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.
Got this note in my comments file:
"Peter, you may be interested in some recent articles in the April, 2004 issue of the Journal of Allergy and Clinical Immunology re: lectin binding pathway of complement activation and fucosylated proteins that function as selectin ligands. [J Allergy Clin Immunol, Volume 113, Number 4] Regards, Ann Robb, MDâ€?
Thought it would make a good teaching point.
Warning! Technical stuff follows!
Selectins are multifunctional adhesion molecules that mediate the initial interactions between circulating white blood cells and cells lining the blood vessels, usually with the intent of allowing the white blood cells passage through the vessels walls and on into the tissues. They play a role in arteriosclerosis, inflammatory diseases, and metastatic spreading of some cancers. The best understood selectins, E-selectin and P-selectin, show some variation according to ABO type, with higher levels of E-selectin shown to occur in individuals who are type A. The sugar fucose appears to be critical the proper function of selectins. Interestingly, most likely through the interaction of the selectin molecule with variations of the Lewis A (non-secretor) and Lewis X antigens, which are in themselves fucosylated.
In a 1999 study published in the Journal Blood, leukocyte adhesion deficiency type II (LAD II), a rare inherited disorder of fucose metabolism that leads to severe mental retardation and immunodeficiency (caused by the absence of carbohydrate-based selectin ligands on the surface of the white blood cells) was reversed by oral supplementation of fucose, which induced the expression of fucosylated selectin ligands on the patient's white blood cells. During 9 months of treatment, infections and fever disappeared, elevated white blood cell counts returned to normal, and psychomotor capabilities improved.
In short, fucose is important for proper selectin function, proper selectin function is critical for efficient regulation of inflammation --and a host of other metabolic and immune functions.
The Complement System is a part of the immune response that occurs when an antibody comes into contact with the antigen to which it was manufactured. In some instances, such as when a transfusion is mismatched, the antibody-antigen interaction is so lethal that the foreign object is destroyed immediately. More commonly, the antibody-antigen interaction stimulates an â€˜effector mechanism' that actually does the dirty work.
There are three pathways to complement activation, though as a student twenty-five years ago, I was taught that there were only two. The two I was taught were referred to as the â€˜classic' and â€˜alternative' pathways.
The Classic Pathway is the standard way that an antibody-antigen complex stimulates complement, usually by activating a chain reaction resulting in the conversion of a preexisting circulating inactive molecule into a new molecule that coats the membrane of the invader and then itself is converted into another molecule that attacks the membrane of the invader by boring holes in it.
The Alternative Pathway to activating complement is really much like the Classic, except that instead of antigen-antibodies triggering the complement cascade, many bacteria and foreign objects trigger it directly.
Recently, it was discovered that lectins form a unique, third way to activate complement, most notably through the example of a lectin that is found in our blood serum called Manna Binding Protein (MP. Non-secretors appear to have lower levels of complement than secretors.
Put another way, antibodies â€˜finger' the target, complement destroys it.
Someone asked about whether celiac disease and blood types have any link. There is a published study that claims a strong link between non-secretor status and celiac disease, and other authors have seen a link between the variations in intestinal alkaline phosphatase seen with the ABO types and celiac.
Cassini-Huygens has provided some reassuring proof the we can still 'get it right.' Now I just have to convince myself that these wonderful photographs are not just close-ups of my old LP collection.
Someone left the comment that I was a 'betterer,' which is why I can't always just relax and take in the view.
Everything has to be made better by The Betterer.
However, there are some things that cannot be made better.
Had the most interesting email exchange over the last week with a Swedish neurology professor. The gentleman contacted my publicist and requested some early articles that I had written while at Bastyr College, as he had been asked to write an evaluation of the Blood Type Diet for a Swedish medical journal. He suggested that he had been chosen as he had 'taught classes in alternative medicine.'
When the email was forwarded to me, I noticed that he had a website. Featured were a few articles on homeopathy and acupuncture, seemingly quite negative, which to me called his alternative medicine-teaching career into question.
Over the last five years I have noticed an increasing infiltration of quackbuster-types into positions involving alternative medicine. From these internal positions, medical students and the public interested in alternative medicines can be taught that they are dangerous or ineffective. A good example of this is the hyperbolically titled â€˜The Scientific Review of Alternative Medicine,' which in fact is staffed by renowned opponents of alternative medicine, and which does not feature a single researcher or practitioner of any alternative medicine on its editorial board. This last year, at a local hospital, the first thing the new â€˜Department of Alternative Medicine' did was to sponsor a lecture of the dangers of herbal medicine.
Although the homepage was in Swedish, an obvious link to a page about the Blood Type Diet was available, so I investigated. Since I don't read Swedish, it was not completely decipherable, but the gist was evident. Every negative article on the internet on the diet was featured, though virtually all of these are ad hominem attacks (an ad hominem rejects an idea on the basis of some irrelevant fact about the author of or the person presenting the claim or argument.) An example of ad hominem attacks against the Blood Type Diet are the 'reviews' of the diet by vegan authors, such as Klaper and McMahon who are simply against the notion of anybody eating meat, regardless of how you came to that conclusion.
Had I recommended that each blood type adopt a different version of veganism, I'd certainly be a darling of the vegan world.
Curiously, on the professor's webpage I was described as the Editor of the Journal of Neuropathic Medicine which, while I am interested in nutritional approaches to neuropathy, was not the journal I edited.
I answered back with a link to the article he requested and pointed out the nature of the material he was including in his article. As a series of emails unfolded between us it became evident that the gentleman had long ago made up his mind. Eventually the exchange came down to semantics, centering on the syntax of whether his â€˜opinion' on the Blood Type Diet was all that relevant. Obviously not happy about having a â€˜opinion,' his last note tried to make that appear that opinions are a bad thing, which, at least to me, they are not.
As long as they remain â€˜opinions.'
And yet, other things can be made better.
I have been slowing reconstituting my research lab, moving it out of mothballs at the clinic and into an area behind the garage at home. It will be great to have the ability to work on projects right here versus having to motor over to the office. It's nice to see the â€˜old friends' one more time! The back-breakingly heavy star of the lab: an Integrated Separation System electrophoresis unit, long-ago birthday present from Martha. Incubators, centrifuges, Treff tubes, micro liter pipettes â€“hello again!
I'm especially interested in looking at a class of mucopolysaccharides in Fucus vesiculosus called â€˜fucoidins' which have very fascinating anti-microbial and metabolic effects. Interestingly, (perhaps in true type A fashion) I'll be restarting my research at exactly the place where I left it.
However, it will also be a good time to test a variety of new food substances as well. When the time comes for that, I'll put up a submission form so readers can make suggestions.
"Islands -- I don't get them.
Surrounded by water, poor things."
Patrizia, in Antonioni's L'Adventura
Have been dutifully working through the manuscript worksheet for 'Fatigue' this morning.
Funny how one's perception about something changes with proximity. This subject for the ies was not developed by either Catherine Whitney or me, but rather by our editor, and I was always a bit leery about the concept, since it is not a proper disease per se, but rather a common component of a tremendous number of other, more specific, diseases.
Yet now that I work on it, I am beginning to believe that there is an important contribution here.
One thing I had forgotten about was the large body of work that I had done on the subject back in the late 1980's, most of which has never seen the printed page. Things like second-messenger (cAMP) enhancement, Schwartzman's endotoxin phenomenon,and the cortisol- 11 beta-hydroxysteroid dehydrogenase axis.
Now I just have to decipher all the cryptic doodlings in my notebooks, which could be a problem since I am one of those people who cannot read their own handwriting.
The quote above is from the delightful Waterfront by Phillip Lopate. The book is literary tour around Manhattan island, from the perspective of a social historian. I am a sucker for architectural history, especially of my beloved borough of Brooklyn ('Fourth Largest City in America'). About a year ago, I embarked on a project to determine the exact whereabouts of original Dutch settlement of New Utrecht, a neighborhood of Brooklyn close to where I grew up, and probably most famous for supplying the high school shots at the opening of 'Welcome Back Kotter.'
From old landholding maps I found on the internet, I could superimpose the old street drawings of New Utrecht as layers in Photoshop over the Mapquest diagrams of the modern area. To my surprise, the town center of New Utrecht lay within the parking lot of a ramshackle discount store where as a child I would get my school supplies, and whose owner in 1969 once tried to convince several very sceptical kids that a chunk of sidewalk in the display case under the checkout counter was actually a moon rock from Apollo 11.
To understand the apparent lack of purpose for that interaction, you must read some of Arthur Miller's remembrances of his childhood in Brooklyn .
I believe our 'Blood Relations' columnist Cocky Van Hesteren hails from 'Old Utrecht' --the real one in the Netherlands.
My brother recently gave me An Architectural Guidebook to Brooklyn by Francis Morrone and James Iska which is a tad on the boring side. However I am sure it will serve much better purposes with the buildings directly in front of me.
If you are interested in NYC architectural history, you'd probably enjoy surfing Kevin Walsh's Forgotten NY website.
Spent yesterday's austere training session working on something called a 'jump spin back kick,' a strange gyration that involves spinning in the air as you jump, ultimately kicking into a direction that you cannot actually see.
Interesting how easy something like this appears to a twelve year old, versus, say, a forty-eight year old. A kid just jumps, much like a cat, knowing that he is springy enough to get up and around, and flexible enough to not be troubled by the thought of a posterior landing. By the time you get to my age, you start to ponder the osseous consequences of this sort an action, which is why you hesitate and fail.
Napoleon once said that it was amazing what you could get an eighteen year old to do for a piece of ribbon.
The immortality thing.
The forty-eight year old is more likely to say 'Uh, no thanks. I have enough ribbon right now.'
Last night my sister in law Rita, an nurse with an extensive background in research, sent me an abstract from the Journal of Clinical Oncology, titled 'Herbal Remedies in the United States: Potential Adverse Interactions With Anticancer Agents' (J Clin Oncol 2004;22 2489-2503). The crux of the article being the potential threat to chemotherapy drug effectiveness posed by such botanicals as garlic and echinacea, which may influence the body's ability to metabolize chemotherapy drugs, and compromise their effectiveness. She asked me what I thought about the article.
When I finally got a full version, two things stuck out immediately. One, this was a review article, meaning that there was no proof of any such activity being presented, but rather a tenuous connection between the known, but rather modest, effects of certain herbs on the cytochrome p450 system (drug detoxification) and the p-glycoprotein levels (drug delivery).
More accurately an editorial, it provided absolutely no evidence to back up any of its assertions. C'mon guys, talking about garlic interfering with p-glycoprotein and blocking a drug like taxol is like saying that a paper bag containing your lunch has the 'hidden potential' to derail an Amtrak train. Hey, if garlic or herbal antioxidants and p-450 modulators were all that effective at blocking cell damage (chemically programmed or not), there wouldn't be any need for oncologists and oncology journals in the first place.
Amazingly, the article then goes on to advise physicians to look into herbal use in non-responding cancer patients as a rationale for treatment failure, a rather cruel balm to the fact that greater than 99% of those non-responders are simply not going to be cured by chemotherapy, herbal medicine or no herbal medicine.
An article published in the Archives of Internal Medicine (Archive Int Med; 1998;20: 2187-2191) may help explain why medical academics spend their time worrying about garlic blocking chemotherapy. It looked at conventional attitudes toward supplementation. Their conclusions: Throughout 20th century American academic medicine has resisted the concept that supplementation with micronutrients might have health benefits.
According to the authors, this resistance is evident in several ways:
(1) by the uncritical acceptance of news of toxicity, such as the belief that vitamin C supplements cause kidney stones;
(2) by the angry, scornful tone used in discussions of micronutrient supplementation in the leading textbooks of medicine; and
(3) by ignoring evidence for possible efficacy of a micronutrient supplement, such as the use of vitamin E for intermittent claudication.
Part of the resistance stems from the fact that the potential benefits of micronutrients were advanced by outsiders, who took their message directly to the public, and part from the fact that the concept of a deficiency disease did not fit in well with prevailing biomedical paradigms, particularly the germ theory. Similar factors might be expected to color the response of academic medicine to any alternative treatment.
I boldfaced the line about 'outsiders' as I can relate to that one personally, since I am a naturopathic physician (strike one!) posit a diet theory that does not fit in well with the prevailing paradigm (strike two!) and wrote a book on the subject for the public (yer out!)
Instead of wasting time looking for herbal inactivators of chemotherapy these folks should look at ABO polymorphism to help explain cancer treatment variation. Type A individuals may have as much as seven fold higher levels of p-glycoprotein, 30% higher levels of von Willebrand Factor and significantly higher levels of e-selectin and ICAM --all know modifiers of metastasis, drug delivery or resistance.
There is a certain lack of candor in a medical community that rebukes supplements as weak and ineffective medicines, yet warns that these same supplements are dangerously blocking chemotherapy drugs.
Reminds me of the joke about the two oldtimers at the early bird special:
The first one turns to the other and says 'The food here is terrible.'
The second oldtimer turns to the first and says 'Yeah, and the portions are small, too.'