The Future of the AANP

By Carl Hangee-Bauer, ND, LAc
AANP President

Fall has been a busy time for the AANP Board. After the dust settled from the convention and things relaxed for a bit, attention turned to identifying goals and priorities for the 2011-2012 work plan and budget.

Sounds exciting, huh? Actually, it’s some of the most important work that the AANP Board does. It requires that Board members think strategically, surveying the landscape for political and social trends, considering the future of healthcare reform, understanding readiness in states close to licensure, listening to feedback and the experience of our naturopathic physician members, and bringing that back to the table as we discuss and deliberate.

While the Board discusses these topics throughout the year, the formal start to our planning began at the August Board meeting. We examined programs that are currently underway and ranked programs such as marketing and public relations, state and federal affairs, fundraising, and others in order of importance to the ends and the goals of the AANP. The staff, led by Karen Howard, took this preliminary feedback and constructed the first draft of our next 2-year work plan and budget, getting further feedback from a Board survey that took a closer look at these initial ranking and programs.

This past weekend the Board held its Fall meeting on the beautiful campus of Bastyr University. Most of our time was spent discussing and debating the various details of the proposed 2011-2012 work plan. All of this, by the way, is done with keen attention to how to best serve our membership.

Let me give you some insights of the Board approved work plan.

Far and away the biggest priority is directed toward membership issues such as member benefits and professional success, programs such as the convention and membership services, and tools and resources for membership support including the AANP website.

State and Federal Affairs are a very big piece of the work plan. Facilitation of licensing in more states, inclusion in federal programs for the naturopathic profession under healthcare reform, engaging in strategic partnerships with like-minded organizations to effect change, and training our physicians and naturopathic students at the DC FLI – all are pieces in this very complex work.

Next, our Executive Director will take the work plan and assign budget categories to each area of emphasis for Board review and approval. This will be a very challenging step. While the AANP has weathered the economic downturn quite well compared with other associations, the economy has nonetheless impacted us. The budget will be very tight, and it will be a challenge to meet all of our goals. It is likely that choices will have to be made based on the key goals, priorities and programs we’ve identified.

I tell you all of this so you can understand some of the work that goes on behind the scenes and see why it is so important to be a member of your national association. The AANP is a member-driven organization that represents you in the halls of Congress and to the American people. It supports state licensing efforts and facilitates communication amongst various organizations within the naturopathic profession. It supports research and data collection to better inform others of our work. It provides top-notch continuing education with many of the thought leaders of our profession. It brings unity to our community of doctors and students in every state in the US and other countries.

Please join us as we move into the future by joining or renewing your AANP membership and letting your voice be heard.

Alley Jelly and Modern Chemistry

By Jacob Schor, ND, FABNO

Photo by Rachel Tayes via Flickr, used under the Creative Commons License.

There is a Hebrew prayer that expresses gratitude after tasting the first fruit of the season. This morning I am wondering whether there shouldn’t also be a prayer for the last taste of the season. I think this as I toss our last sprig of fresh basil into a pan of hot olive oil and the kitchen fills with the odor. The basil is in competition, though, with a pot of applesauce; I’d collected golden yellow apples that last night’s wind knocked off the tree around the corner. With the clock’s dropping back over just two weekends ago, there’s room in my morning schedule to make pack away a jar of applesauce before leaving for the office.

The weather here in Colorado collaborated to produce a bumper crop of fruit here in Denver. After watching cherries, apricots, plums and apples compost on the lawns of neighbors who have neglected to harvest their bounty, I’ve taken it upon myself to save what I can. Poppy also has taken advantage of the apples especially, and insists on eating a stomach full each day.

My wife Rena and I have been making grape jelly on weekends with some of the most flavor-filled Concord grapes I can even recall tasting. Thus the last few weekends have found me gathering the grapes hanging into an alley just off Montview Boulevard. This has led me to the grocery store, and to start experimenting with the new forms of pectin available. No doubt some reader will write to tell me that I shouldn’t use these modified pectins, but at this point, in my ignorance, they are very exciting. Traditional jelly-making required very high sugar concentrations to set. If I recall correctly, one heated the jelly ‘broth’ to about 220 degrees Fahrenheit, a temperature at which the mixture was about 65% sugar. Without the high sugar concentration, the jelly wouldn’t set. It had to be sugar; the pectin wouldn’t jell if you tried substituting honey.

Times have changed and food chemists have developed pectins that don’t require added sugar and will still jell if sweetened with honey. This is why you can buy sugar free jelly and preserves in the grocery store. We made our first batch of grape jelly the old fashioned way, making juice from the grapes and cooking it down with what seemed an enormous amount of sugar. Our second batch is still setting, but we made it without adding any sugar. I’m quite looking forward to opening the jar for my first taste in a few weeks.

An excellent discussion of how to make no sugar jellies is available from the University of Tennessee’s Agriculture Extension Service: www.utextension.utk.edu/publications/spfiles/SP325-F.pdf

This leads me to the point in this blog piece when I turn on my computer’s link to the National Library of Medicine and look up some current scientific data linked to whatever I am ruminating upon.

It so happens that there is a new paper looking at the effect of drinking Concord grape juice on blood pressure published a just over a week ago.

Researchers at the Boston University School of Medicine, almost within sight of Concord, the town where the grapes are originally from, conducted a placebo-controlled trial of grape juice in mildly hypertensive individuals. This was a double-blind cross over study. 64 otherwise healthy people participated and drank either grape juice or a placebo for two months, took a month off, and then switched beverages.

Although no statistically significant difference in average blood pressure was measured, several endpoints of interest did change during the grape juice portion of the study. Night-time blood pressures dropped 1.4% while drinking grape juice, while they increased 2.3% during the placebo phase. Blood sugar decreased 2 mg/dL while drinking grape juice, and increased 1 mg/dL during the placebo phase.ⁱ Interesting, but not fascinating.

These results are different from an earlier study from 2004. In this earlier study that was conducted in Korea, systolic blood pressure decreased an average of 7.2 mm Hg (p = 0.005) and diastolic blood pressure average by 6.2 mm Hg (p = 0.001) at the end of 8 weeks.ⁱⁱ In the new study. participants drank 7.5 ml /kg body weight, while in the older study, 5.5 ml/kg body weight was consumed.

Could the grape juice polyphenol content have varied, or could there be some genetic variant that differed between populations? It’s not clear.

Whatever the case with these studies, I remain enchanted with the idea of making sugarless jams and jellies, and look forward to next summer’s possibilities already. And as far as my pondering the lack of a prayer for the last of the season, well, it’s obvious that wiser ones than I understand that one never knows which taste will be our last so that all that we can mark is the first.
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ⁱ Dohadwala MM, Hamburg NM, Holbrook M, Kim BH, Duess MA, Levit A, Titas M, Chung WB, et al. Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension. Am J Clin Nutr. 2010 Nov;92(5):1052-9.
ⁱⁱ Park YK, Kim JS, Kang MH. Concord grape juice supplementation reduces blood pressure in Korean hypertensive men: double-blind, placebo controlled intervention trial. Biofactors. 2004;22(1-4):145-7.

Resilience

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

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

I have a dear friend who is 71 years old and as spunky as they come. She is intensely inquisitive of everyone who has the good fortune of meeting her. With focused determination, in a matter of minutes, she can extract the most intimate details even from the most reticent person. At the same time, she has a constant twinkle in her eye and a belly laugh ready to erupt at any moment. She is entirely unreliable at making plans as something better is quite likely to come along and catch her attention.

Around a table filled with her friends, she loves to debate the deeper meaning of every movie that is showing within a 20 mile radius. At one of these dinner gatherings a few days ago, I asked her a question, “What do you most attribute your good health to?” Her response: “My good health is the most certainly the result of surviving all of my bad habits.” Perhaps she was referring to her daily evening bourbon cocktail. Perhaps she was referring to her disdain for structured exercise. She does have a few bad habits to be sure, but as the evening progressed, I wasn’t thinking of those.

I watched her listen to her friends with complete compassion, while gently and persistently pointing out the silver lining in every cloud that someone resolutely created and simply delighting in the joy of being with people she loves. I thought about her past, too, and the deep adversity and loss she has experienced. It dawned on me that the real secret to her health and vitality was resilience – her unceasing ability to rebound from all manner of disappointments and to emerge into a confident embrace of life within and around her.

Her resilience seeps into those around her as she constantly buoys them up, praises them, and revels in their unique brilliance. You just cannot help but to feel better about yourself when you are with her. She lives life with the expectation that we will swing at anything that life throws at us, that we will make contact with the ball, and that the point is to revel in wherever the ball flies. I smile as think of her now, likely snuggled into her bed, watching one of her favorite shows on TV, eager to fall asleep so that she can start her day tomorrow.

Rediscovering the Value of Fats in Our Diets

By Susan DeLaney, ND, RN
2010 AANP President's Award Winner

Photo by @joefoodie via Flickr, used under the Creative Commons License.

For most of the last 50-60 years, we have been under the influence of the “lipid hypothesis,” which translates into “saturated fats are bad,” that “cholesterol causes heart disease,” and that “to stay healthy one must eat low-fat or non-fat foods.” According to some food theories, any fat at all is bad for you and should be avoided at all costs.

I found this somewhat confusing as my grandparents grew up eating eggs and bacon with lard biscuits and butter. They worked hard and were rarely sick and lived healthy lives even as they aged. Looking at epidemiological evidence, it also seems that various groups of people living around the world consume even more saturated fats in their diets. Eskimos living in extreme cold areas consume approximately 80% of their calories from saturated fats, from marine mammals such as seal and whale meat and their fats, fish and fish eggs and their organ meats. The Masai, an African tribe, live almost exclusively on milk, meat and the blood of the cows they raise, with 80% of their diets consisting of saturated fats. Yet when scientists have examined the health of both of these groups of people living on their traditional diets, they remain free from heart disease, cancer, and the common infectious diseases.

The French present another problem, so much so that we call it the “French Paradox.” In the United States the death rate from heart disease is 315/100,000 and in France the death rate is 145/100,000. Somewhat confusing as the French eat so much butter, cheese, rich sauces and meat, all of the things we have been trained to avoid to prevent heart disease and maintain a healthy lifestyle. So we say “it must be the wine,” which does have beneficial effects but not enough to create such a difference in the death rates from cardiovascular disease. Looking more closely at the data, it turns out that in the region of Glascony, where people eat the highest levels of fats in their diets from duck and goose livers, the death rate from cardiovascular disease is 80/100,000. What’s up with that?: the highest fat in the diet with the lowest rate of heart disease! Bring on the wine, cheese and pâté!

What is now becoming evident to us is that real foods high in fats are essential to our health as they contain important fat soluble vitamins A, D, E and K. These vitamins act more like signaling hormones acting in concert with one another, instructing the body to perform important functions within the cell. They are the primary drivers of every system in the body. Foods such as butter, eggs, cheese and milk from pasture-raised animals contain very high amounts of these important vitamins. Additionally fish and fish livers oils, organ meats, shellfish, the fats of pigs and birds, and even insects prized by certain cultures contain high levels of vitamins A and D. And what about Vitamin K2? Surprisingly, goose and duck livers are amongst the foods containing the vitamin at its highest levels. Other K2-rich sources include cheeses, egg yolks, butter and fatty meats—all those things the French love to eat!!

Science is now beginning to back up these observations with the fat-soluble vitamins, especially K2, which acts by conferring the physical ability for proteins to bind calcium, helping it find its proper placement in the bones rather than the arteries. K2 also offers protection from heart disease by regulating two important proteins involved in monitoring and clearing the plaque from the arteries. In the future it is likely that the lack of vtamin K2 will be considered one of the major contributing factors to heart disease.

As naturopathic physicians, we should take a more holistic approach by considering the combination of ALL of fat-soluble vitamins as they act together, talking to one another and influencing heart disease, not to mention the other systems in our body.

Vitamin D, an important fat soluble vitamin, has been in the news recently, with studies demonstrating that many are deficient. Such deficiency contributes to the increased risk of cancer, auto-immune disease, heart disease, osteoporosis, depression and many other health concerns. Were a lack of sunlight the primary culprit, one of the studies would not have shown that even in Hawaiians with exposure to sun 28 hours per week—a level most of us barely reach in a month—50% of them are vitamin D deficient!!

Why, you ask, is this so?

Our diets are lacking in the foods that are rich in Vitamin D, as well as the other fat-soluble vitamins A, E and K. Fully committed to the low fat diet, most people have limited and even eliminated healthy fat-containing foods from what they eat. Know for a fact that if you supplementing vitamin D, you are lacking in the other vitamins as well. Instead of more supplements, I recommend changing your diet to include healthy fats from animals raised on pasture land: butter, cheese, eggs and milk. Include fatty fish and shellfish from unpolluted waters and, like traditional people and the French, eat more organ meats and the fat from animals. Let real food be the foundation what your health, and enjoy it as well!!

For more information:
http://www.westonaprice.org/
http://www.allergyresearchgroup.com/

The Cream Rises to the Top

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo courtesy of psdGraphics.

In my daily practice life as well as my "political" life as AANP President, I am always on the lookout for trends and conditions in my communities, both local and national, that have effects on my practice and my profession. I came across some news recently that caught my eye and has had me thinking about its ramifications.

Along with being licensed as a naturopathic doctor here in California, I have also carried an acupuncture license since 1989 and have been a long time member of the American Association of Acupuncture and Oriental Medicine (AAAOM) as well as my state acupuncture association. Recently, the AAAOM published a study of the acupuncture profession that found, among other things, that despite the prevalent use of acupuncture in the United States, the demonstrated cost-savings and effectiveness of acupuncture treatment, and the wide reimbursement by third party payers, many licensed acupuncturists are finding it hard to make ends meet.

In John Week's Integrator Blog, he quotes Lisa Rohleder, LAc and co-founder of the Community Acupuncture Network, who concludes that "Acupuncture education, and the conventional acupuncture business model, ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans."

In short, licensed acupuncturists graduate and get licensed, but then struggle for years to pay off student loans and get paid appropriately for their education and skills.  Many encounter barriers in third party reimbursement.  Many fail.

Sound familiar?

As naturopathic physicians, many of us feel that one of the reasons it is hard to make a decent living is that many people out there just don't know what an ND is. But is that truly the case? It seems to me that most if not all people know something about acupuncture -- what it looks like, what it's good for (at least pain, anyway). And yet acupuncturists are dealing with some of the same frustrations and challenges that affect the naturopathic profession.

As I said before, this has given me much to think about, and I've come to some conclusions.

First, the good news: we are not alone. If LAcs are struggling with these issues, you can bet that it's affecting other "CAM" providers. We tend to think we are unique, but maybe not so much.

Next, knowing that these challenges exist, we can and must do better on all levels. Our colleges have to do a better job at preparing our graduates to enter the healthcare marketplace. The AANP has to be more active at developing programs and resources for our member physicians in order to help them excel in the business of naturopathic medicine. Our state organizations must help build awareness of our profession and, together with the AANP, "brand" naturopathic medicine as a desired choice for patients. The AANP and the states must work together better to strengthen laws and policies that allow access to naturopathic care via state and federal programs and remove the unfair barriers to naturopathic physicians in federal and state health programs. For example, did you know that while the Department of Education recognizes ND educational programs as on par with MD and DO training, we are still effectively shut out of loan repayment programs for our ND graduates? If this is not unfair, I don't know what is.

Our graduates (you) have to take the individual initiative to learn the elements of successful practice and focus on the business of our medicine as well as its practice. There are pages devoted to practice growth and success on the AANP website.  Log-in and then visit select "Practice Resource Library" after clicking on "Practice Tools."  There are several courses taught by successful NDs that will help new graduates learn the tools to be successful.  The resources are out there and we must take the responsibility to use them.

When I graduated from Bastyr in 1984, there were few choices for people entering the profession. One could go into a solo practice, perhaps join a small group practice, teach at one of the schools, or maybe work for a supplement company. Now I'm amazed at the choices graduates have, and I am particularly excited to see the increasing opportunities in integrative medical settings for us to take our place alongside our "mainstream" colleagues. I, for one, think our profession could do much more to prepare our graduates to enter these new medical settings.

I can tell you that, both individually and collectively, we are up for these challenges. "The cream rises to the top," it's said, and naturopathic medicine is the gold standard for people seeking new choices and new directions for their healthcare.