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Not Just a Science But an Agenda: Nutrition, Whole Practice Ayurveda for Diabetes in the Recent ATHM PDF Print E-mail
Written by John Weeks   

Not Just a Science But an Agenda: Nutrition and Whole Practice Ayurveda for Diabetes Care in the Recent Alternative Therapies

Summary:  This article reviews two sections from the recent Alternative Therapies in Health and Medicine (ATHM) (Sept/Oct 2006). First, a look at a whole practice approach to diabetes and second, the state of nutrition research, education and its uptake into practice via an interview with Jeffrey Blumberg, PhD. Both remind us that much of our best work is not merely a science, or a practice, but must, as Blumberg's mentor taught him, "be an agenda".

Report on "Whole Systems" Ayurveda and Diabetes Care*

This study, led by Charles Elder, MD, MPH, FACP, was undertaken with patients at HMO Kaiser Permanente Northwest, lays out the challenges and rationale for engaging "whole systems" or "whole practice" research.(2) They researchers state:
"Single-modality studies may not capture the potential synergistic or additive effects of a multi-modality program. Complementary medical systems also may offer alternative paradigms that could lend fresh insight into the etiology and management of the spiraling diabetes epidemic. CAM proponents maintain that holistic interventions offer non-specific quality of life benefits that are difficult to measure and often overlooked. Whole-systems research is an evolving discipline that seeks to rigorously evaluate complex multi-modality CAM interventions as they are authentically practiced."
Staff-model HMO - source of patients in the Ayurdeda study
The study, funded by the NIH National Center for Complementary and Integrative Medicine, involved 60 patents (92% completed) and ran 6 months. The control involved a diabetes education class, used a combination of an herbal preparation, dietary adjustment, transcendental meditation and "daily routine and exercise." The "whole" outcomes included:

  • subjective improvements in general health and "overall well-being"
  • no statistically significant differences on the clinical outcomes, though "trends favored the Ayurvedic group"
  • outcomes were best among those with greater severity of their condition
  • members of the control had higher incidence of adding new pharmaceuticals and or strengthening the pharmaceuticals in their regimes
  • no study-related adverse events.

The researchers conclude that this phase II study succeeded in establishing a good design for a larger, phase III study. They note the paradox of outcomes of the whole practice/system study. These do not allow for "ascertaining which element or elements of a multi-modality protocol may contribute to a given outcome." But then they add, returning to the theme of "authenticity":
"On the other hand, because Ayurveda is actually practiced using a multi-modality paradigm, with the various modalities presumed working in synergy, the entire program's effectiveness remains the clinically relevant issue."
The study was funded through a grant (R21 AT 01324) from NIH NCCAM.

Jeffrey Blumberg, Tufts Researcher, on the State of Nutrition Research and Practice

Tufts University Friedman School of Nutrition Science and Policy researcher and educator Jeffrey Blumberg, PhD, FACN, honors a teacher who taught him early that nutrition is "not just a science, but an agenda." Blumberg, also
associated with the Rosenthal Center for Complementary and Alternative Medicine at Columbia University, states: "Our program was not just academic but had to address much larger problems."

Yet, despite his early grasp of the importance of agenda, Blumberg's
responses to pointed questions in the interview with Frank Lampe and Suzanne Snyder on agenda-related questions reveal how impotent, yet, we've been on the
"Nutrition is not
just a science,
but an agenda.

"Our program
was not just
academic but
to address

critical issues. He speaks on and acknowledges:

  • the continuing dismal state of nutrition education in conventional medicine
  • the way researchers "readily embrace supplements as a research tool" rather than whole foods and diets, even if the agenda value (changing human health) is in the latter (and  knowing that supplement administration, in the whole practice of integrated care, is typically in the context of recommendations of dietary changes)
  • the way that, even following positive studies, "there seems to be reluctance to adapt the actual evidence to practice"
  • how practice and payment processes harm our outcomes since even those who value nutrition feel they "simply do not have the time to assess each patient's dietary pattern and nutritional status."
  • the "false promise" that, if we hold out for "a single gold standard" on nutrition trials that "all the necessary trials will be done in our lifetime or even in our grandchildren's lifetimes."

Blumberg notes that "there are very few large-scale studies underway and "very few planned for the future."

ATHM editor-in-chief Mark Hyman, MD
The ATHM issue leads with an editorial from editor in chief Mark Hyman, MD. He uses the world-wide explosion of diabetes to make the case for shifting primary care toward a whole practice which seeks to - as classic natural healing puts it - remove the obstacles to cure and then aide and abet the body's healing abilities. The approach recognizes diverse contributions to disease - which in turn suggest a multi-modality response. We are talking Agenda with a capital "A" here, spinning the paradigm on its head.

The Ayurvedic exploration exemplifies the approach Hyman recommends.
If our attention to results are also "diverse" and "multiple," we see good directions on various indicators: quality of life, less use of conventional pharmacy, and some positive indications on the reductive measures.

If we view these outcomes from an agenda perspective, we might add the following potential outcomes in the treatment group:

  • suggestion of lower cost of conventional pharmacy
  • potentially lower adverse effects, over time, if the pattern of fewer pharmaceuticals continues
  • potentially lower costs, over time, from fewer additional complications associated with  associated with the emergent pattern of higher pharmacy
  • potentially the benefits of new patterns of behavior, of eating, of exercise, of thought, spreading to influence other areas of morbidity
  • potentially higher productivity and diminished absenteeism from the qualiy of life changes
  • potentially broader positive side-effects of these patients spreading their new habits and learnings to their friends and colleagues through the examples they set.

Publisher of ATHM
In this light, with these potential benefits, the practice Hyman describes becomes a kind of clinical-public health, with value that reaches to communities. Ask an employer if these cost and quality of life outcomes may be meanignful?

Blumberg's perspectives on nutrition, alone, underscore how much pushing whole practice research models must not just be left to the researchers, but also extend to educators and policy makers. What CAM or IM discipline has issued a position paper on this topic? What group has promoting funding for this kind of research as part of its agenda? To what extent have we stood up for the "authenticity" of what people need against the reduction of what works, most easily, for a reductive researcher?

What we are about here, of course, is not just science but also an agenda.

(*) Researchers debate the use of the terms "whole systems" and "whole practice." Elder and his group prefer "systems." I prefer "practice" which I typically use.  From the perspective of a conventional, reductive researcher, focusing on these distinctions, as my earthy father would have said, "is to separate fly-shit from pepper."
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