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The Strange Bedfellows of Medicine and Politics
Perhaps the strangest part of partaking in alternative and nutritional medicine in the mid-1970s was discovering the ostracism practitioners experienced with the conventional medical community. Even with my mentoring physician, Leo Bolles, MD, I was introduced early to the pugnacious vitriol of skeptics locally and elsewhere denigrating natural medicine. Worse, insurance companies were hell bent to deny coverage for integrative medicine procedures and not a few were apt to complain to the local medical society. It did not take long before the state medical board initiated an investigation of the clinic practices; at the time, the board decried the use of hair analysis as a diagnostic tool, later impugning thermography and plethysmography for cardiovascular assessment as well as dark field microscopy. In fact, I had hardly time to get settled at the clinic when the FDA decided to stop by and do its own investigation. (The business manager and I attempted to turn this around with the agent by cajoling him to come in for a medical appointment to assess his medical problems.) Needless to say, the medical doctors in those days who were practicing "alternative" medicine using unconventional therapies were subject not just to harassment but medical board witch-hunts and sanctioning. A hematologist/attorney in New York State, Victor Herbert, MD, took the role as the leading medical critic, "quack buster," attacking alternative medicine.
Like any besieged group, alternative medical practitioners began to organize and fight back. One group Bolles and I joined was AAMP, a group that later became ACAM and then divided into ACAM and ICIM. AAMP, the American Association of Medical Preventics, championed chelation, nutritional medicine, nutraceutical and supplement therapies, and a wide range of unconventional treatments for cancer, cardiovascular disease, and other degenerative diseases. At AAMP, physicians held scientific discourses but also discussed legal and political concerns especially in support of practitioners who were facing lawsuits and delicensure. In the strange world of politics, the greatest support for alternative practitioners came from the political folks who favored constitutional freedom and deregulation. In the 1970s laetrile, a derivative of apricot pits, was being touted as a cancer cure, or at least as a supportive treatment for cancer. Organized medicine, particularly in California, derided laetrile. Consequently laetrile distributors and its proponents were obliged to move their operations to Mexico, particularly Tijuana. Patients who sought this treatment also faced difficulties as authorities attempted to interfere with laetrile deliveries in the US. The John Birch Society, a radical-right political group that has been known to espouse international conspiracy theories, strongly advocated for patient access to laetrile and other unconventional cancer therapies. It did not take long for many alternative medical practitioners to become aligned with the John Birch Society and related groups. The freedom to practice medicine for physicians and freedom to receive medicine as patients became a clarion call to join and support political right-wing groups.
In the 1980s and 90s, Congress began to turn an evil eye on the supplement industry. Democratic representatives Henry Waxman of Beverly Hills, California, and John Dingell of Dearborn, Michigan, were determined to hamstring the supplement industry through regulatory oversight by the FDA. However, following the misguided and bungled raid of Jonathan Wright, MD's office in 1993, citizen and physician groups became energized to form national organizations supporting health freedom, deregulation of supplements, and alternative practitioner advocacy. Through the efforts of Republican Senator Orrin Hatch in Utah and Democratic Senator Tom Harkin of Iowa, the DSHEA act protecting supplements was enacted in 1994. DSHEA has not only retarded the regulatory activities of the FDA, but it has slowed the anti-quackery disciplinary activity of many state medical boards. However, the unfortunate incident three years ago of a New England pharmacy dispensing a fungal-contaminated steroid for pain injection to hospitals and medical clinics led to widespread condemnation of "unregulated" compounding pharmacies. Subsequently Congress acted in 2014 to empower the FDA with new regulatory authority over compounding pharmacies as well as supplement manufacturers. Throughout 2016, the FDA has been establishing new policy to restrict the free manufacturing of supplements as promulgated by DSHEA. The compounding pharmacy industry, particularly the manufacture of injectable vitamin, mineral, and chelation supplies, has been upended and costs have correspondingly skyrocketed.
The recent Trump election with the appointment of anti-government chiefs of multiple agencies suggests that the draconian regulation by the feds of alternative/integrative medicine, nutritional supplements, and medical devices may be loosening up. Given the widespread and predominant Republican base in Congress as well as in state governorships, it would appear that alternative/integrative physicians will find a voice of advocacy at the federal and state level. As much as one may not relish the thought, alternative right political groups are also holding political sway nationwide. These same groups are, like the John Birch Society, keen to support freedom-to-choose medical treatment. At the same time many of the adversarial skeptic groups and proponents who loudly decry therapies that are "not scientifically proven" will find themselves criticized by these alt-right groups. Strange bedfellows, indeed.
Your Third Brain
Perhaps the most remarkable interview that the Townsend Letter published in 2016, maybe ever, was Jacques Fernandez de Santos' interview of Marco Ruggiero, MD on the third brain.1 The interview is based partly on the book, Your Third Brain, authored by Peter Greenlaw and Marco Ruggiero.2 The book has a foreword by John Gray, PhD, author of Men Are from Mars, Women Are from Venus. Greenlaw and Gray are both effusive in their enthusiasm about Ruggiero's "eureka moment," when he made the connection between the human microbiome and third brain. This is not just a figurative description of the microbiota functioning as part of the brain. Ruggiero asserts that the microbiome plays a key role in our eating behavior, emotional moods, even our cognitive functioning. Even more intriguing, Ruggiero thinks that the microbiome can be pivotal in steering our decision-making, our free will; indeed, in the book he opines that the intestinal bacterial organisms contribute more than our human brain, our first brain, in making those decisions. In his interview in this publication, published nearly a year after the book, he modified this position stating that both the microbiome and human brain share, in a cooperative manner, different aspects of behavior, mood, and cognitive functioning; whether the microbiome or human brain dominates is a careful balancing act subject to changes in each brain's physiological and metabolic needs. Not to be ignored is the neuronal activity of the intestinal tract and the vagus nerve thought to serve as a "second brain." Ruggiero further upends our understanding of brain functioning by defining a different microbiome that exists in our "cranial" brain serving as a fourth brain. In other words, we have two human brains, one in the cranium and one in the intestine, and two microbiologic brains, occupying the same anatomy. While these divisions may seem arbitrary and without adequate substantiation, research poses tantalizing evidence in support of Ruggiero's work.
Alcock, Maley and Aktipis review how eating behavior can be manipulated by the gastrointestinal microbiota.3 They postulate that microorganisms have two potential mechanisms for how microorganisms might alter our eating behavior: (1) the organisms create cravings for eating foods that might suppress survival of competitive microorganisms; (2) the microbiota might elicit "dysphoric" emotions until we eat food that benefits their survival. Alcock et al. point out that a diverse microbiome composed of a large number of differing microorganisms has a greater ability to mutually provide for nutritional needs compared to a microbiome with less diversity. When the microbiome has less diversity, there is greater neurochemical signaling to eat more to provide nutritional needs; obese hosts tend to have limited microbiome populations. Numerous studies are cited of how microorganisms can play an important role in host eating behavior, including how their metabolic activity can modify the host's mood. Lactobacillus in breast milk is observed to increase tryptophan metabolism and have a respective calming effect on the suckling infant. When microbiota are transferred to "germ-free" mice from anxious mice, the cohorts are notably more agitated than prior to the transplant. On the other hand, stressed mice fed L. rhamnosus had observable reduction in cortisone levels accompanied with calming behavior. Toxoplasma gondii reduces fear of cats in mice to the mouse's detriment; intestinal cat toxoplasma encourages feline pursuit of mice, providing the microorganism access to a mouse meal. Alcock et al. review neural mechanisms, particularly involving the vagal nerve, of how microbiota can alter eating behavior. Organisms of the microbiome have adapted to produce neurochemicals that closely mimic the human neurochemicals directly influencing emotional response. Alcock notes that the microbiome can be modified by the use of prebiotics and probiotics, microbiota transplantation, antibiotics, and other methods. The authors posit that these approaches may be used to modify our psychiatric state as well as cognitive functioning.
Ruggiero's Your Third Brain cites studies elaborating the interaction of the microbiome with the brain including its role in causing or contributing to mental and physical illness. We accept that depression is a neurochemical imbalance; we don't acknowledge that that imbalance of dopamine or serotonin may be caused by the gut's microbiome. The explosion in the incidence of autism has been well recognized, but causation has been disputed; mercury and chemical toxicity, vaccine insult, infection and other etiologies continue to be debated. The possibility that autism may arise from a microbiome that has been corrupted has been hypothesized. Indeed, the metabolic disruption of the microbiome is thought to be important not only in brain and neurologic dysfunction but contributory to immune dysfunction and cancer. If the microbiome functioning can be restored, Ruggiero suggests, the pathogenesis of disease can be reversed or controlled. For the purpose of restoring normal microbiome functioning, he proposes using a unique probiotic formulation that ferments colostrum and provides probiotic organisms thought to be "normal" for the newborn infant. The formulation is rich in a peptide called GcMAF that is derived from the vitamin D binding protein. Ruggiero's book details how his research on vitamin D, the vitamin D receptor, and the vitamin D binding protein led to his understanding of how GcMAF plays a key role in restoring microbiome balance. Although he provides anecdotal evidence that the use of this formulation is effective in microbiome restoration, there are no controlled clinical studies.
Greenlaw, who authors much of the text devoted to supporting "ordinary" brain functioning, advocates the use of a paleo-type diet emphasizing organic animal proteins, vegetables, and limited fruits together with the judicious use of various nutraceuticals including high quality whey protein. Ruggiero's formulation of probiotics, fermented colostrum, and GcMAF is available commercially as a product called Bravo. The product is the basis for a yogurt that is produced at home; each kit provides the ingredients to prepare what Ruggiero calls a dessert cup sufficient for a two weeks' supply. The authors also advocate the use of a specific whey protein from New Zealand that is claimed to be better than other whey products in restoring brain function as it contains less toxicants and hormones.
One other chapter in Your Third Brain discusses Ruggiero's experience with ultrasound and its potential application in restoring improved microbiome brain functioning. Ruggiero thinks that EMF produced by the myriad devices inside and outside the home and office have a more deleterious effect on the microbiome than human cells. He conjectures that ultrasound may reverse some of these adverse effects.
In Your Third Brain, Ruggiero makes the argument that the microbiome is the key to our free will; a dysfunctional microbiome portends less free will. From a philosophical perspective, from an artistic perspective, we ae obliged to understand the microbiome and its needs.
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