Natural Health Products (NHPs) Are Not Drugs. October 13, 2016Posted by Dreamhealer in Healing, Health, Supplements.
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Written by: Dr. Reuben Dinsmore
I know that I’m preaching to the choir here – if you have been to see a naturopathic doctor, there’s a very high chance you’ve benefitted from the recommendation of certain nutraceutical supplements along your treatment journey. And so I invite you to take a moment to add your voice to the ongoing consultation with Health Canada over whether or not NHPs should be regulated in the same way that drugs are.
I wholeheartedly agree that there needs to be clear regulations over any product that is being marketed for its health benefits. However, there are various reasons why it’s impractical and unnecessary to require manufacturers of NHPs to go through the same procedures as drug manufacturers.
First, drugs are typically single ingredient formulations, with a single or occasionally dual purpose – for example, acetaminophen for pain relief, and also for fever reduction. When combinations are marketed, as in a cold formula, each of the single ingredients undergo their own clinical trials to prove their efficacy in whatever health claim that ingredient is aimed at.
Many supplements, particularly herbal formulations, are designed to take advantage of the synergy between the various ingredients. Less often do we recommend a single remedy for a single purpose, as a main tenet is treating the patient as a whole instead of simply a symptom in a body system.
This becomes difficult, even impossible, to prove efficacy of a formula, as clinical trials are designed around single ingredients, to exclude all possible variables. In addition, supplements are intended to work over a longer time period than drugs – helping the body return to its natural state of health rather than pharmaceutically forcing it into an unnatural place. I’ve often asked patients to be patient – that they’ve often spent decades getting to their current state, so they shouldn’t expect me to fix them in a few weeks. The expense of running a clinical trial is difficult at best, for a product that typically can’t be patented and charged drug company prices for – this onus becomes even more difficult when a clinical trial needs to run over many months to determine efficacy.
Bottom line, changing the regulation requirements will increase prices of NHPs and would likely make access much more difficult – and for what purpose?
Please consider expressing your views, hopefully in opposition to this attempt to fix a system that isn’t even broken. You can read more and find contact information at the following site:
Tags: Alternative medicine, Diet, Health, lifestyle, naturopath, naturopathic medicine, supplements
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As we celebrate the advances that naturopathic medicine has been making, we also have to acknowledge the recent negativity being directed at our profession from certain groups within the medical world and their media minions. A recent tragic case in Alberta saw a couple being convicted of failing to provide the necessities of life for their young son, who died of bacterial meningitis in 2012. Over the course of this case, it was revealed that they had contacted one of our Alberta naturopathic doctors by phone, who had instructed her staff to tell them to take the child to seek emergency medical care. The next day, someone (who later turned out to be a member of the same family) came into her clinic to purchase an herbal immune support formula, something that would commonly be available over the counter at any number of natural pharmacies across Canada. However, subsequent to this, a group of Alberta medical doctors took it upon themselves to call for an investigation into the actions of the ND – the same ND who didn’t see the child, didn’t provide any medical advice other than to go to the ER, and didn’t provide any treatment.
Similarly, our friends at the Globe and Mail have been very active in displaying their bias against safe, natural medicine, doing their best to misrepresent facts to distort the truth. This brings to mind a CBC Marketplace “investigation” from a few years back, that claimed to answer once and for all, whether homeopathy was an effective health care modality. Luckily, they made it perfectly obvious that they didn’t consult a single person with any knowledge or training in homeopathy, as they designed their “study” in such a way as to render it utterly useless. An analogy I could make – if they took a prescription sleep aid, rubbed it on their forehead, then went to bed with it under their pillow – then came to the “scientific” conclusion that it didn’t work.
But most alarming was this editorial penned by Peter McKnight, a journalist whose training in anything medically related extends to an undergraduate degree in psychology. He attempts to convince his readers that Western medicine long ago threw out the notion of the “healing power of nature”, implying that the only thing standing in the way of the certain annihilation of the human race by disease is an army of white-coated medical doctors armed with their trusty prescription pads. If you find me one doctor who tells you that the human body doesn’t have the ability to heal itself, I’ll show you a doctor who is either ignorant or lying. Everyone (including every parent in the world) knows that the body will heal itself, as long as you remove whatever factor is in the way of that. And in fact – if that vis medicatrix naturae isn’t present, nothing any doctor does will have any effect on actually healing a patient, save for keeping them alive. If your kid scrapes his knee – you clean it well, keep it clean, and keep your child from picking at the obviously fascinating scab that will form – and it will heal. On its own. Extend that to a multitude of illnesses, and you’ll find that once you remove the obstacles to health (poor diet and lifestyle, lack of sleep, nutritional deficits, chronic assault from environmental toxins, stress, etc), for the most part, patients will return to a state of health.
A common complaint about naturopathic medicine is around safety and efficacy. They say that manufacturers of natural supplements aren’t required to demonstrate efficacy to Health Canada before having them approved for sale. But they are required to demonstrate safety. With regards to safety, I’m not aware of a single case of a patient dying as a result of any medical intervention by a licensed naturopathic doctor. Compare that to the statistic that medical error is now the third-leading cause of death in the US. Let he who is without a single dead patient cast the first stone, I say.
Regarding efficacy – let’s break this down a little. For medical doctors accustomed to using pharmaceuticals to force the body back into line, they typically see results on the order of days to a few weeks. If there’s no clear benefit in that time, you can conclude the treatment is ineffective. Applying that same quantifier to natural remedies is like comparing apples to oranges. As stated earlier, naturopathic medicine focuses on encouraging a return to health, through (for the most part) gentle interventions that gradually shift the body’s health on both a physical and energetic level. Most people I see have spent years or even decades gradually getting to their current state of ill health. Any intervention that claims to return them to health in a few days will not work, simply because once the medication is discontinued, the body will revert to the state to which it has become accustomed.
Furthermore, if you equate the efficacy of a treatment to a cure, we must consider how many classes of drugs actually purport to “cure” anything”. One notable exception would be antimicrobials for a bacterial or fungal infection. Go beyond that, and the cure rate drops significantly. Anti-depressants only work as long as people remain on the medication (assuming they work at all, or don’t make the condition worse). Statins artificially lower cholesterol levels, which return to pre-treatment levels upon discontinuation of the drug. Same with medications for high blood pressure, stomach acid levels, sleep and anxiety, the list goes on. Until the obstacles to health are removed, health will not be achieved.
In this, the stark difference between naturopathic doctors and medical doctors – the question “why?”. Why are these symptoms occurring? Naturopathic doctors aim to find and treat the cause of illness, rather than simply playing whack-a-mole with symptoms by prescribing one medication after another, often to simply treat the side effects created by the original drug.
So in conclusion, happy Naturopathic Medicine Week, to the tens of thousands of happy and healthy patients across Canada who attribute their good health to their naturopathic care, and to the growing group of allies within the conventional medical community – modern doctors and nurses who recognize the benefit to patients of collaborative and complementary medicine. To the rest of you – the dinosaurs who continue their desperate campaign to convince the public that you’ve got all the answers, that pharmaceuticals are the only way to go, and that under no circumstances, should they ever ask you “why” – it’s not too late to join the right side of history. The future of medicine will be found in the middle ground, currently populated with medically-focused naturopathic doctors and medical doctors practicing what they’ve termed “functional medicine” – where through a mixture of modern innovation and traditional healing we create a paradigm of health – instead of treating disease.
Naturopathic doctors – Medically Trained, but Naturally Focused.
Senior Health – It’s Never Too Late to Feel Better May 30, 2016Posted by Dreamhealer in best vancouver naturopath, Healing, Health, senior health.
Tags: Aging, digestion, energy, hair loss, Health, skin, sleep, stress, supplements, vitality
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People are living longer than ever nowadays. Our average life expectancy in Canada is now 82.4 years, an increase of 5 years just since 1986. Advances in medicine play a big part in this improvement – however, just because we’re living longer, are we still living well?
As we enter our sixties, all the aches and pains that have been visiting once in a while suddenly seem like they’re always there. We might get tired more easily, and not recover as quickly from exertion. Our digestion rebels a bit more often than it used to. Our medicine cabinet starts to look a pharmacy; (actually, it kind of looks like our parents’ medicine cabinet).
So what is it about getting older that ages us so much? And is this process absolutely unavoidable? Let’s look at how aging affects different body systems and what we can do to diminish it.
Caution: many natural supplements can interact with prescription medications in various ways. Some supplements can reduce the effectiveness of drugs, and some can actually increase the effectiveness of a medication. Although this might sound like a positive thing, your dose has been carefully selected by your doctor to maintain a certain therapeutic level in the body – a higher level can be harmful. If you are currently taking any prescribed medications, please speak to a health care practitioner who is well-trained in the safety and use of supplements and medications before starting to take anything new.
You’re not as young as you used to be, but there’s no reason you can’t feel like you are. You all know that one woman, maybe a neighbor or relative, who always seems to have lots of energy. What’s her secret? How can you have the energy to keep up with your grandkids, or just keep up with your own busy life?
The basic formula for more energy – get more, and lose less. Getting more involves a proper diet (including sufficient water) along with good digestion, to maximize the energy received from your food. Also important is getting enough quality sleep. And how to minimize energy lost? Chronic pain, repeated minor infections, mental and emotional stress – these are all insidious drains on your energy that can leave you feeling wiped out at the end of the day. For an extra boost – Vitamin B12 (along with other B vitamins) is used to produce glucose – the main fuel for the body – from the food we eat. And CoQ10 then helps the mitochondria in your cells turn that glucose into energy.
Skin & hair
Mark Twain said “Wrinkles indicate where smiles have been”. One of the things that contribute to wrinkles are facial muscles flexing in emotional expressions – joy, sadness, anger, excitement – the colours of life that make it worth living.
However, a few other things contribute too, and these are worth controlling. If you smoke, quit! It’s the worst cause of premature aging, both skin deep and throughout the body. Skin structure depends on collagen integrity, and vitamin C and hyaluronic acid are two things that go a long way to maintaining younger looking skin. As well, make sure you get your beauty sleep – it’s not just a phrase, it’s a real thing. And there are even supplements out there that claim to reverse greying by targeting the decreasing levels of the catalase enzyme (that normally prevents the greying of your hair by getting rid of naturally-occurring hydrogen peroxide. The SOD enzyme (superoxide dismutase) also helps prevent that by decreasing oxidative damage from free radical molecules (research indicates it might also be partly responsible for hair falling out). And a bonus – controlling free radicals benefits your health in a lot of other ways.
Bones, Joints and Muscles.
In general, pain is thought of as a sign of inflammation. So it makes sense that controlling inflammation will help with many of those aches and pains. Focus on foods rich in anti-oxidants and omega-3 fatty acids. Using spices such as cinnamon and turmeric also help. Even more potent are supplements that provide a concentrated form of these foods, like fish oils (for omega-3s) and curcumin (the active component of turmeric).
Long-term suggestions would concentrate on supporting the general health of your bones and the connective tissues that hold your joints together. Having a diet high in calcium-rich fruits and vegetables is much more beneficial than getting your calcium from dairy sources, which can affect the pH level in the body in such a way that it might actually be harmful for bone health. Vitamin C is integral to the health of ligaments and tendons. And we can’t forget the role that exercise plays – regular, moderate exercise that includes a mixture of cardiovascular and weight-bearing will give you the most health benefits overall. For reducing chronic pain from conditions such as osteoarthritis, acupuncture can be very effective.
Cognition – “Use it or Lose it”
Modern medicine has made incredible breakthroughs that can keep our bodies alive longer, but it lags behind in supporting our cognitive health. And how else will you know if you’re actually enjoying your golden years or not?
Studies have shown that the idea of “use it or lose it” definitely applies to your mind, so keeping mentally active is a great idea. Puzzles such as crosswords, Sudoku, or playing challenging games like chess or bridge are a great way to stay busy and keep healthy. Nutrition is certainly important – nutrients like vitamin B12, omega-3 fatty acids (especially DHA), CoQ10 and vitamin E. High blood pressure is also a risk factor for cognitive decline. Finally, certain medications have recently been associated with a higher risk of developing dementia – for example, long-term use of proton-pump inhibitors (a common class of antacid drugs used to treat heartburn and ulcers). Finally, many other medications can cause symptoms of dementia that will often disappear when the medication is discontinued.
Quite recently there has been some extremely exciting work coming from the American functional medicine community (“functional medicine” is what medical doctors call it when they practice like medically-focused naturopathic doctors). One clinical study significantly reversed the effects of Alzheimer’s disease in multiple patients using a carefully-designed protocol that included monitoring certain lab values and optimizing health targets primarily using natural supplements and other interventions.
A common misconception is that people need less sleep as they get older. Closer to the truth would be that it’s just harder to get the same duration and quality of sleep. Melatonin production decreases with age (this is the hormone that helps us fall asleep). Joint aches and muscle pains can keep you from finding a comfortable sleeping position (as we saw earlier in this article). And many find they have to get up to urinate more often during the night. Finally, snoring is more common as people age – a variety of factors contribute to this, including increased weight and weakening of the muscles in the throat.
What can you do? A melatonin supplement is cheap, safe, and often very effective. Most come in a standard 3 mg dose; if you find you’re groggy the following morning, try a half dose. Limit your fluid intake later in the day, especially anything containing caffeine or alcohol. If you’re on a diuretic medication for high blood pressure, talk to your doctor about moving your dose earlier in the day (and keep reading to find out how to quit your medication altogether). And maintain a healthy weight – this benefits you in lots of ways other than just sleep. If it’s your partner who snores, get a good pair of earplugs, or consider sleeping in another bedroom if it’s really bad.
Let’s start at the beginning – in the mouth. A diminished sense of taste and smell is a common complaint among seniors. This can result in what is called the “tea and toast” diet – food doesn’t taste as good, making it less enjoyable to eat, and so you might be tempted to just go with what’s easy. Unfortunately, this limited diet can lead to nutritional deficiencies – one of which (zinc) might have been the cause of the loss of taste and smell in the first place. Another factor – dental work. Dentures might make it harder to enjoy some of the foods you used to love, including the fresh fruits and vegetables that are so integral to a balanced diet. A popular and easy fix? Smoothies – all your favourites blended up together in an easy-to-swallow meal. Just watch the sugar content.
Next up, we come to the esophagus and stomach, the source of heartburn. Too many people take antacids for this common problem – only thing is, most of the time heartburn isn’t caused by elevated stomach acid, but rather low stomach acid, which means the muscle at the bottom of the esophagus isn’t closing properly. This allows acid from the stomach to contact this sensitive tissue, resulting in that familiar burning sensation. Stomach acid production naturally declines with age, so give it a boost with some digestive bitters just before any larger meals – especially ones containing protein.
Finally – the intestines. Your small intestines continue the digestion process, and carry out most of the nutrient absorption. Healthy levels of beneficial bacteria are vital for this, which come from cultured foods like yogurt, sauerkraut, and more exotic drinks like kombucha and kefir. If that sounds too complicated, just pop a probiotic pill – look for a mix of bacterial strains and a number in the billions. Almost to the end is the large intestine. Problems here include gas and bloating, and the dreaded constipation. Gas usually results from food that hasn’t been properly digested and absorbed in the small intestine. Constipation can generally be fixed by drinking enough water and having plenty of fiber in your diet. If you’re concerned, take a fiber supplement. Psyllium is the fiber in brands like Metamucil, only without the artificial colours, flavours and sugars.
According to the Heart and Stroke Foundation, in 2012, one person died every 7 minutes of heart attack or stroke. And up to 80% of premature cardiovascular disease is considered to be preventable with simple lifestyle changes.
One of the most recent health myths to fall is cholesterol. For years, cholesterol was the devil, to the point where statins (the class of drugs to lower cholesterol) became the most-prescribed class of drugs in North America. And while it’s true that having elevated cholesterol can be a risk factor for cardiovascular disease – that’s only when there’s inflammation present. Without inflammation, cholesterol acts only as the precursor for making certain hormones. But if there’s inflammation in the blood vessels, your body uses cholesterol to plaster over the damage as a quick fix. The more layers that are applied, the more it blocks your arteries, eventually leading to heart attacks and angina – yet another reason to control inflammation.
High blood pressure is pretty much ubiquitous among seniors. In the 60 to 79-year-old group, 52% of people have a diagnosis of hypertension (compared to 22% in the 40 to 59-year-old group). Lifestyle changes including a healthy diet, regular exercise and meditation can be very effective at controlling blood pressure. Add to that supplements like garlic, magnesium, and CoQ10, and you can certainly reduce your blood pressure medications, or possibly even quit them altogether.
This is another system that just naturally decreases with age, for a few reasons we already talked about. That low stomach acid that gives you heartburn? It also means that your first line of defense for bacteria and parasites could be compromised. That tea and toast diet? Not the optimal nutrition that your immune system needs. And the lack of sleep only makes it worse. The last thing to consider is stress – which has a huge negative effect on the health of your immune system. It’s never too late to learn how to really deal with your stress (instead of just pushing it down and pretending it doesn’t exist – more on that below).
But general immune support involves getting your vitamin D levels checked and supplementing if necessary; using proven immune boosters such as astragalus or medicinal mushrooms; or for minor acute illnesses like a cold or the flu, herbs like Andrographis and Echinacea and minerals such as zinc and selenium can get you back on your feet sooner.
After statins, anti-depressants are the second-most prescribed class of drug in North America. And according to some experts, they’re also the drugs that are the most-often wrongly prescribed. When a neurotransmitter imbalance is at the root of those symptoms of depression, then anti-depressants can be a lifesaver.
But what about when depression is secondary to other things? Stress over health concerns or financial problems, loneliness following the death of a partner or lifelong friend, nutritional deficiencies from a poor diet, decreased activity level, or even having less sex – these are all things that can cause symptoms of depression. And in most of these cases, an anti-depressant will have a minimal effect, if any at all. But adaptogenic herbs and B-vitamins help your adrenal glands cope with chronic stress. And meditation is easily the most ignored yet most effective self-care for stress. Other things to rule out – low hormone levels such as thyroid, testosterone, estrogen or progesterone.
Two problems are just for the men who are reading – prostate issues and erectile dysfunction. First, a quick anatomy lesson – your prostate is a small gland located inside the body approximately between the testicles and anus. The urethra passes directly through it before entering the penis to carry urine out of the body. So if you’re experiencing a delay in starting urination, or stopping and starting, or dribbling, there’s a good chance (about 75% if you’re over 70) that you have an enlarged prostate. This is either BPH (benign prostatic hypertrophy) or prostate cancer. Obviously the second one is worse, but even that might not be as bad as you think. Many forms of prostate cancer are very slow-growing, so depending on your age and the severity of your symptoms, you might not need to have it treated at all. Tests for this include PSA and having a DRE done by your doctor.
On to erectile dysfunction – this could be from decreased testosterone (called andropause). More likely it’s caused by one of the conditions we already looked at: high blood pressure, atherosclerosis, or simply from being overweight (fat tissue produces estrogen, further skewing the hormone balance). Fix those things, and the problem will likely be dramatically improved. Now how to treat your wife’s chronic headaches…
After surviving menopause, all sorts of other issues come up from the sudden decrease in hormones. Osteoporosis is one of the most common health issues among older women, resulting from lower estrogen levels. This can also lead to decreased libido and vaginal dryness. Hormone replacement therapy is something that can help dramatically, but should be considered carefully on an individual basis.
A gentler solution can be herbs that contain phytoestrogens – “plant estrogens” – which act as hormone modulators. These compounds resemble hormones closely enough that they can interact with estrogen receptors and weakly stimulate them. But in cases of estrogen being too high, they can also decrease the effects of estrogen by occupying those same receptors – hence the “modulatory” effect. Soy products and flax seeds are two of the most well-known examples of phytoestrogens. Equally crucial for protecting bone density is regular, weight-bearing exercise to stimulate bone growth.
Final words: am I claiming that by using natural medicine, you can get off every one of your medications and solve all your health problems? Absolutely not. But I can guarantee that working with a properly-trained naturopathic doctor can improve your health, decrease your need for certain medications and leave you feeling better. Because what’s the point of living longer if you can’t enjoy it?
Tags: antacids, statin, supplements
Written by: Dr. Reuben Dinsmore BScH, ND
Natural supplements, or nutraceuticals, have been given a bad rap lately – which, in some cases, has been absolutely warranted. But natural formulas that actually contain what they claim to contain, and that are formulated to have maximal efficacy can be equal to their pharmaceutical counterparts – but without the laundry list of side effects.
1. Statins (the class of drugs prescribed to lower cholesterol) accounted for 3.8% of all money spent on prescription drugs in Canada in 2013. High cholesterol is blamed for heart attacks and strokes via formation of arterial plaques. But the real culprit is inflammation, without which the plaques wouldn’t form in the first place. Bottom line – you can lower cholesterol all you want, but as long as there is inflammation present, plaques can still form.
Some common side effects of statins: muscle pain, cognitive impairment, sexual dysfunction, and increased risk of cancer and diabetes.
Nutraceutricals: Omega-3 fatty acids (best sourced from wild-caught fish oils) and curcumin (the active component in turmeric) are two excellent supplements to lower inflammation. Garlic extracts have been proven to improve cholesterol levels. As well, red rice yeast extract is the natural compound statins were derived from, and works in a similar manner – however, it has been suggested that because of this, some of the same side effects may be seen.
2. Antacids 5 million Canadians suffer from heartburn symptoms weekly. Prescriptions for the acid-blocking drugs PPIs (proton pump inhibitors) accounted for $24 million in BC alone in 2013. Risks of taking these mostly involve nutrient deficiencies from poor absorption DUE TO LOW STOMACH ACID (see the problem here?). Examples include bone fractures from poor calcium absorption or anemia from decreased levels of B12 or iron. B12 deficiency can also cause dementia and neurological damage. There has also been a correlation shown between PPI use and C. difficile infection, which causes life-threatening diarrhea.
Nutraceuticals: long story short, most people don’t have too much stomach acid. The problem is the acid they have is getting into the wrong place (the lower esophagus) where it burns. This can be from the muscle between the esophagus and the stomach not closing properly, either from poor tone or insufficient stomach acid, which is the signal for the sphincter to close. Limonene (an extract from citrus peel) helps strengthen this muscle and promotes movement of food downward to the stomach. DGL (an extract from licorice root) stimulates mucus production in the stomach, which acts to coat and protect the sensitive lining of the esophagus.
3. SSRIs (selective serotonin reuptake inhibitors) are the most common class of anti-depressant drugs. One in twelve Canadians will experience major depression in their lifetime, but it’s still one of the most poorly understood conditions. Standard treatment protocols typically target neurotransmitter activity (most commonly serotonin). However, new research indicates the underlying cause may actually be inflammation. Either way, natural medicine has you covered.
Nutraceuticals – 5-HTP is used to make serotonin, with the help of vitamin B6. The herb St. John’s Wort has been studied extensively and appears to work in the same way as SSRIs. Both 5-HTP and St. John’s Wort have shown similar efficacy to SSRIs when given for mild to moderate depression. And as I mentioned earlier, omega-3 fatty acids and curcumin decrease inflammation throughout the body, including the brain.
Side effects of SSRIs include sexual dysfunction, weight gain, and worsened/chronic depression. St. John’s Wort also has a side effect which should be considered if taking other medications – it affects liver function, which can result in either higher or lower blood medication levels.
4. Anti-hypertensives Hypertension (also known as high blood pressure) affects 6 million Canadians, and is responsible for approximately 13% of all deaths. Various classes of anti-hypertensives include diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs). Diuretics increase urine output, which can negatively affect sodium and potassium levels, which can cause muscle cramps. ACEIs and ARBs may both cause a chronic dry cough. All anti-hypertensives can cause dizziness, headache and low blood pressure.
Nutraceuticals – CoQ10, magnesium, garlic extracts, omega-3 fatty acids, L-arginine and vitamin C have all been shown to lower high blood pressure by various means. Dandelion leaf is an effective diuretic that doesn’t lower potassium levels.
5. Benzodiazepines are a class of drugs most often prescribed for anxiety disorders and insomnia. They work by binding to receptors for GABA, a neurotransmitter in the brain that calms activity of the nervous system. Interestingly, this is the same mechanism by which alcohol acts in the brain. One obvious effect of benzodiazepines is sedation – great when the treatment target is insomnia. Not so great when you just want to decrease your anxiety but still function. Other side effects include dizziness, loss of balance, and even cognitive impairment at higher doses. They also have a significant risk of developing physical or psychological dependence and rebound anxiety when discontinued.
Nutraceuticals – you can take GABA itself (but there’s mixed evidence on whether or not it actually gets into the brain), or herbs such as passionflower (same mechanism of action as benzodiazepines), valerian, chamomile, kava – the list goes on.
So now you think you’re ready to ditch all your pharmaceuticals and go natural? Not so fast – the examples used above are by no means the only supplements that have been used effectively for these conditions. And equally as important are diet, exercise, sleep habits, relaxation techniques and other lifestyle factors. The next step – sit down with a naturopathic doctor and work together to develop a personalized approach that takes all your health concerns into consideration.