The long days of summer are upon us and for many people that means hiking, camping, swimming, kayaking and more. However, with being outdoors often comes mosquitos and with mosquitos comes anxiety—and rightfully so. Mosquitos are known to carry a host of harmful diseases, the most notable right now being the Zika virus. But is lathering up with DEET—a chemical whose safety is still called into question—the answer? I wanted to take a quick break from fermented foods to share a great article written by my friend and colleague Dr. Kesley Asplin who practices in Highlands Ranch, Colorado. In her well-researched and interesting article, she shares about the risks of mosquito-transmitted diseases, what we know about the dangers of DEET, and some effective natural alternatives. For more information on Dr. Kelsey, visit Determinant Health Naturopathic Medicine.
A Natural Alternative to DEET
During a recent camping trip in the beautiful Colorado mountains, I was reminded of just how much I dislike mosquitoes. While I can reconcile a purpose for almost all other creatures, the mosquito continues to baffle me. While the silence of the days, the thousands of stars visible in the night sky, and the smell of a campfire offer an amazing escape from city-living, I can’t help but think they’d be even more enjoyable if I wasn’t constantly whacking different areas of my body, or scratching the welts left by the little parasites that escaped my tedious surveillance. And while I did have my preferred brand of herbal-based mosquito repellent with me, it was rendered nearly useless when the pump broke, and pouring the liquid all over me became quite inefficient and wasteful.
While mosquitoes are certainly annoying, there is also a lot of fear regarding their disease transmission potential. Mosquitoes have been known to carry a host of viruses, including Zika virus, Malaria, West Nile Virus, Eastern Equine Encephalitis, Western Equine Encephalitis, St. Louis Encephalitis, La Cross encephalitis, Dengue Fever, Yellow Fever, and others. Zika virus is of particular concern as of late, however according to the CDC, there have been no cases of Zika virus contracted within the United States. That being said, there have been reports of the virus being carried here from people who were bitten and infected in other countries, as well as in the US territories of Puerto Rico, the Virgin Islands, and American Samoa. So while there doesn’t seem to be as high of a risk of humans contracting these diseases in the United States, it certainly doesn’t hurt to act preventatively.
In 1944, the military began using a chemical during jungle warfare to ward off disease carrying mosquitoes. This chemical was called N,N-Diethyl-meta-toluamide, and became more commonly known as “DEET” when it was introduced to commercial bug repellents in 1957. DEET has been repeatedly found to be effective at deterring mosquitoes, but there has also been some apprehension regarding its abundant use, especially in young children and pregnant and lactating women. While substantiating evidence for these areas of unease have been somewhat inconclusive, there has been some more recent research to suggest that there may actually be some cause for concern regarding DEET use.
Two studies in the last month highlight some of the potential negative side effects related to DEET exposure. One study, published in Scientific Reports, supplied evidence to suggest that DEET could stimulate endothelial cells in the body to release increased amounts of certain factors that promote angiogenesis (1) – a process by which new blood vessels are formed to supply extra nutrients to growing tissues. This is most notable, and concerning, as a critical step in the growth of tumors.The data is therefore suggestive that DEET could perpetuate tumor formation.
Another study, published in the Journal of Medical Entomology, showed that when mosquitoes were exposed to DEET, it only reduced the amount of blood they ingested over 24 hours (with most of the effect lasting between 3 and 6 hours). However, it did not affect their landing and “probing” behavior (2). The concern here is that if a mosquito doesn’t suck as much blood as it normally would at the time it feeds, it is more likely to land and re-feed sooner than normal, which could result in an increase in number of bites, and therefore a potentially elevated risk of disease transmission.
DEET has also been implicated in Gulf War Syndrome, possibly as a result of it being mixed with other harmful chemicals. So while the research surrounding DEET seems to be somewhat limited, as with all chemically synthesized compounds it’s never a bad idea to exercise a bit of skepticism and caution. Regardless of research, many people still prefer to be as natural and synthetically free as possible, which usually equates to herbal or other folk remedies.
There have, in fact, been numerous studies done, mostly recent, on the mosquito repelling effects of various botanicals. This research lends support to the use of many herbal repellents including catnip (3) clove oil (4-5), makaen oil (5), Dong qui (6), geranium (7), peppermint (8), citrus (9), and others. Most of the research states that these oils produce as effective of a repelling action as DEET, often times providing complete protection for 2-5 hours.
Just two weeks ago (at the same time that I was providing sustenance for numerous mosquitoes), online media reports started blasting even more support from the CDC that lemon eucalyptus oil was just as effective as low concentrations of DEET at deterring these pesky beasts. Further inquiry on my part revealed that this comparison was actually made at a 2005 CDC press release (10), suggesting that there has been acceptance of these products as legitimate repellents for some time. As a side note for those readers who are essential oil lovers, the CDC does not recommend using pure lemon eucalyptus essential oil that hasn’t been formulated as a repellent, as it’s efficacy has not been validated. It is also important to note that Eucalyptus oil should not be applied topically (or internally) to children under the age of 3, and caution should be taken with pregnant women as well.
Clearly there are some exciting possibilities with Nature’s own home-made bug repellents, but it’s also worth considering whether some of these remedies would be regional in their effectiveness, as the mosquito populations in different regions are likely also varied in their distaste for certain odors. Regardless, it’s interesting and refreshing to know that, especially for those of us who hold a particular appeal to mosquitoes, there are numerous options available for warding them off. Once again, let’s give Mother Nature a well-deserved pat on the back and head on up to the hills.
For those interested in knowing more about the type of bug spray I prefer, it’s called Summer Survivor and was formulated by a Banff Park Ranger. I carry it for sale in my office in both a regular and extra strength form for humans, one for your canine companions, and one for your equine friends. Please feel free to call my office or email if you are interested in purchasing some.
Also, a fun little remedy I recently learned and tried with great success (for when you do get bit) – try heating a spoon under hot water and then touch the back of it to the bite. It stings for just a second but takes the itch away for hours.
(1) Legeay S, Clere N, Hilairet G, et al. The insect repellent N,N-diethyl-m-toluamide (DEET) induces angiogenesis via allosteric modulation of the M3 muscarinic receptor in endothelial cells. Scientific Reports. 2016;6:28546. doi:10.1038/srep28546.
(2) Sugiharto VA, Grieco JP, Murphy JR, et al. Effects of Preexposure to DEET on the Downstream Blood-Feeding Behaviors ofAedes aegypti(Diptera: Culicidae) Mosquitoes. Journal of Medical Entomology. June 2016. doi:10.1093/jme/tjw066.
Epublished ahead of print
(3) Gkinis G, Michaelakis A, Koliopoulos G, Ioannou E, Tzakou O, Roussis V. Evaluation of the repellent effects of Nepeta parnassica extract, essential oil, and its major nepetalactone metabolite against mosquitoes. Parasitology Research. 2014;113(3):1127-1134. doi:10.1007/s00436-013-3750-3.
Epub 2014 Jan 22
(4) Shapiro R. Prevention of Vector Transmitted Diseases With Clove Oil Insect Repellent. Journal of Pediatric Nursing. 2012;27(4):346-349. doi:10.1016/j.pedn.2011.03.011.
(5) Trongtokit Y, Rongsriyam Y, Komalamisra N, Krisadaphong P, Apiwathnasorn C. Laboratory and field trial of developing medicinal local Thai plant products against four species of mosquito vectors. The Southeast Asian journal of tropical medicine and public health. 2004;35(2):325-333. www.ncbi.nlm.nih.gov/pubmed/?term=laboratory and field trial of developing medicinal local thai plant products against four species of mosquito vectors.
(6) Champakaew D, Junkum A, Chaithong U, et al. Assessment of Angelica sinensis (Oliv.) Diels as a repellent for personal protection against mosquitoes under laboratory and field conditions in northern Thailand. Parasites & Vectors. 2016;9(1):373. doi:10.1186/s13071-016-1650-y.
(7) Ali A, Murphy CC, Demirci B, et al. Insecticidal and biting deterrent activity of rose-scented geranium ( Pelargonium spp.) essential oils and individual compounds against Stephanitis pyrioides and Aedes aegypti. Pest Management Science. 2013;69(12):1385-1392. doi:10.1002/ps.3518.
(8) Chauhan N, Malik A, Sharma S, Dhiman RC. Larvicidal potential of essential oils against Musca domestica and Anopheles stephensi. Parasitology Research Parasitol Res. 2016;115(6):2223-2231. doi:10.1007/s00436-016-4965-x.
Epub 2016 Feb 26.
(9) Misni N, Nor ZM, Ahmad R. New Candidates for Plant-Based Repellents AgainstAedes aegypti. Journal of the American Mosquito Control Association. 2016;32(2):117-123. doi:10.2987/moco-32-02-117-123.1.
(10) CDC,. Http://Www.Cdc.Gov/Media/Pressrel/R050428.Htm. 2005. Web. 13 July 2016.
Photo Courtesy of Fix.com
As some of you may know, I recently held a class on healing with fermented foods at RestorMedicine in San Diego. Teaching about cultured foods and beverages reminded me how beneficial these foods can be (and how easy they are to make). In light of this, I wanted to share some of the amazing benefits of fermented foods with you, and at the same time, bust some myths.
FANTASTIC FERMENTED FOODS
Recent research has revealed that we are more bacteria than we are human: bacterial cells outnumber human cells by a factor of 10 to 1. The vast array of bacteria that exists inside us and on us has come to be known as the microbiome. We are coming to understand scientifically that a balanced microbiome regulates the immune system, metabolism, sustains the GI tract, supports mood and brain function, produces important vitamins and nutrients, and helps us to maintain a healthy weight .
Fermented foods are cultured by a process known as lacto-fermentation: the process by which a bacteria converts carbohydrates into lactic acid and yeast coverts sugar into alcohol. Fermentation has been used for thousands of years as method of food preservation. It is a pleasant coincidence that fermentation also enhances the nutrient content of food through the action of bacteria which make the minerals in cultured foods more available and also produce vitamins and enzymes beneficial for digestion. Because the beneficial bacteria present predigests fermented foods, individuals who are lactose-intolerant may be able to consume yogurt and kefir, and making cabbage into sauerkraut or kimchi increases glucosinolate compounds believed to fight cancer.
Although fermented foods have become more commercially available, many fermented foods you buy in the supermarket have been pasteurized at high heat, killing any friendly bacteria. Fortunately, making your own fermented foods at home is easy and safe.
HEALTH BENEFITS OF FERMENTED FOODS
MYTHS ABOUT FERMENTED FOODS
For those interested in trying their hand with fermented foods at home, I will be sharing recipes for DIY fermented vegetables, kefir and kombucha in the coming weeks. Check back often for new ideas and feel free to share your questions, favorite recipes and ideas!
 Kellman, R. (2014). Why Fermented Foods Are Good for Weight Loss, Mood & Glowing Skin. Retrieved from: http://www.mindbodygreen.com/0-14758/why-fermented-foods-are-good-for-weight-loss-mood-glowing-skin.html.
 Tufts University Health & Nutrition Letter. (2014). Discover the Digestive Benefits of Fermented Foods. Retrieved from:http://www.nutritionletter.tufts.edu/issues/10_2/current-articles/Discover-the-Digestive-Benefits-of-Fermented-Foods_1383-1.html.
 Gremont, L. (2012). What Are Fermented Foods? Retrieved from: http://www.homemademommy.net/2012/09/what-arefermented-foods.html.
 Scheers N et al. (2015). Increased iron bioavailability from lactic-fermented vegetables is likely an effect of promoting the formation of ferric iron (Fe). European Journal of Nutrition.
 Shewell, L. (2015). Everything you always wanted to know about fermented foods. Retrieved from:https://www.sciencebasedmedicine.org/everything-you-always-wanted-to-know-about-fermented-foods/#h.1ci93xb.
 Vitetta L et al. (2014). Probiotics, prebiotics and the gastrointestinal tract in health anddisease. Inflammopharmacology 22(3):135-154.
 Kirjavainen P. et al. (2002). Aberrant composition of gut microbiota of allergic infants: a target of bifidobacterial therapy at weaning?Gut 51(1):51-55.
 Michail, S. (2009). The role of Probiotics in allergic diseases. Allergy, Asthmal & Clinical Immunology 5:5.
 Isolauri E, Arvola T, Sutas Y, Moilanen E, & Salminen S (2000). Probiotics in the management of atopic eczema. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology 30(11):1604-1610.
 Malesky, G. (2013). More Proof That Probiotics Boost Immunity. Retrieved from: http://www.prevention.com/health/healthconcerns/more-proof-probiotics-boost-immunity.
I am really excited to be teaching this class on fermented foods at RestorMedicine in San Diego on Thursday. If you are nearby, please come join us! For those who can't make it, I will be sharing some of the recipes, tricks and tips from the class in the coming weeks on the blog. Check back often for fun with fermented food!
Integrative medicine is becoming an ever-popular term used to describe a type of primary care medicine that is different from the norm. While patients intuitively know that integrative medicine implies appointments that are longer than a mere 11-minutes (the national average), more appreciation for the myriad factors that influence a person’s health and well-being, and more emphasis on lifestyle modification as a way to treat disease, there is no real definition of what integrative medicine actually is. However, what we do know is that currently, levels of patient dissatisfaction are higher than ever before and something in the way we treat and interact with patients needs to shift. Could an integrative medicine model be the answer?
I think so. But first we must agree upon exactly what integrative medicine means. After spending a good deal of time thinking about and researching what integrative medicine is, what it should include and how it should be practiced, I have decided that integrative medicine encompasses the following ideas:
Integrative Medicine Is Patient-Centered: Integrative medicine is an approach to care that puts the patient first. As a patient, your story, preferences, values and beliefs about your health are taken seriously. Appointments are significantly longer than the average conventional medical appointment, allowing the provider to really get to know you and therefore, how best to serve you.
Integrative Medicine Focuses on All Aspects of a Patient’s Life: Unlike conventional Western medicine which focuses on disease, integrative medicine focuses on all the aspects of a patient’s life—physical, emotional, mental, spiritual and environmental—that contribute to a patient’s health and well-being. Science has unequivocally shown us there is a real and profound connection between the brain and the immune system and our emotional state and disease. Doctors who practice integrative medicine spend the time to explore a patient’s relationships, happiness, work environment and stress level, believing these all contribute to one’s health and overall wellness.
Integrative Medicine Is Personalized: Integrative medicine is personalized medicine; there is no one-size-fits-all approach. Through the physical exam, laboratory testing, and treatment plan, integrative medicine addresses your individual blueprint. And because each person responds differently to lifestyle changes, nutritional modifications, supplements and medications, your doctor follows your progress closely to ensure lasting results.
Integrative Medicine Addresses the Cause of Illness, Not Just the Symptoms: Whether we are talking about migraines, joint pain, infertility or constipation, we are talking about symptoms, all of which have an underlying cause. Often times in conventional Western medicine, symptoms are misinterpreted as diseases. Integrative medicine works to treat the underlying cause of your symptoms. In doing so, your underlying health status is improved overall.
Integrative Medicine Stimulates the Body’s Innate Healing Process: Anyone who has had cut or burn that has healed or has been sick with an illness and recovered without medication knows that our body has an innate ability to heal itself. It is actually quite amazing what our bodies can heal from if given the opportunity to do so. Integrative medicine uses treatments that stimulate the body’s own innate healing process by removing barriers to healing and then providing the body with what it needs to return to optimal health.
The Least Invasive Treatments Are Used First, When Appropriate: Just as we don’t use a fire extinguisher to put out a single match, it is not always necessary to use invasive or high-force interventions to restore health. Integrative medicine practitioners start with simple and gentle treatments, when appropriate. If a stronger treatment is necessary such as pharmaceutical drugs or surgery, doctors work to help your body prepare for and recover from such treatments.
Evidence-Based Natural Treatments Are Used First, When Appropriate: While it’s true that just because something is natural does not mean that it is safe, natural treatments often work to support our body’s physiology and innate healing abilities instead of overriding them. Furthermore, natural treatments often have fewer side effects than pharmaceutical drugs. We are fortunate to live in a time where a good deal of research is being conducted on the safety and efficacy of natural treatments. Evidence-based natural treatments are used both before and alongside pharmaceutical drugs to achieve the optimal response.
Patient and Doctor Are Partners: Integrative medicine practitioners see the doctor and patient as partners on a journey to health. The role of the doctor is to educate and advise the patient, presenting facts, ideas and recommendations, but is not to overpower or dictate the patient. In this relationship, the patient also takes responsibility for his or her health, asking questions, learning about how the body works, and implementing lifestyle changes. The results that are achieved when patients and doctors act as co-collaborators are significantly more impactful and lasting than when patients are removed from decisions regarding their own health and care.
What does integrative medicine mean to you? We welcome your thoughts and ideas!
Dr. Elizabeth Winter practices integrative and functional medicine in San Diego, CA and sees patients from a distance via Skype. For more information about her and her practice philosophy visit About Dr. Winter.