This Transfusion: Parachutes and death from gravitational challenge | Hawthorn and heart disease | Blood group A and ovarian hyperstimulation syndrome | Rh blood group and hearing loss | Epigenetics, diet and super oxide dismutase (SOD)

Welcome to The Weekly Transfusion, 1.5 for the week of April 13, 2009.

Insufficient evidence for parachute use to prevent death and major trauma related to gravitational challenge

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Article Link

Comment:

Evidence based medicine is the buzz-phrase of the moment, the idea being that you scour the medical literature on a particular association,for example using the herb Hawthorn to treat chronic heart failure. You set the selection criteria, such as the type of study (placebo controlled, etc.) and the amalgamate the data. Evidence Basis has some very important advantages, namely that it gives the most accurate current assessment of a treatment or strategy since you are pooling all the available data.

One problem with evidence based medicine is the simple reality that evidence and benefit are not always the same thing. As shown by this slightly tongue in cheek study, there is still an insufficient evidence basis to conclude that parachutes are effective in preventing major trauma related to gravitational challenge. The researchers failed to find suitable studies showing the effects of using a parachute during free fall, despite setting logical criteria (death or major trauma, defined as an injury severity score > 15) and scouring he available literature.

Setting artificial standards can also impeded the workings of common sense: Edward Murphy put it best in his classic The Logic of Medicine: 'Only a fool would require a double-blind study to see if it was raining outside.'

Lack of evidence is not evidence of lack.

Evidence based medicine has potential to revolutionize day to day health care. However I think an even bigger revolution lurks under the surface: The reinterpretation and reorganization of medical facts derived under the older 'disease-care paradigm' by evolving paradigms that better fit new real-world circumstances.

A common argument against the need for heterodoxy in medicine is that 'when facts are proven, they stop being alternative.' This may well be true, but it neglects that facts themselves are forever open to reevaluation, deconstruction and recycling. Much of my work with the ABO polymorphisms was the simple reappraisal and restructuring of the conventional biomedical literature on the subject --but done with an eye to its ulterior benefits in naturopathic circumstances. Had they not been subjected to the 'naturopathic lens' these facts may well still be floating in their own splendid isolation.

Hawthorn extract for treating chronic heart failure

For the physiologic outcome of maximal workload, treatment with hawthorn extract was more beneficial than placebo... Exercise tolerance were significantly increased by hawthorn extract... The pressure-heart rate product, an index of cardiac oxygen consumption, also showed a beneficial decrease with hawthorn treatment... Symptoms such as shortness of breath and fatigue improved significantly with hawthorn treatment as compared with placebo...These results suggest that there is a significant benefit in symptom control and physiologic outcomes from hawthorn extract as an adjunctive treatment for chronic heart failure.

Article Link

Comment:
I first wrote about Hawthorn (Crataegus spp.) in my book Eat Right For Your Type over thirteen years ago, making specific reference to its benefit for blood group A individuals with cardiovascular problems. In general the plant has a good track record, especially, if used in quite low doses for extended periods of time. The herb seems to allow cardiac patients to derive extra benefit from exercise (link), has some very nice effects on the artery lining (link) and has been shown to lower blood pressure in patients taking diabetic medication. (link)

Hawthorn was shown to be well tolerated and safe. However, it should not be used as a substitute medication in circumstances of active heart disease or concurrently with other cardiac medicines unless under the supervision of a physician trained in its use. In one study, it actually seemed that the hawthorn group had a worse outcome than the placebo group. (link) Hawthorn also does produce occasional side-effects, though they appear uncommon and rather mild.(link) Perhaps this is the darker side of the biochemical individuality revolution; it's no longer acceptable to claim that all natural products are safe in every person. Anything that can add to the personalization of herbal recommendations can only help to increase their safety profile.

Blood type A women get more complications from fertility treatment

Ovarian hyperstimulation syndrome is a potentially life-threatening complication during controlled ovarian stimulation for fertility treatment. Since no association of this condition with ABO blood groups was known, we compared ABO antigens with severity and onset of symptoms in a case-control study...The odds ratio for patients undergoing controlled ovarian stimulation with blood group A versus O to develop the early-onset form of this condition was 2.171 (p-value 0.002). Blood group A may be associated with early-onset ovarian hyper-stimulation syndrome in Caucasians...This possible association may be considered for an individualized hormone dosing in controlled ovarian stimulation.

Article Link | Article Link

Comment:
Ovarian hyperstimulation syndrome (OHSS) is a complication from some forms of fertility medication. Most cases are mild, but a small proportion is severe. Symptoms can range from a more mild form that includes abdominal bloating and feeling of fullness, nausea, diarrhea, and slight weight gain to a more severe form that includes and fullness/bloating above the waist, shortness of breath, urination significantly darker or cessation of urination altogether, calf and chest pains, marked abdominal bloating or distention, and lower abdominal pains. This study looked at 127 Caucasian patients hospitalized because of ovarian hyperstimulation syndrome after receiving in vitro fertilization, in the period from January 2000 to February 2007 and found that blood group A was markedly more frequent and blood group O less frequent in patients with ovarian hyperstimulation syndrome.

Other studies have found a slightly greater incidence of ovarian cancer in women who are blood group A (link) and blood group antigens (as mucins or 'blood group substances') are known to be richly deposited on ovarian tissue. (link) Hopefully fertility specialists will consider individualizing hormonal treatment by blood group when working with fertility patients.

Four patients developed thrombosis (clots) in the jugular or subclavian vein, none of whom had blood group O; this correlates with earlier studies linking blood groups other that type O with an increased risk of thrombosis (link) at some of this clotting may in fact be due to enhanced sensitivity to estrogen, at least in women who are not blood group O.(link)

What was that? Being Rh positive may increase your risk of hearing loss

Noise-induced hearing loss (NIHL) is one of the most common occupational problems and is one of the main causes of deafness. Many factors cause NIHL. Individual susceptibility is one of them. Rhesus (Rh) antigens and ABO blood groups can be factors in determining individual susceptibility. In conclusion, we suggest that the people with Rh-positive blood group are more prone to develop NIHL.

Article Link

Comment:

The researchers looked at factory workers who had been exposed to a noise level more than 85 dB for 8 hours a day for a period of over 15 years. Two hundred and nineteen (55.4%) of Rh-positive workers and seventeen (39.5%) of Rh-negative workers have noise-induced hearing loss, and the difference between the two groups was statistically significant (P < 0.05). There was no link between hearing loss and ABO blood type.

If you are a rabid reader of this blog, you'd immediately notice that these results are just ever-so-slightly statistically significant (and not be much of a discovery) since given enough noise, virtually anyone will develop hearing loss. However we could speculate that something in being Rh positive influences the structure of the ear anatomy to make these people more likely to get hearing damage. Or on the other hand, what is it about being Rh negative that makes these people less likely to get hearing loss?

An earlier study with infants and adults also showed a higher incidence of hearing loss in Rh positive people, with a slightly better level of significance (0.01) if the mother was Rh negative blood type (which might support the idea that the problem would then be seen in the incompatible Rh-positive children). Another maternal influence via blood group!

Diet influences epigenetic regulation of super oxide dismutase (SOD) gene

The impact of nutrition on the epigenetic machinery has increasingly attracted interest. The aim of the present study was to demonstrate the effects of various diets on methylation and gene expression. The antioxidative enzyme mitochondrial superoxide dismutase (MnSOD) was chosen as the model system because epigenetic regulation has been previously shown in cell lines for this gene. A 3-fold increase in the expression of the MnSOD gene was associated with decreased CpG methylation of the analyzed promoter region in the vegetarian group compared with the age-matched omnivores group. These results indicate that diet affects the epigenetic regulation of human MnSOD.

Article Link

Comment:

The super oxide dismutases are a class of enzymes that catalyze the conversion of free radical superoxide molecules into oxygen and hydrogen peroxide. They are an important antioxidant defense in nearly all cells exposed to oxygen. SODs 'outcompete' healthy tissue for the damaging free radical molecules. They protect the cell in a way reminiscent of a common scene in the the old Laurel and Hardy movies where two soldiers in a trench hoist a helmet on a stick above their heads and then retrieve it having been shot full of bullet holes. Although SOD supplements are a common item on health food store shelves, oral SOD products are completely destroyed in the gut, so methods to increase the native (endogenous) production in our own cells would be optimal.

Epigenetics is best explained as the 'non-genomic' or 'post-genomic' control of gene expression, mechanisms such as DNA methylation, or histone acetylation, which act a 'volume controls' on the ability of the cell to read the section of DNA that contains that gene. In the case of this study, the vegetarian group has less methylation on the CpG section of promoter region of the SOD gene.

In English, what they are saying is that diet removed some of the restrictions (methyl groups) on the part of the gene that activates it (the promoter region). Removing methyl groups usually takes the brakes off a gene, especially when they are in the gene's cystine-rich 'front.'

Exciting stuff. Now we'll need to see exactly which specific foods have the maximum epigenetic effects on SOD.

Until next week.

Note to readers: By mistake I had uploaded an earlier, non-spell-checked version of this entry on Monday. I beg your indulgence on this matter. Although I am a reasonably good speller, if truth be told I am a terrible typist.

Welcome to The Weekly Transfusion, 1.4 for the week of April 6, 2009.

Editorial: Medical journal statistics for autodidacts

You can become a better consumer of health information if you take the time to read the research source material (i.e the scientific publication in which the original claim was made). Of course if the study is technical you can see quite a bit of jargon that you may or may not understand. However many medical terms are widely understood and where you bump up against the odd phrase or name that you don't comprehend, there are usually places on the Internet where you can find simple, easy to understand explanations. Wikipedia is actually pretty good for this type of look-up, as long as the subject at hand is not controversial.

However, methodology and monikers aside, most scientific studies distill down to a simple testable premise which is easily understand by almost anyone. Did the medicine work? Was the association between this gene and that disease valid? Past asking the question, what is needed next is to look at and gauge the value of the answer. Surprisingly, even though this is usually some sort of statistical type of answer (and most laypeople are not well versed in statistics) once you know what to look for, you'd be amazed just how easy it is to evaluate most studies.

Most research studies feature a subsection entitled Results or Conclusions. It is here that the results are most often given. There are many way of calculating statistical significance, but the premise is quite simple: What is the chance that the thing we just observed/ hypothesized was random versus the odds of it being due to the relationship we are studying. This is known as probability and in statistics is usually called the P value. To find out just how significant the results of any study are, just look for the P value. The smaller this number is, the less likely the results occurred by chance. Put another way, the lower the P value the more likely you'll want to view the results as significant or important.

The great Ronald Fisher viewed P values as measures of the evidence against a hypotheses, sort of like how a prosecutor presents a case based on exceeding the jury's sense of 'reasonable doubt.'

Now for the secret (OK, not so secret) key to taking control of the medical facts in your life: The standard level of significance used to justify a claim of a statistically significant effect is when P is equal to or less than 0.05; in essence, a one-in-twenty chance that the result had nothing to do with your hypothesis.

For better or worse, the term 'statistically significant' has become synonymous with P<=0.05.

So when looking at any published results, always look for the P value and if it is greater than five cents on the dollar (0.05) you'd probably want to ignore that results (unless the premise of the article was that the researchers failed to show a relationship, which is of course just another type of observation; however, these types of studies usually don't make it out of the researcher's file cabinet) or take a look at the methodology behind the study (scientists are human; studies can be poorly designed and the conclusions derived may not have been the best test of the hypothesis).

So, P<0.05 means the results are significant, but just barely. Good enough to convict, but also likely to send a few innocent people to jail as well, since there are still strong indications that the hypothesis fails to account for the whole of the facts. Personally I like to see P values of at most 0.01-0.02 before I get excited about anything I'm reading. However I do make exceptions for studies with small numbers of participants, or if the we're dealing with an herb or vitamin where the effects studies may be slight or slow to surface.

Oftentimes you'll see P values with lots of zeros. That means they've found a more statistically reliable result. For example, the P value in the following article is P<0.001. This actually means that there 1 in a 1000 chance of the result being a random occurrence and a 999 in 1000 chance that the result was related to the premise of the study.

Just remember, look for at least a P<0.05. That means the results were statistically significant. Beyond that the more zeros you see in the P value, the better. Try your new-found statistical powers on the articles below. Look for the P values in the studies. What do they signify?

Now that you can evaluate scientific material at its source, you'll be less likely to fall for the 'man bites dog' con-jobs that are all too commonly reported in the news or as what passes for scientific discussion these days.

Resting heart rate as a low tech predictor of heart problems in women

In a large, diverse group of postmenopausal women, resting heart rate was an independent predictor of coronary events, with higher heart rate associated with greater risk. The relation between resting heart rate and risk of coronary events was stronger in younger postmenopausal women than in older ones. Resting heart rate did not independently predict stroke.

In general, age, body mass index, and saturated fat consumption were higher and cardiovascular risk factors such as hypertension, diabetes, smoking, hypercholesterolaemia, and depressive symptoms more prevalent in women with higher resting heart rate, as was self reported nervousness. Physical activity and alcohol use were inversely related to heart rate (both P<0.001), and heart rate was lower in women who used postmenopausal hormone therapy than in those who did not (P<0.001).

Article Link

Comment:

One can't argue that this is about as low tech a predictor of future health problems as one is likely to find. It has already been shown that resting heart rate predicts coronary events in men. For women however, the relation between heart rate and coronary events or stroke has been uncertain. The study broke the participants into groups including a 'high heart rate group' whose heart rate was greater that 76 beats per minute and 'low heart rate group' whose heart rate was greater than 61 beats per minute. The association with 'coronary events' (aka heart attacks and death). This association appears stronger in women aged 50-64 than in those aged 65 or older

Being overweight makes you age faster

Obesity and weight gain in adulthood are associated with an increased risk of several cancers. Telomeres play a critical role in maintaining genomic integrity and may be involved in carcinogenesis. Using data from 647 women ages 35 to 74 years in the United States and Puerto Rico (2003-2004), we examined the association between current and past anthropometric characteristics and telomere length in blood. These findings support the hypothesis that obesity may accelerate aging, and highlight the importance of maintaining a desirable weight in adulthood.

Article Link

Comment:

A telomere is a region of repetitive DNA at the end of chromosomes, which protects the end of the chromosome from destruction. When DNA needs to be read (to replicate itself, or generate RNA so as to begin coding proteins) a problem arises in that the enzymes that duplicate the chromosome and its DNA cannot continue their duplication all the way to the end of the chromosome. They need a blank area to 'park' much like the cassette tapes of days past had white 'leader tape' at their front and the back so that the tape head did not start in the song itself. Unlike cassette tape, every time DNA reproduces, a bit of the white leader tape, the 'telomere' at the end, is frittered off and has to be replaced. Telomeres and replenished by an enzyme, the telomerase reverse transcriptase. Telomeres protect a cell's chromosomes from fusing with each other or rearranging - abnormalities which can lead to cancer - and so cells are normally destroyed when their telomeres are consumed. In the women studies for this article, those having a higher body mass index (BMI) in their 30s were associated with shorter telomere length in their 40s (P < 0.01).

I suspect some of this association is epigenetic, and points again to the fact that the GT5 Warrior epigenotype may well need to get their weight profile optimized early in life and be increasingly calorie conscious as they age.

Vitamin D, adult-onset diabetes and metabolic syndrome

Vitamin D is a potent immunomodulator that also enhances the production and secretion of several hormones, including insulin. Vitamin D deficiency has been associated with increased risk of type 1 diabetes. Glycemic control and insulin resistance are improved when vitamin D deficiency is corrected and calcium supplementation is adequate.

Article Link

Comment:

More and more information is surfacing about vitamin D (actually more of a hormone than a vitamin) and insulin resistance. Studies consistently show that vitamin D levels in both North America and the Pacific are typically lower than optimal. In the USA , most vitamin D intake from foods is provided by fortification. Canada and New Zealand have fewer fortified choices, and intakes are correspondingly lower. The mechanism of action of vitamin D in adult onset (type 2) diabetes is thought to be to its role in the control of plasma calcium levels, which help regulate insulin synthesis, but may also be the result of vitamin D stimulating the insulin secreting (beta) cells of the pancreas directly. If you have a history of metabolic syndrome or adult onset diabetes in close family members you may want to consider adding vitamin D to your supplement regimen. However, make sure that you do it in partnership with a nutrition professional.

One from the vaults: Mom's blood type can influence child's risk of Strep (1978)

In a prospective study of maternal genital colonization with streptococci at the time of delivery, epidemiological data, including blood type (ABO group), were recorded for the 1,062 patients studied. Blood type B was found in a statistically significant (P <.005) higher proportion of patients colonized with streptococci (28%) compared with the total population (16.4%)

Article Link

Comment:

Evidence suggests that probiotic supplementation does change the vagina flora of women. Since it appears that the route of transmission of Streptococcus is from the birth canal, physicians should recommend probiotic supplementation for pregnant women beginning 3-4 weeks prior to expected date of delivery as a way to prevent streptococcus infection in neonates. This should be especially emphasized if the mother is either blood group B or AB.

This study again illustrates the fact that some of the best ABO correlation studies are outside the purview to today's physicians, most of whom would tell you that any research from 1978 is better suited to a history class than to any thing taught in medical school.

Since Mother's Day is fast approaching, also remember that recurring otitis media (ear infections) is strongly associated with the child's mother being blood type A. In fact the correlation here is quite startling. Children of mothers who are blood type A are twenty seven times more likely to get a second ear infection within one year of contracting the first. To give you an idea of just how strong this association is, look at the chart below to compare the RR (relative risks) of a few other disease/ lifestyle links.

Update: IfHI 2009

Just a quick word to the wise about the IfHI Conference, Norwalk Connecticut, June 5-7. We had run out of available rooms at the Dolce Center Campus. However 10 additional rooms have just been made available. Unlike previous conferences, where attendees could book almost to the day of the event, IfHI 2009 looks like it will be completely booked by the middle of May, a full month before the event. If you are planning on attending, either for certification or just personal enrichment, please make your reservations ASAP, especially if you want to stay overnight on campus.

Until next week.

As is typical of this time of year, it’s been a very active time for your humble physician-author-blogger.

January started off with a whirlwind visit out to Arizona for a daylong presentation to the Arizona Naturopathic Medical Association. This was followed by a two week intensive period of website redesign, overhauling the website of The D’Adamo Clinic in addition to the navigation system for North American Pharmacal. The Clinic website is a simple white design that I like very much and it conveys what being inside the Clinic feels like to me. I’m not normally a fan of all-white walls, but in the Clinic it works.

The NAP redesign was much more challenging. Here the issue was to present a myriad of different links and categories in a way that did not alienate or confuse visitors. I had long admired the witty way that Apple uses to showcase their Mac computers, but was unaware of anyone other than Apple who used this widget. I suspected that the bright folks over there had conjured this up themselves. Googling around the Internet, I found a lot of threads speculating on how they did it, but no one seemed to have done it. My chance came when someone mentioned that Apple appeared to have built the showcase around a package of free JavaScript libraries called ‘Scriptilicious.’ After downloading and studying these scripts it became evident just how they did it. I’ll spare you the gory details, but it turns out that Apple did make a small coding mistake on their site, which, if you notice, prohibits them from using bulleted text on pages that use the product showcase. Maybe I’ll email them and alert them to this.

One problem you come across again and again when you program for the Internet is cross-browser support. I’ve learned the hard way that a web page that works and looks good in Firefox for the Mac may not necessarily look or work the same way in Internet Explorer for Windows. Many, many times it’s been a last minute check on an outdated browser running Windows 95 that kiboshed a terrific idea.

Putting the final touches on the SWAMI software. I’ve decided to port it to two platforms. One will be the traditional SWAMI GenoType for professionals, the other will be a SWAMI Xpress that will be available online. Introduction of the SWAMIGenoType will be linked to the IfHI 2009 Conference, where Tom Greenfield, Natalie Colicci and I will have the time to take the attendees through the interface, filters and matrices. If you are a physician or IFHI certified educator planning to use SWAMI GenoType in your practice, you’ll need to attend IfHI 2009 to get the full training.

SWAMI Xpress will contain all the base programs of his more muscular brother, but is being designed for general-purpose use. SWAMI GenoType has advanced filters and controls that allow a physician to exert complete control over the client diet and is geared to practitioners who want to have a more micrometric control over things. Introduction of SWAMI Xpress will be as part of NAP’s “Do It For A Month” program.

On the lecture horizon, I’ve got a webinar with the Massachusetts College of Pharmacy on March 31 and an upcoming Grand Rounds presentation at the University of Bridgeport College of Naturopathic Medicine on February 11. After that things calm down until the IfHI 2009 Conference June 5. IfHI should be challenging. I’ve scheduled myself for something like 9 hours of lecture time, and if you could believe it I’m stressing out about not having enough time to do justice to the material. Figured out how to control my slide show from an iPhone, which is very cool. I should be able to pace around the room and use the iPhone to cue the next slide.

After completing a few movies/animations I’ll be pretty much done preparing material for the conference, leaving plenty of time to perfect the software and get the 1971 VW Camper ready.

Got lucky yesterday. Found a site that had the entire LP of the 1974 classic The Portsmouth Sinfonia Plays The Popular Classics available as a download. I certainly don’t support intellectual property theft but this album has never made it to CD and I think the original record label is now extinct. The Portsmouth Sinfonia is the ultimate ode to amateurism: Take a bunch of English art school students --who either cannot play a musical instrument or are willing to play one they are unfamiliar with-- and put them into an orchestra. The only rules being that you had to come to rehearsal and you could not purposely play the wrong notes.

What resulted were renditions of the popular classics (Peer Gynt Suite, The Blue Danube Waltz, The William Tell Overture, etc) in which the inexperience and lack of talent produces a series of acoustic near-misses that collect into this cloud-like approximation of what the proper pitch and notes should sound like. Popular classics were selected on purpose since everyone in the orchestra would know the music and could at least aspire to what the piece should resemble--or at the very minimum whether they should be sounding higher or lower pitched notes.

Here is their rendition of Blue Danube Waltz, Op. 314 (Johann Strauss)

Beethoven was supposedly fond of listening to amateur productions of his work, and I’ve often thought that this would be among the most perfect of medical education paradigms.

In addition to my feverish efforts to bring www.dadamo.com back into the Information Age ---the shoemaker's kids do in fact often lack shoes--- the so-called holiday week finds your humble blogger finally mastering the intricacies of Apple's wonderful Keynote presentation software. If like me you've always used PowerPoint, Keynote is indeed a revelation.

The purpose of using presentation software is to give presentations and my upcoming lectures in Arizona are providing the necessary threat-impetus.

At the request of the Arizona Naturopathic Medical Association (AzNMA) on Saturday, January 10, 2009 I'll be doing a total of four hours of lecturing to docs and a one hour public lecture (with a half hour reserved for questions and answers) at the Doubletree Paradise Valley in Scottsdale, AZ. If you are in the Phoenix area why not plan to stop by. I can promise you that the slide/multimedia/rumination presentation may well give old Al Gore a run for the money.

Any trip to Phoenix also affords the extra benefit of seeing our good friends Paul and Laura Mittman. I'm so proud of what Paul has accomplished at Southwest College.

Found this little unused snippet from the volumes of material that was prepared for The GenoType Diet but never used. Thought it might make for interesting reading.

The high water mark of hunter-gathering is often called the Mesolithic period ('Middle Stone Age') which began around 10,000 years ago and ended with the introduction of farming. The onset of farming differed from place to place, starting early in the Near East and much later in Europe. Hunter-gatherer technology reached its apex during the Mesolithic era; fishing tackle, stone adzes, canoes and bows have all been found preserved at various sites.

Popular culture tends to depict our Stone Age ancestors as crude, simplistic animals perpetually at the point of starvation. "Solitary, poor, nasty, brutish and short" as Thomas Hobbes had put it in 1651. Nothing could be farther from the truth. Though small in number, Paleolithic hunter-gatherers worked far fewer hours and enjoyed more leisure than typical members of industrial society, and they still ate well, satisfied with very little in the material sense. The transition from hunting and gathering to agriculture was not necessarily a one way process, and evidence seems to disprove any notion that hunter-gatherers were saved from extinction by the advent of farming technology. They seem to have been familiar with farming practices when it arose, but for the longest time simply rejected it, or used it as a marginal supplement to the diet.

As these late hunter-gatherer societies evolved, they began to develop specializations such as fishing and seafood collection, harvesting nuts and fruits, or trapping small animals. They often had simple forms of representative government, based around family or clan.

Perhaps it is not coincidental that the story of the Garden of Eden in the Bible shares some of the same elements in its storyline. Some anthropologists have hypothesized that the Garden of Eden does not represent a geographical place, but rather represents cultural memory of the simpler times of hunter-gathering, when man lived off God's bounty, as opposed to being civilized and toiling at agriculture.

A large percentage of the world's cultures have stories of a Great Flood that devastated earlier civilization. This flood is sent by God or the gods as an act of divine retribution to destroy civilization. Noah and the Ark in Genesis, Matsya in the Hindu Puranas and the Epic of Gilgamesh are among the most familiar versions of these myths, all of which divide prehistory into a pre-flood or Antediluvian and a post-flood world.

Certainly there were major changes to the planetary water table at the end of the last ice age, as melting waters for the rapidly diminishing glaciers would have caused the levels of the seas and oceans to rise about 125-150 feet, deluging and destroying many prior land bridges, such as that between Alaska and Siberia, and isolating many populations. The end of the last ice age was also accompanied by the mother of all volcanic eruptions as the movement of the African plate opened a fault-line under the Mediterranean Sea, creating a string of volcanoes that still exist, such as Vesuvius and Etna. There is some geological evidence suggesting that a massive prehistoric flood occurred around 8000 years ago as the Mediterranean Sea spilled into the present day Black Sea.

William Ryan and Walter Pitman, geologists from Columbia University proposed what came be called the 'Black Sea Deluge Theory' which hypothesizes that melting of the last great glaciers caused the rising Mediterranean to finally spill over a rocky sill at the Bosporus eventually flooding 155,000 square kilometers of land. Despite some supportive findings, the theory remains an active subject of debate among archaeologists.

Although by this time agriculture had already reached the plains of central Europe, the Ryan and Pitman linked its spread with farming people displaced by the flood. It has been suggested that the memories of these displaced survivors was the source of the Great Flood Legends.

This has been a busy time of things lecture-wise. Last month I lectured on 'Cancer Survivorship' at Backus Hospital in Norwich Connecticut, as part of their Fall Oncology Support Series. I really appreciate that Amy, the program coordinator (Center for Healthcare Integration) took the time to write a very nice thank you note:

Thank you so very much for the wonderful program you offered at Backus last week. Your use of metaphors to translate the scientific research is so effective and at the same time so much fun to listen to. I had many a-ha moments and between that lots of laughter. You are truly a gifted teacher.

It is a great support program from an imaginative hospital.

Immediately after this I lectured to a large group of doctors and nurses over at Soundview Medical Associates in Norwalk, Connecticut. This lecture was pretty much straight blood group science and physiology and despite some early technical glitches I was made most welcome, treated to an attentive and lively audience, and had a great time.

Early October featured a lecture at the Annual Conference of the New York Association of Naturopathic Physicians in Manhattan. This lecture was entitle 'Verisimilitude and Malignancy' and discussed how cancer systems often elude the immune system by posing as quasi blood type markers. Most naturopathic physicians were new to this type of information and as I looked out into the audience all I saw was a sea of heads pointed down as they furtively scribbled note after note.

At the conference I bumped into my old friend Dr. Russell Marz, one of the top naturopathic nutrition educators, whose 'Nutrition from Marz' is a standard nutrition text in the schools. Russell also write the nutrition reviews for NPLEX (the Naturopathic Licensing Exams). We're both expatriate New Yorkers and Russell always brings out the Brooklyn kid in me. Got a nice note afterward:

Good to see you and I just wanted to tell you how much I have appreciated your work. You really have created a whole new dimension in the field of nutrition and I believe especially in the area of cancer.

As I write this I'm preparing to leave for the airport and fly to Nashville, Tennessee for the first IFHI Micro Conference. I'll be lecturing for 3-4 hours throughout the day tomorrow. Hopefully the larynx holds up. Dr. Natalie Colicci is coming along to help with the certification, and tells me that she has already packed the lozenges.

After Tennessee things calm down a bit, which is great since I've discovered a few new veins of research that I want to pursue, and have just purchase a 1971 Volkswagon Bus that I am itching to restore.

Looming on the horizon is IFHI 2009, our biannual master conference. Unlike the prior 2005 and 2007 conferences I'll be doing most of the lecturing (something like nine hours total) by myself, with assistance from Drs. Tom Greenfield and Natalie Colicci. Again and again the feedback from prior conferences has been that, although the attendees have enjoyed the guest speakers, they would prefer that I spend more time on core curriculum and training. So here it is. I'm challenged by the idea of encapsulating an entire lifespan of work into such an information intensive format.

For the first time IFHI 2009 will be held on the east coast of the US (Norwalk Connecticut). It is close to our base of operations and affords a more easy access for the EU attendees, who comprise a rather large share of the audience. Proximity to NYC also allows folks to do some Manhattan site-seeing before or after the conference. Unlike prior conferences which held about 350 attendees, IFHI 2009 is limited to 125 on site and about 25 off site attendees. Also unlike the Buttes in Phoenix, the conference price is a 'soup to nuts package.'

I designed this little flyer for the conference. Almost prophetically it is the exact same model VW Bus that I'll be restoring. However my bus in in something over 1000 parts in over 50 crates.

I thought a recent abstract from one of the premiere nutrition journals did a pretty good job of catching up to, and explaining the theory behind The GenoType Diet:

Epigenetics encompasses changes to marks on the genome that are copied from one cell generation to the next, which may alter gene expression but which do not involve changes in the primary DNA sequence. These marks include DNA methylation and post-translational modifications (acetylation, methylation, phosphorylation and ubiquitination) of the histone tails protruding from nucleosome cores. The sum of genome-wide epigenetic patterns is known as the epigenome. It is hypothesised that altered epigenetic marking is a means through which evidence of environmental exposures (including nutritional status and dietary exposure) is received and recorded by the genome. At least some of these epigenetic marks are remembered through multiple cell generations and their effects may be revealed in altered gene expression and cell function. Altered epigenetic marking allows plasticity of phenotype in a fixed genotype. Despite their identical genotypes, monozygotic twins show increasing epigenetic diversity with age and with divergent lifestyles. Differences in epigenetic markings may explain some inter-individual variation in disease risk and in response to nutritional interventions.

Session 2: Personalised nutrition. Epigenomics: a basis for understanding individual differences? Mathers JC. Proc Nutr Soc. 2008 Nov;67(4):390-4.