Diagnostic Evaluation for IBD (part 2 of 5)

Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of inflammatory disorders of the gastrointestinal tract. Each of these disorders involves some degree of inflammation (redness, swelling, erosion and sometimes bleeding) of the gastrointestinal mucosa or lining that commonly leads to ulceration of the mucosa to varying degrees. The inflammation is usually a result of an immune reaction of the body against its own intestinal tissue. Therefore, the diseases included in IBD are considered to be autoimmune disorders.

This is Part 1 of a 5-part article including:

1. An Integrated Approach to Managing Inflammatory Bowel Disease

2. Diagnostic Evaluation of IBD

3. IBD Treatment: Remove the Obstacles to Cure

4. IBD Treatment: Quiet the Inflammation

5. IBD Treatment: Repair the Gut

(or, download the PDF of the entire article.)

Blood work must be done and should include complete blood count, blood chemistry, iron studies, nutrient evaluation, and inflammatory markers. In agreement with the latest scientific research, I highly recommend screening for celiac disease. This includes genetic testing and blood tests for immune reactions as well as intestinal biopsies. It is important to note here according to the latest research, biopsies can be negative in patients with latent celiac disease. Celiac screening is especially important with microscopic colitis. A blood test called IBD serology (pANCA and pASCA) may be done if there are questions over the biopsy results regarding diagnosis of ulcerative colitis versus Crohn’s disease.

Stool samples should be examined to rule out infectious (bacterial or parasitic) causes of symptoms. This may include Complete Stool Diagnostic Analysis (CSDA) which checks for multiple stool factors to determine quality of digestion, absorption, bacterial environment, parasites, blood, inflammation, etc.

Nutritional evaluation should be done, especially with Crohn’s disease. This should include evaluation of electrolytes, zinc, folic acid, iron, B12, vitamin D25, total protein, albumin, and others. I highly recommend being tested for food allergies and intolerances such as celiac disease and lactose intolerance. This nutritional evaluation can include blood tests (IgE RAST and IgG4 RAST) or skin scratch testing to identify allergic foods.

Diagnostic Procedures will definitely include a colonoscopy and biopsy as this is the “Gold Standard” for diagnosing IBD. Sometimes a CT scan will be done to check for strictures, abdominal abscesses, fistulas, or obstruction of the intestines when the symptoms indicate it. Plain X-Rays of the abdomen could be done as a quick, easy, and inexpensive way to show narrowing of the intestines or an intestinal blockage. Contrast X-Rays such as barium swallow (small intestine) and barium enema (large intestine) might be done as well.

This is Part 2 of a 5-part article including:

1. An Integrated Approach to Managing Inflammatory Bowel Disease

2. Diagnostic Evaluation of IBD

3. IBD Treatment: Remove the Obstacles to Cure

4. IBD Treatment: Quiet the Inflammation

5. IBD Treatment: Repair the Gut

(or, download the PDF of the entire article)

References

1. The Lancet Infectious Diseases. Volume 7, Issue 9, September 2007, 607-613

2. Gastroenterology.Volume 115, Issue 6, December 1998, 1405-1413

3. Inflamm Bowel Dis. 2005 Feb;11(2):178-84

4. World J Gastroenterol. 2009 Nov 28;15(44):5517-24

5. Inflamm Bowel Dis. 2008 Jun;14(6):738-43

6. World J Gastroenterol. 2008 Jan 21;14(3):331-7

7. Inflamm Bowel Dis. 2008 Jun;14(6):775-9

8. Eur J Gastroenterol Hepatol. 2001 Feb;13(2):93-5

9. Curr Pharm Des. 2009;15(18):2087-94

10. Int J Colorectal Dis. 2001 Apr;16(2):88-95

11. Curr Med Chem. 2006;13(28):3359-69

12. J Immunol. 2006 Mar 1;176(5):3127-40

13. Int J Colorectal Dis. 2001 Apr;16(2):88-95

14. Eur J Med Res. 1997 Jan;2(1):37-43

15. Nutrition. 2001 Jul-Aug;17(7-8):669-73

16. Cancer Epidemiol Biomarkers Prev. 2008 May;17(5):1136-43

17. Cochrane Database Syst Rev. 2007 Apr 18;(2):Crohn's disease006320

18. Clin Rheumatol. 2007 Mar;26(3):289-97

19. Clin Rheumatol. 1996 Jan;15 Suppl 1:62-66

20. Clin Rheumatol. 2007 Mar;26(3):289-97

21. Z Rheumatol. 2000;59 Suppl 2:II/108-18

22. World J Gastroenterol. 2007 May 28;13(20):2826-32

23. J Clin Gastroenterol. 2006 Mar;40(3):235-43

24. Adv Exp Med Biol. 1999;472:149-58

25. Dig Dis. 2009;27(4):450-4

26. Int J Med Microbiol. 2010 Jan;300(1):25-33

27. Dig Dis. 2009;27(3):412-7

28. Rev Recent Clin Trials. 2008 Sep;3(3):167-84

29. Aliment Pharmacol Ther. 2009 Oct 15;30(8):826-33

30. J Biol Chem. 2006 Aug 25;281(34):24449-54

31. Aliment Pharmacol Ther. 2009;30(8):826-33

32. Scand J Gastroenterol. 2008;43(7):842-8

33. Dig Dis Sci. 2000 Jul;45(7):1462-4

An Integrated Approach to Managing Inflammatory Bowel Disease (part 1 of 5)

Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of inflammatory disorders of the gastrointestinal tract. Each of these disorders involves some degree of inflammation (redness, swelling, erosion and sometimes bleeding) of the gastrointestinal mucosa or lining that commonly leads to ulceration of the mucosa to varying degrees. The inflammation is usually a result of an immune reaction of the body against its own intestinal tissue. Therefore, the diseases included in IBD are considered to be autoimmune disorders.

This is Part 1 of a 5-part article including:

1. An Integrated Approach to Managing Inflammatory Bowel Disease

2. Diagnostic Evaluation of IBD

3. IBD Treatment: Remove the Obstacles to Cure

4. IBD Treatment: Quiet the Inflammation

5. IBD Treatment: Repair the Gut

(or, download the PDF of the entire article.)

Ulcerative Colitis and Crohn’s Disease

IBD: Signs and Symptoms Abdominal Pain very common Urgency to Stools very common Fatigue very common Bleeding from Rectum very common in ulcerative colitis Bloating very common Weight Loss more common in Crohn's disease Stool: loose, can be constipated in Crohn's disease Mucus in Stool very common Fever very common Gastritis or Stomach Ulcers common in Crohn's disease Canker Sores in the Mouth common in Crohn's disease Anemia common (B12, folate, iron) Dehydration common in ulcerative colitis Delayed Growth in Children very common in Crohn's disease Nutritional Deficiencies very common in Crohn's disease Fissures/Fistulas common in Crohn's disease Abdominal Abscesses common in Crohn's disease Intestinal Obstruction common in Crohn's disease (stricture) Arthritis 33% IBD patients Iritis / Uveitis up to 12% of IBD patients Skin Rashes common Hepatobiliary Disease (liver and gallbladder) more common in ulcerative colitis Kidney Stones (calcium oxalate) more common in Crohn's disease Protein, Calorie Malnutrition & Micro/Macro Nutrient Deficiencies common in Crohn's disease IBD: Risk Factors Familial History of IBD up to 10 times the risk if family with IBD Spouse with IBD Increases Risk for IBD Slight Female Predominance in Crohn's disease and a Slight Male predominance in ulcerative colitis Greater Predominance in Jewish Population Greater Risk if White, More Affluent, Live in Metropolitan Areas and in the Northeast Region of the United States Recent or Excessive Use of Antibiotics History of Delayed Growth and Development History of Chronic Perceived Stress and Suppressed Anger Peak Incidence Between ages 15 and 25 Smoking is Risk Factor for Crohn's disease Diet High in Processed Foods Especially White Flour, Anti-Caking Agents and Food Preservatives (8) Appendectomy is Protective for ulcerative colitis Presence of Genetic Markers for Celiac Disease (HLA-DQ2 and DQ8)

Two major types of IBD are ulcerative colitis and Crohn’s disease. There is also a subtype of colitis called microscopic colitis commonly occurring in adults over the age of 50. As the name suggests, ulcerative colitis is limited to the large intestine or colon. Its inflammatory pathology is easily visualized via a colonoscopy. On the other hand, microscopic colitis can only be detected via microscopic examination of tissue samples of the colonic mucosa.

Crohn's disease can involve any part of the gastrointestinal tract from the mouth to the anus. However, it most commonly affects the small intestine; sometimes the colon and stomach may also be affected. Its inflammatory reaction is often deeper and can penetrate the full thickness of the intestines leading to serious infections in the abdominal cavity and intestinal strictures causing obstruction. Because Crohn’s disease involves the small intestine which is the primary site of nutrient absorption, Crohn’s disease can also lead to malabsorption, weight loss, and failure to grow when occurring in children. Both ulcerative colitis and Crohn's disease usually run a waxing and waning course in the intensity and severity of illness.

When there is severe inflammation, these diseases are considered to be in an active stage causing the person to experiences a flare-up of the condition. When the degree of inflammation is less (or absent) and the person usually is without symptoms, the disease is considered to be in remission. Both disorders are not considered to be “curable” but can be nutritionally and medically managed into remission in most people.

What Causes IBD?

Since ulcerative colitis and Crohn’s disease are autoimmune-mediated, “disregulation” of the person’s normal or innate and adaptive immune system is involved. This disregulation leads to an immune response directed against “self” i.e., the person’s own mucosal cells and proteins.

Immune Response and Genetic Predisposition

Presently, it is suspected this disregulated or inappropriate immune response against self is due to intrinsic alterations in mucosal barrier function caused/stimulated by an immune response directed against specific dietary proteins such as gliadin (the protein in gluten) or various bacteria in the intestinal tract that don’t normally cause such a response. It is becoming more evident that a genetic predisposition leads to this inappropriate, cross-reactive immune response to self-proteins. (1, 2)

Hygiene Hypothesis

The old naturopathic “hygiene hypothesis” for autoimmune disorders has gained respect in contemporary medicine as a possible explanation for this cross-reactive response and the development of IBD and other autoimmune disorders. It suggests that cleaner, hygienic environments offer less exposure to parasitic infections of the gastrointestinal tract and this may negatively affect normal development of the immune system, predisposing to disregulation and over-reaction of the immune system leading to autoimmunity and IBD. (3)

Autoimmune and Self-Inflamed

Inflammation leading to swelling, erosion and ulcerations of the gastrointestinal mucosa (superficial with ulcerative colitis and full-thickness through the intestine with Crohn’s disease) is the common feature with IBD. White blood cells (T cells) recognize gut-associated self-proteins and direct auto-antibodies against them… against one’s own “self.” This immune response stimulates the production and local release of immune-active chemicals that cause intestinal inflammation and damage leading to the symptoms and complications associated with IBD.

Leaky Gut

Besides the apparent local inflammatory damage to the intestinal mucosa in IBD, the intestines can become highly “leaky” to larger protein molecules (bacterial and dietary) that normally would stay in the intestines without leaking through the intestinal barrier. The leaked protiens alert the immune system outside of the gastrointestinal tract. This is called “leaky gut.”

When "leaky gut" happens, gut-associated proteins get into systemic circulation and become immune-activating throughout the body. This immune activation results in inflammatory reactions and disorders in other parts of the body which can further develop into other autoimmune diseases. To illustrate this point, people with IBD are at higher risk for developing:

• Arthritic disorders such as rheumatoid arthritis, arthritis of the spine, and psoriatic arthritis (arthritis associated with the skin disorder called psoriasis). (4)
• Iritis (inflammation of the iris in the eye), inflammation of the liver, and multiple sclerosis.(5-7)

IBD: Signs, Symptoms, and Risk Factors

If you're experiencing any of the common signs and symptoms of IBD (right) with or without the common risk factors (right), the next step is to meet with your healthcare practitioner for a diagnostic evaluation.

Diagnostic Evaluation and Treatment of IBD

Diagnostic evaluation of IBD includes blood work, stool samples, nutritional evaluation, and diagnostic procedures. Click here to learn more.

Treatment: Employing basic Naturopathic philosophy and guidelines, there are three primary actions to consider as part of the treatment and management of IBD. First, “remove the obstacles to cure,” then “quiet the inflammation” and finally “repair the gut.” All three can be done simultaneously. Click the links below to learn.

Remove the Obstacles to Cure

Quiet the Inflammation

Repair the Gut

Summary

Inflammatory bowel disease is a group of autoimmune, inflammatory disorders of the gastrointestinal tract all of which involve some degree of inflammation (redness, swelling, erosion and sometimes bleeding) and damage to the gastrointestinal lining to varying degrees.

The inflammation is usually a result of an immune reaction of the body against its own intestinal tissue thought to be induced and commonly worsened by various dietary and gut-bacterial immune-stimulating proteins.

Management and prevention of the inflammation and associated complications is reliant on three naturopathic factors: removing the obstacles to cure, quieting the inflammation, and healing the gut. This is achieved best through an integrated treatment approach incorporating diet, nutritional supplements, standardized botanical medicines, and conventional medications under the astute direction and guidance of a gastroenterologist and a qualified health care team.

This is Part 1 of a 5-part article including:

1. An Integrated Approach to Managing Inflammatory Bowel Disease

2. Diagnostic Evaluation of IBD

3. IBD Treatment: Remove the Obstacles to Cure

4. IBD Treatment: Quiet the Inflammation

5. IBD Treatment: Repair the Gut

(or, download the PDF of the entire article.)

References

1. The Lancet Infectious Diseases. Volume 7, Issue 9, September 2007, 607-613

2. Gastroenterology.Volume 115, Issue 6, December 1998, 1405-1413

3. Inflamm Bowel Dis. 2005 Feb;11(2):178-84

4. World J Gastroenterol. 2009 Nov 28;15(44):5517-24

5. Inflamm Bowel Dis. 2008 Jun;14(6):738-43

6. World J Gastroenterol. 2008 Jan 21;14(3):331-7

7. Inflamm Bowel Dis. 2008 Jun;14(6):775-9

8. Eur J Gastroenterol Hepatol. 2001 Feb;13(2):93-5

9. Curr Pharm Des. 2009;15(18):2087-94

10. Int J Colorectal Dis. 2001 Apr;16(2):88-95

11. Curr Med Chem. 2006;13(28):3359-69

12. J Immunol. 2006 Mar 1;176(5):3127-40

13. Int J Colorectal Dis. 2001 Apr;16(2):88-95

14. Eur J Med Res. 1997 Jan;2(1):37-43

15. Nutrition. 2001 Jul-Aug;17(7-8):669-73

16. Cancer Epidemiol Biomarkers Prev. 2008 May;17(5):1136-43

17. Cochrane Database Syst Rev. 2007 Apr 18;(2):Crohn's disease006320

18. Clin Rheumatol. 2007 Mar;26(3):289-97

19. Clin Rheumatol. 1996 Jan;15 Suppl 1:62-66

20. Clin Rheumatol. 2007 Mar;26(3):289-97

21. Z Rheumatol. 2000;59 Suppl 2:II/108-18

22. World J Gastroenterol. 2007 May 28;13(20):2826-32

23. J Clin Gastroenterol. 2006 Mar;40(3):235-43

24. Adv Exp Med Biol. 1999;472:149-58

25. Dig Dis. 2009;27(4):450-4

26. Int J Med Microbiol. 2010 Jan;300(1):25-33

27. Dig Dis. 2009;27(3):412-7

28. Rev Recent Clin Trials. 2008 Sep;3(3):167-84

29. Aliment Pharmacol Ther. 2009 Oct 15;30(8):826-33

30. J Biol Chem. 2006 Aug 25;281(34):24449-54

31. Aliment Pharmacol Ther. 2009;30(8):826-33

32. Scand J Gastroenterol. 2008;43(7):842-8

33. Dig Dis Sci. 2000 Jul;45(7):1462-4

Fruits, Berries, and YOU!

Take note!  Fruits and berries bring extreme health benefits via their polyphenolic, anthocyanin compounds known as “flavonoids”.

What are Flavonoids?

Flavonoids provide much of the deep colors in the plant kingdom, especially fruits and berries. 

What Do They Do?  

Flavonoids trigger genetic signaling that promotes human health and disease prevention. Flavonoids exhibit some of the strongest antioxidant activity known and are well-respected for their anti-inflammatory effects.  They protect many tissues from inflammatory damage and the degenerative changes of aging.

Studies Showing Preventative Health Benefits

In the past few years so much scientific evidence has accumulated from the research studies to support the preventive health benefits of these flavonols in relation to cancer, cardiovascular disease, diabetes, inflammatory diseases, and Alzheimer's disease. 

Studies Showing Anti-aging and Disease Reduction

In numerous studies, their dietary intake is directly related to improved longevity and disease reduction. More recently, research has focused on their anticancer and cancer prevention capabilities. 

Studies Demonstrating Cancer Prevention Qualities of Flavonoids

An impressive body of information exists on the antitumor action of plant flavonoids. In vitro work has concentrated on the direct and indirect actions of flavonoids on tumor cells, and has found a variety of anticancer effects. In vivo studies have demonstrated dietary flavonoids to have the power to block the ability of cancerous tumors to generate their own blood supply (angiogenesis). This ultimately results in the death of the tumor cells and restriction of the tumor’s growth. Furthermore, experimental animal studies indicate that certain dietary flavonoids possess clear antitumor activity.

A considerable amount of evidence indicates that the development of cancer is associated with inflammation. Nuclear factor-kappa B (NF-kappa B), a master regulator of infection and inflammation, has been identified as a key modulator in which inflammation could develop into cancer. Known for their anti-inflammatory actions, many dietary flavonoids have been shown to have marked inhibitory effects on the activation of NF-kappa B. This may be one of the major ways in which flavonoids prevent the development of various human cancers. 

What Should YOU Do With This Information?

Eat a colorful diet rich in fruits and berries of all kinds especially cranberries, blackberries, blueberries, cherries, raspberries, strawberries, currents, grapes, elderberries, pomegranates, and plums. Consider also supplementing your diet with various berry concentrates. These are great added to yogurt.

Berry Concentrates and Supplements Using Berry-derived Flavoioids

Barleans Berry Greens Powder

Vital Nutrients Berry Well Powder

VerryBerry from Dr. Nita's / New World Naturals

WinterBerry from Dr. Nita's / New World Naturals

PolyResveratrol-SR from Thorne Research

BioGenesis Resveratrol plus Flavonoids

References

Mol Nutr Food Res. 2007 Jun;51(6):675-83

In Vivo. 2005 Sep-Oct;19(5):895-909

J Agric Food Chem. 2008 Feb 13;56(3):630-5

J Agric Food Chem. 2006 Dec 13;54(25):9329-39

J Agric Food Chem. 2004 May 5;52(9):2512-7

J Nutr. 2007 Jan;137(1 Suppl):186S-193S

Nutr Cancer. 2009 Nov;61(6):811-5

Nutr Cancer. 2009 Nov;61(6):807-10

FDA Labeling Rules are a Straitjacket

Food and Medicine are NOT opposites

FDA rules dictate that every product must be labeled as either a FOOD or a SUPPLEMENT but NOT both.   The FDA position is that it is impossible for any one product to both heal and feed you.

Every Naturopathic physician knows this is simply not true. We have been using carefully selected foods as effective medicines for  over 100 years.  There is no quackery here;  it’s backed up by the 2002 Human Genome project.   This provided scientific evidence that certain co-factors (which influence chemical reactions in your body) match up to certain “nutrient genes”.  If we “plug in” these nutrient co-factors and foods into these chemical reactions – which occur every second of every minute of every day –  we might positively impact the expression of your DNA and prevent disease.

It is time for a paradigm change.  In fact, it’s long overdue. 

This is shown clearly by my experience with the  Amazon Sacha inchi nut.  This organic tree nut is so high in Omega 3 oil content that 12 sacha nuts are equivalent to the 400 mg RDA Omega 3 stated as sufficient by the FDA.  That’s no empty claim;  it was calculated by Food Quality Labs in Portland, Oregon which tested Sacha inchi nuts in a fatty acid profile.  But the FDA insists it must be labeled and sold as either a food or a supplement when it is obviously both.

And take chocolate, which was once thought to be nothing more than a decadent indulgence. The latest scientific research shows that it may be the top antioxidant, higher than even than blueberries.

Twenty years ago when I was in the Amazon, our shaman/guide sliced open a cacao bean and a dazzling purple juice flowed forth. I realized what I was seeing were those purple anthocyanins, similar to what is in blueberries. So chocolate by its very nature was an antioxidant. A few years later at a worldwide Flavonoid conference in Malta conducted by French agricultural scientists, I met the Hershey’s European division who were introducing a healthy antioxidant chocolate called Coco Via. This was not successful, but only because the world wasn’t ready yet.

The world is ready now: Nestle Health Sciences, a newly created division of the food giant for researching and developing medical and functional foods this week stated they believe there is an “opportunity between food and pharma.”  and have opened a war chest of funding to study phytochemicals and plant extracts in foods 

I strongly believe in chocolate as medicine.   Unfortunately, most chocolate companies process chocolate at over 110°F, which doesn’t affect taste but severely diminishes the antioxidant potential.   You won’t find a flavonol content category on any FDA label.  Antioxidant values are extrapolated by running an expensive battery of lab tests (TROLOX, TEAC, FOLIN ASSAY, ORAC) and averaging the results.  But flavonol content may be the single most important thing when choosing chocolate.

Now chocolate is opening her secrets.  Research is demonstrating what Naturopathic physicians, practicing science-based nutrition, have always known; food IS medicine.  Food has a superior effectiveness and relative freedom from side effects.

Food is not just A medicine – It is your BEST medicine. 

Visit our Healthy Chocolates Page !

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The Dispensary Online is proud to be an authorized retailer of Dr. Nita's healing foods and medicines. From her signature VerryBerry antioxidant supplement to her high omega chocolate clusters, Dr. Nita brings new life to the idea of nutrition.

Is it a Healthy Fever?

Many parents become understandably alarmed when their child has a fever, so it is important to keep in mind that fevers are commonly a healthy response to an infective agent. Healthy fevers allow the immune system to perform more efficiently. A child with a healthy fever is a child whose immune system is working well.

My Own Experience with My Children's Fevers

I am a practicing Naturopathic physician in Seattle and have worked in the health field for well over thirty-five years. I have two children, now 14 and 25 years old respectively. Both of my children got fevers and flus when they were young. My oldest was a youngster when I was doing my residency at the Bastyr University outpatient clinic. She taught me a lot firsthand about what works well to keep children healthy through colds, fevers, and flus, as she was my original guinea pig and very healthy today because of it. 

How I Treated Their Healthy Fevers

When either of my children got a fever, it was often a "healthy fever" due to a common viral infection. After I would determine they had a "healthy fever", I would give them the indicated homeopathic remedies along with natural, immune-supportive botanical medicines and nutrients as treatment for their fever. Then I would hydrate, hydrate, hydrate and watch them quickly get better.

Before I would treat my child's fever, however, I would call the pediatrician and with his/her help, I would evaluate the fever to determine if it was a "healthy fever". A "healthy fever" is one related to a common viral infection for my child’s age group. In the case of a "healthy fever," I let the fever burn at 99.5 to 102.5 while keeping my child comfortable and well hydrated. Keeping a "healthy fever" suppressed can prolong the course of the infection. Allowing it to "burn" while vigilantly managing your child’s condition, can help resolve the infection quicker.

Because the homeopathic and immune supportive treatments were successful, I rarely, if ever, used Tylenol except once or twice when one or another child was too uncomfortable to sleep. I certainly would never use aspirin. Aspirin use in children with an infectious fever has been associated with a potentially fatal disorder called Reye’s Syndrome and should not be used with children under 16 years of age.

Remember that healthy fevers are a healthy response to an infective agent. Parents can keep their children healthy by boosting their immune systems naturally with immune supportive herbal / botanical medicines and nutrients. In my family practice, I recommend that parents keep on hand a homeopathic kit for flus and fevers, as well as some kid-friendly immune system boosters such as VerryBerry, Winterberry, BerryWell, Esberitox, Vitamin C, Betaplex, and Vitamin D. With these tools in your medicine chest, and a consult with your pediatrician or primary care provider, you and your family can bravely face cold and flu season.

*How do you Evaluate Your Child's Fever?

How do you evaluate whether your child has a healthy fever? Consult with your pediatrician or primary health care provider first and then answer the following questions.

1. Is my child's fever relatively slow to rise (over a few hours) and /or stable at 99.5 to 102.5 degrees?
2. Is my child playing, talking, easily distracted and entertained, and interacting somewhat normally in spite of the fever?
3. Is my child urinating, perspiring and drinking fluids regularly without abdominal discomfort or recurrent vomiting while maintaining a somewhat usual appetite?
4. Is my child's skin moist, warm, normal appearing and is he/she sweating if too warm?
5. Is my child having normal stools without diarrhea?
6. Is my child without a stiff neck; severe headache; rash, persistent abdominal pain; productive cough; difficulty breathing; joint pain, particularly in one specific joint (knee or hip especially); a bad sore throat with tender, swollen glands?
7. Is my child without an injury or cut that could be infected?
8. Is my child's response to this illness/fever pretty much normal for his/her usual fevers?

Have Your Remedies on Hand

Homeopathic Remedies: The homeopathic medicines I used to treat my children’s fevers are the same homeopathic remedies that parents can get in a homeopathic kit. Every parent should have a homeopathic kit in her home. It typically comes with about thirty remedies that are commonly used to combat acute fevers, colds, flus, and even ear infections. My favorite homeopathic pharmacies are Boiron and Hahnemann. With a homeopathic remedy kit you can begin treating a fever quickly while getting in touch with your child’s pediatrician. You can use the instructional handbook that comes with the kit or call an experienced homeopathic doctor and work with him/her over the telephone.

Homeopathy treats the body by stimulating its vital energy to reorganize itself into a higher level of integration and balance to resolve the illness. Substances used as remedies (minerals, plants, animal, etc.) are homeopathically prepared by serial dilution and succussion, a technique specific to homeopathic pharmacy which follows the standards established by the Homeopathic Pharmacopeia of the United States (HPUS) and the regulatory requirements of the FDA. And they are safe! The correct or "indicated" homeopathic remedy normally works to reduce the fever within about 30 minutes. Some of the common homeopathic fever remedies I used with my children include homeopathic belladonna, ferrum phosphoricum, aconite, mercurious vivus, and chamomile.

VerryBerry and WinterBerry: VerryBerry and Winterberry from Dr. Nita's / NewWorld Naturals support your child's immune system (and also tastes delicious). It is a flavonoid and antioxidant supplement that contains organic concentrates of six fruits with notably high antioxidant levels: elderberry, blueberry, blackberry, cranberry, raspberry, and pomegranate. VerryBerry hadn't been invented when my children were growing up so I treated them with tinctures of elderberry.

Esberitox: Esberitox from Integrative Therapeutics is a chewable immune stimulant for kids. Esberitox contains echinacea and other safe, immune stimulating herbs. Echinacea fortifies cells with natural fighting power by stimulating B-cell and antibody production. Over 30 studies support its use. Esberitox has been the top-selling remedy in Europe for over 70 years, and is clinically tested. It doesn't interfere with commonly prescribed medications and can be used by your entire family. You can get these at thedispensaryonline.com.

Hydration: Some of the best fluids for hydration include miso soup; vegetable juices; chicken, meat, fish and vegetable broths. Miso soup is a good source of sodium and electrolytes commonly lost during an infection with fever. Miso is also very high in antioxidants, and very alkaline, which helps fight infection. Diluted vegetable juices and/or meat, chicken and vegetable broths are also high in sodium and electrolytes, in addition to vitamins, minerals and proteins. Over-the-counter Pedialyte can also help in a pinch.

NOTE: Never manage your child’s fever without the consult and advice of your pediatrician or primary health care provider.

The Preventable Epidemic of Fatty Liver Disease

There is an epidemic of Fatty Liver Disease in the U.S. that can have grave consequences if not prevented, treated or diagnosed early enough. The good news is that it can be prevented and successfully treated if caught early enough.

Non-Alcoholic Steatohepatitis (NASH)...what is it?

NASH is a common liver disease that is generally without symptoms. It is the most prevalent progressive liver disease in the United States affecting up to 5% of Americans (5 people in every 100).

Although NASH resembles alcoholic liver disease, it occurs in people who drink little or no alcohol (defined as under 7 drinks per week for women and under 14 drinks per week for men*).

The major feature of NASH is a fatty liver (fat deposition in the liver) associated with inflammation. The fatty deposition and inflammation in the liver leads to damage of the liver cells and liver tissue causing liver fibrosis (scarring) in approximately 50% of people with NASH and cirrhosis in up to 25% of people with NASH. Those people who develop cirrhosis will die in 7-10 years if they do not get a liver transplant. Ironically, most people with NASH feel well and are not aware they have a progressive liver disorder. (Hepatology 2006; 43: S99)

NASH Begins with NAFLD

NASH begins with nonalcoholic fatty liver disease (NAFLD) without the associated inflammation, fibrosis and cirrhosis... simply called “fatty liver.” 30 million adults have NAFLD or “fatty liver.” NAFLD is considered to be the primary liver complication of metabolic syndrome i.e., obesity, hypertension, dyslipidemia (high cholesterol and lipids), insulin resistance, and late-onset or type II diabetes.

NAFLD is recognized today as the most prevalent liver disease in the Western population with estimated prevalence rates approaching 34%. That is 1/3 of the population! Some researchers have found prevalence rates to be approaching 50% of the population in patients seen at urban primary care clinics in states such as Texas, known to have the highest rates of obesity.

Nearly 10% of children in the U.S. ages 2-19 have fatty liver. That equals approximately 6.5 million children! Most of those children (81%) with fatty liver are overweight and obese. Nearly 25% of those children already have NASH. (NEJM 2002; 346: 1221) (Pediatrics: Oct 2, 2006)

NASH: Primary Causes and Risk Factors

I am going to focus on the primary causes of NASH, although there are a number of secondary causes and risk factors such as viral hepatitis; autoimmune hepatitis; environmental toxins; and medications and drugs such as steroids, cocaine, synthetic estrogens, and some anticancer drugs.

Both NASH and NAFLD are becoming more common, primarily because of the greater number of Americans with obesity and metabolic syndrome. In the past 10 years, the rate of obesity in the U.S. has doubled in adults and tripled in children. Insulin resistance, type II diabetes and dyslipidemia (aspects of metabolic syndrome) are also becoming more common among Americans.

Over 90% of patients with NAFLD have at least one feature of metabolic syndrome while 30% have the complete syndrome defined as three of the following:

• Central obesity (around the abdomen and flanks),
• Impaired/elevated fasting blood glucose,
• Elevated triglycerides
• Low HDL cholesterol
• High blood pressure
• Elevated uric acid in the blood

NASH: Diagnosis

The first hint of NAFLD and/or NASH is first seen in a blood chemistry test. An elevation of liver enzymes known as transaminases, most specifically the ALT, is suspect for fatty liver particularly in a patient with symptoms and signs of metabolic syndrome as described above when all other risk factors are negative. Next a liver ultrasound is required to visualize fatty infiltration of the liver. Unfortunately, however, an ultrasound can only detect NAFLD when there is more than 30% fatty infiltration. If the ultrasound demonstrates fatty infiltration, a liver biopsy may be required for final diagnosis, particularly if metabolic syndrome is well established.

NASH: The Best Treatment is Prevention

The best treatment for NASH is prevention because, it can be prevented! More than anything, prevention means reducing exposure to environmental toxins and preventing obesity.

Environmental toxins known to cause fatty liver include heavy metals such as lead and mercury, petrochemicals, and organic solvents found in cigarette smoke, paints, automobile exhaust, pesticides, air fresheners, and solvents used for cleaning and dry cleaning.

Preventing obesity in most people means eliminating the over-consumption of nutrient-poor, high-fat (particularly saturated fats), high-sugar (especially high-fructose corn syrup), highly processed fast foods and sodas while encouraging daily aerobic exercise (20 minutes or more) and a healthy diet. High-fructose corn syrup and high-fructose diets are now thought to be a major cause of obesity, type II diabetes, and metabolic syndrome in the U.S. They are also associated with the development of NAFLD. (Gastroenterol 2009; 136[5]: S1: 289) (Endocrine Rev 2009; 30: 96-1126) (Hepatology 2010; 51: 1961-71)

A “healthy diet” to prevent obesity and NASH must be one consisting of colorful, fresh vegetables and fruits; whole grains and legumes; seeds and nuts; fresh, wild-caught fish; and fresh, free-ranged organic fowl, meats and dairy products. Well over 50% of one’s daily intake should come form the vegetable and fruit categories, 30% from seeds, nuts, legumes and whole grains, and 20% from fish, fowl, meat and dairy. Dairy products should be organic and low-fat or non-fat. They should be eaten not drunk…eaten as fermented yogurts, kefirs, and aged cheeses.

Organic is stressed here because pesticides and herbicides are a principle source of environmental toxins and are most concentrated in animal fats and oily foods.

There are specific foods and spices scientifically demonstrated to have liver-protective effects and should be routinely included in one’s diet. Some of these include: Artichoke leaves and hearts; beets; radishes; garlic; omega-3 fatty acids from fish oils; cabbage family vegetables especially broccoli, cauliflower and Brussels sprouts; turmeric; ginger; and green tea.

NASH: Treatment

NASH can be prevented and successfully treated if caught early enough. The following nutritional supplements are well studied compounds that are used in the treatment of NASH.

Fish Oils: Omega-3 fatty acids have been shown to improve insulin sensitivity and lower markers of liver inflammation in animal models and clinical trials.

N-Acetylcysteine (NAC): Animal and human studies of NAC have shown it to have powerful antioxidant activity. It is effective in promoting normal liver detoxification. As a sulfur source, NAC stimulates glutathione (an important antioxidant produced in the body) synthesis and activity thereby promoting liver detoxification and the scavenging of free radicals.

Alpha Lipoic Acid (ALA): ALA increases cell sensitivity to insulin and is liver-protective and regenerative. It is essential to the proper metabolism of carbohydrates.

Vitamin E: Vitamin E decreases liver fibrosis by reducing the release of TGF-1, a peptide in the liver shown to cause liver fibrosis. Supplementation of 300 IUs daily over 12 months has been shown to significantly reduce inflammation, fibrosis and fatty infiltration.

Vitamin D: Low vitamin D levels are associated with the severity of fatty infiltration, inflammation and fibrosis in the liver. The lower the vitamin D levels the greater the severity.

L-Carnitine: L-carnitine supplementation over 12 months has been shown to induce regression of NASH in clinical trials even if both plasma and hepatic carnitine levels have been shown to be normal.

Liver-protective botanicals: There are a number of scientifically proven, liver-protective botanical compounds that can be used to decrease fatty infiltration and inflammation in the liver.

Silymarin: Silymarin is a well studied flavonoid from milk thistle. It has liver-protective effects that are accomplished via several mechanisms including antioxidation, inhibition of lipid peroxidation, enhanced liver detoxification via inhibition of Phase I detoxification and enhanced glucuronidation, and protection of glutathione depletion. Silymarin can stimulate liver cell regeneration as well.

Picrorhiza: Picrorhiza increases bile production in the liver and has also been shown to protect the liver from damage by several potent liver toxins, offering protection as good as or better than silymarin. The liver-protective effects of Picrorhiza may be due to its antioxidant activity and free radical scavenging. Like silymarin, Picrorhiza can stimulate liver regeneration, possibly via stimulation of nucleic acid and protein synthesis. Picrorhiza also benefits individuals with acute hepatitis. In a double-blind study, it reduced bilirubin and the liver enzymes ALT and AST significantly compared to placebo.

Catechin compounds: Catechins are antioxidant flavonoid compounds found primarily in green tea. They have been shown to stimulate liver lipid metabolism and fat breakdown in the liver. They reduce fatty infiltration in the liver and are liver-protective.

Curcumin: Curcumin is the yellow pigmented flavonoid in turmeric. It is one of the most researched natural compound today, studied for its anti-oxidant, anti-inflammatory, anticancer, and liver-protective effects.

Weight Loss is also a prescribed treatment for NASH.

Weight Loss: Weight loss can improve liver biopsy results in patients with NASH. This should not be a radical weight loss but average approximately 1-2 pounds per week.

NASH: Summary

There is an epidemic of NASH in the U.S. that parallels the epidemic of obesity and metabolic syndrome. It can have grave consequences if not prevented, treated or diagnosed early enough. The good news is it can be prevented and successfully treated if caught early enough.

Interesting Question for Those Over 40: 

Did Crosby have Nash when he had his liver transplant or was he Still too Young?

References

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Endocrine Rev 2009; 30: 96-1126

Fitoterapia 1999;70:54–7

Gut 2002; 51: 89-94

Gastroenterol 2009; 136(5): S1: 289

Hepatology 2010; 51: 1961-71

Hepatology 2006; 43: S99

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Rational Phytotherapy: A Physician’s Guide to Herbal Medicine. 3rd ed, Berlin: Springer, 1998

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* A standard drink equals 12 ounces beer, 5 ounces wine, 1.5 ounces 80-proof spirits.