Viva la Mitochondria!

Last week, I found myself in the swank ballroom of the Four Seasons Hotel in midtown Atlanta. Unlike the functions I attend for my government clients, this one had swag bags, free hors d'oeuvres and soft drinks, and an open bar for VIPs. It was a nice event.  But I wasn't there to soak up the atmosphere - I was there to listen and learn and to support  one of my clients, the Foundation for Mitochondrial Medicine, who sponsored the program.*  

And I'm so glad I went. The program was impressive: top researchers and clinicians from Harvard, the Mayo Clinic, Georgia State University, and private practice in Atlanta shared their research into how mitochondrial dysfunction is at the crux of the diseases and conditions they study, conditions ranging from autism to Parkinson's disease and that include muscular dystrophy, ALS, and more. The illustration above provides a graphic representation of the central role mitochondrial dysfunction plays in many common diseases. You can read more about it here.

A brief primer on mitochondria:  These organelles, found in almost every cell in our bodies, are responsible for many functions in the body and brain. Perhaps their main contribution to our health is taking chemical elements from the food we eat and the air we breathe and turning it into adenosine triphosphate, or ATP, which is the fuel on which our bodies run. But mitochondria perform other tasks in our bodies, as well: organ-specific ones, like working in the liver to detoxify ammonia that is created as a waste product of protein metabolism; or regulating calcium so that neurons can function smoothly; and even telling cells when to die, an important housekeeping tasks that ensures the availability of robust cells to take care of our bodies' business.

So when mitochondria become damaged, either through inborn genetic mutations or through environmental assaults, diseases and conditions can develop that range from moderate to severe, from feeling fatigued to being unable to breathe, move, see, or think clearly. Researchers also suspect that damage to our mitochondria are responsible for the aging process itself.

This is terribly exciting research. Importantly, this particular group of researchers is working not just on laying out how mitochondrial dysfunction results in disease, but how to fix the problems. Currently, the most helpful therapies, such as CoEnzyme Q, exercise, excellent nutrition, specific supplements, and rest are pretty basic. But that gives you an idea how important those aspects are, and how much we take them for granted in supporting our bodies' daily energy needs.

Of special interest to me is how fragile mitochondria are. Many things, including some drugs, pesticides, and other chemicals, including air pollution, can damage them. And, last I looked, we are all living in an increasingly polluted world, which might help explain why certain diseases are increasing. Excellent nutrition, therefore, offers a basic defense from the continuous assault of chemicals we all experience. And it's not just the protective nature of good foods that is important, but also recognition of the damaging aspects of bad fats and artificial additives, including the creation of free radicals when they are metabolized that can harm the delicate mitochondria.

This post is more "gee-whiz"than most of my posts, but I really think mitochondrial medicine is one of the great promises for understanding, preventing, and treating some of the most common and debilitating diseases and conditions of our time. If you look around your family tree and map out diseases and conditions in various family members (this post can help you get started), you might find patterns between the generations, one of which may be linked to mitochondria. That can give you a clue about how clean you need to make your personal environment, whether it's the foods you eat, the air you breathe, or how you control pests in your house and weeds in your yard, in order to support mitochondrial health. The evidence is strong that the combination of family genetics and one's personal environment can make the difference between good health and disease and now we're beginning to understand that high-functioning mitochondria may be one of the key sentinels standing guard over our well being. Therefore, since we can't do much about the genetic hand we are dealt, we need to be vigilant about creating personal environments that support these vital sources of energy and cellular protection.

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Did you know that mitochondria are believed to be ancient bacteria that were ingested by single-celled organisms, where they eventually created a mutually beneficial relationship by providing energy to the organism in return for a safe place to live? The enhanced energy is why organisms could evolve from one cell to many.


* disclaimer: The Foundation for Mitochondrial Medicine is one of my clients. It pays me to do scientific writing and strategic communication counseling. This blog posts represents my own opinions and not those of the Foundation. I was not asked to write this post, did not have anyone from the Foundation vet it, and take full responsibility for its content. I'm just really excited about this field of medicine.

Image from the Foundation for Mitochondrial Medicine.

Home Ec: It's Not Just for Dummies (and it never was)

Embarrassing memory: When I was in high school, I wasn't very respectful of my fellow students who took home economics ("home ec"). After all, I had places to go and I was in a hurry, and my schedule of math, science, and literature did not allow me the time to take home ec.  I'm afraid I was fairly dismissive of what was actually being taught in those classrooms on the second floor that housed stand mixers and sewing machines.

And now? Now I see what a total dummy I was.

Because all those life skills that were taught in home ec either didn't happen for me, or they happened in a haphazard, on-the-fly type of way. You know all those beautiful end-of-summer fruits and vegetables that are currently available? I can only enjoy them in season because I don't know how to preserve them with anything other than the most basic freezing techniques. Canning actually scares me - and I don't scare easily.  I know how to plan meals economically only because I watched my mom do so and I learned through trial and error once I had a family. I've never figured out a cleaning cycle that allows everything in every room in my house to be clean and tidy at the same time. I spend a fortune having my clothes altered. So, yeah, I'm afraid the home ec students are having the last laugh on me.

Of course, many of these tasks can be outsourced, which I, and many of my friends, gladly do. But hiring people costs significant money and without the basic how-to knowledge we can never really oversee the tasks we hire out. In other words, we are at the mercy of the maids, the dry cleaners, the tailors, and the local grocery stores to tell us the best way to clean a bathtub, to remove a red wine stain from an heirloom tablecloth, to hem our  pants or shorten our sleeves so that our clothes look like they were made specifically for us, or to supply a quick meal on the go. We've lost some important control in our lives by not knowing how to do basic life skills.

An interesting article in the New York Times makes the case that bringing back home ec might be good for another reason: to combat obesity. And I think it has merit.

Home ec is where individuals learn the science behind healthy eating - why fruits and vegetables and lean proteins should be the centerpieces of all meals, as well as how to shop, prepare, and store foodstuffs so that a roast chicken enjoyed for Sunday dinner becomes fajitas on Tuesday and finally soup on Friday. That's the economics part of home ec. It sounds like common sense, and it is, but only after you've learned the secrets of cooking and repurposing. Without those keys, your head may be turned by seemingly economical foods (and fake foods) that may offer immediate satiation, but can't go the distance to feed a family for three or more meals.

I come from a long line of home ec'ers. My grandmothers were masters at creating good food for their families with seasonal, local ingredients (their own!) and in preserving those ingredients so that long winters did not mean a lack of vitamins from nutritious foods. My mom,  who holds a degree in home economics/early childhood education, taught meal planning and preparation to women with low incomes and big families. Even my grandfather got involved during the Great Depression and World War II by teaching urbanites how to plant and grow gardens (Victory Gardens!). Side note: times were so difficult during the Depression that my grandfather recounted how families would eat the beans they were given to plant rather than have the patience to plant them and reap an entire crop.

So, even as our schools have become better at AP classes and IB programs, perhaps there is still room in our education system for the life skills that home ec can provide. After all, even if you don't know how to turn on your kitchen appliances, you still need to eat. Fortunately, there are online blogs and resources rushing in to fill the voids in our knowledge. These resources cover everything from tracing the source of a mildewy smell in your home to figuring out how long to cook a turkey. And Martha Stewart is perhaps the most famous home ec'er of all, creating an entire industry around the arts of home making. But you have to seek out those resources rather than have them imparted as part of a well-rounded education. Personally, I think learning the basics of real food vs processed food, how to plan and cook meals, and how to read labels may make a positive difference in addressing the growing roundness of the citizens of this country. At the least, it's food for thought about the tools we all need to live healthy, practical lives.

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Maybe it's Not All in Your Head

Para nuts, fresh from the rain forest, at the outdoor market
 in Belem, Brazil

Everyone knows that food can cause all sorts of physical effects on our bodies. Sugary desserts can cause cavities, sodas can leach calcium out of our bones, and too many carbs can make us soft and push us toward diabetes. None of that is disputed.

What is disputed, and is a topic of ongoing research, is the effect certain foods have on our mental health. There is a growing body of evidence showing that for certain individuals, some foods can cause mental fogginess, depression, anxiety, and can aggravate more severe mental issues, such as schizophrenia. The flip side to that cause and effect is that removing the offending foods may allow individuals to alleviate their symptoms and eliminate or reduce certain medications - a very promising concept.

Before I go on, a quick fact: did you know that about 10% of all adults in the United States (and about 2% of all children - yikes) have prescriptions for anti-depressants? And that number doubled between 1995 and 2005 (coinciding with the advent of direct-to-consumer advertising, by the way). So there are a lot of people out there being medicated for depression.

Let me state up front that I believe some individuals do have brain chemistries that can benefit from anti-depressants. And for those individuals, medications can be lifesaving. However, I am suspicious that 1 in 10 adults in the United States need an anti-depressant. Therefore, I do wonder if there are commonalities in our environments, like, say, an intolerance to wheat or dairy products, or an inability to process ever-increasing amounts of sugar, that affect the brains in individuals with susceptibilities to those products.

There is a lot of interest in the food/brain connection.

Recently, Alice Bradley, the talented writer of the blog Finslippy, wrote about her new diet that eliminated wheat, dairy, sugar, and grains, and focused on fruits, vegetables, and protein. After only a few weeks, she was able to wean herself off of Remeron, Klonopin, and sleep meds, retaining only her prescription for Prozac. If you Google "wheat and depression," you get 11,900,000 hits. Google sugar and depression and you get a whopping 30,600,000 hits. Part of the interest in sugar can be traced to Gary Taubes' fascinating New York Times article on the perils of sugar.

However, once you delve into the research behind the claims, you are quickly confronted with a wide divide between medical professionals who believe food intolerances can cause all sort of mental problems and those who pooh-pooh the entire concept, chalking up any gains made in mental health from altering one's diet to the placebo effect. It's confusing.

A lot of the confusion comes from the research not catching up to the anecdotal evidence. Mental health is difficult to quantify because symptoms are, for the most part, self-reported. Depression and anxiety can vary from person to person and treatment success often boils down to, "I feel fine." But the fact that the placebo effect exists tells us that there are still many mysteries in medicine that cannot be fully explained by science.

Despite the problems with quantifying mental health, there has been compelling information published on how the gut is like a "second brain," with its own nervous system operating independently of the brain. A new field, neurogastroenterology, has been proposed to better understand how the gut mediates the immune response, and there are even murmurings of psychiatry expanding to include treatment of this second brain in addition to the one the field currently focuses on. (Side note: sounds a bit like holistic medicine, no?).

Further, research on the different antibodies, IgE (immediate ones associated with hives and anaphylactic shock) versus IgG (delayed ones associated with food intolerances, a concept that current medical practice does not fully embrace), is plodding along. Fascinating stuff from an academic perspective. But frustrating when you are interested in the practical application of the information. Thus far, no one has scientifically mapped out why foods being digested in the gut can have effects on the brain. So a lot of medical professionals are skeptical of any food/brain effect link.


But I don't think you need clear-cut answers in order to move ahead with managing your health. If you are being treated for anxiety or depression you might want to talk to your doctor about trying an elimination diet to determine if some of the common allergens, such as wheat, dairy, or soy, could be underlying or contributing to your condition.  Here is information on elimination diets, and a good nutritionist can guide you through the challenges of what may at first seem to be a daunting task.

I look forward to the emerging research that will map out how our second brain interacts with our "first" brain. Until then, I think there is enough information to encourage us all to look closely at the link between our diets and our mental health.

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Orange Things

I just have to say this: I love Nicholas D. Kristoff. I really do. His efforts to raise awareness of crimes against women and girls worldwide have been heroic. And his overall work to shine a light on areas of inequity and poverty are enough to qualify him for, if not a full saint, then at least someone working his way up the rungs of the sainthood ladder. But his Thanksgiving day column that encouraged the development and use of biofortification of certain crops in developing nations gave me pause.

At first glance, one might wonder what's wrong with breeding crops to incorporate iron, zinc, Vitamin A or other important vitamins and minerals into their edible parts. After all, these substances can save vision and lives. As he noted,

"It may turn out that one of the best ways to save children's lives, or to save women in childbirth, doesn't involved doctors, but rather, high-tech seeds." 

Sounds simple, cheap, and easy, right? At the risk of being all wet-blanket-y about it, I think it sounds neither simple nor cheap and also as if it has great potential for unintended consequences.

There are two avenues of research here - conventionally bred crops produced in the public domain, and genetically modified ones developed and owned by corporations. Developing nutrient-dense crops available to anyone is a noble idea and enabling families in Africa to grow vitamin-packed orange sweet potatoes instead of the typical white sweet potatoes that they always have grown is a great idea. However, once it gets more complicated than that scenario, I have concerns.

For one thing, I have long been uncomfortable in rushing science in the name of helping impoverished countries. After all, the United States and Europe are still grappling with the role genetically-modified crops - of which many biofortified crops would be - can play in feeding their citizens, especially in light of the facts that pests are growing resistant to some of those expensive, herbicide-intensive crops and the long-term implications of ingesting those crops are not fully understood even by those who embrace them.  It also seems like bringing back the buggy whip when you consider that some of the crops that are proposed will require pesticides and herbicides, chemicals whose use citizens in the developed world are trying to minimize, due to the mounting evidence of their health and environmental hazards. So why do we think making ever-more complicated plants and encouraging their use in impoverished areas are good ideas - especially when individuals in developed countries are clamoring for simpler, organic, back-to-basics clean food? Is cast-off technology from the developed world the best we can offer to developing countries?

Some may argue that that imperfect solutions are better than nothing when the stakes are as black and white as survival versus death . There is a grain of truth to that argument, which basically falls under the heading of "don't just sit there, do something." However, we already have a perfect solution - vitamins exist in pill and powder forms and some designer waters are already enhanced with some of those vitamins. The problem is that vitamins are too expensive for many developing countries, and the logistics of getting them to every person on a regular basis can be daunting. However.

For-profit companies do just that.

Let's repeat that sentence.

For-profit companies do just that.

They just don't do it with vitamins.

But they do it with cigarettes. And they do it with soft drinks. It no longer surprises me when I see the cheery red and white of Coca-Cola products in the Amazon basin in Brazil or a kid puffing on a Marlboro in Thailand. It seems when the bottom line is at stake, human ingenuity finds ways to source components of products, assemble those products, and then figure out how to market, deliver, and sell them regardless of the challenges presented by the location. For example, by harnessing local ingenuity and providing a profit incentive, Coca Cola has mastered the logistics of getting its, shall I say,  product-of-questionable-nutritive-value into the most remote reaches of Africa. And I believe one of Coke's products is vitamin-enhanced water.

Therefore, for this particular problem, it may be better to practice what Buddhists know: "Don't just do something, sit there." Just sit there and think. Look around. Take a page from Melinda Gates' play book and learn what we can from what Coca-Cola already does.

One of the reasons I would encourage the public health world to look for a simpler solution is firsthand knowledge of how long it can take to create these complicated plants and then figuring out how much of them individuals would have to ingest in order to attain certain levels of the vitamin. Years ago, I used to manage a series of seminars for the American Cancer Society. These seminars were very high-level. The audiences were top-line national medical and scientific reporters. The presenters were the researchers who push the envelope, like the ones who brought you Gleevac, virtual colonoscopies, and basic knowledge about cancer including oncogenes and suppressor genes. The panel chairpersons were directors of national cancer centers, Nobel laureates, and Mary Lasker Award winners. The seminars were three days of intense science and emerging research.

One presentation in 1996 showcased a scientist from Roswell Park Cancer Institute who presented her research on "Transgenic Plants as a New Vaccine Source." The specific project she was working on was inserting hepatitis B antigens into bananas. Once eaten, the theory was that the antigens would effectively vaccinate the banana eaters against hepatitis B,  a leading cause of liver cancer around the world. This edible vaccine would be especially useful, the scientist postulated, in developing countries, where cost and logistics create obstacles to vaccinating the local population.

Sound familiar?

Fourteen years after that presentation, there is still no banana/hepatitis B vaccine. A quick Google search of "hepatitis vaccine banana" returned 27,000 hits, showing that research is still going strong on this concept. But still no edible vaccine.

I'm sure you can see where I'm going with this. We already have vitamins and vaccines against many diseases. What is being proposed - biofortification of existing plants to enable them to carry vitamins - is expensive research. Then, intensive education programs must be carried out so that individuals in countries that need these plants can learn how to grow, harvest, and cook them. And no one has done the research - asked the individuals who will be expected to grow these plants - if they are interested in changing their social norms to eat orange sweet potatoes instead of the white ones, or golden rice instead of white rice. And, last I checked, these plants are still in development.

So, with all due respect to the researchers and to Mr. Kristoff, I'd rather put my money on creating partnerships between the public health world and Coca-Cola or other global brands to oversee the distribution of vitamins that we already have, instead of investing a lot of money into a more complicated situation. The price seems to be a red herring at some level - after all, individuals seem to have the money to purchase Coke products, as evidenced by Mexico's astonishing 665 per capita ingestion of Coke products in 2009. Or, if you want to go further with this concept, Coca-Cola already makes VitaminWater. Couldn't the public health world work with Coke to develop a VitaminWater to deliver the key vitamins lacking in certain parts of the world?

We already have vitamins. Multi-national corporations have distribution systems and perhaps even products that can be tweaked to provide specific nutrients to children, or pregnant women, or the elderly. What seems simple to me is not the creation of complicated seeds that require costly chemicals and unpredictable weather to grow, but a linkage that would combine the best of the knowledge from the public health world and the infrastructures of big corporations in order to get those vitamins where they can do a lot of good.

PS to Mr. Kristoff. I still think you rock.

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