October 22, 2009
Originally published as part of a blog called 'The Shift', detailing the events of Dr. D'Adamo's Personalized Medicine Shift at the University of Bridgeport Naturopathic College.
Last week, Dr. D'Adamo was the keynote speaker at Grand Rounds at UBCNM. After the presentation, your faithful blogger solicited some questions from the audience. Here are some selected responses from the good doctor.
How did Dr. D’Adamo come up with the lists of beneficials and avoids? Did he test every food and, if so, how did he do it?
The starting point was of course, many of the empirical observations recorded by my father, James D’Adamo. This became the ‘framework’ from where values were added and subtracted, validated and discarded. To that I added the existing literature on direct food-blood group antigen interactions, mostly in the form of published lectin specificities. Certain foods for which I was suspicious, but could not find specific references in the literature were eluted via SDS Page electrophoresis and compared against banks of carefully categorized (ABO/A1-A2/Secretor/Lewis/MN/P1/Ii/CDEcde) erythrocytes. For a while I was also doing this against a simple benchmark I developed using categorized sera and measured myeloperoxidase activity to examine the effect of food constituents on viability prolongation of intracellular Candida inclusions in neutrophils.
I also began testing foods for the ability to induce opposing blood group antibodies: either through basic saline isohemagglutinins titration or a more advanced form of ‘block titration’ that I rediscovered from the work of Elvin Kabat using anti-IgG1-4 antibodies subsequently applied to the basic isohemagglutinins titers, or to the results of direct and indirect antiglobulin (Coombs) testing. I also scanned the published literature for relative concentrations of blood group antigens in dietary food sources.
I’ve also looked at other, more generalized, biomarkers of digestive disturbance to see how they related to poor food matching. These have included tests such as the urinary indican (Obermayer) and more recently sequential breath hydrogen testing.
Of course this was done in the mid 1980s-early 90s, long before CLIA!
Finally, there was just very simple reverse engineering from the pathophysiologies associated with these polymorphisms. For example, numerous studies have shown group A individuals (even normal subjects) have higher blood viscosity. My father has always recommended that his group A patients drink a bit of lemon and water in the morning. He felt that it helped with their inherent mucosity. Now, Dr. John Bastyr once told me that the juice of six lemons roughly equaled the anti-thrombotic effect of a conventional anti-coagulant, so I thought this was a recommendation well worth preserving, maybe even embellishing.
Another might be the difference in digestive phosphatase activity between the blood groups. Again looking at group A, we see that their levels intestinal alkaline phosphatase (IAP) is quite low, which compromise several assimilation functions. Now, besides the fact that the physical expression of the blood group A antigen actually inactivates IAP (not something you can not do much about) a quick look at the enzyme kinetics shows that it can be influenced, both positively and negatively, by the amino acid phenylalanine. Hence high phenylalanine foods are probably more bioactive in the digestive tract of blood group A individuals, especially with regard to mineral absorption.
My interest of late is more along the lines of ‘food inter-relatibility.’ Trying to find the multidimensional relationships between clusters of foods and whatever therapeutic objectives I have in mind. In trying to accomplish this I think I’ve become a better software engineer, since the methods behind actually accomplishing this (which has seen a simple manifestation in the ‘GenoHarmonics’ routines in SWAMI) is very much similar to what is known as ‘object orientation’ in computer science. You make certain ‘classes’ of foods and nutrients that together work on their own unique and specific clinical circumstances and data. You create whatever classes you need (‘AGE removal’, ‘Endothelial shedding’, ‘Overgrowth Inhibition’) then set them free on the person. It’s like looking the individual tiles in tile floor for a while, then stepping back and realizing that it is actually a mosaic. Perhaps amazingly (though not for a confirmed surrealist) the computer term for the ability of these objects, each in its own way, to respond differently to identical messages is known as a ‘polymorphism.’
As a student about to graduate, I really admire your career and the work you've done as an ND. What's your secret? If you could offer advice to naturopathic students just graduating and starting out, what would it be?
- You have to be you own polymath. This involves surmounting serious confidence issues, since in our intellectual theocracy, one is made to feel that they have to gain permission from some properly endowed expert in order to think seriously about something. Not true, although you can expect a fair amount of flak from less imaginative quarters that may feel that you are 'uppity' and should have played by the game
- Don't deprive your failures of their spiritual significance. Failures can crush and de-enervate you. They can also force you to re-evaluate your methods, question your basis and re-invigorate your appetite to get to the top of the mountain next time. Let failure hone the future 'austere' version of yourself
- Build your organization from the ground up. Keep it simple for starters, but never let an opportunity slip by that could increase your scope and reach
- Keep strong family ties and a mattress by the window. You're in school now, where everything is 'bubbly yours,' as John Lennon used to say. However, it is a lonely profession you embark upon once you get out. You will be broke and most likely in debt in a world where people value wealth. You will have an ND degree in a world where most people will think your degree is a typo. A percentage of the people to who you describe yourself will think you are a weird quack. You will have your failures. Patients will die. You needn't take it personal. Once you start thinking for yourself you are bigger than your profession, so let it off the hook every once in a while
- Love every patient, despite his or her best efforts otherwise. Throw their problems into the recesses of your subconscious. You'll be surprised just when and where you'll get an answer
- Don't compete against your colleagues. A lot of ND's seem to fight over the same patient pool. Develop the tools to bore your own shaft, sink a mine and excavate for your own patients. Much nicer!
What do you think the future of our profession holds? Do you think it's going to take off, as everyone says?
I have given a few commencement addresses, and honestly, they've usually come of as somewhat depressive affairs. The future for our profession? Probably OK for a while longer with our current working model. You guys will do well, since we now have newly licensed states that will need ND's. Long term? Frankly unless we reorient our focus, I'm more pessimistic: More co-opting of our legacy from the top by the more socially acceptable mixer-type MD's and from the bottom by the health food hucksters; more plagiarism of our teachings and wisdom by Madison Avenue. We need to stop worrying about what the 'others' think about us and stop believing that if we just act in the expected manner-- give everybody a low fat diet and some Echinacea, we are somehow going to be accepted on some sort of terms we could live with. So my major worry is this disturbing trend towards what some people consider 'normalcy': A kinder, gentler Naturopathy stripped of whatever bothers the pure scientists. As far as I'm concerned, you are not practicing naturopathy correctly unless you are making the 'science-with-a-capital-s-apparatchiks' apoplectic. We have a robust profession that contains innumerable insights into new resources for healing. We should be running towards these insights, not away from them.
I'm so interested in how the idea for GenoType took shape - how did this come to Dr. D'Adamo? Did it develop slowly after seeing lots of patients or did it come to him in a burst of inspiration?
Almost everything I do comes about thru a rather excruciating step-by-step process. Working with blood groups was easy; the starting point was my father. The Epigenotypes are a process at I began working on two decades ago; however it was a stop-start sort of thing, because I knew what I wanted the concept to comprise, but at point in the journey, the avenues of approach were not yet possible. Also at the end of two decades work with ABO, I had exhausted almost any possible point for further exploration in that area, so the idea of adjusting people to their genes, started giving way to the notion of adjusting genes to their owners.
I'd always been intrigued with inter-generational aspect of pathology. I think the miasms are a brilliant concept that deserves to be examined with an eye towards their epigenetic elements. I suppose I was trying to figure out a way to influence the patient 'after' the one who was actually in my office.