Monday, October 25, 2010

One afternoon at the conference (#15)

Recently, I was at a large medical conference. After my talk, I thought I would sit in on an open discussion of a case being presented by a well known doctor. When I arrived there were about 40 other physicians/practitioners as well as the mother of the child, whose history was laid out in front of us. She sat calm and poised on the platform next to the doctor.

The mother and doctor went back and forth filling in the details of her son’s history. The blood and other medical test results were flashed on to a large screen and the presentation was going as these things generally do.

Somebody asked a question which I did not hear. The mother responded that the most important factor in a successful patient-doctor relationship was utter and complete confidence in the doctor, which she had. Many of the attendees nodded their heads in solemn agreement but this type of comment to me, usually means bad things are a comin’.

I am all for complete confidence in the medical professional one works with but draw the line at utter. In any relationship, there has to be one finger of yourself left to raise questions and consider other possibilities in case the practitioner is human and prone to mistakes or has a few gigantic blind spots, like everyone in the world. “Don’t give all your power away,” I wanted to shout. “Retain your right to question authority.” Alas, it was too late. Not only had she given all of her power away, most of the practitioners in the room seemed only too happy to take it.

Yet, she seemed peaceful and satisfied with her care and she had a right to her own views so I got off my little mental soapbox and decided to get what information I could from the session. With all of these highly educated people in the room, there should be some good clinical pearls, I reasoned optimistically.

The doctor finished showing the blood tests and explained what he had done in response and a lively back and forth with the audience ensued. Most of comments were started with, “I spent 20 years as head researcher on this topic….” or “I used to be clinical director of….” These were followed by an observation or advice wrapped in a question. “In the hundreds of similar cases I have seen,” went one, “I found such and such worked best. Why didn’t you use that?”

The presenter took these Monday morning quarterbacking comments equitably, explaining his thinking about this or throwing questions back to the audience when an unfamiliar concept was broached. The audience jumped on these like bears at a salmon convention. And they were so smart. Obscure and fascinating research was quoted. The usual wind up for these tidbits was,” You are no doubt familiar with Dopplehoffer’s seminal work on blah, blah, blah.” I wasn’t! I furiously took notes.

As the presentation went along, I waited to hear what the doctor did to figure out what type of infection this child had. There was a significant infection marker in the blood work that he had skipped but surely would come up in his treatment protocol. It did not. I tentatively raised my hand and asked. He looked at me blankly. “Nothing,” he said and moved on to the next comment.

I eyed the audience suspiciously and stopped writing. This could not be good. Why aren’t these doctors concerned about a possible infection? Instead, he highlighted a low iron level which he explained needed to be corrected. Many heads nodded in agreement once again and there was a brisk discussion about how everyone is afraid of iron but how important it is. One former clinical director claimed he even prescribed iron injections. The consensus was, iron: excellent choice.

MayDay! MayDay! Iron goes low when there is an infection. The body has a protein called lactoferrin that eats it up so the bacteria don’t get it because bacteria need iron to thrive. The case went straight downhill from there. A secondary gastrointestinal infection was uncovered which was treated with antibiotics. Iron stops antibiotics from working so I was not surprised to hear that the child had the same recurring GI infection. The doctor treated the problem with antibiotics but sighed with frustration when reporting it just was not going away.

Here I thought I was in an educational seminar but I had forgotten about how myopic the culture of medicine can be. Everyone was more interested in quoting medical literature and looking brilliant than considering new perspectives or asking real questions. I tried to raise a few delicate points without being insulting but nobody was listening.

Afterwards, I realized my failure was in being polite and not coldly explaining the forgotten basic principles of infections and iron. I was not speaking their language. The most important criteria for being heard is thrusting forth with unassailable confidence. “To anyone familiar, as I am sure you all are, with the studies by Smurf that found that iron deactivates antibiotics,” is what I should have said. I have done this many times one on one with other medical professionals to help clients. The trouble is that Smurf did not do those studies and I would have to look up who did in order to posture effectively. And though I can be an intellectual bully when arguing for proper patient care, it always leaves a bad taste in my mouth.

When I left, I was downtrodden. Intellectual arrogance and jockeying is usually bad for patient care. That poor kid. He has some kind of primary infection nobody is looking for, he is being treated for a secondary infection with antibiotics which might even accidentally help the primary infection but are being deactivated by supplemental iron and everybody just thinks this is an unusually tough case.

I took a breath. There are many ways to do things and mine may not be the only or dare I say, the best. I should take my own advice to question my own thinking. Iron is an important nutrient so perhaps I am not using it effectively and often enough. Perhaps this child will get better because of other unknown factors. Maybe the mother’s unquestioning faith in her doctor will overcome the biochemical factors. Question everything, I told myself. Try not to be attached to what you think you know.

The truth is the price for good health care is eternal vigilance. Ask more questions if the advice you are getting does not feel right. Get a second or third opinion. Like your doctor or nutritionist but do not adore them unconditionally because they are human and therefore, will screw up sometimes.

But don’t take my word for it.

Sunday, October 17, 2010

Blog #14 Coming soon to a store new you

A good detective keeps up to date with what’s new in her field and to that end every year my husband and I spend a day at the Natural Products Expo. This is an enormous natural foods convention where new products are trotted out and old standards search for new vendors. The fun part is getting to taste everything.

Through the years we have noticed the health food industry, like everything else is subject to trends. One year there was a whole aisle of soy enhanced foods including soy meats, drinks and puddings. Another time it was the year of the obscure berries and exotic fruit like acai, goji berries and mangosteen. Goji berries tasted like red lint no matter what they mix with them including chocolate. But we try everything.

Once we ran into our friend, Enrique, who works for the FDA. Last we had heard he was hot on the trail of a dangerous man parts enhancer that was heavily advertised on the internet. “You should see what happens to the poor slubs when this goes wrong,” he confided, shuttering. The whole project was depressing him. We were glad to see him out doing some fun field work but though we love Enrique, we could not bring ourselves to invite him to walk around with us.

“Being with you is like wearing a “cooties” badge,” I apologized lamely. “Nobody will tell us anything interesting when they see you are from the FDA.” He understood and was not offended. To make amends, we told him where all the good organic ice cream samples were.

This year was all about gluten free foods. Coming to a store near you soon is gluten free….everything. The best was a line of naturally gluten free frozen soups by Kettle Cuisine. Their yet-to-be released Thai chicken with a coconut milk base was particularly yummy. The cookies and cakes on the other hand were consistently too sweet. After trying a half dozen, I could not stomach them any more. For gluten free treats stick to chocolate, ice cream, macaroons or Pamela’s cookies is my advice.

As for new cool discoveries, my husband’s favorite was a naturally fermented “soda”. Technically, it was a type of water kefir made with probiotics. They make it using a process similar to the one used to make kombucha. It is sweeter than kombucha however and only has 40 calories. His favorite flavor was tarragon. Check out:

My fun new find was Sea Buckthorn. It only grows in the harshest environments like salty marshes and the Himalayas. To survive these inhospitable environments the plant has developed some unique bio-defense mechanisms. These chemical mechanisms are often anti-oxidants and nutrients to the plant consumer.

“Sea Buckthorn is the world’s only source of essential omega 7 fatty acids,” the enthusiastic sales rep informed me.

“I was not aware that omega 7 fats were essential,’” I replied.

“Oh, they are for the skin,” he assured me. “In fact, my girlfriend complains my skin is too soft because I work with them so much.”

“That seems like an unusual complaint,” I retorted eyeing him suspiciously. “Let me see your hands.”

His hands were spookily soft for a man; it was like touching Gumby. “Very impressive,” I commented. “What else is it good for?”

“Acne,” he said with confidence. “Clears it right up.”

Luckily, Enrique was not here to witness such a claim but I wanted to know more. “I wonder how it works,” I mused while trying to read the bottle. “You know omega 7 fats have to be made from something else, so are they long chain polyunsaturated fats?” I asked.

He looked at me blankly and then recovered. “I am not sure but they are essential.”

No, they are not, I explained. There are two essential fats and omega 7 is not one of them. Every other fat is made from these two though it is sometimes useful to get non-essential long chain fats like DHA and EPA directly. Now, he was stepping back from me.

“Think about it,” I challenged, “how could this fat for which there is only one direct food source in the world, be essential? Ninety nine point nine percent of the people in the world would not have access to it. The question is, what is the structure of it and why is this form particularly good for the skin?”

“You need to talk to Dr. Liu,” he decided and scribbled a name and number on a card. In the meantime, I ordered a few bottles. I thought about someone who might be willing to be a guinea pig to test it out.

But all this talk about chemistry was making me hungry. “Look,” called my husband, “I found some high antioxidant chocolate.” Now that sounded essential.

Wednesday, October 13, 2010

About the book.....

Dear Rosa Maria....

Thank you for asking about the book. "What's Eating Your Child? The Hidden Connections Between Food and Your Child’s Well-Being — and What Every Parent Can Do," is deep in the process of editing which takes a long, long time. In fact, it feels like I produced three children in less time. The good news is that this paperback baby is expected from Workman Press in April 2011. Hopefully, Jim Carey will be between movies and will be available to star in the movie version. Just kidding. I want Diane Lane.

Friday, October 8, 2010

Blog #13 Vitamin M

Julia dropped by to discuss her son, Colin. I had seen him many years ago but now he was attending a famous military college that starts with “The”. I will call it, “The Academy” though it is not really THE Academy but a different equally famous The something. Anyway, she was worried because Colin was diagnosed with ADHD and she wanted him to be successful at The Academy. Colin had discovered the reported wonders of Ritalin by scoring it from some buddies and believed he was not nearly as focused without it. The Academy, like all military institutions, did not allow its cadets to take stimulants, prescription or otherwise. In fact, they randomly and frequently drug test the students.

I love this place! I wish all universities did the same thing though for all I know one of my own children might have been kicked out which such a policy. I have talked to many college students and most of them have admitted to me (usually without their parents) that they have tried stimulants for studying and/or test taking. They are the most abused drugs on college campuses. The military thinking is you cannot have a soldier running out of medicine while under fire somewhere, especially a narcotic. (Technically, stimulants are narcotics.) Who knows who you would be dealing with? They certainly do not want to find out.

Colin had survived freshman year with a “B” average. It was rough physically with many hours of intense physical training every day plus academics. There was little we could do about his diet. He had to eat at the dining hall and he was already making good choices eating salads and vegetables whenever they did not look too soggy.. And, he was doing the best he had ever done academically I think I know why.

He was getting a gigantic dose of vitamin M: Movement. For a certain type of attention issue, the best strategy in the entire world is loading up with vitamin M. Colin was getting 4 or 5 hours a day of motion and physical activity. The Academy was doing for him what no other university and a fistful of medication would ever match.

The movement centers are right next to the language centers in the brain. All that running around was organizing Colin’s thinking and putting his frenetic energy to productive use. His mother admitted he was calm and happy. The biggest problem was he was comparing his present performance to how he felt taking stimulants. The stimulants gave him a false sense of confidence because his thinking was so remarkably sharp. What can I say? This is why people like cocaine and stimulants are similar.

I assured Colin’s mom he was thriving and that the magic of vitamin M would keep him in balance. I also explained the concept of neurodiversity. That is, there is a wide range of ways that brains function and process and there was not anything particularly wrong with Colin’s. I call people like Colin who have been diagnosed with ADHD, Warriors. Until recently, Warriors were highly prized in society. They were the knights and warriors you called (and paid) when the village needed to be cleared of marauders. They were athletic types who had no trouble riding their horses all day and were what we would now call, “risk takers”. They would shoot first and ask questions later. It makes you wonder if Clint Eastwoods’s Dirty Harry would be classified as ADHD if he had to get through the police academy today. You can imagine the report. “Has trouble following directions. Cannot sit still. Tends to shoot first and ask questions later suggesting impulsive tendencies. “

Today, the valued jobs go to people with brains that can concentrate for long periods of time while sitting at a desk. The physical warrior has been replaced with the computer warrior. Not a better brain, just a different, presently in more style brain. (For more on this fascinating subject see one of Thom Hartmann’s 8 books on neurodiversity at )

Along with many assurances, I suggested some nutrients that help with cognition and would not trip any drug tests…..just for insurance. Besides, it can never hurt to be a little smarter. But this is not all vitamin M can do……(To be continued.)