White Coat Underground

In case you were worried that the Huffington Post had “gone legit” with regards to medical reporting, fear no more. Barry Sears, creator of a popular diet book, has written a searingly stupid piece called We’re Fighting the Wrong Epidemic. Like Gaul, it is divided into three parts: wrong information about influenza; an invented medical condition with enough truth to sound plausible; and a pitch.

Barry doesn’t get the flu

And it’s not because of his splendid diet. He really doesn’t get it. I’m up to my eyeballs in influenza A at a time when flu season should be but a memory. The H1N1 flu really is out there, and is causing suffering, lost time at work, and generally making a pain of itself. It’s hard to say precisely where the stupid begins and ends here, but I’ll give you some of the highlights.

“The flu pandemic never happened and was an excuse to grab power and money”

This is ridiculous. First of all, we are still at WHO Pandemic Alert Level 5, meaning “impending pandemic”. This is because we are seeing a significant increase in influenza, much of it the new H1N1 strain. As you can see by this graph, we are experiencing an uptick in positive flu tests. Some of this is because of increased testing due to the emerging strain, but some is clearly due to the new strain itself.

“Pandemic influenza doesn’t kill people, anyway”

This is so idiotic that my palm is now permanently attached to my face. Here’s the quote:

Unfortunately, no one seems to have read an article in last year’s Journal of Infectious Diseases (Vol. 198: 962-970 {2008}) that indicated that the millions of deaths in 1918 flu pandemic were not due to the flu, but caused by bacterial pneumonia.

First, if you get the flu and it is complicated by pneumonia and you die, the flu is one of the causes of death. Without the flu, you wouldn’t have gotten pneumonia and died. Idiot. Second, many of the flu deaths in the 1918 pandemic may have been from pneumonia, and many may have been from the flu itself—this single article cannot tell us with certainty. Finally, the conclusion of the article itself isn’t, “don’t worry about the flu,” but, “worry about the flu and prepare for the pneumonia that complicates it,” or in the authors’ own words:

If severe pandemic influenza is largely a problem of viral‐bacterial copathogenesis, pandemic planning needs to go beyond addressing the viral cause alone (e.g., influenza vaccines and antiviral drugs). Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning.

That’s just a taste of the idiocy. On to Part II.

Let’s invent a disease

An old Yiddish saying (supposedly) goes, “A half-truth is a whole lie.” This article contains many a half-truth. Sears invents a disease out of whole cloth, but he uses some real medical facts to dress it up. He calls his new disease “silent inflammation” and apparently, it is a real pandemic, not a fake one like influenza.

However, there is a worldwide pandemic that does currently exist, but no one seems concerned about. This is the pandemic spread of silent inflammation. Silent inflammation occurs when the body starts attacking itself. Unlike classical inflammation that hurts, silent inflammation remains below the threshold of pain. As a consequence, it goes untreated for decades. With new breakthroughs in molecular biology, leading medical researchers are coming to the conclusion that virtually all chronic diseases (diabetes, heart disease, cancer, Alzheimer’s, etc.) are ultimately caused by this type of silent inflammation. The symptoms that we call chronic disease only emerge years, if not decades, after continuing inflammatory attack by silent inflammation until there is long-term organ damage that it is often irreversible.

Some of the truth: inflammation plays a role in coronary heart disease. Yep, that’s about it for the truth.

Inflammation is a process, not a disease. One cannot just create a new “kind” of inflammation out of whole cloth and then blame all important diseases on it (especially cancer!). He goes on to blame this invented disease on “toxic fat” and other dietary factors, which, by logic should mean that “virtually all chronic diseases (diabetes, heart disease, cancer, Alzheimer’s, etc.) ” are caused by diet—which is wrong. But you know where this is going.

The real reason for writing

Yep. Once again, HuffPo hosts and infomercial. Sure, Sears recommends ending subsidies to producers of “toxic fats”, but the real pitch is for his diet products, clearly linked on his profile page. Sure, he doesn’t mention them explicitly in the article, but any good pitchman know that if you yell, “OMFG YOU’RE DYING OF BAD DIET!!!” and just happen to have a raft of diet products behind curtain number one, you’re not going to go hungry.

Shameless.

Comments

#1 daedalus2u
May 27, 2009

Actually he is right about one thing (and one thing only). There is a problem of chronic inflammation. It is not caused by diet; it is caused by low nitric oxide.

NO is a major regulator of the immune system where NO inhibits NFkB, the major transcription factor that has been called the “master switch” of inflammation. It is low NO caused by the respiratory burst of immune cells that causes a robust turn on of the immune system.

The chronic inflammation that is problematic becomes most serious when there has been vascular remodeling under conditions of low NO. A major factor that regulates capillary spacing is the NO level between the capillaries. Because hemoglobin in blood is the sink for NO, cells regulate how diffusively close they are to hemoglobin by measuring the local NO level. If the NO level is high, that tissue compartment acts as if it is far from a capillary and angiogenesis is triggered. If the NO level is low, then the tissue compartment acts as if it is diffusively close to hemoglobin and begins to ablate existing vasculature to increase capillary spacing. I discuss this in more detail here.

http://daedalus2u.blogspot.com/2008/10/role-of-low-basal-no-in-capillary-and.html

What happens when the capillaries get too far apart is that the cells that are “too far” from a capillary don’t get enough O2. They are in a chronic hypoxic state and so are starved for ATP. They try to make up for it by increasing glycolysis, but expression of glycolytic enzymes is triggered by HIF-alpha, which is also regulated by NO. High NO triggers HIF-alpha .accumulation (as does low O2). Not enough NO and O2 needs to get pathologically low to trigger stuff.

The end result of chronic low NO is capillary rarefaction (observed in hypertension). To compensate for those cells not getting enough O2, the body causes hyperglycemia (to get more glucose for glycolysis which takes 19x more glucose per molecule of ATP), hypertension to increase the pressure drop across the capillary bed to increase extravascular fluid flow to deliver more glucose, insulin resistance to get more insulin to those cells too far from a capillary (the first cells become insulin resistant to leave some for the later cells). The hypoxia causes superoxide formation in mitochondria which pulls down the NO level still more.

The upshot of all of this is that individual cells “too far” from a capillary get metabolically stress, and stressed until they die. Sometimes they will die by apoptosis which leaves essentially no trace, but when the cell is cleared, the capillaries are now one cell width closer, so low NO induced vascular remodeling moves the capillaries one cell width farther apart. This is one mechanism for organ shrinkage.

In something important like the heart, pumping can’t be supported by a shrunken heart. The capillaries are too far apart to support active and strong heart muscle with lots of mitochondria, so active muscle gets replaced with fibrotic tissue with lower metabolic capacity. This weakened heart can’t pump enough, so it gets bigger. This is the mechanism for dilative cardiomyopathy.

When the cells die by apoptosis, they are cleared by the immune system with relatively little inflammation. However they don’t always die by apoptosis, when the cells necrose, they spill their guts into the extravascular space which causes inflammation. This is the mechanism behind the chronic and diffuse inflammation that accompanies many of the degenerative diseases (which are all caused by low NO). You can’t see anything because it happens one cell at a time.

Physiology is pretty robust, so this can go on for quite a while. It affects all tissue compartments, which one fails first and causes the characteristic symptoms of that degenerative disease is an idiosyncratic detail. Eventually they all fail, depending on how much reserve capacity an individual has; the failure occurring mostly in tissue compartments with the highest metabolic capacity brain, liver, kidney, heart.

The inflammation isn’t caused by diet. People choose to eat more carbohydrates because that is what they need to supply glucose to those cells that are too far from a capillary. Unfortunately that generates lactate which the liver doesn’t have the capacity to recycle via the Cori cycle, so it gets converted into fat. That is why people become morbidly obese, their cells too far from a capillary are starving and calling for more glucose. More glucose is consumed and only a part of it is used to satisfy cellular needs, the rest gets converted into fat. I think this is why people who undergo bariatric surgery often become seriously depressed after they stop losing weight. While in ketosis the ketone bodies bypass the GLUT transporters. Once their depot fat is gone, they can’t deliver enough glucose to the brain cells too far from a capillary and they become depressed (this is a complicated process).
#2 Denice Walter
May 27, 2009

Pal MD refers to anti-vaxers as “Infectious Disease Promoters”,I would go further and refer to *most* woo-meisters/*maitresses* as “Disease Promoters”,par example: 1.AIDS denialists, by trivializing the virus,its transmission, or even the syndrome itself,see no need to advocate for safer sex practices or EBM treatments(HAART).2.Alt med *provocateurs* who dismiss pharmaceutical/surgical treatment for many serious diseases(cardiovascular,arthritis,peptic ulcers,cancer) instead encourage treatment by vitamins, herbs,diet,exercise, and other non-EB modalities.3.Mental illness denialists eschew EBM in favor of herbal and/or vitamin therapy,”auditing”, and other pseudo-psychological therapy, and 4.others still promote(the belief in) diseases that probably don’t exist at all, well, at least, not in the physical plane.In summary,these “disease promoters” by rejecting modern, effective treatment allow the diseases to spread and/or progress *naturally*.I guess that’s why they call it natural medecine.
#3 Blake Stacey
May 27, 2009

Quoth the quack:

With new breakthroughs in molecular biology, leading medical researchers are coming to the conclusion that virtually all chronic diseases (diabetes, heart disease, cancer, Alzheimer’s, etc.) are ultimately caused by this type of silent inflammation.

On the one hand, they say “virtually all chronic diseases” can be attributed to the same cause. On the other, the same people who’ll blame an inflammation (or a liver fluke) for “all chronic diseases” turn around and accuse “Western medicine” of ignoring the individuality of the patient.
#4 Kim
May 27, 2009

What a strange little article that is. Sears’ issue with arachidonic acid (or at least the “bad” pro-inflammatory eicosanoids derived from it) goes back 15 years at least it’s just odd that he’s suddenly had this little outburst. Not to mention, trying to discredit a real, verifiable public health situation *in which people have died* to bring the focus onto your pet issue is just in incredibly poor taste.

I’m not entirely sure he wants to shill his diet products, though. It must be a bit embarrassing to have his name on all that crap (bars, pasta, cereal) that most Zone followers today would snub due to wheat and soy content. Yesterday’s heart-friendly soy protein is today’s paleo-unfavorable industrial legume byproduct, got to keep up!
#5 Matthew
May 28, 2009

I was skimming the article and read the quoted conclusion from the journal article… except I thought it was from Sears. I read it 2.5 times thinking, “where’s the crackpottery in that?”
#6 Dr Benway
May 28, 2009

Interesting. Subclinical inflammation was featured at the APA this year. Causes depression. Maybe.

I’ve no problem with thinking outside the box. But I frown upon the rapid leap from conjecture and pilot study to the promotion of unproven treatment ideas and products to patients.

In other APA news: Dean Ornish gave the “Frontiers of Science” lecture. He received a standing ovation from a packed house. The titmouse, however, was unimpressed. “Synergy” has an unambiguous dictionary definition, and it does not involve 19 interventions combined when the effect of each individually is unknown.

Most depressing: a seeming majority of MDs don’t grok “synergy” either. The ass kissing during the Q&A was painful. Blogging to follow at some point.

Final APA update: no more Big Pharma sponsorship of CME events. Thank God. Finally, we’ll get some unbiased research instead of the usual pro-drug lies.

/snark
#7 Zetetic
June 3, 2009

When will daedalus2u start plugging a website where he sells nitric oxide infused products? Should be easy to develop and quite profitable – It would likely fall under the “supplements” umbrella.!
#8 PalMD
June 3, 2009

daedalus is an upstanding, ethical kinda guy, so prob. won’t be seeing that soon.
#9 daedalus2u
June 4, 2009

Zetetic, I am trying to start a company to do just that, and no, products to increase nitric oxide are not at all easy. There are none on the market that work because of that tremendous difficulty (despite much research, much hype, and counter to the marketing claims being made). The reason it is so difficult is because NO is so important that all of the thousands of pathways are under absolutely intense regulation. It is very difficult to perturb NO physiology pharmacologically and extremely difficult to do so artificially without causing side effects (essentially impossible). You need a “natural” method that couples to the body’s own normal NO/NOx regulatory physiology. I have that method, unfortunately it is considered “far out” by people who don’t understand it. So “far out” that people are unwilling to spend the time to understand it.

PalMD is right, my “problem” is that I am an ethical kind of person, and can’t follow the path that the quacks and sCAM artists use (even though what I have is based on rock-solid science, it just doesn’t have clinical trials). In the fullness of time it will be appreciated that I am correct. My hope is that that can happen sooner rather than later because the number of adverse health effects that remain uncorrected is not small, and the numbers of people that could potentially benefit is gigantic. The chronic inflammation example above is only a subset. The best (and really only way) to prevent the adverse effect that accompany chronic inflammation is by prevention. The only physiological way to do that (i.e. the only way that won’t have side effects) is by raising NO levels with a physiological method.