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The article reported the overall average of the baseline and post treatment nitric oxide levels; the individual results of each of the 23 participants were not included.

Although pain and function were not measured, most participants reported an enhanced relaxation response after treatment.

The cranial therapy was associated with changes in NO levels in exhaled breath. The level of NO increased from 13.3 +/- 2.09 (SD) to 15.0 +/- 2.95 (SD) ppb (P=0.001, based upon the paired t tests of the subjects). The median level of NO before the cranial therapy was 13.0 ppb (ranging from 8 to 17 ppb); after cranial therapy, it was 16.0 ppb (ranging from 6 to 18 ppb).

Although pain and function were not measured, most participants reported an enhanced relaxation response after treatment; the most relaxed participants were those with the highest post-treatment exhaled NO levels.

Practice Implications
This study is the first to explore the physiological effect of cranial therapy on NO production. These finding are significant, especially since we are increasingly learning of the important role that NO plays in various aspects of health. It is also a big step for the cranial community, because despite having a long, rich history and an immense archive of anecdotal evidence, cranial therapy lacks substantial clinical research studies. Currently an explanation of how cranial therapy can produce an increase in exhaled NO levels remains theoretical.

Traditionally, elevated exhaled NO levels have been closely associated with chronic pulmonary conditions such as asthma. This is why it was so vital to choose participants who were qualified as “healthy adults.” Since there were no asthmatic participants, and those with post-treatment elevated levels of NO reported an enhanced relaxation response, I would hypothesize that there is an intimate connection between naturally increasing the body’s ability to produce NO and being able to decrease the devastating effects that stress has on the body. The article also states that this therapy could be a key adjunct in the prevention of coronary artery disease (CAD) and diabetes—both of which damage epithelial lining of blood vessels (indicative of low NO production). When lowered NO levels allow damage to the blood vessels to occur, the endothelium is less able to produce the necessary amount of NO, thus facilitating further endothelial damage. This, over time, can manifest into serious pathological conditions. Given the noninvasive nature of the procedure, this cranial therapy could potentially be an incredible asset to those treating such conditions.

Since the 1990s, NO has been aggressively studied—its relationship to cardiovascular health only discovered in 1998—and it has been found that too little NO, as seen in CAD and diabetic cases, can have a damaging effect, but too much can also be detrimental. In the instance of an excess of NO, further research to examine whether this cranial maneuver may have a modulating effect on NO levels would be interesting, as colleagues in the cranial field have reported positive results with asthmatic patients.

Although this study is small and uncontrolled, which is not typically the type of study highlighted in this column, these findings are relevant to clinical practice. NO is, as we’ve seen, a critical component in maintaining health. In the clinical field, NO and its precursors are being utilized in a variety of ways, ranging from treatment of pulmonary vascular disease in pediatrics, to pain associated with angina, to erectile dysfunction. It’s also becoming a staple for preventative and anti-aging protocols.

We’ve long known that there are noninvasive, effective methods of increasing NO levels, whether through supplementing with arginine or even regular exercise, but until now there has not been a physical modality that has shown a possible systemic increase in NO. These findings also suggest that various healthcare providers and readers of this column may, in addition to their current prevention or treatment protocols, begin to incorporate this type of cranial therapy into their practice.

Study Medication and Dosage
All patients received a standard triple antibiotic therapy for H. pylori infection consisting of a 2-week course of lansoprazole, amoxicillin, and clarithromycin. In addition, twice each day, 46 of the patients drank a cup of kefir and the remaining 36 drank a cup of milk.

Outcome Measures
A urea breath test was performed on all patients 45 days after beginning treatment. A questionnaire was completed 15 days after the start of treatment in order to assess side effects.

Key Findings
Kefir significantly improved triple antibiotic therapy eradication of H. pylori. Infection was eradicated in more than three-quarters of those patients drinking kefir (36 of 46 [78.2%]), compared with only half of those who received antibiotics plus placebo (18 of 36 [50.0%]). Reported side effects occurred significantly less often and were less severe in those who received kefir.

Practice Implications
One cup of kefir twice per day should be added to standard antibiotic protocol used in the treatment of H. pylori. Kefir increased effectiveness of standard treatment by about 30%. The standard pharmaceutical protocols that employ proton pump inhibitors plus 3 separate antibiotics to treat these infections are not 100% successful; cure rates have fallen below 80%.

Yogurt does not appear to have the same benefit. A paper published in January 2011 reported that using a yogurt that contained multiple strains of probiotic bacteria, along with triple antibiotic therapy, to treat H. pylori infection “neither improved H. pylori eradication rates nor reduced the adverse events of treatment.”

Side effects occurred significantly less often and were less severe in those who received kefir.

Kefir differs significantly from yogurt. Yogurt is milk that has been fermented by any of several strains of lactic acid–producing bacteria, typically Lactobacillus acidophilus. Kefir in contrast “is produced by microbial activity of “kefir grains,” which have a relatively stable and specific balance of lactic acid bacteria and yeast.” Yogurt cultures do not contain yeast. Yogurt fermentation requires incubation at warm temperatures, while kefir is fermented at room temperature.

Kefir has become quite popular in recent years because of the many claimed health benefits, including “reduction of lactose intolerance symptoms, stimulation of the immune system, lowering cholesterol, and antimutagenic and anticarcinogenic properties.”

In the literature, kefir is often lumped with other probiotic preparations, and search engines do not distinguish studies on kefir from those on yogurt. For example, a 2009 meta-analysis on fermented milk products and whether they improve H. pylori eradication did not distinguish between them. In this review, the combined data did show a small benefit: “Fermented milk-based probiotic preparations improve H. pylori eradication rates by approximately 5–15%.”

A 2007 meta-analysis that combined data from earlier studies also examined the effect of probiotic preparations on H. pylori eradication by triple antibiotic therapy. This earlier paper also reported slightly improved eradication rates—about 10% over placebo. All of the studies in this earlier review investigated yogurt made from Lactobacilli acidophilus and not kefir.

If kefir increases the efficacy of antibiotics against H. pylori, does it improve antibiotic effect against other types of intestinal infections? Possibly. A 2009 paper reports an open trial in which kefir appeared useful in treating Clostridium difficile infections in combination with antibiotics.

Renowned naturopathic physician, educator, researcher, and natural health pioneer, Joseph E. Pizzorno, Jr., ND, and fellow naturopath, researcher, author, and health expert, Michael T. Murray,ND, have collaborated with Canada’s leading functional food manufacturer to develop the ultimate professional line: Bioclinic Naturals.

Launched in 2009, Bioclinic Naturals consulted extensively with doctors, scientists, nutritionists and patients to create unique formulas that address patient concerns. Bioclinic Naturals is different from other professional lines, according to Murray. “There are gaps in the range of supplements currently available. As NDs, we follow six guiding principles; Bioclinic Naturals products specifically support and align with these,” Murray says. “In developing this product line, we focused on physiology-specific solutions with unique formulas for men and women. At the same time, we kept in mind the importance of optimum nutrition for whole body—whole life health. We have designed them specifically for use under professional guidance to achieve therapeutic results for the patient.”

To ensure pure, potent, safe and effective products, the doctors partnered with the Factors Group of Nutritional Companies. The Factors Group has the facilities, expertise, and technology to manufacture supplements that meet or exceed the most stringent international standards in addition to the demands of clinicians and patients. “Bioclinic Naturals is unique in that it grows many of its own raw materials, produces its own finished products, and has its own quality control laboratory to check every step of the process,” Pizzorno explains. “The company even has its own clinic to conduct clinical trials of innovative products on real patients.”

Professional Support
To support practitioners, Bioclinic Naturals offers a unique service: the Pro2Pro™ Practitioner-Only Support Line. Pro2Pro allows practitioners to ask Pizzorno questions and receive an answer, usually within 24 hours. The service is free to all Bioclinic Naturals customers, and questions can be submitted by email, phone, or fax.

Bioclinic Naturals products are supported with Product Specification, Clinical Highlight, a comprehensive Product Reference Guide, and a soon-to-be-released Clinical Guide. The Clinical Guide presents a functional medicine review focusing on 10 aspects of clinical practice, including common dysfunctions; causes for dysfunctions; methods of assessment using signs, symptoms, and laboratory tests; and natural health approaches and products known to be effective for these health concerns.

Bioclinic Naturals Highlights

Research-driven and clinically proven

Vertically integrated manufacturing

Condition-specific and therapeutically unique

Peer-formulated by fellow healthcare professionals

In-house laboratory facilities and testing

Patient-centered clinic

Safe, pure, and effective

100% natural

Affordable, with no quality compromises

Study Medication and Dosage
After a 1-week run-in phase, subjects ate 20 grams of one of two forms of high-polyphenol dark chocolate daily for 2 weeks, after which they crossed over to the next intervention separated by a 1-week washout period. One of the chocolates contained 500 mg of polyphenols per serving, the other 1,000 mg.

Outcome Measures
Changes in fasting blood sugar, blood chemistry, cortisol/cortisone ratio, and blood pressure were tracked.

Key Findings
Both doses, the 500 mg and the 1,000 mg/day of polyphenols, were equally effective at reduced fasting blood glucose levels and systolic and diastolic blood pressure. This suggests a possible saturation effect with increasing doses of polyphenols. A trend towards a reduction in urinary free cortisone levels was seen, but it did not reach statistical significance. Cholesterol levels did not change.

The fact that the decrease in free cortisol did not reach statistical significance may be related to a number of factors: Sample size was small, measuring techniques could have been more complete, and all but one of the subjects had peripheral rather than abdominal obesity.

Practice Implications
The present study tells us that eating dark chocolate with 500 mg polyphenol is as effective at reducing fasting blood sugar levels in overweight or obese individuals as a dose twice as large. Obesity is associated with insulin resistance and elevated blood pressure. The authors of this study had hoped to establish a causal link to improved cortisol levels to explain some of these changes.

This study, although suggestive of a connection between chocolate and cortisol, was unable to prove a connection; though these authors did not prove it, chocolate might someday become a treatment for metabolic syndrome.

This study, although suggestive of a connection between chocolate and cortisol, was unable to prove a connection. Though these authors did not prove it, chocolate might someday become a treatment for metabolic syndrome. This is just one in a fast growing series of papers telling us that the poyphenols in chocolate are beneficial to health. Earlier papers by Grassi et al and Taubert et al have already demonstrated decreases in fasting blood sugar and blood pressure using 500 mg/day polyphenol doses over periods of several weeks.

The caveat in interpreting these data is that these researchers have not used “over the counter” chocolate but instead selected chocolates especially manufactured to contain much higher than usual polyphenol levels. In this particular study the chocolate was made by Barry Callebaut, a Belgium company, and manufactured using the Acticoa process, which preserves the cocoa bean flavanols that are typically lost during processing. Analysis and comparison of 20 grams of 70% cocoa solid chocolate made through the Acticoa process with a 70% cocoa solid chocolate made by conventional manufacturing processes found that the Acticoa chocolate had more than 600 mg flavanols, while the standard process had less than 30 mg.4 The chocolate used in this research is about 20 times as strong as what we might buy as ‘good’ chocolate (the brand used in this and several other recent studies is not yet sold in the United States).

She desire to take control over our bodies and control our weight has created many food-related industries. Several of these alone cost untold billions of dollars a year. We try diets, specialty foods, fads, surgeries and a slew of other methods. Some people seek complementary treatments such as physical exercise, hypnotherapy and acupuncture. Having years of experience in helping clients with weight control I can say outright that I do not believe any modality in itself is a solution. I do not believe there is any silver bullet. Weight control is a multifaceted issue and it requires in-depth, multi-layered solutions.

There are excellent supports. Acupuncture is a great tool for weight control, but not in the way most people think of it. There are no acupuncture points to permanently control overeating, binging or addiction of any kind. Some points support release of addiction, but that is a far cry from being a solution.

When it comes to weight control many holistic health care professionals hear: “this is broken, please fix it,” which generally translates to “a part of me is broken and you are the therapist so please fix me.” Success will only come when this approach to support changes dramatically.

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Here are nine points to help a client seeking weight control through acupuncture or any other modality:

1. The treatment, be it acupuncture, hypnotherapy, or other is a support modality. In and of itself it is not a solution.

2. No matter what treatment a person seeks, if the underlying emotions and habits remain, the world’s greatest treatments are doomed.

3. To release weight and permanently control it, an individual must redefine their relationship to food.

4. In most cases the client must be willing to release the emotional hold of food as well as the physiological..

5. A person seeking to change bad eating habits will have a greater likelihood of permanent success if they view the problem as one of addiction. Unlike other addictions such as smoking or drugs, we all must eat to survive. This means food cannot be viewed as an ‘enemy.’

Which brings me to my final points about weight control:

6. Success is not linked to a diet. The subject of diets and overeating is too large to handle here. Suffice it to say that there tends to be a converse relationship between the two — more dieting leads to more difficulty with controlling weight, not less.

7. It bears repeating: The enemy is NOT food! That belief leads to feeling helpless, which supports addictive behavior and bad habits.

8. The enemy is feeling ugly and depressed because of overweight. It is feeling like a failure because we lost the battle once again with the refrigerator demons. The enemy is loss of spirit and loss of heart because the journey feels too long, the goal too far.

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9. SUCCESS is linked to self-acceptance, self-knowledge, and personal responsibility. It is knowing that the journey begins with a small step and that while there may be occasional straying, as long as the way is forward, all is well. It is linked to a willingness to leave old beliefs and habits that no longer support us and actively seek ones that do.

Seeking help with acupuncture or another healthy modality as a support is valuable. Vastly more important is accepting that lasting change is up to you. As with all personal journeys the greatest reward is often in what we learn along the way. Weight control opens the door to many changes. Success is measured not only in pounds shed, but in the awareness that we are more conscious and confident and able to experience life on our terms.

Key Findings
Drinking two or more sodas a week almost doubles a person’s risk of developing pancreatic cancer. Following these people for 14 years yielded 648,387 person-years of data and 140 cases of pancreatic cancer (PC). Individuals who consumed 2 or more soft drinks a week experienced a statistically significant increase in risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10–3.15) compared with individuals who did not consume soft drinks. There was no association seen between drinking fruit juice and risk of PC.

Practice implications
This is just the latest in a series of studies on the subject that have yielded sometimes conflicting and confusing results. Yet the bottom line consensus appears to be that soda or other concentrated forms of sugar, such as candy bars, do increase risk of pancreatic cancer.

Pancreatic cancer does not respond well to treatment: 5-year survival even with modern treatment is less than 5%. Therefore, prevention is the best approach. Cigarette smoking is the one accepted risk factor consistently associated with increased risk of pancreatic cancer. Type 2 diabetes also increases risk, which led to a theory that producing high levels of insulin might somehow lead to malignant transformation of pancreatic cells.

In most cancers, the cells that become cancerous have been somehow overworked, irritated, or in some way abused before becoming cancer cells. They have been pushed by something to grow faster, work harder, secrete more or in some manner live harder lives. Estrogen pushes both breast and uterine cells to become cancerous. Testosterone pushes prostate cells to become prostate cancer. Infections push lymph cells to become lymphoma. This theory about pancreatic cancer suggests that high sugar intake pushes the pancreas.

Diabetes has been associated with pancreatic cancer for decades. A study on Seventh Day Adventists published in 1988 reported that “prior history of diabetes was associated with increased risk of subsequent fatal pancreas cancer.”1

A Kaiser Permanente study published that same year found that while cigarette smoking increased risk of pancreatic cancer by a factor of 2.5, people who had been treated for diabetes had 4.5 times the risk. (Smoking: relative risk, 2.5; 95% confidence interval, 1.3–4.7. Diabetes: relative risk, 4.5; 95% confidence interval, 1.2–16.7)2

A Dutch paper published in 1990 that analyzed data on 164 patients with pancreatic cancer found “a significant, positive association between pancreatic cancer and past habitual intake of simple sugars.” (OR 1.95; 95% confidence interval, 1.24–3.07). This led the study authors to suggest that “the development of exocrine pancreatic carcinoma is positively related to past habitual intake of total energy, total carbohydrates, and simple sugars.”3

A 1991 Australian paper that analyzed the habits of 104 people who developed PC also found a link to sugar consumption. “For the top quartile of refined sugar intake, the estimated relative risk was 2.21 (95% confidence interval, 1.07–4.55).”4

A December 1995 study that looked at 179 cases of PC in French speaking Canadians found a similar effect of sugar consumption. Again, high sugar consumption nearly tripled risk. Of interest in this paper was the pronounced effect of cooking with firewood, a habit that increased relative risk by a factor of almost 5, while cooking in a pressure cooker lowered risk to one-third the average.5

Sweetened carbonated drinks, what we call soft drinks, or soda, are a major source of simple sugars in western diets. As such, soda consumption provides a measure of overall sugar consumption.6 Soda consumption is associated with hyperglycemia and hyperinsulinemia, obesity, and type 2 diabetes.

Rates of developing pancreatic cancer have plateaued and are stable in the United States, but they are rising among Chinese men and women in Singapore. From 1968 to 1998, they have almost doubled (going from 3.7 to 5.4 per 100,000 for men and 1.5 to 3.4 per 100,000 for women). One explanation for this increase is the shift toward a more western diet and increased consumption of sugar and sugar-sweetened sodas. It may be that during this transition period between traditional diets and western diets, the effect of soda consumption is more pronounced. Soda may be adopted into the diet while traditional foods and recipes still comprise the basic diet.

Design
Statistical mining of data collected on dietary habits of women with breast cancer. Diet in the 12–24 months before diagnosis was assessed with an extensive food frequency questionnaire, and confounders assessed from an epidemiologic interview and abstracted clinical data. Lignan intake was calculated using published food composition data.
Participants: 1,122 women, aged 35–79 years, diagnosed with breast cancer between 1996 and 2001. Data were collected as part of a study looking at lifetime alcohol consumption and breast cancer (WEB Study).

Study Methodology
The association between dietary lignan intake and survival was analyzed. Vital Status was tracked until the end of 2006. Extensive food questionnaires were used to track diet for 1–2 years before initial diagnosis. Lignan intake was calculated using current food composition tables. Hazard ratios (HR) for dietary lignan intake with all-cause and breast cancer mortality were calculated.

Outcome Measure
Vital status (living or deceased)

Key Findings
Postmenopausal women who consumed the most lignans had a significantly lower risk of dying from any cause and especially from breast cancer than women who ate only small amounts of lignan-containing foods. When upper versus lower quartiles of lignan intake were compared, there was a 51% (HR 0.49, 95% CI: 0.26–0.91) reduction of all-cause mortality in those consuming the higher lignan levels. These women had a 71% decreased risk of dying of breast cancer (HR 0.29, 95% CI: 0.11–0.76). High intakes of dried beans (HR 0.61, 95% CI: 0.36–1.03) may have also lowered risk of overall mortality and breast cancer mortality (HR 0.53, 95% CI: 0.24–1.14), though these numbers did not reach statistical significance.

Practice Implications
This is the first paper to examine the association of lignan intakes prior to breast cancer diagnosis and risk of dying. These findings suggest that we should actively promote consumption of lignan-containing foods, particularly in postmenopausal women.

One of the pleasures of winter in New England is its revelation of the wonder of my dog’s nose. During our walks at any other time of year, with her nose pressed to the ground, it appears as if my dog is enthusiastically, albeit randomly, on the hunt for something—anything—that she hasn’t found yet. However, in the winter, those apparently random sniffs are transformed before my eyes into a precise tracing of an animal’s trail. With the help of tracks left in the snow, I can now see the trail that my dog’s nose is leading her along. It amazes me how accurate she is in staying on the trail, and I know that, with enough time, she could easily follow the trail all the way to its source.

Dietary supplement products leave their own trails; however, I think my dog would meet her match in trying to follow these paths. For one thing, the trails leading to dietary supplements start in all parts of the globe. For another, the trails branch and intersect their way to the final product. There are very few linear, entirely transparent paths from starting material to finished product. As ingredients work their way from their original source to the final product, they can be mixed with the same ingredient from other parts of the world. The ingredients, while the same by name, may have different histories of cultivation, processing, extraction, and testing. The globalization of the dietary supplement industry along with the increasing demand on ingredients has turned the traceability into a veritable maze.

The globalization of the dietary supplement industry along with the increasing demand on ingredients has turned the traceability into a veritable maze.

In the midst of this layered and complex supply chain, manufacturers are left with the formidable challenge of identifying safe and pure ingredients that they can reliably utilize in their products. Thus, manufacturers source every ingredient with a myriad of considerations in mind. These considerations include things like ingredient price, availability, quality, processing, and traceability. A good manufacturer will set specifications for each of these areas and will use these specifications to determine from whom to purchase their ingredients. While this may seem challenging enough, to make matters even more complicated, for many ingredients there are multiple layers of supply. An ingredient may actually be sourced from multiple suppliers around the globe, and then mixed and sold to the manufacturer by a broker of that ingredient. This layering of suppliers can make it very challenging to identify the traceability of raw materials. Ultimately, manufacturers have three choices. They can decide to test every receipt of raw material for all known quality attributes (ie, identity, potency, known possible contaminants); they can vertically integrate, taking responsibility for all of their products’ ingredients from seed to bottle; or they can qualify their raw material suppliers to be reliable purveyors of acceptable-quality materials and do skip-lot testing verification. The majority of dietary supplement manufacturers fall into this last category.

“It is always an honor to host the AANP convention but the 25th Anniversary celebration was even more special because of the depth and breadth of continuing education,” says Karen E. Howard, executive director and CEO of the American Association of Naturopathic Physicians (AANP).

Held August 11–15, 2010, in Portland, Ore., the theme of this year’s convention and exposition was “Celebrating the Foundation of Medicine.” Participants were able to choose from more than 30 concurrent sessions and more than a dozen research sessions to attend. Most of the sessions focused on naturopathic practice and philosophy and were led by respected leaders in the naturopathic profession. The convention was approved for a total of 26 AMA PRA Category 1 credits, and the NCCAOM approved continuing education for acupuncturists. There were 145 exhibitors who supported this event with more than 600 attendees.

According to AANP President Carl Hangee-Bauer, ND, LAc, the sessions featured information that provoked thought and also provided practical pearls that clinicians can use the first day back in the office. He said the convention helped participants “reconnect with friends and celebrate the growth and successes of the naturopathic profession over the past 25 years, as well as look forward to the future.”

The conference objectives, as outlined in the Proceedings, were for attendees to:

• Know more about naturopathic medicine in general and integrating its techniques in their own practice specifically.
• Evaluate the most recent research on practices and modalities in natural medicine and healing.
• Describe specific techniques that are working in clinical settings to help patients heal from a variety of illnesses, with a goal towards improving overall patient care.
• Devise more efficient ways to run their practice, which will help physicians in their endeavor to work more effectively and professionally.

The Convention Content Committee included Sara Thyr, ND (Chair); Wendy Weber, ND (Research Chair); Jami Kupperman, ND; David Field, ND, LAc; Michael Owen, ND; and Michael Slezak, ND. During the annual meeting, Michael Cronin, ND, was voted in as the President-Elect of the organization. This was the first time in the history of the organization that a membership based competitive election was held to choose the next President.

“Our annual convention reinforces the fact that this work is not only changing people’s lives everyday, it is also changing everyday life and the future health of a nation,” concluded Howard.
“Our annual convention reinforces the fact that this work is not only changing people’s lives everyday, it is also changing everyday life and the future health of a nation,” concluded Howard.

It is clear that Gaby has taught many clinicians through the years and understands how to distill information, whether from trials or molecular biology, into useful patient care-oriented take home points.

The three of us also agreed that this would be the go-to textbook for that moment when you realize you are about to see a patient with a condition you haven’t thought about in many years. Each condition begins with a short summary, then goes into clinical considerations divided into three sections: Dietary Factors, Nutritional Supplements, and Other Treatments. There are references throughout the text, whether from clinical trials or case reports of therapeutic agents.

Let’s look at chapter 306 on Beta Thalassemia as a sample chapter. First, under Dietary Factors, we find that patients with this condition who drank black tea with their meals reduced their iron absorption by 41-95%, a desirable effect given the propensity for iron overload with blood transfusions that often accompany the disease. Moving on to Nutritional Supplements, considerations include folic acid, L-carnitine, magnesium, vitamin E, B6, riboflavin, vitamin C, and zinc. Each of these supplements has multiple lines of evidence regarding possible therapeutic usage. In the case of B6, Gaby cites evidence suggesting the conversion of pyridoxine to pyridoxal-5-phosphate (P5P) is impaired. Both genetics and a deficiency in riboflavin, the cofactor for the rate-limiting enzyme pyridoxine phosphate oxidase, are implicated in the impaired metabolism. Regardless of the cause, he suggests one consider supplementing B6 specifically in the form of P5P in this population, along with riboflavin. In the same chapter, under the heading Other Treatments, he cites a small trial of wheat grass juice. Consumption of 100 ml of wheat grass juice daily decreased transfusion requirements by 25% in more than 50% of study subjects. This chapter is an example of how the evidence is woven together with a thoughtful consideration of what has possible therapeutic benefit without risk to the patient. It is this perspective, from a long-time practicing clinician, that is infused throughout the book, bringing with it a clinical utility that busy practitioners can appreciate.

The shortfalls of the book were few and none of any substantial note. Absent for each condition was a thorough review of the progression and clinical presentation. Of course, this information can be gotten from reliable references such as Cecil’s Textbook of Medicine or the Merck Manual. As Gaby admits, this textbook was never intended to be exhaustive, but to be a review of therapeutic agents and a compilation of the must-know natural medicine interventions for given conditions. Certainly, at the size and weight of the current volume, any additions to the chapters would warrant at least a two-volume set. From clinicians who are just graduating to those that have been out long enough to forget a few things, this book is an invaluable resource for any practitioner who uses natural medicine in his or her practice, regardless of degree or years in practice.

When Alan Gaby’s Nutritional Medicine textbook arrived in the mail, my first thought was, “This book weighs a lot.” I walked over and placed it on the office scale. It weighs in at just over 8 pounds, 6 ounces. “Dr. Gaby birthed a textbook,” I thought to myself. As I read the textbook, I realized that the analogy of birth was not far from the truth. The information contained in its pages is a culmination of evidence, anecdotal cases, and Gaby’s own clinical experience. This seemed to be a rare deviation for a textbook, most of which use only staid information cited from medical literature.

The reason for this departure from the norm is best explained by Gaby himself in the Introduction to Therapeutic Agents: “Because of the low risk of adverse effects and the relatively low cost of most of the therapeutic agents discussed in this book, I believe the reader should be aware of all the potentially useful clinical applications, not just those that are supported by the highest levels of evidence.” (p51) In addition to his experience, the textbook has Dr. Gaby’s immutable writing style throughout: no words are superfluous, there are no irrelevant tangents to distract, and it is at all times obvious that the intended audience is practicing clinicians.

The textbook is divided into 3 parts. The first is a short section (49 pages) titled “Fundamentals of Nutritional Medicine,” covering topics such as food additives and food storage and cooking. Part 2, titled “Therapeutic Agents” is 185 pages divided into 4 sections: Vitamins, Minerals, Amino Acids, and Other Therapeutic Agents. Then comes the vast majority of the book: “Medical Conditions.” Beginning with chapter 72 on page 239, each chapter explores a different condition. 263 conditions later, this section ends at chapter 335, page 1272. The next section, called “Modalities,” reviews many novel pieces of clinically useful information to address symptoms that may arise from conventional interventions such as anesthesia and radiation. Finally, the last chapter is a concise overview of drug-nutrient interactions, with an emphasis on drug-nutrient depletions. Without the index or the appendix on Food Elimination, the text of this book spans a total of 1322 pages. I cannot recall ever having read a textbook of such breadth that was authored by one person. Certainly, there have been texts with a single author’s name attributed, but in truth that person is generally the editor with many authors contributing. Having written a fair amount myself, I am left in awe of the gargantuan task Gaby has completed.

What is the clinical utility of Nutritional Medicine? I asked two other practicing naturopathic physicians to use the textbook and give me feedback regarding its strengths and weaknesses. Teresa Silliman, ND, has been practicing for more than 10 years and has an emphasis in women’s health. Catherine Clinton, ND, is a more recent graduate whose interests are autoimmune disease and gastrointestinal complaints. My specialty is naturopathic oncology, and I have seen oncology patients exclusively for many years now. Interestingly, despite our differing knowledge bases, many of our observations about the book were in lock step. Namely, we were impressed by Gaby’s approachable and easy-to-understand writing style, the well organized chapters and index, and the impressive number of references, including some too obscure to find through mere internet searching. Of course, our commonality is that we are all clinicians. It is clear that Gaby has taught many clinicians through the years and understands how to distill information, whether from trials or molecular biology, into useful patient care-oriented take home points.