Advanced Naturopathic Case Taking: Case Analysis: Antecedents, Mediators & Triggers

Question 1

Antecedents

Answer 1

Antecedents are predisposing factors to a disease, and include:

• Genetics and constitution:
  o Constitution (e.g. hot, cold, moist, dry), and the energetics of the individual’s life stage (i.e. in teenage years, there is a tendency towards conditions of excess heat e.g. acne).
  o Diseases in family (i.e. parents, brothers, sisters, grandparents, aunties, uncles).
• Age and sex:
  o For example, older women are more susceptible to developing osteoporosis due to the effects of declining oestrogen on bone density and normal ageing changes. However, these are compounded by other factors (i.e. lifestyle, diet).
• Lifestyle / environment:
  o Nutritional deficiency e.g. folate and neural tube defects.
  o Dietary toxins (e.g. pesticides, additives) and alcohol use.
  o Drugs (e.g. antibiotics and the subsequent impact on the microflora and immune development; tonsillectomy).
  o Other toxins: Pollution, heavy metals.
• Historical trauma:
  o Physical or emotional trauma e.g. accident, surgery, shocking events, abuse, labour.

Question 2

Genetics:

Answer 2

Each person is genetically unique, which is evaluated by genomic testing and family history e.g. coeliac.
* Genes can switch on or off, due to the environment.
* This means two things —genetics can influence the person, but the expression of genes can be altered throughout (eating junk / organic food; smoking / detoxing) —switching genes on or off to create or prevent the disease.
Congenital factors can be affected by:
* Gestational environment during pregnancy. Low / high birth weight and infections.
* Environment on the epigenetics of the baby.

Question 3

Epigenetics

Answer 3

The study of modifying gene expression rather than the genetic code itself.

Question 4

Genomic testing

Answer 4

Analysis of genetic material to detect genetic predispositions.

Question 5

Trigger

Answer 5

Anything that initiates an acute illness or the emergence of symptoms. Common triggers include:
* Physical or emotional trauma —‘never been well since…’
* Microbes e.g. H. pylori, food-poisoning microbes
* Medications e.g. antibiotics (eczema after vaccination).
* Dietary allergens and / or chemicals.
* Stressful life events (divorce, problems at work).
* Environmental toxins and toxins in the home.
* Temperature change e.g. asthma and osteoarthritis in winter.

Question 6

Assessing triggers

Answer 6

Requires comprehensive case-history taking:
* Medical history, illnesses, surgeries, vaccinations, current and past medications, pregnancies, major emotional events.
o Ask: If there was a critical incident when their health changed.
o Use ‘open-ended’ questions: E.g. “when did it start?”, “what happened at the time of onset?”, before gradually funnelling into more closed questions for clarification.
o Lab testing for trigger factors: Parasitology, dysbiosis (stool testing), heavy metal toxicity, hair mineral analysis (e.g. from a mercury filling).
o Other forms of testing: Kinesiology (muscle testing), NAET(an allergy elimination technique, www.naet.com), Bio-resonance (machine to measure and positively influence EMFs).
EMF= electromagnetic frequencies

Question 7

Mediators

Answer 7

Factors that contribute to pathological changes and dysfunctional responses. These factors can include physiological and emotional changes, but as naturopaths, we must still establish what is causing this.
* Physiological mediators (with example causes) include:
o Chronic stress - hormones (e.g. due to work problems) can = ↑cortisol + ↓ progesterone. This can be associated with menstrual problems, for example.
o Intestinal dysbiosis- neurotransmitters: (e.g. caused by a western diet, antibiotic use etc.) = ↓ melatonin, ↑ oxidative stress
o Sedentary lifestyle - neuropeptides: ↑ substance P = ↑ pain

Question 8

Mediators (biochemical):

Answer 8

• Free radicals: Increased risk of Alzheimer’s and cardiovascular disease due to free radicals produced from smoking, alcohol, a highly-processed diet, medications, vaccines etc.
• Electromagnetic frequencies (EMFs): For example, TVs, computers, Wi-Fi, mobile phones and electrical wiring can disrupt sleep (lowering melatonin). Melatonin is crucial for its anti-oxidant, circadian rhythm-regulating and tumour-surveillance properties.

Question 9

Common mediators - Cognitive/emotional:

Answer 9

Cognitive/emotional:
* Fear of, and level of pain.
* Personal beliefs about illness and lack of relevant health information.
* Poor self-esteem
* How might someone feel after being told that their illness would last four weeks? Four months? Forever? How might this influence the client?

Question 10

Common mediators - Social / cultural:

Answer 10

Social / cultural:
* Reinforcement for staying sick (e.g. supported emotionally and financially whilst sick, but not when well).
* Lack of resources due to social isolation or poverty
* Lack of cultural understanding.

Question 11

Assessing biochemical mediators

Answer 11

Lab testing may be helpful to discover:
* Inflammatory mediators: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum ferritin, calprotectin.
* Endocrine mediators: TSH, T4, fT4, fT3oestrogen metabolism, progesterone, testosterone, cortisol, DHEA, HbA1C.
* Knowing these and where they fit in the disease process can be extremely helpful in reducing symptoms, and in preventing further disease processes.
* Tests = blood, urine, stool, saliva.