Column: Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH, FACN, FACPM

On Treating What’s Treatable

Introduction

Sometimes potential treatments are overlooked, in part because they do not fit into the conventional framework. In this Townsend Letter issue on recalcitrant disease, we ask a similar question: What potentially treatable conditions are holding this patient back from recovering from the disease itself that isn’t so treatable? The examples are drawn from a recent New England Journal of Medicine publication and the authors of Advancing Medicine with Food and Nutrients, 2nd edition. Diverse, the examples uniformly illustrate how nutrition supports innate healing.

An Example from Malnutrition

Children with life-threatening severe, acute malnutrition, and no clinically apparent infections began recovering when they were administered an antibiotic. The response held for antibiotics of different classes, for both marasmus and kwashiorkor, and lasted beyond the antibiotics course. These results from a clinical study by Trehan and colleagues were published in the January 31, 2013, New England Journal of Medicine.

To be clear, I am not recommending a new indication for antibiotic use. This profound study points to a very important not-yet-fully-studied observation. Thousands of starved children recovered when (and possibly only when) food was administered with additional therapy. We don’t know if the children had infections to which they were not able to mount a clinically detectable immune response, if an unfavorable shift in microbial flora was reversed, if antibiotics signal something directly to the brain, or any other number of possible biologic mechanisms. Treating an underlying complication yet to be elucidated was allowing seriously malnourished children to respond to food with weight gain and growth.

Various Thought-Leaders Comment on Biotoxins and the Brain

Pat Summitt, coach emeritus of the University of Tennessee Women’s basketball team, famous for her winning record, is now courageously open about another opponent: Alzheimer’s disease, with onset in her 50s. In her book Summitt Up, she describes growing up on a dairy farm and her favorite sport – battling her brothers in the hayloft. On learning of her personal journey, I wondered if childhood exposures such as mycotoxins are factoring in to her early-onset dementia, and if treating these exposures might forestall her debilitation in a clinically meaningful way.

To be clear, this is not suggesting a new treatment for Alzheimer’s disease, but a smart “game strategy” underscored by Advancing Medicine with Food and Nutrients chapter author Dr. Daniel Amen as follows: “[In cognitive decline] the use of neuroimaging, nutrients, and genetic markers are essential pieces of the puzzle to be able to individualize or personalize treatment, together with appropriate lifestyle changes.” (p. 498)

Dr. Neil Speight in Chapter 43, “Mycotoxin-Related Illness,” elaborates on the clinical challenge of diagnosing mycotoxin-related illness:

The primary challenge for clinicians is that while mycotoxins may influence the onset and progression of disease, the same diseases occur in the complete absence of mold. Except in the setting of massive food contamination (such as Balkan Endemic Nephropathy) or post hurricane mold overgrowth (Hurricane Katrina in New Orleans, LA) the opportunity to treat patients’ underlying mycotoxin-related illness is under-recognized. (p. 821)

In the same text, Chapter 44 on biotoxins, Dr. Dietrich Klinghardt proposes an underlying mechanism for the observed clinical association between biotoxins (including mycotoxins) and various disease processes.

The human body eliminates biotoxins such as those associated with Lyme disease, Streptococcal infections, foodborne illness, and associated immune reactions through a common detoxification pathway. This series of enzymatic steps is needed to eliminate all environmental toxins such as lead, benzene, mold toxins, food additives and most other neurotoxins. When these pathways are already fully occupied by a silent chronic load of lead, mercury, PBDEs and others, the client’s system cannot successfully deal with a new, biotoxin producing illness, such as Lyme disease or mold exposures from water damaged buildings. The system is on overload and shuts down. When the toxic burden is large and the elimination pathways are overloaded or constitutionally weak, healing will be impaired on all levels. Optimizing epigenetic, metabolic and nutritional support should be an essential part of a biotoxin-centered medical approach to chronic illness. (p.866)

Parasites are producers of biotoxins, and the daily toll on health that these may exact are largely unstudied. I’ll relate a story from my own experience. Following a probable exposure to schistosomiasis, I was administered the appropriate antihelminthic medication. When I was taking it, a pea-sized lump in my calf became irritated and then disappeared. In reflection the lump emerged a decade earlier following public health work in a region of the world endemic for pork tapeworm. (See my June 2012 column on cysticercosis). Pork tapeworm cysts respond to some treatments for schistosomiasis. The clinical observation made me wonder how many ways my body was defending itself, involved in invisible battles of which blood tests only give a clue.

Treatment Opportunities Stemming from EMF Exposure

Also in Advancing Medicine with Food and Nutrients, authors Dr. John Cline and Beth Ellen DiLuglio describe how they help the body fight disease by minimizing the potential impact of electromagnetic radiation. From Chapter 42, “Electromagnetic Hypersensitivity and Implications for Metabolism”:

The human being is bio-electromagnetic, responding to electromagnetic radiation (EMR) at the sub molecular level. The electromagnetic spectrum consists of ionizing (IR) and non- ionizing radiation (NR) and it has been known for many years that IR has enough energy to break chemical bonds and therefore disrupt molecular structures leading to various pathologies, especially neoplastic disease. There is emerging evidence that ongoing exposures to NR also results in a number of disease states including neoplastic disease.

The same authors then elaborate their approach to helping patients reduce the effects of EMR:

• identifying and removing both ionizing and nonionizing radiation exposure where feasible.

• optimizing the antioxidant potential of food.

• avoiding irradiated food may be prudent given the limited safety data.

• restoring the body’s electrolytes and minerals.

• employing detoxification strategies:

• using supplemental nutrients (pp 814–815)

More on Treating What’s Treatable

When seeking to help patients achieve the best quality of life possible, nutritional medicine offers strategies relevant to many disease processes. Nutrition, in sum, ameliorates pathophysiology. The body’s innate healing capacity can be directed more fully to the recalcitrant disease at hand.

Ingrid Kohlstadt, MD, MPH, FACN, FACPM, is the founder of INGRIDients Inc., where she has edited Advancing Medicine with Food and Nutrients, 2nd edition (CRC Press; 2012). On the faculty of Johns Hopkins Bloomberg School of Public Health, Dr. Kohlstadt is researching an approach to leverage nutrition more fully in disease prevention.