Lecture (Part VIII) by Jeffrey Bland, PhD (recorded July 9, 2009) on clinical nutrition and clinical practice. Bland emphasizes the centrality of human pattern recognition and observational skills (examining tongue, nails, skin to form diagnostic hypotheses), the primacy of food/diet before relying on supplements, guidance on safe/effective nutrient dosing citing established ranges (mentions John Hathcock and Council for Responsible Nutrition), and practical treatment timelines (states fundamental biochemical change often requires ~12 weeks). He also critiques the U.S. healthcare model for being economically unsustainable and not reducing disease burden, arguing that economics and dissemination — not lack of research — will drive change.
Questions this video answers
July 9, 2009
About 12 weeks (three months)
John Hathcock (and the Council for Responsible Nutrition guidelines)
He states the U.S. spends ~37% more per capita on healthcare than any country and ranks 35th in health outcomes (reference to WHO-based comparison).
Chapters
This is what good clinicians in this field do. It separates the kind of hospital based dietitian, maybe from the clinical nutrition person, is that person understands those characteristics and when they sit, they're doing pattern recognition when they're looking at that patient and they're making all these observations. This is the wisdom of this field. That's why we call it the art. Right. Of healthcare rather than the science of healthcare. Because there's still no computer that's ever been developed that can be as good as in quickly recognizing patterns as a human brain. But you have to know what the patterns are. It's like garbage in, garbage out. So you have to have a good pattern recognition system, which is the training and experience you have asking questions. So my answer is there's no lab test, there is no proteomic analysis that will ever beat this. This is, this will trump everything. And the better that you get at that, the more extraordinary miracles you will be present for. You know, I can tell you that when you get to my age, the key principle that guides me every day is I want to maximize miracles. I've already been through the training and the diligence and the speaking and the 4 million miles and all that stuff. What I want to be as present, either vicariously or directly, for as many miracles as possible. And then I want to replicate those miracles. Once you see them, then you ask, how can I make that happen in another person and another person, then they become a standard of practice. So where does that start? Really good observation. It doesn't start with a lab test. It starts with really good observation. So that to me is the core of a good nutritional curriculum, is to understand that recipe, how you make those observations. AM I okay, Mr. Shilling? Did that answer your question or did I not answer your question?
No, it did. I guess what I'm thinking is that no matter, you're looking, you're looking at the symptoms and maybe thinking back to like, say if someone has dermatitis and niacin has something to do with that, or like just making some education.
Oh, see, there you go, there you go. Now you're, now you're starting to do it. This is a whole course in logic tree analysis. So you say, ah, dermatitis. Let's see what's on my bibliography for dermatitis. And, and if you don't remember, you can now go to the computer and you can find it, right? So you'd say, let's see, it could be food allergy, or it could be essential fatty acid deficiency, or it might be magnesium deficiency, or it might be a zinc problem, or it might be related to a B vitamin insufficiency. So you start going down this list of this possibility. So you hold that. Then you look at the patient, you say, oh, gee, look at their tongue. They have a lot of fissures in their tongue and they've got. It's a smooth, low papilli with fissures. Gee whiz, that sounds like a B vitamin deficiency. Now I have a second bit of information. Then you go and you look at their fingernails and you say, my word, they've got a lot of redness in their cuticles and their nails and a lot of slumping of tissue. That's an iron and vitamin B deficiency. So they're starting to develop a pattern. Right? Each step along the way is reinforcing your hypothesis. So it's a detector story. That's what's so exciting about this field. And, and that's where this field falls short. I think many times when I teach the students out of the textbook to somehow recognize tropical diseases and vitamin deficiency, because these are the skills that you really want to know when you're going to provide service to people that are asking about their own problems. Please.
When you've summarized all of your clinical findings and you think you have narrowed down the specific nutrient or nutrients that you think could fix them, when you're dealing with these mega doses, how and when do you draw the line as far as reaching toxicity, taxing out the organs? And for how long do you go without seeing change? I mean, is there a length of time that you continue dosing them or.
Those are superb questions. Those are like three hour lectures each one of those questions. So it's all compressive. First of all, and I didn't say this and I should have to begin with, and I apologize, it should be the standard upon which all this is built. You can't do what was stated in the Life Extension book some years ago that created a big fur on the big celebrity status on the television. This is way before most of your time. There was this book in the. I think it was probably the early 80s. Pearson Shaw called Life Extension a big tome and he was very popularized on tv. He's a very good speaker and a smart guy and very kind of idiosyncratic in his dress. And so he was on one of the very popular talk shows at the time on tv. And he was saying, you can eat anything you want as long as you took the right amount of vitamins. And in his books, if you Go back and you look at this Life Extension, Sandy Shaw and Dirk Pearson's book. You'll find there's these photographs in the book of them in their house with these 50 gallon barrels of nutritional supplements. I'm serious. In which they have their hands dug in like the mother lobe. Right. And the concept was if you eat crappy, just neutralize it with these things. And so there were all these like neutralizing Life extension vitamins and it built the whole industry of. Well actually that's for life extension that the company came from. And ultimately the A4M, the American Academy of Anti Asian Medicine was kind of derived out of the Pearson and Shaw book because it was so highly popular. They sold a million copies of the hardback book in a year to show you how popular it was. Well, let me just tell you, I don't believe that's true at all. I think the proof of The Putting Nelson 20 years later is that if you look at Shaw and Pearson probably you can make your own assessment. But the bottom line is it starts with a good diet. You have to start with food. Food is where it all starts. And then you add on to that the needs that that person might have individually based upon their health history. So that's my first point. My second point relates to toxicity. Toxicity. You know there are these, what are called safe effective ranges that have been established by the Council for Responsible Nutrition and other organizations. You can go and find these. John Hathcock published these, was an ex member of the Food Nutrition Board at the usda. And these guidelines give you a fairly broad range. I mean selenium has a much more narrow range. Vitamin A has a narrow range, vitamin C has a broad range. Right. So you can use these nutrients in those ranges based on good scientific evidence in any theaters of evaluation, with impunity, with safety. And so I would say stay in those ranges. And if there are other reasons to go out then you always ask the risk benefit question. Because everything is toxic at some level, even air and water. Even love. I think you can over love a person by becoming codependent and stealing their independence. Right. So everything has a balance point and you have to kind of find where that balance point is. So that's my second concept, my third concept, the third question was really how long does it take to change in general, to change fundamental biochemistry takes 12 weeks. So all the programs we try to work with are kind of on the 12 week, three month time zone. That's not a hard and fast rule, but that's kind of a good guideline so if a patient or client doesn't give you three months of a commitment, don't even go there. If they're going to be frustrated, then you're going to be frustrated. You know, this is qualifying patients as to where they are on their locus of control model. And if they're still struggling and they're looking for a magic rescue with tomorrow's going to pull them out of the ravages of low esteem and they'll give you one day to do it. Forget it. I mean it's just going to be frustrating and they're going to come back as being a problem client later if they're invested to say I'll give you three months but I want to see results. And you say I'll provide result with the program for results. But it's going to be your program. I don't own it. You own it. You go home. This is you, not me. And you can have that alliance as working as a team. Three months is generally going to do. Other questions, please.
What do you see as the biggest challenge in getting us to remodel work and wanting us how they research need to be done or do you feel like it's the dissemination?
That's another really good question. I used to think that it was research and published papers and you know, I'm kind of a bibliophile and so I always like to shoot out an a corral. OK corral. There we go. OK corral. Utilizing references. So I've always believed that the person who has the most references wins at the end of the day. But I don't believe that that's I think now because we have more than enough references. It's not like no science. The problem really comes down to economics and the driver is going to be the change based upon the fact we can't afford this health care system we are in right now. You don't even have to have a philosophical position on this anymore. The bottom line is we're bankrupting the country with this present model and we're not reducing the burden of disease. We are not reducing the burden of disease. In fact, as you know, in 2005 this paper was published in Journal of Medicine said the children born today will be the first generation in the history of the United States whose average life expectancy will be likely less than that of their parents. Never before happened. We're spending 37% more per capita on health care than any country in the world and we are 35th in health outcomes based on the World Health Organization. Now when you put all that together, what's that say? The model is broken. So by economic reasoning alone, regardless if you're a Republican or a Democrat or Independent or a socialist or doesn't really matter when you're bankrupt, at the end of the day, you've got to make a change. So that's, I think, going to be the driver.
