Practicing Nutritional Medicine

Even Nutritional Medicine Can Cause Devastating Damage

2011-11-02T02:26:00.000-07:00

I just watched the BBC report where nutritional therapy caused brain damage to a person. This was by a graduate from a nutritional therapy slimming program.

It is clear that the truth was spun and comments taken out of context. And the expert that stated that giving more Iodine will cause hyperthyroidism is just hypocritical. She seems has never had the chance of hearing about homeostasis.

Having said all that this does not removes the fact that how bad can things go even with “natural therapy.” Even when only using water, food and food supplements.Mainstream medicine is not immune of such disasters. US Institute of Medicine 1999 report: To Err is Human reports 44-99 thousands US hospital deaths because of medical mistakes!

However there is no excuse for causing such a devastating damage. I think if we truly believed in nutritional medicine, we should train new graduate well. In mainstream medicine this is what happen. A licensed physician passes through years of directly supervised training. It is my opinion that this should be emulated.

Why does ‘mom’ plant packs nutrients in its seeds?

2011-10-02T13:24:00.000-07:00

Imagine a mother getting her child a lunchbox. Both moms (human and seeds producing plant) want to make sure that their children have enough food to get them through few hours, a day, or more.

Let have a look at what mom plant packs in its seed:
minerals
vitamins
antioxidants
fat
starch
proteins
etc..

Are you a good mom if you do not pack all of these; without exceptions and in the right proportions?

Eating Incomplete Food is a Form of Theft

2011-10-02T03:25:00.000-07:00

At a certain level we all agree that to metabolize a given amount of carbohydrates, fats, or proteins, we need to consume essential nutrients; mainly vitamins and minerals.
Every-time a meal does not provide these vitamins and minerals your body must use its reserves. In other words when you eat that piece of seemingly innocent cake, it is stealing from your reserves (if present.)
I can even-rephrase it further:
when we rob our food from their nutrients, as in the process of producing white wheat, food turns around and robs us.

How to use Clinical Trials in Nutritional Medicine?

2011-06-08T18:59:00.001-07:00

Image via Wikipedia

Few days ago I had the pleasure of watching a nutricentre webcast for Linda Lazarides, author and course director at the School of Modern Naturopathy

Lazardies dedicated the first 20 minutes or so for her take on how to integrate clinical trials in nutritional medicine. I am not qualified to assess a person as Lazardies, but I must declare my humble opinion. Lazardies take on the integration of medical research in nutrition is thought provoking and insightful (which is expected from a person of her stature). I see her opinion as one of the missing links I was searching for to formulate my own opinion for the proper scientific methodology to formulate and advance nutritional therapy.

Lazarides mentioned three points relating to clinical trials, yet the third is the most poignant and deserves deep thinking. Please note that I am extensively rephrasing:

Let assume you read a trial for giving pyridoxine (vitamin B6) for premenstrual syndrome (PMS) and the trial shows benefit. Would this lead to you recommending vitamin B6 to PMS sufferers?

If you are interested in Lazarides answer than continue reading. However, I will first mention Lazarides first two points.

1. Clinical trials assess efficacy, that is if a drug is effective in reaching a predetermined goal or not. But, often people equate efficacy with ‘cure’. For example if a clinical trial concludes that that vitamin B6 is effective in PMS, many assume vitamin B6 would cure PMS when all what the clinical trial states that Vitamin B6 can improve PMS. This improvement could be merely masking patients discomfort while the disease process is worsening.
2. Clinical trials only tell us that an intervention or drug is more effective than the other arm of the trial which is usually a placebo. The tested intervention or drug can be toxic or harmful. Drugs do not need to have any curative value.

Now back to the answer to the main question:
Would you recommending pyridoxine to PMS sufferers based on a trial that shows benefit?
Lazarides states that such a clinical trial should not push us to start to treat PMS with pyridoxine. All what this clinical trial should tell us is that PMS has a nutritional bases. Therefore, for patients suffering from PMS, a full nutritional assessment should be performed. Yes, we should focus on pyridoxine, but never limit ourselves to it.

An unanswered question that poses itself based on Lazarides opinion is if all what nutritional clinical trials suggest is a nutritional link to a disease and that the next step is performing a full nutritional assessment, what should be the scientific basis for this nutritional assessment? My humble answer is to perform systematic reviews that do not preclude qualitative studies. For this, I would point you to a two page article by Robbert van Haselen titled: ‘Medical Study Formats: An Overview’ published in the Nov 2010 issue of the Journal of Biomedical Therapy

What do you think?

NEJM Article: I am Astonished to the Ignorance by Medical Researchers to Basic Facts About the Food We Eat!

2010-12-26T22:12:00.000-08:00

Image via WikipediaLeaving aside the outcome of this study and what it means, I am astonished to the ignorance of basic chemical facts about polyunsaturated fatty acids as EPA and DHA used in this study? The ignorance of the fact that polyunsaturated fatty acids are unstable compounds unless handled appropriately. Mishandling of polyunsaturated fatty acids can convert them into the dangerous trans-fatty acids!

In short, this study compared margarines’ that post myocardial infarction (MI) patients would eat with margarines with added low dose two omega three fatty acids; EPA and DHA. (usually present in cold seas fish as salmon and cod) These patients were kept on the standard post MI drugs. In the published article there is no mention of how was this margarine used and handled. For anyone with knowledge about the chemistry of fatty acids, this information is vital to know if patients truly consumed EPA and DHA or altered ones.

N–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction — NEJM

Good Research that is Unable to Go all the Way

2010-09-06T04:50:00.000-07:00

Image via Wikipedia

Again a very nice podcast by Michael Krasny on KQED. It is an interview with Dr. Dr. Dean Ornish. The show brings good news and shows a path to disseminating nutritional treatment, however, also illustrates a fundamental problem with orthodox approach to nutrition.
First the good news: medicare and medicaid, the US Governmetal organizations that deliver free health care to the elderly and poor, will pay for lifestyle programs that diet is one of their cornerstones. This shows that a government organization is willing to considered the available evidence that proves that nutrition can be used successfully for the treatment of illness.
In my first paragraph, I eluded that Dr. Ornish approach goes in-line with orthodox approach. This is not totally fair. Dr. Ornish approach is a bit of a departure. He advocates the use of nutrition and lifestyle as a central tool for the treatment of illness, which most of orthodox medicine do not agree with. He conducted randomised controlled trial that was published in the Lancet in 1990 with a follow up published in JAMA in 1998, that shows reversal of coronary artery atherosclerosis with nutrition. Publishing of his papers in these two reputable medical journals speaks to the quality of Dr. Ornish work. It is actually surprising that not enough attention is paid to his work.

The problem that I see with Dr. Ornish approach is in the scientific methodology or in other words the thinking process. Listening to Dr. Ornish and going quickly over one of his papers, it is obvious that Dr. Ornish is using the same scientific methodology used in orthodox medicine and applies it to nutritional therapy. However, I see the reason for our poor state of health is this scientific methodology. Having said that, if Dr. Ornish would have used a different method, his papers would not have been published in such reputable papers, and medicare and medicaid would continue to refuse to reimburse for nutritional therapy.
In science, if we have the correct starting point and then have the correct approach to move forward, or in other wards the correct scientific methodology, science would evolve in the right direction. Having the wrong starting point or the wrong scientific methodology (wrong reasoning) would lead to the current state of medical science.
I have two criticism to the work of Dr. Ornish :
First diet interventions are complex interventions. this is quite different than simple intervention as those of testing drugs. The number of variables is tremendous and even worse these change over time. I’ve written a post in 2008 on the subject. The post was comments I’ve written on Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement presentation. The presentation was titiled: Eating Soup with a Fork. Yes, Dr. Berwick sees using randomised controlled trials for complex interventions as eating soup with a fork.
Second, I do not think Dr. Ornish went far enough in the selection of the proper diet. Here there are multiple issues. Does one dietary approach fits all? Probably not. But then, if Dr. Ornish varied the diet, he would not be able to call it a randomised controlled trial and it would not have been neither funded nor published. The other point that needs to be addressed is that the knowledge we now have about fat types was available in the 1980’s when Dr. Ornish started his research. This point should be considered seriously if Dr. Ornish program is to be applied.

Do not Fall in the Evidence Based Medicine Trap

2010-06-18T12:25:00.001-07:00

Human subtlety...will never devise an invention more beautiful, more simple or more direct than does nature, because in her inventions nothing is lacking, and nothing is superfluous
Leonardo de Vinci

I just bought a book titled "an evidence-based approach to dietary phytochemicals" by Higdon for the Linus Pauling Institute. The title is very attractive Having the term “evidence-based” in the title justified spending $ 57 for the book. The book covers a number of phytochemicals; ones with studies supporting them. I still think the book is worth having. But, I do think using the term “evidence-based” in the title is worth nothing more than its marketing value.

Orthodox medicine uses the term evidence-based medicine (EBM) for a specific purpose, which is not addressed in this book. The book uses this term to emphasize that the claims presented in the book are supported by research. But, this is not EBM as per the people who coined the term. Here, I am not taking orthodox medicine off the hook. I believe that the term EBM is also abused in orthodox medicine literature. You can check my post.

The seeds of evidence based medicine started in 19th century. (Sackett et al. 1996) The movement was an outcry to the quality of research conducted then. The McMaster group that coined the term EBM intended it to be a tool used to make better clinical decisions. Their initial proposition proved to require more time than available to practicing clinicians; therefore, they adjusted it definition to:

the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. (Sackett et al. 1996)

The most practical method to practice EBM in orthodox medicine is to use secondary sources of evidence: The process goes as follows:
someone with available time and resources reviews relevant clinical studies. He/she uses EBM tools presented by McMaster group in JAMA in 1993 (or updated tools) to rate the quality of the study. The level of evidence deciphered from the study is given a rating from one to four (I -IV).
Then, recommendations that are based on this evidence is also rated, but now graded from A to D. Grade A recommendations are usually based on Level Ia and Ib evidence. (The grading does differ slightly between publications, but the general framework stands)
These recommendations are considered secondary resources for evidence. The primary resources are the original research papers.
For example, if a clinical question as should I give vitamin D 5000 IU to a patient with Serum vitamin D of 50ng/mL is raised. And, I find a very poorly conducted study where according to EBM tools rating is level III evidence. If this is the only available evidence, I will use it as it is the best available. I will then combine this fact with patient condition and values and either prescribe or not prescribe her vitamin D 5000IU.
EBM as intended by those who coined the term is a dynamic process of basing clinical decisions on best available evidence. This evidence can be poor. But, it is assumed the best available.

You must realize that EBM rating tools are designed to assess the quality of research that naturopath see fundamentally wrong. Here, I can quote Landlhr (1913):

No matter how learned a man may be, if he begins a problem in arithmetic with the proposition 2x2=5, he never will arrive at a correct solution if he continue to figure into all eternity. Neither can allopathy solve the problem of disease and cure as long as its fundamental conception of disease is based on error.

At the heart of EBM is a call for better research. We believe in the Law of cure. Therefore, we believe that well conducted research will prove our theories. But, this will never happen unless orthodox medicine poses the right question.Orthodox clinical research tries to answer questions as : if I give this medicine will the patient live longer? or will he have less pain? The question that should be answered is: what are the Laws of nature that govern health and disease? Once we know these Laws,we need to learn how to apply them in clinical situations. We will need good quality studies to discover these Laws and good quality studies to learn how to apply these Laws.
The way I see it, Naturopthic medicine has the right starting point, but is not advancing fast enough mainly due to the lack of resources. While, orthodox medicine has the resources to advance but unfortunately has started with the wrong beginning.

What I am calling for is illustrated by Foster (2003) research. He started with a Law of nature that states that our cells need the proper nutrition to function well and ended up with the best treatment till date for AIDS. He has the term "EBM" nowhere in his book. It is because he did not use this term he appropriately had to lay the ground for his theory in details supporting it using all available research.

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS., 1996. Evidence based medicine: what it is and what it isn't. BMJ (Clinical Research Ed.), 312(7023), 71-72

It is not Inflammation, but How you Present it that Divides Mainstream and Naturopathic Medicine

2010-06-02T19:06:00.001-07:00

Image via Wikipedia

Solving a problem simply means representing it so as to make the solution transparent

Herbert Simon

As I am reading more into naturopathy, in particular Henry Lindlahr book (philosophy of natural therapeutics) and my study material at Plaskett International, I am astonished by how both mainstream medicine and naturopathic medicine are based on the same basic science principles. They both see inflammation as a mechanism of ridding the body of unwanted matter and a mechanism for tissue healing. But, Naturopathy present inflammation in a way that the solution becomes obvious: support patients by allowing inflammation to take its natural course (without endangering patients’ lives)

While main stream medicine present inflammation in a way that the obvious solution is to suppress it to relive the discomfort caused by it. This prevents inflammation from taking its natural course; the course that ends up by healing!

The Antibiotics Fluoroquinolones can cause Tendon Inflammation and Rupture

2010-05-31T01:12:00.001-07:00

Image via Wikipedia

As I am starting to learn about naturopathy, I am learning about naturopathy stance against the use of medications. They see medications as toxic matter that should be avoided.

Toxins settle in certain parts of our bodies. One method our bodies rid itself from these toxins is by initiating inflammatory reactions. The multiple studies that show that fluoroquinolones (cipro, is the best known) cause tendonitis and tendon rupture are evidence of this naturopathic insight.

Khaliq and Zhane, Fluoroquinolone Associated Tendinopathy: A Critical Review of the Literature, Clinical Infectious Diseases 2003;36:1404-1410

Making Sense of Natural Healing: Autoimmune diseases: so The Body Really Does Not Know What It Is Doing!

2010-05-15T04:48:00.000-07:00

Image via Wikipedia

Part of my first course at Plaskett International is an introduction to naturopathic and natural healing philosophy. Their philosophy is simple and logical. It is as follows:

The human body has the innate capability of healing it self. Inflammation is seen as a major method of how the human body does that. We in mainstream medicine know this and believe in it. That is, we believe that one of the goals of inflammation is healing. Naturopaths see suppressing this inflammation prevents healing. They see the role of the practitioner is to support this natural process by providing our cells with the nutrients they need, taking away cells waste, and strengthening energy. I will describe these three pillars of naturopaths therapy in another post.

So, as I am trying to make sense of this, I started asking myself: is the inflammation generated by our bodies in autoimmune disease an effort for healing and though should not be suppressed as we routinely do in mainstream medicine. Or are we correct in mainstream medicine and our bodies do not know what they are doing by initiating inflammation.

Don't Give Vitamin D as a single Annual Dose of 500 000 IU

2010-05-12T09:08:00.000-07:00

Image via Wikipedia

I am new at this, but I am missing the rationale why the authors of this study choose to give all of a year's supply of vitamin D on a single day?

This study compared giving 500 000 IU of vitamin D to placebo to 2256 community-dwelling women, aged 70 years or older who are considered to be at high risk of fractures. The absolute risk of falls was higher in the vitamin D group by 10.7 falls per 100 people per year. And risk of fractures was higher in the vitamin D group by 1 fracture per 100 people per year.

The point that I am missing is the rationale for giving all the yearly supply of vitamin D together in one day. Do you know the rationale?

JAMA -- Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial, May 12, 2010, Sanders et al. 303 (18): 1815

Vitamin E better than Placebo and Pioglitazone for Nonalcoholic Steatohepatitis

2010-04-30T12:15:00.000-07:00

Image via Wikipedia

In this NEJM study, 800 IU of vitmain E was given for 96 weeks. This was compared to placebo and Pioglitazone. The target was histological improvement. Vitamin E was associated with improvements compared to placebo. Liver enzymes (a secondary marker in this study) also showed improvement.

Vitamin E was RRR--tocopherol (d--tocopherol).

NEJM -- Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis

Lasting Words

2010-04-29T22:04:00.000-07:00

Image via Wikipedia

Let Food Be Your Medicine and Medicine Be Your Food

It is only nature that heals and wherever and whenever possible nature should be given the opportunity to do so

Disease is only an expression of purification

All disease is one

Hippocrates