Altes Labor eines Landarztes

What Your Doctor Isn’t Thinking About (Dragging Medical Professionals Into the Modern Era)

Altes Labor eines LandarztesThe other day I came across this alarming video of what it’s like to drive in Poland. My first thought after watching the clip was “What’s the Toxoplasmosis gondii infection rate in Poland?” T. gondii is a brain parasite easily acquired from eating undercooked meat, or contact with cats, and is associated with a six-fold increase in traffic accidents (this association has been replicated a number of times, in different countries). Well, I looked it up, and found that the latent infection rate in 2003 was around 41% (at least among pregnant women). That’s quite high — in the U.S. the infection rate is only about 11%.

Is there anything to my hypothesis that terrible driving in Poland is related to the relatively high T. gondii infection rate? Probably not. The accident fatality rate in Poland is relatively high for a modern industrialized country. But France has a very low accident fatality rate, and a much higher rate of T. gondii infection. So while T. gondii might be a contributing factor, it’s probably not the most important variable.

I’m fascinated by latent/chronic biological infections, and how they affect human health and behavior. T. gondii in particular is linked to changes in personality, and even schizophrenia.

What’s shocking to me, as shocking as the driving in Poland video above, is that so few medical professionals are considering latent infections as part of their diagnostic process. The research is here, and so are the diagnostic tests. So why aren’t medical professionals taking advantage of them?

‘The Future Is Here, It’s Just Not Evenly Distributed’ – William Gibson

The above quote definitely applies to the medical profession. How many general practitioners are doing the following?

  • a detailed dietary questionnaire (cost: $0, benefits: insights into common subclinical nutritional deficiencies, including vitamins C, D, B12, K2, magnesium, iron, zinc, copper, and chromium, as well as information re: macronutrients — is the patient eating enough protein and omega-3 fatty acids? or consuming too much fructose/sucrose/alcohol?)
  • a personal genetic profile (cost: $200, benefits: insights into disease risk for common health problems, and precise genotype information re: less common genetic conditions)
  • antibody testing for a full range of common viral infections (HSV1, HSV2, CMV, HPV, etc.) (cost: a few hundred dollars, benefits: insight into diseases that are linked to multi-decade viral infections, including heart disease, dementia, many types of cancer, etc.)
  • an enterotype panel

I’m hoping that in ten years or so, the above practices will be commonplace. Spit in a tube, piss in a cup, prick your finger, and twenty minutes later get a full genome analysis, a full spectrum nutrient level analysis, a metal and chemical toxicity report (lead, mercury, bisophenol-A, etc.), an extremely wide antibody report (for hundreds or thousand of viruses), a complete bacterial panel (blood, gut, and mouth), testing for protozoan parasites like T. gondii, etc.

Why isn’t this happening already?

Gibson didn’t anticipate cheap genome sequencing. In some cases cost is prohibitive. While a genome SNP test has come down to $200, micronutrient testing like the kind Spectracell offers is still quite expensive. I suspect that we’re on the cusp of (or in the midst of) a rapid advance in portable diagnostic technology, so testing costs may change quickly. It remains to be seen how quickly HMO’s will take advantage of the new technologies as they come online.

Another reason is that your doctor isn’t necessarily thinking along these lines, because when she was in medical school, you couldn’t get an accurate micronutrient panel, or a genome analysis, or an enterotype panel. These tests just weren’t available.

Educate Yourself, Test Yourself, Take Preventative Measure

It’s irritating to me that the medical profession hasn’t caught up with medical research and diagnostic technology. For most people, it’s probably worth taking the following diagnostic and preventive measures:

  1. If you can afford it, get a full micronutrient profile from Spectracell or another reputable vendor. I’m putting this at the top of my list because I haven’t actually done it yet (but I’m going to). At the very least, get a vitamin D test. If your levels are suboptimal, you’ll probably need to supplement, and also consider vitamin A and K2 levels.
  2. Get your genome analyzed, from 23andMe or a similar service. Find out what your risks are. One way to think about it is that reading your genome is like reading your death sentence. Another way to think about it is that reading your genome will give you possible clues into improving your quality of life, and possibly extending your life for a decade or more if you take the appropriate preventative measures.

What about prevention? Some measures are common sense. Others, like implementing a general viral suppression protocol, perhaps less so.

  1. Diet – get most gluten, casein, fructose, and refined vegetable oil (canola, corn, soy) out of the diet to drastically reduce your risk of IBS, autoimmune diseases, heart problems, and diabetes. Eat nutrient dense whole foods, mostly those available during the paleolithic era (for which we are genetically best-adapted to). This would include seafood, grass-fed meat, eggs from free-roaming birds, vegetables, low-sugar fruits, and nuts/seeds. For the research, please see Mark Sisson’s site.
  2. Reduce your carcinogen/toxin load (lead, mercury, bisophenol-A, air pollution, tobacco, hard alcohol, narcotics) to reduce risk of cancer, reproductive, and neurological problems.
  3. Ramp-up autophagy (clean out cellular debris) with both intense exercise and intermittent fasting. This will help ward off cancer, dementia, and suppress chronic viral and parasitic infections (which we all have after age 2 or so, unless we live in a bubble).
  4. Consume chemicals that kill cancer cells and interfere with viral replication. A short list would include curcumin (turmeric/yellow curry), garlic, resveratrol/grapeseed extract/red wine, and coconut oil. The links all go to research or articles about research.
  5. Reduce artificial light in the evenings to encourage natural sleep patterns. My post about giving up artificial light for a month has seen a spike in traffic since this recent BBC article (I was also on The Doctors about a month ago discussing the experiment).

I think the clinical research is there to back up all these claims. But are you going to get any of this advice from your doctor? Probably not. Your doctor is going to tell you to eat a low fat diet, but won’t distinguish good fats (olive oil, coconut oil, fats from grass-fed meats and wild fish) from bad fats (refined vegetable oil, fats from grain-fed animals). He will probably not mention vitamin D, vitamin K2, or the beneficial effects of polyphenols and flavonols. Your doctor is going to ask about your family history, but he’s not going to recommend that you actually look at your genome. Sugar and carbohydrate consumption won’t be mentioned unless you already have diabetes. Viral infections won’t be identified unless they have very specific symptoms (like chicken pox or cold sores), and no recommendations will be made to suppress chronic viral infection to prevent cancer or dementia twenty or forty years later.

I’m not against going to the doctor, or taking medical advice from someone who is better educated and informed than myself. But we should push our medical professionals. We should drag them (even if they protest, kicking and screaming) into the modern era.

The future is here … please help spread it around.



  • danpardi

    I’m sure many medical professional would like to treat this way.

  • john cameron

    Why do you consider casein to be harmful? There have been many studies that show that those who consume the most fermented dairy such as cheese and yogurt , which contain casein, have significantly reduced overall mortality, chd mortality and cancer mortality compared to those who consume no fermented dairy. The reduced mortality is apparently mediated by vitamin K2, subtypes 8 and 9, which is synthesized by lactose fermenting bacteria and which is more effective than subtype MK-4 from meat, dairy and eggs that are not fermented.

    • danpardi

      Putative health benefits of vitamin k2 are probably independent of casein. I have not formulated a clear opinion about dairy. In the mean time, I do consume fermented sources, including cheeses and yogurts. I’m curious to see @JDMoyer’s response, since he wrote this.

      • john cameron

        That is true. The point is that if there are adverse effects of the casein content of fermented dairy they appear to be more than offset by the benefits vitamin K2 content (subtypes mk-8 and mk-9) from the fermented dairy. Further, the benefits of the fermented dairy containing both vitamin K2 and casein appear to be greater than the benefits of meat containing vitamin vitamin K2, subtype mk-4, and no casein.

        Lactose fermenting bacteria are gram positive bacteria that utilize vitamin k2 as an electron transfer agent in their respiratory chain and therefor must synthesize vitamin K2 to survive. The long chain vitamin K2 produced by dairy fermentation is more lipid soluble that the mk-4 found in meat, butter and eggs which may account for its greater effectiveness in the activation of osteocalcin and greater solubility. Long chain vitamin k2 has been found to increase serum mk-4 levels better than mk-4 itself. So fermented dairy seems to have a very positive health benefit in sprite of its casein content.

        The book “Devil in the Milk” by keith Woodford attributes adverse health effects in milk of cows that produce A1 milk to a certain casein, beta-casomorphin 7. (BMC7). Studies have shown that BMC7 is destroyed during fermentation of cheese and yogurt.

        I too am curious to see JDMoyer’s response.

    • JD Moyer

      Hi John. I agree that for many, dairy products provide measurable health benefits. The evolutionary record shows a sharp drop in child mortality around age 4 (ancestral weaning age) for the first populations to domesticate cattle.

      For modern populations, autoimmune factors are a bigger consideration than living to the age of 5 (though I would still recommend dairy products to children who produce lactase — in other words those who are not genetically lactose intolerant — my own daughter drinks goat milk and kefir). Many adults, on the other hand, might have developed an allergic response to casein (especially the “Type A1” casein — see http://www.snowvillecreamery.com/a1-and-a2-beta-casein-in-cow-milk.html), possibly due to consuming milk/sugar combination which encourage leaky gut and thus undigested proteins in the bloodstream. I think it’s worth it for anybody with IBS, asthma, MS, or anything like that to try eliminating dairy and see if they feel better.

      So, to provide a more nuanced recommendation around dairy products:

      Lowfat, homogenized, pasteurized dairy products made from milk from cows fed antibiotics, mostly corn, and raised without sunlight and pasture: Not health-promoting, not ethical.

      Aged cheeses made from pasture-raised goats/cows/sheep: health-promoting for most (K2, better fatty acid profile), more ethical.

      Fermented dairy products, live-culture kefir and yogurt (cultured with lactobacillus, esp. l rhamnosus, and other probiotic strains): health-promoting for most, more ethical.

      People who might do better avoiding dairy altogether: people with any kind of autoimmune condition, people who don’t produce lactase as adults, people who have ethical issues using other animals as food sources.

      Hope that answers your question. Enjoy the holiday season, and good health to you!

      • danpardi

        Women and Osteoarthritis: More Milk, Less Progression

        Women who drank milk regularly had less progression of knee osteoarthritis, data from the Osteoarthritis Initiative showed.

        All quotations from the article:
        -In a multivariate analysis, inverse associations were seen for osteoarthritis progression and higher levels of milk consumption per week among women (P for trend=0.008):
        -Three or fewer glasses, HR 0.67 (95% CI 0.50-0.91)
        -Four to six glasses, HR 0.71 (95% CI 0.50-1)
        -Seven or more glasses, HR 0.56 (95% CI 0.38-0.81)

        – For women, an increase of 10 glasses of milk each week over the 4-year study period was associated with a change in joint space width of 0.06 mm (P=0.020), the authors observed. For men, risk was only reduced with consumption of seven or more glasses per week.

        LIMITATIONS
        1. Observational design, and causality cannot be assumed.
        2. Study lacked information about whether milk was high-, low-, or fat-free.

        http://www.medpagetoday.com/Rheumatology/Arthritis/46031

    • danpardi

      I enjoyed the presentation by Pedro Bastos from the Ancestral Health Symposium, 2011 at UCLA.

      “Dairy, Hormones, and Human Health” by Pedro Bastos, MA, MS

      • Ginny RoBards

        Thanks for posting that presentation. Pedro Bastos offers an interesting perspective on (adult) human consumption of milk.

        At the very least, it is clear that the position of dairy in the current dietary guidelines, as a discrete food group that is necessary for health, is quite unjustified based on available evidence. The nutrients that were cited as the basis for the recommendation of dairy are all readily obtained from other sources.

        • danpardi

          Interesting point. Do you think that being an exclusive source for a nutrient is fundamental to its endorsement? Few fundamental nutrients are found in only one or few food sources. Can a nutrient dense food, regardless of it lacking unique nutrients, be on a guideline? I do get your point, though. Why direct people to consume that specific food type over others that contain similar nutrients? The answer to that question, in part, has to do with the existing food system, and the ability of that system to deliver the foods it recommends in a ubiquitous manner.

          • Ginny RoBards

            No, I definitely don’t think, in general, that a food needs to be an exclusive source of a particular nutrient to be worthy of recommendation.

            I think that the evidence concerning dairy specifically does not support a sweeping recommendation of three cups per day for adults. I also don’t really like how it is situated on the MyPlate diagram, implying that it needs be consumed at every meal.

            I’d probably be ok with dairy being cited as a decent source of potassium, bioavailable calcium, (fortified) vitamin D, etc. I just didn’t think that the case made for dairy in the 2010 Dietary Guidelines documents really justified its prominence – and it failed to address its potential drawbacks. I can’t help but suspect that it is industry driven.

          • danpardi

            All fair points and syncretic with what I wrote above. I think its prominence in the guidelines is worthy of suspicion and has more to do with the food system needs, versus nutritionally-specific needs. The potential drawbacks give me pause for uninhibited consumption. Rather, I proceed with some caution, and that caution directs my own consumption to specific, fermented and pastured sources, for the most part.

      • john cameron

        A major focus of the talk by Pedro Bastros is the possible effects of dairy induced increased circulating insulin-like growth factor (igf-1) which “may promote development of prostate cancer.” While observations provide circumstantial evidence of increased levels of serum IGF-1 through excessive milk intake, a 2013 study “Insulin-like growth factors and insulin-like growth factor binding proteins and prostate cancer risk” found no evidence that supports the theory. The study, in which presence or absence of
        all cancers was biopsy-determined, found that “in general, serum IGF-axis analytes were not associated with prostate cancer risk in the trial. The exception was the finding that serum IGFBP2 is a risk factor for low-grade disease.” (PMID 23315596, 2013, U..S). Another study found that animal protein intake, including milk protein, is inversely associated with IGFBP2 which suggests that dairy protein decreases risk of low-grade prostate cancer. Thus it
        appears that IGF-1 is not guilty of causing prostate cancer. (PMID 22527168, 2012, UK).

        The endogenous synthesis of igf-1 in humans is essential to health. The age associated decline in anabolic hormones such as testosterone and IGF-1 is a strong predictor of metabolic syndrome, diabetes and mortality in older men. Magnesium intake affects the secretion of total IGF-1 and increases testosterone bioactivity. In a cohort of older men, magnesium levels are
        strongly and independently associated with the anabolic hormones testosterone and IGF-1. (PMID ;21675994). Cholesterol lowering statin drugs impair synthesis of igf-1 which results in increased risk of type 2 diabetes. In a recent
        study, statin use at baseline was associated with a significant increase in risk of diabetes mellitus (hazard ration 1.71). It seems plausible that the igf-1 content of milk may be of benefit to the elderly and to those aflicted by statin drugs. (PMID: 23333902).

        • danpardi

          Hi John,

          From my notes from his talk, Bastos started this talk discussing how single nucleotide polymorphism (SNP) occurrence coincides with
          domestication in eastern EU 6000 years ago, and that this SNP spread via pastoralism 3000 y ago in Africa. This is important because the occurrence of this SNP coincided with adult lactase persistence.

          What I found fascinating is that, according to Bastons, milk contains more than 100,000 different substances. The ‘purpose’ of cow milk is to fulfill the entire nutritional needs of neonate during a period of time when growth rate is high but simultaneously when endogenous hormone production is low. In other words, milk provides the hormones to grow for a animal not yet producing adequate growth hormones themselves.

          Bastos postulated that several mechanisms may be responsible for inducing growth. He discussed how the insulin response to cows milk is 5x higher than expected for its glycemic index, regardless of whether the milk is skim or whole. The reason for this grow is due to whey proteins, which increases GLP-1 and glucose-dependent insolinotropic peptide that stimulate insulin biosynthesis. He noted that some have had concern that consuming link several times a day could lead to hyperinsulinemia. But, multiple epidemiological studies have show an inverse correlation between milk and metabolic syndrome (http://ajcn.nutrition.org/content/82/3/523.abstract), (http://www.ncbi.nlm.nih.gov/pubmed/17630368)

          But, not only does milk promote the release of hormones, it also contains hormones:

          Betacellulin: Another growth factor in milk is. Survives pastorization. Found in cheese.
          IGF-1: in bovine milk is identical to human IGF-1. Not high amounts in bovine milk. Casein: may ↑ IGF-1 but not insulin. But milk may ↑ IGF-1 indirectly via insulin because insulin ↑s IGF-1 binding protein which allows for more free IGF-1. Cows milk: Casein much higher than in human milk.
          Lactoferrin: May inhibit proteolysis in GI track. Prevent milk IGF-1 breakdown. More bioavailable to milk drinker. Milk ↑ IGF-1: 20-30% in children. 10-20% in adults.

          He also notes that the type of pasteurization really matters, because the fermentation and pasteurization process modify the hormonal response of dairy. For example, the fermentation of dairy to yogurt
          decreases IGF-1 by 45%.

          Bastos himself noted that he doesn’t think IGF-1 itself causes cancer, but in the condition of the lifestyle – with epigenetic triggers, genotoxic substances and poor nutrition – chronic increases in IGF-1 levels may be bad. Even if a person has a great diet and lifestyle, they still don’t know what mutations they have, so extra growth promotion could be problematic.

          Basically, it’s not a clean story, and more info is needed. Like I mentioned earlier (somewhere in the comment string), personally, I consume dairy but not a large amount, and most of it is fermented.