Emergent versus Traditionalist and Standards of Evidence

The other day I posted an article on one of my facebook pages about the role nutritional deficiencies may play in mental health conditions, such as anxiety and panic attacks. A lady commented on the post who brought up some valid concerns about the tone of the article being potentially misleading for the general public as to clinical best practices regarding the incorporation of nutritional supplementation with medical intervention. She questioned the validity of the research article, which she had a right to do, but it brought up for me the often confused differences between researchers, especially those in medical fields where clinical best practice guidelines are based on 20 to 30 years of solid gold standard research, versus the quality of evidence found for researchers in emerging fields, such as rehabilitative science (in which I’m currently finishing my masters), or what the world of epigenetics was when I did my undergrad in molecular biology (we still used coffee filters and paper clips for our DNA extractions, and yes I’m a lot older than I look…)

Since this is a common point of misunderstanding for a lot of people in the traditional medical world, I felt it necessary to write a blog post of the difference between the standards of evidence in both cases to help educate the public so that those concerns may begin to be addressed for anyone reading future social media posts by me. I often assume that we are all working from a similar context, and that’s not always the case. 

So, what are the differences and how can the general public tell when they should be incorporating alternative therapies or lifestyle changes into their routines based on the information they are reading online? 

First off – in no way am I advocating not using medication, should that be required. I believe wholeheartedly in modern medicine. I just also believe that all advances in best clinical practice have to begin somewhere. And in the world of rehabilitative science, the interplay of the effects of the microbiome and gut health on mental health, the integration of alternative medicine and traditional medicine best practices, etc., there isn’t always a lot to go on, research-wise. So best clinical-practice is a much more fluid process than it is in fields such as traditional medicine, where, again, there is typically a larger base of well-done, peer-reviewed, meta-analysis of meta-analyses done over many, many years to determine how much of what you should take when for what results. So typically this is where the emerging fields tend to butt heads with the traditional fields. Traditionalists need that solid evidence. Emergents tend to find some interesting studies, think ‘hey – that’s neat. I wonder if it’s replicatable?’ and off they go from there. Emergents are interested in furthering the body of scientific evidence on a topic of interest where there isn’t much research already done. Traditionalists are concerned with implementing best practices based on the mountains of evidence collected over years by emergents. So the two are very linked – you can’t have one without the other – and yet the traditionalists often go to ‘there isn’t enough evidence to make a best clinical practice from this’. Yes. Correct. But that’s what emergent science is for. And that’s a fundamental key to understanding those conversations, when they occur. It’s also fundamental for your own understanding when reading articles as to whether or not you should be bringing that information to your practitioner or incorporating what you’ve read into your daily habits. It’s also important for anyone in the emergent fields to understand that you can’t claim that an intervention that has a few research studies is the same as one that is backed by years of research. Which is often where some of the disagreements lie. But when you have a patient with a sprained knee who wants to use arnica cream and asks you whether or not it’s a good idea, you can at least have the discussion from a, ‘there are a few studies that suggest it might be beneficial. It’s not harmful so you can try it and see if it helps. However, that said, here are some things you might want to watch out for and should any of them occur than stop using it and see your doctor. Your pharmacist might be a good source of information on this, if you’re interested in more information’ standpoint. 

I think a lot of the conflict from traditionalists comes from a concept of ‘either/or’, such as, “either we give you traditional medical treatment OR we do an alternative one instead’. But that’s not what I’m advocating. I advocate, ‘okay, how do we incorporate other factors, like nutrition and lifestyle changes, into your daily habits to optimize the medical treatments that you are receiving for this condition?’ I’m not saying that going against traditional practices is a good idea. I believe in combined approaches – for example, an often useful kind of research practice when it comes to alternative therapies is to use two groups of people in your study – those receiving the gold standard medical treatment alone, and those receiving the gold standard medical treatment combined with the new intervention or treatment that you’re studying. This way, everyone gets the same base level of care, and if the intervention improves that care, then it might be worth conducting further research to better understand the mechanisms behind why it works and better characterize how best to use it for optimal results. I like to think of it as ‘how do we optimize the treatment you are already receiving?’ 

Another important thing to note is that there are adverse events that can occur when incorporating new therapies, treatments, or even diet and lifestyle changes into your life. This is why integrative medicine is so very important. It’s important to have that traditional medicine oversight to ensure that the alternative medicine therapies are actually benefiting YOU as a person. Without that piece, it’s kind of a no man’s land that a patient is left to navigate alone. So working with a team of professionals – both traditional and alternative - who collaborate to get you to your best healthy state is the safest option for incorporating the emergent therapies into your life. 

So how can you tell the difference between research used to generate discussion and further exploration into an emerging field of study, versus a well-characterized field of study that has enough research conducted to be able to make solid clinical best practice guidelines? Well, unfortunately, you have to do your homework. And our commentor highlighted how to do this very well. Check the sources of the information. Is it reputable? How many studies have been done on this? Are they from creditable universities or hospitals? 

The interesting thing about the transition from emergent fields into traditional fields is that you can watch the progress over time, if you’re paying attention. And this is often where I forget that people online don’t know me so don’t understand that I do this. Research has to start somewhere. And usually that’s in less reputable places. It usually starts with one person in some University somewhere who thinks ‘here, this might be interesting to try…’ That may or may not get published, but it usually inspires someone to take that concept and try something else with it. That becomes another experiment. Which again, may or may not get published. But now other people have become involved, and so that idea grows, and depending on the results of the experiment, may be getting a bit of backing from department heads. More research happens, maybe a few papers get published by a master’s student. Now that research area is out into a larger audience of people. Someone in another country might find it interesting and try a variation of it. That might get published. Now we have an accumulating body of evidence. That sparks more people’s interest. If the results are intriguing enough, it will spark a lot more people’s interest – either to refute or validate the claims. This is where the scientific debate begins. What even IS this thing we’re studying? Well, it is this under these conditions, but not under these conditions. But can you really trust the results from that one because the way they designed this experiment it’s not really showing that the result is only from that thing, it could have been from these 3 other things. We should make 3 more experiments to test THAT out. And on and on it goes until, 20 to 30 years later we can DEFINITELY say that this thing is THIS and NOT that under these specific conditions. So, now that we know that information, how do we use it to make a policy on how we treat patients who come in with this specific condition to make their lives better? Best Clinical Practice Guidelines. 

That is my summary of the scientific process as it pertains to health related disciplines. You can see how somewhere in that ‘scientific debate’ stage that you will start to have a pretty good indication that something is happening here that deserves further research, versus we know that this thing is at least helpful and not harmful so it’s safe to try, but we’re not exactly sure under what specific conditions yet it’s the most benefical, versus we have years of data to say that this thing is the most beneficial under these specific conditions so you should definitely do it this way only every time. 

So… that. I should come up with a colour coding system or something for my social media posts that can organize my posts into one of those categories… That would probably help limit the confusion… 

Stay tuned for that!  And thank you so very much to the commentor who sparked my interest in writing this post! This was so much fun! 

Till next time, Folks!

Slowing Life Down When Recovering From Illness or Injury

If you’re at all like me, getting sick for a week is a bit like being in a coma for a year. Being sick or injured in a way that means you’re down for weeks, if not months? Unimaginable for most people. I think we all live with this vague concept that it could happen to us somewhere in the backs of our minds. But when it happens, we’re very rarely prepared for it. 

I’ll admit, I’m not very good at slowing down. I have so many passion projects on the go at any given time that not working on them feels… weird. But I also know that rest is important. So, how do you slow back down to allow yourself time to recover when life decides for you that you need it? 

Ask for help - From delegating tasks you can’t do right now, to making sure you find the proper therapists and practitioners to help with your rehabilitation, get vocal about what you need help with. Let other people carry some of the weight for a while. 

Triage - Illness and Injury have this great way of helping us figure out what’s actually important to us. It can also be a great catalyst for learning to delegate. You can come up with lots of creative solutions for getting work done by farming it out to willing volunteers. The stuff you refuse to hand over? Those are the things you likely love more than anything. Feel free to keep those. 

Experiment - There are always multiple ways to get anything done. Can’t run anymore? Can you swim instead? Bike? Yoga? Maybe high-intensity exercise isn’t what you need right now. Maybe bowling and painting classes are the things you’ll fall in love with next. Point is, using this opportunity to explore your options means giving yourself the chance to discover all kinds of new things that fit who you are now. And that might just mean sofa and netflix for the next little while, but have you binge-watched the OA yet? If not, go do it now. 

Mourn - Don’t forget to throw yourself a pity party for a day or two. Totally allowed. Life handed you a rough go of things. You’ll have some emotions about that. Not processing those emotions will just backfire in the long run. So how can you make your pity party the most loving, supportive pity party ever? I mean, just cause you’ve got to feel sad for yourself doesn’t mean it can’t be fun to do. 

Learn from it - Illness and injuries are great barometers that something in our lives just isn’t working for us. So going right back to the same workload and stress levels that led to this event are just asking for a repeat of it. Use the downtime to really think about how you want to reconfigure your life so that, when you return to it, you can better manage the stress. Have you been neglecting self-care? Maybe it’s time to re-instate that meditation practice and get back to eating healthier. Taking on too much? What are the things you delegated that you are least looking forward to taking back? How can you get rid of those things for good? 

Slowing down doesn’t mean giving up. It means getting to let go of the things in your life you don’t really love so you can focus only on the things that bring you the most joy. Take the Universe’s handily crafted excuse for getting out of whatever doesn’t fill your heart with glee anymore and move on to the things that do. 

Medical ‘Health’ Versus ‘Optimal Wellness’

What do you call ‘alternative medicine’ that actually works? ‘Medicine’ - Bill Nye

This is a tricky time to be in health and wellness. You’ve got the ‘conventional medicine’ guys who are working from a frame of reference of the ‘minimum requirements to keep you alive’ or ‘what does or does not kill you’. That is a very different set of standards than ‘what requirements do you need for optimal health?’ Plus, you have a lot of quackery and disingenuous people selling a lot of garbage, which tends to mean everyone in the health and wellness field gets painted with the same ‘quackery’ brush. 

Wellness care has very different requirements than conventional healthcare, and the lack of general consensus of terms has led to a lot of misrepresentation, miscommunication and just general misunderstanding on both sides of the fence. Conventional medicine doctors look at alternative and complementary medicine as quackery, but a lot of those treatments are not nor should ever be used as a treatment for illness care but rather as a complement to conventional medicine during rehabilitation and recovery or as a means of maintaining a standard of health or achieving an optimal state of wellness. Often a lot of the research gets misrepresented or overstated in terms of conventional medicine. A claim of milk thistle, for example, which supports liver functioning, does not mean that milk thistle can cure liver disease. But there is evidence to suggest that it can provide the liver with things it needs to function at a more optimal level. Those are two very different extremes. And from a preventative medicine standpoint, an extremely important one. Because a liver that is functioning at an optimal level will have a bigger impact on overall wellness over time than a liver that is only sub-optimally performing. It’s like your car engine and the argument between the most and least expensive versions of fuel. Using the more expensive one means less impurities in the gasoline, less gunk builds up on your engine over time, and so the parts last longer. The same thing happens in the body. A liver or a kidney only partly functioning means certain metabolites build up in the body. That’s why we have medications and dialysis in the first place. But your conventional medicine doctor is looking at it from the perspective of what will kill you in the shortest amount of time, and your integrative or preventative medicine doctor is looking at it from a ‘how do we get the most mileage and the least amount of build up over the longest term’ stand point. And here’s the thing about this entire argument that drives me absolute nuts - BOTH ARE INCREDIBLY IMPORTANT AND CORRECT!! You’re both right. Both sides are arguing true things. Which one is more important depends on the patient you have in front of you. Which one does THAT patient need?

And this is why researching these types of therapies is often difficult. Because the gold standard of medical research is based on the effectiveness of a treatment against a particular illness or condition. But complementary and alternative medicine (CAM) therapies and treatments are often working within a healthy state to improve that healthy state. It’s a much narrower threshold between healthy and optimally healthy than between healthy and disease. But if we are moving into a more preventative health care framework, the difference between healthy and optimally healthy is a very important one. And there is a lot of real and genuine research that has to be done so that proper guidelines and practices are put in place to protect the public and to prove the effectiveness of treatments and therapies and to determine which ones work best for maintaining which healthy states. 

And conventional medicine needs to keep right on being its awesome, kickass, save the day self. Because we need it to. This shouldn’t be a fight against each other. We’re on the same team!! Both sides should be working together for the best outcomes for the patients. Because we are all going to get to sick and/or injured. And I want my emergency room doctor to know how to set a bone and prevent infection and blood clots and all of those horrible, life threatening things that will keep me alive. And then I want to be able to go to my integrative medicine doctor for my ‘return to optimal wellness’ plan so I can recover from that injury or illness and return to my best healthy state as fast as possible. What we’re lacking is an organized system on the ‘wellness’ side that’s as established and structured as conventional medicine already is. We’re not competing with it. It will always be necessary. But we are not at all talking about the same type of healthcare. It’s not even the same as comparing orthopedic surgery to cardiovascular surgery. Because both of those are surgeries and should only be required because ‘health’ has been compromised. ‘Wellness Care’, and establishing best practices and requirements and guidelines around it is something that has to be accomplished. Because otherwise, we leave it up to the quacks and the charlatans who promise pie in the sky treatments that make people sick or take their money. And so dismissing ‘sound therapy’ or crystal healing or magnets or any of the many other modalities as having ‘no effect’ is ill-conceived. They actually have demonstrable physiological effects. Whether or not those effects contribute to wellness or not, and for which specific kinds of ‘healthy state’ conditions they may or may not impact is all research that needs to be done in structured and well-designed ways with well-defined criteria and terms, etc etc. Because the daily minimum requirements of vitamins and nutrients is a very different threshold than the optimal daily requirements for optimal health. So, how about we quit slinging mud at each other, realize we’re all talking about two very separate things, and agree that we’re all equally awesome. We work together. Hence, complementary. No one’s saying dogwood cures cancer or anything… oh, wait… Okay, hang on, bad example. White willow bark isn’t useful… Nope, not that one either. Poppies! Nope. Wait… opium became heroin became morphine became fentanyl… Marijua…. wait. Nope. Penicillin! Crap, hang on, now I’ve reversed it. That was bread mold…

I’m going to get back to you on this… I forgot that everything is synthesized from something, and a lot of the conventional medicine drugs we use today came from isolations and derivatives of plants and other naturally occurring things. 

That sounds bitchy, and I mean it to be. Because we poo poo crystals and yet what electronic device doesn’t rely on them? We say magnets can’t possibly have an effect on our knee pain and yet we have a lot of very specific MRI imaging that says that magnets actually have a very useful and important physiological effect on the body. So what you mean is that the studies that have been done to date on magnets and pain have been inconclusive so far. But what are the criteria you’re using to judge effectiveness? Because I know of some anterior cervical spine surgeries that have an 11% effectiveness outcome that are routinely used despite a much higher incidence of poor post-surgical outcomes. But lets all jump on the magnet knee brace. At least those magnets, at worst, won’t do anything for your knee pain. They won’t give you liver failure or renal failure or bowel obstruction, etc etc. And sure, it's entirely possible that someone’s bilking someone out of their money here. I’m in no way saying that we don’t need to come up with regulations and requirements. We do. But by NOT doing the research we aren’t doing anyone any favours. Someone has to be doing the work that these things don’t have an effect. Just to prove it. Because again, we know that magnetic fields and radio waves have a very measurable and demonstrable effect on our physiology. There’s a reason patients have muscles contractions in those MRI machines if the field strength gets too high. Now, granted, we can get into a discussion on ‘minimally effective and safe dosaging’ here, but I’ve got posts on that elsewhere. After all, anything can be a poison, it's a question of concentration. But just because we haven’t figured out a way to measure something yet doesn’t mean the effect isn’t there. Why do we have science at all if we already know everything? And just because it comes to the human body suddenly all the rules change? We segment the study of the human body into so many different disciplines that we forget we aren’t all talking about the same thing and we forget to take into account the frame of reference for the information. 

I’m all for discussion and open dialogue. I just don’t like all the name calling and egocentric behaviour. We call something ‘mindfulness’ and suddenly it's a medical therapy and acceptable, but someone else calls it ‘ascension processing through the 4th light ray’ and now it's quackery. The effect it has on the physiology of the patient, from the wellness side of the discussion, is determined by the beliefs of the patient, how well they feel like their beliefs are being represented by the provider of care, etc etc. So to dismiss that person’s beliefs, or to have it performed by someone ‘less woo woo’ would impact the strength of the physiological response. And on the wellness care side of things, you actually need that. From a healthcare side of the fence, I totally get your argument and agree. But the thing that’s going to determine which practitioner is effective for that patient is which one creates the bigger response for the patient. You can’t have a woo woo person go to a hardcore medical doctor. It’s the same effect as the nocebo effect. It will cause more anxiety and more symptoms because of it. They can better relax and activate their parasympathetic response with a shaman, or a reiki practitioner, or an energy healer. And we cannot say that that practitioner isn’t creating a valid physiological response for that patient. Because they are. What we need to do is to help develop guidelines and diagnostics to better be able to predict which practitioners work best for which patients and which conditions so we can send the right patients with the right types of complaints that can be helped by those therapies than just write the whole thing off altogether. Because it’s about the experience of the patient that matters in that case. 

And yes, I’m aware that there is some logic here that my argument suggests that all of those therapies are utilizing the placebo effect and therefore don’t work. But so too are a lot of things in the peak performance world. Again, peak performance world, anything that enhances the effectiveness of something IS considered a treatment. There’s the ‘Mind Body Connection’ and how to utilize it IS a valid therapy in that instance. Because you’re not dealing with preventing or curing an illness. You’re trying to enhance and optimize your physiological responses. The woo woo crowd are the same. So we have to rethink the way we approach that world if we want to develop ethical standards and guidelines and proper regulations around it to protect the patients. 

The point is many medical advancements that revolutionized ‘medicine’ came from pretty ridiculous origins. I mean, bread mold? Seriously? You want me to take bread mold to fix my infection? That sounds made up. And even Bill Nye, who I love more than anything, just did an experiment on the second episode of his new show on stomach acid that kind of highlights my point. He set up an experiment to highlight that sometimes ‘natural supplements’ are ineffective utilizing an acid base experiment. He used acid to simulate overactive stomach acid and then neutralized it with milk of magnesia. And then used the ‘organic remedy’ for upset stomachs that didn’t neutralize it because it contained vinegar. Which, yes, okay, but the claim of the supplement was not that it was an antacid. It was ‘for upset stomachs’. And often an ‘upset stomach’ results from a lack of stomach acid causing a lack of digestion of food stuffs, which in turn begin to ferment, causing the ‘upset stomach’ symptoms, in which case the organic remedy would be the better choice and not the milk of magnesia, which would exacerbate the symptoms. Which only illustrates the fundamental lack of understanding of the physiological causes of the presentation of various symptomology and why we need better guidelines around the uses and treatments of various things. And just better education. 

Just because something is labelled ‘organic and natural’ does not mean it is ‘healthy’. And just because something is is labelled ‘organic and natural’ does not mean it is ineffective. But understanding when to use vinegar and when to use milk of magnesia when you have an upset stomach comes down to whether or not you understand what might be causing your symptoms and how to tell the difference. In which case - performing the correct diagnostics is the key (the burp test in this case). The same goes for his experiment with the magnets. I agree that they don’t affect the iron in blood, and therefore likely have little if any effect on blood flow through action on the iron in the blood. However, we know that patients can experience muscle contractions and nerve activation from the magnetic fields of MRI machines, which means that magnetic fields CAN impact the physiology. Does that mean that magnets on knee braces work? I have no idea. At the very least if the brace claims to help by improving circulation by affecting the iron in the blood, then likely that is a false claim, but they may impact circulation based on the affect of stimulating vasomotion of capillary beds through neuronal activation, but I’d have to look at the research on that. Regardless, it highlights my point that we need more rigorous testing of the claims and some guidelines around them. But to poo poo them outright is as misguided as saying that bread mould as a treatment of bacterial infection is ludicrous. Because yup, it very well could be. But under the proper circumstances, as crazy as it sounds, it is also true. And thankfully, science was there to be non-judgemental and open minded enough to figure out what those conditions might be and then design a treatment protocol around them. 

Time and time again history has shown us that the people who wind up making huge impacts on science are ridiculed and harassed and ostracized and then, eventually, shown to be correct. Why can’t we learn from our own experiences and stop picking on people for their curiosity? I’m not saying we shouldn’t be rigorous and have standards. Discussion and disagreement are how sound theories are eventually agreed upon. But why do we have to ridicule and belittle others for their open-mindedness? Being a skeptic is healthy and great. And doing an experiment that shows what something isn’t is just as important as showing what it is. And Bill Nye, by highlighting what happens when we fail to understand the concepts behind something enough to design proper experimental conditions can be just as misleading as the ‘false claims’ he was trying to show. The public doesn’t know that his premise was flawed. What his experiment with the stomach acid showed was that using vinegar when stomach acid is too high will not result in neutralization. Which is helpful. But his study design failed to prove his premise that organic natural products are ineffective. It was just as flawed as the science he was trying to debunk. Which kind of just exacerbates the problems of flawed science…

Okay, I think I’m done ranting now. 

Til next time, folks!

What’s Your Version of Optimal Wellness?

Everyone has a different answer to that question. It’s why I’m asking it. It’s incredibly easy to get bogged down by all of the information out there about what your healthiest state should look like - six pack abs, able to run a marathon, eating only lettuce or ketowhatsitcalled? And I think that scares a lot of people off. If they can’t go whole hog with it, why even bother? 

But your version of optimal wellness doesn’t have to look like anyone else’s. It certainly doesn’t have to look like that. You don’t have to radically alter your diet or spend hours at the gym. Maybe you’re perfectly content just as you are and just want some tips on how to stay that way as you get older. And that’s completely fine and awesome. You do you. I’m just here to help you figure out what, exactly, that looks like and how to get there. 

The important thing is that you start. That’s it. Just start somewhere. Anywhere. Don’t much care where. Just pick a place. Getting healthy is kind of like cleaning out the shed - you just take it one piece at a time and eventually you look back and it’s done. So maybe you decide to start drinking a little extra water. Maybe you switch out your usual side of fries for a salad a couple times a week. You hear it over and over that people who make gradual small changes tend to stick with it longer than the folks that go overboard. And it’s usually because the people who go into it all ‘FOOTBALL IS LIFE, B*#CH! WHOORAH!!’ are actually looking for an excuse to fail. “See? I tried. I made a valiant effort. Fitness just doesn’t work for me. I always injure myself, etc etc.” Know why? Because change is scary and hard. We have this idea that if we change, it means we can never eat fast food again. We have to give up everything we know that makes us feel better when we’re stressed out and then what? The interesting part is that when you make the small changes, you’re more likely to stick with it because you’re working with your physiology. 

Let me drop some science on you. 

When you make too many changes at once, health wise, you actually wind up overloading your system. You have to keep in mind that maybe your physiology isn’t used to so much nutrition. Most of us have some underlying nutritional deficiencies. And the influx of nutrients when you make big changes to your diet means that suddenly your body is able to use them. Which means it goes into Repair mode. This means pain and feeling crappy for you because all of that extra metabolic work produces extra metabolic waste. Throw in some improper exercise on top of that, to muscles and tissue that haven’t done that kind of activity in a good long while, and your body goes into crash mode. It’s busy repairing stuff and you’re throwing extra work in on top of that? How do you react to your boss or coworkers when they dump a bunch of work onto your already overloaded plate? Your body does basically the same thing. It goes on strike. 

Small changes built up gradually over time means that you’re working with your physiology. You’re respecting the extra workload it’s under as it works to repair past damage without dumping a bunch of new work on top of it. It’s able to heal AND get stronger and you both benefit from your kind treatment of it. 

So you are officially off the hook, pressure wise. I’m not going to promise you 30 days to fitness or any of that. Unless you’re here for the Peak Performance stuff, in which case, get ready to suffer!! (Kidding…mostly…) But if you’re just here thinking “meh, maybe I should start thinking about my health” or trying to recover from an injury, don’t worry. Expectation free zone. Pressure free health. You go at your pace and make the changes that feel right for you. Individualized wellness, that’s the name of the game. Your healthy state is unique to you. I’m just here to help you figure out what that is. 

Ready to get started…? 

Take your time… No rush at all.