How Poppy Got Her Name and the Limitations of Evidence-Based Medicine

By Jacob Schor, ND, FABNO

Hamantaschen. Photo by stu_spivack via Flickr, used under the Creative Commons License.

Our dog Poppy was named on the 14^th day of the Hebrew month of Adar in the year 5765. It was Purim, the Jewish holiday that commemorates the deliverance of the Jewish people in the ancient Persian Empire from destruction by an evil advisor to the king, a story recorded in the Book of Esther. Our puppy was about 12 weeks old at the time and still unnamed. We had simply been calling her ‘puppy.’

Part of the celebration of Purim involves the making and sharing of pastries called hamantashen. These triangular shaped pastries traditionally contain fillings made of either poppy seed or prune. How far back the tradition of making them goes is unclear. The holiday of Purim itself has been celebrated for nearly two millennia. As both opium and prunes both originated in the general vicinity in which the Purim story occurred, one might assume the custom of eating hamantashen goes back equally far in time.

In our home, we take making hamantashen seriously. We actually own a special hand crank grinder designed just for crushing the poppy seeds to prepare the filling. And I must admit that my dear wife Rena Bloom makes the best hamantashen I’ve ever tasted.

One cannot, or at least should not, eat poppy seed hamantaschen alone. All poppy plant derivatives have, to a varying degree, the same effect on the intestines. They slow things down. Whether we are talking about opium, heroine, or just poppy seed filling, they all cause constipation.

Alternating the consumption of poppy seed hamantashen with prune filled hamantashen completely solves the problem. Prunes, as we are all well aware, have a laxative action. With ease, one can achieve a balance between the poppy and the prunes’ therapeutic actions.

Let me come back to the story of our dog’s name. Six years ago, during the feast of Purim, as we sat around the dinner table consuming the last plate of homemade hamantashen, my dear wife lifted her last fragment of poppy seed filled hamantashen into the air and declared, “I love poppy.” Our young dog, up to then who had only been referred to as ‘puppy’, assumed Rena was talking about her and came bounding over to us.

This memory came back to me as I was reading a soon-to-be-published study about prunes.

We may all know what eating too many prunes will do but, in truth, this is only anecdotal evidence and until recently an unproven fact. We live in the age of Evidence-Based Medicine (EBM) and according to the rules, we had no way to know whether the laxative effect attributed to prunes was real or merely a placebo effect. That worry is over.

A paper written by researchers from the University of Iowa College of Medicine will be published next month, April 2011, which will tell us that prunes really do help constipation.ⁱ

The researchers fed 40 constipated test subjects either prunes or psyllium powder daily for three weeks in amounts that supplied six grams per day of fiber. After three weeks, the subjects took a week off and then switched therapies. During the course of the experiment, the subjects kept careful diaries, tracking all sorts of details about bowel habits that we don’t really need to discuss here. Suffice to say that when the data were collated and analyzed, it was abundantly clear that prunes had a significant effect in doing what we all know they do.

This was not a perfect study by any means. It was only a single-blinded placebo controlled trial, not the hallmark double-blinded trial that modern medicine considers the gold standard. There were only 40 subjects, 37 of whom were female. One might easily argue that this study is insufficient evidence to base clinical decisions upon.

Still, it may be the first study that clearly demonstrates that prunes do what everyone has known they do since the Book of Esther was written in the third or fourth century BCE.

This points out the weakness of our current reliance on Evidence-Based Medicine (EBM). If we adhere faithfully to the tenets of EBM, we would be obligated to suggest sodium docusate to relieve constipation, a substance that the drug manufacturers have proven works. Or if we insist on a more natural approach, we might consider psyllium, a fiber that research suggests may work better than sodium docusate.ⁱⁱ Up until now, prunes were not evidence-based medicine; they were just food. Now we can say they work better than either of the other two therapies, at least in women.

When we are dealing with serious pharmaceutical agents, it is nice to have evidence that they are beneficial. That’s because they often come with unwanted side effects. It’s nice to know that they will do what they promise. Perhaps we don’t need to require the same degree of caution with simple food therapies such as prunes. And especially with things that have so obvious and well-acknowledged action, we may not need double-blinded, placebo-controlled randomized trials.

Some times we need to preserve a bit of common sense in the practice of medicine.

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ⁱ Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8.


ⁱⁱ McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998 May;12(5):491-7.

A Spring Cleanse – For the Body and Mind

By Sara Thyr, ND

A CSA farm box. Photo by Unhindered by Talent via Flickr, used under the Creative Commons License.

My husband and I, along with a group of 15 people from my practice, are on day two of our annual spring cleanse. It is an event that I always look forward to and relish when it comes – feeling the warmth of spring, new sprouts of life everywhere, and taking some time for our health.

This morning we are taking the time to be creative with the abundance of greens and root vegetables from our local farm box (CSA = community supported agriculture). Making a big batch of roasted vegetables and some brown rice will help sustain us. A smoothie of carrots, collards, beet greens, frozen mango, and the detoxification powder supplement that we are using this year comprises our breakfast. We will be on this plan for ten days, with the food choices becoming more restrictive as we go along. From the beginning we bid a fond farewell to caffeine, sugar, alcohol, refined carbohydrates, eggs, dairy products, and flesh foods.

I lead liver detoxification workshops twice per year in the spring and fall, the most optimal times to cleanse. But spring is always my favorite. I’m a summertime gal, so spring is when I can let myself start to get excited about longer days, growing tomatoes, and all of the fun that summer brings. That feeling of excitement and motion is why many people are moved to do spring cleaning – it is a natural shift from the hibernation of winter. Acknowledgment of the changing of seasons helps us to be more connected to nature, to eat more seasonally (which I appreciate is a little easier in a climate where we can grow food year round), and to shift our bodies and activities in concert with these practices.

So too it is the right time to think about cleaning out our bodies.

The eating plan while detoxing is more restrictive that what I normally do. For some people, making the changes is not that difficult. For many of us, it is. I encourage cleansers to pay attention to the luscious healthiness of what they are consuming rather than focusing on what they cannot eat. Food on the cleanse is focused on nutrient density and paying close attention to what you are putting in your body. It feels so good to me to do this. We just don’t take the time in our normal daily routines, at least not to the extent that we do now. I love the permission on the detox to take it easy, spend more time with food, focus on greens, and feel all of the cells of my body soak up the intensity of the nutrition.

We are exposed to toxins all the time. When I began leading detox workshops, I spent lots of time talking about all of the things in our environment that are bad for us and ended up seeing many deer-in-the-headlights faces. I find that the people who want to come to the program realize there are some inherent toxins in their environment, so I don’t belabor the point quite so much. But education is one of my passions, so I always have to throw in a few little details about safe sunscreens and toothpaste. Some people are more exposed on the job, but everyone, even those who live clean lives, has some toxic load. Pollution, plastic bottles, pesticides on produce, medications, and personal care products (like deodorant, lotions, cortisone cream, cosmetics, sun screen, shampoo) have chemicals that have been shown to cause harm. Categories of damage include endocrine disruption, carcinogenesis, neurotoxicity, reproductive toxicity, and allergies or immunotoxicity.

While finding the balance between awareness and panic, between making positive changes and falling into bottomless depression about how we’ve polluted our world, I now lean more towards a detox that is also good for your spirit. Find a place where you can make some positive shifts without feeling completely overwhelmed. Doing a detox requires spending more time preparing your food rather than buying something quick. Relish that. Give up some of the other tasks of the day to make chopping the carrots meditative. Rest and take care of yourself, so that putting together a delicious vegan dinner doesn’t feel like such a heavy load. Appreciate the new leaves on the Japanese maple, or the tulips or whatever is blooming in your yard.

That is the beauty of spring. That is all part of the health of our natural world.

President's Message: Running for Naturopathic Medicine

By Carl Hangee-Bauer, ND, LAc
AANP President

The Run: Moving Natural Medicine Forward

Some people walk their talk; others run with it.

On July 17, 2011, Dennis Godby, ND, of Sacramento, California, with his two sons and his nephew, will begin The Run across the USA to increase awareness of naturopathic medicine. The Run will start in San Francisco, and 123 days and 3,250 miles later, will arrive in Bridgeport, Connecticut (to the University of Bridgeport, the only east coast naturopathic medical school). The Run will expose thousands of Americans to naturopathic medicine and raise awareness of natural medicine options for creating a healthier America. Dr. Godby believes that The Run, through participation of NDs across the country and through grassroots efforts, can dramatically increase national naturopathic awareness.

I had lunch with Dr. Godby a few weeks ago and we talked about what motivated him 16 months ago to plan this run and to set out on this arduous journey. Dennis recalled how he came to naturopathic medicine relatively late in life compared to other students; he graduated from the National College of Natural Medicine in 2004 at 48 years old (he turns 55 during his run). Though he has practiced for only 6 years, Dr. Godby related how many “miracles” he’s seen using naturopathic medicine to help his patients in addressing their health problems and improving their health and vitality. Seeing so many of his patients’ improved health has only increased his passion to deliver the message to all of America that naturopathic medicine exists and may help them meet their health goals.

His run is an example of how one person can act to make a real change in his profession and in the health of this country, as well as a tremendous opportunity for the naturopathic profession to raise its visibility. Along the course of his run, Dr. Godby and his team will pass through both licensed and unlicensed states, 30 cities of over 100,000 people, past 25+ naturopathic clinics and ≈300 naturopathic doctors. All told, over 65 million people live in cities and towns along his route.

Of course, Dr. Godby is not planning this alone. NDs Rebecca Asmar, Holly Lucille, and Jaime Schehr are also on The Run leadership team, along with many others. Organizers are already planning local events, connecting with local media outlets and planning the public relations arm of this event. Over 260 events and press conferences are in the works. This will not only raise the public’s general awareness of our profession, but also serve as an invaluable opportunity for NDs along the route and those in states seeking licensure to gain significant local media exposure for their practices and legislative goals.

Dr. Godby is out there running and networking with NDs across the country for our profession and to improve the health of all Americans. I urge you to support him, The Run, and our profession. Get involved where you can to further these goals. There are many ways you can participate:

• Go to The Run website and endorse The Run.
• Make a financial contribution. A penny a mile for each of the four runners for 3,250 miles is $130 to help pay for motor home, food, insurance, marketing, running shoes, etc.
• If The Run is passing through your area, or even if it is not, get involved on the local level planning media and PR events, sponsoring a segment of The Run, and linking your practice to this event. Wisconsin NDs are driving down to Illinois to host an event.
• Come to the April 16th FUNraiser Dinner in Sacramento for an evening of celebration and fun!
• Be the support person on the motor home with the running team.

Following Dr. Godby’s lead, we can all make this one of the most successful events in modern times for raising the public’s awareness of naturopathic medicine and the choices it offers to health-care consumers.

Humility

By Lise Alschuler, ND, FABNO
AANP Past-President (2008-2009)

Photo by a.drian via Flickr, used under the Creative Commons License.

I have come to believe that it is very hard for doctors to be truly and authentically humble. Our days are typically filled with instructing others in various ways that they can tame the unruly pathways of disease. We are, in effect, attempting to exert our control over illness. We may refer to this process more gently as empowering our patients, but, even still, our attempt at dominion over illness remains an integral part of these empowerment efforts.

This force that we exert requires that we declare unspoken allegiance to our underlying beliefs and understandings about illness and about health. And holding this allegiance together is our ego, which, with any investment of attention, quickly becomes an attachment. Here is where things get dicey. Our attachment to our ideals about healing can blind us to other possibilities, and can make us feel overly confident in our direction and position.

I would go so far as to suggest that every healer worth her salt has displayed this ego-driven behavior. It seems a natural consequence of having the will to attempt to heal. Nonetheless this determination, while perhaps necessary at times, will ultimately impede our effort. When we start to lose that edge of wondering whether what we have recommended is actually the best recommendation, or when we find ourselves talking a lot more than the people seeking our care, or when we find ourselves feeling bored or uninspired, or when we start treating diagnoses instead of people – we have succumbed to our egos. We have lost our humility in the face of disease. With that, I suspect that the healing that we each uniquely offer when we are fully present and compassionately attentive is muted, if not mutated.

I think that Bill Mitchell, ND, may have had it right when he spoke about us as being our most powerful medicine – if we don’t get in our own way. True humility - with each other, our patients and, yes, with disease, too – affords us the best opportunity to support the Vis and allow healing in.