keeping active patients on their feet

Magnesium: an athlete’s best friend P5Are your patients taking vitamin I? P9Treating plantar fasciitis P13

In this issue

Keeping active patients on their feet

ND NOTES A Practical Resource for Naturopathic & Integrative Practice

Spring 2016 | Vol 2 No. 1

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ND Notes | Vol 2 No. 1

chemistry class the notion of redox. It’s a short form for reduction and oxidation.

A redox (reduction-oxidation) reaction refers to the process of transferring electrons between two molecules. If a molecule loses an electron during this transfer, then it has been oxidized. If a molecule has gained an electron during this transfer, then it has been reduced.

Ubiquinone and ubiquinol are a redox pair, with ubiquinone being the oxidized form and ubiquinol the reduced form. Because ubiquinol has more electrons, it has more to give to free radicals. That’s why ubiquinol is a better antioxidant. On the flip side, the oxidized property of ubiquinone is the reason it is better suited for the energy metabolism inside your cells.

Both ubiquinone and ubiquinol have roles to play. But there's no need to prescribe both. The body smartly converts between the two forms automatically, depending which functions are in demand.

I always thought ubiquinone was the best form of CoQ10 until ubiquinol came along. What is CoQ10 exactly?Good question. Coenzyme Q10 (CoQ10) is a vitamin-like, fat soluble nutrient composed of one unit of benzoquinone and ten units of isoprene. It’s made by the body and found in every cell. In the bloodstream and lymphatic system, it is used as a potent antioxidant. Within individual cells and mitochondria, it is an important part of ATP synthesis, creating energy for cellular function

Incidentally, that’s why certain organs like the muscles, heart, kidneys and liver have a higher concentration of CoQ10 - they expend more energy.

What about ubiquinone and ubiquinol? What’s the difference between the two forms?You might remember from your high school

Q & A

ND Notes

Spring 2016 | Vol 2 No. 1

Editor Jennifer Hopf

Copy Editors Mary Calmes

Heidi Hoff

Contributors Adriana Restagno ND

Cecilia Ho ND Jamila James ND James Yoon ND

Janet Neilson Homeopath Tatiana Khoudiachova ND

Jenna Mangan CNP Rory Gibbons ND Cand 2017

Art Direction & Design Tina Amouzgar

Dorvan Davoudi Sophia Kim

Published by CanPrev and Orange Naturals

We believe naturopathic medicine should be safe, effective and accessible to all Canadians.

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The information provided is intended for the use of healthcare practitioners

and should not be used for diagnosing or treatment of a health problem, or as a

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ISSN 2368-7908

Message from the editor

Athletes are not your average patients. Their bodies represent their hobby, their passion, and quite often, their livelihood. They tend to have more uncommon needs compared to their less active counterparts, but are also typically more proactive when it comes to their health.

In this issue, we’ll explore the challenges and requirements of patients who live a more active lifestyle, along with ways you might approach assessment and treatment in your practice. We’ll take a look at trending topics like nutrient timing and fitness tracking, as well as weigh in on heavier issues, examining the risks of prescribing natural supplements to competitive athletes and the effects of taking ibuprofen prophylactically.

We’re also pleased to announce the 2017 CanPrev guide to natural medicine has arrived. See p. 42 to learn how to request a copy (or two). It’s an ideal resource for practitioners and patients alike!

Here’s to good health,Jennifer HopfEditor

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workflow of the kidneys and causes you to excrete water soluble vitamins like B and C a little faster.

Regardless of whether your patients are just drinking coffee or adding CanPrev Core to it, the risk of certain nutrient loss remains. If your patient is deficient in a particular nutrient or has osteoporosis, it’s best to avoid the combination. Or if your patients are really concerned about nutrient loss, you can simply recommend they top up with extra vitamins and minerals throughout the day, just in case!

So which should I prescribe? Is one form actually better than the other? We already know that the body converts CoQ10 molecules back and forth between ubiquinone and ubiquinol forms. So whether

your patient takes ubiquinone or ubiquinol CoQ10, one will be converted to the other and back again. Both forms have important health benefits.

However, taking ubiquinol instead of

ubiquinone may be a better option for some. Certain population groups like older patients, or people with a genetic variation in NQO1, may have trouble with reducing ubiquinone to ubiquinol.

A patient asked me recently: “I started adding two scoops of CanPrev Core to my morning coffee. Can you tell me if the caffeine might have a negative effect on the nutrients?” You may find this to be a common practice among your athletic patients who are looking for a caffeine boost before a workout, in addition to their nutritional shake. However, taking caffeine with vitamins or minerals can potentially interfere with their absorption and/or increase excretion.

For example, some sources claim that for every 150mg of caffeine ingested (about the amount in one cup of coffee) 5mg of calcium is lost - which isn't much, but it can be problematic if you have osteoporosis and also drink a lot of coffee. It's also thought that caffeine can inhibit the amount of calcium absorbed through the intestinal tract and deplete the amount retained by the bones.

Caffeine can interfere with iron absorption as well, though the effects are quite minimal at around 6% or so. Because coffee is a diuretic, it also speeds up the

SIMPLE REDOX REACTION EXAMPLE

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Coconut water: is it nature’s perfect sports drink?

Sports drink vs coconut water (8 oz. serving)

Beefing up a worthy opponent to commercial sports drinksAn easy way to overcome what is lacking in coconut water alone is to create a customized sports drink around a base of coconut water. This way you can have full control over your patient’s intake of electrolytes, without worrying about artificial colours or other nasty additives. This also gives you room to experiment with what works best for each patient.

What about plain old water?Depending on the intensity of the workout and the rate your patient’s nutrients are depleted, water may not be enough to replace lost electrolytes, sodium, potassium and carbohydrates. For instance, after running a marathon or participating in any vigorous endurance activity lasting longer than 60 minutes, an enhanced coconut water is the best option to rehydrate and replenish

Whether your patient is a casual gym-goer or an elite athlete, he or she is likely bombarded with the selection of sports drinks available today and may be wondering which option is right for them. More recently, coconut water is being viewed as an all natural, healthy replacement for traditional sports drinks. But is it really?

While coconut water certainly seems to be a cleaner sports drink and a much greater source of potassium, there are still a few shortcomings. When compared to commercial sports drinks, coconut water is lower in two of the main ingredients that an athlete’s exhausted system would need after a tough workout: sodium, the main electrolyte lost through sweat, and carbohydrates, which help replenish the body's spent energy stores.

So how can athletes get the benefits of a more natural sports drink that will still give their bodies what they need to recover after intense exercise?

A 2007 study by Ismail, Singh and Sirisinghe out of the University of Malaysia, showed that coconut water enhanced with sodium performed as well as a commercial sports drink in a post-exercise rehydration test, but with better fluid tolerance and less stomach fullness or upset.

ENHANCED COCONUT WATER MOCKTAIL

• 2 cups (480ml) coconut water

• ½ tsp sea salt

• 4 tsps honey, maple syrup or natural sweetener of your choice

• 1 large lemon or lime slice

Mix all the ingredients together well, pour into water bottles and keep chilled until you are ready to use. You can also add 1 tablespoon fresh mint, ½ cup fresh berries, half of an orange, or create your own custom flavour!

*The salt to sugar ratio is based on WHO’s recommendation of 3.5g of sodium per 100ml of water.

electrolytes. If your patient experiences white streaks or a gritty feeling on their face, this is an indication of sodium loss, which can be restored with an enhanced coconut water as well. If, however, your patient perspires heavily enough to soak through a t-shirt, a sports drink will not be enough to replace what’s been lost. The individual would need to consume a quick source of energy like a banana, dried fruit, pretzels or rice chips.

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An average person sweats between 0.8 to 1.4 litres of fluid per hour of exercise. Most endurance athletes might already be aware of the crucial vitamins they lose through sweat, but many non-competitive athletes may think it’s only water (and salt) they’re excreting through their pores.

Whether your patients are casual or professional athletes, it’s always good practice to remind them how important it is to replace water soluble vitamins like C and the range of Bs that their sweat carries out during intense training. Here are some ways to help your athletic patients restore important nutrients post-workout.

B vitamins play a role as coenzymes in the energy production of cells. Exercise appears to especially increase the loss of thiamin, riboflavin and vitamin B6. In fact, the body might need to take in twice the daily recommended amount of these vitamins to replace what the body sweats out through exertion.

In vitamin C’s case, multiple studies have found blood and plasma levels of vitamin C to be lower in those who exercise, since stores are used to combat exercise-induced oxidation in muscles and other cells, which is brought on by physical activity. Vitamin C also plays an important role in muscle growth, as it’s essential for building collagen, the connective tissue that helps repair tissues and tendons.

Research shows that vitamin C may even help reduce post-exercise pain and inflammation due to it’s ability to help repair the tiny tears in our muscle fibres that can result in muscle soreness and pain after workouts. Proper vitamin C supplementation both pre and post-workout can be effective in helping prevent deficiencies and promote faster muscle recovery.

Although there is evidence that exercise increases the demand for these vitamins, supplementation does not appear to have an enhancing or ergogenic effect.

Sweating it outWhy crucial vitamins need replacing after exercise

The general consensus among sports nutritionists is that most athletes and active individuals would be able to meet these increased nutrient demands by eating a balanced diet.

Individuals at greatest risk for exercise-induced vitamin deficiency are those following a low-fat or low-calorie diet, and those who don’t eat enough fruits, vegetables and whole grains. In these individuals supplementation of the above key nutrients to prevent deficiency is crucial.

Vitamins lost in sweat

Vitamin Concentration (mcg per 100 ml)

Thiamin 0-15

Riboflavin 0.5-12

Nicotinic acid 8-14

Pantothenic acid 4-30

Ascorbic acid 0-50

Pyridoxine 7

Folic acid (plus metabolites) 0.26

Source: Marriott, B. M. (1993). The Effect of Exercise and Heat on Vitamin Requirements

HOW TO DETERMINE SWEAT LOSS AND PROPER REHYDRATION

1. Measure body weight both before and after at least one hour of exercise under conditions similar to a competition or hard practice.

2. The difference between your pre and post-workout body mass measurement is your fluid loss. ex. Pre-exercise weight =74.5kg

Post-exercise weight = 72.8kgFluid deficit = 1.7kg

3. Estimate the weight of any fluid or foods you have consumed during the workout.ex. 800ml of fluid = 800g

4. Sweat loss = body mass before exercise (in kg) - body mass after exercise (kg) + weight of fluids/foods consumed (kg).

ex. 74.5-72.8 = 1.7kg deficit + 80kg= 2.5kg of sweat loss

5. The total amount of sweat or fluid loss will be a gauge as to how well you hydrated during the session and how much you need to rehydrate afterwards.

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tend to be most focused on their physical performance, activities like energy production and muscle strengthening tend to become more primary functions, leaving less magnesium available for secondary functions, like their immune system.

All of the additional demands athletes put on their bodies also makes them more susceptible to suppressed immune function, which can open the door to infection, most commonly of the upper respiratory tract. The study “Exercise, Magnesium, and Immune Function” (Laires, 2008) found a magnesium deficiency not only impairs the ability of the body to do physical work, but can also impair optimal immune function. Magnesium, the study suggests, has a strong bond within the immune system to both non-specific and specific immune function, and a magnesium deficiency can lead to “immunopathological changes” that trigger the body’s inflammatory response.

Greater staying powerEndurance athletes are especially prone to magnesium deficiency, as their stores can be quickly depleted when they work up a sweat or increase their energy output. Interestingly, taking magnesium supplements has actually shown improvement in cellular metabolism in competitive athletes (Golf et al, 1998). Saris et al (2000) reported that adults who participated in moderate physical training while supplementing with magnesium actually showed improved cardiorespiratory function during a 30-minute submaximal exercise test. Siebrecht (2013), in his review

As a health care professional, you’re likely well aware of how crucial magnesium is for normal cell function, as well as several metabolic processes. Canada’s Natural Health Products Directorate (NHPD) recommends a daily allowance of 20 to 500mg of magnesium per day for adults - this is the minimum amount required to avoid a deficiency. It is estimated that more than half of the population may, in fact, be deficient in magnesium, with some dietary surveys putting that rate up higher still to 70%.

However, athletes are not your average patients with typical magnesium requirements. For hard training or endurance athletes, the suggested daily amounts are between 400 and 800mg daily. There is emerging evidence that athletes have higher magnesium needs than people who may not exercise as much or as hard. Those who constantly push their bodies to the limit can ironically be lacking in one of the most important minerals they need to take their athleticism to the next level.

How athletes benefit Magnesium is used by athletes in these important ways:

• For energy production, first and foremost - athletes typically expend more energy and therefore require more magnesium.

• To be absorbed and utilized at a high rate by the nervous system during strenuous exercise.

• For assisting in the removal of accumulated lactic acid and fueling DNA repair enzymes, post-exercise.

• To replace what’s lost through sweat after intense exercise.

Even symptoms that many athletes typically accept as the hazards of hard training may actually be the result of a deficiency, which can be alleviated by magnesium supplementation. As athletes

Magnesium: an athlete's best friendHow to recognize and treat a deficiency

HOW MUCH MAGNESIUM IS IN THE HUMAN BODY?

20 to 28g (equivalent to almost one ounce or the volume and weight of one tablespoon of flax seeds or sesame seeds)

• 59% is in the bones

• 40% is in muscles and tissues

• 1% is in extracellular fluid

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WHY DO WE GET MUSCLE CRAMPS?

The reason muscle cramps occur is not that well understood. Exercise-induced muscle cramps may be related to neuromuscular fatigue and shortened muscle contraction (continued shortening through prolonged use prevents muscle from relaxing). They are also thought to be caused by dehydration and electrolyte loss – in particular, sodium and magnesium loss, in hot and humid conditions. This may be due to the fact that mineral losses through sweat are increased during long exercise periods.

of the safe supplementation of magnesium in human nutrition, echoes that research like this suggests a potentially beneficial effect of magnesium supplementation on muscle metabolism.

A study by Cinar et al (2007), concluded that exercise performance improved with magnesium supplementation in subjects that exercised 90 to 120 minutes, five days per week. It’s thought that magnesium works to increase red blood cell count and hemoglobin levels, allowing for greater oxygen distribution in the body. Magnesium plays an important role in increasing oxidative capacity, which in turn can enhance endurance training for your athletetic patients.

Recharge the ATP batteryATP, the compound that when broken down releases energy for cellular function, needs magnesium to work. Magnesium is crucial for energy metabolism because it activates enzymes known as ATPases, which are needed to generate ATP. When ATP is broken down, energy is released for all of the body’s muscle contractions. During strenuous exercise, this turnover is extremely rapid, meaning that ATP needs to be synthesized quickly - especially since the body cannot easily store ATP (and frequently what gets stored is used up within seconds). The body does this in two ways: through aerobic metabolism (with oxygen), used during endurance activities like

marathon running, and anaerobic metabolism (without oxygen), used during weight training.

Strengthening muscle with magnesiumThere is data suggesting magnesium levels in the body are indirectly related to strength improvement. A study published in the Journal of the American College of Nutrition measured the effects of a dietary magnesium supplement on strength development during a double-blind, seven week strength training program in 26 untrained subjects. Results showed that the oral magnesium supplementation group produced significantly increased strength outcomes than the control group. It has also been noted in research studies that maximal contraction of the quads is positively correlated to serum magnesium status (Stendig-Lindberg et al, 1983).

Magnesium is also used in the RNA process to create proteins. This type of protein synthesis depends on high magnesium concentrations, and it’s thought that low magnesium levels may adversely affect protein manufacture and metabolism. For the athlete, this results in lowered strength gains during workouts - not the payoff they’re looking for. This means athletes on high protein diets should also be advised to up their magnesium intake as well, in order to maintain adequate magnesium levels needed for protein synthesis.

Prescribing magnesium to your active patients You might think about prescribing magnesium to your more active patients or clients, if you’re not already. Helping them understand the underlying mechanics behind supplementation can help with compliance, perhaps more so than with other patients, as athletes already have a vested interest in their health and performance.

Remember, the most bioavailable form, magnesium bisglycinate, is best at a dosage of 400 to 800mg per day. Taking divided doses of 100 to 200mg at a time is recommended for maximizing absorption. Whether they prefer to take it in capsule, powder or effervescent drink form, the key to getting athletes in the habit of taking magnesium is to make it a convenient part of their workout regime.

Is it a magnesium deficiency?Here is a quick checklist to go over with your patients:

• Ask about symptoms:

Nausea

Vomiting

Anorexia

Muscle weakness

Muscle spasms and / or tremors

• Assess nutritional status:

Poor health

• Screen for health conditions:

Gastrointestinal absorption problems

Anorexia nervosa

Recent acute illness

Alcoholism

Diabetes

• Environmental conditions:

Very cold weather

• Medications / supplements:

Medications that interact with magnesium absorption

Supplements that interact with magnesium absorption

The more items checked off on this list, the more likely there is a deficiency in magnesium.

WHY MAGNESIUM BISGLYCINATE

Magnesium bisglycinate appears to be the safest and most effective form of magnesium for human absorption according to a magnesium research review published in the European Journal of Orthomolecular Medicine (Siebrecht, 2013). Magnesium bisglycinate is very stable, highly bioavailable and absorbed through a dipeptide channel in the intestine, so it doesn’t compete with other minerals like calcium. It also doesn’t bind or get excreted with dietary phosphates, phytates, oxalates, tannins or fibrous roughage.

Mg[Ne] 3s 2

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pain can be felt inconsistently depending on how and when the patient moves and where the pain is located.

The effects of chronic painIt’s important to mention that not all pain is bad. We need acute pain to act as a physiological warning sign. Chronic pain, however, which is often associated with inflammatory diseases like arthritis and cancer, is a more complex concept. The inflammatory response launched by a stressed nervous system creates a cascade of events that further harm our biological portfolio and change the chemistry of our tissues.

When tissue is damaged, nerve fibres are affected, too. The body is able to sense tissue damage when destroyed cells release chemical substances like prostaglandins and histamines, which adds to the stress load of our body’s biological terrain. Cells, membranes and enzymes are destroyed, basically creating disaster at a cellular level that affects our terrain, sometimes permanently. Biochemical individuality plays a huge role in chronic pain, and we all have a unique portfolio based on our past experiences that make pain subjective, and for the most part, healing methods as well.

It’s not just our lungs that can benefit from deep breathing Neuroanatomist Bud Craig developed a theory based on interoception, which explores whether internal organs and tissues have their own feelings that create sensations. He hypothesizes that since sensations travel from the body up to the brain through the vagus nerve, perhaps our organs can experience feelings of anxiety, stress, exhaustion and pain, too. If this is true, then maybe our organs and internal body can benefit from a deep breathing practice just as much as our minds would.

Researchers are now seeing proof of how deep breathing practices can have a restorative effect on a damaged or diseased nervous system, and how certain breathing techniques can actually kickstart the parasympathetic nervous system. Many ancient traditional forms of movement and meditative practices involve breathing, chanting or singing - techniques used for centuries to restore the nervous system by stimulating the vagal nerves through the breath. Identified as forms of resistance breathing, these methods act to slow the heart rate and lengthen the exhale, which in turn stimulates the parasympathetic nervous system.

What do belly breathing, alternate nostril breathing, singing, chanting, deep slow breathing (DSB) and other forms of resistance breathing all have in common?

Interestingly enough, incorporating one or more of these types of breathing at the first sign of pain can greatly help with providing relief. As a fitness guru, yoga instructor and Certified Nutritional Practitioner, I often come across clients who experience some degree of chronic pain every single day. As correlations are now being made between maladaptive biological memories and changes in tissue and nervous systems, as well as chronic conditions like fibromyalgia, PTSD and joint and nerve pain, the connection between breathing techniques and healing mechanisms are becoming more widely accepted.

Medical doctors, neuroscientists, sports therapists and health professionals everywhere are now discovering the immeasurable healing effects that deep breathing practices can have on clinical and ongoing chronic pain.

An inside look at painThe stress response that is activated when we experience trauma or stress for short or long periods of time can manifest sensations in the tissues and eventually in the nerves themselves. When this happens, allodynia, the term used to describe pain produced by an innocuous stimuli, rises. Wherever these changes in tissue occur, small fibres of the periphery nerves learn to respond to non-painful stimuli and perceive them as hurtful. We know that with chronic pain, the stimuli does not have to be present for pain to be felt. In the case of neurological pain, like shingles, multiple sclerosis, phantom limb pain, diabetic neuropathy and fibromyalgia,

Just breathe! Exploring the connection between deep breathing and pain management

Guest contributor: Jenna Mangan, Holistic Nutritionist, Certified Nutritional Practitioner, RNPA, Athletic Recovery, JOGA Trainer, 200RYT

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Since there is a synergy between the nervous system and breathing patterns, as well as the nervous system and hormonal and glandular functionality, it is likely that pain and other symptoms may appear and disappear according to one’s breathing practices.

Though further studies may be needed to explore the exact reasons why, current feedback from people who practice yoga, Tai Chi, kung fu, Qigong, meditation and other traditional methods of exercise that focus heavily on deep breathing techniques, say they are finding relief from their pain symptoms.

Your patient may feel relief from the release of muscle tension alone, even if the perception of pain may still be present. I often find that clients in this state welcome guided breathing practices that allow them to forget that they’re hurting.

As effective as taking a pill?We have endogenous mechanisms in our bodies that help us to manage pain, like our large peripheral nerves and our opioid systems, which involve endorphins. It’s

thought that deep breathing may have an effect on increasing one’s production of endorphins, which may help block nerve cells from releasing pain signals to the brain and provide some relief when experiencing acute or chronic pain.

Your patients may already use anti-inflammatory drugs, massage, acupuncture or hypnosis to help manage pain. Why not suggest deep breathing as well?

Breathe deep for best resultsDeep breathing results in greater oxygen and nutrient delivery because air is drawn deep into the pockets of the lungs, which is where the greatest amount of blood flow occurs. As a result, there may be an increase in energy levels and an improvement in stamina during physical activity.

There are also times when severe pain can bring on fatigue; short chest breaths from living in an anxious or fight-or-flight state can lead to the fatigue of ischemic tissue. When the breath is slowed and deepened, ischemia may disappear and blood supply may be restored. When tissue becomes less acidic, nutrients become more accessible, energy levels increase and the stress response system becomes more resilient, leaving the sufferer with less wear and tear on the body and an overall more flexible cardiovascular system.

Revisiting the ancient art of deep breathing to manage painThroughout history, many great healers focused on breathing techniques and realized the power that the respiratory system has on our health. Any dedicated yogi or yogini will point out the great difference between breathing and conscious deep breathing. Breathing deeply and consciously offers us a chance to seek clarity, be present, steady the mind, sway our perception, and heal by means of changing tissue pH at a cellular level, thereby decreasing inflammation and restoring balance to our nervous systems.

Skeptics may say that we have been breathing our whole lives and techniques such as diaphragmatic breathing or Lamaze breath act simply as distractions. Even if it is merely a distraction, anyone in real pain will tell you that even if nothing happens at a cellular level to repair and

JENNA’S FAVOURITE BREATHING EXERCISE

I enjoy Nadi Shodhana, an alternate nostril yoga breathing practice designed to increase the flow of prana (breath). It acts to balance the two hemispheres of the brain and help increase the flow of breath while reducing heart rate and purifying the subtle energy channels of the body. The hands are placed over alternate nostrils in Mrigi Mudra (healing mudra) while breath moves in and out.

heal the root cause, it’s still better to participate in the breathing exercise rather than focus on the pain.

It’s also interesting to note that babies, whose brains and emotional and cognitive abilities haven’t yet fully developed, breathe more deeply than adults. They’ve got the hang of deep breathing, naturally!

A simple deep breathing exercise for your patients Here’s an extremely simple breathing technique that can be done almost anywhere:

Take a large, exaggerated breath from deep in the belly. Count to five, inhaling through the nose and count to five again on the exhale, blowing out through the mouth. Try to lie in a supine position, if possible. Complete five sets, five to 10 times a day for best pain relief results.

Encourage your patients to experiment with different breathing techniques alongside a qualified healthcare professional. There are a wide range of practices offered, so suggest they find one that’s comfortable for them and prescribe it as a daily ritual.

Deep breathing not only brings relief from mental, emotional and physical pain, but can also improve mental and physical performance, increase blood flow and reduce tension in the body and mind.

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Are your patients taking vitamin I?

In addition to supplements and protein shakes, your proactive athlete patient may also be popping ‘vitamin I’, or ibuprofen, as part of their regimen. Inflammation can slow down training and affect their overall performance, so many athletes wind up taking ibuprofen prophylactially to guard against it. But should athletes really be using this NSAID as a training aid?

Since ibuprofen is so widely used among athletes, it might be interesting to examine if their reliance on it actually helps or hinders their performance.

Even with a prevalence of around 90% in certain sports, this certainly does not mean ibuprofen is the key to success. Research shows that while non-steroidal anti-inflammatory drugs (NSAIDs) are very good at their job as pain-relievers and anti-inflammatories, they can have detrimental effects on skeletal muscle tissue and tissue in the gastrointestinal tract.

Ibuprofen mechanism of actionsIbuprofen is an NSAID, which carries analgesic (pain-reducing) and antipyretic (heat-reducing) properties. The exact

mechanism of action of ibuprofen is unknown, however ibuprofen is postulated to be a non-selective inhibitor of the multi-form enzyme cyclooxygenase (COX). This enzyme is a key player in the synthesis of prostaglandins (inflammation modulators) via a specific metabolic pathway (see diagram). It acts to inhibit cyclooxygenase-1 and cyclooxygenase-2 enzymes, which in turn dampen protective prostaglandin synthesis and inflammatory prostaglandin synthesis, respectively. The antipyretic effect of ibuprofen is believed to occur at the level of the hypothalamus, which is the centre in the brain that controls our body’s temperature. NSAID drugs will bind to receptors in the hypothalamus, resulting in a dissipation of heat via changes in blood flow to heat outlets like our skin.

Since ibuprofen does not have the ability to block one COX enzyme without blocking the other, taking this drug can have a negative impact on areas that are not necessarily targeted for pain-relief, such as the intricate lining of our gastrointestinal tract. As a result, it is considered “non-selective”, when compared to other anti-inflammatory medications.

Guest contributor: Rory Gibbons, BSc, Kin, ND Cand 2017

Ibuprofen is thought to be a non-selective inhibitor of cyclooxygenase. Although it does suppress pain caused by inflammation, the absence of gastric mucosal protection can cause gastrointestinal issues from prolonged use.

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The effects on skeletal muscleDelayed onset muscle soreness (DOMS) is a phenomenon that will occur 24-72 hours following progressive exercise (exercise that occurs at a higher and/or longer duration than the athlete’s usual exercise regime) and is frequently the reason why athletes take ibuprofen before exercising. However, taking ibuprofen prophylactically to eliminate pain is only providing a disservice to the body’s healing process.

Research has shown that levels of pain and ratings of perceived exertion do not differ if the athlete takes ibuprofen prophylactically or not at all, given the same exercise. This particular study also showed that there were higher levels of inflammatory markers present in the athletes taking ibuprofen, indicating an additive effect of injury (the type of injury was not specified).

Pain and inflammation are the body’s response to damage from trauma (accidental trauma or athletic training) or disease (ex. Crohn’s, ulcerative colitis, cancer, etc). Taking ibuprofen will dampen pain and inflammation and potentially lead the athlete to injuring already damaged tissue more. Once that pathway is down, pain will no longer let us know when to stop.

Much like we sense pain, we respond to increased stress and adapt to it. Inflammatory enzymes (specifically cyclooxygenase-2) and prostaglandins are integral in the responsiveness and adaptation

of connective tissue to mechanical stimuli, and if they are not present then injured tissue may be predisposed to further injury. Prophylactic ibuprofen use may also inhibit skeletal muscle from adapting to prolonged endurance activity, by blocking the production of new blood vessels and collagen in the active tissues. Furthermore, ibuprofen’s inhibitory effects may slow the synthesis of collagen, the foundation of connective tissue strength. Continually taking ibuprofen preventatively may reduce the rate of collagen production and subsequent tissue repair following exercise and/or injury.

The effects on the gutIbuprofen has a damaging effect on muscle, but it does not just stop there. It is common knowledge that “ibuprofen wrecks the gut”. Studies of endurance athletes have shown that 50-80% report upper and lower GI manifestations, most commonly heartburn and diarrhoea.

But why? Our body is smart when it comes to blood flow, giving needy muscles nutrients by increasing blood flow in their direction. During periods of exercise, blood will be shunted towards the tissue that is most in need, such as the skeletal muscles putting in the time and effort. However, this happens to the detriment of tissues the body deems “less important” at the time, such as gastrointestinal tissue. If this state of blood flow continues for a prolonged time, the tissue can become ischemic and damaged. Keep in mind this is what happens when the body is functioning without any additional substances, such as ibuprofen.

Research now indicates that ibuprofen exacerbates exercise-induced intestinal injury significantly, increasing permeability of the stomach, duodenum and the rest of the small intestine. The increased spacing between the gut cells allows potentially threatening pathogens into the bloodstream and elicits stress on the immune system.

The gut damage may even have an inhibitory effect on the absorption of nutrients post-exercise, thus impeding recovery. The hypothesis of pathogens/digestive enzymes permeating the gut lining and the absorptive capacity post-exercise has not yet been fully investigated and warrants further studies.

Taking ibuprofen prophylactically may block the production of collagen, the foundation of connective tissue strength.

Four other ways to address painSo now that we have discussed how ibuprofen eliminates pain/inflammation and can amplify damage to skeletal muscle and our gut lining during exercise, what are some tactics for patients to eliminate pain before, during and after exercise?

1. Determine the cause of the pain.

Pain can be a result of a whole host of issues. Poor biomechanics can cause damaging repetitive use of muscles and ongoing damage of passive structures in joints, such as ligaments and meniscus. If we can work with the athlete to move more efficiently (for instance, improve gait patterns by consciously using different muscles), there will be less stress on the joints and musculature.

Stretching out tight tissues and strengthening unbalanced muscles will also help immensely in joint/muscle function, leading to less pain. Often athletes (more specifically newer athletes) will begin their pursuit of competition at a level that is too advanced, at a speed that is too fast. This can be a shock to their body, which may not be able to adapt to the sudden increase in training, causing a higher inflammatory response - and in turn higher levels of pain.

The failure to adapt may also result in injury, and therefore, pain and inflammation. In order to prevent this from happening, the athlete needs to follow a graduated training program that outlines proper overload and appropriate recovery techniques, facilitated by a person who understands human physiology and movement.

Sometimes mental/emotional trauma can cause an exaggeration of pain. This may not be obvious at first, so taking a thorough history and exploring the mental/emotional facets of the patient’s life is necessary. Once those issues are dealt with, pain may be more easily managed or even disappear completely.

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2. Support/control the inflammatory process.

A common misconception in the world of sport is to completely suppress inflammation, by taking anti-inflammatory products like ibuprofen and using methods like icing, following exercise and acute injury. There are times to allow the natural inflammatory process to proceed healing and there are times to suppress it. Because of this, every situation needs to be assessed for severity, progression and duration of pain/inflammation. For more information on supporting and controlling the inflammatory process, please refer to Notes on natural anti-inflammatories, p.12.

3. Don’t neglect cool-down!

We can break down the act of athletic exercise/competition into three phases: warm-up, competition and cool-down. It is common to see a thorough warm-up phase (foam rolling, dynamic stretching, etc.), a 100% effort during the competition phase, and then a brief or

absent cool-down phase.

So why is this? It could be due to lack of energy following competition, too many distractions or simply ignorance to the importance of a proper cool-down. A cool-down usually consists of, but is not limited to, much lighter exercise (10-15% of competition), followed by stretching and/or soft tissue work, like massage or foam rolling.

A cool-down does not have to be long! Continuation of light exercise will help to sustain blood flow to active tissues, clearing out leftover toxins, such as lactate and other metabolic by-products. It can also prevent pooling from the sudden stoppage of the muscle-blood pump that is the skeletal muscle. However, we cannot forget the hardest working muscle of them all, the heart. Light exercise following hard exercise helps the heart lower its workload gradually instead of suddenly, as if the athlete stopped moving after a sprint to the finish line. Ten to 15 minutes of light

exercise similar to competition is enough time to help the body start to wind down from hard work.

4. Stretch.

During exercise, tiny micro-tears occur in active musculature and once exercise stops, repair of that tissue begins. A simple regime of post-exercise static stretching of the major active muscles will facilitate repair by realigning muscle fibres and preventing contracture of tendons. Partaking in a regular post-exercise stretching routine will also help to maintain long-term elasticity in the muscle tissue that will translate to lower levels of pain during exercise and lower levels of delayed onset muscle soreness.

To get the most out of a post-exercise regime, recommend a professional who can develop a personalized stretching routine for the patient and can physically show them how they should be moving throughout it.

DANGERS OF DEHYDRATION

Roughly 75% of our body is made up of water and even the slightest change in levels can cause problems. Dehydration upsets mineral balance, slows enzymatic activity, causes toxins to accumulate more easily and affects your lungs and breathing, just to name a few. Don’t wait until you’re thirsty before getting up to get a glass of water. By then you’re already dehydrated.

LABEL THE WATER BOTTLE

Label a clear water bottle with different times, indicating 250ml (about one glass) of water for each one hour interval. When it’s the time marked on your bottle, your water should be at the same level. It’s a great visual reminder to make sure you’re drinking enough water throughout the day.

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Notes on natural anti-inflammatories

Patients relying on the daily use of ibuprofen could be presented with the following alternatives instead. With the exception of boswellia, all of these natural anti-inflammatories are considered safe enough for long-term use.

This can be used as a refresher on the safety of natural anti-inflammatories commonly prescribed by naturopathic doctors, and as a handy tool to help patients understand why it is critical they let their health care providers know about all the medications and supplements they are taking.*

Bromelain Great for: Pain due to inflammation, when taken away from meals. Can be very useful to treat acute swelling due to trauma and surgery.

Word to the wise: May cause gastric upset, diarrhoea, chest pain and increased heart rate. People who are allergic to latex or pineapple should not use bromelain. Discontinue bromelain two weeks before a surgery.

Boswellia serrata Great for: Osteoarthritis and rheumatoid arthritis. May see improvement of symptoms within 7 days of treatment.

Word to the wise: May cause nausea, epigastric pain, diarrhoea and acid reflux. People who have autoimmune conditions should take boswellia with caution because of its immunostimulant properties. Not safe for long-term use.

Ginger root Great for: Rheumatoid arthritis, osteoarthritis and nausea. Ginger can also be effective on reducing the symptoms of vertigo.

Word to the wise: It is generally well tolerated, but people with bleeding disorders, diabetes or heart conditions should take ginger with caution because it might increase their risk of bleeding, cause hypoglycemia, and decrease heart rate and heart muscle contraction.

Green tea extract Great for: Inflammation. Gargling green tea can be used to help prevent colds and flus. Topically, green tea can be used as a poultice to help reduce bags under the eyes from tiredness.

Word to the wise: People should take this with caution if they have iron deficiency, anxiety, cardiac arrhythmias, diabetes, glaucoma or osteoporosis, because it might promote cardiac arrhythmias, impair glucose metabolism, increase intraocular pressure, and may also increase urinary excretion of calcium.

CurcuminGreat for: Osteoarthritis and rheumatoid arthritis. Did you know that curcumin, which is found in the spice turmeric, can be used in foods, textile dyes and cosmetics to add vibrant colour?

Word to the wise: Although it is generally well-tolerated, people with gallstones, bleeding disorders, diabetes or hormone-sensitive cancers should take curcumin with caution because it might cause gallbladder contractions, decrease blood glucose, and have mild estrogenic effects. Discontinue curcumin two weeks before surgery.

Holy basil Great for: Arthritis, immunomodulation and inflammation. Holy basil can be applied topically to treat ringworm.

Word to the wise: It may cause prolonged bleeding time, so people on anticoagulant supplements, medications or herbs should take holy basil with caution. Discontinue two weeks before surgery.

Resveratrol Great for: Pain and inflammation. Can be used to help increase HDL cholesterol levels.

Word to the wise: Patients with hormone-sensitive conditions should not take this because of its possible estrogenic effects. Discontinue two weeks before surgery.

RosemaryGreat for: Musculoskeletal pain, gout and sciatica. Can be used in combination with other essential oils to treat alopecia areata. Word to the wise: People with an allergy to aspirin or bleeding disorders should take rosemary with caution because it has salicylates. People with seizure disorders should not take rosemary. because it might increase the likelihood of having a seizure.

Stinging nettle

Great for: Osteoarthritis and allergic rhinitis. Can be used both orally and topically for osteoarthritis.

Word to the wise: Stinging nettle is generally well-tolerated, but people with diabetes, hypotension or renal insufficiency should take this with caution because it is a diuretic and might cause hypoglycemia and low blood pressure.

* Always refer to the most up-to-date safety data concerning pregnancy and lactation before recommending any supplement or botanical. All information has been sourced from Natural Medicines (the former Natural Standard database) https://naturalmedicines.therapeuticresearch.com

Plantar fasciitis is especially common in people who run. Distance runners and sprinters should be especially vigilant of the following:

• Excessive training or increased activity

• Poor fitting footwear

• Running on unyielding surfaces like concrete

• Flat feet (pes planus)

• High arches (pes cavus)

If left untreated, plantar fasciitis can develop into heel spurs from repetitive trauma to the affected tissues. A heel spur, or calcification near the attachment point of the plantar fascia, is easily diagnosed with an X-ray.

Home care treatmentThere are plenty of things a patient can do on their own to help alleviate plantar fasciitis symptoms.

Rest If you suspect that a patient’s foot pain is being caused by plantar fasciitis, suggest they limit athletic activities and get a lot of rest to help ease symptoms. You might also recommend avoiding excessive and repetitive movements that cause impact to the heel specifically, but at the same time emphasize that activity should not be stopped completely. No foot movement at all can cause the plantar fascia to stiffen up and pain symptoms to return.

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Don’t let plantar fasciitis knock you off your feetTips and treatments for healing heel pain

Distance runners and dancers suffer from it. So do cashiers and those who wear worn out shoes. Plantar fasciitis, the painful foot condition that centres on the heel is one of the most common causes of foot complaints in adults.

SymptomsHow can you tell if your patient is suffering from plantar fasciitis and not just typical foot pain? The most common symptom of plantar fasciitis is pain near the inside, or medial aspect, of the heel and sole of the foot. It might be felt first thing in the morning upon getting out of bed as the feet hit the floor or getting up out of a chair after sitting for a period time. Even movements that stretch the plantar fascia, like extending the big toe or ankle dorsiflexion can cause a sufferer to wince in pain. While walking or slowly jogging might lessen the pain as the heel warms up, the relief is only temporary and will return again once activity stops.

Risk factorsPeople who play a lot of sports, who work at a job that requires a lot of walking on concrete or hard floors, or who are always on the go are more likely to develop plantar fasciitis than those with sedentary jobs or who spend more time on the couch than the basketball court. Running, marching, dancing and jumping are some activities that can trigger or make plantar fasciitis worse.

Achilles tendon

Plantar fascia

Even carrying a few extra pounds, standing stationary for long periods of time, or having decreased ankle flexibility can increase the risk of an irritated fascia.

If you treat a lot of active individuals in your clinic, you may have come across plantar fasciitis, or an irritated plantar fascia.

Plantar fascia is the thick band of connective tissue that starts at the heel bone and fans out to the toes on the bottom, or plantar, surface of the foot. It acts as a support mechanism, holding the bones and muscles of the foot steady while it’s in motion, or even standing still. The term “fasciitis” simply means the fascia is injured.

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Icing You may want to recommend your patients apply an ice pack to the area for up to 20 minutes four times a day to help relieve pain and discomfort. Gentle massage and a few minutes with an ice pack just before exercising can also be an effective treatment method.

Protective footwearCushion-soled shoes, arch supports, gel pad inserts or heel cups may do wonders for providing temporary pain relief. Silicone inserts are likely to provide better support than felt pads or rubber heel cups. Pharmacies that specialize in orthopedic supplies often carry splints that are worn overnight, and work by placing the foot in a position that provides pain relief and a gentle stretch at the same time. Wearing supportive shoes or sandals indoors can also be helpful, especially after getting out of bed first thing in the morning. Though it may seem comfortable to your patients and feel like it’s providing relief, remind them that walking barefoot may cause pain symptoms to return or worsen, even if floors are carpeted.

Rehabilitation exercises Stretching and strengthening exercises may be helpful, but remind patients to ease into them slowly and with care to avoid causing more pain. Home exercises include the calf-plantar fascia stretch, foot/ankle circles, toe curls and toe towel curls, as illustrated here.

Calf stretch exercise - Sit with legs straight out and loop a towel around the foot. Gently pull the top of the foot towards the body. Hold for 10 to 30 seconds. Complete a set of 5 and aim for 2 sessions a day. Modify this exercise by pushing the ball of the foot against the towel, which also effectively strengthens the foot muscles.

Supplies

2 basins or tubs for feet Hot water

Bath thermometer

Cold compress for head

Towels Cold water

Foot/ankle circles - While sitting, rest one leg on a chair keeping the other foot on the floor and alternately point and flex the raised foot 15-20 times.

As part of the same session, make small circles with the foot by rotating the ankle. Complete 2-3 sets by rotating clockwise 15 times and then reverse for another 15 times.

Toe curls - Standing on a thick book, curl the toes over the edge and then straighten. Complete as many repetitions as possible within a 2 minute period, twice a day.

Toe towel curls - Curl toes around a towel then grip and release for 1 to 2 minutes, twice a day.

Hydrotherapy - alternating foot bathAlternating hot and cold foot baths can be extremely helpful with reducing pain and increasing circulation to speed healing.

Contraindications: Do not use alternating hot and cold foot baths in patients with cancer, vascular disease (including diabetes), diminished sensation or hemorrhage.

Caution: Always finish with a short cold bath, except for those with rheumatoid arthritis, whose condition is aggravated by cold. End treatment with a warm bath in this case instead.

Directions

1. Prepare a tub of hot water at a temperature of 40 to 43ºC. Do not exceed 49ºC.

2. Prepare an alternate tub of cold water at a temperature of about 7ºC.

3. Immerse feet in the tub of hot water for 3 minutes.

4. After 3 minutes, change feet to cold foot bath and immerse for 30 seconds.

5. Make 3 complete changes between the hot and cold tubs (3x-hot/3x-cold).

6. Always start the treatment with the hot bath and finish with the cold.

7. If the patient starts to sweat, place a cold compress on the forehead.

8. Dry feet thoroughly and let the patient rest on a bed for at least 30 minutes before going home.

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Side notes:

• Add hot water to the hot tub if the temperature falls below 4ºC.

• The greater the temperature difference between the hot and cold water, the stronger the treatment.

In-office therapiesThe following is a list of plantar fasciitis treatment options you might try with your patients.

Nutritional supplements Vitamin C is the key for initiating connective tissue repair. A deficiency can result in decreased tensile strength of fibrous tissues, like those found in the plantar fascia. Recommended dosage for the purpose of tissue repair is 1 to 3g daily.

Zinc is an important factor in tissue regeneration and repair and works together with vitamin C to increase the tensile strength of wounded tissue. In fact, animal studies show that zinc deficiency is a contributor in delaying wound healing. Patients with chronic injuries, high stress levels, or those who exercise at an intense level are at an increased risk for zinc deficiency. A daily dosage of 15 to 30mg is recommended to help to speed healing.

Fish oil is rich in the omega-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and has been found to be a factor in suppressing the production of inflammatory mediators. In a double blind, placebo-controlled study of 49 patients with rheumatoid arthritis, those who supplemented with fish oil for 24 weeks showed less morning stiffness and fewer tender joints than the control group. Recommended dosage is 2 to 3g daily, but may require two to six months to take full effect.

Soft tissue or manual therapyIn many plantar fasciitis cases, manipulation of the soft tissue can provide a measure of relief to sufferers. Through observation and palpation, aim to lengthen the tightened areas between each of the points that support the arches: the heel, the first metatarsal head and the fifth metatarsal head. Work your way posteriorly and loosen

UB 56 (Chengjin)

UB 57 (Chenshan)

the Achilles tendon and the muscles attached to it, including the soleus and gastrocnemius muscles. Instrument-assisted therapies, like Graston, Fibroblaster and Gua sha, are also helpful tools to break down scar tissue, adhesions and fascial restrictions.

Sports medicine acupuncture - motor point locationsThough acupuncture is often recommended as an effective treatment for plantar fasciitis, most positive reports have only been anecdotal. Research regarding acupuncture's efficacy shows promise, though. In a study that documented the treatment of 11 patients with acupuncture and electrical stimulation, most indicated improved overall pain scores.

A motor point is typically located in the central aspect of the muscle. This sensitive area has a strong influence on pain management, and is also helpful in strengthening and increasing the range of motion of the treated muscles. In Traditional Chinese Medicine, these are known as Ashi points, or trigger points, in other health circles. The following are muscles that may relate to the plantar fascia, and therefore can be helped with acupuncture therapy or electrostimulation to relax the tightened and/or contracted muscle tissue.

Tibialis posteriorLocation: 1 cun medial to the point between UB 56 and UB 57

Insertion: Oblique needle insertion 1 to 1.25 inches directed towards the centre of the calf

Caution: Posterior tibialis artery and nerve

Head of fibula

SP 8 (Diji)

SP 7 (Lougu)

Soleus - 3 pointsLocation 1: 3 cun inferior to head of fibula, on the posterior border of the fibula

Insertion: Perpendicular needle insertion with a depth of 0.5 to 0.75 inch

Location 2: 1 cun posterior from SP 8

Insertion: Perpendicular needle insertion 0.5 to 0.75 inch

Location 3: Halfway between SP 7 and SP 8


K2 (Rangu)

Abductor hallucis longusLocation: Kidney 2


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Tape support Taping the affected foot with a technique known as low-dye taping may bring some relief to plantar fasciitis sufferers. Four strips of tape are applied as shown below. Caution against applying the tape too tightly and switch to hypoallergenic tape for patients who have adverse reactions to regular tape.

UB 58 (Feiyang)

UB 59 (Fuyang)

SP 7 (Lougu)

1 2 3 4

Flexor hallucis longusLocation: Halfway between UB 58 and UB 59

Insertion: Perpendicular needle insertion 1-1.5 inch

Flexor digitorum longusLocation: SP 7

Insertion: Perpendicular needle insertion 1 inch

Directions

1. Wrap a strip of tape around the ball of the foot.

2. Wrap a second strip of tape around the heel, starting just below the pinky toe, around either side of the heel and back up to the first strip of tape.

3. Wrap a third strip of tape around the heel, starting just below the pinky toe, as in step 2. This time, circle the heel and wrap the tape in a criss-cross fashion, so that it ends just below the big toe.

4. Repeat step 3. The tape does not need to align perfectly and can stay in place for up to one week.

Other options for treating plantar fasciitis If your patient has not noticed an improvement with the above recommended treatments, you may wish to try some of these alternatives:

Pain medication - A short course of a nonsteroidal antiinflammatory drug (NSAID) like ibuprofen can be helpful to relieve pain. However, these types of medications have many possible side effects. It might be a good idea to discuss the potential risks versus benefits with your patients.

Steroid injection - An injection of a steroid (glucocorticoid) medication into the foot may relieve pain, though the effect may wear off after only a few weeks.

Casting - A walking cast with a rocker-shaped bottom allows the foot and ankle to be in an optimal position for pain relief and healing for the duration of treatment.

Plantar fasciitis is a common foot condition that can thankfully be managed using many different approaches. As a practitioner, you may already be using some of the options suggested here, or perhaps you have learned some new treatments you might implement in your office or suggest as at-home protocols. Having a hand in getting runners back on track, dancers back up on their toes and people back to their physically demanding jobs is certainly a satisfying and rewarding end result for practitioners - and a huge relief for sufferers.

INSIDE A PULLED MUSCLE

A strained muscle occurs when muscle fibres or attaching tendons are overstretched or torn, typically resulting from overuse, fatigue or improper form. A pulled hamstring (the muscle group behind the thigh that flexes the knee) is common among athletes, especially runners.

17


To ice or not to ice?Read why Shayne Glass-Smith recommends heat for an acute injury

Do you recommend your clients ice an acute injury or not?It's standard practice to recommend clients use ice anywhere up to 48 hours after an injury and anytime they feel inflammation. Personally, I don't follow this practice and neither does the gentleman who created the acronym RICE, Dr. Gabe Mirkin.

In an athletic injuries course that I took at the University of Western Ontario, the following rationale was given. When an injury occurs, metabolites involved in healing are released, which impede the flow of blood, oxygen and nutrients to the site of injury. That same tissue is "starving" for oxygen and if it doesn't get it, the tissue will die or will be severely injured for the long haul.

My thinking (some of which evidence is now supporting) is as follows:

• Inflammation is critical to the healing process, so by icing you're actually impeding that process.

• If a tissue is starving for oxygen after damage, why wouldn't you increase the oxygen supply by promoting blood flow to that area? Heat promotes blood flow; therefore promoting oxygen and nutrients to the damaged tissue.

• Muscles shorten in cold ( just as humans shiver and curl up to stay warm) and so any tearing or straining might be exacerbated by applying cold.

I believe that icing became popular for two reasons:

• Professional sports: In any given sports season, there are a number of games that an elite athlete has to be ready to play. By icing the area, the athlete temporarily achieves enough comfort to complete the game and ultimately finish out the season, before taking care of the rehabilitation thoroughly in the off-season.

• Discomfort: Swelling is incredibly uncomfortable and so icing helps to temporarily relieve that discomfort, but it does not help the healing process in any way.

For the long-term it would be much better - and I think we'll see it come out in literature in the next few years - to heat the injured area. Allowing continuous blood flow through the application of heat will reduce the seizing or shortening of muscles that would make them more difficult to reattach, should there be a tear or strain of any degree. The application of heat also allows the damaged tissue to be flushed out, while replacing it with oxygen and nutrients resulting in new, healthy tissue!

Shayne Glass-Smith, B. Kin (Hons.)Shayne Glass-Smith earned his Honours degree in Kinesiology from Western University in 2009. Since then, he has worked at several physiotherapy clinics in London, Ontario and Toronto, Ontario. He currently lives in Edmonton, Alberta and is working toward becoming a physiotherapist. Shayne has a true passion for the health, wellness, fitness and care of athletes and the general population. In his spare time, he enjoys playing basketball, volleyball and weightlifting. He is continually increasing his knowledge on health and fitness by reading current health and medical literature.

BRUISING EXPLAINED

A bruise occurs when injury to soft tissues causes the underlying capillaries to break and leak red blood cells. Hemoglobin in red blood cells then breaks down to bilirubin and biliverdin byproducts, which give bruises their black, blue and yellow hues.

18


Featured productsHere are a few key remedies that you might find helpful to keep in your dispensary, along with their suggested uses.

CanPrev Core for Women & MenRecommended to help restore the immune system and boost energy levels. Formulated with easy-to-digest plant proteins and antioxidants from greens and berries, along with complete multivitamin and essential nutrients, and developed specifically for women’s and men’s health.

Directions: Adults - Add 2 rounded scoops (40g) to 250ml of your favourite beverage and shake well. For a delicious smoothie, blend with a ½ cup of fresh or frozen fruit. Enjoy everyday for optimal health!

Complete Nutrition for Men & Women2 rounded scoops (40g) contain:

Plant Protein Blend ........................................................ 18gYellow pea protein (pisum sativum) ......................................... 13g

Brown Rice Protein (oryza sativa) ................................................. 5g

Greens Blend .................................................................... 4g Beet root (beta vulgaris) .................................................... 900mgBroccoli (brassica oleracea var. italica) ............................750mgParsley leaf (petroselinum crispum) ................................ 725mgKale (brassica oleracea var. acephala) ............................. 525mgSpinach leaf (spinacia oleracea) ...................................... 500mgAlfalfa leaf & stem extract (4:1, medicago sativa) ......... 125mg Chlorella (chlorella vulgaris, broken cell) ........................ 100mg

Superfruit Blend .............................................................. 1g Cherry fruit (prunus avium) ............................................... 250mgBlueberry fruit (vaccinium corymbosum) ...................... 200mg Goji fruit juice (lycium barbarum) .................................... 200mg Mangosteen fruit (garcinia mangostana) ....................... 150mgAcai fruit extract (4:1, euterpe oleracea) .......................... 50mg

CanPrev Core For Women Nutrients specific to women’s health:Cassia cinnamon bark extract (4:1, Cinnamomum aromaticum) . 750mg

Cranberry fruit extract (40:1, vaccinium macrocarpon) .. 300mgElemental calcium (citrate) ............................................. 250mg

Women’s MultiVitamin A (acetate) ........................................................... 1,250IUBeta-carotene (natural) ...................................................... 500IUVitamin C (ascorbic acid ) .................................................... 50mg Vitamin D2 (ergocalciferol) .............................................. 1,000IU Vitamin E (d-alpha) ................................................................. 25IU Vitamin K1 (phytonadione) ............................................. 120mcgVitamin B1 (thiamine hydrochloride) .............................. 12.5mg Vitamin B2 (riboflavin) ...................................................... 12.5mg Vitamin B3 (niacinamide) ................................................. 12.5mgVitamin B5 (calcium pantothenate) ................................ 12.5mg Vitamin B6 (pyridoxine hydrochloride) .......................... 12.5mg Vitamin B7 (biotin) .............................................................. 25mcg Vitamin B9 (folic acid) ...................................................... 200mcg Vitamin B12 (methylcobalamin) ..................................... 125mcgCholine (bitartrate) ................................................................. 5mg Inositol ...................................................................................... 5mgLutein (marigold) .................................................................. 1.5mg Elemental Chromium (polynicotinate) ........................... 45mcg Elemental Copper (citrate) ............................................ 500mcgElemental Iodine (brown kelp) ....................................... 100mcgElemental Magnesium (bisglycinate) ............................. 110mg Elemental Manganese (citrate) ........................................ 1.5mgElemental Molybdenum (sodium molybdate) ............ 100mcgElemental Potassium (citrate) ......................................... 100mg Elemental Selenium (selenium yeast) ............................ 50mcg Elemental Vanadium (vanadyl sulfate) ........................... 15mcg Elemental Zinc (citrate) ......................................................... 5mg

CanPrev Core For MenNutrients specific to men’s health:Cassia cinnamon bark extract (4:1, Cinnamomum aromaticum) 750mgCoenzyme Q10 ....................................................................... 30mgLycopene ............................................................................... 6.5mg

Men’s MultiVitamin A (acetate) ............................................................ 1500IU Beta-carotene (natural) ...................................................... 600IUVitamin C (ascorbic acid) ..................................................... 60mg Vitamin D2 (ergocalciferol) .............................................. 1,000IUVitamin E (d-alpha) ................................................................. 30IU Vitamin K1 (phytonadione) ............................................. 36mcg

Vitamin B1 (thiamine hydrochloride) ................................. 15mg Vitamin B2 (riboflavin) ......................................................... 15mg Vitamin B3 (niacinamide) .................................................... 15mg Vitamin B5 (calcium pantothenate) ................................... 15mg Vitamin B6 (pyridoxine hydrochloride) ............................. 15mg Vitamin B7 (biotin) .............................................................. 30mcg Vitamin B9 (folic acid) ...................................................... 240mcg Vitamin B12 (methylcobalamin) ..................................... 150mcg Choline (bitartrate) ................................................................. 6mg Inositol ...................................................................................... 6mgLutein (marigold) .................................................................. 1.8mg Elemental Calcium (citrate) .............................................. 200mgElemental Chromium (polynicotinate) . .......................... 45mcg Elemental Copper (citrate) ............................................ 500mcgElemental Iodine (brown kelp) ....................................... 100mcgElemental Magnesium (bisglycinate) ............................. 110mg Elemental Manganese (citrate) ........................................ 1.5mgElemental Molybdenum (sodium molybdate) ............ 100mcgElemental Potassium (citrate) ......................................... 100mgElemental Selenium (selenium yeast) - ........................... 50mcg Elemental Vanadium (vanadyl sulfate) ........................... 15mcg

Elemental Zinc (citrate) ......................................................... 5mg

Vanilla non-medicinal ingredients: psyllium husk powder, apple pectin, inulin, guar gum, natural green tea flavour, natural french vanilla flavour, natural vanilla flavour, xylitol, organic stevia.

840 g

ND’s Note: I recommend CanPrev Core to most of my active patients as a post-workout supplement. Single serve pouches are easy to travel with. You can also sprinkle the protein powder on oatmeal or yogurt, or use in baking. Probiotics and fish oil can be added directly into the shake as well.

19


WHY DO OUR MUSCLES ACHE?

Delayed onset muscle soreness (DOMS) that occurs a day or two after a harder than usual or new workout is often mistakenly believed to be caused by lactic acid build up.

However, lactic acid isn’t even a factor in this process. The muscle soreness you’re experiencing is actually caused by inflammation stemming from microscopic tears in your muscle fibres and connective tissues.

chocolate flavour, natural vanilla flavour, cocoa powder, xylitol, organic stevia.

Vanilla non-medicinal ingredients: psyllium husk powder, apple pectin, inulin, guar gum, natural green tea flavour, natural french vanilla flavour, natural vanilla flavour, xylitol, organic stevia.

500 g

ND’s Note: My active female patients absolutely love this nutrient dense shake. My male patients do too! Yes… it is safe for men to use this formula as well; it does not contain any estrogenic ingredients. ND Shakes can be added to your favourite beverage or coconut water for extra electrolyte support. For a more calorie dense shake, consider adding nut butter, coconut butter and/or avocado.

ND Shake Women's SportRecommended before or after workouts to support every woman’s needs. Each serving contains 27g of plant protein blended with greens, superfuits and fibre, plus nutrients such as panax ginseng, cinnamon, CoQ10 and L-glutamine to help support performance, blood sugar, heart health and muscle repair.

Available in chocolate or vanilla.

Directions: Adults - Add 3 rounded scoops (60g) to 300ml of your favourite beverage and shake well. For a delicious smoothie, blend with a ½ cup of fresh or frozen fruit. Enjoy before or after your workout!

3 rounded scoops (60g) contain:

Plant Protein Blend ............................................................... 27gYellow pea protein (pisum sativum) .................................. 19.5g Brown Rice Protein (oryza sativa) ........................................ 7.5g

Greens Blend .............................................................................. 4g Beet root (beta vulgaris) .................................................... 900mgBroccoli (brassica oleracea var. italica) .......................... 750mgParsley leaf (petroselinum crispum) ................................ 725mgKale (brassica oleracea var. acephala) ............................ 525mgSpinach leaf (spinacia oleracea) ...................................... 500mgAlfalfa leaf & stem extract (4:1, medicago sativa) ......... 125mg Chlorella (chlorella vulgaris, broken cell) ........................ 100mg

Superfruit Blend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1g Cherry fruit (prunus avium) ............................................... 250mgBlueberry fruit (vaccinium corymbosum) ...................... 200mg Goji fruit juice (lycium barbarum) .................................... 200mg Mangosteen fruit (garcinia mangostana) ....................... 150mgAcai fruit extract (4:1, euterpe oleracea) .......................... 50mg

Nutrients specific to active women’s health:L-Glutamine ................................................................................. 5gCassia cinnamon bark extract (4:1, Cinnamomum aromaticum) . 750mg

Elemental magnesium (bisglycinate) .............................. 210mgBromelain ............................................................................ 200mgElemental potassium (citrate) .......................................... 150mgElemental sodium (chloride) ............................................ 125mgPanax ginseng root extract (15:1, panax ginseng C.A. meyer) .. 33.4mgCoenzyme Q10 ...................................................................... 30mg

Chocolate non-medicinal ingredients: psyllium husk powder, apple pectin, inulin, guar gum, natural green tea flavour, natural

Joint Pain CreamA comprehensive, powerful and clean homeopathic cream that helps to relieve joint pain, swelling and stiffness from arthritis, or minor sprains and strains. Also helps to reduce stiffness in muscles and tendons. Free from any parabens, fragrances, petroleum, lanolin or propylene glycol.

Directions: Adults and children (0 years and up) - Apply generously to affected areas once daily or as needed. External use only.

Medicinal ingredients:Actaea spicata ........................................................................ 3XArgentum metallicum ........................................................... 3XArgentum metallicum ........................................................... 6XArnica montana ..................................................................... 3XArnica montana ..................................................................... 6XBryonia .................................................................................... 3XBryonia .................................................................................... 6XKalmia latifolia ....................................................................... 3XLedum palustre ...................................................................... 3XRhododendron chrysanthum ............................................. 3XRhododendron chrysanthum ............................................. 6XRhus toxicodendron .............................................................. 3XRhus toxicodendron .............................................................. 6XRuta graveolens ..................................................................... 3XRuta graveolens ..................................................................... 6X

Non-medicinal ingredients: Beeswax, shea butter, MCT oil, cetearyl alcohol, glycerin, tocopherol, sodium citrate, sodium lactate, carbomer, potassium hydroxide, purified water, lactose (trace amount).

50 g

ND’s Note: One of my favourite topical creams - this formula works quickly to mobilize stiff joints and is particularly beneficial for pain that is worsened with movement and motion.

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Pain Relief CreamLike Joint-Pain cream, Pain Relief cream is free from any parabens, fragrances, petroleum, lanolin or propylene glycol and works quickly to abolish the pain and swelling associated with acute injuries like sprains and strains.

Directions: Adults and children (0 years and up) - Apply generously to affected areas once daily or as needed. External use only.

Medicinal ingredients:Arnica montana ............................................................................. 3XArnica montana ............................................................................. 6XBelladonna ..................................................................................... 3XBelladonna ..................................................................................... 6XBellis perennis ................................................................................ 1XBellis perennis ................................................................................ 3XBellis perennis ................................................................................ 6XEchinacea angustifolia ................................................................. 1XHamamelis virginiana ................................................................... 1XHypericum perforatum ................................................................ 3XHypericum perforatum ................................................................ 6XMillefolium ...................................................................................... 1XRuta graveolens ............................................................................. 3XRuta graveolens ............................................................................. 6XSymphytum officinale .................................................................. 1XSymphytum officinale .................................................................. 3XSymphytum officinale .................................................................. 6X

Non-medicinal ingredients: Beeswax, shea butter, MCT oil, cetearyl alcohol, glycerin, tocopherol, sodium citrate, sodium lactate, carbomer, potassium hydroxide, purified water, lactose (trace amount).

50 g

ND’s Note: A must-have in your first-aid kit for all acute traumas. Safe and non-toxic for use on children as well.

ElectroMag / MagPop!Quench your thirst with this highly absorbable magnesium bislgycinate supplement, enhanced with vitamin C and electrolytes. It contains no added sugar, preservatives, artificial flavours or colours.

Directions: Empty contents into a glass and add 150 to 250ml of water, or to taste.

Each packet contains:ElectroMagMagnesium (magnesium bis-glycinate) ............................ 150mgVitamin C (ascorbic acid) ..................................................... 375mg

MagPop!Magnesium (magnesium bis-glycinate) ............................ 100mgVitamin C (ascorbic acid) ..................................................... 325mg

ElectroMag non-medicinal ingredients: Citric acid, tartaric acid, sodium bicarbonate*, calcium carbonate*, potassium carbonate*, stevia, xylitol, maltodextrin, natural lemon-lime flavour, natural lemon flavour, natural lime flavour. *Provides electrolytes.

MagPop! non-medicinal ingredients: Citric acid, tartaric acid, sodium bicarbonate,* calcium carbonate,* potassium carbonate,* stevia, xylitol, maltodextrin, quercetin, beta-carotene, orange juice powder, natural orange flavour. *Provides electrolytes.

ND’s Note: Recommended during and after workouts to replenish magnesium, as well as other important electrolytes, to keep muscles functioning. Vitamin C is not only there to support the immune system, it also plays an important role in collagen synthesis and wound healing. Patients can throw it in their gym bag, add it to water and enjoy the fizz.

30 ElectroMag sachets per box: Lime flavour

35 MagPop! sachets per box: Orange flavour

Many athletes have reported success using and integrating effervescent magnesium into their training.

Recently I have been using ElectroMag, CanPrev's effervescent magnesium drink, as a standalone post-workout beverage. I have also included it in my juices on days that I am not working out due to its great taste and nutrient profile.

After sustained use of this product, I’ve experienced less shin pain from running. I’ve also noticed after performing high-intensity workouts, such as interval training or hill repeats, I find that my body feels refreshed the next day.

I typically avoid many sports drinks while running because the flavours are typically too sweet for me. I have found that ElectroMag has a nice light flavour that doesn't overwhelm my taste buds, which allows me to consume it during a run. Another great feature is the convenience of individual packages, which allow me to store them in my vest or pack while running for use each time I refill my bottle.

I look forward to using this product in the coming months for several different races (ranging from fast, flat 5Ks to mountainous 101Ks).

Robert Hughson, High-altitude mountaineer & ultra-marathon runner

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Eat meals with balanced portions of protein, carbohydrate and fat. Many people envision a large plate of pasta as the poster meal for athletes, but their nutritional requirements are specific to their sport. Athletes should consult with a sport-focused naturopathic doctor or sport nutritionist to ensure proper fuelling for training, events and recovery.

Dr. Jamila M. James, ND (ON)

What is your top dietary recommendation for athletes?

Second opinion

Joint-ProThis formula contains ingredients with analgesic and anti-inflammatory properties to help maintain joint functions and relieve joint pain caused by wear and tear, injury and inflammatory processes.

Directions: Adults - Take 2 capsules 2 times per day with food, or as directed by a healthcare practitioner.

Each vegetable capsule contains:Glucosamine HCI (shellfish) ............................................... 400mgMethylsulfonylmethane (MSM) ....................................... 200mgChondroitin sulfate (bovine) ........................................... 180mgBoswellia serrata extract (45% boswellic acid) ............ 50mgDevil’s claw extract (4:1) ..................................................... 50mgCurcumin (turmeric) ............................................................ 48mg

Non-medicinal ingredients: vegetable-grade magnesium stearate, vegetable capsule.

90 Vegetable Capsules

ND’s Note: Many adults trying to become more physically active start experiencing joint pain. Joint-Pro can be prescribed as a preventative measure, as sometimes some extra support is necessary in the beginning while the joints are getting more accustomed to moving again!

Joint-Pro NEMThe naturally sourced glucosamine, chondroitin, and hyaluronic acid found within the natural eggshell membrane is pivotal in maintaining the health of joints and connective tissue.

Directions: Adults - Take 1 capsule 2 times per day with food, a few hours before or after taking other medications, or as directed by a healthcare practitioner.

Each vegetable capsule contains:Natural eggshell membrane .............................................. 250mgGlucosamine HCl ............................................................... 750mg



ND’s Note: Studies have shown NEM to be quite effective for reducing the pain and stiffness associated with osteoarthritis, particularly of the knee and/or hip. Research has also shown it can relieve pain within 7 days, potentially making it more effective for acute pain.

Osteo ProlongFor the maintenance of healthy bones, this comprehensive formula provides the vitamins and minerals needed for the proper construction of bones that contributes to the maintenance of bone health.

Directions: Adults - Take 2 capsules 2 times per day with food, a few hours before or after taking other medications or as directed by a healthcare practitioner.

Each vegetable capsule contains:Calcium (citrate & carbonate blend) ........................... 200mgMagnesium (bisglycinate) .................................................. 86mgZinc (citrate) ............................................................................. 3mgBoron (citrate) .................................................................. 175mcgVitamin K1 (phytonadione) ............................................. 30mcgVitamin D3 (cholecalciferol) ............................................... 250IU



ND’s Note: Many seniors, especially retirees, want to become more active, but are concerned about their bone integrity. Calcium is not the only important thing for bones. Magnesium and vitamins D and K help direct calcium into the bones. Those with a family history of osteoporosis especially can benefit from using a comprehensive formula like this!

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When it comes to eating for athletic performance there is no one diet that works for everyone; however, whichever dietary route you do choose, try to ensure that it eliminates junk food and reduces inflammation. Foods that contribute to inflammation are processed foods, sugars, refined grains, hydrogenated oils and artificial colours and flavours.

Janet Neilson, Homeopath (ON)

Along with drinking adequate amounts of water, electrolytes that are lost in sweat (sodium, potassium, calcium, magnesium, chloride, bicarbonate, phosphate and sulphate) need to be replaced. Consuming enough water based on body-weight and activity level, combined with a good quality electrolyte replacement, can be key for optimal performance.

Dr. Jenny Cundari, ND (BC)

Bananas! I love that you can just grab them and go - a natural and unprocessed snack. They are nature’s energy bar, a great source of natural and easy-to-digest sugar, and a rich source of potassium. An average banana contains about 422-450 mg of potassium to help regulate fluids and prevent muscle cramps and spasms.

Dr. Cecilia Ho, ND (ON)

Magnesium Bis.Glycinate 200This happy fusion of magnesium (essential mineral) and glycine (amino acid) helps to support muscle relaxation and nervous system health. The glycinate form improves absorption and reduces GI irritation.

Directions: Adults - Take 1 capsule per day or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium (bisglycinate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200mg



ND’s Note: It is important for active patients to replenish their electrolyte levels, especially magnesium, because the majority of the North American population is already depleted in this essential mineral. I recommend it after workouts to support muscle recovery and prevent muscle cramps.

Available in capsule and powder form.

Curcumin-ProAn excellent anti-inflammatory formula containing curcumin and bromelain. The lecithin helps to increase bioavailability of the curcumin.

Directions: Adults - Take 1 capsule 3 times per day away from food or as directed by a healthcare practitioner. For prolonged use, consult a healthcare practitioner.

Each vegetable capsule contains:Curcumin (turmeric) ........................................................... 400mgBromelain (pineapple stem) ............................................. 60mgLecithin (20% Phosphatidylcholine) .............................. 125mg



ND’s Note: Patients suffering from inflammatory conditions such as arthritis can benefit from natural anti-inflammatories, which can be a good alternative for those who experience side-effects from conventional anti-inflammatories. Studies show curcumin can also benefit patients with Alzheimer’s disease.

Pain-ProThis formula combines anti-inflammatories, analgesics and antioxidants to provide joint pain relief and reduce inflammation of the joints.

Directions: Adults - Take 2 capsules 3 times per day with food or as directed by a healthcare practitioner. Consult a healthcare practitioner for use beyond 3 months.

Each vegetable capsule contains:Bromelain (pineapple stem) ......................................... 140mgBoswellia extract (resin, 45% boswellic acid) ............. 100mgGinger extract (root, 5% gingerols) ................................ 100mgStinging nettle extract (root, 4:1) ................................... 83mgRosemary extract (leaf, 4:1) ............................................... 67mgCurcumin (turmeric) ............................................................ 64mgGreen tea extract (leaf, 95% polyphenols) ..................... 35mgHoly basil extract(leaf, 4:1) ................................................. 33mgResveratrol (polygonum, root) ..................................... 400mcg



ND’s Note: This formula is ideal as an alternative to COX-2 drugs, making it is useful for patients who experience side-effects from the COX-2 drugs, but seek pain relief.

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Sciatica (homeopathic)Helps to relieve the itching, cutting pain of sciatica. Contains key remedies that address pain alternating with numbness, and made worse by damp weather.

Directions: Adults - For general dosing, take 1ml, 3 times per day under the tongue or in a little water. For acute symptoms, take 1ml every 30-60 minutes (up to 12 times per day). When symptoms improve, resume general dosing.

Each ml contains:Agaricus muscarius ............................................................... 3XArsenicum album ............................................................... 6CHColocynthis .......................................................................... 6CHGnaphalium polycephalum .................................................. 3XKali iodatum ........................................................................... 3XRhus toxicodendron .............................................................. 3X

Non-medicinal ingredients: 25% grain alcohol, purified water, lactose (trace amount).

100 ml

ND’s Note: Recommended in conjunction with anti-inflammatory Turmeric tincture or Pain-Pro by CanPrev.

Fibromyalgia (homeopathic)A gentle formula to address to the bruising, tenderness and sensitivity associated with fibromyalgia. Helps to reduce insomnia, exhaustion, sleep-deprivation and low-grade fatigue, as well as improve muscular control and reduce stiffness and spasming.

Directions: Adults - For general dosing, take 1ml, 3 times per day under the tongue or in a little water. For acute symptoms, take 1ml every 30-60 minutes (up to 12 times per day). When symptoms improve, resume general dosing.

Each ml contains:Arnica montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30CHAvena sativa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3XChelidonium majus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1XCimicifuga racemosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12CHMagnesia phosphorica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8XPicricum acidum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6CHPlumbum metallicum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12CHRhamnus californica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2XZincum metallicum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6X

Non-medicinal ingredients: 25% grain alcohol, purified water, lactose (trace amount).

100 ml

ND’s Note: An ideal formula as part of a comprehensive protocol, to be taken along with magnesium, vitamin D and a vitamin B complex.

Omega-Pro HP 40/20Excellent source of EPA and DHA, which are natural anti-inflammatories that can help relieve joint pain and improve range of motion. These molecularly distilled fish oils are derived from small, wild, deep sea fish, with added Vitamin E to retain freshness.

Directions: Adults - Take 1 to 3 softgels per day with food or as directed by a healthcare practitioner.

Each softgel contains:Fish oil (wild sardine, anchovy & mackerel) ................. 1000mgEPA AEP ........................................................................................ 400mgDHA ADH ....................................................................................... 200mg

Non-medicinal ingredients: D-alpha tocopherol, bovine gelatin, glycerin, purified water.

90 Softgels

ND’s Note: Omega 3 is one of the most commonly prescribed anti-inflammatories in my practice, especially for those who don’t consume enough fatty fish. With a daily dose of only 3 capsules, your patients will get 1200mg of EPA, which is a good therapeutic dose for inflammatory conditions, such as pain, sports injuries, arthritis, etc. Taking fish oils right before a meal can help prevent the regurgitation of the oil.

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Joint Pain (tincture)Devil’s claw has long been used to help relieve joint pain due to osteoarthritis. It is also beneficial for patients with arthritic and rheumatic conditions and for low back pain.

Directions: Adults - Take 2ml, 3 times per day under the tongue or in a little water, on an empty stomach (either 15 minutes before meals or 1 hour after). Use for a minimum of 2-3 months to see beneficial effects.

Each ml contains:Devil’s claw extract (root, 1:4) . . . . . . . . . . . . . . . . . . . . . . . . 250mg

Non-medicinal ingredients: 40% grain alcohol, purified water.

100 ml

ND’s Note: Devil’s claw does require some build-up time in the joints to see effects, which can often take up to 8-12 weeks. This formula is particularly beneficial for patients who are taking other medications, as the there are few to no contraindications associated with this botanical.

Turmeric (tincture)This potent anti-inflammatory boosting botanical works aggressively to block the COX pain-promoting pathway without any of the side-effects of common NSAIDs.

Directions: Adults - Take 2 ml, 3 times per day under the tongue or in a little water, on an empty stomach (either 15 minutes before meals or 1 hour after). Use for a minimum of 2-3 months to see beneficial effects.

Each ml contains:Turmeric rhizomes extract (rhizome, 1:5) . . . . . . . . . . 200mg

Non-medicinal ingredients: 40% grain alcohol, purified water.

100 ml

ND’s Note: One of our most popular tinctures, this formula at its recommended daily dose provides 1.2g of curcumin. For stronger anti-inflammatory support, consider doubling the dose and pairing with CanPrev’s Pain-Pro for additional anti-inflammatory botanical support.

D3+K2 Drops This combination formula of vitamins D3 and K2 is immersed in a medium chain triglyceride oil to enhance the absorption of these fat-soluble vitamins.

Directions: Adults - Take 4 drops per day.

Each drop contains:Vitamin D3 (cholecalciferol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250IUVitamin K2 (menaquinone-7) . . . . . . . . . . . . . . . . . . . . . . . . . 30mcg

Non-medicinal ingredients: Medium chain triglycerides, d-alpha tocopherol.

15ml MCT Base

ND’s Note: Vitamin D3 supports the maintenance of bone integrity as well as modulates the immune system. Vitamin K2 has clinically demonstrated significant protection of bone strength.

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CanPrev Core

SPORTS NUTRITIONIST'S TOOLBOX

If you specialize in sports nutrition, there are a few essential staples to keep stocked on your shelves and

recommend to your patients - additional protein, magnesium for muscle and

bone support, and a natural anti-inflammatory such as curcumin,

as an alternative to ibuprofen.

Featured naturopath

Meet Dr. Tracey Teasdale, a Naturopathic Doctor and Certified Sports Nutritionist, who focuses her practice on sports medicine. Dr. Teasdale is the clinic director of Absolute Athlete Care with two locations in Barrie, Ontario and Alliston, Ontario. In addition to private practice, Dr. Teasdale is an assistant professor of clinical education at CCNM, and a supervisor on the sports medicine focus shift. Dr. Teasdale has helped many patients improve their health and achieve their goals, including completing a marathon for the first time, recovering from a sports injury, and reaching the podium! Read on to learn more about the exciting focus of naturopathic sports medicine.

Orange Naturals MagPop!

CanPrev Curcumin-Pro

What are the most common sport medicine conditions encountered in your practice?I see mainly overuse injuries relating to the hip, knee and shoulder. Iliotibial band syndrome, patellofemoral syndrome and rotator cuff disorders are among the top three. I also encounter a lot of plantar fasciitis.

What special challenges do you encounter when treating athletes?I have two main challenges. The first is getting the athletes to take adequate time off from training to allow their injury to heal. Most of them fear the losses in performance they might suffer if they reduce or stop their training. My approach is to help my athletes adapt their training program through their injury recovery.

The second is getting the athletes to fuel properly. Most of the athletes I see consume far too few calories, and what they do eat is generally lower in protein and fats.

Changing the timing of their meals and the composition of their diet takes some buy-in as it takes extra effort. We work together to come up with easy options that will fit into their busy schedules.

What are some of your "go-to-remedies" for sprains and strains?I love using acupuncture, electrostim and

instrument-assisted soft tissue mobilization for sprains and strains. I also use acute homeopathics like Arnica, Ruta, and Rhus Tox, as well as topical treatments such as Arnica cream/gel, hydrotherapy and castor oil. The prescription depends on the patient’s presentation.

What treatment modalities do you use the most with athletes?While my main modalities are acupuncture and clinical nutrition, I add in any other modality that is indicated for patients. I try to keep my treatments cost-effective for my athletes, so I try to find ways to supplement vitamins and minerals through their diet. I also use a lot of home care hydrotherapy, as well as prescription rehabilitation exercises.

Do you recommend your patients use ice or not with an acute injury?The evidence on cryotherapy is conflicting. I use it in cases where there is significant swelling. Otherwise, I use it short-term for pain management or if the patient reports that their symptoms are ameliorated with cold.

What are some common bad habits of seasoned athletes? In my practice, the bad habits are neglecting their nutrition and supplementation regime, not doing rehabilitation exercises, and trying to do too much too soon after an injury.

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If you could recommend a book to a new graduate starting up his or her practice, what would it be (sport-related or not)?I’m a fan of most books by Seth Godin. He has some really great ideas on business and what you can do to be successful.

To learn more about Dr. Tracey Teasdale’s clinic, please visit absoluteathletecare.com.

Most of the athletes I see consume far too few calories, and what they do eat is generally lower in protein and fats.

TURMERIC FOR INFLAMMATION RELIEF

Certain herbal extracts, such as turmeric, act as potent COX inhibitors, blocking the enzymes responsible for bruising, swelling and pain. They are considered safe and are generally well-tolerated by most people.

What is your favourite sport?These days, I really enjoy triathlons. I’m able to change up my training routine and it gives me a lot of variety, so I don’t get bored. It allows me to train with a group when I need motivation, but it also lets me train on my own when I need more of a moving meditation.

Which athletes are your favourite to work with?My favourites are motivated athletes. I love working with anyone who is committed to improving their performance. Beginner and novice athletes are fun because I am able to guide them through the process of becoming active. Injured athletes are also rewarding, as I get to see the joy in their smiles as they recover and return to the sport that they love. Elite athletes are really interesting as they go off to their competitions abroad, and come back to tell me their stories and show me their awards! They also add another layer of difficulty since we have to make sure that

anything we do is in accordance with their anti-doping policies.

Do you have any advice or tips for new graduates interested in focusing their practice in sports medicine?I have three main tips:

1. Learn about sports. It is imperative that you understand exactly what your athletes are doing while you are working with them. Learn what you can, and always ask your patients about their experience.

2. Brush up on your orthopedic skills. The key to clinical diagnosis of musculoskeletal conditions is in your physical exam. Know which tests to perform, and make sure you do them correctly and understand what they mean.

3. Take more continuing education courses in assessment, pain management and rehabilitation techniques. The field is constantly changing, so you need to be on the cutting edge.

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when athletes may unknowingly consume these banned substances.

Unfortunately, testing doesn't discern between intentional and inadvertent use, so the athlete becomes the victim.

For this reason, most elite athletes are advised against using any nutritional substances at all.

But this may not be the practical approach for your patient who is looking to maintain peak health through the use of supplements, in order to compensate for the toll intense training and competition takes on their body.

The Linford Christie caseDuring the 1988 Olympic Summer Games in Seoul, South Korea, sprinter Linford Christie tested positive for pseudoephedrine, simply by drinking ginseng tea (www.bjsportmed.com, July 2007).

While Christie maintained his innocence and many believed he didn’t intentionally cheat, he tested positive again in 1999. This time he was not alone, as a few other British athletes also tested positive for banned substances. After an investigation, the cause was traced to their unknowing consumption of contaminated nutritional supplements - an example of why caution is always necessary when taking any nutritional or natural performance related products.

Spotting contaminated supplements At the 2002 Salt Lake City Winter Olympics, athletes volunteered to have their supplements tested and 20% were found to be contaminated with banned substances. From a public health point of view, trace amounts do not actually endanger general health, but for athletes, even low amounts can cause a positive doping result.

One of the biggest concerns with athletes taking natural health products is that it may lead to positive results on drug panels, banning the athlete from their sport for a few months or even a lifetime.

Wait - natural supplements?Surprisingly, yes. While natural health products are marketed as, well, natural, there is a risk that some products will test positive. There are two main reasons.

One is a lack of understanding of how natural substances can act like drug analogues or pro-hormones in the body. A common example is ursolic acid. Ursolic acid is a phytochemical commonly found in large quantities in apple peels. It’s often taken as a supplement, and despite being natural, is capable of testing positive.

The other reason, and arguably the larger concern, is that athletes may inadvertently take natural health products that are contaminated with ingredients not listed on the label.

How contaminated supplements can lead to positive doping testsAn International Olympic Committee (IOC) study conducted in 2002 indicated that an astounding 15% of nutritional supplements reviewed contained anabolic androgenic steroids (mainly pro-hormones) not declared on the label. Since doping is currently the single biggest threat in the sporting world, this has resulted in warnings for athletes, new information systems and changing legislation.

It is the now the norm for many countries and sports organizations to carry out random blood or urine tests for banned substances to ensure a fair competitive playing field. However, there are instances

NHPs and inadvertent doping in competitive sports

Before prescribing natural supplements to any patients who play competitive sports, it’s important to understand the potential associated risks that could jeopardize their athletic aspirations - and careers.

87% of Canadian athletes say they use nutritional supplements. But where are they getting their nutritional advice?

Teammates10.8%

Doctor4%

Strength trainers13.5%

Family & friends19.8%

Dietician0.8%

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• Stimulants (like ephedrineand amphetamines)

• Narcotics (like codeineand marijuana)

• Diuretics (like furosemideor hydrochlorothiazide)

• Steroids (like DHEA andtestosterone)

• Beta-2 Agonists (likesalbutamol)

A 2004 IOC sponsored study conducted in Cologne, Germany, found that up to almost 15% of the 634 commonly available nutritional supplements tested were contaminated with substances not listed on the label. This is a substantial level of contamination. Tests show that a banned substance can be detected in the body a few hours to several days after ingesting a single supplement.

You may wondering how exactly natural supplements become contaminated. Two reasons are frequently cited:

• Cross-contamination during production.

• Lack of sufficient hygiene in the machinery used during production of a supplement.

Contamination can happen to any form of nutritional or natural supplements, whether pills, powders, capsules or liquids.

In addition, the variety of banned substances found in contaminated supplements is really quite extensive - ranging from caffeine and ephedrine to testosterone and methylenedioxymethylamphetamine (MDMA).

There are now more than 200 banned substances for athletes - a large number for sure - but these can easily be divided into five categories:

Overcoming the lack of quality control When it comes to the production of supplements, many countries still have inadequate quality control standards in place. Globally, there are great inconsistencies in the methods surrounding the production of both pharmacological medications and nutritional supplements. The Directorate for Health in the Netherlands, for example, has found traces of “designer steroids” in commonly used supplements.

The UK, Norway and Switzerland are now trying to help athletes choose supplements from companies deemed reliable. However, the ATP (Association of Tennis

Branched-chain amino acids (BCAAs)

Carnitine

Chrysine

Conjugated linoleic acid (CLA)

Creatine

Glutamine

Guarana

Minerals

Ornithine-alpha-ketoglutarate (OKG)

Proteins

Pyruvate

Ribose

Saw palmetto

Tribulus terrestris

Vitamins

Zinc

Nutritional supplements that have been contaminated with doping substances (in alphabetical order):

Professionals) is currently the only sports organization with their own supplement testing system in place. While Australia, Austria, France, Germany and North America do conduct lab analyses in an effort to help athletes, they are not on the same batch-by-batch basis as the ATP.

However, all countries are in agreement that at the very least supplements need to be manufactured under Good Manufacturing Practices or GMP standards. This certification assures manufacturing processes and facilities are held to a high standard of quality. Yet, this does not guarantee that a product is free of any banned substances.

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• Advising registered athletes - Advise this group of patients to maximize their nutrition with highly nutritious food or use (with caution) supplements with an NSF rating. However, be advised that sticking to only NSF-approved supplements will severely limit your patient’s product choices.

Athletes are ultimately accountable for the substances they consumeThe Canadian Centre for Ethics in Sports (CCES) states that athletes are responsible for anyprohibited substance found in a urine or blood sample. In Canada, the federal government has very few regulations related to the testing of supplements for athletes. As a result, it is virtually impossible for organizations like CCES to say that any natural health product is 100% free of banned substances.

Due to the difficulty in regulating the supplement industry, CCES emphasizes that elite athletes will always run the risk of a positive banned substance result if they continue to use nutritional supplements.

Internationally, there is a third party certification process in place called the NSF Certified for Sport Program, which offers lab testing services to help ensure supplement content and purity.

Products are checked for adulteration, label claims are verified against the contents, and finished product ingredients are checked for banned athletic substances.

NSF maintains close ties to regulatory bodies around the globe, including Canada. However, this program is by no means a guarantee that a natural health

product is 100% safe - as not every batch is tested, there can be no guarantee against the presence of banned substances. It is merely a means of reducing the risk associated with supplement use.

Although athletes are still ultimately responsible for what they choose to consume, CCES recommends athletes refer to the NSF International Certified for Sport Program to help minimize the risk of unintentional doping.

Health Canada’s position is to warn against the following risks when using natural health supplements, especially those not produced in Canada, not carrying a Natural Products Number (NPN), or not manufactured under GMP standards.

Health Canada’s concerns include:

• Contamination of the product.

• Incorrect ingredients.

• Incorrect dosage suggestions.

• Unproven claims (for non-Canadian products or products without an NPN).

• Failure to include warnings that a product may not be suitable for certain users.

• Warnings of interactions with prescription drugs or other natural products that could lead to unpredictable side effects or drug action interference.

• Warnings of unwanted side effects, like allergic reactions to plants, for example.

But even products produced in Canada cannot be guaranteed 100% pure for competitive athletes.

What does this mean for your practice?Athletes that are subject to anti-doping regulations belong to the Registered Testing Pool (RTP) and include national, international and general members who compete internationally in the NorAm circuit or invitational events outside of Canada. Some athletes who do not belong to the RTP, but who still compete domestically, can include Canadian Interuniversity Sport athletes, Canadian Athletic Association athletes, Canada Games athletes or even junior football players.

If you use intake questionnaires in your practice, be sure to include a question that asks your patients the level at which they compete and if they fall into any of the aforementioned categories. This is especially important for university level athletes who may be completely unaware of their responsibilities regarding nutritional supplementation rules.

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• Advising serious, elite non-registered, non-circuit, non-association athletes - Advise this group of patients to use only supplements produced in Canada with an NPN on the label. This guarantees that the product is fully compliant with Health Canada licensing standards. As their health advisor, it is your responsibility to only carry or recommend supplements that are manufactured to GMP standards, with stringent quality control measures and third party testing for purity and quality. Warn against supplements from multi-level marketing companies (who can fly under the regulatory radar) or cross-border products ordered over the internet – your patients do not want to consume contaminated supplements or products that might have been made in someone’s basement!

Helping athlete patients reach their potential - without the riskThere is a strong feeling among athletes that supplements and natural health products, like antioxidants, protein powders and multivitamins, are essential contributing factors to achieving athletic goals.

However, many athletes take advice from family and friends, teammates or trainers - and not from knowledgeable health professionals. This can result in over-supplementing and getting more nutrients than they need, or becoming depleted in an essential nutrient like iron. Unfortunately, there are also those who have no idea what they are actually taking. Some athletes end up using supplements

Warning: Don’t fall for products with claims that they are CCES, WADA or IOC certifiedSome companies will claim that their natural health products are certified by well-known sports organizations. It is important to understand that these organizations do not have certification programs for natural health products or supplements. Definitely question the legitimacy of a product marketed this way.

that could potentially compromise their status and future as an athlete.

As a natural health professional interested in furthering the potential of athletes, you are in a unique position to offer valuable advice on navigating the murky world of supplements. Only you may be able to see through the hype and advertising geared towards the enhancement of athletic performance.

Read the research, understand how and where the supplements you recommend are made, and educate your patients about their responsibilities as an athlete. Wise counsel to your patients will ultimately result in a gold medal practice.

WHY DO WE SWEAT?

There are two types of sweat glands in mammals, apocrine and eccrine. Apocrine glands secrete sweat only when the body is under emotional stress, while eccrine glands (which are controlled by the sympathetic nervous system) help to regulate body temperature. They secrete a salty, watery liquid on the surface of the skin to cool it down when the internal body temperature rises too high.

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The energy phase - before and during exerciseThe pre-exercise period happens about one to four hours before exercise and is designed to maximize muscle glycogen stores, letting us exercise longer. Eating a meal containing 150 to 200g of carbohydrate four hours before exercise can increase muscle glycogen stores and improve exercise performance.

The efficacy of carbohydrate supplementation during exercise can be improved by adding a moderate amount of protein. One study measured the endurance of trained athletes during a cycling exercise who consumed either a carbohydrate-only beverage or a mixed carbohydrate-protein beverage. The mixed carbohydrate-protein beverage resulted in cyclists being able to perform longer, compared to the carbohydrate-only beverage.

In addition to improved performance, carbohydrate/protein supplementation during exercise has been shown to lower levels of plasma creatine kinase, lessening muscle damage and muscle soreness 24 hours post-exercise, when compared to a carbohydrate-only supplementation.

A practical strategy for supplementation during exercise is to drink a beverage containing 3-6% carbohydrate every 15 to 20 minutes during prolonged exercise lasting longer than 60 to 90 minutes. You might also advise your patients to add 1.0–1.5% protein to their supplement.

The anabolic phase - the post-workout window of opportunity Immediately after an intense training session, the body’s muscle and liver glycogen stores are depleted. Muscle protein breakdown is elevated, blood insulin is low and cortisol is elevated. Skeletal muscle is very responsive to nutrients post-exercise and consuming the appropriate types and amounts of nutrients will encourage the body to rebuild its tissues and enhance recovery.

Muscles are sensitive to carbohydrates following a workout and muscle glycogen synthesis occurs almost immediately after

How to boost performance and speed recovery with nutrient timing

Nutrient timing, the science of consuming specific nutrients in specific amounts at specific times, can affect the body’s physical response. In many cases, when and how nutrients are consumed play just as an important role as what is eaten. How does nutrient timing work? And how can you best use it for planning your athletes’ nutritional strategy?

You may have had an athlete visit your office and complain that they seem to have ‘plateaued’. In other words, they have reached a standstill with their strength and performance gains.

They might also notice that it's taking longer for them to recover after training - they are left feeling exhausted with muscle soreness lasting longer than ever - and as a result are becoming discouraged to go back to the gym.

When this happens, introducing a structured resistance training program - paired with proper nutrient intake and timing - can help athletes increase their strength, speed recovery, reduce muscle soreness, and even increase energy before and after a workout.

This concept of nutrient timing can be divided into three phases: the energy phase, the anabolic phase and the adaptation phase.

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At this time, regular daily meals and snacks are sufficient enough to help in the recovery process. Snacks should contain approximately a 1:1 ratio of carbohydrate/protein and total 100 to 200kcal. Even a low-calorie protein snack before bedtime can be an effective way to optimize recovery, and should contain approximately 20g of protein, with minimal amounts of carbohydrate and fat.

Incorporating nutrient timing into your patient’s routineSee the table below as an example of possible nutrient timing with workouts, supplements and meals for three different daily training schedules:

A post-workout supplement should provide sufficient carbohydrate (1.0 to 1.5g/kg of body weight) and contain 20 to 30g of protein to maximize muscle glycogen storage during the first hours of recovery. For light to moderate intensity workouts, a light carbohydrate (0.3 to 0.8g/kg of body weight) with protein (10 to 12g) supplement is recommended.

The adaptation phase - post-exercise supplementation This phase occurs four to six hours after the effects of the initial post-exercise supplementation period. It emphasizes maintaining muscle glycogen storage and protein synthesis by ingesting carbohydrate and protein periodically.

a carbohydrate meal is consumed. Waiting longer than two hours to eat following a session can reduce muscle glucose uptake and glycogen synthesis by at least 50%. The longer post-exercise nutrient supplementation is delayed, the longer the catabolic (breakdown) state, leading to increased inflammation, muscle damage and soreness.

Most research studies support eating soon after exercise for optimal stimulation of protein synthesis, enhancing training adaptation and reducing indicators of muscle damage and soreness. A combination of carbohydrate and either protein or essential amino acids have been shown to be especially effective.

Daily workout schedule

Time of day AM workout PM workout 2x/day workouts

7:00 AM Breakfast Breakfast Breakfast

8:00 AM ― ― ―

9:00 AM Workout ― Workout

10:00 AM PW supplement ― PW supplement

11:00 AM ― ― ―

12:00 AM Lunch Lunch Lunch

1:00 PM ― ― ―

2:00 PM ― ― ―

3:00 PM CP snack CP snack ―

4:00 PM ― ― Workout

5:00 PM ― Workout PW supplement

6:00 PM Dinner PW supplement ―

7:00 PM ― ― ―

8:00 PM Bedtime snack Dinner ―

9:00 PM ― ― ―

10:00 PM ― Bedtime snack Bedtime snack

Source: Ivy JL, Ferguson-Stegall LM (2014). Nutrient timing: the means to improved exercise performance, recovery, and training adaptation. American Journal of Lifestyle Medicine 8: 246-259

LegendWorkout - Supplementation should include a beverage containing 3-6% carbohydrate every 15 to 20 minutes during prolonged exercise greater than 60 to 90 minutes. One should also consider the addition of 1.0 – 1.5% protein to their supplement.

PW supplement - Following prolonged, intense workouts, the post-workout (PW)

supplement should provide sufficient carbohydrate (1.0 to 1.5g/kg of body weight) to maximize muscle glycogen storage during the first hours of recovery and also contain between 20 and 30g protein. For light to moderate intensity workouts, a light carbohydrate (0.3 to 0.8 g/kg of body weight) with protein (10 to 12g) supplement is recommended.

CP snack - Between-meal (CP) snacks should be approximately a 1:1 ratio of carbohydrate/protein and contain 100 to 200kcal.

Bedtime snack - A snack before bed should contain approximately 20g protein with minimal carbohydrate and fat.

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Cons

• Does not have a heart rate monitor (can be accessed through third party linking).

• Does not assess sleep quality (but does track time user goes to bed and wakes up).

This guide only covers specialized trackers. Multipurpose smartwatches, like the Apple watch, can be quite cumbersome and expensive, and are designed to perform so many more functions than simple fitness tracking, so we’ll leave these for another time.

Moov Now

Features

• Functions include step tracking, sleep tracking and real-time athletic tracking or coaching for 12 different workouts.

• Capable of identifying 200 different fitness levels.

• iOS or Android compatible.

• Average battery life of about six months.

Pros

• Provides audio coaching transmitted via earbuds for sports like cardio boxing, walking, running and cycling, offering suggestions such as ‘take longer strides,’ or ‘change gears now’ to keep users motivated and on track.

• Band is light, breathable and waterproof, allowing swimmers to collect data on their laps, flip-turn times and stroke rates.

You may have noticed an increasing number of patients wearing rubber-banded fitness trackers on their wrists. Athletic and non-athletic types alike are using the flexible bracelet devices to check how many steps they’ve taken, when they’ve reached their target training zone, and how their sleep patterns fluctuate each night.

One out of every 10 adults owns or has owned a fitness tracker of some kind. The idea of fitness self-tracking follows the theory that people tend to modify or improve a part of their behaviour when they think they’re being watched, a phenomenon known as the Hawthorne Effect. In the sports world, the Hawthorne Effect is observed whenever professional or Olympic level coaches pay particular attention to some athletes more than others, resulting in better performances and placements.

These days, companies like Nike, Adidas and Apple are applying the principles of the Hawthorne Effect to their own products, with the hope that the more detailed ways people can keep track of their progress, the better results they’ll see, and the more devices the manufacturers will sell.

Every year a barrage of new tools and technologies are released that allow anyone to collect crunchy data about their lives - what they’re eating, how far they’re walking, how long and how well they’re sleeping and how often their hearts are beating. Fitness trackers and the current flood of apps, sensors and devices happily feed the new quantified self movement by measuring multiple aspects of our daily lives with the help of technology.

Fitness tracker buying guideMany fitness trackers act as pedometers, coaches, and heart rate and sleep monitors. In our research, we came across three standalone wearable devices retailing between $100 to $200 CAD each that are worth mentioning should your patients ask for a recommendation.

Fitness trackers raise self-awareness - and motivation!


34

Overall impression: Moov Now’s primary focus is to encourage people to increase their physical activity by using an accelerometer that documents the number of active minutes they accumulate in a day (even the time spent sitting down and getting up from one’s chair), and the number of calories burned.

Moov Now seems like a great device for guiding users through easy or difficult workouts and for encouraging them to increase physical performance each time they exercise. But be forewarned: it’s definitely not a device for people who dislike being talked at!

Fitbit Charge HR Features

• Pedometer-style tracker encased in a comfortable, non-descript rubber band with a small LED screen on top.

• Built-in heart rate and pulse monitor.

• Unique caller ID feature lights up the screen whenever the user’s phone rings.

• Battery lasts five or six days and can be charged from a computer.

Pros

• Data can be viewed on the band itself (steps taken, heart rate, miles walked, calories burned and stairs climbed).

• Sleep tracking is automatic and comes with a silent alarm.

• Display stays hidden until a button is pushed to make it visible.

• Stopwatch feature included.

Cons

• Unable to combine and analyze fitness data for improvements over time.

• Limited waterproof capabilities (can be worn in the shower).

Overall impression: The Fitbit Charge HR was found to be by far the most accurate of all the wearable devices when tested against gym cardio machines that also monitor heart rate. It is a reliable pulse tracker and scored perfect readings when compared to straight pedometers. The Fitbit Charge HR’s app for phone or computer has been lauded for being extremely clean-looking and easy to use, and the GPS feature on most phones can be accessed by the Fitbit Charge HR’s app to track runs and users coach in real time.

Jawbone UP3 Features

• Low-profile aluminum casing.

• Quietly tracks basic physical activity like sleep or exercise through phone software.

• Display lights on the band indicate which mode the device is in (sleep or activity).

• Small sensors on the inside of the band act as accelerometers, bioimpedance sensors and skin ambient sensors.

• Device can be programmed to give ‘get up and move around now’ alerts via vibration.

• Long battery life, typically needing only one charge per week.

Pros

• Can recognize a wide range of step-based activities like running, tennis, hiking and even dance.

• Able to tell the difference between the user's REM, deep or light sleep stages by monitoring pulse, respiration, body temperature and galvanic skin response.

Cons

• No visible display.

• Clasp is reportedly fussy to work with, but does come with a watch band-like strap for extra security.

• Only water-resistant, not waterproof.

• Does not have a heart rate monitor.

• Very short charging cable can be awkward to use.

Overall impression: Jawbone argues that continuous heart rate monitoring is not necessary since resting heart rate is a better measurement of fitness; a fact that fitness buffs may argue on the basis that continuous heart rate monitoring is crucial for high-intensity training. It does, however, allow you to track and trend your heart rate over a week, a month or longer.

Special mentions: Check out Withings Activite Pop (expensive at around $500 CAD) or Misfit Shine (fully waterproof and can be worn anywhere on the body), as they can give more accurate details on sleep patterns than either Moov Now or Fitbit Charge HR.

BALANCE BLOOD SUGAR WITH EXERCISE

Help keep your blood sugar levels balanced with regular exercise. Research shows physical activity can improve your body’s insulin sensitivity by 30 to 50%.

35


Energy requirements for athletes

Energy spent during training or competition should be correlated with an athlete’s caloric intake. It’s important to know how many calories are needed to sustain a sport or activity. This is especially striking for weekend warriors adopting a new activity, like cycling. Consider for instance that participants of the Tour de France consume roughly 6,000 calories in a single day! Now while the majority of your patients may not be training for 3,500km endurance events, the list below provides patients with a rough reference on caloric intake.

Weight training

Hockey

Running

Cycling

Swimming

Rowing

Source: https://books.google.ca/books?id=L4aZIDbmV3oC&pg=PA110&lpg=PA110&dq=energy+intake+kcal+tour+de+france+triathlon&source=bl&ots=WmsUocDeZR&sig=co-W00yCr-owv9dadfBmfziYB3Y&hl=en&sa=X&ved=0ahUKEwir8Mjbg9XMAhXi7oMKHYA0Ak4Q6AEILDAC#v=onepage&q=energy%20intake%20kcal%20tour%20de%20france%20triathlon&f=false

MenWomen

36


Course Name/Theme

Organizers Location Date CE info Registration Info Description

3rd International Congress on Naturopathic Medicine

International Congress on Naturopathic Medicine

Barcelona, Spain

Jul 1-3, 2016 TBC icnmnaturopathy.eu

We recommend this conference with its amazing lineup of speakers from around the world, including the following Canadians: sports medicine-focused Dr. Marc Bubbs, ND and CCNM faculty member Dr. Ellen Wong, ND. Oh and did we mention, it’s in Spain? This awesome, international event comes at a steeper price than most domestic conferences, but the extra cost is worth the global perspective on naturopathic medicine.

The Treatment of Infertility - The Complete Series

Pro D Seminars

Recorded online course

Ongoing 19 CEprodseminars.net/product/treatment-infertility-complete-series

This course series covers diagnostic methods and treatment options for infertility, and weighs the pros and cons of combining TCM and IVF treatment. We think this course would be great for most practitioners, as you are likely to encounter patients with fertility issues in your practice.

Pro D Seminars’ online recorded courses offer you the convenience of getting continuing education credits when and where you please. You’ll likely be missing out on the opportunity to ask questions or network with others, but if you invite a few colleagues over to your place to go through the seminar together, you will still have the opportunity to exchange knowledge!

2nd Annual Integrative Fertility Symposium 2016

Healthy Seminars

Vancouver, British Columbia

Apr 29 - May 12016

TBC ifsymposium.com

From discussions on egg quality to men’s infertility, this event covers all the bases when it comes to the fertility challenges your patients may present to you. If you were lucky enough to get in, you were sure to have a robust learning experience from this diverse group of healthcare practitioners. Yes, registration filled quickly for this year’s event, but recordings should be made available now that the conference is over. You will have to check with the event coordinators to ensure that CE credits will be available for the recordings in your jurisdiction.

Continuing education course listings

Keep up-to-date and current with ongoing continuing education. See below for some upcoming courses.

To have a course listed in an upcoming issue of Naturopathic Notes, please submit course details to [email protected]. Please remember to double check the amount of credits and the category in which these courses will be placed, according to your province’s regulatory body.

37


A cheat sheet to orthopedic tests

Here’s a quick guide to refresh your memory and help you determine which tests to use to diagnose musculoskeletal concerns. The digital version of this newsletter allows you click on each test to view a video demonstration.

HIP & PELVIS

Sacroiliac Joint Dysfunction / Pathology

• Yeoman’s Test

• Pelvic Rock Test

• Patrick’s (FABER) Test

• Hibb’s Test

• Gaenslen’s Test

• Nachlas’ Test

TFL Tightness

• Ober’s Test

• Ely’s Test

IT Band Tightness

• Ober’s Test

FOOT & ANKLE

Ligament Injury

• Anterior Drawer Test

• Posterior Drawer Test

• Talar Tilt Test

Ruptured Achilles Tendon

• Thompson’s (Squeeze) Test

Stress Fracture

• Forefoot Squeeze (Morton’s) Test

VERTEBRAL COLUMN

Scoliosis

• Adam’s Sign

Sciatica

• Braggard’s Test

• Bechtrew’s Test

• Minor’s Sign

Thoracic Outlet Syndrome

• E.A.S.T. (Roo’s) Test

• Wright’s Test

• Shoulder Depression Test

IVD Herniation

• Soto Hall Test

• Valsalva Test

• Milgram’s Test

• Linder’s Test

• Lasegue’s Test (Straight Leg Raise)

https://www.youtube.com/watch?v=c_rBq388UWo&list=PL08412370D8EE8DBB&index=1

https://youtu.be/4PxwHysGjxU?list=PL08412370D8EE8DBB&t=460

https://youtu.be/zfWKcTixM6E?t=124

https://youtu.be/4PxwHysGjxU?list=PL08412370D8EE8DBB&t=308

https://www.youtube.com/watch?v=bfU6yNSR0TU&list=PL08412370D8EE8DBB&index=5

https://www.youtube.com/watch?v=-v-Ox1rlwLA&index=3&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=9n7009LmHGY&list=PL08412370D8EE8DBB&index=32

https://www.youtube.com/watch?v=FF7L_2QTUx8&index=31&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=9n7009LmHGY&list=PL08412370D8EE8DBB&index=32

https://youtu.be/e4IehK8uyHo?t=265

https://youtu.be/e4IehK8uyHo?t=307

https://www.youtube.com/watch?v=l3hNRmtpNLQ

https://www.youtube.com/watch?v=-tdyVlQR--o&index=1&list=PLCEF89BFA4C6EBEB1

https://www.youtube.com/watch?v=K9oboVn5wN4&index=2&list=PLCEF89BFA4C6EBEB1

https://www.youtube.com/watch?v=K9oboVn5wN4&index=2&list=PLCEF89BFA4C6EBEB1

https://youtu.be/irtwPuIZ2t0?t=23

https://www.youtube.com/watch?v=yZ1IKmNcElY&list=PL08412370D8EE8DBB&index=21

https://www.youtube.com/watch?v=t9jkND_k05A&index=20&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=gEFOZloBMI4&list=PL08412370D8EE8DBB&index=11

https://www.youtube.com/watch?v=_xBYpjSjE2Q&list=PL08412370D8EE8DBB&index=18

https://www.youtube.com/watch?v=gmtHStW7MB8&index=6&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=Ta7V8U_fLrU

https://www.youtube.com/watch?v=k_li6VYiRGY&index=9&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=ISI75xaLHVw&index=13&list=PL08412370D8EE8DBB

https://www.youtube.com/watch?v=ISI75xaLHVw&list=PL08412370D8EE8DBB&index=13



38


WRIST

Carpal Tunnel Syndrome

• Phalen’s Test

• Tinel’s Test

De Quervain’s Tenosynovitis

• Finkelstein’s Test

ELBOW

Lateral Epicondylitis “Tennis Elbow”

• Cozen’s Test

• Mill’s Test

MCL /LCL (Elbow) Injury

• Valgus and Varus Tests of the Elbow

KNEE

ACL / PCL Injury

• Anterior / Posterior Drawer Sign

• Lachman’s Test

Meniscal Tear / Injury

• Apley’s Compression Test

• Bounce Home Test

• McMurray’s Test

MCL / LCL (Knee) Sprain

• Apley’s Distraction

• Valgus and Varus Stress Tests

SHOULDER

Rotator Cuff Tear

• Apley’s Scratch Test

• Drop Arm (Codman’s) Test

• Glenohumeral Apprehension Test

Bicipital Tendinitis

• Lippman’s Test

• Yergason’s Test

• Speed’s Test

39


Product quick guide

Resources & references

The adult patient treatment plans on the next pages can be torn out, copied and given to your patients to help them find the remedies you’ve prescribed. We’ve already written out directions and daily doses. The chart below outlines indicated uses and potential contraindications to help integrate any new remedies with your patient’s current protocol.

Recommended Use

Contraindications

Possible Contraindications

NOTE: Homeopathics generally do not have interactions or contraindications with any medication.

Vaso

dila

tors

(Nitr

ogly

cerin

)

Seda

tives

Laxa

tives

Diur

etic

s (th

iazi

de)

Cort

icos

tero

ids

Antip

late

let A

gent

s

Anti-

infla

mm

ator

ies

Antih

yper

tens

ives

Antid

epre

ssan

ts (S

SRI)

Antic

oagu

lant

s / B

lood

Thi

nner

s

Antib

iotic

s

Antia

rrhyt

hmics

/ Ca

rdia

c Glyc

osid

es

Alco

hol

Toni

c

Prop

hyla

ctic

Nut

ritiv

e Su

ppor

t

Chro

nic

Acut

e

Hyp

ogly

cem

ics

Imm

unos

uppr

essa

nts

Horm

one M

edica

tions

/Con

trace

ptive

s/HRT

Products Recommended Use Contraindications

CanPrev & Orange Naturals (Supplements)

Adrenal-Pro • • • • •Advanced B-Complex •Antioxidant Network • • •C crystals •Curcumin-Pro • •Joint-Pro • •Joint-Pro NEM •Magnesium Bisglycinate 200 • • •Magnesium glycinate • • •Omega 3 Fish Oil •Omega-Pro •Osteo Prolong •Pain-Pro •pH-Pro •Stress with B vitamins • • • • •Synergy C •Synergy B •Ubiquinol 100 •CanPrev & Orange Naturals (Shakes)

ND Shake Women's Sport •CanPrev Core for Men •CanPrev Core for Women •Orange Naturals (Single Tinctures)

Panax Ginseng • •Rhodiola • •Turmeric • •Orange Naturals (Herbal Remedy)

Joint Pain • •Orange Naturals (Homeopathics Remedy)

Fibromyalgia • •Sciatica • •Orange Naturals (Homeopathics Creams)

Joint Pain cream •Pain Relief cream •

Pre-Workout Support Adult Patient Treatment Plan

Tear

this

out

, mak

e co

pies

and

use

with

you

r pat

ient

s

Date

The medicines/remedies checked off below are recommended

for (patient’s name):

Clinic Information

Available in CanPrev Available in Orange Naturals

Product Name Recommended Directions Take For Notes

PRE-WORKOUT SUPPORT (ADULTS)

Adrenal-Pro Take 2 capsules, 2 times daily with food. days

Antioxidant Network Take 1 capsule, 1-2 times per day. days

ElectroMag Empty 1 sachet into your water bottle and drink throughout your workout. days

CanPrev Core for Men Add 2 rounded scoops to 250ml of your favourite beverage and shake well. days

CanPrev Core for Women Add 2 rounded scoops to 250ml of your favourite beverage and shake well. days

C crystals Take 1/4 teaspoon per day in water or juice. days

MagPop! Empty 1 sachet into your water bottle and drink throughout your workout. days

ND Shake Women's Sport Add 3 rounded scoops to 300ml of your favourite beverage and shake well. days

Omega 3 Fish Oil Take 1 to 3 softgels per day with food. days

Omega-Pro Take 1 to 3 softgels per day with food. days

Panax Ginseng (tincture) Take 3 ml, 3 times per day. days

Rhodiola (tincture) Take 2 ml, 3 times per day. days

Stress with B vitamins Take 1 capsule, 2 times per day. days

Synergy C Take 2 capsules daily. days

Ubiquinol 100 Take 1 softgel per day. days

Circle the recommended products and add in the suggested duration.

Lifestyle/Dietary Recommendation Exercise Recommendations Other Recommendations

Tear

this

out

, mak

e co

pies

and

use

with

you

r pat

ient

s

Available in CanPrev Available in Orange Naturals

Date

The medicines/remedies checked off below are recommended

for (patient’s name):

Adult Patient Treatment Plan

Clinic Information

Post-Workout Support

Product Name Recommended Directions Take For Notes

POST-WORKOUT SUPPORT (ADULTS)

Curcumin-Pro Take 1 capsule, 3 times per day away from food. days

Magnesium Bisglycinate 200 Take 1 capsule daily. days

Magnesium glycinate Take 1 capsule daily. days

ND Shake Women's Sport Add 3 rounded scoops to 300ml of your favourite beverage and shake well. days

CanPrev Core for Men Add 2 rounded scoops to 250ml of your favourite beverage and shake well. days

CanPrev Core for Women Add 2 rounded scoops to 250ml of your favourite beverage and shake well. days

pH-Pro Take 1 capsule, 1 to 2 times per day away from food. days

Turmeric Take 2 ml, 3 times per day. days

Joint-Pro Take 2 capsules, 2 times per day. days

Joint-Pro NEM Take 1 capsule, 2 times per day. days

Joint Pain cream Apply generously to affected areas as needed. days

Pain Relief cream Apply generously to affected areas as needed. days

Circle the recommended products and add in the suggested duration.

Lifestyle/Dietary Recommendation Exercise Recommendations Other Recommendations

42


CanPrev guide to natural medicine is here!

Our new 2017 guide is now available. It’s a comprehensive 148-page guide of CanPrev's natural products, complete with detailed descriptions and practical health advice. A great resource for your patients - or as a handy reference for your practice.

To request or download your copy, visit canprev.ca/guide

New reader? Address change?

Would you like to receive a fresh issue of ND Notes delivered straight to your mailbox 4 times a year? Make sure we have your up-to-date contact information on file to receive our latest print issues.

Email [email protected]

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Visit ndnotes.ca today

ND NOTESCanPrev & Orange Naturals70 North Wind PlToronto, ON, M1S 3R5

Tel 905.881.6800Fax 905.881.6802

[email protected]

For more information about the mentioned products, please visit canprev.ca or orangenaturals.com, or ask our product developers at [email protected].

Let us know how it goes. We love to hear feedback, suggestions and successes at [email protected].

ND NOTESSpring 2016 | VOL 2 NO.1

Head of fibula

SP 8 (Diji)

SP 7 (Lougu)

UB 56 (Chengjin)

UB 57 (Chenshan)

K2 (Rangu)

UB 58 (Feiyang)

UB 59 (Fuyang)

SP 7 (Lougu)

Achilles tendon

keeping active patients on their feet

Documents