Keynote Presentations at AANP Convention

By Jacob Schor, ND, FABNO

Chair, AANP Conference Speaker Committee

Something unique is about to occur at this year’s AANP convention in Bellevue, Washington.  A number of the keynote speakers have presentations that revolve around and attempt to inform a common theme, the question of how our medicine works.  To my knowledge this has never been attempted at our conferences before. 

Actually William Mitchell, ND, spoke at length about the vis medicatrix naturae but this is going to be different because we are trying to understand and explain our medicine in the context of modern science. I have been asked to write briefly about these presentations and how they will tie together, so that’s what I will attempt here.

Valter Longo, PhD, from the University of Southern California, is going to review his research on fasting and cancer chemotherapy.  Fasting triggers an adaptive response that reduces the damage chemotherapy causes in healthy cells while increasing the cytotoxic impact it has on cancer cells.  While Longo’s results are of great interest to those of us who work with cancer patients, the concept of adaptive response is of interest to all of us.  This same adaptive response triggered by fasting underlies many of the traditional nature cures our profession has long endorsed. 

Robert Rountree, MD, is going to lecture on hormesis and how this applies to the action of many of the modern phytochemicals we use in practice.  Hormesis is the idea that small amounts of seemingly toxic substances can have the opposite effect, triggering an adaptive response that benefits the organism rather than harming it. 

Dana Ullman is going to take this idea of hormesis a step further and apply it to homeopathy.  Could homeopathy be another example of hormetic action used to elicit an adaptive response, just using smaller and weaker triggers?   Dana tells me he is ready to try. 

These three presentations focus on triggering an adaptive response by either stressing the organism or pretending to stress it in order to elicit a healing response.  There is another approach we employ in our practices that is the opposite.

More and more what we try to do is to remove stress and the resulting absence of stress allows restoration of health.  We have two presentations that examine this approach.  David Katz, MD, of the Yale School of Public Health will focus on basic lifestyle modifications.  Getting a patient to stop smoking or lose weight reduces the physical stress on their body.  Our own Lise Alschuler, ND, will speak on the effects of emotional stress and its impact on health and, in particular, on cancer.

We have two additional keynote speakers scheduled.  Dave Macallan, ND, is what I would describe as a serious “talker.”  A one time BBC correspondent, Dr. Macallan will help us define naturopathy to the public. 

Our last speaker is Clemont Bezold who is a part of a unique profession. He is a Futurist and will describe the potential future of naturopathic medicine.

Inherently Political: Student Leadership and Legislative Success

By Carrie Runde, 2011 ND Candidate
AANP Student Representive for Bastyr University

Drs. Jamey Wallace and Jane Guiltinan (center) with the entire student
contingent from Bastyr University at the 2010 DC FLI.
Photo by Clark Porter.

This May marked my 3^rd year attending the AANP’s DC Federal Legislative Initiative (DC FLI), and I am excited to report that this year’s event was the best by far. I was proud to lead the group of 34 Bastyr ND students, from all years in the program, to Washington, D.C. Our crew had been tirelessly fundraising since last fall, generating over $15,000 to offset the travel and accommodation costs associated with the trip. I am incredibly impressed by the effort all members of the group contributed to our cause. Despite the distance from Seattle and the trip’s proximity to midterm exams, I heard only positive feedback from the Bastyr students who attended. Everyone was so glad to have made the trip, as it was a truly unbelievable learning experience.

When talking to students about participating in the DC FLI, I commonly hear claims that they are uninterested in, or overwhelmed by, general politics. My response to that is simple: the FLI teaches us about specific legislation and political issues pertinent to naturopathic medicine. Once they learn about the politics that directly affect them as students (such as loan repayment programs), as future physicians (like state licensure and scope of practice), and their patients (such as access to supplements), students become interested in the political work of the AANP and our home state affiliates. The first two days of training sessions ignited the students with a curiosity that translated into very effective lobbying on the third day of the DC FLI.

One thing that resounds clearly at each DC FLI is that students have a powerful voice in the legislative process and the future policies of naturopathic medicine. The passion, intelligence, and perspective that we bring to conversations on health care are true mediators for change. The work that we have done in the past is paying off. As AANP President Dr. Carl Hangee-Bauer pointed out in a previous post, this year’s FLI was remarkable because healthcare staffers on Capitol Hill now know the AANP. We spent less time educating them about naturopathic medicine, and more time discussing how we can best be utilized in our nation’s healthcare system. I have specifically experienced this over the last three years in meetings with Massachusetts Senator John Kerry’s health care staffer, who is encouraged by visits from a positive group of people so dedicated to health and wellness.

The student presence at the FLI is, in my slightly biased estimation, the most important. This year, 100 of the 171 participants were ND students representing four U.S. naturopathic schools! We need to continue to increase our numbers at the event each year. The FLI has a greater political impact because students represent many home states, thus allowing us to deliver our message to as many representatives as possible. The FLI helps students as well. It allows us get outside of our medical school bubbles and into the real environment in which we will someday practice our medicine. Despite the challenges associated with missing class and clinic rotations, the FLI gives a new perspective on naturopathic medicine and recharges students when they return to the daily grind of medical school. The FLI also acts as a catalyst for involvement with the AANP, setting students up to be leaders at our respective schools and to become involved in state legislative work early in their careers.

The work that the AANP does for our profession is invaluable, and my personal goal is to increase student involvement in the organization. The more students that have the opportunity to attend the DC FLI and get involved with the AANP, the stronger the AANP will be in the future. The success of our professional organization has a huge impact on our future as naturopathic physicians, and students are a vital part of the equation. I hope that political work, like that done at the DC FLI, will become part of the naturopathic curricula at all schools because, as Dr. Bastyr was known to say, being a naturopathic physician is inherently political. Each year the FLI leaves me with the oft-quoted Margaret Mead adage in my head: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

Carrie is a 3^rd year ND student at Bastyr University and is originally from Baltimore, Maryland. Carrie is the Bastyr student representative to the AANP and can be contacted at AANPrep@bastyr.edu.

Two Schools

By Jacob Schor, ND, FABNO

Curcumin is the principal curcuminoid of the popular Indian spice turmeric, pictured above.
Photo by FootosVanRobin via Flickr, used under the Creative Commons License.

There were two distinct schools of thought regarding the dosing of herbal medicines when I was a student at National College of Naturopathic Medicine during the 1980s, a couple of decades ago. Most of our teachers in Portland thought in terms of what I now regard as low doses of botanical medicines. We would often prescribe doses of just several drops of tincture diluted in water.

Apparently those at Bastyr University held a different view. This was brought home when Dr. Silena Heron came down to Portland from Seattle one rainy day and lectured our class. She didn’t talk of drops but instead talked of doses in milliliters and teaspoons. She was dosing herbs to get pharmacological effect while we were looking for homeopathic effects.

These thoughts are on my mind because of a study I came across recently about curcumin and cholesterol. Over the years a number of papers have looked to see if curcumin or turmeric lowered cholesterol. Some report benefit, others not. But this paper reports something I would have not predicted. Let me tell you more about it.

The paper, authored by Alwi et al., was published in 2008 in an Indonesian medical journal and looked at the effect of curcumin on lipid levels in patients with acute coronary syndrome. This is a broad term, referring to most any situation in which the heart isn’t getting enough oxygen. For a year, between May 2005 and May 2006, the researchers enlisted patients at several hospitals to participate in a randomized double blind controlled trial. They administered curcumin in escalating doses that ranged from a low dose of just 15 mg/ 3 times per day, up to 60 mg/ three times a day, on the participathing patients’ lipid profiles. The researchers tracked total cholesterol, LDL, HDL, and triglycerides along with other common blood parameters in 63 patients who completed the study.

The researchers report that they saw lipid improvements stemming from the curcumin that varied with the doses and that in regard to, “… the effects of curcumin on total cholesterol level and LDL cholesterol level, there was a trend that the lower the dose of curcumin, the higher the effect of reduction. For HDL cholesterol level, there was also a trend that the lower the dose of curcumin, the higher the effect of increase in HDL cholesterol level.”

Let me make sure you are reading this right. They are telling us that 45 mg of curcumin per day worked better than 180 mg per day. Neither of these are particularly high doses. The smallest capsule we have on our pharmacy shelf contains 250 mg of curcumin and that product in particular claims enhanced absorption so that it is equivalent to a dose of 2,000 mg. Our standard curcumin product comes in 750 mg capsules. If we believe this Alwi study, we should divide those 750 mg capsules and spread it out over a two week period.

Perhaps we need to rethink our ‘more is better’ assumptions and even re-examine our earlier habits of using tiny doses when it comes to prescribing some botanical medicines.

The late William Mitchell would sometimes use a specific word to describe how a botanical extract affects an organism. He would say that it “informs” the body or the mind or the vital force. I don’t pretend to understand exactly what Dr. Mitchell meant by the word ‘inform,’ but I’ve taken it to mean that the particular molecules isolated from the plant bring information, that teaches or shows by example, a different pattern of behavior and function to the organism. Thus botanical medicine can act as a catalyst to change function.

We certainly have some unpleasant examples with which we might illustrate this idea. Certain addictive drugs appear to trigger permanent changes in brain chemistry after even a single exposure. Even if we aren’t talking about crack cocaine, it is not unreasonable to think that other more benign plant extracts will also cause lasting permanent changes in function. Botanical medicine, when well practiced, is perhaps more like the automatic software updates that my computer routinely downloads. They teach the system how to work better and update it so it understands how to respond to new challenges.

If we are using the analogy that herbs act like catalysts, then it makes sense that relatively small doses are all that’s needed to turn the trick. Maybe we only need the large doses when we are using herbs as drugs and not as information carriers. Perhaps drugs deliver orders to the body, while herbs deliver knowledge. [If I keep up this kind of train of thought I may have to move back to Oregon and eat granola again.]

These are the sorts of discussions we engaged in decades ago as naturopathic students. We hear these kinds of arguments less often these days. I often just reach for standardized plant extracts whose chemical actions have been multiplied by refining, distillation and concentration. More is better and stronger is better; these have become our quiet mantras. We once condescendingly attributed this type of thinking to medical doctors (especially those claiming to practice natural medicine) and considered it to be an inferior approach to treating the patient. We allowed that some one in our profession might out of necessity fall back and prescribe botanical medicine like this out of desperation but it wasn’t the preferred path of treatment, the way a real naturopathic doctor worked. We were such idealists.

Luckily many of us still are idealists and this paper on curcumin should serve as a reminder. Sometimes less is more. Sometimes what we need is a tiny nudge from something so small as to seem like magic. Or perhaps, in our rush to keep up with all the new science, we have to leave a little space in our understanding for the magic in our medicine to do its work.

President's Message: A Final Farewell

By Carl Hangee-Bauer, ND, LAc

AANP President

Winter is upon us as I write this, my last blog as AANP President. It is a time for drawing inward, reflection and preparation for growth as well as new things to come as the light begins to return and Spring is right around the corner. We see this season reflected in our microcosm of the AANP, with our Executive Director of the past nine years having moved on, Board members departing (Thank you so much, Trevor Holly Cates and Corey Resnick!), Helen Healy finishing her term as HoD Speaker, and other changes in AANP staff. It is truly a time of great change and with that change comes challenges and opportunities.

AANP's renewal is already taking shape, like an early Spring thaw. Terri Deerr has stepped into the role of Chief Operating Officer (COO) and will manage the association during the interim period as we seek our next ED. Michael Cronin takes the reins of AANP President on January 1st and brings vigor, passion and new ideas for moving the AANP and profession forward. Bruce Milliman is stepping up as the next HoD Speaker, and the Board welcomes new member Michelle Simon. 

As I like to say, "Change is the order of the Universe." I believe these changes are timely and I'm optimistic about the growth and future of the AANP. We must embrace change if we are to adapt and grow.

Please renew your AANP membership or rejoin if your membership has lapsed. We have so much to accomplish with regards to changes in the federal health care landscape, state licensing and scope of practice issues, PR & Branding, member support and a host of other ongoing projects. We need your help, your active participation and your support if we are to meet the challenges ahead. Your actions and your voice are a vital part of this process.

In August, I gave my farewell speech to those gathered at our annual Awards banquet. As I re-read it, it still reflects my thoughts and observations as I finish my term as AANP President. I have reprinted it below: 

"Last year the AANP celebrated its 25^th anniversary. At the gala we formally recognized those who founded this association, our past leaders and award recipients and my speech envisioned what the next 25 years would bring to this profession and to the AANP. It was a very formal event befitting of the time and venue.

This year I am going to be less formal and speak more from my heart and share a few of my experiences and insights. I have served nearly four years on the Board and my last year as AANP President is coming to a close. It has been a very interesting, challenging and, as I tell many who ask, a growth experience. There have been moments of great joy as well as moments of struggle and conflict.

It’s said that change is the nature of the universe. It is certainly true for the naturopathic profession. Over the past year we’ve suffered losses with the passing of Dr. Konrad Kail, Friedhelm Kirchfeld and others who have led, taught and inspired us. We’ve learned that our next naturopathic medical school will open in San Diego in 2012; meanwhile our other naturopathic colleges are growing as we’ve never seen before. We’ve seen another state licensed with more poised to follow. We’ve been inspired by how one man, Dr. Dennis Godby, with great personal sacrifice and dedication is acting to change the world by running across the United States to raise awareness of naturopathic medicine and how it can improve the health of all Americans. The AANP membership has grown and surveys show member satisfaction with the AANP is very high.

We bear witness to the renaissance of naturopathic medicine in the US.

Change is also on the horizon for the AANP.

We have a dynamic board dedicated to making naturopathic medicine a household name and have elected new board members who are stepping up as our future leaders.  

The House of Delegates has worked diligently to improve its process and has set an ambitious agenda as well as the work the House and the Board will do together will move this profession forward. 

Our next president, Michael Cronin, a long time pioneer and leader in Arizona and founding board member of the AANP, takes office in January at a time of great challenges and changes at both the federal and state levels, and I believe he is ready and up to the task. 

Our executive director, Karen Howard, who has dedicated herself to serving this profession for the past 9 years has decided that it is time to move on to the next challenges and opportunities that life presents and we will sorely miss her. With the support of her professional and dedicated staff, she has worked tirelessly to make naturopathic medicine known on Capitol Hill and the houses of Congress, to build bridges with other professions and coalitions, to support the growth and success of our members and to build our organizational structure, finances and resources so we can meet our goals as the national association representing naturopathic physicians. Please join me in thanking Karen and wishing her much success wherever her future takes her.

On a more personal level, serving as AANP President has been one of the greatest challenges and opportunities of my life and I have had a few insights along the way I want to share with you now.

Some of you in this room who know me know I love the outdoors and our garden. Often if I’m stressed out or feel overwhelmed with everything, I’ll make time to get out into my backyard, repot some orchids, pull some weeds, prune a few plants and get my hands dirty. There’s something about getting my hands in the earth that I find grounding. During these activities I often reflect on problems and issues I’m dealing with and something about gardening helps me step back and get the bigger picture.

In these moments, one train of thought I’ve followed recently is how the naturopathic profession is alike and different from other health professions. For example, allopathic medicine, for all of its great strengths and weaknesses often favors a mechanistic approach and relies on specific diagnoses to treat disease; prevention, for example, often focuses on vaccinations or screening tests. It has produced major advances in medicine and surgery to be sure, but can sometimes miss the forest for the trees.

We naturopathic physicians are most like gardeners in the care of our patients and we must apply these principles in our professional associations and in our interactions with one another. We must nurture our community like we nurture our patient’s health.

We must focus on the soil.

In Metchnikoff’s discussions with Pasteur, he argued that “it’s not the germs but the soil” that is most important to focus on in health care. As NDs we learn how to improve our patients’ health by laying the foundation with proper diet, exercise and play, adequate hydration and sunlight. We check for mineral levels, pH and indications of imbalances. We focus on achieving health and wellness as much or more than disease itself.

The AANP, our state, specialty and other associations as well as our colleges prepare the soil and the environment for the growth of our profession by educating our doctors, passing licensing laws, creating board exams, nurturing federal recognition, and other steps to insure that naturopathic care is available for all Americans and that the sprouts of our graduates have the opportunity to grow, thrive and become fruitful. Our corporate partners help us nourish the soil by their support for our goals and our programs.

We care for and tend our gardens.

Naturopathic Physicians are trained as systems thinkers. In patient care, we are wholistic in our approach even while focusing on specific health issues. Even while we help our patients manage or overcome their challenges, we encourage their growth, vigor and hardiness through preventive strategies and by dealing with health problems in context with the individual in all our aspects-body, mind and spirit.

As an association the AANP nurtures the growth and robustness of our profession.

We companion plant by building coalitions with our natural partners and creating deep ties with external organizations with mutually supportive goals. However effective as we are, we know that we cannot do this alone.

We pay attention and we tend the garden of our profession. When we are engaged, focused, thoughtful, attentive and have our vision, we produce beautiful and productive ecosystems in balance with nature. If we don’t pay attention or have a plan, we see a few plants thrive, many struggle to survive, our soil become deficient and the weeds take over.

We are the gardeners and it’s our responsibility to take care of the land.

Sustainability depends on good caretaking. If we are good caretakers, our harvest will be the health of our patients and the health of this profession. How well we do this will determine our yield. We must work together, knowing that while we may have differences of opinion and approach, we are all working toward the same goals and ends. Respectful debate and listening will yield better solutions. And we must take care of each other and nurture one another, because our greatest strength is our community and our relationships with one another. We are a small and growing health profession yet together we are much greater than the sum of our parts. Our strength does not lie in our numbers but our connectedness to each other.

In closing, I want to thank you for the good work you all do everyday to benefit the health of your patients and this planet and for your dedication to this profession. And from my heart, I want to thank you for the honor and privilege to serve as AANP President."

Mahatma Gandhi, India’s "Father of Naturopathy"

Michael Cronin, ND
AANP President 

The entrance to S-VYASA's Prashanti Kutiram Campus

I am writing this from the Swami Vivekananda Yoga Anusandhana Samsthanain University (S-VYASA) near Bangalore, India in the state of Karnataka. I was invited (with 4 weeks notice) to give a presentation on the evolution of the naturopathic profession and naturopathic education in North America at the first International Conference on Yoga, Naturopathy and Arogya (ICYN) in Bangalore, known as the Silicon Valley of India. Naturopathy as a healthcare profession is considered to include Yoga, and there are 12 universities across the country offering a degree in Naturopathy and Yogic Sciences, as well as numerous inpatient facilities. Mohandas (often referred to as Mahatma, meaning “great soul”) Gandhi revived naturopathy in India and is often referred to as the "Father of Naturopathy." Gandhi's birthday, October 2nd, is to be celebrated here by the profession as Yoga and Naturopathy Day.

The ICYN was sponsored by the state government of Karnataka’s Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). They see Naturopathy as an intrinsic part of the healthcare system and just this week announced that 10% of the state's overall healthcare budget would be dedicated to patients receiving AYUSH care. There is an epidemic of non-communicable disease in India, including diabetes, and cardiovascular diseases are the country’s leading cause of death. There are also other provisions in the works to improve the public access to Naturopathy care, including adding outpatient naturopathic services in all municipal hospitals. 

The scope of practice in Naturopathy includes hydrotherapy, fasting, diet therapy, massage, Acupuncture and Yoga. It does not include medicine administered orally, Homeopathy or Botanical Medicine. Steps are being taken to bridge this divide in order to use evidence-based practices, following the established principles of Naturopathy. Historically, Homeopathy, Ayurveda, and Unani (Persian herbal medicine, widely practiced in Southern Asia) have existed as separate branches of traditional knowledge systems in India and traditional Chinese medicine is not practiced.

The Jindal NatureCure Center

Most naturopathic care is currently delivered through inpatient services. Patients frequently stay for two to four weeks if not longer. The patients fast and juice and afterwards eat natural organic foods, massage, hydrotherapy and learn therapeutic yoga as well as relaxation and meditation techniques for their specific health condition. I just visited the Jindal NatureCure Institute, a beautiful 275-bed, 100-acre inpatient naturopathic and yogic hospital/sanatorium, established as a charitable trust. 

Naturopathic evidence-based research is alive and well in India. At S-VYASA, where we are staying, they have Ph.D. candidates in Yoga who are focusing on many aspects of naturopathy. One Ph.D. candidate I spoke with is researching hydrotherapy for hypertension, another on diabetes and a third on migraines. There is much published work on the physiologic effects of meditation as well as work towards understanding which specific yoga asanas (postures), breathing, relaxation and meditative techniques are best for specific conditions.   

An international working group on naturopathy and yoga convened the day after the conference with participants from over 20 countries. There were four subgroups established, including education, research, clinical practice and regulatory advocacy. Participants from the United States included representatives from Harvard Medical School, the Department of Defense, the Samueli Institute and the AANP. The working group is being funded by the State government of Karnataka’s Department of AYUSH. The government perceives the promotion of Naturopathy and Yoga as not only good for public health, but also an economic engine, separate from their conventional medical tourism. The state has 3 colleges and many hospitals/sanatoriums including, one 275-bed facility and another 200-bed facility. There is clearly dynamic development of Karnataka’s medical tourism capacity and naturopathy is seen as an important component. 

The Indian educational system offers a Science pre-university “stream” in what would be considered an American 11^th and 12^th grade. They have a four-year academic program and a fifth year of internship. They have also established a two-year advanced degree program offering an MD in Naturopathy. 

Learning about India’s unique relationship with Naturopathy was very exciting, but the enthusiasm of the students, doctors, educators and officials was by far the best part. They are all so pleased to connect with the North American profession, as we are to connect with them!

Namaste,

Michael Cronin, ND