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Fundamentals of Generative Medicine, volume one, by Peter D'Adamo, ND, MIHFI
Aug 2010, Drum Hill Publishing, Wilton, CT
Reviewed by Mitchell Bebel Stargrove, ND, LAc
Published in: Naturopathic News and Reviews (NDNR)
In principle naturopathic medicine has always been about personalized care: treat the person, not just the disease; however, all too often daily clinical practice falls into the chasm between theory and application. Throughout his professional life Dr. Peter D'Adamo has been working to manifest this core principle in clinical reality by developing models and evolving tools. Never willing to rely on platitudes or hand-me-down anecdotes, he weaves together naturopathic philosophy and cutting-edge science with skill and artistry. While he is all too often simply tagged as that 'blood type diet guy,' Peter deserves credit for challenging healthcare professionals and the public to move beyond one-size-fits-all declarations based on 'healthy diet' generalizations and moral declarations. If all you know of this author is his popular works or secondhand discussions of the ABO diet system then you are in for a major revelation when you step into the material geared for healthcare professionals. In his writing and teaching he has long since moved far beyond those simple formulae through secretor status specificities and epigenotype refinements and now into Generative Medicine with Volume One (!) clocking in at 800+ pages. Like the rock star who gets tired of playing his top ten hits from a decade ago this work pushes the limits and challenges naturopathic physicians to catch up with, integrate, apply and move beyond the research, concepts and nomenclature of systems theory, genomics, epigenetics and the emergent properties of a scientific era that could simply be indigestible for conventional medicine but a feast for those of us who love Nature and revel in the revealing of Her mysteries.
I've been known to declare that naturopathic medicine needs to frame itself as primarily the medicine of physiology, in contrast to conventional medicine's position as almost exclusively the medicine of pathology; a bit overstated but fundamentally accurate. In our daily dialogue with patients and each other, many of us talk of 'the Body' as an active participant in the therapeutic process; what that actually refers to is seeing the patient's bodymind as a microcosmic localization of the macrocosm of Nature. Well Nature has been opening up some big secrets over the past few decades and our worldview, educational programs and clinical practices would do well to surf these big waves.
I often wonder how the emergence of pharmacogenomics and all the talk of personalized medicine will come to fruition in a conventional medical model. What happens when the state of the art medicine can no longer operate on the default bias of treating generic patients for generic diagnoses and expecting a generic response to drug therapy? At first blush that doesn't seem much of a challenge to our evaluation and prescribing but once you look into what is in this book you will be seeing a fresh perspective on familiar terrain. If you had intuited that the emerging –omics sciences might somehow fit well into the personalized approach aspired to in the naturopathic paradigm, then you now have a refresher course, a methodology, and basic set of analytic tools.
This book represents a solid foundation to practical clinical application of the principles of scientifically-informed network medicine; and, as such, a challenge to members of the naturopathic profession to evolve, synthesize and reformulate our methods and models to reflect or core theories and principles in a contemporary iteration. Whether you use his toolset or not is secondary. The point is that the bar has been raised, the terrain of discussion has shifted; moving naturopathic medicine into this century demands that we make a qualititative leap in our discourse and nomenclature, models and implementation. If you are not one of the students on his clinic shift at the University of Bridgeport, you may want to parcel out a little time every day to digest and assimilate this nutritive offering.
The six sections of Volume One reintroduce the reader to many basic of physiology, biochemistry and genetics, albeit reframed within a cutting-edge model synthesizing naturopathic principles and state-of-the art complexity science. Bringing together ageless philosophy and scientific detail cuts to the quick in challenging the reader to engage the nuances of the scientific literature to substantiate the potential of clinical genomics of susceptibility, compatibility and opportunity. Neither protocols nor platitudes, D'Adamo delivers a reasoned and researched methodology for understanding, parsing and implementing personalized care.
In Section I complexity theory and systems biology reveal themselves as an emergent explication of the dynamics of health, dysfunction and disease that updates and expands the classic principles of vitalistic medicine in a way our forebears could only have dreamed of. Yes, natural systems thrive in the stability of chaos; too much order can translate into stagnant physiology, wayward self-organization and poor responses to contextual challenges and therapeutic interventions. This often dense and intricate material offers some rewarding recovery and clarification of valuable insights misunderstood or discarded by the Neo-Darwinian status quo and conventional medicine. The second section retells the basics of genetics and mutation but with a special emphasis on the migration patterns of ancient peoples and their implications for haplotype mapping. As a historian, I welcome the chance to learn more about the historical basis of genetic variation and the evolving interplay between diet and culture. As a clinician, I enjoy playing with the morphometrics, dermatoglyphics and other practical expressions of morphology in the context of the particulars of physical examination. Polymorphisms and their influence in shaping biochemical individuality through enzyme variability set the stage for stepping forward into a working discussion of 'morphogenic' patterns and phenotypic plasticity in Section IV. Sections V and VI engage us with the peril and promise of epigenetics and introduce us to the opportunities and risks of gene expression. On the one hand, environmental exposures can induce downstream genetic aberrations more rapidly and deeply than Lamarck or Darwin would have ever imagined.
Conversely, by knowing our genotypic predispositions, D'Adamo offers the meaningful challenge of navigating our choices to favorably tilt the probabilities of gene expression – favorable foods and life-enriching (literally) activities vs. exposure to reaction-inducing foods and life-deranging xenotoxins; all we need is some clear road signs. In particular, the reader receives a guided tour of LectinLand where the specifics of phytochemistry (as well as synthetic compounds) reveal the reactivities and benefits of individual and classes of foods, isolated nutrients and botanical constituents extending far beyond the basic blood type (ABO) categorization. Even without implementing all this system proposes there are literally hundreds of clinically relevant bits of data, analysis and pattern recognition that could guide every physician in selecting what to prescribe and advise, and what to avoid, or at least be more skeptical of, in treating each patient as an individual – rather than just repeating the mantra of doing so. Overall, this work presents a rich and enriching orchestration of fact and theory, data and principles, model and implementation that effectively provides the reader with a wealth of practical detail for immediate application. Yet, more broadly, D'Adamo offers a grounded, flexible and vigorous approach that can also renew your sense of awe for the mysteries of Nature, not just in the forest, mountains or sea but in the intricacy, elegance and resilience of the natural systems we embody.
The ongoing and often caricatured debate of 'classical naturopathy' 'versus' 'green allopathy' (including easy recourse to pharmaceuticals) demands a major upgrade in its level of discussion with a sincere openness to the as yet unimagined. In this landmark publication, Peter opens the door into a big room where lots of familiar pieces are brought together in ways we will discover or recognize as never before. The issue is no longer old or new, or even drugs or herbs/nutrients, or one or another suite of diagnostic techniques, treatments and procedures, but fundamentally an invitation, actually an imperative, to build upon core philosophy and principles and expand in new ways that challenge our complacency and fear of innovation and the challenges of facing our own ignorance. This book opens up a bold new frontier that carries on the tradition of Hahnemann and Hering, Scudder and Jones, Bastyr and Turska, Mitchell and Pizzorno, the innovators, clinicians and educators within the naturopathic profession, as well as our precedent and allied communities of practice. The pivotal issue is not one of science or no science, but of sound, specific and clinically relevant science within a comprehensive vitalistic worldview. That means claiming and shaping an approach to scientific discovery and methodology that expresses our philosophy, values and worldview, one that respects Nature and the vital wisdom of the patient, their physiology and their life force, and that assists us in helping patients recover and enhance their health.
In my own work with drug-herb and drug-nutrient interactions we focus on pharmacogenomics as much as we can, given the immature state of the available literature, but quite frankly I will need to be putting on my D'Adamo cap while working on future iterations. Bravo, Peter, and thanks for the pictures and charts, they make all the big words and imposing nomenclature easier to grow into. In particular, I'm looking forward to Volume Two and the playing out of this knowledge and these patterns of analysis into clinical practice by strengthening herbal and nutritional prescribing with genomic discrimination. I could use a peek, as could most of us striving to grok and apply power-law distribution!
Published by Drum Hill Publishing, Wilton, CT, 2010.
Reviewed and revised on: 05/02/18