Wednesday, April 21, 2010

Naturopathic Leaders and Leadership

By Carl Hangee-Bauer, ND, LAc
AANP President

Earlier this month, I attended three meetings in three days in Portland, Oregon. The first was our AANP Board meeting, bringing together 13 Board members elected by the membership to represent their interests and guide the direction of the association. The second day was a meeting of the Naturopathic Coordinating Council (NCC), a diverse group representing the AANP, the schools and colleges, the CNME, NABNE, and other established and recognized organizations representing the naturopathic profession in North America who collaborate in planning and coordinating action toward a vibrant and successful naturopathic profession. The third day was a meeting of the American Association of Naturopathic Medical Colleges (AANMC) where representatives from the seven naturopathic medical schools met to discuss topics of mutual interest and promote successful programs and improve student education.

As I sat in these 3 days of meetings, it struck me that, by and large, I was spending time with most of the current leaders of the naturopathic profession, a relatively small group of people who through their hard work and dedication, are advancing naturopathic medicine and in their small ways, changing the world.

It is currently estimated that there are about 6000 licensed NDs in the United States and Canada. My guess is there are around 100 people who are in key leadership roles. Some are employed by various organizations to do their work (the schools and colleges come to mind), but many are volunteers who are members of Boards or officers in their state associations. What all have in common is a vision of where naturopathic medicine can go and what it can do to improve the health of the public and influence the course of health care policies that affect us all.

It’s a funny thing. I think that when most of us became students of naturopathic medicine, we were focused on our studies, learning about how this medicine can benefit our patients as we go out into the world and establish our practices. Little did we know how important it would be to get involved in politics, both at state and federal levels, to expand access to naturopathic care, assure scopes of practice to reflect our training and education, and to dispel much of the ignorance and misperceptions around the naturopathic profession.

While on vacation last month, I ran into a ND at the Kona Farmers Market. We chatted a bit, and I found out she had become involved in the Hawaii association during its recent successful effort to update the scope of practice for Hawaii NDs. She mentioned that she had not planned to get involved in these political doings, but that she felt she had to because of the effects on her practice and her abilities to be of benefit to her patients. I think many of us can relate to her experience. Whether we expected it or not, many of us have found that to do our work well, we must become involved in big picture thinking and join with others in cultivating and growing the profession.

As I write this, the AANP has sent out its call for nominations for the 2010 elections. This year, we will be choosing a new President-Elect for the 2012-2013 term as well as 5 new board members. The AANP is a member-driven association; candidates are nominated by the membership and elected by a majority of the members votes. Your participation in this process is vital to the direction and future of the AANP.

This election promises to be an exciting one. I know of some candidates who plan to run and am impressed by the experience and professionalism they bring to the ballot. It is very likely this years elections will be competitive, with more candidates running than there are available positions. This means choices for AANP members to influence the direction and goals of the association.

My charge to you is simple: Get Involved! Vote! Read the candidates statements and decide who best speaks for you and your concerns and desires. For those of you with leadership experience and interest, consider running for a Board position.

With your voice and your vote, you have the power to grow and guide the naturopathic profession as it gains its rightful place in the healthcare system.

Wednesday, April 14, 2010

The Lack of Conference Childcare: A Barrier to Professional Development

By Nancy Dunne, MA, ND

Photo by {just jennifer} via Flickr, used under the Creative Commons License.

Kids need to move; they’ve got to ask their questions and have their snacks, now. Babies will cry and adults are hard-wired and emotionally programmed to stop what we are doing and attend to the sound. Their needs are real, relentless and never mix gracefully with a professional learning environment. We need childcare at our convention.

Cementing connections and active networking are vital components of career development, especially for young professionals. Although NDs are a diverse group, it’s safe to say a majority of new graduates are in their peak child-bearing and early child- rearing years. And so, each year as the AANP convention rolls around, many of us are facing again the difficult question of how to balance participation in our premier unifying celebration and CE opportunity with the needs of our children. I don’t want my colleagues for whom this is a current personal dilemma to face this hard choice alone, any longer.

We pride ourselves on our inclusiveness, our sense of family. I am here to tell you that we do not always walk our talk. I started medical school in 1984 with a two year old daughter. When I raised my hand during orientation to ask “What about child care facilities?” I was naively stunned to learn my school had absolutely no institutional provision to assist young parents. In that moment I made my new best friend, a classmate whose daughter was three. Nearly 30 years later this cherished, brilliant doctor and I have each made significant contributions to and with naturopathic medicine. We also remain acutely aware of the profound risks we took with our children’s development, and the literally sickening cost we paid, in order to become naturopathic physicians. She and I regularly reaffirm that it was our bonding and mutual support that got us through what was frankly an ordeal as young parents.

Our non-parent classmates, our teachers and the leadership of the profession at the time were unable to grasp and meaningfully empathize with our experience. We brought our kids to class when we had to; naturally, they were never happy to sit and be quiet. We did not learn optimally. Classmates and teachers did their best to accommodate our situation, but never once was it comfortable experience and at times we endured direct verbal criticism. This was in the 1980s, in a profession that was rapidly becoming majority female. Twenty-eight years later we have barely advanced in this arena. I want to change that, now.

Our schools are where we learn what it means to be a naturopath; it is where we are enculturated. It’s where I learned that reciting the prettiest ideals is no guarantee they will be lived out, unless there is also a meaningful commitment of resources and behavioral follow through. I am no longer affiliated with a school, but I am an AANP member. As such, I am asking you to join me in examining this issue. I am asking you to be part of the healing by putting your money where (I hope, I believe) your mouth is. Providing child care resources in support of whole family health for our colleagues who need it should be a fundamental value that we all make real, by making it a collective funding priority.

When I was AANP president, people regularly complained to me about kids being a bother at the convention. When I encouraged them to speak up with functional solutions, 100% of them replied with some version of ”They chose to have kids. Let them deal with it.” That attitude is both disappointing, and incorrect. This is a personal, career-development issue. It is also an aspect of the maturation of a profession. People combining parenting with their professional career is an established reality in our cultures and economy. Dual-priority parents bring uniquely valuable assets to the practitioner and patient communities. Their requests for child care provisions are not the complaints of irresponsible whiners. Accommodating family needs in professional environments is about removing barriers that represent an insupportable, regressive position that is also primarily gender-specific.

It is rare for professional women with children to have spouses who are available 24/7 for the kids. Generally speaking professional women marry professional men far more often than the reverse--according to a 2003 University of California, Berkeley, study, the figure for women was 61% compared to just 27% for men. Despite advances, in our culture women still provide the majority of direct care, or pay for others to care for their children. The barriers to career development related to child-rearing disproportionately affect women. The naturopathic profession, especially for those graduating since 1990, is predominately female.

Not attending the AANP conference is a loss for both the docs who stay home, and for those of us who miss the social, spiritual and learning opportunities these colleagues are not available to be part of, to add to, to solely author, at the convention. We are all poorer for their absence. When they bring their children and have to tote them around, strain to shush and contain them during lectures, when parents miss out on the shared learning experiences that meld and elaborate our practices, we all lose.

For most NDs, paying for a companion, a friend or relative, to come along to take care of the children just isn't a realistic option. But how much responsibility should the AANP assume? We have provided on-site nursing rooms with lecture sound piped in. Some associations provide a list of local providers on their conference Web sites. But when offered, this rather arms-length provision has not been satisfactory for our member parents. Our standards and preferences being what they are, we require child care services congruent with our wholism and our practice philosophy.

We have to make hard decisions about how to use limited time and resources. The 2010 AANP convention is recognizing the importance of our family members with a family picnic on Friday after sessions. It is at a great park/courtyard right near the convention center. We will have picnic foods, a band and kid-focused fun. Knowing that so many docs live local to Portland, we wanted to plan something that they could bring their families to. This is the AANP putting our money where our mouth is, acknowledging the heart-centers of our lives with a family specific moment.

To carry this value through to its full integrity requires a community-wide commitment to institute this value where it belongs. We must establish childcare as a regular feature in all of our institutions, including at the annual national convention. We do this by committing as a community to fund it as if it were as important as every other element we expect as a matter of course to be available to us.

Think about it. Next week I’ll fill you in on the practical liability and cost details that we have to work with. There will be a survey made during the convention to poll your personal decision regarding what level of commitment you will make to provide for our families at the AANP convention. Meanwhile, I welcome all your feedback and creativity for identifying funding sources to make this a foundational element of the naturopathic community.

Tuesday, April 13, 2010

Quercetin Synergy

By Jacob Schor, ND, FABNO

A quercetin molecule. Image by the Shaddack via, used under the Fair Use Doctrine.

Buckminster Fuller invented the term 'synergy' to explain some of his stranger architectural concepts. Although I idealized Fuller in my younger years, I admit that, for the most part, I had no idea what he was talking about. The concept of synergy and geodesic domes are probably the most prominent legacy with which Fuller has left us.

The term synergy in modern medical science is now used to describe the way drugs, nutrients, or toxins interact to enhance each other’s effects, both good and bad. One classic example is codeine mixed with acetaminophen, a combination that enhances the codeine’s pain relieving action.

I am often guilty of overlooking the synergistic actions of the supplements I suggest to patients. I fall into a simplistic worldview in which nutrients isolated from food and plants act singly and alone. This is absurd but easy to do. My only excuse is reading too much peer reviewed medical literature. Interactions between multiple nutrient complexes are difficult to test, and synergistic effects even more difficult. Most of the research related to nutrients is goal oriented, searching to isolate single patentable chemicals for market.

I am lead to these ruminations by a fascinating series of reports published over the past few years describing the effects of quercetin on athletic performance. David Nieman and fellow researchers at Appalachian State University in Boone, North Carolina are behind many of these studies.

Quercetin is found in many kinds of fruits and vegetables. It is well established that people who eat larger that average amounts of fruits and vegetables are protected against many diseases. It was an easy jump for researchers to wonder if these benefits were correlated with greater quercetin intake. Indeed in test tube and animal experiments quercetin appears to exert many powerful chemical effects that appear protective against human disease.

Quercetin should be anti-oxidative, anti-inflammatory, anti-bacterial, immunomodulatory, anti-carcinogenic and cardio-protective. Those who eat the most quercetin have lower rates of cancer (colorectal, kidney, pancreatic, prostate and lung cancer), cardiovascular disease and diabetes.

Food sources of quercetin include elderberries (42 mg/100 gm), red onions (33 mg/100 gm), hot peppers (15 mg/100 gm), apples (4.7 mg/100 gm), kale (7.7 mg/100 gm) etc. Capers actually contain the most quercetin (180 mg/100 gm) of pretty much any food but as few people consume them in quantity are rarely listed.

Athletes are useful test subjects to use in studying certain types of disease. The effects of sustained endurance ‘events’ in many ways mimic the physiologic effects caused by aging, trauma and surgery on blood chemistry. Thus in theory one could test the benefits of quercetin relatively easily.

Prolonged and intensive physical exertion by endurance athletes causes inflammation, oxidative stress and lowers immune protection, leaving them at high risk of upper respiratory tract infection (URTI).

In the first of their quercetin studies, the Nieman and the Boone researchers gave competitive cyclists either 1000 mg/day doses of quercetin or a placebo. After three weeks supplementation, the cyclists were rode very hard (3 hours per day) for three days in a row. They were then tested for multiple measures of inflammation, oxidative stress and immune function along with incidence of URTI. Those who took quercetin increased plasma quercetin levels and had fewer URTIs during the two week period following their 3 day burst of hard riding, but taking the quercetin had no effect on laboratory measurements of immune dysfunction, inflammation or oxidative stress.

The Boone researchers conducted a second similar study but, instead of cyclists, used the ultra-marathon runners who competed in the 160 Kilometer Western States Endurance Run (WSER). Subjects again took 1,000 mg of quercetin or a placebo each day for three weeks and again supplementation had no effect on blood measurements of inflammation, immune dysfunction or oxidative stress triggered by this severe exertion. URTI rates were again lower in those who took quercetin but not statistically significant. Combining URTI data from this WSER study with data from the earlier cyclist study did yield a statistically significant reduction in post exertion illness; URTI rates were a full 2/3 lower in the quercetin group than in the placebo group. Yet the lack of measurable effect on blood chemistry was frustrating.

The Boone researchers looked to knowledge gained in rat studies on the synergistic effect of other nutrients on quercetin.

In an experiment published in July 2009, again cyclists took 1000 mg of quercetin per day this time for only two weeks, but with or without the addition of 120 mg of epicallocatechin 3–gallate (EGCG), 400 mg isoquercetin and 400 mg of EPA-DHA. The EGCG dose is about equivalent to a single cup of green tea. The riders again went through a 3 hour per day, 3 day period of extreme exertion. This trial yielded far different results: the mixture reduced the measurements of inflammation, oxidative stress, and immune disruption significantly. The levels of quercetin in the blood of those who took the mixture of supplements were almost twice as high in those who took only quercetin.

Adding a few other supplements to quercetin worked far better than quercetin alone. What is most surprising about this information, at least in hindsight, is that it took so long to figure it out. Researchers were looking so hard to find the single chemical that would act magically and cause all the positive health changes that they lost sight of the bigger picture.

Single foods provide complex mixtures of nutrients. Diets consist of complex mixtures of foods. Expecting to isolate a single nutrient from a diet that provides all the benefits of the diet seems absurd. We now consider the Mediterranean Diet to be very healthy. Choosing foods like those eaten by Mediterranean cultures certainly provides eaters with a fair amount of quercetin; it also provides omega-3 fats from fish and a decent amount of EGCG. It is this combination of nutrients that together brings some of the benefit.

The easy take home lesson from this research is that we should forget about giving quercetin alone to people. If we want clinical benefit we should always give doses of green tea and fish oil along with quercetin to maximize its benefit.

The more advanced lesson is that we need to look further in the direction of identifying synergistic combinations of nutrients. We can easily list several other major phytonutrients common in the Mediterranean Diet, for example, resveratrol and genestein. It shouldn’t surprise us that resveratrol and EGCG have synergistic action against cancer cells. Or that resveratrol and genestein do as well. A combination of nutrients may work well where a single nutrient fails.

The real lesson though is that we can’t really fully understand the interactions between the countless components found in food within our bodies. At best we can mimic the eating habits of healthy populations and hope to see similar benefit in ourselves. This brings to mind the advice given by my nutrition professor thirty years ago. “Eat a wide variety of healthy foods.”

For those of us who seek health benefits through nutritional supplements, we should be cautious of over idolizing single nutrients and realize nutrients often work far better in combination with others than they do alone.

Note: Much of the information in this article is from a still unpublished review paper written by David Nieman, PhD. It deserves special and particular mention rather than simply to be referenced as a footnote. Dr. Nieman has been the guiding force behind quercetin research that has emerged from the Human Performance Laboratory at Appalachian State University in Boone, North Carolina. The paper is titled, “Quercetin’s bioactive effects in human athletes.” His paper was accepted for publication February 11, 2010 and will appear in Current Topics in Nutraceutical Research, Volume 8, No. 1 later this year. A special thank you to Dr. Nieman both for sharing this paper but for tolerating my many questions.

The 1,000 mg/day dose of quercetin used in these recent trials far exceeds the amount of quercetin that can easily be consumed via diet. Food sources of quercetin include elderberries (42 mg/100 gm), red onions (33 mg/100 gm), hot peppers (15 mg/100 gm), apples (4.7 mg/100 gm), kale (7.7 mg/100 gm) etc. Capers, by the way, actually contain the most quercetin (180 mg/100 gm) of pretty much any food but as few people consume them in quantity, are rarely listed.

Nieman DC. Risk of Upper Respiratory Tract Infection in Athletes: An Epidemiologic and Immunologic Perspective. J Athl Train. 1997 Oct;32(4):344-349

McAnulty SR, McAnulty LS, Nieman DC, Quindry JC, Hosick PA, Hudson MH, Still L, Henson DA, et al. Chronic quercetin ingestion and exercise-induced oxidative damage and inflammation. Appl Physiol Nutr Metab. 2008 Apr;33(2):254-62.

Nieman DC, Henson DA, Davis JM, Dumke CL, Gross SJ, Jenkins DP, et al. Quercetin ingestion does not alter cytokine changes in athletes competing in the Western States Endurance Run. J Interferon Cytokine Res. 2007 Dec;27(12):1003-11.

Moon YJ, Wang L, DiCenzo R, Morris ME. Quercetin pharmacokinetics in humans. Biopharm Drug Dispos. 2008 May;29(4):205-17.

Mostafavi-Pour Z, Zal F, Monabati A, Vessal M. Protective effects of a combination of quercetin and vitamin E against cyclosporine A-induced oxidative stress and hepatotoxicity in rats. Hepatol Res. 2008 Apr;38(4):385-92. Epub 2007 Oct 9.

Zal F, Mostafavi-Pour Z, Vessal M. Comparison of the effects of vitamin E and/or quercetin in attenuating chronic cyclosporine A-induced nephrotoxicity in male rats. Clin Exp Pharmacol Physiol. 2007 Aug;34(8):720-4.

Camuesco D, Comalada M, Concha A, Nieto A, Sierra S, Xaus J, Zarzuelo A, Gálvez J. Intestinal anti-inflammatory activity of combined quercitrin and dietary olive oil supplemented with fish oil, rich in EPA and DHA (n-3) polyunsaturated fatty acids, in rats with DSS-induced colitis. Clin Nutr. 2006 Jun;25(3):466-76.

Nieman DC, Henson DA, Maxwell KR, Williams AS, McAnulty SR, Jin F, et al. Effects of quercetin and EGCG on mitochondrial biogenesis and immunity. Med Sci Sports Exerc. 2009 Jul;41(7):1467-75.

Hsieh TC, Wu JM. Suppression of cell proliferation and gene expression by combinatorial synergy of EGCG, resveratrol and gamma-tocotrienol in estrogen receptor-positive MCF-7 breast cancer cells. Int J Oncol. 2008 Oct;33(4):851-9.

Gynecol Oncol. 2009 Jun;113(3):374-8. Regulation of Vascular Endothelial Growth Factor in endometrial tumour cells by resveratrol and EGCG. Dann JM, Sykes PH, Mason DR, Evans JJ.

Ahmad KA, Harris NH, Johnson AD, Lindvall HC, Wang G, Ahmed K. Protein kinase CK2 modulates apoptosis induced by resveratrol and epigallocatechin-3-gallate in prostate cancer cells. Mol Cancer Ther. 2007 Mar;6(3):1006-12.

Harper CE, Cook LM, Patel BB, Wang J, Eltoum IA, Arabshahi A, Shirai T, Lamartiniere CA. Genistein and resveratrol, alone and in combination, suppress prostate cancer in SV-40 tag rats. Prostate. 2009 Nov 1;69(15):1668-82.

Monday, April 5, 2010

Horsing Around at the NIH

By Bill Benda, MD, FACEP, FAAEM

Image by the NICHD via, used under the Fair Use Doctrine.

An interesting thing happened to me back in February – I received a request from the National Institutes of Health to serve on a panel that would determine how to dole out quite a few millions of dollars to fund research in what the NIH refers to as Human-Animal Interaction (HAI), usually referred to as animal-assisted therapy. Apparently the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Nursing Research, and the WALTHAM Center for Pet Nutrition (the pet food division of the Mars company) had entered into a public-private partnership to pursue research on this topic.

My invitation, I am sure, was the result of having published two prior research studies (one part of an NCCAM Center grant) investigating the effect of hippotherapy (physical therapy on horseback) on children with spastic cerebral palsy. It seems that all of the other “experts” in this relatively tiny field had in fact applied for the current grants, leaving yours truly as a rather singularly available authority. The rest of the 35-plus members on the March review panel consisted of sociologists, psychologists, and behavioral scientists, with one or two other MDs thrown in for good measure.

The rather impressive vows of confidentiality we were asked to give preclude me from mentioning who was at the table, the nature of the submissions, or any aspect of the ensuing discussions, but that is not relevant to the gist of this blog report. What was most surprising was that exploration of this rather unique arena did not come from NCCAM, or in fact from any realm associated with the practice of alternative, or complementary, or holistic, or integrative, or naturopathic, or whatever-shall-we-call-it medicine. It came from pediatrics, nursing, and a pet food company. Surprising, as it awoke me to the fact that we do not have dominion over unconventional therapies, as our marketing brochures and indeed last February’s Institute of Medicine Summit on Integrative Medicine or last May’s North American Research Conference on Complementary and Integrative Medicine would have us believe.

This is a very, very good thing, especially for naturopathic medicine, because it confirms that no medical field, conventional or other, is able to usurp any clinical or research field as some have feared – the realm of healthcare is simply too slippery to remain within the grasp of any one profession. It’s sort of like the power of the Internet in China, or even here in the U.S. No government, or industry, or social experiment will ever control any culture or country or endeavor as long as people can find a way to share information with each other. Like in a blog.

By the way, if you may be wondering why the NIH has a new-found interest in the human-animal bond as a healing modality, keep in mind that there are over 750 equine therapy centers and over 2000 canine therapy programs up and running in our hospitals, cancer centers, nursing home, prisons, et al. – each with certified therapists and each with a waiting list stretching around the proverbial block. In other words, it exists, people are using it and paying for it out of pocket, and so we might as well research it and give it our medical stamp of approval.

Sound familiar?