March 23, 2014

AANP 2011 Convention Report

Composing effective patient care
"Natural Medicine Journal's" editors share highlights from the recent AANP convention and exposition in Phoenix, AZ.

The AANP's annual convention and exposition took place August 17-20, 2011, in Phoenix, AZ. Natural Medicine Journal's publisher and editors attended and have synthesized some of the session highlights below.

Achieving Wellness: A Hierarchy of What is Important

Michael Murray, ND

The first general session of this year’s AANP convention featured a presention by Michael Murray, ND. Murray’s presentation provided a foundational view of what it means to achieve “whole person” wellness. His talk, which was well-received by audience participants, focused on attitude, health habits, diet, and lifestyle. Session attendee Lise Alschuler, ND, said “Dr. Murray eloquently distilled those attributes of natural health that have the greatest potential to create wellness in our patients and in ourselves. Through his presentation, he both modeled and reminded us of the importance of bringing our hearts, our gratitude, and our optimism to each and every encounter.”

Composing Effective Homeopathic Care: 25 Years of Refining Practice and Teaching What We Know

Paul Herscu, ND, and Amy Rothenberg, ND

In a keynote lecture, husband-wife team Paul Herscu, ND, and Amy Rothenberg, ND, teamed up to entertain and enlighten their fellow naturopaths on how to apply homeopathy in their practices. Homeopathy is notoriously difficult in its complexity, but Herscu and Rothenberg make the application of homeopathy seem not only doable, but pleasurably simple. Herscu lectured on what he has made a career of doing: distilling homeopathic medicines down into systematic usage based on presenting symptoms. On a more personal note, Herscu covered the evolution of his practice from general practitioner to a sought-after pediatric homeopath. With belly laughs echoing in the hall, Rothenberg interjected with personal quips that can only be derived from 25 years of marriage. Rothenberg, a prominent homeopath in her own right, gave a heartfelt lesson on how to overcome the many obstacles to becoming a good homeopath. As most who have attempted homeopathy have experienced, there are periods of self-doubt and indecision. Coping with the challenges head on, Rothenberg inspired everyone present to be patient with themselves, approach the medicine systematically, and use it only when confident in its application. Together, team Herscu-Rothenberg inspired and educated the audience, leaving us grateful to have their family in the fold of the larger naturopathic community.

Appropriate Treatment for Every Stage of Kidney Disease

Jenna Henderson, ND

Jenna Henderson, ND, gave a lecture on naturopathic considerations in kidney disease. It was a clinically relevant distillation of naturopathic treatment of kidney disease, providing invaluable information on the dos and don’ts for patients at every stage of the disease. Henderson educated and inspired the attendees, as she shared with us her evolution into nephrology. Diagnosed with kidney disease herself, she entered naturopathic medical school with the intent to specialize in nephrology. As a physician and dialysis patient of 13 years herself, she brings a depth of understanding on the topic that is unparalleled.

The emphasis of Henderson’s lecture was on the best-evidenced practices for patients with kidney disease. Perhaps most enlightening was how best practices in naturopathic medicine change according to the stage of kidney disease. Protein requirements, electrolyte intake, and appropriate botanical medicines to support kidney function were covered in detail. Henderson has contributed in the past to Natural Medicine Journal, and we hope she continues to teach and bring her insight to clinicians within and outside of the naturopathic profession.

The Documented Health Risks of Genetically Modified Foods—Overwhelming Evidence of Harm

Jeffrey Smith

Jeffrey Smith, author and activist, gave an impassioned lecture on the health hazards of genetically modified organisms (GMO’s) used in agriculture. The history of the development of GMOs is wrought with twists and turns in the struggle between proof of harm and public policy. From the “ah-hah” moment of discovering the scientific feasibility of creating GMOs to the “uh-oh” moment of observing what happens to animals that eat them, the lecture wound through the years to culminate in a summary of the difference in government policies around the world. More specifically, the startling complacency of their use in the United States was contrasted with the cautiousness of the United Kingdom, where their distribution is banned outright.

Controversies in Nutrition

Alan Gaby, ND

Alan Gaby, clinician and author of Nutritional Medicine, presented a lecture covering some of the most challenging questions regarding the evidence-based use of nutritional supplements in practice, including folic acid and cancer, strontium for bone health, and optimal vitamin D dosing. The use of vitamin D in practice was perhaps the most talked-about segment of his lecture in naturopathic chat groups afterwards. Vitamin D has gone from obscurity to fame in the last decade. Most practitioners are aware of the low serum values found commonly on laboratory tests for 25-hydroxycolecalciferol. Our knowledge base of the many roles of vitamin D in physiological processes has grown exponentially in recent years. Given the proliferation of information on the essential role of vitamin D on cancer prevention, bone health, cognitive function, and myriad other health concerns, it is no wonder it has undergone a “more is better” assumption throughout natural medicine circles. However, Gaby claimed a close look at the evidence suggests that maintaining high serum levels of 25-hydroxycolicalciferol may not be the correct goal for our patients. Perhaps the physiology of vitamin D is more complicated, including metabolites that have undergone little research. He concluded that there is little evidence supporting the current use of very large doses of cholecalciferol (D3), and he advocates for more moderation in dosing.

Natural Products, Quality Control

Mark Blumenthal

Over the years, we’ve all heard many cautionary tales involving herbal supplements. Perhaps the most striking information delivered by Blumenthal is that the toxicity of some herbs is based on contamination of a product with another herb altogether. Whether by mistake or unscrupulous design, a few herbal supplements have contained toxic substances or herbs in place of, or in addition to, what is found on the label. The herb on the label is then presumed to be the culprit in the toxic reactions. Some of what has become canon in herbal references is based on these quality control failures of a supplemental herbal product. A prominent example given was Cimicifuga racemosa, or black cohosh, which is listed as hepatotoxic in some herbal references. In fact, the herb found in the supplements having hepatotoxicity a different herb that wasn't even listed on the label. This unfortunate continuation of misinformation is very difficult to undo. The adulteration of a supplement with a prescriptive agent has also occurred, although this is a rarity. Such stories remind us that we should be vigilant about sourcing our products from reputable companies, and we should not be complacent about the supplements our patients source from unknown companies.

Later the same day, a panel discussion covered some of the challenges in the production and quality control of nutritional supplements. The topic of quality control is of interest to all practitioners, as the manufacturing process and raw materials are increasingly coming from China. Of note in the discussion is that the U.S. Food and Drug Administration (FDA) has ramped up oversight of supplement manufacturers in the United States. FDA inspections of facilities have begun, with the largest facilities being inspected first. Inspection includes all processes involved in the manufacturing and distribution of supplements, including paper trails of sourcing, identification, shelf life, and so forth of the substances used in the supplements. In addition, labeling is also undergoing scrutiny by the FDA, with an eye for false claim of efficacy that go beyond the current “structure and function” claims. Over time, all manufacturers will be subject to FDA inspection, which is a boon for the consumer but may have fatal consequences for some mom-and-pop operations. The take-home point is that while it is still a buyer-beware market, there is increasing oversight that should bring at least a level playing field of quality control to the industry. Weeding out unscrupulous companies making outrageous claims will benefit all practitioners of natural medicine.

The Tones of Healing

Matthew Baral, ND

Chair of Pediatrics at Southwest College of Naturopathic Medicine, Matthew Baral, ND, gave a lecture weaving together the topics of communication, biorhythms, and human development into an all-encompassing thesis of wholism. His energetic pace held the attention of the packed hall in this keynote address. He used many video clips demonstrating the innate rhythm found in all beings to convey his message—for example, toddlers bopping rhythmically to music, or babbling with each other with the give and take of conversation normally reserved for adults. From these tiny beginnings to the sounds of galaxies light years away, Baral tied together the idea that rhythm is everywhere, it infuses our environment, it is with us whether we recognize it or not. Further, he postulated that expression of one's self through rhythm may preserve cognitive function. Ultimately expression, in the form of communicating with others through music or words, may hold its own powerful benefits to a long and happily lived life.

Homeopathic Research & Treatment of Attention-Deficit Hyperactivity Disorder (ADHD)

Jamie Oskin, ND

In his lecture on homeopathy in the treatment of attention-deficit hyperactivity disorder, Jamie Oskin, ND, spoke of his clinical experience treating children grappling with violent, uncontrollable behavior. He profiled one particular young boy who terrified his family with his violent outbursts, lack of remorse, and seeming lack of morality. “These are the kids we want to help with homeopathy,” Oskin said, “because you worry that they’ll get to be teens and have drug or gang problems.”

In his assessment of this child, Oskin noted that he bit his nails constantly, wet his bed, couldn’t fall asleep before 1 a.m., and was always hot. Oskin prescribed medorrhinum, and within a month the child was dramatically improved. But after a plateau, Oskin got impatient and changed the remedy—with terrible results. From that experience he learned an important clinical pearl that he shared with attendees: When a remedy that had been working seems to stop working, go up in potency rather than trying another remedy. If you still haven’t improved after trying several different potencies, start to look for another remedy.

Some practitioners get overwhelmed prescribing homeopathy because of the many variables, but Oskin offered this encouraging piece of information: the top-10 remedies prescribed successfully treat 71% of patients. In a lot of your cases you’ll have success with the basic remedies, so Oskin recommends you “learn the big fish first.”

Comprehensive Treatment for Disordered Eating

Nicola St. Mary, ND

More than 10 million women and 1 million men in the United States are dealing with a diagnosable eating disorder; millions more are affected on a subclinical level. Greater than half of adolescent girls see themselves as overweight, and body dissatisfaction is seen in girls as young as 6—perhaps even younger. This is an urgent issue that needs addressing: Anorexia has the highest mortality rate of any psychiatric diagnosis. Ten percent of people with anorexia will die within 10 years of diagnosis, from suicide, infection, or effects of chronic starvation.

Treating disordered eating isn’t about labs and physiology, Nicola St. Mary, ND, will point out; it’s about reconnecting to food in a more healthy way. St. Mary shared her extensive experience dealing with clients with disordered eating and offered up these tips to attendees:

  • Use a glucometer instead of weight as a measure of eating because weight is so emotionally loaded.
  • Establish a healthy and safe relationship with your client before trying for change. Be the provider who allows it to be OK that this is happening for now, because there’s so much shame and self-loathing that they have nowhere else to turn to. You need to build up other coping skills before you take away the unhealthy ones they feel they need.
  • Work in tandem with a therapist who can monitor the patient once or more a week and can get to the issue in a different way than an ND can. Cognitive Behavior Therapy has been most beneficial in changing eating patterns. EMDR helps to repackage any negative experience a person has had.
  • Mindfulness Based Eating Awareness Training combines mindfulness and meditation skills with imagery around successful meals and eating patterns.
  • 5-HTP helps with feelings of satiety and helps with impulse control.
  • Check for digestion issues and deficiencies, and supplement with bitters, enzymes, probiotics, and deficient nutrients.
  • When discussing nutrition, be sure to emphasize that perfection is not the goal; aim for a good diet 80% of the time and explain that our bodies can handle slip ups 20% of the time.
  • Diet diaries might do more harm than good in people with disordered eating because it triggers the issues around their poor relationship to food. Instead, have them write down questions about food that come up throughout the week.
  • Yoga has been shown to be more effective than CBT in disordered eating. Meditation practice improves control.

And when the client is finally ready to make a change, have her write a goodbye letter to the eating disorder stating what the benefits of the disorder have been, what she has gotten out of it, and what gratitude she can offer it, and then explaining what changes she wants to make and finally saying goodbye.

Most importantly, providers need to be very compassionate with their clients. “Ultimately, effective treatment means building compassion,” St. John explains.

Living in Rhythm—Imperative to Health

Kathleen Darley, ND

As human physiology evolved, when the sun went down it was dark and cool. Night was longer in winter, shorter in summer. Amount and variety of food changed seasonally. But now? With electric lighting, climate control, and the global food chain, we are out of synch with our physiological roots. Kathleen Darley, ND, explained the effects of these changes in her lecture on the importance living in rhythm.

The problems caused by rhythm disruption are even worse in people with sleep disorders or who work schedules that cause them to be awake at night. Shift workers are prone to develop depression, social difficulty, problems with marital satisfaction, cardiovascular health problems, cancer, reproductive health issues, and digestive disturbances.

When working with a client, be sure to ask not only about how much they work, but also what hours they work. Ask about their daily rhythms. Look at whatever health issues they’re struggling with. Is there a time of day or year that they’re more at risk? Put preventive steps in place. Explain the importance of interacting with nature to get natural light cues. Teach them to eat in rhythm—with regular mealtimes and seasonal foods. Light therapy can help too—use a light box immediately upon waking and blue-light omitting goggles hours before bedtime. Instruct them to spend at least an hour before bed with no television or computer. See if shift workers’ work environments can be altered to use full-spectrum lights.

Human beings are inherently rhythmic organisms, Darley points out, so it’s imperative that we help patients get their bodies back in rhythm.

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