In June 2016, Aging published an updated version of a 2014 study of a systemic integrative medicine protocol for 10 patients with Alzheimer’s.1 The research was based on a strategy developed by Dale Bredesen, md , at the University of California, Los Angeles school of medicine that he calls Metabolic Enhancement for NeuroDegeneration (MEND). Of 10 patients with either “well-defined mild cognitive impairment, subjective cognitive impairment, or frank Alzheimer’s disease diagnosis” prior to beginning the program, 9 improved. Some were able to go back to work. Others regained mathematic skills. Science Alert published an article on the outcomes, with a headline that shouted, “Small Trial Shows Memory Loss From Alzheimer’s Disease Can Be Reversed.”2 The MEND protocol, described in the study, includes more than 2 dozen interventions. Among the most significant, in Bredesen’s view, are a requirement to fast at least 3 hours before sleep and at least 12 hours between evening and morning meals. A gluten-free diet, yoga, or another form of mindfulness, and a number of natural agents including curcumin, fish oil, vitamin D, and others are also included. Bredesen acknowledges that all patients can’t do everything in the protocol. MEND is being promoted nationally to practitioners, integrative medical centers, and other medical delivery organizations by Muses Labs.
The report in Aging was announced within a week of a related notice that the integrative medicine center at George Washington University (GWU), led by integrative geriatrics specialist Mikhail Kogan, md , has become the first academic medical center to offer the MEND protocol.3 Says Kogan: “I developed a similar program five years ago with similar results. I had some cures. If I hadn’t met [Bredesen] two years ago I would have been developing a program of my own.” Then he adds: “I decided to jump onto the bandwagon since they already have the structure to support patients and families in the program.”4 Kogan, who presently serves along with Kenneth Pelletier, p h d, md (hc), as an adviser to the MEND program, says other academic health centers are presently looking into adding the program to their offerings.
Comment: The protocol and the study itself offer twin beauties for veterans of the movement to advance whole person naturopathic-integrative-functional medicine models. The first is that Bredesen’s approach is a classic everything including the kitchen sink approach to resolving a complex chronic condition. It’s individualized. It varies based on what a given patient can take. It’s got lifestyle interventions plus natural agents, and a complex physiologic rationale. It is, in this way, a pure form of such integrative care.
The second beauty is what drives home the first beauty: the simple reporting design that is in integrity with the practice. The design goes like this: First, comment on the failures or short comings of conventional “monotherapy” treatment. Second, provide a rationale for the whole person approach. Third, describe the protocol. Finally, provide short individual case reports and a table that summarizes each. The beauty is, again, that the reporting model does not require the researchers to engage the contortions of fitting the therapeutic model into a reductive study design. Finally, comment that more research is clearly valuable, on a larger scale. Yet prioritize not the hygiene of the methods but instead reporting outcomes of the complex ambiguities.
Bottom line is that we wouldn’t have this potentially incredibly exciting report—especially to those of us who are reaching a certain age—if we left our research up to reductive models. We have instead the satisfaction of examining what may happen with the application of care following an unadulterated integrative-functional-naturopathic approach. This community should be publishing scores of these exploratory trials, on multiple chronic conditions. For now, it is pleasure to see the unheard of phrase “reversal of Alzheimer’s” via an integrative approach join “reversal of atherosclerosis”—as Dean Ornish, md , showed via his integrative diet, meditation, community, lifestyle strategy more than 2 decades ago.
Comment: An ongoing creative tension in the movement toward integrative care is the town-versus-gown divide. In 2014, former chair of the Academic Consortium for Integrative Medicine and Health Ben Kligler, md, mph, and I wrote a perspective on the varying views of evidence between the 2 communities in “Finding a Common Language: Resolving the Town and Gown Tension in Moving Toward Evidence-Informed Practice.”14 On the one hand, the historic alternative-holistic-functional medicine movement that has advanced in community practices throughout North America. On the other, the integrative medicine and health movement that began in the mid-1990s that is now formally housed inside nearly 70 of the nation’s academic health centers. There is little cross-over. Participants at major functional medicine/restorative medicine/naturopathic medicine conferences rarely attend the major research conference hosted every second year by the academic group.
ShortTakes
▶ After 15 years with the Institute for Functional Medicine (IFM), Laurie Hoffman, mph , is stepping down from her position as chief executive officer (CEO). Hoffman served IFM in multiple positions in a period of significant growth of influence for the organization: as vice chair of the board of directors, consultant, executive management team member, executive director, and, most recently, as CEO.5
▶ The Council of Colleges of Acupuncture and Oriental Medicine led a rapid response to the attack in Orlando by securing 25 000 donated needles to support teams providing acupuncture stress reduction services to those affected.6
▶ A “project collaboration agreement” between the World Health Organization (WHO) and government of India will lead to “benchmarks for training in yoga as well as practice in traditional systems of medicine such as Ayurveda, Unani and Panchakarma.”7
▶ The American Association of Naturopathic Physicians (AANP) has honored Mark Pocan, a Democratic member of Congress from Wisconsin, as their Congressional Champion. Pocan is leading the AANP’s efforts to gain access in the Veterans Health Administration.8
▶ An important, strategically developed systematic review of massage for pain conditions undertaken by the Samueli Institute has positioned the field for Department of Defense coverage of the modality.9
▶ Herbal supplement manufacturer MediHerb reports a study that “identified major shortcomings in the use of DNA barcoding to authenticate botanical materials in finished products.”10 Last year, the New York attorney general Eric Schneiderman stimulated major bad press for the dietary supplement industry when his team used barcoding then reported no evidence of herbs in products of multiple manufacturers.
▶ The step-wise, self-regulatory process of emergence of yoga therapy as a profession over the past decade is shared in this International Association of Yoga Therapist-published review of their self-regulatory work.11
▶ Those interested in understanding the challenges in regular medicine may find of interest this perspective of one of the most progressive voices in regular medicine, former Oregon governor John Kitzhaber, md , who offers 4 “converging forces” in health system change.12
▶ The chiropractic profession, via the Foundation for Chiropractic Progress, has produced a document that makes the case for “Chiropractic—A Safer Strategy Than Opioids.”13
Thus for example, among the more than 800 participants in the May 2016 International Congress for Integrative Medicine and Health were very few integrative, functional, and naturopathic clinicians. The state of the emerging science carried out by a global set of researchers and reported in more than 350 posters and presentations remains largely invisible to the average integrative practitioner. The divide between the two communities is thus reinforced.
It occurred to me that one way to help bridge the distance is to point IMCJ readers toward 2 resources from the May 2016 conference. One is the open-access publication of each of the abstracts from roughly 350 presentations.15 The other is to point readers to the set of webcasts of the keynotes.16 Favorites for me were those from the Dalai Lama’s neuroscience partner, Richard Davidson, p h d , and pain and the brain researcher Lorimer Moseley, p h d . Although all IMCJ readers may not view a journey through the abundance of the abstracts as I do— picture Scrooge McDuck with his hands passing avariciously through mounds of gold—I suspect that most will find the work led by their academic colleagues to be of more than passing interest. Alignment of interest note: I served on the organizing committee for the Congress.
Participants at a June 2016 integrative health and medicine conference in Germany issued the Stuttgart Integrative Health & Medicine Declaration at the conference’s close.17 The Declaration describes global challenges for regular medicine, particularly with the rise of chronic disease. The authors provide an extended definition of integrative medicine referencing “evidence-informed integration of conventional biomedicine with traditional and complementary medicine (T&CM).” The declaration notes that, although more research is needed, “There is growing, and in many cases good, evidence on efficacy, including quality of life, safety and cost-effectiveness of traditional and complementary medicine, integrative health and medicine and the integrative care model.” The declaration concludes with a pledge that urges individuals, professional organizations and government agencies to support the campaign toward the integrative model.
The attendees had some grounds to claim a global reach. The cosponsors were the Academy of Integrative Health and Medicine (AIHM), the Institute for Functional Medicine (IFM), and a German society of anthroposophical medicine. Speakers included the leader of the World Health Organization’s (WHO’s) ongoing effort to better integrate the products, practices, and practitioners of traditional medicine into that organization’s mission of providing primary care for all18 and a leader of the Pan American Health Organization who is similarly taking up the integration charge in the Western hemisphere.19
Work on the Declaration began with AIHM’s mission to go global.20 AIHM’s work has been led by David Riley, md , a former AIHM board member, and Tabatha Parker, nd , the AIHM director of education. To give the declaration visibility, AIHM posted the document at http://www.change.org. i The campaign had more than 2300 supporters at the time of this writing.
Comment: Credit the AIHM and its affiliates for working to weave the integrative and traditional medicine worlds together. Thus far, the 2 have largely existed in a kind of parallel play. Last year, I explored the emerging use of “integrative” in nations more known for their traditional medicine contributions in an open access article entitled “In Name and Concept: The Global Uptake of the Movement for Integrative Medicine and Health.”21 Check out the Declaration. Sign the pledge. Post it. For those interested, the World Congress on Integrative Medicine and Health in Berlin May 3 through 5, 2017, has a traditional medicine focus and will be working on similar themes. It serves the future of the earth to connect the dots, and the lives of all who are working toward a more respectful, multicultural health and medicine.
This column is offered in collaboration with The Integrator Blog News & Reports (http://theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community. For more information on these and other stories, enter keywords from the articles in the site’s search function.
1. Reversal of cognitive decline in Alzheimer’s disease. Aging Web site. [Accessed July 25, 2016]. No author listed. http://www.aging-us.com/papers/v8/n6/pdf/100981.pdf.
2. Small trial shows memory loss from Alzheimer’s disease can be reversed. Science Alert Web site. [Accessed July 25, 2016]. No author listed. http://www.sciencealert.com/small-trial-shows-memory-loss-from-alzheimer-s-disease-can-be-reversed. Published June 20, 2016.
3. George Washington University Offers the MENDTM protocol for Alzheimer’s disease. Muses Labs Web site. [Accessed July 25, 2016]. No author listed. https://museslabs.com/george-washington-university-offers-the-mendtm-protocol-for-alzheimers-disease. Published June 14, 2016.
4. Weeks J. Can the MEND protocol elevate integrative approaches to Alzheimer’s disease? Integrative Practitioner Web site. [Accessed July 25, 2016]. http://www.integrativepractitioner.com/whats-new/news-and-commentary/can-the-mend-protocol-elevate-integrative-approaches-to-alzheimers-disease/. Published July 1, 2016.
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6. Weeks J. Acupuncturists prepare trauma relief treatments for Orlando victims. Integrative Practitioner Web site. [Accessed July 25, 2016]. http://www.integrativepractitioner.com/whats-new/news-and-commentary/acupuncturists-prepare-trauma-relief-treatments-for-orlando-victims/. Published June 16, 2016.
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13. Foundation for Chiropractic Progress. FCP Web site. [Accessed July 25, 2016]. http://www.f4cp.com/f4cp_opioid_white_paper.pdf. Published 2016.
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