Mar 2025 | Volume 20 | Issue 3 N : simplebooklet.com

Seasonal allergy/atopic disease affects between 10-30% of the adult population and up to 40% of children in the world.[1] The economic burden of seasonal allergy in the US is estimated to be greater than $5.3 billion annually, with the majority of medications being antihistamines and intranasal corticosteroids for palliative care.[2] Both medications, while being effective in the short-term, bear adverse effects and secondary sequelae when used long-term, and tend to become less effective over time due to the development of drug tolerance.[3,4] Most importantly, they do not address the condition at its root – an imbalance of the immune system.Instead of simply blocking histamine receptors or the entire inflammatory response with the likes of corticosteroids, there are natural ingredients that have demonstrated anti-allergy effects via various mechanisms of action:1. Balancing Th1/Th2 Ratio & Exerting Immune-Modulatory Actions2. Promoting Histamine Metabolism & Down-Regulating Histamine Synthesis3. Reducing Concentration and Infiltration of Eosinophils/Mast Cells at Target Tissues4. Stabilizing Eosinophils/Mast Cells from Releasing Immune MediatorsMulti-Mechanistic Approach to Manage Symptoms & Optimize Immune Response1) Th1/Th2 Balancing & Immune-Modulatory ActionsSeasonal allergy is considered an atopic disease and classified as a type 1/IgE-mediated hypersensitivity. The production of specific IgE by B cells is regulated by T cells via cytokines. T helper 2 (Th2) cytokine profiles (e.g. IL-4 and IL-13) are the primary drive to IgE isotope switching in B cells, whereas T helper 1 (Th1) cytokine profiles (e.g. IFN-gamma, TNF-alpha) inhibit it.[5] In other words, Th1 and Th2 cells reciprocally inhibit each other’s effect on the immune system. It is proposed that the decrease in severe infancy infections (via the use of antibiotics and vaccinations) and improved sanitation systems over the past few decades may have contributed to the increased prevalence of allergic diseasec as an infection would drive a Th1 response and downregulate the tendency for Th2-related disease to develop. Allergic disease is essentially the result of an imbalance in the ratio of Th2 greater than Th1.Perilla [6,7], Quercetin [8], and Vitamin C [9,10] have demonstrated their potential to modulate Th2 cytokines, particularly IL-4, shifting to the Th1 immune response. Vitamin D3 [11] and probiotics such as LrGG [12] and LrHN001 [13] have a broader breadth of beneficial effects on immune-modulation in atopic disease.2) Promoting Histamine Metabolism & Down-Regulating Histamine SynthesisThe two enzymatic pathways of histamine metabolism are monoamine oxidase (MAO) and diamine oxidase (DAO), with MAO being the predominant route. The MAO pathway works hand-in-hand with Dr. Joseph Cheng, NDAdvertisementthe methylation cycle via SAMe, while DAO is independent; the key cofactors/coenzymes that are involved include Magnesium, Copper, Vitamin B1, B2 & B6, and Vitamin C (Figure 1). In addition, Vitamin C can further reduce histamine levels by inhibiting histidine decarboxylase – the rate-limiting enzyme in the synthesis of histamine.[14] 3) Reducing Concentration and Infiltration of Eosinophils/Mast Cells at Target Tissues There is a phenomenon called ‘allergy priming’, in which patients experience more severe symptoms later in the season than the onset. This is likely due to the process of aggregation of allergy effector cells (i.e. T cells, mast cells, eosinophils) at the epithelium of affected tissues according to biopsy studies in asthma, rhinitis, and atopic dermatitis.[5]Tinospora [15], Quercetin [8], Perilla [6], and Vitamin C [9] have been shown to reduce eosinophil/mast cell accumulation, as well as infiltration into the affected tissues. 4) Stabilize Mast Cells/Eosinophils Preventing degranulation of effector cells mitigates the release of pro-inflammatory mediators such as histamine, leukotrienes, and prostaglandins. Quercetin blocks mast cell cytokine release by inhibiting calcium influx and proteinkinase activation [16]; in fact, it has been shown to be more effective than its pharmaceutical counterpart - cromolyn.[17] Other ingredients that demonstrate mast cell stabilizing actions include stinging nettle [18], EGCG [19], and L-theanine [20]. 5) Other ConsiderationsSubcutaneous or Sublingual Immunotherapy (SCIT or SLIT) are viable adjunct therapies for allergic disease with a long track record of use for environmental allergens. SLIT works by introducing a low amount of allergen into the system and slowly increasing the quantity (i.e. without triggering a major inflammatory response) to induce the continued production of ‘anti-allergen’ IgG/IgA/IgE in the serum as well as mucus membranes. It also induces a shift of Th2 to T reg cells, which helps control multiple aspects of allergic inflammation.[21] The main drawbacks of SLIT are that it is allergen-specific and each treatment course generally takes at least 2 years to complete.Final ThoughtsSeasonal allergic disease – albeit a cyclical nuisance for most people, until it becomes long-term suffering – is no easy feat to ‘cure’ as multiple factors contribute to the disease process, such as digestive, liver and HPA axis functions. That said, providing an effective relief strategy that tackles multiple aspects of allergy can have profound effects on quality of life and decrease inflammatory burden as well as the burden of associated conditions. A Multi-Mechanistic Approach to Seasonal Atopic DiseaseVita Aid Seasonal Allergy ProtocolPreparation Phase (start 1-2 months prior to allergy season)•Immutonin: take 2 caps CC BID•Supreme-PB30+ DF: take 1 cap CC QDAcute Phase (during allergy season)•Histalief: take 2 caps BID-TID•XenobioX (promote histamine metabolism): take 1 cap CC BID•Bio-C: take 1 cap CC BID•Supreme-PB30+ DF: take 2 caps CC QDFull Ref.:© 2022 Vita Aid Professional Therapeutics Inc. All Right Reserved.P: 1.800.490.1738www.vitaaid.comPromote Healthy Histamine Levels* *The statements made herein have not been evaluated by the Food and Drug Administraon. Products are not intended to diagnose, treat, cure, or prevent disease. If you have any concerns about your own health, you should always consult with a physician or healthcare professional.Proudly in Collaboraons with:• Synergisc Acons to Provide Relief for IgE-Mediated Allergic Symptoms*: 9 Modulate Histamine Release & Synthesis* 9 Balance Th1/Th2* 9 Reduce Eosinophil Aggregaon*• Featuring Highly Concentrated An-Allergy Extracts (2,585 mg DHE†/cap): Tinospora, Perilla, and Snging Nele• Fored with Quercen, NAC, and Vitamin C †DHE - Dried Herb EquivalentLearn More:HistaliefFigure 1. Histamine Reduction, Methylation Cycle, and the Collateral PathwaysMast Cell Stability

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Clinical pearlsCase management/case studiesNaturopathic philosophyPractice building and business managementCurrent trends and issues that affect naturopathic physicians in your areaNews, announcements, and event noticesDevelopment of new techniques or protocolsAbstracts and reviewsDiscussions pertaining to diagnosticsPublic/media relations and networkingUsing technology to make practices more efficient and profitableEducational and grassroots programs that further the naturopathic causeAny other trend, event, or development you believe is pertinent to theprofessionFor more information regarding article submission, or to receive a copy ofsubmission guidelines, please contact editor@ndnr.com or scan the QR code formore information. Opinions expressed in Naturopathic Doctor News & Review do not necessarilyreflect those of this publication and its publishers.Copyright © 2024 Naturopathic Doctor News & Review. All rights reserved. No portionof this publication may be copied, reproduced, or redistributed without express writtenpermission from the publisher. Reprint information is available by contactingpublisher@ndnr.com.Naturopathic Doctor News & Review reserves the right to edit or reject any submittededitorial or advertising. Opinions expressed by contributors and advertisers are notnecessarily the opinions of Naturopathic Doctor News & Review or its principals.Naturopathic Doctor News & Review is published and circulated as an annualsubscription (12 issues) to licensed naturopathic doctors (NDs) and students andgraduates of CNME recognized naturopathic colleges in North America, and certainsuppliers to the profession. Annual subscriptions (12 issues) are available to other healthcare providers and NDs outside of North America: $199 USDINSIDEThe (Not So) Hidden HealthEffects of Fast FashionThe (Not So) Hidden HealthEffects of Fast Fashion07Nozomi Gonzalez, NDFast fashion has revolutionized the clothing industry,making trendy apparel accessible to the masses.However, its environmental toll and associated healthrisks, including exposure to toxicants and microplastics,cause concern. Learn how naturopathic strategies canmitigate these impacts.Homotoxicology—A Revolutionary Approach toUnderstanding and Reversing Chronic DiseaseMark Iwanicki, ND, LAcExploring how toxin bioaccumulation driveschronic illness and how homotoxicologyprovides a systematic framework fordetoxification, ECM restoration, and long-termhealing.Bone as a Source of Elevated Metal Toxicants –Concerns, Assessment, TherapeuticsPaul Anderson, NMDUnderstanding the impact of bone turnover onheavy metal toxicity and how to managechelation therapy safely. Homeopathic Case Study: Treating PANDASwith Tarentula HispanicaJennifer Bahr, ND, DHANP, FMAPSA Case Study on Pediatric AutoimmuneNeuropsychiatric Disorder Associated withStrep (PANDAS) Successfully Managed withHomeopathyFrom Toxicology to Clinical Application:Applying Primary Source Research toHomeopathic PracticeJamie Oskin, ND, DTBRm, DHANPExploring the clinical significance of primarytoxicology reports in homeopathic medicine,with a case study on Arsenicum album.Therapeutic Order: Navigating an Ever-Increasing Toxic WorldKim Furtado, NDExploring how naturopathic principles providea structured approach to healing in anincreasingly toxic world.Allergies, Asthma & Eczema: PediatricTreatment of the Atopic TriadAutumn Frandsen, NDA clinical naturopathic approach to managingthe pediatric atopic triad—eczema, asthma, andallergies—by addressing immune dysfunction,gut health, and environmental triggers.From Kitty Litter to Cortical Recovery: ANaturopathic Case Study on Reversing CIRS-Induced Brain AtrophyEric Dorninger ND, LAcExploring the Role of Biotoxins in ChronicInflammatory Response Syndrome (CIRS) andHow Proper Screening, Diagnosis, andTreatment Can Reverse Neurological DamageArticle Submissions: Articles should be original,previously unpublished, and should cover aspecific topic, protocol, modality, diagnostic,philosophy, commentary, or case study pertainingto naturopathic medicine rather than a generaloverview. Illustrations, photographs, charts, andprotocols are encouraged. Naturopathic DoctorNews & Review does not reprint articles fromother publications except under unusualcircumstances. Typical word requirements are 700 to 2000 words per article. Topics of interestinclude:TOLLE TOTUM311152029JOIN THE CONVERSATIONMAR 2025 - VOLUME 20 | ISSUE NO. 03213742

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20YEAREST. 2005ANNIVERSARYLetter from the PublisherDear Readers,Spring is just around the corner, bringing with it a season ofrenewal and, for many, the familiar challenges of allergiesand immune sensitivities. In this March issue of NDNR, wedelve into the complex landscape of Allergy, Immunology,Environmental Medicine, and Toxicology—areas of growingconcern and profound relevance in today’s increasingly toxicworld.Our expert contributors bring forward innovativeperspectives and practical solutions for navigating theimpacts of environmental toxins, chronic immunedysfunction, and complex disease patterns. We begin withDr. Mark Iwanicki, who explores the revolutionary field ofHomotoxicology, shedding light on the role of toxinbioaccumulation in chronic illness and offering a systematicframework for detoxification and long-term healing.Dr. Paul Anderson provides a critical examination of theimpact of bone turnover on Heavy Metal Toxicity, guidingpractitioners on how to assess and safely manage chelationtherapy. Meanwhile, Dr. Jennifer Bahr presents a compellingHomeopathic Case Study on treating Pediatric AutoimmuneNeuropsychiatric Disorder Associated with Strep(PANDAS) using Tarentula Hispanica, offering hope forcomplex pediatric conditions.Continuing with homeopathic insights, Dr. Jamie Oskinexplores the clinical application of primary toxicologyreports in practice, highlighting a fascinating case study onArsenicum album. Dr. Oskin also shares industry news froma recent conference, including the unveiling of a new open-access digital library poised to enhance clinical applicationand research within the homeopathic community.Applied Naturopathic Medicine 20th Annual Environmental Medicine Issue 4NATUROPATHIC DOCTOR NEWS & REVIEWNavigating an increasingly toxic world requires a structuredapproach, and Dr. Kim Furtado revisits the TherapeuticOrder, reinforcing naturopathic principles for sustainablehealing. Dr. Autumn Frandsen offers a comprehensive lookat managing the Pediatric Atopic Triad—eczema, asthma,and allergies—through a holistic approach that addressesimmune dysfunction, gut health, and environmental triggers.Finally, Dr. Eric Dorninger presents a remarkable case studyon Reversing CIRS-Induced Brain Atrophy, demonstratinghow thorough screening, accurate diagnosis, and strategictreatment can reverse neurological damage, offering newpossibilities for those affected by chronic inflammatoryresponse syndrome.This issue is a testament to the ever-evolving landscape ofnaturopathic medicine, highlighting the importance ofintegrative and evidence-informed approaches. Aspractitioners, staying informed and adaptable is essential tomeet the growing health challenges of our time. We hope thisissue empowers you with the knowledge and tools needed tomake a meaningful impact in your patients' lives.Thank you for your continued dedication to theadvancement of naturopathic medicine. We are honored tosupport you in this journey.In Health, Razi BerryPublisher | NDNR & NaturalPathALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUERazi Berry

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The (Not So) Hidden HealthEffects of Fast FashionThe (Not So) Hidden HealthEffects of Fast FashionNOZOMI GONZALEZ, NDWe live in one of the trendiest times in history. Trends in fashion have existed almost as long as humanshave worn clothes, but for most of the past, only a select number of people had the means to participate.Until the early 19th century, clothing was handmade at home or made-to-order for those who could affordit. Clothing was created with natural fibers at a sustainable rate by individual people. Because it wasexpensive and time-consuming to produce, you only replaced your clothes when worn out. However, thestandardization of sizes, the Industrial Revolution, and the creation of the sewing machine in 1829 led tothe advent of mass production of clothing.¹ Ready-to-wear clothing began being sold at department stores,making clothes cheaper, faster, and more attainable than ever before. By the 1920s, fashion trends wereaccessible to the public, rather than just the elite, for the first time in history. In just 50 years, this industryincreased from today’s equivalent of $333 million to $20 billion.¹ By 1951, 90% of garments purchased inthe United States were ready-made.²Unveiling the Environmental and Health Costs ofTrendy, Affordable ClothingUnveiling the Environmental and Health Costs ofTrendy, Affordable Clothing7TOLLE CAUSAMMAR 2025 - VOLUME 20 | ISSUE NO. 03

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What is Fast Fashion?Today, half the fashion industry is considered ‘fast fashion.’³Fast fashion, coined in the 1990s, refers to an acceleratedproduction model of trendy and low-quality clothing focusedon convenience, accessibility, and affordability.⁴ Itperpetuates and takes advantage of a culture ofoverconsumption, short attention spans, and hyper-accelerated fashion trends, so-called ‘microtrends,’ to sellclothes at rates never seen before. Long gone are the days offastidiously handmade pieces that lasted a lifetime. Today, ittakes 10 days to turn a design into a garment, and 100 billionnew garments are manufactured yearly. ⁵ ⁶ Though the worldis an avid consumer of clothes – 80 billion pieces are soldannually – half of the clothes in closets never get worn, thepieces that are worn are considered ‘old’ after just 1 to 2wears, and are thrown out after wearing 7 to 10 times.⁷ ⁸ Mass-produced clothing has made fashion trends accessibleto anyone with a few dollars – at a dire environmental andhealth cost. Fast fashion is excessively affordable toconsumers because it cuts costs in production whereverpossible. This has translated to poor labor practices,questionable and increasingly resource-heavy textile creation,and significant pollution. Health EffectsFashion is now considered one of the largest polluters in theworld, responsible for 4% of the world’s total greenhouse gasemissions and 10% of the world’s total annual carbonfootprint.⁹ ¹⁰ Part of the problem lies in transportation.Though the United States is the largest consumer of clothingand textiles globally, almost all the clothing purchased here isproduced in a different country.¹¹ Shein, a global e-commercefast fashion platform based out of Singapore with productionin China, encompasses 50% of the fast fashion market sharein the U.S. – more than the next top 5 competitorscombined.¹² ¹³ To keep up with the demand of quicklychanging styles, Shein relies on air shipping to send hundredsof thousands of individually addressed packages daily. Infact, 38% of Shein’s climate footprint relies on thistransportation method.⁵ Unfortunately, reliance on aviationis hardly a long-term solution. There is mounting evidence ofthe health effects related to aviation fuel and air pollutants,including respiratory conditions, cardiovascular disease,dementia, and even lead toxicity and cancer.¹⁴ Some studieshave concluded that aviation emissions are responsible forover 50,000 premature deaths yearly.¹⁵ Textile production is an even more significant contributor tofast fashion’s climate footprint. Fast fashion companieslargely use and produce cheap synthetic fibers – specificallypolyester – to create their low-cost pieces. Production ofpolyester alone was responsible for the emission of over 700million tons of carbon dioxide in 2015 and is expected todouble by 2030.¹⁶ Aside from the apparent healthrepercussions of climate change due to greenhouse emissions,the air pollutants themselves pose a serious health risk. Theseeffects are due in part to ozone exposure and in part toparticulate matter exposure.¹⁵ Particulate matter emitted fromburning fossil fuels has been linked to neurodevelopmentaldisorders, reductions in brain white matter surface, andincreased hospitalizations due to respiratory issues.¹⁷Furthermore, air pollution is considered the largestenvironmental cause of premature death in the world,estimated to be responsible for 16% of deaths worldwide.¹⁸Most of these occur in the low- and middle-income countrieswhere fast fashion is produced.¹⁸ The textiles that are the product of this significant pollutionare primarily synthetic fibers such as elastane, nylon, andpolyester; the latter make up over half of all fibers used toproduce these clothes.¹³ Shein’s clothing is comprised of 76%polyester.⁵ These low-cost materials can lead to poorer healthoutcomes, particularly for our patients who struggle withdermatitis. Polyester and other tightly woven fabrics havebeen shown to promote overall trans epidermal water loss onthe skin. They are often produced through chemical processesinvolving petroleum, which may be irritating.¹⁹ The dyes usedto color synthetic fibers are also more likely to be associatedwith contact dermatitis than those used to color naturalfibers.²⁰ Even for those in whom dermatitis is not an issue, cheaplymade fabrics present a significant toxic risk. Several reportshave independently tested clothing from fast fashion brandsand found hazardous chemicals and heavy metals at levels ofconcern. These toxicants – phthalates, perfluoroalkoxyalkanes (PFAs), bisphenol A (BPA), nickel, and lead – havebeen found in everything from children’s clothing to items asintimate as underwear.²¹⁻²⁴ Consumers are at risk of exposureto these toxicants through constant and direct contact withthe textiles on the skin and through inhalation or ingestion ofdust released from them. Concerningly, studies already showthe potential for toxicants to permeate deeper layers of theskin and suggest eventual systemic absorption throughclothing exposure.²⁵ 8ALLERGY / IMMUNOLOGY /ENVIRONMENTAL / TOXICOLOGY ISSUE

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Polyester and synthetic fibers continue to wreak havoc even ifthey are not being worn. Polyester fibers comprise a longchain of polymers, the most common of which is polyethyleneterephthalate (PET).²⁶ Polymers, synthesized in part for theirdurability, are estimated to take years or centuries to breakdown entirely.²⁷ In the meantime, they degrade into smallerand smaller particles that infiltrate our oceans, soil, air, andbody. These particles, known as microplastics, are tiny piecesof plastic measuring as small as 100 nanometers and have bighealth concerns. Synthetic fiber use in clothing hascontributed to a rise in microplastic fiber release, particularlyfrom laundering. Over 550,000 tons of plastic microfibers –equivalent to more than 50 billion plastic water bottles – areestimated to pollute the ocean yearly from washing.¹⁰ There ismounting evidence regarding the health effects ofmicroplastics and suggestions that humans consumesignificantly more than previously thought. Microplasticshave been found to elicit health effects through a broad rangeof mechanisms and organ systems, such as causing loss ofintegrity of mitochondria, lipid metabolism disturbance, andgut microbiota dysbiosis.²⁸ Studies have even suggested thatthese tiny plastics can cross the blood-brain barrier andaccumulate in microglial cells, eventually triggering celldeath.²⁹ InterventionsFortunately, many naturopathic detoxification strategies canmitigate multiple of the health effects secondary to fastfashion’s rise. Vegetables from the brassica family, forexample, can protect against air particulate matter andsupport liver glucuronidation necessary for removingxenobiotics.³⁰“Studies have even suggestedthat these tiny plastics can crossthe blood-brain barrier andaccumulate in microglial cells,eventually triggering cell death.²⁹”9Probiotics have emerging research as a potential therapy tobind heavy metals, eliminate BPA, and counteract the effectsof microplastics through actions such as strengthening theblood-brain barrier and improving the integrity of tightjunction proteins.³¹⁻³³ N-acetylcysteine is well known for itsrespiratory and liver-supportive actions. It is an establishedantioxidant and mucolytic, especially for chronic obstructiverespiratory disease patients, and is the primary antidote foracetaminophen overdose.³⁴ ³⁵ What may be less known is itsrising prospect for use in heavy metal chelation. Studies haveshown its ability to increase the excretion of mercury andlead, and, importantly, without depletion of other essentialmetals such as iron and magnesium, with significantly fewerside effects than traditional chelators.³⁶ Furthermore, it cancounteract neurodegenerative changes and increasemitochondrial functioning that may be impacted bymicroplastic accumulation.³⁷ ³⁸ Sauna therapy can increaseskin hydration and stability of the epidermal barrier, reducethe risk of respiratory disease, and facilitate the excretion ofmetals and toxicants through perspiration.³⁹⁻⁴¹The best protection against fast fashion’s impact is anoverhaul of the culture that stimulates the desire to shopexcessively. Our second-best protection is educating ourselveson its risks and avoiding its products. Many endeavors arealready underway to make this effort easier for the consumer.For example, in response to the overwhelming evidence of thenegative health impacts of fast fashion, some brands havebased their mission on selling only clothing made withrecycled or recyclable materials. Standardized certificationsnow endorse clothing that has been produced with reducedenvironmental impact, such as Bluesign and B Corp. MAR 2025 - VOLUME 20 | ISSUE NO. 03NATUROPATHIC DOCTOR NEWS & REVIEW

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Nozomi Gonzalez, ND, is a third-year andchief resident at NUNM. She graduatedfrom NUNM in 2022 and has worked in avariety of clinical roles from primary care todermatology, with a focus on environmentalmedicine and IV therapy. She is additionallypassionate about community health andleads a clinic shift through the Volunteers ofAmerica for individuals being treated forsubstance use disorders.1. Thanhauser S. Worn: A People’s History of Clothing. Penguin Books; 2023.2. Green NL. Ready-to-Wear and Ready-to-Work: A Century of Industry andImmigrants in Paris and New York. Duke University Press; 1997.3. Behind the seams: shocking fast fashion statistics you need to know | illuminem. May10, 2024. Accessed December 12, 2024. https://illuminem.com/illuminemvoices/behind-the-seams-shocking-fast-fashion-statistics-you-need-to-know4. Fast fashion explained | meaning, history, issues & problems. SANVT. May 9, 2022.Accessed December 12, 2024. https://sanvt.com/blogs/journal/fast-fashion-explained-meaning-and-history5. Grist SKM. Shein is officially the biggest polluter in fast fashion » Yale ClimateConnections. Yale Climate Connections. September 19, 2024. Accessed December 12,2024. http://yaleclimateconnections.org/2024/09/shein-is-officially-the-biggest-polluter-in-fast-fashion-ai-is-making-things-worse/6. Fast fashion by the numbers. PIRG. September 20, 2023. Accessed December 12,2024. https://pirg.org/articles/fast-fashion-by-the-numbers/7. How Clothes Harm the Environment - Tala Tabishat, 2022. Accessed October 17,2024. https://journals.sagepub.com/doi/10.1177/153650422210830118. Shedlock K. UNRAVELLING THE HARMS OF THE FAST FASHIONINDUSTRY.9. How the fashion industry can reduce its carbon footprint | McKinsey. AccessedDecember 12, 2024. https://www.mckinsey.com/industries/retail/our-insights/fashion-on-climate10. Fashion’s impact in numbers. Accessed December 12, 2024.https://www.cnn.com/interactive/2020/09/style/fashion-in-numbers-sept/11. Bick R, Halsey E, Ekenga CC. The global environmental injustice of fast fashion.Environ Health. 2018;17(1):92. doi:10.1186/s12940-018-0433-712. Perri J. Shein holds largest U.S. fast fashion market share. Bloomberg SecondMeasure. January 4, 2023. Accessed December 12, 2024.https://secondmeasure.com/datapoints/fast-fashion-market-share-us-consumer-spending-data-shein-hm-zara/13. Fast Fashion Statistics 2024 | UniformMarket. July 24, 2024. Accessed December12, 2024. https://www.uniformmarket.com/statistics/fast-fashion-statistics14. Grebe S, van Seters D, Faber J. Health Impacts of Aviation UFP Emissions inEurope. CE Delft; 2024.REFERENCESNumerous organizations generate research and resourcesintending to eliminate fashion waste and pollution. Forexample, the Ellen MacArthur Foundation champions the‘circular economy’ as a method of fully recycling materials.⁴²The United Nations established the UN Alliance forSustainable Fashion in 2019, intending to collaborate withexisting environmental initiatives around the world, one ofwhich includes the signing of 100 brands committed toreducing greenhouse gases by 30% by 2030.⁴³ France, home tothe fashion capital of the world, recently had a bill seekingpenalties on fast fashion products passed by the lower houseof parliament.⁴⁴ 10ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUEIn ConclusionFast fashion has gained popularity as a means of makingtrendy clothing affordable to a larger population than everbefore. Unfortunately, low-cost clothing made fromproblematic production practices comes at a high cost to ourhealth. We eventually pay, whether directly through exposureto toxicants or indirectly through air pollutants fromincreased air travel and plastic microfiber accumulation. Ashealthcare providers, we must become aware of these risksand arm ourselves and our patients with this knowledge tocombat its deleterious effects best. 15. Eastham SD, Chossière GP, Speth RL, Jacob DJ, Barrett SRH. Global impacts ofaviation on air quality evaluated at high resolution. Atmospheric Chem Phys.2024;24(4):2687-2703. doi:10.5194/acp-24-2687-202416. Fossil fashion: the hidden reliance of fast fashion on fossil fuels • Changing Markets.Changing Markets. Accessed December 12, 2024.https://changingmarkets.org/report/fossil-fashion-the-hidden-reliance-of-fast-fashion-on-fossil-fuels/17. Perera FP. Multiple Threats to Child Health from Fossil Fuel Combustion: Impactsof Air Pollution and Climate Change. Environ Health Perspect. 2017;125(2):141-148.doi:10.1289/EHP29918. The Lancet Commission on pollution and health - The Lancet. Accessed December12, 2024. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32345-0/fulltext19. Jaros J, Wilson C, Shi VY. Fabric Selection in Atopic Dermatitis: An Evidence-Based Review. Am J Clin Dermatol. 2020;21(4):467-482. doi:10.1007/s40257-020-00516-020. Svedman C, Engfeldt M, Malinauskiene L. Textile Contact Dermatitis: How FabricsCan Induce Dermatitis. Curr Treat Options Allergy. 2019;6(1):103-111.doi:10.1007/s40521-019-0197-521. Taking the shine off SHEIN: Hazardous chemicals in SHEIN products break EUregulations, new report finds. Greenpeace International. December 1, 2024. AccessedDecember 12, 2024. https://www.greenpeace.org/international/press-release/56979/taking-the-shine-off-shein-hazardous-chemicals-in-shein-products-break-eu-regulations-new-report-finds/22. Cowley J, Matteis S, Agro C. Experts warn of high levels of chemicals in clothes bysome fast-fashion retailers. CBC News. https://www.cbc.ca/news/business/marketplace-fast-fashion-chemicals-1.6193385. October 1, 2021. Accessed December 12, 2024.23. Carnevale S. What You Need to Know About BPA in Clothing. Center forEnvironmental Health. February 24, 2023. Accessed December 12, 2024.https://ceh.org/what-you-need-to-know-about-bpa-in-clothing/24. Durosko E. Death by Fashion: Consumers Face Health Risks By Purchasing FromUnregulated Fast Fashion Brands. Loyola Consum Law Rev. 2023;35(2):261.25. Iadaresta F, Manniello MD, Östman C, Crescenzi C, Holmbäck J, Russo P.Chemicals from textiles to skin: an in vitro permeation study of benzothiazole. EnvironSci Pollut Res Int. 2018;25(25):24629-24638. doi:10.1007/s11356-018-2448-6References [26-48] on NDNR.com

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HomotoxicologyA Revolutionary Approach to Understanding & Reversing Chronic DiseaseMARK IWANICKI, NDExploring how toxin bioaccumulation drives chronic illnessand how homotoxicology provides a systematic frameworkfor detoxification, ECM restoration, and long-term healing.Chronic disease is the defining health challenge of our era,with conditions such as autoimmune disorders, metabolicdysfunction, degenerative illnesses, and cancer on the rise.¹Conventional medicine often focuses on managing symptomsrather than addressing the underlying causes of disease.Homotoxicology, a revolutionary medical framework withinthe larger body of medicine often referred to as EuropeanBiological Medicine, provides a systematic approach tounderstanding how our body’s accumulated toxic burdencontributes to disease progression. By targeting theextracellular matrix (ECM) and guiding the body through astructured detoxification process, Homotoxicology also offersa path to true healing.Toxins (of biological and metabolic origin) and toxicants (ofman-made origin) bioaccumulate in the body due tocontinuous production (when referring to metabolic toxins)and constant exposure (when referring to environmentaltoxicants) that outpace the body’s ability to eliminate themeffectively.² Environmental toxicants (commonly calledtoxins) are particularly egregious, accumulating in fat, tissues,organs, and the extracellular matrix (ECM), disruptingcellular function, hormonal signaling, mitochondrial energyproduction, and immune regulation.³ A study published in theJournal of Exposure Science and EnvironmentalEpidemiology identified over 3,600 chemical substances,including hazardous chemicals like bisphenols, phthalates,and heavy metals from food contact materials, such aspackaging and kitchen utensils, present in human biologicalsamples, including blood, breast milk, and fat tissue.⁴ TOLLE TOTUM11NATUROPATHIC DOCTOR NEWS & REVIEWALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUEWith over 350,000 synthetic chemicals produced globally,bioaccumulation is inevitable for every human, increasingwith age and exposure.⁵ This total toxic burden is a majorunaddressed driver of chronic disease, contributing tooxidative stress, metabolic dysfunction, immunedysregulation, and neurotoxicity.⁶ Without properdetoxification and drainage support, these accumulatedtoxins continue interfering with normal cellular processes,leading to progressive disease and degeneration.Homotoxicology-A New Framework for Workingwith Toxin BioaccumulationHomotoxicology, first developed by German physician Dr.Hans-Heinrich Reckeweg is a framework within EuropeanBiological Medicine (also referred to as Biological Medicine,German Biological Medicine, Swiss Biological Medicine (asper Dr. Thomas Rau), or in North America asBioregulatory Medicine) based on the premise that disease isthe body's response to accumulating toxins (referred to byDr. Reckeweg collectively as "homotoxins") that disruptnormal cellular function. Homotoxicology describes how, astoxin load increases, the body progresses through distinct,clinically verifiable phases of advancing pathology.⁷ At the core of understanding Homotoxicology lies thebiological concept of the extracellular matrix (ECM), firstextensively studied by Alfred Pischinger, who identified it asthe key regulatory system of the body. The ECM is a vast,dynamic network of connective tissue, structured water,collagen fibers, glycoproteins, and proteoglycans, serving asthe primary communication and exchange interface betweencells, capillaries, and the lymphatic system. It is the spacethat surrounds and bathes all body cells and forms onecontinuous whole.

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PhaseDescriptionExample (Skin Health)1. Excretion Phase (Healthiest)The body actively eliminates toxins via urine, stool,sweat, and breath. Minimal bioaccumulationoccurs.Clear, vibrant skin as toxins are efficientlyeliminated.2. Inflammation PhaseAcute inflammation occurs as the body attempts toneutralize toxins. Inflammatory processes helpremove accumulating toxins.Temporary rashes, redness, or eczema-likereactions indicate increased toxin removal.3. Deposition PhaseToxin elimination is outpaced by bioaccumulation,leading to toxin storage in the extracellular matrix(ECM) and connective tissues.Chronic eczema, acne, and persistent skinirritation emerge.4. Impregnation PhaseToxins penetrate organ cells, causing cellulardysfunction. Storage in the ECM is compromised,pushing toxins intracellularly.Loss of skin elasticity, premature aging, deepwrinkles, and hyperpigmentation due to toxicityaffecting collagen and elastin.5. Degeneration PhaseToxins accumulate inside cells, leading to structuraldamage and breakdown of normal cellularfunction. Organelles and mitochondria fail,disrupting cell duties.Severe skin conditions like psoriasis and dermatitisindicate deep degenerative damage and immunedysregulation.6. Neoplasm Phase (Most Advanced)Toxins reach the nucleus, damaging DNA andcausing abnormal cellular replication. Prolongedtoxicity and immune dysregulation causeuncontrolled cell growth.Melanomas and other skin cancers may developdue to long-term toxin exposure and impaireddetoxification.12NATUROPATHIC DOCTOR NEWS & REVIEWIt plays a crucial role in nutrient delivery, toxin filtration, andimmune surveillance, acting as a buffer zone that regulates thebiochemical environment surrounding cells. The ECM is alsothe key area where toxins bioaccumulate, leading to impairmentof cellular signaling, disruption of nutrient exchange, and thebreakdown of normal cellular functioning, all contributing tochronic inflammation and disease progression. Homotoxicologyfocuses on clearing homotoxins from the ECM, restoring itsfunction, and optimizing the body’s self-regulatory capacity topromote long-term health.⁸The Six-Phase Table of HomotoxicologyDr. Reckeweg developed a six-phase disease table to mapdisease progression based on increasing toxicity levels withinevery organ system of the body. This framework helpspractitioners determine the severity of the toxic burden andtrack the health of an organ system through these phases. Eachbody system— the skin, lungs, liver, kidneys, or cardiovascularsystem—can be assessed within this model to understand howincreasing toxic bioaccumulation affects its normal functioning.⁹The following is a description of each phase of the table usingthe skin as an example organ system:Understanding where a patient falls within this six-phasesystem allows practitioners to tailor treatment strategies andencourage the body to reverse its disease progression.⁹ Deeperdegeneration will require longer, more aggressive treatments tomove patients out of illness. Practitioners can guide patientstoward restored health and optimal well-being by addressingtoxicity early, supporting detoxification, and preventing toxinaccumulation.Regressive and Progressive Vicariation: The Path toHealingOne of the most exciting concepts within homotoxicology isregressive vicariation—or the process in which the body canshift from deeper, chronic disease states and high levels ofbioaccumulation to acute inflammatory phases and toxinelimination. This means that as patients are supported throughdetoxification, they move from right to left on the 6 phasedisease table and may experience temporary inflammatoryreactions such as fevers, skin eruptions, or mucus discharge,which are good signs that the body is moving out of deeperlevels of degeneration and back out toward excretion andelimination. Successful homotoxicological treatment involvesunderstanding this and effectively guiding the body throughregressive vicariation, ensuring that toxins move out of theECM and are eliminated safely.ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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13NATUROPATHIC DOCTOR NEWS & REVIEWConversely, progressive vicariation occurs when toxins continueto bioaccumulate and/ or are suppressed, causing the patient toshift from acute to chronic degenerative states through the 6phases of disease progression. The frequent use of anti-inflammatory drugs to suppress fevers can prevent proper toxinelimination through acute inflammation. It can drive the bodyinto deeper levels of toxicity, resulting in all the advanceddegenerative disease states seen on the extreme right-hand sideof the 6-phase disease table, such as arthritis, cardiovascularconditions, and cancer. Recognizing the process of progressivevicariation allows practitioners to correct treatment strategiesand support detoxification at early phases and appropriatepaces.¹⁰Hering’s Law of Cure and Vicariation inHomotoxicologyHering’s law of cure and the concept of regressive vicariation inHomotoxicology share important similarities, both describingthe predictable patterns of disease progression and healing,though from different perspectives. Hering’s Law, afoundational principle in homeopathy, states that true healingoccurs from inside out, top-down, and in reverse order ofsymptom appearance, reflecting the body’s natural self-regulatory propensity. Regressive vicariation mirrors Hering’sLaw, where detoxification and drainage therapies move thebody backward through the 6 phases of disease progression,temporarily experiencing signs of physiological inflammation astoxins are eliminated. This physiological inflammation describessymptoms similar to the “healing crisis” (fever, fatigue, aches,skin rashes, etc.) described in traditional homeopathy through adistinctly modern lens of understanding. Homotoxicology alsouniquely describes the reverse process, progressive vicariation,and how disease deepens as toxins accumulate in theextracellular matrix (ECM), tissues, and cells, leading toadvancing chronic and degenerative states. Understanding theseprinciples from this new perspective reinforces the importance ofproper detoxification and drainage in facilitating true healingrather than symptom suppression.¹¹Detoxification, ECM Restoration, and ProgressiveVicariation TreatmentsTo effectively reverse chronic disease and restore health,Homotoxicology encourages a structured approach of regressivevicariation treatments centered on detoxification and ECMrestoration. Detoxification is the first crucial, foundational step,as it mobilizes and eliminates stored toxins that impair normalcellular function.MAR 2025 - VOLUME 20 | ISSUE NO. 03Hering’s Law, a foundationalprinciple in homeopathy,states that true healingoccurs from inside out, top-down, and in reverse orderof symptom appearance,reflecting the body’s naturalself-regulatory propensity.

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14NATUROPATHIC DOCTOR NEWS & REVIEWThe body’s natural flow of toxin elimination starts with theECM, moves into the lymphatics, and then neutralizes via theliver and kidneys. The lymphatic system pulls toxins out fromdeep storage within the ECM, directing them toward the liverand kidneys for processing and filtration. Sweat from theskin and gas exchange via the lungs play secondary roles. Bysupporting the primary organs of detoxification globally, wecan enhance the body's ability to pull toxins from deepstorage, lighten the toxic burden on the ECM, and restoreoptimal physiological function.Within homotoxicology, drainage remedies play a crucial rolein detoxification by supporting the primary organs ofelimination globally, sometimes referred to as emunctories,thereby facilitating toxin elimination. These low-dose,complex combination of homeopathic and/ or spagyricpreparations of herbs and minerals prime the pump of detoxby sending blood, nutrients, and energy to the main organs ofelimination. Many European and increasing USmanufacturers have proven track records of producingclinically effective drainage remedies. MAR 2025 - VOLUME 20 | ISSUE NO. 03Interventions in ECM restoration focus on alkalization,remineralization, and oxygenation to improve cellular signaling anddetoxification efficiency. Alkalizing diets and supplements,oxygenation therapies, and IV therapies such as ozone andintravenous bicarbonate create an optimal ECM environment fortoxin clearance. Additionally, manual lymphatic drainage, infraredsauna therapy, and hydrotherapy support circulation and toxinmobilization, reducing stagnation within the ECM.These therapies and treatments help guide the body throughregressive vicariation in a controlled healing process, ensuring thattoxins move from deeper cellular storage back to superficialdetoxification phases of excretion and acute inflammation. Thisprocess is monitored through symptom tracking, ensuring thatdetox reactions are appropriately managed and that suppression ofsymptoms does not occur, which could otherwise lead to furtherunwanted progressive vicariation.¹² By implementing acomprehensive detoxification protocol centered on drainagealongside ECM restoration strategies, practitioners can supportpatients in effectively reversing chronic disease and optimizing long-term health.

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15ALLERGY / IMMUNOLOGY /ENVIRONMENTAL / TOXICOLOGY ISSUEDr. Mark Iwanicki, ND, LAc, is a naturopathicdoctor, licensed acupuncturist, educator, andexpert in European Biological Medicine. Agraduate of the National University of NaturalMedicine (NUNM), Dr. Iwanicki specializes indetox and drainage modalities and theirapplication to chronic disease reversal andprevention. His courses, Mastering theFoundations of Detox and Intro to Drainage forPractitioners, provide further learning on clinicallybacked protocols for deep cellular healing utilizingconcepts in European Biological Medicine. Learnmore at drmarkiwanicki.com.social media-@dr_markiwanicki Benavidez GA, Zahnd WE, Hung P, Eberth JM. Chronic diseaseprevalence in the US: sociodemographic and geographic variations byzip code tabulation area. Prev Chronic Dis. 2024;21:230267.doi:10.5888/pcd21.230267.1.Centers for Disease Control and Prevention. National Report onHuman Exposure to Environmental Chemicals. Updated 2019.https://www.cdc.gov/exposurereport/index.html2.Reddam A, McLarnan S, Kupsco A. Environmental chemicalexposures and mitochondrial dysfunction: a review of recentliterature. Curr Environ Health Rep. 2022;9(4):631-649.doi:10.1007/s40572-022-00371-7.3.Geueke B, Parkinson LV, Groh KJ, Kassotis CD, Maffini MV,Martin OV, et al. Evidence for widespread human exposure to foodcontact chemicals. J Expo Sci Environ Epidemiol. 2024.doi:10.1038/s41370-024-00718-2 4.Wang Z, et al. Toward a global understanding of chemical pollution:A first comprehensive analysis of national chemical inventories.Environ Sci Technol. 2020;54(5):2575-2584.6. 5.Sears ME, Genuis SJ. Environmental determinants of chronic diseaseand medical approaches: recognition, avoidance, supportive therapy,and detoxification. J Environ Public Health. 2012;2012:356798.doi:10.1155/2012/356798.6. Reckeweg HH. Homotoxicology: Illness and Healing through Anti-homotoxic Therapy. Aurelia-Verlag; 1985.7.Pischinger A. The Extracellular Matrix and Regulation of CellularFunction. North Atlantic Books; 2007.8.Heine H, Schimmel M, Benjes C, et al. Introduction to BioregulatoryMedicine. Stuttgart, Germany: Thieme; 2010.9.Rau T. Biological Medicine: The Future of Natural Healing. 2nd ed.Lustmühle, Switzerland: Biological Medicine Publishers; 201910.Vithoulkas G. Levels of Health. International Academy of ClassicalHomeopathy; 2010.11.Thom D, Odell JPM, Drobot J, Pleus F, Kelley JH. BioregulatoryMedicine: An Innovative Holistic Approach to Self-Healing. WhiteRiver Junction, VT: Chelsea Green Publishing; 2018. 12.image reference: Reckeweg HH. Homotoxicology: Illness and Healingthrough Anti-homotoxic Therapy. Aurelia-Verlag; 1985.13.REFERENCESSummaryHomotoxicology provides a powerful and practicalframework for understanding chronic disease in our moderntimes. It can be seen as a fresh take on classical homeopathyand Hering’s Law of Cure that integrates the latestunderstanding of cellular pathology, detoxification, anddisease progression. Pioneered by German physician Dr.Hans-Heinrich Reckeweg, it contextualizes how chronicdisease results from chronic toxin bioaccumulation within theextracellular matrix (ECM) space, eventually leading tocellular degeneration and breakdown. With the six-phasedisease table, we can see how regressive vicariation, through astructured process of toxin removal via dynamic therapiesthat support the primary organs of detoxification: thelymphatics, liver, kidneys, and gut leads to the reversal ofchronic disease, helping to re-establish self-regulation andself-management in the body. Homotoxicology provides theultimate framework for the modern naturopathic clinician byintegrating principles in homeopathy, toxicology, andimmunology. As chronic disease continues to rise,Homotoxicology provides an invaluable paradigm fortransforming patient outcomes and shifting modernhealthcare toward a detoxification and regeneration model.

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Understanding the impact of bone turnover on heavy metaltoxicity and how to manage chelation therapy safely.Acute and ongoing exposures should be assessed andidentified to the degree possible before starting heavy metalchelation. Sources of acute and ongoing metal exposure mayinclude exposure via food, drink, respiratory, skin, andothers. Bone turnover can also cause metals to be releasedfrom bone and appear on heavy metal testing.Any person at risk for increased bone turnover should bescreened before heavy metal chelation for bone turnover.This allows a safe chelation procedure and appropriateconsent, reducing the risk of chelating metals from activebone turnover.Data shows lower levels of metals (blood or urine) areassociated with lower levels of osteopenia andosteoporosis.⁵′⁸ This is because people with more significantbone turnover have more release of metals from bone.Heavy metals are also associated with lower bone mineraldensity.¹³Bone as a Source of ElevatedMetal Toxicants – Concerns, Assessment, TherapeuticsPAUL ANDERSON16NATUROPATHIC DOCTOR NEWS & REVIEWPREVENTIONMAR 2025 - VOLUME 20 | ISSUE NO. 03While DEXA testing is recommended forbenchmarking and managingosteopenia and osteoporosis, therequirements for assessing andmanaging a chelation patient may needto be more dynamic. Crosslink testing,such as NTx and CTX, is dynamic andeasier to perform (and less costly) forthe patient.

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QuestionsIs this a problem? (What is the propensity of heavymetals to be incorporated into bone?)1.Who should be assessed (What are the average agesand comorbid health issues to consider before testingbone turnover)?2.Problems?Many references support the pathologic effect of heavymetals becoming incorporated into bone. Two papersreviewed for this update include one that affirms boneuptake of toxicant metals and outlines the variety ofpathogenic effects toxicant metals have on bone.¹¹ Theother paper used bone biopsies with metal assays from65 patients, including two pathological groups and ahealth control group.¹³ This paper found higher heavymetals in the pathological (osteoporotic) groups and alikely causal connection between heavy metals andosteoporosis.Who Should be Screened?Age and comorbidity are additional considerations inwho we decide to add bone turnover screening beforechelation therapy. Clinicians are generally trained thatpeak bone mineral density is reached in the seconddecade and begins to degrade in the third and fourthdecades. Indeed, in healthy individuals, decreases in bonemineral density do start in the early to middle forties inmen and women.¹² Based on available data, screening forincreased bone turnover in healthy men and womenstarting in their forties would be wise. Other factorsbesides age should be considered, which may lower thebone turnover screening age.The two main categories (beyond age) are inflammatoryand chronic diseases and medication-induced bone loss:Inflammatory and other diseases can trigger boneloss at any age.³ Some studies include children withrheumatological or other inflammatory conditions asyoung as 13.⁷17ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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18NATUROPATHIC DOCTOR NEWS & REVIEWWhy is Screening Critical?If the chelation process begins with increased bone turnoverand net loss, you will have high metals on the testing as long asthe patient is alive (as you are speeding metal elimination fromthe bone). Unless you stop or slow the bone turnover, you willnever chelate them appropriately as you pull heavy metals andnutrient minerals out while the bones are unstable. To oppose these dangers requires:Bone turnover assessmentSupportive detoxBone support slows bone turnover and cleans up metals asthey move out of the bone.Who should we test for bone turnover before initiating chelation?All patients of any gender are in their forties and older.Any patient younger than their forties with a chronicdisease, especially rheumatological or inflammatorydiseases.Pediatric patients with rheumatological diagnoses orchronic inflammatory diseases.Patients of any age are on medications known to causebone loss.Post-chemotherapy patients.Hyperthyroidism.Monitoring:Testing may show elevated lead (and other metals) if boneturnover is elevated, regardless of how long chelation therapylasts. Elevated metals on a non-challenged urine toxic metalstest, normed to NHANES16, will also be seen for the samereason. This has created trouble (legal and patientmanagement) for practitioners who “chelated for months”only to find the lead and other metals never decreased.While DEXA testing is recommended for benchmarking andmanaging osteopenia and osteoporosis, the requirements forassessing and managing a chelation patient may need to bemore dynamic. Crosslink testing, such as NTx and CTX, isdynamic and easier to perform (and less costly) for the patient. If used as serial measures, they can track trends in boneturnover. NTx can be performed on urine or serum,whereas CTX is a serum test. The chosen test does notmatter as long as the same test is used for serial testingthrough treatment and follow-up.NTx - N-Telopeptide Cross-links (NTx), Urine (SerialMonitor) is available at most reference laboratories.Subsequent specimens for comparison should becollected at approximately the same time of day asthe baseline specimen.The “NTx” in the example below (and reported bymost labs) is the N-telo/Creat ratio (not the raw N-telopeptide value).The reference ranges for NTx in urine, as measuredin BCE/mM creatinine, are as follows [Mayo Labs]:Male: 21-83, Female (premenopausal): 17-94,Female (postmenopausal): 26-124In anyone (male or female) with suspected boneturnover (see list above), obtain an NTx (urine), and ifgreater than:90 in a male100 in a premenopausal female130 in a postmenopausal femaleInitiate bone health support (p19) and re-test every 6months.Elevated non-challenged urine toxic metals (overNHANES 95th percentile) should have bone turnover inthe differential diagnosis.Carboxy-terminal collagen crosslinks (CTX) are ananalogous test to NTx. NTx can be obtained via serumor urine, whereas CTX is typically serum only. As thegoal is to test the rate of bone turnover on serialmeasurements to protect the patient during chelation,either test may be used. CTX and NTx are consideredequally efficacious for this purpose.1 In the therapeuticguidelines below, if CTX is used, simply substitute CTXfor NTx, and the clinical process is the same.MAR 2025 - VOLUME 20 | ISSUE NO. 03

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19Marked bone turnover elevation: Consent / Procedure:If chelation therapy proceeds, follow the above.Consent the patient that they must includeaggressive bone support while chelating, and thatfollow-up NTx and UTM (Pre and Post UTM) arerequired for safety.They should have consented that their UTM levelswill likely stay high until the bone turnover is undercontrol.If chelation therapy is held temporarily:Consent the patient and explain the dynamics ofthe bone release of heavy metals. It is recommendedthat baseline NTx (with pre/post-UTM) beperformed and that bone health be treatedaggressively for 3 months while gentledetoxification is supported. This can include glutathione, fiber, bowelregularity, and low weekly doses of oral DMSA to“mop up” circulating metals. For this purpose, the author usually gives 250 – 500mg DMSA orally and QHS two nights a week. It is critical to notify the patient of the dynamics and thatthey cannot expect metal levels on the UTM to decreaseuntil bone turnover stabilizes. Clinically, testing andmonitoring are most critical.NTx levels of elevation [Mayo Labs]: Although these ranges appear arbitrary, they reflectstandard NTx/bone turnover norms. Therapeutic Approaches to Lower Bone Turnover:Mild to moderate bone turnover elevation: Consent / Procedure:Chelation may be held until bone turnover isslowed. If chelation proceeds for any reason, the patientshould consent to initiate detoxification andchelation as usual but acknowledge that bone healthsupport will be added to the protocol. The patient must acknowledge the inclusion ofbaseline NTx and that a repeat NTx will be run atthe first re-check of the Urine Toxic Metals (UTM)(Pre and Post challenge). All follow-up UTM are pre- and post-challenge,with the pre-challenge being normed to NHANES.Mild to ModerateMarked ElevationMale: 90 - 134135 +Premenopausalfemale: 100 - 149 150 +Postmenopausalfemale: 130 - 194 195 +ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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20Blumenthal M, Goldberg A, Brinckmann J, et al. Herbal Medicine:Expanded Commission E Monographs. Newton, MA: IntegrativeMedicine Communications, 2000.1.Chang Q, Zuo Z, Harrison F, Chow M. Hawthorn. The Journal ofClinical Pharmacology. 2002;42(6): 605-612.2.Daniele C, Mazzanti M, Pittler M, Ernstet E. Adverse-event profileof Crataegus spp. A systematic review. Drug safety. 2006;29: 523-535. 3.Gao GY, Feng YX, Qin XQ. Analysis of the chemical constituentsof hawthorn fruits and their quality evaluation. Yaoxue Xuebao.1995;30: 138-143.4.Guo W, Shao T, Peng Y, Yang H, et al. Chemical composition,biological activities, and quality standards of hawthorn leaves usedin traditional Chinese medicine: a comprehensive review. Frontiers inPharmacology. 2023;14: 1275244.5.Herbs in History: Hawthorn. [Web Page}.https://www.ahpa.org/herbs_in_history_hawthorn. AccessedJanuary 5, 2025.6.Mills S, Bone K. Principles and Practice of Phytotherapy. London:Churchill Livingstone, 2000. 7.Moeini F, Jafarian A, Aletaha N, Naderi N, et al. The Effect ofCommon Hawthorn (Crataegus monogyna Jacq.) Syrup onGastroesophageal Reflux Disease Symptoms: The effects ofhawthorn syrup on gastroesophageal reflux symptoms. IranianJournal of Pharmaceutical Sciences 2016;12(4): 69-76.8.The Naturopathic Herbalist: Crataegus oxycantha. [Web page].https://thenaturopathicherbalist.com/herbs/c-2/crataegus-oxycantha-hawthorne/. Accessed January 4, 2025.9.Rehwald A, Meier B, Sticher O. Qualitative and quantitativereversed-phase high-performance liquid chromatography offlavonoids in Crataegus leaves and flowers. J Chromatogr. 1994;677:25-33.10.American Dragon: Shan Zha. [Web page].https://www.americandragon.com/Individualherbsupdate/ShanZha.html. Accessed January 2, 2025.11.Tassell M, Kingston R, Gilroy D, Lehane M, et al. Hawthorn(Crataegus spp.) in the treatment of cardiovascular disease.Pharmacognosy reviews. 2010;4(7): 32.12.Wei A, Ai L, Chen X, Li L, et al. Comparative studies on theregulatory effects of raw and charred hawthorn on functionaldyspepsia and intestinal flora. Tropical Journal of PharmaceuticalResearch. 2019;18(2): 333-339.13.Zhang J, Chai X, Zhao F, Hou G, et al. Food applications andpotential health benefits of hawthorn. Foods. 2022;11(18): 2861.14.REFERENCESBone Support Ideas:Physical support [aka ‘Super Heavy/Super Slow’workout programs] “Osteostrong” or “PerfectWorkout” are examples.Vitamin D is Sufficient to keep 25(OH) and 1,25(OH) inthe upper 50 - 75% of the normal range [See resourcesbelow]Vitamin K2: (MK-4) 45 – 90 mg / day [4] or (MK-7) 180– 250 mcg / day6Vitamin C, Ca/Mg/Zn, etc. (Any other nutrients asclinically indicated).Boron 3-6 mg QDStrontium Citrate 500-700 mg BID9,14**Bisphosphonate Rx, if indicated2Appropriate hormone replacement therapy** The use of high-dose strontium citrate is indicated in non-responsive bone loss.ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUEDr. Anderson is a recognized educator andclinician in integrative and naturopathicmedicine with a focus on complex chronicillness and cancer. In addition to threedecades of clinical experience, he was head ofthe interventional arm of a US-NIH-fundedhuman research trial using IV and integrativetherapies in cancer patients. He founded Advanced Medical Therapies in Seattle, Washington, aclinic focusing on cancer and chronic diseases. He now collaborateswith clinics and hospitals in the US and other countries. His formerpositions included multiple medical school posts, as well as being aprofessor of pharmacology and clinical medicine at Bastyr Universityand chief of IV services for Bastyr Oncology Research Center. He co-authors the Hay House book “Outside the Box CancerTherapies” with Dr. Mark Stengler and the Lioncrest Publishing book“Cancer… The Journey from Diagnosis to Empowerment.”. He is alsoco-author with Dr. Osborne and Carter of the IV textbook “A ScientificReference for Intravenous Nutrient Therapy.” He is a frequent CMEspeaker and writer and has extended his educational outreach bycreating an online CE website “ConsultDrA.com” and AdvancedApplications in Medical Practice (AAMP)conferences. AAMP isdedicated to bringing next-level learning to healthcare professionals toenhance their knowledge and clinical skills in a CME-approved format.

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She had just-right OCD and would get upset if her handwritingwasn’t perfect or if she felt that something was out of place.She would repeat steps or backtrack to make things right. Shedidn’t have apparent tics but would pull her hair and bite hernails. Her review of systems was unremarkable. Her generals werebroadly unremarkable other than a fear of dogs and a strongsensitivity to being reprimanded or criticized. Case AnalysisLW’s main thing was hyperactivity/impulsivity and anger. Thehyperactivity was primarily located in her legs with intenserestlessness and need to move, and expressed as silly or foolishbehavior. There were no clear modalities of inciting cause foreach episode, time of day, ameliorating or aggravating factors.Her anger presented with quick, destructive efforts. LW wasunable to describe any physical sensations when she was angry.The only thing that would relieve her was hiding alone in hercloset, breaking things to ease pressure, or playing music withheavy beats. The nature of her OCD (fastidiousness) and separation anxietyis relatively common in PANDAS and important for heroverall case but not the most important for remedy selection.Nevertheless, I included it in my repertorization. Repertorization Here was my initial repertorization on RadarOPUS usingSynthesis repertory in full view:A flare of PANDAS always starts with hyperactivity andimpulsivity. She would jump off tables and laugh hystericallyat inappropriate things. She went from being able to sit still tobeing very restless. Mom said she would frequently get upfrom the table to spin around in circles or act silly, runningaround and running into things. If she were forced to sit still,she would bounce her knee. Mom also described a perceptiblechange in the look in her eyes. She said, “It is almost impish.Like she is planning something.” She would also get moreimpatient/hurried. LW shared that she always sang and needed to jump around.Mom would play music for her, and the music with heavybeats helped her feel calmer. The impulsive, silly behavior would ramp up to have moremean, angry behavior. She would throw water at her sisterand get much more aggressive than usual. She became moresensitive to being looked at, sometimes leading to aggressivebehavior. She has reportedly thrown a chair at someone forlooking at her once. Mom described a mean face andclenching her jaw, but no changes in color or appearance weredescribed beyond “mean.”LW shared that she would get irate and break things likepencils. She said she wanted to break more things but didn’twant to get into trouble. She also had separation anxiety with her flares, particularly atnight. The separation was specifically from her mom, so sheused a pillow with a jacket of her mom’s zipped around it,which she called “faux mom.” 22ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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MAR 2025 - VOLUME 20 | ISSUE NO. 0323Materia MedicaSymptoms of Tarentula hispanica from Allen’s Encyclopediaof Pure Materia Medica1 (hereafter referenced as AE in text)correspond via similarity to the symptoms of the case include: 16 - * Great taciturnity and irritability;desire to strike himselfand others, [a13].Corresponds to her irritability with aggression24 - * Desire to joke, to play, and to laugh; extreme gayety,[a13].Corresponds to her foolish, impulsive behavior26 - * Singing until becoming hoarse and exhausted, [a13].Corresponds to her desire to sing when hyper28 - Music cheers up, amuses, and relieves; the proverperspires and experiences a general bruised feeling,disappearing with one dose of Zincum 200th, [a13].Corresponds to her amelioration from music59 - * Cross the tendency to get angry and to speak abruptly;is obliged to move the limbs, with tearing and pressing painsin the stomach and in the left side of the chest; great thirst,with the necessity of introducing his fingers into the mouth,[a13].Corresponds to her restlessness, specifically in the legs65 - From the first, there was an indescribable melancholy,anguish, and restlessness; peevishness, the attendants coulddo nothing to suit me; great haste in whatever I undertook,from a constant fear that something would happen to preventmy finishing it; I would start up suddenly, and hastily changemy position, through fear that something would fall on me;when walking I would stop short or suddenly throw my headto one side, through fear of striking it against some imaginaryobject which appeared to be suspended a few inches above myhead. A great fear of an imaginary impending calamity. Greatdesire to be alone, with fear of being alone, even duringdaylight. Frightful visions as soon as the eyes were closed,unable to sleep [a16].:Corresponds to her fear of being alone, even though shehides alone when she is upset.Symptoms of Tarentula hispanica from Hering’s GuidingSymptoms of Our Materia Medica2 (hereafter referred to asHGS in text) correspond via similarity to the symptoms of thecase include: 1-12 - || Sudden foxlike destructive efforts, requiring utmostvigilance to prevent damage, followed by laughter andapologies.Corresponds to her destructiveness and the “impish”behavior her mother described33-1 - Uneasiness in legs with the necessity of constantlymoving them.Corresponds to her restless legsPrescriptionMy initial prescription was Tarentula hispanica 30C. Iinstructed mom to give her two pellets, dry-dosedsublingually once, and then wait for 72 hours. She wouldbegin giving the remedy daily if she had no aggravationafter 72 hours. I opted for daily dosing in this case for easefor Mom and because I didn’t anticipate an aggravation. I had also considered Hyoscyamus niger because it treatsthe same symptoms that are most characteristic in her casethat Tarentula hispanica does - foolish behavior ( 9 -Foolishness, [a68]) singing (AE1 58 - * He sings amorousand obscene songs, [a21a].), anxiety in the evening (AE1 80- Anxiety, soon after dinner, as though a sad occurrenceimpended(after six hours), [_a2].) and aggressive behavior(AE1 107 - * He is violent, and beats people, [a21c].). Thesimilarity of the same symptoms was stronger in Tarentulahispanica, and the specific amelioration and description ofthe impish behavior were more confirmatory for Tarentulahispanica. I additionally considered Phosphorus primarily for theexpression of anxiety (AE1 96 - * Great anxiety andirritability when alone, [_a1].) (AE1 112 - * Fear and dread,in the evening, [_a1].) (AE1 117 - * Did not like to be alone,[a50].). It also covers laughing (AE1 31 - Great excitement;she sang, laughed, and afterward fell asleep; on thefollowing day woke with great anxiety (after half an hour),[a135].:), irritability (AE1 131 - Irritable and peevish, [_a1].)and destructiveness (HGS2 1-32 - || Maniacal attacks,coming on during sleep; fury and extreme violence, so thatno one dares approach him; destroys everything in theroom; eyes remain closed; after two or three hours liesdown and sleeps a few minutes, recollects nothing onwaking.). It covers restlessness but is mainly associated withanxiety and sleep, less so in general, and it is more likely tobe aggravated by music (HGS2 3-10 - ¤ Sick-headache: withpulsations and burning primarily in forehead; with nauseaand vomiting from morning until noon; agg from music,while masticating, and in a warm room). Phosphorusultimately didn’t cover the most characteristic symptoms,similar to Tarentula hispanica. NATUROPATHIC DOCTOR NEWS & REVIEW

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24Follow-up: Date 1: March 24, 2015I always do a brief free check-in after starting with a newpatient to assess for aggravation and answer any questionsthe patient might have, especially when they are new tohomeopathy. At our brief free check-in, LW’s mother saidshe hadn’t started the remedy. She was wholly unfamiliarwith homeopathy when she booked the appointment with meand was alarmed at the remedy that was recommended to herdaughter. I had spent significant time explaining howremedies are made and their safety profile when we wrappedup our first visit, but she needed more information to feelcomfortable. Unfortunately, internet searches made her morescared. She additionally shared that she was worried aboutaggravation because she was generally doing well at themoment. I spent the visit explaining homeopathy in more detail andasked her what she would be comfortable with. She agreed totake a single dose of the remedy on Friday so that if sheaggravated, it wouldn’t interfere with school. I instructed herto give two dry pellets of Tarentula hispanica 30C SL DU andfollow up in 2 weeks. Date 2: April 14, 2015 As instructed, Mom had given exactly one dose of theremedy. She reported being a bit moody, but no more thanusual, and she seemed greatly improved. Mom reported thefollowing: Signs of strep infection: NoneHyperactivity: NoneImpulsivity: NoneAnger: Some, but quickly reigned in. Separation anxiety: MinorNegative self-talk: Not muchDestructiveness: NoneSleep: GoodShe reported no new symptoms and an overall trend ofdoing better, which surprised Mom because she had thoughtshe was generally doing well before the remedy. Given Mom’s previous hesitancy with the remedy, wediscussed dosing as needed. Mom was very interested in thisapproach, having seen her daughter improve with the singledose she had. I assessed that she had had a positive response to theremedy, and potency recommended that she continue thesame medicine, Tarentula hispanica 30C. CME Environmental Webinar Bundles UPCOMING EVENTSAAMPCARDIOLOGY CONFERENCEScottsdale, AZ May 30 - June 1, 2025BIMCBELIZE INTEGRATIVEMEDICINE CONFERENCE:San Ignacio, Belize July 27 - Aug 2Dr. Anderson’s2025 ONLINE CMEACCME & AANP-APPROVED | 30+ YRS OF EXPLive or Virtual AAMP Conference:AAMP: 18 AMA Cat-1 CMEOther Speaking Venues: BELIZE INTEGRATIVE MEDICINE CONFERENCEWHOLE PERSON DETOXWEBINAR BUNDLEDETOX & TOXICANT DEPURATION& GI TRACT THERAPIESCE 3.5 Total / 2.5 Are FARM (AANP)METABOLIC TOXINSDETOX BUNDLESULFITE TOXICITY, SULFATIONPATHWAYS & METABOLIC TOXINSCE 3.5 Total / 1.5 Are FARM (AANP)HEAVY METAL DETOXWEBINAR BUNDLEORAL CHELATION & DETOX OFUNUSUAL METALSCE 3 Total / 3 Are FARM (AANP)MCAS CME BundleMCAS CME BUNDLE: + 120 RECORDED CME AVAILABLECLICK ON THE VIDEO PREVIEW LINKS BELOW

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REFERENCESAllen, T.F. (1874). Encyclopedia of Pure Materia Medica. Boericke and Tafel. 1.Hering, C (1879). Guiding Symptoms of Our Materia Medica. The Estate of ConstantineHering.2.Dr. Jennifer Bahr, ND, DHANP is the founder ofResilience Naturopathic, a practice devoted tomaking PANS/PANDAS a thing of the past andhomeopathy the medicine of the future. She earnedher doctor of naturopathic medicine degree fromSonoran University, formerly Southwest Collegeof Naturopathic Medicine. She is on the board ofdirectors for the American Institute ofHomeopathy and the Homeopathic Academy ofNaturopathic Physicians. Prior to her career innaturopathic medicine, she studied physiology andneurobiology at the University of Maryland andworked as an Arabic linguist in the US Navy andas a defense contractor. ConclusionI continued to work with LW for several years. Her primarypresenting complaint was resolved with Tarentula hispanicaby her first anniversary of care, with one exception of ashort-lived resurgence in the summer of her second year aftera viral pharyngitis that quickly and permanently resolvedwith Tarentula hispanica. She continued to work with meafter that for non-PANDAS-related anxiety. During ourwork together, she also responded to Ignatia amara,Lycopodium clavatum, and Argentum nitricum at timeswhen anxiety was her only concern. Her anxiety has fullyresolved. Since then, her mother has checked in sporadicallyto share that she is still doing well.25ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUEMy directions were to give two dry pellets sublingually asneeded for mood or sleep changes or at the first signs ofupper respiratory or strep infection. We scheduled her follow-up for 6 weeks later. Date 3: April 20, 2015 LW’s mom emailed me between visits because LW had beenexposed to strep through a friend. She was starting to showsigns that she typically gets in response to strep, so mom gavea dose. She woke up anxious the following day and showedsigns of school refusal. Mom was concerned aboutaggravation and sought guidance about whether to providean additional dose or wait. I explained to her that when thereis an acute infection, we often need to dose more frequently,even when dosing PRN. I instructed her to give another dosethat day and to continue to dose as needed until symptomsresolved. Date 4: May 29, 2015 LW recovered quickly from the strep exposure with only twodoses of the remedy. She did well for a week and then hadanger return “out of nowhere,” which caused her to get angryand destroy some paper. Mom recognized this as anindication of a dose, so she gave one, and the next day, theanger was gone. A few weeks later, the family went on a short vacation. LW’snighttime anxiety increased on the trip, and she started askingfor the faux mom. Eager to put that crutch in the past, Momdecided to give LW a dose of her remedy to see if it wouldhelp. She was happy to report that it did and that faux momwas not needed. Reviewing symptoms, we found that LW never got anyphysical signs of strep infections and that all of her othersymptoms increased following exposure, and all improvedwith the doses she was given. I assessed that she had responded positively to the remedyand was still responding. She would continue Tarentulahispanica 30C, two dry pellets SL PRN, and follow up in 4weeks.

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The lower end of the range is appropriate for children underthe age of 4, while children between the ages of 4 and 15 willbenefit from higher doses. I prefer formulas with a higher EPA-to-DHA ratio, as EPA and DHA help reduce PGE2 levels.Flaxseed oil: 1-2 tsp, up to 2 times per daySunflower oil: 2 grams, 1-2 times per dayFish oil: 15-30 mL cod liver oil daily or up to 3 grams EPA1-2 times per day Reduction of Systemic and GI InflammationCurcumin: 600 mg, 2-3 times per day. Curcumin downregulates pro-inflammatoryinterleukins and inhibits the synthesis of a pro-inflammatory enzyme, 5-lipoxygenase (5-LO,)including 5-hydroxyeicosatetraenoic acid (5-HETE)and leukotriene B4 (LTB-4), which contributebronchoconstriction, chemotaxis, and increasedvascular permeability.¹³Other anti-inflammatory plant constituents, such asquercetin, also inhibit 5-LO but act more broadly asantioxidants, whereas boswellic acids specifically target5-LO.¹⁴Healing of the GI TractL-glutamine: 2.5 g 1-2 times per dayGlutamine is a critical nutrient for the small bowelmucosa, serving as a primary fuel source for cellularmetabolism, regulating cell proliferation, and repairingand maintaining the gut barrier functions. Itsconsumption in small bowel mucosa exceeds theproduction rate during catabolic stress such as trauma,sepsis, and post-surgery.¹⁴Slippery Elm (Ulmus rubra, aka Ulmus fulva):approximately 400-500 mg 3 times per dayIn the upper stomach and esophagus, Slippery Elm’smechanism of action appears to involve reflex stimulation ofthe nerve endings in the mucosal lining, leading to increasedmucous secretion. This enhanced mucus production creates aprotective coating, shielding the stomach and small intestinefrom excess acidity.¹⁵Pathophysiology of Atopic Triad in ChildrenAsthma, eczema, and allergies have very similar triggers andimmune reactions. However, there is a difference inpathophysiology between children and adults. Infections,environmental allergens, specific food allergies unique toeach person, chemical exposure and allergy, and overallinflammation in the gut trigger each member of the atopictriad. The predominant pathway that links all threeconditions is the activation of cytokines and the release ofeosinophils, followed by the release of histamine. Thedifference lies in the type of interleukin the CD4 immunecomplement releases.³Immune System Differences in Children In children with eczema, the issue often arises because theimmune response is heavily skewed toward T helper 2 (Th2)cells because there are fewer Th1 cells, not strictly becausethe body is inflamed. This helps explain why eczema tends toappear before asthma or allergies. When children get viralinfections, and the immune system activates the Th1pathway, flares often decrease, while the cascade tendstoward the Th1 pathway. In adults, there are increasedinstances of interleukin 22 (IL-22)-producing CD4 and CD8T cells within the skin and increased activation of humanleukocyte antigen DR. Hence, the pathogenesis is much morecomplex.³ In asthma, T lymphocytes produce mostly IL-4,IL-5, and IL-13, while in allergies the pathway favorsproduction of IL-4 and IL-5 only.⁴⁻⁸Treatment of the Atopic TriadThere are several common themes in treating children'seczema, allergies, and asthma. Due to the varying symptomsand location of reactivity, there are specific treatments foreach as well. The commonality lies in the need for treatmentwith supplements such as vitamin D, bromelain, curcumin,quercetin, essential fatty acids, and pre/probiotics. Guthealing, testing for infectious triggers, allergy testing, anddesensitization/elimination are also indicated.⁶Essential Fatty Acids Working with essential fatty acids can be complicated. It ishard to predict which fatty acid will work best for eachpatient, so several options are listed below. The lower end ofthe range is appropriate for children under the age of 4, whilechildren between the ages of 4 and 15 will benefit from higherdoses.27ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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MAR 2025 - VOLUME 20 | ISSUE NO. 0328Marshmallow Root (Althea officinalis): 100 mg per day.Acts as an antimicrobial and a demulcent, helpingcoat and soothe the GI lining and providing anti-inflammatory effects.¹⁶Larch arabinogalactan: 200-1500 mg per daySupports the growth of beneficial intestinalmicroflora, including Bifidobacterium andLactobacillus acidophilus.¹⁷Further ConsiderationsAddress any anxiety, as stress creates inflammationUse stool testing to identify and treat any pathogens orenzyme deficienciesBlood tests can be done for either mother or child forfactors including allergies, Lyme disease, Candida, andEpstein-Barr virusAddressing Triggers In my experience with testing for IgE-mediated allergicresponses to foods and environmental triggers, there aresome cases where little to no reaction is detected. In thesecases, eliminating foods found to be sensitive through IgG orIgA testing is beneficial and sometimes more beneficial thaneliminating IgE-mediated food allergies. This is attributed tothe fact that several immune pathways can also cause atopicdermatitis or asthma, such as the activation of memory T-cells found within the epithelium of the skin and mucousmembranes.⁷ ⁸ Potential desensitization methods include sublingualimmunotherapy, weekly oral immunotherapy, low-doseallergen therapy, mental field therapy/tapping, andacupuncture. My favorite method is weekly oralimmunotherapy, as it can address both food andenvironmental allergic triggers as well as sulfites, nickel, andother chemicals without having to stress the immune systemso frequently.⁹Eczema TreatmentIn addition to the above treatments recommended for everyatopic triad patient, it is important to consider certain skinirritants, such as nickel, in treating eczema. Nickel-inducedeczema typically occurs on the hands and feet but is limitedto those locations. Ingestion of foods high in nickel orcooking with stainless steel can also trigger a flare in thosewith nickel sensitivity.¹⁰The microbiome in our GI tract influences our mood,immune system function, and overall health. Imbalance inour microbiome, genetic predisposition, and allergic triggersare very important factors to consider when determiningwhether a patient is likely to develop eczema. Some less-publicized studies have shown that the skin's microbiome isvital in protecting a child from developing both eczema andallergies. A healthy cutaneous microbiome inhibitscolonization with pathogens such as Staphylococcus aureus,a crucial component of an intact, functional epidermalbarrier. The microbiome of the GI tract has gainedincreasing attention; the microbiome of the skin is likely notfar behind.¹¹ As the diversity of the cutaneous microbiome decreases,eczema tends to become more severe, and pathogenicbacteria, such as S. aureus, colonize the skin more easily.Early clinical studies suggest that when applied topically,commensal organisms such as Staphylococcus hominis orRoseomonas mucosa can help reduce eczema severity. Thisapplication supports commensals' role in decreasing S.aureus colonization in patients with eczema.¹¹NATUROPATHIC DOCTOR NEWS & REVIEWMarshmallow Root

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REFERENCESLyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinicalfeatures, pathophysiology, and treatment. Immunol Allergy ClinNorth Am. 2015;35(1):161-183.1.Burgess JA, Lowe AJ, Matheson MC, et al. Does eczema lead toasthma? J Asthma. 2009;46(5):429-436.2.Czarnowicki T, Esaki H, Gonzalez J, et al. Early pediatric atopicdermatitis shows only a cutaneous lymphocyte antigen (CLA)(+)TH2/TH1 cell imbalance, whereas adults acquire CLA(+) TH22/TC22cell subsets. J Allergy Clin Immunol. 2015;136(4):941-951.e3.3.Min YG. The pathophysiology, diagnosis and treatment of allergicrhinitis. Allergy Asthma Immunol Res. 2010;2(2):65-76.4.Fireman P. Understanding asthma pathophysiology. Allergy AsthmaProc. 2003;24(2):79-83.5.Moghtaderi M, Farjadian S, Kashef S, et al. Specific IgE to commonfood allergens in children with atopic dermatitis. Iran J Immunol.2012;9(1):32-38.6.Ryan GE, Harris JE, Richmond JM. Resident Memory T Cells inAutoimmune Skin Diseases. Front Immunol. 2021;12:652191.7.Romagnani S. Th1/Th2 cells. Inflamm Bowel Dis. 1999;5(4):285-294.8.Wood RA. Oral Immunotherapy for Food Allergy. J Investig AllergolClin Immunol. 2017;27(3):151-159.9.Mahler V, Dickel H. Wichtigste Kontaktallergene beim Handekzem[Most important contact allergens in hand eczema]. Hautarzt.2019;70(10):778-789.10.Paller AS, Kong HH, Seed P, et al. The microbiome in patients withatopic dermatitis [published correction appears in J Allergy ClinImmunol. 2019 Apr;143(4):1660]. J Allergy Clin Immunol.2019;143(1):26-35.11.Halken S. Prevention of allergic disease in childhood: clinical andepidemiological aspects of primary and secondary allergy prevention.Pediatr Allergy Immunol. 2004;15 Suppl 16:4-32.12.Peng Y, Ao M, Dong B, Jiang Y, Yu L, Chen Z, Hu C, Xu R. Anti-Inflammatory Effects of Curcumin in the Inflammatory Diseases:Status, Limitations and Countermeasures. Drug Des Devel Ther. 2021Nov 2;15:4503-4525. doi: 10.2147/DDDT.S327378. PMID: 34754179;PMCID: PMC8572027.13.Perna S, Alalwan TA, Alaali Z, Alnashaba T, Gasparri C, Infantino V,Hammad L, Riva A, Petrangolini G, Allegrini P, Rondanelli M. TheRole of Glutamine in the Complex Interaction between GutMicrobiota and Health: A Narrative Review. Int J Mol Sci. 2019 Oct22;20(20):5232. doi: 10.3390/ijms20205232. PMID: 31652531; PMCID:PMC6834172.14.Misra SM. Integrative Therapies and Pediatric Inflammatory BowelDisease: The Current Evidence. Children (Basel). 2014 Aug25;1(2):149-65. doi: 10.3390/children1020149. PMID: 27417473;PMCID: PMC4928727.15.Bonaterra GA, Schmitt J, Schneider K, Schwarzbach H, Aziz-Kalbhenn H, Kelber O, Müller J, Kinscherf R. Phytohustil® and rootextract of Althaea officinalis L. exert anti-inflammatory and anti-oxidative properties and improve the migratory capacity of endothelialcells in vitro. Front Pharmacol. 2022 Dec 8;13:948248. doi:10.3389/fphar.2022.948248. PMID: 36569306; PMCID: PMC9773075.16.Dion C, Chappuis E, Ripoll C. Does larch arabinogalactan enhanceimmune function? A review of mechanistic and clinical trials. NutrMetab (Lond). 2016 Apr 12;13:28. doi: 10.1186/s12986-016-0086-x.PMID: 27073407; PMCID: PMC4828828.17.Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent:an overview. Indian J Pharm Sci. 2011 May;73(3):255-61. doi:10.4103/0250-474X.93507. PMID: 22457547; PMCID: PMC3309643.18.29ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE Asthma TreatmentUrtica dioica: 1 tsp herb in infusion 1-2 times per dayBoswellia serrata: 600 mg 2 times per day (18)Quercetin: 1200 mg twice per day or for dietary sources, eatonions, kale, cherry tomatoes, apples, broccoli, black or greentea, and blueberries- Quercetin causes a decrease in pro-inflammatory cytokines, has a role in leukotriene creation, andsuppresses interleukin IL-4 production. It can improve theTh1/Th2 balance and restrain antigen-specific IgE antibodyformation. It is also effective in inhibiting enzymes such aslipoxygenase, eosinophil, and peroxidase and in suppressinginflammatory mediators.Herbal decoction: ¼ ounce of a combination of Tussilagofarfara, Verbascum thapsus, Foeniculum vulgare, Lobelia inflata,and Glycyrrhiza glabra decocted in 1-2 pints of water for up to10 minutes. This can be administered when cooled at 1 tbspevery 2-4 hours.Vitamin C: 1-3 g, up to 3 times per day to act as an antioxidant Biotherapeutic drainage remedies, as indicated, can help reducethe total body burden, thereby decreasing reactivity.Magnesium glycinate: 200-400 mg per dayAllergy TreatmentHomeopathic remedies such as Natrum muriaticum 200C: 3pellets up to 5 times per dayFinal Thoughts The younger the child is when parents seek eczema treatment –especially through a holistic provider – the more likely it is that thepresence of asthma or allergies will be subclinical or nonexistent.Methods used to treat the immune system dysfunction thatprecipitates eczema often provide the triple benefit of addressingthe atopic triad – all at once.¹² A naturopathic approach to healingthe gut and the skin, coupled with eliminating triggers andinfections, gives a child a chance to get a handle on their healthbefore they even remember there was an issue.Autumn Frandsen, ND, received her doctorate innaturopathic medicine from the University ofBridgeport in 2011. She is certified through theKlinghardt Academy in Autonomic ResponseTesting and uses electrodermal screening and oralimmunotherapy to treat allergies, skin conditions,and bronchopulmonary disorders. Dr Frandsen hasextensive experience in treating autoimmuneconditions, thyroid conditions, chronic Lymedisease, mood disorders, obesity, fibromyalgia,chronic fatigue syndrome, allergies, anddermatological conditions. She treats patients of allages with Chinese medicine, homeopathy, herbalremedies, and nutritional and lifestylemodifications. Dr Frandsen holds licenses inMaryland and Washington DC and provides bothin-office care and telemedicine.

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Healing Chronic Illness through Environmental MedicineTherapeutic Order: Navigatingan Ever-Increasing Toxic WorldTherapeutic Order: Navigatingan Ever-Increasing Toxic WorldKIM FURTADO, N.D.30MAR 2025 - VOLUME 20 | ISSUE NO. 03TOLLE TOTUMNATUROPATHIC DOCTOR NEWS & REVIEWExposure to heavy metals, persistent organic pollutants, and other chemicals is rising, with no clear end in sight.The identification of novel forever chemicals, contamination of everyday household products and food, toxicimpacts of natural and human-caused disasters, and the general deluge of research implicating the ongoing role ofenvironmental pollutants in chronic illness are enough to make anyone feel a sense of loss, violation, andhelplessness. While navigating Environmental Medicine, clinicians can fall prey to overwhelm and despondence.As evidence mounts, research supports that toxic exposure is a driving factor of chronic illness, exceedingcommonly associated factors such as nutritional deficiencies and sedentary lifestyles.1,2,3,4 The increase in chronicillnesses over the past 50 years affects all age groups. Environmental medicine (EM) is a branch of medicine that explores how the environment interacts with thehuman body. It also relates to toxicology, industrial medicine, and public health. Using a holistic, systems-widemodel, EM evaluates how various toxicants, pollutants, chemicals, and microbes may compromise the body.

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Top TenCauses ofDeath in theUS6Number ofDeaths (2022data)Data Related to Pollution ImpactHeart disease702,88024 percent of the global burden ofischemic heart disease is due to airpollution7 Cancer608,371For every 10 micrograms per cubic meter(µg/m3) of increased exposure to PM2.5,the risk of dying from any cancer rose by22 percent.8PCBs are significantlyassociated with breast cancer.9Accidents(unintentionalinjuries)227,039n/aCOVID-19186,552Empirical estimates demonstrate anassociation between the environmentalpollutants PM2.5, CO, NO2, and O3andSARS-CoV-2 infections.10Stroke(cerebrovascular diseases)165,393Environmental exposure to lead, even atblood concentrations lower than 5 μg/dL,entails a population-attributable risk ofcardiovascular mortality of 37.4%, therebyequaling the risk of smoking.11Lead andcadmium are considered independent riskfactors for cardiovascular disease.12Chronic lowerrespiratorydiseases147,382Higher short-term exposure to PM2.5andtraffic-related pollutants is associatedwith an increased risk of symptomaticacute respiratory infections amongadults.13Alzheimer’sdisease120,122Greater exposure to PM2.5, NO2/NOx,and CO in the review were all associatedwith an increased risk of dementia. Theevidence for air pollutant exposure andcognitive decline was more equivocal.14Diabetes101,209Air pollutants may be associated withimpaired glucose metabolism, insulinresistance (IR), and type 2 diabetesmellitus (T2DM)15Serum concentrations ofdioxins, PCBs, and chlorinated pesticideswere significantly associated with T2D risk;BPA and phthalates were alsoassociated.16,17Nephritis,nephroticsyndrome,and nephrosis57,937The kidney is an organ of elimination.Elevated blood pressure related to toxicmetals like lead can damage thekidneys.Environmental pollutants such asheavy metals, PM, industrial degreasers,PFAS, insecticides, and herbicides arereported to influence kidneydisease.18,19Chronic liverdisease andcirrhosis54,803The liver is an organ of elimination.Polychlorinated biphenyls, lead, andmercury associated with liver disease20Training in EM involves enhancing a clinician’s ability toidentify patient signs, symptoms, and clinical laboratory testresults that may be caused by environmental toxicant exposure.Several resources exist for this evolving branch of medicine.Providing a more detailed assessment requires a more intrinsicknowledge of the toxicants, their impacts on pathophysiology,and the nuances of their elimination. The capacity to instructyour clients exponentially expands as your knowledge of thetoxicants deepens. Patients will present in varying stages of symptomatology. Assuccinctly described by Joe Pizzorno, ND, there are threeclinical presentations where the principles of EM should beapplied.5 First are patients with a known high-dose exposure totoxicants. Second, Pizzorno describes the “yellow canaries” aschronically unwell without an apparent cause or explicittoxicant exposure. These patients often have underlyingdisruptions in detoxification pathways, particularly involvingglutathione, hepatic cytochrome P450 (CYP450) enzymes, andmethylation impairments.Lastly, Pizzorno asserts that all patients with chronic illness are,to some extent, affected by environmental toxicants. Examiningthe top ten causes of death in the U.S. further highlights thegrowing body of research linking pollution to adverse healthoutcomes.Closer Look at Pollution Impact and Epidemiology31ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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Clinical Detoxification Key StepsCorrelation to Therapeutic OrderIdentify and avoid toxicantsDeterminants of Health (DOH):Environmental PollutantsSupport adrenals and balancesympathetic /parasympatheticnervous system (Optimize rest,digest, repair, detox pathways)DOH: Stress/ResilienceDOH:Sleep/RelaxationNourish and neutralize (nutritiontherapy, high fiber, highantioxidants, balance microbiome,and gut health)DOH: Nutrition/HydrationDOH:Micro-organismsUse NaturalTherapies to Address Pathologyand SymptomsEnhance blood and lymphaticcirculationDOH: Movement/ExerciseSupportand Restore WeakenedSystemsCorrect StructuralIntegrityEnhance detoxification pathwaysSupport and Restore WeakenedSystemsUse Natural Therapies toAddress Pathology and SymptomsChelate, as indicated to removeidentified toxicantsUse Natural Therapies to AddressPathology and SymptomsUsePharmaceutical or SyntheticSubstances to Stop ProgressivePathology32ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE Therapeutic Order Creates Path to ImplementPrinciples of EM The Therapeutic Order (TO) is influential in harsh, complexterrain. Principles of clinical detoxification involve the sameclinical directives found in the TO. Still, the identification oftoxicants is often considered only in acute, high-doseexposures or known contact with a point source pollutant.Most commonly, clinicians overlook the insidious,debilitating effects of daily, ubiquitous, low-dose exposuresand thus miss the opportunity to remove a potentiallyimpactful obstacle to cure.21,22 EM Assessment Tools A thorough history is critical to identifying and removingenvironmental pollutants affecting your patient’s clinicalpicture. Listen for stories of running in the wake of trucksspraying DDT for mosquitoes, playing with mercurythermometers, or several years of known occupationalexposures, but don’t count on your client casuallymentioning the primary emerging data you need tounderstand their toxic body burden. If you’re not actively investigating, testing for toxicants (asable), and assessing detox pathways, a simple interrogationof the client, who reports any environmental exposures frommemory, may prove woefully inadequate. The Environmental Health Questionnaire (EHQ) can helpinform environmental factor investigations. The NationalAssociation of Environmental Medicine (NAEM), anaffiliate organization of the AANP, freely provides this tool;training on implementing it is also available.Another step is to investigate symptoms of toxin overload orpoor metabolism. For example, inquiring along these lineshelps identify clients needing EM support but have notreported any known high-dose pollution exposures. Insteadof waiting to be told what toxicant has been involved, listenfor key indicators of detoxification pathway imbalances.For example, is there a sudden onset of symptoms(headaches, skin rashes, nausea, fatigue, shortness of breath,etc.) on exposure to fragrance, cigarettes, mold, dust, pollen,or other environmental allergens? Does your patient reportthey smell odors when others can’t, or do they regularlyavoid walking down the detergent/fertilizer aisles in a storebecause it makes them feel ill or have other symptoms? Dothey become symptomatic when sitting in traffic with carexhaust? Does a patient frequently have to lower regularprescription doses, over-the-counter medications, or herbalsupplements because they are intolerant of full doses? Askdirectly if they ever had to leave their residence or jobbecause the environment was making them feel sick. Doesthe client quickly get rashes or skin irritation through contactwith clothing or body care products? Does the client quicklyget drunk or have a hangover on one or less alcoholicbeverages? Do they avoid caffeine because it makes themjittery, irritated, or causes insomnia?

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In an investigation beyond clinical history, you areinformed of conventional laboratory markers such asserum glutathione, vitamin D, GGTP, ALT, and uricacid. Other markers of the impact of toxicants, such asorganic acid testing and microbiome stool analysis, andmarkers of oxidative stress, such as 8-OHdG and lipidperoxides, should also be included. Genomic markersrelated to phase II conjugation and oxidative stresspathways are critical to successful clinical outcomes. Testing for toxicants is a complex, confounding, andvaluable part of the inquiry. Determining whichtoxicants to test for relies on informed clinical history.It also can be guided by a clinical indication andknowledge about associated toxicants. Training intoxicant testing and detox pathway assessment isavailable through NAEM and its partner organizations.NAEM’s clinical guidelines, which augment but do notreplace training in EM, are available for Plastics,Solvents and Volatile Organic Compounds (VOCs),Pesticides, Metals, Mold, Persistent Organic Pollutants (POPs),Electro-Magnetic Fields (EMFs), Personal CareProducts, and Allergens.Most importantly, patients must be educated on how toremove or limit exposure to everyday toxicants. Thiscan foster fear in our patients, leaving them scared tointeract with the world. Rather than feeling like weneed to place our patients into protective bubbles, workto empower them to do the best of both worlds: createan oasis of low toxin exposure within their homes andoptimize nutrition and the organs of elimination toprotect and defend in today’s complex industrial world. It is key to engage solution-oriented resources thateducate patients on consumer product decisions,toxicant avoidance, and water and air filtration optionsfor their specific needs. Your in-depth understanding ofthese tools makes you an excellent resource for clientsoverwhelmed by the magnitude of this topic. Resourcesare available in patient handouts from NAEM,specifically on Plastics, EMF, personal care products,solvents & VOCs, and pesticides. There are also variouspatient-facing materials and several clinical tools,including free webinars, book recommendations,podcasts, and online class modules available. 33Support and Restore Liver, Microbiome, and Lymphatic FunctionsFor practical impact on EM practice, clinicians serve patientswell by focusing on supporting and restoring weakenedsystems, with a focus on the liver, microbiome, andlymphatics. Most chronic illnesses are not overt liverdiseases, and toxicants may not directly affect all the liver’sfunctions. Upon closer analysis, however, one may find thatthe liver has a role in the pathophysiology of severalcommon, pervasive chronic illnesses. Toxicants also have anassociation with diseases, and the presence of that diseasecan also inform the need to attend to clinical detoxification. Clinical detoxification provides a way to bridge optimizedliver function to the resolution of chronic inflammatoryillness. The toxicant may or may not be linked with a specificliver disease. Still, a functional role of the liver may beinvolved in either the disease pathophysiology or beingimpacted by the effects of the toxicants. MAR 2025 - VOLUME 20 | ISSUE NO. 03NATUROPATHIC DOCTOR NEWS & REVIEWVeins of the Lymphatic System

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Examples of Liver Functions that relate to Diseases and their Association with ToxicantsFunctions of the LiverSample of Diseases Influenced bySpecific Liver FunctionsToxicants that Influence Associated Diseases²³Albumin productionIt creates osmotic balance in theblood and carries hormones,vitamins, and enzymes throughthe body.This relates in general,to many conditions/hormoneissuesPulmonary edemaAmmonia, beryllium,chloro-phosphate compounds,diquat, ethyleneoxide,formaldehyde, hydrofluoric acid, hydrogen sulfide, mercury,methyl bromide, nickel, nitrogen oxides, organophosphates,paraquat,phosgene, phosphine,tetrachloroethylene (PCE), thioureasBile ProductionBile is critical for digestion andabsorption of fats in the smallintestine.Fats are critical forgood nerve function.Cognitive impairment (includesimpaired learning, impairedmemory, and decreased attentionspan) / mental retardation /developmental delay1,1-dichloroethane, carbamates, carbon disulfide,carbon monoxide,cocaine, DDT/DDE, ethyl alcohol (ethanol), lead, mercury,methyl bromide,nicotine,nitrates/nitrites, organochlorine pesticides,organophosphates,PCBs (polychlorinated biphenyls), not otherwisespecified,pentachlorophenol (PCP), pesticides, solvents,styrene,tetrachloroethylene (PCE), tobacco smoke, tobacco smoke(secondhand), toluene,trichloroethylene (TCE), xyleneAttention Deficit Disorderethyl alcohol (ethanol), lead, DDT, mercury, organophosphate pesticides,PAHs, PCBs (polychlorinated biphenyls), not otherwise specifiedFilters Blood/ Removes toxinsAll blood leaving thegastrointestinal tract passesthrough the first pass effectthrough the liver to removetoxins, byproducts, and otherharmful substances.Thisfunction is relevant to manyclinical diseases associated withtoxins.CirrhosisAflatoxins, arsenic, carbon tetrachloride, chlorinated naphthalene’s, ethylalcohol (ethanol), halothane, PCBs (polychlorinated biphenyls), nototherwise specified, solvents, tetrachloroethane, TNT (trinitrotoluene),trichloroethylene (TCE)Hormone metabolismCritical role in peripheralconversion of thyroid hormoneand steroid hormonemetabolismHypothyroidismOrganochlorine compounds (PCBs, DDT, dioxins), pesticides (chlorinatedorganophosphates), mercury, cadmium, perchlorates, PBDE, phthalatesMenstrual disorders (abnormalbleeding, short cycles, long cycles,irregular cycles, painful periods)2-bromopropane, atrazine,Benzene, carbon disulfide, chlordecone,chlorination byproducts, DDT/DDE, dioxins / TCDD, estrogens / DES, ethylalcohol (ethanol),Formaldehyde, fungicides,Herbicides,hexachlorobenzene, ionizing radiation, Lead, lindane, mancozeb, mercury,organochlorine pesticides, organophosphates, PCBs (polychlorinatedbiphenyls), not otherwise specified, pesticides,solvents,tetrachloroethylene (PCE),tobacco smoke(secondhand),toluene, toxaphene, trihalomethanes, xyleneInfertilityChlorinated pesticides, PCBs, organophosphate pesticides, BPS,herbicides, solvents, mercury, cadmium, trihalomethanes, PFOS,phthalates34ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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Processes GlucoseThe liver removes excessglucose from the blood, stores itas glycogen, and converts itback to glucose.DiabetesArsenic, mercury, persistent organic pollutants, polycyclic aromatichydrocarbons, BPA, PCBs, dioxins, organochlorine pesticidesRegulates Amino AcidsAll protein production in thebody relies on amino acidsPsychiatric disturbances(disorientation, hallucinations,psychosis, delirium, paranoias,anxiety/depression, emotionallability, mood changes,euphoria)(neurotransmitters aremade from amino acids)carbon disulfide, chlorpyrifos, DDT/DDE,Dichloropropene, ethyl alcohol(ethanol), ethylene oxide, lead, manganese, mercury, methylbromide,Organophosphates, pesticides, trichloroethylene (TCE)Cholesterol ProductionCoronary artery disease,peripheral vascular disease,atherosclerosisArsenic, cadmium,carbon disulfide, carbon monoxide,dinitrotoluenes,dioxins / TCDD, lead, mercury, particulate air pollution(soot), TNT (trinitrotoluene), tobacco smoke (active smoking),tobaccosmoke (secondhand)Resists InfectionsFilters microbes from thebloodstream and influencesimmune function with antibodyproduction, nutrients, and otherfactorsAsthma - allergen, sensitizeracid anhydrides, acrylates,aluminum, amines, amylase,animal antigens,captafol,chlorothalonil, chromium,cobalt, colophony, egg lysozyme,enzymes, epoxy resins, ethanolamine’s, ethylenediamine, fiberdust,fungal antigens, glutaraldehyde, grain dust,insect antigens,isocyanates,latex, metal fumes, methacrylates, nickel,p-phenylenediamine, papain,pepsin, plant pollens, plastic dusts, plasticfumes,platinum, polypropylene, PVC, subtilase,trypsin,tungsten carbide,vanadium,wood dustAutoimmune antibodies (positiveANA, anti-DNA, RF, etc.)1,1,1-trichloroethane, asbestos, benzene, carbon tetrachloride,formaldehyde,mercury24, silica, solvents,trichloroethylene (TCE)Immune suppressionAldicarb, asbestos, benzene,benzo(a)pyrene, carbamates,chlordane,chlorpyrifos, dichlorvos, dioxins / TCDD,ionizing radiation, lead, mercury,methyl isocyanate,nickel, nitrogen dioxide,organochlorinepesticides,organophosphates, PAHs,PBBs, PCBs (polychlorinatedbiphenyls), not otherwise specified, PCDDs, PCDFs,pentachlorophenol(PCP),pesticides, phosgene,tobacco smoke (active smoking), tobaccosmoke (secondhand), UV radiationStores Vitamins and MineralsThe liver stores significantamounts of Vitamins A, D, E, K,and B12, as well as iron andcopper. These vitamins arerelated to many conditions.Vitamin D is particularlyinfluential in cellularproliferation and refers tocancer risks.Breast cancer (example of onecancer)aromatic amines, estrogens / DES, ethyl alcohol (ethanol),ionizingradiation, oryzalin,PAHs, PCBs (polychlorinated biphenyls)25, nototherwise specified, progestins, solvents, tetrachloroethylene (PCE),tobacco smoke (active smoking), tobacco smoke (secondhand)BPA issignificantly associated with breast cancer²⁶ OsteoporosisLead, cadmium, fluoride, tobacco smoke35ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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Common clinical detoxification support includes herbs,nutrients, binding, and chelation agents to optimize thedetoxification system. Nutritional supplementation is helpfulin a clinical detoxification process for two key reasons. Thefirst is the ability of various nutrients to protect vulnerablecells from oxidative stress and inflammation generated by themovement of toxins. The second is to support the highlynutrient-dependent CYP450 enzyme function or to enhancethe toxicants' excretion essentially.Common antioxidant supplements include vitamins C and E,selenium, glutathione, N-acetyl cysteine (NAC), magnesium,quercetin, anthocyanins, polyphenols, and omega-3 essentialfatty acids. Vitamins B2, B3, B6, B12, and C, folic acid, niacin,magnesium, copper, zinc, and flavonoids also support phase 1and II detoxification.Specific nutrients can target the support of the highly nutrient-dependent CYP450 enzymes. For example, support for phase Ican be provided with a high protein, low carbohydrate, low-fat diet, anthocyanins (found in berries and grapes), quercetin,and magnesium. The conjugation pathways in phase IIenzymes can also be specifically targeted for support. Themost active pathways for clearing environmental toxins areamino acid conjugation, glucuronidation, glutathioneconjugation, and methylation.Botanical medicine has a time-honored tradition of targetingliver and kidney function to aid the body to rid itself ofmetabolic wastes and environmental toxicants. Herbs withhepatoprotective properties include Curcuma longa(turmeric), Cynara scolymus (artichoke) and Silybummarianum (Carduus marianum, milk thistle.) This affinityarises from their anti-inflammatory, antioxidant, antifibrotic,antiviral, and immunomodulatory actions created bycomponents such as sulfur compounds, resins, salicylates,steroidal and triterpenoid saponins, essential fatty acids,flavonoids, and volatile oils.Most liver-supportive herbs have cholagogue and cholereticproperties that can increase the flow of bile released by theliver and gallbladder. In addition, some clinicians will includeherbs with laxative properties to improve bowel function andeliminate stool. Bulk laxatives provide fiber, which bulks upthe stool and eases constipation by calming an inflamedbowel. Sequestrants are activated charcoal, rice bran fiber,chlorophyll, and cholestyramine. Soluble and insoluble fiberslike lignan, alfalfa, bran, and guar can bind 10 percent to 30percent of bile acids.36MAR 2025 - VOLUME 20 | ISSUE NO. 03NATUROPATHIC DOCTOR NEWS & REVIEWClinicians must also balance the gut microbiome tointerrupt the cycle of toxicant exposures and chronicdisease development. Significant research has implicated therole of pollution in disrupting the microbiome. Studiesshow that a dose-related continuum of exposure to short-and long-term ambient particulate air pollution reduceslower gut diversity and shifts taxa, including evidence ofhigher levels of gut damage, inflammation, oxidative stress,and permeability.27,28 Not surprisingly, pollution wreaks havoc on themicrobiome, yet researchers also implicate them in thecapacity to biotransform and eliminate pollutants such asarsenic.29 Notably, the mechanism of action is beginning toemerge, and gut microbiota can play a role in thebiotransformation of forever chemicals such asperfluoroalkyl substances (PFAS) and bisphenols.30,31This understanding leads us to educate our patients that themicrobiome may epitomize the front-line defense system.The microbiota takes on heavy casualties and dysregulationbut also are critical for defense and disarming industrialcombatants. Healing this requires both the bolstering ofbiodiversity and the strength of the microbiome while alsoremoving the toxicants. Failure to accomplish both clinicalgoals leaves the microbiome in disarray. In addition, lymphatic support is imperative.Unfortunately, many chemicals persist in the body and arestored in various tissues. Heat liberates toxicants from fats,moving through the lymphatics to the skin, liver, andkidneys. CPYP450 enzymes essentially work to bio-transform those lipid-soluble toxicants into more water-soluble excretory derivatives. However, the enzymes can’taccess the molecules if sequestered in tissues like adipose,muscle, and bone. The lymph system operates at the lowestpressure gradient—physical movement, including exercise,massage, and skin brushing, all support lymphaticcirculation. Saunas can be gentle, effective tools in today’s toxic worldand have been reliably the best tools for encouraging themovement of environmental pollutants by increasingmetabolic and oxygen consumption rates and reducingoxidative stress. Perhaps sauna is less effective for mercury,lead, cadmium, nickel, and antimony but more effective forbisphenol A, phthalates, chlorinated pesticides, variousOCPs, and metabolites, including DDT, DDE,methoxychlor, endrin, and endosulfan sulfate.³²

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Identified ToxinSupportive Nutrients/Herbs/Relevant Pathways38ArsenicMethylation supportGreen and black teasCadmiumALA, anthocyanins (berries), magnesium, NAC, seleniumLeadALA, curcumin, NAC, SAMe, Vitamins C and E, zincMercuryMethylation supportBrassica sp. Curcumin, methionine, NAC,selenium, Vitamin E, zincPesticidesGlutathione supportBrassica sp, curcumin, green tea, magnesium,NACPolycyclicAromaticHydrocarbons(PAH)Glutathione supportBrassica sp., curcumin, fish oil, green teaquercetinSolventsGlycine conjugation supportGlucuronidation supportCurcumin,green tea, NAC, milk thistleDetox PathwaySupportive Nutrients and HerbsAcetylationVitamins B1, B5 and vitamin CAmino AcidconjugationArginine, glycine, cysteine, ornithine, taurine, glutamineGlucuronidationCruciferous vegetables, Bifidobacterial longum, fish oil, green teaextract, Lactobacillus rhamnosus, limonene from the peel oforanges, lemons, limes and grapefruitsGlutathioneConjugationCurcumin, green tea extract, liposomal GSH, Magnesium, NAC,Vitamin CMethylationS-adenosyl-L-methionine (SAMe), methylfolate, methylcobalamin, L-methionine, curcumin, choline, vitamin B6SulfationCysteine,methionine, molybdenum, niacin, Vitamin CDepuration therapy is never the first step in an EM protocolbecause if the toxicants are mobilized without firstavoidance, balancing chronic stress, optimizing nutrition, gutmicrobiome, and enterohepatic circulation, the impact ofmobilizing toxins may worsen an inflammatory clinicalsituation. Once determinants of health are addressed,depuration with a sauna may very well prove to be the mostreliable and consistent ally in an EM treatment process.33,34,35,36,3737ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE No specific drug on the market can comprehensively protectfrom oxidative stress and other deleterious effects of thearsenal of toxicants created by our industrial practices.However, some notable both natural and pharmaceuticalchelation agents are commonly included in clinicaldetoxification protocols.39 In medical therapeutics, chelation is a process in which theorganic chelator molecules bind the target metal ions with highaffinity. This complex is then more readily filtered by thekidneys or excreted by the liver than the metal ion alone. Theagents most widely recognized and utilized for heavy metalchelation are 2,3-dimercapto-1propanesulfonic acid (DMPS),2,3-dimercaptosuccinic acid (DMSA), edetate disodium(disodium ethylenediaminetetraacetic acid) (EDTA), anddeferoxamine (DFO). While the bond requirement for affinity with toxic metals ishigh, some natural substances and herbs have shown somelimited ability to act as natural chelators, such as NAC, Alphalipoic acid, high doses of antioxidants, and, to some extent,modified citrus pectin. Chlorella-broken cell wall (Chlorellaregularis) can be utilized as a natural chelator with variedresults. EM resources offer in-depth training for the safe andeffective use of chelation agents. As clinicians navigate EM through their application of thetherapeutic order, the larger conversation requires a deeperunderstanding of environmental social justice. With this lens,we affirm that communities and individuals are not equallyaffected by pollution, industry, consumer choices, and climatechange. Instead, wealth, geography, race, and ethnicityinfluence the harm subtly and overtly. Inequity relates toexposures, incidence of disease, and access to clean food, air,and water. Beyond the scope of this conversation, it inevitablyleads us to work to educate and advocate against social andenvironmental injustices while we deepen our capacity topractice EM. Our ecosystems require comprehensive, sustainable solutionsto the mess that industrial pollution has created. AlbertEinstein asserts, “We cannot resolve the problems of the worldby using the same techniques that have created them.” Leadersin planetary health chart a course involving sustainableagriculture, climate change mitigation, energy and resourcemanagement, policy, and healthcare.40 Bioremediation consistsof using microorganisms to assimilate, digest, or transformhazardous substances into less harmful or nontoxic forms andis emerging as a part of the solution.41

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Just as we deem the medieval practice of tossing raw sewageinto streets utterly ignorant and dangerous, our survivaldepends on radical shifts in current thinking and practice.Change must occur in how our toxic releases permeate theenvironment and ultimately in our capacity to cease thedestabilizing and traumatic practices that create suchcontamination. In the face of pervasive pollution, one realityremains undeniably present. The healing power of MotherNature reigns.Kim Furtado, ND, received her Doctor ofNaturopathic Medicine (ND) degree from BastyrUniversity in Kenmore, Washington in 2000.Inspired by the healing power of naturopathicmedicine, she has been in private practice in Lewes,Delaware. She specializes in environmental medicineand women’s health. She is an executive boardmember of the National Association ofEnvironmental Medicine (NAEM). She is afounding director for SNAC Gardens Foundation,working to enrich communities through cultivatingmeaningful relationships to nature, food, andpersonal well-being. She is author of E-Book: AnIntroduction to Clinical Detoxification inIntegrative Medicine 381. Cave M, Appana S, Patel M, et al. Polychlorinated biphenyls, lead, andmercury are associated with liver disease in American adults: NHANES2003-2004. Environ Health Perspect. 2010;118(12):1735-1742.2. Prüss-Ustün A, Wolf J, Corvalán C, Bos R, Neira M. Preventing diseasethrough healthy environments: A global assessment of the burden of diseasefrom environmental risks. World Health Organization. 2016.https://apps.who.int/iris/handle/10665/2045853. Laden F, Neas LM, Dockery DW, Schwartz J. Association of fineparticulate matter from different sources with daily mortality in six US cities.Environmental Health Perspectives. 2000 Oct; 108(10): 941–947;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240126/4. Pizzorno J. (2016). Is the Diabetes Epidemic Primarily Due to Toxins?.Integrative medicine (Encinitas, Calif.), 15(4), 8–17.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991654/5. Pizzorno, J. How to Practice Environmental Medicine. IntegrativeMedicine . Vol. 16, No. 5. October 2017. Integrative Medicine - A Clinician'sJournal - Archives (imjournal.com)6. National Center of Health Statistics. Leading cause of death.CDC/National Center for Health Statistics. October 25, 2024. ViewedFebruary 5, 2025. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm7. Prüss-Üstün, Annette, Wolf, J., Corvalán, Carlos F., Bos, R. & Neira,Maria Purificación. ( 2016) . Preventing disease through healthy environments:a global assessment of the burden of disease from environmental risks. WorldHealth Organization. https://iris.who.int/handle/10665/2045858. Wong, et al. Cancer Mortality Risks from Long-term Exposure toAmbient Fine Particle. Cancer Epidemiol Biomarkers Prev (2016) 25 (5):839–845. https://doi.org/10.1158/1055-9965.EPI-15-06269. Morgan M, Deoraj A, Felty Q, Roy D. Environmental estrogen-likeendocrine disrupting chemicals and breast cancer. Mol Cell Endocrinol. 2017Dec 5;457:89-102. doi: 10.1016/j.mce.2016.10.003. Epub 2016 Oct 4. PMID:27717745.REFERENCESALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE10. Meo SA, Abukhalaf AA, Alessa OM, Alarifi AS, Sami W, Klonoff DC.Effect of Environmental Pollutants PM2.5, CO, NO2, and O3 on theIncidence and Mortality of SARS-CoV-2 Infection in Five Regions of theUSA. Int J Environ Res Public Health. 2021 Jul 23;18(15):7810. doi:10.3390/ijerph18157810. PMID: 34360104; PMCID: PMC8345586.11. Lanphear BP, Rauch S, Auinger P, Allen RW, Hornung RW. Low-levellead exposure and mortality in US adults: a population-based cohort study.Lancet Public Health. 2018 Apr;3(4):e177-e184. doi: 10.1016/S2468-2667(18)30025-2. Epub 2018 Mar 12. PMID: 29544878.12. Gervasio, L. Ujeta, F., Navas-Acien, A. Lead and Cadmium asCardiovascular Risk Factors: The Burden of Proof Has Been Met. Journal ofthe American Heart Association.2021;10.10.https://www.ahajournals.org/doi/epub/10.1161/JAHA.120.01869213. Kipruto Kirwa, Carly M Eckert, Sverre Vedal, Anjum Hajat, Joel DKaufman - Ambient air pollution and risk of respiratory infection amongadults: evidence from the multiethnic study of atherosclerosis (MESA): BMJOpen Respiratory Research 2021;8:e000866.14. Peters R, Ee N, Peters J, Booth A, Mudway I, Anstey KJ. Air Pollutionand Dementia: A Systematic Review. J Alzheimers Dis. 2019;70(s1):S145-S163. doi: 10.3233/JAD-180631. PMID: 30775976; PMCID: PMC6700631.15. Li Y, Xu L, Shan Z, Teng W, Han C. Association between air pollutionand type 2 diabetes: an updated review of the literature. Ther Adv EndocrinolMetab. 2019 Dec 24;10:2042018819897046. doi: 10.1177/2042018819897046.PMID: 31903180; PMCID: PMC6931138.16. Song Y, Chou EL, Baecker A, You NC, Song Y, Sun Q, Liu S.Endocrine-disrupting chemicals, risk of type 2 diabetes, and diabetes-relatedmetabolic traits: A systematic review and meta-analysis. J Diabetes. 2016Jul;8(4):516-32. doi: 10.1111/1753-0407.12325. Epub 2015 Sep 1. PMID:26119400.17. Lee DH, Lee IK, Song K, Steffes M, Toscano W, Baker BA, Jacobs DRJr. A strong dose-response relation between serum concentrations ofpersistent organic pollutants and diabetes: results from the National Healthand Examination Survey 1999-2002. Diabetes Care. 2006 Jul;29(7):1638-44.doi: 10.2337/dc06-0543. PMID: 16801591.18. Kshirsagar AV, Zeitler EM, Weaver A, Franceschini N, Engel LS.Environmental Exposures and Kidney Disease. Kidney360. 2022 Oct17;3(12):2174-2182. doi: 10.34067/KID.0007962021. PMID: 36591345;PMCID: PMC9802544.19. Lin P-ID, et al. , Per- and polyfluoroalkyl substances and kidneyfunction: Follow-up results from the Diabetes Prevention Program trial.Environment International, 2021. 148.20. Cave M, Appana S, Patel M, et al. Polychlorinated biphenyls, lead, andmercury are associated with liver disease in American adults: NHANES2003-2004. Environ Health Perspect. 2010;118(12):1735-1742.21. Wu X, Cobbina SJ, Mao G, Xu H, Zhang Z, Yang L. A review of toxicityand mechanisms of individual and mixtures of heavy metals in theenvironment. Environ Sci Pollut Res Int. 2016 May;23(9):8244-59. doi:10.1007/s11356-016-6333-x. Epub 2016 Mar 11. PMID: 26965280.22. Cobbina SJ, Chen Y, Zhou Z, Wu X, Zhao T, Zhang Z, Feng W, WangW, Li Q, Wu X, Yang L. Toxicity assessment due to sub-chronic exposure toindividual and mixtures of four toxic heavy metals. J Hazard Mater. 2015Aug 30;294:109-20. doi: 10.1016/j.jhazmat.2015.03.057. Epub 2015 Mar 28.PMID: 25863025.23. Collaborative on Health and the Environment. Disease and ToxicantDatabase. Retrieved from: https://www.healthandenvironment.org/our-work/toxicant-and-disease-database/?showdisease=62724. Pollard KM, Cauvi DM, Toomey CB, Hultman P, Kono DH. Mercury-induced inflammation and autoimmunity. Biochim Biophys Acta Gen Subj.2019 Dec;1863(12):129299. doi: 10.1016/j.bbagen.2019.02.001. Epub 2019Feb 10. PMID: 30742953; PMCID: PMC6689266. 25. Wan MLY, Co VA, El-Nezami H. Endocrine disrupting chemicals andbreast cancer: a systematic review of epidemiological studies. Crit Rev FoodSci Nutr. 2022;62(24):6549-6576. doi:10.1080/10408398.2021.1903382 References 26-41 Available on NDNR.com

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MAR 2025 - VOLUME 20 | ISSUE NO. 0340Hahnemann recruits the following eight symptoms intoArsenicum album from this account from Baylies:154. Falling out of the hair of the head. [B15]228. Obscuration of sight. [B15]255. Roaring in the ears. [T6; B15]289. The lips are bluish. [B15] [blackish]319. The tongue is bluish. [B15] [blackish]587. Black, acrid, putrid stools. [B15]817. Discolored nails. [B15]1038. Spots here and there on the skin. [B15]Case Example: Herein is a case from the authors’ practice to illustrate theapplication of the law of similars from toxicology reports tosymptom inclusion in the materia medicæ to clinicalapplication in praxis. An 11-year-old female presented to me on February 14, 2024.Her parents were seeking homœopathic treatment forsymptoms related to autism spectrum disorder. Below is a listof the main symptoms in her case: History of greenish-blue spots on the back of hands andback at birth due to lack of oxygenation (lasted 6 monthsafter birth). Autism Spectrum Disorder (ASD): regression aftervexation with shock at 11 months old after a religioushead shaving ceremony/ear piercing followed by whenDad moved from India to the US and temporarily leftthe family behind until they could follow. It was as if itwas a PTSD-like reaction with regression and speechdelay due to separation anxiety from Dad. Separation anxiety specifically from Dad ever since theinitial shock at 1-year-old (e.g., she was constantlychecking for Dad, must sleep next to Dad nearby, andtouching his ear to make sure he's there). Poor focus and short attention span (better when acutelysick). Difficult comprehension. Speech delay (constant speaking, repeating questionsbefore answering, echolalia, better when acutely sick). NATUROPATHIC DOCTOR NEWS & REVIEWRepetitive speech (anxiously repeats the same thing 100-200 times daily - e.g., “Tuesday is a school day”). Hyperactivity (running, jumping, sitting still when acutelysick). Hypersensitivity to noise to certain particular sounds(e.g., a specific sound in a song, shrill sounds, blowingsounds). Sensitive to touching hair, combing hair, and cutting hair(worse after ceremonial head shaving at 11 months old).Stimming (tapping fingers, flapping hands). History of frequent ear infections and fevers when Dadleft for the US. Aversion to socializing with strangers and desire to spendtime alone on her media device (e.g., not afraid ofstrangers and not shy, but at a party, she will find a roomto go off to be alone while watching media on asmartphone). Thirst for large quantities of room temperature water. She wants things to be clean and is a perfectionist aboutthings being as she wants them to be. The case was analyzed using the computerized version ofBönninghausen’s Therapeutic Pocketbook through its mostaccurate English translation, TBR2.12.I prescribed Arsenicum album Q1 (L) daily. This remedy iswell known historically for its applicability in cases withanxiety, perfectionism, restlessness, and thirst, which aresimilar to my patient’s case. In addition, there is evidencefrom the materia medica of symptoms of Arsenicum toxicitycausing dark spots on the skin to confirm the match viasimilars. Arsenicum album in The Chronic Diseases, Their PeculiarNature and Their Homœopathic Cure. CD3271. Earthy and leaden complexion, with green and bluespots and stripes. [Knape, l.c.]291. Black-spotted lips. [Guilbert, l.c.]1038. Spots here and there on the skin. [Baylies, l.c.]1039. Blue spots on the abdomen, on the genitals, and inthe white of the eye. [Kaiser, l.c.]

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With the digitized PDF, we can now find these Hahnemannsources and examine them ourselves. Now, with the HANPDimitriadis Literature Collection. Here are screenshots. I searchedfor this Arsenicum toxicological report in our new online library. Here is a retyped extract from William Baylies brief toxicologyreport of Arsenicum toxicity.1A“Dr. Turner quotes an instance from a learned writer, wherein awound made on the head with a comb wet with oil in whicharsenic had been infused, brought on vomitings and purgings thatproved mortal: and in the Edinburgh medical essays, we have aninstance of a person who by only touching with her tongue the tipof her finger that was all arsenic, to discover what it was; thoughshe was certain she swallowed none of it, that twelve hours afterbecame suddenly vertiginous & was affected with most of thecommon consequence of taking it inwardly; and which by theseveral ingenious authors who have wrote on the subject aredescribed to be pricking, twitching, irritating and burningsensations, a cruel pain and heat at the stomach with ragingtorture of the bowels which it frequently corrodes and ulcerates; ablackness & swelling of the tongue and lips, great distension of thehypocondrias, a dryness of the jaws & throat, tremblings,intermiting pulse, failure of strength, dimness of sight, noise in theears, hiccough, palpitation of the heart, cold sweats, coldness ofthe extremities, sownings, convulsions & a bloating of the wholebody; a discolouration of the nails, falling off of the hairs, spots onthe skin in several parts, a violent discharge both upwards &downwards, which is sometimes black poisonous and filthy like tocarrion, and is accompanied with a gangrene & mortification ofthe stomach & intestines, by some or all of which the scene isgenerally closed with a painful death.” Toxicology Report: I will present a short example from the literature of atoxicology report of Arsenicum album to demonstrate the valueof examining these primary source citations from Hahnemannto better understand substance effects as a method for studyingmateria medica, which can lead to improved clinical outcomes.One of the great values of these toxicology reports is that theytell a story with a timeline of events that unfold with a personexposed to a substance. These stories of toxicologicalpoisonings are often so richly described that they form animpression of the substance’s effects that are easilyremembered in a much more complex way to apprehend simplyfrom the symptom lists in the materia medicæ. Unfortunately, we no longer have access to the provers’ daybooks to see the time course of symptom development thatemerged during the original provings (methodical substancetrials) because Hahnemann abstracted bits of each provers’symptoms and rearranged them by their anatomical location inthe schema of his materia medicæ because the purpose ofHahnemann’s Materia Medica Pura and Chronic Diseases wasmeant to be a reference work for the prescriber, but notnecessarily a place to study the substance effects in theiroriginal sequence in time. Additionally, the toxicologicalreports extend to pathology in a way that provings do not,since it would be unethical to do a prospective trial on healthysubjects to the point of pathological poisoning. As such, thetoxicological reports give us a glimmer of insight into theextension of possible pathologies that may be treated withmedicine applied homœopathically (via similars). 41ALLERGY / IMMUNOLOGY /ENVIRONMENTAL / TOXICOLOGY ISSUE

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MAR 2025 - VOLUME 20 | ISSUE NO. 0342The family returned for the first follow-up on Arsenicum Q1(L) once per day four weeks later. They reported that she wasless restless and could now sit for fifteen to twenty minutes ata time. She was also experiencing improved comprehension.For example, she was now paying attention to the family’sconversations—whereas, in the past, she would leave theroom. After a conversation, she would repeat some words.She had a trip to her new middle school the day prior, andwhen asked about the experience, she said she liked theschool, "bus ride, black school, black school, like school,swimming pool, playground." Typically, she would repeatonly the last two or three words her parents said, but thistime, she responded with three to four words. Since sheappeared to be responding to the medicine, we continued atthe same potency and frequency.She returned for her second follow-up on Arsenicum Q1 (L)once per day three weeks later. The restlessness maintainedthe same improvement, with her able to sit for fifteen totwenty minutes before getting up. Additionally, her parentsreported that she had been using new words. For example,when they asked her what happened in school, she would listall the activities: "school bus, recess, break, lunchtime, gohome, writing, math." When they asked, “What in class?” formore detail, she responded, "Math, writing.” NATUROPATHIC DOCTOR NEWS & REVIEWDespite these improvements, she slightly worsened in askingobsessive, repetitive questions. Since the case was still wellcovered by the same medicine, we increased the potency toArsenicum Q2 (L) once per day.They returned for a four-week follow-up on Arsenicum Q2(L) once per day. The parents reported that she could now sitand focus for up to twenty minutes at a time. Her speech hadimproved from one-word phrases to two- to three-wordphrases with more depth in her communication. Theobsessive, repetitive speech had reduced to thirty to fiftyrepetitions, down from the previous one hundred to twohundred repetitions of a phrase. Her thirst was normal, andher perfectionist desire for things to be clean was no longerpresent. She had been improving, but slowly. However, sinceher parents were familiar with homœopathy and wanted totry a higher potency for more marked improvement, weagreed to begin Arsenicum 200c (L) daily.At her subsequent one-month follow-up on Arsenicum 200c(L) once per day, she showed improvement in being lesshyperactive, less tapping (stimming), better comprehension infollowing directions, reduced separation anxiety from herfather (not needing to touch him while sleeping), andallowing her mother to comb her hair with less crying.

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REFERENCESMAR 2025 - VOLUME 20 | ISSUE NO. 0343She was also more engaged at a recent social event andwas okay with having her picture taken. Her repetitivespeech had improved but was gradually returning, sowe increased the potency to Arsenicum 1M (L) oncedaily.She followed up seven weeks after starting Arsenicum1M (L). At that appointment, her parents reported thatshe was trying new foods, whether she liked them ornot. They took her to a wedding, where she could sit inher seat without inappropriate behaviors for aboutthree hours—without any aid from media devices. Onanother occasion, they went to the park, and sheresponded to a social cue from her brother withoutprompting, indicating increased social awareness. Herparents also reported she was using more new wordsand still spoke in one- to two-word phrases but with abroader vocabulary. She continued to tap and talkcontinuously. Notably, she saw a pregnant woman andapproached her, saying, "baby inside," demonstratingimproved awareness of others and expressive speech.However, she began experiencing intense sweating withmarked body odor, prompting a remedy change toBaryta carbonica, which later proved effective—butthat is another story.This case demonstrates gradual improvement insymptoms experienced by a young female on theAutism Spectrum with the homœopathic medicineArsenicum album, selected via similars and supportedby evidence from primary source literature.Conclusion: This brief Arsenicum toxicology report and caseexample demonstrate the value of examining theseprimary source citations from Hahnemann to betterunderstand substance effects as a method for studyingmateria medica, which can lead to improved clinicaloutcomes. We hope that our profession will widely use the HANPDimitriadis Literature Collection and will inspire anew generation of homœopaths to utilize this tool tocreate a revival of interest in source literature researchthat can be used for a wide variety of purposes such aspersonal study, group materia medica study groups,research to update and correct our materia medicæsources, publications, future conferences on relatedtopics, and much more. NATUROPATHIC DOCTOR NEWS & REVIEWBaylies, William: Practical Essays on medical Subjects by a member of the Royal College ofPhysicians of London and Edinburgh, London, 1765, p.85.1.Dimitriadis G.: The Bönninghausen Repertory-therapeutic pocket book method,Hahnemann Institute Sydney, 2010, 2nd edition [TBR2]. Analyses shown using TBR2.1software version (of TBR2) which is now available as cloud based online platform,available by annual/monthly subscription.2.Hahnemann S.: The Chronic Diseases, Their Peculiar Nature and Their HomœopathicCure. 2nd ed. Translated by Tafel LH [1895]. Indian Reprint, New Delhi: B. JainPublishers; 2011.3.Dr. Jamie Oskin graduated from SonoranUniversity of Health Sciences (formerly SouthwestCollege of Naturopathic Medicine) in Tempe, AZ.After completing a general medicine residency atthe Southwest Naturopathic Medical Center, hewas accepted into a specialized homœopathyresidency sponsored by Standard Homeopathicunder Dr. Stephen Messer, ND, DHANP. Dr.Oskin was on the homœopathic faculty at SonoranUniversity for 9 years and has served on the boardof HANP (hanp.net). He is always active in thecommunity, publishing well received articles(https://droskin.com/publications/), speaking atconferences, teaching on various topics(https://droskin.com/education-for-practitioners/)including the TBR2 method(https://wholehealthnow.com/Home/Details/68)which he has himself been utilizing almostexclusively for over a decade. Dr. Oskin has beenand maintains a telehealth practice focused onhelping children with developmental disorders,especially Autism Spectrum Disorders. For moreinformation visit https://droskin.com/

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A Naturopathic Case Study on Reversing CIRS-InducedBrain AtrophyFrom Kitty Litter toCortical RecoveryFrom Kitty Litter toCortical RecoveryERIC DORNINGER ND, LAC44MAR 2025 - VOLUME 20 | ISSUE NO. 03This case study examines a 39-year-old male with severe neurological symptoms linked to Chronic Inflammatory ResponseSyndrome (CIRS) triggered by endotoxin exposure from a kitty litter box and a water-damaged home. The article explores thepathophysiology of CIRS, effective screening, and diagnostic methods, and how the Shoemaker Protocol successfully reversedbrain atrophy and restored health.What is Chronic Inflammatory Response Syndrome (CIRS)?Chronic Inflammatory Response Syndrome (CIRS) is a multisystem, multi-symptom illness with many neurologicalphenomena including, but not limited to, headache, light sensitivity, blurred vision, ice pick pain, memory impairment,decreased assimilation of new knowledge, difficulty concentrating, confusion, tingling, numbness, poor temperatureregulation, mood swings, appetite swings, vertigo, metallic taste, and tremors.¹ ² Like many other inflammatory disorders (RA, Hashimoto’s, psoriatic arthritis, celiac), CIRS has an HLA predisposition.When exposed to biotoxins, humans with specific HLA for CIRS have enhanced susceptibility for expressing chronicinflammatory responses via the innate immune pathways, resulting in non-sensical, dysregulated cytokine storms (TGFB-1,MMP-9, C4a).

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The unrelenting inflammatory cascades in CIRS result inmolecular hypometabolism, proliferative physiology (theWarburg effect), metabolic acidosis, pulmonaryhypertension, T-reg cell deficiency, insulin resistance, andneuronal injury.³Like Celiac disease needs gluten, CIRS needs a unifyingtrigger called biotoxins or “nature toxins” to express illnessand was initially called “biotoxin illness.” Biotoxins are tinychemicals produced or derived from microorganisms and canenter the human body through inhalation, ingestion, andinjection (bites). Biotoxins are ionophores oramphipaths/amphiphiles with hydrophilic and hydrophobicproperties. They can move from cell to cell (“walk throughwalls”) due to their tiny size (as small as 1.4 angstroms) andtheir ability to share electrons. Biotoxins are stored in adipose and nerve tissue, where theyinteract with cellular receptors, including toll 2,4 receptors,mannose, dectin, and C-type lectin receptors, triggeringinnate immune activation. Fungi, actinobacteria, gram-negative bacteria (bartonella, endotoxins), recluse spidervenom, seafood toxins (ciguatera, pfesteria), cyanobacteria(algae blooms), borrelia burgdorferi (bbtoxin1) andapicomplexans (babesia, sarcocystis, eimneria) are allexamples of biotoxin producing organisms.⁴There are three critical stages for discovering, solving, andresolving symptoms caused by Chronic InflammatoryResponse Syndrome: 1) Screening, 2) Diagnosis and 3)Treatment.Screening for CIRS: Identifying Patients at Risk:Why Urinary Mycotoxin Tests Are InaccurateAlthough routinely used with patients, urinary mycotoxinsare not a proper screening tool for CIRS, as they simply tellthe provider if you have mold exposure. Healthy people also have urinary mycotoxins. Multiplestudies with over 2500 combined healthy controls show that60-100% of urine samples showed mycotoxins andmetabolites in asymptomatic healthy people.⁵ Unfortunately,no published urinary mycotoxin ranges exist to separatehealthy and sick patients. This is why one spouse withelevated urinary mycotoxin can feel fine in the same buildingas the sick spouse experiencing CIRS. 45ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE Nerve TissueAdipose Tissue

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Interview for Biotoxin Exposure History1. Have you ever lived, worked, worked out, stayed, orvacationed in buildings with water damage? (give examples for the patient to ponder; provide achecklist in your paperwork).2. Have you ever noticed musty smells or sewer smells?Sulfur smells? 3. History of spider bites?4. History of tick bites? Bullseye rash? Pictures?5. Have you ever been treated for Lyme disease? Wheredid you grow up?6. Have you ever had seafood poisoning or eaten reeffish?7. Have you ever had traveler’s diarrhea or gotten sickwhile traveling?8. Name all the continents you’ve traveled to.9. Have you ever recreated or lived near water with algaebloom? Red tides?10. Have you ever lived near or had a hobby or localpond?Clustered Symptoms:Clustered symptoms are a list of 37 symptomsoriginating from eight primary categories: General,Musculoskeletal, Eye, Respiratory, Gastrointestinal,Cognitive, and Hypothalamic. The clustered symptomsare present in at least 30% of patients with CIRS. Hence,a symptom questionnaire cannot sort specific biotoxinexposure but can sort/screen for CIRS. 46ALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE Moreover, urinary mycotoxins and fungal antibody testingare not screening or diagnostic measures for fungal infection.These tests often result in improper use of herbal andprescription antifungals. Antifungals can enhance horizontalgene transfer (HGT), a mechanism where microbesspread/share resistance genes, resulting in multiplepathogenic bacteria that are resistant.6 Itraconazole has beenshown to shut down aerobic metabolism via closure of theVDAC (Voltage Dependent Anion Channel) and hassubsequently been patented for use as a potentialchemotherapy agent. Proper Screening for CIRS is cost-effective andstraightforward; it simply requires… Interviewing for biotoxin exposure history 1.Clustered Symptoms questionnaire (administered by theprovider or trained staff)2.Visual Contrast Sensitivity test (VCS)3.

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VISUAL CONTRAST SENSITIVITY (VCS)Contrast sensitivity (CS) is perceiving sharp and clearoutlines of tiny objects. It is also defined as identifyingminute differences in the shadings and patterns. CShelps detect objects without a clear outline anddistinguish them from their background contrast.⁹Biotoxin Illness reduces the ability to see contrast viainflammatory cytokine effects on the retinal artery(measured by the Heidelberg retinal blood flow meter).Healthy controls demonstrated 400 units of retinalblood flow with a 5% VCS fail rate. In contrast,patients with CIRS post-biotoxin exposuredemonstrated a marked retinal blood flow reduction(200 units) and a high VCS fail rate (50-92%,depending on the clinic data set).¹⁰ Treatment with theShoemaker protocol restored retinal blood flow andallowed for contrast visualization to similar levels ofhealthy controls. Logistics of VCS Screening:There are two current validated versions of the VCStest available on survivingmold.com. One is handheldin the office, and the other is online for patients athome or in a potentially clean/contaminated building(computer screen on full brightness, well-lit room with18” string to account for screen distance).47Visual conditions affect VCS, including, but not limited to,cataracts, glaucoma, LASIK, retinopathy, and dry eye. Atapproximately 7 years of age, pediatric patients canconceptualize and execute the VCS.Diagnosis Although clustered symptoms and a failed VCS test can beused as an alternative means to CIRS diagnosis, this approachis suggestive of natural disasters, severe financial constraints,and large populations in crisis and to validate illness thatcannot see response to treatment if stuck in a concerningbuilding.The diagnostic confirmation for CIRS utilizes the multipleinflammatory and neuroendocrine peptides and hormonesthat differ in CIRS patients from healthy controls.¹¹ Publisheddata shows high confidence in CIRS diagnosis when 5 of 10 ormore of the original biomarkers differ from the range ofhealthy controls. In contrast, healthy controls never showedmore than 3 of 10 biomarkers positive. The original CIRSresearch reference ranges were set on averaging healthycontrols laboratory analysis. A healthy control was defined asa human with three or less of the 37 clustered symptoms.There are now 52 objective biomarkers to aid in the diagnosis,prognosis, and treatment of CIRS, including more laboratorybiomarkers, brain MRI with Neuroquant, nasopharyngealculture, skin culture transcriptomic testing (GENIE),echocardiogram (PASP) and PFT’s. MAR 2025 - VOLUME 20 | ISSUE NO. 03NATUROPATHIC DOCTOR NEWS & REVIEW*Blood Markers:* Elevated ACLACIRS as a cause formiscarriage?*Low VEGFCapillaryhypoperfusion*HLA-geneticsusceptibility-Cheek swab for kids* Elevated C4a/C3aactivation ofCompliment pathwayNational Jewish*Elevated MMP-9degrading enzyme ofBBBLabcorp/Quest*Elevated TGFB-1loss of T-Reg functionQuest*AGA-Anti-GliadinAntibodies +*Elevated Leptin(with weight lossresistance CIRS patient)*Dysregulation ofADH and osmolality* Dysregulation ofACTH and CortisolFrequent urinationCircadian rhythms*Low MSH:the master NEIRegulators*Low AndrogensDHEA/Testosterone*MARCONSMultiple AntibioticResistance Coag NegStaph*AcquiredVon Willebrand'sFactorNose bleedsFollow the Confirmatory Labs on the Biotoxin pathway (5 of these original 10 confirm CIRS):VCS > HLA > C4a, TGFB-1,MMP-9 > MSH > ACTH/Cortisol > ADH/Osmolality > AGA > VEGF

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48Treating CIRS: The Shoemaker ProtocolThe 12-Step Shoemaker ProtocolA peer-reviewed, reproducible, published sequential twelve-step protocol known as the Shoemaker (see diagram 1)solves and resolves CIRS when applied in earnest.¹²Although the first three steps are arduous and involvedramatic improvements, the last step, “VIP” (vasoactiveintestinal peptide), has been published to safely restoreatrophic gray matter nuclei in patients with brain atrophysecondary to CIRS.¹³ ¹⁴ Moreover, VIP has also beenpublished to help normalize immune dysregulation andinnate immune responses.¹⁵ CIRS in practice: Case Study: a 39-year-old male with multiple nuclearatrophy secondary to CIRS-WDB andCIRS-Endotoxin.MAR 2025 - VOLUME 20 | ISSUE NO. 03NATUROPATHIC DOCTOR NEWS & REVIEWSHOEMAKER'S TREATMENT PROTOCOL:1. Removal from exposure; (Assess ERMI, Actinobacteria, Endotoxin, Beta-Glucans)2. Correction of biotoxin carriage with Cholestyramine, Welchol, Colesevelam; prime with4200 mg EPA/DHA; monitor with VCS if initial fail; less valuable if initial pass.3. Eradication of biofilm-forming MARCONS; check API-Staph nasal culture (microbiologydx.com)4. Gluten-free diet; okay to reintroduce gluten post protocol if not celiac or gluten sensitive5. Correction of androgens (support liver/GB if necessary pre-DHEA load)6. Correction of ADH/osmolality7. Correction of elevated MMP-9 - EPA/DHA, Resveratrol help, but first 3 steps will usually normalize8. Correction of low VEGF - EPA/DHA, VIP, slow reintroduction of movement9. Correction of elevated C3a - can elevate with acute Lyme; evaluate Lyme and coinfection iselevated10. Correction of elevated C4a - usually normalizes with first 3 steps11. Reduction of elevated TGF beta-1-Usually normalizes with first 3 steps; fish oil, Vitamin D andLosartan if not normalizing12. VIP - can titrate slowly if patient is sensitive13. Recheck labs to ensure normalization; use VCS and clustered symptoms for tracking progressand exposures

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Patient PresentationA 39-year-old male presented with 34 out of 37 clusteredsymptoms, including severe reflux. Overnight oximetryrevealed sleep apnea as part of the underlying cause of reflux,and four tsp. of DGL powder per quart of warm water wasprescribed to drink throughout the day to dampen reflux andtonify gastric lining while referral for C-PAP was in progress.4200 mg of EPA/DHA fish oil was administered to modulatethe immune system's pre-bile acid sequestrant and to supporta healthy Omega-3 index.The Shoemaker protocol was started (4 gramscholestyramine tid-qid), and home testing throughenvirobiomics.com was ordered for patient-administeredtesting. A microfiber dust cloth collected ERMI,actinobacteria, and endotoxin from the basement andsubsequent floors (one #8 kit per floor). Building testingrevealed astronomically elevated endotoxin on the main andupstairs bedroom floors. HERTSMI-2 mold scores were alsoelevated. A follow-up inspection elucidated that a kitty litter box inthe utility closet was the source of endotoxin, whichspread through the house via HVAC. In addition,multiple water-damaged areas were elucidated andaddressed with various rounds of remediation. BrainMRI with Neuroquant revealed multiple (four) very age-inappropriate nuclear atrophy relative to age-matchedcontrols, including cortical gray, hippocampus, caudate,and pallidum. Neuroquant also revealed the specificcausation pattern of endotoxin exposure (cortical grayatrophy, plus at least two more nuclear atrophy). 49Utilizing NDNR’s Streamlined Media Access &Resources Technology ( ), we can deliverinteractive content embedded into each and everyissue of NDNR. This innovative approach allowsreaders to seamlessly engage with a variety ofmedia formats directly within the pages of ourpublication. With SMART, users can view videos,participate in continuing education (CE)opportunities, listen to and subscribe to podcasts,read insightful articles, and explore much more—all without leaving the PDF. By integrating theseinteractive elements, we enhance the readerexperience, making each issue of NDNR a dynamicand valuable resource for our audience.Subscribe NowSubscribe NowALLERGY / IMMUNOLOGY / ENVIRONMENTAL / TOXICOLOGY ISSUE

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After the first three steps of the Shoemaker protocol, theclustered symptoms dropped from 34 to 14. Afterimplementing intranasal vasoactive intestinal peptide,symptoms dropped from 14 > 4 > 1, and the patientreported still having some fatigue that he felt “could onlyrestore in the gym.” Despite previous exercise intolerance,the patient could return to the gym, slowly ramp upworkouts, and restore pre-CIRS energy and athletic levels. Conclusion: Recognizing and Treating CIRS inClinical PracticeWater-damaged building molds are well published in theliterature as a cause of multisystem, multi-symptom illness.However, bacteria (gram-positive actinobacteria andLPS/endotoxin-forming gram-negative bacteria) need tobecome a regular part of our differential when striving toidentify and treat the underlying cause.Eric Dorninger ND, LAc completed his Doctor ofNaturopathic Medicine and Master of Science inAcupuncture at Bastyr University in 2003 andthereafter completed a 2-year residency inNaturopathic Primary Care. In 2005, he foundedRoots and Branches Integrative Healthcare, a clinicdedicated to “Mystery Illness” where he focuses onelucidating the underlying causes of unrelentingchronic Illness. He is cofounder of CIRSx conferenceand institute, Director of Research and education forBlue Sky CBD and teaching functional medicine forApex Energetics.50Cartwright, M. J., Martin, S. E., & Donta, S. T. (1999, May). A novelneurotoxin (Bbtox1) of Borrelia burgdorferi. Meeting of the AmericanSociety of Microbiology, Chicago.1.Head, S., Shi, W., Zhao, L., Gorshkov, K., Pasunooti, K., et al. (2015).Antifungal drug itraconazole targets VCAC1 to modulate theAMPK/mTOR signaling axis in endothelial cells. Proceedings of theNational Academy of Sciences, 112, E2726-E7285.2.Kaur, K., & Gurnani, B. (2023, June 11). Contrast Sensitivity. InStatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Available from: https://www.ncbi.nlm.nih.gov/books/NBK580542/3.McMahon, S. W. (2017). An evaluation of alternate means to diagnosechronic inflammatory response syndrome and determine prevalence.Medical Research Archives, 5(3). https://doi.org/10.18103/mra.v5i3.10004.Ryan, J., & Shoemaker, R. (2017). RNA-Seq on patients with chronicinflammatory response syndrome (CIRS) treated with vasoactiveintestinal peptide (VIP) shows a shift in metabolic state and innateimmune functions that coincide with healing. Medical Research Archives,4, 1.5.Shoemaker, R. (2003, September). Use of visual contrast sensitivity andcholestyramine in diagnosis and treatment of indoor air acquired,chronic, neurotoxin-mediated illness. Conference peer review. Availablefrom:https://www.survivingmold.com/docs/Use_of_visual_contrast_sensitivity.PDF6.Shoemaker, R. (2020). Metabolism, molecular hypometabolism, andinflammation: Complications of proliferative physiology includemetabolic acidosis, pulmonary hypertension, T reg cell deficiency, insulinresistance, and neuronal injury. Trends in Diabetes & Metabolism, 3, 1-15.7.Shoemaker, R., Heyman, A., & Lark, D. (2023). Transcriptomics andbrain volumetrics define the causes of cognitive impairment in patientswith CIRS and support the use of VIP in treatment. Medical ResearchArchives, 11(2).8.Shoemaker, R., House, D., & Ryan, J. (2013). Vasoactive intestinalpolypeptide (VIP) corrects chronic inflammatory response syndrome(CIRS) acquired following exposure to water-damaged buildings. Health,5(3), 396-401.9.Shoemaker, R., Johnson, K., Jim, L., Berry, Y., Dooley, M., Ryan, J., &McMahon, S. (2018). Diagnostic process for chronic inflammatoryresponse syndrome (CIRS): A consensus statement report of theConsensus Committee of Surviving Mold. International Medical Review,4(5), 1-47.10.Shoemaker, R., Katz, D., McMahon, S., & Ryan, J. (2017). IntranasalVIP safely restores atrophic grey matter nuclei in patients with CIRS.Internal Medicine Review, 3(4), 1-14.11.Shoemaker, R., & Ritchie, M. D. (2019, October). Urinary mycotoxins:A review of contaminated buildings and food in search of a biomarkerseparating sick patients from controls. Internal Medicine Review.12.U.S. Centers for Disease Control and Prevention. (n.d.). Aboutantimicrobial resistance. Retrieved fromhttps://www.cdc.gov/antimicrobial-resistance/about/index.html13.Shoemaker, R., Heyman, A., & Lark, D. (2023). Transcriptomics andbrain volumetrics define the causes of cognitive impairment in patientswith CIRS and support the use of VIP in treatment. Medical ResearchArchives, 11(2). https://doi.org/10.18103/mra.v11i214.Ryan, J., & Shoemaker, R. (2017). RNA-Seq on patients with chronicinflammatory response syndrome (CIRS) treated with vasoactiveintestinal peptide (VIP) shows a shift in metabolic state and innateimmune functions that coincide with healing. Medical Research Archives,4(1).15.REFERENCESALLERGY / IMMUNOLOGY /ENVIRONMENTAL / TOXICOLOGY ISSUE

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