How do I select a Practitioner?

I want to become a doctor to help correct the way medicine is being practiced, I am tired of medicine by the numbers, or standardized treatments for complicated conditions.  When I explain to my family and friends the reasons I moved across the country to become a Naturopath, they get super excited and then they ask me “Where can I get a doctor like that?”

Unfortunately, the number of sick people is far greater than the amount of practitioners that are available. And even if you have a practitioner, maybe you just visit your doctor once per year to get “your numbers” or when you have an acute condition. How will you find a practitioner that is concerned with true preventative medicine? Or, maybe you developed a chronic condition such as cancer, MS, Alzheimer’s, diabetes, etcetera, and you want to look at complementary options.

In this blog post series, I will talk about some important guidelines I have shared with family and friends to help them find a practitioner. In this first part, I will discuss how to select a qualified practitioner and some pointers that I believe help identify effective practitioners. Part two will cover the different practitioners that could be part of your quest for health, and why I believe evolutionary science is more important than the letters after your practitioner’s name. Finally, on the last part of the series, I will discuss how your practitioner should tackle disease. I hope you find the series helpful.

Over a period of years, I was able to identify that wheat does not agree with me, that some carbohydrates are better in smaller doses and that my lipid profile looks better when I use avocado oil (monounsaturated fat) over coconut oil (saturated fat). This came after countless hours reading through literature, listening to podcasts and self experimentation. But, not every one has the luxury (or the patience) to experiment. I am reasonably healthy, and my health has been more like a fun project to look for ways to optimize my performance.  Even after being able to correct most of my ailments, I still need a practitioner to care for me.

“The doctor who treats himself has a fool for a patient.”

-William Osler

In order to find my practitioner, I had to do a ton of investigation. I don’t have time or patience to explain to my practitioner the reasons I eat paleo, and I don’t want my practitioner telling me to eat low fat or to “eat healthy”. I especially don’t want a practitioner who will make me feel like I am crazy or that I am problematic or hypochondriac.

Let me be clear, everyone needs a practitioner. You need a person that makes the observations from the outside, and can make recommendations without bias. In order to achieve perfect health, we should seek advice from a qualified and licensed professional practitioner. Your practitioner should be up to date with the current literature, and your practitioner should be willing to work with you in order reach the lofty goal of health.

When looking for a practitioner, we should look for someone that is accredited by a reputable body. Where do we find these “unicorns”? It might take some digging, looking through websites such as “AANP” or the “Paleo Physicians Network” might be a good starting point. Once you identify someone, then the fun begins. Making a phone call to the office might give you an insight on their philosophy of practice. Many times they might offer a free over-the-phone consult or a brief one-on-one introductory meeting.

Maybe you selected a particular practitioner to try complementary therapies for a chronic condition. If that is the case, they probably have appeared on podcasts, given interviews or presented their theories at conferences. Before your consult, you as a good patient, could listen to the presentations and get a better idea of the way they practice.

Your doctor should be your ally, not your boss. Your practitioner should understand limitations to your diet choices, such as your job, your exercise concerns, religious beliefs, etc. A good practitioner should be able to accommodate your needs; they should be able to prepare an action plan that will be achievable. That does not mean that they should be “pushovers”, your practitioner might have legitimate reasons for strict guidelines.

For example, even though I have some level of gluten sensitivity, my life is not going to come to a halt if I accidentally consume some gluten. On the other hand, a person suffering from cancer, seizures or autism could derail months of progress by careless gluten cross-contamination. In those cases, a good practitioner should be able to explain with concise and clear language the importance of his recommendation.

I have overheard stories of practitioners asking questions like “what is your favorite thing to eat?” Or “what is the one thing that you can’t live without?” and then asking their patient to stop eating or doing that item. The theory is that if a patient agrees, it will gauge the level of commitment or compliance. Such practices raise red flags for me. If your practitioner asks you to modify your diet, to add a supplement or to change something in your daily routine, they should have a good reason other than to test your metal.

The medical community is not free from “that’s just the way we’ve always done it” style practices. I am learning so much everyday in school, and very often I just put it in the back of my head. That does not mean that I should not be liable for understanding all that I learn, but it becomes overwhelming. A good practitioner will always investigate common practices, and improve or change them as legitimate evidence arises.

Before this post gets overly lengthy, look for a practitioner with compassion. Even though the healthcare profession is often rewarding, it can also be very frustrating. The most difficult part of treatment will always be habit modifications, and your practitioner should be compassionate and understanding even when you as a patient are not complying to the prescribed treatment.

I am constantly learning approaches for lifestyle modification from my professors, and it goes deeper than that. At AANP, I learned about mind-body techniques to remove mental obstacles to weight loss. I am also learning psychological approaches such as motivational interviewing to become a more effective practitioner.

In short, we should not take our health advice from infomercials, billboards, multi-level marketing operations or good old Dr. Google. We should look for a practitioner that is licensed, a practitioner who is up to date with research and a practitioner that is compassionate. In my next post I will explain why the philosophy of the practitioner is sometimes more important than the letters after a name. 

Autism: When nutrition could be the key.

Amino acid supplementation sounds like a strategy that a body builder might use to get jacked, but in reality, amino acids are used for more than just building muscle. Amino acids form proteins, and proteins form many different important molecules that are used in your body [1]. Sure, proteins build muscle but amino acids also form enzymes, neurotransmitters, can be used as energy and are essential for many biological processes.

It is not surprising that an amino acid imbalance could have devastating effects to a person’s health. When we think of an amino acid deficiency we might think about a protein deficient diet, but what if your body did not have the genetic code to create these important amino acids? [2]

At AANP I attended a talk on the importance of amino acid testing as a treatment for autism. It is fascinating how a simple amino acid can have so many devastating effects on the body, Dr. Jared Skowron spoke about the current methods he uses at his clinic to test for amino acid imbalances, and the different recommendations he makes that have changed people lives. [3]

During his talk I learned that eating a whole foods diet that includes easily absorbable protein could be enough to maintain a good balance of amino acids. There might be many obstacles to this absorption, for example, poor digestion, low quality protein, intestinal permeability [4] or even genetic mutations that prevent you from using these building blocks.

What I took from that talk is that nutrition is very complicated, and you could have a perfect diet but you could still have obstacles that are not addressed by your diet. Yes, you should correct your diet and try to eat the healthiest and most anti-inflammatory diet you can achieve, but what if your diet does not get you to an optimal state of health? That’s where practitioners become indispensable, a trained physician will be able to order labs, diagnose and suggest strategies to correct the underlying problem. Does that mean that we can supplement ourselves out of sickness? No, what it means is that in specific diseases, you might need some supplemental amino acids that you might not be able to get from a normal diet.

My biggest take was, that sometimes difficult diseases such as autism could be just a couple of amino acids away from a resolution. It makes me so excited to be in a profession that allows me to think outside the box, and eventually it will let me help those patients that many think are beyond help.

1.-  Erdmann, R. & Jones , M., (1987) The Amino Revolution, First Fireside Edition, p2.

2.- http://www.nature.com/news/amino-acid-deficiency-underlies-rare-form-of-autism-1.11375

3.- http://www.naturopathicanswer.com/naturopathic-medicine/dr-jared-m-skowron-n-d/

4.- Rapin JR, Wiernsperger N. Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine. Clinics (Sao Paulo). 2010;65(6):635-43. 

The August Wrap up

What a crazy month! My month started with a bang, in between experiments and preparing for presentations I had to take my first set of boards, the dreaded NPLEX. NPLEX tests everything you learn during the first two years of naturopathic medical school. I decided to approach this huge test by dedicating a minimum of five hours every day to review the material learned. I used videos (The Pathoma videos helped me through GENMED class), flash cards and the USMLE Step One (this was invaluable to my preparation) to make sure I covered as much material from different perspectives. All in all it was a beast. But the test came, and my preparation paid off. All those quizzes, midterms and finals served a purpose, and thankfully, that was over.

Then the real fun began. The following week I flew to Oakland California and had the privilege of presenting at the 30th annual convention of the American Association of Naturopathic physicians. The conference was amazing; I learned many pearls of wisdom from practitioners and profession elders, I learned about new treatments for autism and even witnessed a hookworm inoculation for the treatment of autoimmunity. Dr. Mark Davis gave a fantastic presentation on fecal transplants and Dr. Jaren Skworon shared his experience using amino acids to treat autism spectrum disorder.

My presentation took place on Friday evening, and it focused on the bulk of my research at the Southwest College of Naturopathic Medicine. I presented on the Antibacterial Activity of Botanical Tinctures, and their Possible Mechanisms of Action, the presentation was well received and I received a ton of support for our work!