Clinical Skills with Paul Bergner, RH (AHG)

Transcription

1 AHG Advanced Webinar Intensives Presents: Clinical Skills with Paul Bergner, RH (AHG) Hosted by Adaira McInerney AHG Special Projects

2 The American Herbalists Guild promotes clinical herbalism as a viable profession rooted in ethics, competency, diversity, and freedom of practice. The American Herbalists Guild supports access to herbal medicine for all and advocates excellence in herbal education.

3 Interested in More Educational Tools? AHG Members may access the following fast growing list of resources: 50+ archived webinars presented by leading voices in herbal medicine Over 300 lecture mp3s from 12 years of AHG Symposia 22 fully digitized and archived Journal publications New JAHG published digitally twice a year Join the AHG within 30 days of this live event and save $10 Special Promo Code: WEBINAR10 Our members include students, educators, researchers, growers, wildcrafters, practitioners, product makers, and herbal enthusiasts!

4 See all supplemental files:

5 Sleep Debt Lifestyle pattern See Sleep Cycle Questionnaire

6 Pattern Immunodeficency, with frequent colds and infections (differentiate families with children in school) Insulin resistance. Pre diabetes. Abnormal Glucose Tolerance. Contributes to diabetes and obesity Cortisol disturbances. Specifically a second cortisol peak in the afternoon, with elevated levels in evening causing insomnia May affect thyroid.

7 Sleep Debt Is an endocrine state. Begins to occur for some individuals when they sleep less than 9 hours a night. Begins in many individuals when they sleep less than 8 hours. Is universal at sleep below 7 hours a night. Is pathologically severe at sleep less than 6 hours a night. Is the root of a thousand conditions

8 See Handout/Form Sleep Cycle Questionaire

9 Improvement or recovery typically requires a dose of restorative sleep, nighttime bedrest with lights off, of hours a night for 3 nights in a row. If patient is not greatly improved after the third night, a dose is 10 days. If not recovered then, a deep stage of burnout had been reached. See file Sleep Debt Bergner

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12 Nutritional Patterns

13 Broad Spectrum Nutrient Deficiencies A variety of physical symptoms. Mood/energy symptoms strong or chief complaints. Depression, anxiety, fatigue Immunodeficiency, frequent colds and viral infections. (screen for exposure through school aged children or occupation) Systemic inflammation. Musculoskeletal aches and pains. Hormonal imbalances Compensatory addictions

14 Compensatory addictions As a nutrient deficiency develops, the first disorders are functional. Physical aches and pains, neurotransmitter imbalances, mood and energy. The individual then typically self medicates with over the counter medications, mood altering substances, caffeine, nicotine, alcohol, cannabis, etc. and over-the-counter. Tolerance and dependence results in an overlay of withdrawal symptoms in addition to the original misery. Often a third layer of prescription drugs is overlaid. An individual who attempts to quit the substance must return to a level of deficiency induced misery that is perhaps worse now when it originally cried for self medication

15 Addictive patterns are a sign of malnutrition Organic diseases are later end stages of these. Nutrients can rapidly restore the disordered functions. Days to weeks. But the organic changes may never respond.

16 Address with nutrient density Address with mineral rich decoctions Urtica, Avena straw, Rubus, etc.

17 Vitamin D deficiency Muscle and bone pain Weak easily torn connective tissue Fatigue Cognitive dullness/depression Frequent wintertime infections Symptoms worse during Vitamin D winter January through March.

18 Essential Fatty Acid deficiency Dry skin, inflammation, allergies May have raised keratinous bumps on back of arms. Cognitive dullness Diet history suggesting deficiency

19 Magnesium deficiency Cramps, spasm, muscle stiffness, cervical syndrome, heart palpitations Low energy Inflammation.

20 Vitamin C deficiency Key symptom is easy bruising (rule out red flags) Dietary pattern suggesting low intake. Nearly universal in heavy drinkers.

21 Protein deficiency Guiding symptom: fatigue Sore muscles and connective tissue Muscles unresponsive to training. May be evident from review of diet diary

22 Optimal protein intake for metabolic health Active healthy adult (non-athlete) Adult building muscle mass 1.2 to 1.6 grams/kg* 1.7 to 2.1grams/kg 0.5 to.75 grams/lb 0.7 to 1.0 grams/lb g for women grams g for men grams Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, Woods SC, Mattes RD. The role of protein in weight loss and maintenance. Am J Clin Nutr Apr 29.

23 Optimal Protein per meal Young adult grams Age grams 60+ > 25 grams A threshold effect for beneficial effects on appetite, metabolism, and muscle development. Triggered by the amino acid leucine Layman DK, Anthony TG, Rasmussen BB, Adams SH, Lynch CJ, Brinkworth GD, Davis TA. Defining meal requirements for protein to optimize metabolic roles of amino acids. Am J Clin Nutr Apr 29.

24 Iron deficiency Anemia and iron deficiency are not synonymous. Any anemia must be evaluated with lab work and physician level assessment. Chief symptom: fatigue. (Iron is essential to the electronic transport chain in the mitochrondria.) May be accompanied by paleness and hair loss. If iron deficient, no therapy other than diet/supplementation will correct the fatigue.

25 Dietary archetypes

26 The Standard American Diet (SAD Diet) Typical American Diet. See it in the diet diary Typically has all previously described deficiency. By default, assume deficiencies of Mg, EFA, B-vitamins, trace elements, Vitamin D, Chromium, Zinc Typically corrected with a combination of improvement of nutrient density, plus at least initial supplementation for repletion of reservoirs.

27 Fast Food Vegetarian May be identical to SAD diet, but without meat. May focus on problematic foods such as soy, or processed vegetarian specialty foods. Most common micronutrient deficiencies are iron and zinc. Suboptimal protein nearly universal. EFA deficiency nearly universal.

28 Disordered eating A pattern of undereating and overexercise with a focus on body image. Most cases seen clinically do not meet the criteria for a diagnostic eating disorder. Recognizable with 4-day diet diary. Difficult to address.

29 Stress-carbohydrate pattern A pattern of high stress activity, an energy crash, and stress-cravings for carbohydrates. The underlying pattern is often insulin resistance, which we will describe in more detail next week.

30 Digestive patterns

31 Food Intolerance Triangle GI Symptoms Mood/energy Musculeskeletal or skin symptoms

32 See NAIMH course Systemic Inflammation, Food Intolerance, and Autoimmunity

33 Intestinal dysbiosys History of antibiotic use, even after some years. History of celiac disease or gluten associated gut symptoms Use of acid blocker medications.

34 Leaky Gut Syndrome Intestinal or gastric inflammation Connective tissue manifestations of inflammation Guiding symptoms: abdominal bloating (lymphatic)

35 Digestive insufficiency Inability to digest many foods Inability to digest normal portions of food Guiding symptom: undigested food in the stool

36 Liver stagnancy Skin problems, non-specific itching Fullness in the chest Sluggish digestion in general Constipation Intolerance of fat (Steatorrea = gas after eating fat, stool oily and floats) May exhibit false-cold pattern described last week.

37 See all supplemental files: