Archive for March, 2018

“One Small Step for Man and One Giant Leap for Microbes” a quote from Dr. Dan Handley

March 29th, 2018
F. Nicholas (Nick) Jacobs. FACHE

F. Nicholas (Nick) Jacobs. FACHE

Implementing programs in Integrative Medicine and Wellness plus Precision Medicine and Pharmacogenomics

By: Nick Jacobs

This story could easily have had several other titles including: “Our skin has as many ecosystems as the landscapes of the Americas,” but the reason I selected the moon landing one is, according to Dr. Dan Handley, our presence there didn’t just leave a footprint. There are trillions of Earthlings that took that first step on the moon. The Apollo 11 astronauts were just two out of two trillion Earth inhabitants that took that “first step for mankind.”

We always knew that our bodies had microbes, but we didn’t know that the microbes numbered in the trillions, or that we are totally dependent on them and they on us. According to Alanna Colleen, author of the book “10% Human,” “We are superorganisms of collective species living side by side and co-operatively running the body that sustains us.”

It was difficult to figure out which microbes had what functions, but a few years ago, the equipment that was invented to map genomes became available to map our microbes as well. Previously, scientists could only study what microbes they could grow in the laboratory. Most microbes won’t grow under laboratory conditions, but with gene sequencing equipment, we can directly sequence the genomes of these microbes. We can discern what microscopic life lives on us and within us. And microbes outnumber our own cells at least 5 to 1, and their genes outnumber ours about 100 to 1.

Over the years we discovered the bugs that cause smallpox, cholera, and polio. We also discovered antibiotics like penicillin, and we reduced hospital infections and deaths through medical hygiene. Now that we can analyze these microbes, the scientific world is in a gold rush to understand the role these microbes play in both disease and health. Most of the microbes that inhabit us are either completely benign, or essential to our health. These microbes do many positive things including producing essential vitamins and bolstering our immune systems.

We have already discovered there are very specific links between the types of microbes that inhabit our bodies and autism, obesity, asthma, autoimmune diseases such as Type 1 diabetes, multiple sclerosis, irritable bowel syndrome, and eczema, as well as nut and wheat allergies and a myriad other 21st century ailments.

We also know that, because our intestinal tract is only one cell thick, it can leak, become distended and bloated. It also appears that our bodies, due to a lack of infectious diseases, may have begun to turn on themselves.

Microbes can also impact our psychological health and moods. For example, Whipple’s disease, caused by the bacterium Tropheryma Whipple, causes aggression, lack of communication and loss of certain inhibitions. We also know that gastrointestinal symptoms are surprisingly common in people with mental and neurological conditions.

Cats can carry a parasite called Toxoplasma gondii, and humans can be infected from their litter boxes or from a scratch. When a man is infected, he becomes less pleasant and more aggressive, disregards societal rules, becomes suspicious, jealous and insecure. Women, on the other hand, become more easy-going, warm-hearted, and trusting. Being infected by this microbe makes you three or four times more likely to have an automobile accident.

Many of us have had loved ones who developed something called Clostridium difficile or C.diff. When a patient receives too many very strong antibiotics, the good bacteria in our intestines are killed, allowing these marauders to take over. C. diff infections are serious and can be life-threatening. Current research has shown that a patient’s ecosystem can, however, be restored, with a transplant of microbes from a healthy donor. The unfortunate name for this is a fecal microbial transplant, where a donor’s stool is liquefied and placed into the recipient’s intestines. It’s a virtual microbial miracle, and the trillions of microbes that help sustain our lives can get back to work doing just that.

Microbes don’t live in us, we live in them


Become compassionate caregivers

March 8th, 2018
Last week it was my privilege once again to attend the Lake Nona Impact Forum. One of the most important sessions was a panel discussion by some of the top thought-leaders in the medical community on the opioid addiction crisis. Speaking on this panel moderated by Dr. Sanjay Gupta were people such as Dr. Toby Cosgrove, former CEO of the Cleveland Clinic; Tim Ryan, Ohio Congressman; and Dr. Tom Mayer, Medical Director of the NFL Players Association.

Earlier in the week, Dr. David Nicholson, former Chief Executive of the National Health Service in England, and Dr. Mark Britnell, Chairman and Partner of Global Health Practice for the accounting firm KPMG, referred to the opioid crisis in the United States as a blight on our country.

What did we learn? Although we have about 4.4 percent of the world’s population, we’re consuming 80 percent or more of the world’s opioid production.

Opioid addiction is the leading cause of accidental death in the United States. From 2001 until now, opioids have produced over a trillion dollars in losses to the American economy. But money isn’t everything, or is it?

The panel agreed that the manufacturing, marketing, and distribution of these opioid products was in part attributable to pharmaceutical and distribution companies misleading the physicians and patients regarding the addictive nature of these drugs.

When OxyContin was introduced, the marketing line was, “OxyCotin is safe and controlled pain relief all day and all night.” One of the speakers pointed out that the only word in that sentence that was true was the word and.

Of course, there was some casual culpability placed on pain control requirement guidelines, compounded by the emphasis placed on the reimbursable HCAHPS scores that impact health systems and physicians financially.

We do know that 80 percent of the individuals using heroin today started with prescription drugs. I spoke with a pharmacist last week who confirmed to me that they are selling far fewer opioid prescriptions but can’t keep hypodermic needles in stock.

One sad fact that has come out of this epidemic is that only one in 10 addicted individuals seek treatment, and this is primarily because of the shame inflicted upon the users by our society. Rather than seeing addiction as a sickness, the media, and we individually, continue to portray these addicts as sub-quality human beings.

Numerous steps can be taken to help control the national tragedy, many of which were delineated during the discussion. We can, of course, stop stigmatizing the individuals who have become addicted. We can provide transparency through primary care, and according to Congressman Ryan, we can change the arcane Medicaid reimbursement of thirty days and you’re back on the street. This was the typical cure for alcoholics, but drug users need more time to rid their system of these killers.

Dr. Cosgrove of the Cleveland Clinic would like to see a publicly visible daily clock showing exactly how many individuals have overdosed and died each day in the United States from opioid abuse. We’re fast approaching the number of people killed in total during the Vietnam war each year with opioid deaths.

With less than 3percent of emergency room physicians prescribing opioid meds, we know there are numerous other ways to control pain, and we must educate all physicians as to what these methods can be.

Of course, this would not be a Nick Jacobs article if I didn’t endorse the use of mindfulness training, acupuncture, massage, biofeedback, osteopathic and chiropractic manipulation and several more world treatments that are not drug-based.

Final warning, in some states, even marijuana has been laced with fentanyl and carfentanil, originally a weapon of mass destruction and now used for elephant sedation. It’s 5,000 times as potent as a unit of heroin and instantly fatal.

Bottom line? Clean out your medicine cabinets and become compassionate caregivers. This must end.



March 1st, 2018

Over the past two months, I’ve become an ardent follower of National Geographic Fellow and New York Times bestselling author, Dan Buettner. He is the founder of the Blue Zones and Blue Zones, LLC. Dan has spent the last 15 years or so studying the five places in the world where people simply forget to die. They live into their late 90s and early 100s and include places like Sardinia, Italy; Loma Linda, California; Okinawa, Japan; Nicoya, Costa Rica; and Ikaria, Greece.

In his original book, Dan found that only 10 to 20 percent of longevity is dictated by genes. In those areas where people lived longer it was not because of diets, treadmills or supplements. “Long life was not something they pursued. It was something that ensued.”

These long-lived people had a great sense of purpose to their lives, were nudged into movement about every 20 minutes by their geography, were completely energized by being in what he described as “Like-tribes” that help keep people on the right track, and were facilitated by living in the right community. They lived in interconnected, mutually supportive clusters of behavior allowing them to do the right thing long enough not to get disease.

He then changed his focus slightly to attempt to determine where the happiest places were in the world. What he found might throw some of you for a loop, but for many of us, it’s that not so common, common sense that our grandparents, parents and friends have shared with us throughout our lives.

Mike Norton from Harvard asked this question on three continents: Do you think life is short and hard or long and easy? The people who selected long and easy were always happier, and they were also more civic-minded and generous. In fact, they were 40 percent happier, 30 percent more likely to vote, and 60 percent more likely to donate money. So when you have your next fundraising event, invite only generous, civic-minded, happy people.

Dan Buettner worked with Google, Gallup and the University of Pennsylvania and discovered that the 50 billion Google searches they analyzed were more predictive of happiness than either age or income. They found, for example, that people who own dogs are happier than people who own cats. People who like action movies or comedies are happier than those looking for romance movies.

From his world studies, he found that gender equality is important. In fact, it makes the men happier when women are treated equally. (Read that again, guys.) Education for both men and women is an important key to happiness, not Ph.D education, but at least a high school education because educated girls become educated mothers and produce better everything.

They found that healthcare–not America’s sick care, but genuine health care which includes prevention and wellness–is a great predictor of happiness, and countries where there is complete healthcare equality is where the happiest people live.

Happy people place their values on family, some type of belief system, face to face conversations, walking to the church, market and friends’ homes, laughter, and seven hours of sleep a day. They also take all their vacation days, try new things and have some type of intimate relations at least twice a week.

So, own a dog, socialize, stay married if you can, pick a job you love over money, give something back, and most importantly, pick where you live because that is the single most important happiness indicator. If you live in an unhappy place and move to a happy one, you will be exponentially happier within a year.

He also recommends meditation, financial security over consumption, big windows for lots of light, a front porch, and having a best friend at work. Armando Fuentes said, “Eat without gluttony, drink without drunkenness, love without jealousy, argue but don’t go to bed mad, and occasionally, with great discretion, misbehave.”

Check off your happiness boxes, and make some changes.