CAND Journal

Spring 2024 Editor’s Letter

Marianne Trevorrow — 2024-03-21

Exploring the Impact of a 7-Week Heart Rate Variability Biofeedback Protocol on Skin Severity, Quality of Life, and Mental Health in a Proof-of-Concept Pre–Post Trial of Individuals with Psoriasis

Sarah Park — 2024-03-21

Background: Psoriasis often coexists with psychiatric disorders and decreased quality of life (QoL), with treatments commonly overlooking the psychological impact of the disease. Heart rate variability biofeedback (HRVB) may offer a mind–body solution by providing real-time feedback on autonomic functions, teaching individuals to manage stress via controlled breathing.

Objective: To examine the impact of a 7-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and determine the sustainability of any outcomes post-intervention.

Methods: A single-arm, proof-of-concept pre–post trial was conducted at Bastyr University Clinic in San Diego, CA. Five individuals were recruited, screened, and underwent a 7-week HRVB protocol. Assessments included SS through the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL via the Cardiff Dermatology Life Quality Index (DLQI), and MH using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Data collection points were baseline, post-protocol, and 1-month follow-up.

Results: Notable improvements were observed between baseline and post-protocol for PASI-P, DLQI, and GAD-7. A significant change remained for GAD-7 between baseline and follow-up. No major differences were identified for PASI-C and PHQ-9 across any timeframe, and other scales remained consistent between post-protocol and follow-up.

Conclusion: HRVB showed promise in enhancing perceived SS, QoL, and anxiety over 7 weeks. Further studies should expand participant numbers and diversify initial scores, comparing HRVB with a control group.

Trial registration: ClinicalTrials.gov NCT05506644, retrospectively registered on 16 August 2022.

Adjunctive Naturopathic Medicine in the Management of Depression and Anxiety Symptoms: A Retrospective Chart Review

Joy Dertinger — 2024-03-21

Background: Naturopathic medicine uses natural and evidence-based treatments to promote health. The objective of this study was to characterize and evaluate the effectiveness of naturopathic medicine in reducing symptoms of anxiety and depression in patients seeking care from the Mental Health Shift at a Canadian naturopathic teaching clinic.

Methods: Charts of 192 consecutive patients who attended appointments between 1 January 2019 and 6 March 2020 were reviewed. Subjects were included if they screened positive on the General Anxiety Disorder 7 (GAD7) or the Patient Health Questionnaire 9 (PHQ9) and attended follow up at least 4 weeks after initial treatment.

Results: Of the 22 included subjects, a clinically significant decrease of at least 5 points occurred in 76% of individuals with elevated baseline PHQ9 scores and 59% of individuals with elevated GAD7 scores. Mean PHQ9 and GAD7 scores decreased 7.5 (p<0.0001) and 4.6 (p<0.008) points, respectively. Mild adverse events were reported in 9 charts (41%). No serious adverse events were reported. Most subjects were also in the care of a medical doctor and counsellor.

Conclusion: Naturopathic medicine as performed on the Mental Health Shift may be effective in reducing depression and anxiety symptoms as an adjunctive treatment. Further research incorporating comparison groups is warranted.

Cultural Adaptations Addressing Diversity and Health Access in the Mediterranean Diet: A Realist Synthesis

Nana-Adjoa Bourne — 2024-03-21

Background: The Mediterranean diet (MD) has been studied for its benefits, including metabolic risk factors, since the 1950s. In recent years, debates around barriers to access within cultural and environmental fields have arisen within non-Eurocentric cultural backgrounds. Using data related to health benefits derived from dietary components, this review will produce a map of MD modifications to match various cultures.

Methods: Foods and constituents of the MD were compared and analyzed to assess benefits for both healthy and metabolic disease states using both empirical and theoretical approaches. Databases (PubMed and Cochrane) were searched using terms for cultural diets and metabolic disease outcomes associated with the MD (e.g., HbA1C, cholesterol, waist circumference, weight, AST and ALT). One multicultural diet database was chosen to identify culturally specific foods that match components of the MD to each cultural affinity.

Results: Cultural alternatives to foods and components of the MD exist. However, there is modest research on the specific health effects of most culturally adapted diets.

Conclusion: While some evidence gaps exist, it is feasible to translate most components of the MD to diets suitable for various cultural affinities. Future research is needed to examine the overall effects of these diets based on MD macronutrient presentation and the barriers associated with cultural–religious dietary practices and access to foods. Healthcare practitioners may benefit from this as a resource and to facilitate inclusivity and cultural competency for a broader range of dietary behaviours.

Intravenous Vitamin C in Cancer Care: Evidence Review and Practical Guidance for Integrative Oncology Practitioners

Ellen Conte — 2024-03-21

Intravenous vitamin C (IVC) is a common therapy used by naturopathic doctors and other licensed integrative practitioners. With several proposed mechanisms of action related to cancer care, it is often used in integrative oncology settings. Despite its common use, there are no published evidence-based resources on the efficacy, safety, and procedural considerations for the use of IVC in practice. The objectives of this review are to summarize the evidence on high-dose IVC in supportive cancer care and to provide a resource of practical clinical guidance for IVC application. In cancer care, IVC is most commonly used at doses high enough to achieve a potential cancer cell cytotoxicity. This review focuses on IVC at doses of ≥15 g which we have defined as high-dose. To date, there are 23 published clinical trials evaluating the use of high-dose IVC in cancer support. Based on data from these clinical studies, IVC used concurrently with oxidative therapies, such as chemotherapy and radiotherapy, seems to produce the greatest likelihood for improvements in quality of life and additive anti-tumour effects compared with IVC as monotherapy or with non-oxidative therapies. IVC has shown promise in improving quality of life in patients with breast cancer and advanced pancreatic and ovarian cancers. Limited evidence suggests survival and/or tumour response may be improved with the inclusion of IVC in patients with advanced pancreatic cancer, non-small cell lung cancer, and RAS-mutated colorectal cancer. IVC does not offer curative potential, and further research is needed to explore its effectiveness relevant to mortality outcomes. Practical guidance including assessment, monitoring, dosing, safety, and communication with other healthcare providers is discussed.