jeudi 28 mars 2013

DR JESUS ALVAREZ THE ASTURIAN, THE GENIAL GIANT OF BARACOA, CUBA


DR JESUS ALVAREZ OF BARACOA
A PASSOVER REMEMBRANCE
15 NISSAN 5773
I knew Jesus Alvarez well. A genial giant of a man bearded with a half muted cigar in his hand and drove around Baracoa in a 1964 Black Chevrolet.

How did we become good friends?
Baracoa had become my adopted home and I spent considerable time there, with brief forays out of Cuba connected with my work. We were a large group of friend who met regularly, almost on a daily basis, for conversation, food and drinks. We referred to this period as the Golden Era.
Before the Second World War there might have been some Jewish merchants but their presence is but a memory now. So I always planned to be away during Jewish Holidays so that I can spend it with Jewish friends and family elsewhere in the world. Pesach is the only Jewish holiday I wish to spend with family, recalling the story of the slavery under the Pharaohs and the escape from Egypt 3300 years ago!

Once I happened to be in Baracoa for the first day of Pesach, the only Jew in town, it might have been about 12 years ago. I wanted to be with my brothers in Portland, but here I was in Baracoa, feeling pitiable.on the morning. Pesach was to begin that evening. To prepare a Pesach meal, one needs many ingredients, most of which was not readily available in Baracoa or Cuba for that matter, now as it was then.
I was sitting at home, feeling a little miserable, wondering what I was going to do on this day.

There was a knock on the door. I opened, and a giant of a man was standing outside. My name is Jesus, may I come in?
He explained that he had heard about my presence in Baracoa for a while and wanted to introduce himself to me. A Spaniard, Cuban by adoption, educated as a doctor in Cuba, decided to stay on in Cuba, despite his colleagues migrating elsewhere. An ENT surgeon, who used to work for many years in the local hospital, was forced to retire recently due to Gout and Hypertension.
How are you feeling? He asked as our conversation became a little friendlier.
I am a little sad that I cannot celebrate my favourite Jewish holiday. I explained to him the significance of Pesach and the variety of ingredients needed to make a Seder.
He had a special way of looking at you, especially when he was thinking, slightly cocking his head.
I continued: all these ingredients are difficult to get in Baracoa, especially at such short notice, shank bone; you may as well forget it. Impossible, of course.
He got up, it was little before lunchtime, he said. Let us see what I can do.
At 7 pm, I will reserve a table at the local paladar (restaurant) and you may invite six or seven of your close friends and I will bring my wife and you show us this Jewish celebration, we will be proud to participate!
I was happy beyond words. I got busy looking for my Sephardic hagadah and a collection of hats (mainly African, which can pass for a kippah; mostly from Benin). I got in touch with my closest friends, The Little poet of Baracoa among them.
At the appointed time, Jesus and Walkyria picked me up in their 1964 Black Chevrolet drove up to the Paladar where my friends were waiting. A table had been set. A proud bottle of red wine stood at the head of the table and a variety of vegetables (to be substituted for maror, charosset, parsley) were scattered on the table, along with a boiled egg and a shank bone.
Jesus smiled benevolently at me, and I was grateful.
You couldn't have imagined my exhilaration. Now it was up to me to conduct a Seder.in this town in the eastern end of Cuba, which might have heard these songs in the historic past. (A shopkeeper who left for La Habana in the 1940s may have been a Lebanese Jew, the famous La Rusa, was married to Baruch Manasseh, a Turkish diplomat stationed in St Petersburg, La Rusa’s son showed me documents in which that name was inscribed in Hebrew!)

We put our hats on, wine opened, I dutifully said my prayers. Fortunately I had a package of Matzo, which was placed in the middle of the table.
For the next few hours, we had an untraditional, Cuban Oriental Seder with many questions asked, four glasses of wine imbibed with glee.
At midnight our party repaired to my home to listen to some Cuban music and empty few bottles of Rum.

From that day onwards, I never failed to visit Dr Alvarez at his home in Van Van. On each of my subsequent visits, the first lunch was at his home, creole food, with an ever welcome Cuba Libre.
Over the ensuing years his health deteriorated but our friendship only strengthened. I truly considered Jesus and Walkyria my good friends. I was proud of the fact that Jesus, the Asturian considered me a good friend also.
At Singapore Airport on 11th March 2013, waiting for Air China flight to Beijing, I received a terse email from Baracoa. It said: I am sorry to have to inform you that your good friend Jesus passed away last Saturday. He seemed to have suffered a Myocardial Infarction.

The SATS lounge was busy, but I found enough solitude in my head and in my heart to think and be grateful for the friendship of Dr Jesus Alvarez of Baracoa, it was truly a pleasure to be his friend. My condolences to Walkyria and their sons.

IT IS ALL IN THE GUTS: MICROBIOME AND OBESITY

I had written a blog regarding the importance of various types of Microbiome that inhabit our guts as paying passengers just a few hours ago.
Imagine my excitement when I received this notification from our professional society: just a few minutes ago!



CHANGE IN GUT FLORA AFTER ROUX-EN-Y MAY AID IN WEIGHT LOSS 
The Los Angeles Times (3/27, Brown) reports, "In the latest of a slew of studies examining the role of the so-called microbiome - the mix of microscopic critters that colonize our bodies and our environment - in human health, Harvard researchers said Wednesday that part of the reason that gastric bypass surgery works so well in helping people lose weight is because it causes changes in the mix of bacteria in our bellies." The researchers came to that conclusion after "conducted an experiment on mice." The finding "suggests that doctors might someday be able to mimic the microbial effects of weight-loss surgery without putting patients under the knife, said Dr. Lee Kaplan, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital and co-senior author of a report detailing the research in the journal Science Translational Medicine."
        The New York Times (3/28, A16, Grady, Subscription Publication) reports on the mouse study, and also reports on "a second study by a different group," which "found that overweight people may be more likely to harbor a certain type of intestinal microbe." These "microbes may contribute to weight gain by helping other organisms to digest certain nutrients, making . more calories available. That study was published Tuesday in the Journal of Clinical Endocrinology & Metabolism."
        Reporting on the mouse studyBloomberg News (3/28, Lopatto) reports, "Researchers gave mice the stomach-shrinking surgery and monitored changes in the gut's bacterial inhabitants." The investigators found that "when bacteria from the mice that got surgery were transferred into mice with no gut germs, those mice also lost weight, about a fifth of what they would have lost with surgery." HealthDay (3/28, Dotinga) and MedPage Today(3/28, Bankhead) also report on the mouse study. Reuters (3/28, Begley) also reports on both studies

We can expect very personalized medical care for chronic conditions in the future. The doctors of tomorrow will have to have much more than just general knowledge about the bodies and medications to treat them. In fact many of the medications prescribed by the doctors alter the flora of the gut and let some of the nefarious one secrete chemicals that increases the body fat and body weight...

ANTIOBIOTICS, NATURAL MEDICATIONS IN PILL FORM, MULTIVITAMINS, CHEMICALS AND PRESERVATIVES ADDED TO FOOD ALL NOW STAND GUILTY TO BE JUDGED BEFORE AN ENLIGHTENED AUDIENCE .. who have serious interest in this topic because it concerns their HEALTH...
Doctors will have to learn to take care of the HEALTH of the people rather than the DISEASES of the people..

Exciting times indeed!

CULTURE, NUTRITION, METHANE GAS AND OBESITY


I have been fortunate to work with American Indians in the USA. Because of their uniqueness, I tried to learn as much of their history and culture as possible. Jokingly my teacher once said: What a pity, you are not smart enough to learn everything we can teach you.

A good lesson in HUMILITY, it was!
From the beginning I wondered: why is that a population that was all LEAN, was now all overweight. In a book published in 1908, after doing anthropometric studies among various tribes, Ales Hrdlicka, considered father of American Physical Anthropology, emphatically stated: Pathological Obesity does not exist.
If a certain percentage of the population becomes overweight or obese as has happened in rapidly developing economies of late, BRIC countries are an example: Brasil, Indian, China and South Africa, we could blame it on indiscretion on those affected. But when it comes to American Indians, they are unique; perhaps another Native group such as Australian Aboriginals face a similar problem, in that over 90 per cent of the Indians are either overweight or obese.
I enjoyed talking to many of the older people, during my early days with the Indians, and all of them said, that as late as the 1950s, overweight and obesity was uncommon.


Another startling fact to learn was the dramatic changes in the nutrition of the American Indians. I can think of no other group, perhaps Australian Aboriginals could be included here, which had undergone such a dramatic CHANGES in nutrition. During the Second World War in Europe and during the Pol Pot/Khmer Rouge regime in Cambodia, there was malnutrition but not a complete substitution of ones natural food for the manufactured food of another culture, as happened to the American Indians following the institution of Reservation System.
Wouldn't a dramatic change in the nutrition/ingredients have some dent in the metabolism of these ancient people? Who can claim to be older than the American Indians when it comes to continuous inhabitation of the land they call Turtle Island.
During a visit to Melbourne, I had a chance to discuss these matters with an Endocrinologist who had a keen interest and eye for such matters. He was the one who told me that the hepatic glucose output among the Australian aboriginals was not controlled by Insulin. Later on when I became an anthropologist I was to understand the significance of his statement.
A leading Nutritionist had published some work suggesting that Native people eating their tradition foods were protected against higher levels of postprandial glucose excursions and Insulin levels.
Long before I became interested in such matters, long before I dreamt of being a doctor, I had noticed that certain foods satisfied me more than the others. Even though I was living in Australia at that time, I am of Asian origin and I remember enjoying Greek Food, which suited me more than the Australian steak and potato diet or creamy pastas of the Italian migrants.  So it was easier for me to accept the theory of Mediterranean diet, which became popular decades later.
Could it be possible that the sudden and dramatic changes in nutritional components presented to these ancient people, elicited a reaction from their metabolism, which became detrimental to them, leading them towards Obesity, Diabetes and other chronic diseases of the Western Civilization?
In the last few years, there has been tremendous interest in the micro biome of the gut, the paying passengers in our intestinal tract.
I began to feel that the alteration of these beneficial bacteria and other matters, resulted in many of the chronic diseases that began to appear among the Indigenous peoples: Auto immune diseases, endocrine related cancers such as Breast Cancer, and of course Obesity.
And perhaps manipulation of the very same would be the treatment of the future, as has been shown in Gastro Jejunal Bypass surgery in which many of the Chronic Diseases are shown to disappear even before there is any great difference in the weight of the person.
So it was with great pleasure and excitement I read a paper published this week in the Journal of Clinical Endocrinology and Metabolism, the flagship journal of our professional society, The Endocrine Society.

Methane and Hydrogen Positivity on Breath Test Is Associated With Greater Body Mass Index and Body Fat

Division of Endocrinology, Diabetes, and Metabolism (R.M.), GI Motility Program (M.A., K.S.C., G.M.B., M.P.), and Biostatistics Core (J.M.), Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048

Abstract

Context: Colonization of the gastrointestinal tract with methanogenic archaea (methanogens) significantly affects host metabolism and weight gain in animal models, and breath methane is associated with a greater body mass index (BMI) among obese human subjects.
Objective: The objective of the study was to characterize the relationship between methane and hydrogen on breath test (as a surrogate for colonization with the hydrogen requiring methanogen, Methanobrevibacter smithii), body weight, and percent body fat in a general population cohort.
Design and Subjects: This was a prospective study (n = 792) of consecutive subjects presenting for breath testing.
Setting: The study was conducted at a tertiary care center.
Outcome Measurements: BMI and percent body fat were measured.

Conclusions: The presence of both methane and hydrogen on breath testing is associated with increased BMI and percent body fat in humans. We hypothesize that this is due to colonization with the hydrogen-requiring M smithii, which affects nutrient availability for the host and may contribute to weight gain.
(Highlighting done by me, and not the authors)
Methanogens are a type of microorganism, to differentiate them from bacteria that produce methane as a by-product of metabolism. We normally associate methane gas production in swamps, bogs and wetland. Cows and humans also harbor methanogen in their guts, they are classified as Archaea. Methanobrevibacter smithii is the prominent methanogen in the human gut, where it helps digest polysaccharides or complex sugars. They are strictly anaerobes, in that they do not require oxygen, in some cases cannot even survive in its presence.
At this stage, I though to myself, American Indians were very healthy when the Europeans arrived in their continent. Their way of life and with it eating patterns and ingredients, hunting and gathering, disappeared and were replaced by artificial foods and ingredients.
This certainly must have had a tremendous influence on the metabolism of the bacteria and archiae inhabiting their guts. It is of greatest interest to note that American Indians became overweight and obese long before their European North American Counterparts caught up with them.
Was there a chemical connection? What did they put in that artificial food which they gave to the Indians in the Reservations in the early part of the last century that now is commonly consumed by all the Americans?
Is there is anything in our modern nutrition that can be shown to alter the behaviour of the micro flora of our guts?
It did not take me too long before I came across the following information.


Oleic acid, an 18 carbon acid with one double bond (C18 : 1) was degraded anaerobically to palmitic (C16 : 0) and myristic (C14 : 0) acid by-products at 21°C by a culture unacclimated to long-chain fatty acids. These by-products were degraded to acetate and ultimately to methane. In comparison, no long-chain fatty acid by-products were observed in unacclimated anaerobic cultures receiving stearic (C18 : 0) acid although slow removal of stearic acid occurred. Oleic acid concentrations above 30 mg l–1 inhibited acetate degradation but stearic acid up to 100 mg l–1 did not inhibit aceticlastic methanogenesis. Hydrogenotrophic methanogenesis was slightly inhibited by oleic and stearic acids. A thermodynamic basis for comparing anaerobic C18 acid degradation and predicting by-products is presented.

Anaerobic degradation and methanogenic inhibitory effects of oleic and stearic acids

·       1 Department of Biosystems and Agricultural Engineering, Oklahoma State University, 218 Ag Hall, Stillwater, OK 74078-6021, USA
·       2 Department of Civil Engineering, University of Toronto, 35 St. George Street, Toronto, ONT., Canada M5S 1A4

We have two pieces of scientific information here. High Oleic and Low stearic Acid can be beneficial in the methanogenesis. And secondly, methanogenesis seems to be correlated to Obesity in a current general population.

It does not take much imagination to understand that the complete conversion of food from a natural state to an artificial state that has taken place since the industrialization of food production in America, the most overweight of all nations.


Now we read about Oleic Acid and Stearic Acid, there is a resonance between their presence and absence and the sound nutritional advice given to our patients now. Just see what food is high in Oleic Acid that we should use more of (such as Olive Oil) and the high stearic acid foods we should avoid (Fatty meat, White Chocolate etc.) and adopt low stearic acid foods (rice paddy gruel, lactic acid bacilli etc.).

Oleic acid is a monounsaturated fatty acid found naturally in many plant sources and animal products. It is an omega-9 fatty acid, and as such is considered one of the healthier sources of fat in the diet. Health experts often recommend using it in cooking, and a number of so-called health foods and diet products will use this compound in place of animal fats.
Where It’s Found
One of the chief sources of this acid in foods is olive oil. Whole olives also contain the compound, but typically only in trace amounts. When pressed and drained together, however, the olives' acid levels are combined, leading to high concentrations in most cases. Canola and grapeseed oil also contain oleic acid.
Many nuts and seeds contain the fat as well, and it can also also be found readily in most poultry, particularly chicken and turkey. Isolating it from animal sources is often somewhat challenging, however. While vegetables and nuts usually contain oleic acid as the primary fat, most meats contain a combination of both saturated and monounsaturated elements.

Oleic acid has the molecular formula C18H34O2 and is usually found trapped in triglycerides, which are lipids closely connected to oil secretion and production. Blood triglycerides help the liver isolate fat and glucose, and are often responsible for the secretion of skin oils. In vegetables and plants, they occur as a means of providing nutrition and sustenance. Scientists sometimes isolate oleic acid from triglycerides in order to conduct health research, but most of the time, the compound is sought after for its health benefits.
Health Benefits
 oleic acid is one of the better fats for humans to consume. It can lower total cholesterol levels by raising blood concentrations of high-density lipoproteins while reducing low-density lipoproteins, also known as the “bad” cholesterol. It has been shown to slow the development of heart disease and also promotes the production of antioxidants, elements that can help trap harmful free radicals in the body.


Nutrition and pharmaceutical therapies are moving away from Calories, fats and carbohydrates and proteins to quality of what we eat and how it secondarily impacts our metabolism, thus we would have new means to decrease this damage to ourselves.

Medical knowledge is advancing rapidly, but the practice always lags behind by about ten years. One of the advantages of working with a group of indigenous people is that we can culturally enforce our decisions to treat and prevent diseases which cultural contacts with our civilizations gave it to them.

Stearic Acid. Oleic Acid, Cooking Oils myths about Omega 6 all are in the right direction. The future nutritional counseling would be done by anthropologically trained nutritionists, they would know more about culture than macro ingredients, such as why shouldn't a Hindu not begin consuming beef on his arrival in the USA.
This would also answer many health related questions, which has a cultural basis to it:
Why do Khmer people have such high rate of Diabetes? Why so many of them require Insulin but it is not necessary for their survival?
Why do East Indians die 15 years earlier when they migrate to the West?
Why do Diaspora Africans have high rates of Blood Pressure compared to their countries of origin?

In the future, treatment of a chronic disease such as Diabetes, will be done not by Physicians but people who have a global understanding of the patient, society, culture and physiology. There would not be disappointed professors who express their dismay that FDA has denied permission for newer insulins or continue to promote medications that cause damage to the patient, such as Pancreatitis or Cancer! The newer medications for treatment of Type 2 Diabetes, the so called Incretin mimetics, work on the assumption that there is a hormone secreted by the Gastro Intestinal Tract.. I am sure there is more to this story!

During my first week with the Meskwakia, Dr B, the clinic nurse who was to become my teacher, said to me: They poisoned us… the significance of it is slowly beginning to seep in.

mardi 26 mars 2013

MIND BODY MEDICINE AT HARVARD UNIVERSITY


THIS COURSE IS ONE OF HARVARD’S HIGHEST RATED CME COURSES

CME CONTINUING MEDICAL EDUCATION

Obviously the doctors and other Health/Disease Care providers found this course to be interesting and useful that they gave it the highest rating!
Could this have been dealing with the latest developments in the field of the Science of Medicine?
About wonder drugs introduced this past year?
Drug Company sponsored, luscious entertainment masquerading as Medical Education?
No, NO, NOOO!
The conference in question is about MIND BODY MEDICINE. And all the speakers and presenters are not well known names in Biomedicine, and the guest faculty sounds like faculty from some college in California. But this is real; the presenters have all spent their professional lives at various integrative and complimentary medicine fields. They have obviously something to say, otherwise, doctors are not willing to pay $1000 for a four-day conference in Boston in September?
I am gratified beyond words about this increasing interest in Mindfulness and other integrative mind/medical themes in the general medical public’s eyes and hearts.
Jon Kabbat-Zinn, P.hD

It also reflects the growing realization on the part of many practitioners of Medicine that Machines and Medications are not going to take care of their patients and that there are extra biological aspects to medical care for which the majority of the heath/disease care providers are not prepared. There is a growing realization that Body is not a Machine and that you cannot just objectify the symptoms the patient presents to you and turn them into mechanical failures within the body machine.
This year’s conference takes place in Boston on September 17-20 and the keynote speaker would be Jon Kabat-Zinn, PhD. For those of you who don't know about Dr Kabat-Zinn, he is the person responsible to introduce the ancient Yogic concept of Mindfulness to the western audiences.

It would be good to attend this conference.

The New Science of Resiliency and its Clinical Applications