Naturopathic Approaches to Neurological Disease

July 4, 2018

A.C.:   Well hello, here we are with Dr. Paul Saunders, thanks for joining us. So to begin, can you tell readers a little bit about your background and what brought you to naturopathic medicine?

P.S.:    So I have two different areas of training or education. My undergraduate was started in pre-med but then I got my Bachelor’s and Master’s in Resource Management Forestry and then I got my PhD in Forest Ecology and Botany. And then I taught in universities, several universities, for a number of years and then when I was sort of in my mid-30s, I decided I wanted to go back into medicine and so what was available because my age was only Naturopathic medicine or optometry. I was too old to go to medical school at that time. And so I ended up with three schools. There was The Canadian College of Naturopathic Medicine (in North York), The National University of Natural Medicine (in Portland) and Bastyr (University School of Naturopathic Medicine) and I ended up here.

A.C.:   Right.

P.S.:    And we were not accredited at the time so I went back and got a second ND and did a residency.  And then they wanted me to come back here–

A.C.:   – to CCNM…

P.S.:    Yes, to CCNM and run the clinic, so that’s what I did. I came back as clinic director. That’s the short story.

A.C.:   That’s the short story! That’s quite the history. So today’s topic is on naturopathic approaches to neurological disease, as we discussed. So just to start I don’t know if it’s the summer season, or what it is, but what I’ve noticed lately is this troubling trend with more and more concussions occurring. I’ve noticed this in my personal life and professional life. I think the general population tends to downplay concussions as it’s common to hear about athletes and active people having multiple incidents and then they’re “okay”.

P.S.:    Yeah, they’re “okay”. Then they’re back at it, right.

A.C.:   Exactly. So could you speak to this a little bit?

P.S.:    Concussions are serious. Yeah, concussions are serious and the damage that can occur can be immediate and long term. I think all we have to do is look to professional sports and I’ll use Sidney Crosby as an example. There’s a top level player who has a series of concussions…he even missed a major part of the season in hockey as a result of that. And then there’s some recent studies with pro football players showing the brain damage is pretty significant as a result of all the trauma that they get, which starts in high school for most of them and goes right through university and into their professional life.

A.C.:   Wow!

P.S.:    So yeah, I think a lot of people write it off because they don’t know what to do with it and so it’s just, you know, a fact. If you’re going to play sports, you’re going to get a concussion.

A.C.:   Sure. And then it’s a cumulative thing.

P.S.:    It’s a cumulative thing. Yeah and for some people, like Sydney [Crosby] or these pro players, it has substantial effects. For some people it’s relatively minor, especially the first one, but you know, repeated concussions can be more severe each time they occur.

A.C.:   Absolutely. Is there a number that you would tap someone out of playing a certain sport for example…

P.S.:    Well no. I don’t think professionally and in the sports world that they’ve made a decision like two concussions and you’re out, or three and you’re out. I think once you’re off their concussion protocol which is probably rest and R&R then you go back at it until it happens again. Hopefully it doesn’t happen again, but it often does.

A.C.:   Athletes are also often told to play on or take a game or two off before returning to full activity.

P.S.:    I think they should take time off.

A.C.:   And so what does the research say about the healing role of rest?

P.S.:    Actually, the research says that rest is really important. A concussion creates inflammation. If you think about it, if you bruise yourself or bang yourself, there’s local bleeding, typically. And there’s a bruise that you see and then the blood has to be stopped, the bleeding has to be stopped, the blood has to be dried up and reabsorbed and everything and so I think that’s the same thing with the brain. You know when there’s a contre-coup, which is where you hit one side and the brain bounces on the other side, that takes time to heal well. The brain is a very blood rich organ and we don’t have ways of really seeing that because we don’t open up the brain to look at it, but that takes time to heal up as well. The typical thing is to rest until you have no more symptoms.

A.C.:   No more symptoms.

P.S.:    Yeah, I think most people rest until they feel like they can go back at it, but I think symptoms often persist.

A.C.:   Definitely and I’ve had patients that have noticed months and months of brain fog, of memory loss, of..

P.S.:    …headaches and mood changes. All of those things, yes.

A.C.:   It can be significant. So recently, a friend of mine, her young son of eight years old sustained a concussion playing goalie in the school yard. He’s a young hockey player.

P.S.:    That’s pretty young to start.

A.C.:   Absolutely. So what are the repercussions, you would say, of somebody this age?

P.S.:    We don’t really know. My thought is that the risk is it’s not good for the brain long term. With brain cancer, you can never know cause and effect. But I had a colleague who worked with a patient who had brain cancer and, actually, that patient eventually passed. One of the things that was significant was that he played soccer and did a lot of heading the ball. And we talked about it (not with the parents because they weren’t open to that), but we talked about it and both of us wondered if heading the ball a lot was a factor. He had had a few concussions, but a lot of heading. We just wondered if the bruising eventually set up an inflammatory process that could have caused his severe brain cancer. Unfortunately, he passed.

A.C.:   Oh my goodness.

P.S.:    I don’t know. And I don’t want to predict that for the eight year old–

A.C.:   Absolutely.

P.S.:    — but I do think, in some cases, I wonder if that was what was happening. Because the kind of cancer he had at the age he had it and he wasn’t even out of high school is pretty unusual.

A.C.:   So what you’re saying is I think we tend to wait for these labels of, well, “Did you get a concussion? Did the doctor say you had a concussion?” But what about the fact that you hit your head?

P.S.:    Yes, you hit your head…that’s enough. That’s enough! You hit your head and that’s not good.

A.C.:   So it’s not that there are no consequences if it’s not deemed ‘concussion’.

P.S.:    Right, right yeah.

A.C.:   So aside from rest, what natural health products or therapies have you found can be helpful in someone who is recovering?

P.S.:    So a few years ago, I was at a seminar and there was a military medical general there and, in Afghanistan, he was dealing with sappers. Sappers are people who take the IEDs, the explosive devices and they get rid of them and what they do is they collect them, they take them somewhere and they blown them up. He said they get concussed every day in a minor way. They’re not directly hit, there is still some distance, but there’s a blast. And what he noticed was a tremendous amount of mood change and depression when he ran the Beck [depression inventory] for example, lots of depression. So he read some stuff and he put them on very high doses of fish oil. Like 5 grams or more of EPA three times a day and he noticed that when he did that they got significant improvement.

And his commanding officer… he was maybe a major and it was his general or whatever, the order rank I don’t know [laughing]… he just poo-pooed it and said it was no good. Then that guy, his commanding officer, was in an accident himself. The commanding officer’s wife called him and says “my husband isn’t all right, he’s in a pretty bad shape. Would you go see him?” And so he told the guy what to do. Take the fish oil! Then after that, it got accepted.

A.C.:   He had to experience it for himself.

P.S.:    He had to experience it for himself to see that his lower officer knew what he was talking about. And that’s US military.

A.C.:   Right, right. So those small blasts were deemed the cause of depression, not just being part of —

P.S.:    — being in war zone. It was like the small blasts… because he noticed that they were more depressed than other guys.

A.C.:   Interesting. So 5 grams of fish oil.

P.S.:    …and actually this was male and female. A sapper is not a gender specific kind of occupation. So women can do this, men can do it, because it’s more about detection, disarming or blowing it up. Because if you disarm it, you would risk killing yourself. The best way to deal with it is to blow it up.

A.C.:   Right, okay and so that was specifically EPA?

P.S.:    Yes, very high EPA, very high EPA. DHA, is also important because it’s really important for the nerves and brain, I like DHA. But definitely, I could see the EPA as an anti-inflammatory with that and then the DHA to help with memory and movement. So that those I think are really important. Rest is really important. I actually like to use homeopathy if I can figure out a medicine that matches the particular symptoms… the mood or the headache or whatever the kind of symptoms they have. Arnica, NatMur and NatSulph [homeopathic remedies] are the top three that I’ve seen most often.

A.C.:   And you’ve seen that to good effect.

P.S.:    I’ve seen them to good effect.

A.C.:   Ok. In terms of the pediatric population, have you found the same therapies to be effective, of course adjusting for weight, etc.? Yeah! Years ago, I had this mother brought me in her boy and it was, it was hockey.

A.C.:   It’s always hockey [laughs].

P.S.:    Yeah, it was hockey. He had ptosis. So he had one side of his face that was drooped and had been ever since there was a concussion. The doctor just told him – this is before concussions really became a thing – the doctor said “that’s just the ‘new you’”. And he had headaches and all sorts of stuff and the mother came in and she was kind of a lay homeopath. She had taken him to doctors, they had tried a variety of things and so I sort of knew what had not worked. I gave him a different remedy than what I mentioned and the ptosis went away and the doctor was like–

A.C.:   Not the new you!

P.S.:    Not the new you. His headaches went away and his mood improved and she was very happy. I think he was too. He even got back to doing better in school too, so that was good. But I said, you know, you have to think about these sports.

A.C.:   That’s where it’s coming from. So, in your opinion, can natural therapies actually speed up recovery or are they used as enhancers for somebody’s own healing while they’re resting?

P.S.:    Well I think if you give the right things that will reduce the inflammation and get the blood vessels and the brain cells to work better, I think they can speed up recovery. Yeah, yeah, I do think so.

A.C.:   Okay. Just switching now to the topic of Parkinson’s disease. For many years and still today, Levodopa is the pharmaceutical drug that has shown tremendous efficacy.

P.S.:    Yes, Levodopa or Carbidopa is the standard of care.

A.C.:   Could you explain for readers how this works?

P.S.:    What it does is it works on Acetylcholine in the brain and helps the brain to function better. That’s what it does. It works for a period of time and then eventually, the brain no longer responds to it and it loses its effectiveness. But it can work for a number of years in these patients.

A.C.:   Have naturopathic therapies shown similar efficacy, or are they used as adjunct to somebody already on one of these drugs?

P.S.:    Usually, the patients I get with Parkinson’s are already on some medication and they want support. What I do is usually adjunct. Exercise is really important. I have one patient and walking two or three times a day is really critical to reducing that cogwheel gait and the stiffness that comes with that…and the slow speech. So that’s really critical.

A.C.:   Okay.

P.S.:    He’s also very sensitive to temperature. You know our winter… well, they live in Florida for the six months that you can do that, and there he goes for a walk several times a day there as well.

A.C.:   His symptoms are worse in the winter?

P.S.:    Yes for him it’s worse in the winter. So they do much better in a warmer climate. Now I don’t know that all Parkinson’s is like that but it’s the case with him.

A.C.:   In terms of naturopathic medicine, then, treating the person and not the disease. So looking at his specific symptoms.

P.S.:    That works for him, yeah. I mean there have been articles about Niacin, Vitamin B3, being effective in Parkinson’s. Glutathione can help particularly when it is given intravenously. There are a number of things like that which can be beneficial.

A.C.:   Are there traditional treatments that may not have the same presence in peer reviewed literature, but that have a long history of use?

P.S.:    Well there is a doctor, a Dr. Perlmutter, and he’s very fond of B complexes, B12 and Glutathione in an IV push. I don’t know if that’s ever been published as a trial, but I think that it is effective.

A.C.:   Going back to pediatrics, Juvenile Parkinson’s is an unfortunate reality. What is the prognosis considering that upper tolerable limit you were talking about for the pharmaceuticals?

P.S.:    Yeah the prognosis for pediatrics is not good. Yeah, it’s not good. I have actually never treated pediatric Parkinson’s to be perfectly honest so I haven’t actually seen a patient that I’m aware of. But it’s my understanding that the prognosis is poor because it’s such a severe condition and it occurs at such an early age. And Parkinson’s tends to be progressive.

A.C.:   Then when you’ve reached the medication’s top end–

P.S.:    Because you can only take so much… the medication stops working or there are side effects with it and so that’s kind of at the limit with Levodopa or Carbidopa. I mean there’s talk about new stuff I read all the time, but nothing has really made it to the fore that looks good.

A.C.:   What would you advise parents then? There’s something called Deep Brain Stimulation on the horizon now, which is a type of brain surgery.   Would you advise a parent to —

P.S.:    I would say explore it. Explore it. I don’t know if you can do that in Canada. I don’t know if I’ve ever heard of a case here.

A.C.:   I see.

P.S.:    I don’t know but I think it’s worth exploring. You could probably get it in the States or Europe or something like that.

A.C.:   Changing course now to our final topic, Alzheimer’s and various forms of Dementia.

P.S.:    Dementia, right. So I don’t like the term Alzheimer’s, personally, because it’s a diagnosis on autopsy.

A.C.:   Yes.

P.S.:    And it’s a term that is misused. It should be Dementia and then if an autopsy is done and it’s Alzheimer’s, it’s Alzheimer’s. But we can’t diagnose Alzheimer’s. We might be suspicious of it but we can’t diagnose Alzheimer’s until we take the brain and we look at it under the microscope. When somebody says they have Alzheimer’s I say “Dementia? Are they alive? Then they have Dementia.” They don’t have Alzheimer’s until you do an autopsy.

A.C.:   Perfect, thank you for the clarification.

P.S.:    You know it’s a serious diagnosis and I think we need to be honest about what they have. They have Dementia okay, but there are multiple types of Dementia. There’s Alzheimer’s which is associated with plaque in the brain. There are the micro TIAs [transient ischemic attacks], micro circulation issues. There are probably other inflammatory processes when you look at it.

So “Dementia” covers a wide range of things and if you’ve treated patients with dementia as I have, they present differently. You know, Alzheimer’s is typically thought of as the Sundowner syndrome. They get worse in the afternoon, they have the anxiety and all of that sort of thing and if you’ve seen that, that’s probably Alzheimer’s. But then you have the other kinds of Dementia where there are issues with words or issues with focus and so forth. Where you don’t have the Sundowner syndrome, you don’t have all that.

A.C.:   Right.

P.S.:    You see some fine distinctions there which suggests that we need to understand those more so we can treat differently, or more appropriately.

A.C.:   In terms of separating Dementia with MCI and Lewy Body–

P.S.:    Because Lewy Body is a separate type of Dementia.

A.C.:   Yes.

P.S.:    Now that can be picked up pre-death, I believe. I believe there’s a blood test. Because I have had patients who have said they had Lewy Body Dementia or they were highly suspicious. I forget whether it’s genetic or through blood or how that’s done to be honest. But Lewy Body can be worked out a little bit in advance. And they present a little bit differently.

A.C.:   Oh do they? Okay. If somebody is experiencing memory or other cognitive impairments, what would you recommend as the best tests they or their naturopath could perform to distinguish natural physiological aging from an actual Dementia process?

P.S.:    That’s a very good question. What kind of natural test could you do? In Dementia, the decline in memory and function, I would say, is generally more rapid than what you would see with aging. And so I think doing the mini mental status test which is like a 27 point or 28 point test would be a good way to see which areas are a concern. Because that looks at figures, that looks at drawing, that looks at memory, that looks at variety of things to see what areas have weakness and what areas you need to address.

A.C.:   So, the MMSE that you’re talking about it, the Mini Mental Status Examination, somebody that was just aging and was maybe losing a little bit of memory here and there would still perform relatively well on something like that.

P.S.:    Exactly. I recall an individual that was– they went and saw their family doctor which was a new family doctor and so they were a little flustered and they did that test and they performed it very poorly. The doctor said “You have Alzheimer’s. You need to be institutionalized.” The daughter brought her father to me and I– I had seen him before so he knew who I was so I administered the exam. I did it one more time and he actually did very well, he passed.

A.C.:   How was that?

P.S.:    I think it had to do with the situation where he was with that new family doctor who was pushy, that versus knowing somebody and saying “okay, I want you to memorize these numbers and later recall them back to me.”

A.C.:   So a little bit of white coat syndrome.

P.S.:    I think a little bit of white coat syndrome. It’s a big issue. I mean he continued to function quite well.

A.C.:   Oh great!

P.S.:    He passed another six or eight years later in his 90s.

A.C.:   Wow! So that’s a really great point. Not–

P.S.:    Not to jump to conclusions.

A.C.:   Especially when we have these tools that should be useful to us, and then we just pigeonhole somebody. Well you have this and label you.

P.S.:    “You need to be in an institution”…which his daughter thought “what?’

A.C.:   Yeah, let’s get a second opinion.

P.S.:    She thought yes, ok, he’s got some memory issues but he was already in his mid-80s at that point but that doesn’t mean he’s got Alzheimer’s.

A.C.:   Sure, absolutely.

P.S.:    Or Dementia really. It’s a very gradual cognitive decline. Which does happen. Although in some people, you don’t see that decline. I have some 80+ year old patients who are very sharp.

A.C.:   So that was going to my next question – is it an inevitability?

P.S.:    Well, that’s a good question. There was an article yesterday I read that talked about the fact that humans could probably live to be about 105, that’s kind of where we could go, but there’s probably no limit actually with the right kind of health and care.

A.C.:   So if somebody had optimization and prevention, and they were seeing naturopaths their whole lives, if they were working on diet…

P.S.:    The person who most impressed me when I think about it now was Linus Pauling, who won two Nobel Prizes; a Peace Prize and one in Biochemistry. And I remember he came to Toronto, he was 80– either 84 or 88 years old at that time and he gave a seminar which was of an excellent biomedical seminar. He answered questions and he was sharp and to the point. I said “I hope I can be that way at that age”. You would not have known, you would not have said this was a typical 80-year old.

You know Abram Hoffer continued to practice into his late 80s and he was sharp. I knew him personally.

A.C.:   Oh did you? He was the orthomolecular–

P.S.:    Orthomolecular Nutrition, yes, in Victoria B.C. He finally retired, but he could think things through and remember things and discuss things. He wasn’t demented.

A.C.:   So it’s there for all of us! It’s something achievable.

P.S.:    We just have to work on keeping the marbles working.

A.C.:   Absolutely and so what would be the best medicine for that, for prevention?

P.S.:    I think fish oil again is really important. I’m also really fond of Gingko. I’ve seen changes in some people with Gingko and there have been trials (I’m going to speak about some of those trials later next week) that have shown that Gingko can improve function. There was a trial where they gave them Gingko and then they followed up about 12 years later and the ones who stuck with the Gingko actually had the best mental function compared to those did not. There was some memory loss because this was a geriatric crowd in their 70s and 80s and even 90s, but over the 12 year span, the people with the Gingko continued to perform better.

A.C.:   Gingko working on the circulation aspect.

P.S.:    Micro circulation, micro circulation yes.

A.C.:   And fish oil works on that as well?

P.S.:    Right, and inflammation. More anti-inflammatory.

A.C.:   Right, so there’s a laundry list of possible treatments if you are on PubMed: CoQ10, Phosphatidylserine, Caprylic acid…the things you’ve seen work the most–

P.S.:    Yes, phosphatidylcholine, phosphatidylserine… are possibilities, yeah. You know I’m a bit disappointed with CoQ10.

A.C.:   Really?

P.S.:    I mean I see stuff and it’s positive but…I don’t know. It’s not as impressive as I’d like. Not to knock CoQ10 but I just haven’t seen it to be impressive.

A.C.:   Do you mean in terms of research outcomes in the literature or what you’ve seen in practice?

P.S.:    Clinical practice.

A.C.:   Which is ultimately what matters.

P.S.:    Which is what matters. And it’s a pricey supplement so you want to see results.

A.C.:   Absolutely. Conventionally, FDA approved therapies are largely based on blocking Acetylcholine.

P.S.:    That’s right.

A.C.:   Which we know is a neurotransmitter involved in memory and thinking.

P.S.:    Right, they’re acetylcholine inhibitors.

A.C.:   With Ginkgo or fish oils…is there any natural therapy that we know that works in the same way?

P.S.:    That’s a very good question. Off the top of my head, I’m going to say no. I think there are some that imitate it and that I have to watch when I have patients on those but there’s nothing as strong as with drugs. Let me put it that way. Yeah, there’s nothing as strong as the drugs.

A.C.:   As food really is our primary medicine, do you suggest a certain diet to your parents suffering from cognitive decline?

P.S.:    Yeah, so lots of greens and veggies, cut the sweets and carbs, get adequate protein which I think as we get older is really, really important. And get some fresh air.

A.C.:   Get some fresh air!

P.S.:    Get some sunshine and fresh air.

A.C.:   For helping the brain specifically.

P.S.:    Yes. We spend most of our time inside and that’s not how we evolved. I think the outdoors and the light probably have something to do with brain function.

A.C.:   Okay that’s really interesting food for thought.

P.S.:    I can’t prove that but just– just an observation, that’s all.

A.C.:   Have you put patients on a specific regimen?

P.S.:    I tell them, in the summer, “you need to get outside”. Or when children have brought their parents in who have Dementia or are on the edges of something like that, I’ve said, “Do they get outside?” No. “Make sure they get out on the patio or the deck, and then sit there for a few minutes every day.”

A.C.:   Sometimes it’s the simple things. And how about therapies that don’t involve nutritional or herbal supplementation? Acupuncture, hydrotherapy, homeopathy?

P.S.:    Those are all very useful, absolutely. If you can find a picture that matches the homeopathic medicine, yes. With acupuncture, you can certainly do tongue and pulses and figure out what needs to be sedated or stimulated, tonified… that sort of thing.

A.C.:   Last question! As far as prevention goes, what would be your top three recommendations for those concerned about eventual cognitive decline, having a family history or otherwise?

P.S.:    The first thing would be to understand what kind of cognitive decline the family history is. And then, if it appears to be a circulatory thing, then the Gingko might be useful or the fish oil might be useful. If it appears to be an Alzheimer’s type pattern (I’ll use that word) then things that reduce inflammation in the brain: things like EGCG which is from green tea, Quercetin and perhaps phosphatidylcholine or phosphatidylserine are better approaches for something like that.

A.C.:   For the inflammation.

P.S.:    Yes.

A.C.:    Well that’s a lot of information you’ve given us. I really appreciate your time. Thank you for joining us.

P.S.:    You’re welcome, very welcome.