Browsing Posts published in June, 2011

    Medium-chain triglycerides (MCT) have unique characteristics relating to energy density and metabolism giving them advantages over more common long-chain triglycerides (LCT). Human consumption of MCT oils is low since naturally occurring sources of MCTs are rare; however, those sources include milk fat, palm kernel oil and coconut oil.

    MCTs are less energy dense and highly ketogenic compared to LCTs. First, the energy density of MCTs is less than that of LCTs due to their shorter chain length. MCTs provide about ten percent fewer calories than LCTs; 8.3 Cal per gram for MCTs versus 9 Cal per gram for LCTs. MCTs also differ from LCTs in their metabolic pathway because they are easily oxidized and utilized as energy, with little tendency to deposit as body fat. Consequently, the intake of MCTs can decrease caloric intake and potentially decrease body weight and body fat in the long term.

    The literature supports that MCT oil increases energy expenditure and decreases body fat in the majority of studies in both animals and humans. In addition, MCTs may have a greater effect in overweight subjects as opposed to normal weight or obese subjects. Overall, short-term intakes of MCT oil have been shown to promote weight loss; however, chronic intakes of MCTs have shown various effects on energy expenditure, body weight, and fat mass. Yet, appetite control may play a bigger role in weight loss in long-term feedings of MCTs. The exact mechanism for the satiating effects of MCT is unknown, but may perhaps be explained by the distinctive energy density of MCT or the increase in fat oxidation. These studies suggest that replacing LCT with MCT oil could generate body fat loss over long periods of time, with or without reduced energy intake.

    Studies provide varying results concerning the influence of MCT on lipid metabolism such as increased TG concentrations. In addition, several studies have reported that MCTs do not affect blood cholesterol levels(94,95,98-100); however, others have reported hypercholesterolemic effects of MCTs due to their high saturated fat content. Therefore, the incorporation of other functional foods, such as conventional oils, essential fatty acids or plant sterol may minimize the risk of negative effects of MCT on blood lipids while optimizing decreases in body weight and body fat accumulation. In addition, the ingestion of MCT incorporated into the diet does not appear to cause any adverse symptoms.

    MCTs are easily included in food products without negatively affecting their taste or producing undesirable effects. MCT production is cost-effective compared to other oil-based functional foods. The short-term efficacy of MCT is proven; however, long-term effects of MCT still need to be examined more carefully. Overall, MCT shows a good AECES model and demonstrates the greatest potential for use as a functional fat for weight control.

    All cooking oils naturally contain small quantities of diacylglycerols (DAG), ranging from 0.8% in rapeseed oil to 9.5% in cottonseed oil.39 In addition, DAG is produced in the digestive tract as a metabolic intermediate, as 1,2-diacyl-sn-glycerol (1,2-DAG) or 2,3-diacyl-sn-glycerol (2,3-DAG), after the ingestion of TG.40 In recent years manufacturers have developed an enzymatic process to produce 1,3-diacyl-sn-glycerol (1,3-DAG) by migration of the acyl group with the reverse reaction of the 1,3-specific lipase. DAG oil can be easily incorporated into food products since it is similar in taste, appearance, and fatty acid composition to other oils.

    It is the specific structural differences of DAG isomers and not the fatty acid composition of DAG or TG that appear to explain the different action on lipid metabolism and body weight. The main end products of lipase action on 1,3-DAG are glycerol and free fatty acids, which may be less readily re-synthesized to chylomicron TG. Moreover, larger amounts of fatty acids from digested DAG may be released into the portal circulation rather than being incorporated into chylomicrons, compared with TG oils. In addition to producing lower TG content of chylomicrons, lower serum TG levels in a fasted state and in the postprandial state occur after DAG ingestion. This hepatic exposure to fatty acids by increasing DAG intake may lead to greater fat oxidation by the liver than following TG intake. Enhanced fat oxidation may lead to increased satiety. Thus, decreasing caloric intake may induce a decrease in weight and fat loss in long-term DAG feedings.

    While certain studies indicate that 1,3-DAG has a positive outcome in animal and human trials, other studies show no effect on body weight63-67 or TG levels. This lack of effect may be due to insufficient doses used (10% in the diet) or the heterogeneity across subjects used including overweight or obese versus normal weight individuals. Overweight and obese subjects could have defective fat oxidation; thus, higher fat oxidation may produce greater weight loss. Although the use of DAG oils for weight control is promising, much remains to be clarified regarding the mechanism of dietary DAG.

    DAG oil studies do not indicate any severe adverse health effects related to its consumption. However, it still remains to be seen how DAG oil intake will affect humans on a long-term basis as well as synergistically with other nutrients.

    Overall, DAG oils are easily incorporated into foods without affecting palatability, but have slightly higher costs than conventional oils. The AECES model for DAG shows it being a generally appropriate functional food for weight control; however, DAG oil has not yet been a huge success with consumer acceptance due to conflicting studies on the efficacy of the product. Overall, DAG oil demonstrates potential as a weight loss agent, but future research is needed to elucidate mechanisms responsible for its action on weight loss.

    p>Conjugated linoleic acid (CLA) is a collective term for a group of positional and geometrical conjugated dienoic isomers of linoleic acid that are found in dairy products and meat.3 The cis-9, trans-11 CLA is the principal dietary CLA form, but lower levels of the other isomers (trans-10, cis-12 CLA, trans-9, trans-11 CLA, and trans-10, trans-12-CLA) are present in food CLA sources. Naturally, CLA is produced in the rumen of ruminant animals by the fermentative bacteria that isomerize linoleic acid into CLA.

    Mechanisms of action of CLA include: enhanced thermogenesis, increased satiety, augmented fat oxidation, reduced fat cell size as well as fat deposition, increased apoptosis of adipocytes and altered preadipocyte differentiation. Potentially, the combination or additive effects of all these mechanisms of action of CLA may lead to changes in weight and body fat, as no single mechanism fully explains CLA action.

    Studies have shown that CLA, specifically the trans-10, cis-12 isomer, can reduce body weight and fat mass. Most animal studies associated with feeding CLA have shown that CLA lowers body fat and energy retention as well as increases energy expenditure, thereby decreasing weight(7-10); yet, others have shown no effects on weight.(11-14) This may be due to the dose or the CLA isomers used in animal studies. Results demonstrate that body weight and/or fat mass of animals were not affected when they were supplemented with low amounts of CLA mixture (0.5% in the diet), which contained about equal amounts of the trans-10, cis-12 isomer and cis-9, trans-11 isomer. Yet, weight gain was similar to control when high amounts of CLA mixture with mostly the cis-9, trans-11 isomer were given. However, most human studies have not been able to replicate the magnitude of weight lost. Only a few human studies suggest that CLA supplementation has reduced body fat and other studies did not show any effect. The variety of species used in studies may also explain the discrepancy of results obtained.

    In animals, CLA supplements appear to have some undesirable side effects such as induced insulin resistance as well as fatty liver and spleen. These animal studies also demonstrate that CLA may have detrimental effects on plasma lipids. Human studies also show evidence that CLA may adversely influence health, in particular insulin sensitivity and blood lipids, but the results are conflicting. CLA is widely available in capsule form that improves its oxidative stability, therefore having an appropriate matrix, cost, and sensory quality for consumers. However, the efficacy of CLA is questionable because the animal evidence is more convincing than the human data. The lack of clarity on the mechanism of action can explain the inconsistencies in the research results. In addition, human studies should be carried out to determine the long-term effects of CLA and whether any adverse outcomes occur. In summary, the data available from literature demonstrates a poor AECES model. More research is needed to investigate the efficacy and the safety aspects before CLA will have optimal consumer acceptance.

    Numerous functional foods have been examined for their potential as weight-loss agents. To evaluate the future of functional foods, the AECES model has been developed to verify the following: Acceptability, Ease of formatting, Cost-effectiveness, Efficacy and Safety. The goal of this review is to assess three oil-based weightloss functional foods, including: conjugated linoleic acid (CLA), diacylglycerols (DAG) and medium-chain triglycerides (MCT), in terms of the AECES model for consumer acceptability. First, CLA is an overall poor AECES model due to its weaknesses in the efficacy and safety aspects since most of the evidence of CLA is based on animal studies. Secondly, oils rich in DAG, specifically the 1,3-isoform, have an appropriate AECES model. Although, the efficacy still needs more research to determine the exact mechanisms of action for DAG-rich oils. Thirdly, MCT oils exhibit a good AECES model; nevertheless, the long-term efficacy of MCT needs to be further explored. The capability of these three functional oils as effective anti-obesity agents is substantial, yet further investigation should be conducted to determine the missing gaps in research and to accomplish satisfactory AECES model for market acceptance.

    Obesity is at the forefront of global health issues as it directly contributes to many chronic illnesses. Excess weight is the result of an imbalance between energy intake (EI) and energy expenditure (EE), by which surplus EI is stored as triacylglycerol (TG) in adipose tissue. Overweight and obese consumers often turn to natural health products to help support and maintain their weightloss program. Although the weight management industry is large, most of the weight-loss supplements on the market have not been scientifically proven to be effective.(1) Recently, several natural health products have shown promise in the treatment of obesity, some of which are oil rich in conjugated linoleic acid (CLA), diacylglycerols (DAG) and mediumchain triglycerides (MCT).

    The AECES model has been developed by experts in the nutrition field to determine the future of functional foods in the marketplace. Five criteria can be used to evaluate the potential of functional foods and nutraceuticals, including: acceptability, ease of formatting, cost-effectiveness, efficacy and safety. This is known as the AECES model. A “good” AECES model includes the following characteristics: easily incorporated into a suitable matrix and diet, acceptable cost to manufacturer and consumer, ability to produce a desired effect and lack of major side effects. All the components of the AECES model are closely interrelated sharing the same final goal: consumer acceptability of the functional food. The range of “appropriate” to “poor” in the AECES model would be assigned to functional foods that either lack data or provide some negative research results in one or more of the model criteria, which would lead to decreased consumer acceptance of the functional food. The purpose of this review is to examine the role of functional foods in health promotion, in relation to body weight and circulating lipid levels, such as oils rich in CLA, DAG and MCT oils. Particularly, this review is intended to evaluate these functional oils in terms of the AECES model for consumer suitability.

    I would like to take this opportunity to also thank Dr. David Tallman for taking on the task of publishing the journal. Without David’s commitment, this journal’s publication in hard copy format would not have been possible. I can say that given the track record of NDNR, I have every confidence that this journal will be something we can be proud of. Furthermore, we are absolutely committed to having no external financial or industry influence impinge on the editorial integrity of IntJNM. The editorial board of IntJNM brings together a number of highly dedicated and accomplished clinicians and clinician/ researchers who have volunteered to guide and support the journal. As well as providing important content contribution, the editorial board will provide the essential core service of peer review for the articles that are submitted to IntJNM. I am honored to work with such an expert group of individuals. Finally, I would like to offer profound thanks to our senior Associate Medical Editor, Dr. Diana Buehler, for her thorough and generous work as copy editor.

    Success of this journal requires active support by the professional body. We need authors who will take the time to document their work and to share it with our colleagues. In addition, we need an engaged audience of subscribers who will actively support the journal. I urge you to explore the journal’s website at (add it as a favorite in your preferred websurfer), and most importantly to subscribe. To all potential authors, I encourage you to become involved with this publication. Please write, critique, review, debate, and share your insights and concerns. A simple letter to the editor can be very short, but still generate excellent discussion; take the time to comment on a paper you’ve read or raise an issue of importance to the profession and you will be enriched by the process. As with any peer-reviewed journal, I can’t guarantee that everything will get published, but you will get a fair appraisal. A final word to naturopathic researchers and academics; we want to be a preferred forum for publication so that you can communicate with your colleagues. Let’s work together to make this journal a dynamic part of the evolution of naturopathic medicine.

    It was great to see and review a cross-sectional survey of students enrolled at one of the naturopathic colleges in order to test an important hypothesis. Work by Dr. Tippens and colleagues at NCNM has demonstrated that soy allergy may be more likely amongst people who consumed soy formula as a child compared to those who did not. It is interesting to find that the same effect was not demonstrated for dairy allergy; however, further work needs to explore this question (as well as that for soy).

    Related to polarization in the immune system, Gillingham and Lescheid provide a wonderful discussion on the Th1/Th2 division and how imbalances can be corrected by targeted probiotic therapy. This kind of in-depth review allows for real understanding of the pathological and biochemical origin of diseases like Crohn’s and the propensity towards atopy, thus enabling more informed therapeutic choices that may truly address root cause.

    Dillingham and Rao provide a thorough discussion of the evidence, application, and pharmacokinetics of lycopene. From epidemiology to mechanism of action, the paper provides a strong rationale for using this vegetable-based antioxidant in clinical practice.

    A comprehensive review is provided by Drs. Kassis, Santosa, and Jones on the topic of dietary fiber for a variety of health complaints. Dietary interventions that emphasize this staple approach should never be far from mind and a full review of this topic is appreciated. A final review by Drs. Rudkowska and Jones looks closely at the use of fats for weight control, a clear and pressing clinical concern. It is encouraging to see the collaboration of a student with a licensed ND as in the write-up of the case report by Sara Love and Dr. Weizer. The report gives an account of how naturopathic care may well have resolved a patient’s chemotherapy-induced neuropathy. In addition to being an interesting and educational case, this report provides evidence of a successful mentorship. Drs. Kao and Levytam have provided an interesting discussion of a ‘Eubiotic’ diet and its application elucidated in a case report. Of note, this case report and its poster presentation won first prize for a case report competition held by The Canadian Association of Naturopathic Doctors in Halifax.

    The final article in the issue fits within a more classically educational role in that it specifically offers a rough guideline for writing a case report. The intent that Dr. Leung and I have with this article is not to be prescriptive on how to write a case report, but rather to provide assistance where it might help most. In the spirit of good education, the idea is to have a tool to enable rather than a set of rules to follow.

    I would like to take a moment to extend my deep gratitude to the authors of this issue. They have waited a long time to see their work published and we appreciate their patience and loyalty to the idea and existence of this journal to not have sought publication elsewhere. The material published here is excellent and demonstrates a variety that well matches the scope of our medicine and the challenges we continue to face as a profession.

    It is a real pleasure to see, and be a part of, the return of the peer-reviewed International Journal of Naturopathic Medicine (IntJNM) and to share with you the mission statement for this journal. Taking the lead from its prior incarnation as a web-based journal, IntJNM will continue to publish relevant material for both naturopathic clinicians and researchers. The ultimate goal of IntJNM is to enrich the profession by providing a constructive forum for debate and education. IntJNM seeks to encourage a collectively built, experiential, and evidentiary clinical practice that will both hone and extend our system’s unique, eclectic, and unified medical practice.

    We are interested in receiving and publishing original research studies, but also are keen to hear of any unusual cases that occur directly in clinical practice, or for that matter common cases that strike you as important or interesting in some way. The material that IntJNM will publish includes case reports and series, primary research (e.g. clinical trials, observational studies, and lab-based work), and secondary/synthesis/review work on topics directly relevant to naturopathic medicine. If you find a topic interesting and relevant, then rest assured that your colleagues will as well. Please take the opportunity and the time to educate the rest of us.

    The articles written for IntJNM and submitted for peer-review lie at the heart of any appeal this journal may have. Without quality publications, there is no educational message, no stimulation for new clinical application, and a weak development of our body of knowledge. I think you will agree with me that the articles in this issue are worthwhile, engaging, and fully within the spirit of the journal’s mission. These publications are a testament to authors who are dedicated to providing rigorous literature review, novel research, insightful analysis, and direction for clinical practice and future research.

    My thanks to Dr. Don Warren for providing his perspective and support in the guest editorial he has provided. We need to hear from our well-respected elders and want readers to benefit from their depth of experience and clinical wisdom. To all those with the desire to share clinical pearls or any other insights on clinical practice or other issues of relevance, please be in touch, we want to hear from you.

    It is a delight to be able to publish some of the primary research that is being conducted by naturopathic physicians. Clearly the North American colleges that both educate NDs and actively support growth in the evidence base of naturopathic medicine are fostering high-quality research. This is research that has relevance to healthcare overall, and has direct and immediate significance to naturopathic clinical practice.

    The chart review provided by Dr. Chinnock and colleagues starts with an explanation of how cortisol dysregulation and DHEA levels may contribute to glucose control. The retrospective analysis, conducted at the Helfgott Research Institute and NCNM, is valuable in that it provides information on salivary cortisol excretion patterns from a group of patients who are either diabetic or prediabetic. Importantly, three distinct patterns of cortisol dysregulation are identified; and it is interesting to note that fasting blood glucose did not appear correlated with any of these patterns identified. The limitations to this review and chart reviews in general are well characterized, and I only hope that this line of investigation can be continued with well-controlled and prospective studies to further explore the findings discussed here.


    Before beginning to write the final or even initial draft of your report, you may first want to choose where you intend on publishing. Most peer-reviewed journals have very specific criteria regarding length, structure, and formatting requirements that need to be carefully followed if you want your work to be published. Choosing which journal to begin with will depend on a number of factors. Primarily, what is the condition and context of your case? Journals often focus on a specific pathological condition so if your patient is suffering from coronary heart disease, you’re obviously not going to try to publish in the Journal of Pediatric Hematology/Oncology. In choosing a possible home for your case report, good places to explore can be found in the medical databases. The best-known medical database is PubMed, a massive collection of peer-reviewed articles provided free by the National Library of Medicine and the National Institutes of Health in the US. PubMed can be accessed at and is relatively easy to navigate with some practice (a tutorial is available). Another avenue to take is to seek out journals that focus entirely on Complementary and Alternative Medicine (CAM). The benefit here is that these journals are mandated to publish CAM-related research and will likely be more open to accepting your submission. A short list of possible candidates includes:

    • International Journal of Naturopathic Medicine
    • Journal of Complementary and Alternative Medicine
    • Integrative Cancer Therapies
    • Evidence-based Complementary and Alternative Medicine
    • Complementary Therapies in Medicine
    • BMC Complementary and Alternative Medicine
    • Complementary Therapies in Clinical Practice
    • Alternative Therapies in Health and Medicine
    • Alternative Medicine Review

    When writing for your peers and a general medically astute audience, the art of medical writing requires clarity and brevity. The importance of proper language and grammar usage needs to be followed closely. Finally, it is not uncommon to be rejected from one journal and then warmly welcomed by another. If, in the more common scenario, a journal’s editor offers ‘acceptance pending revision’, be sure to heed the reviewers’ comments closely and respond to each of their concerns even if you disagree with them. The process of conceptualizing, writing, and submitting a case report does take some time and can appear quite daunting to begin with. That said, publishing a case report is rewarding both professionally and personally. You will be surprised at the correspondence that may arise and you can be sure that others will also benefit from your efforts.

    So you have a case, now what? First, gather your information in a clear, concise manner. A worksheet is provided here for reference. Once the information is gathered, it needs to be put together. The components of a case report can vary, again depending on whom or where you are writing for and how much time and energy you have. At the very least, a case report should contain 1) an introduction, 2) a presentation of the case, and 3) a discussion. If you are writing for the purpose of sharing academic knowledge, then it should include 1) an abstract, 2) an introduction with literature support, 3) an in-depth analysis of the case, 4) the discussion with literature documentation, and 5) a conclusion with recommendations or hypothesis generating ideas. A final and important point is that the key to writing a good case report is to be clear about the “single message” that you want to deliver. What is the priority message that you want the reader to take away? Clear description of this and development of why this is so will provide a meaningful addition to the literature and offer real benefit to your colleagues.

    Components of a case report in detail

    1. The abstract provides a concise synopsis of your case report to allow potential readers a quick glimpse into the content of your article. Depending on the journal, the length of an abstract may be 100 to 250 words.

    2. The introduction provides the background to why the case may be of interest to the reader. Literature support on theoretical or research basis of the case may be presented here.

    3. The case presentation gives the detailed description of the case (i.e. presenting symptoms, treatments and outcomes) and analysis of the findings. However, this does not mean you should go on ad nauseam on the details of the case. The goal is to provide essential information and noteworthy features that may be of interest to your reader.

    4. The discussion is the most important part of the case report. This is where the significance of the case is discussed; what the outcomes are, what features are unique and interesting to the reader, and why this case is important. Supporting literature that is relevant to the case should be included here as well as ideas for generating hypotheses for future research.

    5. The conclusion gives a brief summary to what you have learned from the case, any implications to clinical care and recommendations that other clinicians could learn from.

    Other Considerations

    A case report is the medical history of a person and the clinical/therapeutic approach used to treat the person and achieve the outcome. The bottom line is that it is about a person. Thus, as an author, it is proper etiquette for you to get consent from your patient. In fact, obtaining consent from the patient is not only good medical practice, but also mandatory for some journals. In the consent form, you can inform your patient about your intentions, the types of information being shared, and any known or potential risks/ benefits. It is your responsibility to ensure your patient’s confidentiality and anonymity. For example, if photographs are used, anonymity may not be guaranteed. In such a situation, the patient needs to be informed.