I'm a believer in 'Fat Tony Science.'

I imagine that Fat Tony is some sort of quasi-questionable figure, or maybe just a street-wise person, like so many of the people I could observe growing up in Brooklyn. Fat Tony Science attempts to inject a healthy dose of street smarts into the decision tree by looking beyond simple facts and assumptions to things like ulterior motives and inter-personal realpolitik. Fat Tony Science becomes especially handy when parsing patient histories.

Here's an example:

You flip a coin 99 times and every toss comes up heads. What are the odds of it coming up tails on the next toss?

Little old lady at the slots:
It will come up tails, it's bound to after so many heads.

The Scientist:
The same odds as always, 50-50.

Fat Tony:
It will come up heads, since only a rigged coin will produce 99 consecutive heads.

The year 1956 stands out in my mind for a variety of reasons, the most important being (at least for me) that it was the year I was born. It also marked the year of the only ‘perfect game’ even thrown in a baseball World Series. Music fans might remember that it was the year that Elvis Presley entered the United States music charts for the first time, with 'Heartbreak Hotel.'

1956 was also the year a scientist named Roger Williams published a book called Biochemical Individuality, which attempted to relate inherited individual distinctions to nutritional requirements. Although Williams was no small figure in medicine (at the University of Austin he had discovered pantothenic acid, one of the critical B vitamins, and had published skews of articles detailing some of the most basic biochemical discoveries) Biochemical Individuality attracted little, if any attention from the medical community, probably due to the fact, as Jeffrey Bland speculates in his book Genetic Nutritioneering, Williams expressed many of his ideas in biochemical terms, which doctors of the time were far less comfortable with compared with today.

How prescient is the following phrase:

“The existence in every human being of a vast array of attributes which are potentially measurable (whether by present methods or not), and often uncorrelated mathematically, makes quite tenable the hypothesis that practically every human being is a deviate in some respects.”

It’s a strange choice of words, but the word deviate in this context signifies a turning away from the normal or a variance of some sort. Of course, we tend to think of the word more as a term for individuals who deviate from some sort of social norm; but norms are norms.

Williams was certainly deviating from conventional medical wisdom. Nobody at the time was looking at peculiar and individual aspects of nutrition that might be predicted genetically. More importantly, in 1956 there wasn’t anywhere near the enormous genetic industry and technology that exists today; it had only been three years before that James Watson and Francis Crick deduced the basic structure of DNA, (Deoxyribonucleic acid) –the double helix-- that contains the genetic instructions specifying the biological development of all cellular forms of life.

Thus when Williams talked of “attributes that are potentially measurable (by present methods or not)” he is taking an amazingly huge step into the future.

So Williams’ phrase “often uncorrelated mathematically” should probably be reinterpreted to mean “we can’t see the connections because of our current puny computational abilities.” Nowadays we link supercomputers together into vast neural networks and process data at a speed and accuracy that just boggles the mind. It was just this type of muscular computing that allowed scientists like Craig Venter and his firm Celera Genomics to help crack the human genome in record time. Today, the combination of gene sequencing and supercomputers is a day to day event in hundreds of laboratories worldwide, and is a prime part of a vast new field called bioinformatics.

In 1956, nutrition science was still in its infancy, concerned mostly with deficiency types of diseases such as pellagra and anemia, and making sure that we all ate “balanced meals.” There was no link between diet and cholesterol or between cholesterol and hardening of the arteries and medical journals often featured cigarette ads on their back pages. Ulcers were often treated by telling the patient to drink copious amounts of milk, the so-called “sippy-diet.” In other words, nutritional thinking at the time was predominantly disease-based, which is odd, since almost everything we do with food has absolutely nothing to do with disease. This resulted in what my friend and colleague Jonathan Wright used to call "The Association Diets.'

This is not to say that pieces of the puzzle weren’t evident, or that intelligent people were not already beginning to ask the right questions. It’s just that the questions could only be based on what was thought to be known, and what was known was not very much.

I can remember taking a computer class in high school (already well into the 1960’s) where we were taught to diligently inscribe a series punch cards with a 'number 2' pencil, which were then collated and fed to a machine the size of a large refrigerator, which then hacked and coughed for a while, finally yielding a half page printout of a list of fifty prime numbers.

Unless, of course, you had the misfortune to have penciled in the wrong box, in which case you just started all over again; a frustrating experience, which lead to one of my young colleagues, in a rage of frustration, placing one of the cards on the floor and proceeding to stomp on it repeatedly with his shoed foot, sending it on to the card reader --and probably producing the first computer virus-- a trick many of us would repeat when similarly frustrated. Your home computer can do these functions in micro-seconds, and the software to do it is considered so basic that it is usually packaged for free with the operating system.

Click on the image to listen to this broadcast or use the player below:

Interview with Dr. Mehmet Oz, Oprah and Friends on XM Radio, February 13, 2008

I wrote this note as a comment on my colleague Rick Kirschner's blog:

Hey Rick,

I thought long and hard on this, especially since I've spent a lot of time dealing with misrepresentations of my own work. On one hand there is the ever-present desire to turn the other cheek and convert my response into a teaching opportunity. This works in certain circumstances --often if the skeptic is actually curious about that which they are skeptical of.

Most are not.

In most other circumstances, turning the other cheek will often get that side of your head smacked as well. As Ho Chi Minh once said in reference to Mahatma Gandhi, "Had he grown up in Vietnam, he'd have ascended into heaven long before he did."

Because these people are often prisoners of their own zealotry their tactics are not very often of the velvet-glove variety. Since they don't respect that which they are skeptical of, and anything goes and every tactic is permissible

Of course this automatically brands them as pseudo-skeptics not skeptics, since true skeptics are more than happy to amend an existing opinion with the presentation of new evidence. Most of these guys just feel that modern allopathic medicine (and hence the public) is under attack from vicious, dangerous woo-merchants and it is their anointed job to exterminate this vermin.

Thus it is unlikely that appeals to reason will ever work effectively, since dialogue is not what they are interested in -- anymore than someone would ever be interested in dialoging with a cockroach before they stepped on it. People who dialogue with cockroaches usually don't step on them.

Like Ho, Adolf Hitler also had an opinion of Gandhi, remarking once to Lloyd George: 'Why doesn't someone just shoot him and be done with it?'

Let's call a spade a spade: The more extreme of these 'anti-SCAM' pseudo-skeptics will not rest until we're completely discredited and eliminated.

Thus their tactics and criticisms are almost always of the 'gotcha' variety. This is usually performed by trying very hard to cover their opponents in manure so that they can stand back, point to them and say 'look, they are covered in manure.'

Gerhard Uhlenbruck, the worlds leading lectin researcher, and one of the few scientists who has openly acknowledged the value of my work has a nice way of reflecting on the silliness of what these people do with their time:

"Never chase a lie. Let it alone, and it will run itself to death."

Stephen Jay Gould also had a nice way of turning the tables on pseudo-skeptics. This from 'The Structure of Evolutionary Thinking' (2002):

"If none of the foregoing charges can bear scrutiny, strategists of personal denigration still hold an old and conventional tactic in reserve: they can proclaim a despised theory both trivial and devoid of content. This charge is so distasteful to any intellectual that one might wonder why detractors don't try such a tactic more often, and right up front at the outset. But I think we can identify a solution: the "triviality caper" tends to backfire and to hoist a critic with his own petard -- for if the idea you hate is so trivial, then why bother to refute it with such intensity? Leave the idea strictly alone and it will surely go away all by itself. Why fulminate against tongue piercing, goldfish swallowing, skateboarding, or any other transient fad with no possible staying power?

So, if Uhlenbruck and Gould are correct, why do so many people spend some much time making life miserable for people with new ideas?

Probably because, although we talk of ideas, it all distills back down to power and money. New ideas often threaten the exact type of person who (personality-wise) would go on to make the perfect pseudo-skeptic. The type of person who buys into the existing power structure, hook, line and sinker. Anything that takes away from the reflected light ('My son the doctor.') they have spent so much time and money on gaining. For which they so sacrificed and assiduously played the game in order to secure. This is not just a threat -- it is also a nightmare.

So what is the answer?

Like any test of will (and for a myriad of reasons) victory goes to those with the ultimate staying power.

In military terminology there is a tactic called 'the refuse.'

Back in the old days, these guys would just line up opposite each other on some level field and go at it. Typically, since most people are right-handed, the right side of an army's line would often be stronger than the left. Thus the idea of any good commander would be to 'refuse' to fight (usually by slowly pulling back) on his left side while trying to press the advantage on his right.

This is a fundamental tactic in Aikido martial art. It is called 'entering,' the idea being to enter inside the physical space of the attacker and then by turning as you enter, you align your force with his and for a brief transcendental moment, see the world as he sees it. Very hard to have a fight with someone who is trying their hardest to see your point of view. It is very hard to hit something which has as its ultimate goal to be where you are not.

I stopped writing for pseudo-critics years ago: You can't please them, they won't buy your books anyway and the people I really want to help educate don't want to read that type of stuff.

I just refused to do it.

Now, while most magazine articles critical of my theories have long-ago been relegated to the landfill, you can still buy my first book only in hardcover despite being twelve years in print.

Why? Because the theory works in many people and they go on to tell other people.

Now, if I need to buy a new hammer I'd be somewhat interested in reviews that tell me which hammers 'not to buy,' but ultimately if my best friend tells my which brand of hammer he's happy with, I'm probably going to go with that advice. I would also find questionable reviewers who had nothing good to say about all hammers in general.

Let's commit to always doing the hard work. Let's accept the fact that we practice a revolutionary form of medicine and let's stop looking for approbation from the very people whose preeminence we threaten and who cannot appreciate the strides we've made and the struggles we've endured in order to put this profession back on its feet.

Let every patient see the value of what we can do. These pseudo-skeptics will always have their coffee claches; their little goldfish bowls, where naturopaths do nothing right and allopaths nothing wrong. But let's refuse to make it into something bigger than it really is, because that is not the main battlefield.

Instead, let's wake up every day determined to redouble our efforts to improve the lives of our patients.

I'll end this diatribe with two more Vietnam Era quotes, which to me seem oddly relevant since US health care is currently in a Vietnam-like quagmire.

The first is from Lyndon Johnson, a fundamentally un-quotable president. Johnson did once say something I thought was of note. In dealing with criticisms of his Great Society program, he was heard to say:

'It takes a master carpenter to build a good barn. Funny thing though, is that any fool with a match can then burn it down.'

Let's remember that we are master carpenters. The public can be trusted to see the benefit of good barns. Let's also refuse to put the matches in the hands of our opponents.

The second quote is from a meeting between a Vietnamese general and an American general in Hanoi several years after the war ended.

'You know' said the American general, 'you never beat us in a single battle.'

'Yes, that is true.' replied the Vietnamese general, 'however it is also irrelevant.'

Remember water always beats rock. That's because water can go around rock. Let's refuse to butt heads with rocks.

And as the quote goes "Medicine progresses funeral by funeral."

They were referring to the doctor's funeral, not the patient's.

Take care and good luck with the new book.

Peter

Major news about one of my favorite molecules, l-fucose. In addition to being part of the antigenic structure of the H antigen found in blood group O, fucose is now garnering attention as an important component in learning. Although neurophysiology spends quite a bit of time looking at the neurosynaptic junction (the gap between two nerve cells, where nerve conduction occurs) most of the emphasis is on the neurotransmitters (such as serotonin and dopamine) that can jump the gap.

However, what goes into holding the synapse together may be as important a factor in cognition and learning as what jumps across the synapse. And that appears to be lectin-like receptors on one side of the nerve synapse which bind to fucose as a ligand on the other.

In other words your nerves have a sweet tooth for fucose.

What stands between you and your next thought.

Reaction in the brain involving fucose skyrocket during periods of intense learning. And human milk is a very rich source of the sugar, with amounts far higher than all other species. The sugar content of human milk varies by ABO blood type and secretor status which makes me want to do a study looking at learning differences along blood group and secretor status in breast fed and bottle fed children.

The fucosyltransferase enzymes FUT1, FUT2 and FUT3 are very intimately involved in determining ABO, secretor and Lewis blood types and recent research has linked serum B12 levels (another important player in proper nerve function) to the FUT2 (secretor) gene.

Fucose and fucosylation have a big role in ontogeny (the origin and the development of an organism from the fertilized egg to its mature form) via it's role in the development of the Lewis X antigen (FUT9) which supports cell-to-cell-adhesion in embryos. Lewis X expression in the brain is in turn controlled by the PAX6 gene, which regulates many elements of nerve growth in addition to forming the architecture of the iris.

The link between PAX6 and Lewis X (FUT9) may explain why a recent study showed that at least some aspects of personality were determined by the genetics of iris formation. Close-up pictures were taken of the study participants' irises, and they also filled out a questionnaire about their personalities. The researchers looked at crypts (pits) and contraction furrows (lines curving around the outer edge of the iris), which are formed when pupils dilate. It was found that those with more crypts were likely to be tender, warm and trusting, while those with more furrows were more likely to be neurotic, impulsive and give in to cravings.

PAX6 is gene that helps regulate embryonic differentiation. PAX6 also has some interesting effects on adrenal and pancreatic function as well as norepinephrine expression in the gut via the enteric nervous system. Maybe there's a future in medicine for the iris after all.

Going forward, I predict that soon the best thing to use in kids who are learning-challenged will not be the usual suspects like Ritalin or SSRIs, but rather glycomic agents from the diet that enhance fucosylation. These drugs do enhance the function or persistence of neurotransmitters, but fucosylation enhancers seem to enhance the stability of the entire neural network. It makes no sense to up-regulate neurotransmitters if you haven't insured that the nerves are holding to each other in the first place.

Of course, most of the old blood typers know that Bladderwrack (Fucus vesiculosis) is a decent source of fucose.

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-schizophrenics, 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.