Monday, February 28, 2011

Find Your Voice and Use It at the 2011 DC FLI

By Christine Girard, ND
2010 AANP Physician of the Year

The AANP will train you to become an advocate for naturopathic medicine.
This year, I’ve had the honor of testifying before the Arizona Senate Health Committee, regarding expanding the ND scope of practice, and the Iowa Senate State Government subcommittee on regarding ND licensure in that state. If you’re like me, speaking before legislators feels daunting - important, but daunting. It has taken me years to feel anything close to comfortable and I owe that to the DC FLI.

For those who aren’t familiar with the DC FLI, it is the Federal Legislative Initiative, that the AANP hosts in Washington, D.C., each May. The event is free for all members and serves as a great opportunity for students and physicians alike to connect with their legislators in Washington. If you’re new to the game, want to learn the ropes, and feel safer doing so with friends and colleagues, this is the way to go. The three-day event is well-organized and offers two days of interactive and comprehensive preparation for your day on the Hill.

In addition to the training, the AANP schedules your meeting with legislators and makes sure you are part of a small group so you don't feel out on a limb. Additionally, the will provide you with packets that include fact sheets about the issues, biographies of your legislators, and leave-behind materials. Your day on the Hill will culminate with a reception featuring organic food, wine and chocolate, an even that legislators and their staffers have come to know and love.

There’s an amazing energy about the FLI. Part of the it is generated by NDs coming together with purpose. The other part is the amazing experience of finding one’s voice – and using it!

Every year I attend the FLI, I am reminded of how important it is that we become or remain connected to our legislators. If we don’t state who we are as a profession or voice what is important to us, who will? No one or, worse yet, our opponents.

Join me this year. Raise your voice and feel the energy of purpose.

Wednesday, February 23, 2011

The One True Way

By Bill Benda, MD, FACEP, FAAEM

Image by Nick Bygon via Flickr, used under the Creative Commons License.
Tunisia, Egypt, Yemen, Bahrain, Libya - what a wild month February has brought to the area we call the Middle East. What began as a singular objection to dictatorial rule has been spreading like a desert wildfire, and as with such conflagrations, holds both the potential of destruction and the promise of new growth from clearing out old deadwood. What is notable to those of us living half way around the planet is the undercurrent of excitement we feel with each passing news report of populist demonstration, triumph, and, possibly, democracy. Our uniquely American system of government may soon take root in a land of perpetual unrest and war, freeing the populace to seek the freedoms and capitalistic success we have come to enjoy.

Or likely not.

One of the idiosyncrasies of a privileged society is tunnel vision – if it works for us, it must be the best for everyone. Our old ally Sir Winston Churchill remarked, “democracy is the worst form of government except all the others that have been tried.” John Adams? “Remember, democracy never lasts long. It soon wastes, exhausts, and murders itself. There is never a democracy that did not commit suicide.” And of course, George Bernard Shaw: “Democracy is a device that insures we shall be governed no better than we deserve.” So why am I talking about this on the AANP blog?

Because I’ve noticed over the past few years that we in the “integrative” field tend to believe that ours is the “one true medicine,” depending of course upon what our chosen field happens to be. Naturopaths believe naturopathy is. Holistic MDs believe holistic medicine is. Homeopaths believe homeopathy is. As with religion – Christians believe Christianity is the one true faith. Muslims believe Islam is. Hindus believe Hinduism is. Buddhists believe nothing is. Isn’t what we personally believe the One True Way?

Likely not.

Our way, whether political, or religious, or medical, is not at all best for everyone else. But you would not know this from attending political campaigns, or church services, or annual conferences of any of the aforementioned guild organizations. And the primary problem with our devotion to our own profession is the irresistible urge to convert others, patients and practitioners alike, to our perspective, an urge that results in uncountable energies devoted to rehabilitating the unbelievers (always a failed strategy) rather than in creating continuity and tranquility within our own chosen, flawed system. And eventually we waste, exhaust, and murder ourselves.

Egypt and her extended family of repressed countries may not become democracies, but they will become what they choose or are forced to become, whether socialist, parliamentary, or remaining monarchies or dictatorships. American health care will likely not become holistic, or naturopathic, or integrative, but it will not remain allopathic either. It will become what it will become via known and unknown forces. The key for us is to not worry so much about how we can fix everyone else’s blindness to our perfection, but about how we can fix our own little professional realms. Are our students happy? Are our members heard? Are our leaders leading? These are the questions we need to pursue, beyond “are we evidence-based?” or “can we get CPT codes?” The latter questions hold definite merit, but need be servants to the former. Because the One True Way is always inward.

Wednesday, February 16, 2011

President's Message: Science and Naturopathic Medicine

By Carl Hangee-Bauer, ND, LAc
AANP President

When I was a teenager, my first career choice was marine biology. Growing up along the coast in Florida, I spent much of my spare time in nature and in the water, enjoying the marvels of life and the natural world around me, and I still spend most of my vacations in natural settings and in the water. In school, I was a science geek and took every course in biology, chemistry, physics, etc., I could. When I went to college at Florida State University, my major was Biology, with dual minors in Chemistry and Physics. It was during my four-year stint in the United States Army that my attention was redirected to the medical field (I was a Medical Service Corps Officer), which eventually led me to naturopathic medicine and my true life career.

I tell you this to let you know that I am no stranger to science. I still find it fascinating and appreciate the many ways it helps us understand the workings of nature and the world, helping us separate what appears to be the truth of things from reality. Studying naturopathic medicine, and especially acupuncture, presented me with many challenges, and I learned along the way that our medicine, as well as all other systems of medicine, are really a combination of science and art. When we work with our patients, we draw from both in order to stimulate the vis and provide well-rounded care to our patients.

Thus it has become an increasing concern to me when I read articles and blogs on the Internet blasting naturopathic medicine for being “unscientific.” These frequently polemic articles, while professing to come from scientific logic, to my eye are biased misrepresentations of the truth. They often lambast our profession and philosophy as unscientific, yet I have yet to see any one of them provide a critical analysis of research done by naturopathic physicians and researchers. It is sad that science can be used in these political ways.

This is important. As a student at Bastyr University, I remember Dr. Joe Pizzorno saying that if our profession is to be taken seriously by the larger world of medicine, we must speak in a language that everyone can understand and appreciate. That language is the language of science, and few have done more over the past 25 years than Dr. Pizzorno to increase the credibility of the naturopathic profession using this approach. While I think we all can agree that we draw both from science as well as traditional practices and experiences when evaluating the efficacy of our therapies and approaches to practicing medicine, advancing the research and science agenda remains an important step for our profession to move forward, especially with the continued interest in evidence-based approaches to health care.

Fortunately there is now a great effort within the profession to advance our understanding of how science informs naturopathic practice, especially in the realm of whole practice approaches to health issues. Dr. Michael Cronin, the AANP’s President-Elect, has been a strong advocate on the AANP Board for promoting scientific affairs. The Naturopathic Physicians Research Institute (NPRI), headed by Dr. Carlo Calabrese, is a group of academic and community clinicians, clinical researchers and other health scientists whose aim is to increase the amount of original data and analysis on the practice of naturopathic medicine for the purposes of its documentation and improvement, the discovery of potentially generalizable health applications, and to inform policy. And, of course, there is active research going on presently at all of our naturopathic colleges by well-trained and experienced researchers who are testing the theories and practices of naturopathic medicine. Much of the discussion I’ve heard lately focuses on studies of whole practice approaches to health care versus single agent actions.

On August 16, 2011, the Tuesday before the start of the 2011 AANP Convention, the AANP will be sponsoring a scientific summit. While only in the early stages of planning, it promises to be a gathering for the different players in the naturopathic profession to connect and define how the AANP mission, naturopathic research, and evidence-informed health policy can join and result in healthier patients, a more effective health-care system, and a flourishing naturopathic profession. Core discussion points will include articulating policy and practice issues driving our research agenda, where the profession is now and what future possibilities exist, and defining the core research questions relating to safety, effectiveness, and costs.

The AANP Board and many in our profession agree that where possible providing a scientific basis for our therapies and for the naturopathic approach is an important step in growing our professions credibility and inclusion in the greater health care system. How we prioritize this and communicate to the public is of vital importance.

I hope to see many of you there.

Thursday, February 10, 2011

It’s Time to Bust the Myths About Chocolate

By Nita Bishop, ND

Photo by chaunceydavis818 via Flickr, used under the Creative Commons License.
Myth: The darker the chocolate, the higher content of cacao and better for you.
Fact: Dark can be a misleading term. Chocolate in its untreated natural state is a yellowish-brown color, but “dutching” or alkalinizing, a common practice in the baking/food industry makes the chocolate a deeper, richer brown color. Acidity in chocolate is caused by the high polyphenol content and changing the pH by “dutching” imparts a milder flavor.

Myth: It is better to remove the cocoa butter from chocolate.
Fact: Most companies do not leave the cocoa butter in chocolate because they can sell it at a higher price on the secondary market. Some companies will leave a percentage of the cocoa butter in their chocolate for a creamier texture. Cocoa butter is a natural fat and has a combination of stearic acid which is cholesterol neutral, and mono-or polyunsaturated fat which can reduce cholesterol levels, so leaving a little cocoa butter in your chocolate can be a good thing.

KEY Myth: Most Chocolate has antioxidants.
Fact: An unfortunate problem in the chocolate industry is that most chocolate is processed above 110 degrees which greatly reduces the flavonol/antioxidant content. Very few chocolate companies care about this since the industry emphasis is placed on appearance and flavor. It is a rare experience to have a piece of RAW, ORGANIC, high antioxidant chocolate but it’s out there, you just have to search for it.

Myth: It is important to choose a Fair Trade chocolate.
Fact: Fair Trade means the farmer will be paid a fair wage for his cocoa beans. The downside to Fair Trade is that some farmers who produce inferior quality cacao beans are still paid the same as if they produced good quality beans. Choose a company that goes beyond Fair Trade and takes a personal interest in visiting and supporting the indigenous culture. Some companies give a bigger percentage back to the community and/or foster a nursery where farmers can work and stay on their land and not have to leave their families to work in the city for subsistence wages.

Myth: Chocolate made from Criollo variety tastes better.
Fact: Just like wines, cacao beans differ by region of origin, harvesting methods, etc. Criollo is touted as the richest, most expensive and is only 1% of the world production. Exceptionally rare criollo is harvested by dugout canoe deep in the Amazon rainforest. Criollo has less bitterness and astringency due to the lack of polyphenols. The strong and bitter tasting Forasterio variety, coming from W. Africa and S. America, comprises 80% of the worlds’ production. Trinitario comes from Ecuador and Columbia is a deeply flavorful bean with qualities of both varieties. The Arriba National variety unique only to Pacari/Ecuador was just rated #1 in the U.S. in the 70% Dark Chocolate Bar category.

Enjoy YOUR chocolate YOUR WAY, since only you can be the true judge.

Monday, February 7, 2011

Valentine’s Day: Pistachio Nuts and Erectile Dysfunction

By Jacob Schor, ND, FABNO

Photo by theogeo via Flickr, used under the Creative Commons License.
Given the results of several recent studies, pistachio nuts should soon become the most prominent ingredient in Valentine’s Day meals. As our population of baby boomers age, they look less for aphrodisiacs and more for some sort of natural Viagra. Pistachios may fill this function.

Pistachios were likely the first nut to be cultivated. Remnants of pistachios found in archaeological digs in Jordan have been dated back to 6760 BCE, that’s close to 9,000 years ago. It’s thought that pistachio cultivation began in Iran, then spread through the Middle East to Turkey and then Italy. Immigrants from these areas began importing the nuts to the United States in the late 1880s. Trees were imported to the U.S. originally as ornamentals in 1854. Trees imported from France were planted in Sonoma, California, in 1875. In the early 1900s, the U.S. Department of Agriculture planted pistachio nut trees at the Plant Introduction Station in Chico, California. Still, few pistachios were grown in the U.S. Most were imported from Iran until the 1970s. It was when commercial exports from Iran became unavailable in the U.S. that significant commercial production of pistachio nuts began in the San Joaquin Valley of California.

It’s pretty well established that nuts improve lipid levels, lowering LDL and triglyceride levels and raising HDL, the good cholesterol. This is certainly true for pistachios.

Two papers on pistachio consumption and heart disease risk factors, Kay et al and Gebauer et al, published 2008 and 2010 respectively, are good examples. To briefly summarize, Kay reported in 2008 that eating two servings of pistachios per day dropped cholesterol by 8%, LDL by 11% and the non-HDL cholesterol/HDL cholesterol ratio by 10%.i In 2010, analyzing blood samples retained from Kay’s initial 2008 study, Gebauer reported that eating pistachios had had a significant impact on reducing levels of oxidized LDL.ii

An April 2010 paper by Sari et al was the first suggestion that pistachios might be useful for erectile dysfunction. This study reported that a diet high in pistachios improved lipid and blood glucose levels, but more importantly improved endothelial function. Endothelial function is important in relation to heart disease, and it’s also important in some other areas. The 32 participants in the Sari study followed a Mediterranean style diet for four weeks prior to instituting the pistachio phase. After the month of eating pistachios, low density lipoprotein had dropped by 23 % and total cholesterol by 21%. The pistachio diet significantly improved endothelium-dependent vasodilation (P=0.002, 30% relative increase).iii It should be noted that the participants followed a Mediterranean diet for a month prior to starting the pistachio phase of the study. Following a Mediterranean diet in itself might improve erectile dysfunction.iv

A recent study from just a few weeks ago, published in mid-January, focused directly on erectile dysfunction. Aldemir et al recruited 17 men with complaints of erectile dysfunction for at least a year. They were fed 100 grams (about four ounces) of pistachios each day for just three weeks. This was long enough to see a significant increase in function, a 51% increase in scores on the International Index of Erectile Function.v

Valentine’s Day is coming up fast. How many pistachio nuts do you think your patients will be willing to eat between now and then?

i Gebauer SK, West SG, Kay CD, Alaupovic P, Bagshaw D, Kris-Etherton PM. Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: a dose-response study. Am J Clin Nutr. 2008;88(3):651-659.

ii Kay CD, Gebauer SK, West SG, Kris-Etherton PM. Pistachios increase serum antioxidants and lower serum oxidized-LDL in hypercholesterolemic adults. J Nutr. 2010 Jun;140(6):1093-8. Epub 2010 Mar 31.

iii Sari I, Baltaci Y, Bagci C, Davutoglu V, Erel O, Celik H, et al. Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: a prospective study. Nutrition. 2010 Apr;26(4):399-404. Epub 2009 Jul 31.

iv Esposito K, Giugliano F, Maiorino MI, Giugliano D. Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med. 2010 Jul;7(7):2338-45. Epub 2010 May 4.

v Aldemir M, Okulu E, Neşelioğlu S, Erel O, Kayıgil O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int J Impot Res. 2011 Jan 13.