Thursday, October 22, 2009

D'Adamo, Unfiltered

Last week, Dr. D'Adamo was the keynote speaker at Grand Rounds at UBCNM. After the presentation, your faithful blogger solicited some questions from the audience. Here are some selected responses from the good doctor.


How did Dr. D’Adamo come up with the lists of beneficials and avoids? Did he test every food and, if so, how did he do it?


The starting point was of course, many of the empirical observations recorded by my father, James D’Adamo. This became the ‘framework’ from where values were added and subtracted, validated and discarded. To that I added the existing literature on direct food-blood group antigen interactions, mostly in the form of published lectin specificities. Certain foods for which I was suspicious, but could not find specific references in the literature were eluted via SDS Page electrophoresis and compared against banks of carefully categorized (ABO/A1-A2/Secretor/Lewis/MN/P1/Ii/CDEcde) erythrocytes. For a while I was also doing this against a simple benchmark I developed using categorized sera and measured myeloperoxidase activity to examine the effect of food constituents on viability prolongation of intracellular Candida inclusions in neutrophils.

I also began testing foods for the ability to induce opposing blood group antibodies: either through basic saline isohemagglutinins titration or a more advanced form of ‘block titration’ that I rediscovered from the work of Elvin Kabat using anti-IgG1-4 antibodies subsequently applied to the basic isohemagglutinins titers, or to the results of direct and indirect antiglobulin (Coombs) testing. I also scanned the published literature for relative concentrations of blood group antigens in dietary food sources.

I’ve also looked at other, more generalized, biomarkers of digestive disturbance to see how they related to poor food matching. These have included tests such as the urinary indican (Obermayer) and more recently sequential breath hydrogen testing.

Of course this was done in the mid 1980s-early 90s, long before CLIA!

Finally, there was just very simple reverse engineering from the pathophysiologies associated with these polymorphisms. For example, numerous studies have shown group A individuals (even normal subjects) have higher blood viscosity. My father has always recommended that his group A patients drink a bit of lemon and water in the morning. He felt that it helped with their inherent mucosity. Now, Dr. John Bastyr once told me that the juice of six lemons roughly equaled the anti-thrombotic effect of a conventional anti-coagulant, so I thought this was a recommendation well worth preserving, maybe even embellishing.

Another might be the difference in digestive phosphatase activity between the blood groups. Again looking at group A, we see that their levels intestinal alkaline phosphatase (IAP) is quite low, which compromise several assimilation functions. Now, besides the fact that the physical expression of the blood group A antigen actually inactivates IAP (not something you can not do much about) a quick look at the enzyme kinetics shows that it can be influenced, both positively and negatively, by the amino acid phenylalanine. Hence high phenylalanine foods are probably more bioactive in the digestive tract of blood group A individuals, especially with regard to mineral absorption.

My interest of late is more along the lines of ‘food inter-relatibility.’ Trying to find the multidimensional relationships between clusters of foods and whatever therapeutic objectives I have in mind. In trying to accomplish this I think I’ve become a better software engineer, since the methods behind actually accomplishing this (which has seen a simple manifestation in the ‘GenoHarmonics’ routines in SWAMI) is very much similar to what is known as ‘object orientation’ in computer science. You make certain ‘classes’ of foods and nutrients that together work on their own unique and specific clinical circumstances and data. You create whatever classes you need (‘AGE removal’, ‘Endothelial shedding’, ‘Overgrowth Inhibition’) then set them free on the person. It’s like looking the individual tiles in tile floor for a while, then stepping back and realizing that it is actually a mosaic. Perhaps amazingly (though not for a confirmed surrealist) the computer term for the ability of these objects, each in its own way, to respond differently to identical messages is known as a ‘polymorphism.’


As a student about to graduate, I really admire your career and the work you've done as an ND. What's your secret? If you could offer advice to naturopathic students just graduating and starting out, what would it be?

1) You have to be you own polymath. This involves surmounting serious confidence issues, since in our intellectual theocracy, one is made to feel that they have to gain permission from some properly endowed expert in order to think seriously about something. Not true, although you can expect a fair amount of flak from less imaginative quarters that may feel that you are ‘uppity’ and should have played by the game.

2) Don’t deprive your failures of their spiritual significance. Failures can crush and de-enervate you. They can also force you to re-evaluate your methods, question your basis and re-invigorate your appetite to get to the top of the mountain next time. Let failure hone the future ‘austere’ version of yourself.

3) Build your organization from the ground up. Keep it simple for starters, but never let an opportunity slip by that could increase your scope and reach.

4) Keep strong family ties and a mattress by the window. You’re in school now, where everything is ‘bubbly yours,’ as John Lennon used to say. However, it is a lonely profession you embark upon once you get out. You will be broke and most likely in debt in a world where people value wealth. You will have an ND degree in a world where most people will think your degree is a typo. A percentage of the people to who you describe yourself will think you are a weird quack. You will have your failures. Patients will die. You needn’t take it personal. Once you start thinking for yourself you are bigger than your profession, so let it off the hook every once in a while.

5) Love every patient, despite his or her best efforts otherwise. Throw their problems into the recesses of your subconscious. You’ll be surprised just when and where you’ll get an answer.

6) Don’t compete against your colleagues. A lot of ND’s seem to fight over the same patient pool. Develop the tools to bore your own shaft, sink a mine and excavate for your own patients. Much nicer!


What do you think the future of our profession holds? Do you think it's going to take off, as everyone says?

I have given a few commencement addresses, and honestly, they’ve usually come of as somewhat depressive affairs. The future for our profession? Probably OK for a while longer with our current working model. You guys will do well, since we now have newly licensed states that will need ND’s. Long term? Frankly unless we reorient our focus, I’m more pessimistic: More co-opting of our legacy from the top by the more socially acceptable mixer-type MD’s and from the bottom by the health food hucksters; more plagiarism of our teachings and wisdom by Madison Avenue. We need to stop worrying about what the ‘others’ think about us and stop believing that if we just act in the expected manner-- give everybody a low fat diet and some Echinacea, we are somehow going to be accepted on some sort of terms we could live with. So my major worry is this disturbing trend towards what some people consider ‘normalcy’: A kinder, gentler Naturopathy stripped of whatever bothers the pure scientists. As far as I’m concerned, you are not practicing naturopathy correctly unless you are making the ‘science-with-a-capital-s-apparatchiks’ apoplectic. We have a robust profession that contains innumerable insights into new resources for healing. We should be running towards these insights, not away from them.


I’m so interested in how the idea for GenoType took shape – how did this come to Dr. D’Adamo? Did it develop slowly after seeing lots of patients or did it come to him in a burst of inspiration?

Almost everything I do comes about thru a rather excruciating step-by-step process. Working with blood groups was easy; the starting point was my father. The Epigenotypes are a process at I began working on two decades ago; however it was a stop-start sort of thing, because I knew what I wanted the concept to comprise, but at point in the journey, the avenues of approach were not yet possible. Also at the end of two decades work with ABO, I had exhausted almost any possible point for further exploration in that area, so the idea of adjusting people to their genes, started giving way to the notion of adjusting genes to their owners.

I’d always been intrigued with inter-generational aspect of pathology. I think the miasms are a brilliant concept that deserves to be examined with an eye towards their epigenetic elements. I suppose I was trying to figure out a way to influence the patient ‘after’ the one who was actually in my office.

Two Newbies

After last Friday, which was our first week of four new patients in four hours, we are beginning to get the hang of things. Dr. D’Adamo is continually and masterfully tinkering with the patient flow so that everyone is working at her most effective; the pace does not let up, though, as we go from lab to clinic room for measurements to consultation. D’Adamo has been using military metaphors to describe how we will all work in concert with one another so that everything gets done, and done well, and it seems applicable. So, when the clock hits ten, we are set in motion, a regular, well-oiled battalion, as it were.

Our first patient, Hillary, is an 63 year-old administrator at University of Bridgeport—a soft-spoken and agreeable middle-aged woman, simply dressed and seemingly mellow about her health concerns. Her chief complaints are hypertension that she’s had for five years (today it’s 130/90), borderline high cholesterol (210-220) with an elevated HDL, and chronic sinusitis. Lab results return that she is a type A non-secretor and her hydrogen breath test indicates moderate small intestine bacterial overgrowth, which is a more rare result, as most of our patients have come in with overgrowth at a much higher level. SWAMI tells us that she is a Warrior. One of the markers of Warrior is endothelial dysfunction, which speaks to her high cholesterol. D’Adamo says he wants to decrease her soluble endothelial factors by emphasizing plant-based proteins in her diet, especially glycitine and genistein—both of which are isoflavones found in soy products, which have protective effects on vascular inflammation and act as potent antioxidants. He also puts her on 100 mcg/day of selenium, Histona that contains magnolia for overall metabolic support, CoQ10 because she’s on a statin, and Genoma Cardia that contains hawthorn, which is known to improve cardiac health.

Dwight is our second patient, a charming 60-year old African-American man who has been brought to the Clinic by his daughter, a naturopathic medical student. Dwight is a pastor and former software programmer, which immediately captures Dr. D’Adamo’s attention. The two men have a brief chat about computer languages and then Dr. D’Adamo turns his attention to Dwight’s skin condition, which appears to be vitiligo, as his skin is mottled and dry in places. His other chief concerns are massive edema throughout both legs, powerfully debilitating allergies, and hypothyroidism. Of main concern is his incredibly allergic immune response: past IgE labs have been over 34,000. In the past he’s been on immunosuppressants such asCyclosporin, but he stopped because it increased his blood pressure. He is currently not taking anything. When we take his hydrogen breath tests, he blows the highest number D’Adamo has ever seen: 150. The doctor quickly determines that if we address his small intestine overgrowth, his immune response will quickly normalize. Dwigh is given his GenoType diet (he’s an A-positive secretor Teacher). Dr. D’Adamo also recommends a list of supplements for him: Polyflora, Intrinsa, Gastro D, apocyanum for edema, quercetin and arabinogalactan for mast cell stabilization, bromelain as an anti-inflammatory, and the homeopathic cistus Canadensis 30C for his skin condition. As part of our future plan for Dwight, we will propose a detox, as well as hydrotherapy.

Wednesday, October 14, 2009

Cancer's Deep Blues

Today is our first day of seeing four new patients, as opposed to the two we’ve been seeing in previous weeks. Needless to say, it’s going to be a whirlwind. Dr. D’Adamo has even warned us to bring snacks. Dr. Ginger Nash, an excellent ND who works at The New England Center for Personalized Medicine with Dr. D’Adamo, is on hand to see patients. At ten o’clock on the dot, our first two patients arrive and it’s time to hustle. Jen and I meet James and his wife Liz in the lobby. They’re both in their 60’s, a sophisticated and stylish couple: he in jeans, a blazer and loafers and she in a white sweater wrapped with a belt, cool-looking chunky silver jewelry and red lipstick. After we’re finished doing James’s secretor test in the lab, we take him upstairs to start on his patient history and measurements.

As I peruse his intake forms, which he’s filled out, I notice that Liz has made little footnotes throughout, to clarify or expand on any points of interest; she is also holding Cancer: Fight It With Your Blood Type Diet by D’Adamo. James, it turns out, is a big-time state prosecutor but it’s Liz, I’m starting to think, who’s the brains behind the operation—at least when it comes to looking after the couple’s health. She, a Type O who beat breast cancer some years back, has had the both of them on their blood type diets for some time and has found it to be effective. They’re both very active: he plays racketball several times a week and she runs and does Pilates and I find they share a deadpan sense of humor. When James makes a few jokes that are dryly humorous, she says, “Oh, ignore his non sequiturs.” When she starts to talk about how much he loves sugar, he replies with a chuckle, “It’s always nice to bring your critic with you.” Despite the levity, their reason for being here is serious: a recurrence of James’s prostate cancer.

In 2004, a biopsy confirmed a malignancy in James’s prostate, with a Gleason score of 7, which indicates a more highly aggressive form of cancer. His prostate was removed in a robotic prostatectomy, which is less invasive and traumatic than an open prostatectomy. He had no chemotherapy. In the last five years, James has suffered from both impotence and incontinence, the severity of which, he jokes that no one really gave him a heads-up on. In a recent trip to his GP, lab results indicated that his PSA (prostate specific antigen) had gone from 0 to 4/5, so it appears the cancer is recurring, despite the removal of his prostate—a cruel reality that sometimes does occur to prostatectomy patients. In the next week, James will have an MRI of his prostate bed to determine where the cancer is and how far it’s spread. In the meantime, he and Liz want some dietary supplement recommendations to best contain the cancer and build up his vitality. It turns out, from his measurements, that James is a Nomad; he is also a Type B + secretor. We talked about the first three GenoTypes last week, so this time let’s talk about the last three.

As its name would suggest, Nomad is a GenoType that has developed over years of living in different environments, never too long in any one specific place. Their immunity, then, is a bit of a hodge-podge, as they never stayed put anywhere long enough to develop a specific survival strategy. “The price they pay for their more selective immunity is a problematic connection between their immune system, their cardiovascular system, and their nervous system, resulting in a lack of coordination between the three. This makes the Nomad prone to highly idiosyncratic health problems, such as chronic viral infections, debilitating long-term fatigue, and memory problems,” writes D’Adamo in The GenoType Diet. When they are healthy, their immune systems are very balanced; they also have an excellent mind-body connection and handle stress well. Personality-wise, they are quietly witty (like James), easy-going and optimistic. They fall at the extremes of the height scales: either quite tall or short, have a squarish head and have a higher number of red-headed, green-eyed people like Elizabeth I, who D’Adamo speculates was a Nomad.

Teachers, D’Adamo says, are remarkable for their immunological altruism. Developing from a time, perhaps, when people first started migrating and encountering other environments—and germs—Teachers can withstand a pretty strong assault of bacteria and viruses, without the quick immune response of the Hunter. The problem with this is that they can carry the precursor to disease for some time without any symptoms, until the disease state hits, and hits hard. They are particularly prone to digestive problems, lung disorders, and cancer. With the GenoType diet, the Teacher’s immune responses can be trained to be more effective, thus protecting the lungs, stomach, and colon, in particular. They are often Type A, or sometimes AB and tend to look wiry, with a more masculine body type. Like Abraham Lincoln, a probably Teacher, these people are balanced, spiritual and have great powers of analysis.

D’Adamo is a Warrior, in case you’re wondering (I’m an Explorer). Warriors are one of the newer GenoTypes, dating from several years B.C.E., nonetheless. This was a time in D’Adamo’s estimation when people lived in agriculturally harsh conditions and wars first started breaking out, so people had a lot of children to ensure the survival of the tribe. Warriors had to learn how to survive, so their strength and resilience is remarkable. When active, metabolism is great and Warriors burn lots of calories; when they’re sedentary, they put on weight very easily. In youth, they are beautiful, but they can age badly and early, turning rather round and insulin-resistant. They are also prone to stress-related illnesses, chronic gastrointestinal problems, hormonal imbalance and infertility and heart disease. Type As and ABs, they are intellectually very sharp and often need to force themselves to relax.

So let’s get back to James, our stylish and witty lawyer with a recurrence of prostate cancer. While we’re formulating his diet plan, D’Adamo throws a switch in SWAMI called Deep Blue, which is special for cancer patients. Essentially, Deep Blue tweaks the diet so that it includes foods with anti-cancer properties, such as:
• Anti-oxidants (petunidin, peonidin, cyanidin, delphinidin, catechins, quercetins)
• Lectins (cellular agglutinins)
• Mineral chelators, which deprive cancer cells of nutrients (phytic and oxalic acids)
• Cellular growth factor inhibitors (squalenes, polyamine production inhibitors).
Deep Blue also cuts out foods that might be detrimental to cancer patients. As for supplements, Liz has a long list that James is already on. D’Adamo reviews this and then adds a few (if you’re really interested, see below for descriptions from dadamo.com). After a long appointment, I show the couple to the lobby where Liz tells me they’re on their way south for a few days of vacation to bolster themselves for the fight ahead. We’ll check in with them again in a few weeks.




James’s Supplements:

Helix plus: As mentioned in Eat Right 4 Your Type, Helix has a powerful component, which helps the immune system to function more effectively and efficiently. This species, Helix Aspersia, is not the common edible snail (‘escargot’), but rather a hard to identify distant relative. The consumption of this species of snail may serve as a very potent protective agent, allowing your immune system to more accurately distinguish between healthy and unhealthy cells, especially in blood type A and AB.
Intrinsa: Created for use in his clinical practice, Dr. D’Adamo has blended two synergistic dietary nutrients, Butyric Acid and Caprylic Acid, with Larch Arabinogalactan to create a superior formula to protect and support stomach, intestine, and colon health. For this patient, in particular, it is being used to prevent histone deacetylation.
Polyflora B: Polyflora B was especially designed by Dr. Peter D'Adamo to deliver therapeutic levels of blood type friendly bacteria (probiotics) and growth media (prebiotics) specific for type B.
Rekon pro: There are times when the body needs immune support that goes deeper. Dr. D’Adamo designed his exclusive Rekon Pro formula for use in his clinic. Blended from botanicals historically known for their immune enhancing properties, Rekon Pro boosts healthy natural antibody function, which tends to drop with age and infirmity.
Scienca: Turmeric, quercetin and bromelain to protect against oxidative stress and inflammation.
Scutellaria: Scutellaria has been shown to decrease inflammatory cytokine production from human mast cells (immune system hormones which ramp up inflammation). Scutellaria also has a cell-regulating effect; encouraging the body to more efficiently remove cells which have become dysfunctional, either though age or malformation.
Itaru tea: Green tea, a powerful antioxidant, has been found to reduce cancer risk.

Thursday, October 8, 2009

Send in the Clown, Part II

Today marks the return of Jane the Clown. Remember Jane from a few blogs ago? She’s a professional clown and refers to herself as Jane the Clown, so we’ve begun affectionately calling her that, as well. Jane visited the Clinic a few weeks ago at the urging of her friend Angela, a sharp nurse, who is here to lend moral support to her dear friend Jane, who is a little weary of diet protocols and a little leery of making any kind of lifestyle changes. When I greet them in the lobby and ask how the supplements have been working out, Angela sort of rolls her eyes and looks toward Jane who giggles sheepishly and admits to not being totally consistent with taking them. Angela gives Jane a playful nudge and asks her what it’s going to take to get her to get serious about her health. Jane replies by throwing up her arms, laughing and saying, “Give me a break, I’m here, I’m trying. This ain’t easy.” Indeed, the level of commitment Dr. D’Adamo asks of his patients is not insignificant but the willingness to change is the key, though our patients certainly come in with varying degrees of that. Having a friend who’s a personal cheerleader never hurts.

I take Jane back to the lab to have some final lab work completed and when we’re done there, we — Jaime and Ann the student clinicians, Barbara the UB resident, Dr. D’Adamo, Jane, Angela and myself — all troop upstairs to feed Jane’s information into SWAMI to determine her GenoType and to print out her diet and recipe guide. While Jane and Angela wait in the consultation room, the rest of us convene in the conference room to discuss Jane’s results. As Ann and I enter her data into SWAMI, D’Adamo peruses her measurements and results. Two things stick out. First, her fingerprint pattern is mostly whorls. Finding a majority of whorls in a woman is a big red flag for breast cancer and, in fact, Jane’s mom had the disease. Secondly, it’s clear from her overweight status, sedentary lifestyle and lack of energy that her metabolism is compromised. D’Adamo points out that she is predisposed to metabolic syndrome, typical of Type A non-secretors like Jane. As D’Adamo looks into his crystal ball, to use his words, he can see a not-too-rosy health picture if she continues as she is.

After Ann and I feed all of her measurements and lab results into SWAMI, the almighty software tells us that she is an Explorer. What exactly does that mean? Let’s look at all the first three GenoTypes and what they entail.

First, we'll examine Explorer so we can get greater insight into what characterizes Jane. Explorers are the idiosyncratic GenoType and, according to D’Adamo, probably originated 20,000 to 30,000 years ago. They are often left-handed, have a negative blood type, and are asymmetrical – meaning that their left fingerprints don’t match their right, indicating a stressful fetal period. It’s called Explorer because D’Adamo sees these people as glacial refugees — “ they never had the chance to settle down into a stable relationship with one environment…accordingly, they fine-tuned their responses but in unpredictable and inexplicable ways.” For example, Explorers are highly sensitive to their environments and chemicals; they have a tendency toward blood irregularities; they are hard to diagnose. Liver detoxification can be difficult, which makes them very caffeine sensitive and prone to skin breakouts. Diseases they are prone to include type 1 diabetes, anemia and breast cancer. On the upside, they have good gene repair, excellent physical stamina and retain memory into old age. What do they look like? They’re muscular with wide heads and “chiseled” features. Psychologically, they are broad and flexible thinkers, effectively take in several stimuli at once and have above-average intelligence like Julius Caesar, who D’Adamo speculates was an Explorer.

Our next GenoType, the Hunter, has an incredibly reactive immune system that attacks and usually overcomes whatever bugs come its way. The problem with this is that such a strong and swift immune response can lead to overreaction in the form of asthma, allergies and autoimmune disease. This is one of the earliest GenoTypes, according to D’Adamo and they can therefore metabolize meat quite well, but not grains. Hunters look tall and thin and are psychologically intense and often run on adrenaline, to the point of burning out their nervous systems; the pituitary-adrenal axis is often compromised in times of stress; D'Adamo thinks Michael Jordan is a good example of a Hunter. This GenoType is always Type O. Because they are so hyped up metabolically, they can burn out in middle age and the aging process can be difficult as a result. They are also prone to depression, gastrointestinal disease and joint problems.

The last GenoType we’ll look at for now is the Gatherer. As D’Adamo writes, “If you need to survive a famine —and many of our ancestors did—[Gatherer] is designed to get you through it. Gatherers have thrifty genes whose primary goal is to hang on to every ingested calorie for dear life—literally.” While this may have been helpful at one point, for Gatherers in present-day America, having genes that hoard calories means a tendency toward obesity, diabetes and a generally slow metabolism. Gatherers, then, are endomorphic, meaning they have more body fat no matter how hard they work on diet and exercise (think Oprah). They usually have O or B blood type. Because they have high estrogen, they can tend toward hormonal cancers. They also suffer from Alzheimer’s disease, high blood pressure and low thyroid activity. But the Gatherer will have an excellent capacity for mental endurance, are highly fertile and great family people, and are often “early adopters” of new ideas.

Next week, we’ll look at the last three GenoTypes, but right now, let’s get back to Jane. When D’Adamo gives her his crystal ball prediction (breast cancer and metabolic syndrome), Jane’s eyes widen and her usually jokey disposition drops as she listens intently to what Dr. D’Adamo recommends. For a patient, having the mirror held up in front of her for the first time is often the reality jolt she needs to make changes. We walk her through her new diet, which D’Adamo has altered in SWAMI to reflect foods choices that combat inflammation; he also planned her meals to be smaller to accommodate weight loss. The idea of the diet will be to decrease overall inflammation in her body, which will not only make it easier to lose weight, but will also address her complaint of significant back pain in the thoracic area. He advises her to do “elongating” exercises like weights and yoga. D’Adamo wants to get her stress hormones under control to get her metabolism back on track; her digestive problems will improve along with gastrointestinal recovery. Indeed, after a couple weeks on supplements, Jane’s complexion looks less sallow and she is eliminating more easily.

As D’Adamo wraps up the consultation, Jane asks about what she should be doing for her candida rash (D’Adamo recommends coconut oil for its lauric acid), hair falling out (he advises to take 8 mg biotin and 800 mg folic acid to rid the scalp of yeast that makes hair fall out) and uneven sleep. At this point, D’Adamo throws back his head, laughs and says that he thinks we have enough to deal with right now and, well, it’s all connected: with an ideal diet, a bit of exercise and correct supplements, anything is possible…even better sleep.