Developing Your Baseline Program
In 2012, our research team at the Functional Medicine Clinical Research Center undertook a sixteen-month functional medicine–based intervention program in a group of 130 modestly overweight women and men. As you can imagine, in sixteen months of frequent visits, you get to know the participants in a study very well, and you come to appreciate their lives, their concerns, and who they are as people. So it was gratifying indeed that the study’s preliminary results demonstrated the profound positive effects on health outcomes of certain fundamental actions taken in diet, lifestyle, and environment.
These actions constitute, in my view, a baseline program for helping every individual fulfill the WHO’s definition of health—the perfect starting point for the development of a personalized health-management plan.
It works according to what I call the 80-20 principle. If these fundamental actions are built into an individual’s life, that individual will be 80 percent along the way toward improving his or her health. The remaining 20 percent will come from building onto this baseline specific actions to address the individual’s personal process imbalances, as we’ll see in more detail in the next chapter.
I saw the 80 percent baseline effect in action back in the late 1990s, when a high-ranking army commander in the Desert Storm campaign came to our research center for a health consultation. Since his return from the war, he had not felt right. At the age of fifty-four, he was experiencing fatigue, severe and progressive muscle weakness, and—his key worry—a deteriorating memory. He knew of some family history of cardiovascular disease and exertion intolerance, but he had never experienced any such problems himself. In fact, he had been an Ironman athlete before Desert Storm and had served in previous military combat situations without any ill effects. The military doctors had put him through an extensive battery of tests for infectious diseases, poisoning, or a definitive diagnosis. To date, all had come up negative. The only medical assessment he had received was that he was suffering from post-traumatic stress disorder and needed rest and counseling.
Our researchers were aware that resilience studies on animals put under extreme physical and mental stress demonstrated the importance of overall health and basic nutrition in improving resilience, and we believed our commander was deficient in both. We further hypothesized that he may have had some type of genetic susceptibility to specific substances he may have been exposed to in the desert, where his unit was camped for many months. This led us to a twofold plan of action: the implementation of a baseline program to strengthen his overall health and refresh his capability for resilience, to be followed by a program aimed at strengthening the commander’s detoxification and cellular energy processes.
What was most interesting was how quickly he recovered his strength after implementing the first steps of the baseline program—before he went on to the more complex components of his personalized program to restore process imbalances. Within six months, he had regained his resilience and was able to return to active duty.
For me, this example was a lesson in how important it is, when embarking upon a personalized health-management program, to take what might seem simple first steps. The health payoff can be enormous.
The functional medicine baseline program consists of recommendations for diet and dietary supplements, exercise, stress management, and management of your environment—the factors that interact with our genes to affect the balance of our seven core physiological processes.
Yet even as you follow the recommendations and make your own choices to develop your baseline program, it makes sense to be aware of what your family health history may tell you about your own genetic susceptibilities. Specifically, is there a history of any of the following in your family?
1. Heart disease
2. Diabetes
3. Cancer
4. High blood pressure
5. Depression or mental illness
6. Autoimmune or inflammatory disorders
7. Obesity
8. Osteoporosis
9. Dementia
10. Allergies, atopic dermatitis, or asthma
11. Alcoholism or drug abuse
12. Emotional or psychological burnout
13. Inborn genetic disease
14. Anemia
15. Eye diseases such as glaucoma or macular degeneration
Again, none of these conditions is strictly inherited, but a family history of any of them indicates an area of possible genetic sensitivity. Coupled with your responses to the Health Self-Assessment Questionnaire and the answers you gave to the questionnaires in Chapters 4 through 10, family health history can help the detective work as you look for the patterns that define your own health strengths and weaknesses. So many of us feel doomed to repeat the conditions we saw our parents or grandparents suffer through, or we are stunned when we receive a diagnosis that is unheard of in the family’s previous experience. Yet studies of disease prevalence in identical twins confirm that inherited genes alone are not decisive in causing a health condition or averting it. Rather, our differing degrees of genetic susceptibility to various conditions can be modified by lifestyle, diet, and environment. After all, families share these three things—lifestyle, diet, and environment—just as they share genes. The genes don’t change; lifestyle, diet, and environment may.
The functional medicine baseline program is a first step toward changes that may modify your genetic expression to cure a chronic illness or get you squarely on the path to a state of good health in which you achieve balance in all your core processes.
THE BASELINE DIET
By now, you are well versed in the power of nutrition to influence genetic expression; the way we eat is no longer the best-kept secret of good health. In support of this, Chapter 11 laid out the basic criteria for what a diet should and should not do to support proper balance in and between each of the seven core physiological processes. The underlying objective is to lower physiological stress and increase the delivery of nutrients to the cells, tissues, and organs that control healthy physiological function.
Basically, we’re looking for foods that stabilize the balance of hormones and cellular mediators released into the bloodstream after eating and thus help turn on the expression of the health-promoting genes, not the alarm genes. Such a baseline diet will include a great diversity of foods, but as a group, the characteristics that pertain are these: fresh, minimally processed, organic, natural, whole-food, multicolored, low-sugar, and low in saturated fat. Where fish are concerned, “natural” means line-caught wild fish that contain omega-3 oils. Why should your diet be multicolored? The colors in fresh fruits, vegetables, and beans represent their phytonutrient content. A multicolored diet gives you a wide-ranging palette of phytonutrients, each of which has its own unique and beneficial effect on genetic expression.
The baseline diet stays away from common allergy-producing foods until you know more about what might be problem foods based upon your own genetic uniqueness. The common triggers of food allergy or sensitivity include gluten-containing grains, uncultured dairy products, shellfish, citrus, eggs, yeast, any food that has seen mold or fungus, peanuts, whole soy, and processed foods containing multiple additives.
The baseline diet also avoids fried or fat-laden foods, whether they are high in animal fat or vegetable oils. It recommends that foods be cooked at as low a temperature as possible. Longer cooking at a lower temperature prevents the formation of glycotoxins and is therefore preferable to high-temperature cooking for short periods of time.
Finally, of course, make sure your baseline diet contains digestion-friendly foods. Yogurt enriched with probiotics is highly recommended, but be sure also that you get enough soluble and insoluble fiber in your diet. A diet that is 60 to 70 percent plant-based foods and 30 to 40 percent animal products will fulfill that requirement.
Does this mean you can’t be a vegetarian on this baseline diet? No. But a vegetarian diet needs to be approached with some care to avoid imbalances in such nutrients as iron, vitamin B12, and calcium. Obviously, the composition of the diet is also key; a diet of potato chips, soft drinks, and hard candy could be called vegetarian, but under no circumstances could it be called healthy—or sensible.
Want to see what a typical week of the baseline diet might look like? The full menu plan and the recipes for the various dishes are provided in Appendix A, but with breakfasts like homemade granola or spicy carrot muffins, lunches of salad or casserole or hash, and dinners ranging from chicken and broccoli stir-fry to sea scallops with Asian flavoring, I think you see how diverse and satisfying this kind of eating can be. Keep in mind that the meal plan in Appendix A is not meant to be prescriptive; it’s just representative of kinds of food and of the diversity of foods in a baseline diet. In fact, it will also help you make good choices when you are eating in a restaurant or on the go. Note that the foods fulfill the criteria set forth above for achieving the baseline goals.
Note also that the recipes for these meals mostly produce from four to six servings. That is intentional. First, leftovers are useful. Second, and more important, you probably live with a spouse or partner, a roommate, or a family, and what we’ve learned is that making a change in diet works better when your significant others are engaged as well. In fact, engagement can be key to making any and all changes in behavior. For one thing, others can serve as a support group. For another, the people you live with are going to be affected by your personalized health-management program, too, and if you share the experience so that all of you own it, they too may be influenced to undertake more healthy eating. It can make the whole experience not just a joint venture but a joint adventure, encouraging shopping together for food and preparing meals together.
THE BASELINE DIETARY SUPPLEMENT PROGRAM
In 2009, the Nobel Prize in Physiology or Medicine was awarded to three scientists, Elizabeth Blackburn, Carol Greider, and Jack Szostak, for their discovery of telomeres and their pioneering work on the enzyme that produces them, telomerase. Telomeres are a unique piece of chemical structure at the end of each chromosome in our genome, and they’re there to protect the chromosome—and the information it holds—from damage. But as part of doing this job, telomeres get shorter, and that renders the chromosomes vulnerable to harm, making the genome as susceptible to defacement as the pages of treasured books in a library in which vandals have been let loose. Defacement results in a loss of the integrity of our genetic code, which in turn alters the core physiological processes that we associate with health and resilience, so the bottom line of the shortening of the telomeres is an increased incidence of all the chronic illnesses we dread—including cardiovascular disease, diabetes, dementia, and cancer.
We now know that lifestyle, diet, and environment play a role in determining the length of the telomeres. Research in Europe examined telomere shortening over a five-year period in individuals consuming a nutrient-dense Mediterranean diet. The study showed that telomere length “significantly predicted” decreases in weight, body mass index, waist circumference, and waist-to-height ratio. Conclusion: longer telomeres mean less obesity, and the Mediterranean diet can be a key differentiating factor in telomere length. Yet another study, this one tracking 5,862 women, found that those adhering to the kinds of diet and lifestyle regimen defined in the functional medicine baseline program had significantly longer telomeres. Studies by Dean Ornish and Nobel laureate Elizabeth Blackburn on men with prostate cancer found that an aggressive lifestyle and diet intervention increased the activity of the enzyme telomerase, which repairs the shortened telomeres. In 2013, the Ornish-Blackburn group reported in The Lancet Oncology that prostate cancer patients adhering to a comprehensive lifestyle and diet intervention program experienced a significant 10 percent increase in telomere length versus the control group, which experienced a 3 percent decrease in telomere length. The study also found that the greater the compliance with the lifestyle and diet intervention program, the greater the increase in the length of the telomeres. Bottom line: nutrition preserves and produces telomere length essential for good health.
We also know that vitamins B3 (niacin), folic acid, and B12 all play important roles in maintaining telomere length. Michael Fenech, a senior scientist in nutrition at the Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia’s national research agency, has published numerous studies defining the roles that specific nutrients play in protecting our book of life against injury. The U.S. National Institute of Environmental Health Sciences published the compelling results of a study of 586 women, aged thirty-five to seventy-four, exploring the role that supplementary vitamins and minerals may have in protecting our telomeres. The telomeres were 5 percent longer in the women who took a multivitamin supplement daily than in those women who did not. Longer telomeres were also noted in women who supplemented daily with 3 grams of omega-3 fatty acids.
These are important observations about health. They tell us that the role of nutrients in cellular function goes beyond that of protecting us against vitamin deficiency diseases like scurvy, beriberi, pellagra, or rickets. The preservation of telomere length is a cellular measure of organ reserve, the key marker of biological age. It is now clear that a well-balanced multivitamin-mineral supplement and a fish oil supplement may do much more than just produce “expensive urine.” These nutrients help protect our most precious asset, the DNA in our book of life, thus enhancing and extending our health span.
A prudent baseline dietary supplement program, therefore, is a reasonable component of any personalized health-management program. It should include the following daily doses:
• A multivitamin-mineral supplement with at least 1,000 IU of vitamin D
• 1,000 to 2,000 milligrams of vitamin C
• 2 to 3 grams of omega-3 oil containing EPA/DHA
• A probiotic supplement containing at least 3 billion live organisms.
THE BASELINE EXERCISE PROGRAM
Get yourself a pedometer. Really. Head for the nearest sporting goods store or, if you’re digitally inclined, find the right app for your smartphone so you can track the number of steps you take as you walk. It is a great way to begin an exercise program; there are no barriers to getting started, no new equipment to buy apart from the pedometer or the app, no place you can’t just start walking. Your goal is gradually to get to a point where you are walking a minimum of 10,000 steps per day.
Now that may seem like a lot of steps, but it’s less than you think. I find that taking the dog out three times a day uses up about 6,000 steps each day, so you can see that the steps quickly add up. A fifteen-minute post-meal walk, which, as we’ll show in Chapter 13, significantly improves blood sugar and insulin regulation, can typically take about 2,000 steps. So the 10,000-steps-per-day target is not unrealistic. Still, you will probably need to make a conscious effort at first to get there, because the amount of walking most of us tend to do often comes up short of the target.
That the effort is worth it, however, is not in doubt. Studies on university students who went from “sedentary” to 10,000 steps per day showed lowered blood pressure and improved cardiovascular fitness after only six weeks. In several other studies, achieving the target resulted in improved cardiovascular function, psychological well-being, and blood cholesterol and HDL levels.
Here’s even more proof: Studies confirm that days after stopping a regular walking program, insulin sensitivity decreases, and angry fat starts to accumulate. The impairment in insulin sensitivity occurs before the accumulation of body fat—an indication yet again that it is not obesity alone that causes type 2 diabetes but the alteration in the cellular communications process from the altered physiological fitness. So walking 10,000 steps per day is definitely worth the effort. Don’t stop.
What if you are already engaged in a regular activity program? Good! But make sure that you do it regularly and that you hit appropriate goals of intensity and duration. Specifically, you should get into your aerobic training zone—a pulse rate of approximately 180 minus your age in years—and stay there for twenty minutes at least five times per week. Or, think of it as engaging in an activity that puts you in your aerobic training zone for a minimum of 150 minutes per week.
The choice of activity is up to you; mix and match the aerobic and anaerobic, the cardiovascular fitness with the strengthening and flexibility as you find what is enjoyable for you and what fits into your daily routine. The key is to just do it.
THE BASELINE STRESS MANAGEMENT PROGRAM
In my view, just about everyone living in today’s fast-paced, time-urgent global society could benefit from some form of stress management. We’re all carrying too much allostatic load, which in turn diminishes our capability for resilience. The urgency to get things done now has become a prison, constraining our minds and oppressing our bodies.
Yet even a little bit of time reserved each day to listen to music, be out in nature, look at art, tend a garden, or remain still or quiet in reflection or prayer can create the genetic expression that renews core physiological processes—and instills a sense of peace.
A simple way to get started is with techniques of cognitive behavioral and mindfulness therapies. These combine traditional behavioral therapies with strategies of meditation to reduce stress and anxiety. Start by inventorying the events in your life that trigger a distress response, that create a sense of burden or anxiety. Prioritize them, and then create a mindful approach to controlling your body’s response to them.
Creating such an approach is not easy. It requires practice to prepare yourself to think about how you will respond to stressors the next time you confront them. But the time spent in preparation through mindful contemplation or quiet introspection will pay dividends the next time you are exposed to the triggering event. Sometimes, the introspection itself might create a tension that you would like to avoid, but practice in confronting that tension is a key part of preparedness, and preparedness is the solution to the recurring distress you feel when you do confront those tension-making issues.
The skill of meditative relaxation can be learned; it can be developed, although getting good at it typically requires a safe, quiet spot and at least twenty minutes of time a day. At first the busy-mind syndrome takes over, but with practice in addressing in quietude how you will manage the response to issues, you learn to execute that response when issues in fact trigger your alarm reaction.
As skill in mindfulness-based cognitive therapy increases, individuals typically begin to reorder the balance of importance between things to do and ways to be. Our society rewards us for doing things, but some of the most important moments in our lives are about being present—without necessarily doing anything at all. Finding the right balance between doing and being is a key objective of mindfulness-cognitive therapy. It helps us fulfill Dr. Eliot’s two rules from Chapter 11: don’t sweat the small stuff, and anything that is going to kill us is the small stuff.
The health payoff from implementing a baseline stress management program has been demonstrated to be significant. One study found that mindfulness-based cognitive therapy, along with exercise, was the most promising treatment approach for chronic fatigue syndrome. Another showed that mindfulness-based cognitive behavioral therapy was effective in managing chronic illnesses associated with increased allostatic load in Gulf War veterans. A randomized controlled trial of mindfulness-based cognitive therapy in 130 men and women with significant chronic stress showed that the therapy significantly improved the subjects’ social coping skills and reduced their alarm physiology.
One of the most interesting recent studies was done on patients suffering from severe post-traumatic stress disorder (PTSD). The study showed that the mindfulness-based cognitive therapy altered the genetic expression of a very important network of genes, regulated by the gene FKBP5, which controls coping with stress and the central nervous system’s response to stress. The therapy increased the expression of FKBP5, which clinically improved the PTSD symptoms and enlarged the volume of the hippocampus, the region of the brain associated with mood, memory, and emotion. These results are powerful evidence of how trauma or stress signals from the environment can alter genetic expression in the physiology of alarm. They also demonstrate how mindfulness-based cognitive therapy can modify the imbalanced core physiological processes associated with traumatic stress.
So again, the work done gaining skill in responding to stress pays dividends. Find twenty minutes each day to practice your mindful introspection. Here’s an idea: do it while walking some of your 10,000 steps to combine exercise and mindfulness, letting each bolster the other.
THE BASELINE ENVIRONMENTAL MANAGEMENT PROGRAM
We learned about a kind of benevolent hormesis back in Chapter 9—the idea that exposure to very small amounts of some things may have a much greater effect on our health than expected. There’s also a malevolent version of hormesis—for example, in the way very low levels of the plasticizer BPA can alter genetic expression and cellular function with a subtle but significantly adverse impact on long-term health. We can put both versions of this principle to work in managing our environment when we remember Sidney Baker’s wonderful instruction about how to address autism: “Take away the things that are a problem and provide the things that are missing.” Put a bit more elaborately, we can say our aim is to take away the things that create genetic expression of the physiological alarm responses in our environment, and to provide the things that create genetic expression of the physiological resilience responses—and hope for a hormetic effect on both sides of the equation.
To this end, a baseline environmental management program should focus on ending exposure to persistent organic pollutants (POPs); to the toxic minerals lead, mercury, cadmium, and arsenic; to such forms of ionizing radiation as ultraviolet and X-ray; and to foods that have been exposed to biocides and herbicides.
What about nonionizing environmental energy pollution from the use of cellular telephones? My answer to this is to use a headset hardwired from the earpiece to the phone. This provides the minimum of exposure to the microwave frequencies that can interfere with the cellular communications process.
What about GMOs—genetically modified foods? This is a thorny issue. It is true that scientists have been studying the effects on animals of consuming genetically modified plants—and have found no unequivocal evidence that they cause any adverse health effects. But what is also true is that as scientists have developed new ways of observing subtle changes in genetic expression and its influence on cellular physiology, new questions have emerged.
The question most commonly raised is whether the genetic modification of plants by the insertion of foreign genes from other organisms could produce more allergenic proteins in the plant food. Studies analyzing the composition of proteins in genetically modified crops have so far found no definitive answers to this question.
Another question is if GMO varieties of plants could have different epigenomes from wild-growing varieties, and if so, if this could confer a different influence on people eating the plant.
Finally, we want to know whether studying the effects of feeding GMO plant foods to animals is a reliable marker for evaluating their long-term safety in humans. After all, rats and mice, the common test animals in these studies, live a very short life span compared with humans. The duration of their exposure to GMO products is thus also much shorter, so these studies may tell us very little about the effects of long-term usage.
One of the most controversial of GMO crops is rice—controversial because the majority of the world’s population derives its calories from this plant. A number of animal studies by prominent researchers in China have all demonstrated the safety of specific strains of GMO rice. But many in the field are still not convinced that these studies offer sufficient proof of safety to be able to say that GMO rice makes no difference to human physiology.
In my view, the body of science evaluating both the long-term safety of GMO foods and their cellular effects is still in development. Questions continue to be raised as to why food-related allergies and sensitivities are on the rise throughout the world; could GMO varieties have any relationship to this rapid increase in allergies? A GMO potato is one into which the gene of a Brazil nut has been inserted; the same has been done to soybeans. In both cases, insertion of the Brazil nut genes increases the essential sulfur amino acid methionine level in the plant protein. And allergy testing of the GMO potato and the GMO soy confirmed that each is able to trigger brazil nut allergy.
In short, I think it is premature to render a final decision on the safety of GMO. It may prove safe and effective in improving the food crop in some cases and cause long-term adverse implications for health in other cases. For the moment, we must insist on full disclosure in the labeling of all GMO food products so that consumers can know what they’re taking in if they choose the product. I’ll add only that my personal preference is to eat organic foods that I can be sure are not derived from GMO plants or animals.
BUILDING ON THE BASELINE
Introduce a functional medicine baseline program into your life right now. You don’t need to wait till you have analyzed your own specific core process imbalances or devised strategies for restoring balance. You have a pretty good idea by now in any event about what may be contributing to your specific chronic illnesses or problems. Getting going on a baseline program as soon as possible is a great first step toward addressing those causes. It’s also the foundation onto which you will layer the very specific strategies for dealing with your very specific imbalances.