From The March 1999 Issue of Nutrition Science News
By Peter Barry Chowka
Two decades ago Leo Galland, M.D., an honors graduate of Harvard University Medical School, left academic medicine to establish a private practice in a small Connecticut town. During his extensive work in the medical field, Galland expanded the scope of his practice to include both innovative and traditional natural therapies. Currently he maintains a private consulting practice in New York City, where he specializes in helping people who suffer from complex, chronic illnesses. Through his work with patients, as well as his popular lectures and booksSuperimmunity for Kids (Delta, 1989), The Four Pillars of Healing (Random House, 1997) and Power Healing: Use the New Integrated Medicine to Cure Yourself (Random House, 1998)Galland has emerged as one of the country's most thoughtful and articulate advocates of holistic and integrated medicine.
Chowka: When did you first become aware that there was a kind of medicine other than what you had been taught in medical school?
Galland: It wasn't so much a process of discovering something alternative as it was a dissatisfaction with the results of conventional medicine. As soon as I stopped working with critically ill patients in the intensive care unit and started seeing people who were chronically ill, it became apparent that what worked for emergency situations was not very useful for restoring health.
That was 25 years ago, and there wasn't much "alternative" out there. But I found a tremendous amount of scientific research about nutritional and psychological influences on illness and recovery and about the role of exercise in health. I've always felt most comfortable working from a platform of what's scientific and rational.
I realized the insights I was acquiring were not going to make it into an academic medi-cal center for another 20 years. I wasn't interested in academic politics or in waiting, so I went to practice in a small town in northwestern Connecticut and immersed myself in patient care. I started putting different alternative treatment ideas together.
Chowka: Give me an example of what you were doing clinically.
Galland: I discovered that prostaglandins, which were the hottest new thing in the early 1980s, were derived from essential fatty acids. I started giving patients omega-3 essential fatty acid supplements. The results were really impressive, for example, in controlling arthritic symptoms in people who were intolerant of anti-inflammatory drugs.
Chowka: Back then, in the 1970s and 1980s, the problems facing alternative medicine included the isolation of practitioners, difficulty in finding information and, in some cases, the active suppression of alternative medicine proponents. Today, the problems for complementary and alternative medicine (CAM) often seem to be the result of too much success and of mainstreaminga watering down of core philosophy, dumbing down of primary alternatives, the potential co-optation of alternative medicine by conventional medicine.
|It's tragic that the tremendous power of science has not been placed at the disposal of a much older model that views the job of the
healer as helping a person to restore harmony and balance.|
Galland: Suppression still occurs, although today there's more of an information overload than a difficulty in getting information.
There's such a ground swell supporting CAM that all sorts of people who haven't earned their spurs are coming forward and placing themselves in positions of leadership and influence. Half the medical centers in the country are setting up departments of integrative or complementary medicine. Faculty members who have had a closet interest in CAM are emerging as the leaders in these institutions. But often they know very little about what they're doing. I see that as potentially dangerous.
As far as co-optation, that was always to be expected. There are a lot of people coming along saying, "Oh, yeah, this works, that works." But they are not really embracing the underlying philosophy.
JAMA [Journal of the American Medical Association], for example, devoted a whole issue [Nov. 11, 1998] to alternative medicine. But what do they mean by "alternative medicine"? There was an article on whether Garcinia cambogia helps with weight loss. What does that have to do with alternative medicine? It's just taking an herb and using it as if it were a drug. In a previous issue of JAMA, an article reported cranberry juice prevents bacterial urinary infections. But that wasn't called alternative medicine. The November JAMA editorial said there is no such thing as alternative medicine or conventional medi-cine; there's only one medicine, and it's effective medicine and, the only question is, "Does it work?"
That statement is ambiguous. What do they mean by "it"? And what do they mean by "work"? Because "it" is not just the substance that is administered by the doctor, it is the system within which the doctor operates and within which the doctor treats the patient. "It" is an intellectual, cultural, interpersonal construct. And to pretend that all you have to do is ask, "Does it work?" and say, "It is a thing" is really misleading and ultimately dishonest.
Chowka: Your comments bring to mind what I call the allopathic practice of unconventional medicine. Many alternative and complementary proponents seem to be practicing allopathic nutrition or allopathic this-or-thatmeaning symptomatic treatment simply using a different set of tools without any sense of vision, philosophy or grounding.
Galland: I totally agree. I see that as being perhaps the biggest danger to holistic medi-cine. I had a patient with severe rheumatoid arthritis. She had tried every toxic drug and they'd all failed her. In keeping with the spirit of the times, her rheumatologist recommended acupuncture and St. John's wort. Neither of them did anything. Nobody had looked at this woman's diet, which was horrible, things that were going on in her life or her pattern of exercise. When I looked at the whole person, what really stood out as a major impediment to healing was her diet. Today, after a dietary change and some targeted nutritional supplements, she's like a new person. Her experience before she came to me is a real example of doctors using alternative therapies in an allopathic fashion, which is not the way they were designed to be used.
Chowka: You are closely associated with the concept of integrated medicine. How do you define integrated medicine?
Galland: Integrate means many things, including to make whole. What needs to be integrated is the power of modern biological and social science with the ancient approach to healing, which views illness as the result of disharmony or imbalance. The main problem is that the power of science has been placed primarily at the disposal of a disease theory that is limited and idealizedthe notion that people get sick because they contract diseases and diseases exist just the way species of plants exist. Using this model, you can define and treat diseases without any regard for the person who has the disease. It's clear what we're treating today is not people, it's diseases.
If you work within managed care today, you are treating ICD [International Classification of Diseases] codes. Treatments consist of CPT [Current Procedural Terminology] codes. The codes have to match up. Nothing else matters. It's tragic that the tremendous power of science has not been placed at the disposal of a much older model that views the job of the healer as helping a person to restore harmony and balance. One that recognizes if you can restore harmony and balance, many different diseases begin to disappear.
Chowka: What are the greatest misconceptions your new patients, and maybe the public in general, have about CAM?
|The main thing still missing, even in the alternative medicine movement, is the focus on each patient's individuality.
Galland: People get hung up on one program or one thing. Either they plateau or the program is wrong. They get into a track that says, "This is the way to health." And it may be for somebody else, but it's not for them. The main thing still missing, even in the alternative medicine movement, is the focus on each patient's individuality as the critical determinant.
Chowka: So in your view there's a problem with "one-size-fits-all" medicine.
Galland: That's right. During the 1980s there was a move toward vegetarian diets and lifestyles. That's great for some people. But I've seen people who have ruined their health by becoming vegetarians. Now the big thing is high-protein, low-carbohydrate diets. Well, that's good for some people and not for others.
Chowka: What tools do you use to determine a person's biochemical individuality?
Galland: I give my new patients a 20-page questionnaire that takes them an hour or more to complete. It's part of a process I call person-centered diagnosisto help people understand what their areas of strength and weakness are. For example, in the nutritional area, how to best balance their need for essential fatty acids, calcium and magnesium. And also how to identify if they need a high-protein/low-carbohydrate diet or a low-fat/high-carbohydrate diet, or if their metabolism is flexible enough to enable them to just eat healthy foods and lots of vegetables. There is a range of questions to help people begin identifying their biological individuality and also the potential role that environmental, interpersonal and psychological factors may be playing in destabilizing them.
Chowka: Do you do tests as well?
Galland: Through the years I've found I need to do less laboratory testing. You can really be misled by the results of laboratory tests. One problem in alternative medicine is the tendency of many physicians to overtest and to rely excessively on the results. That's a carryover from regular allopathic medicine. There's almost nothing you can't test for these days. But how meaningful is that really? What does it tell you about what a person needs? I think it's helpful for doctors to work with as few tests as possible because then they have to interact with their patients and think.
Chowka: What is the single most important change people can make to improve their health?
Galland: It starts with knowing yourself and developing an understanding of where your personal health strengths and weaknesses aretaking stock of your diet, your personal relationships, your lifestyle. There's an awful lot you know already about what's necessary to improve your health. That is not even really in dispute. It's just kind of ignored. The first thing is to take stock of how you are doing compared to what we know is really important about diet, exercise, rest and so on.
Chowka: What are some of the errors people make nutritionally? With the explosion of information available, are people more confused?
Galland: People these days are more confused. They don't know who to believe. The biggest mistake people make nutritionally is they don't understand the concept of nutrient density. It is important to understand that calories, from whatever source, need to be accompanied by nutrients and phytochemicals. The density of these in your diet are two of the main determinants of how well you're doing nutritionally. If you start there, a number of other things will naturally fall into place. Even so, a certain percentage of people, including those on a nutrient-dense diet, still don't do well. They have either food allergies or special biochemical needsa high-protein or high-carbohydrate diet or specialized needs for individual nutrients. Once you're on a good, nutrient-dense diet, the most common problem people have is they still are not getting the right balance of essential fatty acids.
Chowka: The field of clinical nutrition today seems to be going in many directions: nutraceuticals, chemoprevention, diet, biochemical individuality. Is there one direction you see the field eventually settling on?
Galland: I think it will wind up going in a circle. Scientifically, we are learning more and more about what individual food components do physiologically in the body. It's fascinating, for example, to know that EGCG, the bioflavonoid in green tea that's been associated with the prevention of colon cancer, inhibits an enzyme involved in regulating cell growth. There are going to be more and more stimulating discoveries of this type, many of which will come from basic researchers looking for chemicals to inhibit or enhance reactions. They are going to find components of food that do this better than any drug. In 100 years when they're all summed up, they may just bring us back to a nutrient-dense, traditional diet. We'll just understand it better. That's where we're going to wind upnot with a different set of principles, just understanding and appreciating the ones we already have to a deeper extent.
Chowka: Do you see a need for people working in CAM to be more self-critical, self-regulating and aware of the pitfalls so they can clean up their act before somebody else tries to do it for them?
Galland: The personalities of alternative practitioners are different from those of conventional practitioners. Conventional doctors are afraid to take risks. That's why they became doctors and that's why they remain so ready to follow the rules. The whole process of becoming a doctor selects people who are afraid of taking risks. It's responsible for a lot of the mediocrity in medicine. Many of the people in alternative medicine are willing to take some risks, but their main characteristics are enthusiasm and zeal. That's good because it leads them to be open. But they need to incorporate scientific skepticism about the work they're doing. What makes science strong is skepticism. In science there is no such thing as truth, only falsehood. Because humans are adept at developing false ideas, science is a great tool for pruning what is false. We need to be more adept at doing that in our own work.
Chowka: What is your vision for optimum health and medicine in the future? How do we get there and does your vision differ from where you think we might really be headed?
Galland: In order for us to really get there, more has to change than individuals. We can't get there merely through individual choices and decisions. There have to be changes in society at all levels. There have to be changes in the availability of food and in the way it's grown, and in the way our environments are treated. It's an illusion to think a select group of middle-class individuals can create a bubble for themselves in which they have pure environments and pure food while the vast bulk of Americans who aren't as well off are eating low-quality, polluted food and breathing polluted air. That kind of polarization of society isn't good. Unfortunately, that's the way I see things goingpolarization increasing rather than decreasing.
Chowka: What needs to be taught, or taught more intensively, in medical schools?
Galland: How to interview patients and understand them as individuals. How to talk to them. But it's not just a question of bedside manner and the human quality of the relationship, which are important. It's much more profound: how to approach medicine fundamentally as something that exists between two individualspractitioner and patient. How to understand, respect, support and empower the individuality of each patient you see. "What does this individual person need from me at this particular time?" Being able to answer that question is the most important thing health professionals need to be taught.