1. Naturopathic Medicine- Treating the Whole Scleroderma Patient
Hello everyone, thank you for coming
My name is Sara – I’m a naturopathic doctor
IFHC- team of chiro’s, RMT’s
Dr. Sara Korsunsky, B.Sc., N.D.
The Centre for Natural Medicine
1218 Lorette Avenue

2. What is naturopathic medicine?

3. What is Naturopathic Medicine?
A primary health care profession
Combines effective traditional therapies with current advances in modern medicine
Focuses on prevention and treatment of illness

4. What is a Naturopathic Doctor?
Licensed Naturopathic Doctor's (ND's) are the most highly trained practitioners in the broadest scope of natural medical treatments. ND's are required to complete at least 3 years of standard pre- medical studies at a recognized university before going on to 4 years at an accredited Naturopathic medical school.

5. Principles of Naturopathic Medicine
First, do no harm.
Address the causes of disease.
Heal the whole person.
Cooperate with the healing power of nature.
Teach the principles of healthy living and preventative medicine.
Naturopathic Principles
Primary Health Care Profession- diagnoses, labs, physical exams, work with MD’s.
Family practice, all ages
Modalities- herbs, clinical nutrition, acupuncture, homeopathy, other healing physical therapies

6. Naturopathic Medical Training
Basic medical sciences
Medical diagnostics
Full physical exams
Laboratory diagnostics
Phlebotomy
Pharmacology
Radiology

7. Naturopathic Treatment Options
Herbs
Clinical Nutrition & Neutraceuticals
Homeopathy
symptom specific, no interactions with medications
Acupuncture
Lifestyle Coaching
stress reduction, balance, wellness
Prevention
early screening and education, proactive medicine

8. The Naturopathic Profession
Today:
Increased demand
For supportive medications and alternatives
Treatments for stress related illnesses
Preventative medicine
Covered by private health insurance
Regulated, safe
Canadian Association of Naturopathic Doctors (CAND), Manitoba Naturopathic Association (MNA)

9. What is Health? Physical Mental Emotional Energetic
- Health IS NOT the absence of dis-ease
- Having a diagnosis does not exclude health
Physical
Mental
Emotional
Energetic
BALANCE

10. What is Health?
A state of balance and good function that permits a person to achieve their ultimate purpose of existence. A place where there is spiritual fulfillment. It is a changing process that requires persistent effort to maintain.
Education,
Commitment,
Choices

11. Health and disease- a new paradigm for the 21st century?

12. TM

13. The River of Health Program
Health and wellness is a process
1-The Source- optimal physical, mental, emotional health, healthy lifestyle and self care
2- Upstream- good physical health, underlying mental or emotion issues, lacking in some self care and healthy lifestyle habits

14. The River of Health Program
3- Mid stream- moderate physical health with several symptoms, mental or emotional issues, poor mood or energy, unhealthy lifestyle choices 4- Down stream- polluted body, many symptoms, unhealthy lifestyle choices 5- End of the river- degeneration or death, body cannot cope

15. The Source of the River: Clean, clear, ideal terrain

16. Midstream- Impurities, toxins

17. Downstream- Polluted waters

18. End of the River

19. Where would you like to be?
Where are you….
In the River of Health?
Where would you like to be?

20. The Foundations of Health
Proper Hygiene
Regular Movement/ Exercise
Adequate Rest & Quality Sleep
Healthy Nutrition & Digestion
Effective Stress Management
Functional Organs
= Anti-inflammatory lifestyle

21. Factors that Contribute to Disease
Poor digestion (malnutrition) and elimination
Immune system malfunction or suppression
Toxic exposure
Unhealthy lifestyle
Genes
Stress

22. Factors that Contribute to Disease
Poor digestion and elimination
Bad breakdown- bloating and promotion of unhealthy microbes
Bad absorption- low levels of nutrients, weight loss or obesity
Bad bowel movements- toxins reabsorbed or nutrients blood lost, pain.
Immune system malfunction or suppression
Poor recovery, autoimmunity, sclerosis,
Both can present through skin

23. Factors that Contribute to Disease
Environmental toxins
Chemical, pollution, pesticides, etc.
Unhealthy lifestyle
Lack of movement, poor mental health, drugs, alcohol
Unhealthy diet- low in nutrients, high in fat/ sugars/ salt, skipping meals or overeating

24. Factors that Contribute to Disease
Lack of rest or quality sleep
Affects adrenal stress glands
Increases inflammation
Genes
Not a definitive outcome, can be turned on or off
STRESS!
Contributes to every single disease
Is inflammatory

25. The Root Causes of Scleroderma
Genetics (HLA)
Infections
Toxins (environmental)
Stress- oxidative, other?

26. Scleroderma Problems and Immunity
 Overactive T- lymphocytes- T helper, CD +, IL-2 (infections and self- non-self)
Fibroblasts display cell growth abnormalities- proto oncogene c-myc
Platelet derived growth factor alpha receptors are increased (accelerates growth of collagen, regulator of cell division)
Natural medicines can influence these

27. Infections & Poor Microbiology (Microbiome)
Bacteria
Viruses
Parasites
Fungi
Lack of healthy levels of good bacteria/ overgrowth of poor microflora
Very common
Diagnosis by stool culture (CSDA) or ELISA/ PCR bloodwork

28. Infections & Poor Microbiology (Microbiome)
Research shows distinct improvement using probiotics in Scleroderma
After 2 months use, significant improvements were seen in scores of total gastrointestinal symptoms, reflux, and bloating/distention.
Frech TM, Khanna D, Maranian P, Frech EJ, Sawitzke AD, Murtaugh MA. Probiotics for the treatment of systemic sclerosis-associated gastrointestinal bloating/distention. Clin Exp Rheumatol 2011;29(Suppl 65):S22-S25.
Nutritional Medicine, a textbook by Dr. Alan R Gaby M.D.

29. Infections Release inflammatory toxins Steal nutrients
Block immune system
Suboptimal bacterial levels lead to greater risk for infections
Immune support is important

30. Toxins Environmental Chemicals Ingested Medications
Detoxification to relieve the body of toxins and impurities can benefit pathophysiology of autoimmunity1
1. Crinnion WJ. Results of a decade of naturopathic treatment for environmental illnesses: a review of
clinical records. J Naturopathic Med 1997;7:21-27.

31. Stress Adrenal gland- deals with stress daily
Dysfunction caused by chronic:
Anger, sadness, grief
Insomnia
Overwork
Surgery
Trauma, injury, chronic illnesses

32. Symptoms of Stress Gland Dysfunction
Fatigue, Sleep disturbances
Anxiety/ low mood
Overweight
Heart palpitations
Poor memory/ focus
Headaches
Dizziness standing up
Low blood pressure
Propensity for autoimmune and liver diseases

33. Naturopathic Approach to Health
No referral needed
60-75 minute initial visit
Thorough history
Physical Exam
Review records
Appropriate laboratory testing
Diagnosis
Treatments
Visits may be weekly, monthly, seasonally

34. Clinical Nutrition- Why?
Better function (enzymes, energy)
Malnutrition in Scleroderma Of 160 consecutive Italian patients with systemic sclerosis, 15% had evidence of malnutrition. Malnutrition was significantly associated with disease activity, and was nonsignificantly associated with gastrointestinal involvement. Caporali R, Caccialanza R, Bonino C, Klersy C, Cereda E, Xoxi B, et al. Disease-related malnutrition in outpatients with systemic sclerosis. Clin Nutr 2012;31:
Vitamins, minerals, other nutrients
Oral or injected

35. Nutritional Tips for Healing
Avoid inflammatory foods
Trans fats, deep fried foods, charred foods
Sugar- stops white blood cell response- The Loma Linda study
Refined grains and flours (ie Not WHOLE)
Red farmed meats
Secondarily: dairy, nightshades (tomatoes, potatoes, eggplants), corn
Food sensitivities or intolerances
The Loma Linda study observed the effect of sugar ingestion upon neutrophilic activity. After an overnight fast, subjects were administered oral 100 gram portions of either glucose, fructose, sucrose, honey, or orange juice. Blood was drawn before and after administration of the sugar, then mixed with a shot of staphylococcus epidermidis (a fairly common bacterial strain that can be virulent in compromised immune systems) to determine the neutrophilic phagocytosis response. After ingestion of sugar (but not starch), the phagocytic index (a rough measurement of the neutrophilic response) was significantly decreased, while fasting significantly increased the response. Sugar eating didn’t decrease the number of neutrophils; it simply decreased their responsiveness. Read more: 

36. Nutritional Tips for Healing
Whole Grains
Healthy fats and oils
Natural sugars only
Fish, lean meats, vegetarian protein
Increased organic vegetable intake
Water, water, water
Green or herbal teas

37. Nutritional Tips for Healing
Diets rich in bioflavonoids benefit inflammation, immunity, blood vessels
Virtually all fruits, vegetables, herbs and spices contain antioxidants
Non-toxic, best absorbed with food
Avoid overcooking foods
Examples: quercetin, carotenoids, isoflavones
Caution with high fiber diets!!

38. Nutrition:
patients/nutrition.htm

39. Scleroderma Specifics
Vitamin D: often low in scleroderma, autoimmunity and MB.
Vitamin E supplementation resulted in improvements in the skin of scleroderma patients, including morphea, calcinosis cutis, and Raynaud’s phenomenon.
Zinc improves Morphea
Don’t self- prescribe high doses.
ND’s check interactions with medications!!!

40. Natural Treatments TREATMENT DOSAGE RATIONALE Fiber Use with caution
Decreased colonic motility
Para-aminobenzoic Acid (PABA)
12 g/day KPABA (potassium-PABA)
Anti-fibrotic
Vitamin E
200-1,200 IU/day orally; topical application
Antioxidant; anti-fibrotic, dermatologic improvements
Vitamin D
mcg/day calcitriol OR 1, ,000 IU/day D3 (not studied)
Immunoregulatory; inhibition of fibroblast growth and collagen synthesis
GLA (sources; black currant, borage, or evening primrose oil)
540 mg/day GLA (evening primrose oil used in the studies)
Converts to prostaglandin E1 to increase capillary flow and decrease inflammation; especially for patients with concomitant Raynaud’s phenomenon.
Estriol
2 mg/day orally OR mg/week subcutaneously
Mechanism unknown
N-acetylcysteine
IV infusion of mg/kg/hour for five days.
S- adenosylmethionine (SAMe)
IV infusion of 600 mh/day followed by 400mg three times daily
Bromelain
mg/day enterically coated
Avocado/Soybean Extract (unsaponifiable)
mg/day
Zinc/copper
15-60 mg/day zinc; 1-4 mg/day copper
Correct a deficiency, aids morphea

41. Stop inflammation Fish oils- high dosage
Turmeric- bonded to a lipid (fat)
Boswellia, cayenne, licorice
Flaxseed, hemp
Ginger
Stress management- counselling, spirituality, energy medicine
Meditation

42. Improving Energy and Sleep
Treat Adrenal gland dysfunction
Testing- Adrenal Stress Index
Treat Anxiety
Correct dysfunction (gut, brain)
Natural options:
Lifestyle
Herbs, vitamins
Homeopathy
Acupuncture

43. Why Consult an ND? Integrative Safe Options Improved lifestyle
Science, medical technology and nature
Work with MDs to support health
Safe
NDs do not remove medications
NDs know interactions and side effects
Standardized training, licensure
Options
where possible, fewer medications is advantageous
Improved lifestyle
Improved body physiology means reduced symptoms

44. Naturopathic Medicine
IS IT FOR ME?
A medical process, not a magic quick fix
Reduces toxins and harm from medications
Patient-centered care & participation
Whole person focused
Time taken to listen, discuss

45. Naturopathic medicine treats all health concerns:
from pediatric to geriatric,
from irritating symptoms to chronic illness and from physical to the psychological.
ND’s attend to your individual physical, mental & emotional harmony

46. Optimal Health Care ND’s work with you to meet your health goals
Results:
Better energy
Fewer symptoms
Treatment options
Empowered patients
Reduced disease

47. Contact Information
Dr. Sara Korsunsky BSc, N.D. The Centre for Natural Medicine 1218 Lorette Avenue