The 2017 annual conference for the American Association of Naturopathic Physicians (AANP) was held at the Arizona Biltmore Hotel, July 12-15. Approximately 600 attendees, vendor representatives, and speakers convened for 4 days of learning, networking, and reconnecting with friends and colleagues. More than 50 educational sessions allowed naturopathic doctors to earn as many as 22.75 continuing education credits. The exhibit hall buzzed with chatter, product samples, and conference deals. Cocktail receptions, dinners, and a speakeasy at the Wrigley Mansion offered ample opportunities for participants to socialize and relax.
Tieraona Low Dog, MD, kicked off the conference with an inspirational keynote, discussing the strengths and weaknesses of reductionism and the benefits of a broader, more holistic medical approach. In a similar vain, Mimi Guarneri, MD, later made a case for interprofessional teams from all global healing traditions to deliver true healthcare. John Weeks proposed that the most effective way for naturopathic physicians to advance healthcare is by influencing conventional, integrative, and functional medicine providers and paradigms.
The conference was not only philosophy and inspiration, however. The majority of lectures delivered deep, clinically relevant content. The gut microbiome and gastrointestinal health programs were—strictly by a numerical count—the most popular topics of discussion. Below are some highlights and clinical pearls taken from lectures on these topics as well as others.
Microbiome Content
Nigel Plummer, PhD, comprehensively reviewed the crisis of antibiotic resistance. He discussed the important role probiotics can play in reducing antibiotic resistance, reducing the risk of conditions like obesity and eczema, and even as alternatives to growth-promoting antibiotics in livestock.
Don Brown, ND, reviewed research supporting the indications for probiotics in the pediatric population, including antibiotic-associated diarrhea, infectious diarrhea, functional abdominal pain, functional constipation, and for the risk reduction of atopic dermatitis and upper respiratory tract infections (URIs).
David Brady, ND, presented research detailing the importance of intestinal microflora and probiotics in the management of autoimmune disease. Brady detailed a number of research articles demonstrating altered microflora in patients with autoimmune diseases, including rheumatoid arthritis and ankylosing spondylitis. He also reviewed the concept of molecular mimicry to explain how dysbiosis might contribute to the development or progression of autoimmunity.
Jennifer Ryan, ND, presented research showing that the human milk oligosaccharide, 2’-fucosyllactose (2’-FL), effectively increases butyrate and beneficial microbes, decreases pathogenic bacteria, and improves functional symptoms in patients with gastrointestinal dysfunction.
Gary Weiner, ND, gave a primer on the elemental diet as a treatment strategy for irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and other conditions that relate to gastrointestinal inflammation, microbiome disturbance, and intestinal permeability.
Kara Fitzgerald, ND, (sponsored by Metagenics) presented research in support of Bifidobacterium lactis B-420 as a novel probiotic for body weight regulation.
Microbiologist Kiran Krishnan (sponsored by MegaSporeBiotic) made a case for metabolic endotoxemia as a contributor to most chronic disease. Defined as a condition of subclinical chronic inflammation, endotoxemia results from the passage of bacterial endotoxins, particularly lipopolysaccharide (LPS), into circulation because of dysbiosis, intestinal permeability, and dietary patterns. He referred to research showing that saturated fats, including coconut oil, produce a more significant postprandial endotoxic response than do other oils, such as olive oil or omega-3s. He concluded with recommendations for how to reduce metabolic endotoxemia, including supplementation with probiotic spores; increasing fiber intake; supporting secretory IgA with glutathione, glutamine, glycine, and other nutraceuticals; and boosting mucin production with l-threonine, l-serine, l-proline, and l-cysteine.
Gastrointestinal Health Content
Glen Nagel, ND, touted the ability of herbal bitters to reduce cravings for sugar, alcohol, and overall calories. He recommended that bitters be used as a simple intervention for patients with diseases ranging from obesity to hypothyroid. Nagel proposed that practitioners and patients take a “30-day bitters challenge,” taking some combination of gentian, dandelion, artichoke, hops, or other bitters (10-30 drops before or after meals) for 30 days and assessing health outcomes.
Matthew Marturano, ND, presented a comprehensive approach to treating functional gastrointestinal disorders—a method he calls the “COHERENT” method, which he has made available to clinicians on an open-source license. The COHERENT method encompasses interventions that Colonize microbiota, Optimize absorption, Harmonize digestion, Energize metabolism, Realize self-awareness, Equalize terrain, and Tranquilize gut tissue.
Caitlin O’Connor covered assessments and treatments for pediatric functional constipation, including over-the-counter laxatives, suppositories, Lactobacillus casei rhamnosus, glucomannan, fiber, senna, slippery elm powder, prune puree, magnesium, and herbal formulas recommended by Mary Bove, ND. O’Connor also discussed a Traditional Chinese Medicine (TCM) formula called Diju, suggesting a starting dosage of only 3 pellets twice per day for children and never exceeding any more pellets than twice the child’s age.
A representative from the a2 Milk Company presented research showing that milk containing only the a2 beta-casein protein (and not the a1 protein) is well tolerated by patients with lactose intolerance. Conventional milk in the United States contains both the a1 and a2 proteins, and a2 milk is produced only by cows with genes to produce solely a2.
Other Clinical Content
In addition to the discussions of gastrointestinal health and the microbiome, lectures spanned a broad spectrum of topics: women’s health (endometriosis, vaginitis, and HPV); pediatric health (juvenile arthritis, ADHD, and the vaccine-autism controversy); mental health (stress, suicide, Alzheimer’s disease, and psychoneuroimnology); chronic disease (fatty liver, traumatic brain injury, mitochondrial dysfunction, and Lyme disease); emergency medicine; manual manipulation; interpretation of research statistics; prescription medications; botanical medicine; and more. Considering the breadth of this information, it would be impossible to review all of these topics here. Instead, glimpses from 3 excellent talks are summed up here.
Bill Walter, ND, detailed the importance of the diagnosis of pain in determining the best pain medication. He mentioned a study showing that acetaminophen (which is taken by 1 in 4 Americans every week) affects the ability to empathize and regulate prosocial or antisocial behavior, suggesting that prescription patterns may influence broader society.
Joseph Pizzorno, ND, described how to use conventional laboratory tests to evaluate patients for toxicity. White blood cell count, for example, is lower with exposure to polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and benzene; platelet counts drop with chronic exposure to benzene, carbon monoxide, or solvents; and gamma-glutamyl transferase (GGT)—even within the normal reference range—increases in proportion to toxic exposure. Pizzorno recently published a book that delves into this topic: The Toxin Solution.
Krista Anderson-Ross, ND, discussed the benefits of what she referred to as “magical melatonin,” suggesting that an extremely low dose (500 mcg) can be equally effective as more typical doses (3 mg-5 mg) to induce sleep and a good way to reduce the risk of nightmares or morning grogginess. She also mentioned the option of dosing melatonin in an immediate-release form before bed for those who have trouble falling asleep along with a sustained-release form if they also wake during the night. Anderson-Ross suggested that clinicians consider Phenibut at a low dose of 500 mg or less to induce sleep, as this GABA agonist has demonstrated benefit without ill effect in the gray literature.
Summing Up
The 2017 AANP conference was the first to bring the AANP together with the World Naturopathic Federation (WNF) and the Naturopathic Medical Student Association (NMSA). Discussions about global opportunities, residency programs, hospital practice, ethics, and practice management were woven among the many clinical lectures. In the true spirit of all AANP annual conferences, the 2017 conference was marked by 4 days of jovial reunion in the Valley of the Sun.
The 2018 AANP annual conference will be held at the Town and Country Resort in San Diego, California, July 12-14, 2018.
