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PAUL A. GOLDBERG, M.P.H., D.C., D.A.C.B.N. Infinite Variety: An Introduction To Biochemical Individuality (Part III)

Home Dr. Paul Goldberg Patient Letters Works published PAUL A. GOLDBERG, M.P.H., D.C. Natural Hygiene Practitioner, Professor, Educator, and Researcher NEW! Lecture INFINITE VARIETY: An Introduction To Biochemical Individuality Part I Part II   CASE STUDIES Part III Books Read excerpts from: Arthritis and Rheumatism Sufferers: The Forgotten Patients Rheumatic Disease Case Studies Fibromyalgia - Another name for Impaired Health Exploring Chronic Fatigue Syndrom Inflammatory Bowel Disease (Ulcerative Colitis/Crohn's Disease) Hygienic Heights - Your Questions Answered BOOKS Order Dr. Goldberg's books here. PATIENTS Information for first-time patients here. SITEMAP here.

THE IMPORTANCE OF THE CASE HISTORY THE "MEDICAL DIAGNOSIS" ASSESSMENT FOR BIOCHEMICAL INDIVIDUALITY BEYOND THE CASE HISTORY PHYSICAL EXAMINATION WHICH LABORATORY TESTS SHOULD BE CONSIDERED? ETIOLOGY (CAUSE) WORKING WITH THE HAND OF CARDS WE WERE DEALT "I am what I am what I am." Popeye This is the third and final part of Dr. Goldberg's series on Biochemical Individuality and the importance of understanding each client as a unique entity. In this section the tools used to identify factors that make each person unique are explored, while giving consideration to the basic commonalities humans have that need consideration in any health building regimen. A convincing way to appreciate biochemical individuality is to read any dog book which describes and illustrates different breeds from the tiny Chihuahua to the Great Dane. All domestic dogs belong to a single species, Canis familiaris. The many breeds are descended from a small subspecies of wolf, Canis lupus pallipes, which is still found from Israel to India. (1) Certain distinct breeds brought about by selective breeding such as the Saluki may go back as far as 8,000 years ago but this is still a minuscule amount of time relative to the history of life on earth. Selective breeding has produced a wide variation of different canine appearances, strengths, weaknesses,and personalities. It is difficult to imagine, when one compares different breeds, that all share a common ancestry. The differences in appearance are remarkable in addition to the variances in strengths and weaknesses among them. The dachshund is subject to intervertebral disc disease and diabetes, the Rhodesian Ridgeback to dermoid sinuses (cysts), the Scottish Deerhound to gastric torsion, the Chihuahua to incomplete closure of its skull, the Toy Poodle to early tooth loss, the Bulldog to heat stroke, the German Shepherd to hip dysplasia, etc. Life spans differ widely also. The Schipperke from the Flemish provinces of Belgium commonly lives to 20 years of age, while its canine cousin the Irish Wolfhound averages only about five to six years. As in humans, environmental factors e.g. diet, exercise, sleep patterns, etc., will affect the propensity of each breed to develop the weaknesses it is subject to as well as determining how long the lifespan will be, within the boundaries of its genetic inheritance. The personalities of the various breeds also differ widely. There is the affectionate, easy going, Golden Retriever to the aloof (and not too intelligent) Afghan Hound, to the lively and charming yet somewhat stubborn ShihTzu. One can predict with a fair degree of certainty what the personality strengths and weaknesses of the purebred puppy will be even before obtaining him or her. As in humans, environmental factors e.g. diet, exercise, sleep patterns, etc., will affect the propensity of each breed to develop its weaknesses as well as determining its lifespan. THE IMPORTANCE OF THE CASE HISTORY Human health care practitioners do not have an equal advantage in predicting the weaknesses and strengths of their patients as the Veterinarian has for his purebred canine patrons. (2) The case history as discussed in Part II, however, can afford much valuable information as to what is occurring with the patient. The case history includes family and occupational history, health background including diet, exercise, drug habits, sleep and rest patterns, personal/familial stressors, etc. and should be taken by the doctor, not the chiropractic assistant or nurse. Proper case history forms completed by the patient prior to the interview with the doctor allows the patient to list their symptoms, prior care, family history, etc. making the interview more fruitful. The case history has specific aspects that need to be covered but should also flow based on where the interview leads. I am sure many of our patients feel as if they are being scrutinized macroscopically and microscopically as a barrage of questions are thrown at them and they are encouraged to unfold their histories. It is important to not only hear the words the patient is saying, but also the manner in which the patient acts including body language. In many cases more will be learned by a thorough case history than by examinations, x-rays, and laboratory methods combined. It is important to not only hear the words the patient is saying, but also the manner in which the patient acts including body language. A thoroughly performed case history allows the opportunity for the doctor to: Learn the concerns of the patient. Important not only from a clinical standpoint, but also therapeutic for the patient to have the opportunity to express him or herself to a caring individual as to what is bothering them. Familiarize him or herself with the personality of the patient. It is during this initial contact between doctor and patient that the practitioner has an opportunity to learn about the patient that has the disease. Learn the family history of the patient i.e. genetic factors that may be playing a role in present or future health problems. This is the time to begin to understand what the patient's diasthesis is, i.e. what are his or her natural tendencies towards a variety of problems. This information is useful in correcting current problems as well as addressing preventive issues. Begin to identify lifestyle factors that may play a contributory role in the patient's problems. Selective questions posed to the patient and information from the patient questionnaire give insights as to habits that are contributing to current problems or might make the patient more subject to future ones. Understand the types of prior care the patient has had and the affects of that care upon the patient. Patients often present with a history of having been through a number of prior types of care including surgical procedures and the taking of a variety of drugs. These will influence their phenotype, i.e. the way their genes are expressing themselves. Develop an understanding of what radiological and/or laboratory tests would be helpful. Patients require different x-rays and br laboratory work. It is through the case history and physical examination that this can best be ascertained. Work through in his or her mind what type of corrective approach might would be best with the patient. If the case history is done in a detailed and careful manner, it allows the practitioner to begin mentally forming the care plan. During the history the doctor becomes familiar with how the patient functions or is not functioning e.g. the inflammation they suffer with, problems with hearing and vision, parameters of strength, efficiency of digestion, ability to focus and memorize, etc. Dietary habits should be reviewed as part of the case history to analyze what the patient consumes and see if there are problems with excess (more likely) deficiency (less likely), eating behaviors, and maladaptive responses to the foods that are eaten such as headaches, indigestion, etc. A computerized dietary analysis and a diet diary sheet (for one to two weeks time) are useful tools. Dietary factors contribute greatly to the patient's phenotype and therefore our understanding of the patients individuality. In many cases more will be learned by a thorough case history than by examinations, x-rays, and laboratory methods combined.

THE "MEDICAL DIAGNOSIS" As discussed in Part II, it is important that natural health care practitioners not be unduly influenced by the patients medical diagnosis, which gives only very limited insight into the patient's biochemical individuality. The medical diagnosis is generally far less important than the case history, physical examination, and radiological and/or laboratory studies. It can be difficult for doctors and patients indoctrinated by the medical model not to be overwhelmed by the medical diagnosis. Frequently a doctor of chiropractic, chiropractic student or patient asks me: What kind of a diet would you give someone with cancer? or What supplements would you give someone with lupus? or What foods are bad for someone with chronic fatigue syndrome? or What exercise plan should I give a female with hypertension? or How long should a person with multiple sclerosis fast? or What laboratory tests should be run on someone with dermatitis? Or other questions regarding how one should treat some medical entity. To answer these questions we must know the patient that has the disease name, not the disease name that has the patient. Individuality is the key beginning with our case history. It is important that natural health care practitioners not be unduly influenced by the patients medical diagnosis, which gives only very limited insight.

ASSESSMENT FOR BIOCHEMICAL INDIVIDUALITY BEYOND THE CASE HISTORY Part I of this series produced numerous inquiries as to how biochemical individuality can be assessed particularly as through laboratory testing or through a computerized program of some type. In this automated age quick and easy solutions by the use of technology have come to be expected. It is the doctor, however, his clinical experience, his willingness to devote thought and time to the case, trial and error, intuition, and hard work to uncover the cause(s) of the patient's problems, that still reign supreme today in assessing a client's individuality just as they did in the time of Hippocrates. There is no single tool that enables the practitioner to assess biochemical individuality. Observational skills and detective work are the keys. There is no single tool that enables the practitioner to assess biochemical individuality. Observational skills and detective work are the keys.

PHYSICAL EXAMINATION: ANOTHER KEY TO ASSESSING INDIVIDUALITY The physical examination should focus on both general and individual areas and not be performed in a mechanical drone like fashion. The practitioner should think and analyze and not perform the examination by rote memory. Doctors of Chiropractic know the importance of biomechanical individuality and how patients differ in this regard. They appreciate how structure determines function and thereby influences the biochemical individuality of the patient. The structural analysis therefore may play an important role in assessing factors influencing biochemical uniqueness. In addition to a general and abdominal examination, giving specific attention to stated complaint areas on all patients, I spend additional time examining the patients tongue, teeth, gums, eyes, skin, hair, scalp, and nails. These are valuable in revealing nutritional problems at an early stage and help reveal client individuality. Radiological Analysis: Determined by the case history, physical examination. and specific requirements of the Doctor of Chiropractic. Some indicators of biochemical individuality may reveal themselves in radiographic studies but not until pathological changes have occurred. Since x-rays always damage the patient through radiation exposure, their use should be as limited as possible. Laboratory Analysis: I began doing laboratory analysis while working as an associate doctor in West Virginia. I increased my knowledge in this area through independent study, hospital work, and most importantly through experience with numerous patients. I spend additional time examining the patients tongue, teeth, gums, eyes, skin, hair, scalp, and nails. These are valuable in revealing nutritional problems at an early stage.

As a Doctor of Chiropractic and Hygienic Practitioner there are three reasons for doing laboratory testing: (Note that making a "medical diagnosis" or "naming the disease" is not one of them) To assess individual biochemical traits Uncover etiological (causal) factors Monitor Patient Progress - Phenylketouria is a classical example of a genetic/biochemical trait detected through laboratory analysis. The condition represents an inability to utilize normal amounts of the essential amino acid phenylalanine. In the U.S. babies are routinely tested for this condition soon after birth through a blood sample. If the baby is positive, a diet limited in phenylalanine is constructed. Failure to do so may result in profound mental and physical retardation. - Hemochromotosis is another genetic problem identified through laboratory analysis. It causes iron to accumulate to a dangerously high level in the body. Undetected and uncontrolled, the condition can lead to death through heart failure. This genetic condition can be controlled, however, by environmental factors e.g. avoiding alcohol & rich sources of dietary iron and having the patient give blood on a regular basis. - Siderosis on the other hand, is a developmental problem presenting with the same problems as Hemochromotosis. Siderosis also results from an excess of iron, but is of environmental (dietary) origin. Removing excess iron from the diet generally resolves the situation. Failure to do so dramatically increases the risk of heart disease. Excessive dietary iron is common in the U.S. with the artificial "enriching" of processed foods and this likely plays a role in the incidence of heart disease and other health problems. Iron overload may also increase the risk of cancer. (3) The subject of iron overload serves as an example of how a single factor (iron overload) may result from genetic or environmental factors. In either case, iron levels can be evaluated through serum ferritin levels. Most Natural Practitioners using laboratory analysis have focused on the role of environmental factors in the functioning of the patient.

Medical physicians have focused much of their attention on laboratory testing in order to name a disease entity. This rarely serves of benefit to the patient, since it does not focus on cause. Doctors of Chiropractic and other Natural Health Care Practitioners will want to avoid making this error. Most Natural Practitioners using laboratory analysis have focused on the role of environmental factors, e.g. diet, emotional stress, exposure to toxic materials, digestive efficiency etc. in the functioning of the patient For analytical purposes laboratory testing can be placed in the following categories: Tests utilized to measure pathological changes, e.g. a liver biopsy. Tests utilized to measure functional efficiency e.g. a glucose tolerance test, adrenal stress test. Tests utilized to name a "disease entity", e.g. AIDS, R.A. factor, Hepatitis. Tests utilized to identify genetic factors, e.g. hemochomatosis, phenylketonuria, or blood typing. There is some overlap, but most tests fall primarily in one or two of these categories. With hundreds of different laboratory tests available, they need to be used selectively as per the patient's history and physical examination results. Laboratory testing can be an valuable tool for uncovering biochemical individuality, and serve in helping sick people get well, but requires experience, training, good judgment, and facilities for its usage. The use of laboratory testing should be avoided by any doctor who does not have the necessary interest, experience, and training. There are some doctors employing laboratory testing who do not know how to select what test(s) should be used, how to interpret the results, nor (importantly) how to make application of the results to the patient's benefit. Such usage of lab testing serves to cause the patient unnecessary expense and may lead to inappropriate care programs. (4) Laboratory testing may also be employed to objectively monitor patient progress to determine if the care program employed is benefiting the patient or needs to be altered. In this sense laboratory testing is equally useful whether one is a Doctor of Chiropractic or an Allopathic, Osteopathic or Naturopathic Physician. The use of laboratory testing should be avoided by any doctor who does not have the necessary interest, experience, and training

WHICH LABORATORY TESTS SHOULD BE CONSIDERED? This will vary from patient to patient based on the case history, examination, objectives of the patient, and expertise of the doctor. In seeking out the core parameters of health reflecting both a measure of genetic and developmental factors, I have found the following tests to be most widely applicable. The goal is to assess fundamental aspects of the patients makeup and reveal key factors that can be modified by environmental factors. Examples of basic tests that look at core parameters while helping uncover biochemical individuality include: Basic Blood Chemistry: Covers essentials such as blood glucose and electrolytes, and reflects basic liver and kidney function. Blood Count with Differential: White and red blood cell counts along with hemoglobin, hematocrit, platelet count, and white blood cell count differential. May reveal genetic as well as functional problems e.g. anemia due to internal bleeding, parasites, malabsorption, dietary deficiency, infection, poor clotting ability, allergic tendencies, etc. Total Cholesterol: Reflective of both genetic individuality and environmental factors. Triglycerides: Reflective of genetic variability, stress patterns, carbohydrate intake, other dietary factors, and insulin resistance. Homocysteine: An amino acid reflective of genetic and environmental factors. Important to look at in regards to cardiovascular disease risk factors. Proper levels depend on adequate levels of folic acid, B6, B12, and magnesium. Some people appear to have a genetic tendency for poor homocysteine metabolism allowing its buildup in the blood leading to damage to the lining of blood vessels and resultant atherosclerotic plaque. (5) Glucose Tolerance Test: Reflective of both genetic and environmental factors in the control of blood glucose. Amino Acid Analysis: Reflects dietary intake, special needs for individual amino acids, and the bodys ability to break down proteins. Lipoprotein (a) : A carrier molecule. Elevated levels believed to increase risk of heart attack. A strong genetic tendency may pass from parent to child to make too much Lp(a). Lifestyle (environmental) factors can be employed in such individuals to reduce risk such as lowering triglyceride levels, stabilizing blood sugar levels, proper exercise, rest, and sleep, etc. Tests For Insulin Sensitivity: Insulin is a fundamental hormone of the body and is reflective of many parameters of health and disease. It is affected by a combination of genetic and environmental factors. There are several tests that have been used to measure insulin sensitivity/insulin resistance including taking a fasting insulin level, a two hour post glucose insulin evaluation, and the insulin challenge test. Insulin resistance is significantly affected by environmental factors such as caloric and carbohydrate intake, stress levels, activity levels, and dietary fat components. Our choice of foods is an individual matter and dietary choices should be based on individual characteristics, not simply that a food is "good or bad".

The utility of doing blood typing is a common question doctors and patients have, particularly since the publication of the book Eat Right for Your Type by Peter D'Adamo, N.D. The book has been more enthusiastically received by the public at large (perhaps due to the simplicity that his approach entails) than by health professionals or researchers. The book makes the point that our choice of foods is an individual matter and that dietary choices should be based on individual characteristics, not simply that a food is "good or bad". There are a number of characteristics about our blood types that have been well established e.g. people with blood type O being more prone to peptic ulcers. Dr. Adamo's thesis is that each blood type has blood group antigens that will react more strongly with specific food substances, in particular certain lectins (6) found in foods. Dr. Jeffrey Bland comments on this relationship:   "Lectins, which are found in the seeds of various plants, have a chemical personality similar to the blood group antigens. In a sense, specific plant lectins can cross react with the A or B antigens that line the digestive tract. The result can be specific, genetically linked food sensitivities that increase the probability of adherence of an infectious bacterium to the digestive lining, creating infection or amplifying an immune reaction that can result in digestive inflammation and generalized inflammation throughout the body. It seems surprising that principles such as lectins in foods can communicate through the cell surface antigens on the digestive tract to the body's immune system and to hormones such as insulin, thus regulating overall body function and the risk of disease. But results of research that have accumulated during the last 40 years have continued to support this association." (7) The potential role of certain plant lectins creating significant problems for a person based on their particular blood type again reinforces Dr. Roger Williams concept of biochemical individuality and the need to avoid any single health/nutritional plan or program which trys to be all things to all people. There are certain natural, hygienic, rules which have general applicability to all of us as human beings, but hard and fast rules regarding what each person should eat dangerously ignores our genetic as well as developmental differences. We cannot afford to give out dietary programs wholesale that are "good for everybody" simply because they are "high in protein" or "vegetarian" or "low fat" or for any other single factor. A range of variables must be considered based on individual requirements. There are numerous other laboratory tests that can be employed selectively with patients to reveal genetic characteristics, digestive efficiency, toxicity, and other parameters. Most important is that the results of the test will be useful to the client, i.e. that the results can be employed to make positive changes. It makes little sense to run a laboratory test which, if positive, simply gives additional reasons to eliminate alcohol, refined carbohydrates, stop smoking, etc. We already know that the patient should stop doing those things. The more experienced a practitioner becomes, generally the more selective he or she becomes in doing laboratory testing. There are tests I ran fairly frequently in the past that I now do rarely. Experience has allowed me to accurately predict the results of some tests based on patient history and examination, so performing the test would be superfluous. Laboratory tests rarely, by themselves, give us "the answer" but they can provide a valuable additional method of assessing biochemical status and provide a way with which to monitor progress over time. Appropriately conducted and interpreted they can contribute clues as to what steps need to be taken to optimize the patients health. (8) The more experienced a practitioner becomes, generally the more selective he or she becomes in doing laboratory testing. ETIOLOGY One of the things I have appreciated most about my training and involvement in Natural Hygiene and Public Health has been the emphasis in both fields on etiology i.e. cause. What are the root causes of a person's problems that produce the symptoms manifested? Generally there are multiple factors at play in a client's disease emanating from both genetic and environmental factors. It is the role of being a detective that can make a practitioner's job most challenging and exciting. It is the role of being a detective that can make a practitioner's job most challenging and exciting.

WORKING WITH THE HAND OF CARDS WE WERE DEALT Understanding our genetics and how the environment allows genes to be expressed is to become better able to maximize our potential. An understanding of genetics also produces an appreciation of our different potentials. It was difficult to do, but by seventeen years of age, having reached only five feet four inches tall, and 120 lbs., I reluctantly gave up all hopes of ever being a professional television wrestler, although my "cousin" (Bill) Goldberg has clearly done quite well, but his genetics were slightly different than my own. I came to realize that despite a rigorous schedule of weight lifting, bicycling, and swimming, that there was only so far I could go in building muscle mass and strength. Born a "runt" with certain genetic weaknesses, I had to learn to live within certain runt limitations. I have tried to be the best runt possible. Nonetheless, a Chihuahua, no matter what he does, is not going to become a Great Dane. I have learned the hard way that if one pushes oneself beyond one's genetic boundaries that there can be a serious price to pay in terms of ill health. We must do the best we can with the hand of cards we were dealt. We can capitalize on our genetic strengths and minimize our genetic weaknesses by employing every environmental advantage possible. Understanding our Biochemical Individuality and fostering our possibilities through the application of Natural Hygienic Principles, allows each of us to work towards our own greatest potential. I have learned the hard way that if one pushes oneself beyond one's genetic boundaries that there can be a serious price to pay in terms of ill health. REFERENCES 1 Harpers Illustrated Handbook of Dogs Roger Caras editor, pg.10, published 1985 2 There are some clues, however, we can obtain from ethnic and racial characteristics e.g. sickle cell anemia in black individuals. 3 R.G. Stevens et. al., "Body Iron Stores and the risk of Cancer," New England Journal of Medicine 319. no.16 (1988): 1047-1052 4 Doctors of Chiropractic should check their state regulations as to the legalities of laboratory testing by Chiropractors in their state. The laws in this regard differ tremendously state to state. 5 K.S. McCully, The Homocysteine Revolution: Medicine for the New Millenium. New Canaan, Conn: Keasts Publishing 1997 6 Lectins are proteins found mostly in plant seeds e.g. beans and lentils, which tend to bind to the receptor sites of the surface of cells. 7 Bland, Jeffrey S.: Genetic Nutritioneering. pps 72-73. Keats Publishing 1999 8 Note: Over the past twenty years a number of functional laboratories catering to natural health practitioners have arisen. In seeking doctor patronage, seminars are given that encourage routine usage of their testing procedures. Much of the information presented may be of value. Nonetheless, the lecturers represent the laboratorys interests and the momentum of the presentation is towards the doctor attendees employing testing from that specific laboratory (or allied supplement companies). I do not fault the laboratories for promoting their services. I am concerned, however, at the influence some of the metabolic laboratories are having with State Chiropractic Organizations throughout the country who are featuring presentations by these laboratories at continuing education seminars. This limits the objectivity of the information that professionals receive in a forum (post graduate - continuing education seminars hosted by State Chiropractic Organizations) that should be non-biased and objective. Decisions by the doctor regarding the employment of laboratory studies should be based on objective data, not by presentations by laboratory representatives.

For Infinite Variety: An Introduction To Biochemical Individuality - PART I click here

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