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Gaby's Nutritional Medicine, 2nd Edition, Brims with Clinical Pearls

By Kristen Schepker, Assistant Editor

In today's era of disposable digital media and ephemeral "alternative facts", there's something reassuring about a good old fashioned medical textbook---especially one as thorough and carefully referenced as the new second edition of Dr. Alan Gaby's landmark work, Nutritional Medicine.

Tackling the "Seven Deadly Toxins"

By Kristen Schepker, Assistant Editor

A number of pervasive toxins -- seven, to be exact -- are wreaking daily havoc on health and wellbeing, according to detox expert Deanna Minich, PhD.

"We are living in a sick, toxic world," Minich said at the recent Clinical and Scientific Insights (CASI) conference sponsored by Designs for Health in San Francisco. She discussed her unique holistic approach to detoxification.

Minich, a faculty member of the Institute for Functional Medicine, is a nutrition researcher, clinician, and author of the book Whole Detox.  She holds that effective detoxification programs need to address much more than just diet alone. To successfully clear the body of toxins, it is essential to consider the whole spectrum of toxic elements to which an individual patient is exposed. This includes factors that negatively affect the the mind and spirit.

Deanna MinichThroughout human history and across the globe, we find examples of specific practices aimed at cleansing and purifying the body, but also for clearing the mind and heart. These include salt baths and saunas, fasting regimens, and even more extreme interventions like bloodletting. The point here is that medical traditions in all times and places have understood that people have a need for periodic cleansing activities.

Our present-day infatuation with detox diets and juice cleanses shows that we still share this urge today. And while many who cleanse certainly notice positive physical changes, they often report other less tangible benefits like achieving a clear state of mind or a sense of feeling centered and grounded.

Minich outlined what she defines as the "Seven Deadly Toxins," a constellation of destructive forces that profoundly heighten toxic load. Describing their myriad impacts on human health and wellbeing, she offered practical detox strategies to target each one and support healing throughout all the body's systems.


Like many other detox experts, Minich focuses first on food. Our highly processed modern food supply is rife with agricultural chemicals, industrial byproducts, heavy metals, and other toxins that present serious health risks. To identify and avoid the main sources of food-based toxins, patients must first learn how food is produced, packaged, and distributed.

Each year, the average human consumes around 2,000 pounds of food. Unfortunately, there area fair number of toxins in among the nutrients. 

The Natural Resources Defense Council reports that over 80,000 different synthetic man-made chemicals are currently in use in the United States. Those thousands of substances lurk not just in the diet but in countless everyday items, from cosmetics and household cleaners to furniture and even toys. Over 2,000 new substances are added to the chemical index each year, Minich noted.

These numbers capture just the substances that scientists presently know about. They do not include chemicals that researchers have not yet catalogued, or toxic metabolites of known compounds that only appear once those compounds are ingested.

The average human adult human body contains over 7,000 different chemicals, approximately 200 of which are already present in the blood at birth. 

Some food-borne chemicals have direct negative effects on the neurological and endocrine systems, and epidemiological studies show associations between environmental toxins and increasing rates of food intolerance, escalating cancer rates, and rising autoimmunity diagnoses (see Death & Toxins: Tackling the Main Drivers of Chronic Disease).

Some foods are more likely than others to contain toxic chemical residues, and understanding how food is made helps to inform safer, healthier dietary choices. On a more philosophical level, Minish added, failing to recognize where food comes from leads to spiritual fragmentation, separating us from the earth that provides our nourishment.

Understanding the intricate link between human health and the health of the planet is an equally important step in the cleansing process. It is difficult for us to achieve collective wellness without a healthy Earth -- and today, the planet's health status is far from optimal.

"If the planet were a person or a patient, we'd say she is out of balance, toxic, inflamed, and most of all, she's really distressed," Minich said. "Our air, food and water -- our most basic elements of survival -- are now in jeopardy."

To reduce toxic exposure,  Minich recommends eating a colorful diet rich in phytonutrients and whole, unprocessed, organic foods. She also stresses the importance of developing a healthy, constructive emotional relationship with food.

Emotional Baggage

Enjoyment of food comes easier to some personality types than others. A host of negative emotions and conditions can block one's ability to enjoy the simple process of preparing and eating food. For some people, guilt or shame around dietary choices can be major obstacles. In other cases, people may be struggling with serious eating disorders. 

Emotional baggage connected with food is a major health stressor, Minich said, which is why it also appears on her list of deadly toxins.

Whether associated with food or any other element in our lives, unprocessed negative emotions cloud our ability to live as fully and vibrantly as possible. Helping people "detox" requires clinicians to develop a lexicon for talking with patients about emotions, and aiding them in identifing and expressing what they are feeling.

Although it's common to extol the physical benefits detoxing, Minich asserted that, "Detox is a unique interface of medicine and spirituality."

When intentionally addressing both emotional and physical wellbeing, detox is a powerfully cathartic process -- and is not one to be entered lightly. Emotional cleansing can take a long time and require support, Minich counseled. "The longest distance a human travels in the lifetime is 18 inches," she said, defining the short but complex seperation between our heads and our hearts.

Undertaking that lengthy journey with purpose, awareness, and guidance from trained professionals prompts profound detoxifying benefits beyond what can be obtained with dietary changes alone.

Negative Thinking

Similarly to emotional baggage, negative thinking is a toxic health risk. Of the 60-80,000 different thoughts we think in a given day, most of which are reccurring, the majority are also negative, Minich said. All too often, she declared, "we feed ourselves with negative programming."

The scientific literature on negative thought patterns illustrates the health dangers of chronic pessimism: premature aging, inflammation, and stress. Because bad attitudes can deter wellness, it is as important that patients learn to identify and distance themselves from their pessimistic thoughts as it is for them to learn to read food labels.

Minich believes that every thought we think has the capacity to either boost us up or deplete us. It is essential that we ask ourselves which thoughts are draining our vital energy rather than replenishing it.


Minich's fourth deadly toxin is failure to move the body. "We're becoming more toxic because we're sedentary," she argued. Breathing, sweating, and oxygenating the blood through movement are all fundamental pieces of the detox puzzle.

Vigorous rhythmic movement also promotes neuronal plasticity, supports healthy aging, and stimulates a fluid, dynamic emotional flow.

In a study of prostate cancer patients receiving androgen-deprivation therapy (ADT), researchers found that supervised aerobic and resistance exercise not only significantly reduced treatment-related toxicity, but also improved social functioning and mental health (Cormie, P. et al. Brit J Urol Int. 2015; 115(2): 256–266).

For chronic disease patients and healthy individuals alike, moving the body is paramount to the detoxification process. To develop sustainable exercise habits, Minich asks patients what they love to do, crafting movement plans based around activities they find pleasurable. Whatever form exercise takes, if it's not enjoyable, it is not likely to last long.

Not Speaking Truth

When detoxing, honesty is the best policy -- though perhaps the least intuitive of Minich's recommendations for toxin removal.

In the Ayurvedic healing tradition, the mouth represents a source of authenticity, awareness, and personal choice. Like the food we put into our mouths, the words that come out of them hold tremendous power. Speech has its own form of gluttony: some people speak, lie, brag, or swear too much, which not only negatively affects others but also disrupts metabolism, chewing mechanics, and other sensory experiences like smelling and hearing.

Individuals who overspeak often do so because they have difficulty hearing and believing themselves. They benefit from learning to hear and harness their own voice, Minich suggested.

On the other hand, some individuals tend to remain silent when it would better serve them to speak up---a form of self-expression anorexia.

To prevent the buildup of toxic thoughts and emotions, it is helpful to guide quieter patients to learn to express themselves and share their vital truths. For those who struggle to speak out, Minich recommends the use of positive affirmations to develop a strong, loving voice.

Poor Sleep

Poor sleep is the sixth of Minich's deadly toxins. Many toxic substances are eliminated during sleep. At the same time, buildup of toxins can often disrupt sleep or degrade the quality of slee-, creating a negative feed-forward cycle.

Dreams are another important  facet of sleep. According to Minich, dreaming represents a potent form of detoxification, providing us with messages that offer insights into elements in our lives that require attention. But most people only sleep for four or five hours a night, challenging their ability to clearly remember their dreams. Deep, adequate sleep that fuels dreaming and restores the body is crucial for detoxification.

For patients with difficulty sleeping, Minich recommends visualizations and guided imagery to encourage a "best self" view and to achieve a higher quality of rest. She believes that an ability to visualize what we want to manifest in our lives can offer a locus of control, teaching us to "step into the driver's seat of our life, harness our intellect and imagination, well it up, and bring it out."

Lack of Purpose

Lacking purpose is the final toxin on Minich's list. Inability to experience awe and joy in life, or a numbness to the absolute miracle of life will contribute to a sense of disconnection from ourselves and others. In Minich's view, these are all toxic states of mind that over time have serious negative effects on health.

In many traditional healing practices, mediation is a powerful pathway towards finding meaning in one's life. Minich encourages patients to develop meditation or prayer practices that facilitate connection to a greater sense of purpose, fulfillment, and healthful vitality.

Combining science and spirituality, Minich takes a broad scope view toward detoxification. The process involves far more than just juice-fasts or intensive supplement regimens. Deep detoxification requires attention to all the aspects that make us human.


Probiotics Have Adjunctive Role in Diabetes Care

By Lucy Karanja, PharmD, Contributing Writer

Nearly a decade ago, microbiome researchers began publishing reports suggesting that bacteria in the intestines play a role in glucose metabolism.  Recent studies support that thesis, and provide a basis for use of probiotics as adjunctive treatments for people with type 2 diabetes. 

Sulfate: A Common Nutrient Deficiency You’re Probably Ignoring

By Kristen Schepker, Assistant Editor

"Sulfate deficiency is the most common nutritional deficiency you've never heard of," says MIT Senior Research Scientist Stephanie Seneff, PhD, at the recent Clinical and Scientific Insights (CASI) conference in San Francisco.Seneff

Seneff believes that sulfate deficiency is a major culprit behind most modern chronic diseases and health conditions. But it is one that is largely overlooked.

Sulfate, comprised of the elements sulfur and oxygen is the fourth most abundant anion in our blood. It exists throughout the body in a variety of forms, filling numerous biological functions. A critical component of extracellular matrix proteins, it aids in the detoxification of drugs, food additives, and toxic metals. It also prevents blood from coagulating during transit through capillaries.

Cerebroside sulfate, an integral constituent of the myelin sheaths surrounding neuronal axons in the brain, helps to maintain optimal neurological health.

Like vitamin D--the widely recognized "sunshine vitamin"--sulfate levels depend depend on sun exposure. It is synthesized from sulfide in the skin and red blood cells via a sunlight-dependent chemical reaction.

Seneff described the skin as "a solar powered battery" that captures energy from sunshine to catalyze sulfate synthesis. The enzyme Endothelial Nitric Oxide Synthase (eNOS) "performs the magic" of turning sun energy into sulfate in the skin, she said.

Sunlight & Sulfation

In her research, Seneff identified what she describes as two critical and "mysterious" forms of sulfate: vitamin D3 sulfate and cholesterol sulfate. We simultaneously produce both molecules, which exist in the bloodstream and many other parts of the body, when we're exposed to sunlight.

Vitamin D and cholesterol share a key biochemical connection. Cholesterol, though potentially harmful in large quantities, must be present for the body to make vitamin D. Sunlight acts like a bridge between the two nutrients, as ultraviolet B rays from the sun reach the skin and activate 7-hydrocholesterol, a chemical precursor of vitamin D, converting it to vitamin D3.

While many people get their vitamin D3 from nutritional supplements, Seneff pointed to a significant difference between the type our bodies produce naturally and the kind that comes from a bottle.

In the presence of sunlight, skin cells produce vitamin D3 sulfate, a water-soluble form of the typically fat-soluble vitamin D. The sulfate form can travel freely throughout the bloodstream. But the vitamin D3 found in oral supplements is an unsulfated form  that requires low density lipoprotein (LDL) -- the so-called "bad" cholesterol -- for transport to receptor sites in the body.

It is difficult to obtain the sulfated vitamin D3  from food sources alone, heightening the importance of sun exposure to achieving a healthy vitamin D status (Nair, R. & Maseeh, A. J Pharmacol Pharmacother. 2012; 3(2): 118–126). Sun exposure is really the key.

In addition to vitamin D, many other vitamins, hormones, and neurotransmitters must be sulfated for transport in the blood. Sulfate transport, says Seneff, ranks among the most important bodily functions these various substances perform.

Mysterious Molecules

Cholesterol sulfate is another mystery molecule that Seneff believes deserves more attention from health practitioners. Scientists do not yet fully understand the many biological tasks that cholesterol sulfate carries out. Seneff views this as a problematic oversight, urging that both cholesterol and sulfate are "essential to the wellbeing of all cells."

Red blood cells produce cholesterol sulfate, which collects around the exterior of the cells and creates a negatively charged field around them. This aids their smooth passage through tiny capillaries. In essence, the negative charges prevent the cells from getting stuck to each other or to the capillary walls. Cholesterol sulfate also prevents red blood cells from rupturing, a condition known as hemolysis.

In a paper published in the journal,Theoretical Biology and Medical Modelling, Seneff and her colleagues theorized that sulfur deficiency contributes to the development of atherosclerosis, and the buildup of fats, cholesterol, and other undesirable substances in the artery walls.

Most health experts blame atherosclerosis and CVD on elevated serum LDL, low HDL, and elevated homocysteine. But Seneff and colleagues offer a different theory, one that identifies deficiencies in critical biosulfates--especially cholesterol sulfate--as a prime cause of heart disease.

She suggests that when the body is deficient in sulfates, cardiovascular plaque develops intentionally as an "alternative mechanism" to make and supply more cholesterol and sulfate to the heart. When sulfate levels are low, artery walls cannot function properly, triggering cascades that lead to plaque production and buildup.

Elevated cholesterol is commonly treated with lipid-lowering statin drugs. But Seneff's team says addressing heart disease with medications that lower cholesterol is problematic, because "the cholesterol is desperately needed to maintain blood stability."

"Endothelial cells, macrophages, and platelets collaborate to produce [cholesterol sulfate] from homocysteine and oxidized LDL," she wrote in a 2015 paper. Formation of atherosclerotic plaque is, in her view, the body's elegant way of providing itself with "a well-choreographed program for renewal of cholesterol sulfate"  in conditions where insufficient dietary sulfur and inadequate sun exposure contribute to low cholesterol sulfate levels,(Seneff, S. et al. Theor Biol Med Model. 2015; 12(1): 9). 

Seneff believes there is a link between sulfate deficiency and numerous other health conditions including autism, eczema, asthma, anemia, preeclampsia, premature birth, and digestive disorders (Seneff, S. et al. Entropy. 2012: 14(11): 2265-2290).

If her hypothesis seems like a radical departure from conventional views, that should not be surprising. Seneff is no stranger to scientific controversy.

An electrical engineer and computer scientist by training, she generated considerable consternation from some sectors of the medical world when she jumped the interdisciplinary fences and started publishing research on environmental health issues roughly a decade ago.

Her publications linking incidence of autism with exposure to the herbicide glyphosate, triggered considerable outcry from some toxicologists and medical thought leaders who argued that Seneff was playing loose and fast with epidemiological data and that her claims do not stand up to scrutiny.

For her part, Seneff has not tempered her views on the dangers of glyphosate.

Toxins Disrupt Sulfate Synthesis

Her more recent work on sulfates makes a compelling case for increasing sun exposure, and perhaps increasing dietary sulfate intake. A number of environmental and lifestyle factors make this a challenging goal to achieve.

Countless toxic chemicals in the environment -- and glyphosate is one of them -- can disrupt sulfate synthesis and sulfate transport, leading to sulfate deficiency.

In the last two decades, the use of glyphosate as an agricultural product has skyrocketed in the US and worldwide. Known as the main ingredient in Monsanto's Roundup weedkillers, glyphosate was in the spotlight two years ago when the World Health Organization defined it as a "probable human carcinogen." Last year, the WHO revised its position and downplayed the potential risk. 

But many scientists--and certainly many members of the general public--view it as a pervasive poison in our food system that increases the risk of cancer, autism, heart failure, dementia, and joint pain.

According to Seneff, the herbicide's deleterious impacts on human health can be traced to its effects on sulfate synthesis.

"Glyphosate is a trainwreck for sulfate," she said. It not only disturbs sulfate production, transport, and delivery, but causes loss of sulfate through the kidneys and urine as well. The toxin can also disrupt intestinal bacteria, triggering gut dysbiosis and leaky gut syndrome.

Furthermore, it suppress the activities of members of the cytochrome P450 (CYP) family of enzymes (Samsel, A. & Seneff, S. Entropy. 2013; 15(4): 1416-1463). 

Endothelial nitric oxide synthase (eNOS), which Seneff believes is largely responsible for catalyzing sulfate production in the body, is a CYP enzyme that is highly susceptible to damage from glyphosate and other environmental toxicants including mercury and aluminum (Seneff, S. et al. Entropy. 2012; 14(12): 2492-2530). Arsenic, cadmium, and lead also disrupt CYP enzymes (see Death & Toxins: Confronting the Main Driver of Chronic Disease).

Glyphosate can cause eNOS to malfunction, interrupting production of both sulfate and nitric oxide (NO), leading to excessive haemolysis (anaemia), vascular constriction and hypertension (Samsel, A. & Seneff, S. J Biol Phys Chem. 2016; 16(1): 9–46).

Seneff further argues that the overuse of sunscreen disrupts eNOS as well. In addition to preventing sunlight from catalyzing central chemical processes like vitamin D sulfation, high-SPF sunscreens contain aluminum, which disrupts eNOS. 

Boosting Sulfur Intake

To prevent sulfate deficiency, Seneff recommends avoiding exposure to glyphosate and other toxins that impair sulfate synthesis. Glyphosate testing has revealed residues of the herbicide in many staple foods, primarily sugar, corn, soy and wheat. Replacing conventionally grown produce with organic, non-genetically modified foods significantly lessens the likelihood of unintended toxin consumption.

Eating sulfur-rich foods is another important strategy for boosting sulfate production. Animal protein is a significant source of dietary sulfur. Other sulfur-containing foods include coconut oil, olive oil, organic pastured eggs, legumes, garlic, onions, brussels sprouts, asparagus, kale, broccoli, and wheat germ.

But as with vitamin D, the best way to enhance sulfate synthesis is to get out into the sun.. Easily accessible and entirely free of charge, sunlight is the best and simplest antidote to the problem of sulfate deficiency.


The "Wheat Zoomer"--A Game-Changer for Gluten Testing?

By Madiha Saeed, MD, Contributing Writer

A new suite of antigen tests collectively called the Wheat Zoomer is being forwarded as a definitive tool to help clinicians figure out if a patient truly is--or is not--sensitive to gluten and other grain-based proteins. Is the Zoomer all that it's cracked up to be? Experts share their views.

“Why Did We Have to Wait 35 Years?” Raphael Mechoulam on Clinical Cannabis

By Laura Lagano, Contributing Writer

Dr. Raphael Mechoulam is widely recognized as the grandfather of modern cannabis research. In the early 1960s, his team identified and isolated THC. He later discovered the endocannabinoid system in the human nervous system. In this far-ranging interview with Laura Lagano, Dr. Mechoulam--now 86 and still active--shares his thoughts on the strenghts and limits of cannabis medicine, and its implications for clinical practice, research, and public policy.

Soft Drinks Raise Uric Acid...and Gout Risk

By Megan Copeland, MS, CNS, Contributing Writer

Sugar-sweetened beverages—SSB’s as they’re known in public health circles—trigger surges in plasma uric acid levels, typically within 30-60 minutes. While these are temporary, people who drink several soft drinks every day are putting themselves at increased risk for gout.