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Advancing the science of natural medicine


Wisdom begins in wonder

–Socrates


Letter from the Director Greetings from the Helfgott Research Institute at the National College of Natural Medicine! Helfgott continues to grow and expand each year, striving to become the premier natural medicine research institute in the United States. Investigators at Helfgott spend a great deal of time in the public eye. Our investigators speak at national and international conferences. We have been interviewed for magazines and books. We have published original research and won awards. We serve on committees at the National Institutes of Health. Our impact in natural medicine continues to grow. As the health of Americans continues to decline, the need for additional approaches to disease is increasingly evident. Our research in Chinese medicine, naturopathic medicine, nutrition, mind-body medicine and other natural therapies demonstrates that there are powerful alternatives for people to achieve wellness. With every study, we at Helfgott hope to provide evidence for how natural therapies can decrease obesity, treat pain, prevent cancer, and help people live healthier lives. We stay ever true to our mission to advance the science of natural medicine. This brochure will introduce you to some of the many things we are doing at Helfgott. We hope you will take some time to find out more about us on our website at www.ncnm.edu/research. Finally, we encourage you to get involved! Participate in a study! Volunteer as a researcher! Donate to research in natural medicine! We value the energy of all those who work with us to make natural medicine research thrive. With gratitude,

Heather Zwickey, PhD Director, Helfgott Research Institute Dean of Research, National College of Natural Medicine

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the Science Helfgott: Advancing of Natural Medicine The Helfgott Research Institute is a nonprofit research institute at National College of Natural Medicine. Helfgott’s mission is to conduct rigorous, high quality, research on the art and science of healing, specifically working to understand natural forms of medicine. Together, scientists and clinicians from the various fields of complementary and alternative medicine apply their expertise to advance the science of natural medicine. Established in June of 2003 at the National College of Natural Medicine (NCNM) with the help of a donation from Don Helfgott, the Helfgott Research Institute has a state-of-the-art basic science laboratory, as well as the resources to carry out clinical research. Research projects at Helfgott include grants funded by the National Institutes of Health, company-sponsored research, pilot studies and student research projects. Helfgott often collaborates on projects with other institutions involved with CAM research, including Oregon Health & Sciences University (OHSU), the Oregon College of Oriental Medicine, University of Western States, the Kaiser Permanente Center for Health Research and the University of Arizona. As the use of natural medicine continues to grow, research on its safety and effectiveness is more important than ever. With natural medicine’s focus on prevention and treating the root cause of disease, it often excels at treating many of today’s most common and difficult diseases, such as type 2 diabetes, heart disease, arthritis, back pain and depression. However, there is a lack of an extensive evidence base behind many natural medicine therapies. Researchers face unique challenges when designing rigorous scientific research

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on natural medicine. While many of these therapies and modalities are ancient, applying a biomedical research perspective to the field is a relatively new undertaking. The challenge is to research the therapies of natural medicine in a way that remains true to how they are actually practiced while maintaining scientific rigor. Natural medicine studies often require innovative research methods. Whole systems approaches to disease, combination effects and therapies with unclear mechanisms do not easily fit into the standard, double-blind, placebo-controlled randomized trial. Nevertheless, research must be done to ensure that patients are receiving safe and effective treatments. Helfgott is also dedicated to providing students and postdoctoral fellows the opportunity to gain clinical research training in a natural medicine institution. Many NCNM students participate in faculty-driven research projects or conduct independent research mentored by faculty sponsors. The goal is to develop the next generation of natural medicine researchers, who are trained as both natural medicine practitioners and scientists. In the short term, we hope that our research will inform clinical practice. In the long term, we hope these studies play a part in transforming our health care system to emphasize prevention, promote health instead of just treating symptoms, and provide cost-effective, safe natural medicine treatment options.

The challenge is to research the therapies of natural medicine in a way that remains true to how they are actually practiced while maintaining scientific rigor.


An Overview of Complementary & Alternative Medicine The definition of complementary & alternative medicine (CAM) is a moving target—it can include any medical system, therapy or substance that is not considered to be part of “conventional” medicine as currently practiced. There is ongoing debate on how to refer to these practices, and how to categorize them. The National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health (NIH), funds major research on CAM and uses the following definitions:

Complementary Medicine Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy (a therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being) to help lessen a patient’s discomfort following surgery.

Alternative Medicine

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.

Integrative Medicine Integrative medicine combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness. It is also called integrated medicine. An approach to medicine that combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness.


Whole Medical Systems Whole medical systems are complete systems of theory and practice. Examples include naturopathic, Chinese, Ayruvedic and homeopathic medicine. These systems are often the traditional medicine that developed within a particular culture. For example, naturopathic medicine has its origins in the medical traditions of Europe and Ayurvedic medicine is the traditional system of medicine in India. These systems typically have a basic structure or philosophy, and a number of various treatments or modalities. Treatments may be used for prevention of disease, to heal illnesses directly, or to stimulate the body’s own healing process. Some systems may seem more familiar, while others have unfamiliar concepts such as the idea of Qi in Chinese medicine or the premise of “like treats like” in homeopathy.

Energy Medicine Energy medicine involves the use of energy fields. These fields may be one of two types—based on either electromagnetic energy or biofields. Electromagnetic-based therapies typically involve the unconventional use of electromagnetic fields generated by specialized equipment. While these therapies may be unconventional, the energy involved is usually measurable. Biofield therapies are said to affect the energy fields around and within the human body. The existence of these fields has not been scientifically proven and these fields are often not measurable, at least not with current technology. The energy fields used in biofield therapies are generated by a human being through thought, touch or other methods that are not yet understood. Examples of biofield therapies include qigong, Reiki and therapeutic touch.

Manipulative and Body-Based Practices Manipulative and body-based practices are primarily known for treating musculoskeletal complaints such as back pain, although they can be used for other conditions. These treatment methods include chiropractic manipulation, massage, and other physical medicine techniques employed in naturopathic and osteopathic medicine.

Mind-Body Medicine Mind-body medicine includes techniques that are designed to enhance the mind’s ability to affect the body and improve health. Some techniques that were considered CAM in the past have become mainstream therapies, such as support groups and cognitive-behavioral therapy. CAM mind-body techniques include meditation, yoga, taiji, qigong and guided imagery.

Biologically-Based Practices Biologically-based practices include the use of herbal medicines, vitamins, dietary supplements, foods and special diets. Herbal medicine (also called botanical medicine) uses one or more plants or plant parts for their healing properties, without isolating the chemical components of the plant. “Dietary supplement” is a catch-all phrase for substances that are not an herb, food, drug or vitamin—such as probiotics or fish oil. As the use of these various substances and practices continues to grow, so does the importance of research to ensure their safety and effectiveness. www.ncnm.edu/research | 7


Areas of Research at Helfgott Natural Therapies & the Immune System With a state-of-the-art research laboratory, Helfgott is wellequipped to study natural therapies and their effect on the immune system. To date, investigators have looked at the immunological effects of a range of botanicals, vitamins and naturopathic therapies. Highlights of this research include studies on Vitamin A, an Ayurvedic herb called Ashwagandha (Withania somnifera), a combination of purported immuneenhancing herbs including Echinacea purpurea, Astragalus membranaceus, and Glycyrrhiza glabra, and the effects of hydrotherapy, the application of alternating hot and cold temperatures to the skin.

Cancer Cancer development and prognosis can be strongly influenced by nutrition, lifestyle and the environment. Investigators at Helfgott seek to develop innovative, holistic and effective strategies to address cancer prevention and treatment. In addition to investigating immune-enhancing botanicals and therapies, Helfgott also researches the effects of nutritional and mind-body therapies in relation to cancer. Studies in this area include the effect of cruciferous vegetables on estrogen metabolism and the use of relaxation and visualization therapy for breast cancer patients.

Psychophysiology Lab

Helfgott investigators and students are committed to researching natural approaches to women’s health issues. Projects include an investigation into an all-natural spermicide, a study on the herb Vitex agnus castus to treat female infertility, and a project on the effects of a strontium supplement on bone health. In addition, Helfgott postdoctoral fellows Carolyn Iacullo, ND, and Jill Edwards, ND, are launching a practice-based research network for naturopathic midwives. Women use natural medicine treatments more frequently than men and Helfgott researchers are working to expand the evidence base on these treatments to ensure that they are safe and effective.

The psychophysiology lab at Helfgott was established to study subtle physiologic changes that occur in response to a variety of natural medicine treatments. Helfgott researchers are able to measure heart rate variability, respiration rate, skin temperature, blood pressure, brain waves and other vital functions. Helfgott Senior Investigator Agatha Colbert, MD, and her team are looking to see if these objective outcome measures correlate with people’s subjective reports of improvement as indicators of response to meditation, neurofeedback, acupuncture, massage and other therapies. Current and past projects include evaluating neurofeedback for insomnia, determining the effects of meditation on heart rate variability and developing an instrument to measure skin impedance at various acupuncture and non-acupuncture points on the body.

Nutrition & Diabetes

Social Medicine

Chronic disease, including diabetes and cardiovascular disease, is on the rise in the U.S., but effective ways to reverse this trend remain elusive. At Helfgott, studying nutritional and mind-body approaches to chronic illness is a strong focus of our research. Helfgott studies have looked at about the efficacy of weight loss methods and the expectancy effects associated with these methods. In addition, Helfgott investigators study a range of diets to determine possible effects on the cellular level and in clinical applications. These nutritional studies include investigations into effects of detoxification diets, cruciferous vegetable supplements and the naturopathic anti-inflammatory Diet’s effects on immune parameters in diabetics and pre-diabetics.

Several studies are under way at Helfgott to examine the cultural, societal, economic and environmental factors that play a role in health. Helfgott investigator Kim Tippens, ND, MSAOM, specializes in this area. She is focused on research to understand barriers to health care access and the establishment of accessible and effective preventive care for diverse communities. One of Dr. Tippens’ projects looks at community acupuncture clinics—a recent innovation designed to provide low-cost, acupuncture treatment in a group setting. Another study aims to determine the best integrative medical practices for diabetes care by understanding how different medical practices approach diabetes treatment.

Women’s Health

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Investigators at Helfgott seek to develop innovative, holistic and effective strategies to address cancer prevention and treatment.

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Recent Studies The First Whole Systems Trial of Chinese and Naturopathic Medicine A recent study broke new ground as the first study of whole systems of complementary and alternative medicine to be funded by the National Institutes of Health. The study evaluated the use of naturopathic medicine and Traditional Chinese Medicine for the chronic jaw pain known as temporomandibular joint dysfunction (TMD)—a common condition that affects up to one third of adults. Whole systems research is distinct from most research in that it examines an entire system of care, rather than one specific treatment. Naturopathic medicine and Traditional Chinese Medicine are both examples of whole medical systems that utilize multiple methods and modalities in their approach to treating patients. Due to the variation and complexity of whole systems treatment approaches, research of this type is only just beginning. It is challenging to design research that is both faithful to the practice of the medicine in terms of tailoring treatment to the individual, while still being scientifically rigorous and reproducible. This study sought to overcome these challenges and develop methods for studying these complex systems. Multiple institutions were involved with the design and execution including the Helfgott Research Institute, Oregon College of Oriental Medicine, Kaiser Permanente Northwest and the University of Arizona. The study involved 160 women who had been referred for TMD treatment. Participants were randomly assigned to one Helfgott Research Institute | 10

of three treatment groups—Traditional Chinese Medicine, naturopathic medicine or specialty care. Participants in the Chinese medicine group received acupuncture, herbs, tuina (Chinese bodywork) and listened to relaxation tapes. The naturopathic medicine group received nutritional supplements, physical medicine (bodywork), exercise recommendations and individualized nutritional and stress reduction recommendations. The specialty care group received treatment from two dentists specializing in TMD, including bite splints, education on the cause and available treatments, and individual counseling about self-care and pain management strategies. Referrals for physical therapy and counseling were also available. Results from the study showed that both Chinese and naturopathic medicine provided participants significantly more relief from their worst pain than specialty care. Chinese and naturopathic medicine were similar in their effectiveness for severe pain. This was the first published study of individualized naturopathic and Chinese medicine practiced much as they would be in the real world. The results of this study suggest that naturopathic and Chinese medicine may be more effective than specialty dental care for TMD. This study also demonstrates that whole systems research is feasible and has great potential for understanding complementary and alternative medical systems and identifying effective treatments.


Examining Skin Resistance at Acupuncture Points How does acupuncture work? The basic nature of acupuncture meridians and points remains a mystery despite numerous studies and the popularity of acupuncture as a treatment method. The meridians and points have not been associated with any known anatomic or physiologic systems, but many believe that they are electrically different from the surrounding areas. Studies on this are limited in number and have conflicting results. The Helfgott Research Institute, in collaboration with Miridia Technology Inc., recently developed a prototype system to investigate the electric nature of the points.

use screening tools based on this concept for point location and diagnosis. Many believe that the skin resistance at acupuncture points will vary depending on the patient’s health and that acupuncture treatments will normalize resistance at the points.

It has been theorized that acupuncture points have lower electrical skin resistance than non-acupuncture points. Electrical skin resistance refers to how easily electricity flows through the skin and underlying tissue. Some acupuncturists

Using the Octopus, researchers at Helfgott hope to learn more about the nature of acupuncture points, their electrical properties and how they differ from surrounding nonacupuncture points.

The system developed by Helfgott and its collaborators is an automated, eight-channel system nicknamed the Octopus. Most devices built to measure skin resistance take just one measurement, but the Octopus takes continuous measurements over time.

The Anti-Inflammatory Diet Specialized diets and dietary recommendations are commonly used in complementary and alternative medical practice. Although the relationship between diet and inflammation is of great interest, the science behind it is not well understood. One frequent recommendation to patients is to follow an anti-inflammatory diet. This typically consists of eliminating certain foods such as wheat, dairy, processed sugar and other foods believed to provoke inflammation. Helfgott recently conducted a study to evaluate the effects of an anti-inflammatory diet in diabetic and pre-diabetic individuals. The foods that are excluded or emphasized in an antiinflammatory diet can vary, depending on the practitioner and the condition being treated. In the Helfgott study, foods were excluded either because they may cause an allergic response in susceptible individuals, or because they might contribute to inflammation through metabolic pathways. Other foods were emphasized because they are believed to reduce inflammation, such as foods high in essential fatty acids or anti-oxidants.

enrolled in the study, yet were not taking medication. Individuals taking most medications were not eligible for the study because their medications might mask some of the lab results. Thirty participants were enrolled in the study and 26 completed the full six weeks—a completion rate of 87 percent. The intention of this small preliminary study was not to achieve statistically significant results, but rather to show that conducting this type of dietary research is possible. Recruiting participants for the study was challenging, but those enrolled were able to stick to the diet and enjoyed the food. The results show that this type of study is feasible and that with enough support, individuals can adhere to therapeutic diets. Clinical and biological outcomes from the study will be reported in an upcoming journal article.

During the six-week study, participants were provided with all their food and allowed to consume only items provided by the study. Enrolling participants was challenging, as the schedule required a significant time commitment and individuals had to be willing to adhere to the study diet for the full six weeks. It was also challenging to identify participants who had blood sugar high enough to be www.ncnm.edu/research | 11


Student Research Some students at NCNM seek a career in alternative medicine research, whereas others will do research in their clinical practice. To train these students and provide research experience for those who desire it, the Helfgott Research Institute at NCNM has developed a robust student research program. Students have several options for participating in research. Some students do research as a work-study position and others take research for elective credit. Choice of study design and content is tailored specifically to the student and is in context with Helfgott’s overall mission to understand the art and science behind natural medicine. After participating in the research field under the careful direction of Helfgott investigators and staff, students become better physicians, capable of understanding natural medicine in a modern-day setting.

Independent Study

In the independent study program, students work independently—designing and conducting their own project

or work in a group on a new or already established study. They earn up to two credits per term while working on their own research projects. This is a great opportunity for students interested in developing a research career or applying to a Master of Public Health (MPH) program. Students in the independent study program typically spend two to five hours per week doing research during their first two years, and five to ten hours per week their second two years. This flexible schedule fits easily into the student’s education plan. Students who choose to work in a group setting usually work in teams of six or seven.

Work-Study Positions

Work-study positions provide a flexible option for students who want to gain research experience, or just learn more about the process of research. Work-study students assist with the day-to-day operations of ongoing, funded studies. Work-study spaces are limited and dependent upon eligibility for federal funding.

Group Acupuncture

Immune Herbs Detoxification Diets

Hydrotherapy

Guava

Personality & Health

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Neurofeedback for stress

Blood-Type Diet

Relaxation-Visualization Therapy for Fatigue & Skin Toxicity CoQ10 for Statin-

Psoriasis

Natural Spermicide

Induced Myopathy

Meditation & Heart Rate Variability

Probiotics Botanicals for H. Pylori

Ashwagandha Magnesium


SPARC Symposium for Portland Area Research on Complementary and Alternative Medicine SPARC is Portland’s own symposium for complementary and alternative medicine (CAM) research—a unique environment where researchers, clinicians and students from various backgrounds and disciplines gather to learn about the latest research taking place in our community. Portland has a unique research climate because it is home to a variety of medical schools including naturopathic, Chinese, chiropractic and conventional medicine. This diversity in approaches to medicine, along with a strong core of devoted researchers, make Portland the ideal place to pursue and present CAM research. Studying complementary and alternative medicine presents numerous challenges—especially when it comes to research methodology. The randomized, double-blind, placebocontrolled trial works for testing pharmaceuticals, but often does not work for testing CAM modalities. For example, someone cannot be blinded to receiving a massage; finding an appropriate placebo (sham) for acupuncture is complicated. SPARC provides a forum for researchers to share and address the methodological issues they encounter with their colleagues. Together, researchers, interested clinicians and students from across disciplines offer support and advice from their experiences and work together to move CAM research forward. Research abstracts from local investigators and students are peer-reviewed and accepted for poster or oral presentation. Accepted posters are part of a traveling poster session and are displayed at each participating institutions in the days leading up to the symposium. This allows a wide audience of faculty, students and staff to learn about local CAM research studies, and presents an opportunity for each institution to host their own research festivities. SPARC culminates in a symposium where rigorous, highquality, scientific research is presented on CAM modalities. Topics have included acupuncture, herbal medicine, chiropractic, Ayurveda, Reiki, shamanism and clinical informatics. The studies presented reflect the diversity of the research being conducted in Portland.

Keynote speakers at SPARC are renowned researchers from around the world. Past keynote speakers include: • Iris Bell, PhD, MD Director of Research at the University of Arizona Program in Integrative Medicine • Josephine Briggs, MD Director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health • Daniel Cherkin, PhD & Karen Sherman, PhD, MPH Senior Investigators at the Group Health Research Institute • Vinjar Fønnebø MD, PhD Director of the National Research Center in Complementary and Alternative Medicine (NAFKAM) and professor of preventive medicine at the University of Tromsø, Norway • Leanna Standish, ND, PhD Research professor, Bastyr University, clinical professor at the University of Washington School of Public Health and Affiliate Research Professor at the University of Washington School of Medicine

Participating institutions: • Kaiser Permanente Center for Health Research • National College of Natural Medicine • Oregon College of Oriental Medicine • Oregon Health & Science University • Portland State University • University of Portland • Western States Chiropractic College

Visit www.ncnm.edu/research for conference updates.

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Global Medicine & International Collaborations Helfgott’s mission to advance the science of natural medicine doesn’t stop at country borders. Helfgott team members are collaborating with a number of organizations in all corners of the world in order to determine the efficacy and safety of various traditional medicines and build research capabilities in underserved areas. Helfgott is partnering with Natural Doctors International (NDI), an organization dedicated to treating underserved populations through natural medicine. NDI has created an integrative clinic on the island of Ometepe, Nicaragua that serves residents 24 hours a day. In addition, NDI provides opportunities for international medical rotations for naturopathic doctors and medical students, as well as other complementary and alternative medical health professionals. Currently, Helfgott investigators and students are assisting NDI in developing a pilot study of the use of guava in the treatment of infectious diarrheal disease. Helfgott will continue to work with NDI to conduct observational and outcomes research that can inform NDI’s clinical practice, as well as its community outreach activities. In addition, Helfgott has developed a partnership in Tanzania with the Tanga AIDS Working Group, and the Institute for Traditional Medicine at Muhimbili University. Helfgott hopes to develop a number of programs with these institutions in the next few years, including a student exchange to learn about traditional healing methods and an effort to help further develop laboratory capabilities at the organizations. In the future, Helfgott will establish a full-fledged Center for Global Health that will serve as a hub of knowledge for natural medicine applications to acute and chronic disease in underserved populations both domestically and internationally.

“When it comes to global health, there is no ‘them’... only ‘us’.” –Global Health Council

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Your donation to the Helfgott Research Institute helps to fund innovative clinical research that can advance health care in the U.S. and throughout the world. Join us and help to advance the science of natural medicine. Learn more at www.ncnm.edu/research

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Science is a way of thinking much more than it is a body of knowledge

–Carl Sagan


049 SW Porter Street Portland, OR 97201 www.helfgott.org NCNM, in compliance with state and federal laws and regulations, does not discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, disability, or veteran’s status in any of its policies, procedures, or practices. This nondiscrimination policy covers admission and access to, and treatment and employment in, college programs and activities, including but not limited to academic admissions, financial aid, educational services, and employment.

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