A Wellspring for Our Community Renewing Mind, Body and Spirit From Stephanie Taylor, M.D., Ph.D.
“True wellness and deep healing is more than the application of a pill to a diagnosis. I have pioneered a new approach to healthcare that is based on personal and community wellness. Here is what this means:
The first community is you. Each person is a composite of their own life experiences and their own circle of support. Every factor needs to be evaluated to develop a picture of the whole person. Each element can then be recruited into the healing process.
The second community is where you live. The majority of public health research shows that the health of individuals is not separate from the health of the community. We have an obligation to ourselves to care for our community. This means taking the ecological initiative and also supporting the small businesses that are based in our community, especially our local farmers. Over time the community that you care for will also care for you.
The center of the program is the office visit. We offer 30 and 60 minute patient visits. This gives us enough time to really get to know you. The relationship does not end at the office visit. You will enter a supportive community linked by regular newsletters and educational programs. You will have the opportunity to re-discover yourself and the joys of living on the Monterey Peninsula. Visit Medical Program and Educational Program and see how this unique holistic program can benefit you and assist you in achieving your life’s purpose.”
Mini-Medical School #4 August 6, 2016
Stephanie Taylor MD PhD
"I have reached an age when, if someone tells me to wear socks, I don't have to." Albert Einstein (1879-1955).
Healthy aging is the most popular topic in the Mini-Medical School Series, and for good reasons. The average lifespan has increased dramatically in the last 100 years, and nothing in our social structure has kept pace with that fact.
In 1900, the average lifespan for women was 48 years (men 46), in 1950 it was 71 years (men 66) and in 2000 it was 80 (men 74). Social Security was enacted in 1935 and was intended to support the aging population for the few years before their natural death. We have moved from a time when an elder could look forward to a few years of rest before a quiet death by infectious disease or multi-organ failure to a prolonged maturity of three decades. This is an international crisis, especially in the developed world.
Popular interest in maintaining vitality is exploding. Fortunately, the science is keeping pace.
"Those who think they have no time for bodily exercise will sooner or later have to find time for illness." Edward Stanley (1826-1893)
The first principle of healthy aging is to not break the equipment before you wear it out. There is robust scientific evidence for these assertions:
Stress and social isolation accelerates aging possibly by shortening telomeres.
Environmental toxins accelerate aging, often by direct damage to DNA.
Excess calories accelerate aging, possibly through hormonal signaling by fat cells.
Vascular disease and diabetes accelerate aging.
Exercise and meditation slow aging. The most physically active were 40% less likely to decline, and 50% less likely to develop Alzheimer’s. Scans show an increase in hippocampal size and in tests of memory. Animal studies show that physical activity increased blood vessels, and increased hormones that support nerve growth.
A diet rich in phytonutrients shows aging, probably through its antioxidant effects. Mediterranean Diet.
"Grow old along with me! The best is yet to be." Robert Browning (1812-1889)
What healthy brains do as they age: they adapt. Let me show you!
First meet the players-The major brain regions in aging research are the frontal cortex (proactive planning and working memory), the hippocampus (episodic memory). The structure of the brain is composed of nerve cells and their supporting glial cells. These cells are very high fat and high water, and this will become important later.
The fMRI studies show there is a difference in young and old brains, but what that means is very open to interpretation. The good news is that the older brain recruits new regions when there is a slowdown in a prior processing area. The brain may recruit another region, but the most fascinating fact about the older brain is that this recruitment crosses into the opposite hemisphere. This does not happen in younger people.
"He who is of a calm and happy nature will hardly feel the pressure of age, but to him who is of an opposite disposition, youth and age are equally a burden." Plato (427-346 B.C.)
The aging brain responds best to active management. This has many layers of meaning, and here are some from the researchers:
Enhancing memory-repetition is less effective than investing the memory with meaning, especially if it is surprising or funny.
We are hard wired to remember visual and spatial information much better than words.
We remember things better if they are associated with something else that we already know.
Recalling information (self-testing) enhances memory much better than repetition.
"Because I could not stop for death – He kindly stopped for me." Emily Dickinson (1830-1886)
As a society, we are developing a more mature attitude toward dying. This is most welcome, but we have not solved the crisis of losing your mind long before the death of the body. Alzheimer’s disease is the third leading cause of death, and affects 5.2 million Americans. The lifetime risk is 15%, which means that 45 million Americans will be affected as the population ages. This is a national emergency.
There are several types of dementia, but the most common is called Alzheimer’s disease. Alzheimer’s disease is defines by the presence of amyloid plaque and tau protein. These “scars” in the brain are thought to cause Alzheimer’s disease and have been the target of therapy. Unfortunately, all the pharmaceutical therapies to date have failed. Here is the reason:
There is more than one kind of Alzheimer’s disease, and they have different causes. All three types are beta-amyloid positive and tau positive, and are currently diagnosed as Alzheimer’s disease.
Type 1-Inflammatory-Multiple inflammatory associated genes; inability of the innate immune system to remove amyloid, persistent “wound-like” micro-pockets; systemic inflammation affecting the brain, and ApoE4 associated. Symptoms are focused on memory loss, and MRI shows hippocampal atrophy, with no cortical atrophy.
Type 2-Non-inflammatory-Insulin resistance, low Vitamin D, elevated homocysteine, steroid hormonal loss. Systemic markers of inflammation are usually normal. Also associated with ApoE4.
Type 3-Cortical-non-amnestic. A fundamentally different process than Types 1 &2. Typically early onset (with preceding stress or toxic exposure), with loss of long-term memory, no family history, ApoE4 negative, MRI shows general cortical atrophy rather than hippocampal loss, and a reduction in glucose utilization. Zinc levels are low. The six patients reviewed by Bredesen MD all had a history of toxic exposures, including mycotoxins. This subtype is also called “Inhalational Alzheimer’s disease.”
Treatment depends on the type and by metabolic characterization. This work is being done at the Easton Lab for Neurodegenerative Disease, UCLA and the Buck Institute for Research on Aging in Novato. The protocol (MEND) is in development, and I think we can expect some news stories in the coming year. In the meantime, don’t break the equipment and keep yourself well fed, exercised, safe and happy.
Bredesen, Dale E. “Reversal of cognitive decline: A novel therapeutic approach.” Aging. September 2014.
Bredesen, Dale E. et al. “Reversal of Cognitive Decline in Alzheimer’s disease.” Aging, June 2016.
Spices for Health and Healing
April 2, 2016
by Stephanie Taylor MD PhD
Definition of a spice: A spice is “edible, aromatic and dried”
Our second Mini-Medical School focused on another aspect of healing with whole foods, namely Spices! These rare and tasty items were revered as medicines in the not too distant past. Recent research has identified spices as concentrated sources of many healthful compounds. Dr. Taylor discussed many common spices and their uncommon health benefits. A few are listed below. For more specific and detailed information, see the book "Healing Spices" listed below.
Adding more spices to your daily life the Easy Way.
Almonds: Have 1-2 oz per day.
Black Cumin: Add the seeds to more foods, but you may need the oil to get therapeutic levels. Buy this in capsules, as the oil is not very palatable.
Black pepper: make it fun with a lovely pepper grinder in the table.
Cardamom: Put a slightly bruised pod in the bottom of your coffee cup.
Cinnamon: Well, you can add this to about everything!
Cocoa: There are two kinds of cocoa-Dutch and natural. Dutch processed is darker and has been treated with alkali to make it less acidic. Dutch process is lower in the beneficial flavanols. Heavy metal contamination, especially cadmium, is common in cocoa powder, and less so in dark chocolate. Consumerlab.com has a complete report of best brands (including concentration of heavy metals) on their website which can be accessed for a modest annual fee.
Get a cookbook that focuses on Spices. Here are some recommendations:
Claiborne, Craig. An Herb and Spice Cookbook, 1963. An old favorite of mine and available as a used book.
Lawson, Jane. The Spice Bible, 2008. New interpretation with recipes by spice.
Aggarwal, Bharat. Healing Spices, 2011. A n entertaining list of recent research studies on a large number of spices familiar and strange.
And for historical inspiration, try: Nabhan, Gary. Cumin, Camels and Caravans: A Spice Odyssey, 2014. A personal journey into the heart of the Silk Road and the spice trade.
The Spice House, www.TheSpiceHouse.com. Great variety and grind their own spices weekly.
Penn Herb Co. www.pennherb.com Also great variety and has black cumin oil in capsules.
Mini-Medical School #1 2016
Stephanie Taylor MD PhD
All disease begins in the gut-Hippocrates, 3rd c, B.C.E.
Who are the Microbiome?
Currently, all the bacteria that live on and within you. Very soon, this definition will also include viruses and parasites. As of 2016, 10,000 bacteria types have been identified comprising eight million genes. This outnumbers your genes more than 30/1.
What are they doing?
Assist digestion, defend against harmful organisms, neutralize toxins in food, educate and nourish the gut associated immune system, produce enzymes, vitamins and neurotransmitters, reduce inflammation.
So what’s the problem?
Imbalances in the microbiome cause: weight gain, neurological disease, inflammation (think cancer and heart disease). Imbalances are caused by stress, antibiotics, cesarean sections and perverse cleanliness. Specifically: weight gain is associated with an excess of Firmicutes and a deficiency of Bacteroidetes. Babies delivered by Cesarean section have: 5X increased allergies, 50% increased risk of obesity, and 70% increased risk of Type II diabetes. Antibiotics disrupt the microbiome and are grossly overused, especially in industrial meat and poultry production. Do not eat dinner late at night-your microbiome needs a rest.
Remove from the diet processed foods, preservatives, and chemical sweeteners etc. that harm bacteria: identify pathogens, and remove with natural compounds.
Replace as needed: stomach acid (naturally), and digestive enzymes. Chew your food.
Reinoculate with probiotics. Should contain:lactobacillus acidophilous, l. rameseses, l. plantaris, and different types of Bifidobacter.
Repair with supplements or pre-biotics. Useful supplements are: glutamine, NAC, and DGL. Repair with friendly foods: asparagus, oats, carrots, garlic, Jerusalem artichoke, jicama, leeks, onions, radishes, tomatoes, cinnamon, turmeric…..and fermented foods.
Brain Maker by David Perlmutter MD-focus on neurology
The Gut Balance Revolution by Gerald Mullin MD-focus on weight loss
The Microbiome Diet- Raphael Kellerman MD-focus on weight loss
The Art of Fermentation by Sandor Katz- learn what your grandmother knew about keeping a family healthy.
http://ubiome.com/ “The world’s first effort to map the human microbiome with citizen science”. They offer direct to consumer microbiome sequencing and a free eBook on weight loss. They co-ordinate with the National Institute of Health Microbiome project at: https://commonfund.nih.gov/hmp/index
Happy Girl Kitchen, 173 Central Ave, PG gives workshops on fermentation and canning. A great local community resource. Web site: http://happygirlkitchen.com/pages/events
Grocery Shopping: The best vegetable ferments are found at Farmhouse Culture- many sauerkrauts and kimchee as well as the infamous Gut Shot. Available widely and at Costco! Kathryn Lukas, the owner, gave our very first Mini-Medical School.
Check out the fermented dairy products: yogurt, kefir and kefir cheese. The dairy must be organic and/or grass and pasture raised. Avoid homogenized milks. Dairy free yogurt can be purchased or made at home. You an even ferment water, really! Every world culture has several ferments. We are familiar with miso from Japan, unpasteurized wine and beer from all times and places, and many more.
General shopping advice: Shop at the perimeter of the supermarket and not the central isles where all the processed foods abide. Try for organic if possible since this eliminates the following: herbicides and pesticides, antibiotic residues and the DNA of antibiotic resistant organisms.
Genetics for you
Mini Medical School #6
December 5, 2015
Presented by Stephanie Taylor MD PhD
History of genetics:
Many of you are familiar with Gregor Mendel, who lived in the mid-19th century. He was an Augustinian friar who did significant genetic research. You may not know that he initially started his research with mice. Apparently his superiors felt that keeping mice in his monk’s cell was unseemly. In addition the fact that he was propagating mice by mating was also unseemly for celibate friar. His superiors suggested he work with another less human organism and he retreated to the safety of the lowly garden pea. His work was lost in obscurity until it was rediscovered in 1905. This work formed the foundation of modern genetic teaching of autosomal dominant and recessive inheritance. This is probably what you remember from your years in high school taking biology. For example, the gene for blue eyes is thought to be recessive. Two individuals with blue eyes should only have blue-eyed children. However a parent with brown eyes who carried a recessive gene for blue eyes married to another brown-eyed parent also carrying the recessive blue eyed gene, would have 25% possibility of having a blue-eyed child. We now know that inheritance is much more complex, even with a simple model such as eye color.
Watson and Crick published a paper proposing the double helix model of DNA in 1953. It’s not well known, however, that they got significant assistance from reviewing Rosalind Franklin’s x-ray crystallography data strongly supporting the double helical structure of DNA. Rosalind Franklin was a very gifted young scientist who did not get along well with her supervisor. While she was away from the laboratory, her supervisor showed her research to Watson and Crick providing critical insight on the correct 3-D configuration of the DNA helix. She is now getting the recognition that she deserves. Unfortunately Rosalind Franklin died very young of ovarian cancer and never shared the Nobel Prize with Watson and Crick.
The next major advance in genetics was nucleotide sequencing which began in 1977. It was originally a very slow and expensive process. Technology continued to improve and the human genome was sequenced in 2003 to much fanfare. This took a massive effort over a long period of time to sequence one person’s genetic code. Even though sequencing the human genome was a significant advance we still only knew about one individual. We knew the code but we did not know how the code was regulated. To learn more about this will need to look at a short video describing the process of translating the DNA code into a protein. This is called The Central Dogma.
Using the knowledge-Rare disorders
Let’s see how this knowledge has been applied. We will look at genetic research on rare disorders and direct to consumer genetic testing for ancestry and health risks. We will then move on to epigenetics-the regulation of the genome, pharmaco-genomics, nutri-genomics and the inheritance of acquired characteristics.
Rare disorders are a very fruitful field of study because there is often an identifiable underlying metabolic dysfunction that causes a significant disease. Understanding these rare dysfunctions often adds important details to our understanding of normal metabolism. Populations that are relatively small and have some degree of consanguinity have a higher frequency of rare mutations. A familiar example, is the BRCA gene which is much more common among Ashkenazi Jews than other Caucasians from Northern Europe. In the United States, the Amish population, which is quite small, also has a higher frequency of rare disorders.
The Clinic for Special Children in Pennsylvania is an extraordinary institution that is created for and supported by the Amish population. The clinic does cutting edge research, diagnosis and specific therapy for children with genetically determined diseases. If that was not extraordinary enough, the clinic is supported primarily by the Amish community annual craft fundraiser and private charitable grants. The Amish community donated the 2 ½ acres for the clinic site, gave the lumber and raised the building themselves. The advantage of community outreach and early intervention is illustrated in this family history. The older brother came to the clinic at four years of age already significantly disabled by his disorder. The metabolic defect was identified and after consultation with experts in the field he was successfully treated with a relatively common over-the-counter supplement called betaine. He recovered some neurological function, but remains partially disabled. His sister, born two years later, was treated immediately at birth and is entirely normal as long as she takes her supplement. This illustrates the importance of early diagnosis and intervention in metabolic genetic disorders. The gratifying part of this particular story is that the treatment is relatively easy and inexpensive once the diagnosis is established.
Significant discoveries beneficial to the larger population can come from studying relatively rare genetic variants. The Amish population has an unusually high frequency bipolar disorder, a source of tremendous suffering in the community. Careful investigation of affected persons identified a gene segment that may be a candidate for therapy. The function of this section of the DNA involves potassium movement across cell membranes and partially explains the cyclic nature of bipolar disease. Hopefully, further study will suggest a relatively simple and more direct treatment.
Using the Knowledge-Direct to consumer genetic testing
23 and me is the leader in direct to consumer genetic testing. 23 and me was founded by Linda Avey, Paul Cusenza and Anne Wojcicki in 2006. Their strength is the reliance on very large volumes of data (Metadata) and the computing power to perform deep analytics on that data. Right now they have over 1 million individual’s gene sequences. They have recently been FDA approved to reinstitute the health module and in the interim have been continuing to do their ancestry testing.
Testing is performed on a saliva sample results are obtainable in several weeks. It takes quite a while to amplify and sequence the DNA. This is done on highly sophisticated processing machines. Here is an entertaining short marketing summary of the journey of your DNA at 23 and me.
Even though your health report from 23 and me is somewhat constrained by FDA guidelines you do still have access to the raw data. The 23 and me website allows you to upload your raw data to other services. Dr. Taylor cannot endorse any of these sites but if you want to do your own independent research and are willing to assume the privacy risks they are reasonable options. This is an opportune moment to discuss privacy matters. When genetic testing was first developed many individuals refused testing because they feared discrimination by employers and insurance companies. Legislation was passed to prevent discrimination regarding employment and insurance coverage however that did not extend to life and disability health coverage. An additional concern is the possibility that your personal information could be hacked with the relatively small amount of information publically available on the Internet. This is a decision that you will have to make personally given your own unique situation.
Using the knowledge-Pharmacogenomics
Pharmacogenetics is the study of how your unique genetic constitution affects your response to prescription medications. It is a relatively new field combining pharmacology and genetics. Pharmacogenetics testing profiles an individual’s ability to activate and metabolize prescription medications. Individuals vary a great deal in their metabolic pathways. Knowing this information before prescribing a medication will help your physician prescribe a medication that will be both effective and have minimal side effects. This is the heart of The Precision Medicine initiative announced by Pres. Obama and funded for 2016. The tag line for this initiative is “the right drug, at the right dose, at the right time”.
Watch Jo Handelsman, Associate Director for Science in the Office of Science and Technology Policy, explain the Precision Medicine Initiative.
Here is a familiar example of a drug-gene interaction that is entirely preventable. Cholesterol-lowering medications, despite all being HMG CoA reductase inhibitors, are metabolized differently. For example, Lipitor is metabolized in the liver by the 3A4 and 3A5 P450 system, Lescol by the C29 P450 system and Crestor is not metabolized at all, and is excreted unchanged. Consequently an individual whose 3A4 or 3A5 system was slow would have an increased risk of side effects by taking Lipitor. Cholesterol in that individual would be better controlled with a drug such as Crestor which is not dependent on the 3A4 and 3A5 systems.
Using the Knowledge-Nutrigenomics
Nutri-genomics is the study of the effect of foods on gene expression, colloquially put: you are what you eat. The research focuses on understanding the interaction between individual nutrients and regulation of DNA expression. This is a vast topic but one familiar example that is quite compelling are the foods that influence cancer risk. Examples of protective foods are green tea, carrots, leafy greens, turmeric, blueberries, raspberries, cruciferous vegetables, tomatoes, grapes, plums, and berries. These foods respectively contain EGCG, beta-carotene, curcumin, delphinidin, isothocyanates, lycopene and resveratrol, and cumulatively confer significant protection against cancer.
Using the knowledge-The inheritance of acquired characteristics
Can you inherit memories?
There is very exciting recent research in both animal and human models demonstrating the transgenerational inheritance of experience. The most compelling research is done in mice, since several generations can be followed. In our example, mice are exposed to a strong odor and given a mildly painful stimulus. They associate the odor with a shock, and become afraid of the odor even when it is not paired with a shock. The olfactory receptor for this specific odor as well as the DNA code for expressing that receptor has been very well-characterized in the past. The mice continue to have a negative reaction to the odor even though the shock is been gone for a very long time. Of interest to you, is the observation that the fear of the specific odor is passed down to the next generation. Because it is possible that dysfunctional parenting may account for the offspring’s fear, the newborn pups were fostered to a mouse that had never been conditioned to be afraid of the odor. The offspring raised by foster parents still have the fear of the odor. Second generation mice born by in vitro fertilization using a fearful parents DNA also still had the fear of the odor. This suggests the presence of an inheritable modification of the DNA. Fortunately since this receptor and its code have been so well-characterized was possible to demonstrate a heritable change in the methylation of the DNA regulatory sequence which codes for that receptor. A more familiar example from human health is the inheritance of posttraumatic stress disorder. Many children of individuals who have severe PTSD have exaggerated fear responses, even though they have never been exposed to their parent’s traumatic situation. The children’s behavior was originally thought to be due to dysfunctional parenting but once again there is the research support for a heritable modification in the DNA. Additional research on these questions have been primarily carried out in mice however the implications to the human situation are compelling. It is possible to deconditioned the fear response and actually demonstrate changes on a molecular level in DNA methylation. Hopefully it will be possible to break the chain of suffering. The old adage that the sins of the father will be visited upon the future generations can be modified to include the sentence “unless we do something about it”.
As you can see, we are at the beginning of a big adventure in human health and genetics. I hope that this brief review has given you a foundation as well as a curiosity about future developments.MORE
Are you confused about the conflicting recommendations for breast cancer screening? Here is a quick summary of the issues.
The US Preventive Services Task Force's strongest recommendation was breast cancer screening every two years for low risk women aged 50-74. Starting earlier or continuing after 74 was an individual decision.
More recently the American Cancer Society (ACS) presented another set of recommendations for average risk women. Briefly, average risk means no personal risk of breast cancer, no genetic risk (e.g., BRCA), and no history of radiotherapy to the chest at a young age, no significant family history of breast cancer, no prior diagnosis of benign proliferative disease, and no significant mammographic breast density.
The new ACS recommendations are:
Annual screening, age 45-54.
Biennial screening at 55.
Younger women who desire screening should not be refused.
Screening should continue until the woman has less than 10 years of future life expectancy.
Physical exam of the breasts as a part of the annual exam and breast self-exam is not recommended. (Weak Recommendation).
The American College of OB-GYN responded by reaffirming their guidelines, which are annual screening for ages 40 and up, breast self-exam, and a medical breast exam as part of the annual exam for women aged 19 and up.
How do we make sense of these conflicting guidelines? Dr. Jennifer Harvey, Professor of Radiology at the University of Virginia discussed these conflicting recommendations in greater depth. Here is a summary of her opinion founded in her daily practice of breast cancer detection and prevention.
Breast cancer diagnosed in young women represents a more aggressive form of the disease, and these lives are worth saving. The down side of early screening is the increased risk of a false positive mammogram. If this is a major concern, consideration should be given to other imaging such as 3D tomography, which reduces false positives 15-30% and increases detection of invasive cancers 30-40%. Changing to screening every 2 years for low risk women is problematic because there is no accurate method to identify low and high risk women. For example, no risk assessment method accurately accounts for breast density.
Her recommendation is for women to start at age 40 with annual mammograms and continue as long as they are in good health and their life expectancy is 10 years or longer.