Answers to Questions About Milk

After a review of 56 articles was published in the Journal Pediatrics (the voice of the American Academy of Pediatrics-See below) in March 2005, documenting that milk does not strengthen bones, stunned reporters in Salt Lake City took to the streets to interview people. Just about all the mothers with a mic in their face stated they didn't care and they would continue to give milk to their children. In my opinion, this signals that no amount of evidence will any time soon undo the perception that "milk does a body good." Nonetheless, here are some answers to posted responses and more references. But, the best is for you do do your own research. Don't take my word or anybody else's as the final arbiter.

Are there no nutritional benefits to milk?

There are many nutritional benefits to milk; it has many amino acids, sugars, vitamins and minerals. In fact, the most perfect food is milk, as long as it is our own mother's. The problem is the downside of milk. So, the cost-benefit analysis will depend on your own opinion and how much you love the taste.... and sugar. Milk is much like processed red meat. These foods are very nutritious, but, the incidence of health problems to both is well documented. In a pinch (famine, etc) we do well to eat both. But, as a daily food they are problematic.

Is the calcium or some other component of milk the cause of increased cancer risk?

No, it's the growth hormones, antibiotics and pesticides given to cows to increase yield and profits. In addition, milk from cows or any other non human species has insulin from those foreign species, which increases not only the risk of diabetes in humans, but also the risk of cancer, since insulin acts like growth hormone. The calcium in milk is the reason why the industry claims that milk strengthens bones. But, its acidity and inflammatory effects on the gut curtail the absorption of minerals, so the net result is a much lower rate of absorption of calcium, not enough to significantly strengthen bones.

Are all forms of milk equally bad for you (whole, 2%, skim)?

No. The more processed the milk is, the worse it is for us. Cottage cheese seems to be the worst. Taking out fat out of milk does help those who have cholesterol problems; however, many of those people need to also eliminate excessive sugar, which is a concern in milk, too (lactose.) I believe "sugarholics" are the ones who find it nearly impossible to give up milk, ice cream and cheese.

"Would soda be a preferred beverage to milk or is water the only acceptable beverage for a healthy diet?"

Soda is just as bad for different reason, but equally addicting, in my opinion. It is the millions of dollars in advertisement by the food industry that creates the unfortunate impression that beverages are limited to soda and milk. After discouraging processed fruit juices prepared with High Fructose Corn Syrup, I encourage my patients to drink pure, organic, refrigerated carrot juice, in addition to green tea, and Pom wonderful. Any fruit and veggies juice will do. If you have weight or metabolic problems, try to get used to diluting these juices with water. After losing the addicting taste of excessive sugar, people find that q combination of 1/3 juice and 2/3 water is an excellent treat and very nutritious. Isn't it amazing that our society feels that water is not good enough?

More references:

“Studies probe microbes in raw milk, swine,” JAMA 2007;298:1388

Legalizing raw milk is ill advised
76% of the time it has Listeria monocytogenes and Coxiella burnetti. The latter is more virulent.
“Diet Gains Legitimacy as Potential Factor in Acne,” J. Skin and Allergy news, May 2008, page 9. Report on Annual Hawaii Dermatology Seminar, Waikoloa, 2008

· Milk, high sugar, high fat diets the culprit

· 6.096 girls aged 9-15 drinking more milk had more acne. And 4,273 teen boys had more acne with milk consumption, J. Am Acad Derm 2008 [doi:10.1016/j.jaad.2007.08.049]

· Mik has progesterone, dihydrotestosterone precursors, somatostatin, prolactin, insulin growth factor-releasing hormone, insulin-like growth factors1 and 2, and other substances that could stimulate pilosebaceous activity, J. Am Acad Dermatol 2005;52:360

· No acne in natives in Paraguay and Papua New Guinea, because they don’t eat refined foods

· A low glycemic diet lowers insulin resistance and improves acne, J. Am Acad Derm 2007;57:247

· Low glycemic diet has 30 % more fiber than average diets and substantially more poly unsaturated fats, both of which decrease androgen levels that worsen acne, J. Am Acad Derm 2007;57:1092

Ovarian cancer risk higher with milk

J. Lancet 2006;367:797,

“To realize tea’s health benefits, hold the milk,”

European Heart J., January 9th, 2007

“Cow’s milk allergy,” J. Skin and Allergy News, January 2006, page 49

Even though half of children who develop milk allergy by 7 months of age develop tolerance by 2 years of age, those who are IgE positive tend to remain allergic longer. These children, by the time they turn 8.6 years old, have more asthma, rhinoconjunctivitis, atopic eczema, urticaria, and more allergies in general. This study included 6,209 children, 118 of which had their allergy to milk confirmed by an elimination challenge (J. Allergy and Clinical Immunology 2005;116:869.)
Milk associated with autism

J. Applied Nutrition 1990;42:1

“Calcium, dairy products, and bone health in children and young adults,” J. Pediatrics 2005;115:736

* 58 studies reviewed. Most of them found no relationship between dietary calcium intake, and measurement of bone health.

* Dairy consumption is among highest in the USA, yet, osteoporosis and fracture rates are also high.

* Animal protein, including milk, is associated with urinary calcium losses.

* Doubling protein intake in creases loss of calcium by %50.

* Physical activity in 12-18 year-olds strengthens bones more than calcium intake.

* “We found no evidence to support the notion that milk is a preferred source of calcium.

* The NIH does not say that milk is the preferred source of calcium. Only the industry interpreted it so.

* “Calcium in dairy products is not as well absorbed as that in many dark green leafy vegetables... Dairy products contain protein and sodium (the latter competeswith calcium), and some dairy products, especially processed cheeses, clearly increase the urinary excretion of calcium as a result of the increase sodium, sulphur containing amino acids, and phosphorus content. Although dairy products tend to contain more calcium I absolute amounts than calcium-rich plant foods, when absorption fraction is taken into account, the amount of plant food needed to get the same amount of absorbable calcium is modest. For example, one cup of cooked kale or turnip greens, 2 packets of instant oats, two thirds cup of tofu, or 1 2/3 cups of broccoli provide the same amount as 1 cup of milk, as would 1 cup of fortified orange juice, soy milk, or basic 4 cereal.”

“Dairy products do not lead to alterations in body weight or fat mass,” American J. Clinical Nutrition 2005;81:751

“Experts charge new US dietary guidelines pose daunting challenge for the public,” says the JAMA 2005;293:918

“The health benefits of milk have been contradictory... there are many reasons to be suspicious of the need to have 3 cups of milk a day.”

J. Allergy 2004;59:1017

Cow’s milk increases risk of wheezing attacks

Children fed cow’s milk early in life are more obese as adults, and have more hypertension and Heart disease (AJCN, May 2003.)

“Acne vulgaris: a disease of western civilization,”
J. Arch Derm 2002;138:1584

It comes from processed food high in refined sugars and low in essential fatty acids and micronutrients. Acne is not seen in primitive societies eating the paleolithic diet.

“Got Milk? Got acne? New research suggests link,” Atlantic Dermatology Conference, J. Skin and Allergy News, June 2004, p6

* Harvard study with 47,000 participants.

* It’s not just raging hormones... There are multiple sources of hormones that turn into the male hormone 5 alpha dihydrotestosterone, a driving force behind acne, and milk is one of them... There is a high volume of hormones produced in the milk of cows, particularly when pregnant... [it] contains progesterone and other steroid hormones... [which] break down ito dihydrotestosterone.”

* Milk also increases levels of IGF-1 which promotes acne through hyperkeratinization.”

Milk allergy on the rise: 1/3 of practice if Ped G.I. fellow

J. Family Practice News, April 2004, p91

Breast milk higher in Linoleic acid is linked to mother’s consumption of cow’s milk. The higher the Linoleic acid of breast milk, the higher the chances of eczema developing in child by one year of age (J. Allergy 2004;59:394.)

Estrogen in milk increases risk of prostate cancer

J. Med Hypothesis 2004;62:133

Daily consumption of ½ L of milk increases the risk of Diabetes three times. It goes up to 5 times in genetically susceptible children.

J. Diabetes 2000;49:912

Viruses may trigger Diabetes type I by sensitizing children to bovine insulin through GALT AM J. Clin Nut 2003;78:1053

“Cow’s milk protein-sensitive enteropathy at school age”

J. Pediatrics 2001;139:797

* Milk sensitivity does not disappears by age 3-5 yrs.

* Children did better with allergies off milk

* Cow’s milk associated with lymphonodular hyperplasia in duodenun

* Later in life: development of celiac dz? Breast feeding protects against celiac dz

Am J. Clin Nut 2002;75:914

Milk causes immune response in intestinal mucosa (J. Ann All Asthma, Imm 2003;90:348.)

GERD and Cow milk allergy (J. Pediatrics 2002;110:972.)

J. Ann Neurology 2002;52:793

Dairy consumption raises risk of Parkinson's Disease.

Book “Eat, drink and be healthy,” Dr Willet, Harvard

* Misinformation and old food pyramid: “shaky scientific grounds”

* Examples: “All fats are bad, all carbs are good, eat lots of dairy to prevent osteoporosis”

* “No long term studies have shown reduced risk of fractures with high milk intake”

* “Whether the USDA is capable of revising the pyramid without being influenced by meat and dairy lobbying remains to be seen.”

* New concepts: glycemic index, differences in fats and carbs

* New pyramid: whole grains and oils at the bottom, then fruits (2-3) and veggies in abundance

Then nuts, legumes

Then Fish, poultry, eggs

Then dairy of Calcium supplement

Then Red meat, butter and high glycemic foods.

“Dairy consumption, obesity and the insulin resistance syndrome in young adults,”
JAMA 2002;287:2081

Letters to editor 2002;288:693

* Most dairy consumption is cheese: not accounted for. SO milk “drinkers” may be healthier, and eating less cheese

Ctr for Science in Public Interests, 2/6/2001

Farm life in childhood and milk = asthma

J. Lancet 2001;358:1129

More lactose intolerance in Chron’s

J. Clin Gastroent 2002;34:49

Early milk exposure; more asthma

J Allergy and Clin Imm 2001;108:720

TOO FEW STUDIES TO CONCLUDE THAT “MILK DOES A BODY GOOD.”

AM J CLI NUT 2000;72:681

Will the Mayans Get Us?

The year 2012 is finally here. My guess is that a certain percentage of people reading Integrative (alternative) blogs like this one may also be exposed to disparate ideas and predictions about this much-anticipated point in time. Starting with the understanding that no one can responsibly claim to know the future, I herein venture my own opinion on 2012, because our beliefs about it may greatly impact our health.

In a nutshell, I don’t believe we will see the end of the world. Doomsayers have a poor track record, even though one big asteroid or CME from the Sun and we could be toast any day. But, I so believe we will see the end of world as we know it, that is, more sustainable practices will consolidate themselves to bring us a better way of life, closer to our loved ones and the soil. Our intuitive feeling that “business as usual,” driven by whim, egotism and materialism have never been characteristic of an enlightened society has been proven correct in the last 3 years. The financial deck of cards built on those philosophies is crumbling. No change for the better comes without pain. After centuries of unsustainable practices, any adjustment is bound to trigger spasms of realignments. This is the grain of truth in the apocalyptic visions of some.

Interestingly, “Apocalypse” means “enlightenment” or “seeing clearly.” Also worth remembering is that the Chinese symbol for “catastrophe” also includes the symbol for “opportunity.” I am betting there will be more pain, in addition to what we have already seen; but, I hope we take advantage of the upheaval to become less materialistic, more self sufficient, and that we adopt a more communal and less materialistic life style. In short, I wish for all of you to turn inward to recommit to spiritual values most of us have already embraced and that we turn outward to live closer to our loved ones and friends.

Happy New Year, my friends, HR

Don't Cry Over Hyped Milk

I know going after milk is foolish and similar to questioning a sacred cow. But, when the weight of evidence compels the New England Journal of Medicine to opine on this matter it is time to listen. Yet, the goodness of milk is so entrenched in our society that merely reading about the evidence that recommends de-throning milk from its pedestal is not going to be enough to convince the faithful. I will never forget reporters interviewing young mothers in the streets of Salt Lake City after a landmark article on milk appeared in the Journal Pediatrics. Despite the evidence that refuted the claims of the dairy industry that milk strengthens bones [1], mothers pledged their undying belief in milk; they pledged to continue giving it to their children and damn the infidels who dared attack their Holy nutrient.

So, let me get out of the way to only provide the quotes from the NEJM and other reputable journals:

The 2010 Dietary Guidelines — The Best Recipe for Health? NEJM 2011;365:1563

The 2010 U.S. Dietary Guidelines were issued earlier this year, though they received little notice in the press. The lack of attention is troubling in a country in the throes of a nutritional crisis manifested most conspicuously in the form of an obesity epidemic that threatens to reverse recent gains in life expectancy. The guidelines' development was carefully watched by agro-industrial interests that stand to gain or lose from their implementation.

Unfortunately, several components of the new guidelines lack scientific foundation and hinder progress. The 35% limit on calories from fat, which remains embedded deep within the document, may inadvertently undermine the quality of federally funded nutrition programs…. However, [the fat-obesity] relationship has since been refuted in many well-controlled, prospective, observational studies and clinical trials that show little independent effect of dietary fat on body weight. Nevertheless, the diets of millions of Americans who participate in school-lunch and nutrition-assistance programs remain loaded with refined carbohydrates in an effort to reduce fat as a proportion of total calories, whereas the focus should be on replacing trans and saturated fats with healthier fat.

The guidelines continue to recommend three daily servings of dairy products, despite a lack of evidence that dairy intake protects against bone fractures1 and probable or possible links to prostate and ovarian cancers. In addition, the recommendation to consume large amounts of dairy products follows from IOM-inspired goals for nutrient intake that may be fundamentally flawed. For example, the calcium DRI is based on measurements of calcium intake and losses in feces and urine over periods of less than 14 days, which probably don't reflect bones' long-term calcium content.

“High milk consumption has consistently not been associated with lower risk of fractures in large prospective studies, whereas increased risks of advanced or fatal prostate cancer have been observed in many studies.” Am J. Preventive Medicine 2005;29:320 & British J. Nutrition 2006;95:539

There are many other studies questioning the dairy industry’s claim that “milk does a body good.” But, it is futile to include them herein. If you are in love with milk and you believe in the “white-washed” propaganda, you will not be convinced no matter what you read.

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[1] “Calcium, dairy products, and bone health in children and young adults,” J. Pediatrics 2005;115:736

Should You Get the Test for Prostate Cancer?

Two years ago the United States Preventive Services Task Force stirred up a bit of controversy by stating, after an intensive review of the medical literature, that Mammograms don’t have a good cost/benefit analysis for women under age 50 (see blog November 2009.) Just as the dust was beginning to settle, the Task Force is at it again; it now recommends that asymptomatic men forego the famous PSA, or Prostate Specific Antigen widely used to screen for prostate cancer.

Just as I agreed with the Task’s Mammogram recommendations, I agree that the PSA should no longer be done, unless men are having symptoms in their genitourinary area. But, before you have a cow, please, keep in mind that any man who wants the test may still get it, just as any woman who wishes to have a Mammogram may do so.

I plan to recommend ambivalent asymptomatic men that they forego the PSA. Of course, some men will choose to get the PSA and then ignore a positive finding, or will welcome aggressive follow up testing and treatment if the PSA were to be elevated. Some men may also choose screening to implement the lifestyle changes outlined below. I will gladly do the test for them while I review the Task Force’s reasons for its recommendation stance. It is based on many studies, most of which I have reviewed, that have concluded that any treatment or prostate cancer is not likely to prolong life. While they may make the consequences of cancer less problematic in some cases, the incidence of problems like incontinence and impotence is high enough to question the potential benefits from aggressive therapy. In fact, conservative therapy has better survival.[1]Besides, the PSA leads to over-diagnosing or unwarranted testing and procedures on healthy men.[2]

Whence prostate cancer?

Once we determine why men get prostate cancer we may then be more effective in preventing it. At an Endocrine Society Symposium in 2005 it was posited that estrogen-like chemicals in the environment (plastics, heavy metals, pesticides, dioxins chlorinated compounds, etc) over stimulate growth of the prostate and female sex organs and breasts.[3] This problem is worsened in those who do not eat optimal amounts of plant-based foods, particularly cruciferous vegetables[4] that are redolent with antioxidants to fuel our detoxification pathways.[5] In other words, any amount of over stimulation of those sensitive tissues is “the canary in the coal mine.”[6]

Consequently, poor diets high in alcohol, fats[7] and refined sugars[8] increase the risk of any cancer. In 1931 Dr. Otto Warburg won the Nobel Prize in Medicine by demonstrating that cancers are more common in those whose glucose levels are higher. This is one of the reasons that dairy has been linked to prostate cancer:

“High milk consumption has consistently not been associated with lower risk of fractures in large prospective studies, whereas increased risks of advanced or fatal prostate cancer have been observed in many studies.”[9]

How to lower your risk of prostate cancer

Obviously, avoiding estrogen-like toxins (“xenoestrogens”) is the first step. Minimizing processed foods and cutting down on alcohol and dairy products is also recommended. Eating plant based foods may reduce the risk of ANY cancer by 2/3.[10] Changing our lifestyles for only two years as above, while being more active and maintaining good relationships has been shown to significantly reduce the risk of prostate cancer.[11] It seems that the protective changes accrued involve DNA changes, specifically, lengthening the chromosomes’ telomeres,[12] a concept that won the Nobel Prize in 2008.

Details

Vegetables have more zinc[13] and selenium;[14] they help lower the risk of prostate cancer. Herbs like Milk Thistle[15] and Curcumin[16]have shown significant benefits. The following nutrients have also been shown to be helpful, in addition to the ones highlighted in the September 2011 newsletter, like pomegranate juice:

Soy isoflavones, J. Nut and Cancer 2008;60:461

Green tea, J. Nut and Cancer 2008;60:483

Walnuts, J. Clin Cancer Res 2008;14:4491

Fish, J. Nut and Cancer 2008;60:222

Tomatoes, J. Nutrition and Cancer 2008;60:145

Vitamin D J. Carcinogenesis 2005;27:32

Grape seed extract, Int J. Cancer 2004;108:733

Olive oil, Br J. Nut 2002;88:225

The best!

…. Or men would like to think so: frequency of ejaculation is not related to prostate cancer, but it might reduce its incidence![17] Guys always ask me to write that down as a prescription to show their significant others….

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[1] “Conservative Management on Prostate Cancer,” JAMA 2009;302:1202

[2] J. Natl. Cancer Inst. 2009 :101; 1293

[3] “Endocrine-disrupting chemicals probed as potential pathways to illness,” JAMA 2005;294:291

[4] J. National Cancer Institute 2000;92:61

[5] J. National Cancer Institute January 5^th 2000

[6] “Prostate enlargement: the canary in the coal mine?” Am J. Clin Nut 2002;75:605

[7] American Cancer Society 2005

[8] “Prostate cancer prevention [is possible] by nutritional means to alleviate metabolic syndrome,” AJCN 2007;86:889S

[9] Am J. Prev Med 2005;29:320 & British J. Nutrition 2006;95:539

[10] “Apoptosis by dietary factors,” J. Carcinogenesis 2007;28:233

[11] “Clinical Events in Prostate Cancer Lifestyle Trial: results from 2 years follow up,” J. Urology 2008;72:1319

[12] “Increased Telomere Activity and Comprehensive Lifestyle Changes,” J. Lancet Oncology 2008;9:1048

[13] “Zinc deficiency alters DNA damage response genes in normal human prostate epithelial cells,” J. Nutrition 2008;138:667

[14] J. Nut and Cancer 2008;60:171

[15] J. Carcinogenesis 2001;22:1399

[16] J. Carcinogenesis 2007;28:1188

[17] JAMA 2004;291:1578

"Salus Populi Suprema Lex" -- The health of the people is the supreme law.

“Salus Populi Suprema Lex.” The health of the people is the supreme law[1]

“The responsibilities of the physician extend not only to the individual but also to society and demand his cooperation and participation in activities which have as their objective the improvement of the health and welfare of the individual and the community... As good citizens it is the duty of physicians to be ever vigilant for the welfare of the community.”[2]

Doctor Rudolph Virchow, considered to be the father of Cell Pathology, was a contemporary of Otto Bismarck. Virchow was very involved in public health, which irritated Bismarck to no end. When Virchow opposed him on the issue of Employer-Based Health Insurance, Bismarck challenged the good doctor to a duel. As tradition would have it, Virchow had the questionable honor of choosing the weapons: sausages. At that time, and perhaps to this day, sausages were widely felt to be the reason many fell ill, no doubt due to the conditions under which they were made. Bismarck, on viewing the “weapons” relented, amused, and perhaps fearful that handling the wieners could make him ill. He famously declared that “Laws are like sausages; it is better not to see them
being made.”

Today, doctors face the same dilemma: community involvement versus politics that would absolve physicians of that noble obligation as described in the AMA code of ethics.

Virchow was a man ahead of his time. He determined over 150 years ago that practically all diseases are inflammatory conditions, a fact not fully understood until the 21^st century. But, in my opinion, his skills as an Anthropologist sealed his place in medicine by stating that “Medicine is a social science, and politics nothing but medicine on a large scale. Physicians are the natural attorneys of the poor.” Many doctors have followed his example and thus laid the foundations of modern Public Health and Medicine. By taking care of community issues such as clean water and food, garbage disposal, sewage, etc. illnesses were dramatically reduced and in many cases prevented. Leaps forward in longevity were thus achieved.

“Much of the subsequent spectacular progress in public health in the 19^th and early 20^th centuries was due to a better understanding of microbiology and the transmission of infectious diseases, together with the recognition of the importance of clean water, hygiene and sanitation.”

But what are public health physicians and government policy makers doing about this state of affairs? There is no coordinated strategy, and there is a very poor information base on effectiveness and cost-effectiveness... Properly thought out prevention, especially targeting young adults and children will save the resources necessary for treatment of chronic diseases later. But where are the zealous physicians and public health advocates of the 19^th and 20^th centuries?”[3]

Doctors like Virchow are struggling to be heard over the chorus of voices who feels physicians should not be involved in the community.[4] No doubt economic pressures and the inherent arduous nature of practicing medicine make community involvement difficult if not impossible. After all, attending to patients in our clinics is our main obligation. By maximizing effectiveness, quality and savings in our clinics we also benefit the patients we serve.

One group of doctors in Salt Lake City (IHC) has made national news by computerizing practice protocols for maximum efficiency in their pharmaceutical/surgical approach. Why not do the same with community/environmental issues?

If doctors were to study similar protocols designed to track public health issues like polluted air, processed foods, and other community issues that impact our patients’ health, how much more efficiently could we serve our patients? These protocols already exist, but they tend to be ignored as not “hard” enough evidence[5] or as “a socialist agenda.”

The new baseball movie “MoneyBall” chronicles how teams are now using the same computerized approach; by crunching player stats teams rank the best players available. Mr. Beane struggled to convince baseball higher ups to adopt this approach for years. He finally succeeded with the Boston RedSox who went on to win the World Series in 2004 and 2007. There is no argument that money and profits are powerful motivators. Even the most idealistic physicians would agree. In a sense we now have “MoneyHealth.”If ALL issues pertaining to our patients’ health were plugged into the computer, we would certainly save a lot of money[6] and keep our communities healthier.[7]

Capitalist innovators like Schumacher[8] have pleaded for years that the bottom line of Capitalism be expanded beyond profits to include social and environmental responsibility.[9]

It is tempting to retreat away from public health issues in today’s present economic/political situation. But, strong ideologies may not be conducive to putting patients’ welfare first, which is bound to deteriorate, especially for the poor.[10] If physicians do not live up to Virchow’s legacy, our communities may be at a higher risk of “Collapse.”[11]

“Should medicine ever fulfill its great ends it must enter into the larger political and social life of our times. It must indicate the barriers which obstruct the normal completion of the life cycle and remove them. Should this ever come to pass, medicine whatever it may then be will become the good of all.”[12] Virchow

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[1] American J. Public Health 2001;91:689

[2] AMA statement quoted in “Social and Political Responsibilities of Physicians,” J. Med Philos 1977;2: 376

[3] “The Catastrophic Failures of Public Health,” J. Lancet 2004;363:745

[4] “Medicine Is a Social Science in Its Very Bone and Marrow,” J. Mayo Clin Proc October 2011;86(10):930

[5] “Medicine Is a Social Science in Its Very Bone and Marrow,” J. Mayo Clin Proc October 2011;86(10):930

[6] “The future of Public Health,” Special issue, J. Managed Care, September 2005;14#9

[7] “Structural Interventions for Addressing Chronic Health Problems,” JAMA 2009;302(6):683

[8] Book “Small is Beautiful: economics as if people mattered,” E.F. Shumacker; Hartley & Marks 1973

[9] Book “The Politics of Fortune; a new agenda for business leaders,” Jeffrey Garten; Harvard Business School Press, 2002

[10] “Facing the New Reality: preparing poor America for harder times.” Report by Community Action Agencies, 2011

[11] Book “Collapse: how societies choose to fail or succeed” by award-winning anthropologist Jared Diamond; Viking Press, 2005

[12] “Rudolf Virchow, Public Health and the Built Environment,” J. of Urban Health 2003;80:523

Running Out of Energy, But Not Information

“Doctors routinely measure chemicals in the body to get health information, such as cholesterol and triglycerides. METABOLOMICS, however, involves measuring hundreds or thousands of chemical processes, such as the breakdown of nutrients from diet, going on in the body at the same time, which could yield a lot of information. [METABOLOMICS] can also account for environmental factors, such as how well a patient is absorbing medications. Since METABOLISM-energy generation and breakdown-gets disrupted in many diseases, figuring out how these metabolic pathways change could potentially yield better ways of diagnosing or treating a wide range of diseases.”[1]

If you have been following my newsletter and blogs you are familiar with the concept that ALL diseases start at the cellular level due to less optimal energy and information for cells (no matter what type of cell) to do their job and be properly structured. Despite volumes of evidence pointing in the direction predicted by physicists, the medical profession has been very slow in assimilating these concepts, which has resulted in much frustration for me. Instead, we continue to rearrange the chairs on the Titanic ship of Health Care Reform.

Nothing will improve in health care delivery, until we de-emphasize the pharmaceutical approach and focus on METABOLOMICS. This has been the central focus of my career, which I am strongly contemplating ending. It is not worth it to me when I am having chest pain out of sheer stress, since my excellent diet and exercise routine have shown my heart is physically quite healthy.

The only thing that keeps me going is flashes of brilliance, like the quote above; I found it while waiting to get on the air (KTALK 630 AM on Sundays at 4PM.) There was an old copy of the Wall Street Journal in the studio. The quote came from the editor of the Journal Metabolomics; he was commenting on an article on dandruff, of all things.

But, my isolation from society at large and the medical profession has gotten so unbearable that I fear my health is suffering.

Even though many doctors like what I am doing, I estimate that about 1/3 of them are bitterly antagonistic. Amazingly, I don’t have the support of many herbalists, naturopaths and other so called health workers. I feel it is because I have been known to condemn their over emphasis on the supplements and herbs they sell. There is nothing wrong with those items IF they are properly and honestly manufactured (a big IF.) But, when the sole emphasis is questionable marketing without emphasizing METABOLOMICS (nutrition, environment, and mind-body issues,) I fear this “natural approach” is not much better than treating with pharmaceuticals. For example, treating depression with St John’s Wort or Prozac only address symptoms, not the roots of the problem; Energy and Information, or METABOLOMICS are the best approach

To make matters worse, there are certain “patients” who do not come back to see me when they discover I don’t share the predominant faith in my state. There are also those “patients” who don’t return because they believe the misinformation planted against me in several sites. But, none of them are more hurtful to me than those “patients” who don’t return when they see that I am not as white as they are….

Added to all this is my social isolation, which I am not ready to share at this point. Suffice it to say that emotional and social issues are also Energy and Information issues.

This blog is not a pitty-party, but a realistic assessment of the struggles an Integrative Doctor faces in a protracted fight with a dysfunctional health care system. Added to this battle is the sense of never having belonged in a society whose main goal is profits and materialistic consumption. It is with these thoughts in mind that I, like all of us at times of existential crisis, muse about “what ifs…” Yes, maybe I should have become a Jesuit priest, when, as a child, I sensed modern societies do not care much about their spiritual, economic, physical, mental or political health.

There are three things that keep me going in this struggle: (1) the economy, since this is not the time to look for a second career at my age, (2) the sense of having been “called” to this work, and (3) all those faithful patients who express their support and love to me at each visit. To them, I say thank you from the bottom of my aching heart.

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[1] Wall Street Journal, July 19^th
2011

Literacy, health, and the 4th of July

“When power leads man toward arrogance, poetry reminds him of his limitations. When power narrows the areas’ of man’s concerns, poetry reminds him of the richness and diversity of his experience. When power corrupts, poetry cleanses, for art establishes the basic human truths which must serve as the touchstones of our judgment. The artist becomes the last champion of the individual mind and sensibility against an intrusive society and an offensive state.” JFK[1]

It is easy to lose our peace of mind in todays fast pace cities and societies[2] where loud noises, consumerism, dense traffic, pollution and superficial, meaningless data flood our senses. Watching too much TV and playing too many video games contribute to the problem, and also push out reading printed matter (and loved ones, too for that matter.) These are some of the reasons why depression will be the number 1 disease in this decade,[3] outpacing heart disease, which also is worsened by the above inherent inactivity.[4]

Despite the tsunami of data in our lives, we are “dumbing down,” a problem that also afflicts most medical doctors, I am afraid:

“The amount of information published in the medical journals far outpaces the ability to organize it... we don’t know a whole lot anymore about too many topics... This dumbing down is not ideal for medical education… A broad glimpse of recent medical findings may help some of us retreat from reductionist ways of thinking that have been ingrained as we become increasingly specialized. Such cross fertilization can stimulate new avenues of research.”[5]

Somewhat aware of this pitfall, I chose to become a Generalist Doctor while in training. To prepare myself, I seldom took my medical books home, so I would have more time with my family and read literature. Asimov, Chekov, Hugo, Miller, Hemingway, Pagnol, Wolf, Buddha, Aquinas, etc helped me keep grounded and conscious of what medicine really is service to “humanity.”

“Medicine and scientific developments rely on multidisciplinary involvement of science and humanities. The arts and humanities can also contribute ways to re-conceptualizing medicine itself... Medicine and health are human concerns in the widest sense... The humanities can foster a depth of humane understanding, knowledge and experience…

The medical humanities encompass history, literature, philosophy, ethics, theology, sociology, anthropology and law. They value the aesthetic as well as reason, focus on meaning as well as emotion and explore ambiguity, uncertainty and complexity as well as theoretical lucidity. They offer understanding through synthesis as well as analysis. The humanities develop analysis of personal and professional values and the capacity for empathy and teamwork.”[6]

Patients also benefit from cultivating peace and the finer things in life. Of course, low incomes make this difficult, but, still, used books are cheap. Less TV and more reading do improve our health.[7] And, we may find out some of the reasons our health care system is so chaotic and dysfunctional.

In his last book, “Bill Moyer’s Journal,” he interviews many thought leaders, including Wendell Potter, a former insurance company PR executive. Mr. Potter’s testimony before Congress was not publicized very well at the time, but it had profound revelations. He claimed that his insurance company, following the play book of every other insurance company, engaged in well orchestrated and funded tactics to discredit sound solutions to the problem by falsely planting misinformation about “socialist” control of their industry. Mr. Potter’s cronies felt that the movie “Sicko” in 2007 was quite dangerous because it told the truth about their industry’s nefarious dealings that are based on maximizing profits, not patient care.

In his book Bill Moyer also interviews Dr. Margaret Flowers who was arrested for trying to reach President Obama with her proposal, backed by most doctors and patients, that the USA adopt the Single Payer system. Of course, under pressure from Mr. Potter and his ilk, President Obama abandoned his campaign promise to look into a system used by the top 5 ranking countries in health parameters.

And so it is that We The People must always be “educated” and aware of the “noise” from special interests that will tend to demonize anything that favors We The People and cuts into their profits. But, as history has it, We The People are the real leaders. Every mayor movement and social change has been started and carried out by grass roots movements. This fact is well documented by another Moyer interviewee, the late professor Howard Zinn who wrote one of my most favorite books, “A People’s History of the United States.” of the USA.” I first became aware of this point reading Tolstoy’s “War and Peace” while in Medical School; so-called “leaders” are ultimately forced to follow We The People. But, since the “leaders” end up controlling the media and other institutions, history ends up written in a way that discounts We The People’s input.

Our role in society demands that we stay informed and aware that the “dumbing down” of our society threatens our very democracy. Unfortunately, getting the education our children need is proving to be a challenge these days. Believe it or not, our climbing obesity rates is also keeping some of our children from attending school, which then sets them up for lower incomes and related health problems.[8] But, if they do end up going to school, the lunch they are given, which is leftovers from industrialized food that the regular consumer won’t but (for example, chicken that were egg-laying hens have splintering bones,) will add to their bulging waistlines.[9]

As we celebrate our country’s independence, let us ponder our role in our democracy and commit to be “educated,” to read and inform ourselves so that our government remains “of the people, for the people and by the people.” Staying well informed must include the humanities and art, in pursuit of which countless Americans have been and are open-minded enough to seek lessons from other cultures. The number #1 non-fiction bestseller right now, McCullough’s “The Greater Journey,” (he also wrote “1776”) chronicles the lives of pioneering American artists and writers who lived in Paris over a hundred years ago, a time charmingly covered by the movie “Midnight in Paris,” now playing in your neighborhood theater.

Happy 4^th of July!

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[1] “Spend slightly less on health and more on the arts: health would probably be improved,”

British Medical J. 2002;325:1432

[2] J. Nature, July 2011

[3] “Using Ecological Momentary Assessment to Determine Media Use by Individuals With and Without Major

Depressive Disorder,” J.Arch of Peds & Adol Med 2011;165:360

[4] “Television Viewing and Risk of Type II Diabetes, Cardiovascular Disease, and All-Cause Mortality,”

JAMA 305:2448

[5] “Dumbing down” JAMA 2003;289:1349

[6] “Medicine, the arts and the humanities,” J. Lancet 2003;362:93

[7] “Reading is fundamental,” J. Arch Int Med 2005;165:1943

[8] Utah State University study reported on June 20^th 2011 in the Salt Lake tribune

[9] “National School Lunch Program Participation and Sex Differences in Body Mass Index Trajectories of Children From Low-Income Families,” J. Arch of Ped & Adol Med 2011;165:346.