and founded in the disease rather than a health-focused
treatment model.
FIRST DO NO HARM (PRIMUM NON NOCERE)
The principle of inflicting no harm on patients is a naturopathic reaction to the heroic medical procedures of the
past that saw the use of mercury, arsenic and the practice of bloodletting. An understanding of this principle
necessitates an acknowledgement of the healing power of
nature. The naturopath’s role is to facilitate the body’s
natural ability to heal and if this approach underpins
practice, then harmless practice will be a direct result.
Naturopathic practice that respects the principle of harmfree treatment is traditionally non-invasive, and avoids
the suppression of symptoms and the prescription of
harmful doses of medicine.
DOCTOR AS TEACHER (DOCERE)
The word doctor has a Latin origin and originally meant
‘teacher’. The maxim doctor as teacher reiterates the principle that as part of nature, the body can heal without
human intervention. The power to eliminate disease and
optimise health lies with the body itself not with the
naturopath, and in this sense the naturopath assumes the
role of teacher so that the body’s natural healing mechanisms are supported. In this teaching role, the naturopath
seeks to educate the patient and encourage self-education.
The naturopath must be able to inspire and motivate the
patient and encourage self-motivation. Ultimately, naturopathy seeks to empower the patient and encourage
self-empowerment.
PREVENTION (PREVENTARE)
Seeing a naturopath to facilitate disease prevention is a
concept that is becoming increasingly difficult to promote in a sickness-focused healthcare system. As a result
of this, the principle of disease prevention is more readily
applied once a person is already under the care of a naturopath. Treatment of the primary complaint can begin and
through a process of risk factor analysis, constitutional
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susceptibility and genetic tendency, naturopathy can be
employed to prevent both the sequelae of disease states
and the development of new states.
THE NATUROPATHIC APPROACH
The naturopathic approach to health and disease focuses
on the restoration of health where health has deteriorated,
the optimisation of health where good health prevails,
and the prevention or slowing of health deterioration.
Naturopathy, in its basic form, is a celebration of simplicity with the promotion of fresh air, clean water, adequate
rest, nutritious food and the use of herbal remedies and
nutrition to assist with the body’s self-healing processes.
Despite the complexities of modern disease pathogenesis,
astounding improvements in the patient’s quality of life
can be achieved by adhering to simple yet effective techniques to encourage self-healing.
As a key feature of naturopathic practice, simplicity does
not necessitate that the naturopathic approach is in any
way unintelligent. The brilliance of this system of healing is the intelligence behind the simplicity. Comprehensive case taking plays a fundamental role in naturopathic
practice as practitioners strive to find answers in the many
causes of health deterioration rather than rely on a single
diagnosis. Naturopathic clinicians are often presented
with numerous therapeutic challenges; informed clinical reasoning and case management will ensure optimal
client care. Modern medicine treats symptoms and often
suppresses disease states. This method of approach does
little to identify and understand the dynamic causal interplay of symptoms that can only be elicited with comprehensive care taking.
Integral to treatment and optimal patient care is the naturopath’s understanding of their role. This reveals a comprehension of the extent to which naturopathy can be
used for patient benefit as well as an understanding of the
limits of treatment. In any case, successful case management requires that the naturopathic practitioner draws on
a network of qualified and experienced practitioners from
other modalities (counsellors, acupuncturists, homeopaths, osteopaths), so that the patient is offered the
best care.
A key strength of naturopathic practice is the ability to offer consultations (between 30 minutes and
1 hour) that enable and facilitate a longer comprehensive case taking process. The ability to offer appointments
allows the practitioner and the patient to establish a rapport and provides a base where key issues (often not what
the patient presents with) can be identified and discussed.
This consultation time is what many patients seek, and
fail to find, in the current healthcare system. Notwithstanding, naturopathy offers much more than just lending an ear to patients, but it is this ear that opens dialogue
and can unfold issues that block healing.
An initial visit to a naturopath would usually begin with
a complete health history. If necessary, physical examination or inspection will take place and the patient
will be referred to a general practitioner if necessary.
After the initial case has been taken, the naturopath
may order pathology tests through private laboratories;
these can be general, functional or specialised. Other
specific diagnostic tests can be requested, for example:
comprehensive diagnostic stool analysis (CDSA), gastrointestinal tract tests, functional liver detoxification
profile (FLDP), Helicobacter pylori stool antigen (HpSA),
intestinal permeability (IP), 3-day parasitology (3DP),
genetic diagnostic testing, salivary hormone profiles,
adrenal hormone profile, baseline hormone profiles,
metabolic profiles, nutritional profiles, hair tissue
mineral analysis (HTMA) and food sensitivity profiles.
Some naturopaths choose to work with fewer laboratory investigations and rely on laboratory tests ordered
through the patient’s doctor and good case taking to
identify problems.
Augmenting the conventional medical history, the naturopathic assessment will also spend considerable time
assessing dietary, lifestyle, occupational, social, environmental and emotional influences and the impact these
have on patient health and illness. The naturopath will
then formulate a treatment plan which addresses both
symptomatic relief and the cause of the illness or disease
the patient presents with. Herbal medicine, nutritional
supplementation, nutritional advice and counselling are
key practice components with homeopathy, with flower
essences and massage being introduced where necessary.
Follow-up appointments allow for treatments to be
adapted, modified and tailored to suit ongoing or differing demands. The second or third appointment can often
introduce the naturopath to many of the patient’s underlying drives that influence health. Follow-up appointments
also allow for an approach to healing that is shared by both
the patient and the practitioner as these appointments
allow the patient to report progress, setback, insights and
experiences – all components are essential to healing.
At all times the naturopath must remain cognisant of the
need to do no harm. Often, patients will present with
debilitation from conventional treatments, so the practitioner’s job is to first restore then optimise health with
as much care for patient safety and well-being as possible.
Mills and Bone[41] refer to the need to balance physiological enhancement with physiological compensation. In
this instance, physiological enhancement aims to create
a state of robustness by raising vitality and physiological compensation attempts to compensate for organs or
organ systems that are over- or under-functioning.
THERAPEUTIC ORDER
The therapeutic order is the cornerstone of naturopathic
treatment; it recognises the principles of naturopathic
medicine and prioritises treatment according to these
principles. This order fundamentally acknowledges the
use of non-invasive and restorative agents as the first line
of treatment. Treatments should then build in intensity
as necessary. The therapeutic order is generally consistent
for each patient; however, individual treatments should
always be prescribed within the context of this therapeutic order. An Australian specific therapeutic order (after
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the original US order authored by Zeff and Snyder) is generally understood to be as shown below:
1. Restore the basis of health by understanding and minimising the obstacles to cure and promoting opportunities for
healing.
2. Identify potential obstacles to health and support/treat
accordingly:
a. Hereditary/genetic influences – including parental preconception health, inborn errors, epigenetics
b. Lifestyle considerations – hygiene, environmental, spiritual, social, relaxation, exercise, socioeconomic, interrelationships, stress
c. Previous medical history and treatment
d. Dietary intake and assimilation.
3. Stimulate the body’s natural ability to heal by addressing
the cause of the disease.
4. Modulate body systems – strengthen weakened organs and
tonify overactive organs. The focus includes:
a. Strengthening the immune system
b. Eliminating toxins
c. Reducing inflammation
d. Tonifying the nervous system
e. Balancing metabolic and hormonal activity
f. Strengthening and toning other body systems as
necessary.
5. Address structural disturbances – referral to a massage therapist or osteopath may be necessary.
6. Address specific pathology or conditions and prescribe
accordingly once the cause has been identified and treated.
7. Refer for suppression or surgical intervention if required.
Adapted from A Hierarchy of Healing: The Therapeutic Order. The Unifying
Theory of Naturopathic Medicine, Jared Zeff, ND, LacPamela Snider, ND,
Stephen P. Myers, ND, BMed, PhD, in Textbook of Natural Medicine. This
was originally adapted from Zeff J, Snyder P. Course syllabus: NM51 71,
Naturopathic clinical theory. Seattle: Bastyr University, 1997–2005.
Although the therapeutic order in the Unites States continues and suggests diagnosis and treatment with drugs
and the inclusion of surgery, in Australia the therapeutic
order cannot progress unless the practitioner is qualified
in conventional medicine or surgery. Referral at any necessary point during the therapeutic order is essential.
THE HOLISTIC PRACTITIONER
The holistic practitioner can be defined by the way that
practitioner handles cases and relates to patients and
family members of the patient, and by how other support is sourced, introduced and managed. Effective case
taking and case management are imperative to holistic
treatment and perhaps the ability to restore a patient’s
health rests heavily on the quality of the case history that
is taken. The tradition of follow-up consultations is also
important in holistic treatment. Trust between the patient
and practitioner develops over time as the therapeutic
relationship develops and deepens, thus treatment can
often address concerns that would have otherwise gone
unnoticed without this relationship. The importance of
follow-up consultations is imperative to this deepening
therapeutic relationship.
Holistic treatment must also endeavour to ascertain what
a practitioner can bring to a therapeutic arrangement.
Qualities such as confidence, certainty, presence (or the
ability to hold a space) and gratitude to the patient for
sharing their healing journey are key components of a
holistic approach to healing. An area of holistic treatment
that is often overlooked, either ignorantly or unashamedly, is the health of the practitioner. With such emphasis
on the optimisation of patient health, practitioner health
is often overlooked and without investing in self-care, the
practitioner will fail to deliver the qualities necessary for
a truly holistic treatment approach.
The first tenet of naturopathy introduces the concept first
do no harm. Traditionally this has been interpreted to
explain the necessity of harmless practice and the importance of patient safety. A more holistic interpretation can
see this tenet expanded to include the need for the naturopath to encourage the patient to do no harm to him/
herself and for the naturopath to likewise do no harm to
him/herself. This brings with it the notion of practitioner
self-care.
An understanding of the principle doctor as teacher would
not be complete without an understanding of disease as
teacher. This transcendental view may not be appropriate at all times; however, patients facing terminal illness
may address this topic in consultation without being
prompted. In this teaching role, the naturopath also
becomes a listener and a confidant. The ability to hold
the space is a prerequisite; advice and opinion are far
less powerful than open ears, an open mind and an open
heart. An understanding of the principle doctor as teacher
would not be complete without acknowledgement of the
patient as teacher role in naturopathic practice. The ability
of a patient to continually teach is reliant on the practitioner’s ability to continually learn from patients. Such an
organic relationship is truly symbiotic and holistic.
MIND–BODY MEDICINE – ANCIENT
TRADITIONS
All ancient cultures acknowledge a role for the spirit
within. It has only been with the superimposition of
allopathic medicine that this spirit has been dismissed
and ridiculed as being unscientific. A Western understanding of health is founded in mechanistic biomedical
theory. Founded in reductionism and rationalism, this
understanding provides little framework within which
non-dichotomous concepts of healing can exist. With
the emergence of modern allopathic medicine, the holistic patient-specific model of healing was replaced by a
disease-specific model with little room for mind–body
understanding, acceptance or investigation, and also with
allopathic medicine came a shift from the art of healing
to the science of disease.
The interconnectedness of the body and mind is paramount to all ancient and indigenous systems of healing.
Healing temples in Ancient Greece provided healing in
the form of cleansing baths and fasts and the use of imagery and prayer, and hands-on healing was common practice.[42,43] Paracelsus maintained a fundamental belief in
the mind–body connection; he believed that faith and
imagination were the true vehicles of healing and that
physicians were only able to heal by tapping into the
power of God.[44] Australian aboriginal concepts of health
have also traditionally been holistic and based heavily on
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relationships between the people, the land and spiritual
belief. Traditional Chinese Medicine relies on the force of
chi, as Ayurveda relies on prana; the notion of universal
energy connecting mind, body and spirit and generating
each individual’s life force is fundamental to these healing traditions.
Early Research Questions the Mind–Body
Dichotomy
The learned German abbess and mystic Hildegard of
Bingen (1098–1179) practised mind–body medicine
through her belief in the elements; the accumulation
of black bile, for instance, was regarded not only as an
imbalance in the natural humours but also as a build up
of suppressed emotion.[45] The dichotomous view can be
traced back to the concept of dualism, which has largely
been attributed to Descartes (1596–1650), who proposed that the mind and body are different substances.[46]
Newton presented a departure from Descartes’s approach
and the accepted notion of Cartesian duality at the time.
In his student notebooks he showed an early interest in
the causal interdependence of the mind and body and
expressed a particular interest in the connection between
memory and physiology.[47]
In 1905 Darwin alluded to the as yet undiscovered concept of mind–body medicine when he linked emotions
with the potential of physical strength. He stated ‘a man
or animal driven through terror is endowed with wonderful strength, and is notoriously dangerous in the highest
degree’.[48] The first scientific understanding of the mind–
body connection was documented in the literature 6 years
later by Walter Cannon. Cannon pioneered understanding of the emotional influence on disease states and the
influence of hormonal and nerve transmission on bodily
functions. In 1911 he published research[49] that correlated emotional disturbance with digestion dysfunction
in animals. In 1914, he documented[50] the interaction
between fear, rage, stress and asphyxia on bodily function, and in revolutionary work in 1928 he suggested that
emotion could be transported either to the hypothalamus
to influence peripheral movement, or to the neo-cortex
where higher brain activity was stimulated.[51] In 1936[52]
he published more extensive research on the role of emotion in disease formation. Cannon was the first investigator of this emerging field of psychosomatic medicine that
attempted to link and explain emotional influences on
disease states.
In groundbreaking work in 1949, MacLean identified and
named the limbic system and suggested that psychosomatic disorders were the result of disrupted communication between the limbic system and the neo-cortex.[53]
In fact, the term psychosomatic was first introduced by
MacLean; he described psychosomatics as the pursuit of
knowledge that attempts to explain how and why psychological processes were expressed through physiological
body changes.[54] In the 1950s, Alexander[55] suggested
that psychological disorder and conflict contributed to
the development and pathogenesis of medical conditions; his work was criticised as it failed to link psychological function to the majority of disease states present
at that time. The failings of such early models provoked
more research and in the 1970s Engel[56] presented a
biopsychosocial model of illness that identified interrelationships among biological, psychological, and social
systems that influence health and disease processes.
In 1980, the Nobel laureate and physicist David Bohm
detailed the presence of energy that permeated and connected every subatomic particle, atom and molecule in
the universe. Bohm argued that mind and matter could
not be separated – he considered them two aspects of an
indivisible reality and proposed that meaning which can
be both mental and physical links but is not separate from
them.[57] Central to this theory is the concept of interconnectedness; the universe simply cannot be separated into
material (body) or non-material (mind/spirit) components. Furthermore, the sense of interconnectedness does
not imply superimposition of one state onto the other;
the two forms are inseparable and form part of the whole.
Isolating either the physical or the mental is as useless as
attributing the power of a magnet to only one of its poles.
Psychoneuroimmunology is the study of the interactions between behaviour, neural and endocrine function, and immune system processes. This new field
was introduced to the scientific community in 1981 by
Ader,[58] who revealed that immunoregulatory processes
were influenced by the brain and that neural function,
endocrine function and behaviour are in turn influenced
by the immune system. Further insights into the power
of mind–body medicine were revealed as studies on
the ancient traditions of transcendental meditation,[59]
prayer[60] and yoga,[61] as well as more Westernized concepts of imagery,[62] relaxation[63] and stress reduction[64]
were published.
There is an abundance of evidence in the scientific literature which documents the power of mind–body healing.
So the question remains, why has modern medicine not
overwhelmingly embraced this research? The problem
herein perhaps lies not so much with the cohort of people
who identify as mind–body medicine deniers, but with
the inability of the reductionist, mechanistic paradigm of
both Western medicine and current scientific research to
effectively facilitate mind–body enquiry and practice.
The Placebo Effect
A placebo is an inert substance that is believed to have
therapeutic effects through the mobilisation of the body’s
natural healing powers. J. Haygarth reported it in an
unusual 1800 publication entitled Of the Imagination, as
a Cause and as a Cure of Disorders of the Body: Exemplified by Fictitious Tractors, and Epidemical Convulsions. Early
work by Pepper,[65] Osler,[66] Wolf[67] and Beecher[68] laid
the foundation for future investigations into the clinical
significance of the placebo effect.
The placebo effect has been the subject of numerous
clinical trials and has sparked extensive clinical[69] and
ethical[70] debate. The power of placebo has been demonstrated in the treatment of pain[71] and insomnia[72] and
researchers have noted the placebo can increase immunity, alleviate depression, prevent asthma, improve angina
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and hasten the wound healing process.[73] Researchers
have also concluded that certain types of placebos work
more effectively than others; two placebo pills have more
demonstrated efficacy than one, intravenous placebo
injections are more powerful than pills, larger pills that
are brown or purple in colour are more powerful than
smaller pills, and extremely small red or yellow pills demonstrate most therapeutic effect.[74,75]
Much less reported than the placebo effect is the concept
of the nocebo. The nocebo is a substance with inert properties that increases pain and results in health deterioration. It is estimated that 20–30% of patients receiving
placebos experience mild side-effects such as diarrhoea,
pain, nausea, skin rashes and heart palpitations.[76]
In a 2004 study,[77] patients with Parkinson’s disease
underwent a surgical procedure in which human neurons
were transplanted into participants’ brain tissue. Half of
the study participants received no neurons but were told
they had undergone the procedure. The power of placebo
was demonstrated when the group who received no surgical intervention showed significant improvements in
both brain and body function, leading the researchers to
report evidence of a very strong placebo effect.
The mind and body cannot be separated; herbal medicines, nutrition and physical adjustments can be used to
correct the physical manifestation of disease processes.
Remedies and interventions are employed to bring
out change in organ systems, organs, tissues and cells.
However, they also influence molecules, atoms, subatomic particles and energetic vibrations. Naturopathy,
like Ayurveda and Traditional Chinese Medicine, is the
embodiment of mind–body medicine; and let us not forget the basic tenets – the body has the power to heal itself.
REFERENCES
[1] Chast F. A brief history of drugs: from plant extracts to DNA technology.
In: Wermuth CG, editor. The practice of medicinal chemistry. 2nd edn
Edinburgh: Elsevier; 2003 p. 3–28.
[2] [Anonymous]. What medicine owes to Greek culture. Lancet 1939;
234(6045):90–104.
[3] Stelmack RM, Stalikas A. Galen and the humour theory of temperament. Pers
Individ Dif 1991;12(3):255–63.
[4] Eadie MJ. The antiepileptic materia medica of Pediacus Dioscorides. J Clin
Neurosci 2004;11(7):697–701.
[5] Sanai M. Avicenna. Lancet 1954;264(6833):329–30.
[6] Kirchfield F, Boyle W. Nature doctors pioneers in naturopathic medicine.
East Palestine, OH: Buckeye Naturopathic Press; 1994.
[7] Scoutetten H. Hydrotherapy in Germany. Graefenberg and Priessnitz. Lancet
1843;40(1029):274–6.
[8] Blake E. Naturopathic hydrotherapy. In: Chaitow L, editor. Naturopathic
physical medicine: theory and practice for manual therapists and naturopaths. Edinburgh: Elsevier; 2008.
[9] Winston D, Dattner AM. American system of medicine. Clin Derm
1999;17:53–6.
[10] Willard TL. Textbook of modern herbology. 2nd ed. Calgary: Wild Rose College of Natural Healing; 1993.
[11] Griggs B. Green pharmacy: a history of herbal medicine. London: Robert
Hale; 1983.
[12] Haller JS. Kindly medicine, physio-medicalism in America, 1836–1911. Kent,
OH: Kent State University Press; 1997.
[13] Thurston JM. The philosophy of physiomedicalism: its theorum, corollary,
and laws of application for the cure of disease. Richmond, In: Nicholson
Printing; 1901.
[14] Haller JS. Medical protestants, the eclectics in American medicine, 1825–1939.
Carbondale, IL: Southern Illinois University Press; 1994.
[15] Wood M. Vitalism – the history of herbalism, homeopathy and flower
essences. Berkeley: North Atlantic Books; 1992.
[16] Ody P. The herb society’s complete medicinal herbal. London: Dorling
Kindersley; 1993.
[17] Micozzi MS. Historical aspects of complementary medicine. Clin Derm
1998;16:651–8.
[18] Pizzorno JE, Snider P. Naturopathic medicine. In: Micozzi MS, editor. Fundamentals of complementary and integrative medicine. 3rd ed. St Louis: Elsevier; 2006.
[19] Rosengart MR. Critical care medicine: landmarks and legends. Surg Clin
North Am 2006;86(6):1305–21.
[20] Rifkind D, Freeman GL. The Nobel prize winning discoveries in infectious
diseases. Edinburgh: Elsevier; 2005.
[21] Berthelsen PG, Cronqvist M. The first intensive care unit in the world:
Copenhagen 1953. Acta Anaesthesiol Scand 2003;47(10):1190–5.
[22] Somerson SJ, Sicilia MR. Historical perspectives on the development and use
of mechanical ventilation. AANA J 1992;60(1):83–94.
[23] Bailey CP, Musser BG, Morse DP. The accomplishments of open heart surgery: the status of 35 patients 18 to 36 months following the operation. Am
J Cardiol 1959;4(2):147–54.
[24] Mathalone MB. Ocular effects of phenothiazine derivatives and reversibility.
Lancet 1965;2:29–35.
[25] Ullman D. The homeopathic revolution: why famous people and cultural
heroes choose homeopathy. Berkeley: North Atlantic Books; 2007.
[26] Banta DH. Abraham Flexner – a reappraisal. Soc Sci Med 1971;5:655–61.
[27] Coulter HL. Divided legacy: the conflict between homoeopathy and the
American Medical Association. Berkeley: North Atlantic Books; 1973.
[28] Martyr P. Paradise of quacks: an alternative history of medicine in Australia.
Sydney: Macleay Press; 2002.
[29] Claridge RT. Hydropathy: or the system of effecting cures by means of cold
water, epitomised from the celebrated work of Captain Claridge, FSA. In:
Martyr P, editor. Paradise of quacks: an alternative history of medicine in
Australia. Sydney: Macleay Press; 2002. p. 108.
[30] Evans S. The story of naturopathic education in Australia. Complement Ther
Med 2000;8:234–40.
[31] Loh M. Victoria as a catalyst for Western and Chinese medicine. Journal of
the Royal Historical Society of Victoria 1985;56(3):38–46.
[32] Trickey R. Women, hormones and the menstrual cycle. Sydney: Allen &
Unwin; 1995.
[33] McGregor P. A history of complementary medicine in Victoria. Diversity
2000;2(2):12–9.
[34] Jacka J. The politics and the passion: the development of natural therapies in
Australia, a twentieth century phenomenon. Diversity 1997;12:6–9.
[35] Kirby RA. herbal heritage. Five generations: biography of Paul Wheeler, herbalist. Sydney: National Herbalists Association of Australia; 1990.
[36] Baer H. The drive for legitimation in Australian naturopathy: successes and
dilemmas. Soc Sci Med 2006;63:1771–83.
[37] Smith MJ, Logan AC. Naturopathy. Complement Alternat Med 2002;
86(1):173–84.
[38] Bensoussan A, Myers SP, Wu SM, et al. Naturopathic and Western herbal
medicine practice in Australia – a workforce survey. Complement Ther Med
2004;12:17–27.
[39] Furnham A, Kirkcaldy B. The health beliefs and behaviours of orthodox and
complementarty medicine clients. Br J Clin Psychol 1996;35:49–61.
[40] Furnham A, Forey J. The attitudes and beliefs of patients of conventional versus alternative (complementary medicine). J Clin Psychol 1994;50:458–69.
[41] Mills S, Bone K. Principles and practice of phytotherapy. Edinburgh: Elsevier;
2000.
[42] Caton R. Health temples in Ancient Greece and the work carried on in them.
Lancet 1914;183(4715):126–9.
[43] Caton R. Hippocrates and the newly discovered health temple of Cos. Lancet
1906;167(4306):695–7.
[44] Rodgers D. Mind body matters. In: Micozzi MS, editor. Fundamentals of
complementary and integrative medicine. 3rd ed. Edinburgh: Elsevier; 2006.
[45] Strehlow W, Hertza G. Hildegard of Bingen’s medicine. New Mexico: Bear
1988.
[46] Harré R. Mind–body dualism. In: Smelser NJ, Bates PB, editors. International
encyclopedia of the social and behavioral sciences. Edinburgh: Elsevier;
2004. p. 9885–989.
[47] Dempsey L. Written in the flesh: Isaac Newton on the mind–body relation.
Stud Hist Philos Sci 2006;37:420–41.
[48] Darwin C. Expression of emotions in man and animals. New York: D. Appleton; 1905.
[49] Cannon WB. Mechanical factors of digestion. New York: Green; 1911.
[50] Cannon WB. The emergency function of the adrenal medulla in pain and the
major emotions. Am J Physiol 1914;33:356–72.
sample proofs only
© Elsevier Australia
Chapter 1 Naturopathic Philosophy
[51] Cannon WB. The mechanism of emotional disturbance of bodily functions.
N Engl J Med 1928;198:877–84.
[52] Cannon WB. 1936 The role of emotions in disease. Ann Intern Med
1936;9:1453–65.
[53] MacLean PD. Psychosomatic disease and the visceral brain. Recent developments bearing on the Papez theory of emotion. Psychosom Med
1949;11:338–53.
[54] Maclean PD. Contrasting functions of limbic and neocortical systems of the
brain and their relevance to psychophysiological aspects of medicine. Am J
Med 1958;25(4):611–26.
[55] Alexander F. Psychosomatic medicine. New York: Norton; 1958.
[56] Engel GL. The need for a new model: a challenge for biomedicine. Science
1977;196(4286):129–36.
[57] Bohm D, Factor D. Unfolding meaning: a weekend of dialogue with David
Bohm. London: Routledge; 1986.
[58] Ader R. Psychoneuroimmunology. New York: Academic Press; 1981.
[59] Travis F, Haaga DAF, Hagelin J, et al. Effects of transcendental meditation
practice on brain functioning and stress reactivity in college students. Int J
Psychophysiol 2009;71(2):170–6.
[60] Mao J, Farrar JT, Xie SX, et al. Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to
other populations without cancer. Complement Ther Med 2007;15(1):21–2.
[61] Salmon P, Lush E, Jablonski M, et al. Yoga and mindfulness: clinical aspects
of an ancient mind/body practice. Cogn Behav Pract 2009;16(1):59–72.
[62] Reed T. Imagery in the clinical setting: a tool for healing. Nurs Clin North Am
2007;42(2):261–77.
[63] Kushner K, Marnocha M. Meditation and relaxation. In: O’Donohue WT,
Cummings NA, editors. Evidence-based adjunctive treatments. Edinburgh:
Elsevier; 2008. p. 177–205.
[64] Speca M, Carlson LE, MacKenzie MJ, et al. Mindfulness-based stress reduction (MBSR) as an intervention for cancer patients. In: Baer R, editor. Mindfulness-based treatment approaches. Edinburgh: Elsevier; 2006. p. 239–61.
[65] Pepper OHP. A note on the placebo. Trans Stud Coll Physicians Phila
1945;13(8):81–2.
[66] Osler W. Aequanimitas. 3rd ed. New York: Blakiston; 1953.
[67] Wolf S. Effects of suggestion and conditioning on the action of chemical agents in human subjects the pharmacology of placebos. J Clin Invest
1950;29(1):100–9.
[68] Beecher HK. The powerful placebo. J Am Med Assoc 1955;159(17):1602–6.
[69] Hróbjartsson A, Gøtzsche PC. Is the placebo powerless? An analysis
of clinical trials comparing placebo with no treatment. N Engl J Med
2001;344:1594–602.
[70] Polgar S, Ng J. Ethics, methodology and the use of placebo controls in surgical trials. Brain Res Bull 2005;67(4):290–7.
[71] Wager TD. The neural bases of placebo effects in anticipation and pain. Seminars in Pain Medicine 2005;3(1):22–30.
[72] Perlis ML, McCall WV, Jungquist CR, et al. Placebo effects in primary insomnia. Sleep Med Rev 2005;9(5):381–9.
[73] Humphrey N. Great expectations: the evolutionary psychology of faith healing and the placebo effect. In: Humphrey N, editor. The mind made flesh:
essays from the frontiers of psychology and evolution. New York: Oxford
University Press; 2002.
[74] Turner JA, Deyo RA, Loeser JD, et al. The importance of placebo effects in
pain treatment and research. JAMA 1994;271(20):1609–14.
[75] Arnstein P. The placebo effect. Seminars in Integrative Medicine 2003;
1(3):125–35.
[76] Wolf S, Pinsky RH. Effect of placebo administration and occurrence of toxic
reactions. JAMA 1954;155:339–41.
[77] McRae C, Cherin E, Yamazaki TG, et al. Effects of perceived treatment on
quality of life and medical outcomes in a double-blind placebo surgery trial.
Arch Gen Psychiatry 2004;61:412–20.
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13
The Endocrine System
17
Leah Hechtman and Tini Gruner
CHAPTER OUTLINE
Overview of the Endocrine System
Role of the Naturopath
Investigations
Potential Interactions
Hypothyroidism
Hyperthyroidism
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SECTION A
OVERVIEW OF THE ENDOCRINE
SYSTEM
See Fig. 17.1 for an overview of the endocrine system.[1]
The endocrine system is a complex system of glands and
their secretions, known as hormones (a term first used by
Starling in 1905).[394] The functions of these hormones
have far-reaching implications for our health and wellbeing, as they play a vital role in multiple essential life
functions. This includes our ability to reproduce, metabolise food, fight infection, grow and develop. The endocrine system comprises both the endocrine glands and
their associated hormone-secreting tissues and organs.
The endocrine glands include the pituitary, thyroid, parathyroid, adrenal and pineal glands. The associated tissues
and organs (which have the ability to secrete hormones)
include adipose tissue, the hypothalamus, ovaries, testes,
pancreas, thymus, kidneys, stomach, liver, small intestine,
skin, heart and placenta.[93]
GLANDS AND HORMONES
OF THE ENDOCRINE SYSTEM
Please see Table 17.1 for a summary of the glands and the
associated hormones.
GLANDS
Pituitary Gland
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1111
1124
1126
However, both are regulated by the hypothalamus region
of the brain, with the hypothalamic hormones being
transported through the hypophyseal portal system. These
hormones act on the anterior pituitary to produce numerous hormones, but are released directly from the posterior
pituitary (which acts as a storage and releasing conduit
rather than a synthesiser of hormones). This direct link
between the hypothalamus and pituitary ensures immediate communication between the two, without the hormones being diluted into the general circulatory system.
This gland is a key link between the nervous and endocrine systems, as emotional, painful and stressful experiences all affect the secretion of pituitary hormones due to
its vital connection with the hypothalamus.
Thyroid Gland
The thyroid is a highly vascularised butterfly-shaped
gland that weighs approximately 30 g and receives
80–120 mL of blood per minute. It is located below the larynx and straddles the trachea. The thyroid is influenced by
the anterior pituitary hormone thyroid stimulating hormone (TSH) and produces thyroxine (T4) triiodothyronine (T3) and calcitonin. It is the only endocrine gland
that stores its hormones in large quantities, with a normally functioning thyroid storing approximately a 100day supply of hormones. The control of thyroid hormone
secretion is via a negative feedback system, although
the level of iodine also contributes to this by influencing
the amount of viable thyroid hormones.
Parathyroid Glands
The pituitary gland is a 1–1.5 cm pea-shaped structure that
has two anatomically separated lobes, known as the anterior and posterior pituitary. Of these two lobes the anterior pituitary is the larger and it secretes more hormones.
© 2012 Elsevier Australia.
Diabetes Mellitus
Hypoglycaemia
Stress
Addison’s Disease
Cushing’s Syndrome/Disease
The parathyroid glands are located behind the ‘wings’ of
the thyroid, and normally consist of four small round
glands (two on each lateral lobe of the thyroid, with one
superior and one inferior). Parathyroid hormone (PTH)
regulates the concentrations of calcium, magnesium 1025
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1026 P A R T 3 : T H E B O D Y S Y S T E M S
Pineal
Hypothalamus
Pituitary
Thyroid
Parathyroids
Thymus
Adrenals
Pancreas
Ovary
Testes
FIGURE 17.1 The endocrine system.
and phosphate ions in the blood. The level of calcitonin
(from the thyroid) and PTH is directly linked to the blood
calcium level via a negative feedback system. PTH has the
following functions: it promotes the activity of osteoclasts, it acts on the kidneys to release calcitriol (in order
to increase the amount of calcium that is absorbed from
foods in the presence of vitamin D), slows the loss of both
calcium and magnesium through urine and increases the
loss of phosphate through the urine.
Adrenal Glands
The adrenal (also called suprarenal) glands are two highly
vascularised pyramid-shaped glands lying superior to each
kidney. Both weigh approximately 3.5–5 g with a height of
3–5 cm, width of 2–3 cm and thickness of approximately
1 cm, and they double in size from birth. Each gland comprises an adrenal cortex (which accounts for 80–90% of
its size) and a centrally located adrenal medulla. The adrenal cortex is subdivided into three zones: the zona glomerulosa (producing the mineralocorticoid aldosterone),
the zona fasciculata (producing glucocorticoids cortisol,
corticosterone and cortisone) and the zona reticularis
(producing androgens). The production of aldosterone is
related to increased blood levels of potassium and angiotensin II, while the production of both the glucocorticoids
and androgens are linked with the release of adrenocorticotropic hormone (ACTH). The adrenal medulla is a part
of the autonomic nervous system (ANS). Instead of having nerve ganglions and neurotransmitters, the adrenal
medulla releases the hormones adrenaline and noradrenaline from chromaffin cells. Eighty percent of the adrenal
medulla cells produce adrenaline, with only 20% producing noradrenaline. It is cortisol from the adrenal cortex
that induces the production of an enzyme to convert noradrenaline to adrenaline. The secretion of adrenaline and
noradrenaline is induced when a person is in a stressful
situation. Impulses from the hypothalamus stimulate the
preganglionic neurons, which then stimulate the chromaffin cells to produce adrenaline and noradrenaline.
These hormones then add to the flight-or-fight response
by acting on the autonomic nervous system.
Pancreas
The pancreas is located in the curve of the duodenum.
It is not only an endocrine gland but also an exocrine
gland, due to the release of pancreatic enzymes via the
pancreatic and accessory ducts. In this section we are concerned about the function of the endocrine alpha (secrete
glucagon), beta (secrete insulin), delta (secrete somatostatin) and F (secrete pancreatic polypeptide) cells of the
pancreas. These occur in tiny clusters throughout the pancreas, called pancreatic islets or islets of Langerhans (after
Paul Langerhans who discovered these cells in 1869). To
date the interactions between these hormones is not fully
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C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1027
TABLE 17.1 Summary of Hormone Function
Gland
Hormone
Control Condition
Target
Effect of Secretion
Anterior
pituitary
Human growth
hormone (hGH) or
somatotropin
(WS)*
Hypothalamus monitors low blood sugar
then secreting growth hormone-releasing hormone (GHRH). A rise in blood
sugar causes the secretion of growth
hormone-inhibiting hormone (GHIH)
Liver, muscle
and connective tissues
Stimulates tissues to synthesise and
release insulin-like growth factors
(IGFs). These cause a rise in blood
glucose and build proteins
Thyroid-stimulating
hormone (TSH) or
thyrotropin
(WS)*
Hypothalamus monitors low blood levels
of thyroid hormone and secretes TSH.
A rise causes the secretion of GHIH
Thyroid gland
Stimulates the thyroid gland to
secrete T3 and T4. The secretion of
TSH may also be due to lowering of
blood temperature or blood sugar
Follicle-stimulating
hormone (FSH)
(WS)*
Hypothalamus matures at puberty and
begins to secrete gonadotrophin-releasing
hormone (GnRH)
Ovaries and
testes
In females causes the development
of egg cells and the ovarian secretion
of oestrogen. In males the production of sperm is increased
Luteinising hormone
(LH)
(WS)*
Hypothalamus matures at puberty and
begins to secrete GnRH
Ovaries and
testes
In females causes the ovulation and
stimulates the secretion of progesterone. In males the secretion of
testosterone
Prolactin (PRL)
(WS)*
Fall in sex hormones before menstruation
inhibits. Pregnancy and suckling increase
secretion
Mammary
glands
Initiates and maintains milk secretion
in the mammary glands together
with oxytocin and sex hormones
Adrenocorticotropic
hormone (ACTH)
(WS)*
Hypothalamus monitors stress and
secretes corticotropin-releasing hormone
(CRH). A negative feedback system
inhibits
Adrenal cortex
ACTH causes secretion of glucocorticoids, e.g. cortisol
Melanocytestimulating
hormone (MSH)
(WS)*
Hypothalamus monitors stress and
releases CRH secretion of melanocytestimulating hormones (MSH). Dopamine
inhibits secretion
Melanocytes
in skin
Causes melanocytes to secrete pigment called melanin
Oxytocin (OT)
(WS)*
Hypothalamus controls levels after
puberty. In birthing the secretion of
oxytocin increases
Uterus and
breast
Causes smooth muscle contraction
in the uterus and release of milk from
mammary ducts
Antidiuretic
hormone (ADH)
(WS)*
In hypothalamus, osmo (water)-receptors
stimulate secretion of ADH in response to
high blood concentration
Kidneys,
sweat glands,
arterioles
Decreases volumes of urine and perspiration. Raises blood pressure. The
overall affect is to increase movement of nutrients from capillaries
Triiodothyronine (T3),
thyroxine (T4)
(LS)**
Hypothalamus monitors body temperature and metabolic rate. If either falls TSH
is released
All cells of
body
Increases oxygen use in cells, cellular
metabolism and growth
Calcitonin (CT)
(WS)*
High levels of blood calcium increases
and low blood calcium decreases
calcitonin
Osteoclasts and
osteoblasts
Decreases the activity of osteoclasts
and increases uptake of calcium and
phosphate into the bone matrix
Parathyroid
Parathyroid
hormone (PTH)
(WS)*
High levels of blood calcium decreases
and low blood calcium increases secretion of PTH
Osteoclasts
Increases the activity of osteoclasts,
and absorption of calcium from
foods. In the presence of vitamin D
Adrenal cortex
Mineralocorticoids,
aldosterone
(LS)**
Formation of angiotensin or increased
blood potassium (K+)
Nephron in
kidneys, blood
filtration
tissues
Increases the reabsorption of Na+
from the kidneys and loss of potassium in the urine. Regulating blood
ion concentration
Glucocorticoids,
cortisol
(LS)**
Homeostasis disrupted, hypothalamus
secretes CRH, this along with low levels of
blood glucocorticoid stimulate anterior
pituitary to secrete ACTH
Muscles, liver,
adipose tissue,
blood vessels
and immune
cells
Increases protein breakdown (muscles) and formation of glucose from
amino acids and lactate. Increases fat
breakdown and use of fatty acids for
energy. Depresses inflammatory and
immune responses. Overall aim to
increase energy availability
Androgens, other
and sex hormones
(LS)**
Hypothalamus matures and stimulates
secretion of androgens
All body cells
Promotes growth particularly,
secondary sexual characteristics.
Continues to produce oestrogens
after menopause in women
Posterior
pituitary
(secreted by
hypothalamus
and stored)
Thyroid
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1028 P A R T 3 : T H E B O D Y S Y S T E M S
TABLE 17.1 Summary of Hormone Function—cont’d
Gland
Hormone
Control Condition
Target
Effect of Secretion
Adrenal
medulla
Adrenaline,
noradrenaline
(LS)**
Receive direct stimulation from sympathetic division of autonomic nervous
system (ANS) to cause secretion when
homeostasis disrupted
Heart, circulatory system
and lungs
Increase heart output of blood,
blood flow to liver/muscles and
airway size in lungs. Suppress blood
flow to skin and digestive system.
Actions of the fight or flight response
as neurotransmitters
Pancreatic
alpha cells
Glucagon
(WS)*
Low blood glucose level causes secretion
of glucagon from alpha cells in pancreas
Liver
Increase blood glucose level by
formation of glucose from glycogen
(glycogenolysis), lactic acid and
amino acids (gluconeogenesis)
Pancreatic beta
cells
Insulin
(WS)*
High blood glucose levels stimulate
secretion of insulin from beta cells in the
pancreas
Liver, muscle
and adipose
tissue
Decreases blood glucose level by
increasing permeability of glucose
to cells. Increases formation of glycogen, proteins and lipids
Pancreatic
delta cells
Somatostatin
(WS)*
High levels of free glucagon and insulin
stimulate secretion. Also suppresses
secretion of hGH
Alpha and
beta cells.
Small intestine
Stabilises levels of glucose, amino
acids and lipids in blood. Reduces
cell metabolic processes that promote growth
Pancreatic
F cells
Pancreatic
polypeptide (WS)*
Pancreatis polypeptide is secreted by
intake of high protein meal and exercise
Delta cells,
pancreatic
digestive
enzymes and
gall bladder
Increases ability of digestive system
to absorb proteins (as amino acids)
and fats. Increases availability of
nutrients for cell growth
Ovaries
Oestrogens and
progesterone
(LS)**
FSH stimulates the production of oestrogens and progesterone
Female
reproductive
system, mammary glands
Regulate female reproductive cycle
and promote development of feminine secondary sexual characteristics
Relaxin
(WS)*
Secreted in later stages of pregnancy
Connective
tissues (esp.
cartilage)
Increases elastic qualities of pubic symphysis and cervix to facilitate movement of child through the birth canal
Inhibin
(WS)*
Stimulated by increased secretion of
oestrogens and progesterone
Anterior
pituitary
Inhibits secretion of FSH
Testosterone
(LS)**
FSH stimulates the production of
testosterone
Male reproductive system
Regulates production of sperm
cells and promotes development
of masculine secondary sexual
characteristics
Inhibin
(WS)*
Stimulated by increased secretion of
testosterone
Anterior
pituitary
Inhibits secretion of FSH
Pineal
Melatonin
(WS)*
Released in darkened environment
Hypothalamus, possibly
reproductive
organs
Contributes to setting of body clock
and sleeping rhythms. Inhibits
activity of reproduction in animals
Thymus
Thymosin,
thymopoeitin
(WS)*
Production begins in utero and thymus
shrinks after puberty
T cell
maturation
These hormones control development of T cells into functioning
immune cells
Testes
*WS, water soluble, target receptor on cell membrane.
**LS, lipid soluble, target receptor in nucleus.
understood. See Fig. 17.2 for more detailed information
on the negative feedback between glucagon and insulin.
Ovaries and Testes
The ovaries and testes are the vital endocrine glands
responsible for sexual maturation and reproduction. They
are also referred to as the gonads due to their production
of gametes (sperm in males and oocytes in females).
The ovaries are the two female gonads. They are the
size and shape of two unshelled almonds and are
located on either side of the uterus. They produce two
steroid hormones (oestradiol and oestrone, which are
both oestrogens), as well as inhibin (a hormone that
inhibits the secretion of follicle-stimulating hormone
(FSH)) and relaxin (a hormone that increases flexibility and dilates the cervix during the later stages of
pregnancy).
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C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1029
Direct effects of insulin
Glycogenolysis
Gluconeogenesis
Indirect effects of insulin
Decrease free fatty acid
flux to liver
Glucagon secretion
Gluconeogenesis
Insulin
–
Adipose
tissue
Glucagon Insulin –
–
Free +
fatty
acid Glucose
Glycogen
+ Glucagon
Insulin
–
Glucose
Islet
FIGURE 17.2 Flow diagram of negative feedback between glucagon and
insulin.[4]
The testes are two oval glands measuring approximately
5 cm in length and 2.5 cm in diameter, each weighing
approximately 10–15 g. Developing near the kidneys,
they descend via the inguinal canals during the seventh month of fetal development, and eventually sit in
the scrotum. The testes produce both testosterone and
inhibin, which regulate the production of sperm and
masculine secondary sexual characteristics via a negative
feedback system.
Pineal Gland
The pineal gland is located on the midline roof of the
third ventricle of the brain, and has a mass of only
0.1–0.2 g. It consists of both neuroglia and pinealocytes,
which secrete melatonin. Melatonin is a water-soluble
hormone that is derived from serotonin, and is released
in higher quantities when a person is away from sunlight
(for instance, at night-time). It plays a role in the setting
of the ‘body clock’, in the setting of sleeping rhythms, and
has been found to inhibit reproductive activity in some
animals during non-reproductive seasons.
Thymus
The thymus consists of two lobes, located posterior to
the sternum and anterior to the aorta. The size of the
lobes varies greatly from birth to adulthood, enlarging
during childhood to approximately 70 g and atrophying
during adolescence to approximately 3 g. The thymus
has an important role in immune function, secreting the
hormones thymosin, thymic humoral factor (THF), thymic factor (TF) and thymopoietin. These hormones promote the maturation of T cells into functioning immune
cells.
HORMONES
Hormone Receptors
The hormones secreted from these glands, tissues and
organs are released into the surrounding interstitial fluid,
which then diffuse into capillaries and disperse directly
into the bloodstream. This distinguishing feature differentiates them from exocrine glands (such as oil and sweat
glands), which utilise ducts to transport their secretions.
These hormones act as signals to their target tissues, and
to the system as a whole. While exocrine gland secretions
are delivered to their targets via ducts, endocrine hormones circulate freely in the bloodstream. They are only
able to promote a response in tissues by ‘fitting’ to the target tissue’s glycoprotein receptors, just as a lock and key
fit together to open a door. If a cell does not contain any
receptors for that type of hormone, it will not be able to
produce an effect on that cell. For example, thyroid cells
do not have any receptors for oxytocin, thus oxytocin
does not affect the function of the thyroid. This is despite
its general presence in the bloodstream.
Hormone receptors are constantly being produced and
broken down according to their perceived requirement.
The perceived requirement is altered if there is too much
or too little of a hormone present, with a target cell having anywhere from 2000 to 100,000 receptors. For example, if a patient has a consistently high level of blood
insulin the number of insulin receptors in target tissues
will reduce.
The location of hormone receptors differs according to
the type of hormone that binds to it. For lipid-soluble
hormones (e.g. steroid and thyroid hormones) the receptors are inside the target cells, and for water-soluble
hormones (e.g. thyroid-stimulating hormone (TSH),
oxytocin and antidiuretic hormone) they are part of the
plasma membrane surrounding cells. A target cell will
have a greater response to a hormone depending upon
the level of hormone in the bloodstream, the number of
receptors and the influence of other hormones. For example, the presence of both FSH and oestrogen has a greater
effect on the production of oocytes in the ovaries than
either hormone acting alone. In contrast some hormones
act antagonistically with one another, for example glucagon and insulin.
Hormone Secretion
The secretion of hormones is dependent upon the stimulation of the gland. This is regulated by chemical changes
in the blood, the presence of other hormones and signals from the nervous system. Regulatory systems within
the endocrine system primarily operate via a negative
feedback system. This means that if a level of the hormone is low, more is secreted, and when this level is high
again the secretion is inhibited. For example, low blood
levels of T3 and T4 stimulate the release of thyrotropinreleasing hormone (TRH) in the hypothalamus, which
then causes the anterior pituitary gland to secrete TSH.
This then leads the thyroid to release more T3 and T4,
but when the hypothalamus and anterior pituitary detect
elevated T3 levels, TRH and TSH release is inhibited. As
such most hormones are released into the blood stream
in short bursts, stopping and starting due to this negative feedback mechanism (Fig. 17.3). In contrast, the
release of a hormone in a positive feedback system then
stimulates more to be released, with no direct stopping
mechanism. An example of a positive feedback system is
the production of oxytocin during childbirth. The presence of oxytocin continues to rise with each contraction
of the smooth muscle of the uterus, and this rising level
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1030 P A R T 3 : T H E B O D Y S Y S T E M S
DNA damage
Growth
factors
E2F
DHFR
p53
Cyclin A-cdk2
Replication
p14ARF
DNA
Polymerase α
Cyclin A
Cyclin E
RB-E2F
P
p21cip1
p27kip1
Cyclin E-cdk2
p57kip2
E2F-DP
?
P
p16INK4a
p15INK4b
RB- P
Cyclin D-cdk4/6
Cyclin A-cdk-2
Cyclin E-cdk-2
p18INK4c
E2F- P
DP- P
FIGURE 17.3 Flow diagram of negative and positive feedback systems.[5]
leads to more contractions, and so the cycle continues
until the delivery of the child. This feedback system has
been used traditionally to ensure the prompt delivery of
the placenta after the birth of a child, as the stimulation
caused by breastfeeding immediately after birth further
enhances the release of oxytocin, thus aiding the contraction of the uterus.
ROLE OF THE NATUROPATH
TRADITIONAL INTERPRETATION
The traditional understanding of the endocrine glands
was largely reliant upon symptomatic evidence, as there
was no deeper knowledge of the functions of the endocrine system until the mid 19th century. More comprehensive theories were developed in the mid to late
twentieth century, but many questions still remain to be
answered today.
The developmental changes caused by the castration of
calves and humans (as evident in eunuchs) caught the
attention of many enquiring minds in ancient Egypt and
China, and led philosophers of those times to wonder at
the mechanism of action of the testes. Similarly goitres
were first recognised in China in 2700 BC,[391] and repeatedly noted in numerous cultures since. Avicenna (Abou
Ali Sina, 980–1037), in his medicinal and philosophical
masterpiece al-Qanun (‘The Cannon of Medicine’), outlined the physical symptoms of both insulin-dependent
and non-insulin-dependent diabetes.[392] However, it was
many centuries later, in 1869, before the pancreatic insula
were discovered by Langerhans.
The anatomical discoveries of each of the endocrine
glands greatly pre-dated the understanding of their functions. The thymus gland was known to the Alexandrians
in the 3rd century BC, and the thyroid, pineal and pituitary glands were anatomically described by Galen.[393]
The adrenal glands were not discovered until the 16th
century and the pancreatic and parathyroid glands in the
latter 19th century. Pre-dating each of these discoveries
was the anatomical observation by the earliest physicians
of both the gonads and the liver.[393]
Although the functions of individual endocrine ‘hormones’ (a term first used by Starling in 1905)[394] were
unknown, symptomatic treatment of endocrine diseases
was widespread. For example, goat’s rue (Galega officinalis) was used in medieval Europe for the treatment
of diabetes and became the basis of the modern drug
metformin. Goat’s rue continues to be used by modern
herbalists for its blood sugar regulating actions. Similarly
fenugreek (Trigonella foenum-graecum) was used by Avicenna in the treatment of diabetes, and also continues to
be used for this condition in modern naturopathic treatment.[395] The treatment of the endocrine system initially
centred on the humoral beliefs of Galen. The pituitary
was thought to be a sump for phlegm (waste products)
from the brain which were then expelled via the nasal
passage.[396] Similarly, goitres were thought to be caused
from excess phlegm; however, they were treated with
empirical treatments of marine sponge and seaweed.[391]
These humoral theories were largely believed until 1855,
when a number of scientists and physicians disproved
them, although they had been anatomically disproved
some 200 years previously by anatomists such as Conrad
Victor Schneider and Richard Lower.[394]
MODERN INTERPRETATION
The modern interpretation of the endocrine system is
based on both the traditional use of herbs (for both
symptomatic relief and treating the cause) and the scientific understanding of the connection between the
nervous and endocrine systems. The scientific experimentation of the mid 19th century saw a radical shift
and deeper understanding of the endocrine system, as
experiments such as those carried out by A.A. Berthold
(in 1849) were able to show that the action of the endocrine glands was not local, but systemic.[397] Berthold castrated four out of six young male chickens. Two of these
four had their testes transplanted to the abdominal cavity, while the remaining two had their testes removed
completely. The growth of the two uncastrated chickens
was normal, and they developed into roosters with fully
developed cones, wattles and plumage. The two fully castrated chickens failed to develop any male rooster characteristics, displaying only atrophied combs and wattles.
Surprisingly for the scientists of the time, the two chickens with the transplanted testes grew to become fully
developed roosters, displaying the same male characteristics as the control roosters. This was among the first evidence that hormones existed, that they were transported
throughout the body in the bloodstream, and that they
had a decisive role in sexual growth and maturation. Further experiments and observations conducted around
this time helped to prove this theory, such as the observations of Thomas Addison (also in 1849) on patients with
what he termed ‘melasma suprarenale’ (adrenal disease),
a disorder which is now called Addison’s disease in his
honour.[393]
The understanding of the endocrine system progressed
rapidly from this point, as these ‘internal secretions’
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C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1031
were eventually shown to be chemical structures called
‘hormones’.[393] The discovery of each individual hormone quickly ensued at the turn of the 20th century.
Following this the role of the hormones on the overall
process of metabolism (a term first used by Michael
Foster in 1876) and regulation was discovered via the
work of Harvey Cushing and Langdon-Brown.[393] Until
the mid 20th century the symptomatic approach to
treatment remained, with varying results. This is evident in the quote below from Ellingwood (1910)[398]
discussing the treatment and prognosis of diabetes
mellitus:
Treatment:–As yet no specifics have been discovered, either for
this disease as a whole, or for any of its attendant conditions.
Various measures have been devised but these have usually been
ultimately abandoned. While dietary measures are by far the
most important.
Prognosis:–The prognosis as to cure is always unfavourable.
The most recent development in the understanding and
subsequent treatment approach to the endocrine system
has developed since the 1920s due to the knowledge
of the interconnected nature of both the endocrine and
nervous systems.[8] Specifically, it is the vast amount of
research conducted in the latter part of the 20th century
regarding the hypothalamic–pituitary–adrenal (HPA)
axis and psychoneuroimmunology (PNI) that has most
significantly altered the understanding of the endocrine system.[399] This innate link between the brain,
the body and health has given a greater scientific basis
to the holistic nature of the naturopathic treatment
approach. For example, studies conducted in Russia
on Siberian ginseng (Eleutherococcus senticosus) during
the great ‘space race’ have helped to establish that the
use of single herbs can alter immune function, physical
stamina and aid stress adaptation, all via the endocrine
system.[283] This holistic treatment of the endocrine system is often a key factor in treatment due to the role
stress plays in many patients’ lives. However, the power
of what Bellamy and Pfister (1992)[368] term ‘the largest
endocrine gland’ (the brain) is yet to be fully realised.
They quote Albert Schweizer’s musings to better explain
their point:
INVESTIGATIONS
Investigations used in endocrine disorders are summarised in Table 17.4.
TESTOSTERONE AND SEX HORMONE BINDING
GLOBULIN (SHBG)
Normal values of testosterone and sex hormone binding
globulin are shown in Table 17.5.
HUMAN CHORIONIC GONADOTROPHIN (HCG)
TEST (URINE PREGNANCY TEST)
This test is used to diagnose pregnancy, monitor ‘high
risk’ pregnancy, and as a tumour marker for certain
tumours (Table 17.6). Human chorionic gonadotrophin hormone is normally secreted by the placental
tissue after the ovum is fertilised (i.e. from the earliest stages of development). HCG will appear in the
blood of pregnant women as early as 10 days after
conception.
URINARY HORMONE ASSESSMENT
Oestrogen metabolites – an assessment of the urinary
levels of oestrogen metabolites 2-hydroxyoestrone
(2-OHE1) and 16α-hydroxyoestrone (16α-OHE1) provides information about the way in which oestrogen is
being metabolised by the patient. A result showing a
low ratio (a reduced 2-hydroxyoestrone) indicates that
there is a state of oestrogen excess within the patient.
Alternatively a high ratio (increased 2-hydroxyoestrone)
indicates an oestrogen deficient state. This test is suitable for males and females and is conducted using the
first morning urine sample (the patient must fast from
10 p.m. the evening before). Females taking the test are
advised to take it between days 18 and 25 of their menstrual cycle.
URINARY IODINE
The witch doctor succeeds for the same reason all the rest of us
succeed. Each patient carries his own doctor inside him. They
come to us not knowing that cure. We are at our best when we
give the doctor who resides within each patient a chance to go
to work. (p. 259)
Excess iodine is excreted via the kidneys, thus providing
an accurate measurement of recent iodine usage/requirement (Table 17.7). First morning urine samples provide
the most accurate results; 24-hour urine samples are not
required for this test. A study conducted in Indonesian
children found urinary iodine excretion to be the best
method for detecting iodine deficiency when compared
with TSH, goitre palpation, ultasonography, intellectual
performance and anthropometric indices (Pardede, Hardjowasito et al. 1998).
This concept of the patient’s innate healing ability is central to the naturopathic approach to treatment, and is
rapidly being given a scientific basis of evidence via the
function of the endocrine system.
Nutritional medicine treatment of endocrine disorders
is described in Table 17.2. Some useful herbal medicines
are listed in Table 17.3. And Table 17.8 lists some potential herb–drug interactions.
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TABLE 17.2 Nutritional Medicine
Requirement
Justification
RDI[350]
Therapeutic Dose
Food Sources
A high strength,
sustained release
multivitamin/
mineral
preparation
The excess production of thyroid hormones
that occurs in hyperthyroidism leads to a higher
metabolic rate and subsequently nutrients are
depleted at a higher rate. Additionally, in hyperthyroidism there is malabsorption. Due to these
factors a greater number of nutrients are required
by the body. Similarly where there is adrenal
exhaustion higher requirements will be required
by the body to meet increased demands
–
–
N/A
Vitamin B complex
The B vitamins provide energy and support
during physically demanding periods. They
are involved in maintaining the health of the
hormone-producing glands[351]
Comprehensive
complex containing
individual B vitamins as
per below:
–
Legumes, whole
grains, nuts, beans,
brewer’s yeast, leafy
green vegetables
Thiamin
(vitamin B1)
Vitamin B1 is involved with other B vitamins in
energy metabolism and the normal functioning of
nerves. Vitamin B1 may be needed during periods
of increased physical and mental stress and has
been clinically proven to protect the adrenal
gland from functional exhaustion
Men:
19–30 years 1.2 mg/d
31–50 years 1.2 mg/d
51–70 years 1.2 mg/d
> 70 years 1.0–1.2 mg/d
Women:
19–30 years 1.1 mg/d
31–50 years 1.1 mg/d
51–70 years 1.1 mg/d
> 70 years 1.1 mg/d
5–150 mg/d
Legumes,
liver, nuts,
whole grains,
wheatgerm
Vitamin B2
Vitamin B2 is crucial in the production of energy
and may be needed in periods of heightened
stress. Along with vitamins B5, B12, folic acid,
potassium and sodium it stabilises the activity of
the adrenal glands
Men:
19–30 years 1.3 mg/d
31–50 years 1.3 mg/d
51–70 years 1.3 mg/d
>70 years 1.6 mg/d
Women:
19–30 years 1.1 mg/d
31–50 years 1.1 mg/d
51–70 years 1.1 mg/d
>70 years 1.3 mg/d
10–200 mg/d
Avocados, beans,
currants, eggs,
milk and dairy
products, sprouts,
whole grains
Vitamin B3
Nicotinamide is converted into the active forms
of niacin in the body. Niacin is required for the
function of more than 200 enzymes throughout
the body and is a component of the glucose tolerance factor, which helps to control blood glucose
delaying or preventing the need for insulin by
interfering with immune-mediated beta cell
destruction. Vitamin B3 has also been found to
help slow down the development of nephropathy
in diabetes[351]
(As niacin equivalents)
Men:
19–30 years 16 mg/d
31–50 years 16 mg/d
51–70 years 16 mg/d
>70 years 16 mg/d
Women:
19–30 years 14 mg/d
31–50 years 14 mg/d
51–70 years 14 mg/d
>70 years 14 mg/d
10–3000 mg/d
Almonds, eggs,
chicken, mackerel,
meat, peanuts,
salmon, sardines,
sunflower seeds
Vitamin B5
Vitamin B5 enhances adrenal cortex function.
Deficiency leads to a compromised adrenal cortex
function. Vitamin B5 down-regulates hypersecretion of cortisol secondary to high stress situations
Men:
19–30 years 6 mg/d
31–50 years 6 mg/d
51–70 years 6 mg/d
>70 years 6 mg/d
Women:
19–30 years 4 mg/d
31–50 years 4 mg/d
51–70 years 4 mg/d
>70 years 4 mg/d
20–500 mg/d
Avocado, beans,
egg yolks, green
vegetables, milk,
mushrooms,
oranges,
royal jelly,
sweet potato,
wholegrain
cereals
Vitamin B6
Along with the other B vitamins, vitamin B6 is
important during periods of stress, providing support to the nervous system and adrenal glands.
Vitamin B6 deficiency has been shown to cause
symptoms of hypoglycaemia, increased insulin
sensitivity and degeneration of beta cells
Men:
19–50 years 1.3 mg/d
51–70 years 1.7 mg/d
Women:
19–50 years 1.3 mg/d
51–70 years 1.5 mg/d
10–150 mg/d
Brewer’s yeast,
chicken, yolk,
legumes, mackerel, oatmeal,
salmon, tuna,
walnuts
Vitamin B9
Along with vitamins B2, B5, B12, potassium and
sodium vitamin B9 stabilises the activity of the
adrenal glands
Men:
19–70 years 400 μg/d
Women:
19–70 years 400 μg/d
1000–5000 μg/d
Beans, eggs,
green leafy
vegetables, lentils,
yeast
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C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1033
TABLE 17.2 Nutritional Medicine—cont’d
Requirement
Justification
RDI[350]
Therapeutic Dose
Food Sources
Vitamin B12
Along with vitamins B2, B5, folic acid, potassium
and sodium, vitamin B12 stabilises the activity of
the adrenal glands
Men:
19–70 years 2.4 μg/d
Women:
19–70 years 2.4 μg/d
300–800 μg
Bacterial synthesis
in the gut
Clams, egg yolk,
herring, milk,
meat, oysters,
salmon, sardines
Biotin
Supplementation with biotin has been found to
help maintain healthy blood sugar levels in individuals with diabetes as the generation of glucose
is dependent on a biotin-containing enzyme
Men:
19–70 years: 30 μg/d
Women:
19–70 years: 25 μg/d
0.5–15 mg/d
Bean sprouts,
egg yolk, milk,
peanuts, soy
beans, wholegrain
cereals
Vitamin C
Vitamin C is a water soluble antioxidant that
protects against oxidative stress associated with
thyroid diseases. The adrenal gland is among the
organs with the highest concentration of vitamin C
in the body. Interestingly, both the adrenal cortex
and the medulla accumulate such high levels of
ascorbate. Vitamin C is a co-factor required both
in catecholamine biosynthesis and in adrenal
steroidogenesis. Production of adrenaline and
noradrenaline are dependent on vitamin C.[352]
Vitamin C can also help to regulate blood glucose
Men:
19–70 years 45 mg/d
Women:
19–70 years 45 mg/d
250–10,000 mg/d
Blackcurrant,
broccoli, citrus
fruits, kiwis,
strawberries,
rosehips, guava,
mangoes,
pineapple
Vitamin D
Glucose intolerance and insulin secretion has
been observed during vitamin D deficiency,
resulting in type 2 diabetes. It is theorised that
this is due to vitamin D receptors in several tissues
and cells, including the pancreatic beta-cells
Men:
19–50 years 5.0 μg/d
51–70 years 10.0 μg/d
>70 years 15.0 μg/d
Women:
19–50 years 5.0 μg/d
51–70 years 10.0 μg/d
>70 years 15.0 μg/d
400–1600 IU/d
Synthesised by
the action of
sunlight on skin,
fish liver oils–cod,
halibut, herring,
tuna, egg yolk,
milk, sprouted
seeds
Vitamin E
Hypothyroidism is accompanied with increased
oxidative stress and fat soluble antioxidant vitamin E supplementation exerts beneficial effects
on this situation. Vitamin E can enhance insulin
sensitivity thus reducing the need for insulin and
other hypoglycaemics[351]
Men:
19–70 years 300 mg/d
Women:
19–70 years 300 mg/d
100–800 mg/d
Almonds, beef,
corn, egg yolks,
nuts, safflower,
sunflower,
wheatgerm
L-tyrosine
L-tyrosine is an essential precursor for the synthesis of the catecholamines adrenaline, noradrenaline and dopamine and the thyroid hormone
thyroxine. Supplementation with tyrosine aids
adrenal function helping during periods of prolonged stress, to support the body and improve
stress adaptation.
1120 mg/d
1120 mg/d
Almonds, beef,
cheese, chicken,
eggs, fish, soy
beans, wild game
Zinc
Zinc is required for healthy thyroid function
and the synthesis and metabolism of thyroid
hormones. Deficiency of zinc dependent enzymes
may result in decreased thyroid hormone levels
and resting metabolic rate (RMR). Changes in zinc
metabolism are commonly observed in diabetic
patients
Men:
19–70 years 14 mg/d
Women:
19–50 years 6 mg/d
10–100 mg/d
Beef, baked beans,
cashews, egg
yolks, ginger, herrings, liver, milk,
lamb, oysters,
sunflower and
pumpkin seeds,
whole grains
Selenium
Selenium is essential for the biosynthesis and
function of the iodothyronine deiodinase
enzymes that are essential for the conversion
of T4 to T3. Selenium-dependent glutathione
peroxidases protect against oxidative damage to
the thyroid gland. Deficiency leads to decreased
conversion of T4 to T3, and oxidative stress on the
thyroid gland as a result of reduced glutathione
peroxidise activity. The thyroid gland contains
more selenium per gram than any other tissue in
the body. Selenium is also important for healthy
blood sugar regulation. Deficiency may reduce
insulin secretion
Men:
19–70 years 70 μg/d
Women:
19–70 years 60 μg/d
200–600 μg/d
Alfalfa, brazil
nuts, cashews,
crab, eggs, fish,
garlic, kidney,
liver, mackerel,
oysters, peanuts,
tuna, whole grain
cereals, broccoli,
onions
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1034 P A R T 3 : T H E B O D Y S Y S T E M S
TABLE 17.2 Nutritional Medicine—cont’d
Requirement
Justification
RDI[350]
Therapeutic Dose
Food Sources
Magnesium
Magnesium assists in the maintenance of normal
healthy blood glucose metabolism. Hypomagnesaemia is frequently present in diabetic
patients hence magnesium is often suggested
in patients with diabetes mellitus who have
proven hypomagnesaemia and the presence of its
complications
Men:
19–30 years 410 mg/d
31–70 years 420 mg/d
Women:
19–30 years 310 mg/d
31–70 years 320 mg/d
300–1000 mg/d
Eggs, cocoa,
almonds, brewer’s
yeast, cashews,
kelp, wheatbran,
wheatgerm,
buckwheat
Manganese
Manganese plays a crucial role as part of its role
in the glucose tolerance factor and is required
for metabolism of carbohydrates as the synthesis
of new glucose from puyruvate is necessary on
manganese-containing enzymes as well as for
normal insulin secretion. Deficiency may contribute to blood sugar abnormalities and reduced
pancreatic cell function
Manganese is required for thyroid hormone
function
Men:
19–70 years 5.5 mg/d
Women:
19–70 years 5 mg/d
2–50 mg/d
Almonds, beans,
coconuts, corn,
kelp, sunflower
seeds, legumes,
walnuts, whole
grains
Alpha lipoic acid
Alpha lipoic acid, also known as thioctic acid,
is an antioxidant and decreases the risk of cell
damage attributed to free radicals. Alpha lipoic
acid is unique in that it is soluble in water as
well as fat and is therefore able to scavenge
both fat- and water-soluble free radicals. It also
has the ability to recycle or regenerate endogenous antioxidants including vitamins C and E,
CoQ10 and glutathione. Alpha lipoic acid plays
a role in glucose metabolism and is involved in
the transport of blood glucose into cells. It may
therefore help maintain healthy blood sugar
levels and has been used in diabetics to assist
with the conversion of sugar to energy and is
thought to be beneficial in reducing the effects
of oxidative stress[353] which are associated with
this condition, as well as decreasing symptoms
associated with diabetes such as diabetic
polyneuropathy[354]
50–600 mg/d[355]
600 mg/d[353,355]
Typical dietary
sources of lipoic
acid are muscle
meats, heart,
kidney, and liver,
and to a lesser
degree, fruits
and vegetables;
potatoes
Chromium
Chromium is an essential micronutrient for
humans. It plays a role as a co-factor in all
insulin-regulated activities including carbohydrate, lipid and protein metabolism and is
an essential component of glucose tolerance
factor, a compound that helps to regulate blood
sugar. Chromium is particularly important for
normal carbohydrate metabolism and assists
in maintaining healthy blood glucose levels, by
aiding the transport of glucose from the blood
into the cells
Chromium may be used where diets are high
in simple sugars and refined carbohydrates,
which may have increased chromium
requirements
Men:
19–70 years 45 μg/d
Women:
19–70 years 35 μg/d
100–400 μg[356,357]
Asparagus, beer,
cheese, egg yolk,
molasses, nuts,
oysters, peanuts,
prunes, raisins
Iodine
Iodine is an essential component of the thyroid
hormones thyroxine (T4) and triiodothyronine
(T3), and deficiency impairs synthesis of these
hormones. Approximately 60 μg of iodine
is absorbed each day by the thyroid gland;
however, it is estimated that 150 μg is required
each day for optimum functioning of the thyroid
gland[358]
Men:
19–70 years 150 μg/d
Women:
19–70 years 150 μg/d
100–1100[356,359]
Seaweed
(e.g. wakame),
cod, iodised
salt, lima beans,
mushrooms,
oysters
Sources: see end of chapter
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C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1035
TABLE 17.3 Herbal Medicine
Class
Example
Justification
Adaptogen
Eleuthrococcus senticosus
(Siberian ginseng)
Adaptogens improve non-specific responses to stress by increasing the resistance of the
recipient to a variety of physical, chemical, or biological stressors while also promoting
recovery and acting as a general regulator in the body. Siberian ginseng has traditionally
been used as a prophylactic to build resistance, reduce susceptibility to illness, and promote health and longevity. Its activity appears to be based on whole body effects rather
than particular organs or systems, which lends support to the traditional view that ginseng
is a tonic that can revitalise the functioning of the organism as a whole. Siberian ginseng
increases levels of noradrenaline, serotonin, adrenaline and cortisol (improving positive
and negative responses to stress)
Adrenal restorative
Rehmannia glutinosa
(rehmannia)
Rehmannia is an adrenal tonic that has been used in Traditional Chinese Medicine to
nourish qi (vital energy). Rehmannia works by supporting the adrenal cortex and pituitary
gland during prolonged stress and regulates cortisol levels. In trials done on rabbits, rehmannia reversed morphological changes to the pituitary and adrenal cortex, antagonising
the suppressive effect of glucocorticoids on the hypothalamus–pituitary–adrenal axis[360]
Tonic
Withania somnifera
(ashwagandha)
Withania somnifera is a gentle tonic that is considered to be the pre-eminent adaptogen
from the Ayurvedic medical system. Withania improves responses to stress, possibly via an
action on the adrenal glands, and also has anti-inflammatory and sedative effects. Withania
is used to treat nervous exhaustion, convalescence and debility associated with chronic
inflammatory conditions
Aldose reductase
inhibitor
Glycyrrhiza glabra
(liquorice)
Aldose reductase is an enzyme in carbohydrate metabolism that converts glucose to
sorbitol. Its activity increases as the glucose concentration rises in diabetes particularly
in the lens of the eyes, the peripheral nerves and glomerulus, leading to retinopathy and
neuropathy. Liquorice in its role as an aldose reductase inhibitor helps to prevent eye and
nerve damage in people with diabetes
Antiobesity
Coleus forskohlii (coleus)
The exact mechanism of Coleus forskohlii in weight loss is unknown; however, based on in
vitro data it is hypothesised that Coleus forskohlii may cause an increase in cyclic adenosine
phosphate (cAMP) which in turn leads to an activation of protein kinase which activates
lipase (an enzyme involved in the breakdown of triglycerides, fatty substances in the blood
and components of LDL cholesterol). This results in thermogenesis, loss of body fat and the
maintenance of lean body mass.[361] Coleus forskohlii may have a thyroid stimulating action,
thus possibly increasing metabolic rate and thermogenesis and may regulate insulin
secretion thus positively affecting fat and protein metabolism
Appetite inhibiting
Gymnema sylvestre
(gymnema)
Gymnema is an Ayurvedic herb with the ability to inhibit the taste of sweetness, hence its
nickname ‘sugar destroyer’. Gymnema reduces desire for food, particularly those that are
sweet in taste, leading to its action as an appetite inhibitor. This action also means it is a
useful addition to any weight-loss programme
Hypoglycaemic
Galega officinalis
(goat’s rue)
Galegine in goat’s rue has been associated with marked reductions in blood sugar levels.
Studies in the 1970s demonstrated that the alkaloid galegine within goat’s rue is responsible for reducing blood sugar levels.[362] The British Herbal Pharmacopeia confirms the
action of galega as a hypoglycaemic agent with anti-diabetic activity and indicates its use
for diabetes[363]
Hepatic,
hepatoprotective,
hepatotrophorestorative
Bupleurum falcatum
(bupleurum)
The liver plays an important role in the effective metabolism of the thyroid hormones as
well as the regulation of their systemic endocrine effects. Suboptimal liver function can
affect thyroid hormone metabolism hence the application of hepatics in the management
of thyroid conditions. Bupleurum falcatum is a Traditional Chinese Medicine which displays
hepatoprotective activity. It is highly indicated where there is poor liver function
Pancreatic
trophorestorative
(endocrine functions)
Gymnema sylvestre
(gymnema)
The exact mode of action by which gymnema exerts its pancreatic trophorestorative action
is unknown. It appears that gymnema helps to support healthy pancreatic function via a
wide array of actions rather than just one; these include the inhibition of intestinal absorption of glucose and promotion of glucose homeostasis, and also increasing the number of
cells in the pancreas responsible for insulin production
Thyroid stimulant
Fucus vesiculosus
(bladderwrack)
Fucus vesiculosus is a valuable source of iodine, a trace element necessary for regulating the
body’s metabolism and normal production of thyroid hormones. Organic iodine, such as
that found in bladderwrack, is likely to be better utilised by the body in terms of bioavailability and less likely to be excreted than potassium iodide[364]
Thyroid suppressant/
regulator
Lycopus spp. (bugleweed)
Lycopus is a perennial herb containing phenolic acids. In the 19th century Lycopus was
given to calm the nerves. Today Lycopus is primarily used to help manage hyperthyroid
conditions as well as the associated cardiac symptoms. High doses of Lycopus cause a
reduction of thyroid stimulating hormone in animal experiments; conversely in hyperthyroid patients treated with low doses of Lycopus improvement of cardiac symptoms was
reported[365]
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TABLE 17.8 Potential Interactions
Drug Classes Commonly Used
Herb/Supplement
Potential Outcome
Recommendation
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Alpha lipoic acid (ALA)
Possible additive or synergistic effect;
hypoglycaemia may result; however,
clinical significance uncertain
ALA may protect insulin action under
oxidative stress
Consider co-administration: the use of ALA as
an adjunctive to other
diabetic treatment may act
as in a preventative mode,
particularly in dysglycaemic patients
Monitor patient closely
in conjunction with other
health professionals
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glibenclamide,
glimepiride)
Coenzyme Q10
Possible beneficial effect; some hypoglycaemic drugs inhibit the CoQ10
enzyme NADH-oxidase, which may
exert further adverse effects on insulin
biosynthesis in individuals with diabetes mellitus
Consider co-administration: monitor glucose
levels closely
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Oral hypoglycaemic agents/Insulin sensitisers/α-glucosidase inhibitors (acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Conjugated linoleic
acid (CLA)
Interaction inconclusive; CLA has been
shown to improve glucose tolerance,
but also to increase fasting plasma
glucose concentrations
Low risk: monitor patient
closely in conjunction with
other health professionals
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Omega-3 fatty acids
Interaction uncertain; adverse effects
of fish oil on glucose control medications are unlikely, possibly short-lived,
and may vary according to the patient
Low risk: clinical implications of interaction will
depend on a variety of
factors: monitor patient
Lifestyle interventions also
recommended to moderate
possible adverse effects of
omega-3 fatty acid therapy
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin sensitisers/α-glucosidase inhibitors (acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Acetyl-L-carnitine
Possible additive effect; L-carnitine
significantly lowers fasting plasma
glucose in type 2 diabetic patients.
However, fasting triglyceride levels are
increased
Low risk: consider
co-administration in
patients with healthy lipid
profile. Monitor lipid levels
in conjunction with other
health professionals
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin
sensitisers/α-glucosidase inhibitors
(acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Chromium
Possible additive effect; chromium
potentiates insulin activity through
multiple mechanisms and has hypoglycaemic activity in some individuals
Possible beneficial effect; compromised
chromium status may contribute to
insulin resistance, dysglycaemia and
onset of diabetes
Caution: monitor drug and
nutrient requirements,
and patient glucose levels
closely
Consider co-administration
if deficiency is indicated.
Monitor patient in
conjunction with other
health professionals
Diabetes mellitus
sample proofs only
© Elsevier Australia
C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1041
TABLE 17.8 Potential Interactions—cont’d
Drug Classes Commonly Used
Herb/Supplement
Potential Outcome
Recommendation
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (glipizide,
glibenclamide, glimepiride)
Magnesium
Possible beneficial interaction; magnesium intake may improve insulin
sensitivity and secretion, thus increasing drug activity on glucose. Enhanced
drug response may cause hypoglycaemia or facilitate therapeutic strategy
Consider co-administration: Monitor patient
closely and titrate drug
dose
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Magnesium
Possible beneficial effect; magnesium
can improve insulin sensitivity and
secretion
Consider co-administration: monitor patient
closely
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Vitamin B1
Possible adverse effect; taken together,
thiamine and metformin may increase
the risk of lactic acidosis, and reduce
thiamine activity
Low risk: co-administer if
indicated. Separate doses
by 2–4 hours
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Oral hypoglycaemic agents/insulin
sensitisers/α-glucosidase inhibitors
(acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Vitamin B3
Possible adverse effect: high-dose
niacin administration could interfere
with the therapeutic activity of glucose
control medications, resulting in
hyperglycaemia
Possible beneficial effect: niacinamide
may enhance secretion and increase
insulin sensitivity, and may be beneficial in preventing and/or delaying
type 1 diabetes. Niacinamide does
not appear to interfere with insulin or
hypoglycaemic medications
Moderate risk: consider coadministration of low-dose
niacin or niacinamide in
deficient patients. Monitor
patient closely and regularly in conjunction with
other health professionals
(plasma glucose and liver
enzymes)
Lifestyle interventions also
recommended
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Vitamin B9 (folate)
Possible adverse effect: metformin
may reduce folate levels in diabetics by
reducing folic acid absorption
Low risk: consider coadministration. Diabetic
patients may need folic
acid supplements to
reduce hyperhomocysteinaemia and their risk of
cardiovascular disease
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Vitamin B12
Beneficial nutritional effect: metformin
therapy causes reduced vitamin B12
absorption and low serum total vitamin
B12 by depressing intrinsic factor (IF)
secretion and uptake of B12-IF complex.
May also reduce folate
Low risk: consider
co-administration.
Supplement also with folic
acid and calcium
Monitor folate and
cobalamin status
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Vitamin E
Interaction uncertain; vitamin E may
improve glucose tolerance in diabetics
Low risk: caution is
warranted against high
doses of vitamin E in obese
patients. Monitor patient
in conjunction with other
health professionals
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Oral hypoglycaemic agents/Insulin
sensitisers/α-glucosidase inhibitors
(acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Zinc
Possible additive effect; zinc may
improve both insulin secretion and
insulin sensitivity and may exert
insulin-like effects
Low risk: use cautiously
with diabetes medications.
Monitor patient closely
Continued
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© Elsevier Australia
1042 P A R T 3 : T H E B O D Y S Y S T E M S
TABLE 17.8 Potential Interactions—cont’d
Drug Classes Commonly Used
Herb/Supplement
Potential Outcome
Recommendation
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Allium cepa
Allium sativum
Possible additive effect; significant
hypoglycaemic effects of garlic and
onion are preliminary
Garlic extracts may provide other, beneficial and cardioprotective effects
Low risk: consider coadministration in some
patients, but not as a strategy for reducing blood
glucose levels
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Cinnamomum
zeylanicum
Possible additive effects; cinnamon has
been shown to potentiate insulin activity and increase glucose metabolism
May produce synergistic, beneficial
effect under professional supervision
Low risk: consider coadministration. Monitor
patient and drug levels
closely
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Oral hypoglycaemic agents/insulin
sensitisers/α-glucosidase inhibitors (acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Coleus forskohlii
Possible additive effect; coleus stimulates insulin release and may enhance
the effect of hypoglycaemic agents or
exogenous insulin
Moderate risk: use with
caution. Monitor serum
glucose levels in conjunction with other health
professionals. Drug dose
may require adjustment
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
sensitisers/ glitazones/thiazolidinediones
(rosiglitazone, troglitazone, pioglitazone)
Oral hypoglycaemic agents/insulin
sensitisers/α-glucosidase inhibitors (acarbose)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Oral hypoglycaemic agents/insulin
secretagogues/glitinides (repaglinide)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Gymnema sylvestre
Possible additive effect; the hypoglycaemic effects of gymnema may
potentiate the effects of hypoglycaemic drugs in diabetic patients
May produce synergistic, beneficial
effect under professional supervision
Moderate risk: monitor
serum glucose levels in
conjunction with other
health professionals.
Drug dose may require
adjustment
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Momordica charantia
Possible additive effects; Bitter melon
has been shown to produce hypoglycaemic activity
May produce beneficial effect under
professional supervision
Moderate risk: monitor
patient and drug requirements closely in conjunction with other health
professionals
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Panax quinquefolius
Possible adverse effect; American ginseng can induce lowering of postprandial glucose levels in humans
Moderate risk: prescription
for glycaemic control is
not indicated for this herb,
particularly in conjunction
with antidiabetic drugs
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Insulin analogue (lispro, aspart, isophane,
lente, ultralente, detemir, glargine)
Panax ginseng
Interaction uncertain; theoretical
adverse interaction is based on established property of American ginseng
to induce lowering of postprandial
glucose levels
Low risk: prescription for
glycaemic control is not
indicated for this herb
Oral hypoglycaemic agents/insulin
sensitisers/biguanides (metformin)
Oral hypoglycaemic agents/insulin
secretagogues/sulfonylureas (gliclazide,
glipizide, glibenclamide, glimepiride)
Trigonella
foenum-graecum
Possible additive effects; fenugreek
exerts hypoglycaemic activity by delaying glucose absorption and enhancing
its utilisation
May produce beneficial effect under
professional supervision
Moderate risk: monitor
blood sugar levels closely
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© Elsevier Australia
C h a p te r 1 7 Th e E n d o c r i n e Sys te m 1043
TABLE 17.8 Potential Interactions—cont’d
Drug Classes Commonly Used
Herb/Supplement
Potential Outcome
Recommendation
Analgesic/acetylsalicylic acid (aspirin)
Omega-3 fatty acids
Inconclusive; the combination of
omega-3 fatty acids and aspirin may be
beneficial under certain circumstances
(e.g. heart disease due to improved
blood flow characteristics, relaxation
of endothelial cells, etc.) but problematic in other conditions (e.g. warfarin
therapy due to increased risk of bleeding complications)
Risk variable: closely
monitor patients at risk for
excessive bleeding
Analgesic/acetylsalicylic acid (aspirin)
Chromium
Possible adverse effects; interaction
inconclusive. Aspirin may theoretically
increase chromium levels, which could
increase the risk and magnitude of
side-effects
Low risk: monitor patient
closely. Check chromium
levels in patients on longterm chromium therapy
Analgesic/acetylsalicylic acid (aspirin)
Vitamin B2
Interaction uncertain; concurrent
intake of aspirin and riboflavin has
been reported to cause gastric intolerance in some patients
Low risk: monitor patient
closely
Analgesic/acetylsalicylic acid (aspirin)
Vitamin B3
Possible beneficial effect; aspirin can
moderate niacin-induced cutaneous
flushing and other niacin-induced
effects
Low risk: consider
co-administration
Caution: closely monitor
patients at risk for bleeding. Monitor liver enzymes
Analgesic/acetylsalicylic acid (aspirin)
Vitamin C
Possible beneficial effect; aspirin
increases urinary excretion of ascorbic
acid and decreases its metabolic availability. Vitamin C can reduce aspirininduced gastric mucosal damage
and toxicity, and enhance its activity.
However, vitamin C may increase blood
levels and adverse effects of aspirin
Consider co-administration, especially with
potential ascorbic acid
depletion. Promote nutritional diet in patients on
long-term aspirin therapy
Analgesic/acetylsalicylic acid (aspirin)
Vitamin E
Possible additive effect; vitamin E may
reduce platelet aggregation and hence
cardiovascular risk
Low risk: consider
co-administration with
multiple antioxidants,
including mixed tocopherols and coenzyme Q10
Analgesic/acetylsalicylic acid (aspirin)
Zinc
Interaction uncertain
Regular monitoring is
essential if aspirin and zinc
are used concomitantly.
Separate doses by at least
2 hours
Analgesic/acetylsalicylic acid (aspirin)
Allium sativum
Possible additive effect; may provide additional antiplatelet activity,
increasing the risk of bleeding. Coadministration in antithrombotic protocols may enable lower doses of the
drugs, and reduce adverse drug effects
Moderate risk
Avoid or adopt and monitor bleed times
Anticoagulants/antiplatelet drugs
(aspirin, warfarin)
Codonopsis pilosula
Possible additive effect; Codonopsis
may inhibit platelet aggregation,
enhancing drug effect
Low risk: monitor patient
bleeding times in conjunction with other health
professionals
Analgesics/acetylsalicylic acid (aspirin)
Coleus forskohlii
Possible adverse effect; coleus may
increase the risk of bleeding associated
with some pain relievers
Moderate risk: use with
caution
Analgesic/acetylsalicylic acid (aspirin)
Glycyrrhiza glabra
Possible beneficial effect; liquorice
helps reduce gastroirritant adverse
effects of aspirin
Consider co-administration
using deglycyrrhizinated
liquorice (DGL)
Lipid-lowering therapies (statins)
Chromium
Interaction uncertain; chromium may
increase HDL levels
Low risk: monitor patient
closely. Check HDL levels
in patients on long-term
chromium therapy
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© Elsevier Australia
Continued