Gases, Prebiotics, Probiotics and Irritable Bowel Syndrome

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This is an un-sanitary topic. Yet, for those who have an illness as irritable bowel syndrome (IBS) is a life quality issue. For the same level of colonic distension, pain and discomfort is worse for people suffering from IBS.

Lately, I started reading on prebiotics and probiotics. This led me to read on our gut microbiota. Some consider our gut micorbiota an organ. Yes, an organ that we did not learn about while in medical school.(Gibson 2004)
Above picture is for the 1908 Noble prize in medicine winner Ilya Ilych Mechnikov who started the interest in the gut microbiotia and its connection to health.
Gut microbiota is the bacteria and other micro-organisms living in our gut. Number of their cells is 10 times our cells. They are not all parasitic or pathogenic, rather most are symbiotic. They feed off of use and offer many health benefits. They even feed us. They produce short chain fatty acids that our enterocytes feed on. (Bixquert Jiménez 2009) This is an area of active research and most of the benefits are shown on animal models. For a handful of reasons (big corporations is one) I don’t see this science advancing fast enough. Having said this, there are studies on humans showing some benefits in certain disease entities.

Integrative Thinking for Preventive Medicine

It is time for a new paradigm in preventive therapy. RCTs and meta-analyses are not suited for complex interventions as primary prevention. For primary prevention we need to eat well, exercise regularly, and sleep well. I do not believe that family physicians are trained enough in these areas. More, I do not believe that the science in these areas has reached where it is supposed to be.

It is a shame that over 70 years after the death of Dr. Alexis Carrel his observation holds true till today:

Medicine is far from having decreased human sufferings as much as it endeavors to make us believe. Indeed, the number of deaths from infectious diseases has greatly diminished. But we still must die in much larger proportion from degenerative diseases.

Roger Martin the dean of Toronto’s Rotman School of Business has a suggestion that I think is worth trying in medicine. You can find his suggestion in his book ‘The Opposable Mind: How Successful Leaders Win Through Integrative Thinking’

1. Have a good stance. A stance is how we think of the word, and what we value. Thinking high of RCTs can be thought of as a stance. Refusing to accept any reductionist science to guide preventive medicine is another stance. Always being open to different ideas is another stance.

2. Use abductive reasoning along with adductive and inductive reasoning. You may need to read the book to understand abductive reasoning. My understanding is to use our current knowledge to come we with new and imaginative solutions. Abductive reasoning is imagining the possible.

Therapeutics Education Collaboration: a Must Listen to Podcast for Any Family Physician

If you are family physicians you must listen to the therapeutics education collaboration podcast. This podcast in excellent to perfect on all dimensions:
The presented information, the show notes, the style and the audio qualtiy. Superingly, many podcast don't even come close to this quality.

The two primary hosts are a pharmacist Prof. James McCormack and family physicians Dr. Michael Allan.
I will leave you with this you-tube video for Prof. James McCormack

Blind Men and an Elephant: are Drug Preventive Strategies Missing the Elephant?

You probably know the blind men and an elephant fable. If not this is a Jain version of it:

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Six blind men were asked to determine what an elephant looked like by feeling different parts of the elephant's body. The blind man who feels a leg says the elephant is like a pillar; the one who feels the tail says the elephant is like a rope; the one who feels the trunk says the elephant is like a tree branch; the one who feels the ear says the elephant is like a hand fan; the one who feels the belly says the elephant is like a wall; and the one who feels the tusk says the elephant is like a solid pipe.

Wikipedia

Each of these six men is correct. Yet, their conclusions are useless to say the least.

The question I would like to raise: are preventive treatments using drugs as aspirin, statins, warfarin, and ACE inhibitors missing the elephant?

These blind men are one tool of perception: vision. Scientists use different tools to perceive reality. These tools evolve. Nowadays, we have electron microscope and PCR. Before using these tools scientist were blind to existing facts. This fable shows that being a 100% correct does not assure understanding reality. The outcome of randomized controlled trials can be 100% correct and still derail us from reality.

If you have read some of my previous post, you probably know where I am going with this. This is another criticism to using reductionist science in preventive science.

Researchers as Weston A. Price and Daphne Miller noticed the dramatic preventive effect of particular diets. Price went further in connecting the quality of the soil to the quality of fruit, vegetables, milk, and meat. To understand reality we must always consider the possibility of the presence of a striking reality that our perception is not to seeing. This strategy should prevent overplaying findings, as overplaying the effect of saturated fat on heart disease.

Miller, D., 2008. The Jungle Effect: A Doctor Discovers the Healthiest Diets from Around the World--Why They Work and How to Bring Them Home, William Morrow.

Price, W.A., 2008. Nutrition and Physical Degeneration 8th ed., Price Pottenger Nutrition.

Scientific Writing Style Should not be Hypnotizing

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Scientific articles writing style tires to emphasize the presented data and not the presenter of the data. This requires a peculiar writing style known to those who read scientific articles. One rule is never to use the first person.

This style is supposed to aid in the impartiality of presented data. However, this writing style is exploited. Drug companies study how to present data to clinicians in ways that would support drug companies interests. More, everyone, including scientific papers' writers, is biased. In complying with scientific writing, this bias is purposely hidden.

Any reader needs to judge the accuracy and usefulness of what he or she reads. So why no ease up the rules of scientific writings and allow for enjoyable reads?

An Old Known Fact: Degenerative Diseases are Increasing

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Medicine is far from having decreased human sufferings as much as it endeavors to make us believe. Indeed, the number of deaths form infectious diseases has greatly diminished. But we still must die in much larger proportion from degenerative diseases.

Alexis Carrel, 1873-1944

I started reading the 1939 published book: Nutrition and Physical Degeneration by Weston Price. Price is a Canadian born American dentist, who closed his practice and travelled the world in search for the reasons of rocketing dental degenerative diseases. His book details the findings of his research.

Alexis Carrel is the 1912 Nobel prize winner in physiology or medicine.

A Welldell Berry Quote Against Reductionism

Here is the quote without any commnets:

Reductionism (ultimately, the empirical explanability of everything and a cornerstone of science), has uses that are appropriate, and it also can be used inappropriately. It is appropriately used as a way (one way) of understanding what is empirically known or empirically knowable. When it becomes merely an intellectual "position" confronting what is not empirically known or knowable, then it becomes very quickly absurd, and also grossly desensitizing and false.