Nutritional Medicine 
                                                           written for the Nutritional Therapist, June 2011

I squandered four of the rare sunny days we had this spring in the PNW, attending a conference put on by Dr. Jonathan Wright (famous among NTPs for his excellent book Why Stomach Acid is Good For You) and Dr. Allan Gaby (perhaps not yet as famous among NTPs, but certaily deserves to become so).  It turns out to have been a well spent four days. With thirty years or more of practicing nutritional medicine under each of their belts, and prodigious memories for details, they spoke with respectable authority about the effects of a wide range of natural therapeutic agents and the ways that they can promote health. What I found particularly appealing about the way the seminar was presented is that each piece of information offered was backed up by detailed clinical experience and an extensive collection of research studies. Occasionally they would interpret the studies differently from each other and it was fun to hear their process of debating the points. Rather than offering a set of lecture slides, they provided attendees with two books where the material was organized with index and chapters. It was a great way to retain the subject matter where you could write notes of the anecdotes and specific points they mentioned right in the book and have all the material easily retrievable by index or table of contents when you review the seminar. 

Even better than the booklets provided at the conference was a heavy tome written by Dr Gaby with the same title as the seminar: Nutritional Medicine. Purchasing this book was another splurge this spring which turns out to have been well worth while. I find this book to be a valuable asset in a couple of ways, first in finding my way in the controversies of modern healthcare, and second in providing specific suggestions of dietary and supplemental ways to support different conditions. 

Although the gain in percentage of the market share by alternative health modalities indicates a shift in consumer preference, conventional medicine is still the predominant medical model in our culture.  As nutritional therapists, it behooves us to be conversant with the logic of these different perspectives. Dr Alan Gaby’s conventional training and decades of practice and review of the medical literature qualifies him as useful guide in this endeavor While in college Dr Gaby became interested in the possibility that dietary modification, nutritional supplements and other natural remedies might provide the basis for a healing approach that was safer, less expensive and potentially more effective than the conventional approach of drugs and surgery. Since completing his medical training in 1980, he has spent one third of his time seeing patients and two thirds of his time collecting and analyzing tens of thousands of studies that relate to nutritional medicine.  He looked through the entire table of contents of fifty major medical journals. In his forward Dr Wright tells that Dr Gaby spent more time researching the literature than anyone he, Dr Wright, has known. What dedication and what a treasure trove of information he came up with. At 1300 pages it is not the kind of book one is likely to sit down and read from cover to cover, but to break open when questions arise from client interactions or readings.

For example, this morning when talking to my husband, the inveterate skeptic, about what to do about the terrible road rash and bruising he had received from a bicycle accident, I gave him the talk that we had learned in our NTA classes about how proteolytic enzymes help with recovery from wounds and then opened Gaby’s book to the section about “Soft Tissue Injuries”.  There I found, among other material, a study comparing the recovery of seventy four boxers given proteolytic enzymes with seventy two who were given a placebo. The improved recovery rate with the enzymes was dramatic. Where would we be without boxers anyway? So willing to be bruised! And how helpful to have a source which will back up our understandings so aptly.

In his years of practice, Gaby has found that four overlapping disorders frequently play an important role in a number of chronic health conditions: hypoglycemia, food allergies, hypothyroidism and Candida. The book starts out with a section called the Fundamentals of Nutritional Medicine where he looks at these four elements and the fundamentals of diet, the effects of food additives and high fructose and favorable ways to cook and store foods. His views on these topics are similar to those we have been taught at Nutritional Therapy Association. The depth of his research allows him to backup each point with a reassuring amount of detail and number of related studies.

Gaby states that nutrition oriented practitioners find reactive hypoglycemia to be one of the most frequently encountered disorders and one that exhibits a diverse range of symptoms. Because many patients given a clinical diagnosis of hypoglycemia do not show abnormalities on a glucose tolerance test, the prevailing view of conventional doctors is that hypoglycemia is over diagnosed. Gaby, points out that, as these patients have a syndrome that resembles hypoglycemia and respond to treatment in the same way as those for whom the medical definition applies,   “ the use of the term reactive hypoglycemia to encompass a broader range of related but incompletely understood metabolic and endocrine disturbances is loose from an academic standpoint, but valuable from a clinical standpoint.”   Dr Jonathan Wright and Alan Gaby were the formulators of one of Biotic’s supplements for hypoglycemia that many of you are probably familiar with: Glucobalance.

Gaby has found that food allergies are one of the most common causes for a wide range of health concerns. He sites one study which states that as much as 60% of the population suffers from food allergies. Conventional doctors are not convinced that hidden food allergies present a significant problem. Many doubt that it even exists and point to the fluctuation of symptoms and the possible psychological component. Proponents point out that food allergies are often difficult to identify, as the symptoms are varied and might not be immediate. In Gaby’s experience, the best way to determine a food allergy is the elimination challenge diet. He found the incidence of false positives and false negatives in the other available methods of testing for food sensitivities to be unacceptably high. It is amazing how often food allergies appear in his discussion of specific ailments.

In the thyroid section, Gaby describes what he calls “sub-laboratory” hypothyroidism, where patients exhibit symptoms of hypothyroidism which are not confirmed in lab results. His criterion for diagnosing hypothyroidism is based on a clinical history, a physical examination (including Achilles reflex  response, something that requires a lot of experience to master) and basal body temperature (an under the arm temperature upon rising, but before getting out of bed of 97.4 on average.)  He has found desiccated thyroid to be more effective for a wide range of symptoms than the conventional medical treatment, Levothyroxin (T4 ).  He offers a logical and thorough debate to the conventional medicine’s challenges to his approach. Based on his clinical experience, he feels that the conventional diagnostic approach might overlook a significant percentage of clients who might benefit from thyroid support.  Having recently read Byron Richard’s book Mastering Leptins, where he suggests that leptins are higher on the endocrine chain of command than thyroid and that an approach to treating thyroid is to address leptin dirsregulation with diet, I send Dr Gaby an email inquiring his opinion about this and he replied that his head spins when he reads about leptins.  It is reassuring that even his head still spins with the complexity of these interconnected topics, but intriguing that diet could be a useful approach to supporting thyroid. May we all live long healthy lives so we can begin to discover some of these answers in the course of our practices and in the literature of other’s work!

The book continues with a section about the beneficial effects of specific nutrients followed by the largest section, where he goes through specific illnesses and how to treat them. He describes the conventional treatment for the malady and often respectfully addresses the debate between a conventional and a nutritional approach What I found thrilling is that, although he discusses specific nutritional supplements which might be helpful for every illness, he places emphasis by starting out each item with a dietary approach: general nutritional support and food allergies.  As is his way, these writings are deeply researched.

Written and researched by a medical doctor who has chosen to take a nutritional approach to health, this book offers both an excellent way to back up our learning with research and a careful and respectful addition to the ongoing debates about the best way to help our clients in their road to health. For those of you interested in attending the seminar, I highly recommend it. For those unable to do so, the book is a great tool to have on one’s shelf. I caution that the book is quite expensive at just under $300  (http://www.doctorgaby.com/). In my own personal journey of learning it has been important to make an attempt to learn a language which can  bridge the gap between the conventional and functional views of healing and this book has been a very helpful asset.