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 Historic Moment for Integrative Medical Practice: Alan Gaby, MD Publishes Long-Awaited Nutritional Medicine 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: Few practitioners of integrative medicine who use nutritional agents have not benefited from the teachings of Yale-educated integrative clinician Alan Gaby, MD. The publication of Gaby's long-awaited 1374 page Nutritional Medicine, the product of 30 years of research and analysis, ranks as a historic moment for the field. Here is a look at the book, informed by Gaby's clinical practice with over 6,000 patients. I share comments from Integrator adviser Bill Manahan, MD, Jonathan Wright, MD, and Joseph Pizzorno, ND, on the power of this textbook. Gaby believes that the book has significant public health applications. Manahan thinks comprehending Gaby's value means recalling William Osler, MD. Wright urges a forward-thinking conventional medical school to scoop Gaby up and honor him with a professorship. I contacted Gaby to catch up with him on this turning point in his life and conclusion of a record-long gestation period. What did Gaby's medical doctor father think of him embracing this medical direction more than 3 decades ago? Pizzorno's advice to clinicians is simple: "Buy Nutritional Medicine now. You'll use it every day."

"I wouldn't be surprised if, after reading Nutritional Medicine,
a fair and open-minded University medical school dean might
consider offering Dr. Gaby the eminently well-deserved
position of Professor of Nutritional Medicine ..."

- Jonathan Wright, MD, from the Foreword

Gaby's 1374 page tome
"I got this into my head in 1973," recalls pioneering integrative medicine expert Alan Gaby, MD. I had asked him about the length of the gestation period for his long-awaited textbook Nutritional Medicine.

The idea that much of his professional life would be spent searching the literature, writing and speaking on nutritional medicine hit Gaby, as he shares, "when I was sitting on the ramp of Exit 22 waiting for a college friend to visit." He adds: "I just got this message saying this is what you are going to do with your life." Gaby, a Yale undergrad and the son of general surgeon Sam Gaby, MD, has spent roughly two-thirds of his professional life sifting through the escalating volume of nutritional medicine research dating back to 1920. The other third is in the clinical practice. The result is Gaby's widely heralded, recently-published
1374 page tome.

Gaby: 30+ years pursuing a calling in nutritional medicine
Gaby first became known to many in the 1980s through his regular column in the Townsend Letter for Doctors, at the time the premier periodical for physician-level clinical communication on nutrition and integrative topics. His nutritional medicine seminars became don't-miss events and his handouts key reference guides for any clinician who valued nutrition in a patient's treatment and health. Gaby later was selected by his colleagues to serve a term as president of the American Holistic Medical Association.

"Alan Gaby is a composite of four
of my heroes in medicine - Patch Adams,
Christiane Northrup, Linus Pauling
and William Osler.

- Bill Manahan, MD

Attendees of Gaby's multiple-day seminars knew they would benefit from the grounding of his teaching in his 3 decades of a continuous integrative nutritional medicine practice in which he has treated over 6,000 patients. Seminar attendees also came to anticipate that Gaby would likely entertain them on his guitar with a clever, self-composed topical song.

In a forward to the book, holistic and integrative medicine leader Bill Manahan, MD, calls Gaby a "composite of four of my heroes in medicine" - Patch Adams, Christiane Northrup, Linus Pauling and William Osler. Manahan, an Integrator adviser, likens Gaby to Osler's traits as "a brilliant clinician who clearly understood that the majority of healing occurs from within." Manahan concludes:
"I believe that Nutritional Medicine will stand as one of the foundational cornerstones upon which nutrition becomes a primary treatment modality in the 21st century."

Gaby's Nutritional Medicine Textbook
At a Glance

Years in the Making
Pages   1374
References   15,000
Nutrition-related articles
in Gaby's data base*
Health conditions covered
Chapters on individual
Patients treated by Gaby
with nutritional medicine
Price   $295
Institutional price for health
profession students

* He jointly builds and manages the database with Jonathan Wright, MD.

I recently caught up with Gaby, who I first met some 22 years ago, to talk about the book, its reception, and his post-partum plans now that his long labor is over. Here are edited segments of that conversation.

Integrator:  I am of course not a clinician. What's the basic argument for nutritional medicine in lay terms?

Gaby: The book and my practice build on the work of pioneers like Linus Pauling, Roger Williams, Abram Hoffer, and Adelle Davis who argue that many diseases can be prevented or treated by adjusting the concentration of molecules normally present in the body, such as vitamins, minerals, amino acids and hormones. This is my experience.

Integrator: What is it that makes this book unique - other than its sheer weight. Aren't there a number of reviews of nutritional literature out there?

Gaby: This is a textbook. It consists of scientifically based, clinically relevant information on how to use diet, nutritional supplements, and other natural substances to prevent and treat more than 400 health conditions. It also discusses how to use various individual nutrients, including biochemical effects, clinical indications, adverse effects, interactions, preparations, and dosages. The uniqueness of the book is in its critical analysis of a vast body of research, its direct applicability to the clinical setting, its comprehensive nature, and its attention to detail.  I think this book has a lot of public health implications.

Integrator: What sort of public health implications?

Gaby: Widespread use of the treatments discussed in this book would improve overall health, reduce the need for potentially dangerous medications, and lower healthcare costs.

Integrator: How is the reception?

Gaby: When I sent it to Bill Manahan for his review I sent a note and told him that I hoped he found it worthwhile, otherwise I've wasted my entire adult life. I was glad to find he liked it.

Integrator: You note in your introduction that "for reasons that are not entirely clear, there appears to be an inherent bias in academic medicine against micronutrient supplements." I am curious about your speculations as to why.

Gaby:  I could have gone into great detail on this. The bias against this is stuff is clear. At the same time, the claims that some proponents of nutritional products put out is part of what turns more conservative doctors off.  I take on both the anti-nutrition bias and pro-supplement hype text but leave the political issues pretty much to my editorials in the Townsend Letter and elsewhere. You've probably read them. This textbook is not the place for that.

Integrator: You dedicated the book in part to your Dad, himself a medical doctor. How did he take to this life-choice of his son?

Gaby: He was a general surgeon. Early on he said "I think eating well is important - I don't know about this megavitamin stuff." He ended up doing some nutrition in his practice in later years. He started putting 6 grams/day of IV Vitamin C in the fluids he gave his patients in their recovery. He found that when he did he saw fewer urinary tract infections and that they healed more quickly.

Integrator: Isn't one of the challenges in gaining stature for nutritional medicine that often multiple products are used in combination. This not only breaks the mold of single agent thinking and research but also leaves a practitioner open to the charge of pushing supplements.

Gaby: The first nutrition book I read, in 1972, was written by Roger Williams, Nutrition Against Disease. He said that nutrients work as a team, that the chain is only as strong as the weakest link so sometimes one nutrient will not work if another is not also present in adequate amounts. We know this is true with CoQ10. The complexity of nutritional interventions is more challenging since the nutritional therapies are typically prescribed in combination with stress reduction, diet changes and other treatments. There is not a whole lot of research on all of these in combination. This is a place where philosophy and clinical experience come in.

Integrator: You mentioned that you have clinical experience from some 6000 patients informing this book. What percent do you believe showed real improvement due to the nutritional interventions?

Gaby: I estimate that 80% improved. Many of these patients had previously failed to respond to conventional medicine. I would never have continued with this work all these years and written this book had I not seen people getting better.

Integrator: Isn't there a possibility here of doctors just throwing micronutrients at a patient and sending them out the door with a bag of supplements?

Gaby: I believe the better trained you are, the fewer tests you need to order and the fewer treatments you need to recommend. In some cases, the best is less. One of the goals of my writing is to help clinicians learn how to prioritize their treatments; how to use a medical history and physical exam to determine which interventions are most likely to help a particular patient.

Integrator: So then, what's next for you?

Gaby: For now I am enjoying the book's sales, seeing who is buying it, appearing at a series of conferences this year. After that, I believe that my work may have something to do with the public health. I am not sure yet. For now I am enjoying this process.


Comment:  Gaby's mention of the value of Nutritional Medicine for the public health immediately brought to mind the importance, presently on the table, of educating members of the
National Prevention and Health Promotion Council, birthed by the Obama reform plan, to influence our national strategy in these areas. As Gaby writes in his introduction:
"Many of the 'side-effects' reported by patients who follow a nutritional program are positive, such as more energy, better mood, fewer cravings, better mental concentration and less aches and pains."
These are wellness and health promotion changes, in individuals, fully aligned with the Council's agenda. In contra-distinction, the reactive, suppressive nature of the anti-agents that dominate most conventional practices have created a rift between clinical practice and the public health. This book can be a healing agent. Getting Nutritional Medicine into the curriculum of our medical schools and nursing schools would be a great step toward mending this split.

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 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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