The document discusses magnesium needs for athletes. It notes that athletes have higher magnesium requirements than non-athletes, between 400-800mg daily, as magnesium plays an important role in energy production, nervous system function, lactic acid removal, and replacing what is lost through sweat during exercise. A magnesium deficiency can impair immune function and increase susceptibility to infection in athletes. The document recommends magnesium supplementation for athletes, especially endurance athletes, to improve cellular metabolism, cardiorespiratory function, and magnesium stores.

1. Magnesium: an athlete’s best friend P5
Are your patients taking vitamin I? P9
Treating plantar fasciitis P13
In this issue
Keeping active
patients on their feet
ND NOTESA Practical Resource for Naturopathic & Integrative Practice
Spring 2016 | Vol 2 No. 1

2. 1
ND Notes | Vol 2 No. 1
chemistry class the notion of redox. It’s a
short form for reduction and oxidation.
A redox (reduction-oxidation) reaction refers
to the process of transferring electrons
between two molecules. If a molecule loses
an electron during this transfer, then it has
been oxidized. If a molecule has gained an
electron during this transfer, then it has
been reduced.
Ubiquinone and ubiquinol are a redox pair,
with ubiquinone being the oxidized form
and ubiquinol the reduced form. Because
ubiquinol has more electrons, it has more
to give to free radicals. That’s why ubiquinol
is a better antioxidant. On the flip side,
the oxidized property of ubiquinone is the
reason it is better suited for the energy
metabolism inside your cells.
Both ubiquinone and ubiquinol have roles
to play. But there's no need to prescribe
both. The body smartly converts between
the two forms automatically, depending
which functions are in demand.
I always thought ubiquinone
was the best form of CoQ10
until ubiquinol came along.
What is CoQ10 exactly?
Good question. Coenzyme Q10 (CoQ10)
is a vitamin-like, fat soluble nutrient
composed of one unit of benzoquinone
and ten units of isoprene. It’s made by
the body and found in every cell. In the
bloodstream and lymphatic system, it
is used as a potent antioxidant. Within
individual cells and mitochondria, it is an
important part of ATP synthesis, creating
energy for cellular function
Incidentally, that’s why certain organs like
the muscles, heart, kidneys and liver have
a higher concentration of CoQ10 - they
expend more energy.
What about ubiquinone and
ubiquinol? What’s the difference
between the two forms?
You might remember from your high school
Q & A
ND Notes
Spring 2016 | Vol 2 No. 1
Editor
Jennifer Hopf
Copy Editors
Mary Calmes
Heidi Hoff
Contributors
Adriana Restagno ND
Cecilia Ho ND
Jamila James ND
James Yoon ND
Janet Neilson Homeopath
Tatiana Khoudiachova ND
Jenna Mangan CNP
Rory Gibbons ND Cand 2017
Art Direction & Design
Tina Amouzgar
Dorvan Davoudi
Sophia Kim
Published by
CanPrev and Orange Naturals
We believe naturopathic medicine
should be safe, effective and
accessible to all Canadians.
Privacy Policy
CanPrev & Orange Naturals respect your
privacy. We do not rent, trade or sell our
mailing lists. If you do not wish to receive
this publication or wish to change your
mailing address, please contact
support@ndnotes.ca
or 905.881.6800
We welcome your letters, submissions,
news and comments. Please contact
editors@ndnotes.ca
All material is copyright © 2016
ND Notes is intended for educational purposes only
and is not intended to serve as medical advice.
The information provided is intended for the use of
healthcare practitioners
and should not be used for diagnosing or
treatment of a health problem, or as a
substitute for professional care.
ISSN 2368-7908
Message from the editor
Athletes are not your average patients. Their bodies represent their hobby, their passion, and quite
often, their livelihood. They tend to have more uncommon needs compared to their less active
counterparts, but are also typically more proactive when it comes to their health.
In this issue, we’ll explore the challenges and requirements of patients who live a more active
lifestyle, along with ways you might approach assessment and treatment in your practice. We’ll
take a look at trending topics like nutrient timing and fitness tracking, as well as weigh in on heavier
issues, examining the risks of prescribing natural supplements to competitive athletes and the
effects of taking ibuprofen prophylactically.
We’re also pleased to announce the 2017 CanPrev guide to natural medicine has arrived. See p. 42
to learn how to request a copy (or two). It’s an ideal resource for practitioners and patients alike!
Here’s to good health,
Jennifer Hopf
Editor

3. 2
ND Notes | Vol 2 No. 1
workflow of the kidneys and causes you to
excrete water soluble vitamins like B and C
a little faster.
Regardless of whether your patients are
just drinking coffee or adding CanPrev
Core to it, the risk of certain nutrient loss
remains. If your patient is deficient in a
particular nutrient or has osteoporosis,
it’s best to avoid the combination. Or if
your patients are really concerned about
nutrient loss, you can simply recommend
they top up with extra vitamins and minerals
throughout the day, just in case!
So which should I prescribe? Is one
form actually better than the other?
We already know that the body converts
CoQ10 molecules back and forth between
ubiquinone and ubiquinol forms. So whether
your patient takes ubiquinone or ubiquinol
CoQ10, one will be converted to the other
and back again. Both forms have important
health benefits.
However, taking ubiquinol instead of
ubiquinone may be a better option for
some. Certain population groups like older
patients, or people with a genetic variation
in NQO1, may have trouble with reducing
ubiquinone to ubiquinol.
A patient asked me recently:
“I started adding two scoops of
CanPrev Core to my morning
coffee. Can you tell me if the
caffeine might have a negative
effect on the nutrients?”
You may find this to be a common practice
among your athletic patients who are
looking for a caffeine boost before a
workout, in addition to their nutritional
shake. However, taking caffeine with
vitamins or minerals can potentially
interfere with their absorption and/or
increase excretion.
For example, some sources claim that
for every 150mg of caffeine ingested
(about the amount in one cup of coffee)
5mg of calcium is lost - which isn't much,
but it can be problematic if you have
osteoporosis and also drink a lot of coffee.
It's also thought that caffeine can inhibit
the amount of calcium absorbed through
the intestinal tract and deplete the amount
retained by the bones.
Caffeine can interfere with iron absorption
as well, though the effects are quite
minimal at around 6% or so. Because
coffee is a diuretic, it also speeds up the
SIMPLE REDOX REACTION EXAMPLE

4. 3
ND Notes | Vol 2 No. 1
Coconut water: is it nature’s perfect sports drink?
Sports drink vs coconut water (8 oz. serving)
Beefing up a worthy opponent
to commercial sports drinks
An easy way to overcome what is lacking
in coconut water alone is to create a
customized sports drink around a base
of coconut water. This way you can have
full control over your patient’s intake
of electrolytes, without worrying about
artificial colours or other nasty additives.
This also gives you room to experiment
with what works best for each patient.
What about plain old water?
Depending on the intensity of the workout
and the rate your patient’s nutrients are
depleted, water may not be enough to replace
lost electrolytes, sodium, potassium and
carbohydrates. For instance, after running
a marathon or participating in any vigorous
endurance activity lasting longer than 60
minutes, an enhanced coconut water is
the best option to rehydrate and replenish
Whether your patient is a casual gym-
goer or an elite athlete, he or she is
likely bombarded with the selection of
sports drinks available today and may
be wondering which option is right for
them. More recently, coconut water is
being viewed as an all natural, healthy
replacement for traditional sports drinks.
But is it really?
While coconut water certainly seems to be
a cleaner sports drink and a much greater
source of potassium, there are still a few
shortcomings. When compared to commercial
sports drinks, coconut water is lower in two
of the main ingredients that an athlete’s
exhausted system would need after a tough
workout: sodium, the main electrolyte lost
through sweat, and carbohydrates, which help
replenish the body's spent energy stores.
So how can athletes get the benefits of a
more natural sports drink that will still give
their bodies what they need to recover after
intense exercise?
A 2007 study by Ismail, Singh and
Sirisinghe out of the University
of Malaysia, showed that
coconut water enhanced with
sodium performed as well as a
commercial sports drink in a post-
exercise rehydration test, but with
better fluid tolerance and less
stomach fullness or upset.
ENHANCED COCONUT
WATER MOCKTAIL
• 2 cups (480ml) coconut water
• ½ tsp sea salt
• 4 tsps honey, maple syrup or
natural sweetener of your choice
• 1 large lemon or lime slice
Mix all the ingredients together well,
pour into water bottles and keep
chilled until you are ready to use. You
can also add 1 tablespoon fresh mint,
½ cup fresh berries, half of an orange,
or create your own custom flavour!
*The salt to sugar ratio is based on
WHO’s recommendation of 3.5g of
sodium per 100ml of water.
electrolytes. If your patient experiences white
streaks or a gritty feeling on their face, this is
an indication of sodium loss, which can be
restored with an enhanced coconut water
as well. If, however, your patient perspires
heavily enough to soak through a t-shirt, a
sports drink will not be enough to replace
what’s been lost. The individual would need
to consume a quick source of energy like a
banana, dried fruit, pretzels or rice chips.

5. 4
ND Notes | Vol 2 No. 1
An average person sweats between 0.8 to
1.4 litres of fluid per hour of exercise. Most
endurance athletes might already be aware
of the crucial vitamins they lose through
sweat, but many non-competitive athletes
may think it’s only water (and salt) they’re
excreting through their pores.
Whether your patients are casual or
professional athletes, it’s always good
practice to remind them how important it
is to replace water soluble vitamins like C
and the range of Bs that their sweat carries
out during intense training. Here are some
ways to help your athletic patients restore
important nutrients post-workout.
B vitamins play a role as coenzymes in
the energy production of cells. Exercise
appears to especially increase the loss
of thiamin, riboflavin and vitamin B6. In
fact, the body might need to take in twice
the daily recommended amount of these
vitamins to replace what the body sweats
out through exertion.
In vitamin C’s case, multiple studies have
found blood and plasma levels of vitamin
C to be lower in those who exercise,
since stores are used to combat exercise-
induced oxidation in muscles and other
cells, which is brought on by physical
activity. Vitamin C also plays an important
role in muscle growth, as it’s essential for
building collagen, the connective tissue
that helps repair tissues and tendons.
Research shows that vitamin C may
even help reduce post-exercise pain and
inflammation due to it’s ability to help
repair the tiny tears in our muscle fibres
that can result in muscle soreness and
pain after workouts. Proper vitamin C
supplementation both pre and post-
workout can be effective in helping
prevent deficiencies and promote faster
muscle recovery.
Although there is evidence that exercise
increases the demand for these vitamins,
supplementation does not appear to have
an enhancing or ergogenic effect.
Sweating it out
Why crucial vitamins need
replacing after exercise
The general consensus among sports
nutritionists is that most athletes and
active individuals would be able to meet
these increased nutrient demands by
eating a balanced diet.
Individuals at greatest risk for exercise-
induced vitamin deficiency are those
following a low-fat or low-calorie diet,
and those who don’t eat enough fruits,
vegetables and whole grains. In these
individuals supplementation of the above
key nutrients to prevent deficiency is crucial.
Vitamins lost in sweat
Vitamin
Concentration
(mcg per 100 ml)
Thiamin 0-15
Riboflavin 0.5-12
Nicotinic acid 8-14
Pantothenic acid 4-30
Ascorbic acid 0-50
Pyridoxine 7
Folic acid
(plus metabolites)
0.26
Source: Marriott, B. M. (1993). The Effect of Exercise
and Heat on Vitamin Requirements
HOW TO DETERMINE
SWEAT LOSS AND
PROPER REHYDRATION
1. Measure body weight both before and
after at least one hour of exercise under
conditions similar to a competition or
hard practice.
2. The difference between your pre and
post-workout body mass measurement
is your fluid loss.
ex. Pre-exercise weight =74.5kg
Post-exercise weight = 72.8kg
Fluid deficit = 1.7kg
3. Estimate the weight of any fluid or foods
you have consumed during the workout.
ex. 800ml of fluid = 800g
4. Sweat loss = body mass before exercise
(in kg) - body mass after exercise (kg) +
weight of fluids/foods consumed (kg).
ex. 74.5-72.8 = 1.7kg deficit + 80kg=
2.5kg of sweat loss
5. The total amount of sweat or fluid
loss will be a gauge as to how well you
hydrated during the session and how
much you need to rehydrate afterwards.

6. 5
ND Notes | Vol 2 No. 1
tend to be most focused on their physical
performance, activities like energy
production and muscle strengthening tend
to become more primary functions, leaving
less magnesium available for secondary
functions, like their immune system.
All of the additional demands athletes put
on their bodies also makes them more
susceptible to suppressed immune function,
which can open the door to infection,
most commonly of the upper respiratory
tract. The study “Exercise, Magnesium, and
Immune Function” (Laires, 2008) found a
magnesium deficiency not only impairs the
ability of the body to do physical work, but
can also impair optimal immune function.
Magnesium, the study suggests, has a strong
bond within the immune system to both
non-specific and specific immune function,
and a magnesium deficiency can lead to
“immunopathological changes” that trigger
the body’s inflammatory response.
Greater staying power
Endurance athletes are especially prone
to magnesium deficiency, as their stores
can be quickly depleted when they
work up a sweat or increase their energy
output. Interestingly, taking magnesium
supplements has actually shown
improvement in cellular metabolism in
competitive athletes (Golf et al, 1998).
Saris et al (2000) reported that adults who
participated in moderate physical training
while supplementing with magnesium
actually showed improved cardiorespiratory
function during a 30-minute submaximal
exercise test. Siebrecht (2013), in his review
As a health care professional, you’re likely
well aware of how crucial magnesium is
for normal cell function, as well as several
metabolic processes. Canada’s Natural
Health Products Directorate (NHPD)
recommends a daily allowance of 20 to
500mg of magnesium per day for adults - this
is the minimum amount required to avoid a
deficiency. It is estimated that more than half
of the population may, in fact, be deficient
in magnesium, with some dietary surveys
putting that rate up higher still to 70%.
However, athletes are not your average
patients with typical magnesium
requirements. For hard training or
endurance athletes, the suggested daily
amounts are between 400 and 800mg daily.
There is emerging evidence that athletes
have higher magnesium needs than people
who may not exercise as much or as hard.
Those who constantly push their bodies to
the limit can ironically be lacking in one of
the most important minerals they need to
take their athleticism to the next level.
How athletes benefit
Magnesium is used by athletes in these
important ways:
• For energy production, first and foremost
- athletes typically expend more energy
and therefore require more magnesium.
• To be absorbed and utilized at a high
rate by the nervous system during
strenuous exercise.
• For assisting in the removal of
accumulated lactic acid and fueling DNA
repair enzymes, post-exercise.
• To replace what’s lost through sweat after
intense exercise.
Even symptoms that many athletes
typically accept as the hazards of hard
training may actually be the result of a
deficiency, which can be alleviated by
magnesium supplementation. As athletes
Magnesium: an
athlete's best friend
How to recognize and
treat a deficiency
HOW MUCH
MAGNESIUM IS IN
THE HUMAN BODY?
20 to 28g (equivalent to almost one ounce
or the volume and weight of one tablespoon
of flax seeds or sesame seeds)
• 59% is in the bones
• 40% is in muscles and tissues
• 1% is in extracellular fluid

7. 6
ND Notes | Vol 2 No. 1
WHY DO WE GET
MUSCLE CRAMPS?
The reason muscle cramps occur is not
that well understood. Exercise-induced
muscle cramps may be related to
neuromuscular fatigue and shortened
muscle contraction (continued
shortening through prolonged use
prevents muscle from relaxing). They
are also thought to be caused by
dehydration and electrolyte loss – in
particular, sodium and magnesium loss,
in hot and humid conditions. This may
be due to the fact that mineral
losses through sweat are increased
during long exercise periods.
of the safe supplementation of magnesium
in human nutrition, echoes that research
like this suggests a potentially beneficial
effect of magnesium supplementation on
muscle metabolism.
A study by Cinar et al (2007), concluded
that exercise performance improved with
magnesium supplementation in subjects
that exercised 90 to 120 minutes, five days
per week. It’s thought that magnesium
works to increase red blood cell count and
hemoglobin levels, allowing for greater
oxygen distribution in the body. Magnesium
plays an important role in increasing
oxidative capacity, which in turn can enhance
endurance training for your athletetic patients.
Recharge the ATP battery
ATP, the compound that when broken down
releases energy for cellular function, needs
magnesium to work. Magnesium is crucial
for energy metabolism because it activates
enzymes known as ATPases, which are needed
to generate ATP. When ATP is broken down,
energy is released for all of the body’s muscle
contractions. During strenuous exercise,
this turnover is extremely rapid, meaning
that ATP needs to be synthesized quickly -
especially since the body cannot easily store
ATP (and frequently what gets stored is used
up within seconds). The body does this in
two ways: through aerobic metabolism (with
oxygen), used during endurance activities like
marathon running, and anaerobic metabolism
(without oxygen), used during weight training.
Strengthening muscle
with magnesium
There is data suggesting magnesium
levels in the body are indirectly related to
strength improvement. A study published
in the Journal of the American College of
Nutrition measured the effects of a dietary
magnesium supplement on strength
development during a double-blind, seven
week strength training program in 26
untrained subjects. Results showed that the
oral magnesium supplementation group
produced significantly increased strength
outcomes than the control group. It has also
been noted in research studies that maximal
contraction of the quads is positively
correlated to serum magnesium status
(Stendig-Lindberg et al, 1983).
Magnesium is also used in the RNA process
to create proteins. This type of protein
synthesis depends on high magnesium
concentrations, and it’s thought that low
magnesium levels may adversely affect
protein manufacture and metabolism. For
the athlete, this results in lowered strength
gains during workouts - not the payoff
they’re looking for. This means athletes on
high protein diets should also be advised to
up their magnesium intake as well, in order
to maintain adequate magnesium levels
needed for protein synthesis.
Prescribing magnesium to your
active patients
You might think about prescribing
magnesium to your more active patients
or clients, if you’re not already. Helping
them understand the underlying mechanics
behind supplementation can help with
compliance, perhaps more so than with other
patients, as athletes already have a vested
interest in their health and performance.
Remember, the most bioavailable form,
magnesium bisglycinate, is best at a
dosage of 400 to 800mg per day. Taking
divided doses of 100 to 200mg at a time is
recommended for maximizing absorption.
Whether they prefer to take it in capsule,
powder or effervescent drink form, the key
to getting athletes in the habit of taking
magnesium is to make it a convenient part
of their workout regime.
Is it a magnesium deficiency?
Here is a quick checklist to go over with
your patients:
•Ask about symptoms:
Nausea
Vomiting
Anorexia
Muscle weakness
Muscle spasms and / or tremors
•Assess nutritional status:
Poor health
•Screen for health conditions:
Gastrointestinal absorption problems
Anorexia nervosa
Recent acute illness
Alcoholism
Diabetes
•Environmental conditions:
Very cold weather
•Medications / supplements:
Medications that interact with
magnesium absorption
Supplements that interact with
magnesium absorption
The more items checked off on this list, the
more likely there is a deficiency in magnesium.
WHY MAGNESIUM
BISGLYCINATE
Magnesium bisglycinate appears to
be the safest and most effective form
of magnesium for human absorption
according to a magnesium research
review published in the European
Journal of Orthomolecular Medicine
(Siebrecht, 2013). Magnesium bisglycinate
is very stable, highly bioavailable and
absorbed through a dipeptide channel
in the intestine, so it doesn’t compete
with other minerals like calcium. It also
doesn’t bind or get excreted with dietary
phosphates, phytates, oxalates, tannins
or fibrous roughage.
Mg
[Ne] 3s2
12 24.305
2
1380
922

8. 7
ND Notes | Vol 2 No. 1
pain can be felt inconsistently depending
on how and when the patient moves and
where the pain is located.
The effects of chronic pain
It’s important to mention that not all pain
is bad. We need acute pain to act as a
physiological warning sign. Chronic pain,
however, which is often associated with
inflammatory diseases like arthritis and
cancer, is a more complex concept. The
inflammatory response launched by a
stressed nervous system creates a cascade
of events that further harm our biological
portfolio and change the chemistry of
our tissues.
When tissue is damaged, nerve fibres
are affected, too. The body is able to
sense tissue damage when destroyed
cells release chemical substances like
prostaglandins and histamines, which adds
to the stress load of our body’s biological
terrain. Cells, membranes and enzymes
are destroyed, basically creating disaster
at a cellular level that affects our terrain,
sometimes permanently. Biochemical
individuality plays a huge role in chronic
pain, and we all have a unique portfolio
based on our past experiences that make
pain subjective, and for the most part,
healing methods as well.
It’s not just our lungs that can
benefit from deep breathing
Neuroanatomist Bud Craig developed
a theory based on interoception, which
explores whether internal organs and
tissues have their own feelings that create
sensations. He hypothesizes that since
sensations travel from the body up to the
brain through the vagus nerve, perhaps our
organs can experience feelings of anxiety,
stress, exhaustion and pain, too. If this is
true, then maybe our organs and internal
body can benefit from a deep breathing
practice just as much as our minds would.
Researchers are now seeing proof of
how deep breathing practices can have
a restorative effect on a damaged or
diseased nervous system, and how certain
breathing techniques can actually kickstart
the parasympathetic nervous system. Many
ancient traditional forms of movement and
meditative practices involve breathing,
chanting or singing - techniques used for
centuries to restore the nervous system by
stimulating the vagal nerves through the
breath. Identified as forms of resistance
breathing, these methods act to slow the
heart rate and lengthen the exhale, which
in turn stimulates the parasympathetic
nervous system.
What do belly breathing, alternate nostril
breathing, singing, chanting, deep slow
breathing (DSB) and other forms of
resistance breathing all have in common?
Interestingly enough, incorporating one or
more of these types of breathing at the first
sign of pain can greatly help with providing
relief. As a fitness guru, yoga instructor and
Certified Nutritional Practitioner, I often
come across clients who experience some
degree of chronic pain every single day. As
correlations are now being made between
maladaptive biological memories and
changes in tissue and nervous systems, as
well as chronic conditions like fibromyalgia,
PTSD and joint and nerve pain, the
connection between breathing techniques
and healing mechanisms are becoming
more widely accepted.
Medical doctors, neuroscientists, sports
therapists and health professionals
everywhere are now discovering the
immeasurable healing effects that deep
breathing practices can have on clinical
and ongoing chronic pain.
An inside look at pain
The stress response that is activated
when we experience trauma or stress for
short or long periods of time can manifest
sensations in the tissues and eventually in
the nerves themselves. When this happens,
allodynia, the term used to describe pain
produced by an innocuous stimuli, rises.
Wherever these changes in tissue occur,
small fibres of the periphery nerves learn
to respond to non-painful stimuli and
perceive them as hurtful. We know that
with chronic pain, the stimuli does not
have to be present for pain to be felt. In
the case of neurological pain, like shingles,
multiple sclerosis, phantom limb pain,
diabetic neuropathy and fibromyalgia,
Just breathe!
Exploring the connection
between deep breathing
and pain management
Guest contributor: Jenna Mangan, Holistic Nutritionist,
Certified Nutritional Practitioner, RNPA, Athletic Recovery,
JOGA Trainer, 200RYT

9. 8
ND Notes | Vol 2 No. 1
Since there is a synergy between the nervous
system and breathing patterns, as well as the
nervous system and hormonal and glandular
functionality, it is likely that pain and other
symptoms may appear and disappear
according to one’s breathing practices.
Though further studies may be needed
to explore the exact reasons why, current
feedback from people who practice yoga,
Tai Chi, kung fu, Qigong, meditation and
other traditional methods of exercise
that focus heavily on deep breathing
techniques, say they are finding relief
from their pain symptoms.
Your patient may feel relief from the
release of muscle tension alone, even if the
perception of pain may still be present. I
often find that clients in this state welcome
guided breathing practices that allow them
to forget that they’re hurting.
As effective as taking a pill?
We have endogenous mechanisms in our
bodies that help us to manage pain, like
our large peripheral nerves and our opioid
systems, which involve endorphins. It’s
thought that deep breathing may have
an effect on increasing one’s production
of endorphins, which may help block
nerve cells from releasing pain signals to
the brain and provide some relief when
experiencing acute or chronic pain.
Your patients may already use anti-
inflammatory drugs, massage, acupuncture
or hypnosis to help manage pain. Why not
suggest deep breathing as well?
Breathe deep for best results
Deep breathing results in greater oxygen
and nutrient delivery because air is drawn
deep into the pockets of the lungs, which
is where the greatest amount of blood flow
occurs. As a result, there may be an increase
in energy levels and an improvement in
stamina during physical activity.
There are also times when severe pain can
bring on fatigue; short chest breaths from
living in an anxious or fight-or-flight state
can lead to the fatigue of ischemic tissue.
When the breath is slowed and deepened,
ischemia may disappear and blood supply
may be restored. When tissue becomes less
acidic, nutrients become more accessible,
energy levels increase and the stress
response system becomes more resilient,
leaving the sufferer with less wear and tear
on the body and an overall more flexible
cardiovascular system.
Revisiting the ancient art of
deep breathing to manage pain
Throughout history, many great healers
focused on breathing techniques and
realized the power that the respiratory
system has on our health. Any dedicated
yogi or yogini will point out the great
difference between breathing and
conscious deep breathing. Breathing
deeply and consciously offers us a chance
to seek clarity, be present, steady the mind,
sway our perception, and heal by means
of changing tissue pH at a cellular level,
thereby decreasing inflammation and
restoring balance to our nervous systems.
Skeptics may say that we have been
breathing our whole lives and techniques
such as diaphragmatic breathing or
Lamaze breath act simply as distractions.
Even if it is merely a distraction, anyone in
real pain will tell you that even if nothing
happens at a cellular level to repair and
JENNA’S FAVOURITE
BREATHING EXERCISE
I enjoy Nadi Shodhana, an alternate
nostril yoga breathing practice
designed to increase the flow of
prana (breath). It acts to balance
the two hemispheres of the brain and
help increase the flow of breath while
reducing heart rate and purifying the
subtle energy channels of the body.
The hands are placed over alternate
nostrils in Mrigi Mudra (healing mudra)
while breath moves in and out.
heal the root cause, it’s still better to
participate in the breathing exercise rather
than focus on the pain.
It’s also interesting to note that babies,
whose brains and emotional and cognitive
abilities haven’t yet fully developed, breathe
more deeply than adults. They’ve got the
hang of deep breathing, naturally!
A simple deep breathing
exercise for your patients
Here’s an extremely simple breathing
technique that can be done almost anywhere:
Take a large, exaggerated breath from deep
in the belly. Count to five, inhaling through
the nose and count to five again on the
exhale, blowing out through the mouth.
Try to lie in a supine position, if possible.
Complete five sets, five to 10 times a day
for best pain relief results.
Encourage your patients to experiment with
different breathing techniques alongside a
qualified healthcare professional. There are
a wide range of practices offered, so suggest
they find one that’s comfortable for them
and prescribe it as a daily ritual.
Deep breathing not only brings relief from
mental, emotional and physical pain, but
can also improve mental and physical
performance, increase blood flow and
reduce tension in the body and mind.

10. 9
ND Notes | Vol 2 No. 1
Are your patients taking vitamin I?
In addition to supplements and protein shakes, your proactive
athlete patient may also be popping ‘vitamin I’, or ibuprofen,
as part of their regimen. Inflammation can slow down training
and affect their overall performance, so many athletes wind up
taking ibuprofen prophylactially to guard against it. But should
athletes really be using this NSAID as a training aid?
Since ibuprofen is so widely used among
athletes, it might be interesting to examine if
their reliance on it actually helps or hinders
their performance.
Even with a prevalence of around 90%
in certain sports, this certainly does not
mean ibuprofen is the key to success.
Research shows that while non-steroidal
anti-inflammatory drugs (NSAIDs) are very
good at their job as pain-relievers and anti-
inflammatories, they can have detrimental
effects on skeletal muscle tissue and tissue
in the gastrointestinal tract.
Ibuprofen mechanism of actions
Ibuprofen is an NSAID, which carries
analgesic (pain-reducing) and antipyretic
(heat-reducing) properties. The exact
mechanism of action of ibuprofen is
unknown, however ibuprofen is postulated
to be a non-selective inhibitor of the
multi-form enzyme cyclooxygenase
(COX). This enzyme is a key player in the
synthesis of prostaglandins (inflammation
modulators) via a specific metabolic
pathway (see diagram). It acts to inhibit
cyclooxygenase-1 and cyclooxygenase-2
enzymes, which in turn dampen protective
prostaglandin synthesis and inflammatory
prostaglandin synthesis, respectively.
The antipyretic effect of ibuprofen is
believed to occur at the level of the
hypothalamus, which is the centre in the
brain that controls our body’s temperature.
NSAID drugs will bind to receptors in the
hypothalamus, resulting in a dissipation
of heat via changes in blood flow to heat
outlets like our skin.
Since ibuprofen does not have the ability
to block one COX enzyme without blocking
the other, taking this drug can have a
negative impact on areas that are not
necessarily targeted for pain-relief, such
as the intricate lining of our gastrointestinal
tract. As a result, it is considered “non-
selective”, when compared to other anti-
inflammatory medications.
Guest contributor: Rory Gibbons, BSc, Kin, ND Cand 2017
Ibuprofen is thought to be a non-selective inhibitor of cyclooxygenase.
Although it does suppress pain caused by inflammation, the absence of gastric
mucosal protection can cause gastrointestinal issues from prolonged use.

11. 10
ND Notes | Vol 2 No. 1
The effects on skeletal muscle
Delayed onset muscle soreness (DOMS) is
a phenomenon that will occur 24-72 hours
following progressive exercise (exercise that
occurs at a higher and/or longer duration
than the athlete’s usual exercise regime) and
is frequently the reason why athletes take
ibuprofen before exercising. However, taking
ibuprofen prophylactically to eliminate pain
is only providing a disservice to the body’s
healing process.
Research has shown that levels of pain and
ratings of perceived exertion do not differ if
the athlete takes ibuprofen prophylactically
or not at all, given the same exercise. This
particular study also showed that there
were higher levels of inflammatory markers
present in the athletes taking ibuprofen,
indicating an additive effect of injury (the
type of injury was not specified).
Pain and inflammation are the body’s
response to damage from trauma
(accidental trauma or athletic training)
or disease (ex. Crohn’s, ulcerative colitis,
cancer, etc). Taking ibuprofen will dampen
pain and inflammation and potentially lead
the athlete to injuring already damaged
tissue more. Once that pathway is down,
pain will no longer let us know when to stop.
Much like we sense pain, we respond
to increased stress and adapt to it.
Inflammatory enzymes (specifically
cyclooxygenase-2) and prostaglandins are
integral in the responsiveness and adaptation
of connective tissue to mechanical stimuli,
and if they are not present then injured
tissue may be predisposed to further
injury. Prophylactic ibuprofen use may also
inhibit skeletal muscle from adapting to
prolonged endurance activity, by blocking
the production of new blood vessels and
collagen in the active tissues. Furthermore,
ibuprofen’s inhibitory effects may slow the
synthesis of collagen, the foundation of
connective tissue strength. Continually taking
ibuprofen preventatively may reduce the
rate of collagen production and subsequent
tissue repair following exercise and/or injury.
The effects on the gut
Ibuprofen has a damaging effect on muscle,
but it does not just stop there. It is common
knowledge that “ibuprofen wrecks the gut”.
Studies of endurance athletes have shown
that 50-80% report upper and lower GI
manifestations, most commonly heartburn
and diarrhoea.
But why? Our body is smart when it comes
to blood flow, giving needy muscles
nutrients by increasing blood flow in their
direction. During periods of exercise, blood
will be shunted towards the tissue that is
most in need, such as the skeletal muscles
putting in the time and effort. However,
this happens to the detriment of tissues
the body deems “less important” at the
time, such as gastrointestinal tissue. If
this state of blood flow continues for a
prolonged time, the tissue can become
ischemic and damaged. Keep in mind
this is what happens when the body
is functioning without any additional
substances, such as ibuprofen.
Research now indicates that ibuprofen
exacerbates exercise-induced intestinal
injury significantly, increasing permeability
of the stomach, duodenum and the rest of
the small intestine. The increased spacing
between the gut cells allows potentially
threatening pathogens into the bloodstream
and elicits stress on the immune system.
The gut damage may even have an
inhibitory effect on the absorption of
nutrients post-exercise, thus impeding
recovery. The hypothesis of pathogens/
digestive enzymes permeating the gut lining
and the absorptive capacity post-exercise
has not yet been fully investigated and
warrants further studies.
Taking ibuprofen prophylactically
may block the production of
collagen, the foundation of
connective tissue strength.
Four other ways to address pain
So now that we have discussed how
ibuprofen eliminates pain/inflammation
and can amplify damage to skeletal muscle
and our gut lining during exercise, what are
some tactics for patients to eliminate pain
before, during and after exercise?
1. Determine the cause of the pain.
Pain can be a result of a whole host of
issues. Poor biomechanics can cause
damaging repetitive use of muscles and
ongoing damage of passive structures in
joints, such as ligaments and meniscus.
If we can work with the athlete to move
more efficiently (for instance, improve
gait patterns by consciously using
different muscles), there will be less stress
on the joints and musculature.
Stretching out tight tissues and
strengthening unbalanced muscles will
also help immensely in joint/muscle
function, leading to less pain. Often
athletes (more specifically newer athletes)
will begin their pursuit of competition at a
level that is too advanced, at a speed that
is too fast. This can be a shock to their
body, which may not be able to adapt to
the sudden increase in training, causing
a higher inflammatory response - and in
turn higher levels of pain.
The failure to adapt may also result
in injury, and therefore, pain and
inflammation. In order to prevent this
from happening, the athlete needs to
follow a graduated training program that
outlines proper overload and appropriate
recovery techniques, facilitated by
a person who understands human
physiology and movement.
Sometimes mental/emotional trauma
can cause an exaggeration of pain. This
may not be obvious at first, so taking
a thorough history and exploring the
mental/emotional facets of the patient’s
life is necessary. Once those issues are
dealt with, pain may be more easily
managed or even disappear completely.

12. 11
ND Notes | Vol 2 No. 1
75%777775555%%%%%%
2. Support/control the inflammatory process.
A common misconception in the
world of sport is to completely
suppress inflammation, by taking anti-
inflammatory products like ibuprofen
and using methods like icing, following
exercise and acute injury. There are
times to allow the natural inflammatory
process to proceed healing and there
are times to suppress it. Because of this,
every situation needs to be assessed for
severity, progression and duration of
pain/inflammation. For more information
on supporting and controlling the
inflammatory process, please refer to
Notes on natural anti-inflammatories, p.12.
3. Don’t neglect cool-down!
We can break down the act of athletic
exercise/competition into three phases:
warm-up, competition and cool-
down. It is common to see a thorough
warm-up phase (foam rolling, dynamic
stretching, etc.), a 100% effort during the
competition phase, and then a brief or
absent cool-down phase.
So why is this? It could be due to lack of
energy following competition, too many
distractions or simply ignorance to the
importance of a proper cool-down. A
cool-down usually consists of, but is not
limited to, much lighter exercise (10-15%
of competition), followed by stretching
and/or soft tissue work, like massage or
foam rolling.
A cool-down does not have to be long!
Continuation of light exercise will help
to sustain blood flow to active tissues,
clearing out leftover toxins, such as
lactate and other metabolic by-products.
It can also prevent pooling from the
sudden stoppage of the muscle-blood
pump that is the skeletal muscle.
However, we cannot forget the hardest
working muscle of them all, the heart.
Light exercise following hard exercise
helps the heart lower its workload
gradually instead of suddenly, as if the
athlete stopped moving after a sprint to
the finish line. Ten to 15 minutes of light
exercise similar to competition is enough
time to help the body start to wind down
from hard work.
4. Stretch.
During exercise, tiny micro-tears occur
in active musculature and once exercise
stops, repair of that tissue begins. A
simple regime of post-exercise static
stretching of the major active muscles
will facilitate repair by realigning muscle
fibres and preventing contracture of
tendons. Partaking in a regular post-
exercise stretching routine will also help
to maintain long-term elasticity in the
muscle tissue that will translate to lower
levels of pain during exercise and lower
levels of delayed onset muscle soreness.
To get the most out of a post-exercise
regime, recommend a professional who
can develop a personalized stretching
routine for the patient and can physically
show them how they should be moving
throughout it.
DANGERS OF DEHYDRATION
Roughly 75% of our body is made up of water and even the slightest
change in levels can cause problems. Dehydration upsets mineral
balance, slows enzymatic activity, causes toxins to accumulate
more easily and affects your lungs and breathing, just to name a
few. Don’t wait until you’re thirsty before getting up to get a glass of
water. By then you’re already dehydrated.
LABEL THE WATER BOTTLE
Label a clear water bottle with different
times, indicating 250ml (about one glass)
of water for each one hour interval. When
it’s the time marked on your bottle, your
water should be at the same level. It’s a great
visual reminder to make sure you’re drinking
enough water throughout the day.

13. 12
ND Notes | Vol 2 No. 1
Notes on natural anti-inflammatories
Patients relying on the daily use of ibuprofen could be presented with the following alternatives
instead. With the exception of boswellia, all of these natural anti-inflammatories are considered
safe enough for long-term use.
This can be used as a refresher on the safety of natural anti-inflammatories commonly prescribed
by naturopathic doctors, and as a handy tool to help patients understand why it is critical they let
their health care providers know about all the medications and supplements they are taking.*
Bromelain
Great for: Pain due to inflammation, when
taken away from meals. Can be very useful to
treat acute swelling due to trauma and surgery.
Word to the wise: May cause gastric upset,
diarrhoea, chest pain and increased heart rate.
People who are allergic to latex or pineapple
should not use bromelain. Discontinue
bromelain two weeks before a surgery.
Boswellia serrata
Great for: Osteoarthritis and rheumatoid
arthritis. May see improvement of symptoms
within 7 days of treatment.
Word to the wise: May cause nausea,
epigastric pain, diarrhoea and acid reflux.
People who have autoimmune conditions
should take boswellia with caution because
of its immunostimulant properties. Not safe
for long-term use.
Ginger root
Great for: Rheumatoid arthritis, osteoarthritis
and nausea. Ginger can also be effective on
reducing the symptoms of vertigo.
Word to the wise: It is generally well tolerated,
but people with bleeding disorders, diabetes
or heart conditions should take ginger with
caution because it might increase their risk of
bleeding, cause hypoglycemia, and decrease
heart rate and heart muscle contraction.
Green tea extract
Great for: Inflammation. Gargling green tea
can be used to help prevent colds and flus.
Topically, green tea can be used as a poultice to
help reduce bags under the eyes from tiredness.
Word to the wise: People should take this
with caution if they have iron deficiency,
anxiety, cardiac arrhythmias, diabetes,
glaucoma or osteoporosis, because it
might promote cardiac arrhythmias, impair
glucose metabolism, increase intraocular
pressure, and may also increase urinary
excretion of calcium.
Curcumin
Great for: Osteoarthritis and rheumatoid
arthritis. Did you know that curcumin, which
is found in the spice turmeric, can be used
in foods, textile dyes and cosmetics to add
vibrant colour?
Word to the wise: Although it is generally
well-tolerated, people with gallstones,
bleeding disorders, diabetes or hormone-
sensitive cancers should take curcumin with
caution because it might cause gallbladder
contractions, decrease blood glucose, and
have mild estrogenic effects. Discontinue
curcumin two weeks before surgery.
Holy basil
Great for: Arthritis, immunomodulation
and inflammation. Holy basil can be applied
topically to treat ringworm.
Word to the wise: It may cause prolonged
bleeding time, so people on anticoagulant
supplements, medications or herbs should take
holy basil with caution. Discontinue two weeks
before surgery.
Resveratrol
Great for: Pain and inflammation. Can be
used to help increase HDL cholesterol levels.
Word to the wise: Patients with hormone-
sensitive conditions should not take this
because of its possible estrogenic effects.
Discontinue two weeks before surgery.
Rosemary
Great for: Musculoskeletal pain, gout and
sciatica. Can be used in combination with
other essential oils to treat alopecia areata.
Word to the wise: People with an allergy
to aspirin or bleeding disorders should
take rosemary with caution because it has
salicylates. People with seizure disorders
should not take rosemary. because it might
increase the likelihood of having a seizure.
Stinging nettle
Great for: Osteoarthritis and allergic rhinitis.
Can be used both orally and topically for
osteoarthritis.
Word to the wise: Stinging nettle is generally
well-tolerated, but people with diabetes,
hypotension or renal insufficiency should
take this with caution because it is a diuretic
and might cause hypoglycemia and low
blood pressure.
*Always refer to the most up-to-date safety data concerning pregnancy and lactation before recommending any supplement or botanical.
All information has been sourced from Natural Medicines (the former Natural Standard database) https://naturalmedicines.therapeuticresearch.com

14. Plantar fasciitis is especially common in
people who run. Distance runners and
sprinters should be especially vigilant
of the following:
• Excessive training or increased activity
• Poor fitting footwear
• Running on unyielding surfaces like
concrete
• Flat feet (pes planus)
• High arches (pes cavus)
If left untreated, plantar fasciitis can
develop into heel spurs from repetitive
trauma to the affected tissues. A heel spur,
or calcification near the attachment point
of the plantar fascia, is easily diagnosed
with an X-ray.
Home care treatment
There are plenty of things a patient can
do on their own to help alleviate plantar
fasciitis symptoms.
Rest
If you suspect that a patient’s foot pain is
being caused by plantar fasciitis, suggest
they limit athletic activities and get a lot
of rest to help ease symptoms. You might
also recommend avoiding excessive and
repetitive movements that cause impact
to the heel specifically, but at the same
time emphasize that activity should not be
stopped completely. No foot movement at
all can cause the plantar fascia to stiffen up
and pain symptoms to return.
13
Don’t let plantar fasciitis
knock you off your feet
Tips and treatments for healing heel pain
Distance runners and dancers suffer from it. So do cashiers and those
who wear worn out shoes. Plantar fasciitis, the painful foot condition
that centres on the heel is one of the most common causes of foot
complaints in adults.
Symptoms
How can you tell if your patient is suffering
from plantar fasciitis and not just typical foot
pain? The most common symptom of plantar
fasciitis is pain near the inside, or medial
aspect, of the heel and sole of the foot. It
might be felt first thing in the morning upon
getting out of bed as the feet hit the floor
or getting up out of a chair after sitting for a
period time. Even movements that stretch
the plantar fascia, like extending the big toe
or ankle dorsiflexion can cause a sufferer to
wince in pain. While walking or slowly jogging
might lessen the pain as the heel warms up,
the relief is only temporary and will return
again once activity stops.
Risk factors
People who play a lot of sports, who work
at a job that requires a lot of walking on
concrete or hard floors, or who are always
on the go are more likely to develop plantar
fasciitis than those with sedentary jobs or
who spend more time on the couch than the
basketball court. Running, marching, dancing
and jumping are some activities that can
trigger or make plantar fasciitis worse.
Achilles tendon
Plantar fascia
Even carrying a few extra pounds, standing
stationary for long periods of time, or having
decreased ankle flexibility can increase the
risk of an irritated fascia.
If you treat a lot of active individuals in your
clinic, you may have come across plantar
fasciitis, or an irritated plantar fascia.
Plantar fascia is the thick band of connective
tissue that starts at the heel bone and fans
out to the toes on the bottom, or plantar,
surface of the foot. It acts as a support
mechanism, holding the bones and muscles
of the foot steady while it’s in motion, or
even standing still. The term “fasciitis”
simply means the fascia is injured.

15. 14
ND Notes | Vol 2 No. 1
Icing
You may want to recommend your patients
apply an ice pack to the area for up to 20
minutes four times a day to help relieve
pain and discomfort. Gentle massage
and a few minutes with an ice pack just
before exercising can also be an effective
treatment method.
Protective footwear
Cushion-soled shoes, arch supports, gel
pad inserts or heel cups may do wonders
for providing temporary pain relief.
Silicone inserts are likely to provide better
support than felt pads or rubber heel cups.
Pharmacies that specialize in orthopedic
supplies often carry splints that are worn
overnight, and work by placing the foot in
a position that provides pain relief and a
gentle stretch at the same time. Wearing
supportive shoes or sandals indoors can
also be helpful, especially after getting out
of bed first thing in the morning. Though
it may seem comfortable to your patients
and feel like it’s providing relief, remind
them that walking barefoot may cause
pain symptoms to return or worsen, even
if floors are carpeted.
Rehabilitation exercises
Stretching and strengthening exercises may
be helpful, but remind patients to ease into
them slowly and with care to avoid causing
more pain. Home exercises include the calf-
plantar fascia stretch, foot/ankle circles, toe
curls and toe towel curls, as illustrated here.
Calf stretch exercise - Sit with legs straight
out and loop a towel around the foot. Gently
pull the top of the foot towards the body.
Hold for 10 to 30 seconds. Complete a set
of 5 and aim for 2 sessions a day. Modify
this exercise by pushing the ball of the foot
against the towel, which also effectively
strengthens the foot muscles.
Supplies
2 basins or
tubs for feet
Hot water
Bath
thermometer
Cold compress
for head
Towels Cold water
Foot/ankle circles - While sitting, rest one leg
on a chair keeping the other foot on the floor
and alternately point and flex the raised foot
15-20 times.
As part of the same session, make small circles
with the foot by rotating the ankle. Complete
2-3 sets by rotating clockwise 15 times and
then reverse for another 15 times.
Toe curls - Standing on a thick book, curl
the toes over the edge and then straighten.
Complete as many repetitions as possible
within a 2 minute period, twice a day.
Toe towel curls - Curl toes around a towel
then grip and release for 1 to 2 minutes,
twice a day.
Hydrotherapy - alternating
foot bath
Alternating hot and cold foot baths can be
extremely helpful with reducing pain and
increasing circulation to speed healing.
Contraindications: Do not use alternating
hot and cold foot baths in patients with
cancer, vascular disease (including diabetes),
diminished sensation or hemorrhage.
Caution: Always finish with a short cold
bath, except for those with rheumatoid
arthritis, whose condition is aggravated by
cold. End treatment with a warm bath in this
case instead.
Directions
1. Prepare a tub of hot water at a temperature
of 40 to 43ºC. Do not exceed 49ºC.
2. Prepare an alternate tub of cold water at
a temperature of about 7ºC.
3. Immerse feet in the tub of hot water
for 3 minutes.
4. After 3 minutes, change feet to cold foot
bath and immerse for 30 seconds.
5. Make 3 complete changes between the
hot and cold tubs (3x-hot/3x-cold).
6. Always start the treatment with the hot
bath and finish with the cold.
7. If the patient starts to sweat, place a cold
compress on the forehead.
8. Dry feet thoroughly and let the patient
rest on a bed for at least 30 minutes
before going home.

16. 15
ND Notes | Vol 2 No. 1
Side notes:
• Add hot water to the hot tub
if the temperature falls below
4ºC.
• The greater the temperature
difference between the hot
and cold water, the stronger
the treatment.
In-office therapies
The following is a list of plantar fasciitis
treatment options you might try with
your patients.
Nutritional supplements
Vitamin C is the key for initiating connective
tissue repair. A deficiency can result in
decreased tensile strength of fibrous tissues,
like those found in the plantar fascia.
Recommended dosage for the purpose of
tissue repair is 1 to 3g daily.
Zinc is an important factor in tissue
regeneration and repair and works together
with vitamin C to increase the tensile
strength of wounded tissue. In fact, animal
studies show that zinc deficiency is a
contributor in delaying wound healing.
Patients with chronic injuries, high stress
levels, or those who exercise at an intense
level are at an increased risk for zinc
deficiency. A daily dosage of 15 to 30mg is
recommended to help to speed healing.
Fish oil is rich in the omega-3 polyunsaturated
fatty acids eicosapentaenoic acid (EPA)
and docosahexaenoic acid (DHA), and has
been found to be a factor in suppressing the
production of inflammatory mediators. In a
double blind, placebo-controlled study of 49
patients with rheumatoid arthritis, those who
supplemented with fish oil for 24 weeks showed
less morning stiffness and fewer tender
joints than the control group. Recommended
dosage is 2 to 3g daily, but may require two to
six months to take full effect.
Soft tissue or manual therapy
In many plantar fasciitis cases, manipulation
of the soft tissue can provide a measure of
relief to sufferers. Through observation and
palpation, aim to lengthen the tightened
areas between each of the points that
support the arches: the heel, the first
metatarsal head and the fifth metatarsal
head. Work your way posteriorly and loosen
UB 56 (Chengjin)
UB 57 (Chenshan)
the Achilles tendon and the muscles attached
to it, including the soleus and gastrocnemius
muscles. Instrument-assisted therapies,
like Graston, Fibroblaster and Gua sha, are
also helpful tools to break down scar tissue,
adhesions and fascial restrictions.
Sports medicine acupuncture -
motor point locations
Though acupuncture is often recommended
as an effective treatment for plantar fasciitis,
most positive reports have only been
anecdotal. Research regarding acupuncture's
efficacy shows promise, though. In a study
that documented the treatment of 11 patients
with acupuncture and electrical stimulation,
most indicated improved overall pain scores.
A motor point is typically located in
the central aspect of the muscle. This
sensitive area has a strong influence on
pain management, and is also helpful in
strengthening and increasing the range of
motion of the treated muscles. In Traditional
Chinese Medicine, these are known as Ashi
points, or trigger points, in other health
circles. The following are muscles that may
relate to the plantar fascia, and therefore
can be helped with acupuncture therapy
or electrostimulation to relax the tightened
and/or contracted muscle tissue.
Tibialis posterior
Location: 1 cun medial to the point between
UB 56 and UB 57
Insertion: Oblique needle insertion 1 to 1.25
inches directed towards the centre of the calf
Caution: Posterior tibialis artery and nerve
Head of fibula
SP 8 (Diji)
SP 7 (Lougu)
Soleus - 3 points
Location 1: 3 cun inferior to head of fibula,
on the posterior border of the fibula
Insertion: Perpendicular needle insertion
with a depth of 0.5 to 0.75 inch
Location 2: 1 cun posterior from SP 8
Insertion: Perpendicular needle insertion
0.5 to 0.75 inch
Location 3: Halfway between SP 7 and SP 8
Insertion: Perpendicular needle insertion
0.5 to 0.75 inch
K2 (Rangu)
Abductor hallucis longus
Location: Kidney 2
Insertion: Perpendicular needle insertion
0.5 to 0.75 inch

17. 16
ND Notes | Vol 2 No. 1
Tape support
Taping the affected foot with a technique
known as low-dye taping may bring some
relief to plantar fasciitis sufferers. Four strips
of tape are applied as shown below. Caution
against applying the tape too tightly and
switch to hypoallergenic tape for patients
who have adverse reactions to regular tape.
UB 58 (Feiyang)
UB 59 (Fuyang)
SP 7 (Lougu)
1 2 3 4
Flexor hallucis longus
Location: Halfway between UB 58 and UB 59
Insertion: Perpendicular needle insertion
1-1.5 inch
Flexor digitorum longus
Location: SP 7
Insertion: Perpendicular needle insertion
1 inch
Directions
1. Wrap a strip of tape around the ball of
the foot.
2. Wrap a second strip of tape around the heel,
starting just below the pinky toe, around
either side of the heel and back up to the
first strip of tape.
3. Wrap a third strip of tape around the heel,
starting just below the pinky toe, as in step
2. This time, circle the heel and wrap the
tape in a criss-cross fashion, so that it ends
just below the big toe.
4. Repeat step 3. The tape does not need to
align perfectly and can stay in place for up
to one week.
Other options for
treating plantar fasciitis
If your patient has not noticed an
improvement with the above recommended
treatments, you may wish to try some of these
alternatives:
Pain medication - A short course of a
nonsteroidal antiinflammatory drug (NSAID)
like ibuprofen can be helpful to relieve pain.
However, these types of medications have
many possible side effects. It might be a
good idea to discuss the potential risks
versus benefits with your patients.
Steroid injection - An injection of a steroid
(glucocorticoid) medication into the foot
may relieve pain, though the effect may
wear off after only a few weeks.
Casting - A walking cast with a rocker-
shaped bottom allows the foot and ankle to
be in an optimal position for pain relief and
healing for the duration of treatment.
Plantar fasciitis is a common foot condition
that can thankfully be managed using many
different approaches. As a practitioner,
you may already be using some of the
options suggested here, or perhaps you
have learned some new treatments you
might implement in your office or suggest
as at-home protocols. Having a hand in
getting runners back on track, dancers
back up on their toes and people back to
their physically demanding jobs is certainly
a satisfying and rewarding end result for
practitioners - and a huge relief for sufferers.
INSIDE A
PULLED MUSCLE
A strained muscle occurs when
muscle fibres or attaching tendons
are overstretched or torn, typically
resulting from overuse, fatigue or
improper form. A pulled hamstring
(the muscle group behind the thigh
that flexes the knee) is common
among athletes, especially runners.

18. 17
ND Notes | Vol 2 No. 1
To ice or not to ice?
Read why Shayne Glass-Smith
recommends heat for an acute injury
Do you recommend your clients
ice an acute injury or not?
It's standard practice to recommend clients
use ice anywhere up to 48 hours after an
injury and anytime they feel inflammation.
Personally, I don't follow this practice and
neither does the gentleman who created the
acronym RICE, Dr. Gabe Mirkin.
In an athletic injuries course that I took at the
University of Western Ontario, the following
rationale was given. When an injury occurs,
metabolites involved in healing are released,
which impede the flow of blood, oxygen
and nutrients to the site of injury. That same
tissue is starving for oxygen and if it doesn't
get it, the tissue will die or will be severely
injured for the long haul.
My thinking (some of which evidence is now
supporting) is as follows:
• Inflammation is critical to the healing
process, so by icing you're actually
impeding that process.
• If a tissue is starving for oxygen after
damage, why wouldn't you increase the
oxygen supply by promoting blood flow
to that area? Heat promotes blood flow;
therefore promoting oxygen and nutrients
to the damaged tissue.
• Muscles shorten in cold (just as humans
shiver and curl up to stay warm) and
so any tearing or straining might be
exacerbated by applying cold.
I believe that icing became popular for
two reasons:
• Professional sports: In any given sports
season, there are a number of games
that an elite athlete has to be ready
to play. By icing the area, the athlete
temporarily achieves enough comfort
to complete the game and ultimately
finish out the season, before taking care
of the rehabilitation thoroughly in the
off-season.
• Discomfort: Swelling is incredibly
uncomfortable and so icing helps to
temporarily relieve that discomfort, but it
does not help the healing process in any way.
For the long-term it would be much better -
and I think we'll see it come out in literature
in the next few years - to heat the injured
area. Allowing continuous blood flow through
the application of heat will reduce the seizing
or shortening of muscles that would make
them more difficult to reattach, should
there be a tear or strain of any degree. The
application of heat also allows the damaged
tissue to be flushed out, while replacing it
with oxygen and nutrients resulting in new,
healthy tissue!
Shayne Glass-Smith, B. Kin (Hons.)
Shayne Glass-Smith earned his Honours degree in
Kinesiology from Western University in 2009. Since
then, he has worked at several physiotherapy clinics in
London, Ontario and Toronto, Ontario. He currently lives
in Edmonton, Alberta and is working toward becoming
a physiotherapist. Shayne has a true passion for the
health, wellness, fitness and care of athletes and the
general population. In his spare time, he enjoys playing
basketball, volleyball and weightlifting. He is continually
increasing his knowledge on health and fitness by reading
current health and medical literature.
BRUISING EXPLAINED
A bruise occurs when injury to soft tissues causes the
underlying capillaries to break and leak red blood cells.
Hemoglobin in red blood cells then breaks down to
bilirubin and biliverdin byproducts, which give bruises
their black, blue and yellow hues.

19. 18
ND Notes | Vol 2 No. 1
Featured products
Here are a few key remedies that you might find
helpful to keep in your dispensary, along with
their suggested uses.
CanPrev Core for Women Men
Recommended to help restore the immune
system and boost energy levels. Formulated
with easy-to-digest plant proteins and
antioxidants from greens and berries, along
with complete multivitamin and essential
nutrients, and developed specifically for
women’s and men’s health.
Directions: Adults - Add 2 rounded scoops
(40g) to 250ml of your favourite beverage
and shake well. For a delicious smoothie,
blend with a ½ cup of fresh or frozen fruit.
Enjoy everyday for optimal health!
Complete Nutrition for Men Women
2 rounded scoops (40g) contain:
Plant Protein Blend......................................................... 18g
Yellow pea protein (pisum sativum) .......................................... 13g
Brown Rice Protein (oryza sativa) .................................................. 5g
Greens Blend ..................................................................... 4g
Beet root (beta vulgaris) ..................................................... 900mg
Broccoli (brassica oleracea var. italica) .............................750mg
Parsley leaf (petroselinum crispum) ................................. 725mg
Kale (brassica oleracea var. acephala) .............................. 525mg
Spinach leaf (spinacia oleracea) ....................................... 500mg
Alfalfa leaf stem extract (4:1, medicago sativa) .......... 125mg
Chlorella (chlorella vulgaris, broken cell) ......................... 100mg
Superfruit Blend ............................................................... 1g
Cherry fruit (prunus avium) ................................................ 250mg
Blueberry fruit (vaccinium corymbosum) ....................... 200mg
Goji fruit juice (lycium barbarum) ..................................... 200mg
Mangosteen fruit (garcinia mangostana) ........................ 150mg
Acai fruit extract (4:1, euterpe oleracea) ........................... 50mg
CanPrev Core For Women
Nutrients specific to women’s health:
Cassiacinnamonbarkextract(4:1,Cinnamomumaromaticum).. 750mg
Cranberry fruit extract (40:1, vaccinium macrocarpon) ... 300mg
Elemental calcium (citrate) .............................................. 250mg
Women’s Multi
Vitamin A (acetate) ............................................................ 1,250IU
Beta-carotene (natural) ....................................................... 500IU
Vitamin C (ascorbic acid ) ..................................................... 50mg
Vitamin D2 (ergocalciferol) ............................................... 1,000IU
Vitamin E (d-alpha) .................................................................. 25IU
Vitamin K1 (phytonadione) .............................................. 120mcg
Vitamin B1 (thiamine hydrochloride) ............................... 12.5mg
Vitamin B2 (riboflavin) ....................................................... 12.5mg
Vitamin B3 (niacinamide) .................................................. 12.5mg
Vitamin B5 (calcium pantothenate) ................................. 12.5mg
Vitamin B6 (pyridoxine hydrochloride) ........................... 12.5mg
Vitamin B7 (biotin) ............................................................... 25mcg
Vitamin B9 (folic acid) ....................................................... 200mcg
Vitamin B12 (methylcobalamin) ...................................... 125mcg
Choline (bitartrate) .................................................................. 5mg
Inositol ....................................................................................... 5mg
Lutein (marigold) ................................................................... 1.5mg
Elemental Chromium (polynicotinate) ............................ 45mcg
Elemental Copper (citrate) ............................................. 500mcg
Elemental Iodine (brown kelp) ........................................ 100mcg
Elemental Magnesium (bisglycinate) .............................. 110mg
Elemental Manganese (citrate) ......................................... 1.5mg
Elemental Molybdenum (sodium molybdate) ............. 100mcg
Elemental Potassium (citrate) .......................................... 100mg
Elemental Selenium (selenium yeast) ............................. 50mcg
Elemental Vanadium (vanadyl sulfate) ............................ 15mcg
Elemental Zinc (citrate) .......................................................... 5mg
CanPrev Core For Men
Nutrients specific to men’s health:
Cassiacinnamonbarkextract(4:1,Cinnamomumaromaticum).750mg
Coenzyme Q10 ........................................................................ 30mg
Lycopene ............................................................................... 6.5mg
Men’s Multi
Vitamin A (acetate) ............................................................. 1500IU
Beta-carotene (natural) ....................................................... 600IU
Vitamin C (ascorbic acid) ...................................................... 60mg
Vitamin D2 (ergocalciferol) ............................................... 1,000IU
Vitamin E (d-alpha) .................................................................. 30IU
Vitamin K1 (phytonadione) .............................................. 36mcg
Vitamin B1 (thiamine hydrochloride) .................................. 15mg
Vitamin B2 (riboflavin) .......................................................... 15mg
Vitamin B3 (niacinamide) ..................................................... 15mg
Vitamin B5 (calcium pantothenate) .................................... 15mg
Vitamin B6 (pyridoxine hydrochloride) .............................. 15mg
Vitamin B7 (biotin) ............................................................... 30mcg
Vitamin B9 (folic acid) ....................................................... 240mcg
Vitamin B12 (methylcobalamin) ...................................... 150mcg
Choline (bitartrate) .................................................................. 6mg
Inositol ....................................................................................... 6mg
Lutein (marigold) ................................................................... 1.8mg
Elemental Calcium (citrate) .............................................. 200mg
Elemental Chromium (polynicotinate) ............................ 45mcg
Elemental Copper (citrate) ............................................. 500mcg
Elemental Iodine (brown kelp) ........................................ 100mcg
Elemental Magnesium (bisglycinate) .............................. 110mg
Elemental Manganese (citrate) ......................................... 1.5mg
Elemental Molybdenum (sodium molybdate) ............. 100mcg
Elemental Potassium (citrate) .......................................... 100mg
Elemental Selenium (selenium yeast) -............................ 50mcg
Elemental Vanadium (vanadyl sulfate) ............................ 15mcg
Elemental Zinc (citrate) .......................................................... 5mg
Vanilla non-medicinal ingredients: psyllium
husk powder, apple pectin, inulin, guar gum,
natural green tea flavour, natural french vanilla
flavour,naturalvanillaflavour,xylitol,organicstevia.
840 g
ND’s Note: I recommend CanPrev Core to most of
my active patients as a post-workout supplement.
Single serve pouches are easy to travel with. You
can also sprinkle the protein powder on oatmeal
or yogurt, or use in baking. Probiotics and fish oil
can be added directly into the shake as well.

20. 19
ND Notes | Vol 2 No. 1
WHY DO OUR
MUSCLES ACHE?
Delayed onset muscle soreness
(DOMS) that occurs a day or two after
a harder than usual or new workout
is often mistakenly believed to be
caused by lactic acid build­up.
However, lactic acid isn’t even a factor
in this process. The muscle soreness
you’re experiencing is actually caused
by inflammation stemming from
microscopic tears in your muscle
fibres and connective tissues.
chocolate flavour, natural vanilla flavour, cocoa
powder, xylitol, organic stevia.
Vanilla non-medicinal ingredients: psyllium
husk powder, apple pectin, inulin, guar gum,
natural green tea flavour, natural french vanilla
flavour, natural vanilla flavour, xylitol, organic stevia.
500 g
ND’s Note: My active female patients
absolutely love this nutrient dense shake. My
male patients do too! Yes… it is safe for men
to use this formula as well; it does not contain
any estrogenic ingredients. ND Shakes can be
added to your favourite beverage or coconut
water for extra electrolyte support. For a more
calorie dense shake, consider adding nut
butter, coconut butter and/or avocado.
ND Shake Women's Sport
Recommended before or after workouts to
support every woman’s needs. Each serving
contains 27g of plant protein blended with
greens, superfuits and fibre, plus nutrients
such as panax ginseng, cinnamon, CoQ10 and
L-glutamine to help support performance, blood
sugar, heart health and muscle repair.
Available in chocolate or vanilla.
Directions: Adults - Add 3 rounded scoops
(60g) to 300ml of your favourite beverage and
shake well. For a delicious smoothie, blend with
a ½ cup of fresh or frozen fruit. Enjoy before or
after your workout!
3 rounded scoops (60g) contain:
Plant Protein Blend ................................................................ 27g
Yellow pea protein (pisum sativum) ................................... 19.5g
Brown Rice Protein (oryza sativa) ......................................... 7.5g
Greens Blend ............................................................................... 4g
Beet root (beta vulgaris) ..................................................... 900mg
Broccoli (brassica oleracea var. italica) ........................... 750mg
Parsley leaf (petroselinum crispum) ................................. 725mg
Kale (brassica oleracea var. acephala) ............................. 525mg
Spinach leaf (spinacia oleracea) ....................................... 500mg
Alfalfa leaf stem extract (4:1, medicago sativa) .......... 125mg
Chlorella (chlorella vulgaris, broken cell) ......................... 100mg
Superfruit Blend............................................. 1g
Cherry fruit (prunus avium) ................................................ 250mg
Blueberry fruit (vaccinium corymbosum) ....................... 200mg
Goji fruit juice (lycium barbarum) ..................................... 200mg
Mangosteen fruit (garcinia mangostana) ........................ 150mg
Acai fruit extract (4:1, euterpe oleracea) ........................... 50mg
Nutrients specific to active women’s health:
L-Glutamine .................................................................................. 5g
Cassiacinnamonbarkextract(4:1,Cinnamomumaromaticum).. 750mg
Elemental magnesium (bisglycinate)............................... 210mg
Bromelain ............................................................................. 200mg
Elemental potassium (citrate)........................................... 150mg
Elemental sodium (chloride) ............................................. 125mg
Panaxginsengrootextract(15:1,panaxginsengC.A.meyer)... 33.4mg
Coenzyme Q10 ....................................................................... 30mg
Chocolate non-medicinal ingredients:
psyllium husk powder, apple pectin, inulin,
guar gum, natural green tea flavour, natural
Joint Pain Cream
A comprehensive, powerful and clean
homeopathic cream that helps to relieve joint
pain, swelling and stiffness from arthritis,
or minor sprains and strains. Also helps to
reduce stiffness in muscles and tendons.
Free from any parabens, fragrances,
petroleum, lanolin or propylene glycol.
Directions: Adults and children (0 years and
up) - Apply generously to affected areas once
daily or as needed. External use only.
Medicinal ingredients:
Actaea spicata ........................................................................ 3X
Argentum metallicum ............................................................ 3X
Argentum metallicum ............................................................ 6X
Arnica montana ...................................................................... 3X
Arnica montana ...................................................................... 6X
Bryonia ..................................................................................... 3X
Bryonia ..................................................................................... 6X
Kalmia latifolia ........................................................................ 3X
Ledum palustre ....................................................................... 3X
Rhododendron chrysanthum .............................................. 3X
Rhododendron chrysanthum .............................................. 6X
Rhus toxicodendron .............................................................. 3X
Rhus toxicodendron .............................................................. 6X
Ruta graveolens ...................................................................... 3X
Ruta graveolens ...................................................................... 6X
Non-medicinal ingredients: Beeswax, shea
butter, MCT oil, cetearyl alcohol, glycerin,
tocopherol, sodium citrate, sodium lactate,
carbomer, potassium hydroxide, purified water,
lactose (trace amount).
50 g
ND’s Note: One of my favourite topical
creams - this formula works quickly to mobilize
stiff joints and is particularly beneficial for pain
that is worsened with movement and motion.

21. 20
ND Notes | Vol 2 No. 1
Pain Relief Cream
Like Joint-Pain cream, Pain Relief cream is free
from any parabens, fragrances, petroleum,
lanolin or propylene glycol and works quickly
to abolish the pain and swelling associated
with acute injuries like sprains and strains.
Directions: Adults and children (0 years and
up) - Apply generously to affected areas once
daily or as needed. External use only.
Medicinal ingredients:
Arnica montana .............................................................................. 3X
Arnica montana .............................................................................. 6X
Belladonna ...................................................................................... 3X
Belladonna ...................................................................................... 6X
Bellis perennis ................................................................................. 1X
Bellis perennis ................................................................................. 3X
Bellis perennis ................................................................................. 6X
Echinacea angustifolia .................................................................. 1X
Hamamelis virginiana .................................................................... 1X
Hypericum perforatum ................................................................. 3X
Hypericum perforatum ................................................................. 6X
Millefolium ....................................................................................... 1X
Ruta graveolens .............................................................................. 3X
Ruta graveolens .............................................................................. 6X
Symphytum officinale ................................................................... 1X
Symphytum officinale ................................................................... 3X
Symphytum officinale ................................................................... 6X
Non-medicinal ingredients: Beeswax, shea
butter, MCT oil, cetearyl alcohol, glycerin,
tocopherol, sodium citrate, sodium lactate,
carbomer, potassium hydroxide, purified water,
lactose (trace amount).
50 g
ND’s Note: A must-have in your first-aid kit for
all acute traumas. Safe and non-toxic for use
on children as well.
ElectroMag / MagPop!
Quench your thirst with this highly absorbable
magnesium bislgycinate supplement,
enhanced with vitamin C and electrolytes.
It contains no added sugar, preservatives,
artificial flavours or colours.
Directions: Empty contents into a glass and
add 150 to 250ml of water, or to taste.
Each packet contains:
ElectroMag
Magnesium (magnesium bis-glycinate) ............................. 150mg
Vitamin C (ascorbic acid) ...................................................... 375mg
MagPop!
Magnesium (magnesium bis-glycinate) ............................. 100mg
Vitamin C (ascorbic acid) ...................................................... 325mg
ElectroMag non-medicinal ingredients:
Citric acid, tartaric acid, sodium bicarbonate*,
calcium carbonate*, potassium carbonate*,
stevia, xylitol, maltodextrin, natural lemon-lime
flavour, natural lemon flavour, natural lime
flavour. *Provides electrolytes.
MagPop! non-medicinal ingredients: Citric
acid, tartaric acid, sodium bicarbonate,*
calcium carbonate,* potassium carbonate,*
stevia, xylitol, maltodextrin, quercetin, beta-
carotene, orange juice powder, natural orange
flavour. *Provides electrolytes.
ND’s Note: Recommended during and after
workouts to replenish magnesium, as well as
other important electrolytes, to keep muscles
functioning. Vitamin C is not only there to
support the immune system, it also plays
an important role in collagen synthesis and
wound healing. Patients can throw it in their
gym bag, add it to water and enjoy the fizz.
30 ElectroMag sachets per box:
Lime flavour
35 MagPop! sachets per box:
Orange flavour
Many athletes have reported
success using and integrating
effervescent magnesium into
their training.
Recently I have been using
ElectroMag, CanPrev's effervescent
magnesium drink, as a standalone
post-workout beverage. I have also
included it in my juices on days that
I am not working out due to its great
taste and nutrient profile.
After sustained use of this product,
I’ve experienced less shin pain
from running. I’ve also noticed after
performing high-intensity workouts,
such as interval training or hill
repeats, I find that my body feels
refreshed the next day.
I typically avoid many sports drinks
while running because the flavours
are typically too sweet for me. I have
found that ElectroMag has a nice
light flavour that doesn't overwhelm
my taste buds, which allows me to
consume it during a run. Another
great feature is the convenience of
individual packages, which allow
me to store them in my vest or pack
while running for use each time I
refill my bottle.
I look forward to using this product
in the coming months for several
different races (ranging from fast, flat
5Ks to mountainous 101Ks).
Robert Hughson, High-altitude mountaineer
ultra-marathon runner

22. 21
ND Notes | Vol 2 No. 1
Eat meals with balanced portions of protein,
carbohydrate and fat. Many people envision
a large plate of pasta as the poster meal for
athletes, but their nutritional requirements
are specific to their sport. Athletes should
consult with a sport-focused naturopathic
doctor or sport nutritionist to ensure proper
fuelling for training, events and recovery.
Dr. Jamila M. James, ND (ON)
What is your top dietary
recommendation
for athletes?
Second opinion
Joint-Pro
This formula contains ingredients with
analgesic and anti-inflammatory properties
to help maintain joint functions and relieve
joint pain caused by wear and tear, injury and
inflammatory processes.
Directions: Adults - Take 2 capsules 2 times per
day with food, or as directed by a healthcare
practitioner.
Each vegetable capsule contains:
Glucosamine HCI (shellfish) ................................................ 400mg
Methylsulfonylmethane (MSM) ........................................ 200mg
Chondroitin sulfate (bovine) ............................................ 180mg
Boswellia serrata extract (45% boswellic acid) ............. 50mg
Devil’s claw extract (4:1) ...................................................... 50mg
Curcumin (turmeric) ............................................................. 48mg
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
90 Vegetable Capsules
ND’s Note: Many adults trying to become more
physically active start experiencing joint pain.
Joint-Pro can be prescribed as a preventative
measure, as sometimes some extra support is
necessary in the beginning while the joints are
getting more accustomed to moving again!
Joint-Pro NEM
The naturally sourced glucosamine, chondroitin,
and hyaluronic acid found within the natural
eggshell membrane is pivotal in maintaining the
health of joints and connective tissue.
Directions: Adults - Take 1 capsule 2 times
per day with food, a few hours before or after
taking other medications, or as directed by a
healthcare practitioner.
Each vegetable capsule contains:
Natural eggshell membrane ............................................... 250mg
Glucosamine HCl ................................................................ 750mg
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
60 Vegetable Capsules
ND’s Note: Studies have shown NEM to be
quite effective for reducing the pain and stiffness
associated with osteoarthritis, particularly of the
knee and/or hip. Research has also shown it can
relieve pain within 7 days, potentially making it
more effective for acute pain.
Osteo Prolong
For the maintenance of healthy bones,
this comprehensive formula provides the
vitamins and minerals needed for the proper
construction of bones that contributes to the
maintenance of bone health.
Directions: Adults - Take 2 capsules 2 times
per day with food, a few hours before or after
taking other medications or as directed by a
healthcare practitioner.
Each vegetable capsule contains:
Calcium (citrate carbonate blend) ............................ 200mg
Magnesium (bisglycinate) ................................................... 86mg
Zinc (citrate) ............................................................................. 3mg
Boron (citrate) ................................................................... 175mcg
Vitamin K1 (phytonadione) .............................................. 30mcg
Vitamin D3 (cholecalciferol) ................................................ 250IU
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
120 Vegetable Capsules
ND’s Note: Many seniors, especially retirees,
want to become more active, but are concerned
about their bone integrity. Calcium is not the
only important thing for bones. Magnesium
and vitamins D and K help direct calcium
into the bones. Those with a family history of
osteoporosis especially can benefit from using a
comprehensive formula like this!

23. 22
ND Notes | Vol 2 No. 1
When it comes to eating for athletic
performance there is no one diet that works
for everyone; however, whichever dietary route
you do choose, try to ensure that it eliminates
junk food and reduces inflammation. Foods
that contribute to inflammation are processed
foods, sugars, refined grains, hydrogenated
oils and artificial colours and flavours.
Janet Neilson, Homeopath (ON)
Along with drinking adequate amounts of water,
electrolytes that are lost in sweat (sodium,
potassium, calcium, magnesium, chloride,
bicarbonate, phosphate and sulphate) need to
be replaced. Consuming enough water based
on body-weight and activity level, combined
with a good quality electrolyte replacement,
can be key for optimal performance.
Dr. Jenny Cundari, ND (BC)
Bananas! I love that you can just grab them
and go - a natural and unprocessed snack.
They are nature’s energy bar, a great source
of natural and easy-to-digest sugar, and a
rich source of potassium. An average banana
contains about 422-450 mg of potassium
to help regulate fluids and prevent muscle
cramps and spasms.
Dr. Cecilia Ho, ND (ON)
Magnesium Bis.Glycinate 200
This happy fusion of magnesium (essential
mineral) and glycine (amino acid) helps to
support muscle relaxation and nervous
system health. The glycinate form improves
absorption and reduces GI irritation.
Directions: Adults - Take 1 capsule per day or
as directed by a healthcare practitioner.
Each vegetable capsule contains:
Magnesium (bisglycinate) .............................. 200mg
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
90 Vegetable Capsules
ND’s Note: It is important for active
patients to replenish their electrolyte
levels, especially magnesium, because the
majority of the North American population
is already depleted in this essential mineral.
I recommend it after workouts to support
muscle recovery and prevent muscle cramps.
Available in capsule and powder form.
Curcumin-Pro
An excellent anti-inflammatory formula
containing curcumin and bromelain. The lecithin
helps to increase bioavailability of the curcumin.
Directions: Adults - Take 1 capsule 3 times
per day away from food or as directed by a
healthcare practitioner. For prolonged use,
consult a healthcare practitioner.
Each vegetable capsule contains:
Curcumin (turmeric) ............................................................ 400mg
Bromelain (pineapple stem) .............................................. 60mg
Lecithin (20% Phosphatidylcholine) ............................... 125mg
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
60 Vegetable Capsules
ND’s Note: Patients suffering from
inflammatory conditions such as arthritis
can benefit from natural anti-inflammatories,
which can be a good alternative for those who
experience side-effects from conventional anti-
inflammatories. Studies show curcumin can
also benefit patients with Alzheimer’s disease.
Pain-Pro
This formula combines anti-inflammatories,
analgesics and antioxidants to provide joint pain
relief and reduce inflammation of the joints.
Directions: Adults - Take 2 capsules 3 times
per day with food or as directed by a healthcare
practitioner. Consult a healthcare practitioner
for use beyond 3 months.
Each vegetable capsule contains:
Bromelain (pineapple stem) .......................................... 140mg
Boswellia extract (resin, 45% boswellic acid) .............. 100mg
Ginger extract (root, 5% gingerols) ................................. 100mg
Stinging nettle extract (root, 4:1) ................................... 83mg
Rosemary extract (leaf, 4:1) ................................................ 67mg
Curcumin (turmeric) ............................................................. 64mg
Green tea extract (leaf, 95% polyphenols) ...................... 35mg
Holy basil extract(leaf, 4:1) .................................................. 33mg
Resveratrol (polygonum, root) ..................................... 400mcg
Non-medicinal ingredients: vegetable-grade
magnesium stearate, vegetable capsule.
120 Vegetable Capsules
ND’s Note: This formula is ideal as an
alternative to COX-2 drugs, making it is useful
for patients who experience side-effects from
the COX-2 drugs, but seek pain relief.

24. 23
ND Notes | Vol 2 No. 1
Sciatica (homeopathic)
Helps to relieve the itching, cutting pain of
sciatica. Contains key remedies that address pain
alternating with numbness, and made worse by
damp weather.
Directions: Adults - For general dosing, take
1ml, 3 times per day under the tongue or in a
little water. For acute symptoms, take 1ml every
30-60 minutes (up to 12 times per day). When
symptoms improve, resume general dosing.
Each ml contains:
Agaricus muscarius ................................................................ 3X
Arsenicum album ................................................................ 6CH
Colocynthis ........................................................................... 6CH
Gnaphalium polycephalum ...................................................3X
Kali iodatum ............................................................................ 3X
Rhus toxicodendron .............................................................. 3X
Non-medicinal ingredients: 25% grain
alcohol, purified water, lactose (trace amount).
100 ml
ND’s Note: Recommended in conjunction with
anti-inflammatory Turmeric tincture or Pain-Pro
by CanPrev.
Fibromyalgia (homeopathic)
A gentle formula to address to the bruising,
tenderness and sensitivity associated with
fibromyalgia. Helps to reduce insomnia,
exhaustion, sleep-deprivation and low-grade
fatigue, as well as improve muscular control
and reduce stiffness and spasming.
Directions: Adults - For general dosing, take
1ml, 3 times per day under the tongue or in a
little water. For acute symptoms, take 1ml every
30-60 minutes (up to 12 times per day). When
symptoms improve, resume general dosing.
Each ml contains:
Arnica montana........................................... 30CH
Avena sativa .................................................. 3X
Chelidonium majus.......................................... 1X
Cimicifuga racemosa..................................... 12CH
Magnesia phosphorica...................................... 8X
Picricum acidum........................................... 6CH
Plumbum metallicum .................................... 12CH
Rhamnus californica ........................................ 2X
Zincum metallicum.......................................... 6X
Non-medicinal ingredients: 25% grain
alcohol, purified water, lactose (trace amount).
100 ml
ND’s Note: An ideal formula as part of a
comprehensive protocol, to be taken along with
magnesium, vitamin D and a vitamin B complex.
Omega-Pro HP 40/20
Excellent source of EPA and DHA, which
are natural anti-inflammatories that can
help relieve joint pain and improve range of
motion. These molecularly distilled fish oils
are derived from small, wild, deep sea fish,
with added Vitamin E to retain freshness.
Directions: Adults - Take 1 to 3 softgels per
day with food or as directed by a healthcare
practitioner.
Each softgel contains:
Fish oil (wild sardine, anchovy mackerel) .................. 1000mg
EPA
AEP ......................................................................................... 400mg
DHA
ADH ........................................................................................ 200mg
Non-medicinal ingredients: D-alphatocopherol,
bovine gelatin, glycerin, purified water.
90 Softgels
ND’s Note: Omega 3 is one of the most
commonly prescribed anti-inflammatories in
my practice, especially for those who don’t
consume enough fatty fish. With a daily dose
of only 3 capsules, your patients will get
1200mg of EPA, which is a good therapeutic
dose for inflammatory conditions, such as
pain, sports injuries, arthritis, etc. Taking fish
oils right before a meal can help prevent the
regurgitation of the oil.

25. 24
ND Notes | Vol 2 No. 1
Joint Pain (tincture)
Devil’s claw has long been used to help
relieve joint pain due to osteoarthritis. It is
also beneficial for patients with arthritic and
rheumatic conditions and for low back pain.
Directions: Adults - Take 2ml, 3 times per day
under the tongue or in a little water, on an
empty stomach (either 15 minutes before
meals or 1 hour after). Use for a minimum
of 2-3 months to see beneficial effects.
Each ml contains:
Devil’s claw extract (root, 1:4) ......................... 250mg
Non-medicinal ingredients: 40% grain
alcohol, purified water.
100 ml
ND’s Note: Devil’s claw does require some
build-up time in the joints to see effects, which
can often take up to 8-12 weeks. This formula is
particularly beneficial for patients who are taking
other medications, as the there are few to no
contraindications associated with this botanical.
Turmeric (tincture)
This potent anti-inflammatory boosting
botanical works aggressively to block the COX
pain-promoting pathway without any of the
side-effects of common NSAIDs.
Directions: Adults - Take 2 ml, 3 times per
day under the tongue or in a little water, on an
empty stomach (either 15 minutes before
meals or 1 hour after). Use for a minimum
of 2-3 months to see beneficial effects.
Each ml contains:
Turmeric rhizomes extract (rhizome, 1:5) ........... 200mg
Non-medicinal ingredients: 40% grain
alcohol, purified water.
100 ml
ND’s Note: One of our most popular tinctures,
this formula at its recommended daily dose
provides 1.2g of curcumin. For stronger
anti-inflammatory support, consider doubling
the dose and pairing with CanPrev’s Pain-Pro for
additional anti-inflammatory botanical support.
D3+K2 Drops
This combination formula of vitamins D3 and
K2 is immersed in a medium chain triglyceride
oil to enhance the absorption of these fat-
soluble vitamins.
Directions: Adults - Take 4 drops per day.
Each drop contains:
Vitamin D3 (cholecalciferol) ............................. 250IU
Vitamin K2 (menaquinone-7) .......................... 30mcg
Non-medicinal ingredients: Medium chain
triglycerides, d-alpha tocopherol.
15ml MCT Base
ND’s Note: Vitamin D3 supports the
maintenance of bone integrity as well as
modulates the immune system. Vitamin K2 has
clinically demonstrated significant protection
of bone strength.

26. 25
ND Notes | Vol 2 No. 1
CanPrev Core
SPORTS NUTRITIONIST'S
TOOLBOX
If you specialize in sports nutrition,
there are a few essential staples to
keep stocked on your shelves and
recommend to your patients - additional
protein, magnesium for muscle and
bone support, and a natural anti-
inflammatory such as curcumin,
as an alternative to ibuprofen.
Featured naturopath
Meet Dr. Tracey Teasdale, a Naturopathic Doctor and Certified Sports
Nutritionist, who focuses her practice on sports medicine. Dr. Teasdale
is the clinic director of Absolute Athlete Care with two locations in
Barrie, Ontario and Alliston, Ontario. In addition to private practice, Dr.
Teasdale is an assistant professor of clinical education at CCNM, and a
supervisor on the sports medicine focus shift. Dr. Teasdale has helped
many patients improve their health and achieve their goals, including
completing a marathon for the first time, recovering from a sports
injury, and reaching the podium! Read on to learn more about the
exciting focus of naturopathic sports medicine.
Orange Naturals MagPop!
CanPrev Curcumin-Pro
What are the most common sport
medicine conditions encountered
in your practice?
I see mainly overuse injuries relating to the hip,
knee and shoulder. Iliotibial band syndrome,
patellofemoral syndrome and rotator cuff
disorders are among the top three. I also
encounter a lot of plantar fasciitis.
What special challenges
do you encounter when
treating athletes?
I have two main challenges. The first is
getting the athletes to take adequate time
off from training to allow their injury to heal.
Most of them fear the losses in performance
they might suffer if they reduce or stop their
training. My approach is to help my athletes
adapt their training program through their
injury recovery.
The second is getting the athletes to fuel
properly. Most of the athletes I see consume
far too few calories, and what they do eat is
generally lower in protein and fats.
Changing the timing of their meals and the
composition of their diet takes some buy-in
as it takes extra effort. We work together to
come up with easy options that will fit into
their busy schedules.
What are some of your go-to-
remedies for sprains and strains?
I love using acupuncture, electrostim and
instrument-assisted soft tissue mobilization
for sprains and strains. I also use acute
homeopathics like Arnica, Ruta, and Rhus
Tox, as well as topical treatments such
as Arnica cream/gel, hydrotherapy and
castor oil. The prescription depends on the
patient’s presentation.
What treatment modalities do
you use the most with athletes?
While my main modalities are acupuncture
and clinical nutrition, I add in any other
modality that is indicated for patients. I try
to keep my treatments cost-effective for my
athletes, so I try to find ways to supplement
vitamins and minerals through their diet. I
also use a lot of home care hydrotherapy, as
well as prescription rehabilitation exercises.
Do you recommend your
patients use ice or not with
an acute injury?
The evidence on cryotherapy is conflicting.
I use it in cases where there is significant
swelling. Otherwise, I use it short-term for pain
management or if the patient reports that
their symptoms are ameliorated with cold.
What are some common bad
habits of seasoned athletes?
In my practice, the bad habits are neglecting
their nutrition and supplementation regime,
not doing rehabilitation exercises, and trying
to do too much too soon after an injury.

27. 26
ND Notes | Vol 2 No. 1
If you could recommend a book
to a new graduate starting up his
or her practice, what would it be
(sport-related or not)?
I’m a fan of most books by Seth Godin. He
has some really great ideas on business and
what you can do to be successful.
To learn more about Dr. Tracey Teasdale’s clinic,
please visit absoluteathletecare.com.
Most of the athletes I see
consume far too few calories,
and what they do eat is generally
lower in protein and fats.
TURMERIC FOR INFLAMMATION RELIEF
Certain herbal extracts, such as turmeric, act as potent COX inhibitors,
blocking the enzymes responsible for bruising, swelling and pain. They
are considered safe and are generally well-tolerated by most people.
What is your favourite sport?
These days, I really enjoy triathlons. I’m
able to change up my training routine and it
gives me a lot of variety, so I don’t get bored.
It allows me to train with a group when I need
motivation, but it also lets me train on my own
when I need more of a moving meditation.
Which athletes are your favourite
to work with?
My favourites are motivated athletes. I love
working with anyone who is committed to
improving their performance. Beginner and
novice athletes are fun because I am able to
guide them through the process of becoming
active. Injured athletes are also rewarding,
as I get to see the joy in their smiles as they
recover and return to the sport that they love.
Elite athletes are really interesting as they go
off to their competitions abroad, and come
back to tell me their stories and show me
their awards! They also add another layer
of difficulty since we have to make sure that
anything we do is in accordance with their
anti-doping policies.
Do you have any advice or tips
for new graduates interested
in focusing their practice in
sports medicine?
I have three main tips:
1. Learn about sports. It is imperative that
you understand exactly what your athletes
are doing while you are working with them.
Learn what you can, and always ask your
patients about their experience.
2. Brush up on your orthopedic skills. The key to
clinical diagnosis of musculoskeletal conditions
is in your physical exam. Know which tests to
perform, and make sure you do them correctly
and understand what they mean.
3. Take more continuing education courses
in assessment, pain management and
rehabilitation techniques. The field is
constantly changing, so you need to be on
the cutting edge.

28. 27
ND Notes | Vol 2 No. 1
when athletes may unknowingly consume
these banned substances.
Unfortunately, testing doesn't discern
between intentional and inadvertent use,
so the athlete becomes the victim.
For this reason, most elite athletes are
advised against using any nutritional
substances at all.
But this may not be the practical approach
for your patient who is looking to
maintain peak health through the use of
supplements, in order to compensate for
the toll intense training and competition
takes on their body.
The Linford Christie case
During the 1988 Olympic Summer Games in
Seoul, South Korea, sprinter Linford Christie
tested positive for pseudoephedrine, simply
by drinking ginseng tea (www.bjsportmed.
com, July 2007).
While Christie maintained his innocence
and many believed he didn’t intentionally
cheat, he tested positive again in 1999.
This time he was not alone, as a few other
British athletes also tested positive for
banned substances. After an investigation,
the cause was traced to their unknowing
consumption of contaminated nutritional
supplements - an example of why caution
is always necessary when taking any
nutritional or natural performance
related products.
Spotting contaminated
supplements
At the 2002 Salt Lake City Winter Olympics,
athletes volunteered to have their
supplements tested and 20% were found to
be contaminated with banned substances.
From a public health point of view, trace
amounts do not actually endanger general
health, but for athletes, even low amounts
can cause a positive doping result.
One of the biggest concerns with athletes
taking natural health products is that it
may lead to positive results on drug panels,
banning the athlete from their sport for a
few months or even a lifetime.
Wait - natural supplements?
Surprisingly, yes. While natural health
products are marketed as, well, natural,
there is a risk that some products will test
positive. There are two main reasons.
One is a lack of understanding of how
natural substances can act like drug
analogues or pro-hormones in the body.
A common example is ursolic acid. Ursolic
acid is a phytochemical commonly found
in large quantities in apple peels. It’s often
taken as a supplement, and despite being
natural, is capable of testing positive.
The other reason, and arguably the larger
concern, is that athletes may inadvertently
take natural health products that are
contaminated with ingredients not listed
on the label.
How contaminated supplements
can lead to positive doping tests
An International Olympic Committee
(IOC) study conducted in 2002 indicated
that an astounding 15% of nutritional
supplements reviewed contained anabolic
androgenic steroids (mainly pro-hormones)
not declared on the label. Since doping
is currently the single biggest threat in
the sporting world, this has resulted in
warnings for athletes, new information
systems and changing legislation.
It is the now the norm for many countries
and sports organizations to carry out
random blood or urine tests for banned
substances to ensure a fair competitive
playing field. However, there are instances
NHPs and inadvertent doping
in competitive sports
Before prescribing natural supplements to any patients who play
competitive sports, it’s important to understand the potential associated
risks that could jeopardize their athletic aspirations - and careers.
87% of Canadian athletes say they use nutritional supplements.
But where are they getting their nutritional advice?
Teammates
10.8%
Doctor
4%
Strength trainers
13.5%
Family friends
19.8%
Dietician
0.8%

29. 28
ND Notes | Vol 2 No. 1
• Stimulants (like ephedrine
and amphetamines)
• Narcotics (like codeine
and marijuana)
• Diuretics (like furosemide
or hydrochlorothiazide)
• Steroids (like DHEA and
testosterone)
• Beta-2 Agonists (like
salbutamol)
A 2004 IOC sponsored study conducted
in Cologne, Germany, found that up to
almost 15% of the 634 commonly available
nutritional supplements tested were
contaminated with substances not listed
on the label. This is a substantial level of
contamination. Tests show that a banned
substance can be detected in the body a
few hours to several days after ingesting a
single supplement.
You may wondering how exactly natural
supplements become contaminated. Two
reasons are frequently cited:
• Cross-contamination during production.
• Lack of sufficient hygiene in the
machinery used during production
of a supplement.
Contamination can happen to any form of
nutritional or natural supplements, whether
pills, powders, capsules or liquids.
In addition, the variety of banned
substances found in contaminated
supplements is really quite
extensive - ranging from caffeine
and ephedrine to testosterone and
methylenedioxymethylamphetamine (MDMA).
There are now more than 200 banned
substances for athletes - a large number for
sure - but these can easily be divided into
five categories:
Overcoming the lack of
quality control
When it comes to the production of
supplements, many countries still
have inadequate quality control
standards in place. Globally, there are
great inconsistencies in the methods
surrounding the production of both
pharmacological medications and
nutritional supplements. The Directorate
for Health in the Netherlands, for example,
has found traces of “designer steroids” in
commonly used supplements.
The UK, Norway and Switzerland are now
trying to help athletes choose supplements
from companies deemed reliable.
However, the ATP (Association of Tennis
Branched-chain
amino acids
(BCAAs)
Carnitine
Chrysine
Conjugated
linoleic acid
(CLA)
Creatine
Glutamine
Guarana
Minerals
Ornithine-
alpha-
ketoglutarate
(OKG)
Proteins
Pyruvate
Ribose
Saw palmetto
Tribulus
terrestris
Vitamins
Zinc
Nutritional supplements
that have been contaminated
with doping substances
(in alphabetical order):
Professionals) is currently the only sports
organization with their own supplement
testing system in place. While Australia,
Austria, France, Germany and North
America do conduct lab analyses in an
effort to help athletes, they are not on the
same batch-by-batch basis as the ATP.
However, all countries are in agreement
that at the very least supplements
need to be manufactured under Good
Manufacturing Practices or GMP standards.
This certification assures manufacturing
processes and facilities are held to a high
standard of quality. Yet, this does not
guarantee that a product is free of any
banned substances.

30. 29
ND Notes | Vol 2 No. 1
• Advising registered athletes - Advise
this group of patients to maximize their
nutrition with highly nutritious food or
use (with caution) supplements with
an NSF rating. However, be advised
that sticking to only NSF-approved
supplements will severely limit your
patient’s product choices.
Athletes are ultimately
accountable for the
substances they consume
The Canadian Centre for Ethics in Sports
(CCES) states that athletes are responsible
for anyprohibited substance found in
a urine or blood sample. In Canada,
the federal government has very few
regulations related to the testing of
supplements for athletes. As a result, it is
virtually impossible for organizations like
CCES to say that any natural health product
is 100% free of banned substances.
Due to the difficulty in regulating the
supplement industry, CCES emphasizes
that elite athletes will always run the risk of
a positive banned substance result if they
continue to use nutritional supplements.
Internationally, there is a third party
certification process in place called the
NSF Certified for Sport Program, which
offers lab testing services to help ensure
supplement content and purity.
Products are checked for adulteration, label
claims are verified against the contents, and
finished product ingredients are checked for
banned athletic substances.
NSF maintains close ties to regulatory
bodies around the globe, including
Canada. However, this program is by no
means a guarantee that a natural health
product is 100% safe - as not every batch is
tested, there can be no guarantee against
the presence of banned substances. It
is merely a means of reducing the risk
associated with supplement use.
Although athletes are still ultimately
responsible for what they choose to
consume, CCES recommends athletes
refer to the NSF International Certified for
Sport Program to help minimize the risk of
unintentional doping.
Health Canada’s position is to warn against
the following risks when using natural
health supplements, especially those
not produced in Canada, not carrying a
Natural Products Number (NPN), or not
manufactured under GMP standards.
Health Canada’s concerns include:
• Contamination of the product.
• Incorrect ingredients.
• Incorrect dosage suggestions.
• Unproven claims (for non-Canadian
products or products without an NPN).
• Failure to include warnings that a
product may not be suitable for certain
users.
• Warnings of interactions with prescription
drugs or other natural products that
could lead to unpredictable side effects
or drug action interference.
• Warnings of unwanted side effects, like
allergic reactions to plants, for example.
But even products produced in Canada
cannot be guaranteed 100% pure for
competitive athletes.
What does this mean
for your practice?
Athletes that are subject to anti-doping
regulations belong to the Registered
Testing Pool (RTP) and include national,
international and general members who
compete internationally in the NorAm circuit
or invitational events outside of Canada.
Some athletes who do not belong to the
RTP, but who still compete domestically,
can include Canadian Interuniversity Sport
athletes, Canadian Athletic Association
athletes, Canada Games athletes or even
junior football players.
If you use intake questionnaires in your
practice, be sure to include a question
that asks your patients the level at which
they compete and if they fall into any
of the aforementioned categories. This
is especially important for university
level athletes who may be completely
unaware of their responsibilities regarding
nutritional supplementation rules.

31. 30
ND Notes | Vol 2 No. 1
• Advising serious, elite non-registered,
non-circuit, non-association
athletes - Advise this group of patients
to use only supplements produced
in Canada with an NPN on the label.
This guarantees that the product is
fully compliant with Health Canada
licensing standards. As their health
advisor, it is your responsibility to only
carry or recommend supplements
that are manufactured to GMP
standards, with stringent quality
control measures and third party
testing for purity and quality. Warn
against supplements from multi-level
marketing companies (who can fly
under the regulatory radar) or cross-
border products ordered over the
internet – your patients do not want to
consume contaminated supplements
or products that might have been
made in someone’s basement!
Helping athlete patients reach
their potential - without the risk
There is a strong feeling among athletes that
supplements and natural health products,
like antioxidants, protein powders and
multivitamins, are essential contributing
factors to achieving athletic goals.
However, many athletes take advice
from family and friends, teammates or
trainers - and not from knowledgeable
health professionals. This can result in
over-supplementing and getting more
nutrients than they need, or becoming
depleted in an essential nutrient like iron.
Unfortunately, there are also those who
have no idea what they are actually taking.
Some athletes end up using supplements
Warning: Don’t fall for
products with claims that
they are CCES, WADA or
IOC certified
Some companies will claim that
their natural health products
are certified by well-known
sports organizations. It is
important to understand that
these organizations do not
have certification programs
for natural health products
or supplements. Definitely
question the legitimacy of a
product marketed this way.
that could potentially compromise their
status and future as an athlete.
As a natural health professional interested
in furthering the potential of athletes, you
are in a unique position to offer valuable
advice on navigating the murky world of
supplements. Only you may be able to see
through the hype and advertising geared
towards the enhancement of athletic
performance.
Read the research, understand how and
where the supplements you recommend
are made, and educate your patients about
their responsibilities as an athlete. Wise
counsel to your patients will ultimately
result in a gold medal practice.
WHY DO WE SWEAT?
There are two types of sweat glands in mammals, apocrine and eccrine.
Apocrine glands secrete sweat only when the body is under emotional
stress, while eccrine glands (which are controlled by the sympathetic
nervous system) help to regulate body temperature. They secrete a salty,
watery liquid on the surface of the skin to cool it down when the internal
body temperature rises too high.

32. 31
ND Notes | Vol 2 No. 1
The energy phase - before and
during exercise
The pre-exercise period happens about
one to four hours before exercise and is
designed to maximize muscle glycogen
stores, letting us exercise longer.
Eating a meal containing 150 to 200g of
carbohydrate four hours before exercise
can increase muscle glycogen stores and
improve exercise performance.
The efficacy of carbohydrate supplementation
during exercise can be improved by
adding a moderate amount of protein.
One study measured the endurance of
trained athletes during a cycling exercise
who consumed either a carbohydrate-only
beverage or a mixed carbohydrate-protein
beverage. The mixed carbohydrate-
protein beverage resulted in cyclists being
able to perform longer, compared to the
carbohydrate-only beverage.
In addition to improved performance,
carbohydrate/protein supplementation
during exercise has been shown to lower
levels of plasma creatine kinase, lessening
muscle damage and muscle soreness 24
hours post-exercise, when compared to a
carbohydrate-only supplementation.
A practical strategy for supplementation
during exercise is to drink a beverage
containing 3-6% carbohydrate every
15 to 20 minutes during prolonged exercise
lasting longer than 60 to 90 minutes. You
might also advise your patients to add
1.0–1.5% protein to their supplement.
The anabolic phase - the post-
workout window of opportunity
Immediately after an intense training
session, the body’s muscle and liver
glycogen stores are depleted. Muscle
protein breakdown is elevated, blood
insulin is low and cortisol is elevated.
Skeletal muscle is very responsive to
nutrients post-exercise and consuming
the appropriate types and amounts of
nutrients will encourage the body to
rebuild its tissues and enhance recovery.
Muscles are sensitive to carbohydrates
following a workout and muscle glycogen
synthesis occurs almost immediately after
How to boost performance and
speed recovery with nutrient timing
Nutrient timing, the science of consuming specific nutrients in specific
amounts at specific times, can affect the body’s physical response. In
many cases, when and how nutrients are consumed play just as an
important role as what is eaten. How does nutrient timing work? And
how can you best use it for planning your athletes’ nutritional strategy?
You may have had an athlete visit your
office and complain that they seem to
have ‘plateaued’. In other words, they have
reached a standstill with their strength and
performance gains.
They might also notice that it's taking
longer for them to recover after training -
they are left feeling exhausted with muscle
soreness lasting longer than ever - and as
a result are becoming discouraged to go
back to the gym.
When this happens, introducing a
structured resistance training program
- paired with proper nutrient intake and
timing - can help athletes increase their
strength, speed recovery, reduce muscle
soreness, and even increase energy before
and after a workout.
This concept of nutrient timing can be divided
into three phases: the energy phase, the
anabolic phase and the adaptation phase.

33. 32
ND Notes | Vol 2 No. 1
At this time, regular daily meals and
snacks are sufficient enough to help in
the recovery process. Snacks should
contain approximately a 1:1 ratio of
carbohydrate/protein and total 100 to
200kcal. Even a low-calorie protein snack
before bedtime can be an effective way
to optimize recovery, and should contain
approximately 20g of protein, with minimal
amounts of carbohydrate and fat.
Incorporating nutrient timing
into your patient’s routine
See the table below as an example of
possible nutrient timing with workouts,
supplements and meals for three different
daily training schedules:
A post-workout supplement should provide
sufficient carbohydrate (1.0 to 1.5g/kg of body
weight) and contain 20 to 30g of protein to
maximize muscle glycogen storage during the
first hours of recovery. For light to moderate
intensity workouts, a light carbohydrate (0.3
to 0.8g/kg of body weight) with protein (10 to
12g) supplement is recommended.
The adaptation phase -
post-exercise supplementation
This phase occurs four to six hours after
the effects of the initial post-exercise
supplementation period. It emphasizes
maintaining muscle glycogen storage
and protein synthesis by ingesting
carbohydrate and protein periodically.
a carbohydrate meal is consumed. Waiting
longer than two hours to eat following
a session can reduce muscle glucose
uptake and glycogen synthesis by at least
50%. The longer post-exercise nutrient
supplementation is delayed, the longer
the catabolic (breakdown) state, leading to
increased inflammation, muscle damage
and soreness.
Most research studies support eating soon
after exercise for optimal stimulation of
protein synthesis, enhancing training
adaptation and reducing indicators
of muscle damage and soreness. A
combination of carbohydrate and either
protein or essential amino acids have been
shown to be especially effective.
Daily workout schedule
Time of day AM workout PM workout 2x/day workouts
7:00 AM Breakfast Breakfast Breakfast
8:00 AM ― ― ―
9:00 AM Workout ― Workout
10:00 AM PW supplement ― PW supplement
11:00 AM ― ― ―
12:00 AM Lunch Lunch Lunch
1:00 PM ― ― ―
2:00 PM ― ― ―
3:00 PM CP snack CP snack ―
4:00 PM ― ― Workout
5:00 PM ― Workout PW supplement
6:00 PM Dinner PW supplement ―
7:00 PM ― ― ―
8:00 PM Bedtime snack Dinner ―
9:00 PM ― ― ―
10:00 PM ― Bedtime snack Bedtime snack
Source: Ivy JL, Ferguson-Stegall LM (2014). Nutrient timing: the means to improved exercise
performance, recovery, and training adaptation. American Journal of Lifestyle Medicine 8: 246-259
Legend
Workout - Supplementation should include
a beverage containing 3-6% carbohydrate
every 15 to 20 minutes during prolonged
exercise greater than 60 to 90 minutes.
One should also consider the addition of
1.0 – 1.5% protein to their supplement.
PW supplement - Following prolonged,
intense workouts, the post-workout (PW)
supplement should provide sufficient
carbohydrate (1.0 to 1.5g/kg of body weight)
to maximize muscle glycogen storage
during the first hours of recovery and also
contain between 20 and 30g protein. For
light to moderate intensity workouts, a
light carbohydrate (0.3 to 0.8 g/kg of body
weight) with protein (10 to 12g) supplement
is recommended.
CP snack - Between-meal (CP) snacks
should be approximately a 1:1 ratio of
carbohydrate/protein and contain 100
to 200kcal.
Bedtime snack - A snack before bed should
contain approximately 20g protein with
minimal carbohydrate and fat.

34. 33
ND Notes | Vol 2 No. 1
Cons
• Does not have a heart rate monitor (can
be accessed through third party linking).
• Does not assess sleep quality (but does
track time user goes to bed and wakes up).
This guide only covers specialized trackers.
Multipurpose smartwatches, like the Apple
watch, can be quite cumbersome and
expensive, and are designed to perform so
many more functions than simple fitness
tracking, so we’ll leave these for another
time.
Moov Now
Features
• Functions include step tracking, sleep
tracking and real-time athletic tracking
or coaching for 12 different workouts.
• Capable of identifying 200 different
fitness levels.
• iOS or Android compatible.
• Average battery life of about six months.
Pros
• Provides audio coaching transmitted via
earbuds for sports like cardio boxing,
walking, running and cycling, offering
suggestions such as ‘take longer strides,’
or ‘change gears now’ to keep users
motivated and on track.
• Band is light, breathable and waterproof,
allowing swimmers to collect data on
their laps, flip-turn times and stroke rates.
You may have noticed an increasing
number of patients wearing rubber-banded
fitness trackers on their wrists. Athletic
and non-athletic types alike are using the
flexible bracelet devices to check how
many steps they’ve taken, when they’ve
reached their target training zone, and how
their sleep patterns fluctuate each night.
One out of every 10 adults owns or has
owned a fitness tracker of some kind.
The idea of fitness self-tracking follows
the theory that people tend to modify or
improve a part of their behaviour when they
think they’re being watched, a phenomenon
known as the Hawthorne Effect. In the
sports world, the Hawthorne Effect is
observed whenever professional or Olympic
level coaches pay particular attention to
some athletes more than others, resulting in
better performances and placements.
These days, companies like Nike, Adidas
and Apple are applying the principles of the
Hawthorne Effect to their own products,
with the hope that the more detailed ways
people can keep track of their progress,
the better results they’ll see, and the more
devices the manufacturers will sell.
Every year a barrage of new tools and
technologies are released that allow
anyone to collect crunchy data about their
lives - what they’re eating, how far they’re
walking, how long and how well they’re
sleeping and how often their hearts are
beating. Fitness trackers and the current
flood of apps, sensors and devices happily
feed the new quantified self movement by
measuring multiple aspects of our daily
lives with the help of technology.
Fitness tracker buying guide
Many fitness trackers act as pedometers,
coaches, and heart rate and sleep
monitors. In our research, we came across
three standalone wearable devices retailing
between $100 to $200 CAD each that are
worth mentioning should your patients ask
for a recommendation.
Fitness trackers raise
self-awareness -
and motivation!

35. ND Notes | Vol 2 No. 1
34
Overall impression: Moov Now’s
primary focus is to encourage people to
increase their physical activity by using
an accelerometer that documents the
number of active minutes they accumulate
in a day (even the time spent sitting down
and getting up from one’s chair), and the
number of calories burned.
Moov Now seems like a great device for
guiding users through easy or difficult
workouts and for encouraging them to
increase physical performance each time
they exercise. But be forewarned: it’s
definitely not a device for people who
dislike being talked at!
Fitbit Charge HR
Features
• Pedometer-style tracker encased in a
comfortable, non-descript rubber band
with a small LED screen on top.
• Built-in heart rate and pulse monitor.
• Unique caller ID feature lights up the
screen whenever the user’s phone rings.
• Battery lasts five or six days and can be
charged from a computer.
Pros
• Data can be viewed on the band itself
(steps taken, heart rate, miles walked,
calories burned and stairs climbed).
• Sleep tracking is automatic and comes
with a silent alarm.
• Display stays hidden until a button is
pushed to make it visible.
• Stopwatch feature included.
Cons
• Unable to combine and analyze fitness
data for improvements over time.
• Limited waterproof capabilities (can be
worn in the shower).
Overall impression: The Fitbit Charge HR
was found to be by far the most accurate
of all the wearable devices when tested
against gym cardio machines that also
monitor heart rate. It is a reliable pulse
tracker and scored perfect readings
when compared to straight pedometers.
The Fitbit Charge HR’s app for phone
or computer has been lauded for being
extremely clean-looking and easy to use,
and the GPS feature on most phones can
be accessed by the Fitbit Charge HR’s app
to track runs and users coach in real time.
Jawbone UP3
Features
• Low-profile aluminum casing.
• Quietly tracks basic physical activity like
sleep or exercise through phone software.
• Display lights on the band indicate which
mode the device is in (sleep or activity).
• Small sensors on the inside of the band
act as accelerometers, bioimpedance
sensors and skin ambient sensors.
• Device can be programmed to give ‘get
up and move around now’ alerts via
vibration.
• Long battery life, typically needing only
one charge per week.
Pros
• Can recognize a wide range of step-
based activities like running, tennis,
hiking and even dance.
• Able to tell the difference between the
user's REM, deep or light sleep stages
by monitoring pulse, respiration, body
temperature and galvanic skin response.
Cons
• No visible display.
• Clasp is reportedly fussy to work with, but
does come with a watch band-like strap
for extra security.
• Only water-resistant, not waterproof.
• Does not have a heart rate monitor.
• Very short charging cable can be
awkward to use.
Overall impression: Jawbone argues
that continuous heart rate monitoring is
not necessary since resting heart rate is a
better measurement of fitness; a fact that
fitness buffs may argue on the basis that
continuous heart rate monitoring is crucial
for high-intensity training. It does, however,
allow you to track and trend your heart rate
over a week, a month or longer.
Special mentions: Check out Withings
Activite Pop (expensive at around $500
CAD) or Misfit Shine (fully waterproof and
can be worn anywhere on the body), as
they can give more accurate details on
sleep patterns than either Moov Now or
Fitbit Charge HR.
BALANCE BLOOD
SUGAR WITH EXERCISE
Help keep your blood sugar levels
balanced with regular exercise.
Research shows physical activity
can improve your body’s insulin
sensitivity by 30 to 50%.

36. 35
ND Notes | Vol 2 No. 1
Energy requirements for athletes
Energy spent during training or competition should be correlated with an athlete’s caloric intake. It’s
important to know how many calories are needed to sustain a sport or activity. This is especially
striking for weekend warriors adopting a new activity, like cycling. Consider for instance that
participants of the Tour de France consume roughly 6,000 calories in a single day! Now while the
majority of your patients may not be training for 3,500km endurance events, the list below provides
patients with a rough reference on caloric intake.
Weight training
Hockey
Running
Cycling
Swimming
Rowing
Source: https://books.google.ca/books?id=L4aZIDbmV3oCpg=PA110lpg=PA110dq=energy+intake+kcal+tour+de+france+triathlonsource=blots=WmsUocDeZRsig=co-W00yCr-
owv9dadfBmfziYB3Yhl=ensa=Xved=0ahUKEwir8Mjbg9XMAhXi7oMKHYA0Ak4Q6AEILDAC#v=onepageq=energy%20intake%20kcal%20tour%20de%20france%20triathlonf=false
MenWomen

37. 36
ND Notes | Vol 2 No. 1
Course
Name/
Theme
Organizers Location Date
CE
info
Registration Info Description
3rd
International
Congress on
Naturopathic
Medicine
International
Congress on
Naturopathic
Medicine
Barcelona,
Spain
Jul 1-3, 2016 TBC icnmnaturopathy.eu
We recommend this conference with its
amazing lineup of speakers from around the
world, including the following Canadians:
sports medicine-focused Dr. Marc Bubbs,
ND and CCNM faculty member Dr. Ellen
Wong, ND. Oh and did we mention, it’s in
Spain? This awesome, international event
comes at a steeper price than most domestic
conferences, but the extra cost is worth the
global perspective on naturopathic medicine.
The Treatment
of Infertility -
The Complete
Series
Pro D
Seminars
Recorded
online course
Ongoing 19 CE
prodseminars.net/product/
treatment-infertility-
complete-series
This course series covers diagnostic methods
and treatment options for infertility, and
weighs the pros and cons of combining TCM
and IVF treatment. We think this course
would be great for most practitioners, as you
are likely to encounter patients with fertility
issues in your practice.
Pro D Seminars’ online recorded courses
offer you the convenience of getting
continuing education credits when and
where you please. You’ll likely be missing
out on the opportunity to ask questions or
network with others, but if you invite a few
colleagues over to your place to go through
the seminar together, you will still have the
opportunity to exchange knowledge!
2nd Annual
Integrative
Fertility
Symposium
2016
Healthy
Seminars
Vancouver,
British
Columbia
Apr 29 - May 1
2016
TBC ifsymposium.com
From discussions on egg quality to men’s
infertility, this event covers all the bases
when it comes to the fertility challenges your
patients may present to you. If you were
lucky enough to get in, you were sure to
have a robust learning experience from this
diverse group of healthcare practitioners. Yes,
registration filled quickly for this year’s event,
but recordings should be made available
now that the conference is over. You will
have to check with the event coordinators
to ensure that CE credits will be available for
the recordings in your jurisdiction.
Continuing education course listings
Keep up-to-date and current with ongoing continuing education.
See below for some upcoming courses.
To have a course listed in an upcoming issue of Naturopathic Notes, please submit course details to editors@ndnotes.ca.
Please remember to double check the amount of credits and the category in which these courses will be placed, according to your province’s regulatory body.

38. 37
ND Notes | Vol 2 No. 1
A cheat sheet to orthopedic tests
Here’s a quick guide to refresh your memory and help you determine which
tests to use to diagnose musculoskeletal concerns. The digital version of this
newsletter allows you click on each test to view a video demonstration.
HIP PELVIS
Sacroiliac Joint Dysfunction /
Pathology
• Yeoman’s Test
• Pelvic Rock Test
• Patrick’s (FABER) Test
• Hibb’s Test
• Gaenslen’s Test
• Nachlas’ Test
TFL Tightness
• Ober’s Test
• Ely’s Test
IT Band Tightness
• Ober’s Test
FOOT ANKLE
Ligament Injury
• Anterior Drawer Test
• Posterior Drawer Test
• Talar Tilt Test
Ruptured Achilles Tendon
• Thompson’s (Squeeze) Test
Stress Fracture
• Forefoot Squeeze
(Morton’s) Test
VERTEBRAL COLUMN
Scoliosis
• Adam’s Sign
Sciatica
• Braggard’s Test
• Bechtrew’s Test
• Minor’s Sign
Thoracic Outlet Syndrome
• E.A.S.T. (Roo’s) Test
• Wright’s Test
• Shoulder Depression Test
IVD Herniation
• Soto Hall Test
• Valsalva Test ­
• Milgram’s Test
• Linder’s Test
• Lasegue’s Test
(Straight Leg Raise)

39. 38
ND Notes | Vol 2 No. 1
WRIST
Carpal Tunnel Syndrome
• Phalen’s Test
• Tinel’s Test
De Quervain’s Tenosynovitis
• Finkelstein’s Test
ELBOW
Lateral Epicondylitis
“Tennis Elbow”
• Cozen’s Test
• Mill’s Test
MCL /LCL (Elbow) Injury
• Valgus and Varus
Tests of the Elbow
KNEE
ACL / PCL Injury
• Anterior / Posterior
Drawer Sign
• Lachman’s Test
Meniscal Tear / Injury
• Apley’s Compression Test
• Bounce Home Test
• McMurray’s Test
MCL / LCL (Knee) Sprain
• Apley’s Distraction
• Valgus and Varus
Stress Tests
SHOULDER
Rotator Cuff Tear
• Apley’s Scratch Test
• Drop Arm (Codman’s) Test
• Glenohumeral
Apprehension Test
Bicipital Tendinitis
• Lippman’s Test
• Yergason’s Test
• Speed’s Test

40. 39
ND Notes | Vol 2 No. 1
Product
quick
guide
Resources
references
The adult patient
treatment plans on the
next pages can be torn
out, copied and given
to your patients to help
them find the remedies
you’ve prescribed.
We’ve already written
out directions and daily
doses. The chart below
outlines indicated
uses and potential
contraindications to
help integrate any new
remedies with your
patient’s current protocol.
Recommended Use
Contraindications
Possible Contraindications
NOTE: Homeopathics generally
do not have interactions or
contraindications with any
medication.
Vasodilators(Nitroglycerin)
Sedatives
Laxatives
Diuretics(thiazide)
Corticosteroids
AntiplateletAgents
Anti-inflammatories
Antihypertensives
Antidepressants(SSRI)
Anticoagulants/BloodThinners
Antibiotics
Antiarrhythmics/CardiacGlycosides
Alcohol
Tonic
Prophylactic
NutritiveSupport
Chronic
Acute
Hypoglycemics
Immunosuppressants
HormoneMedications/Contraceptives/HRT
Products Recommended Use Contraindications
CanPrev Orange Naturals (Supplements)
Adrenal-Pro
• • • • •
Advanced B-Complex
•
Antioxidant Network
• • •
C crystals
•
Curcumin-Pro
• •
Joint-Pro
• •
Joint-Pro NEM
•
Magnesium Bisglycinate 200
• • •
Magnesium glycinate
• • •
Omega 3 Fish Oil
•
Omega-Pro
•
Osteo Prolong
•
Pain-Pro
•
pH-Pro
•
Stress with B vitamins
• • • • •
Synergy C
•
Synergy B
•
Ubiquinol 100
•
CanPrev Orange Naturals (Shakes)
ND Shake Women's Sport
•
CanPrev Core for Men
•
CanPrev Core for Women
•
Orange Naturals (Single Tinctures)
Panax Ginseng
• •
Rhodiola
• •
Turmeric
• •
Orange Naturals (Herbal Remedy)
Joint Pain
• •
Orange Naturals (Homeopathics Remedy)
Fibromyalgia
• •
Sciatica
• •
Orange Naturals (Homeopathics Creams)
Joint Pain cream
•
Pain Relief cream
•

41. Pre-Workout Support Adult Patient Treatment Plan
Tearthisout,makecopiesandusewithyourpatients
Date
The medicines/remedies checked off below are recommended
for (patient’s name):
Clinic Information
Available in CanPrev Available in Orange Naturals
Product Name Recommended Directions Take For Notes
PRE-WORKOUT SUPPORT (ADULTS)
Adrenal-Pro Take 2 capsules, 2 times daily with food. days
Antioxidant Network Take 1 capsule, 1-2 times per day. days
ElectroMag
Empty 1 sachet into your water bottle and drink
throughout your workout.
days
CanPrev Core for Men
Add 2 rounded scoops to 250ml of your favourite
beverage and shake well.
days
CanPrev Core for Women
Add 2 rounded scoops to 250ml of your favourite
beverage and shake well.
days
C crystals Take 1/4 teaspoon per day in water or juice. days
MagPop!
Empty 1 sachet into your water bottle and drink
throughout your workout.
days
ND Shake Women's Sport
Add 3 rounded scoops to 300ml of your favourite
beverage and shake well.
days
Omega 3 Fish Oil Take 1 to 3 softgels per day with food. days
Omega-Pro Take 1 to 3 softgels per day with food. days
Panax Ginseng (tincture) Take 3 ml, 3 times per day. days
Rhodiola (tincture) Take 2 ml, 3 times per day. days
Stress with B vitamins Take 1 capsule, 2 times per day. days
Synergy C Take 2 capsules daily. days
Ubiquinol 100 Take 1 softgel per day. days
Circle the recommended products and add in the suggested duration.
Lifestyle/Dietary Recommendation Exercise Recommendations Other Recommendations

42. Tearthisout,makecopiesandusewithyourpatients
Available in CanPrev Available in Orange Naturals
Date
The medicines/remedies checked off below are recommended
for (patient’s name):
Adult Patient Treatment Plan
Clinic Information
Post-Workout Support
Product Name Recommended Directions Take For Notes
POST-WORKOUT SUPPORT (ADULTS)
Curcumin-Pro Take 1 capsule, 3 times per day away from food. days
Magnesium Bisglycinate 200 Take 1 capsule daily. days
Magnesium glycinate Take 1 capsule daily. days
ND Shake Women's Sport
Add 3 rounded scoops to 300ml of your favourite
beverage and shake well.
days
CanPrev Core for Men
Add 2 rounded scoops to 250ml of your favourite
beverage and shake well.
days
CanPrev Core for Women
Add 2 rounded scoops to 250ml of your favourite
beverage and shake well.
days
pH-Pro Take 1 capsule, 1 to 2 times per day away from food. days
Turmeric Take 2 ml, 3 times per day. days
Joint-Pro Take 2 capsules, 2 times per day. days
Joint-Pro NEM Take 1 capsule, 2 times per day. days
Joint Pain cream Apply generously to affected areas as needed. days
Pain Relief cream Apply generously to affected areas as needed. days
Circle the recommended products and add in the suggested duration.
Lifestyle/Dietary Recommendation Exercise Recommendations Other Recommendations

43. 42
ND Notes | Vol 2 No. 1
CanPrev guide to
natural medicine is here!
Our new 2017 guide is now available. It’s a
comprehensive 148-page guide of CanPrev's natural
products, complete with detailed descriptions and
practical health advice. A great resource for your
patients - or as a handy reference for your practice.
To request or download your copy,
visit canprev.ca/guide
New reader? Address change?
Would you like to receive a fresh issue of ND Notes
delivered straight to your mailbox 4 times a year? Make
sure we have your up-to-date contact information on
file to receive our latest print issues.
Email subscribe@ndnotes.ca
Read ND Notes online
If you’ve enjoyed reading this issue of ND Notes, sign
up online to receive the latest articles, references and
resources to your inbox.
Visit ndnotes.ca today

44. ND NOTES
CanPrev Orange Naturals
70 North Wind Pl
Toronto, ON, M1S 3R5
Tel 905.881.6800
Fax 905.881.6802
editors@ndnotes.ca
ndnotes.ca
canprev.ca
orangenaturals.com
For more information about the
mentioned products, please visit
canprev.ca or orangenaturals.com,
or ask our product developers at
info@canprev.ca.
Let us know how it goes. We love
to hear feedback, suggestions
and successes at
editors@ndnotes.ca.
ND NOTES
Spring 2016 | VOL 2 NO.1
Head of fibula
SP 8 (Diji)
SP 7 (Lougu)
UB 56 (Chengjin)
UB 57 (Chenshan)
K2 (Rangu)
UB 58 (Feiyang)
UB 59 (Fuyang)
SP 7 (Lougu)
Achilles tendon