Practitioner Roundtable
Practitioner Roundtable
The Participants Are:
Jacob Teitelbaum, MD, Kona, HI, www.vitality101.com
Serena Goldstein, ND, New York, NY, www.drserenagoldstein.com
Isaac Eliaz, MD, MS, LAc, Santa Rosa, CA, www.amitabhaclinic.com
Laura Knoff, BS, NC, Nutrition Consultant Instructor, Bauman College, Berkeley, CA, https://baumancollege.org
Liz Cruz, MD, Phoenix, AZ, www.drlizcruz.com
Holly Lucille, ND, RN, Los Angeles, CA, www.drhollylucille.com
Laurie Steelsmith, ND, LAc, Honolulu, HI, www.drsteelsmith.com
Dr. Marianne Teitelbaum, Cinnaminson, NJ, http://drmteitelbaum.com
Since Natural Practitioner’s (NP) inception, the field of complementary and alternative medicine (CAM) has grown. Here, NP talks with a panel of practitioners about trends they are noticing, technology, patient- and self-care, as well as the future of CAM.
NP: Are there any health issues that you are seeing a rise in? Why do you think this is the case?
J. Teitelbaum: We are seeing a dramatic increase in autoimmune and immune illnesses in general. This has a number of triggers including the 85,000-plus chemicals being added toward [the] environment and a 30 percent decrease in sleep relative to 140 years ago. Adrenal fatigue is also contributing.
Goldstein: People not being able to lose the last few pounds—lifestyle, diet, environmental issues, hormone issues (estrogen dominance is a big one), underlying blood sugar issues, poor sleep. However psychologically, I also see that it’s one of mindset. Losing weight for good means we have to change our lifestyle and habits, some of which are survival mechanisms—so we need to change our lives, and that’s difficult nowadays too with so many distractions or being told for decades a pill or short program will fix it (or currently, a natural pill). Yet I find these habits are manifesting in other parts of their life.
Eliaz: In addition to an increase in certain types of cancers such as pancreatic cancer, we’re also seeing a specific rise in inflammatory diseases involving immune dysregulation. These autoimmune-like conditions are aggravated by hypersensitivity to triggers, including environmental pollutants and common chemicals, microbial pathogens, stress and other factors, but at their root, they’re linked to complex imbalances in the neuro-endocrine-immune axis. They also appear to be presenting in younger populations than we’ve seen in the past. Reasons may be due to the widespread increase in assaults on our collective health: environmental pollutants, overuse of antibiotics and other pharmaceutical agents, nutritional deficiencies, compounding effects of digital and wireless technology, increasingly fast-paced lifestyles and mounting stress levels.
Knoff: Over the past 20 years, I have seen an increase in diabetes, metabolic syndrome and acid reflux syndrome. People are eating more high-calorie foods with less essential nutrients, and they are also experiencing much higher stress levels in general.
Cruz: As a gastroenterologist, we are seeing a rise of general digestive issues, such as reflux, heartburn, constipation, diarrhea, etc. We are also seeing a major rise of pre-cancerous polyps during colonoscopy. Finally, we are seeing way more pre-cancer/cancer in young people. As a GI (gastroinestinal) doc with a more holistic approach, it is my feeling that these polyps are primarily caused by our standard American diet (SAD) along with our high stress/anxiety lifestyle.
Lucille: Yes, SIBO (small intestinal bacteria overgrowth) and all autoimmune and difficult cases. SIBO because we are learning more about it and it is being diagnosed more frequently and the other two, mostly I think because of our ever increasingly toxic environment.
Steelsmith: I have been in practice for 26 years and it is remarkable how many more patients I am seeing who have normal medical exams and labs, but they don’t feel well. Many of these patients have chronic inflammatory conditions and endocrine disorders. I think that people are being bombarded by environmental chemicals that accumulate in the body and create systemic inflammation as well as endocrine disruption.
M. Teitelbaum: Thyroid problems are at epidemic levels. The reasons are numerous and they are different in each person. As a holistic health care practitioner, it is up to you to diagnose and treat all the reasons for the thyroid weakness in that particular patient.
The thyroid gland is like a very delicate flower and will wilt easily if something is out of balance in the physiology. This is partly because the thyroid gland is the only gland whose hormones affect every cell in the body. Thus, in reverse, any stressor, whether it be emotional, mental, physical or environmental, will weaken the thyroid gland.
NP: What trends are you noticing in the field of complementary and alternative medicine?
J. Teitelbaum: As in standard medicine, there is an increasing push toward relying on testing as opposed to listening to the person you’re treating. Physicians are not really aware that how they listen and the words they say have been shown to have as or more of an impact on their client’s well-being than the actual medications and supplements they are giving.
Goldstein: As much as popularity has skyrocketed, I’m no longer seeing people bringing in many supplements, but rather being skeptical of everything. As if people got so much info so fast, tried so much of it yet only a fraction worked, and maybe on the flipside continuing with something because they’re not sure where else to go/what else to do.
Eliaz: The ketogenic diet trend is certainly gaining a stronger foothold, although it’s not the answer for everyone. There is also significant, growing interest in the role of the microbiome in health and disease, with a number of approaches aimed at supporting optimal microbial health using prebiotics, specific probiotics, postbiotics, synbiotics and other targeted interventions.
Knoff: In complementary medicine, I see the tendency to do more testing with less dietary education. Patients are not counseled on what to eat or how to prepare healthy foods.
Cruz: Mostly what I’m seeing are just more supplements in the market. Most of which are geared toward helping people lose weight instead of helping people digest, assimilate and eliminate food better. In addition, the supplements tend to be very poorly made in my opinion, causing more problems in the body than good.
Lucille: There is some pretty cool testing coming out to help with things we need like cognitive decline, mycotoxin exposure, wheat intolerances, genetic SNPs, etc. Cyrex, Vibrant America, GX Sciences and Genova, just to name a few. There is also an increased focus on mitochondrial health, which in my opinion informs everything!
Steelsmith: The trend that I am currently following in natural medicine is increasing mitochondrial function in patients. That means increasing oxygen utilization, promoting healthy cell membranes and promoting energy production inside the cell.
NP: How have you embraced technology within your practice? Do you use a patient portal, created an app for patients, etc.?
J. Teitelbaum: We have created the Cures A-Z phone app, which is like a pocket overall guide to treating over [a] hundred conditions naturally. This app has had over one million downloads. We also have a U.S. patent for a computerized physician, and two free online quizzes which use this technology. One www.EnergyAnalysisProgram.com can be used to determine the underlying causes of and tailor a treatment protocol for fibromyalgia, and the other to give any person a “tune-up,” www.TuneUpDocs.com. By doing a free 90-minute training on the Douglas Labs website, doctors can have their name added to the tune up docs referral list for free.
Goldstein: Yes! I use electronic health records with a patient portal, a site where I order supplements for them, and where they can re-order. They also understand any liability if we do virtual calls.
Eliaz: One technology that we’ve pioneered at Amitabha Clinic is a treatment called therapeutic apheresis. Somewhat similar to dialysis, apheresis is a comprehensive therapy that filters blood through an absorptive column to remove pro-inflammatory and pro-cancer growth factors. Apheresis is commonly used in conventional medical centers for elevated cholesterol that doesn’t respond to other interventions. At our clinic, apheresis is used in a wide range of conditions including cancer, kidney disease, chronic infection and other pro-inflammatory conditions. Our clinical experience demonstrates the important benefits of apheresis—achieved via our unique approach—in the treatment of cancer and other complex conditions beyond hypercholesteremia.
We also have a patient portal, and we’ve set up an online dispensary for patients to order recommended supplements. This online system makes it much easier for patients to quickly order and receive products indicated in their treatment protocols.
Knoff: I have been a bit slow in adopting technology, but I now have a monthly nutrition blog, a virtual dispensary and I do long distance appointments via FaceTime.
Cruz: Yes, we have an electronic medical record that interfaces with our patients through a patient portal. We also use text messages for patient reminders.
Lucille: I haven’t, not beyond email. Not yet at least.
Steelsmith: If you mean by having an electronic medical record system, yes. I also have a website and a Facebook page. We send out newsletters to our patients on a fairly regular basis in order to announce our presentations and/or to update our patients on current medical information.
NP: Do you work with testing labs? If so what types of tests do you use and how do you choose which labs to partner with?
J. Teitelbaum: Mostly stool parasite testing.
Goldstein: I correspond with other health professionals if blood work is desired, and out of state patients have an easier time with out-of-pocket labs. I choose labs based on what patients need, usually hormones/stress related.
Eliaz: We utilize a number of different labs and specific tests in our clinic, depending on the patient and their individual diagnoses. As far as standard tests, we typically recommend LabCorp as they’re able to process some of the less common labs we look at, including inflammatory biomarkers Galectin-3, TGF-Beta, VEGF and others.
One specialty lab that we use regularly is True Health Diagnostics, which offers unique cardiovascular tests and panels. They utilize sensitive diagnostic methods to determine genetic and other less commonly tested factors, which we know play key roles in cardiovascular risk and overall health.
Knoff: I use a few analysis labs, mostly for stool, saliva and urine testing. I choose labs that have reasonable prices and reliable results that correspond with my clients’ symptoms.
Cruz: Yes, aside from the traditional lab and imaging places, we work with four different testing labs for more holistic testing. We use them because they specialize in certain types of tests that we feel are important to help diagnose patient issues. We partner with SpectraCell for our Micronutrient testing to determine how people are digesting and assimilating food. We partner with US BioTek for food allergy testing. We partner with Doctor’s Data for Intestinal Permeability testing and Comprehensive Stool analysis. Finally, we partner with Genova Diagnostics for the Small Intestine Bowel Overgrowth test.
Lucille: See my previous response (on page 32). I like to understand the methodology and I love for the process to be smooth for both my patients and my practice. This is what makes me choose between one laboratory company or another.
Steelsmith: Yes, for 26 years, I have been ordering specialty labs on my patients to help direct their patient care. I have been using some of the same labs for 26 years. I learned about some of these labs when I was at Bastyr University as a student. I’ve learned about new labs over the years and typically find them through the conferences that I go to. I order a plethora of blood and urine tests from standard labs to specialty labs that look for imbalances in the body.
I test for many things in the body including environmental toxins, such as glyphosate and heavy metals, stool and breath tests to evaluate for bacterial flora in both the small and large intestine, I also do stool testing for yeast and parasites. Some labs look for imbalances in the immune system, liver function, and food allergies or reactivities, others are looking for genetic mutations. I also run lab tests to look at hormone and nutrient imbalances, and tests that can evaluate for methylation disorders.
M. Teitelbaum: We cannot rely solely on bloodwork to diagnose a thyroid problem, as there are many stages of weakness which will be present before the problem actually shows up on blood work (mainly during the latter stages of the disease process).
I do utilize any and all types of blood work and diagnostic tools in my practice, however, I am a chiropractor who specializes in ayurveda and have been trained in two important diagnostic modalities: pulse diagnosis and applied kinesiology (which employs muscle testing), both of which can diagnose any disease process in the very early stages, long before it will show up on blood work or other diagnostic tools.
So, while mainstream diagnostic workups are great, they do not pick up very early stages of a disease process where there are only imbalances in the physiology long before a formal diagnosis of a disease can be made. This is why I use pulse diagnosis and muscle testing as an added diagnostic tool. It is easier to prevent a disease by addressing it in its early stages rather than trying to fix it once the disease process has fully taken hold.
NP: What do you do to stay healthy and de-stress?
J. Teitelbaum: I’m a science geek. I read the scientific literature as well as science fiction fantasy.
Goldstein: Go to the gym with my iPod—so, no phone ringing, messages, etc.—old school (considering I can’t find my discman or tape player!). I also read a lot of psychology/philosophy/business books, journal, learn about astrology, spend time with my kitty, and head out to nature (yes, even if it’s to put my feet in a park in the city) every so often.
Eliaz: Meditation, with a focus on an open heart, love and compassion, is something I’ve been studying and practicing my entire adult life. By releasing our attachments and focusing on unconditional love with an open heart, research and practical experience shows that we can reduce stress, reduce inflammatory markers, improve immune function, increase mental and emotional wellbeing, and enhance overall health and healing.
In addition, research-based nutraceutical formulas and ingredients that target underlying pathogenic processes, modulate immunity, and balance inflammatory responses are key in maintaining long-term health and healthy aging.
Knoff: To stay healthy, I play more and worry less.
Cruz: I do several things to stay healthy and de-stress:
• I eat an alkaline diet 80 percent of the time
• I exercise three to five times per week
• I go to bed by 9:30 p.m. most nights
• I drink close to 80 oz. of water per day with electrolyte salts
• I take enzymes with meals, probiotics, detox and green supplements
• I get a deep tissue massage and colonic once a month
• I get a lymphatic treatment a few times per year
• I don’t drink caffeine and drink alcohol in moderation.
Lucille: Well, I eat really well, exercise, I have fun and I have boundaries. I love my family, I love my pets, I love my hobbies, so I just stay grounded and in gratitude.
Steelsmith: What I do to stay healthy are the following: I eat impeccably well and I do a lot of Iyengar yoga, weights and cardio on an elliptical machine. A new addition to my exercise routine is that I now do cardio workouts with an EWOT machine. This is a machine that concentrates oxygen and delivers it via mask to my lungs while I am doing aerobic activity. It boosts oxygen in the blood stream and oxygen utilization. This in turn boosts overall health and wellness by supporting energy production in the body. I also get eight hours of sleep and have a wonderful home life.
NP: Do you carry (or recommend) supplements in your practice? If so, how do you vet the companies you work with?
J. Teitelbaum: I do. I will often visit the companies to double check on their testing methodologies for potency and purity as well as looking at the science behind their supplements.
Goldstein: Generally, ones I’ve been trained on, or if other trusted colleagues use them as well. I ask about their testing, where they’re made, if they have docs on hand to chat with, potential allergies, dosing, when people should expect results.
Eliaz: One of the most important and extensively researched products I use and recommend across the board is PectaSol-C Modified Citrus Pectin. This unique product derived from citrus peel pith, is backed by extensive, independent research showing that it’s the only available agent capable of halting and reversing the widespread impacts of rogue protein biomarker, Galectin-3. Over 50 published studies show PectaSol-C to be an essential supplement which actively supports our most critical areas of health including cellular replication and behavior, cardiovascular and kidney function, and other key areas, via powerful mechanisms of action.
When vetting supplement companies, important factors to look for are the quality and quantity of original, published research highlighting unique mechanisms of action on branded ingredients and formulas.
Physician-formulated products can indicate efficacy and a history of successful clinical application, vs. products formulated by non-health care professionals.
Another important aspect is country of origin; we try to stay exclusively with products manufactured in North America or certain countries in Europe. Compliance with good manufacturing practices (GMPs) is important; it’s even better if manufacturers can prove that their practices exceed standard guidelines set for quality assurance.
Knoff: After suggesting a whole food diet, I may recommend professional supplement brands that are third-party tested and have been effective in the past.
Cruz: Yes, we have our own line of supplements that we have created with a manufacturer. Ones we’ve created ourselves are Everyday Enzymes, Pleasant Probiotics, Gastro Greens, Delicate Detox and Super Salts. We also partner with other vendors for certain supplements, Dr. Bach Stress Drops, Arbonne protein powder, Pitcher of Life for alkaline water pitchers, Chanson for alkaline water machines just to name a few. We work with these companies because they not only support our health regimen but they are the cleanest and best on the market.
Lucille: I personally, only use an online dispensary (Fullscript) and I don’t monetize it. I give my patients my 35 percent margin and I work with companies that have solid research, usually third-party testing for quality and great customer service. Also, those who support the naturopathic/integrative/functional medicine professions!
Steelsmith: Yes many. Again, I’ve been in practice for 26 years so I have the companies that I’ve worked with and that I trust. I also know that the products that I carry work since they’ve been vetted over 26 years.
M. Teitelbaum: I carry over 500 formulas to treat every conceivable condition in my practice. It is easy to sort out the quality herbal companies if you spend a little time contacting the companies and asking pertinent questions to their reps.
NP: Overall, how can practitioners better serve and help their patients?
J. Teitelbaum: 1. They need to realize that 28 hours a week is full-time for direct care of people. More than that can lead to compassion burnout. Other things that are not direct care can be added if needed.
2. Research shows that about 30 percent of most treatment’s benefits are attributable to the person’s own innate healing abilities. In an attempt to disempower people, medicine likes to deride this as the placebo effect. Meanwhile, the nocebo effect is similarly powerful. When side effects and negative expectations are over emphasized, even by careless words, this can be devastating. For example, research shows that if side effects to a treatment are stressed, people are as much as 300 percent more likely to have the side effects. This used to be called putting a curse on somebody. But this means that how the same information is presented can have a greater impact than the actual treatments.
Goldstein: Listen to them. Make sure they can do their plan, and it doesn’t have to be a lot. You can even boil down what’s most important. Reassure them that habits take time, and it’s okay to “mess up”—just be aware. Many feel guilty if they haven’t stayed on protocol, and there’s enough shame and guilt in the world. We as healers can show sensitivity to their journey to educate instead.
Eliaz: Every patient has a unique story. Oftentimes, this story is at the heart of their condition or health issue. If a practitioner is able to “listen between the lines,” ask the right questions, and let the patient’s story unfold in their own words, it can give powerful context and direction to help guide the patient toward greater healing and long-term wellness. Simply putting the patient at the center of your practice, respecting their choices, and offering unconditional love to hold space for their journey of healing and self-awareness, can have powerful and lasting impacts in the course of their recovery and beyond.
Knoff: The most important thing practitioners can do to help their patients is to listen more carefully and to ask follow-up questions.
Cruz: Run not only traditional medical testing but also consider running more holistic tests on patients. Even though insurance may not cover them they are so helpful in diagnosing a patient. They can save so much time and money in the long run when you get to the core issue faster. As a practitioner, it’s also our job to learn and educate patients about the body. I truly feel like we didn’t learn everything we need to know about the body in medical school. It is our responsibility to learn how the body truly works and share that information with our patients. In addition, offering them more holistic/natural ways to heal instead of just pushing pharmaceutical drugs all the time.
Lucille: Grow your capacity to contain your patients in a very comprehensive way. Physically, emotionally, through continued education, all of it!
Steelsmith: The most important thing for practitioners to best serve their patients is to constantly educate themselves by attending conferences, reading and staying at the cutting edge of the profession.
NP: What advice do you have for someone looking to get in to the field of complementary and alternative medicine?
J. Teitelbaum: The Cures A-Z phone app can make them an expert on the basics from day one.
Goldstein: It’s a diverse field, gives you a wide variety of tools to help people, and incredibly fulfilling. You’ll learn a lot, both as a physician and a human being.
Eliaz: An open heart is our greatest healer and protector. By practicing love and compassion as a daily focus and tool for meditation, we can prevent practitioner burnout, increase our healing capacity and offer more to our patients for their own healing journey.
Knoff: For those who are considering getting into the field of complementary or alternative medicine, I would say follow your passion and never stop learning.
Cruz: It’s a great way to go. In my opinion, alternative medicine, is the wave of the future. People are desiring this approach more and more.
Lucille: Empty your cup. This industry is moving fast and we are always learning. Listen. Listening, really listening can tell you almost everything about a patient. Be generous. Make money, but don’t gauge your patients. Do the work that it takes to look into their case and make sense of it and truly help.
Steelsmith: My best advice for a young person considering going into alternative medicine or any career, is to choose a profession that they deeply love so that when they go to work, they are fulfilling their life mission, not working!
M. Teitelbaum: My advice for someone looking to get into the field of complementary and alternative medicine: Seek out traditional healing modalities of either ayurvedic medicine or traditional Chinese medicine, as these two are using truly natural remedies. Don’t be tempted to use synthetic vitamin and mineral supplements, which the integrative, functional medicine doctors and naturopaths are using. These are the toxic version of the real thing found in food, and are toxic to the liver and kidneys and have side effects, just like their pharmaceutical cousins.
Remember, if a health care system is touting itself to be truly “natural,” then its remedies must be grown in nature, filled with “prana” or “chi” as the ayurvedic and Chinese respectively refer to supplements grown in nature, filled with nature’s healing life energy. Synthetically isolating nutrients and making them at high doses in a lab is following the mainstream medical model of using pharmaceuticals, which is why people are seeking out alternative care in the first place! Don’t fall into that trap! I take all my patients off their suitcases of vitamins, detox their liver from all the toxic synthetic vitamins, and our patients feel so much better.
Always remember to honor the liver—it cannot handle detoxifying all those synthetic vitamins, which are registered in the liver as a toxin, and create a great strain on the liver and kidneys to process out of the body.
NP: What does the future hold for the field of complementary and alternative medicine?
J. Teitelbaum: It is growing dramatically as standard medicine shrinks to take its proper role as being used for acute care rather than overall health management and optimization.
Goldstein: Licensing state for naturopathic medicine!
Eliaz: We are witnessing some exciting discoveries in fields like genetics, stem-cell therapies, aging, microbiome science and other areas. These advancements have the potential to radically reshape our current models of medicine, including complementary and alternative practices.
While it’s difficult to say how these developments may translate into clinical care, we see innovative therapies like stem cell medicine already being offered in a growing number of integrative practices. As treatments like therapeutic apheresis gain a foothold in integrative practices and in the peer-reviewed literature, we can hope to see these therapies offered on a larger scale and reimbursed by health insurances as effective treatment modalities.
Knoff: The field of complementary and alternative medicine will continue to grow as the medical/insurance system continues to fail for patients. People are beginning to realize that ultimately nature is what heals us.
Cruz: I believe there is a great future in store for alternative medicine. People are becoming more educated; they are realizing that traditional medicine doesn’t have all the answers. We are going to need more alternative medicine providers to deliver more natural/holistic approaches in the future.
Lucille: The current health care system is ludicrous. It doesn’t make sense. So, we need to keep pushing the common sense, keep thinking, remember the body’s ability to heal, think about the influencing factors, don’t forget pathophysiology, endocrinology or any of it. Connect with people. Remember this is a service industry!
Steelsmith: The future for alternative medicine is expansive! I have already seen how so much of our medicine is now incorporated into traditional medicine. Twenty-six years ago, nobody would’ve thought of giving their patient a probiotic when they were on an antibiotic. All the medical doctors in town thought I was a quack for doing so. Now we have a plethora of research showing how important the microbiome is to overall health and wellness. Medical doctors are now prescribing probiotics to their patients. As more and more research is done on the efficacy of natural medicine, I believe that it will become standard of care.
NP: Is there anything else you would like to add?
Lucille: Don’t embrace the practices of the conventional system that we complain about, the monetization of things beyond your true service as a practitioner. Use your mind and charge for that.
