There was a time when naturopathic doctors (NDs) were not legally recognized as healthcare providers in the state of Colorado. But nobody would’ve guessed it from the turnout at the Colorado Association of Naturopathic Doctors (CoAND) annual conference this week. On Saturday, November 10, nearly a hundred clinicians gathered at the DoubleTree Denver Tech Center in Greenwood Village, CO, to network, learn, and share the latest research on naturopathic approaches to health.

Most of the attendees at the conference were registered NDs in the state of Colorado. These clinicians have graduated from an accredited naturopathic medical school and passed the national science and clinical board exams. There are currently 130 registered NDs in the state of Colorado – which became the 17th state to recognize NDs in June of 2013. 2018 marked the 6th annual gathering and conference for the CoAND.

Under the overarching theme of “Overcoming a Challenged Immune System,” presenters spoke about topics that included rapid-response herbs, mucosal immunity, inflammatory arthritis, and the modulation of lipopolysaccharides. Attendees earned up to 7.5 continuing education units and had the opportunity to meet with sponsors and exhibitors. The presentations were professional, thoroughly researched and referenced, and actionable. Read on for some of the highlights and clinical pearls from this fabulous conference.

Mary Bove, ND

Differential Applications of Botanical Agents

Dr. Mary Bove, ND, set the tone of the conference with an in-depth discussion of echinacea and other herbs to employ in the early stages of a cold, flu, or other infection. Dr. Bove categorized these herbs as “rapid-response remedies” and emphasized the importance of taking them every 2-4 hours while awake (for 5-7 days) to support the best immune response.

Dr. Bove dove deep into the science of botanical remedies. She explained that the active compounds in echinacea depend on the time of year and the part of the plant harvested. The early buds of spring are rich in arabinogalactans and best used for ongoing immune support. The roots, harvested in the fall, contain large amounts of alkylamides, which have potent anti-inflammatory effects and are best used at the onset of an acute infection. Alkylamides are unstable compounds, but the process of supercritical extraction creates products that are stable for up to 18-24 months.

Dr. Bove cited research that taking Echinacea purpurea for four months reduced recurrent respiratory infections, that a standardized extract of echinacea prevented respiratory symptoms with airline travel, and that a Cochrane review found some evidence that echinacea might be effective in the early treatment of colds. She also described rapid-response botanicals that synergize with echinacea, including black elderberry (Sambucus nigra), andrographis (Andrographis paniculate), and Pelargonium sidoides. With Dr. Bove’s permission, we are sharing her recipe for black elderberry gummies.

Black Elderberry Gummies

(recipe from Mary Bove, ND)

Servings per recipe: 18*

Preparation time: 25 minutes plus freezing time

Ingredients:

• 1 cup acai juice, or another juice with no added sugar
• 1 tablespoon agar agar
• 1 tablespoon local honey
• 1 (3-ounce) bottle black elderberry syrup

Preparation:

• Combine and stir the juice, agar agar, and honey in a small pan over low heat until agar agar is completely dissolved
• Remove from heat and add the black elderberry syrup
• Pour into silicon molds or an 8x8 glass dish with parchment that is coated with coconut oil
• Place in freezer for about 30 minutes, until firm
• Remove from freezer and pop out of molds or cut into squares
• Store on parchment, inside an airtight contain in the fridge for up to one week

* Each serving contains 1 teaspoon of black elderberry syrup. One serving can be taken per day to support immune function throughout the winter.

Eric Dorninger, ND, LAc

The Neuroendocrine Immune Web of Mucosal Immunity

Dr. Eric Dorninger, ND, LAc, described mucosal immunity to be “like the foam pad you put on a mattress” – creating a barrier that cushions our internal bodies from the infectious and toxic exposures of the outside world. To best support mucosal immunity, he asserted that we need to support the diversity of the gut microbiome. He showed that if you have gut diversity, you make cell signaling byproducts that balance inflammation, metabolism, and immunity. He cited extensive research to show that gut microbiome diversity is predictive of the risks of asthma, allergies, eczema, rhinitis, chronic immune-mediated inflammatory disease, type 1 diabetes, obesity, and more.

Dr. Dorninger listed his “Fab Five” ways to support the microbiome and mucosal immunity: omega-3 and short-chain fatty acids (SCFAs); prebiotics (vegetable fibers); probiotics; fat-soluble vitamins; and glutathione. His presentation was heavy on research, citing evidence that SCFAs re-establish mucosal tolerance and may fight autoimmunity. He cited further evidence that glutathione is required for intestinal epithelial function and shared an excellent review of glutathione. An interesting clinical pearl from Dr. Dorninger was that anabolic steroid hormones (e.g., testosterone and DHEA) are necessary for adequate repair of a compromised gut lining.

In true Colorado spirit, Dr. Dorninger gave a shout-out to Dr. Charles Lowry (a researcher at CU Boulder who studies the microbiome) and Joseph Henderson (a farmer in Longmont who sells camel milk).

Tyna Moore, ND, DC

Naturopathic Considerations and Treatments of Inflammatory Arthritic Conditions

Dr. Tyna Moore, ND, DC, reviewed the hallmark signs that differentiate the various arthritic conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, Reiter’s syndrome, enteropathic arthritis, systemic lupus erythematosus (SLE), and osteoarthritis. She highlighted the many arthritic conditions that occur in the context of an infectious agent or intestinal disorders: Reiter’s syndrome follows infection with an STD, enteropathic arthritis develops in people with ulcerative colitis or Crohn’s disease, and ankylosing spondylitis often occurs in patients with a Klebsiella infection.

In addition to these classic examples of joint problems associated with infection or digestive disturbance, Dr. Moore proposed that other arthritic conditions might also follow in the wake of intestinal disturbance. She cited research to show a connection between spondyloarthropathies and intestinal inflammation and the well documented association between rheumatoid arthritis and intestinal permeability. She referenced Dr. Alessio Fasano’s 3-component recipe for autoimmune disease: a genetic predisposition, an environmental factor, and a breach in digestive barrier function.

Dr. Moore summarized her protocol to quell inflammation in the joints, which included avoidance of sugar, following an anti-inflammatory diet, supporting the microbiome and the mitochondria, and avoiding stress, exhaustion, and “cortisol bursts.” She strongly advocated for more strength training and less cardio exercise to optimize lean muscle mass and calm the inflammatory response. For those new to strength training, she recommended kettle ball training with a personal trainer from Strong First. Dr. Moore also teaches practitioners how to do regenerative joint injections. She highlighted clinical pearls for any clinician who might refer a patient for joint injections and most strongly emphasized that prolotherapy, stem cell therapy, and other injectable therapies should always be done between (away from) symptom flares.

Erin Stokes, ND

Blood Builder Clinical Study Results

Dr. Erin Stokes, ND, presented research on behalf of MegaFood® and Innate Response™ Formulas. Blood Builder® is the name of the iron supplement produced by MegaFood® (and also called Iron Response™ by Innate Response™ Formulas). Research was recently conducted on this product at the University of Maryland School of Medicine and published in August of 2018 in the Journal of the American College of Nutrition.

The study was an open-label clinical trial of 23 premenopausal women with nonanemic iron deficiency. All of the participants had low serum ferritin (< 20 ug/L) and normal hemoglobin levels (> 12.0 g/dL) at baseline. All participants were given one tablet of Blood Builder® (providing 26 mg of elemental iron) per day for eight weeks. At the end of the trial, participants experienced significant increases in energy, no reports of gastrointestinal side effects, and significant improvements in all measurements of iron status. Their mean serum ferritin increased from 13.9 to 21.1 ug/L.

Blood Builder® contains iron bound in Saccharomyces cerevisiae (nutritional yeast), vitamin B12 bound in S. cerevisiae, vitamin C with organic oranges, folate with broccoli, and beet root. The 26 mg of elemental iron per tablet is lower than many iron supplements, but it is well within the range of the tolerable upper limit for women aged 19-50, which is 45 mg per day. The clinical trial presented by Dr. Stokes is the first of its kind to show that this FoodState® iron effectively promotes healthy iron levels.

Yvan Rochon, PhD

Effective Use of Botanicals in Prevention and Treatment of Infection

Dr. Yvan Rochon, PhD, described humans as “small, moving ecosystems” and plants as “small, nonmoving ecosystems.” Like humans, plants have a microbiome, similar biochemical pathways (such as the breakdown of tryptophan), and similar receptor families (such as the ATP binding cassette super family). Phytoestrogens are a good example of related compounds produced by both humans and plants, but do you know what benefit plants get from phytoestrogens? Dr. Rochon explained that plants release phytoestrogens into the soil to attract good bacteria to their roots via chemotaxis.

Dr. Rochon’s presentation covered more than a dozen botanicals with antimicrobial properties, but here was one of his major themes: our medical ancestors were clinically brilliant, and science is now confirming what traditional practitioners have understood about plants for centuries. He cited research from 2006 that confirmed what was stated about Astragalus back in 1247 and research he conducted with the Southwest College of Naturopathic Medicine that established in vitro mechanisms of action of a 19th century botanical remedy for smallpox.

After detailing the antimicrobial effects of Andrographis paniculata, Scutellaria baicalensis, Epimedium koreanum, Ligustrum lucidum, Camellia sinensis, and more, Dr. Rochon touched on the importance of formulation. Herbs with antimicrobial properties can be combined with herbs that support immune “cleanup” after an infection, herbs that support a healthy microbiome, and herbs that support the tissue or organ affected by the disease. He concluded with three different ways to use herbs to support immunity: at the first sign of sickness (the “rapid response” described by Mary Bove), immune enhancement (through the winter months to strengthen immunity), and immune shielding (during times of exposure, such as airline travel).

Cheryl Burdette, ND

Modulation of Lipopolysaccharides (LPS) and Immune Regulation

There had been a lot of talk of mucosal immunity, intestinal barrier function, and autoimmunity by the time Dr. Cheryl Burdette, ND, took the stage. But she took things a step further. She asked the question, “what is the stimulus underlying the connection between gut health and immune dysregulation?” She proposed that the answer is lipopolysaccharide (LPS). She revealed that researchers induce autoimmune disease in mice by injecting LPS. She cited research to show that LPS is a marker of intestinal permeability and linked to autoimmune disease, heart disease, and obesity.

Lipopolysaccharide (LPS) is a bacterial endotoxin from gram-negative bacteria. It upregulates toll-like receptors (TLR), makes macrophages and other immune cells more active, increases production of interleukins and cytokines, and increases inflammation. The result is an increased Th17 response and a greater need for T-regulatory (Treg) response to bring the inflammation back into check. You can measure the immune response to LPS in the blood, where the LPS IgA, IgM, and IgG should not be too high or too low.

Dr. Burdette highlighted several naturopathic approaches to addressing LPS levels and normalizing Treg function. She suggested using berberine to act as an LPS antagonist, decrease the downstream effects on cytokines and interleukins, and protect against LPS-mediated intestinal injury. She also cited research to show that berberine inhibited MRSA biofilm formation. Other supplements she suggested to support balanced Treg function included andrographis, curcumin, coenzyme Q10, resveratrol, vitamin D, and vitamin A. She cited a new study that showed the essential fatty acid, eicosapentaenoic acid (EPA) reduced the expression of LPS-induced cytokines.

Bill Blanchet, MD

Stopping Heart Disease

Dr. Bill Blanchet, MD, wrapped up the day with a discussion of cardiovascular risk reduction. He challenged the current paradigm of conventional cardiology, which relies on the Framingham risk factors to determine who needs to be treated for high cholesterol or high blood pressure and then performs stress tests and treats with coronary stents or bypass surgery. He claims that this approach is not serving Americans well. A shocking 62.4% of people presenting with acute coronary syndrome have only 0-1 major Framingham risk factors; statins are not always the answer; nuclear stress tests are normal in 80% of patients with advanced coronary artery disease; and stents reduce symptoms of angina but have no effect on coronary death.

Dr. Blanchet proposed that electron beam tomography (EBT) coronary calcium imaging assesses risk better than the Framingham criteria. He cited the St. Francis Heart Study as evidence that EBT coronary calcium is an “independent and incremental predictor of risk for coronary events.” He also cited research to show that an EBT coronary calcium score over 100 is the greatest predictor of heart disease and more predictive of heart attack than atherosclerotic plaque burden. Finally, he showed that the progression of EBT coronary calcium score over time correlates with risk.

Dr. Blanchet made some suggestions for how to support cardiovascular health in patients who demonstrate risk. For example, he referenced a study that showed daily walking at a pace of 3 miles per hour reduces cardiovascular risk. He talked about the need for healthy fats rather than a lack of fats in the diet. But more importantly, he emphasized that the EBT coronary calcium score is a useful way to monitor a person’s response to lifestyle changes or medical interventions.

That’s a wrap!

If you have made it this far in the article, you might feel like I did by the end of this conference: a complex mix of inspired, dazed, and informed. All seven of the presentations were packed with information, research, and clinical pearls.

If you live in Colorado or can easily travel to Denver, this annual conference is one you might want to put on your schedule for 2019. You can stay up to date by visiting the Colorado Association of Naturopathic Doctors website.