Forward into the past – reclaiming our naturopathic roots through aninclusive model of medicine

Andrea Gruszecki, NDDecember 2012

IntroductionThere is a growing debate in our profession about how we, as Naturopaths, move into the 21st century. A recent NDNR article urged areturn to our roots, which I support whole-heartedly, but through a specific philosophy/modality called Anthrophosophy. While I do believe that a return to our roots is a necessary aspect if we are to survive as a profession, I do not believe and cannot support, that anyone person’s favorite therapy or philosophic perspective is the “one size fits all” cure that our profession requires.

My greatest disappointment in Naturopathic medical school, even as I was learning the history and philosophy of Naturopathy, was that no one was teaching me a basic model of health to include all this information and all the modalities I was being taught. There was no model of medicine to help me discern physical from mental, emotional, spiritual or energetic root causes, and no guidance, except my own instincts on which therapies might best bring balance. I have read the Textbook of Functional Medicine, and while they do an admirable job of teaching conventional providers how to perform a Naturopathic intake, they do not offer the therapies we have in our toolkits to assist clients with non-physical issues. The “evidence” is slowly pushing aside our instincts and intuition, the insurance model tempts us to symptom-based, time-limited practices, and like a false god the Functional Medicine model blinds us to all modalities but the body-based, and tempts us to believe that if we focus on the physical symptoms alone we can achieve health and wellness.

If any conventional physician may, after a weekend seminar about supplements, diet and exercise, claim to be an “integrative physician”, it is time to get off that bandwagon. We have fallen a step behind due to our attempts to be recognized as “NMDs”; it is timeto realize that being more like conventional providers is NOT

naturopathy, that it is time to reclaim our true name and nature as Naturopaths. We promoted integration of mind and body before it was fashionable, and we have left it behind in a misguided attempt to be as “science-based” as conventional physicians.

While many conventional integrative providers give lip service to mind-body ideals, they do not incorporate them well into their symptom-driven practices. “Mind-body therapy” has been handed off to conventional psychologists and therapists; the conceptual divide between mind and body that has been traditionally maintained in conventional practices remains with a great many conventional integrative practitioners. And, unfortunately for our profession, a great many naturopaths are taking this approach as well.

I believe this divide is the window of opportunity for naturopathy. Unrecognized and disregarded by all conventional, symptom-based care is the root cause of most illness – the mind/body connection. It is the need to heal on physical, mental, emotional, spiritual and energetic levels that drives patients out of conventional provider’s offices into complementary and alternative care. Mental health professionals do not care for the body. Conventional medical care does not care for the mind or emotions. The division between mind andbody persists, and we are the only primary care providers trained to recognize and manage both. Naturopathy must either embrace its roots and begin to truly and accurately treat the cause or it must be outcompeted by “integrative” MD’s who have taken a couple of weekend courses in nutrition.

Recognition of stress and its impact on our client’s live is key to any shift in how we deliver care. An important set of considerations that are unacknowledged in conventional care and that, left unresolved, may have a negative effect on treatment outcomes involvessomatization of psychological issues (Feder) (McClendon Patricia D., 1995), hidden stressors or unresolved trauma (Harding, 2012; Harvard Health Publications, 2011) (Gareau, Jury, MacQueen, & Sherman, 2007) and current stressors. If we are to truly treat the cause and

practice preventively, this area needs to be addressed with every single patient we see.

What is needed is a model of medicine, a model of health, that is supported by the available science in physical, mental, emotional, spiritual and energetic aspects. The model must be flexible enough toadmit new evidence for each aspect as it becomes available, inclusive enough to support every modality in use, and simple enough for patients and conventional providers to comprehend. I offer the bare bones of such a model here:

The Model: The Five-Part Harmony Model of Health1

Figure 1. The Five-Part Harmony Model of Health (Gruszecki, 2011) recognizes five main aspects of health as physical, mental (conscious mind), emotional (subconscious mind), Spiritual and energy.

1 The Five-Part Harmony Model of Health is the intellectual property of AndreaGruszecki and may not be used without permission.

The Five-Part Harmony Model recognizes five main aspects of health anyone of which may become imbalanced and present as a physical symptom. The five aspects (Figure 1) are physical, mental (conscious mind), emotional (subconscious mind), Spiritual and energy:

Physical includes the body and its biochemistry, metabolic functions andgenetics as affected by diet, exercise, stretch and proper breathing and postureMental includes the cognitive, conscious mind – perception, interpretation, optimism, pessimism, enculturation, societal pressure,external environmental stressorsEmotional includes the subconscious mind – emotional processing, and internal stressors including repression, suppression or avoidance of negative emotions, memories or traumaSpiritual includes all levels of connection: self to Self/Divinity, community, family, friends, nature (the Vis)Energy includes the energy inputs from the environment and the human energy field (Feinstein, 2008 ), the electromagnetic torus around the body created by the pumping heart (McCraty, 2003 ), and the interactions between these electromagnetic fields (McCraty, 2003 ).

The Science SupportOne of the most common problems in mental/emotional/spiritual/energetic therapies is describing how the modality creates changes in the human system. Most conventional providers insist on “evidence-based” complementary modalities, despitethe growing evidence that multiple types of evidence exist and may be appropriate for different levels of review and decision-making (Jonas,2001). As described by Jonas (2001) the evidence house model providesroom for different types of testing and information gathering. The term “science supported” may be more useful. Adding confusion, most complementary /alternative practitioners are quick to insist that their modality covers multiple areas of the Five-Part Harmony model – and they are right – based on current information from the field of psychoneuroimmunology (Azar, 2011) (American Psychological Association, 2006) and the studies of neurocardiology and psychophysiological coherence at the Institute of Heartmath (McCraty,

2002). The physical body is impacted by (and may impact) the emotional, mental and energy aspects of the human system; still most therapies will have a recognizable “entry point” into the model (for example a mindfulness technique will enter the model through the conscious mind, a trauma resolution technique that provides emotional releases enters the model through the emotional subconscious mind, a flower essence will enter the model through energy/vibration).

According to Merriam-Webster Dictionary (The Merriam-Webster Dictionary), psychoneuroimmunology is the study of the interactions between psychological factors, the central nervous system, and immune functionas modulated by the neuroendocrine system. These “molecules of emotion” (Pert) have an impact on the body’s physical systems, including inflammatory process and immune function. Studies have shown that perceived stress creates neuropeptides in the limbic areas of the brain that are released into the bloodstream, and that these neuropeptides are immune-suppressive and pro-inflammation (Lorentz, 2006). This new understanding of the mind-body interaction explains why relaxation, meditation, and stress management demonstrate measurable changes in the physiology of the human system.

An even newer field of research neurogastroenterology is offering compelling evidence of the “gut brain” and its effects on the central nervous system. Ninety percent of the fibers in the vagus nerve travel from the gut to the CNS. Ninety-five percent of the tryptophan in the body is found in the tissues of the GI tract. The microbiota are affected by mood, stress and trauma, and in turn create effects oftheir own by secreting neurologically active peptides and other substances into the bloodstream (Gareau, Jury, MacQueen, & Sherman, 2007).

Research from the Institute of Heartmath further demonstrates that thephysical heart’s afferent neural input to the brain has an effect on perception and mood (McCraty, 2003).They have further demonstrated that the same electrical information measured in an electrocardiogram creates an electromagnetic field around the body, and that this field is capable of interacting with other human electromagnetic fields.

Put together, this information explains why most of the available research into holistic modalities demonstrates similar positive results in a few basic areas, as listed below, due to mind-body interactions (Varvgoli, 2011):

Relaxation (Stress Management)Improved immune functionDecreased inflammatory process (asthma)Decreased anxiety or depressionPain reliefReduced fatigue Reduction of blood pressure Improvements in coronary heart disease or its rehabilitation Reduction of salivary cortisol levels Improved quality of life Reduction in number and severity of headaches Changes in gene expression >Improved Type II diabetes or metabolic syndromeRelief of medical symptoms (Pan, 2000)

The improvements are easily explained through the mind-heart-body feedback loops of psychoneuroimmunology and neurocardiology. The overall pattern seems to indicate that most of the positive benefits of holistic care involve mind-body interactions, the notable exceptions being physical level complementary interventions involvingdiet, herbs, nutritional supplements , manipulation or exercise (although, even in these arenas, the positive regard and personal attention of the provider may have mind-body benefits? (Kaptchuk, 2002). It is entirely possible that the Heartmath coherence effect plays a role in eliciting placebo effects or the “biophysiology of belief” (Seminowicz, 2006). Even an unproven therapy might rely on placebo effect and be up to 60% effective based on placebo effect alone (Kaptchuk, 2002) (Lynn). Lack of evidence does not mean lack ofefficacy (Silberman, 2009), it may simply mean that we don’t know how to measure a therapy or its effects properly yet. While the energy medicines have not been completely elucidated by science as yet, the available evidence may be reviewed in Energy Medicine the Scientific Basis by

James L. Oschman (Oschman, 2000), Vibrational Medicine by Richard Gerber, MD (Gerber, 2001), The Field by Lynn McTaggart (McTaggart, 2008) and The Energy Healing Experiments by Schwartz and Simon (Schwartz, 2007). Information from studies at Heartmath Institute are available online at http://www.heartmath.org/faqs/research/research-faqs.html . On thenear horizon, Science Daily (Science Daily, 2012) reported on August 19th 2012 that cells use the double strands of the DNA helix like wires, running electrical currents through the DNA to look for “circuit breaks” that need repair; can additional science support for energy medicines be far in the future?

Why this matters in practiceWe must return to our roots and incorporate a model of health for one simple reason: our philosophy of care demands it! If we ignore the mind-body aspect of Naturopathic medicine we fail to treat the cause, we fail to support the Vis, we fail to remove the obstacles to cure, wefail to truly practice wellness and preventative care. We ignore the accumulating evidence at our profession’s peril:

Women who have been abused are six time more likely to substance abuse, five times more likely to have family or social problems, are two times as likely to use tobacco, and are overall more likely to be diagnosed with illnesses ranging from chest pain, depression, anxiety, urinary tract infections, sexually transmitted diseases and GERD, as well as the actual injuries of the abuse (Harding, 2009).

The Child Molestation Research and Prevention Institute estimatesthat 2/10 girls and 1/10 boys has been sexually abused by the time they end their thirteenth year (Child Molestation Research and Prevention Institute)

The CDC reports that among people who reported experiencing at least six of eight different bad childhood experiences-from frequent verbal abuse to living with a mentally ill person-average age at death was about 61, compared to 79 for people who didn't have any of these experiences as children (Harding, 2009)

A national survey reveals that 1/10 U.S. children have an alcoholic parent (Kelleher, 2012)

Studies have systematically documented that patients who habitually repress their emotions simultaneously suppress their immune responses; conversely those who are encouraged to experience and express their feelings demonstrate improvements inimmune function, physical condition, and psychological well-being(Selva, 2006)

Research suggests that teaching relaxation, guided imagery and hypnosis to patients along with education about the importance ofminimizing blood loss during surgery halved the amount of blood loss during spinal surgeries. ( Blue Cross CA now covers this type of pre-surgical psycho-educational training) (American Psycological Association, 2003)

Low early-life social class leaves a biological residue manifested by decreased glucocorticoid and increased proinflammatory signaling (Miller G.E., 2009).

There is an elevated risk of inflammatory disease in individuals who experience chronically high levels of subjective social isolation (Social regulation of gene expression in human leukocytes, 2007).

Traumatized rat pups have permanent, detrimental changes in theirgut microbiomes, and increased GI sensitivity to stress as adult rats (Gareau, Jury, MacQueen, & Sherman, 2007)

Probiotic treatment of traumatized rat pups normalized cortisol levels and restored normal GI function in the pups, and also in re-stressed adult trauma survivors (Gareau, Jury, MacQueen, & Sherman, 2007).

Animal models indicate the stress (sympathetic nervous system activation) encourages bone metastasis from cancer (Campbell, 2012)

We know that stress and trauma impact health and wellness, but what dowe actually do about it? Do we “farm it out” like conventional providers? Or, do we ask the tough questions as we look for signs andsymptoms that might be stress or trauma related, and docere – teach ourpatients how such symptoms arise and teach them how to make the fundamental mental, emotional, Spiritual and energetic changes necessary to live vibrant, healthy lives on all levels? Have we “walked

the talk” and made these explorations in ourselves? How do we bring our patients balance, if we do not know how to balance ourselves? Focusing 100% of our effort on the physical 20% of the whole person isnot the answer. It does not work for conventional providers and it will not work for Naturopathy.We get to choose what kind of profession, what types of providers, we wish to be in the 21st century. Let us choose wisely.

Anyone wishing more information on how to recognize the symptoms of

stress or emotional imbalance is referred to http://www.helpguide.org/mental/mental_emotional_health.htm

http://www.helpguide.org/mental/stress_signs.htm

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