Welcome to The Weekly Transfusion, 1.3 for the week of March 31, 2009.

Editorial

I've slowly been coming around to the notion that it is not enough to simply shrug off ad hominem attacks on the links between blood groups, diet and health. Yes it is nice to combat ignorance with patience and understanding. But there are often other motivational factors at work besides simple ignorance. The food and diet industry is big business. Many pet theories and systems abound: For example, it would be unlikely that many vegans would be comfortable with my suggestions for blood type O, or that many low-carbers would be all that happy with those for blood type A. Add to that the fact that my naturopathic training often sets off alarms in skeptical circles and professions in direct competition for you nutritional eyes and dollars.

There is also the challenge to the dominant nutrition paradigms which is inherent in any personalized approach. If your company makes vitamin E, soy flakes or whole wheat bread you will not be all that happy to find out that I don't recommend your product for everyone.

Yet there is still a voice in my head which says, 'Why adopt a path of confrontation?' I mean wouldn't it be better to just try to stay above the fray? In reality it would. However, almost all media nowadays is pure spin, and because it is digital, it persists indefinitely. True, the path of enlightened patience such as that of a Gandhi would be most desirable. But these are different times. As Ho Chi Minh put it, had Gandhi been in French Indochina rather than in British India he would have ascended to heaven long before he eventually did.

Consequently I'm perceiving a change in my attitude towards those whose only goal is to disparage. I have no interest in becoming prosecutorial and finding de novo fault in others; we certainly don't need any more of that. Hopefully I'll also have the courage to change my own opinions when shown to be misguided or incorrect. However, I will now actively address and debate misrepresentations of my work and writings --hopefully in an even-handed manner that educates while it redresses.

Meat intake and mortality

Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality. During 10 years of follow-up, there were 47,976 male deaths and 23,276 female deaths. In general, those in the highest quintile of red meat intake tended to consume a slightly lower amount of white meat but a higher amount of processed meat compared with those in the lowest quintile. Subjects who consumed more red meat tended to be married, more likely of non-Hispanic white ethnicity, more likely a current smoker, have a higher body mass index, and have a higher daily intake of energy, total fat, and saturated fat, and they tended to have lower education and physical activity levels and lower fruit, vegetable, fiber, and vitamin supplement intakes

Article Link

Comment:
No rational person would debate that when making generalized assertions about a heterogeneous population as a whole, diets very high in red meat and processed meats are not very healthy. However this behavior often comes with its own baggage. The fact that the study participants exhibited unhealthy behaviors such as smoking, lack of physical activity, and maintaining a higher body mass index pretty much mix things up, since all of these are known to cause chronic disease. Another confounder is the sad fact that people who eat lots of processed meats just don't take as good care of themselves as those who avoid them. We could probably draw similar conclusions about heavy meat eaters and fatalities from automobile accidents, since people who avoid processed red meat probably buckle also their seat beats more frequently as well.

More tellingly, this study failed to look at individual markers of variation. Blood group A subjects would have been expected to have the typical negative reactions to red meat, since most biomarkers 'down-side associated' with red meat consumption/malabsorption (von Willebrand Factor, E selectin, intestinal alkaline phosphatase, blood viscosity) are associated with type A. Scan at the literature for the last 50 years and you'll see that virtually every study that looked at coronary artery disease, ischemic heart disease or myocardial infarct show a prevalence of type A.

Also a similar specificity of resuts would probably have occurred had the looked at secretor status as gene also has a major effect on intestinal alkaline phosphatase levels. Allowing for individual variation, use of grass-fed meats, non-inclusion of subjects who used processed meats, and a look towards the composition of the 'whole diet' would have probably yielded quite different results.

Vegetarians have fewer cancers but higher risk of colorectal cancer

The overall cancer incidence rates of both the vegetarians and the nonvegetarians in this study are low compared with national rates. Within the study, the incidence of all cancers combined was lower among vegetarians than among meat eaters, but the incidence of colorectal cancer was higher in vegetarians than in meat eaters.

Article Link

Comment:
Compared with meat eaters in the cohort, and after adjusting for age, sex and smoking status, the vegetarians in the cohort showed an 11 per cent lower incidence rate of all cancers. However, vegetarians showed a 39 per cent higher incidence rate compared with meat eaters, which almost seemed counterintuitive. However I have noticed that colon cancer does seem to have its fair share of vegetarians, especially those who are type O.

Theodor Hahn is credited as being the first of the pioneers of the naturopathic/ water cure movement to integrate vegetarian dietetic principles. He was convinced that a meat-free diet would prolong life. In fact he was so convinced of the value of a vegetarian diet that he spent a great deal of his professional life writing books and pamphlets on the subject and was the editor of a magazine called The Vegetarian. He died of colon cancer at the age of 59. One of my most vociferous critics in years past was a type O vegetarian naturopath who recently also passed away from colon cancer in his early 50's.

Perhaps they would have died at an even younger age had they not been vegetarian. Ultimately there is no answer, but it is ironic that the people responsible for integrating vegetarian diets into naturopathic medicine died so young of colon cancer.

I doubt that it is anything in the meat that would offer vegetarians any chance of avoiding colon cancer. More likely their vegetarian diet was rich in plant and legume lectins which were just not right for their type. Many lectins can have hyper-proliferative effects on the intestinal tract, especially the lectin from peanuts [link 1], [link 2] which is not a good food choice for type Os.

The Science Thing: CBO says less than 50% of all medical care is based on adequate evidence.

Drugs and medical devices must be certified as safe and effective before they can be marketed, but with limited exceptions the regulatory process for approving those products does not evaluate them relative to alternatives. Meanwhile, medical procedures—which account for a much larger share of total health care spending—can be in widespread use without a systematic review of their impact. Appraisals of the current situation vary widely, but some experts believe that less than half of all medical care is based on adequate evidence about its effectiveness—a gap that may never close entirely but that remains troubling.

Article Link

Comment:
So, the pot does call the kettle black or as they say in Hungary 'Bagoly mondja verébnek, hogy nagyfejű ("The owl tells the sparrow that it has a big head.") Many conventional medical authorities and skeptics are quick to brand alternative health practices 'unproven' or 'unscientific'? Yet the dirty little secret is contained right in the statements of Douglas W. Elmendorf, director of the Congressional Budget Office.

Not that anyone on alternative medicine, should crow. All right, maybe we can crow a little. However, the record in Alternative, Integrative and Complementary medicine (all monikers I detest, even though I'm responsible for one of them) is even worse. Efforts are now underway to close down the NIH Office of Alternative and Complementary Medicine. Frankly, I think this is a good idea. The avowed purpose of the office from the start was to 'prove' alternative medicine. You can't really be non-subjective if you set out to 'prove' something. Add to that the fact that they study some of the strangest stuff you could imagine - due to the fact that, like any bureaucracy, pride of place goes to those with the sharpest elbows.

Why most published research findings are false.

Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

Article Link
Comment:
And the author doesn't even discuss the most common reason you need to be careful in evaluating science information. Someone, somewhere most likely stands to make a buck out of the result (your humble author included).

William Hogarth had a great quote along similar lines:

The problem with the ancients was that they tried to make medicine an art and failed. The problem with the moderns is that they tried to make it a business and succeeded.

Here it is.. another Monday and another research grab-bag.

Five daily portions of fruits and vegetables raise serum antioxidants in three months

To explore the effects of increasing fruit and vegetable intake and the resulting effects on levels of circulating micronutrients in a community-dwelling population with an already high consumption of fruits and vegetables, 112 volunteers (86% women) underwent targeted dietary counseling for three months. At the beginning of the study and after 4, 8 and 12 weeks a food frequency questionnaire was filled in, and plasma levels of dietary antioxidants as well as biomarkers of oxidative lipid and protein damage were determined. Compared to baseline, especially the intake of fruits was significantly improved after 3 months of intervention, and mean plasma levels of lutein, zeaxanthin, β-cryptoxanthin, lycopene, α- and β-carotene, retinol, α-tocopherol, vitamin C and vitamin B6 were increased. Biomarkers of oxidative stress remained unchanged. Thus, a nutritional counseling program is capable of improving plasma levels of antioxidants even in a health-conscious population.

Article Link
Comment:

What is especially interesting about this study was that they used individuals who were already eating a pretty healthy diet, which just goes to show that even if you follow the BTD or GTD in terms of food choices, something as basic as making sure that you get the required amounts of recommended fruits and vegetables can make a big difference.

Schizophrenia, gluten, and low-carbohydrate, ketogenic diets

We report the unexpected resolution of longstanding schizophrenic symptoms after starting a low-carbohydrate, ketogenic diet. After a review of the literature, possible reasons for this include the metabolic consequences from the elimination of gluten from the diet, and the modulation of the disease of schizophrenia at the cellular level.

Article Link
Comment:

Previously, Dohan (Acta Psych Scand 1966, 42(2):125-152) observed a decrease in hospital admissions for schizophrenia in countries that had limited bread consumption during World War II, which suggested a possible relationship between bread and schizophrenia. Early work with lectins clearly showed that the brains of schizophrenics bind lectins differently than the brain tissue of non-schizoprhenics, which appears to make sense in that the carbohydrate content of schizophrenic brain tissue (in addition to dementia and a few other illnesses) revealed the existence of spherical deposits in the inner and middle molecular layers of the dentate gyrus in the hippocampal formation which contained fucose, galactose, N-acetyl galactosamine, N-acetyl glucosamine, sialic acid, mannose and chondroitin sulfate; many of these blood group active carbohydrates with known lectin binding affinities (link).

Over the years some of the most stirring letters I've received from book readers have centered around improvements in family members with schizophrenia. Almost all of these letters have been from or about blood type O schizophrenics, which may mean that the nutritional approach to schizophrenia might necessarily differ by foods and blood type. We are now only beginning to understand the effects of tissue glycosylation on the development and maintenance of brain neural networks (in particular those utilizing the blood group O specific antigen fucose).

Lectin-epithelial interactions in the human colon.

Similar changes in glycosylation occur in the colonic epithelium in inflammatory conditions such as ulcerative colitis and Crohn's disease and also in colon cancer and precancerous adenomatous polyps...Tools are now available to allow fast and accurate elucidation of glycosylation changes in epithelial disease, characterization of their potential lectin ligands, whether dietary, microbial or human, and determination of the functional significance of their interactions. This should prove a very fruitful area for future research with relevance to infectious, inflammatory and cancerous diseases of the epithelia.

Article Link
Comment:

In years past I've written about the effects of some dietary lectins on the cells of the colon, in particular the lectins found in mushrooms, fava beans and jackfruit. Most of the plant lectins are specific for the Thomsen-Friedenreich Antigen (T antigen) a pseudo blood group antigen which is often expressed in pre-malignant cells of the colon.

Here is a quote from a study examining fava (broad) bean lectin:

VFA stimulated an undifferentiated colon cancer cell line to differentiate into gland like structures. The adhesion molecule epCAM is involved in this. Dietary or therapeutic VFA may slow progression of colon cancer.

(link)

Here is a quote from a study examining standard commercial supermarket mushroom lectin:

Agaricus bisporus agglutinin (ABA) isolated from edible mushroom has a potent anti-proliferative effect on malignant colon cells with considerable therapeutic potential as an anti-neoplastic agent.

(link)

Here is a quote from a study examining jackfruit lectin:

(Jacalin) Lectin binding to human colonocytes can predict the presence of malignant and premalignant lesions of the colon, and has potential as a noninvasive screening tool for colorectal neoplasms.

(link)

If you have a family history of colon cancer, or have been diagnosed with colon abnormalities (such as polyps) you may want to investigate adding more of these foods to you diet (using the BTD as a guide to which would be best for you)

Human pseudogenes of the ABO family show a complex evolutionary dynamics and loss of function.

The GT6 glycosyltransferases gene family, that includes the AB0 blood group, shows a complex evolution pattern, with multiple events of gain and loss in different mammal species.These results suggest that some of these GT6 human pseudogenes may still be functional and retain some valuable unknown function in humans, in some case even at the protein level. The evolutionary analysis of all members of the GT6 family in humans allows an insight in their functional history, a process likely due to the interaction of the host glycans that they synthesize with pathogens; the past process that can be unravelled through the footprints left by natural selection in the extant genome variation.

Article Link
Comment:

Pseudogenes have been defined as nonfunctional sequences of genomic DNA originally derived from functional genes and are sometimes referred to as 'Junk DNA.' However new finding are suggestive that these areas of non-coding DNA and RNA may be involved in developmental changes which differentiate the functions linked to the blood type genes that occur between the various species.

Another nail in the coffin for the 'animals have blood types and don't eat right for their type' criticism of the Blood Type Diet by the nincompoop Andrew Weil.

The Effect of ABO Blood Types on Periodontal Status.

A relatively higher percentage of A group patients was found in gingivitis group and relatively higher percentage of O group patients was found in periodontitis group. A significant relationship was also determined between Rh factor and gingivitis. ABO blood subgroups and Rh factor may constitute a risk factor on the development of periodontal disease. However, long-term studies are needed to make a more comprehensive assessment of the effects of ABO group on periodontal diseases.

Article Link
Comment:

I'm sure that secretor status had something to do with these results, since it has an effect on pellicle formation (link) I do however, agree with the results. In my own patients I have seen periodontal disease resolve easily in many type A's by simply getting their gingivitis under control. Type O's on the other hand have a harder time of things, especially if their protein intake is not adequate.

That's about it for this week.

A bit of news: I would be willing to entertain questions about topics that might be of interest to this community. Just drop a comment (link is below). I will not however, respond to questions of a personal medical nature, nor give medical advice. Thanks for respecting this caveat.

I'm going to try to develop the habit of posting about new and interesting research findings that I come across in the science literature. Where appropriate, I'll add some pithy commentary as well.

Research Bias Against Alternative Medicine

"Slowly they are beginning to report on the welcome trend of evidence based clinical trials for complementary and alternative medicine (CAM), including herbal remedies. Unfortunately, the media still rely for their sources on high quality medical journals, which are more likely to report negative results about CAM and positive results about pharmaceuticals, The clinical trials in the study showed no difference in quality between herbal remedy and pharmaceutical trials, but CAM was still reported on more skeptically".

Comments:

Finally someone has the courage to address the bias against plant medicines often seen in the major media and high-profile science journals. As I have said many times before, the risks of herbal medicine are often blown way out of proportion, while the corresponding high risks of certain pharmaceuticals always seem to be "acceptable in light of their potential benefits." Every medical intervention carries risk, but when viewed against the huge number of drug reactions per year (20,000+ people die every year from NSAIDs such as Advil or Tylenol) the small number of reactions to herbal medicines (mostly allergic type reactions) appear to be over-exaggerated as part campaign of deception. Thanks to my colleague Rick Kirschner for recently mentioning this article.

Take it from me: After more than a decade of similar treatment, I know one of these campaigns when I see one.

BMC MEDICINE

ABO Blood Group and the Risk of Pancreatic Cancer

In two large, independent populations, ABO blood type was statistically significantly associated with the risk of pancreatic cancer. Further studies are necessary to define the mechanisms by which ABO blood type or closely linked genetic variants may influence pancreatic cancer risk.

Comments:

This study was extensively publicized in the media, and while welcome as yet another link in the under-explored relationship between blood group antigens and cancer (see my 'Verisimilitude' lecture), these results have been reported in earlier studies (as well as similar results in bile duct cancer).

More interesting to me is the link between ABH secretor status and the predictability and reliability of the most common tumor marker test for pancreatic cancer. This tumor marker, called CA19-9, is variable based on ABH secretor status, yet this fact is virtually unknown in oncology.

PUBMED

Involvement of intestinal alkaline phosphatase with ABO and secretor blood group types

These results indicate that IAP is strongly involved in chylomicron formation and fatty acid metabolism might change among ABO blood type. In addition, ABO blood type classification in apoB-48 measurement would improve the diagnostic value in the evaluation of metabolic syndrome.

Comment:

Tom Greenfield wrote about this study a few years back, but I wanted to bring it back since, like most studies of this sort, it has gone completely unnoticed by the nutrition communinty at-large. IAP is an enzyme implicated in transcellular transport of chylomicrons, large molecules that transport dietary lipids from the intestines to other locations in the body. Since 1966 it has been known that this enzyme varies among ABO blood groups and secretor status, with type O secretors having the highest amount and A non-secretors the lowest. Since IAP is critical for breaking down dietary cholesterol and enhancing the assimilation of calcium.

This calls into question the so-called 'Bone Hypothesis,' a long-treasured argument of vegans and dietitians everywhere, that dietary protein (especially from animal sources rich in the sulfur amino acids) should increase acid production in the body, and that in response to the acid load induced by a high animal protein diet, bone may be called upon to act as a reservoir of alkali using bone calcium as a buffering source.

As the theory goes, the long-term consequence of this reliance on bone to buffer the endogenous acid would be increased rates of skeletal loss and a decrease in bone mineral density. The hypothesis would also predict that a long-term, high protein diet would increase fractures.

However, in a recent study it was found that:

Studies conducted over the past 8 years in our laboratory call the traditional high protein bone hypothesis to question. We have found that a high protein diet induces high levels of urine calcium primarily because it increases intestinal calcium absorption. Second, a low protein diet acutely reduces intestinal calcium absorption, resulting in an abrupt rise in serum parathyroid hormone.

PUBMED

No only is IAP induced at high levels in blood group O individuals by a protein diet, one can expect it to increase bone density in these people. Not only that, evidence exists which indicates that the physical expression of the blood type A antigen appears to turn off IAP in the intestinal tract.

We found that red cells of blood group A bind almost all intestinal alkaline phosphatase; erythrocytes of blood group B or O to a much lesser degree. This is in accordance with the fact that intestinal alkaline phosphatase is found more frequently in the serum of individuals of blood group O or B than in serum of persons of blood group A.

PUBMED

I challenge anyone who still clings to the idea that blood groups have no scientific role in dietary personalization to respond to these basic facts.

It comes down to this simple challenge: Either put up or shut up.

From Percept Mot Skills. 2008 Dec;107(3):737-46.

Twin and family study findings indicate a substantial heritability of digit ratio (2D:4D), a putative marker for the masculinizing effects of prenatal androgen exposure. Functional polymorphisms of the X-linked androgen receptor gene, i.e., androgen sensitivity, contribute somewhat to the expression of 2D:4D in men, but otherwise the genetics of 2D:4D is unknown. This study investigated differences in 2D:4D by self-reported ABO blood type and Rhesus factor, two easily collectible genetic traits, in two samples (combined N=1273). Effects of blood groups on 2D:4D were small and not significant in all tests in both samples; however, two consistent patterns emerged across samples. Of the ABO types, AB had the lowest right-hand 2D:4D, the highest left-hand 2D:4D, and the lowest right-minus-left difference in 2D:4D, and Rhesus factor Rh- had higher left-hand 2D:4D and lower right-minus-left difference in 2D:4D than Rh+. If replicable, this may suggest genes contributing to the expression of 2D:4D reside in the vicinity of the gene loci (chromosomal locations: 9q34.2 and 1p36.11) of these blood groups or pleiotropic effects of the blood-group genes.

PubMed Link

As if I needed further convinced that epigenetics (the control of gene expression through nutrition) is the great wave of the future, a pre-publication results of a study released to members of The Epigenetic Society should satisfy for quite a while.

In a study soon to be published in the Journal Biological Psychiatry, researchers looked at the epigenetic effects of childhood maltreatment and early trauma. Using laboratory rats (whose epigenetic mechanisms are very similar to humans) the researchers exposed infant rats to stressed caretakers who predominately displayed abusive behaviors.

They found that early maltreatment produced persistent changes in the methylation of a gene called BDNF (brain derived neurotrophic factor) that is responsible for the developmental health of the cerebral cortex.

In addition, they observed disturbed BDNF methylation in the offspring of females that had previously experienced the maltreatment regimen, indicating that the epigenetic effects of abuse, trauma and neglect were carried from one generation to the next.

The GenoType Diet carries the promise of a genetic redemption of sorts, since as in the words of one researcher “Unlike defective genes, which are damaged for life, methylated genes can be demethylated. And, methyl tags that are knocked off can be regained via nutrients, drugs, and enriching experiences.” (2)

1. Tania L. Roth TL, Farah D. Lubin FD, Adam J. Funk and J. David Sweatt. Lasting Epigenetic Influence of Early-life Adversity on the BDNF Gene. Biological Psychiatry, In Press
2. Asim K. Duttaroy Evolution, Epigenetics, and Maternal Nutrition 2006 Darwin Day Celebration.