Even USA Today is getting into the finger measuring business, though their recommended technique is not very accurate. And some of the more recent articles on epigenetics appearing in Medline are reading like sound bites for The GenoType Diet:
Medical practice patterns which are designed to provide quick and effective amelioration of signs and symptoms are frequently not an enduring solution to many health afflictions and chronic disease states. Recent scientific discovery has rendered the drug-oriented algorithmic paradigm commonly found in contemporary evidence-based medicine to be a reductionist approach to clinical practice. Unfolding evidence appears to support a genetic predisposition model of health and illness rather than a fatalistic predestination construct - modifiable epigenetic and environmental factors have enormous potential to influence clinical outcomes. By understanding and applying fundamental clinical principles relating to the emerging fields of molecular medicine, nutrigenomics and human exposure assessment, doctors will be empowered to address causality of affliction when possible and achieve sustained reprieve for many suffering patients.
-'Our genes are not our destiny: incorporating molecular medicine into clinical practice.' J Eval Clin Pract. 2008 Feb;14(1):94-102.
A wealth of evidence points to the diet as one of the most important modifiable determinants of the risk of developing cancer, but a greater understanding of the interaction between diet and genes may help distinguish who will and will not respond to dietary interventions. The term nutrigenomics or nutritional genomics refers to the bidirectional interactions between genes and diet. Nutritional genomics encompasses an understanding about how the response to bioactive food components depends on an individual's genetic background (nutrigenetics), nutrient induced changes in DNA methylation, histone posttranslational modifications, and other chromatin alterations (nutritional epigenetics), and nutrient induced changes in gene expression (nutritional transcriptomics). These approaches to the study of nutrition will assist in understanding how genetic variation, epigenetic events, and regulation of gene expression alter requirements for, and responses to, nutrients. Recognition of the interplay between genes and diet could ultimately help identify modifiable molecular targets for preventing, delaying, or reducing the symptoms of cancer and other chronic diseases.
'Nutritional genomic approaches to cancer prevention research.' Exp Oncol. 2007 Dec;29(4):250-6
Obesity and type 2 diabetes arise from a set of complex gene-environment interactions. Explanations for the heritability of these syndromes and the environmental contribution to disease susceptibility are addressed by the "thrifty genotype" and the "thrifty phenotype" hypotheses. Here, the merits of both models are discussed and elements of them are used to synthesize a "thrifty epigenotype" hypothesis. I propose that: (1) metabolic thrift, the capacity for efficient acquisition, storage and use of energy, is an ancient, complex trait, (2) the environmentally responsive gene network encoding this trait is subject to genetic canalization and thereby has become robust against mutational perturbations, (3) DNA sequence polymorphisms play a minor role in the aetiology of obesity and type 2 diabetes-instead, disease susceptibility is predominantly determined by epigenetic variations, (4) corresponding epigenotypes have the potential to be inherited across generations, and (5) Leptin is a candidate gene for the acquisition of a thrifty epigenotype.
'The thrifty epigenotype: An acquired and heritable predisposition for obesity and diabetes?' Bioessays. 2008 Feb;30(2):156-66.
Compared to other periods of life, infancy is a period of rapid growth, but the relative relationships among rates of linear growth, weight accretion and brain growth vary greatly during the first years of life. Additionally, while the energy requirements for body tissue deposition as a fraction of daily energy needs decrease dramatically during infancy, brain energy demands, measured as the cerebral rate of glucose utilization, increase markedly during the same period. There is now substantial evidence that postnatal growth in infancy is associated with various consequences detrimental to health in adult life, particularly hypertension, cardiovascular disease, obesity and type 2 diabetes, but the relationships vary depending on whether one takes growth to mean statural growth or ponderal growth, as well as on the specific period of infant growth. Recently, several mechanisms have surfaced that might account for the relationships observed. These include epigenetic effects on gene expression, alterations in neuronal signaling because of inappropriate dendritic pruning, and gut microbiota effects on fat storage.
'Growth in the first two years of life.' Nestle Nutr Workshop Ser Pediatr Program. 2008;61:135-44.
The last week has been quite hot and humid over here at D'Adamo World Headquarters. We've finally put in a â€˜deer-proof' fence around a bit of the property, so for the first time since we've moved here (perhaps a decade or so) I can plunk in a few plants and not be forced to view a scene of desolation and carnage the next morning. Apparently from a low of 27 in 1939, the number of deer in Connecticut has now risen to somewhere between one and two million, which is not surprising considering that their natural predator, the wolf, is long gone and the state is full of yummy suburban yards full of tasty treats.
We've put in a variety of things, which I hope to add to over the season. One plant I always try to use is Baptisia tinctoralis (Wild Indigo) which grows well, if slowly in these parts. Baptisia has always interested me in a medical manner, having many immuno-stimulatory polysaccharides, and a few fascinating alkaloids as well. It is one of the few natural products that are known to stimulate the anti-T (Thomsen-Freidenreich) antibody, which may help explain its long use in traditional medicine for the treatment of cancer.
Interestingly, Georg Springer's anti-T vaccine was partly composed of the typhoid vaccine; he felt that it amplified the effect of the other components. Baptisia has a long history of use by many cultures for treating typhoid fever.
The British Naturopathic Association had an editorial on the Blood Type Diet Theory. You can read it here, including an afterpiece by Tom Greenfield. The article is pretty flaccid and tries to be humorous, but I wonder about the appropriateness of editorializing about â€˜things' in a medical journal. Typically, medical journals editorialize about the results of research included in that issue, and often only to speculate on what further conclusions may be drawn from it. The major gripe the author seems to have is that Red Clover, another plant I'm going to plunk in my garden, is an â€˜avoid' for everyone. But that is only to keep it out of the hands of people who don't know how to use it. Hey guys! Knock! Knock!
However, I do think that the British naturopaths (by-and-large) â€˜get it' when it comes to the essence of what all this â€˜polymorphism stuff' means to the practitioner. A lot of the US naturopaths are still incredulous that one of their number could possibly come up with a discovery --the significance of which, if correct-- would have wide and far-reaching implications. Others think everyone should just be vegan and that would solve everything.
Typically when it arrives, like all medical folk, they then trip over themselves so as to not be â€˜the last.'
As I wrote on the Forums, a lot of ND's have the opposite of the â€˜not invented here syndrome,' which is the â€˜I can't believe it was invented here syndrome.'
In both cases, considering the enormous amount of woo-hoo, mumbo-jumbo fantasy that masquerades for â€˜cutting edge' alternative treatments and devices (if my office mail slot is to be believed) it certainly can't be the lack of science that is holding them back. If ideas, as Schopenhauer observed, do go through three phases (ridicule, rejection, acceptance) then we've still got some time. Unfortunately, often by the time you get to the â€˜acceptance' stage, all the fun has been sucked out of things.
Research-wise, this has been a busy week.
Traded emails with Dr. Linda Kim, whose with the Southwest College Research Department over the last two weeks. The microbial adhesion study and the clinical trial of blood type and endothelial dysfunction are on schedule and within budget. Enrollment will be completed for the clinical trial by 7/31 and experiments completed for the adhesion study by 9/30.
Had a wonderful meeting with Dr. Carlo Calabrese and Dr. Heather Zwickey over at the Helfgott Research Institute, which is associated with the National College of Naturopathic Medicine. We're hoping to develop a series of studies that can test the BTD across a variety of conditions and parameters. What is great about working with Carlo --whom I've know for decades-- is that he attracts the very best thinkers, and so much of the work with blood groups (which are really genes when you think of it) is high level math and statistics, and area in which I am not all that muscular.
Someone wrote me that the BTD was discussed in a book called "The Chemistry of Joyâ€?. I've not heard of it, but it's got a heck of a title.
Unless you happen to be named Joy.
This past Saturday (March 11th) I gave my presentation at the Institute for Integrated Nutrition. They base their weekend seminars out of the Time Warner Building in New York City, at the Jazz Theatre. What a wonderful facility! Although there were about 1,100 students in attendance, the theatre made it appear very intimate, as the audience sections went â€˜up' more then â€˜out' so I could almost touch, see and feel this warm, welcoming community.
I was quite worried about the timing of the lecture; I had about 2 hours, and the slides and handouts were clocked to the minute. Yet, despite my neurosis, things went off without a hitch and indeed, it ended exactly on the dime. As part of my arrangement with IIN, I've had to moderate a private online community for their students, who have been uniformly bright and respectful; a testimony to the developers of this program. So the last few days have had a definite lightness to my being; these high stakes lectures (such as the IfHI conferences) always tend to produce a quaking heaviness in the week or so before their delivery date. After everything, this heaviness lifts as in the words of Winston Churchill, I sleep â€˜the sleep of the saved.'
Thanks to Joshua for the kind introduction, and Rose and Kimberly for taking such good care of me. I greatly enjoyed my visit.
Earlier this week we had performance anxieties of a different nature, as my youngest daughter Emily prepared for her performance as Joseph in the lead role in the Montessori presentation of "Joseph and the Amazing Technicolor Dream Coat.â€?
As any parent can attest, come performance time nerves begin to sizzle; you just so want your kid to be happy, and to do a good job of things. And if as a parent I do say so, she sang like a lark. Who knew the kid had such a beautiful voice? Joseph was a bit of an emotional stretch for her, since her four closest friends were all narrators, and got to dress up in princess-like gowns and wear makeup, whereas she had to dress rather plainly.
However, her eventual sartorial splendor brought perhaps the biggest grin I have ever seen on a human face.
More performances appear to beckon. One of the platelet disorder societies wants to set up some sort of lecture opportunity. Apparently they've had numerous individuals with bleeding disorders report back to them that the Blood Type Diets appear to influence their condition for the better. I'd like to do the lecture, but there seem to be a plethora of these obligations in the next two month, which may make doing anything else difficult if not impossible.
Interesting casual mention of the BTD on â€˜Good Morning America', apparently in the context of another story on genetic testing and diet.
Oh well, practice beckons. Gotta hit the shower.
'Low-Fat Diets Flub a Test' proclaims today's main editorial from the always peripatetic New York Times:
"The baffling results came from a $415 million study of almost 49,000 women age 50 to 79 who were tracked for eight years, with repeated exhortations to the low-fat dieters to stick to the regimen. In findings announced this week, the almost 20,000 women on low-fat diets had essentially the same incidence of breast cancer, colorectal cancer, heart disease and stroke as the 29,000 women who followed their normal eating patterns. The results clearly surprised the investigators and may sound the death knell for the belief that reducing the percentage of total fat in the diet is important for health."
Among other concerns, restricting fish, nuts, and seeds immediately cuts off any source of Essential Fatty Acids such as Omega-3. Low fat dieters are also more at risk of suicide.
Eat your rabbit food.
Not unexpected. There's huge amounts of money at stake: Grant money, book sales, you name it.
Although it took me the better part of my first two decades in practice to realize it, a truly resourceful approach to nutrition is not very complicated:
It is the foods that you identify as benefical for a specific person and which truly feed him, that make him more healthy. Telling a person what to avoid will sometime make him less sick, but only rarely more healthy.
I've never seen anyone improve on a diet of rice cakes and lemon water.
Future low fat gurus may want to ponder the wisdom of cajoling sick people into draconian dietary measures.
Now, before anyone thinks that this is the ultimate validation of all things Atkins, the study also found that an increased consumption of carbohydrates and grains is safe and healthy - contradicting the claims by proponents of low-carbohydrate diets such as the Atkins that high carbs increase the risk of diabetes. Those in the study "did not show any signs of diabetes, their triglycerides were normal and their blood glucose was normal," said Dr Elizabeth Nabel, director of the US's National Heart, Lung and Blood Institute, which sponsored the $415 million study.
So, now that we know who lost, when do we find out who won?
Not any time soon. That won't happen until researchers start incorporating specific markers of genetic individuality into their study designs: Polymorphisms (like ABO blood type and secretor status); single nucleotide polymorphisms (SNPs) and metabolomics (the study of genetic differences by analysis of metabolic end products).
Until then, we will constantly be left with conflicting results and confounding, competitive theories.
Could it be that the idea was right, but the execution wrong? That the cause of some cancers does have to do with fat, but not in a way that is addressed by a low fat diet?
In other words, suppose toxins and free radicals in fat tissue do cause breast cancer and cardiovascular disease, but (unfortunately) a low fat diet in and of itself does nothing to help eliminate them?
And perhaps paradoxically, in some people, actually concentrates them instead?
Then you have a reasonable experimental model for the case of the life-long vegan who gets breast cancer.
One of my teachers used to tell us that there were two types of medical students: The first type, who go through four years of medical school; and the second type, who go through the first year of medical school four times.
Sadly, we seem destined to go through this first phase of nutrition research a few more times.
Anyway, some other news:
Put up some new sound files in the Media Center. The first is an extract of a lecture I gave at the Ontario College of Naturopathic Medicine. The second is part one of the 'Century of Blood Type Science' lecture given as the keynote address at IfHI 2003. I hope you enjoy them.
You can access these sound clips by clicking this link.
Dinner out last night with an old friend of ours who has struggled back from a series of health problems. Fish with assorted vegetables. Yummy, if a bit overpriced, but that is Greenwich Connecticut these days. Incredibly high noise levels, to which you can only add your own attempts to scream above the cacophony.
This is an example of what some people call 'the escalation phenomena.'
You can only be heard by screaming above the high noise level, produced by other people screaming loud enough to be heard above your screams.
Like Dean Ornish and Robert Atkins on the Larry King show in 'the old days.'
A good example of the escalation phenomena is sometimes seen in clinical medicine. It usually takes form in a clinician misinterpreting the side effects of his treatment as signs of the further progression of the disease, thereby requiring more treatment. An example of this in the last century was the use in allopathic medicine of huge doses of mercury to treat syphillis. Its use was so accepted that eventually the symptoms of mercury poisoning were included in the descriptions of end-stage syphillis.
Olga, our dinner guest, lost her husband Eric about a year ago. Once, about ten years ago, we got talking about medicine, and Eric volunteered his philosophy that 'the body has a bias towards healing.' I remember having to take a step back from this, since over the course of my life, I have never associated the word 'bias' with anything other than negative meaning.
However, I then remembered that radios were 'biased', i.e. the difference between an AM and FM radio, was simply that the AM radio was biased to receive AM frequencies, while FM radios were biased to receive FM. So to understand his meaning of the word, I had to understand that his use of the word bias was in the context of an orientation or leaning-towards.
It was so like Eric to have the ability to rescue a villified word like bias and put it back to work.
Tom Greenfield's column on blood type and osteoporosis is a must-read. Research published this year showed significant difference between the ABO blood types and the rate of osteoporosis. In a study that looked at 227 postmenopausal women. The results showed that the prevalence of osteoporosis in the proximal femur and lumbar spine averaged 2.3- and 1.7-fold higher in women with blood type AB than in those with blood type O.
This again validates the sophistication of choosing one's diet based upon the genetics of blood type. How many type O's have been lectured by dieticians and other vegetarian nutritionists that 'all that protein will give you osteoporosis.' Guess what? Doesn't happen. Type AB women on the other hand, may have a good friend in cultured dairy products, and the AB diet gives permission to use these high calcium foods.
A new study looked at the distribution of ABO blood groups in acute leukaemias and lymphomas. As I predicted in in my first book over ten years ago, in acute lymphoblastic leukaemia, there were more patients with O blood group. In Hodgkin's lymphoma and non-Hodgkin's lymphoma patients, there less patients with A blood group, respectively. This leads me to believe that the cellular mechanisms (T, Tn) that are found in 'A-like' cancers (breast, colon, stomach) are not a factor in lymphoproliferative diseases, which as my oncology professor many years ago quickly and frequently reminded us, 'are not true cancers.'
A study published in Acta Otolaryngol found a correlation between ABO group and noise induced hearing loss; with a significantly higher number of workers tested being blood group O.