Aetiology

From 1^st of April 2019, the Australian Government will be removing private health insurance subsidies from a range of natural therapies, including Naturopathy and Herbalism. This surprising decision was made in response to a review, conducted by the National Health and Medical Research Clinic (NHMRC) in 2015 assessing the efficacy of 17 natural therapies, ranging from yoga to Naturopathy. The former Commonwealth Chief Medical Officer stated “there was no clear evidence” behind these therapies – a great leap, when you consider the limited information included in the review. The report has since undergone further scrutiny, with critics claiming that it did not follow recognised guidelines or standards in reviewing evidence, lacked transparency and it withheld critical information. The findings conducted by the NHMRC are now under investigation by the Commonwealth Ombudsman.¹ The government says that while consumers can still choose to access these services, they will no longer be able to claim benefits from their insurer.² Understandably, this has upset a large number of the Australian public, who proactively utilise natural therapies. It has also caused confusion as to how this decision has been passed.

Marla Cunningham, the Head of Clinical Research and Innovation at Metagenics, recently wrote an informative article titled “How Did the Australian Government Conclude ‘There’s No Evidence for Naturopathy’?” In this article, Marla refers to a number of reviews and scientific evidence on Natural Medicine that raise question over whether the government has made the right decision especially in the face of a burgeoning economic health care crisis. The full article can be read here.

Did They Review the RIGHT Evidence?

Many Australian’s have stumbled across robust evidence on the individual therapies that are employed by Natural Medicine Practitioners. As an example, omega-3 fish oil, probiotics, magnesium, turmeric, the Mediterranean diet, meditation, just to name a few, all have significant evidence to back up their ability to improve various health outcomes. Yet, one of the major flaws in using this NHMRC report to guide public health policy is that it only reviewed studies that looked at Naturopathy as a complete health service. Articles of this nature are rare. Few choose to study Naturopathy as a whole service, and instead prefer to study the effectiveness and safety of the component therapeutics employed by Naturopaths such as specific herbal and nutritional therapies, diet and lifestyle practices. Not considering the numerous reviews on these treatments of naturopathic practice, is akin to saying there is no value in seeing a doctor for high cholesterol, without any consideration for the pharmaceutical medications they prescribe to manage cholesterol. As Marla states;

“The one systematic review on whole practice Naturopathy that was found by the report – a review of six randomised controlled trials in North America – did provide positive evidence for the practice of Naturopathy. In fact, the review concluded that Naturopathy was effective in improving patient health for a range of chronic health conditions, including anxiety, multiple sclerosis, cardiovascular disease and musculoskeletal conditions.³”

Number of articles published in the last five years on the following individual therapies:

Probiotics – 9171

Turmeric- 2034

Curcumin – 6259

Fish Oil – 8471

Omega 3 – 8727

Is the Government Missing the Point?

Complementary medicine is just that – it can ‘complement’ orthodox treatment. By taking your doctor’s advice, blood tests and pharmaceutical prescriptions into consideration, Naturopaths are able to provide a holistic and personalised solution prescribing herbal and nutritional supplements, diet, exercise, and lifestyle advice to assist in healing to address the underlying cause of your presenting concern. Their treatments have been shown to optimise the results achieved with conventional treatments and minimising the risk of potentially harmful side effects of prescription medication. Naturopathy, when utilised as first port of call, has the ability to reduce the burden on the traditional healthcare system significantly. Numerous reviews and studies have identified the benefits of natural therapies, and Marla also acknowledges the following studies in her article;

A comprehensive review which looked at the nature of complementary medicine usage within Australia, found it to be commonly utilised by patients with these diseases,⁴ a trend that is supported by a wealth of evidence on the effectiveness of natural medicines for these conditions. For example, in the priority area of mental health, highlights high quality (scientifically rigorous) evidence for several herbs in the treatment of anxiety (including passionflower) and depressive disorders (including saffron).

A 2014 Frost and Sullivan report predicted the potential healthcare savings if at-risk Australians utilised just a handful of natural medicines for the prevention or treatment of key conditions – B vitamins and omega-3 for cardiovascular health; magnesium, calcium and vitamin D for bone health; lutein and zeaxanthin for eye health; and St John’s wort for depression⁵”

These ingredients, along with many others, are common components of Naturopathic treatment and due to their accepted efficacy are considered to be medicine. There are countless studies and trials demonstrating many more ingredients within the domain of Naturopathic practice, should become staples in everyday healthcare. It is important to keep the naturopathic industry healthy and thriving so it can continue to feed optimal solutions to the medical community.

Is Australia Lagging Behind?

While Australia lags, globally, other countries are leading the charge accepting nutritional and herbal treatments as effective, everyday medicine. For example, in Switzerland, the Swiss Federal Council acknowledge that complementary medicine meets statutory regulations when it comes to effectiveness, and guaranteeing high quality and safety.⁶ Hence, services such as homeopathy, Traditional Chinese Medicine and herbal medicine, are covered by mandatory health insurance. In India, traditional medicine is widely used, especially in rural areas where 70% of the Indian population lives. Services such as, Naturopathy, homeopathy, and yoga are all recognised by the Government of India.⁷ Whilst the Australian government is balking at providing support for these services, 70% of the Australian population use over-the-counter natural medicines and one third of the population use complementary therapies such as Naturopathy, massage therapy and chiropractic – showing huge public endorsement. What’s more, as per Marla’s article, “There are a number of health conditions which have been identified as national health priority areas by the Australian Government based on their contribution to the burden of disease in Australia – dementia, obesity, arthritis and musculoskeletal conditions, asthma, diabetes, mental health, injuries, cardiovascular disease, and cancer. ⁸

42% of Complementary Medicine users take these medicines to address national priority health conditions.

Your Health is Your Business.

As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure”. Naturopaths shift the emphasis from ‘managing’ disease and symptoms to building and maintaining the best possible health. The principle objective of Natural Medicine is prevention, through educating and empowering people to attain better health through adopting a more natural lifestyle, eating a healthy diet, exercising, regulating sleep, and regenerating themselves physically, emotionally and spiritually. Rather than providing a band-aid that covers up symptoms, the goal is to identify and treat the cause with non-invasive, safe and effective natural therapies. All of these therapies of which have an abundance of research behind them, even if the entire practice of naturopathy as a ‘health service’ has yet to be extensively studied.

When it comes to your health, your freedom of choice should never be confined as to what the Government stipulates as ‘good for us’.

Despite what the Australian Government has concluded, embracing a health-enhanced lifestyle and working alongside a natural healthcare professional, can provide those with presenting health concerns with a greater quality of life.

A 2017 study of 252 Australian individuals aimed to assess patients perceptions of clinical care in complementary medicine. It concluded that complementary medicine practice is characterised by a patient-centred, empathic and empowering approach – with 99.2% of patients claiming they felt seen and heard as a unique individual by their complementary medicine practitioner.

As a result of education initiatives such as the How Dare They Campaign, saw at least 5315 letters be sent to members of parliament to resist the change, and reached over 780,000 people on social.

I Support Natural Medicine and I Vote had 1700 shares and 100,000 views on Facebook.

The Australian Public is invested in natural medicine practitioners and the therapies they offer.

Find a Practitioner here.

¹ http://www.nhmrchomeopathy.com/ombudsman-exec-summary.html

² http://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-removing-coverage-for-some-natural-therapies

³ Australian Government. Department of Health [Internet]. Canberra ACT: Department of Health; 2017 [updated 2017 June 29; cited 2018 Aug 3]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies

⁴ Reid R, Steel A, Wardle J, Trubody A, Adams J. Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC Complementary and Alternative Medicine. 2016 Dec;16(1):176.

⁵ Shanahan C, Lorimier R. Targeted use of complementary medicines: potential health outcomes and cost savings in Australia. Frost & Sullivan (Australia) Pty. Ltd., Sydney. 2014 Oct;116.

⁶ https://www.echamp.eu/news-and-events/news/complementary-medicine-in-switzerland-now-a-mandatory-health-insurance-service

⁷ http://apps.who.int/medicinedocs/en/d/Jh2943e/8.4.html

⁸ Australian Government. National Health and Medical Research Council [Internet]. Canberra ACT: National Health and Medical Research Council; 2016 [updated 2016 Aug 31; cited 2018 Aug 3]. Available from: https://www.nhmrc.gov.au/book/nhmrc-corporate-plan-2016-2017/nhmrc-s-strategic-direction/major-health-issue

You may know that probiotic are live microbes that, when taken in sufficient amounts, provide health bene­fits to the body. However, with so many options out there – how do you decide which one to choose? Well, that depends on what you want the little bugs to do for you. Whilst a Hyundai and a Ferrari are both cars, you know which one you’d pick for fuel economy and which one would win a race. The same story applies with probiotics – whilst many may be beneficial, each strain carries out different actions, so it’s super important to choose the right one for your specific needs.

Probiotics primarily exert their health benefits by influencing the trillions of organisms that exist within your gut, collectively known as your intestinal microbiome. Hot in scientific circles right now, there are many biological processes your microbiome is purported to influence, including:

• Local and systemic immunity, preventing infection and the requirement for medications (such as antibiotics);[1]^,[2],[3],[4]
• Immune system regulation, reducing the risk of allergies or autoimmune conditions;[5]^,[6]
• Preventing the colonisation of pathogenic organisms, protecting you from gastrointestinal infections;[7]
• Appetite regulation, to prevent overeating and weight gain;[8]^,[9] and
• The production of brain chemicals that may help support a healthy mood[10]^,[11] (more on the mind-gut connection here).

It’s important to bear in mind that not every probiotic is going to achieve everything mentioned above.

Probiotic functions are ‘strain specific’ and cannot be generalised to probiotics in general.

To read more about the importance of strain specificity with probiotics, read this blog here.

Offsetting the Disruptive Effects of Antibiotics

One crucial strength of probiotics is their capacity to protect the gut microbiome from disruption when taking antibiotics.[12]^,[13] Recently, an Israeli study refuting this effect made headlines around the world, despite well-established evidence to the contrary. Whilst there were several issues with the study itself, there were also important inaccuracies that were unfortunately disseminated by the mainstream media about the overall findings of the study. To take a closer look at this research, and for a summary of the evidence that supports the use of strain-specific probiotics to restore the microbiome following antibiotic therapy, click here.

With November 12^th to 18^th being Antibiotic Awareness Week, as declared by the World Health Organization (WHO), this is also the perfect time to discuss what specifically can be done to minimise any negative effects that may accompany antibiotic administration. For example, one of the most common yet unwanted side effects is antibiotic-associated diarrhoea (AAD), which in adults is estimated to affect up to 70% of the population.[14] Furthermore, the WHO also has a pretty dire warning about the dangers of antibiotic resistance (see here), something we should all be conscious of when discussing antibiotic use with our GPs.

Be Informed and Choose What Works

That said, antibiotics have their place in specific circumstances so the question is how and what to use to minimise the disruption they can cause to the gut microbiome. With the evidence clear on the benefits of taking probiotics alongside antibiotics,^{[15],[16],[17]} one that particularly shines in this situation is Lactobacillus rhamnosus (LGG®). LGG® is the world’s most researched probiotic,[18] and has been shown to effective in preventing AAD in both children and adults,[19] as it markedly strengthens the important core bacterial species within your gut that keep the entire gut environment healthy.[20]^{,[21],[22],[23]} Whilst there are a number of Lactobacillus rhamnosus GG products on the market, speak to your Practitioner about sourcing authentic LGG®. Only authentic trademarked LGG® will reliably have the unique hair-like appendages (see Figure 1) that increase its adhesion to the mucus membranes lining the gut – it is this feature that allows it to exert its positive health benefits.[24]

Figure 1: LGG^® with pili (hair-like appendages) to maximise mucosal adhesion.

Further, a 2016 review of probiotics found LGG® and the beneficial yeast Saccharomyces cerevisiae(boulardii) or ‘SB’, both reduce the risk of AAD, potentially reducing the need for antibiotics to treat secondary infections. The review went on to say that through this mechanism (and thus the reduction in likelihood that you will experience unpleasant adverse gut effects),

probiotics contribute to better adherence to antibiotic prescriptions, and thereby reduce the evolution of antibiotic resistance.[25]

To fully discover the benefits of probiotics speak to your natural healthcare Practitioner. They are best equipped to advise which strain specific probiotics can optimally support your gut microbiome to achieve gastrointestinal balance, especially if you have taken antibiotics recently. To find an appropriately qualified Practitioner in your area, click here.

[1] Ohland CL, MacNaughton WK. Probiotic bacteria and intestinal epithelial barrier function. Am J Physiol Gastrointest Liver Physiol. 2010 Mar 18;298(6):G807-19.

[2] Szajewska H, Kołodziej M. Systematic review with meta‐analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic‐associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015 Nov;42(10):1149-57.

[3] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016 Dec 15;375(24):2369-79.

[4] Ohland CL, MacNaughton WK. Probiotic bacteria and intestinal epithelial barrier function. Am J Physiol Gastrointest Liver Physiol. 2010 Mar 18;298(6):G807-19.

[5] Claus SP, Guillou H, Ellero-Simatos S. The gut microbiota: a major player in the toxicity of environmental pollutants? NPJ Biofilms and Microbiomes. 2016 May 4;2:16003.

[6] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016 Dec 15;375(24):2369-79.

[7] Ohland CL, MacNaughton WK. Probiotic bacteria and intestinal epithelial barrier function. Am J Physiol Gastrointest Liver Physiol. 2010 Mar 18;298(6):G807-19.

[8] Mazzoli R, Pessione E. The neuro-endocrinological role of microbial glutamate and GABA signaling. Front Microbiol. 2016 Nov 30;7:1934.

[9] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016 Dec 15;375(24):2369-79.

[10] Mazzoli R, Pessione E. The neuro-endocrinological role of microbial glutamate and GABA signaling. Front Microbiol. 2016 Nov 30;7:1934.

[11] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016 Dec 15;375(24):2369-79.

[12] Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis–a review. Clinical and Experimental Gastroenterology. 2015;8:237.

[13] Eloe-Fadrosh EA, Brady A, Crabtree J, Drabek EF, Ma B, Mahurkar A, et al. Functional dynamics of the gut microbiome in elderly people during probiotic consumption. MBio. 2015 May 1;6(2):e00231-15.

[14] Szajewska H, Kołodziej M. Systematic review with meta‐analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic‐associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015 Nov;42(10):1149-57.

[15] Szajewska H, Kołodziej M. Systematic review with meta‐analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic‐associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015 Nov;42(10):1149-57.

[16] Ouwehand AC, Forssten S, Hibberd AA, Lyra A, Stahl B. Probiotic approach to prevent antibiotic resistance. Ann Med. 2016 May 18;48(4):246-55.

[17] Jungersen M, Wind A, Johansen E, Christensen JE, Stuer-Lauridsen B, Eskesen D. The science behind the probiotic strain Bifidobacterium animalis subsp. lactis BB-12®. Microorganisms. 2014 Mar 28;2(2):92-110.

[18] Segers ME, Lebeer S. Towards a better understanding of Lactobacillus rhamnosus GG-host interactions. Microbial Cell Factories. 2014 Aug 29;13 Suppl:S7. Doi: 10.1186/1475-2859-13-S1-S7.

[19] Szajewska H, Kołodziej M. Systematic review with meta‐analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic‐associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015 Nov;42(10):1149-57.

[20] Eloe-Fadrosh EA, Brady A, Crabtree J, Drabek EF, Ma B, Mahurkar A, et al. Functional dynamics of the gut microbiome in elderly people during probiotic consumption. MBio. 2015 May 1;6(2):e00231-15.

[21] Canani RB, Sangwan N, Stefka AT, Nocerino R, Paparo L, Aitoro R, et al. Lactobacillus rhamnosus GG-supplemented formula expands butyrate-producing bacterial strains in food allergic infants. The ISME journal. 2016 Mar;10(3):742.

[22] Korpela K, Salonen A, Virta LJ, Kumpu M, Kekkonen RA, De Vos WM. Lactobacillus rhamnosus GG intake modifies preschool children’s intestinal microbiota, alleviates penicillin-associated changes, and reduces antibiotic use. PloS One. 2016 Apr 25;11(4):e0154012.

[23] Bajaj JS, Heuman DM, Hylemon PB, Sanyal AJ, Puri P, Sterling RK, et al. Randomised clinical trial: Lactobacillus GG modulates gut microbiome, metabolome and endotoxemia in patients with cirrhosis. Aliment Pharmacol Ther. 2014 May;39(10):1113-25.

[24] Segers ME, Lebeer S. Towards a better understanding of Lactobacillus rhamnosus GG-host interactions. Microbial Cell Factories. 2014 Aug 29;13 Suppl:S7. Doi: 10.1186/1475-2859-13-S1-S7.

[25] Ouwehand AC, Forssten S, Hibberd AA, Lyra A, Stahl B. Probiotic approach to prevent antibiotic resistance. Ann Med. 2016 May 18;48(4):246-55

Did you know that your gut and your brain are in regular conversation? They have a pretty close relationship, with your mental state influencing gut function and vice versa. Perhaps you’ve experienced ‘butterflies in your stomach’, or felt nauseous before an event? Or felt your mouth water upon seeing or smelling a delicious meal? These are all very real phenomena and due to your mind-gut connection.

Less ideal is how feeling under pressure or stressed decreases digestive function – this is because when your body-mind perceives ‘danger’ (which is what stress is from a physiological sense – see this article here), then it’s not a priority to be eating, therefore digestion suffers and you may experience bloating or heartburn or some other uncomfortable symptom.

Knowing this mind-gut link exists can help explain how feeling anxious may impact how your gut is functioning, but perhaps more significant (though not as well known) is that what’s going on in your gut could also be impacting your mental health.

Lighting a Fire in the Brain

Though the causes may be multifactorial, a key player in this situation is gut-derived inflammation. This can result from dysbiosis, which is an imbalance in your gut microbiota (the microbial life that resides within your intestines), and/or some degree of insult to the digestive tract lining – your gut ‘barrier’. Both your gut barrier and your microbiota work synergistically to support effective digestion, immune health, and overall wellbeing. However, if they become disrupted then biochemical signals or ‘cytokines’ are released that travel throughout your body causing what’s referred to as oxidative stress in any number of tissues in your body including your brain.

Though many of these cytokines cannot cross what’s called the blood-brain-barrier, their presence triggers similar ‘alarm’ signals in the brain so it too is impacted by its own inflammatory processes. This sequence of events can be why symptoms such as poor mood, brain fog and anxiety occur; but for those who want a more specific example – inflammation can promote the neurotransmitter precursor tryptophan to produce quinolinic acid[1] instead of serotonin and melatonin – the former situation leading to what can most simply be described as nerve cell ‘agitation’ that can present as anxiety.[2]

Soothe Your gut to Settle Your Mind

As gut health is fundamental to all aspects of wellbeing then any symptoms really need to be attended to – and to do that with the least guesswork then my recommendation is to see a natural healthcare Practitioner who can help you navigate what may be the contributing causes for you, e.g. do you need to tweak your diet? Get some help with digesting certain foods? Heal your gut barrier? Equally, if you are struggling with stress, sleep, or experiencing regular mood problems then speak to your Practitioner about this too – there are many natural medicine solutions available, but to find the best ones for you will require assessing your personal situation first.

Is it too Early to Rely on Psychobiotics?

If you are already a fan of natural medicine you may be wondering what the role of probiotics are in this, particularly as there is emerging talk of ‘psychobiotics’ or probiotics that can impact mood. This is clearly of interest to those who may be experiencing stress or anxiety, so I’d say to you that the human evidence for what may be the ‘best’ probiotic strain and at what dose to help is still in its infancy; but watch this space for future research developments.

What we do know currently is that supporting whole gut health by decreasing gut-derived inflammation and increasing the diversity of the gut microbiota is a proven clinical approach to whole-body wellbeing – and this includes improving mental health.

So if you experience symptoms impacting either your mind or your gut, please don’t put up with them any longer, or try to figure it all out on your own. Contact your Clinical Naturopath or Integrative Doctor and let them know what’s going on, so they can personalise a solution for your situation.

[1] Lugo-Huitrón R, Muñiz PU, Pineda B, Pedreaza-Chaverri J, Rios C, Pérez-de la Cruz V. Quinolinic acid: an edogenous neurotoxin with multiple targets. Oxidative Medicine and Cellular Longevity. 2013;Article ID 104024, 14 pages. Available from: https://www.hindawi.com/journals/omcl/2013/104024/

[2] Bryleva EY, Brundin L. Kynurenine pathway metabolites and suicidality. Neuropharmacology. 2017 Jan;112(Pt B):324-330. doi: 10.1016/j.neuropharm.2016.01.034. Epub 2016 Jan 26. Available from: https://www.sciencedirect.com/science/article/pii/S0028390816300338