Category: Personalized Medicine
Spent the last two weeks in feverish rewrites of The Genotype Diet. The results appear to be a manuscript that is tighter, better organized and much less 'difficult' to decipher for the average layperson. Very readable, in fact. Something that my new masters at Random House care (not unexpectedly) very much about.
A lot of credit for this must go to Rachel Kranz, who has come in at the eleventh hour and really polished up the work. Rachel has done a lot of good writing (The Chemistry of Joy and the The Fat Resistance Diet are two books that many people are aware of. So now the manuscript is back at Random House editorial offices and I'm hard at work at finalizing the prescriptive parts of the book.
To do that, I wrote a program to help me sort out the myriad factors that are associated with the food values in the Genotype Diet. How different are things from the of Eat Right For Your Type days, where things were just kept in notebooks! For this book, I condensed huge amounts of information into massive data files. These include, to name a few, the mammoth USDA SR19 Nutrient Database and most of it's adjuncts (such as the proanthrocyanidin, isoflavone, flavone and choline metabolites); all of the Lecster lectin database; all of the BTD values, all available data on food contamination, allergens, chitinase, pesticides, carbohydrate breakdown values, etc.
Putting the data together was just part of the job. A lot of this I could do with judicious use of textfiles, databases and spreadsheet editors. After that I still had to write a program, essentially de novo, that could scan that data and derive conclusions that I was interested in. This I did with the D'Adamo Diet Equalizer a tool that allows me to zoom in on specific nutrients and filter them in and out of my equations.
The idea came from working in my home office and listening to iTunes a lot. Every once in a while a song comes up that just requires a little tweaking to get it to sound right. Normally you do this with a device called an equalizer; a series of sliders that filter out parts of the audio spectrum. At one point I was adjusting the built in equalizer in iTunes for the song listed above (a very good approximation of pre-ambient Brian Eno, if truth be told) when it occurred to me that it might just be a cool idea to write a program that used the equalizer interface to filter my data for The Genotype Diets. Thus the D'Adamo Diet Equalizer:
The stuff on the top are switches that filter specific choices; i.e 'restrict all foods which are avoids for blood type AB non secretors and have a high glycemic index" or 'include all grains which don't contain gluten or gliandin which are neutral or beneficial for type O secretors'. That kind of stuff is simple enough to do in Perl and HTML. However, developing the next series of filters, the slider channels, was more difficult, since browsers and HTML don't have a provision for slider-type input. However, I did find a nice Java applet that solved the problem. This part of the software works by allowing me to move the slider up or down and then letting it adjust the choices based upon falls within that range. For example, if I move the sider up it might include all foods with creatine content above 4 mg per 1 cup serving, or restrict all foods which have greater than 350 mg sodium per cup if I move it down. Problem here is that food values vary considerablly between foods. If I make the top of the slider full value the highest value in the database things can get screwy. For example, the highest value for sodium in the database is (perhaps no surprise) salt. It has something like 35000 mg of sodium per cup. Second place is not even removely close. Thus if the top slider number (+50) was just the highest value (salt), all the other values for normal foods would probably lie between 0 and 1. Although this is how a lot of the online nutritional databases present the data, in this form it is not very useful. Fortunately I was able to use a few log functions to spread out the data till it was silky smooth.
It's a cool tool and like any craftsman, I take some pride in the quality of the presentation as well. Actually perhaps too much pride since I eventually have to stop playing with the thing and go to work. The DDE turns out to be very useful in the Clinic, especially when I have to do a quick tweak on a patient who is already following the basic SWAMI program.
Hopefully by IfHI 2007 I'll be in a position to let the folks there tinker with it.
As for the readers of the GTD, they'll see nothing of this. Just a beautiful stretch of road where the gorgeous scenery just seems to go on forever.
Writing, writing, writing. However, at least recently, it has been rather enjoyable. Like you might hurriedly turn the page of a good novel to see what is going to happen next, so I write The Genotype Diet -often rushing home after karate class or some other engagement just to get back to work and see what might organically follow what I had previously written. It may (or may not) surprise you when you read it, since it turns the entire field of nutrigenomics upside-down, substituting a low-technology, DIY approach for any and all of the high tech glossy stuff that passes for the field nowadays.
Now, I have no gripe with labs and lab testing, but as John Bastyr used to say almost three decades ago when one of us student clinicians would pony up with the latest sophisticated panel, "That's nice, but tests don't get anybody better."
A while back a lawyer friend showed me a very old cartoon of a cow, with one man holding the tail and another holding the horns. The guy holding the tail was labeled "plaintiff" and the guy holding the horns was labeled "defendant". In between, milking the cow, was a third guy, labeled "attorney".
Labs are sort of like that. The doctor looks intelligent and busy, the patient feels that something important is happening. But in reality, nine times out of ten, the only real winner is the lab. I'm constantly amazed at the reams of testing information that typically accompanies a new patient, and how often these tests would appear to have had no basis for being ordered in the first place. Wouldn't the patient have been better off getting a new sweater or some slacks rather than to be left with a photostat of some normal lab values --which most of the time no one bothers to explain to them anyway-- or to have paid good money for spurious or even questionable testing?
Also guys, c'mon, dump the normal test results from a decade ago. Although they may mean something to you, a normal lab result older than about six months is just about worthless to your doctor and forcing him or her to peruse them is apt to just cause something important to be missed. It's nice that your urine was healthy in 1986, but frankly, we're not very interested in that.
You'd think alternative doctors would be less seduced by fancy-pants testing but it seems to me that they are often more likely to order them. Perhaps it is some sort of insecurity, or a desire to look "doctorly". On the allopathic front, how many tests are ordered just so that if things come to some sort of litigation, one's proverbial gluteus maximus is covered. Of course the fact that Big Brother Insurance pays for it all adds to the carnival atmosphere.
I met a new patient recently who had reams of tests including the two most recent which showed a gradually increasing white cell count. However, apparently nobody had paid any attention to this. At first I thought it could be some sort of low grade infection, since she was a B non-secretor. But over the course of the interview she referred several times to a twinge on the right side of the abdomen, which made me think of perhaps a low grade appendicitis flare up. Nine times out of ten these resolve with a change in diet and supportive care, and right then and there nothing more needed to be done, so I just advised her to look for signs of an escalating problem, such as fever or severe cramps, and move on them.
Frankly, I think the over-reliance on obtuse lab testing erodes the doctor-patient relationship. Most patients would do better with a dose of reality, especially when it comes to an appreciation of their limitations.
In clicking on the link today, I saw this story highlighted from the NY Times:
"Despite promising discoveries and multibillion-dollar investments, cancer research is quietly undergoing a crisis. Few drugs are being marketed, and most of those that have been introduced are enormously expensive and provide few of the benefits that patients expect. Officials of the Food and Drug Administration suggest that the failures may result from an obsolete testing system.â€?
Any adult with half a brain could have, and probably already has, arrived at the same conclusion. We are in a scientific quagmire of our own design.
"Although every field has suffered, cancer has had the greatest chasm between hope and reality. One in 20 prospective cancer cures used in human tests reaches the market, the worst record of any medical category. Among those that gained approval in the last 20 years, fewer than one in five have been shown to extend lives, life extensions usually measured in weeks or months, not years.â€?
"True cancer cures are still exceptionally rare. Medicines have been approved for colorectal cancer. Patients who take every one of the high-tech drugs has to spend, on average, $250,000, suffer serious side effects and gain, on average, months of life, according to studies.â€?
Here's another interesting fact: There has not been a significant new development in antibiotic therapy in over two decades, yet we have probably over twenty different drugs that your doctor can prescribe to lower your cholesterol.
Ever wonder why?
Well, it is simple math. Getting a pharmaceutical house interested in researching a drug that people take for a week is less likely to excite the in-house accountants than a drug that people take for the rest of their lives.
Add to that the increasing drug resistance seen to virtually all antibiotics and we have a formula for disaster. Thirty years ago, I remember Dr. Bastyr turning to me during a clinic shift and muttering that '"these things are not going to work forever" after we had examined a child who was on his seventh different antibiotic for a slew of ear infections.
In my early years of practice, I worked with Dr. Jules Harran, an archetypical kindly Jewish Brooklyn neighborhood MD, who often regaled me with stories of his medical years in the army during World War II. Dr. Jules was fond of recounting how 10,000 units of penicillin would completely erradicate a case of venereal disease back then, compared to the often ineffectual doses of over several million units used nowadays.
Natural product research? Forget about it. Going nowhere. As one Drug Company researcher told me in a blunt aside during a conference at which we both were presenting: "We're not interesting in things people can grow on their window boxes.â€?
The harsh reality is that in current day dynamics, doctors prescribe drugs developed by the pharmaceutical interests based upon sophisticated market analysis, and which have their path to market cleared by pharmaceutical insiders that flit back and forth between jobs at the drug companies, academia and the federal regulatory agencies. This is then parsed to the insurance interests, who bestow further scientific credibility by agreeing to pay for the whole thing.
Reminds me of a quote from the famous English artist William Hogarth:
"The sad thing about the ancient physicians is that they attempted to make medicine an art and failed; but the even sadder thing about our modern physicians is that they have attempted to make medicine a business, and have apparently succeeded."
Received my complementary copy of the Textbook Of Natural Medicine edited by my friend and mentor, Dr.Joseph Pizzorno. It was a real treat to see how well the new chapter on the Non Transfusion Significance of Blood Type (that I authored for this new edition of the Textbook) looks on real paper. I'm very happy with the information, which is clear and up to date. As far as I know the only new information on blood types that did not make this article was the association reported between blood types and p-glycoprotein that I had written about in an earlier blog. If you work with natural medicines, or just want the most authoritative reference work on the subject, you'll probably want to invest in a copy of the Textbook.
Hey, today is the winter solstice, first day of winter, at least for all of us on the upper half of the planet. Enjoy the next few days, in whatever manner works for you!
I've been researching P-glycoprotein, a membrane glycoprotein that is associated with resistance to a variety of drugs, including many chemotherapy drugs used in cancer. There is evidence that p-glycoprotein levels can can be expressed up to seven times more numerously in tissues of individuals who are blood type A which may go along way towards explaining why it appears that type A's with cancer who receive chemotherapy often do not have as beneficial an effect as the other blood types.
Obviously finding ways to modulate P-glycoprotein would be very desirable, especially if they could be administered during chemotherapy. So far there appears to be a variety of flavones and alkaloids found in nature that up-regulate or down-regulate P-glycoprotein, so perhaps a nutritional application may be possible. Much more work is needed, but from the biochemical aspect, it is quite fascinating. From a broader perspective, the potential that P-glycoprotein inhibitors may have for the treatment of various immune disorders should also be investigated.