Was asked to give a little chat 'about what it is like to have practiced naturopathic medicine for almost three decades' during a student lunch at The College of Naturopathic Medicine at The University of Bridgeport. The prime mover behind this was one of our clinic externs, Dori (center, turquoise top) who wanted to have the school membership benefit from my 'sage advice.'

'Sage' in naturopathic medicine usually translates into 'aging hippy.'

I only fleetingly touched on my work with blood groups, and that was actually kind of nice, since I could more reflect on what being a physican has meant to me, versus an author, provocateur, etc.

At the end we did gather all the externs and preceptors for a picture:

Me and the current 2006 D'Adamo Clinic Preceptors, Externs and Resident: (l-r) Michelle, Dori, Lauren, Julie, Ani and Samm.

What an honor it is to work with these people. What talent.

Does a word every just get stuck in your head? Today's word is definitely nincompoop.

Interesting word. I like ‘nincompoopery' as well. Apparently the origin is quite old, but uncertain. It's not used much nowadays; the New York Times used it five times in the last year. In its April 3, 2001 edition, it referred to Americans referred to as "nutritional nincompoops."

Recent BTD sightings in the popular and scientific literature would make it appear that the American consumers are not the only nutritional nincompoops.

This morning I picked up a recent issue of Women's Health magazine, featuring such sound nutritional research as ‘The Cheetos Diet,' and came across a comparison of the online diet support sites (you know, eDiets, Weight Watchers, etc.)

eDiets came out pretty well; the only down side was its inclusion of the Blood Type Diet, which in the words of Food Scientist Jennifer Anderson "is scientifically unsound."

Nincompoopery.

Wall-papering your house from the mail slot in the front door is 'scientifically unsound'. Putting out a fire with gasoline is 'scientifically unsound.' Scotch-taping bottle rockets to your sneakers and expecting to fly is scientifically unsound. How, pray tell, is factoring blood type into health calculations 'scientifically unsound'?

Media buzzwords.

A common criticism of my work with blood type and diet seeks to brand the BTD theory as a ‘pseudoscience.' Now, according to most accounts, a pseudoscience is ‘any body of knowledge, methodology, or practice that is erroneously regarded as scientific, and which fails to meet the criteria met by science generally.'

According to most accepted sources, a pseudoscience can be identified by a combination of certain characteristics. So, let's see how the BTD measures up:

Asserting claims or theories unconnected to previous experimental results.

It is amply demonstrated in the scientific literature that ABO blood type and secretor status possess biological significance outside of the realm of transfusion science. Roughly 1/3 of all published studies on blood type polymorphism measure some sort of physiologic response, typically having to do with digestion, immunity and circulation.

Asserting claims which cannot be verified or falsified (claims that violate falsifiability).

Falsifiability is the notion that if something cannot be made false, it cannot be proven or disproved. For example, the notion of constructing an anti-cancer diet for type A could be said to be logical based on the fact that virtually 90% of all published studies show a higher rate of malignancy in type A over the other types.

To say otherwise (i.e that type O had a higher occurence over type A) would be to falsify this fact.

Using type A again, we could also say that a cardio-protective diet would be more appropriate in type A, since virtually all published studies show a higher rate of heart and artery disease in type A over the other blood types. Again, to say otherwise would be to falsify this fact.

Not only do we know the occurrence of these facts, we have biomedical reasons for their existence; for example, many types of cancers mimic the type A antigen, and with regard to heart disease, type A has higher levels of cholesterol and more arterial inflammation than the other blood types.

Other studies show that type O have more of a type of inflammation made worse by wheat, whereas non-secretors have lower level of intestinal enzymes that help the body assimilate fats and calcium. Every fact behind the Blood Type Diets neatly falls within the framework of being falsifiable.

Asserting claims which contradict experimentally established results.

No aspect of the characterizations or recommendations of the Blood Type Diets contradict established experimental results. In fact, the inherent flexibility of its doctrine help explain information and results which would otherwise appear aberrant, such as the inability of herd type epidemiology to produce cogent answers to the ongoing debates in nutrition, and the simultaneous persistence of multiple heterodoxies (paleodiet, vegan, etc.)

Failing to provide an experimental possibility of reproducible results.

All aspects of the Blood Type Diets are eminently testable. Ongoing research is monitoring at a variety of recognized biomarkers (soluble endothelial factors, breath hydrogen, to name two) and their modulation as a direct result of adopting a specific blood type diet protocol. Unfortunately, one of the more dire consequences of our internet fueled ability to mudsling to a scale unknown previously is that nascent ideas can easily die stillborn under a barrage of ad hominem and ad hoc attacks, inhibiting serious consideration from independent researchers. This can be especially dangerous to subsequent scholarly analysis; though any scientific theory should be able to withstand the scrutiny of honest research, even if its ultimate goal is to disprove its claims.

Failing to submit results to peer review prior to publicizing them.

I have authored a number of peer-reviewed papers that examined the influence of specific dietary patterns on individuals of differing ABO groups. Predictably enough, they attracted little or no attention at the time of publication. It was only when I wrote a book for the general public, did any of my work attract any sort of attention at all.

By claiming a theory predicts something that it has not been shown to predict.

The characterizations of the digestive strengths and weaknesses of the ABO blood groups and secretor types are a matter of public record; any one with the interest and free time can explore the existing research on MEDLINE or any of the citation services. As I have said time and again, I have merely reassembled and reorganized prior, largely disorganized material into a cogent collection of facts, That as I understand it, is the basis of virtually all scientific development. Paradoxically, if my training as a naturopathic physician was a liability with regard to my ability to develop this theory in a conventionally scientific environment, it was a distinct advantage with regard to the development of a vista broad and flexible enough to knit the disparate facts about blood type, diet and physiology together in the first place.

By a lack of progress toward additional evidence of its claims.

I think the emerging sciences of nutrigenomics and metabolomics will for the first time give the Blood Type Diets the type of intellectual and conceptual framework necessary to allow for their proper place in science to be established. Far from inhibiting or lacking progress towards additional evidence, the Blood Type Diets probably need at least another decade to allow for the genomic discoveries to penetrate traditional medical sensibilities.

This last point illustrates what would be a much more resourceful way to depict the Blood Type Diets: As Protoscience.

Protoscience is a term sometimes used to describe a hypothesis which has not yet been tested adequately by the scientific method, but which is otherwise consistent with existing science or which, where inconsistent, offers reasonable account of the inconsistency. In essence, a Protoscience is an area of science which is in its formulative stages. Some authorities substitute ‘Frontier Science' for Protoscience. I can accept that as well.

In general, pejorative terms like ‘Pseudoscience' are often employed by skeptics and critics, and may often have ulterior motives behind them, such is the politics of science and health care these days.

However, just as we have pseudoscience, let us not forget that we also have ‘pseudoskeptics' as well. A pseudoskeptic is an individual who claims to support "reason" and the "scientific worldview", but frequently uses logical fallacies, attempts to silence opponents, and employs various invalid strategies of persuasion. Funny enough, pseudoskepticism is a class of pseudoscience, masquerading as proper skepticism.

Historically, how many protoscientific discoveries (Galileo's Astronomy and Harvey's discovery of the circulation of blood are two that come to mind) would have at the time of their publication been classed as pseudoscience when in fact they were on the very frontiers of discovery?

Pseudoskeptics have often taken their shots at me and my work. Yet I wonder how some of these folks get away with a skeptical stance about something they appear to know so little about? How often is what we call skepticism is just the simple lack of curiosity?

Now, is this a tome in defense of the inalienable right to be protoscientific?

Hopefully not.

There is a lot of junk out there. Just the other day I received a hostile email from a book reader who chastized me for not 'being honest' about the 'whole secretor thing.' Apparently my lack of honesty in this person's mind centered around my withholding the knowledge that we can change our secretor status with color therapy.

Note: I used quite a bit of material from the Wikipedia for his blog. Paradoxically, Wikipedia features one of the more pseudoskeptic representations on the BTD to be found. But hey, I still love it.

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 ‘up' more then ‘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 ‘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.�

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 ‘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.

Bad news for fans of the fat-phobic gurus like Dean Ornish, Michael Klaper, John McDougall and John Robbins (all of whom have spent the last two decades guilting people into eating extremely low fat diets) and agribusiness sycophants such as the American Dietetic Association (which spent the last two decades taking money from manufacturers of fake fat foods, so we could all enjoy a 'healthy and tasty low fat dieting').

Eat your rabbit food.Of course, all these folks are now out with their spin control: "Oh, it's not low fat that we're concerned about, it's the right fat."

Not unexpected. There's huge amounts of money at stake: Grant money, book sales, you name it.

What humbug.

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.

Final thoughts:

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.