Crux Health

So it’s been a while since I’ve written here, but that’s mostly because as soon as school let out for the summer I’ve been off on adventures of one kind or another. This is the only summer in our med program that we get off, so I’ve been trying to make the most of it.

I’ve noticed that, even as pale as I am, in the sunny weather I still manage to tan (or at least be a darker shade of pale), and it started me thinking back to all we learned about  Vitamin D this year. 

Vitamin D is an essential nutrient that, among other things, heavily regulates calcium absorption in the intestine. Without vitamin D we would not absorb enough calcium and as a result would have bone health issues from an early age (rickets, etc.),  as well as being at a higher risk for autoimmune disease, cancers and cardiovascular disease.

                                                       Vitamin D3 (Cholecaliferol)

We primarily synthesize vitamin D from sun exposure: ultraviolet radiation causes a chemical change in a cholesterol derivative (7-dehydrocholesterol, for my chemically inclined readers), creating what we call vitamin D3 (cholecalciferol). D3 is absorbed through the skin and transported in the blood to the liver and finally the kidneys before it is the active form of vitamin D known as calcitriol. Calcitriol acts on the intestines to up-regulate the absorption of dietary calcium, which as you might imagine, is incredibly important for bone health and other metabolic processes.

You can also get some vitamin D from plant sources, but even if a food has been specifically fortified with D, it is difficult to get enough without making your own from sun exposure!

The vitamin D3 that you make on your skin from sun exposure is an oil-soluble molecule which stays in your skin’s natural oil layer before being absorbed. Furthermore, full absorption can take up to 48 hours, and during this time you can lose vitamin D by washing it off your skin (such as scrubbing your body with soap). So use less soap (or don’t soap your whole body - especially those areas that have been exposed to the sun)  when you shower to spare some of your vitamin D!

I haven’t written anything here in a few weeks; midterms followed closely by finals have kept me rather busy, and that’s given me a opportunity to think about self-care in the context of the whole monolithic Med School thing.

It’s been so easy to de-prioritize taking care of myself when I can fill every minute with studying for X or reading paper Y or working Z shifts at the clinic. But emphasizing academic performance over my own well-being is not sustainable (nor will it make me a better physician in the long run). So, even though it is finals week I wanted to give myself enough slack to take a moment or two to eat a real meal, write a blog post, and just exist independent of biochemistry and medical microbiology.

A salad was sounding good to me today, since I’ve been looking for ways to increase my vegetable intake while reducing sugar. Noting makes you question your diet quite like learning exactly how the body processes each and every thing you eat… So, I dug up this recipe my mom gave me a while back (thanks ma!), and wanted to share it with you, should you need a momentary respite as well:

Self-Care Salad

Ingredients:

• 1 large handful of greens
• 1 orange, peeled and sectioned
• 1/2 red onion, coarsely chopped
• 1 package extra firm tofu, cut into 1/2-inch strips

Marinade/Dressing:

• 1/3 cup olive oil
• 2 Tbs apple cider vinegar
• 1 and 1/2 Tbs honey
• 1 tsp salt
• 1/2 tsp cumin
• 1/2 tsp pepper
• Dash of cinnamon
• Cayenne powder, to taste

Mix the dressing ingredients together and use approx. 1/2 of the dressing to marinate the tofu. Let rest in the fridge for 30 min. (try not to use this time to cram for a test; relax for a minute or two first). After marinating, sear the tofu in a pan over medium heat, around 5 minutes per side, or until golden brown. While it’s cooking, put greens in a bowl and toss in the onion and orange. After the tofu is cooked and has cooled for a moment, top the salad with a few strips and add a couple spoonfuls of dressing.

Easy, healthy and quick to throw together, this was just the meal I needed today! Enjoy!

One of the criticisms often levels at “alternative” medicine is that there isn’t enough research going into the treatment modalities. I agree with the statement — we do need more research — and as the field grows so does the opportunity to have access to research funding (funding being a large hurdle in all areas of research. Large, well-controlled studies are notoriously expensive to run and analyze). 

In contrast, I was reading this article on a new weight-loss drug called Qnexa. The drug was rejected by the FDA over concerns that it increased risk of birth defects and heart problems. Those FDA reports can be found here. The company which created the drug, Vivus, wants to do further research on the risks, but that will take several years to complete. Years where the millions of potential customers will have to resort to barbaric methods such as eating vegetables and exercising rather than being prescribed a drug that is a combination of a stimulant and epilepsy medication. 

There were two points in the article that I thought were of specific interest: 

1) The company that owns the drug patent is pushing the FDA to approve the drug anyway, and promising to do the research after the fact. I wonder if Vivus understands that’s not how research works. You can’t start at the conclusion that the drug is safe and then do research that looks for the ways it is safe. 

2) Doctors can, and are, already prescribing the equivalent of this drug by combining prescriptions for the two main ingredients. This is called “off-label” use, and common practice for a drugs which are FDA approved for one condition, but may be useful in treating another.

So what we see here is that the FDA is coming out and saying that this drug is unsafe and refusing to approve it for use - but the company that developed it (and stand to profit extensively from it’s approval) wants it to be signed off on regardless of the risks on the premise that they will do the research afterwards.

These are not acceptable research standards, and I hope that the FDA stands by it’s decision.

We’ve been covering fat synthesis in biochemistry the last few weeks, and it’s been interesting to learn how various dietary changes will affect how much fat a person makes.

First of all; we need fats! They make up our cell membranes, hormones, neural tissue and allow us to store energy. Most of the fatty acids we store (as triglycerides in our fat cells) actually come from the sugars we eat. After breaking down a sugar molecule, some of the byproducts will be shunted to a new enzyme complex to be made into fatty acids. This process is enhanced by insulin, the hormone our bodies release when we’ve eaten sugars. Once the fatty acids are made, they are attached to a glycerol backbone and transported to fat cells for storage.

This system makes a lot of sense for us, since in human natural history we generally haven’t had an overabundance of food - so storing extra energy for later would allow us a safety margin between meals. Our brain and muscles use an incredible amount of energy, and being able to fuel these systems with stored reserves of fat is hugely important. Of course, now that we don’t have to hunt and gather our food, this energy storage mechanism can work against us if we over-eat sugary (or fatty) items. But the fact that we can eat ‘fat-free’ foods and still synthesize fat molecules shows us how important fats really are for a healthy body! 

Since being accepted to a naturopathic medical program, I’ve discovered that, even here in Oregon, most people haven’t heard of (and consequently don’t know about) Naturopathy. Usually the first follow-up question when I explain what school I go to is “So you just use herbs and stuff?”

Well, yes, we are trained in herbalism and nutraceuticals, but what isn’t as publicized is that the education included pharmaceuticals and in many states an ND’s scope of practice includes full Rx privileges. 

So what is naturopathy then? How is an ND different from an MD?

The shortest answer is that naturopathy is a medical philosophy centered around the idea that the body, when properly supported, is capable of healing itself of almost any ailment. Our training as naturopaths is based in treating not just the symptoms of a condition but the whole individual. The modalities we are trained in are designed with this in mind. As one professor put it, when describing treatments: “The closer to nature, the better.”

Of course, if someone has a case of sepsis, antibiotics are an immediate necessity. I do not fall for the naturalistic fallacy that just because something is “natural” it is inherently good; there are a great many deadly things in nature and we are wise to acknowledge this. What makes naturopathy different from “conventional” western medicine is the emphasis on preventative care, lifestyle changes and holistic approach. Why prescribe a lifetime of insulin therapy for a Type-II diabetic when permanent dietary and lifestyle changes have the potential to control the condition, while at the same time increasing overall health. 

Naturopathy is a system of healing, one that I believe will continue to grow and develop as the primary healthcare paradigm shifts from treating symptoms to treating individuals, doing so as often as possible with natural alternatives to pharmaceutical intervention. I am grateful to be on the forefront of this movement as the healthcare fields continue to integrate, and I look forward to working with my future colleagues; ND, MD, DO, DC alike.