Last minute shoppers beware.  What I’m requesting under the tree is not attainable in the next 24 hours.  

This is a list for December 25th 2013...what I’d like to see implemented by Christmas of next year.  Forward thinking is a creative process.  Here’s my Christmas wish list for 2013.

1. Autism is recognized not as a psychiatric disorder, but as a complex multi-system condition with gut, immune, biochemical and brain dysfunctions.  As such, the current American Academy of Pediatrics' (AAP) guideline, newly added, to give a trial to a GFCF (gluten and casein free) diet is expanded to include even more evidence-based nutrition treatments.
2. Cancer care is expanded to more routinely include CAM therapies, with Ontario ready and willing to open an Integrative Cancer Care clinic that is publicly funded.
3. Sugar and high-fructose corn syrup are taxed, to deter purchase, help control the obesity epidemic, and provide a a source of funding for Holistic Nutrition integration into doctor’s offices.
4. Meaningful legislation that helps to curb gun violence is signed.
5. Mental health disorders are openly discussed from a comprehensive perspective. In-patients have access to sound nutrition that modifies the flawed Canada’s Food Guide, considers the brain effect of particular foods, utilizes the research showing benefits attributed to omega3 fatty acids and Vitamin D therapy, and assigns a caseworker with education in Nutrition to each individual patient - for outpatient liaising as well.
6. Cardiology patients are routinely offered evidenced-based orthomolecular medicine to complement management of their heart conditions, such as Carnitine, Omega3‘s and CoQ10, and are given the option of chelation therapy based on the results of the TACT study.
7. Probiotics are offered at hospital entrances.

The running theme: integrative care for each condition, and that involves each specialty.  I could continue, but the redundancy is a bit of a turnoff.  Suffice to say that we are ripe for Integrative Medicine moving to the forefront of the health paradigm, both corporately and within the publicly funded system - for the betterment of patient care and the easing of disease-care provincial budgets. Personalized, multi-modal, less poly-pharmacy and more lifestyle-oriented. 

MERRY CHRISTMAS TO ALL!!

In health,

Dr. John Gannage, MD

Mistletoe (viscum album) is a popular herb to have around the house during the holidays though usually people are using it as an excuse for a kiss, not a medicine. Medicinal use of mistletoe has been around for hundreds of years but has to be used carefully because pure mistletoe can be extremely toxic. I have been using mistletoe clinically for years but not to necessarily promote a more romantic lifestyle. Mistletoe extracts can be used to help fight one of our most feared diseases - CANCER. 

Cancer is often thought of as an evil invader of the body. It isn’t. It is a breakdown in the normal regulation of cell growth and maturity. The interesting thing about cancer cells that makes them so dangerous is that cancer cells outcompete our normal cells. This allows them to monopolize energy and space. It is these effects that makes cancer so dangerous but also what makes it hard to treat. Finding therapies that can isolate cancer cells while preserving normal cells is difficult, they are after all both your cells. 

In my approach to cancer therapy I look to not just killing cancer cells but also treatments that support the immune system. The immune system can differentiate cancer cells from normal cells in many cases. It is the immune system that needs to be supported to really help a patient survive not just cancer but cancer therapy. Most cancer therapies target rapidly dividing cells, including those of the immune system. It is a delicate balance with these therapies between help and harm. One of the things I look to do with patients is help to swing the balance towards help and to do this I use special extracts of mistletoe that stimulate and support the immune system. Studies have shown that mistletoe extracts can help to stimulate Natural Killer cells (NK cells) and reduce the metastasis of cancer cells.

This is important to prevent the spread of cancer and speed up the destruction of existing cancer. This is effect is especially important in patients who are receiving surgery to manage a cancer as surgery can reduce NK cell activity in cancer patients. Infusing a patient with mistletoe peri-operatively can reduce the NK cell suppression

As it is always difficult to measure the exact mechanism of the therapy, especially when the mechanism of disease is not fully understood, it is often helpful to simply assess outcomes. In the case of cancer, without being too morbid, the target outcome is survival. A study done in conjunction with the United Nations at the European Center for Peace and Development (what a great name), looking at over 10,000 cancer patients showed that patients who used mistletoe extracts had on average a 40% longer survival than those who did not. This is a very strong finding and is probably the reason that mistletoe, although regarded as complementary medicine, is the number one cancer treatment used in Germany. 

Helping the body to fight disease is our mandate at Markham Integrative Medicine. It is through the use and understanding of substances like mistletoe that support the healing powers of the body that we are able to get results with patients and have them referring their friends and families; our greatest compliment. 

Dr. Beatty practices Naturopathic Medicine at Markham Integrative Medicine.  Consultation with Dr. Beatty can be arranged by phoning (905)294-2335, or by completing the contact form located on our website:
http://www.integrative-medicine.ca/book-your-appointment.html

I’ve always pulled for the underdog.  I love a story where the unexpected happens; where David slays Goliath; the near-defeated rises up and seizes a victory; the little guy that “couldn’t” or “can’t”... DOES. Many of us take great interest in these stories..films are made, books are written about individuals who beat the odds.  They are a source of great inspiration. But as health providers, when it comes to “patients” who beat the odds, do we study these cases enough?

I take great interest in medical success stories.  And pay attention to outliers (no, I have not yet read Malcolm Gladwell’s book).  In research, outliers are data points that are so far out from the cluster that including them in the results is likely to skew the numbers.  They are thus often ignored, deemed to be occurring “by chance”.  I argue they should be studied further.

A child that recovers from autism; an ALS patient that lives 20 plus years; people that live a long, full life despite a cancer diagnosis and a refusal of standard therapy; individuals throughout history that survive an epidemic unscathed; into the future, a woman with the BRCA gene, which carries a significantly higher risk of breast and ovarian cancer, defies the numbers and survives without prophylactic surgery.  Who are they? What are their habits? What did they do? What didn’t they do? How did they defy the odds? There are nuggets of information in these cases that would benefit a deeper understanding of health, not just disease.

To look at it a different way, what of those with minimal mercury exposures who seem to retain much more than one would expect? An individual who walks through the perfume section at Sears and is down for the count for 3 days? The man that smokes 2 packs a day and lives to age 90? What are these cases telling us? Observations like these often lead to a better understanding, when investigated, of how human physiology copes with environmental exposure, and not as a uniform, “everyone-is-the-same” process. The analysis would in theory lead to therapeutic endeavors to support the more susceptible.  In times like these, this is a very worthwhile cause I would say. As Bruce Lipton writes in “The Biology of Belief”, given the chemical and EMF scourge of the planet, human activity against the health of the environment has made it plausible that our species may one day find it has no place to fit in any longer.

In the meantime, the privilege I hold as an integrative medicine physician is in assisting the underdog. It involves guiding clients in the quest to recover from chronic, complex illnesses for which standard therapy often hasn’t any solutions.  It is a thoughtful, collaborative effort - best pursued calmly, confidently and deliberately. Each case is an opportunity to not only change one life, but to learn and understand how to positively impact others further down the road.

In Health,
Dr. John Gannage

As living beings, the quality of our digestion relates holistically to the function of every cell in every organ or gland within our bodies. The first step is making the correct food choices, providing the proper fuel for our inner machinery. What have become staples in our diet e.g. excessive dairy, refined grains, refined sugars, coffee, alcohol and processed meats, can slowly undermine the proper functioning of our digestive tract (and other organs, including our brains). In combination with overuse of medications (e.g. antibiotics, anti-inflammatories, antacids, steroids, and hormones) and stress, the more than 2.5 billion pounds of chemical pollutants dumped into our environment each year contribute to the burden of chronic disease that we are faced with at this point in human history . 

There was a time when foods were eaten as close to their original source as possible, where additives and processing were unheard of. With the advent of modern day agricultural practices, changes in the family unit, the premium placed on convenience, and lack of rotation in our diets of wholesome foods, chronic illness has soared in our population, including heart disease, diabetes and cancer; as well as pediatric cancers, obesity, allergic illnesses and autism. The road back to wellness always includes proper nutrition and behaviour, and MAINTENANCE of them as part of everyday life. Does this need to be difficult? I don’t believe it does. Seek out like-minded individuals, and there are more of them everyday, and the journey will have many rewards.If you have eaten improperly for a number of years, the process of regaining your health may need to extend beyond an incorporation of wholesome foods. In the pyramid of intervention that we focus on at 300 Main Street, the initial step is dedicated to reducing toxicity within one’s intestinal system, and restoring proper liver function. 

One of my favourite American cities, it was a pleasure to return to San Diego for the first time in 10 years. Attending ACAM’s Spring conference, the flashbacks made their appearance.

The Westin Hotel Gaslamp, the site of the 4 day medical conference, is nicely placed, with access to the downtown core and restaurants, and not far from Seaport Village and Petco Park.  Saturday morning I awakened to bullhorns, drums, marchers and chanters  - a protest was in full swing at the hotel entrance by 7:00 am.  I’m thinking: "I haven’t even delivered my presentation yet and already there's dismay and opposition!" (Seems there were a collection of disgruntled hotel workers exercising their right to protest lack of benefits, not a lecture on identifying toxic metals in children.)

As I shared at the beginning of my lecture, alluding to the aforementioned flashbacks, I recalled that in 1989 I visited San Diego for 1 month as a 4th year medical student. I signed up for an elective in Preventative Cardiology at UCSD La Jolla.  At that time, the research being conducted linked menopause and increased risk of heart disease in women to cholesterol elevations that can occur at menopause http://bit.ly/7j1c3I. The intervention was to initiate Hormone Replacement Therapy and monitor cholesterol levels.  I was young and green - and more interested in the beach, visiting my sister and the San Diego area than the idea of giving hormones to women to change lipid blood markers. The hypothesis wasn’t proven - HRT didn’t lower the women’s cholesterol effectively and that aspect of the program’s research died.

Fast forward 10 years to 1999 - my first ACAM conference, where my passion for learning true prevention and addressing underlying cause continued to be fed, having trained then in chelation therapy. Now I was attending training sessions that particularly held my interest!  The studies published in the latter part of the last decade, as The Trial to Assess Chelation Therapy (TACT) was being conducted, further piqued my interest in understanding lead’s role in various health conditions. And this is where today's post comes full circle.

Looking at lead’s biokinetics in the human body, it became apparent through my research that menopause is a time when lead mobilizes from bone storage in a woman, with increasing cholesterol (and uric acid) I suspect acting as compensatory defense mechanisms. The body is attempting to regulate and protect itself in the female at this time of transition and oxidative stress, which can also elevate blood pressure.  The increased risk of postmenopausal women toward heart disease might be attributable to lead, not hormone deficiency - and the intervention that I propose needs to be examined is lead removal, or using antioxidants and other nutrients to manage its negative effects. Hopefully TACT will provide some answers about the clinical effects of chelation therapy in women, and later studies might unravel the mechanism.

"Looking back" is an opportunity for historical reflection and learning. Seeing the interconnections is part of the fun.

Exchange2011 in Portland has come to a close, where ACAM and AAEM combined to stage the General Session of education for Integrative Medicine Practitioners like myself. With the medical conference concluded, these are the impressions I was left with, as I sit in the hotel lounge at the Marriott:

1. Nutrition has likely been argued over, say, since at least the Neolithic Revolution 8000BC. It’ll be debated for the next 10,000 years and beyond. Dr. McDougall and Dr. Morstein provided the evidence - he of the starch-based, high carb approach to nutrition, she of the low carb, lose-the-oatmeal-for-breakfast approach. Each was talking about the best “diet” to manage Type 2 Diabetes.  The audience of PRACTITIONERS was left fired up, some dazed and confused - imagine how the public feels. 
2. Fluoridation of the public water supply has to be one of the largest public health failures, not successes, of our time.  Just ask Dr. Paul Connett, PhD of the Fluoride Action Network, who gave a rousing presentation detailing the hazards.
3. Sweating out toxins is effective, as I’ve advocated, according to evidence provided by Stephen Genuis, MD of Alberta. His research shows excellent excretion of lead and cadmium especially. By exercise, sauna or hot yoga, do SWEAT the small stuff - to detoxify.
4. Dr. Paul Cannell, of the Vitamin D Council, provided strong epidemiological evidence that Vitamin D deficiency leads to a multitude of health problems. The clinical data, detailing the best way to intervene - delivery route, oral dose (if any), optimal blood levels, tissue levels - was lacking, and thus many questions remain for me about the efficacy and safety of high dose oral D supplementation. In 2005, my newsletter about Vitamin D pertained to sun exposure. I still maintain the fallback position is “what did nature intend?”, and that the issue is sunlight deficiency for many populations. Shouldn’t it be corrected that way?
5. Drs. Wright and Sherman provided the take-home recommendation about supplementation of the week for me: naicinamide for diabetes.  Berberine for diabetes was a close second, and from the Chelation workshop Dr. Mark Houston provided ample evidence making the case for ribose, EFA’s, carnitine, and COQ10 for heart patients.
6. Dr. Jeff Bland, PhD of IFM once again provides the inspiration and motivation, with a compelling philosophical, scientific, reductionist and holistic two hour presentation to kick things off early Friday morning. Dr. Bland had a profound influence on my career and education in the mid-1990’s, and continues to captivate while being on the leading edge of research and thinking.

So I’ll leave Portland tomorrow, with kudos to the organizers from ACAM and AAEM for a wonderful conference. A special thanks also to the folks at The Courtyard Marriott at Lloyd Center for their hospitality and gracious hosting. 


And the final word is this: eat a balanced, chemical-free diet; get adequate exercise, with sun going in and sweat coming out if you can; and manage stress for better health. Let’s not get bogged down too much in the details. Keep it simple, keep it fun. 

I had a patient ask me an interesting question some 6 years ago: “What do you think is the most important medical development that you’ve learned about in the past year?” At the time, because I had just returned from an ACAM conference and heard a presentation by Dr. Michael Holick, MD http://bit.ly/ovhAj6weeblylink_new_window, I responded: "The importance of Vitamin D deficiency in disease, how human levels are lowered by sunscreen use and  sedentary living indoors, and why it is important to keep Vitamin D in a healthy range.”  I meant it, so much so it was the cover story of my newsletter back then with the headline “Here Comes the Sun - And I Say It’s Alright!”, but he seemed caught off guard, expecting an innovative surgery or new genetic discovery I suppose.  Of course, now the Vitamin D story has been told, the bandwagon has been weighed down with all the converted, and more frequently we are hearing about disease connections related to D deficiency (although I remain cautious about massive oral doses, the subject of another blog perhaps).

What’s my point? Well, I like his question, and ask myself the same one in my head periodically: “What’s an important medical discovery that you’ve learned for yourself recently, John?” I like to answer with a theory or discovery that applies to my daily practice, something measurable and that is changeable - something that affects a cross-section of illness that, when treated, can have a profound impact on human suffering.  My answer is the subject of today’s blog: mitochondrial dysfunction, its impact on disease, and what I’ve discovered can be done about it in my patient population. I present some concepts in simplistic form.

I sketched the mitochondrion in Cell Biology on a large bristol board in 2nd Year University.  I loved studying the cell back then, adored biology, and spent countless hours perfecting my drawing of a human cell.  It’s ironic that 25 years later I’m writing about this cell organelle as a medical doctor (and looking at cells every day under a microscope!)

The mitochondria are the little power plants suspended in each cell alongside other cell parts like the nucleus.  There may be 2500 of them in a single cell (except RBC’S). An important mitochondria task is to make the energy used to power cell functions, and in turn required by tissues and organs for proper functioning.  They are important for brain, muscle and heart function in particular, as these organs utilize the most energy. On the folded membranes and in the matrix of a mitochondrion, units of energy are made after conversion from foods we eat, in a cascading of biochemistry known as Krebs Cycle and the electron transport chain. Nutrients are needed as cofactors in the cycle, oxygen is required, and contaminants like mercury, lead or pesticides can damage the membranes such that the processes slow down, energy is depleted and/or cells die.  This in turn leads to poorly functioning organs.  For the brain, this means impaired learning, decreased executive functioning, poor attention, speech and language dysfunction, and so on. This occurs because the brain disproportionately requires more energy and oxygen than the other organs do.

What’s interesting about mitochondria, as Figure 1 shows, is the presence of its own DNA, separate from the DNA housed in the nucleus of the cell.  Mitochondrial DNA can mutate and be damaged, in a fashion that impacts energy production, by toxins, viruses or radiation.  An important process in DNA damage and membrane leakage, leading to cell damage and death, is oxidative stress - accelerated by pollution of all kinds, and exacerbated by antioxidant deficiencies.

In my medical clinic, the practical application of these concepts translates first into a requirement to test for mitochondrial dysfunction, as I seek to manage developmental issues in children, particularly autism and global developmental delay.  And just like my testing of Vitamin D, when I too often found easily correctable deficiency, I often discover evidence for mitochondrial dysfunction in children with neurodevelopmental issues. The next step is to provide the nutrient co-factors that improve energy production in the brain and muscle, while simultaneously addressing pro-oxidant exposure in a child’s diet, intestinal and other tissues, home, and immediate environment. The mitochondria can be sped up, protected from damage, or increased in numbers to meet energy demands in vital organs like the brain. The results I’ve observed to date include: improved cognitive functioning, increased endurance, better muscle tone, and more easily attainable developmental milestones.  

Just like the Vitamin D story, starting out as an alternative view prior to becoming conventional practice, mainstream medicine will look to the mitochondria in the future to explain autism and other neurologic diseases, like Parkinson’s Disease, syndromes like Chronic Fatigue and Fibromyalgia, and I suspect cardiac cases as well.  It is a fruitful place to look, since it explains what I have always felt to be true: that much human illness, organ dysfunction and premature aging occurs at the interface between nutrient deficiency and toxic overload, with this organelle’s dysfunction acting as a major player.