TT with HD: Coco Newton
[Ed. note: More information on Coco's approach to clinical nutrition is available at Lifetime Nutrition]
HD: Let's climb aboard!
HD: And the first order of business, before we actually start teetering up and down is to get the standard ...
CN: ... the photo ...
HD: ... yeah, teeter tottering photo taken. [Ed. note: photography ensues]
Let's do some actual teeter tottering.
HD: Is this going to work for you?
CN: Yeah! No hands!
HD: First of all, welcome to the teeter totter.
CN: Thank you!
HD: It's not every week that you see a letter from Ann Arbor show up in the New York Times Magazine letters section. And the letter that you wrote, it was a commentary on this regular feature called Diagnosis--as best I can tell, it is a regular feature, right?
CN: Mm hmm ...
HD: ... presenting some medical puzzle, a real-life thing that someone solved. And as I recall, it had to do with some patient, whose wound was not healing properly?
HD: And the solution was, he turned out to be on mega-doses of zinc, or was it that he was not on enough zinc?
CN: Yeah, he was a guy who had a hernia repair ...
HD: ... so basically garden-variety operation?
CN: Yeah, pretty much no-brainer. And he had no healing--he would just keep coming back with infections and being sick, so he was re-hospitalized--as I recall the write-up that they did. And so months went on, and he was being worked up for various disorders, and several months later, he's in the hospital, and his wife walks in with a little brown bag and says, Here, honey, here's your vitamins. Being that they had worked him up and spent lots of money and lots of time, someone took interest in what those vitamins were. They looked at it, and it turned out that he was taking mega-doses of zinc. What had happened is that he had induced a copper deficiency by taking so much zinc, without the right ratio of zinc to copper.
HD: Did it say in the article who told him it would be a good idea to take the zinc?
CN: His surgeon initially is the one who told him to take zinc--which is not a bad idea, it is involved in wound-healing. But he wasn't given the instructions on how much to take, how often, for how long, and then what other nutrients to take along with it. There is no single nutrient that's going to do it.
HD: So this is not a situation where you have a patient who's doing something that might fall into the general category of 'alternative' medicine and sort of fails to report that. I mean, when Zach London was here--he's a neurologist over at the U of M--he was saying that a frequent issue with patients he sees is that they won't tell you everything they're doing, because they might be a little embarrassed to fess up to the fact that they're doing some kind of 'crazy' herbal thing ...
CN: ... I'm going to interrupt on that, though.
CN: I think that's the perception that the doctor typically holds. I think the perception of the patient--which is the ones I hear from--is that they don't tell their doctors, because they do not want to be invalidated for what they think they're doing correctly. And that they don't think it's crazy, but they think their doctor is going to think it's crazy, and they're not really embarrassed about what they're doing, but they don't want to involve their physician and his or her attitude. That's the issue.
HD: Yeah, I think I remember Zach saying something like, They must have had that bad experience of a physician's reaction at some time or other, or maybe if not they themselves, then maybe it's just part of the received culture of patients ...
CN: ... yes ...
HD: ... that, Yeah those doctors don't have any respect for anything except for traditional, conventional western medicine, so don't tell them.
CN: But the typical answers are, Don't take that, because it's a waste of money and you know you'll just pee it out in your urine. Or, Don't take that, because it could be dangerous, it's not protected by the FDA! So there's these black-and-white answers that most patients get, and that's really easy when you haven't studied it. Because you just give the black or the white--you don't bring new information to the patient.
HD: So do you read that regular feature, Diagnosis, as a clinical nutritionist in the same way a chess player might read the chess column, where it's a case study and as you read through it, ... ?
CN: ... yes ...
HD: ... you're thinking, Okay, so what's the answer to the puzzle? Oh, so you absolutely do?
CN: Yeah! It's like a whodunnit mystery. Do I ever really guess what's going on? Not right away, if ever, because it's such a short one-page article usually, or two-page, so you're reading so quickly that ... But they usually bring in all the answers at the end. But no, I wasn't thinking, Zinc deficiency! But also, at the very end was when they brought in the fact about the zinc, so it all wrapped up at once. But I'm always looking at what I, as a nutritionist, would want to ask.
HD: In your letter, sort of the conclusion that you suggested was couched not in terms of 'doctors should' or 'health professionals should', but rather you chose the word 'healers'. And I figured that was probably a very conscious lexical choice on your part, not random.
CN: Well, the title of the article was 'The Healing Problem'.
HD: Ah, okay.
CN: So that's what made me choose the word 'healers'.
HD: Okay, so the title was the specific reference to wound healing, okay, yeah, got it.
CN: So I just took it to the next level, and not wanting to just point a finger at a doctor. It was the healer. Doctors are healers, nutritionists are healers--if you really look at in a broad sense.
HD: So in trying to get a basic understanding of what it is that you do, it seemed to me like in a lot of cases, people come to you because they're at their wit's end? And they've sort of tried everything that conventional establishment medicine has to offer and they're taking their very last shot? Is that a fair description?
CN: How did you figure that one out? It's true.
HD: Oh, you know, I can read! Do you watch the television show, House?
HD: Basically there's a diagnosis team--they handle all the cases that no one else can figure out.
CN: Wait a minute, which one is this?
HD: It's the one with Hugh Laurie. On FOX.
CN: Okay, what kind of cases?
HD: Oh, all manner of weird stuff. Crohn's disease seems to come up quite often. They're trying to figure out if it's Crohn's disease. Is it Crohn's? No, it can't be Crohn's, because blah blah blah.
CN: Oh, I see. No, I haven't seen that. But you're right, I work with the 'walking wounded'--people who don't have a terminal illness, are able to get to their jobs, they're not disabled, they are functioning--but just barely--and suffering behind the scenes with a lot of ailments that don't get deep attention. So let's say someone is always tired, or has muscle aches, or has skin rashes, or sinus problems, or gut issues--that's a big one, from Crohn's to constipation, to everything unpleasant that can go on. I get those patients.
HD: The testimonial on the website from the national-class tri-athlete--that was basically a gut issue, right?
CN: Oh, right, on my website? Yeah.
HD: Just as a stray question, does that woman have an Australian accent?
HD: Okay. I worked at a bike shop for a little while and I think she may have come into the store a couple of times while I was working there. So I guess this just proves that Ann Arbor is just a really small town.
CN: She volunteered to put her name there. If I was going to do testimonials, I was going to do them because people said they would. I don't want J.L. or A.C. ...
HD: ... because you could just make that up.
CN: You can make anything up, and they have the right to take them down anytime if they change their mind [laugh].
HD: I followed one of the links to the USDA website with their food pyramid thing, and I keyed in my 'data'--male, 170 pounds, 5 foot 11--and based on that it gave me some information. I'd assume you are giving people more detail than: three cups of vegetables and, I forget how many cups of grain. I just thought to myself, This is useless information to me, truly. I don't think in terms of cups of anything, or weight of anything. Tell me how many pop-tarts I should eat, and I can execute on it, that's what I can relate to. So how detailed can it get?
CN: Well, that information is only there for people who care about other aspects of nutrition information. I don't use that website in my practice at all. It is a thing to play with and to look at. People don't fit in pyramids. And people don't fit in cups and ounces. So I agree. Everything I do is very individualized. That would be more of a public health general education approach to go look at the USDA food pyramid. I don't use their material for my education of patients.
HD: I meant it more of a way of expressing my frustration with the USDA that they can't do better than suggesting this many cups of that or that many ounces of the other thing.
CN: But on the other hand, USDA is really meant for a very generic public. So it can't get a whole lot more specific for individuals. What happens sometimes is that USDA material gets used as educational from one individual to another. Or from a doctor to a patient, or from a nutritionist or dietician to a patient. And that's where I see that as a kind of lazy approach and not that relevant.
HD: Do you find yourself constantly fighting a battle with information presented in the media in the general context of 'health news you can use'? I mean, that seems to be a standard beat for any broadcast media, any print media, they all have some section devoted to stories like, Research has now shown that Food X can help prevent Disease Y. Things along those lines.
CN: Mm hmm, or the opposite: that Food X has been proven not to help, basically invalidating the hundred studies before that said it did. That type of thing? Is that what you mean?
HD: Well, any of these kinds of studies. To me, I look at those studies and think, Okay, you gotta die of something. But it'll eventually wind its way back into advertising: Cheerios, has got lots of oat bran! But, you know, I don't care! Put honey on it, and it tastes really good. But I would imagine that it creates a challenge to you, because you have to fight against all of the received knowledge or the conclusions that people might draw based on all these health-news-you-can-use type stories. Do you spend a certain amount of time just saying, Let's wipe all of that out of your head and make a clean slate?
CN: No, it's not happening. I wonder why. I feel that people are coming and they have wiped everything out, and they're just ready to learn. I don't have people coming in saying, Hey, I just read this! Sometmes, if something comes up when I'm seeing someone, they'll ask, What do you think of this? But I don't feel like I'm being pinned to those issues. And I feel like all the work really gets down to that individual level.
HD: It might be that the people who see you self-select as a category that is fundamentally skeptical of that kind of story ...
CN: ... yes ...
HD: ... or they attach a certain distance, taking it as just another data point as opposed to, Oh, I've got to go out and stock up on--I don't know--beets, because beets can help prevent whatever. Are beets, in fact, good for anything?
CN: [laugh] Yeah, beets are good! They're a good source of iron.
HD: But as far as a specific disease?
CN: I think you brought up the thing: we're always looking for that one magic bullet. So we're going to say that Vitamin E does work or doesn't work, or a particular phytochemical is going to fight cancer or not. It is a synthesis and a synergy of nutrients. We're going off that old model of the double-blind, placebo-controlled, randomized trial research study, which is really borrowed from the pharmaceutical industry ...
HD: ... and what is the alternate model?
CN: Well, there isn't one that has been established. There isn't one that has been condoned and used. But what I'm saying is, that to use nutritional research and base it on that gold standard for the pharmaceutical industry isn't appropriate.
HD: So basically, you have a patient and instead of applying generalizations that have been established in the scientific literature, the idea is to figure out how that particular patient's metabolism works?
HD: So you run tests and figure out how well your body is able to absorb this vitamin and is able to process whatever, and figure out something that works for you, as opposed to trying to figure out the scientific rule.
CN: Right, so I do metabolic assessments. And that could be on anything from the thyroid or the adrenal or the gut--we do a lot of gut work.
HD: Could you just describe, maybe not in necessarily graphic detail--but I mean, is it a matter of measuring what goes in, and measuring what comes out, and seeing what the difference in the nutritional content of each is? Or is it a matter of just doing an analysis of blood or?
CN: It's everything. It's blood, urine, stool, saliva. So depending upon what you're looking at, any of that could be done. Most of these labs are specialty labs where the patient is actually sent a kit. And they can collect their stool sample at home, or they can bring the kit into a lab with their urine and have it sent off, or they can go and have blood drawn. But it's a special kit, it's not one of the local labs, usually. But there's a lot of information that can come off regular laboratory tests.
HD: I have say, to be perfectly honest, if you said, Here, Dave, here's a kit, it's a stool-collection kit, I think I'd say, Maybe this whole thing is not for me. Do people ever balk at that step at all?
CN: Nope. Never. I'll tell you why: because they're suffering. By the time they're getting to this point, they are so frustrated that nobody is looking, that they've spent sometimes years, lots of medication, lots of dollars, and a lot of anguish, and they're continuing on with their symptoms or sometimes they're worse because of the side-effects of all the medications. So then they finally end up in my office, thinking of things that haven't been looked at that should be looked at: this [stool-collection kit] is a piece of cake. Because I'm looking at parasites, and yeast, and bacteria, and inflammation, and immunity, and digestive capability. That's where I get a lot of my data, and that's when I can decide what to do next. So actually people don't really have any issues with that. I've never had that happen. But you'd have to be in bad enough shape.
HD: Yeah, I guess I was just thinking, if I were to do it 'just for fun' ...
CN: ... oh, no way! ...
HD: ... I think I'd say, It's been nice chatting with you, but I'll skip this.
CN: I reserve that for only people who need it! It's not a standard.
HD: So what is your understanding of the state of the art of medical student education with respect to nutrition? I mean, I assume they teach future doctors something or other about nutrition beyond what they learned in 8th grade health class?
CN: It varies from medical school to medical school. It is still a very under-served area. A lot of the nutrition classes do not take it to the level of therapeutic relevance. So you might learn about nutrition, but you don't learn about it to the level that you're really applying it in medicine. And you're seeing it often as a specialty that somebody else has--maybe the dietician in the hospital.
HD: The case of that national-level tri-athlete, they actually did two surgeries on her? Which is just kind of mind-boggling to think that somebody said, Let's cut you open twice, when I guess her underlying problem had to do with eating the right stuff in the right proportions.
CN: And it had to do with more than just food. It had to do with correcting some of the ecology of her gut. So it wasn't just, Oh, don't eat this, eat that, that'll make it better! It had to do with healing the tissue ...
HD: ... is this what's referred to as 'detoxification' or is that a different phenomenon?
CN: That's a slightly different phenomenon, but they can go together, because you can detoxify by cleaning out your gut as well as your liver.
HD: Well, you know, before we hop off the teeter totter, I wanted to point out a connection that you have--it's a very tenuous connection--to one of the previous totterees. [Ed. note: Briefly put, the point HD will try to make next--while mis-naming every street possible--is that Dale Winling's thesis used the Thompson Block as a case study, and CN's business is located right in the middle of that block.]
You have your business on Maynard Street, right?
HD: Oh, right, sorry. But it's across from the Maynard parking structure.
HD: So Thompson Street between Main and William, right?
CN: Between Liberty and William.
HD: Okay, I've completely screwed up the names of the streets.
CN: You know where I mean, between Liberty and William on Thompson, right across from the parking structure?
HD: Yeah, yeah. So there was this master's of urban planning student who did a thesis on the historical significance of the Thompson block, which is the same block where you have your downtown business. So you know, I thought that's a interesting connection you two have.
CN: And he's on that block now, or he's on Maynard and he studied that block, or?
HD: No, he just did a master's thesis about that block [Ed. note: This is a gross simplification of what Dale Winling's thesis is about.]
CN: Wow. I'm sure there's a lot of history in this house that I'm in. It's beautiful.
HD: I bet. I bet he could tell probably tell you a lot about the history of the house. His name is Dale Winling.
HD: So I wanted to make sure I mentioned that. And the other thing is, you know, you are located right across from this Maynard Street parking structure and on your website you mention that you validate parking. Now, parking is a topic that people in this town are passionate about. Where do you park?
CN: [laugh] I have the same problem.
HD: So you don't have a permit?
CN: No! I have nothing! I won't pay for a permit, because they're really, really expensive and I would have to be there 365 days a year, practically, to make it worthwhile for me. So I did the math on that, it's not worth it. Even with a permit, sometimes if the garage is full, it's full, and you can't park in it. So I don't know, I just decided not to do that.
HD: So you park on an hourly basis in the structure?
HD: I guess from your math it turns out to be too expensive, but on a gut level do you feel like it's too expensive?
CN: The parking?
HD: Yeah, for the monthly permit.
CN: Yeah, I thought it was. But I guess it would be worth it, if I was there 8 hours a day, five days a week and I didn't take vacations. But if you add up all the time off, it's just not worth it.
HD: Did it rankle you at all that Google's being given however many spaces--200 or 400--or did you just figure that just has to be done?
CN: I just figured it was some inducement--maybe temporary also, as they're getting settled. I didn't make a big deal about it [laugh]!
HD: Is there anything else you had on your mind before we dismount?
CN: I don't know, I can't think of anything!
HD: Well, it's actually a thrill to have you here. Thank you very much for coming to ride!
CN: You're welcome!