Abstract
Dr. Tieraona Low Dog practiced massage therapy, midwifery, herbal medicine, and martial arts prior to going to medical school. She did her medical training at the University of New Mexico School of Medicine, graduating in 1996. Over the past 20 years, she has served on various boards and commissions related to integrative and herbal medicine. These include the White House Commission of Complementary and Alternative Medicine Policy, the United States Pharmacopoeia (USP) Dietary Supplements and Botanicals Expert Committee, and the Advisory Board for the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM). She has also served as chair of the USP Dietary Supplements Admission Evaluation Committee, the Fellowship Director of the Academy of Integrative Health & Medicine, and Director of the Fellowship at the Arizona Center for Integrative Medicine. Dr. Low Dog was a founding board member of the American Board of Integrative Medicine and the Academy of Women's Health. She has written 22 chapters on integrative or herbal medicine for textbooks, authored/co-authored more than 40 peer-reviewed journal articles, presented at more than 500 medical/scientific conferences, and written five books, including four with National Geographic.
My grandmother's mother was a midwife. Everybody always said I was a lot like her. My grandmother had us gargle with sage for a sore throat and would put an onion or mustard plaster on us for a chest cold. Like many women born in the early 1900s, she knew a lot of home remedies. Nobody went to the doctor for minor things back then. I grew up knowing that plants could heal us. I never doubted it. I'd seen them work.
My early love of Nature has sustained me throughout my life. I live in a cabin with my husband, horses, Shepherds, cats, and chickens within the Santa Fe National Forest. We are just under one hour from a grocery store. I had wanted to live on this land for many years and was finally able to buy it. The place needed a lot of work, but I knew this land is special. One day, I was chatting with a local Pueblo sculptor who told me that this land was originally part of the Cicuye Pueblo. He looked me in the eye and said, “The spirits of this land are old, and they want you to sing to them.” It was at that moment I knew I was truly home.
And yes, science will expand our understanding of herbs as researchers continue to identify key compounds that can improve human health. There is room for all of it. Tradition always adapts. Very, very few people do anything the same way it was done 3,000 years ago. That which adapts, thrives. I am concerned, however, that the primary way we continue to evaluate and solve problems is through primarily a reductionist pharmaceutical mindset. We find a new pathway; we can develop a new drug. We create a new questionnaire, diagnose a new mental health problem, and create a new drug to treat it. A reductionist biopharmaceutical model can only take us so far. We have more and more drugs, and people are sicker and sicker.
I know the term “holistic” medicine fell out of favor decades ago. However, I always liked the word “holism.” It honors that the whole is always more than the sum of its parts. We can unravel the human genome but still argue over what constitutes a “healthy diet.” We have a much better understanding of cancer, both its genesis and treatment, but knowing that science does little to ease the pain of the young mother who asks why her two-year-old has neuroblastoma. We practice the art of medicine. We honor the deep and powerful human connection that exists between the healer and the sick. Science without a soul is an empty vessel that can sail to dangerous waters.
This next generation of physicians and clinicians will have access to technologies that we cannot even envision. We will know more about the role genetics play in health and disease, and we will be able to harness the body's natural defenses to heal itself. This is very exciting, but the sword of science can cut both ways. Who profits and at whose expense? Ethical questions must be asked and answered honestly when it comes to genetic testing. If poverty is the biggest driver of disease, how will all that we are doing alter this equation?
I've spent many years teaching Fellows at the University of Arizona Center for Integrative Medicine and then the AIHM. That experience has afforded me the opportunity to meet the clinicians of tomorrow, and I must say, they give me great hope. For they not only are learning the science of meditation and nutrition, but also the social determinants of health, the impact of the environment on human health and how motivational interviewing can help people choose healthier behaviors. They know that the future will require teams of trained professionals providing integrative and integrated care and a political system that encourages business and innovation while ensuring the protection and care of the most vulnerable among us.
As for feeling disconnected, the world is moving very fast, and I don't think it is going to slow down. We are going to have to find ways to adapt to all this amazing but intrusive technology. When asking a patient to stay off his or her cell phone or computer just one day per week, almost always the answer is no. We have to check e-mail or our text messages. When I was a kid, my parents didn't feel like they had to stay home every day in case the phone would ring. That is something new.
This new technology has the potential to be very addictive. Texting is like playing a slot machine. You pull the lever 20 times and don't get anything, and then you hit three cherries and out pours some money. That little dopamine rush is enough to get you to stay there and play the slots for another 20 or 30 minutes. It has been said that texting is very much like that—that you will keep looking at your phone because every now and then, you will get a great text message.
Dopaminergic hunger is rampant in our culture. Dopamine is the neurotransmitter of pleasure. That's why cocaine and meth are so addictive. In a dopamine-deprived, pleasure-seeking species, I think these technologies have the potential to be problematic, if not dangerous.
Sometimes, when I travel around the country, I ask people whether they think life in the United States is more stressful today than it was in the 1930s. Everybody says today. When I ask people why, many believe that there were stronger social bonds in the past. That neighbors were more likely to reach out and help each other. That today everybody thinks they are in it alone. People don't know who lives next door. No one picks up the phone.
When I listen to the responses in the audience, I find myself agreeing with them. That even in one of the worst times in the 20th century, during the Depression and then the war, even though people had it bad, they felt like they were in it together. Today, the stress is isolating. Politics are divisive. The drive for having “stuff” is strong. All of this makes people feel anxious. They instinctively know something is “off”—something is “missing.” And their fix? High-carb diets, binge watching television, working 12 hour days, spending money on things we don't need, blaming others, taking meds to ease the symptoms of our lifestyle and numb our pain. It is heartbreaking because it is true.
The antidotes are awareness, compassion, and connection. To be self-aware is one of the traits that makes us human. And yet, many of us sleepwalk through our lives. Self-awareness requires compassion, however, as we see clearly our imperfections. This awareness allows us to extend compassion to others, no longer needing them to be the bad guy, the foil, the bogeyman. “They” are “us.” That deep realization allows us to feel connected. Connected to others, yes, but more importantly, connected to something outside of ourselves. I know that for me personally, these are central to my existence. And that is through a profoundly deep connection to nature that I am made whole. This place heals me. Other than grace, it is probably the only reason I am still alive.
I made the decision to take the chemotherapy and radiation. It was brutal. And it was wondrous. I cannot begin to describe those final two weeks. I was so weak. We'd arrived at the cancer center, and my husband offered to get me a wheelchair. I said I could walk. It was important for me to feel strong. But when I started to get out of the truck, I just couldn't do it. A little later, I was sitting in the wheelchair waiting to go in for radiation, and I had my head down because I could hardly hold it up. My life force was barely palpable. I finally understood qi. While I was looking down, a scuffed and ugly pair of black shoes came into my view. I remember them so distinctly. I slowly looked up and saw a pair of knee-high hose and a simple floral dress. And as I continued my gaze, there stood a woman. She looked Guatemalan. She told me she did not speak very good English and asked if she could pray for me. I nodded in silence. She kneeled by the wheelchair, took my hand, and started praying in the most melodic, beautiful voice. And I closed my eyes. My husband closed his eyes. And when she stopped praying, I slowly opened my eyes and saw the tears streaming down her face. I took her face in my hands, and said “Tú eres mi ángel,” you are my angel. Then the radiation tech came to get me, and I never saw her again.
On our drive home that day, I told my husband that I had experienced a healing. That if I hadn't been so sick, I would never have received that precious gift. It was such a powerful moment. A perfect stranger gave me so much of herself. I keep her in my prayers. I believe there are all kinds of angels in our lives, and sometimes we only see them in our darkest hours. Cancer is powerful medicine. Cancer is a powerful teacher. People who get sick often ask, why me? But ultimately I asked, why not me? Why not me?
It is not for others to choose how one goes about their own healing. That is a profoundly personal decision. One day, during a conference, a physician came up and said, “Dr. Low Dog, I want you to know that I always really admired you, and I thought a lot of you, but I have really just lost so much respect for you.” I asked why, and he replied, “You know, with all you know about herbs and everything, the fact that you did chemotherapy and radiation. I mean, you are a hypocrite.” I took his face in my hands and smiled. There were no words.
When I was a resident in family medicine, I took care of a woman with breast cancer who had refused any kind of treatment. The tumor eventually ate through her chest wall, and she died of respiratory failure. I got pushback from some of the residents who thought I should have refused to see her because she wouldn't follow sound medical advice. Of course, we had recommended surgery and chemotherapy because that is what we thought would give her the best chance of survival, but that is not what she chose. But how could I abandon her when she needed me? This was not my journey, it was hers. Why would I refuse to take care of her because she did not agree with what I believed was right for her? It was not my journey, any more than it was that physician's journey or his place to decide what was right for me.
Some people have suggested that I am still here because it is not my time to go, that there is still work for me to do. I don't know that to be the truth. I am sure the Creator also had plans for the six-year-old who did not survive. Human beings need a “reason” for things. However, I have learned that many things are just not knowable.
A number of years ago, while I was waiting for a director's meeting, a colleague who was a psychologist came in and shared an interesting experience. He said as he was waiting to get in the elevator, a woman was standing next to him, clearly distraught. He asked if she was okay. She said she was really worried about going in for her first chemotherapy treatment because she was so afraid she was going to be sick. He asked her, “I wonder what you are going to crave for dinner tonight? I wonder what you're going to be hungry for?” She just looked at him and my colleague got in the elevator and wished her well. I was curious. He told me that often doctors will reassure a patient that they have very effective medicines for nausea and vomiting. Being trained in hypnosis, he said that all the brain hears are the words “nausea and vomiting.” That's why he wanted to plant the words “crave” and “hungry.”
Many years later, as I was going for my first chemotherapy treatment, I remembered that story. I asked my husband before and after every treatment to say, “I wonder what you are going to crave tonight for dinner? I wonder what you're going to be hungry for?” It worked. You see, you never know what you are going to need to know. You never know when what somebody shares with you is going to be important. There is something to be learned from everybody. Remember that Aerosmith song, “Live and learn from fools and from sages.”
I don't know if it is accurate, but I heard that in another five to six years, everything we know in clinical medicine will be doubling every 100 days. That we've learned more in the past 20 years than we learned during the past 400. That's shocking. There's no way any one person is going to be able to keep up with all that information, and there will be a limit to what we can actually do with so much knowledge. So, while I love learning and I don't think that will ever change, as I get older, I find myself more comfortable with not knowing. Enveloped in Mystery, the questions themselves take on a new meaning all on their own.
The berberine-rich plants are getting a lot of attention these days. I have thousands of barberry plants growing on my ranch. We harvest the root bark every autumn and put up bottles of tincture and glycerites. I've relied on this plant for more than 35 years to treat eczema, psoriasis, food intolerances, gut infections, topically for wounds, and a whole host of other things. I've seen it successfully eradicate Entamoeba histolytica infections when metronidazole had failed. I have used it to treat giardiasis in our animals for decades.
The research that shows berberine has a profound effect on restoring barrier function in the gastrointestinal (GI) tract 1,2 is enlightening. For centuries, herbalists have witnessed the beneficial effect of goldenseal, barberry, Oregon grape root, and Coptis (all berberine-containing plants) on chronic skin conditions, GI complaints, and infections. The profound effects that occurred on the skin with the oral consumption of these herbs led many to declare them “blood purifiers.” They assumed that there must be some kind of toxin in the blood that was causing the problems manifesting on the skin. This makes sense when you think about it. Modern scientists and clinicians scoffed loudly, “If there were toxins in the blood, the patient would be in the ICU.”
E-mail:
Website:
Further complicating the story was the fact that berberine did not appear to be well absorbed across the gastric mucosa. So, how could it be impacting the skin or the blood? There was never any consideration that the beneficial effects observed by practitioners were possibly due to a local effect in the gut.
We now know that restoring gut barrier function can have profound effects on health. When GI barrier function is disrupted, fragments of Gram-negative bacteria cellular membranes (lipopolysaccharides) can trigger a local immune response as well as enter the bloodstream. This condition, referred to as endotoxemia, may be a significant contributor to conditions ranging from allergies to obesity and diabetes to depression. Berberine enhances the expression of tight junction proteins, improving intestinal barrier function, decreasing endotoxemia, and improving the health of the microbiota. Indeed, we are now seeing in human clinical trials that berberine can improve many aspects of metabolic syndrome. Given the fact that much of modern living negatively impacts gut barrier function (e.g., high fructose diet, antibiotics, insulin resistance, prolonged psychosocial stress, environmental exposures, etc.), these plants may be far more important than we ever realized and are definitely worthy of more research.