digestion, GI health, healing, hood river naturopath

A German Writer Translates a Puzzling Illness Into a Best-Selling Book

MANNHEIM, Germany — IF Giulia Enders had not contracted a mysterious illness as a teenager that left her covered with sores, she, like most of us, might never have thought much about her digestive tract, except when it was out of whack. She might never have enrolled in medical school, either, and she almost certainly would not have written a best-selling book about digestion last year that has captivated Germany, a nation viewed, fairly or not, as exceedingly anal-retentive.

Back in 2007, after a series of mostly ineffective treatments prescribed by doctors, Ms. Enders, then 17, decided to take matters into her own hands. Convinced that the illness was somehow associated with her intestines, she pored over gastroenterological research, consumed probiotic bacterial cultures meant to aid digestion and tried out mineral supplements.

The experiments worked (although she is not sure which one did the trick), leaving her with healthy skin and a newfound interest in her intestines. “I experienced with my own body that knowledge is power,” she writes of the episode in “Gut: The Inside Story of Our Body’s Most Underrated Organ,” which was published in North America last month after its surprising success in Germany, where it has sold almost 1.5 million copies since its release in March 2014.

Inspired by her successful self-experimentation, Ms. Enders enrolled in medical school in 2009 at Goethe University Frankfurt and is now working toward a doctoral degree in microbiology there.

DURING a recent interview in a cafe here next to the Neckar River, not far from her childhood home, Ms. Enders, now 25, sipped chamomile tea and described with characteristic enthusiasm the first stomach operation she saw in person. “The whole body moves like this or like that, but the intestines move in entirely a different way,” she said. “It’s incredibly harmonious!”

Ms. Enders’s wonder at the strange ways of the gut is matched only by her incredulity at the limited public knowledge on the subject. “I’m almost shocked,” she recalled thinking during her first years in medical school as she learned, for example, that it is easier to burp lying on your left side than your right because of the position at which the esophagus connects to the stomach. “Why doesn’t everybody know this?”

In 2012, she began taking it upon herself to fill people in. She had heard about a student event space in Freiburg that was hosting a “science slam,” an open-mike event where young researchers give presentations, and decided to prepare a short lecture on digestion.

Onstage, Ms. Enders was bouncy and jocular, as a video of the event shows. She speaks rapidly, hardly able to contain her excitement, describing the components of the digestive system and lamenting its poor reputation.

“It’s really too bad, because the intestines are totally charming,” she says, citing as evidence the sophisticated communication between our inner and outer sphincter muscles and the some hundred trillion bacteria in our guts that facilitate digestion.

The crowd was smitten. Ms. Enders won the competition and went on to participate in two more science slams in Karlsruhe and Berlin. Soon, videos of her presentations were attracting attention online, and a literary agent contacted her about writing a book.

FANS have praised Ms. Enders for translating abstruse gastroenterological research into breezy, entertaining prose. On a talk show here last April, she described the large intestine as the “chiller” of the two because it processes nutrients at a leisurely pace of about 16 hours on average, compared with the two to five hours that the small intestine needs.

In her book, she catalogs the myriad elaborate operations that our guts dutifully perform every day, like the cleaning mechanism that kicks in a few hours after we eat and keeps the small intestine — all 20 or so feet of it — remarkably tidy. This “little housekeeper,” as Ms. Enders calls it, turns out to be the real source of the grumbling that most attribute to the stomach and mistake as a sign of hunger.

Then there is the growing body of research indicating that our intestines may have a far greater influence on our feelings, decisions and behavior than previously realized. The primary evidence for this, Ms. Enders writes, is the vast network of nerves attached to our guts that monitors our deepest internal experiences and sends information to the brain, including to those regions responsible for self-awareness, memory and even morality.

Just how much your lunch will affect ethical decision making remains unclear; we still know very little about this “gut brain,” as Ms. Enders refers to it. But this byzantine neural architecture suggests that our intestines may play a large part in determining who we are and what we do.

These essential but little-known features of our guts — our identities at their most raw and visceral, Ms. Enders suggests — have riveted Germans. The surprising popularity of Ms. Enders’s book has itself become a topic for discussion, with some commentators invoking Freud to explain Germans’ apparent fascination with their bowels. Profanity here tends to skew to the scatological, and Germans are, according to stereotypes, obsessed with order and neatness.

Ms. Enders dismisses such talk, noting that the book has also topped best-seller lists in Finland, the Netherlands and elsewhere. She suggests that its appeal lies in its frank treatment of topics usually left undiscussed. “Shame always disappears when you really understand something,” she said.

MS. ENDERS grew up on the outskirts of Mannheim, a sleepy city of almost 300,000 residents that was largely flattened by Allied bombs in World War II and filled back in with prim, modern buildings. Her parents split up when she was young, and her father was an irregular presence during her childhood. “You can only say Lebenskünstler,” she said to describe him — a term that means “life artist” and connotes a bohemian disregard for societal conventions.

Instead, it was her mother, a former documentary filmmaker, and grandmother who raised Ms. Enders and her older sister, now a graphic designer based in Karlsruhe who contributed illustrations to the book. Her grandmother, an interpreter by training, proved particularly influential. “She showed us very early on that intellectuality doesn’t have to be so serious,” said Ms. Enders, who recalled free-form games of chess with her grandmother in which they ignored half of the rules.

But Ms. Enders’s interest in science is relatively new. She was, by her own assessment, a mediocre student in elementary school, owing mostly to self-described boredom with the rote exercises in primary education. While her grades improved in high school, her fascination with medicine began outside the classroom, with the unexplained sores she had as a teenager.

By her own account, Ms. Enders’s sudden fame has not changed her life very much. She still shares the same apartment in Frankfurt with five friends. She recently completed a state medical exam and will soon begin a yearlong residency at a hospital.

She does not have any immediate plans to write another book. “If I have that feeling again,” she said, referring to her surprise at how little most people knew about digestion, “then I’d do it. But only then. And if that feeling doesn’t come, then hopefully I’ll just be a good doctor.”

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cultivate, express, happiness, hood river midwife, hood river naturopath, journal, mental health, naturopath, write

Keep a One-Sentence Journal, Be Happier

UnknownEver since I can remember, my grandma has kept a daily journal. Not a “Dear Diary,” emotion-filled journal — just a couple of lines jotting down what she did that day and whom she was with. Often, when the family is together, she’ll dig out one of her old journals and tell us what she and various other family members were doing on a random day, in, say, 1994. I’ve always been amazed at how interesting these little moments are in retrospect.So this morning, as I listened to the newest episode of Gretchen Rubin’s “Happier” podcast, I was intrigued to hear her urge her listeners to adopt the habit my grandma has been following for years. Rubin calls it a one-sentence journal, and she herself has kept one for nearly a decade now. On her show, she talked about how she believes that reliving those daily moments has helped make her happier.

There’s even some research backing up Rubin (and my grandma) on this: Last year, Ting Zhang at Harvard Business School published a paper in Psychological Science outlining a series of experiments testing how much people appreciate memories of the day-to-day moments from their lives. She asked people, for example, to write about a recent conversation, and then to rate whether the chat was ordinary or extraordinary; they then guessed how much they’d appreciate reading their written account of the chat in the future.

Seven months later, Zhang contacted participants, asked them to read the memory they’d written down, and then to tell her how much they enjoyed it. Not only did most participants enjoy rediscovering the written record of the months-old conversation more than they’d anticipated, but those who’d written about an ordinary conversation were particularly likely to underestimate how much they’d appreciate reliving the memory.

What seems like an ordinary moment today, in other words, could become a little more special with time. As one participant in Zhang’s study said, “Re-reading this event of doing mundane stuff with my daughter has certainly brightened my day. I’m glad I chose that event to write about because of the incredible joy it gives me at this moment.”

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alternative medicine, columbia gorge, homeopathy, hood river midwife, hood river naturopath

FDA Ponders Putting Homeopathy To A Tougher Test

Katherine Streeter for NPR

Katherine Streeter for NPR

It’s another busy morning at Dr. Anthony Aurigemma’s homeopathy practice in Bethesda, Md.

Wendy Resnick, 58, is here because she’s suffering from a nasty bout of laryngitis. “I don’t feel great,” she says. “I don’t feel myself.”

Resnick, who lives in Millersville, Md., has been seeing Aurigemma for years for a variety of health problems, including ankle and knee injuries and back problems. “I don’t know what I would do without him,” she says. “The traditional treatments just weren’t helping me at all.”

Aurigemma listens to Resnick’s lungs, checks her throat and then asks detailed questions about her symptoms and other things as well, such as whether she’s been having any unusual cravings for food.

Aurigemma went to medical school and practiced as a regular doctor before switching to homeopathy more than 30 years ago. He says he got disillusioned by mainstream medicine because of the side effects caused by many drugs. “I don’t reject conventional medicine. I use it when I have to,” Aurigemma says.

Throughout his career, homeopathy has been regulated differently from mainstream medicine.

In 1988, the Food and Drug Administration decided not to require homeopathic remedies to go through the same drug-approval process as standard medical treatments. Now the FDA is revisiting that decision. It will hold two days of hearings this week to decide whether homeopathic remedies should have to be proven safe and effective.

“So this will be the first dose,” he says. “Then I’ll give you a daily dose, to try to get underneath into your immune system to try to help you strengthen your energy, basically.”

Homeopathic medicine has long been controversial. It’s based on an idea known as “like cures like,” which means if you give somebody a dose of a substance — such as a plant or a mineral — that can cause the symptoms of their illness, it can, in theory, cure that illness if the substance has been diluted so much that it’s essentially no longer in the dose.

“We believe that there is a memory left in the solution. You might call it a memory. You might call it energy,” Aurigemma says. “Each substance in nature has a certain set of characteristics. And when a patient comes who matches the physical, mental and emotional symptoms that a remedy produces — that medicine may heal the person’s problem.”

Critics say those ideas are nonsense, and that study after study has failed to find any evidence that homeopathy works.

“Homeopathy is an excellent example of the purest form of pseudoscience,” says Steven Novella, a neurologist at Yale and executive editor of the website Science-Based Medicine. “These are principles that are not based upon science.”

Novella thinks consumers are wasting their money on homeopathic remedies. The cost of such treatments vary, with some over-the-counter products costing less than $10.

Some of the costs, such as visits to doctors and the therapies they prescribe, may be covered by insurance. But Novella says with so many people using homeopathic remedies, the costs add up.

There’s also some concern that homeopathic remedies could be dangerous if they’re contaminated or not completely diluted, or even if they simply don’t work.

Somebody who’s having an acute asthma attack, for example, who takes a homeopathic asthma remedy, “may very well die of their acute asthma attack because they were relying on a completely inert and ineffective treatment,” Novella says.

For years, critics like Novella have been asking the FDA to regulate homeopathy more aggressively. The FDA’s decision to revisit the issue now was motivated by several factors, including the growing popularity of homeopathic remedies and the length of time that has passed since the agency last considered the issue.

The FDA is also concerned about the quality of remedies, according to Cynthia Schnedar, director of the FDA’s Center for Drug Evaluation and Research Office of Compliance. The agency has issued a series of warnings about individual homeopathic products in recent years, including one that involved tablets being sold to alleviate teething pain in babies.

“So we thought it was time to take another look at our policy,” Schnedar says.

The FDA’s decision to examine the issue is making homeopathic practitioners like Aurigemma and their patients nervous. “It would be a terrible loss to this country if they were to do something drastic,” he says.

He also disputes claims that homeopathy doesn’t work and is unsafe.

“There’s no question that it helps patients. I have too many files on too many patients that have shown improvements,” Aurigemma says, although he acknowledges some homeopathic products sold over the counter make misleading claims.

Companies that make homeopathic remedies defend their products as well.

“Homeopathic medicines have a very long history of safety,” says Mark Land, vice president of operations and regulatory affairs for Boiron USA, which makes homeopathic products. “One of the hallmarks of homeopathic medicines is safety,” says Land, who is also president of the American Association of Homeopathic Pharmacists.

“The potential risk [of greater FDA regulation] to consumers is if any change in regulation were to limit access to these products,” says Land.

That’s what worries Resnick. She says homeopathic remedies have helped alleviate a long list of health problems she’s experienced over the years. “Why would they want to take that away from us?” she says. “Let us have the freedom to decide what works the best for us.”

The FDA says this week’s hearing is just a chance to start gathering information to decide what — if anything — the agency should do about homeopathy.

For full story see: http://www.npr.org/blogs/health/2015/04/20/398806514/fda-ponders-whether-homeopathy-is-medicine

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add/adhd, adhd, hood river midwife, hood river naturopath, mental health, pediatrics

ADHD Not a Real Disease, Says Leading Neuroscientist

adhd

What do you think?

Alex Pietrowski, Waking Times One of the world’s leading pediatric neuroscientists, Dr. Bruce D. Perry, M.D., Ph.D, recently stated publicly that Attention Deficit/Hyper-Activity Disorder (ADHD) is not ‘a real disease,’ and warned of the dangers of giving psycho-stimulant medications to children.Speaking to the Observer, Dr. Perry noted that the disorder known as ADHD should be considered a description of a wide range of symptoms that many children and adults exhibit, most of which are factors that everyone of us displays at some point during our lives.

“It is best thought of as a description. If you look at how you end up with that label, it is remarkable because any one of us at any given time would fit at least a couple of those criteria,” he said.

Dr. Perry is a senior fellow of the ChildTrauma Academy in Houston, Texas, a highly respected member of the pediatric community, and author of several books on child psychology including, The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook–What Traumatized Children Can Teach Us About Loss, Love, and HealingandBorn for Love: Why Empathy Is Essential–and Endangered.

His comments are quite refreshing at a time when diagnoses for ADHD in the UK and the US are sky-rocketing and prescriptions of stimulant medications to children are also rising rapidly, with many parents and concerned activists growing suspicious of the pharmaceutical industry’s motivations in promoting drugs to children. Ritalin, Adderall, Vyvanse and other mind-altering stimulant medications are increasingly prescribed to children between the ages of 4 and 17.

Dr. Perry noted that the use of medications like these may be dangerous to the overall physical and mental development of the child, remarking on studies where these medications were given to animals and were proven detrimental to health.

“If you give psychostimulants to animals when they are young, their rewards systems change. They require much more stimulation to get the same level of pleasure.

“So on a very concrete level they need to eat more food to get the same sensation of satiation. They need to do more high-risk things to get that little buzz from doing something. It is not a benign phenomenon.

“Taking a medication influences systems in ways we don’t always understand. I tend to be pretty cautious about this stuff, particularly when the research shows you that other interventions are equally effective and over time more effective and have none of the adverse effects. For me it’s a no-brainer.”

Given that the problem of ADHD is complex and the term is more of a blanket term used to describe a wide range of behavioral symptoms, it is important to consider what the root causes of many of the symptoms may be before pharmaceutical intervention should be considered. Citing potential remedies, Dr. Perry suggested an approach that focuses attention on the parents and the child’s environment, while also recommending natural remedies like Yoga, and improved diet.

“There are number of non-pharmacological therapies which have been pretty effective. A lot of them involve helping the adults that are around children,” he said.

“Part of what happens is if you have an anxious, overwhelmed parent, that is contagious. When a child is struggling, the adults around them are easily disregulated too. This negative feedback process between the frustrated teacher or parent and dis-regulated child can escalate out of control.

“You can teach the adults how to regulate themselves, how to have realistic expectations of the children, how to give them opportunities that are achievable and have success and coach them through the process of helping children who are struggling.

“There are a lot of therapeutic approaches. Some would use somato-sensory therapies like yoga, some use motor activity like drumming.

“All have some efficacy. If you can put together a package of those things: keep the adults more mannered, give the children achievable goals, give them opportunities to regulate themselves, then you are going to minimise a huge percentage of the problems I have seen with children who have the problem labelled as ADHD.”

Many people may disagree with the assertion that ADD/ADHD should not be considered a disease, however, the fact remains that the myriad symptoms that are associated with these increasingly common ‘disorders’ can often be addressed and relieved without creating an addiction and dependency on pharmaceutical medications, which disrupt the mind and body in ways that are not fully understood or even researched.

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alternative medicine, medicine, naturopath

Doctor, Shut Up and Listen

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By 

HARRISBURG, Pa. — BETSY came to Dr. Martin for a second — or rather, a sixth — opinion. Over a year, she had seen five other physicians for a “rapid heartbeat” and “feeling stressed.” After extensive testing, she had finally been referred for psychological counseling for an anxiety disorder.

The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.

Betsy’s case was fortunate; poor communication often has much worse consequences. A review of reports by the Joint Commission, a nonprofit that provides accreditation to health care organizations, found that communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.

A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms. Evidently, we have a long way to go.

Three years ago, my colleagues and I started a program in Harrisburg designed to improve doctors’ communication with their patients. This large urban hospital system serves a city with a population of about 50,000, together with the surrounding metropolitan area of more than 550,000 people.

The hospital faces particular challenges: The city has a high poverty rate (32 percent, compared with the state average of 13 percent), and the metro area has a high rate of childhood obesity. Over all, nearly a third of people around Harrisburg are uninsured, compared with about one in 10 for the rest of Pennsylvania.

Our project started with a simple baseline assessment of how we as doctors communicated with our patients. Observation soon revealed that physicians introduced themselves on only about one in four occasions. And without an introduction, it’s no surprise that patients could correctly identify their physician only about a quarter of the time.

Brief, rushed physician encounters were common, with limited opportunity for questions. A lack of empathy was often apparent: In one instance, after a tearful patient had related the recent death of a loved one, the physician’s next sentence was: “How is your abdominal pain?”

We developed a physician-training program, which involved mock patient interviews and assessment from the actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a “physician coach” to sit in on real patient interviews and provide feedback.

Over the next two years, patient satisfaction with doctors, as measured by a standard questionnaire, moved the hospital’s predicted score up in national rankings by a remarkable 40 percentile points. Several studies have found a correlation between higher patient satisfaction scores and better health outcomes. In one, published in The New England Journal of Medicine, Harvard health policy researchers reported that higher patient satisfaction was associated with improved outcomes for several diseases, including heart attacks, heart failure and pneumonia.

The need to train and test physicians in “interpersonal and communication skills” was formally recognized only relatively recently, in 1999, when the American Board of Medical Specialties made them one of physicians’ key competencies. Although medical schools and residency programs then began to train and test students on these skills, once physicians have completed training, they are seldom evaluated on them. And doctors trained before the mid-1990s have rarely, if ever, been evaluated at all.

I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time. But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine.

A passionate diabetes specialist told me how she sat down with a patient to understand why he was not using his diabetes medications regularly, despite numerous hospital admissions for complications.

“I can’t continue to do this anymore,” he told her, on the verge of tears. “I’ve just given up.”

She placed a hand on his shoulder and just sat with him. After a pause, she said: “You have a heart that still beats, and legs you can still walk on — many of my patients don’t have that privilege.”

Five years later, recalling this episode, her patient credits her with inspiring him to take better care of himself. The entire encounter took less than five minutes.

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babies, infants, midwife, sleep

Study shows babies who cry it out remain stressed

The babies learned to be quiet but did not learn how to actually feel calm

A new study offers more reason not to practice “crying it out” with babies.

Researchers at the University of North Texas monitored the cortisol levels of crying babies and their mothers over five nights when the infants were undergoing sleep training in order to learn to “self-settle.”

The researchers found high levels of cortisol, a stress hormone, in both the mothers and the babies during the times the babies were crying. After several days, the babies learned to go to sleep without crying.  Researchers found that during these quiet nights, the mothers no longer had high cortisol levels but the babies’ cortisol levels remained high. They had merely learned to remain quiet while distressed.The study found:

“On the third day of the program, results showed that infants’ physiological and behavioral responses were dissociated. They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated.”Lead researcher Wendy Middlemiss told the UK’s Daily Mail:

Although the infants exhibited no behavioural cue that they were experiencing distress at the transition to sleep, they continued to experience high levels of physiological distress, as reflected in their cortisol scores.

“Overall, outward displays of internal stress were extinguished by sleep training. However, given the continued presence of distress, infants were not learning how to internally manage their experiences of stress and discomfort.”The researchers noted that this was the first time the mothers and babies had not been in sync emotionally. The mothers no longer had high stress levels, not realizing that their babies were still just as upset.

For help with your child’s sleep issues see your local naturopath or make your appointment with Dr. Katherine Walker

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