Learn the differences and similarities between Functional and Naturopathic Medicine…

What is Functional Medicine?

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms.

There are 7 basic principles underlying Functional Medicine:

1. Science-based medicine that connects the emerging research base to clinical practice.
2. Biochemical individuality based on genetic and environmental uniqueness
3. Patient-centered care rather than disease-focused treatment
4. Dynamic balance of internal and external factors that affect total functioning
5. Web-like interconnections among the body’s physiological processes also affect every aspect of functionality
6. Health as a positive vitality, not merely the absence of disease
7. Promotion of organ reserve as a means to enhance the health span

How was Functional Medicine Developed?

Dr. Jeffery Bland and his wife developed the Institute of Functional Medicine in 1991.  Dr. Bland is a nutritional biochemist and registered clinical laboratory director.  He is a former professor of biochemistry at the University of Puget Sound, and a previous Director of Nutritional Research at the Linus Pauling Institute of Science and Medicine. He was the first member of the Board of Trustees of Bastyr University, the first federally accredited university in the United States offering graduate and undergraduate degrees in natural medicine and contributed significantly to its founding and accreditation.

Dr. Bland was involved with Bastyr University one of the accredited Naturopathic Medical schools in Seattle, Washington prior to the development of functional medicine. It is also known that the Institute of Functional Medicine has many Naturopathic Doctors on their staff holding positions such as educators, curriculum creation, and even on the board of directors.

What is Naturopathic Medicine?

Naturopathic medicine is a distinct system of primary health care that emphasizes prevention and the self-healing process through the use of natural therapies. Naturopathic doctors (NDs) blend centuries-old knowledge and a philosophy that nature is the most effective healer with current research on health and human systems.

Naturopathic diagnosis focuses on identifying the underlying causes of disease, while naturopathic therapies are supported by research drawn from peer-reviewed journals from many disciplines, including naturopathic medicine, conventional medicine, European complementary medicine, clinical nutrition, phytotherapy, pharmacognosy, homeopathy, psychology and spirituality.

The therapeutic modalities used in naturopathic medicine (including physical manipulation, clinical nutrition, botanical medicine, homeopathy and hydrotherapy) integrate conventional, scientific and empirical methodology with the ancient laws of nature.

The philosophy and the therapies of naturopathic medicine, which have their origins in Hippocrates and the traditional and indigenous medicines of the world, first became a distinct profession in Germany in the mid-1800s. In 1896, Dr. Benedict Lust, MD, brought naturopathy to America and established the first naturopathic college, the Yungborn Health Institute in New Jersey. Naturopathic medicine has since been present in the US for over a century.

The Following Principles Are The Foundation of Naturopathic Medical Practice:

• The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes an inherent self-healing process in people that is ordered and intelligent. Naturopathic physicians act to identify and remove obstacles to healing and recovery, and to facilitate and augment this inherent self-healing process.
• Identify and Treat the Causes (Tolle Causam): The naturopathic physician seeks to identify and remove the underlying causes of illness rather than to merely eliminate or suppress symptoms.
• First Do No Harm (Primum Non Nocere):Naturopathic physicians follow three guidelines to avoid harming the patient:
  • Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat;
  • Avoid when possible the harmful suppression of symptoms; and
  • Acknowledge, respect, and work with individuals’ self-healing process.
• Doctor as Teacher (Docere): Naturopathic physicians educate their patients and encourage self-responsibility for health. They also recognize and employ the therapeutic potential of the doctor-patient relationship.
• Treat the Whole Person: Naturopathic physicians treat each patient by taking into account individual physical, mental, emotional, genetic, environmental, social, and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development.
• Prevention: Naturopathic physicians emphasize the prevention of disease by assessing risk factors, heredity and susceptibility to disease, and by making appropriate interventions in partnership with their patients to prevent illness.

The Similarities and Differences Between Functional Medicine and Naturopathic Medicine:

Functional Medicine and Naturopathic Medicine are similar in many ways including the incorporation of evidence-based medicine, patient centered care, a whole person approach, and treating the cause rather than just the symptoms.

What has happened is that there has been an increase in demand for holistic, patient-centered care. This has lead MDs and DOs to further their education with functional medicine in order to broaden their scope of practice to incorporate nutrition and natural therapies as well as to perform functional testing.  All of which are part of the curriculum of accredited naturopathic medical programs.

The MDs and DOs obtain functional medical education after graduation in order to learn a more natural approach to medicine, whereas NDs are taught this natural approach throughout their medical training.

One of the major differences in comparing these two fields of medicine is the naturopathic vitalistic principle, the healing power of nature.  This principle is what sets NDs apart.  NDs trust in and support the bodies’ innate ability to heal itself.  All naturopathic therapies work in concert with this vital force to enhance and support the healing capacity.  As naturopathic doctors we simply facilitate this healing ability by removing obstacles to cure and giving the body what it needs.

Another difference lies within a similarity. While both fields aim to treat the cause, they have different ideas of the said cause.  From a functional medical standpoint, they are educated on eradication of the microbe leading to disease.  Whereas from a naturopathic standpoint, our education is based upon evaluation of the terrain.  Terrain being the unique susceptibility of the individual based on lifestyle, environment, and constitutional aspects of the person.  This is the basis of why some people become ill while other do not when exposed to the same microbe.

If you are interested in taking a naturopathic approach to health, contact our office at (804) 977-2634 to schedule an appointment with one of our practitioners.

The majority of people can always use some support buffering stressful situations, and herbs are so helpful to support the nervous system long term.

One of the largest areas of health related disease and imbalance today stems from stress. Chronic stress is something we have a serious problem with (especially in this country), and we’ve set the bar way too high in terms of how much stress we choose to live with on a daily basis. High stress is extremely demanding and depleting to our central nervous system (CNS), and can have predictably negative effects on our health as a whole. The central nervous system is responsible for most of the communication throughout our body, and also is our first line of responsiveness and reactivity to external stimuli (like quick decision making, tolerating long term environmental stressors, and reacting to negative external inputs like difficult people or situations).

Below are 5 herbs to support the nervous system that are easy to find, very safe, and effective to use long term for all ages.

1. Milky Oat (Avena sativa)

Milky oat is jam packed with valuable minerals and nutrients and serves as a calming + building + nourishing tonic that is wonderfully soothing to the central nervous system when taken long term (4 months or more). It makes an excellent addition to herbal teas, and can also be taken as a tincture (hydroalcoholic extract) on a daily basis. The oat straw and spikelets are what is used and harvested for the medicinal properties. Being such a building and nutritive tonic herb, it’s ideal for people who have nervous exhaustion and get more and more exhausted as the day progresses. This is great for people who burn the candle at both ends (like new parents) and generally could be much restored from extra rest. Milky oat is a great choice for them.

2. Chamomile (Matricaria recutita)

Chamomile is wonderful as a central nervous system remedy that also has an affinity for the Enteric Nervous System (ENS) that resides in the gut. These two nervous systems are highly communicative throughout the day, with the ENS actually being much more responsive to external and internal cues that we realize. Chamomile is soothing, anti-spasmodic and calming to the entire gut, as well as restoring and relaxing to an overstimulated person. This is an fitting herb for people who hold their stress in their digestive system (like a nervous stomach or IBS patterns) and a tea is optimal for daily use. The tincture of chamomile can be used for acute support, and is ideal to travel with.

3. Passionflower (Passiflora incarnata)

Passionflower supports a depleted central nervous system that presents as difficulty sleeping and an overactive mind. Often when people are so exhausted they can’t sleep, there is a feeling of desperation and anxiety accompanying sleep, and this is where passionflower can be extremely helpful. It allows the body to fall asleep on it’s own terms (it’s not going to knock someone out) and when taken consistently can be a wonderful and gentle sleep remedy to take long term. Passionflower tea is best taken about 1 hour before bedtime.

4. Holy Basil (Ocimum tenuiflorum)

Holy basil is an ideal adaptogen that is specific to the endocrine system and adrenal glands. It’s a tonic building herb that supports a depleted nervous system both short and long term. The adrenal glands are responsible for releasing cortisol, the hormone that deals with both energy needs and our responsiveness to stress. The adrenal glands are one of the most important glands to support during times of acute and chronic stress, and daily holy basil (also known as Tulsi) tea can be most helpful for people who have long term stress and feeling run down, despondent and emotionally low.

5. Skullcap (Scutellaria lateriflora)

Skullcap is perhaps one of the most underused central nervous system remedies, however it’s it one of the most effective, gentle and powerful nervines available in herb form. Skullcap is specific to the musculoskeletal system and is perfect for folks under long term stress that is held in their muscles and joints (especially stiff necks, tightness when sleeping or for those who hold stress in their shoulders and feel tightness there frequently). Everyone responds to long term stress a bit differently, and skullcap works extremely well for people who become agitated, reclusive and feel overexposed when under stress. Skullcap tea can be consumed daily (and combines very well with chamomile).

If you have been under long or short term stress and could use help supporting your central nervous system, schedule an appointment with one of our practitioners at Richmond Natural Medicine. We can custom compound an herbal formula and care plan just for you and your unique situation.

Additional Reading: Mind-Body Stress Relief

Sexual dysfunction, although not uncommon, does not need to go untreated. Naturopathic medicine can readily address many common sexual concerns and issues.

Sexual practices and preferences may vary by individual, but it’s safe to say that for most people, a healthy lifestyle includes a healthy sex life. Unfortunately, for many people, this is not the case. There are many issues that can disrupt a healthy sex life, so it’s important to discern what the issues are, for each person. This is where naturopathic medicine shines – we are experts in finding the root cause of dysfunction. With regard to sexual difficulties, concerns can certainly stem from physical and structural issues, but often also include mental, emotional or spiritual issues. When addressing the topic of sexual difficulty with someone, we want to make sure to look into the cause behind these issues and address them accordingly.

Some of the more common physical reasons for sexual difficulty and our approaches to them include:

Menopause-related changes like vaginal dryness and thinning of vaginal tissue – this is very common and normal with aging, as levels of estrogen drop. However, it can make sex very uncomfortable or even painful and should be addressed.

Our approach: Supporting the vaginal tissue and ecosystem with local applications and systemically with herbs and homeopathy often works quite well to alleviate these symptoms. We will also want to balance hormone levels and overall health can help to keep vaginal tissue strong and lubricated over time.

Erectile dysfunction (ED)– on a physical level, this is usually due to either cardiovascular issues and/or “andropause” (the natural lowering of testosterone levels with aging).

It is very important to rule out cardiovascular disease as the first step in addressing ED, as this is often one of the first signs of atherosclerosis (the forming of plaques and hardening of the arteries). If that is determined to be the cause, addressing cardiovascular health, including inflammation and lipids, will be the focus.

If a low level of testosterone (adjusted for age) is determined to be the cause, we will want to address hormone balancing as the main objective. One key here would be looking at what is causing the imbalance, which can be anything from abdominal adiposity (which causes higher conversion rates of testosterone into estrogen) to exposure to endocrine-disrupting chemicals and so on.

Our approach: Focus on the cause, per above, and support normal physiology and hormone levels via herbs, homeopathy, nutrition and lifestyle counseling.

Low libido – this comes up fairly regularly for both men and women in our practice. Again – it’s important to determine if this is stemming from a physical issue, like hormone imbalance, or if it’s something related to a relationship, desire, etc. Herbal medicines, homeopathy, and supplements aimed at improving libido via hormone balancing and adrenal health are typically quite helpful in this arena if the cause is physical.

Mental and emotional concerns are also of paramount importance when addressing sexual health and are considered and addressed as needed. Some common causes of sexual dysfunction in this arena include:

• Anxiety
• Depression
• Fear
• Trauma
• Abuse
• Relationship issues
• Lack of safety
• Communication difficulties

Of note: Past trauma and abuse is something that often comes up for folks when looking at sexual history or investigating the cause of his/her sexual difficulties. Naturopathic doctors will discuss this history with their patients if the patient feels comfortable, but it can often be helpful to have additional practitioners on board for support, such as a counselor or therapist. We will discuss these options with you if desired.

Some additional assessment is often quite useful when looking at issues with sexual function and can include any or all of the following:

• An extensive review of one’s health history with your naturopathic doctor to look at symptoms, timing, patterns, potential causes, etc.
• Reviewing recent blood tests or screening lab work you’ve had done, such as thyroid and reproductive hormone levels, CBC, CMP, lipids, etc. If you haven’t had these done, we may request that you have them ordered by your primary care doctor or gynecologist.
• A physical exam by your primary care doctor and/or gynecologist may also be requested, as needed.
• Assessment tools like saliva and urinary assessments to look at adrenal and reproductive hormone levels and their metabolites.

As with any other area of concern we are working on with folks, we want to look at underlying root causes of what is going on, in order to facilitate more complete and lasting healing. If you have concerns about your sexual health, call our office or request an appointment here to schedule with one of the naturopathic doctors at Richmond Natural Medicine.

We recently passed the second “detox” benchmark of the year: the first day of spring is a popular time to focus on cleansing and detoxing (right after the New Year, of course), and the arrival of spring is indeed a more appropriate time to do such a thing. With much more upward movement and energy, the body is now “waking up” and dusting off the cobwebs of winter hibernation. New foods are popping up, more colors are emerging and more energy is flowing through our veins. The body is also becoming more active and awake, and we have a natural tendency to want to eat more green goodies like salads, juices, fresh veggies and fruits! Now that all these foods are becoming available, it’s a wonderful time to focus on their contributions to our cleansing and detoxification processes and support our natural ability to cleanse every day.

The human body is extremely efficient at utilizing every single thing you put into your mouth. Every day, your body goes through a complete cleansing ritual without you even trying, and your foods play a major role in how thorough and complete that cleansing process happens. The farther away we get from eating real foods, the more difficult the body deals with processing those nutrients, and the more probable it becomes to store away toxins in the liver and other organs that are not fully eliminated.

Every organ system, including the lungs, liver, skin, colon, kidneys, lymph and sweat glands play a role in processing our inputs, and every single cell in the body must eliminate waste throughout a 24 hour cycle. The liver is the major player in the detoxification system, and we will go into detail about all of that in my upcoming class, Spring Ayurvedic Cleansing with Whole Foods & Herbs on April 5th.

Probably the best way you can support natural cleansing and detoxification is through your DIET, especially in every single serving of vegetables. My daily motto is “eat the rainbow” – the more colorful the better, and here’s why:

Characterizing by color

Purple Vegetables- Nourish the blood; Tones cardiovascular system; Contains
anthocyanins, to strengthen capillary tone; high in antioxidants
Examples: eggplant, red onion, purple cabbage, beets, blueberries

Red Vetetables – Contain lots of lycopene, great for the heart and cardiovascular system
Examples: Tomatoes, (even pasta sauce & salsa for really depleted people).

Orange Vegetables – Contain beta carotene which is important for immune system and
essential for cell-to-cell communication.
Example: Carrots, golden beets

Green Vegetables – Especially dark leafy & brassicas are important for multiple organ
system detoxification; useful in hormonal imbalance; increases liver detoxification (gets rid
of excess hormone supplies); LOADED with vitamins and minerals.
Examples: kale, broccoli, bok choy, Chinese cabbage, spinach, swiss chard, beet greens

White/Green- Extremely nutritive to immune and lymphatic system.
Examples: garlic, onions, leeks, chives

There are so many aspects to cleansing the body, nurturing the organ systems and keeping the emotional and spiritual guiding principles intact while nourishing the body with good foods. In my upcoming class, Spring Ayurvedic Cleansing with Whole Foods and Herbs, at Richmond Natural Medicine on April 5th at 5:30, you will be guided through selecting appropriate foods for your unique body type and given instruction on how to complete a 3-day holistic kitchari cleanse using whole foods and digestive supporting herbs. Additional recipes, food lists and tea recipes will be provided to enjoy for the rest of the season to maintain balance and nourishment and deeply support every organ system.

What will you receive?

• Group meal of Kitchari and custom blended digestive tea
• 15 + page booklet of cleaning notes + additional customizable food lists & recipes.
• Guidelines & instruction on a 3-day holistic kitchari cleanse + before and after meals and teas to support the immune system and building of a healthy digestive tract.
• Herbal medicine notes for digestive supporting and detoxifying herbs to use for every season.
• Basic Ayurvedic constitutional assessment to assess foods best suited for your cleanse and for daily consumption.
• Q&A with Lindsay Kluge, M.Sc, CNS, LDN, Clinical Herbalist & Licensed Dietitian Nutritionist.

For more information on this upcoming class call our office at 804-977-2634 or check out our events listing for online tickets. 

We are all striving to be “healthy” but what does that entail and how do we attain it?

When you think of your entire lifestyle, is being “healthy” just one part of your life, like your blood pressure, your stress level, your digestion, your relationships or your diet? I’m sure you can find resources out there for the healthiest way to deal with stress or the healthiest way to nurture your relationships, or the healthiest diet on the planet. But truthfully, if we focus on just one single area trying to perfect it to a state of what we’re told is “healthy”, we’re often missing the big picture, and we often struggle to make it feel just right for what we need. That’s because, in my opinion, there is no such thing as “healthy”.

There is such a thing as Mindful Health, which is always changing as your body changes, and as your lifestyle changes.

Mindful Health encompasses everything – from the big things in life to the small, from the tiny parts of your diet to the larger staples of nutrition. My desire as a Nutritionist is to make sure your dietary inputs are reflective of your body’s needs, your lifestyle parameters, and conducive to your entire whole body picture. That includes your stress levels, your job, your family, your current and past medical history, and of course your current state of health. That ends up making nutrition just one part of your overall health – and consequently much more manageable.

As you focus on making dietary changes, it’s always very easy to feel overwhelmed with how to do it the “right way”. Should you be counting calories? Fat content? Avoiding inflammatory foods? Avoiding grains? Avoiding starches? Eating more green vegetables….or orange ones? When we can step back to look at the big picture, we might notice that other areas in life need to be addressed and adjusted before nutrition can even begin to be successfully and sustainably changed.

For example, I have seen several patients who for years struggled with making their diet “healthier” and/or their weight loss and eating habits successful and sustainable but could never reach their goals. Their dietary habits were all over the place, and they always felt a sense of failure when they just couldn’t stick with a recommended strict dietary protocol. After we worked together for a few sessions, it always became clear that their sporadic and perpetually negative eating habits were a small but clear reflection of many other aspects of their life which also held them in a negative cycle, leaving them feeling helpless and angry. Food was often their comfort when other areas of life were not leaving them feeling satisfied.

Although their immediate goal was to improve their overall nutrition, we always needed to look at the bigger picture and focus on why those behavior patterns persist. We needed to explore the other areas of their life that were holding them back from making positive changes. If we continued to focus on just nutrition alone, they would likely fall back into those same negative patterns. Trying to work on one piece of a puzzle while ignoring other ill-fitting pieces doesn’t make for a sustainable approach. Often, they will not see the changes they want to see in their body (nutrition inputs/weight loss/health improvements) unless they make necessary changes to their lifestyle first.

So when it comes to making positive nutrition changes to support your Mindful Health status, begin by making two lists. The first list will include all of the things in life that are going well. This should include people who support you, things you’re grateful for, things you’re happy about, and also things that will ultimately support you to mentally and physically want to stay focused on a holistic nutrition lifestyle. When looking at this list, pick one thing (or more!) that you can implement every single day that will remind you to stay the course and stay positive about your nutrition goals. The second list will include all of the things not going so well. This should include lifestyle habits that do not hold a positive influence for you, (ie. bad habits), people in your life who leave you feeling not your best self, situations you find yourself in daily that make you angry, job situations, family situations, financial situation etc. Ultimately, this list should represent to you the areas in life that are holding you back from making positive changes. When looking at this second list, pick one thing that you can actively change or dismiss from your life. It doesn’t have to be a big thing. Just reducing this list tiny amounts at a time will offer big results over time.

By presenting yourself with these written lists, it’s much easier to see that your overall state of “healthy” is not reliant on just one thing. It should show you that many, many things in your lifestyle either contribute to or detract from you feeling your best self. Nutrition, in turn, is just one part of that, and subject to the many other moving pieces of your life. Take small, manageable steps – they really do add up! 

Not every population or demographic can obtain all of the nutrients that they need from their accessible food source alone, and that’s when supplementation can be beneficial.

For about 5 years, I worked in the supplement industry of small health food stores learning the in’s and out’s of hundreds of different formulas and manufactures. At first, this was a job to tide me through graduate school while I was learning the intricate in’s and out’s of nutrition and clinical practice.  Fast forward to the present day, and it’s sometimes tricky to separate the two between whole food nutrition (the ideal), and nutrition in pill form (the substitute). As a nutritionist, I’m usually working with both. A large part of my goal during my one-on-one nutrition consultations is to weed through a sometimes lengthy list of supplements and end at a minimal list of supplements while keeping whole food nutrition at a maximum. It’s always my goal to get as many nutrients on your plate every day as possible, and through a detailed inquiry of your daily nutrition, get an idea of how we can feasibly do that together and supplement with only the things that are dramatically lacking in the diet.

But not everyone can see a nutritionist, and not everyone has access to customized nutrition plans or a wide variety of foods. And that’s when supplements can play a contributing role in a comprehensive health plan.

When I counsel people about when and how to choose supplements, I usually have five guidelines:

1. If you have access to good quality foods that are affordable and available, always choose whole foods first over supplements. Do not purchase supplements in order to substitute for good nutrition if you have access to good quality, pure foods (i.e – just because you take your multivitamin every day doesn’t mean you can skip out on eating your vegetables).
2. If you feel like you need to supplement with something (like a multi-vitamin or supplemental minerals or essential fatty acids for example), make sure it’s good quality and from a reputable store or manufacturer. The supplement industry is not regulated, so knowing that the company has third party testing, organic standards and is non-GMO are all good things to look for.
3. Before you go on the internet to read about all the things you might be deficient in, get tested for vitamin and mineral deficiencies before spending hundreds of dollars on supplements you may very well not need.
4. Always try to get a 100% food-based supplement (not just extracted solitary minerals) for optimal digestion and absorption. You want your body to absorb as much as of that supplement as possible, and in a “food-based” form, it’s much easier for the digestive system to do this.
5. Do your research on what you should be taking before going into the store to purchase supplements. Folks that work in supplement departments legally cannot give you any advice whatsoever about what to take for anything, but they can educate you about the different brand choices and quality standards. Do not expect supplement stewards to tell you what to take for your given issues. Most simply do not have the training to do this, and legally they’re prohibited from giving you that kind of information.

We are extremely fortunate that most of us have access to a decent amount of good quality foods, however, for many people this is not the case. Not every population or demographic can obtain all of the nutrients that they need from their accessible food source alone, and that’s when supplementation with multi-minerals, multivitamins and omega-3 based oils (essential fatty acids) are ideal to incorporate into the diet. Supplements can add up quickly, both in quantity and in price, and it’s my opinion that you get what you pay for when it comes to quality supplements.

Another excellent rule of thumb (that I see over and over again during my nutrition appointments) is that if you have a cabinet full of supplements that you take every day, and you don’t remember why you’re taking a particular supplement, re-visit that and either research why you were taking it in the first place and educate yourself on whether you need to continue. Supplements, just like any part of a health plan, should change and shift as your health changes and shifts. You don’t necessarily need to take a supplement indefinitely.

If you’d like to get a more thorough understanding of your nutrition needs or need further guidance on selecting appropriate supplements for your health plan, consider making an appointment at Richmond Natural Medicine with one of our practitioners.

I can almost guarantee that anyone who goes into a grocery store, picks up a packaged, processed and otherwise unrecognizable item off of the shelf and takes it home for dinner will at some point (at least subconsciously) ask themselves, “Do the benefits outweigh the risks?”  We have a lot of blind faith in the food and supplement industry that whatever is in the package or supplement bottle is, in fact, safe and real food. It’s hard to know sometimes. Food labeling laws are becoming more lax. “Food-like substances” are becoming more the norm, and the supplement industry is questionable at best sometimes. Quite often, I’m confronted with the quandary from patients about fish oil – is it safe? Should they take it? What about heavy metals? And, most importantly, Do the benefits outweigh the risks?

So here’s the scoop on fish oil.

Touted for it’s cardiovascular protecting benefits, it was recommended to increase fatty fish consumption soon after the publication of a 1980 study on Greenland Eskimos (with a diet high in fatty fish) and their unusually low risk for coronary heart disease. Following further clinical research, fish oil was shown to benefit patients with high cholesterol, reduce the chance of stroke, aid in clinical depression and even help age-related macular degeneration. More and more clinical studies are coming out now encouraging us to supplement with fish oil high in Omega-3, DHA and EPA, and the popularity of fish (and fish oil) had soared. With all of this new interest in the health benefits of fish, demand has skyrocketed and the harvesting practices of cold-water fish have really taken a hit. Enter Good Manufacturing Practices (GMP’s) into the mix.

Good manufacturing practices (cGMPs) are regulatory requirements that provide guidelines for procedures and documentation necessary to assure that the product produced has the identity, strength, composition, quality, and purity it is represented to possess.

To keep up with demand, millions of pounds of fish must be harvested and processed every year, sold “fresh” to the supermarkets or turned into supplemental form fish oil. Like any food (especially animal derived) the FDA must oversee the manufacturing of the actual fish for the safety of the general public pretty scrupulously. However, the FDA does not regulate dietary fish oil supplements. That’s up to the individual manufacturers, hence where a concern arises. The International Fish Oil Standards Program (IFOS) was established as a third-party testing agency to test supplemental fish oil for three main criteria: Omega-3 content, contaminants, and stability. This ensures that fish oil sold commercially has a guaranteed level of omega-3, is virtually free of heavy metals and is manufactured in a stable manner (not denaturing the oil in processing) to ensure freshness. Not all manufactures ensure their fish oil is tested with the IFOS, unfortunately. That is not a requirement.

 Risks

Fish does have the potential to be contaminated with high levels of mercury and other environmental chemicals (depending on where it was harvested). Mercury is all over the planet from natural sources like volcanos to more man made sources like coal fired electric power plants and chlorine production. It is recycled through rainwater into our oceans and streams and into our soil. Mercury is generally not well absorbed by the human body and cannot cross into tissues or the placenta. However, mercury is often converted into organic methylmercury via microbial activity while still in this recycling process. This methylmercury is the main concern because it can be easily absorbed into the body, transport into tissues and even affect fetal health. This happens within the fish (hence the higher absorption rates in fatty fish like salmon, sardines & tuna) and in effect into our own bodies. If the fish is living an area high in mercury, any supplement made from that fish will also contain mercury.

There is also the risk of PCBs and Dioxins in fish oil supplements. PCBs were once used in industrial processes as synthetic organochlorine compounds until the late 70’s when they were prohibited. Dioxins are the by-products of organochlorines from things like pesticides, paper bleaching, and the production of polyvinyl chloride plastics. These chemicals can persist in the environment for decades and still be present in some foods. Dioxin use has been significantly reduced since the late ’80s, however, it is still in use in some places. Both PCBs and dioxins have been found to be carcinogenic in humans and especially present in some meat products (beef, chicken, and pork), some vegetables and dairy products. Fish products were thought to contain a lesser amount, however, with recent testing, farmed salmon was shown to contain the same amounts as the before mentioned foods.

Finally, there is the issue of freshness. Fish oil, like any oil, can go rancid and has a finite shelf life. When you’re taking something in a capsule, most companies take extra care that everything looks the same, has no smell, and especially with fish oil, you shouldn’t even be able to tell you’re taking fish (the taste is not fantastic). So how are you to know if you’re taking a fresh capsule or a rancid one if it has been chemically treated to have no smell? Good question. This is why I always encourage my patients to purchase fish OIL, not in a soft gel. Smell your food and taste your food folks – its important on so many levels. Unless it comes from a super reputable source, stick with the liquid fish oil.

So what to do? Personally, I believe that eating fish or supplementing with fish oil actually does have more health benefits than risk. Fish oil is high in Omega-3 and omega-9, essential fatty acids that are essential because our bodies cannot make these fatty acids on our own. We must get them from food. The protective effects of fish oil for our cardiovascular health, joint health, brain health, and cholesterol health (among so many other benefits) cannot be ignored. I also think where you get your fish is the most important factor in this puzzle. When purchasing fish at the store, aim for variety. Don’t stick the same type of fish all the time. Also, get organic fish as much as possible and local whenever available. And, wild-caught fish as often as possible (there are fewer chemicals and antibiotics in wild-caught fish). ASK WHERE THE FISH CAME FROM. Stores need to know you care about this or else they will not care where they purchase it from.

When purchasing fish oil supplements, look for the IFOS seal and also that it is extra virgin cold-pressed. Ideally, your fish oil supplement companies will harvest sustainably and not use high heat multi-step processing on their oils either. Do not buy the cheapest brand out there. That is a hands-down way to get poor quality fish oil.

In my experience, the best brands I have found are Nordic Naturals, Carlson, and New Chapter.

You can also talk with your health care provider or nutritionist about appropriate dosing and where to find a good source. Ask questions and make sure to do your own research!